1. Pediatr Rheumatol Online J. 2024 Apr 18;22(1):44. doi: 
10.1186/s12969-024-00979-z.

Risk perception, well-being, depression and anxiety in children and adolescents 
with rheumatic diseases during the COVID-19 pandemic - results from the 
prospective multicenter KICK-COVID study in Germany.

Sengler C(1), Klotsche J(2), Pedersen MJ(2)(3), Niewerth M(2), Göldel J(4), 
Windschall D(5)(6), Haas JP(7), Dressler F(8), Trauzeddel R(9), Hospach A(10), 
Weller-Heinemann F(11), Lanzinger S(12), Kamrath C(13), Holl RW(12), 
Warschburger P(4), Minden K(2)(14).

Author information:
(1)Deutsches Rheuma-Forschungszentrum Berlin, a Leibniz Institute, Epidemiology 
Unit, Charitéplatz 1, 10117, Berlin, Germany. sengler@drfz.de.
(2)Deutsches Rheuma-Forschungszentrum Berlin, a Leibniz Institute, Epidemiology 
Unit, Charitéplatz 1, 10117, Berlin, Germany.
(3)Department of Public Health, Aarhus University, Aarhus, Denmark.
(4)Department of Psychology, Counselling Psychology, University of Potsdam, 
Potsdam, Germany.
(5)Clinic for Pediatric and Adolescent Rheumatology, Northwest German Center for 
Rheumatology, St. Josef Stift Sendenhorst, Germany.
(6)University of Halle-Wittenberg, Halle (Saale), Germany.
(7)German Centre for Child and Adolescent Rheumatology, Pediatric Rheumatology, 
Garmisch-Partenkirchen, Germany.
(8)Children's Hospital, Hannover Medical School, Clinic for Pediatric 
Pneumology, Allergology and NeonatologyHannover Medical School, Hannover, 
Germany.
(9)Department of Pediatrics, Pediatric and Adolescent Rheumatology, Helios 
Klinik Berlin-Buch, Berlin, Germany.
(10)Department of Pediatrics, Olgahospital, Stuttgart, Germany.
(11)Klinikum Bremen-Mitte, Eltern-Kind-Zentrum Prof. Hess, Pediatric 
Rheumatology, Bremen, Germany.
(12)Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, 
Germany.
(13)University Childrens Hospital, Giessen, Germany.
(14)Department of Pediatric Respiratory Medicine, Immunology and Critical Care 
Medicine, Charité- Universitätsmedizin Berlin, corporate member of Freie 
Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.

OBJECTIVE: To investigate the psychosocial burden in children and adolescents 
with juvenile rheumatic diseases during the COVID-19 pandemic.
METHODS: As part of the multicentre observational KICK-COVID study linked to the 
National Pediatric Rheumatology Database, adolescents < 21 years and parents of 
children < 12 years with rheumatic diseases answered questions on perceptions of 
health risk (PHR) due to SARS-CoV2, stress, well-being (WHO-5) and symptoms of 
depression (PHQ-9) and anxiety (GAD-7). Data were collected at routine visits 
from June to December 2021 and assessed for association with demographic and 
clinical parameters, treatment and patient-reported outcomes by multivariable 
regression analyses.
RESULTS: Data from 1356 individuals (69% female, 50% adolescents) were included. 
Median PHR on a numeric rating scale (NRS, 0-10) was 4 (IQR 2-6), median 
perceived stress was 3 (IQR 1-6). Adolescents reported a worse well-being with a 
significantly lower median WHO-5-score (60, IQR 40-76) than parents reported for 
their children < 12 years (80, IQR 68-84). Moderate to severe symptoms of 
depression and anxiety were reported by 14.3% and 12.3% of the adolescents, 
respectively. PHR was significantly higher in patients with systemic lupus 
erythematosus, methotrexate or biologic disease-modifying anti-rheumatic drug 
therapy than in patients without these characteristics, whereas lower WHO-5 or 
higher PHQ-9 or GAD-7 scores were only associated with poorer patient-reported 
health status and physical functioning.
CONCLUSION: The perception of health risk due to SARS-CoV2 infection was not 
paralleled by an impairment of mental health, which were, however, significantly 
correlated with self-rated health status and functional capacity, highlighting 
the importance of patient-reported outcome assessment.
TRIAL REGISTRATION: German Clinical Trials Register (DRKS), no. DRKS00027974. 
Registered on 27th of January 2022.

© 2024. The Author(s).

DOI: 10.1186/s12969-024-00979-z
PMCID: PMC11025219
PMID: 38637849 [Indexed for MEDLINE]

Conflict of interest statement: CS: none; NG: none; MJP: none; MN: none; JK: 
none; JG: none; DW: none; JPH: none; FD: speaker`s fees from Novartis and 
Pfizer; RT: none, AH: none; FWH: none, SL: none, CK: none; RWH: none, PW: none; 
KM: received honoraria from Amgen, Pfizer, Novartis and medac.


2. PLoS One. 2024 Apr 18;19(4):e0297097. doi: 10.1371/journal.pone.0297097. 
eCollection 2024.

Unpaid caregiving and mental health during the COVID-19 pandemic-A systematic 
review of the quantitative literature.

Ervin J(1), Fleitas Alfonzo L(1), Taouk Y(1), Maheen H(1), King T(1).

Author information:
(1)Centre for Health Policy, Melbourne School of Population and Global Health, 
The University of Melbourne, Parkville, Victoria, Australia.

The COVID-19 pandemic imposed additional and specific challenges on the lives 
and wellbeing of informal unpaid carers. Addressing an important gap in the 
existing literature, this systematic review (prospectively registered with 
PROSPERO CRD42022376012) synthesises and evaluates the quantitative evidence 
examining the association between unpaid caregiving and mental health (compared 
to non-caring), during the pandemic. Five databases were searched (Medline, 
PsycInfo, EMBASE, Scopus, Web of Science) from Jan 1, 2020, to March 1, 2023. 
Population-based, peer-reviewed quantitative studies using any observational 
design were included, with screening, data extraction and quality assessment 
(amended NOS) independently conducted by two reviewers. Of the 3,073 records 
screened, 20 eligible studies (113,151 participants) were included. Overall 
quality of evidence was moderate. Narrative synthesis was complemented by 
Effect-direction and Albatross plots (given significant between-study 
heterogeneity precluded meta-analysis). Results indicate that the mental health 
of informal carers, already poorer pre-COVID compared to non-caregivers, was 
disproportionally impacted as a result of the pandemic and its associated public 
health containment measures. This review highlights the vulnerability of this 
group and should motivate political will and commensurate policies to ensure 
unpaid caregivers are better supported now, in the medium term, and crucially 
if, and when, another global public health emergency emerges.

Copyright: © 2024 Ervin et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0297097
PMCID: PMC11025839
PMID: 38635604 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


3. PLoS One. 2024 Apr 17;19(4):e0301009. doi: 10.1371/journal.pone.0301009. 
eCollection 2024.

Perceptions of risk and coping strategies during the COVID-19 pandemic among 
women and older adults.

Ke GN(1)(2), Gow A(2)(3), Wong RMM(1), Raman S(1), Mohammad Z(1), De-Lima N(1), 
Khairudin R(4), Lau WY(5), Kamal KA(6), Lee SC(6), Grajfoner D(2)(3)(7).

Author information:
(1)Department of Psychology, School of Social Sciences, Heriot-Watt University, 
Putrajaya, Malaysia.
(2)Centre for Applied Behavioural Sciences, Heriot-Watt University, Putrajaya, 
Malaysia.
(3)Department of Psychology, School of Social Sciences, Heriot-Watt University, 
Edinburgh, United Kingdom.
(4)National University Malaysia (UKM), Bangi, Malaysia.
(5)Faculty of Economics and Administration, Department of Applied Statistics, 
University Malaya, Kuala Lumpur, Malaysia.
(6)Malaysian Institute of Economic Research (MIER), Kuala Lumpur, Malaysia.
(7)DOBA Business School, Maribor, Slovenia.

The world's health, economic, and social systems have been adversely impacted by 
the COVID-19 pandemic. With lockdown measures being a common response strategy 
in most countries, many individuals were faced with financial and mental health 
challenges. The current study explored the effect of the COVID-19 pandemic on 
the psychological well-being, perception of risk factors and coping strategies 
of two vulnerable groups in Malaysia, namely women and older adults from 
low-income households (USD592). A purposive sample of 30 women and 30 older 
adults was interviewed via telephone during Malaysia's Movement Control Order 
(MCO) regarding the challenges they faced throughout the pandemic. Thematic 
analysis was subsequently conducted to identify key themes. The themes 
identified from the thematic analysis indicated a degree of overlap between both 
groups. For women, seven themes emerged: 1) Psychological challenges due to 
COVID-19 pandemic, 2) Family violence, 3) Finance and employment related stress 
and anxiety, 4) Women's inequality and prejudice, 5) Coping strategies, 6) 
Professional support, and 7) Women's empowerment. Similarly, there were six 
themes for the older adults: 1) Adverse emotional experiences from COVID-19, 2) 
Threats to health security, 3) Loss of social connections, 4) Government aid to 
improve older adults' psychological well-being, 5) Psychological support from 
family members and pets, and 6) Self-reliance, religion, and spirituality. The 
findings provide valuable information on the specific burdens faced by these 
groups, and support psychological interventions and mitigations that would be 
appropriate to improve well-being during the recovery phase.

Copyright: © 2024 Ke et al. This is an open access article distributed under the 
terms of the Creative Commons Attribution License, which permits unrestricted 
use, distribution, and reproduction in any medium, provided the original author 
and source are credited.

DOI: 10.1371/journal.pone.0301009
PMCID: PMC11023439
PMID: 38630742 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


4. Kathmandu Univ Med J (KUMJ). 2023 Apr-Jun;21(82):207-214.

Mental Health Problems and Social Media Exposure during the COVID-19 Pandemic 
among Adult Population of Nepal.

Dhakal R (1), Thapa M (2), Karki A (3), Shrestha D (4), Karki P (1), Kaphle HP 
(5), Neupane N (1), Sharma C (6).

Author information:
(1)Department of Nursing Program, School of Health and Allied Sciences, Pokhara 
University, Pokhara, Nepal.
(2)Nepalese Army Institute of Health Sciences, College of Nursing, Kathmandu, 
Nepal.
(3)Health Training Center, Gandaki Province, Nepal.
(4)School of Business, Pokhara University, Pokhara, Nepal.
(5)Department of Public Health, School of Health and Allied Sciences, Pokhara 
University, Pokhara, Nepal.
(6)Maharajgunj Nursing Campus, Institute of Medicine, Tribhuvan University, 
Kathmandu, Nepal.

Background The COVID-19 pandemic is a significant global health crisis that 
poses a threat to a person's psychological well-being. A very large number of 
people got exposed to social network sites during this period which can be 
hazardous and cause psychological difficulties. There is no prior research or 
limited studies in this area during emergencies in Nepal. Objective To assess 
the mental health issues and examine their relationship with social media 
exposure in adults. Method A descriptive cross-sectional study was conducted by 
using a validated scale of Depression, Anxiety, and Stress (DAAS-21) and the 
Insomnia Severity Index (ISI) among 18 years above adult population. Data were 
collected through an online survey. Descriptive statistics was used to describe 
sociodemographic data. Binary logistic regression analysis were performed to 
examine the relationship between psychological problems and social media 
exposure. Result Out of 422 participants, the overall prevalence of depression, 
anxiety, stress, and insomnia among the study population were 32%, 28.4%, 24.5%, 
and 47% respectively. Additionally, 86.5% of individuals said they were 
frequently exposed to social media. Age, ethnicity, gender, past health 
problems, and health status were significantly associated with psychological 
problems. Further, social media exposure was associated with gender and marital 
status. There was no evidence of an association of psychological problems with 
social media exposure. Conclusion Depression, anxiety, stress and insomnia are 
common mental health problems found in the adult population during the time of 
the first wave of COVID-19 pandemic and highly affected were under 25 years age. 
Female and unmarried adults are using more social media.

PMID: 38628016 [Indexed for MEDLINE]


5. PLoS One. 2024 Apr 16;19(4):e0298584. doi: 10.1371/journal.pone.0298584. 
eCollection 2024.

Double-duty caregivers enduring COVID-19 pandemic to endemic: "It's just wearing 
me down".

Parmar J(1), L'Heureux T(1), Lobchuk M(2), Penner J(2), Charles L(1), St Amant 
O(3), Ward-Griffin C(4), Anderson S(1).

Author information:
(1)Department of Family Medicine Faculty of Medicine & Dentistry, University of 
Alberta, Edmonton, Alberta, Canada.
(2)Helen Glass College of Nursing, Rady Faculty of Health Sciences, University 
of Manitoba, Winnipeg, Manitoba, Canada.
(3)Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, 
Ontario, Canada.
(4)Arthur Labatt Family School of Nursing, University of Western Ontario, 
London, Ontario, Canada.

The COVID-19 pandemic has considerably strained health care providers and family 
caregivers. Double-duty caregivers give unpaid care at home and are employed as 
care providers. This sequential mixed-method study, a survey followed by 
qualitative interviews, aimed to comprehensively understand the experiences of 
these Canadian double-duty caregivers amidst the pandemic and the transition to 
the endemic phase. The multi-section survey included standardized assessments 
such as the Double-duty Caregiver Scale and the State Anxiety Scale, along with 
demographic, employment-related, and care work questions. Data analysis employed 
descriptive and linear regression modeling statistics, and content analysis of 
the qualitative data. Out of the 415 respondents, the majority were female 
(92.5%) and married (77.3%), with 54.9% aged 35 to 54 years and 29.2% 55 to 64 
years. 68.9% reported mental health decline over the past year, while 60.7% 
noted physical health deteriorated. 75.9% of participants self-rated their 
anxiety as moderate to high. The final regression model explained 36.8% of the 
variance in participants' anxiety levels. Factors contributing to lower anxiety 
included more personal supports, awareness of limits, younger age, and fewer 
weekly employment hours. Increased anxiety was linked to poorer self-rated 
health, and both perceptions and consequences of blurred boundaries. The 
eighteen interviewees highlighted the stress of managing additional work and 
home care during the pandemic. They highlighted the difficulty navigating 
systems and coordinating care. Double-duty caregivers form a significant portion 
of the healthcare workforce. Despite the spotlight on care and caregiving during 
the COVID-19 pandemic, the vital contributions and well-being of double-duty 
caregivers and family caregivers have remained unnoticed. Prioritizing their 
welfare is crucial for health systems as they make up the largest care 
workforce, particularly evident during the ongoing healthcare workforce 
shortage.

Copyright: © 2024 Parmar et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0298584
PMCID: PMC11020535
PMID: 38626216 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


6. PLoS One. 2024 Apr 16;19(4):e0298369. doi: 10.1371/journal.pone.0298369. 
eCollection 2024.

Protocol of the study: Multilevel community-based mental health intervention to 
address structural inequities and adverse disparate consequences of COVID-19 
pandemic on Latinx Immigrants and African refugees.

Goodkind JR(1), Van Horn ML(2), Hess JM(3), Lardier D(4), Vasquez Guzman 
CE(1)(5), Ramirez J(1), Echeverri Herrera S(1), Blackwell M(6), Lemus A(1), 
Ruiz-Negron B(1), Choe R(1)(7).

Author information:
(1)Department of Sociology, University of New Mexico, Albuquerque, NM, United 
States of America.
(2)Department of Individual, Family, and Community Education, University of New 
Mexico, Albuquerque, NM, United States of America.
(3)Department of Pediatrics, University of New Mexico, Albuquerque, NM, United 
States of America.
(4)Department of Psychiatry and Behavioral Sciences, University of New Mexico, 
Albuquerque, NM, United States of America.
(5)Department of Family Medicine, Oregon Health & Science University, Portland, 
Oregon, United States of America.
(6)Department of Psychology, University of New Mexico, Albuquerque, NM, United 
States of America.
(7)United Voices for Newcomer Rights, Albuquerque, New Mexico, United States of 
America.

The NIMH-funded Multilevel Community-Based Mental Health Intervention to Address 
Structural Inequities and Adverse Disparate Consequences of COVID-19 Pandemic on 
Latinx Immigrants and African Refugees study aims to advance the science of 
multilevel interventions to reduce the disparate, adverse mental health, 
behavioral, and socioeconomic consequences of the COVID-19 pandemic that are a 
result of complex interactions between underlying structural inequities and 
barriers to health care. The study tests three nested levels of intervention: 1) 
an efficacious 4-month advocacy and mutual learning model (Refugee and Immigrant 
Well-being Project, RIWP); 2) engagement with community-based organizations 
(CBOs); and 3) structural policy changes enacted in response to the pandemic. 
This community-based participatory research (CBPR) study builds on long-standing 
collaboration with five CBOs. By including 240 Latinx immigrants and 60 African 
refugees recruited from CBO partners who are randomly assigned to 
treatment-as-usual CBO involvement or the RIWP intervention and a comparison 
group comprised of a random sample of 300 Latinx immigrants, this mixed methods 
longitudinal waitlist control group design study with seven time points over 36 
months tests the effectiveness of the RIWP intervention and engagement with CBOs 
to reduce psychological distress, daily stressors, and economic precarity and 
increase protective factors (social support, access to resources, English 
proficiency, cultural connectedness). The study also tests the ability of the 
RIWP intervention and engagement with CBOs to increase access to the direct 
benefits of structural interventions. This paper reports on the theoretical 
basis, design, qualitative and quantitative analysis plan, and power for the 
study.

Copyright: © 2024 Goodkind et al. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0298369
PMCID: PMC11020834
PMID: 38626038 [Indexed for MEDLINE]

Conflict of interest statement: I have read the journal’s policy and the authors 
of this manuscript have the following competing interests: Jessica R. Goodkind 
is an unpaid Board Member of United Voices for Newcomer Rights, a partner 
organization in the study.


7. Int J Geriatr Psychiatry. 2024 Apr;39(4):e6087. doi: 10.1002/gps.6087.

Age-related differences in the impact of resilience on mental health outcomes 
during the COVID-19 pandemic in Hong Kong.

Lei LKS(1), Suen YN(2), Hui CLM(1), Chan SKW(1)(3), Lee EHM(1), Michael WTH(1), 
Chen EYH(1)(4)(5).

Author information:
(1)Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of 
Medicine, Hong Kong SAR, China.
(2)School of Nursing, Li Ka Shing Faculty of Medicine, Hong Kong SAR, China.
(3)State Key Laboratory of Brain and Cognitive Sciences, Hong Kong SAR, China.
(4)Institute of Mental Health, Singapore, Singapore.
(5)Lee Kong Chian School of Medicine, Nanyang Technological University, 
Singapore, Singapore.

OBJECTIVE: This study investigated changes in mental health in Hong Kong over 
two years and examined the role of resilience and age in mitigating the negative 
effects of public health emergencies, particularly the COVID-19 pandemic.
METHODS: Complete data of interest from two telephone surveys conducted in 2020 
(n = 1182) and 2021 (n = 1108) were analysed. Participants self-reported 
depressive and anxiety symptoms using the Patient Health Questionnaire 4-item 
version (PHQ), psychotic-like experiences (PLEs) using three items from the 
Prodromal Questionnaire Brief (PQB), and resilience using the Connor-Davidson 
Resilience Scale 2-item version (CD-RISC-2).
RESULTS: We observed an increase in the percentage of participants with high 
depressive and anxiety symptoms and PLEs from 1.6% to 6.5% between 2020 and 
2021. The likelihood of having high depressive and anxiety symptoms or PLEs 
depended on resilience and age, with no significant between-year differences. 
Resilience and age interaction effects were significant when comparing the high 
PHQ-high PQB group to the low PHQ-low PQB group only in 2021 but not in 2020.
CONCLUSIONS: This study provides valuable insights into the impact of the 
COVID-19 pandemic on mental health in Hong Kong, emphasising the age-dependent 
nature of resilience in mitigating negative effects. Future research should 
explore the mechanisms by which resilience promotes mental health and well-being 
and identify ways to enhance resilience among older individuals during public 
health crises.

© 2024 The Authors. International Journal of Geriatric Psychiatry published by 
John Wiley & Sons Ltd.

DOI: 10.1002/gps.6087
PMID: 38613130 [Indexed for MEDLINE]


8. BMC Pregnancy Childbirth. 2024 Apr 11;24(1):262. doi: 
10.1186/s12884-024-06439-6.

Pregnant and postpartum women's experiences of the indirect impacts of the 
COVID-19 pandemic in high-income countries: a qualitative evidence synthesis.

Tan A(1)(2)(3), Blair A(4)(5), Homer CS(6)(4), Digby R(6)(7)(8), Vogel JP(6)(4), 
Bucknall T(6)(7)(8).

Author information:
(1)School of Nursing and Midwifery, Deakin University, Geelong, Australia. 
tanann@deakin.edu.au.
(2)Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, 
Australia. tanann@deakin.edu.au.
(3)Centre for Quality and Patient Safety Research, Institute of Health 
Transformation, Geelong, Australia. tanann@deakin.edu.au.
(4)Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, 
Australia.
(5)Melbourne School of Population and Global Health, The University of 
Melbourne, Melbourne, Australia.
(6)School of Nursing and Midwifery, Deakin University, Geelong, Australia.
(7)Centre for Quality and Patient Safety Research, Institute of Health 
Transformation, Geelong, Australia.
(8)Alfred Health, Melbourne, Australia.

BACKGROUND: Pregnant and postpartum women's experiences of the COVID-19 
pandemic, as well as the emotional and psychosocial impact of COVID-19 on 
perinatal health, has been well-documented across high-income countries. 
Increased anxiety and fear, isolation, as well as a disrupted pregnancy and 
postnatal period are widely described in many studies. The aim of this study was 
to explore, describe and synthesise studies that addressed the experiences of 
pregnant and postpartum women in high-income countries during the first two 
years of the pandemic.
METHODS: A qualitative evidence synthesis of studies relating to women's 
experiences in high-income countries during the pandemic were included. Two 
reviewers extracted the data using a thematic synthesis approach and NVivo 20 
software. The GRADE-CERQual (Confidence in the Evidence from Reviews of 
Qualitative research) was used to assess confidence in review findings.
RESULTS: Sixty-eight studies were eligible and subjected to a sampling framework 
to ensure data richness. In total, 36 sampled studies contributed to the 
development of themes, sub-themes and review findings. There were six 
over-arching themes: (1) dealing with public health restrictions; (2) navigating 
changing health policies; (3) adapting to alternative ways of receiving social 
support; (4) dealing with impacts on their own mental health; (5) managing the 
new and changing information; and (6) being resilient and optimistic. Seventeen 
review findings were developed under these themes with high to moderate 
confidence according to the GRADE-CERQual assessment.
CONCLUSIONS: The findings from this synthesis offer different strategies for 
practice and policy makers to better support women, babies and their families in 
future emergency responses. These strategies include optimising care delivery, 
enhancing communication, and supporting social and mental wellbeing.

© 2024. Crown.

DOI: 10.1186/s12884-024-06439-6
PMCID: PMC11007880
PMID: 38605319 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


9. Inquiry. 2024 Jan-Dec;61:469580241246338. doi: 10.1177/00469580241246338.

Psychosocial and Service Delivery Impacts of the COVID-19 Pandemic on Children 
With Respiratory Conditions, Their Parents and Their Health Care Providers.

Nicholas DB(1), Katz SL(2)(3)(4), Ciesielski J(1), Zulla RT(1).

Author information:
(1)Faculty of Social Work, Central and Northern Alberta Region, University of 
Calgary, Edmonton, AB, Canada.
(2)Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.
(3)University of Ottawa, Ottawa, ON, Canada.
(4)Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, 
Canada.

The COVID-19 pandemic imposed widespread impacts on the health and well-being of 
children with respiratory challenges and their families, as well as on the 
health care system that supports them. An exploratory qualitative study was 
undertaken to examine how the pandemic impacted families' and health care 
providers' daily lives and experiences of care. Four youth, 12 parents and 7 
health care providers participated in interviews via telephone or online 
technology. Content analysis of transcribed interviews revealed participant 
experiences, including initial responses to the pandemic, adjustment to pandemic 
shifts, and anticipation of the future. While deleterious physical health 
impacts were minimal for children with pre-existing respiratory conditions, 
their mental health was negatively impacted by the pandemic and related health 
protocols. Families and health care providers experienced strain, yet 
demonstrated resilience. Pandemic-related shifts profoundly impacted daily life 
at home, school, and work. Pediatric pandemic planning in clinical care is 
recommended to better address the needs of children with respiratory conditions 
and their families as well as pediatric health care providers.

DOI: 10.1177/00469580241246338
PMCID: PMC11008339
PMID: 38602062 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting InterestsThe 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


10. Clin Psychol Psychother. 2024 Mar-Apr;31(2):e2969. doi: 10.1002/cpp.2969.

Perceived Hospital Preparedness Is Negatively Associated With Pandemic-Induced 
Psychological Vulnerability in Primary Care Employees: A Multicentre 
Cross-Sectional Observational Study.

Corradi-Dell'Acqua C(1)(2), Horisberger G(3), Caillet-Bois D(4), Toraldo 
A(5)(6), Christ M(7), Santa VD(8), Frochaux V(9), Mols P(10), Penaloza A(11), 
Rezzonico S(12), Tagliabue L(12), Hugli O(3)(4).

Author information:
(1)Center for Mind/Brain Sciences (CIMeC), University of Trento, Trento, Italy.
(2)Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, 
Switzerland.
(3)Faculty of Biology and Medicine, University of Lausanne, Lausanne, 
Switzerland.
(4)Emergency Department, University Hospital of Lausanne, Lausanne, Switzerland.
(5)Department of Brain and Behavioural Sciences, University of Pavia, Pavia, 
Italy.
(6)Milan Center for Neuroscience (NeuroMI), Milan, Italy.
(7)Emergency Department, Kantonsspital Luzern, Luzern, Switzerland.
(8)Emergency Department, Réseau hospitalier neuchâtelois, Neuchâtel, 
Switzerland.
(9)Emergency Department, Hôpital du Valais, Sion, Switzerland.
(10)Emergency Department, St. Pierre University Hospital, Université Libre de 
Bruxelles, Brussels, Belgium.
(11)Emergency Department, Cliniques Universitaires Saint-Luc, Université 
Catholique de Louvain, Brussels, Belgium.
(12)Emergency Department, Faculty of Biology and Medicine, Bellinzona Hospital, 
Bellinzona, Switzerland.

OBJECTIVE: The COVID-19 pandemic had a profound negative impact on the 
psychological wellbeing of healthcare providers (HPs), but little is known about 
the factors that positively predict mental health of primary care staff during 
these dire situations.
METHODS: We conducted an online questionnaire survey among 702 emergency 
department workers across 10 hospitals in Switzerland and Belgium following the 
first COVID-19 wave in 2020, to explore their psychological vulnerability, 
perceived concerns, self-reported impact and level of pandemic workplace 
preparedness. Participants included physicians, nurses, psychologists and 
nondirect care employees (administrative staff). We tested for predictors of 
psychological vulnerability through both an exploratory cross-correlation with 
rigorous correction for multiple comparisons and model-based path modelling.
RESULTS: Findings showed that the self-reported impact of COVID-19 at work, 
concerns about contracting COVID-19 at work, and a lack of personal protective 
equipment were strong positive predictors of Depression, Anxiety, and Stress, 
and low Resilience. Instead, knowledge of the degree of preparedness of the 
hospital/department, especially in the presence of a predetermined contingency 
plan for an epidemic and training sessions about protective measures, showed the 
opposite effect, and were associated with lower psychological vulnerability. All 
effects were confirmed after accounting for confounding factors related to 
gender, age, geographical location and the role played by HPs in the 
hospital/department.
CONCLUSIONS: Difficult working conditions during the pandemic had a major impact 
on the psychological wellbeing of emergency department HPs, but this effect 
might have been lessened if they had been informed about adequate measures for 
minimizing the risk of exposure.

© 2024 The Authors. Clinical Psychology & Psychotherapy published by John Wiley 
& Sons Ltd.

DOI: 10.1002/cpp.2969
PMID: 38600791 [Indexed for MEDLINE]


11. Child Care Health Dev. 2024 May;50(3):e13256. doi: 10.1111/cch.13256.

Parent perceptions of social well-being in children with special educational 
needs during COVID-19: A mixed-methods analysis.

Osman L(1), Whitley J(1).

Author information:
(1)Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada.

BACKGROUND: Children's educational experiences worldwide have been significantly 
impacted as a result of global school closures during the COVID-19 pandemic of 
Spring 2020. A growing number of studies aim to analyse impacts of these changes 
on social well-being, with limited studies placing an emphasis on the 
experiences of students with special educational needs (SENs). This article 
focusses on parent perspectives regarding impacts of school closures on social 
well-being in Canadian children with SEN.
METHODS: This study uses a mixed-methods approach, drawing from both qualitative 
and quantitative survey data from Spring/Summer 2020. Participants (n = 263) 
were eligible for participation if they were a parent/guardian of a child or 
adolescent with an SEN. We first conducted a descriptive analysis of the key 
variables, namely, social well-being, grade level of the child, internet and 
device availability, and the presence of other school-aged children in the home 
(single child vs. multiple children). Next, we explored the relationship between 
these using a bivariate correlation. Finally, open-ended responses were analysed 
using an inductive approach to qualitative thematic analysis.
RESULTS: The majority of parents expressed concern for their child's social 
well-being during the Spring 2020 school closures, with increased concerns for 
younger children. According to parents, children experienced communication 
barriers to peer interaction and many experienced emotional difficulties as a 
result. Technology was described as critical for some in maintaining social 
connections. Parents raised concerns about the impact of limited peer 
interaction on broader social skill development, in the short and long term. A 
small number of participants noted feelings of relief and reduced anxiety among 
their children with SEN.
CONCLUSIONS: Findings highlight parent views of the negative impact of the 
pandemic on social well-being and the critical role in-person schooling plays in 
supporting peer relationships for children with SEN.

© 2024 The Authors. Child: Care, Health and Development published by John Wiley 
& Sons Ltd.

DOI: 10.1111/cch.13256
PMID: 38600787 [Indexed for MEDLINE]


12. BMC Health Serv Res. 2024 Apr 10;24(1):450. doi: 10.1186/s12913-024-10724-7.

The burden of anxiety, depression, and stress, along with the prevalence of 
symptoms of PTSD, and perceptions of the drivers of psychological harms, as 
perceived by doctors and nurses working in ICUs in Nepal during the COVID-19 
pandemic; a mixed method evaluation.

Kc S(1), Gooden TE(2), Aryal D(3), Koirala K(1), Luitel S(1), Haniffa R(4)(5), 
Beane A(4)(5); Collaboration for Research, Implementation, and Training in 
Critical Care in Asia and Africa (CCAA).

Collaborators: Aryal D, Kc S, Koirala K, Luitel S, Nepal R, Khanal S, Paneru HR, 
Shreshta SK, Lakhey S, Amatya S, Thapa K, Maharjan R, Kafle R, Bashyal A, 
Shrestha R, Khadka D, Dullewe N.

Author information:
(1)Nepal Intensive Care Research Foundation, Kathmandu, Nepal.
(2)Institute of Applied Health Research, University of Birmingham, Birmingham, 
UK.
(3)Nepal Intensive Care Research Foundation, Kathmandu, Nepal. 
diptesharyal@gmail.com.
(4)Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK.
(5)Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand.

BACKGROUND: The COVID-19 pandemic resulted in significant physical and 
psychological impacts for survivors, and for the healthcare professionals caring 
for patients. Nurses and doctors in critical care faced longer working hours, 
increased burden of patients, and limited resources, all in the context of 
personal social isolation and uncertainties regarding cross-infection. We 
evaluated the burden of anxiety, depression, stress, post-traumatic stress 
disorder (PTSD), and alcohol dependence among doctors and nurses working in 
intensive care units (ICUs) in Nepal and explored the individual and social 
drivers for these impacts.
METHODS: We conducted a mixed-methods study in Nepal, using an online survey to 
assess psychological well-being and semi-structured interviews to explore 
perceptions as to the drivers of anxiety, stress, and depression. Participants 
were recruited from existing national critical care professional organisations 
in Nepal and using a snowball technique. The online survey comprised of 
validated assessment tools for anxiety, depression, stress, PTSD, and alcohol 
dependence; all tools were analysed using published guidelines. Interviews were 
analysed using rapid appraisal techniques, and themes regarding the drivers for 
psychological distress were explored.
RESULTS: 134 respondents (113 nurses, 21 doctors) completed the online survey. 
Twenty-eight (21%) participants experienced moderate to severe symptoms of 
depression; 67 (50%) experienced moderate or severe symptoms of anxiety; 114 
(85%) had scores indicative of moderate to high levels of stress; 46 out of 100 
reported symptoms of PTSD. Compared to doctors, nurses experienced more severe 
symptoms of depression, anxiety, and PTSD, whereas doctors experienced higher 
levels of stress than nurses. Most (95%) participants had scores indicative of 
low risk of alcohol dependence. Twenty participants were followed up in 
interviews. Social stigmatism, physical and emotional safety, enforced role 
change and the absence of organisational support were perceived drivers for poor 
psychological well-being.
CONCLUSION: Nurses and doctors working in ICU during the COVID-19 pandemic 
sustained psychological impacts, manifesting as stress, anxiety, and for some, 
symptoms of PTSD. Nurses were more vulnerable. Individual characteristics and 
professional inequalities in healthcare may be potential modifiable factors for 
policy makers seeking to mitigate risks for healthcare providers.

© 2024. The Author(s).

DOI: 10.1186/s12913-024-10724-7
PMCID: PMC11007980
PMID: 38600462 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


13. PLoS One. 2024 Apr 10;19(4):e0291278. doi: 10.1371/journal.pone.0291278. 
eCollection 2024.

The well-being and work-related stress of senior school leaders in Wales and 
Northern Ireland during COVID-19 "educational leadership crisis": A 
cross-sectional descriptive study.

Marchant E(1), Dowd J(2), Bray L(3), Rowlands G(4), Miles N(5), Crick T(1), 
James M(6), Dadaczynski K(7)(8), Okan O(9)(10).

Author information:
(1)Department of Education and Childhood Studies, Faculty of Humanities and 
Social Sciences, Swansea University, Swansea, United Kingdom.
(2)Health Researcher (Freelance), Northern Ireland, United Kingdom.
(3)School of Nursing, Midwifery and Allied Health, Faculty of Health, Social 
Care and Medicine, Edge Hill University, Edge Hill, United Kingdom.
(4)Public Health Sciences Institute, Newcastle University, Newcastle, United 
Kingdom.
(5)National Academy for Educational Leadership Wales, United Kingdom.
(6)National Centre for Population Health and Wellbeing Research, Population Data 
Science, Faculty of Medicine, Health and Life Science, Swansea University, 
Swansea, United Kingdom.
(7)Department of Health Sciences, Fulda University of Applied Sciences, Fulda, 
Germany.
(8)Centre for Applied Health Sciences, Leuphana University Lüneburg, Lüneburg, 
Germany.
(9)Department of Sport and Health Sciences, Center for Health and Medicine in 
Society, School of Medicine and Health, Munich, Germany.
(10)Department of Sport and Health Sciences, Center for Health Promotion in 
Childhood and Adolescence, School of Medicine and Health, Munich, Germany.

The COVID-19 pandemic caused far-reaching societal changes, including 
significant educational impacts affecting over 1.6 billion pupils and 100 
million education practitioners globally. Senior school leaders were at the 
forefront and were exposed to particularly high demands during a period of 
"crisis leadership". This occupation were already reporting high work-related 
stress and large numbers leaving the profession preceding COVID-19. This 
cross-sectional descriptive study through the international COVID-Health 
Literacy network aimed to examine the well-being and work-related stress of 
senior school leaders (n = 323) in Wales (n = 172) and Northern Ireland (n = 
151) during COVID-19 (2021-2022). Findings suggest that senior school leaders 
reported high workloads (54.22±11.30 hours/week), low well-being (65.2% n = 202, 
mean WHO-5 40.85±21.57), depressive symptoms (WHO-5 34.8% n = 108) and high 
work-related stress (PSS-10: 29.91±4.92). High exhaustion (BAT: high/very high 
89.0% n = 285) and specific psychosomatic complaints (experiencing muscle pain 
48.2% n = 151) were also reported, and females had statistically higher outcomes 
in these areas. School leaders were engaging in self-endangering working 
behaviours; 74.7% (n = 239) gave up leisure activities in favour of work and 
63.4% (n = 202) sacrificed sufficient sleep, which was statistically higher for 
females. These findings are concerning given that the UK is currently 
experiencing a "crisis" in educational leadership against a backdrop of 
pandemic-related pressures. Senior leaders' high attrition rates further 
exacerbate this, proving costly to educational systems and placing additional 
financial and other pressures on educational settings and policy response. This 
has implications for senior leaders and pupil-level outcomes including health, 
well-being and educational attainment, requiring urgent tailored and targeted 
support from the education and health sectors. This is particularly pertinent 
for Wales and Northern Ireland as devolved nations in the UK, who are both 
implementing or contemplating major education system level reforms, including 
new statutory national curricula, requiring significant leadership, engagement 
and ownership from the education profession.

Copyright: © 2024 Marchant et al. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0291278
PMCID: PMC11006137
PMID: 38598518 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


14. Int J Circumpolar Health. 2024 Dec;83(1):2336680. doi: 
10.1080/22423982.2024.2336680. Epub 2024 Apr 8.

A cross-sectional study exploring community perspectives on the impacts of 
COVID-19 in Nunavut and recommendations for a Holistic Inuit Qaujimajatuqangit 
approach to emergency response.

Rana Z(1), Leach M(1), Healey Akearok GK(1), Ukpatiku J(1), Umenwofor-Nweze 
N(1).

Author information:
(1)Qaujigiartiit Health Research Centre, Nunavut, Canada.

The goal of this study was to examine and address critical knowledge gaps and 
develop an understanding of both the positive and negative societal outcomes 
resulting from the public health measures associated with the COVID-19 pandemic 
in Nunavut and the interventions being undertaken to promote positive 
well-being. Data collection for this study included narrative, in-person 
interviews in Iqaluit, Rankin Inlet, Baker Lake, and Cambridge Bay between 
September 2022 and January 2023. A total of 70 participants were interviewed for 
this study. Community highlighted challenges, such as crowding and food 
insecurity, and concern for the collective wellbeing of the community. Strengths 
included financials supports, food sharing, and maintaining community 
connections over a distance. Recommendations included a focus on holistic health 
such as 1) public education and awareness about communicable disease, 2) 
financial supports, 3) housing, 4) access to healthcare, 5) focus on Inuit 
Qaujimajatuqangit, 6) mental-health and addiction supports, and 7) community 
spaces. Community members described both strengths and challenges they believe 
impacted their experiences and service delivery as well as recommendations for 
the future.

DOI: 10.1080/22423982.2024.2336680
PMCID: PMC11005875
PMID: 38590216 [Indexed for MEDLINE]

Conflict of interest statement: No potential conflict of interest was reported 
by the author(s).


15. J Med Life. 2023 Dec;16(12):1864-1868. doi: 10.25122/jml-2023-0475.

The impact of the COVID-19 pandemic on the mental health of patients diagnosed 
with inflammatory bowel diseases.

Sarb OF(1)(2), Vacaras V(1), Filip VP(3), Sarb AD(4), Zaharie RD(5)(6), Draghici 
N(1), Muresanu DF(1), Tantau AI(2).

Author information:
(1)Department of Neuroscience, Iuliu Hatieganu University of Medicine and 
Pharmacy, Cluj-Napoca, Romania.
(2)4 Department of Internal Medicine, Iuliu Hatieganu University of Medicine and 
Pharmacy, Cluj-Napoca, Romania.
(3)Department of Infectious Disease, Clinical Hospital of Infectious Disease, 
Cluj-Napoca, Romania.
(4)Heart Institute, Iuliu Hatieganu University of Medicine and Pharmacy, 
Cluj-Napoca, Romania.
(5)Department of Gastroenterology, Octavian Fodor Regional Institute of 
Gastroenterology and Hepatology, Cluj-Napoca, Cluj, Romania.
(6)Department of Gastroenterology, Iuliu Hatieganu University of Medicine and 
Pharmacy, Cluj-Napoca, Romania.

Understanding the profound impact of a viral pandemic on the mental health of 
patients with autoimmune diseases undergoing biological treatment is crucial for 
future insights. This cross-sectional case-control study aimed to assess the 
mental health implications of the COVID-19 pandemic on individuals with 
inflammatory bowel disease (IBD) in Romania, spanning from November 2022 to 
March 2023. A specialized self-report questionnaire in the Romanian language was 
developed to measure the multifaceted effects of COVID-19 on the mental 
well-being of these patients. The findings revealed a significant decline in the 
mental health of patients with IBD during the pandemic compared to the control 
group. Patients with IBD exhibited elevated levels of anxiety and concern 
regarding the virus. Intriguingly, despite the challenges, the vaccination rate 
was notably higher among patients with IBD, indicating a proactive approach to 
safeguarding their health. The study also shed light on various coping 
mechanisms employed by patients with IBD to navigate the pandemic-related 
restrictions. Engaging in activities such as social media and computer games 
emerged as effective strategies for managing heightened stress and limitations. 
In conclusion, the emergence of a novel viral pathogen represents a significant 
distress factor for patients with autoimmune diseases. Recognizing and 
comprehending these consequences enhances our understanding of the intricate 
interplay between physical and mental health and equips authorities with 
valuable insights to better manage future epidemics or viral outbreaks. This 
study underscores the importance of tailored support systems and strategies for 
patients with autoimmune diseases during global health crises.

© 2023 The Author(s).

DOI: 10.25122/jml-2023-0475
PMCID: PMC10994603
PMID: 38585531 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


16. West Afr J Med. 2024 Feb 29;41(2):169-174.

COVID-19 and Activities of Daily Living Among Primary Health Care Workers in 
Ekiti State, South-West Nigeria.

Adeniran A(1), Bakare OQ(1), Oluwole EO(2), Chieme FC(3), Durojaiye T(4), Ojo 
OY(5), Olujobi B(6), Ilesanmi MM(7).

Author information:
(1)Department of Community Health & Primary Health Care, Lagos State University 
College of Medicine, Ikeja, Lagos, Nigeria. Phone No: 08023044194 E-mail: 
wunmibakare@hotmail.com.
(2)Department of Community Health & Primary Care, College of Medicine of the 
University of Lagos, Surulere, Nigeria.
(3)Petra Global Consulting, Lagos, Nigeria.
(4)Department of Community Health & Primary Health Care, Lagos State University 
Teaching Hospital, Ikeja, Lagos, Nigeria.
(5)Department of Community Medicine & Primary Care, Federal Medical Centre, 
Abeokuta, Ogun State, Nigeria.
(6)State Primary Health Care Development Agency, Ado-Ekiti, Ekiti State, 
Nigeria.
(7)Department of Community Health & Epidemiology, College of Medicine University 
of Saskatchewan, Saskatoon, Canada.

BACKGROUND AND OBJECTIVES: Globally, COVID-19 has greatly impacted humans 
physically, socially, mentally, and economically. No doubt, healthcare workers 
seemed to bear the greatest impact. The study therefore assessed the impact of 
COVID- 19 on the primary healthcare workers' daily activities in Ekiti, 
Southwest, Nigeria.
METHODS: The study was a cross-sectional study using a quantitative data 
collection method among 716 primary healthcare workers. Respondents were 
selected using an online convenience sampling method via their social media 
platforms. Data was collected, collated, and analyzed using SPSS version 25 
software and presented as frequency tables, mean and standard deviation. 
Bivariate/multivariate analyses were conducted using t-tests and ANOVA 
statistics. The level of statistical significance was set at p<0.05.
RESULTS: The mean age of respondents was 44.4+6.4SD with less than half (47.1%) 
between 41-50 years age group. The majority of the respondents (89.4%) were 
female and almost all (96.2%) were married. Ninety percent (90%) had ever heard 
of Coronavirus and (85.8%) had to spend more money on activities of daily living 
such as transportation (90.1%), groceries (80.6%), assisting relations (95.8%) 
and sanitary measures (disinfection) at home (95.0%). COVID-19 had a huge 
negative impact on the majority (89.7%) of healthcare workers with a mean score 
of 22+4.8.
CONCLUSION: COVID-19 negatively impacted the daily living and professional 
duties of primary healthcare workers which reflected in their psychological, 
physical, social and economic well-being. Disease outbreaks are unlikely to 
disappear soon, hence, global proactive interventions and homegrown measures 
should be adopted to protect healthcare workers and save their lives.

Publisher: CONTEXTES ET OBJECTIFS: Globalement, la COVID-19 a grandement impacté 
les êtres humains physiquement, socialement, mentalement et économiquement. Sans 
aucun doute, les travailleurs de la santé semblent être les plus touchés. 
L'étude a donc évalué l'impact de la COVID-19 sur les activités quotidiennes des 
travailleurs des soins de santé primaires à Ekiti, au Sud-Ouest du Nigeria.
MÉTHODES: L'étude était une étude transversale utilisant une méthode de collecte 
de données quantitative auprès de 716 travailleurs des soins de santé primaires. 
Les répondants ont été sélectionnés en utilisant une méthode d'échantillonnage 
de convenance en ligne via leurs plateformes de médias sociaux. Les données ont 
été collectées, compilées et analysées à l'aide du logiciel SPSS version 25 et 
présentées sous forme de tableaux de fréquence, de moyenne et d'écart-type. Des 
analyses bivariées/multivariées ont été réalisées à l'aide de tests t et 
d'ANOVA. Le niveau de signification statistique a été fixé à p<0,05.
RÉSULTATS: L'âge moyen des répondants était de 44,4+6,4 SD avec moins de la 
moitié (47,1 %) dans le groupe d'âge de 41 à 50 ans. La majorité des répondants 
(89,4 %) étaient des femmes et presque tous (96,2 %) étaient mariés. 
Quatre-vingt-dix pour cent (90 %) avaient déjà entendu parler du Coronavirus et 
(85,8 %) avaient dû dépenser plus d'argent pour les activités de la vie 
quotidienne telles que le transport (90,1 %), les courses (80,6 %), l'aide aux 
relations (95,8 %) et les mesures sanitaires (désinfection) à domicile (95,0 %). 
La COVID-19 a eu un impact négatif important sur la majorité (89,7 %) des 
travailleurs de la santé avec un score moyen de 22+4,8.
CONCLUSION: La COVID-19 a eu un impact négatif sur la vie quotidienne et les 
devoirs professionnels des travailleurs des soins de santé primaires, ce qui 
s'est reflété dans leur bien-être psychologique, physique, social et économique. 
Les épidémies de maladies ne disparaîtront probablement pas de sitôt, c'est 
pourquoi des interventions proactives mondiales et des mesures locales doivent 
être adoptées pour protéger les travailleurs de la santé et sauver leurs vies.
MOTS-CLÉS: COVID-19, Main-d'œuvre de la santé, Soins de Santé Primaires, 
Systèmes de Santé, Dépression.

Copyright © 2024 by West African Journal of Medicine.

PMID: 38581692 [Indexed for MEDLINE]

Conflict of interest statement: The Authors declare that no competing interest 
exists.


17. J Int Assoc Provid AIDS Care. 2024 Jan-Dec;23:23259582241235779. doi: 
10.1177/23259582241235779.

Providing Trauma-Informed Care During a Pandemic: How Health Care Workers at 
Ryan White-Funded Clinics in the Southeastern United States Responded to 
COVID-19 and Its Effects on Their Well-Being.

Kokubun CW(1), Anderson KM(1), Manders OC(2), Kalokhe AS(2)(3), Sales JM(1).

Author information:
(1)Department of Behavioral, Social, and Health Education Sciences, Rollins 
School of Public Health, Emory University, Atlanta, GA, USA.
(2)Hubert Department of Global Health, Rollins School of Public Health, Emory 
University, Atlanta, GA, USA.
(3)Division of Infectious Diseases, School of Medicine, Emory University, 
Atlanta, GA, USA.

As HIV/AIDS health care workers (HCWs) deliver services during COVID-19 under 
difficult conditions, practicing trauma-informed care (TIC) may mitigate 
negative effects on mental health and well-being. This secondary qualitative 
analysis of a larger mixed methods study sought to understand the pandemic's 
impact on HCWs at Ryan White-funded clinics (RWCs) across the southeastern US 
and assess changes in prioritization of TIC. RWC administrators, providers, and 
staff were asked about impacts on clinic operations/culture, HCW well-being, 
institutional support for well-being, and prioritization of TIC. HCWs described 
strenuous work environments and decreased well-being (eg, increased stress, 
burnout, fear, and social isolation) due to COVID-19. RWCs initiated novel 
responses to disruptions of clinic operations and culture to encourage 
continuity in care and promote HCW well-being. Despite increased awareness of 
the need for TIC, prioritization remained variable. Implementing and 
institutionalizing trauma-informed practices could strengthen continuity in care 
and safeguard HCW well-being during public health emergencies.

Plain Language Summary: COVID-19 and Its Effects on the Well-being of Ryan White 
Health Care Workers in the Southeastern United States.

DOI: 10.1177/23259582241235779
PMCID: PMC10998491
PMID: 38576400 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting InterestsThe authors 
declared no potential conflicts of interest with respect to the research, 
authorship, and/or publication of this article.


18. PeerJ. 2024 Mar 29;12:e17193. doi: 10.7717/peerj.17193. eCollection 2024.

Factors that contributed to Ontario adults' mental health during the first 16 
months of the COVID-19 pandemic: a decision tree analysis.

Shillington KJ(1)(2)(3), Vanderloo LM(4)(5), Burke SM(1)(6)(7), Ng V(8)(9), 
Tucker P(1)(5)(7), Irwin JD(1)(6).

Author information:
(1)Health and Rehabilitation Sciences, Faculty of Health Sciences, University of 
Western Ontario, London, Ontario, Canada.
(2)Department of Neurobiology, University of California San Diego, San Diego, 
California, United States.
(3)Center for Empathy and Social Justice in Human Health, T. Denny Sanford 
Institute for Empathy and Compassion, University of California San Diego, San 
Diego, California, United States.
(4)Child Health Evaluative Science, The Hospital for Sick Children, Toronto, 
Ontario, Canada.
(5)School of Occupational Therapy, Faculty of Health Sciences, University of 
Western Ontario, London, Ontario, Canada.
(6)School of Health Studies, Faculty of Health Sciences, University of Western 
Ontario, London, Ontario, Canada.
(7)Children's Health Research Institute, London, Ontario, Canada.
(8)Schulich School of Medicine and Dentistry, University of Western Ontario, 
London, Ontario, Canada.
(9)Division of Professional Development and Practice Support, College of Family 
Physicians of Canada, Mississauga, Ontario, Canada.

The COVID-19 pandemic has negatively impacted the mental health of individuals 
globally. However, less is known about the characteristics that contributed to 
some people having mental health problems during the pandemic, while others did 
not. Mental health problems can be understood on a continuum, ranging from acute 
(e.g., depression following a stressful event) to severe (e.g., chronic 
conditions that disrupt everyday functioning). Therefore, the purpose of this 
article was to generate profiles of adults who were more or less at risk for the 
development of mental health problems, in general, during the first 16-months of 
the COVID-19 pandemic in Ontario, Canada. Data were collected via online surveys 
at two time points: April-July 2020 and July-August 2021; 2,188 adults (Mage = 
43.15 years; SD = 8.82) participated. Surveys included a demographic 
questionnaire and four previously validated tools to measure participants' 
mental health, subjective wellbeing, physical activity and sedentary behaviour, 
and sleep. A decision tree was generated at each time point for those with 
mental health problems, and those with no mental health problems. Results showed 
that subjective wellbeing was the biggest contributor to mental health status. 
Characteristics associated with no mental health problems among adults included 
having good wellbeing, being a good sleeper (quantity, quality, and patterns of 
sleep), and being over the age of 42. Characteristics associated with mental 
health problems included having poor wellbeing and being a poor sleeper. 
Findings revealed that specific characteristics interacted to contribute to 
adults' mental health status during the first 16 months of the COVID-19 
pandemic. Given that wellbeing was the biggest contributor to mental health, 
researchers should focus on targeting adults' wellbeing to improve their mental 
health during future health crises.

© 2024 Shillington et al.

DOI: 10.7717/peerj.17193
PMCID: PMC10984169
PMID: 38563002 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


19. Child Care Health Dev. 2024 May;50(3):e13247. doi: 10.1111/cch.13247.

Caregiver and parent-child relationship during COVID-19: The mediator role of 
anxiety and life satisfaction.

Ayran G(1), Çevik Özdemir HN(2).

Author information:
(1)Faculty of Health Sciences, Erzincan Binali Yıldırım University, Erzincan, 
Turkey.
(2)Faculty of Health Science, Afyon Karahisar Health Science University, Afyon, 
Turkey.

AIM: This research was conducted to evaluate the mediation effect of anxiety and 
life satisfaction on the relationship between Care burden and Parent Child 
Relationship in Turkish parents during the COVID-19 epidemic.
METHODS: The research was carried out with parents (221 women and 219 men) who 
have children between the ages of 6-18 living in Turkey. Data were collected in 
June-July 2021 using the demographic data form, "Care Burden Scale," "Pervasive 
Anxiety Disorder-7 Test," "Satisfaction with Life Scale," and "Parent Child 
Relationship Scale." Path analysis was used to analyse the relationships. In 
this study, structural equation modelling (SEM) was used to examine the path 
analysis.
RESULTS: It was found that the burden of care and anxiety of the parents and the 
parent-child conflict relationship were positively correlated and negatively 
correlated with the life satisfaction and parent-child closeness relationship 
(p < 0.05). Path model analyses revealed that the burden of care had a direct 
effect on anxiety and life satisfaction, and an indirect effect on the 
parent-child relationship, respectively.
CONCLUSIONS: It shows that parents' perceptions of how the COVID-19 pandemic is 
affecting their mental health have implications for parent and child well-being, 
with stronger relationships for low-income families. Anxiety and life 
satisfaction had a mediating effect between care burden and parent-child 
relationship. Given the demonstrable impact of COVID-19 on the parent-child 
relationship, this study may guide the planning of coping strategies and 
programmes focused on mental health.

© 2024 John Wiley & Sons Ltd.

DOI: 10.1111/cch.13247
PMID: 38558179 [Indexed for MEDLINE]


20. PLoS One. 2024 Apr 1;19(4):e0300812. doi: 10.1371/journal.pone.0300812. 
eCollection 2024.

Effects of working from home on lifestyle behaviors and mental health during the 
COVID-19 pandemic: A survey study.

Scoditti E(1), Bodini A(2), Sabina S(1), Leo CG(1), Mincarone P(3), Rissotto 
A(4), Fusco S(4), Guarino R(1), Ponzini G(3), Tumolo MR(5), Magnavita N(6), 
Tripepi GL(7), Garbarino S(8).

Author information:
(1)Institute of Clinical Physiology (IFC), National Research Council (CNR), 
Lecce, Italy.
(2)Institute for Applied Mathematics and Information Technologies "E. Magenes" 
(IMATI), National Research Council (CNR), Milano, Italy.
(3)Institute for Research on Population and Social Policies (IRPPS), National 
Research Council (CNR), Research Unit of Brindisi, Brindisi, Italy.
(4)Training and Welfare Unit, National Research Council (CNR), Rome, Italy.
(5)Department of Biological and Environmental Sciences and Technology (DISTEBA), 
University of Salento, Lecce, Italy.
(6)Post-graduate School of Occupational Health, Università Cattolica del Sacro 
Cuore, Rome, Italy.
(7)Institute of Clinical Physiology (IFC), National Research Council (CNR), 
Reggio Calabria, Italy.
(8)Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and 
Maternal/Child Sciences (DINOGMI), University of Genoa, Genoa, Italy.

The COVID-19 outbreak has led to relevant changes in everyday life worldwide. 
One of these changes has been a rapid transition to and an increasing 
implementation of working from home (WH) modality. This study aimed to evaluate 
the impact of mandatory WH during the COVID-19 pandemic on lifestyle behaviors, 
Mediterranean diet adherence, body weight, and depression. An online 
cross-sectional survey was conducted in the early 2022 at the National Research 
Council of Italy using ad hoc questions and validated scales collecting 
information on physical activity, sedentary behavior, hobbies/pastimes, dietary 
habits including adherence to the Mediterranean diet, body weight, and 
depression during WH compared with before WH. 748 respondents were included in 
the study. An increased sedentary lifetime was reported by 48% of respondents; 
however, the subsample of workers who previously performed moderate physical 
activity intensified this activity. Body weight gain during WH was self-reported 
in 39.9% of respondents. Mediterranean diet adherence increased (p≪0.001) during 
WH compared with before WH. The average level of mental health did not record an 
overall variation; however, the proportion of subjects with mild and moderate 
depression increased (p = 0.006), while workers who reported values indicative 
of depression before the transition declared an improvement. These findings 
highlight health-related impact of WH during the COVID-19 pandemic that may 
inform future strategies and policies to improve employees' health and 
well-being.

Copyright: © 2024 Scoditti et al. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0300812
PMCID: PMC10984516
PMID: 38558099 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


21. Turk Psikiyatri Derg. 2024 Spring;35(1):56-62. doi: 10.5080/u26948.

Evaluation of Sexual Function According to Gender and Sexual Orientation during 
the COVID-19 Pandemic in Turkey: A National Online Survey Study.

Şahin AB, Büyüktopcu E, Tükel R.

OBJECTIVE: Coronavirus Diseases-19 (COVID-19) pandemic that has caused the death 
of thousands of people affected negatively not only people's physical wellbeing 
but also their mental health. The aim of this study was to evaluate the sexual 
function, depression, anxiety and stress, and fear of COVID-19 of individuals 
according to gender and sexual orientation during the COVID-19 pandemic.
METHOD: The questionnaire form included sociodemographic data form, the Arizona 
Sexual Experiences Scale (ASEX), the Depression, Anxiety and Stress Scale-Short 
Form (DASS-21), and the Fear of COVID-19 Scale (FCV-19S). The form was 
distributed on social media platforms.
RESULTS: 1593 sexually active participants were included in the study. 47.5% of 
the participants were females and 52.5% were males. 86.9% of them were 
heterosexuals and 13.1% were lesbian, gay, and bisexual (LGB) individuals. ASEX, 
DASS-21 Depression, Anxiety, and Stress, and FCV-19S scores were significantly 
higher in females than males (p<0.001). When anxiety, depression, stress, and 
fear of COVID-19 were controlled, level of sexual dysfunction continued to be 
higher in women. We found that while the ASEX and FCV-19S scores were similar 
between the heterosexuals and LGBs (respectively p=0.66 and p=0.31), the DASS-21 
Depression, Anxiety, and Stress scores were higher in LGBs (p<0.001).
CONCLUSION: Our results reveal the effect of the pandemic period on female 
sexual functions and the importance of addressing this topic in clinical 
practice and research.

DOI: 10.5080/u26948
PMCID: PMC11003367
PMID: 38556937 [Indexed for MEDLINE]


22. Turk Psikiyatri Derg. 2024 Spring;35(1):24-33. doi: 10.5080/u27017.

Fear, Perceived Threat, and Anxiety During COVID-19 Pandemic: The Mediating Role 
of Cognitive Control/Flexibility and Intolerance of Uncertainty.

Akgül Ö, Uzgan BÖ, Tetik M, Aykaç C.

OBJECTIVE: In this study, we aimed to evaluate the relationship between fear of 
COVID-19, perceived threat of COVID-19, anxiety, cognitive control/flexibility, 
and intolerance to uncertainty. In addition, the mediating role of cognitive 
control/flexibility and intolerance to uncertainty were investigated.
METHOD: 224 volunteers aged between 18-55 years were included in the study. 
Cognitive Control and Felxibility Scale, Intolerance of Uncertainty Scale, Fear 
of COVID-19 Scale, Perceived COVID-19 Threat Form and Beck Anxiety Scales were 
administered to all participants via an online environment. In this context, 
Pearson correlation, linear regression, and mediation analyzes were performed.
RESULTS: There were significant relationships among Cognitive Control and 
Flexibility, Intolerance of Uncertainty, Beck Anxiety, fear of COVID-19, 
perceived COVID-19 threat (p<0,01). Linear regression analysis showed that the 
Beck Anxiety Scale, Intolerance of Uncertainty and Cognitive Control/ 
Flexibility Scale scores significantly predicted fear of COVID-19 and the 
perceived threat of COVID-19 (p<0,001). In addition, mediation analysis revealed 
that intolerance to uncertainty and cognitive control/flexibility are mediating 
factors between anxiety and the perceived threat of COVID-19 (p<0,01).
CONCLUSION: There is a relationship between fear of COVID-19 and perception of 
threat, anxiety, intolerance of uncertainty, and cognitive control mechanisms. 
In accordance with these findings, psychosocial support and therapy programs can 
be created based on cognitive control/flexibility and intolerance of uncertainty 
in order to increase the mental health well-being of individuals.

DOI: 10.5080/u27017
PMCID: PMC11003365
PMID: 38556934 [Indexed for MEDLINE]


23. J Affect Disord. 2024 Jun 15;355:247-253. doi: 10.1016/j.jad.2024.03.157. Epub 
2024 Mar 28.

Unmasking the triad of burnout, absenteeism, and poor sleep among healthcare 
workers during the third wave of COVID-19 pandemics. Results from the national 
AMADEUS study.

Fond G(1), Smith L(2), Tran B(3), Lucas G(4), Nguyen TT(5), Yon DK(6), Boyer 
L(7).

Author information:
(1)Aix-Marseille University, CEReSS-Health Service Research and Quality of Life 
Center, 27, boulevard Jean -Moulin, 13005 Marseille, France; Fondation 
FondaMental, Créteil, France.
(2)Centre for Health, Performance and Wellbeing, Anglia Ruskin University, 
Cambridge, UK.
(3)Aix-Marseille University, CEReSS-Health Service Research and Quality of Life 
Center, 27, boulevard Jean -Moulin, 13005 Marseille, France; Institute of 
Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Viet 
Nam.
(4)Aix-Marseille University, CEReSS-Health Service Research and Quality of Life 
Center, 27, boulevard Jean -Moulin, 13005 Marseille, France.
(5)Institute for Global Health Innovations, Duy Tan University, Da Nang, 550000, 
Vietnam; Faculty of Medicine, Duy Tan University, Da Nang, 550000, Vietnam.
(6)Department of Pediatrics, Kyung Hee University College of Medicine, Seoul, 
Republic of Korea; Center for Digital Health, Medical Science Research 
Institute, Kyung Hee University Medical Center, Kyung Hee University College of 
Medicine, Seoul, Republic of Korea.
(7)Aix-Marseille University, CEReSS-Health Service Research and Quality of Life 
Center, 27, boulevard Jean -Moulin, 13005 Marseille, France; Fondation 
FondaMental, Créteil, France. Electronic address: laurent.boyer@univ-amu.fr.

BACKGROUND: Burnout and absenteeism are prevalent among healthcare workers, 
reflecting prolonged work-related stress and dissatisfaction with their job. 
Identifying poor sleep as a contributing factor can assist in developing 
targeted interventions. This study explored the relationship between burnout, 
absenteeism, and sleep among healthcare workers.
METHODS: A nationwide online cross-sectional study was conducted among 
healthcare professionals in France during the third wave of COVID-19, from May 
2021 to June 2021. Recruitment strategies included outreach through social and 
professional networks and email invitations. Burnout was assessed using the 
Maslach Burnout Inventory, absenteeism through self-reported days absent in the 
preceding 12 months, and sleep quality using the Pittsburgh Sleep Quality Index. 
The association between burnout, absenteeism, and poor sleep was analyzed using 
multivariate logistic regression, accounting for individual and professional 
variables. The study also explored various sleep dimension abnormalities.
RESULTS: Of 10,087 healthcare workers, 55.2 % reported burnout, 20.5 % 
absenteeism, and 64.8 % poor sleep. Burnout and absenteeism were more frequent 
in individuals with poor sleep compared to those with good sleep (74.2 % vs. 
25.8 % and 75.6 % vs. 24.4 %, respectively). The multivariate analyses confirmed 
the associations between burnout, absenteeism, and poor sleep (Adjusted Odds 
Ratio [aOR] = 2.15, 95 % CI [1.97-2.35], p < 0.001; and aOR = 1.49, 95 % CI 
[1.32-1.67], p < 0.001, respectively).
INTERPRETATION: The study highlighted the intricate relationship between 
burnout, absenteeism, and poor sleep among healthcare professionals, informing 
workforce management and policy decisions to foster a supportive work 
environment and enhance their well-being.

Copyright © 2024. Published by Elsevier B.V.

DOI: 10.1016/j.jad.2024.03.157
PMID: 38554883 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest None.


24. BMJ Open. 2024 Mar 29;14(3):e078388. doi: 10.1136/bmjopen-2023-078388.

Mixed-methods study exploring health service access and social support linkage 
to the mental well-being of Canadian Indigenous pregnant persons during the 
COVID-19 pandemic.

Mollons M(1), Levasseur-Puhach S(2), Kaur J(3), Doyle J(4), Giesbrecht G(5)(6), 
Lebel CA(5)(7), Woods L(8), Tomfohr-Madsen L(4), Roos L(2)(9).

Author information:
(1)Psychology, University of Manitoba, Winnipeg, Manitoba, Canada 
mollonsm@myumanitoba.ca.
(2)Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.
(3)Psychology, University of Regina, Regina, Saskatchewan, Canada.
(4)Educational and Counselling Psychology, The University of British Columbia, 
Vancouver, British Columbia, Canada.
(5)Alberta Children's Hospital Research Institute, Calgary, Province of Alberta, 
Canada.
(6)Department of Community Health Sciences, University of Calgary, Calgary, 
Province of Alberta, Canada.
(7)Department of Radiology, University of Calgary, Calgary, Province of Alberta, 
Canada.
(8)New Directions, Winnipeg, Manitoba, Canada.
(9)University of Manitoba Children's Hospital Research Institute, Winnipeg, 
Manitoba, Canada.

OBJECTIVES: This study aimed to explore how the unprecedented stressors 
associated with the COVID-19 pandemic may have contributed to heightened levels 
of depression and anxiety among pregnant Indigenous persons, and identify 
protective individual-level factors.
DESIGN: The current study used a mixed-methods design including standardised 
questionnaires and open-ended response questions. Using hierarchical regression 
models, we examined the extent to which COVID-19-related factors of service 
disruption (ie, changes to prenatal care, changes to birth plans and social 
support) were associated with mental well-being. Further, through qualitative 
analyses of open-ended questions, we examined the coping strategies used by 
pregnant Indigenous persons in response to the pandemic.
SETTING: Participants responded to an online questionnaire consisting of 
standardised measures from 2020 to 2021.
PARTICIPANTS: The study included 336 self-identifying Indigenous pregnant 
persons in Canada.
RESULTS: Descriptive results revealed elevated rates of clinically relevant 
depression (52.7%) and anxiety (62.5%) symptoms among this population. 76.8% of 
participants reported prenatal care service disruptions, including appointment 
cancellations. Thematic analyses identified coping themes of staying informed, 
social and/or cultural connections and activities, and internal mental 
well-being strategies. Disruptions to services and decreased quality of prenatal 
care negatively impacted mental well-being of Indigenous pregnant persons during 
the COVID-19 pandemic.
CONCLUSIONS: Given the potential for mental well-being challenges to persist and 
long-term effects of perinatal distress, it is important to examine the quality 
of care that pregnant individuals receive. Service providers should advance 
policies and practices that promote relationship quality and health system 
engagement as key factors linked to well-being during the perinatal period for 
Indigenous persons.

© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2023-078388
PMCID: PMC11005712
PMID: 38553054 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


25. BMC Psychol. 2024 Mar 28;12(1):179. doi: 10.1186/s40359-024-01618-8.

Medical student wellbeing during COVID-19: a qualitative study of challenges, 
coping strategies, and sources of support.

West HM(1), Flain L(2), Davies RM(3)(4), Shelley B(3)(5), Edginton OT(3)(6).

Author information:
(1)Department of Psychology, University of Liverpool, Eleanor Rathbone Building, 
Bedford Street South, Liverpool, L69 7ZA, UK. h.west@liverpool.ac.uk.
(2)Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
(3)School of Medicine, University of Liverpool, Liverpool, UK.
(4)Salford Royal NHS Foundation Trust, Manchester, UK.
(5)Calderdale and Huddersfield NHS Foundation Trust, West Yorkshire, UK.
(6)Leeds Teaching Hospitals NHS Foundation Trust, Leeds, UK.

BACKGROUND: Medical students face challenges to their mental wellbeing and have 
a high prevalence of mental health problems. During training, they are expected 
to develop strategies for dealing with stress. This study investigated factors 
medical students perceived as draining and replenishing during COVID-19, using 
the 'coping reservoir' model of wellbeing.
METHODS: In synchronous interactive pre-recorded webinars, 78 fourth-year 
medical students in the UK responded to reflective prompts. Participants wrote 
open-text comments on a Padlet site. Responses were analysed using reflexive 
thematic analysis.
RESULTS: Analysis identified five themes. COVID-19 exacerbated academic 
pressures, while reducing the strategies available to cope with stress. 
Relational connections with family and friends were affected by the pandemic, 
leading to isolation and reliance on housemates for informal support. 
Relationships with patients were adversely affected by masks and telephone 
consultations, however attending placement was protective for some students' 
wellbeing. Experiences of formal support were generally positive, but some 
students experienced attitudinal and practical barriers.
CONCLUSIONS: This study used a novel methodology to elicit medical students' 
reflections on their mental wellbeing during COVID-19. Our findings reinforce 
and extend the 'coping reservoir' model, increasing our understanding of factors 
that contribute to resilience or burnout. Many stressors that medical students 
typically face were exacerbated during COVID-19, and their access to coping 
strategies and support were restricted. The changes to relationships with 
family, friends, patients, and staff resulted in reduced support and isolation. 
Recognising the importance of relational connections upon medical students' 
mental wellbeing can inform future support.

© 2024. The Author(s).

DOI: 10.1186/s40359-024-01618-8
PMCID: PMC10979564
PMID: 38549145 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


26. Midwifery. 2024 Mar 20;132:103980. doi: 10.1016/j.midw.2024.103980. Online ahead 
of print.

Trends and disparities in perinatal health outcomes among women from refugee 
backgrounds in Victoria, Australia: A population-based study.

Yeshitila YG(1), Gold L(2), Riggs E(3), Abimanyi-Ochom J(2), Sweet L(4), Le 
HND(2).

Author information:
(1)Institute for Health Transformation, Deakin Health Economics, School of 
Health and Social Development, Faculty of Health, Deakin University, 1Gheringhap 
Street, Geelong, Victoria 3220, Australia; School of Nursing, College of 
Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia; 
Intergenerational Health, Murdoch Children's Research Institute, Parkville, 
Victoria, Australia. Electronic address: y.yeshitila@deakin.edu.au.
(2)Institute for Health Transformation, Deakin Health Economics, School of 
Health and Social Development, Faculty of Health, Deakin University, 1Gheringhap 
Street, Geelong, Victoria 3220, Australia.
(3)Intergenerational Health, Murdoch Children's Research Institute, Parkville, 
Victoria, Australia; Department of General Practice, The University of 
Melbourne, Victoria, Melbourne, Australia.
(4)School of Nursing and Midwifery, Deakin University, Victoria, Australia; 
Centre for Quality and Patient Safety Research, Western Health Partnership, 
Institute for Health Transformation, Victoria, Australia.

BACKGROUND: Women from refugee backgrounds generally experience poorer 
pregnancy-related outcomes compared to host populations.
AIM: To examine the trend and disparities in adverse perinatal outcomes among 
women of refugee background using population-based data from 2003 to 2017.
METHODS: A population-based cross-sectional study of 754,270 singleton births in 
Victoria compared mothers of refugee backgrounds with Australian-born mothers. 
Inferential statistics, including Pearson chi-square and binary logistic 
regression, were conducted. Multiple logistic regression was conducted to 
explore the relationship between adverse perinatal outcomes and the women's 
refugee status.
FINDINGS: Women of refugee background had higher odds of adverse neonatal and 
maternal outcomes, including stillbirth, neonatal death, low APGAR score, small 
for gestational age, postpartum haemorrhage, abnormal labour, perineal tear, and 
maternal admission to intensive care compared to Australian-born women. However, 
they had lower odds of neonatal admission to intensive care, pre-eclampsia, and 
maternal postnatal depression. The trend analysis showed limited signs of gaps 
closing over time in adverse perinatal outcomes.
DISCUSSION AND CONCLUSION: Refugee background was associated with unfavourable 
perinatal outcomes, highlighting the negative influence of refugee status on 
perinatal health. This evidences the need to address the unique healthcare 
requirements of this vulnerable population to enhance the well-being of mothers 
and newborns. Implementing targeted interventions and policies is crucial to 
meet the healthcare requirements of women of refugee backgrounds. Collaborative 
efforts between healthcare organisations, government agencies and 
non-governmental organisations are essential in establishing comprehensive 
support systems to assist refugee women throughout their perinatal journey.

Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.midw.2024.103980
PMID: 38547597

Conflict of interest statement: Declaration of competing interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


27. Adv Neonatal Care. 2024 Apr 1;24(2):141-150. doi: 10.1097/ANC.0000000000001160. 
Epub 2024 Mar 28.

A Systematic Review of Psycho-Spiritual Interventions in the NICU: Supporting 
Parents' Mental Health and Psychological Well-Being.

Brelsford GM(1), Doheny KK, Stoner J.

Author information:
(1)Author Affiliations: Penn State Harrisburg, Middletown, Pennsylvania (Dr 
Brelsford); Penn State College of Medicine, Hershey, Pennsylvania (Dr Doheny); 
and Penn State Children's Hospital, Hershey, Pennsylvania (Ms Stoner).

BACKGROUND: The presence of psychospiritual supports and interventions for 
neonatal intensive care unit (NICU) parents is unclear.
PURPOSE: This systematic review examines the psychological and medical 
literature for psychospiritual interventions designed to support parents' mental 
health and psychological well-being during or after the NICU experience.
DATA SOURCES: Data sources include PubMed, PsycINFO, and Cochrane Library 
(Cochrane Database of Systemic Reviews, Cochrane Central Register of Controlled 
Trials) with peer-reviewed studies published between 2013 and 2023.
STUDY SELECTION: Peer-reviewed studies that included spiritual and psychological 
intervention components focused on supporting parents during or after the NICU 
were included for this systematic review. There were 42 records located in 3 
databases ultimately yielding 4 peer-reviewed studies that met inclusion 
criteria. Articles must have been written in English and evaluate 
parents'/caregivers' mental health/psychological well-being in relation to a 
psychospiritual intervention.
DATA EXTRACTION: Because of the small number of studies, article summaries are 
provided within the results section and were written by the first author with 
approval by the second and third authors.
RESULTS: Results indicated that when psychological (focus on coping) and 
spiritual components were included psychological and well-being outcomes were 
better for NICU parents.
IMPLICATIONS FOR PRACTICE AND RESEARCH: The inclusion of psychological and 
spiritual aspects of coping and supportive care is necessary for the best 
family-centered NICU care. More work needs to be done to develop psychospiritual 
supports and include fathers in these endeavors as most work occurs with 
mothers. Nurses need support and training to facilitate family-centered care 
with a focus on parents' psychospiritual needs.

Copyright © 2024 by The National Association of Neonatal Nurses.

DOI: 10.1097/ANC.0000000000001160
PMID: 38547481 [Indexed for MEDLINE]


28. Int J Environ Res Public Health. 2024 Mar 21;21(3):375. doi: 
10.3390/ijerph21030375.

Evolution of Primary Research Studies in Digital Interventions for Mental 
Well-Being Promotion from 2004 to 2023: A Bibliometric Analysis of Studies on 
the Web of Science.

Armaou M(1), Pears M(1), Konstantinidis ST(1), Blake H(1)(2).

Author information:
(1)School of Health Sciences, University of Nottingham, Nottingham NG7 2UH, UK.
(2)NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH, UK.

Research into digital interventions for mental well-being promotion has grown in 
recent years, fuelled by the need to improve mental health prevention strategies 
and respond to challenges arising from the coronavirus (COVID-19) pandemic. This 
bibliometric analysis provides a structured overview of publication trends and 
themes in primary research studies reporting an array of digital interventions 
indexed at WoS from 2004 to 2023. Bibliometric data were collected on a sample 
of 1117 documents and analysed using the Biblioshiny package. Supplemental 
network visualisation analysis was conducted using VosViewer. The study, based 
on Web of Science and Scopus databases, indicates a marked increase in 
publications post-2020. There were seven groups of research themes clustered 
around "Mindfulness", "Anxiety", "COVID-19", "Acceptance and Commitment 
Therapy", "Depression", "Web-based", and "Positive Psychology". Further, results 
demonstrated the growth of specific themes (e.g., mindfulness, mhealth), the 
defining impact of COVID-19 studies, and the importance of both randomised 
controlled trials and formative research. Overall, research in the field is 
still early in its development and is expected to continue to grow. Findings 
highlight the field's dynamic response to societal and technological changes, 
suggesting a future trajectory that leans increasingly on digital platforms for 
mental health promotion and intervention. Finally, study limitations and 
implications for future studies are discussed.

DOI: 10.3390/ijerph21030375
PMCID: PMC10970530
PMID: 38541374 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


29. Brain Sci. 2024 Feb 20;14(3):189. doi: 10.3390/brainsci14030189.

Psychological Distress in Patients Who Needed Invasive versus Non-Invasive 
Ventilation Following SARS-CoV-2 Viral Infection.

Abbruzzese L(1), Basagni B(1), Damora A(1), Salti G(1), Martinelli G(1), 
Gambarelli C(2), Maietti A(3), Scarselli C(1), Carlucci L(4), Zoccolotti 
P(1)(5), Mancuso M(6).

Author information:
(1)Tuscany Rehabilitation Clinic, Montevarchi (AR), 52025 Montevarchi, Italy.
(2)Complex Structure of Rehabilitative Medicine, University-Hospital of Modena 
and Reggio Emilia, 41121 Modena, Italy.
(3)Specialist Rehabilitation Unit, Fondazione Poliambulanza Istituto 
Ospedaliero, 25133 Brescia, Italy.
(4)Department of Humanities, Letters, Cultural Heritage and Educational Studies, 
Foggia University, 71121 Foggia, Italy.
(5)Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy.
(6)Recovery and Functional Re-Education UOC-Grosseto Area, USL South-East 
Tuscany, 58100 Grosseto, Italy.

The COVID-19 pandemic has affected the mental health of those who survived the 
illness but underwent long treatment and hospitalization. Much research has 
highlighted signs of emotional distress in those who experienced intensive care, 
and the procedures implemented to fight the infection. The present study 
investigated the effects of the illness experience in 40 subjects admitted to a 
rehabilitation unit after discharge from intensive care by focusing on the 
possibility of differences in emotional well-being depending on the type of 
ventilation. The results of the administration of psychological scales for 
anxiety, depression, and post-traumatic stress disorder showed that many 
subjects experienced some form of emotional distress. There were no differences 
between patients who underwent invasive ventilation and those who did not.

DOI: 10.3390/brainsci14030189
PMCID: PMC10968147
PMID: 38539579

Conflict of interest statement: The authors declare no conflicts of interest.


30. BMC Geriatr. 2024 Mar 27;24(1):286. doi: 10.1186/s12877-024-04804-w.

'In the shower crying…but we came back in the following day and did it all 
again'. Distress and resilience in care home staff during the COVID-19 pandemic- 
A qualitative interview study.

Cockshott Z(1), Russell S(2), Stocker R(3), Knight J(4), Mason S(5), Hanratty 
B(2), Preston N(6).

Author information:
(1)International Observatory on End of Life Care, Faculty of Health and 
Medicine, Lancaster University, Bailrigg, Lancaster, UK. 
z.cockshott1@lancaster.ac.uk.
(2)Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle 
University, Newcastle upon Tyne, UK.
(3)School of Biomedical, Nutritional and Sport Sciences, Faculty of Medical 
Sciences, Newcastle University, Newcastle upon Tyne, UK.
(4)Lancaster Medical School, Faculty of Health and Medicine, Lancaster 
University, Bailrigg, Lancaster, UK.
(5)Sheffield Centre for Health and Related Research, School of Medicine and 
Population Health, University of Sheffield, Sheffield, UK.
(6)International Observatory on End of Life Care, Faculty of Health and 
Medicine, Lancaster University, Bailrigg, Lancaster, UK.

BACKGROUND: Care homes (long-term care facilities) were profoundly impacted 
early in the COVID-19 pandemic, both in terms of resident mortality and 
restrictions for infection control. This study investigated the impact on the 
emotional well-being of care home staff of challenges faced at this time, and 
the strategies used to manage them.
METHODS: Semi-structured interviews conducted October 2020-June 2021 with care 
home staff and health service staff working with them explored the impact of the 
early waves of the COVID-19 pandemic (March 2020-June 2021). Interview data were 
analysed using reflexive thematic analysis.
RESULTS: Interview participants were 16 care home staff and 10 health service 
staff. Analysis generated four key themes: 1)Anxiety and distress, 
2)Overwhelming workload, 3)Pulling through; and 4)Resilience in a time of 
crisis. Care home staff experienced Anxiety and distress due to uncertainty of 
what to expect; witnessing illness and deaths of residents; concerns regarding 
their own health, and sometimes feeling their work was under-recognised. They 
also experienced an Overwhelming workload due to infection control measures, 
caring for sick residents and reduction in external healthcare support. Our 
theme of Pulling through reflects the peer support and problem-solving 
strategies with which care home staff managed the impact of the pandemic, along 
with a sense of responsibility and meaning towards their work. An overarching 
theme of Resilience in a time of crisis drew on the other three themes and 
describes how many staff managed, maintained, and often increased their work 
despite the challenges of the pandemic. Participants also described increasing 
emotional fatigue as the pandemic continued.
CONCLUSIONS: This paper builds on literature on the emotional impact of the 
pandemic on care home staff, also exploring ways that staff responded to this 
impact. These findings can help inform planning for future crises including 
disease outbreaks, and raise important questions for further work to develop 
pandemic preparedness in care homes and beyond. They also raise wider questions 
about the current cultural status of care work, which may have exposed care home 
staff to greater risk of distress, and which contrasts with the professionalism 
and responsibility shown by staff in response to pandemic challenges.

© 2024. The Author(s).

DOI: 10.1186/s12877-024-04804-w
PMCID: PMC10967173
PMID: 38539097 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


31. Front Public Health. 2024 Mar 12;12:1297402. doi: 10.3389/fpubh.2024.1297402. 
eCollection 2024.

The challenges of mental health in Chilean university students.

Beroíza-Valenzuela F(1)(2).

Author information:
(1)Universidad Metropolitana de Ciencias de la Educación, Santiago, Chile.
(2)Universidad de Chile, Santiago, Chile.

Mental health is a crucial issue in Chile and worldwide, gaining even more 
relevance following social events in Chile in 2019, including the sociopolitical 
crisis and the COVID-19 pandemic. In Chile, over 20% of adolescents experience 
mental health problems such as anxiety, depression, and stress, with many going 
untreated due to limited access or the stigma associated with these issues. The 
COVID-19 pandemic has exacerbated this situation, with a 25% increase in the 
prevalence of anxiety and depression. The university population is particularly 
vulnerable to mental health challenges due to the unique pressures of the 
academic environment, including increased academic demands and the acquisition 
of university-related behaviors that can negatively impact physical and mental 
health, with notable gender differences. Effectively addressing these issues is 
essential for ensuring the emotional and psychological well-being of university 
students. Specific policies and programs are needed to address the mental health 
needs of university adolescents and ensure that they have access to mental 
health services required to navigate the challenges of daily life. A methodology 
reflective of the essayistic approach guides this exploration, which is 
characterized by critical reflection and structured argumentation.

Copyright © 2024 Beroíza-Valenzuela.

DOI: 10.3389/fpubh.2024.1297402
PMCID: PMC10963499
PMID: 38532969 [Indexed for MEDLINE]

Conflict of interest statement: The author declares that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


32. Hu Li Za Zhi. 2023 Apr;70(2):58-69. doi: 10.6224/JN.202404_71(2).08.

[Exploring Significant Predictors of Retention Willingness in Nurses Diagnosed 
With COVID-19].

[Article in Chinese; Abstract available in Chinese from the publisher]

Yang PH(1), Tseng YH(2), Cheng SC(3).

Author information:
(1)PhD, RN, Supervisor, Department of Nursing, Kaohsiung Medical University 
Hospital, and Adjunct Associate Professor, Department of Nursing, Fooyin 
University, Taiwan, ROC. yaugtaug@gmail.com.
(2)PhD, RN, Associate Professor, School of Nursing, Kaohsiung Medical 
University, Taiwan, ROC.
(3)MSN, RN, Deputy Head Nurse, Department of Nursing, Kaohsiung Medical 
University Hospital, Taiwan, ROC.

BACKGROUND: COVID-19 affected both the physical and mental health of frontline 
nurses and the stability of the nursing workforce.
PURPOSE: This study was designed to explore the influence of demographic 
variables, physical and mental health status, perceived work stress, and job 
satisfaction on intention to continue working as nurses among nursing staff who 
had been infected by COVID-19.
METHODS: In this cross-sectional study, an internal online survey was used to 
collect data from 152 nurses at a hospital in southern Taiwan. The 
questionnaires in the survey included the Chinese Health Survey Scale, Stress 
Scale on COVID-19 Patient Care, McCloskey/ Mueller Satisfaction Scale, and 
Employee Retention Scale. Data analysis was conducted using SPSS/Windows 22.0.
RESULTS: The most significant predictors identified included age, seniority, 
level of education, job satisfaction, physical and mental wellbeing, and work 
stress. These predictors collectively explained 32% of the total variance in 
retention willingness (F [18,128] = 4.78, p < .001). Almost half (46.7%; 71/152) 
of the participants expressed intent to continue working in nursing. Being a 
senior staff and having a master's degree or higher were positively associated 
with retention.
CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The findings may be referenced by 
healthcare organizations and managers to help healthcare staff gain strength and 
resilience against future pandemics. Key recommendations include reducing staff 
work stress, increasing job satisfaction, and facilitating a more equitable 
life-work balance.

Publisher: TITLE: 曾確診COVID-19護理師留任意願重要預測因子之探討.
背景: 感染COVID-19影響第一線護理師的身心健康和護理人力的穩定性。.
目的: 探討南台灣醫院確診過COVID-19護理師留任意願的重要預測因子。.
方法: 
採取橫斷式研究設計，經南部一家醫院倫理委員會審核後通過，再經相關單位主管同意由院內系統通知同仁進行網路問卷調查152位護理師。採用「華人健康調查量表」、「醫院員工照顧COVID-19病人壓力量表」、「穆勒-麥克勞斯基工作滿意度量表」及「留任意願量表」結構式問卷，以SPSS/ 
Windows 22.0版軟體程式進行統計分析。.
結果: 
在醫院防疫過程中，年齡、教育程度、身心健康、工作滿意度及工作壓力為曾確診COVID-19護理師留任意願之重要預測因子，可解釋留任意願總變異量32%，F(18,128) 
= 4.78, p < .001。曾確診COVID-19護理師46.7%（71/152）有留任意願，資深、大學以上之護理師留任意願較高。.
結論／實務應用: 
本研究結果能提供醫療機構及主管訊息，在傳染病防疫期間護理師受到感染後，可安排放鬆訓練與休閒活動，使生活與工作能達到平衡，讓護理師在面對新興傳染病散播衝擊時更有韌性，願意繼續留在工作崗位。.

DOI: 10.6224/JN.202404_71(2).08
PMID: 38532675 [Indexed for MEDLINE]


33. Turk J Pediatr. 2024;66(1):42-56. doi: 10.24953/turkjped.2023.701.

The impact of the prolonged COVID-19 pandemic on adolescents with eating 
disorders: a follow-up study from Türkiye.

Torun ŞE(1), Akgül S(2), Kızılkan MP(2), Nalbant K(3), Kanbur N, Akdemir D(3), 
Alan BE(3), Tüzün Z(2), Derman O(2).

Author information:
(1)Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara.
(2)Division of Adolescent Medicine, Department of Pediatrics, Hacettepe 
University, Ankara.
(3)Department of Child and Adolescent Psychiatry, Faculty of Medicine, Hacettepe 
University, Ankara, Türkiye.

BACKGROUND: At the onset of the pandemic, we conducted a study on adolescents 
with eating disorders (EDs) and found no deterioration in ED symptoms. The 
objective of this subsequent study was to conduct a follow-up evaluation of the 
same cohort and investigate the consequences of the prolonged pandemic.
METHODS: This longitudinal study was conducted one year after the first study 
between May 2021 and June 2021 with 37 adolescents aged 12-18 years 
(pre-existing EDs). The reassessment included an evaluation of sociodemographic 
and clinical characteristics, the impact of pandemic-related restrictions on ED 
behaviors, well-being, and quality of life. All the participants underwent a 
re-administration of the ED examination questionnaire (EDE-Q), Beck Depression 
Inventory, the State Anxiety Inventory for Children, and the Maudsley Obsessive 
Compulsive Inventory.
RESULTS: No significant difference was observed in the EDE-Q scores or the ED 
examination questionnaire scores between the initial (T1) and subsequent (T2) 
study. The ED-related quality of life was seen to have slightly improved in the 
later stage. While depression (T1: 18, T2: 15, p=0.883) and obsession scores 
(T1: 11, T2: 14, p: 0.536) showed no disparity between the studies, anxiety 
scores (T1: 38, T2: 43, p:0.011) exhibited a significant increase.
CONCLUSIONS: Consistent with the early phase, no exacerbation of ED symptoms in 
adolescents was observed during the later stages of the pandemic. Close clinical 
monitoring during the pandemic might have been protective against the 
deteriorating effects of the pandemic. During social isolation, it is important 
to monitor adolescents with EDs continously for depression and anxiety.

DOI: 10.24953/turkjped.2023.701
PMID: 38523378 [Indexed for MEDLINE]


34. P R Health Sci J. 2024 Mar;43(1):32-38.

Resilience, Self-Efficacy, and Symptoms of Anxiety and Depression in Older 
Adults during COVID-19 Confinement.

Pérez-Jiménez D(1), Maldonado-Martínez JA(1), Jiménez-Torres AL(2).

Author information:
(1)Institute for Psychological Research, University of Puerto Rico, San Juan, 
Puerto Rico.
(2)Department of Psychology, University of Puerto Rico, San Juan, Puerto Rico.

OBJECTIVE: This study examined the relationship between resilience, 
self-efficacy, anxiety, and depression to test whether self-efficacy affected 
anxiety and depression and compared how the participants in different age groups 
experienced anxiety, as well as the differences in anxiety between employed and 
unemployed participants.
METHOD: A cross sectional web-based survey study that included adults aged 60 
years or older living in Puerto Rico was performed during April and May 2020.
RESULTS: A total of 299 older adults completed the online questionnaire (14% 
men, 83.6% women). Of the total sample, 25.4% reported having moderate to severe 
symptoms of anxiety, while 20.8% reported having moderate to severe symptoms of 
depression. Our path analysis model suggested that while self-efficacy did not 
directly affect anxiety, it had an impact on resilience, thereby reducing 
anxiety symptoms. The participants who were 71 years old or older had lower 
anxiety levels than their younger counterparts did. We also confirmed that work 
might serve as a protective factor against anxiety.
CONCLUSION: Our findings underscore the importance of resilience, self-efficacy, 
and working later in life to promote well-being and successful aging.

PMID: 38512759 [Indexed for MEDLINE]


35. PLoS One. 2024 Mar 20;19(3):e0299547. doi: 10.1371/journal.pone.0299547. 
eCollection 2024.

The impact of COVID-19 on young people's mental health, wellbeing and routine 
from a European perspective: A co-produced qualitative systematic review.

Dewa LH(1)(2), Roberts L(1)(2)(3)(4), Choong E(2), Crandell C(2), Demkowicz 
O(5), Ashworth E(6), Branquinho C(7), Scott S(8).

Author information:
(1)NIHR Patient Safety Translational Research Centre, Institute of Global Health 
Innovation, Imperial College London, London, United Kingdom.
(2)School of Public Health, Imperial College London, London, United Kingdom.
(3)Centre for Health Policy, Institute of Global Health Innovation, Imperial 
College London, London, United Kingdom.
(4)Liggins Institute, University of Auckland Waipapa Taumata Rau, Auckland, New 
Zealand.
(5)Manchester Institute of Education, The University of Manchester, Manchester, 
United Kingdom.
(6)School of Psychology, Liverpool John Moores University, Liverpool, United 
Kingdom.
(7)Environmental Health Institute, Medicine Faculty, University of Lisbon, 
Lisbon, Portugal.
(8)Newcastle Population Health Sciences Institute, Faculty of Medical Sciences, 
University of Newcastle, Newcastle upon Tyne, United Kingdom.

BACKGROUND: The impact of the Covid-19 pandemic on young people's (YP) mental 
health has been mixed. Systematic reviews to date have focused predominantly on 
quantitative studies and lacked involvement from YP with lived experience of 
mental health difficulties. Therefore, our primary aim was to conduct a 
qualitative systematic review to examine the perceived impact of the Covid-19 
pandemic on YP's (aged 10-24) mental health and wellbeing across Europe.
METHODS AND FINDINGS: We searched MEDLINE, PsycINFO, Embase, Web of Science, 
MEDRXIV, OSF preprints, Google, and voluntary sector websites for studies 
published from 1st January 2020 to 15th November 2022. European studies were 
included if they reported qualitative data that could be extracted on YP's (aged 
10-24) own perspectives of their experiences of Covid-19 and related disruptions 
to their mental health and wellbeing. Screening, data extraction and appraisal 
was conducted independently in duplicate by researchers and YP with lived 
experience of mental health difficulties (co-researchers). Confidence was 
assessed using the Confidence in the Evidence from Reviews of Qualitative 
Research (CERQual) approach. We co-produced an adapted narrative thematic 
synthesis with co-researchers. This study is registered with PROSPERO, 
CRD42021251578. We found 82 publications and included 77 unique studies in our 
narrative synthesis. Most studies were from the UK (n = 50; 65%); and generated 
data during the first Covid-19 wave (March-May 2020; n = 33; 43%). Across the 
79,491 participants, views, and experiences of YP minoritised by ethnicity and 
sexual orientation, and from marginalised or vulnerable YP were limited. Five 
synthesised themes were identified: negative impact of pandemic information and 
restrictions on wellbeing; education and learning on wellbeing; social 
connection to prevent loneliness and disconnection; emotional, lifestyle and 
behavioural changes; and mental health support. YP's mental health and wellbeing 
across Europe were reported to have fluctuated during the pandemic. Challenges 
were similar but coping strategies to manage the impact of these challenges on 
mental health varied across person, study, and country. Short-term impacts were 
related to the consequences of changing restrictions on social connection, 
day-to-day lifestyle, and education set-up. However, YP identified potential 
issues in these areas going forward, and therefore stressed the importance of 
ongoing long-term support in education, learning and mental health 
post-Covid-19.
CONCLUSIONS: Our findings map onto the complex picture seen from quantitative 
systematic reviews regarding the impact of Covid-19 on YP's mental health. The 
comparatively little qualitative data found in our review means there is an 
urgent need for more high-quality qualitative research outside of the UK and/or 
about the experiences of minoritised groups to ensure all voices are heard and 
everyone is getting the support they need following the pandemic. YP's voices 
need to be prioritised in decision-making processes on education, self-care 
strategies, and mental health and wellbeing, to drive impactful, meaningful 
policy changes in anticipation of a future systemic crisis.

Copyright: © 2024 Dewa et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0299547
PMCID: PMC10954119
PMID: 38507395 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


36. Int J Equity Health. 2024 Mar 19;23(1):62. doi: 10.1186/s12939-024-02142-2.

Family and community resilience: a Photovoice study.

Tan Y(1), Pinder D(2), Bayoumi I(2)(3), Carter R(3), Cole M(3), Jackson L(3), 
Watson A(3), Knox B(3), Chan-Nguyen S(3), Ford M(3)(4), Davison CM(2), Bartels 
SA(2)(5), Purkey E(6)(7).

Author information:
(1)School of Medicine, Queen's University, 80 Barrie Street, Kingston, ON, K7L 
3N6, Canada.
(2)Department of Public Health Sciences, Queen's University, 62 Fifth Field 
Company Lane, Kingston, ON, K7L 3N6, Canada.
(3)Department of Family Medicine, Queen's University, 220 Bagot Street, 
Kingston, ON, K7L 5E9, Canada.
(4)Department of Psychology, Queen's University, Humphrey Hall, 62 Arch Street, 
Kingston, ON, K7L 3N6, Canada.
(5)Department of Emergency Medicine, Queen's University, 76 Stuart Street, 
Kingston, ON, K7L 4V7, Canada.
(6)Department of Public Health Sciences, Queen's University, 62 Fifth Field 
Company Lane, Kingston, ON, K7L 3N6, Canada. eva.purkey@queensu.ca.
(7)Department of Family Medicine, Queen's University, 220 Bagot Street, 
Kingston, ON, K7L 5E9, Canada. eva.purkey@queensu.ca.

BACKGROUND: Adverse childhood experiences (ACEs), in combination with adverse 
community environments, can result in traumatic stress reactions, increasing a 
person's risk for chronic physical and mental health conditions. Family 
resilience refers to the ability of families to withstand and rebound from 
adversity; it involves coping with disruptions as well as positive growth in the 
face of sudden or challenging life events, trauma, or adversities. This study 
aimed to identify factors contributing to family and community resilience from 
the perspective of families who self-identified as having a history of adversity 
and being resilient during the COVID-19 pandemic.
METHODS: This study used Photovoice, a visual participatory research method 
which asks participants to take photographs to illustrate their responses to a 
research question. Participants consisted of a maximum variation sample of 
families who demonstrated family level resilience in the context of the pair of 
ACEs during the COVID-19 pandemic. Family members were asked to collect 
approximately five images or videos that illustrated the facilitators and 
barriers to well-being for their family in their community. Semi-structured 
in-depth interviews were conducted using the SHOWeD framework to allow 
participants to share and elucidate the meaning of their photos. Using thematic 
analysis, two researchers then independently completed line-by-line coding of 
interview transcripts before collaborating to develop consensus regarding key 
themes and interpretations.
RESULTS: Nine families were enrolled in the study. We identified five main 
themes that enhanced family resilience: (1) social support networks; (2) factors 
fostering children's development; (3) access and connection to nature; (4) 
having a space of one's own; and (5) access to social services and community 
resources.
CONCLUSIONS: In the context of additional stresses related to the COVID-19 
pandemic, resilient behaviours and strategies for families were identified. The 
creation or development of networks of intra- and inter-community bonds; the 
promotion of accessible parenting, housing, and other social services; and the 
conservation and expansion of natural environments may support resilience and 
health.

© 2024. The Author(s).

DOI: 10.1186/s12939-024-02142-2
PMCID: PMC10949719
PMID: 38504281 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


37. Sci Rep. 2024 Mar 19;14(1):6565. doi: 10.1038/s41598-024-56979-2.

The effect of a prosocial environment on health and well-being during the first 
COVID-19 lockdown and a year later.

Trachtenberg E(1)(2), Ruzal K(1)(2), Forkosh O(3)(4), Ben-Ami Bartal I(5)(6).

Author information:
(1)Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
(2)School of Psychological Sciences, Faculty of Social Sciences, Tel Aviv 
University, Tel Aviv, Israel.
(3)Department of Cognitive and Brain Sciences, Hebrew University of Jerusalem, 
Jerusalem, Israel.
(4)Department of Animal Sciences, Hebrew University of Jerusalem, Jerusalem, 
Israel.
(5)Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel. 
inbalbe@tauex.tau.ac.il.
(6)School of Psychological Sciences, Faculty of Social Sciences, Tel Aviv 
University, Tel Aviv, Israel. inbalbe@tauex.tau.ac.il.

The outset of the COVID-19 pandemic was characterized by prolonged periods of 
chronic stress and social isolation. While studies have investigated the changes 
to well-being (WB) during this period, the impact of the social environment on 
long-term physical and mental health requires further study. This study aimed to 
assess the factors influencing WB and health outcomes, with the hypothesis that 
a positive social environment would play a significant immediate and long-term 
role in improving WB and preventing the effects of anxiety associated with the 
pandemic. At time point 1 (April 2020), an Israeli sample of 206 participants 
(84% female, mean age 31.5) responded to traditional questionnaires assessing 
mental health and social support. Factors affecting WB were assessed within 
subjects during the first COVID-19 lockdown for 6 weeks using a daily survey 
(Beiwe phone application). A year later, in May 2021, at time point 2, the 
initial questionnaires were readministered to a subset of the same participants 
(N = 94). We found that anxiety during the first lockdown adversely affected WB 
and predicted health and WB deterioration a year later. In contrast, a high 
quality of social relationships was associated with better short- and long-term 
WB, and mitigated the adverse effects of anxiety. Daily activities, including 
physical activity, meditation, and romantic relations, were also positively 
associated with WB during the first lockdown but did not have long-term effects. 
In summary, our study underscores the enduring health advantages of a positive 
social environment, particularly during stressful periods. These results have 
implications for health policymakers: programs which support individuals with 
high anxiety and low support, by integrating them into community-based 
interventions, promise to enhance well-being (WB) and health, as well as to 
fortify the community as a whole.

© 2024. The Author(s).

DOI: 10.1038/s41598-024-56979-2
PMCID: PMC10951249
PMID: 38503824 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


38. Sci Rep. 2024 Mar 19;14(1):6573. doi: 10.1038/s41598-024-56981-8.

Entrepreneurial mental health in the wake of COVID-19 in China with an emphasis 
on attention deficit hyperactivity disorder (ADHD) and dyslexia analysis.

Fan Y(1), Li Y(2)(3), Dong Z(4), Ong M(5), Hope J(6).

Author information:
(1)Department of Chinese Language Studies (CHL), The Education University of 
Hong Kong New Territories, Hong Kong, SAR, China.
(2)School of Civil and Environmental Engineering, University of Auckland, 
Auckland, 1010, New Zealand. yuanzhe001@e.ntu.edu.sg.
(3)College of Design and Engineering, National University of Singapore, 
Singapore, 117575, Singapore. yuanzhe001@e.ntu.edu.sg.
(4)School of Civil, Aerospace and Mechanical Engineering, University of Bristol, 
Bristol, BS8 1QU, UK.
(5)Stirling Management School, Singapore Institute of Management, Singapore, 
599491, Singapore.
(6)Sustainability Design Institution, China Academy of Art, Hangzhou, 310002, 
China.

The COVID-19 pandemic has precipitated a global mental health crisis, with a 
particularly pronounced impact on the entrepreneurial sector. This paper 
presents a comparative analysis of mental health challenges among entrepreneurs 
in China during the pandemic, with a specific focus on attention deficit 
hyperactivity disorder (ADHD) and Dyslexia. The study assesses the prevalence of 
ADHD and dyslexia symptoms among established and emerging entrepreneurs in 
China, finding notable occurrences within this group. The research also examines 
the self-care practices of these entrepreneurs, shedding light on their 
approaches during the pandemic period. The findings highlight a complex 
interplay between mental health issues and entrepreneurial activities, 
suggesting that certain ADHD and dyslexia traits may offer unexpected benefits 
in the entrepreneurial realm. These insights are critical for developing 
supportive frameworks that leverage the strengths of neurodiverse entrepreneurs 
while mitigating associated challenges, especially in a post-pandemic economic 
landscape. The study concludes with policy and practice recommendations to 
bolster the wellbeing and resilience of entrepreneurs facing the multifaceted 
impacts of the pandemic.

© 2024. The Author(s).

DOI: 10.1038/s41598-024-56981-8
PMCID: PMC10951316
PMID: 38503790 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


39. Health Promot Chronic Dis Prev Can. 2024 Mar;44(3):112-125. doi: 
10.24095/hpcdp.44.3.05.

COVID-19 among Black people in Canada: a scoping review.

[Article in English, French; Abstract available in French from the publisher]

Olanlesi-Aliu A(1), Kemei J(1), Alaazi D(2), Tunde-Byass M(3)(4), Renzaho A(5), 
Sekyi-Out A(6), Mullings DV(7), Osei-Tutu K(8), Salami B(1)(2)(9).

Author information:
(1)Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
(2)Health and Immigration Policies and Practices Research Program (HIPP), 
University of Alberta, Edmonton, Alberta, Canada.
(3)Black Physicians of Ontario, Toronto, Ontario, Canada.
(4)Department of Obstetrics and Gynecology, University of Ontario, Toronto, 
Ontario, Canada.
(5)Translational Health Research Institute, School of Medicine, Campbell Town 
Campus, Western Sydney University, Australia.
(6)Black Opportunity Fund, Toronto, Ontario, Canada.
(7)School of Social Work, Memorial University, St John's, Newfoundland and 
Labrador, Canada.
(8)Department of Family Medicine, University of Calgary, Calgary, Alberta, 
Canada.
(9)Department of Community Health Sciences, University of Calgary, Calgary, 
Alberta, Canada.

INTRODUCTION: The COVID-19 pandemic exacerbated health inequities worldwide. 
Research conducted in Canada shows that Black populations were 
disproportionately exposed to COVID-19 and more likely than other ethnoracial 
groups to be infected and hospitalized. This scoping review sought to map out 
the nature and extent of current research on COVID-19 among Black people in 
Canada.
METHODS: Following a five-stage methodological framework for conducting scoping 
reviews, studies exploring the effects of the COVID-19 pandemic on Black people 
in Canada, published up to May 2023, were retrieved through a systematic search 
of seven databases. Of 457 identified records, 124 duplicates and 279 additional 
records were excluded after title and abstract screening. Of the remaining 54 
articles, 39 were excluded after full-text screening; 2 articles were manually 
picked from the reference lists of the included articles. In total, 17 articles 
were included in this review.
RESULTS: Our review found higher rates of COVID-19 infections and lower rates of 
COVID-19 screening and vaccine uptake among Black Canadians due to pre-COVID-19 
experiences of institutional and structural racism, health inequities and a 
mistrust of health care professionals that further impeded access to health 
care. Misinformation about COVID-19 exacerbated mental health issues among Black 
Canadians.
CONCLUSIONS: Our findings suggest the need to address social inequities 
experienced by Black Canadians, particularly those related to unequal access to 
employment and health care. Collecting race-based data on COVID-19 could inform 
policy formulation to address racial discrimination in access to health care, 
quality housing and employment, resolve inequities and improve the health and 
well-being of Black people in Canada.

Publisher: INTRODUCTION: La pandémie de COVID-19 a exacerbé les iniquités 
partout dans le monde. Selon les travaux de recherche menés au Canada, les 
populations noires ont été démesurément exposées à la COVID-19 et ont donc 
risqué davantage que les autres groupes ethnoraciaux d’être infectées et 
hospitalisées. L’examen de la portée dont fait état cet article visait à établir 
la nature et l’envergure des travaux de recherche récents sur la COVID-19 chez 
les personnes noires au Canada.
MÉTHODOLOGIE: Suivant un cadre méthodologique d’examen de la portée en cinq 
étapes, nous avons effectué une exploration systématique de sept bases de 
données et en avons extrait les études portant sur les effets de la pandémie de 
COVID-19 sur les personnes noires au Canada publiées jusqu’en mai 2023. Des 457 
articles relevés, 124 doublons et 279 publications additionnelles ont été exclus 
à la suite de l’analyse des titres et des résumés. Des 54 articles restants, 39 
ont été exclus à la suite de l’analyse de leur contenu et 2 articles ont été 
ajoutés à partir des références fournies dans les articles inclus. Au total, 17 
articles ont donc fait l’objet de notre examen de la portée.
RÉSULTATS: Les taux d’infection par le virus de la COVID-19 ont été plus élevés 
et les taux de dépistage et de vaccination plus faibles au sein de la population 
canadienne noire que dans les autres groupes de population, en raison 
d’expériences antérieures à la COVID-19 en matière de racisme institutionnel et 
structurel, d’iniquités en santé et d’une méfiance à l’égard des professionnels 
de la santé, qui ont accentué les problèmes d’accès aux soins. La désinformation 
à propos de la COVID-19 a aussi exacerbé les problèmes de santé mentale au sein 
de la population noire du Canada.
CONCLUSION: Selon nos constatations, il serait nécessaire de corriger les 
iniquités sociales que vit la population canadienne noire, en particulier celles 
liées aux inégalités d’accès à l’emploi et aux soins de santé. La collecte de 
données raciales en ce qui concerne la COVID-19 pourrait contribuer à la 
formulation de politiques de lutte contre la discrimination raciale en matière 
d’accès aux soins de santé, de logement de qualité et d’emploi ainsi qu’en 
matière de correction des iniquités et d’amélioration de la santé et du bienêtre 
des personnes noires au Canada.

Plain Language Summary: Black Canadians are overrepresented in frontline jobs, 
which increases their risk of contracting COVID-19. Low uptake of COVID-19 
screening and vaccine hesitancy may be attributed to mistrust of the health care 
system in Canada. Existing structural racism within the Canadian health care 
system has created inequities in accessing COVID-19–related health care services 
among Black Canadians. There is a need to collect race-based data with a focus 
on resolving inequities and improving the health and well-being of Black people 
in Canada.

Plain Language Summary: La population canadienne noire est surreprésentée parmi 
les travailleurs de première ligne, et elle risque donc davantage de contracter 
la COVID-19. La faible adhésion au dépistage de la COVID-19 et la réticence à la 
vaccination seraient attribuables à la méfiance envers le système de soins de 
santé du Canada. Un racisme structurel au sein du système de santé canadien a 
créé des iniquités en matière d’accès aux services de santé relatifs à la 
COVID-19, au désavantage de la population noire du Canada. La collecte de 
données raciales s’impose et devrait être axée sur la correction des iniquités 
et l’amélioration de la santé et du bien-être des personnes noires au Canada.

DOI: 10.24095/hpcdp.44.3.05
PMID: 38501682 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


40. Inquiry. 2024 Jan-Dec;61:469580241239844. doi: 10.1177/00469580241239844.

COVID-19: Experiences of Social Workers Supporting Older Adults With Dementia in 
Nigeria.

Oyinlola O(1)(2), Mahmoud K(3), Adeoti AB(4), Abiodun AA(4).

Author information:
(1)School of Social Work, McGill University, Montreal, QC, Canada.
(2)Medical Social Services Department, University College Hospital, Ibadan, Oyo, 
Nigeria.
(3)Center for Innovation in Social Science, Boston University, Boston, MA, USA.
(4)Department of Social Work, University of Ibadan, Ibadan, Oyo, Nigeria.

Amidst the COVID-19 pandemic, numerous public health protocols were instituted 
by government agencies to safeguard individuals with dementia, their family 
caregivers, and formal care providers. While these preventive measures were 
implemented with good intentions, they inadvertently imposed significant 
challenges on medical social workers in Nigeria. This paper explored the 
experiences of medical social workers caring for people with dementia during the 
COVID-19 pandemic in Nigeria. Twenty-six medical social workers from 6 
government hospitals in Southwestern Nigeria participated in an in-depth 
interview. The research reveals 3 pivotal aspects: Firstly, the escalating 
demands within the work environment, where medical social workers grapple with 
the intricate task of conveying sensitive information about dementia diagnosis 
and COVID-19 prevention protocol, managing expectations regarding dementia 
diagnoses, and navigating resource constraints for individuals with dementia 
during the pandemic. Secondly, discernible impacts on the work climate and 
interprofessional relationships shed light on the challenges these professionals 
face in collaborating with other healthcare providers. Lastly, the 
reverberations on social workers' personal lives underscore the pandemic's toll 
on their well-being. Thus, the findings underscore the need for proactive 
measures to equip medical social workers to face the distinctive challenges in 
dementia care during future pandemics. Recognizing the potential resurgence of 
global health crises, the research highlights the need for strategic 
preparedness to mitigate the impact of future pandemics on the well-being of 
individuals with dementia and the professionals dedicated to their care.

DOI: 10.1177/00469580241239844
PMCID: PMC10949545
PMID: 38500245 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting InterestsThe 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


41. J Perinatol. 2024 Mar 18. doi: 10.1038/s41372-024-01936-0. Online ahead of 
print.

Promoting mental well-being among parents in the neonatal intensive care unit: a 
perspective on the role of Physician Associates.

Wile B(1)(2), Skowronski K(1), Shariati K(3), Olagunju AT(4)(5).

Author information:
(1)Neonatal Intensive Care Unit, McMaster Children's Hospital, 1200 Main Street 
West, Hamilton, ON, L8N 3Z5, Canada.
(2)Physician Assistant Education Program, McMaster University, 1280 Main Street 
West, Hamilton, ON, L8S 4K1, Canada.
(3)Department of Psychiatry and Behavioral Neurosciences, McMaster University/St 
Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, 
Canada.
(4)Department of Psychiatry and Behavioral Neurosciences, McMaster University/St 
Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, 
Canada. olagunja@mcmaster.ca.
(5)Discipline of Psychiatry, University of Adelaide, Adelaide, SA, 5000, 
Australia. olagunja@mcmaster.ca.

Emotional disorders in parents of infants admitted to the neonatal intensive 
care unit (NICU) carry the potential for serious ramifications in neonatal and 
childhood outcomes. Despite this, current NICU mental health supports are less 
than optimum; postpartum mental health screening is limited, often missed in 
parents of inpatient infants, and may not be applicable to all family 
structures. Current evidence demonstrates improved outcomes in neonates and 
family members with early identification and multidisciplinary approaches to 
managing mental health problems. Physician Associates/Assistants (PAs) are a 
skilled group of advanced practice providers who are often a point of first 
contact for parents in the NICU, helping maintain continuity of care. In this 
perspective, we underscore leveraging the skills of PAs to promote the emotional 
wellbeing of parents in the NICU by way of practice and policy involvement. We 
also included a generic set of recommendations to equip PAs in this role.

© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.

DOI: 10.1038/s41372-024-01936-0
PMID: 38499755


42. PLoS One. 2024 Mar 18;19(3):e0300329. doi: 10.1371/journal.pone.0300329. 
eCollection 2024.

Psychological well-being of healthcare workers during COVID-19 in a mental 
health institution.

Leung H(1), Lim M(2), Lim WO(1), Lee SA(1), Lee J(3)(4).

Author information:
(1)Department of Psychology, Institute of Mental Health, Singapore, Singapore.
(2)Research Division, Institute of Mental Health, Singapore, Singapore.
(3)Population and Global Health, Lee Kong Chian School of Medicine, Nanyang 
Technological University, Singapore, Singapore.
(4)North Region, Institute of Mental Health, Singapore, Singapore.

INTRODUCTION: This study examined the psychological wellbeing of Healthcare 
Workers (HCWs) during COVID-19 in a mental health setting, associations of 
psychosocial wellbeing with coping style, and ways that organisations can 
mitigate the psychosocial burden on HCWs.
METHODS: Thirty-seven Mental HCWs (MHCWs) from infected and non-infected wards 
(control group), were recruited and assessed at three timepoints. Psychological 
wellbeing, perceived cohesion, and coping style (Brief-COPE) were assessed. 
Reports on individual coping and feedback on the organisation were collected 
through in-depth interview. Comparison between infected and non-infected wards, 
as well as comparison of psychosocial measures and perceived cohesion, across 
the three timepoints were made. As there were no significant changes in coping 
styles across the timepoints, Timepoint 1 (T1) coping style was used to 
correlate with the psychosocial measures across all timepoints. Thematic 
analysis was used for qualitative data.
RESULTS: MHCWs from infected wards reported significantly higher levels of 
stress, χ2(1) = 6.74, p = 0.009, effect size: medium (ε2 = 0.198), and more 
severe sleep disturbance (PSQI), χ2(1) = 6.20, p = 0.013, effect size: medium 
(ε2 = 0.182), as compared to the control group at T2. They also engaged in more 
problem-focused coping (T2 and T3) and emotion-focused coping (T2). As expected, 
negative coping style was correlated with negative outcomes except 
problem-focused coping that was correlated with both negative (sleep disturbance 
and anxiety symptoms) and positive outcomes (wellbeing). Emotion-focused coping 
was moderately correlated (Tb = 0.348, p<0.017) with higher levels of wellbeing 
at T2. Thematic analyses revealed MHCWs felt supported by the responsiveness of 
the institution, emotional and informational support, and the availability from 
direct leaders, presence of team and hospital leaders on the ground, helped 
build trust and confidence in the leadership.
CONCLUSIONS: MHCWs experienced significantly higher levels of stress and sleep 
disturbance during COVID-19. The ways that organizations can offset the 
psychological burden of pandemics on MHCWs are discussed.

Copyright: © 2024 Leung et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0300329
PMCID: PMC10947715
PMID: 38498513 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


43. Front Public Health. 2024 Mar 1;12:1334425. doi: 10.3389/fpubh.2024.1334425. 
eCollection 2024.

Exposure to urban green spaces and mental health during the COVID-19 pandemic: 
evidence from two low and lower-middle-income countries.

Patwary MM(1)(2), Bardhan M(1)(3), İnan HE(3)(4), Browning MHEM(3), Disha 
AS(1)(5), Haque MZ(1)(2), Helmy M(6)(7), Ashraf S(2), Dzhambov AM(8)(9)(10)(11), 
Shuvo FK(12), Alam MA(13), Billah SM(1)(2), Kabir MP(1)(14), Hossain MR(15), 
Azam MG(16), Rahman MM(17), Swed S(18), Sah R(19)(20), Montenegro-Idrogo 
JJ(21)(22), Bonilla-Aldana DK(23), Rodriguez-Morales AJ(21)(24)(25).

Author information:
(1)Environment and Sustainability Research Initiative, Khulna, Bangladesh.
(2)Environmental Science Discipline, Life Science School, Khulna University, 
Khulna, Bangladesh.
(3)Department of Parks, Recreation, and Tourism Management, Clemson University, 
Clemson, SC, United States.
(4)Department of Tourism Management, Faculty of Tourism, Ondokuz Mayıs 
University, Samsun, Türkiye.
(5)Department of Environmental Science and Management, North South University, 
Dhaka, Bangladesh.
(6)Psychology Department, College of Education, Sultan Qaboos University, 
Muscat, Oman.
(7)Psychology Department, Faculty of Arts, Menoufia University, Shibin el Kom, 
Egypt.
(8)Department of Hygiene, Faculty of Public Health, Medical University of 
Plovdiv, Plovdiv, Bulgaria.
(9)Research Group "Health and Quality of Life in a Green and Sustainable 
Environment", SRIPD, Medical University of Plovdiv, Plovdiv, Bulgaria.
(10)Environmental Health Division, Research Institute at Medical University of 
Plovdiv, Medical University of Plovdiv, Plovdiv, Bulgaria.
(11)Institute of Highway Engineering and Transport Planning, Graz University of 
Technology, Graz, Austria.
(12)Swinburne University of Technology, Hawthorn, VIC, Australia.
(13)Department of Computational Diagnostic Radiology and Preventive Medicine, 
The University of Tokyo Hospital, Tokyo, Japan.
(14)Department of Civil Engineering, University of Ottawa, Ottawa, ON, Canada.
(15)Institute of Disaster Management, Khulna University Engineering & 
Technology, Khulna, Bangladesh.
(16)Remote Sensing, Center for Environmental and Geographic Information Services 
(CEGIS), Dhaka, Bangladesh.
(17)Department of Geography and Environment, Jagannath University, Dhaka, 
Bangladesh.
(18)Faculty of Medicine, Aleppo University, Aleppo, Syria.
(19)Green City Hospital, Kathmandu, Nepal.
(20)Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and 
Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, India.
(21)Faculty of Health Sciences, Universidad Cientifica del Sur, Lima, Peru.
(22)Infectious and Tropical Diseases Service, Hospital Nacional Dos de Mayo, 
Lima, Peru.
(23)Research Unit, Universidad Continental, Huancayo, Peru.
(24)Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación 
Universitaria Autónoma de las Américas-Institución Universitaria Visión de las 
Américas, Pereira, Colombia.
(25)Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American 
University, Beirut, Lebanon.

INTRODUCTION: The COVID-19 pandemic has had a significant impact on mental 
health globally, with limited access to mental health care affecting low- and 
middle-income countries (LMICs) the most. In response, alternative strategies to 
support mental health have been necessary, with access to green spaces being a 
potential solution. While studies have highlighted the role of green spaces in 
promoting mental health during pandemic lockdowns, few studies have focused on 
the role of green spaces in mental health recovery after lockdowns. This study 
investigated changes in green space access and associations with mental health 
recovery in Bangladesh and Egypt across the pandemic.
METHODS: An online survey was conducted between January and April 2021 after the 
first lockdown was lifted in Bangladesh (n = 556) and Egypt (n = 660). We 
evaluated indoor and outdoor greenery, including the number of household plants, 
window views, and duration of outdoor visits. The quantity of greenness was 
estimated using the normalized difference vegetation index (NDVI). This index 
was estimated using satellite images with a resolution of 10x10m during the 
survey period (January-April 2021) with Sentinel-2 satellite in the Google Earth 
Engine platform. We calculated averages within 250m, 300m, 500m and 1000m 
buffers of the survey check-in locations using ArcGIS 10.3. Multiple linear 
regression models were used to evaluate relationships between changes in natural 
exposure and changes in mental health.
RESULTS: The results showed that mental health improved in both countries after 
the lockdown period. People in both countries increased their time spent 
outdoors in green spaces after the lockdown period, and these increases in time 
outdoors were associated with improved mental health. Unexpectedly, changes in 
the number of indoor plants after the lockdown period were associated with 
contrasting mental health outcomes; more plants translated to increased anxiety 
and decreased depression. Refocusing lives after the pandemic on areas other 
than maintaining indoor plants may assist with worrying and feeling panicked. 
Still, indoor plants may assist with depressive symptoms for people remaining 
isolated.
CONCLUSION: These findings have important implications for policymakers and 
urban planners in LMICs, highlighting the need to increase access to natural 
environments in urban areas to improve mental health and well-being in public 
health emergencies.

Copyright © 2024 Patwary, Bardhan, İnan, Browning, Disha, Haque, Helmy, Ashraf, 
Dzhambov, Shuvo, Alam, Billah, Kabir, Hossain, Azam, Rahman, Swed, Sah, 
Montenegro-Idrogo, Bonilla-Aldana and Rodriguez-Morales.

DOI: 10.3389/fpubh.2024.1334425
PMCID: PMC10940342
PMID: 38496388 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest. The author(s) declared that 
they were an editorial board member of Frontiers, at the time of submission. 
This had no impact on the peer review process and the final decision.


44. BMC Health Serv Res. 2024 Mar 15;24(1):343. doi: 10.1186/s12913-023-10468-w.

Can the Reboot coaching programme support critical care nurses in coping with 
stressful clinical events? A mixed-methods evaluation assessing resilience, 
burnout, depression and turnover intentions.

Vogt KS(1)(2)(3), Johnson J(4)(5)(6), Coleman R(4)(7), Simms-Ellis R(4)(5), 
Harrison R(6)(8), Shearman N(9)(10), Marran J(4), Budworth L(4)(11)(12), 
Horsfield C(13), Lawton R(4)(5), Grange A(4).

Author information:
(1)Bradford Institute for Health Research, Bradford Royal Infirmary, Temple Bank 
House, Duckworth Lane, Bradford, BD9 6RJ, UK. k.s.vogt@leeds.ac.uk.
(2)Department of Psychology, University of Leeds, Leeds, LS2 9JT, UK. 
k.s.vogt@leeds.ac.uk.
(3)Department of Primary Care & Mental Health, Institute of Population Health, 
University of Liverpool, Eleanor Rathbone Building, Liverpool, L69 7ZA, UK. 
k.s.vogt@leeds.ac.uk.
(4)Bradford Institute for Health Research, Bradford Royal Infirmary, Temple Bank 
House, Duckworth Lane, Bradford, BD9 6RJ, UK.
(5)Department of Psychology, University of Leeds, Leeds, LS2 9JT, UK.
(6)School of Population Health, University of New South Wales, Sydney, 2052, 
Australia.
(7)School of Health and Wellbeing: College of Medical, Veterinary and Life 
Sciences, University of Glasgow, Clarice Pears Building, Glasgow, G12 8TB, UK.
(8)Centre for Health Systems and Safety Research: Australian Institute of Health 
Innovation, Macquarie University, Sydney, Australia.
(9)Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK.
(10)Mid Yorkshire Teaching NHS Trust, Wakefield, UK.
(11)Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of 
Leeds, Leeds, UK.
(12)NIHR Yorkshire & Humber Patient Safety Research Collaboration, Bradford 
Teaching Hospitals Foundation Trust, Bradford, UK.
(13)West Yorkshire Adult Critical Care Network, Leeds Teaching Hospitals, Leeds, 
UK.

BACKGROUND: Critical care nurses (CCNs) are routinely exposed to highly 
stressful situations, and at high-risk of suffering from work-related stress and 
developing burnout. Thus, supporting CCN wellbeing is crucial. One approach for 
delivering this support is by preparing CCNs for situations they may encounter, 
drawing on evidence-based techniques to strengthen psychological coping 
strategies. The current study tailored a Resilience-boosting psychological 
coaching programme [Reboot] to CCNs. Other healthcare staff receiving Reboot 
have reported improvements in confidence in coping with stressful clinical 
events and increased psychological resilience. The current study tailored Reboot 
for online, remote delivery to CCNs (as it had not previously been delivered to 
nurses, or in remote format), to (1) assess the feasibility of delivering Reboot 
remotely, and to (2) provide a preliminary assessment of whether Reboot could 
increase resilience, confidence in coping with adverse events and burnout.
METHODS: A single-arm mixed-methods (questionnaires, interviews) before-after 
feasibility study design was used. Feasibility was measured via demand, 
recruitment, and retention (recruitment goal: 80 CCNs, retention goal: 70% of 
recruited CCNs). Potential efficacy was measured via questionnaires at five 
timepoints; measures included confidence in coping with adverse events 
(Confidence scale), Resilience (Brief Resilience Scale), depression (PHQ-9) and 
burnout (Oldenburg-Burnout-Inventory). Intention to leave (current role, nursing 
more generally) was measured post-intervention. Interviews were analysed using 
Reflexive Thematic Analysis.
RESULTS: Results suggest that delivering Reboot remotely is feasible and 
acceptable. Seventy-seven nurses were recruited, 81% of whom completed the 
8-week intervention. Thus, the retention rate was over 10% higher than the 
target. Regarding preliminary efficacy, follow-up measures showed significant 
increases in resilience, confidence in coping with adverse events and reductions 
in depression, burnout, and intention to leave. Qualitative analysis suggested 
that CCNs found the psychological techniques helpful and particularly valued 
practical exercises that could be translated into everyday practice.
CONCLUSION: This study demonstrates the feasibility of remote delivery of Reboot 
and potential efficacy for CCNs. Results are limited due to the single-arm 
feasibility design; thus, a larger trial with a control group is needed.

© 2024. The Author(s).

DOI: 10.1186/s12913-023-10468-w
PMCID: PMC10941361
PMID: 38491374 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


45. Front Public Health. 2024 Feb 29;12:1322185. doi: 10.3389/fpubh.2024.1322185. 
eCollection 2024.

Perceived social support and characteristics of social networks of families with 
children with special healthcare needs following the COVID-19 pandemic.

Geweniger A(1), Barth M(2), Haddad A(2), Högl H(3), Insan S(1), Mund A(3), 
Langer T(1).

Author information:
(1)Department of Neuropediatrics and Muscle Disease, Center for Pediatrics, 
Medical Center-University of Freiburg, Freiburg, Germany.
(2)Department of General Pediatrics, Adolescent Medicine and Neonatology, Center 
for Pediatrics, Medical Center-University of Freiburg, Freiburg, Germany.
(3)Kindernetzwerk e.V., Mainaschaff, Germany.

BACKGROUND: Children with special healthcare needs (CSHCN) require more support 
than the average of their peers. Support systems for CSHCN were particularly 
affected by pandemic control measures. Perceived social support is a resource 
for health and wellbeing for CSHCN and their families. Associations of social 
support, mental health and socioeconomic status (SES) have been described. This 
study aims to (1) assess perceived social support in families with and without 
CSHCN; (2) describe structure and types of social networks of families with and 
without CSHCN; and (3) explore associations between perceived social support, 
disease complexity, child and caregiver mental health, and SES.
METHODS: This is the third of a sequential series of cross-sectional online 
surveys conducted among caregivers of children ≤ 18 years in Germany since the 
beginning of the COVID-19 pandemic, administered between 1st December 2022 and 
10 March 2023. The Brief Social Support Scale (BS6) assessed perceived social 
support. Child and parental mental health were assessed using the Strengths and 
Difficulties Questionnaire (SDQ) and WHO-5 Wellbeing index. The CSHCN-Screener 
identified CSHCN. Descriptive statistics and linear regression modeling assessed 
associations between perceived social support, parent-reported child mental 
health problems, disease complexity, caregiver mental wellbeing and SES.
RESULTS: The final sample included 381 participants, among them 76.6% (n = 292) 
CSHCN. 46.2% (n = 176) of caregivers reported moderate, i.e., at least 
occasional social support. Social support was largely provided by informal 
social networks consisting of partners, relatives and neighbors/friends. Linear 
regression modeling revealed associations of lower perceived social support with 
higher disease complexity of the child, lower caregiver mental wellbeing, lower 
SES and increasing caregiver age.
CONCLUSION: The results of this study describe inequalities in perceived social 
support according to disease complexity of the child, caregiver mental health 
and socioeconomic status. They highlight the importance of social support and 
support networks as a resource for wellbeing of caregivers and CSHCN. Moving on 
from the COVID-19 pandemic, recovery strategies should focus on low-threshold 
interventions based in the community to improve social support for families with 
CSHCN and actively involve caregivers in identifying needs and co-creating new 
approaches.

Copyright © 2024 Geweniger, Barth, Haddad, Högl, Insan, Mund and Langer.

DOI: 10.3389/fpubh.2024.1322185
PMCID: PMC10937572
PMID: 38487183 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


46. Int J Equity Health. 2024 Mar 14;23(1):56. doi: 10.1186/s12939-024-02138-y.

A mixed method study on the impact of COVID-19 on mental healthcare in Ghana: 
rethinking mental health service delivery.

Zobi M(#)(1), Abrokwa SK(#)(2), Dordoye E(3), Phuti A(2).

Author information:
(1)Institute of International Health, Global Health Centre, Charité 
Universitätsmedizin Berlin, 13353, Berlin, Germany. michaelzobi@yahoo.com.
(2)Institute of International Health, Global Health Centre, Charité 
Universitätsmedizin Berlin, 13353, Berlin, Germany.
(3)Psychological Medicine & Mental Health Department, School of Medicine, 
University of Health and Allied Sciences, Hohoe, Ghana.
(#)Contributed equally

BACKGROUND: Since its emergence, Severe Acute Respiratory Syndrome Coronavirus 2 
(SARS-CoV-2) has caused severe health, social and economic challenges. Mental 
healthcare has been significantly affected globally, and even worse in 
developing countries. An emerging economy like Ghana in West Africa was not 
spared its disruptive effects. This study aimed to elucidate the impact of the 
coronavirus disease 2019, the COVID-19 pandemic (caused by SARS-CoV-2), on 
Ghana's mental healthcare system.
METHODS: This is a mixed-method study using an emergent sequential exploratory 
design. A total of 15 front-line healthcare professionals were recruited from 
the three psychiatric hospitals, including the mental health department of a new 
teaching hospital in Ghana. Purposive sampling techniques and a semi-structured 
interview approach were used for recruitment and data collection. Quantitative 
data from hospital registries were collected and analysed to triangulate 
qualitative findings.
RESULTS: Fifteen mental health workers were enrolled in the study. The mean age 
of participants was (34.47 ± 4.07) years, average work experience of 
(6.23 ± 3.64) years and the majority as males (60%). This study found an average 
decline of 23% in hospital attendance and a 35% decline in admissions in all 
four facilities compared to the previous year, 2019. The lived experiences 
shared by mental healthcare providers were grouped under 3 main themes: 
Adjustments to workplace regulations, accessibility to mental healthcare, and 
psychological wellbeing of mental healthcare workers. The fear of contracting 
SARS-CoV-2 among healthcare workers, medication shortages, and logistical 
challenges were also reported to affect Mental Health services during the 
pandemic.
CONCLUSION: This study highlights the challenges in mental healthcare during the 
COVID-19 pandemic in Ghana. The experiences encountered present an opportunity 
to gain insights into future pandemic preparedness and establish a framework for 
optimal mental healthcare delivery in Ghana.

© 2024. The Author(s).

DOI: 10.1186/s12939-024-02138-y
PMCID: PMC10941419
PMID: 38486258 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


47. BMC Public Health. 2024 Mar 14;24(1):810. doi: 10.1186/s12889-024-18249-8.

Quantifying the relationship between gardening and health and well-being in the 
UK: a survey during the covid-19 pandemic.

Gulyas BZ(1)(2), Caton SJ(2), Edmondson JL(3).

Author information:
(1)Plants, Photosynthesis and Soil, School of Biosciences, University of 
Sheffield, S10 2TN, Sheffield, UK.
(2)Sheffield Centre for Health and Related Research (SCHARR), School of Medicine 
and Population Health, University of Sheffield, S10 2TN, Sheffield, UK.
(3)Plants, Photosynthesis and Soil, School of Biosciences, University of 
Sheffield, S10 2TN, Sheffield, UK. j.edmondson@sheffield.ac.uk.

BACKGROUND: Rates of non-communicable diseases, including cardiovascular disease 
and type 2 diabetes, and mental health problems, such as anxiety and depression, 
are high and rising in the urbanising world. Gardening could improve both mental 
and physical health and help prevent a range of conditions by increasing fruit 
and vegetable (F&V) consumption, promoting physical activity, and reducing 
stress. However, good quality quantitative research in the area is scarce, and 
our understanding of the role of allotments and home gardens, and the effects of 
the level of engagement in gardening and involvement with food production has 
thus far been limited.
METHODS: We quantitatively assess the relationship between home and allotment 
gardening and various indicators and predictors of health and well-being using 
an online survey of gardeners (n = 203) and non-gardeners (n = 71) in the UK. 
The survey was composed of multiple validated questionnaires (including the 
Short Form Food Frequency Questionnaire (SFFFQ), the Warwick-Edinburgh Mental 
Wellbeing Scale (WEMWBS), the Physical Health Questionnaire (PHQ) and the 
Self-Rated Health question (SRH)) and self-defined questions relating to 
participants' involvement with gardening and food production, and relevant 
demographic and lifestyle factors. Data were analysed using a series of 
hierarchical logistic and multiple linear regression models adjusting for 
socio-demographic variables.
RESULTS: After adjusting for relevant socio-demographic factors, gardening 
related variables were associated with better self-rated health, higher mental 
well-being, increased F&V consumption. Higher F&V intake was in turn also 
associated with better self-rated health and decreased odds of obesity. Thus, 
gardening had a positive association with four different aspects of health and 
well-being, directly or indirectly via increased F&V consumption.
CONCLUSIONS: Our results suggest that gardening in UK allotments and domestic 
gardens may promote different aspects of health and well-being via multiple 
mechanisms. Improving access to growing space and promoting regular gardening 
could provide a range of benefits to public health. More research on how 
socio-economic factors influence the health and well-being benefits of gardening 
will help policymakers devise strategies to maximise these benefits.

© 2024. The Author(s).

DOI: 10.1186/s12889-024-18249-8
PMCID: PMC10941614
PMID: 38486178 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


48. J Safety Res. 2024 Feb;88:354-365. doi: 10.1016/j.jsr.2023.12.002. Epub 2023 Dec 
15.

How job stressors and economic stressors impact public transport drivers' 
performance and well-being under the health risk of the COVID-19 pandemic.

Chen CF(1), Sih J(2).

Author information:
(1)Dept. of Transportation and Communication Management Science, National Cheng 
Kung University, Tainan City, Taiwan. Electronic address: 
cfchen99@mail.ncku.edu.tw.
(2)Dept. of Transportation and Communication Management Science, National Cheng 
Kung University, Tainan City, Taiwan. Electronic address: 
R560995024@gs.ncku.edu.tw.

INTRODUCTION: During the COVID-19 pandemic, public transport (e.g., bus and 
taxi) drivers encountered great stress because they needed to work to maintain 
the operation of the transportation system. This study proposes and empirically 
investigates the impacts of job stressors and economic stressors of public 
transport drivers on emotional exhaustion, and subsequent psychological 
well-being and performance under the health risk of COVID-19. The moderating 
effects of perceived threat and death anxiety on the relationships between 
stressors and emotional exhaustion are also examined.
METHOD AND RESULTS: Using two survey samples collected from bus and taxi drivers 
in Taiwan, the results reveal that, except for the effect of time pressure on 
taxi drivers' exhaustion, job stressors (job overload and time pressure) and 
economic stressors (job insecurity) positively relate to emotional exhaustion 
for both bus and taxi drivers. Drivers' emotional exhaustion has negative 
effects on both job satisfaction and positive effects on risky driving 
behaviors. Perceived pandemic threat strengthens the positive influence of job 
insecurity on emotional exhaustion for bus drivers, while perceived pandemic 
threat and death anxiety weaken the negative influence of job insecurity on 
emotional exhaustion for taxi drivers.
PRACTICAL APPLICATIONS: Effective intervention strategies and policies to 
mitigate perceived pandemic threat and death anxiety of drivers are recommended.

Copyright © 2023 National Safety Council and Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.jsr.2023.12.002
PMID: 38485378 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


49. Med Arch. 2024;78(1):22-28. doi: 10.5455/medarh.2024.78.22-28.

Relationship Between Quality of Sleep and Psychological Well-being Among 
Frontline Nurses During the COVID-19 Pandemic in Saudi Arabia.

Alabdullatif EA(1), Alameri RA(2), Al-Dossary RNM(3).

Author information:
(1)Ministry of Health, Eastern Health Cluster, Ras Tanura Hospital, Saudi 
Arabia.
(2)Fundamentals of Nursing Department, College of Nursing, Imam Abdulrahman Bin 
Faisal University, Dammam, Saudi Arabia.
(3)Department of Nursing Education, College of Nursing, Imam Abdulrahman Bin 
Faisal University, Dammam, Saudi Arabia.

BACKGROUND: The coronavirus 2019 (COVID-19) pandemic is a world health emergency 
crisis that challenges the global health system and healthcare providers, 
especially frontline nurses' physical and mental well-being.
OBJECTIVE: The aim of the study was to examine the association between 
depression, anxiety, and sleep quality among nurses working in Saudi Arabian 
hospitals during the COVID-19 pandemic.
METHODS: This is an quantitative cross-sectional study. An online self-reported 
data was collected from 187 nurses who were on duty during COVID-19 pandemic.
RESULTS: About 87.2% of the nurses were female nurses; not surprising that 88% 
had poor sleep quality; 44.4% had moderate anxiety, and 44% of the studied 
nurses had mild to moderate depression. The study revealed that there was an 
association between level of anxiety and poor sleep quality. Poor sleep quality 
and emotional stability of nurses play a major role in quality of care and 
patients' safety.
CONCLUSION: We conclude that healthcare leaders should adopt an occupational 
wellbeing program for nurses that focuses on their psychological wellbeing and 
sleep quality.

© 2024 Eman Abdulla Alabdullatif, Rana Ali Alameri, Reem Nasser Mohammed 
Al-Dossary.

DOI: 10.5455/medarh.2024.78.22-28
PMCID: PMC10928683
PMID: 38481582 [Indexed for MEDLINE]

Conflict of interest statement: There is no financial or related conflict of 
interest.


50. BMC Med. 2024 Mar 13;22(1):116. doi: 10.1186/s12916-024-03334-x.

Evidence linking COVID-19 and the health/well-being of children and adolescents: 
an umbrella review.

Duan C(#)(1), Liu L(#)(1)(2), Wang T(#)(1), Wang G(1)(3), Jiang Z(1), Li 
H(1)(3), Zhang G(1)(3), Ye L(1)(3), Li C(1)(3)(4), Cao Y(5)(6)(7).

Author information:
(1)State Key Laboratory of Oral Diseases & National Center for Stomatology & 
National Clinical Research Center for Oral Diseases, West China Hospital of 
Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 
610041, China.
(2)Department of Conservative Dentistry and Endodontics, West China Hospital of 
Stomatology, Sichuan University, Chengdu, China.
(3)Department of Head and Neck Oncology, West China Hospital of Stomatology, 
Sichuan University, Chengdu, China.
(4)Department of Evidence-Based Stomatology, West China Hospital of Stomatology, 
Sichuan University, Chengdu, China.
(5)State Key Laboratory of Oral Diseases & National Center for Stomatology & 
National Clinical Research Center for Oral Diseases, West China Hospital of 
Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 
610041, China. yubin.cao@scu.edu.cn.
(6)Department of Oral and Maxillofacial Surgery, West China Hospital of 
Stomatology, Sichuan University, Chengdu, China. yubin.cao@scu.edu.cn.
(7)Department of Evidence-Based Stomatology, West China Hospital of Stomatology, 
Sichuan University, Chengdu, China. yubin.cao@scu.edu.cn.
(#)Contributed equally

BACKGROUND: Experiences during childhood and adolescence have enduring impacts 
on physical and mental well-being, overall quality of life, and socioeconomic 
status throughout one's lifetime. This underscores the importance of 
prioritizing the health of children and adolescents to establish an impactful 
healthcare system that benefits both individuals and society. It is crucial for 
healthcare providers and policymakers to examine the relationship between 
COVID-19 and the health of children and adolescents, as this understanding will 
guide the creation of interventions and policies for the long-term management of 
the virus.
METHODS: In this umbrella review (PROSPERO ID: CRD42023401106), systematic 
reviews were identified from the Cochrane Database of Systematic Reviews; EMBASE 
(OvidSP); and MEDLINE (OvidSP) from December 2019 to February 2023. Pairwise and 
single-arm meta-analyses were extracted from the included systematic reviews. 
The methodological quality appraisal was completed using the AMSTAR-2 tool. 
Single-arm meta-analyses were re-presented under six domains associated with 
COVID-19 condition. Pairwise meta-analyses were classified into five domains 
according to the evidence classification criteria. Rosenberg's FSN was 
calculated for both binary and continuous measures.
RESULTS: We identified 1551 single-arm and 301 pairwise meta-analyses from 124 
systematic reviews that met our predefined criteria for inclusion. The focus of 
the meta-analytical evidence was predominantly on the physical outcomes of 
COVID-19, encompassing both single-arm and pairwise study designs. However, the 
quality of evidence and methodological rigor were suboptimal. Based on the 
evidence gathered from single-arm meta-analyses, we constructed an illustrative 
representation of the disease severity, clinical manifestations, laboratory and 
radiological findings, treatments, and outcomes from 2020 to 2022. Additionally, 
we discovered 17 instances of strong or highly suggestive pairwise 
meta-analytical evidence concerning long-COVID, pediatric comorbidity, COVID-19 
vaccines, mental health, and depression.
CONCLUSIONS: The findings of our study advocate for the implementation of 
surveillance systems to track health consequences associated with COVID-19 and 
the establishment of multidisciplinary collaborative rehabilitation programs for 
affected younger populations. In future research endeavors, it is important to 
prioritize the investigation of non-physical outcomes to bridge the gap between 
research findings and clinical application in this field.

© 2024. The Author(s).

DOI: 10.1186/s12916-024-03334-x
PMCID: PMC10938697
PMID: 38481207 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


51. BMJ Open. 2024 Mar 12;14(3):e076712. doi: 10.1136/bmjopen-2023-076712.

Would've, could've, should've: a cross-sectional investigation of whether and 
how healthcare staff's working conditions and mental health symptoms have 
changed throughout 3 pandemic years.

Reiter J(1), Weibelzahl S(2), Duden GS(3).

Author information:
(1)Department of Occupational, Economic, and Social Psychology, University of 
Vienna, Wien, Austria julia.reiter@univie.ac.at.
(2)Department of Psychology, PFH Private University of Applied Sciences, 
Göttingen, Germany.
(3)Department of Community Psychology, FernUniversitat in Hagen, Hagen, Germany.

OBJECTIVES: Mental health and well-being of healthcare staff were majorly 
impacted by the COVID-19 pandemic. Little attention has been devoted to the role 
employers could choose to play in mitigating long-term negative consequences and 
how effective organisational measures taken were perceived by the individual 
healthcare workers. This study aims to investigate (1) whether and how 
healthcare professionals' mental health has changed from the second to the third 
pandemic year, (2) whether differences between professional groups (physicians, 
nurses, paramedics) identified in previous studies persisted and (3) how job 
demands and resources, for example, work culture and employers' measures, 
impacted this situation.
DESIGN: The study employs an observational, cross-sectional design, using an 
online survey.
SETTING AND PARTICIPANTS: The study was conducted online from mid-June to 
mid-August 2022 among healthcare staff in state-run and private healthcare 
facilities, such as doctor's practices, hospitals and paramedic organisations, 
in Germany and Austria (n=421).
OUTCOME MEASURES: We measured psychological strain using an ICD-10-based symptom 
checklist, as well as subjective strain and importance of stressors using 
self-report questions. The ICD-10 was the 10th version of the International 
Statistical Classification of Diseases and Related Health Problems, a widely 
used standardized diagnostic manual.
RESULTS: Psychological strain stayed relatively consistent, with nursing staff 
suffering the most. While the job demands participants felt most affected by 
were structural issues (eg, staff shortages), employers were far more likely to 
be perceived as taking action against pandemic-specific job demands (eg, lack of 
protective gear). Psychological strain was lowest when staff perceived 
employers' actions as effective. Only 60% of those with severe enough symptoms 
to require psychological help had intentions of seeking such help, which is in 
line with past studies. This help-seeking hesitancy was also dependent on 
different facets of perceived work culture.
CONCLUSIONS: Healthcare staff and nursing staff in particular continue to suffer 
in the aftermath of the COVID-19 pandemic. However, while employers were 
perceived as taking action against pandemic-specific job demands, pre-existing 
job demands causing stress and psychological strain for staff have remained 
uncombatted.

© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2023-076712
PMCID: PMC10936481
PMID: 38479744 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: The authors declare no 
conflicts of interest.


52. J Phys Ther Educ. 2023 Jun 1;37(2):87-93. doi: 10.1097/JTE.0000000000000274. 
Epub 2023 Feb 23.

The Psychological Impacts of Taking Physiotherapy Teaching Online in 2020: What 
Did We Learn?

Bampton J(1)(2)(3)(4)(5)(6)(7)(8), Tang CY(1)(2)(3)(4)(5)(6)(7)(8), McKay 
MJ(1)(2)(3)(4)(5)(6)(7)(8), Paul SS(1)(2)(3)(4)(5)(6)(7)(8), Allen 
NE(1)(2)(3)(4)(5)(6)(7)(8), Darwell C(1)(2)(3)(4)(5)(6)(7)(8), Frawley 
J(1)(2)(3)(4)(5)(6)(7)(8), Dennis S(1)(2)(3)(4)(5)(6)(7)(8).

Author information:
(1)Julie Bampton, associate lecturer, Sydney School of Health Sciences, Faculty 
of Medicine and Health, D18 The Susan Wakil Health Building, Western Avenue, The 
University of Sydney, NSW 2006, Australia (julie.bampton@sydney.edu.au). Please 
address all correspondence to Julie Bampton.
(2)Clarice Y. Tang, director academic program physiotherapy, School of Health 
Sciences, Western Sydney University.
(3)Marnee J. McKay, senior lecturer, program director bachelor of applied 
science physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and 
Health, The University of Sydney.
(4)Serene S. Paul, senior lecturer, Sydney School of Health Sciences, Faculty of 
Medicine and Health, The University of Sydney.
(5)Natalie E. Allen, associate professor, Sydney School of Health Sciences, 
Faculty of Medicine and Health, The University of Sydney.
(6)Christina Darwell, associate lecturer, Sydney School of Health Sciences, 
Faculty of Medicine and Health, The University of Sydney.
(7)Jessica Frawley, lecturer, deputy vice chancellor (education) portfolio, 
Sydney School of Health Sciences, Faculty of Medicine and Health, The University 
of Sydney.
(8)Sarah Dennis, professor allied health, Sydney School of Health Sciences, 
Faculty of Medicine and Health, The University of Sydney.

INTRODUCTION: The rapid shift to online learning due to the COVID-19 pandemic 
presented challenges for physical therapy (PT) education worldwide. This article 
aims to explore the factors influencing the well-being of the PT faculty and 
department chairs involved in delivering PT programs during the initial stages 
of the COVID-19 pandemic.
REVIEW OF LITERATURE: The literature has focused on the pedagogical impacts of 
the rapid shift to online learning. Little is known about the social and 
psychological impacts of this rapid transition on the well-being of the faculty 
involved in implementing PT programs.
SUBJECTS: Physical therapy faculty and department chairs at 3 universities in 
metropolitan Sydney, Australia who taught into or led PT programs in 2020.
METHODS: Focus group methodology was used to explore the experiences of PT 
faculty and department chairs during the initial stages of the COVID pandemic. 
The focus groups were digitally recorded and transcribed verbatim and the 
transcripts analyzed thematically.
RESULTS: The main finding of this study was the extent of stress experienced by 
PT program faculty and chairs during this period. Both work-related 
institutional and faculty factors and non-work-related personal factors 
contributed to perceived high levels of stress. Overall, there was a feeling 
that the stressors had not improved over the duration of the pandemic and that 
this had left the faculty and chairs feeling more fatigued, less collegiate, and 
may have ongoing impacts on their mental health.
DISCUSSION: The pandemic created stresses for faculty and program chairs over 
and above the usual stress of faculty and college work. The reality of taking 
steps to reduce the stressors in the current climate is very difficult.
CONCLUSION: Moving forward, it is vital to secure increased institutional 
support, including the support for creating realistic boundaries without the 
risk of penalty, to address the psychological health and well-being of PT 
faculty and chairs to enable high-quality education in the future.

Copyright © 2023 Academy of Physical Therapy Education, APTA.

DOI: 10.1097/JTE.0000000000000274
PMID: 38478821 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


53. JAMA Netw Open. 2024 Mar 4;7(3):e242076. doi: 10.1001/jamanetworkopen.2024.2076.

Mental Well-Being Among Adversity-Exposed Adolescents During the COVID-19 
Pandemic.

Raney JH(1), Weinstein S(2), Ganson KT(3), Testa A(4), Jackson DB(5), Pantell 
M(6), Glidden DV(7), Brindis CD(1)(8), Nagata JM(1).

Author information:
(1)Division of Adolescent and Young Adult Medicine, Department of Pediatrics, 
University of California, San Francisco.
(2)School of Health, University of Berkeley, Berkeley, California.
(3)Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, 
Ontario, Canada.
(4)Department of Management, Policy and Community Health, University of Texas 
Health Science Center at Houston, Houston.
(5)Department of Population, Family and Reproductive Health, Johns Hopkins 
Bloomberg School of Public Health, Baltimore, Maryland.
(6)Division of Hospital Medicine, Department of Pediatrics, University of 
California, San Francisco.
(7)Department of Epidemiology and Biostatistics, University of California, San 
Francisco.
(8)Philip R. Lee Institute for Health Policy Studies, University of California, 
San Francisco.

IMPORTANCE: Further research is needed to understand factors associated with 
well-being during the COVID-19 pandemic among adolescents who have experienced 
adverse childhood experiences (ACEs).
OBJECTIVE: To explore factors associated with improved mental health during the 
COVID-19 pandemic among adolescents who have experienced ACEs.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the 
baseline (2016-2018) and sixth (March 2021) COVID Rapid Response Research (RRR) 
surveys of the Adolescent Brain Cognitive Development study, which includes 21 
sites across the US. Adolescents aged 11 to 15 years who completed the COVID RRR 
mental health measures were included. Data analyses were conducted from June to 
August 2023.
EXPOSURES: School-based factors (eg, in-person school) and 8 coping behaviors 
(eg, exercise).
MAIN OUTCOMES AND MEASURES: The primary outcomes were adolescent-reported 
positive affect (PA) and perceived stress (PS). Adolescents were stratified by 
no ACEs, low-to-intermediate ACEs (1-3), and high ACEs (≥4). Linear regressions 
estimated associations between factors and mental health, adjusting for 
potential confounders. Unstandardized beta coefficients (B) were compared with 
equality of coefficients tests.
RESULTS: The 4515 adolescents in this study (mean [SD] age, 13.3 [0.88] years; 
51% [95% CI, 50% to 53%] female) were racially and ethnically diverse (American 
Indian/Alaska Native, 2% [95% CI, 2% to 3%]; Asian, 8% [95% CI, 7% to 9%]; 
Black, 11% [95% CI, 10% to 12%]; Latino or Hispanic, 17% [95% CI, 15% to 18%]; 
White, 61% [95% CI, 60% to 63%]; other, 1% [95% CI, 0% to 2%]). For youths with 
high ACEs, caring for one's body (PA B = 4.02 [95% CI, 1.39 to 6.66]; PS 
B = -0.92 [95% CI, -1.84 to 0.00]), exercising (PA B = 3.19 [95% CI, 0.46 to 
5.92]; PS B = -1.41 [95% CI, -2.40 to -0.43]), and engaging in healthy behaviors 
(PA B = 4.07 [95% CI, 1.28 to 6.84]; PS B = -1.01 [95% CI, -1.98 to -0.05]) were 
associated with higher PA and lower PS scores. In-person schooling had a greater 
impact on PA scores for youths with high ACEs (B = 5.55 [95% CI, 2.08 to 9.01]) 
than youths with low-to-intermediate ACEs (B = 1.27 [95% CI, 0.27 to 2.27]).
CONCLUSIONS AND RELEVANCE: These findings suggest that in-person schooling and 
several coping behaviors (caring for one's body, exercising, and engaging in 
healthy behaviors) were associated with significantly higher PA and lower PS 
during the COVID-19 pandemic among adolescents with high ACEs. Adolescents with 
high ACEs demonstrated especially greater mental health scores when they 
reported in-person schooling. Future studies should build on these findings to 
identify clinical and school-based mental health protective factors for 
adolescents with high ACE risk.

DOI: 10.1001/jamanetworkopen.2024.2076
PMCID: PMC10938185
PMID: 38477919 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest Disclosures: None reported.


54. Healthcare (Basel). 2024 Mar 4;12(5):587. doi: 10.3390/healthcare12050587.

Personality Traits, Burnout, and Psychopathology in Healthcare Professionals in 
Intensive Care Units-A Moderated Analysis.

Pakou V(1), Tsartsalis D(2)(3), Papathanakos G(1), Dragioti E(2), Gouva M(2), 
Koulouras V(1).

Author information:
(1)Intensive Care Unit, University Hospital of Ioannina, University of Ioannina, 
45500 Ioannina, Greece.
(2)Laboratory of Psychology of Patients, Families & Health Professionals, 
Department of Nursing, School of Health Sciences, University of Ioannina, 45500 
Ioannina, Greece.
(3)Department of Clinical Physiology, Sundsvall Hospital, 85643 Sundsvall, 
Sweden.

This study explored the associations between personality dimensions, burnout, 
and psychopathology in healthcare professionals in intensive care units (ICUs). 
This study further aimed to discern the differences in these relationships when 
considering the variables of critical care experience (less than 5 years, 5-10 
years, and more than 10 years), profession (nurses versus intensivists), and the 
urban size of the city where the ICU is located (metropolitan cities versus 
smaller urban cities). This cross-sectional investigation's outcomes are based 
on data from 503 ICU personnel, including 155 intensivists and 348 nurses, in 31 
ICU departments in Greece. Participants underwent a comprehensive assessment 
involving a sociodemographic questionnaire, the Eysenck Personality 
Questionnaire (EPQ), the Maslach Burnout Inventory (MBI), and the Symptom 
Checklist-90 (SCL-90). To analyze the interplay among critical care experience, 
burnout status, and psychopathology, a moderation analysis was conducted with 
personality dimensions (i.e., psychoticism, extraversion, and neuroticism) 
serving as the mediator variable. Profession and the urban size of the ICU 
location were considered as moderators influencing these relationships. Male 
healthcare professionals showed higher psychoticism levels than females, 
aligning with prior research. Experienced nurses reported lower personal 
achievement, hinting at potential motivation challenges for professional growth. 
Psychoticism predicted high depersonalization and low personal achievement. 
Neuroticism and psychoticism negatively impacted ICU personnel's mental 
well-being, reflected in elevated psychopathology scores and burnout status. 
Psychoticism appears to be the primary factor influencing burnout among the 
three personality dimensions, particularly affecting intensivists. In contrast, 
nurses are more influenced by their critical care experience on their mental 
health status.

DOI: 10.3390/healthcare12050587
PMCID: PMC10930981
PMID: 38470698

Conflict of interest statement: The authors declare no conflicts of interest.


55. BMC Psychol. 2024 Mar 11;12(1):136. doi: 10.1186/s40359-024-01596-x.

Social support and mental well-being among people with and without chronic 
illness during the Covid-19 pandemic: evidence from the longitudinal UCL covid 
survey.

Aksoy O(1), Wu AF(2), Aksoy S(3), Rivas C(2).

Author information:
(1)UCL Social Research Institute, University College London, 55-59 Gordon 
Square, WC1H 0NU, London, UK. ozan.aksoy@ucl.ac.uk.
(2)UCL Social Research Institute, University College London, 55-59 Gordon 
Square, WC1H 0NU, London, UK.
(3)University of Greenwich, Old Royal Naval College, Park Row, SE10 9LS, London, 
UK.

PURPOSE: An immediate research priority recovering from the COVID-19 pandemic is 
well-being among some of our most vulnerable-people with chronic illness. We 
studied how mental health changed among people with and without chronic illness 
throughout the pandemic and the mediating role of social support.
METHODS: We used the 3-waves of COVID-19 survey within the Millennium Cohort 
Study (MCS, age 19, N = 5522) and MCS Parent (MCSP, age > > 19, N = 7479) 
samples, with additional pre-pandemic measures of some outcomes and exposure. 
Using Structural Equation Panel Models with Full Information Maximum Likelihood 
estimation to address missing data, we studied differences between respondents 
with a chronic illness and without, regarding depressive symptoms and mental 
well-being, with social provision, social support, and loneliness as potential 
mediators.
RESULTS: Mental well-being (SWEMWBS) and psychological distress (Kessler-6) 
worsened significantly during the pandemic relative to baseline for people with 
and without chronic illness, while the latter group had substantially better 
well-being at all waves and the baseline regarding both outcomes. When the 
lockdown was lifted during wave-2, mental well-being temporarily rebounded, and 
distress waned among people without chronic illness but continued to worsen 
among people with chronic illness. Social support partially mediated the link 
between chronic illness and mental well-being.
CONCLUSIONS: The large mental well-being gap between people with and without 
chronic illness persisted during the pandemic. However, social support and 
provision can partially narrow this gap, hence should be employed in future 
pandemic management.

© 2024. The Author(s).

DOI: 10.1186/s40359-024-01596-x
PMCID: PMC10929080
PMID: 38468353 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


56. Asia Pac Psychiatry. 2024 Mar;16(1):e12553. doi: 10.1111/appy.12553.

The impact of COVID-19 on emergency department presentations for mental health 
disorders in Queensland, Australia: A time series analysis.

Jones PM(1)(2)(3), Sweeny A(1)(4)(5), Branjerdporn G(5)(6), Keijzers G(1)(2)(5), 
Marshall AP(4)(7)(8), Huang YL(1)(7)(9), Hall EJ(1), Ranse J(1)(4), Palipana 
D(1)(2), Teng YD(10), Crilly J(1)(4)(7)(11); COVERED COVID study investigators.

Collaborators: Greenslade J, Zhang P.

Author information:
(1)Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, 
Australia.
(2)School of Medicine and Dentistry, Griffith University, Gold Coast, 
Queensland, Australia.
(3)Department of Emergency Medicine, Gold Coast University Hospital, Southport, 
Queensland, Australia.
(4)Menzies Health Institute Queensland, Griffith University, Gold Coast, 
Queensland, Australia.
(5)Faculty of Health Sciences and Medicine, Bond University, Gold Coast, 
Queensland, Australia.
(6)Mental Health and Specialist Services, Gold Coast Hospital and Health 
Service, Gold Coast, Queensland, Australia.
(7)School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, 
Australia.
(8)Intensive Care Unit, Gold Coast Health, Gold Coast, Queensland, Australia.
(9)Faculty of Health (Nursing), Southern Cross University, Gold Coast, 
Queensland, Australia.
(10)Departments of Physical Medicine & Rehabilitation and Neurosurgery, Harvard 
Medical School, Boston, Massachusetts, USA.
(11)Centre for Mental Health, Griffith University, Gold Coast, Queensland, 
Australia.

BACKGROUND: The COVID-19 pandemic has been associated with detrimental effects 
on mental health and psychological well-being. Although multiple studies have 
shown decreases in mental health-related Emergency Department (ED) presentations 
early in the COVID-19 pandemic, the medium-term effects on mental health-related 
ED presentations have remained less clear. This study aimed to evaluate the 
effect of the pandemic on mental health ED presentations by comparing observed 
presentation numbers to predictions from pre-pandemic data.
METHODS: This retrospective cohort study tallied weekly ED presentations 
associated with mental health disorders from a state-wide minimum dataset. Three 
time periods were identified: Pre-Pandemic (January 1, 2018-March 8, 2020), 
Statewide Lockdown (March 9, 2020-June 28, 2020), and Restrictions Easing (June 
29, 2020-June 27, 2021). Time series analysis was used to generate weekly 
presentation forecasts using pre-pandemic data. Observed presentation numbers 
were compared to these forecasts.
RESULTS: Weekly presentation numbers were lower than predicted in 11 out of 
16 weeks in the Statewide Lockdown period and 52 out of 52 weeks in the 
Restrictions Easing period. The largest decrease was seen for anxiety disorders 
(Statewide Lockdown: 76.8% of forecast; Restrictions Easing: 36.4% of forecast), 
while an increase was seen in presentations for eating disorders (Statewide 
Lockdown: 139.5% of forecast; Restrictions Easing: 194.4% of forecast).
CONCLUSIONS: Overall weekly mental health-related presentations across 
Queensland public EDs were lower than expected for the first 16 months of the 
COVID-19 pandemic. These findings underline the limitations of emergency 
department provision of mental health care and the importance of alternate care 
modalities in the pandemic context.

© 2024 The Authors. Asia-Pacific Psychiatry published by John Wiley & Sons 
Australia, Ltd.

DOI: 10.1111/appy.12553
PMID: 38467558 [Indexed for MEDLINE]


57. Intensive Care Med. 2024 Apr;50(4):561-572. doi: 10.1007/s00134-024-07349-z. 
Epub 2024 Mar 11.

Long-term survival and functional outcomes of critically ill patients with 
hematologic malignancies: a Canadian multicenter prospective study.

Munshi L(1)(2), Dumas G(3), Rochwerg B(4)(5), Shoukat F(6), Detsky M(6), 
Fergusson DA(7)(8), Ferreyro BL(6)(9), Heffernan P(10), Herridge M(11), Magder 
S(12)(13), Minden M(14), Patel R(15)(16), Qureshi S(17), Schimmer A(14), Thyagu 
S(14), Wang HT(18), Mehta S(6).

Author information:
(1)Interdepartmental Division of Critical Care Medicine, Department of Medicine, 
Sinai Health System, Mount Sinai Hospital, University of Toronto, 600 University 
Avenue, Toronto, ON, M5G 1X5, Canada. Laveena.munshi@sinaihealth.ca.
(2)Institute of Health Policy, Management and Evaluation, University of Toronto, 
Toronto, Canada. Laveena.munshi@sinaihealth.ca.
(3)Service de Médecine Intensive-Réanimation, CHU Grenoble-Alpes, Université 
Grenoble-Alpes, INSERM U1042-HP2, Grenoble, France.
(4)Department of Medicine, Evidence and Impact, McMaster University, Hamilton, 
Canada.
(5)Department of Health Research Methods, Evidence and Impact, McMaster 
University, Hamilton, Canada.
(6)Interdepartmental Division of Critical Care Medicine, Department of Medicine, 
Sinai Health System, Mount Sinai Hospital, University of Toronto, 600 University 
Avenue, Toronto, ON, M5G 1X5, Canada.
(7)Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, 
ON, Canada.
(8)Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
(9)Institute of Health Policy, Management and Evaluation, University of Toronto, 
Toronto, Canada.
(10)Department of Medicine at Queen's University, Kingston General Health 
Research Institute, Kingston Health Sciences Centre, Kingston, ON, Canada.
(11)Department of Medicine, Interdepartmental Division of Critical Care 
Medicine, Toronto General Hospital, University Health Network, University of 
Toronto, Toronto, Canada.
(12)Department of Medicine, Royal Victoria Hospital, The Research Institute of 
the McGill University Health Centre, McGill University, Montreal, QC, Canada.
(13)Critical Care Department, Royal Victoria Hospital, The Research Institute of 
the McGill University Health Centre, McGill University, Montreal, QC, Canada.
(14)Division of Medical Oncology & Hematology, Department of Medicine, Princess 
Margaret Cancer Center, University Health Network, University of Toronto, 
Toronto, ON, Canada.
(15)Department of Medicine, Ottawa Hospital, Ottawa Hospital Research Institute, 
University of Ottawa, Ottawa, ON, Canada.
(16)Department of Critical Care Medicine, Ottawa Hospital, Ottawa Hospital 
Research Institute, University of Ottawa, Ottawa, ON, Canada.
(17)Department of Medicine, Research Institute of the McGill University Health 
Centre, McGill University, Montreal, QC, Canada.
(18)Division of Critical Care MedicineDepartment of Medicine at Hopital 
Maisonneuve-Rosemont, University of Montreal, Montreal, QC, Canada.

PURPOSE: Patients with hematologic malignancy (HM) commonly develop critical 
illness. Their long-term survival and functional outcomes have not been well 
described.
METHODS: We conducted a prospective, observational study of HM patients admitted 
to seven Canadian intensive care units (ICUs) (2018-2020). We followed survivors 
at 7 days, 6 months and 12 months following ICU discharge. The primary outcome 
was 12-month survival. We evaluated functional outcomes at 6 and 12 months using 
the functional independent measure (FIM) and short form (SF)-36 as well as 
variables associated with 12-month survival.
RESULTS: We enrolled 414 patients including 35% women. The median age was 61 
(interquartile range, IQR: 52-69), median Sequential Organ Failure Assessment 
(SOFA) score was 9 (IQR: 6-12), and 22% had moderate-severe frailty (clinical 
frailty scale [CFS] ≥ 6). 51% had acute leukemia, 38% lymphoma/multiple myeloma, 
and 40% had received a hematopoietic stem cell transplant (HCT). The most common 
reasons for ICU admission were acute respiratory failure (50%) and sepsis (40%). 
Overall, 203 (49%) were alive 7 days post-ICU discharge (ICU survivors). 
Twelve-month survival of the entire cohort was 21% (43% across ICU survivors). 
The proportion of survivors with moderate-severe frailty was 42% (at 7 days), 
14% (6 months), and 8% (12 months). Median FIM at 7 days was 80 (IQR: 50-109). 
Physical function, pain, social function, mental health, and emotional 
well-being were below age- and sex-matched population scores at 6 and 12 months. 
Frailty, allogeneic HCT, kidney injury, and cardiac complications during ICU 
were associated with lower 12- month survival.
CONCLUSIONS: 49% of all HM patients were alive at 7 days post-ICU discharge, and 
21% at 12 months. Survival varied based upon hematologic diagnosis and frailty 
status. Survivors had important functional disability and impairment in 
emotional, physical, and general well-being.

© 2024. Crown.

DOI: 10.1007/s00134-024-07349-z
PMID: 38466402 [Indexed for MEDLINE]


58. West J Nurs Res. 2024 Apr;46(4):296-306. doi: 10.1177/01939459241237663. Epub 
2024 Mar 11.

Implementing Longitudinal Wellbeing Interventions and Evaluation Among 
Midwestern Healthcare Workers During COVID-19.

Lally RM(1), Schmidt R(2), Kupzyk K(1), Wengel SP(3), Cordts KP(4), Mills AC(5), 
Richards SE(6)(7).

Author information:
(1)College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA.
(2)Fred & Pamela Buffett Cancer Center, Nebraska Medicine, Omaha, NE, USA.
(3)Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE, 
USA.
(4)College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
(5)Department of Psychology, Nebraska Medicine, Omaha, NE, USA.
(6)Nebraska Medicine, Omaha, NE, USA.
(7)Division of Hospital Medicine, University of Nebraska Medical Center, Omaha, 
NE, USA.

BACKGROUND: The impact of the COVID-19 pandemic on the mental health of 
healthcare workers throughout the world has been reported, but most studies have 
been cross-sectional and excluded the Midwestern U.S. healthcare workforce.
OBJECTIVE: This study aimed to longitudinally assess the psychological wellbeing 
and wellness strategies used by a Midwestern academic health system's workforce 
at multiple points throughout waves of the COVID-19 pandemic to inform ongoing 
implementation of appropriate wellness activities.
METHODS: An anonymous REDCap survey linked within our team-developed wellness 
education was posted in the employee online newsletter in April (T1), July (T2), 
October 2020 (T3), and May 2021 (T4). Surveys were open to all employees 
(approx. 9000) for approximately 12 days at each time point. Anxiety, depressive 
symptoms, stress, self-efficacy, and self-care activities were assessed. 
Following each data collection, team members discussed findings and planned 
wellness education implementation.
RESULTS: Response ranged from n = 731 (T1) to n = 172 (T4). Moderate to severe 
stress was reported by 29.5% (n = 203) of respondents at T1 and 34.0% (n = 108) 
at T2. At T3, all psychological symptoms significantly increased (p < .001) as 
COVID-19 surged, with 48.5% (n = 141) of respondents reporting moderate to 
severe stress. At T4, stress significantly declined (p < .001). Exercise was the 
most frequently reported coping strategy.
CONCLUSIONS: Mental health symptoms reported by a Midwestern healthcare 
workforce increased during surges of COVID-19 hospitalizations. Individuals in 
non-patient contact roles experienced symptom levels similar to and at times 
with greater severity than healthcare personnel with patient contact roles.

DOI: 10.1177/01939459241237663
PMID: 38465618 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting InterestsThe 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


59. Front Public Health. 2024 Feb 23;12:1354761. doi: 10.3389/fpubh.2024.1354761. 
eCollection 2024.

Honoring our teachings: children's storybooks as indigenous public health 
practice.

Maudrie TL(#)(1), Grubin F(#)(1), Conrad M(1), Velasquez Baez J(2), Saniguq 
Ullrich J(3), Allison-Burbank J(1), Martin L(1), Austin C(1), Joyner J(4), 
Ronyak M(5), Masten K(1), Ingalls A(1), Haroz EE(1), O'Keefe VM(1).

Author information:
(1)Johns Hopkins Center for Indigenous Health, Baltimore, MD, United States.
(2)Department of Molecular Biology and Biochemistry, Wesleyan University, 
Middletown, CT, United States.
(3)Institute for Research and Education to Advance Community Health (IREACH), 
Washington State University, Spokane, WA, United States.
(4)Department of Public Health, Wayne State University, Detroit, MI, United 
States.
(5)Indian Health Service, Rockville, MD, United States.
(#)Contributed equally

INTRODUCTION: American Indian and Alaska Native (AIAN) communities continue to 
flourish and innovate in the face of the COVID-19 pandemic. Storytelling is an 
important tradition for AIAN communities that can function as an intervention 
modality. To support the needs of AIAN children and caregivers, we (a 
collaborative workgroup of Indigenous health researchers) developed a culturally 
grounded storybook that provides pandemic-related public health guidance and 
mental health coping strategies woven with Inter-Tribal values and teachings.
METHODS: A collaborative workgroup, representing diverse tribal affiliations, 
met via four virtual meetings in early 2021 to discuss evolving COVID-19 
pandemic public health guidance, community experiences and responses to emerging 
challenges, and how to ground the story in shared AIAN cultural strengths. We 
developed and distributed a brief survey for caregivers to evaluate the 
resulting book.
RESULTS: The workgroup iteratively reviewed versions of the storyline until 
reaching a consensus on the final text. An AI artist from the workgroup created 
illustrations to accompany the text. The resulting book, titled Our Smallest 
Warriors, Our Strongest Medicine: Honoring Our Teachings during COVID-19 
contains 46 pages of text and full-color illustrations. An online toolkit 
including coloring pages, traditional language activities, and caregiver 
resources accompanies the book. We printed and distributed 50,024 physical 
copies of the book and a free online version remains available. An online survey 
completed by N = 34 caregivers who read the book with their child(ren) showed 
strong satisfaction with the book and interest in future books.
DISCUSSION: The development of this storybook provides insights for creative 
dissemination of future public health initiatives, especially those geared 
toward AIAN communities. The positive reception and widespread interest in the 
storybook illustrate how braiding AIAN cultural teachings with public health 
guidance can be an effective way to disseminate health information. This 
storybook highlights the importance of storytelling as an immersive learning 
experience through which caregivers and children connect to family, community, 
culture, and public health guidance. Culturally grounded public health 
interventions can be effective and powerful in uplifting AIAN cultural values 
and promoting health and well-being for present and future generations.

Copyright © 2024 Maudrie, Grubin, Conrad, Velasquez Baez, Saniguq Ullrich, 
Allison-Burbank, Martin, Austin, Joyner, Ronyak, Masten, Ingalls, Haroz and 
O’Keefe.

DOI: 10.3389/fpubh.2024.1354761
PMCID: PMC10924303
PMID: 38463160 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


60. Allergol Immunopathol (Madr). 2024 Mar 1;52(2):68-79. doi: 
10.15586/aei.v52i2.1054. eCollection 2024.

Are the presence of asthma and the COVID-19 infection associated with behavioral 
changes in Lebanese adolescents?

Azzi V(1), Karam JM(2), D'Andrea W(3)(4), Malaeb D(5), El Khatib S(6)(7), Sakr 
F(8)(9), Dabbous M(8), Hallit S(1)(10), Soufia M(1).

Author information:
(1)School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, 
Jounieh, Lebanon.
(2)Faculty of Medicine, Lebanese University, Beirut, Lebanon.
(3)The New School for Social Research, New York, NY, USA.
(4)Trauma Research Foundation, Brooklyn, MA, USA.
(5)College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates.
(6)Department of Biomedical Sciences, School of Arts and Sciences, Lebanese 
International University, Bekaa, Lebanon.
(7)Center for Applied Mathematics and Bioinformatics (CAMB), Gulf University for 
Science and Technology (GUST), Hawally, Kuwait.
(8)School of Pharmacy, Lebanese International University, Beirut, Lebanon.
(9)École Doctorale Sciences de la Vie et de la Santé, Université Paris-Est 
Créteil, Paris, France.
(10)Applied Science Research Center, Applied Science Private University, Amman, 
Jordan; souheilhallit@hotmail.com.

BACKGROUND: Little evidence is available about psychological stressors in 
Lebanese asthmatic adolescents, where health-risk behaviors are a serious threat 
to public health. In addition, the COVID-19 epidemic has had a substantial 
influence on adolescents' mental health globally, especially in Lebanon, where 
the ongoing economic and political challenges have largely impacted their 
psychological well-being. This study aimed to explore the association of asthma 
and the COVID-19 infection with behaviors among Lebanese adolescents.
METHODS: Data were collected in July 2023, using the snowball sampling 
technique. Inclusion criteria for participation in the study included being of a 
resident and citizen of Lebanon and aged 12-18 years. Behavioral problems were 
assessed using the Youth Self-Report (YSR) scale, which yields nine subscales 
(anxious/depressed, withdrawn/depressed, somatic complaints, social problems, 
thought problems, attention problems, rule-breaking behavior, aggressive 
behavior, and other problems) and a total score.
RESULTS: Asthma was significantly associated with somatic complaints (Beta [β] = 
2.98), attention problems (β = 0.01), and other behavioral problems (β = 0.68). 
Having contracted the COVID-19 infection, compared to healthy asymptomatic state 
(β = 1.55), was significantly associated with more anxious behaviors. In the 
case of stratifying the analysis in terms of gender, the results showed that the 
presence of asthma was significantly associated with more social behaviors (β = 
3.31), thought problems (β = 2.91), attention problems (β = 0.02), other 
behavioral problems (β = 1.71), and total behavioral problems (β = 5.71) in 
males. In case stratifying the analysis as to school type, the presence of 
asthma was significantly associated with more somatic complaints (β = 2.77) in 
participants from private schools whereas it was significantly associated with 
more total behavioral problems (total YSR scores) (β = 5.05) in participants 
from public schools.
CONCLUSION: It is confirmed that asthma and psychiatric disorders are 
interconnected, so it would be of great importance to include screening through 
a psychological intervention in treating asthmatic adolescents by means of (1) 
recognizing factors affecting patients' mental health, and (2) regulating 
uncontrolled behaviors that can exacerbate symptoms in order to avoid the future 
morbidity.

DOI: 10.15586/aei.v52i2.1054
PMID: 38459893 [Indexed for MEDLINE]

Conflict of interest statement: The authors have nothing to disclose.


61. J Psychosom Res. 2024 Apr;179:111625. doi: 10.1016/j.jpsychores.2024.111625. 
Epub 2024 Feb 23.

An open trial of biofeedback for long COVID.

Emerson ND(1), Lavretsky H(2), Pittman WQ(3), Viswanathan N(3), Siddarth P(2).

Author information:
(1)UCLA Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, 
United States. Electronic address: NDEmerson@mednet.ucla.edu.
(2)UCLA Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, 
United States.
(3)UCLA Department of Medicine, David Geffen School of Medicine, United States.

OBJECTIVE: Biofeedback is a therapeutic treatment model that teaches 
self-regulation of autonomic functions to alleviate stress-related symptoms. 
"Long COVID" refers to chronic physical and cognitive sequelae post-SARS-CoV-2 
infection. This study examined the efficacy of a six-week intervention, 
consisting of weekly one-hour sessions combining heart rate variability and 
temperature biofeedback, for alleviating mood symptoms, somatic symptoms and 
sleep disturbance of patients diagnosed with long COVID.
METHODS: Data were collected from 20 adult participants aged 22-63 (Mage = 44.1, 
SDage = 12.2) with varying long COVID symptoms. Within this single arm design, 
16 of the 20 participants completed all six sessions of biofeedback; 14 
completed an assessment at the three-month post-treatment time point.
RESULTS: Participants self-reported significant improvements in somatic, 
anxiety, and depressive symptoms, sleep quality, quality of life, and number of 
"bad days" immediately after the intervention and three months later (Cohen's d 
effect size (ES) = 1.09-0.46). Reduced number of medical doctor visits 
(ES = 0.85) and prescription drug use over the last month (odds ratio = 0.33), 
as well as improved emotional wellbeing (ES = 0.97) were observed at the 
three-month time point only.
CONCLUSION: Results suggest that this short, readily scalable intervention can 
be potentially efficacious in alleviating symptoms of long COVID. Despite 
notable improvements, the major limitation of this study is its lack of control 
group. While a randomized trial merits study, biofeedback appears to be a brief, 
effective, non-invasive, and low-cost treatment option for patients with chronic 
somatic symptoms secondary to SARS-CoV-2 infection.
CLINICALTRIALS: govID: NCT05120648.

Copyright © 2024 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jpsychores.2024.111625
PMID: 38458016 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest None.


62. Medicine (Baltimore). 2024 Mar 8;103(10):e37391. doi: 
10.1097/MD.0000000000037391.

Psychological status of residents at the onset of nationwide COVID-19 lockdown 
in low- and medium-risk areas of China.

Liao Y(1), Liao M(2), Yang Y(3), Zhou Z(3), Du X(1).

Author information:
(1)Department of Oncology, MianYang Central Hospital, School of Medicine, 
University of Electronic Science and Technology of China, Mianyang, Sichuan 
Province, China.
(2)Department of Information, MianYang Central Hospital, School of Medicine, 
University of Electronic Science and Technology of China, Mianyang, Sichuan 
Province, China.
(3)Department of Laboratory, MianYang Central Hospital, School of Medicine, 
University of Electronic Science and Technology of China, Mianyang, Sichuan 
Province, China.

The coronavirus disease 2019 (COVID-19), a dual threat to public physical and 
mental health, prompted an investigation into the psychological well-being of 
residents in low- to medium-risk areas of China during the initial stages of the 
pandemic. We administered WeChat-based questionnaire surveys and employed 
chi-square tests and multiple logistic regression to analyze correlations 
between residents' age, gender, education, symptoms, COVID-19 close contact 
history, information sources, and anxiety, depression, and attitudes toward 
lockdown measures. We received 10,433 valid questionnaires, revealing 26% 
anxiety and 19.5% depression. Support for lockdown measures reached 98.2%. 
Factors such as female gender, self-diagnosed pneumonia symptoms, close contact 
history, and higher education levels increased anxiety risk. Having a doctorate 
posed a severe anxiety risk, at 4.5 times (P = .019, 95% CI 1.29-15.73). Older 
age acted as a protective factor, reducing severe anxiety risk to 0.98 and 0.22 
times (P < .001, 95% CI 0.14-0.34). Females with a master degree or below and 
those receiving COVID-19 information from multiple channels faced higher 
depression risk. Pneumonia symptoms were a risk for all anxiety and depression 
degrees. Attitudes toward lockdown measures had no significant impact on 
psychological status, nor did any of the analyzed factors affect residents' 
overall attitude toward lockdown. Our findings underscore the need for increased 
psychological counseling, particularly for young females with lower educational 
backgrounds or self-suspected infection symptoms, to mitigate mild to moderate 
anxiety and depression in future epidemics or pandemics. The public, especially 
those of working age with doctorates or higher education, bears the highest risk 
of severe anxiety. Lockdown measures enjoy strong support in low- to medium-risk 
areas of China.

Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

DOI: 10.1097/MD.0000000000037391
PMCID: PMC10919516
PMID: 38457587 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no funding and conflicts of 
interest to disclose.


63. CNS Spectr. 2024 Apr;29(2):150-154. doi: 10.1017/S1092852924000099. Epub 2024 
Mar 8.

Impact of Baseline Anxiety on Well-being in People with Post-COVID-19 Condition: 
A Secondary Analysis.

Kleine N(1), Kwan ATH(1)(2), Le GH(1)(3), Guo Z(1), Phan L(1), Subramaniapillai 
M(1), McIntyre RS(1)(4)(5).

Author information:
(1)Brain and Cognition Discovery Foundation, Toronto, ON, Canada.
(2)Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
(3)Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
(4)Department of Pharmacology and Toxicology, University of Toronto, Toronto, 
ON, Canada.
(5)Department of Psychiatry, University of Toronto, Toronto, ON, Canada.

BACKGROUND: Post-COVID-19 condition (PCC) is associated with a host of 
psychopathological conditions including prominent anxiety symptoms. However, it 
is not known what effect anxious symptoms have on measures of well-being in 
individuals living with PCC. This study aims to evaluate anxiety's association 
with measures of well-being in people with PCC.
METHODS: This is a post hoc analysis utilizing data from a placebo-controlled, 
randomized, double-blind clinical trial assessing the effect of vortioxetine on 
cognitive impairment in individuals with PCC (NCT05047952). Baseline data with 
respect to anxiety and well-being were collected using the Generalized Anxiety 
Disorder Scale, 7-Item (GAD-7), and the World Health Organization (WHO) 
Well-Being Index, 5-Item (WHO-5), respectively. A generalized linear model (GLM) 
analysis on baseline GAD-7 and WHO-5 scores was conducted with age, sex, 
employment status, education level, previous major depressive disorder (MDD) 
diagnosis, and confirmed COVID-19 cases as covariates.
RESULTS: Data was analyzed in a sample of 144 participants (N = 144). After 
controlling for the aforementioned covariates, the results found that GAD-7 and 
WHO-5 scores had a significant negative correlation (β = -0.053, p = <0.001), 
signifying that increased anxiety had adverse effects on the overall well-being 
of individuals with PCC.
CONCLUSION: Herein, we observed a clinically meaningful level of anxiety in 
individuals with PCC. We also identified a robust correlation between anxiety in 
PCC and measures of general well-being. Our results require replication, 
providing the impetus for recommending screening and targeting anxious symptoms 
as a tactic to improve general well-being and outcomes in individuals with PCC.

DOI: 10.1017/S1092852924000099
PMID: 38453677 [Indexed for MEDLINE]


64. BMJ Open. 2024 Mar 7;14(3):e079350. doi: 10.1136/bmjopen-2023-079350.

Did the COVID-19 pandemic affect levels of burnout, anxiety and depression among 
doctors and nurses in Bangladesh? A cross-sectional survey study.

Hutchings HA(1), Rahman M(2), Carter K(3), Islam S(3), O'Neill C(3), Roberts 
S(3), John A(3), Fegan G(3), Dave U(2), Hawkes N(4), Ahmed F(5), Hasan M(6), 
Azad AK(7), Rahman MM(7), Kibria MG(8), Rahman MM(9), Mia T(10), Akhter M(10), 
Williams JG(11).

Author information:
(1)Swansea University, Swansea, UK h.a.hutchings@swansea.ac.uk.
(2)Swansea Bay University Health Board, Port Talbot, UK.
(3)Swansea University, Swansea, UK.
(4)Cwm Taf Morgannwg University Health Board, Abercynon, UK.
(5)Department of Gastroenterology, Sheikh Russel National Gastroliver Institute 
and Hospital, Dhaka, Bangladesh.
(6)Gastroliver Foundation, Dhaka, Bangladesh.
(7)Dhaka Medical College and Hospital, Dhaka, Bangladesh.
(8)Sheikh Russel National Gastroliver Institute, Dhaka, Bangladesh.
(9)Sheik Russel National Gastroliver Institute, Dhaka, Bangladesh.
(10)Mugda Medical College and Hospital, Dhaka, Bangladesh.
(11)Faculty of Medicine, Health and Life Science, Swansea University, Swansea, 
UK.

INTRODUCTION: COVID-19 has caused severe disruption to clinical services in 
Bangladesh but the extent of this, and the impact on healthcare professionals is 
unclear. We aimed to assess the perceived levels of anxiety, depression and 
burnout among doctors and nurses during COVID-19 pandemic.
METHODS: We undertook an online survey using RedCap, directed at doctors and 
nurses across four institutions in Bangladesh (The Sheikh Russel Gastro Liver 
Institute & Hospital (SRNGIH), Dhaka Medical College Hospital (DMCH), Mugda 
Medical College Hospital (MMCH) and M Abdur Rahim Medical College (MARMC) 
Hospital). We collected information on demographics, awareness of well-being 
services, COVID-19-related workload, as well as anxiety, depression and burnout 
using two validated questionnaires: the Hospital Anxiety and Depression Scale 
(HADS) and the Maslach Burnout Inventory (MBI).
RESULTS: Of the 3000 participants approached, we received responses from 2705 
(90.2%). There was a statistically significant difference in anxiety, depression 
and burnout scores across institutions (p<0.01). Anxiety, depression and burnout 
scores were statistically worse in COVID-19 active staff compared with those not 
working on COVID-19 activities (p<0.01 for HADS anxiety and depression and MBI 
emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment 
(PA)). Over half of the participants exhibited some level of anxiety (SRNGIH: 
52.2%; DMCH: 53.9%; MMCH: 61.3%; MARMC: 68%) with a high proportion experiencing 
depression (SRNGIH: 39.5%; DMCH: 38.7%; MMCH: 53.7%; MARMC: 41.1%). Although 
mean burnout scores were within the normal range for each institution, a high 
proportion of staff (almost 20% in some instances) were shown to be classified 
as experiencing burnout by their EE, DP and PA scores.
CONCLUSION: We identified a high prevalence of perceived anxiety, depression and 
burnout among doctors and nurses during the COVID-19 pandemic. This was worse in 
staff engaged in COVID-19-related activities. These findings could help 
healthcare organisations to plan for future similar events.

© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2023-079350
PMCID: PMC10921535
PMID: 38453200 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


65. PLoS One. 2024 Mar 7;19(3):e0299638. doi: 10.1371/journal.pone.0299638. 
eCollection 2024.

New in Town-An internet-based self-efficacy intervention for internal migrants: 
A randomized controlled trial.

Maj A(1), Matynia M(1), Michalak N(1), Bis A(1), Andersson G(2)(3).

Author information:
(1)Faculty of Psychology, SWPS University, Warsaw, Poland.
(2)Department of Behavioural Sciences and Learning, Department of Biomedical and 
Clinical Sciences, Linköping University, Linköping, Sweden.
(3)Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, 
Sweden.

OBJECTIVE: Migration is a profound life transition that may threaten migrants' 
well-being and mental health. Results of several studies suggest that social 
self-efficacy beliefs may be beneficial for the psychological adjustment of 
migrants, buffering the effect of specific stressors related to migration, 
helping them reduce anxiety levels, and providing support in forming of new 
social bonds and better integration with a new community or culture. The primary 
purpose of this randomized controlled trial was to examine the effectiveness of 
the New in Town internet-based self-efficacy intervention for internal migrants 
in Poland.
METHODS: Participants were 158 internal adult migrants who had changed residence 
in the last 6 months. They were randomized into two groups: an experimental 
group (receiving an internet-based self-efficacy intervention), and a waiting 
list control group. We examined if the intervention was effective in enhancing 
participants' social self-efficacy (primary outcome), general self-efficacy, 
social support, satisfaction with life, and reduced reported loneliness 
(secondary outcomes). Outcome measures were assessed at baseline (Time 1) and 
3-weeks later (Time 2). The dropout rate was 50.6%. Initially, we planned to 
gather follow-up data also 8-weeks after baseline (Time 3). However, due to 
health and safety reasons related to the COVID-19 pandemic, we decided to stop 
the trial. Finally, we included in our analysis only data gathered before the 
COVID-19 pandemic at Time 1 and Time 2.
RESULTS: A total of 159 individuals who met the study's inclusion criteria and 
completed the baseline assessment were randomly assigned to either the 
experimental group (n = 80) or the waiting list control group (n = 79). 
Nevertheless, one participant assigned to the control group was excluded from 
the analyses because they withdrew their consent to participate after being 
randomized. The study results suggest that compared to the waitlist control 
group (n = 78), participants in the experimental group (n = 80) reported a 
higher level of general self-efficacy beliefs at Time 2 (Cohen's d = 0.47; 95% 
CI: 0.15-0.79). However, there were no statistically significant effects on 
social self-efficacy, social support, satisfaction with life, and loneliness.
CONCLUSION: The study offers preliminary support for the effectiveness of an 
internet-based self-efficacy intervention designed for internal migrants on 
general self-efficacy beliefs.
TRIAL REGISTRATION: The trial was registered with ClinicalTrials.gov 
(identifier: NCT04088487) on 11th September 2019.

Copyright: © 2024 Maj et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0299638
PMCID: PMC10919843
PMID: 38452136 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


66. PLoS One. 2024 Mar 7;19(3):e0285650. doi: 10.1371/journal.pone.0285650. 
eCollection 2024.

Variations in anxiety and emotional support among first-year college students 
across different learning modes (distance and face-to-face) during COVID-19.

Ramírez-Martínez FR(1), Villanos MT(2), Sharma S(2), Leiner M(1).

Author information:
(1)Department of Extension and Students Services. Universidad Autónoma de Ciudad 
Juárez, Chihuahua, México.
(2)Department of Pediatrics, Texas Tech University Health Sciences Center, El 
Paso, Texas, United States of America.

College students with more emotional support experience lower levels of anxiety 
and other psychosocial and behavioral problems. During the COVID-19 pandemic, 
the emotional well-being of college students was additionally challenged by an 
abrupt shift to distance learning followed by a return to face-to-face classes. 
In this exploratory study, we compared the levels of perceived emotional support 
and anxiety among incoming first-year undergraduate students, prior to starting 
classes, which included different learning modes in five semesters of 
instruction from 2021-2023 (three distance semesters and two face-to-face 
semesters). Data from 8659 undergraduate students were extracted from a Mexican 
state university database, corresponding to students' responses collected during 
new student orientation week. Participants were students in the arts and 
humanities (9.7%), social and legal sciences (38%), life and health sciences 
(28.9%), and engineering and architecture (23.4%). Anxiety levels were measured 
with the GAD-7 scale, and emotional support was measured using a subscale of the 
PERACT-R (To go through with resilience) inventory. Comparisons of emotional 
support and anxiety scores among semesters revealed highly significant 
differences with small effect sizes. Anxiety levels increased significantly with 
mean average of 6.65 SD(5.52) during the baseline measure to the highest in 
2022-2 to 7.53 SD(5.3) and Emotional Support decreased systematically each 
semester from baseline mean = 8.03 SD(2.0) to the lowest 7.52 SD(1.8) in 2022-2. 
The results show that a return to face-to-face classes was associated with 
increased anxiety levels, whereas levels of emotional support systematically 
decreased across the five semesters. MANOVA analysis revealed significant 
differences in anxiety and emotional support scores between semesters, with 
peaks during the learning mode semester that students returned to face-to-face 
classes after distance learning even after adjusting for gender. Given that the 
effect of emotional support on anxiety may be related to success in future 
educational and professional activities, it is important to develop 
interventions to restore and increase college students' emotional support levels 
and develop anxiety management strategies.

Copyright: © 2024 Ramírez-Martínez et al. This is an open access article 
distributed under the terms of the Creative Commons Attribution License, which 
permits unrestricted use, distribution, and reproduction in any medium, provided 
the original author and source are credited.

DOI: 10.1371/journal.pone.0285650
PMCID: PMC10919625
PMID: 38451887 [Indexed for MEDLINE]

Conflict of interest statement: NO authors have competing interests.


67. BMC Health Serv Res. 2024 Mar 6;24(1):302. doi: 10.1186/s12913-024-10730-9.

Workforce wellbeing centres and their positive role for wellbeing and 
presenteeism in healthcare workers during the COVID-19 pandemic: secondary 
analysis of COVID-Well data.

Blake H(1)(2), Mancini H(3), Coyne E(4), Cooper J(5), Stanulewicz-Buckley N(6).

Author information:
(1)School of Health Sciences, University of Nottingham, Nottingham, UK. 
holly.blake@nottingham.ac.uk.
(2)NIHR Nottingham Biomedical Research Centre, Nottingham, UK. 
holly.blake@nottingham.ac.uk.
(3)Human Resources, Nottingham University Hospitals NHS Trust, Nottingham, UK.
(4)Clinical Psychology Department, Nottingham University Hospitals NHS Trust, 
Nottingham, UK.
(5)Nursing and Midwifery, Nottingham University Hospitals NHS Trust, Nottingham, 
UK.
(6)School of Psychology, Aston University, Birmingham, UK.

BACKGROUND: Supported wellbeing centres established during the COVID-19 pandemic 
provided high quality rest spaces and access to peer-to-peer psychological first 
aid for healthcare workers (HCWs). The centres were well accessed and valued by 
HCWs, but their relationship with wellbeing and job-related factors is not well 
established. The aim of this study was to explore the relationship between 
wellbeing centre use, HCWs wellbeing and job-related factors (job stressfulness, 
job satisfaction, presenteeism, turnover intentions).
METHODS: Secondary analysis of data from 819 HCWs from an acute hospital trust 
who completed an online survey in April-July 2020, as part of the COVID-Well 
study. Measures included the Warwick Edinburgh Mental Wellbeing Scale, and four 
single-item global measures of job stressfulness, job satisfaction, presenteeism 
and turnover intentions. ANCOVA models and regression analyses were conducted on 
these data.
RESULTS: HCWs who had not accessed the wellbeing centres had lower wellbeing 
(β = 0.12, p < .001), higher job stressfulness (β = - 0.22, p < .001), lower job 
satisfaction (β = 0.39, p < .001), higher presenteeism (β = - 0.22, p < .001) 
and were of younger age (β = 0.09, p = .002). Centre use was associated with 
wellbeing irrespective of job stressfulness. Those reporting presenteeism and 
who accessed the centre (M = 3.30, SE = 0.04) had higher wellbeing than those 
who accessed the centre but did not report presenteeism (M = 3.06, SE = 0.04) 
(F(1, 791) = 18.65, p < .001, ηp2 = 0.02). Centre use was not significantly 
associated with turnover intentions (B = - 0.30, p = .13; Wald = 2.26; 
odds = 0.74), while job stress and job satisfaction showed significant effects.
CONCLUSIONS: Accessing wellbeing centres was associated with higher wellbeing of 
HCWs, particularly for those reporting presenteeism. Therefore, the centres may 
have provided greatest respite and restoration for those present at work but not 
in optimal health. Younger workers were disproportionately affected in terms of 
wellbeing, and targeted support for this population is needed. Strategies to 
decrease presenteeism and maximise job satisfaction are urgently required. 
Healthcare organisations should provide rest spaces and psychological support to 
HCWs for the long-term, as part of a systems-wide approach to improving 
workforce health and wellbeing.

© 2024. The Author(s).

DOI: 10.1186/s12913-024-10730-9
PMCID: PMC10918935
PMID: 38448919 [Indexed for MEDLINE]

Conflict of interest statement: H.M., E.C., and J.C. were employed by the 
participating hospital trust at the time of the study but were not involved in 
data curation or analysis. H.M. and E.C. were involved in service delivery. H.B. 
and N.S.B. declare no conflicts of interest.


68. BMJ Open. 2024 Mar 5;14(3):e075321. doi: 10.1136/bmjopen-2023-075321.

Impact of the economic crisis, COVID-19 and the Beirut explosion on 
ophthalmology training in Lebanon: an observational cohort survey-based study.

Ghannam AB(1), Ibrahim HA(1), Hammoud B(1), Hamam R(2).

Author information:
(1)Department of Ophthalmology, American University of Beirut, Beirut, Lebanon.
(2)Department of Ophthalmology, American University of Beirut, Beirut, Lebanon 
rh46@aub.edu.lb.

OBJECTIVES: The objective of the study is to investigate the effects of the 
COVID-19 pandemic, the economic crisis and the Beirut explosion on the training 
and work of ophthalmology residents and faculty in Lebanon.
DESIGN: This is an observational cohort survey-based research conducted between 
January and December 2022.
SETTING: The study targeted all ophthalmology residents and core faculty in 
Lebanon.
PARTICIPANTS: A total of 52 participants, including 27 residents and 25 core 
faculty members, completed the survey.
PRIMARY OUTCOME MEASURE: Primary outcomes comprised the subjectively reported 
effect of the three major external stressors on the training and well-being of 
ophthalmology trainees and educators in Lebanon.
RESULTS: The study found that the majority of ophthalmology residents and core 
faculty members were significantly affected by the COVID-19 pandemic, Beirut 
explosion and the economic crisis in Lebanon. Significant percentage reported 
financial burden, decrease in outpatient and surgical load and educational 
activities. Furthermore, most participants reported higher levels of stress, 
anxiety and depression during the time of crises.
CONCLUSIONS: This study emphasises the need to support healthcare professionals 
during times of crisis, as they are on the frontlines and can experience high 
levels of stress, anxiety and depression. By providing support and resources to 
healthcare professionals, they can better cope with the challenges they face and 
continue to provide essential care to their patients.

© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2023-075321
PMCID: PMC10916134
PMID: 38448079 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


69. Front Psychol. 2024 Feb 20;15:1293171. doi: 10.3389/fpsyg.2024.1293171. 
eCollection 2024.

"Trust people you've never worked with" - A social network visualization of 
teamwork, cohesion, social support, and mental health in NHS Covid personnel.

Schilling S(1)(2), Armaou M(3), Morrison Z(4), Carding P(5), Bricknell M(6), 
Connelly V(2).

Author information:
(1)Psychology, Faculty of Health and Life Sciences, University of Exeter, 
Exeter, United Kingdom.
(2)Department of Psychology, Health and Professional Development, Oxford Brookes 
University, Oxford, United Kingdom.
(3)School of Health Sciences, University of Nottingham, Nottingham, United 
Kingdom.
(4)Aberdeen Business School, Robert Gordon University, Aberdeen, United Kingdom.
(5)Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford 
Brookes University, Oxford, United Kingdom.
(6)King's College London, School of Security Studies, London, United Kingdom.

BACKGROUND: The unprecedented rapid re-deployment of healthcare workers from 
different care pathways into newly created and fluid COVID-19 teams provides a 
unique opportunity to examine the interaction of many of the established 
non-technical factors for successful delivery of clinical care and teamwork in 
healthcare settings. This research paper therefore aims to address these gaps by 
qualitatively exploring the impact of COVID work throughout the pandemic on 
permanent and deployed personnel's experiences, their ability to effectively 
work together, and the effect of social dynamics (e.g., cohesion, social 
support) on teamwork and mental health.
METHODS: Seventy-five interviews were conducted across the UK between March and 
December 2021 during wave 2 and 3 of COVID-19 with 75 healthcare workers who 
were either permanent staff on Intensive Care/High Dependency Units used as 
COVID wards, had been rapidly deployed to such a ward, or had managed such 
wards. Work Life Balance was measured using the WLB Scale. Interview transcripts 
were qualitatively coded and thematic codes were compared using network graph 
modeling.
RESULTS: Using thematic network analysis, four overarching thematic clusters 
were found, (1) teamwork, (2) organizational support and management, (3) 
cohesion and social support, and (4) psychological strain. The study has three 
main findings. First, the importance of social factors for teamwork and mental 
health, whereby team identity may influence perceptions of preparedness, 
collaboration and communication, and impact on the collective appraisal of 
stressful events and work stressors. Secondly, it demonstrates the positive and 
negative impact of professional roles and skills on the development of teamwork 
and team identity. Lastly the study identifies the more pronounced negative 
impact of COVID work on deployed personnel's workload, mental health, and career 
intentions, exacerbated by reduced levels of social support during, and after, 
their deployment.
CONCLUSION: The thematic network analysis was able to highlight that many of the 
traditional factors associated with the successful delivery of patient care were 
impeded by pandemic constraints, markedly influencing personnel's ability to 
work together and cope with pandemic work stressors. In this environment 
teamwork, delivery of care and staff well-being appear to depend on relational 
and organizational context, social group membership, and psycho-social skills 
related to managing team identity. While results hold lessons for personnel 
selection, training, co-location, and organizational support during and after a 
pandemic, further research is needed into the differential impact of pandemic 
deployment on HCWs mental health and teamwork.

Copyright © 2024 Schilling, Armaou, Morrison, Carding, Bricknell and Connelly.

DOI: 10.3389/fpsyg.2024.1293171
PMCID: PMC10913897
PMID: 38445057

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


70. Soc Work Public Health. 2024 Jan 2;39(1):48-61. doi: 
10.1080/19371918.2024.2316874. Epub 2024 Mar 5.

Entrepreneurship in the Favela: Negotiating Precarity and Mental Health During 
Covid-19.

Garcia MLT(1), Spolander G(2)(3)(4), Tomlins R(5), Xavier Leal F(6), Santana 
Borges RE(6), Sukumar A(5).

Author information:
(1)Programa de Pós-Graduação em Política Social, Federal University of Espírito 
Santo, Vitória, Brazil.
(2)School of Applied Social Studies, Robert Gordon University, Aberdeen, UK.
(3)Extraordinary Professor of Social Work, Centre for Interdisciplinary Studies 
of Children, Families and Society, University of Western Cape, Cape Town, South 
Africa.
(4)Honorary Professor of Global Health and Social Care, University of Keele, 
Newcastle, UK.
(5)International Office, Coventry University, UK.
(6)International Centre for Transformational, Coventry University, Coventry, UK.

This paper aims to explore the impact of the COVID-19 pandemic on the health and 
mental health of necessary entrepreneurs in Brasilian favelas, the social 
problems they experienced and implications for public health social work. The 
study used structured in-person interviews within selected Favela's, with a 
sample size of 721 entrepreneurs, aged between 16-70 years. All participants 
both worked and were resident in 15 out of the 27 Brasilian federal states. The 
bespoke questions explored socio-demographic questions, sought information on 
their entrepreneurship, health and administered the Warwick-Edinburgh Mental 
Wellbeing Scale for Health. The results highlighted that many entrepreneurs have 
engaged in this form of enterprise due to economic necessity, with 64% of women 
and 43.6% of men identifying increased levels of anxiety through the pandemic, 
with the presence of children in the family being statistically significant 
(p ≤ 0.05 chi-square test) for anxiety. Of the 9.8% sample respondents have 
accessed the health care service and for women with children, the impact of the 
pandemic accentuated existing problems of childcare and patriarchy. We conclude 
by highlighting the importance of universal and accessible health and mental 
health support and care, their ongoing accessibility, along with the importance 
of social work during crisis.

DOI: 10.1080/19371918.2024.2316874
PMID: 38439702 [Indexed for MEDLINE]


71. BMC Psychol. 2024 Mar 2;12(1):116. doi: 10.1186/s40359-024-01610-2.

Covid-19 psychological pressures, depression and FOMO: the mediating role of 
online social support and emotional regulation.

Dong Y(1)(2), Chen M(3), Wu Z(3), Zhang Z(4).

Author information:
(1)School of Education, Northwest Normal University, Lanzhou, 730070, Gansu, 
China. YutingDong6699@outlook.com.
(2)School of Energy and Mechanical Engineering, Jiangxi University of Science 
and Technology, Nanchang, 330000, Jiangxi, China. YutingDong6699@outlook.com.
(3)School of Energy and Mechanical Engineering, Jiangxi University of Science 
and Technology, Nanchang, 330000, Jiangxi, China.
(4)Historic Building Division, China Construction First Division Group Huajiang 
Construction Co., Ltd, Jingdezhen, 333099, Jiangxi, China.

BACKGROUND: The spread of the coronavirus has led to significant anxiety among 
university students, resulting in various mental health problems that could 
potentially impact their academic performance.
METHOD: To examine the mediating role of emotional regulation and online social 
support in the relationships between COVID-19 psychological pressures, 
depression, and the fear of missing out (FoMO) among young adult university 
students, a cross-sectional research design was employed using an online survey. 
The sample consisted of 521 full-time university students from China, currently 
enrolled in undergraduate and postgraduate programs.
RESULTS: Findings revealed that more than half (55.09%, n=287) of the university 
students experienced COVID-19 psychological pressures. These pressures directly 
contributed to increased levels of depression (β = 0.339, p < .001) and fear of 
missing out (β = 0.236, p < .001). Moreover, online social support and emotional 
regulation exhibited partial mediating effects on the association between 
COVID-19 psychological pressures, depression, and the fear of missing out. The 
results indicated that COVID-19 psychological pressures were linked to higher 
levels of depressive symptoms and a greater fear of missing out among university 
students.
CONCLUSIONS: However, the provision of timely and adequate online social 
support, as well as the implementation of emotional regulation strategies, 
mitigated the negative effects of the pandemic on students' social and emotional 
well-being. Consequently, this led to reduced levels of depression and fear of 
missing out.

© 2024. The Author(s).

DOI: 10.1186/s40359-024-01610-2
PMCID: PMC10908053
PMID: 38431605 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


72. Sci Total Environ. 2024 May 1;923:171392. doi: 10.1016/j.scitotenv.2024.171392. 
Epub 2024 Feb 29.

A systematic review of the relationship between natural environments and 
physiological and mental health during different stages of the COVID-19 
pandemic.

Yen MH(1), Li D(2), Chiang YC(3).

Author information:
(1)Department of Landscape Architecture, National Chiayi University, Chiayi 
City, Taiwan, ROC.
(2)Department of Landscape Architecture & Urban Planning, Texas A&M University, 
College Station, TX, USA.
(3)Department of Landscape Architecture, National Chiayi University, Chiayi 
City, Taiwan, ROC. Electronic address: ycchiang@mail.ncyu.edu.tw.

COVID-19 has altered how individuals interact with natural environments. 
Numerous studies have investigated the effects of such environments on health. 
However, how natural environments influenced individuals' physiological and 
mental health during various stages of the COVID-19 pandemic remains unclear. 
Therefore, we conducted this study to investigate the effects of natural 
environments on individuals' physiological and mental health during different 
stages of the pandemic; we also identified factors that mediated these effects. 
Overall, we evaluated the importance of natural environments during challenging 
times. This study adhered to the Preferred Reporting Items for Systematic Review 
and Meta-Analysis guidelines. The pandemic period was divided into three stages 
on the basis of severity: pandemic (March 2020 - February 2022), easing 
(February 2022-September 2022), and post-acute COVID pandemic (September 2022 - 
present). An initial pool of 3018 studies was narrowed down to a final sample of 
73 studies. During the pandemic stage, individuals frequenting public green 
spaces exhibited improved well-being, reduced stress levels, and a sense of 
nature deprivation. Private green spaces played crucial roles in maintaining 
health during the pandemic stage. Highquality window views were associated with 
improved well-being and reduced depression. During the easing stage, the 
environmental quality of public green spaces influenced individuals' perceived 
safety and sense of belonging. And coastal areas were the preferred natural 
destinations in this stage. During the post-acute COVID pandemic stage, 
individuals acknowledged the importance of natural environments in maintaining 
physiological and mental health as they gradually returned to prepandemic 
normalcy. In conclusion, the COVID-19 pandemic highlighted humanity's reliance 
on nature. Therefore, sufficient urban spaces should be dedicated to 
preservation of natural environments to mitigate negative emotions arising from 
prolonged indoor stays.

Copyright © 2024 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.scitotenv.2024.171392
PMID: 38431171 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


73. Psychiatry Res. 2024 Apr;334:115802. doi: 10.1016/j.psychres.2024.115802. Epub 
2024 Feb 18.

From facts to feelings: Navigating the complexities of COVID-19 restrictions, 
perceptions, and mental well-being.

Gregory MA(1), Reeves JTH(1), Danyluk A(1), Legg NK(1), Phiri P(2), Rathod S(3), 
Turner BJ(1), Paterson TSE(4).

Author information:
(1)Department of Psychology, University of Victoria, Victoria, BC, Canada.
(2)Research and Innovation Department, Southern Health NHS Foundation Trust, 
Southampton, Great Britain; Psychology Department, Faculty of Environment and 
Life Sciences, University of Southampton, UK.
(3)Research and Innovation Department, Southern Health NHS Foundation Trust, 
Southampton, Great Britain.
(4)Department of Psychology, University of Victoria, Victoria, BC, Canada; 
Neuropsychology and Cognitive Health, Baycrest Health Sciences Centre, Toronto, 
ON, Canada. Electronic address: tpaterson@uvic.ca.

Objectives of the present study were to 1) examine accuracy of COVID-19 public 
health restriction knowledge and the impact of information source, 2) assess the 
effect of perceived level of restriction on perceived infection risk of COVID-19 
infection and level of compliance with restrictions, and 3) investigate the 
relationship between mental health outcomes and perceived as well as actual 
level of restriction. Canadians (n = 5,051) completed an online survey between 
December 2020 and March 2021 assessing public health restriction knowledge, 
accuracy of this knowledge, information sources about COVID-19, perceived 
infection risk, compliance with restrictions, loneliness, anxiety, and 
depressive symptoms. Approximately half of our sample had accurate knowledge of 
the restrictions in their region/province, which significantly differed by 
province. Individuals who perceived restriction levels to be higher than they 
were, reported significantly greater perceived infection risk, more compliance 
with restrictions, worse mental health, and greater loneliness. Individuals 
living under moderate restrictions had better mental health and experienced less 
loneliness compared to minor, significant and extreme restriction levels. 
Findings suggest that while restrictions are beneficial for compliance, stronger 
and clearer restrictions should be coupled with mental health supports to 
remediate the negative effects of restrictions and uncertainty on mental health 
and loneliness.

Copyright © 2024. Published by Elsevier B.V.

DOI: 10.1016/j.psychres.2024.115802
PMID: 38428287 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare no conflicts of interest.


74. Curationis. 2024 Feb 19;47(1):e1-e12. doi: 10.4102/curationis.v47i1.2477.

Psychological distress among South African healthcare workers during the 
COVID-19 pandemic.

Ramlagan S(1), Sewpaul R, Shean Y, Schmidt T, North A, Reddy SP.

Author information:
(1)Department of Human and Social Capabilities, Human Sciences Research Council, 
Pretoria. sramlagan@hsrc.ac.za.

BACKGROUND: The COVID-19 pandemic has placed immense pressure on healthcare 
workers (HCWs).
OBJECTIVES: This study sought to find the prevalence and factors associated with 
psychological distress among HCWs in South Africa during the beginning phases of 
COVID-19 and make relevant recommendations.
METHOD: The survey was administered online through a data-free platform. Data 
were benchmarked to the national population of over 500 000 healthcare 
professionals in South Africa. Multiple logistic regressions were used to 
determine association between psychological distress and potential explanatory 
variables.
RESULTS: A total of 7607 healthcare professionals participated in the study 
(1760 nurses, 2843 medical practitioners and 3004 other healthcare 
professionals). Half of the nurses, 41% of medical practitioners and 47% of 
other healthcare professionals were classified as psychologically distressed. 
Those who were of older age, provided with well-being support services and 
having a positive outlook on the healthcare system were significantly less 
likely to be distressed. Being female medical practitioners and female other 
healthcare professions, requesting routine counselling, being concerned about 
not having enough leave and that their life insurance policy did not cover 
COVID-19 were more likely to be distressed.
CONCLUSION: Psychological well-being of HCWs in South Africa is at risk. We 
recommend that psychological distress of HCWs be routinely assessed and that 
routine counselling, well-being support services, appropriate hazardous leave 
and insurance be provided to all HCWs.Contribution: This study adds to the 
literature on the psychological distress faced by HCWs in South Africa during 
COVID-19.

DOI: 10.4102/curationis.v47i1.2477
PMCID: PMC10912894
PMID: 38426792 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no financial 
or personal relationship(s) that may have inappropriately influenced them in 
writing this article.


75. Front Nutr. 2024 Feb 14;10:1294549. doi: 10.3389/fnut.2023.1294549. eCollection 
2023.

Premature Infant Gut Microbiome relationships with childhood behavioral scales: 
preliminary insights.

Ozorio Dutra SV(#)(1)(2)(3), Sarkar A(#)(2)(3), Yoo JY(2)(3), Shaffer-Hudkins 
E(4), Groer M(2)(3).

Author information:
(1)Nancy Atmospera-Walch School of Nursing, University of Hawaii at Manoa, 
Honolulu, HI, United States.
(2)College of Nursing, University of South Florida, Tampa, FL, United States.
(3)College of Nursing, University of Tennessee-Knoxville, Knoxville, TN, United 
States.
(4)College of Medicine Pediatrics, Morsani College of Medicine, University of 
South Florida, Tampa, FL, United States.
(#)Contributed equally

INTRODUCTION: Very Low Birth Weight (VLBW) infants, born weighing less than 
1,500 grams, are at risk for both gut dysbiosis and later neuropsychological 
developmental deficits. Behavioral effects, while related to neurodevelopment, 
are often more subtle and difficult to measure. The extent of later 
neurobehavioral consequences associated with such microbial dysbiosis has yet to 
be determined. We explored associations between the infants' gut microbiome and 
early childhood behavior at 4 years of age and identified the bacterial taxa 
through a multivariate analysis by linear models.
METHODS: Parents completed the Child Behavior Checklist (CBCL) focused on 
different DSM diagnostic categories: affective, anxiety, pervasive 
developmental, attention deficit/hyperactivity, and oppositional defiant. All 
the CBCL scores were corrected for gender, delivery method, gestational age, 
infant birth weight, occurrence of sepsis, and days on antibiotics prior 
statistical analyses. Canonical correlation analysis (CCA) was performed to 
determine the relationship between early life gut microbiome and the adjusted 
CBCL scores. The association of bacterial Amplicon sequence Variants (ASVs) to 
the CBCL scores were tested with multivariate analysis by linear models 
(MaAsLin).
RESULTS: Nineteen children who were previously born with very low birth weight 
and studied while hospitalized in the Neonatal Intensive Care Unit (NICU) were 
included in this study. Statistically significant associations were observed 
between early life gut bacteria such as Veillonella dispar, Enterococcus, 
Escherichia coli, and Rumincococcus to later behavior at 4 years. No significant 
association could be observed with early-life gut microbiome alpha diversity and 
behavioral measures at 4 years.
DISCUSSION: These preliminary observational data provide insight into the 
relationships between VLBW gut microbiome dysbiosis and childhood behavior. This 
study contributes to the literature on gut microbiome analysis by examining 
various behavioral domains using a standardized tool linked to the Diagnostic 
and Statistical Manual of Mental Disorders (DSM).

Copyright © 2024 Ozorio Dutra, Sarkar, Yoo, Shaffer-Hudkins and Groer.

DOI: 10.3389/fnut.2023.1294549
PMCID: PMC10899318
PMID: 38419643

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


76. J Obstet Gynaecol. 2024 Dec;44(1):2319791. doi: 10.1080/01443615.2024.2319791. 
Epub 2024 Feb 28.

The effect of the COVID-19 pandemic on the mental health of obstetrics and 
gynaecology trainees: a world-wide literature review.

Ganeshan G(1), Sekar H(2), Reilly S(2), Kuo C(1), Singh S(1), Michaels J(1), 
Yoong W(2).

Author information:
(1)St George's International School of Medicine, Grenada, Caribbean.
(2)Department of Obstetrics and Gynaecology, North Middlesex University 
Hospital, London, UK.

BACKGROUND: Coronavirus (COVID-19) pandemic has affected the training and 
wellbeing of obstetrics and gynaecology (O&G) trainees. The aim of this review 
is to offer a worldwide overview on its' impact on the mental health of O&G 
trainees, so that measures can be put into place to better support trainees 
during the transition back to the 'new normal'.
METHODS: Key search terms used on PubMed and Google Scholar databases include: 
mental health, COVID-19, O&G, trainees, residents.
RESULTS: Fifteen articles (cumulative number of respondents = 3230) were 
identified, of which eight employed validated questionnaires (n = 1807 
respondents), while non-validated questionnaires were used in seven (n = 1423 
respondents). Studies showed that COVID-19 appeared to exert more of a negative 
impact on females and on senior trainees' mental health, while protective 
factors included marriage/partner and having had children. Validated and 
non-validated questionnaires suggested that trainees were exposed to high levels 
of anxiety and depression. Their mental health was also affected by insomnia, 
stress, burnout and fear of passing on the virus.
DISCUSSION: This review analyses the global impact of COVID-19 on O&G trainees' 
mental health, showing a pervasive negative effect linked to fear of the virus. 
Limited psychological support has led to prolonged issues, hindering patient 
safety and increasing sick leave. The study underscores the urgency of 
comprehensive support, particularly in female-dominated fields. Addressing these 
challenges is crucial for future pandemics, highlighting the need to learn from 
past mistakes and prioritise mental health resources for trainee well-being 
during and beyond pandemics.

Plain Language Summary: This review provides a worldwide overview of the impact 
Coronavirus (COVID-19) pandemic on the mental health of obstetrics and 
gynaecology (O&G) trainees. Fifteen articles were identified, of which eight 
employed validated questionnaires (n = 1807 respondents), while non-validated 
questionnaires were used in seven (n = 1423 respondents). The pandemic appeared 
to exert more of a negative impact on females and on senior trainees’ mental 
health, while protective factors included marriage/partner and having had 
children. Studies suggested that trainees were exposed to high levels of anxiety 
and depression. Their mental health was also affected by insomnia, stress, 
burnout and fear of passing on the virus.Limited psychological support has led 
to prolonged recovery issues and increasing sick leave. The study underscores 
the urgency of comprehensive support, particularly in female-dominated fields. 
Addressing these challenges is crucial for future pandemics, highlighting the 
need to learn from past mistakes and prioritise mental health resources for 
trainee well-being.

DOI: 10.1080/01443615.2024.2319791
PMID: 38419407 [Indexed for MEDLINE]


77. BMC Geriatr. 2024 Feb 28;24(1):206. doi: 10.1186/s12877-024-04807-7.

"Provided a window on the world and lessened my feeling of isolation": older 
adults' perceived COVID-19 impact and technology use in Australia during 
recurrent lockdowns.

Siette J(1)(2), Ludlow K(3)(4), Dodds L(5), Strutt P(5)(6), Wuthrich V(6).

Author information:
(1)The MARCS Centre for Brain, Behaviour and Development, Western Sydney 
University, New South Wales, 2145, Australia. joyce.siette@westernsydney.edu.au.
(2)Centre for Health Systems and Safety Research, Australian Institute of Health 
Innovation, Macquarie University, New South Wales, 2109, Australia. 
joyce.siette@westernsydney.edu.au.
(3)Centre for Health Systems and Safety Research, Australian Institute of Health 
Innovation, Macquarie University, New South Wales, 2109, Australia.
(4)Centre for Health Services Research, the University of Queensland, 
Queensland, 4102, Australia.
(5)The MARCS Centre for Brain, Behaviour and Development, Western Sydney 
University, New South Wales, 2145, Australia.
(6)Lifespan Health Wellbeing Research Centre, Macquarie University, New South 
Wales, 2109, Australia.

BACKGROUND: An informed understanding of older adults' perceptions of the impact 
(positive or negative) of recurrent COVID-19 long lockdowns is important for the 
development of targeted interventions and resources for future restrictions. 
This study aimed to understand self-reported impacts of COVID-19 recurrent 
restrictions on older adults and how technology has been used to mitigate these.
METHODS: A cross-sectional national study of 257 community-dwelling older 
Australians based in Victoria (mean age = 67.6 years [SD = 7.2]; 20.6% male) 
completed an online or postal survey as part of a larger study examining the 
physical and mental health impacts of a second extended COVID-19 lockdown 
period. This secondary analysis reports on the findings from free-text responses 
to two open-ended questions included in that survey that asked participants to 
comment on the greatest impacts of the COVID-19 lockdowns (positive or negative) 
and the role of technology in supporting their wellbeing during this time. 
Responses were collected between July and September 2020. Data were analysed 
using content (COVID-19 impacts) and thematic (role of technology) analysis.
RESULTS: Respondents gave more negative responses (75.5%) than mixed (15.2%) and 
positive responses (6.2%) in reporting on the biggest impact of COVID-19 
lockdowns. Inductive content analysis revealed two first-order main categories 
(Positive impacts and Negative impacts). Axial coding of main categories showed 
five second-order categories (Environmental, Physical Health, Social, Mental 
Health, and Personal) for both negative and positive main categories (totalling 
10 second-order categories). Overall, respondents highlighted social loss as the 
key negative experience (70%), with acute feelings of social isolation 
contributing to negative impacts on mental wellbeing. The most commonly reported 
positive impact reported (11%) was having more time for relationships, 
relaxation, and new hobbies. Technology was primarily used to sustain 
socialisation and provide access to essential resources, services, and goods, 
which respondents perceived to contribute to maintaining their wellbeing.
CONCLUSIONS: Findings suggest a critical need for interventions that address the 
social loss experienced by older adults during COVID-19 recurrent lockdowns, 
particularly to alleviate the associated negative impact on mental wellbeing. 
Recognising the positive aspect of increased time for relationships and leisure 
activities indicates potential areas for resilience-building strategies. The 
pivotal role of technology in mitigating adverse effects highlights its 
significance in building social connections and supporting overall wellbeing 
during challenging times. These implications can guide future efforts to enhance 
older adults' resilience, mental health, and holistic wellbeing in future public 
health crises.

© 2024. The Author(s).

DOI: 10.1186/s12877-024-04807-7
PMCID: PMC10900585
PMID: 38419001 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


78. J Breast Imaging. 2023 May 22;5(3):287-296. doi: 10.1093/jbi/wbac100.

Ongoing Impact of COVID-19 on Breast Radiologists' Wellness.

Dodelzon K(1), Grimm LJ(2), Plimpton SR(3), Markovic D(3), Milch HS(3).

Author information:
(1)Weill Cornell Medicine at New York-Presbyterian, Department of Radiology, New 
York, NY, USA.
(2)Duke University Medical Center, Department of Radiology, Durham, NC, USA.
(3)David Geffen School of Medicine at UCLA, Department of Radiology, Los 
Angeles, CA, USA.

OBJECTIVE: Assess the ongoing impact of COVID-19 on mental well-being of breast 
radiologists nationwide two years after the start of the pandemic and compared 
to early in the pandemic.
METHODS: A 27-question survey was distributed from December 2021 to January 2022 
to physician members of the Society of Breast Imaging. Psychological distress 
and anxiety scores were calculated, and factors associated with them were 
identified with a multivariate logistic model.
RESULTS: A total of 550 surveys were completed (23% response rate); the mean 
respondent age was 50 +/- 10 years. Fifty percent (265/526) of respondents 
reported two or more psychological distress symptoms, down from 58% in 2020 
(P = 0.002), whereas 70% (362/526) of respondents reported increased anxiety, 
down from 82% in 2020 (P < 0.001). As in 2020, reporting financial strain and 
childcare adversely affecting job ability were associated with worse 
psychological distress scores (OR 3.6, 95% CI: 1.6-8.3, P = 0.02 and OR 6.0, 95% 
CI: 2.5-14.4, P = 0.002, respectively). Less time spent consulting, educating, 
and discussing results with patients was associated with higher psychological 
distress (OR 5.3, 95% CI: 2.1-13.2, P = 0.036) and anxiety (OR 6.4, 95% CI: 
2.3-17.5, P < 0.001). Diminished research collaboration was associated with 
higher anxiety (OR 1.8, 95% CI: 1.1-2.9, P = 0.019).
CONCLUSION: The COVID-19 pandemic continues to cause mental health symptoms in 
breast radiologists, especially for those with pandemic-specific childcare needs 
and financial distress. Pandemic-related decreased opportunities to connect with 
patients and colleagues negatively impacts radiologists' mental health.

© Society of Breast Imaging 2023. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/jbi/wbac100
PMID: 38416885 [Indexed for MEDLINE]


79. BMC Public Health. 2024 Feb 28;24(1):631. doi: 10.1186/s12889-024-18087-8.

Social factors associated with self-reported changes in mental health symptoms 
among youth in the COVID-19 pandemic: a cross-sectional survey.

Moss SJ(1), Stelfox M(1), McArthur E(2), Sriskandarajah C(1), Ahmed SB(3), 
Birnie K(4)(5), Halperin DM(6), Halperin SA(7), Harley M(8), Hu J(5), Kamstra 
JN(9), Leppan L(1), Nickel A(1), Racine N(10), Russell K(1), Smith S(11), Solis 
M(1), Tutelman PR(12), Stelfox HT(13), Fiest KM(14), Parsons Leigh J(15).

Author information:
(1)Faculty of Health, Dalhousie University, Halifax, NS, Canada.
(2)London Health Sciences Centre, London, ON, UK.
(3)Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
(4)Departments of Anesthesiology, Perioperative, and Pain Medicine, Calgary, AB, 
Canada.
(5)Department of Community Health Sciences, University of Calgary, Calgary, AB, 
Canada.
(6)Rankin School of Nursing, St. Francis Xavier University, Antigonish, NS, 
Canada.
(7)Canadian Center for Vaccinology, Departments of Pediatrics and Microbiology & 
Immunology, Dalhousie University, Halifax, NS, Canada.
(8)Frayme, Cornwall, ON, Canada.
(9)Department of Surgery, Massachusetts General Hospital and Harvard Medical 
School, Boston, MA, USA.
(10)Faculty of Social Sciences, University of Ottawa, Children's Hospital of 
Eastern Ontario Research Institute, Ottawa, ON, Canada.
(11)Young Canadian Roundtable On Health, Toronto, ON, Canada.
(12)Department of Oncology, University of Calgary, Calgary, AB, Canada.
(13)Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, 
Canada.
(14)Department of Critical Care Medicine and O'Brien Institute for Public 
Health, University of Calgary, Calgary, AB, Canada.
(15)Faculty of Health, Dalhousie University, Halifax, NS, Canada. 
j.parsonsleigh@dal.ca.

BACKGROUND: Children and youth experienced marked impacts on day-to-day life in 
the COVID-19 pandemic that were associated with poorer familial and friend 
relationships, and greater mental health challenges. Few studies provide 
self-report data on mental health symptoms from children and youth themselves. 
We sought to examine the associations between social factors and child and youth 
self-reported symptoms of worsened mood, anxiety, and irritability during the 
COVID-19 pandemic.
METHODS: A nationally representative cross-sectional survey was administered 
online to collect self-report data across 10 Canadian provinces among children 
(11-14 years) and youth (15-18 years), April-May 2022. Age-appropriate questions 
were based on The Partnership for Maternal, Newborn & Child Health and the World 
Health Organization of the United Nations H6 + Technical Working Group on 
Adolescent Health and Well-Being consensus framework and the Coronavirus Health 
and Impact Survey. Associations between a priori defined social factors (e.g., 
relationship quality) and respondent self-reported mental health were evaluated 
using ordinal logistic regression models adjusted for age, sex, and geographic 
location.
RESULTS: We analyzed data from 483 (51.7%) children (11-14 years; 227, 47.0% 
girls) and 450 (48.3%) youth (15-18 years; 204, 45.3% girls). The parents of 
most children and youth had resided in Canada for over 20 years (678, 72.7%). 
Over one-quarter of children and youth self-identified as Black, Indigenous, or 
a Person of Color (134, 27.7%; 134, 29.8%, respectively). Over one-third of 
children and youth self-reported symptoms of worsened mood (149, 30.9%; 125, 
27.8%, respectively), anxiety (181, 37.5%; 167, 37.1%, respectively), or 
irritability (160, 33.1%; 160, 35.6%, respectively) during, compared to 
pre-pandemic. In descending order of odds ratios (OR), for children and youth, 
worsened familial relationships (during compared to pre-pandemic) was associated 
with the self-reported symptoms of worsened mood (child: OR 4.22, 95%CI 
2.51-6.88; youth: OR 6.65 95%CI 3.98-11.23), anxiety (child: OR 4.24, 
95%CI2.69-6.75; youth: OR 5.28, 95%CI 3.17-8.86), and irritability (child: OR 
2.83, 95%CI 1.76-4.56; youth: OR 6.46, 95%CI 3.88-10.90).
CONCLUSIONS: Self-reported data from a nationally representative sample of 
children and youth suggest strong associations between social factors and mental 
health during the COVID-19 pandemic. Interventions targeting child and youth 
familial relationships may positively impact child and youth mental health.

© 2024. The Author(s).

DOI: 10.1186/s12889-024-18087-8
PMCID: PMC10900679
PMID: 38413913 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


80. Health Rep. 2024 Feb 21;35(2):3-16. doi: 10.25318/82-003-x202400200001-eng.

Work precarity, employment characteristics and health among Canada's long-term 
care and seniors' home workers during the COVID-19 pandemic.

Antonipillai V(1)(2), Ng E(1), Baumann A(2), Crea-Arsenio M(2), Kohen D(1).

Author information:
(1)Health Analysis Division, Statistics Canada.
(2)Global Health, McMaster University.

BACKGROUND: The COVID-19 pandemic has highlighted several issues among health 
care workers in Canada's long-term care and seniors' (LTCS) homes, including 
labour shortages, staff retention difficulties, overcrowding, and precarious 
working conditions. There is currently a lack of information on the health, 
well-being and working conditions of health care workers in LTCS homes - many of 
them immigrants - and a limited understanding of the relationship between them. 
This paper examines differences between immigrant and non-immigrant workers' 
health outcomes and precarious working conditions during the pandemic.
DATA AND METHODS: The data were from the 2021 Survey on Health Care Workers' 
Experiences During the Pandemic, which collected information on LTCS home health 
care workers' (n=2,051) health, employment or work experiences, and working 
environment during the COVID-19 pandemic. Summary statistics and multivariable 
logistic regressions were conducted to examine the association between 
precarious work and workers' health (life stress, mental health and general 
health), stratified by immigrant status. Selected working characteristics were 
included in the regression models as covariates, namely occupation, number of 
locations worked, facility ownership status and number of years worked.
RESULTS: Immigrant health care workers were more likely than non-immigrant 
health care workers to experience precarious work in LTCS homes. Precarious work 
- characterized by income loss, reduced hours of work, and unpaid leave - was 
associated with stress and poor general health among immigrant and non-immigrant 
workers in the sector. Employment precarity was also associated with poor mental 
health for immigrant workers, but there was no association for non-immigrant 
workers.
INTERPRETATION: Employment precarity and the health and well-being of health 
care workers warrants further attention, in particular among immigrants employed 
in the LTCS residential care sector.

DOI: 10.25318/82-003-x202400200001-eng
PMID: 38411496 [Indexed for MEDLINE]


81. Front Public Health. 2024 Feb 9;12:1327999. doi: 10.3389/fpubh.2024.1327999. 
eCollection 2024.

School students' burdens and resources after 2 years of COVID-19 in Austria: a 
qualitative study using content analysis.

Sobotka M(#)(1), Kern T(#)(1), Haider K(1), Dale R(1), Wöhrer V(2), Pieh C(1), 
Probst T(3), Humer E(1)(4), Jesser A(1)(4).

Author information:
(1)Department for Psychosomatic Medicine and Psychotherapy, University for 
Continuing Education Krems, Krems an der Donau, Austria.
(2)Department of Education, University of Vienna, Vienna, Austria.
(3)Division of Psychotherapy, Department of Psychology, Paris Lodron University 
Salzburg, Salzburg, Austria.
(4)Faculty of Psychotherapy Science, Sigmund Freud University Vienna, Vienna, 
Austria.
(#)Contributed equally

INTRODUCTION: The mental health of young people has been severely affected by 
the COVID-19 pandemic and the measures associated with it. Mental health 
symptoms increased across various domains during the pandemic and subjective 
wellbeing decreased.
METHODS: This study examined the burdens and resources of Austrian school 
students (M = 16.63 years old) in the third year of the pandemic and compared 
them descriptively with the burdens and resources identified in a comparative 
study in 2021. A cross-sectional online survey with open-ended questions from 
April to May 2022 provided data that was analyzed using qualitative content 
analysis. A sub-sample of N = 214 was selected from the larger sample. This 
sub-sample is representative for the Austrian population aged 15-19 in terms of 
gender and migrant background.
RESULTS: Analysis of the open-ended questions showed that concerns about the 
pandemic and the burdens of the measures were no longer on young people's minds 
at the time of the survey in 2022. On the other hand, stress at school was 
increasing and the opening of schools and the resumption of face-to-face 
teaching were challenging for respondents. While resuming social contacts and 
leisure activities was mentioned as a resource by many respondents, some also 
expressed a desire for more time off and a retreat into coping strategies such 
as sleeping more or avoiding problems.
DISCUSSION: Our findings suggest that there is a need for low-threshold support 
from teachers and parents to help students catch up on missed lessons and to 
empathize with the mas they make the transition back to "old normal".

Copyright © 2024 Sobotka, Kern, Haider, Dale, Wöhrer, Pieh, Probst, Humer and 
Jesser.

DOI: 10.3389/fpubh.2024.1327999
PMCID: PMC10884163
PMID: 38406498 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


82. Int J Environ Res Public Health. 2024 Feb 1;21(2):171. doi: 
10.3390/ijerph21020171.

Adapting the Stress First Aid Model for Frontline Healthcare Workers during 
COVID-19.

Bellehsen MH(1)(2)(3), Cook HM(1)(4), Shaam P(1)(4), Burns D(1)(3), D'Amico 
P(2), Goldberg A(1)(3), McManus MB(3), Sapra M(2)(3), Thomas L(5), Wacha-Montes 
A(1)(3), Zenzerovich G(1)(3), Watson P(6), Westphal RJ(7), Schwartz RM(1)(2)(4).

Author information:
(1)Center for Traumatic Stress, Resilience and Recovery at Northwell Health, 
Great Neck, NY 11021, USA.
(2)Department of Psychiatry, Zucker Hillside Hospital at Northwell Health, Glen 
Oaks, NY 11004, USA.
(3)Behavioral Health Service Line, Northwell Health, New York, NY 10022, USA.
(4)Department of Occupational Medicine, Epidemiology and Prevention, Donald and 
Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY 11021, 
USA.
(5)Institute for Nursing, Northwell Health, New Hyde Park, NY 11042, USA.
(6)National Center for PTSD, White River Junction, VT 05009, USA.
(7)School of Nursing, University of Virginia, Charlottesville, VA 22903, USA.

The coronavirus pandemic has generated and continues to create unprecedented 
demands on our healthcare systems. Healthcare workers (HCWs) face physical and 
psychological stresses caring for critically ill patients, including 
experiencing anxiety, depression, and posttraumatic stress symptoms. Nurses and 
nursing staff disproportionately experienced COVID-19-related psychological 
distress due to their vital role in infection mitigation and direct patient 
care. Therefore, there is a critical need to understand the short- and long-term 
impact of COVID-19 stress exposures on nursing staff wellbeing and to assess the 
impact of wellbeing programs aimed at supporting HCWs. To that end, the current 
study aims to evaluate an evidence-informed peer support stress reduction model, 
Stress First Aid (SFA), implemented across units within a psychiatric hospital 
in the New York City area during the pandemic. To examine the effectiveness of 
SFA, we measured stress, burnout, coping self-efficacy, resilience, and 
workplace support through self-report surveys completed by nurses and nursing 
staff over twelve months. The implementation of SFA across units has the 
potential to provide the workplace-level and individual-level skills necessary 
to reduce stress and promote resilience, which can be utilized and applied 
during waves of respiratory illness acuity or any other healthcare-related 
stressors among this population.

DOI: 10.3390/ijerph21020171
PMCID: PMC10887691
PMID: 38397662 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


83. Int J Environ Res Public Health. 2024 Jan 25;21(2):132. doi: 
10.3390/ijerph21020132.

Trends in Mental Wellbeing of US Children, 2019-2022: Erosion of Mental Health 
Continued in 2022.

Bhandari N(1), Gupta S(2).

Author information:
(1)Department of Healthcare Administration and Policy, School of Public Health, 
University of Nevada, Las Vegas, NV 89154, USA.
(2)Department of Health Administration, College of Business, University of 
Houston-Clear Lake, Houston, TX 77058, USA.

We provide fresh estimates of a change in the nationwide prevalence of mental 
health symptoms among US children during the COVID-19 pandemic using National 
Health Interview Survey data (2019-22) on children aged 2-17 years (n = 27,378; 
age subgroups 2-5, 6-11, and 12-17) to assess overall mental distress and 19 
specific outcomes related to developmental, communicative, cognitive, affective, 
and behavioral domains. Raw and adjusted (for socio-demographics) linear 
regressions estimated the change in prevalence for each outcome between 2019 
(baseline year) and three succeeding years (2020-2022). Summary scores for 
mental distress rose between 2019 and 2020 (1.01 to 1.18 points, range of 0-15), 
declined slightly in 2021 (1.09), and climbed sharply again in 2022 (1.25). The 
declines primarily affected adolescents (1.11 at baseline, 1.24 in 2020, 1.30 in 
2021, and 1.49 in 2022). Specific outcomes belonging to all domains of mental 
health showed similar increases in prevalence. US children suffered significant 
erosion of mental health during the COVID-19 pandemic that continued into 2022. 
Expansion of mental health programs aimed at school-going children will likely 
be needed to respond effectively to the ongoing crisis.

DOI: 10.3390/ijerph21020132
PMCID: PMC10887976
PMID: 38397623 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


84. PLoS One. 2024 Feb 23;19(2):e0294639. doi: 10.1371/journal.pone.0294639. 
eCollection 2024.

Predictors of unplanned emergency hospital admissions among patients aged 65+ 
with multimorbidity and depression in Northwest London during and after the 
Covid-19 lockdown in England.

Cicek M(1), Greenfield G(1), Nicholls D(1)(2), Majeed A(1), Hayhoe B(1).

Author information:
(1)Applied Research Collaboration Northwest London (ARC NWL), Department of 
Primary Care and Public Health, School of Public Health, Faculty of Medicine, 
Imperial College London, London, United Kingdom.
(2)Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, 
Imperial College London, London, United Kingdom.

INTRODUCTION: Individuals with multimorbidity have an increased likelihood of 
using unplanned secondary care including emergency department visits and 
emergency hospitalisations. Those with mental health comorbidities are affected 
to a greater extent. The Covid-19 pandemic has negatively impacted on 
psychosocial wellbeing and multimorbidity care, especially among vulnerable 
older individuals.
AIM: To examine the risk of unplanned hospital admissions among patients aged 
65+ with multimorbidity and depression in Northwest London, England, during- and 
post-Covid-19 lockdown.
METHODS: Retrospective cross-sectional data analysis with the Discover-NOW 
database for Northwest London was conducted. The overall sample consisted of 
20,165 registered patients aged 65+ with depression. Two time periods were 
compared to observe the impact of the Covid-19 lockdown on emergency hospital 
admissions between 23rd March 2020 to 21st June 2021 (period 1) and 
equivalent-length post-lockdown period from 22nd June 2021 to 19th September 
2022 (period 2). Multivariate logistic regression was conducted on having at 
least one emergency hospital admission in each period against sociodemographic 
and multimorbidity-related characteristics.
RESULTS: The odds of having an emergency hospitalisation were greater in men 
than women (OR = 1.19 (lockdown); OR = 1.29 (post-lockdown)), and significantly 
increased with age, higher deprivation, and greater number of comorbidities in 
both periods across the majority of categories. There was an inconclusive 
pattern with ethnicity; with a statistically significant protective effect among 
Asian (OR = 0.66) and Black ethnicities (OR = 0.67) compared to White patients 
during post-lockdown period only.
CONCLUSION: The likelihood of unplanned hospitalisation was higher in men than 
women, and significantly increased with age, higher deprivation, and 
comorbidities. Despite modest increases in magnitude of risk between lockdown 
and post-lockdown periods, there is evidence to support proactive case-review by 
multi-disciplinary teams to avoid unplanned admissions, particularly men with 
multimorbidity and comorbid depression, patients with higher number of 
comorbidities and greater deprivation. Further work is needed to determine 
admission reasons, multimorbidity patterns, and other clinical and lifestyle 
predictors.

Copyright: © 2024 Cicek et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0294639
PMCID: PMC10890757
PMID: 38394234 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


85. PLoS One. 2024 Feb 23;19(2):e0298134. doi: 10.1371/journal.pone.0298134. 
eCollection 2024.

Determining factors of physical activity and sedentary behaviour in university 
students during the COVID-19 pandemic: A longitudinal study.

Savage MJ(1), Magistro D(1), Hennis PJ(1), Donaldson J(1), Healy LC(1), Hunter 
KA(1), James RM(1).

Author information:
(1)SHAPE Research Group, School of Science and Technology, Nottingham Trent 
University, Nottingham, United Kingdom.

INTRODUCTION: Historically, university students demonstrate poor movement 
behaviours that could negatively impact current and future health. Recent 
literature has focused on identifying determinants of physical activity (PA) and 
sedentary behaviour (SB) in this population to inform the development of 
intervention strategies. However, the COVID-19 pandemic substantially restricted 
movement behaviours in this population, meaning findings of previous research 
may no longer be applicable within the current societal context. The present 
study explored the longitudinal relationships between pre-pandemic 
psychological, behavioural and anthropometric factors, and the movement 
behaviours of UK university students nine months following the outbreak of 
COVID-19.
METHODS: Mental wellbeing (MWB), perceived stress (PS), body mass index (BMI), 
SB, and PA were assessed using an online self-report survey in 255 students 
prior to (October 2019) and nine months following (October 2020) the first 
confirmed case of COVID-19 in the UK. Path analysis was utilised to test 
relationships between pre-COVID mental wellbeing, perceived stress and BMI, and 
movement behaviours during the pandemic.
RESULTS: The fit of the path analysis model was good (χ2 = 0.01; CMIN = 0.10, 
CFI = 1.00, RMSEA = 0.00). Pre-covid MWB and PS positively influenced PA (β = 
0.29; β = 0.24; P < 0.01) but not SB (β = -0.10; β = 0.00; P = 0.79) during the 
pandemic. Additionally, pre-pandemic SB and PA positively influenced SB and PA 
during the pandemic respectively (SB: β = 0.26; P < 0.01) (PA: β = 0.55; P < 
0.01). Pre-pandemic BMI did not influence any measured variable during the 
pandemic (PA: β = 0.03 and P = 0.29; SB: β = 0.06 and P = 0.56), and there was 
no mediating effect of PA on SB during the pandemic (β = -0.26; P = 0.14).
CONCLUSION: These findings indicate that pre-covid mental health and movement 
behaviours had a direct positive influence on PA during the pandemic, but not 
SB. This longitudinal study demonstrates the influence that prior psychological 
and behavioural factors have in determining university students' response to 
periods of elevated stress and uncertainty, furthering our understanding of 
determinants of health-related behaviours in students.

Copyright: © 2024 Savage et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0298134
PMCID: PMC10889634
PMID: 38394147 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


86. J Surg Educ. 2024 Apr;81(4):486-494. doi: 10.1016/j.jsurg.2023.12.013. Epub 2024 
Feb 22.

Psychological Impact of the COVID-19 Pandemic on Canadian Surgical Residents: A 
Province-Wide Study.

Lie JJ(1), Huynh C(1), Li J(1), Mak N(1), Wiseman SM(2).

Author information:
(1)Department of Surgery, St. Paul's Hospital & University of British Columbia, 
Vancouver, British Columbia, Canada.
(2)Department of Surgery, St. Paul's Hospital & University of British Columbia, 
Vancouver, British Columbia, Canada. Electronic address: 
smwiseman@providencehealth.bc.ca.

OBJECTIVES: The objective of this study was to evaluate the psychological impact 
of the COVID-19 pandemic on surgical residents.
DESIGN: An online survey was distributed evaluating multiple domains: 
demographics, health and socioeconomic factors, clinical experience, educational 
experience, and psychological outcomes. The Mayo Clinic Resident Well-Being 
Index (RWBI) was used as a validated measure of resident mental health.
SETTING AND PARTICIPANTS: Surgical residents from University of British 
Columbia's surgical residency programs.
RESULTS: A total of 31/86 surgical residents responded to the survey. Of which, 
57% and 46% reported feeling burned out or depressed, respectively. Residents 
who were concerned about personal protective equipment supply and who lived with 
family members with comorbidities had a higher risk of depression (p = 0.03, 
p = 0.04). The median Mayo Clinic Resident Well-Being Index was 2.5, higher than 
the median of 2 observed in the United States national survey of residents.
CONCLUSIONS: The pandemic had a considerable negative impact on the 
psychological well-being of surgical residents.

Copyright © 2023 Association of Program Directors in Surgery. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jsurg.2023.12.013
PMID: 38388311 [Indexed for MEDLINE]


87. Pediatrics. 2024 Mar 1;153(3):e2023063345. doi: 10.1542/peds.2023-063345.

Pediatricians' Career Satisfaction and Wellbeing by Sex Before and During the 
COVID-19 Pandemic.

Frintner MP(1), Leslie LK(2), Gottschlich EA(1), Starmer AJ(3), Byrne BJ(4), 
Freed GL(5).

Author information:
(1)American Academy of Pediatrics, Itasca, Illinois.
(2)American Board of Pediatrics, Chapel Hill, North Carolina.
(3)Baystate Children's Hospital, Springfield, Massachusetts.
(4)Indiana University School of Medicine, Indianapolis, Indiana.
(5)University of Michigan, Ann Arbor, Michigan.

OBJECTIVE: To compare pediatrician career satisfaction and wellbeing by sex 
during the coronavirus disease 2019 pandemic with prepandemic years using 
longitudinal survey data.
METHODS: Data from a cohort study, the American Academy of Pediatrics 
Pediatrician Life and Career Experience Study, were used to examine career 
satisfaction and wellbeing from 2012 to 2021 among 2002-2004 and 2009-2011 
residency graduates (n = 1760). Mixed effects logistic regression, including key 
pediatrician characteristics, examined career satisfaction and wellbeing 
measures for sex (female vs male), pandemic year (2012-2019 vs 2020-2021), and 
their interaction effect. Adjusted predicted percentage values (PVs) were 
determined.
RESULTS: In total, 73.4% of participants identified as female. Adjusting for key 
pediatrician characteristics, differences were found by sex for satisfaction and 
4 of 5 wellbeing measures, by pandemic year for 2 wellbeing measures, and the 
interaction of sex and pandemic year for 3 wellbeing measures. Female 
pediatricians reported higher levels of anxiety, sadness, and work stress, with 
greater differences during the pandemic. For example, female pediatricians (PV = 
22.6, confidence interval [CI] = 21.0-24.3) were more likely than male 
pediatricians (PV = 14.2, CI = 12.0-16.4) to report anxiety during pre-pandemic 
years, and the difference between female pediatricians (PV = 29.3, CI = 
26.7-32.0) and male pediatricians (PV = 12.4, CI = 9.3-15.5) increased during 
pandemic years (sex by pandemic year interaction, P < .001).
CONCLUSIONS: Compared with male pediatricians, female pediatricians reported 
worse anxiety, sadness, and stress at work, and the differences were more 
pronounced during the pandemic.

Copyright © 2024 by the American Academy of Pediatrics.

DOI: 10.1542/peds.2023-063345
PMID: 38384232 [Indexed for MEDLINE]


88. J Prev Med Hyg. 2024 Jan 1;64(4):E398-E404. doi: 
10.15167/2421-4248/jpmh2023.64.4.3144. eCollection 2023 Dec.

Mpox: "the stigma is as dangerous as the virus". Historical, social, ethical 
issues and future forthcoming.

Orsini D(1), Sartini M(2)(3), Spagnolo AM(2)(3), Cristina ML(2)(3), Martini 
M(2).

Author information:
(1)University Museum System of Siena (SIMUS), History of Medicine, University of 
Siena, Siena, Italy.
(2)Department of Health Sciences, University of Genoa, Genova, Italy.
(3)Hospital Hygiene Unit, Galliera Hospital, Italy.

OBJECTIVES: The authors aim to show the possibility of stigma that hits affected 
Mpox patients because of the statements of society involving their sexual 
sphere.
INTRODUCTION: 23 July 2022, the Director-General of the WHO, Thedos Ghebreyesus, 
issued an international public health alert regarding cases of Mpox (formerly 
known as Monkeypox). Although Mpox has been present in an endemic form for years 
in some Central African countries, the spread of the disease outside Africa has 
aroused considerable alarm in populations already sorely afflicted by the 
COVID-19 pandemic. Aside from the data, what is striking is that Mpox, like 
other infectious diseases, seems to have become a problem only when it began to 
cross the borders of Africa. Some may justify this attitude simply by ascribing 
it to the fear of an epidemic outside the areas where the virus is endemic. 
However, in such cases, and especially after the COVID-19 experience, other 
factors are also involved: lack of information and, even more so, the human 
capacity to utilise diseases to reinforce arguments against the tendencies, 
inclinations, orientations and behaviours of some social groups. Such 
information, albeit basically correct, is nevertheless incomplete. Moreover, it 
tends to prompt a view of this disease that may give rise to highly dangerous 
and embarrassing situations, engendering the risk of repeating the error that 
was made about AIDS. Mpox is the latest in a series of epidemics that have 
struck humanity in the space of very few years.
MATERIAL AND METHODS: Setting and partecipants: people and social groups who, 
due to sexual orientations and behaviours, are considered to be at risk of being 
infected with Mpox. Main outcomes measures: - outcomes directly related to 
mental health of Mpox patients: anxiety, fear and depression, emotional 
difficulties, feelings of loneliness and isolation; - well-being outcomes of 
people with Mpox; - risk of not being able to reduce the epidemic among those 
groups don't feel as though they belong to LGBTQ and therefore do not implement 
any kind of prevention.
RESULTS: Limit the contagion from Mpox through specific health and communication 
campaigns. Remove any stigma related to Mpox disease.
CONCLUSIONS: In the face of this disease, it is absolutely essential that we do 
not needlessly isolate groups of people by feeding stigma, prejudice and 
discrimination, which can have devastating effects not only on individuals but 
also on society as a whole. As the full inclusion of persons of LGBTQ community 
is probably still a long way off, we must surely wonder when we will be ready 
enough to achieve the important objective of equality for all.

©2024 Pacini Editore SRL, Pisa, Italy.

DOI: 10.15167/2421-4248/jpmh2023.64.4.3144
PMCID: PMC10876020
PMID: 38379747 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


89. Nurs Womens Health. 2024 Apr;28(2):152-158. doi: 10.1016/j.nwh.2023.10.004. Epub 
2024 Feb 17.

Understanding the Psychological Risks to Maternal Mental Health, Maternal-Infant 
Bonding, and Infant Development During the COVID-19 Pandemic.

Hale FB, Harris AL.

This short review summarizes two recent U.S.-based studies in which researchers 
evaluated the impact of the COVID-19 pandemic on postpartum outcomes. The first 
study examined the neurodevelopmental status of infants born to women infected 
with SARS-CoV-2, and the second examined psychological risks to maternal-infant 
bonding. Results indicated that pandemic-related stressors likely contributed to 
diminished maternal-infant health outcomes. It is imperative that nurses stay 
informed on the latest science exploring the impact the pandemic has had on the 
health and well-being of pregnant persons and infants.

Copyright © 2024 AWHONN. Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.nwh.2023.10.004
PMID: 38373696 [Indexed for MEDLINE]


90. Front Public Health. 2024 Feb 2;12:1280859. doi: 10.3389/fpubh.2024.1280859. 
eCollection 2024.

Practice and proficiency of Isha Yoga for better mental health outcomes: 
insights from a COVID-19 survey.

Malipeddi S(1), Mehrotra S(2), John JP(3), Kutty BM(1).

Author information:
(1)Centre for Consciousness Studies, Department of Neurophysiology, NIMHANS, 
Bengaluru, Karnataka, India.
(2)Department of Clinical Psychology, NIMHANS, Bengaluru, Karnataka, India.
(3)Multi-modal Brain Image Analysis Laboratory, Department of Psychiatry, 
NIMHANS, Bengaluru, Karnataka, India.

INTRODUCTION: The COVID-19 pandemic has brought about unparalleled suffering on 
a global scale, affecting both physical and mental well-being. In such 
challenging times, it becomes crucial to identify interventions that can 
alleviate negative mental health outcomes, such as stress, while promoting 
positive mental health outcomes, like well-being. We report the effectiveness of 
a mind-body practise, Isha Yoga, in promoting well-being.
METHODS: We conducted an online survey, during the COVID-19 pandemic, with Yoga 
practitioners (n = 1,352) from the Isha Yoga tradition in Karnataka, India. We 
evaluated stress and well-being attributes using conventional psychometric 
questionnaires. Subsequently, we requested the Isha Yoga practitioners to share 
another survey with their friends and family members, assessing similar 
outcomes. From the respondents of this shared survey (n = 221), we identified 
individuals who currently did not engage in any form of Yoga or meditation, 
constituting the non-Yoga control group (n = 110). To enhance the reliability 
and validity of our study and minimize the limitations commonly associated with 
online surveys, we adhered to the CHERRIES guidelines for reporting survey 
studies.
RESULTS: Isha Yoga practitioners had significantly lower levels of stress 
(p < 0.001, gHedges = 0.94) and mental distress (p < 0.001, gHedges = 0.75) 
while reporting significantly higher levels of well-being (p < 0.001, 
gHedges = 0.78) and affective balance (p < 0.001, gHedges = 0.80) compared to 
the control group. Furthermore, expertise-related improvements were observed in 
these outcomes, and a dose-response relationship was found between regularity of 
Isha Yoga practice and outcome changes. A minimum 3-4 days of weekly practice 
showed significant differences with the control group. In addition, we 
investigated the effect of Isha Yoga on stress and well-being among the 
healthcare workers (HCWs) in our sample and observed better mental health 
outcomes.
DISCUSSION: These findings collectively underscore the benefits of Mind and Body 
practices like Isha Yoga on various aspects of mental health and well-being, 
emphasizing its potential as an effective and holistic approach for promoting a 
healthy lifestyle among diverse populations, including healthcare workers, even 
in difficult circumstances such as the COVID-19 pandemic.

Copyright © 2024 Malipeddi, Mehrotra, John and Kutty.

DOI: 10.3389/fpubh.2024.1280859
PMCID: PMC10869487
PMID: 38371236 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


91. Public Health. 2024 Apr;229:1-6. doi: 10.1016/j.puhe.2024.01.017. Epub 2024 Feb 
17.

Healthcare and housing provision for a UK homeless community: a qualitative 
service evaluation.

Bell L(1), Whelan M(1), Lycett D(1), Fernandez E(2), Khera-Butler T(2), Kehal 
I(2), Patel R(3).

Author information:
(1)Research Institute for Health and Wellbeing, Coventry University, Coventry, 
UK.
(2)Warwickshire County Council, Warwickshire, UK.
(3)Research Institute for Health and Wellbeing, Coventry University, Coventry, 
UK; NIHR Applied Research Collaboration-East Midlands (ARC-EM), Leicester, UK. 
Electronic address: rp526@leicester.ac.uk.

OBJECTIVES: Homelessness is both a significant determinant and consequence of 
health and social inequalities. To better meet healthcare needs, dedicated 
mental health and general nurses were implemented to deliver outreach healthcare 
to people experiencing homelessness in one United Kingdom (UK) county. During 
COVID-19, the UK Government also instructed local authorities to accommodate 
individuals sleeping rough and have a national target to end rough sleeping. 
This qualitative study explored experiences of this nurse-let outreach service 
and housing journeys during and beyond COVID-19 among people experiencing 
homelessness.
STUDY DESIGN: Face-to-face, narrative storytelling interviews were conducted via 
opportunistic sampling in community settings. Individuals with recent or current 
experiences of homelessness were eligible.
METHODS: Participants were informed about the study via known professionals and 
introduced to the researcher. Eighteen narrative interviews were conducted, 
transcribed, and analysed using reflective thematic analysis.
RESULTS: Individuals described complex journeys in becoming and being homeless. 
The nurse-led outreach service provided integral support, with reported benefits 
to person-centred and accessible care and improved outcomes in health and 
well-being. After being housed, individuals valued housing necessities and 
described new responsibilities. However, some participants did not accept or 
stay in housing provisions where they perceived risks.
CONCLUSIONS: Interviewed participants perceived that the dedicated nurse-led 
outreach service improved their access to care and health outcomes. In the 
absence of dedicated provisions, mainstream healthcare should ensure flexible 
processes and collaborative professional working. Local authorities must also be 
afforded increased resources for housing, as well as integrated support, to 
reduce social and health inequalities.

Copyright © 2024 The Royal Society for Public Health. Published by Elsevier Ltd. 
All rights reserved.

DOI: 10.1016/j.puhe.2024.01.017
PMID: 38368810 [Indexed for MEDLINE]


92. Nord J Psychiatry. 2024 Apr;78(3):255-263. doi: 10.1080/08039488.2024.2313563. 
Epub 2024 Feb 17.

For better or for worse? Memories and mental health related to COVID-19 
lockdowns in adolescents with Attention Deficit Disorders.

Hjuler TF(1)(2), Rask CU(1)(2), Kallesøe KH(1).

Author information:
(1)Department of Child and Adolescent Psychiatry, Aarhus University Hospital, 
Aarhus, Denmark.
(2)Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.

PURPOSE: In adolescents with Attention Deficit Hyperactivity Disorders (ADHD, 
ICD-10 defined) we examined self-reported well-being, depressive symptoms and 
autobiographical memories from the first COVID-19 lockdown in Denmark in 
comparison to adolescents without an ADHD diagnosis.
METHODS: Data from 16 adolescents with ADHD and 16 non-ADHD age and gender 
matched controls were collected between September 2020 and April 2021. 
Questionnaires included the World Health Organization Well-Being Index (WHO-5), 
the Short Mood and Feelings Questionnaire (SMFQ), and an autobiographical memory 
survey assessing a lockdown memory, a memory not related to lockdown and a 
future projection. Mixed design ANOVAs were used to compare within subject 
differences in memory types across groups and independent sample t-tests were 
used to compare group differences.
RESULTS: Three adolescents with ADHD scored below the WHO-5 cut-off (< 50) and 
above the SMFQ cut-off (> 8) indicating risk of depression, compared to two in 
the control group. Both groups rated lockdown memories as less positive and more 
negative and reported feeling more sad and worried when reminiscing about 
lockdown experiences compared to 'other personal memories' and 'future 
projections'. Compared to the non-ADHD controls, adolescents with ADHD reported 
more sadness, t(30) = -0.2.45, p < .05 and worries t(30) = -3.84, p < .001 when 
reminiscing about the lockdown.
CONCLUSIONS: Even though there were no striking differences between groups in 
the assessments on risk of depression, the findings suggest that adolescents 
diagnosed with ADHD were more negatively affected when recalling memories about 
the lockdown compared to their peers.

DOI: 10.1080/08039488.2024.2313563
PMID: 38368509 [Indexed for MEDLINE]


93. Brain Inj. 2024 Feb 23;38(3):217-226. doi: 10.1080/02699052.2024.2309244. Epub 
2024 Feb 16.

Child and family health-related quality of life and participation outcomes and 
goals after acquired brain injury: a cross-sectional survey.

Keetley R(1)(2), Manning JC(2)(3), Williams J(2), Stewart I(4), Radford K(1).

Author information:
(1)Centre of Rehabilitation and Ageing Research, School of Medicine, University 
of Nottingham, Nottingham, UK.
(2)Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, 
Nottingham, England.
(3)School of Healthcare, University of Leicester, Leicestershire, England.
(4)Faculty of Medicine, Imperial College London, London, England.

OBJECTIVE: To explore longer-term health-related quality of life (HRQoL) and 
participation outcomes and goals of children and young people (CYP) with 
acquired brain injuries (ABI) and their families in a region of the UK and the 
impact of the COVID-19 pandemic.
METHODS: Cross-sectional survey of (5-18 CYP) and their parent-carers 
12-43 months following ABI. Included measures of HRQoL, participation, family 
function and parental wellbeing and demographic and free text questions.
RESULTS: Ninety-five responses (30% response) were received. 67% of CYP were at 
risk of impaired HRQoL, 72% had severely impaired participation. 53% of 
parent-carers reported reduced HRQoL and family functioning, 37% of 
parent-carers screened positive for anxiety/depression. Relationships exist 
between CYP participation and HRQoL and parental HRQoL and family functioning. 
Goals were overwhelmingly activity and participation focused. Participants 
described the global impact of an ABI on the CYP and family as well as the 
additional impact of the COVID-19 pandemic on CYP and family wellbeing.
CONCLUSION: ABI significantly impacts CYP participation and both CYP and 
parent-carer wellbeing in the long-term, potentially further impacted by the 
COVID-19 pandemic. Rehabilitation interventions should address both 
participation and the psychological wellbeing of CYP with ABI and their 
parent-carers.

DOI: 10.1080/02699052.2024.2309244
PMID: 38363813 [Indexed for MEDLINE]


94. Riv Psichiatr. 2024 Jan-Feb;59(1):28-34. doi: 10.1708/4205.41946.

Counseling in the face of crisis: supporting mental health in Tor Vergata 
University students during the Covid-19 era.

Fiori Nastro F(1), Pelle M(2), Di Lorenzo G(1), Ribolsi M(3), Niolu C(4), 
Fortuna E(4), Siracusano A(4).

Author information:
(1)Department of Systems Medicine, Tor Vergata University of Rome, Italy - IRCCS 
Fondazione Santa Lucia, Rome, Italy.
(2)Department of Systems Medicine, Tor Vergata University of Rome, Italy - Unit 
of Neurology, Neurophysiology, Neurobiology and Psychiatry, Department of 
Medicine, University Campus Bio-Medico of Rome, Italy.
(3)Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Department 
of Medicine, University Campus Bio-Medico of Rome, Italy.
(4)Department of Systems Medicine, Tor Vergata University of Rome, Italy - 
Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, 
Rome, Italy.

AIMS: This study aims to present an overview of the clinical experience of the 
counseling service "Sportello Studenti". The service offers free diagnostic and 
therapeutic psychological assistance to all Tor Vergata University of Rome 
students.
METHODS: Preliminary findings on the prevalence of anxious, depressive, and 
prodromal symptoms in a subset of participants recruited during the initial 
three-year period of the service's operation (2019-2022) are presented. Beck's 
Depression Inventory II (BDI-II), Symptom Checklist-90-Revised (SCL-90-R), 
Prodromal Questionnaire 16 (PQ-16) and Aberrant Salience Inventory (ASI) have 
been used to investigate principle psychopathological dimensions.
RESULTS: 261 students aged 18 to 35 completed the assessment (180 female - 69%). 
Mild widespread depressive symptoms (35.5%) and mild to severe suicide ideation 
(5.1%) were highlighted. Ninety students (37.2%) result at a higher risk 
condition for psychosis. A significant statistical correlation between negative 
psychopathological indicators, such as suicidal thoughts and age, suggests that 
younger students exhibit higher susceptibility and vulnerability to mental 
health issues.
DISCUSSION AND CONCLUSIONS: The increasing prevalence of distress among young 
individuals represents an urgent public health concern that necessitates 
immediate intervention. It is crucial for countries to adopt a comprehensive 
approach to promoting psychological and mental health. University counseling 
services serve as an effective initial intervention to address the negative 
impact of mental illness on academic performance, social interactions, and 
emotional well-being in young individuals. They also play a pivotal role in the 
early identification of individuals at risk of developing severe psychiatric 
disorders. Sportello Studenti has proven to be a valuable initiative addressing 
the mental health needs of University of Tor Vergata students, underscoring the 
significance of promoting psychological well-being.

DOI: 10.1708/4205.41946
PMID: 38362786 [Indexed for MEDLINE]


95. Front Public Health. 2024 Feb 1;12:1294538. doi: 10.3389/fpubh.2024.1294538. 
eCollection 2024.

Locked down-locked in: experiences of families of young children with autism 
spectrum disorders in Delhi, India.

Kaur A(1), Lall G(1), Abhilashi M(1), Naithani L(1), Verma M(1), Roy R(1), 
Juneja M(2), Gulati S(3), Taylor C(4), Leadbitter K(4), Patel V(5), Green J(4), 
Divan G(1).

Author information:
(1)Sangath, Child Development Group, New Delhi, India.
(2)Maulana Azad Medical College Associated Lok Nayak Hospital, New Delhi, India.
(3)All India Institute of Medical Sciences, New Delhi, India.
(4)Department of Psychology and Mental Health, University of Manchester, 
Manchester, United Kingdom.
(5)Department of Global Health and Social Medicine, Harvard Medical School, 
Boston, MA, United States.

INTRODUCTION: The onset of the COVID-19 pandemic and subsequent lockdowns in 
March 2020 disrupted the lives of families across India. The lockdown related 
restrictions brought forth a multitude of challenges including loss of 
employment, social isolation, school closures and financial burdens. 
Specifically, it also resulted in the restriction of health-care services for 
children with neurodevelopmental disabilities.
METHODS: This qualitative study was conducted as a part of a larger trial in 
India to understand the experiences of families of young children with autism 
during the pandemic. In-depth interviews were carried out with 14 caregivers 
residing in New Delhi, India.
RESULTS: Our findings identified pandemic and lockdown's universal impacts on 
family life and financial stability stemming from job loss, business closure, 
and salary deductions, affecting quality of life of families. Furthermore, 
COVID-19 pandemic's impact on autistic children was evident through limited 
access to essential services and financial challenges related service 
interruptions even after resumption of services. The lockdown's novelty also 
affected children's behavior, with both challenging behavioral changes and 
positive impacts. Primary caregivers, predominantly mothers, assumed additional 
responsibilities in household tasks, schooling, and therapy administration. 
While some these experiences were universally experienced, a few of these 
improved outcomes for autistic children. Despite challenges, parents expressed 
gratitude for their family's safety and well-being during the difficult time.
DISCUSSIONS: These findings inform service provision for vulnerable families and 
offer implications for designing interventions such as credit schemes for 
families, guidance and resources for establishing and maintaining routines of 
children with autism, adopting flexible and adaptable approaches to service 
delivery, and special provisions for children with autism to be able to maintain 
their routines outside of home. Furthermore, the study highlights the need for 
comprehensive support, including educational resources and stress management 
counselling to empower parents in supporting essential care and routines for 
their children during such unprecedented times.

Copyright © 2024 Kaur, Lall, Abhilashi, Naithani, Verma, Roy, Juneja, Gulati, 
Taylor, Leadbitter, Patel, Green and Divan.

DOI: 10.3389/fpubh.2024.1294538
PMCID: PMC10867826
PMID: 38362218 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


96. Rev Gaucha Enferm. 2024 Feb 12;45:e20230117. doi: 
10.1590/1983-1447.2024.20230117.en. eCollection 2024.

Influence of self-efficiency beliefs on the health and well-being of university 
students in COVID-19.

[Article in English, Portuguese]

Alves DM(1)(2), Pompeo DA(3), Sacardo Y(4), Eid LP(5), Lourenção LG(6), André 
JC(7).

Author information:
(1)Secretaria de Saúde de São José do Rio Preto. São José do Rio Preto, São 
Paulo, Brasil.
(2)Faculdade de Medicina de São José do Rio Preto (FAMERP). Programa de 
Pós-Graduação em Enfermagem. São José do Rio Preto, São Paulo, Brasil.
(3)Faculdade de Medicina de São José do Rio Preto (FAMERP). Departamento de 
Enfermagem Especializada. São José do Rio Preto, São Paulo, Brasil.
(4)Universidade de São Paulo (USP). Faculdade de Medicina. Programa de 
Residência em Enfermagem Oncológica. Ribeirão Preto, São Paulo, Brasil.
(5)Universidade Federal de Jataí (UFJ). Unidade Acadêmica de Ciências da Saúde. 
Jataí, Goiás, Brasil.
(6)Universidade Federal do Rio Grande (FURG). Rio Grande, Rio Grande do Sul, 
Brasil.
(7)Faculdade de Medicina de São José do Rio Preto (FAMERP). Centro de Estudos e 
Desenvolvimento do Ensino em Saúde. São José do Rio Preto, São Paulo, Brasil.

OBJECTIVE: To analyze general self-efficacy beliefs in university students 
during the COVID-19 pandemic and their correlation with psychological well-being 
and anxiety and depressive symptoms.
METHOD: Cross-sectional study, carried out with nursing, medicine and psychology 
students from a higher education institution in the state of São Paulo, Brazil. 
The sample consisted of 329 students and data collection took place through a 
questionnaire and scales, from August to December 2020. Mann-Whitney test and 
Spearman's correlation coefficient were used for analysis of the variables.
RESULTS: Participants' self-efficacy was median (34.3±7.5). Higher self-efficacy 
scores were correlated with better psychological well-being (p<0.001; r= -0.582) 
and absence of anxiety (p<0.001) and depressive (p<0.001) symptoms.
CONCLUSION: High self-efficacy beliefs were associated with better mental health 
outcomes. Strengthening self-efficacy in universities can help improve students' 
health behaviors and prevent mental illness.

DOI: 10.1590/1983-1447.2024.20230117.en
PMID: 38359282 [Indexed for MEDLINE]


97. Clin Ter. 2024 Jan-Feb;175(1):34-41. doi: 10.7417/CT.2024.5031.

Occupational health and psychological wellbeing in first line nurses during 
health crisis periods: reliability study of the SOIC tool.

Pintus G(1), Mannocci A(2), Spataro P(3), Brai E(1), Talucci M(1), Capece G(4), 
Tibaldi L(5), Delli Poggi A(1).

Author information:
(1)Surgery Department, "Sapienza" University of Rome, Italy.
(2)Faculty of Economics and Law, Universitas Mercatorum, Rome, Italy.
(3)Faculty of Society and Communication Sciences, Universitas Mercatorum, Rome, 
Italy.
(4)Faculty of Technological Sciences and Innovation, Univesitas Mercatorum, 
Rome, Italy.
(5)Teaching Hospital "Umberto I" of Rome, Italy.

BACKGROUND: In 2020, the emergence of the new Coronavirus has put health 
professionals under enormous pressure, as they had to work in difficult and 
often disadvantaged situations. Prevention of symptoms such as stress, anxiety 
and burnout therefore become important health management goals.
AIM: The aim of this pilot cross-sectional study was to assess the reliability 
and feasibility of a tool on Occupational Health Nurses after a Pandemic Period 
such as the COVID-19 pandemic (Salute Oc-cupazionale negli Infermieri in Periodo 
Pandemico Covid19 - SOIC) that aims to assess the occupational health and 
psychological wellbeing of nurses during periods of health crisis.
METHODS: This study was conducted from September to November 2022. The SOIC tool 
is composed by two preliminary sections and a third part including five 
validated questionnaires (measuring burnout, work engagement, psychological 
symptoms, resilience, and mindful awareness). An opportunistic sample of 202 
nurses working in a Teaching Hospital of Rome and members of NurSind union were 
invited to participate: of these, 24 nurses completed the SOIC in two subsequent 
occasions (T1 and T2).
RESULTS: The test-retest assessment showed no differences between the two waves 
(T1 and T2) in terms of median scores for all questionnaires included in the 
SOIC tool. The Cronbach alphas, considering all items of each questionnaire 
included in the SOIC tool, showed good or excellent internal consistencies.
CONCLUSION: The test-retest assessments and the reliability analyses encouraged 
the usability of the SOIC tool. Furthermore, consistent associations between the 
five questionnaires were obtained.

DOI: 10.7417/CT.2024.5031
PMID: 38358475 [Indexed for MEDLINE]


98. Nurs Health Sci. 2024 Mar;26(1):e13084. doi: 10.1111/nhs.13084.

Obesity care for youth during the COVID-19 pandemic: Challenges youth healthcare 
nurses experienced in providing obesity care in the Netherlands.

Concincion S(1), van Houtum L(2), van de Vorst B(3), Verhoeff A(2)(4), Dedding 
C(5).

Author information:
(1)Faculty of Social and Behavioural Sciences, University of Amsterdam, Youth 
healthcare Public Health Service Amsterdam, Amsterdam, The Netherlands.
(2)Sarphati Amsterdam, Public Health Service Amsterdam, Amsterdam, The 
Netherlands.
(3)GGD Amsterdam, Amsterdam, The Netherlands.
(4)Faculty of Social and Behavioural Sciences, University of Amsterdam, 
Amsterdam, The Netherlands.
(5)Department Ethics, Law & Humaniora (ERH), Amsterdam University Medical 
Centers, Amsterdam, The Netherlands.

The COVID-19 pandemic deeply affected the lives of children and young people; 
studies report adverse effects on mental, physical, and social well-being. 
However, the impact of the pandemic on obesity care for children received little 
attention. The aim of this study was to gain insight into the challenges youth 
healthcare nurses experienced and to describe implications for future obesity 
care and policy. We conducted interviews, participant observations, and a group 
session with youth healthcare nurses during the pandemic in Amsterdam, the 
Netherlands. Youth healthcare nurses reported a deterioration in the problems of 
children and young people who were already in the highest classification for 
pediatric obesity, such as increased weight gain, mental health problems, and 
socio-economic problems. The nurses experienced immense challenges while trying 
to provide obesity care, such as a decrease in face-to-face contact with youth 
and their families, as well as loss of continuity of care. It is important to 
reconnect with these families, invest in a trusted relationship with youth 
receiving obesity care, and prioritize available and accessible obesity care for 
those who need it the most.

© 2024 The Authors. Nursing & Health Sciences published by John Wiley & Sons 
Australia, Ltd.

DOI: 10.1111/nhs.13084
PMID: 38356109 [Indexed for MEDLINE]


99. BMC Public Health. 2024 Feb 14;24(1):460. doi: 10.1186/s12889-023-17591-7.

Posttraumatic growth of medical staff during COVID-19 pandemic: A scoping 
review.

Li Q(1), Zhu Y(1), Qi X(1), Lu H(1), Han N(1), Xiang Y(1), Guo J(1), Wang L(2).

Author information:
(1)Department of Nursing, The Second Affiliated Hospital of Zhejiang University 
School of Medicine, No. 88 Jiefang Road, Shangcheng District, Hangzhou, 310009, 
Zhejiang Province, China.
(2)Department of Nursing, The Second Affiliated Hospital of Zhejiang University 
School of Medicine, No. 88 Jiefang Road, Shangcheng District, Hangzhou, 310009, 
Zhejiang Province, China. zrwlz@zju.edu.cn.

BACKGROUND: The COVID-19 pandemic has imposed unprecedented stress and 
challenges upon medical staff, potentially resulting in posttraumatic growth 
(PTG). This scoping review aims to synthesize the existing knowledge on PTG 
among medical staff during the pandemic by identifying its current status and 
potential influencing factors. The findings may provide a foundation for future 
research and interventions to enhance the medical staff's psychological 
resilience and well-being.
METHODS: Literature was systematically searched on PTG among medical staff 
during the COVID-19 pandemic from 01 January 2020 to 31 December 2022. The 
following databases were searched: PubMed, Web of Science, Embase, CINAHL, 
PsycINFO, Cochrane Library, China National Knowledge Infrastructure (CNKI), 
Chinese Biomedical Literature Service System (SinoMed), and Wanfang Data. 
Eligibility criteria included: (1) medical staff as research subjects; (2) a 
focus on "posttraumatic growth" or "alternative posttraumatic growth" related to 
the COVID-19 outbreak and pandemic; (3) discussion of the situation and 
influencing factors of PTG; and (4) study types, such as qualitative, 
quantitative, and mixed methods. Two researchers independently selected and 
extracted study characteristics (study design, study population, region, 
measurement instruments, and primary outcomes) from the included literature. The 
data were synthesized qualitatively and descriptively.
RESULTS: Thirty-six papers from 12 countries met the inclusion criteria. 
Moderate PTG levels were observed among healthcare workers during the COVID-19 
pandemic, with emphasis on "interpersonal relationships," "changes in life 
philosophy," and "growth in personal competence." Influencing factors included 
trauma exposure, sociodemographics, psychological characteristics (resilience 
and positive qualities), coping, and social support.
CONCLUSIONS: This review discovered moderate PTG levels among medical staff 
during the COVID-19 pandemic, with critical areas in interpersonal 
relationships, life philosophy, and personal competence. The identified 
influencing factors can inform future research and interventions to enhance 
healthcare workers' psychological resilience and well-being.

© 2024. The Author(s).

DOI: 10.1186/s12889-023-17591-7
PMCID: PMC10865690
PMID: 38355487 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


100. Geriatr Nurs. 2024 Mar-Apr;56:167-172. doi: 10.1016/j.gerinurse.2024.02.009. 
Epub 2024 Feb 13.

Associated factors for fear of COVID-19 scale in long-term care settings in 
Spain.

Cardenas Soriano P(1), Rodriguez-Blazquez C(2), Forjaz MJ(3), Ayala A(4), 
Fernandez-Mayoralas G(5), Rojo-Perez F(5), Sanchez-Gonzalez D(6), 
Rodriguez-Rodriguez V(5).

Author information:
(1)Preventive Medicine Unit, Alcorcón Foundation University Hospital, Alcorcón, 
Spain; Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, Madrid, 
Spain.
(2)National Centre of Epidemiology and Network Centre for Biomedical Research in 
Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, 
Spain. Electronic address: crodb@isciii.es.
(3)National Centre of Epidemiology and Health Service Research Network on 
Chronic Diseases (REDISSEC) and Research Network on Chronicity, Primary Care and 
Health Promotion (RICAPPS), Carlos III Institute of Health, Madrid, Spain.
(4)Department of Statistics, University Carlos III of Madrid, and Health Service 
Research Network on Chronic Diseases (REDISSEC), Carlos III Institute of Health, 
Madrid, Spain.
(5)Grupo de Investigacion sobre Envejecimiento (GIE-CSIC), IEGD, CSIC, Madrid, 
Spain.
(6)Department of Geography, Universidad Nacional de Educación a Distancia 
(UNED), Madrid, Spain.

OBJECTIVE: To examine the relationship between the Fear of COVID-19 Scale 
(FCV-19S) score and sociodemographic, health, emotional and behavioural factors, 
in a cross-sectional observational study in 447 older adults living in long-term 
care (LTC) settings in Madrid (Spain).
METHODS: The sample was stratified by nursing home ownership, geographical 
location, and size. Multiple linear regression analysis was used using backward 
elimination to identify factors that explained associations with fear, and 
logistic regression models were used to examine its role as a predictor of 
adherence to preventive measures.
RESULTS: The mean age of the participants was 83.8 years, most were female, had 
had COVID-19, and were worried about the pandemic. The average score of the 
FCV-19S was 18.36 (SD: 8.28; range: 7-35), and the variables associated in the 
multiple linear regression model (explained variance: 34.00%) were being female, 
lower level of education, satisfaction with life and the residential home, and 
higher worry about the pandemic. The logistic regression models showed that fear 
of COVID-19 was a predictor of adherence to preventive measures like wearing 
facemasks, washing hands, and avoiding physical contact.
CONCLUSIONS: fear of COVID-19 was significantly related with sex and subjective 
factors as life satisfaction and worry; and it influences older people's 
preventive behaviour. Interventions aimed at reducing fear and promoting 
adherence to preventive measures would improve their mental health and 
well-being.

Copyright © 2024 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.gerinurse.2024.02.009
PMID: 38354659 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest None.


101. Am J Public Health. 2024 Feb;114(S2):200-203. doi: 10.2105/AJPH.2024.307574.

Determinants of Staff Intent to Leave Health Care During the COVID-19 Pandemic.

DePierro JM(1), Chan CC(1), Mohamed N(1), Starkweather S(1), Ripp J(1), 
Peccoralo LA(1).

Author information:
(1)Jonathan M. DePierro and Sydney Starkweather are with the Department of 
Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY. Chi C. Chan, 
Jonathan Ripp, and Lauren A. Peccoralo are with the Office of Well-being and 
Resilience, Mount Sinai Health System, New York, NY. Nihal Mohamed is with the 
Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY.

Objectives. To identify potential drivers of health care worker attrition. 
Methods. We conducted a survey of 1083 nonphysician health care workers in a 
large urban health system in New York City from September to October 2022. 
Results. The results of a multivariable logistic regression analysis revealed 
that higher odds of intending to leave health care were significantly associated 
with male gender, registered nurse profession, burnout, self-perceived mental 
health service need, and verbal abuse from patients or visitors, whereas lower 
odds were seen among those reporting greater emotional well-being and a better 
workplace culture. A relative importance analysis indicated that burnout was the 
strongest correlate of intention to leave (22.5% relative variance explained 
[RVE]), followed by subjective emotional well-being (16.7% RVE), being a 
registered nurse (12.3% RVE), poorer perceived workplace culture (9.5% RVE), and 
male gender (5.9% RVE). Conclusions. Overall, our findings suggest the need for 
well-coordinated interventions that address both individual- and system-level 
factors in an effort to improve retention. Public Health Implications. Our 
results indicate a need for interventions targeting workplace culture, staff 
burnout, and mental health service provision. (Am J Public Health. 
2024;114(S2):S200-S203. https://doi.org/10.2105/AJPH.2024.307574).

DOI: 10.2105/AJPH.2024.307574
PMCID: PMC10916731
PMID: 38354356 [Indexed for MEDLINE]


102. Am J Public Health. 2024 Feb;114(S2):167-170. doi: 10.2105/AJPH.2023.307435.

Effectiveness of CBT-Informed Behavioral Health Interventions for Health Care 
Workers in a Specialized Clinical Service During the COVID-19 Pandemic.

Doukas AM(1), Sharma V(1), DePierro JM(1), Ho S(1), Starkweather S(1), Marin 
DB(1).

Author information:
(1)The authors are with the Department of Psychiatry, Icahn School of Medicine, 
Mount Sinai Health System, New York, NY.

Objectives. To evaluate symptomatology and clinical outcomes among 
treatment-seeking health care workers (HCWs). We examined engagement, presenting 
symptomatology, and treatment outcomes among a diverse group of HCWs in a large 
urban health system. Methods. Demographic and pretreatment-posttreatment outcome 
data were available for 69 HCWs who sought cognitive behavioral therapy (CBT), 
with or without medication management, at a specialized clinical center from 
July 1, 2020, to April 25, 2022. Results. Treatment-seeking HWCs predominantly 
identified as female (78.3%) and non-White (53.6%) and had a mean age of 
36.33 ± 10.72 years. Wilcoxon signed-rank tests showed significant reductions in 
all symptoms and increased well-being (P < .001), with effect sizes ranging from 
0.59 to 0.71. Conclusions. Our findings replicate those of existing research on 
the prevalence of psychiatric distress among HCWs, uniquely focusing on those 
seeking care. Our outcome data suggest that short-term CBT is effective in 
reducing clinical symptoms and increasing HCW well-being. Public Health 
Implications. Given the elevated rates of distress found in HCW surveys, 
evidence-based interventions such as ours are essential to ensure workforce 
well-being. Providing mental health care to HCWs has both individual benefits 
and potential implications for improved patient care and workforce retention. 
(Am J Public Health. 2024;114(S2):S167-S170. 
https://doi.org/10.2105/AJPH.2023.307435).

DOI: 10.2105/AJPH.2023.307435
PMCID: PMC10916725
PMID: 38354342 [Indexed for MEDLINE]


103. BMC Public Health. 2024 Feb 13;24(1):455. doi: 10.1186/s12889-024-17912-4.

Economic and social determinants of health care utilization during the first 
wave of COVID-19 pandemic among adults in Ghana: a population-based 
cross-sectional study.

Ayanore MA(1)(2), Adjuik M(3), Zuñiga RAA(4)(5), Amuna P(6), Ezechi O(4)(7), 
Brown B(4)(8), Uzochukwu B(4)(9), Aly NM(4)(10), Quadri MFA(4)(11), Popoola 
BO(4)(12), Ishabiyi AO(4)(13), Ellakany P(4)(14), Yousaf MA(4)(15), Virtanen 
JI(4)(16), Lawal FB(4)(17), Ara E(4)(18), Khan AT(4)(19)(20), Gaffar B(4)(21), 
El Tantawi M(4)(10), Nguyen AL(4)(22), Foláyan MO(4)(23).

Author information:
(1)Mental Health and Wellness Study Group, Ho, Ghana. mayanore@uhas.edu.gh.
(2)Department of Health Policy Planning and Management, Fred N. Binka School of 
Public Health, University of Health and Allied Sciences, Ho, Ghana. 
mayanore@uhas.edu.gh.
(3)Department of Epidemiology and Biostatistics, Fred N. Binka School of Public 
Health, University of Health and Allied Sciences, Ho, Ghana.
(4)Mental Health and Wellness Study Group, Ho, Ghana.
(5)University of Sierra, Sur. Oaxaca, Mexico.
(6)Fred N. Binka School of Public Health, University of Health and Allied 
Sciences, Ho, Ghana.
(7)Department of Social Medicine, Population and Public Health, University of 
California, Riverside School of Medicine, Riverside, CA, United States of 
America.
(8)Department of Clinical Sciences, Nigerian Institute of Medical Research, 
Lagos, Nigeria.
(9)University of Nigeria Nsukka (UNN) Enugu Campus, Nsukka, Nigeria.
(10)Department of Pediatric Dentistry and Dental Public Health, Faculty of 
Dentistry, Alexandria University, Alexandria, Egypt.
(11)Texas Tech University and Health Sciences Center, Texas, United States of 
America.
(12)Department of Child Oral Health, University of Ibadan, Ibadan, Nigeria.
(13)Department of Sociology, Florida Atlantic University, Boca Raton, Florida, 
USA.
(14)Department of Substitutive Dental Sciences, College of Dentistry, Imam 
Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
(15)Institute of Zoology, University of the Punjab, Lahore, Pakistan.
(16)Faculty of Medicine, University of Bergen, Bergen, Norway.
(17)Department of Periodontology and Community Dentistry, University of Ibadan 
and University College Hospital, Ibadan, Nigeria.
(18)Government College for Women, Srinagar, Kashmir (J&K), India.
(19)Department of Biological Sciences, Faculty of Allied Health Sciences, 
Superior University, Kot Araian, Raiwind Road, Lahore, Punjab, Pakistan.
(20)School of Biological Sciences, University of the Punjab, Quaid-e-Azam 
Campus, Lahore, Punjab, Pakistan.
(21)Department of Preventive Dental Sciences, College of Dentistry, Imam 
Abdulrahman bin Faisal University, Dammam, Saudi Arabia.
(22)Department of Family Medicine, Keck School of Medicine, University of 
Southern California, Los Angeles, CA, United States of America.
(23)Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, 
Nigeria.

BACKGROUND: The COVID-19 pandemic had socioeconomic effects in Africa. This 
study assessed the social and economic determinants of healthcare utilization 
during the first wave of COVID-19 among adults in Ghana.
METHODS: Information about individuals residing in Ghana was derived from a 
survey conducted across multiple countries, aiming to evaluate the impact of the 
COVID-19 pandemic on the mental health and overall well-being of adults aged 18 
and above. The dependent variable for the study was healthcare utilization 
(categorized as low or high). The independent variables were economic (such as 
financial loss, job loss, diminished wages, investment/retirement setbacks, and 
non-refunded travel cancellations) and social (including food scarcity, loss of 
financial support sources, housing instability, challenges affording food, 
clothing, shelter, electricity, utilities, and increased caregiving 
responsibilities for partners) determinants of health. A multinomial logistic 
regression was conducted to identify factors associated with healthcare 
utilization after adjusting for confounders (age, gender, access to medical 
insurance, COVID-19 status, educational background, employment, and marital 
status of the participants).
RESULTS: The analysis included 364 responses. Individuals who encountered a loss 
of financial support (AOR: 9.58; 95% CI: 3.44-26.73; p < 0.001), a decrease or 
loss of wages (AOR: 7.44, 95% CI: 3.05-18.16, p < 0.001), experienced investment 
or retirement setbacks (AOR: 10.69, 95% CI: 2.60-43.88, p = 0.001), and 
expressed concerns about potential food shortages (AOR: 6.85, 95% CI: 
2.49-18.84, p < 0.001) exhibited significantly higher odds of low healthcare 
utilization during the initial phase of the pandemic. Contrastingly, 
participants facing challenges in paying for basic needs demonstrated lower odds 
of low healthcare utilization compared to those who found it easy to cover basic 
expenses (AOR: 0.19, 95% CI: 0.06-0.67, p = 0.001).
CONCLUSION: Economic and social factors were associated with low healthcare 
utilization in Ghana during the first wave of the pandemic. Investment or 
retirement loss and financial support loss during the pandemic had the largest 
effect on healthcare utilization. Further research is needed to understand the 
connection between concerns about food shortages, welfare losses during 
pandemics and healthcare utilization during pandemics in Ghana.

© 2024. The Author(s).

DOI: 10.1186/s12889-024-17912-4
PMCID: PMC10865527
PMID: 38350910 [Indexed for MEDLINE]

Conflict of interest statement: Martin Ayanore is an Associate Editor, at BMC 
Public Health while Morenike Oluwatoyin Folayan and Maha El Tantawi are Senior 
Board Members with BMC Oral Health. Jorma Virtanen is an Associate Editor, at 
BMC Oral Health. All other authors declare no conflict of interest.


104. BMC Geriatr. 2024 Feb 14;24(1):151. doi: 10.1186/s12877-024-04766-z.

Cognitive, psychological, and physiological effects of a web-based mindfulness 
intervention in older adults during the COVID-19 pandemic: an open study.

Galluzzi S(1), Lanfredi M(2), Moretti DV(3), Rossi R(4), Meloni S(4), Tomasoni 
E(1), Frisoni GB(5), Chiesa A(6)(7), Pievani M(1).

Author information:
(1)Laboratory Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro 
San Giovanni Di Dio Fatebenefratelli, Brescia, Italy.
(2)Unit of Psychiatry, IRCCS Istituto Centro San Giovanni Di Dio 
Fatebenefratelli, Brescia, Italy. mlanfredi@fatebenefratelli.eu.
(3)Alzheimer's Rehabilitation Unit, IRCCS Istituto Centro San Giovanni Di Dio 
Fatebenefratelli, Brescia, Italy.
(4)Unit of Psychiatry, IRCCS Istituto Centro San Giovanni Di Dio 
Fatebenefratelli, Brescia, Italy.
(5)University Hospitals and University of Geneva, Geneva, Switzerland.
(6)Istituto Mente E Corpo, Bologna, Italy.
(7)Associazione Di Psicologia Cognitiva - Scuola Di Psicoterapia Cognitiva, 
Rome, Italy.

BACKGROUND: The development of effective strategies to maintain good mental 
health of older adults is a public health priority. Mindfulness-based 
interventions have the potential to improve psychological well-being and 
cognitive functions of older adults, but little is known about the effect of 
such interventions when delivered through internet. During the COVID-19 pandemic 
we evaluated short- and long-term cognitive, psychological, and physiological 
effects of a mindfulness-based intervention (MBI) delivered via web-based 
videoconference in healthy older adults.
METHODS: Fifty older adults participated in an 8-week MBI, which comprised 
structured 2-h weekly group sessions. A comprehensive evaluation encompassing 
cognitive (verbal memory, attention and processing speed, executive functions) 
and psychological assessments (depression and anxiety symptoms, mindfulness, 
worries, emotion regulation strategies, well-being, interoceptive awareness and 
sleep) was conducted. Additionally, electroencephalography (EEG) data were 
recorded before and after the MBI and at the 6-month follow-up (T6). Data were 
analyzed using an intention-to-treat approach, using linear mixed models 
adjusted for age. The effect size for time was computed as omega squared.
RESULTS: We observed significant improvements from pre-MBI to post-MBI and at 
the T6 across several measures. These improvements were notable in the areas of 
verbal memory (California Verbal Learning Test, p ≤ .007), attention and 
executive functions (Trail Making Test A and BA, p < .050), interoceptive 
awareness (Multidimensional Assessment of Interoceptive Awareness, p = .0002 for 
self-regulation and p < .05 for noticing, body listening, and trusting 
dimensions), and rumination (Heidelberg Form for Emotion Regulation Strategies, 
p = .018). These changes were associated with low to medium effect size. 
Moreover, we observed significant changes in EEG patterns, with a decrease in 
alpha1 (p = .004) and an increase in alpha2 (p < .0001) from pre-MBI to T6. 
Notably, improvements in TMTBA and rumination were correlated with the decrease 
in alpha1 (p < .050), while improvements in TMTA were linked to the increase in 
alpha2 (p = .025).
CONCLUSIONS: The results of our study show that a web-based MBI in older adults 
leads to improvements in cognitive and psychological measures, with associated 
modulations in specific brain rhythms. While these findings are promising, 
further controlled studies are required to validate these preliminary results.
TRIAL REGISTRATION: The trial has been registered with the United States 
National Library of Medicine at the National Institutes of Health Registry of 
Clinical Trials under the code NCT05941143 on July 12, 2023.

© 2024. The Author(s).

DOI: 10.1186/s12877-024-04766-z
PMCID: PMC10865647
PMID: 38350854 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


105. Health Expect. 2024 Feb;27(1):e13983. doi: 10.1111/hex.13983.

'I am proud of how I handled it'. Exploring the impact of the COVID-19 pandemic 
and related restrictions on well-being of adults with severe mental illness 
using qualitative methods.

van Rijn L(1)(2), Metz MJ(3)(4), van der Velden PR(3), Mathijsen P(3), Swildens 
WE(5)(6), Schellekens AFA(1), Cahn W(2)(5), Milota MM(7), Zinkstok JR(1)(2)(8).

Author information:
(1)Department of Psychiatry, Radboud University Medical Center, Donders 
Institute For Brain, Cognition, and Behavior, Nijmegen, The Netherlands.
(2)Department of Psychiatry, Brain Center, University Medical Center Utrecht, 
Utrecht, The Netherlands.
(3)GGz Breburg, Institute for Mental Health Care, Breda, The Netherlands.
(4)Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, 
The Netherlands.
(5)Altrecht, Institute for Mental Health Care, Utrecht, The Netherlands.
(6)Inholland University of Applied Science, Amsterdam, The Netherlands.
(7)Julius Center for Health Sciences and Primary Care, University Medical Center 
Utrecht, Utrecht, The Netherlands.
(8)Karakter Child and Adolescent Mental Health Care, Nijmegen, The Netherlands.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic and related 
restrictions globally impacted mental health, particularly for those with 
pre-existing severe mental illness (SMI). This qualitative study examined how 
adults with SMI perceived the effects of the COVID-19 pandemic and related 
restrictions in the Netherlands, focusing on their personal recovery, well-being 
and daily life, including an exploration of factors influencing these effects.
METHODS: Semi-structured interviews were conducted, audio-recorded and 
transcribed verbatim. Reflexive thematic analysis was applied. Purposive 
sampling was used to ensure diversity of individuals with SMI (i.e., age, 
gender, diagnosis, cultural background and mental healthcare institution).
RESULTS: Twenty participants (median age: 45 years [SD: 12, 8]; 11 females) were 
interviewed between May and July 2023. Findings revealed a wide range of 
experiences: while some individuals reported a negative impact on their existing 
psychiatric symptoms, others described adaptability, resilience and even 
positive effects of COVID-19 restrictions on their mental health and well-being. 
Factors influencing the heterogeneic perceptions of the COVID-19 pandemic and 
related restrictions include the availability of trusted social relationships 
and enduring interactions with health professionals.
CONCLUSION: Personalised support, both socially and professionally, is crucial 
for addressing fears, building resilience, reducing isolation and encouraging 
positive coping strategies for individuals with SMI during external crises. In 
this project, a participatory research approach that integrated the lived 
experience perspective helped uncover the unique perceptions of people with SMI 
with regard to the pandemic and related restrictions.
PATIENT OR PUBLIC CONTRIBUTION: The study used a participatory action research 
approach, with experts-by-experience involved in every stage of the project as 
part of the research team. This included engagement with the funding application 
process, recruitment strategies for interviews, developing the interview guide, 
piloting the interview, interpreting findings, and knowledge dissemination 
activities.

© 2024 The Authors. Health Expectations published by John Wiley & Sons Ltd.

DOI: 10.1111/hex.13983
PMCID: PMC10862174
PMID: 38348759 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


106. BMC Public Health. 2024 Feb 12;24(1):433. doi: 10.1186/s12889-024-17675-y.

Changes in physical activity and sedentary behavior during the first COVID-19 
pandemic- restrictions in Germany: a nationwide survey : Running head: physical 
activity during the COVID-19 restrictions.

Herbolsheimer F(1), Peters A(2), Wagner S(2), Willich SN(3), Krist L(3), Pischon 
T(4), Nimptsch K(4), Gastell S(5), Brandes M(6), Brandes B(6), Schikowski T(7), 
Schmidt B(8), Michels KB(9), Mikolajczyk R(10), Harth V(11), Obi N(11), Castell 
S(12), Heise JK(12), Lieb W(13), Franzpötter K(13), Karch A(14), Teismann H(14), 
Völzke H(15), Meinke-Franze C(15), Leitzmann M(16), Stein MJ(16), Brenner H(17), 
Holleczek B(18), Weber A(16), Bohn B(19), Kluttig A(10), Steindorf K(20).

Author information:
(1)Division of Physical Activity, Prevention and Cancer, German Cancer Research 
Center (DKFZ), Heidelberg, Germany. florian.herbolsheimer@dkfz.de.
(2)Institute of Epidemiology, Helmholtz Zentrum München - German Research Center 
for Environmental Health (GmbH), Neuherberg, Germany.
(3)Institute of Social Medicine, Epidemiology and Health Economics, Charité - 
Universitätsmedizin Berlin, Berlin, Germany.
(4)Molecular Epidemiology Research Group, Max Delbrück Center for Molecular 
Medicine in the Helmholtz Association (MDC), Berlin, Germany.
(5)German Institute of Human Nutrition Potsdam Rehbruecke, Nuthetal, Germany.
(6)Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, 
Germany.
(7)IUF - Leibniz Research Institute for Environmental Medicine, Duesseldorf, 
Germany.
(8)Institute for Medical Informatics, Biometry and Epidemiology, Essen 
University Hospital, Essen, Germany.
(9)Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and 
Medical Center, University of Freiburg, Freiburg, Germany.
(10)Institute for Medical Epidemiology, Biometrics, and Informatics, 
Interdisciplinary Center for Health Sciences , Medical Faculty of the 
Martin-Luther University Halle-Wittenberg, Halle, Germany.
(11)Institute for Occupational and Maritime Medicine Hamburg (ZfAM), University 
Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany.
(12)Helmholtz Centre for Infection Research, Brunswick, Germany.
(13)Institute of Epidemiology, University of Kiel, Kiel, Germany.
(14)Institute of Epidemiology and Social Medicine, University of Münster, 
Münster, Germany.
(15)Institute for Community Medicine, University Medicine Greifswald, 
Greifswald, Germany.
(16)University of Regensburg, Regensburg, Germany.
(17)Division of Clinical Epidemiology and Aging Research, German Cancer Research 
Center (DKFZ), Heidelberg, Germany.
(18)Saarland Cancer Registry, Saarbrücken, Germany.
(19)NAKO e.V., Heidelberg, Germany.
(20)Division of Physical Activity, Prevention and Cancer, German Cancer Research 
Center (DKFZ), Heidelberg, Germany.

BACKGROUND: The COVID-19 pandemic restrictions posed challenges to maintaining 
healthy lifestyles and physical well-being. During the first mobility 
restrictions from March to mid-July 2020, the German population was advised to 
stay home, except for work, exercise, and essential shopping. Our objective was 
to comprehensively assess the impact of these restrictions on changes in 
physical activity and sedentary behavior to identify the most affected groups.
METHODS: Between April 30, 2020, and May 12, 2020, we distributed a 
COVID-19-specific questionnaire to participants of the German National Cohort 
(NAKO). This questionnaire gathered information about participants' physical 
activity and sedentary behavior currently compared to the time before the 
restrictions. We integrated this new data with existing information on anxiety, 
depressive symptoms, and physical activity. The analyses focused on 
sociodemographic factors, social relationships, physical health, and working 
conditions.
RESULTS: Out of 152,421 respondents, a significant proportion reported altered 
physical activity and sedentary behavioral patterns due to COVID-19 
restrictions. Over a third of the participants initially meeting the WHO's 
physical activity recommendation could no longer meet the guidelines during the 
restrictions. Participants reported substantial declines in sports activities 
(mean change (M) = -0.38; 95% CI: -.390; -.378; range from -2 to + 2) and 
reduced active transportation (M = -0.12; 95% CI: -.126; -.117). However, they 
also increased recreational physical activities (M = 0.12; 95% CI: .117; .126) 
while engaging in more sedentary behavior (M = 0.24; 95% CI: .240; .247) 
compared to pre-restriction levels. Multivariable linear and log-binomial 
regression models indicated that younger adults were more affected by the 
restrictions than older adults. The shift to remote work, self-rated health, and 
depressive symptoms were the factors most strongly associated with changes in 
all physical activity domains, including sedentary behavior, and the likelihood 
to continue following the physical activity guidelines.
CONCLUSIONS: Mobility patterns shifted towards inactivity or low-intensity 
activities during the nationwide restrictions in the spring of 2020, potentially 
leading to considerable and lasting health risks.

© 2024. The Author(s).

DOI: 10.1186/s12889-024-17675-y
PMCID: PMC10860251
PMID: 38347566 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


107. BMJ Open. 2024 Feb 12;14(2):e079931. doi: 10.1136/bmjopen-2023-079931.

Physician and nurse well-being, patient safety and recommendations for 
interventions: cross-sectional survey in hospitals in six European countries.

Aiken LH(1), Sermeus W(2), McKee M(3), Lasater KB(4), Sloane D(1), Pogue CA(1), 
Kohnen D(2), Dello S(2), Maier CBB(5), Drennan J(6), McHugh MD(1); Magnet4Europe 
Consortium.

Collaborators: Sermeus W, Bruyneel L, Witte H, Schaufeli W, Dello S, Kohnen D, 
Aiken LH, McHugh MD, Smith H, Cheney T, Sloane D, Guidice MD, Busse R, Maier C, 
Köppen J, Kleine J, Drennan J, Vera McCarthy EL, Brady N, Scott A, Sjetne IS, 
Lerdal A, Eriksson LE, Lindqvist R, Alenius LS, Svensson I, Jacobsson A, Ball J, 
Griffiths P, Bridges J, Anstee S, Ellis J, Rafferty AM, McKee M, Aken PV, 
Heusden DV, Siebens K, Bogaert PV, Sergeant O.

Author information:
(1)Center for Health Outcomes and Policy Research, University of Pennsylvania, 
Philadelphia, Pennsylvania, USA.
(2)Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium.
(3)London School of Hygiene & Tropical Medicine, London, UK.
(4)Center for Health Outcomes and Policy Research, University of Pennsylvania, 
Philadelphia, Pennsylvania, USA karenbl@nursing.upenn.edu.
(5)Bielefeld University, Bielefeld, Germany.
(6)School of Nursing, Midwifery and Health Systems, University College Dublin, 
Dublin, Ireland.

OBJECTIVES: To determine the well-being of physicians and nurses in hospital 
practice in Europe, and to identify interventions that hold promise for reducing 
adverse clinician outcomes and improving patient safety.
DESIGN: Baseline cross-sectional survey of 2187 physicians and 6643 nurses 
practicing in 64 hospitals in six European countries participating in the 
EU-funded Magnet4Europe intervention to improve clinicians' well-being.
SETTING: Acute general hospitals with 150 or more beds in six European 
countries: Belgium, England, Germany, Ireland, Sweden and Norway.
PARTICIPANTS: Physicians and nurses with direct patient contact working in adult 
medical and surgical inpatient units, including intensive care and emergency 
departments.
MAIN OUTCOME MEASURES: Burnout, job dissatisfaction, physical and mental health, 
intent to leave job, quality of care and patient safety and interventions 
clinicians believe would improve their well-being.
RESULTS: Poor work/life balance (57% physicians, 40% nurses), intent to leave 
(29% physicians, 33% nurses) and high burnout (25% physicians, 26% nurses) were 
prevalent. Rates varied by hospitals within countries and between countries. 
Better work environments and staffing were associated with lower percentages of 
clinicians reporting unfavourable health indicators, quality of care and patient 
safety. The effect of a 1 IQR improvement in work environments was associated 
with 7.2% fewer physicians and 5.3% fewer nurses reporting high burnout, and 
14.2% fewer physicians and 8.6% fewer nurses giving their hospital an 
unfavourable rating of quality of care. Improving nurse staffing levels (79% 
nurses) and reducing bureaucracy and red tape (44% physicians) were 
interventions clinicians reported would be most effective in improving their own 
well-being, whereas individual mental health interventions were less frequently 
prioritised.
CONCLUSIONS: Burnout, mental health morbidities, job dissatisfaction and 
concerns about patient safety and care quality are prevalent among European 
hospital physicians and nurses. Interventions to improve hospital work 
environments and staffing are more important to clinicians than mental health 
interventions to improve personal resilience.

© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2023-079931
PMCID: PMC10862305
PMID: 38346890 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


108. West J Nurs Res. 2024 Mar;46(3):192-200. doi: 10.1177/01939459241228687. Epub 
2024 Feb 11.

How Depression and Anxiety Impact Adherence to COVID-19 Prevention Practices in 
Urban Liberia.

Ridge LJ(1), Kennedy S(2), Davis M(1), McCullagh MC(1).

Author information:
(1)Department of Systems, Populations and Leadership, University of Michigan, 
Ann Arbor, MI, USA.
(2)Pacific Institute for Research and Evaluation, University of Liberia, 
Monrovia, Liberia.

BACKGROUND: Understanding the relationship between mental health and COVID-19 
prevention practices is crucial but challenging considering COVID-19's impact on 
mental well-being. Liberia, a West African country, had well-documented rates of 
depression and anxiety prior to COVID-19. Liberia responded aggressively to 
COVID-19 while case counts remained low; thus, it is an ideal setting to study 
the relationship of mental health and COVID-19 prevention practices.
METHODS: A validated cross-sectional survey was administered to 250 randomly 
selected residents of Montserrado county, Liberia in June 2021, asking about 
their mental health and adherence to COVID-19 prevention practices. The survey 
included the Generalized Anxiety Disorder-7 and the Patient Health 
Questionnaire-9 to assess for anxiety and depression, respectively. Responses 
were analyzed using Spearman correlation and regression.
RESULTS: Scores indicative of depression were present in 43% (95% confidence 
interval [CI]: 37-49) of participants; scores indicative of anxiety were present 
in 41% (95% CI: 34-47). Self-reported adherence to COVID-19 prevention practices 
was middling and varied greatly by behavior. Higher scores for depression and 
anxiety were significantly associated with lower adherence to COVID-19 
prevention practices.
CONCLUSIONS: Results indicate that while the spread of COVID-19 has certainly 
affected mental health, it is likely that pre-existing mental health conditions 
affected the spread of COVID-19 through lower adherence to prevention practices. 
Policymakers should consider investing in mental health services as an important 
step in managing future epidemics, and the needs of people with poor mental 
health when designing epidemic responses, particularly in low-income countries 
where the burdens of adherence are likely to be greater.

DOI: 10.1177/01939459241228687
PMID: 38343034 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting InterestsThe authors 
declared no potential conflicts of interest with respect to the research, 
authorship, and/or publication of this article.


109. Soc Sci Med. 2024 Mar;344:116651. doi: 10.1016/j.socscimed.2024.116651. Epub 
2024 Feb 4.

Stability and shifts in the combined positive and negative mental health of 
clergy: A longitudinal latent class and latent transition analysis study of 
united methodist pastors before and after the onset of COVID-19.

Lee BJ(1), Holleman A(2), Proeschold-Bell RJ(3).

Author information:
(1)Duke Global Health Institute and Center for Health Policy & Inequalities 
Research, 310 Trent Drive, Durham, NC, 27708, USA. Electronic address: 
janebh.lee@duke.edu.
(2)Department of Sociology and Duke Global Health Institute, 417 Chapel Drive, 
Durham, NC, 27708, USA. Electronic address: anna.holleman@duke.edu.
(3)Duke Global Health Institute and Center for Health Policy & Inequalities 
Research, 310 Trent Drive, Durham, NC, 27708, USA. Electronic address: 
rae.jean@duke.edu.

COVID-19 and its associated restrictions presented unprecedented challenges for 
those in the helping professions. In this study, we seek to understand how the 
mental health of those who belong to one specific helping profession - clergy - 
changed in the context of COVID-19. Using longitudinal data of a sample of 
United Methodist pastors from the North Carolina Clergy Health Initiative, we 
conduct both cross-sectional and person-centered analyses to investigate how the 
overall mental health of this occupational group changed, as well as how 
different subgroups of clergy fared within the context of the pandemic, 
depending on their well-being prior to the onset of COVID-19. We found that the 
mental health of pastors suffered within the context of the pandemic, but that 
individual changes in mental health differed based on what the combined positive 
and negative mental health patterns of clergy were prior to the pandemic, for 
which we used latent class analysis to identify as Flourishing, Distressed, 
Languishing, or Burdened but Fulfilled. Of these subgroups, having Flourishing 
pre-pandemic status was protective of mental health following the onset of 
COVID-19, whereas the other three subgroups' mental health statuses worsened. 
This study is the one of the first longitudinal studies of helping professionals 
which has tracked changes in mental health before and after the onset of 
COVID-19. Our findings demonstrate the utility of considering positive and 
negative mental health indicators together, and they point to certain groups 
that can be targeted with well-being resources during future periods of acute or 
abnormal stress.

Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.socscimed.2024.116651
PMID: 38340387 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


110. BMC Infect Dis. 2024 Feb 9;24(1):179. doi: 10.1186/s12879-024-09055-z.

Creation of a pandemic memory by tracing COVID-19 infections and immunity in 
Luxembourg (CON-VINCE).

Tsurkalenko O(#)(1), Bulaev D(#)(2), O'Sullivan MP(2), Snoeck C(2), Ghosh S(3), 
Kolodkin A(2), Rommes B(3), Gawron P(3), Moreno CV(3), Gomes CPC(3), Kaysen 
A(3), Ohnmacht J(2), Schröder VE(3)(4), Pavelka L(2)(4), Meyers GR(2)(3), Pauly 
L(2), Pauly C(2)(4), Hanff AM(2)(3)(5), Meyrath M(2), Leist A(3), Sandt E(2), 
Aguayo GA(2), Perquin M(2), Gantenbein M(2), Abdelrahman T(6), Klucken J(2)(3), 
Satagopam V(3), Hilger C(2), Turner J(2), Vaillant M(2), Fritz JV(2), Ollert 
M(2), Krüger R(2)(3)(4); CON-VINCE consortium and the ORCHESTRA working group.

Collaborators: Acharya G, Alper P, Ammerlaan W, Ancien F, Assele-Kama A, 
Bahlawane C, Beaumont K, Beaupain N, Beckers L, Bellora C, Betsou F, Biver L, 
Boly S, Brenner D, Cauchie HM, Charalambous E, Charpentier E, Coibion E, Coito 
S, Collart D, Counson M, De Witt B, Di Pasquale A, Domingues O, Dording C, 
Dourson JL, Dragomir B, Fautsch T, Ferrand JY, Ferrandon T, Lopes AF, Fournier 
G, Georges L, Gidenne S, Glaab E, Ramos BG, Gorgogietas V, Graas J, Groues V, Gu 
W, Hamot G, Hansen M, Hansen L, Hefele L, Heirendt L, Hemedan A, Henry E, Henry 
M, Herkenne E, Herzinger S, Huiart L, Hundt A, Hübschen J, Iserentant G, Jägi P, 
Khurmin P, Klein F, Klein T, Kler S, Lambert P, Lebioda JJ, Lehmann S, Leick M, 
Lemaire M, Lumley A, Lutz A, Loureiro JM, Marchese M, Marques T, Massart F, May 
P, Minelli M, Mousel A, Munsch M, Mériaux S, Mühlschlegel F, Neumann M, Nguyen 
T, Nicolai B, Ogorzaly L, Olesky C, Penny C, Pexaras A, di Pinto P, Pirard MF, 
Plesseria JM, Rauschenberger A, Remark L, Rodriguez A, Rump K, Santos B, Sausy 
A, Schmitt M, Schmitt C, Schneider R, Schumacher S, Schweicher A, Seal S, 
Servais JY, Simon F, Skrozic A, Sokolowska K, Stute L, Thien H, Toll S, 
Toukourou N, Trefois C, Trouet J, Trung N, Esteves DV, Verschueren C, Vyas M, 
Vögele C, Walczak C, Wang X, Wauters F, Weber B, Weibel E, Zamboni T.

Author information:
(1)Luxembourg Institute of Health, Strassen, Luxembourg. 
olena.tsurkalenko@lih.lu.
(2)Luxembourg Institute of Health, Strassen, Luxembourg.
(3)University of Luxembourg, Esch-Belval, Luxembourg.
(4)Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg.
(5)Maastricht University Medical Centre, Maastricht, The Netherlands.
(6)Laboratoire National de Santé, Dudelange, Luxembourg.
(#)Contributed equally

BACKGROUND: During the COVID-19 pandemic swift implementation of research 
cohorts was key. While many studies focused exclusively on infected individuals, 
population based cohorts are essential for the follow-up of SARS-CoV-2 impact on 
public health. Here we present the CON-VINCE cohort, estimate the point and 
period prevalence of the SARS-CoV-2 infection, reflect on the spread within the 
Luxembourgish population, examine immune responses to SARS-CoV-2 infection and 
vaccination, and ascertain the impact of the pandemic on population 
psychological wellbeing at a nationwide level.
METHODS: A representative sample of the adult Luxembourgish population was 
enrolled. The cohort was followed-up for twelve months. SARS-CoV-2 RT-qPCR and 
serology were conducted at each sampling visit. The surveys included detailed 
epidemiological, clinical, socio-economic, and psychological data.
RESULTS: One thousand eight hundred sixty-five individuals were followed over 
seven visits (April 2020-June 2021) with the final weighted period prevalence of 
SARS-CoV-2 infection of 15%. The participants had similar risks of being 
infected regardless of their gender, age, employment status and education level. 
Vaccination increased the chances of IgG-S positivity in infected individuals. 
Depression, anxiety, loneliness and stress levels increased at a point of study 
when there were strict containment measures, returning to baseline afterwards.
CONCLUSION: The data collected in CON-VINCE study allowed obtaining insights 
into the infection spread in Luxembourg, immunity build-up and the impact of the 
pandemic on psychological wellbeing of the population. Moreover, the study holds 
great translational potential, as samples stored at the biobank, together with 
self-reported questionnaire information, can be exploited in further research.
TRIAL REGISTRATION: Trial registration number: NCT04379297, 10 April 2020.

© 2024. The Author(s).

DOI: 10.1186/s12879-024-09055-z
PMCID: PMC10858600
PMID: 38336649 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


111. Br J Nurs. 2024 Feb 8;33(3):132-138. doi: 10.12968/bjon.2024.33.3.132.

Rapid nursing redeployment from a specialist ward to a COVID-19 high-dependency 
setting.

Robinson R(1), Madge S(2).

Author information:
(1)Clinical Nurse Specialist, Department of Adult Cystic Fibrosis, Royal 
Brompton Hospital, London.
(2)Consultant Nurse, Department of Adult Cystic Fibrosis, Royal Brompton 
Hospital, London.

BACKGROUND: Redeployment in health care can have a negative impact on the mental 
wellbeing of staff. Advanced planning and provisions for wellbeing support for 
health professionals has been recommended following previous pandemics. At the 
authors' institution nurses were redeployed overnight from a specialist cystic 
fibrosis ward to a COVID-19 high-dependency unit.
AIM: To evaluate nurses' wellbeing following this redeployment during the first 
wave of the COVID-19 pandemic.
METHOD: A mixed online survey, consisting of both open and closed questions, 
based on literature, preliminary results of the Impact of COVID-19 on the 
Nursing and Midwifery Workforce (ICON) study and staff feedback. This was sent 
to 28 nurses to explore their feelings and experiences of redeployment to a 
COVID-19 environment. Purposive sampling was used to select study participants 
while thematic analysis and descriptive statistics were used to analyse the 
data.
FINDINGS: The survey had an 86% response rate. Using thematic analysis three key 
themes emerged: redeployment anxiety, lack of organisational preparedness and 
newfound teamworking. More than half (57%) of respondents expressed anxiety and 
concern when told of their redeployment; 52% reported that they did not receive 
adequate support from senior staff and management. However, 74% reported that 
they felt their nursing was positively influenced by support and teamwork from 
those in patient-facing roles. Twenty-five percent reported that they were 
looking for a new job or leaving their current role.
CONCLUSION: This study examines the effects that redeployment to a COVID-19 
environment has had on nurses. It highlights the need for further improvement to 
ensure redeployed staff are supported to safeguard their mental wellbeing.

DOI: 10.12968/bjon.2024.33.3.132
PMID: 38335100 [Indexed for MEDLINE]


112. Eur J Psychotraumatol. 2024;15(1):2306102. doi: 10.1080/20008066.2024.2306102. 
Epub 2024 Feb 9.

Exposure to moral stressors and associated outcomes in healthcare workers: 
prevalence, correlates, and impact on job attrition.

Nazarov A(1)(2)(3), Forchuk CA(1), Houle SA(1)(4), Hansen KT(1)(2), Plouffe 
RA(1)(2), Liu JJW(1)(2), Dempster KS(1), Le T(1), Kocha I(1), Hosseiny F(5), 
Heesters A(6)(7)(8)(9)(10), Richardson JD(1)(2)(3)(11).

Author information:
(1)MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health 
Research Institute, London, Canada.
(2)Department of Psychiatry, Schulich School of Medicine & Dentistry, Western 
University, London, Canada.
(3)Department of Psychiatry and Behavioral Neurosciences, McMaster University, 
Hamilton, Canada.
(4)Research Directorate, Veteran Affairs Canada, Charlottetown, Canada.
(5)Atlas Institute for Veterans and Families, Ottawa, Canada.
(6)Department of Clinical and Organizational Ethics, University Health Network, 
Toronto, Canada.
(7)The Institute for Education Research, University Health Network, Toronto, 
Canada.
(8)Joint Centre for Bioethics, University of Toronto, Toronto, Canada.
(9)The Michener Institute, University Health Network, Toronto, Canada.
(10)The Wilson Centre, University Health Network, Toronto, Canada.
(11)St. Joseph's Operational Stress Injury Clinic, St. Joseph's Health Care 
London, London, Canada.

Introduction: Healthcare workers (HCWs) often experience morally challenging 
situations in their workplaces that may contribute to job turnover and 
compromised well-being. This study aimed to characterize the nature and 
frequency of moral stressors experienced by HCWs during the COVID-19 pandemic, 
examine their influence on psychosocial-spiritual factors, and capture the 
impact of such factors and related moral stressors on HCWs' self-reported job 
attrition intentions.Methods: A sample of 1204 Canadian HCWs were included in 
the analysis through a web-based survey platform whereby work-related factors 
(e.g. years spent working as HCW, providing care to COVID-19 patients), moral 
distress (captured by MMD-HP), moral injury (captured by MIOS), mental health 
symptomatology, and job turnover due to moral distress were assessed.Results: 
Moral stressors with the highest reported frequency and distress ratings 
included patient care requirements that exceeded the capacity HCWs felt 
safe/comfortable managing, reported lack of resource availability, and belief 
that administration was not addressing issues that compromised patient care. 
Participants who considered leaving their jobs (44%; N = 517) demonstrated 
greater moral distress and injury scores. Logistic regression highlighted 
burnout (AOR = 1.59; p < .001), moral distress (AOR = 1.83; p < .001), and moral 
injury due to trust violation (AOR = 1.30; p = .022) as significant predictors 
of the intention to leave one's job.Conclusion: While it is impossible to fully 
eliminate moral stressors from healthcare, especially during exceptional and 
critical scenarios like a global pandemic, it is crucial to recognize the 
detrimental impacts on HCWs. This underscores the urgent need for additional 
research to identify protective factors that can mitigate the impact of these 
stressors.

Plain Language Summary: This study explored the nature of moral stressors 
encountered by health care workers, along with impacts on moral injury and 
intentions to leave their jobs.Morally distressing encounters were common, with 
the most prevalent and distressing experiences being organizational or 
team-based in nature.Findings revealed that severity of moral injury, 
particularly related to trust violation or betrayal, was a key factor 
influencing healthcare workers’ intentions to leave their jobs.

Introducción: Los trabajadores de la salud (TS) a menudo experimentan 
situaciones moralmente desafiantes en sus lugares de trabajo que pueden 
contribuir a la rotación laboral y comprometer su bienestar. Este estudio tuvo 
como objetivo caracterizar la naturaleza y frecuencia de los estresores morales 
experimentados por los TS durante la pandemia por COVID-19, examinar su 
influencia en los factores psicosociales-espirituales y capturar el impacto de 
dichos factores y los estresores morales relacionados a las intenciones de 
abandono laboral de los TS. Métodos: Se incluyó en el análisis una muestra de 
1.204 TS canadienses a través de una encuesta en plataforma web en la que se 
analizaron factores relacionados con el trabajo (p. ej., años trabajados como 
TS, brindando atención a pacientes con COVID-19), angustia moral (evaluado con 
MMD-HP), daño moral (evaluado con MIOS), sintomatología de salud mental y 
rotación laboral debido a angustia moral. Resultados: Los estresores morales con 
mayor frecuencia reportados y tasas de angustia incluyeron requerimientos de 
atención al paciente que excedieron la capacidad en la que los TS se sentían 
seguros/cómodos de manejarlos, falta de disponibilidad de recursos y la creencia 
de que la administración no estaba abordando los problemas que comprometían la 
atención al paciente. Los participantes que consideraron dejar sus trabajos 
(44%; N = 517) demostraron mayores puntuaciones de angustia y daño moral. La 
regresión logística destacó el burnout (AOR = 1,59; p < 0,001), la angustia 
moral (AOR = 1,83; p < 0,001) y el daño moral debido a la violación de la 
confianza (AOR = 1,30; p = 0,022) como predictores significativos asociados a la 
intención de dejar el trabajo. Conclusión: Si bien, es imposible eliminar por 
completo los estresores morales de la atención sanitaria, especialmente durante 
escenarios críticos y excepcionales como una pandemia global, es crucial 
reconocer los impactos perjudiciales para los TS. Esto subraya la necesidad 
urgente de realizar investigaciones adicionales para identificar factores 
protectores que puedan mitigar el impacto de estos factores estresantes.

DOI: 10.1080/20008066.2024.2306102
PMCID: PMC10860421
PMID: 38334695 [Indexed for MEDLINE]

Conflict of interest statement: No potential conflict of interest was reported 
by the author(s).


113. BMC Psychiatry. 2024 Feb 8;24(1):111. doi: 10.1186/s12888-024-05538-0.

Impact of post-COVID-19 olfactory disorders on quality of life, hedonic 
experiences and psychiatric dimensions in general population.

Dumas LE(1)(2), Vandersteen C(3)(4), Metelkina-Fernandez V(3)(5), Gros A(3)(6), 
Auby P(7)(3), Askenazy-Gittard F(7)(3).

Author information:
(1)Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent (SUPEA), 
Hôpitaux Pédiatriques de Nice, Centre Hospitalier Universitaire-Lenval, Nice, 
France. louise-emilie.dumas@hpu.lenval.com.
(2)CoBTeK-Lab, Université Côte d'Azur, Nice, France. 
louise-emilie.dumas@hpu.lenval.com.
(3)CoBTeK-Lab, Université Côte d'Azur, Nice, France.
(4)Institut Universitaire de la Face et du Cou (IUFC), ENT Department, Centre 
Hospitalier Universitaire, Nice, France.
(5)Service de Psychiatrie, Centre Hospitalier Universitaire, Nice, France.
(6)Département d'Orthophonie (DON), Université Côte d'Azur, Nice, France.
(7)Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent (SUPEA), 
Hôpitaux Pédiatriques de Nice, Centre Hospitalier Universitaire-Lenval, Nice, 
France.

BACKGROUND AND OBJECTIVE: Olfactory disorders in COVID-19 impact quality of life 
and may lead to psychological impairments. Prevalence ranges from 8 to 85%, 
persisting in about 30% of cases. This study aimed to evaluate the 6-month 
post-COVID-19 impact on quality of life, hedonic experiences, anxiety and 
depression due to olfactory disorders. Additionally, it sought to compare 
psychophysical tests and self-perceived olfactory evaluations.
METHODS: A prospective, longitudinal study was conducted over baseline (T0) and 
6 months (T1) on individuals with persistent olfactory disorders post-COVID-19 
for more than 6 weeks. Psychophysical tests employed the Sniffin' Sticks Test® 
(TDI score), and self-perceived olfactory evaluation used a Visual Analogue 
Scale. Quality of life was assessed with an Olfactive Disorder Questionnaire and 
the French version of the Quality of Life and Diet Questionnaire. Hedonic 
experiences were gauged using the Snaith-Hamilton Pleasure Scale, while anxiety 
and depression dimensions were measured by The State-Trait Anxiety Inventory, 
The Post Traumatic Stress Checklist Scale, and Hamilton Rating Scale for 
Depression. Participants were classified into the "normosmic group" (NG) and the 
"olfactory disorders group" (ODG) at T0 and T1 based on the TDI score.
RESULTS: Were included 56 participants (58.93% women, 41.07% men) with a mean 
age of 39.04 years and a mean duration of post-COVID-19 olfactory disorders of 
5.32 months. At T1, ODG had a significantly lower quality of life and hedonic 
experiences than NG. No significant differences in anxiety and depression 
dimensions were observed between groups. At T0, psychophysical tests and 
self-perceived olfactory evaluations were significantly correlated with quality 
of life and hedonic experiences in both groups. At T1, self-perceived olfactory 
evaluation in NG correlated significantly with quality of life, hedonic 
experiences, anxiety and depression dimensions, whereas ODG only correlated with 
hedonic experiences.
CONCLUSION: Individuals with persistent post-COVID-19 olfactory disorders after 
six months demonstrated compromised quality of life and hedonic experiences. 
Self-perceived olfactory evaluation played a more significant role in 
influencing quality of life and the dimension of anxiety and depression than the 
psychophysical presence of olfactory disorders. These findings emphasize the 
importance of considering patients' perceptions to comprehensively assess the 
impact of olfactory disorders on their well-being.
TRIAL REGISTRATION: ClinicalTrials.gov number (ID: NCT04799977).

© 2024. The Author(s).

DOI: 10.1186/s12888-024-05538-0
PMCID: PMC10854070
PMID: 38331799 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


114. Radiography (Lond). 2024 Mar;30(2):622-627. doi: 10.1016/j.radi.2024.01.018. 
Epub 2024 Feb 7.

Organisational challenges to wellbeing in nuclear medicine technologists: 
Professionalism, burnout and pragmatic growth.

Shields M(1), James D(2), McCormack L(3).

Author information:
(1)The University of Newcastle, University Dr, Callaghan, NSW, 2308, Australia. 
Electronic address: Melissa.shields@newcastle.edu.au.
(2)The University of Newcastle, University Dr, Callaghan, NSW, 2308, Australia. 
Electronic address: Daphne.James@newcastle.edu.au.
(3)The University of Newcastle, University Dr, Callaghan, NSW, 2308, Australia. 
Electronic address: Lynne.McCormack@newcastle.edu.au.

INTRODUCTION: Occupational risk for burnout in nuclear medicine technologists 
globally, and particularly during disaster demands on the profession, is poorly 
researched. This idiographic study explored the lived experience of nuclear 
medicine technologists during COVID-19 in a regional city in Australia.
METHODS: Data was collected from five participants using semi-structured 
interviews and transcribed and analysed according to the protocols of 
Interpretative Phenomenological Analysis (IPA).
RESULTS: Four group experiential themes were identified: Systemic 
Contraindications, Professional Strengths and Limitations, Pragmatic Growth, and 
Covid Rollercoaster. For these participants a dichotomous health care system, 
impacted by COVID-19, risked career longevity and burnout. Through empathic 
connection with vulnerable patients, they redefined their priorities, re-engaged 
in supportive connections with colleagues, and sought new pathways.
CONCLUSION: Multiple workplace stressors compounded by COVID-19, risked mental 
wellbeing, in these participants. Nevertheless, these challenges provided 
opportunities for reflection around career trajectory and longevity 
precipitating personal growth, job satisfaction and work-life balance.
IMPLICATIONS FOR PRACTICE: This study provided a lens on the risk factors 
inherent for nuclear medicine technologists in Australia, exacerbated by the 
COVID-19 pandemic. Current, and disaster protective practices, to ensure 
wellbeing and prevent burnout risk are recommended for future research.

Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.radi.2024.01.018
PMID: 38330894 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest statement None.


115. Nutr Hosp. 2024 Mar 1;41(Spec No1):1-60. doi: 10.20960/nh.05175.

[A consensus report by the Working Group on Eating Disorders of Sociedad 
Española de Nutrición Clínica y Metabolismo (GTTCA-SENPE). Evaluation, medical 
and nutritional management of anorexia nervosa. Update 2023].

[Article in Spanish; Abstract available in Spanish from the publisher]

Campos Del Portillo R(1), Palma Milla S(2), Matía Martín P(3), Loria-Kohen V(4), 
Martínez Olmos MÁ(5), Mories Álvarez MT(6), Castro Alija MJ(7), Martín Palmero 
MÁ(8), Carrillo Lozano E(1), Valero-Pérez M(2), Campos Del Portillo I(9), 
Sirvent Segovia AE(10), Plaza Blázquez P(1), de la Cruz López DM(11), Pita 
Gutiérrez F(12).

Author information:
(1)Servicio de Endocrinología y Nutrición. Hospital Universitario Puerta de 
Hierro Majadahonda.
(2)Unidad de Nutrición Clínica y Dietética. Servicio de Endocrinología y 
Nutrición. Hospital Universitario La Paz. IdiPAZ.
(3)Servicio de Endocrinología y Nutrición. Hospital Clínico San Carlos. Facultad 
de Medicina. Universidad Complutense de Madrid. Instituto de Investigación 
Sanitaria San Carlos (IdISSC).
(4)Departamento de Nutrición y Ciencia de los Alimentos. Facultad de Farmacia. 
Universidad Complutense de Madrid.
(5)Unidad de Nutrición Clínica y Dietética. Servicio de Endocrinología y 
Nutrición. Complejo Hospitalario Universitario de Santiago de Compostela. Grupo 
de Investigación de Endocrinología Molecular. Instituto de Investigación 
Sanitaria de Santiago de Compost.
(6)Servicio de Endocrinología y Nutrición. Complejo Asistencial Universitario de 
Salamanca.
(7)Centro de Investigación de Endocrinología y Nutrición Clínica. Universidad de 
Valladolid.
(8)Servicio de Endocrinología y Nutrición. Clínica Universitaria de Navarra.
(9)Centro Vínculo Psicoterapia. Madrid. Hospital QuirónSalud Toledo.
(10)Servicio de Endocrinología y Nutrición. Hospital General de Almansa.
(11)Instituto de Formación, Investigación y Tratamiento del Adolescente y su 
Familia. IFITAF.
(12)Unidad de Nutrición. Servicio de Endocrinología y Nutrición. Complexo 
Hospitalario Universitario de A Coruña.

Anorexia nervosa (AN) is a multifactorial disorder. A possible role of the 
social network and the gut microbiota in pathogenesis has been added. Exogenous 
shocks such as the COVID19 pandemic have had a negative impact on patients with 
AN. The potential medical and nutritional impact of malnutrition and/or 
compensatory behaviors gives rise to a complex disease with a wide range of 
severity, the management of which requires a multidisciplinary team with a high 
level of subject matter expertise. Coordination between levels of care is 
necessary as well as understanding how to transition the patient from pediatric 
to adult care is essential. A proper clinical evaluation can detect possible 
complications, as well as establish the organic risk of the patient. This allows 
caregivers to tailor the medical-nutritional treatment for each patient. 
Reestablishing adequate nutritional behaviors is a fundamental pillar of 
treatment in AN. The design of a personalized nutritional treatment and 
education program is necessary for this purpose. Depending on the clinical 
severity, artificial nutrition may be necessary. Although the decision regarding 
the level of care necessary at diagnosis or during follow-up depends on a number 
of factors (awareness of the disease, medical stability, complications, suicidal 
risk, outpatient treatment failure, psychosocial context, etc.), outpatient 
treatment is the most frequent and most preferred choice. However, more 
intensive care (total or partial hospitalization) may be necessary in certain 
cases. In severely malnourished patients, the appearance of refeeding syndrome 
should be prevented during renourishment. The presence of AN in certain 
situations (pregnancy, vegetarianism, type 1 diabetes mellitus) requires 
specific care. Physical activity in these patients must also be addressed 
correctly.

Publisher: La anorexia nerviosa (AN) es una enfermedad de origen multifactorial. 
Recientemente se ha sumado el papel de las redes sociales y la microbiota 
intestinal en la patogenia. La pandemia por COVID-19 ha tenido un impacto 
negativo en los pacientes con AN. La potencial afectación médica y nutricional 
derivada de la desnutrición o las conductas compensatorias dan lugar a una 
compleja enfermedad de gravedad variable, cuyo manejo precisa un equipo 
multidisciplinar con elevado nivel de conocimientos en la materia. Es 
fundamental la coordinación entre niveles asistenciales y en la transición de 
pediatría a adultos. Una adecuada valoración clínica permite detectar eventuales 
complicaciones, así como establecer el riesgo orgánico del paciente y, por 
tanto, adecuar el tratamiento médico-nutricional de forma individualizada. El 
restablecimiento de un apropiado estado nutricional es un pilar fundamental del 
tratamiento en la AN. Para ello es necesario diseñar una intervención de 
renutrición individualizada que incluya un programa de educación nutricional. 
Según el escenario clínico puede ser necesaria la nutrición artificial. Aunque 
la decisión de qué nivel de atención escoger al diagnóstico o durante el 
seguimiento depende de numerosas variables (conciencia de enfermedad, 
estabilidad médica, complicaciones, riesgo autolítico, fracaso del tratamiento 
ambulatorio o contexto psicosocial, entre otros), el tratamiento ambulatorio es 
de elección en la mayoría de las ocasiones. No obstante, puede ser necesario un 
escenario más intensivo (hospitalización total o parcial) en casos 
seleccionados. En pacientes gravemente desnutridos debe prevenirse la aparición 
de un síndrome de alimentación cuando se inicia la renutrición. La presencia de 
una AN en determinadas situaciones (gestación, vegetarianismo, diabetes mellitus 
de tipo 1, etc.) exige un manejo particular. En estos pacientes también debe 
abordarse de forma correcta el ejercicio físico.

DOI: 10.20960/nh.05175
PMID: 38328958 [Indexed for MEDLINE]


116. J Urban Health. 2024 Feb;101(1):205-217. doi: 10.1007/s11524-024-00826-2. Epub 
2024 Feb 7.

Income Loss and Mental Health during the COVID-19 Pandemic in the United 
States-Investigating the Moderating Role of Race and Metro-Level Co-ethnic 
Density.

Huang Y(1)(2).

Author information:
(1)Department of Sociology and Demography, University of Texas at San Antonio, 1 
UTSA Circle, San Antonio, TX, 78249, USA. ying.huang@utsa.edu.
(2)Institute for Health Disparities Research, University of Texas, San Antonio, 
TX, 78249, USA. ying.huang@utsa.edu.

The COVID-19 pandemic has significantly impacted individuals' financial 
well-being and mental health. This study investigates the relationship between 
income loss and mental health outcomes during the pandemic, as well as the 
heterogeneity in this relationship by race/ethnicity and co-ethnic density in 
the metropolitan area. Using nationally representative Household Pulse Survey 
data, this study finds that income loss is associated with a heightened risk of 
depression and anxiety, even after controlling for individual and 
metropolitan-level characteristics. Co-ethnic density in metropolitan areas 
worsens the effects of income loss on depression and anxiety for Hispanics and 
non-Hispanic Blacks while residing in a metropolitan area with more Whites 
cushions the impact of income loss on depression and anxiety for non-Hispanic 
Whites. Overall, the study underscores the importance of considering the 
intersection of race/ethnicity and metropolitan-level co-ethnic density in 
exploring the influence of economic stressors on mental health.

© 2024. The New York Academy of Medicine.

DOI: 10.1007/s11524-024-00826-2
PMCID: PMC10897121
PMID: 38326574 [Indexed for MEDLINE]


117. Sci Rep. 2024 Feb 7;14(1):3131. doi: 10.1038/s41598-024-52993-6.

Fear of COVID-19 among professional caregivers of the elderly in Central 
Alentejo, Portugal.

Mendes FR(1)(2), Sim-Sim M(3), Gemito ML(1)(2), Barros MDL(1)(2), Serra IDC(1), 
Caldeira AT(4)(5).

Author information:
(1)Nursing Department, University of Évora, 7000-811, Évora, Portugal.
(2)Comprehensive Health Research Centre (CHCRC), University of Évora, 7000-811, 
Évora, Portugal.
(3)Comprehensive Health Research Centre (CHCRC), University of Évora, 7000-811, 
Évora, Portugal. msimsim@uevora.pt.
(4)School of Science and Technology, University of Évora, 7000-811, Évora, 
Portugal.
(5)HERCULES Laboratory, University of Évora, 7000-811, Évora, Portugal.

The coronavirus disease 2019 (COVID-19) has infected many institutionalised 
elderly people. In Portugal, the level of pandemic fear among professional 
caregivers of the elderly is unknown, as are its predictive factors. This study 
aimed to investigate predictors of fear of COVID-19 among workers caring for 
institutionalised elderly people in nursing homes. This is a cross-sectional 
study using multiple linear regression applied to a population of 652 caregivers 
located in 14 municipalities in Central Alentejo, Portugal, at March 2021. The 
criterion variable was the fear of COVID-19. Standardised regression 
coefficients showed that the higher the level of education, the lower the level 
of fear (β = - 0.158; t = - 4.134; p < .001). Other predictors of the level of 
fear were gender, with women having higher levels (β = 0.123; t = t = 3.203; 
p < 0.001), higher scores on COVID-19-like suspicious symptoms (β = 0.123; 
t = 3.219; p < 0.001) and having received a flu vaccine (β = 0.086; t = 2.252; 
p = 0.025). The model explains 6.7% of the variation in fear of COVID-19 
(R2Adj = 0.067). Health literacy can minimise the impact on the physical and 
mental health of these workers. In Central Alentejo, caregivers of the elderly 
play a fundamental role in social balance. Further studies are needed to better 
understand the factors that can improve their personal and professional 
well-being.

© 2024. The Author(s).

DOI: 10.1038/s41598-024-52993-6
PMCID: PMC10850084
PMID: 38326517 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


118. Georgian Med News. 2023 Dec;(345):196-202.

EFFECTS OF SOCIAL ESTRANGEMENT ON YOUNG PEOPLE'S MATURATION: A REVIEW OF THE 
RESEARCH.

Kumar B(1), Saxena B(2), Gupta P(3), Batra R(4), Patel J D(5), Ganapathy K(6).

Author information:
(1)1School of Pharmacy & Research, Dev Bhoomi Uttarakhand University, Dehradun, 
India.
(2)2Department of Pharmacy, Vivekananda Global University, Jaipur, India.
(3)3Department of psychiatry, TMMC&RC, Teerthanker Mahaveer University, 
Moradabad, Uttar Pradesh, India.
(4)4Department of Mechanical Engineering, Noida Institute of Engineering and 
Technology, Greater Noida, Uttar Pradesh, India.
(5)5Department of Pharmacology, Parul University, PO Limda, Tal. Waghodia, 
District Vadodara, Gujarat, India.
(6)6Department of Biotechnology, School of Sciences, JAIN (Deemed-to-be 
University), Karnataka, India.

A major issue among adolescents in recent years has been social isolation, or 
the sensation cut off and alone from peers and society. The effects of social 
isolation on youngsters and adolescents are investigated with special attention 
paying to the possible negative effects on their physical and mental health. 
Multiple studies have shown a link between adversity in life domains and 
adolescent social isolation. Firstly, it can have a major effect on mental 
health, raising the probability of experiencing things like anxiety, sadness and 
even suicidal thoughts. Second, it prevents the development of vital social 
abilities, making it harder to make and keep close friends. In addition, social 
isolation is associated with worse academic performance, which in turn reduces 
the number of courses a student can take and the number of jobs they can have in 
the future. After looking over 520 papers, 15 were chosen for the systematic 
review. Four researches reported the implications on general health, while two 
investigations reported on ramifications affecting the 
Hypothalamic-pituitary-adrenal (HPA) axis area along with social and mental 
growth of children. In conclusion, social isolation affects youth development 
across a wide spectrum, including psychological well-being, interpersonal 
skills, and academic success. Children and adolescents who experience isolation 
are more likely to suffer from anxiety and sadness, according to the review's 
findings. Cortical levels rise and mental growth slows in socially isolated 
children. Children and adolescents should be monitored by health professionals 
during and after the COVID-19 pandemic to ensure that their mental and physical 
health needs are met.

PMID: 38325323 [Indexed for MEDLINE]


119. J Adolesc Health. 2024 May;74(5):900-907. doi: 10.1016/j.jadohealth.2023.12.004. 
Epub 2024 Feb 5.

Psychosocial Burden During the COVID-19 Pandemic in Adolescents With Type 1 
Diabetes in Germany and Its Association With Metabolic Control.

Kamrath C(1), Tittel SR(2), Buchal G(3), Brämswig S(4), Preiss E(5), Göldel 
JM(6), Wiegand S(7), Minden K(8), Warschburger P(6), Stahl-Pehe A(9), Holl 
RW(2), Lanzinger S(2).

Author information:
(1)Department of General Pediatrics and Neonatology, Division of Pediatric 
Endocrinology and Diabetology, Center of Child and Adolescent Medicine, Justus 
Liebig University, Giessen, Germany. Electronic address: 
clemens.kamrath@paediat.med.uni-giessen.de.
(2)German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany; 
Institute of Epidemiology and Medical Biometry, CAQM, Ulm University, Ulm, 
Germany.
(3)DRK Children's Hospital Siegen, Siegen, Germany.
(4)RoMed Children's Hospital Rosenheim, Rosenheim, Germany.
(5)Divison of Pediatric Diabetology, Darmstädter Kinderkliniken Prinzessin 
Margaret, Darmstadt, Germany.
(6)Department of Psychology, Counseling Psychology, University of Potsdam, 
Potsdam, Germany.
(7)Department of Pediatric Endocrinology and Diabetology, Center for 
Social-Pediatric Care, Charité Universitätsmedizin Berlin, corporate member of 
Freie Universität Berlin und Humboldt- Universität zu Berlin, Berlin, Germany.
(8)German Rheumatism Research Center (DRFZ), Program Area Epidemiology, Berlin, 
Germany; Department of Pediatric Respiratory Medicine, German Charité University 
Medicine Berlin, corporate member of Freie Universität Berlin und Humboldt- 
Universität zu Berlin, Immunology and Critical Care Medicine at Charité 
University Hospital Berlin, Berlin, Germany.
(9)German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany; 
Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz 
Center for Diabetes Research at Heinrich Heine University Düsseldorf, 
Düsseldorf, Germany.

PURPOSE: To investigate the psychosocial burden during the COVID-19 pandemic in 
adolescents with type 1 diabetes and its association with metabolic control.
METHODS: Prospective multicenter observational cohort study based on data from 
the German Diabetes Prospective Follow-up Registry. Adolescents aged 12-20 years 
with type 1 diabetes were asked during routine follow-up visits to complete a 
questionnaire on psychosocial distress and daily use of electronic media during 
the COVID-19 pandemic from June 2021 to November 2022. Well-being, anxiety, and 
depression symptoms were assessed using World Health Organization Five 
Well-Being Index (WHO-5), General Anxiety Disorder scale 7 (GAD-7), and Patient 
Health Questionnaire-9 questionnaires. The impact of mental health symptoms on 
metabolic control was analyzed by using multivariable linear regression models 
adjusted for sex, diabetes duration, treatment, socioeconomic deprivation, and 
immigrant background.
RESULTS: Six hundred eighty eight adolescents (45.6% females) from 20 diabetes 
centers participated. Compared with a prepandemic cohort, WHO-5 scores were 
lower during the COVID-19 pandemic (estimated mean difference -9.6 [95% 
confidence interval -11.6; -7.6], p < .001), but GAD-7 scores were not different 
(estimated mean difference 0.6 [95% confidence interval -0.2; 1.5], p = .14). 
HbA1c was significantly positively associated with GAD-7 and Patient Health 
Questionnaire-9 and negatively associated with WHO-5 scores (all p < .001). 
Daily electronic media use was positively associated with adjusted mental health 
symptoms (all p < .01).
DISCUSSION: Although the overall well-being of adolescents with type 1 diabetes 
was reduced during the later phase of the COVID-19 pandemic, the additional 
psychological burden was relatively low. However, mental health symptoms were 
associated with poorer metabolic control and higher use of electronic media.

Copyright © 2023 Society for Adolescent Health and Medicine. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jadohealth.2023.12.004
PMID: 38323968 [Indexed for MEDLINE]


120. BMC Geriatr. 2024 Feb 6;24(1):135. doi: 10.1186/s12877-023-04644-0.

Being used for the greater good while fighting on the frontline: care staff's 
experiences of working with older people during the COVID-19 pandemic in Sweden.

Lövenmark A(1), Hammar LM(2)(3)(4).

Author information:
(1)The School of Health, Care and Social Welfare, Mälardalen University, 
Västerås, Sweden. annica.lovenmark@mdu.se.
(2)The School of Health, Care and Social Welfare, Mälardalen University, 
Västerås, Sweden.
(3)Division of Nursing, Department of Neurobiology, Care Sciences and Society, 
Karolinska Institute, Stockholm, Sweden.
(4)The School of Health and Welfare, Dalarna University, Falun, Sweden.

BAKGROUND: Worldwide, older people were more severely affected during the 
COVID-19 pandemic than others. In Sweden, those living in residential care 
facilities had the highest mortality rate, followed by those receiving home care 
services. The Swedish and international literature on the working environment 
for assistant nurses and care aides during the pandemic shows an increase in 
stress, anxiety, depression and post-traumatic stress syndromes. Care 
organisations were badly prepared to prevent the virus from spreading and to 
protect the staff from stress. In order to be better prepared for possible 
future pandemics, the health and well-being of the staff, the care of older 
people and the experiences of the staff both during and after a pandemic are 
important aspects to take into account. Therefore, this study aims to describe 
the experiences of assistant nurses and care aides working in the care of older 
people during the COVID-19 pandemic in Sweden, their working conditions and the 
impact all this had on their lives.
METHODOLOGY: The study has a qualitative, descriptive design. The data was 
collected in four focus group interviews with 21 participants and analysed using 
qualitative content analysis.
RESULTS: The results revealed the theme, Being used for the greater good while 
fighting on the frontline, which was then divided into three categories: 
portrayed as a risk for older people, not being valued and being burnt out. The 
worsening working conditions that the pandemic contributed to resulted in a high 
degree of stress and risk of burnout, with staff members both wanting to and 
actually leaving their employment. After the pandemic they felt forgotten again 
and left to cope in an even worse situation than before.
CONCLUSIONS: The pandemic had a major effect on assistant nurses and care aides 
in terms of their working environment and their private lives. To be better 
prepared for future pandemics or disasters, organisations with responsibility 
for the care of older people will need to ensure that their staff have the 
necessary competencies and that there is adequate staffing in place. This also 
means that adequate government funding and multiple interventions will be 
needed.

© 2024. The Author(s).

DOI: 10.1186/s12877-023-04644-0
PMCID: PMC10848549
PMID: 38321402 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


121. Sci Rep. 2024 Feb 6;14(1):3016. doi: 10.1038/s41598-024-52908-5.

Reduced health-related quality of life, fatigue, anxiety and depression affect 
COVID-19 patients in the long-term after chronic critical illness.

Egger M(1)(2), Wimmer C(3)(4), Stummer S(3), Reitelbach J(3), Bergmann J(3), 
Müller F(3), Jahn K(3)(4).

Author information:
(1)Research Group, Department of Neurology, Schoen Clinic Bad Aibling, 
Kolbermoorer Strasse 72, 83043, Bad Aibling, Germany. megger@schoen-klinik.de.
(2)Institute for Medical Information Processing, Biometry and Epidemiology 
(IBE), Faculty of Medicine, LMU Munich, Pettenkofer School of Public Health, 
Munich, Germany. megger@schoen-klinik.de.
(3)Research Group, Department of Neurology, Schoen Clinic Bad Aibling, 
Kolbermoorer Strasse 72, 83043, Bad Aibling, Germany.
(4)German Center for Vertigo and Balance Disorders, University Hospital 
Grosshadern, Ludwig-Maximilians-Universität München, Munich, Germany.

The term chronic critical illness describes patients suffering from persistent 
organ dysfunction and prolonged mechanical ventilation. In severe cases, 
COVID-19 led to chronic critical illness. As this population was hardly 
investigated, we evaluated the health-related quality of life, physical, and 
mental health of chronically critically ill COVID-19 patients. In this 
prospective cohort study, measurements were conducted on admission to and at 
discharge from inpatient neurorehabilitation and 3, 6, and 12 months after 
discharge. We included 97 patients (61 ± 12 years, 31% women) with chronic 
critical illness; all patients required mechanical ventilation. The median 
duration of ICU-treatment was 52 (interquartile range 36-71) days, the median 
duration of mechanical ventilation was 39 (22-55) days. Prevalences of fatigue, 
anxiety, and depression increased over time, especially between discharge and 
3 months post-discharge and remained high until 12 months post-discharge. 
Accordingly, health-related quality of life was limited without noteworthy 
improvement (EQ-5D-5L: 0.63 ± 0.33). Overall, the burden of symptoms was high, 
even one year after discharge (fatigue 55%, anxiety 42%, depression 40%, 
problems with usual activities 77%, pain/discomfort 84%). Therefore, patients 
with chronic critical illness should receive attention regarding treatment after 
discharge with a special focus on mental well-being.Trial registration: German 
Clinical Trials Register, DRKS00025606. Registered 21 June 2021-Retrospectively 
registered, https://drks.de/search/de/trial/DRKS00025606 .

© 2024. The Author(s).

DOI: 10.1038/s41598-024-52908-5
PMCID: PMC10847136
PMID: 38321074 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


122. JMIR Ment Health. 2024 Feb 5;11:e46637. doi: 10.2196/46637.

Effectiveness of Online and Remote Interventions for Mental Health in Children, 
Adolescents, and Young Adults After the Onset of the COVID-19 Pandemic: 
Systematic Review and Meta-Analysis.

Fischer-Grote L(1)(2), Fössing V(3), Aigner M(1)(4), Fehrmann E(1), Boeckle 
M(3).

Author information:
(1)Department of Psychology and Psychodynamics, Karl Landsteiner University of 
Health Sciences, Krems, Austria.
(2)Department of Clinical Psychology and Psychotherapy, University Hospital 
Krems, Krems, Austria.
(3)Research Centre Transitional Psychiatry, Karl Landsteiner University of 
Health Sciences, Krems, Austria.
(4)Department of Psychiatry for Adults, University Hospital Tulln, Tulln, 
Austria.

BACKGROUND: The prevalence of mental illness increased in children, adolescents, 
and young adults during the COVID-19 pandemic, while at the same time, access to 
treatment facilities has been restricted, resulting in a need for the quick 
implementation of remote or online interventions.
OBJECTIVE: This study aimed to give an overview of randomized controlled studies 
examining remote or online interventions for mental health in children, 
adolescents, and young adults and to explore the overall effectiveness of these 
interventions regarding different symptoms.
METHODS: A systematic literature search was conducted according to PRISMA 
(Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines 
using PubMed, PsycInfo, Psyndex, Embase, and Google Scholar. A meta-analysis was 
conducted using a random effects model to calculate overall effect sizes for 
interventions using standardized mean differences (SMDs) for postintervention 
scores.
RESULTS: We identified 17 articles with 8732 participants in the final sample, 
and 13 were included in the quantitative analysis. The studies examined 
different digital interventions for several outcomes, showing better outcomes 
than the control in some studies. Meta-analyses revealed significant medium 
overall effects for anxiety (SMD=0.44, 95% CI 0.20 to 0.67) and social 
functioning (SMD=0.42, 95% CI -0.68 to -0.17) and a large significant effect for 
depression (SMD=1.31, 95% CI 0.34 to 2.95). In contrast, no significant overall 
treatment effects for well-being, psychological distress, disordered eating, and 
COVID-19-related symptoms were found.
CONCLUSIONS: The qualitative and quantitative analyses of the included studies 
show promising results regarding the effectiveness of online interventions, 
especially for symptoms of anxiety and depression and for training of social 
functioning. However, the effectiveness needs to be further investigated for 
other groups of symptoms in the future. All in all, more research with 
high-quality studies is required.

©Linda Fischer-Grote, Vera Fössing, Martin Aigner, Elisabeth Fehrmann, Markus 
Boeckle. Originally published in JMIR Mental Health (https://mental.jmir.org), 
05.02.2024.

DOI: 10.2196/46637
PMCID: PMC10877489
PMID: 38315524 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


123. Cureus. 2024 Jan 3;16(1):e51588. doi: 10.7759/cureus.51588. eCollection 2024 
Jan.

Patients' Dreams and Unreal Experiences During Intensive Care Unit (ICU) 
Hospitalization.

Dimou K(1), Batiridou AL(1), Tatsis F(2), Georgakis S(2), Konstanti Z(1), 
Papathanakos G(3), Mantzoukas S(1), Dragioti E(1), Gouva M(1), Koulouras V(3).

Author information:
(1)Department of Nursing, School of Health Sciences, University of Ioannina, 
Ioannina, GRC.
(2)Faculty of Medicine, School of Health Sciences, University of Ioannina, 
Ioannina, GRC.
(3)Department of Intensive Care Unit, University Hospital of Ioannina, Ioannina, 
GRC.

In the intensive care unit (ICU), patients often experience fragmented memories, 
primarily comprising dreams and illusions. These experiences can impact 
psychosocial well-being, correlating with post-traumatic stress symptoms and 
heightened anxiety. Understanding these phenomena is crucial for holistic care. 
To systematically explore patients' perspectives concerning the recollection of 
dreams and unreal encounters during their stay in the ICU, considering pertinent 
clinical conditions and potential influencing factors, we conducted a 
comprehensive search in the PubMed/MEDLINE, Web of Science, and Scopus databases 
until November 20, 2023, following Preferred Reporting Items for Systematic 
Reviews and Meta-Analyses (PRISMA) guidelines. From an initial pool of 288 
records, a thorough screening for eligibility resulted in the inclusion of nine 
studies for this systematic review. These selected studies underwent evaluation 
using either the Critical Appraisal Skills Programme (CASP) Qualitative 
Checklist or the Newcastle-Ottawa Scale (NOS). All studies categorized dreams 
into three main types: positive, distressing (including nightmares), and neutral 
experiences. These were further detailed based on aspects such as time, space, 
senses, emotions, and distinguishing between reality and unreality. Two studies 
found associations between dreams and conditions like Guillain-Barré syndrome 
(GBS), mental abnormalities, and delirium. In one study, GBS patients had more 
vivid dreams, hallucinations, and delusions compared to ICU control group 
patients; delirious patients tend to report more frequent frightening dreams. 
Patients in the ICU who recalled dreams often had more severe illness, longer 
stays, and higher ventilation frequency. Notably, a prolonged ICU stay 
significantly predicted the likelihood of dream recall, as consistently observed 
in three other studies. This suggests that patients with prolonged ICU stays, 
experiencing higher dream recall, underwent extended treatments. This systematic 
exploration of patients' perspectives on fragmented memories underscores the 
connections between these experiences, clinical conditions such as GBS and 
delirium, and extended ICU stays. Recognizing and attending to these 
psychological aspects in post-ICU care is critical for alleviating the enduring 
emotional consequences for patients.

Copyright © 2024, Dimou et al.

DOI: 10.7759/cureus.51588
PMCID: PMC10835202
PMID: 38313939

Conflict of interest statement: The authors have declared that no competing 
interests exist.


124. Lancet Healthy Longev. 2024 Feb;5(2):e97-e107. doi: 
10.1016/S2666-7568(23)00238-6.

Behavioural activation to mitigate the psychological impacts of COVID-19 
restrictions on older people in England and Wales (BASIL+): a pragmatic 
randomised controlled trial.

Gilbody S(1), Littlewood E(2), McMillan D(3), Atha L(4), Bailey D(4), Baird 
K(4), Brady S(4), Burke L(4), Chew-Graham CA(5), Coventry P(6), Crosland S(4), 
Fairhurst C(4), Henry A(2), Hollingsworth K(2), Newbronner E(4), Ryde E(2), 
Shearsmith L(7), Wang HI(4), Webster J(8), Woodhouse R(4), Clegg A(7), 
Dexter-Smith S(9), Gentry T(10), Hewitt C(4), Hill A(7), Lovell K(11), Sloan 
C(4), Traviss-Turner G(7), Pratt S(12), Ekers D(2); BASIL trials collective.

Author information:
(1)Department of Health Sciences, University of York, York, UK; Hull York 
Medical School, University of York, York, UK. Electronic address: 
simon.gilbody@york.ac.uk.
(2)Department of Health Sciences, University of York, York, UK; Tees, Esk and 
Wear Valleys NHS Foundation Trust, Research & Development, Flatts Lane Centre, 
Middlesbrough, UK.
(3)Department of Health Sciences, University of York, York, UK; Hull York 
Medical School, University of York, York, UK; Tees, Esk and Wear Valleys NHS 
Foundation Trust, Research & Development, Flatts Lane Centre, Middlesbrough, UK.
(4)Department of Health Sciences, University of York, York, UK.
(5)School of Medicine, Keele University, Staffordshire, UK.
(6)Department of Health Sciences, University of York, York, UK; York 
Environmental Sustainability Institute, University of York, York, UK.
(7)School of Medicine, University of Leeds, Leeds, UK.
(8)Patient and Public Representative, Thornton-le-Dale, UK.
(9)Tees, Esk and Wear Valleys NHS Foundation Trust, Research & Development, 
Flatts Lane Centre, Middlesbrough, UK.
(10)Age UK, London, UK.
(11)Division of Nursing, Midwifery & Social Work, University of Manchester, 
Manchester, UK.
(12)NIHR Clinical Research Network, Newcastle, UK.

BACKGROUND: Older adults were more likely to be socially isolated during the 
COVID-19 pandemic, with increased risk of depression and loneliness. We aimed to 
investigate whether a behavioural activation intervention delivered via 
telephone could mitigate depression and loneliness in at-risk older people 
during the COVID-19 pandemic.
METHODS: BASIL+ (Behavioural Activation in Social Isolation) was a pragmatic 
randomised controlled trial conducted among patients recruited from general 
practices in England and Wales, and was designed to assess the effectiveness of 
behavioural activation in mitigating depression and loneliness among older 
people during the COVID-19 pandemic. Eligible participants were aged 65 years 
and older, socially isolated, with a score of 5 or higher on the Patient Health 
Questionnaire-9 (PHQ-9), and had multiple long-term conditions. Participants 
were allocated in a 1:1 ratio to the intervention (behavioural activation) or 
control groups by use of simple randomisation without stratification. 
Behavioural activation was delivered by telephone; participants were offered up 
to eight weekly sessions with trained BASIL+ Support Workers. Behavioural 
activation was adapted to maintain social connections and encourage socially 
reinforcing activities. Participants in the control group received usual care 
with existing COVID-19 wellbeing resources. The primary clinical outcome was 
self-reported depression severity, assessed by the PHQ-9, at 3 months. Outcomes 
were assessed masked to allocation and analysis was by treatment allocation. 
This trial is registered with the ISRCTN registry (ISRCTN63034289).
FINDINGS: Between Feb 8, 2021, and Feb 28, 2022, 449 eligible participants were 
identified and 435 from 26 general practices were recruited and randomly 
assigned (1:1) to the behavioural activation intervention (n=218) or to the 
control group (usual care with signposting; n=217). The mean age of participants 
was 75·7 years (SD 6·7); 270 (62·1%) of 435 participants were female, and 418 
(96·1%) were White. Participants in the intervention group attended an average 
of 5·2 (SD 2·9) of eight remote behavioural activation sessions. The adjusted 
mean difference in PHQ-9 scores between the control and intervention groups at 3 
months was -1·65 (95% CI -2·54 to -0·75, p=0·0003). No adverse events were 
reported that were attributable to the behavioural activation intervention.
INTERPRETATION: Behavioural activation is an effective and potentially scalable 
intervention that can reduce symptoms of depression and emotional loneliness in 
at-risk groups in the short term. The findings of this trial add to the range of 
strategies to improve the mental health of older adults with multiple long-term 
conditions. These results can be helpful to policy makers beyond the pandemic in 
reducing the global burden of depression and addressing the health impacts of 
loneliness, particularly in at-risk groups.
FUNDING: UK National Institute for Health and Care Research.

Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open 
Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. 
All rights reserved.

DOI: 10.1016/S2666-7568(23)00238-6
PMCID: PMC10834375
PMID: 38310902 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of interests SG and DE are members 
of the NICE Depression Guideline (update) Development Group. CAC-G declares 
royalties from Cambridge University Press Primary Care Mental Health, honoraria 
as Editor-in-Chief of Health Expectations and for organisation of the Royal 
College of General Practitioners (RCGP) One Day Essential learning event, and is 
Chair of the Society for Academic Primary Care awards panel and the RCGP 
Research Paper of the Year. All other authors declare no competing interests.


125. J Adolesc Health. 2024 Apr;74(4):729-738. doi: 10.1016/j.jadohealth.2023.10.016. 
Epub 2024 Feb 2.

Adolescent Mental Health Before and During COVID-19: Longitudinal Evidence From 
the 2004 Pelotas Birth Cohort in Brazil.

Maruyama JM(1), Tovo-Rodrigues L(2), Santos IS(2), Murray J(3), Matijasevich 
A(4).

Author information:
(1)Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, 
Universidade de São Paulo, São Paulo, Brazil. Electronic address: 
jessica.maruyama@alumni.usp.br.
(2)Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, 
Brazil.
(3)Human Development and Violence Research Centre, Federal University of 
Pelotas, Pelotas, Brazil.
(4)Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, 
Universidade de São Paulo, São Paulo, Brazil.

PURPOSE: There is great interest in examining the consequences of the COVID-19 
pandemic on adolescent mental health, but most studies were conducted in 
high-income countries. The identification of overall effects and protective 
factors is essential to understand the determinants of mental wellbeing in 
contexts of stress. We aimed to study changes in adolescent mental health during 
the pandemic and the risk and protective factors associated with these changes 
in a Brazilian birth cohort.
METHODS: One thousand nine hundred forty nine adolescents from the 2004 Pelotas 
Birth Cohort were assessed prepandemic (T1, November 2019 to March 2020, mean 
age 15.69 years) and mid-pandemic (T2, August to December 2021, mean age 
17.41 years). Mental health was assessed using the Strengths and Difficulties 
Questionnaire. Prepandemic and pandemic-related predictors were examined as 
predictors of change in multivariate latent change scores models.
RESULTS: There was a mean increase in adolescent total mental health 
difficulties (M = 1.071, p < .001), hyperactivity/inattention (M = 0.208, p < 
.001), emotion symptoms (M = 0.409, p < .001), and peer problems (M = 0.434, p < 
.001) during the pandemic. This increase was associated with several negative 
family context variables, including harsh parenting and maternal depressive 
symptoms at T2. Higher emotion regulation levels protected against increases in 
adolescent mental health difficulties related to the COVID-19 pandemic.
DISCUSSION: Family-context variables emerged as important risk factors for the 
deterioration of adolescent mental health during the COVID-19 pandemic. 
Interventions promoting emotion regulation strategies are a promising approach 
to protecting adolescent wellbeing in periods of stress.

Copyright © 2024. Published by Elsevier Inc.

DOI: 10.1016/j.jadohealth.2023.10.016
PMID: 38310505 [Indexed for MEDLINE]


126. Int J Equity Health. 2024 Feb 3;23(1):20. doi: 10.1186/s12939-024-02115-5.

Telehealth program for symptomatic COVID-19 patients in Mindanao, Philippines: a 
whole-of-system, pragmatic interventional study on patient monitoring from 
isolation facilities to community reintegration.

Punzalan JK(1)(2), Guingona M(3), Gregorio E(4), Ferraren J(3), Sta Elena MA(5), 
Valaquio M(5), Arnuco FD(3), Punzalan MG(3)(4), Arciaga R(3), Woolley T(6), 
Kunting A(4), Miravite DA(5), Cristobal F(3).

Author information:
(1)Ateneo de Zamboanga University, Zamboanga City, Philippines. 
punzalanjait@adzu.edu.ph.
(2)Zamboanga City Medical Center, Zamboanga City, Philippines. 
punzalanjait@adzu.edu.ph.
(3)Ateneo de Zamboanga University, Zamboanga City, Philippines.
(4)Zamboanga City Medical Center, Zamboanga City, Philippines.
(5)Zamboanga City Health Office, Zamboanga City, Philippines.
(6)James Cook University, Queensland, Australia.

The COVID-19 pandemic is impacting individuals and society's physical and mental 
health. Despite the lack of any definite and effective therapeutic regimen, 
public health measures such as quarantine and isolation have been instituted to 
contain this pandemic. However, these mitigating measures have also raised 
issues regarding isolated patients' mental and psychological well-being. Several 
stakeholders were engaged in this approach, including the university, the local 
health office, the tertiary hospital, and the local communities. This 
intervention addresses concerns regarding the health status of isolated 
individuals due to COVID-19 infection, making the program available to anyone 
who agrees to participate. This was done through telehealth services delivered 
via phone calls and SMS. The university provided technical support and 
telehealth manpower through medical students. The local health unit manages the 
isolation facilities, while the referral hospital offers specialty care for 
isolated patients through teleconsultation. Finally, the local community is the 
one that reintegrates discharged patients into their communities. Three hundred 
forty-four (344) participants were provided seven sessions on telehealth 
education and tracking of their COVID-19 prescribed practices and mental health. 
The mean age of the patients was 37 years; half were females, and 15% had 
comorbidities. Regarding their mental health status, the level of depression 
dropped from 6% to 1% (p<0.0001), the level of anxiety dropped from 12% to 2% 
(p<0.0001), and the level of stress dropped from 3% to 0% (p<0.0001) from the 
first day of admission to 2 weeks after discharge. Moreover, a general trend of 
statistically significant increase in various practices was noted: wearing face 
masks, physical distancing, disinfecting frequently held objects, hand hygiene, 
and self-monitoring for COVID-19 symptoms. Those with progressing symptoms of 
COVID-19 were referred immediately to the referral hospital. There were also no 
reports of complications of co-morbidities during their stay in the isolation 
facilities or social isolation upon community reintegration. The study concludes 
that telehealth services have the potential to address many challenges in 
providing continuous healthcare services to isolated patients until they are 
reintegrated into their community. Furthermore, a whole-of-society approach is 
necessary to provide holistic care to patients affected by the pandemic.

© 2024. The Author(s).

DOI: 10.1186/s12939-024-02115-5
PMCID: PMC10838445
PMID: 38310299 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


127. Eur Rev Med Pharmacol Sci. 2024 Jan;28(2):836-851. doi: 
10.26355/eurrev_202401_35085.

Consequences of COVID-19 restrictions on adolescent mental health and drug abuse 
dynamics.

Marinelli S(1), Basile G, De Paola L, Napoletano G, Zaami S.

Author information:
(1)School of Law, Polytechnic University of Marche, Ancona, Italy. 
simona.zaami@uniroma1.it.

The COVID-19 pandemic has hit elderly people the hardest in terms of severity 
and mortality. However, it is also evident that children and adolescents have 
been significantly impacted and experienced major disruptions in their lives. 
The psychological, mental, and developmental repercussions have been major and 
have led to a reshaping of drug abuse dynamics and substance addiction. The 
authors have outlined a narrative review of the major issues affecting 
adolescents and their mental well-being by clarifying the lingering effects and 
pandemic aftermath, especially on drug abuse, developmental aspects, and 
behavioral addiction. The unique traits of adolescent risk factors have been 
outlined, in order to identify areas to be prioritized for future strategies. 
Possible repercussions on juvenile crime linked to social estrangedness and 
disrupted interactions have been briefly explored as well. All such aspects are 
highly meaningful and relevant from a medicolegal perspective as well. The 
looming mental health crisis involving youngsters will have to be confronted by 
fine-tuning and optimizing mental health care services, building on current 
experiences, raising awareness, and eliminating the stigma that often comes with 
mental issues. Healthcare systems should look at the current scenario as an 
opportunity to improve care delivery to eliminate access inequalities and 
stigmatization of mental issues and raise awareness for the benefit and 
well-being of all. Similarly, law enforcement, lawmakers, and the judiciary will 
have to account for such factors, too, as will economic policy-makers. In that 
regard, a set of defining criteria has been framed in order to provide a degree 
of objectivity when meeting the unique challenges of the pandemic for youth 
mental health, in a comprehensive and tailored fashion.

DOI: 10.26355/eurrev_202401_35085
PMID: 38305627 [Indexed for MEDLINE]


128. BMC Psychiatry. 2024 Feb 1;24(1):92. doi: 10.1186/s12888-024-05542-4.

Implementing internet-based cognitive behavioural therapy (moodgym) for African 
students with symptoms of low mood during the COVID-19 pandemic: a qualitative 
feasibilty study.

Ncheka JM(1), Menon JA(2)(3)(4), Davies EB(5)(6), Paul R(1), Mwaba SOC(2), 
Mudenda J(7), Wharrad H(8), Tak H(6), Glazebrook C(9)(10).

Author information:
(1)School of Medicine, Department of Psychiatry, University of Zambia, Lusaka, 
Zambia.
(2)School of Humanities and Social Sciences, Department of Psychology, 
University of Zambia, Lusaka, Zambia.
(3)School of Liberal Studies, University of Petroleum and Energy Sciences, 
Dehradun, India.
(4)Rochester Institute of Technology, Liberal Arts Department, Dubai, UAE.
(5)Institute of Mental Health, School of Medicine, NIHR MindTech MedTech 
Co-operative, The University of Nottingham, Nottingham, UK.
(6)Clinical Neurosciences and Mental Health, School of Medicine, Institute of 
Mental Health, The University of Nottingham, Nottingham, UK.
(7)Lusaka Apex Medical University, Lusaka, Zambia.
(8)School of Health Sciences, University of Nottingham, Nottingham, UK.
(9)Institute of Mental Health, School of Medicine, NIHR MindTech MedTech 
Co-operative, The University of Nottingham, Nottingham, UK. 
cris.glazebrook@nottingham.ac.uk.
(10)Clinical Neurosciences and Mental Health, School of Medicine, Institute of 
Mental Health, The University of Nottingham, Nottingham, UK. 
cris.glazebrook@nottingham.ac.uk.

BACKGROUND: Online therapies have been shown to be effective in improving 
students' mental health. They are cost-effective and therefore have particular 
advantages in low-income countries like Zambia where mental health resources are 
limited. This study aimed to explore the perceived impact of the COVID-19 
pandemic and the feasibility of implementing an Internet-Based Cognitive 
Behavioural Therapy (iCBT) intervention ('moodgym') to improve resilience in 
vulnerable Zambian students.
METHODS: The study was a qualitative interview study. Participants identifying 
as having symptoms of low mood and completing a baseline, online survey 
(n = 620) had the option to volunteer for a semi-structured interview to explore 
views about their experience of the pandemic and the acceptability and perceived 
benefits and limitations of using moodgym.
RESULTS: A total of 50 students (n = 24 female, n = 26 male) participated in the 
study. One theme with 4 sub-themes, captured the severe emotional and social 
impact of the COVID-19 pandemic. A second, very strong theme, with 5 sub-themes, 
reflected the considerable negative effects of the pandemic on the students' 
educational experience. This included the challenges of online learning. The 
third theme, with three subthemes, captured the benefits and acceptability of 
moodgym, particularly in terms of understanding the relationship between 
thoughts and feelings and improving academic performance. The fourth theme 
described the technical difficulties experienced by students in attempting to 
use moodgym.
CONCLUSION: COVID-19 caused fear and impacted wellbeing in vulnerable students 
and severely impaired the quality of students' educational experience. The 
findings suggest that moodgym might be a valuable support to students in a 
low-income country.

© 2024. The Author(s).

DOI: 10.1186/s12888-024-05542-4
PMCID: PMC10835970
PMID: 38302998 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


129. Matern Child Health J. 2024 May;28(5):915-925. doi: 10.1007/s10995-023-03871-6. 
Epub 2024 Feb 1.

Caregiver Perspectives on Barriers and Facilitators to Timely Well-Child Visits 
for Black Infants.

Dever R(1), Wong CA(2), Franklin MS(3)(4), Howard J(5), Cholera R(3)(6)(7)(8).

Author information:
(1)Department of Pediatrics, University of Washington, 4800 Sand Point Way NE, 
Seattle, WA, 98105, USA. reilly.dever@seattlechildrens.org.
(2)Centers for Disease Control and Prevention, Atlanta, GA, USA.
(3)Duke Margolis Center for Health Policy, 100 Fuqua Drive, Box 90120, Durham, 
NC, 27708, USA.
(4)Department of Psychiatry, Duke University, 2301 Erwin Rd, Durham, NC, 27707, 
USA.
(5)Duke Center for Childhood Obesity Research, 3116 N. Duke Street, Room 1028, 
Durham, NC, 27704, USA.
(6)Duke University School of Medicine, 8 Searle Center Dr, Durham, NC, 27710, 
USA.
(7)Department of Pediatrics, Duke University, 2301 Erwin Rd, Durham, NC, 27707, 
USA.
(8)Department of Population Health Sciences, Duke University, 215 Morris St, 
Durham, NC, 27701, USA.

OBJECTIVES: Missed infant well-child visits (WCV) result in lost opportunities 
for critical preventive care. Black infants consistently receive less WCV care 
than other racial groups. We sought to understand barriers and facilitators to 
timely infant WCV for Black families in the context of COVID-19.
METHODS: We conducted 21 semi-structured interviews with caregivers of 
Medicaid-insured Black children aged 15- to 24-months who attended six or fewer 
of eight recommended well-child visits within the first 15 months of life. 
Interviews focused on WCV value, barriers, and facilitators. After developing 
our initial coding structure through rapid qualitative analysis, we inductively 
derived the final codebook and themes through line-by-line content analysis.
RESULTS: Caregivers attended a mean of 3.53 of eight infant visits. Structural 
(e.g., transportation) and psychological (e.g., maternal depression) barriers 
delayed Black infant WCV. Families most frequently valued monitoring development 
and addressing concerns. Caregivers perceived visits as less urgent when infants 
seemed healthy or more recently avoided visits due to fears around COVID-19. 
Long waits and feeling rushed/dismissed were linked to WCV delays; positive 
provider relationships encouraged WCV attendance. Most caregivers reported 
reluctance to vaccinate. Vaccine hesitancy contributed to delayed infant WCV.
CONCLUSIONS: Caregivers described several factors that impacted WCV attendance 
for Black infants. Persistent structural and psychological barriers are 
compounded by perceptions that caregiver time is not respected and by notable 
vaccine hesitancy. To address these barriers, well-care can meet Black families 
in their communities, better address caregiver wellbeing, more efficiently use 
caregiver and provider time, and cultivate partnerships with Black caregivers.

© 2024. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s10995-023-03871-6
PMID: 38300471 [Indexed for MEDLINE]


130. Am J Health Promot. 2024 May;38(4):459-463. doi: 10.1177/08901171241232248. Epub 
2024 Jan 31.

Research Findings Journalists Cannot Resist: A Tale of Three Mental Health and 
Well-Being Studies.

Terry PE(1).

Author information:
(1)Editor in Chief, American Journal of Health Promotion, Senior Fellow, HERO 
(Heath Enhancement Research Organization).

Addressing employee mental health needs and fostering organizations that enable 
thriving has become a priority for most workplace health and well-being 
initiatives. While mental health issues for the nation were of growing concern 
before COVID-19, the pandemic amplified concerns about loneliness, burnout and 
deaths of despair. A recent study that garnered attention from the popular press 
found that participants of individual-level mental health interventions were no 
better off than non-participants. This editorial reviews that study, summarizes 
limitations and beneficial learnings from the research, and argues that 
organizational factors have been shown to mitigate or amplify the effectiveness 
of mental health services. Tenets of 'patient-centered care' and the principles 
behind Total Worker Health® will need to be more broadly embraced so that the 
voice of employees can better inform workplace well-being strategies and 
strategic plans.

DOI: 10.1177/08901171241232248
PMID: 38297887 [Indexed for MEDLINE]


131. BMC Psychiatry. 2024 Jan 31;24(1):85. doi: 10.1186/s12888-024-05512-w.

Mental health disturbance in preclinical medical students and its association 
with screen time, sleep quality, and depression during the COVID-19 pandemic.

Wiguna T(1), Dirjayanto VJ(2)(3), Maharani ZS(4), Faisal EG(4), Teh SD(1), 
Kinzie E(5).

Author information:
(1)Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General 
Hospital, Jakarta, Indonesia.
(2)Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia. 
Vjosephine8@gmail.com.
(3)Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK. 
Vjosephine8@gmail.com.
(4)Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
(5)Department of Psychiatry, Tulane University School of Medicine, New Orleans, 
USA.

BACKGROUND: Affected by various hurdles during COVID-19, preclinical medical 
students are at an elevated risk for mental health disturbances. However, the 
effects of modern mental health problems on preclinical medical students have 
not been adequately researched. Thus, this study was aimed to identify the 
proportions and implications of current mental health problems for depression, 
sleep quality and screen time among Indonesian medical preclinical students 
during the COVID-19 pandemic.
METHODS: This cross-sectional study was conducted using crowdsourcing between 
October 2020 and June 2021. During the study period, 1,335 subjects were 
recruited, and 1,023 datasets were identified as valid. General Health 
Questionnaire-12 (GHQ-12) was used to measure current mental health disturbances 
(categorized as without current mental health disturbances, psychological 
distress, social dysfunction, or both). The Patient Health Questionnaire-9 
(PHQ-9) was used to assess depression, the Pittsburgh Sleep Quality Index (PSQI) 
was employed to assess sleep quality, and a questionnaire devised for this study 
was used to assess screen time length per day. Multivariate data analysis was 
conducted using SPSS version 24 for Mac.
RESULTS: According to the findings, 49.1% of the 1,023 participants had current 
mental health disturbances: 12.8% had psychological distress, 15.9% had social 
dysfunction, and the rest (20.4%) had both psychological distress and social 
dysfunction. The statistical analysis provided strong evidence of a difference 
(p < 0.001) between the medians of depression and sleep quality with at least 
one pair of current mental health disturbance groups, but the difference for 
screen time was not significant (p = 0.151). Dunn's post-hoc analysis showed 
that groups without current mental health problems had significantly lower mean 
ranks of depression and sleep quality compared to groups that had current mental 
health problems (p < 0.001).
CONCLUSION: Current mental health disturbances during the COVID-19 pandemic were 
significantly associated with preclinical medical students' depression and sleep 
quality in preclinical medical students. Thus, mental health programs for this 
specific population should be tailored to integrate mindfulness therapy, support 
groups, stress management, and skills training to promote mental wellbeing.

© 2024. The Author(s).

DOI: 10.1186/s12888-024-05512-w
PMCID: PMC10832144
PMID: 38297243 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


132. Front Public Health. 2024 Jan 16;11:1292154. doi: 10.3389/fpubh.2023.1292154. 
eCollection 2023.

Urban green space visitation and mental health wellbeing during COVID-19 in 
Bangkok, Thailand.

Arifwidodo SD(1), Chandrasiri O(2).

Author information:
(1)Department of Landscape Architecture, Faculty of Architecture, Kasetsart 
University, Chatuchak, Thailand.
(2)Activethai.org Research Center, Faculty of Architecture, Kasetsart 
University, Chatuchak, Thailand.

Urban green spaces offer numerous benefits, and their role in supporting mental 
health, particularly during global crises such as the COVID-19 pandemic, is of 
growing interest to researchers and policymakers. This study explored the 
relationship between urban green space visitation and mental health well-being 
during the COVID-19 pandemic in Bangkok, Thailand. This cross-sectional study, 
conducted in Bangkok during the COVID-19 lockdown, used a telephone survey of 
579 respondents. A logistic regression model was employed to examine the 
association between urban green space visitation and the WHO-5 mental health 
well-being score, considering various factors such as socioeconomic variables, 
healthy behaviors, and COVID-19-related experiences. The findings revealed a 
significant association between urban green space visitation during the lockdown 
and higher mental health well-being. Socioeconomic variables and healthy 
behaviors of respondents were also notably linked to higher WHO-5 mental health 
well-being scores. These findings collectively indicate that urban greenspace 
visitation serves as a crucial determinant of mental health and well-being, 
especially during the COVID-19 pandemic.

Copyright © 2024 Arifwidodo and Chandrasiri.

DOI: 10.3389/fpubh.2023.1292154
PMCID: PMC10824833
PMID: 38292382 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


133. J Affect Disord. 2024 Apr 15;351:268-277. doi: 10.1016/j.jad.2024.01.253. Epub 
2024 Jan 29.

Cognitive reappraisal moderates the protective effect of body satisfaction on 
mental health and wellbeing in adults: A prospective study during COVID-19 
lockdown.

Murray K(1), Dawel A(2), Batterham PJ(3), Gulliver A(3), Farrer LM(3), Rodney 
Harris RM(4), Shou Y(5), Calear AL(3).

Author information:
(1)School of Medicine and Psychology, College of Health and Medicine, Building 
39, The Australian National University, Canberra ACT 2601, Australia. Electronic 
address: Kristen.Murray@anu.edu.au.
(2)School of Medicine and Psychology, College of Health and Medicine, Building 
39, The Australian National University, Canberra ACT 2601, Australia.
(3)Centre for Mental Health Research, College of Health and Medicine, 63 
Eggleston Road, The Australian National University, Canberra ACT 2601, 
Australia.
(4)Fenner School of Environment and Society, College of Science, The Australian 
National University, Canberra ACT 2601, Australia.
(5)School of Medicine and Psychology, College of Health and Medicine, Building 
39, The Australian National University, Canberra ACT 2601, Australia; Saw Swee 
Hock School of Public Health, National University of Singapore and National 
University Health System, Singapore 117549; Lloyd's Register Foundation 
Institute for The Public Understanding of Risk, National University of 
Singapore, Singapore 117602.

BACKGROUND: Body satisfaction is associated with mental health and well-being in 
adults. However, prospective studies are needed to better understand its 
protective effects, and in whom these are most beneficial. This study 
investigated body satisfaction as a predictor of depressive symptoms, 
generalised anxiety, and well-being in a representative Australian sample 
collected during the initial COVID-19 lockdown. Two emotion regulation 
strategies - cognitive reappraisal and expressive suppression - were also tested 
as moderating variables.
METHODS: The sample comprised 684 adults aged 19 to 87 years who completed three 
primary waves of data spanning two months [Wave 3 (W3), W4 and W7] from the 
Australian National COVID-19 Mental Health, Behaviour and Risk Communication 
Survey.
RESULTS: Hierarchical multiple regression models controlling for demographic and 
COVID-19 risk factors, as well as W3 for each outcome variable, indicated that 
W3 body satisfaction predicted greater W7 well-being, and fewer W7 depressive 
symptoms and greater W7 well-being in participants reporting low levels of W4 
cognitive reappraisal. No moderation for W4 expressive suppression was observed, 
nor predictive relationships between W3 body satisfaction and W7 anxiety.
LIMITATIONS: The two-month follow-up period precludes conclusions relating to 
the longer-term protective effects of body satisfaction within and beyond the 
pandemic context. Examination of focal relationships in clinical samples, and 
inclusion of broader indices of body image, emotion regulation and mental 
health, is needed in future studies.
CONCLUSIONS: Findings suggest body satisfaction warrants attention in community 
well-being promotion in adults, and may be particularly beneficial for those 
lack adaptive emotion regulation strategies.

Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2024.01.253
PMID: 38290577 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest None to 
declare.


134. J Occup Health. 2024 Jan 4;66(1):uiae005. doi: 10.1093/joccuh/uiae005.

Organizational and occupational health issues with working remotely during the 
pandemic: a scoping review of remote work and health.

Lyzwinski LN(1)(2).

Author information:
(1)Center for Clinical Epidemiology, Lady Davis Institute, McGill Medical 
School, McGill University, Montreal, Quebec, Canada.
(2)Faculty of Humanities, Education, and Social Sciences, University of 
Luxembourg, Esch-sur-Alzette, Luxembourg.

BACKGROUND: Stay-at-home orders during the COVID-19 global pandemic created 
unprecedented challenges for workers whose work was transferred to the home 
setting. Little is presently known about the benefits and the challenges 
associated with global remote work on well-being and mental health, work-life 
balance, job satisfaction, productivity, home office adaptability, and gender 
equality.
METHODS: A scoping review of PubMed/Medline was undertaken in October 2021 to 
better understand these broad dimensions associated with remote worker health, 
well-being, and the home office workspace. The review focused on white-collar 
workers who undertook remote work during each of the lockdown waves from March 
2020 to 2021.
RESULTS: A total of 62 studies were included in the review, which spanned Asia, 
North America, South America, and Europe. Overall, workers seemed to enjoy 
remote work, but productivity varied. The main setbacks associated with remote 
work included feelings of isolation and loneliness, which negatively influenced 
well-being. Social support from management and contact with colleagues mitigated 
this. Leadership style also influenced remote worker well-being. Overall, women 
suffered from lower levels of remote work well-being and productivity, 
especially if they had children. The home office and its adaptability were 
integral for successful remote work. Work-life balance was affected in some 
workers who struggled with heavier workloads or family duties.
CONCLUSIONS: To promote well-being and successful remote work, isolation and 
loneliness should be reduced through greater contact with colleagues and 
managers. Managers should promote family friendly policies that may support 
work-life balance and reduce gender inequities in remote work.

© The Author(s) [2024]. Published by Oxford University Press on behalf of 
Journal of Occupational Health.

DOI: 10.1093/joccuh/uiae005
PMID: 38289710 [Indexed for MEDLINE]


135. BMJ Open. 2024 Jan 29;14(1):e081969. doi: 10.1136/bmjopen-2023-081969.

Mixed-methods randomised study exploring the feasibility and acceptability of 
eye-movement desensitisation and reprocessing for improving the mental health of 
traumatised survivors of intensive care following hospital discharge: protocol.

Bates A(1)(2), Golding H(3), Rushbrook S(4), Highfield J(5), Pattison N(6)(7), 
Baldwin D(2)(8), Grocott MPW(3)(2), Cusack R(3)(9).

Author information:
(1)Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research 
Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK 
a.bates@soton.ac.uk.
(2)Clinical and Experimental Sciences, Faculty of Medicine, University of 
Southampton, Southampton, UK.
(3)Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research 
Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
(4)Dorset HealthCare University NHS Foundation Trust, Poole, UK.
(5)Cardiff and Vale University Health Board, Cardiff, UK.
(6)University of Hertfordshire, Hatfield, UK.
(7)East and North Hertfordshire NHS Trust, Stevenage, UK.
(8)Southern Health NHS Foundation Trust, Southampton, UK.
(9)University of Southampton Faculty of Medicine, Southampton, UK.

INTRODUCTION: Post-traumatic symptoms are common among patients discharged from 
intensive care units (ICUs), adversely affecting well-being, increasing 
healthcare utilisation and delaying return to work. Non-pharmacological 
approaches (eg, music, therapeutic touch and patient diaries) have been 
suggested as candidate interventions and trauma-focused psychological 
interventions have been endorsed by international bodies. Neither category of 
intervention is supported by definitive evidence of long-term clinical 
effectiveness in patients who have been critically ill. This study assesses the 
feasibility and acceptability of using eye-movement desensitisation and 
reprocessing (EMDR) to improve the mental health of ICU survivors.
METHODS AND ANALYSIS: EMERALD is a multicentre, two-part consent, pilot 
feasibility study, recruiting discharged ICU survivors from three hospitals in 
the UK. We are gathering demographics and measuring post-traumatic symptoms, 
anxiety, depression and quality of life at baseline. Two months after discharge, 
participants are screened for symptoms of post-traumatic stress disorder (PTSD) 
using the Impact of Events Scale-Revised (IES-R). Patients with IES-R scores<22 
continue in an observation arm for 12 month follow-up. IES-R scores≥22 indicate 
above-threshold PTSD symptoms and trigger invitation to consent for part B: a 
randomised controlled trial (RCT) of EMDR versus usual care, with 1:1 
randomisation. The study assesses feasibility (recruitment, retention and 
intervention fidelity) and acceptability (through semistructured interviews), 
using a theoretical acceptability framework. Clinical outcomes (PTSD, anxiety, 
depression and quality of life) are collected at baseline, 2 and 12 months, 
informing power calculations for a definitive RCT, with quantitative and 
qualitative data convergence guiding RCT refinements.
ETHICS AND DISSEMINATION: This study has undergone external expert peer review 
and is funded by the National Institute for Health and Care Research (grant 
number: NIHR302160). Ethical approval has been granted by South 
Central-Hampshire A Research Ethics Committee (IRAS number: 317291). Results 
will be disseminated through the lay media, social media, peer-reviewed 
publication and conference presentation.
TRIAL REGISTRATION NUMBER: NCT05591625.

© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/bmjopen-2023-081969
PMCID: PMC10826543
PMID: 38286705 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


136. Ann Am Thorac Soc. 2024 Jan 29. doi: 10.1513/AnnalsATS.202310-904OC. Online 
ahead of print.

Novel Definitions of Wellness and Distress among Family Caregivers of Patients 
with Acute Cardiorespiratory Failure: A Qualitative Study.

Wendlandt B(1), Edwards T(2), Hughes S(2), Gaynes BN(3), Carson SS(4), Hanson 
LC(5), Toles M(6).

Author information:
(1)University of North Carolina at Chapel Hill School of Medicine, 6797, Chapel 
Hill, North Carolina, United States; blair.wendlandt@unchealth.unc.edu.
(2)The University of North Carolina at Chapel Hill, 2331, School of Education , 
Chapel Hill, North Carolina, United States.
(3)University of North Carolina at Chapel Hill School of Medicine, 6797, 
Psychiatry , Chapel Hill, North Carolina, United States.
(4)University of North Carolina Chapel Hill, Chapel Hill, North Carolina, United 
States.
(5)University of North Carolina at Chapel Hill School of Medicine, 6797, Chapel 
Hill, North Carolina, United States.
(6)The University of North Carolina at Chapel Hill, 2331, School of Nursing, 
Chapel Hill, North Carolina, United States.

RATIONALE: Family caregivers of patients with acute cardiorespiratory failure 
are at high risk for distress, typically defined as the presence of 
psychological symptoms such as anxiety, depression, or post-traumatic stress. 
Interventions to reduce caregiver distress and increase wellness have been 
largely ineffective to date. An incomplete understanding of caregiver wellness 
and distress may hinder efforts at developing effective support interventions.
OBJECTIVES: To allow family caregivers to define their experiences of wellness 
and distress six months after patient intensive care unit (ICU) admission, and 
to identify moderators that influence wellness and distress.
METHODS: Primary family caregivers of adult patients admitted to the medical ICU 
with acute cardiorespiratory failure were invited to participate in a 
semi-structured interview six months after ICU admission as part of a larger 
prospective cohort study. Interview guides were used to assess caregiver 
perceptions of their own well-being, describe their experiences of family 
caregiving, and identify key stress events and moderators that influenced 
well-being during and after the ICU admission. This study was guided by the 
Chronic Traumatic Stress Conceptual Model and data were analyzed using the 
five-step framework approach.
RESULTS: Among 21 interviewees, the mean age was 58 years, 67% were female and 
76% were white. Nearly half (47%) of patients had died before the caregiver 
interview. At the time of the interview, 9 caregivers endorsed an overall sense 
of distress, 10 endorsed a sense of wellness, and 2 endorsed a mix of both. 
Caregivers defined their experiences of wellness and distress as 
multidimensional and comprised of four main elements: 1) positive vs. negative 
physical and psychological outcomes, 2) high vs. low capacity for self-care, 3) 
thriving vs. struggling in the caregiving role, and 4) a sense of normalcy vs. 
ongoing life disruption. Post-discharge support from family, friends, and the 
community at large played a key role in moderating caregiver outcomes.
CONCLUSION: Caregiver wellness and distress are multidimensional and extend 
beyond the absence or presence of psychological outcomes. Future intervention 
research should incorporate novel outcomes measures incorporating elements of 
self-efficacy, preparedness, and adaptation, and optimize post-discharge support 
for family caregivers.

DOI: 10.1513/AnnalsATS.202310-904OC
PMID: 38285875


137. Med Educ Online. 2024 Dec 31;29(1):2308360. doi: 10.1080/10872981.2024.2308360. 
Epub 2024 Jan 28.

COVID-19 pandemic and its impact on medical interns' mental health of public and 
private hospitals in Guadalajara.

Barbosa-Camacho FJ(1)(2), Rodríguez-Machuca VU(2), Ibarrola-Peña JC(3), 
Chejfec-Ciociano JM(1), Guzmán-Ruvalcaba MJ(1), Tavares-Ortega JA(1), 
Delgado-Hernandez G(1), Cervantes-Guevara G(4), Cervantes-Pérez E(2), 
Ramírez-Ochoa S(2), Fuentes-Orozco C(1), Gonzalez-Ojeda A(1).

Author information:
(1)Unidad de Investigación Biomédica 02 Hospital de Especialidades, Centro 
Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, 
Jalisco, México.
(2)Hospital Civil de Guadalajara "Fray Antonio Alcalde", Universidad de 
Guadalajara, Guadalajara, Jalisco, Mexico.
(3)Hospital General y Medicina Familiar de Zona No. 2, Instituto Mexicano del 
Seguro Social, Nuevo León, Monterrey, México.
(4)Departamento de Bienestar y Desarrollo Sustentable, Centro Universitario del 
Norte, Universidad de Guadalajara, Colotlán, Jalisco, México.

INTRODUCTION: Burnout syndrome is a global burden characterized by exhaustion, 
work detachment, and a sense of ineffectiveness. It affects millions of 
individuals worldwide, with a particularly high prevalence among medical 
students. Factors such as demanding education, exposure to suffering, and the 
COVID-19 pandemic have contributed to elevated stress levels. Addressing this 
issue is crucial due to its impact on well-being and health-care quality.
MATERIALS AND METHODS: This cross-sectional survey study assessed fear of 
COVID-19 and burnout levels among medical student interns in hospitals in 
Guadalajara, Jalisco. The study used validated scales and collected data from 
September 2021 to September 2022. A snowball sampling method was employed and a 
minimum sample size of 198 participants was calculated.
RESULTS: This study included 311 medical students (62.1% female and 37.9% male 
with a mean age of 23.51 ± 2.21 years). The majority were in their second 
semester of internship (60.5%) and from public hospitals (89.1%). Most students 
believed that the COVID-19 pandemic affected the quality of their internship 
(82.6%). Female students had higher personal burnout scores, while male students 
had higher work-related burnout scores. The mean score for fear of COVID-19 was 
13.71 ± 6.28, with higher scores among women (p = 0.004) and those from public 
hospitals (p = 0.009). A positive weak correlation was found between COVID-19 
scores and burnout subscales.
CONCLUSION: Our study emphasizes the significant impact of various factors on 
burnout levels among medical students and health-care professionals during the 
COVID-19 pandemic. Prolonged exposure to COVID-19 patients, reduced staffing, 
and increased workload contributed to burnout, affecting well-being and quality 
of care. Targeted interventions and resilience-building strategies are needed to 
mitigate burnout and promote well-being in health-care settings.

DOI: 10.1080/10872981.2024.2308360
PMCID: PMC10823882
PMID: 38281205 [Indexed for MEDLINE]

Conflict of interest statement: No potential conflict of interest was reported 
by the author(s).


138. J Affect Disord. 2024 Apr 15;351:551-559. doi: 10.1016/j.jad.2024.01.199. Epub 
2024 Jan 26.

Examining enduring effects of COVID-19 on college students' internalizing and 
externalizing problems: A four-year longitudinal analysis.

Brown JK(1), Barringer A(2), Kouros CD(3), Papp LM(4).

Author information:
(1)Human Development & Family Studies, University of Wisconsin-Madison, United 
States of America. Electronic address: jkbrown7@wisc.edu.
(2)Department of Psychology, Augustana College, United States of America.
(3)Department of Psychology, Southern Methodist University, United States of 
America.
(4)Human Development & Family Studies, University of Wisconsin-Madison, United 
States of America.

BACKGROUND: College students' mental health has been a vital concern for 
researchers, policymakers, administrators, and educators since before the 
pandemic, and it is crucial to identify the extent to which the pandemic 
affected college students' mental health.
METHODS: The current study utilized data repeatedly collected over more than 
four years (2017-2022) from N = 355 students enrolled at a large public research 
university in the Midwestern US. The data collection period coincided with the 
COVID-19 pandemic's onset, facilitating systematic examination of whether and 
how college students' trajectories (i.e., level and slopes) of depressive 
symptoms, social anxiety, general disinhibition, callous aggression, and 
problematic alcohol use changed as the pandemic progressed. Across seven waves, 
surveys assessed multiple outcome and predictor domains. Multilevel growth curve 
modeling was used to analyze all outcomes.
RESULTS: Depression symptoms peaked mid-pandemic, whereas social anxiety first 
declined then continued rising. General disinhibition and callous aggression 
showed non-significant changes in trajectories. Problematic alcohol use 
decreased continuously with no significant pandemic-associated effects in the 
best-fitting model.
LIMITATIONS: An important limitation is reliance on a sample from a single 
campus utilizing self-reported, non-clinical assessments. Another important 
limitation is the lack of location information from participants during the 
acute COVID-19 phase.
CONCLUSIONS: Reported longitudinal analyses expand upon findings from previous 
limited repeated-measures and cross-sectional studies. In terms of clinical 
significance, some of the most harmful COVID-19 effects to mental health may be 
long-lasting and cumulative, making them difficult to detect in shorter-term or 
cross-sectional studies. Altogether, findings demonstrate complex changes in 
students' mental health that may have ongoing effects on well-being during key 
developmental stages.

Copyright © 2024 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2024.01.199
PMCID: PMC10923055
PMID: 38280565 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest None.


139. Int J Environ Res Public Health. 2023 Dec 20;21(1):7. doi: 
10.3390/ijerph21010007.

Bushfires and Mothers' Mental Health in Pregnancy and Recent Post-Partum.

Cherbuin N(1), Bansal A(2)(3), Dahlstrom JE(2)(3)(4), Carlisle H(4), Broom 
M(4)(5), Nanan R(6), Sutherland S(2), Vardoulakis S(1), Phillips CB(2), Peek 
MJ(2), Christensen BK(2), Davis D(5)(7), Nolan CJ(2)(3)(4).

Author information:
(1)National Centre for Epidemiology and Population Health, Australian National 
University, Canberra, ACT 2601, Australia.
(2)School of Medicine and Psychology, Australian National University, Canberra, 
ACT 2601, Australia.
(3)John Curtin School of Medical Research, Australian National University, 
Canberra, ACT 2601, Australia.
(4)The Canberra Hospital, Canberra Health Services, Garran, ACT 2605, Australia.
(5)School of Nursing and Midwifery, University of Canberra, Bruce, ACT 2617, 
Australia.
(6)Sydney Medical School and Charles Perkins Centre Nepean, University of 
Sydney, Penrith, NSW 2750, Australia.
(7)Nursing and Midwifery Office, ACT Government Health Directorate, Phillip, ACT 
2606, Australia.

BACKGROUND: The compounding effects of climate change catastrophes such as 
bushfires and pandemics impose significant burden on individuals, societies, and 
their economies. The enduring effects of such syndemics on mental health remain 
poorly understood, particularly for at-risk populations (e.g., pregnant women 
and newborns). The aim of this study was to investigate the impact of direct and 
indirect exposure to the 2019/20 Australian Capital Territory and South-Eastern 
New South Wales bushfires followed by COVID-19 on the mental health and 
wellbeing of pregnant women and mothers with newborn babies.
METHODS: All women who were pregnant, had given birth, or were within three 
months of conceiving during the 2019/2020 bushfires, lived within the catchment 
area, and provided consent were invited to participate. Those who consented were 
asked to complete three online surveys. Mental health was assessed with the 
DASS-21 and the WHO-5. Bushfire, smoke, and COVID-19 exposures were assessed by 
self-report. Cross-sectional associations between exposures and mental health 
measures were tested with hierarchical regression models.
RESULTS: Of the women who participated, and had minimum data (n = 919), most 
(>75%) reported at least one acute bushfire exposure and 63% reported severe 
smoke exposure. Compared to Australian norms, participants had higher depression 
(+12%), anxiety (+35%), and stress (+43%) scores. Women with greater exposure to 
bushfires/smoke but not COVID-19 had poorer scores on all mental health 
measures.
CONCLUSIONS: These findings provide novel evidence that the mental health of 
pregnant women and mothers of newborn babies is vulnerable to major climate 
catastrophes such as bushfires.

DOI: 10.3390/ijerph21010007
PMCID: PMC10815782
PMID: 38276795 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


140. Front Public Health. 2024 Jan 11;11:1285101. doi: 10.3389/fpubh.2023.1285101. 
eCollection 2023.

The impact of COVID-19 on nurses' job satisfaction: a systematic review and 
meta-analysis.

Yasin YM(1), Alomari A(1), Al-Hamad A(2), Kehyayan V(3).

Author information:
(1)Department of Nursing and Midwifery, Collage of Health Sciences, University 
of Doha for Science and Technology, Doha, Qatar.
(2)Daphne Cockwell School of Nursing, Faculty of Community Services, Toronto 
Metropolitan University, Toronto, ON, Canada.
(3)Department of Healthcare Management, College of Business Management, 
University of Doha for Science and Technology, Doha, Qatar.

BACKGROUND: The global healthcare landscape was profoundly impacted by the 
COVID-19 pandemic placing nurses squarely at the heart of this emergency. This 
review aimed to identify the factors correlated with nurses' job satisfaction, 
the impact of their job satisfaction on both themselves and their patients, and 
to explore strategies that might have counteracted their job dissatisfaction 
during the COVID-19 pandemic.
METHODS: The Joanna Briggs Institute (JBI) methodology for systematic reviews of 
prevalence and incidence was used in this review. The electronic databases of 
CINAHL, MEDLINE, SCOPUS, PsycINFO and Academic Search Complete were searched 
between January 2020 to February 2023.
RESULTS: The literature review identified 23 studies from 20 countries on 
nurses' job satisfaction during the COVID-19 pandemic. A pooled prevalence of 
69.6% of nurses were satisfied with personal, environmental, and psychological 
factors influencing their job satisfaction. Job satisfaction improved 
psychological wellbeing and quality of life, while dissatisfaction was linked to 
turnover and mental health issues.
CONCLUSION: This systematic review elucidates key factors impacting nurses' job 
satisfaction during the COVID-19 pandemic, its effects on healthcare provision, 
and the potential countermeasures for job dissatisfaction. Core influences 
include working conditions, staff relationships, and career opportunities. High 
job satisfaction correlates with improved patient care, reduced burnout, and 
greater staff retention.
SYSTEMATIC REVIEW REGISTRATION: 
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023405947, the 
review title has been registered in PROSPERO and the registration number is 
CRD42023405947.

Copyright © 2024 Yasin, Alomari, Al-Hamad and Kehyayan.

DOI: 10.3389/fpubh.2023.1285101
PMCID: PMC10808441
PMID: 38274512 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


141. Hum Resour Health. 2024 Jan 25;22(1):10. doi: 10.1186/s12960-024-00892-2.

Impacts for health and care workers of Covid-19 and other public health 
emergencies of international concern: living systematic review, meta-analysis 
and policy recommendations.

Fronteira I(1)(2), Mathews V(3), Dos Santos RLB(4), Matsumoto K(5), Amde W(3), 
Pereira A(5), de Oliveira APC(5), Craveiro I(6), Chança R(7), Boniol M(8), 
Ferrinho P(#)(6), Poz MRD(#)(5).

Author information:
(1)Global Health and Tropical Medicine, Instituto de Higiene e Medicina 
Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 100, 1349-008, Lisbon, 
Portugal. ines.fronteira@ensp.unl.pt.
(2)National School of Public Health, Public Health Research Centre, 
Comprehensive Health Research Center, NOVA University of Lisbon, Avenida Padre 
Cruz, 1600-560, Lisbon, Portugal. ines.fronteira@ensp.unl.pt.
(3)School of Public, Health University of the Western Cape, South Africa, 
Private Bag X17, Bellville, 7535, Republic of South Africa.
(4)Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Osvaldo Cruz, Rua 
Leopoldo Bulhões, 1480 - Manguinhos, Rio de Janeiro, Brazil.
(5)Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rua 
São Francisco Xavier 524 - 7º andar, Blocos D e E - Maracanã, Rio de Janeiro, 
RJ, 20550-013, Brazil.
(6)Global Health and Tropical Medicine, Instituto de Higiene e Medicina 
Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 100, 1349-008, Lisbon, 
Portugal.
(7)Instituto Nacional de Cancer, Ministério da Saúde, Rua Marquês de Pombal, 
125, Centro, Rio de Janeiro, RJ, 20230240, Brazil.
(8)Health Workforce Department, World Health Organization, Av. Appia 20, 1202, 
Geneva, Switzerland.
(#)Contributed equally

BACKGROUND: Health and care workers (HCW) faced the double burden of the 
SARS-CoV-2 pandemic: as members of a society affected by a public health 
emergency and as HWC who experienced fear of becoming infected and of infecting 
others, stigma, violence, increased workloads, changes in scope of practice, 
among others. To understand the short and long-term impacts in terms of the 
COVID-19 pandemic and other public health emergencies of international concern 
(PHEICs) on HCW and relevant interventions to address them, we designed and 
conducted a living systematic review (LSR).
METHODS: We reviewed literature retrieved from MEDLINE-PubMed, Embase, SCOPUS, 
LILACS, the World Health Organization COVID-19 database, the ClinicalTrials.org 
and the ILO database, published from January 2000 until December 2021. We 
included quantitative observational studies, experimental studies, 
quasi-experimental, mixed methods or qualitative studies; addressing mental, 
physical health and well-being and quality of life. The review targeted HCW; and 
interventions and exposures, implemented during the COVID-19 pandemic or other 
PHEICs. To assess the risk of bias of included studies, we used the Johanna 
Briggs Institute (JBI) Critical Appraisal Tools. Data were qualitatively 
synthetized using meta-aggregation and meta-analysis was performed to estimate 
pooled prevalence of some of the outcomes.
RESULTS: The 1013 studies included in the review were mainly quantitative 
research, cross-sectional, with medium risk of bias/quality, addressing at least 
one of the following: mental health issue, violence, physical health and 
well-being, and quality of life. Additionally, interventions to address short- 
and long-term impact of PHEICs on HCW included in the review, although scarce, 
were mainly behavioral and individual oriented, aimed at improving mental health 
through the development of individual interventions. A lack of interventions 
addressing organizational or systemic bottlenecks was noted.
DISCUSSION: PHEICs impacted the mental and physical health of HCW with the 
greatest toll on mental health. The impact PHEICs are intricate and complex. The 
review revealed the consequences for health and care service delivery, with 
increased unplanned absenteeism, service disruption and occupation turnover that 
subvert the capacity to answer to the PHEICs, specifically challenging the 
resilience of health systems.

© 2024. The Author(s).

DOI: 10.1186/s12960-024-00892-2
PMCID: PMC10809470
PMID: 38273317 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


142. PLoS One. 2024 Jan 25;19(1):e0290792. doi: 10.1371/journal.pone.0290792. 
eCollection 2024.

Cross-sectional survey evaluating the psychological impact of the COVID-19 
vaccination campaign in patients with cancer: The VACCINATE study.

Tregnago D(1), Avancini A(1), Belluomini L(1), Trestini I(1), Sposito M(1), 
Insolda J(1), Bianchi F(1), Sava T(2), Gaiani C(2), Del Piccolo L(3), Guarnieri 
V(4), Verlato G(5), Tfaily A(5), Vesentini R(5), Zuliani S(1), Pilotto S(1), 
Milella M(1).

Author information:
(1)Section of Innovation Biomedicine - Oncology Area, Department of Engineering 
for Innovation Medicine (DIMI), University of Verona and University and Hospital 
Trust (AOUI) of Verona, Verona, VR, Italy.
(2)Medical Oncology, Camposampiero Hospital, Padova, Italy.
(3)Department of Neuroscience, Psychological and Psychiatric Sciences and 
Movement Sciences, University of Verona and Verona University Hospital Trust, 
Verona, Italy.
(4)Medical Oncology, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy.
(5)Department of Public Health and Community Medicine, Unit of Epidemiology and 
Medical Statistics, Istituti Biologici II - University of Verona, Verona, VR, 
Italy.

The COVID-19 pandemic has profoundly impacted on cancer patients' psychological 
well-being and clinical status. We assessed the levels of anxiety, depression, 
and distress and the attitude towards COVID-19 vaccination in cancer patients, 
accepting vaccination at the Verona University Hospital and Camposampiero 
Hospital in the Veneto region. Self-reported questionnaires were administered to 
patients undergoing COVID-19 vaccination between March and May 2021 (first and 
second dose). Twenty-seven items were investigated: i) demographics/clinical 
characteristics; ii) anxiety, depression, and distress (Hospital Anxiety and 
Depression Scale-HADS-and Distress Thermometer-DT); iii) four specific items 
regarding awareness about infection risks, interference with anticancer 
treatments, and vaccine side effects. Sixty-two and 57% of the patients who 
accepted to be vaccinated responded to the survey in the two participating 
Hospitals, respectively. Mean age was 63 years (SD: 12 years; range 19-94 
years), women were slightly more prevalent (57.6%), most participants were 
married (70%), and either worker or retired (60%). Borderline and clinical 
levels of anxiety were recorded in 14% and 10% of respondents; borderline and 
clinical levels of depression in 14% and 8%; and moderate and severe distress 
levels in 33% and 9%. Overall, there was high confidence that vaccination would 
reduce the risk of contracting COVID-19 (70%), which would make patients feel 
less worried about contracting the infection (60%). Fear that vaccine-related 
side effects would interfere with anticancer treatment and/or global health 
status was low (10% and 9% for items 3 and 4, respectively) and significantly 
associated with baseline levels of anxiety, depression, and distress at 
multivariate analysis. Results did not differ between the Verona and 
Camposampiero cohorts. During the COVID-19 vaccination campaign, adult cancer 
patients demonstrated high levels of confidence towards vaccination; baseline 
levels of anxiety, depression, and distress were the only significant predictors 
of reduced confidence.

Copyright: © 2024 Tregnago et al. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0290792
PMCID: PMC10810487
PMID: 38271378 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


143. Front Public Health. 2024 Jan 8;11:1275917. doi: 10.3389/fpubh.2023.1275917. 
eCollection 2023.

Mental health and quality of life in children and adolescents during the 
COVID-19 pandemic: a systematic review of longitudinal studies.

Orban E(1), Li LY(1), Gilbert M(1), Napp AK(1), Kaman A(1), Topf S(1), Boecker 
M(1)(2), Devine J(1), Reiß F(1), Wendel F(3)(4), Jung-Sievers C(3)(4), Ernst 
VS(5), Franze M(5), Möhler E(6), Breitinger E(7), Bender S(7), Ravens-Sieberer 
U(1).

Author information:
(1)Department of Child and Adolescent Psychiatry, Psychotherapy and 
Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
(2)Department of Child and Adolescent Psychiatry, Child Neuropsychology Section, 
University Hospital RWTH Aachen, Aachen, Germany.
(3)Faculty of Medicine, Institute of Medical Information Processing, Biometry 
and Epidemiology (IBE), Ludwig-Maximilians-University Munich, Munich, Germany.
(4)Pettenkofer School of Public Health, Munich, Germany.
(5)Institute for Community Medicine, Epidemiology of Health Care and Community 
Health, University Medicine Greifswald, Greifswald, Germany.
(6)Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Saarland 
University Medical Center, Homburg, Germany.
(7)Department of Child and Adolescent Psychiatry, Psychosomatics, and 
Psychotherapy, Faculty of Medicine and University Hospital Cologne, University 
of Cologne, Cologne, Germany.

BACKGROUND: The COVID-19 pandemic has significantly impacted the mental health 
of children and families, i.e., due to measures like social distancing and 
remote schooling. While previous research has shown negative effects on mental 
health and health-related quality of life (HRQoL), most studies have focused on 
pre-post comparisons in the early pandemic stages. This systematic review aims 
to examine longitudinal studies to understand the long-term impacts of the 
pandemic on children and adolescents.
METHODS: This systematic review adhered to the PRISMA guidelines and was 
preregistered in the international prospective register of systematic reviews 
(Record ID: CRD42022336930). We systematically searched PubMed/MEDLINE, Web of 
Science, PsycINFO, PSYNDEX, and the WHO-COVID-19 database and included studies 
published up to August 30, 2022. Based on pre-defined eligibility criteria, 
longitudinal and prospective studies that assessed the mental health or quality 
of life of children or adolescents (0-19 years) in the general population over a 
longer time span (at two or more measurement points) during the COVID-19 
pandemic were included in the review. The methodological quality of the included 
studies was assessed using an adapted version of the Effective Public Health 
Practice Project (EPHPP) checklist. Narrative data synthesis was used to 
summarize the findings.
RESULTS: A total of 5,099 results were obtained from literature searches, with 
4,935 excluded during title/abstract screening. After reviewing 163 full-text 
articles, 24 publications were included in the review. Sample sizes ranged 
between n = 86 and n = 34,038. The length of the investigated time periods and 
the number of assessment points, as well as outcomes, varied. The majority of 
studies were of moderate methodological quality. Mental health outcomes were 
more frequently studied compared to measures of HRQoL. The findings from these 
studies mostly suggest that children and adolescents experienced heightened 
mental health problems, specifically internalizing symptoms like anxiety and 
depression. Further, there was a decline in their overall HRQoL over the course 
of the COVID-19 pandemic that did not necessarily subside when lockdowns ended.
CONCLUSION: It is crucial to continue monitoring the mental health and 
well-being of children and adolescents following the pandemic to identify groups 
at risks and plan interventions. This should ideally be conducted by large 
systematic studies, using validated instruments, and encompassing representative 
samples to obtain reliable and comprehensive insights with the aim of improving 
youth mental health care.

Copyright © 2024 Orban, Li, Gilbert, Napp, Kaman, Topf, Boecker, Devine, Reiß, 
Wendel, Jung-Sievers, Ernst, Franze, Möhler, Breitinger, Bender and 
Ravens-Sieberer.

DOI: 10.3389/fpubh.2023.1275917
PMCID: PMC10800626
PMID: 38259801 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest. The author(s) declared that 
they were an editorial board member of Frontiers, at the time of submission. 
This had no impact on the peer review process and the final decision.


144. Front Public Health. 2024 Jan 8;11:1297042. doi: 10.3389/fpubh.2023.1297042. 
eCollection 2023.

A 4-year prospective investigation of predictive effects of prepandemic sexual 
stigma, affective symptoms, and family support on fear of COVID-19 among 
lesbian, gay, and bisexual individuals.

Huang MF(1)(2), Chang YP(3), Chou WJ(4)(5), Yen CF(1)(2)(6).

Author information:
(1)Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 
Medical University, Kaohsiung, Taiwan.
(2)Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung 
Medical University, Kaohsiung, Taiwan.
(3)School of Nursing, The State University of New York, University at Buffalo, 
New York, NY, United States.
(4)Department of Child and Adolescent Psychiatry, Chang Gung Memorial Hospital, 
Kaohsiung Medical Center, Kaohsiung, Taiwan.
(5)School of Medicine, Chang Gung University, Taoyuan, Taiwan.
(6)College of Professional Studies, National Pingtung University of Science and 
Technology, Pingtung, Taiwan.

AIM: This prospective study examined whether prepandemic sexual stigma, 
affective symptoms, and family support can predict fear of coronavirus disease 
2019 (COVID-19) among lesbian, gay, and bisexual (LGB) individuals.
METHODS: Data of 1,000 LGB individual on prepandemic sociodemographic 
characteristics, sexual stigma (familial sexual stigma [FSS] measured by the 
Homosexuality-Related Stigma Scale, internalized sexual stigma [ISS] measured by 
the Measure of Internalized Sexual Stigma for Lesbians and Gay Men, and sexual 
orientation microaggression [SOM] measured by the Sexual Orientation 
Microaggression Inventory), affective symptoms (i.e., depression measured by the 
Center for Epidemiologic Studies-Depression Scale and anxiety measured by the 
State-Trait Anxiety Inventory-State version), and family support measured by the 
Adaptability, Partnership, Growth, Affection, and Resolve Index were collected. 
Four years later, the fear of COVID-19 was assessed using the Fear of COVID-19 
Scale and the associations of prepandemic sexual stigma, affective symptoms, and 
perceived family support on fear of COVID-19 4 years later were analyzed using 
multiple linear regression analysis.
RESULTS: In total, 670 (67.3%) participants agreed and completed the follow-up 
assessment. Greater prepandemic FSS, ISS, SOM, affective symptoms, and perceived 
family support were significantly associated with a greater fear of COVID-19 at 
follow-up.
CONCLUSION: The identified predictors should be considered when designing 
interventions aimed at preventing and reducing the fear of COVID-19 in LGB 
individuals.

Copyright © 2024 Huang, Chang, Chou and Yen.

DOI: 10.3389/fpubh.2023.1297042
PMCID: PMC10800656
PMID: 38259737 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


145. Front Public Health. 2024 Jan 8;11:1276898. doi: 10.3389/fpubh.2023.1276898. 
eCollection 2023.

COVID-19 infection prevention and control for hospital workers in Indonesia.

Modjo R(1)(2), Lestari F(1)(3), Tanjung H(1)(2), Kadir A(1), Putra RS(4), 
Rahmadani M(2)(5), Chaeruman AS(2), Lestari F(2), Sutanto J(6).

Author information:
(1)Occupational Health and Safety Department, Faculty of Public Health, 
Universitas Indonesia, Depok, West Java, Indonesia.
(2)Indonesia Occupational Health Experts Association, Jakarta, Indonesia.
(3)Disaster Risk Reduction Center, Universitas Indonesia, Depok, West Java, 
Indonesia.
(4)Directorate of Occupational Health and Sports, Ministry of Health, Jakarta, 
Indonesia.
(5)Universitas Indonesia Hospital, Depok, West Java, Indonesia.
(6)Department of Human Centred Computing, Monash University, Melbourne, VIC, 
Australia.

INTRODUCTION: The outbreak of SARS-CoV-2 in 2019 led to a global pandemic, 
posing unprecedented challenges to healthcare systems, particularly in 
hospitals.
PURPOSE: This study explores the intricacies of strategies employed for 
preventing and controlling COVID-19 in Indonesian hospitals, with a particular 
focus on the protocols, challenges, and solutions faced by healthcare 
professionals.
METHODS: Using a cross-sectional analysis, we examined 27 hospitals and 
uncovered disparities in their preparedness levels. During our investigation, we 
observed the robust implementation of infection prevention measures, which 
encompassed stringent protocols, adequate ventilation, and proper use of 
personal protective equipment. However, shortcomings were identified in areas 
such as surveillance, mental health support, and patient management.
DISCUSSION: This study underscores the importance of addressing these gaps, 
suggesting tailored interventions, and continuous training for healthcare staff. 
Effective leadership, positive team dynamics, and adherence to comprehensive 
policies emerge as pivotal factors. Hospitals should strengthen weak areas, 
ensure the ethical execution of emergency protocols, and integrate technology 
for tracking and improving standard operating procedures. By enhancing the 
knowledge and skills of healthcare workers and maintaining strong management 
practices, hospitals can optimize their efforts in COVID-19 prevention and 
control, thereby safeguarding the wellbeing of professionals, patients, and 
communities.

Copyright © 2024 Modjo, Lestari, Tanjung, Kadir, Putra, Rahmadani, Chaeruman, 
Lestari and Sutanto.

DOI: 10.3389/fpubh.2023.1276898
PMCID: PMC10800904
PMID: 38259732 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


146. J Korean Med Sci. 2024 Jan 22;39(3):e31. doi: 10.3346/jkms.2024.39.e31.

Risk Factors of Postpartum Depression Among Korean Women: An Analysis Based on 
the Korean Pregnancy Outcome Study (KPOS).

Shim SH(#)(1), Lee SY(#)(2), Jung I(3), Heo SJ(3), Han YJ(1), Kwak DW(4), Kim 
MH(5), Park HJ(1), Chung JH(6), Lim JH(7), Kim MY(1), Cha DH(1), Shim SS(1), Cho 
HY(8), Ryu HM(7)(9).

Author information:
(1)Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA 
University, Seoul, Korea.
(2)Department of Psychiatry, Myongji Hospital, Hanyang University College of 
Medicine, Goyang, Korea.
(3)Division of Biostatistics, Department of Biomedical Systems Informatics, 
Yonsei University College of Medicine, Seoul, Korea.
(4)Department of Obstetrics and Gynecology, Ajou University School of Medicine, 
Suwon, Korea.
(5)Department of Obstetrics and Gynecology, Gangseo MizMedi Hospital, Seoul, 
Korea.
(6)Department of Obstetrics and Gynecology, Asan Medical Center, University of 
Ulsan College of Medicine, Seoul, Korea.
(7)Smart MEC Healthcare R&D Center, CHA Future Medicine Research Institute, CHA 
Bundang Medical Center, Seongnam, Korea.
(8)Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA 
University, Seoul, Korea. hycho.md@gmail.com.
(9)Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA 
University, Seongnam, Korea. hmryu2012@naver.com.
(#)Contributed equally

BACKGROUND: Postpartum depression (PPD) can negatively affect infant well-being 
and child development. Although the frequency and risk factors of PPD symptoms 
might vary depending on the country and culture, there is limited research on 
these risk factors among Korean women. This study aimed to elucidate the 
potential risk factors of PPD throughout pregnancy to help improve PPD screening 
and prevention in Korean women.
METHODS: The pregnant women at 12 gestational weeks (GW) were enrolled from two 
obstetric specialized hospitals from March 2013 to November 2017. A 
questionnaire survey was administered at 12 GW, 24 GW, 36 GW, and 4 weeks 
postpartum. Depressive symptoms were assessed using the Edinburgh Postnatal 
Depression Scale, and PPD was defined as a score of ≥ 10.
RESULTS: PPD was prevalent in 16.3% (410/2,512) of the participants. Depressive 
feeling at 12 GW and postpartum factors of stress, relationship with children, 
depressive feeling, fear, sadness, and neonatal intensive care unit admission of 
baby were significantly associated with a higher risk of PPD. Meanwhile, high 
postpartum quality of life and marital satisfaction at postpartum period were 
significantly associated with a lower risk of PPD. We developed a model for 
predicting PPD using factors as mentioned above and it had an area under the 
curve of 0.871.
CONCLUSION: Depressive feeling at 12 GW and postpartum stress, fear, sadness, 
relationship with children, low quality of life, and low marital satisfaction 
increased the risk of PPD. A risk model that comprises significant factors can 
effectively predict PPD and can be helpful for its prevention and appropriate 
treatment.

© 2024 The Korean Academy of Medical Sciences.

DOI: 10.3346/jkms.2024.39.e31
PMCID: PMC10803203
PMID: 38258363 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no potential conflicts of 
interest to disclose.


147. Children (Basel). 2023 Dec 31;11(1):61. doi: 10.3390/children11010061.

Maternal Wellbeing Five Years after a Very Preterm Delivery: Prevalence and 
Influencing Factors in a European Cohort.

Wohlers L(1), Maier RF(2), Cuttini M(3), Wilson E(4), Benhammou V(5), Lebeer 
J(6), Laroche S(7)(8), Sarrechia I(6), Petrou S(9), Thiele N(10), Zeitlin J(5), 
Aubert AM(5); SHIPS Research Group.

Author information:
(1)Physiotherapy School, University Hospital of the Universities of Giessen and 
Marburg (UKGM), 35392 Giessen, Germany.
(2)Children's Hospital, University Hospital, Philipps University Marburg, 35033 
Marburg, Germany.
(3)0-3 Center for the at-Risk Infant, Scientific Institute IRCCS "Eugenio 
Medea", 23842 Lecco, Italy.
(4)Unit of Reproductive Health, Women's and Children's Health, Karolinska 
Institutet, 17177 Stockholm, Sweden.
(5)Inserm, INRAE, Centre for Research in Epidemiology and Statistics (CRESS), 
Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, 
Université Paris Cité, F-75004 Paris, France.
(6)Department of Medicine & Population Health, Faculty of Medicine & Health 
Sciences, University of Antwerp, 2610 Antwerp, Belgium.
(7)Neonatal Intensive Care Unit, University Hospital Antwerp, 2610 Antwerp, 
Belgium.
(8)Center for Developmental Disabilities, University Hospital Antwerp, 2610 
Antwerp, Belgium.
(9)Nuffield Department of Primary Care Health Sciences, University of Oxford, 
Oxford OX1 2JD, UK.
(10)European Foundation for the Care of Newborn Infants (EFCNI), 81379 Munich, 
Germany.

(1) Background: Mothers of very preterm (VPT) infants may experience 
psychological symptoms compromising long-term emotional wellbeing. This study 
describes the emotional wellbeing of mothers of five-year-old children born VPT. 
We assess the association between sociodemographic, perinatal and neonatal 
characteristics, and the child's health and development at five years old and 
maternal emotional wellbeing. (2) Methods: Data are from the prospective 
European "Effective Perinatal Intensive Care in Europe" (EPICE) and subsequent 
"Screening for Health In very Preterm infantS in Europe" (SHIPS) projects 
including births <32 weeks' gestational age in 11 countries in 2011/12. Data 
were abstracted from obstetric and neonatal records. At five years old, 2605 
mothers answered a parental questionnaire including the Mental Health 
Inventory-5 (MHI-5). Associations between sociodemographic and health 
characteristics and the mother's MHI-5 score were investigated using multilevel 
multivariate linear regression analysis with the country modelled as a random 
effect and inverse probability weighting to correct for attrition bias. (3) 
Results: The mean MHI-5 score was 71.3 (SD 16.7) out of 100 (highest emotional 
wellbeing) with a variation among countries from 63.5 (SD 16.8; Poland) to 82.3 
(SD 15.8; the Netherlands). MHI-5 scores were significantly lower for mothers 
whose child had a severe health problem, developmental, or speech delay, for 
multiparous and single mothers, and when at least one of the parents was 
unemployed. (4) Conclusions: The emotional wellbeing of mothers of VPT infants 
differs between European countries. Identifying sociodemographic characteristics 
and child's health and developmental conditions that affect maternal emotional 
wellbeing may help to identify groups of mothers who need special assistance to 
cope with consequences of the delivery of a VPT child.

DOI: 10.3390/children11010061
PMCID: PMC10814990
PMID: 38255374

Conflict of interest statement: The authors declare no conflicts of interest.


148. J Med Internet Res. 2024 Jan 22;26:e51596. doi: 10.2196/51596.

Effects of a Rice-Farming Simulation Video Game on Nature Relatedness, 
Nutritional Status, and Psychological State in Urban-Dwelling Adults During the 
COVID-19 Pandemic: Randomized Waitlist Controlled Trial.

Lee S(#)(1), Yuh C(#)(2), Shin YB(1), Lee HJ(1), Lee YM(2), Lee J(3), Cho 
CH(1)(4).

Author information:
(1)Department of Psychiatry, Korea University College of Medicine, Seoul, 
Republic of Korea.
(2)Department of Medical Education, Korea University College of Medicine, Seoul, 
Republic of Korea.
(3)Department of Environmental Medicine, College of Medicine, Ewha Womans 
University, Seoul, Republic of Korea.
(4)Department of Biomedical Informatics, Korea University College of Medicine, 
Seoul, Republic of Korea.
(#)Contributed equally

BACKGROUND: During the COVID-19 pandemic, urban inhabitants faced significant 
challenges in maintaining connections with nature, adhering to nutritional 
guidelines, and managing mental well-being.
OBJECTIVE: Recognizing the urgent need for innovative approaches, this study was 
designed to explore the potential benefits of a specific digital intervention, 
the rice-farming simulation game Sakuna: Of Rice and Ruin, for nature 
relatedness, nutritional behaviors, and psychological well-being.
METHODS: A total of 66 adults without any prior major psychiatric disorders 
residing in an urban area were recruited for the study. They were randomly 
assigned to 2 groups through block randomization: the immediate intervention 
group (IIG; 34/66, 52%) and the waitlist group (32/66, 48%). Participants in the 
IIG were instructed to play the game for at least 4 days per week for 3 weeks, 
with each session lasting from 30 minutes to 3 hours. Assessments were performed 
at baseline, week 1, and week 3. The Nature Relatedness Scale (NR) and Nutrition 
Quotient Scale were used to evaluate nature relatedness and nutritional state, 
respectively. Furthermore, psychological state was assessed using the World 
Health Organization Quality of Life-Brief Version (WHOQOL-BREF), Brief Fear of 
Negative Evaluation Scale, Social Avoidance and Distress Scale, Toronto 
Alexithymia Scale, State-Trait Anxiety Inventory, Center for Epidemiologic 
Studies Depression Scale Revised, and Korean Resilience Quotient.
RESULTS: This study's results revealed significant time interactions between the 
IIG and waitlist group for both the total NR score (P=.001) and the score of the 
self subdomain of NR (P<.001), indicating an impact of the game on nature 
relatedness. No group×time interactions were found for the total Nutrition 
Quotient Scale and subdomain scores, although both groups showed increases from 
baseline. For psychological state, a significant group×time interaction was 
observed in the total WHOQOL-BREF score (P=.049), suggesting an impact of the 
game on quality of life. The psychological (P=.01), social (P=.003), and 
environmental (P=.04) subdomains of the WHOQOL-BREF showed only a significant 
time effect. Other psychological scales did not display any significant changes 
(all P>.05).
CONCLUSIONS: Our findings suggest that the rice-farming game intervention might 
have positive effects on nature relatedness, nature-friendly dietary behaviors, 
quality of life, anxiety, depression, interpersonal relationships, and 
resilience among urban adults during the COVID-19 pandemic. The impact of 
pronature games in confined urban environments provides valuable evidence of how 
digital technologies can be used to enhance urban residents' affinity for nature 
and psychological well-being. This understanding can be extended in the future 
to other digital platforms, such as metaverses.
TRIAL REGISTRATION: Clinical Research Information Service (CRIS) KCT0007657; 
http://tinyurl.com/yck7zxp7.

©Seulki Lee, Chisung Yuh, Yu-Bin Shin, Heon-Jeong Lee, Young-Mee Lee, Jungsil 
Lee, Chul-Hyun Cho. Originally published in the Journal of Medical Internet 
Research (https://www.jmir.org), 22.01.2024.

DOI: 10.2196/51596
PMCID: PMC10845032
PMID: 38252464 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


149. Int J Environ Res Public Health. 2023 Dec 22;21(1):22. doi: 
10.3390/ijerph21010022.

Attachment, Resilience and Life Satisfaction of University Students in Cyprus 
after the Fourth Wave of COVID-19.

Parpottas P(1), Vogazianos P(1), Pezirkianidis C(2).

Author information:
(1)Department of Social and Behavioral Sciences, School of Humanities, Social 
and Education Sciences, European University of Cyprus, Nicosia 2404, Cyprus.
(2)Laboratory of Positive Psychology, Department of Psychology, Panteion 
University of Social and Political Sciences, 17671 Athens, Greece.

The COVID-19 pandemic has given rise to a large-scale crisis that has also 
impacted the well-being and, more specifically, the life satisfaction of 
university students. Factors such as attachment dimensions and psychological 
resilience can provide us with a better understanding of students' life 
satisfaction levels during the recent pandemic. While previous literature has 
revealed a significant association between attachment dimensions, resilience, 
and life satisfaction, very few studies have attempted to address a more complex 
relationship among all three variables for university students, and even fewer 
have explored this topic during the COVID-19 pandemic. Therefore, the aim of the 
current study was to investigate the impact of attachment dimensions on 
university students' life satisfaction after the fourth wave of COVID-19 in 
Cyprus, with a focus on the mediating role of psychological resilience. The 
sample comprised 780 university students, consisting of 323 men and 457 women, 
aged between 18 and 61 years. Participants were recruited electronically, and 
after being directed to Google Forms, they completed the ECR-R for their 
attachment dimensions, the RES for psychological resilience, and the SWLS for 
life satisfaction. The results indicated significant correlations between 
attachment dimensions, psychological resilience, and life satisfaction. Notably, 
psychological resilience was found to partially mediate the relationship between 
attachment anxiety, as well as attachment avoidance, and life satisfaction. 
Specifically, attachment anxiety and avoidance negatively affected life 
satisfaction, partially due to lower levels of psychological resilience. These 
findings are discussed in relation to the existing literature, and implications 
for practice are provided.

DOI: 10.3390/ijerph21010022
PMCID: PMC10815057
PMID: 38248487 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


150. Sci Rep. 2024 Jan 20;14(1):1790. doi: 10.1038/s41598-024-51854-6.

Residential mobility restrictions and adverse mental health outcomes during the 
COVID-19 pandemic in the UK.

Chan HF(1)(2)(3), Cheng Z(4)(5), Mendolia S(6), Paloyo AR(7), Tani M(8), Proulx 
D(9), Savage DA(9), Torgler B(10)(11)(12)(9)(13).

Author information:
(1)School of Economics and Finance, Queensland University of Technology, 
Brisbane, QLD, 4000, Australia. hofai.chan@qut.edu.au.
(2)Centre for Behavioural Economics, Society and Technology (BEST), Brisbane, 
QLD, 4000, Australia. hofai.chan@qut.edu.au.
(3)Centre for Behavioural Insights for Technology Adoption (BITA), Brisbane, 
QLD, 4000, Australia. hofai.chan@qut.edu.au.
(4)Social Policy Research Centre, University of New South Wales, Kensington, 
NSW, 2052, Australia.
(5)Department of Management, Macquarie Business School, Macquarie University, 
Sydney, NSW, 2109, Australia.
(6)Department of Economics, Social Studies and Applied Mathematics and 
Statistics, University of Turin, Turin, Italy.
(7)University of Wollongong, Keiraville, NSW, 2500, Australia.
(8)School of Business, UNSW Canberra, Canberra, ACT, Australia.
(9)Newcastle Business School, University of Newcastle, Newcastle, NSW, 
Australia.
(10)School of Economics and Finance, Queensland University of Technology, 
Brisbane, QLD, 4000, Australia.
(11)Centre for Behavioural Economics, Society and Technology (BEST), Brisbane, 
QLD, 4000, Australia.
(12)Centre for Behavioural Insights for Technology Adoption (BITA), Brisbane, 
QLD, 4000, Australia.
(13)CREMA - Center for Research in Economics, Management and the Arts, Basel, 
Switzerland.

During the COVID-19 pandemic, several governments tried to contain the spread of 
SARS-CoV-2, the virus that causes COVID-19, with lockdowns that prohibited 
leaving one's residence unless carrying out a few essential services. We 
investigate the relationship between limitations to mobility and mental health 
in the UK during the first year and a half of the pandemic using a unique 
combination of high-frequency mobility data from Google and monthly longitudinal 
data collected through the Understanding Society survey. We find a strong and 
statistically robust correlation between mobility data and mental health survey 
data and show that increased residential stationarity is associated with the 
deterioration of mental wellbeing even when regional COVID-19 prevalence and 
lockdown stringency are controlled for. The relationship is heterogeneous, as 
higher levels of distress are seen in young, healthy people living alone; and in 
women, especially if they have young children.

© 2024. The Author(s).

DOI: 10.1038/s41598-024-51854-6
PMCID: PMC10799952
PMID: 38245576 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


151. J Affect Disord. 2024 Apr 1;350:504-512. doi: 10.1016/j.jad.2024.01.130. Epub 
2024 Jan 19.

Self-compassion, childhood emotional neglect, and posttraumatic growth: Parental 
well-being during COVID-19.

Deitz AHH(1).

Author information:
(1)University of Maryland, Baltimore, School of Social Work, 525 W. Redwood 
Street, Baltimore, MD 21201, United States of America. Electronic address: 
adeitz@ssw.umaryland.edu.

BACKGROUND: The CoronaVirus Disease 2019 (COVID-19) pandemic can be 
conceptualized as a trauma that created additional unique stressors for parents. 
Self-compassion might promote posttraumatic growth (PTG); however, parents with 
histories of childhood emotional neglect may struggle to practice 
self-compassion when their own affectional needs were unmet earlier in life, 
carrying implications for both parental and child well-being. The objective is 
to examine the relationship between childhood emotional neglect and 
pandemic-related PTG, and the moderating role of self-compassion.
METHODS: An online cross-sectional survey collected information from 436 parents 
(M = 37.62 years, SD = 9.31) across the U.S. on pandemic- and parenting-related 
stresses, childhood emotional neglect, self-compassionate behavior, 
psychological distress, and pandemic-related PTG. Multiple regression analyses 
were conducted to analyze relationships among childhood emotional neglect, 
self-compassionate behavior, and pandemic-related PTG.
RESULTS: Parents who reported greater frequency of self-compassionate behavior 
tended to report higher pandemic-related PTG. Childhood emotional neglect alone 
did not predict pandemic-related PTG; however, for parents who reported less 
frequent self-compassionate behavior, greater childhood emotional neglect 
predicted lower pandemic-related PTG.
LIMITATIONS: The cross-sectional design and sample homogeneity limit both causal 
inference and generalizability. Limitations in operationalization of PTG and 
self-compassion constructs are discussed.
CONCLUSIONS: Findings emphasize the utility of self-compassionate behavior in 
promoting pandemic-related PTG, especially for adults with histories of 
childhood emotional neglect. Self-compassion is a freely accessible practice 
that individuals can implement successfully with minimal instruction. In terms 
of clinical relevance, therapists may be able to identify points of intervention 
wherein self-compassion may stimulate pandemic-related PTG.

Copyright © 2024 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2024.01.130
PMID: 38244798 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest None.


152. Infancy. 2024 May-Jun;29(3):386-411. doi: 10.1111/infa.12583. Epub 2024 Jan 20.

COVID-19 pandemic effects: Examining prenatal internalizing symptoms and infant 
temperament.

Mattera JA(1), Erickson NL(2), Barbosa-Leiker C(3), Gartstein MA(1).

Author information:
(1)Department of Psychology, Washington State University, Pullman, Washington, 
USA.
(2)Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, 
USA.
(3)College of Nursing, Washington State University, Spokane, Washington, USA.

For pregnant women, the COVID-19 pandemic has resulted in unprecedented 
stressors, including uncertainty regarding prenatal care and the long-term 
consequences of perinatal infection. However, few studies have examined the role 
of this adverse event on maternal wellbeing and infant socioemotional 
development following the initial wave of the pandemic when less stringent 
public health restrictions were in place. The current study addressed these gaps 
in the literature by first comparing prenatal internalizing symptoms and infant 
temperament collected after the first wave of the pandemic to equivalent 
measures in a pre-pandemic sample. Second, associations between prenatal 
pandemic-related stress and infant temperament were examined. Women who were 
pregnant during the COVID-19 pandemic endorsed higher pregnancy-specific anxiety 
relative to the pre-pandemic sample. They also reported greater infant negative 
emotionality and lower positive affectivity and regulatory capacity at 2 months 
postpartum. Prenatal infection stress directly predicted infant negative affect. 
Both prenatal infection and preparedness stress were indirectly related to 
infant negative emotionality through depression symptoms during pregnancy and at 
2 months postpartum. These results have implications for prenatal mental health 
screening procedures during the pandemic and the development of early 
intervention programs for infants born to mothers during this adverse event.

© 2024 The Authors. Infancy published by Wiley Periodicals LLC on behalf of 
International Congress of Infant Studies.

DOI: 10.1111/infa.12583
PMID: 38244202 [Indexed for MEDLINE]


153. Health Place. 2024 Jan;85:103174. doi: 10.1016/j.healthplace.2024.103174. Epub 
2024 Jan 18.

Social media insights into spatio-temporal emotional responses to COVID-19 
crisis.

Wang S(1), Liang C(2), Gao Y(3), Ye Y(4), Qiu J(5), Tao C(5), Wang H(6).

Author information:
(1)College of Design and Innovation, Tongji University, Shanghai, China; 
Department of Computing, The Hong Kong Polytechnic University, Hong Kong, China.
(2)Guangdong Guodi Institute of Resources and Environment, Guangzhou, China.
(3)Shanghai Research Institute for Intelligent Autonomous Systems, Tongji 
University, Shanghai, China.
(4)College of Architecture and Urban Planning, Tongji University, Shanghai, 
China; Key Laboratory of Ecology and Energy-saving Study of Dense Habitat 
(Tongji University), Ministry of Education, Shanghai, China.
(5)Wayz AI Technology Company Limited, Shanghai, China.
(6)College of Design and Innovation, Tongji University, Shanghai, China. 
Electronic address: carter.whfcarter@gmail.com.

The Coronavirus pandemic has presented multifaceted challenges in urban 
emotional well-being and mental health management. Our study presents a 
spatio-temporal sentiment mining (STSM) framework to address these challenges, 
focusing on the space-time geography and environmental psychology. This 
framework analyzes the distribution and trends of 6 categories of public 
sentiments in Shanghai during the COVID-19 crisis, considering the potential 
urban spatial influencing factors. The research specifically draws on social 
media data temporally coinciding with the spread of COVID-19 and the pre-trained 
language model RoBERTa-wwm-ext to classify public sentiment, in order to 
characterize the distribution and trends of dominant urban sentiment under the 
influence of epidemic at different phases. The interactions between urban 
geospatial features and sentiments are further modelled and explained using 
LightGBM algorithm and SHapley Additive exPlanations (SHAP) technique. The 
experimental findings reveal the subtle yet dynamic impact of the urban 
environment on the long-term spatial variation and trends of public sentiment 
under the epidemic, with green spaces and socio-economic status emerging as 
significant factors. Regions with higher permanent population consumption 
demonstrated more positive sentiments, underscoring the significance of 
socio-economic factors in urban planning and public health policy. This research 
offers the most extensive analysis to date on the influence of urban 
characteristics on public sentiment during Shanghai's epidemic life cycle also 
lays the groundwork for applying the STSM framework in future crises beyond 
COVID-19.

Copyright © 2024 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.healthplace.2024.103174
PMID: 38241850 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


154. J Glob Health. 2024 Jan 19;14:05006. doi: 10.7189/jogh.14.05006.

Pivoting school health and nutrition programmes during COVID-19 in low- and 
middle-income countries: A scoping review.

Carducci B(1)(2), Dominguez G(1), Kidd E(1), Janes K(1), Owais A(1), Bhutta 
ZA(1)(2)(3)(4).

Author information:
(1)Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan 
Centre for Research, and Learning (PGCRL), Toronto, Canada.
(2)Department of Nutritional Sciences, Faculty of Medicine, University of 
Toronto, Toronto, Canada.
(3)Centre of Excellence in Women, and Child Health, Aga Khan University, 
Karachi, Pakistan.
(4)Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.

BACKGROUND: Preventive and promotive interventions delivered by schools can 
support a healthy lifestyle, positive development, and well-being in children 
and adolescents. The coronavirus disease 2019 (COVID-19) pandemic presented 
unique challenges to school health and nutrition programmes due to closures and 
mobility restrictions.
METHODS: We conducted a scoping review to examine how school health and 
nutrition programmes pivoted during the COVID-19 pandemic, and to provide 
summative guidance to stakeholders in strategic immediate and long-term response 
efforts. We searched MEDLINE, Embase, PsycINFO, and grey literature sources for 
primary (observational, intervention, and programme evaluations) and secondary 
(reviews, best practices, and recommendations) studies conducted in low- and 
middle-income countries from January 2020 to June 2023. Programmes that 
originated in schools, which included children and adolescents (5-19.9 years) 
were eligible.
RESULTS: We included 23 studies in this review. They varied in their adaptation 
strategy and key programmatic focus, including access to school meals (n = 8), 
health services, such as immunisations, eye health, and water, sanitation, and 
hygiene-related activities (n = 4), physical activity curriculum and exercise 
training (n = 3), mental health counselling and curriculum (n = 3), or were 
multi-component in nature (n = 5). While school meals, physical activity, and 
mental health programmes were adapted by out-of-school administration (either in 
the community, households, or virtually), all health services were suspended 
indefinitely. Importantly, there was an overwhelming lack of quantitative data 
regarding modified programme coverage, utilisation, and the impact on children 
and adolescent health and nutrition.
CONCLUSIONS: We found limited evidence of successful adaptation of school health 
and nutrition programme implementation during the pandemic, especially from Asia 
and Africa. While the adoption of the World Health Organization health-promoting 
school global standards and indicators is necessary at the national and school 
level, future research must prioritise the development of a school-based 
comprehensive monitoring and evaluation framework to track key indicators 
related to both health and nutrition of school-aged children and adolescents.

Copyright © 2024 by the Journal of Global Health. All rights reserved.

DOI: 10.7189/jogh.14.05006
PMCID: PMC10795858
PMID: 38236689 [Indexed for MEDLINE]

Conflict of interest statement: Disclosure of interest: The authors completed 
the ICMJE Disclosure of Interest Form (available upon request from the 
corresponding author) and disclose no relevant interests.


155. J Fam Psychol. 2024 Mar;38(2):296-308. doi: 10.1037/fam0001181. Epub 2024 Jan 
18.

Parenting young children during COVID-19: Parenting stress trajectories, 
parental mental health, and child problem behaviors.

Aviles AI(1), Betar SK(1), Cline SM(2), Tian Z(1), Jacobvitz DB(1), Nicholson 
JS(3).

Author information:
(1)Department of Human Development and Family Sciences, University of Texas at 
Austin.
(2)Department of Psychology, University of North Florida.
(3)Department of Psychology, Clemson University.

Parenting stress reflects a discrepancy between a parent's perception of their 
resources, the demands of their child's needs, and the caregiving relationship 
and contexts (Abidin, 1992). Parenting stress can increase the risk of issues in 
the parent-child relationship, as well as child behavioral and emotional 
outcomes (Neece et al., 2012; Spinelli et al., 2021). Chronic stressors, such as 
living through the COVID-19 pandemic, have the potential to increase the demands 
of parenting and thus parenting stress. Using latent growth curve modeling, we 
examined parenting stress trajectories of 298 American parents with young 
children (Mage = 15.02 months, range = 1-34 months) over the first year of the 
COVID-19 pandemic. We also examined the effects of parental mental health on 
parenting stress, and the effects of parental mental health and parenting stress 
on child problem behaviors using data gathered through the Prolific survey 
platform. Parental mental health, measured by depressive symptoms Centre for 
Epidemiological Studies Depression Scale-10, anxiety symptoms Generalized 
Anxiety Disorder Scale (GAD-7), and overall stress levels 10-item Perceived 
Stress Scale, was related to higher initial parenting stress index-short form. 
Changes in parenting stress over time were linked with higher levels of 
children's problem behaviors (CBCL). Child temperament was also related to 
initial parenting stress. Lower levels of household income were linked with 
higher levels of parental mental health symptoms and higher rates of parenting 
stress increases over time. These results highlight the importance of 
considering the well-being of all family members in child outcomes, and the ways 
in which different experiences and resources during the COVID-19 pandemic affect 
parental and child well-being. (PsycInfo Database Record (c) 2024 APA, all 
rights reserved).

DOI: 10.1037/fam0001181
PMID: 38236275 [Indexed for MEDLINE]


156. J Relig Health. 2024 Feb;63(1):788-816. doi: 10.1007/s10943-023-01977-3. Epub 
2024 Jan 16.

"We Never Stop Singing": The Dynamics of the Mental and Physical Health of Czech 
Religious Pastors during the COVID-19 Pandemic.

Kotherová S(1), Müller M(2), Jedličková L(3), Havlíček J(3), Bubík T(4).

Author information:
(1)Department of Sociology, Andragogy and Cultural Anthropology, Faculty of 
Arts, Palacky University Olomouc, CO-LAB Palacky University Olomouc, 
Křížkovského 511/10, 779 00, Olomouc, Czech Republic. silvie.kotherova@upol.cz.
(2)Department of Economic and Managerial Studies, Palacky University Olomouc, 
Olomouc, Czech Republic.
(3)Department of Sociology, Andragogy and Cultural Anthropology, Palacky 
University Olomouc, Olomouc, Czech Republic.
(4)Department of Sociology, Andragogy and Cultural Anthropology, Faculty of 
Arts, Palacky University Olomouc, CO-LAB Palacky University Olomouc, 
Křížkovského 511/10, 779 00, Olomouc, Czech Republic.

This study explores the dynamics of coping strategies of Czech religious leaders 
during a peak of the COVID-19 pandemic. An interpretative phenomenological 
analysis reveals that mental health among pastors is closely linked to a need to 
maintain community and social contact, while physical health is related to 
limitations upon ritual elements. In all narratives, the lived experience of 
mental health in the form of prosocial behavior is significantly prioritized 
despite the possibility of spreading infection. The analysis also shows that 
maintaining the community is closely linked to risky behaviors, which positively 
affected group and individual well-being.

© 2024. The Author(s).

DOI: 10.1007/s10943-023-01977-3
PMCID: PMC10861634
PMID: 38227155 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare they have no potential 
conflict of interest.


157. Enferm Clin (Engl Ed). 2024 Jan-Feb;34(1):23-33. doi: 
10.1016/j.enfcle.2024.01.003. Epub 2024 Jan 13.

Anxiety and depression in pregnancy: associated variables during the COVID-19 
pandemic period.

Paz-Pascual C(1), Artieta-Pinedo I(2), Bully P(3), Garcia-Alvarez A(4), Espinosa 
M(4); ema.Q Group.

Author information:
(1)Osakidetza-Servicio Vasco de Salud, Biocruces-Bizkaia Instituto de 
Investigación Sanitaria, Barakaldo, Bizkaia, Spain; Osakidetza-Servicio Vasco de 
Salud, Matrona Atención Primaria, Centro de Salud Markonzaga, Sestao, OSI 
Barakaldo-Sestao, Bizkaia, Spain; Unidad Docente de Matronas del País Vasco, 
Bizkaia, Spain. Electronic address: MARIACARMEN.PAZPASCUAL@osakidetza.eus.
(2)Osakidetza-Servicio Vasco de Salud, Biocruces-Bizkaia Instituto de 
Investigación Sanitaria, Barakaldo, Bizkaia, Spain; Osakidetza-Servicio Vasco de 
Salud, Matrona Atención Primaria, Centro de Salud Zuazo, Barakaldo, OSI 
Barakaldo-Sestao, Bizkaia, Spain; Escuela de Enfermería, Universidad del País 
Vasco, Bizkaia, Spain.
(3)Consultora Metodológica y Estadística, Sopuerta, Bizkaia, Spain.
(4)Osakidetza-Servicio Vasco de Salud, Biocruces-Bizkaia Instituto de 
Investigación Sanitaria, Barakaldo, Bizkaia, Spain.

OBJECTIVE: To assess the association between age, parity, nationality, 
educational level, employment and partner support with depression and anxiety 
during pregnancy. To determine the impact of the evolution of the COVID-19 
pandemic on the anxiety and depression levels of the participants.
METHOD: Cross-sectional descriptive correlational study carried out in the 
Osakidetza/Basque Health Service, Primary Care, Bizkaia (Spain). A total of 295 
pregnant women between 8 and 41 weeks participated. The association between age, 
parity, nationality, educational level, employment, partner support and COVID-19 
incidence rates during the study period and depression (measured with the 
Edinburgh Postnatal Depression Scale) and anxiety (measured with the 
State-Anxiety Inventory/STAI-S subscale) scores during pregnancy was measured. A 
logistic regression model was constructed and odds ratios and their 95% 
confidence intervals were estimated.
RESULTS: The mean score was 18.75 points for anxiety (SD=8.69) and 6.45 points 
for depression (SD=4.32). Women expecting their second or later child had higher 
scores for depression (OR 2.51[95%IC: 1.26-5.01)) and anxiety (OR 1.98 [95%IC: 
1.01-3.89]). Having completed university studies was associated with lower 
scores in depression (OR 0.28 [95%IC: 0.11-0.77]) and in anxiety (OR 0,2 [95%IC: 
0.08-0.54]). A good relationship with the partner was associated with lower 
levels of anxiety (OR 0.45 [95%IC: 0.24-0.81]). The mean anxiety and depression 
scores are related to the incidence of COVID-19 cases; the anxiety score was 
significantly higher in periods of higher incidence.
CONCLUSIONS: Greater emotional care for pregnant women with low educational 
level, multiparous and with weak support from their partner, would reduce 
anxiety and depression in pregnancy. Health emergency situations affect mental 
health during gestation.

Copyright © 2023 The Author(s). Published by Elsevier España, S.L.U. All rights 
reserved.

DOI: 10.1016/j.enfcle.2024.01.003
PMID: 38224816 [Indexed for MEDLINE]


158. Hawaii J Health Soc Welf. 2024 Jan;83(1):16-24.

Examining Mental Health and Economic Consequences During the COVID-19 Pandemic 
Among Filipino Residents in Hawai'i: May - Oct 2020.

Talana ALE(1), Quensell ML(1), Peltzer NK(1), Thompson MD(1), Stupplebeen D(1), 
Pirkle CM(1), Keliikoa LB(1).

Author information:
(1)Office of Public Health Studies, Thompson School of Social Work and Public 
Health, University of Hawai'i at Mānoa, Honolulu, HI.

The coronavirus disease 2019 (COVID-19) pandemic has resulted in rapid and 
drastic changes to daily lives, posing a threat to residents' mental health and 
well-being. Filipinos are disproportionately impacted by COVID-19 and have one 
of the highest COVID-19 prevalence in Hawai'i. The COVID-19 pandemic has been 
associated with a rise in mental health concerns, yet little is known about the 
impact on the mental health of Filipinos in Hawai'i. Using publicly available 
polling data from the SMS Community Pulse Survey, this study sought to describe 
the mental distress experienced by Filipino residents during the COVID-19 
pandemic. Data were collected from an online panel of Hawai'i residents over 4 
timepoints (May 5-10; June 11-17; July 31-August 8; October 19-31, 2020). 
Compared to non-Filipinos, a higher proportion of Filipinos reported feeling 
stress and sadness during 3 of the 4 timepoints. Across all timepoints, 
Filipinos were more likely to respond affirmatively to mental health indicators 
(62.5%). Similarly, Filipinos reported food insecurity in higher proportions 
relative to non-Filipinos in most timepoints, particularly notable in Timepoint 
4 where 33.0% of Filipino respondents reported food insecurity. These findings 
suggest that Filipinos would benefit from social policy and community-supported 
initiatives to address social determinants of health, reduce chronic stress, and 
prevent further mental health disparities.

©Copyright 2024 by University Health Partners of Hawai‘i (UHP Hawai‘i).

PMCID: PMC10782392
PMID: 38223464 [Indexed for MEDLINE]

Conflict of interest statement: None of the authors identify a conflict of 
interest.


159. J Affect Disord. 2024 Apr 1;350:741-745. doi: 10.1016/j.jad.2024.01.103. Epub 
2024 Jan 12.

Food insecurity and affective well-being during COVID-19 in the Middle East and 
North Africa.

Abouelenin M(1), Hu Y(2).

Author information:
(1)Department of Sociology, Lancaster University, Bowland North, Lancaster LA1 
4YW, United Kingdom. Electronic address: m.abouelenin@lancaster.ac.uk.
(2)Department of Sociology, Lancaster University, Bowland North, Lancaster LA1 
4YW, United Kingdom. Electronic address: yang.hu@lancaster.ac.uk.

BACKGROUND: The COVID-19 pandemic and climate crises have led to unprecedented 
food insecurity in the Middle East and North Africa (MENA), with ramifications 
for people's affective well-being. The aim of the study is to explore the 
relationship between food insecurity and affective well-being in Jordan, 
Morocco, Tunisia, and Egypt, considering varied social protection responses 
across these countries.
METHODS: We analyzed data from the COVID-19 MENA Monitor Household Panel Survey 
(2020-2021) and employed hybrid mixed-effects models to differentiate 
within-person and between-person associations between food insecurity and 
affective well-being.
RESULTS: The findings show that higher food insecurity is associated with worse 
affective well-being, with significant cross-country differences. In Jordan, 
where extensive social protection was enacted during the pandemic, there is no 
significant within- or between-person association between food insecurity and 
affective well-being. By contrast, significant between-person associations are 
found in Morocco and Egypt, while within- and between-person associations are 
evidenced in Tunisia. These associations hold strong after controlling for 
sociodemographic characteristics and household circumstances.
LIMITATIONS: Given COVID-19 restrictions, the sample was limited to the universe 
of working-age (18-64) mobile phone users, a demographic that often corresponds 
to higher levels of education and income. Therefore, the results of this study 
likely provide conservative estimates of the association between food insecurity 
and affective well-being in the full population.
CONCLUSIONS: The findings emphasize the critical role of food security in 
maintaining affective well-being, particularly in non-Western contexts during 
global crises. They underline the importance of integrating food security 
considerations into mental health care strategies and interventions.

Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2024.01.103
PMID: 38220114 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
have no conflicts of interest to declare.


160. J Relig Health. 2024 Feb;63(1):1-5. doi: 10.1007/s10943-024-02000-z. Epub 2024 
Jan 13.

Spirituality, Mental Health, and COVID-19.

Carey LB(1)(2), Koenig HG(3)(4)(5), Hill T(6), Drummond D(7), Gabbay E(8), Cohen 
J(9)(10), Aiken C(11), Carey JR(12).

Author information:
(1)School of Psychology and Public Health, La Trobe University, Melbourne, 
Australia. Lindsay.Carey@latrobe.edu.au.
(2)The University of Notre Dame, Sydney, Australia. 
Lindsay.Carey@latrobe.edu.au.
(3)Department of Psychiatry and Behavioral Sciences, Duke University Health 
Systems, Durham, NC, USA.
(4)Department of Medicine, Duke University Health Systems, Durham, NC, USA.
(5)Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
(6)The University of Texas at San Antonio, San Antonio, TX, USA.
(7)McKellar Centre, Barwon Health, North Geelong, VIC, Australia.
(8)Division of General Internal Medicine, Department of Medicine, Hospital 
Medicine Section, Weill Cornell Medicine, New York, NY, USA.
(9)School of Medicine (Sydney), University of Notre Dame Australia, Sydney, NSW, 
Australia.
(10)St. Vincent's Private Hospital Sydney, Sydney, NSW, Australia.
(11)Women's and Children's Hospital, Adelaide and Alumni, Drew University, 
Madison, NJ, USA.
(12)School of Psychology and Public Health, La Trobe University, Melbourne, 
Australia.

This issue of JORH presents a broad range of articles that consider spirituality 
and spiritual care from various international perspectives. It also looks at a 
diverse range of articles relating to mental health disorders and addictions. 
Lastly, this issue considers the aftermath of COVID-19. Readers are 
also reminded of the European Congress on Religion, Spirituality, and Health 
(ECRSH) (Salzburg, Austria), as well as the inaugural International Moral Injury 
and Wellbeing Conference (IMIWC), Brisbane, Australia, 2024.

© 2024. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s10943-024-02000-z
PMID: 38217770 [Indexed for MEDLINE]


161. Women Birth. 2024 Mar;37(2):428-435. doi: 10.1016/j.wombi.2024.01.001. Epub 2024 
Jan 12.

Common mental disorders and perinatal outcomes in Victoria, Australia: A 
population-based retrospective cohort study.

Faulks F(1), Edvardsson K(2), Mogren I(3), Gray R(4), Copnell B(4), Shafiei 
T(2).

Author information:
(1)Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, 
Bundoora, Victoria, Australia. Electronic address: f.faulks@latrobe.edu.au.
(2)Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, 
Bundoora, Victoria, Australia.
(3)Obstetrics and Gynaecology, Senior consultant in Obstetrics and Gynaecology, 
Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, 
SE-901 87 Umeå, Sweden.
(4)Nursing, School of Nursing and Midwifery, La Trobe University, Bundoora, 
Victoria, Australia.

PURPOSE: Common mental disorders (non-psychotic mental health conditions which 
impact on day-to-day functioning) are increasingly common in childbearing women 
and may impact significantly on both maternal and neonatal outcomes. Our study 
examines the associations between common mental disorders and perinatal 
outcomes.
METHODS: We used routinely collected perinatal data (2009-2016) for this 
population-based retrospective cohort study (n = 597,522 singleton births). We 
undertook multiple logistic regression adjusting for key maternal medical 
conditions and sociodemographic factors to determine associations between 
maternal common mental disorders and adverse perinatal outcomes with confidence 
intervals set at 95%.
RESULTS: Women with common mental disorders were more likely to have an 
induction of labour and caesarean birth, have a postpartum haemorrhage (PPH), 
and be admitted to the Intensive Care Unit (ICU) than women without common 
mental disorders. Neonates of women with common mental disorders were more 
likely to have an Apgar score at five minutes of less than seven (a measure of 
neonatal wellbeing at birth), be born preterm and low birthweight, be admitted 
to the Special Care Nursery or Neonatal Intensive Care Unit (SCN/NICU) and have 
a congenital anomaly than neonates of women without common mental disorders.
CONCLUSION: Common mental disorders during the perinatal period were associated 
with poorer perinatal outcomes for mothers and their neonates. Strategies that 
enable early recognition and response to maternal common mental disorders should 
be developed to mitigate the consequential impact on maternal and infant 
wellbeing.

Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.wombi.2024.01.001
PMID: 38216393 [Indexed for MEDLINE]


162. Early Hum Dev. 2024 Feb;189:105931. doi: 10.1016/j.earlhumdev.2023.105931. Epub 
2024 Jan 5.

Does parental mental health mediate the association between parents' perceived 
stress and parent-infant bonding during the early COVID-19 pandemic?

Power C(1), Weise V(2), Mack JT(2), Karl M(3), Garthus-Niegel S(4).

Author information:
(1)Independent researcher/consultant.
(2)Institute and Outpatient Clinics of Occupational and Social Medicine, Faculty 
of Medicine, Technische Universität Dresden, Dresden, Germany.
(3)Institute and Outpatient Clinics of Occupational and Social Medicine, Faculty 
of Medicine, Technische Universität Dresden, Dresden, Germany; Department of 
Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische 
Universität Dresden, Dresden, Germany.
(4)Institute and Outpatient Clinics of Occupational and Social Medicine, Faculty 
of Medicine, Technische Universität Dresden, Dresden, Germany; Institute for 
Systems Medicine (ISM) and Faculty of Medicine, Medical School Hamburg, Hamburg, 
Germany; Department of Childhood and Families, Norwegian Institute of Public 
Health, Oslo, Norway. Electronic address: 
susan.garthus-niegel@uniklinikum-dresden.de.

BACKGROUND: The spread of the COVID-19 virus was declared a pandemic in March 
2020. New restrictions such as 'lockdowns' and 'social distancing' created 
challenges for individuals' work-life balance, financial situation, family life, 
and physical and mental health. The global population's stress levels rose in 
response to these changes, leading to a widespread deterioration of mental 
health. One group particularly affected was parents of infants and very young 
children. Poor parental mental health may disrupt parent-infant bonding, with 
negative consequences for infant well-being and development.
AIMS: To consider parent-infant bonding in relation to parents' perceived stress 
and psychological distress during the first lockdown, and to examine whether 
associations of stress with parent-infant bonding were mediated by parental 
mental health.
METHODS: DREAMCORONA (n = 738: 471 mothers and 267 partners) is a sub-study of 
the prospective German cohort study 'DREAM'. The SPSS modelling tool PROCESS was 
used to assess whether parental mental health mediated the relationship between 
parents' perceived stress response to the COVID-19 pandemic and parent-infant 
bonding, while controlling for covariates.
RESULTS: Higher levels of parental stress were strongly associated with higher 
levels of depression, anxiety, and aggression symptoms for both parents. In 
addition, there was a significant relationship between parents' self-reported 
stress levels and parent-infant bonding. This relationship was mediated by 
symptoms of depression and anxiety for fathers and by symptoms of 
anger-hostility for both parents.
CONCLUSION: Increased parental stress during the early pandemic was associated 
with poorer parent-infant bonding. This has important implications for the 
management of any future public health crises.

Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.earlhumdev.2023.105931
PMID: 38215651 [Indexed for MEDLINE]


163. BMC Pregnancy Childbirth. 2024 Jan 11;24(1):56. doi: 10.1186/s12884-024-06259-8.

The effects of lockdown during the COVID-19 pandemic on fetal movement profiles.

Reissland N(1), Ustun B(2), Einbeck J(3).

Author information:
(1)Department of Psychology, Durham University, Science Site, South Road, 
Durham, UK. n.n.reissland@durham.ac.uk.
(2)Division of Human Nutrition and Health, Wageningen University & Research, 
Stippeneng 4, Wageningen, 6708 WE, The Netherlands.
(3)Department of Mathematical Sciences, Durham University, Durham, UK.

PURPOSE: The current study investigated the direct impact of the COVID-19 
lockdown on fetal movements, addressing a critical research gap. While previous 
research has predominantly examined the effects of lockdown on maternal health 
and postnatal outcomes, little attention has been paid to the direct 
consequences on fetal well-being as indicated by their movement profile.
METHODS: We conducted analysis of movement profiles in 20 healthy fetuses during 
the COVID-19 pandemic lockdown (third national UK lockdown period between 
January and March 2021) and compared them with 20 healthy fetuses from pre-covid 
pregnancies, all at 32 weeks gestation. We controlled for maternal stress, 
depression, and anxiety.
RESULTS: Pregnant mothers during pre-covid compared with those during the 
COVID-19 lockdown reported similar levels of stress (p = 0.47), depression 
(p = 0.15), and anxiety (p = 0.07). Their fetuses, however, differed in their 
movement profiles with mouth movement frequencies significantly higher during 
COVID-19 lockdown (COVID-19 lockdown: mean of 5.909) compared to pre-Covid 
pregnancies (mean of 3.308; p = 0.029). Furthermore, controlling for maternal 
anxiety a regression analysis indicated that frequency of fetal mouth movements 
(p = 0.017), upper face movements (p = 0.008), and touch movements (p = 0.031) 
were all significantly higher in fetuses observed during lockdown compared to 
fetuses before the Covid period.
CONCLUSION: Fetuses show an effect of lockdown independent of maternal anxiety, 
stress, or depression. These findings contribute to our understanding of fetal 
development during extraordinary circumstances, raising questions about the 
potential effects of having to stay indoors during lockdowns.

© 2024. The Author(s).

DOI: 10.1186/s12884-024-06259-8
PMCID: PMC10782783
PMID: 38212680 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


164. Brain Behav Immun. 2024 Mar;117:135-148. doi: 10.1016/j.bbi.2024.01.005. Epub 
2024 Jan 9.

Azithromycin preserves adult hippocampal neurogenesis and behavior in a mouse 
model of sepsis.

Rodríguez-Moreno CB(1), Cañeque-Rufo H(2), Flor-García M(3), Terreros-Roncal 
J(3), Moreno-Jiménez EP(3), Pallas-Bazarra N(4), Bressa C(5), Larrosa M(6), 
Cafini F(7), Llorens-Martín M(8).

Author information:
(1)Department of Molecular Neuropathology, Centro de Biología Molecular "Severo 
Ochoa" (CBMSO), Spanish Research Council (CSIC)-Universidad Autónoma de Madrid 
(UAM), Madrid, Spain; Center for Networked Biomedical Research on 
Neurodegenerative Diseases (CIBERNED), Madrid, Spain.
(2)Department of Chemistry and Biochemistry, School of Pharmacy, Universidad San 
Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660 Boadilla del 
Monte, Spain; Department of Health and Pharmaceutical Sciences, School of 
Pharmacy, Universidad San Pablo-CEU, CEU Universities, Urbanización 
Montepríncipe, 28660 Boadilla del Monte, Spain.
(3)Department of Molecular Neuropathology, Centro de Biología Molecular "Severo 
Ochoa" (CBMSO), Spanish Research Council (CSIC)-Universidad Autónoma de Madrid 
(UAM), Madrid, Spain; Center for Networked Biomedical Research on 
Neurodegenerative Diseases (CIBERNED), Madrid, Spain; Department of Molecular 
Biology, Faculty of Sciences, Universidad Autónoma de Madrid, Madrid, Spain.
(4)Centre for Developmental Neurobiology, Institute of Psychiatry, Psychology 
and Neuroscience, King's College London, London SE1 1UL, UK; MRC Centre for 
Neurodevelopmental Disorders, King's College London, London SE1 1UL, UK.
(5)Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, Ctra. 
Pozuelo-Majadahonda Km 1,800, 28223, Pozuelo de Alarcón, Madrid.
(6)Department of Food Science and Nutrition, Faculty of Pharmacy, Universidad 
Complutense de Madrid, 28040 Madrid, Spain.
(7)Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, 
Madrid, Spain. Electronic address: fabio.cafini@universidadeuropea.es.
(8)Department of Molecular Neuropathology, Centro de Biología Molecular "Severo 
Ochoa" (CBMSO), Spanish Research Council (CSIC)-Universidad Autónoma de Madrid 
(UAM), Madrid, Spain; Center for Networked Biomedical Research on 
Neurodegenerative Diseases (CIBERNED), Madrid, Spain. Electronic address: 
m.llorens@csic.es.

The mammalian hippocampus can generate new neurons throughout life. Known as 
adult hippocampal neurogenesis (AHN), this process participates in learning, 
memory, mood regulation, and forgetting. The continuous incorporation of new 
neurons enhances the plasticity of the hippocampus and contributes to the 
cognitive reserve in aged individuals. However, the integrity of AHN is targeted 
by numerous pathological conditions, including neurodegenerative diseases and 
sustained inflammation. In this regard, the latter causes cognitive decline, 
mood alterations, and multiple AHN impairments. In fact, the systemic 
administration of Lipopolysaccharide (LPS) from E. coli to mice (a model of 
sepsis) triggers depression-like behavior, impairs pattern separation, and 
decreases the survival, maturation, and synaptic integration of adult-born 
hippocampal dentate granule cells. Here we tested the capacity of the macrolide 
antibiotic azithromycin to neutralize the deleterious consequences of LPS 
administration in female C57BL6J mice. This antibiotic exerted potent 
neuroprotective effects. It reversed the increased immobility time during the 
Porsolt test, hippocampal secretion of pro-inflammatory cytokines, and AHN 
impairments. Moreover, azithromycin promoted the synaptic integration of 
adult-born neurons and functionally remodeled the gut microbiome. Therefore, our 
data point to azithromycin as a clinically relevant drug with the putative 
capacity to ameliorate the negative consequences of chronic inflammation by 
modulating AHN and hippocampal-related behaviors.

Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.bbi.2024.01.005
PMCID: PMC7615685
PMID: 38211636 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


165. BMC Psychiatry. 2024 Jan 10;24(1):38. doi: 10.1186/s12888-023-05482-5.

Adolescents' electronic devices use during the COVID-19 pandemic and its 
relationship to anxiety and depression levels: a cross-sectional study.

Hamshari S(1), Yaseen S(1), Zayed M(1), Dalasha A(1), Maraqa B(2), Nazzal Z(3).

Author information:
(1)Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah 
National University, Nablus, Palestine.
(2)Faculty of Medicine, Hebron University, Hebron, Palestine. 
dr.beesan.maraqa@gmail.com.
(3)Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah 
National University, Nablus, Palestine. znazzal@najah.edu.

BACKGROUND: The aim of this study is to assess the prevalence of anxiety and 
depression symptoms among adolescent students in the West Bank region of 
Palestine, with a particular focus on the impact of electronic device usage on 
their mental well-being.
METHODS: This cross-sectional study included a representative sample of 1,140 
adolescents enrolled in governmental secondary schools. We targeted schools 
located in Nablus, Ramallah, and Hebron districts, which, respectively, 
represent the northern, central, and southern regions of the West Bank. We 
collected data on their sociodemographic characteristics, patterns of electronic 
device usage, scores from the Beck Depression Inventory-II, and the 7-item 
Generalized Anxiety Disorder scale, all gathered through a self-administered 
online questionnaire. To explore the independent relationship between anxiety, 
depression, and various factors, we calculated odds ratios and their 
corresponding 95% CI using a binary logistic regression model.
RESULTS: The study revealed a prevalence of moderate to severe anxiety at 35.4% 
[95% CI: 32.7-38.3%] and moderate to severe depression at 23.9% [95% CI: 
21.4-26.4%]. Notably, anxiety scores were significantly higher among females 
[OR = 3.8, 95% CI: 2.5-5.9], individuals with lower academic performance 
[OR = 3.4, 95% CI: 2.1-5.4], and smokers [OR = 1.9, 95% CI: 1.1-3.0]. Similarly, 
significantly elevated depressive scores were observed among females [OR = 2.0, 
95% CI: 1.3-3.1], those with lower academic performance [OR = 3.4, 95% CI: 
2.1-5.4], and smokers [OR = 1.9, 95% CI: 1.3-2.8]. Conversely, students who used 
electronic devices for shorter durations were less likely to experience 
depression [OR = 0.49, 95% CI: 0.32-0.76] or anxiety [OR = 0.47, 95% CI: 
0.32-0.69].
CONCLUSION: Considering the alarming rates of anxiety and depression in 
adolescents, along with their connection to the time spent using electronic 
devices, we strongly recommend the creation of initiatives and support networks 
to alleviate this issue's impact. Encouraging healthier lifestyles, such as 
reducing screen time and increasing physical activity, could potentially enhance 
the mental well-being of adolescents.

© 2024. The Author(s).

DOI: 10.1186/s12888-023-05482-5
PMCID: PMC10777600
PMID: 38200470 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


166. JMIR Form Res. 2024 Jan 10;8:e50827. doi: 10.2196/50827.

Medical Students' Perceptions on Identifying and Addressing Emotional Responses 
in Emergency Medicine: Pilot Investigation.

Agarwal AK(1)(2), Gonzales R(1)(2), Munden C(1), Albright D(3), Tsao S(1).

Author information:
(1)Department of Emergency Medicine, University of Pennsylvania, Philadelphia, 
PA, United States.
(2)Center for Health Care Transformation and Innovation, Penn Medicine, 
Philadelphia, PA, United States.
(3)Department of Obstetrics and Gynecology, University of Pennyslvania, 
Philadelphia, PA, United States.

BACKGROUND: Training in acute care, such as emergency medicine (EM), where 
exposure to critically ill and injured patients is high, impacts the well-being 
of trainees and contributes to burnout. Investigating how, and if, trainees 
prepare for these situations is necessary to ensure they are supported.
OBJECTIVE: This study aimed to evaluate medical students' perspectives and 
emotional preparedness for handling acute care and trauma.
METHODS: We conducted a pilot investigation using a remote digital survey of 
medical students during their EM clerkship at a large, urban academic 
institution. The primary outcome of interest was student-reported preparedness 
and comfort in handling trauma and critical care patient encounters. Secondary 
outcomes included awareness of well-being resources and comfort in accessing 
digital well-being resources.
RESULTS: A total of 57 medical students completed the voluntary digital survey, 
and half of the students (n=28, 49%) reported having witnessed the care of a 
critically ill or a penetrating trauma patient (eg, a victim of gun violence). A 
majority (n=40, 70%) had thought about how these events may impact them, and 
over half felt unprepared to identify the emotional impact these cases may have 
on them (n=31, 54%) or address the emotional or mental health impact (n=36, 
63%). Less than a quarter (n=14, 25%) were aware of digital mental health 
resources, and 58% (n=33) did not feel fully comfortable connecting with 
resources if needed. Students who had previously witnessed critical care were 
significantly more likely to report feeling well prepared in identifying the 
emotional impact and addressing this impact.
CONCLUSIONS: In this cross-sectional survey, students did not feel fully 
prepared to identify or address the emotional impact of working in EM. 
Additionally, they lacked awareness of or comfort with accessing digital 
institutional resources meant to support their well-being, such as a large 
web-based platform. These findings can help inform and guide interventions by 
educational and academic leaders. The aim would be to create and promote 
environments that empower students with tools to identify their own emotions and 
connect to well-being resources.

©Anish Kumar Agarwal, Rachel Gonzales, Cory Munden, DaCarla Albright, Suzana 
Tsao. Originally published in JMIR Formative Research 
(https://formative.jmir.org), 10.01.2024.

DOI: 10.2196/50827
PMCID: PMC10809065
PMID: 38198202

Conflict of interest statement: Conflicts of Interest: None declared.


167. J Public Health (Oxf). 2024 Feb 23;46(1):175-184. doi: 10.1093/pubmed/fdad283.

'I see the high level of interpersonal support during the pandemic as proof that 
the good in people prevails': the COVID-19 pandemic as a catalyst for building a 
caring community?

Strupp J(1), Valerius L(2), Herrler A(2)(3), Kukla H(2), Eichberg S(4), 
Schulz-Nieswandt F(5), Voltz R(1)(6)(7).

Author information:
(1)Faculty of Medicine and University Hospital Cologne, Department of Palliative 
Medicine, University of Cologne, Kerpener Str, 62, 50937 Cologne, Germany.
(2)Faculty of Human Sciences and Faculty of Medicine, Graduate School GROW - 
Gerontological Research on Well-Being, University of Cologne, 
Albertus-Magnus-Platz, 50923 Cologne, Germany.
(3)Institute for Health Economics and Clinical Epidemiology, University Hospital 
Cologne, Gleueler Str. 176-178, 50935 Cologne, Germany.
(4)Division of Health Planning and Promotion, Public Health Department Cologne, 
Neumarkt 15-21, 50667 Cologne, Germany.
(5)Institute for Sociology and Social Psychology, University of Cologne, 
Universitätsstraße 24, 50931 Cologne, Germany.
(6)Faculty of Medicine and University Hospital Cologne, Center for Integrated 
Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, 
Kerpener Str. 62, 50937 Germany.
(7)Faculty of Medicine and University Hospital Cologne, Center for Health 
Services Research, University of Cologne, Eupener Str. 129, 50933 Cologne, 
Germany.

BACKGROUND: The public health approach to end-of-life care has led to 
initiatives to promote caring communities, involving the community in supporting 
vulnerable dying people and their families. Our study aimed to explore how the 
COVID-19 pandemic affected the relevance of a caring community, whether the 
concept of a caring community took on a different meaning during and because of 
the pandemic, and how issues of death, dying and bereavement were perceived.
METHODS: Qualitative online survey of people interested in the 'Caring Community 
Cologne' project. Participants in the survey attended the launch event for the 
Caring Community in Cologne. Direct invitations were sent to professionals and 
experts in various fields. Information about the event was also disseminated via 
social media and the city of Cologne's website. Data were collected from June 
2020 to August 2020 and analyzed using Braun & Clarke's thematic analysis.
RESULTS: N = 63 out of 121 people participated. The median age was 60 years; 65% 
of the participants were female. Most of them worked in the social sector (53%). 
Three respondents described positive changes brought about by the pandemic: 
Greater sense of community and solidarity, more confrontation with one's own 
finiteness, strengthening of relationships, mindfulness and slowing down of the 
pace of life. Negative effects mentioned included a deterioration in mental 
health and well-being, with an increase in anxiety, social isolation but also 
forced togetherness, which can lead to conflict, and a lack of emotional 
closeness due to restricted contact.
CONCLUSIONS: Our study was conducted at the beginning of the pandemic and shows 
that the pandemic has raised awareness of the importance and potential benefits 
of community-based networks and the importance of adopting a public health 
palliative care approach to advocate for those most in need. The findings also 
highlight the role of community social capital in promoting engagement, 
resilience and well-being.

© The Author(s) 2024. Published by Oxford University Press on behalf of Faculty 
of Public Health. All rights reserved. For permissions, please e-mail: 
journals.permissions@oup.com.

DOI: 10.1093/pubmed/fdad283
PMID: 38196267 [Indexed for MEDLINE]


168. Contemp Nurse. 2024 Feb;60(1):7-20. doi: 10.1080/10376178.2023.2300414. Epub 
2024 Jan 9.

The measured impact of the COVID-19 pandemic on nursing students' wellbeing, 
clinical placement and learning experiences: a cross sectional study.

Sheppard-Law S(1), Lamb A(2), Zeng L(1), Axisa C(1), Causby B(1)(3), Matiuk 
S(1), Levett-Jones T(1).

Author information:
(1)Faculty of Health, School of Nursing and Midwifery, University of Technology 
Sydney, Level 7, Building 10, Jones St Broadway, Sydney, NSW, Australia.
(2)Western Sydney University, Building 3, Level 4, Liverpool, NSW, Australia.
(3)Clinical Nurse Specialist, Intensive Care Unit, St Vincent's Hospital, 390 
Victoria St, Darlinghurst, 2010 NSW, Australia.

Background: The epidemiological patterns of COVID-19 varied across Australia and 
differed from most other countries. Few studies describe the impact that the 
pandemic had on nursing student wellbeing, education and career.Aim: This study 
aimed to investigate how the COVID-19 pandemic impacted on nursing students' 
well-being, clinical placement and learning.Design: Cross-sectional 
survey.Setting: Sydney, Australia.Participants: Second- and third-year nursing 
students.Methods: Second- and third-year nursing degree students were asked to 
participate in an ethically approved study during March to May 2021. The 
de-identified on-line survey consisted of 63 closed end question and one open 
ended question. On completion, the dataset was exported from Redcap and imported 
into SPSS for analysis. Open ended text data were analysed by two 
researchers.Results: Of the 105 participating nursing students, a third 
(n = 26/83, 31%) thought about changing their degree to a non-nursing degree. 
The acknowledged risk of caring for a COVID-19 patient incrementally increased 
stress (β-coefficient = 0.6, p value = 0.009, 95% CI 0.2-0.9). Conversely 
students who intended to complete their degree were less likely to report 
stress. Students who had prior nursing experience were three times more likely 
to report an increased generalised anxiety level (OR 3.8, p-value = 0.02, 95% CI 
1.2-12.2), yet they were less likely to experience personal accomplishment 
burnout compared to other students. Nursing students who contemplated a change 
of degree to a non-nursing degree were 15.7 times more likely to experience 
emotional exhaustion and were 3.5 times more likely to be report a risk of 
depersonalisation (p = 0.03, 95% CI, 1.3-11.5).Conclusion: The COVID-19 pandemic 
compromised nursing student well-being, and theoretical and practical learning. 
Findings have implications for healthcare and academic staff who teach nursing 
students. Implementation of student-centred evidence-based strategies to manage 
stress, burnout and anxiety, and to sustain a healthy student cohort is 
essential to retain the future nursing workforce.

DOI: 10.1080/10376178.2023.2300414
PMID: 38193929 [Indexed for MEDLINE]


169. Postgrad Med. 2024 Jan;136(1):44-51. doi: 10.1080/00325481.2024.2303974. Epub 
2024 Jan 17.

Levels and drivers of burnout during the COVID-19 pandemic among a diverse group 
of resident physicians.

Briles B(1), Kahl A(1), Anaissie J(1), Brettmann L(1), Pathak U(1), Staggers 
KA(1), Popat S(1), Agrawal A(1), Rose S(1), Taylor J(1).

Author information:
(1)Department of Medicine, Baylor College of Medicine, Houston, TX, USA.

OBJECTIVES: Evidence has shown significant impacts of the COVID-19 pandemic on 
physicians. We hypothesized that these effects would impact surgical and 
non-surgical resident education differently, with non-surgical specialties being 
more heavily impacted by frontline work and surgical specialties losing elective 
cases.
METHODS: We examined well-being and burnout among resident physicians in 
surgical and non-surgical specialties during the peak of the COVID-19 pandemic 
using the Mayo Physician Well-Being Index (WBI).
RESULTS: Completed surveys were received from 110 residents, 55% of whom were in 
a surgical training program. 35% of respondents were identified as 'at risk' for 
burnout. Increased demands from work (adj. OR 3.79, 95% CI 1.50, 9.59, 
p = 0.005) was associated with an increased likelihood for being 'at risk' 
compared to those without increased demands. Odds of having increased stress 
level were higher amongst residents with fear/anxiety of the unknown (adj. OR 
4.21, 95% CI 1.63, 10.90, p = 0.003) and more demands outside work (adj. OR 
10.54, 95% CI 2.63, 42.16, p = 0.001) but lower amongst residents with more time 
for studying (OR 0.23, 95% CI 0.09, 0.64, p = 0.005). Risk for burnout was not 
significantly different between surgical and non-surgical specialties when 
adjusting for increased demands from work (adj. OR 1.43, 95% CI 0.60, 3.37, 
p = 0.0.418).
CONCLUSION: Perceived effects of the COVID-19 pandemic upon residents' 
educational experience was mixed: reduced clinical volume had a negative impact, 
while increased time for study was perceived favorably. These findings suggest 
potential strategies and targets to mitigate the stress and burnout of a future 
crisis, whether large or small, among surgical and non-surgical trainees.

DOI: 10.1080/00325481.2024.2303974
PMID: 38193442 [Indexed for MEDLINE]


170. Anasthesiol Intensivmed Notfallmed Schmerzther. 2024 Jan;59(1):59-63. doi: 
10.1055/a-2044-8428. Epub 2024 Jan 8.

Hypnose als Chance für die Anästhesie.

[Article in German]

Schmidt B.

Patients undergoing challenging medical procedures often suffer from high levels 
of anxiety and stress. Their most important need is a feeling of control and 
safety. Hypnotic communication provides a means of addressing these feelings 
without medication. The core technique is to use the perceived stimuli, like 
beeping sounds or the pressure of the ventilation mask and re-evaluate them as 
helpful signs. For example, the beeping sounds can be an indicator of the 
optimal treatment with the highest level of medical equipment in the intensive 
care unit and the pressure of the ventilation mask might feel like a tight hug 
of a friend that wants to help. Positive suggestions work even better when 
patients are in a trance state. In the intensive care unit, you can use the 
natural trance state instead of inducing a formal hypnotic trance. Positive 
suggestions can even help to prevent negative emotions before the challenging 
medical procedure starts. It greatly improves patients' well-being to replace 
common phrases in the everyday medical practice. This article gives examples of 
better phrasings and elaborates the scientific evidence of positive suggestions 
that can even stop bleeding. The goal is to show simple ways to improve 
communication with patients and induce feelings of control and safety.

Thieme. All rights reserved.

DOI: 10.1055/a-2044-8428
PMID: 38190827 [Indexed for MEDLINE]

Conflict of interest statement: Die Autorinnen/Autoren geben an, dass kein 
Interessenkonflikt besteht.


171. AIMS Public Health. 2023 Sep 7;10(4):755-774. doi: 10.3934/publichealth.2023051. 
eCollection 2023.

Stress and burnout among Greek critical care nurses during the COVID-19 
pandemic.

Sikioti T(1), Zartaloudi A(2), Pappa D(2), Mangoulia P(3), Fradelos EC(4), 
Kourti FE(5), Koutelekos I(2), Dousis E(2), Margari N(2), Stavropoulou A(2), 
Evangelou E(2), Dafogianni C(2).

Author information:
(1)Hellenic Open University, Athens, Greece.
(2)Faculty of Nursing, University of West Attica, Athens, Greece.
(3)Faculty of Nursing, National and Kapodistrian University of Athens, Athens, 
Greece.
(4)Faculty of Nursing, University of Thessaly, Greece.
(5)Medical School, National and Kapodistrian University of Athens, Athens, 
Greece.

Occupational stress and burnout of health personnel during the COVID-19 
pandemic, especially of the nursing population in intensive care units (ICUs), 
were quite frequent along with negative effects and a direct correlation with 
the manifestation of many physical, behavioral and psychological symptoms. For 
the purposes of this research, a quantitative survey was carried out, in which 
153 ICU nurses of secondary and tertiary public hospitals in Greece 
participated. Nurses completed anonymously and voluntarily a special electronic 
questionnaire about stress, burnout, personal concerns about the pandemic, the 
consequences of the outbreak and their resilience toward COVID-19 patients' 
care. Specific validated scales were used in this study. Female nurses felt, to 
a greater extent than males, work-related burnout, especially patient-related 
burnout and total burnout. There was a statistically significant negative 
relationship between the existence of a psychological support group within a 
hospital and personal burnout. Participants who had experience in caring for 
SARS-CoV-2 patients had higher mental resilience than those without experience. 
As the consequences experienced by the health professionals of the reference 
COVID-19 hospitals were increased, so did mental resilience and stress coping 
strategies during the pandemic. The COVID-19 outbreak and the conditions 
configurated in the health system had negative effects on the psycho-emotional 
state of ICU nurses. The manifestation of anxiety, stress and burnout had a 
direct correlation with both the work and personal functionality of the nurses 
and the whole of the healthcare services provided. The early recognition of 
symptoms and their individualized management are imperative for the protection 
of the psycho-emotional well-being of nurses.

© 2023 the Author(s), licensee AIMS Press.

DOI: 10.3934/publichealth.2023051
PMCID: PMC10764964
PMID: 38187893

Conflict of interest statement: Conflict of Interest: Evangelos C. Fradelos is 
an editorial board member for AIMS Public Health, Evangelos C. Fradelos and 
Polyxeni Mangoulia are guest editors of AIMS Public Health Special Issue, and 
they were not involved in the editorial review or the decision to publish this 
article. All authors declare that there are no competing interests.


172. Qual Life Res. 2024 Apr;33(4):927-939. doi: 10.1007/s11136-023-03573-0. Epub 
2024 Jan 6.

Individual differences in the long-term impact of the pandemic: moderators of 
COVID-related hardship, worry, and social support.

Schwartz CE(1)(2), Borowiec K(3)(4), Li Y(5), Rapkin BD(6).

Author information:
(1)DeltaQuest Foundation, Inc., 31 Mitchell Road, Concord, MA, USA. 
carolyn.schwartz@deltaquest.org.
(2)Departments of Medicine and Orthopaedic Surgery, Tufts University Medical 
School, Boston, MA, USA. carolyn.schwartz@deltaquest.org.
(3)DeltaQuest Foundation, Inc., 31 Mitchell Road, Concord, MA, USA.
(4)Department of Measurement, Evaluation, Statistics, & Assessment, Boston 
College Lynch School of Education and Human Development, Chestnut Hill, MA, USA.
(5)Department of Psychiatry & Behavioral Sciences and the Department of 
Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New 
York, NY, USA.
(6)Department of Epidemiology and Population Health, Albert Einstein College of 
Medicine, Bronx, NY, USA.

PURPOSE: Understanding people's response to the pandemic needs to consider 
individual differences in priorities and concerns. The present study sought to 
understand how individual differences in cognitive-appraisal processes might 
moderate the impact of three COVID-specific factors-hardship, worry, and social 
support-on reported depression.
METHODS: This longitudinal study of the psychosocial impact of the COVID-19 
pandemic included 771 people with data at three timepoints over 15.5 months. 
Participants were recruited from panels of chronically ill or general population 
samples. Depression was measured by an item response theory validated depression 
index created using items from existing measures that reflected similar content 
to the Patient Health Questionnaire-8. COVID-specific factors of hardship, 
worry, and social support were assessed with items compiled by the National 
Institutes of Health. The Quality of Life Appraisal Profilev2 Short-Form 
assessed cognitive appraisal processes. A series of random effects models 
examined whether appraisal moderated the effects of hardship, worry, and social 
support on depression over time.
RESULTS: Over time the association between low social support and depression was 
greater (p = 0.0181). Emphasizing the negative was associated with exacerbated 
depression, in particular for those with low social support (p = 0.0007). 
Focusing on demands and habituation was associated with exacerbated depression 
unless one experienced greater hardship (p = 0.0074). There was a stronger 
positive connection between recent changes and depression for those people with 
higher worry scores early in the pandemic as compared to later, but a stronger 
positive correlation for those with lower worry scores later in the pandemic 
(p = 0.0015). Increased endorsement of standards of comparison, emphasizing the 
negative, problem goals, and health goals was associated with worse depression 
scores (all p < 0.0001). People who were younger, disabled, or had greater 
difficulty paying bills also reported worse depression (p < 0.0001, 0.0001, and 
0.002, respectively).
CONCLUSION: At the aggregate level, COVID-specific stressors changed over the 
course of the pandemic, whereas depression and social-support resources seemed 
stable. However, deeper analysis revealed substantial individual differences. 
Cognitive-appraisal processes showed considerable variability across individuals 
and moderated the impact of COVID-specific stressors and resources over time. 
Future work is needed to investigate whether coaching individuals away from 
maladaptive cognitive-appraisal processes can reduce depression and lead to 
better overall well-being.

© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland 
AG.

DOI: 10.1007/s11136-023-03573-0
PMID: 38183562 [Indexed for MEDLINE]


173. Front Public Health. 2023 Dec 21;11:1272074. doi: 10.3389/fpubh.2023.1272074. 
eCollection 2023.

Burnout, emotional distress and sleep quality among Chinese psychiatric 
healthcare workers during the COVID-19 pandemic: a follow-up study.

Xiong NN(#)(1), Fan TT(#)(1), Liu Q(1), Fritzsche K(2), Leonhart R(3), Stein 
B(4), Waller C(4), Müller MM(4)(5).

Author information:
(1)NHC Key Laboratory of Mental Health (Peking University), National Clinical 
Research Centre for Mental Disorders (Peking University Sixth Hospital), Peking 
University Sixth Hospital, Peking University Institute of Mental Health, Peking 
University, Beijing, China.
(2)Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, 
Center for Mental Health, Medical Centre - University of Freiburg, Freiburg, 
Germany.
(3)Department for Social Psychology and Methodology, Institute of Psychology, 
University of Freiburg, Freiburg, Germany.
(4)Department of Psychosomatic Medicine and Psychotherapy, Nuremberg General 
Hospital, Paracelsus Medical University, Nuremberg, Germany.
(5)Social and Organizational Psychology, Catholic University of 
Eichstätt-Ingolstadt, Eichstätt, Germany.
(#)Contributed equally

BACKGROUND: Different from the very early stages of the COVID-19 pandemic, 
burnout and chronic mental health problems among health care workers (HCWs) has 
become a challenge. Research is lacking on the relationship between burnout, 
stress, emotional distress and sleep quality.
METHODS: The Chinese center has been involved in the Cope-Corona project since 
the second survey (T2). Named after the project, a total of three 
cross-sectional surveys were distributed: T2 (February 16-20, 2021), T3 (May 
10-14, 2022), and T4 (December 20-24, 2022). Burnout, depression, anxiety, sleep 
quality, workplace factors and individual resources were measured. Using the T4 
data, we conducted structural equation model (SEM) to examine the mediating role 
of burnout in predicting emotional distress and sleep quality.
RESULTS: 96, 124, and 270 HCWs were enrolled at T2, T3, and T4, respectively. In 
line with the epidemic trends, the level of perceived COVID-19 related risks was 
significantly higher at T4, while the feeling of health and safety decreased 
significantly. At T4, the percentages of participants with clinically 
significant levels of depression and anxiety symptoms were 18.9% (51/270) and 
9.3% (25/270), respectively, while 30.4% (82/270) of them reported poor or very 
poor sleep quality. According to the SEM, individual resources and workplace 
factors mainly had an indirect effect in predicting depression and anxiety via 
burnout. However, neither burnout nor stress was a mediator or predictor of 
sleep quality. Instead, individual resources, positive workplace factors, and 
younger age had a direct effect in predicting good sleep quality.
CONCLUSION: Measures designed to enhance workplace factors and individual 
resources should be implemented to improve psychosomatic wellbeing of HCWs.

Copyright © 2023 Xiong, Fan, Liu, Fritzsche, Leonhart, Stein, Waller and Müller.

DOI: 10.3389/fpubh.2023.1272074
PMCID: PMC10764523
PMID: 38179557 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


174. Front Public Health. 2023 Dec 20;11:1252530. doi: 10.3389/fpubh.2023.1252530. 
eCollection 2023.

Prevalence of SARS-CoV-2 infection and impact of the COVID-19 pandemic in 
avocado farmworkers from Mexico.

Armendáriz-Arnez C(#)(1), Tamayo-Ortiz M(2), Mora-Ardila F(3), Rodríguez-Barrena 
ME(1), Barros-Sierra D(4), Castillo F(5), Sánchez-Vargas A(6), Lopez-Carr D(7), 
Deardorff J(8), Eskenazi B(8), Mora AM(#)(8).

Author information:
(1)Escuela Nacional de Estudios Superiores Unidad Morelia, Universidad Nacional 
Autónoma de México, Morelia, Mexico.
(2)Department of Environmental Health Sciences, Columbia Mailman School of 
Public Health, New York, NY, United States.
(3)Instituto de Investigaciones en Ecosistemas y Sustentabilidad, Universidad 
Nacional Autónoma de México, Morelia, Mexico.
(4)Instituto Mexicano del Seguro Social, Mexico City, Mexico.
(5)Department of Environmental Science, Policy and Management, University of 
California, Berkeley, Berkeley, CA, United States.
(6)Institute of Economic Research, Universidad Nacional Autónoma de Mexico, 
Mexico City, Mexico.
(7)Department of Geography, University of California, Santa Barbara, Santa 
Barbara, CA, United States.
(8)Center for Environmental Research and Community Health, School of Public 
Health, University of California, Berkeley, Berkeley, CA, United States.
(#)Contributed equally

INTRODUCTION: The COVID-19 pandemic disproportionately affected farmworkers in 
the United States and Europe, leading to increased morbidity and mortality. 
However, little is known about the specific impact of the pandemic on 
agriculture and food production workers in low- and middle-income countries. 
This study aimed to investigate the prevalence of SARS-CoV-2 infection and 
assess the mental health and economic consequences of the COVID-19 pandemic 
among avocado farmworkers in Michoacan, Mexico.
METHODS: We conducted a cross-sectional study of adult farmworkers (n = 395) in 
May 2021. We collected survey data, nasal swabs and saliva samples for 
SARS-CoV-2 RNA detection, and blood samples for immunoglobulin G (IgG) 
reactivity measurements.
RESULTS: None of the farmworkers tested positive for SARS-CoV-2 RNA. However, 
among unvaccinated farmworkers (n = 336, 85%), approximately one-third (33%) 
showed evidence of past infection (positive for IgG against SARS-CoV-2). 
Unvaccinated farmworkers who lived with other farmworkers (aRR = 1.55; 95% CI: 
1.05, 2.05), had ever lived with someone with COVID-19 (aRR = 1.82; 95% CI: 
1.22, 2.43), and who had diabetes (aRR = 2.19; 95% CI: 1.53, 2.85) had a higher 
risk of testing IgG-positive for SARS-CoV-2 infection. In contrast, unvaccinated 
farmworkers living in more rural areas (outside of Tingambato or Uruapan) 
(aRR = 0.71; 95% CI: 0.46, 0.96) or cooking with wood-burning stove (aRR = 0.75; 
95% CI: 0.55, 0.96) had a lower risk of IgG-positivity. Moreover, 66% of 
farmworkers reported a negative impact of the pandemic on their lives, 29% 
reported experiencing food insecurity and difficulty paying bills, and 10% 
reported depression or anxiety symptoms.
CONCLUSION: The COVID-19 pandemic has significantly affected the mental health 
and financial well-being of avocado farmworkers. Consequently, the 
implementation of interventions and prevention efforts, such as providing mental 
health support and food assistance services, is imperative.

Copyright © 2023 Armendáriz-Arnez, Tamayo-Ortiz, Mora-Ardila, Rodríguez-Barrena, 
Barros-Sierra, Castillo, Sánchez-Vargas, Lopez-Carr, Deardorff, Eskenazi and 
Mora.

DOI: 10.3389/fpubh.2023.1252530
PMCID: PMC10761533
PMID: 38174080 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


175. BMC Womens Health. 2024 Jan 3;24(1):15. doi: 10.1186/s12905-023-02849-4.

Emotional intelligence and stress and their relationship with breastfeeding 
self-efficacy in mothers of premature infants.

Arshadi Bostanabad M(1), Hosseinzadeh M(2), Molazemi Z(3), Namdar Areshtanab 
H(4).

Author information:
(1)Department of Pediatric Nursing, Nursing and Midwifery Faculty, Tabriz 
University of Medical Sciences, Tabriz, Iran.
(2)Department of Community Health Nursing, Nursing and Midwifery Faculty, Tabriz 
University of Medical Sciences, Tabriz, Iran.
(3)Department of Mental Health and Psychiatric Nursing, Nursing and Midwifery 
Faculty, Tabriz University of Medical Sciences, Tabriz, Iran.
(4)Department of Mental Health and Psychiatric Nursing, Nursing and Midwifery 
Faculty, Tabriz University of Medical Sciences, Tabriz, Iran. 
namdarh@tbzmed.ac.ir.

BACKGROUND: Premature infants need to be hospitalized in the neonatal intensive 
care unit (NICU) for long periods of time, which can increase anxiety and stress 
in their mothers. Additionally, the breastfeeding rate is lower among preterm 
infants. This study aimed to determine stress levels and emotional intelligence 
in mothers of preterm infants and their relationship with breastfeeding 
self-efficacy.
METHODS: This descriptive-correlational study was performed with a convenience 
sampling of 210 mothers of premature infants admitted to the neonatal intensive 
care unit in Tabriz, Iran in 2021. Data collection tools included 
socio-demographic checklist, perceived stress scale (PSS14), Dennis' 
breastfeeding self-efficacy scale, and the Schering emotional intelligence 
questionnaire. Data were analyzed using SPSS software version 16 via descriptive 
and inferential statistics (Pearson correlation and one-way ANOVA and modified 
general linear model).
RESULTS: Study findings demonstrated that most of the mothers had low stress 
(75.2%) and high breastfeeding self-efficacy (61.9%). The mean (SD) of emotional 
intelligence of the participants was 88.18 (16.60), ranging from 33 to 165. The 
results of the general linear model by modifying the demographic characteristics 
showed that the variables of emotional intelligence (B = 0.23, P = 0.03), stress 
(B=-0.56, P = 0.01), gestational age (B = 2.81, P < 0.001) and number of 
deliveries (B = 9.41, P < 0.001) were predictors of breastfeeding self-efficacy.
CONCLUSION: The findings showed that mothers of preterm infants had low 
emotional intelligence, and the majority of them had low perceived stress and 
high breastfeeding self-efficacy. Findings highlight the importance of 
addressing maternal stress and enhancing emotional intelligence to promote 
successful breastfeeding in mothers of preterm infants. Healthcare providers and 
managers are encouraged to offer support and educational programs to mothers of 
preterm infants, aiming to enhance their emotional intelligence. Further 
research and interventions focusing on these factors are warranted to improve 
the overall well-being of both mothers and infants in the neonatal intensive 
care unit.

© 2023. The Author(s).

DOI: 10.1186/s12905-023-02849-4
PMCID: PMC10765695
PMID: 38172831 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


176. Reprod Biol Endocrinol. 2024 Jan 2;22(1):1. doi: 10.1186/s12958-023-01174-7.

The impact of COVID-19 on the mental and sexual health of patients with 
infertility: a prospective before-and-after study.

Qi J(#)(1)(2)(3), Sun M(#)(4)(2)(3), Yue X(5), Hong X(5), Dong M(6)(7)(8), Tan 
J(9)(10)(11).

Author information:
(1)Center of Reproductive Medicine, Shengjing Hospital of China Medical 
University, No. 39 Huaxiang Street, Shenyang, China.
(2)NHC Key Laboratory of Advanced Reproductive Medicine and Fertility (China 
Medical University), National Health Commission, Shenyang, China.
(3)Key Laboratory of Reproductive Dysfunction Diseases and Fertility Remodelling 
of Liaoning Province, Shenyang, China.
(4)Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical 
University, Shenyang, China.
(5)Northeast Yucai Foreign Language School, Shenyang, China.
(6)Center of Reproductive Medicine, Shengjing Hospital of China Medical 
University, No. 39 Huaxiang Street, Shenyang, China. 494108809@qq.com.
(7)NHC Key Laboratory of Advanced Reproductive Medicine and Fertility (China 
Medical University), National Health Commission, Shenyang, China. 
494108809@qq.com.
(8)Key Laboratory of Reproductive Dysfunction Diseases and Fertility Remodelling 
of Liaoning Province, Shenyang, China. 494108809@qq.com.
(9)Center of Reproductive Medicine, Shengjing Hospital of China Medical 
University, No. 39 Huaxiang Street, Shenyang, China. tjczjh@163.com.
(10)NHC Key Laboratory of Advanced Reproductive Medicine and Fertility (China 
Medical University), National Health Commission, Shenyang, China. 
tjczjh@163.com.
(11)Key Laboratory of Reproductive Dysfunction Diseases and Fertility 
Remodelling of Liaoning Province, Shenyang, China. tjczjh@163.com.
(#)Contributed equally

BACKGROUND: The coronavirus disease (COVID-19) pandemic has seriously impacted 
the mental and sexual health of the general population. Patients dealing with 
infertility constitute a unique subset within society, susceptible to heightened 
sensitivity amid pressures and crises. However, to the best of our knowledge, 
the impact of the different stages of the COVID-19 pandemic on the mental and 
sexual health of patients with infertility has not been investigated. Therefore, 
this study aimed to investigate the mental and sexual health of patients with 
infertility during different stages of the COVID-19 pandemic (during the 
lockdown, when controls were fully liberalized, and during the post-pandemic 
era).
METHODS: This prospective before-and-after study was conducted between April and 
May 2022 (during the lockdown), December and January 2023 (when controls were 
fully liberalized), and May and August 2023 (during the post-pandemic era). This 
study explored the sexual and mental health of women with infertility during the 
three stages of the COVID-19 pandemic using standardized mental health and 
sexual function questionnaires. The Chi-square test was used to compare 
categorical data, and the ANOVA test was used to compare numerical data.
RESULTS: Patients had the highest 7-item Generalized Anxiety Disorder Scale 
(GAD-7) and 9-item Patient Health Questionnaire (PHQ-9) scores and the highest 
rates of anxiety and depression during the immediate full-release phase. During 
the complete liberalization phase, patients had the lowest Female Sexual 
Function Index (FSFI) scores and the highest incidence of sexual dysfunction.
CONCLUSION: This study is the first one to report the repercussions of COVID-19 
on the mental and sexual well-being of individuals experiencing infertility 
across various phases of the pandemic. Upon the complete lifting of control 
measures, close to 99% of participants exhibited varying degrees of anxiety and 
depression. Our research underscores that individuals with infertility faced 
elevated levels of anxiety, depression, and sexual dysfunction during the phase 
of full liberalization of COVID-19 control measures, in stark contrast to the 
periods of lockdown and the post-pandemic era.

© 2023. The Author(s).

DOI: 10.1186/s12958-023-01174-7
PMCID: PMC10759678
PMID: 38167101 [Indexed for MEDLINE]

Conflict of interest statement: All authors have no conflicts of interest to 
declare.


177. Am J Respir Crit Care Med. 2024 Mar 1;209(5):573-583. doi: 
10.1164/rccm.202305-0806OC.

Resilience and Mental-Health Symptoms in ICU Healthcare Professionals Facing 
Repeated COVID-19 Waves.

Azoulay E(1), Pochard F(1), Argaud L(2), Cariou A(3), Clere-Jehl R(4), Guisset 
O(5), Labbé V(6), Tamion F(7), Bruneel F(8), Jourdain M(9), Reuter D(10), 
Klouche K(11), Kouatchet A(12), Souppart V(1), Lautrette A(13), Bohé J(14), 
Vieillard Baron A(15), Dellamonica J(16)(17), Papazian L(18), Reignier J(19), 
Barbier F(20), Dumas G(1), Kentish-Barnes N(1).

Author information:
(1)Medical Intensive Care Unit, Saint Louis University Hospital, Assistance 
Publique-Hôpitaux de Paris, Paris-Cité University, Paris, France; FAMIREA study 
group.
(2)Medical Intensive Care Unit, Edouard Herriot Hospital, Hospices Civils de 
Lyon, Lyon, France.
(3)Medical Intensive Care Unit, Cochin University Hospital, Assistance 
Publique-Hôpitaux de Paris, Paris-Cité University, Paris, France.
(4)Medical Intensive Care Unit, Hautepierre Hospital, Strasbourg, France.
(5)Medical Intensive Care Unit, Saint-André Hospital, Bordeaux, France.
(6)Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Tenon 
University Hospital, Paris, France.
(7)Medical Intensive Care Unit, Rouen University Hospital, Rouen, France.
(8)Intensive Care Unit, André Mignot Hospital, Le Chesnay, France.
(9)Intensive Care Unit, Lille University Hospital-Roger Salengro Site, INSERM, 
Lille, France.
(10)Medical-Surgical Intensive Care Unit, Sud Francilien Hospital, Corbeil, 
France.
(11)Medical Intensive Care Unit, Lapeyronie University Hospital, Montpellier, 
France.
(12)Medical Intensive Care Unit, Angers University Hospital, Angers, France.
(13)Intensive Care Unit, Jean Perrin Oncology Center, Clermont-Ferrand, France.
(14)Medical Intensive Care Unit, Hôpital Lyon Sud, Lyon, France.
(15)Intensive Care Unit, Ambroise-Paré University Hospital, Assistance 
Publique-Hôpitaux de Paris, Boulogne-Billancourt, France.
(16)Medical Intensive Care Unit, UR2CA Clinical Research Unit, Côte d'Azur 
University, Nice, France.
(17)Nice University Hospital, Nice, France.
(18)Respiratory and Infectious Diseases Intensive Care Unit, Marseille-Nord 
University Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, 
France.
(19)Medical Intensive Care Unit, UR 4334 Movement-Interactions-Performance 
Research Unit, Nantes University Hospital, Nantes, France; and.
(20)Medical Intensive Care Unit, La Source Hospital, Orléans Regional Hospital, 
Orléans, France.

Comment in
    Am J Respir Crit Care Med. 2024 Mar 1;209(5):481-482.

Rationale: Psychological resilience (the ability to thrive in adversity) may 
protect against mental-health symptoms in healthcare professionals during 
coronavirus disease (COVID-19) waves. Objectives: To identify determinants of 
resilience in ICU staff members. Methods: In this cross-sectional survey in 21 
French ICUs, staff members completed the 10-item Connor-Davidson Resilience 
Scale, Hospital Anxiety and Depression Scale, and Impact of Event Scale-Revised 
(for post-traumatic stress disorder [PTSD]). Factors independently associated 
with resilience were identified. Measurements and Main Results: The response 
rate was 73.1% (950 of 1,300). The median 10-item Connor-Davidson Resilience 
Scale score was 29 (interquartile range, 25-32). Symptoms of anxiety, 
depression, and PTSD were present in 61%, 39%, and 36% of staff members, 
respectively. Distress associated with the COVID-19 infodemic was correlated 
with symptoms of depression and PTSD. More resilient respondents less often had 
symptoms of anxiety, depression, and PTSD. Greater resilience was independently 
associated with male sex, having provided intensive care during the early waves, 
having managed more than 50 patients with COVID-19, and, compared with earlier 
waves, working longer hours, having greater motivation, and more often involving 
families in end-of-life decisions. Independent risk factors for lower resilience 
were having managed more than 10 patients who died of COVID-19, having felt 
frightened or isolated, and greater distress from the COVID-19 infodemic. 
Conclusions: This study identifies modifiable determinants of resilience among 
ICU staff members. Longitudinal studies are needed to determine whether prior 
resilience decreases the risk of mental ill health during subsequent challenges. 
Hospital and ICU managers, for whom preserving mental well-being among staff 
members is a key duty, should pay careful attention to resilience.

DOI: 10.1164/rccm.202305-0806OC
PMCID: PMC10919111
PMID: 38163380 [Indexed for MEDLINE]


178. Am J Crit Care. 2024 Jan 1;33(1):54-59. doi: 10.4037/ajcc2024140.

Patients' Perceptions of Virtual Live Music in the Intensive Care Unit.

Bruder AL(1), Gururaja A(2), Narayani N(3), Kleinpell R(4), Schlesinger JJ(5).

Author information:
(1)Alexandra L. Bruder is a medical student at the Ohio State University College 
of Medicine, Columbus, and was a lead research assistant, Department of 
Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee 
during the study.
(2)Akash Gururaja is a research associate, Department of Anesthesiology, 
Vanderbilt University Medical Center.
(3)Nikita Narayani is a research associate, Department of Anesthesiology, 
Vanderbilt University Medical Center.
(4)Ruth Kleinpell is an associate dean for clinical scholarship and a professor, 
Vanderbilt University School of Nursing, Nashville.
(5)Joseph J. Schlesinger is a professor of anesthesiology and critical care 
medicine, Department of Anesthesiology, Vanderbilt University Medical Center.

BACKGROUND: Implementing music in the intensive care unit has increased in 
popularity because the environment can be stressful and anxiety inducing for 
many patients. In hospital settings, therapeutic music can be beneficial for 
patients' well-being and recovery. Although live music typically involves a 
face-to-face encounter between the musician and patient, the COVID-19 pandemic 
has prompted a change to virtual live therapeutic music, using technology to 
present music in real time (eg, with a tablet computer).
OBJECTIVE: To generate novel findings regarding patients' perceptions of virtual 
live therapeutic music, which has been little studied compared with live or 
recorded music..
METHODS: Fifty patients in Vanderbilt University Medical Center intensive care 
units listened to virtual live music played by a volunteer musician via an 
online video communication platform. Patients' responses to 5 survey questions 
were transcribed and analyzed qualitatively and quantitatively using data 
analysis software.
RESULTS: Seven major themes describing the familiarity and significance of music 
for patients were identified. Forty-seven patients (94%) experienced positive 
emotions from the music, 46 (92%) indicated that music was a significant part of 
their lives, 28 (56%) accessed a cherished memory, and 45 (90%) indicated that 
they would not change anything.
CONCLUSIONS: Therapeutic virtual music was well received and provided tangible 
benefits to patients. Additional research would provide information on patients' 
outcomes and differences between live and virtual live music.

©2024 American Association of Critical-Care Nurses.

DOI: 10.4037/ajcc2024140
PMID: 38161170 [Indexed for MEDLINE]


179. J Affect Disord. 2024 Mar 1;348:305-313. doi: 10.1016/j.jad.2023.12.061. Epub 
2023 Dec 27.

Prevalence and coping of depression and anxiety among college students during 
COVID-19 lockdowns in China.

Liu J(1), Tai Z(2), Hu F(3).

Author information:
(1)School of Journalism and Communication, Minjiang University, Fuzhou, Fujian 
Province 350108, China. Electronic address: 1036@mju.edu.cn.
(2)School of Journalism and Media, University of Kentucky, 343 S. Martin Luther 
King Blvd., Lexington, KY 40504, USA. Electronic address: ztai2@uky.edu.
(3)Research Center for Cyberspace Governance, MOE Laboratory for National 
Development and Intelligent Governance, Fudan University, Shanghai 200433, 
China. Electronic address: hufb@fudan.edu.cn.

BACKGROUND: This study sought to investigate the prevalence of anxiety, 
depression and mixed anxiety-depression disorder among college students during 
COVID-19 shelter-in-place lockdowns in China.
METHODS: Participants (N = 2818) were selected from 8 provincial regions across 
the country in areas that were under lockdown mandates. The dependent variables 
were anxiety and depression. Multiple regression models were tested using 
anxiety and depression as the respective outcome variables, and binary logistic 
regression was conducted with anxiety-depression comorbidity as the dependent 
variable. Explanatory variables were changes in (social) media use and 
communication behaviors, perceived effectiveness of daily activity involvements 
as well as a number of demographic and environmental factors.
RESULTS: Being a college senior, prior anxiety/depression history, having family 
members and residents in neighborhood tested positive with COVID were all 
important predictors of elevated anxiety, depression and their comorbidity. 
Increased face-to-face family communication and reading more e-books were 
associated with reduced anxiety, depression and their comorbidity. Listening to 
music and playing video games were correlated with lower anxiety but not 
depression.
CONCLUSIONS: Draconian shelter-in-place lockdowns as strictly enforced in China 
within a short notice could be detrimental to individual mental health and 
psychological well-being. Findings in this research can provide practical 
guidance for college counselors and health professionals in targeting particular 
segments of the student population in providing tailored psychological, 
therapeutic and material services during disruptive moments and public health 
crises. The central role of family communication in the emotional and social 
support process deserves critical contemplation.

Copyright © 2023 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2023.12.061
PMID: 38158051 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare no financial or other conflicts of interest.


180. Semergen. 2024 Apr;50(3):102158. doi: 10.1016/j.semerg.2023.102158. Epub 2023 
Dec 28.

[Emotional well-being, perceptions and attitudes against COVID-19 on 
adolescents].

[Article in Spanish]

Marchal Torralbo A(1), Rodoreda Noguerola S(2), Perez Martín V(3), Bielsa 
Pascual J(4), Lizana Alcazo MT(5), Manresa Domínguez MJ(6), Vedia Urgell C(7).

Author information:
(1)SAP Barcelonès Nord i Maresme, Institut Català de la Salut, Badalona, España; 
Referente Salud Comunitaria, Direcció d'Atenció Primària Metropolitana Nord, 
Institut català de la salut, Sabadell, España; Referente programa «Salut i 
escola», Institut Català de la Salut, Barcelona, España; Fundació Institut 
Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina 
(IDIAPJGol), Barcelona, España. Electronic address: amarchal.bnm.ics@gencat.cat.
(2)Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut 
Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Adjunta a la direcció 
d'Atenció Primaria, Institut Català de la Salut, Barcelona, España; Grup de 
Recerca Multidisciplinar en Salut i Societat (GREMSAS), (2017 SGR 917), 
Barcelona, España.
(3)Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut 
Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; EAP Santa Rosa, Institut 
Català de la Salut, Santa Coloma de Gramenet, España.
(4)Grup de Recerca Multidisciplinar en Salut i Societat (GREMSAS), (2017 SGR 
917), Barcelona, España; Unitat de Suport a la Recerca Metropolitana Nord, 
IDIAPJordi Gol, Mataró, España.
(5)Agencia Salut Pública de Catalunya, Cataluña, España.
(6)EAP Santa Rosa, Institut Català de la Salut, Santa Coloma de Gramenet, 
España; Departament d'Infermeria, Universitat Autònoma de Barcelona, Barcelona, 
España.
(7)SAP Barcelonès Nord i Maresme, Institut Català de la Salut, Badalona, España; 
Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut 
Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Facultat de Medicina, 
Universitat Autònoma de Barcelona, Barcelona, España.

INTRODUCTION: The worldwide pandemic of SARS-Cov2 has had a great impact on the 
lives of adolescents, affecting their health and well-being. There is little 
evidence of the emotional impact of the pandemic on adolescents.
OBJECTIVE: To explore the knowledge, perceptions, and attitudes of young people 
regarding COVID-19 and its impact on emotional well-being.
METHOD: A cross-sectional observational and descriptive study based on a survey 
of students aged 16-20 from five high schools in Barcelona metropolitan area.
RESULTS: The study was carried out on 291 surveys. Females made up 56.7% of the 
population. The average age was 16.9 years. A greater lack of knowledge about 
the transmission of the disease was detected. The most frequently used sources 
of information were social networks. In terms of emotional distress, the most 
important aspects were worry about getting sick (64%), family financial problems 
(46%), anxiety and irritability (27%), and apathy (26.5%). Gender differences 
were detected in terms of worries (women: 28.8%; men: 11.1%), sadness (women: 
29.3%, men: 15.5%), and feelings of fear (women: 24.5%; men: 11%). 16.7% of the 
participants consulted a mental health professional, with this being more common 
in women (women: 23.8%; men: 7.4%).
CONCLUSIONS: COVID-19 has affected the emotional well-being of adolescents, 
especially the female population. It is necessary to implement emotional 
well-being strategies in early childhood to cope with possible stressful 
situations in daily life and avoid future mental health problems. There is a 
growing use of social media to combat social isolation. The results of the study 
hold the potential to strategies aimed at preempting forthcoming biopsychosocial 
distress.

Copyright © 2023 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). 
Publicado por Elsevier España, S.L.U. All rights reserved.

DOI: 10.1016/j.semerg.2023.102158
PMID: 38157749 [Indexed for MEDLINE]


181. J Gerontol B Psychol Sci Soc Sci. 2024 Mar 1;79(3):gbad197. doi: 
10.1093/geronb/gbad197.

COVID-19 and Cognitive and Mental Health During Post-Infection Phase: A Study 
Among Middle-Aged and Older Indigenous Adults From Brazilian Amazons.

Bezerra CC(1)(2), Toledo NDN(2), Brucki SMD(3), Souza-Talarico JN(1)(4).

Author information:
(1)Department of Medical-Surgical Nursing, School of Nursing, University of São 
Paulo, São Paulo, Brazil.
(2)School of Nursing at Manaus, Federal University of Amazonas, Manaus, 
Amazonas, Brazil.
(3)Department of Neurology, Faculty of Medicine, University of São Paulo, São 
Paulo, Brazil.
(4)College of Nursing, University of Iowa, Iowa City, Iowa, USA.

OBJECTIVES: To examine the rate of self-reported coronavirus disease-2019 
(COVID-19) and its association with mental and cognitive health during the 
post-infection phase among middle-aged and older indigenous adults.
METHODS: A cross-sectional study was conducted, including 141 individuals ≥50 
and over from an urban indigenous community in Amazonas, Brazil. COVID-19 was 
deduced from self-reported infections. Cognitive function was evaluated using 
the Mini-Mental State Exam, Brief Cognitive Screening Battery (BCSB), and 
language fluency tests. Meanwhile, mental health was assessed through validated 
scales examining happiness, stress, and depression symptoms. The association 
between the rate of COVID-19 and cognitive and mental well-being was analyzed 
using logistic and linear regressions, adjusted for covariates.
RESULTS: From March 2020 to February 2022, 65.2% of the urban indigenous group 
tested positive for COVID-19. Lower functional capacity decreased the odds of 
contracting COVID-19 (p = .03). Adjusted linear regression models showed that 
COVID-19 was associated with higher BCSB learning (p = .017) and delayed recall 
(p = .028). Women, higher age, lower functional capacity, and hospitalization 
were associated with worse cognitive performance (p < .05). No impact of mental 
health indicators on past COVID-19 infection was noted.
DISCUSSION: COVID-19 was prevalent among urban Indigenous Brazilians. 
Unexpectedly, it was linked to enhanced learning and memory, not mental health 
issues. Cognitive performance was lower for men, older individuals, those with 
less functional ability, and hospitalized patients, indicating that participant 
characteristics and disease severity affect the COVID-19 and cognition 
relationship. Longitudinal studies across diverse Indigenous communities are 
necessary to understand COVID-19's impact on their cognitive and mental health.

© The Author(s) 2023. Published by Oxford University Press on behalf of The 
Gerontological Society of America. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/geronb/gbad197
PMID: 38157407 [Indexed for MEDLINE]


182. Front Public Health. 2023 Dec 12;11:1278725. doi: 10.3389/fpubh.2023.1278725. 
eCollection 2023.

Exploring the lived experiences of participants and facilitators of an online 
mindfulness program during COVID-19: a phenomenological study.

Melvin A(#)(1), Canning C(#)(1)(2), Chowdhury F(1), Hunter S(3), Kim S(1)(4).

Author information:
(1)Waypoint Centre for Mental Health Care, Waypoint Research Institute, 
Penetanguishene, ON, Canada.
(2)Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
(3)Research and Innovation, Georgian College of Applied Arts and Technology, 
Barrie, ON, Canada.
(4)Department of Psychiatry and Behavioural Neurosciences, McMaster University, 
Hamilton, ON, Canada.
(#)Contributed equally

The coronavirus pandemic (COVID-19) has placed incredible demands on healthcare 
workers (HCWs) and adversely impacted their well-being. Throughout the pandemic, 
organizations have sought to implement brief and flexible mental health 
interventions to better support employees. Few studies have explored HCWs' lived 
experiences of participating in brief, online mindfulness programming during the 
pandemic using qualitative methodologies. To address this gap, we conducted 
semi-structured interviews with HCWs and program facilitators (n = 13) who 
participated in an online, four-week, mindfulness-based intervention program. 
The goals of this study were to: (1) understand how participants experienced 
work during the pandemic; (2) understand how the rapid switch to online life 
impacted program delivery and how participants experienced the mindfulness 
program; and (3) describe the role of the mindfulness program in supporting 
participants' mental health and well-being. We utilized interpretive 
phenomenological analysis (IPA) to elucidate participants' and facilitators' 
rich and meaningful lived experiences and identified patterns of experiences 
through a cross-case analysis. This resulted in four main themes: (1) changing 
environments; (2) snowball of emotions; (3) connection and disconnection; and 
(4) striving for resilience. Findings from this study highlight strategies for 
organizations to create and support wellness programs for HCWs in times of 
public health crises. These include improving social connection in virtual care 
settings, providing professional development and technology training for HCWs to 
adapt to rapid environmental changes, and recognizing the difference between 
emotions and emotional states in HCWs involved in mindfulness-based programs.

Copyright © 2023 Melvin, Canning, Chowdhury, Hunter and Kim.

DOI: 10.3389/fpubh.2023.1278725
PMCID: PMC10749917
PMID: 38148877 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


183. Front Public Health. 2023 Dec 7;11:1323303. doi: 10.3389/fpubh.2023.1323303. 
eCollection 2023.

Anxiety prevalence and associated factors among frontline nurses following the 
COVID-19 pandemic: a large-scale cross-sectional study.

Wang S(#)(1), Luo G(#)(2), Pan D(#)(3), Ding X(4), Yang F(5), Zhu L(6), Wang 
S(2), Ma X(1).

Author information:
(1)Department of Neurology, Affiliated Fuyang People's Hospital of Anhui Medical 
University, Fuyang, China.
(2)Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin 
Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, 
China.
(3)Department of Clinical Medicine, Anhui Medical University, Hefei, China.
(4)Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, 
China.
(5)Department of Neurology, Affiliated Hospital of North Sichuan Medical 
College, Nanchong, China.
(6)Ya'an People's Hospital, Sichuan University, Yaan, China.
(#)Contributed equally

INTRODUCTION: Nurses are more likely to experience anxiety following the 
coronavirus 2019 epidemic. Anxiety could compromise nurses' work efficiency and 
diminish their professional commitment. This study aims to investigate nurses' 
anxiety prevalence and related factors following the pandemic in multiple 
hospitals across China.
METHODS: An online survey was conducted from April 16 to July 3, 2023, targeting 
frontline nurses who had actively participated in China. Anxiety and depression 
symptoms were assessed using the Self-rating Anxiety Scale and the Self-rating 
Depression Scale (SDS), respectively. Multivariable logistic regression analysis 
was employed to identify factors linked with anxiety.
RESULTS: A total of 2,210 frontline nurses participated in the study. Overall, 
65.07% of participants displayed clinically significant anxiety symptoms. 
Multivariable logistic regression revealed that nurses living with their 
families [2.52(95% CI: 1.68-3.77)] and those with higher SDS scores [1.26(95% 
CI: 1.24-1.29)] faced an elevated risk of anxiety. Conversely, female nurses 
[0.02(95% CI: 0.00-0.90)] and those who had recovered from infection 
[0.05(95%CI: 0.07-0.18)] demonstrated lower rates of anxiety.
DISCUSSION: This study highlights the association between SDS score, gender, 
virus infection, living arrangements and anxiety. Frontline nurses need to be 
provided with emotional support to prevent anxiety. These insights can guide 
interventions to protect the mental well-being of frontline nurses in the 
post-pandemic period.

Copyright © 2023 Wang, Luo, Pan, Ding, Yang, Zhu, Wang and Ma.

DOI: 10.3389/fpubh.2023.1323303
PMCID: PMC10740197
PMID: 38145071 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


184. J Alzheimers Dis. 2024;97(2):741-752. doi: 10.3233/JAD-230229.

Shifting the Paradigm of Nursing Home Care for People with Dementia: The Italian 
Experience of Il Paese Ritrovato and the Impact of SARS-CoV-2.

Mazzola P(1)(2)(3), Zanetti M(4), Ferraguzzi G(5), Villa ML(4), Sandrini MC(4), 
Fumagalli M(4), Volpi M(4), Caggiu G(6), Monzio Compagnoni M(6), Mecocci P(7), 
Bellelli G(1)(2)(3).

Author information:
(1)School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, 
Monza, Italy.
(2)Fondazione IRCCS San Gerardo dei Tintori, Acute Geriatrics Unit, Monza, 
Italy.
(3)NeuroMI - Milan Center for Neuroscience, Clinical Neurosciences research 
area, Milano, Italy.
(4)Cooperativa La Meridiana, Monza, Italy.
(5)Department of Biomedical Sciences for Health, Università degli Studi di 
Milano, Milano, Italy.
(6)Department of Statistics and Quantitative Methods, Università degli Studi di 
Milano-Bicocca, Milano, Italy.
(7)Department of Biomedical Sciences for Health, Università di Perugia, Perugia, 
Italy.

BACKGROUND: Il Paese Ritrovato is an Italian nursing home founded in 2018, it is 
based on the Alzheimer village model and admits people with mild-to-moderate 
dementia.
OBJECTIVE: Describe the impact of the SARS-CoV-2 pandemic on people living at Il 
Paese Ritrovato through a Comprehensive Geriatric Assessment (CGA) regularly 
administered prior to and during the pandemic.
METHODS: We explored the effects of a person-centered approach. We assessed 64 
subjects (enrolled and followed between June 2018 and December 2020), who 
underwent at least 18 months of observation prior to the pandemic. Each subject 
was evaluated using a CGA on admission time (T0) and at defined time-points: T6, 
T12, T18. One last CGA evaluation was performed during the SARS-CoV-2 pandemic 
(TCovid-19). Temporal trends during T0-T18, and differences between T18 and 
TCovid-19 were calculated.
RESULTS: The mean age was 82 years with a prevalence for females (77.0%) and 
Alzheimer's disease diagnosis (60%). Psychiatric and behavioral disorders were 
the most common conditions (80%). We utilized a nonpharmacological approach 
aimed at promoting the residents' overall wellbeing and observed satisfactory 
performance during the first 18 months. In comparison with the pre-pandemic 
period, TCovid-19 enlightened +11.7% use of antidepressants and a decline of 
Mini-Mental State Examination mean values (not statistically significant), while 
engagement in activities dropped.
CONCLUSIONS: The pandemic may have disrupted the existing model of care, but at 
the same time, it confirmed that the Il Paese Ritrovato approach, which 
encompasses symptoms improvement and multicomponent support, is in fact 
beneficial.

DOI: 10.3233/JAD-230229
PMID: 38143344 [Indexed for MEDLINE]


185. Dig Dis Sci. 2024 Feb;69(2):562-569. doi: 10.1007/s10620-023-08176-w. Epub 2023 
Dec 22.

Gastrointestinal Manifestations and Their Association with Neurologic and Sleep 
Problems in Long COVID-19 Minority Patients: A Prospective Follow-Up Study.

Ashktorab H(1)(2), Challa SR(3), Singh G(3), Nanduri S(3), Ibrahim M(3), 
Martirosyan Z(4), Whitsell P(4), Chirumamilla LG(3), Shayegh N(3), Watson K(3), 
Smith T(3), Ogwo V(3)(5)(6)(7)(8)(8), Kolawole O(3), Littleton M(3), Morrison 
N(3), Nair V(3), Byer D(3), Dawodu DO(3), Lexima P(3), Rashid M(3), Deverapalli 
M(3), Atluri SM(3), Nezamloo A(3), Nasrin F(3), Kim RJ(3), Sherif Z(5), Oskrochi 
G(6), Carethers JM(7), Brim H(8).

Author information:
(1)GI Division, Department of Medicine, Cancer Center, Howard University 
Hospital, Washington, DC, USA. hashktorab@howard.edu.
(2)Howard University College of Medicine, 2041 Georgia Avenue, N.W., Washington, 
DC, 20060, USA. hashktorab@howard.edu.
(3)GI Division, Department of Medicine, Cancer Center, Howard University 
Hospital, Washington, DC, USA.
(4)Howard University College of Medicine, 2041 Georgia Avenue, N.W., Washington, 
DC, 20060, USA.
(5)Department of Biochemistry & Molecular Biology, Howard University College of 
Medicine, Washington, DC, USA.
(6)College of Engineering and Technology, American University of the Middle 
East, Egaila, Kuwait.
(7)Division of Gastroenterology & Hepatology, Department of Medicine and Moores 
Cancer Center, UC San Diego, San Diego, USA.
(8)Department of Pathology and Cancer Center, Howard University College of 
Medicine, Washington, DC, USA.

BACKGROUND: Long-COVID is a condition post SARS-CoV-2 infection with persistent 
or recurring symptoms affecting multiple organs, and may involve viral 
persistence, changes to the microbiome, coagulopathies, and alterations to 
neuro-immune interactions. These factors can disrupt the Gut-Brain Axis, which 
is a complex system involving bidirectional communication between the central 
nervous system and the gastrointestinal (GI) system. As a result of these 
disruptions, individuals with long-COVID may develop post-infectious functional 
GI disorders, which can cause a range of symptoms affecting the digestive 
system.
AIM: To understand frequency of GI manifestations of Long-COVID and to determine 
association with sleep or neurological symptoms in a predominantly minority 
population.
METHODS: We included patients with positive SARS-CoV-2 PCR (n = 747) who were 
hospitalized from Feb. 2020 to May 2021 at Howard University Hospital and 
followed between 6 and 12 months from discharge. GI, sleep, and neurological 
symptoms (via the Montreal Cognitive Assessment (MoCA) scoring system) were 
assessed using a standardized questionnaire. Linear regression analysis, χ2 and 
Fisher's exact test were utilized to determine the statistical significance of 
correlations of GI/Neuro/COVID.
RESULTS: The mean age of patients was 58, with 51.6% females and a predominant 
African American ethnicity (73.6%, n = 550). A total of 108 patients died during 
their initial hospital stay, with the remaining 639 patients followed-up. Three 
hundred fifty (350) patients responded to the questionnaire (57 patients died 
during the follow-up period). Overall, 39 (13.3%) patients reported GI-related 
symptoms, out of which 19 (6.4%) had persistent symptoms and 20 (6.8%) developed 
new onset GI symptoms. Nausea and vomiting were the most common 24/39 (61.5%), 
followed by abdominal pain 7/39 (18%), diarrhea 5/39 (12.8%), and others 3/39 
(7.6%). Patients who presented with vomiting during acute SARS-CoV-2 infection 
were more likely to have Long-COVID GI manifestations (P = 0.023). Use of ACE 
inhibitors, abnormal lymphocyte count and elevated ferritin are other variables 
that showed significant associations with Long-COVID GI manifestations 
(P = 0.03, 0.006 and 0.03, respectively). During follow-up, a total of 28 (9.5%) 
patients reported difficulty with sleep and 79 (27%) patients had abnormal MoCA 
assessment. With further analysis, there was a trend between presentation of GI 
symptoms on admission with abnormal MoCA assessment, and an association between 
abnormal LFTs and history of liver disease during hospitalization with 
subsequent sleep problems. Baseline characteristics, clinical comorbidities, 
other laboratory values, hospital length of stay, mechanical ventilation, 
medications during hospitalization, re-admission and Flu or COVID-19 vaccination 
have not shown any association with Long-COVID GI symptoms in our cohort.
CONCLUSION: Dyspeptic symptoms were common GI manifestations in the acute and 
post COVID periods. GI symptoms, abnormal LFTs and a history of liver disease 
during the acute infectious phase associates with abnormal MoCA and sleep 
problems during follow-up. Further large population studies are needed to 
determine if COVID-19 leads to a GI symptoms-associated Long-COVID phenotypes 
and other symptoms through the Gut-Brain-Axis.

© 2023. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s10620-023-08176-w
PMID: 38135813 [Indexed for MEDLINE]


186. PLoS One. 2023 Dec 22;18(12):e0296309. doi: 10.1371/journal.pone.0296309. 
eCollection 2023.

Mental health status and coping strategies of Chinese university students during 
the COVID-19 pandemic: A rapid review.

Luo W(1)(2), Mohammed J(3).

Author information:
(1)Department of Pharmacy, Xiangyang No.1 People's Hospital, Hubei University of 
Medicine, Shiyan, China.
(2)Faculty of Health and Environmental Sciences, Auckland University of 
Technology, Auckland, New Zealand.
(3)Faculty of Health, University of Canterbury, Christchurch, New Zealand.

Since the coronavirus (COVID-19) outbreak in December 2019, students have been 
under unparalleled psychological stress worldwide. As part of its prevention and 
control strategies, the Chinese Ministry of Education proposed online teaching 
activities for universities. For the first time, teaching and learning shifted 
completely online, significantly impacting university students used to classroom 
learning. This research addresses the knowledge gap about the mental health and 
coping strategies employed by Chinese university students during the COVID-19 
pandemic. Electronic databases (PsycINFO, Scopus, Medline, Cochranes and CNKI) 
were searched systematically from 2019 to 2023, as part of this literature 
review. From the 349 articles found, 25 met the inclusion criteria for analysis. 
Thematic analysis was used to identify six sub-themes, organized under two main 
themes: Mental health issues of Chinese university students and their coping 
mechanisms. Heightened stress, anxiety, and depression appeared in Chinese 
university students during the pandemic, which may have been compounded by their 
isolation and the disruptions to their studies. Although the impact of COVID-19 
on Chinese university students is waning, this study emphasizes the potential 
long-lasting impact on their mental health, which requires further 
investigation, particularly regarding gender differences. Moreover, positive and 
negative coping strategies were found in this review. Strategies for seeking 
social and family support and participating in sports activities had significant 
alleviating effects, while negative coping strategies such as alcohol-use and 
smoking did not. This rapid review informs the development of policies and 
interventions to enhance the mental health of university students during crisis 
events. The findings serve to inform health policymakers, university 
psychologists, and educators in improving the well-being of this student 
population.

Copyright: © 2023 Luo, Mohammed. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0296309
PMCID: PMC10745188
PMID: 38134210 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


187. Medicine (Baltimore). 2023 Dec 22;102(51):e36490. doi: 
10.1097/MD.0000000000036490.

Using Rasch Wright map to identify hospital employee satisfaction during and 
before COVID-19.

Chen MY(1), Huang SM(2), Chou W(3)(4).

Author information:
(1)Department of Planning and Management, Chi Mei Medical Center, Taiana, 
Taiwan.
(2)Department of Marketing and Logistics Management, Southern Taiwan University 
of Science and Technology, Tainan, Taiwan.
(3)Department of physical medicine and rehabilitation, Chiali Chi-Mei Hospital, 
Tainan, Taiwan.
(4)Department of Physical Medicine and Rehabilitation, Chung San Medical 
University Hospital, Taichung, Taiwan.

During the surge of the COVID-19 outbreak, medical personnel attended to 
countless patients, which adversely affected their mental well-being. To support 
their staff, hospitals implemented guidelines that focused on promoting mental 
health among medical professionals. The hypothesis that employee satisfaction 
declined during the COVID-19 pandemic needs confirmation. Several findings were 
derived from a series of visualizations using Rasch Wright map. The research 
sample was taken from a medical center in southern Taiwan based on satisfaction 
survey data from 2017 to 2022 (n = 1222). Perceptions on job satisfaction 
perceptions during and prior to COVID-19 in 2 stages of 2017 to 2019 and 2020 to 
2022 were compared using Rasch Wright map. Through a series of visualizations, 
including the dimension with the highest satisfaction, the demographical 
category of hospital employees with the lowest satisfaction during the pandemic, 
and Rasch Wright map displaying employs' perfections on 4 domains over years. 
The results indicated: Employee satisfaction was significantly lower during the 
COVID-19 period in 2 domains: compensation and benefits, work atmosphere; among 
the 23 questions, Question 5 (regarding meals provided by the hospital to staff) 
scored the lowest, while Question 23 (regarding the hospital emergency response 
and disaster prevention capabilities) scored the highest. Among the 4 domains, 
organizational leadership had the highest satisfaction; out of 104 demographic 
variables, 21 groups showed that employee satisfaction during the pandemic was 
significantly (P < .05) lower than before the pandemic; the selection of 
specific demographic variables is for top-tier supervisors, and they showed that 
employee satisfaction during the pandemic was significantly (P < .05) lower than 
before the pandemic across all 4 dimensions. Therefore, this study accepts the 
hypothesis that employee satisfaction was negatively affected during the 
COVID-19 period on 2 domains only: compensation and benefits, work atmosphere. 
The study visual examination, especially using Rasch Wright map, offers a 
comparative perspective on hospital staff satisfaction and serves as a 
methodological guide for subsequent satisfaction research.

Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

DOI: 10.1097/MD.0000000000036490
PMCID: PMC10735066
PMID: 38134069 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no funding and conflicts of 
interest to disclose.


188. Int J Environ Res Public Health. 2023 Dec 15;20(24):7182. doi: 
10.3390/ijerph20247182.

Individual Differences on Wellbeing Indices during the COVID-19 Quarantine in 
Greece: A National Study.

Pezirkianidis C(1), Parpoula C(2), Athanasiades C(3), Flora K(4), Makris N(5), 
Moraitou D(3)(6), Papantoniou G(6)(7), Vassilopoulos S(8), Sini M(1), Stalikas 
A(1).

Author information:
(1)Laboratory of Positive Psychology, Department of Psychology, Panteion 
University of Social & Political Sciences, Syggrou Ave. 136, 17671 Athens, 
Greece.
(2)Department of Psychology, Panteion University of Social & Political Sciences, 
Syggrou Ave. 136, 17671 Athens, Greece.
(3)Department of Psychology, Aristotle University of Thessaloniki, 54124 
Thessaloniki, Greece.
(4)Department of Psychology, University of Western Macedonia, 50100 Kozani, 
Greece.
(5)Department of Primary Education, Democritus University of Thrace, 68100 
Alexandroupolis, Greece.
(6)Laboratory of Neurodegenerative Diseases, Center for Interdisciplinary 
Research and Innovation (CIRI-AUTH), Balkan Center, Aristotle University of 
Thessaloniki, 10th km Thessaloniki-Thermi, 54124 Thessaloniki, Greece.
(7)Laboratory of Psychology, Department of Early Childhood Education, School of 
Education, University of Ioannina, 45110 Ioannina, Greece.
(8)Department of Educational Sciences and Social Work, University of Patras, 
26110 Patras, Greece.

The impact of COVID-19 and the associated lockdown measures on people's physical 
and mental wellbeing, as well as their daily lives and functioning, has been 
extensively studied. This study takes the approach of investigating the 
consequences of COVID-19 on a national scale, considering sociodemographic 
factors. The main objective is to make a contribution to ongoing research by 
specifically examining how age, gender, and marital status influence the overall 
impact of COVID-19 and wellbeing indicators during the second lockdown period 
that was implemented in response to the COVID-19 pandemic in the Greek 
population. The study involved a sample of 16,906 individuals of all age groups 
in Greece who completed an online questionnaire encompassing measurements 
related to personal wellbeing, the presence and search for meaning in life, 
positive relationships, as well as symptoms of depression, anxiety, and stress. 
Additionally, to gauge the levels of the perceived COVID-19-related impact, a 
valid and reliable scale was developed. The results reveal that a higher 
perception of COVID-19 consequences is positively associated with psychological 
symptoms and the search for meaning in life, while being negatively correlated 
with personal wellbeing and the sense of meaning in life. In terms of individual 
differences, the findings indicate that unmarried individuals, young adults, and 
females tend to report higher levels of psychological symptoms, a greater search 
for meaning in life, and a heightened perception of COVID-19-related impact. 
These findings are analyzed in depth, and suggestions for potential directions 
for future research are put forth.

DOI: 10.3390/ijerph20247182
PMCID: PMC10742746
PMID: 38131733 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


189. Geriatr Gerontol Int. 2024 Mar;24 Suppl 1:215-220. doi: 10.1111/ggi.14772. Epub 
2023 Dec 22.

Prevalence and associated factors of work impairment among geriatricians during 
the COVID-19 pandemic in Japan.

Ishii S(1), Jung H(1), Akishita M(2), Kawamura A(1).

Author information:
(1)Department of Medicine for Integrated Approach to Social Inclusion, Graduate 
School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, 
Japan.
(2)Department of Geriatric Medicine, Graduate School of Medicine, The University 
of Tokyo, Tokyo, Japan.

AIM: This study investigated work impairment and its associated factors among 
geriatricians during the coronavirus disease 2019 (COVID-19) pandemic.
METHODS: This cross-sectional study was carried out using an anonymous online 
survey questionnaire administered to members of the Japanese Geriatric Society 
between October and December 2022. The questionnaire included questions 
regarding psychological distress (Kessler Psychological Distress Scale), fear of 
COVID-19 (Fear of COVID-19 Scale) and work impairment (Work Functioning 
Impairment Scale). Multivariate logistic regression analyses were carried out to 
determine the factors associated with work impairment. Causal mediation analyses 
were performed to delineate the relationship between work impairment, 
psychological distress and fear of COVID-19.
RESULTS: The analytic sample included 386 geriatricians, and work impairment was 
observed in 24.8% of them. Work impairment was associated with age, prefecture 
where the institution was located and fear of COVID-19. Mediation analysis 
showed that the effect of fear of COVID-19 on work impairment was almost 
completely mediated by psychological distress.
CONCLUSION: During the COVID-19 pandemic, work impairment was commonly observed 
among geriatricians. We found that fear of COVID-19 might cause work impairment; 
however, this effect was exerted entirely through psychological distress. This 
implies that interventions to prevent or reduce work impairment among doctors 
should mainly target psychological distress; however, the fear of COVID-19, if 
it causes psychological distress, should also be addressed. Managers of 
hospitals and long-term care facilities must take steps to protect healthcare 
workers' mental well-being and maintain work productivity. Therefore, 
understanding the factors related to work impairment might help them devise 
effective measures. Geriatr Gerontol Int 2024; 24: 215-220.

© 2023 Japan Geriatrics Society.

DOI: 10.1111/ggi.14772
PMID: 38131637 [Indexed for MEDLINE]


190. Am J Pharm Educ. 2024 Feb;88(2):100635. doi: 10.1016/j.ajpe.2023.100635. Epub 
2023 Dec 19.

Impact of the COVID-19 Pandemic on US Pharmacy Academia Per Perspectives of 
Faculty and Administrators.

Sevak RJ(1), Sanz RM(2), Patel RA(3), O'Dell KM(3).

Author information:
(1)University of the Pacific, Thomas J. Long School of Pharmacy, Department of 
Pharmacy Practice, Stockton, CA, USA. Electronic address: rsevak@pacific.edu.
(2)Global regulatory affairs, Oncology at Novartis Institute for Biomedical 
Research, Cambridge, MA, USA.
(3)University of the Pacific, Thomas J. Long School of Pharmacy, Department of 
Pharmacy Practice, Stockton, CA, USA.

OBJECTIVE: The COVID-19 pandemic has markedly affected academic and 
administrative facets of pharmacy education. However, to date, no study has 
systematically summarized pandemic-related changes at pharmacy schools across 
the United States. This study aimed to evaluate US pharmacy school faculty and 
administrators' perspectives on the pandemic's impact on pharmacy academia.
METHODS: A web-based survey was sent to US pharmacy school faculty and 
administrators in August 2020. The survey included questions assessing the 
pandemic's impact on the faculty's teaching, the school's financial status, 
administrative aspects, and mental well-being of faculty and administrators. 
Descriptive statistics and 1-sample Z tests were used for conducting statistical 
analyses.
RESULTS: The survey was sent to 6177 individuals, of whom 1068 participated 
(17.3% response rate). In total, 931 respondents (759 faculty and 172 
administrators) completed the entire survey. Both faculty and administrators 
experienced increased workload while their mental health and job satisfaction 
declined. Faculty's teaching satisfaction, research productivity, and service 
activity worsened. Administrators identified decreases in revenue sources and 
increases in expenses associated with the pandemic. Administrators also 
indicated the negative impact of the pandemic on an array of administrative and 
academic aspects within their pharmacy schools. The qualitative analysis 
identified several overlapping themes highlighting the negative effects of the 
pandemic on the faculty's teaching.
CONCLUSION: Present findings indicate the negative effects of the COVID-19 
pandemic on a variety of academic and administrative aspects at US pharmacy 
schools. These findings could provide useful information to stakeholders in 
pharmacy academia.

Copyright © 2023 American Association of Colleges of Pharmacy. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.ajpe.2023.100635
PMID: 38128615 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest None.


191. Alzheimers Dement. 2024 Mar;20(3):1797-1806. doi: 10.1002/alz.13582. Epub 2023 
Dec 20.

Impact of the iWHELD digital person-centered care program on quality of life, 
agitation and psychotropic medications in people with dementia living in nursing 
homes during the COVID-19 pandemic: A randomized controlled trial.

McDermid J(1)(2), Henley W(1), Corbett A(1), Williams G(2), Fossey J(1), Clare 
L(1)(3), Fox C(1), Aarsland D(2), Khan Z(2), Soto M(4), Woodward-Carlton B(5), 
Cook EM(6), Cummings J(7), Sweetnam A(1), Chan X(1), Lawrence M(1), Ballard 
C(1); iWHELD study group.

Author information:
(1)University of Exeter Medical School, University of Exeter, Exeter, UK.
(2)Institute of Psychiatry, Psychology and Neuroscience, King's College London, 
London, UK.
(3)NIHR Applied Research Collaboration South-West Peninsula, University of 
Exeter, Exeter, UK.
(4)Research and Clinical Alzheimer's Disease Center, CMRR Gérontopôle, CHU 
Toulouse, AGING team, axe MAINTAIN CERPOP, Toulouse, France.
(5)Alzheimer's Society UK, London, UK.
(6)Faculty of Health Sciences, University of Hull, Hull, UK.
(7)Chambers-Grundy Center for Transformative Neuroscience, Department of Brain 
Health, School of Integrated Health Sciences, University of Nevada Las Vegas 
(UNLV), Las Vegas, Nevada, USA.

INTRODUCTION: iWHELD is a digital person-centered care program for people with 
dementia in nursing homes adapted for remote delivery during the COVID-19 
pandemic.
METHODS: A 16-week two-arm cluster-randomized controlled trial in 149 UK nursing 
homes compared iWHELD with treatment as usual (TAU). Primary outcome was the 
overall quality of life with secondary outcomes of agitation and psychotropic 
use.
RESULTS: iWHELD conferred benefit to quality of life on the primary (F = 4.3, 
p = 0.04) and secondary measures of quality of life (F = 6.45, p = 0.01) and 
reduced psychotropic medication use (χ2  = 4.08, p = 0.04) with no worsening of 
agitation. Benefit was seen in participants who contracted COVID-19, those with 
agitation at baseline, and those taking psychotropic medications.
DISCUSSION: iWHELD confers benefits to quality of life and key measures of 
well-being, can be delivered during the challenging conditions of a pandemic, 
and should be considered for use alongside any emerging pharmacological 
treatment for neuropsychiatric symptoms.
HIGHLIGHTS: iWHELD is the only remote, digital delivery nursing home training 
programme for dementia care iWHELD improved quality of life in people with 
dementia and reduced antipsychotic use without worsening of agitation Residents 
who contracted Covid-19 during the study also experienced benefits from iWHELD 
iWHELD offers a valuable, pandemic-safe tool for improving dementia care.

© 2023 The Authors. Alzheimer's & Dementia published by Wiley Periodicals LLC on 
behalf of Alzheimer's Association.

DOI: 10.1002/alz.13582
PMCID: PMC10984502
PMID: 38116916 [Indexed for MEDLINE]

Conflict of interest statement: CB has received consulting fees from Acadia 
pharmaceutical company, AARP, Addex pharmaceutical company, Eli Lily, Enterin 
pharmaceutical company, GW Pharmaceuticals, H. Lundbeck pharmaceutical 
company, Novartis pharmaceutical company, Janssen Pharmaceuticals, Johnson and 
Johnson pharmaceuticals, Novo Nordisk pharmaceutical company, Orion Corp 
pharmaceutical company, Otsuka America Pharm Inc, Sunovion Pharm. Inc, Suven 
pharmaceutical company, Roche pharmaceutical company, Biogen pharmaceutical 
company, Synexus clinical research organization and TauRX pharmaceutical company 
and research funding from Synexus clinical research organization, Roche 
pharmaceutical company, Novo Nordisk pharmaceutical company and Novartis 
pharmaceutical company. AC discloses financial relationships with Suven and 
Janssen pharmaceutical companies for consultancy work; MSM has 
received consulting fees from Acadia pharmaceutical company, Avanir company, 
Medesis Pharma, Otsuka company, Roche pharmaceutical company, Biogen 
pharmaceutical company and Biogen pharmaceutical company. JC has provided 
consultation to Acadia, Actinogen, Acumen, Alpha Cognition, Aprinoia, AriBio, 
Artery, Biogen, BioVie, Cassava, Cerecin, Diadem, EIP Pharma, Eisai, GemVax, 
Genentech, GAP Innovations, Janssen, Jocasta, Karuna, Lilly, Lundbeck, LSP, 
Merck, NervGen, Novo Nordisk, Oligomerix, OptoCeutics, Ono, Otsuka, PRODEO, 
Prothena, ReMYND, Roche, Sage Therapeutics, Signant Health, Simcere, Sunbird 
Bio, Suven, SynapseBio, TrueBinding, Vaxxinity, and Wren pharmaceutical, 
assessment, and investment companies. JC owns the copyright of the 
Neuropsychiatric Inventory. JM, WH, GW, DA, CF, JF, LC, BWC, EMC, MSM, AS, and 
KM report no financial relationships with commercial interests. Author 
disclosures are available in the supporting information.


192. S Afr Fam Pract (2004). 2023 Dec 15;65(1):e1-e7. doi: 10.4102/safp.v65i1.5788.

Medical registrars at the University of the Free State: Burnout, resilience and 
coping strategies.

Van der Merwe LJ(1), Motlapema N, Matsepe T, Nchepe K, Ramachela P, Rangolo T, 
Kutu Z, Joubert G, Van Rooyen C.

Author information:
(1)Division of Health Sciences Education, Faculty of Health Sciences, University 
of the Free State, Bloemfontein. merwelj@ufs.ac.za.

BACKGROUND:  Burnout among doctors has been linked with decreased quality of 
patient care. The coronavirus disease 2019 (COVID-19) pandemic highlighted the 
need to protect doctors' mental health and well-being. This study aimed to 
investigate burnout, resilience and coping strategies among registrars in the 
MMed programme of the University of the Free State (UFS) in 2020.
METHODS:  In this quantitative, cross-sectional study, a link to an online 
anonymous self-administered questionnaire with socio-demographic questions, 
perceived stress, Copenhagen Burnout Inventory (CBI), Connor-Davidson Resilience 
Scale and Brief Cope was emailed to all 278 registrars.
RESULTS:  Sixty registrars responded (response rate 21.6%). More than half 
(55.0%) were male and 73.3% were married. There were 28.3% second- and 
third-year students, respectively. Most (58.3%) had 5-10 years' work experience. 
The CBI personal scale had the highest median value (58.3; interquartile range 
[IQR]: 43.3; 70.8) with 70% scoring ≥ 50. The median score for resilience was 78 
of 100 (IQR: 69; 84). There were weak negative correlations between resilience 
and burnout scores (r = -0.31 to r = -0.37). Planning, positive reframing and 
acceptance were the most frequently used adaptive coping mechanisms; 
self-distraction was the most frequently used maladaptive coping mechanism. 
There was no association between gender and burnout and resilience scores.
CONCLUSION:  Registrars were resilient with low levels of patient- and 
work-related burnout, and higher personal burnout, using mostly positive coping 
strategies.Contribution: This study gives insight into the well-being of 
registrars at the UFS during COVID-19. Continuous monitoring and support for 
this population are essential to foster mental health and well-being.

DOI: 10.4102/safp.v65i1.5788
PMCID: PMC10730451
PMID: 38112018 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no financial 
or personal relationships that may have inappropriately influenced them in 
writing this article.


193. MCN Am J Matern Child Nurs. 2024 Mar-Apr 01;49(2):88-94. doi: 
10.1097/NMC.0000000000000984. Epub 2023 Dec 18.

Postpartum Mental Health and Perceptions of Discrimination Among Asian Fathers 
During the COVID-19 Pandemic.

Goyal D, Dol J, Huynh J, Anand S, Dennis CL.

PURPOSE: The purpose of this study was twofold: (1) to examine the prevalence of 
postpartum depression and anxiety symptomatology among fathers of Asian descent 
living in North America during the COVID-19 pandemic, and (2) to identify the 
occurrences of online racial discrimination.
STUDY DESIGN AND METHODS: Using a cross-sectional design and convenience 
sampling methods, we recruited fathers online via social media sites (Facebook, 
Instagram) between March 12 and July 31, 2022. The Edinburgh Postnatal 
Depression Scale, General Anxiety Scale, and the Online Victimization Scale 
assessed mental health well-being and discrimination outcomes. Data were 
analyzed using descriptive statistics, two sample t-test, chi-square test of 
independence, and Pearson's correlation analysis.
RESULTS: Our sample included 61 fathers within 6 months postpartum living in the 
United States and Canada. Participants were on average 34 years old, married, 
and represented 17 Asian ethnic groups, including Asian Indian (41%), Filipino 
(11.3%), and Korean (8.1%). One-third of our participants (31.1%, n = 19) were 
at high risk of developing postpartum depression and scores of three (4.9%) 
fathers indicated they had clinically significant anxiety. Overall, 26.3% 
reported experiencing direct online racial discrimination and 65% reported 
occurrences of indirect online racial discrimination.
CLINICAL IMPLICATIONS: There was a high rate of depressive symptoms and 
occurrences of online racial discrimination among fathers of Asian descent 
living in North America. These rates are higher than the general perinatal 
population and further research is warranted to examine risk factors and 
preventive strategies among this unique paternal ethnic group.

Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/NMC.0000000000000984
PMID: 38108414 [Indexed for MEDLINE]


194. Early Hum Dev. 2024 Jan;188:105918. doi: 10.1016/j.earlhumdev.2023.105918. Epub 
2023 Dec 13.

Effects of SARS-CoV-2 gestational exposure and risk factors on neurodevelopment 
until 12 months: A prospective cohort study in Brazil.

Pinheiro GSMA(1), Lemos SMA(1), Martins IA(1), Januário GC(2), Cintra ML(1), 
Farias AVSR(1), Oliveira RMDS(1), Januário JN(3), Azevedo VMGO(4), Bentes AA(5), 
Alves CRL(6).

Author information:
(1)Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190 - Santa 
Efigênia, Belo Horizonte, MG 30130-100, Brazil.
(2)Secretaria de Estado de Saúde de Minas Gerais, Rodovia Papa João Paulo II, 
4143. Cidade Administrativa - Serra Verde, Belo Horizonte, MG 31630-900, Brazil.
(3)Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190 - Santa 
Efigênia, Belo Horizonte, MG 30130-100, Brazil. Electronic address: 
jnelio@ufmg.br.
(4)Universidade Federal de Uberlândia, Av. João Naves de Ávila, 2121 - Santa 
Mônica, Uberlândia, MG 38408-100, Brazil.
(5)Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190 - Santa 
Efigênia, Belo Horizonte, MG 30130-100, Brazil. Electronic address: 
alinebentes@ufmg.br.
(6)Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190 - Santa 
Efigênia, Belo Horizonte, MG 30130-100, Brazil. Electronic address: 
lindgren@ufmg.br.

BACKGROUND: The effects of SARS-CoV-2 gestational exposure on child development 
remain inconclusive.
AIMS: To analyze the effects of SARS-CoV-2 gestational exposure on 
neurodevelopment until 12 months.
STUDY DESIGN: Prospective cohort study conducted in five municipalities in 
Southeast Brazil from August 2021 to September 2022.
SUBJECTS: Infants were recruited from a serological survey performed during 
neonatal screening and followed up to 12 months old. We included 224 infants 
exposed to SARS-CoV-2 during pregnancy and 225 non-exposed, according to the 
serology results of the newborn as well as their mothers and the maternal 
antenatal RT-PCR results.
OUTCOME MEASURES: Developmental assessments were performed at 6 and 12 months 
using the Survey of Wellbeing of Young Children-Brazilian Version (SWYC-BR). 
Children with suspected developmental delay (SDD) at 6 and 12 months were 
considered at high risk for developmental delay (HRDD). Additionally, risk 
factors associated with SDD were examined.
RESULTS: There were 111 children identified with SDD and 52 with HRDD. 
SARS-CoV-2 gestational exposure was not associated with SDD. Exposure in the 
first gestational trimester increased SDD risk by 2.15 times compared to the 
third. Cesarean delivery predicted SDD (OR 1.56; 95%CI 1.01-2.42) and HRDD (OR 
1.91; 95%CI 1.04-3.48). Additionally, suspected maternal depression predicted 
SDD (OR 1.76; 95%CI 1.01-3.10).
CONCLUSION: SARS-CoV-2 gestational exposure did not increase the developmental 
delay risk. However, our findings suggest that the earlier the gestational 
exposure, the greater the developmental delay risk at 12 months. Cesarean 
delivery and suspected maternal depression increased the developmental delay 
risk, independent of virus exposure.

Copyright © 2023 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.earlhumdev.2023.105918
PMID: 38104363 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest Nothing to 
declare.


195. Sci Rep. 2023 Dec 16;13(1):22370. doi: 10.1038/s41598-023-49702-0.

The effectiveness of nature-based therapy for community psychological distress 
and well-being during COVID-19: a multi-site trial.

Yang Y(1)(2), Kim H(1)(2), Kang M(1)(2), Baik H(3), Choi Y(4), Jang EJ(5), Chang 
EJ(6), Yun S(7), Park M(8), Park E(9), Yun H(10), Lee TJ(11), Kwon YH(12), Hong 
KP(13), Lee AR(14), Jung S(15), Ahn TH(15), Jin HY(15), Choi KH(16)(17).

Author information:
(1)School of Psychology, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 
02841, Korea.
(2)KU Mind Health Institute, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 
02841, Korea.
(3)Korea Research and Institute for People and Environment, 246, Munjeong-ro, 
Songpa-gu, Seoul, 05737, Korea.
(4)GRAMDESIGN, 225, Jangmal-ro, Bucheon, 14609, Korea.
(5)Institute of Science and Natural Resources, Korea University, 145 Anam-ro, 
Seongbuk-gu, Seoul, 02841, Korea.
(6)Department of Counseling Psychology, Korea Baptist Theological University, 
190, Bugyuseong-daero, Yuseong-gu, Daejeon, 34098, Korea.
(7)Department of Smart Green Care, Daegu Catholic University, 13-13, Hayang-ro, 
Hayang-eup, Gyeongsan, 38430, Korea.
(8)Department of Smart Green City Industry Convergence, Korea Nazarene 
University, 48, Wolbong-ro, Seobuk-gu, Cheonan, 31172, Korea.
(9)Department of Environmental Landscape Architecture, Joongbu University, 201 
Daehak-ro, Chubu-myeon, Geumsan-gun, 32713, Korea.
(10)Landscape Yeoleum, 65 Poeun-ro 2ga-gil, Mapo-gu, Seoul, 04026, Korea.
(11)Hantaek Botanical Garden, 2, Hantaek-ro, Baegam-myeon, Cheoin-gu, Yongin, 
17183, Korea.
(12)Department of Horticultural Design, Shingu College, 377 Gwangmyeong-ro, 
Seongnam, 13174, Korea.
(13)Korea Institute of Garden Design, 45, World Cup buk-ro 9-gil, Mapo-gu, 
Seoul, 03998, Korea.
(14)Landscape Urban Planning, Department of Human Environment Design, Cheongju 
University, 298, Daeseong-ro, Cheongwon-gu, Cheongju, 28503, Korea.
(15)Gardens and Education Research Division, Korea National Arboretum, 415, 
Gwangneungsumogwon-ro, Soheul-eup, Pocheon, 11186, Korea.
(16)School of Psychology, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 
02841, Korea. kchoi1@korea.ac.kr.
(17)KU Mind Health Institute, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 
02841, Korea. kchoi1@korea.ac.kr.

During the COVID-19 pandemic, the world population faced various mental health 
challenges, highlighting a need for new community-based psychosocial 
interventions. This study aimed to investigate the effectiveness and feasibility 
of Nature-Based Therapy (NBT) for the community experiencing psychological 
distress during the pandemic. A multi-site trial comparing NBT and control 
groups was conducted in Korea with 291 participants exhibiting mild to severe 
depression or anxiety. A total of 192 participated in 30 sessions of therapeutic 
gardening, while 99 remained in the control group. Psychological distress and 
well-being were assessed using seven measures of depression, anxiety, daily 
activity, life satisfaction, mindfulness, stress, and loneliness. The effect 
sizes (Cohen's d) of NBT compared to the control group were medium to large: 
depression (0.583), anxiety (0.728), daily activity (1.002), life satisfaction 
(0.786), mindfulness (0.645), stress (0.903), and loneliness (0.695). Multilevel 
analysis revealed significant Time × Group interaction effects for all measures. 
Pearson correlation (r = - 0.28 to 0.71) showed that changes in all variables 
correlated significantly with each other, with small to large effect sizes. 
Therapeutic alliance at post-test positively moderated the intervention effects 
on the outcomes. We concluded that NBT is a promising psychosocial intervention 
for treating psychological distress for community dwellers.

© 2023. The Author(s).

DOI: 10.1038/s41598-023-49702-0
PMCID: PMC10724283
PMID: 38102169 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


196. BMJ Open. 2023 Dec 14;13(12):e069514. doi: 10.1136/bmjopen-2022-069514.

Associations of eHealth literacy and knowledge with preventive behaviours and 
psychological distress during the COVID-19 pandemic: a population-based online 
survey.

Lee JJ(1), Poon CY(2), O'Connor S(3), Wong JYH(4), Kwok JYY(2), Choi EPH(2), 
Tsang WN(5), Wang MP(2).

Author information:
(1)School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong 
Kong, China leejay@hku.hk.
(2)School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong 
Kong, China.
(3)Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, 
King's College London, London, UK.
(4)School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong 
Kong, China.
(5)Institute of Psychiatry, Psychology & Neuroscience, King's College London, 
London, UK.

OBJECTIVES: To compare the associations of COVID-19 preventive behaviours and 
depressive and anxiety symptoms with eHealth literacy and COVID-19 knowledge 
among Korean adults.
DESIGN: A cross-sectional online survey was conducted in April 2020.
SETTING: Seoul metropolitan area in South Korea.
PARTICIPANTS: 1057 Korean adults were recruited.
MAIN OUTCOME MEASURES: Associations between eHealth literacy, COVID-19 
knowledge, COVID-19 preventive behaviours and psychological distress were 
computed using Pearson's correlation and logistic regression analyses. eHealth 
literacy, COVID-19 knowledge, COVID-19 preventive behaviours and psychological 
distress were weighted by sex and age distribution of the general population in 
Seoul Metropolitan area.
RESULTS: 68.40% (n=723) perceived high eHealth literacy level (eHEALS ≥26), 
while 57.43% (n=605) had high levels of COVID-19 knowledge (score ≥25). No 
significant association between eHealth literacy and COVID-19 knowledge was 
identified (r=0.05, p=0.09). eHealth literacy and COVID-19 knowledge were 
significantly associated with COVID-19 preventive behaviours (aOR=1.99, 95% CI 
1.51 to 2.62 L; aOR=1.81, 95% CI 1.40 to 2.34, respectively). High eHealth 
literacy was significantly associated with anxiety symptom (aOR=1.71, 95% CI 
1.18 to 2.47) and depressive symptom (aOR=1.69, 95% CI 1.24 to 2.30). COVID-19 
knowledge had negative and no associations with the symptoms (aOR=0.62, 95% CI 
0.46 to 0.86; aOR=0.79, 95% CI 0.60 to 1.03, respectively). High eHealth 
literacy with low COVID-19 knowledge was positively and significantly associated 
with COVID-19 preventive behaviours (aOR=2.30, 95% CI 1.52 to 3.43), and anxiety 
(aOR=1.81, 95% CI 1.09 to 3.01) and depressive symptoms (aOR=2.24, 95% CI 1.41 
to 3.55). High eHealth literacy with high COVID-19 knowledge were significantly 
associated with more preventive behaviours (aOR=3.66, 95% CI 2.47 to 5.42) but 
no significant associations with anxiety and depressive symptoms.
CONCLUSION: We identified that eHealth literacy and COVID-19 knowledge were not 
associated each other, and differently associated with individuals' COVID-19 
preventive behaviours and psychological well-being. Public health strategies 
should pay attention to enhancing both eHealth literacy and COVID-19 knowledge 
levels in the public to maximise their COVID-19 preventive behaviours and 
mitigate their psychological distress during COVID-19 pandemic.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2022-069514
PMCID: PMC10729161
PMID: 38101826 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


197. J Psychiatr Res. 2024 Jan;169:355-363. doi: 10.1016/j.jpsychires.2023.12.012. 
Epub 2023 Dec 9.

Oxytocin as a transdiagnostic biomarker of well-being in severe mental illness 
during the Covid-19 pandemic.

Shemesh S(1), Feldman R(2), Zagoory-Sharon O(2), Tzur Bitan D(3), Grossman-Giron 
A(4), Chen D(5), Maoz H(5), Bloch Y(6).

Author information:
(1)Shalvata Mental Health Center, Hod- Hasharon, Israel.
(2)Reichman University, Herzliya, Israel.
(3)Department of Community Mental Health, University of Haifa, Haifa, Israel.
(4)Department of Behavioral Sciences, Ariel University, Ariel, Israel.
(5)Shalvata Mental Health Center, Hod- Hasharon, Israel; School of Medicine, Tel 
Aviv University, Ramat Aviv, Israel.
(6)School of Medicine, Tel Aviv University, Ramat Aviv, Israel. Electronic 
address: yuvalbloch10@gmail.com.

Individuals with severe mental illness (SMI) have been found to suffer a greater 
decline in psychological well-being compared to the general population in times 
of stress. The present study aimed to examine clinical and endocrine resilience 
factors of psychological well-being in SMI patients during the Covid-19 
pandemic.
METHODS: After Covid-19 crisis outburst in Israel 112 participants, 69 
outpatients, and 43 inpatients and day treatment patients were recruited. 
Outpatients signed an online informed consent and filled in questionnaires 
regarding their level of mental health symptoms (OQ-45), fear of Covid-19 (FCV), 
and psychological well-being (PWB). Inpatients answered the same questionnaires 
and in addition, went through a positive social interaction paradigm while 
providing three saliva samples to measure their s-IgA and oxytocin (OT) levels.
RESULTS: A strong negative correlation was found in the whole sample between 
reported mental health symptoms, fear of Covid-19, and well-being. Hierarchical 
regression did not find additional contribution of the fear of the pandemic in 
predicting well-being beyond the impact of symptomatology. For inpatients 
(N = 39) only, hierarchical regression found that oxytocin, but not s-IgA could 
explain 5% of the variance of well-being (R2 = 0.05) in individuals with SMI 
regardless of their mental health symptoms (R2 = 0.46) and their marital status 
(R2 = 0.21).
CONCLUSIONS: OT is suggested as a possible independent biological resilience 
factor of well-being in times of major stress among SMI patients. It is still 
unknown whether OT is a mediator that contributes to well-being or a biological 
marker that indicates the degree of beneficial social interactions.

Copyright © 2023. Published by Elsevier Ltd.

DOI: 10.1016/j.jpsychires.2023.12.012
PMID: 38101184 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest None.


198. J Sch Health. 2024 Mar;94(3):209-218. doi: 10.1111/josh.13421. Epub 2023 Dec 14.

COVID-19 School Closures: Disruptions in School-Based Support Services and 
Socioemotional Loss Among Middle School Students.

Bates S(1), Harrell DR(2).

Author information:
(1)College of Social Work, The Ohio State University, Columbus, OH.
(2)School of Social Work, University of Texas at Arlington, Arlington, TX.

BACKGROUND: In the United States (U.S.), 77% of school district leaders reported 
that their students had fallen behind in their social-emotional development due 
to COVID-19 school closures. Although research has measured indicators of 
social-emotional well-being from the perspective of other informants, little is 
known about student perceptions of perceived changes in their socioemotional 
competencies and, to a lesser degree, their nonacademic needs.
AIMS: The current study examined middle school students' nonacademic needs, 
perceptions of socioemotional competencies, and predictors of "socioemotional 
loss."
MATERIALS & METHODS: The authors utilized secondary data from 395 middle school 
students gathered in August 2020 and November 2020 in one large middle school in 
the southern region of the U.S. Multivariate and linear regression analyses 
explored students' nonacademic needs, assessed changes in perceptions of their 
socioemotional competencies over time, and identified predictors of 
"socioemotional loss" during the "return to learn" period.
RESULTS: Our findings indicated that 3% to 14% of students reported nonacademic 
needs, with the greatest needs related to food, housing, and healthcare. 
Further, 48% of students reported perceived losses in their socioemotional 
competencies, and students formerly receiving school-based support services were 
those most affected (71% vs. 46%, p = .01). Among the subgroup reporting losses, 
living in a single-parent household significantly predicted socioemotional loss 
(β = -.16, p = .02).
DISCUSSION: School-based practitioners, including educators, policymakers, 
social workers, and mental health providers, can utilize these findings to 
deliver interventions to students that experienced hardships during the 
pandemic.
CONCLUSION: Responding to these risks will be critical as schools adapt and 
intervene in response to the COVID-19 pandemic.

© 2023 The Authors. Journal of School Health published by Wiley Periodicals LLC 
on behalf of American School Health Association.

DOI: 10.1111/josh.13421
PMID: 38097524 [Indexed for MEDLINE]


199. J Psychopathol Clin Sci. 2024 Feb;133(2):167-177. doi: 10.1037/abn0000888. Epub 
2023 Dec 14.

The affective benefits of real-world exploration during the COVID-19 pandemic.

Reneau TR(1), Villano WJ(1), Jaso BA(1), Heller AS(1).

Author information:
(1)Department of Psychology, University of Miami.

Increasing daily exploration is linked to improvements in affective well-being. 
However, COVID-19 elevated uncertainty when leaving the home, altering the 
risk-reward of balance of geospatial novelty. To this end, we simultaneously 
collected real-world geospatial tracking and experience sampling of emotion, 
prior to and during the first year of the pandemic in 630 individuals. COVID-19 
reduced exploration and subjective well-being. Yet, despite the health risks of 
exploring during the pandemic, the days of highest affective well-being were 
those when individuals explored the most. However, this was not true for 
everyone: during the first months of the pandemic, at the height of the 
uncertainty surrounding the transmissibility and prognosis of a COVID-19 
infection, more anxious individuals experienced no affective benefit to leaving 
home. Taken together, real-world exploration improved well-being regardless of 
the presence of real-world threat, but anxiety mitigated these benefits. 
(PsycInfo Database Record (c) 2024 APA, all rights reserved).

DOI: 10.1037/abn0000888
PMCID: PMC10896552
PMID: 38095970 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest None.


200. Front Public Health. 2023 Nov 28;11:1298269. doi: 10.3389/fpubh.2023.1298269. 
eCollection 2023.

Insights from China: understanding the impact of community resilience and 
government trust in psychological resilience and anxiety during COVID-19.

Hu Y(1), Huang Y(1), Zhang H(1), Fang M(2), Chen G(1).

Author information:
(1)School of Political Science and Public Administration, Guangxi Minzu 
University, Guangxi, China.
(2)School of Public Administration, South China Agricultural University, 
Guangzhou, Guangdong Province, China.

BACKGROUND: COVID-19 has the potential to greatly impact an individual mental 
well-being. However, an individual's psychological resilience, combined with 
support from their community and government disaster relief efforts can aid 
individuals in confronting crises with a positive mindset. The purpose of this 
study is to investigate how individuals, across three dimensions of individual 
resilience perception, community resilience perception, and government trust 
perception, mitigate individual anxiety during COVID-19.
METHODS: This study employed an online survey method that was not restricted by 
geographical location. Data collection took place from January 2022 to June 
2022, and the valid questionnaires covered all 31 provinces, autonomous regions, 
and municipalities in China. The assessment of community resilience was 
conducted employing the Conjoint Community Resilience Assessment Measure-10 
(CCRAM-10). Structural Equation Modeling (SEM) was also used to examine the 
relationship between community resilience, government trust, individual 
psychological resilience, and anxiety.
RESULTS: The SEM results reveal that individual psychological resilience is 
significantly negatively correlated with anxiety (b = -0.099, p < 0.001), while 
there is a significant positive correlation between community resilience 
perception (b = 0.403, p < 0.001) and government trust (b = 0.364, p < 0.001) 
with individual psychological resilience. Furthermore, government trust 
perception enhances psychological resilience, consequently reducing anxiety 
(b = -0.036, p < 0.001). The results also revealed that women and increasing age 
had a mitigating effect on individual anxiety during COVID-19.
CONCLUSION: Individual's mental state is influenced on multiple dimensions 
during COVID-19. Not only can individual psychological resilience better cope 
with anxiety, but support at the community and government dimensions has a 
significant impact on individual psychology. These resources can enhance the 
resilience of both individuals and communities, helping them better cope with 
stress and difficulties.

Copyright © 2023 Hu, Huang, Zhang, Fang and Chen.

DOI: 10.3389/fpubh.2023.1298269
PMCID: PMC10715279
PMID: 38089038 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


201. BMC Prim Care. 2023 Dec 13;24(1):269. doi: 10.1186/s12875-023-02228-w.

COVID-19- related work, managerial factors and exhaustion among general 
practitioners in Sweden: a cross-sectional study.

Månsson Sandberg H(1)(2), Landstad BJ(3)(4), Tjulin Å(5), Brulin E(6).

Author information:
(1)Department of Health Sciences, Mid Sweden University, Östersund, Sweden. 
helena.manssonsandberg@miun.se.
(2)Unit of Occupational Medicine, Karolinska Institutet, Stockholm, Sweden. 
helena.manssonsandberg@miun.se.
(3)Faculty of Human Sciences, Mid Sweden University, Östersund, Sweden.
(4)Unit of Research, Education and Development, Östersund Hospital, Östersund, 
Sweden.
(5)Department of Health Sciences, Mid Sweden University, Östersund, Sweden.
(6)Unit of Occupational Medicine, Karolinska Institutet, Stockholm, Sweden.

INTRODUCTION: A significant number of international studies show that general 
practitioners (GPs) suffered from burnout when working during the COVID-19 
pandemic. A Swedish study found that more than 16% of GPs had exhaustion in 
spring 2021. Exhaustion can be regarded as an initial stage of burnout. A 
knowledge gap remains on GPs´ working conditions, the impact of management 
during the pandemic and how it was associated with exhaustion. This study aims 
to explore the association between severe symptoms of exhaustion and COVID-19 
pandemic-related work and managerial factors among Swedish GPs and whether 
managerial factors have an impact on the association between exhaustion and 
COVID-19-related work factors.
METHODS: Cross-sectional data was drawn from the Longitudinal Occupational 
Health survey in Health Care Sweden (LOHHCS), which included a representative 
sample of practicing doctors in Sweden. The sample consisted of 6699 doctors 
with a response rate of 41.2%. This study constitutes a sample of doctors who 
reported working in primary care facilities at the time of data collection, i.e. 
1013 GPs. The Burnout Assessment Tool (BAT) was used to assess severe symptoms 
of exhaustion. Questions were also asked about pandemic-related work and 
managerial factors. The data was analysed using descriptive statistics and 
multivariate logistic regression to identify the association between exhaustion, 
work and managerial factors.
RESULTS: The multivariate analysis showed that GPs who managed COVID-19 patients 
were about twice as likely to report severe symptoms of exhaustion. Further, GPs 
who reported that management was unsupportive, provided unsatisfactory working 
conditions and unsatisfactory policies for patient prioritisation were between 
two and four times more likely to report severe symptoms of exhaustion.
CONCLUSIONS: COVID-19-related work and managerial factors had a significant 
impact on the mental health of GPs. Furthermore, the potentially protective 
effect that satisfactory management actions had on mental health was limited. In 
the aftermath of the COVID-19 pandemic and in preparation for future major 
crises that have a high impact on healthcare, there is a need to investigate the 
measures that can be taken to enable GPs to carry out their work, while 
maintaining their wellbeing.

© 2023. The Author(s).

DOI: 10.1186/s12875-023-02228-w
PMCID: PMC10717449
PMID: 38087223 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare they have no conflicts of 
interest with respect to the research, authorship and/or publication of this 
article.


202. BMJ Open. 2023 Dec 12;13(12):e073687. doi: 10.1136/bmjopen-2023-073687.

COVID-19 pandemic and mental health among Hispanic/Latino/a immigrants in the 
USA: protocol for a scoping review.

Ormiston CK(1), Chiangong J(2), Livinski A(3), Tompkins D(3), Williams F(1).

Author information:
(1)National Institute on Minority Health and Health Disparities Division of 
Intramural Research, Bethesda, Maryland, USA ckormiston@gmail.com 
faustine.williams@nih.gov.
(2)National Institute on Minority Health and Health Disparities Division of 
Intramural Research, Bethesda, Maryland, USA.
(3)National Institutes of Health Library, Bethesda, Maryland, USA.

INTRODUCTION: The COVID-19 pandemic has had drastic effects on worldwide mental 
health and laid bare health disparities and inequities among marginalised groups 
and racial/ethnic minoritised communities in the USA. This is especially the 
case among Hispanic/Latino/a immigrants who face numerous structural and 
socioeconomic barriers to well-being. The increased mental health burden on 
Hispanic/Latino/a immigrants may have far reaching effects if left unaddressed. 
Thus, by understanding further Hispanic/Latino/a immigrant mental health during 
the pandemic, communities and health providers may be able to better address 
this growing issue. This scoping review aims to assess and outline the current 
literature on the pandemic's effects on Hispanic/Latino/a immigrant mental 
health in the USA, identify research gaps and areas of urgent concern, and 
inform future research and public health interventions and guidelines.
METHODS AND ANALYSIS: A scoping review following the Joanna Briggs Institute 
methodology will be conducted. The PsycINFO, PubMed, Scopus and Web of Science: 
Core Collection databases and five grey literature sources will be searched for 
articles published in English from 1 January 2020 to 31 December 2022. Two 
independent reviewers will screen the search results at title and abstract and 
then full text using Covidence with conflicts resolved by a third reviewer. Data 
collection will also be performed in duplicate using Microsoft Excel with 
discrepancies resolved by a third reviewer and consensus discussion.
ETHICS AND DISSEMINATION: Ethics approval is not required for this scoping 
review. Results will be published in a peer-reviewed journal as well as 
presented at local and national conferences and meetings relevant to our field. 
Furthermore, to make our findings accessible to non-scientific audiences, we 
will use various mediums, such as graphical abstracts, policy briefs and fact 
sheets to share the results in both English and Spanish on different platforms.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2023-073687
PMCID: PMC10729216
PMID: 38086590 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


203. BMC Psychol. 2023 Dec 11;11(1):438. doi: 10.1186/s40359-023-01483-x.

Internet use time and subjective well-being during the COVID-19 outbreak: serial 
mediation of problematic internet use and self-esteem.

Lin MP(1), Tseng HY(2), Lee YT(3), Tang WC(2), Cheng LH(2), Wu JY(4), You J(5).

Author information:
(1)Department of Educational Psychology and Counseling, National Taiwan Normal 
University, No.162, Sec. 1, Heping E. Rd., Da-an District, Taipei City, 106, 
Taiwan. lmmpp@ntnu.edu.tw.
(2)Department of Educational Psychology and Counseling, National Taiwan Normal 
University, No.162, Sec. 1, Heping E. Rd., Da-an District, Taipei City, 106, 
Taiwan.
(3)Department of Counseling and Guidance, National University of Tainan, No.33, 
Sec. 2, Shu- Lin St, Tainan, 700, Taiwan.
(4)Good-Day Psychology Clinic, 5F., No. 167, Xialin Rd., South District, Tainan 
City, 702, Taiwan.
(5)Center for Studies of Psychological Application, Guangdong Key Laboratory of 
Mental Health and Cognitive Science, Key Laboratory of Brain, Cognition and 
Education Sciences (South China Normal University), & School of Psychology, 
Ministry of Education, South China Normal University, Guangzhou, 510631, P. R. 
China.

The coronavirus disease (COVID-19) outbreak is a threat to adolescents' mental 
health and livelihoods, and lowers their subjective well-being (SWB). Expanding 
on previous literatures, this study examined whether internet use time was 
related to SWB and whether this relationship was mediated by problematic 
internet use (PIU) and self-esteem during the COVID-19 outbreak. In Taiwan, the 
COVID-19 epidemic broke out in February, 2020. During March 2 to 27, this study 
recruited a total of 1,060 adolescents from junior high schools by both 
stratified and cluster sampling, and administered a comprehensive investigation. 
The results displayed that SWB was significantly and negatively predicted by 
internet use time. PIU fully mediated the relationship. Moreover, PIU predicted 
a decrease of self-esteem, which played a full mediation role between PIU and 
SWB. The results provide evidence in explaining how increased internet use time 
is associated with a greater level of PIU, which relates to lower self-esteem, 
correlating with lower SWB in adolescents. This study can provide reference to 
mental health organizations and educational agencies to design appropriate SWB 
promotion programs for the junior high school population in terms of epidemic 
prevention.

© 2023. The Author(s).

DOI: 10.1186/s40359-023-01483-x
PMCID: PMC10714498
PMID: 38082347 [Indexed for MEDLINE]

Conflict of interest statement: The authors (Min-Pei Lin, Hsin-Yi Tseng, 
Yueh-Ting Lee, Wen-Ching Tang, Li-Hsuan Cheng, Jo Yung-Wei Wu, Jianing You) 
declare no potential conflict of interest pertaining to this BMC Psychology 
submission.


204. BMC Public Health. 2023 Dec 12;23(1):2482. doi: 10.1186/s12889-023-17242-x.

Examining the role of community resilience and social capital on mental health 
in public health emergency and disaster response: a scoping review.

Hall CE(1)(2), Wehling H(1), Stansfield J(3), South J(3), Brooks SK(2), 
Greenberg N(2)(4), Amlôt R(1), Weston D(5).

Author information:
(1)Behavioural Science and Insights Unit, Evaluation & Translation Directorate, 
Science Group, UK Health Security Agency, Porton Down, Salisbury, SP4 0JG, UK.
(2)Health Protection Research Unit, Institute of Psychology, Psychiatry and 
Neuroscience, King's College London, 10 Cutcombe Road, London, SE5 9RJ, UK.
(3)School of Health and Community Studies, Leeds Beckett University, Portland 
Building, PD519, Portland Place, Leeds, LS1 3HE, UK.
(4)King's Centre for Military Health Research, Institute of Psychology, 
Psychiatry and Neuroscience, King's College London, 10 Cutcombe Road, London, 
SE5 9RJ, UK.
(5)Behavioural Science and Insights Unit, Evaluation & Translation Directorate, 
Science Group, UK Health Security Agency, Porton Down, Salisbury, SP4 0JG, UK. 
Dale.Weston@ukhsa.gov.uk.

The ability of the public to remain psychologically resilient in the face of 
public health emergencies and disasters (such as the COVID-19 pandemic) is a key 
factor in the effectiveness of a national response to such events. Community 
resilience and social capital are often perceived as beneficial and ensuring 
that a community is socially and psychologically resilient may aid emergency 
response and recovery. This review presents a synthesis of literature which 
answers the following research questions: How are community resilience and 
social capital quantified in research?; What is the impact of community 
resilience on mental wellbeing?; What is the impact of infectious disease 
outbreaks, disasters and emergencies on community resilience and social 
capital?; and, What types of interventions enhance community resilience and 
social capital?A scoping review procedure was followed. Searches were run across 
Medline, PsycInfo, and EMBASE, with search terms covering both community 
resilience and social capital, public health emergencies, and mental health. 26 
papers met the inclusion criteria.The majority of retained papers originated in 
the USA, used a survey methodology to collect data, and involved a natural 
disaster. There was no common method for measuring community resilience or 
social capital. The association between community resilience and social capital 
with mental health was regarded as positive in most cases. However, we found 
that community resilience, and social capital, were initially negatively 
impacted by public health emergencies and enhanced by social group 
activities.Several key recommendations are proposed based on the outcomes from 
the review, which include: the need for a standardised and validated approach to 
measuring both community resilience and social capital; that there should be 
enhanced effort to improve preparedness to public health emergencies in 
communities by gauging current levels of community resilience and social 
capital; that community resilience and social capital should be bolstered if 
areas are at risk of disasters or public health emergencies; the need to ensure 
that suitable short-term support is provided to communities with high resilience 
in the immediate aftermath of a public health emergency or disaster; the 
importance of conducting robust evaluation of community resilience initiatives 
deployed during the COVID-19 pandemic.

© 2023. Crown.

DOI: 10.1186/s12889-023-17242-x
PMCID: PMC10714503
PMID: 38082247 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


205. J Nurs Adm. 2024 Jan 1;54(1):16-24. doi: 10.1097/NNA.0000000000001372. Epub 2023 
Dec 5.

Clinical Nurse Well-being Improved Through Transcendental Meditation: A 
Multimethod Randomized Controlled Trial.

Bonamer JI(1), Kutash M, Hartranft SR, Aquino-Russell C, Bugajski A, Johnson A.

Author information:
(1)Author Affiliations: Nursing Professional Development-Research Specialist (Dr 
Bonamer), Sarasota Memorial Hospital; Advanced Nurse Specialist for Research (Dr 
Kutash), Tampa General Hospital; and Nurse Scientist (Dr Hartranft), Moffitt 
Cancer Center, Tampa, Florida; Professor (Dr Aquino-Russell), Faculty of 
Nursing, University of New Brunswick, Moncton, New Brunswick, Canada; Associate 
Vice President of Research and Sponsored Studies (Dr Bugajski), Lakeland 
Regional Medical Center, Florida; and Biostatistician (Dr Johnson), University 
of South Florida, Tampa.

OBJECTIVE: To evaluate the impact of Transcendental Meditation® (TM®) practice 
on the multidimensional well-being of nurse clinicians affected by the COVID-19 
pandemic.
BACKGROUND: The health of clinical nurses has substantial impact on both the 
availability of a nursing workforce and the quality and safety of patient care. 
TM improved health and coping strategies across many populations.
METHODS: Clinical nurses were recruited from 3 Magnet®-designated hospitals 
during the COVID-19 pandemic. Well-being outcomes included flourishing, burnout, 
anxiety, and posttraumatic stress disorder. Participants were randomized 
following completion of baseline surveys into immediate (intervention) or 
delayed (control) TM instruction. Surveys were repeated at 1 and 3 months 
following baseline survey or TM instruction. Repeated-measures analysis of 
variance compared differences in groups over time.
RESULTS: Across the 3 sites, there were 104 clinical nurse participants. 
Repeated-measures analysis of variance showed significant medium to large 
effects in improvement over time in well-being measures for the intervention 
group.
CONCLUSIONS: TM improved multidimensional well-being of clinical nurses by 
reducing posttraumatic stress disorder, anxiety, and burnout and improving 
flourishing. TM is easy to practice anywhere. The benefits are immediate and 
cumulative. Organizations and individual nurses can use TM to support clinical 
nurses in the difficult and meaningful work of patient care, especially in 
challenging times. Future studies may consider the feasibility of integrating TM 
into clinical shifts and evaluating its impact on patient and organizational 
outcomes.

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/NNA.0000000000001372
PMID: 38078959 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


206. Biomol Biomed. 2024 Mar 11;24(2):219-229. doi: 10.17305/bb.2023.9680.

COVID-19 and Alzheimer's disease: Impact of lockdown and other restrictive 
measures during the COVID-19 pandemic.

Nawaz AD(1), Haider MZ(1), Akhtar S(1).

Author information:
(1)College of Medicine, QU Health, Qatar University, Doha, Qatar.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection initially 
results in respiratory distress symptoms but can also lead to central nervous 
system (CNS) and neurological manifestations, significantly impacting 
coronavirus disease 2019 (COVID-19) patients with neurodegenerative diseases. 
Additionally, strict lockdown measures introduced to curtail the spread of 
COVID-19 have raised concerns over the wellbeing of patients with dementia 
and/or Alzheimer's disease. The aim of this review was to discuss the 
overlapping molecular pathologies and the potential bidirectional relationship 
between COVID-19 and Alzheimer's dementia, as well as the impact of 
lockdown/restriction measures on the neuropsychiatric symptoms (NPS) of patients 
with Alzheimer's dementia. Furthermore, we aimed to assess the impact of 
lockdown measures on the NPS of caregivers, exploring its potential effects on 
the quality and extent of care they provide to dementia patients.We utilized the 
PubMed and Google Scholar databases to search for articles on COVID-19, 
dementia, Alzheimer's disease, lockdown, and caregivers. Our review highlights 
that patients with Alzheimer's disease face an increased risk of COVID-19 
infection and complications. Additionally, these patients are likely to 
experience greater cognitive decline. It appears that these issues are primarily 
caused by the SARS-CoV-2 infection and appear to be further exacerbated by 
restrictive/lockdown measures. Moreover, lockdown measures introduced during the 
pandemic have negatively impacted both the NPSs of caregivers and their 
perception of the wellbeing of their Alzheimer's patients. Thus, additional 
safeguard measures, along with pharmacological and non-pharmacological 
approaches, are needed to protect the wellbeing of dementia patients and their 
caregivers in light of this and possible future pandemics.

DOI: 10.17305/bb.2023.9680
PMCID: PMC10950341
PMID: 38078809 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of interest: Authors declare no 
conflicts of interest.


207. J Community Health. 2024 Jun;49(3):394-401. doi: 10.1007/s10900-023-01314-5. 
Epub 2023 Dec 8.

Mission Alliance Community Engagement Project: Exploring the Impact of COVID-19 
on Social Isolation, Loneliness, Mental Health and Wellbeing in Veterans.

Pratt BA(1), Krause-Parello CA(2), Nguyen-Feng VN(3), Giordano NA(4), Basin 
SB(5), Peterson AL(6), Walsh P(7), Siebert AQ(8), Ruiz R(9), Kirkland DM(10), 
Nolan JP Jr(11).

Author information:
(1)College of Nursing, Florida Atlantic University, 3200 College Drive, LA49 
228B, Davie, Boca Raton, FL, 33314, USA. bpratt4@health.fau.edu.
(2)College of Nursing, Florida Atlantic University, 3200 College Drive, LA49 
228B, Davie, Boca Raton, FL, 33314, USA.
(3)Department of Psychology, University of Minnesota Duluth, Duluth, MN, USA.
(4)School of Nursing, Emory University, Atlanta, GA, USA.
(5)Oregon Health and Science University, Portland, OR, USA.
(6)University of Texas Health Science Center at San Antonio, San Antonio, TX, 
USA.
(7)University of Rochester Medical Center, Rochester, NY, USA.
(8)Warrior Built Foundation, Lake Elsinore, CA, USA.
(9), San Diego, CA, USA.
(10)Grey Team, Boca Raton, FL, USA.
(11), El Dorado, AR, USA.

During the Coronavirus disease pandemic, many U.S. veterans with posttraumatic 
stress disorder (PTSD) experienced increased symptomology and worsened mental 
health and well-being due in part to social isolation and loneliness. The 
Mission Alliance project explored these ramifications and prioritized critical 
issues expressed by U.S. veterans and stakeholders (N = 182) during virtual 
regional meetings (N = 32). Field notes created specifically for this project 
were recorded and thematically analyzed. Emerging themes included: (1) social 
isolation: missed opportunities, collapsed social circles, work-life balance, 
fostering relationships, and evolving health care delivery; (2) loneliness: 
deteriorated mental health, suffered with PTSD together but alone, looked out 
for each other, ambivalence toward technology, and strained and broken systems; 
(3) mental health: sense of chaos, increased demand and decreased access, 
aggravation, implementation of tools, innovative solutions, fear and loss, and 
availability of resources; (4) wellbeing: sense of purpose, holistic perspective 
on well-being, recognition of balance, persisting stigma, redefined pressures, 
freedom to direct treatment, and reconnection and disconnection. A PTSD-related 
patient centered outcomes research (PCOR)/comparative effectiveness research 
(CER) agenda was developed from these themes. Establishment of a veteran and 
stakeholder network is suggested to support, facilitate, and promote the 
PTSD-related PCOR/CER agenda. Furthermore, enhancement of opportunities for 
veterans with PTSD and stakeholders to partner in PCOR/CER is required to 
develop and conduct projects that lead to PTSD-related comprehensive care of 
veterans affected by traumatic events with the potential to translate findings 
to other populations.

© 2023. The Author(s).

DOI: 10.1007/s10900-023-01314-5
PMCID: PMC10981591
PMID: 38066217 [Indexed for MEDLINE]

Conflict of interest statement: The authors report no financial or non-financial 
interests that are directly or indirectly related to this work.


208. J Affect Disord. 2024 Mar 1;348:70-77. doi: 10.1016/j.jad.2023.12.008. Epub 2023 
Dec 6.

Prevalence and influencing factors of PTSD symptoms among healthcare workers: A 
multicenter cross-sectional study during the surge period of the COVID-19 
pandemic since December 2022 in the Chinese mainland.

Wu Y(1), Dai Z(1), Jing S(1), Liu X(1), Zhang L(1), Liu X(1), Ren T(1), Fu J(1), 
Chen X(1), Xiao W(1), Wang H(1), Huang Y(1), Wang W(2), Gu X(3), Ma L(4), Zhang 
S(5), Yu Y(6), Li L(7), Han Z(8), Su X(9), Qiao Y(10).

Author information:
(1)School of Population Medicine and Public Health, Chinese Academy of Medical 
Sciences & Peking Union Medical College, Beijing, China.
(2)School of Nursing, Jining Medical University, Jining, Shandong, China.
(3)Affiliated Tumor Hospital, Xinjiang Medical University, Urumqi, China.
(4)Public Health School, Dalian Medical University, Dalian, China.
(5)Henan Cancer Hospital, Affiliate Cancer Hospital of Zhengzhou University, 
Zhengzhou, China.
(6)The First Affiliated Hospital of Baotou Medical College, Inner Mongolia, 
China.
(7)Department of Clinical Research, the First Affiliated Hospital of Jinan 
University, Guangdong, China.
(8)China Foreign Affairs University, Beijing, China. Electronic address: 
han.zhili@cfau.edu.cn.
(9)School of Population Medicine and Public Health, Chinese Academy of Medical 
Sciences & Peking Union Medical College, Beijing, China. Electronic address: 
suxiaoyou@hotmail.com.
(10)School of Population Medicine and Public Health, Chinese Academy of Medical 
Sciences & Peking Union Medical College, Beijing, China; Department of 
Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical 
Sciences & Peking Union Medical College, Beijing, China. Electronic address: 
qiaoy@cicams.ac.cn.

BACKGROUND: China has experienced a surge period of COVID-19 pandemic since 
December 2022. Healthcare workers (HCWs) were exposed to huge workload under 
high risk of being infected, and significant levels of trauma, which might cause 
Post-traumatic Stress Disorders (PTSD) symptoms in HCWs.
OBJECTIVES: To identify the prevalence of PTSD symptoms among HCWs in the 
Chinese mainland during the surge period of the COVID-19 pandemic; to explore 
their psycho-social factors of PTSD symptoms.
METHODS: A multicenter cross-sectional study was conducted among HCWs in Chinese 
mainland from January 5 to February 9, 2023, covering seven geographical 
regions. 6552 participants were recruited by convenience sampling. Data were 
collected on demographic characteristics, work-related factors, and 
psychological factors by online questionnaires. Univariate analysis and binary 
logistic regression were used to determine the influencing factors of PTSD 
symptoms.
RESULTS: The prevalence of PTSD symptoms among HCWs was 37.49 %. A higher level 
of mindfulness, resilience, and perceived social support were protective 
factors. Female gender, nurses, higher educational attainment, married status, 
more working years, higher perceived risk of contracting COVID-19 due to work, 
and higher perceived work intensity were risk factors.
CONCLUSION: High prevalence of PTSD symptoms among HCWs necessitates 
psychological interventions. Tailored interventions, designed by professional 
psychiatrists, should be tailored to address the stressors. A comprehensive 
approach, incorporating mindfulness, resilience-building, and perceived social 
support enhancement, is vital to bolster the mental well-being of HCWs exposed 
to traumatic events, thus mitigating the impact of PTSD effectively. 
Additionally, it is essential to provide support to HCWs with other potential 
risk factors.

Copyright © 2023. Published by Elsevier B.V.

DOI: 10.1016/j.jad.2023.12.008
PMID: 38065482 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest None.


209. LGBT Health. 2024 Apr;11(3):210-218. doi: 10.1089/lgbt.2022.0385. Epub 2023 Dec 
7.

Gender Diversity, Disability, and Well-Being: Impact of Delayed and Foregone 
Care Because of COVID-19.

McMaughan DJ(1), Mulcahy A(2), McGehee A(3), Streed CG Jr(4), Wallisch AM(5), 
Kurth NK(6), Hall JP(6).

Author information:
(1)School of Community Health Sciences, Counseling, and Counseling Psychology, 
College of Education and Human Sciences, Oklahoma State University, Stillwater, 
Oklahoma, USA.
(2)Center to Improve Veteran Involvement in Care, Portland VA Healthcare System, 
Portland, Oregon, USA.
(3)Department of Human Development and Family Science, College of Education and 
Human Sciences, Oklahoma State University, Stillwater, Oklahoma, USA.
(4)Section of General Internal Medicine, Department of Medicine, Boston 
University School of Medicine, Boston, Massachusetts, USA.
(5)Juniper Gardens Children's Project, University of Kansas, Kansas City, 
Kansas, USA.
(6)University of Kansas Institute for Health and Disability Policy Studies, Life 
Span Institute, Lawrence, Kansas, USA.

Purpose: This study explored the impact of delayed and foregone care due to 
COVID-19 on well-being among disabled and gender diverse adults. Methods: Using 
data from the 2021 National Survey on Health and Disability and logistic 
regression modeling we assessed the impact of delayed or foregone care due to 
COVID-19 on well-being among disabled people (n = 1638), with comparisons 
between cisgender (n = 1538) and gender diverse (n = 100) people with 
disabilities. We report odds ratios (OR) and confidence intervals (CI). Results: 
Disabled people reported high rates of delayed (79.36%) and foregone (67.83%) 
care and subsequent negative effects on well-being (72.07%). Gender diverse 
disabled people were over four times more likely to have delayed any care (OR 
4.45, 95% CI 1.86-10.77) and three times more likely to have foregone any care 
(OR 3.14, 95% CI 1.71-5.79) due to COVID-19 compared to cisgender disabled 
people. They were three times more likely to report any negative impact on their 
health and well-being because of delayed and foregone care (OR 2.78, 95% CI 
1.43-5.39). Conclusion: The COVID-19 pandemic affected the health care 
utilization of disabled people, resulting in high rates of delayed care, 
foregone care, and negative impacts on well-being. These effects were 
intensified at the intersection of disability and marginalized gender identity, 
with gender diverse disabled people having higher odds of delayed and foregone 
care and negative effects on well-being, including physical health, mental 
health, pain levels, and overall level of functioning.

DOI: 10.1089/lgbt.2022.0385
PMID: 38060697 [Indexed for MEDLINE]


210. JAMA Netw Open. 2023 Dec 1;6(12):e2346106. doi: 
10.1001/jamanetworkopen.2023.46106.

Mental Health of Children With Special Educational Needs and the Return to 
In-Person Learning After the COVID-19 Pandemic.

Tso WWY(1)(2), Leung LK(1), Chow MSC(1), Wang Y(1), Li C(1), Hui KY(1), Ma L(1), 
Wong MW(1), Lui MPK(1), Wong WHS(1), Lee SL(1), Lee TMC(2), Ip P(1).

Author information:
(1)Department of Paediatrics and Adolescent Medicine, The University of Hong 
Kong, Pokfulam, Hong Kong.
(2)State Key Laboratory of Brain and Cognitive Sciences, The University of Hong 
Kong, Pokfulam, Hong Kong.

IMPORTANCE: There is limited evidence on whether the quality of life and 
behavior of children with special educational needs (SEN) have improved or 
worsened since schools reopened after COVID-19-related school closures.
OBJECTIVE: To describe the changes in the mental well-being of children and 
adolescents with SEN during the initial 6 months of resuming in-person learning 
after COVID-19-related school closures.
DESIGN, SETTING, AND PARTICIPANTS: This repeated cross-sectional study reported 
data from surveys completed by parents and caregivers of children and 
adolescents aged 3 to 18 years with SEN studying at special schools in Hong 
Kong. The first cohort was obtained during COVID-19-related school closure in 
April 2020 (wave 1) and the second cohort was obtained 6 months after school 
resumption with data collection between July and October 2021 (wave 2). Data 
analysis occurred from January to June 2022.
EXPOSURE: Diagnosis of a disability or disorder that required school-based 
special educational programming.
MAIN OUTCOMES AND MEASURES: Children's emotional and behavioral difficulties 
(measured with the Strengths and Difficulties Questionnaire [SDQ]), quality of 
life (measured with the Pediatric Quality of Life Inventory [PedsQL]), lifestyle 
habits, parental stress, and parental well-being (measured with the PedsQL 
Family Impact Module) were assessed. Cross-sectional comparisons of well-being 
between the 2 waves were conducted using analysis of covariance, and multiple 
regression analysis was performed to identify factors associated with mental 
health outcomes in wave 2.
RESULTS: In wave 1, a total of 456 parents and caregivers of children with SEN 
(mean [SD] age, 7.44 [3.98] years; 315 boys [69.1%]; 141 girls [30.9%]) 
responded to the surveys. In wave 2, 519 parents and caregivers of children with 
SEN (mean [SD] age, 8.16 [4.47] years; 365 boys [70.3%]; 154 girls [29.7%]) 
responded. After school resumption, preschoolers aged 3 to 5 years with SEN had 
significantly fewer emotional difficulties (mean [SD] SDQ score, 3.26 [2.39] vs 
2.68 [2.03]; standardized mean difference [SMD] = 0.26; 95% CI, 0.07-0.46; 
Bonferroni-corrected P = .04) and conduct difficulties (mean [SD] SDQ score, 
2.88 [1.89] vs 2.41 [1.91]; SMD = 0.25; 95% CI, 0.05-0.44; Bonferroni-corrected 
P = .01), whereas adolescents had more conduct difficulties (mean [SD] SDQ 
score, 1.62 [1.50] vs 2.37 [3.02]; SMD = 0.41; 95% CI, 0.13-0.70; 
Bonferroni-corrected P = .049). The overall quality of life of school-aged 
children with SEN aged 6 to 11 years worsened after school resumption (mean [SD] 
PedsQL score, 67.52 [17.45] vs 60.57 [16.52]; SMD = 0.41; 95% CI, 0.19-0.62; 
Bonferroni-corrected P = .002).
CONCLUSIONS AND RELEVANCE: The findings of this repeated cross-sectional study 
suggest that preschoolers with SEN had improved emotional and behavioral 
functioning when school resumed after COVID-19-related closures. School-aged 
children with SEN, adolescents with SEN, and children with intellectual 
disabilities were at risk of reduced quality of life, indicating that additional 
support should be offered to vulnerable groups as they return to schools.

DOI: 10.1001/jamanetworkopen.2023.46106
PMCID: PMC10704277
PMID: 38060228 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest Disclosures: None reported.


211. Med Lav. 2023 Dec 7;114(6):e2023051. doi: 10.23749/mdl.v114i6.14849.

Cross-Sectional Study of the Psychological Well-Being of Healthcare Workers in a 
Large European University Hospital after the COVID-19 Initial Wave.

Sala E(1), Paraggio E(2), Abrami MA(3), Tomasi C(4), Tomasini E(5), Sansone 
E(6), Barlati S(7), Vita A(8), De Palma G(9).

Author information:
(1)Unit of Occupational Health, Hygiene, Toxicology and Prevention, University 
Hospital ASST Spedali Civili, Brescia, Italy.. emma.sala@unibs.it.
(2)Unit of Occupational Health and Industrial Hygiene, Department of Medical 
Surgical Specialties, Radiological Sciences and Public Health, University of 
Brescia, Brescia, Italy.. e.paraggio@unibs.it.
(3)Unit of Clinical Psychology and of Wellness; Department of Mental Health, 
University Hospital ASST Spedali Civili, Brescia, Italy.. 
mariaangela.abrami@asst-spedalicivili.it.
(4)Unit of Occupational Health and Industrial Hygiene, Department of Medical 
Surgical Specialties, Radiological Sciences and Public Health, University of 
Brescia, Brescia, Italy.. cesare.tomasi@unibs.it.
(5)Prevention, Hygiene and Safety in the Workplace, Local Health Authority, 
Florence, Italy.. emanuela.tomasini@uslcentro.toscana.it.
(6)Unit of Occupational Health and Industrial Hygiene, Department of Medical 
Surgical Specialties, Radiological Sciences and Public Health, University of 
Brescia, Brescia, Italy.. e.sansone@unibs.it.
(7)Department of Mental Health, University Hospital ASST Spedali Civili, 
Brescia, Italy; Department of Clinical and Experimental Sciences, University of 
Brescia, Brescia, Italy.. stefano.barlati@unibs.it.
(8)Department of Mental Health, University Hospital ASST Spedali Civili, 
Brescia, Italy; Department of Clinical and Experimental Sciences, University of 
Brescia, Brescia, Italy.. antonio.vita@unibs.it.
(9)Unit of Occupational Health, Hygiene, Toxicology and Prevention, University 
Hospital ASST Spedali Civili, Brescia, Italy; Unit of Occupational Health and 
Industrial Hygiene, Department of Medical Surgical Special-ties, Radiological 
Sciences and Public Health, University of Brescia, Brescia, Italy.. 
giuseppe.depalma@unibs.it.

BACKGROUND: The SARS-CoV-2 pandemic greatly impacted healthcare workers (HCWs) 
dedicated to caring for COVID-19 patients. The study was conducted in a large 
European hospital to study the psychological distress of HCWs engaged in 
COVID-19 wards in the early phase of the pandemic.
METHODS: A questionnaire was sent to 1229 HCWs aimed at collecting the following 
information: 1) sociodemographic data; 2) depression, anxiety, and stress scales 
(DASS-21); 3) event impact scale (IES-R); 4) perceived stress scale (PSS); and 
5) work interface analysis. The responses were collected through Google® forms 
and then statistically analyzed. Regardless of the outcome of the questionnaire, 
all subjects were offered psychological support voluntarily.
RESULTS: Approximately two-thirds of the workers reported no symptoms according 
to the DASS-21 scales, while the IES-R and PSS scales showed 36% and 43%, 
respectively. There were no statistically significant differences in the levels 
of depression investigated through the different scales in the various 
occupational categories. Symptoms of anxiety, stress, and depression were more 
pronounced in women, while the highest stress levels were observed in the 
younger age groups. The highest scores were observed on the DAS-21 scales of 
anxiety and IES-R but not on the others. Only 51 workers, most of them with 
previous SARS-CoV-2 infection, sought clinical psychological counseling, and 
more than half received subsequent psychological support.
CONCLUSIONS: Our results agree with most of the literature data that anxiety, 
depression, and stress are associated with gender (female), age (18-44 vs. over 
55), and having cared for patients with COVID-19.

DOI: 10.23749/mdl.v114i6.14849
PMCID: PMC10731571
PMID: 38060210 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


212. J Clin Nurs. 2024 Apr;33(4):1470-1481. doi: 10.1111/jocn.16937. Epub 2023 Dec 5.

The mediating and moderating role of recovery experience between occupational 
stress and turnover intention in nurses caring for patients with COVID-19.

Lee J(1), Kim J(2), Lim HA(3), Song Y(3).

Author information:
(1)Department of Nursing, Keimyung College University, Daegu, South Korea.
(2)Department of Nursing, Kyungil University, Gyeongsan, South Korea.
(3)Kyungpook National University College of Nursing, Research Institute of 
Nursing Science, Daegu, South Korea.

AIM: This study aimed to investigate the relationships among occupational 
stress, recovery experience and turnover intention among nurses caring for 
patients with coronavirus disease 2019 (COVID-19).
BACKGROUND: The high turnover intention among nurses affect patient safety 
quality of patient care.
DESIGN: The cross-sectional study design was used. This study was guided by 
STROBE.
METHODS: Convenience sampling identified 202 registered nurses working in the 
COVID-19 wards of three tertiary general hospitals in two cities in South Korea. 
The collected data were analysed using SPSS version 26.0, and the PROCESS macro 
in SPSS was employed to estimate path coefficients and assess the adequacy of 
the model. The moderating effects of recovery experience on the pathway in which 
occupational stress of the participants affects turnover intention were verified 
using model 1 of the SPSS PROCESS macro proposed by Hayes.
RESULTS: The recovery experience did not significantly mediate the relationship 
between occupational stress and turnover intention. However, it had significant 
moderating effect on the relationship between occupational stress and turnover 
intention (β = .005, 95% CI [.001, .010]). The effect of occupational stress on 
turnover intention was dependent on recovery experience.
CONCLUSION: The results revealed that occupational stress among nurses caring 
for patients with COVID-19 affect the turnover intention and the level of 
recovery experience moderates this relationship. Thus, not only during the 
COVID-19 pandemic but also during challenging times of various infectious 
disease outbreaks, hospitals can enhance the health and well-being of nurses and 
promote the retention of nursing staff.
IMPLICATIONS FOR THE PROFESSION: During the COVID-19 pandemic, nurses have been 
exposed to understaffing and overwhelming workloads. However, policies for 
nurses' welfare and benefits are still insufficient, even as the pandemic comes 
to an end. The results of this study indicate that sufficient rest and 
appropriate nursing personnel are of utmost importance to nurses.
PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

© 2023 John Wiley & Sons Ltd.

DOI: 10.1111/jocn.16937
PMID: 38050923 [Indexed for MEDLINE]


213. Disaster Med Public Health Prep. 2023 Dec 5;17:e546. doi: 10.1017/dmp.2023.206.

Insomnia, Suicidal Thoughts, and Mental Health Among Health-Care Workers During 
COVID-19.

Wei LC(1).

Author information:
(1)Department of Addiction Psychiatry, Taoyuan Psychiatric Center, Ministry of 
Health and Welfare, Taoyuan City, Taiwan.

The COVID-19 pandemic has precipitated a significant mental health crisis among 
frontline healthcare workers (FHCWs), with increased reports of depression, 
anxiety, post-traumatic stress, insomnia, and suicidal thoughts. This letter to 
the editor responds to a recent study on the psychological burden among FHCWs in 
Mexico and presents complementary findings from Taiwan. We found that fear of 
COVID-19, trust in information, and resilience were significant factors 
contributing to mental health outcomes, including insomnia and suicidal 
thoughts, among outpatients, healthcare workers, and the general population 
during the pandemic. These findings suggest that mental health interventions for 
healthcare workers should consider these factors and include strategies for 
clear communication, stress management, and resilience building. Particular 
attention should be given to nurses and residents/fellows who seem to be bearing 
a disproportionate share of the psychological burden. Ultimately, understanding 
these contributing factors can guide the development of targeted interventions 
to support the mental well-being of FHCWs during the pandemic.

DOI: 10.1017/dmp.2023.206
PMID: 38050375 [Indexed for MEDLINE]


214. Adv Ther. 2024 Feb;41(2):598-617. doi: 10.1007/s12325-023-02673-0. Epub 2023 Dec 
4.

The Impact of the COVID-19 Pandemic on Patients with Ulcerative Colitis: Results 
from a Global Ulcerative Colitis Narrative Patient Survey.

Peyrin-Biroulet L(1)(2)(3)(4)(5)(6), Ylänne K(7), Sipes A(8), Segovia M(9), 
Gardiner S(10), Cappelleri JC(11), Mulvey A(12), Panaccione R(13).

Author information:
(1)Department of Gastroenterology, Nancy University Hospital, 54500, 
Vandœuvre-lès-Nancy, France.
(2)INSERM, NGERE, University of Lorraine, 54000, Nancy, France.
(3)INFINY Institute, Nancy University Hospital, 54500, Vandœuvre-lès-Nancy, 
France.
(4)FHU-CURE, Nancy University Hospital, 54500, Vandœuvre-lès-Nancy, France.
(5)Groupe Hospitalier privé Ambroise Paré, Hartmann, Paris IBD Center, 92200, 
Neuilly sur Seine, France.
(6)Division of Gastroenterology and Hepatology, McGill University Health Centre, 
Montreal, QC, Canada.
(7)Sidekick Health, Kopavogur, Iceland.
(8), Columbia, SC, USA.
(9)Pfizer Inc, 500 Arcola Road, Collegeville, PA, 19426, USA. 
Michelle.SegoviaMedina@pfizer.com.
(10)Pfizer Inc, New York, NY, USA.
(11)Pfizer Inc, Groton, CT, USA.
(12)The Harris Poll, Chicago, IL, USA.
(13)Division of Gastroenterology and Hepatology, Department of Medicine, 
University of Calgary, Calgary, AB, Canada.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic created 
challenges related to disease management of patients with ulcerative colitis 
(UC).
METHODS: The UC Narrative COVID-19 survey was conducted from August to December 
2021 among adults with UC from the United States, Canada, Japan, France, and 
Finland. Patients were questioned on disease management, health care access and 
experience, and preferences for interactions with their doctor. Data were 
analyzed descriptively.
RESULTS: In total, 584 patients qualified for and completed the survey. Compared 
with 2019, 25% experienced more flares during the pandemic (from early 2020). 
Most patients (88%) taking prescription medication were very/somewhat satisfied 
with their current treatment plan; 53% were hesitant to make changes during the 
pandemic. Factors that patients agreed helped control UC symptoms during the 
pandemic included fewer social outings (37%), working from home (29%), and less 
busy schedules (28%). Greater anxiety/stress (43%) and hesitancy to visit a 
hospital/office (34%) made the control of UC symptoms more difficult. Compared 
with 2019, more patients relied on certain alternative support systems during 
the pandemic. Patients who used in-person and virtual appointments were equally 
very satisfied/satisfied with the quality of care (both 81%). In-person 
appointments were preferred by 68% of patients when meeting a new doctor, 55% 
when experiencing a flare, and 52% for regular check-ups; 41% preferred virtual 
appointments for UC prescription refills.
CONCLUSION: During the pandemic, most patients were satisfied with their current 
UC treatment plan and access to care; more patients relied on certain 
alternative UC management support systems, and many were impacted by 
anxiety/stress.

Plain Language Summary: The coronavirus disease 2019 (COVID-19) pandemic created 
challenges for patients with ulcerative colitis. These challenges included 
managing symptoms, lifestyle changes, and access to health care. We asked 
patients with ulcerative colitis to answer questions about their experience 
during the pandemic to try to understand how the pandemic was affecting them. A 
total of 584 patients from the United States, Canada, Japan, France, and Finland 
took part. Patients were asked questions online. We asked them about their 
disease activity during the COVID-19 pandemic compared with before the pandemic 
and how their disease was managed, their access to health care, and their 
experience during the pandemic. We also asked them about their satisfaction with 
the types of appointments they had during the pandemic (for example, in-person 
or virtual meetings), and their interactions and preference for interactions 
with their doctors. We found that most patients were satisfied with their 
current treatment plan, their access to health care, and the quality of the care 
they received. However, many patients experienced greater stress or anxiety, and 
there was a negative impact on their emotional well-being. During the pandemic, 
more patients relied on alternative support systems such as online patient 
portals or virtual appointments, but patients preferred in-person appointments 
with their doctors in most cases except for refilling prescriptions. This 
information may help doctors understand the impact of the COVID-19 pandemic on 
patients with ulcerative colitis, and may help doctors and patients develop 
treatment plans that include both in-person and virtual appointments.

© 2023. Pfizer Inc. and The Author(s).

DOI: 10.1007/s12325-023-02673-0
PMCID: PMC10838856
PMID: 38048018 [Indexed for MEDLINE]

Conflict of interest statement: Laurent Peyrin-Biroulet has received consulting 
fees from AbbVie, Abivax, Adacyte, Alimentiv, Alma Bio Therapeutics, Amgen, 
Applied Molecular Transport, Arena, Biogen, BMS, Celltrion, CONNECT Biopharm, 
Cytoki Pharma, Enthera, Ferring, Fresenius Kabi, Galapagos, Genentech, Gilead, 
Gossamer Bio, GSK, HAC-Pharma, IAG Image Analysis, Index Pharmaceuticals, 
Inotrem, Janssen, Lilly, Medac, Mopac, Morphic, MSD, Nordic Pharma, Norgine, 
Novartis, OM Pharma, ONO Pharma, OSE Immunotherapeutics, Pandion Therapeutics, 
Par’Immune, Pfizer Inc, Prometheus, Protagonist, Roche, Roivant, Samsung, 
Sandoz, Sanofi, Takeda, Theravance, Thermo Fisher, Tigenix, Tillotts, Vectivbio, 
Ventyx, Viatris, Vifor, and Ysopia. Karoliina Ylänne was an employee of Sidekick 
Health, Kopavogur, Iceland, at the time of the analysis and is currently an 
employee and shareholder of Pfizer Inc; has received lecture fees from IBD ja 
muut suolistosairaudet Ry (patient association), Pfizer Inc, Takeda, and 
Tillotts Pharma, and consultancy fees from Pfizer Inc, Sandoz, Sidekick Health, 
and Takeda. Allyson Sipes has received consultancy fees from Pfizer Inc for work 
unrelated to this analysis. Amy Mulvey is an employee of The Harris Poll, which 
was a paid contractor to Pfizer for related statistical analysis. Sean Gardiner 
and Joseph C. Cappelleri are employees and stockholders of Pfizer Inc. Michelle 
Segovia is an employee of The Medical Affairs Company and a former Postdoctoral 
Fellow of Rutgers University, which was a paid contractor to Pfizer in 
connection with the development of this manuscript. Remo Panaccione has received 
advisory and/or consulting fees from AbbVie, Abbot, Alimentiv (formerly 
Robarts), Amgen, Arena Pharmaceuticals, AstraZeneca, Boehringer Ingelheim, 
Bristol Myers Squibb, Celgene, Celltrion, Cosmos Pharmaceuticals, Eisai, Elan, 
Eli Lilly, Ferring, Galapagos, Genentech, Gilead, GlaxoSmithKline, Janssen, 
Merck, Mylan, Oppilan Pandion, Pandion Pharma, Pfizer Inc, Progenity, 
Protagonist Therapeutics, Roche, Sandoz, Satisfai Health, Schering-Plough, 
Shire, Sublimity Therapeutics, Takeda Pharmaceuticals, Theravance Biopharma, and 
UCB.


215. BMC Public Health. 2023 Dec 2;23(1):2401. doi: 10.1186/s12889-023-17297-w.

How is the COVID-19 pandemic impacting our life, mental health, and well-being? 
Design and preliminary findings of the pan-Canadian longitudinal COHESION study.

Gabet S(1)(2)(3), Thierry B(2), Wasfi R(4), Simonelli G(5)(6), Hudon C(7), 
Lessard L(8)(9), Dubé È(10), Nasri B(1)(2), Kestens Y(1)(2), Moullec G(11)(12).

Author information:
(1)Département de Médecine Sociale et Préventive, École de Santé publique de 
l'Université de Montréal (ESPUM), Québec, QC, Canada.
(2)Centre de Recherche en Santé Publique (CReSP), Université de Montréal (UdeM), 
Québec, QC, Canada.
(3)Univ. Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483-IMPacts de 
l'Environnement Chimique sur la Santé (IMPECS), Lille, 59000, France.
(4)Centre for Surveillance and Applied Research, Health Promotion and Chronic 
Disease Prevention Branch, Public Health Agency of Canada / Government of 
Canada, Ottawa, Ontario, ON, Canada.
(5)Département de Médecine, Université de Montréal (UdeM), Québec, QC), Canada.
(6)Centre de Recherche du Centre intégré universitaire de santé et de services 
sociaux du Nord-de- l'Île-de-Montréal (CIUSSS-NIM), Québec, QC, Canada.
(7)Département de Médecine de Famille et Médecine d'urgence, Université de 
Sherbrooke (UdeS), Québec, QC, Canada.
(8)Département des sciences de la santé, Université du Québec à Rimouski, 
Québec, QC, Canada.
(9)Centre de recherche du CISSS de Chaudière-Appalaches, Québec, QC, Canada.
(10)Centre de recherche du CHU de Québec, Université de Laval, Québec, QC, 
Canada.
(11)Département de Médecine Sociale et Préventive, École de Santé publique de 
l'Université de Montréal (ESPUM), Québec, QC, Canada. 
gregory.moullec@umontreal.ca.
(12)Centre de Recherche du Centre intégré universitaire de santé et de services 
sociaux du Nord-de- l'Île-de-Montréal (CIUSSS-NIM), Québec, QC, Canada. 
gregory.moullec@umontreal.ca.

BACKGROUND: With the advent of the COVID-19 pandemic, in-person social 
interactions and opportunities for accessing resources that sustain health and 
well-being have drastically reduced. We therefore designed the pan-Canadian 
prospective COVID-19: HEalth and Social Inequities across Neighbourhoods 
(COHESION) cohort to provide a deeper understanding of how the COVID-19 pandemic 
context affects mental health and well-being, key determinants of health, and 
health inequities.
METHODS: This paper presents the design of the two-phase COHESION Study, and 
descriptive results from the first phase conducted between May 2020 and 
September 2021. During that period, the COHESION research platform collected 
monthly data linked to COVID-19 such as infection and vaccination status, 
perceptions and attitudes regarding pandemic-related measures, and information 
on participants' physical and mental health, well-being, sleep, loneliness, 
resilience, substances use, living conditions, social interactions, activities, 
and mobility.
RESULTS: The 1,268 people enrolled in the Phase 1 COHESION Study are for the 
most part from Ontario (47%) and Quebec (33%), aged 48 ± 16 years [mean ± 
standard deviation (SD)], and mainly women (78%), White (85%), with a university 
degree (63%), and living in large urban centers (70%). According to the 298 ± 68 
(mean ± SD) prospective questionnaires completed each month on average, the 
first year of follow-up reveals significant temporal variations in standardized 
indexes of well-being, loneliness, anxiety, depression, and psychological 
distress.
CONCLUSIONS: The COHESION Study will allow identifying trajectories of mental 
health and well-being while investigating their determinants and how these may 
vary by subgroup, over time, and across different provinces in Canada, in 
varying context including the pandemic recovery period. Our findings will 
contribute valuable insights to the urban health field and inform future public 
health interventions.

© 2023. Crown.

DOI: 10.1186/s12889-023-17297-w
PMCID: PMC10693083
PMID: 38042782 [Indexed for MEDLINE]

Conflict of interest statement: YK holds shares in Polygon Research Inc., the 
data collection platform that is used for the COHESION study. Other authors have 
no competing interests to declare.


216. Sex Reprod Healthc. 2024 Mar;39:100927. doi: 10.1016/j.srhc.2023.100927. Epub 
2023 Nov 25.

Exposure to violence and associated factors among abortion-seeking women - A 
multicentre study in Sweden during the Covid-19 pandemic.

Klemets L(1), Makenzius M(2).

Author information:
(1)Department of Health Care Sciences, Mid Sweden University, Östersund, Sweden.
(2)Department of Health Care Sciences, Mid Sweden University, Östersund, Sweden; 
Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; 
Department of Women's and Children's Health, Karolinska Institutet, Stockholm, 
Sweden. Electronic address: Marlene.makenzius@miun.se.

This study aimed to investigate factors associated with exposure to violence 
over the past 12 months among women seeking abortion.
MATERIALS AND METHODS: We conducted a cross-sectional study, nested within a 
multi-center questionnaire survey, involving 623 abortion-seeking women in 
Sweden from January to June 2021. Descriptive statistics, bivariate analyses, 
and multivariate regression analysis (using odds ratios [OR] and 95% confidence 
intervals [CI]) were employed.
RESULTS: Out of the 623 women, 9.9% (n = 59) reported exposure to physical, 
psychological, and/or sexual violence in the past 12 months. Several factors 
were correlated with being a victim of violence. However, after adjustment in 
the regression model, the significant factors included: age 16-26 (OR 2.37, 95% 
CI; 1.24-4.52, p <.009), poor physical and mental well-being prior to pregnancy 
(OR 3.29; CI 1.69-6.40, p <.001), having had ≥ 2 previous abortions (OR 2.27, 
95% CI; 1.16-4.44, p =.017), and being single (OR 4.70, 95% CI; 2.51-8.77, 
p <.001).
CONCLUSION: Nearly one in ten women seeking abortion reported exposure to 
violence in the preceding year. Being young, having poor physical and mental 
health, undergoing multiple abortions, and singlehood emerge as risk factors for 
violence exposure. Abortion providers have a crucial role and should 
consistently identify women exposed to violence, offering them the necessary 
guidance and referrals for further support.

Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.srhc.2023.100927
PMID: 38039662 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


217. J Glob Health. 2023 Dec 1;13:06052. doi: 10.7189/jogh.13.06052.

Subjective dry eye symptoms and associated factors among the national general 
population in China during the COVID-19 pandemic: A network analysis.

Wang X(#)(1), Wu Y(#)(2), Zhao F(3), Sun W(3), Pang C(4), Sun X(1), Zang S(1).

Author information:
(1)Department of Community Nursing, School of Nursing, China Medical University, 
Shenyang, China.
(2)School of Public Health, Peking University, Beijing, China.
(3)Department of Ophthalmology, The Fourth Affiliated Hospital of China Medical 
University, Shenyang, China.
(4)Department of Gerontology and Geriatrics, The Second Affiliated Hospital of 
Shenyang Medical College, Shenyang, China.
(#)Contributed equally

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has presented 
numerous challenges to public health, including the emergence of subjective dry 
eye symptoms among individuals. However, there is currently a dearth of 
comprehensive knowledge regarding the associated factors with subjective dry eye 
symptoms in the general population.
METHODS: A nationwide survey in China was carried out from 20 June to 31 August 
2022, involving 21 916 participants. Subjective dry eye symptoms were assessed 
using the Ocular Surface Disease Index-6. We employed random forest 
classification to select potential associated factors based on the 
socioecological model. We also conducted univariate and multivariable logistic 
regression analyses to explore the factors associated with subjective dry eye 
symptoms. Network analyses were employed to explore the network structure of 
subjective dry eye symptoms and associated factors.
RESULTS: The item "watching TV (or similar task)" displayed the highest node 
strength and exhibited the highest predictability within the network. The 
results of the multivariate logistic regression analysis demonstrated 
significant associations between subjective dry eye symptoms and several 
factors, including loneliness (odds ratio (OR) = 1.29; 95% confidence interval 
(CI) = 1.26 to 1.32), problematic Internet use (OR = 1.08; 95% CI = 1.08 to 
1.09), family communication (OR = 1.01; 95% CI = 1.00 to 1.01), the presence of 
depression (OR = 1.53; 95% CI = 1.39 to 1.68) and anxiety (OR = 1.31; 95% 
CI = 1.17 to 1.47) symptoms, older age (OR = 1.01; 95% CI = 1.01 to 1.01), 
self-rated health status (OR = 0.99; 95% CI = 0.98 to 0.99), family health 
(OR = 0.97; 95% CI = 0.96 to 0.97), health literacy (OR = 0.98; 95% CI = 0.97 to 
0.99) and the agreeableness personality trait (OR = 0.97; 95% CI = 0.95 to 
0.99).
CONCLUSIONS: These findings have important implications for public health 
interventions targeting the prevention and management of subjective dry eye 
symptoms in the general population. Strategies addressing individual risk 
factors and supporting psychological well-being may prove beneficial in 
mitigating the burden associated with subjective dry eye symptoms.

Copyright © 2023 by the Journal of Global Health. All rights reserved.

DOI: 10.7189/jogh.13.06052
PMCID: PMC10691301
PMID: 38038375 [Indexed for MEDLINE]

Conflict of interest statement: Disclosure of interest: The authors completed 
the ICMJE Disclosure of Interest Form (available upon request from the 
corresponding author) and disclose no relevant interests.


218. BMJ Open. 2023 Nov 30;13(11):e068333. doi: 10.1136/bmjopen-2022-068333.

Mental health of general practitioners in Chongqing, China during COVID-19: a 
cross-sectional study.

Xu Y(#)(1), Deng J(#)(1), Tan W(1), Yang W(1), Deng H(2).

Author information:
(1)Department of General Practice, The First Affiliated Hospital of Chongqing 
Medical University, Chongqing, China.
(2)Department of General Practice, The First Affiliated Hospital of Chongqing 
Medical University, Chongqing, China 702197987@qq.com.
(#)Contributed equally

OBJECTIVES: In the context of the COVID-19 pandemic, general practitioners (GPs) 
continue to face unprecedented challenges that affect their mental health. 
However, few studies have assessed the mental health status of GPs. This study 
aimed to provide preliminary understanding of stress, job burn-out and 
well-being levels among GPs to train and manage them during public health 
emergencies.
DESIGN: We conducted a cross-sectional online self-report survey.
SETTING: The survey was conducted in Chongqing, China from July to August 2022.
PARTICIPANTS: Data were collected from 2145 GPs, with an effective response rate 
of 91.0%.
PRIMARY AND SECONDARY OUTCOME MEASURES: The main evaluation indicators were 
stress (Cohen's Perceived Stress Scale), job burn-out (Maslach Burnout 
Inventory-Human Services Survey Scale) and well-being (WHO-5 Well-Being Index). 
Multiple linear regression analysis was used to compare the effect of different 
demographic characteristics on the impact of stress, job burn-out and decreased 
well-being.
RESULTS: Stress, job burn-out and decreased well-being were common among GPs. In 
this study, 59.7% experienced job burn-out, 76.1% experienced high levels of 
stress and 52.0% may have experienced depression. The main factors that 
influenced stress, burn-out and well-being were differences in age, working 
hours per week, title, part-time management work, work-life balance, sleep 
disorders, whether GPs received adequate recognition by patients and the work 
team and mental toughness (p<0.05).
CONCLUSION: This survey is the first to investigate stress, job burn-out and 
well-being levels among local GPs in China during the COVID-19 pandemic. Curbing 
stress and job burn-out levels and ensuring well-being among GPs could be 
achieved by reducing paperwork, management work and working hours; promoting 
life and work balance; and increasing resilience among GPs. The findings provide 
a basis for policy-makers to formulate strategies for developing general 
practice.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2022-068333
PMCID: PMC10689386
PMID: 38035743 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


219. Aust Crit Care. 2024 Jan;37(1):98-105. doi: 10.1016/j.aucc.2023.10.004. Epub 
2023 Nov 29.

Post-traumatic stress and health-related quality of life after admission to 
paediatric intensive care: Longitudinal associations in mother-child dyads.

Long DA(1), Gilholm P(2), Le Brocque R(3), Kenardy J(4), Gibbons K(2), Dow 
BL(5).

Author information:
(1)School of Nursing, Centre for Healthcare Transformation, Queensland 
University of Technology, Brisbane, Australia; Paediatric Intensive Care Unit, 
Queensland Children's Hospital, Brisbane, Australia; Child Health Research 
Centre, The University of Queensland, Brisbane, Australia. Electronic address: 
da.long@qut.edu.au.
(2)Child Health Research Centre, The University of Queensland, Brisbane, 
Australia.
(3)School of Nursing, Midwifery and Social Work, The University of Queensland, 
Brisbane, Australia.
(4)School of Psychology, The University of Queensland, Brisbane, Australia; 
Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Herston, 
Australia.
(5)School of Nursing, Centre for Healthcare Transformation, Queensland 
University of Technology, Brisbane, Australia; School of Psychology, The 
University of Queensland, Brisbane, Australia.

OBJECTIVE: Elevated post-traumatic stress symptoms (PTSS) and reduced 
health-related quality of life (HRQoL) are commonly experienced in both children 
and their parent's following admission to the paediatric intensive care unit 
(PICU). Previous research has demonstrated a conflict in the directionality 
between PTSS and HRQoL in children and their parents. Our study sought to 
explore the interconnection and transmission between PTSS and HRQoL in children 
and their mothers following an admission to the PICU.
DESIGN: Prospective longitudinal design.
SETTING: Two tertiary care PICUs in Brisbane, Australia.
PATIENTS: Two hundred eighty-two mother-child dyads of children aged 2-16 
years admitted to the PICU for >8 h.
INTERVENTIONS: None.
MEASUREMENT AND MAIN RESULTS: Four waves of dyadic data (n = 282 mother-child 
dyads) over a 12-month period from the PICU post-traumatic stress study were 
used. Cross-lagged panel modelling was used to examine the link between 
maternal-rated PTSS and HRQoL across children and their mothers. Actor-partner 
interdependence modelling was then used to examine the interconnections between 
mothers and children over time. In the dyadic model, partner effects were only 
present from mother to their child (i.e., higher maternal PTSS was predictive of 
higher child PTSS at subsequent time points). Higher maternal PTSS predicted 
lower maternal mental HRQoL but not lower child psychosocial HRQoL. Actor 
effects were also present with lower child psychosocial HRQoL, predicting higher 
child PTSS at subsequent time points. Findings indicated that a unidirectional 
transmission process from mother to child may be present after a child's 
life-threatening illness.
CONCLUSIONS: This study provides evidence for a long-term negative influence of 
maternal PTSS on child PTSS in families who have experienced a paediatric 
critical illness or injury. This highlights the important role of maternal 
wellbeing in children's mental health outcomes following PICU admission. Further 
research needs to explore the temporal and dyadic relationships of PTSS and 
HRQoL.

Copyright © 2023 Australian College of Critical Care Nurses Ltd. Published by 
Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.aucc.2023.10.004
PMID: 38030534 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest The authors declare that 
the research was conducted in the absence of any commercial or financial 
relationships that could be construed as a potential conflict of interest.


220. Intensive Crit Care Nurs. 2024 Apr;81:103597. doi: 10.1016/j.iccn.2023.103597. 
Epub 2023 Nov 28.

The relationship between role ambiguity and anxiety in intensive care unit 
nurses: The mediating role of emotional intelligence.

Zhang HL(1), Liu F(2), Lang HJ(3).

Author information:
(1)School of Nursing, Shaanxi University of Chinese Medicine, Xianyang, China; 
Department of Nursing, Fourth Military Medical University, Xi'an, China.
(2)School of Nursing, Shaanxi University of Chinese Medicine, Xianyang, China. 
Electronic address: liufang816@126.com.
(3)Department of Nursing, Fourth Military Medical University, Xi'an, China. 
Electronic address: langhj@fmmu.edu.cn.

BACKGROUND: Role ambiguity is recognized as a significant psychological risk 
stressor in nursing practice, which undermines the psychological well-being of 
nurses. Since the well-being of nurses plays a crucial role in ensuring positive 
patient outcomes, it becomes imperative to identify strategies for improving 
nurses' psychological well-being.
OBJECTIVES: This study aimed to explore the effects of role ambiguity on anxiety 
in intensive care unit nurses and the mechanisms mediating emotional 
intelligence.
METHODS: In April-June 2023, a convenience sampling method was used to collect 
data from 360 intensive care unit nurses in a total of 7 hospitals in Shaanxi 
Province, Hunan Province, Beijing, and Jiangsu Province, China. A linear 
regression model was used to verify the mediating effect.
RESULTS: Role ambiguity was significantly and positively associated with anxiety 
in ICU nurses (p < 0.01). A mediating mechanism between role ambiguity and 
anxiety was established for emotional intelligence (p < 0.01).
CONCLUSIONS: Role ambiguity has a significant impact on the mental health of 
intensive care nurses, and emotional intelligence plays a mediating role in 
reducing role ambiguity and anxiety in nurses.
IMPLICATIONS FOR CLINICAL PRACTICE: This study highlights that role ambiguity in 
the intensive care unit setting increases nurses' anxiety, while emotional 
intelligence alleviates the anxiety associated with role ambiguity. Creating 
support systems and improving the environment is a top priority for nursing 
administrators. This includes, but is not limited to, clarifying the roles of 
nurses, conducting social-emotional training, and developing emotional 
intelligence to prevent and regulate nurses' anxiety and maintain mental health.

Copyright © 2023. Published by Elsevier Ltd.

DOI: 10.1016/j.iccn.2023.103597
PMID: 38029677 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


221. Front Public Health. 2023 Nov 10;11:1284460. doi: 10.3389/fpubh.2023.1284460. 
eCollection 2023.

Associations of loneliness with mental health and with social and physical 
activity among university students in Germany: results of the COVID-19 German 
student well-being study (C19 GSWS).

Wenig V(1), Heumann E(1), Stock C(1)(2), Busse H(3), Negash S(4), Pischke CR(5), 
Heinrichs K(1).

Author information:
(1)Charité - Universitätsmedizin Berlin, corporate member of Freie Universität 
Berlin and Humboldt-Universität zu Berlin, Institute of Health and Nursing 
Science, Berlin, Germany.
(2)Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, 
Denmark.
(3)Department Prevention and Evaluation, Leibniz Institute for Prevention 
Research and Epidemiology-BIPS, Bremen, Germany.
(4)Institute for Medical Epidemiology, Biometrics and Informatics, 
Interdisciplinary Center for Health Sciences, Medical School of the 
Martin-Luther University Halle-Wittenberg, Halle, Germany.
(5)Institute of Medical Sociology, Centre for Health and Society, Medical 
Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.

INTRODUCTION: University students are at high risk for loneliness with a 
potential negative impact on health. The COVID-19 measures disrupted students' 
academic routine and social life, which might have affected their perception of 
loneliness. This study investigated the prevalence of perceived loneliness among 
university students in Germany during the COVID-19 pandemic and its associations 
with mental health, behavioral outcomes, and sociodemographic characteristics.
METHODS: COVID-19 German student well-being study (C19 GSWS) collected data from 
five German universities from October 27th to November 14th, 2021, resulting in 
a sample of 7,203 respondents. Associations of loneliness with depressive 
symptoms, anxiety, social and physical activity, as well as sociodemographic 
characteristics, were analyzed using multivariable logistic regressions.
RESULTS: A total of 20.6% of students reported loneliness. Students with 
depressive or anxiety symptoms had more than eight- or sixfold odds, 
respectively, for reporting loneliness (depressive symptoms: OR = 8.29; 95% CI: 
7.21-9.52; anxiety: OR = 6.48; 95% CI: 5.65-7.43) compared with students who did 
not report any symptoms. Students who were less physically active were more 
likely to experience loneliness compared with students who were more physically 
active (no moderate physical activity: OR = 1.39; 95% CI: 1.21-1.59; no vigorous 
physical activity: OR = 1.19; 95% CI: 1.04-1.36). We found no association 
between loneliness and social activity. However, loneliness was associated with 
being single (OR = 2.93; 95% CI: 2.55-3.36), living alone (OR = 1.31; 95% CI: 
1.13-1.52), or having a temporary residency status in Germany (OR = 2.24; 95% 
CI: 1.65-3.04).
CONCLUSION: Our findings highlight the importance of loneliness as a relevant 
factor associated with health. Further research is needed to determine potential 
protective factors to tackle loneliness and to investigate how study conditions 
at higher education institutions may affect students' perceived loneliness.

Copyright © 2023 Wenig, Heumann, Stock, Busse, Negash, Pischke and Heinrichs.

DOI: 10.3389/fpubh.2023.1284460
PMCID: PMC10668152
PMID: 38026349 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest. The author(s) declared that 
they were an editorial board member of Frontiers, at the time of submission. 
This had no impact on the peer review process and the final decision.


222. Front Public Health. 2023 Nov 9;11:1234201. doi: 10.3389/fpubh.2023.1234201. 
eCollection 2023.

Predictors of mental health problems during the COVID-19 outbreak in Egypt in 
2021.

Abdel-Rahman S(1), Awwad FA(2), Ismail EAA(2), Kibria BMG(3), Abonazel MR(4).

Author information:
(1)Department of Demography and Biostatistics, Faculty of Graduate Studies for 
Statistical Research, Cairo University, Giza, Egypt.
(2)Department of Quantitative Analysis, College of Business Administration, King 
Saud University, P.O. Box 71115, Riyadh 11587, Saudi Arabia.
(3)Department of Mathematics and Statistics, Florida International University, 
Miami, FL, United States.
(4)Department of Applied Statistics and Econometrics, Faculty of Graduate 
Studies for Statistical Research, Cairo University, Giza, Egypt.

BACKGROUND: With the widespread outbreak of the coronavirus (COVID-19) pandemic, 
many countries, including Egypt, have tried to restrict the virus by applying 
social distancing and precautionary measures. Understanding the impact of 
COVID-19-induced risks and social distancing measures on individuals' mental 
health will help mitigate the negative effects of crises by developing 
appropriate mental health services. This study aimed to investigate the most 
contributing factors that affected individuals' mental health and how 
individuals' mental health has changed over the lockdown period in Egypt in 
2021.
METHODS: The study draws on a nationally representative sample from the combined 
COVID-19 MENA Monitor Household Survey conducted by the Economic Research Forum. 
The data were collected in Egypt by phone over two waves in February 2021 and 
June 2021. The total number of respondents is 4,007 individuals. The target 
population is mobile phone owners aged 18-64 years. The 5-item World Health 
Organization Well-Being Index (WHO-5) is used to assess the individuals' mental 
health over the past 2 weeks during the pandemic. Penalized models (ridge and 
LASSO regressions) are used to identify the key drivers of mental health status 
during the COVID-19 pandemic.
RESULTS: The mean value of mental health (MH) scores is 10.06 (95% CI: 
9.90-10.23). The average MH score for men was significantly higher than for 
women by 0.87. Rural residents also had significantly higher MH scores than 
their urban counterparts (10.25 vs. 9.85). Middle-aged adults, the unemployed, 
and respondents in low-income households experienced the lowest MH scores (9.83, 
9.29, and 9.23, respectively). Individuals' mental health has deteriorated due 
to the negative impacts of the COVID-19 pandemic. Regression analysis 
demonstrated that experiencing food insecurity and a decrease in household 
income were independent influencing factors for individuals' mental health (p < 
0.001). Furthermore, anxiety about economic status and worrying about 
contracting the virus had greater negative impacts on mental health scores (p < 
0.001). In addition, women, middle-aged adults, urban residents, and those 
belonging to low-income households were at increased risk of poor mental health 
(p < 0.05).
CONCLUSION: The findings reveal the importance of providing mental health 
services to support these vulnerable groups during crises and activating social 
protection policies to protect their food security, incomes, and livelihoods. A 
gendered policy response to the pandemic is also required to address the mental 
pressures incurred by women.

Copyright © 2023 Abdel-Rahman, Awwad, Ismail, Kibria and Abonazel.

DOI: 10.3389/fpubh.2023.1234201
PMCID: PMC10665964
PMID: 38026343 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


223. PeerJ. 2023 Nov 16;11:e16389. doi: 10.7717/peerj.16389. eCollection 2023.

Thinking about it: the impact of COVID-19-related stimuli on prospective memory.

Vicentin S(1)(2), Cantarella G(3), Cona G(1)(2), Bisiacchi P(1)(2).

Author information:
(1)Department of General Psychology, University of Padua, Padua, Italy.
(2)Padua Neuroscience Center, University of Padua, Padua, Italy.
(3)Department of Psychology, University of Bologna, Bologna, Italy.

BACKGROUND: Since 2020, information regarding COVID-19 has been a constant 
presence in the news, in our conversations and thoughts. Continuous exposure to 
this type of stimuli could have an impact on cognitive processes essential for 
our everyday activities, such as prospective memory (PM). PM is the ability to 
remember to perform an intention at a specific point in the future, like 
remembering to take prescribed medicines at a specific time or to turn off the 
stove after cooking. Do COVID-related stimuli affect our ability to perform a PM 
task?
METHODS: To answer this question, we proposed a novel version of the classical 
paradigm used to investigate PM. Namely, this paradigm includes a baseline 
condition, in which an ongoing task is presented alone, and a PM condition in 
which the same task is proposed again together with a second (prospective) task. 
In this study, a short video clip was presented between the baseline and the PM 
condition. The video clip displayed either neutral, negative, or COVID-related 
content. Additionally, participants were asked to respond to two questionnaires 
and a series of questions regarding their well-being and experience with the 
pandemic. Namely, the DASS-21 scale (evaluating depression, anxiety, and 
stress), and the COVID-19-PTSD questionnaire (a questionnaire evaluating 
post-traumatic stress disorder symptoms related to the pandemic experience) were 
administered. Participants' performance and responses were analyzed using a 
linear mixed effect (LME) model approach, and correlation analyses were run to 
highlight possible correlations between participants' scores in the DASS-21, the 
COVID-19-PTSD, and the additional questions on their personal experience with 
the pandemic.
RESULTS: The LME models revealed significant effects of the displayed video on 
performance: in line with previous studies, the clip displaying standard 
negative contents led to impaired accuracy in the ongoing task in the PM 
condition, compared to the Baseline. In contrast, participants who saw the 
COVID-related clip showed improved accuracy in the ongoing task compared to the 
other participants, selectively in the block performed after the video clip was 
displayed (PM condition). Furthermore, the explanatory power of the LME model 
calculated on accuracy to the ongoing trials was enhanced by the inclusion of 
the scores in the anxiety subscale of the DASS-21, suggesting a detrimental role 
of anxiety. Altogether, these results indicate a different effect of the 
exposure to classical negative contents (associated with a cost in terms of 
accuracy in the ongoing task between the baseline and the PM condition) and the 
pandemic-related one, which was instead characterized by a higher accuracy to 
ongoing trials compared to the other video clips. This counterintuitive finding 
seems to suggest that COVID-related stimuli are processed as "acute stressors" 
rather than negative stimuli, thus inducing a state of increased alertness and 
responsivity.

©2023 Vicentin et al.

DOI: 10.7717/peerj.16389
PMCID: PMC10657566
PMID: 38025740 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare there are no competing 
interests.


224. PLoS One. 2023 Nov 29;18(11):e0295064. doi: 10.1371/journal.pone.0295064. 
eCollection 2023.

The long-term impact of the Covid-19 pandemic on financial insecurity in 
vulnerable families: Findings from the Born in Bradford Covid-19 longitudinal 
study.

Reece S(1), Dickerson J(2), Kelly B(2), McEachan RRC(2), Pickett KE(3).

Author information:
(1)Hull York Medical School, York, North Yorkshire, United Kingdom.
(2)Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, 
West Yorkshire, United Kingdom.
(3)Department of Health Services, University of York, Heslington Road, York, 
North Yorkshire, United Kingdom.

There is growing recognition that the public health measures employed to control 
the spread of the COVID-19 pandemic had unintended consequences on socioeconomic 
security and health inequalities, having the greatest impact on the most 
vulnerable groups. This longitudinal study aims to explore the medium to 
long-term impacts of the COVID-19 pandemic and subsequent public health measures 
on financial security for families living in the deprived and ethnically diverse 
city of Bradford. We collected data at four time points before and during the 
pandemic from mothers who participated in one of two prospective birth cohort 
studies in Bradford. The findings demonstrate that the risk of experiencing 
financial insecurity rose sharply during the pandemic and has not returned to 
pre-COVID-19 baseline levels. Several individual characteristics were found to 
be possible predictors of financial insecurity, including homeowner status, free 
school meal eligibility and not working. Protective factors against financial 
insecurity include: living in more affluent areas; greater levels of educational 
attainment; and families with two or more adults in the household. Notably, 
families of Pakistani Heritage were found to have the greatest risk of 
experiencing financial insecurity throughout the pandemic. Furthermore, this 
study demonstrated that there were strong associations between financial 
insecurity and maternal health and wellbeing outcomes, with mothers experiencing 
financial insecurity being more likely to report unsatisfactory general health 
and clinically important symptoms of depression and anxiety. The findings of 
this study highlight that the impact of financial insecurity experienced by 
mothers and their families throughout the pandemic was severe, wide ranging and 
affected the most vulnerable. In the wake of the pandemic, the emerging cost of 
living and energy crisis emphasises the urgent need for policy makers to act to 
support vulnerable families to prevent further widening of existing health and 
social inequalities.

Copyright: © 2023 Reece et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0295064
PMCID: PMC10686492
PMID: 38019781 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


225. J Nerv Ment Dis. 2023 Dec 1;211(12):968-973. doi: 10.1097/NMD.0000000000001607.

Impact of Severe Acute Respiratory Syndrome, Coronavirus Disease 2019, and 
Social Unrest on Adult Psychiatric Admissions in Hong Kong: A Comparative 
Population-Based Study.

Ma CF, Chien WT(1), Luo H(2), Bressington D(3), Chen EYH, Chan SKW.

Author information:
(1)The Nethersole School of Nursing, The Chinese University of Hong Kong.
(2)Department of Social Work and Social Administration, Faculty of Social 
Science, The University of Hong Kong, Hong Kong Special Administrative Region, 
China.
(3)College of Nursing and Midwifery, Charles Darwin University, Casuarina, 
Australia.

In Hong Kong, two infectious disease outbreaks occurred in 2003 (SARS) and 2020 
(COVID-19), and a large-scale social unrest happened in 2019. These were 
stressful societal events that influenced the mental well-being of the public. 
We aimed to explore the impact of these events on psychiatric admissions in Hong 
Kong. Socioeconomic and population-based psychiatric hospital admission data 
were retrieved from the government and Hospital Authority. Negative binomial 
time-series regression analysis was applied and we found overall significant 
reductions of psychiatric admissions during both the SARS and COVID-19 periods 
(-7.4% to -16.8%). Particularly, the admissions for unipolar disorders (-16.2% 
to -39.7%) and neuroses (-20.9% to -31.9%) were greatly reduced during the 
infection outbreaks. But an increase of admissions for schizophrenia (12.0%) was 
seen during the social unrest period. These findings support introducing early 
and targeted community mental health care strategies to the vulnerable people 
during the stressful societal events.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/NMD.0000000000001607
PMID: 38015187 [Indexed for MEDLINE]


226. J Health Care Poor Underserved. 2023;34(3):931-948.

Low-income San Franciscans' Access to Basic Needs during COVID Shelter-in-Place: 
A Focus on People Who Use Drugs.

McDonell C, Li R, Runnels A, Morris MD.

We conducted a cross-sectional study of low-income San Franciscans to assess the 
impact of COVID-19 on their life and well-being during the period of the 
COVID-19 pandemic when the focus was on higher socioeconomic populations. 
Stratified analyses compared people who used drugs with those who did not and 
open-ended response data were sorted into themes. Of the 145 participants, most 
(70%) changed their behavior by practicing social distancing and reducing the 
number of their contacts. Of people who used drugs (98, 68%), 40% reported 
increased difficulty accessing/using drugs, 33% reduced access to drug 
treatment, and 41% increased concern about drug overdose for themselves or 
others. Compared with those who did not, people who used drugs experienced 
improvements in access to food, feeling supported by friends and family, and 
access to medical care. Our findings indicate the shift in services during 
COVID-19 had mixed impacts on people who use drugs.

PMID: 38015130 [Indexed for MEDLINE]


227. Intellect Dev Disabil. 2023 Dec 1;61(6):454-467. doi: 
10.1352/1934-9556-61.6.454.

Pre- and Post-COVID-19 Outcomes for Israelis With Intellectual and Developmental 
Disabilities in the Community.

Gur A(1), Soffer M(2), Blanck PD(3), Quinn G(4), Rimmerman A(5).

Author information:
(1)Ayelet Gur, Tel-Hai College, Israel.
(2)Michal Soffer, University of Haifa, Israel.
(3)Peter D. Blanck, Syracuse University, USA.
(4)Gerard Quinn, National University of Ireland.
(5)Arie Rimmerman, University of Haifa, Israel.

This study is among the first pre-post examinations to explore differences in 
subjective well-being, adaptive and maladaptive behavior, close relationships, 
community integration, family members' satisfaction with residential and 
community living settings, and family contact before and after the COVID-19 
outbreak. Participants demonstrated better life satisfaction and adaptive 
behavior before COVID-19 than after COVID-19. Participants reported closer 
relationships with family members and peers before COVID-19 and closer 
relationships with staff members after COVID-19. The findings reveal mixed, 
although mostly negative, effects of the pandemic on people with intellectual 
and developmental disabilities in the community in Israel, in accord with extant 
comparative research.

©AAIDD.

DOI: 10.1352/1934-9556-61.6.454
PMID: 38011742 [Indexed for MEDLINE]


228. Eur J Dent Educ. 2024 May;28(2):522-529. doi: 10.1111/eje.12977. Epub 2023 Nov 
27.

Before and after: COVID-19 impacts on dental students' well-being, clinical 
competency and employment opportunities.

Hill EB(1), Mastny-Jensen C(1), Loch C(1).

Author information:
(1)Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, 
Dunedin, New Zealand.

INTRODUCTION: The onset of COVID-19 challenged dental schools worldwide, 
impacting clinical training. In Australasia, New Zealand adopted a COVID-19 
'elimination strategy', involving nationwide lockdowns that halted face-to-face 
education. The 'elimination strategy' adopted at the pandemic onset, which 
permitted return to 'normal life' in 2021, allowed the pandemic impacts and 
those related workforce transition to be teased out. This study aimed to 
evaluate perceived impacts of the COVID-19 pandemic on health and well-being, 
clinical competency and employment opportunities of dental students.
MATERIALS AND METHODS: Two surveys were distributed to final year dental 
students (n = 94; age range 20-35): one during their final semester and the 
second six months following graduation. Surveys included open and closed ended 
questions on participants' self-perceived impacts of COVID-19 on health and 
well-being, clinical competency and employment opportunities. Average 
percentages were calculated and descriptive statistics performed.
RESULTS: Pre-graduation, participants reported COVID-19 negatively impacted 
their mental and social health. Slightly lower scores on all dimensions of 
health post-graduation were likely due to transitioning to the workforce. 
Pre-graduation, less than half of participants felt prepared to provide the full 
scope of dental treatment; post-graduation most felt confident to do so. Most 
participants expected COVID-19 would negatively impact employment opportunities 
for their cohort, despite all participants being employed when the second survey 
was conducted.
CONCLUSION: Participants self-rated health and clinical competency scores were 
lower post-graduation when NZ returned to 'normal life', meaning lower scores 
were related to workforce transition. Dental schools need to be prepared to 
provide alternative forms of dental education and help mitigate mental health 
impacts of future major course disruptions.

© 2023 The Authors. European Journal of Dental Education published by John Wiley 
& Sons Ltd.

DOI: 10.1111/eje.12977
PMID: 38009831 [Indexed for MEDLINE]


229. Gac Sanit. 2023 Nov 25;37:102346. doi: 10.1016/j.gaceta.2023.102346. eCollection 
2023.

Impact of the COVID-19 pandemic on the psychological well-being of adolescents 
by gender identity.

Folch C(1), Ganem F(2), Colom-Cadena A(3), Martínez I(3), Cabezas C(4), Casabona 
J(5).

Author information:
(1)Centre for Epidemiological Studies of Sexually Transmitted Disease and AIDS 
in Catalonia (CEEISCAT), Badalona, Barcelona, Spain; Germans Trias i Pujol 
Research Institute (IGTP), Badalona, Barcelona, Spain; CIBER de Epidemiología y 
Salud Pública (CIBERESP), Spain. Electronic address: cfolch@iconcologia.net.
(2)Centre for Epidemiological Studies of Sexually Transmitted Disease and AIDS 
in Catalonia (CEEISCAT), Badalona, Barcelona, Spain; Germans Trias i Pujol 
Research Institute (IGTP), Badalona, Barcelona, Spain; Departament de Pediatria, 
d'Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Publica, 
Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain.
(3)Centre for Epidemiological Studies of Sexually Transmitted Disease and AIDS 
in Catalonia (CEEISCAT), Badalona, Barcelona, Spain; Germans Trias i Pujol 
Research Institute (IGTP), Badalona, Barcelona, Spain.
(4)Public Health Secretary, Health Department of the Government of Catalonia, 
Barcelona, Spain.
(5)Centre for Epidemiological Studies of Sexually Transmitted Disease and AIDS 
in Catalonia (CEEISCAT), Badalona, Barcelona, Spain; Germans Trias i Pujol 
Research Institute (IGTP), Badalona, Barcelona, Spain; CIBER de Epidemiología y 
Salud Pública (CIBERESP), Spain; Departament de Pediatria, d'Obstetrícia i 
Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de 
Barcelona, Bellaterra, Barcelona, Spain.

OBJECTIVE: To describe the impact of the COVID-19 pandemic on the psychological 
well-being of adolescents in Catalan schools by gender identity, and to compare 
coping strategies adopted to manage the health crisis and their relationship 
with the self-perceived impact of COVID-19 on mental health.
METHOD: Cross-sectional study in educational centres that includes 1171 
adolescents over 15 years old from October to November 2021. Multivariate 
logistic regression models were built to evaluate the association between coping 
strategies with self-perceived impact of the pandemic on mental health.
RESULTS: A greater proportion of girls perceived a worsening in mental health 
than boys due to COVID-19 (36.9% and 17.8%, respectively). The main emotions 
reported for both girls and boys were worry and boredom. The study found an 
association between positive coping strategies with less adverse mental health 
among girls, whereas unhealthy habits were associated with a higher probability 
of declaring worsening of mental health for both girls and boys.
CONCLUSIONS: This study demonstrated the negative impact of the COVID-19 
pandemic on psychological well-being in adolescents and a clearly worse impact 
on girls. It is important to keep monitoring the medium- and long-term secondary 
impacts of the pandemic on mental health outcomes of adolescents and to gather 
information that can improve services for the development of healthy coping 
strategies during health crises like COVID-19, which include gender perspective.

Copyright © 2023 SESPAS. Publicado por Elsevier España, S.L.U. All rights 
reserved.

DOI: 10.1016/j.gaceta.2023.102346
PMID: 38007956 [Indexed for MEDLINE]


230. BMC Public Health. 2023 Nov 25;23(1):2340. doi: 10.1186/s12889-023-17230-1.

Mental health and resilience after the covid-19 pandemic: a multi-ethnic 
longitudinal survey.

Sumner J(1)(2), Chen M(3), En AMSS(3), Xun VLW(3), Neo SH(4), Lim YW(5)(4).

Author information:
(1)Department of Medicine, Yong Loo Lin School of Medicine, National University 
of Singapore, Singapore, Singapore. Jennyssumner@gmail.com.
(2)Medical Affairs - Research Innovation & Enterprise, Alexandra Hospital, 
National University Health System, 378 Alexandra Road, Singapore, 159964, 
Singapore. Jennyssumner@gmail.com.
(3)National Centre of Infectious Diseases, Singapore, Singapore.
(4)Medical Affairs - Research Innovation & Enterprise, Alexandra Hospital, 
National University Health System, 378 Alexandra Road, Singapore, 159964, 
Singapore.
(5)Department of Medicine, Yong Loo Lin School of Medicine, National University 
of Singapore, Singapore, Singapore.

BACKGROUND: Longitudinal work on the impact of COVID-19 on population mental 
health and resilience beyond the first year of the pandemic is lacking. We aimed 
to understand how mental health and resilience evolved during the pandemic 
(2020) and two years later (2022) in a multi-ethnic Singaporean population. In 
addition, we assessed what characteristics were associated with mental health 
and resilience scores.
METHODS: We surveyed and analysed two balanced panel samples up to four times 
between 30th April 2020 and 11th July 2022. One panel assessed psychological 
distress (Kessler-10) and well-being (short Warwick Edinburgh Mental Well-being 
scale) n = 313, and one panel assessed resilience (10-item Connor-Davidson 
Resilience Scale©) n = 583. A linear panel regression model with random effects 
assessed the temporal patterns for psychological distress, well-being, and 
resilience.
RESULTS: Mean psychological distress scores (Kessler-10) were relatively stable 
over time and were not statistically significantly worse than baseline at any 
follow-up. Well-being scores improved over time and were significantly better 
than baseline by the third survey (22nd Jul-18th Aug 2020) (0.54 p = 0.007, 
Cohen's d 0.12). Scores had worsened by the last survey (27th June-11th July 
2022) but were not significantly different from baseline 0.20 p = 0.30. 
Resilience scores declined over time. Scores at both follow-ups (14th Aug- 4th 
Sep 2020 and 27th June-11th July 2022) were statistically significantly lower 
than baseline: -1.69 p < 0.001 (Cohen's d 0.25) and -0.96 p = 0.006 (Cohen's d 
0.14), respectively.
CONCLUSIONS: Our study joins a body of work measuring the longitudinal effects 
of COVID-19 on population mental health and resilience. While, the magnitude of 
the effect related to resilience decline is small, our findings indicate that 
particular attention should be given to ongoing population surveillance, with 
the aim of maintaining good health and well-being.

© 2023. The Author(s).

DOI: 10.1186/s12889-023-17230-1
PMCID: PMC10676608
PMID: 38007456 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


231. Int J Environ Res Public Health. 2023 Nov 20;20(22):7086. doi: 
10.3390/ijerph20227086.

Experiences of Remote Provision across a Voluntary Sector Organisation Providing 
Mental Health and Wellbeing Services for Young People.

Worsley J(1)(2), Hassan S(1)(2), Nolan L(3), Corcoran R(1)(2).

Author information:
(1)Department of Primary Care and Mental Health, University of Liverpool, 
Liverpool L69 7ZA, UK.
(2)NIHR Applied Research Collaboration North West Coast (ARC NWC), Liverpool L69 
7ZA, UK.
(3)NHS Cheshire and Merseyside Integrated Care Board, Liverpool L1 2SA, UK.

The global COVID-19 pandemic presented not only challenges for services but also 
opportunities for reflection and change. This study aimed to understand young 
people, parents/carers, and professionals' experiences of remote provision 
across a voluntary sector organization to inform the nature of future delivery. 
Reflections from professionals (n = 7), young people (n = 7), and parents/carers 
(n = 2) were collected through semi-structured interviews and focus groups. Data 
were thematically analysed. Five overarching themes were identified: 
'Accessibility', 'Remote therapeutic experiences', 'Translating to online', 
'Spaces of comfort/discomfort', and 'Moving towards hybrid provision'. The 
COVID-19 pandemic changed service provision, notably with accelerated 
digitalisation. Although the service became more accessible, the digitalisation 
of services impacted the relational experiences for young people. Nevertheless, 
online provision was described as a 'steppingstone', allowing young people to 
engage in online therapy or group programmes before transferring to in-person 
provision. Although remote provision can lead to improvements in young people's 
mental health, this format was not suitable for all. When considering future 
models of provision, assessing needs, preferences, and access to private space 
and hardware are all important considerations when deciding which format to use 
to achieve the best possible outcomes.

DOI: 10.3390/ijerph20227086
PMCID: PMC10671167
PMID: 37998317 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


232. Int J Environ Res Public Health. 2023 Nov 10;20(22):7046. doi: 
10.3390/ijerph20227046.

Positive Mental Health of Migrants in the UK during COVID-19: A Review.

Kotera Y(1)(2), Adam H(3), Kirkman A(4), Aledeh M(5), Brooks-Ucheaga M(4), 
Todowede O(1), Rennick-Egglestone S(1), Jackson JE(4).

Author information:
(1)School of Health Sciences, University of Nottingham, Nottingham NG7 2TU, UK.
(2)Center for Infectious Disease Education and Research, Osaka University, Osaka 
565-0871, Japan.
(3)Institut für Religionswissenschaft, University of Vienna, 1010 Vienna, 
Austria.
(4)College of Health, Psychology and Social Care, University of Derby, Derby 
DE22 1GB, UK.
(5)Department of Psychiatry, Wiener Gesundheitsverbund, Klinik Donaustadt, 
Langobardenstraße 122, 1220 Vienna, Austria.

COVID-19 impacted the mental health of many people in the UK. The negative 
impact was especially substantial among vulnerable population groups, including 
migrants. While research has focused on the negative aspects of mental health 
during the pandemic, the positive mental health of migrants in the UK during 
COVID-19 remained to be evaluated. This review aimed to identify literature that 
focused on positive mental health, and thematically synthesise the findings to 
understand what positive mental health approaches were employed to support 
specific outcomes during the pandemic for them to survive in this difficult 
time. Medline, Embase, and PsycINFO were searched using terms including "mental 
health", "migrants", and "COVID-19". The Critical Appraisal Skills Programme 
checklist was used to assess the quality of the included studies. There were 
only two studies examining the positive mental health of UK migrants during this 
period. They describe approaches such as religious beliefs, passion for and 
acknowledgement of their job, learning new things, being physically active, 
social media, and social activities, producing outcomes such as inner peace, 
confidence, well-being, and a sense of belonging. The quality of the included 
studies was high. More research about positive mental health in migrants in the 
UK during the pandemic is needed.

DOI: 10.3390/ijerph20227046
PMCID: PMC10671421
PMID: 37998277 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


233. Int J Environ Res Public Health. 2023 Nov 9;20(22):7040. doi: 
10.3390/ijerph20227040.

Exploring the Lived Experiences of Vulnerable Females from a Low-Resource 
Setting during the COVID-19 Pandemic.

Haffejee F(1), Maharajh R(1), Sibiya MN(2).

Author information:
(1)Department of Basic Medical Sciences, Durban University of Technology, Durban 
4000, South Africa.
(2)Division of Research, Innovation and Engagement, Mangosuthu University of 
Technology, Umlazi 4031, South Africa.

The onset of the Coronavirus disease 2019 (COVID-19) pandemic has affected the 
mental health and well-being of women in vulnerable settings. Currently, there 
is limited evidence that explores the wellness of elderly women under the 
associated restrictions. This study explores the lived experiences of elderly 
women in a vulnerable community in Durban, South Africa. A face-to-face, 
in-depth qualitative approach was implemented to interview 12 women aged 50 
years and over. Thematic analysis was used to analyse the data. The findings 
suggest that social interactions, the effect of a high death rate, and financial 
strain predominantly affect stress and anxiety levels. Despite the women being 
in receipt of pensions and/or other grants, their supplementary income was 
reduced. This, together with the additional expenses incurred during the 
lockdown, resulted in anxiety over finances. The lack of social interaction, 
with limits on visiting family and other loved ones when they were ill, along 
with the limit on the number of people attending the funerals of loved ones were 
also stressful. This study also reports on the resulting coping mechanisms, 
which included using hobbies such as baking and sewing as a means of self-care. 
Religious beliefs also relieved stress while home remedies were used as 
preventative measures during the lockdown restrictions due to COVID-19.

DOI: 10.3390/ijerph20227040
PMCID: PMC10671480
PMID: 37998271 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


234. Lancet. 2023 Nov;402 Suppl 1:S47. doi: 10.1016/S0140-6736(23)02143-8.

The role of the multiple Index of deprivation in predicting mental health 
outcomes after the COVID-19 pandemic in adolescents: a cross-sectional study.

Hazir SG(1), Ryan C(1), Moore A(1), Lewis C(1), Lunn J(2).

Author information:
(1)Lancaster Medical School, Faculty of Health and Medicine, Lancaster 
University, Lancaster, UK.
(2)Lancaster Medical School, Faculty of Health and Medicine, Lancaster 
University, Lancaster, UK. Electronic address: j.lunn1@lancaster.ac.uk.

BACKGROUND: The number of children and young people (CYP) diagnosed with mental 
health problems has increased over the past decade. The COVID-19 pandemic also 
has accelerated this increase, raising significant concerns about adolescent 
emotional wellbeing. Research suggests that adolescents who live in more 
deprived areas are more likely to experience poor emotional wellbeing. Children 
in the northwest of England are among those with the poorest outcomes in the UK. 
We aimed to investigate the association between deprivation and mental health 
outcomes from 2019 to 2022. The aim was to support local authorities with 
targeted provision of public health services as well as predicting service need 
for 2022 onwards.
METHODS: In this cross-sectional study, we analysed routinely collected Schools 
Health Needs Assessment (SHNA) data. The School Health Needs Assessment dataset 
contained 32 676 responses from Year 6 (ages 10-11 years) and Year 9 (ages 13-14 
years) who completed the annual survey in 2019-22. The questionnaire was offered 
to all mainstream schools, delivered by the public health school nursing 
service. Index of multiple deprivation (IMD) data were provided for household 
postcodes. Data were analysed using IBM SPSS. Factor analysis created a 
composite emotional wellbeing scale (EWS) and estimates generated by school year 
(Years 6 and 9) and three academic years (2019-22). We calculated correlations 
between IMD and EWS overall and within school and academic year samples.
FINDINGS: The final total sample across the three consecutive survey years and 
the two school years was 32 659. The sample consisted of 15 932 (49%) female 
students and 5066 (16%) students who registered at school as from an ethnic 
minority. Of the total sample, 9209 (28%) lived in a postcode in the most 
deprived IMD quintile in England. There was an overall decrease in EWS from Year 
6 to Year 9 and from 2019 to 2022. The Year 6 students in 2022 reported mean 
levels of EWS equivalent to Year 9 students in 2019 indicating a shift toward 
poorer mental health in younger children. The correlational analyses showed no 
significant associations between IMD and EWS scores within the school or 
academic year cohorts. A follow-up analysis of children in receipt or not in 
receipt of free school meals also showed no significant association with EWS 
scores.
INTERPRETATION: Findings showed that the emotional wellbeing of children and 
young people in the northwest of England has deteriorated since 2019, with 
greatest changes observed in the younger cohort of children in Year 6. This was 
not explained by postcode-based indices of multiple deprivation. Although it is 
recognised that deprivation is both a cause and a result of poor mental health, 
policy decisions on service provision for children and young people should not 
be based solely on IMD or receipt of free school meals. A rapid response is 
required to address the decline in emotional wellbeing currently observed in 
younger children of the northwest of England.
FUNDING: None.

Copyright © 2023 Elsevier Ltd. All rights reserved.

DOI: 10.1016/S0140-6736(23)02143-8
PMID: 37997089 [Indexed for MEDLINE]


235. Sci Rep. 2023 Nov 23;13(1):20559. doi: 10.1038/s41598-023-47950-8.

Psychological disturbances encountered by selected undergraduates studying at 
the University of Ruhuna, Sri Lanka during the Covid-19 pandemic: a 
cross-sectional study.

Kaushani THM(1), Weeratunga EB(2).

Author information:
(1)Department of Nursing, Faculty of Allied Health Sciences, University of 
Ruhuna, Galle, Sri Lanka.
(2)Department of Nursing, Faculty of Allied Health Sciences, University of 
Ruhuna, Galle, Sri Lanka. eranthiw@ahs.ruh.ac.lk.

University undergraduates are increasingly recognized as a vulnerable population 
with a higher level of psychological disturbances. During the Covid-19 pandemic, 
universities closed all over the world, resulting in the psychological 
well-being of this population being severely affected across the globe. This 
study examined the prevalence of stress, anxiety, and depressive symptoms 
encountered by undergraduates of the selected five faculties at the University 
of Ruhuna in Southern Sri Lanka due to the Covid-19 pandemic, its associated 
factors, and the correlations between stress, anxiety, and depressive symptoms. 
An online, cross-sectional, descriptive study was conducted among undergraduates 
using pre-tested, self-administered questionnaires from the randomly selected 
five faculties: Allied Health Sciences, Engineering, Humanities and Social 
Sciences, Management and Finance, and Medicine. Undergraduates were invited to 
complete the Google Form. Socio-demographic details and a 21-item Depression, 
Anxiety, and Stress Scale (21-DASS) were used for data collection. Stress, 
anxiety, and depressive symptoms were evaluated using a Sinhala version of the 
21-DASS scale. Ethical permission was granted by the Ethics Review Committee of 
the Faculty of Allied Health Sciences, University of Ruhuna. Among the 359 
undergraduates, the majority were represented by females (62.1%). The mean age 
of the sample was 23.67 years (SD ± 1.6). Stress, anxiety, and depressive 
symptoms were found to be prevalent in 53.7%, 41.8%, and 63.8% of undergraduates 
respectively. Younger and female undergraduates had more impact on psychological 
issues than their counterparts. It revealed a significant positive correlation 
between anxiety and depressive symptoms (r = 0.646, p < .001), anxiety and 
stress (r = 0.868, p < .001), and stress and anxiety (r = 0.786, p < .001). Most 
undergraduates experienced considerable levels of stress, anxiety, and 
depressive symptoms during the Covid-19 as increasing stress, anxiety, or 
depressive symptoms, tend to increase all types of psychological disturbances. 
The development of mental health among undergraduates is essential and needs 
innovative strategies to improve the psychological well-being of undergraduates. 
The initiation of a stress management programme and expanded available 
counseling services are also important. Further studies are needed to be 
conducted on the extended topic of how the Covid-19 era is affecting the 
psychological well-being of undergraduates from different universities 
(state/non-state), locations, and different study departments.

© 2023. The Author(s).

DOI: 10.1038/s41598-023-47950-8
PMCID: PMC10667504
PMID: 37996606 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


236. Scand J Psychol. 2023 Nov 22. doi: 10.1111/sjop.12986. Online ahead of print.

Emerging costs in a "hidden" workforce: The longitudinal psychosocial effects of 
caregiving during the COVID-19 pandemic among Norwegian adults.

Hansen T(1)(2)(3), Hynek K(1)(4), McMunn A(5), Nes RB(1)(3)(6), Skirbekk 
V(7)(8), Vollrath ME(1), Methi F(9).

Author information:
(1)Department of Mental Health and Suicide, Norwegian Institute of Public 
Health, Oslo, Norway.
(2)Oslo Metropolitan University, Oslo, Norway.
(3)Promenta Research Center, University of Oslo, Oslo, Norway.
(4)Division for Health Services, Norwegian Institute of Public Health, Oslo, 
Norway.
(5)Research Department of Epidemiology & Public Health, University College 
London (UCL), London, UK.
(6)Department of Philosophy, Classics, and History of Arts and Ideas, University 
of Oslo, Oslo, Norway.
(7)Center for Fertility and Health, Norwegian Institute of Public Health, Oslo, 
Norway.
(8)Department of Psychology, University of Oslo, Oslo, Norway.
(9)Department of Health Service, Norwegian Institute of Public Health, Oslo, 
Norway.

During COVID-19 many informal caregivers experienced increased caregiving load 
while access to formal and informal support systems and coping resources 
decreased. Little is known about the psychosocial costs of these challenges for 
an essential yet vulnerable and "hidden" frontline workforce. This study 
explores and compares changes in psychosocial well-being (psychological 
well-being, psychological ill-being, and loneliness) before and across up to 
three stages of the COVID-19 pandemic among caregivers and non-caregivers. We 
also examine predictors of psychosocial well-being among caregivers during the 
peak of the pandemic. We use longitudinal data collected online in the Norwegian 
Counties Public Health Survey (age: 18-92) in four counties and up to four data 
points (n = 14,881). Caregivers are those who provide care unpaid, continuous (≥ 
monthly across all time points) help to someone with health problems. Findings 
show that levels of psychosocial well-being first remained stable but later, 
during the peak stages of the pandemic, dropped markedly. Caregivers (13-15% of 
the samples) report lower psychosocial well-being than non-caregivers both 
before and during the pandemic. Caregivers seem especially vulnerable in terms 
of ill-being, and during the peak of the pandemic caregivers report higher net 
levels of worry (OR = 1.22, p < 0.01) and anxiety (OR = 1.23, p < 0.01) than 
non-caregivers. As expected, impacts are graver for caregivers who provide more 
intensive care and those reporting health problems or poor access to social 
support. Our study findings are valuable information for interventions to 
support caregivers during this and future pandemics.

© 2023 The Authors. Scandinavian Journal of Psychology published by Scandinavian 
Psychological Associations and John Wiley & Sons Ltd.

DOI: 10.1111/sjop.12986
PMID: 37994164


237. BMC Health Serv Res. 2023 Nov 22;23(1):1285. doi: 10.1186/s12913-023-10237-9.

Impact of the COVID-19 pandemic on internal medicine training in the United 
States: results from a national survey.

St-Pierre F(#)(1), Petrosyan R(#)(2), Gupta A(3), Hughes S(4), Trickett J(5), 
Read S(6), Van Doren V(7), Zeveney A(6), Shoushtari C(8).

Author information:
(1)Department of Internal Medicine, Division of Hematology/Oncology, 
Northwestern University, 676 N St Clair St (Suite 850), Chicago, IL, 60611, USA. 
Frederique.st-pierre@northwestern.edu.
(2)Combined Brigham and Women's Hospital and Massachusetts General Hospital 
Department of Medicine, Division of Nephrology, Harvard University, Boston, MA, 
USA.
(3)Department of Cardiology, The Mount Sinai Hospital, New York, NY, USA.
(4)Department of Pulmonary, Critical Care, and Sleep Medicine, Naval Medical 
Center San Diego, San Diego, CA, USA.
(5)Department of Internal Medicine, Mayo Clinic, Phoenix, AZ, USA.
(6)Research Center, American College of Physicians, Philadelphia, PA, USA.
(7)Department of Internal Medicine, Emory University School of Medicine, 
Atlanta, GA, USA.
(8)Oak Street Health, Chicago, IL, USA.
(#)Contributed equally

BACKGROUND: Internal medicine (IM) residency is a notoriously challenging time 
generally characterized by long work hours and adjustment to new roles and 
responsibilities. The COVID-19 pandemic has led to multiple emergent adjustments 
in training schedules to accommodate increasing needs in patient care. The 
physician training period, in itself, has been consistently shown to be 
associated with vulnerability with respect to mental well-being. The impact of 
the COVID-19 pandemic on the experience of IM trainees is not well established.
OBJECTIVE: Characterize the impact of the COVID-19 pandemic on trainee clinical 
education, finances, and well-being.
METHODS: We developed a survey composed of 25 multiple choice questions, 6 of 
which had an optional short-answer component. The survey was distributed by the 
American College of Physicians (ACP) to 23,289 IM residents and subspecialty 
fellows. We received 1,128 complete surveys and an additional 269 partially 
completed surveys.
RESULTS: The majority of respondents reported a disruption in their clinical 
schedule (76%) and a decrease in both didactic conferences (71%) and protected 
time for education (56%). A majority of respondents (81%) reported an impact on 
their well-being with an increase in their level of burnout and 41% of 
respondents reported a decrease in level of direct supervision. Despite these 
changes, the majority of trainee respondents (78%) felt well prepared for 
clinical practice after graduation.
CONCLUSIONS: These results outline the vulnerable position of internal medicine 
physicians in training. Preserving educational experiences, adequate 
supervision, and humane work hours are essential in protecting trainees from 
mental illness and burnout during global emergencies.

© 2023. The Author(s).

DOI: 10.1186/s12913-023-10237-9
PMCID: PMC10666403
PMID: 37993947 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


238. Am J Prev Med. 2024 Apr;66(4):645-654. doi: 10.1016/j.amepre.2023.11.015. Epub 
2023 Nov 20.

Helping and Volunteering During COVID-19: Associations With Well-Being and 
Psychological Distress.

Weziak-Bialowolska D(1), Bialowolski P(2).

Author information:
(1)Centre for Evaluation and Analysis of Public Policies, Faculty of Philosophy, 
Jagiellonian University, Cracow, Poland; Human Flourishing Program, Harvard 
Institute for Quantitative Social Science, Cambridge, Massachusetts. Electronic 
address: doweziak@iq.harvard.edu.
(2)Human Flourishing Program, Harvard Institute for Quantitative Social Science, 
Cambridge, Massachusetts; Department of Economics, Kozminski University, Warsaw, 
Poland.

INTRODUCTION: Salutogenic effects of volunteering and helping activities have 
been well recognized in the pre-COVID-19 era. This study examines associations 
between helping others as well as additional volunteer activities during the 
first wave of the COVID-19 pandemic and 6 psychological distress and well-being 
outcomes one year later.
METHODS: Longitudinal data collected between 2019 and 2021 were used. Analyses 
were based on data from 42,005 middle-aged and older adults from 27 European 
countries who participated in the Survey of Health, Ageing, and Retirement in 
Europe (SHARE) and two SHARE Corona Surveys. Prospective associations were 
examined using generalized estimating equations. A series of secondary analyses 
and the sensitivity of the associations to unmeasured confounding provided 
evidence for the robustness of results. All analyses were conducted in December 
2022.
RESULTS: Helping others outside one's home in the first wave of COVID-19 was 
associated with subsequent increased risks of depression and anxiety. It was 
concurrently associated with an increased probability of an uplifting, hope, and 
happiness-inducing experience. Engagement in volunteer activities conducted in 
addition to helping was found to be prospectively associated with higher 
probability of an uplifting experience, but not with depression and anxiety. 
These associations were independent of demographic and socioeconomic 
characteristics, personality traits, prior quality of life and health history as 
well as pre-COVID-19 engagement in altruistic activities.
CONCLUSIONS: Helping and volunteering during the COVID-19 pandemic likely led to 
positive experiences. However, a negative impact on psychological distress of 
the same activities was also noted.

Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.amepre.2023.11.015
PMID: 37993015 [Indexed for MEDLINE]


239. Brain Behav. 2023 Dec;13(12):e3314. doi: 10.1002/brb3.3314. Epub 2023 Nov 21.

Acute stress symptoms in general population during the first wave of COVID 
lockdown in Italy: Results from the COMET trial.

Carmassi C(1), Sampogna G(2), Di Vincenzo M(2), Cipolla S(2), Toni C(2), Albert 
U(3), Carrà G(4), Cirulli F(5), Dell'Osso B(6)(7), Fantasia S(1), Nanni MG(8), 
Pedrinelli V(1), Pompili M(9), Sani G(10)(11), Tortorella A(12), Volpe U(13), 
Fiorillo A(2).

Author information:
(1)Department of Clinical and Experimental Medicine, University of Pisa, Pisa, 
Italy.
(2)Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, 
Italy.
(3)Department of Medicine, Surgery and Health Sciences, University of Trieste 
and Department of Mental Health, Azienda Sanitaria Universitaria Giuliano 
Isontina-ASUGI, Trieste, Italy.
(4)Department of Medicine and Surgery, University of Milan Bicocca, Milano, 
Italy.
(5)Center for Behavioral Sciences and Mental Health, National Institute of 
Health, Rome, Italy.
(6)Neuroscience Research Center, Department of Biomedical and Clinical Sciences 
and Aldo Ravelli Center for Neurotechnology and Brain Therapeutic, University of 
Milan, Milano, Italy.
(7)Department of Psychiatry and Behavioral Sciences, Stanford University, 
Stanford, California, USA.
(8)Institute of Psychiatry, Department of Neurosciences and Rehabilitation, 
University of Ferrara, Ferrara, Italy.
(9)Department of Neurosciences, Mental Health and Sensory Organs, Faculty of 
Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
(10)Department of Neuroscience, Section of Psychiatry, University Cattolica del 
Sacro Cuore, Rome, Italy.
(11)Department of Neuroscience, Sensory organs and Thorax, Department of 
Psychiatry, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy.
(12)Department of Psychiatry, University of Perugia, Perugia, Italy.
(13)Clinical Psychiatry Unit, Department of Clinical Neurosciences, Università 
Politecnica delle Marche, Ancona, Italy.

BACKGROUND: The coronavirus disease of 2019 (COVID-19) pandemic is an 
unprecedented traumatic event that has severely impacted social, economic, and 
health well-being worldwide. The COvid Mental hEalth Trial was specifically 
designed to evaluate the impact of the COVID-19 pandemic and its containment 
measures on the mental health of the Italian general population in terms of 
COVID-19-related acute stress disorder (ASD) symptoms.
METHODS: The present cross-sectional study is based on an online survey carried 
out in the period March-May 2020. Italian general adult population was invited 
to compile an anonymous survey, which included the severity of acute stress 
symptoms scale/National Stressful Events Survey Short Scale to investigate the 
occurrence and severity of ASD symptoms.
RESULTS: The final sample consisted of 20,720 participants. During the lockdown, 
subjects with pre-existing mental health problems reported a statistically 
significant higher risk of acute post-traumatic symptoms compared to the general 
population (B: 2.57; 95% CI:2.04-3.09; p < .0001) and health care professionals 
(B: .37; 95% CI: .02-0.72; p < .05). According to multivariate regression 
models, the levels of acute post-traumatic symptoms (p < .0001) were higher in 
younger and female respondents. Social isolation and sleep disorder/insomnia 
represented positive predictors of acute stress (B = 3.32, 95% CI = 3.08-3.57).
CONCLUSIONS: Concerns about the risk of infection as well as social isolation 
caused a higher incidence of acute post-traumatic stress symptoms that may 
predict the subsequent development of post-traumatic stress disorder symptoms in 
the long term.

© 2023 The Authors. Brain and Behavior published by Wiley Periodicals LLC.

DOI: 10.1002/brb3.3314
PMCID: PMC10726770
PMID: 37990771 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


240. BMC Psychiatry. 2023 Nov 21;23(1):862. doi: 10.1186/s12888-023-05353-z.

Prevalence of obsessive-compulsive disorders (OCD) symptoms among health care 
workers in COVID-19 pandemic: a systematic review and meta-analysis.

SoleimanvandiAzar N(1), Amirkafi A(1), Shalbafan M(2), Ahmadi SAY(1), Asadzandi 
S(3), Shakeri S(1), Saeidi M(4), Panahi R(2), Nojomi M(5)(6).

Author information:
(1)Preventive Medicine and Public Health Research Center, Psychosocial Health 
Research Institute, Department of Community and Family Medicine, School of 
Medicine, Iran University of Medical Sciences, Tehran, Iran.
(2)Mental Health Research Center, Psychosocial Health Research Institute, 
Department of Psychiatry, School of Medicine, Iran University of Medical 
Sciences, Tehran, Iran.
(3)Department of Medical Library and Information Science, School of Health 
Management and Information Sciences, Iran University of Medical Sciences, 
Tehran, Iran.
(4)Research Center for Addiction and Risky Behaviors, Iran University of Medical 
Sciences, Tehran, Iran.
(5)Preventive Medicine and Public Health Research Center, Psychosocial Health 
Research Institute, Department of Community and Family Medicine, School of 
Medicine, Iran University of Medical Sciences, Tehran, Iran. mnojomi@iums.ac.ir.
(6)Department of Sociology and Anthropology, Nipissing University, North Bay, 
ON, Canada. mnojomi@iums.ac.ir.

BACKGROUND: Obsessive Compulsive Disorder (OCD) symptoms, are among the serious 
mental health challenges that Health Care Workers (HCWs) faced during the 
COVID-19 pandemic. As these symptoms reduce the mental well-being and 
effectiveness of HCWs which are followed by poor health outcomes for patients, 
the aim of this systematic review and meta-analysis was to determine the 
prevalence of OCD symptoms among HCWs worldwide.
METHODS: PubMed, Google Scholar, Cochrane, Scopus, Web of Science, ProQuest, 
Emerald, and ERIC databases were searched using related keywords till the end of 
October 2021. Observational studies about the prevalence of OCD symptoms among 
healthcare workers during the COVID-19 pandemic were screened and evaluated. In 
order to assess the quality of studies, the Newcastle-Ottawa scale (NOS) 
checklist was used. The effect measure was the prevalence rate with a 95% 
confidence interval (CI).
RESULTS: A total of 7864 individuals from 11 studies were included. The range of 
OCD symptoms prevalence across these studies was from 0.07 to 0.47. Due to the 
high heterogeneity between the studies (I2 = 98.6%, P < 0.01), the random 
effects model was used. The pooled prevalence was 0.29 (95% CI: 0.22-0.38) based 
on logit transformed CI.
CONCLUSIONS: The pooled prevalence of OCD symptoms was 29% among the HCWs during 
the COVID-19 pandemic. This prevalence was higher than the general population 
according to the pre-pandemic literature, but lower than the recent reports amid 
the pandemic. Psychosocial interventions are suggested to be designed and 
implemented in such conditions.

© 2023. The Author(s).

DOI: 10.1186/s12888-023-05353-z
PMCID: PMC10664495
PMID: 37990311 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


241. PLoS One. 2023 Nov 21;18(11):e0294165. doi: 10.1371/journal.pone.0294165. 
eCollection 2023.

The CLoCk study: A retrospective exploration of loneliness in children and young 
people during the COVID-19 pandemic, in England.

McOwat K(1), Pinto Pereira SM(2), Nugawela MD(3), Ladhani SN(1), Newlands F(3), 
Stephenson T(3), Simmons R(1), Semple MG(4)(5), Segal T(6), Buszewicz M(3), 
Heyman I(3), Chalder T(7), Ford T(8), Dalrymple E(3); Consortium; Shafran R(3).

Author information:
(1)Immunisations and Vaccine Preventable Diseases Department, UK Health Security 
Agency, London, United Kingdom.
(2)Division of Surgery & Interventional Science, Faculty of Medical Sciences, 
University College London, London, United Kingdom.
(3)University College London-Great Ormond Street Institute of Child Health, 
London, United Kingdom.
(4)NIHR Health Protection Research Unit for Emerging and Zoonotic Infections, 
Institute of Infection, Veterinary and Ecological Sciences University of 
Liverpool, Liverpool, United Kingdom.
(5)Respiratory Medicine, Alder Hey Children's Hospital, Institute in The Park, 
University of Liverpool, Liverpool, United Kingdom.
(6)Department of Paediatrics and Adolescence, University College London 
Hospital, London, United Kingdom.
(7)Department of Psychological Medicine, Institute of Psychiatry, Psychology and 
Neuroscience, King's College London, London, United Kingdom.
(8)Department of Psychiatry, University of Cambridge, Hershel Smith Building 
Cambridge Biomedical Campus, Cambridge, United Kingdom.

BACKGROUND: During the COVID-19 pandemic children and young people (CYP) were 
socially restricted during a stage of life crucial to development, potentially 
putting an already vulnerable population at higher risk of loneliness, social 
isolation, and poorer wellbeing. The objectives of this study are to conduct an 
exploratory analysis into loneliness before and during the pandemic, and 
determine which self-reported factors are associated with loneliness.
METHODS AND FINDINGS: Participants from The Children with Long COVID (CLoCk) 
national study were invited to take part via an online survey, with a total of 
31,017 participants taking part, 31,016 of which reported on their experience of 
loneliness. Participants retrospectively answered questions on demographics, 
lifestyle, physical health and mental health and loneliness before the pandemic 
and at the time of answering the survey. Before the pandemic 6.5% (2,006/31,016) 
of participants reported experiencing loneliness "Often/Always" and at the time 
of survey completion 17.4% (5,395/31,016) reported feeling lonelier. There was 
an association between meeting the research definition of long COVID and 
loneliness [3.49 OR, 95%CI 3.28-3.72]. CYP who reported feeling lonelier at the 
time of the survey than before the pandemic were assigned female at birth, older 
CYP, those from Black/African/Caribbean/Black British or other ethnicity groups, 
those that had 3-4 siblings and lived in more deprived areas.
CONCLUSIONS: We demonstrate associations between multiple factors and 
experiences of loneliness during the pandemic. There is a need for a 
multi-faceted integrated approach when developing interventions targeted at 
loneliness. It is important to follow up the CYP involved at regular intervals 
to investigate the progression of their experience of loneliness over time.

Copyright: © 2023 McOwat et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0294165
PMCID: PMC10662715
PMID: 37988366 [Indexed for MEDLINE]

Conflict of interest statement: TS is Chair of the Health Research Authority and 
therefore recused himself from the Research Ethics Application. TC is a member 
of the National Institute for Health and Care Excellence committee for long 
COVID. She has written self-help books on chronic fatigue and has done workshops 
on chronic fatigue and post infectious syndromes. TC also has a grant looking at 
long COVID in adults. MGS reports grants from MRC and Health Protection Research 
Unit in Emerging & Zoonotic Infections, University of Liverpool. He also reports 
a role as Independent external and non-remunerated member of Pfizer’s External 
Data Monitoring Committee for their mRNA vaccine program. He is Chair of 
Infectious Disease Scientific Advisory Board for Integrum Scientific LLC, 
Greensboro, NC, USA and director of MedEx Solutions Ltd. He reports minority 
stock ownership for Integrum Scientific LLC, Greensboro, NC, USA and majority 
stock ownership for MedEx Solutions Ltd. He also reports a gift from Chiesi 
Farmaceutici SPA to his institution of a clinical trial investigational 
medicinal product without encumbrance and distribution of same to trial sites. 
He is also a non-remunerated independent member of HMG UK Scientific Advisory 
Group for Emergencies (SAGE, COVID-19 Response) and HMG UK New Emerging 
Respiratory Virus Threats Advisory Group (NERVTAG). All remaining authors have 
no conflicts of interest. Data cannot be shared publicly due to ethical and 
legal considerations. All requests for data will be reviewed by the Children & 
young people with Long Covid (CLoCk) study team, to verify whether the request 
is subject to any intellectual property or confidentiality obligations. Requests 
for access to the participant-level data from this study can be submitted via 
email to Clock@ukhsa.gov.uk with detailed proposals for approval. A signed data 
access agreement with the CLoCk team is required before accessing shared data. 
This does not alter our adherence to PLOS ONE policies on sharing data and 
materials."


242. Cochrane Database Syst Rev. 2023 Nov 21;11(11):CD013126. doi: 
10.1002/14651858.CD013126.pub2.

Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) for the 
diagnosis of delirium in adults in critical care settings.

Miranda F(1), Gonzalez F(1), Plana MN(2), Zamora J(3)(4), Quinn TJ(5), Seron 
P(6).

Author information:
(1)Department of Medicine, Universidad de Chile, Santiago, Chile.
(2)Health Technology Assessment Unit, Hospital Universitario Ramón y Cajal 
(IRYCIS). CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain.
(3)Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS). 
CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain.
(4)Institute of Metabolism and Systems Research, University of Birmingham, 
Birmingham, UK.
(5)Institute of Cardiovascular and Medical Sciences, University of Glasgow, 
Glasgow, UK.
(6)Facultad de Medicina, Departamento de Ciencias de la Rehabilitación & CIGES, 
Universidad de La Frontera, Temuco, Chile.

Update of
    doi: 10.1002/14651858.CD013126.

BACKGROUND: Delirium is an underdiagnosed clinical syndrome typified by an acute 
alteration of mental state. It is an important problem in critical care and 
intensive care units (ICU) due to its high prevalence and its association with 
adverse outcomes. Delirium is a very distressing condition for patients, with a 
huge impact on their well-being. Diagnosis of delirium in the critical care 
setting is challenging. This is especially true for patients who are 
mechanically ventilated and are therefore unable to engage in a verbal 
interview. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) 
is a tool specifically designed to assess for delirium in the context of ICU 
patients, including those on mechanical ventilation. CAM-ICU can be administered 
by non-specialists to give a dichotomous delirium present/absent result.
OBJECTIVES: To determine the diagnostic accuracy of the CAM-ICU for the 
diagnosis of delirium in adult patients in critical care units.
SEARCH METHODS: We searched MEDLINE (Ovid SP, 1946 to 8 July 2022), Embase (Ovid 
SP, 1982 to 8 July 2022), Web of Science Core Collection (ISI Web of Knowledge, 
1945 to 8 July 2022), PsycINFO (Ovid SP, 1806 to 8 July 2022), and LILACS 
(BIREME, 1982 to 8 July 2022). We checked the reference lists of included 
studies and other resources for additional potentially relevant studies. We also 
searched the Health Technology Assessment database, the Cochrane Library, 
Aggressive Research Intelligence Facility database, WHO ICTRP, 
ClinicalTrials.gov, and websites of scientific associations to access any annual 
meetings and abstracts of conference proceedings in the field.
SELECTION CRITERIA: We included diagnostic studies enrolling adult ICU patients 
assessed using the CAM-ICU tool, regardless of language or publication status 
and reporting sufficient data on delirium diagnosis for the construction of 2 x 
2 tables. Eligible studies evaluated the diagnostic performance of the CAM-ICU 
versus a clinical reference standard based on any iteration of the Diagnostic 
and Statistical Manual of Mental Disorders (DSM) criteria applied by a clinical 
expert.
DATA COLLECTION AND ANALYSIS: Two review authors independently selected and 
collated study data. We assessed the methodological quality of studies using the 
QUADAS-2 tool. We used two univariate fixed-effect or random-effects models to 
determine summary estimates of sensitivity and specificity. We performed 
sensitivity analyses that excluded studies considered to be at high risk of bias 
and high concerns in applicability, due mainly to the target population included 
(e.g. patients with traumatic brain injury). We also investigated potential 
sources of heterogeneity, assessing the effect of reference standard diagnosis 
and proportion of patients ventilated.
MAIN RESULTS: We included 25 studies (2817 participants). The mean age of 
participants ranged from 48 to 69 years; 15 of the studies included critical 
care units admitting mixed populations (e.g. medical, trauma, surgery patients). 
The percentage of patients receiving mechanical ventilation ranged from 11.8% to 
100%. The prevalence of delirium in the studies included ranged from 12.5% to 
83.9%. Presence of delirium was determined by the application of DSM-IV criteria 
in 13 out of 25 included studies. We assessed 13 studies as at low risk of bias 
and low applicability concerns for all QUADAS-2 domains. The most common issue 
of concern was flow and timing of the tests, followed by patient selection. 
Overall, we estimated a pooled sensitivity of 0.78 (95% confidence interval (CI) 
0.72 to 0.83) and a pooled specificity of 0.95 (95% CI 0.92 to 0.97). 
Sensitivity analysis restricted to studies at low risk of bias and without any 
applicability concerns (n = 13 studies) gave similar summary accuracy indices 
(sensitivity 0.80 (95% CI 0.72 to 0.86), specificity 0.95 (95% CI 0.93 to 
0.97)). Subgroup analyses based on diagnostic assessment found summary estimates 
of sensitivity and specificity for studies using DSM-IV of 0.79 (95% CI 0.72 to 
0.85) and 0.94 (95% CI 0.90 to 0.96). For studies that used DSM-5 criteria, 
summary estimates of sensitivity and specificity were 0.75 (95% CI 0.67 to 0.82) 
and 0.98 (95% CI 0.95 to 0.99). DSM criteria had no significant effect on 
sensitivity (P = 0.421), but the specificity for detection of delirium was 
higher when DSM-5 criteria were used (P = 0.024). The relative specificity 
comparing DSM-5 versus DSM-IV criteria was 1.05 (95% CI 1.02 to 1.08). Summary 
estimates of sensitivity and specificity for studies recruiting < 100% of 
patients with mechanical ventilation were 0.81 (95% CI 0.75 to 0.85) and 0.95 
(95% CI 0.91 to 0.98). For studies that exclusively recruited patients with 
mechanical ventilation, summary estimates of sensitivity and specificity were 
0.91 (95% CI 0.76 to 0.97) and 0.98 (95% CI 0.92 to 0.99). Although there was a 
suggestion of differential performance of CAM-ICU in ventilated patients, the 
differences were not significant in sensitivity (P = 0.316) or in specificity (P 
= 0.493).
AUTHORS' CONCLUSIONS: The CAM-ICU tool may have a role in the early 
identification of delirium, in adult patients hospitalized in intensive care 
units, including those on mechanical ventilation, when non-specialized, properly 
trained clinical personnel apply the CAM-ICU. The test is most useful for 
exclusion of delirium. The test may miss a proportion of patients with incident 
delirium, therefore in situations where detection of all delirium cases is 
desirable, it may be best to repeat the test or combine CAM-ICU with another 
assessment. Future studies should compare different screening tests proposed for 
bedside assessment of delirium, as this approach will reveal which tool yields 
superior accuracy. In addition, future studies should consider and report the 
flow and timing of the tests and clearly report key characteristics related to 
patient selection. Finally, future research should focus on the impact of 
CAM-ICU screening on patient outcomes.

Copyright © 2023 The Cochrane Collaboration. Published by John Wiley & Sons, 
Ltd.

DOI: 10.1002/14651858.CD013126.pub2
PMCID: PMC10661047
PMID: 37987526 [Indexed for MEDLINE]

Conflict of interest statement: Fabián Miranda has no conflicts of interest to 
declare. Francisco González has no conflicts of interest to declare. Maria N 
Plana has no conflicts of interest to declare. Javier Zamora has no conflicts of 
interest to declare. Terry Quinn has no conflicts of interest to declare. Pamela 
Seron has no conflicts of interest to declare.


243. Int J Ment Health Nurs. 2024 Apr;33(2):324-343. doi: 10.1111/inm.13251. Epub 
2023 Nov 20.

Interventions to reduce burnout and improve the mental health of nurses during 
the COVID-19 pandemic: A systematic review of randomised controlled trials with 
meta-analysis.

Wong KW(1), Wu X(1), Dong Y(1).

Author information:
(1)Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, 
National University of Singapore, Singapore City, Singapore.

This systematic review aims to investigate and determine the effectiveness of 
interventions on improving mental health (anxiety, depression, stress or mental 
well-being) and/or reducing burnout of nurses working in hospitals during the 
COVID-19 pandemic. A search was conducted on studies from conception to December 
2022 in databases: PubMed, Embase, Cochrane Central Register of Controlled 
Trials, CINAHL, PsycINFO, Scopus and Web of Science and in ProQuest Thesis & 
Dissertations Global Database, Google Scholar and ClinicalTrials.gov. A total of 
17 randomised controlled trials that evaluated different interventions were 
included. The outcomes were anxiety (n = 11), depression (n = 5), stress 
(n = 13) mental well-being (n = 7) and burnout (n = 7). Not all interventions 
led to positive outcomes. Grading of Recommendations Assessment, Development and 
Evaluation (GRADE) appraisal and risk of bias assessment using the Cochrane tool 
for randomised controlled trials (RoB 2.0) revealed poor quality of currently 
available literature, with low to very low certainty. Meta-analysis showed high 
heterogeneity among the five different outcomes, with subgroup analysis showing 
greater success in interventions conducted on nurses involved in the care of 
COVID-19 patients. More well-designed trials are necessary to reinforce current 
evidence to improve the mental health of nurses, to not only protect their 
quality of life but also to ensure the quality of patient care.

© 2023 John Wiley & Sons Australia, Ltd.

DOI: 10.1111/inm.13251
PMID: 37985559 [Indexed for MEDLINE]


244. Psychiatr Hung. 2023;38(3):218-231.

[A study of the psychosocial characteristics of psychiatric teams in Hungary].

[Article in Hungarian]

Molnár L(1), Kalotaszegi S, Gergely B, Takács S, Zana Á.

Author information:
(1)Semmelweis Egyetem Általános Orvostudományi Kar, Magatartástudományi Intézet, 
Budapest, Hungary, E-mail: drmolnarpszichiater@gmail.com.

BACKGROUND: In this study, we examined psychiatric teams in a Hungarian sample 
before the COVID-19 pandemic. The aim of our research is to examine Hungarian 
psychiatric teams along different workplace psychosocial factors (collaboration 
management, organization and job, workplace requirements, work-life balance, 
trust, health and well-being) in order to assess them in terms of hierarchy and 
competence. Moreover we examine the mental and somatic effects of these factors.
METHODS: We conducted a cross-sectional survey of Hungarian mental health care 
workers (N =79). The main question of the study was how perceived hierarchy and 
competence boundary violations are associated to psychosocial factors of the 
COPSOQ-II questionnaire (Copenhagen Psychosocial Questionnaire II) in general, 
and among employees in different job groups.
RESULTS: Based on bootstrapped binary logistic regression performed on the full 
sample, we found that perceived hierarchy is associated with control, social 
support of co-workers and stress, while violation of competence boundaries is 
associated with job recognition, job clarity and fairness.
DISCUSSION: Our results show that where mental health care workers experienced 
less perceived hierarchy within the team, they were more likely to feel that 
they had control over their work. Furthermore, in hierarchies perceived as 
superior-subordinate relations, the quality of the relationships within the team 
seems to be much more important.
CONCLUSIONS: This research can be the starting point for a comprehensive study 
of other psychiatric teams with the aid of a widely used measure, providing an 
opportunity for comparison with other health teams at an international level.

PMID: 37982269 [Indexed for MEDLINE]


245. West J Nurs Res. 2024 Jan;46(1):44-51. doi: 10.1177/01939459231214603. Epub 2023 
Nov 19.

Psychological Health Among Older Adults During and After Quarantine: A 
Multi-Method Study.

Durante A(1), Klompstra L(2), Cezón-Serrano N(3), Deka P(4), Arnal-Gómez A(3), 
Querol-Giner F(3), Marques-Sule E(3).

Author information:
(1)Department of Nursing, GRUPAC, University of La Rioja, Logroño, Spain.
(2)Department of Health, Medicine and Caring Sciences, Linkoping University, 
Linkoping, Sweden.
(3)Physiotherapy in Motion, Multispeciality Research Group (PTin MOTION), 
Department of Physiotherapy, University of Valencia, Valencia, Spain.
(4)College of Nursing, Michigan State University, East Lansing, MI, USA.

OBJECTIVE: Depression among older adults is a growing problem. With aging being 
a risk factor for COVID-19 infection, depression in this population may have 
been exacerbated. This study aimed to describe experiences and changes in 
depressive symptoms and well-being of older adults during and after the COVID-19 
first wave in Spain.
METHODS: The study used a multi-method design. Participants self-reported 
depressive symptoms (Geriatric Depression Scale) and well-being (Cantril Ladder 
of Life). Participants were asked about changes in depressive symptoms or 
well-being during quarantine. If a change was perceived, they were asked to 
describe the change. In addition, the Patient Global Impression of Change scale 
was used. Both quantitative and qualitative analyses were performed on the data.
RESULTS: 111 participants (mean age: 71±5 years; 76% women) completed the study. 
Sixty-three percent reported mild and 2% reported major depressive symptoms. 
Nearly half (47.7%) reported changes in depressive symptoms during the lockdown. 
While 37% reported feeling better during the lockdown, about 11% reported 
depressive symptoms were worse now compared with during the lockdown. 60% 
reported worsening well-being during the quarantining period. The qualitative 
analysis revealed 2 main themes: (1) psychological discomfort (mood deflection, 
fear/worries, and boredom/inactivity) and (2) social issues (inability to go 
out, missing family members and others).
CONCLUSIONS: Worsening depressive symptoms and lowering of well-being were 
noticed in this sample of older adults during and post-COVID lockdowns. 
Evaluation of mental health in the primary care setting and providing referrals 
for mental health services is essential for older adults who experienced 
COVID-19-related lockdowns.

DOI: 10.1177/01939459231214603
PMID: 37981724 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting InterestsThe 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


246. BMC Public Health. 2023 Nov 17;23(1):2275. doi: 10.1186/s12889-023-17238-7.

Addressing mental health problems among persons without stable housing in the 
context of the COVID-19 pandemic: study protocol for a randomised trial. RESPOND 
- France.

Melchior M(1), Figueiredo N(2), Roversi A(2), Dubanchet A(3), Bui E(3), 
Vadell-Martínez J(2), Barbui C(4), Purgato M(4), Ayuso-Mateos JL(5)(6)(7), 
Mediavilla R(5)(6)(7), McDaid D(8), Park AL(8), Petri-Romão P(9)(10), Kalisch 
R(9)(10), Nicaise P(11), Lorant V(11), Sijbrandij M(12), Witteveen AB(12), 
Bryant R(13), Felez M(14), Underhill J(15), Pollice G(2), Tortelli A(2)(16).

Author information:
(1)Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de 
Santé Publique, (IPLESP), Equipe de Recherche en Epidémiologie Sociale, Paris, 
F75012, France. maria.melchior@inserm.fr.
(2)Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de 
Santé Publique, (IPLESP), Equipe de Recherche en Epidémiologie Sociale, Paris, 
F75012, France.
(3)CHU Caen, & Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology 
and Imaging of Neurological Disorders", NeuroPresage Team, Cyceron, Caen, 14000, 
France.
(4)Department of Neuroscience, Biomedicine, and Movement Sciences, Section of 
Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health 
and Service Evaluation, University of Verona, Verona, Italy.
(5)Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, 
Spain.
(6)Instituto de Investigación Sanitaria del Hospital Universitario La Princesa, 
Madrid, Spain.
(7)Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 
Instituto de Salud Carlos III, Madrid, Spain.
(8)Care Policy and Evaluation Centre, Department of Health Policy, London School 
of Economics and Political Science, London, UK.
(9)Leibniz Institute for Resilience Research (LIR), Mainz, Germany.
(10)Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), 
Johannes Gutenberg University Medical Center, Mainz, Germany.
(11)Institute of Health and Society (IRSS), Université Catholique de Louvain, 
Brussels, Belgium.
(12)Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for 
Research and Dissemination of Psychological Interventions, Amsterdam Public 
Health Institute, VU University, Amsterdam, the Netherlands.
(13)School of Psychology, University of New South Wales, Sydney, Australia.
(14)Institut de recerca Sant Joan de Déu, Dr. Antoni Pujadas, Sant Boi de 
Llobregat (Barcelona), 4208830, Spain.
(15), Brighton, UK.
(16)GHU Paris, Psychiatrie & Neurosciences - Pôle Psychiatrie Précarité, Paris, 
France.

BACKGROUND: The COVID-19 pandemic has had an impact on population-wide mental 
health and well-being. Although people experiencing socioeconomic disadvantage 
may be especially vulnerable, they experience barriers in accessing mental 
health care. To overcome these barriers, the World Health Organization (WHO) 
designed two scalable psychosocial interventions, namely the web-based Doing 
What Matters in Times of Stress (DWM) and the face-to-face Problem Management 
Plus (PM+), to help people manage stressful situations. Our study aims to test 
the effectiveness of a stepped-care program using DWM and PM + among individuals 
experiencing unstable housing in France - a majority of whom are migrant or have 
sought asylum.
METHODS: This is a randomised controlled trial to evaluate the effectiveness and 
cost effectiveness of a stepped-care program using DWM and PM + among persons 
with psychological distress and experiencing unstable housing, in comparison to 
enhanced care as usual (eCAU). Participants (N = 210) will be randomised to two 
parallel groups: eCAU or eCAU plus the stepped-care program. The main study 
outcomes are symptoms of depression and anxiety measured using the Patient 
Health Questionnaire Anxiety and Depression Scale (PHQ-ADS).
DISCUSSION: This randomised controlled trial will contribute to a better 
understanding of effective community-based scalable strategies that can help 
address the mental health needs of persons experiencing socioeconomic 
disadvantage, whose needs are high yet who frequently have limited access to 
mental health care services.
TRIAL REGISTRATION: this randomised trial has been registered at 
ClinicalTrials.gov under the number NCT05033210.

© 2023. The Author(s).

DOI: 10.1186/s12889-023-17238-7
PMCID: PMC10656934
PMID: 37978577 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


247. BMC Public Health. 2023 Nov 17;23(1):2280. doi: 10.1186/s12889-023-17206-1.

Assessing parents' and children's psychological well-being and its associated 
factors during the COVID-19 lockdown in a Tunisian-North African population.

Guedria A(1)(2), Slama H(1)(3), Fredj MB(4)(5)(6), Miladi S(2), Kefi HE(3)(7), 
Gatti S(7), Oumaya A(3)(7).

Author information:
(1)University of Monastir, Monastir, Tunisia.
(2)Department of Child and Adolescent Psychiatry, Fattouma Bourguiba University 
Hospital, Monastir, Tunisia.
(3)Military Hospital of Tunis, Tunis, Tunisia.
(4)University of Monastir, Monastir, Tunisia. manel-ben-fredj@hotmail.fr.
(5)Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba 
University, Hospital, University of Monastir, Monastir, Tunisia. 
manel-ben-fredj@hotmail.fr.
(6)Department of Community Medicine, Fattouma Bourguiba University Hospital, 
Monastir, Tunisia. manel-ben-fredj@hotmail.fr.
(7)Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.

BACKGROUND: The rapidly emerging Coronavirus infectious disease 2019 (COVID-19) 
has spread around the world yielding in significant changes in almost every 
aspect of daily life. While primary research of the epidemic COVID-19 has 
focused on the psychological impact on the general population and health 
professionals, no survey of the pandemic-resulting containment on parents and 
their children has been yet addressed in the Tunisian-North African population. 
This study aimed to assess the psychological profile of parents and youth in 
Tunisia during a period of COVID 19 lockdown, and to identify associated factors 
to parental anxiety symptoms.
METHODS: This is an analytical cross-sectional study composed of a total of 538 
adults including 464 mothers and 74 fathers. Parents of children aged less than 
18 years completed an online survey (Google Forms) on the Psychological Impact 
of Confinement which includes the Generalized Anxiety Scale (GAD-7), the 
Parental Burnout Assessment (PBA), and the infantile trait-anxiety scale. The 
survey was initiated in May 2020 on a population of the Tunisian-North African 
citizens and lasted for more than 6 weeks.
RESULTS: The median GAD-7 score was 11 corresponding to a moderate anxiety with 
27.8% reporting severe anxiety. The median PBA score was 31 corresponding to a 
moderate risk of burnout, with 19.5% being affected. The children's anxiety 
scores were associated with their parents' anxiety ratings with 24% of the 
children reported signs of moderate anxiety.
CONCLUSIONS: The COVID-19 pandemic affected parental and their children' 
psychological behavior due to a direct social isolation and distancing. 
Pediatricians need to be alerted on this issue and future measures are essential 
to avoid parental emotional burnout and anxiety disorder in similar situations.

© 2023. The Author(s).

DOI: 10.1186/s12889-023-17206-1
PMCID: PMC10657148
PMID: 37978377 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


248. BMJ Open. 2023 Nov 17;13(11):e072279. doi: 10.1136/bmjopen-2023-072279.

Patterns, prevalence and risk factors of intimate partner violence and its 
association with mental health status during COVID-19: a cross-sectional study 
on early married female adolescents in Khulna district, Bangladesh.

Nishat JF(#)(1), Khan US(#)(1), Shovo TE(#)(1), Ahammed B(2), Rahman MM(3), 
Hossain MT(4).

Author information:
(1)Sociology Discipline, School of Social Science, Khulna University, Khulna, 
Bangladesh.
(2)Statistics Discipline, Science, Engineering and Technology School, Khulna 
University, Khulna, Bangladesh.
(3)Department of Urban and Regional Planning, Faculty of Social Sciences, 
Jahangirnagar University, Savar, Bangladesh.
(4)Sociology Discipline, School of Social Science, Khulna University, Khulna, 
Bangladesh tanvirku05@soc.ku.ac.bd.
(#)Contributed equally

OBJECTIVES: This study was designed to identify the patterns, prevalence and 
risk factors of intimate partner violence (IPV) against female adolescents and 
its association with mental health problems.
DESIGN: Cross-sectional survey.
SETTINGS: Dumuria Upazila (subdistrict) under the Khulna district of Bangladesh.
PARTICIPANTS: A total of 304 participants were selected purposively based on 
some specifications: they must be female adolescents, residents of Dumuria 
Upazila and married during the COVID-19 pandemic when under 18 years of age.
OUTCOME MEASURES: By administering a semi-structured interview schedule, data 
were collected regarding IPV using 12 five-point Likert scale items; a higher 
score from the summation reflects frequent violence.
RESULTS: The findings suggest that the prevalence of physical, sexual and 
emotional IPV among the 304 participants, who had an average age of 17.1 years 
(SD=1.42), was 89.5%, 87.8% and 93.7%, respectively, whereas 12.2% of the 
participants experienced severe physical IPV, 9.9% experienced severe sexual IPV 
and 10.5% experienced severe emotional IPV. Stepwise regression models 
identified age at marriage (p=0.001), number of miscarriages (p=0.005), 
education of spouse (p=0.001), income of spouse (p=0.016), age gap between 
spouses (p=0.008), marital adjustment (p<0.001) and subjective happiness 
(p<0.001) as significant risk factors. Hierarchical regression, however, 
indicated that age at marriage (p<0.001), age gap between spouses (p<0.001), 
marital adjustment (p<0.001) and subjective happiness (p<0.001) had negative 
associations with IPV, while the number of miscarriages (p<0.001) had a positive 
relationship. Pearson's correlation showed that IPV was significantly associated 
with depression, anxiety and stress.
CONCLUSION: During the COVID-19 pandemic, an increase in IPV and mental health 
problems among early married adolescents was documented. To reduce physical and 
mental harm and to assure their well-being, preventive and rehabilitative 
measures should be devised.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2023-072279
PMCID: PMC10660971
PMID: 37977869 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


249. Acta Psychol (Amst). 2023 Nov;241:104081. doi: 10.1016/j.actpsy.2023.104081. 
Epub 2023 Nov 15.

Physical activity and life satisfaction among adolescents before and during the 
COVID-19 pandemic.

Chmelík F(1), Frömel K(2), Groffik D(3), Mitáš J(4).

Author information:
(1)Institute of Active Lifestyle, Faculty of Physical Culture, Palacký 
University Olomouc, Tř. Míru 117, 771 11 Olomouc, Czech Republic. Electronic 
address: frantisek.chmelik@upol.cz.
(2)Institute of Active Lifestyle, Faculty of Physical Culture, Palacký 
University Olomouc, Tř. Míru 117, 771 11 Olomouc, Czech Republic; Institute of 
Sport Science, The Jerzy Kukuczka Academy of Physical Education in Katowice, 
Mikołowska 72a, 40-065 Katowice, Poland. Electronic address: 
karel.fromel@upol.cz.
(3)Institute of Sport Science, The Jerzy Kukuczka Academy of Physical Education 
in Katowice, Mikołowska 72a, 40-065 Katowice, Poland. Electronic address: 
d.groffik@awf.katowice.pl.
(4)Institute of Active Lifestyle, Faculty of Physical Culture, Palacký 
University Olomouc, Tř. Míru 117, 771 11 Olomouc, Czech Republic. Electronic 
address: josef.mitas@upol.cz.

The negative impact of the COVID-19 pandemic and distance education has 
significantly affected adolescents' lives. The restrictive policies negatively 
affected their physical and mental health and life satisfaction. It is therefore 
desirable to look for ways to eliminate similar negative impacts on adolescents 
in the future. This study aimed to identify the differences in the association 
between physical activity and life satisfaction in Polish adolescents before and 
during the pandemic. The study included 1541 participants (891 before the 
pandemic and 650 during the pandemic) aged 15-19 years. The International 
Physical Activity Questionnaire-Long Form questionnaire was used to assess 
physical activity, and the Bern Subjective Well-Being Questionnaire was used to 
evaluate life satisfaction. The objectivity of data collection and analysis 
before and during the pandemic was ensured by the web application the 
International Database for Research and Educational Support. During the 
pandemic, we found lower physical activity and life satisfaction in both boys 
and girls compared to before the pandemic. Girls with low and high physical 
activity levels showed significantly lower life satisfaction during the pandemic 
than they did before. Low life satisfaction was associated with lower physical 
activity, and high life satisfaction was associated with greater total physical 
activity. Both boys and girls with low and high life satisfaction achieved 
significantly fewer physical activity recommendations during the pandemic. High 
life satisfaction increased the likelihood of meeting the recommendations for 
physical activity before and during the pandemic. This study provides new 
insights into the differences and associations between life satisfaction and 
physical activity in adolescent boys and girls before and during the pandemic. 
It provides suggestions for the prevention of possible future restrictions in 
the school settings. Support for post-pandemic life satisfaction in adolescents 
should focus mainly on increasing vigorous physical activity and improving 
adolescent participation in organized physical activity settings.

Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.actpsy.2023.104081
PMID: 37976920 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare no conflicts of interest.


250. Appetite. 2024 Jan 1;192:107120. doi: 10.1016/j.appet.2023.107120. Epub 2023 Nov 
14.

Inter-relationships of obesity-related eating behavior with depression and 
anxiety among adults during the COVID-19 pandemic: A network analysis.

Wang X(1), Wu Y(2), Fu L(3), Fu X(4), Pang C(5), Zang S(6).

Author information:
(1)Department of Community Nursing, School of Nursing, China Medical University, 
No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, 110122, 
China. Electronic address: 13909822541@163.com.
(2)School of Public Health, Peking University, No.38 Xueyuan Road, Haidian 
District, Beijing, 100191, China. Electronic address: bjmuwuyibo@outlook.com.
(3)Nursing Department, Guangzhou Elderly Home, No.1288 Guangcong 10th Road, 
Zhongluotan Town, Baiyun District, Guangzhou, Guangdong Province, 510550, China. 
Electronic address: 502097560@qq.com.
(4)Department of Gastroenterology, Qingdao West Coast New District Central 
Hospital, No.9 Huangpujiang Road, Huangdao District, Qingdao, Shandong Province, 
266555, China. Electronic address: geniusgirlfuxiao@126.com.
(5)Department of General Practice, The Second Affiliated Hospital of Shenyang 
Medical College, No.20 Bei Jiu Road, Heping District, Shenyang, Liaoning 
Province, 110002, China. Electronic address: 949262268@qq.com.
(6)Department of Community Nursing, School of Nursing, China Medical University, 
No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, 110122, 
China. Electronic address: zangshuang@cmu.edu.cn.

The COVID-19 pandemic has significantly impacted individuals' mental health, 
resulting in a higher incidence of depression, anxiety, and changes in eating 
behaviors. The objective of this study is to examine the inter-relationships 
among obesity-related eating behavior, depression, and anxiety in adults during 
the COVID-19 pandemic, utilizing a network analysis method. We conducted a 
cross-sectional survey among a representative sample of 9091 adults between July 
10 and September 15, 2021. Participants completed self-report measures to assess 
obesity-related eating behavior and symptoms of depression and anxiety. Network 
analysis was employed to investigate the inter-relationships among these 
variables. The network analysis revealed that item 2 (i.e., Do not feel 
satisfied unless I eat until full) exhibited the highest node strength within 
the network, followed by item 5 (i.e., Like oily foods). In addition, positive 
correlations were found between the severity of depression and anxiety and most 
of the obesity-related eating behavior items. These findings offer valuable 
insights into the interplay between obesity-related eating behavior, depression, 
and anxiety during the COVID-19 pandemic, underscoring the significance of 
considering these factors in comprehending and addressing mental health and 
well-being in adults. Further research is warranted to explore potential 
interventions and treatment approaches that specifically target the identified 
relationships.

Copyright © 2023 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.appet.2023.107120
PMID: 37972655 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest On behalf of 
all authors, the corresponding author states that there is no conflict of 
interest.


251. PLoS One. 2023 Nov 16;18(11):e0294357. doi: 10.1371/journal.pone.0294357. 
eCollection 2023.

Evaluating the effectiveness of applying aroma seals to masks in reducing stress 
caused by wearing masks: A randomized controlled trial.

Wakui N(1), Ichikawa K(1), Okami A(1), Kagi H(1), Kawakubo S(1), Togawa C(1), 
Matsuoka R(1), Watanabe M(1), Yamamura M(1), Shirozu S(1), Tsubota Y(1), 
Yoshizawa Y(1), Machida Y(1).

Author information:
(1)Division of Applied Pharmaceutical Education and Research, Faculty of 
Pharmaceutical Sciences, Hoshi University, Shinagawa-ku, Tokyo, Japan.

During the COVID-19 pandemic, face masks on patients and healthy people have 
been recommended to prevent airborne transmission of the virus. This increased 
the number of people who felt stressed while wearing masks. In this study, we 
investigated the stress-relieving effects of attaching aroma seals to masks. A 
double-blind, randomized controlled trial was conducted involving 62 university 
students. The participants were randomly assigned to two groups and instructed 
to apply a seal to their masks once a day throughout the study period. The 
primary measure used was the Depression, Anxiety, and Stress Scale-21 (DASS-21), 
while the secondary measures included the assessment of breathlessness 
associated with mask-wearing and the World Health Organization Five Well-Being 
Index (WHO-5). The intervention group, referred to as the aroma-seal use group, 
utilized aroma seals infused with orange-lime essential oil with the expectation 
of experiencing the healing effects of citrus. On the other hand, the 
non-intervention group, known as the placebo-seal use group, utilized identical 
seals without any aroma. Results indicated that the aroma-seal use group 
exhibited significant improvements in both the total DASS-21 scores and 
depression scores compared to their baseline values by the second week of the 
intervention. Furthermore, the aroma-seal use group demonstrated a reduced 
occurrence of breathlessness while wearing masks compared to the placebo-seal 
group. Additionally, when assessing the item "I have felt calm and relaxed" from 
the WHO-5 questionnaire, the aroma-seal use group displayed significantly higher 
scores than the placebo group. Therefore, using aroma seals containing 
orange-lime essential oil could be beneficial in relieving mental stress and 
reducing breathlessness while wearing a mask, thus improving mental health.

Copyright: © 2023 Wakui et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0294357
PMCID: PMC10653515
PMID: 37971989 [Indexed for MEDLINE]

Conflict of interest statement: NO authors have competing interests Enter: The 
authors have declared that no competing interests exist.


252. Prax Kinderpsychol Kinderpsychiatr. 2023 Nov;72(7):574-590. doi: 
10.13109/prkk.2023.72.7.574.

[Effects of the COVID-19-Pandemic on the AffectiveWell-Being of Preschool 
Children].

[Article in German; Abstract available in German from the publisher]

Pfitscher G(1), Wenter A(1), Juen B(2), Sevecke K(3), Exenberger S(4).

Author information:
(1)Institut für Psychologie, Leopold-Franzens Universität Innsbruck Österreich.
(2)Arbeitsgruppe Notfallpsychologie und Psychotraumatologie an der 
Leopold-Franzens Universität Innsbruck Österreich.
(3)Abteilung für Kinder- und Jugendpsychiatrie und Psychotherapie Hall in Tirol 
Österreich.
(4)Abteilung für Kinderund Jugendpsychiatrie, Tirol Kliniken Österreich.

The aim of this study was to determine the predictive value of corona-specific 
variables and post-traumatic stress symptoms associated with the 
COVID-19-pandemic, considering sociodemographic data and health-related quality 
of life, on the affective well-being of preschool children and to identify 
predictors of positive and negative affect. A secondary analysis of third-party 
assessment data by parents of three- to six-year-old preschool children from the 
Tyrolean COVID-19 Children's Study at two measurement time points (123 records 
at t₁ in summer 2020; 467 records at t₂ in winter 2020/21) was conducted. To 
answer the research question hierarchical multiple regression analyses were 
performed.The largest part of the variance explanation of affective well-being 
was explained by health-related quality of life: while self-esteem and 
psychological well-being were measurement-time-independent, effects of physical 
well-being, preschool, family, and friends were only significant in winter. 
Coronaspecific variables caused additional variance explanation due to 
subjective threat experience in winter; post-traumatic stress symptoms had an 
effect at both measurement-times. In times of crisis children's self-esteem, 
psychological well-being, and post-traumatic stress symptoms should be 
considered.Measurement-time-dependent results suggest that the pandemic course 
plays a decisive role regarding the influence on children's affective 
well-being. Everyday life and routines must be redefined accordingly and 
communicated to the children.

Publisher: Zusammenfassung Ziel der Studie war es, den prädiktiven Wert von 
coronaspezifischen Variablen und den einhergehenden posttraumatischen 
Stresssymptomen durch die COVID-19-Pandemie unter Berücksichtigung 
soziodemografischer Daten und der gesundheitsbezogenen Lebensqualität auf das 
affektiveWohlbefinden von Kindergartenkindern zu ermitteln. Zusätzlich sollten 
Prädiktoren positiver und negativer Affekte identifiziert werden. Es wurde eine 
Sekundäranalyse der Fremdbeurteilungsdaten durch die Eltern von drei- bis 
sechsjährigen Kindergartenkindern aus der Tiroler COVID-19 Kinderstudie zu 
zweiMesszeitpunkten (123 Datensätze zu t₁ im Sommer 2020; 467 Datensätze zu t₂ 
imWinter 2020/21) durchgeführt. Zur Beantwortung der Fragestellung wurden 
hierarchische multiple Regressionsanalysen berechnet. Der größte Teil der 
Varianzaufklärung des affektiven Wohlbefindens wurde durch die 
gesundheitsbezogene Lebensqualität erklärt:Während der Selbstwert und das 
psychischeWohlbefindenmesszeitpunktübergreifende Einflussfaktoren darstellten, 
zeigten sich Effekte von körperlichem Wohlbefinden, Kindergarten, Familie und 
Freund/innen ausschließlich im Winter. Coronaspezifische Variablen bewirkten 
über das subjektive Bedrohungserleben im Winter zusätzliche Varianzaufklärung; 
posttraumatische Stresssymptome wirkten sich zu beiden Messzeitpunkten aus. 
Selbstwert, psychisches Wohlbefinden und posttraumatische Stresssymptome der 
Kinder sollten in Krisenzeiten im Auge behalten werden.Messzeitpunktabhängige 
Ergebnisse legen nahe, dass der Pandemieverlauf eine entscheidende Rolle 
hinsichtlich des Einflusses auf das kindliche affektiveWohlbefinden spielt. 
Alltag und Routinenmüssen dementsprechend neu definiert und den Kindern 
kommuniziert werden.

DOI: 10.13109/prkk.2023.72.7.574
PMID: 37971704 [Indexed for MEDLINE]


253. Inquiry. 2023 Jan-Dec;60:469580231212218. doi: 10.1177/00469580231212218.

A Systematic Review of Assessment Methods for Seafarers' Mental Health and 
Well-Being During the COVID-19 Pandemic.

Carrera-Arce M(1), Baumler R(1), Hollander J(1).

Author information:
(1)World Maritime University, Malmo, Sweden.

Seafarers spend more time at sea than on land, which makes them a hard-to-reach 
community. Since their mental health and well-being is usually addressed from a 
land-based perspective, dedicated and validated methods incorporating maritime 
specificities are lacking. During the COVID-19 pandemic, research into 
seafarers' mental health and well-being flourished. However, a systematic review 
of the literature to assess the type and appropriateness of assessment methods 
pertaining to the mental health and well-being of seafarers has yet to be 
undertaken. This study reviews 5 databases (ERIC, Scopus, PubMed, Google Scholar 
and EBSCO) to assess the methods used to examine seafarers' mental health and 
well-being during the pandemic. Peer-reviewed literature alongside grey 
literature that applied quantitative or qualitative instruments to measure 
seafarers' mental health and/or well-being, published in English between March 
2020 and February 2023, was eligible for the review. Studies from all geographic 
regions and regardless of nationality, rank and ship type of the subjects were 
explored. Database searches produced 272 records. Five additional records were 
identified via other methods. We identified 27 studies suitable for review, 
including 24 published in peer-reviewed scientific journals and 3 reports and 
surveys produced by the industry or welfare organizations. Assessment methods 
used to measure seafarers' mental health and well-being vary significantly in 
the literature. The frequent use of ad hoc questionnaires limits the possibility 
to replicate and compare the studies due to various inconsistencies. 
Furthermore, several validation and reliability measures needed more solidity 
when applied to the seafaring population. Such inadequate measuring and a mix of 
assessment methods impacted the comparison of results and might inflate the 
risks of underreporting or overstating mental complaints.

DOI: 10.1177/00469580231212218
PMCID: PMC10655656
PMID: 37970799 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting InterestsThe 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


254. Nurs Crit Care. 2023 Nov 15. doi: 10.1111/nicc.13007. Online ahead of print.

The correlation between death anxiety, loneliness and hope levels in patients 
treated in the cardiac intensive care unit.

Yildirim D(1), Akman O(2), Ozturk S(3), Yakin O(3).

Author information:
(1)Faculty of Health Sciences, Department of Nursing, Istanbul Aydın University, 
Istanbul, Turkey.
(2)Faculty of Health Sciences, Istanbul Topkapı University, Istanbul, Turkey.
(3)Istanbul Provincial Health Directorate Mehmet Akif Ersoy Thoracic and 
Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.

BACKGROUND: A sense of hope plays an important role in relieving stress and 
psychological distress of cardiology patients, as well as improving their 
physical well-being.
AIM: The aim of this study is to investigate the correlation between death 
anxiety, loneliness and hope levels in patients receiving treatment in a cardiac 
intensive care unit (ICU).
DESIGN: This is a prospective, descriptive and correlational study.
METHODS: The study was completed with 150 cardiac ICU patients in Istanbul, 
Turkey. The data were collected using a Patient Information Form, the Templer 
Death Anxiety Scale (TDAS), the Herth Hope Index (HHI) and the UCLA Loneliness 
Scale (UCLA-LS).
RESULTS: The patients had a mean age of 63.56 ± 12.74 years. Most of the 
patients (82%) were treated in the ICU for heart failure. There was a 
statistically significant positive correlation between total scores of TDAS and 
UCLA-LS (r = .337; p < .001) and a statistically significant negative 
correlation between total scores of UCLA-LS and HHI (r = -.292; p < .001). Also, 
there was a statistically significant negative correlation between the scores of 
UCLA-LS and Positive Readiness and Expectancy Subscale (r = -.164; p = .044). 
The multiple linear regression indicated that the model was statistically 
significant (F = 7.177, p < .001). The variables of age and UCLA-LS among those 
included in the model were statistically significant predictors of the death 
anxiety scores of the patients (23.1%) (p < .05).
CONCLUSIONS: The cardiology patients who received treatment in the ICU had a 
high level of death anxiety and moderate levels of loneliness and hope. The age 
and loneliness level were statistically significant predictors of death anxiety.
RELEVANCE TO CLINICAL PRACTICE: It is recommended that individualized nursing 
care be planned and provided to conscious cardiology patients who are treated in 
the ICU, considering their age and loneliness levels and that nursing care be 
planned for individuals who are at risk of fear, anxiety, loneliness and 
hopelessness by periodically assessing their death anxiety, loneliness and hope 
levels.

© 2023 The Authors. Nursing in Critical Care published by John Wiley & Sons Ltd 
on behalf of British Association of Critical Care Nurses.

DOI: 10.1111/nicc.13007
PMID: 37969040


255. Eur J Public Health. 2024 Feb 5;34(1):190-195. doi: 10.1093/eurpub/ckad188.

Changes in weight status during the COVID-19 pandemic: impact of educational 
level and mental health.

Rosenkilde S(1), Sørensen TIA(1)(2), Algren MH(1), Thygesen LC(1).

Author information:
(1)National Institute of Public Health, University of Southern Denmark, 
Copenhagen K, Denmark.
(2)Department of Public Health, Novo Nordisk Foundation Center for Basic 
Metabolic Research, Faculty of Health and Medical Sciences, University of 
Copenhagen, Copenhagen K, Denmark.

BACKGROUND: The COVID-19 pandemic has resulted in a disruption of daily routines 
and changes in health behaviors leading to widespread concerns about unfavorable 
changes in weight status and a potential increase in the prevalence of obesity. 
This study examined the long-term impact of the COVID-19 pandemic on changes in 
weight status and its possible dependency on educational level and mental 
health.
METHODS: The study utilizes the Danish Health and Well-being Survey with 
repeated self-reported information on weight status collected before the 
COVID-19 pandemic (autumn of 2019) and twice during the pandemic (autumns of 
2020 and 2021). Information on educational level was derived from registers, 
whereas mental health was measured using validated scales. Generalized 
estimating equations were performed to investigate changes in mean weight and 
body mass index (BMI) category (BMI < 30 to BMI ≥ 30) between 2019 and 2021 and 
to investigate potential differences in changes in weight status by pre-pandemic 
educational level and mental health.
RESULTS: Mean weight significantly increased by 0.34 kg [95% confidence interval 
(CI): 0.16-0.51] in 2020 and by 0.46 kg (95% CI: 0.26-0.66) in 2021 compared 
with pre-pandemic weight status. The increase was greater among individuals with 
lower educational levels and poorer mental health. There were no significant 
changes in BMI category during the pandemic.
CONCLUSION: The results showed a significant increase in mean weight among the 
Danish population, particularly among individuals with lower educational levels 
and poorer mental health, but without detectable differences in obesity, 
supporting a long-term but minor impact of the COVID-19 pandemic on weight 
status.

© The Author(s) 2023. Published by Oxford University Press on behalf of the 
European Public Health Association.

DOI: 10.1093/eurpub/ckad188
PMCID: PMC10843948
PMID: 37968230 [Indexed for MEDLINE]


256. Arch Womens Ment Health. 2024 Apr;27(2):191-199. doi: 
10.1007/s00737-023-01398-x. Epub 2023 Nov 15.

When time worsens framing: a longitudinal analysis of the psychological effects 
of the COVID-19 pandemic in women with an eating disorder and their healthy 
sisters.

Meneguzzo P(1)(2), Ceccato E(3), Sala A(3), Santonastaso P(4).

Author information:
(1)Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128, 
Padova, Italy. paolo.meneguzzo@unipd.it.
(2)Padova Neuroscience Center, University of Padova, Padova, Italy. 
paolo.meneguzzo@unipd.it.
(3)Vicenza Eating Disorders Center, Mental Health Department, Azienda ULSS8 
"Berica", Vicenza, Italy.
(4)Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128, 
Padova, Italy.

The COVID-19 pandemic has profoundly affected individuals with eating disorders 
(ED), leading to an exacerbation of symptoms worldwide in 2020. However, there 
is a lack of longitudinal analyses of the psychological burdens experienced by 
this population. This study aims to longitudinally assess the psychological 
effects of the COVID-19 pandemic in people with ED and their healthy sisters 
(HS) 1 and 2 years after the onset of the crisis. A sample of 148 individuals, 
consisting of 73 with ED and 45 HS, was evaluated in spring 2021 and spring 2022 
regarding their current psychological and behavioral states. Participants were 
also asked to reflect on their feelings and behaviors during the 2020 lockdown. 
General psychopathology, eating disorders, and trauma-related symptoms were 
evaluated using validated questionnaires. Both groups showed an overall 
improvement in psychopathological symptoms with time. Individuals with ED 
exhibited greater improvement compared to their HS, which may be attributed to 
their initially higher burden. Individuals with ED reported a negative reframe, 
characterized by internalizing negative emotions and behaviors related to the 
2020 lockdown. This longitudinal evaluation revealed two distinct and 
contrasting effects. Both ED patients and their HS demonstrated psychological 
improvement over time. However, people with ED experienced a negative reframe 
that affected their memory of specific life events, subsequently affecting their 
psychological well-being. These findings shed light on the clinical severity 
observed in people with ED during these pandemic years.

© 2023. The Author(s).

DOI: 10.1007/s00737-023-01398-x
PMCID: PMC10933162
PMID: 37964120 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


257. Medicine (Baltimore). 2023 Nov 10;102(45):e35925. doi: 
10.1097/MD.0000000000035925.

Impact of covid-19 outbreak on the behavior of children and adolescents in the 
Kingdom of Bahrain.

Awn MA(1), Mohroofi AD(2), Alsaqer JK(3), Aljowder AA(4), Mohroofi AD(5), 
Alsuliti MA(1).

Author information:
(1)Family Medicine Department, Royal Medical Service - Bahrain Defense Force 
Hospital, Riffa, Bahrain.
(2)Pediatric Department, Royal Medical Service - King Hamad University Hospital, 
Muharraq, Bahrain.
(3)Primary Healthcare Centres, Manama, Bahrain.
(4)Anesthesia Resident, Royal Medical Service - Mohammed Bin Khalid Bin Salman 
Al Khalifa Cardiac Center, Awali, Bahrain.
(5)Arabian Gulf University, Manama, Bahrain.

With coronavirus disease-2019 (COVID-19) pandemic restrictions and lockdown, 
children and adolescents have experienced emotional and physical isolation from 
family and community members. This isolation has a negative impact on children's 
and adolescents' mental health, physical health, and behavior. An online 
cross-sectional study of children and adolescents aged 5 to 11 years was 
conducted to assess the effect of the COVID-19 pandemic on their behavior, 
emotions, and sleep routines. A total of 413 participants, with a mean age of 
seven (217 boys and 195 girls), were included in the study. Most of the children 
were in primary school and lived with both parents. Boys and older children were 
found to have been fatigued during the pandemic. A significant association was 
found between the participants' age and regression, opposition, and adaptation 
behaviors. A significant increase in screen usage and decrease in children's 
physical activity after the outbreak were noted. The COVID-19 pandemic has 
negatively affected children's and adolescents' psychosocial, behavioral, and 
physical habits. Government programs to support the mental and psychological 
well-being of children and adolescents should be encouraged. Social 
communication, physical activity, and collaborative games are also important 
factors.

Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

DOI: 10.1097/MD.0000000000035925
PMCID: PMC10637495
PMID: 37960760 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no funding and conflicts of 
interest to disclose.


258. PLoS One. 2023 Nov 13;18(11):e0294270. doi: 10.1371/journal.pone.0294270. 
eCollection 2023.

Effects of COVID-19 outbreak on Korean adolescents: Impact of altered economic 
perception on physical activity, sedentary behavior, and stress levels in an 
age-, gender-, and BMI-matched study.

Kim J(1), Hwang IW(2)(3), Park JH(4), Kim Y(1), Lee JM(2)(3).

Author information:
(1)Department of Kinesiology and Health Science, Virginia Commonwealth 
University, Richmond, Virginia, United States of America.
(2)Graduate School of Physical Education, Kyung Hee University (Global Campus), 
Giheung-gu, Yongin-si, Gyeonggi-do, Republic of Korea.
(3)Sports Science Research Center, Kyung Hee University (Global Campus), 
Giheung-gu, Yongin-si, Gyeonggi-do, Republic of Korea.
(4)School of Public Health, Texas A&M Health Science Center, Bryan, Texas, 
United States of America.

The current study is to examine the disparities in physical activity (PA), 
sedentary behavior (SB), and stress levels in Korean adolescents concerning 
changes in their perception of family economic status (ES) during COVID-19. 
Among a total of 6144 Korean adolescents aged 12 to 18, the participants were 
categorized into two groups based on their responses regarding changes in their 
family ES due to COVID-19: Declined ES (n = 3072) and Non-changed ES (n = 3072), 
with matching in terms of age, gender, and BMI. All variables were assessed 
using the 16th year (2020) of the Korean Youth Risk Behavior Survey. Statistical 
analyses were conducted using the SPSS 26.0 version, employing independent 
t-tests to examine anthropometrics' differences and multinominal logistic 
regression to predict the impact of perception of family ES on PA, SB, and 
stress while comparing the two groups. The significance level was set at α = 
0.05. Adolescents in the Declined ES group were 1.2 times more likely to engage 
in MVPA for less than 420 mins/wk (OR = 1.16, p = 0.039), 1.7 times more likely 
to meet recommended muscular strength activities (i.e., ≥ 3 days/wk) (OR = 1.70, 
p < 0.001), 37% less likely to not meet recommended recreational sitting time 
(i.e., ≥ 840 mins/wk) (OR = 0.63, p < 0.01), and were 2.1 times more likely to 
experience very severe stress level than the Non-changed ES group (p < 0.001). 
These results shed light on the importance of promoting mental health care in 
adolescents, regardless of PA levels, for their well-being during potential 
future pandemics. Understanding the impact of perceived ES changes on health 
behaviors can inform targeted interventions and support strategies to improve 
the mental health outcomes of adolescents during challenging times.

Copyright: © 2023 Kim et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0294270
PMCID: PMC10642811
PMID: 37956137 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


259. J Epidemiol Glob Health. 2023 Dec;13(4):902-910. doi: 
10.1007/s44197-023-00164-7. Epub 2023 Nov 13.

The Impact of Social Media on the Physical and Mental Well-Being of Medical 
Students During the COVID-19 Pandemic.

Mahevish R(1), Khan A(1), Mahmood HR(1), Qazi S(1), Fakhoury HMA(2), Tamim 
H(3)(4).

Author information:
(1)College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
(2)College of Medicine, Alfaisal University, Riyadh, Saudi Arabia. 
hana.fakhoury@gmail.com.
(3)College of Medicine, Alfaisal University, Riyadh, Saudi Arabia. 
htamim@alfaisal.edu.
(4)Department of Internal Medicine, American University of Beirut Medical 
Center, Beirut, Lebanon. htamim@alfaisal.edu.

COVID-19 pandemic has increased social media engagement globally. This study 
examined the correlation between social media use and physical/mental health 
among university students, considering gender and academic year. Out of 146 
responses, 119 were analyzed after excluding participants with pre-existing 
psychological conditions. Results showed a significant correlation between 
social media use and mental health for all participants (correlation 
coefficient = 0.30, p < 0.001), indicating a negative impact on mental health 
with increased use. Gender-specific analysis revealed a non-significant 
correlation among males (p = 0.21), while females exhibited a significant 
correlation (correlation coefficient = 0.32, p = 0.01), suggesting an adverse 
effect on their mental health. Regarding physical health, females displayed an 
even higher correlation (correlation coefficient = 0.40, p < 0.001), 
highlighting the negative influence of social media on their physical 
well-being. Conversely, no significant correlation was observed among males. 
Analyzing by academic year, both pre-clerkship and clerkship students showed a 
significant correlation between social media use and mental health (correlation 
coefficients of 0.26, p = 0.01, and 0.42, p = 0.03, respectively). Similarly, a 
significant correlation was found between social media use and physical health 
among pre-clerkship students (correlation coefficient = 0.34, p = 0.001), but 
not among clerkship students. In conclusion, this study provides evidence of the 
adverse impact of social media use on physical and mental health among 
university students, particularly among females and across different academic 
years. These findings underscore the importance of promoting healthy social 
media habits and raising awareness about the potential negative effects on 
well-being.

© 2023. The Author(s).

DOI: 10.1007/s44197-023-00164-7
PMCID: PMC10686904
PMID: 37955808 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no competing interests to 
declare that are relevant to the content of this article.


260. Psychooncology. 2023 Dec;32(12):1939-1947. doi: 10.1002/pon.6250. Epub 2023 Nov 
10.

The lived experiences of hematology healthcare providers during and beyond the 
COVID-19 crisis: A qualitative study.

Zomerdijk N(1)(2), Jongenelis MI(2)(3), Collins B(2), Short CE(2)(3)(4), Huntley 
K(5), Smith A(5), Turner J(6).

Author information:
(1)School of Public Health, The University of Queensland, Brisbane, Queensland, 
Australia.
(2)Melbourne School of Psychological Sciences, University of Melbourne, 
Melbourne, Victoria, Australia.
(3)Melbourne Centre for Behaviour Change, University of Melbourne, Melbourne, 
Victoria, Australia.
(4)School of Health Sciences, University of Melbourne, Melbourne, Victoria, 
Australia.
(5)Leukaemia Foundation, Brisbane, Queensland, Australia.
(6)Faculty of Medicine, University of Queensland, Brisbane, Queensland, 
Australia.

OBJECTIVE: Amid the COVID-19 pandemic, healthcare providers (HCPs) of hematology 
patients face unique challenges due to the vulnerability of their patients. This 
study explores the lived experiences of these providers during and beyond the 
crisis.
METHODS: Twenty-one Australian HCPs caring for hematology patients completed 
semi-structured interviews exploring their experiences and needs during the 
COVID-19 pandemic, adequacy of support and information provided by healthcare 
organizations, impact on hematology patients, and the benefits and challenges of 
telehealth care. Data were analyzed using reflexive thematic analysis.
RESULTS: Four themes were identified: (1) Managing an initial state of flux 
(unsettling uncertainty and fear, unique needs of hematology patients, getting 
on with the job together); (2) Concerns about care provision (questioning care 
efficacy, burden of compassion); (3) Disconnect between HCP needs and 
system-level responses (burnout, isolation, and poor work-life balance, 
broadcast fatigue, protecting mental health), and; (4) Reflecting on the future 
(ongoing challenges for hematology patients, higher staff turnover and heavier 
workloads, innovation in the healthcare field).
CONCLUSION: This study sheds light on the challenges that hematology HCPs face 
during and beyond the COVID-19 crisis, impacting their wellbeing. Addressing 
these challenges is paramount for the healthcare system at large. Provider-led 
peer support programs may be beneficial for addressing moral distress and 
building resilience. Additionally, specific consideration for the ongoing 
vulnerability of hematology patients could have positive impacts on providers' 
professional satisfaction.

© 2023 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd.

DOI: 10.1002/pon.6250
PMID: 37950341 [Indexed for MEDLINE]


261. JAMA Netw Open. 2023 Nov 1;6(11):e2342012. doi: 
10.1001/jamanetworkopen.2023.42012.

Ambulatory Intensive Care for Medically Complex Patients at a Health Care Clinic 
for Individuals Experiencing Homelessness: The SUMMIT Randomized Clinical Trial.

Chan B(1)(2), Edwards ST(1)(3), Srikanth P(4), Mitchell M(2), Devoe M(1)(2), 
Nicolaidis C(1)(5), Kansagara D(1)(3), Korthuis PT(1)(6), Solotaroff R(2), Saha 
S(3)(7).

Author information:
(1)Section of Addiction Medicine, Division of General Internal Medicine and 
Geriatrics, Oregon Health & Science University, Portland.
(2)Central City Concern, Portland, Oregon.
(3)Center to Improve Veteran Involvement in Care, Veterans Affairs Portland 
Health Care System, Portland, Oregon.
(4)Biostatistics Design Program, Oregon Health & Science University, Portland.
(5)School of Social Work, Portland State University, Portland, Oregon.
(6)School of Public Health, Oregon Health & Science University-Portland State 
University, Portland.
(7)Division of General Internal Medicine, Johns Hopkins University, Baltimore, 
Maryland.

IMPORTANCE: Intensive primary care interventions have been promoted to reduce 
hospitalization rates and improve health outcomes for medically complex 
patients, but evidence of their efficacy is limited.
OBJECTIVE: To assess the efficacy of a multidisciplinary ambulatory intensive 
care unit (A-ICU) intervention on health care utilization and patient-reported 
outcomes.
DESIGN, SETTING, AND PARTICIPANTS: The Streamlined Unified Meaningfully Managed 
Interdisciplinary Team (SUMMIT) randomized clinical trial used a wait-list 
control design and was conducted at a health care clinic for patients 
experiencing homelessness in Portland, Oregon. The first patient was enrolled in 
August 2016, and the last patient was enrolled in November 2019. Included 
patients had 1 or more hospitalizations in the prior 6 months and 2 or more 
chronic medical conditions, substance use disorder, or mental illness. Data 
analysis was performed between March and May 2021.
INTERVENTION: The A-ICU included a team manager, a pharmacist, a nurse, care 
coordinators, social workers, and physicians. Activities included comprehensive 
90-minute intake, transitional care coordination, and flexible appointments, 
with reduced panel size. Enhanced usual care (EUC), consisting of team-based 
primary care with access to community health workers and mental health, 
addiction treatment, and pharmacy services, served as the comparator. 
Participants who received EUC joined the A-ICU intervention after 6 months.
MAIN OUTCOMES AND MEASURES: The main outcome was the difference in rates of 
hospitalization (primary outcome), emergency department (ED) visits, and primary 
care physician (PCP) visits per person over 6 months (vs the prior 6 months). 
Patient-reported outcomes included changes in patient activation, experience, 
health-related quality of life, and self-rated health at 6 months (vs baseline). 
We performed an intention-to-treat analysis using a linear mixed-effects model 
with a random intercept for each patient to examine the association between 
study group and outcomes.
RESULTS: This study randomized 159 participants (mean [SD] age, 54.9 [9.8] 
years) to the A-ICU SUMMIT intervention (n = 80) or to EUC (n = 79). The 
majority of participants were men (102 [65.8%]) and most were White (121 
[76.1%]). A total of 64 participants (41.0%) reported having unstable housing at 
baseline. Six-month hospitalizations decreased in both the A-ICU and EUC groups, 
with no difference between them (mean [SE], -0.6 [0.5] vs -0.9 [0.5]; 
difference, 0.3 [95% CI, -1.0 to 1.5]). Emergency department use did not differ 
between groups (mean [SE], -2.0 [1.0] vs 0.9 [1.0] visits per person; 
difference, -1.1 [95% CI, -3.7 to 1.6]). Primary care physician visits increased 
in the A-ICU group (mean [SE], 4.2 [1.6] vs -2.0 [1.6] per person; difference, 
6.1 [95% CI, 1.8 to 10.4]). Patients in the A-ICU group reported improved social 
functioning (mean [SE], 4.7 [2.0] vs -1.1 [2.0]; difference, 5.8 [95% CI, 0.3 to 
11.2]) and self-rated health (mean [SE], 0.7 [0.3] vs -0.2 [0.3]; difference, 
1.0 [95% CI, 0.1 to 1.8]) compared with patients in the EUC group. No 
differences in patient activation or experience were observed.
CONCLUSIONS AND RELEVANCE: The A-ICU intervention did not change hospital or ED 
utilization at 6 months but increased PCP visits and improved patient 
well-being. Longer-term studies are needed to evaluate whether these observed 
improvements lead to eventual changes in acute care utilization.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03224858.

DOI: 10.1001/jamanetworkopen.2023.42012
PMCID: PMC10638646
PMID: 37948081 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest Disclosures: None reported.


262. Int J Environ Res Public Health. 2023 Oct 27;20(21):6981. doi: 
10.3390/ijerph20216981.

The Role of Self-Compassion and Attributions in the Mental Health of Older 
Adolescents amid the COVID-19 Pandemic.

Maricic J(1), Bjelic S(1), Jelic K(1).

Author information:
(1)Faculty of Croatian Studies, University of Zagreb, 10000 Zagreb, Croatia.

This study aimed to examine the relationship among self-compassion, 
attributional styles, and mental health and their components in older 
adolescents in the context of the COVID-19 pandemic. The role of each component 
of self-compassion (self-kindness, common humanity, mindfulness, self-judgment, 
isolation, and over-identification) and attributions (globality, stability, 
self-worth, and negative consequences) in predicting mental health was also 
analyzed. There were 322 participants aged 18 to 22 that participated in an 
online survey. The participants filled out a form that consisted of 
sociodemographic questions, COVID-19-related questions, the Self-Compassion 
Scale, the Mental Health Continuum-short form-and the Cognitive Styles 
Questionnaire-very short form. The results indicated moderate levels of 
self-compassion, attributions, and mental health in participants. Furthermore, 
gender differences in self-compassion were confirmed, meaning that male 
participants had higher total levels of self-compassion, and certain differences 
were observed on attribution subscales, but not on well-being subscales. 
Self-compassion and mental health were found to be positively correlated with 
each other and negatively correlated with negative attributions. Of the four 
attributional components, stability and negative consequences were revealed to 
be significant negative predictors in the first step but lost their significance 
with the inclusion of self-compassion components in the second step of the 
analysis. Regarding the six components of self-compassion, self-kindness, 
recoded isolation, and common humanity were significant positive predictors in 
the second step of the analysis. COVID-19-related items did not show any 
significant intergroup differences. Our findings contribute to a better 
understanding of the relationship between positive mental health, 
self-compassion, and attributions in older adolescents so that they can be used 
as theoretical support for related interventions, especially during and after 
times of crisis, such as a pandemic.

DOI: 10.3390/ijerph20216981
PMCID: PMC10648687
PMID: 37947539 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


263. Philos Ethics Humanit Med. 2023 Nov 9;18(1):16. doi: 10.1186/s13010-023-00143-7.

The power of connected clinical teams: from loneliness to belonging.

Hoare J(1).

Author information:
(1)Department of Psychiatry and Mental Health, University of Cape Town, Anzio 
Road Observatory, Cape Town, 7925, South Africa. jackie.hoare@uct.ac.za.

BACKGROUND: We need to preserve the lessons of the COVID-19 pandemic in caring 
for the mental health of clinicians, of shared experiences, interdependence, 
team cohesion and vulnerability, among others. We need reform in the way that 
clinicians are cared for, and a resistance to the idea of a post-pandemic 
'return to normal'.
MAIN TEXT: To build connected and optimally functioning clinical teams, we need 
to create an inclusive culture in which difficult conversations and caring are 
the expectation. If we are to be better at solving problems and better at 
serving our patients, we should be vigilant about creating a psychologically 
safe medical culture in which colleagues feel safe, seen, heard, and respected.
CONCLUSION: Going forward, each of us, regardless of seniority, needs to take 
responsibility for this culture change. We need to create and participate in 
weekly collegial peer support sessions that feel nurturing and safe, that allow 
us to reveal parts of ourselves, to be vulnerable with each other in a way that 
reduces loneliness, and encourages and maintains social connections and a sense 
of belonging within clinical teams, improves clinician well-being and reduces 
the risk of burnout. "Care is a practice of informed responsive actions on 
behalf of the one cared for and authentically aimed toward their growth and 
flourishing." Care Ethics in the Age of Precarity; Maurice Hamington and Michael 
Flower.

© 2023. The Author(s).

DOI: 10.1186/s13010-023-00143-7
PMCID: PMC10633999
PMID: 37946267 [Indexed for MEDLINE]

Conflict of interest statement: None to declare.


264. BMC Complement Med Ther. 2023 Nov 9;23(1):403. doi: 10.1186/s12906-023-04240-0.

Effectiveness of an amygdala and insula retraining program combined with 
mindfulness training to improve the quality of life in patients with long COVID: 
a randomized controlled trial protocol.

Gasión V(1), Barceló-Soler A(2)(3)(4), Beltrán-Ruiz M(1)(5), Hijar-Aguinaga 
R(1), Camarero-Grados L(1), López-Del-Hoyo Y(1)(5), García-Campayo J(1)(5), 
Montero-Marin J(6)(7)(8).

Author information:
(1)Aragon Institute for Health Research, IIS Aragon, Zaragoza, Spain.
(2)Aragon Institute for Health Research, IIS Aragon, Zaragoza, Spain. 
a.barcelo@unizar.es.
(3)Research Network on Chronicity, Primary Care and Health Promotion, RICAPPS, 
Zaragoza, RD21/0016/0005, Spain. a.barcelo@unizar.es.
(4)University of Zaragoza, Huesca, Spain. a.barcelo@unizar.es.
(5)Research Network on Chronicity, Primary Care and Health Promotion, RICAPPS, 
Zaragoza, RD21/0016/0005, Spain.
(6)Department of Psychiatry, University of Oxford, Oxford, UK.
(7)Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant 
Boi de Llobregat, Spain.
(8)Consortium for Biomedical Research in Epidemiology & Public Health (CIBER 
Epidemiology and Public Health - CIBERESP), Madrid, Spain.

BACKGROUND: There has been growing clinical awareness in recent years of the 
long-term physical and psychological consequences of the SARS-CoV-2 virus, known 
as Long COVID. The prevalence of Long COVID is approximately 10% of those 
infected by the virus. Long COVID is associated with physical and 
neuropsychological symptoms, including those related to mental health, 
psychological wellbeing, and cognition. However, research on psychological 
interventions is still in its early stages, in which means that available 
results are still limited. The main objective of this study is to evaluate the 
effects of a program based on amygdala and insula retraining (AIR) combined with 
mindfulness training (AIR + Mindfulness) on the improvement of quality of life, 
psychological well-being, and cognition in patients with Long COVID.
METHODS: This study protocol presents a single-blind randomized controlled trial 
(RCT) that encompasses baseline, post-treatment, and six-month follow-up 
assessment time points. A total of 100 patients diagnosed with Long COVID by the 
Spanish National Health Service will be randomly assigned to either 
AIR + Mindfulness (n = 50) or relaxation intervention (n = 50), the latter as a 
control group. The primary outcome will be quality of life assessed using the 
Short Form-36 Health Survey (SF-36). Additional outcomes such as fatigue, pain, 
anxiety, memory, and sleep quality will also be evaluated. Mixed effects 
regression models will be used to estimate the effectiveness of the program, and 
effect size calculations will be made.
DISCUSSION: Long COVID syndrome is a clinical condition characterized by the 
persistence of symptoms for at least 12 weeks after the onset of COVID-19 that 
significantly affects people's quality of life. This will be the first RCT 
conducted in Spain to apply a psychotherapy program for the management of 
symptoms derived from Long COVID. Positive results from this RCT may have a 
significant impact on the clinical context by confirming the beneficial effect 
of the intervention program being evaluated on improving the symptoms of Long 
COVID syndrome and aiding the development of better action strategies for these 
patients.
TRIAL REGISTRATION: Clinical Trials.gov NCT05956405. Registered on July 20, 
2023.

© 2023. The Author(s).

DOI: 10.1186/s12906-023-04240-0
PMCID: PMC10634181
PMID: 37946190 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


265. Psychiatr Prax. 2024 Apr;51(3):163-166. doi: 10.1055/a-2191-0234. Epub 2023 Nov 
9.

[Anxiety, Depression, Psychological Strain and Physical Complaints before and 
after the Covid-19 Pandemic in a German Longitudinal Study with Adults from 
Saxony].

[Article in German; Abstract available in German from the publisher]

Berth H(1), Brähler E(2)(3), Braunheim L(2), Zenger M(4)(5), Stöbel-Richter 
Y(6), Emmerich F(1), Richter EP(1), Irmscher L(1).

Author information:
(1)Medizinische Fakultät Carl Gustav Carus, Psychosoziale Medizin und 
Entwicklungsneurowissenschaften, Forschungsgruppe Angewandte Medizinische 
Psychologie und Medizinische Soziologie, Technische Universität Dresden.
(2)Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, 
Universitätsmedizin der Johannes Gutenberg-Universität Mainz.
(3)Abteilung Medizinische Psychologie und Medizinische Soziologie, 
Universitätsklinikum Leipzig.
(4)Fachbereich Angewandte Humanwissenschaften, Hochschule Magdeburg-Stendal.
(5)Verhaltensmedizin, Psychosomatische Medizin und Psychotherapie, 
Universitätsmedizin Leipzig, Integriertes Forschungs- und Behandlungszentrum 
AdipositasErkrankungen, Leipzig.
(6)Fakultät Management und Kulturwissenschaften, Hochschule Zittau/Gorlitz.

OBJECTIVE: The objective of the study was to investigate whether psychological 
distress increased in a German community sample from Saxony during the course of 
the Corona pandemic.
METHODS: In 2017/2018 and 2022, N=289 participants (54.7% female) of the Saxon 
Longitudinal Study were interviewed about their psychological well-being using 
questionnaires (PHQ-4, SSS-8).
RESULTS: There is a significant increase in complaints (anxiety, depression, 
psychological distress, physical complaints) compared to 2017/2018 to 2022 with 
effect sizes in the small and medium range (Cohens d=0.26-0.62).
CONCLUSION: Data collection was not due to the pandemic but was routine as part 
of an ongoing long-term study. The Covid-19 pandemic led to an increase in 
psychological distress and physical complaints in a Saxonian, age-homogeneous 
population sample.

Publisher: ZIEL DER STUDIE: Es wird untersucht, ob es im Zuge der Coronapandemie 
zu einer Erhöhung der psychischen Belastung in einer deutschen 
Normalbevölkerungsstichprobe Erwachsener aus Sachsen kommt.
METHODIK: 2017/2018 und 2022 wurden je N=289 Teilnehmer:innen (54,7% weiblich) 
der Sächsischen Längsschnittstudie mittels Fragebögen (PHQ-4, SSS-8) zu ihrem 
psychischen Befinden befragt.
ERGEBNISSE: Im Vergleich von 2017/2018 zu 2022 kommt es zu einer signifikanten 
Zunahme der Beschwerden (Ängstlichkeit, Depressivität, psychische Belastung, 
Körperbeschwerden) mit Effektstärken im kleinen und mittleren Bereich (Cohens 
d=0.26-0.62).
SCHLUSSFOLGERUNG: Die Datenerhebung erfolgte nicht aufgrund der Pandemie sondern 
routinemäßig in einer existierenden Langzeituntersuchung. Die Coronapandemie 
führte in einer sächsischen, altershomogenen Stichprobe längsschnittlich zu 
einem Anstieg der psychischen Belastung und der Körperbeschwerden.

Thieme. All rights reserved.

DOI: 10.1055/a-2191-0234
PMID: 37944944 [Indexed for MEDLINE]

Conflict of interest statement: Die Autorinnen/Autoren geben an, dass kein 
Interessenkonflikt besteht


266. Aging Clin Exp Res. 2023 Dec;35(12):3085-3096. doi: 10.1007/s40520-023-02610-9. 
Epub 2023 Nov 9.

Psychobiological effects of an eHealth psychoeducational intervention to 
informal caregivers of persons with dementia: a pilot study during the COVID-19 
pandemic in Italy.

Singh Solorzano C(1), Cattane N(2), Mega A(3), Orini S(4)(5), Zanetti O(4), 
Chattat R(6), Marizzoni M(7)(2), Pievani M(7), Cattaneo A(2)(8), Festari C(7).

Author information:
(1)Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto 
Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni 4, 25125, Brescia, 
Italy. csolorzano@fatebenefratelli.eu.
(2)Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio 
Fatebenefratelli, Brescia, Italy.
(3)UOC Neurologia, ULSS 9 Scaligera-Distretto 4, Verona, Italy.
(4)Alzheimer Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 
Brescia, Italy.
(5)Department of Clinical and Experimental Sciences, Università degli Studi di 
Brescia, Brescia, Italy.
(6)Department of Psychology, Università di Bologna, Bologna, Italy.
(7)Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto 
Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni 4, 25125, Brescia, 
Italy.
(8)Department of Pharmacological and Biomolecular Sciences, University of Milan, 
Milan, Italy.

BACKGROUND: The workload associated with caring for a person with dementia (PwD) 
could negatively affect informal caregivers' physical and mental health. 
According to the recent literature, there is a need for studies testing the 
implementation of affordable and accessible interventions for improving 
caregivers' well-being.
AIMS: This study aimed to explore the feasibility and effectiveness of an 8 week 
eHealth psychoeducation intervention held during the COVID-19 pandemic in Italy 
in reducing the psychological burden and neuroendocrine markers of stress in 
caregivers of PwD.
METHODS: Forty-one informal caregivers of PwD completed the eHealth 
psychoeducation intervention. Self-reported (i.e., caregiver burden, anxiety 
symptoms, depressive symptoms, and caregiver self-efficacy) and cortisol 
measurements were collected before and after the intervention.
RESULTS: Following the intervention, the caregivers' self-efficacy regarding the 
ability to respond to disruptive behaviours improved (t = - 2.817, p = 0.007), 
anxiety and burden levels decreased (state anxiety: t = 3.170, p = 0.003; trait 
anxiety: t = 2.327, p = 0.025; caregiver burden: t = 2.290, p = 0.027), while 
depressive symptoms and cortisol levels did not change significantly. 
Correlation analyses showed that the increase in self-efficacy was positively 
associated with the improvement of caregiver burden from pre- to 
post-intervention (r = 0.386, p = 0.014). The intervention had a low rate of 
dropout (n = 1, due to the patient's death) and high levels of appreciation.
DISCUSSION: The positive evidence and participation rate support the feasibility 
and effectiveness of the proposed eHealth psychoeducational intervention to meet 
the need for knowledge of disease management and possibly reduce detrimental 
effects on caregivers' psychological well-being.
CONCLUSION: Further placebo-controlled trials are needed to test the 
generalizability and specificity of our results.

© 2023. The Author(s).

DOI: 10.1007/s40520-023-02610-9
PMCID: PMC10721699
PMID: 37943404 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflict of interest to 
report.


267. Brain. 2024 Mar 1;147(3):849-857. doi: 10.1093/brain/awad377.

Vortioxetine for the treatment of post-COVID-19 condition: a randomized 
controlled trial.

McIntyre RS(1)(2)(3), Phan L(3), Kwan ATH(3)(4), Mansur RB(1), Rosenblat JD(1), 
Guo Z(2)(3), Le GH(3)(5), Lui LMW(3), Teopiz KM(3), Ceban F(3)(6), Lee Y(3), 
Bailey J(3), Ramachandra R(3), Di Vincenzo J(3), Badulescu S(3)(5), Gill 
H(3)(5), Drzadzewski P(3), Subramaniapillai M(3).

Author information:
(1)Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada.
(2)Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON 
M5S 1A8, Canada.
(3)Brain and Cognition Discovery Foundation, Toronto, ON M5S 1M2, Canada.
(4)Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.
(5)Institute of Medical Science, Faculty of Medicine, University of Toronto, 
Toronto, ON M5S 1A8, Canada.
(6)Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8P 
1H6, Canada.

Hitherto no therapeutic has received regulatory approval for the treatment of 
post-COVID-19 condition (PCC). Cognitive deficits, mood symptoms and significant 
reduction in health-related quality of life (HRQoL) are highly replicated and 
debilitating aspects of PCC. We sought to determine the impact of vortioxetine 
on the foregoing symptoms and HRQoL in persons living with PCC. An 8-week 
randomized, double-blind, placebo-controlled study of adults ≥ 18 years of age 
residing in Canada and who are experiencing symptoms of World Health 
Organization (WHO)-defined PCC, with a history of confirmed SARS-CoV-2 
infection, was conducted. Recruitment began November 2021 and ended January 
2023. Of the 200 participants enrolled (487 invited: 121 ineligible and 59 
eligible but declined participation; 307 cleared pre-screening stage), a total 
of 149 participants were randomized (1:1) to receive either vortioxetine 
(5-20 mg, n = 75) or placebo (n = 74) daily for 8 weeks of double-blind 
treatment (i.e. end point). The primary outcome was the change from 
baseline-to-end point in the Digit Symbol Substitution Test. Secondary outcomes 
included the effect on depressive symptoms and HRQoL, as measured by changes 
from baseline-to-end point on the Quick Inventory of Depressive Symptomatology 
16-item and WHO Wellbeing Scale 5-item, respectively. A total of 68 (90.7%) 
participants randomized to vortioxetine and 73 (98.6%) participants randomized 
to placebo completed all 8 weeks. Between-group analysis did not show a 
significant difference in the overall change in cognitive function [P = 0.361, 
95% confidence interval (CI) (-0.179, 0.492)]. However, in the fully adjusted 
model, a significant treatment × time interaction was observed in favour of 
vortioxetine treatment with baseline c-reactive protein (CRP) as a moderator (P 
= 0.012). In addition, a significant improvement in Digit Symbol Substitution 
Test scores were observed in vortioxetine versus placebo treated participants in 
those whose baseline CRP was above the mean (P = 0.045). Moreover, significant 
improvement was obtained in measures of depressive symptoms [P < 0.001, 95% CI 
(-4.378, -2.323)] and HRQoL [P < 0.001, 95% CI (2.297, 4.647)] in 
vortioxetine-treated participants and between the treatment groups [depressive 
symptoms: P = 0.026, 95% CI (-2.847, -0.185); HRQoL: P = 0.004, 95% CI (0.774, 
3.938)]. Although vortioxetine did not improve cognitive function in the 
unadjusted model, when adjusting for CRP, a significant pro-cognitive effect was 
observed; antidepressant effects and improvement in HRQoL in this debilitating 
disorder were also noted.

© The Author(s) 2023. Published by Oxford University Press on behalf of the 
Guarantors of Brain. All rights reserved. For permissions, please e-mail: 
journals.permissions@oup.com.

DOI: 10.1093/brain/awad377
PMID: 37936330 [Indexed for MEDLINE]


268. Interact J Med Res. 2023 Nov 29;12:e50148. doi: 10.2196/50148.

Correlation Between the Social Network Structure and Well-Being of Health Care 
Workers in Intensive Care Units: Prospective Observational Study.

Esumi R(#)(1)(2), Ito-Masui A(#)(1)(3), Kawamoto E(#)(1)(4), Ito M(3), Hayashi 
T(5), Shinkai T(3), Hane A(3), Okuno F(3)(4), Park EJ(1), Kaku R(4), Shimaoka 
M(#)(1).

Author information:
(1)Department of Molecular Pathobiology and Cell Adhesion Biology, Mie 
University Graduate School of Medicine, Tsu, Japan.
(2)Department of Emergency Medicine, National Hospital Organization Mie Chuo 
Medical Center, Tsu, Japan.
(3)Department of Emergency and Disaster Medicine, Mie University Hospital, Tsu, 
Japan.
(4)Department of Anesthesiology, Mie University Hospital, Tsu, Japan.
(5)Department of Nursing, Mie University Hospital, Tsu, Japan.
(#)Contributed equally

BACKGROUND: Effective communication strategies are becoming increasingly 
important in intensive care units (ICUs) where patients at high risk are 
treated. Distributed leadership promotes effective communication among health 
care professionals (HCPs). Moreover, beyond facilitating patient care, it may 
improve well-being among HCPs by fostering teamwork. However, the impact of 
distributed leadership on the communication structure and well-being of HCPs 
remains unclear.
OBJECTIVE: We performed a social network analysis (SNA) to assess the 
characteristics of each HCP in the network, identify the number of HCP 
connections, analyze 4 centralities that can measure an HCP's importance, and 
evaluate the impact of distributed leadership structure on the well-being and 
communication structure of the medical staff.
METHODS: Wearable sensors were used to obtain face-to-face interaction data from 
the ICU medical staff at Mie University Hospital, Japan. Participants wore a 
badge on the front of their clothing during working hours to measure the total 
frequency of face-to-face interactions. We collected data about the well-being 
of medical staff using the Center for Epidemiological Studies-Depression (CES-D) 
questionnaire and measured 4 centralities using SNA analysis. A CES-D 
questionnaire was administered during the study to measure the well-being of the 
HCPs.
RESULTS: Overall, 247 ICU workers participated in this clinical study for 4 
weeks yearly in February 2016, 2017, and 2018. The distributed leadership 
structure was established within the ICU in 2017 and 2018. We compared these 
results with those of the traditional leadership structure used in 2016. Most 
face-to-face interactions in the ICU were among nurses or between nurses and 
other professionals. In 2016, overall, 10 nurses could perform leadership tasks, 
which significantly increased to 24 in 2017 (P=.046) and 20 in 2018 (P=.046). 
Considering the increased number of nurses who could perform leadership duties 
and the collaboration created within the organization, SNA in 2018 showed that 
the betweenness (P=.001), degree (P<.001), and closeness (P<.001) centralities 
significantly increased compared with those in 2016. However, the eigenvector 
centrality significantly decreased in 2018 compared with that in 2016 (P=.01). 
The CES-D scores in 2018 also significantly decreased compared with those in 
2016 (P=.01). The betweenness (r=0.269; P=.02), degree (r=0.262; P=.03), and 
eigenvector (r=0.261; P=.03) centralities and CES-D scores were positively 
correlated in 2016, whereas the closeness centrality and CES-D scores were 
negatively correlated (r=-0.318; P=.01). In 2018, the degree (r=-0.280; P=.01) 
and eigenvector (r=-0.284; P=.01) centralities were negatively correlated with 
CES-D scores.
CONCLUSIONS: Face-to-face interactions of HCPs in the ICU were measured using 
wearable sensors, and nurses were found to be centrally located. However, the 
introduction of distributed leadership created collaboration and informal 
leadership in the organization, altering the social network structure of HCPs 
and increasing organizational well-being.
TRIAL REGISTRATION: University Hospital Medical Information Network (UMIN) 
UMIN000037046; 
https://center6.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000042211.

©Ryo Esumi, Asami Ito-Masui, Eiji Kawamoto, Mami Ito, Tomoyo Hayashi, Toru 
Shinkai, Atsuya Hane, Fumito Okuno, Eun Jeong Park, Ryuji Kaku, Motomu Shimaoka. 
Originally published in the Interactive Journal of Medical Research 
(https://www.i-jmr.org/), 29.11.2023.

DOI: 10.2196/50148
PMCID: PMC10719822
PMID: 37935050

Conflict of interest statement: Conflicts of Interest: None declared.


269. Clin Child Fam Psychol Rev. 2023 Dec;26(4):1077-1096. doi: 
10.1007/s10567-023-00460-5. Epub 2023 Nov 7.

Need for Sexual, Reproductive, and Mental Health Promotion Among Diverse College 
Students in a COVID-19 Era.

Cooley-Strickland M(1)(2), Wyatt GE(3), Loeb TB(3), Nicholas LA(4), 
Smith-Clapham A(3), Hamman A(3), Abraham M(5), Scott EN(3), Albarran G(3).

Author information:
(1)Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry 
and Biobehavioral Sciences, David Geffen School of Medicine, University of 
California, Los Angeles, Los Angeles, CA, 90024-1759, USA. 
mcooley@mednet.ucla.edu.
(2)Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins 
University, Baltimore, MD, USA. mcooley@mednet.ucla.edu.
(3)Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry 
and Biobehavioral Sciences, David Geffen School of Medicine, University of 
California, Los Angeles, Los Angeles, CA, 90024-1759, USA.
(4)Department of Obstetrics and Gynecology, David Geffen School of Medicine at 
UCLA, Los Angeles, CA, USA.
(5)David Geffen School of Medicine, University of California, Los Angeles, Los 
Angeles, CA, USA.

In 2020, the COVID-19 pandemic forced unprecedented disruptions in higher 
education operations. While the adverse mental health effects experienced by 
college students due to these changes are well documented, less is known about 
the impact on their sexual and reproductive health (SRH), and the reciprocal 
relationships between SRH and mental health among adolescents and emerging 
adults. This position paper reviews existing literature on the effects of the 
COVID-19 pandemic on SRH, sexual violence, unintended pregnancy, sexually 
transmitted illness and human immunodeficiency virus rates and highlights issues 
specific to college-aged males, females, racial/ethnic and sexual minorities, 
and individuals with disabilities. The need to conceptualize SRH as an integral 
component of normal development, overall health, and well-being in the context 
of COVID-19 is discussed. The need to prioritize the design and implementation 
of developmentally appropriate, evidence-based SRH interventions specifically 
targeting college students is identified. Furthermore, an intergenerational 
approach to SRH that includes parents/caregivers and/or college faculty and 
staff (e.g., coaches, trainers) could facilitate comprehensive SRH prevention 
programming that enhances sexual violence prevention training programs currently 
mandated by many colleges. Policies and programs designed to mitigate adverse 
pandemic-related exacerbations in negative SRH outcomes are urgently needed and 
should be included in mainstream clinical psychology, not only focused on 
preventing unwanted outcomes but also in promoting rewarding interpersonal 
relationships and overall well-being. Recommendations for clinical psychologists 
and mental health researchers are made.

© 2023. The Author(s).

DOI: 10.1007/s10567-023-00460-5
PMCID: PMC10640429
PMID: 37934361 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no relevant 
financial or non-financial conflicts of interest to disclose.


270. Omega (Westport). 2023 Nov 7:302228231214128. doi: 10.1177/00302228231214128. 
Online ahead of print.

Factors Affecting Death Anxiety in Patients Undergoing Open Heart Surgery: A 
Cross-Sectional Study.

Dağcan Şahin N(1), Gürol Arslan G(2), Özbek D(3).

Author information:
(1)Fundamentals of Nursing Department, The Institute of Health Sciences, Dokuz 
Eylül University, Izmir, Turkey.
(2)Fundamentals of Nursing Department, Nursing Faculty, Dokuz Eylül University, 
Izmir, Turkey.
(3)Akhisar Mustafa Kirazoglu State Hospital, Manisa, Turkey.

After the operation, death anxiety of patients is affected by many factors. This 
study aims to investigate the factors affecting death anxiety of patients 
undergoing open heart surgery. A descriptive, cross-sectional study. Data were 
collected using the 'Introductory Information Form,' the 'Templer's Death 
Anxiety Scale,' and the 'Spiritual Well-being Scale.' This study was conducted 
with 313 intensive care patients. The mean scores of the patients on the "Death 
Anxiety Scale" were moderate (7.96 (4.28)). According to the study findings, 
age, gender, length of stay in the intensive care unit, and spiritual well-being 
were found to be important predictors of death anxiety (F (4,308) = 16.149, p < 
.001). Considering gender differences in nursing care, it is thought that the 
intensive care period will be shortened, the level of spiritual well-being will 
increase and death anxiety will decrease.

DOI: 10.1177/00302228231214128
PMID: 37933629

Conflict of interest statement: Declaration of Conflicting InterestsThe 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


271. J Emerg Manag. 2023 Sep-Oct;21(5):375-384. doi: 10.5055/jem.0820.

Surveying mental health stressors of emergency management professionals: Factors 
in recruiting and retaining emergency managers in an era of disasters and 
pandemics.

Patel SS(1), Guevara K(2), Hollar TL(3), DeVito RA(4), Erickson TB(5).

Author information:
(1)Transcultural Conflict and Violence Initiative, Georgia State University, 
Atlanta, Georgia; Harvard Humanitarian Initiative, Harvard TH Chan School of 
Public Health, Harvard University, Boston, Massachusetts. ORCID: 
https://orcid.org/0000-0002-9810-0055.
(2)Founder and CEO, Mozaik Solutions, San Diego, California. ORCID: 
https://orcid.org/0009-0009-9911-8933.
(3)Department of Public Health, Dr. Kiran C. Patel College of Osteopathic 
Medicine, Nova Southeastern University, Fort Lauderdale, Florida. ORCID: 
https://orcid.org/0000-0002-7924-6171.
(4)Journal of Emergency Management, Weston Medical Publishing, LLC, Weston, 
Massachusetts. ORCID: https://orcid.org/0000-0002-2451-276X.
(5)Division of Medical Toxicology, Department of Emergency Medicine, Mass 
General Brigham, Harvard Medical School, Harvard Humanitarian Initiative, 
Boston, Massachusetts. ORCID: https://orcid.org/0000-0002-1809-4805.

Emergency managers are responsible for managing crises and disasters, and while 
their work is essential, it can be stressful and impact their mental health, 
particularly during the COVID-19 pandemic. This study aimed to examine the 
mental health of professional emergency managers and factors associated with 
their intent to leave the field before and during the COVID-19 pandemic. A total 
of 903 respondents completed an online survey assessing their secondary 
traumatic stress, emergency reaction strategies, organizational culture, age, 
length of time in primary position, the highest level of education as well as 
other metrics. The Secondary Traumatic Stress Scale (STSS) was used to determine 
scores of secondary traumatic stress symptoms, and the Emergency Reaction 
Questionnaire (ERQ) index was used to evaluate levels of predominant personality 
types and its tendency towards "fight or flight" reactions in emergency 
situations. Results revealed significant differences among respondents who 
reported considering leaving the field before or during the COVID-19 pandemic in 
terms of secondary traumatic stress scores, ERQ levels, perceived organizational 
culture (OC), age category, length of time in primary position, and the highest 
level of education (p < 0.05). Logistic regression analysis indicated that 
respondents with higher secondary traumatic stress scores, poorer organizational 
culture, younger age, less experience, and a bachelor's degree had nearly three 
times the odds of reporting considering leaving the field (p < 0.05). 
Additionally, respondents with a graduate degree had nearly four times the odds 
of reporting leaving the field (p < 0.05), while those who had directly managed 
between three and five disasters had nearly two times the odds of reporting and 
considering leaving the field (p < 0.05). These findings underscore the 
importance of addressing secondary traumatic stress, promoting positive 
organizational culture, and providing support for emergency managers now and in 
the future. By addressing the factors identified in this study, such as 
secondary traumatic stress symptoms, promoting positive organizational culture, 
and providing adequate support, emergency management organizations can improve 
the mental health and well-being of their personnel, reduce attrition rates, and 
ensure that they are better equipped to respond to future crises.

DOI: 10.5055/jem.0820
PMID: 37932942 [Indexed for MEDLINE]


272. PLoS One. 2023 Nov 6;18(11):e0290267. doi: 10.1371/journal.pone.0290267. 
eCollection 2023.

Introducing effective parameters for predicting job burnout using a 
self-organizing method based on group method of data handling neural network.

Fan T(1), Nazemi E(2).

Author information:
(1)Assumption University, Bangkok, Thailand.
(2)Faculty of Engineering and Physical Sciences, Southampton University, 
Southampton, United Kingdom.

In addition to affecting people's bodily and mental health, the Covid-19 
epidemic has also altered the emotional and mental well-being of many workers. 
Especially in the realm of institutions and privately held enterprises, which 
encountered a plethora of constraints due to the peculiar circumstances of the 
epidemic. It was thus anticipated that the present study would use a group 
method of data handling (GMDH) neural network for analyzing the relationship of 
demographic factors, Coronavirus, resilience, and the burnout in startups. The 
test methodology was quantitative. The research examined 384 startup directors 
and representatives, which is a sizable proportion of the limitless community. 
The BRCS, the MBI-GS, and custom-made assessments of stress due to the 
Coronavirus were all used to collect data. Cronbach's alpha confirmed the polls' 
dependability, and an expert panel confirmed the surveys' authenticity. The GMDH 
neural network's inherent potential for self-organization was used to choose the 
most useful properties automatically. The trained network has a three-layered 
topology with 4, 3, and 2 neurons in each of the hidden layers. The GMDH network 
has significantly reduced the computational load by using just 7 parameters of 
marital status, stress of covid-19, job experience, professional efficiency, 
gender, age, and resilience for burnout categorization. After comparing the 
neural network's output with the acquired data, it was determined that the 
constructed network accurately classified all of the information. Among the 
achievements of this research, high accuracy in predicting job burnout, checking 
the performance of neural network in determining job burnout and introducing 
effective characteristics in determination of this parameter can be mentioned.

Copyright: © 2023 Fan, Nazemi. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0290267
PMCID: PMC10627462
PMID: 37930996 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


273. J Womens Health (Larchmt). 2023 Dec;32(12):1351-1362. doi: 
10.1089/jwh.2023.0045. Epub 2023 Nov 6.

Intersectionality and COVID-19: Academic Medicine Faculty's Lived Experiences of 
Well-Being, Workload, and Productivity During the Pandemic.

Berge JM(1)(2)(3), Freese R(4), Macheledt KC(2), Watson S(2)(5), 
Pusalavidyasagar S(2)(6), Kunin-Batson A(2)(7), Ghebre R(2)(8), Lingras K(2)(9), 
Church AL(2)(10), Dwivedi R(1)(2), Nakib N(2)(11), McCarty CA(2)(12), Misono 
S(2)(13), Rogers EA(2)(6)(7), Patel SI(2)(14), Spencer S(2)(15).

Author information:
(1)Department of Family Medicine and Community Health, University of Minnesota 
Medical School, Minneapolis, Minnesota, USA.
(2)Center for Women in Medicine and Science, University of Minnesota Medical 
School, Minneapolis, Minnesota, USA.
(3)Women's Health Research Center/Building Interdisciplinary Research Careers in 
Women's Health (BIRCWH) Program at the University of Minnesota Medical School, 
Minneapolis, Minnesota, USA.
(4)Clinical and Translational Science Institute, Biostatistical Design and 
Analysis Center at the University of Minnesota, Minneapolis, Minnesota, USA.
(5)Center for Global Health and Social Responsibility at the University of 
Minnesota, Minneapolis, Minnesota, USA.
(6)Department of Medicine, University of Minnesota Medical School, Minneapolis, 
Minnesota, USA.
(7)Department of Pediatrics, University of Minnesota Medical School, 
Minneapolis, Minnesota, USA.
(8)Department of Obstetrics and Gynecology, University of Minnesota Medical 
School, Minneapolis, Minnesota, USA.
(9)Department of Psychiatry and Behavioral Sciences, University of Minnesota 
Medical School, Minneapolis, Minnesota, USA.
(10)Department of Radiology, University of Minnesota Medical School, 
Minneapolis, Minnesota, USA.
(11)Department of Urology, University of Minnesota Medical School, Minneapolis, 
Minnesota, USA.
(12)Department of Family Medicine and Biobehavioral Health, University of 
Minnesota Duluth, Duluth, Minnesota, USA.
(13)Department of Otolaryngology, University of Minnesota Medical School, 
Minneapolis, Minnesota, USA.
(14)Department of Neurology, University of Minnesota Medical School, 
Minneapolis, Minnesota, USA.
(15)Department of Pharmacology, University of Minnesota Medical School, 
Minneapolis, Minnesota, USA.

Purpose: The aim of this study was to utilize an intersectional framework to 
examine academic faculty's lived experiences during COVID-19. Specifically, we 
set out to: (1) describe the multiple intersectional identities (e.g., gender, 
race/ethnicity, rank, caregiver status, disability status) represented by the 
faculty, (2) examine potential disparities in well-being, workload, and 
productivity linked to these intersectional factors, and (3) identify 
qualitative themes endorsed by faculty as they relate to lived experiences 
during COVID-19. Methods: This was a cross-sectional mixed-methods research 
study. The Center for Women in Medicine and Science (CWIMS) at the University of 
Minnesota developed and implemented a survey between February-June of 2021 in 
response to national reports of disparities in the impacts of COVID-19 on 
faculty with lived experiences from multiple intersections. Results: There were 
291 full-time faculty who participated in the study. Quantitative findings 
indicated that faculty with multiple intersectional identities (e.g., 
woman+assistant professor+caregiver+underrepresented in medicine) reported 
greater depression symptoms, work/family conflict, and stress in contrast to 
faculty with fewer intersectional identities. Furthermore, faculty with more 
intersectional identities reported higher clinical workloads and service 
responsibilities and lower productivity with regard to research article 
submissions, publications, and grant submissions in contrast to faculty with 
fewer intersectional identities. Qualitative findings supported quantitative 
findings and broadened understanding of potential underlying reasons. 
Conclusions: Findings confirm anecdotal evidence that faculty with lived 
experiences from multiple intersections may be disproportionately experiencing 
negative outcomes from the pandemic. These findings can inform decisions about 
how to address these disparities moving into the next several years with regard 
to promotion and tenure, burnout and well-being, and faculty retention in 
academic medical settings. Given these findings, it is also important to 
intentionally plan responses for future public health crises to prevent 
continued disparities for faculty with multiple intersectional identities.

DOI: 10.1089/jwh.2023.0045
PMID: 37930683 [Indexed for MEDLINE]


274. J Adolesc. 2024 Feb;96(2):235-250. doi: 10.1002/jad.12270. Epub 2023 Nov 6.

Identifying protective and risk behavior patterns of online communication in 
young people.

Lowthian E(1), Fee G(1)(2), Wakeham C(3), Clegg Z(1), Crick T(1), Anthony 
R(4)(5).

Author information:
(1)Department of Education & Childhood Studies, School of Social Sciences, 
Swansea University, Swansea, UK.
(2)School of Education and Children, Centre of Health, Science and Society, 
University West England, Bristol, UK.
(3)Department of Criminology, Social Policy and Sociology, School of Social 
Sciences, Swansea University, Swansea, UK.
(4)Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, 
UK.
(5)School of Social Sciences, Centre for the Development, Evaluation, Complexity 
and Implementation in Public Health Improvement (DECIPHer), Cardiff University, 
Cardiff, UK.

INTRODUCTION: Research has investigated the association between time spent 
online and mental well-being, however the nuances between specific online 
behaviors and well-being have been less explored. This research examines how 
specific online behaviors (i.e., how young people are engaging online and with 
whom), are associated with one another, and how these patterns of behaviors are 
related to well-being.
METHODS: We used the November 2020 and March 2021 Understanding Society COVID-19 
Panel data. The sample consisted of 1432 adolescents aged 10-15 years, who 
participated in November 2020. Latent class analysis was used to explore 
patterns of online behaviors. We also investigated how sociodemographic 
characteristics differed across the classes, along with physical, social, and 
mental well-being as distal outcomes both cross-sectionally and longitudinally.
RESULTS: We identified four classes: "Avid users," "Scholars," "Midways," and 
the "Passengers." The avid users had the highest frequency of posting online 
content regularly, likewise the scholars also posted online content regularly, 
however the scholars were differentiated by their higher frequency of schoolwork 
and news intake online. The midways had more complex activity characterized by 
talking to friends often and having a social media account, but posted online 
content less frequently. The passengers were the least active online as they 
posted pictures and videos less (76% said "never") and only 63% had a social 
media account. The avid users had the lowest well-being cross-sectionally and 
longitudinally, and the midways had lower social well-being and appearance 
dissatisfaction.
CONCLUSIONS: Online behaviors such as regularly posting or talking to 
internet-only friends could be related to lower well-being. Policymakers should 
consider both improving regulations online and building an evidence base to 
enable caregivers from all backgrounds to support young people.

© 2023 The Authors. Journal of Adolescence published by Wiley Periodicals LLC on 
behalf of Foundation for Professionals in Services to Adolescents.

DOI: 10.1002/jad.12270
PMID: 37929875 [Indexed for MEDLINE]


275. Public Health Res (Southampt). 2023 Oct;11(9):1-147. doi: 10.3310/GRMA6711.

Investigating health and social outcomes of the Big Local community empowerment 
initiative in England: a mixed method evaluation.

Popay J(1), Halliday E(1), Mead R(1), Townsend A(1), Akhter N(2), Bambra C(3), 
Barr B(4), Anderson de Cuevas R(4), Daras K(4), Egan M(5), Gravenhorst K(6), 
Janke K(1), Kasim AS(2), McGowan V(3), Ponsford R(6), Reynolds J(1), Whitehead 
M(4).

Author information:
(1)Division of Health Research, Lancaster University, Lancaster, UK.
(2)Department of Anthropology, Durham University, Durham, UK.
(3)Population Health Sciences Institute, Newcastle University, 
Newcastle-upon-Tyne, UK.
(4)Department of Public Health, Policy and Systems, The University of Liverpool, 
Liverpool, UK.
(5)Department of Public Health, Environments and Society, London School of 
Hygiene & Tropical Medicine, London, UK.
(6)Department of Health Services Research and Policy, London School of Hygiene & 
Tropical Medicine, London, UK.

BACKGROUND: Most research on community empowerment provides evidence on engaging 
communities for health promotion purposes rather than attempts to create 
empowering conditions. This study addresses this gap.
INTERVENTION: Big Local started in 2010 with £271M from the National Lottery. 
Ending in 2026, it gives 150 relatively disadvantaged communities in England 
control over £1M to improve their neighbourhoods.
OBJECTIVE: To investigate health and social outcomes, at the population level 
and among engaged residents, of the community engagement approach adopted in a 
place-based empowerment initiative.
STUDY DESIGN, DATA SOURCES AND OUTCOME VARIABLES: This study reports on the 
third wave of a longitudinal mixed-methods evaluation. Work package 1 used a 
difference-in-differences design to investigate the impact of Big Local on 
population outcomes in all 150 Big Local areas compared to matched comparator 
areas using secondary data. The primary outcome was anxiety; secondary outcomes 
included a population mental health measure and crime in the neighbourhood. Work 
package 2 assessed active engagement in Big Local using cross-sectional data and 
nested cohort data from a biannual survey of Big Local partnership members. The 
primary outcome was mental well-being and the secondary outcome was self-rated 
health. Work package 3 conducted qualitative research in 14 Big Local 
neighbourhoods and nationally to understand pathways to impact. Work package 4 
undertook a cost-benefit analysis using the life satisfaction approach to value 
the benefits of Big Local, which used the work package 1 estimate of Big Local 
impact on life satisfaction.
RESULTS: At a population level, the impacts on 'reporting high anxiety' (-0.8 
percentage points, 95% confidence interval -2.4 to 0.7) and secondary outcomes 
were not statistically significant, except burglary (-0.054 change in z-score, 
95% confidence interval -0.100 to -0.009). There was some effect on reduced 
anxiety after 2017. Areas progressing fastest had a statistically significant 
reduction in population mental health measure (-0.053 change in z-score, 95% 
confidence interval -0.103 to -0.002). Mixed results were found among engaged 
residents, including a significant increase in mental well-being in Big Local 
residents in the nested cohort in 2018, but not by 2020; this is likely to be 
COVID-19. More highly educated residents, and males, were more likely to report 
a significant improvement in mental well-being. Qualitative accounts of positive 
impacts on mental well-being are often related to improved social connectivity 
and physical/material environments. Qualitative data revealed increasing 
capabilities for residents' collective control. Some negative impacts were 
reported, with local factors sometimes undermining residents' ability to 
exercise collective control. Finally, on the most conservative estimate, the 
cost-benefit calculations generate a net benefit estimate of £64M.
MAIN LIMITATIONS: COVID-19 impacted fieldwork and interpretation of survey data. 
There was a short 4-year follow-up (2016/20), no comparators in work package 2 
and a lack of power to look at variations across areas.
CONCLUSIONS: Our findings suggest the need for investment to support community 
organisations to emerge from and work with communities. Residents should lead 
the prioritisation of issues and design of solutions but not necessarily lead 
action; rather, agencies should work as equal partners with communities to 
deliver change.
FUNDING: This project was funded by the National Institute for Health and Care 
Research (NIHR) Public Health Research Programme (16/09/13) and will be 
published in full in Public Health Research; Vol. 11, No. 9. See the NIHR 
Journals Library website for further project information.

Plain Language Summary: The Communities in Control study is looking at the 
health impacts of the Big Local community empowerment programme, funded by the 
National Lottery Community Fund and managed by Local Trust (a national 
charitable organisation). Residents of 150 English areas have at least £1M and 
other support to improve the neighbourhoods. There have been three phases of the 
research. This report shares findings from their third phase, which began in 
2018. First, we used data from a national survey and data from national health 
and welfare services to compare changes in mental health between people living 
in Big Local areas and those in similar areas that did not have a Big Local 
partnership. Furthermore, we also used publicly available data on crime in the 
neighbourhoods. We found weak evidence that Big Local was linked with improved 
mental health and a reduction in burglaries. Second, we used data from a survey 
conducted by Local Trust to look at health and social impacts on the most active 
residents. We found an increase in mental well-being in 2018 but this was not 
maintained in 2020, probably due to the COVID-19 pandemic. Third, we did 
interviews and observations in 14 Big Local areas to understand what helps and 
what does not help residents to improve their neighbourhoods. We found that 
partnerships need to have legitimacy, the right balance of support, and learning 
opportunities. Residents suggested that creating social connections and 
welcoming social spaces, improving how people view the area and tackling poverty 
contributed to health improvements. Direct involvement in Big Local was both 
stressful and rewarding. Finally, we did a cost–benefit analysis by putting a 
monetary value on residents’ increase in life satisfaction due to Big Local and 
comparing it with the costs of Big Local. We found that the benefits exceed the 
costs by at least £60M, suggesting that Big Local provides good value for money.

DOI: 10.3310/GRMA6711
PMID: 37929801 [Indexed for MEDLINE]


276. Sleep Med. 2023 Dec;112:223-231. doi: 10.1016/j.sleep.2023.10.020. Epub 2023 Oct 
26.

Mediating effect of sleep in the association between social media use and mental 
health among French adolescents during the COVID-19 sanitary crisis.

Bérard M(1), Manneville F(2), Minary L(1), Ligier F(1), Bitar S(1), Agrinier 
N(3).

Author information:
(1)Université de Lorraine, APEMAC, F-54000, Nancy, France.
(2)Université de Lorraine, APEMAC, F-54000, Nancy, France; CHRU-Nancy, INSERM, 
Université de Lorraine, CIC, Epidémiologie Clinique, F-54000, Nancy, France. 
Electronic address: f.manneville@chru-nancy.fr.
(3)Université de Lorraine, APEMAC, F-54000, Nancy, France; CHRU-Nancy, INSERM, 
Université de Lorraine, CIC, Epidémiologie Clinique, F-54000, Nancy, France.

OBJECTIVE/BACKGROUND: Social media use could have deleterious effects on mental 
health through short sleep duration and poor sleep quality among adolescents. 
This study aimed to investigate the mediating role of both sleep duration and 
sleep quality in the association between social media use and mental health 
among adolescents.
PATIENTS/METHODS: We used cross-sectional data collected from adolescents in the 
EXIST pilot project conducted during COVID-19 pandemic. Adolescents 
self-reported wellbeing (WEMWBS), anxiety and depression (HADS) as mental health 
outcomes. We used ad-hoc questionnaires to assess social media use during 
weekdays and weekend days, and sleep duration and quality. Mediation analyses 
were carried out following Baron and Kenny's method, using adjusted linear 
regression models.
RESULTS: A total of 340 adolescents (13.5 ± 0.6 years, 45.3 % girls) were 
included. Greater social media use, poorer sleep quality, and shorter sleep 
duration were associated with poorer mental health. Greater social media use was 
associated with poorer sleep quality only during the weekend days. The total 
effect of social media use during weekend days on anxiety (β = 2.54; 95%CI 
[-1.59; 6.68]) was significantly conveyed through sleep quality (β = 1.22; 95%CI 
[0.17; 2.62]; mediated proportion = 48.0 %) and duration (mediated 
proportion = 46.8 %). Mediated proportions ranged from 12.5 % to 20.6 % for 
wellbeing and depression. Mediating effects were not evident during weekdays.
CONCLUSIONS: Sleep duration and quality mediated the association between social 
media use and mental health among adolescents during weekend days but not 
weekdays. Our findings highlight the importance of promoting healthy social 
media habits, especially during periods of increased reliance on digital 
platforms, such as COVID-19 pandemic.

Copyright © 2023 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.sleep.2023.10.020
PMID: 37922784 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest Authors 
declare none.


277. BMC Prim Care. 2023 Nov 4;24(1):231. doi: 10.1186/s12875-023-02187-2.

Study protocol: assessment of the usefulness and practicability of a 
psychoeducational intervention to prevent the negative psychological impact of 
the COVID-19 pandemic on primary care health workers.

Aragonès E(1)(2)(3), Rodoreda S(4), Guitart M(5)(6), Garcia E(7), Berenguera 
A(8), Martin F(9)(8)(10), Rambla C(9)(8), Aragonès G(8), Calvo A(11), Mas A(12), 
Basora J(8).

Author information:
(1)Research Unit. Primary Care Area Camp de Tarragona, Institut Català de la 
Salut, Tarragona, Spain. earagones.tgn.ics@gencat.cat.
(2)Institut Universitari d'Investigació en Atenció Primària Jordi Gol 
(IDIAPJGol), Barcelona, Spain. earagones.tgn.ics@gencat.cat.
(3)Centre d'Atenció Primària de Constantí, Carrer dels Horts, 6, Constantí, 
Tarragona, 43120, Spain. earagones.tgn.ics@gencat.cat.
(4)Primary Care Division, Institut Català de la Salut, Barcelona, Spain.
(5)Primary Care Emotional and Community Wellbeing Program, Department of Health, 
Government of Catalonia, Barcelona, Spain.
(6)Primary Care Centre Sant Vicenç de Castellet, Institut Català de la Salut, 
Barcelona, Spain.
(7)Occupational Risk Prevention Unit, Institut Català de la Salut, Barcelona, 
Spain.
(8)Institut Universitari d'Investigació en Atenció Primària Jordi Gol 
(IDIAPJGol), Barcelona, Spain.
(9)Research Unit. Primary Care Area Camp de Tarragona, Institut Català de la 
Salut, Tarragona, Spain.
(10)School of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, 
Spain.
(11)Galatea Foundation, Barcelona, Spain.
(12)Department of Health, General Directorate of Health Planning and Research, 
Government of Catalonia, Barcelona, Spain.

BACKGROUND: The COVID-19 pandemic has constituted an extraordinarily stressful 
situation for healthcare professionals and has led to psychological distress and 
an increase in various mental disorders. In the post-pandemic context, it is 
necessary to provide professionals with strategies and skills to manage this 
stressful situation and prevent or minimize its negative impact.
METHODS: Aims: To assess the feasibility and clinical effects of a group 
psychoeducational program focused on preventing the adverse psychological and 
emotional effects of the pandemic on primary care workers, and to explore the 
experience and perceptions of participants with regard to the program from a 
qualitative perspective.
DESIGN: A single-arm, before-and-after study conducted in primary care.
SETTING: The 332 primary care centers of the Catalan Institute of Health 
(Catalonia, Spain) Participants: The target population of the intervention is 
primary care workers, including clinical profiles (e.g., nurses and doctors), 
and non-clinical profiles (e.g., administrative staff). The implementation 
strategy will also involve community psychologists, who will lead the 
psychoeducational groups, and the health organization promoting the 
implementation.
INTERVENTION: A group psychoeducational program targeting primary care workers 
to promote emotional well-being and the ability to cope with stressful 
situations. Community psychologists will deliver it in the primary care centers 
they are linked to.
MEASURES: Mixed-methods evaluation, combining quantitative and qualitative 
research. A prospective assessment of the main outcomes (professional quality of 
life, psychological state, and resilience) will be performed using online 
questionnaires before and immediately after the intervention, and at 3 and 6 
months. A qualitative study will be conducted, comprising focus groups and 
individual in-depth interviews with the participants in the intervention and the 
psychologists who provide it.
ETHICS: The Research Ethics Committee of the Jordi Gol Primary Care Research 
Institute (IDIAP) has approved the protocol (22/086-PCV).
DISCUSSION: This project proposes an intervention to promote mental health and 
psychological well-being in primary care workers by learning skills and 
integrating them into personal and professional life. The expected results will 
allow us to determine the usefulness and effectiveness of this psychoeducational 
intervention under the conditions of real clinical practice, provide data to 
model and perfect it, and promote its dissemination.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05720429; registered on 
09/02/2023.

© 2023. The Author(s).

DOI: 10.1186/s12875-023-02187-2
PMCID: PMC10625269
PMID: 37925394 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


278. BMC Public Health. 2023 Nov 3;23(1):2151. doi: 10.1186/s12889-023-17035-2.

Psychosocial work environment and mental health among the global workforce of 
seafarers in the wake of the COVID-19 pandemic.

Hayes-Mejia R(1)(2), Stafström M(3).

Author information:
(1)Division of Social Medicine and Global Health, Lund University, Jan 
Waldenströms gata 35, Malmö, 21428, Sweden.
(2)Marine Benefits AS, Bergen, Norway.
(3)Division of Social Medicine and Global Health, Lund University, Jan 
Waldenströms gata 35, Malmö, 21428, Sweden. martin.stafstrom@med.lu.se.

BACKGROUND: The aim of this study was to investigate the impact of the COVID-19 
pandemic on the mental health outcomes of international seafarers, who played a 
crucial role in maintaining global trade during the pandemic. The study examined 
how changes in psychosocial work environment and policies affected mental health 
outcomes among seafarers.
METHODS: We analyzed a survey including answers from 17,861 seafarers, serving 
on 44 different international commercial vessels with 154 different 
nationalities. Stress, anxiety, and depression were applied as outcome measures 
in this study. Three sets of independent variables were included; work-related 
consequences of the COVID-19 pandemic, general psychosocial work environment 
onboard, and socioeconomic variables. First, we applied binary linear 
regression, followed by a multivariate linear regression analysis.
RESULTS: The study found that changes in safety consciousness and clear 
communication from employers were associated with better mental health outcomes 
among seafarers. Eroded policies related to crew changes had a significant 
negative effect on mental wellbeing due to delays caused by national quarantine 
guidelines and travel restrictions. The results also showed a discrepancy in 
mental health outcomes between those onboard and those onshore, with stress 
being present in both groups.
CONCLUSIONS: The findings suggest that crisis management within shipping 
companies played an important role in mitigating adverse mental health outcomes 
during the pandemic. Clear communication from employers and emphasizing safety 
issues onboard were effective strategies for promoting better mental wellbeing 
among seafarers. However, delays in crew changes had a significant negative 
impact on mental health outcomes, highlighting the need for global cooperation 
and overarching agreements to protect international seafarers during times of 
crises.

© 2023. The Author(s).

DOI: 10.1186/s12889-023-17035-2
PMCID: PMC10623868
PMID: 37924109 [Indexed for MEDLINE]

Conflict of interest statement: The data collection was funded by Marine 
Benefits AS, a Norwegian insurance company that markets global insurances to 
seafarers. RHM is an employee of Marine Benefits AS, a Norwegian insurance 
company and a subsidiary to the Norwegian Hull Club, that provides global health 
insurance for seafarers and their families. She is also enrolled as a part-time 
PhD student at Lund University. She was paid a salary by Marine Benefits when 
managing the data collection in her capacity as an employee. However, Lund 
University was the institution that applied, and received, ethical approval to 
conduct the study. In addition, the informed consent given by the participants 
was a consent to allow Lund University to carry out the research component of 
the survey.


279. BMC Med Educ. 2023 Nov 3;23(1):829. doi: 10.1186/s12909-022-03858-x.

The lockdown experience scale for students (LESS).

Conroy RM(1), Fitzgerald K(2).

Author information:
(1)School of Population Health Sciences, RCSI University of Medicine and Health 
Sciences, Dublin, Ireland. rconroy@rcsi.com.
(2)RCSI University of Medicine and Health Sciences, Dublin, Ireland.

BACKGROUND: The Covid-19 pandemic has resulted in many student populations 
learning online in lockdown. While the mental health consequences of lockdown 
are increasingly understood, the core features of 'cabin fever' - the experience 
of lockdown - are poorly described.
METHODS: We conducted a questionnaire survey of 649 undergraduate medicine and 
health sciences students. Item content was developed based on current literature 
and input from student representatives.
RESULTS: Mokken scaling identified seven questions that together formed a 
strongly unidimensional scale which comprised two domains: social 
isolation/cabin fever and demotivation / demoralisation. Scale scores were 
significantly associated with depression, self-rated mental health, impaired 
study efficacy and doomscrolling.
CONCLUSIONS: The adverse effects of lockdown on student wellbeing appear to be 
driven to an important extent by an experience of isolation and demotivation 
that corresponds to narrative descriptions of cabin fever. In the foreseeable 
event of future pandemics, these experiences are a promising target for health 
promotion in students studying in lockdown.

© 2023. The Author(s).

DOI: 10.1186/s12909-022-03858-x
PMCID: PMC10625255
PMID: 37924033 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


280. BMC Geriatr. 2023 Nov 2;23(1):713. doi: 10.1186/s12877-023-04382-3.

Nurse practitioner led implementation of huddles for staff in long term care 
homes during the COVID-19 pandemic.

McGilton KS(1)(2), Krassikova A(3), Wills A(3), Bethell J(3), Boscart V(4), 
Escrig-Pinol A(5)(6), Iaboni A(3)(7), Vellani S(3), Maxwell C(8), Keatings M(3), 
Stewart SC(3), Sidani S(9).

Author information:
(1)KITE Research Institute, Toronto Rehabilitation Institute, University Health 
Network, Toronto, Canada. kathy.mcgilton@uhn.ca.
(2)Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, 
Canada. kathy.mcgilton@uhn.ca.
(3)KITE Research Institute, Toronto Rehabilitation Institute, University Health 
Network, Toronto, Canada.
(4)School of Health and Life Sciences, Conestoga College, Kitchener, Canada.
(5)Mar School of Nursing, Universitat Pompeu Fabra, Barcelona, Spain.
(6)Social Determinants and Health Education Research Group, Hospital del Mar 
Medical Research Institute, Barcelona, Spain.
(7)Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, 
Toronto, Canada.
(8)Schools of Pharmacy and Public Health Sciences, University of Waterloo, 
Waterloo, Ontario, Canada.
(9)Faculty of Nursing, Toronto Metropolitan University, Toronto, Canada.

BACKGROUND: Staff working in long-term care (LTC) homes during COVID-19 
frequently reported a lack of communication, collaboration, and teamwork, all of 
which are associated with staff dissatisfaction, health concerns, lack of 
support and moral distress. Our study introduced regular huddles to support LTC 
staff during COVID-19, led by a Nurse Practitioner (NP). The objectives were to 
evaluate the process of huddle implementation and to examine differences in 
outcomes between categories of staff (direct care staff, allied care and support 
staff, and management) who attended huddles and those who did not.
METHODS: All staff and management at one LTC home (< 150 beds) in Ontario, 
Canada were included in this pre-experimental design study. The process 
evaluation used a huddle observation tool and focused on the dose (duration, 
frequency) and fidelity (NP's adherence to the huddle guide) of implementation. 
The staff attending and non-attending huddles were compared on outcomes measured 
at post-test: job satisfaction, physical and mental health, perception of 
support received, and levels of moral distress. The outcomes were assessed with 
validated measures and compared between categories of staff using Bayesian 
models.
RESULTS: A total of 42 staff enrolled in the study (20 attending and 22 
non-attending huddles). Forty-eight huddles were implemented by the NP over 15 
weeks and lasted 15 min on average. Huddles were most commonly attended by 
direct care staff, followed by allied care/support, and management staff. All 
huddles adhered to the huddle guide as designed by the research team. Topics 
most often addressed during the huddles were related to resident care (46%) and 
staff well-being (34%). Differences were found between staff attending and 
non-attending huddles: direct care staff attending huddles reported lower levels 
of overall moral distress, and allied care and support staff attending huddles 
perceived higher levels of support from the NP.
CONCLUSIONS: NP-led huddles in LTC homes may positively influence staff 
outcomes. The process evaluation provided some understanding of why the huddles 
may have been beneficial: the NP addressed resident care issues which were 
important to staff, encouraged a collaborative approach to solving issues on the 
unit, and discussed their well-being.
TRIAL REGISTRATION NUMBER: NCT05387213, registered on 24/05/2022.

© 2023. The Author(s).

DOI: 10.1186/s12877-023-04382-3
PMCID: PMC10623826
PMID: 37919676 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


281. PLoS One. 2023 Nov 2;18(11):e0293512. doi: 10.1371/journal.pone.0293512. 
eCollection 2023.

Investigating and promoting health behaviors reactivity among Hong Kong older 
adults in the post-COVID-19 Era: An exploratory network analysis.

Wong MYC(1), Ou KL(2), Man Leung K(1).

Author information:
(1)The Education University of Hong Kong, Hong Kong, China.
(2)Hong Kong Baptist University, Hong Kong, China.

BACKGROUND: Physical distance has increased the risk of developing a variety of 
health problems, especially among older people. During the COVID-19 lockdown 
period, physical activity decreased, screen time increased, food consumption 
increased, as well as exposure to unhealthy behaviour, leading to poorer sleep 
quality and more negative emotions, which ultimately led to poorer physical 
health, mental health, and subjective vitality among older adults. Although 
there were numerous research studies on changes in health behaviours during 
COVID-19, only a few were targeted at older adults, and none were conducted in 
Asian countries.
METHOD: The current study is aiming to identify the changes in health 
behaviours, as well as their associations with older adults' mental health as a 
result of the COVID-19 pandemic among Hong Kong older adults, using exploratory 
network analysis. In this study, a random tele-survey was conducted among older 
adults.
RESULTS: A total of 664 participants have been involved in the telephone survey, 
with 213 males and 451 females, of which mean age was 74.37. The explored 
network showed strong centrality and edge stability, thus enabling to reveal an 
overview of the associations between health behaviours and mental well-being of 
older adults. The lavaan model has also demonstrated the casual paths within the 
explored network, which indicated the significant impact of sleeping quality, 
eating habits and social networking on resilience.
CONCLUSION: The outcomes of the study were able to identify the lifestyle 
changes of Hong Kong older adults due to COVID-19. Although the present study is 
not regarded as novel internationally, it may be representative of the Hong Kong 
community. In order to facilitate active aging during the pandemic, a 
user-friendly electronic platform for healthy living should include older adults 
in the future.

Copyright: © 2023 Wong et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0293512
PMCID: PMC10621926
PMID: 37917757 [Indexed for MEDLINE]

Conflict of interest statement: NO authors have competing interests Enter: The 
authors have declared that no competing interests exist.


282. PLoS One. 2023 Nov 2;18(11):e0292672. doi: 10.1371/journal.pone.0292672. 
eCollection 2023.

Long COVID in the United States.

Blanchflower DG(1)(2)(3), Bryson A(4)(5).

Author information:
(1)Department of Economics, Dartmouth College, Hanover, NH, United States of 
America.
(2)Adam Smith Business School, University of Glasgow, Glasgow, United Kingdom.
(3)NBER, Cambridge, MA, United States of America.
(4)UCL Social Research Institute, University College London, London, United 
Kingdom.
(5)NIESR and IZA, London, United Kingdom.

Although yet to be clearly identified as a clinical condition, there is immense 
concern at the health and wellbeing consequences of long COVID. Using data 
collected from nearly half a million Americans in the period June 2022-December 
2022 in the US Census Bureau's Household Pulse Survey (HPS), we find 14 percent 
reported suffering long COVID at some point, half of whom reported it at the 
time of the survey. Its incidence varies markedly across the United States-from 
11 percent in Hawaii to 18 percent in West Virginia-and is higher for women than 
men, among Whites compared with Blacks and Asians, and declines with rising 
education and income. It is at its highest in midlife in the same way as 
negative affect. Ever having had long COVID is strongly associated with negative 
affect (anxiety, depression, worry and a lack of interest in things), with the 
correlation being strongest among those who currently report long COVID, 
especially if they report severe symptoms. In contrast, those who report having 
had short COVID report higher wellbeing than those who report never having had 
COVID. Long COVID is also strongly associated with physical mobility problems, 
and with problems dressing and bathing. It is also associated with mental 
problems as indicated by recall and understanding difficulties. Again, the 
associations are strongest among those who currently report long COVID, while 
those who said they had had short COVID have fewer physical and mental problems 
than those who report never having had COVID. Vaccination is associated with 
lower negative affect, including among those who reported having had long COVID.

Copyright: © 2023 Blanchflower, Bryson. This is an open access article 
distributed under the terms of the Creative Commons Attribution License, which 
permits unrestricted use, distribution, and reproduction in any medium, provided 
the original author and source are credited.

DOI: 10.1371/journal.pone.0292672
PMCID: PMC10621843
PMID: 37917610 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


283. Front Public Health. 2023 Oct 17;11:1221501. doi: 10.3389/fpubh.2023.1221501. 
eCollection 2023.

The mediation effect analysis of nurse's mental health status and burnout under 
COVID-19 epidemic.

Liu F(1), Zhao Y(2), Chen Y(1), Tu Z(1).

Author information:
(1)Department of Preventive Medicine, School of Health, Quanzhou Medical 
College, Quanzhou, China.
(2)Department of Nursing, Quanzhou First Hospital, Quanzhou, China.

AIM: The objective of this study is to investigate the mental health status of 
nurses during the outbreak of novel coronavirus pneumonia. Additionally, we aim 
to analyze the relationship between anxiety, depression, and burnout among 
nurses. The findings will provide a scientific basis for promoting the 
psychological health of nurses.
METHODS: Using a cross-sectional study, nurses in Quanzhou in May 2020 completed 
a general information questionnaire, the 7-item Generalized Anxiety Disorder 
Questionnaire (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and the Maslach 
Burnout Inventory (MBI). Data analysis was conducted using structural equation 
model.
RESULTS: 372 questionnaires were returned, with a response rate of 92.5%. The 
prevalence of anxiety and depression among the participants were 45.2 and 41.4%, 
respectively. The prevalence of severe burnout among nurses was found to be 
7.3%. There was a correlation between nurses' anxiety, depression, and job 
burnout. The correlation coefficients between anxiety and job burnout, 
depression and job burnout, and anxiety and depression were found to be 
statistically significant (p < 0.001). Depression plays a mediating role between 
anxiety and jod burnout (0.584/1.413, 41.3%).
CONCLUSION: The COVID-19 epidemic has resulted in moderate to high levels of job 
burnout among nurses. In this context, depression has been found to play a 
mediating role in the relationship between anxiety and job burnout. It is 
imperative for hospital administrators to prioritize the mental health of nurses 
and the provide necessary support to ensure their well-being.

Copyright © 2023 Liu, Zhao, Chen and Tu.

DOI: 10.3389/fpubh.2023.1221501
PMCID: PMC10616456
PMID: 37915821 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


284. Front Public Health. 2023 Oct 16;11:1257384. doi: 10.3389/fpubh.2023.1257384. 
eCollection 2023.

The mental condition of Polish adolescents during the COVID-19 pandemic and war 
in Ukraine.

Wójtowicz-Szefler M(1), Grzankowska I(1), Deja M(1).

Author information:
(1)Department of Psychology, Kazimierz Wielki University, Bydgoszcz, Poland.

Recently, the experience of the COVID-19 global pandemic has significantly 
affected the mental condition of entire societies by increasing anxiety and 
stress resulting from its sudden and completely unexpected nature. In Poland, 
apart from the pandemic, there is an ongoing threat of an armed conflict just 
across the border, which can constitute direct and indirect threats to physical 
and mental health. Each of these situations is unusual and difficult. It is also 
in sharp contrast to the developmental needs of children and adolescents. It 
especially violates the principal need of this developmental period, which is to 
grow up in a predictable as well as physically and emotionally safe environment. 
The purpose of the conducted research was to assess the psychological condition 
of Polish adolescents, whose social situation is difficult, in order to take 
appropriate preventive measures based on this assessment. The study was 
conducted using the "Who are You?" Scale of Transparency Anxiety and the Revised 
Child Anxiety and Depression Scale (RCADS), as well as a researcher-made survey 
containing questions about well-being in relation to the pandemic, distance 
learning and the ongoing war in a neighbouring country. Approval was obtained 
from the Bioethics Committee to conduct the projected research. The study 
included 945 adolescents aged 11 to 15 (M = 13.10; SD = 1.11) making a 
representative sample of adolescents from 14 regions in Poland. The results of 
the research and analyses show that the adolescents under study have a medium 
level of intensity of neuroticism, with the highest levels occurring in 
adolescents aged 14. Moreover, the adolescents manifest relatively lower 
symptoms of anxiety and depression as well as concern about the pandemic and the 
war in Ukraine than expected.

Copyright © 2023 Wójtowicz-Szefler, Grzankowska and Deja.

DOI: 10.3389/fpubh.2023.1257384
PMCID: PMC10617677
PMID: 37915812 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


285. PLoS One. 2023 Nov 1;18(11):e0292842. doi: 10.1371/journal.pone.0292842. 
eCollection 2023.

Socioeconomic inequalities in mental health and wellbeing among UK students 
during the COVID-19 pandemic: Clarifying underlying mechanisms.

Dougall I(1), Vasiljevic M(1), Kutlaca M(1), Weick M(1).

Author information:
(1)Department of Psychology, Durham University, Durham, United Kingdom.

Universities are seeing growing numbers of students with poor mental health and 
wellbeing. Given that lower socioeconomic status (SES) students typically have 
poorer mental health and wellbeing than their peers, this may be, in part, 
caused by an increase in the number of students attending university from lower 
SES backgrounds. However, less is known about how socioeconomic inequalities in 
mental health and wellbeing persist within university communities. Research 
investigating psychosocial factors that contribute to socioeconomic disparities 
in mental health and wellbeing suggests perceived control, inclusion, and 
perceived worth to be important underlying mechanisms. However, another strand 
of research suggests perceived competence may also play a mediating role in this 
relationship. Consequently, the present research seeks to examine fulfilment of 
perceived control, inclusion, perceived worth, and competence needs as potential 
mediators in the relationship between subjective SES and mental health and 
wellbeing in university students. Below, we report the results of a 
cross-sectional survey conducted among university students (n = 811) in the UK 
during a period of COVID-19 restrictions. In line with prior research, we found 
evidence of socioeconomic inequalities in mental health and wellbeing among 
students. Further, we found subjective SES predicted perceptions of control, 
inclusion, and competence. In turn, perceived control and competence predicted 
both positive and negative mental health and wellbeing, whilst inclusion 
predicted positive mental health and wellbeing only. Unexpectedly, we found no 
evidence that perceived worth acts as a mediator in this relationship, 
independently of perceived control, inclusion, and competence. As academic 
institutions continue to pursue policies to 'widen participation', they also 
have a responsibility to understand how socioeconomic inequalities in mental 
health and wellbeing are perpetuated within the university community. Research 
in this area marks a first step to improve socioeconomic equality within Higher 
Education.

Copyright: © 2023 Dougall et al. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0292842
PMCID: PMC10619810
PMID: 37910542 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


286. Andes Pediatr. 2023 Jun;94(3):370-378. doi: 10.32641/andespediatr.v94i3.4313.

Maternal mental health and impact on the newborn during the COVID-19 pandemic.

[Article in English, Spanish]

Coo S(1), Garcia MI(1), Olhaberry M(2).

Author information:
(1)Facultad de Psicología, Universidad del Desarrollo, Santiago, Chile.
(2)Instituto Milenio para la Investigación de la Depresión Millennium, Santiago, 
Chile.

The deterioration of mental health in the general population has been one of the 
main consequences of the COVID-19 health crisis, with differences in diverse 
groups. Specifically, recent studies report an increased risk for the 
development of symptoms of anxiety and depression during the perinatal period, 
as well as a negative impact on the newborn.
OBJECTIVE: The objective of this study was to examine the differences in mental 
health, infant and obstetric variables, and childbirth experience in the public 
and private health systems in Chilean primiparous women before and during the 
CO- VID-19 pandemic.
SUBJECTS AND METHOD: This quantitative study compared two cohorts. The first one 
included mothers with babies born before the COVID-19 pandemic (N = 81) and the 
second one involved mothers who delivered during the pandemic (N = 71). 
Sociodemographic and obstetric history, depression, anxiety, and stress were 
evaluated in both groups using self-report questionnaires (EPDS, DASS-21). 
Differences between groups were assessed with ANCOVA, t-tests, and chi-square 
tests.
RESULTS: Women who delivered during the pandemic reported greater depressive 
symptoms and their babies were smaller and had less weeks of gestation than 
babies born before the COVID-19 pandemic. However, this group maintained 
exclusive breastfeeding for a longer period. There were no differences in the 
experience of childbirth between the groups, but there were differences in 
relation to the public or private nature of the hospital where the mothers were 
seen.
CONCLUSIONS: The pandemic negatively affected the mental health of mothers, 
posing significant challenges to promoting the emotional well-being of mothers 
and their infants.

DOI: 10.32641/andespediatr.v94i3.4313
PMID: 37909940 [Indexed for MEDLINE]


287. Medicina (Kaunas). 2023 Oct 22;59(10):1876. doi: 10.3390/medicina59101876.

Mental Health and Contraceptive Knowledge in High Schoolers: Comparing Remote 
and In-Person Learning during COVID-19.

Hinoveanu D(1)(2), Anastasiu DM(1), Citu C(1), Crisan DC(1), Popa ZL(1), Nicolae 
N(1), Dumitru C(1), Neda-Stepan O(2)(3), Fericean RM(2)(4), Stelea L(1).

Author information:
(1)Department of Obstetrics and Gynecology, "Victor Babes" University of 
Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania.
(2)Doctoral School, "Victor Babes" University of Medicine and Pharmacy, Eftimie 
Murgu Square 2, 300041 Timisoara, Romania.
(3)Department VIII-Neurosciences, Discipline of Psychiatry, "Victor Babes" 
University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, 
Romania.
(4)Department of Infectious Diseases, "Victor Babes" University of Medicine and 
Pharmacy Timisoara, 300041 Timisoara, Romania.

Background and Objectives: In response to the COVID-19 pandemic's effects on 
education, this study delves into the behavioral, mental health, and sexual 
education characteristics of high school students during 2020-2021 and 
2022-2023. Materials and Methods: We evaluated a variety of factors, including 
substance use, academic performance, sexual activities, mental health support, 
pandemic-related anxiety levels, and quality of life indicators using 
standardized instruments such as the SF-36, GAD-7, and WHOQOL-BREF. Furthermore, 
we addressed specific questions concerning contraception and sexual education 
during this period. Results: The questionnaires were filled in by 44 students in 
2020-2021 and 41 students in 2022-2023. Significant findings included a 
noteworthy increase in COVID-19 vaccination rates, from 18.2% in 2020-2021 to 
39.0% in 2022-2023 (p = 0.033), enhanced perceptions of mental health support 
during remote learning, from 7.1% to 20.0% (p = 0.044), and a rise in students 
partaking in reproductive health discussions from 10.7% to 25.0% (p = 0.046). 
Additionally, there was a marked decline in anxiety regarding the transition 
back to in-person learning (p = 0.048). Health surveys, such as the SF-36, 
signaled improvements in both physical and mental health over the years (p = 
0.046 and p = 0.019, respectively), while the GAD-7 scores depicted a 
considerable reduction in anxiety symptoms (p = 0.038). The WHOQOL-BREF results 
also highlighted a significant uptick in students' mental well-being in 
2022-2023 (p = 0.039). Conclusions: As the COVID-19 pandemic ended, high school 
students exhibited shifts in behavior, health, and education over four academic 
years, particularly in areas of contraceptive knowledge and mental health 
outcomes. The pronounced enhancements in vaccination rates, perceptions of 
mental health support, participation in health conversations, and overall mental 
wellness emphasize the adaptability and resilience of students in these 
tumultuous periods, and a general increase in contraceptive knowledge and 
quality of life during the end of the pandemic.

DOI: 10.3390/medicina59101876
PMCID: PMC10608468
PMID: 37893594 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


288. BMC Public Health. 2023 Oct 27;23(1):2115. doi: 10.1186/s12889-023-16945-5.

Associations between psychosocial wellbeing and experience of gender-based 
violence at community, household, and intimate-partner levels among a 
cross-sectional cohort of young people living with and without HIV during 
COVID-19 in Cape Town, South Africa.

Hartmann M(1)(2), Giovenco D(3), Zeebari Z(4)(5), Itzikowitz G(3), Ekström 
AM(4)(6), Nielsen A(4), Pettifor A(7), Bekker LG(3), Kågesten AE(4).

Author information:
(1)Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden. 
miriam.hartmann@ki.se.
(2)Women's Global Health Imperative, RTI International, Berkely, CA, USA. 
miriam.hartmann@ki.se.
(3)Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
(4)Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
(5)Jönköping International Business School, Jönköping University, Jönköping, 
Sweden.
(6)Department of Infectious Diseases, South General Hospital, Stockholm, Sweden.
(7)Department of Epidemiology, University of North Carolina at Chapel Hill, 
Chapel Hill, USA.

BACKGROUND: Growing evidence indicates that gender-based violence (GBV) 
increased during COVID-19. We investigated self-reported impact of the pandemic 
on GBV at community, household and intimate partner (IPV) levels among young 
people and its associations with psychosocial wellbeing, i.e., COVID-related 
stressors and mental health.
METHODS: Cross-sectional data were drawn from a survey with young people ages 
13-24 (N = 536) living with HIV (YPLWH) and without HIV (YPLWoH), in peri-urban 
Cape Town, South Africa. The survey, conducted February-October 2021, examined 
the impact of the initial lockdown on experience and perceived changes in GBV at 
each level, and pandemic-related psychosocial wellbeing. Descriptive statistics 
and binomial and multinomial regression analyses were conducted to illustrate 
exposure and perceived changes in GBV since lockdown, and their association with 
COVID-related stress factors (e.g., social isolation, anxiety about COVID), 
mental health (e.g., depression, anxiety), and other risk factors (e.g., age, 
gender, socioeconomic status) by HIV status.
RESULTS: Participants were 70% women with mean age 19 years; 40% were living 
with HIV. Since lockdown, YPLWoH were significantly more likely than YPLWH to 
perceive community violence as increasing (45% vs. 28%, p < 0.001), and to 
report household violence (37% vs. 23%, p = 0.006) and perceive it as increasing 
(56% vs. 27%, p = 0.002) (ref: decreasing violence). YPLWoH were also more 
likely to report IPV experience (19% vs. 15%, p = 0.41) and perception of IPV 
increasing (15% vs. 8%, p = 0.92). In adjusted models, COVID-related stressors 
and common mental health disorders were only associated with household violence. 
However, indicators of economic status such as living in informal housing 
(RRR = 2.07; 95% CI = 1.12-3.83) and food insecurity (Community violence: 
RRR = 1.79; 95% CI = 1.00-3.20; Household violence: RRR = 1.72; 95% 
CI = 1.15-2.60) emerged as significant risk factors for exposure to increased 
GBV particularly among YPLWoH.
CONCLUSIONS: Findings suggest that for young people in this setting, GBV at 
community and household levels was more prevalent during COVID-19 compared to 
IPV, especially for YPLWoH. While we found limited associations between 
COVID-related stressors and GBV, the perceived increases in GBV since lockdown 
in a setting where GBV is endemic, and the association of household violence 
with mental health, is a concern for future pandemic responses and should be 
longitudinally assessed.

© 2023. The Author(s).

DOI: 10.1186/s12889-023-16945-5
PMCID: PMC10612288
PMID: 37891509 [Indexed for MEDLINE]

Conflict of interest statement: LGB has received honoraria for advisory roles 
ViiV Healthcare UK. No other author has a conflict of interest, a financial 
interest, or any relationship with an organization that has a financial interest 
in the content of this manuscript.


289. PLoS One. 2023 Oct 27;18(10):e0293393. doi: 10.1371/journal.pone.0293393. 
eCollection 2023.

Time for You: A process evaluation of the rapid implementation of a multi-level 
mental health support intervention for frontline workers during the COVID-19 
pandemic.

McCann B(1), Hunter SC(1)(2), McAloney-Kocaman K(1), McCarthy P(1), Smith J(1), 
Calveley E(1).

Author information:
(1)Department of Psychology, School of Health and Life Sciences, Glasgow 
Caledonian University, Glasgow, United Kingdom.
(2)Graduate School of Education, University of Western Australia, Perth, Western 
Australia, Australia.

The coronavirus (COVID-19) pandemic had wide-ranging negative impacts on mental 
health. The pandemic also placed extraordinary strain on frontline workers who 
were required to continue working and putting themselves at risk to provide 
essential services at a time when their normal support mechanisms may not have 
been available. This paper presents an evaluation of the Time for You service, a 
rapidly developed and implemented intervention aimed at providing frontline 
workers with quick access to flexible online mental health support. Time for You 
provided service users with three service options: self-guided online cognitive 
behavioural therapy (CBT) resources; guided engagement with online CBT 
resources; 1-1 psychological therapy with trainee sport and exercise 
psychologists and trainee health psychologists. A process evaluation informed by 
the Consolidated Framework for Implementation Research considered service 
fidelity, adaptations, perceived impact, reach, barriers, and facilitators. 
Interviews with project managers (n = 5), delivery staff (n = 10), and service 
users (n = 14) explored perceptions of the service implementation and outcomes, 
supported by data regarding engagement with the online CBT platform (n = 217). 
Findings indicated that service users valued the flexibility of the service and 
the speed with which they were able to access support. The support offered by 
Trainee Psychologists was perceived to be of high quality, and the service was 
perceived by service users to have improved mental health and wellbeing. The 
rapid implementation contributed to issues regarding appropriate service user 
screening that led to trainee psychologists being unable to provide the service 
users with the support they needed as the presenting issues were outside of 
trainees' competencies. Overall, the findings suggest that interventions 
offering flexible, online psychological support to frontline workers can be an 
effective model for future interventions. Trainee psychologists are also able to 
play an important role in delivering such services when clear screening 
processes are in place.

Copyright: © 2023 McCann et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0293393
PMCID: PMC10610521
PMID: 37889922 [Indexed for MEDLINE]

Conflict of interest statement: The service being evaluated in this project was 
staffed by Trainee Health and Sport & Exercise Psychologists from Glasgow 
Caledonian University as part of a course related placement. Some members of the 
research team (BM, PM and JS) supervised trainee placements during this period, 
including some of the trainees delivering the intervention. Independent 
researchers were included in the project team (SH and KM) to reduce any bias 
that may have stemmed from these dual roles. This does not alter our adherence 
to PLOS ONE policies on sharing data and materials.


290. Int J Environ Res Public Health. 2023 Oct 19;20(20):6943. doi: 
10.3390/ijerph20206943.

The Impact of Culture-, Health- and Nature-Based Engagement on Mitigating the 
Adverse Effects of Public Health Restrictions on Wellbeing, Social Connectedness 
and Loneliness during COVID-19: Quantitative Evidence from a Smaller- and 
Larger-Scale UK Survey.

Thomson LJM(1)(2), Spiro N(3)(4), Williamon A(3)(4), Chatterjee HJ(1)(2).

Author information:
(1)UCL Arts & Sciences, University College London, London WC1 6BT, UK.
(2)UCL Biosciences, University College London, London WC1 6BT, UK.
(3)Centre for Performance Science, Royal College of Music, London SW7 2BS, UK.
(4)Faculty of Medicine, Imperial College London, South Kensington Campus, London 
SW7 2AZ, UK.

Numerous UK surveys conducted during COVID-19 examined the pandemic's 
detrimental effects on health, and the consequences of lockdown and other public 
health restrictions on mental health. Some surveys considered specific 
populations and social inequities exacerbated during COVID-19. Fewer surveys 
examined the ways in which the adverse effects of public health restrictions, 
such as lockdown, shielding and social distancing, might be alleviated. Drawing 
upon self-determination theory, the purpose of the current study was to assess 
whether culture-, health- and nature-based engagement would mitigate the effects 
of these restrictions on psychological wellbeing, social connectedness and 
loneliness. Quantitative data from a smaller-scale survey (n = 312) and a subset 
of questions embedded in a larger-scale survey (n = 3647) were analyzed using 
univariate and multivariate methods. Frequency of engagement, whether 
participation was online or offline and with or without other people, and the 
extent to which type of participation was associated with psychological 
wellbeing, social connectedness and loneliness were examined. Sports and 
fitness, gardening and reading occurred frequently in both surveys. For the 
smaller-scale survey, increases in connectedness and frequency of participation 
and decreases in loneliness were significantly associated with improved 
wellbeing, whereas the type of participation and age range were not significant 
predictors. Outcomes from the smaller-scale survey approximated the larger-scale 
survey for measures of loneliness, type and frequency of participation and 
proportion of respondents in each age range. As the frequency of participation 
was a significant predictor of wellbeing, but the type of participation was not 
significant, the findings implied that any type of participation in a sufficient 
quantity would be likely to boost wellbeing.

DOI: 10.3390/ijerph20206943
PMCID: PMC10606618
PMID: 37887681 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript; or in the decision to 
publish the results.


291. Int J Environ Res Public Health. 2023 Oct 19;20(20):6941. doi: 
10.3390/ijerph20206941.

The Impact of the First Wave of the COVID-19 Pandemic on University Staff 
Dietary Behaviours, Sleeping Patterns, and Well-Being: An International 
Comparison Study.

Rabiee Khan F(1), Abdelraheim Titi M(2)(3), Frankowska N(4), Kowalczyk K(5), 
Alziedan R(6), Yin-Kei Lau C(7), Biernat K(8), Brown KG(9).

Author information:
(1)College of Life Sciences, Faculty of Health, Education and Life Sciences, 
Birmingham City University, Birmingham B15 3TN, UK.
(2)Quality Management Department, King Saud University Medical City, Riyadh P.O. 
Box 7805, Saudi Arabia.
(3)Research Chair for Evidence-Based Health Care and Knowledge Translation, 
Deanship of Scientific Research, King Saud University, Riyadh P.O. Box 7805, 
Saudi Arabia.
(4)SWPS University of Social Sciences and Humanities, 03-815 Warsaw, Poland.
(5)The Global Public Health Network, 02-796 Warsaw, Poland.
(6)Cardiology Department, Medical College, King Fuad University, Riyadh P.O. Box 
7805, Saudi Arabia.
(7)Jockey Club School of Public Health and Primary Care, The Chinese University 
of Hong Kong, Hong Kong, China.
(8)Solihull Metropolitan Borough Council, Public Health Department, Council 
House, Solihull B91 9QS, UK.
(9)College of Psychology, Faculty of Business, Law and Social Sciences, 
Birmingham City University, Birmingham B4 7BD, UK.

This study assessed the impact of the first wave of the COVID-19 pandemic on 
well-being by measuring the changes to food security, dietary behaviour, and 
sleeping patterns of university staff in England, Poland, Saudi Arabia, and 
China. Using a cross-sectional study design, participants in four universities 
in the respective countries were surveyed between June and July 2020. The mean 
age of the 902 participants was 42 years old and 67% were female. The findings 
indicate a reduction in emotionally driven food behaviour [t (901.00) = -20.87, 
p <  0.001], food acquisition location [t (901.00) = -51.55, p < 0.001], 
skipping meals [t (901.00) = -24, p < 0.001], and consumption of canned fruit 
and vegetables [t (901.00) = -10.18, p < 0.001]. However, home cooking [t 
(901.00) = 36.61, p < 0.001] and the food shopping experience [t (901.00) = 
4.53, p <  0.001] markedly increased during lockdown. The participants had 
higher levels of well-being during the pandemic and experienced a significant 
increase in sleeping hours (p < 0.001). Increased age and sleeping hours were 
positively associated with overall well-being. Conversely, emotionally driven 
food behaviour (i.e., buying and eating more food out of boredom/fear or 
anxiety) and skipping meals decreased the overall well-being. Lockdown had 
beneficial effects on dietary behaviours, sleeping patterns, and well-being, but 
there were variations between countries.

DOI: 10.3390/ijerph20206941
PMCID: PMC10606338
PMID: 37887679 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


292. Glob Public Health. 2023 Jan;18(1):2270691. doi: 10.1080/17441692.2023.2270691. 
Epub 2023 Oct 26.

Factors associated with psychological distress during the COVID-19 pandemic: 
Data from two early waves in Russia.

Kislitsyn D(1), King EJ(2), Schapov D(1), Aleksandrova E(1).

Author information:
(1)Centre for Public Health Studies, Sechenov University, Moscow, Russian 
Federation.
(2)Department of Health Behavior and Health Education, School of Public Health, 
University of Michigan, Ann Arbor, MI, United States.

There is limited information about how the mental health of people has changed 
over time during the COVID-19 pandemic in low- and middle-income countries. In a 
cross-sectional study, we identified factors associated with psychological 
distress at two periods immediately after two peaks of the COVID-19 pandemic in 
Russia. Data were collected via online surveys. In May-June 2020, we surveyed 
373 respondents across Russia. In January-February 2021, we surveyed 743 people, 
using the same approach for survey distribution. With Kessler-10 as a measure of 
psychological distress, we used regression analysis to determine factors 
associated with higher psychological distress among Russians. Levels of 
psychological distress were high in both time periods and did not significantly 
change between the surveys. Having had COVID-19, losing one's job, experiencing 
problems accessing healthcare, and changing drinking behaviour during the 
pandemic were associated with higher psychological distress. Apart from getting 
sick or worrying about the virus, psychological distress is affected by 
restrictions and the consequences of the pandemic situation. As the COVID-19 
pandemic continues, actions are needed to address the mental well-being of the 
population in Russia.

DOI: 10.1080/17441692.2023.2270691
PMID: 37885273 [Indexed for MEDLINE]


293. J Public Health Manag Pract. 2024 Jan-Feb 01;30(1):E14-E20. doi: 
10.1097/PHH.0000000000001837. Epub 2023 Oct 26.

Symptoms of Posttraumatic Stress During the COVID-19 Pandemic in the 
Governmental Public Health Workforce and General Population.

Dewhurst E(1), Ettman CK, Hare Bork R, Thornburg B, Abdalla SM, Galea S, 
Castrucci BC.

Author information:
(1)de Beaumont Foundation, Bethesda, Maryland (Ms Dewhurst and Drs Hare Bork and 
Castrucci); Department of Health Policy & Management, Johns Hopkins Bloomberg 
School of Public Health, Baltimore, Maryland (Dr Ettman and Mr Thornburg); and 
Department of Global Health (Dr Abdalla) and Office of the Dean (Dr Galea), 
Boston University School of Public Health, Boston, Massachusetts.

We aimed to estimate the prevalence of COVID-19-related posttraumatic stress 
symptoms (PTSS) in the governmental public health workforce and in US adults, 
assess differences in reporting PTSS within subgroups, and evaluate whether 
frontline workers reported higher levels of PTSS than persons in other jobs. We 
used data from 2 nationally representative studies: the 2021 Public Health 
Workforce Interests and Needs Survey (PH WINS) and the COVID-19 and Life 
Stressors Impact on Mental Health and Well-being (CLIMB) study. Our study found 
that the state and local governmental public health workforce was more likely to 
report PTSS than the general adult population. Almost a quarter of public health 
agency employees (24.7%) and 21.1% of adults reported at least 3 symptoms of 
posttraumatic stress. Differences in levels of PTSS appeared within demographic 
groups for both samples. Personal care and service frontline workers had 4.3 
times the odds of reporting symptoms of posttraumatic stress than non-frontline 
workers.

Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc.

DOI: 10.1097/PHH.0000000000001837
PMCID: PMC10664775
PMID: 37882760 [Indexed for MEDLINE]

Conflict of interest statement: The authors have indicated they have no 
potential conflicts of interests to disclose.


294. Respir Res. 2023 Oct 25;24(1):258. doi: 10.1186/s12931-023-02553-9.

Impact of the COVID-19 pandemic on well-being and quality of life of patients 
with alpha-1-antitrypsin deficiency.

Werdecker C(1), Bals R(2)(3).

Author information:
(1)Department of Internal Medicine V - Pulmonology, Allergology and Critical 
Care Medicine, Saarland University, Kirrberger Strasse 1, 66421, Homburg/Saar, 
Germany.
(2)Department of Internal Medicine V - Pulmonology, Allergology and Critical 
Care Medicine, Saarland University, Kirrberger Strasse 1, 66421, Homburg/Saar, 
Germany. robert.bals@uks.eu.
(3)Molecular Therapies for Lung Disease, Helmholtz-Institute for Pharmaceutical 
Research Saarland - HIPS, D-66123, Saarbrücken, Germany. robert.bals@uks.eu.

BACKGROUND: Alpha-1-antitrypsin deficiency (AATD) is a genetic disorder 
characterized by mutations in the SERPINA1 gene, primarily affecting the lungs 
and liver. The COVID-19 pandemic has raised questions about the susceptibility 
of individuals with AATD to COVID-19 and whether patients with rare lung disease 
might experience increased stress-related symptoms and mental health challenges. 
This study aims to investigate the impact of the COVID-19 pandemic on the 
quality of life of individuals living with AATD.
METHODS: The study enrolled participants from the German registry for 
individuals with AATD. Questionnaires were sent to the 1250 participants, and a 
total of 358 patients were included in the analysis. The primary objective was 
to examine the influence of sociodemographic and disease-related factors on the 
occurrence of stress-related symptoms. This was accomplished through correlation 
and regression analyses. We also investigated the role of baseline quality of 
life (QoL), as measured by the St. George's Respiratory Questionnaire (SGRQ), as 
a mediator of this relationship.
RESULTS: Stress-related symptoms were predicted by young age, female gender, 
psychological disorders, and a history of exacerbations of lung disease, as 
determined by multiple regression analysis. QoL as measured by the SGRQ mediated 
the relationship between poor lung function, stress, and a decline in overall 
well-being.
CONCLUSION: The presented data demonstrate that the COVID-19 pandemic 
significantly affects the psychological well-being of patients with rare 
diseases, leading to increased levels of anxiety and stress. Disease-related 
factors can exacerbate stress manifestations, especially when compounded by 
sociodemographic and contextual factors. Thus, our study emphasizes the crucial 
role of taking these factors into account when managing individuals with AATD in 
pandemic situations.

© 2023. BioMed Central Ltd., part of Springer Nature.

DOI: 10.1186/s12931-023-02553-9
PMCID: PMC10601099
PMID: 37880685 [Indexed for MEDLINE]

Conflict of interest statement: Robert Bals is Editor in Chief of Respiratory 
Research.


295. Arch Dis Child Fetal Neonatal Ed. 2024 Apr 18;109(3):253-260. doi: 
10.1136/archdischild-2023-325429.

Parenting stress and health-related quality of life among parents of extremely 
preterm born early adolescents in England: a cross-sectional study.

Suonpera E(1), Lanceley A(2), Ni Y(3), Marlow N(2).

Author information:
(1)EGA UCL Institute for Women's Health, University College London, London, UK 
e.suonpera@ucl.ac.uk.
(2)EGA UCL Institute for Women's Health, University College London, London, UK.
(3)School of Public Health, LKS Faculty of Medicine, The University of Hong 
Kong, Hong Kong, Hong Kong.

OBJECTIVE: To determine whether extremely preterm (EP) birth exerts persisting 
effects on parents in early adolescence.
DESIGN: Cross-sectional survey conducted between March 2017 and October 2018.
SETTING: Evaluation of a longitudinal population-based birth cohort in England 
at 11 years of age (EPICure2@11 Study).
PARTICIPANTS: Parents of EP (<27 weeks of gestation) adolescents and control 
parents of term born (≥37 weeks of gestation) classmates of similar age and sex.
MAIN OUTCOME MEASURES: The Parenting Stress Index Short Form (PSI-4-SF) and the 
Short Form Health Survey (SF-12v1).
RESULTS: The 163 EP and 125 comparison respondents were most commonly mothers in 
their mid-40s. EP parents reported higher total parenting stress scores compared 
with controls, overall (adjusted difference in means: 14 (95% CI 9 to 20)) and 
after exclusion of moderate and severe child disability and multiples (9 (95% CI 
3 to 15). Average physical and mental health-related quality of life scores were 
similar in the two groups (adjusted difference in means physical health: -2 
(95% CI -4 to 1) and mental health: -1 (95% CI -4 to 1)). Among EP parents, 12% 
(20/164) reported the combination of high parenting stress and low mental health 
scores. With increasing child age, parenting stress scores for preterm parents 
were lower in contrast to controls who reported increasing parenting stress.
CONCLUSIONS: In early adolescence, compared with parents of term-born children, 
EP parents experience increased levels of parenting stress that are particularly 
high among a proportion of parents and associated with lower mental 
health-related quality of life. Practitioner awareness of this continuing risk 
throughout childhood is important to support parental abilities and well-being.

© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/archdischild-2023-325429
PMID: 37879883 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


296. PLoS One. 2023 Oct 25;18(10):e0292722. doi: 10.1371/journal.pone.0292722. 
eCollection 2023.

Modelling arts professionals' wellbeing and career intentions within the context 
of COVID-19.

Spiro N(1)(2), Shaughnessy C(1)(2), Waddell G(1)(2), Perkins R(1)(2), Campbell 
A(3), Williamon A(1)(2).

Author information:
(1)Centre for Performance Science, Royal College of Music, London, United 
Kingdom.
(2)Faculty of Medicine, Imperial College London, London, United Kingdom.
(3)Central Faculty, Centre for Languages, Culture and Communication, Imperial 
College London, London, United Kingdom.

The COVID-19 pandemic had a substantial effect on the creative and cultural 
industries in the United Kingdom (UK), as seen in our first snapshot of the 
HEartS Professional Survey (April-June 2020, Phase 1, N = 358). By analysing 
data collected one year later (April-May 2021, Phase 2, N = 685), the aims of 
the current study are to trace the contributors to (1) arts professionals' 
mental and social wellbeing and (2) their expectations of staying in the arts. 
Findings show that artists continued to experience challenges in terms of 
finances, and mental and social wellbeing. Over half of the respondents reported 
financial hardship (59%), and over two thirds reported being lonelier (64%) and 
having increased anxiety (71%) than before the pandemic. Hierarchical multiple 
linear regression models, using the Mental Health Continuum-Short Form, Center 
for Epidemiologic Studies Depression Scale, Social Connectedness Scale, and 
Three-Item Loneliness Scale as outcome variables, indicate that perceived 
financial hardship continued to be associated with higher depression and 
loneliness scores. As in our first study, more physical activity before lockdown 
was associated with higher wellbeing and social connectedness scores, and higher 
self-rated health scores were associated with higher wellbeing and lower 
depression scores. Similarly, increases in physical activity during lockdown, as 
well as older age, were still associated with higher wellbeing and social 
connectedness scores and with lower depression and loneliness scores. An ordinal 
logistic regression model indicated three contributors to artists' professional 
expectations of remaining in the arts: greater proportion of income from the 
arts pre-pandemic, continued maintenance of skills, and greater proportion of 
freelance work. The results suggest that the wellbeing patterns observed at the 
start of the pandemic remained consistent a year on. They point to possible 
strategies to support wellbeing and underline the importance of finances for 
expectations of remaining in arts professions.

Copyright: © 2023 Spiro et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0292722
PMCID: PMC10599533
PMID: 37878618 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


297. Front Public Health. 2023 Oct 9;11:1177683. doi: 10.3389/fpubh.2023.1177683. 
eCollection 2023.

"If you weren't connected to the Internet, you were not alive": experience of 
using social technology during COVID-19 in adults 50.

Ling K(1), Langlois D(2), Preusse H(1), Rheman JM(1), Parson D(1), Kuballa S(1), 
Simecek M(1), Tsui KM(3), Fraune MR(1).

Author information:
(1)Intergroup Human-Robot Interaction Lab, Department of Psychology, New Mexico 
State University, Las Cruces, NM, United States.
(2)Faculty of Informatics, Masaryk University, Brno, Czechia.
(3)Toyota Research Institute, Cambridge, MA, United States.

INTRODUCTION: Loneliness and social isolation reduce physical and mental 
wellbeing. Older adults are particularly prone to social isolation due to 
decreased connection with previous social networks such as at workplaces. Social 
technology can decrease loneliness and improve wellbeing. The COVID-19 pandemic 
prompted quarantine and social distancing for many people, creating a context of 
widespread social isolation.
METHOD: In the current study, we interviewed middle-aged and older adults' (n = 
20) about their use of social technology when social isolation was common: 
during the early part of the pandemic while social isolation and masking were 
still required in the United States, between August 2020 and June 2021.We 
analyzed the data using three-phase coding. We compare our results against the 
model of the bidirectional and dynamic relationship between social internet use 
and loneliness.
RESULTS: We found that during the COVID-19 pandemic, our participants 
experienced decreased social interaction and moved toward online interaction. 
Participant use of social technology supported the stimulation hypothesis - that 
is, they used it to maintain existing relationships and social connection. The 
findings also add novel evidence that the stimulation hypothesis endures for 
older adults during enforced isolation (in this case due to the COVID- 19 
pandemic).
DISCUSSION: Based on our data, we also propose adding the presence or realism of 
connection via social technology as a main factor to the model and engaging with 
construal level theory of social presence to fill in critical variables of this 
relationship. We further find that digital exclusion acts as a barrier to 
obtaining benefits from stimulation via social technology and recommend that 
further research examined digital exclusion in relation to the bidirectional and 
dynamic model. Finally, we discuss recommendations for improving social 
technology to benefit middle-aged and older adults.

Copyright © 2023 Ling, Langlois, Preusse, Rheman, Parson, Kuballa, Simecek, Tsui 
and Fraune.

DOI: 10.3389/fpubh.2023.1177683
PMCID: PMC10590895
PMID: 37876716 [Indexed for MEDLINE]

Conflict of interest statement: MF holds concurrent appointments as a Professor 
of Psychology at New Mexico State University and as an Amazon Visiting Academic. 
This paper describes work performed at University New Mexico State University 
and is not associated with Amazon. The remaining authors declare that the 
research was conducted in the absence of any commercial or financial 
relationships that could be construed as a potential conflict of interest.


298. Nat Commun. 2023 Oct 24;14(1):6588. doi: 10.1038/s41467-023-41879-2.

Long-term health impacts of COVID-19 among 242,712 adults in England.

Atchison CJ(1)(2), Davies B(1)(2)(3), Cooper E(1), Lound A(1), Whitaker M(1)(3), 
Hampshire A(4), Azor A(4), Donnelly CA(1)(5)(6), Chadeau-Hyam M(1)(7), Cooke 
GS(2)(8)(9), Ward H(1)(2)(6)(9), Elliott P(10)(11)(12)(13)(14)(15).

Author information:
(1)School of Public Health, Imperial College London, London, UK.
(2)Imperial College Healthcare NHS Trust, London, UK.
(3)MRC Centre for Environment and Health, Imperial College London, London, UK.
(4)Department of Brain Sciences, Imperial College London, London, UK.
(5)Department of Statistics, University of Oxford, Oxford, UK.
(6)MRC Centre for Global infectious Disease Analysis and Abdul Latif Jameel 
Institute for Disease and Emergency Analytics, Imperial College London, London, 
UK.
(7)Health Data Research (HDR) UK London at Imperial College, London, UK.
(8)Department of Infectious Disease, Imperial College London, London, UK.
(9)National Institute for Health Research Imperial Biomedical Research Centre, 
London, UK.
(10)School of Public Health, Imperial College London, London, UK. 
p.elliott@imperial.ac.uk.
(11)Imperial College Healthcare NHS Trust, London, UK. p.elliott@imperial.ac.uk.
(12)MRC Centre for Environment and Health, Imperial College London, London, UK. 
p.elliott@imperial.ac.uk.
(13)Health Data Research (HDR) UK London at Imperial College, London, UK. 
p.elliott@imperial.ac.uk.
(14)National Institute for Health Research Imperial Biomedical Research Centre, 
London, UK. p.elliott@imperial.ac.uk.
(15)UK Dementia Research Institute at Imperial College, London, UK. 
p.elliott@imperial.ac.uk.

The COVID-19 pandemic is having a lasting impact on health and well-being. We 
compare current self-reported health, quality of life and symptom profiles for 
people with ongoing symptoms following COVID-19 to those who have never tested 
positive for SARS-CoV-2 infection and those who have recovered from COVID-19. 
Overall, 276,840/800,000 (34·6%) of invited participants took part. Mental 
health and health-related quality of life were worse among participants with 
ongoing persistent symptoms post-COVID compared with those who had never had 
COVID-19 or had recovered. In this study, median duration of COVID-related 
symptoms (N = 130,251) was 1·3 weeks (inter-quartile range 6 days to 2 weeks), 
with 7·5% and 5·2% reporting ongoing symptoms ≥12 weeks and ≥52 weeks 
respectively. Female sex, ≥1 comorbidity and being infected when Wild-type 
variant was dominant were associated with higher probability of symptoms lasting 
≥12 weeks and longer recovery time in those with persistent symptoms. Although 
COVID-19 is usually of short duration, some adults experience persistent and 
burdensome illness.

© 2023. Springer Nature Limited.

DOI: 10.1038/s41467-023-41879-2
PMCID: PMC10598213
PMID: 37875536 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


299. PLoS One. 2023 Oct 23;18(10):e0292928. doi: 10.1371/journal.pone.0292928. 
eCollection 2023.

Post-COVID-19 syndrome: Physical capacity, fatigue and quality of life.

Beyer S(1), Haufe S(1), Meike D(2), Scharbau M(3), Lampe V(1), Dopfer-Jablonka 
A(4), Tegtbur U(1), Pink I(3), Drick N(3), Kerling A(1).

Author information:
(1)Department of Rehabilitation and Sports Medicine, Hannover Medical School, 
Hannover, Germany.
(2)Clinic for Neurology, Hannover Medical School, Hannover, Germany.
(3)Department of Respiratory Medicine, Hannover Medical School, Hannover, 
Germany.
(4)Clinic for Rheumatology and Immunology, Hannover Medical School, Hannover, 
Germany.

PURPOSE: Post-Covid-19 syndrome is defined as the persistence of symptoms beyond 
3 months after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) 
infection. The most common symptoms include reduced exercise tolerance and 
capacity, fatigue, neurocognitive problems, muscle pain and dyspnea. The aim of 
our work was to investigate exercise capacity and markers of subjective 
wellbeing and their independent relation to post-COVID-19 syndrome.
PATIENTS AND METHODS: We examined a total of 69 patients with post-COVID-19 
syndrome (23 male/46 female; age 46±12 years; BMI 28.9±6.6 kg/m2) with fatigue 
and a score ≥22 in the Fatigue Assessment Scale (FAS). We assessed exercise 
capacity on a cycle ergometer, a 6-minute walk test, the extent of fatigue 
(FAS), markers of health-related quality of life (SF-36 questionnaire) and 
mental health (HADS).
RESULTS: On average the Fatigue Assessment Scale was 35.0±7.4 points. Compared 
with normative values the VO2max/kg was reduced by 8.6±5.8 ml/min/kg (27.7%), 
the 6MWT by 71±96 m (11.9%), the health-related quality of life physical 
component score by 15.0±9.0 points (29.9%) and the mental component score by 
10.6±12.8 points (20.6%). Subdivided into mild fatigue (FAS score 22-34) and 
severe fatigue (FAS score ≥35), patients with severe fatigue showed a 
significant reduction of the 6-minute walk test by 64±165 m (p<0.01) and the 
health-related quality of life physical component score by 5.8±17.2 points (p = 
0.01). In multiple regression analysis age (β = -0.24, p = 0.02), sex (β = 0.22, 
p = 0.03), mental (β = -0.51, p<0.01) and physical (β = -0.44, p<0.01) 
health-related quality of life and by trend the 6-minute walk test (β = -0.22, p 
= 0.07) were associated with the FAS.
CONCLUSION: Patients with post-COVID-19 syndrome show reduced maximal and 
submaximal physical performance as well as limitations in quality of life, 
particularly pronounced in the physical components. These results are 
essentially influenced by the severity of fatigue and implicating the need for 
targeted treatments.

Copyright: © 2023 Beyer et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0292928
PMCID: PMC10593222
PMID: 37870989 [Indexed for MEDLINE]

Conflict of interest statement: NO authors have competing interest.


300. Rev Colomb Psiquiatr (Engl Ed). 2023 Jul-Sep;52(3):206-212. doi: 
10.1016/j.rcpeng.2021.05.008. Epub 2023 Oct 20.

Analysis of perceptions and emotional repercussions in Twitter users in Colombia 
during the COVID-19 pandemic.

[Article in English, Spanish]

Botero-Rodríguez F(1), Mosquera-Quiñónez M(2), Martínez Torres LM(2), 
Bolívar-Moná S(2), Jovel T G(2), Vargas C L(2), Franco OH(3), Gómez-Restrepo 
C(4).

Author information:
(1)Departamento de Epidemiología Clínica y Bioestadística, Pontificia 
Universidad Javeriana, Bogotá, Colombia. Electronic address: 
felipe.botero@javeriana.edu.co.
(2)Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia.
(3)Institute of Social and Preventive Medicine (ISPM), University of Bern, 
Berna, Switzerland.
(4)Departamento de Epidemiología Clínica y Bioestadística, Pontificia 
Universidad Javeriana, Bogotá, Colombia; Departamento de Psiquiatría y Salud 
Mental, Pontificia Universidad Javeriana, Bogotá, Colombia; Hospital 
Universitario San Ignacio, Bogotá, Colombia.

INTRODUCTION: The COVID-19 pandemic has negatively impacted mental health. Up to 
a quarter of the population has reported mental health disorders. This has been 
studied mainly from a nosological perspective, according to diagnostic criteria. 
Nevertheless, we did not find studies that have explored the daily expressions 
of the population. Our objective was to evaluate the perceptions of the COVID-19 
pandemic and its repercussions on the emotional well-being of the Colombian 
population.
METHODS: We performed a Twitter metrics and trend analysis. Initially, in the 
trend analysis, we calculated the average duration in hours of the 20 most 
popular trending topics of the day in Colombia and we grouped them into trends 
related to COVID-19 and unrelated trends. Subsequently, we identified dates of 
events associated with the pandemic relevant to the country, and they were 
related to the behaviour of the trends studied. Additionally, we did an 
exploratory analysis of these, selected the tweets with the greatest reach and 
categorised them in an inductive way to analyse them qualitatively.
RESULTS: Issues not related to COVID-19 were more far-reaching than those 
related to coronavirus. However, a rise in these issues was seen on some dates 
consistent with important events in Colombia. We found expressions of approval 
and disapproval, solidarity and accusation. Inductively, we identified 
categories of informative tweets, humour, fear, stigma and discrimination, 
politics and entities, citizen complaints, and self-care and optimism.
CONCLUSIONS: The impact of the COVID-19 pandemic generates different reactions 
in the population, which increasingly have more tools to express themselves and 
know the opinions of others. Social networks play a fundamental role in the 
communication of the population, so this content could serve as a public health 
surveillance tool and a useful and accessible means of communication in the 
management of health crises.

Copyright © 2021 Asociación Colombiana de Psiquiatría. Published by Elsevier 
España, S.L.U. All rights reserved.

DOI: 10.1016/j.rcpeng.2021.05.008
PMID: 37867031 [Indexed for MEDLINE]


301. J Health Soc Behav. 2024 Mar;65(1):94-109. doi: 10.1177/00221465231200500. Epub 
2023 Oct 21.

Hurt on Both Sides: Political Differences in Health and Well-Being during the 
COVID-19 Pandemic.

Coleman ME(1), Andersson MA(2).

Author information:
(1)University of Utah, Salt Lake City, UT, USA.
(2)Baylor University, Waco, TX, USA.

Republicans and conservatives report better self-rated health and well-being 
compared to Democrats and liberals, yet they are more likely to reside in 
geographic areas with heavy COVID-19 morbidity and mortality. This harmed health 
on "both sides" of political divides, occurring in a time of rapid 
sociopolitical upheaval, warrants the revisiting of psychosocial mechanisms 
linked to political health differences. Drawing on national Gallup data (early 
2021), we find that predicted differences in health or well-being vary 
substantially by ideology, party, voting behavior, and policy beliefs, with 
model fit depending on how politics are measured. Differences in self-rated 
health, psychological distress, happiness, trouble sleeping, and delayed health 
care tend to reveal worse outcomes for Democrats or liberals. Such differences 
often are reduced to insignificance by some combination of mastery, meritocratic 
beliefs, perceived social support, and COVID-19-related exposures and attitudes. 
Policy beliefs predict health differences most robustly across outcomes and 
mechanism adjustments.

DOI: 10.1177/00221465231200500
PMID: 37864410 [Indexed for MEDLINE]


302. Qual Health Res. 2024 Jan;34(1-2):86-100. doi: 10.1177/10497323231204741. Epub 
2023 Oct 20.

"Too Many Jobs and Not Enough Hands": Immigrant and Refugee Community Health 
Workers at the Frontlines of the COVID-19 Pandemic.

Bearss B(1), Martin A(1), Dorsey Vinton S(2), Chaidez V(3), Palmer-Wackerly 
AL(4), Mollard E(5), Edison-Soe L(2), Chan N(2), Estrada Gonzalez E(6), Carter 
M(1), Coburn K(1), Xia Y(1), Tippens JA(1).

Author information:
(1)Department of Child, Youth and Family Studies, University of 
Nebraska-Lincoln, Lincoln, NE, USA.
(2)Asian Community and Cultural Center of Lincoln, Lincoln, NE, USA.
(3)Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, 
Lincoln, NE, USA.
(4)Department of Communication Studies, University of Nebraska-Lincoln, Lincoln, 
NE, USA.
(5)College of Nursing, University of Nebraska Medical Center, Lincoln, NE, USA.
(6)Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA.

Refugees and immigrants have experienced heightened health inequities related to 
COVID-19. As community-embedded frontline health personnel, refugee and 
immigrant community health workers (riCHWs) played essential roles in the 
provision of informational, instrumental, and emotional support during the 
unprecedented first year of the pandemic. Despite the importance of this 
workforce, riCHWs are at high risk for burnout due to low recognition and 
demanding workloads. This was exacerbated as riCHWs navigated a new and 
uncertain health delivery landscape. We sought to glean insight into riCHWs' 
stressors, coping strategies and resources, and self-efficacy to identify ways 
to support their work and wellbeing. Using a narrative inquiry approach, we 
conducted semi-structured, in-depth interviews with 11 riCHWs working in a 
midsized city in the midwestern United States. We generated three distinct yet 
interrelated themes: (1) Rapid and trustworthy information is key, (2) 
Creativity and perseverance are good … structural support is better, and (3) 
Integrating riCHW expertise into health promotion programming and 
decision-making. Although riCHWs were deeply committed to enhancing community 
wellbeing, quickly shifting responsibilities in tandem with structural-level 
health inequities diminished their self-efficacy and mental health. riCHWs 
relied on work-based friends/colleagues for informational and emotional support 
to enhance their capacity to deliver services. Findings suggest increasing 
opportunities for peer support and idea-exchange, professional development, and 
integration of riCHW expertise in health promotion decision-making are effective 
strategies to enhance riCHWs' professional self-efficacy and personal wellbeing.

DOI: 10.1177/10497323231204741
PMID: 37863477 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting InterestsThe 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


303. JMIR Public Health Surveill. 2023 Oct 20;9:e44155. doi: 10.2196/44155.

Evaluation of Primary Allied Health Care in Patients Recovering From COVID-19 at 
6-Month Follow-up: Dutch Nationwide Prospective Cohort Study.

Slotegraaf AI(#)(1), Gerards MHG(#)(2)(3), Verburg AC(4), de van der Schueren 
MAE(1)(5), Kruizenga HM(6), Graff MJL(4)(7), Cup EHC(7), Kalf JG(7), Lenssen 
AF(3), Meijer WM(8), Kool RA(9), de Bie RA(2), van der Wees PJ(4)(7), Hoogeboom 
TJ(4); Dutch Consortium Allied Healthcare COVID-19(#)(10).

Author information:
(1)Division of Human Nutrition and Health, Wageningen University and Research, 
Wageningen, Netherlands.
(2)Department of Epidemiology, Care and Public Health Institute, Faculty of 
Health, Medicine and Life Sciences, Maastricht University, Maastricht, 
Netherlands.
(3)Department of Physical Therapy, Maastricht University Medical Centre, 
Maastricht, Netherlands.
(4)IQ Healthcare, Radboud Institute for Health Sciences, Radboud University 
Medical Centre, Nijmegen, Netherlands.
(5)Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied 
Sciences, Nijmegen, Netherlands.
(6)Department of Nutrition and Dietetics, Amsterdam University Medical Centers, 
Amsterdam, Netherlands.
(7)Department of Rehabilitation, Donders Institute for Brain, Cognition and 
Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands.
(8)Netherlands Institute for Health Services Research, Nivel, Utrecht, 
Netherlands.
(9)Lung Foundation Netherlands, Amersfoort, Netherlands.
(10)See Acknowledgments, .
(#)Contributed equally

BACKGROUND: Patients recovering from COVID-19 often experience persistent 
problems in their daily activities related to limitations in physical, 
nutritional, cognitive, and mental functioning. To date, it is unknown what 
treatment is needed to support patients in their recovery from COVID-19.
OBJECTIVE: This study aimed to evaluate the primary allied health care of 
patients recovering from COVID-19 at 6-month follow-up and to explore which 
baseline characteristics are associated with changes in the scores of outcomes 
between baseline and 6-month follow-up.
METHODS: This Dutch nationwide prospective cohort study evaluated the recovery 
of patients receiving primary allied health care (ie, dietitians, exercise 
therapists, occupational therapists, physical therapists, and speech and 
language therapists) after COVID-19. All treatments offered by primary allied 
health professionals in daily practice were part of usual care. Patient-reported 
outcome measures on participation, health-related quality of life, fatigue, 
physical functioning, and psychological well-being were assessed at baseline and 
at 3- and 6-month follow-up. Linear mixed model analyses were used to evaluate 
recovery over time, and uni- and multivariable linear regression analyses were 
used to examine the association between baseline characteristics and recovery.
RESULTS: A total of 1451 adult patients recovering from COVID-19 and receiving 
treatment from 1 or more primary allied health professionals were included. For 
participation (Utrecht Scale for Evaluation of Rehabilitation-Participation 
range 0-100), estimated mean differences of at least 2.3 points were observed at 
all time points. For the health-related quality of life (EuroQol Visual Analog 
Scale, range 0-100), the mean increase was 12.3 (95% CI 11.1-13.6) points at 6 
months. Significant improvements were found for fatigue (Fatigue Severity Scale, 
range 1-7): the mean decrease was -0.7 (95% CI -0.8 to -0.6) points at 6 months. 
However, severe fatigue was reported by 742/929 (79.9%) patients after 6 months. 
For physical functioning (Patient-Reported Outcomes Measurement Information 
System-Physical Function Short Form 10b, range 13.8-61.3), the mean increase was 
5.9 (95% CI 5.9-6.4) points at 6 months. Mean differences of -0.8 (95% CI -1.0 
to -0.5) points for anxiety (Hospital Anxiety and Depression Scale range 0-21) 
and -1.6 (95% CI -1.8 to -1.3) points for depression were found after 6 months. 
A worse baseline score, hospital admission, and male sex were associated with 
greater improvement between baseline and 6-month follow-up, whereas age, the 
BMI, comorbidities, and smoking status were not associated with mean changes in 
any outcome measures.
CONCLUSIONS: Patients recovering from COVID-19 who receive primary allied health 
care make progress in recovery but still experience many limitations in their 
daily activities after 6 months. Our findings provide reference values to health 
care providers and health care policy makers regarding what to expect from the 
recovery of patients who receive health care from 1 or more primary allied 
health professionals.
TRIAL REGISTRATION: ClinicalTrials.gov NCT04735744; 
https://tinyurl.com/3vf337pn.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2340/jrm.v54.2506.

©Anne I Slotegraaf, Marissa H G Gerards, Arie C Verburg, Marian A E de van der 
Schueren, Hinke M Kruizenga, Maud J L Graff, Edith H C Cup, Johanna G Kalf, 
Antoine F Lenssen, Willemijn M Meijer, Renée A Kool, Rob A de Bie, Philip J van 
der Wees, Thomas J Hoogeboom, Dutch Consortium Allied Healthcare COVID-19. 
Originally published in JMIR Public Health and Surveillance 
(https://publichealth.jmir.org), 20.10.2023.

DOI: 10.2196/44155
PMCID: PMC10592721
PMID: 37862083 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: All authors have 
completed the International Committee of Medical Journal Editors uniform 
disclosure form and declare that all authors received financial support from 
ZonMw for the submitted work, had no financial relationships with any 
organizations that might have an interest in the submitted work in the previous 
3 years, and had no other relationships or activities that could appear to have 
influenced the submitted work.


304. Soc Sci Med. 2023 Nov;337:116298. doi: 10.1016/j.socscimed.2023.116298. Epub 
2023 Oct 7.

Parents' perceptions of their children's mental health during COVID-19: Evidence 
from Canada.

Abdo Ahmad I(1), Fakih A(2), Hammoud M(3).

Author information:
(1)Department of Economics, Lebanese American University, P.O. Box: 13-5053, 
Beirut, Lebanon. Electronic address: issam.abdoahmad@lau.edu.
(2)Department of Economics, Lebanese American University, P.O. Box: 13-5053, 
Beirut, Lebanon. Electronic address: afakih@lau.edu.lb.
(3)Center for Lebanese Studies, University of Cambridge, P.O. Box: 13-5053, 
Beirut, Lebanon. Electronic address: mohammad.hammoud@lebanesestudies.com.

OBJECTIVE: This study examined several factors affecting the perception of 
Canadian parents about their children's mental health during COVID-19. The 
contribution of this research included fresh evidence from examining the 
demographic and sociological factors influencing children's well-being during 
COVID-19 using the Canadian context.
METHODS: We used a cross-sectional dataset from Statistics Canada titled Impacts 
of COVID-19 on Canadians - Parenting during the Pandemic (2020). We relied on an 
ordered logit model and computed the respective odds ratios.
RESULTS: Our results showed that parents with a university degree and those 
working from home are less concerned about their children's mental health. 
Nonetheless, having a disabled child, belonging to a minority, having children 
aged six-to fourteen-years old, and having lost a job or experienced a drop in 
working hours increased parents' worry. Additionally, having worries about being 
connected with family and friends, being concerned about work-life balance, 
feeling lonely at home, and waiting for the reopening of childcare services all 
increased the likelihood of parents' anxiety about their child's mental health. 
When running the analysis by province, we saw that being an immigrant and 
belonging to a minority increased parents' worry only in Ontario and British 
Columbia.
CONCLUSIONS: Policymakers are encouraged to foster working-from-home practices 
as working from home has been linked to less worry about child mental health, 
mainly among mothers, as indicated in our gender heterogeneity analysis. In 
addition, it is advised that families with a disabled child, and families 
belonging to a minority received additional support. Lastly, policymakers are 
advised to consider the social cost of preventive measures and incorporate this 
into any future preventative policymaking as the social impact variables were 
robust across all models.

Copyright © 2023 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.socscimed.2023.116298
PMID: 37857242 [Indexed for MEDLINE]


305. PLoS One. 2023 Oct 19;18(10):e0292344. doi: 10.1371/journal.pone.0292344. 
eCollection 2023.

Parent-reported child's close contact with non-household family members and 
their well-being during the COVID-19 pandemic: A cross-sectional survey.

Woodland L(1)(2), Smith LE(1)(2), Brooks SK(1)(2), Webster RK(3), Amlôt R(2)(4), 
Rubin A(5), Rubin GJ(1)(2).

Author information:
(1)Department of Psychological Medicine, King's College London, London, United 
Kingdom.
(2)NIHR Health Protection Research Unit in Emergency Preparedness and Response, 
Bristol, United Kingdom.
(3)Department of Psychology, University of Sheffield, Sheffield, United Kingdom.
(4)Behavioural Science and Insights Unit, UK Health Security Agency, Salisbury, 
United Kingdom.
(5)Trustee at Weald of Kent Grammar School, Tonbridge, Kent, United Kingdom.

In England (UK), at the start of the COVID-19 pandemic the public were required 
to reduce their physical contacts to slow the spread of COVID-19. We 
investigated the factors associated with children having: 1) close contact with 
family members from outside their household ('non-adherent behaviour'); and 2) 
low well-being (Revised Child Anxiety and Depression Scale). We conducted an 
online cross-sectional survey, completed at any location of the participant's 
choice between 8 and 11 June 2020 in parents (n = 2,010) who were aged eighteen 
years or over and had a school-aged child (4-18 years old). Parents reported 
that 15% (n = 309) of children had non-adherent contact and that 26% (n = 519) 
had low well-being. We used a series of binary logistic regressions to 
investigate associations between outcomes and child and parent characteristics. 
Children had higher odds of having non-household contact when they had special 
educational needs [adjusted odds ratio, 2.19 (95% CI, 1.47 to 3.27)], lower 
well-being [2.65 (95% CI, 2.03 to 3.46)], were vulnerable to COVID-19 [2.17 (95% 
CI, 1.45 to 3.25)], lived with someone who was over 70 years old [2.56 (95% CI, 
1.55 to 4.24)] and their parent had low well-being [1.94 (95% CI, 1.45 to 
2.58)]. Children had higher odds of lower well-being when they had special 
educational needs [4.13 (95% CI, 2.90 to 5.87)], were vulnerable to COVID-19 
[3.06 (95% CI, 2.15 to 4.36)], lived with someone else who was vulnerable to 
COVID-19 [2.08 (95% CI, 1.64 to 2.64)], or lived with someone who was over 70 
years old [2.41 (95% CI, 1.51 to 3.83)]. Many children came into contact with 
non-household family members, mainly for childcare. Factors relating to 
COVID-19, children's well-being and education were also important. If school 
closures are needed in future, addressing these issues may help reduce contact.

Copyright: © 2023 Woodland et al. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0292344
PMCID: PMC10586646
PMID: 37856464 [Indexed for MEDLINE]

Conflict of interest statement: I have read the journal’s policy and the authors 
of this manuscript have the following competing interests: G.J.R., R.A. and L.S. 
participate in the UK’s Scientific Advisory Group for Emergencies, or its 
subgroups. RA is an employee of the UK Health Security Agency, which is an arm 
of the UK Government. This does not alter our adherence to PLOS ONE policies on 
sharing data and materials. These groups did not fund the study or authors.


306. PLoS One. 2023 Oct 18;18(10):e0292540. doi: 10.1371/journal.pone.0292540. 
eCollection 2023.

Changes in economic activity and mental distress among young adults during the 
COVID-19 pandemic: Differences between the first and second infection waves in 
the UK.

Zhang L(1), Gagné T(1), McMunn A(1).

Author information:
(1)ESRC International Centre for Life Course Studies in Society & Health, 
Research Department of Epidemiology and Public Health, University College 
London, London, United Kingdom.

BACKGROUND: While infection rates, lockdown policies, and labor market 
conditions substantially varied across COVID-19 waves, the majority of evidence 
on young adults' mental health remains focused on initial responses in early 
2020. The variability of the relationship between economic activity and mental 
health over time therefore remains poorly understood in this age group.
METHODS: Using linear mixed models, we investigated the relationship between 
current activity and changes in activity and mental distress (GHQ-12) among 
1,390 young adults aged 16-34 via the UK Household Longitudinal Study COVID-19 
survey. The association was explored in the first (from April to July 2020) and 
second (from September 2020 to March 2021) infection waves. Current activity was 
defined as "not working", "working <17.5 hours/week", "17.5-35 hours/week", and 
"> = 35 hours/week". Changes in activity were derived from current and 
pre-pandemic working hours and divided into four categories: "working with no 
reduced hours", "working fewer hours", "no longer working", and "did not work 
before the pandemic".
RESULTS: During the first wave, no association reached statistical significance. 
During the second wave: 1) compared to "currently not working", working 35 or 
more hours was associated with decreased distress (b = -1.54; 95%CI -2.39, 
-0.69) and working less than 17.5 hours was not (b = -0.62; 95%CI -1.66, 0.41); 
2) compared to "working with no reduced hours compared with before the 
outbreak", no longer working was associated with increased distress (b = 1.58, 
95%CI 0.61, 2.55) and working with reduced hours was not (b = 0.47, 95%CI -0.24, 
1.17).
CONCLUSION: Above the mental health inequalities experienced at the start of the 
pandemic, full-time work-even with variation in work hours-continued to be a 
protective factor against mental distress among young adults during the second 
wave in the UK. Stable, full-time work can better support this age group's 
mental well-being over time.

Copyright: © 2023 Zhang et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0292540
PMCID: PMC10584092
PMID: 37851662 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


307. Acta Biomed. 2023 Oct 17;94(5):e2023199. doi: 10.23750/abm.v94i5.14522.

Psychological health of mothers and siblings of children with autism spectrum 
disorders during COVID-19 pandemic: new evidence in Italian families.

Camia M(1), Scorza M(2), Lipparini A(3), Martorana L(4), Nardocci F(5), Padovani 
R(6), Rubichi S(7), Benassi E(8).

Author information:
(1)University of Modena and Reggio Emilia. michela.camia@unimore.it.
(2)University of Modena an Reggio Emilia. maristella.scorza@unimore.it.
(3). presidente@autautmodena.it.
(4). lorelaymartorana@gmail.com.
(5). nardoccifranco@gmail.com.
(6). r.padovani@ausl.mo.it.
(7). sandro.rubichi@unimore.it.
(8). erika.benassi@unimore.it.

BACKGROUND AND AIM: Psychological challenges are well recognized in families 
with a child with Autism Spectrum Disorders (ASD). Instead, less is known about 
the effects of traumatic scenarios, such as COVID-19, on the psychological 
health of these families. The main aim of this research was to study the 
psychological health of both mothers and typically developing (TD) siblings of 
children with ASD during the COVID-19 pandemic. Second, we investigated the 
relationship between the mothers' psychological resources and their children 
psychological well-being.
METHODS: The sample included 52 mothers and their children: 15 with one child 
with ASD and at least one TD child (aged 4-14) (ASD-siblings group) and 37 with 
one or more TD child (aged 4-14) (TD control group). The data were collected 
through an online platform; four standardized questionnaires (GAD-7, BDI-II, 
CD-RISC 25 and CBCL) were administered.
RESULTS: The analyses revealed more internalizing and total behavioral symptoms 
in the siblings of children with ASD, compared to TD control group. Regarding 
the mothers, we did not find differences in depression and anxious symptoms 
between the two groups. However, the results reported a lower level of 
resilience in the mothers of children with ASD relative to mothers of TD 
children. Finally, the psychological well-being of the TD children was 
associated with the level of mothers' anxiety only in the ASD-siblings group.
CONCLUSIONS: Overall, our data show that the COVID-19 outbreak may had been 
particularly challenging for families of children with ASD, and highlight the 
importance of intensifying psychological support to families.

DOI: 10.23750/abm.v94i5.14522
PMCID: PMC10644939
PMID: 37850771 [Indexed for MEDLINE]

Conflict of interest statement: Each author declares that he or she has no 
commercial associations (e.g. consultancies, stock ownership, equity interest, 
patent/licensing arrangement etc.) that might pose a conflict of interest in 
connection with the submitted article.


308. BMC Public Health. 2023 Oct 17;23(1):2021. doi: 10.1186/s12889-023-16962-4.

The thriving kids and parents schools project: protocol of an incomplete stepped 
wedged cluster randomised trial evaluating the effectiveness of a Triple P 
seminar series.

Boyle C(1), Sanders MR(2), Ma T(3)(2), Hodges J(3)(2), Allen KA(4), Cobham 
VE(2)(5)(6), Darmawan I(3), Dittman CK(2)(7)(8), Healy KL(2)(9), Hepburn SJ(2), 
MacLeod LM(3), Teng J(3), Trompf M(4).

Author information:
(1)School of Education, The University of Adelaide, Adelaide, South Australia, 
5005, Australia. chris.boyle@adelaide.edu.au.
(2)Parenting and Family Support Centre, The University of Queensland, 
Queensland, Australia.
(3)School of Education, The University of Adelaide, Adelaide, South Australia, 
5005, Australia.
(4)School of Educational Psychology & Counselling, Monash University, Victoria, 
Australia.
(5)School of Psychology, The University of Queensland, Queensland, Australia.
(6)Youth Mental Health Service, Children's Health Queensland Hospital and Health 
Service, Brisbane, QLD, Australia.
(7)School of Health, Medical and Applied Sciences, Central Queensland 
University, Queensland, Australia.
(8)Manna Institute, Central Queensland University, Queensland, Australia.
(9)QIMR Berghofer Medical Research Institute, Brisbane, Australia.

BACKGROUND: The COVID-19 pandemic disrupted the normality of daily life for many 
children, their families, and schools, resulting in heightened levels of 
anxiety, depression, social isolation, and loneliness among young people. An 
integrated public health model of interventions is needed to address the problem 
and to safeguard the mental health and wellbeing of children. The Triple P - 
Positive Parenting Program is one system of parenting support with a strong 
evidence-base and wide international reach. When implemented as a public health 
approach, Triple P has demonstrated population level positive effects on child 
wellbeing. This study will be the first large-scale, multi-site randomised 
controlled trial of a newly developed, low-intensity variant of Triple P, a 
school-based seminar series, as a response to the impacts of the pandemic.
METHODS: The evaluation will employ an Incomplete Batched Stepped Wedge Cluster 
Randomised Trial Design. At least 300 Australian primary schools, from South 
Australia, Queensland, and Victoria will be recruited and randomised in three 
batches. Within each batch, schools will be randomly assigned to either start 
the intervention immediately or start in six weeks. Parents will be recruited 
from participating schools. The Triple P seminar series includes three seminars 
titled: "The Power of Positive Parenting", "Helping Your Child to Manage 
Anxiety", and "Keeping your Child Safe from Bullying". Parents will complete 
measures about child wellbeing, parenting, parenting self-regulation and other 
key intervention targets at baseline, six weeks after baseline, and 12 weeks 
after baseline. Intervention effectiveness will be evaluated with a Multilevel 
Piecewise Latent Growth Curve Modelling approach. Data collection is currently 
underway, and the current phase of the project is anticipated to be completed in 
January 2024.
DISCUSSION: The findings from this study will extend the current knowledge of 
the effects of evidence-based parenting support delivered through brief, 
universally offered, low intensity, school-based parenting seminars in a post 
pandemic world.
TRIAL REGISTRATION: The trial is registered at the Australian New Zealand 
Clinical Trials Registry (Trial Registration Number: ACTRN12623000852651).

© 2023. BioMed Central Ltd., part of Springer Nature.

DOI: 10.1186/s12889-023-16962-4
PMCID: PMC10580655
PMID: 37848856 [Indexed for MEDLINE]

Conflict of interest statement: The Parenting and Family Support Centre is 
partly funded by royalties stemming from published resources of the Triple P – 
Positive Parenting Program, which is developed and owned by The University of 
Queensland (UQ). Royalties are also distributed to the Faculty of Health and 
Behavioral Sciences at UQ and contributory authors of published Triple P 
resources. Triple P International (TPI) Pty Ltd is a private company licensed by 
Uniquest Pty Ltd on behalf of UQ, to publish and disseminate Triple P worldwide. 
The authors of this report have no share or ownership of TPI. TPI had no 
involvement in the study design, or analysis or interpretation of data. Sanders, 
Cobham, and Healy are authors of the seminars to be trialled. Sanders and Cobham 
currently receive royalties from TPI and Healy may in future receive royalties. 
Sanders, Ma, Hodges, Cobham, and Hepburn are employees at UQ. Dittman and Healy 
holds honorary title at UQ. Ma is also a student at UQ. The other authors 
declare have no competing interests.


309. PLoS One. 2023 Oct 17;18(10):e0292670. doi: 10.1371/journal.pone.0292670. 
eCollection 2023.

Parent psychological distress and parent-child relationships two years into the 
COVID-19 pandemic: Results from a Canadian cross-sectional study.

Thomson KC(1)(2)(3), Jenkins E(4), Gill R(2), Hastings KG(2), Richardson CG(5), 
Gagné Petteni M(2)(3), McAuliffe C(4), Gadermann AM(2)(3).

Author information:
(1)Children's Health Policy Centre, Faculty of Health Sciences, Simon Fraser 
University, Burnaby, Canada.
(2)Human Early Learning Partnership, School of Population and Public Health, 
University of British Columbia, Vancouver, Canada.
(3)Centre for Advancing Health Outcomes, Providence Health Care Research 
Institute, Vancouver, British Columbia, Canada.
(4)School of Nursing, University of British Columbia, Vancouver, Canada.
(5)School of Population and Public Health, University of British Columbia, 
Vancouver, Canada.

BACKGROUND: Mental health impacts of the COVID-19 pandemic have not been felt 
equally within populations. Parents with children living at home were early on 
identified as a population at heightened mental health risk, with concerns about 
the potential long-term impacts of the pandemic on parents' mental health, 
family functioning, and children's well-being. This study investigates impacts 
of the pandemic on parents' psychological distress, contextual sources of 
distress, and associations with family functioning nearly two years into the 
pandemic.
METHODS AND FINDINGS: Data were drawn from a national cross-sectional survey of 
adults living in Canada in November and December 2021 that was representative by 
age, gender, household income, and region. Parents with children < 18 years old 
living at home (N = 553) reported their experiences of psychological distress, 
pandemic-related stressors, coping mechanisms, and family functioning (changes 
in parent-child interactions, children's anxiety). Chi-square tests, logistic 
regression, and linear regression analyses examined sociodemographic inequities 
in parents' levels of psychological distress, sources and mitigating mechanisms 
of distress, and associations between psychological distress and family 
functioning. Nearly two years into the pandemic, parents with children at home 
reported nearly double pre-pandemic population estimates of moderate to severe 
psychological distress. Psychological distress was more frequently reported 
among parents with pre-existing mental health conditions, disabilities, and 
financial stressors. Parents with greater psychological distress reported 
increases in negative parent-child interactions due to the pandemic and higher 
anxiety among their children.
CONCLUSIONS: This study identifies sustained negative impacts of the pandemic on 
parents' mental health and family functioning in Canada nearly two years into 
the pandemic, despite high vaccine uptake and declining infection rates. 
Disparities in financial stress, social support structures, and pre-existing 
mental health were identified as underlying sources of psychological distress. 
These results highlight that meaningful responses to promote mental health among 
parents and families must address social and structural inequities.

Copyright: © 2023 Thomson et al. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0292670
PMCID: PMC10581480
PMID: 37847679 [Indexed for MEDLINE]

Conflict of interest statement: CGR reports receiving personal fees from the 
University of British Columbia during the conduct of this study. All other 
authors report no competing interests. This does not alter our adherence to PLOS 
ONE policies on sharing data and materials.


310. J Gen Intern Med. 2024 Feb;39(3):450-459. doi: 10.1007/s11606-023-08422-x. Epub 
2023 Oct 16.

Psychological Burden of Systemic Racism-Related Distress in New York City 
Healthcare Workers During the COVID-19 Pandemic.

Tong M(1)(2), Hurtado A(1)(2), Deshpande R(3)(4), Pietrzak RH(5)(6)(7), He C(2), 
Kaplan C(2), Kaplan S(2), Akhtar S(2)(8), Feder A(1), Feingold JH(1), Ripp 
JA(2)(9), Peccoralo LA(10)(11).

Author information:
(1)Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, 
NY, USA.
(2)Department of Medical Education, Icahn School of Medicine at Mount Sinai, One 
Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA.
(3)Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, 
NY, USA.
(4)Population Health Science and Policy, Icahn School of Medicine at Mount 
Sinai, New York, USA.
(5)U.S. Department of Veterans Affairs National Center for Posttraumatic Stress 
Disorder, VA Connecticut Healthcare System, West Haven, CT, USA.
(6)Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
(7)Department of Social and Behavioral Sciences, Yale School of Public Health, 
New Haven, CT, USA.
(8)Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 
New York, NY, USA.
(9)Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, 
NY, USA.
(10)Department of Medical Education, Icahn School of Medicine at Mount Sinai, 
One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA. 
lauren.peccoralo@mountsinai.org.
(11)Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, 
NY, USA. lauren.peccoralo@mountsinai.org.

BACKGROUND: Little is known about the relationship among systemic racism, 
psychological symptoms (depression, anxiety, and/or post-traumatic stress 
disorders), and burnout in healthcare workers (HCWs).
OBJECTIVE: To determine whether distress related to awareness of systemic racism 
contributes to psychological symptoms and/or burnout in HCWs. We explored 
whether this form of racism-related distress may moderate the relationship 
between race, ethnicity, psychological symptoms, and burnout.
DESIGN: A cross-sectional survey was conducted from November 19, 2020, through 
January 11, 2021. Statistical analysis was conducted from May 3, 2022, to June 
15, 2022.
PARTICIPANTS: Frontline HCWs at an urban tertiary care hospital in New York 
City.
MAIN MEASURES: Distress related to awareness of systemic racism (SR) and racial 
disparities in COVID-19 outcomes (RD), psychological symptoms, and burnout.
KEY RESULTS: Two thousand one of 4654 HCWs completed the survey (response rate 
43.0%). Most HCWs reported experiencing distress related to awareness of 
systemic racism (1329 [66.4%]) and to racial disparities in COVID-19 outcomes 
(1137 [56.8%]). Non-Hispanic Black participants (SR odds ratio (OR) 2.84, 
p < .001; RD OR 2.34, p < .001), women (SR OR 1.35, p = .01; RD OR 1.67, 
p < .001), and those with history of mental illness (SR OR 2.13, p < .001; RD OR 
1.66, p < .001) were more likely to report SR- and RD-related distress, 
respectively. HCWs who experienced "quite-a-bit to extreme" SR-related distress 
were more likely to screen positive for psychological symptoms (OR 5.90, 
p < .001) and burnout (OR 2.26, p < .001).
CONCLUSIONS: Our findings suggest that distress related to awareness of systemic 
racism, not race/ethnicity, was associated with experiencing psychological 
symptoms and burnout in HCWs. As the medical community continues to critically 
examine the role of systemic racism in healthcare, our work is a first step in 
characterizing its toll on the psychological well-being of HCWs.

© 2023. The Author(s), under exclusive licence to Society of General Internal 
Medicine.

DOI: 10.1007/s11606-023-08422-x
PMCID: PMC10897117
PMID: 37845586 [Indexed for MEDLINE]

Conflict of interest statement: Dr. Lauren Peccoralo received honoraria for 
speaking engagements at a number of academic medical centers and medical 
societies. Dr. Jonathan Ripp received honoraria for numerous speaking 
engagements at professional societies, academic medical centers, healthcare 
institutions; worked as a consultant for the well-being program at the NYU 
School of Medicine Long Island; served as a nonfiduciary board member of the 
Lorna Breen Foundation; and served on a temporary advisory board established by 
PEPSICO to inform employee well-being efforts. Dr.’s Peccoralo and Ripp are 
currently investigators on a HRSA training grant. Dr Jordyn Feingold recieved a 
TL1 grant, consults with BetterUp Coaching and receives royalties for her book. 
Dr Adriana Feder is an investigator on two CDC-Niosh grants, Dr Robert Pietrzak 
is a paid consultant to the Office of Well-Being and Resilience at the Icahn 
School of Medicine at Mount Sinai. All other authors report no conflicts of 
interests for this work.


311. Aust Health Rev. 2023 Dec;47(6):641-651. doi: 10.1071/AH23120.

Worsening psychological wellbeing of Australian hospital clinical staff during 
three waves of the coronavirus (COVID-19) pandemic.

Holton S(1), Rasmussen B(2), Crowe S(3), Trueman M(3), Dabscheck A(4), Booth 
S(5), Hitch D(6), Said CM(7), Haines KJ(5), Wynter K(1).

Author information:
(1)<institution content-type="university">School of Nursing and 
Midwifery</institution>, <institution content-type="university">Faculty of 
Health</institution>, <institution content-type="university">Deakin 
University</institution>, <city>Geelong</city>, <state>Vic.</state> 
<postal-code>3220</postal-code>, <country>Australia</country>; and <institution 
content-type="university">Centre for Quality and Patient Safety Research in the 
Institute of Health Transformation - Western Health Partnership</institution>, 
<institution content-type="university">Deakin University</institution>, <city>St 
Albans</city>, <state>Vic.</state> <postal-code>3021</postal-code>, 
<country>Australia</country>.
(2)<institution content-type="university">School of Nursing and 
Midwifery</institution>, <institution content-type="university">Faculty of 
Health</institution>, <institution content-type="university">Deakin 
University</institution>, <city>Geelong</city>, <state>Vic.</state> 
<postal-code>3220</postal-code>, <country>Australia</country>; and <institution 
content-type="university">Centre for Quality and Patient Safety Research in the 
Institute of Health Transformation - Western Health Partnership</institution>, 
<institution content-type="university">Deakin University</institution>, <city>St 
Albans</city>, <state>Vic.</state> <postal-code>3021</postal-code>, 
<country>Australia</country>; and <institution content-type="university">Public 
Health</institution>, <city>Copenhagen</city>, <country>Denmark</country>; and 
<institution content-type="university">Faculty of Health Services</institution>, 
<institution content-type="university">University of Southern 
Denmark</institution>, <city>Odense M</city>, <country>Denmark</country>.
(3)<institution content-type="university">Nursing and Midwifery</institution>, 
<institution content-type="university">Western Health</institution>, <city>St 
Albans</city>, <state>Vic.</state> <postal-code>3021</postal-code>, 
<country>Australia</country>.
(4)<institution content-type="university">Medical Services</institution>, 
<institution content-type="university">Western Health</institution>, 
<city>Footscray</city>, <state>Vic.</state> <postal-code>3011</postal-code>, 
<country>Australia</country>.
(5)<institution content-type="university">Allied Health</institution>, 
<institution content-type="university">Western Health</institution>, <city>St 
Albans</city>, <state>Vic.</state> <postal-code>3021</postal-code>, 
<country>Australia</country>.
(6)<institution content-type="university">Allied Health</institution>, 
<institution content-type="university">Western Health</institution>, <city>St 
Albans</city>, <state>Vic.</state> <postal-code>3021</postal-code>, 
<country>Australia</country>; and <institution 
content-type="university">Occupational Science and Therapy</institution>, 
<institution content-type="university">Deakin University</institution>, 
<city>Geelong</city>, <state>Vic.</state> <postal-code>3220</postal-code>, 
<country>Australia</country>.
(7)<institution content-type="university">Allied Health</institution>, 
<institution content-type="university">Western Health</institution>, <city>St 
Albans</city>, <state>Vic.</state> <postal-code>3021</postal-code>, 
<country>Australia</country>; and <institution 
content-type="university">Physiotherapy, Melbourne School of Health 
Sciences</institution>, <institution content-type="university">The University of 
Melbourne</institution>, <city>Parkville</city>, <state>Vic.</state> 
<postal-code>3010</postal-code>, <country>Australia</country>; and <institution 
content-type="university">Australian Institute of Musculoskeletal 
Science</institution>, <city>St. Albans</city>, <state>Vic.</state> 
<postal-code>3021</postal-code>, <country>Australia</country>.

Objective This study aimed to assess and compare the psychological wellbeing of 
Australian hospital clinical staff at three timepoints during the coronavirus 
disease 2019 (COVID-19) pandemic. Methods An anonymous, online, cross-sectional 
survey was conducted at three timepoints during the COVID-19 pandemic (T1: 
May-June 2020; T2: October-December 2020; T3: November 2021-January 2022). The 
surveys were completed by nurses, midwives, doctors and allied health staff 
employed at a large metropolitan tertiary health service located in Melbourne, 
Australia. The Depression, Anxiety and Stress Scale (DASS-21) assessed 
respondents' psychological wellbeing in the past week. General linear models 
were used to measure the effects of survey timepoint on DASS-21 subscale scores, 
adjusting for selected sociodemographic and health characteristics. Results A 
total of 1470 hospital clinical staff completed at least one survey (T1: 668 
(14.7%), T2: 358 (7.9%) and T3: 444 (9.8%)). Respondents' sociodemographic 
characteristics were similar across the three timepoints and within professional 
discipline groups. Respondents' psychological wellbeing was worse at T3 compared 
to the earlier survey timepoints. Adjusting for respondent characteristics, 
depression, anxiety and stress scores were significantly higher for respondents 
of the third survey compared to the first (P  < 0.001). Conclusions There was a 
significant and persistent negative impact on the psychological wellbeing of 
hospital clinical staff in Australia across waves of the COVID-19 pandemic. 
Hospital clinical staff would benefit from ongoing and continued wellbeing 
support during and after pandemic waves.

DOI: 10.1071/AH23120
PMID: 37844618 [Indexed for MEDLINE]


312. Front Public Health. 2023 Sep 28;11:1280423. doi: 10.3389/fpubh.2023.1280423. 
eCollection 2023.

Potential impacts of Russo-Ukraine conflict and its psychological consequences 
among Ukrainian adults: the post-COVID-19 era.

Khan AR(1)(2), Altalbe A(3)(4).

Author information:
(1)Department of Interventional and Vascular Surgery, Shanghai Tenth People's 
Hospital, Tongji University School of Medicine, Shanghai, China.
(2)National United Engineering Laboratory for Biomedical Material Modification, 
Branden Industrial Park, Qihe Economic and Development Zone, Dezhou, China.
(3)Department of Computer Engineering, Prince Sattam Bin Abdulaziz University, 
Al-Kharj, Saudi Arabia.
(4)Faculty of Computing and Information Technology, King Abdulaziz University, 
Jeddah, Saudi Arabia.

BACKGROUND: Since February 2022, the nation of Ukraine has become entangled in 
an escalating conflict that erupted after coronavirus outbreak fostering a 
situation of indeterminacy and precariousness, which adversely affected several 
facets, especially psychological well-being. However, there is a lack of 
empirical evidence on the psychological well-being of Ukrainians during the 
Russo-Ukraine war, as well as their coping strategies in response to the war's 
repercussions. Consequently, this investigation endeavors to explore the 
prevalence of symptoms associated with depression, anxiety, stress, and insomnia 
and to correlate these symptoms with Ukrainians' effective coping mechanisms 
during the ongoing war.
METHODS: An online survey was administered in Ukraine from June to August 2022 
due to the ongoing Russo-Ukraine conflict. The survey employed a quota sampling 
technique, targeting 2,664 individuals (≥18 years). Out of the total sample, 
1,833 valid responses were obtained, yielding a response rate of 68. 81%. 
Depression, anxiety, and stress were measured using the depression, anxiety, and 
stress scale-21 (DASS-21), while the Pittsburgh sleep quality index (PSQI) was 
utilized to evaluate insomnia symptoms. In addition, Brief-COPE was adopted to 
evaluate the coping mechanisms of the selected study participants.
RESULTS: Of 1,833 Ukrainian adults, 60.5% had symptoms of stress; 62.4% of them 
reported symptoms of anxiety; and 58.2% reported symptoms of depression. Symptom 
criteria for insomnia were found in about 21.8% of the study sample. The factors 
of sex, living area, area occupied by Russian forces, and having older adults 
and children in the house were statistically significant with symptoms of 
depression, anxiety, stress, and insomnia. The productive coping strategies of 
self-distraction, using instrumental support, planning, and behavioral 
disengagement, were observed as statistically significant with four 
psychological constructs.
CONCLUSION: The study outcomes highlight a substantial prevalence of symptoms 
related to depression, anxiety, stress, and insomnia attributed to the 
accumulated consequences of ongoing conflict and the COVID-19 outbreak. The 
aforementioned findings emphasize the imperative of providing healthcare 
services and facilitating effective coping strategies among Ukrainians amid the 
ongoing war.

Copyright © 2023 Khan and Altalbe.

DOI: 10.3389/fpubh.2023.1280423
PMCID: PMC10568327
PMID: 37841733 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


313. Front Public Health. 2023 Sep 28;11:1268253. doi: 10.3389/fpubh.2023.1268253. 
eCollection 2023.

Barriers and facilitators to mental health promotion for Mexican immigrants in 
the U.S. through the Ventanillas de Salud program.

González Casanova I(1), Martínez Rodriguez DL(2), Ortiz Brunel J(3), Rangel 
Gómez MG(4), de Groot M(5), Fernández A(6).

Author information:
(1)Department of Applied Health Science, School of Public Health, Indiana 
University Bloomington, Bloomington, IN, United States.
(2)Oaxaca Ministry of Health, Oaxaca, Oaxaca, Mexico.
(3)Department of Sciences of Human Movement, University Center for Health 
Sciences, Universidad de Guadalajara, Guadalajara, Guadalajara, Jalisco, Mexico.
(4)Comision de Salud Fronteriza Mexico-Estados Unidos, Tijuana, Baja California, 
Mexico.
(5)Division of Internal Medicine, Indiana University School of Medicine, 
Indianapolis, IN, United States.
(6)San Francisco General Hospital, University of California, San Francisco, San 
Francisco, CA, United States.

INTRODUCTION: Mental health promotion and screenings are recommended as part of 
standard preventive care. Mexican immigrants in the U.S. are at high risk for 
mental health illness especially after the COVID-19 pandemic, however access to 
mental health prevention for this population has been limited, which results in 
important implementation and equity gaps. The Ventanilla de Salud (VDS) program 
provides preventive services through Mexican consulates in the U.S.
OBJECTIVE: The objective of this study was to assess capability, opportunity, 
and motivation for promotores to implement mental health programming through the 
VDS, leveraging early experiences of ongoing mental health prevention efforts.
METHODS: This was a qualitative study using the Capability, Opportunity, and 
Motivation for Behavior Change model (COM-B). We conducted 9 focus groups with 
40 VDS promotores and 6 semi-structured interviews with program stakeholders. 
Data were analyzed using inductive and deductive coding.
RESULTS: We found high levels of interest from the leadership, partners, and 
promotores to provide mental health services through the VDS. Early 
implementation of a mental health strategy that included training sessions for 
promotores and mental health promotion, screenings and referrals for VDS users 
was ongoing. We identified facilitators and barriers that could affect 
capability, opportunity, and motivation to provide mental health services. 
Facilitators included promotores' extensive knowledge about the importance of 
mental health, promotores service mindset and commitment to provide services to 
VDS users, and general support from the VDS network and partners. Barriers 
included promotores' turnover, need for additional economic compensation, 
burnout, competing priorities, and lack of mental health professionals to 
provide clinical services or supervision. Additional investments are recommended 
to support promotores' well-being.
CONCLUSION: The main lesson learned from this study was that investing in VDS 
promotores' training, resources, and well-being is key to their capability, 
opportunity and motivation to provide mental health services for Mexican 
immigrants in the US. Results from this study can be applied to improve the 
ongoing VDS mental health strategy and increase its impact on the mental health 
of Mexican immigrants.

Copyright © 2023 González Casanova, Martínez Rodriguez, Ortiz Brunel, Rangel 
Gómez, de Groot, and Fernández.

DOI: 10.3389/fpubh.2023.1268253
PMCID: PMC10569420
PMID: 37841719 [Indexed for MEDLINE]

Conflict of interest statement: At the time of the study MR worked at the Border 
Health Commission and was responsible for overseeing the Ventanilla de Salud 
program. The remaining authors declare that the research was conducted in the 
absence of any commercial or financial relationships that could be construed as 
a potential conflict of interest. The author(s) declared that they were an 
editorial board member of Frontiers, at the time of submission. This had no 
impact on the peer review process and the final decision.


314. Int J Environ Res Public Health. 2023 Sep 29;20(19):6863. doi: 
10.3390/ijerph20196863.

Caring for People with Rare Diseases: A Systematic Review of the Challenges of, 
and Strategies for Dealing with, COVID-19.

Faccio E(1), Bottecchia M(1), Rocelli M(1).

Author information:
(1)Department of Philosophy, Sociology, Education and Applied Psychology, 
University of Padua, 35139 Padova, Italy.

The COVID-19 pandemic took a toll on everyone's lives, and patients with rare 
diseases (RDs) had to pay an even higher price. In this systematic review, we 
explored the impact of the COVID-19 pandemic on individuals with RDs from a 
psychological perspective. Using the Preferred Reporting Items for Systematic 
Reviews and Meta-Analyses (PRISMA) guidelines, we retrieved articles from the 
Google Scholar, Scopus, and PubMed databases focusing on 'COVID-19,' 
'psychology,' and 'rare diseases.' Seventeen primary articles were identified 
(mainly from continental Europe). The results revealed the psychological effects 
of the pandemic on rare disease patients, including increased anxiety, stress, 
and depressive moods. This review also highlighted the increased vulnerability 
and reduced quality of life of rare disease patients during the pandemic, as 
well as the importance of telecare and psychological support as critical 
interventions for improving their well-being. There is an urgent need for 
multidisciplinary research and stronger healthcare systems to meet the unique 
challenges of rare disease patients, who represent 3.5-5.9% of the global 
population.

DOI: 10.3390/ijerph20196863
PMCID: PMC10573057
PMID: 37835133 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


315. Int J Environ Res Public Health. 2023 Sep 29;20(19):6861. doi: 
10.3390/ijerph20196861.

Trajectories of Adjustment Disorder and Well-Being in Austria and Croatia during 
20 Months of the COVID-19 Pandemic.

Zrnić Novaković I(1), Streicher A(1), Ajduković D(2), Ajduković M(3), Kiralj 
Lacković J(2), Lotzin A(4)(5), Lueger-Schuster B(1).

Author information:
(1)Department of Clinical and Health Psychology, Faculty of Psychology, 
University of Vienna, 1010 Vienna, Austria.
(2)Department of Psychology, Faculty of Humanities and Social Sciences, 
University of Zagreb, 10000 Zagreb, Croatia.
(3)Department of Social Work, Faculty of Law, University of Zagreb, 10000 
Zagreb, Croatia.
(4)Department of Psychiatry and Psychotherapy, University Medical Center 
Hamburg-Eppendorf, 20246 Hamburg, Germany.
(5)Department of Psychology, MSH Medical School Hamburg, 20457 Hamburg, Germany.

The present study aimed to investigate the trajectories of adjustment disorder 
(AD) symptoms and well-being over 20 months of the COVID-19 pandemic in Austria 
and Croatia. Further objectives of this study were to examine whether 
sociodemographic characteristics and the symptoms of anxiety and depression 
could predict these trajectories. As part of the pan-European ESTSS ADJUST 
study, N = 1144 individuals were recruited using convenience sampling and 
assessed four times between June 2020 and January 2022 through an online survey. 
Latent growth curve modelling was applied to estimate the trajectories of AD 
symptoms and well-being. Over time, the prevalence of probable AD varied between 
9.8% and 15.1%. The symptoms of AD tended to increase, whereas well-being tended 
to decrease. According to the majority of the models tested, women, participants 
from Austria and those with lower income had higher initial AD symptoms, whereas 
older participants and those from Croatia had higher initial well-being. In all 
models and at all timepoints, anxiety and depression significantly predicted AD 
and well-being scores. Overall, our study points to several predictors of AD and 
well-being and indicates high variability in people's reactions to the pandemic. 
Psychosocial support for the general population is needed during pandemics and 
similar crises, with a special focus on vulnerable groups.

DOI: 10.3390/ijerph20196861
PMCID: PMC10572495
PMID: 37835131 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


316. Int J Environ Res Public Health. 2023 Sep 28;20(19):6855. doi: 
10.3390/ijerph20196855.

Gaming in Pandemic Times: An International Survey Assessing the Effects of 
COVID-19 Lockdowns on Young Video Gamers' Health.

DiFrancisco-Donoghue J(1), De Las Heras B(2), Li O(2), Middleton J(3), Jung 
MK(1).

Author information:
(1)Department of Osteopathic Medicine, New York Institute of Technology, College 
of Osteopathic Medicine (NYITCOM), Old Westbury, NY 11568, USA.
(2)School of Physical and Occupational Therapy, Faculty of Medicine, McGill 
University, Montreal, QC H3A 0G4, Canada.
(3)Indiana Institute of Technology, Fort Wayne, IN 46803, USA.

The onset of COVID-19 coincided with the peak growth of video game usage, with 
2.7 billion gamers in 2020. During the pandemic, gaming and streaming platforms 
offered an entertaining, social, and safe alternative to recreation during 
severe lockdowns and social isolations. This study aimed to examine the impact 
of the COVID-19 pandemic on health-related outcomes in self-proclaimed video 
gamers based on the type of lockdown experienced and to discuss the potential 
role of video games during times of preventive lockdown measures. This was a 
cross-sectional international survey constructed by two academic institutions, 
NYIT (NY, USA) and McGill University (Montreal, Canada), and Adamas Esports (BC, 
Canada). The survey consisted of questions including demographics, multiple 
choice, ratings, and Likert scales relating to the periods prior to and during 
the COVID-19 lockdowns. There were 897 respondents from North America (72.7%), 
Europe (10.9%), Asia (4.9%), and other countries (11.5%), with a mean age of 22 
years. Significant increases in game time were reported in casual and 
competitive gamers during the first months of the pandemic. The level of gaming, 
type of lockdown, and physical activity level prior to the pandemic were 
examined as potential moderating factors. Significant increases in sedentary 
behaviors (video game time and sitting time) were observed, while physical 
activity levels remained unchanged in most participants, regardless of the type 
of lockdown. Sleep time, but not sleep quality, increased, while mental health 
exhibited opposing effects, influenced by the type of lockdown and gaming 
competition levels. Video games, when played moderately, could offer a 
cost-effective, safe strategy to promote socialization and mental health and 
improve the overall well-being of the non-gaming and gaming population during 
pandemic times when strict lockdowns are in place.

DOI: 10.3390/ijerph20196855
PMCID: PMC10572799
PMID: 37835124 [Indexed for MEDLINE]

Conflict of interest statement: The co-author Jake Middleton was employed by 
Adamas Esports at the time of the study being conducted. Adamas Esports had no 
commercial or financial relationships that could be construed as a potential 
conflict of interest.


317. Int J Environ Res Public Health. 2023 Sep 23;20(19):6812. doi: 
10.3390/ijerph20196812.

Coping, Supports and Moral Injury: Spiritual Well-Being and Organizational 
Support Are Associated with Reduced Moral Injury in Canadian Healthcare 
Providers during the COVID-19 Pandemic.

D'Alessandro-Lowe AM(1)(2), Karram M(3), Ritchie K(3)(4), Brown A(3), Millman 
H(3), Sullo E(3), Xue Y(3)(5), Pichtikova M(3)(6), Schielke H(7), Malain A(7), 
O'Connor C(7), Lanius R(2)(8), McCabe RE(3)(9), McKinnon MC(2)(3)(9).

Author information:
(1)Department of Psychology Neuroscience and Behaviour, McMaster University, 
Hamilton, ON L8S 4L6, Canada.
(2)Homewood Research Institute, Guelph, ON N13 6K9, Canada.
(3)Department of Psychiatry and Behavioural Neurosciences, McMaster University, 
Hamilton, ON L9C 0E3, Canada.
(4)Trent/Fleming School of Nursing, Trent University, Peterborough, ON K9L 0G2, 
Canada.
(5)Temetry Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, 
Canada.
(6)Department of Applied Psychology and Human Development, University of 
Toronto, Toronto, ON M5S 1V6, Canada.
(7)Homewood Health Centre, Guelph, ON NIE 6K9, Canada.
(8)Lawson Health Research Institute, University of Western Ontario, London, ON 
N6C 2R5, Canada.
(9)St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada.

Healthcare providers (HCPs) have described the onset of shame- and 
trust-violation-related moral injuries (MI) throughout the COVID-19 pandemic. 
Previous research suggests that HCPs may turn to various coping methods and 
supports, such as spirituality/religiosity, substance use, friends/family or 
organizational support, to manage workplace stress. It remains unknown, however, 
if similar coping methods and supports are associated with MI among this 
population. We explored associations between MI (including the shame and 
trust-violation presentations individually) and coping methods and supports. 
Canadian HCPs completed an online survey about their mental health and 
experiences during the COVID-19 pandemic, including demographic indices (e.g., 
sex, age, mental health history) and measures of MI, organizational support, 
social support, spiritual well-being, self-compassion, alcohol use, cannabis use 
and childhood adversity. Three hierarchical multiple linear regressions were 
conducted to assess the associations between coping methods/supports and (i) MI, 
(ii) shame-related MI and (iii) trust-violation-related MI, when controlling for 
age, mental health history and childhood adversity. One hundred and seventy-six 
(N = 176) HCPs were included in the data analysis. Spiritual well-being and 
organizational support were each significantly associated with reduced total MI 
(p's < 0.001), shame-related MI (p = 0.03 and p = 0.02, respectively) and 
trust-violation-related MI (p's < 0.001). Notably, comparison of the 
standardized beta coefficients suggests that the association between 
trust-violation-related MI and both spiritual well-being and organizational 
support was more than twice as great as the associations between these variables 
and shame-related MI, emphasizing the importance of these supports and the 
trust-violation outcomes particularly. Mental health history (p = 0.02) and 
self-compassion (p = 0.01) were additionally related to shame-related MI only. 
Our findings indicate that heightened levels of spiritual well-being and 
organizational support were associated with reduced MI among HCPs during the 
COVID-19 pandemic. Rather than placing sole responsibility for mental health 
outcomes on HCPs individually, organizations can instead play a significant role 
in mitigating MI among staff by implementing evidence-informed organizational 
policies and interventions and by considering how supports for spiritual 
well-being may be implemented into existing models of care where relevant for 
employees.

DOI: 10.3390/ijerph20196812
PMCID: PMC10572244
PMID: 37835082 [Indexed for MEDLINE]

Conflict of interest statement: Authors H.S., C.O. and A.M. were employed by 
Homewood Health Centre. The remaining authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


318. Medicine (Baltimore). 2023 Oct 13;102(41):e35521. doi: 
10.1097/MD.0000000000035521.

A standardized Ashwagandha root extract alleviates stress, anxiety, and improves 
quality of life in healthy adults by modulating stress hormones: Results from a 
randomized, double-blind, placebo-controlled study.

Majeed M(1)(2), Nagabhushanam K(2), Mundkur L(1).

Author information:
(1)Sami-Sabinsa Group Limited, Peenya Industrial Area, Bangalore, Karnataka, 
India.
(2)Sabinsa Corporation, East Windsor, NJ, USA.

BACKGROUND: The coronavirus disease-2019 (COVID-19) pandemic has resulted in a 
surge in stress, anxiety, and depression worldwide. Ashwagandha, an ayurvedic 
adaptogen has been traditionally used to manage stress, anxiety, and general 
well-being.
OBJECTIVE: We assessed the effect of Ashwagandha root extract (ARE-500 mg) 
standardized for 2.5% withanolides as per USP protocol with piperine (5 mg of 
95% piperine) once daily for 60 days (12.5 mg withanolides/day) to alleviate 
stress and anxiety in healthy individuals with mild to moderate symptoms.
METHODS: A randomized, double-blind, placebo-controlled study was conducted for 
60 days using ARE (n = 27) and placebo (n = 27) once daily at night at Narayana 
Institute of Cardiac Sciences, Bangalore, and Vijaya Super Specialty Hospital, 
Nellore, in India. The objectives of this study were to assess an improvement in 
perceived stress scale (PSS), generalized anxiety disorder (GAD-7), quality of 
life (QOL), cognitive scores in the Cambridge Neuropsychological Test Automated 
Battery (CANTAB), changes in salivary cortisol, urinary serotonin, dopamine, 
serum levels of nitric oxide (NO), glutathione (GSH) and malondialdehyde (MDA) 
from baseline to end of the study. Safety was evaluated by laboratory 
parameters, and by monitoring any incidence of adverse events.
RESULTS: 54 individuals were randomized and 50 of them completed the study. The 
PSS, GAD-7, and QOL scores improved significantly in all the participants taking 
ARE compared to the placebo. The CANTAB analysis revealed a significant 
improvement in multitasking, concentration, and decision taking time in ARE 
compared to placebo. ARE was also associated with a greater reduction in the 
morning salivary cortisol and an increase in urinary serotonin compared to 
placebo. Serum levels of NO, GSH, and MDA were not significantly different. 
Biochemical and hematological parameters remained in the normal range in all 
participants and ARE was well tolerated during the study.
CONCLUSION: The results of the study suggest that ARE with 2.5% withanolides can 
effectively improve stress and anxiety by reducing cortisol and increasing 
serotonin in healthy individuals with mild to moderate symptoms.

Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

DOI: 10.1097/MD.0000000000035521
PMCID: PMC10578737
PMID: 37832082 [Indexed for MEDLINE]

Conflict of interest statement: MM, KN, and LM are employees of Sami-Sabinsa 
group limited or Sabinsa Corporation. All the authors have seen and agreed with 
the contents of the manuscript.


319. Medicine (Baltimore). 2023 Oct 13;102(41):e34885. doi: 
10.1097/MD.0000000000034885.

Experiences of adults with opioid-treated chronic low back pain during the 
COVID-19 pandemic: A cross-sectional survey study.

Zgierska AE(1), Burzinski CA(2), Garland EL(3), Barrett B(2), Lennon RP(4), 
Brown RL(5), Schiefelbein AR(5), Nakamura Y(6), Stahlman B(7), Jamison RN(8), 
Edwards RR(8).

Author information:
(1)Departments of Family and Community Medicine, Public Health Sciences, and 
Anesthesiology and Perioperative Medicine, Pennsylvania State University College 
of Medicine, Hershey, PA.
(2)University of Wisconsin-Madison, School of Medicine and Public Health, 
Department of Family Medicine and Community Health, Madison, WI.
(3)University of Utah, College of Social Work, Salt Lake City, UT.
(4)Department of Family and Community Medicine, and Law School, Pennsylvania 
State University College of Medicine, Hershey, PA.
(5)University of Wisconsin-Madison, School of Nursing, Madison, WI.
(6)Department of Anesthesiology, Division of Pain Medicine, Pain Research 
Center, University of Utah School of Medicine, Salt Lake City, UT.
(7)Department of Family and Community Medicine, Pennsylvania State University 
College of Medicine, Hershey, PA.
(8)Departments of Anesthesiology, Perioperative and Pain Medicine and 
Psychiatry, Harvard Medical School, Brigham and Women's Hospital, Chestnut Hill, 
MA.

This study aimed to evaluate the impact of the COVID-19 pandemic on adults with 
opioid-treated chronic low back pain (CLBP), an understudied area. Participants 
in a "parent" clinical trial of non-pharmacologic treatments for CLBP were 
invited to complete a one-time survey on the perceived pandemic impact across 
several CLBP- and opioid therapy-related domains. Participant clinical and other 
characteristics were derived from the parent study's data. Descriptive 
statistics and latent class analysis analyzed quantitative data; qualitative 
thematic analysis was applied to qualitative data. The survey was completed by 
480 respondents from June 2020 to August 2021. The majority reported a negative 
pandemic impact on their life (84.8%), with worsened enjoyment of life (74.6%), 
mental health (74.4%), pain (53.8%), pain-coping skills (49.7%), and finances 
(45.3%). One-fifth (19.4%) of respondents noted increased use of prescribed 
opioids; at the same time, decreased access to medication and overall healthcare 
was reported by 11.3% and 61.6% of respondents, respectively. Latent class 
analysis of the COVID-19 survey responses revealed 2 patterns of 
pandemic-related impact; those with worse pandemic-associated harms (n = 106) 
had an overall worse health profile compared to those with a lesser pandemic 
impact. The pandemic substantially affected all domains of relevant 
health-related outcomes as well as healthcare access, general wellbeing, and 
financial stability among adults with opioid-treated CLBP. A more nuanced 
evaluation revealed a heterogeneity of experiences, underscoring the need for 
both increased overall support for this population and for an individualized 
approach to mitigate harms induced by pandemic or similar crises.

Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

DOI: 10.1097/MD.0000000000034885
PMCID: PMC10578753
PMID: 37832078 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
disclose.


320. Arch Environ Occup Health. 2023;78(6):321-328. doi: 
10.1080/19338244.2023.2268506. Epub 2023 Nov 2.

The impact of the COVID-19 pandemic on professional life and well-being in 
German physicians: A cross-sectional study.

Voltmer E(1), Köslich-Strumann S(1), Goetz K(2).

Author information:
(1)Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, 
Germany.
(2)Institute of Family Medicine, University Medical Centre Schleswig-Holstein, 
Lübeck, Germany.

This study assessed perceptions of German physicians' regarding the impact of 
the COVID-19 pandemic on work-related issues as well as mental and physical 
health. Almost three quarters of the physicians felt stressed by the increased 
quantity (69%) and quality (73%) of the work and felt physically (68%) or 
mentally exhausted (71%). Also about three-quarters of physicians reported the 
pandemic having a strong impact on family life. A higher proportion feared to 
infect their family more than being infected themselves (66% vs 50%). Mental 
health scores were significantly lower in physicians compared to the general 
population. In female physicians, these findings were even more pronounced. 
Stressful work conditions and feelings of isolation were the most important 
predictors for mental health scores (R2 = 0.37), and also for motivation to work 
(R2 = 0.20). Preventive measures to strengthen resilience and optimize work 
organization are warranted to alleviate the toll of the pandemic on physicians.

DOI: 10.1080/19338244.2023.2268506
PMID: 37830498 [Indexed for MEDLINE]


321. Front Public Health. 2023 Sep 27;11:1235903. doi: 10.3389/fpubh.2023.1235903. 
eCollection 2023.

Mental health and life satisfaction among those advised to shield during the 
COVID-19 pandemic in the UK: a secondary analysis of the Understanding Society 
longitudinal study.

Morris SG(1)(2), Kudrna L(1), Martin J(1).

Author information:
(1)Institute of Applied Health Research, University of Birmingham, Birmingham, 
United Kingdom.
(2)Public Health Specialty Training Programme, NHS England - West Midlands, 
Birmingham, United Kingdom.

INTRODUCTION: During the COVID-19 pandemic in the UK, those considered most 
vulnerable to adverse outcomes from infection were designated "clinically 
extremely vulnerable" and advised to "shield." This involved prolonged 
confinement at home with strict limits on face-to-face contact, beyond national 
restrictions. Shielding ended in September 2021 and was considered likely to 
have harmed mental health and wellbeing. As the UK moved toward a new phase of 
"living with COVID-19" the mental health and wellbeing experiences of those 
advised to shield may have diverged from the general population.
METHODS: This study is a secondary analysis of nine "COVID-19 Survey" waves of 
Understanding Society, a longitudinal study of UK participants covering April 
2020 to September 2021 alongside pre-pandemic baseline data. The prevalence of 
clinically significant psychological distress (General Health Questionnaire 12) 
and low life satisfaction were examined at each wave for participants with 
longitudinal responses across all waves, stratified by receipt of shielding 
guidance (Received n = 410, Not received n = 6,878). Mixed effects regression 
modeling examined associations between shielding guidance receipt and mental 
health and life satisfaction when adjusting for potential confounders including 
age and sex, pre-pandemic mental health/life satisfaction, and loneliness.
RESULTS: Those who received shielding guidance were more likely to experience 
poor mental health and low life satisfaction during the pandemic. However, this 
largely reflected differences in pre-pandemic baselines. Variation between waves 
broadly coincided with the changing burden of COVID-19 and associated 
restrictions, with similar patterns regardless of shielding guidance receipt. 
Regression modeling combining data across all waves indicated that receipt of 
shielding guidance did not independently predict adverse outcomes. However, poor 
pre-pandemic mental health and low life satisfaction, and frequent loneliness, 
as well as demographic factors including sex and age, consistently predicted 
adverse pandemic mental health and wellbeing.
DISCUSSION: While those who received shielding guidance did on average 
experience poorer mental health and life satisfaction during the pandemic, this 
study suggests this largely reflects existing inequalities. Drawing on data 
throughout the shielding program, it addresses an existing evidence gap. These 
findings reinforce the importance of addressing existing mental health 
inequalities in the recovery from the current pandemic and for future 
preparedness.

Copyright © 2023 Morris, Kudrna and Martin.

DOI: 10.3389/fpubh.2023.1235903
PMCID: PMC10566375
PMID: 37829093 [Indexed for MEDLINE]

Conflict of interest statement: This study was undertaken as a Masters 
dissertation level by SM. This Masters programme was funded by their employer 
but did not influence the undertaking of this study. The remaining authors 
declare that the research was conducted in the absence of any commercial or 
financial relationships that could be construed as a potential conflict of 
interest.


322. Trials. 2023 Oct 12;24(1):662. doi: 10.1186/s13063-023-07645-x.

Effect of music breathing, a program based on mindful breathing and music 
listening therapy for promoting sense of coherence in young people: study 
protocol for a randomized controlled trial.

Cheng WL(1), Tang AC(2), Tsang MC(3), Wong LL(4), Körlin D(5).

Author information:
(1)School of Health Sciences, Caritas Institute of Higher Education, Hong Kong 
SAR, China. wcheng@cihe.edu.hk.
(2)School of Nursing, Tung Wah College, Hong Kong SAR, China.
(3)School of Arts and Humanities, Tung Wah College, Hong Kong SAR, China.
(4)School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong 
Kong SAR, China.
(5)IMAGEing: European GIM Trainings, Stockholm, Sweden.

BACKGROUND: The negative impacts of the COVID-19 pandemic on public health have 
affected people socially, psychologically, and physically. Young people 
particularly are having to adjust many aspects of their personal lives: 
including transitions to work, college, and independent living. Personal 
resources are important in mitigating stress and improve mental well-being 
during pandemic. Sense of coherence-an orientation to life-could be considered 
as a personal resource. Currently, a number of interventions have been developed 
to target the reduction of stress in young people. Little emphasis has been 
placed on developing sense of coherence to reduce stress and promote mental 
well-being among young people. Young people consider music as a preferred 
leisure activity and an important means of stress relief in their daily lives. 
However, little research concerning music therapy and sense of coherence exists.
METHODS: In the proposed randomized controlled trial, a sample of 290 young 
people (aged 18-30) will be recruited and allocated randomly into one of two 
groups: the experimental group and the control group. Participants in the 
experimental group will participate in a 6-week Music Breathing program that 
will include music listening and mindful breathing guided by a certified music 
therapist. Participants in the control group will receive a control condition 
for 6 weeks Mental Health Education Programme. The primary outcome of the study 
will be measured using Sense of Coherence Scale. The secondary outcomes will be 
measured using the Coping Self-Efficacy Scale, Difficulties in Emotion 
Regulation Scale, Mindful Attention Awareness Scale, Depression Anxiety Stress 
Scales, BBC Subjective Well-being scale, and salivary cortisol levels. Repeated 
measures analysis will be used to compare the outcomes between the two groups.
DISCUSSION: The results will inform practice in coping with stress through 
promoting sense of coherence. Individuals will benefit from the long-term effect 
of this intervention to enhance their sense of coherence to cope with stressful 
events and promote better mental well-being.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05655234. Registered on 
December 8, 2022.

© 2023. BioMed Central Ltd., part of Springer Nature.

DOI: 10.1186/s13063-023-07645-x
PMCID: PMC10568868
PMID: 37828487 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


323. Nurs Educ Perspect. 2024 Jan-Feb 01;45(1):E2-E7. doi: 
10.1097/01.NEP.0000000000001197.

Through the Lens of the Social Determinants of Learning™: Experiences of Online 
Prenursing Students During the COVID-19 Pandemic.

Jennings LA(1), Urban RW.

Author information:
(1)About the Authors Leslie A. Jennings, MSN/Ed, RN, CNE, is a clinical 
assistant professor and PhD candidate, The University of Texas at Arlington 
College of Nursing and Health Innovation, Arlington, Texas. Regina W. Urban, 
PhD, RN, NPD-BC, CNE, MA-LPC, is an assistant professor, The University of Texas 
at Arlington College of Nursing and Health Innovation. An internal Nursing 
Education Research Grant of $5,000.00 was given to the study team (L. A. J. and 
R. W. U.) to conduct this research project by the College of Nursing and Health 
Innovation at the University of Texas at Arlington. Ms. Jennings is grateful to 
her dissertation committee members, Dr. Regina Urban, Dr. Daisha Cipher, and Dr. 
Kathy Daniel, for their support and guidance. For more information, contact her 
at lesliej@uta.edu .

BACKGROUND: Prenursing students represent the future pipeline of nursing 
students, yet their perceptions of how COVID-19 affected their experience as 
prenursing students are unknown.
METHOD: Short-answer data ( n = 289) in US prenursing students were collected in 
fall 2020. Deductive thematic analysis was applied according to the social 
determinants of learning (SDOL™) framework.
RESULTS: Participants verbalized fears of contracting COVID-19 (physical health) 
and difficulties with stress and anxiety (psychosocial health). Participants 
shared pandemic-related financial challenges (economic instability), changes in 
living situations (physical environment), and the lack of hoped-for social 
connections (social environment). Many struggled with focus; others confirmed 
their goals (self-motivation).
CONCLUSION: The SDOL framework can be utilized by educators to conceptualize the 
influence of the COVID-19 pandemic on the experiences of online prenursing 
students and leveraged to develop targeted interventions to improve students' 
well-being as they apply to nursing programs.

Copyright © 2023 National League for Nursing.

DOI: 10.1097/01.NEP.0000000000001197
PMID: 37824421 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


324. Am J Orthopsychiatry. 2024;94(1):89-98. doi: 10.1037/ort0000707. Epub 2023 Oct 
12.

Effects of the COVID-19 pandemic on stress, coping, and well-being among adults 
with histories of child maltreatment.

Fedina L(1), Roberto KA(2), Zhang X(1), Chang Y(1), Love J(1), Herrenkohl TI(1).

Author information:
(1)School of Social Work, University of Michigan.
(2)Virginia Tech Center for Gerontology, College of Liberal Arts and Human 
Sciences, Virginia Tech.

A number of studies now confirm that the COVID-19 pandemic has increased and 
exacerbated mental health problems in the general population. Previous 
quantitative studies have found similar effects on mental health symptoms among 
adults with histories of childhood adversity; however, qualitative research is 
needed to provide a more in-depth understanding of pandemic-related experiences 
among this vulnerable population. Using semistructured qualitative interviews, 
we explored perceptions of adults with histories of child maltreatment and 
neglect to better understand the overall impact of the pandemic on their mental 
health, reported changes in stress and alcohol use, and reported coping 
strategies during the first year of the pandemic (N = 40). Approximately half of 
participants reported that the pandemic had greatly (negatively) impacted their 
life, relationships, and well-being. Contributing stressors included being 
fearful of getting sick, navigating work changes, and experiencing economic and 
housing hardships, grief and loss, and social isolation. Fewer than half of the 
sample reported more stress (46%), whereas a third (33%) indicated no changes to 
stress, and 10% had reduced stress. The majority (80%) indicated no changes in 
their alcohol use. Most participants reported they used positive coping 
strategies during the pandemic. Three primary themes emerged related to 
participants' perceptions of getting through difficult times: seeking outside 
support, engaging in positive reframing, and drawing on internal strength and 
resources. Findings can guide prevention strategies that strengthen social 
support and foster resilience among vulnerable populations of adults with 
histories of childhood maltreatment. (PsycInfo Database Record (c) 2024 APA, all 
rights reserved).

DOI: 10.1037/ort0000707
PMCID: PMC10922049
PMID: 37824239 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None


325. BMC Health Serv Res. 2023 Oct 11;23(1):1088. doi: 10.1186/s12913-023-10091-9.

Swept under the carpet: a qualitative study of patient perspectives on Long 
COVID, treatments, services, and mental health.

Hawke LD(1)(2), Nguyen ATP(3), Sheikhan NY(4)(3), Strudwick G(4)(3), Rossell 
SL(5), Soklaridis S(4)(3), Kloiber S(4)(3), Shields R(3), Ski CF(6), Thompson 
DR(6), Castle D(7)(8).

Author information:
(1)University of Toronto, Toronto, ON, Canada. lisa.hawke@camh.ca.
(2)Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, 
Canada. lisa.hawke@camh.ca.
(3)Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, 
Canada.
(4)University of Toronto, Toronto, ON, Canada.
(5)Centre for Mental Health, Swinburne University of Technology, Melbourne, 
Australia.
(6)School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.
(7)University of Tasmania, Hobart, Australia.
(8)Tasmanian Centre for Mental Health Service Innovation, Hobart, Australia.

BACKGROUND: A constellation of often disabling long-term physical symptoms 
enduring after an acute SARS-COV-2 infection is commonly referred to as Long 
COVID. Since Long COVID is a new clinical entity, research is required to 
clarify treatment needs and experiences of individuals affected. This 
qualitative descriptive study aimed to provide insight into Long COVID treatment 
and service experiences and preferences of individuals experiencing Long COVID 
and the intersections with mental health.
METHODS: The study was conducted out of a tertiary care mental health hospital, 
with online recruitment from the community across Canada. A total of 47 
individuals (average age = 44.9) participated in one of 11 focus groups between 
June and December 2022. Five focus groups were conducted with participants who 
had pre-existing mental health concerns prior to contracting SARS-CoV-2, and six 
were with people with Long COVID but without pre-existing mental health 
concerns. A semi-structured interview guide asked about service experiences and 
service preferences, including mental health and well-being services. 
Discussions were recorded, transcribed, and analyzed using codebook thematic 
analysis.
RESULTS: When accessing services for Long COVID, patients experienced: (1) 
systemic barriers to accessing care, and (2) challenges navigating the unknowns 
of Long COVID, leading to (3) negative impacts on patient emotional well-being 
and recovery. Participants called for improvements in Long COVID care, with a 
focus on: (1) developing Long COVID-specific knowledge and services, (2) 
enhancing support for financial well-being, daily living, and building a Long 
COVID community, and (3) improving awareness and the public representation of 
Long COVID.
CONCLUSIONS: Substantial treatment barriers generate considerable burden for 
individuals living with Long COVID. There is a pressing need to improve 
treatment, social supports, and the social representation of Long COVID to 
create integrated, accessible, responsive, and ongoing support systems.

© 2023. BioMed Central Ltd., part of Springer Nature.

DOI: 10.1186/s12913-023-10091-9
PMCID: PMC10568931
PMID: 37821939 [Indexed for MEDLINE]

Conflict of interest statement: SLR holds a Senior National Health and Medical 
Research Council (NHMRC) Fellowship (GNT1154651) in Australia. SK reports grants 
from the Labatt Family Innovation Fund in Brain Health (Department of 
Psychiatry, University of Toronto), the Max Bell Foundation, the Canadian Centre 
on Substance Use and Addiction, the Ontario Ministry of Health and Long-Term 
Care (MOHLTC), the Canadian Institutes of Health Research (CIHR). David Castle 
has received grant monies for research from Servier, Boehringer Ingelheim; 
Travel Support and Honoraria for Talks and Consultancy from Servier, Seqirus, 
Lundbeck. He is a founder of the Optimal Health Program (OHP), and holds 50% of 
the IP for OHP; and is part owner of Clarity Healthcare. He does not knowingly 
have stocks or shares in any pharmaceutical company. Other authors have no 
conflict of interest to declare.


326. JMIR Public Health Surveill. 2023 Oct 11;9:e47239. doi: 10.2196/47239.

Structural Equation Model for Social Support and Quality of Life Among 
Individuals With Mental Health Disorders During the COVID-19 Pandemic.

Tran BX(#)(1)(2), Dam VAT(#)(1), Auquier P(2), Boyer L(2), Fond G(2), Nguyen 
HM(3), Nguyen HT(4), Le HT(1), Tran HNT(5), Vu GT(6), Nguyen MD(1), Nguyen 
DAT(1), Ly BV(1), Latkin CA(7), Zhang MW(8), Ho RC(9)(10), Ho CS(9).

Author information:
(1)Institute for Preventive Medicine and Public Health, Hanoi Medical 
University, Hanoi, Vietnam.
(2)CEReSS, Research Centre on Health Services and Quality of Life, Aix Marseille 
University, Marseille, France.
(3)Mai Huong Daycare Psychiatric Hospital, Hanoi, Vietnam.
(4)National Psychiatric Hospital No 1, Hanoi, Vietnam.
(5)Hanoi Department of Health, Hanoi, Vietnam.
(6)School of Psychology, The University of Queensland, Brisbane, Australia.
(7)Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 
United States.
(8)Lee Kong Chian School of Medicine, Nanyang Technological University 
Singapore, Singapore, Singapore.
(9)Department of Psychological Medicine, Yong Loo Lin School of Medicine, 
National University of Singapore, Singapore, Singapore.
(10)Institute for Health Innovation and Technology, National University of 
Singapore, Singapore, Singapore.
(#)Contributed equally

BACKGROUND: In light of the COVID-19 pandemic, the distribution of social 
support for mental health problems has likely become unequal. Family- and 
community-based social support has been recognized as a promising approach for 
mental disorders; however, limited global frameworks have been applied to 
developing countries such as Vietnam.
OBJECTIVE: The aim of this study was to evaluate the quality of life and social 
support among patients with mental health disorders in Vietnam and to 
investigate the factors associated with quality of life among these patients.
METHODS: A cross-sectional study was conducted on 222 psychiatric patients in 
Hanoi from 2020 to 2022. A structured questionnaire was developed based on four 
standardized scales: Mental Well-Being-5 scale, Multidimensional Scale of 
Perceived Social Support, EuroQoL-visual analog scale (EQ-VAS), and EuroQoL-5 
dimensions-5 levels (EQ-5D-5L) scale. Tobit regression was used to identify 
factors associated with the EQ-5D-5L and EQ-VAS scores. Structural equation 
modeling was applied to verify the relationship between quality of life and 
social support.
RESULTS: The results showed that perceived support from family scored the 
highest compared to support from friends and significant others. Patients with 
depression reported the lowest quality of life and perceived social support. 
Structural equation modeling showed a root mean square error of approximation of 
0.055 (90% CI 0.006-0.090), comparative fit index of 0.954, Tucker-Lewis index 
of 0.892, and standardized root mean squared error of 0.036 (P<.001). The 
hypothetical model indicated statistically significant correlations between 
EQ-VAS score and social support (P=.004), EQ-5D-5L and mental well-being 
(P<.001), and social support and mental well-being (P<.001). Critical 
deterioration of quality of life and inconsistency in social support for 
patients with mental illness were also recorded.
CONCLUSIONS: There is a need to enhance social support and service delivery in 
Vietnam, focusing on occupation and quality of life. The correlations between 
social support, quality of life, and mental health issues suggest the potential 
of a clinical-social integrated intervention model of care.

©Bach Xuan Tran, Vu Anh Trong Dam, Pascal Auquier, Laurent Boyer, Guillaume 
Fond, Hung Manh Nguyen, Hung Tuan Nguyen, Huong Thi Le, Ha Nhi Thi Tran, Giang 
Thu Vu, Manh Duc Nguyen, Duong Anh Thi Nguyen, Bang Viet Ly, Carl A Latkin, 
Melvyn WB Zhang, Roger CM Ho, Cyrus SH Ho. Originally published in JMIR Public 
Health and Surveillance (https://publichealth.jmir.org), 11.10.2023.

DOI: 10.2196/47239
PMCID: PMC10600649
PMID: 37819706 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


327. J Pediatr Psychol. 2024 Jan 19;49(1):27-34. doi: 10.1093/jpepsy/jsad071.

Student-Athletes' Deteriorating Mental Health During COVID-19: Recommendations 
on Proactive Strategies for Addressing Unique Mental Health Needs.

Cheng M(1), van Niekerk M(1), Biviano G(2).

Author information:
(1)Stanford School of Medicine, Stanford University, USA.
(2)UCSF PlaySafe Sports Medicine Program, University of California San 
Francisco, USA.

High school and college student-athletes face unique stressors that can 
negatively impact their mental health, which were exacerbated by the COVID-19 
pandemic. Although mental health issues are prevalent in athletic communities, 
there often remains stigma around mental health and reluctance to seek 
psychological support. Physical injury can be the cause or the result of the 
psychological struggles that athletes face-holistic care for the adolescent 
athlete population must incorporate both elements. Pediatric psychologists, 
allied healthcare professionals, sports organizations, academic institutions, 
coaches, caregivers, and student-athletes themselves all play an active role in 
shaping the mental health of student-athletes and are therefore responsible for 
creating a culture that prioritizes mental and physical wellness. This paper 
aims to provide clear recommendations for the various stakeholders on how to 
address the unique mental health needs of student-athletes. The recommendations 
presented are based on a review of existing literature in the field and 
on-the-ground experience working with student-athletes during the COVID-19 
pandemic. There are several key interventions highlighted in this paper, 
including changing the athletic community's culture to prioritize the holistic 
well-being of athletes, as well as proactively offering mental health education, 
resources, and programming for student-athletes, with a particular emphasis on 
health equity to meet the needs of students most at risk. Commitment from 
pediatric psychologists and allied healthcare professionals, sports 
organizations, academic institutions, coaches, caregivers, and student-athletes 
will maximize the likelihood of improving student-athletes' psychological 
well-being.

© The Author(s) 2023. Published by Oxford University Press on behalf of the 
Society of Pediatric Psychology. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/jpepsy/jsad071
PMID: 37816146 [Indexed for MEDLINE]


328. Disasters. 2024 Apr;48(2):e12614. doi: 10.1111/disa.12614. Epub 2023 Nov 27.

Investigating the conditions of vulnerability experienced by migrant workers 
during the COVID-19 pandemic in Kerala, India.

McGowran P(1)(2), Mathews MA(3), Johns H(1), Harasym MC(3), Raju E(4)(5)(6), 
Ayeb-Karlsson S(7)(8).

Author information:
(1)PhD is Senior Research Associate, United Nations University Institute for 
Environment and Human Security, Germany.
(2)Lecturer in Development Geography, School of Law and Social Sciences, Oxford 
Brookes University, United Kingdom.
(3)Research Assistant, United Nations University Institute for Environment and 
Human Security, Germany.
(4)Associate Professor, Global Health Section, University of Copenhagen, 
Denmark.
(5)Director, Copenhagen Center for Disaster Research, Denmark.
(6)Visiting Associate Professor, African Centre for Disaster Studies, North-West 
University, South Africa.
(7)PhD is Associate Professor, Institute for Risk and Disaster Reduction, 
University College London, United Kingdom.
(8)Senior Researcher, United Nations University Institute for Environment and 
Human Security, United Kingdom.

This paper analyses findings of the 'PROWELLMIGRANTS'2 project, which 
qualitatively investigated COVID-19 impacts on migrants' well-being and mental 
health in Kerala, India. It draws on a novel conceptual framework that combines 
assemblage-thinking with theories of social contracts in disasters. The paper 
first explores how past development processes and contemporary migration 
policies in Kerala, and India more widely, generated conditions of vulnerability 
for migrant workers in Kerala prior to the pandemic. Next it shows that 
Government of Kerala interventions, in some cases supported by the central 
Government of India, temporarily addressed these vulnerabilities during the 
pandemic. In acknowledging the helpful response of the Kerala government, we 
problematise its stance on migrant workers during 'normal' times and speculate 
that permanently addressing these conditions of vulnerability would be a more 
logical approach. We acknowledge this involves overcoming many wider barriers. 
Thus, the paper also contains national-level policy implications.

Publisher: هذه المقالة تحلل نتائج بحث مشروع سلامة المهاجرين وحمايتهم التي تتفقد 
نوعيًّا تأثير كوفيد-19 على سلامة المهاجرين في كيرلا بالهند وكذلك صحتهم 
العقليَّة؛ حيث تستخلص من إطار مفاهيمي جديد يجمع بين التجمهر والنظريَّات في 
الكوارث، باستكشافها أوَّلاً كيف أدَّت العمليَّات السَّابقة وسياسات الهجرة 
الحالية في كيرلا، والهند على نطاق أوسع إلى خلق ظروف ضعف بالنِّسبة للعمال 
المهاجرين في كيرلا قبل تفشي الجائحة. لذا، نستعرض تدخلات حكومة كيرلا في بعض 
الحالات التي تدعِّمها الحكومة المركزية بدولة الهند، والتي تعالج بصورة مؤقَّتة 
هذه الثغرات أثناء فترات تفشي الجائحة، وينبغي الإشادة بهذه الجهود. ومع أننا نقدر 
استجابة حكومة كيرلا المفيدة، تطرح إشكالية أخرى بشأن وضع المهاجرين العمال في 
الفترات «الطبيعيَّة» فيرى دائمًا بأن معالجة ظروف الضَّعف التي يمرون بها سيصبح 
نهجًا أكثر منطقيَّة؛ حيث نسلم بحقيقة الأمر أنه يستلزم إزالة الكثير من العوائق 
التي تتجذر في تجاوزات الولاية القضائية لحكومة كيرلا الهنديَّة. ولهذا، يسلط بحثنا 
الضوء أيضًا على النتائج المترتبة على السياسات التي تمارسها الهند على المستوى 
المحلي. الكلمات الافتتاحية: كوفيد-19: الهند، والهجرة، والتحركات، والضعف.

Publisher: 
本文分析了PROWELLMIGRANTS的項目研究成果，該項目定性調查了新冠肺炎（COVID-19）對印度喀拉拉邦移民福祉和心理健康的影響。它借鑒了一個新穎的概念框架，將組合思維與災害中的社會契約理論相結合。文章首先探討了在疫情之前，在喀拉拉邦以及更廣泛的印度中，過去的發展進程和當代移民政策是如何為喀拉拉邦的移工產生了弱勢條件。我們隨後證明了，喀拉拉邦政府的干預措施（在某些情況下獲得印度中央政府的支持）在疫情時期暫時解決了這些漏洞。這些努力值得被嘉獎。然而，在感謝喀拉拉邦政府的有益回應的同時，我們質疑他們在“正常”時期對移工的立場，並推測永久解決這些弱勢條件的方式將會是一個更合乎邏輯的方法。我們承認這需要克服許多障礙，而這些障礙的根源遠在喀拉拉邦政府的管轄範圍之外。因此，本文也包含了對印度國家層級的政策影響。 
關鍵詞：新冠肺炎（COVID-19）、印度、移民、流動性、弱勢.

© 2023 The Authors. Disasters published by John Wiley & Sons Ltd on behalf of 
ODI.

DOI: 10.1111/disa.12614
PMID: 37811865 [Indexed for MEDLINE]


329. Riv Psichiatr. 2023 Sep-Oct;58(5):220-225. doi: 10.1708/4113.41071.

[Psychological distress during the Covid-19 pandemic: an analysis of 
antipsychotic drug usage patterns in a sample of Italian residents.].

[Article in Italian]

Ferrara F(1), Trama U(2), Nava E(1), Langella R(3), Valentino F(4), Zovi A(5).

Author information:
(1)Dipartimento Farmaceutico, Asl Napoli 3 Sud, Nola (Napoli).
(2)Direzione Generale per la Tutela della Salute e il Coordinamento del Sistema 
Sanitario Regionale, Napoli.
(3)Società Italiana di Farmacia Ospedaliera (SIFO), Segreteria SIFO della 
Regione Lombardia.
(4)Università di Milano.
(5)Ministero della Salute, Roma.

INTRODUCTION: The ongoing pandemic has not only placed significant strain on 
healthcare systems and global economies but has also exacerbated psychiatric 
issues, undermining the mental well-being of countless individuals. It is widely 
recognized that epidemic events, particularly periods of lockdown, heighten the 
risk of developing anxiety disorders, depression, and aggressive behaviors.
MATERIALS AND METHODS: In an Italian cohort, a retrospective study was conducted 
to examine the consumption and costs of antipsychotic medications during and 
after the Covid-19 pandemic, specifically in the years 2020-2022. Utilizing a 
database known as the "Sistema Tessere Sanitaria", data on medication 
dispensations from publicly accessible community pharmacies were extracted, 
covering a population of approximately one million individuals.
RESULTS: The findings for the years 2020-2021 showed relatively stable patterns, 
with overall consumption and expenditure slightly decreasing from 2020 to 2021. 
However, it is worth noting that the antipsychotic drug aripiprazole exhibited 
an opposite trend, with an increase in consumption. Despite expectations of 
heightened antipsychotic medication use, real-world evidence indicates a 
different phenomenon, suggesting that the pandemic might not have significantly 
influenced the consumption of these medications.
CONCLUSIONS: The limited accessibility to healthcare and medical appointments 
likely played a role in this observation, potentially masking the therapeutic 
needs of the population. It will be crucial to monitor the situation in the 
upcoming years, as normal clinical activities resume, to determine whether there 
will be an upsurge in the consumption of antipsychotic drugs, which represent a 
significant portion of the National Healthcare System's expenditure.

DOI: 10.1708/4113.41071
PMID: 37807867 [Indexed for MEDLINE]


330. Georgian Med News. 2023 Jul-Aug;(340-341):17-24.

THE GUT-BRAIN AXIS: IMPLICATIONS FOR NEUROLOGICAL DISORDERS, MENTAL HEALTH, AND 
IMMUNE FUNCTION.

Sahu S(1), Shah S(2), Supriti -(3), Joshi A(4), Patel J D(5), Yadav A(6).

Author information:
(1)1Department of Ayurveda, Sanskriti University, Mathura, Uttar Pradesh, India.
(2)2Department of Allied Healthcare & Sciences, Vivekananda Global University, 
Jaipur, India.
(3)3Department of Anatomy, Teerthanker Mahaveer University, Moradabad, Uttar 
Pradesh, India.
(4)4Department of Biochemistry, School of Sciences, JAIN (Deemed-to-be 
University), Karnataka, India.
(5)5Department of Pharmacology, Parul University, PO Limda, Tal. Waghodia, 
District Vadodara, Gujarat, India.
(6)6Department of Nursing, IIMT University, Meerut, Uttar Pradesh, India.

A gut-brain axis (GBA) has a long history of conceptual development. Intestinal 
dysbiosis has now been recognized as a key player in the development of adult 
neurodevelopmental disorders, obesity, and inflammatory bowel disease. Recent 
developments in metagenomics suggest those nutrition and gut microbiotas (GM) 
are important regulators of the gut-brain communication pathways that cause 
neurodevelopmental and psychiatric problems in adulthood. Intestinal dysbiosis 
and neurodevelopmental disease outcomes in preterm newborns are being linked by 
recent research. Recent clinical investigations demonstrate that in critical 
care units, intestinal dysbiosis occurs before late-onset newborn sepsis and 
necrotizing enterocolitis. Strong epidemiologic data also shows a connection 
between necrotizing enterocolitis and extremely low birth weight babies' 
long-term psychomotor impairments and late-onset neonatal sepsis. The GBA theory 
suggests that intestinal bacteria may indirectly affect preterm newborns' 
developing brains. In this review, we emphasize the structure and function of 
the GBA and discuss how immune-microbial dysfunction in the gut affects the 
transmission of stress signals to the brain. Preterm babies who are exposed to 
these signals develop neurologic disorders. Understanding neuronal and humoral 
communication through the GBA may provide insight into therapeutic and 
nutritional strategies that may enhance the results of very low-birth-weight 
babies.

PMID: 37805868 [Indexed for MEDLINE]


331. J Clin Psychol Med Settings. 2024 Mar;31(1):143-152. doi: 
10.1007/s10880-023-09975-z. Epub 2023 Oct 7.

Community Teens' COVID-19 Experience: Implications for Engagement Moving 
Forward.

Stiles-Shields C(1)(2), Reyes KM(3), Lennan N(3), Zhang J(4), Archer J(5), 
Julion WA(6), Shalowitz MU(3)(7).

Author information:
(1)Institute for Juvenile Research, Department of Psychiatry, The University of 
Illinois at Chicago, 1747 West Roosevelt Road, Chicago, IL, 60608, USA. 
ecss@uic.edu.
(2)Section of Community Behavioral Health, Department of Psychiatry and 
Behavioral Sciences, Rush University Medical Center, Chicago, USA. ecss@uic.edu.
(3)Section of Community Behavioral Health, Department of Psychiatry and 
Behavioral Sciences, Rush University Medical Center, Chicago, USA.
(4)Rosalind Franklin University of Medicine and Science, North Chicago, USA.
(5)School of Medicine and Public Health, University of Wisconsin, Madison, USA.
(6)Department of Women, Children and Family Nursing, Rush University College of 
Nursing, Chicago, USA.
(7)Department of Pediatrics, Rush University Medical Center, Chicago, USA.

Data collected from pediatric primary care settings during the pandemic suggest 
an increase in internalizing symptoms and disparities in care based upon 
minoritized identity status(es). To inform care moving forward, the current 
study characterized the pandemic and related technology usage experiences of 
teenaged pediatric patients from communities with high hardship indexes. As part 
of a larger mixed-methods study, 17 teens (Mean age = 15.99 ± .99) and 10 
caregivers independently voiced experiences related to the pandemic during 
remote focus group and interview sessions. Thematic analyses were used to assess 
qualitative data; descriptive analyses were used to characterize qualitative 
data. Despite no direct queries about the pandemic, 41% of teens and 40% of 
caregivers described their lived experiences during the pandemic. Two subthemes 
emerged within the primary theme of COVID-19: (1) Wellness/Mental Health and (2) 
Smartphone Use and Utility. Although distress and negative effects were voiced, 
questionnaire data indicated normative psychosocial functioning for both teen 
self-report and caregiver proxy report. Informed by the voiced experiences of 
teens and their caregivers from communities with high hardship indexes, methods 
for better assessing and managing internalizing symptoms in teen patients are 
presented. A multi-modal and multi-informant approach that leverages technology 
to garner information about teens' experiences and deliver care may help improve 
the well-being of teens in communities systemically burdened with disparities.

© 2023. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s10880-023-09975-z
PMID: 37803094 [Indexed for MEDLINE]


332. Intensive Crit Care Nurs. 2024 Feb;80:103535. doi: 10.1016/j.iccn.2023.103535. 
Epub 2023 Oct 4.

Clinician views on actionable processes of care for prolonged stay intensive 
care patients and families: A descriptive qualitative study.

Allum L(1), Terblanche E(2), Pattison N(3), Connolly B(4), Rose L(5).

Author information:
(1)Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, 
King's College London, James Clerk Maxwell Building, 57 Waterloo Road, SE1 8WA 
London, UK; Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' 
Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, 
SE1 7EH London, UK. Electronic address: laura.allum@kcl.ac.uk.
(2)Nutrition and Dietetic Department, Guy's and St Thomas' NHS Foundation Trust, 
Westminster Bridge Road, SE1 7EH, London. Electronic address: 
ella.terblanche@gstt.nhs.uk.
(3)University of Hertfordshire, College Lane, Hatfield AL109AB, UK; East & North 
Herts NHS Trust, Coreys Mill Lane, Stevenage SG14AB, UK. Electronic address: 
n.pattison@herts.ac.uk.
(4)Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' 
Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, 
SE1 7EH London, UK; Wellcome-Wolfson Institute for Experimental Medicine, 
Queen's University Belfast, Belfast, UK; Centre for Human and Applied 
Physiological Sciences, King's College London, UK; Department of Physiotherapy, 
The University of Melbourne, Melbourne, Australia. Electronic address: 
b.connolly@qub.ac.uk.
(5)Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, 
King's College London, James Clerk Maxwell Building, 57 Waterloo Road, SE1 8WA 
London, UK; Department of Critical Care and Lane Fox Clinical Respiratory 
Physiology Research Centre, St Thomas' Hospital, Guy's and St. Thomas' NHS 
Foundation Trust, Westminster Bridge Road, SE1 7EH London, UK. Electronic 
address: Louise.rose@kcl.ac.uk.

OBJECTIVES: To explore clinician perspectives on key actionable processes of 
care that may improve outcomes and experience of patients experiencing a 
prolonged (over 7 days) intensive care unit stay, and their family members.
RESEARCH METHODOLOGY: A descriptive qualitative interview study in the United 
Kingdom. We conducted online semi-structured interviews using video conferencing 
software (October 2020-August 2022). We used purposive sampling ensuring 
participation from a broad range of professions representing the 
interprofessional team in the United Kingdom. We used Framework Analysis methods 
to group actionable processes into the six themes of person-centred care. 
Analyses were informed by our previous scoping review and previous interviews 
with former patients and family members.
FINDINGS: We interviewed 24 staff participants and identified 36 actionable 
processes of care under six themes of person-centred care. Processes relating to 
communication (both establishing an effective communication method for the 
patient and staff communication with the patient and family), continuity of 
staff and care plans, and personalising the environment and routines, and 
allowing flexible family visiting were most frequently articulated. These 
processes were perceived as having a multifaceted impact on patient and family 
wellbeing, for example family visiting helping patient and family emotional 
wellbeing and staff communication with family; and establishing an effective 
communication method for patients reduced their anxiety, enhanced their 
involvement in their care and allowed staff to include them in ward rounds more 
efficiently.
CONCLUSION: We identified 36 actionable processes of care from interviews with 
intensive care staff, with an emphasis on enhancing patient autonomy through 
optimising communication and involvement in decision-making, participation of 
family, and continuity of staff and care plans.
IMPLICATIONS FOR CLINICAL PRACTICE: These 36 actionable processes of care will 
contribute to future development of quality improvement tools, which will be 
used to standardise the care of prolonged-stay intensive care patients and their 
families.

Copyright © 2023. Published by Elsevier Ltd.

DOI: 10.1016/j.iccn.2023.103535
PMID: 37801854 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


333. Glob Public Health. 2023 Jan;18(1):2264946. doi: 10.1080/17441692.2023.2264946. 
Epub 2023 Oct 6.

Social determinants of mental health among older adolescent girls living in 
urban informal settlements in Kenya and Nigeria during the COVID-19 pandemic.

Mũrage A(1), Ngunjiri A(2), Oyekunle A(3), Smith J(1).

Author information:
(1)Simon Fraser University, Burnaby, Canada.
(2)LVCT Health, Nairobi, Kenya.
(3)Monii Development Consult, Lagos, Nigeria.

The health burden due to mental health has historically been underestimated with 
focus on communicable diseases and deaths and little consideration of disability 
and comorbidity effects of poor mental health. Recent data show increasing 
trends of mental health disorders as a share of global health burdens and 
vulnerability of adolescents. This paper aims to explore social determinants of 
mental health as experienced by adolescent girls, drawing attention to gendered 
risks during the COVID-19 pandemic. Semi-structured interviews with twenty-two 
adolescent girls in urban informal settlements in Kenya and Nigeria reveal 
unique environmental, socio-cultural, economic and educational factors that 
threatened their mental wellbeing. The pandemic exacerbated these determinants. 
An equitable recovery will require a consideration of not only disproportional 
mental health outcomes, but also social determinants that contribute to these 
outcomes. As more than half of the urban population in sub-Saharan Africa reside 
in informal settlements, this study has implications for youth-focused mental 
health interventions in these and similar settings.

DOI: 10.1080/17441692.2023.2264946
PMID: 37801724 [Indexed for MEDLINE]


334. Res Child Adolesc Psychopathol. 2024 Feb;52(2):253-266. doi: 
10.1007/s10802-023-01133-1. Epub 2023 Oct 6.

Avoidant Parent-Child Communication About COVID-19: A Longitudinal Investigation 
of Associations with Youth Adjustment Across the First 6 Months of the Pandemic.

Malloy LC(1), Dykstra VW(2), Steen LAR(3), Filoso D(3), Salem H(4), Comer JS(5), 
Peris TS(6), Pincus DB(7), Ehrenreich-May J(8), Evans AD(2).

Author information:
(1)Faculty of Social Science and Humanities, Ontario Tech University, Oshawa, 
ON, Canada. lindsay.malloy@ontariotechu.ca.
(2)Department of Psychology, Brock University, St. Catharine's, ON, Canada.
(3)Faculty of Social Science and Humanities, Ontario Tech University, Oshawa, 
ON, Canada.
(4)Department of Counseling, Clinical, & School Psychology, University of 
California, Santa Barbara, CA, USA.
(5)Center for Children and Families, Florida International University, Miami, 
FL, USA.
(6)Department of Psychiatry & Biobehavioral Sciences / Semel Institute for 
Neuroscience & Human Behavior, University of California, Los Angeles, CA, USA.
(7)Center for Anxiety and Related Disorders, Boston University, Boston, MA, USA.
(8)Department of Psychology, University of Miami, Miami, FL, USA.

In the aftermath of discrete disasters, how families discuss the event has been 
linked with child well-being. There is less understanding, however, of how 
family communication affects adjustment to a protracted and ongoing public 
health crisis such as the COVID-19 pandemic. The present research leveraged a 
large longitudinal sample of families (N = 1884) across the United States and 
Canada to investigate factors that predicted family communication styles (active 
versus avoidant communication) about the COVID-19 pandemic and examined the 
longitudinal sequelae of mental health outcomes for youth associated with 
different family communication styles. Parents of youth between 5 to 17 years 
old completed surveys about their own mental health, their child's mental 
health, and family communication about the COVID-19 pandemic at two time points 
6 months apart. Overall, findings indicated that poorer parental mental health 
was related to greater use of avoidant communication, and avoidant communication 
styles were associated with poorer youth mental health over time. Findings 
suggest potential perils of avoidant family communication about ongoing threats 
and can help identify families at risk of negative mental health outcomes.

© 2023. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s10802-023-01133-1
PMID: 37801269 [Indexed for MEDLINE]


335. Psychiatr Danub. 2023 Oct;35(Suppl 2):256-262.

Post-COVID Neuropsychiatric Complications in Children and Adolescents: a Study 
Design for Early Diagnosis and Treatment Using Innovative Technologies.

Gadelshina D(1), Syunyakov T, Gayduk AJ, Borisova O, Kuvshinova N, Borisova N, 
Gorbachev D, Gonda X, DeSousa A, Yashikhina A, Vlasov A, Sheyfer M, Kolsanov A, 
Smirnova D.

Author information:
(1)Samara State Medical University, Samara, Russia.

BACKGROUND: The COVID-19 pandemic has had significant impacts on the child and 
adolescent population, with long-term consequences for physical health, 
socio-psychological well-being, and cognitive development, which require further 
investigation. We herein describe a study design protocol for recognizing 
neuropsychiatric complications associated with pediatric COVID-19, and for 
developing effective prevention and treatment strategies grounded on the 
evidence-based findings.
METHODS: The study includes two cohorts, each with 163 participants, aged from 7 
to 18 years old, and matched by gender. One cohort consisted of individuals with 
a history of COVID-19, while the other group presents those without such a 
history. We undertake comprehensive assessments, including neuropsychiatric 
evaluations, blood tests, and validated questionnaires completed by 
parents/guardians and by the children themselves. The data analysis is based on 
machine learning techniques to develop predictive models for COVID-19-associated 
neuropsychiatric complications in children and adolescents.
RESULTS: The first model is focused on a binary classification to distinguish 
participants with and without a history of COVID-19. The second model clusters 
significant indicators of clinical dynamics during the follow-up observation 
period, including the persistence of COVID-19 related somatic and 
neuropsychiatric symptoms over time. The third model manages the predictors of 
discrete trajectories in the dynamics of post-COVID-19 states, tailored for 
personalized prediction modeling of affective, behavioral, cognitive, 
disturbances (academic/school performance), and somatic symptoms of the long 
COVID.
CONCLUSIONS: The current protocol outlines a comprehensive study design aiming 
to bring a better understanding of COVID-19-associated neuropsychiatric 
complications in a population of children and adolescents, and to create a 
mobile phone-based applications for the diagnosis and treatment of affective, 
cognitive, and behavioral conditions. The study will inform about the improved 
management of preventive and personalized care strategies for pediatric COVID-19 
patients. Study results support the development of engaging and age-appropriate 
mobile technologies addressing the needs of this vulnerable population group.

PMID: 37800237 [Indexed for MEDLINE]


336. Front Public Health. 2023 Sep 20;11:1210327. doi: 10.3389/fpubh.2023.1210327. 
eCollection 2023.

Predictors of well-being, future anxiety, and multiple recurrent health 
complaints among university students during the COVID-19 pandemic: the role of 
socioeconomic determinants, sense of coherence, and digital health literacy. An 
Italian cross-sectional study.

Lorini C(1)(2), Cavallo G(1)(2), Vettori V(1)(2), Buscemi P(3), Ciardi G(3), 
Zanobini P(1)(2), Okan O(4), Dadaczynski K(5)(6), Lastrucci V(1)(7), Bonaccorsi 
G(1)(2).

Author information:
(1)Department of Health Science, University of Florence, Florence, Italy.
(2)Health Literacy Laboratory, Department of Health Science, University of 
Florence, Florence, Italy.
(3)School of Specialization in Public Health, University of Florence, Florence, 
Italy.
(4)Department of Sport and Health Sciences, Technical University Munich, Uptown 
München-Campus D, Munich, Germany.
(5)Department of Health Science, Fulda University of Applied Sciences, Fulda, 
Germany.
(6)Center for Applied Health Sciences, Leuphana Universitat Lüneburg, Lüneburg, 
Germany.
(7)Epidemiology Unit, Meyer Children's University Hospital, Florence, Italy.

The pandemic deeply changed young adults' life. Lockdown period and the social 
restrictions dramatically affected university students' mental health. The aim 
of our cross-sectional study was to describe psychological well-being, future 
anxiety (FA), and health complaints (HCs) in a sample of 3,001 students of the 
University of Florence in the middle of the first two pandemic waves. We 
assessed the role of subjective social status, chronic diseases, sense of 
coherence (SoC), and digital health literacy (DHL) as predictors of 
psychological well-being, FA, and HCs. Students expressed high levels of FA and 
reported being disturbed by not being able to achieve their desired future 
goals. About 40% reported a low or a very low well-being and 19.1% experienced 
two or more subjective health complaints more than once a week. The likelihood 
of having a better mental health status significantly increased with increasing 
SoC and among males. Subjective Social Status proved to be a predictor for FA. 
Enhancing SoC could improve the health status of the university students during 
the pandemic and beyond.

Copyright © 2023 Lorini, Cavallo, Vettori, Buscemi, Ciardi, Zanobini, Okan, 
Dadaczynski, Lastrucci and Bonaccorsi.

DOI: 10.3389/fpubh.2023.1210327
PMCID: PMC10548390
PMID: 37799148 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


337. PLoS One. 2023 Oct 5;18(10):e0292614. doi: 10.1371/journal.pone.0292614. 
eCollection 2023.

"We lost a lot, but something good came out of it too:" Exploring the impact of 
the COVID-19 pandemic on the mental wellbeing of British Muslim Pakistani women 
with family responsibilities.

Iqbal H(1)(2), Lockyer B(2), Iqbal S(1), Dickerson J(2).

Author information:
(1)Faculty of Health Studies, University of Bradford, Bradford, United Kingdom.
(2)Bradford Institute for Health Research, Bradford Teaching Hospital NHS 
Foundation Trust, Bradford, United Kingdom.

BACKGROUND: The COVID-19 pandemic and associated restrictions caused major 
disruption globally, shedding light on the unprecedented strain upon the mental 
health and wellbeing of individuals around the world. Poor mental health in the 
pandemic is reported to be greater in women, with mothers being at increased 
risk. It is unclear whether there are differences in the impact of mental 
wellbeing on some ethnic groups over others. The aim of this study was to 
explore the experiences of British Muslim Pakistani women with family 
responsibilities during the COVID-19 pandemic, two years on from the first 
lockdown.
METHODS: Qualitative interviews with women were conducted via telephone using a 
semi-structured topic guide. The sample included 25 British Muslim Pakistani 
women with family responsibilities, both English and non-English speaking. Women 
lived in households that ranged in number and included extended family. Key 
themes were determined using thematic analysis.
RESULTS: Results were grouped under three themes. These were (1) Community, 
cultural and religious contributors to poor mental wellbeing, (2) religious and 
cultural mediators of mental distress, and (3) perceived positive impact on 
lifestyle. British Muslim Pakistani women were psychologically distressed by the 
high rates of virus transmission and deaths in their communities and at the 
prospect of older members of their extended family developing the virus. The 
impact of restrictions on fundamental religious and cultural interactions 
further exacerbated poor mental wellbeing in this population. Religion, 
community social capital and larger household structures were all effective 
coping strategies for British Muslim Pakistani women. Positive impacts of the 
pandemic included becoming closer to family and faith, and increased work/life 
harmony.
CONCLUSIONS: An exploration of religious and cultural coping mechanisms should 
be used to inform future national pandemic preparedness plans, as well as 
effective strategies for building and maintaining social capital. This may 
increase adherence to physical distancing and other protective behaviours in 
populations.

Copyright: © 2023 Iqbal et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0292614
PMCID: PMC10553472
PMID: 37796936 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


338. PLoS One. 2023 Oct 5;18(10):e0292470. doi: 10.1371/journal.pone.0292470. 
eCollection 2023.

Fear, stress, anxiety, depression and insomnia related to COVID-19 among 
undergraduate nursing students: An international survey.

Al Maqbali M(1), Madkhali N(2), Gleason AM(3), Dickens GL(4)(5).

Author information:
(1)Fatima College of Health Sciences, Al Ain, United Arab Emirates.
(2)Jazan University, Jizan, Saudi Arabia.
(3)Fatima College of Health Sciences, Abu Dhabi, UAE.
(4)Mental Health Nursing Department of Nursing, Midwifery and Health Faculty of 
Health and Life Sciences, Northumbria University, Newcastle-Upon-Tyne, United 
Kingdom.
(5)Adjunct Professor Western Sydney University, Penrith, Australia.

The emergence of COVID-19 has produced unprecedented change in daily life 
activities leading to major impacts on psychological wellbeing and sleep among 
individuals worldwide. The study aimed to assess levels of fear, stress, 
anxiety, depression, and insomnia among undergraduate nursing students in four 
countries two years after the start of the pandemic. An international, 
multi-centre cross-sectional electronic survey was conducted between December 
2021 and April 2022. An on-line questionnaire was distributed via Qualtrics® and 
JISC® software. Instruments included the Fear of COVID-19 Scale, the Perceived 
Stress Scale, the Hospital Anxiety and Depression Scale and the Insomnia 
Severity Index, and a demographics and academic background questionnaire. The 
independent variables included demographic and academic backgrounds, while fear 
level, stress, anxiety, depression, and insomnia were the dependent variables. A 
total of 918 undergraduate nursing students from KSA, Oman, UK, and UAE were 
participants in the study. Students presented with stress (91.6%), anxiety 
(69.1%), depression (59.8%), and insomnia (73.2%). The participants' mean Fear 
of COVID-19 Scale score was 12.97 (SD = 6.14). There were significant positive 
relationships between fear of COVID-19, stress, anxiety, depression, and 
insomnia. Undergraduate nursing students experienced moderate to severe levels 
of Fear of COVID-19, stress, anxiety, depression, and insomnia two years after 
the onset of the COVID-19 pandemic. Psychological intervention and peer support 
are needed to reduce the long-term adverse outcomes of mental health problems 
and insomnia. It is important to introduce education about crisis management of 
infectious disease during pandemics into the nursing curriculum to increase 
student knowledge and improve their preparedness for such emergencies.

Copyright: © 2023 Al Maqbali et al. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0292470
PMCID: PMC10553289
PMID: 37796791 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


339. Front Public Health. 2023 Sep 19;11:1231326. doi: 10.3389/fpubh.2023.1231326. 
eCollection 2023.

Depression, anxiety and stress among healthcare workers in the context of the 
COVID-19 pandemic: a cross-sectional study in a tertiary hospital in Northern 
Vietnam.

Thu Pham H(1), Viet Cao T(2), Bich Le N(3), T-T Nguyen N(3), Thi Ngoc Vuong 
B(1), Vu Dieu Pham L(1), Thu Hoang T(1), Thi Hanh Pham T(1), Ngoc Nguyen T(1), 
Thi Thu Bui H(1), Van Tran T(4), Thuy Vu L(5), Thi Le P(1).

Author information:
(1)Department of Human Resources, Vietnam National Children's Hospital, Hanoi, 
Vietnam.
(2)Heart Center, Vietnam National Children's Hospital, Hanoi, Vietnam.
(3)Faculty of Fundamental Sciences, Hanoi University of Public Health, Hanoi, 
Vietnam.
(4)Department of Biochemistry, Vietnam National Children's Hospital, Hanoi, 
Vietnam.
(5)International medical Center, Vietnam National Children's Hospital, Hanoi, 
Vietnam.

INTRODUCTION: The outbreak of coronavirus severe acute respiratory syndrome 
coronavirus 2 (SARS-CoV2) had significant effects on the mental well-being in 
general, particularly for healthcare professionals. This study examined the 
prevalence of depression, anxiety, and stress, and identified the associated 
risk factors amongst healthcare workers during the COVID-19 outbreak in a 
tertiary hospital located in Vietnam.
METHODS: We conducted a cross-sectional study at a tertiary-level hospital, 
where the Depression Anxiety and Stress Scale 21 (DASS-21) web-based 
questionnaire was employed. We analyzed the determinant factors by employing 
multivariate logistic models.
RESULTS: The prevalence of depression, anxiety, and stress symptoms were 19.2%, 
24.7%, and 13.9%, respectively. Factors such as engaging in shift work during 
the pandemic, taking care of patients with COVID-19, and staff's health status 
were associated with mental health issues among health professionals. In 
addition, having alternate rest periods was likely to reduce the risk of stress.
CONCLUSION: The prevalence of mental health problems in healthcare workers 
during the COVID-19 pandemic was relatively high. Having resting periods could 
potentially mitigate the development of stress among health professionals. Our 
findings could be taken into account for improving mental health of the health 
professional population.

Copyright © 2023 Thu Pham, Viet Cao, Bich Le, T-T Nguyen, Thi Ngoc Vuong, Vu 
Dieu Pham, Thu Hoang, Thi Hanh Pham, Ngoc Nguyen, Thi Thu Bui, Van Tran, Thuy Vu 
and Thi Le.

DOI: 10.3389/fpubh.2023.1231326
PMCID: PMC10546943
PMID: 37794894 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


340. J Clin Nurs. 2023 Dec;32(23-24):8063-8077. doi: 10.1111/jocn.16879. Epub 2023 
Oct 4.

Symptoms of post-traumatic stress disorder in early career nurses during the 
COVID-19 pandemic: A longitudinal survey study.

Brook J(1), Duguid B(1), Miller N(1).

Author information:
(1)City, University of London, Northampton Square, London, UK.

AIM: To investigate the mental well-being of early career nurses working in the 
United Kingdom during the COVID-19 pandemic, with a particular emphasis on 
symptoms related to post-traumatic stress disorder.
DESIGN: A longitudinal survey study.
METHODS: Data were acquired at three timepoints during the COVID-19 pandemic 
(between May 2020 and March 2021) to determine whether symptoms of 
post-traumatic stress disorder persisted over time. Quantitative measures of 
well-being were supplemented with survey data on the nurses' experiences of 
working during the pandemic.
RESULTS: Twenty-seven per cent of participants suffered from persistent symptoms 
of post-traumatic stress while working as nurses during the pandemic. The 
nurses' baseline resilience, as well as their perception of the quality of their 
work environment, were significant negative predictors of symptoms of 
post-traumatic stress. Participants identified a range of strategies that would 
have helped them during the crisis, including visible, consistent and empathetic 
leadership, adequate training and a supportive work environment.
CONCLUSION: The context of the pandemic has highlighted the vulnerability of the 
psychological well-being of early career nurses in the workforce. Immediate 
implementation of some of the more simple interventions suggested in this paper 
would provide early career nurses with rapid support. More complex support 
mechanisms should be given immediate consideration, with a view to 
implementation in the longer term.
IMPLICATIONS FOR THE PROFESSION: This study contributes new knowledge about the 
psychological well-being of early career nurses working during the pandemic and 
suggests support mechanisms that will be crucial for the retention of these 
nurses in the profession. A measurement of resilience may be useful for 
determining the appropriate level of support to provide to early career nurses.
IMPACT: Early career nurses are vulnerable to attrition from the profession. 
This could be exacerbated if the psychological well-being of these nurses is not 
being supported. Around 25% of early career nurses suffered from persistent 
symptoms of post-traumatic stress disorder while working as nurses during the 
height of the pandemic, which is a novel finding compared to other longitudinal 
studies. Understanding the psychological well-being of early career nurses 
working during a crisis period (such as a pandemic) equips nurse managers with 
appropriate strategies to improve nurses' emotional health and to enhance their 
retention within the workforce. The current findings may be of interest to 
clinical practitioners who have responsibility for the retention of nursing 
staff. No patient or public contribution. One of the authors is a statistician.

© 2023 The Authors. Journal of Clinical Nursing published by John Wiley & Sons 
Ltd.

DOI: 10.1111/jocn.16879
PMID: 37793658 [Indexed for MEDLINE]


341. PeerJ. 2023 Sep 29;11:e16038. doi: 10.7717/peerj.16038. eCollection 2023.

Poor sleep quality and suicidal ideation among pregnant women during COVID-19 in 
Ethiopia: systematic review and meta-analysis.

Hasen AA(1), Seid AA(2), Mohammed AA(2).

Author information:
(1)Department of Statistics, College of Natural and Computational Sciences, 
Samara University, Semera, Afar, Ethiopia.
(2)Department of Nursing, College of Medicine and Health Sciences, Samara 
University, Semera, Afar, Ethiopia.

INTRODUCTION: COVID-19 has profoundly impacted the mental health and well-being 
of pregnant women worldwide. In Ethiopia, the poor sleep quality and suicidal 
ideation among pregnant women has increased due to the COVID-19 pandemic. This 
study aimed to provide comprehensive evidence on the prevalence and associated 
factors of poor sleep quality and suicidal ideation among pregnant women during 
COVID-19 in Ethiopia.
MATERIALS AND METHODS: This study is based on the Preferred Reporting Items for 
Systematic Reviews and Meta-Analyses (PRISMA) recommendation. Data were searched 
from PubMed, Google Scholar, and African Journals Online from the occurrence of 
the COVID-19 pandemic to February 2023. Two researchers extracted the data and 
performed the methodological quality assessment independently. Random-effect 
model was used to estimate the pooled effect size and I2was used to check 
heterogeneity. Stata 14.0 (StataCorp, Collage Station, Texas, USA) was used for 
statistical analysis.
RESULTS: From six studies the pooled prevalence of poor sleep quality was 55% 
(95% CI [0.42-0.69], I2 = 98.1%, p < 0.001). Age ≥ 30 years pooled AOR = 1.95, 
95% CI (0.85, 3.06), 3rd trimester pooled AOR = 3.20, 95% CI (1.82, 4.58), 
substance use pooled AOR = 2.51, 95% CI (0.99, 4.04), depression pooled AOR = 
2.97, 95% CI (0.92, 5.02) and stress pooled AOR 2.14, 95% CI (0.24, 4.03) were 
associated factors of poor sleep quality. Three studies reported about suicidal 
ideation and pooled prevalence was 11% (95% CI: 0.09, 0.13, I2 = 48.2%, 
p = 0.145). Depression pooled AOR = 3.19, 95% CI (1.68, 4.71) was the only 
associated factor of suicidal ideation.
CONCLUSION: Due to COVID-19 pregnant women in Ethiopia were affected by poor 
sleep quality and suicidal ideation. Thus, suitable and well designed programs 
proposing awareness of COVID-19, mental health counseling and involvement should 
be designed to improve the general mental health of pregnant women.
TRIAL REGISTRATION: PROSPERO registration number CRD42023389896.

©2023 Hasen et al.

DOI: 10.7717/peerj.16038
PMCID: PMC10544305
PMID: 37790617 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare there are no competing 
interests.


342. PLoS One. 2023 Oct 3;18(10):e0292108. doi: 10.1371/journal.pone.0292108. 
eCollection 2023.

Second victim syndrome in intensive care unit healthcare workers: A systematic 
review and meta-analysis on types, prevalence, risk factors, and recovery time.

Naya K(1), Aikawa G(2), Ouchi A(2), Ikeda M(3), Fukushima A(4), Yamada S(1), 
Kamogawa M(4), Yoshihara S(4), Sakuramoto H(4).

Author information:
(1)Department of Adult Health Nursing, Tokyo Healthcare University Wakayama 
Faculty of Nursing, Wakayama City, Wakayama, Japan.
(2)Department of Adult Health Nursing, College of Nursing, Ibaraki Christian 
University, Hitachi, Ibaraki, Japan.
(3)Department of Emergency and Critical Care Medicine, Graduate School of 
Comprehensive Human Sciences, University of Tsukuba, Tsukuba City, Ibaraki, 
Japan.
(4)Department of Critical Care and Disaster Nursing, Japanese Red Cross Kyushu 
International College of Nursing, Munakata, Fukuoka, Japan.

INTRODUCTION: Patient safety incidents, including medical errors and adverse 
events, frequently occur in intensive care units, leading to a significant 
psychological burden on healthcare workers. This burden results in second victim 
syndrome, which impacts the psychological and psychosomatic well-being of these 
workers. However, a systematic review focusing specifically on this condition 
among intensive care unit healthcare workers is lacking. Therefore, we aimed to 
conduct a systematic review and meta-analysis to examine the occurrence of 
second victim syndrome among intensive care unit healthcare workers, including 
the types, prevalence, risk factors, and recovery time associated with this 
condition.
METHODS: We conducted a comprehensive search of the MEDLINE, CINAHL, PsycINFO, 
and Igaku Chuo Zasshi databases. The eligibility criteria encompassed 
retrospective, prospective, and cross-sectional studies and controlled trials, 
with no language restrictions. Data on the type, prevalence, risk factors, and 
recovery time of second victim syndrome were extracted and pooled. Prevalence 
estimates from the included studies were combined using a random-effects 
meta-analytic model.
RESULTS: Of the 2,245 records retrieved, 16 potentially relevant studies were 
identified. Following full-text evaluation, five studies met the inclusion 
criteria and were included in the review. The findings revealed that 58% of 
intensive care unit healthcare workers experienced second victim syndrome. 
Frequent symptoms included guilt (12-68%), anxiety (38-63%), anger at self 
(25-58%), and lower self-confidence (7-58%). However, specific risk factors 
exclusive to intensive care unit healthcare workers were not identified in the 
review. Furthermore, approximately 20% of individuals took more than a year to 
recover or did not recover at all from the second victim syndrome.
CONCLUSIONS: Thus, this condition is prevalent among intensive care unit 
healthcare workers and may persist for extended periods, potentially exceeding a 
year. The risk factors for second victim syndrome in the intensive care unit 
setting are unclear and require further investigation.

Copyright: © 2023 Naya et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0292108
PMCID: PMC10547210
PMID: 37788270 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


343. Psychiatry Res. 2023 Nov;329:115494. doi: 10.1016/j.psychres.2023.115494. Epub 
2023 Sep 25.

Understanding the relationship between time spent outdoors, mental well-being 
and health-related behaviours in a Spanish sample: A real time smartphone-based 
study.

Catalan A(1), Tognin S(2), Hammoud R(3), Aymerich C(4), Pedruzo B(5), 
Bilbao-Gonzalez A(6), Salazar de Pablo G(7), Pacho M(5), Fusar-Poli P(8), 
Gonzalez-Torres MÁ(9).

Author information:
(1)Biobizkaia Health Research Institute, Barakaldo, Spain; OSI Bilbao-Basurto, 
Basurto University Hospital, Bilbao, Spain; Neuroscience Department, University 
of the Basque Country UPV/EHU, Leioa, Spain; Centro de Investigación en Red de 
Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; 
Department of Psychosis Studies, Institute of Psychiatry, Psychology and 
Neuroscience, King´s College London, London, UK. Electronic address: 
ana.catalanalcantara@osakidetza.eus.
(2)Department of Psychosis Studies, Institute of Psychiatry, Psychology and 
Neuroscience, King´s College London, London, UK; Outreach and Support in South 
London (OASIS) Service, South London and Maudsley NHS Foundation Trust, London, 
UK.
(3)Department of Psychosis Studies, Institute of Psychiatry, Psychology and 
Neuroscience, King´s College London, London, UK.
(4)Biobizkaia Health Research Institute, Barakaldo, Spain; OSI Bilbao-Basurto, 
Basurto University Hospital, Bilbao, Spain; Centro de Investigación en Red de 
Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
(5)OSI Bilbao-Basurto, Basurto University Hospital, Bilbao, Spain.
(6)Osakidetza Basque Health Service, Basurto University Hospital, Research and 
Innovation Unit, Bilbao, Spain; Network for Research on Chronicity, Primary 
Care, and Health Promotion (RICAPPS), Bilbao, Spain; Kronikgune Institute for 
Health Services Research, Barakaldo, Spain; Department of Medicine, Faculty of 
Health Sciences, University of Deusto, Bilbao, Spain; Health Services Research 
on Chronic Patients Network (REDISSEC), Spain.
(7)Department of Child and Adolescent Psychiatry, Institute of Psychiatry, 
Psychology & Neuroscience, King's College London, London, UK; Department of 
Brain and Behavioral Sciences, University of Pavia, Italy; Child and Adolescent 
Mental Health Services (CAMHS), South London and Maudsley NHS Foundation Trust, 
London, UK.
(8)Department of Psychosis Studies, Institute of Psychiatry, Psychology and 
Neuroscience, King´s College London, London, UK; Department of Brain and 
Behavioral Sciences, University of Pavia, Italy; Outreach and Support in 
South-London (OASIS) service, South London and Maudlsey (SLaM) NHS Foundation 
Trust, UK; Department of Psychiatry and Psychotherapy, 
Ludwig-Maximilian-University, Munich, Germany.
(9)Biobizkaia Health Research Institute, Barakaldo, Spain; OSI Bilbao-Basurto, 
Basurto University Hospital, Bilbao, Spain; Neuroscience Department, University 
of the Basque Country UPV/EHU, Leioa, Spain; Centro de Investigación en Red de 
Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.

INTRODUCTION: COVID-19 pandemic has affected our lifestyle and physical and 
mental well-being. We aimed to study the effect of being outdoors and mental 
well-being after the COVID-19 pandemic.
MATERIAL AND METHODS: We used smartphone based ecological momentary assessments 
(EMA) (Urban Mind app) to study the mental well-being of the Spanish general 
population. We collected socio-demographic data, past and current physical and 
mental health, and social and physical environment. Participants were recruited 
during 5 months (February to June 2021). Longitudinal associations between EMA 
and anxiety, depression, loneliness, tiredness, and happiness during the 
assessments were investigated using random intercept ordinal logistic regression 
models.
RESULTS: 274 subjects downloaded the app and completed the baseline assessment. 
66 participants completed at least 50 % of the assessments. Being outdoors was 
related to a lower likelihood of anxiety (OR: 0.48, 95 %CI 0.34-0.66), 
depression (OR: 0.40, 95 %CI 0.28-0.56), tiredness (OR: 0.47, 95 %CI 0.35-0.63), 
and loneliness (OR: 0.59, 95 %CI 0.42-0.84), and a higher likelihood of 
happiness (OR: 2.14, 95 %CI 1.57-2.93).
CONCLUSIONS: Being outdoors is related to better mental health in the general 
population independently of other factors (baseline mental well-being or 
socio-demographic characteristics). Public policies should include measurements 
to promote outdoor spaces in urban settings.

Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.psychres.2023.115494
PMID: 37783095 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest None.


344. Front Public Health. 2023 Sep 14;11:1224332. doi: 10.3389/fpubh.2023.1224332. 
eCollection 2023.

Presenteeism and mental health of workers during the COVID-19 pandemic: a 
systematic review.

García-Iglesias JJ(1)(2), Gómez-Salgado J(1)(3), Apostolo J(2), Rodrigues R(2), 
Costa EI(2)(4), Ruiz-Frutos C(1)(3), Martínez-Isasi S(5)(6), Fernández-García 
D(7), Vilches-Arenas Á(8)(9).

Author information:
(1)Sociology, Social Work and Public Health, Faculty of Labour Sciences, 
University of Huelva, Huelva, Spain.
(2)Health Sciences Research Unit: Nursing (UICISA: E), Coimbra Nursing School, 
Coimbra, Portugal.
(3)Escuela de Posgrado, Universidad de Especialidades Espíritu Santo, Guayaquil, 
Guayas, Ecuador.
(4)Nursing Department, Health School, University of Algarve, Faro, Portugal.
(5)Simulation and Intensive Care Unit of Santiago (SICRUS), Health Research 
Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Galicia, 
Spain.
(6)CLINURSID Research Group, Faculty of Nursing, University of Santiago de 
Compostela, Santiago de Compostela, Galicia, Spain.
(7)Health Research Nursing Group (GREIS), Department of Nursing and 
Physiotherapy, University of Leon, Leon, Spain.
(8)Preventive Medicine and Public Health, University of Seville, Seville, Spain.
(9)Preventive Medicine, Virgen Macarena University Hospital, Seville, Spain.

BACKGROUND: A large number of workers attend work despite being ill. Attending 
work during sickness can have a number of consequences for the worker (e.g., 
worsening of physical and mental condition), for co-workers, and for the 
company, and for service users.
OBJECTIVES: The aim of this study was to assess the factors influencing 
presenteeism and mental health of workers during the COVID-19 pandemic.
METHODS: A systematic review following the PRISMA format was conducted in the 
PubMed, Scopus, Web of Science (WoS), Cumulative Index to Nursing and Allied 
Health Literature (CINAHL), PsycInfo, and ScienceDirect electronic databases in 
January 2023, using the following key words: Presenteeism, Mental Health, and 
COVID-19. The eligibility criteria applied were original articles published in 
English, Spanish, French, German, and Portuguese, workers during the COVID-19 
pandemic (data collection date: January 01, 2020 - January 01, 2023), and 
articles assessing at least one measure of presenteeism and mental health 
status. Methodological quality was assessed using the critical appraisal tools 
of the Joanna Briggs Institute. The followed protocol is listed in the 
International Prospective Register of Systematic Reviews (PROSPERO) with code 
CRD42023391409.
RESULTS: A total of 25 studies were included in this review recruiting a total 
of 164,274 participants. A number of factors influencing mental health and 
sickness presenteeism were identified: (1) mental health-related factors 
(burnout [in 4 studies], stress [in 9 studies], depression [in 1 study], fear of 
COVID-19 [in 1 study], no well-being [in 2 studies], etc.); (2) individual 
factors (health status [in 1 study], being young [in 1 study], workers who 
experienced interrupted medical care [in 2 studies], having a chronic disease 
[in 1 study], etc.); (3) factors related to the situation caused by COVID-19 
(confinement, symptoms, loss of contract, risk of bankruptcy, etc. [in 1 study 
each one]); and (4) factors derived from working conditions (organisational 
support [in 1 study], patient care [in 1 study], work functioning or task 
performance impairment [in 4 studies], work fatigue [in 2 studies], safety 
climate [in 1 study], workload [in 1 study], etc.).
CONCLUSION: Identifying the key determinants of presenteeism and understanding 
the phenomena and origins of sickness presenteeism will help to create a safe 
working environment and optimal organisational systems to protect vulnerable 
workers in a pandemic context.
SYSTEMATIC REVIEW REGISTRATION: The unique identifier is CRD42023391409.

Copyright © 2023 García-Iglesias, Gómez-Salgado, Apostolo, Rodrigues, Costa, 
Ruiz-Frutos, Martínez-Isasi, Fernández-García and Vilches-Arenas.

DOI: 10.3389/fpubh.2023.1224332
PMCID: PMC10536966
PMID: 37780429 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


345. Int J Public Health. 2023 Sep 15;68:1605893. doi: 10.3389/ijph.2023.1605893. 
eCollection 2023.

The Impact of Being Homeless on the Clinical Outcomes of COVID-19: Systematic 
Review.

Ogbonna O(1), Bull F(2), Spinks B(2), Williams D(1), Lewis R(3), Edwards A(1).

Author information:
(1)Health and Care Research Wales Evidence Centre, Division of Population 
Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom.
(2)Division of Population Medicine, School of Medicine, Cardiff University, 
Cardiff, United Kingdom.
(3)North Wales Centre for Primary Care Research, School of Medical and Health 
Sciences, Bangor University, Bangor, United Kingdom.

Objective: The homeless population experiences inequality in health compared 
with the general population, which may have widened during the COVID-19 
pandemic. However, the impact of being homeless on the outcomes of COVID-19 is 
uncertain. This systematic review aimed to analyse the impact of experiencing 
homelessness on the clinical outcomes of COVID-19, including the effects on 
health inequalities. Methods: A review protocol was developed and registered in 
PROSPERO (PROSPERO registration 2022 CRD42022304941). Nine databases were 
searched in November 2022 to identify studies on homeless populations which 
contained primary research on the following outcomes of COVID-19: incidence, 
hospitalisation, mortality, long COVID, mental wellbeing, and evidence of 
inequalities. Included studies were summarised with narrative synthesis. 
Results: The searches yielded 8,233 initial hits; after screening, 41 studies 
were included. Overall, evidence showed that those in crowded living settings 
had a higher risk of COVID-19 infection compared to rough sleepers and the 
general population. The homeless population had higher rates of hospitalisation 
and mortality than the general population, lower vaccination rates, and suffered 
negative mental health impacts. Conclusion: This systematic review shows the 
homeless population is more susceptible to COVID-19 outcomes. Further research 
is needed to determine the actual impact of the pandemic on this population, and 
of interventions to mitigate overall risk, given the low certainty of findings 
from some of the low-quality evidence available. In addition, further research 
is required to ascertain the impact of long COVID on those experiencing 
homelessness, since the present review yielded no studies on this topic.

Copyright © 2023 Ogbonna, Bull, Spinks, Williams, Lewis and Edwards.

DOI: 10.3389/ijph.2023.1605893
PMCID: PMC10540688
PMID: 37780134 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they do not have any 
conflicts of interest.


346. Psychiatry Res. 2023 Nov;329:115493. doi: 10.1016/j.psychres.2023.115493. Epub 
2023 Sep 24.

Feasibility, acceptability and preliminary efficacy of a mental health 
self-management app in clinicians working during the COVID-19 pandemic: A pilot 
randomised controlled trial.

Kirykowicz K(1), Jaworski B(2), Owen J(2), Kirschbaum C(3), Seedat S(4), van den 
Heuvel LL(5).

Author information:
(1)Department of Psychiatry, Faculty of Medicine and Health Sciences, 
Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, 
South Africa.
(2)The United States (US) Department of Veterans Affairs (VA), National Center 
for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System; 
NCPTSD - 334; 795 Willow Road, Menlo Park, CA 94025, United States.
(3)Biological Psychology, TU Dresden, Zellescher Weg 19, Dresden D - 01062, 
Germany.
(4)Department of Psychiatry, Faculty of Medicine and Health Sciences, 
Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, 
South Africa; South African Medical Research Council / Stellenbosch University 
Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health 
Sciences, Stellenbosch University, Cape Town, South Africa.
(5)Department of Psychiatry, Faculty of Medicine and Health Sciences, 
Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, 
South Africa; South African Medical Research Council / Stellenbosch University 
Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health 
Sciences, Stellenbosch University, Cape Town, South Africa. Electronic address: 
llvdh@sun.ac.za.

COVID-19 affected the well-being of healthcare workers (HCWs) globally. Mental 
health app interventions (MHAIs) may offer appropriate and accessible means to 
support HCWs' mental health. We conducted a pilot randomised controlled 
crossover trial involving 34 clinicians randomised to either a MHAI or a 
waitlisted group. After one month, outcome assessments were repeated and the 
waitlisted group then crossed over to the MHAI; they again completed outcome 
assessments after a month. The primary outcomes were feasibility, assessed with 
the Systems Usability Scale (SUS), and acceptability, assessed with the Client 
Satisfaction Questionnaire (CSQ). Secondary outcomes included efficacy for 
various mental health parameters. The SUS and CSQ scores indicated above average 
feasibility and acceptability. There was a significant difference in anxiety 
from baseline to 1-month follow-up between the groups, with greater improvement 
in the MHAI group. The groups differed in resilience and patient-related burnout 
from baseline to 1-month follow-up, with a trend towards significance, with 
greater improvements in the MHAI group. Anxiety and acute stress disorder 
severity improved significantly from pre- to post-intervention. We demonstrated 
that MHAIs hold potential for improving well-being of HCWs, although these 
findings will need to be replicated in adequately powered trials.

Copyright © 2023. Published by Elsevier B.V.

DOI: 10.1016/j.psychres.2023.115493
PMID: 37778231 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no competing interests.


347. BMC Geriatr. 2023 Sep 30;23(1):615. doi: 10.1186/s12877-023-04350-x.

Quality of life and well-being during the COVID-19 pandemic: associations with 
loneliness and social isolation in a cross-sectional, online survey of 2,207 
community-dwelling older Canadians.

Briere J(1), Wang SH(1), Khanam UA(2), Lawson J(3), Goodridge D(4).

Author information:
(1)Department of Psychology and Health Studies, University of Saskatchewan, 
Saskatoon, Canada.
(2)Health Sciences Program, College of Medicine, Canadian Centre for Health and 
Safety in Agriculture, Respiratory Research Centre, University of Saskatchewan, 
Saskatoon, Canada.
(3)Department of Medicine and Canadian Centre for Health and Safety in 
Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, Canada.
(4)College of Medicine, Respiratory Research Centre, University of Saskatchewan, 
Saskatoon, Canada. donna.goodridge@usask.ca.

BACKGROUND: The far-reaching health and social sequelae of the COVID-19 pandemic 
among older adults have the potential to negatively impact both quality of life 
(QoL) and well-being, in part because of increased risks of loneliness and 
social isolation. The aim of this study was to examine predictors of QoL and 
well-being among Canadian older adults within the context of the pandemic, 
including loneliness and social isolation.
METHODS: This cross-sectional, online survey recruited older adult participants 
through community organizations and research participant panels. Measures 
included the: Older People's Quality of Life Scale-B, WHO-5, DeJong Gierveld 
Loneliness Scale, Lubben Social Network Scale and five COVID-19 specific items 
assessing impact on loneliness and social isolation. Multiple linear regression 
models were used to adjust for potential confounders.
RESULTS: A total of 2,207 older Canadians (55.7% female, with a mean age of 69.4 
years) responded to the survey. Over one-third strongly disagreed that the 
pandemic had had a significant effect on either their mental (35.0%) or physical 
health (37.6%). Different patterns of predictors were apparent for QoL and 
well-being. After adjusting for all variables in the models, the ability of 
income to meet needs emerged as the strongest predictor of higher QoL, but was 
not associated with well-being, except for those who chose not to disclose their 
income adequacy. Age was not associated with either QoL or well-being. Females 
were more likely to experience lower well-being (β=-2.0, 95% C.I. =-4.0,-0.03), 
but not QoL. Reporting three or more chronic health conditions and that the 
COVID-19 pandemic had a negative impact on mental health was associated with 
lower QoL and well-being. Loneliness was a predictor of reduced QoL (β=-1.4, 95% 
C.I. =--1.6, -1.2) and poor well-being (β=-3.7, 95% C.I. =-4.3,-3.0). A weak 
association was noted between QoL and social isolation.
CONCLUSIONS: The COVID-19 pandemic is associated with differential effects among 
older adults. In particular, those with limited financial resources and those 
with multiple chronic conditions may be at more risk to suffer adverse QoL and 
well-being consequences. Loneliness may be a modifiable risk factor for 
decreased QoL and well-being amenable to targeted interventions.

© 2023. BioMed Central Ltd., part of Springer Nature.

DOI: 10.1186/s12877-023-04350-x
PMCID: PMC10542692
PMID: 37777717 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


348. J Prof Nurs. 2023 Sep-Oct;48:152-162. doi: 10.1016/j.profnurs.2023.07.006. Epub 
2023 Jul 25.

State of Mental Health, Healthy Behaviors, and Wellness Support in Big 10 
University Nursing and Health Sciences Faculty, Staff, and Students During 
COVID-19.

Melnyk BM(1), Hsieh AP(2), Tan A(3), Dirks M(4), Gampetro PJ(5), Gawlik K(6), 
Lightner C(7), Newhouse RP(8), Pavek K(9), Semin JN(10), Simpson V(11), Teall 
AM(12), Tschannen D(13).

Author information:
(1)College of Nursing, The Ohio State University, 300N Heminger Hall, 1577 Neil 
Avenue, Columbus, OH 43210, United States of America. Electronic address: 
Melnyk.15@osu.edu.
(2)College of Nursing, The Ohio State University, United States of America. 
Electronic address: Hsieh.336@osu.edu.
(3)Center of Research and Health Analytics, College of Nursing, The Ohio State 
University, United States of America. Electronic address: Tan.739@osu.edu.
(4)College of Nursing, University of Iowa, Iowa City, United States of America. 
Electronic address: Mary-dirks@uiowa.edu.
(5)University of Illinois Nursing, 845 S. Damen Avenue, Room 844, MC802, 
Chicago, IL 60612, United States of America.
(6)The Ohio State University, Columbus, OH 43210, United States of America. 
Electronic address: gawlik.2@osu.edu.
(7)Ross and Carol Nese College of Nursing, Pennsylvania State University, United 
States of America. Electronic address: cml5107@psu.edu.
(8)Indiana University IUPUI, 600 Barnhill Drive, Indianapolis, IN 46202, United 
States of America.
(9)School of Nursing, University of Wisconsin-Madison, United States of America. 
Electronic address: kausher@wisc.edu.
(10)University of Nebraska Medical Center College of Nursing, Omaha, NE 68198, 
United States of America. Electronic address: jessica.semin@unmc.edu.
(11)School of Nursing, Purdue University, West Lafayette, United States of 
America. Electronic address: vsimpson@purdue.edu.
(12)The Ohio State University, Columbus, OH 43210, United States of America. 
Electronic address: teall.3@osu.edu.
(13)University of Michigan School of Nursing, Ann Arbor, MI, United States of 
America. Electronic address: djvs@umich.edu.

BACKGROUND: Federal and national entities urge organizations to assess 
healthcare professionals' mental health and well-being as the COVID-19 pandemic 
has compounded the issue.
AIMS: This study aimed to (1) describe rates of mental health issues, healthy 
lifestyle behaviors, and perceptions of COVID-19's impact among Big 10 
University nursing and health sciences faculty, staff, and students; (2) 
identify predictors of depression, anxiety, stress, and burnout; and (3) assess 
the relationships among perceived school wellness support, healthy lifestyle 
behaviors, physical/mental health, and mattering.
METHODS: A cross-sectional descriptive correlational design was used. Nursing 
and health science deans emailed invitations to faculty, staff, and students 
concerning an anonymous wellness assessment survey. Correlation coefficients 
tested associations among mental health indicators and wellness cultures. 
Multiple linear regression examined factors associated with mental health 
indicators.
RESULTS: Faculty, staff, and students responded (N = 1345). Findings indicated 
that most respondents were not getting adequate sleep, meeting physical activity 
recommendations, or eating the daily recommended number of fruits/vegetables. 
Fourteen to 54.9 % of participants reported depression, anxiety, and burnout. 
Overall, students, faculty and staff at colleges that operated under a strong 
wellness culture had better outcomes.
CONCLUSION: Wellness cultures impact the mental and physical health of faculty, 
staff, and students.

Copyright © 2023 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.profnurs.2023.07.006
PMID: 37775230 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest Bernadette 
Melnyk created the MINDSTRONG and MINDBODYSTRONG programs discussed in this 
paper and has a company, COPE2Thrive, LLC that disseminates the COPE programs. 
At the time the study took place, each author was employed by a Big 10 
University. Beyond these associations, the Authors declare no other conflicts of 
interest.


349. Altern Ther Health Med. 2023 Nov;29(8):910-917.

Analysis of the Influencing Factors of Delirium after PCI for Acute Myocardial 
Infarction and its Impact on the Quality of Life of Patients.

Cao C, Gao D, Wang X, Wan Y, Zhu Y, Yao S, Wang R.

OBJECTIVE: Delirium is a common and serious issue in patients recovering from 
percutaneous coronary intervention (PCI). It can lead to longer hospital stays, 
increased mortality, and decreased quality of life. This study aims to 
investigate different nursing interventions to improve care for post-PCI 
patients by reducing the incidence and duration of delirium.
METHODS: Between December 2021 and April 2023, we enrolled patients who 
underwent PCI surgery for acute myocardial infarction at our hospital as study 
participants. Utilizing a clinical randomized controlled trial design, we 
allocated these patients randomly into either the intervention group or the 
control group. The control group received conventional nursing care, while the 
intervention group received routine nursing care augmented by family visit 
nursing care, encompassing emotional support, education, and enhanced 
communication with family members. Upon the completion of all intervention 
measures, we assessed the incidence of delirium in post-PCI patients using the 
Richmond Agitation Sedation Scale (RASS) and the ICU Ambiguity Assessment Method 
for the Intensive Care Unit (CAM-ICU). Furthermore, we evaluated the patients' 
quality of life using the US Medical Bureau's Quality of Life Health Survey 
(SF-36).
RESULT: Significant differences were observed in Richmond Agitation Sedation 
Scale (RASS) scores at 24 and 48 hours post-PCI, favoring the intervention group 
(P < .05). The intervention group also exhibited a lower incidence of delirium 
at 24 hours (P < .05) and a significantly shorter delirium duration (P < .05). 
While baseline quality of life scores did not differ significantly between the 
groups, post-intervention, the intervention group demonstrated significantly 
higher quality of life scores. These results underscore the positive impact of 
combined nursing interventions on sedation levels, delirium incidence and 
duration, and overall quality of life for post-PCI patients.
CONCLUSION: The combined approach of routine nursing care and home visit 
interventions significantly reduced delirium incidence and duration in post-PCI 
patients. This personalized care strategy emphasizes patient well-being and is 
indicative of a broader shift towards individualized healthcare. It highlights 
the potential for enhanced patient outcomes and improved quality of life in the 
context of post-PCI patient management.

PMID: 37773659 [Indexed for MEDLINE]


350. Curr Probl Cardiol. 2024 Jan;49(1 Pt B):102110. doi: 
10.1016/j.cpcardiol.2023.102110. Epub 2023 Sep 26.

Determinants of Early Mobilization in Postcardiac Surgery Patients.

Awaludin S(1), Novitasari D(2).

Author information:
(1)School of Nursing, Faculty of Health Sciences, Universitas Jenderal 
Soedirman, Karangwangkal, Purwokerto, Indonesia. Electronic address: 
abifayza@yahoo.co.id.
(2)Faculty of Health, Universitas Harapan Bangsa, Purwokerto, Indonesia.

Coronary Heart Disease is the number 1 cause of death in the world, one of which 
is surgical intervention. Surgery can cause immobilization which has a risk of 
complications, reduces comfort, wellbeing and affects the patient's quality of 
life. Early mobilization of postcardiac surgery patients is influenced by 
various factors. The purpose of this study was to identify factors that 
influence the early mobilization of postcardiac surgery patients. 
Cross-sectional study design with a sample size of 86 postcardiac surgery 
patients. The instruments used were observation sheets, Visual Analoque Scale, 
State-Trait Anxiety Inventory compiled by Spilberger, observation sheets 
referring to the Malaysia Society of Intensive Care and Thompson. The 
multivariate analysis used in this study used Structural Equation Modeling. 
There is a significant effect between anxiety and early mobilization p value 
0.041 with a regression coefficient of 0.308. There is a significant effect 
between energy levels and early mobilization p value 0.044 with a regression 
coefficient of 0.191. There is a significant indirect effect of exercise therapy 
intervention on early mobilization mediated by anxiety with a p value of 0.048 
and a regression coefficient of 0.230. Other exogenous variables have no 
significant effect on early mobilization variables, pain and anxiety. Management 
of pain, anxiety, giving exercise therapy and fulfilling energy levels need to 
be done to increase early mobilization of patients after cardiac surgery.

Copyright © 2023 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.cpcardiol.2023.102110
PMID: 37769754 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The study's 
authors state that they have no known financial conflicts of interest or close 
personal links that might have looked to have influenced the findings they have 
provided


351. Healthcare (Basel). 2023 Sep 19;11(18):2583. doi: 10.3390/healthcare11182583.

The Impact of an Intensive Care Diary on the Psychological Well-Being of 
Patients and Their Family Members: Longitudinal Study Protocol.

Bosco V(1), Froio A(1), Mercuri C(2), Sansone V(3), Garofalo E(1), Bruni A(1), 
Guillari A(4), Bruno D(2), Talarico M(2), Mastrangelo H(5), Longhini F(1), Doldo 
P(6), Simeone S(6).

Author information:
(1)Department of Medical and Surgical Sciences, University Hospital Mater 
Domini, Magna Graecia University, 88100 Catanzaro, Italy.
(2)School of Medicine and Surgery, Magna Graecia University, 88100 Catanzaro, 
Italy.
(3)Department of Experimental Medicine, Luigi Vanvitelli University, 80131 
Naples, Italy.
(4)Department of Public Health, University of Naples Federico II, 80138 Naples, 
Italy.
(5)ASP Catanzaro, 88100 Catanzaro, Italy.
(6)Clinical and Experimental Medicine Department, Magna Graecia University, 
88100 Catanzaro, Italy.

BACKGROUND: Thanks to medical and technological advancements, an increasing 
number of individuals survive admission to intensive care units. However, 
survivors often experience negative outcomes, including physical impairments and 
alterations in mental health. Anxiety, depression, cognitive impairments, 
post-traumatic stress disorders, and functional disorders are known collectively 
as post-intensive care syndrome (PICS). Among the key triggering factors of this 
syndrome, memory impairment appears to play a significant role.
AIMS: This study aims to evaluate the impact of an intensive care diary on the 
psychological well-being of patients and their relatives after discharge from 
the ICU.
DESIGN: Prospective observational study.
EXPECTED RESULTS: The results of this study evaluate the impact of an ICU diary 
on the quality of life of ICU survivors and their family members.

DOI: 10.3390/healthcare11182583
PMCID: PMC10531207
PMID: 37761780

Conflict of interest statement: The authors declare no conflict of interest.


352. Cells. 2023 Sep 13;12(18):2267. doi: 10.3390/cells12182267.

Human Alcohol-Microbiota Mice have Increased Susceptibility to Bacterial 
Pneumonia.

Cunningham KC(1), Smith DR(2), Villageliú DN(1), Ellis CM(1), Ramer-Tait 
AE(3)(4), Price JD(3)(4), Wyatt TA(1)(5)(6), Knoell DL(1)(2), Samuelson 
MM(5)(7), Molina PE(8), Welsh DA(9), Samuelson DR(1)(4).

Author information:
(1)Department of Internal Medicine-Pulmonary Division, College of Medicine, 
University of Nebraska Medical Center, Omaha, NE 68198, USA.
(2)Department of Pharmacy Practice and Science, College of Pharmacy, University 
of Nebraska Medical Center, Omaha, NE 68198, USA.
(3)Department of Food Science and Technology, University of Nebraska-Lincoln, 
Lincoln, NE 68588, USA.
(4)Nebraska Food for Health Center, University of Nebraska-Lincoln, Lincoln, NE 
68588, USA.
(5)Department of Environmental, Agricultural and Occupational Health, College of 
Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA.
(6)Department of Veterans Affairs Nebraska-Western Iowa Health Care System, 
Omaha, NE 68198, USA.
(7)Animal Behavior Core, University of Nebraska Medical Center, Omaha, NE 68198, 
USA.
(8)Department of Physiology, Louisiana State University Health Sciences Center, 
New Orleans, LA 70112, USA.
(9)Department of Internal Medicine, Section of Pulmonary/Critical Care & 
Allergy/Immunology, Louisiana State University Health Sciences Center, New 
Orleans, LA 70112, USA.

Preclinical studies have shown that chronic alcohol abuse leads to alterations 
in the gastrointestinal microbiota that are associated with behavior changes, 
physiological alterations, and immunological effects. However, such studies have 
been limited in their ability to evaluate the direct effects of 
alcohol-associated dysbiosis. To address this, we developed a humanized 
alcohol-microbiota mouse model to systematically evaluate the immunological 
effects of chronic alcohol abuse mediated by intestinal dysbiosis. Germ-free 
mice were colonized with human fecal microbiota from individuals with high and 
low Alcohol Use Disorders Identification Test (AUDIT) scores and bred to produce 
human alcohol-associated microbiota or human control-microbiota F1 progenies. F1 
offspring colonized with fecal microbiota from individuals with high AUDIT 
scores had increased susceptibility to Klebsiella pneumoniae and Streptococcus 
pneumoniae pneumonia, as determined by increased mortality rates, pulmonary 
bacterial burden, and post-infection lung damage. These findings highlight the 
importance of considering both the direct effects of alcohol and alcohol-induced 
dysbiosis when investigating the mechanisms behind alcohol-related disorders and 
treatment strategies.

DOI: 10.3390/cells12182267
PMCID: PMC10526526
PMID: 37759490 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


353. BMC Psychol. 2023 Sep 27;11(1):292. doi: 10.1186/s40359-023-01327-8.

The negative association of the SARS-CoV-2 pandemic with the health of mother 
and child considering maternal childhood maltreatment.

Köhler-Dauner F(1), Dalhof Gulde M(2), Hart L(2), Ziegenhain U(2), Fegert JM(2).

Author information:
(1)Department of Child and Adolescent Psychiatry/Psychotherapy, University 
Hospital of Ulm, Steinhövelstraße 5, 89075, Ulm, Germany. 
franziska.koehler-dauner@uniklinik-ulm.de.
(2)Department of Child and Adolescent Psychiatry/Psychotherapy, University 
Hospital of Ulm, Steinhövelstraße 5, 89075, Ulm, Germany.

BACKGROUND: Social distancing strategies during the SARS-CoV-2 pandemic have 
left families facing a variety of different constraints. Especially in this 
stressful time, children need a stable parental home to prevent developmental 
consequences. Additional risk factors such as maternal childhood maltreatment 
(CM) may affect mother's psychosomatic health and children's physical well-being 
in this period.
OBJECTIVE: It was aimed to analyze the associations between maternal CM, 
mother's mental health, and children's physical complaints during the 
SARS-CoV-2-pandemic.
METHOD: Mothers of a well-documented birth cohort from a longitudinal study were 
included in this study. Psychosomatic health was assessed with the PHQ-D and 
children's physical health with the GBB-KJ during the pandemic. N = 159 mothers 
completed the online survey. To describe the maternal CM, data from a 
longitudinal survey were used.
RESULTS: The calculation of three mediation analyses demonstrate that maternal 
depression symptoms (c-path: β = 0.10, p = .02; c'-path: β = 0.07, p = .13), 
somatic symptoms (c-path: β = 0.10, p = .02; c'-path: β = 0.07, p = .13) and 
psychosomatic symptoms (c-path: β = 0.10, p = .02; c'-path: β = 0.06, p = .19) 
fully mediate the relationship between CM and children's physical health 
complaints.
CONCLUSIONS: Maternal CM experiences seem to be one relevant risk factor during 
the pandemic and seem to influence the way in which parents deal with stressful 
situations and increase the risk for depressive symptoms. The present results 
highlight the importance to provide individually adjusted assistance to help the 
families to get through the pandemic.

© 2023. BioMed Central Ltd., part of Springer Nature.

DOI: 10.1186/s40359-023-01327-8
PMCID: PMC10523770
PMID: 37759267 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


354. J Geriatr Oncol. 2023 Nov;14(8):101634. doi: 10.1016/j.jgo.2023.101634. Epub 
2023 Sep 25.

Post-traumatic stress disorder symptoms and quality of life among older patients 
with cancer during the COVID-19 pandemic.

Cherifi F(1), Gernier F(2), Jardin F(3), Lefevre-Arbogast S(4), Bastien E(5), 
Lequesne J(4), Rigal O(6), Quilan F(7), Clarisse B(5), Grellard JM(5), Binarelli 
G(4), Fernette M(5), Lange M(4), Richard D(8), Morel A(7), Griffon B(5), Pepin 
LF(8), Leconte A(5), Faveyrial A(7), Leheurteur M(9), Beauplet B(10), Joly 
F(11).

Author information:
(1)Medical Oncology Department, Centre Francois Baclesse, UNICANCER, Caen 14076, 
France; Normandie University, UniCaen, INSERM U1086 "ANTICIPE" 
(Interdisciplinary Research Unit for Cancers Prevention and Treatment), Caen 
14076, France.
(2)Clinical Research Department, Centre Francois Baclesse, UNICANCER, Caen 14 
076, France; Normandie University, UniCaen, INSERM U1086 "ANTICIPE" 
(Interdisciplinary Research Unit for Cancers Prevention and Treatment), Caen 
14076, France. Electronic address: f.gernier@baclesse.unicancer.fr.
(3)Clinical Research Department, Centre Henri Becquerel, UNICANCER, Rouen 76038, 
France; Hematology Department, Centre Henri Becquerel, UNICANCER, Rouen 76038, 
France.
(4)Clinical Research Department, Centre Francois Baclesse, UNICANCER, Caen 14 
076, France; Normandie University, UniCaen, INSERM U1086 "ANTICIPE" 
(Interdisciplinary Research Unit for Cancers Prevention and Treatment), Caen 
14076, France.
(5)Clinical Research Department, Centre Francois Baclesse, UNICANCER, Caen 14 
076, France.
(6)Hematology Department, Centre Henri Becquerel, UNICANCER, Rouen 76038, 
France; Medical Oncology Department, Centre Henri Becquerel, UNICANCER, Rouen 
76308, France.
(7)Medical Oncology Department, Centre Francois Baclesse, UNICANCER, Caen 14076, 
France.
(8)Clinical Research Department, Centre Henri Becquerel, UNICANCER, Rouen 76038, 
France.
(9)Medical Oncology Department, Centre Henri Becquerel, UNICANCER, Rouen 76308, 
France.
(10)Department of Geriatric Medicine, Centre Hospitalier Universitaire de Caen 
Normandie, Normandie Univ, UNICAEN, INSERM U1086, ANTICIPE, Caen F-14000, 
France; Normandy Interregional Oncogeriatric Coordination Unit, Caen 14000, 
France.
(11)Medical Oncology Department, Centre Francois Baclesse, UNICANCER, Caen 
14076, France; Clinical Research Department, Centre Francois Baclesse, 
UNICANCER, Caen 14 076, France; Normandie University, UniCaen, INSERM U1086 
"ANTICIPE" (Interdisciplinary Research Unit for Cancers Prevention and 
Treatment), Caen 14076, France.

INTRODUCTION: The Coronavirus (COVID-19) pandemic and its associated health 
restrictions have harmed the population psychologically. We aimed to compare the 
post-traumatic stress disorder (PTSD) symptoms and Quality of Life (QoL) in 
older French patients with cancer to the younger ones.
MATERIALS AND METHODS: This longitudinal multicenter study named COVIPACT began 
in April 2020 during the first French lockdown and has included 579 outpatients 
receiving treatment for a solid or hematological malignancy. Data were collected 
every three months, namely at the first release period (M3), at the second 
lockdown (M6), at the second release period (M9), and finally at the last curfew 
period (M12) in France. Standardized validated self-questionnaires were used to 
assess PTSD symptoms (using the Event Scale-Revised self-questionnaire), 
insomnia (through the Insomnia Severity Index questionnaire), QoL (using the 
Functional Assessment of Cancer Therapy - General questionnaire), and cognitive 
complaints (through the Functional Assessment of Cancer Therapy - Cognition 
questionnaire). Student (or Wilcoxon) tests and Chi-squared tests were used for 
continuous or discrete variables, respectively. We conducted linear mixed model 
to study the change during follow-up.
RESULTS: Out of 579 included patients, 157 (27%) were ≥ 70 years old at 
baseline, of whom 104 participated in the longitudinal study. At baseline, older 
patients reported fewer PTSD symptoms (17% versus 23%, p = .06), insomnia (17% 
versus 27%, p = .02), and cognitive complaint (3% versus 16%, p < .01) than 
younger patients. QoL at baseline was similar between age subgroups. We observed 
no significant difference in the trajectory of PTSD symptoms, insomnia, or 
emotional well-being between both groups during the follow-up. Cognitive 
complaints were lower at baseline in older patients but steadily increased 
during the follow-up and reached the same level as younger patients at one year.
DISCUSSION: One in five older patients reported PTSD symptoms, evolving 
similarly to younger patients during the first year of the COVID-19 pandemic. 
While cognitive complaints tend to recover in a bell-shaped curve at one year in 
younger patients, the trend is increasing in older ones. Screening for PTSD 
symptoms and late cognitive impairment should be given special attention in 
older patients.
TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT04366154.

Copyright © 2023. Published by Elsevier Ltd.

DOI: 10.1016/j.jgo.2023.101634
PMID: 37757587 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest Authors 
declare no conflict of interest with this work.


355. Int J Environ Res Public Health. 2023 Sep 9;20(18):6736. doi: 
10.3390/ijerph20186736.

The MothersBabies Study, an Australian Prospective Cohort Study Analyzing the 
Microbiome in the Preconception and Perinatal Period to Determine Risk of 
Adverse Pregnancy, Postpartum, and Child-Related Health Outcomes: Study 
Protocol.

Strout N(1), Pasic L(1), Hicks C(1), Chua XY(1), Tashvighi N(1), Butler P(1), 
Liu Z(2)(3), El-Assaad F(1), Holmes E(4), Susic D(1)(5)(6), Samaras K(7)(8)(9), 
Craig ME(6), Davis GK(5)(6), Henry A(5)(6), Ledger WL(6), El-Omar EM(1).

Author information:
(1)UNSW Microbiome Research Centre, St George and Sutherland Clinical Campuses, 
UNSW Sydney, Sydney, NSW 2052, Australia.
(2)UNSW Stats Central, Biological Sciences South Building (E26), Level 2 
Kensington, UNSW Sydney, Sydney, NSW 2052, Australia.
(3)Healthdirect Australia, Level 4, 477 Pitt Street, Sydney, NSW 2000, 
Australia.
(4)The Australian National Phenome Centre, Harry Perkins Institute, Murdoch 
University, Perth, WA 6150, Australia.
(5)Department of Women's and Children's Health, St George Hospital, Kogarah, NSW 
2217, Australia.
(6)Discipline of Women's Health, School of Clinical Medicine, UNSW Sydney, 
Sydney, NSW 2052, Australia.
(7)Complex Diseases Program, Garvan Institute of Medical Research, Darlinghurst, 
NSW 2010, Australia.
(8)Department of Endocrinology, St Vincent's Hospital, Darlinghurst, NSW 2010, 
Australia.
(9)St Vincent's Clinical Campus, UNSW Sydney, Sydney, NSW 2052, Australia.

The microbiome has emerged as a key determinant of human health and 
reproduction, with recent evidence suggesting a dysbiotic microbiome is 
implicated in adverse perinatal health outcomes. The existing research has been 
limited by the sample collection and timing, cohort design, sample design, and 
lack of data on the preconception microbiome. This prospective, longitudinal 
cohort study will recruit 2000 Australian women, in order to fully explore the 
role of the microbiome in the development of adverse perinatal outcomes. 
Participants are enrolled for a maximum of 7 years, from 1 year preconception, 
through to 5 years postpartum. Assessment occurs every three months until 
pregnancy occurs, then during Trimester 1 (5 + 0-12 + 6 weeks gestation), 
Trimester 2 (20 + 0-24 + 6 weeks gestation), Trimester 3 (32 + 0-36 + 6 weeks 
gestation), and postpartum at 1 week, 2 months, 6 months, and then annually from 
1 to 5 years. At each assessment, maternal participants self-collect oral, skin, 
vaginal, urine, and stool samples. Oral, skin, urine, and stool samples will be 
collected from children. Blood samples will be obtained from maternal 
participants who can access a study collection center. The measurements taken 
will include anthropometric, blood pressure, heart rate, and serum hormonal and 
metabolic parameters. Validated self-report questionnaires will be administered 
to assess diet, physical activity, mental health, and child developmental 
milestones. Medications, medical, surgical, obstetric history, the impact of 
COVID-19, living environments, and pregnancy and child health outcomes will be 
recorded. Multiomic bioinformatic and statistical analyses will assess the 
association between participants who developed high-risk and low-risk 
pregnancies, adverse postnatal conditions, and/or childhood disease, and their 
microbiome for the different sample types.

DOI: 10.3390/ijerph20186736
PMCID: PMC10531411
PMID: 37754596 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


356. Int J Environ Res Public Health. 2023 Sep 7;20(18):6724. doi: 
10.3390/ijerph20186724.

Exploring Students' Emotional Well-Being in the Ideal University Hostel Using 
the Qualitative Repertory Grid Technique.

Jameel F(1), Agiel A(1).

Author information:
(1)Department of Architectural Engineering, United Arab Emirates University, Abu 
Dhabi P.O. Box 15551, United Arab Emirates.

One of the ramifications of the COVID-19 pandemic is that it has lent urgency to 
ongoing discussions on mental well-being, particularly among university 
students. While standard techniques are available to diagnose mental health 
disorders such as depression, anxiety, and stress, ambiguity persists regarding 
the emotional aspect of well-being. Emotional well-being (EWB) is a recently 
developed concept that seeks to understand the contribution of emotions to one's 
well-being. Interactive approaches for such investigations are recommended to 
understand people's contextual experiences in the built environment. This study 
utilizes a qualitative approach, underpinned by personal construct theory (PCT) 
and the qualitative repertory grid technique (RGT), to understand how university 
hostel designs can contribute to students' emotional well-being. We interviewed 
fifteen students from the United Arab Emirates University (UAEU) and obtained 
their perceptions of three built environments they experienced and an ideal 
place they imagined. The results unveiled design-related factors associated with 
students' emotional constructs and elucidated characteristics of an 'ideal' 
hostel in response to these emotional constructs. These findings enrich our 
knowledge of EWB within university hostels offering insights for the future 
design that consider the emotional aspect of well-being for residents.

DOI: 10.3390/ijerph20186724
PMCID: PMC10530330
PMID: 37754584 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


357. PLoS One. 2023 Sep 26;18(9):e0291988. doi: 10.1371/journal.pone.0291988. 
eCollection 2023.

Worsening of mental health outcomes in nursing home staff during the COVID-19 
pandemic in Ireland.

Brady C(1), Shackleton E(1), Fenton C(1), Loughran O(1), Hayes B(2), Hennessy 
M(3), Higgins A(4), Leroi I(5), Shanagher D(6), McLoughlin DM(1).

Author information:
(1)Department of Psychiatry and Trinity College Institute of Neuroscience, 
Trinity College Dublin, St Patrick's University Hospital, Dublin 8, Ireland.
(2)Beaumont Hospital, Dublin 9, Royal College of Surgeons, Dublin 2, Ireland.
(3)WellcomeTrust/Health Research Board Clinical Research Facility, Trinity 
College Dublin, St James's Hospital, Dublin 8, Ireland.
(4)School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.
(5)Global Brain Health Institute, Trinity College Institute of Neuroscience, 
Trinity College Dublin, Dublin 2, Ireland.
(6)Nursing Homes Ireland, Dublin 24, Ireland.

BACKGROUND: Mental health issues in nursing home staff during the COVID-19 
pandemic have been significant; however, it is not known if these issues persist 
following widespread vaccination and easing of restrictions.
OBJECTIVE: To quantify the mental health of nursing home staff at different 
timepoints during the COVID-19 pandemic in the Republic of Ireland.
DESIGN/METHODS: Two identical, online, cross-sectional, nationwide, anonymous 
surveys of Republic of Ireland nursing home staff at two timepoints (survey 1 
(S1, n = 390): November 2020 to January 2021; survey 2 (S2, N = 229: November 
2021 to February 2022) during the COVID-19 pandemic. Convenience sampling was 
used with staff self-selecting for participation. Methods included the World 
Health Organisation's Well-Being Index (WHO-5), the Impact of Events 
Scale-Revised (IES-R), the Moral Injury Events Scale (MIES), two Likert-scale 
items regarding suicidal ideation and planning, the Work Ability Score (WAS), 
the Brief Coping Orientation to Problems Experienced (Brief-COPE) Scale, and a 
15-item questionnaire assessing perceptions of the outbreak with one additional 
Likert-scale item on altruism. Descriptive analysis examined differences between 
staff based on their classification in one of three groups: nurses, healthcare 
assistants (HCA) and nonclinical staff. Pseudonymous identifiers were used to 
link responses across surveys.
RESULTS: An insufficient number of participants completed both surveys for 
linked analyses to be performed; therefore, we performed an ecological 
comparison between these two independent surveys. More staff reported 
moderate-severe post-traumatic stress symptoms (S1 45%; S2 65%), depression (S1: 
39%; S2 57%), suicidal ideation (S1: 14%; S2 18%) and suicidal planning (S1: 9%; 
S2 15%) later in the pandemic. There was a higher degree of moral injury at S2 
(S1: 20.8 standard deviation (SD) 9.1; S2: 25.7 SD (11.3)) and use of avoidant 
(maladaptive) coping styles at S2 (S1: 20.8 (6.3); S2 23.0 (6.3)) with no 
notable differences found in the use of approach (adaptive) coping styles. Staff 
reported more concerns at S2 regarding contracting COVID-19, social stigma, job 
stress, doubts about personal protective equipment and systems and processes.
CONCLUSION: In comparison to our previous survey, mental health outcomes appear 
to have worsened, coping did not improve, and staff concerns, and worries appear 
to have increased as the pandemic progressed. Follow-up studies could help to 
clarify is there are any lingering problems and to assess if these issues are 
related to the pandemic and working conditions in nursing homes.

Copyright: © 2023 Brady et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0291988
PMCID: PMC10521981
PMID: 37751434 [Indexed for MEDLINE]

Conflict of interest statement: DMM has received speaker’s honoraria from MECTA, 
Otsuka and Janssen plus an honorarium from Janssen for participating in an 
esketamine advisory board meeting. This does not alter our adherence to PLOS ONE 
policies on sharing data and materials. The other authors report no conflicts of 
interest.


358. BMC Psychol. 2023 Sep 25;11(1):288. doi: 10.1186/s40359-023-01316-x.

Disease-preventive behaviors and subjective well-being in the COVID-19 pandemic.

Tokson M(1), Rahrig H(2), Green JD(3).

Author information:
(1)S.J. Quinney College of Law, University of Utah, Salt Lake City, UT, USA. 
matthew.tokson@law.utah.edu.
(2)Psychology Department, University of Wisconsin-Madison, Madison, WI, USA.
(3)Psychology Department, Virginia Commonwealth University, Richmond, VA, USA.

BACKGROUND: Safety precautions and activity restrictions were common in the 
early, pre-vaccine phases of the COVID-19 pandemic. We hypothesized that higher 
levels of participation in potentially risky social and other activities would 
be associated with greater life satisfaction and perceived meaning in life. At 
the same time, prosocial COVID-preventive activities such as mask wearing should 
enhance life satisfaction.
METHOD: We assessed the impact of COVID-preventive behaviors on psychological 
well-being in October 2020. A nationally representative sample of U.S. adults 
(n = 831) completed a demographic questionnaire, a COVID-related behaviors 
questionnaire, a Cantril's Ladder item, and the Multidimensional Existential 
Meaning Scale. Two hierarchical linear models were used to examine the potential 
impact of COVID-preventive behaviors on life satisfaction and meaning in life 
while accounting for the influence of demographic factors.
RESULTS: The study revealed significant positive relationships between 
COVID-preventive behaviors and subjective well-being. Wearing a mask was 
significantly associated with higher life satisfaction, while maintaining social 
distancing of six feet and avoiding large groups were significantly associated 
with higher perceived meaning in life. Social activities including dining at 
restaurants and visiting friends and family were also significantly associated 
with higher life satisfaction and meaning in life, respectively.
CONCLUSION: The study's findings support the conclusion that disease prevention 
measures such as social distancing and mask wearing do not reduce, and may 
enhance, subjective well-being during a pandemic. Utilizing the unique context 
of the COVID-19 pandemic to examine relationships between behavior and 
subjective well-being, the study also indicates that shallow or medium-depth 
social activities are likely to be more central to life satisfaction, whereas 
narrower, deeper social interactions with friends and family are more important 
to perceived meaning in life.

© 2023. BioMed Central Ltd., part of Springer Nature.

DOI: 10.1186/s40359-023-01316-x
PMCID: PMC10521491
PMID: 37749642 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


359. Compr Psychiatry. 2023 Nov;127:152424. doi: 10.1016/j.comppsych.2023.152424. 
Epub 2023 Sep 16.

Evaluation of the Early Adolescent Skills for Emotions (EASE) intervention in 
Lebanon: A randomized controlled trial.

Jordans MJD(1), Brown FL(2), Kane J(3), Taha K(4), Steen F(5), Ali R(6), Elias 
J(7), Meksassi B(8), Aoun M(9), Greene CM(10), Malik A(11), Akhtar A(12), van 
Ommeren M(13), Sijbrandij M(14), Bryant R(15); STRENGTHS consortium.

Author information:
(1)War Child, Research and Development Department, Amsterdam, the Netherlands; 
Amsterdam Institute of Social Science Research, University of Amsterdam, 
Amsterdam, the Netherlands. Electronic address: mark.jordans@warchild.nl.
(2)War Child, Research and Development Department, Amsterdam, the Netherlands; 
Amsterdam Institute of Social Science Research, University of Amsterdam, 
Amsterdam, the Netherlands. Electronic address: felicity.brown@warchild.nl.
(3)Department of Epidemiology, Columbia University, New York, USA. Electronic 
address: jk4397@cumc.columbia.edu.
(4)War Child, Lebanon Country Office, Beirut, Lebanon.
(5)War Child, Research and Development Department, Amsterdam, the Netherlands. 
Electronic address: frederik.steen@warchild.nl.
(6)War Child, Lebanon Country Office, Beirut, Lebanon. Electronic address: 
rayane.ali@warchild.nl.
(7)War Child, Lebanon Country Office, Beirut, Lebanon. Electronic address: 
joseph.elias@warchild.nl.
(8)War Child, Lebanon Country Office, Beirut, Lebanon. Electronic address: 
bassel.meksassi@warchild.nl.
(9)War Child, Lebanon Country Office, Beirut, Lebanon. Electronic address: 
may.aoun@warchild.nl.
(10)Program on Forced Migration and Health, Heilbrunn Department of Population 
and Family Health, Columbia University Mailman School of Public Health, USA. 
Electronic address: mg4069@cumc.columbia.edu.
(11)World Health Organization, Geneva, Switzerland. Electronic address: 
malika@who.int.
(12)Department of Clinical Neuroscience, Division of Insurance Medicine, 
Karolinska Institutet, Sweden; School of Psychology, University of New South 
Wales, Australia. Electronic address: aemal.akhtar@ki.se.
(13)World Health Organization, Geneva, Switzerland. Electronic address: 
vanommerenm@who.int.
(14)VU University, Department of Clinical, Neuro- and Developmental Psychology, 
WHO Collaborating Center for Research and Dissemination of Psychological 
Interventions, Amsterdam, the Netherlands. Electronic address: 
e.m.sijbrandij@vu.nl.
(15)School of Psychology, University of New South Wales, Australia. Electronic 
address: r.bryant@unsw.edu.au.

BACKGROUND: There is a need for scalable evidence-based psychological 
interventions for young adolescents experiencing high levels of psychological 
distress in humanitarian settings and low- and middle-income countries. Poor 
mental health during adolescence presents a serious public health concern as it 
is a known predictor of persistent mental disorders in adulthood. This study 
evaluates the effectiveness of a new group-based intervention developed by the 
World Health Organization (Early Adolescent Skills for Emotions; EASE), 
implemented by non-specialists, to reduce young adolescents' psychological 
distress among mostly Syrian refugees in Lebanon.
METHODS: We conducted a two-arm, single-blind, individually randomized group 
treatment trial. Adolescents aged 10 to 14 years who screened positive for 
psychological distress using the Pediatric Symptom Checklist (PSC) were randomly 
allocated to EASE or enhanced treatment as usual (ETAU) (1:1.6). ETAU consisted 
of a single scripted psycho-education home-visit session with the adolescent and 
their caregivers. EASE consists of seven group sessions with adolescents and 
three sessions with caregivers. The primary outcome was adolescent-reported 
psychological distress as measured with the PSC (internalizing, externalizing, 
and attentional symptoms). Secondary outcomes included depression, posttraumatic 
stress, well-being, functioning, and caregivers' parenting and distress. All 
outcomes were assessed at baseline, endline, and 3 months (primary time point) 
and 12 months follow-up.
RESULTS: Due to the COVID-19 pandemic and other adversities in Lebanon at the 
time of this research, the study was prematurely terminated, resulting in an 
under-powered trial sample (n = 198 enrolled compared to n = 445 targeted). We 
screened 604 children for eligibility. The 198 enrolled adolescents were 
assigned to EASE (n = 80) and ETAU (n = 118), with retention rates between 76.1 
and 88.4% across all timepoints. Intent-to-treat analyses demonstrated no 
between-group differences on any of the outcome measures between the EASE and 
ETAU. We did observe a significant improvement on the primary outcome equally in 
the EASE and ETAU groups (-0.90, 95% CI: -3.6, 1.8; p = .52), - a trend that was 
sustained at three months follow-up. Sub-group analyses, for those with higher 
depression symptoms at baseline, showed ETAU outperformed EASE on reducing 
depression symptoms (difference in mean change = 2.7, 95% CI: 0.1, 5.3; p = .04; 
d = 0.59) and internalizing problems (difference in mean change 1.0, 95% CI: 
0.08, 1.9; p = .03; d = 0.56) .
CONCLUSION: No conclusions can be drawn about the comparative effectiveness of 
the intervention given that the sample was underpowered as a result of early 
termination. Both EASE and single session psycho-education home visits resulted 
in meaningful improvements in reducing psychological distress. We did not 
identify any indications in the data suggesting that EASE was more effective 
than a single session family intervention in the context of the COVID-19 
pandemic and other crises in Lebanon. Fully powered research is needed to 
evaluate the effectiveness of EASE.

Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.comppsych.2023.152424
PMID: 37748283 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest None.


360. J Intensive Care Soc. 2023 Aug;24(3):292-298. doi: 10.1177/17511437221116474. 
Epub 2022 Aug 10.

A thematic analysis of staff perspectives on the impact of a mental health nurse 
(RMN) in a critical care unit.

Hill C(1), Sims S(2), Ap Robert M(3), Collier S(3).

Author information:
(1)Swansea Bay University Health Board, Swansea, UK.
(2)Liaison Psychiatry, Swansea Bay University Health Board, Swansea, UK.
(3)Mental Health & Learning Disability, Swansea Bay University Health Board, 
Swansea, UK.

BACKGROUND: Recent guidelines in the UK have shaped Critical Care Units (CCUs) 
to bring the mental health needs of patients, and staff wellbeing to the 
forefront of service provision. A health board based in NHS Wales has trialled 
the secondment of a Mental Health Nurse (RMN) within a CCU to help service 
provision adhere to such guidelines.
METHODS: Critical care staff were invited to attend focus groups to share their 
experiences of how the RMN influenced service provision.
RESULTS: Thematic analysis identified five main themes; including 'smoother care 
pathways', 'a holistic approach to care', 'co-production', 'knowledge and 
confidence' and 'staff wellbeing'. Each of these themes reflected how the RMN 
had both direct and indirect benefits on patient and staff wellbeing.
CONCLUSION: This qualitative exploration suggests that staff perceived value in 
the role of the RMN for both staff and patient outcomes, although further 
measures were considered necessary to improve staff-wellbeing within a critical 
care environment. This service evaluation supports recommendations for 
commissioning a RMN permanently in a CCU.

© The Intensive Care Society 2022.

DOI: 10.1177/17511437221116474
PMCID: PMC10515331
PMID: 37744079

Conflict of interest statement: The author(s) declare the following potential 
conflicts of interest with respect to the research, authorship, and/or 
publication if this article: The study was completed as part of the 
academic/research requirements for the Doctorate in Clinical Psychology at 
Cardiff University, of which CH is training to attain this qualification.


361. Work. 2024;77(2):671-686. doi: 10.3233/WOR-230060.

A bibliometric analysis of telework research based on Web of Science via 
VOSviewer.

Yang Z(1), Huang Y(1).

Author information:
(1)Library of Zhuhai Campus, Jinan University, Zhuhai, China.

BACKGROUND: The COVID-19 pandemic has sparked increased interest in telework as 
a means of reducing the spread of the virus and maintaining social distance.
OBJECTIVE: This study aims to generate a bibliometric analysis of research 
progress and trends in telework over the past 20 years.
METHOD: A search of key terms was conducted in the Social Science Citation 
Index, Science Citation Index Expanded, and Arts and Humanities Citation Index 
categories for documents published on telework from 2000-2023. A total of 3,446 
studies were analyzed using VOSviewer for co-citation, co-word, and cluster 
analysis.
RESULTS: Bibliometric analysis revealed that telework research has experienced a 
significant increase during the COVID-19 pandemic, with the number of 
publications in 2022 being more than 15 times higher than that in 2019. The 
analysis revealed that the most commonly researched areas related to telework 
were applied psychology, management and business. The knowledge base focuses on 
the antecedents, moderators, mediators, and consequences of telework, and the 
research primarily centers around seven directions of well-being, mental health, 
and work-family conflict. A conceptual framework for telework research and 
suggestions for future investigation are proposed based on the results of the 
bibliometric analysis.
CONCLUSION: This study provides an overview of telework research over the past 
two decades, highlighting the current status and hot topics in the field. It 
calls for wider and more active participation of researchers globally to advance 
the understanding of telework.

DOI: 10.3233/WOR-230060
PMID: 37742685 [Indexed for MEDLINE]


362. J Adolesc. 2024 Jan;96(1):31-48. doi: 10.1002/jad.12250. Epub 2023 Sep 22.

Connections matter: Adolescent social connectedness profiles and mental 
well-being over time.

Oberle E(1), Ji XR(2), Alkawaja M(1), Molyneux TM(2), Kerai S(1), Thomson KC(3), 
Guhn M(1), Schonert-Reichl KA(4), Gadermann AM(1).

Author information:
(1)School of Population and Public Health, The Human Early Learning Partnership, 
Faculty of Medicine, The University of British Columbia (UBC), Vancouver, 
British Columbia, Canada.
(2)Department of Educational and Counselling Psychology, and Special Education, 
University of British Columbia (UBC), Vancouver, British Columbia, Canada.
(3)Faculty of Health Science, Children's Health Policy Centre, Simon Fraser 
University, Burnaby, Canada.
(4)Department of Psychology, University of Illinois at Chicago (UIC), Chicago, 
Illinois, USA.

INTRODUCTION: This study examined profiles of social connectedness among early 
adolescents in grade 7 before the COVID-19 pandemic was declared (Winter 2020), 
and in grade 8 during the second Wave of the pandemic (Winter 2021).
METHOD: Linked data from 1753 early adolescents (49% female) from British 
Columbia, Canada who completed the Middle Years Development Instrument survey in 
grades 7 and 8 were used. Participants reported on life satisfaction, depressive 
symptoms, and connectedness with peers and adults at home, school and in the 
community. We used Latent Profile Analysis to identify connectedness profiles at 
both time points, and Latent Transition Analysis to examine transitions in 
connectedness profiles over time. Multiple regression analyses examined the 
associations between profile membership in grade 7 and mental well-being in 
grade 8, and the associations between transitions in profile membership (i.e., 
increase vs. decrease in connectedness over time) and mental well-being.
RESULTS: Connectedness in multiple domains in grade 7 was related to 
significantly higher levels of mental well-being in grade 8, controlling for 
demographics, well-being in grade 7, and COVID-related mental health worries. 
Well-being was highest when students felt highly connected in all domains and 
lowest when they felt lower levels of connection. Increases in connectedness 
were associated with improvements in mental well-being and decreases with a 
decline in well-being over time.
CONCLUSIONS: Experiencing connectedness with peers and adults is critical for 
the mental well-being in early adolescence. Providing opportunities to connect 
is important in the context of major societal challenges such as the COVID-19 
pandemic.

© 2023 The Authors. Journal of Adolescence published by Wiley Periodicals LLC on 
behalf of Foundation for Professionals in Services to Adolescents.

DOI: 10.1002/jad.12250
PMID: 37740505 [Indexed for MEDLINE]


363. Int J Aging Hum Dev. 2024 Apr;98(3):373-394. doi: 10.1177/00914150231202396. 
Epub 2023 Sep 21.

Social Contact, Social Participation, and Emotional Well-Being Among Older 
Adults During the COVID-19 Pandemic: The Roles of Giving and Receiving Social 
Support.

Peng C(1), Yuan Y(2), Burr JA(1), Mutchler JE(1), Song Q(1), Lapane KL(2).

Author information:
(1)Department of Gerontology, John W. McCormack Graduate School of Public and 
Global Studies, University of Massachusetts Boston, Boston, MA, USA.
(2)Department of Population and Quantitative Health Sciences, University of 
Massachusetts Chan Medical School, Worcester, MA, USA.

This study examined whether social contact, social participation, and social 
support during the COVID-19 pandemic were associated with depression and 
anxiety. Data were taken from the 2020 COVID-19 Supplement of the National 
Health and Aging Trends Study (N = 2,778). Depression and anxiety were regressed 
on social contact frequency, social participation, and social support. Path 
analyses were also performed. The results showed that in-person contact was 
related to lower levels of depression, while in-person contact and attending 
religious services were related to lower levels of anxiety. Giving and receiving 
support were associated with higher levels of depression and anxiety. Giving 
support mediated the link between virtual contact, volunteering, and depression, 
while receiving support mediated the link between virtual contact and 
depression. Receiving and giving support mediated the association between 
virtual social contact, volunteering, and anxiety. During the pandemic, being 
socially connected provided some benefits in terms of emotional well-being, but 
in some cases being socially connected did not provide salubrious effects.

DOI: 10.1177/00914150231202396
PMID: 37735920 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting InterestsThe authors 
declared no potential conflicts of interest with respect to the research, 
authorship, and/or publication of this article.


364. JAMA Netw Open. 2023 Sep 5;6(9):e2335016. doi: 
10.1001/jamanetworkopen.2023.35016.

Young People's Mental Health Changes, Risk, and Resilience During the COVID-19 
Pandemic.

Montero-Marin J(1)(2)(3), Hinze V(1), Mansfield K(1), Slaghekke Y(1), Blakemore 
SJ(4), Byford S(5), Dalgleish T(6), Greenberg MT(7), Viner RM(8), Ukoumunne 
OC(9), Ford T(10), Kuyken W(1); MYRIAD Team.

Author information:
(1)Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, 
England, United Kingdom.
(2)Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant 
Boi de Llobregat, Spain.
(3)Consortium for Biomedical Research in Epidemiology and Public Health (CIBER 
Epidemiology and Public Health-CIBERESP), Madrid, Spain.
(4)Department of Psychology, University of Cambridge, Cambridge, England, United 
Kingdom.
(5)Institute of Psychiatry, Psychology & Neuroscience, King's Health Economics, 
King's College London, London, England, United Kingdom.
(6)Medical Research Council Cognition and Brain Sciences Unit, University of 
Cambridge, Cambridge, England, United Kingdom.
(7)Edna Bennett Pierce Prevention Research Center, College of Health and Human 
Development, Pennsylvania State University, State College, Pennsylvania.
(8)Population, Policy and Practice Research and Teaching Department, University 
College London Great Ormond Street Institute of Child Health, London, England, 
United Kingdom.
(9)National Institute for Health and Care Research Applied Research 
Collaboration (PenARC) South West Peninsula, Department of Health and Community 
Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, 
England, United Kingdom.
(10)Department of Psychiatry, School of Clinical Medicine, University of 
Cambridge, Cambridge, England, United Kingdom.

IMPORTANCE: As young people's mental health difficulties increase, understanding 
risk and resilience factors under challenging circumstances becomes critical.
OBJECTIVE: To explore the outcomes of the COVID-19 pandemic on secondary school 
students' mental health difficulties, as well as the associations with 
individual, family, friendship, and school characteristics.
DESIGN, SETTING, AND PARTICIPANTS: For this cohort study, follow-up data from 
the My Resilience in Adolescence (MYRIAD) cluster randomized clinical trial were 
collected across 2 representative UK cohorts. Mainstream UK secondary schools 
with a strategy and structure to deliver social-emotional learning, with an 
appointed head teacher, and that were not rated "inadequate" in their latest 
official inspection were recruited. A total of 5663 schools were approached, 532 
showed interest, and 84 consented. Cohort 1 included 12 schools and 864 
students, and cohort 2 included 72 schools and 6386 students. COVID-19 was 
declared a pandemic after cohort 1 had completed all assessments (September 2018 
to January 2020), but cohort 2 had not (September 2019 to June 2021).
EXPOSURES: Cohort 2 was exposed to the COVID-19 pandemic, including 3 national 
lockdowns. Associations of individual, family, friendship, and school 
characteristics with students' mental health were explored.
MAIN OUTCOMES AND MEASURES: Changes in students' risk for depression (Center for 
Epidemiological Studies-Depression scale); social, emotional, and behavioral 
difficulties (Strengths and Difficulties Questionnaire); and mental well-being 
(Warwick-Edinburgh Mental Well-Being Scale).
RESULTS: Of the 7250 participants included, the mean (SD) age was 13.7 (0.6) 
years, 3947 (55.4%) identified as female, and 5378 (73.1%) self-reported their 
race as White. Twelve schools and 769 of the 864 students (89.0%) in cohort 1 
and 54 schools and 2958 of the 6386 students (46.3%) in cohort 2 provided data 
and were analyzed. Mental health difficulties increased in both cohorts but to a 
greater extent among students exposed to the pandemic, including for risk of 
depression (adjusted mean difference [AMD], 1.91; 95% CI, 1.07-2.76); social, 
emotional, and behavioral difficulties (AMD, 0.76; 95% CI, 0.33-1.18); and 
mental well-being (AMD, -2.08; 95% CI, -2.80 to -1.36). Positive school climate, 
high home connectedness, and having a friend during lockdown were protective 
factors during the pandemic. Female gender and initial low risk for mental 
health difficulties were associated with greater mental health deteriorations. 
Partial school attendance during lockdown was associated with better adjustment 
than no attendance when returning to school.
CONCLUSIONS AND RELEVANCE: This cohort study of secondary school students 
demonstrated that to promote mental health and adjustment, policy interventions 
should foster home connectedness, peer friendship, and school climate; avoid 
full school closures; and consider individual differences.

DOI: 10.1001/jamanetworkopen.2023.35016
PMCID: PMC10514742
PMID: 37733343 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest Disclosures: Dr Hinze 
reported grants from Stiftung Oskar-Helene-Heim as part of a postdoctoral 
fellowship. Prof Ford reported contracted research consultancy with Place2Be 
outside the submitted work. No other disclosures were reported.


365. J Prim Care Community Health. 2023 Jan-Dec;14:21501319231200400. doi: 
10.1177/21501319231200400.

Sociodemographic Factors, Mental Health, and Emotional Eating Associated With 
Concern for COVID-19 Contagion in Nurses: A Cross-Sectional Study.

Ricalde-Castillo Y(1), Celis-Mendoza M(1), Morales-García M(1), Huancahuire-Vega 
S(1), Calizaya-Milla YE(1), Saintila J(2), Sairitupa-Sanchez LZ(1)(3), 
Morales-García SB(4), Morales-García WC(1).

Author information:
(1)Universidad Peruana Unión, Lima, Perú.
(2)Universidad Señor de Sipán, Chiclayo, Perú.
(3)Clínica Good Hope, Miraflores, Lima, Perú.
(4)Universidad Científica del Sur, Lima, Perú.

OBJECTIVE: To determine the association between sociodemographic factors, 
stress, depression and anxiety, emotional eating, and concern about COVID-19 
contagion in first and second-line Peruvian nurses.
METHODOLOGY: The study was cross-sectional and conducted with 500 Peruvian 
nurses of both sexes, over 18 years of age. Validated questionnaires were used 
to measure sociodemographic aspects, concern about COVID-19, generalized 
anxiety, depression, self-perceived stress, and emotional eating. Multiple 
linear regression analysis was performed to analyze the factors affecting 
concern about COVID-19 contagion.
RESULTS: The multiple linear regression analysis showed that stress, being 
between the ages of 18 and 29 years, being male, being from the coastal region 
or the jungle region, having a bachelor's degree, severe anxiety, and severe 
depression were associated with higher concern about COVID-19. On the other 
hand, having more than 5 to 10 years of experience and more than 10 years of 
experience, low emotional eating, and non-emotional eating were negatively 
associated with concern. This model explained 44.05% of the variability among 
the participating nurses.
CONCLUSION: These findings provide resources for future research on the 
comprehensive well-being of nursing staff by exploring various sociodemographic 
aspects and mental conditions associated with greater concern about COVID-19. 
Meanwhile, years of experience and emotional eating behavior were associated 
with lower concern about COVID-19. Future studies could incorporate this 
information to preserve the mental and physical health of nurses in the face of 
potential occupational threats.

DOI: 10.1177/21501319231200400
PMCID: PMC10515584
PMID: 37731344 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


366. Aust J Prim Health. 2024 Feb;30(1):NULL. doi: 10.1071/PY23006.

The impact of COVID-19 on community mental health: lessons learned from 
Tasmania, Australia.

Savaglio M(1), O'Donnell R(1), Skouteris H(2).

Author information:
(1)<institution content-type="university">Health and Social Care Unit, School of 
Public Health and Preventive Medicine, Monash University</institution>, 
<city>Melbourne</city>, <state>Vic.</state>, <country>Australia</country>.
(2)<institution content-type="university">Health and Social Care Unit, School of 
Public Health and Preventive Medicine, Monash University</institution>, 
<city>Melbourne</city>, <state>Vic.</state>, <country>Australia</country>; and 
<institution content-type="university">Warwick Business School, University of 
Warwick</institution>, <city>Coventry</city>, <country>UK</country>.

BACKGROUND: The COVID-19 pandemic had a significant impact on community mental 
health globally and widened pre-existing health and social inequities. Tasmania, 
Australia has one of the highest rates of mental ill health and socioeconomic 
disadvantage in the country. Whilst Tasmania experienced a delayed and reduced 
physical presence of COVID-19 compared to other states and territories, mental 
health impacts remain. It is necessary to understand such impacts to inform 
policy, practice, and recommendations to enhance the mental health service 
sector and prevent future mental health burden. This qualitative study aimed to 
explore expert mental health stakeholders' perspectives of the impact of 
COVID-19 on: (1) the mental health of people living in Tasmania, and (2) mental 
health services.
METHOD: Semi-structured interviews with 12 expert mental health stakeholders 
across Tasmania were conducted. This sample was well-positioned to comment on 
the impact of COVID-19 on community mental health and provide recommendations to 
enhance the sector. Interviews were thematically analysed.
RESULTS: Three subthemes exploring the COVID-19 impact on mental health were 
included: (1) anxiety, distress, and isolation; (2) varying presentations across 
age groups; and (3) increased complexity. Four key themes capturing the COVID-19 
impact on mental health services were identified: (1) transition to telehealth; 
(2) increased service demand; (3) spotlight on service gaps; and (4) local 
workforce shortages.
CONCLUSIONS: The pandemic has highlighted existing gaps across the community 
mental health service sector, and exacerbated existing psychosocial/structural 
stressors resulting in increased presentations and complexity of mental illness 
among the community, particularly for youth. Existing treatment gaps and 
inequities in service access, engagement, and mental health outcomes will 
persist if not addressed. Recommendations have been provided to inform community 
mental health service planning, policy, design, access, and provision, and 
improve wellbeing.

DOI: 10.1071/PY23006
PMID: 37731283 [Indexed for MEDLINE]


367. BMC Geriatr. 2023 Sep 20;23(1):580. doi: 10.1186/s12877-023-04282-6.

Older adults' experiences during the COVID-19 pandemic: a qualitative systematic 
literature review.

Derrer-Merk E(1), Reyes-Rodriguez MF(2), Soulsby LK(3), Roper L(4), Bennett 
KM(3).

Author information:
(1)University of Liverpool, Eleanor Rathbone Building, Bedford Street South, 
Liverpool, L697ZA, UK. e.derrer-merk@liverpool.ac.uk.
(2)Universidad de los Andes, Carrera 1 No. 18A-12, Bogotá, Colombia.
(3)University of Liverpool, Eleanor Rathbone Building, Bedford Street South, 
Liverpool, L697ZA, UK.
(4)Principal Health Psychologist, Resilience Hub, Lancashire & South Cumbria 
Foundation Hospital, Chorley, UK.

OBJECTIVES: Relatively little is known about the lived experiences of older 
adults during the COVID-19 pandemic. We systematically review the international 
literature to understand the lived experiences of older adult's experiences 
during the pandemic.
DESIGN AND METHODOLOGY: This study uses a meta-ethnographical approach to 
investigate the included studies. The analyses were undertaken with 
constructivist grounded theory.
RESULTS: Thirty-two studies met the inclusion criteria and only five papers were 
of low quality. Most, but not all studies, were from the global north. We 
identified three themes: desired and challenged wellbeing; coping and 
adaptation; and discrimination and intersectionality. Overall, the studies' 
findings were varied and reflected different times during the pandemic. Studies 
reported the impact of mass media messaging and its mostly negative impact on 
older adults. Many studies highlighted the impact of the COVID-19 pandemic on 
participants' social connectivity and well-being including missing the proximity 
of loved ones and in consequence experienced an increase in anxiety, feeling of 
depression, or loneliness. However, many studies reported how participants 
adapted to the change of lifestyle including new ways of communication, and 
social distancing. Some studies focused on discrimination and the experiences of 
sexual and gender minority and ethnic minority participants. Studies found that 
the pandemic impacted the participants' well-being including suicidal risk 
behaviour, friendship loss, and increased mental health issues.
CONCLUSION: The COVID-19 pandemic disrupted and impacted older adults' 
well-being worldwide. Despite the cultural and socio-economic differences many 
commonalities were found. Studies described the impact of mass media reporting, 
social connectivity, impact of confinement on well-being, coping, and on 
discrimination. The authors suggest that these findings need to be acknowledged 
for future pandemic strategies. Additionally, policy-making processes need to 
include older adults to address their needs. PROSPERO record [CRD42022331714], 
(Derrer-Merk et al., Older adults' lived experiences during the COVID-19 
pandemic: a systematic review, 2022).

© 2023. BioMed Central Ltd., part of Springer Nature.

DOI: 10.1186/s12877-023-04282-6
PMCID: PMC10510218
PMID: 37730571 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


368. Arthritis Care Res (Hoboken). 2024 Jan;76(1):81-87. doi: 10.1002/acr.25239. Epub 
2023 Dec 14.

Impact of the COVID-19 Pandemic on Health Care Access and Diagnosis of Pulmonary 
Arterial Hypertension Among Patients With Systemic Sclerosis.

Callisto A(1), Hansen D(2), Walker J(3), Ngian GS(4), Apostolopoulos D(4), Liew 
D(5), Chand V(6), Hill CL(7), Griggs K(1), Calderone A(2), Nikpour M(8), Sahhar 
J(4), Stevens W(2), Proudman S(1).

Author information:
(1)Royal Adelaide Hospital and University of Adelaide, Adelaide, South 
Australia, Australia.
(2)St. Vincent's Hospital, Melbourne, Victoria, Australia.
(3)Flinders Medical Centre, Adelaide, South Australia, Australia.
(4)Monash University, Clayton, and Monash Health, Melbourne, Victoria, 
Australia.
(5)Austin Health and University of Melbourne, Melbourne, Victoria, Australia.
(6)School of Public Health and Preventative Medicine, Monash University, 
Melbourne, Australia.
(7)The Queen Elizabeth Hospital, Woodville, and Royal Adelaide Hospital and 
University of Adelaide, Adelaide, South Australia, Australia.
(8)University of Melbourne and St. Vincent's Hospital, Melbourne, Victoria, 
Australia.

OBJECTIVE: Regular clinical assessment for complications of systemic sclerosis 
(SSc) such as pulmonary arterial hypertension (PAH) is essential for early 
institution of therapy and improved outcomes. The objective of this study was to 
determine the impact of COVID-19 pandemic-related restrictions on health care 
access of patients with SSc, including screening for PAH.
METHODS: South Australian and Victorian patients enrolled in the Australian 
Scleroderma Cohort Study were surveyed about their perceptions of the impact of 
the pandemic on mental well-being, access to medications, investigations, and 
management of SSc. Frequency of annual rheumatology assessments, pulmonary 
function tests (PFT), and transthoracic echocardiography (TTE) to screen for PAH 
were compared with rates from before the pandemic.
RESULTS: A total of 312 of 810 patients with SSc responded (38.5% response); 273 
were female (87.5%), the median age was 64.7 years, 77.2% had limited disease, 
the median illness duration was 15.6 years, 15.7% were immunosuppressed, 32.1% 
had interstitial lung disease, and 6.4% had PAH. A total of 65.7% of 
consultations were by telehealth, of which 81.2% were by telephone. Compared 
with respondents in South Australia (n = 109), Victorian respondents (n = 203) 
experiencing prolonged lockdown, reported reduced access to their rheumatologist 
(49.3% vs 27.9%; P = 0.004), greater use of consultation by video (17.3% vs 
2.1%; P = 0.008), greater health care disruption (49.0% vs 23.2%; P < 0.001), 
and worse mental health (P = 0.002). Respondents reported reduced access to PFT 
and TTE (31.7% and 22.5%, respectively). Annual visits, PFT, TTE, and new 
diagnoses of PAH were reduced in 2020 to 2022 compared with 2011 to 2019.
CONCLUSION: The COVID-19 pandemic-related disruption to health care for patients 
with SSc was associated with worse mental health and reduced screening and 
diagnosis of PAH, which may impact long-term outcomes.

© 2023 The Authors. Arthritis Care & Research published by Wiley Periodicals LLC 
on behalf of American College of Rheumatology.

DOI: 10.1002/acr.25239
PMCID: PMC10952702
PMID: 37728139 [Indexed for MEDLINE]


369. Front Public Health. 2023 Sep 1;11:1212297. doi: 10.3389/fpubh.2023.1212297. 
eCollection 2023.

Child and youth mental health and wellbeing before and after returning to 
in-person learning in secondary schools in the context of COVID-19.

Qian L(1), McWeeny R(1), Shinkaruk C(2), Baxter A(3), Cao B(1), Greenshaw A(1), 
Silverstone P(1), Pazderka H(1), Wei Y(1).

Author information:
(1)Department of Psychiatry, University of Alberta, Edmonton, AB, Canada.
(2)Edmonton Catholic School Division, Edmonton, AB, Canada.
(3)Alberta Health Services Calgary Zone, Calgary, AB, Canada.

BACKGROUND: As children reintegrate with in-person classroom learning after 
COVID-19, health and education institutions should remain mindful of students' 
mental health. There is a paucity of data on changes in students' mental health 
before, during and after their return to in-person classroom learning.
METHODS: We collected and analyzed data on self-reported wellbeing, general 
mental health, perceived stress, and help-seeking attitudes from grade 7-12 
students in a Catholic school division in Canada (n = 258 at baseline; n = 132 
at follow-up). Outcomes were compared according to demographic differences such 
as gender, grade level, experience accessing mental health services, and 
presence of support staff between baseline and follow-up. Effects of time points 
and each demographic variable on each outcome and on the prediction of students' 
mental health were also analyzed.
RESULTS: No significant differences were apparent for outcomes between baseline 
and follow-up. However, specific subgroups: junior high students, male students, 
students who had not accessed mental health services, and students who had 
access to support-staff had better outcomes than their counterparts. From 
baseline to follow-up, male students reported mental health decline 
[Mean = 11.79, SD = 6.14; Mean = 16.29, SD = 7.47, F(1, 333) = 8.36, p < 0.01]; 
students who had not accessed mental health services demonstrated greater stress 
[Mean = 20.89, SD = 4.09; Mean = 22.28, SD = 2.24, F(1, 352) = 6.20, p < 0.05]; 
students who did not specify a binary gender reported improved general mental 
health [Mean = 19.87, SD = 5.89; Mean = 13.00, SD = 7.40, F(1, 333) = 8.70, 
p < 0.01], and students who did not have access to support-staff improved 
help-seeking attitudes [Mean = 22.32, SD = 4.62; Mean = 24.76, SD = 4.81; F(1, 
346) = 5.80, p < 0.05]. At each time point, students indicated parents, 
guardians, and close friends as their most-preferred help-seeking sources. High 
stress predicted lower wellbeing at baseline, but higher wellbeing at follow-up.
CONCLUSION: Students presented stable mental health. Subgroups with decreased 
mental health may benefit from extra mental health support through building 
capacity among teachers and health care professionals to support students 
following public health emergencies.

Copyright © 2023 Qian, McWeeny, Shinkaruk, Baxter, Cao, Greenshaw, Silverstone, 
Pazderka and Wei.

DOI: 10.3389/fpubh.2023.1212297
PMCID: PMC10506407
PMID: 37727609 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


370. Int J Public Health. 2023 Sep 4;68:1605851. doi: 10.3389/ijph.2023.1605851. 
eCollection 2023.

Accuracy of the Personal Economic Distress Index Among Arabic Unemployed.

Razki K(1)(2), Zgueb Y(1)(2), Aissa A(1)(2), Ouali ES(3), Wahabi A(4), Ouali 
U(1)(2).

Author information:
(1)Psychiatry Department (A) Razi Hospital, Manouba, Tunisia.
(2)Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia.
(3)Psychiatry Department, Humanitas University, Rozzano, Italy.
(4)Institut des Hautes Etudes Commerciales de Carthage, Tunis, Tunisia.

Objectives: Studies about The Index of Personal Economic Distress (IPED) in Arab 
countries since the onset of the COVID-19 pandemic have been alarming. This 
study aimed to explore the reliability, factor structure, and criterion validity 
of the Arabic IPED in a sample of unemployed Tunisians during the past 6 months. 
Methods: The Arabic version of the IPED and the validated Hospital Anxiety and 
Depression Scale (HADS) were administered to a total of 2011 unemployed people 
originating from all Tunisian regions. Principal component analysis (PCA) with 
confirmatory factor analysis (CFA) was used to establish the spontaneous 
distribution of the 8 items and possible factors of the IPED. Receiver operating 
characteristic (ROC) analysis was conducted to assess the ability of the IPED to 
distinguish between unemployed individuals with no economic distress and those 
in distress. The correlation between the IPED and the HADS were explored. 
Results: The reliability of the Arabic version of the IPED was adequate. The PCA 
suggested two main components of the Arabic version of the IPED: the first 
component including five items focused on financial responsibilities towards 
state structures and the second dimension containing three items focused on 
well-being. A statistically significant association (p = 0.01; r = 0.05) was 
found between the well-being dimension of the IPED and the Anxiety subscale of 
HADS. Conclusion: This validated version of the IPED is an important tool to 
study the impact of economic crises on the mental health of unemployed people, 
as demonstrated in the link found in this study between economic distress and 
anxiety.

Copyright © 2023 Razki, Zgueb, Aissa, Ouali, Wahabi and Ouali.

DOI: 10.3389/ijph.2023.1605851
PMCID: PMC10506069
PMID: 37727582 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they do not have any 
conflicts of interest.


371. Clin Interv Aging. 2023 Sep 14;18:1523-1534. doi: 10.2147/CIA.S410396. 
eCollection 2023.

Potential Mobile Health Applications for Improving the Mental Health of the 
Elderly: A Systematic Review.

Chou YH(#)(1), Lin C(#)(2)(3)(4), Lee SH(#)(2)(5), Chang Chien YW(#)(6), Cheng 
LC(#)(7).

Author information:
(1)Department of Psychiatry, Taoyuan Chang Gung Memorial Hospital, Taoyuan 
County, Taiwan.
(2)College of Medicine, Chang Gung University, Taoyuan County, Taiwan.
(3)Department of Psychiatry, Keelung Chang Gung Memorial Hospital, Keelung City, 
Taiwan.
(4)Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, 
Taiwan.
(5)Department of Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan 
County, Taiwan.
(6)Department of Photography and Virtual Reality Design, Huafan University, New 
Taipei, Taiwan.
(7)Department of Information and Finance Management, National Taipei University 
of Technology, Taipei, Taiwan.
(#)Contributed equally

The rapid aging of the global population presents challenges in providing mental 
health care resources for older adults aged 65 and above. The COVID-19 pandemic 
has further exacerbated the global population's psychological distress due to 
social isolation and distancing. Thus, there is an urgent need to update 
scholarly knowledge on the effectiveness of mHealth applications to improve 
older people's mental health. This systematic review summarizes recent 
literature on chatbots aimed at enhancing mental health and well-being. Sixteen 
papers describing six apps or prototypes were reviewed, indicating the 
practicality, feasibility, and acceptance of chatbots for promoting mental 
health in older adults. Engaging with chatbots led to improvements in well-being 
and stress reduction, as well as a decrement in depressive symptoms. Mobile 
health applications addressing these studies are categorized for reference.

© 2023 Chou et al.

DOI: 10.2147/CIA.S410396
PMCID: PMC10506600
PMID: 37727447 [Indexed for MEDLINE]

Conflict of interest statement: The authors report no conflicts of interest in 
this study.


372. Geriatr Gerontol Int. 2024 Mar;24 Suppl 1:364-369. doi: 10.1111/ggi.14675. Epub 
2023 Sep 19.

Associations among social participation types, mental and subjective well-being 
in Chinese older adults during the COVID-19 pandemic.

Chan SCY(1), Huang QL(2), Fung CK(3).

Author information:
(1)Felizberta Lo Padilla Tong School of Social Sciences, Caritas Institute of 
Higher Education, Tseung Kwan O, Hong Kong.
(2)Department of Social and Behavioural Sciences, City University of Hong Kong, 
Hong Kong.
(3)School of Arts and Social Sciences, Hong Kong Metropolitan University, Hong 
Kong.

AIMS: This study investigated the relationships between specific types of social 
participation and well-being variables (i.e., life satisfaction, positive 
affect, negative affect, symptoms of depression and anxiety) in Chinese older 
adults in Hong Kong.
METHODS: This study was a cross-sectional study. A convenience sample of 341 
participants aged 55-95 years (mean, 70.92; SD, 9.03) was recruited to complete 
a survey questionnaire during the COVID-19 pandemic (between April and June 
2022). Five hierarchical multiple regression analyses were conducted to examine 
the relationships between different types of social participation (physical, 
cultural, recreational, religious, and voluntary work) and outcome variables.
RESULTS: After controlling for covariates, it was revealed that only physical 
activities were associated with all outcome variables. Religious and cultural 
activities were positively related to positive affect, while an inverse 
relationship was found between recreational activities and anxiety.
CONCLUSIONS: With the restrictions on social participation arising from the 
COVID-19 pandemic, these findings suggest that promoting different types of 
social interactions might foster various aspects of well-being in Chinese older 
adults. To achieve successful aging, the role of physical activities might be of 
paramount importance even under adverse situations. Geriatr Gerontol Int 2024; 
24: 364-369.

© 2023 Japan Geriatrics Society.

DOI: 10.1111/ggi.14675
PMID: 37726869 [Indexed for MEDLINE]


373. BMC Public Health. 2023 Sep 19;23(1):1823. doi: 10.1186/s12889-023-16731-3.

Measuring COVID-19 related stress and its associated factors among the parents 
of school-aged children during the first lockdown in France.

Bourion-Bédès S(1)(2), Rousseau H(3), Batt M(4), Beltrand C(5), Machane R(5), 
Tarquinio P(6), Tarquinio C(7), Baumann C(3)(7).

Author information:
(1)Centre Hospitalier de Versailles, Service Universitaire de Psychiatrie de 
L'Enfant Et de L'Adolescent, 78000, Versailles-Le Chesnay, France. 
sbourionbedes@ght78sud.fr.
(2)Université Paris-Saclay, UVSQ, Inserm U1018, CESP, 'DevPsy', 94807, 
Villejuif, France. sbourionbedes@ght78sud.fr.
(3)Methodology, Data Management and Statistics Unit, University Hospital of 
Nancy, 54000, Nancy, France.
(4)InterPsy, GRC Team, University of Lorraine, 54000, Nancy, France.
(5)Centre Hospitalier de Versailles, Service Universitaire de Psychiatrie de 
L'Enfant Et de L'Adolescent, 78000, Versailles-Le Chesnay, France.
(6)Pierre Janet Center, University of Lorraine, 57 000, Metz, France.
(7)UR 4360 APEMAC (Health Adjustment, Measurement and Assessment, 
Interdisciplinary Approaches), University of Lorraine, 54000, Nancy, France.

BACKGROUND: The COVID-19 pandemic placed important challenges on parents, as 
they had to meet various demands during lockdown, including childcare, work and 
homeschooling. Therefore, the current study aimed to investigate perceived 
stress levels among the parents of school-aged children and explore their 
association with sociodemographic, environmental and psychological factors 
during lockdown.
METHODS: A cross-sectional study was conducted among the parents of school-aged 
children ages 8 to 18, who lived in the Grand Est region of France during the 
first wave of the pandemic. An online survey collected sociodemographic data, 
living and working conditions, and exposure to COVID-19 as well as parent's 
levels of perceived stress (PSS-10), self-perceived health status (SF-12), 
social support (MSPSS) and resilience (BRS). Multivariable logistic regression 
models were conducted to evaluate the association between moderate to severe 
perceived stress and various factors.
RESULTS: In total, 734 parents were included. The results indicated that 47% 
were experiencing moderate stress and 7.2% were experiencing severe stress. 
Factors most strongly associated with risk of moderate to severe levels of 
stress were lower levels of parental resilience (OR = 3.8, 95% CI: 2.2-6.6) and 
poor self-perceived mental health status (OR = 7.3, 95% CI: 5.0-10.8). The 
following risk factors were also identified: female sex; being in the age range 
of 35-44; difficulties isolating and contracting COVID-19, which involved 
hospitalization and separation or isolation from family. The support of friends 
(OR = 0.8, 95% CI: 0.7-1.0) and family (OR = 0.5, 95% CI: 0.3-0.8) were 
protective factors.
CONCLUSIONS: These findings suggest that supportive and preventive programs 
should focus on the improvement of resilience and mental health management to 
promote parents' wellbeing. Research has to focus both on individuals' inner 
potential for increasing resilience and the environmental resources to be 
activated. Building and boosting resilience among parents could serve as a 
protective factor against negative outcomes for them and their families.

© 2023. BioMed Central Ltd., part of Springer Nature.

DOI: 10.1186/s12889-023-16731-3
PMCID: PMC10510290
PMID: 37726674 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


374. Age Ageing. 2023 Sep 1;52(9):afad170. doi: 10.1093/ageing/afad170.

The mental health impact of the COVID-19 pandemic on older adults: a systematic 
review and meta-analysis.

Schäfer SK(1)(2), Lindner S(3), Kunzler AM(1)(4), Meerpohl JJ(4), Lieb K(1)(3).

Author information:
(1)Leibniz Institute for Resilience Research, Mainz, Germany.
(2)Department of Clinical Psychology, Psychotherapy and Diagnostics, Technische 
Universität Braunschweig, Braunschweig, Germany.
(3)Department of Psychiatry and Psychotherapy, University Medical Center of the 
Johannes Gutenberg University Mainz, Mainz, Germany.
(4)Institute for Evidence in Medicine, Medical Center - University of Freiburg, 
Faculty of Medicine, University of Freiburg, Freiburg, Germany.

BACKGROUND: Early in the COVID-19 pandemic, many experts pointed to potential 
adverse mental health effects for older adults. By contrast, many studies in 
young to middle-aged adults found older age to be associated with reduced mental 
burden. However, a systematic review on older adults is missing.
OBJECTIVES: To comprehensively assess the pandemic's mental health impact on 
older adults.
DATA SOURCES: We searched nine databases from December 2019 to April 2022.
STUDY SELECTION: We included longitudinal and repeated cross-sectional studies 
assessing pre- and/or peri-pandemic mental distress and/or positive mental 
health indicators (e.g. wellbeing) on at least two occasions.
DATA SYNTHESIS: We identified 108 studies comprising 102,136 participants 
(≥60 years). After removal of outliers, there was a small increase in mental 
distress from pre-to-peri-pandemic assessments, standardised mean difference 
(SMD) = 0.10, 95% confidence interval (CI) [0.01, 0.18]. Furthermore, a small 
peri-pandemic decrease in anxiety symptoms was observed, whereas other symptoms 
remained unchanged. For positive mental health indicators, wellbeing and quality 
of life showed an initial decrease, whereas overall positive mental health 
increased during the pandemic, SMD = 0.08, 95% CI [0.01, 0.15]. Being female was 
related to larger peri-pandemic increases in mental distress.
CONCLUSIONS: Based on many studies, this review demonstrated small decreases in 
mental health during early stages of the pandemic in older adults, with evidence 
for later recovery. These findings are similar to those for younger adults and 
correct earlier claims that older adults are at particular risk for negative 
mental health consequences. The results ask for further research into resilience 
and adaptation processes in older adults.

© The Author(s) 2023. Published by Oxford University Press on behalf of the 
British Geriatrics Society. All rights reserved. For permissions, please email: 
journals.permissions@oup.com.

DOI: 10.1093/ageing/afad170
PMID: 37725975 [Indexed for MEDLINE]


375. J Pediatr Health Care. 2023 Nov-Dec;37(6):658-672. doi: 
10.1016/j.pedhc.2023.08.003. Epub 2023 Sep 17.

The Cost of Caring During COVID-19: A Clarion Call to Action to Support the 
Pediatric Advanced Practice Nursing Workforce.

Sonney J, Peck JL.

INTRODUCTION: This study reexamined the holistic impacts of COVID-19 on the 
pediatric advanced practice registered nursing (APRN) workforce two years after 
the 2020 assessment.
METHOD: This cross-sectional descriptive study used a convenience sample of 
pediatric APRNs affiliated with the National Association of Pediatric Nurse 
Practitioners (NAPNAP). A modified NAPNAP survey explored numerous impacts of 
COVID-19 on the pediatric APRN workforce.
RESULTS: Study participants (n = 1,087) reported widespread pandemic impacts 
across personal and professional domains. Alarmingly, 87% reported professional 
burnout, and 80% expressed concern over their overall mental health. The impacts 
of the pandemic on child health are ominous, with 94% of participants reporting 
pediatric mental health concerns, a devastating increase from the previous 
study.
DISCUSSION: The pediatric APRN workforce is in crisis amid a national pediatric 
mental health emergency. Multilevel interventions are critically emergent to 
sustain the APRN workforce and promote the health and well-being of children and 
families.

Copyright © 2023 National Association of Pediatric Nurse Practitioners. 
Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.pedhc.2023.08.003
PMID: 37725029 [Indexed for MEDLINE]

Conflict of interest statement: CONFLICTS OF INTEREST None to report.


376. Hum Resour Health. 2023 Sep 18;21(1):76. doi: 10.1186/s12960-023-00862-0.

Psychosocial status and risk perception among Iranian healthcare workers during 
the fifth wave of the COVID-19 pandemic.

Khazaee-Pool M(1), Moradi M(2), Pashaei T(3), Ponnet K(4).

Author information:
(1)Department of Health Education and Promotion, School of Health, Health 
Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran. 
khazaie_m@yahoo.com.
(2)Department of Biostatistics and Epidemiology, School of Health, Health 
Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
(3)Social Determinants of Health Research Center, Research Institute for Health 
Development, Kurdistan University of Medical Sciences, Sanandaj, Iran. 
pashaeit@gmail.com.
(4)Department of Communication Sciences, imec-mict-Ghent University, Ghent, 
Belgium.

BACKGROUND: Healthcare workers (HCWs) are essential resources, and their health 
and wellbeing are key not only for offering constant and useful care facilities 
to clients, but also for maintaining the safety of the workforce and patients. 
The risk of severe mental health problems among HCWs may have increased during 
large outbreaks of COVID-19. To evaluate the psychosocial status and risk 
perception of HCWs who participated in treating COVID-19 patients in Northern 
Iran, we performed a web-based cross-sectional study.
METHODS: The web-based cross-sectional design was applied between June 27 and 
September 2, 2021. Using convenience sampling, 637 HCWs were recruited from 
hospitals in Northern Iran (Mazandaran). The HCWs completed self-report 
questionnaires that included a sociodemographic information form, the 12-item 
General Health Questionnaire, Impact of the Event Scale-Revised, Risk Perception 
Questionnaire, and Anxiety Stress Scale-21. The data were analyzed via 
descriptive and inferential statistics and univariate/multivariate logistic 
regression to assess the risk factors linked to each psychosocial consequence.
RESULTS: The results reveal that the COVID-19 pandemic had an adverse 
psychosocial influence on HCWs, which was already apparent 1.5 years after the 
crisis began. Based on the results, 71.6%, 55.6%, and 32.3% of HCWs reported 
having anxiety, depression, and stress symptoms, respectively, since the 
outbreak of this disease. The logistic regression models displayed that marital 
status, having children, and working hours with patients were all risk factors 
of psychosocial impairment.
CONCLUSIONS: The outbreak of COVID-19 can be considered an important experience 
of a bio-disaster resulting in a significant rate of psychiatric problems in 
HCWs. There is a need for designing and promoting supportive programs to help 
HCWs cope and to improve their psychosocial state, and the present study has 
detected for whom psychosocial support may be effective and practical 1.5 years 
after the primary outbreak. Moreover, detecting and managing concerns and 
reducing infection-related embarrassment/stigma are essential for improving 
HCWs' mental health.

© 2023. BioMed Central Ltd., part of Springer Nature.

DOI: 10.1186/s12960-023-00862-0
PMCID: PMC10506218
PMID: 37723512 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


377. Appl Nurs Res. 2023 Oct;73:151721. doi: 10.1016/j.apnr.2023.151721. Epub 2023 
Aug 4.

Work anxiety factors, coronavirus anxiety and job satisfaction of Polish nurses 
facing COVID-19 pandemic outbreak.

Andruszkiewicz A(1), Kruczek A(2), Betke K(3), Adamczyk K(4).

Author information:
(1)Department of Basic Clinical Skills and Postgraduate Education of Nurses and 
Midwives, Faculty of Health Sciences, Collegium Medicum im. L. Rydygier in 
Bydgoszcz, Nicolaus Copernicus University in Toruń, Collegium Medicum in 
Bydgoszcz, 85-094 Bydgoszcz, Poland. Electronic address: 
anna.andruszkiewicz@cm.umk.pl.
(2)Department of Clinical Neuropsychology, Faculty of Health Sciences, Nicolaus 
Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, 85-094 
Bydgoszcz, Poland. Electronic address: agnieszka.kruczek@cm.umk.pl.
(3)Department of Basic Clinical Skills and Postgraduate Education of Nurses and 
Midwives, Faculty of Health Sciences, Collegium Medicum im. L. Rydygier in 
Bydgoszcz, Nicolaus Copernicus University in Toruń, Collegium Medicum in 
Bydgoszcz, 85-094 Bydgoszcz, Poland. Electronic address: 
katarzyna.betke@cm.umk.pl.
(4)Department of Health Psychology, Faculty of Health Science, Collegium 
Medicum, Jagiellonian University, 31-008 Cracow, Poland. Electronic address: 
katarzyna.1.adamczyk@uj.edu.pl.

BACKGROUND: During the SARS-CoV-2 pandemic, as in past disasters and 
emergencies, nurses around the world play an important role. What is more, the 
unprecedented pressure exerted by the pandemic on healthcare systems in every 
country brings big challenges to nurses, which may affect their well-being, work 
efficacy and job satisfaction.
OBJECTIVE: The main objective of the presented studies was to describe anxiety 
factors related to the work of nurses during the SARS-CoV-2 pandemic; to assess 
the intensity of coronavirus anxiety and job satisfaction experienced by nurses 
at that time; to assess predictors of job satisfaction of nurses during the 
COVID-19 pandemic; to assess the differences in the intensity of job 
satisfaction and coronavirus anxiety depending on the selected variables related 
to their experiences during the COVID-19 pandemic.
DESIGN: Anonymous questionnaire surveys were conducted online among the 
participants between 23 June 2020 and 23 March 2022 in Poland.
PARTICIPANTS: 433 nurses from 15 Polish provinces were included in the studies 
(age range 22-68; M = 41.63). Nursing seniority M = 18.6.
METHODS: The studies were based on: Satisfaction with Job Scale (SSP), 
Coronavirus Anxiety Scale (CAS), and a self-report structured questionnaire.
RESULTS: The most respondents indicated that they were afraid of becoming 
infected with SARS-CoV-2 (25.4 %), transmitting infection to the family 
(22.4 %), becoming sick with COVID-19 and experiencing health complications 
(6.7 %) and of excessive work responsibilities and physical fatigue (6.5 %). 
Based on the bivariate correlation, it can be concluded that job satisfaction of 
the respondents during the COVID-19 pandemic was on an average level (M = 19.9); 
coronavirus anxiety was on an average level (M = 4.9), and stress at work was on 
a high level (M = 7.1). Coronavirus anxiety did not constitute statistically 
significant predictors of job satisfaction of subjects studied during the 
pandemic (SE = 0,048; β = 0,05; p = 0.942).
CONCLUSIONS: Coronavirus anxiety wasn't associated with job satisfaction of 
nurses directly. Job satisfaction of nurses during the COVID-19 pandemic was 
likely to be shaped by a range of different factors.
TWEETABLE ABSTRACT: In Polish nurses coronavirus anxiety was average and wasn't 
associated with their job satisfaction.

Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.apnr.2023.151721
PMID: 37722789 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare that the research was conducted in the absence of any commercial or 
financial relationships that could be construed as a potential conflict of 
interest.


378. CMAJ. 2023 Sep 18;195(36):E1221-E1230. doi: 10.1503/cmaj.220507.

Emergency department visits and hospital admissions for suicidal ideation, 
self-poisoning and self-harm among adolescents in Canada during the COVID-19 
pandemic.

Poonai N(1), Freedman SB(2), Newton AS(2), Sawyer S(2), Gaucher N(2), Ali S(2), 
Wright B(2), Miller MR(2), Mater A(2), Fitzpatrick E(2), Jabbour M(2), Zemek 
R(2), Eltorki M(2), Doan Q(2); Pediatric Emergency Research Canada (PERC) 
Network.

Author information:
(1)Departments of Pediatrics, Internal Medicine, and Epidemiology and 
Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, 
Western University; Children's Health Research Institute (Poonai, Miller), 
London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency 
Medicine and Gastroenterology (Freedman), Departments of Pediatrics and 
Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, 
University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), 
Faculty of Medicine & Dentistry, College of Health Sciences, University of 
Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of 
Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine 
(Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and 
Women and Children's Health Research Institute (Ali, Wright), Faculty of 
Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's 
Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's 
Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency 
Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of 
Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; 
Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), 
Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, 
McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University 
of British Columbia, Vancouver, BC naveen.poonai@lhsc.on.ca.
(2)Departments of Pediatrics, Internal Medicine, and Epidemiology and 
Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, 
Western University; Children's Health Research Institute (Poonai, Miller), 
London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency 
Medicine and Gastroenterology (Freedman), Departments of Pediatrics and 
Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, 
University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), 
Faculty of Medicine & Dentistry, College of Health Sciences, University of 
Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of 
Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine 
(Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and 
Women and Children's Health Research Institute (Ali, Wright), Faculty of 
Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's 
Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's 
Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency 
Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of 
Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; 
Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), 
Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, 
McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University 
of British Columbia, Vancouver, BC.

BACKGROUND: The COVID-19 pandemic had profound effects on the mental wellbeing 
of adolescents. We sought to evaluate pandemic-related changes in health care 
use for suicidal ideation, self-poisoning and self-harm.
METHODS: We obtained data from the Canadian Institute for Health Information on 
emergency department visits and hospital admissions from April 2015 to March 
2022 among adolescents aged 10-18 years in Canada. We calculated the quarterly 
percentage of emergency department visits and hospital admissions for a 
composite outcome comprising suicidal ideation, self-poisoning and self-harm 
relative to all-cause emergency department visits and hospital admissions. We 
used interrupted time-series methods to compare changes in levels and trends of 
these outcomes between the prepandemic (Apr. 1, 2015-Mar. 1, 2020) and pandemic 
(Apr. 1, 2020-Mar. 31, 2022) periods.
RESULTS: The average quarterly percentage of emergency department visits for 
suicidal ideation, self-poisoning and self-harm relative to all-cause emergency 
department visits was 2.30% during the prepandemic period and 3.52% during the 
pandemic period. The level (0.08%, 95% confidence interval [CI] -0.79% to 0.95%) 
or trend (0.07% per quarter, 95% CI -0.14% to 0.28%) of this percentage did not 
change significantly between periods. The average quarterly percentage of 
hospital admissions for the composite outcome relative to all-cause admissions 
was 7.18% during the prepandemic period and 8.96% during the pandemic period. 
This percentage showed no significant change in level (-0.70%, 95% CI -1.90% to 
0.50%), but did show a significantly increasing trend (0.36% per quarter; 95% 
0.07% to 0.65%) during the pandemic versus prepandemic periods, specifically 
among females aged 10-14 years (0.76% per quarter, 95% CI 0.22% to 1.30%) and 
females aged 15-18 years (0.56% per quarter, 95% CI 0.31% to 0.81%).
INTERPRETATION: The quarterly change in the percentage of hospital admissions 
for suicidal ideation, self-poisoning and self-harm increased among adolescent 
females in Canada during the first 2 years of the COVID-19 pandemic. This 
underscores the need to promote public health policies that mitigate the impact 
of the pandemic on adolescent mental health.

© 2023 CMA Impact Inc. or its licensors.

DOI: 10.1503/cmaj.220507
PMCID: PMC10506508
PMID: 37722746 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: Naveen Poonai reports 
research funding from the Canadian Institutes of Health Research (CIHR) and 
Physicians Services Incorporated (PSI). Amanda Newton reports research funding 
from CIHR, the Women and Children’s Health Research Institute and Alberta 
Innovates. She sits on the mental health section board with the Canadian 
Paediatric Society. Samina Ali is a member of the scientific advisory board of 
the National Pain Advisory Council. Eleanor Fitzpatrick is executive chair of 
the IWK Research Ethics Board. Roger Zemek holds a Clinical Research Chair in 
Pediatric Concussion from the University of Ottawa, and receives research 
funding from the CIHR, Ontario Neurotrauma Foundation, PSI Foundation, CHEO 
Foundation, Ontario Brain Institute, National Football League, Ontario Ministry 
of Health, Public Health Agency of Canada, Parachute Canada and Ontario SPOR 
Support Unit. He sits on the board of directors for the North American Brain 
Injury Society in a volunteer role and is a cofounder of and minority 
shareholder in 360 Concussion Care, an interdisciplinary concussion clinic; no 
proceeds have been transferred to him. No other competing interests were 
declared.


379. Work. 2024;77(2):407-416. doi: 10.3233/WOR-220627.

Impact of COVID-19 on the self-esteem, psychological and dental esthetics of 
dental students.

Alqarawi FK(1), Alam BF(2), Nayab T(3), Alshehri S(4), Al-Jandan B(4), Fahim 
F(5), Ali S(4).

Author information:
(1)Department of Substitutive Dental Sciences, College of Dentistry, Imam 
Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
(2)Department of Oral Biology, Bahria University Dental College, Karachi, 
Pakistan.
(3)Department of Dental Materials Science, Sindh Institute of Oral Health 
Sciences, Jinnah Sindh Medical University, Karachi, Pakistan.
(4)Department of Biomedical Dental Sciences, College of Dentistry, Imam 
Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
(5)Department of BUCPT, Bahria University Health Sciences Campus, Karachi, 
Pakistan.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has badly affected the mental 
health, quality of life, and self-esteem of students worldwide.
OBJECTIVE: The current study aimed to evaluate the psychological impact and 
self-esteem of dental students using Rosenberg self-esteem scale and PIDAQ 
during the COVID-19 pandemic.
METHOD: This cross-sectional research was conducted amongst the dental students 
studying at various dental colleges in Karachi, Pakistan from January to May 
2022. Evaluation of psychological aspect and self-esteem of students was carried 
out using "Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ)", and 
"Rosenberg self-esteem scale" as perceived by students during the pandemic. For 
data analysis SPSS v24 was used. Data analysis comprised of descriptive 
analysis, Spearman correlation, One-way Anova and Linear regression. The level 
of significance of p value was less than 0.05.
RESULTS: Overall 332 students participated, among which there were 181 females 
(54.5%), 151 males (45.5%). Dental self-confidence showed a negative 
relationship with social influence, psychological effect, and aesthetic concern, 
while it was positively linked with self-esteem during the pandemic. Social 
impact demonstrated association with psychological impact, aesthetic concern, 
and self-esteem, while it was negatively correlated with dental confidence. 
Rosenberg score showed positive correlation with all the variables. 
Statistically significant association was identified for variables when compared 
with gender. Regression analysis indicated association of age with dental 
confidence and RSS, while gender with social influence.
CONCLUSION: The pandemic, aside from affecting the health of individuals 
worldwide, also badly affected the well-being, mental health, and self-esteem of 
the dental students. Dental aesthetics plays a crucial role in the mental 
wellbeing and self-esteem of the students.

DOI: 10.3233/WOR-220627
PMID: 37718829 [Indexed for MEDLINE]


380. Geriatr Nurs. 2023 Nov-Dec;54:99-107. doi: 10.1016/j.gerinurse.2023.08.012. Epub 
2023 Sep 18.

Together yet apart: Rethinking creativity and relational dementia care during 
the Covid-19 pandemic.

Tischler V(1), Zeilig H(2), O'Malley M(3), Asker C(4).

Author information:
(1)School of Psychology, Faculty of Health and Medical Sciences, University of 
Surrey, Guildford. GU2 7XH, UK. Electronic address: v.tischler@surrey.ac.uk.
(2)London College of Fashion, University of the Arts London, London. E20 2AR, 
UK.
(3)Association for Dementia Studies, University of Worcester, Worcester. WR2 
6AJ, UK.
(4)School of Psychology, Faculty of Health and Medical Sciences, University of 
Surrey, Guildford. GU2 7XH, UK.

Culture Box was a creative project that responded to deprivation and distress 
experienced by those with dementia in care homes during the COVID-19 pandemic. 
Remote and digital creative activities were designed and delivered as 'Culture 
Boxes' to care homes, aiming to alleviate social isolation and loneliness for 
people with dementia. Eighty-eight people with dementia and 33 care staff from 
33 care homes across England were recruited to the study, with 68 people with 
dementia and 28 staff completing the study 12 months later. Participatory Action 
Research combining mixed methods was used to evaluate the project. Baseline and 
follow-up surveys and dialogic interviews at 3 time points during the study 
collected quantitative and qualitative data and were analysed descriptively and 
via inductive thematic analysis respectively. Qualitative findings indicated 
that the project activities facilitated relational care through creative 
experiences characterised by sharing, building relationships, and developing a 
sense of community. Social health was promoted via participation in social 
activities and fostering independence. Future studies should further explore the 
utility of creative practices to develop relational care, to support care staff, 
and to maximise wellbeing benefits for those living with dementia.

Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.gerinurse.2023.08.012
PMID: 37717304 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


381. Medicine (Baltimore). 2023 Sep 15;102(37):e35171. doi: 
10.1097/MD.0000000000035171.

Loneliness and depression among community-dwelling older adults in China during 
the COVID-19 epidemic: The mediating role of social support.

Li P(1)(2), Zhong J(3), He Y(1), Yan H(1), Xie M(1), Meng L(1)(2).

Author information:
(1)School of Nursing, Xiangnan University, Chenzhou, China.
(2)College of Nursing and Allied Health Sciences, St. Paul University Manila, 
Malate Manila, Philippines.
(3)University Library, Xiangnan University, Chenzhou, China.

The psychological condition of community-dwelling older adults is a global 
concern under coronavirus disease 2019. Loneliness is the key risk factor for 
depression among community-dwelling older adults. This study aims to explore the 
role of social support as a mediating factor in the relationship between 
depression and loneliness among community-dwelling older adults. We conducted a 
cross-sectional study in Chenzhou, Hunan Province, China, from June to December 
2021. The sample consisted of 570 community-dwelling adults aged over 60 years. 
Data were collected through a general information questionnaire, the Social 
Support Rating Scale, the University of California at Los Angeles Loneliness 
Scale, and the Center for Epidemiological Survey, Depression Scale. Statistical 
Package for the Social Sciences PROCESS macro was used to examine the mediating 
effect of social support between loneliness and depression. This study found 
that depression was negatively associated with social support (r = -0.381, 
P < .001), but it was positively correlated with loneliness (r = 0.403, 
P < .001); loneliness was a predictor of depression (B = 0.333, P < .001). In 
addition, social support significantly mediated the relationship between 
loneliness and depression, with an indirect effect of 0.239 (95% Bootstrap CI 
-0.264 to -0.510), the overall effect value for depression was 0.572, accounting 
for 56.3% of the total variance in depression within this model. In conclusion, 
the findings suggest that social support plays a mediating role between 
depression and loneliness in older adults. This implies that interventions aimed 
at reducing loneliness and enhancing social support have the potential to 
alleviate depressive symptoms among this population. By addressing these 
factors, healthcare professionals and caregivers can promote the mental 
well-being of older adults and contribute to improved overall quality of life.

Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

DOI: 10.1097/MD.0000000000035171
PMCID: PMC10508438
PMID: 37713830 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
disclose.


382. Int J Soc Psychiatry. 2024 Feb;70(1):144-156. doi: 10.1177/00207640231196741. 
Epub 2023 Sep 15.

Effect of work from home and employee mental health through mediating role of 
workaholism and work-family balance.

Krishnan C(1), Singh S(1), Baba MM(2).

Author information:
(1)Symbiosis Center for Management Studies, Noida; Symbiosis International 
Deemed University, Pune, India.
(2)University of Kashmir, Srinagar, India.

BACKGROUND: The current global outbreak caused by COVID-19 has produced a unique 
situation with severe health and financial consequences. The fast and quick 
global impact called for an immediate response. A key public health action was 
the decision to amend the law to allow employees to work from home (WFH) 
whenever it was possible. In response to public health restrictions to stop the 
spread of COVID-19, organizations quickly switched to WFH without fully 
comprehending the effects of continued WFH on mental and physical health. 
Working from anywhere and at any time has made the separation between business 
and personal life more difficult. These modifications may cause employees' 
workdays to be longer and to experience greater work-life conflict. Overwork and 
work addiction provide a greater risk to the public's health and can harm 
various facets of mental and physical health, such as depression, anxiety, and 
sleep difficulties. There hasn't been much research on the underlying processes 
that link workaholism to poor mental health, especially among Indian academics.
PURPOSE: There is a rise in the number of people who are worried about their 
mental health in academic settings. The primary purpose of this study is to 
determine whether academicians in India can potentially have a healthy 
work-family balance, which may mitigate the negative impacts of workaholism and 
poor mental health especially due to the Work from Home system.
METHODOLOGY: A population-based study was conducted on academicians (n = 456) at 
private and public universities in Delhi NCR, India. Workaholism, work-family 
balance, and mental health difficulties were all measured using self-reported 
scales in the study. By using path analysis, the proposed mediation model was 
evaluated. The survey responses had an accuracy rate of 80%. Based on the 
conceptual research framework, PLS-SEM path modeling is used to find the causal 
connection between the indicators and latent components.
FINDINGS: The findings indicated that workaholism has been associated with 
mental health in two different ways: directly and through work-family balance. 
The path analysis found a statistically significant relationship between work 
from home and mental health through workaholism and work-family balance. 
Increased levels of anxiety, depression, stress, headaches, exhaustion, and 
reduced job satisfaction were some of the mental health consequences of Work 
from Home.
PRACTICAL IMPLICATION: This study provides real-world guidance to human resource 
managers on how to prioritize composite-level interventions at all levels of the 
university to create highly satisfied employees, provide a good working 
environment, and improve employees' mental health.
ORIGINALITY/VALUE: Many researches have been done on the relationship between 
work-from-home and employee mental health, but relatively few have looked at how 
work-life balance and workaholism play a role in how work-from-home affects 
employees' mental health. This study fills a need in the academic and 
practitioner literature by investigating the relationship between work-from-home 
from home and employee mental health as well as the mediating function of 
work-family balance and workaholism with regard to Indian higher education 
institutions.

DOI: 10.1177/00207640231196741
PMID: 37712681 [Indexed for MEDLINE]


383. Aust Crit Care. 2024 Mar;37(2):258-264. doi: 10.1016/j.aucc.2023.07.005. Epub 
2023 Sep 13.

Relationships of nursing stress and trait emotional intelligence with mental 
health in neonatal intensive care unit nurses: A cross-sectional correlational 
study.

Barr P(1).

Author information:
(1)Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, 
Sydney, NSW, Australia. Electronic address: peterbarr@bigpond.com.

BACKGROUND: The neonatal intensive care unit (NICU) is a stressful and 
emotionally laden environment, but the relationships between nursing stress, 
emotional intelligence, and mental health have not been studied in NICU nurses.
OBJECTIVES: The study aimed to determine (i) whether nursing stress and trait 
emotional intelligence controlled for the five-factor model of personality 
predict mental health in NICU nurses and (ii) whether trait emotional 
intelligence buffers the effect of nursing stress on mental health.
METHODS: A cross-sectional correlational study in 123 (28%) of 440 eligible NICU 
nurses using self-report questionnaire measures of nursing stress (Nursing 
Stress Scale), trait emotional intelligence (Assessing Emotions Scale), and 
psychological distress and emotional well-being (Mental Health Inventory). The 
data were analysed using hierarchical multiple regression and moderation 
analyses.
RESULTS: The hierarchical multiple regressions showed nursing stress predicted 
psychological distress (ΔR2 = .11) and emotional well-being (ΔR2 = .10) at Step 
1. The five-factor model of personality explained further variance in 
psychological distress (ΔR2 = .27) and emotional well-being (ΔR2 = .26) at Step 
2. Finally, trait emotional intelligence predicted further increments in 
psychological distress (ΔR2 = .05) and emotional well-being (ΔR2 = .08) at Step 
3. The optimism (expecting good things to occur in one's life) and mood 
regulation (dampening, repairing and maintaining emotions) subdimension of trait 
emotional intelligence predicted psychological distress (β = -.29) and emotional 
well-being (β = .41) in the final models of the hierarchical multiple 
regressions. Trait emotional intelligence did not moderate the effect of nursing 
stress on psychological distress or emotional well-being.
CONCLUSIONS: NICU managers and educators should seek to remedy controllable 
work-related stressors and support NICU nurses' emotional competence because 
these respective environmental and personal factors predict mental health in 
these nurses.

Copyright © 2023 Australian College of Critical Care Nurses Ltd. Published by 
Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.aucc.2023.07.005
PMID: 37709657 [Indexed for MEDLINE]


384. Psychol Trauma. 2024 Apr;16(Suppl 1):S115-S124. doi: 10.1037/tra0001578. Epub 
2023 Sep 14.

Collective trauma: Childhood abuse, perceived discrimination, and COVID-19.

Wu Y(1), Hartman DT(1), Brown L(2), Wang Y(1), Vidales D(1), Grandchamp J(1), 
Enriquez R(1), Moriarty N(1), Goldfarb D(3), Goodman GS(1).

Author information:
(1)Department of Psychology, University of California, Davis.
(2)Department of Psychology, University of Maine.
(3)Department of Psychology, Florida International University.

OBJECTIVE: Few studies have examined the interplay between collective trauma 
(e.g., the COVID-19 pandemic) and personal trauma (e.g., child abuse and 
discrimination). In a longitudinal child maltreatment study, with a community 
sample added, negative COVID impact (e.g., financial and mental health 
difficulties due to COVID) was examined in relation to childhood abuse exposure 
and perceived discrimination.
METHOD: Adults (N = 135) completed an online survey about trauma- and 
pandemic-related experiences. Regressions examined predictors of negative COVID 
impact and posttraumatic stress disorder (PTSD) symptoms during the pandemic.
RESULTS: Although cumulative maltreatment contributed to negative COVID impact, 
when high levels of cumulative maltreatment had been experienced in childhood, 
greater negative COVID impact did not significantly relate to PTSD symptoms: For 
these participants, PTSD symptoms were relatively high (but not at ceiling) in 
adulthood overall. Negative COVID impact predicted PTSD symptoms only at low 
levels of cumulative child abuse. Perceived discrimination was associated with 
negative COVID impact and PTSD symptomatology.
CONCLUSIONS: Cumulative childhood abuse at high levels likely set the stage for 
PTSD symptoms in adulthood, regardless of negative COVID impact. Individuals 
with lower levels of cumulative childhood abuse had fewer PTSD symptoms unless 
COVID had a stronger negative impact on their lives. Discrimination contributed 
to lower pandemic-related well-being. Insight is provided into special 
vulnerabilities associated with maltreatment backgrounds and discrimination at 
times of collective challenges. (PsycInfo Database Record (c) 2024 APA, all 
rights reserved).

DOI: 10.1037/tra0001578
PMID: 37707479 [Indexed for MEDLINE]


385. J Nutr Health Aging. 2023;27(8):619-625. doi: 10.1007/s12603-023-1949-2.

Impact of the COVID-19 Pandemic on Older People's Loneliness: Findings from a 
Longitudinal Study between 2019 and 2021 among Older Home-Dwellers in Finland.

Knuutila MT(1), Rautiainen L, Lehti TE, Karppinen H, Kautiainen H, Strandberg 
TE, Öhman H, Savikko NM, Jansson AH, Pitkälä KH.

Author information:
(1)Mia Knuutila, Tammisalontie 20 as 4, 00830 Helsinki, Finland, 
mia.knuutila@helsinki.fi, ORCID ID: 0000-0001-5220-103X.

Comment in
    J Nutr Health Aging. 2023;27(8):617-618.

OBJECTIVES: To investigate the change in feelings of loneliness among Finnish 
community-dwelling older people from before the COVID-19 pandemic in 2019 to 
during the pandemic in 2021. Moreover, we explore the changes in other 
dimensions of psychological well-being (PWB) during the study period.
DESIGN: Questionnaires were mailed in the 2019 Helsinki Aging Study, a repeated 
cohort study. A follow-up interview was carried on over the telephone during the 
year 2021.
SETTING AND PARTICIPANTS: A random sample of 2,917 home-dwelling older people 
aged 75-104 years residing in Helsinki, Finland were mailed the questionnaire. 
Altogether 898 participated in the follow-up.
MEASUREMENTS: Loneliness was measured using a single item question "Do you 
suffer from loneliness?". Other items of psychological well-being were measured: 
"Are you satisfied with your life?" (yes/no), "Do you feel useful?" (yes/no), 
"Do you have a zest for life?" (yes/no),"Do you have plans for the future?" 
(yes/no), and "Do you feel depressed?"("rarely or never"/ "sometimes"/ "often or 
always").
RESULTS: Altogether 898 people participated both in 2019 and 2021. The subjects' 
mean age was 83 years and 66% were women. Between 2019 and 2021, the prevalence 
of experienced loneliness increased among older home-dwellers from 26% to 30%. 
During two years of the pandemic feelings of loneliness (RR 1.79, 95% CI: 1.30 
to 2.46) and depression (RR 1.37, 95% CI: 1.12 to 1.67) increased even adjusted 
with various confounders.
CONCLUSION: Considering the impact loneliness has on health and well-being, the 
finding of increased feelings of loneliness among older people is alarming. 
Actions to combat loneliness need to be taken.

DOI: 10.1007/s12603-023-1949-2
PMID: 37702334 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


386. Front Public Health. 2023 Aug 28;11:1234023. doi: 10.3389/fpubh.2023.1234023. 
eCollection 2023.

Predictors of mental well-being over the first lockdown period due to the 
COVID-19 pandemic in France. A repeated cross-sectional study.

Barbalat G(1)(2)(3), Tanguy Melac A(4), Zante E(1), Haesebaert F(1)(5), Franck 
N(1)(2)(3).

Author information:
(1)Centre Ressource de Réhabilitation Psychosociale, Centre hospitalier Le 
Vinatier, Bron, France.
(2)UMR 5229, CNRS and Université Claude Bernard Lyon 1, Université de Lyon, 
Lyon, France.
(3)Pôle Centre rive gauche, Centre hospitalier Le Vinatier, Bron, France.
(4)Health Data Department, Lyon University Hospital, Lyon, France.
(5)PSYR2, INSERM U1028, CNRS UMR 5292, CRNL, Université de Lyon, UCBL, Lyon, 
France.

INTRODUCTION: Numerous studies have investigated the positive and negative 
effects of potential predictors of well-being during lockdowns due to COVID-19. 
Yet, little is known on whether these effects significantly changed with time 
spent in lockdown. In the current study, we described the association of mental 
well-being with a large number of background characteristics (e.g., 
socio-demographic or health-related factors), COVID-related factors, and coping 
strategies, over the duration of the first lockdown due to COVID-19 in France.
METHODS: A nationwide online survey was conducted over 7 of the 8 weeks of the 
1st lockdown in France, i.e., from 25 March 2020 to 10 May 2020. The level of 
mental well-being was reported using the Warwick-Edinburgh Mental Well-Being 
Scale (WEMWBS). We also measured various background characteristics (e.g., age, 
sex, education, health issues), COVID-related factors (e.g., health and economic 
risks, agreement with lockdown), and coping strategies. Our analytical strategy 
enabled us to disentangle effects aggregated over the study period from those 
that linearly vary with time spent in lockdown.
RESULTS: Our final dataset included 18,957 participants. The level of mental 
well-being dropped gradually from the third to the eighth week of lockdown [49.7 
(sd 7.9) to 45.5 (sd 10.6)]. Time in lockdown was associated with a decrease in 
well-being (for each additional 10 days of lockdown: B = -0.30, 95%CI: -0.62, 
-0.15). Factors that showed significantly negative and positive effects on 
well-being as time in lockdown progressed were (for each additional 10 days of 
lockdown): having current psychiatric problems (B = -0.37; 95%CI: -0.63, -0.04), 
worries about having access to personal protective equipment (B = -0.09; 95%CI: 
-0.18, -0.01), coping by having positive beliefs about the future of the 
pandemics (B = 0.29; 95%CI: 0.04, 0.62), being supported by neighbors (B = 0.24; 
95%CI: 0.04, 0.44), and being involved in collective actions (B = 0.23; 95%CI: 
0.04, 0.46).
DISCUSSION: Participants from our sample saw a drop in their mental well-being 
throughout the first period of COVID-19 lockdown. Policymakers should be mindful 
of factors contributing to greater deterioration of mental well-being over time, 
such as having current psychiatric issues. Promoting collective actions and 
local support from neighbors may alleviate the deterioration of mental 
well-being over time.

Copyright © 2023 Barbalat, Tanguy Melac, Zante, Haesebaert and Franck.

DOI: 10.3389/fpubh.2023.1234023
PMCID: PMC10493269
PMID: 37701911 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


387. Chronobiol Int. 2023 Aug;40(8):1133-1145. doi: 10.1080/07420528.2023.2255667. 
Epub 2023 Sep 12.

Impact of the early months of the COVID-19 pandemic on the sleep patterns of a 
Brazilian population sample.

Tufik SB(1), Pires GN(1)(2), Porcacchia AS(2), Bezerra AG(2), Andersen ML(1)(2), 
Tufik S(1)(2).

Author information:
(1)Instituto do Sono, São Paulo, Brazil.
(2)Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, 
Brazil.

Humanitarian and health crisis have drastic effects on the physical and mental 
well-being of people. The COVID-19 pandemic forced many countries to impose 
containment measures on its population to halt the spread of the new coronavirus 
(SARS-CoV-2). This aim of this study was to explore self-reported sleep quality 
and insomnia symptoms in a sample of the Brazilian population before and during 
the COVID-19 quarantine period. Our data was collected through online 
questionnaires, including the Pittsburgh Sleep Quality Index, the Insomnia 
Severity Index, and the Sleep Hygiene Index. The final sample comprised 1,109 
volunteers. Generalized estimating equations (GEE) revealed that during the 
initial months of the COVID-19 pandemic, alterations in self-reported sleep 
parameters were observed in the participants. Sleep efficiency and sleep 
duration increased, but there was a worsening in sleep quality and an increase 
in symptoms related to insomnia.

DOI: 10.1080/07420528.2023.2255667
PMID: 37700530 [Indexed for MEDLINE]


388. Int J Qual Health Care. 2023 Sep 13;35(3):mzad070. doi: 10.1093/intqhc/mzad070.

The crisis of physician well-being in Nepal: a multifaceted dilemma demanding 
urgent intervention.

Singh B(1)(2).

Author information:
(1)Department of Medicine, National Cardiac Centre, Bashundhara, Kathmandu 
44600, Nepal.
(2)Department of Neurology, Shanghai East Hospital, Tongji University School of 
Medicine, 150 Jimo Road, Lujiazui, Pudong, Shanghai 200120, China.

The healthcare system in Nepal faces challenges despite the establishment of 
numerous medical colleges and an increasing number of doctors. The distribution 
of medical colleges is disproportionately concentrated in urban areas, leaving 
rural populations without quality health care. The mental well-being of 
physicians is a growing concern, with studies indicating high levels of burnout, 
stress, and depression among healthcare workers, worsened by the Coronavirus 
Disease 2019 (COVID-19) pandemic. Rising suicide rates among medical 
professionals highlight the severity of burnout and depression in the healthcare 
sector. Factors contributing to this crisis include inadequate recruitment in 
government hospitals, a shortage of healthcare professionals, and inefficiencies 
in resource distribution. Attacks on physicians have become alarmingly frequent, 
necessitating comprehensive studies to understand the challenges faced by 
different specialties and the impact of rural versus urban settings. To address 
these issues, prompt filling of vacant positions in government hospitals and 
prioritizing physicians' mental health is crucial. The government should offer 
competitive salaries, effective management, and supportive working environments 
to combat the brain drain. Initiatives inspiring professionals to stay in Nepal, 
along with maintaining the National Health Insurance Program and controlling 
healthcare privatization, are necessary. Resilience training, professional 
programs, and improved infrastructure in government medical colleges are vital. 
This crisis demands global attention and a national study to evaluate burnout, 
depression, and suicide among healthcare professionals. By addressing these 
challenges and supporting the well-being of healthcare workers, Nepal can work 
toward a sustainable healthcare system that provides quality care for all.

© The Author(s) 2023. Published by Oxford University Press on behalf of 
International Society for Quality in Health Care. All rights reserved. For 
permissions, please e-mail: journals.permissions@oup.com.

DOI: 10.1093/intqhc/mzad070
PMID: 37698917 [Indexed for MEDLINE]


389. Sci Rep. 2023 Sep 11;13(1):14052. doi: 10.1038/s41598-023-41199-x.

Longitudinal and transcultural assessment of the relationship between 
hallucinogens, well-being, and post-traumatic growth during the COVID-19 
pandemic.

Bouso JC(1)(2)(3), Révész D(4), Ona G(4)(5), Rossi GN(6), Rocha JM(6), Dos 
Santos RG(4)(6)(7), Hallak JEC(6)(7), Alcázar-Corcoles MÁ(8).

Author information:
(1)ICEERS-International Center for Ethnobotanical Education, Research, and 
Service, C/ Sepúlveda, 65 Bajos 2, 08015, Barcelona, Catalunya, Spain. 
jcbouso@iceers.org.
(2)Medical Anthropology Research Center (MARC), Universitat Rovira i Virgili, 
Tarragona, Catalunya, Spain. jcbouso@iceers.org.
(3)Department of Neurosciences and Behavior, Ribeirão Preto Medical School, 
University of São Paulo, Ribeirão Preto, Brazil. jcbouso@iceers.org.
(4)ICEERS-International Center for Ethnobotanical Education, Research, and 
Service, C/ Sepúlveda, 65 Bajos 2, 08015, Barcelona, Catalunya, Spain.
(5)Medical Anthropology Research Center (MARC), Universitat Rovira i Virgili, 
Tarragona, Catalunya, Spain.
(6)Department of Neurosciences and Behavior, Ribeirão Preto Medical School, 
University of São Paulo, Ribeirão Preto, Brazil.
(7)National Institute of Science and Technology-Translational Medicine, São 
Paulo, Brazil.
(8)Department of Biological and Health Psychology, School of Psychology, 
Autonomous University of Madrid (UAM), Madrid, Spain.

The COVID-19 pandemic has had a devastating impact on the health and wellbeing 
of the global population. This paper presents the results of a longitudinal 
transcultural study that was begun at the peak of the pandemic (in April, 2020). 
An online survey was used to collect data from English-, Spanish-, and 
Portuguese-speaking participants. The survey collected information about 
sociodemographics, lifestyle activities, COVID-19-related circumstances, and 
drug use (with an emphasis on hallucinogenic drugs), as well as involving 
psychometric questionnaires. Users of hallucinogenic drugs had higher 
psychological well-being and lower scores on psychopathology scales, both at 
baseline and during follow-ups. This difference was larger when users were 
distinguished by frequency of use, as regular users scored higher on 
psychological well-being and lower on psychopathology scales. Subjects with more 
psychological distress had lower scores for all scales of post-traumatic growth, 
but if they were regular hallucinogens users, they had higher scores for 
post-traumatic growth. When comparing the results between cultural contexts, 
heterogeneous results were obtained. There were more English-speaking regular 
users of hallucinogenic drugs. Further research should analyse the potential 
role of hallucinogens in large-scale catastrophes, with a special focus on 
post-traumatic growth.

© 2023. Springer Nature Limited.

DOI: 10.1038/s41598-023-41199-x
PMCID: PMC10495368
PMID: 37696900 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


390. Front Public Health. 2023 Aug 24;11:1216833. doi: 10.3389/fpubh.2023.1216833. 
eCollection 2023.

Understanding pandemic resilience: a mixed-methods exploration of burdens, 
resources, and determinants of good or poor well-being among Austrian 
psychotherapists.

Schaffler Y(1), Bauer M(1), Schein B(1), Jesser A(1), Probst T(2), Pieh C(1), 
Humer E(1)(3).

Author information:
(1)Department for Psychosomatic Medicine and Psychotherapy, University for 
Continuing Education Krems, Krems, Austria.
(2)Division of Psychotherapy, Department of Psychology, Paris Lodron University 
Salzburg, Salzburg, Austria.
(3)Faculty of Psychotherapy Science, Sigmund Freud University Vienna, Vienna, 
Austria.

INTRODUCTION: The COVID-19 pandemic has exacerbated the mental health burden on 
the general population, resulting in increased demands on mental healthcare 
professionals, including psychotherapists. This cross-sectional study assessed 
the challenges and resources encountered by 513 psychotherapists based on an 
online survey conducted between April and May 2022.
METHODS: Qualitative methods content analysis of written reports was employed to 
investigate the emerging challenges and sources of support during the pandemic. 
A comparative analysis of burdens, resources, sociodemographic factors and daily 
physical activity was conducted to discern patterns of good and poor well-being.
RESULTS: The predominant burden identified was mental health-related issues, 
followed by global crises and government-imposed restrictions to mitigate virus 
transmission. Essential resources encompassed social connections, mindfulness, 
work satisfaction, and internal processes. Notably, psychotherapists 
demonstrating good well-being were older, more physically active, had a lower 
proportion of females, were employed in private practices rather than in 
institutionalized settings, had more years of professional experience and 
treated more patients weekly than their counterparts with poor well-being. 
Furthermore, they exhibited greater optimism, health focus, and satisfaction 
with their coping methods.
DISCUSSION: These findings can help develop support systems, policies, and 
educational programs to better support mental health professionals during global 
crises and offer strategies for individual practitioners to maintain their 
well-being.

Copyright © 2023 Schaffler, Bauer, Schein, Jesser, Probst, Pieh and Humer.

DOI: 10.3389/fpubh.2023.1216833
PMCID: PMC10483144
PMID: 37693716 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


391. Front Public Health. 2023 Aug 25;11:1249255. doi: 10.3389/fpubh.2023.1249255. 
eCollection 2023.

Psychology, stress, insomnia, and resilience of medical staff in China during 
the COVID-19 policy opening: a cross-sectional survey.

Cheng Z(1), Tao Y(1), Liu T(1), He S(1), Chen Y(1), Sun L(1), Chen Z(1).

Author information:
(1)Health Management Centre, First Affiliated Hospital of Army Medical 
University, Chongqing, China.

BACKGROUND: Since 8 January 2023 China has liberalized its control of COVID-19. 
In a short period of time, the infection rate of COVID-19 in China has risen 
rapidly, which has brought a heavy burden to medical staff. This study aimed to 
investigate the psychological status, stress, insomnia, effort-reward imbalance, 
resilience, and influencing factors of medical staff in China during the period 
of epidemic policy liberalization.
METHODS: This survey was conducted from 6 February to 27 March 2023 with 
non-random sampling. An online questionnaire survey was conducted using HADS, 
PSS-14, ISI, ERI, and the resilience assessment scale for medical staff. The 
levels of psychological, stress, insomnia, effort-reward imbalance, and 
resilience of medical staff during the pandemic policy opening period were 
measured.
RESULTS: A total of 2,038 valid questionnaires were collected. 68.5% and 53.9% 
of medical staff had different degrees of anxiety and depression, respectively. 
Excessive stress, insomnia, and high effort and low reward were 40.2%, 43.2%, 
and 14.2%, respectively. Gender, Profession, education level, and age are 
important factors that lead to anxiety and depression. Women, nurses, higher 
education, longer working years and hours, high effort, and low reward are risk 
factors for the above conditions. There was a certain correlation among the five 
scales, among which anxiety, depression, stress, insomnia, effort-reward 
imbalance, and other factors were positively correlated, while resilience was 
negatively correlated with these factors.
CONCLUSION: This study found that anxiety, depression, stress, insomnia, and 
other psychological problems of medical staff in China during the policy opening 
period of COVID-19 were more serious than before. At the individual and 
organizational levels, it is necessary to improve the well-being of medical 
staff, optimize the allocation of human resources, and promote the mental health 
of medical staff with a focus on prevention and mitigation, with the entry point 
of improving resilience and preventing the effort-reward imbalance.

Copyright © 2023 Cheng, Tao, Liu, He, Chen, Sun and Chen.

DOI: 10.3389/fpubh.2023.1249255
PMCID: PMC10485264
PMID: 37693701 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


392. Int J Soc Psychiatry. 2023 Dec;69(8):2139-2147. doi: 10.1177/00207640231194480. 
Epub 2023 Sep 10.

Facing a dual threat: Pandemic stress and immigration policy vulnerability on 
mental health among Latinx immigrant parents.

Lemon ED(1), Crookes DM(2), Del Carmen Chacón L(1), Santiago C(3), Urbina B(3), 
Livingston M(1), Woods-Jaeger B(1).

Author information:
(1)Department of Behavioral, Social and Health Education Sciences, Rollins 
School of Public Health, Emory University, Atlanta, GA, USA.
(2)Department of Health Sciences Bouvé College of Health Sciences and Department 
of Anthropology and Sociology, College of Social Sciences and Humanities, 
Northeastern University, Boston, MA, USA.
(3)Ser Familia, Atlanta, GA, USA.

BACKGROUND: Exclusionary immigration policies rooted in structural racism 
threaten the wellbeing of Latinx families, increasing stress, anxiety, 
depression, and distress among immigrant parents. The COVID-19 pandemic has had 
devastating and disproportionate impacts on communities of color with unique 
impacts on Latinx immigrant parents in mixed-status families.
AIMS: From a syndemic theory lens, we explored the convergence of structural 
racism and the COVID-19 pandemic to explore if the stress of the COVID-19 
pandemic may compound harmful immigration-related policies.
METHODS: Our community-based participatory research cross-sectional study 
administered 145 surveys among Latinx immigrant parents in mixed-status families 
in Georgia. We examined the relationship of pandemic stress and perceived 
statewide immigration policy vulnerability to depressive, anxiety, and PTSD 
symptoms. We conducted multiple linear regression analyses to test these 
relationships and their interaction.
RESULTS: We found that that greater perceived policy immigration vulnerability 
and reported pandemic stress were associated with higher symptoms of depression. 
Increased PTSD symptoms were also associated with immigration policy 
vulnerability, but not pandemic stress. Tests to assess if pandemic stress 
strengthened the relationship between policy vulnerability on depressive, 
anxiety, and PTSD symptoms revealed no statistically significant interactions.
CONCLUSION: Our findings suggest that stress of the COVID-19 pandemic and 
longstanding anti-immigrant policies in Georgia were salient for and related to 
the mental health of these Latinx immigrant parents.

DOI: 10.1177/00207640231194480
PMID: 37691431 [Indexed for MEDLINE]


393. Nutrients. 2023 Aug 30;15(17):3802. doi: 10.3390/nu15173802.

Neuroimmunological Effect of Vitamin D on Neuropsychiatric Long COVID Syndrome: 
A Review.

Chen TB(1), Chang CM(2)(3)(4), Yang CC(5), Tsai IJ(6), Wei CY(7)(8), Yang HW(9), 
Yang CP(6)(10)(11)(12).

Author information:
(1)Department of Neurology, Neurological Institute, Taichung Veterans General 
Hospital, Taichung 407219, Taiwan.
(2)Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei 
11217, Taiwan.
(3)Faculty of Medicine, College of Medicine, National Yang Ming Chiao Tung 
University, Taipei 11217, Taiwan.
(4)Institute of Traditional Medicine, National Yang Ming Chiao Tung University, 
Taipei 11217, Taiwan.
(5)Department of Healthcare Administration, Asia University, Taichung 41354, 
Taiwan.
(6)Department of Medical Research, Kuang Tien General Hospital, Taichung 433, 
Taiwan.
(7)Department of Exercise and Health Promotion, College of Kinesiology and 
Health, Chinese Culture University, Taipei 11114, Taiwan.
(8)Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua 
50544, Taiwan.
(9)Department of Family Medicine, Kuang Tien General Hospital, Taichung 433, 
Taiwan.
(10)Department of Neurology, Kuang Tien General Hospital, Taichung 433, Taiwan.
(11)Department of Nutrition, HungKuang University, Taichung 433, Taiwan.
(12)Ph.D. Program in Translational Medicine, National Chung Hsing University, 
Taichung 402, Taiwan.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative 
agent of the coronavirus disease 2019 (COVID-19). COVID-19 is now recognized as 
a multiorgan disease with a broad spectrum of manifestations. A substantial 
proportion of individuals who have recovered from COVID-19 are experiencing 
persistent, prolonged, and often incapacitating sequelae, collectively referred 
to as long COVID. To date, definitive diagnostic criteria for long COVID 
diagnosis remain elusive. An emerging public health threat is neuropsychiatric 
long COVID, encompassing a broad range of manifestations, such as sleep 
disturbance, anxiety, depression, brain fog, and fatigue. Although the precise 
mechanisms underlying the neuropsychiatric complications of long COVID are 
presently not fully elucidated, neural cytolytic effects, neuroinflammation, 
cerebral microvascular compromise, breakdown of the blood-brain barrier (BBB), 
thrombosis, hypoxia, neurotransmitter dysregulation, and provoked 
neurodegeneration are pathophysiologically linked to long-term neuropsychiatric 
consequences, in addition to systemic hyperinflammation and maladaptation of the 
renin-angiotensin-aldosterone system. Vitamin D, a fat-soluble secosteroid, is a 
potent immunomodulatory hormone with potential beneficial effects on 
anti-inflammatory responses, neuroprotection, monoamine neurotransmission, BBB 
integrity, vasculometabolic functions, gut microbiota, and telomere stability in 
different phases of SARS-CoV-2 infection, acting through both genomic and 
nongenomic pathways. Here, we provide an up-to-date review of the potential 
mechanisms and pathophysiology of neuropsychiatric long COVID syndrome and the 
plausible neurological contributions of vitamin D in mitigating the effects of 
long COVID.

DOI: 10.3390/nu15173802
PMCID: PMC10490318
PMID: 37686834 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interest.


394. Medicine (Baltimore). 2023 Sep 8;102(36):e35059. doi: 
10.1097/MD.0000000000035059.

Factors influencing nurses self-efficacy two years after the COVID-19 outbreak: 
A cross-sectional study in Wuhan, China.

Li W(1), Wan Z(2), XianYu Y(1).

Author information:
(1)Master of Medicine, Department of Nursing, Renmin Hospital of Wuhan 
University, Wuhan, Hubei Province, China.
(2)Master of Medicine, Department of Psychiatry, Renmin Hospital of Wuhan 
University, Wuhan, Hubei Province, China.

This study explored the anxiety, depression, and self-efficacy of nurses in 
Wuhan, China 2 years after the corona virus disease 2019 outbreak. A total of 
552 nurses were enrolled in the study. Four well-established test tools were 
applied: The 9-item patient health questionnaire, The 7-item generalized anxiety 
disorder, generalized self-efficacy scale, Connor Davidson resilience scale. 
Twenty-eight points twenty-six percentage of the nurses had mild depression, and 
5.62% had moderate or severe depression. Twenty-one points seventy-four 
percentage of nurses had mild anxiety and 1.82% had moderate or severe anxiety. 
The average score of self-efficacies is negatively correlated with the average 
score of the 9-item patient health questionnaire (r = -0.303, P < .01), and 
the7-item generalized anxiety disorder (r = -0.275, P < .01). The average score 
of self-efficacies is correlated with the resilience score (R = 0.799, P < .01). 
Through multiple linear regression analysis, the tenacity dimension and monthly 
income are most closely related to the sense of self-efficacy. Nurses 
self-efficacy and resilience are important factors in promoting their 
psychological well-being. This study suggests that increasing the salary and 
providing some strategies to increase nurses mental tenacity can promote 
self-efficacy.

Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

DOI: 10.1097/MD.0000000000035059
PMCID: PMC10489413
PMID: 37682191 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
disclose.


395. Int J Environ Res Public Health. 2023 Aug 23;20(17):6629. doi: 
10.3390/ijerph20176629.

"Embracing the Inner Strength and Staying Strong": Exploring Self-Care 
Preparedness among Nurses for Enhancing Their Psychological Well-Being against 
the Long-Term Effect of COVID-19 Pandemic in Brunei Darussalam.

Abdul-Mumin KH(1)(2), Maideen AA(1)(3), Lupat A(1), Mohd-Alipah SN(4), 
Mohammad-Alli RH(3), Abd-Manaf HH(3), Osman AR(3), Abd Fata HMR(3), Busrah N(3), 
Darling-Fisher C(5), Idris DR(1).

Author information:
(1)Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, 
Universiti Brunei Darussalam, Gadong BE1410, Brunei.
(2)School of Nursing and Midwifery, La Trobe University, Bundoora, Melbourne, 
VIC 3086, Australia.
(3)Department of Nursing Services, Ministry of Health, Bandar Seri Begawan 
BB3910, Brunei.
(4)School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki 
852-8523, Japan.
(5)School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA.

During three years of the unprecedented, massive COVID-19 pandemic that affected 
the world, nurse front liners faced substantial challenges and experienced 
long-term adverse mental health. This study explored psychological self-care 
practices undertaken by nurses to strengthen their mental health and develop 
resilience in their professional care role while addressing the challenges of 
the COVID-19 era. A qualitative descriptive exploratory study was conducted on 
40 nurses who worked in providing COVID-19 care across Brunei using focus groups 
aided by semi-structured open-ended questions. Data were thematically analyzed 
using constructivist grounded theory. Four themes emerged: (1) 'Care of the 
mind, heart and soul'; (2) 'Physical care for the psychological well-being'; (3) 
'Venting out and distraction'; (4) 'Have faith, think and stay positive'. The 
challenges of dealing with a worldwide pandemic unintentionally placed nurses' 
mental well-being at risk while the government strategized and prioritized 
containing and preventing the spread of and death from COVID-19. Health 
administrators, as well as nursing educators, need to promote and develop 
resources to strengthen nurses' psychological self-care practices. This will not 
only benefit individual nurses but will help promote the well-being of patients 
and employees, improve the health of all, and counteract any unintended 
stressful situations, even beyond the COVID-19 pandemic.

DOI: 10.3390/ijerph20176629
PMCID: PMC10487716
PMID: 37681769 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, and 
interpretation of data; in the writing of the manuscript; and in the decision to 
publish the results.


396. Disaster Med Public Health Prep. 2023 Sep 8;17:e485. doi: 10.1017/dmp.2023.118.

Context-Dependent Responses to the Spread of COVID-19 Among National and 
International Students During the First Lockdown: An Online Survey.

Andreatta M(1), Jongerling J(2), Wieser MJ(1).

Author information:
(1)Department of Psychology, Education and Child Studies, Erasmus University 
Rotterdam, Netherlands.
(2)Department of Methodology and Statistics, Tilburg School of Social and 
Behavioral Science, Tilburg, Netherlands.

BACKGROUND: Restrictions to minimize social contact was necessary to prevent the 
spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus 
but may have impacted individuals' mental well-being. Emotional responses are 
modulated by contextual information. Living abroad during the coronavirus 
disease 2019 (COVID-19) pandemic may have boosted the feeling of isolation as 
the context is unfamiliar.
OBJECTIVES: This study compared the psychological impact of social distancing in 
national students (living in a familiar context) versus international students 
(living in an unfamiliar context).
METHODS: During March/April 2020 (first lockdown in the Netherlands), 850 
university students completed an online survey. Structural equation modeling 
(SEM) was conducted to compare how students' responses to the virus were 
predicted by health anxiety, emotional distress, and personal traits.
RESULTS: Compared with national students, international students showed higher 
levels in 4 identified factors (COVID-19-related worry, perceived risk of 
infection, distance from possibly contaminated objects, distance from social 
situations). The factors were mainly predicted by health anxiety across 
international students, while emotional distress and individual traits (eg, 
intolerance of uncertainty) played a role across national students.
CONCLUSIONS: In the familiar context, individual characteristics (traits) 
predicted the responses to the virus, while the unfamiliar context drove 
individuals' health-focused responses. Living in a foreign country is associated 
with psychological burdens and this should be considered by universities for 
more pronounced social support and clear references to health-related 
institutions.

DOI: 10.1017/dmp.2023.118
PMID: 37680189 [Indexed for MEDLINE]


397. Psychogeriatrics. 2023 Nov;23(6):1007-1018. doi: 10.1111/psyg.13021. Epub 2023 
Sep 7.

Frailty, psychological well-being, and social isolation in older adults with 
cognitive impairment during the SARS-CoV-2 pandemic: data from the GeroCovid 
initiative.

Terziotti C(1), Ceolin C(1), Devita M(1)(2), Raffaelli C(1), Antenucci S(3), 
Bazzano S(4), Capasso A(5), Castellino M(6), Signore SD(7), Lubian F(8), Maiotti 
M(9), Monacelli F(10), Mormile MT(11), Sgarito C(12), Vella F(13), Sergi G(1), 
Gareri P(14), Trevisan C(1)(15), Bellio A(1), Fini F(1), Malara A(16), Mossello 
E(17), Fumagalli S(17), Volpato S(15), Monzani F(18), Bellelli G(19), Zia G(7), 
Incalzi RA(20), Coin A(1).

Author information:
(1)Department of Medicine (DIMED), Geriatrics Division, University of Padova, 
Padova, Italy.
(2)Department of General Psychology, University of Padova, Padova, Italy.
(3)Psychogeriatric Outpatient Clinic, Ortona, Italy.
(4)Geriatrics Unit, Azienda ULSS 16, Padova, Italy.
(5)Territorial Care Department, ASL NA2 Nord, Naples, Italy.
(6)"B.V. Consolata" Rehabilitation Hospital-Fatebenefratelli, San Maurizio 
Canavese, Italy.
(7)Bluecompanion, Ldt, London, UK.
(8)Geriatrics Unit, Memory Clinic, Bozen Hospital, Bozen, Italy.
(9)Clinical Neuropsychology, S.Giovanni Battista Hospital, Foligno, Italy.
(10)Section of Geriatrics, Department of Internal Medicine and Medical 
Specialties (DIMI), University of Genoa, Genoa, Italy.
(11)CDCD DS 46 and 47, ASL Napoli 2 Nord, Naples, Italy.
(12)UOC Involutive Degenerative Diseases, Territorial Psychogeriatrics, ASP of 
Agrigento, Agrigento, Italy.
(13)CDCD, District 2, Trieste, Italy.
(14)Center for Cognitive Disorders and Dementia-Catanzaro Lido ASP, Catanzaro, 
Italy.
(15)Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
(16)ANASTE Humanitas Foundation, Rome, Italy.
(17)Geriatric Intensive Care Unit, Department of Experimental and Clinical 
Medicine, University of Firenze, Firenze, Italy.
(18)Geriatrics Unit, Department of Clinical and Experimental Medicine, 
University of Pisa, Pisa, Italy.
(19)School of Medicine and Surgery, Acute Geriatric Unit, University of 
Milano-Bicocca, San Gerardo Hospital, Monza, Italy.
(20)Unit of Geriatrics, Department of Medicine, Campus Bio-Medico University and 
Teaching Hospital, Rome, Italy.

BACKGROUND: The containment measures linked to the COVID-19 pandemic negatively 
affected the phyco-physical well-being of the population, especially older 
adults with neurocognitive disorders (NCDs). This study aims to evaluate whether 
the frailty of NCD patients was associated with different changes in multiple 
health domains, in particular in relation to loneliness and social isolation, 
pre- and post-lockdown.
MATERIALS AND METHODS: Patients were recruited from 10 Italian Centers for 
Cognitive Disorders and Dementia. Data were collected in the pre-pandemic period 
(T0), during the pandemic lockdown (T1), and 6-9 months post-lockdown (T2). The 
UCLA Loneliness Scale-3, Activities of Daily Living (ADL), Instrumental ADL 
(IADL), Mini-Mental State Examination, and Neuropsychiatric Inventory (NPI) were 
administered. Caregivers' burden was also tested. Patients were categorized as 
non-frail, pre-frail, and frail according to the Fatigue, Resistance, 
Ambulation, Illness, and Loss of Weight scale.
RESULTS: The sample included 165 subjects (61.9% women, mean age 
79.5 ± 4.9 years). In the whole sample, the ADL, IADL, and NPI scores 
significantly declined between T0 and T2. There were no significative variations 
in functional and cognitive domains between the frail groups. During lockdown we 
recorded higher Depression Anxiety Stress Scales and Perceived Stress Scale 
scores in frail people. In multivariable logistic regression, frailty was 
associated with an increase in social isolation, and a loss of IADL.
CONCLUSIONS: We observed a global deterioration in functional and 
neuro-psychiatric domains irrespective of the degree of frailty. Frailty was 
associated with the worsening of social isolation during lockdown. Frail 
patients and their caregivers seemed to experience more anxiety and stress 
disorders during SARS-CoV-2 pandemic.

© 2023 The Authors. Psychogeriatrics published by John Wiley & Sons Australia, 
Ltd on behalf of Japanese Psychogeriatric Society.

DOI: 10.1111/psyg.13021
PMID: 37679953 [Indexed for MEDLINE]


398. Cochrane Database Syst Rev. 2023 Sep 7;9(9):CD013472. doi: 
10.1002/14651858.CD013472.pub2.

Musical and vocal interventions to improve neurodevelopmental outcomes for 
preterm infants.

Haslbeck FB(1), Mueller K(2), Karen T(1), Loewy J(3), Meerpohl JJ(4), Bassler 
D(1).

Author information:
(1)Department of Neonatology, University Hospital Zurich, Zurich, Switzerland.
(2)Zentrum für Kinder und Jugendmedizin, University Freiburg, Freiburg, Germany.
(3)Mount Sinai Health System, The Louis Armstrong Center for Music & Medicine, 
New York City, USA.
(4)Institute for Evidence in Medicine, Medical Center - University of Freiburg, 
Faculty of Medicine, University of Freiburg, Freiburg, Germany.

Update of
    doi: 10.1002/14651858.CD013472.

BACKGROUND: Preterm birth interferes with brain maturation, and subsequent 
clinical events and interventions may have additional deleterious effects. Music 
as therapy is offered increasingly in neonatal intensive care units aiming to 
improve health outcomes and quality of life for both preterm infants and the 
well-being of their parents. Systematic reviews of mixed methodological quality 
have demonstrated ambiguous results for the efficacy of various types of 
auditory stimulation of preterm infants. A more comprehensive and rigorous 
systematic review is needed to address controversies arising from apparently 
conflicting studies and reviews.
OBJECTIVES: We assessed the overall efficacy of music and vocal interventions 
for physiological and neurodevelopmental outcomes in preterm infants (< 37 
weeks' gestation) compared to standard care. In addition, we aimed to determine 
specific effects of various interventions for physiological, anthropometric, 
social-emotional, neurodevelopmental short- and long-term outcomes in the 
infants, parental well-being, and bonding.
SEARCH METHODS: We searched Cochrane Central Register of Controlled Trials 
(CENTRAL), MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, RILM Abstracts, 
and ERIC in November 2021; and Proquest Dissertations in February 2019. We 
searched the reference lists of related systematic reviews, and of studies 
selected for inclusion and clinical trial registries.
SELECTION CRITERIA: We included parallel, and cluster-randomised controlled 
trials with preterm infants < 37 weeks` gestation during hospitalisation, and 
parents when they were involved in the intervention. Interventions were any 
music or vocal stimulation provided live or via a recording by a music 
therapist, a parent, or a healthcare professional compared to standard care. The 
intervention duration was greater than five minutes and needed to occur more 
than three times.
DATA COLLECTION AND ANALYSIS: Three review authors independently extracted data. 
We analysed the treatment effects of the individual trials using RevMan Web 
using a fixed-effects model to combine the data. Where possible, we presented 
results in meta-analyses using mean differences with 95% CI. We performed 
heterogeneity tests. When the I2 statistic was higher than 50%, we assessed the 
source of the heterogeneity by sensitivity and subgroup analyses. We used GRADE 
to assess the certainty of the evidence.
MAIN RESULTS: We included 25 trials recruiting 1532 infants and 691 parents (21 
parallel-group RCTs, four cross-over RCTs). The infants gestational age at birth 
varied from 23 to 36 weeks, taking place in NICUs (level 1 to 3) around the 
world. Within the trials, the intervention varied widely in type, delivery, 
frequency, and duration. Music and voice were mainly characterised by calm, 
soft, musical parameters in lullaby style, often integrating the sung mother's 
voice live or recorded, defined as music therapy or music medicine. The general 
risk of bias in the included studies varied from low to high risk of bias. Music 
and vocal interventions compared to standard care Music/vocal interventions do 
not increase oxygen saturation in the infants during the intervention (mean 
difference (MD) 0.13, 95% CI -0.33 to 0.59; P = 0.59; 958 infants, 10 studies; 
high-certainty evidence). Music and voice probably do not increase oxygen 
saturation post-intervention either (MD 0.63, 95% CI -0.01 to 1.26; P = 0.05; 
800 infants, 7 studies; moderate-certainty evidence). The intervention may not 
increase infant development (Bayley Scales of Infant and Toddler Development 
(BSID)) with the cognitive composition score (MD 0.35, 95% CI -4.85 to 5.55; P = 
0.90; 69 infants, 2 studies; low-certainty evidence); the motor composition 
score (MD -0.17, 95% CI -5.45 to 5.11; P = 0.95; 69 infants, 2 studies; 
low-certainty evidence); and the language composition score (MD 0.38, 95% CI 
-5.45 to 6.21; P = 0.90; 69 infants, 2 studies; low-certainty evidence). Music 
therapy may not reduce parental state-trait anxiety (MD -1.12, 95% CI -3.20 to 
0.96; P = 0.29; 97 parents, 4 studies; low-certainty evidence). The intervention 
probably does not reduce respiratory rate during the intervention (MD 0.42, 95% 
CI -1.05 to 1.90; P = 0.57; 750 infants; 7 studies; moderate-certainty evidence) 
and post-intervention (MD 0.51, 95% CI -1.57 to 2.58; P = 0.63; 636 infants, 5 
studies; moderate-certainty evidence). However, music/vocal interventions 
probably reduce heart rates in preterm infants during the intervention (MD 
-1.38, 95% CI -2.63 to -0.12; P = 0.03; 1014 infants; 11 studies; 
moderate-certainty evidence). This beneficial effect was even stronger after the 
intervention. Music/vocal interventions reduce heart rate post-intervention (MD 
-3.80, 95% CI -5.05 to -2.55; P < 0.00001; 903 infants, 9 studies; 
high-certainty evidence) with wide CIs ranging from medium to large beneficial 
effects. Music therapy may not reduce postnatal depression (MD 0.50, 95% CI 
-1.80 to 2.81; P = 0.67; 67 participants; 2 studies; low-certainty evidence). 
The evidence is very uncertain about the effect of music therapy on parental 
state anxiety (MD -0.15, 95% CI -2.72 to 2.41; P = 0.91; 87 parents, 3 studies; 
very low-certainty evidence). We are uncertain about any further effects 
regarding all other secondary short- and long-term outcomes on the infants, 
parental well-being, and bonding/attachment. Two studies evaluated adverse 
effects as an explicit outcome of interest and reported no adverse effects from 
music and voice.
AUTHORS' CONCLUSIONS: Music/vocal interventions do not increase oxygen 
saturation during and probably not after the intervention compared to standard 
care. The evidence suggests that music and voice do not increase infant 
development (BSID) or reduce parental state-trait anxiety. The intervention 
probably does not reduce respiratory rate in preterm infants. However, 
music/vocal interventions probably reduce heart rates in preterm infants during 
the intervention, and this beneficial effect is even stronger after the 
intervention, demonstrating that music/vocal interventions reduce heart rates in 
preterm infants post-intervention. We found no reports of adverse effects from 
music and voice. Due to low-certainty evidence for all other outcomes, we could 
not draw any further conclusions regarding overall efficacy nor the possible 
impact of different intervention types, frequencies, or durations. Further 
research with more power, fewer risks of bias, and more sensitive and clinically 
relevant outcomes are needed.

Copyright © 2023 The Cochrane Collaboration. Published by John Wiley & Sons, 
Ltd.

DOI: 10.1002/14651858.CD013472.pub2
PMCID: PMC10483930
PMID: 37675934 [Indexed for MEDLINE]

Conflict of interest statement: FH works as a music therapist and senior 
researcher at the University Hospital Zurich, Switzerland. FH was the project 
leader of a study included in this review (Haslbeck 2021), and so did not 
determine the overall study inclusion and exclusion criteria; make study 
eligibility decisions about, extract data from, carry out the risk of bias 
assessment for, or perform GRADE assessments for that study. TK and KM assessed 
this study instead. KM has no conflicts of interest to declare. TK has no 
conflicts of interest to declare. JL works as Director, Louis Armstrong Center 
for Music and Medicine, New York City, USA. She has published opinions in 
medical journals related to the subject of this review. JL was an author on a 
study included in this review (Loewy 2013), and so did not determine the overall 
study inclusion and exclusion criteria; make study eligibility decisions about, 
extract data from, carry out the risk of bias assessment for, or perform GRADE 
assessments for that study. JM is Director of the German Cochrane Centre. JM 
determined the final overall inclusion and exclusion criteria. DB works as the 
director of the Department of Neonatology at the University Hospital Zurich, 
Switzerland. DB was a co‐author on a study included in this review (Haslbeck 
2021), and so did not determine the overall study inclusion and exclusion 
criteria; make study eligibility decisions about, extract data from, carry out 
the risk of bias assessment for, or perform GRADE assessments for that study. TK 
and KM assessed this study instead.


399. Addict Sci Clin Pract. 2023 Sep 6;18(1):52. doi: 10.1186/s13722-023-00406-w.

Piloting the integration of SMART Recovery into outpatient alcohol and other 
drug treatment programs.

Manning V(1)(2), Roxburgh AD(3)(4), Savic M(1)(2).

Author information:
(1)Monash Addiction Research Centre, Eastern Health Clinical School, Monash 
University, Clayton, Australia.
(2)Turning Point, Eastern Health, Box Hill, Australia.
(3)Monash Addiction Research Centre, Eastern Health Clinical School, Monash 
University, Clayton, Australia. ari.roxburgh@monash.edu.
(4)Turning Point, Eastern Health, Box Hill, Australia. ari.roxburgh@monash.edu.

BACKGROUND: Research suggests peer support groups can amplify and extend 
treatment effects and enhance long-term recovery from Alcohol and Other Drug 
(AOD) problems. However, they are rarely integrated into outpatient treatment 
programs, resulting in a missed opportunity for peer-to-peer learning, and 
increased connection to others social networks where people want to reduce or 
cease substance use.
METHOD: In this mixed-methods study, we examined the uptake, participant 
experiences and impacts of Self-Management and Recovery Training (SMART) when 
embedded in three public AOD treatment programs in a pilot program in Australia. 
Groups were delivered initially in-person but transitioned online during the 
COVID-19 pandemic.
RESULTS: A total of 75 SMART Recovery groups were run by the pilot sites, with 
an average attendance of 6.5 people per meeting. Among Participants (N = 31) who 
completed the survey, 94% reported benefits relating to substance use (i.e., 
reduction/ successful maintenance of abstinence), 71% reported improvements in 
their mental health and wellbeing, 74% reported improvements in their physical 
health, and 81% reported feeling better connected with others. In-depth 
qualitative interviews were conducted with 10 participants to explore their 
experiences. Thematic analysis revealed four themes: motivation to attend, 
active ingredients, views on the integration of SMART into formal AOD, and the 
advantages and disadvantages of online groups.
CONCLUSION: Taken together, these findings suggest embedding SMART Recovery in 
AOD treatment is a worthwhile endeavour. This was indicated by a good uptake and 
evidence of multiple and unique benefits to participants over and above their 
usual care, notably, better management of their AOD use, health, wellbeing, and 
sense of connection with others.

© 2023. Evans Medical Foundation, Inc. and BioMed Central Ltd.

DOI: 10.1186/s13722-023-00406-w
PMCID: PMC10481580
PMID: 37674227 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


400. Psychol Med. 2024 Apr;54(5):895-901. doi: 10.1017/S003329172300257X. Epub 2023 
Sep 6.

Depressive symptoms in youth before and during the COVID-19 pandemic: 
longitudinal investigation of patterns dependent on age, sex, and family history 
of mental illness.

Howes Vallis E(1)(2), Stephens M(2), Ross B(2), Rempel S(2), Howard C(2), Liu 
D(2), Villars K(2), Mazurka R(1)(2), Cumby J(2), Alda M(1)(2), Pavlova B(1)(2), 
Uher R(1)(2).

Author information:
(1)Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.
(2)Nova Scotia Health Authority, Halifax, NS, Canada.

BACKGROUND: Cross-sectional studies report high levels of depressive symptoms 
during the COVID-19 pandemic, especially in youth and females. However, 
longitudinal research comparing depressive symptoms before and during the 
pandemic is lacking. Little is known about how the pandemic affected individuals 
with familial history of mental illness. The present study examines the impact 
of the pandemic on youth depressive symptoms, including offspring of parents 
with major mood and psychotic disorders.
METHODS: Between March 2018 and February 2020, we measured depressive symptoms 
in 412 youth aged 5-25 years. We measured depressive symptoms again in 371 (90%) 
of these youth between April 2020 and May 2022. Two thirds (249) participants 
had a biological parent with a major mood or psychotic disorder. We tested the 
effect of the pandemic by comparing depression symptoms before and after March 
2020. We examined age, sex, and family history as potential moderators.
RESULTS: We found an overall small increase in youth depressive symptoms (b = 
0.07, 95% CI -0.01 to 0.15, p = 0.062). This was driven by an increase in female 
youth without familial history of mental illness (b = 0.35, 95% CI 0.14 to 0.56, 
p = 0.001). There was no change in depressive symptoms among offspring of 
parents with mental illness or males.
CONCLUSIONS: Our results provide reassurance about the wellbeing of children of 
parents with mental illness during a period of restricted access to resources 
outside the family. Rather than increasing symptoms in established risk groups, 
the pandemic led to a redistribution of depression burden towards segments of 
the youth population that were previously considered to be low-risk.

DOI: 10.1017/S003329172300257X
PMID: 37671680 [Indexed for MEDLINE]


401. PLoS One. 2023 Sep 5;18(9):e0290693. doi: 10.1371/journal.pone.0290693. 
eCollection 2023.

Physical, mental and social status after COVID-19 recovery in Nepal: A mixed 
method study.

Silwal S(1), Parajuli K(1), Acharya A(1), Ghimire A(1), Pandey S(1), Pandey 
A(1), Poudyal A(1), Bista B(1), Gyanwali P(1), Dhimal M(1).

Author information:
(1)Nepal Health Research Council, Ramshahpath, Kathmandu, Nepal.

BACKGROUND: Nepal has been devastated by an unprecedented COVID-19 outbreak, 
affecting people emotionally, physically, and socially, resulting in significant 
morbidity and mortality. Approximately 10% of COVID-19 affected people have 
symptoms that last more than 3-4 weeks and experience numerous symptoms causing 
an impact on everyday functioning, social, and cognitive function. Thus, it is 
vital to know about the recovered patient's health status and undertake rigorous 
examinations to detect and treat infections. Hence, this study aims to assess 
the health status of COVID-19 post-recovery patients in Nepal.
METHOD: A descriptive cross-sectional mixed-method study was conducted in all 
seven provinces of Nepal. A total of 552 interviews were conducted for the 
quantitative study, and 25 in-depth interviews were conducted for the 
qualitative study among above 18 years COVID-19-recovered patients. The data was 
gathered over the phone through the purposive sampling method The results of a 
descriptive and thematic analysis were interpreted.
FINDING: The majority (more than 80%) of the recovered patients could routinely 
perform household duties, activities outside the home, and financial job 
accounting. However, a few of them required assistance in carrying out all of 
those tasks. Prior and then after COVID-19 infection, smoking habits reduced by 
about one-tenth and alcohol intake decreased by a twelve percent. A qualitative 
finding revealed that the majority of COVID-19 symptomatic patients experienced 
a variety of physical symptoms such as fever, headache, body pain, fatigue, 
tiredness, sore throat, cough, loss of taste, loss of smell, sneezing, loss of 
appetite, and difficulty breathing, while others felt completely fine after 
being recovered. Furthermore, there was no variation in the daily functional 
activities of the majority of the recovered patients, while a few were found 
conducting fewer activities than usual because they were concerned about their 
health. For social health, quantitative data indicated that more than half of 
the participants' social health was severely impacted. According to the IDI, the 
majority of the interviewees perceived society's ignorance and misbehavior. 
Family members were the most often solicited sources of support. Some 
participants got care and assistance, but the majority did not get affection or 
love from their relatives. Moreover, regarding mental health, 15 percent of 
participants had repeated disturbing and unwanted thoughts about COVID-19 after 
being recovered, 16 percent tried to avoid information on COVID-19 and 7 .7 
percent of people had unfavorable ideas or sentiments about themselves. More 
than 16 percent of participants reported feeling some level of stress related to 
the workplace and home. While in-depth interviews participants revealed that 
COVID-infected patients who were asymptomatic didn't experience any emotional 
change in them but recovered patients who are symptomatic symptoms had anxiety 
and still being conscious of COVID-19 in fear of getting infected again 
Additionally, it was discovered that participants' mental health is influenced 
by ignorance of society, as well as by fake news posted to social media.
CONCLUSION: COVID-19 infection has had an impact on physical, mental, and social 
well-being. Hence, to aid in the early recovery of COVID-19 patients, provision 
of evaluating and reporting the clinical features, early detection and 
management of long COVID case is needed from the local and provincial and 
central government of Nepal.

Copyright: © 2023 Silwal et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0290693
PMCID: PMC10479937
PMID: 37669253 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


402. J Patient Rep Outcomes. 2023 Sep 5;7(1):88. doi: 10.1186/s41687-023-00628-1.

Health and well-being of the Portuguese citizens: impacts of the COVID-19.

Ferreira LN(1)(2)(3), Pereira LN(1)(2)(3), Ferreira PL(4)(5).

Author information:
(1)Universidade do Algarve, Faro, Portugal.
(2)Research Centre for Tourism, Sustainability and Well-Being (CinTurs), Faro, 
Portugal.
(3)Centre for Health Studies and Research of the University of Coimbra (CEISUC), 
Coimbra, Portugal.
(4)Centre for Health Studies and Research of the University of Coimbra (CEISUC), 
Coimbra, Portugal. pedrof@fe.uc.pt.
(5)Faculty of Economics, University of Coimbra, Coimbra, Portugal. 
pedrof@fe.uc.pt.

BACKGROUND: COVID-19 pandemic placed unprecedented pressure on societies and 
healthcare systems around the world. Over the last years, measures imposed in 
almost all countries dealing with the pandemic sent the entire world into an 
extensive crisis and thus into a deep global recession. Since the outbreak 
began, many European countries have faced three/four waves of pandemic. Portugal 
has mainly dealt with three waves (March/April'2020; October/November'2020; 
January/February'2021), the third being the deadliest one. The purpose of this 
article is to provide evidence on the impact of the COVID-19 on health-related 
quality of life (HRQol) and well-being (W-B) of Portuguese citizens. It aims to 
(i) characterize these outcomes during the COVID-19 pandemic; (ii) compare them 
to pre-COVID-19 Portuguese population; and (iii) identify the social 
determinants that may affect these outcomes during the COVID-19 pandemic.
METHODS: This study used data from a survey that collected data on HRQoL, W-B, 
satisfaction with life, economic and labour impacts, access to healthcare, 
mental and physical health, amongst others. The survey was implemented by 
telephone to a representative random sample of 1,255 respondents from the 
general adult Portuguese population, stratified by sex, age group and region. 
Data was collected during the end of the second national lockdown. For 
comparison purposes, we have also used two other representative databases from 
the general Portuguese population: (i) data from before the pandemic 
(n = 1,006); and (ii) data from a survey conducted during the first lockdown, 
(n = 904).
RESULTS: Looking at health and access to healthcare, 4% of citizens had their 
surgeries postponed or cancelled because of COVID-19, more than a quarter had 
medical appointments or complementary exams postponed or cancelled, with 7% over 
65 years old with surgeries cancelled or postponed and 32% medical appointments. 
COVID-19 pandemic also impacted negatively on the HRQoL of citizens, especially 
in the first lockdown. Half of the respondents reported feeling nervous, 
anxious, or on edge, about 45% of citizens felt sad or depressed. Sleeping 
problems were reported for almost 39% of citizens, and loneliness is reported by 
29% of citizens. For about 70-85% of citizens, these feelings were more so than 
before the pandemic. Citizens with fair/strong economic stability were the most 
economically affected by the pandemic.
CONCLUSIONS: We provided evidence on the impact of COVID-19 on health and W-B of 
Portuguese citizens. Their health was worse than before the pandemic and the 
access to healthcare was highly affected.

© 2023. International Society for Quality of Life Research (ISOQOL).

DOI: 10.1186/s41687-023-00628-1
PMCID: PMC10480107
PMID: 37668845 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


403. Soc Psychiatry Psychiatr Epidemiol. 2024 Jan;59(1):137-150. doi: 
10.1007/s00127-023-02557-2. Epub 2023 Sep 5.

School learning modes during the COVID-19 response and pre- to during pandemic 
mental health changes in a prospective cohort of Canadian adolescents.

Patte KA(1), Battista K(2), Ferro MA(2), Bélanger RE(3)(4), Wade TJ(5), Faulkner 
G(6), Pickett W(5), Riazi NA(5), Michaelson V(5), Carsley S(7), Leatherdale 
ST(2).

Author information:
(1)Faculty of Applied Health Sciences, Department of Health Sciences, Brock 
University, Niagara Region, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 
3A1, Canada. kpatte@brocku.ca.
(2)School of Public Health Sciences, University of Waterloo, 200 University Ave, 
Waterloo, ON, N2L 3G1, Canada.
(3)Projet COMPASS-Québec, VITAM-Centre de recherche en santé durable de 
l'Université Laval, 2480 Chemin de La Canardière, Quebec City, QC, G1J 2G1, 
Canada.
(4)Faculty of Medecine, Departement of Pediatrics, Université Laval, Ferdinand 
Vandry Pavillon, 1050 Avenue de La Médecine, Quebec City, QC, G1V 0A6, Canada.
(5)Faculty of Applied Health Sciences, Department of Health Sciences, Brock 
University, Niagara Region, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 
3A1, Canada.
(6)School of Kinesiology, University of British Columbia, Lower Mall Research 
Station Room 337, 2259 Lower Mall, Vancouver, BC, V6T 1Z3, Canada.
(7)Public Health Ontario, 661 University Avenue, Suite 1701, Toronto, ON, M5G 
1M1, Canada.

PURPOSE: Considerable debate centered on the impact of school closures and 
shifts to virtual learning on adolescent mental health during the COVID-19 
pandemic. We evaluated whether mental health changes differed by school learning 
modes during the pandemic response among Canadian adolescents and whether 
associations varied by gender and perceived home life.
METHODS: We used prospective survey data from 7270 adolescents attending 41 
Canadian secondary schools. Conditional change linear mixed effects models were 
used to examine learning mode (virtual optional, virtual mandated, in-person, 
and blended) as a predictor of change in mental health scores (depression 
[Centre for Epidemiologic Studies - Depression], anxiety [Generalized Anxiety 
Disorder-7], and psychosocial well-being [Flourishing scale]), adjusting for 
baseline mental health and covariates. Gender and home life happiness were 
tested as moderators. Least square means were calculated across interaction 
groups.
RESULTS: Students learning in a blended learning mode had greater anxiety 
increases relative to their peers in other learning modes. Females learning 
fully in-person and males learning virtually when optional reported less of an 
increase in depression scores relative to their gender counterparts in other 
learning modes. Learning virtually when optional was associated with greater 
declines in psychosocial well-being in students without happy home lives 
relative to other learning modes.
CONCLUSION: Findings demonstrate the importance of considering gender and home 
environments as determinants of mental health over the pandemic response and 
when considering alternative learning modes. Further research is advised before 
implementing virtual and blended learning modes. Potential risks and benefits 
must be weighed in the context of a pandemic.

© 2023. The Author(s).

DOI: 10.1007/s00127-023-02557-2
PMCID: PMC10799804
PMID: 37668673 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


404. Eur Rev Med Pharmacol Sci. 2023 Aug;27(16):7728-7737. doi: 
10.26355/eurrev_202308_33427.

Impact of COVID-19 vaccination on parental and childhood stress levels in 
Greece.

Gkentzi D(1), Plotas P, Terzi M, Bertzouanis A, Karantaglis N, Gidaris D, 
Cassimos D, Tsalkidis A, Kostopoulou E, Karatza A, Sinopidis X, Dimitriou G, 
Fouzas S.

Author information:
(1)Department of Pediatrics, Medical School, University of Patras, Rio, Patras, 
Greece. pplotas@upatras.com.

OBJECTIVE: The impact of COVID-19 vaccination on parental and childhood stress 
levels has not been thoroughly investigated. Our aim was to explore the above 
relationship and identify factors that may influence the dissemination of stress 
within the family during the pandemic.
SUBJECTS AND METHODS: A cross-sectional e-survey was conducted among a 
nationwide sample of parents in May 2021 in Greece. Parental stress was assessed 
using the Perceived Stress Scale (PSS) and the Revised Impact of Event Scale 
(IES-R) tools. Childhood mental well-being was evaluated with the Children's 
Revised Impact of Event 13 (CRIES 13) scale.
RESULTS: 1,703 unique questionnaires were analyzed; 19.5% of responders were 
completely vaccinated, 23.7% were partially vaccinated, 38.3% were awaiting 
vaccination, and 18.5% were classified as vaccine-hesitant (15.2% would delay, 
and 3.3% refused the vaccination). Stress levels were significantly lower in 
completely or partially vaccinated parents than in vaccine-hesitant ones 
(p<0.001 for PSS/IES-R). Vaccination status emerged as a strong and independent 
predictor of PSS and IES-R. A significant decrease in PSS and IES-R scores was 
observed in 991 participants between March 2020 and May 2021 (p<0.001 for 
PSS/IES-R). Vaccine uptake was associated with lower PSS and IES-R scores, 
irrespective of the phase of the pandemic or other sociodemographic factors. The 
CRIES 13 score of the participant's children (n=2,969) was 19.4 ±14.9 and 
positively correlated with the PSS and IES-R scores. Children whose parents were 
vaccinated had lower stress levels than those of vaccine-hesitant parents 
(p<0.001).
CONCLUSIONS: Parental vaccination against COVID-19 is a significant stress and 
anxiety predictor for both parents and their offspring. Parental and childhood 
stress levels were correlated, while the effect of vaccination was independent 
of the pandemic phase. The campaigns to promote vaccine uptake against COVID-19 
should also highlight its potential benefit on the psychological well-being of 
the family.

DOI: 10.26355/eurrev_202308_33427
PMID: 37667951 [Indexed for MEDLINE]


405. Sci Rep. 2023 Sep 4;13(1):14529. doi: 10.1038/s41598-023-41684-3.

Physical function and mental health trajectories in COVID-19 patients following 
invasive mechanical ventilation: a prospective observational study.

Yamamoto H(#)(1), Tanaka S(#)(1), Kasugai D(2), Shimizu M(3), Tsuchikawa Y(1), 
Hori Y(1), Fugane Y(1), Inoue T(1), Nagaya M(1), Omote N(4), Higashi M(5), 
Yamamoto T(5), Jingushi N(5), Numaguchi A(5), Goto Y(5), Nishida Y(1)(6).

Author information:
(1)Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan.
(2)Department of Emergency and Critical Care Medicine, Nagoya University 
Graduate School of Medicine, Tsurumai-Cho 65, Syowa-Ku, Nagoya, Japan. 
dkasugai@med.nagoya-u.ac.jp.
(3)Department of Rehabilitation, Mie University Hospital, Tsu, Japan.
(4)Department of Respiratory Medicine, Nagoya University Graduate School of 
Medicine, Nagoya, Japan.
(5)Department of Emergency and Critical Care Medicine, Nagoya University 
Graduate School of Medicine, Tsurumai-Cho 65, Syowa-Ku, Nagoya, Japan.
(6)Department of Orthopaedic Surgery, Nagoya University Graduate School of 
Medicine, Nagoya, Japan.
(#)Contributed equally

This prospective observational cohort study was performed to investigate the 
physical function and mental health trajectories of novel coronavirus disease 
2019 (COVID-19) patients requiring invasive mechanical ventilation (IMV) after 
discharge from the intensive care unit (ICU). The study population consisted of 
64 patients (median age, 60 years; 85.9% male; median IMV duration, 9 days). At 
ICU discharge, 28.1% of the patients had Medical Research Council (MRC) sum 
score < 48 points, and prolonged IMV was significantly associated with lower MRC 
sum score and handgrip strength. Symptoms were similar between groups at ICU 
discharge, and the symptoms most commonly reported as moderate-to-severe were 
impaired well-being (52%), anxiety (43%), tiredness (41%), and depression (35%). 
Although muscle strength and mobility status were significantly improved after 
ICU discharge, Edmonton Symptom Assessment System score did not improve 
significantly in the prolonged IMV group. EuroQol five-dimension five-level 
summary index was significantly lower in the prolonged than short IMV group at 
6 months after ICU discharge. We found substantial negative physical function 
and mental health consequences in the majority of surviving COVID-19 patients 
requiring IMV, with prolonged period of IMV showing greater negative effects not 
only immediately but also at 6 months after discharge from the ICU.

© 2023. Springer Nature Limited.

DOI: 10.1038/s41598-023-41684-3
PMCID: PMC10477337
PMID: 37666912 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


406. Sci Rep. 2023 Sep 4;13(1):14540. doi: 10.1038/s41598-023-40836-9.

Perceived stress of mothers and fathers on two NICUs before and during the 
SARS-CoV-2 pandemic.

Deindl P(#)(1), Witting A(#)(2), Dür M(3)(4), Berger A(2), Klebermass-Schrehof 
K(2), Singer D(1), Giordano V(5), Fuiko R(2).

Author information:
(1)Department of Neonatology and Pediatric Intensive Care Medicine, University 
Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, 
Germany.
(2)Department of Pediatrics and Adolescent Medicine, Division of Neonatology, 
Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for 
Pediatrics, Medical University of Vienna, Vienna, Austria.
(3)Duervation, Krems, Austria.
(4)Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 
Stockholm, Sweden.
(5)Department of Pediatrics and Adolescent Medicine, Division of Neonatology, 
Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for 
Pediatrics, Medical University of Vienna, Vienna, Austria. 
vito.giordano@meduniwien.ac.at.
(#)Contributed equally

Parents of very low birth weight (VLBW) infants in a neonatal intensive care 
unit experienced additional stress during the SARS-CoV-2 pandemic due to the 
related restrictions in hospital visiting policies. Our study aimed to compare 
parents' burdens before and during the pandemic. This survey included 121 
parents of 76 VLBW infants in two European Level IV perinatal centers before and 
during the pandemic. We performed standardized parent questionnaires with 
mothers and fathers separately to evaluate their emotional stress and 
well-being. The pandemic worsened the emotional well-being of parents of VLBW 
infants, particularly of mothers. During the pandemic, mothers reported 
significantly higher state anxiety levels (48.9 vs. 42.9, p = 0.026) and 
hampered bonding with the child (6.3 vs. 5.2, 0 = 0.003) than before. In 
addition, mothers felt more personally restricted than fathers (6.1 vs. 5.2, 
p = 0.003). Fathers experienced lower levels of stress than mothers; they were 
equally burdened before and during the pandemic. Restrictions in visiting 
policies for families of VLBW infants during the SARS-CoV-2 pandemic have a 
significant negative impact on parental stress and should therefore be applied 
cautiously.

© 2023. Springer Nature Limited.

DOI: 10.1038/s41598-023-40836-9
PMCID: PMC10477236
PMID: 37666877 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


407. Int J Occup Saf Ergon. 2023 Dec;29(4):1552-1557. doi: 
10.1080/10803548.2023.2254600. Epub 2023 Sep 3.

Change in the form of work of psychologists after the outbreak of the COVID-19 
pandemic in Poland, and the subjective mental state of this professional group.

Sokół-Szawłowska M(1).

Author information:
(1)Outpatient Clinic, Institute of Psychiatry and Neurology in Warsaw, Poland.

Objectives. The first wave of the COVID-19 pandemic in Poland in spring 2020 
forced psychologists to fight the psychological consequences, which were 
triggered by drastic life changes among the entire population. This group of 
professionals had an incredibly difficult role to play in society; the level of 
their overload in studies was even compared to doctors treating COVID-19. This 
article aims to analyze the situation of both personal and professional 
psychologists in the first wave of the pandemic. Methods. During the study, 341 
psychologists were surveyed using the snowball method (hybrid access). Data were 
collected between 12 March and 3 May 2020. The study is part of a large project 
from all waves of the pandemic. Results. In total, 82.7% of psychologists 
experienced moderate to high-intensity stress, and 61.29% switched to a remote 
or hybrid mode of working with patients. Subjectively depressed mood occurred in 
16.13%, reduced drive in 27.57% and dyssomnia in 18.77%. A total of 61.58% had 
concerns about their professional and/or financial future after the pandemic. 
Conclusion. The challenges during, as well as after, the pandemic period require 
taking care of individual mental well-being for psychologists. This is a 
necessary condition for undertaking a committed job.

DOI: 10.1080/10803548.2023.2254600
PMID: 37661633 [Indexed for MEDLINE]


408. Transl Psychiatry. 2023 Sep 1;13(1):290. doi: 10.1038/s41398-023-02578-0.

Reducing intrusive memories after trauma via an imagery-competing task 
intervention in COVID-19 intensive care staff: a randomised controlled trial.

Iyadurai L(1), Highfield J(2), Kanstrup M(3), Markham A(1), Ramineni V(1)(3), 
Guo B(4), Jaki T(5)(6), Kingslake J(1), Goodwin GM(7), Summers C(8), Bonsall 
MB(9), Holmes EA(10).

Author information:
(1)P1vital Products Ltd, Wallingford, Oxfordshire, UK.
(2)Intensive Care Society, 7-9- Breams Buildings, London, UK.
(3)Department of Psychology, Uppsala University, Uppsala, Uppsala County, 
Sweden.
(4)NIHR ARC East Midlands, University of Nottingham, Nottingham, UK.
(5)MRC Biostatistics Unit, University of Cambridge, Cambridge, Cambridgeshire, 
UK.
(6)University of Regensburg, Regensburg, Bavaria, Germany.
(7)Department of Psychiatry, University of Oxford, Oxford, Oxfordshire, UK.
(8)Heart and Lung Research Institute, University of Cambridge, Cambridge, 
Cambridgeshire, UK.
(9)Department of Biology, University of Oxford, Oxford, Oxfordshire, UK.
(10)Department of Psychology, Uppsala University, Uppsala, Uppsala County, 
Sweden. emily.holmes@psyk.uu.se.

Intrusive memories (IMs) after traumatic events can be distressing and disrupt 
mental health and functioning. We evaluated the impact of a brief 
remotely-delivered digital imagery-competing task intervention on the number of 
IMs for intensive care unit (ICU) staff who faced repeated trauma exposure 
during the COVID-19 pandemic using a two-arm, parallel-group, single-blind 
randomised controlled trial, with the comparator arm receiving delayed access to 
active treatment (crossover). Eligible participants worked clinically in a UK 
NHS ICU during the pandemic and had at least 3 IMs of work-related traumatic 
events in the week before recruitment. Participants were randomly assigned (1:1) 
to immediate (weeks 1-4) or delayed (weeks 5-8) intervention access. Sequential 
Bayesian analyses to optimise the intervention and increase trial efficiency are 
reported elsewhere [1]. The primary endpoint for the pre-specified frequentist 
analysis of the final study population compared the number of IMs experienced in 
week 4 between the immediate and delayed access arms. Secondary outcomes 
included clinical symptoms, work functioning and wellbeing. Safety was assessed 
throughout the trial by scheduled questions and free report. All analyses were 
undertaken on an intention-to-treat basis (86 randomised participants). There 
were significantly fewer intrusive memories during week 4 in the immediate 
(median = 1, IQR = 0-3, n = 43), compared to the comparator delayed arm 
(median = 10, IQR = 6-17, n = 43), IRR 0.31, 95% CI: 0.20-0.48, p < 0.001. After 
crossover, the delayed arm also showed a significant reduction in IMs at week 8 
compared to week 4. There were convergent findings for symptoms of PTSD, 
insomnia and anxiety, work engagement and burnout, general functioning and 
quality of life. The intervention was found safe and acceptable to participants. 
All adverse events were unrelated to the study. Our study provides the first 
evidence of a benefit on reducing IMs, improving other clinical symptoms, work 
functioning and wellbeing, as well as safety of a brief remotely-delivered 
digital imagery-competing task intervention. An efficacy trial with an active 
control and longer follow-up is warranted. The trial is registered at 
ClinicalTrials.gov (NCT04992390).

© 2023. Springer Nature Limited.

DOI: 10.1038/s41398-023-02578-0
PMCID: PMC10474101
PMID: 37658043 [Indexed for MEDLINE]

Conflict of interest statement: The study was funded by the Wellcome Trust 
(223016/Z/21/Z). JK is shareholder and director of P1vital Products Ltd which is 
the study sponsor and manufacturer of i-spero®. LI, AM and VR are employed by 
P1vital Products Ltd. MBB is an adjunct member of the DMC. CS salary is part 
funded by National Institute for Health and Care Research (NIHR133788) and 
Medical Research Council (MR/S035753/1, MR/X005070/1, MR/P502091/1). EAH salary 
is part funded by the Wellcome Trust (223016/Z/21/Z) via consultancy to P1vital 
Products Ltd. EAH is on the Board of Trustees of the MQ Foundation. EAH 
developed the imagery-competing task intervention for intrusive memories, and 
training in using it (ANEMONE ™). EAH receives book royalties from Guildford 
Press and Oxford University Press, and receives occasional honoraria for 
conference keynotes and clinical workshops. GMG is a NIHR Emeritus Senior 
Investigator and Chief Medical Officer at Compass pathways, holds shares and 
share options in Compass pathways, and has served as consultant, advisor or CME 
speaker in the last 3 years for Beckley Psytech, Boehringer Ingelheim, 
Clerkenwell Health, Compass pathways, Evapharma, Janssen, Lundbeck, Medscape, 
Novartis, Ocean Neuroscience, P1vital, Servier and Takeda. All other authors 
declare no competing interests. The views expressed are those of the author(s) 
and not necessarily those of the NHS, the NIHR or the Department of Health.


409. Gerontologist. 2024 May 1;64(5):gnad122. doi: 10.1093/geront/gnad122.

Perceived Anxiousness About COVID-19 and Preventive Behaviors Among Dyads of 
Older Adults and Family Caregivers.

Liang J(1), Aranda MP(1), Jang Y(1)(2).

Author information:
(1)Edward R. Roybal Institute on Aging, Suzanne Dworak-Peck School of Social 
Work, University of Southern California, Los Angeles, California, USA.
(2)Department of Social Welfare, Ewha Womans University, Seoul, Republic of 
Korea.

BACKGROUND AND OBJECTIVES: Adopting preventive behaviors is crucial to avoiding 
coronavirus disease 2019 (COVID-19) infection, and perceived anxiousness may 
influence such behaviors among older adults and their caregivers. This study 
investigated the relationships between perceived anxiousness about COVID-19 and 
preventive behaviors in older adult-caregiver dyads.
RESEARCH DESIGN AND METHODS: A cross-sectional study was conducted using 1,565 
older adult-caregiver dyads from the 2020 National Health and Aging Trend Study 
(NHATS)/National Study of Caregiving (NSOC) COVID-19 Supplements data. 
Actor-partner interdependence models were estimated to examine the associations 
between older adults' and family caregivers' perceived anxiousness about 
COVID-19 and their engagement in personal (e.g., wearing masks, washing hands) 
and social (e.g., avoiding contact with friends, limiting grocery shopping) 
preventive behaviors. Separate models were estimated based on older adults' 
dementia status.
RESULTS: We found significant actor effects of anxiousness about COVID-19 on 
preventive behaviors of both older adults and caregivers in nondementia dyads. 
The anxiousness about COVID-19 of older adults had significant partner effects 
on both personal and social preventive behaviors of caregivers, whereas 
caregivers' anxiousness about COVID-19 only had a significant partner effect on 
social preventive behaviors of older adults. No significant partner effect was 
found in dementia dyads.
DISCUSSION AND IMPLICATIONS: Our findings highlight the critical role of 
caregivers in promoting older adults' health behaviors during the COVID-19 
pandemic and maintaining mental well-being of older adults. The study also 
implies future efforts to explore the dyadic relationship of dementia care dyads 
in promoting health behaviors and mental health.

© The Author(s) 2023. Published by Oxford University Press on behalf of The 
Gerontological Society of America. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/geront/gnad122
PMCID: PMC11020246
PMID: 37656168 [Indexed for MEDLINE]

Conflict of interest statement: None.


410. PLoS One. 2023 Aug 31;18(8):e0286439. doi: 10.1371/journal.pone.0286439. 
eCollection 2023.

Emotional overeating affected nine in ten female students during the COVID-19 
university closure: A cross-sectional study in France.

Constant A(1)(2), Fortier A(1), Serrand Y(1), Bannier E(3)(4), Moirand R(1)(5), 
Thibault R(1)(6), Coquery N(1), Godet A(1), Val-Laillet D(1).

Author information:
(1)INRAE, INSERM, CHU Rennes, Nutrition Metabolisms and Cancer, NuMeCan, Univ 
Rennes, Rennes, France.
(2)EHESP, School of Public Health, Rennes, France.
(3)Inria, CRNS, Inserm, IRISA UMR 6074, Empenn U1228, Univ Rennes, Rennes, 
France.
(4)Radiology Department, CHU Rennes, Rennes, France.
(5)Unité d'Addictologie, CHU Rennes, Rennes, France.
(6)Unité de Nutrition, CHU Rennes, Rennes, France.

OBJECTIVES: To estimate the proportion of female university students reporting 
overeating (EO) in response to emotions during the COVID-19 university closures, 
and to investigate social and psychological factors associated with this 
response to stress.
DESIGN: Online survey gathered sociodemographic data, alcohol/drugs use 
disorders, boredom proneness and impulsivity using validated questionnaires, and 
EO using the Emotional Overeating Questionnaire (EOQ) assessing eating in 
response to six emotions (anxiety, sadness, loneliness, anger, fatigue, 
happiness), whose structure remains to be determined.
PARTICIPANTS: Sample of 302 female students from Rennes University, France.
MAIN OUTCOME MEASURE: Frequencies of emotional overeating.
ANALYSIS: The frequency of emotional overeating was expressed for each emotion 
as percentages. Exploratory Factor analyses (EFA) were used to determine EOQ 
structure and provide an index of all EOQ items used for further analysis. 
Linear regression models were used to explore relationships between EO and 
others covariates.
RESULTS: Nine in ten participants reported intermittent EO in the last 28 days, 
mostly during 6 to 12 days, in response to Anxiety (75.5%), Sadness (64.5%), 
Happiness (59.9%), Loneliness (57.9%), Tiredness (51.7%), and to a lesser extent 
to Anger (31.1%). EFA evidenced a one-factor latent variable reflecting 
"Distress-Induced Overeating" positively correlated with internal boredom 
proneness, tobacco use, attentional impulsivity, inability to resist emotional 
cues, and loss of control over food intake, and negatively with age and 
well-being. EO was unrelated to body mass index or substance abuse.
CONCLUSION AND IMPLICATIONS: Nine in ten female students reported emotional 
overeating during the COVID-19 university closure. This response to stress was 
related to eating tendencies typical of young women, but also to 
personality/behavioral patterns such as boredom and impulsivity proneness. 
Better understanding of the mechanisms underlying EO in response to stress and 
lack of external/social stimulation would improve preventive interventions.

Copyright: © 2023 Constant et al. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0286439
PMCID: PMC10470954
PMID: 37651411 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


411. PLoS One. 2023 Aug 31;18(8):e0290230. doi: 10.1371/journal.pone.0290230. 
eCollection 2023.

Teacher mental health and workplace well-being in a global crisis: Learning from 
the challenges and supports identified by teachers one year into the COVID-19 
pandemic in British Columbia, Canada.

Gadermann AM(1), Gagné Petteni M(1), Molyneux TM(1), Warren MT(2), Thomson 
KC(1), Schonert-Reichl KA(1)(3), Guhn M(1), Oberle E(1).

Author information:
(1)Human Early Learning Partnership, School of Population and Public Health, 
University of British Columbia, Vancouver, BC, Canada.
(2)Department of Psychology, Western Washington University, WA, United States of 
America.
(3)Department of Psychology, University of Illinois Chicago, Chicago, IL, United 
States of America.

The COVID-19 pandemic and related school disruptions have led to increased 
concerns for the mental health of teachers. This study investigated how the 
challenges and systemic supports perceived by teachers during the COVID-19 
pandemic were associated with their mental health and workplace well-being. This 
cross-sectional, survey-based study was conducted in February 2021, just prior 
to the third wave of the pandemic in British Columbia (BC), Canada (N = 1,276). 
Four multivariable linear regression models examined the associations between 
teachers' pandemic-related challenges (pandemic-related personal stressors, 
teacher workload, difficulty implementing safety measures, meeting students' 
needs), systemic supports (education system mental health and well-being 
support), and four mental health (psychological distress, and quality of life) 
and workplace well-being outcomes (job-related positive affect, turnover 
intentions), adjusting for sociodemographic and school characteristics. The 
Pratt index (d) was used to assess the relative importance of each predictor. A 
thematic qualitative analysis was conducted on teachers' open-ended responses. 
Teachers' workplace well-being (job-related positive affect and turnover 
intentions) was predominantly associated with their perceptions of education 
system support for their mental health and well-being (d = 46%, d = 41%, 
respectively). The most important predictor of general mental health 
(psychological distress and quality of life) was the number of COVID-19 related 
personal stressors teachers reported (d = 64%, d = 43%, respectively). The 
qualitative analyses corroborated and expanded upon the quantitative findings. 
Understanding pandemic-related challenges and supports impacting teacher mental 
health and workplace well-being equips us to make evidence-informed policy 
decisions to support teachers now and in future school disruptions.

Copyright: © 2023 Gadermann et al. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0290230
PMCID: PMC10470891
PMID: 37651356 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


412. Eat Behav. 2023 Dec;51:101792. doi: 10.1016/j.eatbeh.2023.101792. Epub 2023 Aug 
24.

Family body culture, disordered eating and mental health among young adult 
females during COVID-19.

White HJ(1), Sharpe H(2), Plateau CR(3).

Author information:
(1)School of Sport, Exercise and Health Sciences, Loughborough University, 
Loughborough, UK. Electronic address: H.J.White@lboro.ac.uk.
(2)School of Health in Social Science, University of Edinburgh, Teviot Place, 
EH8 9AG Edinburgh, UK. Electronic address: H.Sharpe@ed.ac.uk.
(3)School of Sport, Exercise and Health Sciences, Loughborough University, 
Loughborough, UK. Electronic address: C.R.Plateau@lboro.ac.uk.

Different family interactions related to body weight and shape may co-occur and 
represent a broader 'family body culture'. This may be important in the context 
of COVID-19 due to a heightened focus on body weight/shape, and many young 
adults living back with their families. This study aimed to, first, explore 
relationships between different family body-related interactions to assess the 
presence of a family body culture, and second, explore relationships between 
aspects of family body culture, disordered eating and mental health among young 
adult females during the COVID-19 pandemic. Participants were 233 females aged 
18-25 years who completed measures of family body culture (family fat talk; 
family weight concern; family weight teasing), disordered eating, anxiety and 
depression. Results showed all aspects of family body culture were 
significantly, positively related. Engaging in fat talk with family members 
(self fat talk) was a key correlate of disordered eating, anxiety and 
depression. Family concern with weight was also significantly associated with 
disordered eating. Findings suggest that among some families there is a more 
problematic family body culture with a greater importance placed on body weight 
and shape through various body-related interactions. Additionally, findings 
highlight two key aspects of family body culture related to disordered eating 
and wellbeing among young adult females. Specifically, vocalising critical 
remarks about one's own body when with family and an environment that may 
indirectly communicate a high importance of body weight and shape (e.g., via 
dieting). These should be considered in future family interventions to support 
healthy eating behaviours.

Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.eatbeh.2023.101792
PMID: 37647687 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest None.


413. Dementia (London). 2023 Nov;22(8):1950-1976. doi: 10.1177/14713012231198748. 
Epub 2023 Aug 30.

Online gallery facilitated art activities for people with dementia during the 
COVID-19 pandemic and beyond: A narrative review.

Wiseman L(1)(2), Isbel S(1)(2), Boag A(3), Halpin-Healy C(4), Gibson D(1)(2), 
Bail K(1)(2), Noble JM(4)(5), D'Cunha NM(1)(2).

Author information:
(1)Faculty of Health, University of Canberra, Bruce, ACT, Australia.
(2)Ageing Research Group, Faculty of Health, University of Canberra, Bruce, ACT, 
Australia.
(3)National Gallery of Australia, Parkes, ACT, Australia.
(4)Arts and Minds, New York, NY, USA.
(5)Taub Institute, Columbia University Irving Medical Center, New York, NY, USA.

Art activities for people with dementia have a range of therapeutic benefits 
including psychosocial wellbeing and enhanced quality of life. Successful art 
programs promote social engagement, are inclusive and empowering, and enable 
opportunity for people with dementia to express themselves verbally and 
non-verbally. The COVID-19 pandemic and associated social distancing precautions 
have impacted the capacity of art galleries and museums to deliver in-person 
programs. However, they have also provided a new opportunity. This paper 
explores the potential benefits, challenges, and future directions for research 
relating to the online delivery of gallery-facilitated art activities for people 
with dementia. The evidence revealed that increased digitisation of programs 
increased access for participants, however, the majority of the research was 
published before the pandemic. Nevertheless, COVID-19 has necessitated many 
museums and galleries to engage with people with dementia online. Future 
research is needed to improve the usability of online delivery platforms and a 
comparison of online and onsite delivery is recommended, particularly to 
evaluate benefits to people living in rural and remote areas where access to 
museums and galleries may be limited.

DOI: 10.1177/14713012231198748
PMCID: PMC10644691
PMID: 37647250 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of conflicting interestsThe 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


414. BMJ. 2023 Aug 29;382:e074787. doi: 10.1136/bmj-2023-074787.

Promoting Activity, Independence, and Stability in Early Dementia and mild 
cognitive impairment (PrAISED): randomised controlled trial.

Harwood RH(1)(2), Goldberg SE(3), Brand A(4), van Der Wardt V(5), Booth V(2)(6), 
Di Lorito C(6), Hoare Z(4), Hancox J(7), Bajwa R(6), Burgon C(6), Howe L(6), 
Cowley A(2)(6), Bramley T(8), Long A(6), Lock J(6), Tucker R(3), Adams EJ(3), 
O'Brien R(3), Kearney F(2), Kowalewska K(6), Godfrey M(9), Dunlop M(9), Junaid 
K(10), Thacker S(11), Duff C(12), Welsh T(13), Haddon-Silver A(14), Gladman 
J(2)(6), Logan P(6), Pollock K(3), Vedhara K(15), Hood V(8), Das Nair R(6)(16), 
Smith H(8), Tudor-Edwards R(17), Hartfiel N(17), Ezeofor V(17), Vickers R(6), 
Orrell M(10)(18), Masud T(2).

Author information:
(1)School of Health Sciences, University of Nottingham, Queen's Medical Centre, 
Nottingham, NG7 2HA, UK Rowan.harwood@nottingham.ac.uk.
(2)Nottingham University Hospitals NHS Trust, Queen's Medical Centre, 
Nottingham, UK.
(3)School of Health Sciences, University of Nottingham, Queen's Medical Centre, 
Nottingham, NG7 2HA, UK.
(4)North Wales Organisation for Randomised Trials in Health, Bangor University, 
Bangor, Gwynedd, UK.
(5)Department of General, Preventative and Rehabilitation Medicine, 
Philipps-Universität Marburg 35032 Marburg, Germany.
(6)School of Medicine, University of Nottingham, Queen's Medical Centre, 
Nottingham, UK.
(7)School of Sport, Exercise and Health Sciences, Loughborough University, 
Loughborough, UK.
(8)Nottinghamshire Healthcare NHS Foundation Trust, Lings Bar Hospital, Gamston, 
Nottingham, UK.
(9)Public representative, Nottingham, UK.
(10)Mental Health Services for Older People, Nottinghamshire Healthcare NHS 
Foundation Trust, Highbury Hospital, Nottingham, UK.
(11)Centre for Research and Development, Derbyshire Healthcare NHS Foundation 
Trust, Kingsway Hospital, Derby, UK.
(12)Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK.
(13)The RICE Centre, Research Institute for the Care of Older People, Royal 
United Hospital, Bath, UK.
(14)Oxford Health NHS Foundation Trust, Research and Development, Warneford 
Hospital, Oxford, UK.
(15)Centre for Academic Primary Care, Lifespan and Population Health, University 
of Nottingham, Nottingham, UK.
(16)SINTEF, Torgarden, Trondheim, Norway.
(17)Centre for Health Economics and Medicines Evaluation, College of Health and 
Behavioural Sciences, Bangor University, Bangor, Gwynedd, UK.
(18)Institute for Mental Health, University of Nottingham, Nottingham, UK.

OBJECTIVE: To determine the effectiveness of an exercise and functional activity 
therapy intervention in adults with early dementia or mild cognitive impairment 
compared with usual care.
DESIGN: Randomised controlled trial.
SETTING: Participants' homes and communities at five sites in the United 
Kingdom.
PARTICIPANTS: 365 adults with early dementia or mild cognitive impairment who 
were living at home, and family members or carers.
INTERVENTION: The intervention, Promoting activity, Independence, and Stability 
in Early Dementia and mild cognitive impairment (PrAISED), was a specially 
designed, dementia specific, rehabilitation programme focusing on strength, 
balance, physical activity, and performance of activities of daily living, which 
was tailored and progressive and addressed risk and the psychological needs of 
people with dementia. Up to 50 therapy sessions were provided over 12 months. 
The control group received usual care plus a falls risk assessment. Procedures 
were adapted during the covid-19 pandemic.
MAIN OUTCOME MEASURES: The primary outcome was score on the carer (informant) 
reported disability assessment for dementia scale 12 months after randomisation. 
Secondary outcomes were self-reported activities of daily living, physical 
activity, quality of life, balance, functional mobility, fear of falling, 
frailty, cognition, mood, carer strain, service use at 12 months, and falls 
between months 4 and 15.
RESULTS: 365 patient participants were randomised, 183 to intervention and 182 
to control. The median age of participants was 80 years (range 65-95), median 
Montreal cognitive assessment score was 20 out of 30 (range 13-26), and 58% 
(n=210) were men. Intervention participants received a median of 31 therapy 
sessions (interquartile range 22-40) and reported completing a mean 121 minutes 
of PrAISED exercise each week. Primary outcome data were available for 149 
intervention and 141 control participants. Scores on the disability assessment 
for dementia scale did not differ between groups: adjusted mean difference -1.3, 
95% confidence interval -5.2 to 2.6; Cohen's d effect size -0.06, 95% confidence 
interval -0.26 to 0.15; P=0.51). Upper 95% confidence intervals excluded small 
to moderate effects on any of the range of outcome measures. Between months 4 
and 15 the intervention group experienced 79 falls and the control group 200 
falls (adjusted incidence rate ratio 0.78, 95% confidence interval 0.5 to 1.3; 
P=0.3).
CONCLUSION: The intensive PrAISED programme of exercise and functional activity 
training did not improve activities of daily living, physical activity, or 
quality of life; reduce falls; or improve any other secondary health status 
outcomes, despite good uptake. Future research should consider alternative 
approaches to maintaining ability and wellbeing in people with dementia.
TRIAL REGISTRATION: ISRCTN Registry ISRCTN15320670.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmj-2023-074787
PMCID: PMC10463053
PMID: 37643788 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: All authors have completed 
the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and 
declare: support from the National Institute for Health and Care Research for 
the submitted work; no financial relationships with any organisations that might 
have an interest in the submitted work in the previous three years; no other 
relationships or activities that could appear to have influenced the submitted 
work.


415. BMC Public Health. 2023 Aug 28;23(1):1642. doi: 10.1186/s12889-023-16476-z.

Married women's decision to delay childbearing, and loneliness, severe 
psychological distress, and suicidal ideation under crisis: online survey data 
analysis from 2020 to 2021.

Matsushima M(1), Yamada H(2), Kondo N(3), Arakawa Y(4), Tabuchi T(5).

Author information:
(1)Faculty of Humanities and Social Sciences, University of Tsukuba, 1-1-1 
Tennodai, Tsukuba Ibaraki, 305-8577, Japan. 
matsushima.midori.gb@u.tsukuba.ac.jp.
(2)Department of Economics, Keio University, Tokyo, Japan.
(3)Department of Social Epidemiology, Graduate School of Medicine, University of 
Kyoto, Kyoto, Japan.
(4)Departments of Health and Social Behavior, Graduate School of Medicine, 
University of Tokyo, Tokyo, Japan.
(5)Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan.

BACKGROUND: The COVID-19 pandemic has affected every aspect of our lives, 
including the decision to become pregnant. Existing literature suggests that 
infertility and the decision to delay childbearing at a younger age are 
associated with a lower level of well-being and regrets when women start to 
desire a baby. Thus, the decision to delay childbearing due to the pandemic 
could negatively affect the well-being of women. This study focuses on how 
pregnancy decisions affect the well-being of women during the COVID-19 pandemic.
METHODS: From the Japan COVID-19 and Society Internet Survey, a nationally 
representative web-based survey, 768 observations of married women aged 18 to 
50 years who had the intention of getting pregnant during the pre-pandemic 
period (conducted in 2020 and 2021) were used. Loneliness, severe psychological 
distress, and suicidal ideation were used as well-being indicators. For pooled 
data, a generalised estimated equation (GEE) model was used to estimate how 
pregnancy decision related to well-being indicators. For a sub-analysis, the 
sample was divided by the survey year and a Poisson regression model was used.
RESULTS: The GEE analysis showed an association between delaying childbearing 
and severe psychological distress, with the prevalence ratio (PR) being 2.06 
[95% CI (1.40-3.03)]. Furthermore, loneliness and suicidal ideation that 
occurred after the beginning of the pandemic were significantly related to the 
decision to delay childbearing-1.55 [95% CI (1.03,2.34)] and 2.55 [95% CI 
(1.45-4.51)], respectively. Moreover, these PRs were larger for 2021 compared to 
2020.
CONCLUSION: During the COVID-19 pandemic, approximately one-fifth of married 
women who had childbearing intentions before the pandemic decided to postpone 
pregnancy. They exhibited a deteriorated mental health state. Furthermore, the 
negative associations were larger in 2021 compared to 2020. Loneliness has 
negative consequences for both mental and physical health, as well as elevated 
severe psychological distress and suicidal ideation among those who decided to 
postpone pregnancy. Therefore, the current results should not be overlooked by 
society.

© 2023. BioMed Central Ltd., part of Springer Nature.

DOI: 10.1186/s12889-023-16476-z
PMCID: PMC10464056
PMID: 37641039 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


416. BMJ Open. 2023 Aug 28;13(8):e072155. doi: 10.1136/bmjopen-2023-072155.

Stress and safety of maternal and newborn healthcare workers early in the 
COVID-19 pandemic: a repeat cross-sectional analysis from a global online survey 
from March 2020 to March 2021.

Ezema A(#)(1), Caputo M(#)(2), Semaan A(3), Benova L(3), Liang ST(2), Hirschhorn 
LR(4)(5).

Author information:
(1)Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
(2)Robert J Havey, MD Institute for Global Health, Feinberg School of Medicine, 
Northwestern University, Chicago, Illinois, USA.
(3)Department of Public Health, Institute of Tropical Medicine, Antwerpen, 
Belgium.
(4)Robert J Havey, MD Institute for Global Health, Feinberg School of Medicine, 
Northwestern University, Chicago, Illinois, USA 
lisa.hirschhorn@northwestern.edu.
(5)Department of Medical Social Sciences, Feinberg School of Medicine, 
Northwestern University, Chicago, Illinois, USA.
(#)Contributed equally

OBJECTIVES: This study aims to characterise the physical and psychological 
well-being of maternal and newborn healthcare workers (MNHCWs) during the 
COVID-19 pandemic.
DESIGN: Observational repeated cross-sectional study.
SETTING: An online questionnaire was distributed to MNHCWs around the globe in 
three separate rounds from March 2020 to March 2021.
PARTICIPANTS: Total samples of N=1357 (round 1) and N=420 (round 3) primarily 
consisted of doctors, midwives and nurses in maternal and newborn specialties. 
Samples represented all WHO regions, with 33% (round 1) and 42% (round 3) from 
low- or middle-income countries (LMICs).
PRIMARY AND SECONDARY OUTCOME MEASURES: Responses from rounds 1 (March-June 
2020) and 3 (December 2020-March 2021) were analysed to measure self-reported 
levels of relative stress and workplace protection from COVID-19, while 
associated factors were determined through multivariable ordinal logistic 
regression.
RESULTS: In round 1, 90% of MNHCWs reported increased stress levels and 45% 
reported insufficient personal protective equipment (PPE) access. Nurses and 
physicians were less likely to report increased stress than midwives at the 
pandemic onset. Factors associated with increased stress included being female, 
being from an LMIC and insufficient PPE. In round 3, 75% reported similar or 
increased stress while 10% reported insufficient PPE. In both rounds, over 50% 
of MNHCWs felt relatively or completely unprotected from COVID-19 in the 
workplace. Those from LMICs were more likely to report feeling unprotected, 
while receiving organisational information that valued safety was associated 
with better feelings of protection in the workplace.
CONCLUSIONS: Among our international sample of MNHCWs, we observed high rates of 
self-reported stress increase at the start of the pandemic with persistence or 
increase up to a year later. High rates of feeling unprotected persisted even as 
PPE became more available. These results may inform interventions needed to 
support and protect MNHCWs during this and future pandemics.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2023-072155
PMCID: PMC10462945
PMID: 37640461 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


417. Int J Qual Stud Health Well-being. 2023 Dec;18(1):2251236. doi: 
10.1080/17482631.2023.2251236.

Adolescents' and young people's experiences of social relationships and health 
concerns during COVID-19.

Sundler AJ(1), Bergnehr D(2), Haffejee S(3), Iqbal H(4), Orellana MF(5), Vergara 
Del Solar A(6), Angeles SL(7), Faircloth C(4), Liu L(5), Mwanda A(3), Sepúlveda 
Galeas M(8), Simelane T(3), Twamley K(4), Darcy L(1).

Author information:
(1)Department of Caring Science, University of Borås, Borås, Sweden.
(2)Department of Pedagogy and Learning, Linnaeus University, Växjö, Sweden.
(3)Centre for Social Development in Africa, University of Johannesburg, 
Johannesburg, South Africa.
(4)Thomas Coram Research Unit, University College London, London, UK.
(5)School of Education and Information Studies, University of California, Los 
Angeles, USA.
(6)Faculty of Humanities, Universidad de Santiago, Santiago, Chile.
(7)College of Education, Penn State University, Pennsylvania, USA.
(8)Faculty of Psychology, Universidad Diego Portales, Chile.

PURPOSE: To illuminate the meaning of social relationships and health concerns 
as experienced by adolescents and young people during the COVID-19 pandemic.
METHODS: A longitudinal qualitative study was conducted. Data reported from 172 
adolescents and young people aged 12-24 years in five countries; Chile, South 
Africa, Sweden, the United Kingdom and the United States collected from May 2020 
to June 2021 were analysed via thematic analysis.
RESULTS: Adolescents and young peoples' experiences of social relationships and 
health concerns were described in seven themes: Family proximity, conflicts and 
frustration; difficulties and challenges related to limited living space; peer 
relations and maintaining friendship in times of social distancing; the 
importance of school as a place for interaction; vulnerability, emotional 
distress and uncertainty about the future; health concerns and sense of caring 
for others; and worries and concerns related to financial hardship. These 
reports show that the changes to everyday life that were introduced by public 
responses to the pandemic generated feelings of loneliness, vulnerability, and 
emotional distress, as well as increased sense of togetherness with family.
CONCLUSIONS: The everyday lives of adolescents and young people were restricted 
and affected more by the consequences of the pandemic than by the COVID-19 
virus. These experiences had various impacts on well-being and mental health, 
where some individuals felt more exposed and vulnerable to emotional distress 
and loneliness than others. Family and peer relationships could be protective 
and support a sense of togetherness and belonging. Hence, social relationships 
are important to provide emotional support. Support for adolescents and young 
people should be tailored accordingly around social and emotional concerns, to 
encourage health and well-being.

DOI: 10.1080/17482631.2023.2251236
PMCID: PMC10464546
PMID: 37639471 [Indexed for MEDLINE]

Conflict of interest statement: No potential conflict of interest was reported 
by the author(s).


418. Front Public Health. 2023 Aug 10;11:1237443. doi: 10.3389/fpubh.2023.1237443. 
eCollection 2023.

Sports activity limitation during the COVID-19 pandemic in young Italian 
athletes: impact on mental health in children, adolescents, and young adults.

Tomezzoli E(#)(1), D'Ecclesiis O(#)(2), Raimondi S(2), Pravettoni G(1), 
Cammarata G(2), Testa G(3), Bellerba F(2), Gnagnarella P(4), Iannuzzo ML(5), 
Sartorio A(6), Sasso C(7), Ricci D(8), Marazzi N(6), Galli F(9), Gandini S(2).

Author information:
(1)Applied Research Division for Cognitive and Psychological Science, IEO, 
European Institute of Oncology Istituto di Ricovero e Cura a Carattere 
Scientifico (IRCCS), Milan, Italy.
(2)Molecular and Pharmaco-Epidemiology Unit, Department of Experimental 
Oncology, IEO, European Institute of Oncology Istituto di Ricovero e Cura a 
Carattere Scientifico (IRCCS), Milan, Italy.
(3)Independent Researcher, Milan, Italy.
(4)Division of Epidemiology and Biostatistics, IEO, European Institute of 
Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, 
Italy.
(5)AULSS 9 Scaligera, Dipartimento di Prevenzione, UOC Medicina Legale, Verona, 
Italy.
(6)Experimental Laboratory for Auxo-endocrinological Research, Istituto 
Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico 
(IRCCS), Milan, Italy.
(7)Istituto Nazionale di Astrofisica (INAF)-Capodimonte Astronomical 
Observatory, Naples, Italy.
(8)ARES-ODV Associazione Regionale Emergenza Sanitaria, Ancona, Italy.
(9)Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of 
Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
(#)Contributed equally

INTRODUCTION: The closure of sports centres was implemented as a preventive 
measure to mitigate the transmission of SARS-CoV-2. Given the observed global 
decline in physical activity and concurrent rise in sedentary behaviour, even 
among younger age groups, a retrospective cross-sectional study was undertaken 
to evaluate the effects of this measure on mental health in children, 
adolescents, and young adults during the initial phases of the COVID-19 
pandemic.
METHODS: A total of 1,717 non-professional athletes (age range: 6-25; 53.9% 
males, 44.6% females) completed an online questionnaire including widely used 
and validated measures for mental health assessment (SDQ and PGWB-S) and 
questions regarding sociodemographic characteristics (such as gender), physical 
activity, and screen time. The association between mental health and 
sociodemographic characteristics, physical activity, and screen time was 
evaluated by using univariate and multivariable logistic regression models.
RESULTS: In children and adolescents, the incidence of psychological 
difficulties was associated with not being physically active (OR = 1.49; 95% CI: 
1.09, 2.07; p = 0.015). Engaging in physical activity during the period of 
closures, particularly if more than twice a week, was significantly associated 
with less psychological difficulties for children/adolescents (OR = 0.54; 95% 
CI: 0.35, 0.82; p = 0.004) and psychological symptoms (i.e., psychological 
well-being lower than the median) for youth/young adults (OR = 0.25; 95% CI: 
0.14, 0.45; p < 0.001). More psychological difficulties were also found in males 
for children and adolescents (OR = 1.37; 95% CI: 1.06, 1.79; p = 0.018). 
However, young adult males showed less psychological symptoms than females (OR = 
0.35; 95% CI: 0.22, 0.55; p = 0.001). Additionally, a greater amount of screen 
time was associated with a higher incidence of psychological symptoms in the 
whole sample.
CONCLUSIONS: Our results confirm the positive impact of physical activity on 
mental health during the COVID-19 pandemic among younger age groups. They also 
provide valuable insights into the risk-benefit relationship of interrupting 
sports activities as a preventive measure for infectious diseases.

Copyright © 2023 Tomezzoli, D'Ecclesiis, Raimondi, Pravettoni, Cammarata, Testa, 
Bellerba, Gnagnarella, Iannuzzo, Sartorio, Sasso, Ricci, Marazzi, Galli and 
Gandini.

DOI: 10.3389/fpubh.2023.1237443
PMCID: PMC10448519
PMID: 37637799 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


419. Telemed Rep. 2023 Aug 4;4(1):249-258. doi: 10.1089/tmr.2023.0030. eCollection 
2023.

Evaluation of a Telehealth-Enabled Pilot Program to Address Intensive Care Unit 
Health Care Worker Mental Health Distress.

Shah N(1), Goodwin AJ(1), Verdin R(2), Clark JT(3), Rheingold AA(4), Ruggiero 
KJ(5), Simpson AN(6), Ford DW(1).

Author information:
(1)Division of Pulmonary Critical Care Allergy and Sleep Medicine, Medical 
University of South Carolina, Charleston, South Carolina, USA.
(2)Telehealth Center of Excellence; Leadership and Management; Medical 
University of South Carolina, Charleston, South Carolina, USA.
(3)Biomedical Informatics Center; Leadership and Management; Medical University 
of South Carolina, Charleston, South Carolina, USA.
(4)Department of Psychiatry and Behavioral Sciences; Leadership and Management; 
Medical University of South Carolina, Charleston, South Carolina, USA.
(5)College of Nursing, Leadership and Management; Medical University of South 
Carolina, Charleston, South Carolina, USA.
(6)Department of Healthcare, Leadership and Management; Medical University of 
South Carolina, Charleston, South Carolina, USA.

INTRODUCTION: Health care workers (HCWs) are at heightened risk of adverse 
mental health events (AMHEs) and burnout with resultant impact on health care 
staffing, outcomes, and costs. We piloted a telehealth-enabled mental health 
screening and support platform among HCWs in the intensive care unit (ICU) 
setting at a tertiary care center.
METHODS: A survey consisting of validated screening tools was electronically 
disseminated to a potential cohort of 178 ICU HCWs. Participants were given 
real-time feedback on their results and those at risk were provided invitations 
to meet with resiliency clinicians. Participants were further invited to engage 
in a 3-month longitudinal assessment of their well-being through repeat surveys 
and a weekly text-based check-in coupled with self-help tips. Programmatic 
engagement was evaluated and associations between at-risk scores and engagement 
were assessed. Qualitative input regarding programmatic uptake and acceptance 
was gathered through key informant interviews.
RESULTS: Fifty (28%) HCWs participated in the program. Half of the participants 
identified as female, and most participants were white (74%) and under the age 
of 50 years (93%). Nurses (38%), physicians-in-training (24%), and faculty-level 
physicians (20%) engaged most frequently. There were 19 (38%) requests for an 
appointment with a resiliency clinician. The incidence of clinically significant 
symptoms of AMHEs and burnout was high but not clearly associated with 
engagement. Additional programmatic tailoring was encouraged by key informants 
while time was identified as a barrier to program engagement.
DISCUSSION: A telehealth-enabled platform is a feasible approach to screening 
at-risk HCWs for AMHEs and can facilitate engagement with support services.

© Nihar Shah et al., 2023; Published by Mary Ann Liebert, Inc.

DOI: 10.1089/tmr.2023.0030
PMCID: PMC10457649
PMID: 37637378

Conflict of interest statement: No competing financial interests exist.


420. Acad Psychiatry. 2023 Oct;47(5):504-509. doi: 10.1007/s40596-023-01844-z. Epub 
2023 Aug 27.

Before and During the First COVID-19 Surge: Work Conditions, Burnout, and Mental 
Health Among Resident Physicians in a Department of Psychiatry in the USA.

Agrawal A(1), De La Torre K(2), Cooper C(3), Flores J(3), Miotto K(3), Wells 
K(3)(2)(4), Bromley E(3), Yano EM(3)(2)(4), Heldt J(3)(2), Castillo EG(3), 
DeBonis K(3)(2).

Author information:
(1)Geffen School of Medicine at University of California, Los Angeles Medical 
Center, Los Angeles, CA, USA. aagrawal@mednet.ucla.edu.
(2)VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
(3)Geffen School of Medicine at University of California, Los Angeles Medical 
Center, Los Angeles, CA, USA.
(4)UCLA Fielding School of Public Health, Los Angeles Medical Center, Los 
Angeles, CA, USA.

OBJECTIVE: Resident physicians are critical frontline workers during pandemics, 
and little is known about their health. The study examined occupational and 
mental health risks among US psychiatry residents before and during the first 
COVID-19 surge.
METHODS: Longitudinal data were collected from a cohort of US psychiatry 
residents at one academic medical center in October 2019, before the pandemic, 
and April 2020 after the initiation of a state-level stay-at-home order. Primary 
outcome measures were psychological work empowerment, defined as one's 
self-efficacy towards their work role, and occupational burnout. A secondary 
outcome was mental health. In May and June 2020, resident engagement sessions 
were conducted to disseminate study findings and consider their implications.
RESULTS: Fifty-seven out of 59 eligible residents participated in the study 
(97%). Half the study sample reported high burnout. From before to during the 
first COVID-19 surge, psychological work empowerment increased in the total 
sample (p = 0.03); and mental health worsened among junior residents 
(p = 0.004), not senior residents (p = 0.12). High emotional exhaustion and 
depersonalization were associated with worse mental health (p < 0.001). In 
engagement sessions, themes related to residents' work conditions, COVID-19, and 
racism emerged as potential explanations for survey findings.
CONCLUSIONS: The study is exploratory and novel. During early COVID, psychiatry 
residents' well-being was impacted by occupational and societal factors. 
Postpandemic, there is a growing psychiatrist shortage and high demand for 
mental health services. The findings highlight the potential importance of 
physician wellness interventions focused on early career psychiatrists who were 
first responders during COVID.

© 2023. The Author(s).

DOI: 10.1007/s40596-023-01844-z
PMCID: PMC10602943
PMID: 37634240 [Indexed for MEDLINE]

Conflict of interest statement: On behalf of all authors, the corresponding 
author states that there is no conflict of interest.


421. BMC Public Health. 2023 Aug 26;23(1):1637. doi: 10.1186/s12889-023-16565-z.

Ignored and distressed: a cross-sectional study of the impact of COVID-19 on 
last responders.

Afifi RA(1), Calderon JL(2), Pham H(3), Teahen P(4)(5), Zarate-Sada S(2), Sewell 
DK(3), Vander Weg MW(2).

Author information:
(1)Department of Community and Behavioral Health, College of Public Health, 
University of Iowa, 145 N Riverside Drive, Iowa City, Iowa, N416, USA. 
rima-afifi@uiowa.edu.
(2)Department of Community and Behavioral Health, College of Public Health, 
University of Iowa, 145 N Riverside Drive, Iowa City, Iowa, N416, USA.
(3)Department of Biostatistics, College of Public Health, University of Iowa, 
Iowa City, Iowa, USA.
(4)Teahen Funeral Home, Cedar Rapids, Iowa, USA.
(5)Clinical Mental Health Counseling, College of Education, University of Iowa, 
Iowa City, Iowa, USA.

BACKGROUND: Last responders constitute an occupational category that includes 
all those that are involved in the postmortem care of deceased persons and their 
families. Last responders are exposed to several categories of work-related 
stressors that affect their health and well-being. COVID-19 exacerbated these 
stressors. Research to understand the consequences of COVID-19 on the health and 
wellbeing of last responders is nascent. This study aimed to assess COVID-19 
related stress, coping and wellbeing among last responders in the United States.
METHODS: We conducted a national cross-sectional survey of last responders in 
July through September of 2020. The survey measured wellbeing, stress, coping, 
and stigma; COVID-19 experiences, and socio-demographics. A ridge regression 
model was fit for the outcome variables.
RESULTS: Analysis was conducted on 366 respondents from 43 states. Respondents 
were male (55.4%), age 50 + (57.4%), and White non-Hispanic (90.3%); 54% 
reported moderate-high stress and 41% endorsed mild-severe anxiety. 
Seventy-seven percent had experienced at least one form of stigma related to 
their occupation. Variables associated with higher perceived stress and anxiety 
included gender (female), shorter length of employment, perceiving a higher 
impact from COVID-19 on everyday life, and increased perceived stigma.
CONCLUSIONS: Last responders are a critical part of the health care system. 
Throughout this pandemic, last responders have been frequently ignored and not 
prioritized for protection and support. Interventions to support last responders 
cope with stress, and to decrease anxiety are urgently needed. There is also a 
critical need to challenge community stigma towards last responders.

© 2023. BioMed Central Ltd., part of Springer Nature.

DOI: 10.1186/s12889-023-16565-z
PMCID: PMC10463888
PMID: 37633898 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


422. Medicina (Kaunas). 2023 Aug 18;59(8):1486. doi: 10.3390/medicina59081486.

Quality of Life Predictors in a Group of Informal Caregivers during the COVID-19 
Pandemic.

Damian AC(1)(2), Mihăilescu AI(2)(3), Anghele C(2), Ciobanu CA(4), Petrescu 
C(1)(2), Riga S(5)(6), Dionisie V(2)(7), Ciobanu AM(1)(2).

Author information:
(1)Neuroscience Department, Discipline of Psychiatry, Faculty of Medicine, 
"Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania.
(2)Department of Psychiatry, 'Prof. Dr. Alexandru Obregia' Clinical Hospital of 
Psychiatry, 041914 Bucharest, Romania.
(3)Department of Medical Psychology, Faculty of Medicine, University of Medicine 
and Pharmacy "Carol Davila", 050474 Bucharest, Romania.
(4)Faculty of Medicine, "Titu Maiorescu" University of Medicine and Pharmacy, 
040441 Bucharest, Romania.
(5)Department of Stress Research and Prophylaxis, 'Prof. Dr. Alexandru Obregia' 
Clinical Hospital of Psychiatry, 041914 Bucharest, Romania.
(6)Romanian Academy of Medical Sciences, 927180 Bucharest, Romania.
(7)Department of Psychiatry and Psychology, "Carol Davila" University of 
Medicine and Pharmacy, 020021 Bucharest, Romania.

Background and Objectives: The informal caregiver's contribution to the 
wellbeing of dementia patients is critical since these individuals become 
dependent on others for all daily activities. Our goal was to investigate the 
dynamics of anxiety, depression, burnout, sleep, and their influence on quality 
of life over a 6-month period in the context of pandemic distress in a sample of 
informal caregivers of Alzheimer's patients. Materials and Methods: For this 
prospective, longitudinal study, we conducted a 6-month telephonic survey 
between 2021 and 2022, administering a series of questionnaires at three 
timepoints (baseline, 3 months and 6 months) to a group of informal caregivers 
of patients suffering from dementia due to Alzheimer's disease. Results: A total 
of 110 caregivers were included at baseline, out of which 96 continued to the 
second stage and 78 followed through to the last stage. The majority of the 
participants were female (most likely the patients' daughters), around 55 years 
old, living in urban areas, married, with children, having a high school degree 
or a higher education degree, and working in jobs that required physical 
presence; in the best-case scenario, they were sharing their responsibilities 
with another two-three caregivers. More than half of the 110 participants 
(50.9%) reported mild to moderate anxiety at baseline, and 27.3% reported 
significant anxiety, with no changes between the three timepoints, F(2, 154) = 
0.551, p = 0.57; 25% reported moderate-severe depression at the start, with no 
changes between the three timepoints, F(2, 154) = 2.738, p = 0.068; and many 
reported a decrease in quality of life, poor quality of sleep, and decreased 
fear of COVID infection. Cynicism, professional effectiveness, anxiety, 
depression, and sleep quality explained up to 87.8% of the variance in quality 
of life. Conclusions: Caregivers' decreased quality of life during the pandemic 
was explained by their levels of burnout, anxiety, and depression throughout the 
6-month period.

DOI: 10.3390/medicina59081486
PMCID: PMC10456842
PMID: 37629776 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


423. Soc Psychiatry Psychiatr Epidemiol. 2024 Apr;59(4):599-609. doi: 
10.1007/s00127-023-02553-6. Epub 2023 Aug 25.

Persistence of anxiety among Asian Americans: racial and ethnic heterogeneity in 
the longitudinal trends in mental well-being during the COVID-19 pandemic.

Cheslack-Postava K(1), Forthal S(2)(3), Musa GJ(2)(3), Ryan M(2), Bresnahan 
M(2)(3), Sapigao RG(2)(4), Lin S(2), Fan B(2), Svob C(2)(3), Geronazzo-Alman 
L(2), Hsu YJ(2), Skokauskas N(5), Hoven CW(2)(3).

Author information:
(1)Global Psychiatric Epidemiology Group, Division of Child and Adolescent 
Psychiatry, Department of Psychiatry, Columbia University-New York State 
Psychiatric Institute, 1051 Riverside Drive Unit 23, New York, NY, 10032, USA. 
Keely.Cheslack@nyspi.columbia.edu.
(2)Global Psychiatric Epidemiology Group, Division of Child and Adolescent 
Psychiatry, Department of Psychiatry, Columbia University-New York State 
Psychiatric Institute, 1051 Riverside Drive Unit 23, New York, NY, 10032, USA.
(3)Department of Epidemiology, Columbia University Mailman School of Public 
Health, New York, NY, USA.
(4)CUNY Graduate School of Public Health and Health Policy, New York, USA.
(5)Department of Mental Health, Regional Centre for Child and Youth Mental 
Health and Child Welfare (RKBU Central Norway), Norwegian University of Science 
and Technology (NTNU), Trondheim, Norway.

PURPOSE: To examine within-individual time trends in mental well-being and 
factors influencing heterogeneity of these trends.
METHODS: Longitudinal telephone survey of adults over 3 waves from the New York 
City (NYC) Metropolitan area during the COVID-19 Pandemic. Participants reported 
depression using the Patient Health Questionnaire (PHQ)-8, anxiety using the 
Generalized Anxiety Disorder (GAD)-7, and past 30-day increases in tobacco or 
alcohol use at each wave. Adjusted mixed effects logistic regression models 
assessed time trends in mental well-being.
RESULTS: There were 1227 respondents. Over 3 study waves, there were 
statistically significant decreasing time trends in the odds of each outcome 
(adjusted OR (95% CI) 0.47 (0.37, 0.60); p < 0.001 for depression; aOR (95% CI) 
0.55 (0.45, 0.66); p < 0.001 for anxiety; aOR (95% CI) 0.50 (0.35, 0.71); 
p < 0.001 for past 30-day increased tobacco use; aOR (95% CI) 0.31 (0.24, 0.40); 
p < 0.001 for past 30-day increased alcohol use). Time trends for anxiety varied 
by race and ethnicity (p value for interaction = 0.05, 4 df); anxiety declined 
over time among white, Black, Hispanic, and Other race and ethnicity but not 
among Asian participants.
CONCLUSIONS: In a demographically varied population from the NYC Metropolitan 
area, depression, anxiety and increased substance use were common during the 
first months of the pandemic, but decreased over the following year. While this 
was consistently the case across most demographic groups, the odds of anxiety 
among Asian participants did not decrease over time.

© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

DOI: 10.1007/s00127-023-02553-6
PMID: 37624465 [Indexed for MEDLINE]


424. Int J Environ Res Public Health. 2023 Aug 8;20(16):6543. doi: 
10.3390/ijerph20166543.

Differential Mental Health Impact of COVID-19 Lockdowns on Persons with 
Non-Communicable Diseases in Trinidad and Tobago.

Reid SD(1), Motilal S(2), Pooransingh S(2), St Bernard G(3), Ivey MA(2).

Author information:
(1)Psychiatry Unit, Department of Clinical Medical Sciences, Faculty of Medical 
Sciences, The University of the West Indies (The UWI), Champs Fleurs, Trinidad 
and Tobago.
(2)Public Health and Primary Care Unit, Department of Paraclinical Sciences, 
Faculty of Medical Sciences, The University of the West Indies (The UWI), Champs 
Fleurs, Trinidad and Tobago.
(3)Sir Arthur Lewis Institute of Social and Economic Studies, The University of 
the West Indies (The UWI), St. Augustine, Trinidad and Tobago.

Persons with chronic non-communicable diseases (NCDs) were identified as 
particularly at risk of severe morbidity and mortality during the COVID-19 
pandemic. Little is written about the impact of COVID-19 on this sub-population 
in the Caribbean, where the prevalence of NCDs is disproportionately high. This 
study aimed to ascertain COVID-related concerns, and the mental health impact of 
the pandemic among persons with and without NCDs in Trinidad and Tobago, during 
the acute period of COVID-19 lockdowns early in the pandemic. An anonymous 
online survey collected cross-sectional data from a convenience sample 
nationwide. Of 1287 respondents, 219 self-identified as having an NCD. Findings 
suggest that the pandemic was experienced unequally by persons with NCDs, who 
were more likely to be concerned about health and wellbeing and to report health 
inequalities-unemployment, social isolation and negative effects of government 
restrictions. Compared to those without NCDs, they were more likely to increase 
use of marijuana during the lockdown period, and to report severe 
anxiety/depression that can result in exacerbation of NCDs. Interventions for 
persons with NCDs must address the mental health consequences of any pandemic, 
including increased drug use, and also address social inequalities to reduce 
sustained post-pandemic mental health impact and negative health outcomes.

DOI: 10.3390/ijerph20166543
PMCID: PMC10454168
PMID: 37623129 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


425. BMC Public Health. 2023 Aug 24;23(1):1618. doi: 10.1186/s12889-023-16549-z.

Measuring changes in adult health and well-being during the COVID-19 pandemic 
and their relationship with adverse childhood experiences and current social 
assets: a cross-sectional survey.

Bellis MA(1)(2)(3), Hughes K(4)(5), Ford K(5), Lowey H(6).

Author information:
(1)Faculty of Health, Liverpool John Moores University, Liverpool, L2 2ER, UK. 
m.a.bellis@ljmu.ac.uk.
(2)World Health Organization Collaborating Centre on Investment for Health and 
Well-Being, Policy and International Health, Public Health Wales, Wrexham, LL13 
7YP, UK. m.a.bellis@ljmu.ac.uk.
(3)Public Health Collaborating Unit, School of Medical and Health Sciences, 
College of Human Sciences, Bangor University, Wrexham, LL13 7YP, UK. 
m.a.bellis@ljmu.ac.uk.
(4)World Health Organization Collaborating Centre on Investment for Health and 
Well-Being, Policy and International Health, Public Health Wales, Wrexham, LL13 
7YP, UK.
(5)Public Health Collaborating Unit, School of Medical and Health Sciences, 
College of Human Sciences, Bangor University, Wrexham, LL13 7YP, UK.
(6)Helen Lowey Consultancy Ltd, Lathom, L40 4BQ, UK.

BACKGROUND: Adverse childhood experiences (ACEs) can impact mental and physical 
health, leaving people with less resilience to health challenges across the 
life-course. This study examines whether individuals' levels and changes in 
levels of mental health, physical health and sleep quality reported across the 
first year of the COVID-19 pandemic are associated with ACEs and moderated by 
social assets such as having trusted family and friends.
METHODS: A cross-sectional household telephone survey in England (a North West 
local authority) and Wales (nationally) using landline and mobile numbers 
stratified by health areas, deprivation quintile and age group and supplemented 
by an online survey. Data were collected from 4,673 English and Welsh residents 
aged ≥ 18 years during national COVID-19 restrictions (December 2020 to March 
2021). Measures included nine types of ACE; self-reported mental health, 
physical health and sleep quality at time of survey (in pandemic) and one-year 
earlier (pre-pandemic); numbers of trusted family members and friends, knowledge 
of community help; and COVID-19 infection.
RESULTS: ACEs were strongly related to moving into poorer mental health, 
physical health, and sleep categories during the pandemic, with likelihoods more 
than doubling in those with ≥ 4 ACEs (vs. 0). ACEs were also associated with 
increased likelihood of moving out of poorer health and sleep categories 
although this was for a much smaller proportion of individuals. Individuals with 
more trusted family members were less likely to move into poorer health 
categories regardless of ACE counts.
CONCLUSIONS: ACEs are experienced by large proportions of populations and are 
associated with poorer health even in non-pandemic situations. However, they 
also appear associated with greater vulnerability to developing poorer health 
and well-being in pandemic situations. There is a minority of those with ACEs 
who may have benefited from the changes in lifestyles associated with pandemic 
restrictions. Connectedness especially with family, appears an important factor 
in maintaining health during pandemic restrictions.

© 2023. BioMed Central Ltd., part of Springer Nature.

DOI: 10.1186/s12889-023-16549-z
PMCID: PMC10463476
PMID: 37620866 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


426. J Community Health. 2024 Feb;49(1):173-182. doi: 10.1007/s10900-023-01273-x. 
Epub 2023 Aug 25.

Mental Health and well-being During the COVID-19 Pandemic and After the Russian 
Invasion of Ukraine.

Pavlova I(1), Rogowska AM(2), Zhang SX(3).

Author information:
(1)Theory and Methods of Physical Culture Department, Lviv State University of 
Physical Culture, Lviv, Ukraine.
(2)Institute of Psychology, University of Opole, Opole, Poland. 
arogowska@uni.opole.pl.
(3)Faculty of Arts, Law and Economics, Adelaide Business School, University of 
Adelaide, Business, Adelaide, Australia.

The study compared the mental health of university students during the COVID-19 
pandemic and the Russian invasion of Ukraine. A repeated online cross-sectional 
study was performed twice among university students in Ukraine: in November 2020 
(Pre-war sample, n = 752) and September-October 2022 (During-war sample, 
n = 862). The survey measured life satisfaction (SWLS), perceived stress 
(PSS-10), anxiety (GAD-7), and depression (PHQ-9). Stress, anxiety, and life 
satisfaction levels were similar during the war and pandemic, while symptoms of 
depression decreased during the war, compared to the pandemic. Network analysis 
showed that anxiety has a crucial effect on depression and stress, and stress is 
most closely related to life satisfaction. The association of life satisfaction 
with anxiety and depression disappeared in wartime, in contrast to the pandemic. 
The priority of prevention and intervention programs in wartime Ukraine should 
focus on anxiety as the most influential factor in other mental health and 
well-being problems. The results showed high resistance and adaptation to war 
conditions among university students in Ukraine.

© 2023. The Author(s).

DOI: 10.1007/s10900-023-01273-x
PMCID: PMC10881779
PMID: 37620707 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no financial 
or non-financial interests that are directly or indirectly related to the work 
submitted for publication.


427. BMJ Open. 2023 Aug 24;13(8):e074387. doi: 10.1136/bmjopen-2023-074387.

How is transition to medical practice shaped by a novel transitional role? A 
mixed-methods study.

Burford B(1), Mattick K(2), Carrieri D(2), Goulding A(3), Gale T(4), Brennan 
N(4), Vance G(3).

Author information:
(1)School of Medicine, Newcastle University, Newcastle upon Tyne, UK 
bryan.burford@newcastle.ac.uk.
(2)University of Exeter Medical School, University of Exeter, Exeter, UK.
(3)School of Medicine, Newcastle University, Newcastle upon Tyne, UK.
(4)Collaboration for the Advancement of Medical Education Research (CAMERa), 
Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, 
UK.

OBJECTIVES: This study considered a novel 'interim' transitional role for new 
doctors (termed 'FiY1', interim Foundation Year 1), bridging medical school and 
Foundation Programme (FP). Research questions considered effects on doctors' 
well-being and perceived preparedness, and influences on their experience of 
transition. While FiY1 was introduced in response to the COVID-19 pandemic, 
findings have wider and ongoing relevance.
DESIGN: A sequential mixed-methods study involved two questionnaire phases, 
followed by semi-structured interviews. In phase 1, questionnaires were 
distributed to doctors in FiY1 posts, and in phase 2, to all new FP doctors, 
including those who had not undertaken FiY1.
SETTING AND PARTICIPANTS: Participants were newly qualified doctors from UK 
medical schools, working in UK hospitals in 2020. 77% (n=668) of all 
participants across all phases had undertaken FiY1 before starting FP in August. 
The remainder started FP in August with varying experience beforehand.
OUTCOME MEASURES: Questionnaires measured preparedness for practice, stress, 
anxiety, depression, burnout, identity, and tolerance of ambiguity. Interviews 
explored participants' experiences in more depth.
RESULTS: Analysis of questionnaires (phase 1 n=441 FiY1s, phase 2 n=477 FiY1s, 
196 non-FiY1s) indicated that FiY1s felt more prepared than non-FiY1 colleagues 
for starting FP in August (β=2.71, 95% CI=2.21 to 3.22, p<0.0001), which 
persisted to October (β=1.85, CI=1.28 to 2.41, p<0.0001). Likelihood of feeling 
prepared increased with FiY1 duration (OR=1.02, CI=1.00 to 1.03, p=0.0097). 
Despite challenges to well-being during FiY1, no later detriment was apparent. 
Thematic analysis of interview data (n=22) identified different ways, structural 
and interpersonal, in which the FiY1 role enhanced doctors' emerging 
independence supported by systems and colleagues, providing 'supported 
autonomy'.
CONCLUSIONS: An explicitly transitional role can benefit doctors as they move 
from medical school to independent practice. We suggest that the features of 
supported autonomy are those of institutionalised liminality-a structured role 
'betwixt and between' education and practice-and this lens may provide a guide 
to optimising the design of such posts.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2023-074387
PMCID: PMC10450058
PMID: 37620275 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


428. Emotion. 2024 Mar;24(2):397-411. doi: 10.1037/emo0001235. Epub 2023 Aug 24.

Emotional experiences and psychological well-being in 51 countries during the 
COVID-19 pandemic.

Sun R(1), Balabanova A(1), Bajada CJ(2), Liu Y(3), Kriuchok M(4), Voolma SR(5), 
Đurić M(6), Mayer CH(7), Constantinou M(8), Chichua M(9), Li C(10), 
Foster-Estwick A(11), Borg K(12), Hill C(7), Kaushal R(13), Diwan K(14), Vitale 
V(15), Engels T(1), Aminudin R(16), Ursu I, Fadhlia TN(1), Wu YJ(17), Sekaja 
L(7), Hadchity M, Deak A(18), Sharaf S(1), Figueras P(19), Kaziboni A(20), 
Whiston A(21), Ioumpa K(22), Montelongo A(23), Pauw L(24), Pavarini G(25), 
Vedernikova E(14), Vu T(26), Nummenmaa L(27), Cong YQ(1), Nikolic M(28), Olguin 
A(29), Hou WK(30), Israelashvili J(31), Koo HJ(32), Khademi S(33), Ukachukwu 
CG(34), Juma DO(35), Kamiloğlu RG(1), Makhmud A(36), Lunga PS(37), Rieble C(1), 
Rizwan M(38), Helmy M(39), Vuillier L(40), Manokara K(1), Quezada EC(1), 
Tserendamba D(41), Yoshie M(42), Du AH(43), Philip-Joe K(44), Kúld PB(14), 
Damani K(45), Osei-Tutu A(46), Sauter D(43).

Author information:
(1)Department of Psychology, University of Amsterdam.
(2)Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, 
University of Malta.
(3)Department of Human Development and Quantitative Methodology, University of 
Maryland.
(4)Faculty of Computer Science, Kyiv-Mohyla Academy.
(5)Institute of Genomics, University of Tartu.
(6)Department of Experimental and Applied Psychology, Vrije Universiteit 
Amsterdam.
(7)Department of Industrial Psychology and People Management, University of 
Johannesburg.
(8)Center for Applied Neuroscience, University of Cyprus.
(9)Applied Research Division for Cognitive and Psychological Science, IEO 
European Institute of Oncology IRCCS.
(10)East2west International.
(11)George Alleyne Chronic Disease Research Centre.
(12)Department of Public Policy, Faculty of Economics, Management & Accountancy, 
University of Malta.
(13)Department of Information Technology, Indira Gandhi Delhi Technical 
University for Women.
(14)School of Social and Behavioral Sciences, Tilburg University.
(15)Department of Psychology of Developmental and Socialization Processes, 
Sapienza University of Rome.
(16)Department of Political Science, International Islamic University Malaysia.
(17)Department of Educational Leadership and Policy Analysis, University of 
Wisconsin-Madison.
(18)Institute of Psychology, University of Pecs.
(19)School of Mathematical Sciences, Queen Mary University of London.
(20)Institute for the Future of Knowledge, University of Johannesburg.
(21)Department of Psychology, University of Limerick.
(22)Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts 
and Sciences.
(23)Operations Research Department, Management School, University Federal of Rio 
Grande do Sul.
(24)Department of Social, Health and Organisational Psychology, Utrecht 
University.
(25)Ethox Centre, Oxford Population Health, University of Oxford.
(26)Department of Clinical, Neuro-, and Developmental Psychology, Vrije 
Universiteit Amsterdam.
(27)Turku PET Centre, University of Turku.
(28)Research Institute of Child Development and Education, University of 
Amsterdam.
(29)Department of Psychology, University of Cambridge.
(30)Department of Psychology, Centre for Psychosocial Health, Education 
University of Hong Kong.
(31)Department of Psychology, Hebrew University of Jerusalem.
(32)Department of Psychological Science, University of California, Irvine.
(33)Nijmegen School of Management, Radboud University.
(34)My Mind Our Humanity, Lancet Youth Leader for Global Mental Health.
(35)Healthy Brains Global Initiative.
(36)Department of Psychology, Durham University.
(37)Department of Teacher Education, Norwegian University of Science and 
Technology.
(38)Department of Psychology, University of Haripur.
(39)Psychology Department, College of Education, Sultan Qaboos University.
(40)Department of Psychology, Bournemouth University.
(41)National Psychological Centre in Mongolia.
(42)Department of Information Technology and Human Factors, National Institute 
of Advanced Industrial Science and Technology (AIST), School of Psychology, 
Victoria University of Wellington.
(43)School of Psychology, Victoria University of Wellington.
(44)John F. Kennedy Memorial Hospital, Department of Pediatrics.
(45)EdTech Hub.
(46)Department of Psychology, University of Ghana.

The COVID-19 pandemic presents challenges to psychological well-being, but how 
can we predict when people suffer or cope during sustained stress? Here, we test 
the prediction that specific types of momentary emotional experiences are 
differently linked to psychological well-being during the pandemic. Study 1 used 
survey data collected from 24,221 participants in 51 countries during the 
COVID-19 outbreak. We show that, across countries, well-being is linked to 
individuals' recent emotional experiences, including calm, hope, anxiety, 
loneliness, and sadness. Consistent results are found in two age, sex, and 
ethnicity-representative samples in the United Kingdom (n = 971) and the United 
States (n = 961) with preregistered analyses (Study 2). A prospective 30-day 
daily diary study conducted in the United Kingdom (n = 110) confirms the key 
role of these five emotions and demonstrates that emotional experiences precede 
changes in well-being (Study 3). Our findings highlight differential 
relationships between specific types of momentary emotional experiences and 
well-being and point to the cultivation of calm and hope as candidate routes for 
well-being interventions during periods of sustained stress. (PsycInfo Database 
Record (c) 2024 APA, all rights reserved).

DOI: 10.1037/emo0001235
PMID: 37616109 [Indexed for MEDLINE]


429. Mil Psychol. 2023 Sep-Oct;35(5):408-419. doi: 10.1080/08995605.2022.2126655. 
Epub 2022 Oct 4.

Providing recovery support to wounded, injured, and sick UK military personnel 
throughout the COVID-19 pandemic.

Kay CWP(1), Sutton RJ(1), Margerison GL(1), McKenna J(1).

Author information:
(1)Carnegie School of Sport, Leeds Beckett University, Leeds, UK.

Health precautions implemented by the United Kingdom (UK) government to limit 
the spread of the Coronavirus Disease 2019 (COVID-19) led to the closure of many 
well-being support services in 2020. This created a need to re-think how 
impactful recovery support courses can be provided. One such service was that of 
the five-day Multi Activity Course (MAC) which was redesigned in accordance with 
national health guidelines to allow continued access for Wounded, Injured and 
Sick (WIS) military personnel to the service; the positive impacts of which are 
well established. This study investigated the influence of the newly developed 
Reduced numbers MAC (R-MAC) on the WIS participants lives during and for 
12 months after attending. The R-MAC led to comparable impacts for participants 
well-being, at a time in which people's mental well-being was often being 
adversely affected. The positive mental well-being of the 261 participants 
improved by 33% throughout the course and remained 14% higher for the 37 
participants who provided data six months after attending. Key facets of the 
experience that were most impactful for the participants were (i) shared 
experience with other veterans, (ii) discussing issues in a safe environment 
while receiving support from the staff and (iii) developing knowledge around 
self-help/personal development. Adapting to the challenging circumstances and 
developing the R-MAC mitigated against the already adverse impact of the 
COVID-19 pandemic for the WIS participants.

DOI: 10.1080/08995605.2022.2126655
PMCID: PMC10453965
PMID: 37615553 [Indexed for MEDLINE]

Conflict of interest statement: No potential conflict of interest was reported 
by the author(s).


430. Front Public Health. 2023 Aug 8;11:1236990. doi: 10.3389/fpubh.2023.1236990. 
eCollection 2023.

Long-term outcomes of COVID-19 intensive care unit survivors and their family 
members: a one year follow-up prospective study.

Laurent R(1), Correia P(1), Lachand R(1), Diconne E(1), Ezingeard E(1), Bruna 
F(1), Guenier PA(1), Page D(1), Périnel-Ragey S(1)(2)(3), Thiéry G(1)(2)(4).

Author information:
(1)Service de Médecine Intensive Réanimation G, Centre Hospitalier Universitaire 
de Saint-Etienne, St Etienne, France.
(2)Université Jean Monnet, Saint-Etienne, France.
(3)Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude 
Bernard Lyon, Lyon, France.
(4)Laboratoire INSERM 1059 SAINBIOSE, Université Jean Monnet, Saint-Etienne, 
France.

PURPOSE: To describe the long-term physical, functional and mental status of 
COVID-19 intensive care unit (ICU) patients and their family members 1 year 
after ICU discharge.
METHODS: We performed a prospective observational cohort study among patients 
admitted to the ICU for COVID-19-associated respiratory failure and their family 
members. Patients attended a one-year follow-up consultation with family 
members. Physical, functional and respiratory outcomes were collected. In 
addition, participants completed the Hospital Anxiety and Depression Scale and 
the Revised Impact of Event Scale. Qualitative components were collected during 
a 2-h face-to-face interview.
RESULTS: Fifty-four patients and 42 family members were included. Thirty-four 
(63%) patients reported chronic fatigue and 37 (68.5%) dyspnea. Computed 
tomography scans were abnormal in 34 patients (72.3%). Anxiety symptoms were 
present in 23 (48%) patients and 26 (66%) family members, depression in 11 (23%) 
and 13 (33%), and post-traumatic stress disorder in 12 (25%) and 23 (55%), 
respectively. Visit limitation was reported as the most painful experience for 
family members. Numerous patients recalled nightmares that contributed to the 
anxiety. Long-term reconstruction was difficult for both patients and family 
members.
CONCLUSION: The vast majority of patients and their relatives reported long-term 
consequences on various physical and mental components, leading to a profound 
impact on their well-being.

Copyright © 2023 Laurent, Correia, Lachand, Diconne, Ezingeard, Bruna, Guenier, 
Page, Périnel-Ragey and Thiéry.

DOI: 10.3389/fpubh.2023.1236990
PMCID: PMC10442651
PMID: 37614444 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


431. BMJ Open. 2023 Aug 23;13(8):e071826. doi: 10.1136/bmjopen-2023-071826.

Implementing psychological support for health and social care staff affected by 
the COVID-19 pandemic: a qualitative exploration of staff well-being hubs 
('Resilience Hubs') using normalisation process theory.

Allsopp K(1)(2), Varese F(3)(2), French P(4)(5), White H(3), Chung P(6), Hassan 
AA(7), Wright SA(6), Young E(8), Barrett A(8)(9), Bhutani G(6)(10), McGuirk 
K(11), Huntley F(7)(12), Sarsam M(7), Ten Cate H(6), Watson R(8)(13), Willbourn 
J(8), Hind D(14).

Author information:
(1)Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health 
NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK 
kate.allsopp@gmmh.nhs.uk.
(2)Division of Psychology and Mental Health, The University of Manchester, 
Manchester Academic Health Science Centre, Manchester, UK.
(3)Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health 
NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
(4)Faculty of Health, Psychology and Social Care, Manchester Metropolitan 
University, Manchester, UK.
(5)Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK.
(6)Lancashire and South Cumbria Resilience Hub, Lancashire and South Cumbria NHS 
Foundation Trust, Lancashire, UK.
(7)Cheshire and Merseyside Resilience Hub, Mersey Care NHS Foundation Trust, 
Liverpool, UK.
(8)Greater Manchester Resilience Hub, Pennine Care NHS Foundation Trust, 
Ashton-under-Lyne, UK.
(9)School of Health Sciences, University of Salford, Salford, UK.
(10)School of Psychology, University of Liverpool, Liverpool, UK.
(11)Greater Manchester Health and Social Care Partnership, Manchester, UK.
(12)Doctorate of Clinical Psychology, School of Health in Social Science, 
University of Edinburgh, Edinburgh, UK.
(13)Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
(14)School of Health and Related Research, The University of Sheffield, 
Sheffield, UK.

OBJECTIVES: Evaluate the implementation of Hubs providing access to 
psychological support for health and social care keyworkers affected by the 
COVID-19 pandemic.
DESIGN: Qualitative interviews informed by normalisation process theory to 
understand how the Hub model became embedded into normal practice, and factors 
that disrupted normalisation of this approach.
SETTING: Three Resilience Hubs in the North of England.
PARTICIPANTS: Hub staff, keyworkers who accessed Hub support (Hub clients), 
keyworkers who had not accessed a Hub, and wider stakeholders involved in the 
provision of staff support within the health and care system (N=63).
RESULTS: Hubs were generally seen as an effective way of supporting keyworkers, 
and Hub clients typically described very positive experiences. Flexibility and 
adaptability to local needs were strongly valued. Keyworkers accessed support 
when they understood the offer, valuing a confidential service that was separate 
from their organisation. Confusion about how Hubs differed from other support 
prevented some from enrolling. Beliefs about job roles, unsupportive managers, 
negative workplace cultures and systemic issues prevented keyworkers from 
valuing mental health support. Lack of support from managers discouraged 
keyworker engagement with Hubs. Black, Asian and minority ethnic keyworkers 
impacted by racism felt that the Hubs did not always meet their needs.
CONCLUSIONS: Hubs were seen as a valuable, responsive and distinct part of the 
health and care system. Findings highlight the importance of improving promotion 
and accessibility of Hubs, and continuation of confidential Hub support. Policy 
implications for the wider health and care sector include the central importance 
of genuine promotion of and value placed on mental health support by health and 
social care management, and the creation of psychologically safe work 
environments. Diversity and cultural competency training is needed to better 
reach under-represented communities. Findings are consistent with the 
international literature, therefore, likely to have applicability outside of the 
current context.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2023-071826
PMCID: PMC10450134
PMID: 37612138 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: PF has previously been a 
member of NIHR HTA Prioritisation Committee and is a current member of NIHR HTS 
Clinical Evaluation and Trials funding Committee. DH has previously been a 
member of NIHR Research for Patient Benefit, Yorks & NE Regional Advisory 
Committee, and is a current member of NIHR Health Technology Assessment Clinical 
Evaluation and Trials Funding Committee (2019-2024). FV has received an NIHR 
Advanced Fellowship in a clinical research area unrelated to the Resilience 
Hubs. FV, PF, DH, and GB are Investigators/Co-Investigators in several other 
NIHR projects funded by various funding streams (RfPB, HTA, EME, HS&DR). AB is 
an honorary member of the National Mental Health & Wellbeing expert reference 
group at NHS England and NHS Improvement. AB, JW, KM and FV are members of the 
Greater Manchester Psychosocial Board, and JW, RW and KM are members of the 
Greater Manchester Expert Reference Group. GB is Interim co-chair of the 
National Institute of Health & Care Excellence (NICE) Quality Standards Advisory 
Committee. PF is clinical advisor to National Clinical Audit of Psychosis at 
Royal College of Psychiatry and Board member of International Early Psychosis 
Association. GB, AB, HTC, KM, FH, MS, RW and JW have all held senior clinical 
and/or operational roles at the Hub sites involved in this study. PF has 
previously led research to evaluate the original Resilience Hub service set up 
to support those affected by the 2017 Manchester Arena bombing, in which DH and 
KA were also involved. KA has also held a research and evaluation role at a 
second Hub involved in this project.


432. J Neurol Sci. 2023 Sep 15;452:120768. doi: 10.1016/j.jns.2023.120768. Epub 2023 
Aug 15.

The joint impact of symptom deterioration and social factors on wellbeing for 
people with Parkinson's during the covid-19 pandemic in the UK.

Eccles FJR(1), Garner IW(2), Murray CD(2), Doyle C(3), Simpson J(2).

Author information:
(1)Division of Health Research, Faulty of Health and Medicine, Lancaster 
University, Lancaster LA1 4AT, UK. Electronic address: f.eccles@lancaster.ac.uk.
(2)Division of Health Research, Faulty of Health and Medicine, Lancaster 
University, Lancaster LA1 4AT, UK.
(3)Parkinson's UK, 215 Vauxhall Bridge Road, London SW1V 1EJ, UK.

The covid-19 pandemic and associated restrictions have had significant 
consequences for those living with chronic conditions such as Parkinson's. The 
restrictions in access to healthcare as well as reductions in social care, 
family support and community activities have led to decreases in physical and 
mental wellbeing. However, not everyone has been equally affected and the 
predictors of distress are currently being investigated worldwide. Here we use 
data from a UK survey conducted by the charity Parkinson's UK during Summer 2021 
to look at physical and social predictors of wellbeing of people with 
Parkinson's. Specifically, we aimed to look at the combined effects of worsening 
physical symptoms, social isolation and loneliness on psychological wellbeing 
when controlling for age, gender and disease duration. The data from 612 
participants were analysed using multiple regression analyses and showed that 
worsened physical symptoms, loneliness and social isolation each independently 
predicted wellbeing thus showing the impact of both physical symptoms and social 
factors. Improved access to healthcare and physical activity is needed to help 
improve physical health. However, addressing the social needs of people with 
Parkinson's is also important, and not only during a pandemic. Additional 
interventions may be needed to reduce social isolation and loneliness as there 
may be added barriers for people with Parkinson's which need to be considered.

Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jns.2023.120768
PMID: 37611512 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest None.


433. Health Place. 2023 Sep;83:103103. doi: 10.1016/j.healthplace.2023.103103. Epub 
2023 Aug 22.

Green and blue spaces, COVID-19 lockdowns, and mental health: An Australian 
population-based longitudinal analysis.

Li A(1), Mansour A(2), Bentley R(2).

Author information:
(1)NHMRC Centre of Research Excellence in Healthy Housing, Centre for Health 
Policy, Melbourne School of Population and Global Health, Faculty of Medicine, 
Dentistry and Health Sciences, The University of Melbourne, Australia. 
Electronic address: ang.li5@unimelb.edu.au.
(2)NHMRC Centre of Research Excellence in Healthy Housing, Centre for Health 
Policy, Melbourne School of Population and Global Health, Faculty of Medicine, 
Dentistry and Health Sciences, The University of Melbourne, Australia.

Australia experienced some of the world's longest and most stringent lockdowns 
during the COVID-19 pandemic. While lockdown measures had consequences for 
mental health, investigation is lacking on the potential for green and blue 
space coverage within people's local environments to ameliorate the impact of 
lockdowns with varied lengths using longitudinal cohorts. This study examined 
the impact of lockdown durations on population mental health and tests the 
effect modification of neighbourhood green and inland and coastal blue space 
coverage in metropolitan areas. We merged population-based longitudinal data on 
more than 11,000 individuals collected over a ten-year period from 2012 to 2021 
with national land use data describing green and blue space coverage. We used 
fixed effect models to estimate the relationship between lockdowns (with 
different durations and staggered introduction) and mental health, controlling 
for sociodemographic, health, and geographical confounders, and tested the 
significance of effect modification of green and blue space. Results show that 
extended lockdowns led to considerably larger decreases in mental health 
(COVID-y1: -2.66, 95%CI: -3.43, -1.89; COVID-y2: -2.65, 95%CI: -3.33, -1.97) 
relative to short lockdowns. The mental health effect of lockdowns was smaller 
where green spaces and inland and coastal blue spaces were available. Effect 
modification was statistically significant for green space, with smaller 
negative mental health effects observed where there was sizeable green space 
coverage, particularly during long lockdowns (COVID-y1: -2.69, 95%CI: -3.63, 
-1.76 for coverage <5%; -3.27, 95%CI: -4.70, -1.84 for coverage 5%-10%; -0.60, 
95%CI: -2.03, 0.83 for coverage ≥30%; COVID-y2: -2.74, 95%CI: -3.62, -1.87 for 
coverage <5%, -2.95, 95%CI: -3.98, -1.92 for coverage 5%-10%; -2.08, 95%CI: 
-3.28, -0.88 for coverage ≥30%). Findings support the consideration of nature 
exposure to improve people's mental wellbeing and resilience when designing 
lockdown measures in response to future public health emergencies.

Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.healthplace.2023.103103
PMID: 37611381 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare they have nothing to disclose.


434. Dev Psychobiol. 2023 Sep;65(6):e22413. doi: 10.1002/dev.22413.

Neural sensitivity to social reward predicts links between social behavior and 
loneliness in youth during the COVID-19 pandemic.

Dziura SL(1), McNaughton KA(1)(2), Giacobbe E(1), Yarger HA(1), Hickey AC(3), 
Shariq D(1)(2), Redcay E(1)(2).

Author information:
(1)Department of Psychology, University of Maryland, College Park, Maryland, 
USA.
(2)Neuroscience and Cognitive Science Program, University of Maryland, College 
Park, Maryland, USA.
(3)Department of Communication Sciences and Disorders, University of South 
Carolina, Columbia, South Carolina, USA.

Neural reward network sensitivity in youth is proposed to differentially impact 
the effects of social environments on social outcomes. The COVID-19 pandemic 
provided an opportunity to test this hypothesis within a context of diminished 
in-person social interaction. We examined whether neural sensitivity to 
interactive social reward moderates the relationship between a frequency of 
interactive or passive social activity and social satisfaction. Survey reports 
of frequency of interactions with friends, passive social media use, and 
loneliness and social satisfaction were gathered in 2020 during mandated 
precautions limiting in-person contact. A subset of participants (age = 10-17) 
previously participated in a functional magnetic resonance imaging (fMRI) study 
examining social-interactive reward during a simulated peer interaction (survey 
n = 76; survey + fMRI n = 40). We found evidence of differential response to 
social context, such that youth with higher neural reward sensitivity showed a 
negative association between a frequency of interactive connections with friends 
and a combined loneliness and social dissatisfaction component (LSDC) score, 
whereas those with lower sensitivity showed the opposite effect. Further, high 
reward sensitivity was associated with greater LSDC as passive social media use 
increased, whereas low reward sensitivity showed the opposite. This indicates 
that youth with greater sensitivity to social-interactive reward may be more 
susceptible to negative effects of infrequent contact than their low 
reward-sensitive counterparts, who instead maintain social well-being through 
passive viewing of social content. These differential outcomes could have 
implications for supporting youth during times of major social disruption as 
well as ensuring mental health and well-being more broadly.

© 2023 The Authors. Developmental Psychobiology published by Wiley Periodicals 
LLC.

DOI: 10.1002/dev.22413
PMCID: PMC10454977
PMID: 37607890 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest Disclosure: The authors 
declare that they have no competing interests, financial or otherwise.


435. BMJ Open. 2023 Aug 22;13(8):e068551. doi: 10.1136/bmjopen-2022-068551.

Psychosocial impact of COVID-19 pandemic on front-line healthcare workers in 
Sierra Leone: an explorative qualitative study.

Tengbe SM(1), Kamara IF(2), Ali DB(3), Koroma FF(3), Sevalie S(4)(5), Dean L(6), 
Theobald S(6).

Author information:
(1)Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone 
siamoreniketengbe@outlook.com.
(2)Emergency Preparedness and Response Cluster, World Health Organisation 
Country Office for Sierra Leone, Freetown, Sierra Leone.
(3)Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone.
(4)34 Military Hospital, Wilberforce, Freetown, Sierra Leone.
(5)Case Management Pillar, National COVID-19 Emergency Response Centre, 
Freetown, Sierra Leone.
(6)International Public Health, Liverpool School of Tropical Medicine, 
Liverpool, UK.

INTRODUCTION: The COVID-19 pandemic has wide-reaching health and non-health 
consequences, especially on mental health and psychosocial well-being. 
Healthcare workers involved in COVID-19 patient care are particularly vulnerable 
to psychosocial distress due to increased pressure on healthcare systems. We 
explored the psychosocial experiences of front-line healthcare workers during 
the COVID-19 pandemic in Sierra Leone.
METHODS: This qualitative study used purposive sampling to recruit 13 healthcare 
workers from different cadres across 5 designated COVID-19 treatment centres in 
Freetown, Sierra Leone. In-depth interviews were conducted remotely in July and 
August 2020, transcribed verbatim and analysed using the framework approach.
RESULTS: This study identified three overarching themes: vulnerability, 
resilience and support structures. Participants expressed vulnerability relating 
to the challenging work environment and lack of medications as key stressors 
resulting in anxiety, stress, anger, isolation and stigmatisation. Signs of 
resilience with experiences drawn from the 2014 Ebola outbreak, teamwork and a 
sense of duty were also seen. Peer support was the main support structure with 
no professional psychosocial support services available to healthcare workers.
CONCLUSIONS: This is the first study to provide evidence of the psychosocial 
impacts of COVID-19 among front-line healthcare workers in Sierra Leone. Despite 
signs of resilience and coping mechanisms displayed, they also experienced 
adverse psychosocial outcomes. There is a need to focus on enhancing strategies 
such as psychosocial support for healthcare workers and those that overall 
strengthen the health system to protect healthcare workers, promote resilience 
and guide recommendations for interventions during future outbreaks.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/bmjopen-2022-068551
PMCID: PMC10445370
PMID: 37607792 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


436. J Med Internet Res. 2023 Aug 22;25:e45834. doi: 10.2196/45834.

Effect of an Internet-Delivered Cognitive Behavioral Therapy-Based Sleep 
Improvement App for Shift Workers at High Risk of Sleep Disorder: Single-Arm, 
Nonrandomized Trial.

Ito-Masui A(1), Sakamoto R(2), Matsuo E(3), Kawamoto E(1), Motomura E(4), Tanii 
H(5), Yu H(6), Sano A(6), Imai H(1), Shimaoka M(3).

Author information:
(1)Emergency and Critical Care Center, Mie University, Tsu, Japan.
(2)Department of Medical Informatics, Mie University Hospital, Tsu, Japan.
(3)Department of Molecular Pathology & Cell Adhesion Biology, Mie University 
Graduate School of Medicine, Tsu, Japan.
(4)Department of Neuropsychiatry, Mie University Graduate School of Medicine, 
Tsu, Japan.
(5)Center for Physical & Mental Health, Mie University, Tsu, Japan.
(6)Department of Electrical & Computer Engineering, Rice University, Houston, 
TX, United States.

BACKGROUND: Shift workers are at high risk of developing sleep disorders such as 
shift worker sleep disorder or chronic insomnia. Cognitive behavioral therapy 
(CBT) is the first-line treatment for insomnia, and emerging evidence shows that 
internet-based CBT is highly effective with additional features such as 
continuous tracking and personalization. However, there are limited studies on 
internet-based CBT for shift workers with sleep disorders.
OBJECTIVE: This study aimed to evaluate the impact of a 4-week, 
physician-assisted, internet-delivered CBT program incorporating machine 
learning-based well-being prediction on the sleep duration of shift workers at 
high risk of sleep disorders. We evaluated these outcomes using an 
internet-delivered CBT app and fitness trackers in the intensive care unit.
METHODS: A convenience sample of 61 shift workers (mean age 32.9, SD 8.3 years) 
from the intensive care unit or emergency department participated in the study. 
Eligible participants were on a 3-shift schedule and had a Pittsburgh Sleep 
Quality Index score ≥5. The study comprised a 1-week baseline period, followed 
by a 4-week intervention period. Before the study, the participants completed 
questionnaires regarding the subjective evaluation of sleep, burnout syndrome, 
and mental health. Participants were asked to wear a commercial fitness tracker 
to track their daily activities, heart rate, and sleep for 5 weeks. The 
internet-delivered CBT program included well-being prediction, activity and 
sleep chart, and sleep advice. A job-based multitask and multilabel 
convolutional neural network-based model was used for well-being prediction. 
Participant-specific sleep advice was provided by sleep physicians based on 
daily surveys and fitness tracker data. The primary end point of this study was 
sleep duration. For continuous measurements (sleep duration, steps, etc), the 
mean baseline and week-4 intervention data were compared. The 2-tailed paired t 
test or Wilcoxon signed rank test was performed depending on the distribution of 
the data.
RESULTS: In the fourth week of intervention, the mean daily sleep duration for 7 
days (6.06, SD 1.30 hours) showed a statistically significant increase compared 
with the baseline (5.54, SD 1.36 hours; P=.02). Subjective sleep quality, as 
measured by the Pittsburgh Sleep Quality Index, also showed statistically 
significant improvement from baseline (9.10) to after the intervention (7.84; 
P=.001). However, no significant improvement was found in the subjective 
well-being scores (all P>.05). Feature importance analysis for all 45 variables 
in the prediction model showed that sleep duration had the highest importance.
CONCLUSIONS: The physician-assisted internet-delivered CBT program targeting 
shift workers with a high risk of sleep disorders showed a statistically 
significant increase in sleep duration as measured by wearable sensors along 
with subjective sleep quality. This study shows that sleep improvement programs 
using an app and wearable sensors are feasible and may play an important role in 
preventing shift work-related sleep disorders.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/24799.

©Asami Ito-Masui, Ryota Sakamoto, Eri Matsuo, Eiji Kawamoto, Eishi Motomura, 
Hisashi Tanii, Han Yu, Akane Sano, Hiroshi Imai, Motomu Shimaoka. Originally 
published in the Journal of Medical Internet Research (https://www.jmir.org), 
22.08.2023.

DOI: 10.2196/45834
PMCID: PMC10481224
PMID: 37606971 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: AS has received travel 
reimbursement or honorarium payments from Leuven Mindgate, American Epilepsy 
Society, IEEE, and Apple. AS has also received research support from Microsoft, 
Sony Corporation, NEC Corporation, Pola Chemicals, and Meta and consulting fees 
from Gideon Health and Suntory Global Innovation Center.


437. Curr Opin Infect Dis. 2023 Oct 1;36(5):366-370. doi: 
10.1097/QCO.0000000000000959. Epub 2023 Aug 22.

Gastrointestinal involvement in post-acute Coronavirus disease (COVID)-19 
syndrome.

Ghoshal UC(1), Ghoshal U(2).

Author information:
(1)Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of 
Medical Sciences, Lucknow.
(2)Department of Microbiology, All India Institute of Medical Science, Kalyani, 
West Bengal, India.

PURPOSE OF REVIEW: Ten percentage of patients with coronavirus disease 
(COVID)-19 report having gastrointestinal (GI) symptoms as severe acute 
respiratory syndrome coronavirus-2 (SARS-CoV2) not only infects the pulmonary 
but also the GI tract. GI infections including that due to viral infection is 
known to cause postinfection disorders of gut-brain interaction (DGBI); hence, 
we wish to review the long-term GI consequences following COVID-19, particularly 
post-COVID-19 DGBI.
RECENT FINDINGS: At least 12 cohort studies, four of which also included 
controls documented the occurrence of post-COVID-19 DGBI, particularly IBS 
following COVID-19. The risk factors for post-COVID-19 DGBI included female 
gender, symptomatic COVID-19, particularly GI symptoms, the severity of 
COVID-19, the occurrence of anosmia and ageusia, use of antibiotics and 
hospitalization during the acute illness, persistent GI symptoms beyond 1 month 
after recovery, presence of mental health factors, The putative mechanisms for 
post-COVID-19 DGBI include altered gut motility, visceral hypersensitivity, gut 
microbiota dysbiosis, GI inflammation, and immune activation, changes in 
intestinal permeability, and alterations in the enteroendocrine system and 
serotonin metabolism.
SUMMARY: Long-term sequelae of SARS-CoV2 infection may persist even after 
recovery from COVID-19. Patients with COVID-19 are more likely to develop 
post-COVID-19 IBS than healthy controls. Post-COVID-19 IBS may pose a 
substantial healthcare burden to society.

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/QCO.0000000000000959
PMID: 37606895 [Indexed for MEDLINE]


438. Int J Ment Health Nurs. 2023 Dec;32(6):1735-1744. doi: 10.1111/inm.13213. Epub 
2023 Aug 21.

Mental health nurses' experience of resilience during COVID-19: A qualitative 
inquiry.

Bui MV(1), McInnes E(1)(2), Ennis G(3), Foster K(1).

Author information:
(1)School of Nursing, Midwifery and Paramedicine, Australian Catholic 
University, Fitzroy, Victoria, Australia.
(2)Nursing Research Institute - St Vincent's Health Network Sydney, St Vincent's 
Hospital Melbourne and Australian Catholic University, Fitzroy, Victoria, 
Australia.
(3)Northern Health, Epping, Victoria, Australia.

The COVID-19 pandemic created unprecedented demands and additional stress for 
nurses in mental health settings. There is no prior evidence on nurses' 
experience of building and maintaining resilience in the context of work during 
COVID-19. The aim of this study was to explore the experience and impacts of the 
COVID-19 pandemic on the resilience of nurses in mental health settings. Data 
from semi-structured interviews with 20 nurses from an Australian mental health 
service were analysed using reflexive thematic analysis. Four main themes were 
generated: experiencing significant disruptions; making sense of shared chaos; 
having professional commitment; and growing through the challenges. Nurses' 
practice and teamwork were disrupted by COVID-19 related changes to care models 
and infection prevention policies. They successfully adjusted by having 
awareness of self and others' emotions, using mental and emotional 
self-regulatory strategies, engaging in self-care, using 'bricolage' to create 
different ways to provide care, and having mutually supportive relationships. 
Nurses connected to their sense of purpose and professional commitment to fuel 
their therapeutic work and sustain care delivery. They experienced personal and 
professional growth with an increased understanding of their strengths and 
resilience. In the post-pandemic period, although the challenges presented by 
the pandemic have lessened, there are ongoing negative impacts on nurses' 
wellbeing. To maintain and strengthen their wellbeing and practice, the findings 
indicate the importance of professional development in emotional regulation 
skills, and strategies to strengthen self-care and build collegial relationships 
in teams. Resilience education can be implemented to support nurses' resilient 
practice skills.

© 2023 The Authors. International Journal of Mental Health Nursing published by 
John Wiley & Sons Australia, Ltd.

DOI: 10.1111/inm.13213
PMID: 37605316 [Indexed for MEDLINE]


439. BMC Public Health. 2023 Aug 21;23(1):1587. doi: 10.1186/s12889-023-16524-8.

Long-term health consequences among individuals with SARS-CoV-2 infection 
compared to individuals without infection: results of the population-based 
cohort study CoMoLo Follow-up.

Heidemann C(1), Sarganas G(2), Du Y(2), Gaertner B(2), Poethko-Müller C(2), 
Cohrdes C(2), Schmidt S(3), Schlaud M(#)(2), Scheidt-Nave C(#)(2).

Author information:
(1)Department of Epidemiology and Health Monitoring, Robert Koch Institute, 
Berlin, Germany. heidemannc@rki.de.
(2)Department of Epidemiology and Health Monitoring, Robert Koch Institute, 
Berlin, Germany.
(3)Clinical Study Center, Berlin Institute of Health at Charité - 
Universitätsmedizin Berlin, Berlin, Germany.
(#)Contributed equally

BACKGROUND: Most of the previous studies on health sequelae of COVID-19 are 
uncontrolled cohorts and include a relatively short follow-up. This 
population-based multi-center cohort study examined health consequences among 
individuals about 1 to 1.5 years after SARS-CoV-2 infection compared with 
non-infected.
METHODS: The study population consisted of adults (≥ 18 years) from four 
municipalities particularly affected by the COVID-19 pandemic in the year 2020 
who completed a detailed follow-up questionnaire on health-related topics. 
Exposure was the SARS-CoV-2 infection status (based on IgG antibodies, PCR test, 
or physician-diagnosis of COVID-19) at baseline (May to December 2020). Outcomes 
assessed at follow-up (October 2021 to January 2022; mean: 452 days) included 
recurrent or persistent health complaints, incident diseases, health-related 
quality of life (PROMIS-29), subjective health, and subjective memory 
impairment. Logistic and linear regression models were adjusted for baseline 
sociodemographic and lifestyle characteristics (age, sex, municipality, 
education, smoking, body mass index), pre-existing health conditions (chronic 
disease/health problem, health-related activity limitation, depressive/anxiety 
disorder), and follow-up time.
RESULTS: Among 4817 participants, 350 had a SARS-CoV-2 infection at baseline and 
4467 had no infection at baseline or during follow-up. Those with an infection 
statistically significantly more often reported 7 out of 18 recurrent or 
persistent health complaints at follow-up: smell/taste disorders (12.8% vs. 
3.4%, OR 4.11), shortness of breath (23.0% vs. 9.5%, 3.46), pain when breathing 
(4.7% vs. 1.9%, 2.36), fatigue (36.9% vs. 26.1%, 1.76), weakness in legs (12.8% 
vs. 7.8%, 1.93), myalgia/joint pain (21.9% vs. 15.1%, 1.53) and cough (30.8% vs. 
24.8%, 1.34) and 3 out of 6 groups of incident diseases: liver/kidney (2.7% vs. 
0.9%, 3.70), lung (3.2% vs. 1.1%, 3.50) and cardiovascular/metabolic (6.5% vs. 
4.0%, 1.68) diseases. Those with an infection were significantly more likely to 
report poor subjective health (19.3% vs. 13.0%, 1.91), memory impairment (25.7% 
vs. 14.3%, 2.27), and worse mean scores on fatigue and physical function domains 
of PROMIS-29 than non-infected.
CONCLUSION: Even after more than one year, individuals with SARS-CoV-2 infection 
showed an increased risk of various health complaints, functional limitations, 
and worse subjective well-being, pointing toward profound health consequences of 
SARS-CoV-2 infection relevant for public health.

© 2023. BioMed Central Ltd., part of Springer Nature.

DOI: 10.1186/s12889-023-16524-8
PMCID: PMC10440884
PMID: 37605232 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


440. J Community Health. 2023 Dec;48(6):970-974. doi: 10.1007/s10900-023-01267-9. 
Epub 2023 Aug 21.

Self-reported Impacts of the COVID-19 Pandemic and Economic Inflation on the 
Well-being of Low-income U.S. Veterans.

Tsai J(1)(2)(3), Hird R(4), Collier A(5).

Author information:
(1)U.S. Department of Veterans Affairs National Center on Homelessness among 
Veterans, Tampa, FL, USA. Jack.Tsai@uth.tmc.edu.
(2)UTHealth School of Public Health, University of Texas Health Science Center 
at Houston, 1200 Pressler St, Houston, TX, 77030, USA. Jack.Tsai@uth.tmc.edu.
(3)Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA. 
Jack.Tsai@uth.tmc.edu.
(4)Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
(5)UTHealth School of Public Health, University of Texas Health Science Center 
at Houston, 1200 Pressler St, Houston, TX, 77030, USA.

The health and well-being of low-income populations may be disproportionately 
impacted by major public health and economic events. This study examined written 
self-reported impacts of the Coronavirus Disease-2019 (COVID-19) pandemic and 
the economic inflationary period on health from a national sample of 854 
low-income U.S. veterans. Responses were analyzed using rapid assessment 
procedures. In response to the COVID-19 pandemic, 59% of participants reported 
the pandemic had "no effect" on their health, 7% reported increased social 
isolation, and small proportions of participants reported negative effects on 
physical and mental health. In response to economic inflation, 43% of 
participants reported inflation had "no effect" on their health, 11% reported 
concerns about personal finances, and only small proportions reported other 
negative psychosocial impacts. Collectively, these findings suggest many 
low-income veterans are resilient during major events. Further research is 
needed on long-term health effects of inflation on this population.

© 2023. This is a U.S. Government work and not under copyright protection in the 
US; foreign copyright protection may apply.

DOI: 10.1007/s10900-023-01267-9
PMID: 37605100 [Indexed for MEDLINE]


441. J Allergy Clin Immunol Pract. 2023 Nov;11(11):3365-3372. doi: 
10.1016/j.jaip.2023.07.052. Epub 2023 Aug 20.

Allergy and Immunology Physician and Patient (Un)Wellness During COVID-19 and 
Beyond: Lessons for the Future.

Bingemann TA(1), Bansal P(2), Nanda A(3), Sharma H(4).

Author information:
(1)Department of Allergy, Immunology and Rheumatology, University of Rochester 
School of Medicine, Rochester, NY; Department of Pediatric Allergy and 
Immunology, University of Rochester School of Medicine, Rochester, NY. 
Electronic address: Theresa_Bingemann@URMC.rochester.edu.
(2)Asthma and Allergy Wellness Center, St Charles, Ill; Northwestern Feinberg 
School of Medicine, Northwestern University, Chicago, Ill.
(3)Asthma and Allergy Center, Lewisville and Flower Mound, Texas; Division of 
Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, 
Texas.
(4)Division of Allergy and Immunology, Children's National Hospital, Washington, 
DC.

The COVID-19 pandemic increased stress and reduced wellness for patients and 
physicians alike. The uncertainty, frequent changes, fear of illness and death, 
and supply chain issues taxed an already broken health care system. The pandemic 
undermined the factors that allow for a healthy workplace: control, 
predictability, and certainty. During this time, rates of depression, 
suicidality, and anxiety all increased among physicians and the community at 
large. These challenges were aggravated by disagreements regarding masking and 
vaccinations. These factors, as well as the degree to which people felt valued 
or not also contributed to burnout. Some changes such as the transition to 
telemedicine, although initially stressful, led to patient satisfaction and 
allowed clinical care to continue. Other changes, such as trying to homeschool, 
or watching young children while also trying to work were less desirable. 
Patients and physicians did their best to combat isolation, fear, anxiety, and 
the numerous societal changes. Burnout fluctuated throughout the pandemic 
related to local and systemic factors such as rates of infection, vaccination, 
supply chain issues, and individual support. The pandemic highlighted problems 
with our health care system, including structural racism, health care 
disparities, and how easily the system can be overwhelmed. Physicians may have 
been thrown into roles they did not feel comfortable filling and may have had 
insufficient staff to practice in the way they wanted. These factors led to 
frustration among patients and physicians alike. The National Plan for Health 
Workforce Well-Being outlines the need for health care reform to allow for 
effective and safe health care while protecting clinicians from burnout.

Copyright © 2023 American Academy of Allergy, Asthma & Immunology. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jaip.2023.07.052
PMID: 37604427 [Indexed for MEDLINE]


442. Alcohol. 2024 Feb;114:1-7. doi: 10.1016/j.alcohol.2023.08.006. Epub 2023 Aug 19.

The association between mental health symptoms and alcohol use among Chinese 
psychiatrists during the early stage of the COVID-19 pandemic.

Mo D(1), Gluck R(2), Jiang F(3), Tao R(4), Geng F(5), Liu T(6), Liu Y(6), Liu 
H(7), Yi-Lang Tang(8).

Author information:
(1)Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, 
China; Department of Psychiatry, Hefei Fourth People's Hospital, 316 Huangshan 
Road, Shushan District, Hefei, 230022, China; Department of Psychiatry, School 
of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 
China.
(2)Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, 
GA, USA.
(3)School of International and Public Affairs, Shanghai Jiao Tong University, 
Shanghai, China; Institute of Healthy Yangtze River Delta, Shanghai Jiao Tong 
University, Shanghai, China.
(4)Department of Psychiatry, Hefei Fourth People's Hospital, 316 Huangshan Road, 
Shushan District, Hefei, 230022, China.
(5)Department of Psychiatry, Second Affiliated Hospital of Anhui Medical 
University, Hefei, China.
(6)School of Health Policy and Management, Chinese Academy of Medical Sciences & 
Peking Union Medical College, Beijing, China.
(7)Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, 
China; Department of Psychiatry, School of Mental Health and Psychological 
Sciences, Anhui Medical University, Hefei, China. Electronic address: 
huanzhongliu@ahmu.edu.cn.
(8)Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, 
GA, USA; Atlanta Veterans Affairs Medical Center, Decatur, GA, USA. Electronic 
address: ytang5@emory.edu.

AIM: To investigate the association between mental health symptoms, alcohol use, 
and alcohol misuse among psychiatrists in China during the early stage of the 
COVID-19 pandemic.
METHODS: We conducted an online survey to collect data regarding mental health 
symptoms and alcohol use among psychiatrists in early 2020. The Depression 
Anxiety Stress Scale-Chinese Version (DASS-21) was used to assess depression, 
anxiety, and stress symptoms, and the Alcohol Use Disorders Identification 
Test-Consumption (AUDIT-C) was used to assess alcohol use.
RESULTS: In total, 3774 psychiatrists completed the survey. AUDIT-C scores were 
positively correlated with DASS total and depression, anxiety, and stress 
subscales (total: r = 0.015, depression: r = 0.121, anxiety: r = 0.103, and 
stress: r = 0.096, all p < 0.05). Alcohol misuse was associated with male sex 
(OR = 4.754), cigarette smoking (OR = 2.441), administrative position 
(OR = 1.811), depression (OR = 1.489), and stress (OR = 1.504). Those who 
reported increased alcohol use during the pandemic were more likely to be male 
(OR = 2.174), endorse anxiety symptoms (OR = 2.386), or increased stress 
(OR = 2.402).
CONCLUSIONS: Mental health symptoms were common among psychiatrists during the 
COVID-19 pandemic. Depression and stress symptoms were significantly associated 
with alcohol misuse. Anxiety and stress symptoms were associated with reported 
increases in alcohol use. Though a causal relationship cannot be inferred, our 
findings suggest that strategies promoting healthcare professionals' mental 
well-being should include alcohol use.

Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.alcohol.2023.08.006
PMID: 37604320 [Indexed for MEDLINE]


443. Age Ageing. 2023 Aug 1;52(8):afad166. doi: 10.1093/ageing/afad166.

The facilitators and barriers to improving functional activity and wellbeing in 
people with dementia: a qualitative study from the process evaluation of 
Promoting Activity, Independence and Stability in Early Dementia (PrAISED).

Di Lorito C(1), van der Wardt V(2), Pollock K(3), Howe L(4), Booth V(4)(5), 
Logan P(4), Gladman J(4), Masud T(5), das Nair R(6), Goldberg S(3), Vedhara 
K(4), O'Brien R(4), Adams E(4), Cowley A(4)(5), Bosco A(7), Hancox J(8), Burgon 
C(3), Bajwa R(4), Lock J(4), Long A(4), Godfrey M(4), Dunlop M(4), Harwood 
RH(3).

Author information:
(1)Division of Primary Care and Population Health, University College London, 
UK.
(2)Institute of General Practice, University of Marburg, Germany.
(3)School of Health Sciences, University of Nottingham, UK.
(4)School of Medicine, University of Nottingham, UK.
(5)Nottingham University Hospitals NHS Trust, UK.
(6)Health Services Research, SINTEF Digital, Norway.
(7)Primary Care Unit, University of Cambridge, UK.
(8)School of Sport, Exercise and Health Sciences, Loughborough University, UK.

BACKGROUND: The PRomoting Activity, Independence and Stability in Early Dementia 
(PrAISED) study delivered an exercise and functional activity programme to 
participants living with dementia. A Randomised Controlled Trial showed no 
measurable benefits in activities of daily living, physical activity or quality 
of life.
OBJECTIVE: To explore participants' responses to PrAISED and explain why an 
intervention that might be expected to have produced measurable health gains did 
not do so.
METHODS: A process evaluation using qualitative methods, comprising interviews 
and researcher notes.
SETTING: Data were collected in participants' homes or remotely by telephone or 
videoconferencing.
SAMPLE: A total of 88 interviews were conducted with 44 participants living with 
dementia (n = 32 intervention group; n = 12 control group) and 39 caregivers. A 
total of 69 interviews were conducted with 26 therapists.
RESULTS: Participants valued the intervention as proactively addressing health 
issues that were of concern to them, and as a source of social contact, 
interaction, information and advice. Facilitators to achieving positive outcomes 
included perceiving progress towards desired goals, positive expectations, 
therapists' skills and rapport with participants, and caregiver support. 
Barriers included: cognitive impairment, which prevented independent engagement 
and carry-over between sessions; chronic physical health problems and 
intercurrent acute illness and injury; 'tapering' (progressively infrequent 
supervision intended to help develop habits and independent activity); and the 
COVID-19 pandemic.
CONCLUSIONS: Self-directed interventions may not be appropriate in the context 
of dementia, even in the mild stages of the condition. Dementia-specific factors 
affected outcomes including caregiver support, rapport with therapists, 
availability of supervision, motivational factors and the limitations of remote 
delivery. The effects of cognitive impairment, multimorbidity and frailty 
overwhelmed any positive impact of the intervention. Maintenance of functional 
ability is valued, but in the face of inevitable progression of disease, other 
less tangible outcomes become important, challenging how we frame 'health gain' 
and trial outcomes.

© The Author(s) 2023. Published by Oxford University Press on behalf of the 
British Geriatrics Society. All rights reserved. For permissions, please email: 
journals.permissions@oup.com.

DOI: 10.1093/ageing/afad166
PMCID: PMC10442073
PMID: 37603841 [Indexed for MEDLINE]

Conflict of interest statement: None.


444. J Med Internet Res. 2023 Aug 21;25:e47784. doi: 10.2196/47784.

The Careers and Professional Well-Being of Women Oncologists During the COVID-19 
Pandemic: Responding for Tomorrow.

Majmudar S(#)(1), Graff SL(#)(2), Kays M(3), Braz BX(4)(5), Matt-Amaral L(6), 
Markham MJ(7), Subbiah IM(8), Bergsland E(9), Jain S(10).

Author information:
(1)College of Medicine, University of Illinois at Chicago, Chicago, IL, United 
States.
(2)Lifespan Cancer Institute, Legorreta Cancer Center, Brown University, 
Providence, RI, United States.
(3)Department of Surgery, University of Minnesota, Minneapolis, MN, United 
States.
(4)Department of Internal Medicine, Federal University of Ceará, Fortaleza, 
Brazil.
(5)Department of Internal Medicine, University of Miami, Miami, FL, United 
States.
(6)McDowell Cancer Center, Cleveland Clinic Akron General, Akron, OH, United 
States.
(7)Division of Hematology & Oncology, University of Florida, Gainesville, FL, 
United States.
(8)Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, 
Houston, TX, United States.
(9)Department of Medicine, University of California San Francisco, San 
Francisco, CA, United States.
(10)Department of Medicine, University of Illinois at Chicago, Chicago, IL, 
United States.
(#)Contributed equally

The COVID-19 pandemic exacerbated gender inequity in medicine, with women 
physicians reporting greater household responsibilities than their men 
counterparts and steeper barriers to career advancement. The pandemic 
highlighted the systemic assumptions and challenges faced by women physicians, 
which we anticipate is also true in our field of oncology. Prior literature 
suggests that women physicians were tasked with increased personal and 
professional responsibilities without compensation for their additional work, as 
well as derailments in career progression and significant burnout. Our aims are 
to highlight areas of opportunity to optimize the workplace experience of the 
oncology workforce and to invest in the professional well-being and 
sustainability of women oncologists as a step toward global workplace equity and 
future pandemic preparedness.

©Shivani Majmudar, Stephanie L Graff, Marah Kays, Beatriz X Braz, Laurie 
Matt-Amaral, Merry J Markham, Ishwaria M Subbiah, Emily Bergsland, Shikha Jain. 
Originally published in the Journal of Medical Internet Research 
(https://www.jmir.org), 21.08.2023.

DOI: 10.2196/47784
PMCID: PMC10477917
PMID: 37603399 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: SLG is a consultant at 
Pfizer, Daiichi Sankyo, Eli Lilly, AstraZeneca, Genentech, SeaGen, Novartis, and 
Menarini. She owns stock in HCA Healthcare and receives travel support from 
Paxman. SJ is a guest coeditor of the Women in Medicine and Science theme issue 
in the Journal of Medical Internet Research. The other authors have no conflicts 
of interest to declare.


445. Int J Nurs Stud. 2023 Oct;146:104568. doi: 10.1016/j.ijnurstu.2023.104568. Epub 
2023 Jul 27.

Family visits and depression among residential aged care residents: An 
integrative review.

Tan JDL(1), Maneze D(2), Montayre J(3), Ramjan LM(4), Wang D(5), Salamonson 
Y(6).

Author information:
(1)School of Nursing and Midwifery, Western Sydney University, Sydney, 
Australia. Electronic address: josh.tan@westernsydney.edu.au.
(2)School of Nursing and Midwifery, Western Sydney University, Sydney, 
Australia; School of Nursing, University of Wollongong, Wollongong, Australia; 
Australian Centre for Integration of Oral Health (ACIOH), Liverpool, Australia; 
Ingham Institute for Applied Medical Research, Liverpool, Australia. Electronic 
address: dmaneze@uow.edu.au.
(3)School of Nursing and Midwifery, Western Sydney University, Sydney, 
Australia; School of Nursing, University of Wollongong, Wollongong, Australia; 
Joanna Briggs Institute, Sydney, Australia; Australian Centre for Integration of 
Oral Health (ACIOH), Liverpool, Australia; Ingham Institute for Applied Medical 
Research, Liverpool, Australia; School of Nursing, The Hong Kong Polytechnic 
University, Hong Kong. Electronic address: j.montayre@westernsydney.edu.au.
(4)School of Nursing and Midwifery, Western Sydney University, Sydney, 
Australia; School of Nursing, University of Wollongong, Wollongong, Australia; 
Australian Centre for Integration of Oral Health (ACIOH), Liverpool, Australia; 
Ingham Institute for Applied Medical Research, Liverpool, Australia. Electronic 
address: l.ramjan@westernsydney.edu.au.
(5)School of Nursing, University of Wollongong, Wollongong, Australia; 
Australian Centre for Integration of Oral Health (ACIOH), Liverpool, Australia; 
Ingham Institute for Applied Medical Research, Liverpool, Australia. Electronic 
address: dw968@uowmail.edu.au.
(6)School of Nursing and Midwifery, Western Sydney University, Sydney, 
Australia; School of Nursing, University of Wollongong, Wollongong, Australia; 
Australian Centre for Integration of Oral Health (ACIOH), Liverpool, Australia; 
Ingham Institute for Applied Medical Research, Liverpool, Australia. Electronic 
address: yenna@uow.edu.au.

BACKGROUND: Depression in older people living in residential aged care is a 
serious and highly prevalent health issue, with loneliness and social isolation 
being major contributors. The COVID-19 pandemic underscored the harm visiting 
restrictions have on the mental wellbeing of older people in residential aged 
care. However, there is a need to systematically review the relationship between 
family visits and depression in this population.
OBJECTIVE: This literature review seeks to explore the association between 
family visits and depression among those living in residential aged care.
METHODS: An integrative review was conducted in March 2022, based on a search of 
seven databases from inception to 2022. Papers were included if the studies were 
situated in a residential aged care facility and explored the impact of 
in-person family visits on depression of residents. Those that examined impact 
of family visits on community-dwelling older people and papers examining virtual 
family visits were excluded. The quality of the included papers was assessed 
using appropriate critical appraisal tools. Guided by the aim of this study, the 
included papers were narratively synthesised and presented thematically 
(PROSPERO ID CRD42022325895).
RESULTS: Ten papers, published between 1991 and 2022, were included in the final 
synthesis. Multiple categorisations of frequency of visits and different scales 
were used to assess depression. Depression among residents in aged care 
facilities varied from 20 % to 58.7 % with 40 % of studies showing a positive 
association between the frequency of family visits and lower rate of depression. 
Three themes influencing the association between family visits and depression in 
residential aged care were identified. These were: (i) intersection of culture, 
filial values, and depression; (ii) resident-related factors including whether 
admission was voluntary and presence of functional impairment; and (iii) 
non-resident-related factors such as social activities for residents and staff 
involvement.
CONCLUSION: Family visits ameliorated loneliness and depression among residents 
in aged care however, other factors such as culture, comorbidities and 
functional impairment, opportunities for socialisation and the social 
involvement of facility staff also influenced depression. Whilst the low number 
of studies reviewed limited comparison and generalisation of results, the review 
highlighted the broader and crucial role of healthcare staff in facilitating 
socialisation and promoting mental wellbeing of residents especially those who 
are not visited by families.
TWEETABLE ABSTRACT: Family visits ameliorate depression in institutionalised 
older people but may not be the "silver bullet" as depression is multifactorial.

Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.ijnurstu.2023.104568
PMID: 37597458 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare no conflicts of interest.


446. Curr Opin Psychol. 2023 Oct;53:101659. doi: 10.1016/j.copsyc.2023.101659. Epub 
2023 Aug 17.

COVID-19 and indigenous youth wellbeing: A review.

Mollons MO(1), Penner KE(2), Elsom AL(2), Cameron EE(2), Hunter S(2), Woods 
L(3), Tomfohr-Madsen LM(4), Nijdam-Jones A(2), Roos LE(5).

Author information:
(1)Department of Psychology, University of Manitoba, Winnipeg, Manitoba, R3T 2N, 
Canada. Electronic address: mollonsm@myumanitoba.ca.
(2)Department of Psychology, University of Manitoba, Winnipeg, Manitoba, R3T 2N, 
Canada.
(3)New Directions, Winnipeg, Manitoba, R3G 0M8, Canada.
(4)Department of Educational and Counselling Psychology, and Special Education, 
University of British Columbia, Vancouver, V6T 1Z4, Colombia.
(5)Department of Psychology, University of Manitoba, Winnipeg, Manitoba, R3T 2N, 
Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, 
R3E 3P4, Canada; Rady Faculty of Health Sciences, University of Manitoba, 
Winnipeg, Manitoba, R3E 0W2, Canada. Electronic address: 
leslie.roos@umanitoba.ca.

Indigenous youth in Canada and the United States of America (USA) have been 
disproportionately affected by the COVID-19 pandemic due to the compounding of 
increased illness risk and legacies of colonization. This article reports the 
findings of a Cochrane rapid review of 23 studies that examined mental wellbeing 
outcomes for Indigenous youth from March 2020 to April 2023 in Canada and the 
USA. Reported pandemic-related mental wellbeing impacts included changes in 
alcohol and substance use, anxiety, depression, sleep, and suicidality. 
Protective factors emerged including cultural and community connection. Results 
suggest that mental wellbeing worsened for many Indigenous youth during 
COVID-19. Clinical implications are discussed alongside guidance for service 
provision improvements to support Indigenous youth wellbeing, from a lens of 
self-determination.

Copyright © 2023 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.copsyc.2023.101659
PMID: 37597427 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


447. J Gerontol B Psychol Sci Soc Sci. 2023 Nov 14;78(11):1903-1916. doi: 
10.1093/geronb/gbad122.

Social Isolation and Worsening Health Behaviors Among Older Adults During the 
COVID-19 Pandemic.

Choi KW(1), Waite LJ(1)(2), Finch LE(2), Kotwal AA(3).

Author information:
(1)Department of Sociology, University of Chicago, Chicago, Illinois, USA.
(2)Academic Research Centers, NORC at the University of Chicago, Chicago, 
Illinois, USA.
(3)Division of Geriatrics, Department of Medicine, University of California, San 
Francisco, San Francisco, California, USA.

OBJECTIVES: We examine the relationship between social isolation, poor health 
behaviors, and the perceived worsening of older adults' health behaviors 
following the coronavirus outbreak. We assess the extent to which psychological 
pathways mediate the relationship between social isolation and worsening health 
behaviors.
METHODS: Drawing on data from the National Social Life Health and Aging Project 
Round 3 (2015) and its coronavirus immune disease 2019 (COVID-19) substudy 
(2020; N = 2,549), we use generalized linear models to explore how indicators of 
social isolation during the COVID-19 pandemic-infrequent in-person contact with 
friends and family in 2020 and decreased in-person contact with friends and 
family since COVID-19 started-are associated with (1) poor health behaviors (low 
physical activity, drinks per week, smoking, and poor sleep) in 2020 and (2) 
perceived worsening of health behaviors (reports of decreased physical activity, 
increased drinking and smoking, and feeling less rested) since the pandemic 
started.
RESULTS: Infrequent in-person contact was not associated with poor health 
behaviors. Decreases in in-person contact, on the other hand, were associated 
with worsening health behaviors. Older adults who reported decreases in 
in-person contact were more likely to perceive a decrease in physical activity, 
an increase in drinking, and feeling less rested. Emotional well-being, 
particularly loneliness compared to anxiety or depressive feelings, partially 
mediated the relationship between perceived worsening of health behaviors and a 
decrease in in-person contact with friends, and to a lesser extent, with family.
DISCUSSION: Our study suggests that in-person contact may play a distinct role 
in shaping older adults' well-being during the pandemic.

© The Author(s) 2023. Published by Oxford University Press on behalf of The 
Gerontological Society of America. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/geronb/gbad122
PMCID: PMC10645306
PMID: 37591797 [Indexed for MEDLINE]

Conflict of interest statement: A.K. reports personal consulting fees from Papa 
Inc. outside of the submitted research.


448. Torture. 2023;33(2):119-132. doi: 10.7146/torture.v33i2.135769.

The community pillars project: engaging survivors as cross- cultural 
facilitators in Aotearoa/ New Zealand.

Auckland New Zealand RASR(1).

Author information:
(1)Contributing authors: Mortensen, A., O'Connor, S., Hibtit, A., Sheikh, J., 
Alkass, E., Arshad, R., Behayaa, H., Dawson, P., Misghina, G., Ntawe, M., 
Sumanasiri, V., Tun, S. K., Vanegas, E., Wardak, D., and Yousufi, M.

INTRODUCTION: Communities who have fled torture and persecution in their home 
countries can find it difficult to access services in new cultural settings. 
Past research has shown that it is helpful to provide cultural bridging services 
to form a connection between locally-trained professionals and newly relocated 
communities.
METHOD: This article presents, from a practitioner's perspective, a case example 
of cultural bridging involving a pilot programme to train individuals with 
refugee-like backgrounds (including torture survivors, former refugees, forced 
migrants) to become Cross-Cultural Facilitators supporting mental health 
services for displaced communities.
RESULTS: The Cross-Cultural Facilitator role has become an integral part of the 
case example agency's services. Internal agency reviews of the Cross-Cultural 
Facilitators' work shows that they have been continuing to operate successfully 
through challenging times, including the many societal disruptions and stressors 
entailed in the Covid-19 pandemic. The agency has also gathered notable 
anecdotal evidence that the pilot training programme has been positively 
impactful and supportive not only for the Cross-Cultural Facilitators but for 
the communities they serve.
DISCUSSION: Healthcare workers and civil society organisations have an important 
role to play in supporting survivors to engage in this form of cultural 
facilitation aimed at addressing the consequences of traumatic experiences at a 
community level. In doing so, they must balance efforts to empower survivors and 
former refugees to participate as agents of change with a duty of care not to 
push individuals into roles or settings that may diminish their own wellbeing.

DOI: 10.7146/torture.v33i2.135769
PMID: 37589069 [Indexed for MEDLINE]


449. Adv Exp Med Biol. 2023;1425:359-364. doi: 10.1007/978-3-031-31986-0_35.

Better Understand to Better Predict Subjective Well-Being Among Older Greeks in 
COVID-19 Era: Depression, Anxiety, Attitudes Towards eHealth, Religiousness, 
Spiritual Experience, and Cognition.

Giannouli V(1), Giannoulis K(2).

Author information:
(1)School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, 
Greece.
(2)School of Theology, Aristotle University of Thessaloniki, Thessaloniki, 
Greece.

Despite similarities with previous pandemics, the potential physical and 
psychosocial impact of COVID-19 on older adults is still little investigated in 
Greece. This study examines the intercorrelations between subjective 
well-being/life satisfaction, depression, state anxiety, global cognitive 
function, attitudes towards eHealth, religiousness and spiritual experience in 
older adults during COVID-19. Results revealed that statistically significant 
negative correlations exist between subjective life satisfaction and depressive 
symptomatology as well as with religiousness, a finding that can be explained by 
the COVID-19 externally imposed religious practice restrictions. Subjective life 
satisfaction was positively correlated with overall cognition as measured by 
Mini-Mental State Examination (MMSE). MMSE was also negatively correlated with 
state anxiety, depression, and attitudes towards eHealth use. The best 
predictors of subjective well-being is global cognition (as measured by MMSE) 
and depressive symptomatology (measured by GDS). The conclusions of this study 
underscore the need to examine in more detail psychological variables during 
COVID-19 and quality of life in older adults.

© 2023. The Author(s), under exclusive license to Springer Nature Switzerland 
AG.

DOI: 10.1007/978-3-031-31986-0_35
PMID: 37581810 [Indexed for MEDLINE]


450. BMJ Open. 2023 Aug 14;13(8):e071926. doi: 10.1136/bmjopen-2023-071926.

Protocol for the COVID-19 Wellbeing and Stress Study: a longitudinal study of 
parent distress, biological stress and child biopsychosocial development during 
the pandemic and beyond.

Khoury JE(1), Atkinson L(2), Jack S(3), Bennett T(4)(5), Raha S(6), Duku E(5), 
Gonzalez A(4)(5).

Author information:
(1)Department of Psychology, Mount Saint Vincent University, Halifax, Nova 
Scotia, Canada jennifer.khoury@msvu.ca.
(2)Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, 
Canada.
(3)School of Nursing, McMaster University, Hamilton, Ontario, Canada.
(4)Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, 
Ontario, Canada.
(5)Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, 
Canada.
(6)Department of Biochemistry & Biomedical Sciences, McMaster University, 
Hamilton, Ontario, Canada.

INTRODUCTION: The COVID-19 pandemic has had a unique impact on the mental health 
and well-being of pregnant individuals and parents of young children. However, 
the impact of COVID-19-related stress during pregnancy on early child 
biopsychosocial development, remains unclear. The COVID-19 Wellbeing and Stress 
Study will: (1) investigate the impact of different forms of prenatal stress 
experienced during the pandemic (including objective hardship, perceived 
psychological distress and biological stress) on child stress biology, (2) 
examine the association between child stress biology and child developmental 
outcomes, (3) determine whether child stress biology acts as a mechanism linking 
prenatal stress to adverse child developmental outcomes and (4) assess whether 
gestational age at the onset of the COVID-19 pandemic or child sex, moderate 
these associations.
METHODS AND ANALYSES: The COVID-19 Wellbeing and Stress Study is a prospective 
longitudinal study, consisting of six time points, spanning from pregnancy to 3 
years postpartum. The study began in June 2020, consisting of 304 pregnant 
people from Ontario, Canada. This multimethod study is composed of 
questionnaires, biological samples, behavioural observations and developmental 
assessments ETHICS AND DISSEMINATION: This study was approved by the Hamilton 
Integrated Research Ethics Board (#11034) and the Mount Saint Vincent University 
Research Ethics Board (#2020-187, #2021-075, #2022-008). Findings will be 
disseminated through peer-reviewed presentations and publications, community 
presentations, and electronic forums (social media, newsletters and website 
postings).

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2023-071926
PMCID: PMC10432660
PMID: 37580092 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


451. J Addict Med. 2023 Jul-Aug 01;17(4):e262-e268. doi: 
10.1097/ADM.0000000000001156. Epub 2023 Mar 2.

Clinician Perspectives on Delivering Medication Treatment for Opioid Use 
Disorder during the COVID-19 Pandemic: A Qualitative Evaluation.

Lott AM(1), Danner AN, Malte CA, Williams EC, Gordon AJ, Halvorson MA, Saxon AJ, 
Hagedorn HJ, Sayre GG, Hawkins EJ.

Author information:
(1)From the Center of Excellence in Substance Addiction Treatment and Education, 
VA Puget Sound Health Care System, Seattle, WA (AML, AND, CAM, AJS, EJH); 
Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health 
Services Research and Development, Veterans Affairs (VA) Puget Sound Health Care 
System, Seattle, WA (AML, AND, CAM, ECW, AJS, GGS, EJH); Department of Health 
Systems and Population Health, University of Washington, Seattle, WA (ECW); 
Informatics, Decision-Enhancement, and Analytic Sciences Center, Health Services 
Research and Development, VA Salt Lake City Health Care System, Salt Lake City, 
UT (AJG); Program for Addiction Research, Clinical Care, Knowledge and Advocacy, 
Department of Internal Medicine, University of Utah School of Medicine, Salt 
Lake City, UT (AJG); VA Puget Sound Health Care System, Seattle, WA (MAH); 
Department of Psychology, University of Washington, Seattle, WA (MAH); 
Department of Psychiatry and Behavioral Sciences, University of Washington 
School of Medicine, Seattle, WA (AJS, EJH); Center for Care Delivery and 
Outcomes Research, Health Services Research and Development, Minneapolis VA 
Health Care System, Minneapolis, MN (HJH); Department of Psychiatry, University 
of Minnesota, Minneapolis, MN (HJH); and Department of Health Services, 
University of Washington, Seattle, WA (GGS).

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic necessitated changes 
in opioid use disorder care. Little is known about COVID-19's impact on general 
healthcare clinicians' experiences providing medication treatment for opioid use 
disorder (MOUD). This qualitative evaluation assessed clinicians' beliefs about 
and experiences delivering MOUD in general healthcare clinics during COVID-19.
METHODS: Individual semistructured interviews were conducted May through 
December 2020 with clinicians participating in a Department of Veterans Affairs 
initiative to implement MOUD in general healthcare clinics. Participants 
included 30 clinicians from 21 clinics (9 primary care, 10 pain, and 2 mental 
health). Interviews were analyzed using thematic analysis.
RESULTS: The following 4 themes were identified: overall impact of the pandemic 
on MOUD care and patient well-being, features of MOUD care impacted, MOUD care 
delivery, and continuance of telehealth for MOUD care. Clinicians reported a 
rapid shift to telehealth care, resulting in few changes to patient assessments, 
MOUD initiations, and access to and quality of care. Although technological 
challenges were noted, clinicians highlighted positive experiences, including 
treatment destigmatization, more timely visits, and insight into patients' 
environments. Such changes resulted in more relaxed clinical interactions and 
improved clinic efficiency. Clinicians reported a preference for in-person and 
telehealth hybrid care models.
CONCLUSIONS: After the quick shift to telehealth-based MOUD delivery, general 
healthcare clinicians reported few impacts on quality of care and highlighted 
several benefits that may address common barriers to MOUD care. Evaluations of 
in-person and telehealth hybrid care models, clinical outcomes, equity, and 
patient perspectives are needed to inform MOUD services moving forward.

Copyright © 2023 Written work prepared by employees of the Federal Government as 
part of their official duties is, under the U.S. Copyright Act, a “work of the 
United States Government” for which copyright protection under Title 17 of the 
United States Code is not available. As such, copyright does not extend to the 
contributions of employees of the Federal Government.

DOI: 10.1097/ADM.0000000000001156
PMCID: PMC10417321
PMID: 37579107 [Indexed for MEDLINE]

Conflict of interest statement: AJS reports personal fees from Indivior, 
consulting fees and travel support from Alkermes, and royalties from UpToDate, 
Inc, outside the submitted work. AJG reports an honorarium from UpToDate, Inc, 
and serves on the board of directors for the American Society of Addiction 
Medicine, the Association for Multidisciplinary Education and Research in 
Substance Use and Addiction, and the International Society of Addiction, all 
organizations that are not-for-profit. The other authors report no conflicts of 
interest.


452. J Addict Med. 2023 Jul-Aug 01;17(4):e211-e216. doi: 
10.1097/ADM.0000000000001127. Epub 2023 Jan 6.

Pandemics Interlaced: The Impact of the COVID-19 Pandemic on the Wellbeing of 
Sober Living Home Residents.

Noonan G(1), Glenn J.

Author information:
(1)From the University of Kansas School of Medicine, Kansas City, KS.

OBJECTIVES: This study aimed to discover how the COVID-19 pandemic altered the 
implementation of the social model of recovery in sober living homes (SLHs). 
Researchers analyzed associations between residents' feelings of 
interconnectedness, social service utilization, and relapse predictors 
throughout the pandemic. This study provides an understanding of how the 
COVID-19 pandemic impacted treatment of substance use disorder (SUD).
METHODS: This study used retrospective surveyed data from 105 SLH residents. 
Correlational analysis was used to determine the relationship between social 
service use, social connectivity, and relapse predictors at three different time 
points: February 2020, December 2020, and June 2021. Three residents underwent 
additional interviews.
RESULTS: There was a decline in social service utilization from February 2020 to 
December 2020 with an associated decline in feelings of social connectivity. 
From December 2020 to June 2021, there was an increase in residents' use of 
social services with an associated increase in connectivity. There was a 
significant negative correlation between relapse predictors and number of 
supportive services used in February 2020 ( r = -0.217, P < 0.05) and in 
December 2020 ( r = -0.352, P < 0.001). In June 2020, there was a significant 
negative correlation between interconnectedness and relapse predictors ( r = 
-0.297, P < 0.05). The number of interviews was not sufficient for formal 
qualitative analysis.
CONCLUSIONS: The results suggest the COVID-19 pandemic possibly interrupted the 
course of recovery in SLHs. These findings offer insight to how the pandemic 
impacted individuals recovering from SUD and suggest that SUD treatment 
professionals should develop interventions to enhance social connectivity to 
deploy in response to global stressors.

Copyright © 2023 American Society of Addiction Medicine.

DOI: 10.1097/ADM.0000000000001127
PMCID: PMC10417211
PMID: 37579090 [Indexed for MEDLINE]

Conflict of interest statement: The authors report no conflicts of interest.


453. J Clin Psychol. 2023 Dec;79(12):2781-2797. doi: 10.1002/jclp.23578. Epub 2023 
Aug 14.

A multisite, quasiexperimental trial of a college course to support student 
mental health during the COVID-19 pandemic.

Chugani CD(1)(2), Mazza JJ(3), Fuhrman BJ(1), Lavage DR(1), Murphy C(1), Talis 
J(1), Miller E(1), Coulter RWS(4).

Author information:
(1)Department of Pediatrics, University of Pittsburgh School of Medicine, 
Pittsburgh, Pennsylvania, USA.
(2)Mantra Health, New York, New York, USA.
(3)College of Education, University of Washington, Seattle, Washington, USA.
(4)School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, 
USA.

OBJECTIVE: The purpose of this study was to investigate the acceptability, 
appropriateness, feasibility, and preliminary effectiveness of a three-credit 
college Wellness and Resilience Course (WRC) for improving student mental health 
and well-being outcomes in the context of the coronavirus disease 2019 
(COVID-19) pandemic.
METHOD: Undergraduate students aged 18-24 years old on five campuses in Western 
Pennsylvania or West Virginia who had either enrolled in the WRC (n = 81) or 
were attending university as usual (i.e., not enrolled in the WRC; n = 171) 
participated in surveys at baseline (beginning of semester), end of semester, 
and 3-month follow-up during the Spring and Fall 2020 semesters.
RESULTS: Overall, students rated the WRC as acceptable, appropriate, and 
feasible. From baseline to the end of semester, students who received the WRC 
reported significant improvements in psychological flexibility (d = 0.30), 
mindfulness (d = 0.42), distress tolerance (d = 0.36), and use of dysfunctional 
and adaptive coping skills (d = 0.32), compared with students who did not 
receive the WRC. At follow-up, all gains remained statistically significant and 
students who received the WRC additionally reported significant improvements in 
stress (d = 0.44) and life satisfaction (d = 0.35) compared with students who 
did not receive the WRC.
CONCLUSIONS: These findings offer preliminary evidence that college courses 
focused on mental wellness may be an important component of campus strategies to 
increase universal access to mental health support and skills. This study was 
registered on clinicaltrials.gov on April 8, 2020.

© 2023 Wiley Periodicals LLC.

DOI: 10.1002/jclp.23578
PMID: 37578213 [Indexed for MEDLINE]


454. Front Public Health. 2023 Jul 27;11:1225254. doi: 10.3389/fpubh.2023.1225254. 
eCollection 2023.

Behavioral and psychosocial factors related to mental distress among medical 
students.

Carlos KM(1)(2), Ahmadi H(2), Uban KA(2)(3), Riis JL(2)(4).

Author information:
(1)Program in Public Health, Department of Health, Society, and Behavior, 
University of California, Irvine, Irvine, CA, United States.
(2)Institute for Interdisciplinary Salivary Bioscience Research, University of 
California, Irvine, Irvine, CA, United States.
(3)Developing Brains Laboratory, Program in Public Health, Department of Health, 
Society, and Behavior, University of California, Irvine, Irvine, CA, United 
States.
(4)Department of Psychological Science, University of California, Irvine, 
Irvine, CA, United States.

INTRODUCTION: Physicians die by suicide at rates higher than the general 
population, with the increased risk beginning in medical school. To better 
understand why, this study examined the prevalence of mental distress (e.g., 
depressive symptoms and suicide risk) and behavioral and psychosocial risk 
factors for distress, as well as the associations between mental distress and 
risk factors among a sample of medical students in a pre-COVID-19-era.
METHODS: Students enrolled in a large California medical school in 2018-2019 (N 
= 134; 52% female) completed questionnaires assessing sociodemographic 
characteristics, depression and suicide family history, health behaviors, and 
psychosocial wellbeing. Assessment scores indexing mental distress (e.g., 
depressive symptoms, thoughts of suicide in the past 12 months, suicide risk, 
and history of suicidality) and risk factors (e.g., stress, subjective sleep 
quality, alcohol use, impostor feelings, and bill payment difficulty) were 
compared across biological sex using chi-squared tests, and associations between 
mental distress and risk factors were determined through logistic regression.
RESULTS: Elevated mental distress indicators were observed relative to the 
general public (e.g., 16% positive depression screen, 17% thought about suicide 
in previous 12 months, 10% positive suicide risk screen, and 34% history of 
suicidality), as well as elevated risk factors [e.g., 55% moderate or high 
stress, 95% at least moderate impostor feelings, 59% poor sleep quality, 50% 
screened positive for hazardous drinking (more likely in females), and 25% 
difficulty paying bills]. A positive depression screen was associated with 
higher stress, higher impostor feelings, poorer sleep quality, and difficulty 
paying bills. Suicidal ideation in the previous 12 months, suicide risk, and a 
history of suicidality were independently associated with higher levels of 
impostor feelings.
DISCUSSION: Higher scores on assessments of depressive symptoms and suicidal 
thoughts and behaviors were related to several individual-level and potentially 
modifiable risk factors (e.g., stress, impostor feelings, sleep quality, and 
bill payment difficulties). Future research is needed to inform customized 
screening and resources for the wellbeing of the medical community. However, it 
is likely that the modification of individual-level risk factors is limited by 
the larger medical culture and systems, suggesting that successful interventions 
mitigate suicide risk for medical providers need to address multiple 
socio-ecological levels.

Copyright © 2023 Carlos, Ahmadi, Uban and Riis.

DOI: 10.3389/fpubh.2023.1225254
PMCID: PMC10413116
PMID: 37575125 [Indexed for MEDLINE]

Conflict of interest statement: HA was employed by University Statistical 
Consulting, LLC. The remaining authors declare that the research was conducted 
in the absence of any commercial or financial relationships that could be 
construed as a potential conflict of interest.


455. BMC Public Health. 2023 Aug 12;23(1):1539. doi: 10.1186/s12889-023-16482-1.

Socioeconomic inequality, health inequity and well-being of transgender people 
during the COVID-19 pandemic in Nigeria.

Folayan MO(1)(2), Yakusik A(3), Enemo A(4), Sunday A(5), Muhammad A(6), Nyako 
HY(7), Abdullah RM(8), Okiwu H(9), Lamontagne E(3)(10).

Author information:
(1)Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, 
Nigeria. toyinukpong@yahoo.co.uk.
(2)Nigeria Institute of Medical Research, Yaba, Lagos State, Nigeria. 
toyinukpong@yahoo.co.uk.
(3)Joint United Nations Programme on HIV/AIDS, CH, Geneva, Switzerland.
(4)Nigeria Sex Workers Association, Kubwa, Nigeria.
(5)African Network of Adolescent and Young Persons Development, Barnawa, 
Nigeria.
(6)Northern Nigerian Transgender Initiative, Abuja, Nigeria.
(7)Jami Al Hakeem Foundation Jimeta-Yola, Jimeta, Nigeria.
(8)National Association of Persons with Physical Disability, Abuja, Nigeria.
(9)YouthRise, Abuja, Nigeria.
(10)School of Economics, Aix-Marseille University, Marseille, France.

BACKGROUND: We aimed to explore socioeconomic inequality, health inequity, and 
the well-being of transgender people during the COVID-19 crisis in Nigeria.
METHODS: Between June and December 2021, a cross-sectional survey was conducted 
collaboratively with community-based organisations in Nigeria. Participants 
living with or at risk of HIV were recruited voluntarily, online and 
face-to-face, using a combination of venue-based and snowball sampling. We 
assessed the association between gender identity (transgender and vulnerable 
cisgender women), and (i) socioeconomic inequality measured with socioeconomic 
status, social status, economic vulnerability, macrosocial vulnerability; (ii) 
health inequity measured with self-assessment of health, recency of HIV test, 
access to HIV and sexual and reproductive health services, gender-affirming 
care, financial and non-financial barriers to accessing health services; and 
(iii) well-being, measured with gender-based violence, mental health, 
psychoeconomic preferences. We used multivariable logistic regressions and 
controlled for interactions and confounders.
RESULTS: There were 4072 participants; 62% were under 30, and 47% reported 
living with HIV. One in ten (11.9%; n = 485) was transgender, and 56.5% reported 
living with HIV. Compared to vulnerable cisgender women, the results showed 
significantly higher odds (aOR:3.80) of disruption in accessing HIV services in 
transgender participants; gender-based violence (aOR:2.63); severe (aOR:2.28) 
symptoms of anxiety and depression. Among the barriers to accessing health and 
HIV services, transgender had three-time higher odds of reporting additional 
non-official fees compared to vulnerable cisgender women. The disclosure of 
their gender identity or sexual orientation was the most important non-financial 
barrier to accessing health services (aOR:3.16). Transgender participants faced 
higher housing insecurity (aOR: 1.35) and lower odds of using drugs (aOR:0.48). 
Importantly, they are more likely to have performed a recent HIV test and less 
likely to not know their HIV status (aOR:0.38) compared to vulnerable cisgender 
women.
CONCLUSIONS: Socioeconomic inequality, health and well-being inequity in 
transgender people appear to be exacerbated by the COVID-19 pandemic in Nigeria. 
Interventions are necessary to mitigate socioeconomic challenges, address 
structural inequality, and ensure equitable access to health services to meet 
the Sustainable Development Goals for transgender people.

© 2023. BioMed Central Ltd., part of Springer Nature.

DOI: 10.1186/s12889-023-16482-1
PMCID: PMC10422710
PMID: 37573293 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


456. Int J Environ Res Public Health. 2023 Jul 31;20(15):6485. doi: 
10.3390/ijerph20156485.

Impact of COVID-19 Pandemic on Well-Being, Social Relationships and Academic 
Performance in a Sample of University Freshmen: A Propensity Score Match 
Evaluation Pre- and Post-Pandemic.

Buizza C(1), Ferrari C(2), Sbravati G(1), Dagani J(1), Cela H(1)(3), Rainieri 
G(1), Ghilardi A(1).

Author information:
(1)Department of Clinical and Experimental Sciences, University of Brescia, 
Viale Europa 11, 25123 Brescia, Italy.
(2)Research and Clinical Trials Office, Fondazione Poliambulanza Istituto 
Ospedaliero, Via Bissolati 57, 25124 Brescia, Italy.
(3)Department of Psychology, University of Graz, Universitätsplatz 2, 8010 Graz, 
Austria.

The COVID-19 pandemic has impacted freshmen, compromising their mental health, 
lifestyles, and academic performance. There are few studies that have 
investigated changes in the health status and lifestyles of freshmen before and 
after the pandemic. The aims of this study were: (1) to carry out a 
pre-post-COVID-19 pandemic comparison between two freshmen samples, in order to 
detect differences in their socio-demographic characteristics and in some 
clinical variables; (2) to assess the effect of the COVID-19 pandemic on the 
social and academic lives of the second sample of freshmen. The samples 
recruited in 2019 and 2022, matched by propensity score procedure (N = 553), 
were mostly female (57.3% vs. 55.3%); the mean age was 22.9 and 20.9 years, 
respectively. The freshmen recruited after the pandemic had less psychological 
distress and substance use than freshmen recruited before the pandemic. 
Seventy-eight percent of the freshmen stated that the pandemic had an impact on 
their social relationships. This effect was greater for females and Italian 
students. Forty-seven percent reported that the pandemic has worsened their 
academic performance, while 60% stated that pandemic has improved their grades. 
The results of this study can provide valuable insights into the impact of the 
pandemic on freshmen, in order to implement interventions to mitigate the 
consequences of the pandemic in some subgroups of this target population.

DOI: 10.3390/ijerph20156485
PMCID: PMC10418828
PMID: 37569025 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


457. Sci Rep. 2023 Aug 11;13(1):13094. doi: 10.1038/s41598-023-39004-w.

Variation in the stringency of COVID-19 public health measures on self-reported 
health, stress, and overall wellbeing in Canada.

Cameron-Blake E(1)(2), Annan H(3)(4), Marro L(5), Michaud D(6), Sawatzky J(7), 
Tatlow H(8).

Author information:
(1)Blavatnik School of Government, University of Oxford, Radcliffe Observatory 
Quarter, Woodstock Road, Oxford, OX2 6GG, UK. e.a.cameron-blake@sms.ed.ac.uk.
(2)School of Social and Political Science, University of Edinburgh, 15a George 
Square, Edinburgh, EH8 9LD, UK. e.a.cameron-blake@sms.ed.ac.uk.
(3)Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
(4)IWK Health, Halifax, NS, Canada.
(5)Health Canada, Environmental and Radiation Health Sciences Directorate, 
Environmental Health Science and Research Bureau, Biostatistics Section, 251 Sir 
Frederick Banting Driveway, Tunney's Pasture, Ottawa, ON, K1A0K9, Canada.
(6)Health Canada, Environmental and Radiation Health Sciences Directorate, 
Consumer and Clinical Radiation Protection Bureau, 775 Brookfield Road, Ottawa, 
ON, K1A 1C1, Canada.
(7)Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
(8)Blavatnik School of Government, University of Oxford, Radcliffe Observatory 
Quarter, Woodstock Road, Oxford, OX2 6GG, UK.

Evidence is building regarding the association between government implemented 
public health measures aimed at combating COVID-19 and their impacts on health. 
This study investigated the relationship between the stringency of public health 
measures implemented in Canada and self-reported mental health, physical health, 
stress, and wellbeing among a random sample of 6647 Canadians 18 years of age 
and older. The analysis was based on self-reported health data from the Canadian 
Perspectives on Environmental Noise Survey. This data was combined with the 
Oxford COVID-19 Government Response Tracker database, which included overall 
stringency index (SI), and four of its sub-components, i.e., school and business 
closures, restrictions on gatherings, and stay at home policies. Adjusted 
multivariate logistic regression models indicated that the magnitude of the 
overall SI was associated with higher or lower odds of reporting worse physical 
health, mental health, stress and/or overall wellbeing, depending on the measure 
evaluated. Similarly, policy directed at the four sub-components had varying 
impacts on the odds of reporting worse health, depending on the sub-component, 
the strength of the policy restriction, and the health outcome evaluated. The 
association between the strength of the public health measures and self-reported 
health, and how this may inform future policy, is discussed.

© 2023. Springer Nature Limited.

DOI: 10.1038/s41598-023-39004-w
PMCID: PMC10421886
PMID: 37567870 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


458. Women Birth. 2024 Feb;37(1):128-136. doi: 10.1016/j.wombi.2023.07.128. Epub 2023 
Aug 9.

'I might have cried in the changing room, but I still went to work'. Maternity 
staff balancing roles, responsibilities, and emotions of work and home during 
COVID-19: An appreciative inquiry.

Arnold R(1), van Teijlingen E(2), Way S(2), Mahato P(3).

Author information:
(1)Centre for Midwifery and Women's Health, Bournemouth University, Bournemouth, 
UK. Electronic address: rarnold@bournemouth.ac.uk.
(2)Centre for Midwifery and Women's Health, Bournemouth University, Bournemouth, 
UK.
(3)Department of Health Studies, Royal Holloway University of London, London, 
UK.

PROBLEM: Knowing how to help staff thrive and remain in practice in maternity 
services.
BACKGROUND: A chronic shortage of staff in maternity services in the United 
Kingdom and high levels of stress and burnout in midwifery and medical staff.
PURPOSE: To understand how to support and enhance the wellbeing of staff in a 
small UK maternity service.
METHODS: An appreciative inquiry using interviews with n = 39 maternity staff 
and n = 4 group discussions exploring meaningful experiences, values and factors 
that helped their wellbeing.
RESULTS: Staff members were highly motivated, managing a complex melee of 
emotions and responsibilities including challenges to professional confidence, 
mental health, family situation, and conflict between work-life roles. Despite 
staff shortages, a demanding workload, professional and personal turmoil, and 
the pandemic participants still found meaning in their work and relationships.
DISCUSSION: A 'whole person' approach provided insight into the multiple 
stressors and emotional demands staff faced. It also revealed staff 
resourcefulness in managing their professional and personal roles. They invested 
in relationships with women but were also aware of their limits - the need to be 
self-caring, employ strategies to switch-off, set boundaries or keep a 
protective distance.
CONCLUSION: Staff wellbeing initiatives, and research into wellbeing, would 
benefit from adopting a holistic approach that incorporates home and family with 
work. Research on emotion regulation strategies could provide insights into 
managing roles, responsibilities, and the emotional demands of working in 
maternity services. Emotion regulation strategies could be included in midwifery 
and obstetric training.

Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.wombi.2023.07.128
PMID: 37567851 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interests One of our authors 
Professor Sue Way was until recently an associate editor of Women and Birth. 
Professors Sue Way and Edwin van Teijlingen are both peer reviewers for this 
journal. There are no other conflicts of interest to declare.


459. Am J Ind Med. 2023 Oct;66(10):884-896. doi: 10.1002/ajim.23522. Epub 2023 Aug 
10.

Impact of work schedule characteristics on teacher mental health and burnout 
symptoms while remote working.

Cavallari JM(1)(2), Garza JL(2), Charamut NR(3), Szarka C(3), Perry SD(3), 
Laguerre RA(4), Sanetti LMH(3), Dugan AG(2).

Author information:
(1)Department of Public Health Sciences, UConn School of Medicine, Farmington, 
Connecticut, USA.
(2)Division of Occupational and Environmental Medicine, Department of Medicine, 
UConn School of Medicine, Farmington, Connecticut, USA.
(3)Department of Educational Psychology, Neag School of Education, University of 
Connecticut, Storrs, Connecticut, USA.
(4)Department of Psychology, Montclair State University, Montclair, New Jersey, 
USA.

BACKGROUND: During the COVID-19 pandemic, teachers quickly shifted to remote 
teaching with many teachers experiencing increased work demands with limited 
resources, affecting both mental health and work.
METHODS: Within a cross-sectional study, we evaluated the relationship between 
one type of work demand, non-standard work schedule characteristics, and 
depressive and burnout symptoms in kindergarten through 8th grade U.S. teachers 
working remotely in May 2020. We further assessed the impact of COVID-19 and 
work resources. Work schedule characteristics were self-assessed across six 
domains on a 5-point frequency scale from always (1) to never (5). We used 
multilevel Poisson models to calculate prevalence ratios (PRs) and 95% 
confidence intervals (CIs).
RESULTS: In fully adjusted models, frequently working unexpectedly was 
associated with a higher prevalence of depressive symptoms (PR = 1.18, 95% 
CI = 1.07-1.31, p < 0.01), high emotional exhaustion (PR = 1.17, 95% 
CI = 1.05-1.30, p < 0.01), and high depersonalization (PR = 1.40, 95% 
CI = 1.02-1.92, p = 0.03). Remote work resources were significantly associated 
with a lower prevalence of depressive symptoms (PR = 0.88, 95% CI = 0.79-0.98, 
p = 0.02). There was a linear association between low coworker support and a low 
sense of personal accomplishment (PR = 0.68, 95% CI = 0.53-0.87, p < 0.01).
CONCLUSIONS: Frequently having to work unexpectedly while remote teaching was 
associated with symptoms of depression and burnout during the COVID-19 pandemic. 
Workplaces should support predictable working times to lessen the disruption 
caused by unexpected work to promote worker well-being.

© 2023 Wiley Periodicals LLC.

DOI: 10.1002/ajim.23522
PMCID: PMC10947992
PMID: 37563744 [Indexed for MEDLINE]

Conflict of interest statement: Disclosure (Authors): The authors declare no 
conflicts of interest.


460. PLoS One. 2023 Aug 10;18(8):e0288501. doi: 10.1371/journal.pone.0288501. 
eCollection 2023.

The impact of family support and organization on adolescents during school 
closure under Covid-19 lockdown regulations in an area of South Africa.

Kvalsvig JD(1), Taylor M(1), Watt KG(2), Desmond C(2).

Author information:
(1)Discipline of Public Health Medicine, School of Nursing and Public Health, 
University of KwaZulu-Natal, Durban, South Africa.
(2)Centre for Rural Health School of Nursing and Public Health, University of 
KwaZulu-Natal, Durban, South Africa.

The Covid-19 pandemic and resultant disruptions to schooling presented 
significant challenges for many families. Well organised families have been 
shown to have a protective effect on adolescent wellbeing in periods of shock. 
At the onset of the Covid-19 pandemic, Asenze, a population-based cohort study, 
was conducting a third wave of data collection in peri-urban South Africa, 
examining risk and protective factors during adolescence. By March 2020, n = 272 
adolescents and their caregivers (n = 241) in the cohort had been assessed when 
in-person data collection was halted by lockdown measures countrywide. During 
this cessation we undertook a brief telephonic qualitative sub-study to explore 
whether families enrolled in the cohort were able to cohabit cohesively and 
undertake distance learning during lockdown. A purposeful sample of 20 families 
(caregivers n = 20, adolescents n = 24) recently assessed in the Wave 3 of the 
main study, participated in semi-structured interviews. Quantitative data from 
Waves 1-3 of the main study was used to measure family function, adolescent 
cognitive function, and profile adolescent and caregivers. The quantitative and 
qualitative data were integrated to illustrate the dynamics of the participants' 
lives before and during lockdown. We found that families classified as 
well-organized before lockdown, were more likely to report co-operation during 
lockdown. Adolescents who were self-motivated, had access to smartphones or the 
internet, and were supported by both family and educators, were well-placed to 
continue their education without much disruption. However, few schools 
instituted distance learning. Of the adolescents who were not assisted- some 
studied on their own or with peers, but others did no schoolwork, hindered by a 
lack of digital connectivity, and poor service delivery. The experience of 
adolescence and caregivers in the Asenze Cohort during lockdown highlight the 
importance of family functioning for adolescent wellbeing in crisis, as well as 
the need for access to health, mental health, and social services, communication 
upgrades, and enhancements to the education system during peaceful times, to 
make a difference to young lives in times of crisis.

Copyright: © 2023 Kvalsvig et al. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0288501
PMCID: PMC10414574
PMID: 37561806 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


461. PLoS One. 2023 Aug 10;18(8):e0277392. doi: 10.1371/journal.pone.0277392. 
eCollection 2023.

Coping strategies employed by public psychiatric healthcare workers during the 
COVID-19 pandemic in southern Gauteng, South Africa.

Scheunemann A(1)(2), Kim AW(1)(3)(4), Moolla A(1), Subramaney U(5).

Author information:
(1)Health Economics and Epidemiology Research Office, Department of Internal 
Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of 
the Witwatersrand, Johannesburg, South Africa.
(2)T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, 
United States of America.
(3)SAMRC Developmental Pathways for Health Research Unit, Faculty of Health 
Sciences, University of the Witwatersrand, Johannesburg, South Africa.
(4)Department of Anthropology, University of California, Berkeley, Berkeley, 
California, United States of America.
(5)Department of Psychiatry, University of the Witwatersrand, Johannesburg, 
South Africa.

Within the context of the novel coronavirus pandemic and new challenges to a 
resource-constrained public healthcare system, many healthcare workers in South 
Africa have faced numerous stressors that have compromised their mental health. 
While the current literature on COVID-19 in South Africa highlights the 
widespread psychosocial stress experienced by healthcare workers during the 
pandemic, little is known about the coping strategies utilized to continue 
service delivery and maintain one's mental health and well-being during this 
ongoing public health emergency. In this study, we sought to explore the coping 
strategies used by healthcare workers employed in the public psychiatric care 
system in southern Gauteng, South Africa during the coronavirus disease 
(COVID-19) pandemic. Psychiatric healthcare workers (n = 55) employed in three 
tertiary public hospitals and two specialized psychiatric facilities 
participated in in-depth interviews between July 2020 and March 2021. We found 
that coping strategies spanned multi-level and multi-systemic efforts. 
Intrapersonal, interpersonal, material, and structural coping were mapped across 
individual, family, and hospital systems. The most commonly utilized coping 
strategies included positive mindsets and reappraisal, social support systems, 
and COVID-19 specific protections. Findings also highlighted the contextual and 
interconnected nature of coping. Healthcare workers applied multiple coping 
strategies to combat the negative mental health effects of the COVID-19 
pandemic. Better understanding these strategies, contexts in which they are 
employed, and how they interact can be used to develop evidence-based 
interventions to support healthcare workers experiencing healthcare-related 
stressors during the COVID-19 pandemic.

Copyright: © 2023 Scheunemann et al. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0277392
PMCID: PMC10414601
PMID: 37561687 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


462. J Psychiatr Ment Health Nurs. 2024 Feb;31(1):111-116. doi: 10.1111/jpm.12962. 
Epub 2023 Aug 10.

The nurse faculty role: A lived experience of mentoring nurses while coping with 
anxiety during the COVID-19 pandemic.

Orth SJ(1), Evanson TA(1).

Author information:
(1)College of Nursing and Professional Disciplines, University of North Dakota, 
Grand Forks, North Dakota, USA.

WHAT IS KNOWN ON THE SUBJECT?: Anxiety is common in women, nurses and nurse 
educators and can negatively impact overall mental well-being and work-life 
satisfaction. Anxiety increased during the COVID-19 pandemic. Hope is a personal 
resource that can be employed to help cope with anxiety. Professional identity, 
'our why', is important to recognize and revisit as a way to add value to daily 
work in anxious times. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Compassion 
fatigue has contributed to burnout and turnover of nurses and nursing faculty. 
Knowing our 'why' helps understand the motivation in our work. Using hope as a 
personal resource, and sharing my lived experience, could be useful to other 
nursing faculty struggling with anxiety. WHAT ARE THE IMPLICATIONS FOR MENTAL 
HEALTH NURSING?: There is a need for mental health resources within healthcare 
and education systems to support nurses and nurse educators not only during the 
COVID-19 pandemic but through future healthcare crises. Support programmes and 
interventions need to be developed to sustain and retain both nurses and nursing 
faculty.
ABSTRACT: BACKGROUND: Providing patient care and nurse education in today's 
healthcare environment is high-stress, often resulting in high-anxiety among 
both nurses and nurse educators. The impact of the COVID-19 pandemic on nurse 
faculty is largely unexplored.
AIMS: The aim was to share the experience of living and work working with 
anxiety in the nurse faculty role during the COVID-19 pandemic.
MATERIALS & METHODS: This is a lived experience narrative of one nurse faculty 
member.
RESULTS: Through daily purposeful self-motivation and reflection, yoga, and 
brief outdoor respites, the author was able to strengthen professional identity, 
to see value in her work and to activate the personal resource of hope (Nursing 
Management, 52, 2021, 56; Journal of Occupational and Organizational Psychology, 
93, 2020, 187).
DISCUSSION: 'Nursing faculty are essential to the profession' and likely 
experienced 'emotional exhaustion' during the pandemic (Nursing Education 
Perspectives, 42, 2021, 8) in their efforts to buoy students. It needs to be 
acknowledged that nursing faculty can experience anxiety, secondary trauma 
(International Journal of Environmental Research and Public Health, 17, 2020, 
8358) and compassion fatigue, through listening to students' experiences and 
offering reinforcement during chaotic times.
CONCLUSION: Little is known about what nursing faculty experienced as they 
attempted to support students (Nursing Education Perspectives, 42, 2021, 285). 
It is hoped that by sharing this lived experience, nurses and nurse faculty will 
understand how employing hope as a personal resource and re-engaging with their 
professional identity will help them cope with the significant stresses that 
future healthcare pandemics or disasters may bring.

© 2023 John Wiley & Sons Ltd.

DOI: 10.1111/jpm.12962
PMID: 37559527 [Indexed for MEDLINE]


463. Lancet Planet Health. 2023 Aug;7(8):e718-e725. doi: 
10.1016/S2542-5196(23)00134-1.

Heatwaves and wildfires suffocate our healthy start to life: time to assess 
impact and take action.

Bansal A(1), Cherbuin N(2), Davis DL(3), Peek MJ(4), Wingett A(5), Christensen 
BK(6), Carlisle H(4), Broom M(7), Schoenaker DAJM(8), Dahlstrom JE(4), Phillips 
CB(9), Vardoulakis S(2), Nanan R(10), Nolan CJ(11).

Author information:
(1)School of Medicine and Psychology, College of Health and Medicine, Australian 
National University, Canberra, ACT, Australia; John Curtin School of Medical 
Research, College of Health and Medicine, Australian National University, 
Canberra, ACT, Australia.
(2)National Centre for Epidemiology and Population Health, College of Health and 
Medicine, Australian National University, Canberra, ACT, Australia.
(3)Midwifery, University of Canberra, ACT, Australia; ACT Government, Health 
Directorate, ACT, Australia.
(4)School of Medicine and Psychology, College of Health and Medicine, Australian 
National University, Canberra, ACT, Australia; The Canberra Hospital, Canberra 
Health Services, ACT, Australia.
(5)National Aboriginal Community Controlled Health Organisation, Canberra, ACT, 
Australia.
(6)School of Medicine and Psychology, College of Health and Medicine, Australian 
National University, Canberra, ACT, Australia.
(7)Midwifery, University of Canberra, ACT, Australia; The Canberra Hospital, 
Canberra Health Services, ACT, Australia.
(8)School of Primary Care, Population Sciences and Medical Education, Faculty of 
Medicine, University of Southampton, Southampton, UK; NIHR Southampton 
Biomedical Research Centre, University of Southampton and University Hospital 
Southampton NHS Foundation Trust, Southampton, UK; School of Medical, Indigenous 
and Health Sciences, Faculty of Science, Medicine and Health, University of 
Wollongong, Wollongong, NSW, Australia.
(9)School of Medicine and Psychology, College of Health and Medicine, Australian 
National University, Canberra, ACT, Australia; Companion House Refugee Medical 
Service, Canberra, ACT, Australia.
(10)Sydney Medical School and Charles Perkins Center Nepean, University of 
Sydney, NSW, Australia.
(11)School of Medicine and Psychology, College of Health and Medicine, 
Australian National University, Canberra, ACT, Australia; John Curtin School of 
Medical Research, College of Health and Medicine, Australian National 
University, Canberra, ACT, Australia; The Canberra Hospital, Canberra Health 
Services, ACT, Australia. Electronic address: christopher.nolan@anu.edu.au.

Adverse environmental exposures in utero and early childhood are known to 
programme long-term health. Climate change, by contributing to severe heatwaves, 
wildfires, and other natural disasters, is plausibly associated with adverse 
pregnancy outcomes and an increase in the future burden of chronic diseases in 
both mothers and their babies. In this Personal View, we highlight the 
limitations of existing evidence, specifically on the effects of severe heatwave 
and wildfire events, and compounding syndemic events such as the COVID-19 
pandemic, on the short-term and long-term physical and mental health of pregnant 
women and their babies, taking into account the interactions with individual and 
community vulnerabilities. We highlight a need for an international, 
interdisciplinary collaborative effort to systematically study the effects of 
severe climate-related environmental crises on maternal and child health. This 
will enable informed changes to public health policy and clinical practice 
necessary to safeguard the health and wellbeing of current and future 
generations.

Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open 
Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. 
All rights reserved.

DOI: 10.1016/S2542-5196(23)00134-1
PMID: 37558352 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of interests We declare no competing 
interests.


464. Birth. 2023 Dec;50(4):1034-1044. doi: 10.1111/birt.12760. Epub 2023 Aug 9.

Influence of the COVID-19 pandemic on prenatal and postpartum patient 
experiences and well-being.

Riggan KA(1), Weaver AL(2), Ashby G(3), Huang L(4), Long ME(5), Torbenson VE(5), 
Wick MJ(5), Allyse MA(1)(5), Rivera-Chiauzzi EY(5).

Author information:
(1)Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA.
(2)Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, 
Minnesota, USA.
(3)Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA.
(4)Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, 
Florida, USA.
(5)Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, 
USA.

BACKGROUND: It has yet to be fully elucidated how differing populations of 
obstetric patients adapted to the disruptions in perinatal care and postpartum 
support from the COVID-19 pandemic. We surveyed an enriched sample of 
socioeconomically advantaged patients to understand the influence of COVID-19 on 
their perinatal care experience, well-being, and coping.
METHODS: We surveyed pregnant and postpartum patients (n = 6140) at a large 
academic medical center in the Midwest of the United States using the 
Coronavirus and Perinatal Experiences instrument in Spring 2021.
RESULTS: The survey was sent to 6141 pregnant and postpartum patients; 1180 
(17.8%) respondents completed the survey, including 256 who were pregnant and 
834 postpartum. Most pregnant patients experienced no changes in their prenatal 
care with 16.5% indicating somewhat worsened care. In the postpartum cohort, 
37.5% stated their care had somewhat worsened. In describing influences on 
stress and mental health, 58.1% of postpartum respondents stated it was 
moderately, and 17.4% significantly, worse. The pandemic had a somewhat or 
moderately negative influence for 72.7% of respondents, with 11.0% stating these 
effects were extremely negative. Both cohorts characterized a range of coping 
strategies, most commonly, talking with friends and family (76.3%).
CONCLUSION(S): Even among this sample of socioeconomically advantaged patients, 
respondents indicated that the pandemic disrupted many facets of their medical 
care and daily life, especially social activities and postpartum support. Our 
findings suggest that counseling on coping and adaptation strategies for 
stressors and increased health systems support be part of perinatal care during 
public health emergencies for all demographic groups.

© 2023 Wiley Periodicals LLC.

DOI: 10.1111/birt.12760
PMCID: PMC10843728
PMID: 37555375 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest: The authors report no 
conflict of interest.


465. Creat Nurs. 2023 Feb;29(1):23-41. doi: 10.1177/107845352202900112.

Integrative Nursing: A Framework for Whole-Person Mental Health Care.

Voss ME(1), Sandquist L(2), Otremba K(2), Kreitzer MJ(1).

Author information:
(1)Earl E. Bakken Center for Spirituality & Healing and School of Nursing at the 
University of Minnesota in Minneapolis, Minnesota, US.
(2)Penny George Institute for Health and Healing at Allina Health in 
Minneapolis, Minnesota, US.

The incidence of mental illness continues to increase since the start of the 
COVID-19 pandemic (Mental Health America, 2022). Demand for mental health 
services has grown, and providers report being "unable to meet the demand" or 
having an increase in wait times for access to care (American Psychological 
Association, 2022, para. 1). Due to this increase in demand, more patients are 
seeking mental health care from their primary care providers. Over the past 
decade, integrative models of care have been expanding into mental health care 
(Lake, 2017). Integrative Nursing is a strategy for improving the quality of 
care provided to patients seeking care for mental health diagnoses, as well as 
those with a goal of increasing mental health and wellbeing. This article 
proposes that Integrative Nursing can serve as a framework for providing 
whole-person mental health care.

DOI: 10.1177/107845352202900112
PMID: 37551004 [Indexed for MEDLINE]


466. Front Public Health. 2023 Jul 21;11:1255642. doi: 10.3389/fpubh.2023.1255642. 
eCollection 2023.

Editorial: The impact of sedentary behavior and virtual lifestyles on physical 
and mental wellbeing.

Hanna F(1), You E(2), El-Sherif M(3).

Author information:
(1)Public Health Program, Torrens University Australia, Melbourne, VIC, 
Australia.
(2)Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The 
University of Melbourne, Melbourne, VIC, Australia.
(3)Department of Bariatric Surgery, Hamad Medical Centre, Doha, Qatar.

Comment on
    Editorial on the Research Topic The impact of sedentary behavior and virtual 
lifestyles on physical and mental wellbeing.

DOI: 10.3389/fpubh.2023.1255642
PMCID: PMC10401583
PMID: 37546294 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


467. Afr Health Sci. 2023 Mar;23(1):44-50. doi: 10.4314/ahs.v23i1.6.

Psychological impact of COVID-19 Pandemic on dentists.

Patil B(1), Mishra S(1), Ramesh S(1), Savant S(2).

Author information:
(1)Dental Surgeon, Bharati Vidyapeeth Dental College, Navi Mumbai, Maharashtra, 
India.
(2)Department of Public Health Dentistry, Bharati Vidyapeeth Dental College, 
Navi Mumbai, Maharashtra, India.

BACKGROUND: The Covid-19 pandemic seems to have an incessant out-turn on the 
people in every field in some or the other way. It has been reported that 
maximum number of deaths in the countries during this pandemic are caused due to 
a term called death anxiety or phobia. There are certain parameters such as 
anxiety, apprehension, depression which if influence a person can alter one's 
well-being.
OBJECTIVE: The steadfast intent of this review article is to narrate the 
psychological impact of this pandemic on dentists. The eloquence and emergence 
of this topic will alarm all the medicos and paramedics to have a check on this 
scenario.
METHODS: The article consists of detailed study from several articles from 
PubMed publications. Articles written only in English language were referred. 
Various keywords such as "Covid-19 pandemic" or "Psychological Impact" were 
used.
RESULTS: The Covid-19 Pandemic has adversely affected all of us physically as 
well as psychologically. This article signifies the psychological impact of this 
pandemic on dentists.
CONCLUSION: The current studies that are carried out till date show an extensive 
impact on the psychology of the dental professionals. The following review 
article elaborates the importance of the same.

© 2023 Patil B et al.

DOI: 10.4314/ahs.v23i1.6
PMCID: PMC10398508
PMID: 37545956 [Indexed for MEDLINE]

Conflict of interest statement: The authors report no conflict of interest.


468. Afr Health Sci. 2023 Mar;23(1):59-71. doi: 10.4314/ahs.v23i1.8.

Evaluation of the association between fear of COVID-19 and pregnancy distress.

Mamuk R(1), Akbulut Ş(2), Erdoğan A(3).

Author information:
(1)Nursing Department, Faculty of Health Sciences, Eastern Mediterranean 
University. Famagusta, North Cyprus.
(2)Nursing Department, Faculty of Health Sciences, Batman University, Batman, 
Turkey.
(3)Nursing Department, Sabahattin Zaim University, Istanbul, Turkey.

BACKGROUND: Mental health problems experienced during pregnancy negatively 
affect both maternal and fetal wellbeing.
OBJECTIVE: This study aimed to investigate the relationship between fear of 
COVID-19 and pregnancy distress in healthy pregnant women living in Turkey.
METHODS: A descriptive, relational/cross-sectional study was conducted by 
interviewing 363 pregnant women in person. Data were collected using a personal 
information form, the Fear of COVID-19 Scale (FCV-19S), and the Tilburg 
Pregnancy Distress Scale (TPDS).
RESULTS: The mean FCV-19S score was 19.03±5.65 and the mean TPDS score was 
19.97±7.97. According to the TPDS cut-off score, 19.0% of the participants were 
at risk of pregnancy distress. There was a significant positive correlation 
between FCV-19S and TPDS scores (r = 0.263, p<0.05). According to the regression 
analysis, age (β= -0.217), years of education (β= -0.272), and number of births 
(β= 0.502) were associated with fear of COVID-19, and fear of COVID-19 was 
associated with TPDS scores (β= 0.369) (p<0.05).
CONCLUSION: The pregnant women in this study had moderate fear of COVID-19. 
Compared to the literature data, the prevalence of pregnancy distress was 
slightly higher than pre-COVID-19 reports but quite low compared to other 
studies conducted during the pandemic.

© 2023 Mamuk R et al.

DOI: 10.4314/ahs.v23i1.8
PMCID: PMC10398489
PMID: 37545897 [Indexed for MEDLINE]


469. Expert Rev Neurother. 2023 Jul-Dec;23(8):703-720. doi: 
10.1080/14737175.2023.2239500. Epub 2023 Aug 7.

Long-term central nervous system (CNS) consequences of COVID-19 in children.

Howe de la Torre S(1), Parlatini V(2), Cortese S(1)(3)(4)(5).

Author information:
(1)School of Psychology, University of Southampton, Southampton, UK.
(2)Department of Child and Adolescent Psychiatry, Institute of Psychiatry, 
Psychology and Neuroscience, King's College London, London, UK.
(3)Horizon Centre, CAMHS West, William Macleod Way, Solent NHS Trust, 
Southampton, UK.
(4)Division of Psychiatry and Applied Psychology, School of Medicine, University 
of Nottingham, Nottingham, UK.
(5)Hassenfeld Children's Hospital at NYU Langone, New York University Child 
Study Center, New York City, New York, USA.

INTRODUCTION: Neurological/neuropsychiatric symptoms are commonly reported by 
children/young people with long COVID, especially headache, fatigue, cognitive 
deficits, anosmia and ageusia, dizziness, mood symptoms, and sleep problems. 
However, reported prevalence estimates are highly variable due to study 
heterogeneity and often small sample size; most studies only considered 
short-term follow-ups; and, apart from mood and sleep problems, neuropsychiatric 
conditions have received less attention. Considering the potential debilitating 
effects of neurological/neuropsychiatric conditions, a comprehensive review of 
the topic is timely, and needed to support clinical recognition as well as to 
set the direction for future research.
AREAS COVERED: The authors discuss neurological/neuropsychiatric manifestations 
of long COVID in pediatric populations, with a focus on prevalence, associated 
demographic characteristics, and potential pathogenetic mechanisms.
EXPERT OPINION: Children/young people may develop persistent 
neurological/neuropsychiatric symptoms following acute SARS-CoV-2 infection, 
which may affect daily functioning and well-being. Studies in larger samples 
with longer follow-ups are needed to clarify prevalence and symptom duration; as 
well as less investigated risk factors, including genetic predisposition, 
ethnicity, and comorbidities. Controlled studies may help separate 
infection-related direct effects from pandemic-related psychosocial stressors. 
Clarifying pathogenetic mechanisms is paramount to develop more targeted and 
effective treatments; whilst screening programs and psychoeducation may enhance 
early recognition.

DOI: 10.1080/14737175.2023.2239500
PMID: 37545414 [Indexed for MEDLINE]


470. Ethn Health. 2024 Jan;29(1):25-45. doi: 10.1080/13557858.2023.2243548. Epub 2023 
Aug 5.

Attitudes and perceptions toward the COVID-19 risk-mitigation strategies among 
racially and ethnically diverse older adults in the United States and Puerto 
Rico: a qualitative study.

Nvé Díaz San Francisco C(1)(2), Zhen-Duan J(1)(3), Fukuda M(1), Alegría 
M(1)(3)(4).

Author information:
(1)Disparities Research Unit, Department of Medicine, Massachusetts General 
Hospital, Boston, MA, USA.
(2)Departamento de Antropología Social y Cultural, Universidad de Educación a 
Distancia, UNED, Madrid, Spain.
(3)Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
(4)Department of Medicine, Harvard Medical School, Boston, MA, USA.

OBJECTIVES: There is limited qualitative research investigating how 
risk-mitigation strategies during the COVID-19 pandemic impacted the lives of 
diverse older adults, who met criteria for mild to severe generalized anxiety or 
depression and minor to moderate disability. This study aims to address this gap 
by examining how racially and ethnically diverse older adults with at least mild 
mental health symptoms and minor physical disability in the United States and 
Puerto Rico adapted to guidelines during COVID-19. It aims to inform the medical 
community and policymakers of potential threats to these older adults' 
well-being given the COVID-19 burden.
DESIGN: Based on descriptive qualitative inquiry and phenomenological 
perspectives, we conducted semi-structured interviews over the phone with a 
racially and ethnically diverse sample of older (age 60+), predominantly 
minoritized adults (N = 100) in four states and territories across the United 
States and Puerto Rico in 2021. Interviews were recorded, coded, and analyzed 
using a thematic analysis approach.
RESULTS: Findings centered on five themes: (1) Previous experiences with the 
healthcare system and cultural beliefs related to trust and distrust led to 
mixed attitudes toward COVID-19 risk-mitigation strategies; (2) Compliance with 
COVID-19 mitigation strategies ensured safety and addressed fear of illness; (3) 
Compliance led to isolation due to interrupted social relations; (4) Isolation 
and disrupted social networks negatively impacted mental health and finances, 
and (5) Coping strategies and embracing support reduced the effects of social 
isolation.
CONCLUSION: This study underscores the importance of increasing support and 
social connectedness during a pandemic and beyond to ensure the well-being of 
older adults in racially and ethnically diverse communities. It highlights the 
resiliency of older adults in identifying strategies to cope with negative 
impacts. We recommend safeguarding economic security through policy efforts 
toward financial safety nets during health crises and collaborative approaches 
with community-based organizations to mitigate social isolation.

DOI: 10.1080/13557858.2023.2243548
PMCID: PMC10867780
PMID: 37543717 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of interest statement The authors 
declare no conflicts of interest.


471. BMC Psychol. 2023 Aug 4;11(1):222. doi: 10.1186/s40359-023-01244-w.

Early intervention to prevent adverse child emotional and behavioural 
development following maternal depression in pregnancy: study protocol for a 
randomised controlled trial.

Milgrom J(1)(2), Hirshler Y(1), Holt C(1), Skouteris H(3), Galbally M(4)(5)(6), 
East C(7)(8), Glover V(9), Reece J(10), O'Donnell KJ(11)(12)(13), Walker 
SP(8)(14), Malloy S(15), Gemmill AW(16).

Author information:
(1)Parent-Infant Research Institute, Austin Health, 300 Waterdale Road, 
Heidelberg Heights, VIC, 3081, Australia.
(2)Melbourne School of Psychological Sciences, University of Melbourne, Grattan 
Street, Parkville, VIC, 3010, Australia.
(3)Health and Social Care Unit, School of Public Health and Preventive Medicine, 
Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
(4)Health Futures Institute, Murdoch University, 90 South Street, Murdoch, WA, 
6150, Australia.
(5)School of Clinical Sciences, Monash University, Clayton, VIC, 3168, 
Australia.
(6)Mental Health, Program Monash Medical Centre, Monash Health, 246 Clayton 
Road, Clayton, VIC, 3168, Australia.
(7)Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, 
Plenty Rd & Kingsbury Drive, Bundoora, VIC, 3086, Australia.
(8)Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC, 3084, Australia.
(9)Institute of Reproductive and Developmental Biology, Imperial College London, 
Du Cane Road, London, W12 ONN, UK.
(10)School of Psychological Sciences, Australian College of Applied Professions, 
123 Lonsdale Street, Melbourne, VIC, 3000, Australia.
(11)Yale Child Study Center, Yale School of Medicine, 230 South Frontage Road, 
New Haven, CT, 06519, USA.
(12)Department of Obstetrics Gynecology and Reproductive Sciences, 230 South 
Frontage Road, New Haven, CT, 06519, USA.
(13)Department of Psychiatry, McGill University, 1033 Pine Avenue West, 
Montreal, QC, H3A 1A1, Canada.
(14)Melbourne Medical School, University of Melbourne, Grattan Street, 
Parkville, VIC, 3010, Australia.
(15)Ovia Health, 263 Summer Street, Boston, MA, 02210, USA.
(16)Parent-Infant Research Institute, Austin Health, 300 Waterdale Road, 
Heidelberg Heights, VIC, 3081, Australia. alan.gemmill@austin.org.au.

BACKGROUND: Substantial evidence indicates that maternal depression during 
pregnancy (i.e., antenatal depression) is associated not only with maternal 
wellbeing but also with child emotional and behavioural development. Children of 
antenatally depressed women are at risk of emotional and behavioural problems, 
including internalising problems (e.g., anxiety and depression) and 
externalising problems (e.g., attention problems), that may last at least to 
adolescence. These enduring effects also constitute an enormous economic cost. 
Despite the seriousness of this problem, until recently there existed very few 
controlled studies evaluating whether active psychological treatment for 
antenatal depression can prevent adverse child outcomes. Our previous pilot 
randomised controlled trial (RCT) exploring the effect of cognitive behavioural 
therapy (CBT) for antenatal depression on child outcomes showed promising 
results. We aim to assess whether treating antenatal depression with an 
evidence-based 8-week structured CBT program can prevent or ameliorate adverse 
child developmental outcomes at 2 years of age.
METHODS: Pregnant women ≤ 30 weeks gestation diagnosed with a depressive 
disorder are recruited and randomised to CBT or treatment as usual (TAU). The 
target sample size is 230 and the primary outcome measure is the infant 
Internalising scale of the Child Behaviour Checklist (CBCL) at 24 months of age. 
Secondary infant outcome measures at 24 months are the Externalising scale of 
the CBCL and the motor and cognitive development subscales of the Ages & Stages 
Questionnaire (ASQ-3). Additional secondary outcome measures are subscales of 
the Revised Infant Behaviour Questionnaire (IBQ-R), ASQ-3 and the 
ASQ-Socio-Emotional (ASQ-SE) at 3 and 12 months of age and the quality of 
mother-infant interaction at 3 and 24 months. Maternal measures, including 
demographic data, depression diagnosis, depressive and anxiety symptoms, 
perceived stress and parenting stress, are collected across all time points.
DISCUSSION: The trial is ongoing and recruitment was slowed due to the COVID-19 
pandemic. If results suggest a beneficial effect of antenatal depression 
treatment on infant outcomes, the project could have repercussions for standard 
antenatal care, for maternal and infant health services and for preventing the 
intergenerational transmission of mental health disorders.
TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Register: 
ACTRN12618001925235 Date Registered: 27 November 2018.

© 2023. BioMed Central Ltd., part of Springer Nature.

DOI: 10.1186/s40359-023-01244-w
PMCID: PMC10401817
PMID: 37542332 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


472. Am J Occup Ther. 2023 Jul 1;77(4):7704345010. doi: 10.5014/ajot.2023.050247.

Impact of Age and School Instruction Mode on Children's Occupations Early in the 
COVID-19 Pandemic: A Longitudinal Survey Study.

Nemanich ST(1), Velez G(2), Millard A(3), Pleva A(4).

Author information:
(1)Samuel Thomas Nemanich, PhD, MSCI, is Assistant Professor, Department of 
Occupational Therapy, Marquette University, Milwaukee, WI; 
sam.nemanich@marquette.edu.
(2)Gabriel Velez, PhD, is Assistant Professor, Department of Educational 
Psychology, Marquette University, Milwaukee, WI.
(3)Ann Millard, OTD, MOT, OTR/L, BCP, SCSS, is Assistant Professor, Department 
of Occupational Therapy, Marquette University, Milwaukee, WI.
(4)Anne Pleva, PT, DPT, PCS, is Assistant Professor, Department of Physical 
Therapy, Marquette University, Milwaukee, WI.

IMPORTANCE: The coronavirus disease 2019 (COVID-19) pandemic disrupted 
participation in routines and daily activities. It is unclear how children 
reengaged in activities during the pandemic, particularly as a new school year 
began. Differences in school instruction mode (in person, hybrid, or remote) 
during the pandemic could further affect activity participation.
OBJECTIVE: To examine changes in sedentary and nonsedentary activity 
participation in children and to determine whether school instruction mode was 
associated with participation.
SETTING: Home-based survey of U.S. residents.
PARTICIPANTS: Parents of 208 children (46.2% female) between ages 5 and 18 yr 
were surveyed at two waves: March through April 2020 and October 2020.
OUTCOMES AND MEASURES: Frequency of sedentary (indoor play, electronic device 
usage) and nonsedentary (outdoor play, leisure and extracurriculars) activity 
participation was observed. Descriptive and inferential statistics of the 
changes from Wave 1 to Wave 2 and linear regression were used to determine 
statistically significant variables associated with activity participation.
RESULTS: Nonsedentary activity participation increased and sedentary activity 
decreased from Wave 1 to Wave 2. Instruction mode was statistically associated 
with nonsedentary, but not sedentary, participation. Negative mood, local 
COVID-19 severity, and household income were also associated with nonsedentary 
and sedentary participation.
CONCLUSIONS AND RELEVANCE: Children's participation in sedentary and 
nonsedentary activities normalized during the new school year; however, many 
factors likely contributed to these changes. What This Article Adds: Despite 
differences in school instruction mode and the influence of mental health early 
in the pandemic, children's nonsedentary activity participation increased. 
Occupational therapy practitioners can reinforce the importance of reengaging in 
activities and regular routines to promote health and well-being during 
challenging situations.

Copyright © 2023 by the American Occupational Therapy Association, Inc.

DOI: 10.5014/ajot.2023.050247
PMID: 37540762 [Indexed for MEDLINE]


473. PLoS One. 2023 Aug 4;18(8):e0289533. doi: 10.1371/journal.pone.0289533. 
eCollection 2023.

The association between COVID-19 preventive behaviors and mental health 
conditions.

Wachira E(1), Chavan B(2), Nganga-Good C(3), Kingori C(4).

Author information:
(1)Department of Health and Human Performance, Texas A&M University- Commerce, 
Commerce, Texas, United States of America.
(2)College of Osteopathic Medicine, Ohio University, Athens, Ohio, United States 
of America.
(3)AWN Foundation, Baltimore, Maryland, United States of America.
(4)College of Health Sciences and Professions, Ohio University, Athens, Ohio, 
United States of America.

BACKGROUND: An unintended consequence of COVID-19 quarantine preventive 
measures, is the increased prevalence of anxiety and depression. The purpose of 
this study was to examine the association between COVID-19 preventive behaviors 
and mental health conditions.
METHODS: A cross-sectional study was conducted using secondary data collected 
weekly from US adults aged 18 and older nationwide as part of the COVID-19 
Household Impact Survey (CIS) from the University of Chicago. Logistic 
regression examined associations between COVID-19 preventive behaviors (wearing 
a face mask, washing or sanitizing hands, and keeping six-feet distance from 
those outside their household), mental health conditions (self-reporting feeling 
nervous, anxious, or on edge, feeling lonely, and feeling hopeless about the 
future and a history of a mental health condition) and demographic factors.
RESULTS: Majority of study participants were under 60 years (62.2%), female 
(55.8%), and non-Hispanic White (72.2%). Overall, participants more likely to 
have followed all three COVID-19 measures were those who reported high 
psychological distress compared to those with low distress for feeling anxious 
(adj. OR 1.16, 95% CI: 1.06-1.28, p = 0.002), lonely (adj. OR 1.12, 95% CI: 
1.02-1.23, p = 0.019) or hopeless (adj. OR 1.10, 95% CI: 1.00-1.21, p = 0.043) 
for more than a day during the past 7 days.
CONCLUSION: Our findings highlight that individuals with mental health 
conditions reported more psychological distress. Specifically, feeling 
depressed, anxious, lonely, and hopeless were triggered and exacerbated as a 
result of the pandemic and may have long-term effects on general well-being and 
productivity. Therefore, our findings have important implications on the need to 
include mental health promotion as part of pandemic response efforts. This 
includes developing policies and allocating funding so as to ensure sustainable 
mental health interventions and support, public and provider education on the 
importance of screening for mental health issues.

Copyright: © 2023 Wachira et al. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0289533
PMCID: PMC10403101
PMID: 37540660 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


474. Nurs Ethics. 2023 Aug 4:9697330231191280. doi: 10.1177/09697330231191280. Online 
ahead of print.

Alleviating suffering of individuals with multimorbidity and complex needs: A 
descriptive qualitative study.

Younas A(1), Inayat S(2).

Author information:
(1)Memorial University of Newfoundland, St. John's, NL, Canada.
(2)University of Calgary, Calgary, AB, Canada.

BACKGROUND: Individuals living with multimorbidity and/or mental health issues, 
low education, socioeconomic status, and polypharmacy are often called complex 
patients. The complexity of their health and social care needs can make them 
prone to disease burden and suffering. Therefore, they frequently access health 
care services to seek guidance for managing their illness and suffering.
AIMS: The aim of this research was to describe the approaches used by nurses to 
alleviate the suffering of individuals with multimorbidity and complex needs in 
acute care settings.
RESEARCH DESIGN: A qualitative descriptive approach.
PARTICIPANTS AND RESEARCH CONTEXT: Semi-structured interviews were conducted 
with 19 nurses working in general, medical-surgical, specialized, and intensive 
care settings across five hospitals in Pakistan. Reflexive thematic analysis was 
used for analysis.
ETHICAL CONSIDERATIONS: Ethical approval was obtained from the Ethical Committee 
of Al-Nafees Medical College Islamabad, Pakistan.
FINDINGS: Four themes were generated: Deeper Exploration of Patients' 
Health-Illness Situation and Complexity, Prioritizing Patient Psychosocial and 
Emotional Needs, Instilling Hope and Encouragement in Patients, and Creating a 
Comforting Environment to Foster Sharing of felt needs.
DISCUSSION: Nurses emphasized the need of deeper inquiry into patients illness 
situation and complexity to discern the impact of determinants on their 
well-being and develop care plans that are tailored to address psychosocial, 
emotional, and physical suffering of this patient population.
CONCLUSIONS: Alleviation of patient suffering is integral to compassionate 
nursing care. Nurses use a multifaceted approach entailing sensitive 
understanding, recognizing sociocultural and structural determinants impact on 
patient situation, and individual and interdisciplinary altruistic actions to 
alleviate patient suffering.

DOI: 10.1177/09697330231191280
PMID: 37540492


475. BMC Psychol. 2023 Aug 3;11(1):220. doi: 10.1186/s40359-023-01260-w.

"I miss the normalness": Mother and child perspectives of well-being and 
effective remote support from primary schools during Covid-19 school closures.

Lacey AJ(1), Banerjee R(1), Dockalova L(1), Lester KJ(2).

Author information:
(1)School of Psychology, University of Sussex, Falmer, Brighton, UK.
(2)School of Psychology, University of Sussex, Falmer, Brighton, UK. 
K.Lester@sussex.ac.uk.

BACKGROUND: Covid-19 related school closures radically disrupted children's 
access to social and educational opportunities and changed daily life for 
millions of families across the world. Emerging evidence indicates that, 
overall, closures were associated with a decline in children's mental health and 
well-being, although individual experiences varied widely. The extent to which 
primary schools adapted remote well-being support is likely to have contributed 
to child and family adjustment, although this has not yet been fully explored in 
Covid related research.
METHODS: This longitudinal qualitative study examines variability in remote 
well-being provision in primary schools during the pandemic, and following 
school reopening, from the perspective of mothers and children using a whole 
school approaches framework. Twenty-one primary school aged children and their 
mothers took part in a semi-structured interview at two time points: time one 
during the first UK national lockdown and time two approximately seven months 
later after most children had returned to school. A hybrid inductive-deductive 
thematic analysis approach identified key themes relating to trajectories of 
well-being and remote school approaches over this period.
RESULTS: School closures were associated with a decline in well-being for most 
children. Disrupted contact with friends and teachers, and limited opportunities 
for enriched, meaningful activity were identified as key risk factors. 
Protective factors included family and child characteristics that mitigated 
against the loss of wider systems of support, including family socioeconomic 
status, parental availability, child temperament, and structured daily routines. 
Four key dimensions of effective remote well-being provision were identified 
(the 4Cs). The 4Cs - contact, content, creativity and community - provide an 
accessible framework for schools to foster children's social relationships and 
sense of belonging during periods of closure. Analysis of pupil reintegration 
outcomes suggest that post-Covid support priorities should include extending 
social and play-based universal interventions in schools.
CONCLUSION: Remote well-being support for children during Covid-related school 
closures varied in quality with implications for children's mental health and 
well-being. Findings from this study highlight the importance of ongoing social 
contact and enriched daily activities to protect children's well-being and 
development and present a framework of effective remote wellbeing support for 
primary schools in the event of future closures or prolonged pupil absence.

© 2023. BioMed Central Ltd., part of Springer Nature.

DOI: 10.1186/s40359-023-01260-w
PMCID: PMC10401740
PMID: 37537676 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


476. Nord J Psychiatry. 2023 Nov;77(8):760-767. doi: 10.1080/08039488.2023.2240301. 
Epub 2023 Aug 3.

Lockdown during the early phase of Covid-19 - effects on specialized mental 
health services and vocational activities for patients with psychotic disorders.

Schjøtt-Pedersen O(1)(2), Seierstad A(1), Evensen S(1)(3), Horgen Evensen J(1), 
Færden A(1), Lunde Gjerstad C(1)(2)(4), Fadler Martinsen F(1), Sørgård KM(1), 
Ullevoldsæter Lystad J(1)(5).

Author information:
(1)Division of Mental Health and Addiction, Oslo University Hospital, Oslo, 
Norway.
(2)Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
(3)Norwegian Labour and Welfare Administration, Nesodden, Norway.
(4)Norwegian Armed Forces Joint Medical Services, Institute of Military 
Psychiatry Oslo, Norway.
(5)Department of Psychology, University of Oslo, Oslo, Norway.

PURPOSE: People with psychotic disorders may be particularly vulnerable to 
adverse effects from restrictions implemented to limit the COVID-19 pandemic. 
Mental health professionals may also be at risk of adverse effects. The aim of 
this study was to investigate the impact of potential changes in accessibility, 
quality of care and vocational activity on people with psychotic disorders and 
the impact on clinicians working in these conditions.
MATERIALS AND METHODS: Patients and clinicians in specialized mental health 
services for psychotic disorders answered questionnaires regarding changes in 
treatment, quality of treatment, vocational activity, and well-being. Data was 
analyzed with nonparametric tests.
RESULTS: Inpatients appeared more influenced by the restrictions than 
outpatients, however, quality of treatment was regarded relatively unaffected. 
Clinicians seemed satisfied working under these conditions, though a larger 
portion of clinicians reported changes in treatment compared to patients. The 
patients who reported being affected by changes in vocational activity tended to 
report negative effects, but the majority reported being unaffected.
CONCLUSION: Overall, patients and clinicians appeared to cope well with the 
changes they experienced in accessibility, quality of care and vocational 
activity during the early phases of the pandemic.

DOI: 10.1080/08039488.2023.2240301
PMID: 37534458 [Indexed for MEDLINE]


477. Int J Neuropsychopharmacol. 2023 Oct 19;26(10):747-760. doi: 
10.1093/ijnp/pyad046.

Longitudinal Impact of the COVID-19 Pandemic on Stress and Occupational 
Well-Being of Mental Health Professionals: An International Study.

Kogan CS(1), Garcia-Pacheco JA(2), Rebello TJ(3), Montoya MI(1), Robles R(4), 
Khoury B(5), Kulygina M(6), Matsumoto C(7), Huang J(8), Medina-Mora ME(9), 
Gureje O(10), Stein DJ(11)(12), Sharan P(13), Gaebel W(14), Kanba S(15), Andrews 
HF(16), Roberts MC(17), Pike KM(18), Zhao M(8), Ayuso-Mateos JL(19), Sadowska 
K(3), Maré K(11), Denny K(20), Reed GM(21).

Author information:
(1)School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.
(2)Centro de Investigación y Docencia Económica, Mexico City, Mexico.
(3)Columbia University Vagelos College of Physicians and Surgeons, New York, New 
York, USA.
(4)Center for Global Mental Health Research, National Institute of Psychiatry 
Ramón de la Fuente Muñiz, Mexico City, Mexico.
(5)Department of Psychiatry, American University of Beirut Medical Center, 
Beirut, Lebanon.
(6)Training and Research Centre, Mental-health clinic No.1 named after N.A. 
Alekseev, Moscow, Russian Federation.
(7)Japanese Society of Psychiatry and Neurology, Tokyo, Japan.
(8)Shanghai Mental Health Center and Shanghai Jiao Tong University School of 
Medicine, Shanghai, People's Republic of China.
(9)Faculty of Psychology, National Autonomous University of Mexico and Center 
for Global Mental Health Research, National Institute of Psychiatry Ramón de la 
Fuente Muñiz, Mexico City, Mexico.
(10)WHO Collaborating Centre for Research and Training in Mental Health, 
Neuroscience, Drug and Alcohol Abuse, Department of Psychiatry, University of 
Ibadan, Ibadan, Nigeria.
(11)Department of Psychiatry, Neuroscience Institute, Faculty of Health 
Sciences, University of Cape Town and Groote Schuur Hospital, Observatory, South 
Africa.
(12)SAMRC Unit on Risk and Resilience on Mental Disorders, Department of 
Psychiatry, University of Cape Town and Groote Schuur Hospital, Observatory, 
South Africa.
(13)Department of Psychiatry, All India Institute of Medical Sciences, New 
Delhi, India.
(14)Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine 
University, Düsseldorf, Germany.
(15)Kyushu University, Fukuoka and Japan Depression Center, Tokyo, Japan.
(16)Departments of Biostatistics and Psychiatry, Columbia University and New 
York State Psychiatric Institute, Columbia University Medical Center, New York, 
New York, USA.
(17)Clinical Child Psychology Program, University of Kansas, Lawrence, Kansas, 
USA.
(18)Departments of Psychiatry and Epidemiology, Columbia University Irving 
Medical Center, New York, New York, USA.
(19)Department of Psychiatry, Universidad Autónoma de Madrid, Instituto de Salud 
Carlos III, Centro de Investigacíon Biomédica en Red de Salud Mental (CIBERSAM), 
Instituto de Investigacíon Sanitaria La Princesa, Madrid, Spain.
(20)Department of Sociology and Anthropology, Carleton University, Ottawa, 
Ontario, Canada.
(21)Department of Psychiatry, Columbia University Vagelos College of Physicians 
and Surgeons, New York, New York, USA.

BACKGROUND: Increased levels of occupational stress among health professionals 
during the COVID-19 pandemic have been documented. Few studies have examined the 
effects of the pandemic on mental health professionals despite the heightened 
demand for their services.
METHOD: A multilingual, longitudinal, global survey was conducted at 3 time 
points during the pandemic among members of the World Health Organization's 
Global Clinical Practice Network. A total of 786 Global Clinical Practice 
Network members from 86 countries responded to surveys assessing occupational 
distress, well-being, and posttraumatic stress symptoms.
RESULTS: On average, respondents' well-being deteriorated across time while 
their posttraumatic stress symptoms showed a modest improvement. Linear growth 
models indicated that being female, being younger, providing face-to-face health 
services to patients with COVID-19, having been a target of COVID-related 
violence, and living in a low- or middle-income country or a country with a 
higher COVID-19 death rate conveyed greater risk for poor well-being and higher 
level of stress symptoms over time. Growth mixed modeling identified 
trajectories of occupational well-being and stress symptoms. Most mental health 
professions demonstrated no impact to well-being; maintained moderate, 
nonclinical levels of stress symptoms; or showed improvements after an initial 
period of difficulty. However, some participant groups exhibited deteriorating 
well-being approaching the clinical threshold (25.8%) and persistently high and 
clinically significant levels of posttraumatic stress symptoms (19.6%) over 
time.
CONCLUSIONS: This study indicates that although most mental health professionals 
exhibited stable, positive well-being and low stress symptoms during the 
pandemic, a substantial minority of an already burdened global mental health 
workforce experienced persistently poor or deteriorating psychological status 
over the course of the pandemic.

© The Author(s) 2023. Published by Oxford University Press on behalf of CINP.

DOI: 10.1093/ijnp/pyad046
PMCID: PMC10586039
PMID: 37531283 [Indexed for MEDLINE]


478. Front Public Health. 2023 Jul 17;11:1188690. doi: 10.3389/fpubh.2023.1188690. 
eCollection 2023.

Mental health trajectories in university students across the COVID-19 pandemic: 
findings from the Student Wellbeing at Northern England Universities prospective 
cohort study.

Paton LW(1)(2), Tiffin PA(1)(2), Barkham M(3), Bewick BM(4), Broglia E(3)(5), 
Edwards L(6), Knowles L(5), McMillan D(1)(2), Heron PN(2).

Author information:
(1)Hull York Medical School, University of York, York, United Kingdom.
(2)Department of Health Sciences, University of York, York, United Kingdom.
(3)Department of Psychology, University of Sheffield, Sheffield, United Kingdom.
(4)School of Medicine, University of Leeds, Leeds, United Kingdom.
(5)Student Mental Health, Counselling and Therapies Service, The University of 
Sheffield, Sheffield, United Kingdom.
(6)Faculty of Health Studies, University of Bradford, Bradford, United Kingdom.

INTRODUCTION: Psychological wellbeing in university students is receiving 
increased focus. However, to date, few longitudinal studies in this population 
have been conducted. As such, in 2019, we established the Student Wellbeing At 
Northern England Universities (SWANS) cohort at the University of York, United 
Kingdom aiming to measure student mental health and wellbeing every six months. 
Furthermore, the study period included the COVID-19 pandemic, giving an 
opportunity to track student wellbeing over time, including over the pandemic.
METHODS: Eligible participants were invited to participate via email. Data were 
collected, using Qualtrics, from September 2019 to April 2021, across five waves 
(W1 to W5). In total, n = 4,622 students participated in at least one wave of 
the survey. Data collection included sociodemographic, educational, personality 
measures, and mental health and wellbeing. Latent profile analyses were 
performed, exploring trajectories of student wellbeing over the study period for 
those who had completed at least three of the five waves of the survey 
(n = 765), as measured by the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS).
RESULTS: Five latent profile trajectories of student wellbeing were identified. 
Of these, the two latent classes with initially higher wellbeing scores had 
broadly stable wellbeing across time (total n = 505, 66%). Two classes had lower 
initial scores, which lowered further across time (total n = 227, 30%). 
Additionally, a fifth class of students was identified who improved 
substantially over the study period, from a mean WEMWBS of 30.4 at W1, to 49.4 
at W5 (n = 33, 4%). Risk factors for having less favourable wellbeing 
trajectories generally included identifying as LGBT+, self-declaring a 
disability, or previously being diagnosed with a mental health condition.
CONCLUSION: Our findings suggest a mixed picture of the effect of the COVID-19 
pandemic on student wellbeing, with a majority showing broadly consistent levels 
of wellbeing across time, a smaller but still substantial group showing a 
worsening of wellbeing, and a small group that showed a very marked improvement 
in wellbeing. Those from groups traditionally underrepresented in higher 
education were most at risk of poorer wellbeing. This raises questions as to 
whether future support for wellbeing should target specific student 
subpopulations.

Copyright © 2023 Paton, Tiffin, Barkham, Bewick, Broglia, Edwards, Knowles, 
McMillan and Heron.

DOI: 10.3389/fpubh.2023.1188690
PMCID: PMC10387533
PMID: 37529437 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


479. Soc Sci Med. 2023 Sep;332:116101. doi: 10.1016/j.socscimed.2023.116101. Epub 
2023 Jul 18.

Impact of the expanded child tax credit and its expiration on adult 
psychological well-being.

Cha E(1), Lee J(1), Tao S(2).

Author information:
(1)Columbia University, 1255 Amsterdam Avenue, New York, NY, 10027, USA.
(2)Columbia University, 1255 Amsterdam Avenue, New York, NY, 10027, USA. 
Electronic address: st3331@columbia.edu.

The COVID-19 pandemic has exacerbated stress and psychological distress among 
adults with children, with certain populations experiencing a greater mental 
health burden. The expanded Child Tax Credit (CTC) under the 2021 American 
Rescue Plan Act provided temporary relief to families with children through 
monthly payments from July through December 2021, offering a unique opportunity 
to examine the impact of a near-universal cash transfer on adult psychological 
well-being in the United States. We use the Household Pulse Survey Waves 28-41 
(April 14, 2021 to January 10, 2022) to analyze the CTC expansion and Waves 
34-42 (July 21, 2021 to February 7, 2022) to examine the expiration of the 
expanded CTC to investigate the effects of the expanded CTC and its expiration 
on psychological distress of adults in households with children and its 
differential effects by gender, education, marital status, and race and 
ethnicity (N = 167,772). We employ a difference-in-difference methodology by 
leveraging the policy-induced variation in the additional credits that 
households are eligible for. Our results indicate that the expanded CTC led to a 
significant reduction in the percentage of having at least mild symptoms of 
psychological distress in the overall sample, especially among female, single, 
married, and Hispanic adults. No significant effects were found on the rate of 
moderate or severe psychological distress symptoms, suggesting that more severe 
forms of psychological distress may require more comprehensive and long-term 
interventions. We find that more adults experienced moderate to severe 
psychological distress after the monthly CTC payments ended. We discuss the role 
of the expanded CTC in buffering mental health crises during the pandemic and 
the implications of the heterogeneous policy effects by subgroups.

Copyright © 2023 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.socscimed.2023.116101
PMID: 37527567 [Indexed for MEDLINE]


480. J Pediatr Hematol Oncol. 2023 Oct 1;45(7):e857-e860. doi: 
10.1097/MPH.0000000000002726. Epub 2023 Jul 27.

The Psychosocial Impact of the COVID-19 Pandemic on Families of Children With 
Cancer in the Low-income Setting.

Khalil D(1), Alyoussef R, Al Hosni H, Idriss S, Ahmad A, Al Rooh S, Ghanem KM.

Author information:
(1)BASMA Pediatric Oncology Unit, Damascus, Syria.

The coronavirus disease 2019 (COVID-19) pandemic has had a profound effect on 
families' psychosocial well-being worldwide. This study aimed to investigate the 
pandemic's impact on families of children with cancer in a low-income setting in 
Syria. The study conducted a cross-sectional survey of 50 families of children 
with cancer receiving treatment at a nongovernmental organization-based 
pediatric oncology unit in Syria. The survey used the Corona Anxiety Scale (CAS) 
to assess the pandemic's impact on families' anxiety, and other items to 
evaluate the financial toxicity of the strict measures implemented during the 
pandemic's first months. The study's results revealed that the COVID-19 pandemic 
significantly negatively impacted the psychosocial well-being of families of 
children with cancer in Syria. Specifically, 22% of families reported a major 
increase in anxiety levels (CAS of >9), and the majority of families (84%) 
reported excessive indirect financial costs, including travel and living 
expenses. The study emphasizes the significant social and psychological impact 
of the COVID-19 pandemic on families of children with cancer in Syria, 
highlighting the need for additional psychosocial interventions to mitigate 
future global health crises or pandemics' impact on this vulnerable population. 
The interventions should prioritize promoting resilience and adaptive coping 
strategies.

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/MPH.0000000000002726
PMID: 37526410 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


481. BMJ Open. 2023 Jul 31;13(7):e068633. doi: 10.1136/bmjopen-2022-068633.

Assessment of COVID-19 management and its consequences on healthcare 
professionals: a cross-sectional study from Bangladesh.

Ara T(1), Ferdous Z(2), Mahi M(3), Amin E(4), Chowdhury SB(5), Shafiur Rahman 
M(6), Rahman L(1), Rahman MM(7).

Author information:
(1)Institute of Statistical Research and Training, University of Dhaka, Dhaka, 
Bangladesh.
(2)Institute of Health Economics, University of Dhaka, Dhaka, Bangladesh.
(3)Mathematics and Natural Sciences, BRAC University, Dhaka, Bangladesh.
(4)Institute of Epidemiology Disease Control and Research, Dhaka, Bangladesh.
(5)Department of Economics, University of Chittagong, Chittagong, Bangladesh.
(6)National Institute of Preventive and Social Medicine, Dhaka, Bangladesh.
(7)Health Systems and Population Studies Division, International Centre for 
Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh mrahman4@isrt.ac.bd.

OBJECTIVE: This explorative study aims to identify the gaps in COVID-19 
management and their consequences on physicians in terms of contracting 
infection and psychological well-being during the early phase of the pandemic.
DESIGN, SETTINGS AND PARTICIPANTS: We conducted a nationwide cross-sectional 
online study to collect information from 420 intern doctors who were at their 
internship in government medical colleges from February to August 2020.
METHODS: We performed univariate and bivariate analyses to assess COVID-19 
management. We investigated the consequences of COVID-19 management on infection 
risk, experiencing stress, developing anxiety, depression and sleep disturbance 
using five sets of multivariable logistic regression analyses.
RESULTS: Findings indicate a delay in first-case detection and identify people's 
tendency to hide COVID-19 symptoms as one of the possible causes of that delay. 
About 56% of the intern doctors experienced that patients were trying to hide 
COVID-19 symptoms in the earlier phase of the pandemic. More than half of the 
respondents did not get any training on COVID-19 from their working 
institutions. About 30% and 20% of the respondents did not use personal 
protective equipment (PPE) and masks while treating patients. Respondents who 
treated patients without PPE, masks, face shields and gloves were almost two 
times as likely to be infected by COVID-19. The odds of experiencing 
COVID-19-related stress was almost twofold among respondents who treated 
patients without wearing PPE and masks. Experiencing COVID-19-related stress was 
further associated with an increased risk of developing anxiety and depression 
that led to sleep disturbance.
CONCLUSION: Ensuring the maximum utilization of limited resources during any 
public health crisis such as COVID-19 needs developing coping mechanisms by 
projecting future demand. Ensuring proper training and safety measures can 
reduce physical and psychological hazards among physicians.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2022-068633
PMCID: PMC10391835
PMID: 37524557 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


482. PLoS One. 2023 Jul 31;18(7):e0289294. doi: 10.1371/journal.pone.0289294. 
eCollection 2023.

Cohort profile: The Corona Behavioral Unit cohort, a longitudinal mixed-methods 
study on COVID-19-related behavior, well-being and policy support in the 
Netherlands.

van den Boom W(1), van Dijk M(1), Snijders B(1), Luijben G(1), van der Laan 
J(1), Euser S(1), Sanders JG(1), Buitenhuis AH(1), Spruijt P(1), Kroese F(1)(2), 
Lambooij M(1)(3), Muhren Y(1), Tak N(4), van der Swaluw K(1)(5), van Rossum 
C(1), Nielen T(1), Elberse J(1), Renes RJ(6), Leurs M(1), de Bruin M(1)(7).

Author information:
(1)National Institute for Public Health and the Environment (RIVM), Bilthoven, 
The Netherlands.
(2)University of Utrecht, Utrecht, The Netherlands.
(3)Erasmus School of Health Policy and Management, Erasmus University, 
Rotterdam, The Netherlands.
(4)GGD GHOR Nederland, Utrecht, The Netherlands.
(5)Radboud University, Nijmegen, The Netherlands.
(6)Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
(7)Radboud University Medical Center, Institute of Health Sciences, IQ 
Healthcare, Nijmegen, The Netherlands.

This 'cohort profile' aims to provide a description of the study design, 
methodology, and baseline characteristics of the participants in the Corona 
Behavioral Unit cohort. This cohort was established in response to the COVID-19 
pandemic by the Dutch National Institute for Public Health and the Environment 
(RIVM) and the regional public health services. The aim was to investigate 
adherence of and support for COVID-19 prevention measures, psychosocial 
determinants of COVID-19 behaviors, well-being, COVID-19 vaccination, and media 
use. The cohort also examined specific motivations and beliefs, such as for 
vaccination, which were collected through either closed-ended items or open text 
responses. In April 2020, 89,943 participants aged 16 years and older were 
recruited from existing nation-wide panels. Between May 2020 and September 2022, 
99,676 additional participants were recruited through online social media 
platforms and mailing lists of higher education organizations. Participants who 
consented were initially invited every three weeks (5 rounds), then every six 
weeks (13 rounds), and since the summer of 2022 every 12 weeks (3 rounds). To 
date, 66% of participants were female, 30% were 39 years and younger, and 54% 
completed two or more questionnaires, with an average of 9.2 (SD = 5.7) 
questionnaires. The Corona Behavioral Unit COVID-19 cohort has published 
detailed insights into longitudinal patterns of COVID-19 related behaviors, 
support of COVID-19 preventive measures, as well as peoples' mental wellbeing in 
relation to the stringency of these measures. The results have informed COVID-19 
policy making and pandemic communication in the Netherlands throughout the 
COVID-19 pandemic. The cohort data will continuously be used to examine COVID-19 
related outcomes for scientific analyses, as well as to inform future pandemic 
preparedness plans.

Copyright: © 2023 van den Boom et al. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0289294
PMCID: PMC10389736
PMID: 37523360 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


483. Front Public Health. 2023 Jul 13;11:1136031. doi: 10.3389/fpubh.2023.1136031. 
eCollection 2023.

The psychological impact of COVID-19 pandemic and associated factors among 
college and university students in Ethiopia: a systematic review and 
meta-analysis, 2022.

Anteneh RM(1), Dessie AM(1), Azanaw MM(1), Anley DT(1), Melese BD(1), Feleke 
SF(2), Abebe TG(1), Muche AA(3).

Author information:
(1)Department of Public Health, College of Health Science, Debre Tabor 
University, Debre Tabor, Ethiopia.
(2)Department Public Health, College of Health Science, Woldia University, 
Woldia, Ethiopia.
(3)Department of Epidemiology and Biostatistics, Institute Public Health, 
College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.

BACKGROUND: The Corona virus disease 19 (COVID-19) pandemic is a human tragedy 
that occurred in this era. It poses an unprecedented psychological, social, 
economic, and health crisis. The mental health and well-being of entire 
societies are suffering as a result of this crisis, but the suffering is greater 
in students at all levels of education and must be addressed immediately. Thus, 
this study was aimed to estimate the pooled prevalence and associated factors of 
the psychological impact of COVID-19 among higher education students.
METHODS: The potential studies were searched via PubMed, HINARI, the Cochrane 
Library, and Google Scholar. Studies were appraised using the Joanna Briggs 
Institute appraisal checklist. Micro Soft Excel was used to extract the data, 
which was then exported to Stata version 14 for analysis. Heterogeneity between 
studies was tested using Cochrane statistics and the I2 test, and small-study 
effects were checked using Egger's statistical test. A random-effects model was 
employed to estimate the pooled prevalence of the psychological impact of 
COVID-19 and its associated factor.
RESULTS: After reviewing 227 studies, eight fulfilled the inclusion criteria and 
were included in the meta-analysis. The pooled prevalence of the psychological 
impact of Corona virus disease 19 among higher education students in Ethiopia, 
including depression, anxiety, and stress was 43.49% (95% CI: 29.59, 57.40%), 
46.27% (95% CI: 32.77, 59.78%), and 31.43% (95% CI: 22.71, 40.15), respectively. 
Having a medical illness, being an urban resident, living with parents, having 
relative death due to pandemics, and having a non-health field of study were 
identified as significant associated factors for the impact of the pandemic in 
higher education students.
CONCLUSION: The COVID-19 pandemic had a significant psychological impact on 
college and university students. Depression, anxiety, and stress were the most 
commonly reported psychological impacts across studies among higher education 
students. Hence, applying tele-psychotherapy using, smartphones, and social 
media platforms has an effect on reducing the impact. Programs for preventing 
and controlling epidemics should be developed by the government and higher 
education institutions that incorporate mental health interventions and build 
resilience.

Copyright © 2023 Anteneh, Dessie, Azanaw, Anley, Melese, Feleke, Abebe and 
Muche.

DOI: 10.3389/fpubh.2023.1136031
PMCID: PMC10374415
PMID: 37521996 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


484. Stress. 2023 Nov;26(1):2234060. doi: 10.1080/10253890.2023.2234060.

Psychological, endocrine and polygenic predictors of emotional well-being during 
the COVID-19 pandemic in a longitudinal birth cohort.

Nguyen T(1), Zillich L(2), Cetin M(2), Hall ASM(2), Foo JC(2)(3), Sirignano 
L(2), Frank J(2), Send TS(1), Gilles M(1), Rietschel M(2), Deuschle M(1), Witt 
SH(2), Streit F(2).

Author information:
(1)Department of Psychiatry and Psychotherapy, Central Institute of Mental 
Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
(2)Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental 
Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
(3)Institute for Psychopharmacology, Central Institute of Mental Health, Medical 
Faculty Mannheim, University of Heidelberg, Mannheim, Germany.

The COVID-19 pandemic severely affected the lives of families and the well-being 
of both parents and their children. Various factors, including prenatal stress, 
dysregulated stress response systems, and genetics may have influenced how the 
stress caused by the pandemic impacted the well-being of different family 
members. The present work investigated if emotional well-being during the 
COVID-19 pandemic could be predicted by developmental stress-related and genetic 
factors. Emotional well-being of 7-10 year-old children (n = 263) and mothers 
(n = 241) (participants in a longitudinal German birth cohort (POSEIDON)) was 
assessed during the COVID-19 pandemic using the CRISIS questionnaire at two time 
periods (July 2020-October 2020; November 2020-February 2021). Associations of 
the children's and mothers' well-being with maternal perceived stress, of the 
children's well-being with their salivary and morning urine cortisol at 
45 months, and polygenic risk scores (PRSs) for depression, schizophrenia, 
loneliness were investigated. Lower emotional well-being was observed in both 
children and mothers during compared to before the pandemic, with the children's 
but not the mothers' emotional well-being improving over the course of the 
pandemic. A positive association between the child and maternal emotional 
well-being was found. Prenatally assessed maternal perceived stress was 
associated with a lower well-being in children, but not in mothers. Cortisol 
measures and PRSs were not significantly associated with the children's 
emotional well-being. The present study confirms that emotional well-being of 
children and mothers are linked, and were negatively affected by the COVID-19 
pandemic, with differences in development over time.

DOI: 10.1080/10253890.2023.2234060
PMID: 37519130 [Indexed for MEDLINE]


485. Curr Opin Psychol. 2023 Oct;53:101654. doi: 10.1016/j.copsyc.2023.101654. Epub 
2023 Jun 30.

Daily experiences and adolescent affective wellbeing during the COVID-19 
pandemic: The CHESS model.

McMahon TP(1), Villaume SC(2), Adam EK(3).

Author information:
(1)Institute for Innovations in Developmental Sciences, Northwestern University, 
USA.
(2)School of Education and Social Policy, and Institute for Policy Research, 
Northwestern University, USA.
(3)School of Education and Social Policy, and Institute for Policy Research, 
Northwestern University, USA. Electronic address: ek-adam@northwestern.edu.

The COVID-19 pandemic resulted in adolescents' increased exposure to daily 
experiences of risk factors for depression and anxiety (e.g., loneliness). 
Intensive longitudinal studies examining daily experiences during the pandemic 
have revealed short-term and long-term consequences on youth mental health. 
Although evidence suggests small average increases in adolescent depression and 
anxiety, most of the story is in variability: increases are higher for youth and 
families with greater pre-existing mental health vulnerabilities and fewer 
socioeconomic resources, whereas increases are lower when social or financial 
support and positive coping and health behaviors are available and employed. 
Public health and economic policies should be mindful of youth mental health 
risks and actively promote known mental health supports, including family 
economic resources, access to mental healthcare, and social connection.

Copyright © 2023 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.copsyc.2023.101654
PMCID: PMC10592260
PMID: 37517164 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


486. Psychiatry Res. 2023 Sep;327:115359. doi: 10.1016/j.psychres.2023.115359. Epub 
2023 Jul 23.

Psychological impact of six weeks of strict home confinement in Spanish families 
having school-aged children with attention-deficit/hyperactivity disorder.

Fernández-Martín P(1), Madueño P(2), Cánovas R(2), Flores P(3).

Author information:
(1)Department of Psychology, Faculty of Psychology, University of Almeria, 
Almería, Spain; Health Research Center (CEINSA), University of Almeria, Almería, 
Spain.
(2)Neurorehabilitation and Autonomy Center Imparables, Almería, Spain.
(3)Department of Psychology, Faculty of Psychology, University of Almeria, 
Almería, Spain; Health Research Center (CEINSA), University of Almeria, Almería, 
Spain; Neurorehabilitation and Autonomy Center Imparables, Almería, Spain. 
Electronic address: pflores@ual.es.

After the COVID-19 outbreak, early publications reported worsening symptoms and 
increased caregiver burden in families having children with 
Attention-Deficit/Hyperactivity Disorder (ADHD). In the present study, we 
launched an online survey to examine the psychological impact of the 41 days of 
strict home confinement implemented in Spain in families having children with 
ADHD compared to families having children with typical development (TD). We 
achieved a representative sample of 190 school-aged children (NADHD =100 and 
NTD=90) from 181 families. Respondents were mainly mothers (≈96%). We found that 
mother reports of hyperactive-impulsive symptoms significantly increased during 
home confinement regardless of ADHD diagnosis. During the lockdown, we also 
found that perceived stress significantly increased in mothers of ADHD and TD 
children, but, unexpectedly, this increase was much more noticeable for the 
latter group. Moreover, our study suggests that children having parents working 
in frontline jobs or living in families with higher household conflicts might 
display increased ADHD symptoms during the lockdown, irrespective of ADHD 
diagnosis. Our results highlight the need to provide psychological support to 
families most exposed to the pandemic and target household problems and mothers' 
well-being at intervention processes, in both ADHD and TD families.

Copyright © 2023. Published by Elsevier B.V.

DOI: 10.1016/j.psychres.2023.115359
PMID: 37516038 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
report there are no competing interests to declare.


487. J Infect Dev Ctries. 2023 Jul 27;17(7):911-921. doi: 10.3855/jidc.17368.

SARS-CoV-2 pandemic and beyond: The impact of the SARS-CoV-2 pandemic on Turkish 
youth and their attitude toward future prospects.

Turkmen L(1), Tekedere H(1).

Author information:
(1)Department of Medical Laboratory, Vocational High School of Health Services, 
Gazi University, Ankara, Turkey.

INTRODUCTION: The impact of SARS-CoV-2 is intergenerational, and although it 
affects everyone differently, its effects on young people have been systematic, 
violent, and disproportionate compared to many social groups. This study aims to 
understand the impact of the SARS-CoV-2 pandemic on Turkish youth and their 
attitude toward future prospects.
METHODOLOGY: This cross-sectional study was carried out between March 15 and May 
20, 2022, with young people aged 18-29 living in Turkey. The data was collected 
using an online survey tool. In descriptive statistical analyses, categorical 
variables were presented as frequency and percentage, and continuous variables 
as mean (M) and standard deviation (SD). The independent samples t-test and the 
one-way analysis of variance (ANOVA) were used to test between-group differences 
in continuous variables.
RESULTS: In total, 696 participants responded to the online survey. For the 
majority of Turkish young people, SARS-CoV-2 has not impacted their physical 
health (55.7%) and mental health (57.8 %). In contrast, youth believe that the 
SARS-CoV-2 pandemic will negatively or strongly affect their future in terms of 
educational opportunities (58.7%), job prospects (58.6%), physical (58.1%), or 
mental health well-being (56.9%), economic stability (65.1%), financial 
stability (65.1%), and their overall future (58.2%).
CONCLUSIONS: Our findings pointed to adverse effects that would last longer than 
the pandemic. Priority should be given to strategies that reduce the long-term 
impact of the pandemic on young people and provide them with a sense of optimism 
that the future they desire is still achievable.

Copyright (c) 2023 Lale Turkmen, Hakan Tekedere.

DOI: 10.3855/jidc.17368
PMID: 37515791 [Indexed for MEDLINE]

Conflict of interest statement: No Conflict of Interest is declared


488. J Adv Nurs. 2024 Jan;80(1):237-251. doi: 10.1111/jan.15773. Epub 2023 Jul 28.

"Like fighting a fire with a water pistol": A qualitative study of the work 
experiences of critical care nurses during the COVID-19 pandemic.

Miller J(1), Young B(2), Mccallum L(3), Rattray J(4), Ramsay P(4), Salisbury 
L(5), Scott T(6), Hull A(7), Cole S(8), Pollard B(1), Dixon D(1)(9).

Author information:
(1)Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
(2)School of Health & Wellbeing, University of Glasgow, Glasgow, UK.
(3)Nursing & Health Care School, University of Glasgow, Glasgow, UK.
(4)School of Health Sciences, University of Dundee, Dundee, UK.
(5)School of Health Sciences, Queen Margaret University, Edinburgh, UK.
(6)Critical Care Unit, NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, UK.
(7)Institute of Medical Sciences, University of Dundee, Dundee, UK.
(8)Anaesthesia & Intensive Care Medicine, NHS Tayside, Ninewells Hospital, 
Dundee, UK.
(9)School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK.

AIM: To understand the experience of critical care nurses during the COVID-19 
pandemic, through the application of the Job-Demand-Resource model of 
occupational stress.
DESIGN: Qualitative interview study.
METHODS: Twenty-eight critical care nurses (CCN) working in ICU in the UK NHS 
during the COVID-19 pandemic took part in semi-structured interviews between May 
2021 and May 2022. Interviews were guided by the constructs of the Job-Demand 
Resource model. Data were analysed using framework analysis.
RESULTS: The most difficult job demands were the pace and amount, complexity, 
physical and emotional effort of their work. Prolonged high demands led to CCN 
experiencing emotional and physical exhaustion, burnout, post-traumatic stress 
symptoms and impaired sleep. Support from colleagues and supervisors was a core 
job resource. Sustained demands and impaired physical and psychological 
well-being had negative organizational consequences with CCN expressing 
increased intention to leave their role.
CONCLUSIONS: The combination of high demands and reduced resources had negative 
impacts on the psychological well-being of nurses which is translating into 
increased consideration of leaving their profession.
IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The full impacts of the 
pandemic on the mental health of CCN are unlikely to resolve without appropriate 
interventions.
IMPACT: Managers of healthcare systems should use these findings to inform: (i) 
the structure and organization of critical care workplaces so that they support 
staff to be well, and (ii) supportive interventions for staff who are carrying 
significant psychological distress as a result of working during and after the 
pandemic. These changes are required to improve staff recruitment and retention.
REPORTING METHOD: We used the COREQ guidelines for reporting qualitative 
studies.
PATIENT AND PUBLIC CONTRIBUTION: Six CCN provided input to survey content and 
interview schedule. Two authors and members of the study team (T.S. and S.C.) 
worked in critical care during the pandemic.

© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons 
Ltd.

DOI: 10.1111/jan.15773
PMID: 37515348 [Indexed for MEDLINE]


489. Medicina (Kaunas). 2023 Jul 19;59(7):1330. doi: 10.3390/medicina59071330.

Breastfeeding Practices and Postpartum Depression in Mexican Women during the 
COVID-19 Pandemic: A Cross-Sectional Study.

Chávez-Tostado M(1), Chávez-Tostado KV(2), Cervantes-Guevara G(3), 
Cervantes-Cardona G(4), Hernandez-Corona DM(5), González-Heredia T(5), 
Méndez-Del Villar M(5), Corona-Meraz FI(5), Guzmán-Ornelas MO(5), 
Barbosa-Camacho FJ(6), Álvarez-Villaseñor AS(7), Cervantes-Pérez E(8), 
Fuentes-Orozco C(9), Barrera-López NG(9), López-Bernal NE(9), González-Ojeda 
A(9).

Author information:
(1)Departamento de Reproducción, Centro Universitario de Ciencias de la Salud, 
Universidad de Guadalajara, Guadalajara 44410, Mexico.
(2)Departamento de Cirugía General y Endócrina, Hospital General Medio Ajusco, 
Ciudad de México 04510, Mexico.
(3)Departamento de Bienestar y Desarrollo Sustentable, Centro Universitario del 
Norte, Universidad de Guadalajara, Colotlán 46200, Mexico.
(4)Departamento de Disciplinas Filosóficas, Metodológicas e Instrumentales, 
Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, 
Guadalajara 44410, Mexico.
(5)Departamento de Ciencias Biomédicas, División de Ciencias de la Salud, Centro 
Universitario de Tonalá, Universidad de Guadalajara, Tonalá 45425, Mexico.
(6)Departamento de Psiquiatría, Hospital Civil Fray Antonio Alcalde, Universidad 
de Guadalajara, Guadalajara 44340, Mexico.
(7)Coordinación Auxiliar Médica de Investigación en Salud, Instituto Mexicano 
del Seguro Social, La Paz 23060, Mexico.
(8)Departamento de Medicina Interna, Hospital Civil de Guadalajara "Fray Antonio 
Alcalde", Universidad de Guadalajara, Guadalajara 44340, Mexico.
(9)Unidad de Investigación Biomédica 02, Hospital de Especialidades, Centro 
Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara 
44340, Mexico.

Background: Breastfeeding is a characteristic process of mammals that ensures 
delivery of an adequate nutritional supply to infants. It is the gold standard 
food source during an infant's first months of life. Since the onset of the 
COVID-19 pandemic in 2020, people in quarantine have experienced a wide range of 
feelings, which may make isolation challenging in terms of maternal health. This 
study focused on the prevalence of breastfeeding practices and postpartum 
depression (PPD) among Mexican women during the COVID-19 pandemic. Materials and 
Methods: This cross-sectional study included 586 postpartum women who completed 
an online survey 4-8 weeks after delivery from April to December 2020 in 
Guadalajara, Mexico. The aim was to identify potentially depressed mothers 
according to the Edinburgh Postnatal Depression Scale (EPDS) and describe their 
breastfeeding practices. Results: The mean maternal age was 30.4 ± 4.6 years, 
the mean EPDS score was 9.6 ± 5.0, and the PPD prevalence according EPDS scores 
was 27.1%. Exclusive breastfeeding (EBF) was reported by 32.3% of mothers in the 
first 48 h and by 70.3% of mothers 48 h after delivery. EBF was associated with 
a lower prevalence of PPD during the first 48 h (p = 0.015) and after the first 
48 h (p = 0.001) after delivery. Skin-to-skin contact (SSC) was reported by 385 
(65.7%) mothers. PPD was less frequent in mothers practicing SSC (20.3%) than it 
was in those not practicing SSC (40.3%) (p = 0.001). A higher percentage of 
mothers practiced SSC breastfed (66.9%) and used EBF (150, 79.4%) (p = 0.012 and 
0.001, respectively). Conclusions: Results suggest that the pandemic emergency 
and restrictions imposed on the population significantly affected the well-being 
of mothers after birth, and that these effects may have posed risks to the 
mental health and emotional stability of postpartum mothers. Therefore, 
encouraging BF or EBF and SSC may improve or limit depressive symptoms in 
postpartum mothers.

DOI: 10.3390/medicina59071330
PMCID: PMC10385480
PMID: 37512141 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


490. Int J Environ Res Public Health. 2023 Jul 22;20(14):6428. doi: 
10.3390/ijerph20146428.

Association of Emotional Self-Regulation with Psychological Distress and 
Positive Functioning Dimensions in Brazilian University Students during the 
COVID-19 Pandemic.

Rech M(1), Diaz GB(1), Schaab BL(1), Rech CGSL(1), Calvetti PÜ(1), Reppold 
CT(1).

Author information:
(1)Research Laboratory for Psychological Assessment, Federal University of 
Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil.

Emotional self-regulation is a relevant factor for human development capable of 
minimizing emotional difficulties in the face of adverse events, as was 
particularly useful during the COVID-19 pandemic. The present study aimed to 
evaluate emotional self-regulation in Brazilian health science university 
students and its relationship with positive psychology constructs (subjective 
well-being, hope, optimism, spirituality, self-compassion, and self-efficacy) 
and psychological distress (depression, anxiety, and stress). This was a 
prospective, cross-sectional, observational, analytic study of 1062 Brazilian 
undergraduate students with data collected using self-administered online 
questionnaires. Students in the first years of their undergraduate degree 
programs had significantly higher dysregulation scores than those in the final 
years. Multiple linear regression yielded a model that explained 71.8% of the 
variation in emotion dysregulation. The correlations of emotion dysregulation 
were significant and strong, scoring negatively with self-compassion, optimism, 
and subjective well-being and positively with psychological distress.

DOI: 10.3390/ijerph20146428
PMCID: PMC10379342
PMID: 37510660 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


491. Int J Environ Res Public Health. 2023 Jul 20;20(14):6407. doi: 
10.3390/ijerph20146407.

Can a Clinic-Based Community Health Worker Intervention Buffer the Negative 
Impact of the COVID-19 Pandemic on Health and Well-Being of Low-Income Families 
during Early Childhood.

Salaguinto T(1), Guzman Y(1), Lowry SJ(1), Liljenquist K(1)(2), LaFontaine R(2), 
Ortiz JE(3), Szilagyi PG(3), Fiscella K(4), Weaver MR(5), Coker TR(1)(2).

Author information:
(1)Seattle Children's Research Institute, Seattle Children's, Seattle, WA 98101, 
USA.
(2)Department of Pediatrics, School of Medicine, University of Washington, 
Seattle, WA 98109, USA.
(3)Department of Pediatrics, University of California, Los Angeles, CA 90095, 
USA.
(4)Department of Family Medicine, University of Rochester, Rochester, NY 14611, 
USA.
(5)Departments of Health Metrics Sciences & Global Health, University of 
Washington, Seattle, WA 98121, USA.

We examined changes in self-reported mental health, physical health, and 
emotional support among low-income parents with children ages 0-2 years old from 
pre-pandemic to pandemic periods and compared changes in parental health among 
parents who did versus did not have access to a clinic-based community health 
worker intervention supporting parents at early childhood preventive care 
visits. We utilized longitudinal parent survey data from pre-COVID-19 and 
COVID-19 time periods from both the intervention and control arms of an existing 
cohort of parents enrolled in a 10-clinic cluster randomized controlled trial 
(RCT). At enrollment (pre-pandemic) and 12-month follow-up (pandemic), 
participants reported on mental health, physical health, and emotional support 
using PROMIS measures (n = 401). During the pre-pandemic portion, control and 
intervention group parents had similar mean T-scores for mental health, physical 
health, and emotional support. At follow-up, mean T-scores for mental health, 
physical health, and emotional support decreased across both control and 
intervention groups, but intervention group parents had smaller declines in 
mental health T-scores (p = 0.005). Our findings indicate that low-income 
parents with young children suffered significant declines in mental and physical 
health and emotional support during the pandemic and that the decline in mental 
health may have been buffered by the community health worker intervention.

DOI: 10.3390/ijerph20146407
PMCID: PMC10379322
PMID: 37510639 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflict of interest 
relevant to this article to disclose.


492. Int J Environ Res Public Health. 2023 Jul 14;20(14):6361. doi: 
10.3390/ijerph20146361.

Contact with Nature in Social Deprivation during COVID-19: The Positive Impact 
on Anxiety.

Fornara F(1), Rinallo E(2), Scopelliti M(2).

Author information:
(1)Department of Education, Psychology, Philosophy, University of Cagliari, 
09123 Cagliari, Italy.
(2)Department of Human Studies, Libera Università Maria Ss. Assunta (LUMSA 
University), 00193 Rome, Italy.

The 2019 outbreak of the novel coronavirus disease (COVID-19) had a devastating 
impact on millions of people worldwide. Following the constantly changing course 
of the pandemic, the Italian government massively restricted public and private 
life to prevent the further spread of the virus. Unfortunately, lockdown 
policies negatively impacted many people's mental and physical health. Numerous 
studies recognized an essential role of urban green areas in promoting human 
well-being. The present study aims to evaluate the effect of personal 
dispositions towards nature, measured using the connectedness to nature scale 
(CNS) and actual contact with green spaces (CwN) on human well-being (i.e., 
anxiety) and medicine intake during COVID-19 lockdowns. A total of 637 Italian 
residents answered a survey aimed at gathering information about the above 
variables. A series of path analyses were performed. The results showed that the 
CNS was positively associated with the CwN, and the latter, in turn, was 
negatively associated with anxiety. Finally, anxiety was positively related to 
medicine intake. In sum, these results identify the positive role of 
person-nature relationships for individual well-being during COVID-19 
restrictions.

DOI: 10.3390/ijerph20146361
PMCID: PMC10379001
PMID: 37510593 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


493. J Gerontol Soc Work. 2024 Feb-Mar;67(2):143-156. doi: 
10.1080/01634372.2023.2237076. Epub 2023 Jul 27.

Social isolation, loneliness, and mental health among older adults during 
COVID-19: a scoping review.

Mushtaq A(1), Khan MA(1).

Author information:
(1)Department of Social Work, Aligarh Muslim University, Aligarh, India.

COVID-19 continues to have detrimental effects worldwide, especially on 
vulnerable populations. The burden of mental health concerns and psychological 
well-being resulting from social isolation and loneliness induced by COVID-19 
are increasingly recognized in old age. The aim is to determine the extent of 
social isolation and loneliness among older adults, the methodologies used, the 
effect on mental health during COVID-19, and review intervention strategies and 
lifestyle changes to improve the current situation through the recommendations 
of the studies included. The articles published on PubMed, ProQuest, and Scopus 
databases from December 2019 to December 2021 with the following keywords 
("Older Adults" "Social Isolation," "Loneliness," "Mental Health," "COVID-19") 
in English were included. Older adults have faced a serious burden of social 
isolation and adverse mental health effects during COVID-19. Anxiety, 
depression, stress, and insomnia are the major mental health concerns among 
older adults worldwide. It is suggested that spousal support and social 
networks, adaptive organizational change, and a responsive public sector are 
critical in reducing the obstacles to older adults. COVID-19 resilience among 
the aging population can be remarkable if adequately cared for with 
senior-friendly pandemic-related intervention strategies, policies and 
legislation.

DOI: 10.1080/01634372.2023.2237076
PMID: 37501381 [Indexed for MEDLINE]


494. BMC Pregnancy Childbirth. 2023 Jul 27;23(1):543. doi: 
10.1186/s12884-023-05846-5.

Do antenatal preparation and obstetric complications and procedures interact to 
affect birth experience and postnatal mental health?

Cross H(1)(2), Krahé C(1)(3), Spiby H(4), Slade P(5).

Author information:
(1)Department of Primary Care and Mental Health, Institute of Population Health, 
University of Liverpool, Liverpool, UK.
(2)Lancashire and South Cumbria NHS Foundation Trust, Blackpool, UK.
(3)School of Psychology, Liverpool John Moores University, Liverpool, UK.
(4)School of Health Sciences, University of Nottingham, Nottingham, UK.
(5)Department of Primary Care and Mental Health, Institute of Population Health, 
University of Liverpool, Liverpool, UK. ps1ps@liverpool.ac.uk.

BACKGROUND: Antenatal preparation is commonly offered to women in pregnancy in 
the United Kingdom, but the content is highly variable, with some programmes 
orientated towards 'normal birth', whilst others may incorporate information 
about complications and procedures (broader focus). However, the impact of this 
variability on birth experience has not been explored. We examined the 
relationship between the content of antenatal preparation received and birth 
experience, taking into account obstetric complications and procedures. As birth 
experience can have a profound impact on a mother's postnatal well-being, we 
also investigated associations with mothers' postnatal mood and anxiety.
METHODS: N = 253 first-time mothers completed a cross-sectional survey measuring 
demographic and clinical factors, antenatal preparation content (categorised as 
normality-focused or broader-focused), obstetric complications and procedures 
experienced, birth experience (measured using three separate indices; the 
Childbirth Experience Questionnaire, emotional experiences, and presence/absence 
of birth trauma), postnatal depression and anxiety, and qualitative information 
on how the COVID-19 pandemic had affected birth experience.
RESULTS: Regarding birth experience, receiving more broader-focused preparation 
was associated with a more positive birth experience irrespective of 
complications/procedures experienced, while receiving only normality-focused 
preparation was beneficial in the context of fewer complications/procedures. 
Regarding birth trauma, receiving more broader-focused preparation was 
associated with lower likelihood of reporting birth as traumatic only in the 
context of more complications/procedures. Degree of normality-focused 
preparation was unrelated to experience of birth trauma. Lastly, while more 
complications/procedures were associated with greater anxiety and low mood, only 
greater normality-focused preparation was linked with better postnatal mental 
health.
CONCLUSIONS: Antenatal preparation including both normality- and broader-focused 
information is positively related to women's birth experience. While 
normality-focused preparation seems most beneficial if fewer 
complications/procedures are experienced, broader-focused preparation may be 
most beneficial in the context of a greater number of complications/procedures. 
As complications/procedures are often unpredictable, offering broader-focused 
preparation routinely is likely to benefit women's birth experience. This 
antenatal preparation should be freely available and easily accessible.

© 2023. The Author(s).

DOI: 10.1186/s12884-023-05846-5
PMCID: PMC10375777
PMID: 37501081 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


495. PLoS One. 2023 Jul 27;18(7):e0288332. doi: 10.1371/journal.pone.0288332. 
eCollection 2023.

Benefit finding and well-being over the course of the COVID-19 pandemic.

Moore JB(1), Rubin KCR(1), Heaney CA(1)(2).

Author information:
(1)Stanford Prevention Research Center, Stanford School of Medicine, Stanford, 
California, United States of America.
(2)Department of Psychology, Stanford University, Stanford, California, United 
States of America.

This study focuses on understanding benefit finding, the process of deriving 
growth from adversity, and its relationship to well-being amidst the COVID-19 
pandemic. Participants (n = 701) completed online surveys at 1, 3, 6, and 12 
months after a shelter-in-place mandate was announced in California, USA. 
Identifying as female or of Asian descent, having a supportive social network, 
and reporting more distress were associated with higher levels of general 
benefit finding at all data collection points, while other demographics were 
not. Benefit finding exhibited small but statistically significant associations 
with two measures of well-being. Understanding the extent to which various 
groups of people experience benefit finding during ongoing adversity and how 
such benefit finding is associated with well-being may help to promote mental 
health during a collective trauma like the COVID-19 pandemic.

Copyright: © 2023 Moore et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0288332
PMCID: PMC10374125
PMID: 37498840 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


496. J Med Internet Res. 2023 Jul 27;25:e44079. doi: 10.2196/44079.

The Effectiveness and Cost-Effectiveness of a Universal Digital Parenting 
Intervention Designed and Implemented During the COVID-19 Pandemic: Evidence 
From a Rapid-Implementation Randomized Controlled Trial Within a Cohort.

Palmer M(1), Beckley-Hoelscher N(1), Shearer J(1), Kostyrka-Allchorne K(1), 
Robertson O(2), Koch M(1), Pearson O(1), Slovak P(1), Day C(1), Byford S(1), 
Goldsmith K(1), Waite P(2), Creswell C(2), Sonuga-Barke EJS(1).

Author information:
(1)Institute of Psychiatry, Psychology & Neuroscience, King's College London, 
London, United Kingdom.
(2)University of Oxford, Oxford, United Kingdom.

BACKGROUND: Children's conduct and emotional problems increased during the 
COVID-19 pandemic.
OBJECTIVE: We tested whether a smartphone parenting support app, Parent 
Positive, developed specifically for this purpose, reversed these effects in a 
cost-effective way. Parent Positive includes 3 zones. Parenting Boosters (zone 
1) provided content adapted from standard face-to-face parent training programs 
to tackle 8 specific challenges identified by parents and parenting experts as 
particularly relevant for parents during the pandemic. The Parenting Exchange 
(zone 2) was a parent-to-parent and parent-to-expert communication forum. 
Parenting Resources (zone 3) provided access to existing high-quality web-based 
resources on a range of additional topics of value to parents (eg, 
neurodevelopmental problems, diet, and sleep).
METHODS: Supporting Parents And Kids Through Lockdown Experiences (SPARKLE), a 
randomized controlled trial, was embedded in the UK-wide COVID-19: Supporting 
Parents, Adolescents and Children during Epidemics (Co-SPACE) longitudinal study 
on families' mental health during the pandemic. Parents of children aged 4 to 10 
years were randomized 1:1 to Parent Positive or follow-up as usual (FAU) between 
May 19, 2021, and July 26, 2021. Parent Positive provided advice on common 
parenting challenges and evidence-based web-based resources and facilitated 
parent-to-parent and expert-to-parent support. Child conduct and emotional 
problems and family well-being were measured before randomization (T1) and at 1 
(T2) and 2 (T3) months after randomization. Service use, costs, and adverse 
events were measured, along with app use and satisfaction. The primary outcome 
was T2 parent-reported child conduct problems, which were analyzed using linear 
mixed regression models.
RESULTS: A total of 320 participants were randomized to Parent Positive, and 326 
were randomized to FAU. The primary outcome analysis included 79.3% (512/646) of 
the participants (dropout: 84/320, 26% on Parent Positive and 50/326, 15% on 
FAU). There were no statistically significant intervention effects on conduct 
problems at either T2 (standardized effect=-0.01) or T3 (secondary outcome; 
standardized effect=-0.09) and no moderation by baseline conduct problems. 
Significant intervention-related reductions in emotional problems were observed 
at T2 and T3 (secondary outcomes; standardized effect=-0.13 in both cases). 
Parent Positive, relative to FAU, was associated with more parental worries at 
T3 (standardized effect=0.14). Few intervention-attributable adverse events were 
reported. Parent Positive was cost-effective once 4 outliers with extremely high 
health care costs were excluded.
CONCLUSIONS: Parent Positive reduced child emotional problems and was 
cost-effective compared with FAU once outliers were removed. Although small when 
considered against targeted therapeutic interventions, the size of these effects 
was in line with trials of nontargeted universal mental health interventions. 
This highlights the public health potential of Parent Positive if implemented at 
the community level. Nevertheless, caution is required before making such an 
interpretation, and the findings need to be replicated in large-scale, 
whole-community studies.
TRIAL REGISTRATION: ClinicalTrials.gov NCT04786080; 
https://clinicaltrials.gov/ct2/show/NCT04786080.

©Melanie Palmer, Nicholas Beckley-Hoelscher, James Shearer, Katarzyna 
Kostyrka-Allchorne, Olly Robertson, Marta Koch, Oliver Pearson, Petr Slovak, 
Crispin Day, Sarah Byford, Kimberley Goldsmith, Polly Waite, Cathy Creswell, 
Edmund J S Sonuga-Barke. Originally published in the Journal of Medical Internet 
Research (https://www.jmir.org), 27.07.2023.

DOI: 10.2196/44079
PMCID: PMC10415938
PMID: 37498669 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: CC receives royalties 
from the sale of books for parents and clinicians on managing child anxiety 
problems from LittleBrown and Guilford Press. CD is the lead developer and has a 
nonfinancial interest in a number of parenting programs including Empowering 
Parents Empowering Communities, Helping Families Programme, Family Partnership 
Model, and BabyCHAT. EJSSB was involved in the development of the New Forest 
Parent Programme, Families Under Pressure and Parent Positive. Receiving 
royalties for a book on the former. PW receives royalties from the sale of books 
for parents on helping their children overcome common psychological and 
emotional problems from LittleBrown. All other authors declare no conflicts of 
interest.


497. J Glob Health. 2023 Jul 28;13:04081. doi: 10.7189/jogh.13.04081.

Anxiety, concerns and COVID-19: Cross-country perspectives from families and 
individuals with neurodevelopmental conditions.

Sideropoulos V(#)(1), Van Herwegen J(#)(1), Meuleman B(2), Alessandri M(3), 
Alnemary FM(4), Rad JA(5), Lavenex PAB(6), Bolshakov N(7), Bölte S(8), Buffle 
P(9), Cai RY(10), Campos R(11), Chirita-Emandi A(12), Costa AP(13), Costanzo 
F(14), Des Portes V(15), Dukes D(16), Faivre L(17), Famelart N(18), Fisher 
MH(19), Gamaiunova L(20), Giannadou A(21), Gupta R(22), Hardan AY(23), 
Houdayer-Robert F(24), Hrncirova L(25), Iaochite RT(26), Jariabkova K(27), 
Klein-Tasman BP(28), Lavenex P(29), Malik S(30), Mari F(31), Martinez-Castilla 
P(32), Menghini D(14), Nuske HJ(33), Palikara O(34), Papon A(6), Pegg RS(35), 
Pouretemad H(36), Poustka L(37), Prosetzky I(38), Renieri A(31), Rhodes SM(39), 
Riby DM(40), Rossi M(41), Sadeghi S(36), Su X(42), Tai C(39), Tran M(6), Tynan 
F(43), Uljarević M(23), Van Hecke AV(44), Veiga G(45), Verloes A(46), Vicari 
S(47), Werneck-Rohrer SG(48), Zander E(8), Samson AC(6).

Author information:
(1)Department of Psychology and Human Development, IOE, UCL's Faculty of 
Education and Society, London, UK.
(2)Swiss Center for Affective Sciences, University of Geneva, Geneva, 
Switzerland.
(3)Department of Psychology, University of Miami, Coral Gables, Florida, USA.
(4)Autism Center of Excellence, Riyadh, Kingdom of Saudi Arabia.
(5)Department of Cognitive Modeling, Institute for Cognitive and Brain Sciences, 
Shahid Beheshti University, Tehran, Iran.
(6)Faculty of Psychology, UniDistance Suisse, Brig, Switzerland.
(7)Independent researcher.
(8)Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), 
Center for Psychiatry Research, Department of Women's and Children's Health, 
Stockholm, Sweden.
(9)Laboratory of Sensori-Motor Affective and Social Development, Faculty of 
Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.
(10)Aspect Research Centre for Autism Practice, Autism Spectrum Australia, 
Frenchs Forest, New South Wales, Australia.
(11)Department of Basic Psychology, Faculty of Psychology, Universidad Autónoma 
de Madrid, Madrid, Spain.
(12)Department of Microscopic Morphology - Genetics, Center of Genomic Medicine, 
University of Medicine and Pharmacy "Victor Babes" Timisoara, Timisoara, 
Romania.
(13)Department of Behavioural and Cognitive Sciences, University of Luxembourg, 
Luxembourg.
(14)Child and Adolescents Neuropsychiatry Unit, Bambino Gesù Children's 
Hospital, Rome, Italy.
(15)National Reference Center for Intellectual Disabilities of Rare causes, Lyon 
University Hospital, France.
(16)Institute of Special Education, University of Fribourg, Fribourg, 
Switzerland.
(17)Centre de Génétique et Centre de Référence Anomalies du Développement et 
Syndromes Malformatifs, FHU TRANSLAD, INSERM UMR1231, Hôpital d'Enfants, CHU 
Dijon, Dijon Cedex, France.
(18)Laboratory CLLE, University of Toulouse, CNRS, Toulouse, France.
(19)Department of Counselling, Educational Psychology, & Special Education, 
Michigan State University, East Lansing, Michigan, USA.
(20)Institute for Social Sciences of Religions, University of Lausanne, 
Lausanne, Switzerland.
(21)Cabinet office, London, UK.
(22)Cognitive and Behavioural Neuroscience Laboratory, Department of Humanities 
and Social Sciences, Indian Institute of Technology Bombay, Mumbai, Powai, 
Maharashtra, India.
(23)Department of Psychiatry and Behavioural Sciences, Stanford University, 
Stanford, California, USA.
(24)Genetics Department, Reference Centre for Developmental Disorders Centre 
East, Bron, France.
(25)Department of Special and Inclusive Education, Faculty of Education, Masaryk 
University, Brno, Czech Republic.
(26)Department of Education, Sao Paulo State University (UNESP), Rio Claro, 
Brazil.
(27)Institute for Research in Social Communication, Slovak Academy of Sciences, 
Bratislava, Slovakia.
(28)University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA.
(29)Laboratory of Brain and Cognitive Development, Institute of Psychology, 
University of Lausanne, Lausanne, Switzerland.
(30)eMbrace, New Delhi, India.
(31)Medical Genetics, University of Siena, Siena, Italy.
(32)Department of Developmental and Educational Psychology, Universidad Nacional 
de Educación a Distancia (UNED), Madrid, Spain.
(33)Penn Center for Mental Health, University of Pennsylvania Perelman School of 
Medicine, Philadelphia, Pennsylvania, USA.
(34)Department of Education Studies, Faculty of Social Sciences, University of 
Warwick, Warwick, UK.
(35)Williams Syndrome Association, Troy, Michigan, USA.
(36)Department of Cognitive Psychology, Institute for Cognitive and Brain 
Sciences, Shahid Beheshti University, Tehran, Iran.
(37)Department of Child and Adolescent Psychiatry and Psychotherapy, University 
Medical Centre Göttingen, Göttingen, Germany.
(38)Faculty of Social Sciences, University of Applied Sciences Zittau / Görlitz, 
Görlitz, Germany.
(39)Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
(40)Department of Psychology, Centre for Neurodiversity & Development, Durham 
University, Durham, UK.
(41)Service de génétique HCL, INSERM U1028, CNRS UMR5292, CRNL, GENDEV Team, 
UCBL1, Bron, France.
(42)Department of Early Childhood Education, Faculty of Education, East China 
Normal University, Shanghai, China.
(43)Faculty of Education, Mary Immaculate College, Limerick, Ireland.
(44)Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA.
(45)Comprehensive Health Research Centre (CHRC), Departamento de Desporto e 
Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, Évora, 
Portugal.
(46)Department of Genetics, APHP.NUP Robert DEBRE University Hospital, Paris, 
France.
(47)Department of Life Sciences and Public Health, Catholic University, Rome, 
Italy.
(48)Department of Child and Adolescent Psychiatry, Medical University of Vienna, 
Vienna, Austria.
(#)Contributed equally

BACKGROUND: The COVID-19 pandemic had a major impact on the mental health and 
well-being of children with neurodevelopmental conditions (NDCs) and of their 
families worldwide. However, there is insufficient evidence to understand how 
different factors (e.g., individual, family, country, children) have impacted on 
anxiety levels of families and their children with NDCs developed over time.
METHODS: We used data from a global survey assessing the experience of 8043 
families and their children with NDCs (mean of age (m) = 13.18 years, 37% 
female) and their typically developing siblings (m = 12.9 years, 45% female) in 
combination with data from the European Centre for Disease Prevention and 
Control, the University of Oxford, and the Central Intelligence Agency (CIA) 
World Factbook, to create a multilevel data set. Using stepwise multilevel 
modelling, we generated child-, family- and country-related factors that may 
have contributed to the anxiety levels of children with NDCs, their siblings if 
they had any, and their parents. All data were reported by parents.
RESULTS: Our results suggest that parental anxiety was best explained by 
family-related factors such as concerns about COVID-19 and illness. Children's 
anxiety was best explained by child-related factors such as children's concerns 
about loss of routine, family conflict, and safety in general, as well as 
concerns about COVID-19. In addition, anxiety levels were linked to the presence 
of pre-existing anxiety conditions for both children with NDCs and their 
parents.
CONCLUSIONS: The present study shows that across the globe there was a raise in 
anxiety levels for both parents and their children with NDCs because of COVID-19 
and that country-level factors had little or no impact on explaining differences 
in this increase, once family and child factors were considered. Our findings 
also highlight that certain groups of children with NDCs were at higher risk for 
anxiety than others and had specific concerns. Together, these results show that 
anxiety of families and their children with NDCs during the COVID-19 pandemic 
were predicted by very specific concerns and worries which inform the 
development of future toolkits and policy. Future studies should investigate how 
country factors can play a protective role during future crises.

Copyright © 2023 by the Journal of Global Health. All rights reserved.

DOI: 10.7189/jogh.13.04081
PMCID: PMC10373111
PMID: 37497751 [Indexed for MEDLINE]

Conflict of interest statement: Disclosure of interest: The authors completed 
the ICMJE Disclosure of Interest Form and declare the following activities and 
relationships: Dr Bölte discloses that he has in the last three years acted as 
an author, consultant, or lecturer for Medice and Roche. He receives royalties 
for textbooks and diagnostic tools from Hogrefe, Kohlhammer, Reinhardt and 
Liber. Bölte is a partner of NeuroSupportSolutions International AB. Dr Poustka 
served in an advisory or consultancy role for infectopharm and Roche and 
received speaker’s fee by Infectopharm, Takeda, and Medice. She received 
royalties from Hogrefe, Kohlhammer and Schattauer. Dr Zander receives royalties 
from Hogrefe. Dr Hardan served in an advisory or consultancy role for IAMA 
Therapeutics, Beaming Health, and As You Are. He also has equity in Quadrant 
BioSciences and I-SCAN.


498. J Psychiatr Res. 2023 Sep;165:123-131. doi: 10.1016/j.jpsychires.2023.06.037. 
Epub 2023 Jul 13.

The perceived impact of pandemic scale (PIPS): Initial development and 
examination among U.S. military veterans.

Kittel JA(1), Monteith LL(2), Tock JL(3), Schneider AL(3), Holliday R(4), Barnes 
SM(4), Hoffmire CA(5).

Author information:
(1)VA Rocky Mountain Mental Illness Research, Education and Clinical Center for 
Suicide Prevention, Aurora, CO, USA; University of Colorado Anschutz Medical 
Campus, Department of Physical Medicine and Rehabilitation, Aurora, CO, USA.
(2)VA Rocky Mountain Mental Illness Research, Education and Clinical Center for 
Suicide Prevention, Aurora, CO, USA; University of Colorado Anschutz Medical 
Campus, Department of Physical Medicine and Rehabilitation, Aurora, CO, USA; 
University of Colorado Anschutz Medical Campus, Department of Psychiatry, 
Aurora, CO, USA.
(3)VA Rocky Mountain Mental Illness Research, Education and Clinical Center for 
Suicide Prevention, Aurora, CO, USA.
(4)VA Rocky Mountain Mental Illness Research, Education and Clinical Center for 
Suicide Prevention, Aurora, CO, USA; University of Colorado Anschutz Medical 
Campus, Department of Psychiatry, Aurora, CO, USA.
(5)VA Rocky Mountain Mental Illness Research, Education and Clinical Center for 
Suicide Prevention, Aurora, CO, USA; University of Colorado Anschutz Medical 
Campus, Department of Physical Medicine and Rehabilitation, Aurora, CO, USA. 
Electronic address: claire.hoffmire@va.gov.

The COVID-19 pandemic has had significant impacts, including increases in mental 
health problems, distress, interpersonal conflict, unemployment, loss of income, 
housing instability, and food insecurity. Veterans may be particularly 
vulnerable to such impacts given their burden of mental and physical health 
problems. Few existing measures assess pandemic impact, and none have been 
validated for use with Veterans. We developed such a measure (the Perceived 
Impact of the Pandemic Scale; PIPS) and examined its psychometric performance in 
a national sample of US Veterans. Survey data from 567 Veterans were collected 
between 12/2020 and 2/2021. To examine PIPS factor structure, split sample 
exploratory/confirmatory factor analyses (EFA/CFA) were conducted to identify 
and test the most plausible model among an initial set of 18 items. Based on 
tests of factor extraction and factor loadings, 15 items clearly loaded onto 
three distinct factors. Internal reliability of all factors was ω > 0.8 and CFA 
model fit was good (χ2(87) = 167.39, p < .001; SRMR = 0.068; RMSEA = 0.060 [95% 
CI: 0.05, 0.07], CFI = 0.92). Mean factor scores were significantly positively 
correlated with measures of depression and loneliness, and negatively correlated 
with perceived social support. Results suggest the PIPS assesses three 
internally reliable factors comprised of perceived impact of the pandemic on 
interpersonal relationships, financial impact, and personal health and 
well-being. Construct validity with US Veterans was supported. The PIPS may be 
useful for examining the potentially disparate impact of pandemics on different 
populations. Research is needed to validate the PIPS in non-Veteran populations.

Copyright © 2023 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.jpsychires.2023.06.037
PMID: 37494749 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest All authors 
were employed by the VA while writing this manuscript. Authors have received 
grant funding from the VA Office of Mental Health and Suicide Prevention 
(Monteith, Hoffmire, Holliday, Schneider, Barnes), VA Health Services Research 
and Development (Monteith, Hoffmire, Holliday, Schneider), VA Rehabilitation 
Research and Development (Barnes), VA Office of Clinical Science Research and 
Development (Barnes), VA Office of Rural Health (Monteith, Schneider), VA 
National Center on Homelessness among Veterans (Holliday, Monteith), VA National 
Center for Patient Safety (Monteith, Hoffmire), VA Office of Women’s Health 
(Monteith), the National Institutes of Health (Brenner, Hoffmire, Holliday), the 
Department of Defense (Monteith, Hoffmire, Holliday), the American Psychological 
Association (Monteith, Holliday), and the State of Colorado (Hoffmire). The 
other authors (Kittel, Tock) report no conflicts of interest.


499. JAMA Psychiatry. 2023 Sep 1;80(9):962-967. doi: 
10.1001/jamapsychiatry.2023.2355.

Envisioning the Future of Well-Being Efforts for Health Care Workers-Successes 
and Lessons Learned From the COVID-19 Pandemic.

Mangurian C(1)(2)(3)(4), Fitelson E(5), Devlin M(5)(6), Pumar M(1), Epel E(1), 
Dahiya P(1), Mayer LES(5)(6), Jackson-Triche M(1).

Author information:
(1)Department of Psychiatry and Behavioral Sciences, University of California, 
San Francisco, San Francisco.
(2)Department of Biostatistics and Epidemiology, University of California, San 
Francisco, San Francisco.
(3)UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General 
Hospital, San Francisco, California.
(4)Philip R. Lee Institute for Health Policy Studies, University of California, 
San Francisco, San Francisco.
(5)Department of Psychiatry, Columbia University Irving Medical Center, New 
York, New York.
(6)New York State Psychiatric Institute, New York.

IMPORTANCE: The National Academy of Medicine's National Plan for Health 
Workforce Well-Being provides recommendations for supporting the mental health 
and well-being of health care workers. This article aims to guide implementation 
of National Academy of Medicine recommendations by describing 2 programs at 
Columbia University Irving Medical Center and the University of California, San 
Francisco (UCSF), designed early in the COVID-19 pandemic to respond to the 
behavioral health needs of the health care workforce. The development of these 
programs, their similarities and differences, and the key lessons learned are 
discussed.
OBSERVATIONS: The well-being programs, CopeColumbia and UCSF Cope, shared key 
elements. Both efforts were led by their respective departments of psychiatry 
and used similar frameworks. Teams created strategic cross-university 
partnerships to share difficulties and successes across both programs. Moreover, 
both programs addressed compounding stressors of racial and political unrest, 
evaluated program components, and created resources for employee 
self-management. CopeColumbia and UCSF Cope differed in approaches to 
identifying high-risk employees and formal assessment and treatment pathways. 
From the authors' experience implementing these programs and having knowledge 
regarding health care workforce burnout, this article offers recommendations for 
the development of well-being programs. These include structural changes and 
resources to promote group and individual well-being emphasizing equity and 
justice, intentional involvement of psychiatry on well-being leadership teams, 
and bold efforts to destigmatize mental health care alongside clear paths to 
mental health treatment.
CONCLUSIONS AND RELEVANCE: The impact of the COVID-19 pandemic revealed a need 
for institutions to support the mental health and emotional well-being of health 
care workers. By outlining the development and implementation of 2 well-being 
programs in large academic health care settings and making recommendations to 
promote workforce well-being, it is the authors' hope that leaders will be 
empowered to carry forward critical changes. Most importantly, implementing 
plans now will provide the resilience needed both for the long shadow of the 
pandemic and future crises.

DOI: 10.1001/jamapsychiatry.2023.2355
PMID: 37494012 [Indexed for MEDLINE]


500. Aust J Rural Health. 2023 Oct;31(5):914-920. doi: 10.1111/ajr.13025. Epub 2023 
Jul 25.

An exploration of mental health, stress and well-being concerns among health 
students undertaking rural placements in Australia during the early stages of 
the COVID-19 pandemic.

Podubinski T(1), Jessup B(2), Obamiro K(2)(3), Hoang H(2), Bourke L(1)(4).

Author information:
(1)Department of Rural Health, The University of Melbourne, Wangaratta, 
Victoria, Australia.
(2)Centre for Rural Health, The University of Tasmania, Launceston, Tasmania, 
Australia.
(3)Central Queensland Centre for Rural and Remote Health, James Cook University, 
Emerald, Queensland, Australia.
(4)Department of Rural Health, The University of Melbourne, Shepparton, 
Victoria, Australia.

INTRODUCTION: The emergence of COVID-19 in 2020 led to an increase in stressors 
for students on rural placements, but little is known about how this impacted 
their mental health and well-being.
OBJECTIVE: To explore self-reported mental health, stress and well-being 
concerns among allied health, nursing and medical students who completed a 
scheduled University Department of Rural Health (UDRH)-faciliated rural 
placement in Australia between February and October 2020 (n = 1066).
DESIGN: Cross-sectional design involving an online survey measuring mental 
health, stress and well-being concerns. The survey was distributed via email by 
the 16 UDRHs across Australia.
FINDINGS: A total of 42.9%, 63.8% and 41.1% of survey respondents reported 
concerns about their mental health, levels of stress and well-being, 
respectively, during the early stages of the pandemic. Multiple logistic 
regression models found clinical training, course progression and financial 
concerns were predictive of negative mental health, increased stress and reduced 
well-being, while feeling connected was predictive of positive mental health, 
reduced stress and increased well-being.
DISCUSSION: Universities, UDRHs and health placement sites all have a 
responsibility to support the mental health and well-being of students 
undertaking rural placements. This support needs to encompass strategies to 
reduce financial stress, protect learning opportunities and increase 
connectedness. Ensuring adequate resourcing and support for those providing 
rural placement opportunities will safeguard quality rural placements during 
times of pandemic disruption.

© 2023 The Authors. Australian Journal of Rural Health published by John Wiley & 
Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.

DOI: 10.1111/ajr.13025
PMID: 37491797 [Indexed for MEDLINE]


501. Hosp Pract (1995). 2023 Oct;51(4):211-218. doi: 10.1080/21548331.2023.2241342. 
Epub 2023 Aug 1.

Global well-being, anxiety, social isolation, and emotional support among 
hospitalists during COVID-19 and Mpox outbreaks.

Dugani SB(1)(2), Fischer KM(3), Schroeder DR(3), Geyer HL(4), Maniaci MJ(5), 
Paulson M(6), Croghan IT(2)(3)(7)(8), Burton MC(1).

Author information:
(1)Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA.
(2)Robert D. and Patricia E. Kern Center for the Science of Health Care 
Delivery, Mayo Clinic, Rochester, MN, USA.
(3)Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
(4)Division of Hospital Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA.
(5)Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA.
(6)Division of Hospital Internal Medicine, Mayo Clinic Health System, Eau 
Claire, WI, USA.
(7)Department of Medicine, Division of General Internal Medicine, Mayo Clinic, 
Rochester, MN, USA.
(8)Department of Medicine, Research Hub, Mayo Clinic, Rochester, MN, USA.

OBJECTIVE: The Coronavirus Disease-19 (COVID-19) pandemic caused a decline in 
hospitalist wellness. The COVID-19 pandemic has evolved, and new outbreaks (i.e. 
Mpox) have challenged healthcare systems. The objective of the study was to 
assess changes in hospitalist wellness and guide interventions.
METHODS: We surveyed hospitalists (physicians and advanced practice providers 
[APPs]), in May 2021 and September 2022, at a healthcare system's 16 hospitals 
in four US states using PROMIS® measures for global well-being, anxiety, social 
isolation, and emotional support. We compared wellness score between survey 
periods; in the September 2022 survey, we compared wellness scores between APPs 
and physicians and evaluated the associations of demographic and hospital 
characteristics with wellness using logistic (global well-being) and linear 
(anxiety, social isolation, emotional support) regression models.
RESULTS: In May 2021 vs. September 2022, respondents showed no statistical 
difference in top global well-being for mental health (68.4% vs. 57.4%) and 
social activities and relationships (43.8% vs. 44.3%), anxiety (mean difference: 
+0.8), social isolation (mean difference: +0.5), and emotional support (mean 
difference: -1.0) (all, p ≥ 0.05). In September 2022, in logistic regression 
models, APPs, compared with physicians, had lower odds for top (excellent or 
very good) global well-being mental health (odds ratio [95% CI], 0.31 
[0.13-0.76]; p < 0.05). In linear regression models, age <40 vs. ≥40 years was 
associated with higher anxiety (estimate ± standard error, 2.43 ± 1.05; 
p < 0.05), and concern about contracting COVID-19 at work was associated with 
higher anxiety (3.74 ± 1.10; p < 0.01) and social isolation (3.82 ± 1.21; 
p < 0.01). None of the characteristics showed association with change in 
emotional support. In September 2022, there was low concern for contracting Mpox 
in the community (4.6%) or at work (10.0%).
CONCLUSION: In hospitalists, concern about contracting COVID-19 at work was 
associated with higher anxiety and social isolation. The unchanged wellness 
scores between survey periods identified opportunities for intervention. Mpox 
had apparently minor impact on wellness.

DOI: 10.1080/21548331.2023.2241342
PMCID: PMC10775116
PMID: 37491767 [Indexed for MEDLINE]


502. J Int Med Res. 2023 Jul;51(7):3000605231182664. doi: 10.1177/03000605231182664.

Healthcare worker burnout during the first COVID-19 lockdown in Italy: 
experiences from an intensive neurological rehabilitation unit.

Luca R(1), Rifici C(1), Terranova A(1), Orecchio L(1), Castorina MV(1), Torrisi 
M(1), Cannavò A(2), Bramanti A(3), Bonanno M(1), Calabrò RS(1), Cola MC(1).

Author information:
(1)IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy.
(2)Azienda Universitaria Gaetano Martino, Messina, Italy.
(3)University of Salerno, Salerno, Italy.

OBJECTIVE: The study aim was to investigate the prevalence of behavioral 
symptoms and burnout in healthcare workers in an intensive neurological 
rehabilitation unit in Messina, Italy, during the first COVID-19 lockdown in 
Italy.
METHODS: Forty-seven healthcare workers (including neurologists, physiatrists, 
nurses and rehabilitation therapists) were enrolled in this cross-sectional 
study from February 2020 to June 2020. Participants were administered the 
following psychometric tests to investigate burnout and related symptoms: the 
Maslach Burnout Inventory, which measures emotional exhaustion, 
depersonalization and reduced personal accomplishment; the Zung Self-Rating 
Depression Scale (SDS); the Pre-Sleep Arousal Scale (PSAS); the Dyadic 
Adjustment Scale; and the Buss-Perry Aggression Questionnaire (BPAQ).
RESULTS: We found several correlations between test scores and burnout 
subdimensions. Emotional exhaustion was correlated with SDS (r = 0.67), 
PSAS-Cognitive (r = 0.67) and PSAS-Somatic (r = 0.70) scores, and moderately 
correlated with all BPAQ dimensions (r = 0.42). Depersonalization was moderately 
correlated with SDS (r = 0.54), PSAS-Cognitive (r = 0.53) and PSAS-Somatic 
(r = 0.50) scores.
CONCLUSION: During the first COVID-19 lockdown in Italy, healthcare workers were 
more exposed to physical and mental exhaustion and burnout. Research evaluating 
organizational and system-level interventions to promote psychological 
well-being at work for healthcare workers are needed.

DOI: 10.1177/03000605231182664
PMCID: PMC10369104
PMID: 37486238 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest in 
preparing this article.


503. Front Psychol. 2023 Jul 7;14:1200839. doi: 10.3389/fpsyg.2023.1200839. 
eCollection 2023.

Key predictors of psychological distress and wellbeing in Australian frontline 
healthcare workers during COVID-19 (Omicron wave).

Lee BEC(1), Ling M(1)(2), Boyd L(3), Olsson CA(1)(4)(5), Sheen J(1).

Author information:
(1)Centre for Social and Early Emotional Development, School of Psychology, 
Deakin University, Geelong, VIC, Australia.
(2)Neami National, Preston, VIC, Australia.
(3)Eastern Health, Box Hill, VIC, Australia.
(4)Department of Paediatrics, University of Melbourne, Parkville, VIC, 
Australia.
(5)Centre for Adolescent Health, Murdoch Children's Research Institute, 
Parkville, VIC, Australia.

INTRODUCTION: The COVID-19 pandemic has led to significant challenges for 
frontline healthcare workers' (FHW), raising many mental health and wellbeing 
concerns for this cohort. To facilitate identification of risk and protective 
factors to inform treatment and interventions, this study investigated key 
predictors of psychological distress and subjective wellbeing in FHWs.
METHODS: During the Omicron wave of the COVID-19 pandemic (January 2022), 
Victorian (Australia) doctors, nurses, allied health and non-medical staff from 
Emergency Departments, Intensive Care units, Aged Care, Hospital In The Home, 
and COVID Wards completed a cross-sectional survey consisting of the Kessler 6 
item (Psychological Distress), Personal Wellbeing Index (Subjective Wellbeing), 
Coronavirus Health Impact Survey tool (COVID-19 related factors) and 
occupational factors. Multivariable linear regressions were used to evaluate 
unadjusted and adjusted associations. Relative weight analysis was used to 
compare and identify key predictors.
RESULTS: Out of 167 participants, 18.1% screened positive for a probable mental 
illness and a further 15.3% screened positive for low wellbeing. Key risk 
factors for greater psychological distress included COVID infection worries, 
relationship stress and younger age. For both psychological distress and lower 
wellbeing, health status and supervisor support were key protective factors, 
while infection risks were key risk factors. Only positive changes in 
relationship quality was protective of lower wellbeing.
CONCLUSION: This study highlights the significance of social determinants and 
individual level factors alongside work related factors, in influencing FHWs' 
mental health and wellbeing during public health crises, such as the COVID-19 
pandemic. Findings suggest that future interventions and supports should take a 
more holistic approach that considers work, social and individual level factors 
when supporting FHWs' mental health and wellbeing.

Copyright © 2023 Lee, Ling, Boyd, Olsson and Sheen.

DOI: 10.3389/fpsyg.2023.1200839
PMCID: PMC10361570
PMID: 37484084

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


504. Front Public Health. 2023 Jul 6;11:1147967. doi: 10.3389/fpubh.2023.1147967. 
eCollection 2023.

The effects of COVID-19 on Central Florida's community gardens: lessons for 
promoting food security and overall community wellbeing.

Schanbacher WD(1), Cavendish JC(2).

Author information:
(1)Department of Religious Studies, University of South Florida, Tampa, FL, 
United States.
(2)Department of Sociology and Interdisciplinary Social Sciences, University of 
South Florida, Tampa, FL, United States.

For quite some time, food systems scholars, public health workers, and food 
justice activists have recognized structural problems in the global food system 
that can cause food insecurity and inequitable access to nutritious foods. The 
COVID-19 pandemic and the accompanying disruption in food supply chains (FSCs) 
exposed these problems and raised questions about how community gardening and 
urban agriculture might offer some solutions. In this article, we examine the 
effects of the pandemic on the operations of community gardens in Central 
Florida and the attempts of these gardens to address the disruption in food 
supplies in their local communities. We do so by using data drawn from two 
research strategies employed by the members of University of South Florida's 
Urban Food Sovereignty Group: (1) a survey conducted in 2021 of 45 leaders of 
community gardens throughout the Central Florida region; and (2) participation 
in the meetings and activities of a coalition of community gardens based in 
Tampa, Florida, from 2019 to 2022. Results reveal that although most community 
gardens in Central Florida were forced to change their routines in various ways 
(e.g., limiting the number of workers or volunteers who could work at the garden 
at the same time, or delivering workshops and education programs online instead 
of in-person), some gardens were able to maintain their regular operations and 
even reported increases in their membership or participation during the 
pandemic. Many community garden leaders also recognized the positive effect that 
community gardening seemed to have on their gardeners' mental health, noting 
that their gardens became places of refuge for gardeners who sought safe, 
outdoor spaces, to relieve stress and interact with their neighbors. These same 
leaders also observed the effect of the pandemic on residents' access to quality 
food, and intensified their efforts to provide more fresh food to pantries and 
traditional emergency food outlets. Survey respondents also shared important 
lessons they learned from the pandemic by suggesting that community gardens 
establish clear emergency protocols, use existing resources more efficiently, 
continue their educational programs, and strengthen their communications and 
cooperation with other gardens and actors in local food supply chains in order 
to ensure food security. We conclude by suggesting that one of the best ways 
that local communities can avert future food crises and strengthen their 
resilience is to root themselves more firmly in the principles of food 
sovereignty so they can sustain themselves when commercial FSCs are disrupted.

Copyright © 2023 Schanbacher and Cavendish.

DOI: 10.3389/fpubh.2023.1147967
PMCID: PMC10359818
PMID: 37483929 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


505. Work. 2024;77(1):49-59. doi: 10.3233/WOR-220507.

Occupational burnout and public stigma associated with employee mental 
well-being: A multi-industry, cross-sectional study during COVID-19.

Fannin A(1), Hooley C(2), Reeves CJ(3), Marçal K(4), Treglown R(5), Woerner 
R(5).

Author information:
(1)Industrial/Organizational Psychology, University of Tulsa, Tulsa, OK, USA.
(2)School of Social Work, Brigham Young University, Provo, UT, USA.
(3)Marriott School of Business, Brigham Young University, Provo, UT, USA.
(4)School of Social Work, Rutgers University, NewBrunswick, NJ, USA.
(5)Room Here, Lehi, UT, USA.

BACKGROUND: While mental illness (e.g., depression, anxiety) has been examined 
frequently in the workplace, the COVID-19 pandemic has only increased the 
attention towards mental illness. Mental well-being views mental health as a 
continuum from ill health to thriving. Few studies have examined factors 
associated with mental well-being in the workplace. Public stigma for mental 
illness, the general population's negative attitude towards mental illness, and 
occupational burnout are examined.
OBJECTIVE: The purpose of this study was to examine the relationship between 
burnout and public stigma on mental well-being in a sample of employees across 
industries in the United States.
METHODS: Employees surveyed from 16 companies from various industries were 
assessed. Room Here, a non-profit organization whose goal is to improve employee 
mental fitness, gathered data from these companies located in the western 
mountain region of the U.S. Data were collected during the pandemic. Across this 
portfolio of companies, 259 employees were included in the sample. Survey 
assesses respondents' mental well-being, stigma towards mental illness, and 
occupational burnout. Ordinary least squares (OLS) regression was used in this 
cross-sectional study on secondary data.
RESULTS: Results suggested occupational burnout was associated with a decrease 
in mental well-being, while public stigma was associated with an improvement in 
mental well-being.
CONCLUSION: This study sought to examine the relationship between mental 
well-being, burnout, and public stigma. Employee burnout and public stigma were 
related to mental well-being. Implications for burnout and stigma reduction 
programs are discussed as well as future research.

DOI: 10.3233/WOR-220507
PMID: 37483050 [Indexed for MEDLINE]


506. Work. 2024;77(1):37-47. doi: 10.3233/WOR-220394.

Teachers during COVID-19: Examining burnout levels and their work-life.

Rossi L(1), Zanetti M(1), Pasca MG(2).

Author information:
(1)Niccolò Cusano University, Rome, Italy.
(2)Tuscia University, Viterbo, Italy.

BACKGROUND: In March 2020, with the scope to reduce the spread of COVID-19, most 
national governments around the world canceled in-person education and moved to 
online learning. Therefore, teachers and students had to adapt a new way of 
teaching. Most of Italian teachers never had such an experience before and 
encountered difficulties in effectively carrying out this process on their own. 
Difficulties that can naturally increase anxiety and stress, leading, in 
situations perceived as extreme, to burnout syndrome.
OBJECTIVES: This paper endeavored to verify levels of job stress and burnout of 
Italian teachers caused by the COVID-19 pandemic using the validated Maslach 
Burnout Inventory-General. This study aimed to measure the association among the 
three main dimensions of burnout and the variables of teachers' personal and 
working lives that changed due to COVID-19.
METHOD: The aim of this paper was to verify burnout state and to measure the 
association among the three dimensions of burnout and the personal and working 
lives of Italian teachers using structural equation model analysis. The analysis 
was conducted in December 2021 and considered the situation in which the Italian 
teachers (from primary to middle and upper school) are working since March 2020.
RESULTS: The results showed that teachers were emotionally exhausted; they did 
not feel able to fully fulfill their task towards the students. This involved a 
high absenteeism, a lower quality of work performance and the impossibility of 
making an objective evaluation of the students with an inevitable flattening of 
the class level. In contrast, the study shows that teachers who experienced few 
problems had relatively low levels of burnout.
CONCLUSION: The findings brought out some proposals to reduce the risk of 
burnout and increase the individual well-being of schoolwork organization with 
positive effects on the lives of students: to strengthen social identity, to 
avoid a full-time online connection, to promote a psychological support service 
and to promote resilience training.

DOI: 10.3233/WOR-220394
PMID: 37483048 [Indexed for MEDLINE]


507. Aging Ment Health. 2024 Jan-Feb;28(1):103-111. doi: 
10.1080/13607863.2023.2236569. Epub 2023 Jul 23.

Mental health and self-rated health of older carers during the COVID-19 
pandemic: evidence from England.

Price D(1), Di Gessa G(2).

Author information:
(1)Department of Sociology, School of Social Sciences, University of Manchester, 
Manchester, UK.
(2)Institute of Epidemiology & Health Care, Department of Epidemiology & Public 
Health, University College London, London, UK.

OBJECTIVES: Older carers play a vital role supporting population health and 
protecting health and social care systems, yet there has been little research on 
understanding the effect of the pandemic on this group. In this paper, we 
investigate caring as a factor contributing to mental and self-rated health.
METHODS: We investigate cross-sectional and longitudinal associations between 
provision of family care and mental health and wellbeing using longitudinal data 
from 5,149 members of the English Longitudinal Study of Ageing who responded to 
Wave 9 (2018/2019) and two COVID-19 sub-studies (June/July 2020; 
November/December 2020). We use logistic or linear regression models depending 
on outcome measures, controlling for pre-pandemic socioeconomic, demographic, 
and health-related variables.
RESULTS: Before the pandemic, 21% of respondents cared for family or friends. 
Older people caring for someone inside the household mostly continued to provide 
care during the pandemic, with more than a quarter reporting an increase in the 
amount of care provided. Co-resident carers were disproportionately female, 
older, in the lowest wealth quintile, and more likely to report disability and 
chronic conditions. Both cross-sectional and longitudinal analyses suggest that, 
compared to those caring for people living outside the household, co-resident 
carers were significantly more likely to report poorer mental health and 
self-rated health.
CONCLUSION: The health of older carers worsened disproportionately in the first 
year of the pandemic, a period also characterised by disruptions to support and 
closure of respite services. Support for carers' mental and physical health 
requires greater policy attention, especially in pandemic conditions.

DOI: 10.1080/13607863.2023.2236569
PMCID: PMC10803633
PMID: 37482075 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


508. BMJ Open. 2023 Jul 21;13(7):e074887. doi: 10.1136/bmjopen-2023-074887.

Exploring physical and biological manifestations of burnout and post-traumatic 
stress disorder symptoms in healthcare workers: a scoping review protocol.

Kottler J(1), Gingell MJ(2), Khosla S(3), Kordzikowski M(2), Raszewski R(4), 
Chestek D(3), Maki K(5).

Author information:
(1)Department of Emergency Medicine, University of Illinois Hospital & Health 
Sciences System, Chicago, Illinois, USA jjubas2@uic.edu.
(2)Department of Population Health Nursing Science, College of Nursing, 
University of Illinois Chicago, Chicago, Illinois, USA.
(3)Department of Emergency Medicine, University of Illinois Hospital & Health 
Sciences System, Chicago, Illinois, USA.
(4)Library of the Health Sciences Chicago, University of Illinois at Chicago, 
Chicago, Illinois, USA.
(5)Translational Biobehavioral and Health Disparities Branch, National 
Institutes of Health Clinical Center, Bethesda, Maryland, USA.

Update of
    medRxiv. 2023 Apr 19;:

INTRODUCTION: The COVID-19 pandemic has strained the mental and physical 
well-being of healthcare workers (HCW). Increased work-related stress and 
limited resources have increased symptoms of anxiety, depression, insomnia and 
post-traumatic stress disorder (PTSD) in this population. Stress-related 
disorders have been strongly associated with long-term consequences, including 
cardiometabolic disorders, endocrine disorders and premature mortality. This 
scoping review aims to explore available literature on burnout, PTSD, and other 
mental health-associated symptoms in HCW to synthesise relationships with 
physiological and biological biomarkers that may be associated with increased 
risk of disease, creating an opportunity to summarise current biomarker 
knowledge and identify gaps in this literature.
METHODS AND ANALYSIS: This scoping review uses the Arksey and O'Malley six-step 
scoping review methodology framework. The research team will select appropriate 
primary sources using a search strategy developed in collaboration with a health 
sciences librarian. Three reviewers will initially screen the title and 
abstracts obtained from the literature searches, and two reviewers will conduct 
independent reviews of full-text studies for inclusion. The research team will 
be reviewing literature focusing on which burnout and/or PTSD-associated 
physiological and biological biomarkers have been studied, the methodologies 
used to study them and the correlations between the biomarkers and HCW 
experiencing burnout/PTSD. Data extraction forms will be completed by two 
reviewers for included studies and will guide literature synthesis and analysis 
to determine common themes.
ETHICS AND DISSEMINATION: This review does not require ethical approval. We 
expect results from this scoping review to identify gaps in the literature and 
encourage future research regarding improving biological and physiological 
biomarker research in HCW. Preliminary results and general themes will be 
communicated back to stakeholders. Results will be disseminated through 
peer-reviewed publications, policy briefs and conferences as well as presented 
to stakeholders to an effort to invest in HCW mental and physical health.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2023-074887
PMCID: PMC10364163
PMID: 37479518 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


509. BMJ Open. 2023 Jul 21;13(7):e073660. doi: 10.1136/bmjopen-2023-073660.

Effects of virtual reality for psychological health of ICU patients: a study 
protocol for systematic review and meta-analysis.

Zou J(1), Chen Q(1), Wang J(1), Gu M(1), Jiang X(1), Mao M(2).

Author information:
(1)Department of Nursing, Changshu No 1 People's Hospital, Changshu, Jiangsu, 
China.
(2)Department of Nursing, Changshu No 1 People's Hospital, Changshu, Jiangsu, 
China wahh13@126.com.

INTRODUCTION: Virtual reality (VR) has been shown to have a certain influence on 
the psychological health of intensive care unit (ICU) patients. However, its 
specific effects-particularly on psychological health problems, such as 
psychological well-being, quality of life (QOL) and patient satisfaction-remain 
unclear.
METHOD AND ANALYSIS: This study follows the Preferred Reporting Items for 
Systematic Review and Meta-analysis Protocols guidelines. Electronic data search 
is carried out on PubMed, Web of Science, CINAHL, EBSCO, EMBASE, Cochrane 
Library, PsycINFO, China National Knowledge Infrastructure, Wan Fang, VIP and 
Chinese Biology Medicine Database. The inclusion criteria follow the PICO 
principle, wherein ICU patients who have been hospitalised for 24 hours or more 
are included. Studies using VR-based interventions to improve the psychological 
health of ICU patients, compared with waitlist controls or traditional therapy 
groups; outcome assessments containing psychological well-being, QOL and patient 
satisfaction; and those designed as randomised controlled trials (RCTs) and 
quasi-experimental research are included. Search time is from inception of each 
database to July 2023. No language restriction is considered. Studies for 
inclusion are screened by two independent reviewers for data extraction. Any 
dispute is resolved through discussion. Unresolved disputes are decided on by 
consulting a third author. For the risk of bias assessment in RCTs and non-RCTs, 
the Cochrane risk-of-bias tool for randomised trials and risk of bias in 
non-randomised studies of interventions tool are used, respectively. For 
meta-analysis, RevMan V.5.3 is used.
ETHICS AND DISSEMINATION: This protocol study does not include clinical research 
and thus does not require ethical approval. Research findings will be released 
in a peer-reviewed journal.
PROSPERO REGISTRATION NUMBER: CRD42023400428.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2023-073660
PMCID: PMC10364162
PMID: 37479513 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


510. PLoS One. 2023 Jul 21;18(7):e0288609. doi: 10.1371/journal.pone.0288609. 
eCollection 2023.

Respected but stigmatized: Healthcare workers caring for COVID-19 patients.

Spruijt I(1), Cronin A(1), Udeorji F(1), Nazir M(1), Shehu S(1), Poix S(1), 
Villanueva A(2), Jansen N(1), Huitema I(1), Suurmond J(3), Fiekert K(1).

Author information:
(1)KNCV Tuberculosis Foundation, The Hague, The Netherlands.
(2)KNCV Tuberculosis Foundation, Manila, The Philippines.
(3)Department Social Science, Amsterdam Public Health Institute, University 
Medical Centre Amsterdam, Amsterdam, The Netherlands.

BACKGROUND: Healthcare workers (HCWs) caring for Corona Virus Disease 2019 
(COVID-19) patients are at increased risk of being stigmatized, which 
compromises their individual mental well-being and the quality of care they 
deliver. Stigma-reduction interventions may (partly) prevent this. However, 
there is a lack of in-depth understanding of the experiences and underlying 
causes of COVID-19 stigma among HCWs, which is needed to design such 
interventions. We conducted in-depth semi-structured interviews to assess 
COVID-19 stigma among COVID-19 HCWs in Ireland, Nigeria, The Netherlands, 
Pakistan, and The Philippines.
METHODS: We used a purposive and snowball sampling to recruit a total of 53 HCWs 
for online interviews (13 in Ireland; 15 in Nigeria; 6 in The Netherlands; 6 in 
Pakistan; and 13 in The Philippines (2021). After verbatim transcribing 
interviews, we used a thematic approach for data analysis.
RESULTS: In all countries, stigmatization of COVID-19 HCWs is driven by fear of 
infection and the perception of HCWs being carriers of the disease amplified by 
them wearing of scrubs and personal protective equipment. There were differences 
between countries in the way stigma manifested in self- anticipated and 
experienced stigma like scolding, discrimination, avoidance, (self-) isolation, 
and exclusion in public, in the community, at work, and in the household. The 
stigma resulted in feelings of depression, loneliness, isolation, and the desire 
to quit one's job.
DISCUSSION: COVID-19 HCWs from all countries experienced all forms of 
stigmatization related to their work as a COVID-19 frontliner. This affected 
their mental well-being, which in turn affects job performance and quality of 
care, there is a high need to develop stigma reduction tools for HCWs.

Copyright: © 2023 Spruijt et al. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0288609
PMCID: PMC10361490
PMID: 37478112 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


511. Int Arch Occup Environ Health. 2023 Nov;96(9):1235-1244. doi: 
10.1007/s00420-023-02002-6. Epub 2023 Jul 20.

Changes in anxiety and depression among public health workers during the 
COVID-19 pandemic response.

Stone KW(1), Jagger MA(2), Horney JA(3), Kintziger KW(4).

Author information:
(1)Department of Health and Human Performance, Middle Tennessee State 
University, Murfreesboro, TN, 37132, USA.
(2), Austin, TX, 78746, USA.
(3)Epidemiology Program, University of Delaware, 100 Discovery Blvd, Room 731, 
Newark, DE, 19713, USA. horney@udel.edu.
(4)Department of Environmental, Agricultural, and Occupational Health, College 
of Public Health, University of Nebraska Medical Center, Omaha, NE, 68198, USA.

OBJECTIVES: The COVID-19 pandemic has negatively impacted mental health 
indicators, leading to an increase in symptoms of anxiety and depression in both 
the general population of adults and children and many occupational groups. This 
study aims to examine changes in anxiety and depression among a cohort of public 
health workers in the U.S. during the first year of the COVID-19 pandemic and 
identify potential risk factors.
METHODS: Longitudinal data were collected from a sub-sample (N = 85) of public 
health workers in 23 U.S. states who completed two surveys in 2020 and 2021. 
Information on background characteristics, personal well-being, and work 
environment as well as validated scales to assess generalized anxiety disorder 
(GAD), depressive disorder, and burnout was collected. Data were analyzed using 
Stata Version 17, and significant differences were determined using Pearson's 
Chi2 and Fisher's Exact tests.
RESULTS: The proportion of those reporting GAD (46.3% to 23.2%) or depression 
(37.8% to 26.8%) improved from Survey 1 to Survey 2 overall; symptoms of anxiety 
saw the largest improvement. Persistent depression was associated with sustained 
burnout, changes in social support, and days worked per week.
CONCLUSION: Public health workers experienced elevated levels of anxiety and 
depression during the initial pandemic response, but a reduction in these 
symptoms was observed in the subsequent year after vaccines had become widely 
available. However, unmet needs remain for ongoing workplace mental health 
supports to address burnout, as well as for additional emotional supports 
outside of work for public health professionals.

© 2023. The Author(s).

DOI: 10.1007/s00420-023-02002-6
PMCID: PMC10560145
PMID: 37474659 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no interests, 
financial or otherwise, that are directly or indirectly related to the work 
submitted for publication.


512. J Sport Exerc Psychol. 2023 Jul 19;45(4):224-233. doi: 10.1123/jsep.2022-0262. 
Print 2023 Aug 1.

The Relationship of Resilience, Self-Compassion, and Social Support to 
Psychological Distress in Women Collegiate Athletes During COVID-19.

Mikesell M(1), Petrie TA(2), Chu TLA(3), Moore EWG(4).

Author information:
(1)Premier Sport Psychology, Edina, MN,USA.
(2)University of North Texas, Denton, TX,USA.
(3)University of Wisconsin Green Bay, Green Bay, WI,USA.
(4)Wayne State University, Detroit, MI,USA.

Given how COVID-19 had caused significant increases in collegiate athletes' 
psychological distress, we examined the extent to which such distress may have 
been ameliorated by the athletes' psychosocial resources (e.g., resilience). We 
used structural equation modeling to examine the direct and indirect 
relationships of resilience, self-compassion, and social support to women 
collegiate athletes' (N = 3,924; 81.2% White) psychological distress; athletes 
completed measures of these constructs from mid-April to mid-May 2020. Analyses 
revealed significant direct effects: More supported (β = -0.12 to -0.19), 
self-compassionate (β = -0.48 to -0.53), and resilient (β = -0.21 to -0.35) 
athletes experienced less psychological distress (R2 = .61-.65). Further, 
self-compassion and social support were related indirectly (and inversely) to 
psychological distress through higher levels of resilience. These psychosocial 
resources appear to have played a positive role in how athletes coped with the 
pandemic, being associated with less psychological distress. These findings have 
application beyond the pandemic, providing direction for how sport psychology 
professionals may assist athletes in maintaining their well-being.

DOI: 10.1123/jsep.2022-0262
PMID: 37474120 [Indexed for MEDLINE]


513. Gen Hosp Psychiatry. 2023 Sep-Oct;84:125-141. doi: 
10.1016/j.genhosppsych.2023.07.001. Epub 2023 Jul 15.

Impact of COVID-19 on health of menopausal women: A scoping review.

Wu X(1), Wong KW(1), Gurvich C(2), Dong Y(3).

Author information:
(1)Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, 
National University of Singapore, Singapore.
(2)Faculty of Medicine, Nursing and Health Sciences, Monash University, 
Australia.
(3)Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, 
National University of Singapore, Singapore. Electronic address: 
nurdy@nus.edu.sg.

OBJECTIVE: This scoping review aims to map and summarize the direct impact of 
contracting COVID-19, and the indirect consequences of the pandemic on the 
health of peri- and postmenopausal women.
METHODS: Searches for published studies were conducted in CINAHL, Cochrane, 
EMBASE, PubMed, Scopus, Web of Science, PsycINFO and ProQuest from inception to 
26 Oct, 2022. Grey literature and reference lists of included studies were 
searched. Results are presented as a narrative synthesis and tables.
RESULTS: Thirty-eight studies were selected in this review. Overall, a majority 
of studies (n = 31) suggest that menopausal women were negatively impacted, 
while lesser studies (n = 21) concluded that they were not and some studies 
(n = 14) produced both negative and neutral results. Twenty-three studies 
presented on the direct health impact of COVID-19 infections on menopausal 
women. Eleven studies focused on the indirect impact of COVID-19 in terms of 
contact restriction measures on menopausal health during the pandemic compared 
to before the pandemic. Six studies described the different indirect impact of 
COVID-19 on health of menopausal women with various characteristics or 
lifestyles.
CONCLUSION: The direct and indirect impacts of COVID-19 on menopausal women on 
physical, mental health and social wellbeing are largely negative.

Copyright © 2023. Published by Elsevier Inc.

DOI: 10.1016/j.genhosppsych.2023.07.001
PMID: 37473503 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no competing interests.


514. PLoS One. 2023 Jul 20;18(7):e0288358. doi: 10.1371/journal.pone.0288358. 
eCollection 2023.

Coping with the COVID-19 pandemic: A cross-sectional study to investigate how 
mental health, lifestyle, and socio-demographic factors shape students' quality 
of life.

Bou-Hamad I(1), Hoteit R(2), Hijazi S(3), Ayna D(4), Romani M(5), El Morr C(6).

Author information:
(1)Department of Business Information and Decision Systems, Suliman S. Olayan 
School of Business, American University of Beirut, Beirut, Lebanon.
(2)Department of Internal Medicine, Clinical Research Institute, American 
University of Beirut, Beirut, Lebanon.
(3)Faculty of Social Sciences, Lebanese University, Saida, Lebanon.
(4)Faculty of Medicine, Department of Psychiatry, American University of Beirut 
Medical Center, Beirut, Lebanon.
(5)Faculty of Medicine, Department of Family Medicine, American University of 
Beirut Medical Center, Beirut, Lebanon.
(6)School of Health Policy and Management, York University, Toronto, Canada.

PURPOSE: The high prevalence of COVID-19 has had an impact on the Quality of 
Life (QOL) of people across the world, particularly students. The purpose of 
this study was to investigate the social, lifestyle, and mental health aspects 
that are associated with QOL among university students in Lebanon.
METHODS: A cross-sectional study design was implemented using a convenience 
sampling approach. Data collection took place between November 2021 and February 
2022, involving 329 undergraduate and graduate students from private and public 
universities. Quality of life was assessed using the Quality-of-Life Scale 
(QOLS). Descriptive statistics, Cronbach's alpha, and linear regression-based 
methods were used to analyze the association between QOL and socio-demographic, 
health-related, lifestyle, and mental health factors. The significance level for 
statistical analysis was predetermined at α = 0.05.
RESULTS: The study participants' average (SD) QOL score was 76.03 (15.6) with a 
Cronbach alpha of 0.911. QOL was positively associated with importance of 
religion in daily decisions (β = 6.40, p = 0.006), household income (β = 5.25, p 
= 0.017), general health ratings (β Excellent/poor = 23.52, p <0.001), access to 
private counseling (β = 4.05, p = 0.020), physical exercise (β = 6.67, p 
<0.001), and a healthy diet (β = 4.62, p = 0.026); and negatively associated 
with cigarette smoking (β increased = -6.25, p = 0.030), internet use (β ≥4 
hours = -7.01, p = 0.005), depression (β = -0.56, p = 0.002) and stress (β = 
-0.93, p <0.001).
CONCLUSION: In conclusion, this study reveals the key factors that positively 
and negatively influence students' quality of life (QOL). Factors such as 
religion, higher income, and a healthy diet improve QOL, while depression, 
stress, excessive internet use, and cigarette smoking negatively impact it. 
Universities should prioritize initiatives like physical activity promotion, 
affordable nutritious options, destigmatizing mental health, counseling 
services, and self-help interventions to support student well-being and enhance 
their QOL.

Copyright: © 2023 Bou-Hamad et al. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0288358
PMCID: PMC10358926
PMID: 37471388 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


515. J Cancer Res Ther. 2023 Apr-Jun;19(3):713-719. doi: 10.4103/jcrt.jcrt_1348_21.

Psychological impact of COVID-19 pandemic on cancer patients: A cross-sectional 
study.

Abrol D(1), Chandel RK(2), Ali M(2), Bhagat S(2), Sharma VK(1).

Author information:
(1)Department of Radiation Oncology, Government Medical College, Kathua, Jammu 
and Kashmir, India.
(2)Department of Psychiatry, Government Medical College, Kathua, Jammu and 
Kashmir, India.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has globally impacted not only 
physical wellbeing but also the mental aspects in a far more extensive manner. 
The prevalence of psychological issues in cancer patients is much higher than in 
the general population, and the same has been impacted more during the COVID-19 
pandemic. The purpose of this study was to estimate the psychological impact of 
COVID-19 on the mental health of cancer patients with no prior history of any 
form of mental disease.
METHODOLOGY: A cross-sectional study of both inpatients and outpatients 
undergoing treatment and follow-up for different forms of cancer was conducted, 
and patients were assessed for perceived risk, anxiety, and depression.
RESULTS: Among the total of 150 participants, 31.8% of patients reported fear 
and concern. The major concern was regarding fear of treatment delay and fear of 
getting lonely. Over the prevalence of anxiety disorder with a cut-off score of 
≥10 based on Generalized Anxiety Disorder-7 and Patient Depression Health 
Questionnaire-9 were 34% and 24%, respectively. Patient with female gender, 
married, being treated for ovarian cancer and who does not have metastatic 
changes were more anxious. Depressive symptoms were more in female patients, 
those who are married, and in the group with treatment delay due to COVID-19.
CONCLUSION: There is urgent need for psychological intervention among cancer 
patients as there is an increase in mental health problems in this special group 
due to COVID-19 pandemic.

DOI: 10.4103/jcrt.jcrt_1348_21
PMID: 37470599 [Indexed for MEDLINE]

Conflict of interest statement: None


516. Hu Li Za Zhi. 2023 Aug;70(4):4-6. doi: 10.6224/JN.202308_70(4).01.

[Changing Mindsets to Create a New Mental Health Nursing Care Landscape].

[Article in Chinese; Abstract available in Chinese from the publisher]

Yang CI(1).

Author information:
(1)PhD, RN, Professor, Department of Nursing, Hungkuang University, Taiwan, ROC. 
arcoyang@mail2000.com.tw.

Perception of change is a real and profound out come of the recently ended 
COVID-19 pandemic. The course of this pandemic was unpredictable and subject to 
change with no clear end in sight. Thus, "uncertainty" became the only certainty 
in daily life. The realities of the pandemic necessitated that changes and 
adjustments be made in our physical, psychological, and emotional states as well 
as life and work styles, which tested everyone's resilience. Change interpreted 
through Buddha Siddhartha's "Theory of Dependent Origination" is normal and to 
be expected. The Buddha believed all "conditioned dharmas" in the world (things 
that can be seen with form) were not created from nothing and could not exist 
alone. Instead, they must have been formed through a combination of various 
causal conditions and, once these conditions disappear, must return again to 
nothingness. Thus, "All dharmas arise due to conditions, and all dharmas cease 
due to conditions (Sina Buddhism, 2017)". Because of this, the Buddha believed 
all things and all phenomena to be impermanent and changing (Master Sheng Yen, 
2002). According to the Buddha, change is normal and impermanence is permanent. 
As such, the practice of mental healthcare has not been passively changed by the 
epidemic, but has always been changing continuously and proactively. The process 
of treating and restoring to health in patients with mental illness is actually 
a long and arduous journey, and mental health nurses play a very important role 
throughout this long process of recovery. We abandon the traditional treatment 
and care model that only focuses on mental disorders and symptoms, and instead 
adopt the concept of holistic healthcare (Mandal et al., 2020), which focuses on 
patient physical, psychological, social and spiritual aspects, helping them 
achieve whole person wellness (Swanson et al., 2019). Each patient should be 
regarded as a unique individual not only in terms of their disease diagnosis, 
symptoms, physical and mental states, understanding, and communications but also 
in terms of their socioeconomic status, family support, and social resources. 
Because of this, nursing care plans should not be institutionalized or 
mechanistic, but rather allow flexibility to address each patient's current 
condition. Through comprehensive and integrated care and consultation and 
interdisciplinary teamwork, the psychiatric and mental health nurses work hard 
to ensure every patient and family member who receives care is satisfied in 
terms of their physical, psychological, social, and spiritual needs. Another 
aspect of change is the adoption by mental health nurses of a more active, more 
professional, larger pattern, and broader vision of their professional services. 
After all, mental patients may not necessarily fully understand their needs. As 
mental health professionals, we can develop our professional sensitivity. 
Moreover, while devoting ourselves to helping patients move towards holistic 
health and providing holistic care for patients, we should also try our best to 
detect and pay attention to whether current mental-health-related policies, 
medical system norms, or usual modes of operation may be ignoring patient needs 
or increasing the obstacles encountered in the rehabilitation process. In 
addition, we should try to seek strategies to change the situation, advocate for 
the health and well-being of patients, and improve the quality and effectiveness 
of overall mental healthcare. In this issue, four professors respectively 
discuss issues related to mental health policy, clinical practice, community 
rehabilitation and employment support, and the expansion of the professional 
role and service field of mental health nursing. These authors share how the 
field and functions of mental healthcare can change and evolve along a positive 
path forward. They not only provide direction and light but also show the 
results of their efforts.

Publisher: TITLE: 改變思維，創造精神衛生護理新格局.
變，是我們在過去這一段新冠疫情肆虐期間最真實深刻的體認，疫情不僅詭譎多變，還一度看不到盡頭。那段時間，「不確定性」成了唯一可以確定的日常。因應疫情變化，我們個人的身體、心理、情緒狀態、生活及工作型態都做了某種程度的改變和調整，非常考驗大家的應變能力。事實上，變，如果用佛陀悉達多的根本思想「緣起論」來理解，是乎是再正常不過，佛陀認為，世間上一切有為法（有形、有相可看的事物），都非憑空而有，也不能單獨存在，必須依靠種種因緣條件和合而成，一旦組成的因緣消失，事物本身也就歸於烏有，正所謂「諸法因緣生，諸法因緣滅」（新浪佛學，2017）。正因如此，佛陀認為所有一切事物和一切現象，都是無常變化的，也稱之為「諸行無常」（聖嚴法師，2002）。依佛陀觀點，變是正常，無常為常。而精神衛生護理的實踐，不是被動於疫情而變，而是早就持續在變，主動的變。精神科病人的治療及復原，其實是一條艱辛漫長的路，精神衛生護理專業人員在病人冗長的復健過程中，扮演著一個非常重要的角色。我們摒棄傳統只關注精神障礙與症狀的治療照護模式，而改採全人照護（holistic 
health care）的概念，關注病人的生理、心理、社會及心靈各層面（Mandal et al., 2020），幫助病人朝向全人健康（whole-person 
wellness）的方向而努力（Swanson et al., 
2019）。每個精神病人都被視為一個獨立個體，不僅是疾病診斷、症狀、身心狀態，理解及溝通方式，其社經地位、家庭支持與社會資源也都各有差異，在治療過程中病人遇到種種困難等也不同。正因如此，我們照護的方式與做法，不能是機構式、機械式的僵化，而需要視病人狀況，因人、因病制宜。在醫療照護的過程中，透過全方位及整合性的照護與諮詢，跨專業團隊合作，讓每個接受照護的病人甚至其家屬，在生理、心理、社會以及靈性各層面需求，都能獲得滿足。另一種變，是精神衛生專業護理人員更主動、更專業，格局更大、視野更遠的變。畢竟，精神病人不一定清楚理解自己的需求是什麼，作為精神衛生護理專業人員，我們可以培養我們的專業敏感細胞，在致力於幫助病人朝向全人健康，提供病人全人照護的同時，也不忘努力察覺，注意現行精神衛生相關政策或醫療體制的規範，以及專業人員慣有的運作模式，是否可能導致某些病人的需求被忽略，或者在復健過程中可能遇到更大的阻礙，接著設法謀求因應策略以改變現況，為病人健康福祉倡議，提升整體精神衛生照護品質與成效。本期專欄有四位教授，分別就精神衛生政策、臨床實務、社區復健與就業支持、以及精神衛生護理專業角色與服務場域之拓展，依據個人經驗與觀點，分享了精神衛生護理專業領域和專業角色，可以如何朝著正向的道路改變與進化，他們不僅提供了方向，指引了明燈，也展現了他們努力的成果。.

DOI: 10.6224/JN.202308_70(4).01
PMID: 37469314 [Indexed for MEDLINE]


517. BMC Public Health. 2023 Jul 19;23(1):1390. doi: 10.1186/s12889-023-16260-z.

A systematic review of the impact of the COVID-19 pandemic on the mental health 
of adolescents and young people with disabilities aged 15-29 years.

Leung XY(1), Kavanagh AM(1), Quang QT(1), Shields M(1), Aitken Z(2).

Author information:
(1)Melbourne School of Population and Global Health, The University of 
Melbourne, Parkville, Australia.
(2)Melbourne School of Population and Global Health, The University of 
Melbourne, Parkville, Australia. zoe.aitken@unimelb.edu.au.

BACKGROUND: The COVID-19 pandemic has exacerbated the psychological burden on 
young people around the world and may have disproportionately large impacts for 
young people with disabilities. This review aims to systematically review the 
quantitative evidence on the impact of the COVID-19 pandemic on the mental 
health of young people with disabilities and evaluate the quality of included 
studies.
METHODS: A systematic search was conducted using 5 electronic databases. The 
quality of the studies was assessed using the SIGN risk of bias assessment tool. 
A narrative synthesis was performed to synthesize the results of included 
studies.
RESULTS: The initial search yielded 1935 studies, of which two met the 
eligibility criteria, one longitudinal study and one cross-sectional study, both 
assessed to be of low quality. In the cross-sectional study, young people with 
intellectual and developmental disabilities self-reported an increase in mental 
health symptoms. The longitudinal study found no evidence of a change in mental 
health symptoms from pre-pandemic to during the pandemic among young people with 
autism spectrum disorder, although these individuals reported negative impacts 
of the COVID-19 pandemic on their emotional or mental health.
CONCLUSIONS: The findings of this review provide some weak evidence of a 
negative impact of the COVID-19 pandemic on the mental health of young people 
with disabilities. Importantly, the findings highlight the lack of research in 
this area. More research is needed to investigate the impact of the pandemic on 
the mental health of young disabled people, in order for governments to develop 
emergency preparedness plans to safeguard the well-being of this population.

© 2023. The Author(s).

DOI: 10.1186/s12889-023-16260-z
PMCID: PMC10357662
PMID: 37468866 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


518. Women Health. 2023 Aug 9;63(7):531-538. doi: 10.1080/03630242.2023.2237608. Epub 
2023 Jul 19.

Are COVID-19 lockdowns associated with a change in sexual desire? Results from 
an online survey of Australian women.

Fang W(1), Coombe J(1), Hocking JS(1), Bittleston H(1).

Author information:
(1)Melbourne School of Population and Global Health, University of Melbourne, 
Carlton, Victoria, Australia.

In early 2020, the Australian government implemented lockdown restrictions to 
prevent the spread of COVID-19. Our study aims to investigate the impact of 
lockdowns on sexual desire and enjoyment of sex among Australian women. We 
conducted an online survey in August 2020 when Victoria was in strict lockdown, 
but all other states/territories had minimal restrictions. Here, we report on 
responses from female participants aged ≥18 years. Respondents were asked 
whether COVID-19 had impacted their desire and/or enjoyment of sex (yes/no). 
Those who responded "yes" were asked to elaborate in a free-text question. 
Factors associated with desire were investigated using the chi-square test. 
Conventional content analysis was used to explore free-text responses. Of the 
622 participants, 44.1% reported COVID-19 related impacts on their sexual 
desire. Women living in Victoria, who were not heterosexual, and whose 
employment was negatively affected by lockdown were all more likely to report an 
impact on their sexual desire. Free-text comments revealed that mental health, 
living arrangements, and a reduced ability to meet with sexual partners were key 
reasons behind these impacts. The COVID-19 pandemic and lockdown measures 
clearly impacted the desire and enjoyment of sex for many women, important 
factors of people's relationships, health, and wellbeing.

DOI: 10.1080/03630242.2023.2237608
PMID: 37468136 [Indexed for MEDLINE]


519. Telemed J E Health. 2024 Feb;30(2):422-429. doi: 10.1089/tmj.2023.0141. Epub 
2023 Jul 19.

Telemedicine from Home or the Office: Perceptions of Mental Health Providers.

Wilczewski H(1), Ong T(1), Ivanova J(1), Soni H(1), Barrera JF(1)(2), Cummins 
MR(1)(3), Welch BM(1)(4), Bunnell BE(1)(2).

Author information:
(1)Doxy.me Research, Doxy.me, Inc., Rochester, New York, USA.
(2)Department of Psychiatry and Behavioral Neurosciences, University of South 
Florida, Tampa, Florida, USA.
(3)College of Nursing and Department of Biomedical Informatics, University of 
Utah, Salt Lake City, Utah, USA.
(4)Department of Public Health Sciences, Medical University of South Carolina, 
Charleston, South Carolina, USA.

Introduction: The COVID-19 pandemic led to a rapid transition to telemedicine 
for mental health care and redefined many providers' work environments and 
practices. The purpose of the study was to investigate the impact of work 
location on telemental health (TMH) benefits, disruptions, and concerns to 
further understand the rapid implementation of telemedicine for mental health 
treatment. Methods: A sample of 175 practicing TMH providers completed an online 
survey between July and August 2020. Providers answered questions about personal 
demographics and practice characteristics. Next, they answered questions about 
benefits, disruptions, and concerns regarding the use of telemedicine in their 
practice. Chi-square and independent samples t-test were conducted to identify 
work location differences for personal demographics and clinical practice 
characteristics. Three multivariate analyses of covariance were conducted to 
examine overall differences in perceptions of telemedicine benefits, concerns, 
and disruptions based on work location while covarying for provider race, 
ethnicity, percentage of caseload seen through telemedicine, practice type, 
specialty, and primary method of reimbursement. Results: TMH providers who 
primarily work from an office reported more benefit of reduced costs/overhead 
(ηp2 = 0.039), less benefit of limiting the spread of the virus (ηp2 = 0.028), 
and more concern about reimbursement (ηp2 = 0.046) than those who primarily work 
from home. We observed no difference in disruptions, patient access to care, 
quality of care, and work-life balance. Discussion: Exploration into work 
location of TMH providers aids in understanding of clinical workflows and 
provider wellbeing. Our findings suggest that telemedicine may be easily 
integrated into different types of clinical workflows and work locations.

DOI: 10.1089/tmj.2023.0141
PMCID: PMC10877387
PMID: 37466479 [Indexed for MEDLINE]

Conflict of interest statement: Dr. B.M.W. is a shareholder, and all other 
authors are employees of Doxy.me, Inc., a commercial telemedicine company. The 
authors declare no other conflicts of interest.


520. J Nurs Adm. 2023 Jul-Aug 01;53(7-8):420-428. doi: 10.1097/NNA.0000000000001308.

Nurse Resiliency and Health in Practicing Nurses Before and During COVID-19.

Stallings Welden LM(1), Chen C, Willegal-Russ K, Kalb E.

Author information:
(1)Author Affiliations: Clinical Nurse Specialist (Dr Stallings Welden), 
Deaconess Hospital, Inc of Deaconess Health System, Evansville, Indiana; 
Assistant Professor (Dr Chen), Zhejiang University, Hangzhou; and Nurse 
Clinician (Dr Willegal-Russ), Memorial Hospital and Health Care Center, Jasper; 
and Psychologist Consultant (Dr Kalb), Ascension St. Vincent's Evansville, 
Indiana.

OBJECTIVES: The aim of this study was to compare the degree of resilience and 
self-perceived physical and mental health in nurses before and during the 
COVID-19 pandemic.
BACKGROUND: Work-related stress among nurses is recognized as an antecedent of 
burnout, which in turn impacts resiliency and well-being. The work of nursing 
has long been noted as stressful. Although nurse resilience and perceived 
well-being have been shown to decrease during a period of usual stress (constant 
and chronic), the impact and significance of prolonged stress on nurse 
resilience and well-being illuminates throughout the literature.
METHODS: Replicating a cross-sectional prepandemic study, nurses were resurveyed 
in 2020 during the COVID-19 pandemic. In both studies, the Connor-Davidson 
Resilience Scale and PROMIS Global Health was used to measure respondent's: 1) 
resilience level; 2) physical health status; and 3) mental health status, 
respectively. Independent 2-sample t tests were performed to compare the 
pre-and-post score differences in the 3 outcomes. To identify characteristics 
that were associated with the pre-and-post differences, comparison analyses were 
also performed within each level of the respondents' characteristic variables.
RESULTS: A higher proportion of postsurvey respondents reported working more 
than 8 hours of overtime per week, had thoughts of quitting their current job, 
and thought their workload was too much compared with the presurvey respondents. 
Generally, the postgroup resilience scores and self-perceived physical and 
mental scores were statistically significantly lower compared with the pregroup 
scores, but those differences were only observed in certain subgroups defined by 
respondents' characteristics.
CONCLUSIONS AND IMPLICATIONS: Self-perceived physical and mental health are 
significantly associated with the degree of resilience and worsened during the 
COVID-19 pandemic, especially in younger and older nurse cohorts. Engaged nurse 
leaders are key to implement interventions that build resilience and perceived 
well-being during periods of usual and prolonged stress.

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/NNA.0000000000001308
PMID: 37463265 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


521. Can J Public Health. 2023 Oct;114(5):787-795. doi: 10.17269/s41997-023-00803-3. 
Epub 2023 Jul 18.

Operating an overdose prevention site within a temporary emergency shelter 
during the COVID-19 pandemic.

Galarneau LR(1)(2)(3), Speed K(1)(2), Taylor M(4), Hyshka E(5)(6).

Author information:
(1)School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
(2)Inner City Health and Wellness Program, Edmonton, Alberta, Canada.
(3)George Spady Society, Edmonton, Alberta, Canada.
(4)Boyle Street Community Services, Edmonton, Alberta, Canada.
(5)School of Public Health, University of Alberta, Edmonton, Alberta, Canada. 
ehyshka@ualberta.ca.
(6)Inner City Health and Wellness Program, Edmonton, Alberta, Canada. 
ehyshka@ualberta.ca.

SETTING: A temporary emergency shelter was established inside the Commonwealth 
Stadium in Edmonton, Alberta, to reduce COVID-19 transmission and mitigate 
health risks among people experiencing homelessness.
INTERVENTION: A non-profit organization, Boyle Street Community Services, opened 
an overdose prevention site (OPS) between February and March 2022 inside the 
temporary emergency shelter. People accessed the shelter-based OPS to consume 
unregulated drugs (via injection, intranasally, or orally), receive medical aid, 
access sterile drug use equipment, and be connected to additional health and 
social supports, without leaving the shelter. We conducted short 
interviewer-administered surveys with OPS participants to examine participant 
views and identify suggested improvements.
OUTCOMES: The shelter-based OPS was accessed a total of 1346 times by 174 unique 
people. Fentanyl was the most common self-reported drug consumed (59%) and most 
consumption (99% of episodes) was by injection. OPS staff responded to 66 
overdoses and reported no deaths. Survey respondents reported that the 
shelter-based OPS was convenient, with no need to forfeit their shelter spot or 
find transportation to another OPS. Respondents indicated that the OPS felt safe 
and accessible and reported that it reduced drug use in other shelter areas. 
Participants identified the OPS' exclusion of inhalation as a limitation.
IMPLICATIONS: People who use unregulated drugs and are experiencing homelessness 
are at a higher risk of negative health outcomes, which COVID-19 exacerbated. 
Integrating temporary shelter/housing and harm reduction services may be an 
innovative way to lower barriers, increase accessibility, and improve well-being 
for this structurally vulnerable population. Future operators should consider 
incorporating inhalation services to further reduce service gaps.

Publisher: RéSUMé: LIEU: Un refuge d’urgence temporaire avait été établi dans le 
stade du Commonwealth à Edmonton (Alberta) pour réduire la transmission de la 
COVID-19 et atténuer les risques pour la santé chez les personnes en situation 
d’itinérance. INTERVENTION: Un organisme sans but lucratif, Boyle Street 
Community Services, a ouvert un centre de prévention des surdoses (CPS) entre 
février et mars 2022 à l’intérieur de ce refuge d’urgence temporaire. Les gens 
avaient accès au CPS du refuge pour consommer des médicaments non réglementés 
(par injection ou par voie intranasale ou buccale), recevoir de l’aide médicale, 
se procurer du matériel de consommation stérile et être mis en rapport avec 
d’autres intervenants et intervenantes de la santé et des services sociaux sans 
sortir du refuge. Nous avons mené de brefs sondages administrés par l’enquêteur 
ou l’enquêtrice auprès des participantes et des participants du CPS pour étudier 
leurs points de vue et formuler des suggestions d’améliorations. RéSULTATS: Le 
CPS du refuge a été utilisé 1 346 fois par 174 personnes. Le fentanyl a été le 
médicament le plus souvent consommé selon les utilisateurs et utilisatrices (59 
%), et la plupart du temps (dans 99 % des cas), il était consommé par injection. 
Le personnel du CPS est intervenu lors de 66 surdoses et n’a rapporté aucun 
décès. Les répondantes et répondants aux sondages ont indiqué que le CPS du 
refuge était pratique, car il n’était pas nécessaire d’abandonner leur place 
dans le refuge, ni de trouver un moyen de se rendre dans un autre CPS. Ces 
personnes ont trouvé le CPS sûr et accessible et ont dit qu’il avait réduit la 
consommation de drogue dans d’autres zones de refuge. Les participantes et 
participants ont indiqué que l’exclusion de la consommation par inhalation dans 
le CPS était toutefois une contrainte. CONSéQUENCES: Les personnes en situation 
d’itinérance qui consomment des médicaments non réglementés courent un plus 
grand risque d’avoir des résultats cliniques négatifs, ce que la COVID-19 a 
exacerbé. L’intégration de refuges/logements temporaires et de services de 
réduction des méfaits peut être un moyen novateur de réduire les obstacles, 
d’accroître l’accessibilité et d’améliorer le bien-être de cette population 
structurellement vulnérable. Les futurs gestionnaires devraient songer à 
intégrer des services d’inhalation pour réduire encore davantage les lacunes 
dans les services.

© 2023. The Author(s) under exclusive license to The Canadian Public Health 
Association.

DOI: 10.17269/s41997-023-00803-3
PMCID: PMC10486343
PMID: 37462841 [Indexed for MEDLINE]

Conflict of interest statement: Taylor, a co-author of our study, is the 
Director of Health Services at Boyle Street Community Services and managed the 
intervention reported on in our manuscript. In addition, Elaine Hyshka’s faculty 
received funding from Boyle Street Community Services to evaluate the 
intervention. We have no other conflicts of interest to disclose.


522. PLoS One. 2023 Jul 17;18(7):e0288591. doi: 10.1371/journal.pone.0288591. 
eCollection 2023.

A longitudinal investigation of the effects of the COVID-19 pandemic on 2SLGBTQ+ 
youth experiencing homelessness.

Abramovich A(1)(2)(3), Pang N(1)(4), Kim KV(1), Stark RK(1), Lange S(1), Chaiton 
M(1), Logie CH(4), Hamilton HA(1), Kidd SA(3).

Author information:
(1)Institute for Mental Health Policy Research, Centre for Addiction and Mental 
Health, Toronto, Ontario, Canada.
(2)Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, 
Canada.
(3)Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
(4)Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, 
Ontario, Canada.

INTRODUCTION: The objective of this study was to examine the impacts of the 
coronavirus 2019 (COVID-19) pandemic on various dimensions of wellbeing among 
2SLGBTQ+ youth experiencing homelessness over a 12-month period during the 
COVID-19 pandemic.
METHODS: 2SLGBTQ+ youth (recruited using a convenience sampling method) 
participated in three online surveys to assess mental health (depression, 
anxiety, suicidality), substance and alcohol use, health care access, and 
violence for 12-months between 2021-2022. Quantitative data analysis included 
non-parametric one-sample proportion tests, paired t-test and McNemar's test. 
Longitudinal data collected across all three timepoints were treated as paired 
data and compared to baseline data using non-parametric exact multinomial tests, 
and if significant, followed by pairwise post-hoc exact binomial tests. For the 
purposes of analysis, participants were grouped according to their baseline 
survey based on pandemic waves and public health restrictions.
RESULTS: 2SLGBTQ+ youth experiencing homelessness (n = 87) reported high rates 
of mental health challenges, including anxiety and depression, over 12-months 
during the pandemic. Youth participants reported experiencing poor mental health 
during the early waves of the pandemic, with improvements to their mental health 
throughout the pandemic; however, results were not statistically significant. 
Likewise, participants experienced reduced access to mental health care during 
the early waves of the pandemic but mental health care access increased for 
youth throughout the pandemic.
CONCLUSION: Study results showed high rates of mental health issues among 
2SLGBTQ+ youth, but reduced access to mental health care, due to the COVID-19 
pandemic. Findings highlight the need for 2SLGBTQ+ inclusive and affirming 
mental health care and services to address social and mental health issues that 
have been exacerbated by the pandemic.

Copyright: © 2023 Abramovich et al. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0288591
PMCID: PMC10351701
PMID: 37459299 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


523. J Neuroinflammation. 2023 Jul 15;20(1):166. doi: 10.1186/s12974-023-02825-7.

Gastrointestinal microbiome of ARDS patients induces neuroinflammation and 
cognitive impairment in mice.

Zheng H(#)(1), Zhao Q(#)(1), Chen J(2), Lu J(1), Li Y(3), Gao H(4).

Author information:
(1)Oujiang Laboratory, School of Pharmaceutical Sciences, Wenzhou Medical 
University, Wenzhou, 325035, China.
(2)Department of Pulmonary and Critical Care Medicine, The First Affiliated 
Hospital of Wenzhou Medical University, Wenzhou, 325015, China.
(3)Department of Pulmonary and Critical Care Medicine, The First Affiliated 
Hospital of Wenzhou Medical University, Wenzhou, 325015, China. wzliyp@163.com.
(4)Oujiang Laboratory, School of Pharmaceutical Sciences, Wenzhou Medical 
University, Wenzhou, 325035, China. gaohc27@wmu.edu.cn.
(#)Contributed equally

BACKGROUND: Acute respiratory distress syndrome (ARDS) is a respiratory failure 
syndrome that can cause many complications, impacting patients' quality of life. 
Behavioral and cognitive disorders have attracted increasing attention in 
patients with ARDS, but its potential mechanisms are still elusive.
METHODS: Herein we transferred the faecal microbiota from patients with ARDS 
caused by community-acquired pneumonia (CAP) to antibiotics-treated recipient 
male mice to explore the microbiota-gut-brain mechanisms. Behavioral functions 
of mice were evaluated by the open field test, Morris water maze and Y-maze 
test. The structure and composition of the gut microbiota were analyzed by using 
16S rRNA sequencing analysis. Microglia, astrocyte and neuron in the cortex and 
hippocampus were examined via immunofluorescent staining.
RESULTS: We found that the major characteristic of the intestinal flora in 
ARDS/CAP patients was higher abundances of Gram-negative bacteria than normal 
controls. The gut microbiota derived from ARDS/CAP patients promoted 
neuroinflammation and behavioral dysfunctions in mice. Mice who underwent fecal 
transplant from ARDS/CAP patients had increased systemic 
lipopolysaccharide (LPS), systemic inflammation, and increased colonic barrier 
permeability. This may adversely impact blood barrier permeability and 
facilitate microglia activation, astrocyte proliferation, and loss of neurons.
CONCLUSIONS: Our study proposes the role of the microbiota-gut-brain crosstalk 
on ARDS/CAP-associated behavioral impairments and suggests the gut microbiota as 
a potential target for the protection of brain health in ARDS patients in 
clinical practice.

© 2023. The Author(s).

DOI: 10.1186/s12974-023-02825-7
PMCID: PMC10349492
PMID: 37454113 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


524. Public Health Res (Southampt). 2023 May;11(4):1-100. doi: 10.3310/AHFF6175.

Exploring the relationship between working from home, mental and physical health 
and wellbeing: a systematic review.

Blank L(1), Hock E(1), Cantrell A(1), Baxter S(1), Goyder E(1).

Author information:
(1)School for Health and Related Research, University of Sheffield, Sheffield, 
UK.

BACKGROUND: Understanding the impact of working from home on health and 
wellbeing is of great interest to employers and employees alike, with a strong 
need for up-to-date guidance. The aim of this systematic review was to identify, 
appraise and synthesise existing research evidence that explores the impact of 
home working on health and wellbeing outcomes for working people and health 
inequalities in the population.
METHODS: We conducted a systematic review of qualitative, quantitative and 
observational studies. We searched databases, reference lists and UK grey 
literature and completed citation searching of included papers. We extracted and 
tabulated key data from the included papers and synthesised narratively. Factors 
associated with the health and wellbeing of people working at home reported in 
the literature were displayed by constructing mind maps of each individual 
factor which had been identified. The findings were combined with an a priori 
model to develop a final model, which was validated in consultation with 
stakeholders.
RESULTS: Of 96 studies which were found to meet the inclusion criteria for the 
review, 30 studies were published before the COVID-19 pandemic and a further 66 
were published during the pandemic. The quality of evidence was limited by the 
study designs employed by the authors, with the majority of studies being 
cross-sectional surveys (n = 59). For the most part, for studies which collected 
quantitative data, measures were self-reported. The largest volume of evidence 
identified consisted of studies conducted during the COVID-19 pandemic which 
looked at factors which influence the relationship between working from home and 
measures relating to mental health and wellbeing. Fifteen studies which 
considered the potential for working at home to have different effects for 
different subgroups suggested that working at home may have more negative 
consequences during the COVID-19 pandemic for women and in particular, mothers. 
There was very little evidence on age (two studies), ethnicity (one study), 
education or income (two studies) in terms of moderating home working effects, 
and very limited evidence from before the COVID-19 pandemic. The concept of 
enforced working from home and having 'no choice' was reported in only one paper 
prior to the pandemic and two papers reporting on working from home as a result 
of COVID-19. However, the concept of lack of choice around working from home was 
implicit in much of the literature - even though it was not directly measured. 
There were no clear patterns of wellbeing measures which changed from positive 
to negative association (or vice versa) during the pandemic.
LIMITATIONS: The quality of the evidence base was very much limited by study 
designs, particularly for studies published during the COVID-19 pandemic, with 
the majority of studies consisting of data collected by cross-sectional surveys 
(often online). Due to the rapidly expanding nature of the evidence on this 
topic, it is possible that new studies were published after the final citation 
searches were conducted.
DISCUSSION: The evidence base for the factors which influence the relationship 
between home working and health-related outcomes has expanded significantly as a 
result of the need for those whose work could be done from home to work at home 
during the COVID-19 pandemic. Our findings suggest that there are factors 
relating to the external context, the role of employers and the circumstances of 
the employee which contribute to determining whether someone works at home and 
what the associated impacts on health and wellbeing may be. Learning from the 
COVID-19 lockdown experience will be important to inform future policy on home 
and hybrid working.
FUTURE WORK: There is a need for better-quality studies of the health impact of 
home working, in particularly studies which recruit a range of participants who 
are representative of the working population and which are designed to minimise 
sampling/recruitment biases and response biases.
FUNDING: This project was funded by the National Institute for Health and Care 
Research (NIHR) Public Health Research programme (project reference 18/93 PHR 
Public Health Review Team) and will be published in full in Public Health 
Research; Vol. 11, No. 4. See the NIHR Journals Library website for further 
project information. The views expressed are those of the authors and not 
necessarily those of the NIHR or the Department of Health and Social Care.
STUDY REGISTRATION: This study is registered as PROSPERO 2021 CRD42021253474.

Plain Language Summary: INTRODUCTION: Working from home is becoming more common 
and has increased due to the COVID-19 pandemic. However, the impact of working 
at home on the health of home workers and the general population remains 
unclear.
METHODS: We looked for research which had been undertaken to help to understand 
the impact of home working on people’s health. One researcher summarised the 
findings of each paper in tables, and these were checked by a second researcher. 
These were then drawn together into a final diagram to summarise the findings of 
all the relevant studies.
RESULTS: We found 96 papers and reports: 30 published before the COVID-19 
pandemic and 66 published during the pandemic. This shows that the number of 
studies in this area has increased significantly as a result of home working due 
to COVID-19 lockdowns. The largest volume of studies we found were conducted 
during the pandemic and looked at measures of wellbeing and mental health. Lack 
of choice over whether to work from home was also considered in respect to 
wellbeing. Further measures linked to the home-work environment included feeling 
in control of time, lack of commuting to work, more time with the family, lower 
work/family conflict, and spaces shared with others. Openness to new ways of 
living was also included. Fifteen studies suggested overall that working at home 
may have more negative consequences during the COVID-19 pandemic for women and, 
in particular, mothers. There was very little evidence to tell us how a person’s 
age, ethnicity, education or income might affect their health when working from 
home.
CONCLUSIONS: Many factors determine whether someone works at home, and the 
effects on their health and wellbeing. These are related to what is happening in 
the world, the employer and type of job, and the circumstances of the employee.

DOI: 10.3310/AHFF6175
PMID: 37452651 [Indexed for MEDLINE]


525. Mol Psychiatry. 2023 Oct;28(10):4463-4473. doi: 10.1038/s41380-023-02172-2. Epub 
2023 Jul 14.

Sepsis exacerbates Alzheimer's disease pathophysiology, modulates the gut 
microbiome, increases neuroinflammation and amyloid burden.

Giridharan VV(1), Catumbela CSG(2), Catalão CHR(1)(3), Lee J(2), Ganesh BP(2), 
Petronilho F(4), Dal-Pizzol F(4), Morales R(2)(5), Barichello T(6)(7).

Author information:
(1)Faillace Department of Psychiatry and Behavioural Sciences, McGovern Medical 
School, The University of Texas Health Science Center at Houston (UTHealth), 
Houston, TX, USA.
(2)Department of Neurology, McGovern Medical School, The University of Texas 
Health Science Center at Houston (UTHealth), Houston, TX, USA.
(3)Department of Neurosciences and Behavioral Sciences, Ribeirao Preto Medical 
School, University of Sao Paulo (USP), Ribeirao Preto, SP, Brazil.
(4)Graduate Program in Health Sciences, University of Southern Santa Catarina 
(UNESC), Criciúma, SC, Brazil.
(5)Centro Integrativo de Biología y Química Aplicada (CIBQA), Universidad 
Bernardo O'Higgins, Santiago, Chile.
(6)Faillace Department of Psychiatry and Behavioural Sciences, McGovern Medical 
School, The University of Texas Health Science Center at Houston (UTHealth), 
Houston, TX, USA. Tatiana.Barichello@uth.tmc.edu.
(7)Graduate Program in Health Sciences, University of Southern Santa Catarina 
(UNESC), Criciúma, SC, Brazil. Tatiana.Barichello@uth.tmc.edu.

Erratum in
    Mol Psychiatry. 2024 Jan 22;:

While our understanding of the molecular biology of Alzheimer's disease (AD) has 
grown, the etiology of the disease, especially the involvement of peripheral 
infection, remains a challenge. In this study, we hypothesize that peripheral 
infection represents a risk factor for AD pathology. To test our hypothesis, 
APP/PS1 mice underwent cecal ligation and puncture (CLP) surgery to develop a 
polymicrobial infection or non-CLP surgery. Mice were euthanized at 3, 30, and 
120 days after surgery to evaluate the inflammatory mediators, glial cell 
markers, amyloid burden, gut microbiome, gut morphology, and short-chain fatty 
acids (SCFAs) levels. The novel object recognition (NOR) task was performed 30 
and 120 days after the surgery, and sepsis accelerated the cognitive decline in 
APP/PS1 mice at both time points. At 120 days, the insoluble Aβ increased in the 
sepsis group, and sepsis modulated the cytokines/chemokines, decreasing the 
cytokines associated with brain homeostasis IL-10 and IL-13 and increasing the 
eotaxin known to influence cognitive function. At 120 days, we found an 
increased density of IBA-1-positive microglia in the vicinity of Aβ dense-core 
plaques, compared with the control group confirming the predictable clustering 
of reactive glia around dense-core plaques within 15 μm near Aβ deposits in the 
brain. In the gut, sepsis negatively modulated the α- and β-diversity indices 
evaluated by 16S rRNA sequencing, decreased the levels of SCFAs, and 
significantly affected ileum and colon morphology in CLP mice. Our data suggest 
that sepsis-induced peripheral infection accelerates cognitive decline and AD 
pathology in the AD mouse model.

© 2023. The Author(s), under exclusive licence to Springer Nature Limited.

DOI: 10.1038/s41380-023-02172-2
PMCID: PMC10926876
PMID: 37452088 [Indexed for MEDLINE]

Conflict of interest statement: COMPETING INTERESTS The authors declare no 
competing interests.


526. Midwifery. 2023 Oct;125:103772. doi: 10.1016/j.midw.2023.103772. Epub 2023 Jul 
7.

A feasibility study of Online Mellow Bumps: A Turkish pilot study of an online 
group-based antenatal parenting intervention.

Miles A(1), Lovell M(2), Ibrahim R(2), Dagli TE(3), Dagli FS(4), Sethna DV(5).

Author information:
(1)Institute of Psychiatry, Psychology and Neuroscience, King's College London, 
Strand, London WC2R 2LS, United Kingdom. Electronic address: 
alex_miles@live.com.
(2)Mellow Parenting, Unit 4, Six Harmony Row, Glasgow G51 3BA, Scotland.
(3)Department of Pediatric Surgery, Marmara University Faculty of Medicine, 
Istanbul, Turkey.
(4)Department of Pediatrics, Gazi University Faculty of Medicine, Ankara, 
Turkey.
(5)Department of Forensic and Neurodevelopmental Sciences, Institute of 
Psychiatry, Psychology and Neuroscience, King's College London, Strand, London 
WC2R 2LS, United Kingdom.

BACKGROUND: As a result of the COVID-19 pandemic, Mellow Parenting proposed 
online strategies for some of their interventions. One such intervention was 
Mellow Bumps - becoming Online Mellow Bumps. The objective of this study was to 
evaluate the implementation of antenatal parenting intervention Mellow Bumps in 
an online format and determine if this can be done safely and without detriment 
to pregnant women in Turkey.
METHOD: The study used an exploratory study design to investigate routine 
evaluation data collected pre- and post-intervention. Outcomes were online 
feasibility, mental health symptoms (depression, anxiety and stress), maternal 
subjective well-being, perceived quality of relationship with baby, maternal 
confidence and maternal social connectivity. 128 mums-to-be took part in the 
intervention between January 2021 and May 2021 from a total of 21 different 
provinces in Turkey.
RESULTS: 57 pre- and post-intervention responses were eligible for analysis. 
This gives a response rate of 44.5% for evaluation, though the intervention 
completion rate was high at 89.5%, suggesting the intervention is engaging and 
accessible. Improvements were found for maternal stress levels, maternal 
subjective well-being and perceived relationship with baby. Improvements were 
also found for maternal confidence and maternal social connectivity.
CONCLUSIONS: This is the first study to evaluate the antenatal parenting 
intervention Mellow Bumps in an online format, namely Online Mellow Bumps. The 
online format makes the programme accessible for at-risk mothers and families, 
with the potential to continue reaching wider audiences beyond the pandemic who 
otherwise might struggle to access support. The findings show that the online 
group can be effective in improving mental health symptoms and mental 
well-being, supporting expectant mothers before the baby is born. Future 
research using a control group, a larger and more inclusive sample, and 
assessing the longer-term effects on parent and child would be beneficial.

Copyright © 2023. Published by Elsevier Ltd.

DOI: 10.1016/j.midw.2023.103772
PMID: 37451037 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest Michael Lovell 
and Raquib Ibrahim were paid employees of Mellow Parenting. Tolga Dagli and 
Figen Dagli were Mellow trainers. Alex Miles was a placement student with Mellow 
Parenting from January 2021 to June 2021, continuing voluntarily afterwards.


527. Front Public Health. 2023 Jun 28;11:1211471. doi: 10.3389/fpubh.2023.1211471. 
eCollection 2023.

Incidence and trends in workplace violence within emergency departments in the 
United Kingdom 2017-2022: an observational time series analysis.

Donald N(1), Lindsay T(2)(3).

Author information:
(1)Department of Surgery, Dartford and Gravesham NHS Trust, Dartford, United 
Kingdom.
(2)Department of Trauma and Orthopaedics, London North West University Hospitals 
NHS Trust, London, United Kingdom.
(3)Imperial College London, London, United Kingdom.

BACKGROUND: Workplace violence (WPV) is a notable issue facing healthcare 
services and workers globally. WPV impacts upon the well-being of staff and can 
put healthcare provision at risk with detrimental effects on patient care. This 
study aims to investigate and quantify, at national and regional levels, the 
incidence and trends of WPV within emergency departments (EDs).
METHODS: We requested data relating to WPV from all 152 trusts with an ED in the 
United Kingdom from January 2017-March 2022. We applied interrupted time series 
and trend analysis to check for significant differences in WPV across the 
COVID-19 pandemic.
RESULTS: We conducted time series analysis on 58 million attendances and 
detected statistically significant increases in WPV in March 2020-5.06/100,000 
attendances (95% CI 1.59/100,000-8.53/100,000 p < 0.01) and May 
2020-20.63/100,000 attendances (95% CI 9.39-31.87 p < 0.01). Rises in incidents 
of 0.37/100,000 attendances per month (95% CI 0.21-0.53 p < 0.0001) were found 
January 2017-March 2020. We analyzed 96 million attendances for yearly trends, 
which revealed statistically significant increasing trends of WPV in London and 
North-West England (p < 0.05), and physical WPV in the North West England 
(p < 0.05).
CONCLUSION: There have been dramatic increases in incidents of WPV in United 
Kingdom EDs over the last 5 years with concerning rises during the COVID-19 
period. Our findings highlight the potential to further demoralize a workforce 
already under significant strain, resulting in increased absences for physical 
or mental health and an exodus of staff. Therefore, trusts should ensure there 
are robust systems in place to protect and safeguard staff.

Copyright © 2023 Donald and Lindsay.

DOI: 10.3389/fpubh.2023.1211471
PMCID: PMC10336324
PMID: 37448656 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


528. Int J Environ Res Public Health. 2023 Jul 7;20(13):6318. doi: 
10.3390/ijerph20136318.

Remote, Disconnected, or Detached? Examining the Effects of Psychological 
Disconnectedness and Cynicism on Employee Performance, Wellbeing, and 
Work-Family Interface.

Petitta L(1), Ghezzi V(1).

Author information:
(1)Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 
00185 Rome, Italy.

Owing to the COVID-19 pandemic, organizations worldwide have implemented remote 
working arrangements that have blurred the work-family boundaries and brought to 
the forefront employees' sense of disconnectedness from their workplace (i.e., 
organizational disconnectedness) as a concern for multiple organizational 
outcomes. Cynicism, a job burnout subdimension, refers to a negative and 
excessively detached response to relational overload at work. While both 
workplace disconnectedness and cynicism involve a toxic sense of detachment, 
they refer to different psychological mechanisms. The present study aims to 
examine how employee workplace disconnectedness differs from their cynicism, and 
how both constructs differentially exert their detrimental effects on employee 
performance, work-family interface, and wellbeing. Using anonymous survey data 
collected online in 2021 and 2022 from a sample of in-person and flexible 
workers nested within organizations, conceptual distinctiveness between 
workplace disconnectedness and cynicism was supported. Measurement invariance 
across the two groups was supported, and subsequent structural invariance 
analyses suggested a similar pattern of results for flexible and in-person 
workers. Specifically, compared to disconnectedness, cynicism exerted higher 
negative effects on mental health and higher positive effects on cognitive 
failures and family-to-work conflict. Conversely, compared to cynicism, 
disconnectedness exerted higher negative effects on performance and 
work-to-family conflict. That is, feeling indifferent toward others particularly 
affects mental health and errors, while feeling excluded especially hampers 
productivity and family life. Theoretical and practical (e.g., inclusive 
leadership, support groups) implications of these results are discussed in light 
of the globally rising rates of hybrid work arrangements and related costs for 
employee wellbeing and productivity.

DOI: 10.3390/ijerph20136318
PMCID: PMC10342056
PMID: 37444165 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


529. Int J Environ Res Public Health. 2023 Jul 5;20(13):6300. doi: 
10.3390/ijerph20136300.

The Association of Moral Injury and Healthcare Clinicians' Wellbeing: A 
Systematic Review.

Thibodeau PS(1), Nash A(1), Greenfield JC(1), Bellamy JL(1).

Author information:
(1)Graduate School of Social Work, University of Denver, 2148 S. High Street, 
Denver, CO 80210, USA.

Research focused on elucidating moral injury amongst healthcare workers (HCWs) 
is essential due to the deep connection with morality and individuals' overall 
wellbeing. Examining moral injury provides an avenue through which researchers 
can connect individual experiences with systemic level causes (i.e., structural 
power imbalances between clinicians and health systems) to better study 
workplace wellbeing. The omnipresence of the COVID-19 pandemic has amplified the 
need to study moral injury. This paper describes a systematic review conducted 
using PRISMA-P guidelines to answer the question, "what is the association 
between moral injury and professional wellbeing and mental health amongst 
healthcare workers." Twelve databases were searched to identify specified 
studies. This study's criteria included: (1) articles published through December 
2022; (2) qualitative and quantitative empirical studies; (3) articles written 
in English; (4) articles including moral injury; and (5) articles including at 
minimum one other measure of professional or personal wellbeing. The initial 
search produced 248 articles, and 18 articles were ultimately included in the 
final review. To confirm that no articles were left out of this study, the first 
author of each included article was contacted to inquire about any additional 
works that met the inclusion criteria of this study. The elements of the 18 
included articles described in this review are discussed. The results indicate 
that moral injury is associated with both professional wellbeing factors and 
mental health outcomes. Further theoretical development, including 
(professional- and identity-based) exploratory research on moral injury, and 
evidenced-based interventions for moral injury are needed.

DOI: 10.3390/ijerph20136300
PMCID: PMC10341511
PMID: 37444147 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


530. Int J Environ Res Public Health. 2023 Jun 27;20(13):6233. doi: 
10.3390/ijerph20136233.

Socioeconomic Deprivation and Inequalities in Mental Well-Being during the 
COVID-19 Pandemic among Adolescents.

Jeriček Klanšček H(1), Furman L(1).

Author information:
(1)National Institute of Public Health, Trubarjeva 2, 1000 Ljubljana, Slovenia.

The COVID-19 pandemic highlighted the existing inequalities in education and 
mental health. The aim of this study was to examine socioeconomic disadvantages 
and mental well-being inequalities among Slovenian adolescents in October 2020. 
The study used nationally representative data from 3052 adolescents aged 14 and 
18 (Mage = 14.4 and 18.4). The WHO-5 Well-Being Index (WHO-5) was used to 
measure mental well-being and risk for depression. Multinomial logistic 
regression was used to identify differences in the pattern of associations 
regarding sociodemographic characteristics and experiences during the pandemic 
with poor well-being and risk for depression. Our study found that adolescents 
from socially disadvantaged families faced poorer conditions as regards academic 
performance, had fewer opportunities to socialise with friends online, and were 
more likely to feel lonely; they reported lower levels of mental well-being and 
were at a higher risk for depression. The unemployment of both parents and 
adolescents' perceptions of family wealth were found to be the most important 
predictors of depression risk. In addition, experiencing deprivation and 
economic hardship during the pandemic was also identified as a significant 
predictor. The study concludes that social and economic conditions were critical 
determinants of adolescents' mental health during the pandemic and that 
effective intervention is needed to promote their well-being and reduce 
inequalities.

DOI: 10.3390/ijerph20136233
PMCID: PMC10341098
PMID: 37444081 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


531. Nurs Open. 2023 Nov;10(11):7106-7117. doi: 10.1002/nop2.1935. Epub 2023 Jul 13.

Caring for critically ill patients with a mental illness: A discursive paper 
providing an overview and case exploration of the delivery of intensive care to 
people with psychiatric comorbidity.

Flaws D(1)(2)(3), Patterson S(2)(4), Bagshaw T(1)(5), Boon K(1), Kenardy 
J(6)(7), Sellers D(5), Tronstad O(2)(5).

Author information:
(1)Caboolture Hospital, Caboolture, Queensland, Australia.
(2)Critical Care Research Group, The Prince Charles Hospital, Chermside, 
Queensland, Australia.
(3)Queensland University of Technology, Brisbane City, Queensland, Australia.
(4)School of Dentistry, University of Queensland, Brisbane City, Queensland, 
Australia.
(5)The Prince Charles Hospital, Chermside, Queensland, Australia.
(6)School of Psychology, University of Queensland, Brisbane City, Queensland, 
Australia.
(7)Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Herston, 
Queensland, Australia.

AIM: To address the need for additional education in the management of mental 
illness in the critical care setting by providing a broad overview of the 
interrelationship between critical illness and mental illness. The paper also 
offers practical advice to support critical care staff in managing patients with 
mental illness in critical care by discussing two hypothetical case scenarios 
involving aggressive and disorganised behaviour. People living with mental 
illness are over-represented among critically unwell patients and experience 
worse outcomes, contributing to a life expectancy up to 30 years shorter than 
their peers. Strategic documents call for these inequitable outcomes to be 
addressed. Staff working in intensive care units (ICUs) possess advanced 
knowledge and specialist skills in managing critical illness but have reported 
limited confidence in managing patients with comorbid mental illness.
DESIGN & METHODS: A discursive paper, drawing on clinical experience and 
research of the authors and current literature.
RESULTS: Like all people, patients with mental illnesses draw on their 
cognitive, behavioural, social and spiritual resources to cope with their 
experiences during critical illness. However, they may have fewer resources 
available due to co-morbid mental illness, a history of trauma and social 
disadvantage. By identifying and sensitively addressing patients' underlying 
needs in a trauma-informed way, demonstrating respect and maximising patient 
autonomy, staff can reduce distress and disruptive behaviours and promote 
recovery. Caring for patients who are distressed and/or display challenging 
behaviours can evoke strong and unpleasant emotional responses. Self-care is 
fundamental to maintaining a compassionate approach and effective clinical 
judgement. Staff should be enabled to accept and acknowledge emotional responses 
and access support-informally with peers and/or through formal mechanisms as 
needed. Organisational leadership and endorsement of the principles of equitable 
care are critical to creation of the environment needed to improve outcomes for 
staff and patients.
RELEVANCE TO CLINICAL PRACTICE: ICU nurses hold an important role in the care of 
patients with critical illnesses and are ideally placed to empower, advocate for 
and comfort those patients also living with mental illness. To perform these 
tasks optimally and sustainably, health services have a responsibility to 
provide nursing staff with adequate education and training in the management of 
mental illnesses, and sufficient formal and informal support to maintain their 
own well-being while providing this care.
PATIENT AND PUBLIC INVOLVEMENT: This paper is grounded in accounts of patients 
with mental illness and clinicians providing care to patients with mental 
illness in critical care settings but there was no direct patient or public 
contribution.

© 2023 The Authors. Nursing Open published by John Wiley & Sons Ltd.

DOI: 10.1002/nop2.1935
PMCID: PMC10563417
PMID: 37443430 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare they have no conflicts of 
interest.


532. BMC Health Serv Res. 2023 Jul 13;23(1):751. doi: 10.1186/s12913-023-09744-6.

The impact of emotional support on healthcare workers and students coping with 
COVID-19, and other SARS-CoV pandemics - a mixed-methods systematic review.

Härkänen M(1), Pineda AL(2)(3), Tella S(4), Mahat S(1), Panella M(5), Ratti 
M(5), Vanhaecht K(6)(7), Strametz R(8), Carrillo I(9), Rafferty AM(10), Wu 
AW(11), Anttila VJ(12), Mira JJ(13)(14).

Author information:
(1)Department of Nursing Science, University of Eastern Finland, Yliopistoranta 
1c, Kuopio, Finland.
(2)Department of Clinical Medicine, Miguel Hernandez University, San Juan de 
Alicante, Spain.
(3)The Foundation for the Promotion of Health and Biomedical Research of 
Valencia Region, Alicante, Spain.
(4)LAB University of Applied Sciences, Lappeenranta, Finland.
(5)Department of Translational Medicine (DIMET), Università del Piemonte 
Orientale, Novara, Italy.
(6)Leuven Institute for Healthcare Policy, Department of Public Health & Primary 
Care, University of Leuven, Leuven, Belgium.
(7)Department of Quality Management, University Hospitals Leuven, Leuven, 
Belgium.
(8)Wiesbaden Business School of RheinMain University of Applied Sciences, 
Wiesbaden, Germany.
(9)Health Psychology Department, Miguel Hernández University, Elche, Spain.
(10)Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's 
College, London, UK.
(11)Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of 
Medicine, Baltimore, MD, USA.
(12)Helsinki University Hospital, Helsinki, Finland.
(13)The Foundation for the Promotion of Health and Biomedical Research of 
Valencia Region, Alicante, Spain. jose.mira@umh.es.
(14)Health Psychology Department, Miguel Hernández University, Elche, Spain. 
jose.mira@umh.es.

BACKGROUND: Pandemics such as COVID-19 pose threats to the physical safety of 
healthcare workers and students. They can have traumatic experiences affecting 
their personal and professional life. Increasing rates of burnout, substance 
abuse, depression, and suicide among healthcare workers have already been 
identified, thus making mental health and psychological wellbeing of the 
healthcare workers a major issue. The aim of this systematic review is to 
synthesize the characteristics of emotional support programs and interventions 
targeted to healthcare workers and students since the onset of COVID-19 and 
other SARS-CoV pandemics and to describe the effectiveness and experiences of 
these programs.
METHOD: This was a mixed method systematic review. The Preferred Reporting Items 
for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and 
the review was registered on PROSPERO [CRD42021262837]. Searches were conducted 
using Medline, CINAHL, PsycINFO, Cochrane Library, and Scopus databases. The 
COVIDENCE systematic review management system was used for data selection and 
extraction by two independent reviewers. The JBI (Joanna Briggs Institute) 
critical appraisal tools were used to assess the quality of selected studies by 
two additional reviewers. Finally, data extraction and narrative analysis were 
conducted.
RESULTS: The search retrieved 3161 results including 1061 duplicates. After 
screening, a total of 19 articles were included in this review. Participants in 
studies were nurses, physicians, other hospital staff, and undergraduate medical 
students mostly working on the front-line with COVID-19 patients. Publications 
included RCTs (n = 4), quasi-experimental studies (n = 2), cross-sectional 
studies (n = 6), qualitative interview studies (n = 3), and systematic reviews 
(n = 4). Most (63.4%) of the interventions used online or digital solutions. 
Interventions mostly showed good effectiveness (support-seeking, positive 
emotions, reduction of distress symptoms etc.) and acceptance and were 
experienced as helpful, but there were some conflicting results.
CONCLUSION: Healthcare organizations have developed support strategies focusing 
on providing emotional support for these healthcare workers and students, but it 
is difficult to conclude whether one program offers distinct benefit compared to 
the others. More research is needed to evaluate the comparative effectiveness of 
emotional support interventions for health workers.

© 2023. The Author(s).

DOI: 10.1186/s12913-023-09744-6
PMCID: PMC10339499
PMID: 37443003 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


533. J Affect Disord. 2023 Oct 15;339:172-179. doi: 10.1016/j.jad.2023.07.009. Epub 
2023 Jul 11.

Helpful activities during the COVID-19 pandemic: Perceived benefits and actual 
association with psychiatric symptoms and psychological wellbeing.

Murphy E(1), Svob C(2), van Dijk MT(2), Gameroff MJ(2), Yangchen T(3), 
Wickramaratne PJ(2), Weissman MM(4), Talati A(2).

Author information:
(1)Department of Psychiatry, Vagelos College of Physicians and Surgeons, 
Columbia University, New York, NY 10032, United States of America; Manhattan 
Psychiatric Center, New York, NY 10035, United States of America. Electronic 
address: Eleanor.Murphy@nyspi.columbia.edu.
(2)Department of Psychiatry, Vagelos College of Physicians and Surgeons, 
Columbia University, New York, NY 10032, United States of America; New York 
State Psychiatric Institute, Division of Translational Epidemiology, New York, 
NY 10032, United States of America.
(3)New York State Psychiatric Institute, Division of Translational Epidemiology, 
New York, NY 10032, United States of America.
(4)Department of Psychiatry, Vagelos College of Physicians and Surgeons, 
Columbia University, New York, NY 10032, United States of America; New York 
State Psychiatric Institute, Division of Translational Epidemiology, New York, 
NY 10032, United States of America; Department of Epidemiology, Mailman School 
of Public Health, Columbia University, New York, NY 10032, United States of 
America.

BACKGROUND: Few studies have rigorously examined the effectiveness of commonly 
reported coping activities during the COVID-19 pandemic. This study was designed 
to assess perceived helpful activities during the pandemic and to investigate 
the extent to which these activities were associated with psychological 
outcomes.
METHOD: Adults living in the US (N = 204), who were part of a longitudinal 
family study of depression responded to an online survey. They reported on their 
perceived helpful activities during the pandemic. General linear regression 
models (GLM) were used to evaluate the association between perceived helpful 
activities and current psychiatric symptoms, controlling for demographic 
factors, and pre-pandemic psychiatric history and symptoms.
RESULTS: The top perceived helpful activity during COVID-19 was communicating 
with friends/family via telephone text or video (75.5 %). However, of the top 
five activities endorsed, cooking/baking was associated with the most clinical 
outcomes, including lower anxiety/depression and greater psychological wellbeing 
(all ps < 0.05). These relationships were most prominent among younger 
individuals < age 40 years, females, and those with recent psychiatric history, 
although they extended to younger males, and individuals at high or low 
depression risk.
LIMITATIONS: Close ended items limited variability in coping activities 
reported. The study lacked data on substance use. The sample was racially and 
ethnically homogenous.
CONCLUSIONS: These findings move beyond anecdotal evidence that cooking/baking 
as a coping activity yields protection against psychopathology. Its ready 
accessibility and ability to confer benefits across a range of individual 
characteristics, make it a useful adjunct in therapeutic interventions for 
people confined to their homes.

Copyright © 2023 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2023.07.009
PMCID: PMC10529101
PMID: 37442441 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest In the last 
three years, Dr. Weissman has received funding from NIMH, John J Templeton 
Foundation and Brain and Behavior {NARSAD} and has received royalties from 
Oxford University Press, Perseus Books Group, American Psychiatric Association 
Publishing, and Multi-Health Systems. None of these present any conflict with 
the present work, and no other authors report any disclosures.


534. Am Psychol. 2024 Feb-Mar;79(2):268-284. doi: 10.1037/amp0001188. Epub 2023 Jul 
13.

Distressed yet bonded: A longitudinal investigation of the COVID-19 pandemic's 
silver lining effects on life satisfaction.

Guan Y(1), Jiang D(2), Wu C(3), Deng H(4), Su S(5), Buchtel EE(6), Chen SX(7).

Author information:
(1)Department of International Business and Management, Nottingham University 
Business School China.
(2)Department of Special Education and Counselling, Education University of Hong 
Kong.
(3)Division of Epidemiology, Department of Internal Medicine, University of 
Utah.
(4)Department of Management and Marketing, Durham University Business School.
(5)Applied Psychology Program, School of Humanities and Social Science, Chinese 
University of Hong Kong (Shenzhen).
(6)Department of Psychology, Education University of Hong Kong.
(7)Department of Applied Social Sciences, Hong Kong Polytechnic University.

It is a common understanding that the 2019 coronavirus pandemic (COVID-19) 
significantly harmed mental health. However, findings on changes in overall life 
satisfaction have been mixed and inconclusive. To address this puzzling 
phenomenon, we draw upon the domain-specific perspective of well-being and 
research on catastrophe compassion and propose that the pandemic can have 
opposing effects on mental health and communal satisfaction, which then 
differently relate to people's overall life satisfaction. Longitudinal analyses 
of the Household, Income and Labour Dynamics (HILDA) Survey of Australia (N = 
12,093) showed that while there was a greater decrease in mental health in the 
first COVID-19 pandemic year (2019-2020) than in the previous years (2017-2019), 
an increase in communal satisfaction also occurred, demonstrating a potential 
silver lining effect of the pandemic on people's satisfaction with family, 
community, and neighborhood. Moreover, consistent with socioemotional 
selectivity theory, changes in mental health, communal satisfaction, and life 
satisfaction were related to age, such that older adults generally reported less 
harmful and more beneficial psychological changes. We further found that age was 
associated with stronger associations of mental health and communal satisfaction 
with life satisfaction during the pandemic year. Overall, our findings speak to 
the importance of communal life in life satisfaction during the pandemic and 
age-related differences in the process, shedding light on the need to devise 
customized support to address inequalities in pandemic effects on public 
well-being. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

DOI: 10.1037/amp0001188
PMID: 37439754 [Indexed for MEDLINE]


535. Infant Ment Health J. 2023 Jul;44(4):572-586. doi: 10.1002/imhj.22074.

Mental health and sleep quality of low-income mothers of one-year-olds during 
the COVID-19 pandemic.

Premo EM(1), Magnuson KA(1), Lorenzo NE(2), Fox NA(2), Noble KG(3).

Author information:
(1)Sandra Rosenbaum School of Social Work, University of Wisconsin-Madison, 
Madison, Wisconsin, USA.
(2)Department of Human Development and Quantitative Methodology, University of 
Maryland, College Park, Maryland, USA.
(3)Department of Biobehavioral Sciences and Human Development, Teachers College, 
Columbia University, New York City, New York, USA.

The COVID-19 pandemic and subsequent social restrictions created an 
unprecedented context for families raising young children. Although studies have 
documented detrimental effects of the pandemic on maternal well-being, less is 
known about how the pandemic specifically impacted low-income mothers. We 
examined depression, anxiety, and sleep quality among low-income mothers of 
one-year-olds during the early months of the pandemic using data from the Baby's 
First Years study. Focusing on the control group (n = 547), we compared mothers 
interviewed before March 14th, 2020 (n = 342) to mothers interviewed between 
March 14th and June 30th, 2020 (n = 205) to determine whether the pandemic was 
associated with differences in mental health and sleep quality. Mothers were 
recruited from four cities in the United States, and most of the sample 
identified as Hispanic (42.2%) or Black, non-Hispanic (38.6%). We found that 
mothers interviewed during the pandemic reported better mental health and sleep 
quality. While we cannot speak to longer-term impacts of the pandemic, it is 
possible low-income mothers experienced relief from daily stressors during the 
initial shelter-in-place orders, which may have led to improvements in 
well-being. These results have implications for understanding how complex life 
stressors influence mental health and sleep quality among low-income mothers 
raising young children.

Publisher: La pandemia del COVID-19 y las subsecuentes restricciones sociales 
crearon un contexto sin precedentes para las familias que estaban criando niños 
pequeños. Aunque los estudios han documentado los efectos perjudiciales de la 
pandemia sobre el bienestar materno, menos se conoce acerca de cómo la pandemia 
específicamente tuvo un impacto sobre madres de bajos recursos económicos. 
Examinamos la depresión, ansiedad y calidad del sueño entre madres de bajos 
recursos económicos de niños de un año de edad durante los primeros meses de la 
pandemia usando datos del estudio Primeros Años del Bebé. Enfocándonos en el 
grupo de control (n = 547), comparamos las madres entrevistadas antes del 14 de 
marzo de 2020 (n = 342) con madres entrevistadas entre el 14 de marzo y el 30 de 
junio de 2020 (n = 205) para determinar si la pandemia se asociaba con 
diferencias en salud mental y calidad del sueño. A las madres se les reclutó en 
cuatro ciudades de Estados Unidos y la mayor parte del grupo muestra se 
identificaron como Hispanas (42.2%) o Negras no Hispanas (38.6%). Encontramos 
que las madres entrevistadas durante la pandemia reportaron mejor salud mental y 
calidad del sueño. A pesar de que no podemos hablar sobre el impacto a largo 
plazo de la pandemia, es posible que las madres de bajos recursos económicos 
experimentaran alivio en los factores diarios de estrés durante el inicial 
mandato de quedarse en su casa, lo cual pudiera haber llevado a mejoras en el 
bienestar. Estos resultados tienen implicaciones para comprender cómo los 
complejos factores de estrés influyen en la salud mental y la calidad del sueño 
entre madres de bajos recursos económicos que crían a niños pequeños.

Publisher: La pandémie du COVID-19 et les restrictions sociales qui en ont 
découlé ont créé un contexte sans précédent pour les familles élevant de jeunes 
enfants. Bien que des études aient documenté des effets préjudiciables de la 
pandémie sur le bien-être maternel, on en sait moins sur la manière dont la 
pandémie a spécifiquement impacté les mères de milieux défavorisés. Nous avons 
examiné la dépression, l'anxiété, et la qualité du sommeil chez des mères de 
milieux défavorisés avec un enfant d'un an durant les premiers mois de la 
pandémie, en utilisant des données de l’étude Baby's First Years. Nous 
concentrant sur le groupe de contrôle (n = 547), nous avons comparé des mères 
interviewées avant le 14 mars 2020 (n = 342) à des mères interviewées entre le 
14 mars et le 30 juin 2020 (n = 205) afin de déterminer si la pandémie était 
liée à des différences en santé mentale et en qualité de sommeil. Les mères ont 
été recrutées dans quatre villes des Etats-Unis et la plupart de l’échantillon 
s'identifiait comme Hispanique (42,2%) ou Noires, non hispaniques (38,6%). Nous 
avons trouvé que les mères interviewées Durant la pandémie faisaient état d'une 
meilleure santé mentale et d'une meilleure qualité de sommeil. Bien que nous ne 
puissions pas parler des impacts de la pandémie à long terme, il est possible 
que les mères de milieux défavorisés aient fait l'expérience d'un soulagement 
des facteurs de stress quotidiens durant la période initiale de confinement, ce 
qui pourrait avoir mené à des améliorations dans le bien-être. Ces résultats ont 
des implications pour la compréhension de la manière dont des facteurs de stress 
complexes influencent la santé mentale et la qualité du sommeil chez les mères 
de milieux défavorisés élevant de jeunes enfants.

Publisher: Die COVID-19-Pandemie und die darauffolgenden sozialen 
Einschränkungen schufen ein noch nie dagewesenes Umfeld für Familien, die kleine 
Kinder aufziehen. Obwohl Studien negative Auswirkungen der Pandemie auf das 
Wohlbefinden von Müttern dokumentiert haben, ist weniger darüber bekannt, wie 
sich die Pandemie speziell auf Mütter mit niedrigem Einkommen auswirkte. Wir 
untersuchten Depression, Angst und Schlafqualität bei einkommensschwachen 
Müttern von Einjährigen in den ersten Monaten der Pandemie anhand von Daten aus 
der Baby's First Years-Studie. Wir konzentrierten uns auf die Kontrollgruppe (n 
= 547) und verglichen Mütter, die vor dem 14. März 2020 befragt wurden (n = 
342), mit Müttern, die zwischen dem 14. März und dem 30. Juni 2020 befragt 
wurden (n = 205), um festzustellen, ob die Pandemie mit Unterschieden in der 
psychischen Gesundheit und der Schlafqualität assoziiert war. Die Mütter wurden 
aus vier Städten in den Vereinigten Staaten rekrutiert und ein Großteil der 
Stichprobe identifizierte sich als hispanisch (42,2 %) oder schwarz, 
nicht-hispanisch (38,6 %). Wir fanden heraus, dass Mütter, die während der 
Pandemie befragt wurden, von einer besseren psychischen Gesundheit und 
Schlafqualität berichteten. Zwar können wir keine Aussagen zu den 
längerfristigen Auswirkungen der Pandemie treffen, allerdings ist es möglich, 
dass Mütter mit niedrigem Einkommen während der Phase der ersten 
Schutzanordnungen eine Entlastung von den täglichen Stressfaktoren erfuhren, was 
zu einer Verbesserung des Wohlbefindens geführt haben könnte. Diese Ergebnisse 
sind wichtig, um zu verstehen, wie komplexe Lebensstressoren die psychische 
Gesundheit und die Schlafqualität von Müttern mit geringem Einkommen und kleinen 
Kindern beeinflussen.

Publisher: 
COVID-19のパンデミックとその後の社会的制約は、幼な子を育てる家族にとって前例のない状況を作り出した。パンデミックが母親の幸福に有害な影響を及ぼすことは研究によって報告されているが、パンデミックが特に低所得の母親にどのような影響を与えたかについては、あまり知られていない。私達はBaby's 
First Years研究のデータを用いて、パンデミックの初期に1歳児を抱える低所得層の母親の抑うつや不安、睡眠の質を調査した。対照群 (n = 547) 
に焦点を当て、2020年3月14日以前に面接を受けた母親 (n = 342) と、2020年3月14日から6月30日までに面接を受けた母親 (n = 205) 
を比較し、パンデミックがメンタルヘルスと睡眠の質の違いに関連しているかどうかを検討した。母親は米国の4都市において募集し、サンプルのほとんどがヒスパニック 
(42.2％) または非ヒスパニック系の黒人 (38.6％) 
であった。パンデミック時にインタビューを受けた母親は、精神的な健康と睡眠の質が向上していると答えたことが分かった。パンデミックの長期的な影響については言及できないが、低所得の母親が最初の屋内退避命令中に日常的なストレスから解放され、それが幸福度の向上につながった可能性がある。これらの結果は、幼い子どもを育てている低所得の母親において、複雑な生活上のストレス要因がメンタルヘルスや睡眠の質にどのように影響するかを理解する上で示唆的である。.

Publisher: COVID-19大流行及其后续的社会限制为养育幼儿的家庭创造了前所未有的环境。虽然研究已经记录了疫情对母亲健康的不利影响, 
但人们对疫情如何具体影响低收入母亲知之甚少。我们使用“婴儿的第一年”研究的数据, 
考察了疫情早期阶段低收入一岁幼儿母亲的抑郁、焦虑和睡眠质量。我们将焦点放在对照组 (n = 547)上, 比较了2020年3月14日之前接受采访的母亲 (n = 
342)和在2020年3月14日至6月30日之间接受采访的母亲 (n = 205), 
以确定疫情是否与心理健康和睡眠质量的差异有关。母亲是从美国的四个城市招募的, 大部分样本被确定为西班牙裔 (42.2%) 或非西班牙裔黑人 
(38.6%)。我们发现, 在疫情期间接受采访的母亲表示心理健康和睡眠质量更好。虽然我们无法谈论疫情的长期影响, 但是在最初的避难令期间, 
低收入母亲可能经历了日常压力的缓解, 这可能导致了健康状况的改善。这些结果对于理解复杂的生活压力如何影响养育幼儿的低收入母亲的心理健康和睡眠质量具有重要意义。.

Publisher: خلقت جائحة كوفيد-19 والقيود الاجتماعية المترتبة عليها بيئة غير مسبوقة 
للأسر التي تربي أطفالاً صغاراً. على الرغم من أن الدراسات قد وثقت الآثار الضارة 
للوباء على رفاهية الأم ، إلا أنه لا يُعرف الكثير عن كيفية تأثير الوباء على 
الأمهات ذوات الدخل المنخفض على وجه التحديد. قمنا بفحص الاكتئاب والقلق وجودة 
النوم بين الأمهات ذوات الدخل المنخفض لأطفال بعمر عام واحد خلال الأشهر الأولى من 
الوباء باستخدام بيانات من دراسة السنوات الأولى للطفل. بالتركيز على المجموعة 
الضابطة (العدد = 547) ، قمنا بمقارنة الأمهات اللواتي تمت مقابلتهن قبل 14 مارس 
2020 (العدد = 342) بالأمهات اللائي تمت مقابلتهن بين 14 مارس و 30 يونيو 2020 
(العدد = 205) لتحديد ما إذا كان الوباء مرتبطاً بالاختلافات في الصحة النفسية 
ونوعية النوم. اشتركت الأمهات من أربع مدن في الولايات المتحدة ، وتم تحديد معظم 
العينة على أنها لاتينية (42.2٪) أو سوداء ، وغير لاتينية (38.6٪). وجدنا أن 
الأمهات اللواتي تمت مقابلتهن أثناء الوباء أبلغن عن صحة نفسية وجودة نوم أفضل. في 
حين أننا لا نستطيع التحدث عن الآثار طويلة المدى للوباء ، فمن الوارد أن الأمهات 
ذوات الدخل المنخفض قد حصلن على بعض الراحة من الضغوط اليومية نتيجة الإغلاق ، مما 
أدى إلى تحسين مستوى الرفاهية. هذه النتائج لها تطبيقات لفهم مدى تأثير ضغوطات 
الحياة المعقدة على الصحة النفسية وجودة النوم بين الأمهات ذوات الدخل المنخفض 
اللائي يقمن بتربية أطفال صغار.

© 2023 The Authors. Infant Mental Health Journal published by Wiley Periodicals 
LLC on behalf of Michigan Association for Infant Mental Health.

DOI: 10.1002/imhj.22074
PMCID: PMC10403317
PMID: 37439103 [Indexed for MEDLINE]


536. BMC Psychiatry. 2023 Jul 13;23(1):506. doi: 10.1186/s12888-023-04947-x.

Parents' self-reporting of Child Physical Maltreatment (CPM) in a 
low-middle-income country.

Abdeen MS(1), Hashim MA(2), Ghanem MM(3), El-Din NYS(4), Nagar ZME(2).

Author information:
(1)Psychiatry Department, Faculty of Medicine, Ain Shams University, 38 Abbaseya 
St, Cairo, Egypt. mai_saifeldin@med.asu.edu.eg.
(2)Psychiatry Department, Faculty of Medicine, Ain Shams University, 38 Abbaseya 
St, Cairo, Egypt.
(3)Psychiatry Department, Faculty of Medicine, Helwan University, Cairo, Egypt.
(4)Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, 
Egypt.

BACKGROUND: Because of COVID-19 pandemic, families across the world are 
experiencing new stressors that threaten their health, and economic well-being. 
Such a stress may jeopardize parents-children relationship. We aim to 
investigate the magnitude of child physical maltreatment (CPM) by parents in 
Egypt during the COVID-19 pandemic, to relate it to parents' stress, and to 
identify other potential risk factors.
METHODS: This cross-sectional study assessed parent-reported CPM and their 
personal experience of stress, depression, and anxiety among a sample of 
Egyptian parents using an electronic survey. It included sociodemographic data, 
Depression, Anxiety and Stress Scale (DASS-21), and the Child physical 
maltreatment scale (CPMS). We also briefly assessed COVID-19 -related data.
RESULTS: Out of 404 respondents, (62.9%) and (32.9%) reported performing minor 
and severe CPM toward their children during the past 3 months, respectively. The 
age of youngest child, and anxiety score were significantly correlated with both 
minor and severe forms of CPM. While number of children, and online education 
system ratings were only significantly correlated with severe CPM. Parental 
definition of CPM was significantly correlated to minor CPM, but not to severe 
CPM.
CONCLUSIONS: CPM by parents is not uncommon in Egypt, especially during the 
COVID-19 pandemic. These findings highlight the importance of regular support 
and intervention that help parents learn parenting skills and the use of 
non-violent child disciplining methods.

© 2023. The Author(s).

DOI: 10.1186/s12888-023-04947-x
PMCID: PMC10339565
PMID: 37438727 [Indexed for MEDLINE]

Conflict of interest statement: None.


537. Eur J Public Health. 2023 Oct 10;33(5):764-770. doi: 10.1093/eurpub/ckad108.

Assessing the impact of energy and fuel poverty on health: a European scoping 
review.

Champagne SN(1), Phimister E(2)(3), Macdiarmid JI(4), Guntupalli AM(1).

Author information:
(1)Institute of Applied Health Sciences, School of Medicine, Medical Sciences 
and Nutrition, University of Aberdeen, Aberdeen, UK.
(2)Department of Economics, Business School, University of Aberdeen, Aberdeen, 
UK.
(3)Stellenbosch Business School, Stellenbosch University, South Africa.
(4)Rowett Institute, School of Medicine, Medical Sciences and Nutrition, 
University of Aberdeen, Aberdeen, UK.

Erratum in
    Eur J Public Health. 2023 Sep 20;:

BACKGROUND: The burden of energy and fuel poverty (EFP) in Europe is increasing 
in the face of the cost-of-living crisis, the Russian invasion of Ukraine, the 
coronavirus disease 2019 (COVID-19) pandemic and the climate emergency. While 
the health impacts of EFP are often the driving reason for addressing it, EFP's 
association with health is poorly delineated. This review aims to scope the 
evidence of EFP's association with health in Europe.
METHODS: A scoping review based on Arksey and O'Malley's framework was conducted 
using search terms relevant to EFP, health and Europe. Five databases were 
searched, in addition to hand searching. Review selection was performed by two 
independent reviewers, and articles were thematically analyzed.
RESULTS: Thirty-five articles published between January 2000 and March 2022 were 
included. The literature varied in definitions and measurements of EFP and in 
the health indicators examined. The review revealed a negative association 
between EFP and health, specifically, general unspecified poor health (9 
articles), excess winter mortality (3 articles), communicable diseases (3 
articles), non-communicable diseases (11 articles), mental health (15 articles) 
and well-being (12 articles). While women were reported to be at a higher risk 
of EFP than men, children and older adults were identified as particularly 
vulnerable to EFP's adverse health repercussions.
CONCLUSIONS: This scoping review illustrates a significant and complex 
association between EFP and various domains of health. Though heterogeneity 
across research makes it difficult to compare findings, our review supports the 
use of health as a justification to address EFP and urges public health to be 
more involved in EFP mitigation.

© The Author(s) 2023. Published by Oxford University Press on behalf of the 
European Public Health Association.

DOI: 10.1093/eurpub/ckad108
PMCID: PMC10567131
PMID: 37437903 [Indexed for MEDLINE]


538. PLoS One. 2023 Jul 11;18(7):e0287821. doi: 10.1371/journal.pone.0287821. 
eCollection 2023.

The impact of COVID-19 on the mental health and well-being of ambulance care 
professionals: A rapid review.

Ebben RHA(1), Woensdregt T(1), Wielenga-Meijer E(2), Pelgrim T(1), de Lange 
A(3)(4)(5)(6), Berben SAA(1)(7), Vloet LCM(1)(7).

Author information:
(1)Research Department of Emergency and Critical Care, HAN University of Applied 
Sciences, School of Health Studies, Nijmegen, the Netherlands.
(2)Research Department Human Resource Management, HAN University of Applied 
Sciences, School of Organisation and Development, Nijmegen, the Netherlands.
(3)Department of Psychology, Universidade da Coruna, A Coruña, Spain.
(4)Faculty of Psychology, Open University Heerlen, Heerlen, Netherlands.
(5)University of Stavanger, Norwegian School of Hotel Management, Stavanger, 
Norway.
(6)Faculty of Psychology, Norwegian University of Science and Technology, 
Trondheim, Norway.
(7)Radboud University Medical Center, Radboud Institute for Health Sciences, IQ 
healthcare, Nijmegen, The Netherlands.

The COVID-19 pandemic has a significant impact on the health and well-being of 
all healthcare professionals. However, for ambulance care professionals it is 
unknown on which health outcomes the impact of COVID-19 is measured, and what 
the actual impact on these health outcomes is. Therefore, the aim of this study 
was to gain insight in a) which type of health outcomes were measured in 
relation to the impact of COVID-19 among ambulance care professionals, and b) to 
determine the actual impact on these outcomes. A rapid review was performed in 
PubMed (including MEDLINE) and APA PsycInfo (EBSCO). All types of study designs 
on health and well-being of ambulance care professionals were included. 
Selection on title an abstract was performed by pairs of two reviewers. Full 
text selection, data extraction and quality assessment were performed by one 
reviewer, with a check by a second independent reviewer. The systematic searches 
identified 3906 unique hits, seven articles meeting selection criteria were 
included. Six studies quantitatively measured distress (36,0%) and PTSD 
(18.5%-30.9%), anxiety (14.2%-65.6%), depression (12.4%-15.3%), insomnia 
(60.9%), fear of infection and transmission of infection (41%-68%), and 
psychological burden (49.4%-92.2%). These studies used a variety of instruments, 
ranging from internationally validated instruments to self-developed and 
unvalidated questionnaires. One study qualitatively explored coping with 
COVID-19 by ambulance care professionals and reported that ambulance care 
professionals use five different strategies to cope with the impact of COVID-19. 
There is limited attention for the health and well-being of ambulance care 
professionals during the COVID-19 pandemic. Although the included number of 
studies and included outcomes are too limited to draw strong conclusions, our 
results indicate higher rates of distress, PTSD and insomnia compared to the 
pre-COVID-19 era. Our results urge the need to investigate the health and 
well-being of ambulance care professionals during and after the COVID-19 
pandemic.

Copyright: © 2023 Ebben et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0287821
PMCID: PMC10335670
PMID: 37432937 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


539. BMC Psychiatry. 2023 Jul 10;23(1):494. doi: 10.1186/s12888-023-04969-5.

Depression, anxiety, and burnout among psychiatrists during the COVID-19 
pandemic: a cross-sectional study in Beijing, China.

Dong P(#)(1), Lin X(#)(1), Wu F(1), Lou S(1), Li N(1), Hu S(1), Shi L(1), He 
J(1), Ma Y(1), Bao Y(2), Lu L(1)(2)(3), Sun W(4), Sun H(5).

Author information:
(1)NHC Key Laboratory of Mental Health (Peking University), Peking University 
Sixth Hospital, Peking University Institute of Mental Health, National Clinical 
Research Center for Mental Disorders (Peking University Sixth Hospital, Peking 
University), Beijing, 100191, China.
(2)National Institute on Drug Dependence and Beijing Key Laboratory on Drug 
Dependence Research, Peking University, Beijing, 100191, China.
(3)Peking-Tsinghua Center for Life Sciences and PKU-IDG, McGovern Institute for 
Brain Research, Beijing, 100191, China.
(4)NHC Key Laboratory of Mental Health (Peking University), Peking University 
Sixth Hospital, Peking University Institute of Mental Health, National Clinical 
Research Center for Mental Disorders (Peking University Sixth Hospital, Peking 
University), Beijing, 100191, China. weisun@bjmu.edu.cn.
(5)NHC Key Laboratory of Mental Health (Peking University), Peking University 
Sixth Hospital, Peking University Institute of Mental Health, National Clinical 
Research Center for Mental Disorders (Peking University Sixth Hospital, Peking 
University), Beijing, 100191, China. sunhq@bjmu.edu.cn.
(#)Contributed equally

BACKGROUND: With the rise of reported mental disorders and behavioral issues 
after the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, 
psychiatrists and mental health care are urgently needed more than ever before. 
The psychiatric career carries a high emotional burden and stressful demands, 
which bring issues on psychiatrists' mental health and well-being into question. 
To investigate the prevalence and risk factors of depression, anxiety, and work 
burnout among psychiatrists in Beijing during the COVID-19 pandemic.
METHODS: This cross-sectional survey was conducted from January 6 to January 30, 
2022, two years after COVID-19 was declared a global pandemic. Recruitment was 
performed using a convenience sample approach by sending online questionnaires 
to psychiatrists in Beijing. The symptoms of depression, anxiety, and burnout 
were evaluated using the Patient Health Questionnaire-9 (PHQ-9), Generalized 
Anxiety Disorder-7 (GAD-7), and Maslach Burnout Inventory-General Survey 
(MBI-GS). The perceived stress and social support were measured by the Chinese 
Perceived Stress Scale (CPSS) and Social Support Rating Scale (SSRS), 
respectively.
RESULTS: The data of 564 psychiatrists (median [interquartile range] age, 37 
[30-43] years old) of all 1532 in Beijing were included in the statistical 
analysis. The prevalence of symptoms of depression, anxiety and burnout were 
33.2% (95% CI, 29.3-37.1%, PHQ-9 ≥ 5), 25.4% (95% CI, 21.8-29.0%, GAD-7 ≥ 5) and 
40.6% (95% CI, 36.5-44.7%, MBI-GS ≥ 3 in each of the three subdimensions), 
respectively. The psychiatrist with a higher score on perceived stress was more 
likely to suffer from depressive symptoms (adjusted odds ratios [ORs]: 4.431 
[95%CI, 2.907-6.752]); the anxiety symptoms (adjusted ORs: 8.280 [95%CI, 
5.255-13.049]), and the burnout conditions (adjusted ORs: 9.102 [95%CI, 
5.795-14.298]). Receiving high social support was an independent protective 
factor against symptoms of depression (adjusted ORs: 0.176 [95%CI, 
[0.080-0.386]), anxiety (adjusted ORs: 0.265 [95%CI, 0.111-0.630]) and burnout 
(adjusted ORs: 0.319 [95%CI, 0.148-0.686]).
CONCLUSIONS: Our data suggest a considerable proportion of psychiatrists also 
suffer from depression, anxiety, and burnout. Perceived stress and social 
support influence depression, anxiety, and burnout. For public health, we must 
work together to reduce the pressure and increase social support to mitigate 
mental health risks in psychiatrists.

© 2023. The Author(s).

DOI: 10.1186/s12888-023-04969-5
PMCID: PMC10334525
PMID: 37430237 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


540. BMJ Open. 2023 Jul 10;13(7):e071083. doi: 10.1136/bmjopen-2022-071083.

Cohort profile: Ngā Kawekawe o Mate Korona | Impacts of COVID-19 in Aotearoa - a 
prospective, national cohort study of people with COVID-19 in New Zealand.

Russell L(1), Jeffreys M(2), Churchward M(1), Cumming J(1), McKenzie F(3), 
O'Loughlin C(1), Asiasiga L(4), Bell R(5), Hickey H(6), Irurzun-Lopez M(1), 
Kamau L(1), Kokaua J(7), McDonald J(1), McFarland-Tautau M(8), Smiler K(8), Uia 
T(1), Vaka S(4), Veukiso-Ulugia A(4), Wong C(4), Ellison Loschmann L(3).

Author information:
(1)Health Services Research Centre, Victoria University, Wellington, New 
Zealand.
(2)Health Services Research Centre, Victoria University, Wellington, New Zealand 
mona.jeffreys@vuw.ac.nz.
(3)Flax Analytics Ltd, Wellington, New Zealand.
(4)Independent Researcher, Auckland, New Zealand.
(5)Remix Coaching and Consulting, Blenheim, New Zealand.
(6)Pukenga Consultancy, Auckland, New Zealand.
(7)Independent Researcher, Dunedin, New Zealand.
(8)School of Health, Victoria University of Wellington, Wellington, New Zealand.

PURPOSE: The COVID-19 pandemic has had significant health, social and economic 
impacts around the world. We established a national, population-based 
longitudinal cohort to investigate the immediate and longer-term physical, 
psychological and economic impacts of COVID-19 on affected people in Aotearoa 
New Zealand (Aotearoa), with the resulting evidence to assist in designing 
appropriate health and well-being services for people with COVID-19.
PARTICIPANTS: All people residing in Aotearoa aged 16 years or over, who had a 
confirmed or probable diagnosis of COVID-19 prior to December 2021, were invited 
to participate. Those living in dementia units were excluded. Participation 
involved taking part in one or more of four online surveys and/or in-depth 
interviews. The first wave of data collection took place from February to June 
2022.
FINDINGS TO DATE: By 30 November 2021, of 8735 people in Aotearoa aged 16+ who 
had COVID-19, 8712 were eligible for the study and 8012 had valid addresses so 
were able to be contacted to take part. A total of 990 people, including 161 
Tāngata Whenua (Māori, Indigenous peoples of Aotearoa) completed one or more 
surveys; in addition, 62 took part in in-depth interviews. Two hundred and 
seventeen people (20%) reported symptoms consistent with long COVID. Key areas 
of adverse impacts were experiences of stigma, mental distress, poor experiences 
of health services and barriers to healthcare, each being significantly more 
pronounced among disabled people and/or those with long COVID.
FUTURE PLANS: Further data collection is planned to follow-up cohort 
participants. This cohort will be supplemented by the inclusion of a cohort of 
people with long COVID following Omicron infection. Future follow-ups will 
assess longitudinal changes to health and well-being impacts, including mental 
health, social, workplace/education and economic impacts of COVID-19.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2022-071083
PMCID: PMC10335514
PMID: 37429685 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


541. Rehabil Psychol. 2023 Nov;68(4):362-373. doi: 10.1037/rep0000498. Epub 2023 Jul 
10.

Subjective well-being of adults with multiple sclerosis during COVID-19: 
Evaluating stress-appraisal-coping and person-environment factors.

Iwanaga K(1), Chan F(2), Rumrill P(3), Ditchman N(4).

Author information:
(1)Department of Rehabilitation Counseling, College of Health Professions, 
Virginia Commonwealth University.
(2)Department of Rehabilitation Psychology and Special Education, University of 
Wisconsin-Madison.
(3)Department of Early Childhood, Special Education, and Counselor Education, 
University of Kentucky.
(4)Department of Psychology, Illinois Institute of Technology.

BACKGROUND: People with multiple sclerosis (MS) have been coping with high 
levels of stress during the ongoing coronavirus pandemic, affecting their 
employment, physical, and mental health, and overall life satisfaction.
OBJECTIVE: This study evaluated constructs of the stress-appraisal-coping theory 
and positive person-environment factors as predictors of subjective well-being 
for adults with MS.
METHOD: Participants included 477 adults with MS recruited through the National 
Multiple Sclerosis Society. Hierarchical regression analysis was used to 
determine the incremental variance in subjective well-being accounted for by 
demographic covariates, functional disability, perceived stress, stress 
appraisal, coping styles, and positive person-environment contextual factors.
RESULTS: Positive stress appraisal and coping flexibility were significantly 
associated with subjective well-being at the bivariate correlation level and at 
the step they were entered into the regression model. Marital status, household 
income, functional disability, perceived stress, hope, core self-evaluations, 
and social support were significant predictors in the final model, accounting 
for 60% of the variance in subjective well-being scores (R² = .60, f² = 1.48; 
large effect size).
CONCLUSIONS: Findings from this study support a stress management and well-being 
model based on constructs of Lazarus and Folkman's stress-appraisal-coping 
theory and positive person-environment contextual factors, which can inform the 
development of theory-driven and empirically supported stress management and 
well-being interventions for people with MS during the ongoing global health 
crisis. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

DOI: 10.1037/rep0000498
PMID: 37428785 [Indexed for MEDLINE]


542. Front Public Health. 2023 Jun 22;11:1194908. doi: 10.3389/fpubh.2023.1194908. 
eCollection 2023.

eHealth literacy was associated with anxiety and depression during the COVID-19 
pandemic in Nigeria: a cross-sectional study.

Akingbade O(1)(2), Adeleye K(3), Fadodun OA(4), Fawole IO(2)(5), Li J(6), Choi 
EPH(6), Ho M(6), Lok KYW(6), Wong JYH(7), Fong DYT(6), Ogungbe O(8).

Author information:
(1)The Nethersole School of Nursing, The Chinese University of Hong Kong, 
Shatin, Hong Kong SAR, China.
(2)Institute of Nursing Research, Osogbo, Osun, Nigeria.
(3)University of Massachusetts, Amherst, MA, United States.
(4)Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada.
(5)Ladoke Akintola University of Technology, Ogbomoso, Nigeria.
(6)School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, 
China.
(7)School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong 
Kong, Hong Kong SAR, China.
(8)Johns Hopkins University School of Nursing, Baltimore, MD, United States.

BACKGROUND: Electronic health (eHealth) literacy may play an important role in 
individuals' engagement with online mental health-related information.
AIM: To examine associations between eHealth literacy and psychological outcomes 
among Nigerians during the Coronavirus disease-2019 (COVID-19) pandemic.
METHODS: This was a cross-sectional study among Nigerians conducted using the 
'COVID-19's impAct on feaR and hEalth (CARE) questionnaire. The exposure: 
eHealth literacy, was assessed using the eHealth literacy scale, and 
psychological outcomes were assessed using the PHQ-4 scale, which measured 
anxiety and depression; and the fear scale to measure fear of COVID-19. We 
fitted logistic regression models to assess the association of eHealth literacy 
with anxiety, depression, and fear, adjusting for covariates. We included 
interaction terms to assess for age, gender, and regional differences. We also 
assessed participants' endorsement of strategies for future pandemic 
preparedness.
RESULTS: This study involved 590 participants, of which 56% were female, and 38% 
were 30 years or older. About 83% reported high eHealth literacy, and 55% 
reported anxiety or depression. High eHealth literacy was associated with a 66% 
lower likelihood of anxiety (adjusted odds ratio aOR, 0·34; 95% confidence 
interval, 0·20-0·54) and depression (aOR: 0·34; 95% CI, 0·21-0·56). There were 
age, gender, and regional differences in the associations between eHealth 
literacy and psychological outcomes. eHealth-related strategies such as medicine 
delivery, receiving health information through text messaging, and online 
courses were highlighted as important for future pandemic preparedness.
CONCLUSION: Considering that mental health and psychological care services are 
severely lacking in Nigeria, digital health information sources present an 
opportunity to improve access and delivery of mental health services. The 
different associations of e-health literacy with psychological well-being 
between age, gender, and geographic region highlight the urgent need for 
targeted interventions for vulnerable populations. Policymakers must prioritize 
digitally backed interventions, such as medicine delivery and health information 
dissemination through text messaging, to address these disparities and promote 
equitable mental well-being.

Copyright © 2023 Akingbade, Adeleye, Fadodun, Fawole, Li, Choi, Ho, Lok, Wong, 
Fong and Ogungbe.

DOI: 10.3389/fpubh.2023.1194908
PMCID: PMC10323132
PMID: 37427252 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


543. Sci Rep. 2023 Jul 8;13(1):11078. doi: 10.1038/s41598-023-38287-3.

Exploring park visitation trends during the Covid-19 pandemic in Hungary by 
using mobile device location data.

Csomós G(1), Borza EM(2), Farkas JZ(3).

Author information:
(1)Department of Civil Engineering, Faculty of Engineering, University of 
Debrecen, 2-4 Ótemető út, Debrecen, 4028, Hungary. csomos@eng.unideb.hu.
(2)CIAS, Corvinus University of Budapest, 8 Fővám tér, Budapest, 1093, Hungary.
(3)Centre for Economic and Regional Studies, Great Plain Research Department, 3 
Rakóczi út, Kecskemét, 6000, Hungary.

Sweeping changes in park visitation have accompanied the Covid-19 pandemic. In 
countries where governments imposed strict lockdowns during the first wave, park 
visitation declined in cities. The benefits of visiting urban green spaces on 
people's mental and physical health and well-being are generally acknowledged; 
many people in confinement during lockdowns reported increasing mental health 
issues. Therefore, based on lessons learned from the Covid-19 pandemic's first 
wave, urban parks and other urban green spaces remained open in most countries 
in subsequent pandemic phases. Furthermore, many studies have reported an 
overall increase in park visitation after strict lockdowns imposed in the 
pandemic's first wave have been removed. This study aims to investigate park 
visitation trends in Hungary based on a dataset of 28 million location data 
points from approximately 666,000 distinct mobile devices collected in 1884 
urban parks and other urban green spaces in 191 settlements between June 1, 
2019, and May 31, 2021. Findings demonstrate that park visitation increased in 
the inter-wave period of 2020, compared to the pre-pandemic period of 2019, and 
decreased in Waves 2-3 of 2021, compared to Wave 1 of 2020.

© 2023. The Author(s).

DOI: 10.1038/s41598-023-38287-3
PMCID: PMC10329667
PMID: 37422583 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


544. Psychol Health Med. 2023 Jul-Dec;28(7):1803-1817. doi: 
10.1080/13548506.2023.2229235. Epub 2023 Jul 6.

Associations between COVID-19 mental impact and distress, resilience, burnout 
and well-being in Hong Kong community adults: A structural equation model.

Fong TCT(1), Chang K(2), Sit HF(3), Ho RTH(1)(4).

Author information:
(1)Centre on Behavioral Health, The University of Hong Kong, Pokfulam, Hong Kong 
SAR.
(2)Department of Psychology, University of Macau, Taipa, Macau SAR.
(3)Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong 
SAR.
(4)Department of Social Work and Social Administration, The University of Hong 
Kong, Pokfulam, Hong Kong SAR.

The COVID-19 pandemic poses substantial risks to individuals' physical and 
mental health and prolonged psychological responses to the pandemic could lead 
to emotional exhaustion. The present study aimed to examine the mediating role 
of COVID-19 related mental impact and distress in the relationship among 
resilience, burnout, and well-being. The present study recruited 500 community 
adults (mean age = 38.8 years, SD = 13.9; 76% females) in Hong Kong via an 
online survey in autumn 2021. The participants completed the Mental Impact and 
Distress Scale: COVID-19 (MIDc) and validated measures on resilience, burnout, 
and well-being. Confirmatory factor analysis was conducted to evaluate the 
psychometric properties of the MIDc. Direct and indirect effects of resilience 
on burnout and well-being via MIDc were examined via structural equation 
modeling. Confirmatory factor analysis supported factorial validity for the 
three factors of MIDc (situational impact, anticipation, and modulation). 
Resilience showed negative effects on the MIDc (β = -0.69, SE = 0.04, p < 0.01) 
and burnout (β = 0.23, SE = 0.06, p < 0.01). Burnout was positively associated 
with MIDc (β = 0.63, SE = 0.06, p < 0.01) and negatively associated with 
well-being (β = -0.47, SE = 0.07, p < 0.01). Resilience showed a significant and 
positive indirect effect (αβγ = 0.203, 95% CI = 0.131 to 0.285) on well-being 
via MIDc and burnout. The results support a potential mediating role for MIDc as 
psychological responses in the relationship among resilience and burnout and 
well-being.

DOI: 10.1080/13548506.2023.2229235
PMID: 37415290 [Indexed for MEDLINE]


545. BMC Public Health. 2023 Jul 6;23(1):1299. doi: 10.1186/s12889-023-16233-2.

Intimate Partner Violence among women living in families with children under the 
poverty line and its association with common mental disorders during COVID-19 
pandemics in Ceará, Brazil.

Giacomini SG(1), Machado MM(1), de Santana OM(2), Rocha SG(1), de Aquino CM(3), 
Gomes LG(4), de Albuquerque LS(1), de Soares MDA(4), Leite ÁJ(3), Correia LL(1), 
Rocha HA(5).

Author information:
(1)Department of Community Health, Federal University of Ceará, Fortaleza, CE, 
Brazil.
(2)Laboratory of Epidemiology and Data Analysis, University Health Center ABC. 
FMABC, Santo André, São Paulo, Brazil.
(3)Department of Maternal and Child Health, Federal University of Ceará, 
Fortaleza, CE, Brazil.
(4)Social Protection Secretariat. Ceará State Government, Fortaleza, CE, Brazil.
(5)Department of Community Health, Federal University of Ceará, Fortaleza, CE, 
Brazil. hermano@ufc.br.

BACKGROUND: Intimate partner violence (IPV) is a pervasive public health issue 
that affects millions of women worldwide. Women living below the poverty line 
experience higher rates of violence and fewer resources to escape or cope with 
the abuse, and the COVID-19 pandemic has significantly impacted women's economic 
well-being worldwide. We conducted a cross-sectional study in Ceará, Brazil, on 
women in families with children living below the poverty line at the peak of the 
second wave of COVID to assess the prevalence of IPV and its association with 
common mental disorders(CMD).
METHODS: The study population comprised families with children up to six years 
of age who participated in the cash transfer program "Mais Infância". The 
families selected to participate in this program must meet a poverty criterion: 
families must live in rural areas, in addition to a monthly per capita income of 
less than US$16.50 per month. We applied specific instruments to evaluate IPV 
and CMD. To access IPV, we used the Partner Violence Screen (PVS). The 
Self-Reporting Questionnaire (SRQ-20) was used to assess CMD. To verify the 
association between IPV and the other evaluated factors with CMD, simple and 
hierarchical multiple logistic models were used.
RESULTS: Of the 479 participant women, 22% were positively screened for IPV (95% 
CI 18.2-26.2). After multivariate adjustment, the chances of CMD are 2.32 higher 
in women exposed to IPV than in those not exposed to IPV ((95%CI 1.30-4.13), p 
value = 0.004). CMD was also associated with job loss during the COVID-19 
pandemic (ORa 2.13 (95% CI 1.09-4.35), p-value 0.029). In addition to these, 
separate or single marital status, as well as non-presence of the father at home 
and food insecurity were associated with CMD.
CONCLUSION: We conclude that the prevalence of intimate partner violence in 
families with children up to six years of age living below the poverty line in 
Ceará is high and is associated with greater chances of common mental disorders 
in mothers. Also, job loss and reduced access to food caused by the Covid 19 
pandemic exacerbated both phenomena, constituting a double burden generator 
factor on mothers.

© 2023. The Author(s).

DOI: 10.1186/s12889-023-16233-2
PMCID: PMC10327360
PMID: 37415137 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


546. Public Health Rep. 2023 Sep-Oct;138(5):812-821. doi: 10.1177/00333549231176000. 
Epub 2023 Jul 5.

General Mental Health, Loneliness, and Life Satisfaction in the Context of 
COVID-19 Policies: A 2-Year Cohort Study in the Netherlands, April 2020-January 
2022.

van den Boom W(1), Marra E(1)(2), van der Vliet N(1)(3), Elberse J(1)(2), van 
Dijken S(4), van Dijk M(1), Euser S(1), Derks M(1), Leurs M(1), Albers C(5), 
Sanderman R(6)(7), de Bruin M(1)(8).

Author information:
(1)Corona Behavioral Unit, National Institute for Public Health and the 
Environment, Bilthoven, the Netherlands.
(2)Centre for Environmental Safety and Security, National Institute for Public 
Health and the Environment, Bilthoven, the Netherlands.
(3)Tilburg School of Social and Behavioral Sciences, Tilburg University, 
Tilburg, the Netherlands.
(4)Municipal Health Service, Almere, the Netherlands.
(5)Heymans Institute for Psychological Research, University of Groningen, 
Groningen, the Netherlands.
(6)University Medical Center Groningen, University of Groningen, Groningen, the 
Netherlands.
(7)Department of Psychology, Health and Technology, University of Twente, 
Enschede, the Netherlands.
(8)Institute of Health Sciences, IQ Healthcare, Radboud University Medical 
Center, Nijmegen, the Netherlands.

OBJECTIVE: Although the COVID-19 pandemic has affected mental health, 
understanding who has been affected most and why is incomplete. We sought to 
understand changes in mental health in the context of transmission numbers and 
pandemic (social) restrictions and whether changes in mental health varied among 
population groups.
METHODS: We analyzed data from 92 062 people (aged ≥16 years and able to read 
Dutch) who participated in the Corona Behavioral Unit cohort study at the 
National Institute for Public Health and the Environment, the Netherlands, from 
April 17, 2020, through January 25, 2022. Participants self-reported mental 
well-being through multiple rounds of surveys. We used a multivariable linear 
mixed-effects model to analyze loneliness, general mental health, and life 
satisfaction.
RESULTS: As strictness of pandemic prevention measures and social restrictions 
increased, people's feelings of loneliness increased and mental health and life 
satisfaction decreased. As restrictions were relaxed, loneliness decreased and 
general mental health improved. Younger people (aged 16-24 y) versus older 
people (aged ≥40 y), people with low (vs high) education levels, and people 
living alone (vs living together) were more likely to have negative well-being 
outcomes. We observed that trajectories over time differed considerably only by 
age, with participants aged 16-24 years affected substantially more than 
participants aged ≥40 years by pandemic social restrictions. These patterns were 
consistent across multiple waves of SARS-CoV-2 infection.
CONCLUSIONS: Our findings suggest that the social restrictions imposed by the 
Dutch government during the study period were associated with reduced mental 
well-being, especially among younger people. However, people appeared resilient 
as they recovered during periods when restrictions were relaxed. Monitoring and 
supporting well-being, in particular to reduce loneliness, may help younger 
people during periods of intense social restrictions.

DOI: 10.1177/00333549231176000
PMCID: PMC10323514
PMID: 37408335 [Indexed for MEDLINE]

Conflict of interest statement: The authors declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


547. BMC Public Health. 2023 Jul 5;23(1):1294. doi: 10.1186/s12889-023-16135-3.

Risk factors for newly-developed cardiovascular disease and quality of life 
during the COVID - 19 pandemic: an analysis of the English longitudinal study of 
ageing.

Patel M(1), Uthman O(2).

Author information:
(1)Warwick Evidence, Warwick Medical School (WMS), University of Warwick, 
Coventry, CV47AL, UK. Mubarak.patel@warwick.ac.uk.
(2)Warwick Medical School (WMS), University of Warwick, Coventry, CV47AL, UK.

INTRODUCTION: The COVID-19 pandemic had a wide range of effects on the English 
population, including on health and quality of life due to the subsequent 
lockdown restrictions set.
AIMS: To investigate longitudinal changes in developing cardiovascular disease 
(CVD) and how that affects quality of life from pre-pandemic and during two 
lockdowns in England, in adults aged 50 years and above, and what factors are 
associated with this.
METHODS: Wave 9 of the core English Longitudinal Study of Ageing (ELSA) and 
Waves 1 and 2 of the ELSA COVID-19 sub-study were used to investigate the 
factors associated with developing CVD between timepoints, and what factors 
alongside CVD are associated with quality of life.
RESULTS: Higher age and depression were associated with newly-developed CVD from 
pre-COVID to both COVID sub-study waves. Additionally, body mass index (BMI) 
increased odds of CVD and physical activity decreased odds. Non-White ethnicity, 
depression, females, and developing CVD were lower associated with quality of 
life. Decreased age and increased physical activity were associated with higher 
quality of life.
DISCUSSION: Ethnicity was not associated with newly-developed CVD but was 
associated with quality of life. Other factors of importance include age, 
depression, gender, and physical activity. Findings are informative for future 
risk stratification and treatment strategies, especially while the COVID-19 
pandemic is ongoing.

© 2023. Crown.

DOI: 10.1186/s12889-023-16135-3
PMCID: PMC10320953
PMID: 37407910 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


548. Arch Womens Ment Health. 2023 Oct;26(5):651-658. doi: 
10.1007/s00737-023-01343-y. Epub 2023 Jul 5.

Maternal prenatal attachment during the COVID-19 pandemic: exploring the roles 
of pregnancy-related anxiety, risk perception, and well-being.

Akdağ B(1), Erdem D(2), Bektaş M(3), Yardımcı F(4).

Author information:
(1)Department of Child and Adolescent Psychiatry, Silifke State Hospital, 
Mersin, Turkey. drberhanakdag@gmail.com.
(2)Department of Gynecology and Obstetrics, Alaaddin Keykubat University Alanya 
Training and Research Hospital, Alanya, Turkey.
(3)Department of Pediatric Nursing, Dokuz Eylül University, İzmir, Turkey.
(4)Department of Pediatric Nursing, Ege University, İzmir, Turkey.

Pregnant women have faced novel physical and mental health risks during the 
pandemic. This situation is remarkable because a parent's emotional bond with 
their unborn baby (also known as prenatal attachment) is related to the parent's 
mental state. Prenatal attachment helps parents psychologically prepare for the 
transition into parenthood. Moreover, it plays a pivotal role in the future 
parentchild relationship and psychosocial development of the baby. Based on the 
available literature, the current study integrated risk perception theories with 
mental health indicators to examine maternal prenatal attachment during the 
pandemic. Pregnant women (n = 258) completed the Pregnancy-Related Anxiety 
Questionnaire-Revision 2 (PRAQ-R2), the WHO Well-being Index (WHO-5), the 
Prenatal Attachment Inventory (PAI), and answered questions about COVID-19 risk 
perception. The findings illustrated that pregnancy-related anxiety was 
positively associated with maternal prenatal attachment. Moreover, COVID-19 risk 
perception and well-being mediated this relationship. In other words, the higher 
levels of pregnancy-related anxiety were associated with increased COVID-19 risk 
perception and decreased well-being, inhibiting prenatal attachment in pregnant 
women. Considering the importance of prenatal attachment, it is crucial to 
understand the experiences of pregnant women and develop policies for promoting 
prenatal attachment, especially during challenging times such as the COVID-19 
pandemic.

© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, 
part of Springer Nature.

DOI: 10.1007/s00737-023-01343-y
PMID: 37407838 [Indexed for MEDLINE]


549. BMJ Open. 2023 Jul 5;13(7):e071533. doi: 10.1136/bmjopen-2022-071533.

Social support and psychosocial well-being among older adults in Europe during 
the COVID-19 pandemic: a cross-sectional study.

Lu J(1), Xiong J(1), Tang S(1), Bishwajit G(2), Guo S(3).

Author information:
(1)School of medicine and health management, Tongji Medical College, Huazhong 
university of science and technology, Wuhan, China.
(2)Faculty of health sciences, University of ottawa, Ottawa, Ontario, Canada.
(3)National Institute of Hospital Administration, National Health Commission, 
Beijing, China guoshuyan@niha.org.cn.

The objective of the study was to identify the association between social 
support and psychosocial well-being among men and women aged over 65 years in 
Europe during the COVID-19 pandemic.
METHODS: Cross-sectional data on 36 621 men (n=15 719) and women (n=20,902) aged 
65 years or higher were obtained from the ninth round of the Survey of Health, 
Ageing and Retirement in Europe. The outcomes were measured by psychosocial 
well-being reflected with self-reported depression, nervousness, loneliness and 
sleep disturbances. Social support was measured in terms of receiving help from 
own children, relatives and neighbours/friends/colleagues since the pandemic 
outbreak.
RESULT: About one-third of the participants reported depression (31.03%), 
nervousness (32.85%), loneliness (32.23%) and sleep trouble (33.01%). The 
results of multivariable regression analysis revealed that social support was a 
protective factor to psychological well-being. For instance, receiving help from 
own children (RD=-0.13, 95% CI=-0.14 to -0.12), relatives (RD=-0.08, 
95% CI=-0.11 to -0.06), neighbours/friends/colleagues (RD=-0.11, 95% CI=-0.13 to 
-0.09) and receiving home care (RD=-0.20, 95% CI=-0.22 to -0.18) showed 
significantly lower risk difference for depression. Similar findings were noted 
for loneliness, nervousness, and sleep trouble as well, with the risk difference 
being slightly different for men and women in the gender-stratified analysis. 
For instance, the risk difference in depression for receiving help from own 
children was -0.10 (95% CI=-0.12 to -0.08) among men compared with -0.12 (95% 
CI=-0.14 to -0.11) among women. The risk differences in the outcome measures 
were calculated using generalised linear model for binomial family.
CONCLUSION: Findings of the present study highlight a protective role of social 
support on psychological well-being among both men and women. Developing 
strategies to promote social support, especially among older adults, may 
mitigate the rising burden of psychological illness during the COVID-19 
pandemic.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/bmjopen-2022-071533
PMCID: PMC10335576
PMID: 37407036 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


550. Cyberpsychol Behav Soc Netw. 2023 Aug;26(8):631-639. doi: 
10.1089/cyber.2022.0319. Epub 2023 Jul 5.

Cyberchondria and Chinese Adolescent Mental Health in the Age of COVID-19 
Pandemic.

Liu Y(1)(2), Peng W(3), Cao M(1)(2), Zhang S(1)(2), Peng J(1)(2), Zhou Z(1)(2).

Author information:
(1)Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of 
Education, Wuhan, China.
(2)School of Psychology, Central China Normal University, Wuhan, China.
(3)Faculty of Psychology, Beijing Normal University, Beijing, China.

One of the far-reaching impacts of the COVID-19 pandemic is that it has become 
the fertile soil of cyberchondria. Adolescents' mental health was severely hit 
by this by-product of the COVID-19 pandemic both due to the direct effects and 
its indirect effects on security. This study investigated whether and how 
cyberchondria was associated with Chinese adolescents' mental health (i.e., 
well-being and depressive symptoms). Based on a large Internet sample 
(N = 1,108, 67.5 percent female, Mage = 16.78 years), cyberchondria, 
psychological insecurity, mental health, and a series of covariates were 
assessed. Preliminary analyses were conducted in SPSS Statistics software and 
main analyses were conducted in Mplus. Path analyses indicated that (a) 
cyberchondria was negatively associated with well-being (b = -0.12, p = 0.001) 
and positively associated with depressive symptoms (b = 0.17, p < 0.001); (b) 
psychological insecurity could fully mediate the association between 
cyberchondria and mental health (indirect effect well-being = -0.15, 95% 
confidence interval [CI -0.19 to -0.12] and indirect effect depressive 
symptoms = 0.15, 95% CI [0.12 to 0.19]); (c) the two dimensions (social 
insecurity and uncertainty) of psychological insecurity could play the mediating 
role in the associations between cyberchondria and mental health, uniquely and 
parallelly; and (d) these results did not vary by gender. This study suggests 
that cyberchondria may arouse individuals' psychological insecurity about 
interpersonal interaction and the development of events, which ultimately 
decreases their well-being and increases the risk of depressive symptoms. These 
findings facilitate the establishment and implementation of relevant prevention 
and intervention programs.

DOI: 10.1089/cyber.2022.0319
PMID: 37406285 [Indexed for MEDLINE]


551. J Relig Health. 2023 Dec;62(6):3887-3903. doi: 10.1007/s10943-023-01865-w. Epub 
2023 Jul 5.

A Proposed Pastoral Response to the Increase in the Number of Suicide Cases in 
the Philippines During the COVID-19 Pandemic.

Gozum IEA(1)(2), Gutierrez JG(3)(4).

Author information:
(1)Institute of Religion, University of Santo Tomas, Sampaloc, Manila, 1008, 
Philippines. iagozum@ust.edu.ph.
(2)The Graduate School, University of Santo Tomas, Sampaloc, Manila, 1008, 
Philippines. iagozum@ust.edu.ph.
(3)Institute of Religion, University of Santo Tomas, Sampaloc, Manila, 1008, 
Philippines.
(4)Center for Theology, Religious Studies, and Ethics, University of Santo 
Tomas, Sampaloc, Manila, 1008, Philippines.

This paper aims to provide a pastoral response to the increase in the number of 
suicides in the Philippines during the COVID-19 pandemic. This paper will look 
into the reasons and statistics related to suicide since there was a sudden 
spike in number during the pandemic. The See-Discern-Act method is used in this 
study so that the current social issue will be viewed from the teachings of the 
Church. First, we will discuss the reports on the cases of mental health issues. 
This issue has alarmed several professionals that focus on protecting one's 
mental health. Second, we will discuss key concepts from the Catechism of the 
Catholic Church to present the view on suicide. Also, John Paul II's Evangelium 
Vitae will be cited to provide a perspective on the value of human life. The 
Compendium of the Social Doctrine of the Church will also be tackled to explain 
the Church's view on mental health and well-being. Third, we will attempt to 
unearth the mental well-being of some Filipinos concerning suicide cases in the 
Philippines in light of the Church's teachings. Hence, our goal is to provide a 
perspective on this problem using the teachings of the Church on human life so 
that we may draw a proposed pastoral theological response. Hence, we propose 
that the Church must provide plans for prevention, intervention, and postvention 
when it comes to people involved in any suicide case as these actions are 
aligned with the goal of the Church to take care of those who suffer from mental 
illness and emphasize the value of human life.

© 2023. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s10943-023-01865-w
PMID: 37405584 [Indexed for MEDLINE]


552. Front Public Health. 2023 Jun 19;11:1204662. doi: 10.3389/fpubh.2023.1204662. 
eCollection 2023.

Mental wellbeing of frontline health workers post-pandemic: lessons learned and 
a way forward.

Grünheid T(1), Hazem A(2).

Author information:
(1)Division of Orthodontics, School of Dentistry, University of Minnesota, 
Minneapolis, MN, United States.
(2)Department of Hospitalist Medicine, Essentia Health, Duluth, MN, United 
States.

OBJECTIVE: To assess the state of mental wellbeing among medical and dental 
frontline health workers as the COVID-19 pandemic transitions to an endemic 
phase and to determine what employer-provided intervention strategies these 
workers perceive as effective and desirable to improve their mental wellbeing.
METHODS: An anonymous online survey distributed to frontline health workers in a 
hospitalist program of a tertiary care medical center and a university dental 
school in Minnesota in September 2022. The survey contained validated tools to 
measure depression severity, levels of perceived stress, and mental health 
status as well as questions to determine effective strategies to improve 
emotional wellbeing among these health workers. Data was evaluated on an 
aggregate level as well as stratified by level (e.g., physician, staff) and 
field (e.g., medicine, dentistry).
RESULTS: On average, all groups of health workers suffered from moderate to 
moderately severe depression, had a much higher perceived stress level than 
average, and had a fair mental health status. There were no significant 
differences in depression severity, stress level, or mental health status among 
physicians, dentists, medical staff, and dental staff. The majority of the 
respondents perceived adjusted work hours, rewards and incentives, and teamwork 
as the most effective and desirable strategies to improve their mental 
wellbeing.
CONCLUSION: The current mental wellbeing of frontline health workers is poor. 
Many are dissatisfied with healthcare and consider leaving the industry. To 
improve their employees' mental wellbeing, healthcare employers might want to 
consider adjusted work hours, rewards, and teamwork as these intervention 
strategies are perceived as most effective and desirable by the intended 
recipients.

Copyright © 2023 Grünheid and Hazem.

DOI: 10.3389/fpubh.2023.1204662
PMCID: PMC10315458
PMID: 37404276 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


553. BMC Health Serv Res. 2023 Jul 4;23(1):727. doi: 10.1186/s12913-023-09716-w.

Mental health experiences of HIV/TB healthcare workers during the COVID-19 
pandemic - lessons for provider well-being and support from a qualitative study 
in seven South African provinces.

Yang B(1), Egg R(1), Brahmbhatt H(2), Matjeng M(2), Doro T(2), Mthembu Z(2), 
Muzah B(2), Foster B(1), Theunissen J(1), Frost A(2), Peetz A(2), Reichert K(1), 
Hoddinott G(3).

Author information:
(1)Panagora Group, Walker Creek Office Building, 90 Florence Ribeiro Ave, 
Muckleneuk, Pretoria, South Africa.
(2)USAID, 100 Totius St, Groenkloof, Pretoria, South Africa.
(3)Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty 
of Medicine and Health Sciences, Stellenbosch University, Cape Town, South 
Africa. graemeh@sun.ac.za.

BACKGROUND: COVID-19 has substantially reshaped health service delivery. 
Healthcare workers have had to serve more clients, work longer shifts, and 
operate in conditions of uncertainty. They have experienced multiple stressors 
related to the additional 'labour of care', including managing the frustration 
of inadequate therapeutic or symptom relief options, witnessing clients dying, 
and having to give this news to clients' family members. Ongoing psychological 
distress among healthcare workers can severely undermine performance, 
decision-making and well-being. We sought to understand the impact of the 
COVID-19 pandemic on the mental health experiences of healthcare workers 
delivering HIV and TB services in South Africa.
METHODS: We used a pragmatic and exploratory design to understand HCWs' mental 
health experiences with in-depth qualitative data. We implemented the study in 
ten high HIV/TB burden districts across seven of South Africa's nine provinces 
among healthcare workers employed by USAID-funded implementing partners. We 
conducted in-depth interviews (virtual) with 92 healthcare workers across 10 
cadres.
RESULTS: Healthcare workers reported experiencing a range of extreme and rapidly 
fluctuating emotions because of COVID-19 that negatively impacted on their 
well-being. Among these, many healthcare workers report experienced a great deal 
of guilt at their inability to continue to provide quality care to their 
clients. In addition, a constant and pervasive fear of contracting COVID-19. 
Healthcare workers' stress coping mechanisms were limited to begin with, and 
often further interrupted by COVID-19 and non-pharmaceutical response measures 
e.g., 'lockdowns'. Healthcare workers reported a need for greater support for 
managing the everyday burden of work - not only when experiencing a mental 
well-being 'episode'. Further, that whenever they were exposed to stressor 
events, e.g., supporting a child living with HIV who reports sexual abuse to the 
healthcare worker, that this this would trigger additional support interventions 
and not rely on the healthcare worker seeking this out. Further, that 
supervisors spend more effort demonstrating appreciation toward staff.
CONCLUSIONS: The COVID-19 epidemic has added significant mental health burden 
for healthcare workers in South Africa. Addressing this requires broad and 
cross-cutting strengthening of everyday support for healthcare workers and 
centring staff's mental well-being as core to delivering quality health 
services.

© 2023. The Author(s).

DOI: 10.1186/s12913-023-09716-w
PMCID: PMC10320863
PMID: 37403094 [Indexed for MEDLINE]

Conflict of interest statement: None declared.


554. BMC Pregnancy Childbirth. 2023 Jul 4;23(1):494. doi: 10.1186/s12884-023-05774-4.

Being pregnant and becoming a parent during the COVID-19 pandemic: a 
longitudinal qualitative study with women in the Born in Bradford COVID-19 
research study.

Jackson C(1), Brawner J(2), Ball M(3), Crossley K(4), Dickerson J(4), Dharni 
N(5), Rodriguez DG(6), Turner E(3), Sheard L(7), Smith H(8).

Author information:
(1)Valid Research Ltd, Sandown House, Sandbeck Way, Wetherby, LS22 7DN, UK. 
cath@validresearch.co.uk.
(2)Royal Society, London, UK.
(3)Justice Studio, 10 Portfleet Place, De Beauvoir Road, London, N1 5SZ, UK.
(4)Bradford Institute for Health Research, Temple Bank House, Bradford Royal 
Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK.
(5)Institute of Applied Health Research, University of Birmingham, Birmingham, 
B15 2TT, UK.
(6)Faculty of Social Sciences, University of Nottingham, Nottingham, UK.
(7)York Trials Unit, Department of Health Sciences, University of York, 
Heslington, YO10 5DD, York, UK.
(8)Anthrologica, Oxford, UK.

BACKGROUND: Uncertainty around the risk of COVID-19 to pregnant women and their 
babies prompted precautionary restrictions on their health and care during the 
pandemic. Maternity services had to adapt to changing Government guidance. 
Coupled with the imposition of national lockdowns in England and restrictions on 
daily activities, women's experiences of pregnancy, childbirth and the 
postpartum period, and their access to services, changed rapidly. This study was 
designed to understand women's experiences of pregnancy, labour and childbirth 
and caring for a baby during this time.
METHODS: This was an inductive longitudinal qualitative study, using in-depth 
interviews by telephone with women in Bradford, UK, at three timepoints during 
their maternity journey (18 women at timepoint one, 13 at timepoint two and 14 
at timepoint three). Key topics explored were physical and mental wellbeing, 
experience of healthcare services, relationships with partners and general 
impact of the pandemic. Data were analysed using the Framework approach. A 
longitudinal synthesis identified over-arching themes.
RESULTS: Three longitudinal themes captured what was important to women: (1) 
women feared being alone at critical points in their maternity journey, (2) the 
pandemic created new norms for maternity services and women's care, and (3) 
finding ways to navigate the COVID-19 pandemic in pregnancy and with a baby.
CONCLUSIONS: Modifications to maternity services impacted significantly on 
women's experiences. The findings have informed national and local decisions 
about how best to direct resources to reduce the impact of COVID-19 restrictions 
and the longer-term psychological impact on women during pregnancy and 
postnatally.

© 2023. The Author(s).

DOI: 10.1186/s12884-023-05774-4
PMCID: PMC10320984
PMID: 37403018 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare they have no competing 
interests.


555. Sci Rep. 2023 Jul 4;13(1):10759. doi: 10.1038/s41598-023-37568-1.

The longitudinal study of subjective wellbeing and absenteeism of healthcare 
workers considering post-COVID condition and the COVID-19 pandemic toll.

Nehme M(1), Vieux L(2), Kaiser L(3)(4)(5)(6), Chappuis F(3)(7), Chenaud C(2); 
HealthCo Study Team; Guessous I(8)(3).

Collaborators: Braillard O, Courvoisier DS, Reny JL, Assal F, Bondolfi G, Graf 
C, Zekry D, Stringhini S, Spechbach H, Jacquerioz F, Salamun J, Lador F, 
Guerreiro I, Coen M, Agoritsas T, Benzakour L, Genevay S, Lauper K, Meyer P, 
Poku NK, Landis BN, Grira M, Allali G, Vetter P.

Author information:
(1)Division of Primary Care Medicine, Geneva University Hospitals, Geneva, 
Switzerland. Mayssam.nehme@hcuge.ch.
(2)Division of Occupational Medicine, Geneva University Hospital, Geneva, 
Switzerland.
(3)Faculty of Medicine, University of Geneva, Geneva, Switzerland.
(4)Division of Infectious Diseases, Geneva University Hospitals, Geneva, 
Switzerland.
(5)Geneva Center for Emerging Viral Diseases, Geneva University Hospitals, 
Geneva, Switzerland.
(6)Division of Laboratory Medicine, Laboratory of Virology, Geneva University 
Hospitals, Geneva, Switzerland.
(7)Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, 
Geneva, Switzerland.
(8)Division of Primary Care Medicine, Geneva University Hospitals, Geneva, 
Switzerland.

Experts have warned against the pandemic burden on healthcare workers early on, 
however little is known about the evolution of this burden with time, in 
addition to the long-term effects of post-COVID symptoms in healthcare workers. 
Staff at the Geneva University Hospitals in Switzerland had an online follow-up 
in July and December 2021, on their physical and mental health, quality of life 
and functional capacity using validated scales. Descriptive analyses compared 
the prevalence of symptoms, functional impairment and quality of life in 
SARS-CoV-2 positive and negative individuals at baseline and at follow-up. Out 
of the initial n = 3,083 participants that answered at baseline in July 2021, 
n = 900 (mean age of 46.4 years, 70.1% women) completed the follow-up in 
December 2021. With time, more individuals reported fatigue (+ 9.4%), headache 
(+ 9.0%), insomnia (+ 2.3%), cognitive impairment (+ 1.4%), stress/burnout 
(+ 8.8%), pain (+ 8.3%), digestive symptoms (+ 3.6%), dyspnea (+ 1.0%), and 
cough (+ 7.7%) compared to baseline, with a differentially larger increase in 
symptoms in the SARS-CoV-2 negative group. Individuals had more functional 
impairment (12.7% at baseline and 23.9% at follow-up), with more absenteeism and 
worsening quality of life. Healthcare workers are potentially suffering from 
long term consequences of the pandemic burden, calling for urgent action and 
solutions.

© 2023. The Author(s).

DOI: 10.1038/s41598-023-37568-1
PMCID: PMC10319731
PMID: 37402726 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


556. J Med Internet Res. 2023 Aug 14;25:e43000. doi: 10.2196/43000.

Frontline Health Care Workers' Mental Health and Well-Being During the First 
Year of the COVID-19 Pandemic: Analysis of Interviews and Social Media Data.

Vera San Juan N(#)(1)(2), Martin S(#)(1)(3), Badley A(4)(5), Maio L(1), Gronholm 
PC(2), Buck C(6), Flores EC(7)(8), Vanderslott S(9)(10), Syversen A(11), Symmons 
SM(12), Uddin I(13), Karia A(1), Iqbal S(1)(14), Vindrola-Padros C(1).

Author information:
(1)Rapid Research Evaluation and Appraisal Lab (RREAL), Department of Targeted 
Intervention, University College London, London, United Kingdom.
(2)Centre for Global Mental Health and Centre for Implementation Science, Health 
Services and Population Research Department, Institute of Psychiatry, Psychology 
and Neuroscience, King's College London, London, United Kingdom.
(3)Ethox Centre, Big Data Institute, University of Oxford, Oxford, United 
Kingdom.
(4)Academy Research and Improvement, Solent Trust, Southampton, United Kingdom.
(5)School of Health Sciences, University of Southampton, Southampton, United 
Kingdom.
(6)Department of Behavioural Science and Health, University College London, 
London, United Kingdom.
(7)Centre on Climate Change & Planetary Health, London School of Hygiene and 
Tropical Medicine, London, United Kingdom.
(8)Stanford Center for Innovation in Global Health, Stanford Woods Institute for 
the Environment,, Stanford University, Stanford, CA, United States.
(9)Oxford Vaccine Group, Churchill Hospital, University of Oxford, Oxford, 
United Kingdom.
(10)NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United 
Kingdom.
(11)Institute of Epidemiology and Healthcare, University College London, London, 
United Kingdom.
(12)Centre for Interdisciplinary Research, Education and Innovation in Health 
Systems, School of Nursing, Midwifery and Health Systems, University College 
Dublin, Dublin, Ireland.
(13)Division of Psychiatry, Marie Curie Palliative Care Research Department, 
University College London, London, United Kingdom.
(14)Department of Psychology, University of Bradford, Bradford, United Kingdom.
(#)Contributed equally

BACKGROUND: The COVID-19 pandemic has shed light on fractures in health care 
systems worldwide and continues to have a significant impact, particularly in 
relation to the health care workforce. Frontline staff have been exposed to 
unprecedented strain, and delivering care during the pandemic has affected their 
safety, mental health, and well-being.
OBJECTIVE: This study aimed to explore the experiences of health care workers 
(HCWs) delivering care in the United Kingdom during the COVID-19 pandemic to 
understand their well-being needs, experiences, and strategies used to maintain 
well-being (at individual and organizational levels).
METHODS: We analyzed 94 telephone interviews with HCWs and 2000 tweets about 
HCWs' mental health during the first year of the COVID-19 pandemic.
RESULTS: The results were grouped under 6 themes: redeployment, clinical work, 
and sense of duty; well-being support and HCW's coping strategies; negative 
mental health effects; organizational support; social network and support; and 
public and government support.
CONCLUSIONS: These findings demonstrate the need for open conversations, where 
staff's well-being needs and the strategies they adopted can be shared and 
encouraged, rather than implementing top-down psychological interventions alone. 
At the macro level, the findings also highlighted the impact on HCW's well-being 
of public and government support as well as the need to ensure protection 
through personal protective equipment, testing, and vaccines for frontline 
workers.

©Norha Vera San Juan, Sam Martin, Anna Badley, Laura Maio, Petra C Gronholm, 
Caroline Buck, Elaine C Flores, Samantha Vanderslott, Aron Syversen, Sophie 
Mulcahy Symmons, Inayah Uddin, Amelia Karia, Syka Iqbal, Cecilia 
Vindrola-Padros. Originally published in the Journal of Medical Internet 
Research (https://www.jmir.org), 14.08.2023.

DOI: 10.2196/43000
PMCID: PMC10426381
PMID: 37402283 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


557. Health Expect. 2023 Oct;26(5):2050-2063. doi: 10.1111/hex.13812. Epub 2023 Jul 
4.

Healthy Parent Carers: Acceptability and practicability of online delivery and 
learning through implementation by delivery partner organisations.

Garrood A(1), Bjornstad G(2), Borek A(3), Gillett A(2), Lloyd J(4), Brand S(2), 
Tarrant M(2), Ball S(2), Hawton A(5), McDonald A(1), Fredlund M(1), Boyle F(1), 
Berry V(2), Logan S(1), Morris C(1).

Author information:
(1)Peninsula Childhood Disability Research Unit (PenCRU) and NIHR Applied 
Research Collaboration South West Peninsula (PenARC), University of Exeter 
Medical School, University of Exeter, Exeter, UK.
(2)NIHR Applied Research Collaboration South West Peninsula (PenARC), University 
of Exeter, Exeter, UK.
(3)Nuffield Department of Primary Care Health Sciences, Medical Sciences 
Division, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK.
(4)Relational Health Group and NIHR Applied Research Collaboration (PenARC) 
South West Peninsula, Department of Health and Community Sciences, Institute of 
Health Research, University of Exeter Medical School, University of Exeter, 
Exeter, UK.
(5)Health Economics Group and NIHR Applied Research Collaboration (PenARC) South 
West Peninsula, University of Exeter Medical School, University of Exeter, 
Exeter, UK.

BACKGROUND: Parent carers of disabled children are at increased risk of physical 
and mental health problems. The Healthy Parent Carers (HPC) programme is a 
manualised peer-led group-based programme that aims to promote parent carer 
health and wellbeing. Previously, the programme had been delivered in person, 
with recruitment and delivery managed in a research context. This study explored 
implementation by two delivery partner organisations in the United Kingdom. 
Facilitator Training and Delivery Manuals were modified for online delivery 
using Zoom due to COVID-19.
METHODS: The study methodology utilised the Replicating Effective Programs 
framework. A series of stakeholder workshops informed the development of the 
Implementation Logic Model and an Implementation Package. After delivering the 
programme, delivery partner organisations and facilitators participated in a 
workshop to discuss experiences of implementing the programme. A wider group of 
stakeholders, including commissioners, Parent Carer Forums and charity 
organisations representatives and researchers subsequently met to consider the 
sustainability and potential barriers to delivering the programme outside the 
research context.
RESULTS: This study explored implementation by two delivery partner 
organisations in the United Kingdom that were able to recruit facilitators, who 
we trained, and they recruited participants and delivered the programme to 
parent carers in different localities using Zoom. The co-created Implementation 
Logic Model and Implementation Package were subsequently refined to enable the 
further roll-out of the programme with other delivery partner organisations.
CONCLUSIONS: This study provides insight and understanding of how the HPC 
programme can be implemented sustainably outside of the research context. 
Further research will evaluate the effectiveness of the programme and refine the 
implementation processes.
PATIENT AND PUBLIC CONTRIBUTION: Parent carers, delivery partner organisation 
staff and service commissioners were consulted on the design, delivery and 
reporting of the research.

© 2023 The Authors. Health Expectations published by John Wiley & Sons Ltd.

DOI: 10.1111/hex.13812
PMCID: PMC10485339
PMID: 37401625 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


558. Health Policy. 2023 Sep;135:104863. doi: 10.1016/j.healthpol.2023.104863. Epub 
2023 Jun 26.

COVID-19 and healthcare worker mental well-being: Comparative case studies on 
interventions in six countries.

Byrne JP(1), Humphries N(2), McMurray R(2), Scotter C(2).

Author information:
(1)Graduate School of Healthcare Management (GSM), RCSI University of Medicine 
and Health Sciences, RCSI, Ballymoss Road, Sandyford Industrial Est. Dublin 18, 
Ireland. Electronic address: johnpaulbyrne@rcsi.ie.
(2)Graduate School of Healthcare Management (GSM), RCSI University of Medicine 
and Health Sciences, RCSI, Ballymoss Road, Sandyford Industrial Est. Dublin 18, 
Ireland.

Healthcare worker (HCW) mental well-being has become a global public health 
priority as health systems seek to strengthen their resilience in the face of 
the COVID-19 pandemic. Analysing data from the Health System Response Monitor, 
we present six case studies (Denmark, Italy, Kyrgyzstan, Lithuania, Romania, and 
the United Kingdom) as a comparative review of policy interventions supporting 
HCW mental health during the pandemic. The results illustrate a wide range of 
interventions. While Denmark and the United Kingdom built on pre-existing 
structures to support HCW mental wellbeing during the pandemic, the other 
countries required new interventions. Across all cases, there was a reliance on 
self-care resources, online training tools, and remote professional support. 
Based on our analysis, we develop four policy recommendations for the future of 
HCW mental health supports. First, HCW mental health should be seen as a core 
facet of health workforce capacity. Second, effective mental health supports 
requires an integrated psychosocial approach that acknowledges the importance of 
harm prevention strategies and organisational resources (psychological first 
aid) alongside targeted professional interventions. Third, personal, 
professional and practical obstacles to take-up of mental health supports should 
be addressed. Fourth, any specific support or intervention targeting HCW's 
mental health is connected to, and dependent on, wider structural and employment 
factors (e.g. system resourcing and organisation) that determine the working 
conditions of HCWs.

Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.healthpol.2023.104863
PMCID: PMC10292916
PMID: 37399678 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest None.


559. Front Public Health. 2023 Jun 16;11:1192733. doi: 10.3389/fpubh.2023.1192733. 
eCollection 2023.

The assessment and validation of the depression, anxiety, and stress scale 
(DASS-21) among frontline doctors in Pakistan during fifth wave of COVID-19.

Nadeem MU(1), Kulich SJ(1), Bokhari IH(2).

Author information:
(1)SISU Intercultural Institute (SII), Shanghai International Studies University 
(SISU), Shanghai, China.
(2)School of Commerce and Accountancy, University of Management and Technology 
(UMT), Lahore, Punjab, Pakistan.

OBJECTIVE: The study aims to document sociodemographic features, address the 
symptoms and levels of depression, anxiety, and stress among frontline doctors 
in Pakistan, and validate the depression, anxiety, stress scale (DASS-21) on the 
context of Pakistan.
METHOD: A cross-sectional survey was conducted throughout the regions of 
Pakistan on frontline doctors to document their sociodemographic patterns and 
the levels of depression, anxiety, and stress while dealing with the fifth wave 
(Omicron-variant) of the coronavirus (SARS-CoV-2) pandemic in Pakistan (December 
2021-April 2022). Respondents (N = 319) were recruited through a snowball 
sampling process.
RESULTS: Though previous literature reported declines in psychological symptoms 
after earlier waves of COVID-19, these DASS-21 findings show that as the 
pandemic has worn on, frontline doctors in Pakistan are having considerable 
personal symptoms of depression (72.7%), anxiety (70.2%), and stress (58.3%). 
Though specifically related to the COVID-19 pandemic, they rated only moderate 
levels of depression and stress, however they reported severe levels of anxiety. 
The results also revealed a positive correlation between depression and anxiety 
(r = 0.696, p < 0.001), depression and stress (r = 0.761, p < 0.001), and 
anxiety and stress (r = 0.720, p < 0.001).
CONCLUSION: Through the application of all required statistical procedures, 
DASS-21 is validated in the cultural context of Pakistan among this group of 
frontline doctors. The findings of this study can provide new directions for the 
policy makers (government and hospitals' administration) of Pakistan to focus on 
the mental wellbeing of the doctors under similar enduring public health crises 
and to protect them from short- or long-term disorders.

Copyright © 2023 Nadeem, Kulich and Bokhari.

DOI: 10.3389/fpubh.2023.1192733
PMCID: PMC10311542
PMID: 37397733 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


560. Am J Psychiatry. 2023 Jul 1;180(7):473-482. doi: 10.1176/appi.ajp.20230371.

Recent Advances on Social Determinants of Mental Health: Looking Fast Forward.

Alegría M(1), Alvarez K(1), Cheng M(1), Falgas-Bague I(1).

Author information:
(1)Disparities Research Unit, Department of Medicine, Massachusetts General 
Hospital and the Mongan Institute, Boston (Alegría, Cheng, Falgas-Bague); 
Department of Medicine (Alegría, Falgas-Bague) and Department of Psychiatry 
(Alegría), Harvard Medical School, Boston; Bloomberg School of Public Health, 
Johns Hopkins University, Baltimore (Alvarez); Department of Epidemiology and 
Public Health, Swiss Tropical and Public Health Institute and University of 
Basel, Allschwil, Basel, Switzerland (Falgas-Bague).

The fields of psychiatry and mental health are increasingly recognizing the 
importance of social determinants of health (SDOH) and their impact on mental 
health outcomes. In this overview, the authors discuss the recent research, from 
the past 5 years, on advances made in SDOH work. SDOH frameworks and theories 
have expanded to include more social conditions, from traumas associated with 
immigration to psychosocial and community strengths, that impact mental health 
and well-being. Research has consistently shown the pervasive deleterious 
impacts of inequitable social conditions (e.g., food insecurity, housing 
instability) on minoritized populations' physical and mental health. Social 
systems of oppression (e.g., racism, minoritization) have also been shown to 
confer higher risk for psychiatric and mental disorders. The COVID-19 pandemic 
illuminated the inequitable impact of the social determinants of health 
outcomes. More efforts have been made in recent years to intervene on the social 
determinants through interventions at the individual, community, and policy 
levels, which have shown promise in improving mental health outcomes in 
marginalized populations. However, major gaps remain. Attention should be paid 
to developing guiding frameworks that incorporate equity and antiracism when 
designing SDOH interventions and improving methodological approaches for 
evaluating these interventions. In addition, structural-level and policy-level 
SDOH efforts are critical for making long-lasting and impactful advances toward 
mental health equity.

DOI: 10.1176/appi.ajp.20230371
PMID: 37392038 [Indexed for MEDLINE]

Conflict of interest statement: The authors report no financial relationships 
with commercial interests.


561. J Plast Reconstr Aesthet Surg. 2023 Sep;84:313-322. doi: 
10.1016/j.bjps.2023.06.025. Epub 2023 Jun 10.

Psychological impact of the COVID-19 pandemic on breast cancer patients.

Farewell JT(1), Perez K(1), Henderson S(2), Crook J(1), Hunter M(1), Zhang 
AY(3).

Author information:
(1)University of Texas Southwestern, Department of Plastic Surgery, 1801 Inwood 
Road, Dallas, TX, USA.
(2)Baylor College of Medicine, Department of Surgery, Houston, TX, USA.
(3)University of Texas Southwestern, Department of Plastic Surgery, 1801 Inwood 
Road, Dallas, TX, USA. Electronic address: Andrew.Zhang@utsouthwestern.edu.

PURPOSE: The COVID-19 pandemic uniquely impacted patients with breast cancer as 
mastectomies were allowed to proceed, yet breast reconstruction surgeries were 
halted. The purpose of this study was to examine the effect of the COVID-19 
pandemic on the rates of breast reconstruction and patients' well-being.
METHODS: A chart review included all patients who underwent mastectomy from 
December 2019 to September 2021. Patients were contacted by a member of the 
research team and asked to participate in a COVID-19-specific survey and to 
complete the Hospital Anxiety and Depression Scale (HADS). Patients were then 
grouped into "surge" or "nonsurge" groups based on the date of mastectomy.
RESULTS: Two hundred and fifty-nine patients were included in this study. During 
the study period, 42% (n = 111) of the patients underwent breast reconstruction. 
The "surge" group included 106 patients whereas the "nonsurge" group included 
153 patients. Fewer patients began breast reconstruction during the surge period 
compared with the nonsurge period (34.0% vs. 49.0%, p = 0.017). Eighty-six 
patients participated in the COVID-19 survey. Forty-one percent (n = 35) of the 
patients felt that their care was disrupted because of COVID-19. Eighty-three 
patients completed the HADS survey. Overall, 16.8% and 15.7% of the respondents 
fell into the moderate to severe ranges for both anxiety and depression scales, 
respectively.
CONCLUSIONS: Patients with breast cancer have faced increased difficulties with 
access to breast reconstruction throughout the COVID-19 pandemic. Our 
institution demonstrated decreased rates of breast reconstruction and an 
increase in anxiety and depression. The positive benefits of breast 
reconstruction cannot be overlooked when determining resource allocation in the 
future.

Copyright © 2023 British Association of Plastic, Reconstructive and Aesthetic 
Surgeons. Published by Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.bjps.2023.06.025
PMCID: PMC10257321
PMID: 37390540 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
have no conflicts of interest to disclose.


562. Front Public Health. 2023 Jun 14;11:1160896. doi: 10.3389/fpubh.2023.1160896. 
eCollection 2023.

COVID-19 related psychosocial problems among university students in Mexico - a 
longitudinal qualitative examination.

Martinez-Torteya C(1), Figge CJ(2), Ramírez Hernández LI(3), Treviño-de la Garza 
B(4).

Author information:
(1)Department of Psychiatry, University of Michigan, Ann Arbor, MI, United 
States.
(2)Department of Mental Health, John Hopkins Bloomberg School of Public Health, 
Baltimore, MD, United States.
(3)Department of Education, Universidad de Monterrey, San Pedro Garza García, 
Mexico.
(4)Department of Psychology, Universidad de Monterrey, San Pedro Garza García, 
Mexico.

Research on the impact of the COVID-19 pandemic among college students around 
the world has primarily focused on their mental health symptoms and 
COVID-specific worry. However, contextually specific understanding of outbreak 
impacts is key to inform directed public health messaging and programming to 
improve wellbeing and coping. The current study aimed to identify the main 
psychosocial problems college students experienced during the first 6 months of 
the COVID-19 pandemic in Monterrey, Mexico. Participants were 606 college 
students (71% female) enrolled in a private university. Participants described 
COVID-related problems in an open-ended prompt as part of a longitudinal online 
survey: initially in May 2020, and then every 2 weeks for 3 months. Thematic 
analyses were conducted within a longitudinal inductive qualitative approach to 
rank responses by frequency across themes. Five major categories emerged. At 
baseline, over 75% of participants noted the outbreak negatively impacted their 
daily activities and responsibilities, 73% their mental health, 50% their 
physical health, 35% their interpersonal relationships, and 22% their economic 
situation. Concerns remained relatively stable throughout the follow-up period, 
with interpersonal and economic concerns becoming more prevalent as the pandemic 
progressed. Problems identified in this study can inform preventative measures 
for future health crises, including tailoring public health messaging and 
expanding access to contextually sensitive mental and behavioral health 
programming.

Copyright © 2023 Martinez-Torteya, Figge, Ramírez Hernández and Treviño-de la 
Garza.

DOI: 10.3389/fpubh.2023.1160896
PMCID: PMC10300440
PMID: 37388161 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


563. BMJ Open. 2023 Jun 29;13(6):e071203. doi: 10.1136/bmjopen-2022-071203.

Workplace interventions to improve well-being and reduce burnout for nurses, 
physicians and allied healthcare professionals: a systematic review.

Cohen C(1), Pignata S(2), Bezak E(3), Tie M(4), Childs J(3).

Author information:
(1)Allied Health and Human Performance, University of South Australia, Adelaide, 
South Australia, Australia catherine.cohen@mymail.unisa.edu.au.
(2)STEM, University of South Australia, Adelaide, South Australia, Australia.
(3)Allied Health and Human Performance, University of South Australia, Adelaide, 
South Australia, Australia.
(4)Australian Radiology Clinics, Adelaide, South Australia, Australia.

There is a growing need for interventions to improve well-being in healthcare 
workers, particularly since the onset of COVID-19.
OBJECTIVES: To synthesise evidence since 2015 on the impact of interventions 
designed to address well-being and burnout in physicians, nurses and allied 
healthcare professionals.
DESIGN: Systematic literature review.
DATA SOURCES: Medline, Embase, Emcare, CINAHL, PsycInfo and Google Scholar were 
searched in May-October 2022.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies that primarily investigated 
burnout and/or well-being and reported quantifiable preintervention and 
postintervention outcomes using validated well-being measures were included.
DATA EXTRACTION AND SYNTHESIS: Full-text articles in English were independently 
screened and quality assessed by two researchers using the Medical Education 
Research Study Quality Instrument. Results were synthesised and presented in 
both quantitative and narrative formats. Meta-analysis was not possible due to 
variations in study designs and outcomes.
RESULTS: A total of 1663 articles were screened for eligibility, with 33 meeting 
inclusion criterium. Thirty studies used individually focused interventions, 
while three were organisationally focused. Thirty-one studies used secondary 
level interventions (managed stress in individuals) and two were primary level 
(eliminated stress causes). Mindfulness-based practices were adopted in 20 
studies; the remainder used meditation, yoga and acupuncture. Other 
interventions promoted a positive mindset (gratitude journaling, choirs, 
coaching) while organisational interventions centred on workload reduction, job 
crafting and peer networks. Effective outcomes were reported in 29 studies, with 
significant improvements in well-being, work engagement, quality of life and 
resilience, and reductions in burnout, perceived stress, anxiety and depression.
CONCLUSION: The review found that interventions benefitted healthcare workers by 
increasing well-being, engagement and resilience, and reducing burnout. It is 
noted that the outcomes of numerous studies were impacted by design limitations 
that is, no control/waitlist control, and/or no post intervention follow-up. 
Suggestions are made for future research.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2022-071203
PMCID: PMC10314589
PMID: 37385740 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


564. J Affect Disord. 2023 Oct 1;338:440-448. doi: 10.1016/j.jad.2023.06.056. Epub 
2023 Jun 27.

Longitudinal patterns of alcohol use and psychological symptoms during COVID-19 
pandemic and role of alexithymia: A latent transition analysis in the FinnBrain 
Birth Cohort Study.

Li R(1), Kajanoja J(2), Karlsson L(3), Karlsson H(4), Nolvi S(5), Karukivi M(6).

Author information:
(1)Department of Psychiatry, University of Turku and Turku University Hospital, 
Finland; FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku 
Brain and Mind Center, University of Turku, Finland. Electronic address: 
ru.li@utu.fi.
(2)Department of Psychiatry, University of Turku and Turku University Hospital, 
Finland; FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku 
Brain and Mind Center, University of Turku, Finland; Department of Psychiatry, 
Satakunta Hospital District, Pori, Finland.
(3)Department of Psychiatry, University of Turku and Turku University Hospital, 
Finland; FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku 
Brain and Mind Center, University of Turku, Finland; Centre for Population 
Health Research, University of Turku and Turku University Hospital, Finland; 
Department of Pediatrics and Adolescent Medicine, University of Turku and Turku 
University Hospital, Finland.
(4)Department of Psychiatry, University of Turku and Turku University Hospital, 
Finland; FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku 
Brain and Mind Center, University of Turku, Finland; Centre for Population 
Health Research, University of Turku and Turku University Hospital, Finland.
(5)FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain 
and Mind Center, University of Turku, Finland; Turku Institute for Advanced 
Studies, Department of Psychology and Speech-Language Pathology, University of 
Turku, Finland.
(6)FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain 
and Mind Center, University of Turku, Finland; Department of Adolescent 
Psychiatry, University of Turku and Turku University Hospital, Finland.

BACKGROUND: The COVID-19 pandemic has been posing widespread influence on mental 
well-being. However, research on the dynamic relations between alcohol use and 
psychological symptoms in the context of the pandemic and the role of 
alexithymic traits in predicting the development of mental health problems 
longitudinally remains scarce.
METHODS: Latent profile and transition analyses were conducted to model the 
longitudinal patterns of transitions in the profiles of alcohol use and 
psychological symptoms across 10 months during the pandemic (from May 2020 to 
March 2021) and to investigate the role of alexithymia and its dimensions 
Difficulty Identifying and Describing Feelings (DIF and DDF), and Externally 
Oriented Thinking (EOT) in 720 parents from the FinnBrain Birth Cohort Study.
RESULTS: Three profiles, Risky Drinking, Distressed Non-Risky Drinking, and 
Non-Distressed, Non-Risky Drinking, and their transitions were identified. The 
role of alexithymia appeared to be stronger in Risky Drinking than 
Non-Distressed, Non-Risky Drinking. DIF predicted the development of symptoms in 
Risky Drinking, whereas DDF predicted Risky Drinking remaining stable over time 
and showed a trend towards psychological distress in Risky Drinking and 
Non-Distressed, Non-Risky Drinking. EOT was more likely to be a risk factor for 
Risky Drinking remaining constant and Non-Distressed, Non-Risky Drinking 
becoming Risky Drinking.
LIMITATIONS: This study was mainly limited by the generalizability of the 
findings.
CONCLUSIONS: Our findings add deeper insights into the longitudinal development 
of alcohol use and psychological symptoms as well as evidence on the role of 
alexithymia in shaping mental health, providing implications for tailoring 
clinical preventive and therapeutic measures.

Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2023.06.056
PMCID: PMC10299841
PMID: 37385387 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare no conflicts of interest.


565. Intensive Crit Care Nurs. 2023 Oct;78:103478. doi: 10.1016/j.iccn.2023.103478. 
Epub 2023 Jun 27.

Shifting focus: A grounded theory of how family members to critically ill 
patients manage their situation.

Vogel G(1), Joelsson-Alm E(2), Forinder U(3), Svensen C(4), Sandgren A(5).

Author information:
(1)Department of Clinical Science and Education, Karolinska Institutet, Unit of 
Anaesthesiology and Intensive Care, Södersjukhuset, Sjukhusbacken 10, SE-118 83 
Stockholm, Sweden. Electronic address: gisela.vogel@ki.se.
(2)Department of Clinical Science and Education, Karolinska Institutet, Unit of 
Anaesthesiology and Intensive Care, Södersjukhuset, Sjukhusbacken 10, SE-118 83 
Stockholm, Sweden. Electronic address: eva.joelsson-alm@ki.se.
(3)Faculty of Health and Occupational Studies, University of Gävle, 
Kungsbäcksvägen 47, SE-801 76 Gävle, Sweden. Electronic address: 
ulla.forinder@hig.se.
(4)Department of Clinical Science and Education, Karolinska Institutet, Unit of 
Anaesthesiology and Intensive Care, Södersjukhuset, Sjukhusbacken 10, SE-118 83 
Stockholm, Sweden. Electronic address: christer.svensen@ki.se.
(5)Center for Collaborative Palliative Care, Department of Health and Caring 
Sciences, Linnaeus University, Universitetsplatsen 1, SE-352 52 Växjö, Sweden. 
Electronic address: anna.sandgren@lnu.se.

OBJECTIVES: Critical illness is a life-threatening condition for the patient, 
which affects their family members as a traumatic experience. Well-known 
long-term consequences include impact on mental health and health-related 
quality of life. This study aims to develop a grounded theory to explain pattern 
of behaviours in family members of critically ill patients cared for in an 
intensive care unit, addressing the period from when the patient becomes 
critically ill until recovery at home.
RESEARCH METHODOLOGY/DESIGN: We used a classic grounded theory to explore the 
main concern for family members of intensive care patients. Fourteen interviews 
and seven observations with a total of 21 participants were analysed. Data were 
collected from February 2019 to June 2021.
SETTING: Three general intensive care units in Sweden, consisting of a 
university hospital and two county hospitals.
FINDINGS: The theory Shifting focus explains how family members' main concern, 
living on hold, is managed. This theory involves different strategies: decoding, 
sheltering and emotional processing. The theory has three different outcomes: 
adjusting focus, emotional resigning or remaining in focus.
CONCLUSION: Family members could stand in the shadow of the patients' critical 
illness and needs. This emotional adversity is processed through shifting focus 
from one's own needs and well-being to the patient's survival, needs and 
well-being. This theory can raise awareness of how family members of critically 
ill patients manage the process from critical illness until return to everyday 
life at home. Future research focusing on family members' need for support and 
information, to reduce stress in everyday life, is needed.
IMPLICATIONS FOR CLINICAL PRACTICE: Healthcare professionals should support 
family members in shifting focus by interaction, clear and honest communication, 
and through mediating hope.

Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.iccn.2023.103478
PMID: 37384978 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


566. Soc Sci Med. 2023 Jul;329:116035. doi: 10.1016/j.socscimed.2023.116035. Epub 
2023 Jun 18.

Bright sides and dark sides: Unveiling the double-edged sword effects of social 
networks.

Li X(1), Guo X(2), Shi Z(3).

Author information:
(1)Department of Sociology, Xi'an Jiaotong University, China. Electronic 
address: xiaoguangli@xjtu.edu.cn.
(2)Department of Sociology, Xi'an Jiaotong University, China.
(3)Population Research Center, Zhongnan University of Economics and Law, China.

Social networks have both positive and negative effects as a double-edged sword. 
However, previous studies have mostly focused on the positive effects of social 
networks, whereas the negative effects have received less scrutiny and need to 
be tapped empirically. In this quantitative study, we investigate the multiple 
effects of social networks, including positive instrumental, positive 
sentimental, negative instrumental, and negative sentimental effects, using data 
from the 2020 Urban and Rural Community Survey in China (N = 19,585). The 
results showed that the four types of effects were manifested during the 
coronavirus disease 2019 (COVID-19) pandemic and were dominated by positive 
effects. More importantly, social networks can significantly shape individual 
subjective well-being and social trust. As positive effects, transmitting 
epidemic information and providing psychological comfort significantly protect 
subjective well-being and enhance social trust. However, as negative effects, 
spreading rumors and conveying negative emotions can significantly detriment 
subjective well-being and undermine social trust. In this regard, future 
research needs to pay special attention to the double-edged sword effect of 
social networks to more comprehensively understand the effect of multiple 
pathways of interpersonal social networks on individuals' subjective well-being 
and life opportunities.

Copyright © 2023 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.socscimed.2023.116035
PMCID: PMC10277161
PMID: 37384953 [Indexed for MEDLINE]


567. Curr Opin Psychol. 2023 Aug;52:101626. doi: 10.1016/j.copsyc.2023.101626. Epub 
2023 Jun 27.

The compounded effect of the dual pandemic on ethnic-racial minority 
adolescents' mental health and psychosocial well-being.

Eboigbe LI(1), Simon CB(1), Wang YS(1), Tyrell FA(2).

Author information:
(1)Department of Psychology, University of Maryland, College Park, United 
States.
(2)Department of Psychology, University of Maryland, College Park, United 
States. Electronic address: ftyrell@umd.edu.

During the COVID-19 pandemic, U.S. youth faced various stressors that affected 
their schooling experiences, social relationships, family dynamics, and 
communities. These stressors negatively impacted youths' mental health. Compared 
to White youths, ethnic-racial minority youths were disproportionately affected 
by COVID-19-related health disparities and experienced elevated worry and 
stress. In particular, Black and Asian American youths faced the compounded 
effects of a dual pandemic due to their navigation of both COVID-19-related 
stressors and increased exposure to racial discrimination and racial injustice, 
which worsened their mental health outcomes. However, protective processes such 
as social support, ethnic-racial identity, and ethnic-racial socialization 
emerged as mechanisms that attenuated the effects of COVID-related stressors on 
ethnic-racial youths' mental health and promoted their positive adaptation and 
psychosocial well-being.

Copyright © 2023 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.copsyc.2023.101626
PMCID: PMC10293782
PMID: 37384949 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could influence the work reported in this paper.


568. Cancer Causes Control. 2023 Dec;34(Suppl 1):149-157. doi: 
10.1007/s10552-023-01742-7. Epub 2023 Jun 28.

Losing a part of life: experiences of cancer survivors accessing treatment and 
sheltering in place during the COVID-19 pandemic.

Wickersham KE(1), Morrill KE(2), Lopez-Pentecost M(3), Heiney SP(4), King JJ(5), 
Madhivanan P(6), Hirschey R(7).

Author information:
(1)College of Nursing, University of South Carolina, Columbia, SC, USA. 
kwickers@mailbox.sc.edu.
(2)Community & System Health Sciences Division, College of Nursing, University 
of Arizona, Tucson, AZ, USA.
(3)Sylvester Comprehensive Cancer Center, University of Miami Miller School of 
Medicine, Miami, FL, USA.
(4)College of Nursing, University of South Carolina, Columbia, SC, USA.
(5)University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA.
(6)Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, 
AZ, USA.
(7)School of Nursing, UNC Chapel Hill, and Lineberger Comprehensive Cancer 
Center, Chapel Hill, NC, USA.

PURPOSE: To explore experiences of sheltering in place and accessing treatment 
during the initial stages of the COVID-19 pandemic among survivors with cancer 
receiving tyrosine kinase inhibitor (TKI) therapy.
METHODS: Participants from two pilot studies evaluating TKI therapy use in the 
Southeastern United States during the start of the COVID-19 pandemic (March 
2020) were interviewed. Identical interview guides were used across both studies 
to assess participants' experiences accessing cancer treatment, sheltering in 
place, and coping during the COVID-19 pandemic. Digitally recorded sessions were 
transcribed professionally and checked for accuracy. Descriptive statistics were 
used to summarize participant sociodemographics, and a six-step thematic 
approach was used to analyze interview data and identify salient themes. Dedoose 
qualitative research software was used to manage and organize qualitative codes, 
themes, and memos.
RESULTS: Participants (n = 15) ranged from 43 to 84 years of age, and were 
mostly female (53.3%), married (60%), and survivors with hematologic 
malignancies (86.7%). The research team identified five salient themes: 
Participants followed pandemic guidelines, Variable impact on well-being, Common 
feelings of fear, anxiety and anger, No barriers to accessing therapy and 
medical care, and Faith and God as powerful forces for coping.
CONCLUSIONS: The conclusions of the study provide several implications for 
survivorship programs or clinics for supporting survivors who are taking chronic 
TKI therapy during COVID-19, including enhancement of current psychosocial 
support efforts for cancer survivors or development of new programs tailored to 
the unique needs of a survivor during a pandemic, such as focused coping 
strategies, modified physical activity programs, family/professional role 
changes, and access to safe public spaces.

© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland 
AG.

DOI: 10.1007/s10552-023-01742-7
PMID: 37378866 [Indexed for MEDLINE]


569. Clin Exp Rheumatol. 2023 Jun;41(6):1301-1309. doi: 
10.55563/clinexprheumatol/i7kod6. Epub 2023 Jun 28.

Adverse effects of the COVID-19 pandemic on fibromyalgia patients in Germany: a 
longitudinal investigation including pre-pandemic data of pain and 
health-related outcomes.

Mosch B(1), Hagena V(1), Herpertz S(1), Diers M(2).

Author information:
(1)Department of Psychosomatic Medicine and Psychotherapy, LWL University 
Hospital, Ruhr University Bochum, Germany.
(2)Department of Psychosomatic Medicine and Psychotherapy, LWL University 
Hospital, Ruhr University Bochum, Germany. martin.diers@rub.de.

OBJECTIVES: The COVID-19 pandemic, along with the associated restrictions and 
changes, has had a far-reaching impact on the mental health and well-being of 
people around the world. The most serious impact can arguably be observed in 
vulnerable populations, such as chronic pain patients. Using a 
pre-test/post-test design with pre-pandemic comparative data, the present study 
sought to investigate how the pandemic impacted chronic pain and well-being in 
individuals with fibromyalgia (FM) (N = 109).
METHODS: We assessed longitudinal changes of various clinical parameters, such 
as pain severity, disability, FM impact, depressive mood and several items 
assessing the individual experience of the pandemic as well as self-perceived 
changes of pain, anxiety, depression and physical activity levels.
RESULTS: Results suggested a significant self-perceived worsening of pain, 
depressive mood, anxiety as well as reduced physical activity due to the 
pandemic. Interestingly, these self-perceived changes were not reflected in 
longitudinal increases of test values (T1-T2). Pain severity at T1 was the 
strongest predictor of pain severity at T2, while COVID-related outcomes showed 
no critical importance, with COVID-related fear being the only significant 
predictor of T2 pain. The general perceived negative impact of the pandemic was 
the only predictor of self-perceived worsening of pain. Finally, patients with 
less severe pre-pandemic pain symptoms displayed greater longitudinal worsening 
of pain.
CONCLUSIONS: These findings emphasise the importance of addressing the specific 
needs of chronic pain suffers during a pandemic.

DOI: 10.55563/clinexprheumatol/i7kod6
PMID: 37378488 [Indexed for MEDLINE]


570. Int J Environ Res Public Health. 2023 Jun 6;20(12):6064. doi: 
10.3390/ijerph20126064.

Assessing Resilience and Its Correlates among Residents of Fort McMurray during 
the COVID-19 Pandemic.

Nkire N(1), Shalaby R(1), Obuobi-Donkor G(2), Agyapong B(1), Eboreime E(1), 
Agyapong VIO(1)(2).

Author information:
(1)Department of Psychiatry, Faculty of Medicine and Dentistry, University of 
Alberta, Edmonton, AB T6G 2R3, Canada.
(2)Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, 
NS B3H 4R2, Canada.

BACKGROUND: The coronavirus disease of 2019 (COVID-19) pandemic has led to a 
global health crisis that has affected the psychological well-being of 
individuals across the world. The persistence of the pandemic and measures to 
curtail it have tested people's ability to cope successfully and bounce back 
from the pandemic, otherwise referred to as resilience. The present study 
examined resilience levels among residents of Fort McMurray and identified the 
demographic, clinical and social factors associated with resilience.
METHODS: The study used a cross-sectional survey design and collected data from 
186 participants using online questionnaires. The survey included questions 
assessing sociodemographic information, mental health history and 
COVID-19-related variables. The main study outcome was resilience measured using 
the six-item Brief Resilience Scale (BRS). The data from the survey were 
analyzed using chi-squared tests and binary logistic regression analyses in the 
Statistical Package for Social Sciences (SPSS), version 25.
RESULTS: The results showed that seven independent variables (age, history of 
depression, history of anxiety, willingness to receive mental health 
counselling, support from the government of Alberta and support from employer) 
were statistically significant within the context of the logistic regression 
model. A history of an anxiety disorder was demonstrated to best predict low 
resilience. Participants who had a history of anxiety disorder were five times 
more likely to show low resilience compared to those without such a history. 
Participants with a history of depression showed a three-fold likelihood of 
having low resilience in comparison to those who did not have a history of 
depression. Individuals who expressed a desire to receive mental health 
counselling had a four-times likelihood of having low resilience than those who 
did not express a desire to receive mental health counselling. The results also 
showed that younger participants were more prone to low resilience compared to 
older participants. Receiving support from the government and one's employer is 
a protective factor.
CONCLUSIONS: This study highlights the importance of examining resilience and 
its associated factors during a pandemic such as COVID-19. The results 
demonstrated that a history of anxiety disorder, depression and being younger 
were important predictors of low resilience. Responders who reported the desire 
to receive mental health counselling also reported expressing low resilience. 
These findings could be used to design and implement interventions aimed at 
improving the resilience of individuals affected by the COVID-19 pandemic.

DOI: 10.3390/ijerph20126064
PMCID: PMC10298239
PMID: 37372651 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


571. BMC Public Health. 2023 Jun 27;23(1):1248. doi: 10.1186/s12889-023-16186-6.

School closures and well-being-related topic searches on Google during the 
COVID-19 pandemic in Sub-Saharan Africa.

Anaduaka US(1), Oladosu AO(2).

Author information:
(1)Department of Accountancy, Economics and Finance, Hong Kong Baptist 
University, 34 Renfrew Road, Kowloon Tong, Hong Kong.
(2)School of Graduate Studies, Lingnan University, 8 Castle Peak Road, Tuen Mun, 
Hong Kong, Hong Kong. ayomideoluwasoladosu@ln.hk.

BACKGROUND: Following the outbreak of the 2020 coronavirus, governments adopted 
non-pharmaceutical interventions (NPIs) to save lives. The NPIs have been deemed 
to have unintended consequences on mental health and well-being. This study 
aimed to estimate the impact of the COVID-19 pandemic-induced school closures on 
the relative search volumes (RSVs) of well-being-relevant topics in 30 low and 
lower- middle income countries in Sub-Saharan Africa.
METHODS: Google Trends search data, difference-in-differences and event study 
methods were used to evaluate the impact on the related search volume (RSV) of 
well-being related topic queries in Sub-Saharan Africa.
RESULTS: The results suggest positive and significant increases in the search 
intensity for anger, boredom, fear, sleep, exercise, and prayer. Contrary to 
other studies, we find no discernible effects on the relative search volumes 
(RSVs) on loneliness, sadness, and suicide.
CONCLUSION: Our findings suggest that the pandemic and the associated 
restrictions had a mixed effect on well-being-related searches. We recommend 
increased vigilance and proactive communication from the government and policy 
makers with the general population in times of emergencies when social policies 
that restrict lives and liberties need to be adopted.

© 2023. The Author(s).

DOI: 10.1186/s12889-023-16186-6
PMCID: PMC10294314
PMID: 37370082 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


572. BMC Geriatr. 2023 Jun 27;23(1):392. doi: 10.1186/s12877-023-03992-1.

"I felt like I had been put on the shelf and forgotten about" - lasting lessons 
about the impact of COVID-19 on people affected by rarer dementias.

Harding E(1), Rossi-Harries S(1), Gerritzen EV(2), Zimmerman N(1), Hoare Z(3), 
Proctor D(4), Brotherhood E(1), Crutch S(1), Suárez-González A(5).

Author information:
(1)Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, 8-11 
Queen Square, London, WC1N 3BG, UK.
(2)Institute of Mental Health, Mental Health and Clinical Neuroscience, School 
of Medicine, University of Nottingham, Nottingham, UK.
(3)NWORTH Clinical Trials Unit, School of Health Sciences, Bangor University, 
Bangor, UK.
(4)Department of Clinical, Educational, and Health Psychology, UCL Division of 
Psychology and Language Sciences, UCL, London, UK.
(5)Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, 8-11 
Queen Square, London, WC1N 3BG, UK. aida.gonzalez@ucl.ac.uk.

BACKGROUND: The public health measures imposed in many countries to contain the 
spread of COVID-19 resulted in significant suspensions in the provision of 
support and care for people with dementia. The negative effects of these 
measures have been extensively reported. However, little is known about the 
specific impact on people with young onset, non-memory-led and inherited 
dementias. This group may have experienced different challenges compared to 
those with late onset dementia given their non-memory phenotypes and younger 
age. We explored the impact of the first COVID-19 lockdown on people living with 
familial Alzheimer's disease, behavioural variant frontotemporal dementia, 
familial frontotemporal dementia, dementia with Lewy bodies, posterior cortical 
atrophy and primary progressive aphasia and their carers in the UK and their 
self-reported strategies for coping.
METHODS: This was a mixed methods study. An online survey was administered to 
people with dementia and family carers recruited via Rare Dementia Support. 
Free-text responses were analysed using framework analysis to identify key 
issues and themes.
RESULTS: 184 carers and 24 people with dementia completed the survey. Overall, 
people with dementia experienced worsening of cognitive symptoms (70%), ability 
to do things (62%), well-being (57%) and changes to medication (26%) during 
lockdown. Carers reported a reduction in the support they received (55%) which 
impacted their own mental health negatively. Qualitative analysis of free-text 
responses shed light on how the disruption to routines, changes to roles and 
responsibilities, and widespread disconnection from friends, family and health 
and social care support varied according to phenotype. These impacts were 
exacerbated by a more general sense that precious time was being lost, given the 
progressive nature of dementia. Despite significant challenges, respondents 
demonstrated resilience and resourcefulness in reporting unexpected positives 
and strategies for adapting to confinement.
CONCLUSIONS: This study has highlighted the specific impacts of the COVID-19 
restrictions on people with young onset, non-memory-led and inherited dementias, 
including behavioural variant frontotemporal dementia, primary progressive 
aphasia and posterior cortical atrophy, and their carers. The specific 
challenges faced according to diagnosis and the self-reported strategies speak 
to the importance of - and may inform the development of - tailored support for 
these underrepresented groups more generally.

© 2023. The Author(s).

DOI: 10.1186/s12877-023-03992-1
PMCID: PMC10303850
PMID: 37370011 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no competing interests to 
disclose.


573. BMJ Open. 2023 Jun 26;13(6):e072533. doi: 10.1136/bmjopen-2023-072533.

Codesigning a user-centred digital psychoeducational tool for youth mental 
well-being with families in Canada: study protocol for a sequential exploratory 
mixed methods study.

Moss SJ(1), Racine N(2), Ahmed S(3), Birnie K(3), Cherak MS(1), Curran JA(1), 
Halperin D(4), Halperin SA(5), Harley M(1), Hu J(3), Leppan L(1), Nickel A(1), 
Russell K(1), Solis M(1), Smith S(1), Soo A(3), Stelfox M(1), Tutelman PR(3), 
Stelfox HT(3), Fiest KM(3), Parsons Leigh J(6).

Author information:
(1)Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada.
(2)School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.
(3)Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
(4)School of Nursing, St Francis Xavier University, Antigonish, Nova Scotia, 
Canada.
(5)Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
(6)Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada 
j.parsonsleigh@dal.ca.

INTRODUCTION: On 11 March 2020, WHO declared the novel coronavirus (COVID-19) 
disease a global pandemic. Governments globally implemented physical distancing 
measures and closure of public institutions that resulted in varying 
implications to youth mental well-being (eg, social isolation, reduced 
extracurricular activities). These impacts may have detrimental short-term and 
long-term effects on youth mental well-being; care for youth with mental health 
disorders was already overstretched, underfunded and fragmented before the 
pandemic and youth are not often considered in mental health initiatives. There 
is a pressing need to partner with youth and families to target and improve 
youth mental well-being prior to the onset of a mental health disorder, as well 
as to conduct research on youth mental well-being needs related to pandemic 
recovery. Here we present a protocol for partnering with youth and families to 
codesign a user-centred digital tool for youth mental well-being.
METHODS AND ANALYSIS: We will conduct a national research study to develop a 
catalogue of recommendations specific to supporting youth mental well-being, and 
a digital tool to support youth mental well-being through three phases of work: 
(1) expert consultation on data related to supporting youth mental well-being 
existing within our Pandemic Preparedness Research Program; (2) codesign of an 
innovative digital tool for youth mental well-being; and (3) assessment of the 
tool's usability and acceptability.
ETHICS AND DISSEMINATION: This study has been approved by the Dalhousie Research 
Ethics Board (2023-6538) and the Conjoint Health Research Ethics Board 
(23-0039). This study will complement ongoing foundational research in youth 
conducted by our team that involves partnering with youth and families to 
understand the unique implications of the pandemic on this population.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/bmjopen-2023-072533
PMCID: PMC10410808
PMID: 37369410 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


574. J Pediatr Psychol. 2023 Nov 16;48(11):879-892. doi: 10.1093/jpepsy/jsad034.

Parents' Preferences for Primary Care-Based Behavioral Services and the COVID-19 
Pandemic: A Mixed Method Study.

Hails KA(1), Wellen BC(2), Simoni M(3), Gaultney WM(4), Petts RA(5), Hostutler 
CA(6), Riley AR(2).

Author information:
(1)Prevention Science Institute, University of Oregon, USA.
(2)Department of Pediatrics, Institute on Development and Disability, Oregon 
Health & Science University, USA.
(3)Pediatric Mental Health Institute, Children's Hospital Colorado, USA.
(4)Department of Anesthesiology, University of Colorado, Anschutz Medical 
Campus, USA.
(5)School of Psychology and Counseling, Fairleigh Dickinson University, USA.
(6)Department of Pediatric Psychology and Neuropsychology, Nationwide Children's 
Hospital, USA.

Comment in
    J Pediatr Psychol. 2023 Aug 28;:

OBJECTIVE: This study examined how family factors impacted parents' attitudes 
toward integrated behavioral health (IBH) in pediatric primary care during the 
COVID-19 pandemic. We hypothesized that COVID-19 impact would predict family 
functioning challenges, and that pre-existing familial contextual factors would 
predict parents' interest in IBH modalities.
METHODS: Parents of children ages 1.5-5 years (N = 301) from five primary care 
clinics completed a survey with measures assessing familial contextual factors 
(income, race and ethnicity, and parents' childhood adversity), COVID-19 impact 
on family relationships and wellbeing, family functioning (child behavior, 
parenting self-efficacy, and parent psychological functioning), and parents' 
preferences for behavioral support in primary care. A subsample of parents 
(n = 23) completed qualitative interviews to provide deeper insights into 
quantitative relationships.
RESULTS: Higher COVID-19 impact was significantly associated with worse parent 
mental health and child behavior problems, as well as lower interest in IBH 
virtual support options. Overall, lower SES and racial and/or ethnic minority 
parents both indicated greater interest in IBH modalities compared to higher SES 
and White parents, respectively. Qualitative interviews identified how pandemic 
stressors led to increases in parents' desire for behavioral support from 
pediatricians, with parents sharing perspectives on the nature of support they 
desired, including proactive communication from providers and variety and 
flexibility in the behavioral supports offered.
CONCLUSIONS: Findings have important implications for the provision of 
behavioral supports for families in primary care, underlying the need to 
increase parents' access to IBH services by proactively providing evidence-based 
resources and continuing to offer telehealth support.

© The Author(s) 2023. Published by Oxford University Press on behalf of the 
Society of Pediatric Psychology. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/jpepsy/jsad034
PMCID: PMC11025383
PMID: 37369014 [Indexed for MEDLINE]


575. Int J Older People Nurs. 2023 Sep;18(5):e12557. doi: 10.1111/opn.12557. Epub 
2023 Jun 26.

What are the holistic care impacts among individuals living through the COVID-19 
pandemic in residential or community care settings? An integrative systematic 
review.

Jackson N(1), Turner M(1), Paterson C(1)(2)(3).

Author information:
(1)Faculty of Health, University of Canberra, Bruce, Australian Capital 
Territory, Australia.
(2)Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research 
Group, University of Canberra, Bruce, Australian Capital Territory, Australia.
(3)Robert Gordon University, Aberdeen, UK.

INTRODUCTION: To critically synthesise evidence in relation to the holistic care 
impacts (physical, psychological, social, spiritual, and environmental 
well-being) among individuals living in residential aged care facilities (RACFs) 
with restrictions during the COVID-19 pandemic.
METHODS: An integrative systematic review followed a pre-registered protocol and 
has been reported according to the Preferred Reporting Items for Systematic 
Reviews and Meta-analysis (PRISMA) Guidelines. Electronic databases were 
searched from inception to June 2022. Qualitative, quantitative, and mixed 
methods studies were included. All articles were double screened according to a 
pre-determined eligibility criterion. The review process was managed using 
Covidence systematic review software. Data from the studies were extracted, 
methodological quality appraisal conducted, and a narrative synthesis conducted.
RESULTS: 18 studies were included. The impact of restrictive practices and 
periods of lockdown impacted older people on all levels of individual 
quality-of-life. With or without COVID-19, residents experienced functional 
decline and many experienced malnutrition, increased incontinence, increased 
pain, and poorer general health and significant psychological distress. 
Depression increased with reduced social contact, as did anxiety and loneliness. 
Some residents spoke of suicidal ideation.
CONCLUSION: It is highly plausible that further outbreaks may prompt knee-jerk 
reactions from public health departments and governing bodies to continue to 
restrict and lockdown facilities. Public health COVID-19 outbreak policy for 
aged care across the globe will need to consider the benefits verses risk debate 
given the findings uncovered in this review. These findings showed that it is 
vital that policy considers quality-of-life domains not solely survival rates.

© 2023 The Authors. International Journal of Older People Nursing published by 
John Wiley & Sons Ltd.

DOI: 10.1111/opn.12557
PMID: 37365716 [Indexed for MEDLINE]


576. GMS J Med Educ. 2023 Apr 17;40(2):Doc21. doi: 10.3205/zma001603. eCollection 
2023.

The impact of COVID-19 pandemic on mental burden and quality of life in medical 
students - results of an online survey.

Halfmann M(1)(2), Wetzel L(1)(2), Castioni N(1)(2), Kiefer F(1)(2), König S(3), 
Schmieder A(4), Koopmann A(1)(2).

Author information:
(1)Central Institute of Mental Health (CIMH), Department of Addictive Behavior 
and Addiction Medicine, Mannheim, Germany.
(2)University of Heidelberg, Feuerlein Centre on Translational Addiction 
Medicine (FCTS), Heidelberg, Germany.
(3)University Hospital Würzburg, Institute for Medical Teaching and Medical 
Education Research, Würzburg, Germany.
(4)University Hospital Würzburg, Clinic for Dermatology, Venereology and 
Allergology, Würzburg, Germany.

OBJECTIVES: Changes in academic conditions due to the COVID-19 pandemic are 
potential stressors for medical students and can make them vulnerable for the 
development of psychiatric disorders.Previous pandemics had a negative 
impairment on well-being due to social isolation and the perceived threat, an 
increase in fear, anger and frustration and an increase in post-traumatic stress 
disorder among health professionals. Therefore, this study examines the impact 
of the COVID-19 pandemic on medical students' mental health and possible 
psychological consequences.
METHODS: In this anonymous online survey (online 12/01/2021-03/31/2022), we 
examined the impact of COVID-19 pandemic on mental health of 561 German medical 
students aged between 18 und 45 years. Perceived anxiety and burden were 
assessed retrospectively from spring 2020 to autumn 2021. Changes in symptoms of 
anxiety and depression were assessed using the Hospital Anxiety and Depression 
Scale (HADS), quality of life was assessed using the WHO Quality of Life 
Questionnaire (WHOQOL BREF).
RESULTS: Anxiety and burden showed wavelike courses with higher scores in 
autumn, winter and spring. The scores for depression and anxiety increased after 
the outbreak of the COVID-19 pandemic compared to the time before (p<.001). 
Results of a multifactorial ANOVA showed, that previous psychiatric illness 
(p<.001), being in the first two years of studies (p=.006), higher burden 
(p=.013) and greater differences in symptoms of depression (p<.001) were 
associated with a decreased quality of life in medical students.
CONCLUSION: The COVID-19 pandemic has a negative impact on mental health of 
medical students and their actual quality of life. Therefore, medical faculties 
should establish specific support to prevent the development of psychiatric 
sequelae probably resulting in long-term medical leaves.

Publisher: ZIELSETZUNG: Die durch die COVID-19-Pandemie veränderten 
Studienbedingungen stellen potenzielle Stressoren für Medizinstudierende dar und 
können sie für die Entwicklung psychiatrischer Erkrankungen anfällig 
machen.Frühere Pandemien führten aufgrund der sozialen Isolation und der 
wahrgenommenen Bedrohung zu negativen Effekten auf das Wohlbefinden, zu einer 
Zunahme von Angst, Wut und Frustration sowie zu einer Zunahme von 
posttraumatischen Belastungsstörungen bei Angehörigen der Gesundheitsberufe. In 
dieser Studie werden daher die Auswirkungen der COVID-19-Pandemie auf die 
psychische Gesundheit von Medizinstudierenden und mögliche psychologische Folgen 
untersucht.
METHODIK: In dieser anonymen Online-Befragung (online 12/01/2021-03/31/2022) 
untersuchten wir die Auswirkungen der COVID-19-Pandemie auf die psychische 
Gesundheit von 561 deutschen Medizinstudierenden im Alter zwischen 18 und 45 
Jahren. Die wahrgenommenen Ängste und Belastungen wurden retrospektiv für den 
Zeitraum Frühjahr 2020 bis Herbst 2021 erhoben. Veränderungen von Angst- und 
Depressionssymptomen wurden mit der Hospital Anxiety and Depression Scale (HADS) 
erfasst, die Lebensqualität wurde mit dem WHO Quality of Life Questionnaire 
(WHOQOL BREF) erfragt.
ERGEBNISSE: Angst und Belastung zeigten wellenförmige Verläufe mit höheren 
Werten im Herbst, Winter und Frühjahr. Die Werte für Depressionssymptome und 
Ängste stiegen nach dem Ausbruch der COVID-19-Pandemie im Vergleich zur Zeit 
davor an (p<.001). Die Ergebnisse einer multifaktoriellen ANOVA zeigten, dass 
eine psychiatrische Vorerkrankung (p<.001), die Zugehörigkeit zur Gruppe der 
Studierenden in den ersten beiden Studienjahren (p=.006), eine höhere Belastung 
(p=.013) und größere Differenzen zwischen den Depressionssymptomen vor und 
während der Pandemie (p<.001) mit einer verminderten Lebensqualität bei 
Medizinstudierenden zusammenhingen.
SCHLUSSFOLGERUNGEN: Die COVID-19-Pandemie hat negative Auswirkungen auf die 
psychische Gesundheit von Medizinstudierenden und ihre aktuelle Lebensqualität. 
Daher sollten die medizinischen Fakultäten spezifische Unterstützungsangebote 
einrichten, um die Entwicklung psychiatrischer Folgeerscheinungen bei den 
angehenden Ärztinnen und Ärzten zu verhindern, die wahrscheinlich zu 
langfristigen Krankschreibungen führen könnten.

Copyright © 2023 Halfmann et al.

DOI: 10.3205/zma001603
PMCID: PMC10285365
PMID: 37361244 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


577. J Clin Immunol. 2023 Oct;43(7):1519-1525. doi: 10.1007/s10875-023-01538-z. Epub 
2023 Jun 26.

Immunoglobulin Replacement Therapy During COVID-19 Pandemic: Practical and 
Psychological Impact in Patients with Antibody Deficiency.

Maimaris J(1)(2), O'Sullivan A(3), Underhill I(3), Green G(3), Symes A(3), Lowe 
D(4)(3), Burns S(4)(3), Campbell M(#)(4)(3), Elfeky R(#)(4)(3).

Author information:
(1)Institute of Immunity and Transplantation, University College London, London, 
UK. j.maimaris@ucl.ac.uk.
(2)Department of Immunology, Royal Free London NHS Foundation Trust, London, UK. 
j.maimaris@ucl.ac.uk.
(3)Department of Immunology, Royal Free London NHS Foundation Trust, London, UK.
(4)Institute of Immunity and Transplantation, University College London, London, 
UK.
(#)Contributed equally

PURPOSE: The COVID-19 pandemic has impacted on how health services deliver care 
and the mental health of the population. Due to their clinical vulnerability, to 
reduce in-hospital attendances during the COVID-19 pandemic, modifications in 
immunoglobulin treatment regimens were made for patients with antibody 
deficiency. These patients were also likely to experience social isolation due 
to shielding measure that were advised. We aimed to investigate the impact of 
modifying immunoglobulin treatment regimen on infection and mental health burden 
during shielding restrictions.
METHOD: Patients on immunoglobulin replacement therapy (IGRT) responded to a 
standardised questionnaire examining self-reported infection frequency, anxiety 
(GAD-7), depression (PHQ-8), fatigue (FACIT), and quality of life during the 
pandemic. Infection frequency and immunoglobulin trough levels were compared to 
pre-pandemic levels.
RESULTS: Patients who did not change treatment modality or those who received 
immunoglobulin replacement at home during the pandemic reported fewer 
infections. In patients who received less frequent hospital infusions, there was 
no significant increase in infections whilst immunoglobulin trough levels 
remained stable. There was no significant difference in anxiety, or depression 
scores between the treatment modality groups. Patients reported higher fatigue 
scores compared to the pre-COVID general population and in those discharged 
following hospitalisation for COVID.
CONCLUSION: Changing immunoglobulin treatment regimen did not negatively impact 
infection rates or psychological wellbeing. However, psychological welfare 
should be prioritised for this group particularly given uncertainties around 
COVID-19 vaccination responsiveness and continued social isolation for many.

© 2023. The Author(s).

DOI: 10.1007/s10875-023-01538-z
PMCID: PMC10499672
PMID: 37357249 [Indexed for MEDLINE]

Conflict of interest statement: SOB has received grant support from CSL Behring 
and personal fees or travel expenses from Immunodeficiency Canada/IAACI, CSL 
Behring, Baxalta US Inc and Biotest. DML has received: research grants to his 
institution from LifeArc, Blood Cancer UK, Bristol Myers Squibb, GSK, British 
Society of Antimicrobial Chemotherapy, National Institute of Health Research and 
the UK Medical Research Council; speaker fees from Langland, Biotest and Gilead 
(educational video); travel, accommodation and conference fees from Octapharma; 
personal fees for a round-table discussion from Merck; and consultancy fees (to 
institution) from GSK. The rest of the authors declare that they have no 
conflicts of interest.


578. Intensive Crit Care Nurs. 2023 Oct;78:103474. doi: 10.1016/j.iccn.2023.103474. 
Epub 2023 Jun 22.

Effects of an interactive handgrip game on surgical patients requiring intensive 
care: An assessor-blinded randomized controlled trial.

Han PH(1), Shih CY(2), Wang AY(3), Chen YC(2), Yang CC(4), Fan YC(5), Hsiang 
HF(4), Chiu HY(6).

Author information:
(1)Department of Interaction Design, National Taipei University of Technology, 
Taipei, Taiwan.
(2)School of Nursing, College of Nursing, Taipei Medical University, Taipei, 
Taiwan.
(3)Department of Critical Care Medicine, Taipei Medical University Hospital, 
Taipei, Taiwan; Department of Critical Care Medicine, Fu Jen Catholic University 
Hospital, Fu Jen Catholic University, New Taipei City, Taiwan; School of 
Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, 
Taiwan.
(4)Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan.
(5)College of Public Health, Taipei Medical University, Taipei, Taiwan.
(6)School of Nursing, College of Nursing, Taipei Medical University, Taipei, 
Taiwan; Department of Nursing, Taipei Medical University Hospital, Taipei, 
Taiwan; Research Center of Sleep Medicine, Taipei Medical University Hospital, 
Taipei, Taiwan; Research Center of Sleep Medicine, College of Medicine, Taipei 
Medical University, Taipei, Taiwan. Electronic address: hychiu0315@tmu.edu.tw.

OBJECTIVE: To explore the effect of an interactive handgrip game on 
psychological distress and handgrip strength among critically ill surgical 
patients.
DESIGN: A randomised controlled trial.
SETTING: A surgical intensive care unit.
INTERVENTION: Participants were enrolled in the program within 48 hours of 
admission to the intensive care unit. Patients in the intervention group played 
a 20-minute interactive handgrip game twice daily for a maximum of three days in 
the intensive care unit in addition to routinely passive physical 
rehabilitation. Patients in the routine care group had a daily target of 20 min 
of passive physical rehabilitation as needed.
MEASUREMENT: The primary outcomes included depression, anxiety, and stress 
measured using the shortened version of the Depression Anxiety Stress Score 
scale. The secondary outcomes were perceived sleep evaluated using the 
Richards-Campbell Sleep Questionnaire, delirium assessed using the Intensive 
Care Delirium Screening Checklist, and handgrip strength measured using handgrip 
dynamometry within a handgrip device.
RESULTS: Two hundred and twenty-seven patients were eligible and 70 patients 
were recruited in the intervention (n = 35) and routine care groups (n = 35). 
The patients in the intervention group had lower scores (median = 6.0, 4.0, and 
12.0) for depression, anxiety, and stress compared with those in the routine 
care group (12.0, 12.0, and 20.0; all p < 0.05). The interactive handgrip game 
did not significantly improve sleep quality and prevent the occurrence of 
delirium (both p > 0.05). The patients who received the interactive handgrip 
game intervention exhibited significantly enhanced handgrip strength in both 
hands over time (both p < 0.001).
CONCLUSION: An interactive handgrip game may benefit the psychological 
well-being and handgrip strength of critically ill patients.
IMPLICATIONS FOR CLINICAL PRACTICE: Interactive handgrip games is effective 
active exercise which should be integrated into routine nursing practice.

Copyright © 2023 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.iccn.2023.103474
PMID: 37354696 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


579. Acta Paediatr. 2023 Oct;112(10):2164-2171. doi: 10.1111/apa.16886. Epub 2023 Jun 
30.

Depressive symptoms in mothers of preterm infants before and during COVID-19 
restrictions in neonatal intensive care units.

Itoshima R(1)(2)(3), Tuura K(4), Toome L(5), Varendi H(6), Saik P(7), Axelin 
A(8), Lehtonen L(1)(2), Ahlqvist-Björkroth S(1)(4).

Author information:
(1)Department of Clinical Medicine, University of Turku, Turku, Finland.
(2)Department of Paediatrics and Adolescent Medicine, Turku University Hospital, 
Turku, Finland.
(3)Division of Neonatology, Nagano Children's Hospital, Azumino, Japan.
(4)Department of Psychology and Language Pathology, University of Turku, Turku, 
Finland.
(5)Department of Neonatal and Infant Medicine, Tallinn Children's Hospital, 
Tallinn, Estonia.
(6)Neonatal Unit, Children's Clinic of Tartu University Hospital, Tartu, 
Estonia.
(7)Department of Neonatology, West-Tallinn Central Hospital, Tallinn, Estonia.
(8)Department of Nursing Science, University of Turku, Turku, Finland.

AIM: Little is known about the specific restriction measures used in intensive 
care units (NICUs) during the COVID-19 pandemic and their impact on parental 
well-being. Hence, this study aimed to assess the association between 
restriction measures and mothers' post-partum depressive symptoms.
METHODS: This comparative cohort study included mothers who gave birth before 
35 weeks of gestation in Estonia. The outcome measure was mothers' post-partum 
depressive symptoms at the time of infant discharge, evaluated using the 
Edinburgh Postnatal Depression Scale (EPDS). In addition to the pandemic itself, 
the number of restriction measures in the NICUs was analysed as a potential 
explanatory factor for depressive symptoms.
RESULTS: The study included 55 mothers before the pandemic in 2018-2019 and 54 
mothers during the COVID-19 pandemic in 2021. No significant difference was 
found in the median EPDS scores between the cohorts: 7.0 [interquartile range 
(IQR): 4.0-12.0] and 8.0 (IQR: 5.0-12.8) respectively. The number of restriction 
measures was not associated with mothers' EPDS scores in either unadjusted or 
adjusted models.
CONCLUSION: The COVID-19 pandemic or the number of restriction measures used in 
Estonian NICUs did not associate with mothers' post = partum depressive 
symptoms.

© 2023 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on 
behalf of Foundation Acta Paediatrica.

DOI: 10.1111/apa.16886
PMID: 37354112 [Indexed for MEDLINE]


580. PLoS One. 2023 Jun 23;18(6):e0287388. doi: 10.1371/journal.pone.0287388. 
eCollection 2023.

A compassion-based program to reduce psychological distress in medical students: 
A pilot randomized clinical trial.

Rojas B(1), Catalan E(1)(2), Diez G(3), Roca P(4)(5).

Author information:
(1)Medical School, Complutense University of Madrid, Madrid, Spain.
(2)Virgen de la Victoria Hospital, Málaga, Spain.
(3)Nirakara Lab, Complutense University of Madrid, Madrid, Spain.
(4)Faculty of Health Sciences, Universidad Villanueva, Madrid, Spain.
(5)Valencian International University, Valencia, Spain.

OBJECTIVES: Physicians and medical students are subject to higher levels of 
psychological distress than the general population. These challenges have a 
negative impact in medical practice, leading to uncompassionate care. This pilot 
study aims to examine the feasibility of Compassion Cultivation Training (CCT) 
to reduce psychological distress and improve the well-being of medical students. 
We hypothesize that the CCT program, as compared to a waitlist control group, 
will reduce psychological distress (i.e., stress, anxiety, and depression) and 
burnout symptoms, while improving compassion, empathy, mindfulness, resilience, 
psychological well-being, and emotion-regulation strategies after the 
intervention. Furthermore, we hypothesize that these improvements will be 
maintained at a two-month follow-up.
METHODS: Medical students were randomly assigned to an 8-week CCT or a Waitlist 
control group (WL). They completed self-report assessments at pre-intervention, 
post-intervention, and a 2-month follow-up. The outcomes measured were 
compassion, empathy, mindfulness, well-being, resilience, emotional regulation, 
psychological distress, burnout, and COVID-19 concern. Mixed-effects models and 
Reliable Change Index were computed.
RESULTS: Compared with WL, CCT showed significant improvements in 
self-compassion, mindfulness, and emotion regulation, as well as a significant 
decrease in stress, anxiety, and emotional exhaustion component of burnout. 
Furthermore, some of these effects persisted at follow-up. No adverse effects of 
meditation practices were found.
CONCLUSIONS: CCT enhanced compassion skills while reducing psychological 
distress in medical students, this being critical to preserving the mental 
health of physicians while promoting compassionate care for patients. The need 
for institutions to include this type of training is also discussed.

Copyright: © 2023 Rojas et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0287388
PMCID: PMC10289411
PMID: 37352295 [Indexed for MEDLINE]

Conflict of interest statement: NO authors have competing interests.


581. Psychiatr Pol. 2023 Apr 30;57(2):297-309. doi: 10.12740/PP/OnlineFirst/139019. 
Epub 2023 Apr 30.

Well-being and depressive symptoms among corporate employees during the COVID-19 
pandemic.

[Article in English, Polish]

Grajek MK(1), Kempa A(2), Kobza J(1).

Author information:
(1)Zakład Zdrowia Publicznego, Wydział Nauk o Zdrowiu w Bytomiu, Śląski 
Uniwersytet Medyczny w Katowicach.
(2)Wydział Psychologii, Uniwersytet Społeczno-Humanistyczny SWPS, Katowice.

OBJECTIVES: The aim of the study was to assess the well-being of corporate 
employees and whether it has changed from the beginning of the first wave of 
COVID-19 (March) to the development of the second wave of the disease (October). 
The essence of the study was to estimate the risk of depressive symptoms in the 
studied population.
METHODS: The study involved 250 corporate IT employees. The study was conducted 
using the WHO-5 questionnaire and the Beck test. Statistical significance was 
determined using the Wilcoxon test (p=0.05).
RESULTS: In the first stage of the study, the average well-being of the 
respondents was assessed at 20.2 points, which means moderate well-being. It was 
observed that the average well-being was worse in the group of women (18.4 
points) than in the group of men (22.0 points). In the last stage of the study, 
the respondents' feeling was 11.0 points - level of bad mood (10.0 points in 
women and 12.0 points in men). It was found that in the October stage the 
percentage of people with mild and moderate depression is higher than in the 
March stage.
CONCLUSIONS: On the basis of this research, it can be concluded that COVID-19 
and related restrictions had a negative impact on the mental condition of the 
respondents.

DOI: 10.12740/PP/OnlineFirst/139019
PMID: 37350704 [Indexed for MEDLINE]


582. Clin Neuropsychol. 2024 Feb;38(2):326-353. doi: 10.1080/13854046.2023.2227407. 
Epub 2023 Jun 23.

Cognition and psychological well-being in adults with post COVID-19 condition 
and analyses of symptom sequelae.

Ashton Rennison VL(1)(2), Chovaz CJ(3), Zirul S(1).

Author information:
(1)Psychology Department, London Health Sciences Centre, London, ON, Canada.
(2)Schulich School of Medicine & Dentistry Department of Psychiatry, Western 
University, London, ON, Canada.
(3)Psychology Department, King's University College at Western University, 
London, ON, Canada.

OBJECTIVE: As the coronavirus disease 2019 (COVID-19) pandemic moves into its 
fourth year, gaining a better clinical understanding of individuals with post 
COVID-19 condition is paramount. The current study examined the neurocognitive 
and psychological status of adults with post COVID-19 condition, as well as 
explored the impact of high psychological burden on objective neurocognitive 
functioning and the relationship between subjective cognitive concerns and 
objective neurocognitive findings.
METHOD: Valid neuropsychological assessments were completed with 51 symptomatic 
adults who were 297.55 days, on average, following a confirmed severe acute 
respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Participants 
completed brief self-report depression, anxiety, and PTSD questionnaires, a 
questionnaire with subjective ratings of cognitive abilities, and standardized 
neurocognitive tests that examined performance validity, attention, processing 
speed, verbal learning and memory, naming, visual construction, and executive 
functioning.
RESULTS: The participants were mostly Caucasian (80.39%), middle-aged (average 
47.37 years), women (82.35%), who were never hospitalized (86.27%). Despite all 
individuals reporting cognitive problems in daily life, mean performances on 
objective testing did not reveal any neurocognitive deficits (at or below the 
8th percentile) at a group level. Approximately half (49.02%) of the 
participants reported co-occurring mental health symptoms that were considered 
clinically elevated based on questionnaire results. High psychological symptom 
burden was associated with greater subjective cognitive difficulties but did not 
result in neurocognitive dysfunction on objective testing.
CONCLUSIONS: This study contributes to the literature regarding post COVID-19 
condition in adults including the relationship between the cognitive and 
psychological symptoms. Results are summarized in key clinical learning points.

DOI: 10.1080/13854046.2023.2227407
PMID: 37350239 [Indexed for MEDLINE]


583. Am J Health Promot. 2024 Feb;38(2):238-241. doi: 10.1177/08901171231185765. Epub 
2023 Jun 22.

Exploring the Impact of the COVID-19 Pandemic on Employees' Workplace Health 
Promotion Preferences.

Hammerback K(1), Strait M(1), Kohn MJ(1), Garcia C(1), Harris JR(1), Hannon 
PA(1).

Author information:
(1)Health Promotion Research Center, Department of Health Systems and Population 
Health, University of Washington, Seattle, WA, USA.

PURPOSE: The COVID-19 pandemic has led to profound changes in the workplace as 
well as increases in stress, missed preventive care, and other health concerns. 
There is limited research since the onset of the pandemic on employees' primary 
health concerns and their willingness to engage with workplace health promotion 
(WHP) programs to address these needs. We conducted this survey about employees' 
current health priorities as a first step to exploring whether WHP programs need 
to evolve to be responsive to employees' needs at this stage of the pandemic.
DESIGN: National cross-sectional survey.
SETTING: United States, April 29-May 5, 2022.
SUBJECTS: 2053 Americans employed part or full time.
MEASURES: 17-item online survey assessing demographics, health priorities, and 
impact of the pandemic on health.
ANALYSIS: Descriptive statistics, SPSS Version 19.
RESULTS: Employees' most common health concerns included work/life balance and 
stress (each cited by 55%). Nearly half (46%) said their health or well-being 
was affected by the pandemic; within this group, the most common concerns were 
stress (66%), anxiety (61%), sleep (49%), and depression (48%). Almost all (94%) 
indicated they would be open to receiving support from their employers.
CONCLUSION: This research is a first step in learning about employees' current 
health priorities and how they may have changed. WHP researchers and 
practitioners can determine how their programs align with current priorities. 
Our future research will explore employees' preferences, heath behaviors, and 
their current workplace environments in more depth.

DOI: 10.1177/08901171231185765
PMCID: PMC10291210
PMID: 37349879 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting InterestsThe 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


584. BMC Health Serv Res. 2023 Jun 22;23(1):675. doi: 10.1186/s12913-023-09669-0.

Assessing safe and personalised maternity and neonatal care through a pandemic: 
a case study of outcomes and experiences in two trusts in England using the 
ASPIRE COVID-19 framework.

Neal S(1), Stone L(2), Moncrieff G(3), Matthews Z(4), Kingdon C(3), Topalidou 
A(3), Balaam MC(3), Cordey S(3), Crossland N(5), Feeley C(6), Powney D(7), 
Sarian A(8), Fenton A(9), Heazell AEP(10), de Jonge A(11), Severns A(12), 
Thomson G(5), Downe S(3).

Author information:
(1)Department of Social Statistics and Demography, University of Southampton, 
Southampton, UK. S.Neal@soton.ac.uk.
(2)Faculty of Medicine, Health & Life Sciences, Swansea University Medical 
School, Swansea University, Swansea, UK.
(3)ReaCH Group, School of Community Health and Midwifery, Faculty of Health and 
Care, University of Central Lancashire, Preston, UK.
(4)Department of Social Statistics and Demography, University of Southampton, 
Southampton, UK.
(5)MAINN Group, School of Community Health and Midwifery, Faculty of Health and 
Care, University of Central Lancashire, Preston, UK.
(6)Nursing, Midwifery & Palliative Care, Methodologies Division, King's College 
London, London, UK.
(7)School of Justice, University of Central Lancashire, Preston, PR1, UK.
(8)School of Medicine, University of Central Lancashire, Preston, UK.
(9)Newcastle Neonatal Service, Newcastle Upon Tyne Hospitals NHS Foundation 
Trust, Newcastle Upon Tyne, UK.
(10)Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine and 
Health, University of Manchester, Manchester, UK.
(11)Department of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam 
University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
(12)Lancashire And South Cumbria Cardiac Network, Preston, UK.

BACKGROUND: The COVID-19 pandemic has resulted in profound and far-reaching 
impacts on maternal and newborn care and outcomes. As part of the ASPIRE 
COVID-19 project, we describe processes and outcome measures relating to safe 
and personalised maternity care in England which we map against a pre-developed 
ASPIRE framework to establish the potential impact of the COVID-19 pandemic for 
two UK trusts.
METHODS: We undertook a mixed-methods system-wide case study using quantitative 
routinely collected data and qualitative data from two Trusts and their service 
users from 2019 to 2021 (start and completion dates varied by available data). 
We mapped findings to our prior ASPIRE conceptual framework that explains 
pathways for the impact of COVID-19 on safe and personalised care.
RESULTS: The ASPIRE framework enabled us to develop a comprehensive, 
systems-level understanding of the impact of the pandemic on service delivery, 
user experience and staff wellbeing, and place it within the context of 
pre-existing challenges. Maternity services experienced some impacts on core 
service coverage, though not on Trust level clinical health outcomes (with the 
possible exception of readmissions in one Trust). Both users and staff found 
some pandemic-driven changes challenging such as remote or reduced antenatal and 
community postnatal contacts, and restrictions on companionship. Other key 
changes included an increased need for mental health support, changes in the 
availability and uptake of home birth services and changes in induction 
procedures. Many emergency adaptations persisted at the end of data collection. 
Differences between the trusts indicate complex change pathways. Staff reported 
some removal of bureaucracy, which allowed greater flexibility. During the first 
wave of COVID-19 staffing numbers increased, resolving some pre-pandemic 
shortages: however, by October 2021 they declined markedly. Trying to maintain 
the quality and availability of services had marked negative consequences for 
personnel. Timely routine clinical and staffing data were not always available 
and personalised care and user and staff experiences were poorly captured.
CONCLUSIONS: The COVID-19 crisis magnified pre-pandemic problems and in 
particular, poor staffing levels. Maintaining services took a significant toll 
on staff wellbeing. There is some evidence that these pressures are continuing. 
There was marked variation in Trust responses. Lack of accessible and timely 
data at Trust and national levels hampered rapid insights. The ASPIRE COVID-19 
framework could be useful for modelling the impact of future crises on routine 
care.

© 2023. The Author(s).

DOI: 10.1186/s12913-023-09669-0
PMCID: PMC10288742
PMID: 37349751 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


585. Int J Pharm Pract. 2023 Sep 30;31(5):472-477. doi: 10.1093/ijpp/riad038.

Australian community pharmacists' experiences during the COVID-19 pandemic.

Kanaani E(1), Salahudeen MS(1), Curtain C(1).

Author information:
(1)School of Pharmacy and Pharmacology, University of Tasmania, Hobart, 
Tasmania, Australia.

OBJECTIVES: Community pharmacists have played an important role in providing 
services for their community during the COVID-19 pandemic. In this study, the 
purpose is to present the attitudes and experiences of Australian pharmacists 
regarding the COVID-19 pandemic.
METHODS: A qualitative semi-structured interview explored community pharmacist 
experiences during the initial COVID-19 lockdown. Thematic analysis of 
transcribed interviews was conducted to investigate the experiences of 
pharmacists.
KEY FINDINGS: Interviews were conducted with 15 pharmacists from different 
regional areas and states of Australia. In the study, five main themes were 
developed: COVID-19 practice complications; pharmacy practice changes; difficult 
patient interactions; worsened mental well-being and coping strategies; and 
career dissatisfaction. Pharmacists stated that an increase in workload, 
shortage of supplies and frequent COVID-19 management updates increased pressure 
on their duties. The negative customer interactions during COVID-19 lockdown 
adversely affected some pharmacists' mental health and career satisfaction.
CONCLUSIONS: Community pharmacists are subject to multiple factors affecting 
their practice, impairing their mental well-being and triggering them to 
reconsider their career choice. It is important to provide support to community 
pharmacists to help improve their well-being and workplace satisfaction.

© The Author(s) 2023. Published by Oxford University Press on behalf of the 
Royal Pharmaceutical Society.

DOI: 10.1093/ijpp/riad038
PMID: 37348933 [Indexed for MEDLINE]


586. LGBT Health. 2023 Nov-Dec;10(8):595-607. doi: 10.1089/lgbt.2022.0296. Epub 2023 
Jun 23.

Change in Finances, Peer Access, and Mental Health Among Trans and Nonbinary 
People During the COVID-19 Pandemic.

Ghabrial MA(1), Scheim AI(1)(2), Chih C(3), Santos H(2), Adams NJ(4)(5)(6), 
Bauer GR(1)(7).

Author information:
(1)Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, 
Western University, London, Ontario, Canada.
(2)Department of Epidemiology and Biostatistics, Dornsife School of Public 
Health, Drexel University, Philadelphia, Pennsylvania, USA.
(3)Mechanical and Industrial Engineering and University of Toronto, Toronto, 
Ontario, Canada.
(4)Ontario Institute for Studies in Education, University of Toronto, Toronto, 
Ontario, Canada.
(5)Center for Applied Transgender Studies, Chicago, Illinois, USA.
(6)Transgender Professional Association for Transgender Health, Canada.
(7)Institute for Sexual and Gender Health, University of Minnesota Medical 
School, Minneapolis, Minnesota, USA.

Purpose: Due to structural transphobia, trans and nonbinary (TNB) individuals 
were particularly vulnerable to the negative effects of social isolation and 
financial instability resulting from COVID-19. The present study examined the 
effect of change in finances and access to TNB peer gatherings on anxiety and 
depression during the COVID-19 pandemic. Methods: Participants were 18 years and 
older (mean = 30) and completed prepandemic baseline (Fall 2019) and pandemic 
follow-up (Fall 2020) surveys. Multivariable regressions examined associations 
between mental health and change in (1) finances and (2) access to TNB peer 
gatherings (in person or online). Results: Of 780 participants, 50% reported 
that the COVID-19 pandemic had a negative impact on personal income and 58.3% 
reported negative impact on access to TNB peer gatherings. Depression and 
anxiety symptoms increased from prepandemic to follow-up, and most participants 
were above measurement cutoffs for clinical levels at both time points. Change 
in finances and access to TNB peer gatherings interacted with prepandemic 
depression scores to predict depression symptoms during the COVID-19 pandemic. 
For participants with high prepandemic depression scores, financial stability 
predicted pandemic depression scores comparable to that predicted by negative 
financial change. No interaction was found between these variables when 
predicting anxiety symptoms during the COVID-19 pandemic. Conclusion: Findings 
underscore the influence of inequality and prepandemic mental health when 
considering the impact of COVID-19 on wellbeing. Results suggest need for 
multifaceted programs and services, including financial support and meaningful 
TNB community engagement, to address barriers to health equity posed by 
systematic gender oppression.

DOI: 10.1089/lgbt.2022.0296
PMCID: PMC10712362
PMID: 37347954 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflicts 
of interest.


587. Psychol Aging. 2023 Nov;38(7):627-643. doi: 10.1037/pag0000760. Epub 2023 Jun 
22.

Middle-aged and older adults' psychosocial functioning trajectories before and 
during the COVID-19 pandemic: Evidence for multidirectional trends.

Wettstein M(1), Spuling SM(2), Wünsche J(2), Henning G(2).

Author information:
(1)Department of Psychology, Developmental and Educational Psychology, Humboldt 
University of Berlin.
(2)German Centre of Gerontology.

So far little is known with regard to the impact of the COVID-19 pandemic on 
changes in psychosocial functioning of middle-aged and older adults across 
multiple indicators, interindividual differences in these changes, as well as 
the extent to which pandemic-related changes are temporary or not. We 
investigate different domains of psychosocial functioning (views on aging: 
attitude toward own aging [ATOA] and subjective age; subjective well-being: life 
satisfaction and depressive symptoms; health: self-rated health) across up to 7 
years (prepandemic measurement occasions: 2014 and 2017; peri-pandemic 
measurement occasions: Summer 2020 and Winter 2020/2021) among middle-aged and 
older adults (n = 10,856; Mage in 2014 = 64.3 years, SD = 11.58), based on data 
of the German Ageing Survey. Longitudinal multilevel regression models revealed 
that mean-level change toward more negative ATOA over time was aggravated by an 
additional shift toward more pessimistic ATOA in Summer 2020. In contrast, the 
mean-level change toward older subjective ages over time was interrupted by a 
shift toward younger subjective ages in Summer 2020. This shift was more 
pronounced among chronologically younger individuals. Depressive symptoms 
remained on average stable over time, but there was a temporary increase in 
Summer 2020. No pandemic-related change was observed for life satisfaction and 
self-rated health. Our findings suggest that different psychosocial functioning 
indicators reveal a different susceptibility to "COVID-19 effects," but all 
changes were temporary, potentially reflecting processes of adaptation. We 
discuss our results in the context of established theories, such as 
socioemotional selectivity theory or set-point theory of well-being. (PsycInfo 
Database Record (c) 2023 APA, all rights reserved).

DOI: 10.1037/pag0000760
PMID: 37347922 [Indexed for MEDLINE]


588. Emotion. 2024 Feb;24(1):177-195. doi: 10.1037/emo0001255. Epub 2023 Jun 22.

COVID-19 on mind: Daily worry about the coronavirus is linked to negative affect 
experienced during mind-wandering and dreaming.

Sikka P(1), Tuominen J(2), Ezquerro Nassar A(3), Kirberg M(4), Loukola V(2), 
Revonsuo A(2), Valli K(2), Windt J(4), Bekinschtein TA(3), Noreika V(5).

Author information:
(1)Department of Psychology, Stanford University.
(2)Department of Psychology and Speech-Language Pathology, University of Turku.
(3)Consciousness and Cognition Lab, Department of Psychology, University of 
Cambridge.
(4)Department of Philosophy, Monash University.
(5)Department of Biological and Experimental Psychology, School of Biological 
and Behavioural Sciences, Queen Mary University of London.

Despite a surge of studies on the effects of COVID-19 on our well-being, we know 
little about how the pandemic is reflected in people's spontaneous thoughts and 
experiences, such as mind-wandering (or daydreaming) during wakefulness and 
dreaming during sleep. We investigated whether and how COVID-19-related general 
concern, anxiety, and daily worry are associated with the daily fluctuation of 
the affective quality of mind-wandering and dreaming, and to what extent these 
associations can be explained by poor sleep quality. We used ecological 
momentary assessment by asking participants to rate the affect they experienced 
during mind-wandering and dreaming in daily logs over a 2-week period. Our 
preregistered analyses based on 1,755 dream logs from 172 individuals and 1,496 
mind-wandering logs from 152 individuals showed that, on days when people 
reported higher levels of negative affect and lower levels of positive affect 
during mind-wandering, they experienced more worry. Only daily sleep quality was 
associated with affect experienced during dreaming at the within-person level: 
on nights with poorer sleep quality people reported experiencing more negative 
and less positive affect in dreams and were more likely to experience 
nightmares. However, at the between-person level, individuals who experienced 
more daily COVID-19 worry during the study period also reported experiencing 
more negative affect during mind-wandering and during dreaming. As such, the 
continuity between daily and nightly experiences seems to rely more on stable 
trait-like individual differences in affective processing. (PsycInfo Database 
Record (c) 2024 APA, all rights reserved).

DOI: 10.1037/emo0001255
PMID: 37347885 [Indexed for MEDLINE]


589. CBE Life Sci Educ. 2023 Sep;22(3):ar32. doi: 10.1187/cbe.22-12-0243.

Modifying Summer Undergraduate Research Programs during COVID-19 Increased 
Graduate School Intentions but Exacerbated Anxieties.

Grineski SE(1), Morales DX(2), Collins TW(3).

Author information:
(1)Department of Sociology, University of Utah, Salt Lake City, UT 84112.
(2)Department of Urban Studies, Worcester State University, Worcester, MA 01602.
(3)Department of Geography, University of Utah, Salt Lake City, UT 84112.

COVID-19 created unprecedented challenges for college students, highlighting the 
need to provide educational contexts that foster well-being. Summer 
undergraduate research experiences (SUREs) constitute a high-impact practice, 
yet little systematic knowledge exists about how the first surge of COVID-19 
influenced undergraduate researchers' well-being. This knowledge is important 
for preparing for future disruptions. This study applies the student well-being 
model (SWBM) to examine how SURE status (e.g., modification vs. cancellation) 
impacted students' mental health and graduate school intentions using primary 
survey data collected from U.S. undergraduate researchers in science, 
technology, engineering, and mathematics (STEM) fields in Summer 2020 (n = 408, 
from 131 institutions). Just under half had their SURE canceled, and the others 
engaged in modified SUREs. Students whose SUREs were canceled had reduced 
anxiety severity (p < 0.05), but greater concerns about graduate school 
matriculation (p < 0.001), compared with students with modified SUREs. Results 
suggest that modified SUREs are a reasonable path forward under conditions where 
in-person contact is untenable. Results point toward potential improvements in 
higher education practices that may enhance student well-being following 
disruptive events. Program directors can address potential causes of anxiety in 
modified SUREs, advocate for student-centered adjustments to graduate admission 
processes, and use experiences during COVID-19 as a springboard to broaden 
participation in undergraduate research.

DOI: 10.1187/cbe.22-12-0243
PMCID: PMC10424227
PMID: 37347814 [Indexed for MEDLINE]


590. Front Public Health. 2023 Jun 5;11:1162707. doi: 10.3389/fpubh.2023.1162707. 
eCollection 2023.

High stress related to COVID-19 among health workers in the Plateau Central 
healthcare region (BURKINA FASO): a cross-sectional study.

Traoré S(#)(1), Dahourou DL(#)(2), Paré BC(#)(3), Lompo YD(4), Kaboré WJ(1), 
Ouédraogo WA(1), Kambou DT(1), Salou WRA(5), Kaboré D(6), Ouédraogo A(7), Sia 
S(8), Zorné M(9), Ouoba B(8), Guira O(10)(11).

Author information:
(1)Department of Medicine and Medical Specialties, Ziniaré Regional Hospital, 
Plateau Central Healthcare Region, Ziniaré, Burkina Faso.
(2)Department of Biomedical and Public Health, Research Institute of Health 
Sciences, Ouagadougou, Burkina Faso.
(3)Training and Research Unit in Health Sciences, Department of Public Health, 
Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso.
(4)Gynecology and Obstetric Department of the Regional Hospital Center of 
Ziniaré, Plateau Central Healthcare Region, Ziniaré, Burkina Faso.
(5)Boussé Healthcare District, Plateau Central Healthcare Region, Boussé, 
Burkina Faso.
(6)Zorgho Healthcare District, Plateau Central Healthcare Region, Zorgho, 
Burkina Faso.
(7)Ziniaré Healthcare District, Plateau Central Healthcare Region, Ziniaré, 
Burkina Faso.
(8)Regional Healthcare Directorate of the Plateau Central Healthcare Region, 
Ziniaré, Burkina Faso.
(9)Head Directorate of the Regional Hospital Center of Ziniaré, Plateau Central 
Healthcare Region, Ziniaré, Burkina Faso.
(10)Training and Research Unit in Health Sciences, Joseph Ki-Zerbo University, 
Ouagadougou, Burkina Faso.
(11)Internal Medicine Department, Yalgado Ouédraogo University Hospital, 
Ouagadougou, Burkina Faso.
(#)Contributed equally

BACKGROUND: The COVID-19 pandemic challenged the mental wellbeing of health 
workers. The objective of this study was to assess health workers' perceived 
stress during the response to COVID-19 in the Central Plateau region (Burkina 
Faso).
METHODS: We conducted a cross-sectional study of health workers in the Central 
Plateau health region from September 20 to October 20, 2021. Agents' perceived 
stress was assessed by the Perceived Stress Scale (PSS-10). Factors associated 
with high stress (PSS-10 score ≥ 27) were identified by logistic regression.
RESULTS: A total of 272 officers participated in the survey. The mean PSS-10 
score was 29.3 points (standard deviation: 6.2). Three out of ten agents (68%) 
had a high level of stress. The main sources of stress were the risk of being 
exposed to contamination (70%) and being the source of contamination (78%). 
Working at the referral health center [adjusted odds ratio (aOR): 2.29; 95% 
confidence interval (95% CI): 1.19-4.41], the hospital as the main source of 
COVID-19 information (aOR: 1.17; 95% CI: 1.01-3.04), fear of COVID-19 patients 
being managed at one's center (aOR: 1.8; 95% CI: 1.06-3.07) were factors 
associated with high health worker stress levels during the first wave of 
COVID-19.
CONCLUSION: The COVID-19 pandemic caused high stress among health care workers 
in Burkina Faso. Psychological support for health center workers in responding 
to future epidemics would improve their mental health.

Copyright © 2023 Traoré, Dahourou, Paré, Lompo, Kaboré, Ouédraogo, Kambou, 
Salou, Kaboré, Ouédraogo, Sia, Zorné, Ouoba and Guira.

DOI: 10.3389/fpubh.2023.1162707
PMCID: PMC10277688
PMID: 37342275 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


591. Am J Public Health. 2023 Jun;113(S2):S149-S156. doi: 10.2105/AJPH.2023.307289.

Implications of the COVID-19 Pandemic on Interpersonal Violence Within 
Marginalized Communities: Toward a New Prevention Paradigm.

Smith-Clapham AM(1), Childs JE(1), Cooley-Strickland M(1), Hampton-Anderson 
J(1), Novacek DM(1), Pemberton JV(1), Wyatt GE(1).

Author information:
(1)Amber M. Smith-Clapham, Michele Cooley-Strickland, and Gail E. Wyatt are with 
the Semel Institute for Neuroscience and Human Behavior, Department of 
Psychiatry and Biobehavioral Sciences, University of California, Los Angeles. 
Gail E. Wyatt is also a guest editor of this special issue. Julia E. Childs is 
with the School of Social Work, California State University Dominguez Hills, 
Los Angeles. Joya Hampton-Anderson is with the Department of Psychiatry and 
Behavioral Sciences, School of Medicine, Emory University, Atlanta, GA. Derek M. 
Novacek is with the VA Greater Los Angeles Healthcare System, Desert Pacific 
Mental Illness Research, Education, and Clinical Center, Los Angeles, CA. 
Jennifer V. Pemberton is with the School of Educational Psychology and 
Counseling, California State University, Northridge.

During the COVID-19 pandemic, reports of domestic violence across the United 
States increased from 21% to 35%. Stay-at-home orders, designed to protect the 
public against the spread of COVID-19, along with heightened societal stressors 
as a result of the global pandemic, inadvertently increased rates of illicit 
drug and alcohol use, job loss, and isolation, resulting in increased stress and 
nonphysical (e.g., psychological, emotional, economic, technological) abuse that 
often escalated to physical violence. These processes were exacerbated in 
marginalized communities. These risks were heightened among Black women and 
Latinas, who experience high rates of domestic violence, long-standing distrust 
in law enforcement, and compromised self-reporting or anonymous reporting of 
abuse. We make recommendations for training key stakeholders (e.g., law 
enforcement, mental health clinicians, and public health care professionals) to 
facilitate the safety and well-being of domestic violence survivors and to 
better manage prevention or intervention efforts targeted at domestic violence. 
We make public health policy suggestions for individuals, communities, and 
governing structures. (Am J Public Health. 2023;113(S2):S149-S156. 
https://doi.org/10.2105/AJPH.2023.307289).

DOI: 10.2105/AJPH.2023.307289
PMCID: PMC10282862
PMID: 37339424 [Indexed for MEDLINE]


592. J Appl Gerontol. 2023 Oct;42(10):2055-2065. doi: 10.1177/07334648231182243. Epub 
2023 Jun 20.

Active Aging Policies Targeting Health and Care During the of COVID-19 Pandemic: 
A Systematic Review and Thematic Analysis of Italian National and Regional 
Policies.

Barbabella F(1), Principi A(1), Lucantoni D(1), Lamura G(1), Socci M(1).

Author information:
(1)Centre for Socio-Economic Research on Ageing, National Institute of Health 
and Science on Ageing (IRCCS INRCA), Ancona, Italy.

A primary objective of active aging policies is to promote health and optimize 
care for individuals. In aging societies, the maintenance of good physical and 
mental health and the management of risk factors are of utmost importance. Few 
research studies have analyzed active aging policies related to health and care 
from a multi-level governance perspective. The aim of this study was to 
determine what national and regional policies in these domains existed in Italy. 
We conducted an inductive thematic analysis of health- and care-related policies 
on active aging, selected through a systematic review in 2019-2021. The analysis 
uncovered three themes at both the national and regional levels (health 
promotion and disease prevention, health monitoring, and informal caregivers) 
and two additional themes at the regional level (access to health and social 
care services, and mental health and well-being). According to the findings, 
COVID-19 partially influenced the evolution of active aging policies.

DOI: 10.1177/07334648231182243
PMCID: PMC10290927
PMID: 37338167 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


593. Cyberpsychol Behav Soc Netw. 2023 Sep;26(9):690-697. doi: 
10.1089/cyber.2022.0248. Epub 2023 Jun 19.

360° Digital Travel to Improve Emotional State and Well-Being During the 
COVID-19 Pandemic: The Role of Presence and Sense of Place.

Liu ZM(1), Liu CY(1), Chen CQ(1), Ye XD(1).

Author information:
(1)Department of Educational Technology, Wenzhou University, Wenzhou, China.

The continuation of the COVID-19 pandemic has caused a decline in people's 
subjective well-being and emotional states. Digital travel based on 360° videos 
provides an alternate way for people to improve their mental health at home 
during this specific period. Yet, how to construct effective digital travel 
content that improves emotions remains an issue. This investigation assessed the 
impact of people's perceived presence and sense of place (SOP) on emotional 
improvement during a 360° digital travel experience. A total of 156 
undergraduate students volunteered to participate, and anxiety, emotion levels, 
and life satisfaction were measured before and after the digital travel 
experience; presence and SOP ratings were also collected after the experience. A 
Latent Change Score model was then developed, and the results indicated that the 
greater presence and SOP individuals experienced during their digital travel, 
the better their digital travel experience and emotional improvement. 
Furthermore, the current data highlight that SOP has a greater impact on 
emotional improvement than presence. This result provides a novel understanding 
that how SOP is generated may be more critical to digital travel than presence. 
This new understanding should help improve relevant applications in the field of 
digital travel, such as the possibility of providing meaningful narrative 
context in a virtual environment to induce SOP more effectively, and improve the 
digital travel experience. Overall, the findings of this study expand our 
understanding of the digital travel experience and lay the groundwork for future 
research on SOP and digital travel.

DOI: 10.1089/cyber.2022.0248
PMID: 37335922 [Indexed for MEDLINE]


594. Soc Sci Med. 2023 Jul;329:116027. doi: 10.1016/j.socscimed.2023.116027. Epub 
2023 Jun 13.

COVID-19 vaccinations and mental health among U.S. adults: Individual and 
spillover effects.

Coley RL(1), Carey N(2), Baum CF(3), Hawkins SS(4).

Author information:
(1)Department of Counseling, Developmental, and Educational Psychology, Boston 
College, Chestnut Hill, MA, USA. Electronic address: coleyre@bc.edu.
(2)Department of Counseling, Developmental, and Educational Psychology, Boston 
College, Chestnut Hill, MA, USA.
(3)Department of Economics & School of Social Work, Boston College, Chestnut 
Hill, MA, USA.
(4)School of Social Work, Boston College, Chestnut Hill, MA, USA.

RATIONALE: The COVID-19 pandemic led to dramatic increases not only in physical 
illness, but also in mental health symptoms and disorders among U.S. adults. 
Although the introduction of COVID-19 vaccines dramatically lowered rates of 
physical illness and death, little is known about the effects of vaccines on 
mental health.
OBJECTIVES: We assessed both individual and spillover effects of COVID-19 
vaccination on mental health disorders, and whether effects of individual 
vaccination varied based on contextual risks indicated by state infection rates 
and state vaccination rates.
METHODS: Using data from the Household Pulse Survey, we assessed 448,900 adults 
surveyed within approximately the first six months of the U.S. vaccine rollout 
(February 3 - August 2, 2021). Coarsened exact matching balanced vaccinated and 
non-vaccinated participants on demographic and economic characteristics.
RESULTS: Logistic regression analyses found 7% lowered odds of depression among 
vaccinated individuals, but no significant difference in anxiety. Reflecting 
potential spillover effects, state vaccination rates predicted lowered odds of 
anxiety and depression (1% decrease in odds for each additional 1% of the state 
population vaccinated). Although state COVID-19 infection rates did not moderate 
effects of individual vaccination on mental health outcomes, significant 
interactions indicated that effects of individual vaccination on mental health 
were stronger in contexts of lower state vaccination rates, and links between 
state vaccination rates and mental health problems were stronger among 
unvaccinated individuals.
CONCLUSIONS: Results suggest that COVID-19 vaccinations improved the mental 
health of adults in the U.S., with lower rates of self-reported mental health 
disorders both among vaccinated individuals themselves and among other 
individuals living in the same state, particularly when those individuals were 
not themselves vaccinated. These direct and spillover effects on mental health 
expand our understanding of the benefits of COVID-19 vaccination for the 
wellbeing of adults in the U.S.

Copyright © 2023 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.socscimed.2023.116027
PMCID: PMC10263226
PMID: 37331285 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest None.


595. Sci Rep. 2023 Jun 16;13(1):9743. doi: 10.1038/s41598-023-35789-y.

Mental health problems and resilience in adolescents during the COVID-19 
pandemic in a post-armed conflict area in Colombia.

Gómez-Restrepo C(1), Sarmiento-Suárez MJ(2), Alba-Saavedra M(1), 
Calvo-Valderrama MG(1), Rincón-Rodríguez CJ(1), González-Ballesteros LM(1), Bird 
V(3), Priebe S(3), van Loggerenberg F(3).

Author information:
(1)Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia.
(2)Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia. 
cecilia.sarmiento@javeriana.edu.co.
(3)Unit for Social and Community Psychiatry, Queen Mary University of London, 
London, UK.

The impact of COVID-19 pandemic on mental health of adolescents are emerging and 
require particular attention in settings where challenges like armed conflict, 
poverty and internal displacement have previously affected their mental 
wellbeing. This study aimed to determine the prevalence of anxiety symptoms, 
depressive symptomatology, probable post-traumatic stress disorder and 
resilience in school-attending adolescents in a post-conflict area of Tolima, 
Colombia during the COVID-19. A cross-sectional study was carried out with 657 
adolescents from 12 to 18 years old, recruited by convenience sampling in 8 
public schools in the south of Tolima, Colombia, who completed a 
self-administered questionnaire. Mental health information was obtained through 
screening scales for anxiety symptoms (GAD-7), depressive symptomatology 
(PHQ-8), probable post-traumatic stress disorder (PCL-5) and resilience 
(CD-RISC-25). The prevalence observed for moderate to severe anxiety symptoms 
was 18.9% (95% CI 16.0-22.1) and for moderate to severe depressive 
symptomatology was 30.0% (95% CI 26.5-33.7). A prevalence of probable 
post-traumatic stress disorder (PTSD) of 22.3% (95% CI 18.1-27.2) was found. The 
CD-RISC-25 results for resilience had a median score of 54 [IQR 30]. These 
results suggest that approximately two-thirds of school-attending adolescents in 
this post-conflict area experienced at least one mental health problem such as 
anxiety symptoms, depressive symptomatology or probable PTSD during the COVID-19 
pandemic. Future studies are of interest to establish the causal relationship 
between these findings and the impact of the pandemic. These findings highlight 
the challenge that schools have after pandemic to address the mental health of 
their students in order to promoting adequate coping strategies and implement 
prompt multidisciplinary interventions to reduce the burden of mental health 
problems in adolescents.

© 2023. The Author(s).

DOI: 10.1038/s41598-023-35789-y
PMCID: PMC10276040
PMID: 37328494 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


596. Gesundheitswesen. 2023 Aug;85(8-09):688-696. doi: 10.1055/a-2075-7814. Epub 2023 
Jun 16.

[Effects of Wearing Face Masks to Prevent Infectious Diseases On Children's and 
Adolescents' Well-Being and Behavior: An Interview Study].

[Article in German; Abstract available in German from the publisher]

Drössler S(1), Horvath K(2)(1), Freiberg A(1), Kämpf D(1), Spura A(3), Buhs 
B(3), Seidler A(1).

Author information:
(1)Institut und Poliklinik für Arbeits- und Sozialmedizin, Medizinische Fakultät 
Carl Gustav Carus, Technische Universität Dresden, Germany.
(2)Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, 
Krankenhaus St. Elisabeth und St. Barbara, Halle/Saale, Germany.
(3)Bundeszentrale für gesundheitliche Aufklärung, Köln, Germany.

AIM: To investigate the effects of wearing masks in terms of well-being, 
behavior and psychosocial development on children and adolescents during the 
COVID-19 pandemic.
METHODS: Expert interviews were conducted with educators (n=2), teachers from 
primary and secondary education (n=9), adolescent student representatives (n=5) 
as well as paediatricians from primary care (n=3) and the public health service 
(n=1), transcribed and subjected to thematic analysis using MAXQDA 2020.
RESULTS: The most frequently reported short- and medium-term direct effects of 
mask-wearing were primarily in terms of limited communication due to a reduction 
in hearing and facial expressions. These restrictions in communication had 
consequences for social interaction and teaching quality. It is assumed that 
there will be effects on language development and social-emotional development 
in the future. A reported increase in psychosomatic complaints as well as 
anxiety, depression and eating disorders was attributed more to the conglomerate 
of distancing interventions than to just wearing of masks. Vulnerable groups 
were children with developmental difficulties, those with German as a foreign 
language, younger children, and shy and quiet children and adolescents.
CONCLUSION: While the consequences of mask-wearing for children and adolescents 
can be described quite well for different aspects of communication and 
interaction, effects on aspects of psychosocial development cannot be clearly 
identified yet. Recommendations are made primarily for dealing with the 
limitations in the school setting.

Publisher: ZIEL: Auswirkungen des Maskentragens während der COVID-19 Pandemie 
auf Befinden, Verhalten und die psychosoziale Entwicklung von Kindern und 
Jugendlichen zu untersuchen.
METHODIK: Es wurden leitfadengestützte Expert:inneninterviews mit Erzieher:innen 
(n=2), Lehrkräften aus dem Primar- und Sekundarbereich (n=9), Jugendlichen aus 
der Schüler:innenvertretung (n=5) und Ärztinnen aus der Primärversorgung (n=3) 
und dem Öffentlichen Gesundheitsdienst (n=1) geführt, transkribiert und mit 
MAXQDA 2020 einer thematischen Analyse unterzogen.
ERGEBNISSE: Am häufigsten werden kurz- und mittelfristige direkte Auswirkungen 
des Maskentragens auf eine eingeschränkte Kommunikation durch Reduktion von 
Hörverstehen und Mimik berichtet. Aus diesen Kommunikationseinschränkungen 
ergeben sich Folgen für die soziale Interaktion und die Qualität des 
Unterrichts. Auswirkungen auf Sprachentwicklung und sozial-emotionale 
Entwicklung werden eher perspektivisch vermutet. Es wird eine Zunahme von 
psychosomatischen Beschwerden, Ängsten, Depressionen und Essstörungen 
beschrieben, die nur sehr eingeschränkt auf das Maskentragen als vielmehr auf 
das Konglomerat an Distanzierungsmaßnahmen zurückgeführt wird. Als vulnerable 
Gruppen werden Kinder mit Entwicklungsschwierigkeiten, nichtdeutscher 
Muttersprache, jüngere Kinder sowie schüchterne und stille Kinder und 
Jugendliche genannt.
SCHLUSSFOLGERUNG: Während für den gesamten Bereich der Kommunikation und 
Interaktion die Folgen des Maskentragens für Kinder und Jugendliche recht gut 
beschrieben werden können, sind Auswirkungen auf die anderen Bereiche der 
psychosozialen Entwicklung (noch) nicht eindeutig identifizierbar. Empfehlungen 
für den Umgang mit den Einschränkungen werden vor allem mit Blick auf den 
schulischen Bereich gegeben.

Thieme. All rights reserved.

DOI: 10.1055/a-2075-7814
PMID: 37327813 [Indexed for MEDLINE]

Conflict of interest statement: Die Autorinnen/Autoren geben an, dass kein 
Interessenkonflikt besteht.


597. J Public Health (Oxf). 2023 Jun 14;45(2):529-534. doi: 10.1093/pubmed/fdac130.

Training during the COVID-19 pandemic: the experience of public health 
registrars in the London and Kent, Surrey, Sussex training programme.

Hall L(1), Bisset K(1), Lynch L(1), Young Y(2), Ruggles R(3); Clinical and 
Public Health Group, UK Health Security Agency.

Author information:
(1)Public Health Registrar, UK Health Security Agency, London SE1 8UG, UK.
(2)Consultant in Health Protection, UK Health Security Agency, London SE1 8UG, 
UK.
(3)Consultant in Public Health, UK Health Security Agency, London SE1 8UG, UK.

BACKGROUND: Public Health registrars (SpRs) were an important component of the 
workforce that contributed to the COVID-19 response. This study explores their 
contribution and the impact the early stages of the pandemic had on their 
learning and training.
METHODS: Data were collected from SpRs in the London and Kent, Surrey, Sussex 
training programme between July and September 2020 through a mixture of 
questionnaires and semi-structured interviews. A thematic analysis of interview 
transcripts was undertaken to identify themes.
RESULTS: 35/128 SpRs responded to the survey and 11 were interviewed. SpRs were 
placed across a range of organizations and made a significant contribution to 
the COVID-19 response. Overall, SpRs learned important skills but working on the 
response may for some have impacted negatively on training. A number of 
facilitators and barriers to learning were identified.
CONCLUSION: The study findings highlight the opportunities for learning created 
by the pandemic. However, changing projects and the desire of SpRs to contribute 
to the response meant the impacts on training were mixed. Future deployment of 
SpRs should consider the balance of responsibility and pace when delegating 
work, as well as the need to supervise effectively and support remote working to 
maintain good mental wellbeing.

© Crown copyright 2022.

DOI: 10.1093/pubmed/fdac130
PMID: 37326349 [Indexed for MEDLINE]


598. Acta Biomed. 2023 Jun 14;94(3):e2023150. doi: 10.23750/abm.v94i3.14468.

Impact of emotional intelligence (EI) on social network abuse among adolescents 
during COVID-19 outbreak in Italy.

Pino O(1), Mastromarino S(2).

Author information:
(1)University of Parma, Department of Medicine & Surgery, Neuroscience Unit. 
olimpia.pino@unipr.it.
(2)Department of Medicine & Surgery, University of Parma. 
silvia.mastrom@gmail.com.

BACKGROUND AND AIM: This paper explores the relationship between Online Social 
Network (OSNs) abuse, Emotional Intelligence (EI), and distress due to COVID-19 
confinement among adolescents.
METHODS: A sample of 226 students from North Italy aged between 16 and 18 years 
completed from March to June 2020 the Bergen Social Media Scale (BSMAS), Trait 
Emotional Intelligence Questionnaire-Short Form (TEIQue-SF) and Depression, 
Anxiety and Stress Scale (DASS-21).
RESULTS: Females scored higher in social network use as compared to males [t 
(225) = 46.56, p = <.05]. The prevalence of symptoms of distress was also higher 
in females. Conversely, males scored significantly higher on total EI as 
compared to their counterparts [t (178) = 4.1544, p = <.003] indicating that 
high EI contributes towards better self-perception of psychological wellbeing. 
On the contrary, having high stress levels and low EI levels seems to predict 
the possibility to experience in a social network addiction.
CONCLUSIONS: Our findings suggested EI as a protective factor for OSNs' 
addiction. Results support the need of implementing programs aimed at adopting 
an appropriate approach to the digital world and particularly addressed towards 
the growth of EI to reduce dysfunctional behaviors in adolescence. 
(www.actabiomedica.it).

DOI: 10.23750/abm.v94i3.14468
PMCID: PMC10308479
PMID: 37326263 [Indexed for MEDLINE]

Conflict of interest statement: Each author declares that he or she has no 
commercial associations that might pose a conflict of interest in connection 
with the submitted article.


599. Front Vet Sci. 2023 May 30;10:1124982. doi: 10.3389/fvets.2023.1124982. 
eCollection 2023.

Evaluation of different methods of environmental enrichment to control anxiety 
in dogs undergoing hemilaminectomy after acute intervertebral disc extrusion: a 
randomized double-blinded study.

Pennington E(1), Springer C(1), Albright J(1), Castel A(2).

Author information:
(1)Small Animal Clinical Sciences, The University of Tennessee, Knoxville, TN, 
United States.
(2)College of Veterinary Medicine, The University of Tennessee, Knoxville, TN, 
United States.

OBJECTIVE: The goal of this randomized, double-blinded, placebo-controlled study 
was to evaluate the effect of environmental enrichment (EE) on post-operative 
pain and anxiety in dogs following hemilaminectomy for acute intervertebral disc 
extrusion (IVDE).
METHODS: Twenty healthy client-owned dogs undergoing a hemilaminectomy for IVDE 
with the same immediate post-operative analgesia protocol were randomly assigned 
to either the EE or standard environment (SE) group post-operatively. Recovery 
was achieved in an intensive care room (SE) or a separate quiet room (EE) 
equipped with white noise and classical music. EE dogs were also exposed to 
dog-appeasing pheromones, essential oil scents, and positive human interactions 
and were provided meals through food toys. A blinded evaluator assessed all dogs 
using the modified Glasgow Composite Pain Scale (mGCPS) on presentation and at 
several time points post-operatively. A rescue injection of the opioid methadone 
was given to the dogs with an mGCPS score of ≥5/20. Dogs received the 
antidepressant trazodone when anxious behaviors (5 mg/kg) were observed. The 
mGCPS scores, the latencies to receive the first methadone and trazodone doses 
and to eat the first meal, the number of methadone and trazodone doses, and the 
number of meals ingested in the first 24 and 48 h post-surgery were compared 
using Wilcoxon tests, and Benjamini-Hochberg correction for false discovery rate 
was applied.
RESULTS: Although median mGCPS scores did not differ between the groups, 
compared to SE dogs (n = 10), EE dogs (n = 6) received trazodone earlier (p = 
0.019), were administered fewer methadone injections at 24 h (p = 0.043), and 
ate more at 48 h post-surgery (p = 0.007). Therefore, EE and anti-anxiety 
medications could be beneficial in improving the wellbeing of dogs 
post-operatively.

Copyright © 2023 Pennington, Springer, Albright and Castel.

DOI: 10.3389/fvets.2023.1124982
PMCID: PMC10267703
PMID: 37323840

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


600. Tijdschr Psychiatr. 2023;65(4):234-240.

[The impact of COVID-19 according to people in care at FACT and autism teams: 
wave 1 and 2 and Omikron wave].

[Article in Dutch]

Castelein S, Crutzen S, van Balkom IDC, Bruins J.

BACKGROUND: COVID-19 affected our collective well-being. Measures during a 
pandemic may disproportionately impact individuals with mental illness.
AIM: To measure the impact of COVID-19 on clients of FACT and autism teams over 
three waves.
METHOD: Through a digital questionnaire participants (wave 1: n=100; wave 2: 
n=150; Omikron wave: n=15) reported on: <br />1. mental health, 2. outpatient 
care experiences, 3. government measures and information services.
RESULTS: Happiness was rated on average with a 6 in the first two waves, 
positive consequences of wave 1 (clearer world, more reflection) persisted. The 
most frequently mentioned negative consequences were: decreased social 
interactions, increased mental problems and daily functioning. No new 
experiences were mentioned during the Omikron wave. The quality and amount of 
mental health care was rated &ge;7 by 75-80%. Phone and video consultations were 
the most frequently mentioned positive care experience; missing face-to-face 
contact was considered most negative. Measures were harder to sustain in the 
second wave. Vaccination readiness and vaccination coverage were high.
CONCLUSION: All COVID-19-waves show a consistent picture. Telepsychiatry was 
evaluated positively. Considering the results, the mental health sector could be 
ready for a next lockdown taking into account possibly higher expectations of 
clients.

PMID: 37323041 [Indexed for MEDLINE]


601. Sci Rep. 2023 Jun 15;13(1):9708. doi: 10.1038/s41598-023-36718-9.

The longer-term impact of the COVID-19 pandemic on wellbeing and subjective 
cognitive functioning of older adults in Belgium.

De Pue S(1), Gillebert C(2), Dierckx E(3)(4), Van den Bussche E(2).

Author information:
(1)Brain and Cognition, KU Leuven, Leuven, Belgium. sarah.depue@kuleuven.be.
(2)Brain and Cognition, KU Leuven, Leuven, Belgium.
(3)Personality and Psychopathology, Vrije Universiteit Brussel, Brussels, 
Belgium.
(4)Psychiatric Hospital, Alexianen Zorggroep Tienen, Tienen, Belgium.

In earlier survey research, we observed a severe impact of the first peak of the 
COVID-19 pandemic on the subjective wellbeing, sleep and activity of adults aged 
65 years or older in Flanders, Belgium. The impact on subjective cognitive 
functioning, however, was limited. Since then, periods of lockdown and periods 
with less strict regulations alternated, but social distancing remained, 
especially for older adults. To study the longer-term impact of the pandemic on 
wellbeing and subjective cognitive functioning, we re-assessed the older adults 
from the first measurement moment (May-June 2020) in a second (June-July 2020) 
and third (December 2020) wave of the survey (n = 371, M = 72 years old, range 
65-97 years old). Results indicated that wellbeing fluctuated with the severity 
of the pandemic. Results for self-reported cognitive functioning were mixed. 
While participants indicated a slightly better general subjective cognitive 
functioning at the end of the study, experienced problems with most cognitive 
subdomains significantly increased over time. The presence of depressive and 
anxiety symptoms were related to the longer-term impact of the pandemic on 
wellbeing and subjective cognitive functioning. Our study shows the long-lasting 
impact of the pandemic on the wellbeing and subjective cognitive functioning of 
older adults, without full recovery from the first wave.

© 2023. The Author(s).

DOI: 10.1038/s41598-023-36718-9
PMCID: PMC10272225
PMID: 37322085 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


602. Appl Psychol Health Well Being. 2023 Nov;15(4):1750-1771. doi: 
10.1111/aphw.12462. Epub 2023 Jun 15.

Positivity and coping as key to well-being and psychological adjustment during 
the pandemic of COVID-19: A follow-up study in Portugal.

Ferreira MJ(1)(2), Sofia R(3)(4), Carreno DF(5), Eisenbeck N(6), Cruz JFA(7).

Author information:
(1)HEI-Lab: Digital Human-Environment Interaction Lab, Lisbon, Portugal.
(2)Faculty of Psychology, Sports and Education, Lusófona University, Porto, 
Portugal.
(3)Center of Research, Education, Innovation and Intervention in Sport, Faculty 
of Sport, University of Porto, Porto, Portugal.
(4)School of Sports and Leisure, Polytechnic Institute of Viana do Castelo, 
Viana do Castelo, Portugal.
(5)Department of Psychology, University of Almeria, Almeria, Spain.
(6)Department of Personality, Evaluation and Psychological Treatment, University 
of Seville, Seville, Spain.
(7)CiPsi-Psychology Research Center, University of Minho, Braga, Portugal.

This follow-up study aimed to analyze the protective role of positivity and 
coping strategies on the well-being and psychological distress levels reported 
during Portugal's first and third waves of COVID-19. The total sample consisted 
of 135 participants (82.0% women) with ages ranging from 20 to 72 years 
(M = 39.29, SD = 11.46). Results suggested a significant decrease in well-being 
levels but no changes in psychological distress were observed. Positivity was a 
strong and significant predictor of well-being and psychological distress during 
the pandemic crisis. Among the set of strategies used by individuals at the 
first wave, denial, self-blame, and self-distraction predicted a poorer 
adaptation with more significant mental health impairment, with self-blame 
standing out as the most harmful. This study highlighted the key role of 
positivity in adjusting to the current pandemic crisis and the lasting 
detrimental impact of specific coping strategies.

© 2023 International Association of Applied Psychology.

DOI: 10.1111/aphw.12462
PMID: 37321921 [Indexed for MEDLINE]


603. J Am Board Fam Med. 2023 Aug 9;36(4):662-669. doi: 10.3122/jabfm.2022.220374R1. 
Epub 2023 Jun 15.

The Impact of COVID-19 on Patients Receiving Care Coordination in Primary Care: 
A Qualitative Study.

Whitebird RR(1), Solberg LI(1), JaKa MM(1), Kindt JM(1), Bergdall AR(1), 
LaPlante B(1), Dehmer SP(1).

Author information:
(1)From the Morrison Family College of Health, School of Social Work, University 
of St. Thomas, St. Paul, MN (RRW); HealthPartners Institute, Minneapolis, MN, 
USA (LIS, MMJ, ARB, SPD); Minnesota Department of Health, MN, USA. (JMK, BL).

INTRODUCTION: Care coordination addresses the needs of patients with complex 
chronic illness and psychosocial issues, coordinating their care and social 
needs. It is not known how such patients receiving these services managed during 
the COVID-19 pandemic. The objective of this study was to learn how the health, 
health care, social needs, and finances of patients receiving care coordination 
were affected by the disruptions caused by the COVID-19 pandemic.
METHOD: We conducted semistructured interviews with 19 patients receiving care 
coordination in primary care across a statewide sample about how the COVID-19 
pandemic affected their life in general, including their overall health, social 
connections, finances and employment, and mental health. A content analysis 
approach was applied in the data analysis.
RESULTS: We identified 4 primary themes in patient interviews including: (1) 
patients reported few to no impacts on their physical health status or health 
care services; (2) patients felt disconnected from family, friends, and 
community in ways that affected their mental health and wellbeing; (3) there 
were little to no pandemic related impacts for those on fixed incomes or 
government supports; and (4) care coordinators provided a significant and 
reliable source of help, support, and comfort.
CONCLUSIONS: Care coordination provided a supporting framework for the health 
and the health care needs of these patients, helping them navigate resources and 
maintain their physical health during the pandemic. Care coordinators were seen 
as providing needed communication, connection, and support that was especially 
needed during a time of social isolation and disconnection.

© Copyright by the American Board of Family Medicine.

DOI: 10.3122/jabfm.2022.220374R1
PMID: 37321657 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest: The authors have no 
conflict of interest.


604. Mult Scler Relat Disord. 2023 Aug;76:104825. doi: 10.1016/j.msard.2023.104825. 
Epub 2023 Jun 10.

The psychological impact of the COVID-19 pandemic on people with multiple 
sclerosis.

Vacaras V(1), Nistor C(1), Schiopu AM(2), Vacaras C(3), Marin GE(2), Muresanu 
DF(1).

Author information:
(1)Neurology Department, Cluj Emergency County Hospital, Cluj-Napoca 400012, 
Romania; Department of Neurosciences, Faculty of Medicine, Iuliu Hațieganu 
University of Medicine and Pharmacy, Cluj-Napoca 400012, Romania.
(2)Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 
Cluj-Napoca 400349, Romania.
(3)Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 
Cluj-Napoca 400349, Romania. Electronic address: cvacaras@yahoo.ro.

BACKGROUND: Multiple sclerosis (MS) is a demyelinating disease of the central 
nervous system that leads to neurological impairment and disability, mostly in 
young-aged people. Depression and anxiety are important associated mental 
disorders for people with MS (PwMS), which influence their life quality. During 
the COVID-19 pandemic, fear and stress levels enhanced dramatically for the 
general population, but mostly in progressive chronic pathologies such as MS.
AIM: This study aimed to analyze the dynamic of psychological aspects in PwMS 
pre-pandemic and during pandemic, their connection with clinical outcomes, and 
with the coronavirus disease.
METHODS: We included 95 PwMS with relapsing-remitting MS (RRMS) and secondary 
progressive MS (SPMS), who were first evaluated 4 years before the pandemic 
outbreak and the second time 2 years after. They completed a series of 
psychological tests for depression, anxiety, negative automatic thoughts, and 
stress: Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), 
Endler Multidimensional Anxiety Scales (EMAS), Automatic Thoughts Questionnaire 
(ATQ). A neurologist evaluated the Expanded Disability Status Scale (EDSS) and a 
COVID-19 survey was completed by 78 patients.
RESULTS: During the pandemic, depression was encountered in 9.47% of PwMS, only 
1.05% with a severe form, and 6.3% with suicidal thoughts, while anxiety was 
more frequent (39% of cases). Compared to the pre-pandemic period, depression 
levels remained stable over time (p = 0.55), anxiety was reduced (p<0.001), and 
stress levels significantly increased (p = 0.001). Some social aspects, such as 
having sufficient income, reduced the risk for psychological comorbidities. 
There was a mild correlation between emotional well-being and neurological 
disability. Of all patients who responded to the survey, 53.84% had previous 
COVID-19 infections, no patient was hospitalized and 69.23% were vaccinated. 
There was no relationship between the COVID-19 infection and psychological test 
results.
CONCLUSION: During the pandemic, in the MS population depression remained 
stable, anxiety decreased, and stress levels were enhanced compared to the 
pre-pandemic period. Psychiatric comorbidities were not influenced by the 
coronavirus infection.

Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.msard.2023.104825
PMCID: PMC10257333
PMID: 37320938 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare no conflict of interest.


605. J Adolesc Health. 2023 Sep;73(3):510-518. doi: 10.1016/j.jadohealth.2023.04.016. 
Epub 2023 May 4.

Psychological Well-Being in Asian and Asian American University Students: 
Impacts of Discrimination During the COVID-19 Pandemic.

Rivera Juarez AG(1), Prichard JR(2), Berg SS(3).

Author information:
(1)Department of Psychology and Program in Neuroscience, University of St. 
Thomas, St. Paul, Minnesota.
(2)Department of Psychology and Program in Neuroscience, University of St. 
Thomas, St. Paul, Minnesota. Electronic address: jrprichard@stthomas.edu.
(3)Department of Computer and Information Sciences, University of St. Thomas, 
St. Paul, Minnesota.

PURPOSE: The aim of this study is to determine what modifiable behavioral and 
sociological factors were predictive of psychological distress and suicide risk 
in Asian and Asian American students, the ethnic group with the highest unmet 
mental health need in collegiate populations. We also compared these 
relationships in Fall 2019 to Fall 2020 to better understand how the impact of 
these factors changed during the COVID-19 pandemic and concurrent increase in 
Anti-Asian discrimination.
METHODS: We used factor analysis to extract a wide range of predictor variables 
from the Fall 2019 and Fall 2020 American College Health Association's National 
College Health Assessment III. Next, we used structural equation modeling to 
identify significant drivers of psychological distress (Kessler-6 scale) and 
suicidality (Suicide Behavior Questionnaire-Revised scale) in Asian and Asian 
American students (n = 4,681 in 2019 and 1,672 in 2020).
RESULTS: When compared to 2019, experiencing discrimination in 2020 had a 
substantially larger effect on both psychological distress and suicidality among 
Asian and Asian American university students. Loneliness and depression were 
also significant drivers of negative mental health outcomes both years, and 
their effect magnitudes remained largely unchanged. Being well rested had a 
protective effect against psychological distress both years.
DISCUSSION: During the COVID-19 pandemic, discrimination was an important driver 
of psychological distress and suicidality in Asian and Asian American students. 
These findings suggest that organizations should enhance culturally competent 
mental healthcare services, while also working at the systems level to reduce 
bias and discrimination.

Copyright © 2023 Society for Adolescent Health and Medicine. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jadohealth.2023.04.016
PMID: 37318412 [Indexed for MEDLINE]


606. J Intellect Disabil Res. 2023 Oct;67(10):973-985. doi: 10.1111/jir.13064. Epub 
2023 Jun 15.

Hey Google! Intelligent personal assistants and well-being in the context of 
disability during COVID-19.

van Wingerden E(1), Vacaru SV(2)(3), Holstege L(2), Sterkenburg PS(1)(2).

Author information:
(1)Bartiméus, Doorn, The Netherlands.
(2)Department of Clinical Child and Family Studies & Amsterdam Public Health, 
Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, 
Amsterdam, The Netherlands.
(3)Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition 
and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands.

BACKGROUND: Amidst the greatest technological advancement that societies have 
seen, the (health)care and quality of life of all, and especially of vulnerable 
individuals, see unprecedented improvements. Intelligent personal assistants 
(IPAs), such as Google Home (GH), can easily be implemented in their daily lives 
to facilitate routines. Technology can offer significant benefits for 
individuals with impairments and/or limitations in achieving greater autonomy 
and well-being. However, this opportunity still needs to be fully exploited, 
especially in long-term care facilities. Furthermore, such potential may be 
particularly needed during social isolation due to health concerns, such as the 
COVID-19 lockdowns and restrictions. We investigated the validity of 
implementing GH in residential care for individuals with visual impairments 
(VIs) and intellectual disabilities (IDs) and assessed the effects of a 10-week 
intervention on self-reported well-being.
METHODS: We used a mixed-methods multiple case studies approach (N = 7) and 
performed intensive assessments (20 weeks), including self-report well-being 
questionnaires and observations focusing on well-being, autonomy, social 
participation and GH experiences. Nonoverlap of all pairs analyses were 
performed for quantitative data indexing performance differences between 
intervention phases. Thematic analysis was performed for the qualitative data.
RESULTS: We found meaningful improvements in well-being in five clients, while 
all rated the experience of using GH positively.
CONCLUSIONS: Our findings from the quantitative and qualitative analyses 
document that individuals with VI and/or ID benefit from IPAs in fostering 
better autonomy by facilitating access to information and entertainment. Further 
implications and possible barriers to large-scale implementation of IPAs in 
residential care are discussed.

© 2023 The Authors. Journal of Intellectual Disability Research published by 
MENCAP and International Association of the Scientific Study of Intellectual and 
Developmental Disabilities and John Wiley & Sons Ltd.

DOI: 10.1111/jir.13064
PMID: 37317950 [Indexed for MEDLINE]


607. J Am Geriatr Soc. 2023 Sep;71(9):2924-2934. doi: 10.1111/jgs.18466. Epub 2023 
Jun 15.

Effect of the COVID-19 pandemic on meaningful activity engagement in racially 
and ethnically diverse older adults.

Oh A(1)(2), Gan S(3), Boscardin WJ(3)(4), Neilands TB(5), Stewart AL(6), Nguyen 
TT(7), Smith AK(3)(8).

Author information:
(1)Office of Research and Patient Care Services, Stanford Health Care, Stanford, 
California, USA.
(2)Department of Social and Behavioral Sciences, School of Nursing, University 
of California San Francisco, San Francisco, California, USA.
(3)Division of Geriatrics, Department of Medicine, University of California San 
Francisco, San Francisco, California, USA.
(4)Division of Epidemiology and Biostatistics, University of California San 
Francisco, San Francisco, California, USA.
(5)Division of Prevention Science, Department of Medicine, University of 
California San Francisco, San Francisco, California, USA.
(6)Institute for Health and Aging, University of California San Francisco, San 
Francisco, California, USA.
(7)Division of General Internal Medicine, University of California San 
Francisco, San Francisco, California, USA.
(8)Geriatrics and Palliative Care, San Francisco VA Health Care System, San 
Francisco, California, USA.

BACKGROUND: Participation and active engagement in meaningful activities support 
the emotional and physical well-being of older adults. In 2020, the onset of the 
COVID-19 pandemic altered lives, including the ability to participate in 
meaningful activities. This study compared meaningful activity engagement before 
and at the beginning of the COVID-19 pandemic in a nationally representative, 
diverse sample >65 years between 2015 and 2020.
METHODS: We described the proportions and characteristics of National Health and 
Aging Trends Study participants and their engagement in four activities: 
visiting friends or family, attending religious services, participating in 
clubs/classes/other organized activities, and going out for enjoyment. We used 
mixed effects logistic regressions to compare probabilities of activity 
engagement before 2020 and in 2020, adjusting for age, sex, functional status, 
income, geographic region, anxiety-depression, and transportation issues.
RESULTS: Of 6815 participants in 2015, the mean age was 77.7 (7.6) years; 57% of 
participants were female; 22% were Black, 5% Hispanic, 2% were American Indian, 
and 1% were Asian; 20% had disability; and median income was $33,000. 
Participation in all four activities remained consistent between 2015 and 2019 
and declined in 2020. Significant differences existed in attending religious 
services (p < 0.01) and going out for enjoyment (p < 0.001) by race and 
ethnicity, before and after the start of COVID-19. Black and Hispanic 
participants experienced the largest decline in attending religious services 
(-32%, -28%) while Asian and White participants experienced the largest decline 
in going out for enjoyment (-49%, -56%).
CONCLUSIONS: Potential quality of life tradeoffs should be considered to a 
greater extent in future pandemic emergencies.

© 2023 The American Geriatrics Society.

DOI: 10.1111/jgs.18466
PMCID: PMC10524549
PMID: 37317827 [Indexed for MEDLINE]


608. Psychol Sci. 2023 Aug;34(8):899-913. doi: 10.1177/09567976231170560. Epub 2023 
Jun 14.

Thinking Beyond COVID-19: How Has the Pandemic Impacted Future Time Horizons?

Fynes-Clinton S(1), Addis DR(1)(2)(3).

Author information:
(1)Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, 
Canada.
(2)Department of Psychology, University of Toronto.
(3)School of Psychology, The University of Auckland.

Older age is reportedly protective against the detrimental psychological impacts 
of the COVID-19 pandemic, consistent with the theory that reduced future time 
extension (FTE) leads to prioritization of socioemotional well-being. We 
investigated whether depression severity and pandemic-related factors (regional 
severity, threat, social isolation) reduce FTE beyond chronological age and 
whether these relationships differ between younger and older adults. In May 
2020, we recruited 248 adults (younger: 18-43 years, older: 55-80 years) from 13 
industrialized nations. Multigroup path analysis found that depression severity 
was a better predictor of FTE than the reverse association in both age groups, 
suggesting an affective foreshortening of future time. In both age groups, older 
age was protective against depression severity, and younger age was associated 
with heightened vulnerability to the negative impacts of pandemic-related 
factors. Future research should consider the complex interrelationships between 
FTE, age, and depression severity and the potential impacts of the broader 
psychosocial milieu.

DOI: 10.1177/09567976231170560
PMCID: PMC10271815
PMID: 37314434 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared that there were no 
conflicts of interest with respect to the authorship or the publication of this 
article.


609. Arch Sex Behav. 2023 Jul;52(5):1969-2010. doi: 10.1007/s10508-023-02633-3. Epub 
2023 Jun 13.

Struggling, Forgotten, and Under Pressure: A Scoping Review of Experiences of 
Sex Workers During the COVID-19 Pandemic.

Brooks SK(1), Patel SS(2)(3), Greenberg N(4).

Author information:
(1)Department of Psychological Medicine, King's College London, Weston Education 
Centre, London, SE5 9RJ, UK. samantha.k.brooks@kcl.ac.uk.
(2)Transcultural Conflict and Violence Initiative, Georgia State University, 
Atlanta, GA, USA.
(3)Department of Global Health and Population, Harvard T.H. Chan School of 
Public Health, Boston, MA, USA.
(4)Department of Psychological Medicine, King's College London, Weston Education 
Centre, London, SE5 9RJ, UK.

The COVID-19 pandemic profoundly affected physical, mental, and economic 
well-being across the globe and has disproportionately affected certain 
vulnerable groups. This paper provides a scoping review of literature on the 
impact of the COVID-19 pandemic on sex workers, published between December 2019 
and December 2022. Six databases were systematically searched, identifying 1009 
citations; 63 studies were included in the review. Thematic analysis revealed 
eight main themes: financial issues; exposure to harm; alternate ways of 
working; COVID-19 knowledge, protective behaviors, fear, and risk; well-being, 
mental health, and coping; access to support; access to health care; and the 
impact of COVID-19 on research with sex workers. COVID-associated restrictions 
led to reduced work and income, leaving many sex workers struggling to cover 
basic needs; additionally, government protections excluded those working in the 
informal economy. Fearing the loss of their already reduced number of clients, 
many felt compelled to compromise both prices and protective measures. Although 
some engaged in online sex work, this raised concerns about visibility and was 
impossible for those without technological access or skills. Many feared 
COVID-19, but felt pressure to continue working, often with clients who refused 
to wear masks or share exposure history. Other negative impacts on well-being 
related to the pandemic included reduced access to financial support or health 
care. Marginalized populations (and especially those in professions which 
require close contact like sex workers) need further support and 
capacity-building within the community to recover from the impact of COVID-19.

© 2023. The Author(s).

DOI: 10.1007/s10508-023-02633-3
PMCID: PMC10263380
PMID: 37311934 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no competing interests to 
declare that are relevant to the content of this article.


610. J Adv Nurs. 2023 Oct;79(10):3866-3875. doi: 10.1111/jan.15730. Epub 2023 Jun 12.

Nursing home staff perceptions of well-being during the COVID-19 pandemic: A 
qualitative study.

van Diepen C(1)(2), Vestjens L(1)(3), Nieboer AP(1), Scheepers R(1).

Author information:
(1)Department of Socio-Medical Sciences, Erasmus School of Health Policy & 
Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.
(2)Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, 
Sweden.
(3)De Zorggroep Noord- en Midden-Limburg, Venlo-Blerick, the Netherlands.

AIMS: To explore how nursing home staff perceived their work environment during 
the COVID-19 pandemic and how this impacted their well-being.
DESIGN: A qualitative interview study.
METHODS: Interviews were held with twenty-two registered nurses and assistant 
nurses from five nursing homes in the Netherlands between April 2021 and July 
2021. The interviews were analysed using qualitative content analysis. The 
Standards for Reporting Qualitative Research (SRQR) were followed.
RESULTS: Five themes emerged from the interviews and indicated that working 
during the COVID-19 pandemic impacted perceived well-being of nursing home 
staff. Three themes concerned experiences at work: eroding care, additional 
roles and workplace support. Specifically, the increased workload with 
additional tasks, the constant stream of new guidelines and constrictive 
personal protective equipment caused discomfort and anxiety. Two other themes 
concerned experiences outside of work: work-life interference and social 
interactions and status. The nurses reported that when they returned home after 
work, they were tired and worried about spreading the virus while facing limited 
social interactions and support.
CONCLUSION: The social distancing measures due to the COVID-19 pandemic 
negatively impacted nursing home staff well-being by increasing demands in the 
absence of adequate resources.
IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The well-being needs of 
nurses should receive continued attention to ensure the sustainability of 
healthcare during future crises.
PATIENT OR PUBLIC CONTRIBUTION: The nursing home managers participated in 
recommending the topics to be covered during interviews.
IMPACT: What problem did the study address? The pressure of stressful working 
conditions on the well-being of nurses during the pandemic. What were the main 
findings? Nurses created strategies to cope with declining well-being. However, 
the available resources did not alleviate the increased demands caused by the 
pandemic. Where and on whom will the research have an impact? This study is 
important for healthcare organizations to understand how the COVID-19 pandemic 
affected nurses so that they may better prepare for future crises.

© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons 
Ltd.

DOI: 10.1111/jan.15730
PMID: 37309050 [Indexed for MEDLINE]


611. J Osteopath Med. 2023 Jun 12;123(9):427-434. doi: 10.1515/jom-2022-0244. 
eCollection 2023 Sep 1.

Critical care medicine training in the age of COVID-19.

Mickey W(1).

Author information:
(1)Mercy Hospital, St. Louis, USA.

CONTEXT: The COVID-19 pandemic caused the largest disruption to graduate medical 
education in modern history. The danger associated with SARS-CoV-2 necessitated 
a paradigm shift regarding the fundamental approach to the education of medical 
residents and fellows. Whereas prior work has examined the effect of the 
pandemic on residents' experiences during training, the effect of the pandemic 
on academic performance of critical care medicine (CCM) fellows is not well 
understood.
OBJECTIVES: This study examined the relationship between CCM fellow's lived 
experiences during the COVID-19 pandemic and performance on in-training 
examinations.
METHODS: This mixed-methods study consisted of a quantitative retrospective 
analysis of critical care fellows' in-training examination scores and a 
qualitative, interview-based phenomenological examination of fellows' 
experiences during the pandemic while training in a single large academic 
hospital in the American Midwest. Quantitative: Prepandemic (2019 and 2020) and 
intrapandemic (2021 and 2022) in-training examination scores were analyzed 
utilizing an independent samples t test to determine whether a significant 
change occurred during the pandemic. Qualitative: Individual semi-structured 
interviews were conducted with CCM fellows exploring their lived experiences 
during the pandemic and their perception of the effect on their academic 
performance. Transcribed interviews were analyzed for thematic patterns. These 
themes were coded and categorized, and subcategories were developed as indicated 
during the analysis. The identified codes were then analyzed for thematic 
connections and apparent patterns. Relationships between themes and categories 
were analyzed. This process was continued until a coherent picture could be 
assembled from the data to answer the research questions. Analysis was performed 
from a phenomenological perspective with an emphasis on interpretation of the 
data from the participants' perspectives.
RESULTS: Quantitative: Fifty-one in-training examination scores from 2019 to 
2022 were obtained for analysis. Scores from 2019 to 2020 were grouped as 
prepandemic scores, while scores from 2021 to 2022 were grouped as intrapandemic 
scores. Twenty-four prepandemic and 27 intrapandemic scores were included in the 
final analysis. A significant difference was found between mean total 
prepandemic and intrapandemic in-service examination scores (t 49=2.64, p=0.01), 
with mean intrapandemic scores being 4.5 points lower than prepandemic scores 
(95 % CI, 1.08-7.92). Qualitative: Interviews were conducted with eight CCM 
fellows. Thematic analysis of the qualitative interviews revealed three main 
themes: psychosocial/emotional effects, effects on training, and effects on 
health. The factors that most effected participants' perceptions of their 
training were burnout, isolation, increased workload, decreased bedside 
teaching, decreased formal academic training opportunities, decreased procedural 
experience, a lack of an external reference point for normal training in CCM, 
fear of spreading COVID-19, and neglect of personal health during the pandemic.
CONCLUSIONS: In-training examination scores decreased significantly during the 
COVID-19 pandemic for CCM fellows in this study. The fellows in this study 
reported perceived effects of the pandemic on their psychosocial/emotional 
well-being, medical training, and health.

© 2023 the author(s), published by De Gruyter, Berlin/Boston.

DOI: 10.1515/jom-2022-0244
PMID: 37307290 [Indexed for MEDLINE]


612. Acad Pediatr. 2024 Jan-Feb;24(1):68-77. doi: 10.1016/j.acap.2023.05.016. Epub 
2023 Jun 9.

COVID-19 and Adolescent Outpatient Mental Health Service Utilization.

Burrell TD(1), Sheu YS(2), Kim S(2), Mohadikar K(2), Ortiz N(3), Jonas C(2), 
Horberg MA(2).

Author information:
(1)Kaiser Permanente Mid-Atlantic Permanente Research Institute (TD Burrell, YS 
Sheu, S Kim, K Mohadikar, C Jonas, and MA Horberg), Rockville, Md; Kaiser 
Permanente Mid-Atlantic Permanente Medical Group (TD Burrell, YS Sheu, S Kim, K 
Mohadikar, N Ortiz, C Jonas, and MA Horberg), Rockville, Md. Electronic address: 
Tierra.D.Burrell@kp.org.
(2)Kaiser Permanente Mid-Atlantic Permanente Research Institute (TD Burrell, YS 
Sheu, S Kim, K Mohadikar, C Jonas, and MA Horberg), Rockville, Md; Kaiser 
Permanente Mid-Atlantic Permanente Medical Group (TD Burrell, YS Sheu, S Kim, K 
Mohadikar, N Ortiz, C Jonas, and MA Horberg), Rockville, Md.
(3)Kaiser Permanente Mid-Atlantic Permanente Medical Group (TD Burrell, YS Sheu, 
S Kim, K Mohadikar, N Ortiz, C Jonas, and MA Horberg), Rockville, Md.

OBJECTIVE: The COVID-19 pandemic created challenges in accessing mental health 
(MH) services when adolescent well-being declined. Still, little is known about 
how the COVID-19 pandemic affected outpatient MH service utilization for 
adolescents.
METHODS: Retrospective data were collected from electronic medical records of 
adolescents aged 12-17 years at Kaiser Permanente Mid-Atlantic States, an 
integrated health care system from January 2019 to December 2021. MH diagnoses 
included anxiety, mood disorder/depression, anxiety and mood 
disorder/depression, attention-deficit/hyperactivity disorder, or psychosis. We 
used interrupted time series analysis to compare MH visits and 
psychopharmaceutical prescribing before and after the COVID-19 onset. Analyses 
were stratified by demographics and visit modality.
RESULTS: The study population of 8121 adolescents with MH visits resulted in a 
total of 61,971 (28.1%) of the 220,271 outpatient visits associated with an MH 
diagnosis. During 15,771 (7.2%) adolescent outpatient visits psychotropic 
medications were prescribed. The increasing rate of MH visits prior to COVID-19 
was unaffected by COVID-19 onset; however, in-person visits declined by 230.5 
visits per week (P < .001) from 274.5 visits per week coupled with a rise in 
virtual modalities. Rates of MH visits during the COVID-19 pandemic differed by 
sex, mental health diagnosis, and racial and ethnic identity. 
Psychopharmaceutical prescribing during MH visits declined beyond expected 
values by a mean of 32.8 visits per week (P < .001) at the start of the COVID-19 
pandemic.
CONCLUSIONS: A sustained switch to virtual visits highlights a new paradigm in 
care modalities for adolescents. Psychopharmaceutical prescribing declined 
requiring further qualitative assessments to improve the quality of access for 
adolescent MH.

Copyright © 2023 Academic Pediatric Association. Published by Elsevier Inc. All 
rights reserved.

DOI: 10.1016/j.acap.2023.05.016
PMCID: PMC10250250
PMID: 37302698 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


613. Int J Mol Sci. 2023 May 31;24(11):9577. doi: 10.3390/ijms24119577.

Neurodegenerative and Neurodevelopmental Diseases and the Gut-Brain Axis: The 
Potential of Therapeutic Targeting of the Microbiome.

Bicknell B(1), Liebert A(1)(2)(3), Borody T(4), Herkes G(3), McLachlan C(5), 
Kiat H(1)(5)(6)(7).

Author information:
(1)NICM Health Research Institute, University of Western Sydney, Westmead, NSW 
2145, Australia.
(2)Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, 
Australia.
(3)Department of Governance and Research, Sydney Adventist Hospital, Wahroonga, 
NSW 2076, Australia.
(4)Centre for Digestive Diseases, Five Dock, NSW 2046, Australia.
(5)Centre for Healthy Futures, Torrens University Australia, Ultimo, NSW 2007, 
Australia.
(6)Macquarie Medical School, Macquarie University, Macquarie Park, NSW 2109, 
Australia.
(7)ANU College of Health and Medicine, Australian National University, Canberra, 
ACT 2601, Australia.

The human gut microbiome contains the largest number of bacteria in the body and 
has the potential to greatly influence metabolism, not only locally but also 
systemically. There is an established link between a healthy, balanced, and 
diverse microbiome and overall health. When the gut microbiome becomes 
unbalanced (dysbiosis) through dietary changes, medication use, lifestyle 
choices, environmental factors, and ageing, this has a profound effect on our 
health and is linked to many diseases, including lifestyle diseases, metabolic 
diseases, inflammatory diseases, and neurological diseases. While this link in 
humans is largely an association of dysbiosis with disease, in animal models, a 
causative link can be demonstrated. The link between the gut and the brain is 
particularly important in maintaining brain health, with a strong association 
between dysbiosis in the gut and neurodegenerative and neurodevelopmental 
diseases. This link suggests not only that the gut microbiota composition can be 
used to make an early diagnosis of neurodegenerative and neurodevelopmental 
diseases but also that modifying the gut microbiome to influence the 
microbiome-gut-brain axis might present a therapeutic target for diseases that 
have proved intractable, with the aim of altering the trajectory of 
neurodegenerative and neurodevelopmental diseases such as Alzheimer's disease, 
Parkinson's disease, multiple sclerosis, autism spectrum disorder, and 
attention-deficit hyperactivity disorder, among others. There is also a 
microbiome-gut-brain link to other potentially reversible neurological diseases, 
such as migraine, post-operative cognitive dysfunction, and long COVID, which 
might be considered models of therapy for neurodegenerative disease. The role of 
traditional methods in altering the microbiome, as well as newer, more novel 
treatments such as faecal microbiome transplants and photobiomodulation, are 
discussed.

DOI: 10.3390/ijms24119577
PMCID: PMC10253993
PMID: 37298527 [Indexed for MEDLINE]

Conflict of interest statement: B.B and A.L are cofounders and shareholders of 
SYMBYX Pty Ltd., a med tech company developing protocols targeting the 
microbiome to address metabolic and neurodegenerative diseases.


614. Int J Environ Res Public Health. 2023 May 26;20(11):5960. doi: 
10.3390/ijerph20115960.

Eudaimonic Well-Being of Italian Young Adults during the COVID-19 Pandemic: 
Predictive and Mediating Roles of Fear of Death and Psychological Inflexibility.

Calvo V(1), Masaro C(1), Fusco C(2), Pellicelli C(1), Ghedin S(3), Marogna C(1).

Author information:
(1)Department of Philosophy, Sociology, Pedagogy, and Applied Psychology, 
University of Padova, 35131 Padua, Italy.
(2)Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy.
(3)Servizio per le Dipendenze ASL Roma 6, 00041 Anzio, Italy.

The literature has widely acknowledged the impact of the COVID-19 pandemic on 
the mental health of young adults. Despite extensive research, eudaimonic 
well-being, which focuses on self-knowledge and self-realization, has been 
scarcely investigated. This cross-sectional study aimed to add knowledge on the 
eudaimonic well-being of young adults one year after the outbreak of the 
COVID-19 pandemic, verifying its potential linkages with fear of death and 
psychological inflexibility. A total of 317 young Italian adults (18-34 years), 
recruited through a chain sampling method, completed measures of psychological 
inflexibility, fear of death, and eudaimonic well-being included in an online 
survey. The study's hypotheses were tested with multivariate multiple regression 
and mediational analyses. Results showed that psychological inflexibility was 
negatively associated with all the dimensions of well-being, while fear of the 
death of others was associated with autonomy, environmental mastery, and 
self-acceptance. Furthermore, in the association between fear of death and 
well-being, the mediation role of psychological inflexibility was verified. 
These results contribute to the extant literature on the factors associated with 
eudaimonic well-being, providing clinical insights into the work with young 
adults within challenging times.

DOI: 10.3390/ijerph20115960
PMCID: PMC10252345
PMID: 37297564 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


615. Int J Environ Res Public Health. 2023 May 23;20(11):5918. doi: 
10.3390/ijerph20115918.

Self-Reported Cognitive Aging and Well-Being among Older Middle Eastern/Arab 
American Immigrants during the COVID-19 Pandemic.

Sayed L(1), Alanazi M(2)(3), Ajrouch KJ(4)(5).

Author information:
(1)James Madison College, Michigan State University, 842 Chestnut Rd, East 
Lansing, MI 48825, USA.
(2)College of Nursing, Michigan State University, East Lansing, MI 48825, USA.
(3)Department of Nursing, College of Applied Medical Sciences, University of 
Bisha, Bisha 67714, Saudi Arabia.
(4)Department of Sociology, Anthropology and Criminology, Eastern Michigan 
University, Ypsilanti, MI 48197, USA.
(5)Institute for Social Research, University of Michigan, Ann Arbor, MI 48109, 
USA.

The COVID-19 pandemic posed new challenges for cognitive aging since it brought 
interruptions in family relations for older adults in immigrant communities. 
This study examines the consequences of COVID-19 for the familial and social 
support systems of aging Middle Eastern/Arab immigrants in Michigan, the largest 
concentration in the United States. We conducted six focus groups with 45 
participants aged 60 and older to explore participant descriptions of changes 
and difficulties faced during the pandemic relating to their cognitive health, 
familial and social support systems, and medical care. The findings indicate 
challenges around social distancing for older Middle Eastern/Arab American 
immigrants, which generated three overarching themes: fear, mental health, and 
social relationships. These themes provide unique insights into the lived 
experiences of older Middle Eastern/Arab American adults during the pandemic and 
bring to light culturally embedded risks to cognitive health and well-being. A 
focus on the well-being of older Middle Eastern/Arab American immigrants during 
COVID-19 advances understanding of how environmental contexts inform immigrant 
health disparities and the sociocultural factors that shape minority aging.

DOI: 10.3390/ijerph20115918
PMCID: PMC10252503
PMID: 37297521 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


616. BMJ Open. 2023 Jun 9;13(6):e071331. doi: 10.1136/bmjopen-2022-071331.

Mental health and well-being in the first year of the COVID-19 pandemic among 
different population subgroups: evidence from representative longitudinal data 
in Germany.

Jaschke P(#)(1), Kosyakova Y(#)(2)(3), Kuche C(#)(4), Walther L(#)(5), Goßner 
L(2), Jacobsen J(6)(7), Ta TMT(5), Hahn E(5), Hans S(4), Bajbouj M(5).

Author information:
(1)Migration and International Labour Studies, Institute for Employment Research 
(IAB), Nuremberg, Germany Philipp.Jaschke@iab.de.
(2)Migration and International Labour Studies, Institute for Employment Research 
(IAB), Nuremberg, Germany.
(3)Professorship of Migration Research, University of Bamberg, Bamberg, Germany.
(4)Department of Sociology, Georg-August-Universität Göttingen, Göttingen, 
Germany.
(5)Klinik für Psychiatrie und Psychotherapie, Charite Universitatsmedizin 
Berlin, Berlin, Germany.
(6)Deutsches Zentrum für Integrations- und Migrationsforschung (DeZIM), Berlin, 
Germany.
(7)Berlin Social Science Center (WZB), Berlin, Germany.
(#)Contributed equally

OBJECTIVES: To examine potential deteriorations in mental health and well-being 
in the first COVID-19 pandemic year compared with the previous decade focusing 
on the following vulnerable subgroups in Germany: women with minor children in 
the household, those living without a partner, younger and older adults, those 
in a precarious labour market situation, immigrants and refugees, and those with 
pre-existing physical or mental health risks.
DESIGN: Analyses of secondary longitudinal survey data using cluster-robust 
pooled ordinary least squares models.
PARTICIPANTS: More than 20 000 individuals (aged 16+ years) in Germany.
PRIMARY AND SECONDARY OUTCOME MEASURES: Mental Component Summary Scale (MCS) of 
the 12-item Short-Form Health Survey measuring mental health-related quality of 
life, single item on life satisfaction (LS).
RESULTS: We find a decline in the average MCS in the 2020 survey that is not 
particularly striking in the overall time course, still resulting in a mean 
score below those of all preceding waves since 2010. We find no change in LS 
from 2019 to 2020 against the background of a general upward trend. Regarding 
vulnerability factors, only the results on age and parenthood are partially in 
line with our expectations. In 2020, LS declined among the youngest adults; MCS 
declined among mothers (and women and men without children) but not fathers. 
Unlike respective comparison groups, refugees, those unemployed before the 
pandemic and those with pre-existing mental health risks experienced no MCS 
declines in 2020, whereas persons living without a partner, the eldest, and 
those with pre-existing health risks exhibited continued increases in LS.
CONCLUSIONS: There is no evidence for substantial breakdowns in mental health or 
subjective well-being in the first pandemic year in the German population or its 
subgroups, particularly when considering developments of the previous decade. 
Since the majority of hypothesised vulnerable groups to pandemic stressors 
showed more stable MCS and LS, our results warrant further study.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2022-071331
PMCID: PMC10276970
PMID: 37295837 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


617. BMC Psychol. 2023 Jun 8;11(1):179. doi: 10.1186/s40359-023-01205-3.

Experiences of parents of children with rare neurogenetic conditions during the 
COVID-19 pandemic: an interpretative phenomenological analysis.

Martin JA(1)(2), Robertson K(3), Richards C(4), Scerif G(5), Baker K(6), Tye 
C(3).

Author information:
(1)Department of Psychology, Institute of Psychiatry, Psychology and 
Neuroscience, King's College, London, UK. jessica.martin@mrc-cbu.cam.ac.uk.
(2)MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, 
UK. jessica.martin@mrc-cbu.cam.ac.uk.
(3)Department of Psychology, Institute of Psychiatry, Psychology and 
Neuroscience, King's College, London, UK.
(4)Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, 
University of Birmingham, Birmingham, UK.
(5)Department of Experimental Psychology, University of Oxford, Oxford, UK.
(6)MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, 
UK.

BACKGROUND: The Coronavirus disease 2019 (COVID-19) pandemic has impacted 
parental and child mental health and wellbeing in the UK. This study aimed to 
explore the experiences of parents of children with rare neurological and 
neurodevelopmental conditions with a known or suspected genetic cause 
(neurogenetic) across the first year of the pandemic in the UK.
METHODS: Semi-structured interviews were conducted with 11 parents of children 
with rare neurogenetic conditions. Parents were recruited via opportunity 
sampling from the CoIN Study, a longitudinal quantitative study exploring the 
impact of the pandemic on the mental health and wellbeing of families with rare 
neurogenetic conditions. Interviews were analysed using Interpretative 
Phenomenological Analysis.
RESULTS: Four main themes were identified: (1) "A varied impact on child 
wellbeing: from detrimental to 'no big drama'"; (2) "Parental mental health and 
wellbeing: impact, changes, and coping"; (3) "'The world had shut its doors and 
that was that': care and social services during the pandemic"; and (4) "Time and 
luck: abstract concepts central to parents' perspectives of how they coped 
during the pandemic". The majority of parents described experiencing an 
exacerbation of pre-pandemic challenges due to increased uncertainty and a lack 
of support, with a minority reporting positive effects of the pandemic on family 
wellbeing.
CONCLUSIONS: These findings offer a unique insight into the experiences parents 
of children with rare neurogenetic conditions across the first year of the 
pandemic in the UK. They highlight that the experiences of parents were not 
pandemic-specific, and will continue to be highly relevant in a non-pandemic 
context. Future support should to be tailored to the needs of families and 
implemented across diverse future scenarios to promote coping and positive 
wellbeing.

© 2023. The Author(s).

DOI: 10.1186/s40359-023-01205-3
PMCID: PMC10249551
PMID: 37291611 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


618. PLoS One. 2023 Jun 8;18(6):e0285270. doi: 10.1371/journal.pone.0285270. 
eCollection 2023.

The antenatal psychological experiences of women during two phases of the 
COVID-19 pandemic: A recurrent, cross-sectional, thematic analysis.

Jackson L(1), Davies SM(2)(3), Podkujko A(1), Gaspar M(1), De Pascalis LLD(1), 
Harrold JA(1), Fallon V(1), Soulsby LK(1), Silverio SA(3).

Author information:
(1)Department of Psychology, Institute of Population Health, University of 
Liverpool, Liverpool, Merseyside, United Kingdom.
(2)School of Psychology, Faculty of Health, Liverpool John Moores University, 
Liverpool, Merseyside, United Kingdom.
(3)Department of Women & Children's Health, School of Life Course & Population 
Sciences, King's College London, Southwark, London, United Kingdom.

Initial COVID-19-related social distancing restrictions, imposed in the UK in 
March 2020, and the subsequent lifting of restrictions in May 2020 caused 
antenatal disruption and stress which exceeded expected vulnerabilities 
associated with this lifecourse transition. The current study aimed to explore 
the antenatal psychological experiences of women during different phases of 
pandemic-related lockdown restrictions in the UK. Semi-structured interviews 
were held with 24 women about their antenatal experiences: twelve were 
interviewed after the initial lockdown restrictions (Timepoint 1; T1), and a 
separate twelve women were interviewed after the subsequent lifting of those 
restrictions (Timepoint 2; T2). Interviews were transcribed and a recurrent, 
cross-sectional thematic analysis was conducted. Two themes were identified for 
each timepoint, and each theme contained sub-themes. T1 themes were: 'A Mindful 
Pregnancy' and 'It's a Grieving Process', and T2 themes were: 'Coping with 
Lockdown Restrictions' and 'Robbed of Our Pregnancy'. COVID-19 related social 
distancing restrictions had an adverse effect on women's mental health during 
the antenatal period. Feeling trapped, anxious, and abandoned were common at 
both timepoints. Actively encouraging conversations about mental wellbeing 
during routine care and adopting a prevention opposed to cure attitude toward 
implementing additional support provisions may serve to improve antenatal 
psychological wellbeing during health crises.

Copyright: © 2023 Jackson et al. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0285270
PMCID: PMC10249846
PMID: 37289809 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


619. PLoS One. 2023 Jun 8;18(6):e0286155. doi: 10.1371/journal.pone.0286155. 
eCollection 2023.

An intelligent framework to measure the effects of COVID-19 on the mental health 
of medical staff.

Irfan M(1), Shaf A(2), Ali T(2), Zafar M(2), Rahman S(1), I Hendi MA(3), M 
Baeshen SA(4), Maghfouri MMM(5), Alahmari HSM(4), Shahhar FAI(5), Shahhar 
NAI(5), Halawi AS(3), Mahnashi FH(6), Alqhtani SM(7), Ali M BT(3).

Author information:
(1)Electrical Engineering Department, College of Engineering, Najran University, 
Najran, Saudi Arabia.
(2)Department of Computer Science, COMSATS University Islamabad, Sahiwal Campus, 
Sahiwal, Pakistan.
(3)Armed Forces Hospital Jazan, Jazan, Saudi Arabia.
(4)Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia.
(5)Ministry of Health, Riyadh, Saudi Arabia.
(6)Al-Twal General Hospital, Al-Twal, Jazan, Saudi Arabia.
(7)Department of Information Systems, College of Computer Science and 
Information Systems, Najran University, Najran, Saudi Arabia.

Erratum in
    PLoS One. 2023 Nov 30;18(11):e0295459.

The mental and physical well-being of healthcare workers is being affected by 
global COVID-19. The pandemic has impacted the mental health of medical staff in 
numerous ways. However, most studies have examined sleep disorders, depression, 
anxiety, and post-traumatic problems in healthcare workers during and after the 
outbreak. The study's objective is to evaluate COVID-19's psychological effects 
on healthcare professionals of Saudi Arabia. Healthcare professionals from 
tertiary teaching hospitals were invited to participate in the survey. Almost 
610 people participated in the survey, of whom 74.3% were female, and 25.7% were 
male. The survey included the ratio of Saudi and non-Saudi participants. The 
study has utilized multiple machine learning algorithms and techniques such as 
Decision Tree (DT), Random Forest (RF), K Nearest Neighbor (KNN), Gradient 
Boosting (GB), Extreme Gradient Boosting (XGBoost), and Light Gradient Boosting 
Machine (LightGBM). The machine learning models offer 99% accuracy for the 
credentials added to the dataset. The dataset covers several aspects of medical 
workers, such as profession, working area, years of experience, nationalities, 
and sleeping patterns. The study concluded that most of the participants who 
belonged to the medical department faced varying degrees of anxiety and 
depression. The results reveal considerable rates of anxiety and depression in 
Saudi frontline workers.

Copyright: © 2023 Irfan et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0286155
PMCID: PMC10249891
PMID: 37289778 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


620. PLoS One. 2023 Jun 8;18(6):e0286733. doi: 10.1371/journal.pone.0286733. 
eCollection 2023.

The effect of psychological factors on financial behaviour among older 
Australians: Evidence from the early stages of COVID-19 pandemic.

Arya V(1), Banerjee R(1), Lowies B(1)(2), Viljoen C(1), Lushington K(3).

Author information:
(1)UniSA Business, University of South Australia, Adelaide, South Australia, 
Australia.
(2)Department of Financial Management, University of Pretoria, Hatfield, 
Pretoria, South Africa.
(3)UniSA Justice and Society, University of South Australia, Adelaide, South 
Australia, Australia.

The current study investigated the association between psychological factors and 
financial behaviour during the COVID-19 pandemic in older people. Older people 
were chosen compared to other age groups because of the relatively greater 
impact in this age group of suboptimal financial decisions on future financial 
wellbeing. We hypothesised that the psychological factors facilitating general 
wellbeing during the COVID-I9 pandemic, i.e., positive mental wellbeing, hope, 
and positive coping, will have positive effects on financial behaviour. Based on 
telephone interviews, 1501 older Australians (Men = 750 and Women = 751; 55-64y 
= 630; > 65y = 871) completed an omnibus questionnaire examining coping, hope, 
mental wellbeing, and financial behaviour. Data was analysed using logistic 
regression and an ordinary and two-stage least square frameworks. Analyses 
revealed that the psychological factors identified as facilitating general 
wellbeing during the COVID-I9 pandemic also facilitated positive financial 
behaviour with hope and mental wellbeing emerging as significant determinants. 
Based on weightings from principal component analysis, one item each from the 
hope and mental wellbeing scale with eigenvalues > 1 were found to be robust 
predictors of positive financial behaviours. In conclusion, the findings support 
the assumption that the psychological factors associated with general wellbeing 
during the COVID-19 pandemic are also associated with positive financial 
behaviour. They further raise the possibility that single hope and positive 
mental well-being items can also be used to monitor psychological health and 
predict financial behaviour in older people and, in particular, at times of 
crisis. The latter may be useful measures for government to monitor 
psychological and financial wellbeing and inform policy for supporting older 
people at times of crisis.

Copyright: © 2023 Arya et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0286733
PMCID: PMC10249876
PMID: 37289775 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


621. Br J Nurs. 2023 Jun 8;32(11):514-520. doi: 10.12968/bjon.2023.32.11.514.

Restorative clinical supervision: a chance for change but are we ready?

Featherbe R(1).

Author information:
(1)Practice Educator, Torbay and South Devon NHS Foundation Trust, Torquay.

In the wake of the COVID-19 pandemic, nurses are experiencing increasing stress, 
burnout and mental health problems. The Advocating and Educating for Quality 
ImProvement (A-EQUIP) model of clinical supervision aims to support staff 
wellbeing, promote positive work cultures and improve patient care. Although a 
growing body of empirical evidence supports the positive impact of clinical 
supervision, several individual and organisational barriers may impede the 
implementation of A-EQUIP in practice. Organisational culture, staffing and 
workforce pressures all affect employees' ability to engage with supervision, 
and organisations and clinical leaders must consciously work to sustain lasting 
change.

DOI: 10.12968/bjon.2023.32.11.514
PMID: 37289712 [Indexed for MEDLINE]


622. BMC Public Health. 2023 Jun 7;23(1):1099. doi: 10.1186/s12889-023-16037-4.

Experiences of distress and gaps in government safety net supports among parents 
of young children during the COVID-19 pandemic: a qualitative study.

Mooney AC(1), Jackson KE(2), Hamad R(2), Fernald LCH(3), Hoskote M(4), Gosliner 
W(5).

Author information:
(1)Philip R. Lee Institute for Health Policy Studies, University of California, 
San Francisco, 490 Illinois St, San Francisco, CA, 94158, USA. 
alyssamooney@gmail.com.
(2)Philip R. Lee Institute for Health Policy Studies, University of California, 
San Francisco, 490 Illinois St, San Francisco, CA, 94158, USA.
(3)Division of Community Health Sciences, School of Public Health, University of 
California, Berkeley, 2121 Berkeley Way, Room 5302, Berkeley, CA, 94720, USA.
(4)University of California, Berkeley-University of California, San Francisco 
Joint Medical Program, 570 University Hall MC #7360, 2018 Oxford Street, 
Berkeley, CA, 94720, USA.
(5)Division of Agriculture and Natural Resources, Nutrition Policy Institute, 
University of California, 1111 Franklin Street, Oakland, CA, 94607, USA.

BACKGROUND: The COVID-19 pandemic prompted rapid federal, state, and local 
government policymaking to buffer families from the health and economic harms of 
the pandemic. However, there has been little attention to families' perceptions 
of whether the pandemic safety net policy response was adequate, and what is 
needed to alleviate lasting effects on family well-being. This study examines 
the experiences and challenges of families with low incomes caring for young 
children during the pandemic.
METHODS: Semi-structured qualitative interviews conducted from August 2020 to 
January 2021 with 34 parents of young children in California were analyzed using 
thematic analysis.
RESULTS: We identified three key themes related to parents' experiences during 
the pandemic: (1) positive experiences with government support programs, (2) 
challenging experiences with government support programs, and (3) distress 
resulting from insufficient support for childcare disruptions. Participants 
reported that program expansions helped alleviate food insecurity, and those 
attending community colleges reported accessing a range of supports through 
supportive counselors. However, many reported gaps in support for childcare and 
distance learning, pre-existing housing instability, and parenting stressors. 
With insufficient supports, additional childcare and education workloads 
resulted in stress and exhaustion, guilt about competing demands, and stagnation 
of longer-term goals for economic and educational advancement.
CONCLUSIONS: Families of young children, already facing housing and economic 
insecurity prior to the pandemic, experienced parental burnout. To support 
family well-being, participants endorsed policies to remove housing barriers, 
and expand childcare options to mitigate job loss and competing demands on 
parents. Policy responses that either alleviate stressors or bolster supports 
have the potential to prevent distress catalyzed by future disasters or the more 
common destabilizing experiences of economic insecurity.

© 2023. The Author(s).

DOI: 10.1186/s12889-023-16037-4
PMCID: PMC10244861
PMID: 37287030 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


623. PLoS One. 2023 Jun 7;18(6):e0286819. doi: 10.1371/journal.pone.0286819. 
eCollection 2023.

Hindering and enabling factors for young employees with common mental disorder 
to remain at or return to work affected by the Covid-19 pandemic - a qualitative 
interview study with young employees and managers.

Wallberg M(1), Tinnerholm Ljungberg H(1), Björk Brämberg E(1), Nybergh L(1), 
Jensen I(1), Olsson C(1).

Author information:
(1)Unit of Intervention and Implementation Research for Worker Health, Institute 
of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.

BACKGROUND: During the COVID-19 pandemic, changes in working life occurred, even 
in Sweden, where there was no general lockdown. The aim of this study was to 
examine how the COVID-19 pandemic was perceived as affecting the hindering and 
enabling factors among young employees with CMD to remain at or return to work, 
here as investigated from the perspective of young employees and managers.
MATERIAL AND METHODS: A qualitative design was applied with semistructured 
interviews with 23 managers and 25 young employees (20-29 years old). The 
interviews were recorded and transcribed verbatim, and the parts of the 
interviews related to the aim of this article were analysed using conventional 
content analysis.
RESULTS: The hindering factors were changed working conditions, decreased 
well-being when spending more time at home, and uncertainty. The enabling 
factors were decreased demands, increased balance, and well-functioning work 
processes. For managers it is important to be aware of warning signals 
indicating blurred boundaries between work and private life, to create and 
maintain well-functioning communication, and leave room for recovery.
CONCLUSION: The hindering and enabling factors can be described as two sides of 
the same coin. Changes in the working conditions during the pandemic led to 
difficulties for both young employees and managers when the margins of maneuver 
were insufficient.

Copyright: © 2023 Wallberg et al. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0286819
PMCID: PMC10246792
PMID: 37285347 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


624. BMC Psychiatry. 2023 Jun 6;23(1):406. doi: 10.1186/s12888-023-04875-w.

Meaningful Activities and Recovery (MA&R): a co-led peer occupational therapy 
intervention for people with psychiatric disabilities. Results from a randomized 
controlled trial.

Bjørkedal SB(1), Bejerholm U(2)(3), Hjorthøj C(4)(5), Møller T(6)(5), Eplov 
LF(4).

Author information:
(1)CORE: Copenhagen Research for Mental Health, Gentofte Hospitalsvej 15, 3A, 
2900, Hellerup, Denmark. Siv-Therese.Bogevik.Bjoerkedal@regionh.dk.
(2)Department of Health Sciences, Centre of Evidence-Based Psychosocial 
Interventions, CEPI, Lund University, Lund, Sweden.
(3)Department of Research, Development and Education, Division of Psychiatry and 
Habilitation, Region Skåne, Lund, Sweden.
(4)CORE: Copenhagen Research for Mental Health, Gentofte Hospitalsvej 15, 3A, 
2900, Hellerup, Denmark.
(5)Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 
1353, Copenhagen K, Denmark.
(6)University Hospitals Centre for Health Research (UCSF), Department 9701, 
Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, 
Denmark.

BACKGROUND: Activity and participation are critical to health and wellbeing. 
Limited evidence exists on how to support people with mental illness in 
participating in everyday activities.
AIM: To investigate the effectiveness of Meaningful Activities and Recovery 
(MA&R), a co-led peer occupational therapy intervention focusing on activity 
engagement, functioning, quality of life, and personal recovery.
METHODS: In a statistician blinded, multicenter RCT including 139 participants 
from seven community and municipal mental health services in Denmark, 
participants were randomly assigned to 1) MA&R and standard mental health care 
or 2) standard mental health care. The MA&R intervention lasted 8 months and 
consisted of 11 group sessions, 11 individual sessions, and support to engage in 
activities. The primary outcome, activity engagement, was measured using Profile 
of Occupational Engagement in People with Severe Mental Illness (POES-S). 
Outcomes were measured at baseline and post-intervention follow-up.
RESULTS: Meaningful Activities and Recovery was delivered with high fidelity and 
83% completed the intervention. It did not demonstrate superiority to standard 
mental health care, as intention-to treat analysis revealed no significant 
differences between the groups in activity engagement or any of the secondary 
outcomes.
CONCLUSION: We did not find positive effects of MA&R, possibly because of 
COVID-19 and related restrictions. Fidelity assessments and adherence rates 
suggest that MA&R is feasible and acceptable. However, future studies should 
focus on refining the intervention before investigating its effectiveness.
TRIAL REGISTRATION: The trial was registered 24/05/2019 at ClinicalTrials.gov 
NCT03963245.

© 2023. The Author(s).

DOI: 10.1186/s12888-023-04875-w
PMCID: PMC10243265
PMID: 37280561 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no competing interests.


625. BMC Public Health. 2023 Jun 6;23(1):1097. doi: 10.1186/s12889-023-15813-6.

Resilience in adolescence during the COVID-19 crisis in Canada.

Chin J(1), Di Maio J(1), Weeraratne T(2), Kennedy KM(1)(3)(4), Oliver LK(5), 
Bouchard M(6), Malhotra D(7), Habashy J(8), Ding J(8), Bhopa S(8), Strommer 
S(9), Hardy-Johnson P(9)(10), Barker M(9), Sloboda DM(11)(12)(13)(14), 
McKerracher L(15).

Author information:
(1)Department of Biochemistry and Biomedical Sciences, McMaster University, 1280 
Main Street West, HSC 4H30A, HamiltonHamilton, ON, L8S 4K1, Canada.
(2)Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.
(3)Farncombe Family Digestive Health Research Institute, McMaster University, 
Hamilton, ON, Canada.
(4)Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, 
Canada.
(5)Werklund School of Education, University of Calgary, Calgary, AB, Canada.
(6)Department of Epidemiology, and Occupational Health, McGill University, 
BiostatisticsMontreal, QC, Canada.
(7)Department of Medicine, McMaster University, Hamilton, ON, Canada.
(8)Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
(9)MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, 
UK.
(10)Primary Care Population Sciences and Medical Education, Faculty of Medicine, 
University of Southampton, Southampton, UK.
(11)Department of Biochemistry and Biomedical Sciences, McMaster University, 
1280 Main Street West, HSC 4H30A, HamiltonHamilton, ON, L8S 4K1, Canada. 
sloboda@mcmaster.ca.
(12)Farncombe Family Digestive Health Research Institute, McMaster University, 
Hamilton, ON, Canada. sloboda@mcmaster.ca.
(13)Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, 
Canada. sloboda@mcmaster.ca.
(14)Department of Pediatrics, McMaster University, Hamilton, ON, Canada. 
sloboda@mcmaster.ca.
(15)Department of Public Health, Aarhus Institute for Advanced Studies, Aarhus 
University, Høegh-Guldbergs Gade 6B, 8000, Aarhus, Denmark. 
luseadramckerracher@aias.au.dk.

BACKGROUND: The COVID-19 pandemic constitutes a social crisis that will have 
long-term health consequences for much of the global population, especially for 
adolescents. Adolescents are triply affected as they: 1) are experiencing its 
immediate, direct effects, 2) will carry forward health habits they develop now 
into adulthood, and 3) as future parents, will shape the early life health of 
the next generation. It is therefore imperative to assess how the pandemic is 
influencing adolescent wellbeing, identify sources of resilience, and outline 
strategies for attenuating its negative impacts.
METHODS: We report the results of longitudinal analyses of qualitative data from 
28 focus group discussions (FGDs) with 39 Canadian adolescents and of 
cross-sectional analyses of survey data from 482 Canadian adolescents gathered 
between September 2020 and August 2021. FGD participants and survey respondents 
reported on their: socio-demographic characteristics; mental health and 
wellbeing before and during the pandemic; pre- and during-pandemic health 
behaviours; experiences living through a crisis; current perceptions of their 
school, work, social, media, and governmental environments; and ideas about 
pandemic coping and mutual aid. We plotted themes emerging from FGDs along a 
pandemic timeline, noting socio-demographic variations. Following assessment for 
internal reliability and dimension reduction, quantitative health/wellbeing 
indicators were analyzed as functions of composite socio-demographic, 
health-behavioural, and health-environmental indicators.
RESULTS: Our mixed methods analyses indicate that adolescents faced considerable 
mental and physical health challenges due to the pandemic, and were generally in 
poorer health than expected in non-crisis times. Nevertheless, some participants 
showed significantly better outcomes than others, specifically those who: got 
more exercise; slept better; were food secure; had clearer routines; spent more 
time in nature, deep in-person social relationships, and leisure; and spent less 
time on social media.
CONCLUSIONS: Support for youth during times of crisis is essential to future 
population health because adolescence is a period in the life course which 
shapes the health behaviours, socio-economic capacities, and neurophysiology of 
these future parents/carers and leaders. Efforts to promote resilience in 
adolescents should leverage the factors identified above: helping them find 
structure and senses of purpose through strong social connections, 
well-supported work and leisure environments, and opportunities to engage with 
nature.

© 2023. The Author(s).

DOI: 10.1186/s12889-023-15813-6
PMCID: PMC10243272
PMID: 37280549 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


626. J Clin Immunol. 2023 Oct;43(7):1483-1495. doi: 10.1007/s10875-023-01524-5. Epub 
2023 Jun 6.

Impact of COVID-19 Pandemic on Clinical Care of Patients and Psychosocial Health 
of Affected Families with Chronic Granulomatous Disease: an Observational Study 
from North India.

Vignesh P(#)(1), Sharma R(#)(2), Barman P(#)(2), Mondal S(2), Das J(2), Siniah 
S(2), Goyal T(2), Sharma S(2), Pilania RK(2), Jindal AK(2), Suri D(2), Rawat 
A(3), Singh S(2).

Author information:
(1)Pediatric Allergy and Immunology Unit, Department of Pediatrics, Advanced 
Pediatrics Centre, Post Graduate Institute of Medical Education and Research, 
Chandigarh, India, 160012. vigimmc@gmail.com.
(2)Pediatric Allergy and Immunology Unit, Department of Pediatrics, Advanced 
Pediatrics Centre, Post Graduate Institute of Medical Education and Research, 
Chandigarh, India, 160012.
(3)Pediatric Allergy and Immunology Unit, Department of Pediatrics, Advanced 
Pediatrics Centre, Post Graduate Institute of Medical Education and Research, 
Chandigarh, India, 160012. rawatamit@yahoo.com.
(#)Contributed equally

Day-to-day clinical management of patients with inborn errors of immunity, 
including chronic granulomatous disease (CGD), has been affected by the 
coronavirus disease-2019 (COVID-19) pandemic. There is a dearth of information 
on impact of this pandemic on clinical care of children with CGD and 
psychological profile of the caretakers. Among the 101 patients with CGD 
followed up in our center, 5 children developed infection/complications 
associated with COVID-19. Four of these children had a mild clinical course, 
while 1 child developed features of multisystem inflammatory syndrome in 
children (MISC) requiring intravenous glucocorticoids. Parents and caretakers of 
CGD patients (n = 21) and 21 healthy adults with similar ages and genders were 
also evaluated on the following scales and questionnaires: COVID-19 Fear Scale 
(FCV 19S), Impact of Event Scale (IES-R), Depression, Anxiety, and Stress Scale 
(DASS 21), Preventive COVID-19 Behavior Scale (PCV 19BS), and a "COVID-19 
Psychological wellbeing questionnaire." Median age of the parents/caregivers was 
41.76 years (range: 28-60 years). Male:female ratio was 2:1. In the study group, 
71.4% had higher IES scores compared to 14.3% in controls. The caregivers had a 
high prevalence of stress, anxiety, avoidance behavior, and depression compared 
to controls (p < 0.001). Children with CGD have had predominantly mild infection 
with COVID-19; however, caregivers/parents of these children were at risk of 
developing psychological distress. The COVID-19 pandemic has brought to light 
the importance of patients' and caretakers' mental health which needs periodic 
assessment and appropriate interventions.

© 2023. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s10875-023-01524-5
PMCID: PMC10243701
PMID: 37280467 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


627. Health Promot Int. 2023 Jun 1;38(3):daad048. doi: 10.1093/heapro/daad048.

Gender differences in sense of coherence among university students during the 
COVID-19 pandemic in Turkey.

Kayi I(1), Uzunköprü G(2), Dadaczynski K(3)(4), Soylar P(5), Otludil B(2), 
Dündar P(6), Bakırcı N(7), Okan O(8), Sakarya S(1).

Author information:
(1)Department of Public Health, Koç University School of Medicine, İstanbul, 
Turkey.
(2)Koç University School of Medicine, İstanbul, Turkey.
(3)Department of Health Science, Fulda University of Applied Sciences, Fulda, 
Germany.
(4)Center for Applied Health Sciences, Leuphana University, Lueneburg, Germany.
(5)Department of Health Sciences, Nursing School, Fırat University, Elazığ, 
Turkey.
(6)Department of Public Health, Celal Bayar University School of Medicine, 
Manisa, Turkey.
(7)Acıbadem University School of Medicine, Dean, İstanbul, Turkey.
(8)Technical University Munich, TUM Department of Sports and Health Science, 
Munich, Germany.

Non-pharmaceutical interventions (NPIs) implemented to mitigate the COVID-19 
pandemic halted everyday life in higher education along with social and 
psychological impacts. The objective of our study was to explore the factors 
related to sense of coherence (SoC) from a gender perspective among university 
students in Turkey. This is a cross-sectional survey conducted online with a 
convenience sampling method as part of the international COVID-Health Literacy 
(COVID-HL) Consortium. SoC was measured by a nine-item questionnaire that was 
adapted to the Turkish language, including socio-demographic information and 
health status, including psychological well-being, psychosomatic complaints, and 
future anxiety (FA). 1595 students from four universities, of whom 72% were 
female, participated in the study. Cronbach's alpha for the SoC scale was 0.75. 
Based on the median split of the individual scores, levels of SoC showed no 
statistically significant difference according to gender. Logistic regression 
analysis indicated that higher SoC was associated with medium and high 
subjective social status, studying in private universities, high psychological 
well-being, low FA, and none/one psychosomatic complaint. While results were 
similar among female students, type of university and psychological well-being 
showed no statistically significant association with SoC among males. Our 
results indicate that structural (subjective social status) and contextual (type 
of university) factors, along with gender-based variations, are associated with 
SoC among university students in Turkey.

© The Author(s) 2023. Published by Oxford University Press.

DOI: 10.1093/heapro/daad048
PMCID: PMC10243759
PMID: 37279469 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflict of interest to 
declare.


628. Brain Behav. 2023 Aug;13(8):e3106. doi: 10.1002/brb3.3106. Epub 2023 Jun 5.

Estonian National Mental Health Study: Design and methods for a registry-linked 
longitudinal survey.

Laidra K(1), Reile R(1), Havik M(2), Leinsalu M(1)(3), Murd C(2), Tulviste J(2), 
Tamson M(4), Akkermann K(5), Kreegipuu K(5), Sultson H(5), Ainsaar M(6), Uusberg 
A(5), Rahno J(2), Panov L(7), Leetmaa K(8), Aasa A(8), Veidebaum T(2), Lehto 
K(9), Konstabel K(2).

Author information:
(1)Department of Epidemiology and Biostatistics, National Institute for Health 
Development, Tallinn, Estonia.
(2)Department of Chronic Diseases, National Institute for Health Development, 
Tallinn, Estonia.
(3)Stockholm Centre for Health and Social Change, Södertörn University, 
Huddinge, Sweden.
(4)Department of Drugs and Infectious Diseases Epidemiology, National Institute 
for Health Development, Tallinn, Estonia.
(5)Institute of Psychology, University of Tartu, Tartu, Estonia.
(6)Institute of Social Studies, University of Tartu, Tartu, Estonia.
(7)Department of Health Statistics, National Institute for Health Development, 
Tallinn, Estonia.
(8)Department of Geography, University of Tartu, Tartu, Estonia.
(9)Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, 
Estonia.

OBJECTIVES: The Estonian National Mental Health Study (EMHS) was conducted in 
2021-2022 to provide population-wide data on mental health in the context of 
COVID-19 pandemic. The main objective of this paper is to describe the 
rationale, design, and methods of the EMHS and to evaluate the survey response.
METHODS: Regionally representative stratified random sample of 20,000 persons 
aged 15 years and older was drawn from the Estonian Population Register for the 
study. Persons aged 18 years and older at the time of the sampling were enrolled 
into three survey waves where they were invited to complete an online or postal 
questionnaire about mental well-being and disorders, and behavioral, cognitive, 
and other risk factors. Persons younger than 18 years of age were invited to 
fill an anonymous online questionnaire starting from wave 2. To complement and 
validate survey data, data on socio-demographic, health-related, and 
environmental variables were collected from six national administrative 
databases and registries. Additionally, a subsample was enrolled into a 
validation study using ecological momentary assessment.
RESULTS: In total, 5636 adults participated in the survey wave 1, 3751 in wave 
2, and 4744 in wave 3. Adjusted response rates were 30.6%, 21.1%, and 27.6%, 
respectively. Women and older age groups were more likely to respond. Throughout 
the three survey waves, a considerable share of adult respondents screened 
positive for depression (27.6%, 25.1%, and 25.6% in waves 1, 2, and 3, 
respectively). Women and young adults aged 18 to 29 years had the highest 
prevalence of depression symptoms.
CONCLUSIONS: The registry-linked longitudinal EMHS dataset comprises a rich and 
trustworthy data source to allow in-depth analysis of mental health outcomes and 
their correlates among the Estonian population. The study serves as an evidence 
base for planning mental health policies and prevention measures for possible 
future crises.

© 2023 The Authors. Brain and Behavior published by Wiley Periodicals LLC.

DOI: 10.1002/brb3.3106
PMCID: PMC10454261
PMID: 37278143 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


629. BMC Med Educ. 2023 Jun 6;23(1):411. doi: 10.1186/s12909-023-04387-x.

The prevalence of depressive and anxiety symptoms among first-year and 
fifth-year medical students during the COVID-19 pandemic: a cross-sectional 
study.

Alshehri A(1), Alshehri B(2), Alghadir O(2), Basamh A(2), Alzeer M(2), Alshehri 
M(2), Nasr S(2).

Author information:
(1)Department of Surgery, College of Medicine, King Saud University, Riyadh, 
Saudi Arabia. Abalshehri@ksu.edu.sa.
(2)College of Medicine, King Saud University, Riyadh, Saudi Arabia.

BACKGROUND: Medical students have higher risk of psychological disorders due to 
the relatively stressful environment. Educators are becoming increasingly aware 
of the impact of stresses on the students general well-being. The objective of 
the current study was to examine the prevalence of and risk factors for 
depressive and anxiety symptoms among first-year and fifth-year medical 
students. Additionally, we aimed to determine whether the COVID-19 pandemic has 
affected students' mental well-being.
METHODS: A cross-sectional study was performed at the College of Medicine at 
King Saud University between September 2020 and January 2021. The target 
population was first-year and fifth-year medical students. Depressive symptoms 
were screened using the 9-item Patient Health Questionnaire (PHQ-9), while 
anxiety symptoms were screened using the 7-item Generalized Anxiety Disorder 
assessment (GAD-7). Students were also directly asked about the effect of the 
COVID-19 pandemic on their mental well-being. Outcomes were compared between 
groups using the chi-squared test and Student's t test. Multivariate logistic 
regression analysis was performed to identify factors associated with depressive 
and anxiety symptoms.
RESULTS: A total of 182 medical students were included. Depressive symptoms 
(52.9% versus 35.8%, p = 0.020) and anxiety symptoms (35.6% versus 26.3%, 
p = 0.176) were higher in the first-year students than in the fifth-year 
students. Approximately 19.2% of the students were worried about acquiring 
COVID-19, 49.4% were worried about academic performance, and 30.8% were feeling 
sad, depressed or anxious during the COVID-19 pandemic. Independent risk factors 
for depressive symptoms included having concomitant anxiety, being worried about 
acquiring COVID-19, being worried about academic performance, and feeling sad, 
depressed or anxious. Independent risk factors for anxiety included having a 
lower grade point average and having concomitant depressive symptoms.
CONCLUSION: Medical students have an alarmingly high prevalence of depressive 
and anxiety symptoms, which might have been negatively impacted by the COVID-19 
pandemic. There is a need for a special mental health program targeting new and 
current medical students.

© 2023. The Author(s).

DOI: 10.1186/s12909-023-04387-x
PMCID: PMC10241552
PMID: 37277742 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


630. Disaster Med Public Health Prep. 2023 Jun 5;17:e403. doi: 10.1017/dmp.2022.295.

Call for Faith: Religiousness, Religious Coping and Psychological Disturbance of 
Chinese Christians During COVID-19.

Xie Z(1), Ren Z(2).

Author information:
(1)China University of Political Science and Law, School of Sociology, Beijing, 
102249, China.
(2)Department of Clinical Psychology, The Third Affiliated Hospital of Chongqing 
Medical University, Chongqing, 401120, China.

OBJECTIVES: This study is aimed at investigating the relationships between 
religious practice, religious coping strategies, and mental health among Chinese 
Christians in the context of the COVID-19 outbreak.
METHODS: A total of 915 participants from several cities in China completed 
online questionnaires, including sociodemographic data, mental disorder history, 
and years as a Christian, as well as frequency of weekly religious practice, 
Religious Coping Scale, the Patient Health Questionnaire-9 (PHQ-9), and the 
Generalized Anxiety Disorder scale (GAD-7).
RESULTS: The result of multivariate analysis indicated that during the COVID-19 
pandemic, among Chinese Christians without a history of mental disorder, 
negative religious coping were associated with depression, and anxiety symptoms. 
Among Chinese Christians with a history of mental disorders, comorbidity with 1 
mental disorder, comorbidity with 2 or more mental disorders, negative religious 
coping, and positive religious coping were associated with depression symptoms. 
Comorbidity with 2 or more mental disorders, negative religious coping, and 
positive religious coping were associated with anxiety symptoms.
CONCLUSION: Christians with a previous history of mental illness are more likely 
to experience anxiety during the epidemic. In the future, mental health services 
during disasters may put more attention on certain religious groups and provide 
more spiritual care to maintain their well-being accordingly.

DOI: 10.1017/dmp.2022.295
PMID: 37272537 [Indexed for MEDLINE]


631. Med J Malaysia. 2023 May;78(3):301-307.

Perception, views, and barriers of primary care doctors regarding screening of 
depression among elderly patients attending public healthcare clinics in Kuching 
district: a qualitative study.

Benjamin TWC(1), Aznida FAA(2), Ali MF(1).

Author information:
(1)Universiti Kebangsaan Malaysia, Faculty of Medicine, Department of Family 
Medicine, Kuala Lumpur, Malaysia.
(2)Universiti Kebangsaan Malaysia, Faculty of Medicine, Department of Family 
Medicine, Kuala Lumpur, Malaysia. draznida@ppukm.ukm.edu.my.

INTRODUCTION: Depression in the elderly constitutes 7.3% of the total Malaysian 
national prevalence of depression. However, depression is commonly 
underdiagnosed by primary care physicians, which may impact coexisting comorbid 
conditions and general well-being. As depression in the elderly increases with 
age, its prevalence is expected to become even more significant due to the 
increased life expectancy and isolation during the pandemic. This study aims to 
determine the perceptions, views and barriers encountered among primary care 
physicians on screening for depression among the elderly.
MATERIALS AND METHODS: This qualitative study involved five public healthcare 
clinics in the Kuching district with indepth interviews (IDI) conducted on 14 
primary care doctors (PCDs). Semi-structured interviews and in-depth discussions 
were conducted via videoconferencing. One representative was selected from each 
clinic at initiation, followed by snowball method for subsequent subject 
selection until saturation of themes. Interviews were transcribed verbatim, and 
analysis based on framework analysis principles via NVivo software. Themes were 
analysed deductively according to study objectives and evidence from literature.
RESULTS: Three main themes emerged from the IDI: (1) The perception of 
depression in elderly patients, (2) The perceived barriers to screening, and (3) 
The screening processes. Majority of the PCDs perceived depression as part of 
ageing process. Time constraints, lack of privacy in consultation rooms, 
dominant caregivers and failure to recognise recurrent somatic symptoms as part 
of depression influenced PCDs decision to screen. Screening was technically 
challenging for PCDs to use the DASS-21, which was not socio-culturally 
validated for local native population. Only 21.4% of respondents (3/14) reported 
screening at least three out 10 elderly patients seen over 1- month period. 
During the covid pandemic, due to the same human resource support and practices, 
most participants thought their screening for depression in elderlies had not 
changed.
CONCLUSION: Awareness of depression among PCDs needs to be re-enforced via 
continuous medical education programs to use appropriate screening tools, 
address infrastructure related barriers to optimise screening practices. The use 
of appropriate locally validated and socio-culturally adapted tool is vital to 
correctly interpret the screening test for patients.

PMID: 37271839 [Indexed for MEDLINE]


632. Curr Opin Psychol. 2023 Jun;51:101592. doi: 10.1016/j.copsyc.2023.101592. Epub 
2023 May 17.

College and COVID-19: The Pandemic's reverberations on adolescents and emerging 
adults on campus.

Velez GM(1).

Author information:
(1)Educational Policy and Leadership, College of Education, Marquette 
University, USA. Electronic address: gabriel.velez@marquette.edu.

The COVID-19 pandemic deeply disrupted all aspects of life for young people in 
college. Beginning early in the pandemic, research has documented how young 
people experienced these challenges and the impacts on their psychosocial 
wellbeing and development. This review highlights patterns in identified 
challenges, mental health, and associated risk and protective factors. Overall, 
the pandemic led to rises in negative affect and emotional struggles, though the 
review of the literature also raises critical areas for supporting these young 
people. Additionally, the review suggests providing resources that focus on 
valuable elements of young people's experiences on college campuses; namely 
social support and connection, belonging, and effective psychosocial coping 
strategies.

Copyright © 2023 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.copsyc.2023.101592
PMCID: PMC10188371
PMID: 37270878 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


633. Soc Psychiatry Psychiatr Epidemiol. 2024 Jan;59(1):165-174. doi: 
10.1007/s00127-023-02501-4. Epub 2023 Jun 4.

Psychosocial and financial well-being mediated the effects of COVID-19 distress 
on suicidality: a serial mediation model among Hong Kong young adults.

So WWY(#)(1), Fong TCT(#)(2), Woo BPY(1), Yip PSF(3)(4).

Author information:
(1)HKJC Centre for Suicide Research and Prevention, University of Hong Kong, 
2/F, HKJC Building for Interdisciplinary Research, Pokfulam, Hong Kong.
(2)Centre on Behavioral Health, The University of Hong Kong, Pokfulam, Hong 
Kong.
(3)HKJC Centre for Suicide Research and Prevention, University of Hong Kong, 
2/F, HKJC Building for Interdisciplinary Research, Pokfulam, Hong Kong. 
sfpyip@hku.hk.
(4)Department of Social Work & Social Administration, University of Hong Kong, 
Pokfulam, Hong Kong. sfpyip@hku.hk.
(#)Contributed equally

PURPOSE: The COVID-19 pandemic has brought significant distress on not only the 
physical health but also mental health of individuals. The present study 
investigated the direct and indirect effects from COVID-19 distress to 
suicidality via psychosocial and financial well-being among young people.
METHODS: This cross-sectional survey recruited 1472 Hong Kong young people via 
random sampling in 2021. The respondents completed a phone survey on COVID-19 
distress, the four-item Patient Health Questionnaire and items on social 
well-being, financial well-being, and suicidality. Structural equation modeling 
(SEM) was conducted to examine the direct and indirect effects of COVID-19 
distress on suicidality via psychosocial and financial well-being.
RESULTS: The direct effect of COVID-19 distress on suicidality was not 
significant (β = 0.022, 95% CI  - 0.097-0.156). The total indirect effect from 
COVID-19 distress to suicidality was significant and positive (αβγ = 0.150, 95% 
CI = 0.085-0.245) and accounted for 87% of the total effect (B = 0.172, 95% 
CI = 0.043-0.341). There were significant specific indirect effects via social 
well-being and psychological distress, and financial well-being and 
psychological distress.
CONCLUSION: The present findings support different pathways from COVID-19 
distress to suicidality via functioning in different domains among young people 
in Hong Kong. Measures are needed to ameliorate the impact on their social and 
financial well-being to reduce their psychological distress and suicidality.

© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

DOI: 10.1007/s00127-023-02501-4
PMCID: PMC10239540
PMID: 37270725 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no competing interests to 
declare that are relevant to the content of this article.


634. Scand J Public Health. 2023 Jul;51(5):648-655. doi: 10.1177/14034948231176708. 
Epub 2023 Jun 2.

Effects of the COVID-19-induced lockdown period on general well-being, perceived 
stress and activity levels in the Faroe Islands.

Honnudóttir V(1)(2), Veyhe AS(2), Mohr M(1), Strøm M(2), Mohr M(1)(2)(3).

Author information:
(1)Faroese Board of Public Health, Faroe Islands.
(2)Centre of Health Science, Faculty of Health, University of the Faroe Islands, 
Faroe Islands.
(3)Department of Sports Science and Clinical Biomechanics, SDU Sport and Health 
Sciences Cluster (SHSC), Faculty of Health Sciences, University of Southern 
Denmark, Denmark.

AIMS: Detrimental effects on health and well-being were reported during the 
COVID-19-induced lockdown periods in several countries, but these associations 
have not been studied in small-scale island societies. This study aimed to 
examine the lockdown period's impact on general well-being, perceived stress and 
activity levels in the Faroe Islands.
METHODS: We used cross-sectional data from two extensive population-based 
surveys of the general health conducted in November 2019 (the pre-COVID survey; 
n=2906), and four to six weeks into the first national lockdown (the lockdown 
survey; n=1204).
RESULTS: A larger proportion of participants in the lockdown survey versus 
pre-COVID survey displayed excellent/very good self-rated health (68.1% vs. 
62.0%; p<0.001), and the same pattern was observed for reporting good quality of 
life (85.7% vs. 82.7%; p<0.05). These associations remained statistically 
significant in a logistic regression model after adjusting for characteristics 
for which varying impact of the pandemic has been shown. Indicators of health 
behaviour showed that larger proportions of participants kept active during the 
lockdown survey versus pre-COVID survey, and these differences were 
statistically significant for physical, mental and spiritual activities 
(p<0.001). On the other hand, similar stress levels in the pre-COVID/lockdown 
periods were observed, but stratified analysis showed that participants with a 
high-stress level displayed better self-rated health in the lockdown period 
compared to the pre-COVID period (p=0.001).
CONCLUSIONS: Findings indicate that self-reported health and quality of life 
improved during the early phase of the COVID lockdown, and individuals reported 
higher activity levels associated with good mental health during the 
COVID-19-induced lockdown period.

DOI: 10.1177/14034948231176708
PMCID: PMC10240299
PMID: 37264919 [Indexed for MEDLINE]

Conflict of interest statement: The authors declared no potential conflicts of 
interest with respect to the research, authorship and/or publication of this 
article.


635. Aust N Z J Psychiatry. 2024 Jan;58(1):58-69. doi: 10.1177/00048674231175618. 
Epub 2023 Jun 1.

Predictors of individual mental health and psychological resilience after 
Australia's 2019-2020 bushfires.

Macleod E(1)(2), Heffernan T(1)(3), Greenwood LM(1), Walker I(1)(4), Lane J(5), 
Stanley SK(1), Evans O(1), Calear AL(2), Cruwys T(1), Christensen BK(1), Kurz 
T(6), Lancsar E(2), Reynolds J(1), Rodney Harris R(7), Sutherland S(1).

Author information:
(1)School of Medicine and Psychology, The Australian National University, 
Canberra, ACT, Australia.
(2)Centre for Mental Health Research, The Australian National University, 
Canberra, ACT, Australia.
(3)School of Built Environment, University of New South Wales, Sydney, NSW, 
Australia.
(4)Melbourne Centre for Behaviour Change, The University of Melbourne, 
Parkville, VIC, Australia.
(5)National Centre for Epidemiology and Population Health, The Australian 
National University, Canberra, ACT, Australia.
(6)School of Psychological Science, The University of Western Australia, Perth, 
WA, Australia.
(7)Centre for Entrepreneurial Agri-Technology, The Australian National 
University, Canberra, ACT, Australia.

AIMS: We assessed the mental health effects of Australia's 2019-2020 bushfires 
12-18 months later, predicting psychological distress and positive psychological 
outcomes from bushfire exposure and a range of demographic variables, and 
seeking insights to enhance disaster preparedness and resilience planning for 
different profiles of people.
METHODS: We surveyed 3083 bushfire-affected and non-affected Australian 
residents about their experiences of bushfire, COVID-19, psychological distress 
(depression, anxiety, stress, post-traumatic stress disorder) and positive 
psychological outcomes (resilient coping, wellbeing).
RESULTS: We found high rates of distress across all participants, exacerbated by 
severity of bushfire exposure. For people who were bushfire-affected, being 
older, having less financial stress, and having no or fewer pre-existing mental 
disorders predicted both lower distress and higher positive outcomes. Being male 
or having less income loss also predicted positive outcomes. Severity of 
exposure, higher education and higher COVID-19-related stressors predicted both 
higher distress and higher positive outcomes. Pre-existing physical health 
diagnosis and previous bushfire experience did not significantly predict 
distress or positive outcomes.
RECOMMENDATIONS: To promote disaster resilience, we recommend investment in 
mental health, particularly for younger adults and for those in rural and remote 
areas. We also recommend investment in mechanisms to protect against financial 
distress and the development of a broader definition of bushfire-related impacts 
than is currently used to capture brushfires' far-reaching effects.

DOI: 10.1177/00048674231175618
PMCID: PMC10756019
PMID: 37264605 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting InterestsThe 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship and/or publication of this article.


636. BMJ Open. 2023 Jun 1;13(6):e071023. doi: 10.1136/bmjopen-2022-071023.

Protocol for the OCAY study: a cohort study of orphanhood and caregiver loss in 
the COVID-19 era to explore the impact on children and adolescents.

Steventon Roberts KJ(#)(1)(2), Du Toit S(#)(3), Mawoyo T(#)(3), Tomlinson 
M(3)(4), Cluver LD(1)(5), Skeen S(3)(6), Laurenzi CA(3), Sherr L(7).

Author information:
(1)Department of Social Policy and Intervention, University of Oxford, Oxford, 
UK.
(2)Institute for Global Health, University College London, London, UK.
(3)Institute for Life Course Health Reseach, Department of Global Health, 
Stellenbosch Univeristy, Stellenbosch, South Africa.
(4)School of Nursing & Midwifrey, Queens University, Belfast, UK.
(5)Department of Psychiatry & Mental Health, Univeristy of Cape Town, Cape Town, 
South Africa.
(6)Amsterdam Institute for Social Science Research, Faculty of Social & 
Behavioural Sciences, Univeristy of Amsterdam, Amsterdam, Netherlands.
(7)Institute for Global Health, University College London, London, UK 
l.sherr@ucl.ac.uk.
(#)Contributed equally

INTRODUCTION: Globally, no person has been untouched by the COVID-19 pandemic. 
Yet, little attention has been given to children and adolescents in policy, 
provision and services. Moreover, there is a dearth of knowledge regarding the 
impact of COVID-19-associated orphanhood and caregiver loss on children. This 
study aims to provide early insights into the mental health and well-being of 
children and adolescents experiencing orphanhood or caregiver loss in South 
Africa.
METHODS AND ANALYSIS: Data will be drawn from a quantitative longitudinal study 
in Cape Town, South Africa. A sample of children and adolescents between the 
ages of 9 and 18 years, experiencing parental or caregiver loss from COVID-19, 
will be recruited together with a comparison group of children in similar 
environments who did not experience loss. The study aims to recruit 500 children 
in both groups. Mental health and well-being among children will be explored 
through the use of validated and study-specific measures. Participants will be 
interviewed at two time points, with follow-up data being collected 12-18 months 
after baseline. A combination of analytical techniques (including descriptive 
statistics, regression modelling and structural equation modelling) will be used 
to understand the experience and inform future policy and service provision.
ETHICS AND DISSEMINATION: This study received ethical approval from the Health 
Research Ethics Committee at Stellenbosch University (N 22/04/040). Results will 
be disseminated via academic and policy publications, as well as national and 
international presentations including high-level meetings with technical 
experts. Findings will also be disseminated at a community level via various 
platforms.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/bmjopen-2022-071023
PMCID: PMC10254791
PMID: 37263702 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


637. Eur Rev Med Pharmacol Sci. 2023 May;27(10):4792-4800. doi: 
10.26355/eurrev_202305_32490.

The influence of the COVID-19 pandemic on the psychological well-being of 
college students: a cross-sectional study.

Siddiqua A(1), Makki S, Siddiqui S, Hani U, Alshreem AH, Alshaban RA, Al-Huraysi 
BY, Khaled A.

Author information:
(1)Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, 
Abha, Kingdom of Saudi Arabia. ayshafiq@kku.edu.sa.

OBJECTIVE: Even before the outbreak of the COVID-19 pandemic, concerns regarding 
college students' mental health were on the rise due to the increasing number of 
students afflicted with mental health issues. Exposure to numerous 
pandemic-related measures exacerbated existing issues with anxiety, depression, 
and stress. This study aimed to assess depression, anxiety, and stress levels 
among university students in the Aseer region in Saudi Arabia.
SUBJECTS AND METHODS: Data were collected from eligible individuals using a 
web-based, self-administered DASS-21 questionnaire. This questionnaire consists 
of 21 questions with a rating scale of 0-3. Each of the psychological factors of 
depression, anxiety, and stress was categorized as normal, mild, moderate, 
severe, and extremely severe. Results were expressed using descriptive 
statistics as proportions, and the Mann-Whitney/Kruskal-Wallis' test was used to 
evaluate the presence of a significant difference between each of the 
socio-demographic factors of the respondents and the psychological outcomes.
RESULTS: Respondents aged between 18-24 years reported higher rates of extremely 
severe depression than other age groups. Females had higher rates of depression, 
especially severe and extremely severe forms. Extremely severe anxiety had a 
relatively high prevalence across all age groups. Extremely severe stress was 
more common among respondents aged between 18-24 years, while respondents older 
than 34 years reported the highest prevalence of severe stress. The 
Mann-Whitney/Kruskal-Wallis' tests showed statistically significant differences 
between participants in the different groups.
CONCLUSIONS: The COVID-19 pandemic had a high psychological impact on university 
students, which indicates that a psychological support program should be 
implemented to reduce this impact.

DOI: 10.26355/eurrev_202305_32490
PMID: 37259762 [Indexed for MEDLINE]


638. BMC Nurs. 2023 May 31;22(1):186. doi: 10.1186/s12912-023-01348-z.

Shift handover quality in Saudi critical care units: determinants from nurses' 
perspectives.

Abou Hashish EA(1)(2)(3), Asiri AA(4)(5), Alnajjar YK(4)(5).

Author information:
(1)College of Nursing, King Saud bin Abdul-Aziz University for Health Sciences, 
Jeddah, Saudi Arabia. ebtsam_ss@hotmail.com.
(2)King Abdullah International Medical Research Center, Jeddah, Saudi Arabia. 
ebtsam_ss@hotmail.com.
(3)Faculty of Nursing, Alexandria University, Alexandria, Egypt. 
ebtsam_ss@hotmail.com.
(4)College of Nursing, King Saud bin Abdul-Aziz University for Health Sciences, 
Jeddah, Saudi Arabia.
(5)King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.

BACKGROUND: Nurses' effective handover communication is vital for patient safety 
and quality of care. Few studies have empirically tested how certain factors 
influence the quality of handover in the Saudi context.
METHODS: A descriptive correlational design was used with a convenience sample 
of all nurses (N = 201) working in Saudi hospital CCUs in 2022. Demographics and 
handover quality instruments were used to collect the necessary data in addition 
to two open-ended questions that asked about perceived barriers and facilitators 
to handover. The analysis was conducted using descriptive statistics and 
regression analysis.
RESULTS: The majority of nurses reported good-quality handover. The regression 
analysis showed that staffing, cognitive capacity, the focus of attention, 
relationships, and safety climate factors contributed positively to the variance 
of handover quality. In contrast, intrusions, distractions, anxiety, time 
stress, and acute and chronic fatigue factors negatively affected the prediction 
of handover quality (p < 0.05). Nurses added types of shifts and languages as 
barriers to handover while emphasizing training and the use of standardized 
tools for handover as facilitators.
CONCLUSION AND RECOMMENDATIONS: Nursing handover is a multidimensional 
phenomenon. By understanding the determinants that contribute to or hinder 
handover quality, it is possible to develop targeted interventions aimed at 
improving communication and the quality of shift handover in CCUs. The current 
study's findings highlight the need for nurses to work in a more supportive 
environment, receive better training, and follow a standardized handover 
protocol. Additionally, nurse managers should pay more attention to nurses' 
well-being to control or mitigate the effect of psychological precursors on the 
quality of nurses' handover. Future research should investigate handover 
practices and outcomes on units that have both good and bad practice 
environments.

© 2023. The Author(s).

DOI: 10.1186/s12912-023-01348-z
PMCID: PMC10230764
PMID: 37259086

Conflict of interest statement: The authors declare no competing interests.


639. Acad Med. 2023 Oct 1;98(10):1173-1184. doi: 10.1097/ACM.0000000000005283. Epub 
2023 May 29.

Strategies to Support Faculty Caregivers at U.S. Medical Schools.

Cutter CM(1), Szczygiel LA(2), Jones RD(3), Perry L(4), Mangurian C(5), Jagsi 
R(6).

Author information:
(1)C.M. Cutter is assistant professor, Department of Emergency Medicine, 
University of Michigan, Ann Arbor, Michigan.
(2)L.A. Szczygiel is qualitative analyst, Center for Healthcare Outcomes and 
Policy, University of Michigan, Ann Arbor, Michigan.
(3)R.D. Jones is research area specialist senior, Center for Bioethics & Social 
Sciences in Medicine, University of Michigan, Ann Arbor, Michigan.
(4)L. Perry is research area specialist associate, Center for Bioethics & Social 
Sciences in Medicine, University of Michigan, Ann Arbor, Michigan.
(5)C. Mangurian is professor, Departments of Psychiatry & Behavioral Sciences 
and Epidemiology & Biostatistics, Weill Institute for Neurosciences, University 
of California, San Francisco, San Francisco, California.
(6)R. Jagsi is the Lawrence W. Davis Professor and chair, Department of 
Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia.

PURPOSE: To describe the policies, processes, and programs at U.S. medical 
schools to support faculty caregivers before and in response to the COVID-19 
pandemic.
METHOD: In 2021, the Doris Duke Charitable Foundation and founding members of 
the COVID-19 Fund to Retain Clinical Scientists (FRCS) Collaborative launched 
and supported the COVID-19 FRCS program to recognize medical schools and their 
efforts to strengthen policies, processes, and programs supporting biomedical 
faculty with family caregiving responsibilities in the context of 
COVID-19-related impacts. The authors conducted a qualitative conceptual content 
analysis of the deidentified, open-ended responses submitted by institutions in 
their applications to the COVID-19 FRCS program and summarized the reported 
strategies using recurring patterns and common approaches.
RESULTS: Fifty-four institutions applied to the COVID-19 FRCS program in 2021 
and were included in this study. COVID-19-related impacts on biomedical faculty 
included stymied career progression and academic productivity, exacerbated 
career-caregiving time conflicts, adverse effects on family and personal 
well-being and mental health, increased financial hardships, and amplified 
faculty caregiver stigma. The described policies, processes, and programs to 
support faculty caregivers fell into 4 domains: support for dependent care, 
career and workplace flexibility, career development support, and institutional 
culture change to reduce stigma. COVID-19-related modifications spanned these 
domains with remote and flexible work manifesting as disruptive changes. 
Strategies to support women and underrepresented in medicine faculty, who bear a 
disproportionate burden of caregiving responsibilities, centered on career 
development support and institutional culture change. The projected durability 
of the enacted changes varied by institution and across strategies.
CONCLUSIONS: The COVID-19 pandemic presents a disruptive opportunity to 
translate lessons learned into positive change to better support faculty 
caregivers, particularly women and underrepresented in medicine faculty. This 
study's findings provide a framework to guide sustainable change to support 
equity, diversity, and vitality in the academic biomedical workforce.

Copyright © 2023 by the Association of American Medical Colleges.

DOI: 10.1097/ACM.0000000000005283
PMID: 37257023 [Indexed for MEDLINE]


640. PLoS One. 2023 May 31;18(5):e0286405. doi: 10.1371/journal.pone.0286405. 
eCollection 2023.

Impacts of the COVID-19 pandemic on subjective wellbeing in the Middle East and 
North Africa: A gender analysis.

Sieverding M(1), Krafft C(2), Selwaness I(3), Nassif AA(1).

Author information:
(1)Faculty of Health Sciences, Department of Health Promotion and Community 
Health, American University of Beirut, Beirut, Lebanon.
(2)Department of Economics and Political Science, St. Catherine University, St. 
Paul, Minnesota, United States of America.
(3)Faculty of Economics and Political Science, Cairo University, Giza, Egypt.

The pathways through which the COVID-19 pandemic has impacted population mental 
health are potentially gendered. Little research has explored these pathways in 
low- and middle-income country contexts, such as in the Middle East and North 
Africa (MENA) region, where socioeconomic roles are highly gendered. To address 
this gap, we examine the relationships between pandemic-related socioeconomic 
changes and subjective wellbeing in the MENA region. Our core hypothesis is that 
the COVID-19 pandemic affected men and women's subjective wellbeing differently 
in part because these effects were mediated by gendered socioeconomic roles. We 
exploit multiple waves of longitudinal, nationally-representative phone survey 
data across Egypt, Jordan, Morocco, Sudan, and Tunisia. The data were collected 
between November 2020 and August 2021 and include 32,296 observations of 20,256 
unique individuals. Mental health is measured through the WHO-5 subjective 
wellbeing scale. Our key independent variables capture pandemic-related 
employment loss, income loss, experience of limitations on food access, 
enrollment of children in alternative schooling modalities, and receipt of 
formal and informal transfers. We find significantly worse subjective wellbeing 
for women in Egypt and Morocco during the pandemic, but not the three other 
countries. There were negative associations between employment and income loss 
during the pandemic and subjective wellbeing, but not gender-differentiated 
ones. In contrast, high levels of limitations on food access were associated 
with worse mental health for men than women. Receipt of transfers generally did 
not have any association with subjective wellbeing. Further research is needed 
into how social assistance programs implemented in response to pandemics may be 
designed so as to address the negative mental health consequences of such 
events.

Copyright: © 2023 Sieverding et al. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0286405
PMCID: PMC10231778
PMID: 37256877 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


641. SAGE Open Nurs. 2023 May 25;9:23779608231177800. doi: 10.1177/23779608231177800. 
eCollection 2023 Jan-Dec.

Psychological Reactions of Lebanese Nurses to Workplace Violence in Critical 
Care Units.

Morra S(1), Fawaz M(2), Rayan A(3), Malak MZ(4), Abdalrahim A(5), Al-Amer R(6), 
Al Omari O(7), Ayed A(8), Al-Dwaikat T(9), Ayasreh I(10), Al-Osoufe L(11), 
Mohammad KI(12), Alhroub N(13), Al Dameery K(14), ALBashtawy M(5), Alkhawaldeh 
A(5).

Author information:
(1)Beirut Arab University, Beirut, Lebanon.
(2)Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon.
(3)Faculty of Nursing, Zarqa University, Zarqa, Jordan.
(4)Community Health Nursing, Faculty of Nursing, Al- Zaytoonah University of 
Jordan, Amman, Jordan.
(5)Department of Community and Mental Health, Princess Salma Faculty of Nursing, 
Al al-Bayt University, Mafraq, Jordan.
(6)Faculty of Nursing, Isra University, Amman, Jordan.
(7)Faculty of Nursing, Sultan Qaboos University, Muscat, Oman.
(8)Faculty of Nursing, Arab American University, Jenin, Palestine.
(9)Community and Mental Health Nursing Department, Faculty of Nursing, Jordan 
University of Science and Technology, Irbid, Jordan.
(10)Department of Adult Nursing, Faculty of Nursing, Jerash University, Jerash, 
Jordan.
(11)Department of Pediatric Nursing, Faculty of Nursing, Jerash University, 
Jerash, Jordan.
(12)Department of Midwifery, Faculty of Nursing, Jordan University of Science 
&Technology, Irbid, Jordan.
(13)Faculty of Nursing, Jerash University, Jerash, Jordan.
(14)College of Nursing, Sultan Qaboos University, Muscat, Oman.

INTRODUCTION: Workplace violence (WPV) is a growing concern that constitutes a 
major threat to occupational health and safety, thereby comprising a priority 
issue for policymakers. Given the increasing prevalence of chronic diseases and 
comorbidities among the Lebanese population, nurses working in critical care 
settings encounter intense workloads and high-risk interactions, potentially 
increasing the risk of WPV.
OBJECTIVES: This study aimed to investigate the traumatic and psychological 
reactions of Lebanese critical nurses who have been exposed to WPV, and the risk 
factors for depression and anxiety.
METHODS: The study utilized a cross-sectional descriptive correlational design; 
112 critical care nurses from diverse departments took part in this study during 
the period of June to July 2021.
RESULTS: A positive, significant correlation between WPV exposure and 
self-reported anxiety was observed, p = .03 with high levels of WPV, especially 
among patients and their families. Although verbal abuse was found to be more 
prevalent among critical care nurses in Lebanon compared to physical and sexual 
violence, the severity of the situation and its impact on the nurses' mental 
health and well-being cannot be ignored.
CONCLUSIONS: WPV for critical care nurses is a serious issue that needs to be 
considered. Policy-makers should develop the politics of regulating the nursing 
profession, especially for critical care nurses in Lebanon.

© The Author(s) 2023.

DOI: 10.1177/23779608231177800
PMCID: PMC10226333
PMID: 37255581

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


642. Public Health Res (Southampt). 2023 Mar;11(2):1-185. doi: 10.3310/AQXC8219.

Impact of a social prescribing intervention in North East England on adults with 
type 2 diabetes: the SPRING_NE multimethod study.

Moffatt S(1), Wildman J(1), Pollard TM(2), Gibson K(1), Wildman JM(1), O'Brien 
N(3), Griffith B(1), Morris SL(2), Moloney E(1), Jeffries J(1), Pearce M(1), 
Mohammed W(4).

Author information:
(1)Population Health Sciences Institute, Newcastle University, Newcastle upon 
Tyne, UK.
(2)Department of Anthropology, Durham University, Durham, UK.
(3)Department of Psychology, Northumbria University, Newcastle upon Tyne, UK.
(4)Public Health Economics and Decision Science (DTC), Sheffield University, 
Sheffield, UK.

BACKGROUND: Link worker social prescribing enables health-care professionals to 
address patients' non-medical needs by linking patients into various services. 
Evidence for its effectiveness and how it is experienced by link workers and 
clients is lacking.
OBJECTIVES: To evaluate the impact and costs of a link worker social prescribing 
intervention on health and health-care costs and utilisation and to observe link 
worker delivery and patient engagement.
DATA SOURCES: Quality Outcomes Framework and Secondary Services Use data.
DESIGN: Multimethods comprising (1) quasi-experimental evaluation of effects of 
social prescribing on health and health-care use, (2) cost-effectiveness 
analysis, (3) ethnographic methods to explore intervention delivery and receipt, 
and (4) a supplementary interview study examining intervention impact during the 
first UK COVID-19 lockdown (April-July 2020).
STUDY POPULATION AND SETTING: Community-dwelling adults aged 40-74 years with 
type 2 diabetes and link workers in a socioeconomically deprived locality of 
North East England, UK.
INTERVENTION: Link worker social prescribing to improve health and 
well-being-related outcomes among people with long-term conditions.
PARTICIPANTS: (1) Health outcomes study, approximately n = 8400 patients; 
EuroQol-5 Dimensions, five-level version (EQ-5D-5L), study, n = 694 (baseline) 
and n = 474 (follow-up); (2) ethnography, n = 20 link workers and n = 19 
clients; and COVID-19 interviews, n = 14 staff and n = 44 clients.
MAIN OUTCOME MEASURES: The main outcome measures were glycated haemoglobin level 
(HbA1c; primary outcome), body mass index, blood pressure, cholesterol level, 
smoking status, health-care costs and utilisation, and EQ-5D-5L score.
RESULTS: Intention-to-treat analysis of approximately 8400 patients in 13 
intervention and 11 control general practices demonstrated a statistically 
significant, although not clinically significant, difference in HbA1c level 
(-1.11 mmol/mol) and a non-statistically significant 1.5-percentage-point 
reduction in the probability of having high blood pressure, but no statistically 
significant effects on other outcomes. Health-care cost estimates ranged from 
£18.22 (individuals with one extra comorbidity) to -£50.35 (individuals with no 
extra comorbidity). A statistically non-significant shift from unplanned 
(non-elective and accident and emergency admissions) to planned care (elective 
and outpatient care) was observed. Subgroup analysis showed more benefit for 
individuals living in more deprived areas, for the ethnically white and those 
with fewer comorbidities. The mean cost of the intervention itself was £1345 per 
participant; the incremental mean health gain was 0.004 quality-adjusted 
life-years (95% confidence interval -0.022 to 0.029 quality-adjusted 
life-years); and the incremental cost-effectiveness ratio was £327,250 per 
quality-adjusted life-year gained. Ethnographic data showed that successfully 
embedded, holistic social prescribing providing supported linking to navigate 
social determinants of health was challenging to deliver, but could offer 
opportunities for improving health and well-being. However, the intervention was 
heterogeneous and was shaped in unanticipated ways by the delivery context. 
Pressures to generate referrals and meet targets detracted from face-to-face 
contact and capacity to address setbacks among those with complex health and 
social problems.
LIMITATIONS: The limitations of the study include (1) a reduced sample size 
because of non-participation of seven general practices; (2) incompleteness and 
unreliability of some of the Quality and Outcomes Framework data; (3) 
unavailability of accurate data on intervention intensity and patient 
comorbidity; (4) reliance on an exploratory analysis with significant 
sensitivity analysis; and (5) limited perspectives from voluntary, community and 
social enterprise.
CONCLUSIONS: This social prescribing model resulted in a small improvement in 
glycaemic control. Outcome effects varied across different groups and the 
experience of social prescribing differed depending on client circumstances.
FUTURE WORK: To examine how the NHS Primary Care Network social prescribing is 
being operationalised; its impact on health outcomes, service use and costs; and 
its tailoring to different contexts.
TRIAL REGISTRATION: This trial is registered as ISRCTN13880272.
FUNDING: This project was funded by the National Institute for Health and Care 
Research (NIHR) Public Health Research programme, Community Groups and Health 
Promotion (grant no. 16/122/33) and will be published in full in Public Health 
Research; Vol. 11, No. 2. See the NIHR Journals Library website for further 
project information.

Plain Language Summary: Social prescribing happens when health-care staff refer 
patients to a link worker. Link workers support and help patients to access 
community services to improve their health and well-being. Social prescribing is 
popular within the NHS, but there is little evidence that it works. We looked at 
a social prescribing model being delivered in a disadvantaged area in north-east 
England.

Plain Language Summary: LIST: We used different methods to find out if social 
prescribing improved health and well-being.
LIST: • We compared data from medical records of over 8000 patients with type 2 
diabetes whose general practice used social prescribing with data from similar 
patients in surgeries that did not. Data included blood pressure and blood 
glucose control. We also calculated if social prescribing was good value for 
money.
LIST: • We spent time with link workers and patients observing their routines 
and interviewing them about their experiences.

Plain Language Summary: In general practices that accessed social prescribing, 
blood glucose control for people with type 2 diabetes improved by a small but 
statistically significant amount. Other health outcomes did not improve 
significantly. Social prescribing cost more than usual care. Patients who were 
given support that matched their needs could achieve positive changes and deal 
with social and health-related problems, for example getting benefit 
entitlements helped with reducing anxiety. However, providing the right type of 
support was time-consuming and challenging because of the high caseload of link 
workers and because many patients were living in difficult circumstances. This 
model of social prescribing improved blood glucose control for people with type 
2 diabetes but was not necessarily good value for money. Social prescribing 
provided other important benefits, such as support to connect with community 
services that help improve health and well-being, but it was challenging to 
deliver and its effects were difficult to measure and varied from patient to 
patient.

DOI: 10.3310/AQXC8219
PMID: 37254700 [Indexed for MEDLINE]


643. Public Health Res (Southampt). 2023 Mar;11(3):1-77. doi: 10.3310/FKPY6814.

A multicomponent psychosocial intervention to reduce substance use by 
adolescents involved in the criminal justice system: the RISKIT-CJS RCT.

Coulton S(1), Nizalova O(2), Pellatt-Higgins T(1), Stevens A(2), Hendrie N(1), 
Marchand C(1), Vass R(1), Deluca P(3), Drummond C(3), Ferguson J(4), Waller 
G(4), Newbury-Birch D(4).

Author information:
(1)Centre for Health Services Studies, University of Kent, Canterbury, UK.
(2)School of Social Policy, Sociology and Social Research, University of Kent, 
Canterbury, UK.
(3)Institute of Psychiatry, Psychology and Neurosciences, King's College London, 
London, UK.
(4)School of Social Sciences, Humanities and Law, Teesside University, 
Middlesbrough, UK.

BACKGROUND: Substance use and offending are related in the context of other 
disinhibitory behaviours. Adolescents involved in the criminal justice system 
constitute a particularly vulnerable group, with a propensity to engage in risky 
behaviour that has long-term impact on their future health and well-being. 
Previous research of the RISKIT programme provided evidence of a potential 
effect in reducing substance use and risky behaviour in adolescents.
OBJECTIVES: To evaluate the clinical effectiveness and cost-effectiveness of a 
multicomponent psychosocial intervention compared with treatment as usual in 
reducing substance use for substance-using adolescents involved in the criminal 
justice system.
DESIGN: A mixed-methods, prospective, pragmatic, two-arm, randomised controlled 
trial with follow-up at 6 and 12 months post randomisation.
SETTING: The study was conducted across youth offending teams, pupil referral 
units and substance misuse teams across four areas of England (i.e. South East, 
London, North West, North East).
PARTICIPANTS: Adolescents aged between 13 and 17 years (inclusive), recruited 
between September 2017 and June 2020.
INTERVENTIONS: Participants were randomised to treatment as usual or to 
treatment as usual in addition to the RISKIT-Criminal Justice System 
(RISKIT-CJS) programme. The RISKIT-CJS programme was a multicomponent 
intervention and consisted of two individual motivational interviews with a 
trained youth worker (lasting 45 minutes each) and two group sessions delivered 
over half a day on consecutive weeks.
MAIN OUTCOME MEASURES: At 12 months, we assessed per cent days abstinent from 
substance use over the previous 28 days. Secondary outcome measures included 
well-being, motivational state, situational confidence, quality of life, 
resource use and fidelity of interventions delivered.
RESULTS: A total of 693 adolescents were assessed for eligibility, of whom 505 
(73%) consented. Of these, 246 (49%) were allocated to the RISKIT-CJS 
intervention and 259 (51%) were allocated to treatment as usual only. At month 
12, the overall follow-up rate was 57%: 55% in the RISKIT-CJS arm and 59% in the 
treatment-as-usual arm. At month 12, we observed an increase in per cent days 
abstinent from substances in both arms of the study, from 61% to 85%, but there 
was no evidence that the RISKIT-CJS intervention was superior to treatment as 
usual. A similar pattern was observed for secondary outcomes. The RISKIT-CJS 
intervention was not found to be any more cost-effective than treatment as 
usual. The qualitative research indicated that young people were positive about 
learning new skills and acquiring new knowledge. Although stakeholders 
considered the intervention worthwhile, they expressed concern that it came too 
late for the target population.
LIMITATIONS: Our original aim to collect data on offences was thwarted by the 
onset of the COVID-19 pandemic, and this affected both the statistical and 
economic analyses. Although 214 (87%) of the 246 participants allocated to the 
RISKIT-CJS intervention attended at least one individual face-to-face session, 
98 (40%) attended a group session and only 47 (19%) attended all elements of the 
intervention.
CONCLUSIONS: The RISKIT-CJS intervention was no more clinically effective or 
cost-effective than treatment as usual in reducing substance use among 
adolescents involved in the criminal justice system.
FUTURE RESEARCH: The RISKIT-CJS intervention was considered more acceptable, and 
adherence was higher, in pupil referral units and substance misuse teams than in 
youth offending teams. Stakeholders in youth offending teams thought that the 
intervention was too late in the trajectory for their population.
TRIAL REGISTRATION: This trial is registered as ISRCTN77037777.
FUNDING: This project was funded by the National Institute for Health and Care 
Research (NIHR) Public Health Research programme and will be published in full 
in Public Health Research; Vol. 11, No. 3. See the NIHR Journals Library website 
for further project information.

Plain Language Summary: We explored how useful a psychological intervention was 
in reducing substance use among young people who had some involvement in the 
criminal justice system. We recruited young people aged between 13 and 17 years 
in four areas of England (i.e. South East, London, North West and North East). 
Young people were recruited from youth offending teams, pupil referral units and 
substance misuse teams. Those young people who were willing to participate were 
offered usual treatment and half, chosen at random, were offered an opportunity 
to take part in the RISKIT-Criminal Justice System (RISKIT-CJS) programme. The 
RISKIT-CJS programme had four distinct parts. The first was a 1-hour session 
that used an approach called motivational interviewing to explore the young 
person’s substance use and discuss different strategies to change their 
behaviour. This was followed by two group sessions delivered over 2 consecutive 
weeks. These group sessions addressed risks associated with substance use, what 
triggers use and the health and social consequences. In addition, young people 
were taught new skills to help them manage in situations in which they might 
normally use substances. At the end of the group sessions, the young people had 
another motivational interview. Twelve months after participants started, we 
found that the frequency of substance use had decreased in both groups; however, 
the RISKIT-CJS intervention was no better than treatment as usual. When we spoke 
with young people who had taken part and staff involved with this population, we 
got a mixed picture. In some settings, particularly pupil referral units, the 
RISKIT-CJS intervention was well received by young people and staff, and staff 
felt that it was a useful additional resource to the work that they were 
currently undertaking. On the other hand, in the youth offending teams, the 
staff thought that the programme was too different from their normal work to be 
implemented easily and they considered the population they work with too 
established in their substance use and criminal activity to benefit from the 
programme.

DOI: 10.3310/FKPY6814
PMID: 37254608 [Indexed for MEDLINE]


644. Arch Sex Behav. 2023 Jul;52(5):2249-2260. doi: 10.1007/s10508-023-02617-3. Epub 
2023 May 30.

Psychological Treatment of Persistent Genital Arousal Disorder/Genitopelvic 
Dysesthesia Using an Integrative Approach.

Merwin KE(1)(2), Brotto LA(3).

Author information:
(1)Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, 
Canada.
(2)Borderline Personality Disorder Treatment Program, Mental Health and 
Addictions Program, Nova Scotia Health Authority, Dartmouth, NS, Canada.
(3)Department of Obstetrics and Gynaecology, Faculty of Medicine, UBC Sexual 
Health Research, University of British Columbia, 2775 Laurel Street, 6th Floor 
Gordon & Leslie Diamond Health Care Centre, Vancouver, BC, V5Z 1M9, Canada. 
lori.brotto@ubc.ca.

Persistent genital arousal disorder/genitopelvic dysesthesia (PGAD/GPD) is 
characterized by persistent, unwanted physiological genital arousal (i.e., 
sensitivity, fullness, and/or swelling) in the absence of sexual excitement or 
desire which can persist for hours to days and causes significant impairment in 
psychosocial well-being (e.g., distress) and daily functioning. The etiology and 
course of PGAD/GPD is still relatively unknown and, unsurprisingly, there are 
not yet clear evidence-based treatment recommendations for those suffering from 
PGAD/GPD. We present the case of a 58-year-old woman with acquired persistent 
genital arousal disorder, which began in March 2020; she believed she developed 
PGAD/GPD due to a period of significant distress and anxiety related to the 
COVID-19 pandemic. After seeking medical diagnosis and treatment from multiple 
healthcare providers and trying a combination of pharmacological and medical 
treatment modalities, she presented for psychological treatment. An integrative 
therapy approach (3 assessment sessions, 11 treatment sessions), which included 
cognitive behavior therapy, distress tolerance and emotion regulation skills 
from dialectical behavior therapy, and mindfulness practice, was utilized. The 
patient reported improvements anecdotally (e.g., decreased impact on 
occupational and social functioning, greater self-compassion, less frequent and 
shorter duration of PGAD/GPD flare-ups, improved ability to cope with PGAD/GPD 
symptoms, and decreased need for sleeping medication) and on self-report 
measures (e.g., lower PGAD/GPD catastrophizing, lower anxiety and depression, 
and greater overall quality of life).We report the use of an integrative (i.e., 
psychoeducational, cognitive behavioral, dialectical behavioral, and 
mindfulness-based) intervention, which may be an effective psychological 
treatment for PGAD/GPD.

© 2023. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s10508-023-02617-3
PMCID: PMC10228892
PMID: 37253921 [Indexed for MEDLINE]

Conflict of interest statement: Not applicable.


645. PLoS One. 2023 May 30;18(5):e0286321. doi: 10.1371/journal.pone.0286321. 
eCollection 2023.

Effects of physical activity on Chinese overseas students' mental health during 
the COVID-19: A multi-country cross-sectional analysis.

Nie Y(1), Ma Y(2), Yao X(1), Gao Y(3), Zheng X(1).

Author information:
(1)College of the Physical Education, Wuhan Sports University, Wuhan, China.
(2)College of Sports, Huazhong Normal University, Wuhan, China.
(3)College of the Arts, Wuhan Sports University, Wuhan, China.

BACKGROUND: COVID-19 caused severe effects on the psychological well-being of 
Chinese students overseas (COS). Physical activity (PA) is critical to 
strengthen immunity, prevent infection, and reduce the psychological burden 
caused by COVID-19. However, there is a severe lack of effective PA intervention 
for mental health in most countries, and COS have limited access to mental 
healthcare during the pandemic.
OBJECTIVE: We aim to examine the effects of PA on COS' mental health during the 
pandemic abroad and to better understand that certain types of PA might be 
associated with a greater reduction in psychological burdens during the 
pandemic.
METHODS AND RESULTS: In a multi-country cross-sectional analysis, a 
questionnaire was distributed to COS living in 37 foreign countries via WeChat 
Subscription using a snowball sampling strategy. A total of 10,846 participants 
were included. Descriptive statistics and Binary logistic regression analysis 
were used for statistical analysis. We found that COS had negative psychology 
during the pandemic, especially with fear (2.90, 95% CI 2.88-2.92), anxiety 
(2.84, 95% CI 2.82-2.85), and stress (2.71, 95% CI 2.69-2.73). PA had meaningful 
effects on reducing COS self-reported mental health burdens (3.42, 95% CI 
3.41-3.44) during the pandemic. The largest associations were seen for 
recreational and home-based PA (i.e., family games, home aerobic exercise), 
individual outdoor PA (i.e., walking or running, rope skipping), and PA with a 
duration of 30 to 70 min per session at frequencies of 4 to 6 times and a total 
of 150 to 330 min of moderate and vigorous intensity per week tends to be an 
optimal choice during social distancing times.
CONCLUSIONS: COS had several poor mental health conditions during the pandemic. 
The improvement of PA on COS' psychology was positively effective during the 
pandemic. Specific types, intensities, durations, and frequencies of PA might 
have advantages over others for improving COS' mental health during periods of 
public health emergencies, and the topic may merit interventional study to 
reveal multiple factors causing COS' psychological burdens and enrich the PA 
forms for all COS' mental health improvement (i.e., infected, recovered, and 
asymptomatic COS).

Copyright: © 2023 Nie et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0286321
PMCID: PMC10228799
PMID: 37253054 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


646. Elife. 2023 May 30;12:e81241. doi: 10.7554/eLife.81241.

Affectionate touch and diurnal oxytocin levels: An ecological momentary 
assessment study.

Schneider E(1)(2), Hopf D(1)(2), Aguilar-Raab C(1)(2), Scheele D(3), Neubauer 
AB(4)(5), Sailer U(6), Hurlemann R(7), Eckstein M(1)(2), Ditzen B(1)(2).

Author information:
(1)Institute of Medical Psychology, Center for Psychosocial Medicine, Heidelberg 
University Hospital, Heidelberg, Germany.
(2)Heidelberg University, Heidelberg, Germany.
(3)Department of Social Neuroscience, Faculty of Psychology, Ruhr University 
Bochum, Bochum, Germany.
(4)Department for Education and Human Development, DIPF|Leibniz Institute for 
Research and Information in Education, Frankfurt, Germany.
(5)Center for Research on Individual Development and Adaptive Education of 
Children at Risk, Frankfurt, Germany.
(6)Department of Behavioural Medicine, Faculty of Medicine, Institute of Basic 
Medical Sciences, University of Oslo, Oslo, Norway.
(7)Department of Psychiatry, University of Oldenburg, Bad ZwischenahnOldenburg, 
Germany.

Update of
    doi: 10.2139/ssrn.4068369.

BACKGROUND: Affectionate touch, which is vital for mental and physical health, 
was restricted during the Covid-19 pandemic. This study investigated the 
association between momentary affectionate touch and subjective well-being, as 
well as salivary oxytocin and cortisol in everyday life during the pandemic.
METHODS: In the first step, we measured anxiety and depression symptoms, 
loneliness and attitudes toward social touch in a large cross-sectional online 
survey (N = 1050). From this sample, N = 247 participants completed ecological 
momentary assessments over 2 days with six daily assessments by answering 
smartphone-based questions on affectionate touch and momentary mental state, and 
providing concomitant saliva samples for cortisol and oxytocin assessment.
RESULTS: Multilevel models showed that on a within-person level, affectionate 
touch was associated with decreased self-reported anxiety, general burden, 
stress, and increased oxytocin levels. On a between-person level, affectionate 
touch was associated with decreased cortisol levels and higher happiness. 
Moreover, individuals with a positive attitude toward social touch experiencing 
loneliness reported more mental health problems.
CONCLUSIONS: Our results suggest that affectionate touch is linked to higher 
endogenous oxytocin in times of pandemic and lockdown and might buffer stress on 
a subjective and hormonal level. These findings might have implications for 
preventing mental burden during social contact restrictions.
FUNDING: The study was funded by the German Research Foundation, the German 
Psychological Society, and German Academic Exchange Service.

© 2023, Schneider et al.

DOI: 10.7554/eLife.81241
PMCID: PMC10229112
PMID: 37252874 [Indexed for MEDLINE]

Conflict of interest statement: ES, DH, CA, DS, AN, US, RH, ME, BD No competing 
interests declared


647. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2023 
Jul;66(7):727-735. doi: 10.1007/s00103-023-03720-5. Epub 2023 May 30.

[Epidemiology of mental well-being in childhood and adolescence. Results from 
three epidemiological studies before and during the COVID-19 pandemic].

[Article in German; Abstract available in German from the publisher]

Reiß F(1), Kaman A(1), Napp AK(1), Devine J(1), Li LY(1), Strelow L(1), Erhart 
M(1)(2)(3), Hölling H(4), Schlack R(4), Ravens-Sieberer U(5).

Author information:
(1)Zentrum für Psychosoziale Medizin, Klinik für Kinder- und Jugendpsychiatrie, 
-psychotherapie und -psychosomatik, Universitätsklinikum Hamburg-Eppendorf, 
Martinistraße 52, 20246, Hamburg, Deutschland.
(2)Alice Salomon Hochschule, Berlin, Deutschland.
(3)Apollon Hochschule der Gesundheitswirtschaft, Bremen, Deutschland.
(4)Robert Koch-Institut, Berlin, Deutschland.
(5)Zentrum für Psychosoziale Medizin, Klinik für Kinder- und Jugendpsychiatrie, 
-psychotherapie und -psychosomatik, Universitätsklinikum Hamburg-Eppendorf, 
Martinistraße 52, 20246, Hamburg, Deutschland. ravens-sieberer@uke.de.

BACKGROUND: Continuous nationwide health monitoring is important to track the 
well-being of children and adolescents and to map developmental trajectories. 
Based on the results of three selected epidemiological studies, developments in 
child well-being over the past 20 years are presented.
METHODS: Data are based on (1) the mental health module of the German National 
Health Interview and Examination Survey among Children and Adolescents (BELLA 
study, 2003-2017, N = 1500 to 3000), which is a module of the KiGGS study; 
(2) the COvid-19 and PSYchological Health Study (COPSY, 2020-2022, 
N = 1600-1700), which is based on the BELLA Study; and (3) the International 
Health-Behaviour in School-aged Children Study (HBSC, 2002-2018, N = 4300-7300). 
Well-being was assessed in 7‑ to 17-year-olds using indicators of health-related 
quality of life (KIDSCREEN-10), life satisfaction (Cantril Ladder), and mental 
health problems (Strenghts and Difficulties Questionnaire (SDQ), Screen for 
Child Anxiety Related Emotional Disorders (SCARED), and Center for 
Epidemiological Studies Depression Scale for Children (CES-DC)).
RESULTS: Overall, children and adolescents show consistently high health-related 
quality of life and high overall life satisfaction pre-pandemic (2002-2018), 
which initially worsened with the onset of the 2020 COVID-19-pandemic. Two years 
later, improvements are evident but have not yet reached baseline levels. 
Psychological problems, as well as symptoms of anxiety and depression, increased 
by up to 12 percentage points at the beginning of the pandemic and are still 
higher two years after the onset of the pandemic compared to pre-pandemic 
studies.
CONCLUSION: The epidemiology of child well-being provides a necessary data basis 
to assess the support needs of children and adolescents and to use this as 
a basis for developing measures of health promotion, prevention, and 
intervention.

Publisher: ZUSAMMENFASSUNG: HINTERGRUND: Ein kontinuierliches bundesweites 
Gesundheitsmonitoring ist wichtig, um das Wohlbefinden von Kindern und 
Jugendlichen im Blick zu behalten und Entwicklungsverläufe abzubilden. Anhand 
der Ergebnisse von 3 ausgewählten epidemiologischen Studien werden Entwicklungen 
zum kindlichen Wohlbefinden der letzten 20 Jahre vorgestellt.
METHODIK: Datengrundlage bilden (1.) die bevölkerungsbezogene BEfragung zum 
seeLischen WohLbefinden und VerhAlten (BELLA-Studie, 2003–2017, N = 1500–3000), 
die ein Modul der KiGGS-Studie ist, (2.) die COrona und PSYche Studie (COPSY, 
2020–2022, N = 1600–1700), die auf der BELLA-Studie aufbaut, und (3.) die 
internationale Health-Behaviour in School-aged Children Studie (HBSC, 2002–2018, 
N = 4300–7300). Das Wohlbefinden wurde bei 7‑ bis 17-Jährigen mittels der 
Indikatoren gesundheitsbezogene Lebensqualität (KIDSCREEN-10), 
Lebenszufriedenheit (Cantril Ladder) und psychische Auffälligkeiten (Strenghts 
and Difficulties Questionnaire (SDQ), Screen for Child Anxiety Related Emotional 
Disorders (SCARED) und Center for Epidemiological Studies Depression Scale for 
Children (CES-DC)) erfasst.
ERGEBNISSE: Insgesamt zeigen Kinder und Jugendliche präpandemisch (2002–2018) 
eine konstant hohe gesundheitsbezogene Lebensqualität und eine hohe allgemeine 
Lebenszufriedenheit, die sich mit Beginn der COVID-19-Pandemie 2020 zunächst 
verschlechterte. 2 Jahre später zeigen sich Verbesserungen, die jedoch noch 
nicht das Ausgangsniveau erreichen. Psychische Auffälligkeiten, ängstliche und 
depressive Symptome nahmen mit Pandemiebeginn um bis zu 12 Prozentpunkte zu und 
zeigen auch 2 Jahre nach Pandemiebeginn noch höhere Werte als präpandemische 
Studien.
DISKUSSION: Die Epidemiologie kindlichen Wohlbefindens bietet eine notwendige 
Datengrundlage, um den Unterstützungsbedarf von Kindern und Jugendlichen zu 
erfassen und auf dieser Basis Maßnahmen der Gesundheitsförderung, Prävention und 
Intervention zu entwickeln.

© 2023. The Author(s).

DOI: 10.1007/s00103-023-03720-5
PMCID: PMC10227816
PMID: 37249582 [Indexed for MEDLINE]


648. BMC Public Health. 2023 May 30;23(1):996. doi: 10.1186/s12889-023-15340-4.

Behavioral and psychosocial factors and their effects on insomnia among people 
undergoing entry quarantine in hotels during COVID-19 pandemic: a 
cross-sectional study in Guangzhou, China.

Luo R(#)(1), Li J(#)(1)(2)(3), Shang M(1), Peng Z(4), Wang Z(5), Gu 
J(6)(7)(8)(9).

Author information:
(1)Department of Medical Statistics, School of Public Health, Sun Yat-Sen 
University, No.74, Zhongshan Second Road, Guangzhou, 510080, China.
(2)Sun Yat-Sen University Global Health Institute, School of Public Health and 
Institute of State Governance, Sun Yat-Sen University, Guangzhou, 510080, China.
(3)Guangdong Key Laboratory of Health Informatics, Guangzhou, 510080, China.
(4)Department of Logistics and Security, Guangzhou Center for Disease Control 
and Prevention, Guangzhou, China.
(5)Department of 12320 Health Hotline, Guangzhou Center for Disease Control and 
Prevention, Guangzhou, China. 625456616@qq.com.
(6)Department of Medical Statistics, School of Public Health, Sun Yat-Sen 
University, No.74, Zhongshan Second Road, Guangzhou, 510080, China. 
gujing5@mail.sysu.edu.cn.
(7)Sun Yat-Sen University Global Health Institute, School of Public Health and 
Institute of State Governance, Sun Yat-Sen University, Guangzhou, 510080, China. 
gujing5@mail.sysu.edu.cn.
(8)Guangdong Key Laboratory of Health Informatics, Guangzhou, 510080, China. 
gujing5@mail.sysu.edu.cn.
(9)Guangzhou Joint Research Center for Disease Surveillance, Early Warning, and 
Risk Assessment, Guangzhou, China. gujing5@mail.sysu.edu.cn.
(#)Contributed equally

BACKGROUND: The COVID-19 pandemic continues to impact global health and China 
requires a 14-day quarantine for individuals on flights with positive COVID-19 
cases. This quarantine can impact mental well-being, including sleep. This study 
aims to examine the impact of psychosocial and behavioral factors on insomnia 
among individuals undergoing quarantine in hotels.
METHODS: This study was a cross-sectional survey carried out in Guangzhou, 
China. The data was gathered through online questionnaires distributed to 
international passengers who arrived in Guangzhou on flights and were required 
to undergo a 14-day quarantine in hotels arranged by the local government. The 
questionnaires were sent to the participants through the government health 
hotline "12,320."
RESULTS: Of the 1003 passengers who were quarantined, 6.7% reported significant 
anxiety and 25.0% had varying degrees of insomnia. Anxiety was positively 
associated with insomnia (β = 0.92, P < 0.001), while collectivism (β = -0.07, 
P = 0.036), indoor exercise (β = -0.50, P < 0.001), and the perceived people 
orientation of the public health service (β = -0.20, P = 0.001) were negatively 
associated with insomnia. The study also identified moderating effects, such 
that a higher sense of collectivism, a greater frequency of indoor exercise, and 
a higher perception of the people-oriented of the public health service were 
associated with a lower impact of anxiety on insomnia. These moderating effects 
were also observed in participants with varying degrees of insomnia.
CONCLUSIONS: This study reveals that a proportion of people undergoing entry 
quarantine experience insomnia and confirms how psychosocial and behavioral 
factors can alleviate insomnia in this population.

© 2023. The Author(s).

DOI: 10.1186/s12889-023-15340-4
PMCID: PMC10226877
PMID: 37248484 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


649. BMC Psychiatry. 2023 May 29;23(1):374. doi: 10.1186/s12888-023-04867-w.

Maternal distress and parenting during COVID-19: differential effects related to 
pre-pandemic distress?

Low A(1), Yu Y(1), Sim LW(1), Bureau JF(2), Tan NC(3)(4), Chen H(3)(5), Yang 
Y(1), Cheon B(6), Lee K(7), Bakermans-Kranenburg M(8), Tsotsi S(9), 
Rifkin-Graboi A(10).

Author information:
(1)Centre for Research in Child Development, National Institute of Education, 
Nanyang Technological University, Block 5, Level B3, Singapore, 637616, 
Singapore.
(2)School of Psychology, Faculty of Social Sciences, University of Ottawa, 136 
Jean-Jacques Lussier, Vanier Hall, Room 6005, Ottawa, ON, K1N 6N5, Canada.
(3)Duke-National University of Singapore, 8 College Road, Singapore, 169857, 
Singapore.
(4)SingHealth Polyclinics, Connection One, 167 Jalan Bukit Merah, Tower 5, 
#15-10, Singapore, 150167, Singapore.
(5)Department of Psychological Medicine, KK Women and Children's Hospital, 100 
Bukit Timah, 17 Road, Singapore, 229899, Singapore.
(6)Eunice Kennedy Shriver National Institute of Child Health and Human 
Development, National Institutes of Health, Bethesda, MD, USA.
(7)Department of Early Childhood Education, Education University of Hong Kong, 
New Territories, 10 Lo Ping Road, Tai Po, Hong Kong, Hong Kong SAR, China.
(8)ISPA - University Institute of Psychological, Social and Life Sciences, 
1149-041, Rua Jardim do Tabaco, 34, Lisbon, Portugal.
(9)PROMENTA Research Centre, Department of Psychology, University of Oslo, 
Postboks 1094 Blindern, 0317, Oslo, Norway.
(10)Centre for Research in Child Development, National Institute of Education, 
Nanyang Technological University, Block 5, Level B3, Singapore, 637616, 
Singapore. anne.rifkin@nie.edu.sg.

BACKGROUND: Distinguishing whether and how pre-existing characteristics impact 
maternal responses to adversity is difficult: Does prior well-being decrease the 
likelihood of encountering stressful experiences? Does it protect against 
adversity's negative effects? We examine whether the interaction between 
relatively uniformly experienced adversity (due to COVID-19 experience) and 
individual variation in pre-existing (i.e., pre-pandemic onset) distress 
predicted mothers' pandemic levels of distress and insensitive caregiving within 
a country reporting low COVID-19 death rates, and strict nationwide regulations.
METHOD: Fifty-one Singaporean mothers and their preschool-aged children provided 
data across two waves. Pre- pandemic onset maternal distress (i.e., 
psychological distress, anxiety, and parenting stress) was captured via 
self-reports and maternal sensitivity was coded from videos. Measures were 
repeated after the pandemic's onset along with questionnaires concerning 
perceived COVID-19 adversity (e.g., COVID-19's impact upon stress caring for 
children, housework, job demands, etc.) and pandemic-related objective 
experiences (e.g., income, COVID-19 diagnoses, etc.). Regression analyses (SPSS 
v28) considered pre-pandemic onset maternal distress, COVID-19 stress, and their 
interaction upon post-pandemic onset maternal distress. Models were re-run with 
appropriate covariates (e.g., objective experience) when significant findings 
were observed. To rule out alternative models, follow up analyses (PROCESS 
Model) considered whether COVID-19 stress mediated pre- and post-pandemic onset 
associations. Models involving maternal sensitivity followed a similar data 
analytic plan.
RESULTS: Pre-pandemic maternal distress moderated the association between 
COVID-19 perceived stress and pandemic levels of maternal distress (β = 0.22, 
p < 0.01) but not pandemic assessed maternal sensitivity. Perceived COVID-19 
stress significantly contributed to post-pandemic onset maternal distress for 
mothers with pre-pandemic onset distress scores above (β = 0.30, p = 0.05), but 
not below (β = 0.25, p = 0.24), the median. Objective COVID-19 adversity did not 
account for findings. Post-hoc analyses did not suggest mediation via COVID-19 
stress from pre-pandemic to pandemic maternal distress.
CONCLUSIONS: Pre-existing risk may interact with subsequent perceptions of 
adversity to impact well-being. In combination with existing research, this 
small study suggests prevention programs should focus upon managing concurrent 
mental health and may highlight the importance of enhanced screening and 
proactive coping programs for people entering high stress fields and/or phases 
of life.

© 2023. The Author(s).

DOI: 10.1186/s12888-023-04867-w
PMCID: PMC10225758
PMID: 37248473 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


650. Acta Biomed. 2023 May 29;94(S1):e2023033. doi: 10.23750/abm.v94iS1.13714.

Early treatment with N-acetylcysteine reduces hepatotoxicity in acute 
acetaminophen poisoning.

Ferretti S(1), Curatola A(2), Chiaretti A(3), Graglia B(4), Gatto A(5), 
Capossela L(6), Pansini V(7).

Author information:
(1)Department of Pediatrics, Fondazione Policlinico Universitario "Agostino 
Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy. 
serena.ferretti01@icatt.it.
(2)Department of Pediatrics, Fondazione Policlinico Universitario "Agostino 
Gemelli", IRCCS, Rome, Italy. c.anto91@libero.it.
(3)Department of Pediatrics, Fondazione Policlinico Universitario "Agostino 
Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy. 
antonio.chiaretti@policlinicogemelli.it.
(4)Department of Pediatrics, Fondazione Policlinico Universitario "Agostino 
Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy. 
benedetta.graglia@gmail.com.
(5)Department of Pediatrics, Fondazione Policlinico Universitario "Agostino 
Gemelli", IRCCS, Rome, Italy. antonio.gatto@policlinicogemelli.it.
(6)Department of Pediatrics, Fondazione Policlinico Universitario "Agostino 
Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy. 
laviniacapossela@gmail.com.
(7)Department of Pediatrics, Fondazione Policlinico Universitario "Agostino 
Gemelli", IRCCS, Rome, Italy. pansini.valeria@gmail.com.

During the outbreak of COVID19 measures taken to contain the spread of the virus 
have influenced the mental well-being of adults and adolescents. Acetaminophen 
overdose is the major cause of drug intoxication among children and adolescents. 
We reported a case of a 15-year- old girl referred to our Emergency Department 3 
hours after ingestion of 10 g of paracetamol for suicidal purposes. She promptly 
started the administration of intravenous N-acetylcysteine (NAC) and the patient 
was discharged after 5 days of hospitalization in good clinical condition and 
with neuropsychiatric follow-up. Our case shows that the timing of the 
intravenous NAC administration is considered the most important factor in the 
prevention of acetaminophen-induced hepatic failure, despite high serum levels 
after acetaminophen ingestion.

DOI: 10.23750/abm.v94iS1.13714
PMID: 37247196 [Indexed for MEDLINE]


651. J Affect Disord. 2023 Oct 1;338:32-40. doi: 10.1016/j.jad.2023.05.080. Epub 2023 
May 27.

Mental health and drug use in college students: Should we take action?

Pérez T(1), Pardo MC(2), Cabellos Y(1), Peressini M(1), Ureña-Vacas I(3), 
Serrano DR(4), González-Burgos E(3).

Author information:
(1)Department of Statistics and Data Science, Complutense University of Madrid, 
Madrid, Spain.
(2)Department of Statistics and Operational Research, Complutense University of 
Madrid, Madrid, Spain; Instituto de Matemática Interdisciplinar (IMI), 
Complutense University of Madrid, Madrid, Spain.
(3)Department of Pharmacology, Pharmacognosy and Botany, Faculty of Pharmacy, 
Complutense University of Madrid, Madrid, Spain.
(4)Pharmaceutics and Food Technology Department, Faculty of Pharmacy, 
Complutense University of Madrid, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain.. 
Electronic address: drserran@ucm.es.

BACKGROUND: College students are vulnerable to suffering from anxiety and 
depression. Moreover, mental disorders can contribute to drug consumption or 
inappropriate use of prescribed drugs. Studies on this topic in Spanish college 
students are limited. This work analyses anxiety and depression and psychoactive 
drug intake pattern in the post-COVID era in college students.
METHODS: An online survey was conducted among college students from UCM (Spain). 
The survey collected data including demographic, academic student perception, 
GAD-7 and PHQ-9 scales, and psychoactive substances consumption.
RESULTS: A total of 6798 students were included; 44.1 % (CI95%: 42.9 to 45.3) 
showed symptoms of severe anxiety and 46.5 % (CI95%: 45.4 to 47.8) symptoms of 
severe or moderately severe depression. The perception of these symptoms did not 
change after returning to face-to-face university classes in the post-COVID19 
era. Despite the high percentage of cases with clear symptoms of anxiety and 
depression, most students never had a diagnosis of mental illnesses [anxiety 
69.2 % (CI95%: 68.1 to 70.3) and depression 78.1 % (CI95%: 77.1 to 79.1)]. 
Regarding psychoactive substances, valerian, melatonin, diazepam, and lorazepam 
were the most consumed. The most worrying issue was the consumption of diazepam, 
10.8 % (CI95%: 9.8 to 11.8), and lorazepam, 7.7 % (CI95%: 6.9 to 8.6) without 
medical prescription. Among illicit drugs, cannabis is the most consumed.
LIMITATIONS: The study was based on an online survey.
CONCLUSIONS: The high prevalence of anxiety and depression aligned with poor 
medical diagnosis and high intake of psychoactive drugs should not be 
underestimated. University policies should be implemented to improve the 
well-being of students.

Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2023.05.080
PMID: 37245551 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare they have no conflicts of interest.


652. Appl Health Econ Health Policy. 2023 Sep;21(5):761-771. doi: 
10.1007/s40258-023-00810-y. Epub 2023 May 27.

Symptomatic SARS-CoV-2 Episodes and Health-Related Quality of Life.

Alacevich C(1)(2), Thalmann I(3), Nicodemo C(4)(5), de Lusignan S(4), Petrou 
S(4).

Author information:
(1)Nuffield Department of Primary Care Health Sciences, University of Oxford, 
Oxford, UK. calacevich@ufl.edu.
(2)Health Outcomes and Biomedical Informatics, University of Florida, 
Gainesville, USA. calacevich@ufl.edu.
(3)Nuffield Department of Population Health, University of Oxford, Oxford, UK.
(4)Nuffield Department of Primary Care Health Sciences, University of Oxford, 
Oxford, UK.
(5)Department of Economics, University of Verona, Verona, Italy.

BACKGROUND: Understanding the physical and mental health needs of the population 
through evidence-based research is a priority for informing health policy. 
During the COVID-19 pandemic, population wellbeing dramatically dropped. The 
relationship between experiences of symptomatic illness episodes and 
health-related quality of life has been less documented.
OBJECTIVE: This study analysed the association between symptomatic COVID-19 
illness and health-related quality of life.
METHODS: The analyses drew from a cross-sectional analysis of data from a 
national digital symptoms' surveillance survey conducted in the UK in 2020. We 
identified illness episodes using symptoms and test results data and we analysed 
validated health-related quality of life outcomes including health utility 
scores (indexed on a 0-1 cardinal scale) and visual analogue scale (VAS) scores 
(0-100 scale) generated by the EuroQoL's EQ-5D-5L measure. The econometric model 
controlled for respondents' demographic and socioeconomic characteristics, 
comorbidities, social isolation measures, and regional and time fixed effects.
RESULTS: The results showed that the experience of common SARS-CoV-2 symptoms 
was significantly associated with poorer health-related quality of life across 
all EQ-5D-5L dimensions of mobility, self-care, usual activities, 
pain/discomfort and anxiety/depression, a decrement in utility score of - 0.13 
and a decrement in the EQ-VAS score of - 15. The findings were robust to 
sensitivity analyses and restrictive test results-based definitions.
CONCLUSION: This evidence-based study highlights the need for targeting of 
interventions and services towards those experiencing symptomatic episodes 
during future waves of the pandemic and helps to quantify the benefits of 
SARS-CoV-2 treatment in terms of health-related quality of life.

© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland 
AG.

DOI: 10.1007/s40258-023-00810-y
PMCID: PMC10224647
PMID: 37243797 [Indexed for MEDLINE]

Conflict of interest statement: None. SdeL has received funding through his 
University for vaccine related research from AstraZeneca, GSK, Sanofi, Seqirus, 
MSD and Takeda. He has been a member of advisory boards for AstraZeneca, Sanofi 
and Seqirus.


653. Public Health Rep. 2023 Jul-Aug;138(4):691-704. doi: 10.1177/00333549231173941. 
Epub 2023 May 27.

Experiences of Sign Language Interpreters and Perspectives of Interpreting 
Administrators During the COVID-19 Pandemic: A Qualitative Description.

Roman G(1)(2)(3), Samar V(4), Ossip D(2)(3), McKee M(5), Barnett S(1), 
Yousefi-Nooraie R(2)(3).

Author information:
(1)Department of Family Medicine, University of Rochester, Rochester, NY, USA.
(2)Clinical and Translational Science Institute, University of Rochester, 
Rochester, NY, USA.
(3)Department of Public Health Sciences, University of Rochester, Rochester, NY, 
USA.
(4)Department of Liberal Studies, National Technical Institute for the Deaf, 
Rochester Institute of Technology, Rochester, NY, USA.
(5)Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA.

OBJECTIVE: Interpreting during the COVID-19 pandemic caused stress and adverse 
mental health among sign language interpreters. The objective of this study was 
to summarize the pandemic-related work experiences of sign language interpreters 
and interpreting administrators upon transitioning from on-site to remote work.
METHODS: From March through August 2021, we conducted focus groups with 22 sign 
language interpreters in 5 settings, 1 focus group for each setting: staff, 
educational, community/freelance, video remote interpreting, and video relay 
services. We also conducted 5 individual interviews with interpreting 
administrators or individuals in positions of administrative leadership in each 
represented setting. The 22 interpreters had a mean (SD) age of 43.4 (9.8) 
years, 18 were female, 17 were White, all identified as hearing, and all worked 
a mean (SD) of 30.6 (11.6) hours per week in remote interpreting. We asked 
participants about the positive and negative consequences of transitioning from 
on-site to remote at-home interpreting. We established a thematic framework by 
way of qualitative description for data analysis.
RESULTS: We found considerable overlap across positive and negative consequences 
identified by interpreters and interpreting administrators. Positive 
consequences of transitioning from on-site to remote-at-home interpreting were 
realized across 5 overarching topic areas: organizational support, new 
opportunities, well-being, connections/relationships, and scheduling. Negative 
consequences emerged across 4 overarching topic areas: technology, financial 
aspects, availability of the interpreter workforce, and concerns about the 
occupational health of interpreters.
CONCLUSIONS: The positive and negative consequences shared by interpreters and 
interpreting administrators provide foundational knowledge upon which to create 
recommendations for the anticipated sustainment of some remote interpreting 
practice in a manner that protects and promotes occupational health.

DOI: 10.1177/00333549231173941
PMCID: PMC10225799
PMID: 37243519 [Indexed for MEDLINE]

Conflict of interest statement: The authors declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


654. Int J Environ Res Public Health. 2023 May 17;20(10):5853. doi: 
10.3390/ijerph20105853.

The Psychological and Wellbeing Impacts of Quarantine on Frontline Workers 
during COVID-19 and Beyond.

Holmes OS(1), Ellen S(1), Smallwood N(2), Willis K(3), Delaney C(4), Worth 
LJ(5), Dolan S(6), Dunlop L(7), McDonald G(8), Karimi L(9), Rees M(10), Ftanou 
M(1)(11).

Author information:
(1)Psychosocial Oncology Program, Peter MacCallum Cancer Centre Melbourne, 
Melbourne 3000, Australia.
(2)Chronic Respiratory Disease Laboratory, Central Clinical School, Monash 
University, Melbourne 3800, Australia.
(3)Institute for Sport and Health, Victoria University, Melbourne 3011, 
Australia.
(4)Department of Medical Education, University of Melbourne, Melbourne 3010, 
Australia.
(5)National Centre for Infections in Cancer, Sir Peter MacCallum Department of 
Oncology, University of Melbourne, Melbourne 3010, Australia.
(6)Executive Team, Peter MacCallum Cancer Centre Melbourne, Melbourne 3000, 
Australia.
(7)Clinical Governance and Strategic Projects, Peter MacCallum Cancer Centre 
Melbourne, Melbourne 3000, Australia.
(8)Prevention and Wellbeing, Peter MacCallum Cancer Centre Melbourne, Melbourne 
3000, Australia.
(9)Department of Psychology, School of Applied Health, RMIT University, 
Melbourne 3000, Australia.
(10)Respiratory, Sleep, and General Medicine, Royal Melbourne Hospital, 
Melbourne 3050, Australia.
(11)School of Population and Global Health, University of Melbourne, Melbourne 
3010, Australia.

OBJECTIVE: The current study investigated the experiences, wellbeing impacts, 
and coping strategies of frontline workers who participated in "Hotels for 
Heroes", an Australian voluntary hotel quarantine program during the COVID-19 
pandemic. The program was open to those who were COVID-19 positive or exposed to 
COVID-19 as part of their profession.
METHODS: Frontline workers who had stayed in voluntary quarantine between April 
2020 and March 2021 were invited to participate in a voluntary, anonymous, 
cross-sectional online survey including both quantitative and qualitative 
responses. Complete responses were collected from 106 participants, which 
included data on sociodemographic and occupational characteristics, experiences 
of the Hotels for Heroes program, and validated mental health measures.
RESULTS: Mental health problems were prevalent amongst frontline workers (e.g., 
moderate anxiety symptoms, severe depression symptoms, and greater than usual 
impact of fatigue). For some, quarantine appeared to be helpful for anxiety and 
burnout, but quarantine also appeared to impact anxiety, depression, and PTSD 
negatively, and longer stays in quarantine were associated with significantly 
higher coronavirus anxiety and fatigue impacts. The most widely received support 
in quarantine was from designated program staff; however, this was reportedly 
accessed by less than half of the participants.
CONCLUSIONS: The current study points to specific aspects of mental health care 
that can be applied to participants of similar voluntary quarantine programs in 
the future. It seems necessary to screen for psychological needs at various 
stages of quarantine, and to allocate appropriate care and improve its 
accessibility, as many participants did not utilise the routine support offered. 
Support should especially target disease-related anxiety, symptoms of depression 
and trauma, and the impacts of fatigue. Future research is needed to clarify 
specific phases of need throughout quarantine programs, and the barriers for 
participants receiving mental health supports in these contexts.

DOI: 10.3390/ijerph20105853
PMCID: PMC10218533
PMID: 37239579 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


655. Int J Environ Res Public Health. 2023 May 17;20(10):5840. doi: 
10.3390/ijerph20105840.

Loneliness before and after COVID-19: Sense of Coherence and Hope as Coping 
Mechanisms.

Einav M(1)(2), Margalit M(1)(3).

Author information:
(1)Behavioral Sciences Department, Peres Academic Center, Rechovot 7610202, 
Israel.
(2)Behavioral Sciences Department, The Academic College of Tel-Aviv-Yaffa, 
Tel-Aviv 6818218, Israel.
(3)School of Education, Tel Aviv University, Tel-Aviv 6997505, Israel.

The COVID-19 pandemic posed a major threat to public health, with long-lasting 
consequences for the daily habits and practices of people around the world. The 
combination of hazardous health conditions and extensive changes to people's 
daily routines due to lockdowns, social restrictions, and employment uncertainty 
have led to mental health challenges, reduced levels of subjective wellbeing, 
and increased maladaptive behaviors and emotional distress. Nevertheless, some 
studies have reported increased adaptive functioning and resilience after the 
pandemic, suggesting a more complex pattern of effects. The goals of the current 
study were to explore the role of two coping variables, sense of coherence and 
hope, in people's emotional wellbeing and adaptation in dealing with loneliness 
before and after such a stressful period. In a cross-sectional study, 974 
Israeli participants (sample 1: 540 participants before the pandemic; sample 2: 
434 participants after the pandemic restrictions) answered online questionnaires 
about their loneliness, hope and sense of coherence levels before and after the 
pandemic. While the two groups did not differ in their levels of hope, the 
participants in the group before COVID-19 reported lower levels of loneliness 
and sense of coherence. However, the results also indicated that although the 
COVID-19 pandemic was related to increased levels of loneliness, the 
participants' sense of coherence mediated this increase and their levels of hope 
moderated it. The theoretical contribution of these findings is discussed, as 
well as interventional implications and future directions.

DOI: 10.3390/ijerph20105840
PMCID: PMC10218178
PMID: 37239566 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


656. Int J Environ Res Public Health. 2023 May 16;20(10):5837. doi: 
10.3390/ijerph20105837.

Estimating Prevalence of Bereavement, Its Contribution to Risk for Binge 
Drinking, and Other High-Risk Health States in a State Population Survey, 2019 
Georgia Behavioral Risk Factor Surveillance Survey.

Miles TP(1)(2), Li C(2)(3), Khan MM(2), Bayakly R(4), Carr D(5).

Author information:
(1)Rosalynn Carter Institute for Caregivers, Atlanta, GA 31709, USA.
(2)Department of Health Policy and Management, College of Public Health, 
University of Georgia, Athens, GA 30602, USA.
(3)School of Health Management, Fujian Medical University, Fuzhou 350122, China.
(4)Georgia Department of Public Health, Atlanta, GA 30303, USA.
(5)Center of Innovation in Social Science, Boston University, Boston, MA 02215, 
USA.

BACKGROUND: Binge drinking is a pattern of alcohol abuse. Its prevalence and 
associated risk factors are not well documented. Heavy drinking, on the other 
hand, has a well-documented association with bereavement. This report uses a 
cross-sectional, population-based survey to estimate prevalence of bingeing and 
its association with new bereavement. Bingeing is defined as 4 or more drinks 
(women) or 5 or more drinks (men) in a 2-4-h setting. For the first time in 
2019, the Georgia Behavioral Risk Factor Surveillance Survey (BRFSS) included a 
bereavement item: 'Have you experienced the death of a family member or close 
friend in the years 2018 or 2019?'
METHODS: Georgia BRFSS is a complex sampling survey administered annually. It is 
designed to represent the 8.1 million people aged 18 years and older in the U.S. 
state of Georgia. Alcohol consumption patterns are routinely measured in the 
common core. In 2019, the state added a new item probing for bereavement in the 
prior 24 months predating the COVID-19 pandemic. Imputation and weighting 
techniques were applied to yield the population prevalence rates of new 
bereavement, bingeing, and their co-occurrence with other high-risk health 
behaviors and outcomes. Multivariate models, adjusted for age, gender, and race, 
were used to estimate the risk for other unhealthy behaviors posed by the 
co-occurrence of bereavement and bingeing.
RESULTS: In Georgia, bereavement (45.8%), and alcohol consumption (48.8%) are 
common. Bereavement and alcohol use co-occurred among 1,796,817 people (45% of 
all drinkers) with a subset of 608,282 persons reporting bereavement combined 
with bingeing. The most common types of bereavement were death of a 
friend/neighbor (30.7%) or three plus deaths (31.8%).
CONCLUSIONS: While bingeing is a known risk to public health, its co-occurrence 
with recent bereavement is a new observation. Public health surveillance systems 
need to monitor this co-occurrence to protect both individual and societal 
health. In a time of global bereavement, documenting its influence on binge 
drinking can support the work towards Sustainable Development Goal #3-Good 
health and Well-Being.

DOI: 10.3390/ijerph20105837
PMCID: PMC10218207
PMID: 37239563 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


657. BMC Psychiatry. 2023 May 26;23(1):371. doi: 10.1186/s12888-023-04849-y.

Does social media usage ameliorate loneliness in rural youth? A cross sectional 
pilot study.

Gregory L(1), Dutton T(1), Osuagwu UL(2)(3)(4), Vines R(1).

Author information:
(1)Bathurst Rural Clinical School, School of Medicine, Western Sydney 
University, Bathurst, NSW, 2795, Australia.
(2)Bathurst Rural Clinical School, School of Medicine, Western Sydney 
University, Bathurst, NSW, 2795, Australia. l.osuagwu@westernsydney.edu.au.
(3)Translational Health Research Institute (THRI), Western Sydney University, 
Campbelltown, NSW, 2560, Australia. l.osuagwu@westernsydney.edu.au.
(4)African Vision Research Institute (AVRI), Department of Optometry, University 
of KwaZulu-Natal, Durban, South Africa. l.osuagwu@westernsydney.edu.au.

AIM: To investigate the relationship between social media use and loneliness and 
psychological wellbeing of youth in rural New South Wales.
DESIGN: This was a web-based cross-sectional survey.
METHODS: The survey consisted of 33 items including demography (12 items), 
participants' social media use (9 items), mood and anxiety (6 items), perceived 
loneliness (6 items), the impact of COVID-19 on social media usage or perceived 
loneliness (2 items). The participants' mood and anxiety were evaluated using 
the psychological distress tool (K6), while loneliness was measured using the De 
Jong Gierveld 6-item scale. Total loneliness and psychological distress scores 
were compared between demographic variables.
RESULTS: A total of 47 participants, aged 16-24 years took part in the study. 
The majority were women (68%) and many had K6 score that was indicative of 
psychological distress (68%). About half of the participants indicated that 
Facebook (FB) was their most used social media platform and two in five 
participants were on social media within 10 min of waking up each day, about 30% 
spent more than 20 h per week on social media, and more than two-third sent 
private messages, images, or videos, multiple times a day. The mean loneliness 
score was 2.89 (range, 0 to 6), with 0 being 'not lonely' and 6 being 'intense 
social loneliness'. One-way ANOVA and χ2 test results showed that those who used 
FB most frequently had significantly higher mean scores for loneliness compared 
to those that used other social media platforms (p = 0.015). Linear regression 
analysis revealed that those who commonly used FB were more likely to report 
higher loneliness scores (coefficient = -1.45, 95%CI -2.63, -0.28, p = 0.017), 
while gender (p = 0.039), age (p = 0.048), household composition (p = 0.023), 
and education level (p = 0.014) were associated with severe psychological 
distress.
CONCLUSIONS: The study found that social media usage, particularly FB, as 
measured by time used and active or passive engagement with the medium, was 
significantly linked to loneliness, with some impact on psychological distress. 
Social media use within ten minutes of waking increased the likelihood of 
psychological distress. However, neither loneliness nor psychological distress 
were associated with rurality among the rural youth in this study.

© 2023. The Author(s).

DOI: 10.1186/s12888-023-04849-y
PMCID: PMC10214363
PMID: 37237363 [Indexed for MEDLINE]

Conflict of interest statement: None declared.


658. BMC Public Health. 2023 May 26;23(1):967. doi: 10.1186/s12889-023-15909-z.

LGBTQ College student health and wellbeing at the onset of the pandemic: 
additional evidence and lessons learned from COVID-19.

Gonzales G(1), de Mola EL(2), Robertson L(3), Gavulic KA(4), McKay T(5).

Author information:
(1)Department of Medicine, Health & Society, Department of Health Policy, 
Program for Public Policy Studies, Vanderbilt University, 2301 Vanderbilt Place 
PMB #351665, Nashville, TN, USA. gilbert.gonzales@vanderbilt.edu.
(2)Department of Community Health Sciences, School of Public Health, Boston 
University, Boston, MA, USA.
(3)Department of Psychology, Florida State University, Tallahassee, Florida, 
USA.
(4)Yale School of Medicine, New Haven, Connecticut, USA.
(5)Department of Medicine, Health & Society, Vanderbilt University, Nashville, 
TN, USA.

BACKGROUND: The coronavirus (COVID-19) pandemic has killed more than six million 
people and disrupted health care systems globally. In the United States alone, 
more than one million people have died from COVID-19 infections. At the start of 
the pandemic, nearly all aspects of our lives paused to prevent the spread of 
the novel coronavirus. Many institutions of higher education transitioned to 
remote learning and enacted social distancing measures. This study examined the 
health needs and vulnerabilities of lesbian, gay, bisexual, transgender, queer, 
and questioning (LGBTQ) college students at the start of the COVID-19 pandemic 
in the United States.
METHODS: We fielded a rapid-response online survey between April and June of 
2020. We recruited 578 LGBTQ-identifying college students aged 18 years and 
older by reaching out to LGBTQ-serving organizations on 254 college campuses and 
via targeted social media advertising.
RESULTS: Approximately 40% of LGBTQ college students surveyed were dissatisfied 
with life at the start of the COVID-19 pandemic, and almost all (90%) were 
concerned that COVID-19 would threaten their mental health. Moreover, about 40% 
of LGBTQ college students reported unmet mental health needs, and 28% were 
worried about seeking care during the pandemic because of their LGBTQ identity. 
One out of four LGBTQ college students had to go back in the closet because of 
the pandemic, and approximately 40% were concerned about their finances or 
personal safety during the COVID-19 pandemic. Some of these adverse outcomes 
were prominent among younger students, Hispanic/Latinx students, and students 
with unsupportive families or colleges.
CONCLUSIONS: Our study adds novel findings to the large body of research 
demonstrating that LGBTQ college students experienced distress and elevated 
mental health needs early in the pandemic. Future research should examine the 
long-term consequences of the pandemic among LGBTQ and other minoritized college 
students. Public health policymakers, health care providers, and college and 
university officials should provide LGBTQ students affirming emotional supports 
and services to ensure their success as the COVID-19 pandemic transitions to 
endemic.

© 2023. The Author(s).

DOI: 10.1186/s12889-023-15909-z
PMCID: PMC10214329
PMID: 37237277 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no competing or conflicts of 
interest to declare.


659. Dementia (London). 2023 Aug;22(6):1292-1313. doi: 10.1177/14713012231178445. 
Epub 2023 May 26.

Effectiveness of digital technologies to engage and support the wellbeing of 
people with dementia and family carers at home and in care homes: A scoping 
review.

Bradley L(1), Shanker S(1), Murphy J(1), Fenge LA(2), Heward M(1).

Author information:
(1)Ageing and Dementia Research Centre, Faculty of Health & Social Sciences, 
Bournemouth University, Bournemouth, UK.
(2)Centre for Seldom Heard Voices, Faculty of Health & Social Sciences, 
Bournemouth University, Bournemouth, UK.

Use of digital technologies to support meaningful engagement of people with 
dementia and carers increased during the COVID-19 pandemic. The purpose of this 
scoping review was to determine the effectiveness of digital technologies in 
supporting the engagement and wellbeing of people with dementia and family 
carers at home and in care homes. Studies published in peer reviewed literature 
were identified across four databases (CINAHL, Medline, PUBMED, PsychINFO). 
Sixteen studies met the inclusion criteria. Findings indicate that digital 
technologies can potentially support the wellbeing of people with dementia and 
family carers, although only a few studies had measured impact on wellbeing, as 
many were reporting on technology at proof-of-concept stage rather than 
commercially ready products. Moreover, current studies lacked meaningful 
involvement of people with dementia, family carers, and care professionals in 
the design of the technology. Future research should bring together people with 
dementia, family carers, care professionals and designers to coproduce digital 
technologies with researchers and evaluate them using robust methodologies. 
Codesign should start early in the intervention development phase and continue 
until implementation. There is a need for real world applications that nurture 
social relationships by focusing on how digital technologies can support more 
personalised, adaptive forms of care. Developing the evidence base to identify 
what makes digital technologies effective in supporting the wellbeing of people 
with dementia is crucial. Future interventions should therefore consider the 
needs and preferences of people with dementia, their families, and professional 
carers, as well as the suitability and sensitivity of wellbeing outcome 
measures.

DOI: 10.1177/14713012231178445
PMCID: PMC10336719
PMID: 37235791 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


660. PLoS One. 2023 May 26;18(5):e0286424. doi: 10.1371/journal.pone.0286424. 
eCollection 2023.

Problematic use of the internet, smartphones, and social media among medical 
students and relationship with depression: An exploratory study.

Sserunkuuma J(1), Kaggwa MM(1)(2)(3), Muwanguzi M(2), Najjuka SM(4), Murungi 
N(1), Kajjimu J(1), Mulungi J(1), Kihumuro RB(1), Mamun MA(5)(6), Griffiths 
MD(7), Ashaba S(1)(2).

Author information:
(1)Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, 
Uganda.
(2)Department of Psychiatry, Faculty of Medicine, Mbarara University of Science 
and Technology, Mbarara, Uganda.
(3)Department of Psychiatry and Behavioural Neurosciences, McMaster University 
Hamilton, Hamilton, Ontario, Canada.
(4)College of Health Sciences, Makerere University, Kampala, Uganda.
(5)CHINTA Research Bangladesh, Savar, Dhaka, Bangladesh.
(6)Department of Public Health and Informatics, Jahangirnagar University, Savar, 
Dhaka, Bangladesh.
(7)Psychology Department, Nottingham Trent University, Nottingham, United 
Kingdom.

BACKGROUND: Students in sub-Saharan African countries experienced online classes 
for the first time during the COVID-19 pandemic. For some individuals, greater 
online engagement can lead to online dependency, which can be associated with 
depression. The present study explored the association between problematic use 
of the internet, social media, and smartphones with depression symptoms among 
Ugandan medical students.
METHODS: A pilot study was conducted among 269 medical students at a Ugandan 
public university. Using a survey, data were collected regarding 
socio-demographic factors, lifestyle, online use behaviors, smartphone 
addiction, social media addiction, and internet addiction. Hierarchical linear 
regression models were performed to explore the associations of different forms 
of online addiction with depression symptom severity.
RESULTS: The findings indicated that 16.73% of the medical students had moderate 
to severe depression symptoms. The prevalence of being at risk of (i) smartphone 
addiction was 45.72%, (ii) social media addiction was 74.34%, and (iii) internet 
addiction use was 8.55%. Online use behaviors (e.g., average hours spent online, 
types of social media platforms used, the purpose for internet use) and 
online-related addictions (to smartphones, social media, and the internet) 
predicted approximately 8% and 10% of the severity of depression symptoms, 
respectively. However, over the past two weeks, life stressors had the highest 
predictability for depression (35.9%). The final model predicted a total of 
51.9% variance for depression symptoms. In the final model, romantic 
relationship problems (ß = 2.30, S.E = 0.58; p<0.01) and academic performance 
problems (ß = 1.76, S.E = 0.60; p<0.01) over the past two weeks; and increased 
internet addiction severity (ß = 0.05, S.E = 0.02; p<0.01) was associated with 
significantly increased depression symptom severity, whereas Twitter use was 
associated with reduced depression symptom severity (ß = 1.88, S.E = 0.57; 
p<0.05).
CONCLUSION: Despite life stressors being the largest predictor of depression 
symptom score severity, problematic online use also contributed significantly. 
Therefore, it is recommended that medical students' mental health care services 
consider digital wellbeing and its relationship with problematic online use as 
part of a more holistic depression prevention and resilience program.

Copyright: © 2023 Sserunkuuma et al. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0286424
PMCID: PMC10218731
PMID: 37235547 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


661. J Affect Disord. 2023 Sep 15;337:1-10. doi: 10.1016/j.jad.2023.05.062. Epub 2023 
May 23.

The effect of exposure to COVID-19 on life satisfaction: The mediating role of 
hyperarousal and moderating/mediating role of affective forecasting.

Pan W(1), Zhou W(1), Wu J(1), Huang Z(1), Ding L(1), Guo L(1), Hang B(1), Li 
X(2).

Author information:
(1)Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of 
Education, Wuhan 430079, China; School of Psychology, Central China Normal 
University, Wuhan 430079, China; Key Laboratory of Human Development and Mental 
Health of Hubei Province, Wuhan 430079, China.
(2)Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of 
Education, Wuhan 430079, China; School of Psychology, Central China Normal 
University, Wuhan 430079, China; Key Laboratory of Human Development and Mental 
Health of Hubei Province, Wuhan 430079, China. Electronic address: 
xuli@ccnu.edu.cn.

BACKGROUND: As a global trauma event, the Coronavirus disease (COVID-19) hugely 
impacts people's mental health and well-being. The purpose of our study is 
threefold: first, investigate the relationship between exposure to COVID-19 and 
life satisfaction among a large sample in China; second, test the mediating role 
of hyperarousal in the association between exposure to COVID-19 and life 
satisfaction; third, explore the moderating/mediating role of affective 
forecasting in the association between hyperarousal and life satisfaction.
METHOD: The current study recruited 5546 participants to complete a set of 
self-report questionnaires online from April 22, 2020 to April 24, 2020. The 
moderated mediation and chain mediation model analyses were conducted using the 
SPSS software and PROCESS macro program.
RESULTS: Exposure to COVID-19 negatively predicted life satisfaction 
(Effect = -0.058, p < 0.001). This relationship was partially mediated by the 
hyperarousal level (Effect = -0.018, CI = [-0.024, -0.013]). The moderating role 
of forecasted positive affect (PA)/forecasted negative affect (NA) between 
hyperarousal and life satisfaction was significant (β = 0.058, CI = [0.035, 
0.081]; β = 0.037, CI = [0.014, 0.06]). The chain mediating effect of 
hyperarousal and forecasted PA/forecasted NA on the relationship between 
exposure to COVID-19 and life satisfaction was also significant 
(Effect = -0.003, CI = [-0.004, -0.002]; Effect = -0.006, CI = [-0.008, 
-0.004]).
LIMITATIONS: The cross-sectional design precludes causal inference.
CONCLUSION: Greater exposure to COVID-19 was associated with more severe 
hyperarousal symptoms, decreased life satisfaction. Forecasted PA and forecasted 
NA could moderate and mediate the negative impact of hyperarousal on life 
satisfaction. The moderating/mediating role of forecasted PA/NA implied that 
future interventions targeting at improving affective forecasting and reducing 
hyperarousal might be helpful to improve life satisfaction during the 
post-COVID-19 era.

Copyright © 2023 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2023.05.062
PMCID: PMC10202896
PMID: 37230267 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest All authors 
disclosed no relevant relationships.


662. Fam Syst Health. 2023 Dec;41(4):443-453. doi: 10.1037/fsh0000801. Epub 2023 May 
25.

Primary care provider perspectives on virtual and in-person depression 
management during the COVID-19 pandemic.

Leung LB(1), Chrystal JG(1), Dyer KE(1), Brayton CE(1), Karakashian MA(1), Yano 
EM(1), Young AS(1), Shekelle PG(1), Hamilton AB(1).

Author information:
(1)Center for the Study of Healthcare Innovation, Implementation, & Policy, VA 
Greater Los Angeles Healthcare System.

INTRODUCTION: During the COVID-19 pandemic, primary care providers (PCPs), 
nurses, and integrated mental health specialists continued to collaboratively 
manage depression among patients using both in-person and virtual (i.e., hybrid) 
modalities. Few studies have characterized how hybrid services are currently 
delivered within interdisciplinary primary care teams. This study aimed to 
understand frontline PCPs' perspectives on providing hybrid virtual and 
in-person depression care during the pandemic.
METHOD: From September to November 2020, 12 semistructured individual interviews 
focused on depression management were conducted with PCPs in two Veterans Health 
Administration (VA) clinics in Los Angeles, which resumed in-person services 
while balancing rising COVID-19 cases. Interviews were audio-recorded, 
transcribed, and coded for depression management patterns. Themes were derived 
using a team-based constant comparative analytic approach.
RESULTS: The pandemic and subsequent expanded use of virtual care necessitated 
clinic adaptations to depression assessments and procedures. PCPs perceived 
increased depression and anxiety among patients with existing psychiatric 
conditions, attributed to social distancing and isolation restrictions. They 
expressed acceptance of virtual care modalities for patients' depression 
management. PCPs did not perceive a delay in mental health care delivery in the 
shift to virtual care but noted the possibility of patients being lost to 
follow-up.
CONCLUSIONS: During the pandemic, there has been heightened PCP concern for 
patients' emotional well-being and adaptations of clinic processes to meet needs 
for depression care. While PCPs were optimistic about new virtual care options 
for depression management, virtual care transfers remained poorly defined and 
the extent to which patient care experiences and health outcomes have been 
disrupted remains unknown. (PsycInfo Database Record (c) 2024 APA, all rights 
reserved).

DOI: 10.1037/fsh0000801
PMCID: PMC10674027
PMID: 37227826 [Indexed for MEDLINE]


663. Public Health Rep. 2023 May-Jun;138(1_suppl):48S-55S. doi: 
10.1177/00333549231151888.

Mental Health Needs Due to Disasters: Implications for Behavioral Health 
Workforce Planning During the COVID-19 Pandemic.

Gaiser M(1), Buche J(1), Baum NM(1)(2), Grazier KL(1).

Author information:
(1)The Behavioral Health Workforce Research Center, Department of Health 
Management and Policy, School of Public Health, University of Michigan, Ann 
Arbor, MI, USA.
(2)Center for Health and Research Transformation at the University of Michigan, 
Ann Arbor, MI, USA.

Public health emergencies impact the well-being of people and communities. 
Long-term emotional distress is a pervasive and serious consequence of high 
levels of crisis exposure and low levels of access to mental health care. At 
highest risk for mental health trauma are historically medically underserved and 
socially marginalized populations and frontline health care workers (HCWs). 
Current public health emergency response efforts provide insufficient mental 
health services for these groups. The ongoing mental health crisis of the 
COVID-19 pandemic has implications for the resource-strained health care 
workforce. Public health has an important role in delivering psychosocial care 
and physical support in tandem with communities. Assessment of US and 
international public health strategies deployed during past public health 
emergencies can guide development of population-specific mental health care. The 
objectives of this topical review were (1) to examine scholarly and other 
literature on the mental health needs of HCWs and selected US and international 
policies to address them during the first 2 years of the pandemic and (2) to 
propose strategies for future responses. We reviewed 316 publications in 10 
topic areas. Two-hundred fifty publications were excluded, leaving 66 for this 
topical review. Findings from our review indicate a need for flexible, tailored 
mental health outreach for HCWs after disasters. US and global research 
emphasizes the dearth of institutional mental health support for HCWs and of 
mental health providers who specialize in helping the health care workforce. 
Future public health disaster responses must address the mental health needs of 
HCWs to prevent lasting trauma.

DOI: 10.1177/00333549231151888
PMCID: PMC10225905
PMID: 37226951 [Indexed for MEDLINE]

Conflict of interest statement: The authors declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


664. Subst Abus. 2023 Jan-Apr;44(1):73-85. doi: 10.1177/08897077231165860. Epub 2023 
Apr 26.

The Association of Vaping With Social/Emotional Health and Attitudes Toward 
COVID-19 Mitigation Measures in Adolescent and Young Adult Cohorts During the 
COVID-19 Pandemic.

Oliver AL(1), Kossowsky J(2)(3), Minegishi M(4), Levy S(1)(5), Weitzman 
ER(4)(5)(6).

Author information:
(1)Adolescent Substance Use and Addiction Program, Division of Developmental 
Medicine, Boston Children's Hospital, Boston, MA, USA.
(2)Department of Anesthesiology, Critical Care & Pain Medicine, Boston 
Children's Hospital, Boston, MA, USA.
(3)Department of Anaesthesia, Harvard Medical School, Boston, MA, USA.
(4)Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 
Boston, MA, USA.
(5)Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
(6)Computational Health Informatics Program, Boston Children's Hospital, Boston, 
MA, USA.

Erratum in
    Subst Abus. 2023 Jul 18;:8897077231185670.

BACKGROUND: Vaping is a major health risk behavior which often occurs socially. 
Limited social activity during the COVID-19 pandemic contributed to worsening 
social and emotional health. We investigated associations among youth vaping, 
and reports of worsening mental health, loneliness, and relationships with 
friends and romantic partners (ie, social health), as well as perceived 
attitudes toward COVID-19 mitigation measures.
METHODS: From October 2020 to May 2021, a clinical convenience sample of 
adolescents and young adults (AYA) reported on their past-year substance use, 
including vaping, their mental health, COVID-19 related exposures and impacts, 
and their attitudes toward non-pharmaceutical COVID-19 mitigation interventions, 
via a confidential electronic survey. Multivariate logistic regressions were 
used to estimate associations among vaping and social/emotional health.
RESULTS: Of 474 AYA (mean age = 19.3 (SD = 1.6) years; 68.6% female), 36.9% 
reported vaping in the prior 12 months. AYA who self-reported vaping were more 
likely than non-vaping AYA to report worsening: anxiety/worry (81.1%; P = .036), 
mood (78.9%; P = .028), eating (64.6%; P = .015), sleep (54.3%; P = .019), 
family discord (56.6%; P = .034), and substance use (54.9%; P < .001). 
Participants who vaped also reported easy access to nicotine (63.4%; P < .001) 
and cannabis products (74.9%; P < .001). No difference in perceived change in 
social wellbeing was seen between the groups. In adjusted models, vaping was 
associated with symptoms of depression (AOR = 1.86; 95% CI = 1.06-3.29), less 
social distancing (AOR = 1.82; 95% CI = 1.11-2.98), lower perceived importance 
of proper mask wearing (AOR = 3.22; 95% CI = 1.50-6.93), and less regular use of 
masks (AOR = 2.98; 95% CI = 1.29-6.84).
CONCLUSIONS: We found evidence that vaping was associated with symptoms of 
depression and lower compliance with non-pharmaceutical COVID-19 mitigation 
efforts among AYA during the COVID-19 pandemic.

DOI: 10.1177/08897077231165860
PMCID: PMC10133863
PMID: 37226905 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared the following potential 
conflicts of interest with respect to the research, authorship, and/or 
publication of this article: Dr. Levy serves as an expert for the litigation 
against JUUL. The other authors have no conflicts of interest to disclose.


665. Int J Med Inform. 2023 Aug;176:105065. doi: 10.1016/j.ijmedinf.2023.105065. Epub 
2023 Apr 9.

The role of digital health in supporting cancer patients' mental health and 
psychological well-being for a better quality of life: A systematic literature 
review.

Elkefi S(1), Trapani D(2), Ryan S(3).

Author information:
(1)School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, 
NJ, USA. Electronic address: hphactors@gmail.com.
(2)Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 
USA; Harvard Medical School, Boston, MA, USA.
(3)Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 
USA.

BACKGROUND: This work aims to evaluate the role of digital health in supporting 
the mental and psychological well-being of patients with cancer and identify the 
associated challenges of use and implementation.
METHODS: Eligibility criteria: We included peer-reviewed studies 
(quantitative/qualitative) published between January 2011 and July 2022, that 
are written in English using technology to support cancer patients' mental 
health. We excluded opinion papers, editorials, and commentaries.
INFORMATION SOURCES: The systematic review was conducted across ProQuest 
CENTRAL, Scopus, PubMed, PsycInfo, Web Of Science, and IEEE Xplore. The study 
selection followed the Preferred Reporting Items for Systematic Reviews, 
meta-Analysis Reviews, and meta-Analysis guidelines (PRISMA). Risk of bias: All 
screening steps followed a consensus between the authors to minimize bias or 
discrepancy. Synthesis of the results: Data were extracted following the 
Six-factor Model of Psychological Well-being (SMPW). The technology challenges 
are summarized following the Systems Engineering Initiative for Patient Safety 
model (SEIPS), focusing on design, impact on processes, and outcomes.
RESULTS: We included 25 studies satisfying our inclusion criteria. The studies 
had little interest in minorities and sociodemographic factors' assessment 
within their results. The review showed that mental health and psychological 
well-being tools cover many applications. In addition to allowing personal 
growth, digital health can help cancer patients gain more autonomy and 
self-acceptance. Moreover, these health technologies can aid in mastering the 
environment, shaping social relationships, and pursuing life goals. Many 
challenges were identified related to the environment, organization, users, and 
tasks.
DISCUSSION: Digital health applications for cancer care cover a broad spectrum 
of mental health interventions. Challenges warrant analyzing the needs and 
usability. Lessons learned during COVID-19 may help refine technology 
interventions for mental health in cancer care. More interest in minorities is 
needed when designing technologies for patients to ensure more access to 
equitable care.

Copyright © 2023 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.ijmedinf.2023.105065
PMID: 37224644 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


666. BMC Health Serv Res. 2023 May 23;23(1):530. doi: 10.1186/s12913-023-09452-1.

Accessing healthcare during the COVID-19 pandemic: a qualitative exploration of 
the experiences of parents and carers of children with chronic illness to inform 
future policies in times of crisis.

Reed D(1), Wolfe I(1), Greenwood J(1), Lignou S(2).

Author information:
(1)Institute of Women and Children's Health, King's College London, 1 Lambeth 
Palace Rd, South Bank, SE1 7EU, London, UK.
(2)Ethox Centre and Wellcome Centre for Ethics and Humanities, Nuffield 
Department of Population Health, University of Oxford, Big Data Institute, Old 
Road Campus, Oxford, OX3 7LF, UK. sapfo.lignou@ethox.ox.ac.uk.

BACKGROUND: The purpose of thispaper is to explore the experiences of parents 
and carers of children with chronic health conditions in accessing healthcare 
during the Covid-19 pandemic. Children with chronic conditions typically rely on 
both planned and unplanned care, and contact with healthcare professionals over 
extensive periods of time. Their distinct care needs render these children 
vulnerable to even to minor changes in healthcare provision. The wide-ranging 
care disruptions during the pandemic were therefore likely drastically to affect 
their health and wellbeing; an assessment of the effects of Covid-19 policies on 
healthcare access and quality of care delivered for this group is needed.
METHODS: From 25/01/2022 to 25/05/2022, four focus groups were held with 
parents/carers of children with diabetes, neurodivergence, mental health 
conditions, and medical complexities to explore their experiences in navigating 
the healthcare system during the pandemic. Interviews were transcribed and then 
subjected to thematic analysis using NVivo qualitative research software.
RESULTS: Our results indicate that children with chronic health conditions (and 
their parents/carers) experienced difficulties accessing healthcare during the 
pandemic. Problems with late diagnosis, prolonged waiting times, and 
deficiencies with telemedicine were identified, as were impacts of healthcare 
disruptions on children's wellbeing, and the wellbeing of wider families. We 
found that children with neurodivergence and those with mental health conditions 
were particularly affected with their health needs repeatedly de-prioritised. 
Furthermore, the loss of contact with multi-specialty clinical teams profoundly 
affected parents and carers, leaving them feeling isolated in managing their 
children's health. These diminished relationships became another vector for 
uncertainty in supporting children's health.
CONCLUSION: The effects of healthcare disruptions on the welfare of children 
with chronic conditions (and their families), are well evidenced in this work, 
providing deeper understandings of the relationships between these children, 
their families and clinicians. The evidence in this paper aims to inform future 
policy and ethical guidelines so that the needs of children with long-term 
health conditions can be properly considered in times of crisis.

© 2023. The Author(s).

DOI: 10.1186/s12913-023-09452-1
PMCID: PMC10205033
PMID: 37221508 [Indexed for MEDLINE]

Conflict of interest statement: There are no competing interests to declare.


667. J Occup Environ Med. 2023 Aug 1;65(8):699-705. doi: 
10.1097/JOM.0000000000002889. Epub 2023 May 21.

The State of Health, Burnout, Healthy Behaviors, Workplace Wellness Support, and 
Concerns of Medication Errors in Pharmacists During the COVID-19 Pandemic.

Melnyk BM(1), Hsieh AP, Tan A, McAuley JW, Matheus M, Larson B, Dopp AL.

Author information:
(1)From the Vice President for Health Promotion, University Chief Wellness 
Officer, Dean and Helene Fuld Health Trust Professor of Evidence-based Practice, 
College of Nursing, The Ohio State University, Columbus, Ohio (B.M.M., A.P.H.); 
Center for Research and Healthy Aging, College of Nursing, The Ohio State 
University, Columbus, Ohio (A.T.); College of Pharmacy, The Ohio State 
University, Columbus, Ohio (J.W.M.A.); Member and Market Insights, American 
Society of Health-System Pharmacists, Bethesda, Maryland (M.M.); of 
Health-System Pharmacists, Bethesda, Maryland (B.L.); and Clinical Guidelines 
and Quality Improvement, Center on Medication Safety and Quality, American 
Society of Health-System Pharmacists, Bethesda, Maryland (A.L.D.).

OBJECTIVES: The aims of the study were to describe the well-being and lifestyle 
behaviors of health-system pharmacists during the COVID-19 pandemic and to 
determine the relationships among well-being, perceptions of workplace wellness 
support, and self-reported concern of having made a medication error.
METHODS: Pharmacist ( N = 10,445) were randomly sampled for a health and 
well-being survey. Multiple logistic regression assessed associations with 
wellness support and concerns of medication error.
RESULTS: The response rate was 6.4% ( N = 665). Pharmacists whose workplaces 
very much supported wellness were 3× more likely to have no depression, anxiety, 
and stress; 10× more likely to have no burnout; and 15× more likely to have a 
higher professional quality of life. Those with burnout had double the concern 
of having made a medication error in the last 3 months.
CONCLUSIONS: Healthcare leadership must fix system issues that cause burnout and 
actualize wellness cultures to improve pharmacist well-being.

Copyright © 2023 American College of Occupational and Environmental Medicine.

DOI: 10.1097/JOM.0000000000002889
PMCID: PMC10417224
PMID: 37217830 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest: M.M., B.L., and A.L.D. are 
associated with the American Society of Health-System Pharmacists. A.L.D. has 
Merck individual stock. The other authors declare no conflict of interest.


668. Psychiatriki. 2023 Jul 19;34(2):99-101. doi: 10.22365/jpsych.2023.009. Epub 2023 
May 12.

Sexual expression and the COVID-19 pandemic: The future of sexual intimacy after 
the COVID-19 pandemic.

[Article in English, Greek, Modern]

Mourikis I(1).

Author information:
(1)Psychiatrist, PhD Head of outpatient clinic for OCD; Head of outpatient 
clinic for Sexual Health First Department of Psychiatry, National and 
Kapodistrian University of Athens.

Humans, as social beings, rely on interaction in order to survive and 
"flourish". By nature, they are "weak" and when in solitary, their freedom is 
jeopardized. Connecting with others, intimacy, physical contact, and the sense 
of belonging are core needs, and once recognized as such, they ultimately serve 
one's freedom. In this context, social interaction serves as a fundamental 
factor for survival. The creation of bonds improves one's position in the 
evolutionary process, and paves the way towards the ultimate "goal" of 
existence. The COVID-19 pandemic and the measures to control its spread have 
disrupted every aspect of human activity. Social, academic, cultural, business, 
and economic activities have been drastically modified.1 The conscious 
experience of the threat of life has been a ubiquitous "dramatic reminder of 
human vulnerability". The environment became unintelligible, death was "present" 
at all times. People tried to find a new meaning of life and discover a new 
sense of self-worth. The triggered vulnerability, the isolation from friends and 
relatives that to date validated one's self-esteem, the unprecedented obstacles 
with respect to career goals, and unexpected job losses affected the global view 
of things.1 The restrictive measures and the resulting urgent vaccination 
created "dystopian" conditions, under which deriving pleasure became a luxury. 
Scientific data have shown that social distancing has led to high levels of 
psychological distress. Primary research conducted during the social 
restrictions as well as subsequent meta-analytical studies have revealed 
increased irritability, emotional instability, and ultimately an increase in 
emotional and anxiety disorders' prevalence.2 Undoubtedly, mental and sexual 
health share a strong and bidirectional relationship.3 International health 
organizations emphasize the positive impact of a healthy sexual life on 
psychological well-being. Sexual well-being can serve - along with other factors 
- as a protective measure against the development of psychopathology, while 
stable sexual activity acts as a safeguard for well-being in general. The 
negative relationship between psychological symptoms and sexual gratification 
has been repeatedly documented by research, highlighting the impact of anxiety 
on sexual desire, arousal, and overall satisfaction with sexual life.4 Given 
this relationship and the increased emotional vulnerability during the pandemic, 
one might wonder how this reciprocal path has been affected. Physical intimacy, 
one of the basic expressions of the connection between partners, could not 
remain unaffected. During the first year of the pandemic and the restrictive 
measures, it became difficult for partners to meet. Due to the measures and 
discouragement of gatherings, a strong fear of infection gradually developed and 
avoidance behaviors emerged. In some countries, there were recommendations for 
physical-sexual interactions' limitation, and use of masks in intimate 
situations.5 The end result of these circumstances was that one in three 
individuals demonstrated such fear that they completely avoided engaging in 
sexual contact with the person they desired, even in cases they cohabited.6 The 
anxiety and reduced quality of life seemed to affect sexual function, especially 
aspects related to sexual desire and arousal. The fear and anxiety caused by the 
constant threat to life deprived individuals of the ability to derive 
satisfaction from intimate relationships, guiding sexual expression towards a 
safer "self-centered" orientation. As a result, self-gratification through 
masturbation increased for both single individuals as well as for stable, 
cohabiting partners.7 On the other hand, the newly formed living conditions 
served as a "vehicle' in an attempt to search for new paths towards pleasure. 
People, as in every past crisis, needed to "reinvent" themselves in order to 
adapt. Given that every sexual contact is a multi-sensory experience as well as 
a means of psychological discharge, they searched for or even created new paths 
that led to sexual release. The concept of "virtual sexuality" emerged even more 
strongly than it did before the pandemic. The pre-existing use of digital sexual 
content, which priorly simply facilitated individual sexual practices, took 
another form. The use of interactive technologies allowed people to create and 
share - in most cases for the first time - their personal erotic content.8 The 
internet emerged as an effective substitute for the discharge of sexual desire 
for people not in a stable romantic relationship, while for those with a stable 
partner in some cases facilitated their relationships, but for most of them 
prolonged behaviors of fear and avoidance of intimacy. The human need for 
connection, love, flirting, and sexual expression cannot be eliminated. The 
questions that arise whether the changes that have occurred are permanent, 
whether the need for real-life, physical contact has decreased, and whether the 
ways through which people connect with others have been permanently modified. It 
is possible that sexual intimacy is now conceptualized and experienced as 
something different, and perhaps the pandemic is a causal factor and a strong 
catalyst for a predetermined change of course with respect to close 
relationships. In any case, the clinical significance of the dynamic interaction 
between sexual factors and psychological well-being must be understood in depth. 
As mental health professionals, we must take into account the altered or new 
aspects of sexual expression, and with scientific rigor and respect for human 
nature, we should keep highlighting the unbreakable bond between sexuality and 
quality of life. We must recognize the timeless human need for intimacy and 
meaningful, stable connections, irrespective of threatening factors and 
uncertainty caused by conditions such as the recent pandemic.

DOI: 10.22365/jpsych.2023.009
PMID: 37212801 [Indexed for MEDLINE]


669. Psychooncology. 2023 Jul;32(7):1106-1113. doi: 10.1002/pon.6152. Epub 2023 May 
22.

Psychosocial well-being during the COVID-19 pandemic among women with and 
without breast cancer.

Pinheiro LC(1)(2), Fasano GA(3), An A(2), Mount L(2), Bayard S(3), Rosenberg 
S(2), Taiwo E(4), Loeb-Zeitlin S(5), Marti J(3), Ashamalla H(6), Balogun O(6), 
Smith M(6), Siegel B(7), Astrow A(4), Newman L(3), Malik M(7), Bea V(8), Tamimi 
RM(2).

Author information:
(1)Division of General Internal Medicine, Department of Medicine, Weill Cornell 
Medicine, New York, New York, USA.
(2)Department of Population Health Science, Weill Cornell Medicine, New York, 
New York, USA.
(3)Department of Surgery, Weill Cornell Medicine, New York, New York, USA.
(4)Department of Hematology and Oncology, NewYork-Presbyterian Brooklyn 
Methodist Hospital, Brooklyn, New York, USA.
(5)Division of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New 
York, USA.
(6)Department of Radiation Oncology, NewYork-Presbyterian Brooklyn Methodist 
Hospital, Brooklyn, New York, USA.
(7)Department of Surgery, NewYork-Presbyterian Queens, Queens, New York, USA.
(8)Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, 
Brooklyn, New York, USA.

OBJECTIVE: Treatment delays in combination with general social distancing 
practices to reduce transmission may have negative impacts on the mental health 
of women with breast cancer who may need more social and emotional support. We 
sought to elucidate the psychosocial effects of the COVID-19 pandemic among 
women with and without breast cancer in New York City.
METHODS: We conducted a prospective cohort study among women aged 18+ across the 
spectrum of breast health care at New York Presbyterian (NYP)-Weill Cornell, 
NYP-Brooklyn Methodist Hospital and NYP-Queens. Women were contacted between 
June and October 2021 to assess their self-reported depression, stress, and 
anxiety during the COVID-19 pandemic. We compared women who were recently 
diagnosed, those with a history of breast cancer, and women without cancer whose 
other health visits were delayed during the pandemic.
RESULTS: There were 85 women who completed the survey. Breast cancer survivors 
(42%) were the least likely to report a delay in care due to COVID compared to 
breast cancer patients who were recently diagnosed (67%) and women without 
cancer (67%). Compared to women without cancer and breast cancer survivors, 
women recently diagnosed with breast cancer reported higher levels of anxiety 
and depression with a statistically significant difference in perceived stress.
CONCLUSIONS: Our findings highlight the need to identify and risk-stratify 
patients facing a new breast cancer diagnosis in and around the COVID-19 
pandemic who may benefit from additional resources to mitigate the adverse 
impacts of the pandemic and a breast cancer diagnosis on psychosocial health.

© 2023 John Wiley & Sons Ltd.

DOI: 10.1002/pon.6152
PMID: 37212636 [Indexed for MEDLINE]


670. Dementia (London). 2023 Aug;22(6):1241-1258. doi: 10.1177/14713012231177491. 
Epub 2023 May 21.

The impact of a pilot telehealth coaching intervention to improve caregiver 
stress and well-being and to increase dietary protein intake of caregivers and 
their family members with dementia - Interrupted by COVID-19.

D'Avolio D(1), Gropper SS(1), Appelbaum M(2), Thiengtham S(3), Holt J(3), Newman 
D(3).

Author information:
(1)Christine E Lynn, College of Nursing, Florida Atlantic University, Boca 
Raton, FL, USA.
(2)Department of Nutritional Sciences, University of Georgia, Athens, GA, USA.
(3)Christine E Lynn, College of Nursing, Florida Atlantic University, Boca 
Raton, FL, USA.

The prevalence of dementia is growing as the population and longevity increase. 
Caregivers of adults with dementia report stress and fatigue and often neglect 
their health. They also indicate the need for information to address 
health-related issues, including nutritional problems, of their family members 
with dementia (FMWD). This study examined the impact of coaching to improve 
family caregiver (FCG) stress and well-being and to increase the protein intake 
of both FCGs and their FMWD. All participants received nutrition education 
including a protein prescription (1.2 g/kg body weight/day) and FCGs received 
stress-reduction materials. Coached-group randomized participants also received 
weekly diet coaching and stress-reduction coaching. At baseline and 8 weeks, 
anthropometrics, a mini-nutritional assessment questionnaire, and diet (protein 
intake) were assessed in FCGs and FMWD; well-being, fatigue and strain were 
assessed in FCGs. Repeated two words measures analysis of variance and Fisher's 
exact tests examined within group and intervention effects. Twenty-five FCGs (13 
coached group, 12 not-coached group) and 23 FMWD (12 coached group, 11 
not-coached group) completed the study. No significant differences were found 
between coached and not-coached FCGs and FMWD at baseline. After 8- weeks, FCGs' 
protein intake significantly increased from 1.00 ± 0.17 to 1.35 ± 0.23 g/kg/body 
weight in the coached group and from 0.91 ± 0.19 to 1.01 ± 0.33 g/kg/body weight 
in the not-coached group; there was also an intervention effect (p=.01, η2 = 
.24). The percentage of FCGs with baseline protein intake less than prescription 
guidelines and with an end-of-study protein intake meeting/exceeding the 
prescription significantly differed, with 60% of coached FCGs versus 10% of not 
coached FCGs meeting the prescription. No intervention effects were shown for 
protein intake in FMWD or for well-being, fatigue or strain among FCGs. Diet 
coaching with nutrition education successfully assisted FCGs with improving 
their protein intake versus nutrition education alone.

DOI: 10.1177/14713012231177491
PMCID: PMC10201283
PMID: 37211791 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


671. Childs Nerv Syst. 2023 Nov;39(11):3255-3262. doi: 10.1007/s00381-023-05980-7. 
Epub 2023 May 20.

COVID-19- Experiences and support needs of children and young people with 
Hydrocephalus and parents in the United Kingdom.

Collaço N(1), Campion A(2), McNicholas R(3), Darlington AS(4).

Author information:
(1)School of Health Sciences, Centre for Psychosocial Research in Cancer 
(CentRIC+), University of Southampton, Southampton, SO17 1BJ, England. 
n.b.collaco@soton.ac.uk.
(2)Southampton General Hospital, Southampton, England.
(3)School of Medicine, University of Leeds, Leeds, England.
(4)School of Health Sciences, Centre for Psychosocial Research in Cancer 
(CentRIC+), University of Southampton, Southampton, SO17 1BJ, England.

PURPOSE: Little is known about the impact of COVID-19 on children and young 
people (CYP) with hydrocephalus and their families. This study explored the 
experiences and support needs of CYP with hydrocephalus and parents who have a 
child with hydrocephalus during the COVID-19 pandemic.
METHODS: CYP with hydrocephalus and parents of CYP with hydrocephalus in the 
United Kingdom completed an online survey with open and closed questions 
exploring experiences, information, support needs and decision making processes. 
Qualitative thematic content analysis and descriptive quantitative analyses were 
undertaken.
RESULTS: CYP aged 12-32 years (n=25) and parents of CYP aged 0-20 years (n=69) 
responded. Parents (63.5%) and CYP (40.9%) worried about the virus, and both 
were vigilant for virus symptoms (86.5% and 57.1%). Parents (71.2%) and CYP 
(59.1%) worried about their child/feeling more isolated during the virus 
outbreak. Parents felt concerned about having to take their child to hospital 
with a suspected shunt problem during the virus outbreak (64.0%). Qualitative 
findings reported the following themes: (1) Healthcare and treatment provision: 
delays and challenges to access and availability of care (2) Impact of 
COVID-19/lockdown on daily lives and routines, and (3) Provision of information 
and support for parents and CYP with hydrocephalus.
CONCLUSION: The impact of COVID-19 and national measures to control the spread 
of the virus- no contact with anyone outside the household significantly 
impacted the daily lives and routines of CYP with hydrocephalus and parents. 
Social engagements were missed, families faced challenges to their work life, 
education and access to health care and support, which subsequently contributed 
negatively to their mental wellbeing. CYP and parents highlighted a need for 
clear, timely and targeted information to address their concerns.

© 2023. The Author(s).

DOI: 10.1007/s00381-023-05980-7
PMCID: PMC10199430
PMID: 37209198 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
declare.


672. BMC Psychol. 2023 May 19;11(1):164. doi: 10.1186/s40359-023-01208-0.

Views and experiences of migrants and stakeholders involved in social and health 
care for migrants in Italy during the COVID-19 pandemic: a qualitative study.

Lotito C(1)(2), Turrini G(3)(4), Purgato M(1)(2), Bryant RA(5), Felez-Nobrega 
M(6)(7), Haro JM(6)(7), Lorant V(8), McDaid D(9), Mediavilla R(10)(11)(12), 
Melchior M(13), Nicaise P(8), Nosè M(1)(2), Park AL(9), McGreevy KR(10)(11), 
Roos R(14), Tortelli A(13), Underhill J(15), Martinez JV(13), Witteveen A(14), 
Sijbrandij M(14), Barbui C(1)(2).

Author information:
(1)WHO Collaborating Centre for Research and Training in Mental Health and 
Service Evaluation, Department of Neuroscience, Biomedicine and Movement 
Sciences, Section of Psychiatry, University of Verona, Verona, Italy.
(2)Cochrane Global Mental Health, University of Verona, Verona, Italy.
(3)WHO Collaborating Centre for Research and Training in Mental Health and 
Service Evaluation, Department of Neuroscience, Biomedicine and Movement 
Sciences, Section of Psychiatry, University of Verona, Verona, Italy. 
giulia.turrini@univr.it.
(4)Cochrane Global Mental Health, University of Verona, Verona, Italy. 
giulia.turrini@univr.it.
(5)School of Psychology, University of New South Wales, Sydney, Australia.
(6)Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, 
Barcelona, Spain.
(7)Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, 
Spain.
(8)Institute of Health and Society (IRSS), Université Catholique de Louvain, 
Brussels, Belgium.
(9)Care Policy and Evaluation Centre, Department of Health, London School of 
Economics and Political Science, London, UK.
(10)Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, 
Spain.
(11)Centro de Investigaci?n Biom?dica en Red de Salud Mental (CIBERSAM), Madrid, 
Spain.
(12)Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.
(13)Département d'Epidémiologie Sociale, Sorbonne Université, INSERM, Institut 
Pierre Louis d'Epidémiologie et de Santé Publique, 27 rue de Chaligny, Paris, 
75012, France.
(14)Department of Clinical, Neuro- and Developmental Psychology, Amsterdam 
Public Health Institute and WHO Collaborating Center for Research and 
Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, 
Amsterdam, The Netherlands.
(15)Research consultant, Brighton, UK.

BACKGROUND: The COVID-19 pandemic has had major and potentially long-lasting 
effects on mental health and wellbeing across populations worldwide. However, 
these impacts were not felt equally, leading to an exacerbation of health 
inequalities, especially affecting vulnerable populations such as migrants, 
refugees and asylum seekers. Aiming to inform the adaptation and implementation 
of psychological intervention programmes, the present study investigated 
priority mental health needs in this population group.
METHODS: Participants were adult asylum seekers, refugees and migrants (ARMs) 
and stakeholders with experience in the field of migration living in Verona, 
Italy, and fluent in Italian and English. A two-stage process was carried out to 
examine their needs using qualitative methods including free listing interviews 
and focus group discussions, according to Module One of the DIME (Design, 
Implementation, Monitoring, and Evaluation) manual. Data were analyzed using an 
inductive thematic analyses approach.
RESULTS: A total of 19 participants (12 stakeholders, 7 ARMs) completed the free 
listing interviews and 20 participants (12 stakeholders and 8 ARMs) attended 
focus group discussions. Salient problems and functions that emerged during free 
listing interviews were discussed during the focus group discussions. During the 
COVID-19 pandemic, ARMs struggled with many everyday living difficulties in 
their resettlement country due to social and economic issues, revealing a strong 
influence of contextual factors in determining mental health. Both ARMs and 
stakeholders highlighted a mismatch between needs, expectations and 
interventions as factors that may hamper proper implementation of health and 
social programmes.
CONCLUSIONS: The present findings could help in the adaptation and 
implementation of psychological interventions targeting the needs of asylum 
seekers, refugees and migrants aiming to find a match between needs, 
expectations, and the corresponding interventions.
TRIAL REGISTRATION: Registration number 2021-UNVRCLE-0106707, February 11 2021.

© 2023. The Author(s).

DOI: 10.1186/s40359-023-01208-0
PMCID: PMC10198022
PMID: 37208725 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


673. J Med Imaging Radiat Sci. 2023 Jun;54(2S):S70-S76. doi: 
10.1016/j.jmir.2023.02.009. Epub 2023 Mar 2.

Systemic disregard, demoralising occupational burnout, protective maturity: The 
'lived' experience of nuclear medicine technologists and the impact of COVID-19.

Shields M(1), James D(2), McCormack L(2).

Author information:
(1)The University of Newcastle, Newcastle, NSW, Australia. Electronic address: 
Melissa.Shields@newcastle.edu.au.
(2)The University of Newcastle, Newcastle, NSW, Australia.

OBJECTIVE: It has been shown that stress in the workplace can contribute to the 
development or worsening of mental health conditions, as well as having a 
negative impact on personal relationships and life outside of work. Therefore, 
prolonged job stress can be damaging to an individual's mental health and 
wellbeing, potentially leading to burnout. There is limited research surrounding 
the wellbeing of nuclear medicine technologists practicing globally, and more 
specifically in Australia. This interpretative phenomenological study seeks the 
lived experience of nuclear medicine technologists within a large metropolitan 
city in Australia, how these experiences and COVID-19 has impacted their 
wellbeing.
METHODS: Five participants were recruited who had greater than five years 
working experience as a nuclear medicine technologist. Data was collected using 
semi-structured interviews conducted online via Zoom to accommodate COVID-19 
restrictions. The data was transcribed and analysed according to interpretative 
phenomenological analysis (IPA) protocols.
RESULTS: One superordinate theme: systemic regard, demoralizing burnout, 
protective maturity, overarched four subordinate themes: staying physically and 
psychologically safe; risk of burnout; maturity as protective against burnout; 
and COVID-19 drain. Pressures both prior to and during COVID-19 leave the 
participants feeling undervalued, discredited, and at risk of burnout. However, 
maturity brings confidence to incorporate their strengths in a more holistic 
view of life. Glimmers of positivity come from choices to alter their career 
path and the unexpected opportunities to spend time with family through COVID-19 
restrictions.
DISCUSSION: Overall, the participants of this study expressed a lack of 
positivity about their own individual experiences within their career. 
Occupational stress, caused by workplace bullying, increased workload and 
understaffing increased their risk of burnout. Although as the participants 
matured, their ability to cope with occupational stressors improved. The recent 
COVID-19 pandemic exacerbated the participants' risk of burnout.
CONCLUSION: Due to a number of contributing workplace factors, exacerbated by 
the unexpected COVID-19 pandemic, participants in this study appeared to have an 
increased risk of developing burnout. However, maturity and life experience has 
helped mitigate this risk.

OBJECTIF: Il a été démontré que le stress au travail peut contribuer au 
développement ou à l'aggravation de troubles de la santé mentale, et avoir une 
incidence négative sur les relations personnelles et la vie en dehors du 
travail. Par conséquent, un stress professionnel prolongé peut être 
préjudiciable à la santé mentale et au bien-être d'un individu, et peut conduire 
à l'épuisement professionnel. Il existe peu de recherches sur le bien-être des 
technologues en médecine nucléaire dans le monde, et plus particulièrement en 
Australie. Cette étude phénoménologique interprétative s'intéresse à 
l'expérience vécue par les technologues en médecine nucléaire dans une grande 
ville métropolitaine d'Australie, et à la façon dont ces expériences et la 
pandémie de COVID-19 ont eu une incidence sur leur bien-être.
MÉTHODOLOGIE: Cinq participants ayant plus de cinq ans d'expérience 
professionnelle en tant que technologue en médecine nucléaire ont été recrutés. 
Les données ont été recueillies au moyen d'entretiens semi-structurés menés en 
ligne via Zoom pour tenir compte des restrictions liées à la COVID-19. Les 
données ont été transcrites et analysées selon les protocoles de l'analyse 
phénoménologique interprétative.
RÉSULTATS: Un thème superordonné : regard systémique, épuisement démoralisant, 
maturité protectrice, surplombe quatre thèmes subordonnés : rester en sécurité 
physiquement et psychologiquement; risque d'épuisement; maturité comme 
protection contre l'épuisement; et l'épuisement découlant de la COVID-19. Les 
pressions exercées avant et pendant la pandémie de COVID-19 donnent aux 
participants le sentiment d'être sous-estimés, discrédités et de risquer le 
burnout. Cependant, la maturité apporte la confiance nécessaire pour intégrer 
leurs forces dans une vision plus holistique de la vie. Des lueurs de positivité 
proviennent du choix de modifier leur parcours professionnel et des opportunités 
inattendues de passer du temps avec leur famille grâce aux restrictions liées à 
la COVID-19.
DISCUSSION: Dans l'ensemble, les participants à cette étude ont exprimé un 
manque de positivité quant à leurs expériences individuelles au sein de leur 
carrière. Le stress professionnel, causé par l'intimidation au travail, 
l'augmentation de la charge de travail et le manque de personnel, a augmenté 
leur risque d'épuisement professionnel. Bien que les participants aient mûri, 
leur capacité à faire face aux facteurs de stress professionnel s'est améliorée. 
La récente pandémie de COVID-19 a exacerbé le risque d'épuisement professionnel 
des participants.
CONCLUSION: En raison d'un certain nombre de facteurs liés au lieu de travail, 
exacerbés par la pandémie inattendue de COVID-19, les participants à cette étude 
semblaient avoir un risque accru de développer un épuisement professionnel. 
Cependant, la maturité et l'expérience de vie ont contribué à atténuer ce 
risque.

Copyright © 2023. Published by Elsevier Inc.

DOI: 10.1016/j.jmir.2023.02.009
PMCID: PMC9977609
PMID: 37208217 [Indexed for MEDLINE]


674. Front Public Health. 2023 May 3;11:1152366. doi: 10.3389/fpubh.2023.1152366. 
eCollection 2023.

Exploring mental health challenges and coping strategies in university students 
during the COVID-19 pandemic: A case study in Dhaka city, Bangladesh.

Billah M(1), Rutherford S(2), Akhter S(3), Tanjeela M(1).

Author information:
(1)Department of Sociology, East West University, Dhaka, Bangladesh.
(2)School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, 
Australia.
(3)School of Health and Social Development, Deakin University, Melbourne, VIC, 
Australia.

BACKGROUND: Mental health challenges have emerged worldwide during the COVID-19 
pandemic. University students experienced changes in their lifestyles, academic 
life, family relationships, earning capacity, and support systems. This study 
explores the common mental health challenges in university students and their 
coping strategies using social support in the first wave of lockdowns in Dhaka 
city in 2020. By learning from young people's impacts and coping responses, we 
can help build an improved strategy for future events of this magnitude.
METHODS: A qualitative study design was employed to conduct 20 in-depth 
interviews and two focus group discussions with students from purposively 
selected three public and three private universities in Dhaka city and five key 
informant interviews with different stakeholders. We used inductive reflexive 
thematic analysis and applied six phases of the thematic analysis. Codes 
retrieved from two differently prepared codebooks were merged and compared to 
identify themes for a fair interpretation of the underlying data. Data were 
manually indexed, summarized, and interpreted to categorize codes into 
sub-themes leading to themes.
RESULTS: Financial constraints, academic pressure, learning resources shortages, 
losing confidence, relationship breakup, excessive internet dependency, and 
traumatic experiences challenged the mental health conditions of the students 
unevenly across universities during the COVID-19 pandemic. Expressed mental 
health well-being impacts ranged from anxiety, stress, and depression to 
self-harm and suicidal ideation. Family bonding and social networking appeared 
as robust social support mechanisms to allow students to cope with anxiety, 
stress, and depression. Partial financial subsidies, soft loans to purchase 
electronic resources, faculty members' counseling, and sessional health 
counseling contributed to minimizing the mental health impacts of COVID-19.
CONCLUSION: Mental health is still not a resourced area of health and well-being 
in Bangladesh. Concentration on developing strong social support and improving 
increased financial subsidies, including learning resources, can be effective in 
assisting students in coping with the common mental health burdens during 
pandemic periods. A national intervention plan should be immediately designed 
and implemented by engaging different stakeholders including healthcare 
professionals and establishing effective mental healthcare support centers at 
universities to avoid immediate and prolonged negative mental health impacts.

Copyright © 2023 Billah, Rutherford, Akhter and Tanjeela.

DOI: 10.3389/fpubh.2023.1152366
PMCID: PMC10188952
PMID: 37206868 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


675. JNMA J Nepal Med Assoc. 2023 Mar 1;61(259):249-251. doi: 10.31729/jnma.8067.

Depression, Anxiety and Stress among School-going Adolescents of a Secondary 
School: A Descriptive Cross-sectional Study.

Shrestha S(1), Phuyal R(1), Chalise P(2).

Author information:
(1)Department of Paediatrics, Kathmandu Medical College and Teaching Hospital, 
Sinamangal, Kathmandu, Nepal.
(2)Department of Psychiatry, Kathmandu Medical College and Teaching Hospital, 
Sinamangal, Kathmandu, Nepal.

INTRODUCTION: Mental health of adolescents can affect growth and development, 
decrease school performance, and impair social relationships with peers and 
families. The COVID-19 pandemic has changed the social and educational scenario 
and affected the psychological condition of children and adolescents. This study 
aimed to find out the prevalence of depression, anxiety and stress among 
school-going adolescents in a secondary school.
METHODS: A descriptive cross-sectional study was done among school-going 
adolescents of a school from 1 October 2021 to 31 November 2021. Ethical 
approval was taken from the Institutional Review Committee (Reference number: 
0609202101). Data was collected using a questionnaire consisting of 
sociodemographic parameters and a diagnosis of depression anxiety and stress was 
made using a standard scale. The whole sampling method was used. Percentage and 
frequency were calculated for binary data.
RESULTS: Among 95 patients, the depression was found in 31 (32.63%), anxiety in 
36 (37.89%), and stress in 3 (3.16%).
CONCLUSIONS: The prevalence of depression, anxiety and stress was lower than in 
other studies done in similar settings. The mental health status of school-going 
adolescents should be identified and appropriate timely interventions need to be 
taken. Family members, teachers and the concerned authorities should give 
emphasis to the psychological well-being of the adolescents.
KEYWORDS: adolescent; anxiety; depression; stress.

DOI: 10.31729/jnma.8067
PMCID: PMC10231532
PMID: 37203951 [Indexed for MEDLINE]

Conflict of interest statement: None.


676. Psychol Psychother. 2023 Dec;96(4):833-848. doi: 10.1111/papt.12471. Epub 2023 
May 19.

Exploring experiences of moral injury and distress among health care workers 
during the Covid-19 pandemic.

Denham F(1), Varese F(1)(2), Hurley M(1), Allsopp K(1)(2).

Author information:
(1)Division of Psychology and Mental Health, School of Health Sciences, Faculty 
of Biology, Medicine and Health, Manchester Academic Health Science Centre, The 
University of Manchester, Manchester, UK.
(2)Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health 
NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.

OBJECTIVE: Health care workers have been exposed to a variety of practical and 
emotional challenges because of the Covid-19 pandemic, leaving them vulnerable 
to experiencing moral injury and distress. However, there is currently sparse 
research which directly explores such experiences. This study aimed to explore 
and characterise the experiences and impacts of moral injury and distress among 
health care workers during the pandemic.
METHODS: Twenty semi-structured interviews were conducted with health care 
workers employed across both mental and physical health care services. 
Interviews were analysed from a critical realist perspective using thematic 
analysis.
RESULTS: Three key themes were identified: attitudes towards moral injury, 
experiences of moral injury and consequences of moral injury. Participants 
appeared to identify with the idea of acting against their morals to varying 
extents based on their job roles. Participants experienced a range of 
potentially morally injurious and distressing events throughout the pandemic and 
many ultimately felt that they provided sub-standard levels of care due to 
extreme pressures on services. Detrimental impacts upon wellbeing were commonly 
reported, including high levels of emotional distress and feelings of guilt and 
shame. Some reported a loss of enthusiasm for their job and a desire to leave 
the profession entirely.
CONCLUSION: Moral injury and distress presents a real concern for staff 
wellbeing and retention within the profession. During and beyond the Covid-19 
pandemic, there is an urgent need for health care providers to implement wider 
strategies to target moral injury and distress, and support staff within health 
care settings.

© 2023 The Authors. Psychology and Psychotherapy: Theory, Research and Practice 
published by John Wiley & Sons Ltd on behalf of The British Psychological 
Society.

DOI: 10.1111/papt.12471
PMID: 37203424 [Indexed for MEDLINE]


677. J Psychiatr Res. 2023 Jul;163:63-67. doi: 10.1016/j.jpsychires.2023.04.014. Epub 
2023 Apr 29.

Dramatic increase of suicidality in children and adolescents after COVID-19 
pandemic start: A two-year longitudinal study.

García-Fernández L(1), Romero-Ferreiro V(2), Izquierdo-Izquierdo M(3), Rodríguez 
V(4), Alvarez-Mon MA(5), Lahera G(6), Santos JL(7), Rodriguez-Jimenez R(8).

Author information:
(1)Clinical Medicine Department. Universidad Miguel Hernández, Ctra. de 
Valencia, Km 87, 03550, San Juan, Alicante, Spain; Department of Psychiatry. 
Hospital Universitario de San Juan, Ctra, N-332, S/n, 03550, San Juan, Alicante, 
Spain; CIBERSAM-ISCIII (Biomedical Research Networking Centre in Mental Health), 
Spain. Electronic address: lorena.garciaf@umh.es.
(2)CIBERSAM-ISCIII (Biomedical Research Networking Centre in Mental Health), 
Spain; Universidad Europea de Madrid, Madrid, Spain; Department of Psychiatry. 
Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Av. 
Córdoba S/n, 28041, Madrid, Spain.
(3)Department of Psychiatry. Hospital Universitario de San Juan, Ctra, N-332, 
S/n, 03550, San Juan, Alicante, Spain.
(4)Department of Psychosis Studies. Institute of Psychiatry, Psychology & 
Neuroscience. King's College, 16 De Crespigny Park, London, SE5 8AF, United 
Kingdom.
(5)Department of Medicine and Medical Specialities, University of Alcala, 28801, 
Alcala de Henares, Madrid, Spain; Ramón y Cajal Institute of Sanitary Research 
(IRYCIS), 28034, Madrid, Spain; Department of Psychiatry and Mental Health. 
Hospital Universitario Infanta Leonor, Madrid, Spain.
(6)CIBERSAM-ISCIII (Biomedical Research Networking Centre in Mental Health), 
Spain; Department of Medicine and Medical Specialities, University of Alcala, 
28801, Alcala de Henares, Madrid, Spain; Ramón y Cajal Institute of Sanitary 
Research (IRYCIS), 28034, Madrid, Spain; Príncipe de Asturias University 
Hospital, Alcalá, Madrid, Spain.
(7)Department of Psychiatry, Hospital Virgen de La Luz, Cuenca, Spain; 
Neurobiological Research Group. Institute of Technology. Universidad de 
Castilla-La Mancha, Cuenca, Spain.
(8)CIBERSAM-ISCIII (Biomedical Research Networking Centre in Mental Health), 
Spain; Department of Psychiatry. Instituto de Investigación Sanitaria Hospital 
12 de Octubre (imas12), Av. Córdoba S/n, 28041, Madrid, Spain; Universidad 
Complutense de Madrid (UCM), Plaza Ramón y Cajal, S/n, 28040, Madrid, Spain.

The COVID-19 pandemic has impacted the mental health of the youngest, worsening 
their emotional well-being. The demand for care in psychiatric emergencies may 
indirectly reflect the mental health state of children and adolescents and the 
emotional consequences of the pandemic. Moreover, suicidality can be considered 
a marker of severity in this population group. Therefore, we have aimed to 
longitudinally describe the number of children and adolescents attended in the 
psychiatry emergency department due to suicidal ideation or attempts and, to 
explore differences in suicidality according to gender and age. A retrospective 
study was carried out in the University Hospital of San Juan, Alicante, Spain, 
from January 01, 2018 to December 31, 2021. A total of 138 participants under 18 
years requesting psychiatric care due to suicidal ideation or attempts were 
included. The sample was composed by 35% of males and the mean age was 14.8 
years old (SD = 2.2). The number of cases per year range from 10 in 2018 to 88 
in 2021. Attendances were significantly higher between 2021 and the three 
previous years. Besides, the number of attentions registered in the last 9 
months of 2021 equals those that occurred in the entire previous period. Most of 
the cases were girls and middle adolescents. Suicide ideation or attempts have 
skyrocketed in children and adolescents. This alarming increase presents a 
one-year lag peak from the COVID-19 outbreak and continues until the end of 
2021. Girls and those over 12 years have been identified as risk groups to 
present suicidal ideation or attempts.

Copyright © 2023. Published by Elsevier Ltd.

DOI: 10.1016/j.jpsychires.2023.04.014
PMCID: PMC10148600
PMID: 37201239 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest Dr. R. 
Rodriguez-Jimenez has been a consultant for, spoken in activities of, or 
received grants from: Instituto de Salud Carlos III, Fondo de Investigación 
Sanitaria (FIS), Centro de Investigación Biomédica en Red de Salud Mental 
(CIBERSAM), Madrid Regional Government (S2010/BMD-2422 AGES; S2017/BMD-3740), 
JanssenCilag, Lundbeck, Otsuka, Pfizer, Ferrer, Juste, Takeda, Exeltis, 
Casen-Recordati, Angelini. Dr. G. Lahera has been a consultant to or has 
received honoraria or grants from Janssen-Cilag, Otsuka-Lundbeck, Lilly, 
Astra-Zeneca, CIBERSAM and Instituto de Salud Carlos III. All other authors 
declare that they have no conflict of interest.


678. BMJ Lead. 2023 Jun;7(2):102-107. doi: 10.1136/leader-2022-000622. Epub 2022 Sep 
12.

"See us as humans. Speak to us with respect. Listen to us." A qualitative study 
on UK ambulance staff requirements of leadership while working during the 
COVID-19 pandemic.

Eaton-Williams PJ(1), Williams J(2)(3).

Author information:
(1)Research and Development Department, South East Coast Ambulance Service NHS 
Foundation Trust, Crawley, West Sussex, UK pete.eaton-williams@secamb.nhs.uk.
(2)Research and Development Department, South East Coast Ambulance Service NHS 
Foundation Trust, Crawley, West Sussex, UK.
(3)Research, College of Paramedics, Bridgwater, UK.

BACKGROUND: The COVID-19 Ambulance Response Assessment (CARA) study aimed to 
enable the experiences of UK frontline ambulance staff working during the first 
wave of the pandemic to be heard. Specifically, CARA aimed to assess feelings of 
preparedness and well-being and to collect suggestions for beneficial leadership 
support.
METHODS: Three online surveys were sequentially presented between April and 
October 2020. Overall, 18 questions elicited free-text responses that were 
analysed qualitatively using an inductive thematic approach.
FINDINGS: Analysis of 14 237 responses revealed participants' goals and their 
requirements of leadership to enable those goals to be achieved. A large number 
of participants expressed low confidence and anxiety resulting from 
disagreement, inconsistency and an absence of transparency related to policy 
implementation. Some staff struggled with large quantities of written 
correspondence and many desired more face-to-face training and an opportunity to 
communicate with policymakers. Suggestions were made on how best to allocate 
resources to reduce operational demands and maintain service delivery, and a 
need to learn from current events in order to plan for the future was stressed. 
To further support well-being, staff wanted leadership to understand and 
empathise with their working conditions, to work to reduce the risks and if 
required, to facilitate access to appropriate therapeutic interventions.
CONCLUSIONS: This study demonstrates that ambulance staff desire both inclusive 
and compassionate leadership. Leadership should aim to engage in honest dialogue 
and attentive listening. Resultant learning can then inform policy development 
and resource allocation to effectively support both service delivery and staff 
well-being.

© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and 
permissions. Published by BMJ.

DOI: 10.1136/leader-2022-000622
PMID: 37200184 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: JW is Head of Research for 
the College of Paramedics and additionally for the South East Coast Ambulance 
Service NHS Foundation Trust.


679. Nurs Crit Care. 2024 Jan;29(1):32-39. doi: 10.1111/nicc.12930. Epub 2023 May 17.

The impact of COVID-19 on mental health and well-being in critical care nurses - 
a longitudinal, qualitative study.

Credland N(1), Griffin M(2), Hamilton P(3), Harness O(4), McMurray R(5).

Author information:
(1)Reader, Faculty of Health Sciences, The University of Hull, Cottingham Road, 
Hull, UK.
(2)Sheffield University Management School, Sheffield University, Sheffield, UK.
(3)Human Resource Management, Durham University Business School, Durham 
University, Durham, UK.
(4)Lecturer in Critical Management and Org Studies, Newcastle Business School, 
Northumbria University, Newcastle upon Tyne, UK.
(5)Graduate School of Healthcare Management (GSM), Royal College of Surgeons in 
Ireland, Dublin, Ireland.

BACKGROUND: The COVID-19 pandemic has had both a psychological and physiological 
effect on the human race. For those working in health care, particularly in 
critical care, the pandemic has put unprecedented strain on staff. Witnessing 
suffering during crisis in an organizational setting can be a traumatic 
experience and critical care nurses often risked, not only their own lives, but 
their psychological well-being, so that those infected with the virus might have 
a better chance at survival.
AIM: The aim of this study was to explore the challenges to mental health and 
psychological well-being experienced by Critical Care Nurses during the COVID-19 
pandemic.
STUDY DESIGN: A longitudinal, qualitative study involving semi-structured 
interviews with 54 critical care nurses across 38 hospitals in the United 
Kingdom and Ireland. Interviews were transcribed verbatim and analysed using 
thematic analysis.
RESULTS: Four key themes were identified which represent the challenges faces by 
critical care nurses during the COVID-19 pandemic: Lack of control, 
Psychological trauma, Unexpected leadership, Public-political betrayal.
CONCLUSIONS: While public-political praise may lead to a short-term lift in 
morale for front line workers; where it is not accompanied by practical support 
in terms of appropriate equipment, leadership, emotional support and 
renumeration it is likely to be damaging in the longer term.
RELEVANCE TO CLINICAL PRACTICE: This study has provided a greater understanding 
of the factors which affected the well-being and mental health of critical care 
nurses during a global pandemic.

© 2023 British Association of Critical Care Nurses.

DOI: 10.1111/nicc.12930
PMID: 37198703 [Indexed for MEDLINE]


680. Sci Rep. 2023 May 17;13(1):7972. doi: 10.1038/s41598-023-34544-7.

A muti-informant national survey on the impact of COVID-19 on mental health 
symptoms of parent-child dyads in Canada.

Leigh JP(#)(1), Moss SJ(#)(2), Sriskandarajah C(2), McArthur E(3), Ahmed SB(4), 
Birnie K(5)(6), Halperin D(7), Halperin S(8), Harley M(9), Hu J(6), Ng Kamstra 
J(10), Leppan L(2), Nickel A(2), Racine N(11), Russell K(12), Smith S(13), Solis 
M(2), Stelfox M(2), Tutelman PR(14), Stelfox HT(15)(16), Fiest KM(15)(16).

Author information:
(1)Faculty of Health, Dalhousie University, Halifax, NS, Canada. 
J.ParsonsLeigh@dal.ca.
(2)Faculty of Health, Dalhousie University, Halifax, NS, Canada.
(3)London Health Sciences Centre, London, ON, Canada.
(4)Department of Medicine, University of Calgary, Calgary, AB, Canada.
(5)Department of Anesthesiology, Perioperative, and Pain Medicine, Calgary, 
Canada.
(6)Department of Community Health Sciences, University of Calgary, Calgary, AB, 
Canada.
(7)Rankin School of Nursing, St. Francis Xavier University, Antigonish, NS, 
Canada.
(8)Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
(9)Frayme, Cornwall, ON, Canada.
(10)Department of Surgery, University of Hawaii John A Burns School of Medicine, 
Honolulu, HI, Canada.
(11)Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada.
(12)Sepsis Canada, Hamilton, ON, Canada.
(13)Young Canadian Roundtable On Health, Toronto, ON, Canada.
(14)Department of Oncology, University of Calgary, Calgary, Canada.
(15)Department of Critical Care Medicine, Calgary, Canada.
(16)O'Brien Institute for Public Health, University of Calgary, Calgary, Canada.
(#)Contributed equally

The COVID-19 pandemic negatively impacted the mental health of children, youth, 
and their families which must be addressed and prevented in future public health 
crises. Our objective was to measure how self-reported mental health symptoms of 
children/youth and their parents evolved during COVID-19 and to identify 
associated factors for children/youth and their parents including sources 
accessed for information on mental health. We conducted a nationally 
representative, multi-informant cross-sectional survey administered online to 
collect data from April to May 2022 across 10 Canadian provinces among dyads of 
children (11-14 years) or youth (15-18 years) and a parent (> 18 years). 
Self-report questions on mental health were based on The Partnership for 
Maternal, Newborn & Child Health and the World Health Organization of the United 
Nations H6+ Technical Working Group on Adolescent Health and Well-Being 
consensus framework and the Coronavirus Health and Impact Survey. McNemar's test 
and the test of homogeneity of stratum effects were used to assess differences 
between children-parent and youth-parent dyads, and interaction by 
stratification factors, respectively. Among 933 dyads (N = 1866), 349 (37.4%) 
parents were aged 35-44 years and 485 (52.0%) parents were women; 227 (47.0%) 
children and 204 (45.3%) youth were girls; 174 (18.6%) dyads had resided in 
Canada < 10 years. Anxiety and irritability were reported most frequently among 
child (44, 9.1%; 37, 7.7%) and parent (82, 17.0%; 67, 13.9%) dyads, as well as 
among youth (44, 9.8%; 35, 7.8%) and parent (68, 15.1%; 49, 10.9%) dyads; 
children and youth were significantly less likely to report worsened anxiety 
(p < 0.001, p = 0.006, respectively) or inattention (p < 0.001, p = 0.028, 
respectively) compared to parents. Dyads who reported financial or housing 
instability or identified as living with a disability more frequently reported 
worsened mental health. Children (96, 57.1%), youth (113, 62.5%), and their 
parents (253, 62.5%; 239, 62.6%, respectively) most frequently accessed the 
internet for mental health information. This cross-national survey 
contextualizes pandemic-related changes to self-reported mental health symptoms 
of children, youth, and families.

© 2023. The Author(s).

DOI: 10.1038/s41598-023-34544-7
PMCID: PMC10189235
PMID: 37198202 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


681. Appl Psychol Health Well Being. 2023 Nov;15(4):1472-1489. doi: 
10.1111/aphw.12447. Epub 2023 May 17.

The perks of being grateful to partners: Expressing gratitude in relationships 
predicts relational self-efficacy and life satisfaction during the COVID-19 
pandemic.

Buenconsejo JU(1), Fincham FD(2), Datu JAD(1).

Author information:
(1)Department of Special Education and Counselling, The Education University of 
Hong Kong, Hong Kong SAR, China.
(2)FSU Family Institute, Florida State University, Tallahassee, Florida, USA.

Being grateful to one's partner matters for a diverse range of interpersonal and 
individual well-being outcomes. However, there is little investigation on the 
psychological benefits of expressing gratitude to partners during the 
coronavirus 2019 (COVID-19) pandemic. Using a short-term longitudinal design, 
this study of undergraduate students (Mage  = 20.31; SDage  = 1.81; n = 268) in 
the United States explores the link between expressing gratitude in romantic 
relationships, subsequent relationship self-efficacy, life satisfaction, 
psychological well-being, and the COVID-19 anxiety. Results demonstrated that 
expressing gratitude in relationships positively predicted subsequent 
relationship self-efficacy and life satisfaction even after controlling for age, 
gender, ethnic background, trait gratitude, and auto-regressor effects. These 
findings show that relational gratitude had incremental validity in predicting 
relational self-efficacy and subjective well-being above and beyond the effects 
of demographic factors and dispositional gratitude. This research emphasizes the 
psychological payoffs of cultivating gratitude in relational contexts.

© 2023 International Association of Applied Psychology.

DOI: 10.1111/aphw.12447
PMID: 37195635 [Indexed for MEDLINE]


682. Stress Health. 2024 Feb;40(1):e3274. doi: 10.1002/smi.3274. Epub 2023 May 17.

Emotion regulation styles and Adolescent adjustment following a COVID-19 
lockdown.

Scharf N(1), Benita M(1), Benish-Weisman M(2).

Author information:
(1)Ben-Gurion University of the Negev, Beer-Sheva, Israel.
(2)The Hebrew University of Jerusalem, Jerusalem, Israel.

This study explored the effect of emotion regulation styles - integrative 
emotion regulation (IER), suppressive emotion regulation, and dysregulation-on 
adolescents' psychosocial adjustment following a Covid-19-related lockdown. 114 
mother-adolescent dyads were surveyed after lockdown and at two additional time 
points (three and six months later). Adolescents were aged 10-16 years, 50.9% 
females. Adolescents reported on their emotion regulation styles. Mothers and 
adolescents reported on adolescents' well-being (depressive symptoms, negative 
and positive emotions) and social behaviour (aggression and prosocial 
behaviour). Results of multilevel linear growth models showed IER predicted 
optimal well-being and social behaviour reported by both mothers and adolescents 
at baseline and a self-reported reduction in prosocial behaviours over time. 
Suppressive emotion regulation predicted reduced self-reported well-being after 
lockdown, evident in higher levels of negative affect and depressive symptoms 
and reductions in mother-reported prosocial behaviour over time. Dysregulation 
predicted reduced well-being and impaired social behaviour after lockdown, 
reported by both mothers and adolescents, and a reduction in self-reported 
depressive symptoms over time. Results suggest adolescents' adjustment to 
lockdown was affected by their habitual emotion regulation styles.

© 2023 The Authors. Stress and Health published by John Wiley & Sons Ltd.

DOI: 10.1002/smi.3274
PMID: 37195084 [Indexed for MEDLINE]


683. Scand J Caring Sci. 2023 Jun;37(2):350-363. doi: 10.1111/scs.13115. Epub 2022 
Aug 17.

Informal care burden during the COVID-19 pandemic in Flanders, Belgium: The role 
of perceived threat, personality and resilience.

De Coninck D(1), Van Doren S(2), Matthijs K(1), Declercq A(1)(2).

Author information:
(1)Centre for Sociological Research, KU Leuven, Leuven, Belgium.
(2)LUCAS Centre for Care Research and Consultancy, KU Leuven, Leuven, Belgium.

BACKGROUND: In this study, we investigate how socio-demographic characteristics 
(age, gender and education) and informal care relationship characteristics 
(e.g., time spent on care, number of informal caregivers, professional care) are 
linked with informal care burden during the COVID-19 pandemic. In addition, we 
expect this burden to differ by personality characteristics, degree of 
resilience, and-in this specific context-perceived the COVID-19 threat.
METHOD: We used the fifth wave of a longitudinal study to identify 258 informal 
caregivers. These online survey data came from a five-wave longitudinal study in 
Flanders, Belgium that ran from April 2020 to April 2021. Data were 
representative of the adult population by age and gender. Analyses include 
t-tests, ANOVA, SEM and binomial logistic regression.
RESULTS: We found that the informal care burden was strongly linked with a 
socio-economic gradient, time investment changes in care since the start of the 
pandemic, and whether there was more than one informal caregiver. Personality 
traits such as agreeableness and openness to experience, and the perceived 
threat of COVID-19 were also related to care burden.
CONCLUSIONS: During the pandemic, informal caregivers were put under extra 
considerable pressure: restrictive government measures sometimes led to the 
temporary suspension of some or all professional care for persons with care 
needs, which may have resulted in a growing psychosocial burden. We recommend 
that, in the future, the focus should be on supporting the mental wellbeing and 
social participation of caregivers along with measures to protect caregivers and 
their relatives from COVID-19. Support structures for informal caregivers should 
be kept running during crises now and in the future, but it is also important to 
adopt a case-by-case basis to consider support for informal caregivers.

© 2022 Nordic College of Caring Science.

DOI: 10.1111/scs.13115
PMCID: PMC9539008
PMID: 37195074 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


684. BMJ Lead. 2023 Sep;7(3):178-181. doi: 10.1136/leader-2022-000687. Epub 2023 Mar 
10.

Burn-out in the health workforce during the COVID-19 pandemic: opportunities for 
workplace and leadership approaches to improve well-being.

Smallwood N(1)(2), Bismark M(3), Willis K(4).

Author information:
(1)Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, 
Australia Natasha.smallwood@monash.edu.
(2)Respiratory Research@Alfred, Central Clinical School, The Alfred Hospital, 
Monash University, Clayton, Victoria, Australia.
(3)Centre for Health Policy, Melbourne School of Population and Global Health, 
The University of Melbourne, Parkville, Victoria, Australia.
(4)Institute for Health and Sport, Victoria University, Melbourne, Victoria, 
Australia.

BACKGROUND: Burn-out is a long-standing problem among healthcare workers (HCWs) 
and leads to poorer quality and less safe patient care, lower patient 
satisfaction, absenteeism and reduced workforce retention. Crises such as the 
pandemic not only generate new challenges but also intensify existing workplace 
stresses and chronic workforce shortages. As the COVID-19 pandemic continues, 
the global health workforce is burnt-out and under immense pressure, with 
multiple individual, organisational and healthcare system drivers.
METHOD: In this article, we examine how key organisational and leadership 
approaches can facilitate mental health support for HCWs and identify strategies 
to support HCWs that are critical for supporting workforce well-being during the 
pandemic.
RESULTS: We identified 12 key approaches at the organisational and individual 
levels for healthcare leadership to support workforce well-being during the 
COVID-19 crisis. These approaches may inform leadership responses to future 
crises.
CONCLUSION: Governments, healthcare organisations and leaders must invest and 
deliver long-term measures to value, support and retain the health workforce to 
preserve high-quality healthcare.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/leader-2022-000687
PMID: 37192091 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


685. J Prof Nurs. 2023 May-Jun;46:83-91. doi: 10.1016/j.profnurs.2023.02.010. Epub 
2023 Mar 17.

The link among academic stress, sleep disturbances, depressive symptoms, 
academic performance, and the moderating role of resourcefulness in health 
professions students during COVID-19 pandemic.

Alhamed AA(1).

Author information:
(1)College of Nursing, King Saud bin Abdulaziz University for Health Sciences, 
Prince Mutip Ibn Abdullah Ibn Abdulaziz Rd, Ar Rimayah, Riyadh 14611, Saudi 
Arabia. Electronic address: Hamedar@ksau-hs.edu.sa.

BACKGROUND: The rapid shift to virtual learning in response to the COVID-19 
pandemic contributed to high academic stress among health profession students. 
High academic stress was associated with impaired psychosocial well-being and 
decreased academic performance.
OBJECTIVES: The purpose of this study was to assess the relationship between 
academic stress, anxiety, sleep disturbances, depressive symptoms, academic 
performance, and the moderating effect of resourcefulness among undergraduate 
health profession students.
METHODS: This descriptive and cross-sectional study included undergraduate 
health profession students. The primary investigator distributed the study link 
to all students through the university's Central Messaging Centre, Twitter 
account, and WhatsApp. The study variables were measured using the Student Life 
Stress Inventory, the Generalized Anxiety Disorder-7 questionnaire, the Centre 
for Epidemiology Scale of Depression, the Pittsburgh Sleep Quality Index, and 
the Resourcefulness Skills Scale. Pearson R correlation and linear regression 
analysis were utilized for statistical analysis.
RESULTS: Our sample included 94 undergraduate health profession students, 60 % 
of which were females with a mean age of 21, and the majority were nursing and 
medicine students. High academic stress, anxiety, sleep disturbances, depressive 
symptoms, and resourcefulness were reported among 50.6 %, 43 %, 79.6 %, 60.2 %, 
and 60 % of the participants, respectively. However, no effect of 
resourcefulness was found on any of the study variables. Instead, academic 
stress and sleep disturbances were the strongest predictors of depressive 
symptoms regardless of the level of resourcefulness.
CONCLUSION: Adequate academic support during virtual learning and tools to early 
detect subtle signs of high academic stress, anxiety, depression, and sleep 
disturbance should be routinely utilized by educational institutions. In 
addition, incorporating sleep hygiene and resourcefulness training in health 
professions education is highly indicated.

Copyright © 2023 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.profnurs.2023.02.010
PMCID: PMC10020862
PMID: 37188428 [Indexed for MEDLINE]


686. Can J Occup Ther. 2023 Jun;90(2):161-172. doi: 10.1177/00084174231160954.

Quality of Physical Activity Participation Among Adults with Disabilities 
Through Pandemic Restriction.

Tao G, Singh G, Simpson E, Battalova A, Rash I, Mohammadi S, Schmidt J, Borisoff 
J, Mortenson B, Miller WC.

Background. Physical activity (PA) is essential for maintaining well-being in 
adults with disabilities. This population experienced reduced PA during the 
COVID-19 pandemic; yet, the impact on quality of PA participation remains 
unclear. Purpose. This secondary analysis explored how pandemic restrictions 
impacted six experiential dimensions of quality of PA participation among adults 
with disabilities. Methods. An exploratory sequential mixed-methods design, 
including semi-structured interviews (n  =  10) and self-reported surveys 
(n  =  61), was conducted in May-2020 and February-2021. Quality of PA 
participation was measured using the Measure of Experiential Aspects of 
Participation (MeEAP). Participants included community-dwelling adults over 19 
years of age (mean 59.2  ±  14.0 years) living with stroke, spinal cord injury, 
or other physical disabilities. Findings. Directed content analysis identified 
three themes related to adjusting PA participation for restrictions, motivation 
barriers, and valuing social support. These themes highlighted five factors, 
such as resilience, as potential quantitative predictors of quality of PA 
participation. While paired correlations with MeEAP scores were observed, these 
factors were not statistically predictive in multiple regression analysis 
(adjusted R2 = -0.14, F(10,50)  =  0.92, p  =  .53). Implications. The interplay 
between Meaning, Autonomy, Engagement, and Belongingness dimensions of quality 
of PA participation was complex, with an emphasized role for mental health, in 
adults with disabilities.

Description. L’activité physique est essentielle pour préserver le bien-être des 
adultes qui ont des incapacités. Cette population a dû réduire ses activités 
physiques pendant la pandémie de COVID-19; toutefois, les conséquences sur la 
qualité de la participation aux activités physiques restent incertaines. But. 
Cette analyse secondaire explore la manière dont les restrictions liées à la 
pandémie ont affecté six dimensions expérientielles de la qualité de la 
participation aux activités physiques chez les adultes ayant des incapacités. 
Méthodologie. Une étude à méthode mixte utilisant un devis séquentiel 
exploratoire, comprenant des entretiens semi-dirigés (n  =  10) et des enquêtes 
où les informations étaient autodéclarées (n  =  61), a été réalisée en mai 2020 
et février 2021. La qualité de la participation aux activités physiques a été 
mesurée à l’aide de l’outil Measure of Experiential Aspects of Participation 
(MeEAP). Les participants étaient des adultes de plus de 19 ans vivant dans la 
collectivité (moyenne de 59,2  ±  14,0 ans) et composant avec les suites d’un 
accident vasculaire cérébral, une lésion de la moelle épinière ou un autre 
handicap physique. Résultats. Une analyse descriptive qualitative a permis 
d’identifier trois thèmes liés à l’ajustement de la participation aux activités 
physiques en fonction des restrictions, aux obstacles à la motivation et à la 
valorisation du soutien social. Ces thèmes ont mis en évidence 5 facteurs, tels 
que la résilience, comme prédicteurs quantitatifs potentiels de la qualité de la 
participation aux activités physiques. Bien que des corrélations appariées avec 
les scores MeEAP aient été observées, ces facteurs n’étaient pas statistiquement 
prédictifs dans l’analyse de régression multiple (R2 ajusté  =  -0,14, 
F[10,50]  =  0,92, p  =  0,53). Conséquences. L’interaction entre les dimensions 
de la qualité de la participation aux activités physiques que sont le sens, 
l’autonomie, l’engagement et l’appartenance était complexe, avec un rôle 
accentué pour la santé mentale, chez les adultes présentant des incapacités.

DOI: 10.1177/00084174231160954
PMCID: PMC10189534
PMID: 37186790 [Indexed for MEDLINE]


687. BMJ Open. 2023 Apr 26;13(4):e064033. doi: 10.1136/bmjopen-2022-064033.

Experience of loneliness during the COVID-19 pandemic: a cross-sectional study 
of 50 968 adult Danes.

Christoffersen LA(1), Helenius D(2), Schwinn M(3), Erikstrup C(4), Hjalgrim 
H(5)(6), Nissen J(3), Banasik K(7), Nielsen K(8), Kaspersen KA(4)(9), Dinh 
KM(4), Bruun MT(10), Ostrowski SR(3)(11), Sækmose S(12), Hansen TF(7)(13), Werge 
T(2), Didriksen M(3), Pedersen OB(12).

Author information:
(1)Institute of Biological Psychiatry, Mental Health Services Copenhagen, 
Copenhagen University Hospital, Copenhagen, Denmark 
lea.arregui.nordahl.christoffersen@regionh.dk.
(2)Institute of Biological Psychiatry, Mental Health Services Copenhagen, 
Copenhagen University Hospital, Copenhagen, Denmark.
(3)Department of Clinical Immunology, Copenhagen University Hospital 
Rigshospitalet, Copenhagen, Denmark.
(4)Department of Clinical Immunology, Aarhus University Hospital, Aarhus, 
Denmark.
(5)Danish Cancer Society Research Center, Copenhagen, Denmark.
(6)Department of Epidemiology Research, Statens Serum Institut, Copenhagen, 
Denmark.
(7)Novo Nordisk Foundation Center for Protein Research, University of 
Copenhagen, Copenhagen, Denmark.
(8)Department of Clinical Immunology, Aalborg University Hospital, Aalborg, 
Denmark.
(9)Danish Big Data Centre for Environment and Health (BERTHA), Aarhus 
University, Aarhus, Denmark.
(10)Department of Clinical Immunology, Odense University Hospital, Odense, 
Denmark.
(11)Department of Clinical Medicine, University of Copenhagen, Copenhagen, 
Denmark.
(12)Department of Clinical Immunology, Zealand University Hospital, Køge, 
Denmark.
(13)Department of Neurology, NeuroGenomic Group, Rigshospitalet, Glostrup, 
Denmark.

OBJECTIVES: To examine the level of loneliness experienced during the COVID-19 
pandemic in Denmark and to identify associated behavioural patterns and 
demographic factors.
DESIGN: Cross-sectional cohort study.
SETTING: Includes Danish active and former blood donors.
PARTICIPANTS: A questionnaire was sent to 124 307 active and former blood 
donors, of these a total of 50 968 participants completed the study 
questionnaire (response rate=41%).
PRIMARY AND SECONDARY OUTCOME MEASURES: Subjective experience of loneliness was 
measured using the 3-item University of California, Los Angeles Loneliness Scale 
(UCLA-3). Besides the UCLA-3, the respondents answered items on sociodemographic 
and economic characteristics, items on precautionary measures taken to avoid 
COVID-19 infection as well as on COVID-19 anxiety.
RESULTS: The participants indicated their experienced level of loneliness both 
before and during the pandemic. Comparing the two reports yielded a mean 
increase in loneliness scores of 14.1% (p<0.001). Exploratory factor analysis 
identified the factor well-being, which comprised three questionnaire items 
related to emotional heath, physical health and happiness. A high score on the 
factor well-being was associated with reduced levels of loneliness 
(coefficient=-0.47, 95% CI -0.49 to -0.46)). Furthermore, women were more likely 
than men to have experienced increased levels of loneliness during the pandemic 
(coefficient=0.27, 95% CI 0.25 to 0.29). Furthermore, a negative correlation 
between higher age and change in loneliness score was observed.
CONCLUSIONS: The findings document an increase in the level of experienced 
loneliness during the COVID-19 pandemic, particularly affecting individuals with 
low well-being, women and younger individuals.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2022-064033
PMCID: PMC10151242
PMID: 37185636 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


688. Curr Oncol. 2023 Mar 30;30(4):3886-3900. doi: 10.3390/curroncol30040294.

Psychosocial Wellbeing among Patients with Breast Cancer during COVID-19.

Maculaitis MC(1), Liu X(2), Berk A(3), Massa A(3), Weiss MC(4)(5), Kurosky 
SK(2), Li B(2), McRoy L(2).

Author information:
(1)Cerner Enviza, Malvern, PA 19355, USA.
(2)Pfizer Inc., New York, NY 10017, USA.
(3)Invitae Corporation, San Francisco, CA 94103, USA.
(4)Breastcancer.org, Ardmore, PA 19003, USA.
(5)Lankenau Medical Center, Wynnewood, PA 19096, USA.

The impact of coronavirus disease 2019 (COVID-19) on the wellbeing of breast 
cancer (BC) patients is not well understood. This study described psychosocial 
problems among these patients in the United States (US) during the COVID-19 
pandemic. Data were collected from BC patients via an online self-report survey 
between 30 March-6 July 2021 to assess the prevalence of COVID-19 diagnosis 
history and potential depression, health-related quality of life, COVID-related 
stress, and financial toxicity. Patients with early-stage (eBC) and metastatic 
(mBC) disease were compared. Of 669 patients included in the analysis, the 
prevalence of COVID-19 diagnosis history (10.9% versus 7.7%) and potential 
depression (33.7% versus 28.3%) were higher in mBC than eBC patients. Patients 
with eBC (versus mBC) had higher scores on nearly all Functional Assessment of 
Cancer Therapy-Breast scales (all, p < 0.001). For the Psychological Impact of 
Cancer subscales measuring negative coping strategies, the emotional distress 
score was the highest (9.1 ± 1.8) in the overall sample. Comprehensive Score for 
Financial Toxicity scores were higher in eBC than in mBC patients (24.2 ± 11.3 
vs. 21.3 ± 10.2, p < 0.001). Overall, the COVID-19-related stress score was 
highest for danger/contamination fears (8.2 ± 5.6). In conclusion, impairments 
to psychosocial wellbeing among patients during the pandemic were observed, 
particularly financial toxicity and poor mental health and emotional 
functioning, with greater problems among mBC patients.

DOI: 10.3390/curroncol30040294
PMCID: PMC10136618
PMID: 37185407 [Indexed for MEDLINE]

Conflict of interest statement: M.C.M. is an employee of Cerner Enviza, which 
received funding from Pfizer to conduct and report on the study. X.L., S.K.K., 
B.L. and L.M. are employees and stockholders of Pfizer Inc. A.B. and A.M. are 
employees of Invitae Corporation, which received funding from Pfizer to conduct 
and report on the study. M.C.W. is an employee of Breastcancer.org and practices 
breast radiation oncology at Lankenau Medical Center.


689. BMJ Open. 2023 Apr 25;13(4):e070409. doi: 10.1136/bmjopen-2022-070409.

'I never leave my house without praying': a qualitative exploration of the 
psychospiritual experiences of ethnically diverse healthcare staff during the 
COVID-19 pandemic.

Gill HK(1), Chastney J(2), Patel R(3), Nyatanga B(4), Henshall C(5)(6), Harrison 
G(6).

Author information:
(1)Oxford Institute of Nursing, Midwifery and Allied Health Research (OxINMAHR), 
Oxford Brookes University, Oxford, UK.
(2)Chaplaincy, Oxford Health NHS Foundation Trust, Oxford, UK.
(3)Centre for Healthcare and Communities, Research Institute for Health and 
Wellbeing, Coventry University, Coventry, UK.
(4)The Three Counties School of Nursing and Midwifery, Department of Continuing 
Professional Development, University of Worcester, Worcester, UK.
(5)Oxford Institute of Nursing, Midwifery and Allied Health Research (OxINMAHR), 
Oxford Brookes University, Oxford, UK chenshall@brookes.ac.uk.
(6)Research and Development Department, Oxford Health NHS Foundation Trust, 
Oxford, UK.

OBJECTIVES: The study aimed to understand the psychospiritual experiences and 
support needs of ethnically diverse healthcare staff during the COVID-19 
pandemic.
DESIGN: A qualitative study using focus groups conducted remotely on Microsoft 
Teams.
SETTING: The study took place across 10 National Health Service Trusts in 
England: 5 were Acute Hospital Trusts and 5 were Community and Mental Health 
Trusts.
PARTICIPANTS: Fifty-five participants were recruited to the study across 16 
focus group meetings. Participants were all National Health Service staff from 
ethnically diverse backgrounds.
RESULTS: Psychospiritual concerns were central to participants' understanding of 
themselves and their work in the National Health Service. Participants felt 
there was limited recognition of spirituality within the health service. They 
described close links between their spirituality and their ethnicities and felt 
that the psychospiritual support offered within the healthcare setting was not 
reflective of diverse ethnic and spiritual needs. Improved psychospiritual care 
was viewed as an opportunity to connect more deeply with other colleagues, 
rather than using the more individualistic interventions on offer. Participants 
requested greater compassion and care from leadership teams. Participants 
described both positive and negative changes in their spirituality as a result 
of the COVID-19 pandemic.
CONCLUSIONS: Culturally sensitive psychospiritual support is a key aspect of 
healthcare staff's well-being, despite identified gaps in this area. Aside from 
affecting physical, psychological, social and financial aspects of healthcare 
staff's lives, the pandemic has also had a significant impact on the ways that 
people experience spirituality.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2022-070409
PMCID: PMC10151241
PMID: 37185195 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


690. J Nurs Adm. 2023 Jun 1;53(6):337-343. doi: 10.1097/NNA.0000000000001293. Epub 
2023 May 12.

Thinking, Feeling, Behaving: Using the MINDBODYSTRONG ® Intervention to Improve 
Nurse Well-being Using a Virtual Format.

Price DM(1), Figueroa N, Macera-DiClemente L, Wintermeyer-Pingel S, Riley P, 
Tschannen D.

Author information:
(1)Author Affiliations: Clinical Associate Professor (Dr Price), Clinical 
Assistant Professor (Dr Macera-DiClemente), Clinical Instructor (Dr 
Wintermeyer-Pingel), Director of Undergraduate Studies (Dr Riley), and Associate 
Dean of Undergraduate Studies (Dr Tschannen), University of Michigan School of 
Nursing; and Nurse Leader for Wellbeing (Figueroa), Office of Workplace 
Resilience, University of Michigan Health, Ann Arbor.

OBJECTIVE: This study examined the impact of the MINDBODYSTRONG ® program on 
mental health and lifestyle behaviors among a sample of staff nurses, clinical 
nurse leaders, and faculty, when offered after the onset of the COVID-19 
pandemic.
BACKGROUND: Previous studies have demonstrated the MINDBODYSTRONG program 
decreased anxiety and depressive symptoms, improved job satisfaction, and 
sustained healthy lifestyle behaviors in newly licensed RNs. This program has 
not been studied with experienced nurses. In addition, the use of a virtual 
format is unique.
METHODS: A pre-post design was used for this pilot study. Subjects were 
recruited from a large Midwestern medical center and affiliated school of 
nursing. Registered participants of the MINDBODYSTRONG program attended 7 weekly 
sessions virtually.
RESULTS: The MINDBODYSTRONG intervention suggests sustained improvement in 
perceived stress, anxiety, depression, and use of healthy behaviors.
CONCLUSION: This pilot study supports that the MINDBODYSTRONG program may be 
effective in addressing mental health and healthy lifestyle beliefs for staff 
nurses, clinical nurse leaders, and nursing faculty.

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/NNA.0000000000001293
PMID: 37184457 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


691. Neuro Endocrinol Lett. 2023 Apr 30;44(2):86-96.

Obstruction sleep apnoea and panic disorder.

Vanek J(1), Belohradova Minarikova K(1), Prasko J(1)(2)(3)(4), Genzor S(5)(6), 
Subova D(7), Hodny F(1), Pobeha P(8), Bocek J(1), Ociskova M(1)(3).

Author information:
(1)Department of Psychiatry, Faculty of Medicine and Dentistry, University 
Palacky Olomouc, 77520 Olomouc, Czech Republic.
(2)Department of Psychology Sciences, Faculty of Social Science and Health Care, 
Constantine the Philosopher University in Nitra, Slovak Republic.
(3)Department of Psychotherapy, Institute for Postgraduate Training in Health 
Care, Prague, Czech Republic.
(4)Rehabilitation Hospital Beroun, Jessenia Inc, Akeso Holding, MINDWALK, 
s.r.o., Czech Republic.
(5)Department of Respiratory Medicine, Faculty of Medicine and Dentistry, 
Palacky University Olomouc and University Hospital Olomouc, Czech Republic.
(6)Center for Digital Health, University Hospital and Faculty of Medicine and 
Dentistry, Olomouc, Czech Republic.
(7)Library of Faculty of Medicine and Dentistry, University Palacky in Olomouc, 
Czech Republic.
(8)Department of Respiratory Diseases and Tuberculosis, University Hospital and 
Faculty of Medicine and Dentistry, Pavol Jozef Safarik University Kosice, Slovak 
Republic.

OBJECTIVE: Both panic disorder (PD) and obstructive sleep apnea (OSA) are 
frequent conditions that can be comorbid. This article reviews the current state 
of knowledge about the comorbidity of PD and OSA and the effectiveness 
of therapy in patients with this comorbidity.
METHOD: Articles obtained via PubMed and Web of Science search were selected; 
the publishing date was between January 1990 and December 2022. The applied 
search terms were: obstructive sleep apnea; panic disorder; CPAP; 
antidepressants; anxiolytics; antipsychotics. Eighty-one articles were chosen by 
primary search via keywords. After a complete assessment of the full texts, 60 
papers were chosen. Secondary papers from the references of the primary 
documents were investigated, evaluated for suitability, and included in the list 
of documents (n = 18). Thus, seventy-eight papers were incorporated into the 
review article.
RESULTS: Studies describe a greater prevalence of panic disorder in OSA 
patients. So far, there is no data on the prevalence of OSA in PD patients. 
Limited evidence is found regarding the influence of CPAP treatment on PD, and 
this evidence suggests that CPAP can partially alleviate PD symptoms. Medication 
used in PD treatment can significantly impact comorbid OSA, as explored in 
several studies.
CONCLUSIONS: The relationship between the two conditions seems bidirectional, 
and it is necessary to assess OSA patients for comorbid panic disorder and vice 
versa. Both disorders can worsen the other and must be treated with a complex 
approach to ensure improvement in patients' physical health and psychological 
well-being.

PMID: 37182230 [Indexed for MEDLINE]


692. Front Public Health. 2023 Apr 26;11:1145002. doi: 10.3389/fpubh.2023.1145002. 
eCollection 2023.

Health and well-being of refugees, asylum seekers, undocumented migrants, and 
internally displaced persons under COVID-19: a scoping review.

El Arab RA(1)(2), Somerville J(3), Abuadas FH(4), Rubinat-Arnaldo E(1)(2), 
Sagbakken M(5).

Author information:
(1)Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.
(2)Institute for Biomedical Research (IRBLleida), Healthcare Research Group 
(GRECS), Lleida, Spain.
(3)Department of Optometry, Inverness College, University of the Highlands and 
Island, Inverness, United Kingdom.
(4)Community Health Nursing Department, College of Nursing, Jouf University, 
Sakaka, Saudi Arabia.
(5)Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo 
Metropolitan University, Oslo, Norway.

OBJECTIVES: The objective of this scoping review was to identify what is known 
about the impact of COVID-19 on the physical and mental well-being of refugees, 
asylum seekers, undocumented migrants, and internally displaced persons. The aim 
was also to identify barriers influencing access to treatment or prevention.
METHODS: The search was conducted using PubMed/Medline, CINAHL, Scopus, and 
ScienceDirect. A mixed methods appraisal tool was used to assess methodological 
rigor. The study findings were synthesized using a thematic analysis approach.
RESULTS AND DISCUSSION: This review comprised 24 studies and were conducted 
utilizing a mixed method approach incorporating both quantitative and 
qualitative methodologies. Two major themes were identified related to the 
impact of COVID-19 on the health and wellbeing of refugees, asylum seekers, 
undocumented migrants, and internally displaced persons and the key barriers 
influencing access to treatment or prevention of COVID-19. They often have 
barriers to accessing healthcare due to their legal status, language barriers, 
and limited resources. The pandemic has further strained already limited health 
resources, making it even more challenging for these populations to receive 
healthcare. This review reveals that refugees and asylum seekers in receiving 
facilities face a higher risk of COVID-19 infection than the general population 
due to their less favorable living conditions. The various health impacts stem 
from a lack of access to accurate information about the pandemic, 
misinformation, and the exacerbation of pre-existing mental health issues caused 
by heightened stress, anxiety, and uncertainty, fear of deportation among 
undocumented migrants, and overcrowding camps and detention facilities that 
increase exposure risk. Social distancing measures are difficult to implement in 
these settings, and inadequate sanitation, hygiene, and a lack of personal 
protective equipment further compound the problem. Moreover, the pandemic has 
had significant economic consequences for these populations. Many of them rely 
on informal or precarious employment, which has been disproportionately affected 
by the pandemic. Job losses and reduced working hours, and limited access to 
social protection can lead to increased poverty, and food insecurity. Children 
faced specific challenges, such as disruptions to education, additionally, 
interruptions in support services for pregnant women. Some pregnant women have 
avoided seeking maternity care due to fears of contracting COVID-19, resulting 
in increased home births and delays in accessing healthcare services. Factors 
that play a role in vaccination reluctance include uncertainty of undocumented 
migrants' inclusion in vaccination programs, furthermore, a growing vaccine 
hesitancy in the population; skepticism about the safety of vaccines, inadequate 
knowledge/education, a variety of access barriers such as language barriers, and 
logistical challenges including remote locations, and inaccurate information.
CONCLUSION: This review highlights that the physical health of refugees, asylum 
seekers, undocumented migrants, and internally displaced persons has been 
significantly impacted by various barriers to healthcare access during the 
pandemic. These barriers include legal and administrative challenges, such as a 
lack of documentation. Additionally, the shift to digital tools has introduced 
new obstacles, not only due to language barriers or limited technical knowledge 
but also because of structural barriers, such as the requirement of a bank ID 
that is often inaccessible to these groups. Other factors contributing to 
limited healthcare access include financial constraints, language barriers, and 
discrimination. Additionally, limited access to accurate information about 
health services, prevention measures, and available resources may hinder them 
from seeking care or following public health guidelines. Misinformation and lack 
of trust in healthcare systems can also contribute to a reluctance to access 
care or vaccination programs. There is concerning evidence regarding vaccine 
hesitancy that needs to be addressed to reduce any future pandemic outbreak, in 
addition there is a need to explore the factors that play a role in vaccination 
reluctance among children in these populations.

Copyright © 2023 El Arab, Somerville, Abuadas, Rubinat-Arnaldo and Sagbakken.

DOI: 10.3389/fpubh.2023.1145002
PMCID: PMC10169615
PMID: 37181725 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


693. Trials. 2023 May 13;24(1):328. doi: 10.1186/s13063-023-07360-7.

Cardiovascular implications and physical activity in middle-aged and older 
adults with a history of COVID-19 (CV COVID): a protocol for a randomised 
controlled trial.

Rahman M(#)(1)(2), Russell SL(#)(1)(2), Okwose NC(1)(2), Hood OMA(3), Harwood 
AE(1)(2), McGregor G(1)(2)(4), Raleigh SM(1), Sandhu H(1), Roden LC(1)(5), 
Maddock H(1), Banerjee P(1)(2)(4), Jakovljevic DG(6)(7).

Author information:
(1)Research Centre for Health and Life Sciences, Institute for Health and 
Wellbeing, Faculty of Health and Life Sciences, Coventry University, Alison 
Gingell Building, 20 White Friars Street, Coventry, CV1 2DS, UK.
(2)Department of Cardiology, University Hospitals Coventry and Warwickshire NHS 
Trust, Coventry, UK.
(3)School of Biosciences, College of Biomedical and Life Sciences, Cardiff 
University, Cardiff, UK.
(4)Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, 
Coventry, UK.
(5)Health Through Physical Activity Lifestyle and Sport Research Centre & 
Division of Exercise Science and Sports Medicine, Department of Human Biology, 
Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
(6)Research Centre for Health and Life Sciences, Institute for Health and 
Wellbeing, Faculty of Health and Life Sciences, Coventry University, Alison 
Gingell Building, 20 White Friars Street, Coventry, CV1 2DS, UK. 
djordje.jakovljevic@coventry.ac.uk.
(7)Department of Cardiology, University Hospitals Coventry and Warwickshire NHS 
Trust, Coventry, UK. djordje.jakovljevic@coventry.ac.uk.
(#)Contributed equally

BACKGROUND: The clinical manifestation of COVID-19 is associated with infection 
and inflammation of the lungs, but there is evidence to suggest that COVID-19 
may also affect the structure and function of the cardiovascular system. At 
present, it is not fully understood to what extent COVID-19 impacts 
cardiovascular function in the short- and long-term following infection. The aim 
of the present study is twofold: (i) to define the effect of COVID-19 on 
cardiovascular function (i.e. arterial stiffness, cardiac systolic and diastolic 
function) in otherwise healthy individuals and (ii) to evaluate the effect of a 
home-based physical activity intervention on cardiovascular function in people 
with a history of COVID-19.
METHODS: This prospective, single-centre, observational study will recruit 120 
COVID-19-vaccinated adult participants aged between 50 and 85 years, i.e. 80 
with a history of COVID-19 and 40 healthy controls without a history of 
COVID-19. All participants will undergo baseline assessments including 12-lead 
electrocardiography, heart rate variability, arterial stiffness, rest and stress 
echocardiography with speckle tracking imaging, spirometry, maximal 
cardiopulmonary exercise testing, 7-day physical activity and sleep measures and 
quality of life questionnaires. Blood samples will be collected to assess the 
microRNA expression profiles, cardiac and inflammatory biomarkers, i.e. cardiac 
troponin T; N-terminal pro B-type natriuretic peptide; tumour necrosis factor 
alpha; interleukins 1, 6 and 10; C-reactive protein; D-dimer; and vascular 
endothelial growth factors. Following baseline assessments, COVID-19 
participants will be randomised 1:1 into a 12-week home-based physical activity 
intervention aiming to increase their daily number of steps by 2000 from 
baseline. The primary outcome is change in left ventricular global longitudinal 
strain. Secondary outcomes are arterial stiffness, systolic and diastolic 
function of the heart, functional capacity, lung function, sleep measures, 
quality of life and well-being (depression, anxiety, stress and sleep 
efficiency).
DISCUSSION: The study will provide insights into the cardiovascular implications 
of COVID-19 and their malleability with a home-based physical activity 
intervention.
TRIAL REGISTRATION: ClinicalTrials.gov NCT05492552. Registered on 7 April 2022.

© 2023. The Author(s).

DOI: 10.1186/s13063-023-07360-7
PMCID: PMC10181919
PMID: 37179415 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


694. J Affect Disord. 2023 Aug 15;335:233-238. doi: 10.1016/j.jad.2023.05.019. Epub 
2023 May 11.

Genetic predisposition to subjective well-being, depression, and suicide in 
relation to COVID-19 susceptibility and severity.

Song H(1), Lei N(1), Zeng L(1), Li X(1), Li X(1), Liu Y(1), Liu J(1), Wu W(2), 
Mu J(3), Feng Q(4).

Author information:
(1)School of Basic Medical Sciences, Chengdu University of Traditional Chinese 
Medicine, Chengdu, PR China.
(2)School of Basic Medical Sciences, Chengdu University of Traditional Chinese 
Medicine, Chengdu, PR China. Electronic address: M13881955768@163.com.
(3)School of Basic Medical Sciences, Chengdu University of Traditional Chinese 
Medicine, Chengdu, PR China. Electronic address: 1041415560@qq.com.
(4)School of Basic Medical Sciences, Chengdu University of Traditional Chinese 
Medicine, Chengdu, PR China. Electronic address: fengqs118@163.com.

BACKGROUND: Epidemiological studies have reported associations between 
subjective well-being (SWB), depression, and suicide with COVID-19 illness, but 
the causality has not been established. We performed a two-sample Mendelian 
randomization (MR) analysis to investigate the causal link between SWB, 
depression, suicide and COVID-19 susceptibility and severity.
METHODS: Summary statistics for SWB (298,420 cases), depression (113,769 cases) 
and suicide (52,208 cases) were obtained from three large-scale GWAS. Data on 
the associations between the Single Nucleotide Polymorphisms (SNPs) and COVID-19 
(159,840 cases), hospitalized COVID-19 (44,986 cases), and severe COVID-19 
(18,152 cases) were collected from the COVID-19 host genetics initiative. The 
causal estimate was calculated by the Inverse Variance Weighted, MR Egger and 
Weighted Median methods. Sensitivity tests were used to evaluate the validity of 
the causal relationship.
RESULTS: Our results showed that genetically predicted SWB (OR = 0.98, 95 % CI: 
0.86-1.10, P = 0.69), depression (OR = 0.76, 95 % CI: 0.54-1.06, P = 0.11), and 
suicide (OR = 0.99, 95 % CI: 0.96-1.02, P = 0.56) were not causally related to 
COVID-19 susceptibility. Similarly, we did not find a potential causal 
relationship between SWB, depression, suicide and COVID-19 severity.
CONCLUSIONS: This indicated that positive or negative emotions would not make 
COVID-19 better or worse, and strategies that attempted to use positive emotions 
to improve COVID-19 symptoms may be useless. Improving knowledge about the 
SARS-CoV-2 and timely medical intervention to reduce panic during a pandemic is 
one of the effective measures to deal with the current decrease in well-being 
and increase in depression and suicide rates.

Copyright © 2023. Published by Elsevier B.V.

DOI: 10.1016/j.jad.2023.05.019
PMCID: PMC10174343
PMID: 37178830 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
(Hongfei Song, Na Lei, Ling Zeng, Xue Li, Xiuyan Li, Yuqiao Liu, Jibin Liu, 
Wenjun Wu, Jie Mu, Quansheng Feng) have declared that they have no competing or 
potential conflicts of interest.


695. Healthcare (Basel). 2023 Apr 29;11(9):1277. doi: 10.3390/healthcare11091277.

Enhancing Psychological Resilience: Examining the Impact of Managerial Support 
on Mental Health Outcomes for Saudi Ambulance Personnel.

Al-Wathinani AM(1), Almusallam MA(2), Albaqami NA(1), Aljuaid M(3), Alghamdi 
AA(1), Alhallaf MA(1), Goniewicz K(4).

Author information:
(1)Department of Emergency Medical Services, Prince Sultan bin Abdulaziz College 
for Emergency Medical Services, King Saud University, Riyadh 11451, Saudi 
Arabia.
(2)National Guard Health Affairs, King Abdulaziz Medical City, Dirab Primary 
Health Center Riyadh, Riyadh 14972, Saudi Arabia.
(3)Department of Health Administration, College of Business Administration, King 
Saud University, Riyadh 11451, Saudi Arabia.
(4)Department of Security Studies, Polish Air Force University, 08-521 Dęblin, 
Poland.

Ambulance personnel are among the groups with high mental health risks. This 
study aims to investigate the role of managerial support in determining the 
mental well-being of ambulance personnel, a group at high risk for mental health 
issues. A descriptive, cross-sectional survey design was conducted in Riyadh, 
Saudi Arabia, in February 2022, involving a convenience sample of 354 ambulance 
personnel. An online survey was distributed via social media platforms. Manager 
behavior and mental well-being were assessed using the Manager Behavior 
Questionnaire (MBQ) and the Short Warwick-Edinburgh Mental Well-being Scale 
(SWEMWBS). The participants represented nearly equal-sized groups from different 
agencies, with 50.3% residing in the Riyadh Region and 67.5% aged between 25 and 
34. The mean score for manager behavior was 2.92 ± 1.124, while the mental 
well-being scale's mean score was 3.398 ± 0.8219. Variance analyses revealed 
statistically significant differences in manager behavior concerning gender, 
age, residence, and years of experience (p < 0.05), as well as in the mental 
well-being of ambulance personnel. Generalized linear regression analysis 
demonstrated a statistically significant relationship between manager behavior 
and mental well-being (p < 0.01). Focusing on improving organizational 
management behaviors is a promising strategy for enhancing mental health 
interventions among ambulance personnel. Further research is recommended to 
monitor the mental health of these professionals and develop evidence-based 
interventions to support their well-being.

DOI: 10.3390/healthcare11091277
PMCID: PMC10178426
PMID: 37174818

Conflict of interest statement: The authors declare no conflict of interest.


696. Int J Environ Res Public Health. 2023 Apr 24;20(9):5622. doi: 
10.3390/ijerph20095622.

Self-Reported Anxiety and Depression among Parents of Primary School Children 
during the COVID-19 Pandemic in Thailand, 2022.

Pudpong N(1), Julchoo S(1), Sinam P(1), Uansri S(1), Kunpeuk W(1), Suphanchaimat 
R(1)(2).

Author information:
(1)International Health Policy Program, Ministry of Public Health, Nonthaburi 
11000, Thailand.
(2)Division of Epidemiology, Department of Disease Control, Ministry of Public 
Health, Nonthaburi 11000, Thailand.

One significant concern during the COVID-19 pandemic is parents' mental health, 
which may consequently affect children's health and well-being. The objective of 
this study is to investigate generalized anxiety and depression in parents of 
primary-school-aged children and identify risk factors for mental health 
problems. A cross-sectional survey comprising 701 parents of primary school 
children in five of Thailand's major provinces was carried out from January to 
March 2022. Generalized anxiety and depression levels were assessed using the 
GAD-7 and PHQ-9. Logistic regression was performed to determine the effects of 
independent variables on anxiety and depression. Results showed that the 
prevalence of generalized anxiety and depression was 42.7% and 28.5%, 
respectively, among Thai parents. Three strong associative factors included: (1) 
having a youngest child with mental health problems; (2) not assisting their 
children every day; and (3) drinking alcohol. These findings show that the 
parents must deal with several difficulties when trying to maintain work and 
parenting duties while being confined at home during emergency situations. The 
government should provide sufficient assistance to parents who lack skills in 
handling children with emotional and behavioral problems. Meanwhile, health 
promotion to reduce alcohol consumption should continue to be an area of focus.

DOI: 10.3390/ijerph20095622
PMCID: PMC10178323
PMID: 37174142 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest in 
this study.


697. J Clin Nurs. 2023 Aug;32(15-16):5065-5075. doi: 10.1111/jocn.16758. Epub 2023 
May 12.

Anxiety and depression among nursing students during the COVID-19 lockdown: A 
cross-sectional correlational study.

Mosteiro-Diaz MP(1), Baldonedo-Mosteiro C(2), Campos Pavan Baptista P(3)(4), 
Gamez-Fernandez A(2), Franco-Correia S(2).

Author information:
(1)Department of Medicine, Nursing Area, Faculty of Medicine and Health 
Sciences, University of Oviedo, Oviedo, Spain.
(2)Faculty of Medicine and Health Sciences, University of Oviedo, Oviedo, Spain.
(3)Department of Professional Guidance, University of São Paulo School of 
Nursing, Sao Paulo, Brazil.
(4)CNPq, Sao Paulo, Brazil.

AIMS AND OBJECTIVES: To determine the prevalence and levels of anxiety and 
depression symptoms among nursing students during the coronavirus lockdown, and 
to examine factors associated with higher levels of anxiety and depression on 
this population.
BACKGROUND: Nursing students deal with diverse stressors during their university 
lives. Confinement measures during COVID-19 outbreak may have inﬂuenced 
students' mental health and well-being. Anxiety and depression are common among 
nursing students due to different factors. Evidence relating to anxiety and 
depression in nursing student population during SARS-CoV-2 pandemic is limited.
DESIGN: A cross-sectional descriptive co-relational study during the lockdown 
due to the coronavirus outbreak in Spain was conducted.
METHODS: An online questionnaire was developed by using google forms. 
Sociodemographic characteristics form, and the Spanish version of the Hospital 
Anxiety and Depression Scale (HADS) were used. Spanish nursing students across 
the country were enrolled. Data collection was performed between 4 April 2020 
and 21 April 2020. A multivariate analysis was performed to determine the 
association between sociodemographic variables, COVID-19 and HADS scores.
RESULTS: 1319 participants were enrolled. The sample was formed by 87.1% female 
students with a mean age of 22 years (SD ± 5.677). We found a mean score of 
8.47 ± 4.104 on Scale HADS-Anxiety and 6.80 ± 2.988 on HADS-Depression. 31.6% 
students presented abnormal scores of anxiety symptoms, and only 11.4% 
participants revealed abnormal scores on HADS-Depression.
CONCLUSIONS: The reported prevalence of anxiety and depression symptoms on 
nursing students during the COVID-19 lockdown is 56.4% and 38.2%, respectively. 
43.6% of the sample scored normal anxiety levels, and 61.8% obtained normal 
depression levels. Higher anxiety and depression levels were statistically 
associated with being a first-year student, being a smoker, feeling fear, 
feeling stress and having any close family member infected.
RELEVANCE TO CLINICAL PRACTICE: These data should be valuable for detection and 
for further treatment decision of this disorders at the initial stage and could 
be important to prevent further damages to mental health and promote physical, 
psychological and well-being among this population.

© 2023 The Authors. Journal of Clinical Nursing published by John Wiley & Sons 
Ltd.

DOI: 10.1111/jocn.16758
PMID: 37170706 [Indexed for MEDLINE]


698. Midwifery. 2023 Aug;123:103706. doi: 10.1016/j.midw.2023.103706. Epub 2023 May 
1.

Perinatal mental health and women's lived experience of the COVID-19 pandemic: A 
scoping review of the qualitative literature 2020-2021.

Jin Y(1), Murray L(2).

Author information:
(1)School of Health Sciences, College of Health, Massey University, Private Bag 
11 222, Palmerston North 4442, New Zealand. Electronic address: 
y.jin@massey.ac.nz.
(2)School of Health Sciences, College of Health, Massey University, Wellington, 
New Zealand.

BACKGROUND: The COVID-19 pandemic resulted in global physical distancing 
restrictions and lockdown orders. Despite the clear documentation of increased 
mental distress amongst adult populations during the pandemic, there is limited 
evidence about the mental health challenges of people in the perinatal period 
(pregnancy, birth and postpartum). The aim of this review is to summarise the 
qualitative research about women's lived experience and emotional wellbeing 
during the COVID-19 pandemic.
METHODS: A comprehensive search strategy was developed. Twenty peer-reviewed 
qualitative research articles published in English from January 1, 2020, to 
December 15, 2021, were included. Data synthesis outlined the evidence from 
common themes in a narrative format.
RESULTS: Themes during pregnancy included: (1) information seeking: anxiety and 
fear; (2) experiencing isolation and disruptions to my social support; (3) 
'Going it alone' in pregnancy care; (4) anticipatory grieving and despair; (5) 
finding 'silver linings' in social restrictions. One key theme during birth was 
"birthing in a crisis". Themes during postpartum included: (1) isolating 'Early 
motherhood is much like lockdown'; (2) breastfeeding: triumphs and tribulations; 
(3) facing disruptions during postpartum care; (4) 'Affecting us for years to 
come' - COVID-19 was not the only trauma; (5) 'silver linings' during postpartum 
care.
CONCLUSIONS: This review provides important insights into how experiences of 
isolation, decreased social support and adaptions to maternity services affect 
women's mental health. Maternity services should consider how perinatal mental 
health support may be integrated into the care of women who may still be 
required to isolate or have reduced visitors during their perinatal care.
STATEMENT OF SIGNIFICANCE: The restrictions and disruptions to maternity care 
due to the COVID-19 pandemic were likely to impact the mental health of women in 
the perinatal period (pregnancy, birth and postpartum). What is already known is 
that public health measures due to COVID-19 increased the prevalence of common 
perinatal mental disorders (CPMDs) and exacerbated common risk factors for CPMDs 
(i.e., poor social support).
WHAT THIS PAPER ADDS: The qualitative research with women in the perinatal 
period during the pandemic provides unique insights into how these events 
impacted perinatal mental and emotional health. In particular, the ways that 
global physical distancing measures and maternity care adaptations contributed 
to women's feelings of distress, isolation, and depression/despair. Silver 
linings such as more uninterrupted time with immediate family were also 
identified.

Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.midw.2023.103706
PMCID: PMC10150412
PMID: 37167674 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest None declared.


699. J Nurs Res. 2023 Jun 1;31(3):3272. doi: 10.1097/jnr.0000000000000559.

Exploring Mental Health and Psychosocial Well-Being in Recovered Jordanian 
Individuals With COVID-19: A Phenomenological Study.

Hamdan Mansour AM(1), Khalifeh AH(2), Alshibi AN(3), Hamaideh SH(4), Abu 
Al-Khair FM(5), Khraisat O(6), Alhalaiqa FN(7).

Author information:
(1)PhD, RN, Professor, School of Nursing, The University of Jordan, Amman, 
Jordan.
(2)PhD, RN, ANS-PMHN, Assistant Professor, Faculty of Nursing, Zarqa University, 
Zarqa, Jordan.
(3)MSN, RN, CNS-PMHN, MHPSS Coordinator, International Medical Corps, Jordan.
(4)PhD, RN, Professor, Community and Mental Health Nursing Department, Faculty 
of Nursing, The Hashemite University, Zarqa, Jordan.
(5)PhD, Assistant Professor of Clinical Psychology, Psychology Department, Art 
and Science College, Al-Ahliyya Amman University.
(6)PhD, RN, Associate Professor, Faculty of Nursing, Al Ahliyya Amman 
University, Salt, Jordan.
(7)PhD, RN, Professor, Faculty of Nursing, Philadelphia University, Amman, 
Jordan.

BACKGROUND: COVID-19-related healthcare services focus primarily on medical and 
physical treatments. Related treatments for psychosocial and mental health needs 
have not been a priority for healthcare professionals. Understanding the process 
by which individuals who have recovered from COVID-19 adapt psychologically will 
allow better planning for mental healthcare and healthcare outcomes.
PURPOSE: The purpose of this study was to explore how recovered individuals with 
COVID-19 adapted to related psychological and social stressors during the 
infection period.
METHODS: A descriptive phenomenological approach was used to investigate a 
purposive sample of 13 individuals in Jordan who had recovered from COVID-19. 
Data were collected using semistructured interviews.
RESULTS: Perceptions related to being diagnosed with COVID-19 were distinguished 
into four major themes: conscious awareness (acceptance, victimization, and 
normalizing), uncertainty (apprehension and poor communication), sources of 
psychosocial support (caring family, healthcare professionals' support, and 
self-grieving), and resilience (optimism, positive thinking, and spirituality).
CONCLUSIONS: The findings of this study indicate the need to integrate 
psychosocial and mental healthcare services into healthcare plans provided to 
individuals with COVID-19 and similar pandemic infections.

Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc.

DOI: 10.1097/jnr.0000000000000559
PMID: 37167611 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


700. PLoS One. 2023 May 11;18(5):e0283254. doi: 10.1371/journal.pone.0283254. 
eCollection 2023.

Predicting resilience during the COVID-19 Pandemic in the United Kingdom: 
Cross-sectional and longitudinal results.

Bennett KM(1), Panzeri A(2), Derrer-Merk E(1), Butter S(3), Hartman TK(4), Mason 
L(5), McBride O(3), Murphy J(3), Shevlin M(3), Gibson-Miller J(6), Levita L(7), 
Martinez AP(6), McKay R(8), Lloyd A(5), Stocks TVA(6), Bottesi G(2), Vidotto 
G(2), Bentall RP(6), Bertamini M(2).

Author information:
(1)Department of Psychology, University of Liverpool, Liverpool, United Kingdom.
(2)Department of General Psychology, University of Padova, Padova, Italy.
(3)School of Psychology, Ulster University, Coleraine, United Kingdom.
(4)Department of Social Statistics, University of Manchester, Manchester, United 
Kingdom.
(5)Division of Psychology and Language Sciences, University College London, 
London, United Kingdom.
(6)Department of Psychology, University of Sheffield, Sheffield, United Kingdom.
(7)School of Psychology, University of Sussex, Brighton, United Kingdom.
(8)Department of Psychology, Royal Holloway, University of London, London, 
United Kingdom.

Although the COVID-19 pandemic has impacted the psychological wellbeing of some 
people, there is evidence that many have been much less affected. The Ecological 
Model of Resilience (EMR) may explain why some individuals are not resilient 
whilst others are. In this study we test the EMR in a comparison of UK survey 
data collected from the COVID-19 Psychological Research Consortium (C19PRC) 
longitudinal study of a representative sample of the United Kingdom (UK) adult 
population and data from an Italian arm of the study. We first compare data from 
the third wave of the UK arm of the study, collected in July/August 2020, with 
data from an equivalent sample and stage of the pandemic in Italy in July 2020. 
Next, using UK longitudinal data collected from C19PRC Waves 1, 3 and 5, 
collected between March 2020 and April 2021 we identify the proportion of people 
who were resilient. Finally, we examine which factors, drawn from the EMR, 
predict resilient and non-resilient outcomes. We find that the 72% of the UK 
sample was resilient, in line with the Italian study. In the cross-sectional 
logistic regression model, age and self-esteem were significantly associated 
with resilience whilst death anxiety thoughts, neuroticism, loneliness, and Post 
Traumatic Stress Disorder (PTSD) symptoms related to COVID-19 were significantly 
associated with Non-Resilient outcomes. In the longitudinal UK analysis, at Wave 
5, 80% of the sample was Resilient. Service use, belonging to wider 
neighbourhood, self-rated health, self-esteem, openness, and externally 
generated death anxiety were associated with Resilient outcomes. In contrast, 
PTSD symptoms and loneliness were associated with Non-Resilient outcomes. The 
EMR effectively explained the results. There were some variables which are 
amenable to intervention which could increase resilience in the face of similar 
future challenges.

Copyright: © 2023 Bennett et al. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0283254
PMCID: PMC10174573
PMID: 37167208 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


701. JAMA Netw Open. 2023 May 1;6(5):e2312708. doi: 
10.1001/jamanetworkopen.2023.12708.

Investigating Social Media to Evaluate Emergency Medicine Physicians' Emotional 
Well-being During COVID-19.

Agarwal AK(1)(2)(3)(4), Mittal J(5), Tran A(3), Merchant R(1)(2)(3)(4), Guntuku 
SC(1)(5)(4).

Author information:
(1)Penn Medicine Center for Digital Health, Philadelphia, Pennsylvania.
(2)Department of Emergency Medicine, University of Pennsylvania, Philadelphia.
(3)Perelman School of Medicine, University of Pennsylvania, Philadelphia.
(4)Leonard Davis Institute of Health Economics, University of Pennsylvania, 
Philadelphia.
(5)Computer and Information Science, University of Pennsylvania, Philadelphia.

IMPORTANCE: Emergency medicine (EM) physicians experience tremendous emotional 
health strain, which has been exacerbated during COVID-19, and many have taken 
to social media to express themselves.
OBJECTIVE: To analyze social media content from academic EM physicians and 
resident physicians to investigate changes in content and language as indicators 
of their emotional well-being.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used machine 
learning and natural language processing of Twitter posts from self-described 
academic EM physicians and resident physicians between March 2018 and March 
2022. Participants included academic EM physicians and resident physicians with 
publicly accessible posts (at least 300 total words across the posts) from the 
US counties with the top 10 COVID-19 case burdens. Data analysis was performed 
from June to September 2022.
EXPOSURE: Being an EM physician or resident physician who posted on Twitter.
MAIN OUTCOMES AND MEASURES: Social media content themes during the prepandemic 
period, during the pandemic, and across the phases of the pandemic were 
analyzed. Psychological constructs evaluated included anxiety, anger, 
depression, and loneliness. Positive and negative language sentiment within 
posts was measured.
RESULTS: This study identified 471 physicians with a total of 198 867 posts 
(mean [SD], 11 403 [18 998] words across posts; median [IQR], 3445 [1100-11 591] 
words across posts). The top 5 prepandemic themes included free open-access 
medical education (Cohen d, 0.44; 95% CI, 0.38-0.50), residency education (Cohen 
d, 0.43; 95% CI, 0.37-0.49), gun violence (Cohen d, 0.37; 95% CI, 0.32-0.44), 
quality improvement in health care (Cohen d, 0.33; 95% CI, 0.27-0.39), and 
professional resident associations (Cohen d, 0.33; 95% CI, 0.27-0.39). During 
the pandemic, themes were significantly related to healthy behaviors during 
COVID-19 (Cohen d, 0.83; 95% CI, 0.77-0.90), pandemic response (Cohen d, 0.71; 
95% CI, 0.65-0.77), vaccines and vaccination (Cohen d, 0.60; 95% CI, 0.53-0.66), 
unstable housing and homelessness (Cohen d, 0.40; 95% CI, 0.34-0.47), and 
emotional support for others (Cohen d, 0.40; 95% CI, 0.34-0.46). Across the 
phases of the pandemic, thematic content within social media posts changed 
significantly. Compared with the prepandemic period, there was significantly 
less positive, and concordantly more negative, language used during COVID-19. 
Estimates of loneliness, anxiety, anger, and depression also increased 
significantly during COVID-19.
CONCLUSIONS AND RELEVANCE: In this cross-sectional study, key thematic shifts 
and increases in language related to anxiety, anger, depression, and loneliness 
were identified in the content posted on social media by academic EM physicians 
and resident physicians during the pandemic. Social media may provide a 
real-time and evolving landscape to evaluate thematic content and linguistics 
related to emotions and sentiment for health care workers.

DOI: 10.1001/jamanetworkopen.2023.12708
PMCID: PMC10173019
PMID: 37163264 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest Disclosures: None reported.


702. Aging Clin Exp Res. 2023 Jun;35(6):1145-1160. doi: 10.1007/s40520-023-02409-8. 
Epub 2023 May 9.

Dementia, infections and vaccines: 30 years of controversy.

Ecarnot F(1)(2), Boccardi V(3), Calcagno A(4), Franceschi C(5)(6), Fülop T(7), 
Itzhaki RF(8), Michel JP(9), Panza F(10)(11), Rainero I(12), Solfrizzi V(11), 
Ticinesi A(13)(14), Veronese N(15), Maggi S(16).

Author information:
(1)EA3920, University of Franche-Comté, 25000, Besancon, France.
(2)Department of Cardiology, University Hospital Besancon, 3-8 Boulevard 
Fleming, 25000, Besancon, France.
(3)Institute of Gerontology and Geriatrics, Department of Medicine and Surgery, 
University of Perugia, Santa Maria Della Misericordia Hospital, Piazzale Gambuli 
1, 06132, Perugia, Italy.
(4)Unit of Infectious Diseases, Department of Medical Sciences, University of 
Turin, Turin, Italy.
(5)Laboratory of Systems Medicine of Healthy Aging, Institute of Biology and 
Biomedicine and Institute of Information Technology, Mathematics and Mechanics, 
Department of Applied Mathematics, N. I. Lobachevsky State University, Nizhny 
Novgorod, Russia.
(6)Department of Medical and Surgical Sciences, Alma Mater Studiorum, University 
of Bologna, Bologna, Italy.
(7)Department of Medicine, Geriatrics Division, Research Center on Aging, 
Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, 
QC, J1H 5N4, Canada.
(8)Institute of Population Ageing, University of Oxford and Faculty of Life 
Sciences, University of Manchester, Manchester, UK.
(9)University Hospitals of Geneva, Geneva, Switzerland.
(10)Unit of Research Methodology and Data Sciences for Population Health, 
National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, 
Castellana Grotte, Bari, Italy.
(11)Dipartimento Interdisciplinare di Medicina, Clinica Medica e Geriatria 
"Cesare Frugoni", University of Bari Aldo Moro, Bari, Italy.
(12)Dementia Center, Department of Neuroscience "Rita Levi Montalcini", 
University of Torino, Turin, Italy.
(13)Department of Medicine and Surgery, University of Parma, Parma, Italy.
(14)Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di 
Parma, Parma, Italy.
(15)Geriatrics Section, Department of Internal Medicine, University of Palermo, 
Palermo, Italy. nicola.veronese@unipa.it.
(16)National Research Council, Neuroscience Institute, Aging Branch, Padua, 
Italy.

This paper reports the proceedings of a virtual meeting convened by the European 
Interdisciplinary Council on Ageing (EICA), to discuss the involvement of 
infectious disorders in the pathogenesis of dementia and neurological disorders 
leading to dementia. We recap how our view of the infectious etiology of 
dementia has changed over the last 30 years in light of emerging evidence, 
and we present evidence in support of the implication of infection in dementia, 
notably Alzheimer's disease (AD). The bacteria and viruses thought to be 
responsible for neuroinflammation and neurological damage are reviewed. We then 
review the genetic basis for neuroinflammation and dementia, highlighting the 
genes that are currently the focus of investigation as potential targets for 
therapy. Next, we describe the antimicrobial hypothesis of dementia, notably the 
intriguing possibility that amyloid beta may itself possess antimicrobial 
properties. We further describe the clinical relevance of the gut-brain axis in 
dementia, the mechanisms by which infection can move from the intestine to the 
brain, and recent findings regarding dysbiosis patterns in patients with AD. We 
review the involvement of specific pathogens in neurological disorders, i.e. 
SARS-CoV-2, human immunodeficiency virus (HIV), herpes simplex virus type 1 
(HSV1), and influenza. Finally, we look at the role of vaccination to prevent 
dementia. In conclusion, there is a large body of evidence supporting the 
involvement of various infectious pathogens in the pathogenesis of dementia, but 
large-scale studies with long-term follow-up are needed to elucidate the role 
that infection may play, especially before subclinical or clinical disease is 
present.

© 2023. The Author(s).

DOI: 10.1007/s40520-023-02409-8
PMCID: PMC10169152
PMID: 37160649 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no relevant financial or 
non-financial interests to disclose.


703. Cochrane Database Syst Rev. 2023 May 9;5(5):CD013619. doi: 
10.1002/14651858.CD013619.pub2.

Family presence during resuscitation.

Afzali Rubin M(1), Svensson TL(2), Herling SF(3)(4), Jabre P(5)(6)(7), Møller 
AM(1)(4).

Author information:
(1)Department of Anaesthesiology and Herlev ACES, Herlev Anaesthesia Critical 
and Emergency Care Science Unit, Copenhagen University Hospital, 
Herlev-Gentofte, Copenhagen, Denmark.
(2)Department of Anaesthesia, Bispebjerg Hospital, Copenhagen, Denmark.
(3)The Neuroscience Centre, Rigshospitalet, University of Copenhagen, 
Copenhagen, Denmark.
(4)University of Copenhagen, Copenhagen, Denmark.
(5)Assistance Publique-Hôpitaux de Paris (AP-HP), SAMU (Service d'Aide Médicale 
Urgente) de Paris, Hôpital Universitaire Necker-Enfants Malades, Paris, France.
(6)Cochrane Pre-hospital and Emergency Care Field, Paris, France.
(7)Université Paris Cité, Paris Cardiovascular Research Centre (PARCC), INSERM, 
Integrative Epidemiology of Cardiovascular Diseases Team, Paris, France.

Update of
    doi: 10.1002/14651858.CD013619.

BACKGROUND: Patients and their relatives often expect to be actively involved in 
decisions of treatment. Even during resuscitation and acute medical care, 
patients may want to have their relatives nearby, and relatives may want to be 
present if offered the possibility. The principle of family presence during 
resuscitation (FPDR) is a triangular relationship where the intervention of 
family presence affects the healthcare professionals, the relatives present, and 
the care of the patient involved. All needs and well-being must be balanced in 
the context of FPDR as the actions involving all three groups can impact the 
others.
OBJECTIVES: The primary aim of this review was to investigate how offering 
relatives the option to be present during resuscitation of patients affects the 
occurrence of post-traumatic stress disorder (PTSD)-related symptoms in the 
relatives. The secondary aim was to investigate how offering relatives the 
option to be present during resuscitation of patients affects the occurrence of 
other psychological outcomes in the relatives and what effect family presence 
compared to no family presence during resuscitation of patients has on patient 
morbidity and mortality. We also wanted to investigate the effect of FPDR on 
medical treatment and care during resuscitation. Furthermore, we wanted to 
investigate and report the personal stress seen in healthcare professionals and 
if possible describe their attitudes toward the FPDR initiative.
SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, PsycINFO, and CINAHL from 
inception to 22 March 2022 without any language limits. We also checked 
references and citations of eligible studies using Scopus, and searched for 
relevant systematic reviews using Epistomonikos. Furthermore, we searched 
ClinicalTrials.gov, WHO ICTRP, and ISRCTN registry for ongoing trials; OpenGrey 
for grey literature; and Google Scholar for additional trials (all on 22 March 
2022).
SELECTION CRITERIA: We included randomized controlled trials of adults who have 
witnessed a resuscitation attempt of a patient (who was their relative) at the 
emergency department or in the pre-hospital emergency medical service.  The 
participants of this review included relatives, patients, and healthcare 
professionals during resuscitation.  We included relatives aged 18 years or 
older who have witnessed a resuscitation attempt of a patient (who is their 
relative) in the emergency department or pre-hospital. We defined relatives as 
siblings, parents, spouses, children, or close friends of the patient, or any 
other descriptions used by the study authors. There were no limitations on adult 
age or gender. We defined patient as a patient with cardiac arrest in need of 
cardiopulmonary resuscitation (CPR), a patient with a critical medical or 
traumatic life-threatening condition, an unconscious patient, or a patient in 
any other way at risk of sudden death. We included all types of healthcare 
professionals as described in the included studies. There were no limitations on 
age or gender.
DATA COLLECTION AND ANALYSIS: We checked titles and abstracts of studies 
identified by the search, and obtained the full reports of those studies deemed 
potentially relevant. Two review authors independently extracted data. As it was 
not possible to conduct meta-analyses, we synthesized data narratively.
MAIN RESULTS: The electronic searches yielded a total of 7292 records after 
deduplication. We included 2 trials (3 papers) involving a total of 595 
participants: a cluster-randomized trial from 2013 involving pre-hospital 
emergency medical services units in France, comparing systematic offer for a 
relative to witness CPR with the traditional practice, and its 1-year 
assessment; and a small pilot study from 1998 of FPDR in an emergency department 
in the UK. Participants were 19 to 78 years old, and between 56% and 64% were 
women. PTSD was measured with the Impact of Event Scale, and the median score 
ranged from 0 to 21 (range 0 to 75; higher scores correspond to more severe 
disease). In the trial that accounted for most of the included participants 
(570/595), the frequency of PTSD-related symptoms was significantly higher in 
the control group after 3 and 12 months, and in the per-protocol analyses a 
significant statistical difference was found in favor of FPDR when looking at 
PTSD, anxiety and depression, and complicated grief after 1 year.  One of the 
included studies also measured duration of patient resuscitation and personal 
stress in healthcare professionals during FPDR and found no difference between 
groups. Both studies had high risk of bias, and the evidence for all outcomes 
except one was assessed as very low certainty.
AUTHORS' CONCLUSIONS: There was insufficient evidence to draw any firm 
conclusions on the effects of FPDR on relatives' psychological outcomes.   
Sufficiently powered and well-designed randomized controlled trials may change 
the conclusions of the review in future.

Copyright © 2023 The Cochrane Collaboration. Published by John Wiley & Sons, 
Ltd.

DOI: 10.1002/14651858.CD013619.pub2
PMCID: PMC10167940
PMID: 37159193 [Indexed for MEDLINE]

Conflict of interest statement: Monika Afzali Rubin: is a member of the Danish 
parliament with a special interest in healthcare politics. Tintin Svensson: 
nothing to declare. Suzanne Forsyth Herling: nothing to declare. Patricia Jabre 
is the first author of a primary study (which she has conducted) included in 
this review (Jabre 2013; Jabre 2014). She did not extract data from her own 
study. Instead, review authors MAR, TS, and AMM extracted these data, and 
checked the interpretation against the study report and any available study 
registration details or protocol. Ann Merete Møller: nothing to declare.


704. Front Public Health. 2023 Apr 21;11:1139921. doi: 10.3389/fpubh.2023.1139921. 
eCollection 2023.

A call to create evidence-based mental health promotion interventions for youth 
that are equitable across ethnic/racial subgroups: Advocates 4-ALL Youth.

Kaar JL(1), Bowen AE(2), Simon SL(1), Dadematthews A(3), Chandrasekhar JL(1), 
Musci R(4), Pangelinan M(3).

Author information:
(1)Department of Pediatrics, University of Colorado School of Medicine, Aurora, 
CO, United States.
(2)Children's Hospital Colorado, Aurora, CO, United States.
(3)School of Kinesiology, Auburn University, Auburn, AL, United States.
(4)Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins 
University, Baltimore, MD, United States.

BACKGROUND: Adolescents from historically racial and ethnic minoritized and 
low-income communities have higher rates of early-life and chronic difficulties 
with anxiety and depression compared to non-Hispanic White youth. With mental 
health distress exacerbated during and in the wake of the COVID-19 pandemic, 
there is a need for accessible, equitable evidence-based programs that promote 
psychological well-being, strengthen one's ability to adapt to adversity, and 
build self-efficacy prior to adolescence.
METHODS: An evidenced-based resiliency-focused health coaching intervention was 
adapted using a health equity implementation framework to meet the needs of a 
Title I elementary school in rural Alabama (AL) that serves over 80% Black and 
Hispanic students. To ensure that the program met local community needs while 
maintaining core program educational activities, all adaptations were documented 
utilizing a standard coding system.
RESULTS: Leveraging an existing academic-community partnership with Auburn 
University and a local AL school district, a new program, Advocates 4-All Youth 
(ALLY), was created. Three major adaptations were required: (1) the use of local 
community volunteers (ALLYs) to deliver the program versus health coaches, (2) 
the modification of program materials to meet the challenge of varying levels of 
general and health-related literacy, and (3) the integration of the Empower 
Action Model to target protective factors in a culturally-tailored delivery to 
ensure key program outcomes are found equitable for all students.
CONCLUSION: With continued increases in youth mental health distress, there is a 
need for the development of universal primary prevention interventions to 
promote mental well-being and to strengthen protective factors among youth from 
historically disadvantaged backgrounds. ALLY was created to meet these needs and 
may be an effective strategy if deemed efficacious in improving program 
outcomes.

Copyright © 2023 Kaar, Bowen, Simon, Dadematthews, Chandrasekhar, Musci and 
Pangelinan.

DOI: 10.3389/fpubh.2023.1139921
PMCID: PMC10160640
PMID: 37151585 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


705. Nurse Educ Pract. 2023 Jul;70:103640. doi: 10.1016/j.nepr.2023.103640. Epub 2023 
Apr 11.

Long-term effects of a tailored mindfulness-based program for Chinese intensive 
care unit nurses: A randomized parallel-group trial.

Lu F(1), Xu Y(2), Yu Y(3), Zhao R(4), Peng L(2), Liu B(2), Li M(5).

Author information:
(1)School of Psychology, Army Medical University, Chongqing, China; School of 
Nursing, Army Medical University, Chongqing, China.
(2)School of Psychology, Army Medical University, Chongqing, China.
(3)Department of Social Work, Sichuan International Studies University, 
Chongqing, China.
(4)School of Nursing, Army Medical University, Chongqing, China.
(5)School of Psychology, Army Medical University, Chongqing, China. Electronic 
address: limin52267@tmmu.edu.cn.

AIM: This study investigated the direct and long-term improvements that 
mindfulness-based interventions exert on intensive care unit nurses. We assessed 
an abbreviated four-week, twice-weekly mindfulness-based intervention program's 
effect on work-related mental health variables and examined whether the 
intervention impact was maintained at two- and six-month follow-up assessments. 
We also examined the training program's effects on work and life.
BACKGROUND: Previous research has shown that mindfulness interventions exert 
positive effects immediately after treatment. However, few studies have examined 
whether treatment effects are maintained over time or under different 
circumstances. Moreover, treatment effects among Chinese intensive care unit 
nurses have rarely been examined.
DESIGN: We conducted a randomized, non-blinded, parallel-group trial.
METHODS: Participants included 90 intensive care unit nurses, divided into two 
cohorts, who participated in the program in October 2016 and April 2017. They 
completed validated measures of mindfulness, burnout syndromes, anxiety and 
depressive symptoms and well-being at baseline (T1), immediately after 
intervention (T2), two months after (T3) and six months after (T4) the 
intervention.
RESULTS: We observed a significant group effect (1) immediately 
post-intervention and two months after intervention for mindfulness; (2) at two 
months after intervention for anxiety, depression and subjective well-being and 
(3) at post-intervention, two months after and six months after for emotional 
exhaustion.
CONCLUSIONS: These findings suggest that the tailored four-week 
mindfulness-based intervention program improved intensive care unit nurses' 
mental health, although further research is needed to verify its feasibility in 
a clinical working environment.

Copyright © 2023. Published by Elsevier Ltd.

DOI: 10.1016/j.nepr.2023.103640
PMID: 37148845 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no competing interests.


706. Dementia (London). 2023 Aug;22(6):1205-1226. doi: 10.1177/14713012231173812. 
Epub 2023 May 5.

Emotion-focused dyadic coping styles used by family carers of people with 
dementia during the COVID-19 pandemic.

Colclough C(1), Miles E(1), Rusted J(1), Perach R(2), Hicks B(3)(4), Dixon J(5), 
Dangoor M(5), Gridley K(6), Birks Y(6), Donaghy P(7), Mcardle R(7), Moseley 
E(8), Sondh HK(8), Banerjee S(9); DETERMIND team.

Author information:
(1)School of Psychology, University of Sussex, Brighton, UK.
(2)School of Social Sciences, University of Westminster, London, UK.
(3)Brighton and Sussex Medical School, Brighton, UK.
(4)University of Sussex, Brighton, UK.
(5)Care Policy and Evaluation Centre, London School of Economics and Political 
Science, London, UK.
(6)Social Policy Research Unit, University of York, York, UK.
(7)Translational and Clinical Research Institute, Faculty of Medical Sciences, 
Newcastle University, Newcastle upon Tyne, UK.
(8)South London and Maudsley NHS Foundation Trust, London, UK.
(9)Faculty of Health, University of Plymouth, Plymouth, UK.

Emotional wellbeing of family carers and people with dementia is associated with 
not only how each individual copes with stress and conflict, but also by how 
they cope together. Finding ways to positively cope together was particularly 
important during COVID-19 lockdown restrictions, when other avenues of emotional 
support were less available. We explored how carers experienced and used 
emotion-focused dyadic coping styles during the COVID-19 pandemic. In-depth 
qualitative interviews were conducted during the pandemic with 42 family carers, 
supplemented by quality of life scores collected both pre- and during the 
pandemic and household status. Abductive thematic analysis identified five 
styles of emotion-focused dyadic coping: common, supportive, hostile, disengaged 
avoidance and protective. The COVID-19 pandemic left many dyads unsupported. 
While many carers adapted, reporting increases in quality of life and enjoying 
the extra time with the person with dementia, others experienced dyadic conflict 
and reductions in quality of life. This variation was associated with dyadic 
coping styles, including challenges in using 'positive' styles and the 
protective use of 'negative' disengaged avoidance in the right situations. 
Dyadic coping styles also differed as a function of whether the dyad lived 
together. As many people with dementia are supported by an informal carer, 
considering how they cope together could help us to better support them. We make 
suggestions for dyadic interventions tailored by co-residency status that could 
help dyads identify and communicate coping needs, reconnect following avoidance 
coping, and replenish their coping resources through social support.

DOI: 10.1177/14713012231173812
PMCID: PMC10164090
PMID: 37147119 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


707. BMJ Open. 2023 May 5;13(5):e071903. doi: 10.1136/bmjopen-2023-071903.

Impact of the COVID-19 pandemic on young people from black and mixed ethnic 
groups' mental health in West London: a qualitative study.

Lenoir R(1), Wong KK(2).

Author information:
(1)Psychology & Human Development, University College London, London, UK.
(2)Psychology & Human Development, University College London, London, UK 
keri.wong@ucl.ac.uk.

OBJECTIVES: The COVID-19 pandemic has disproportionately impacted vulnerable 
groups' physical and mental health, especially young people and minority ethnic 
groups, yet little is known about the crux of their experiences and what support 
they would like. To address this gap, this qualitative study aims to uncover the 
effect of the COVID-19 outbreak on young people with ethnic minority 
backgrounds' mental health, how this changed since the end of lockdown and what 
support they need to cope with these issues.
DESIGN: The study utilised semi-structured interviews to conduct a 
phenomenological analysis.
SETTING: Community centre in West London, England.
PARTICIPANTS: Ten 15 min in-person semistructured interviews were conducted with 
young people aged 12-17 years old from black and mixed ethnic groups who 
regularly attend the community centre.
RESULTS: Through Interpretative Phenomenological Analysis, results indicated 
that the participants' mental health was negatively impacted by the COVID-19 
pandemic, with feelings of loneliness being the most common experience. However, 
positive effects were concurrently observed including improved well-being and 
better coping strategies post lockdown, which is a testament to the young 
people's resilience. That said, it is clear that young people from minority 
ethnic backgrounds lacked support during the COVID-19 pandemic and would now 
need psychological, practical and relational assistance to cope with these 
challenges.
CONCLUSIONS: While future studies would benefit from a larger ethnically diverse 
sample, this is a start. Study findings have the potential to inform future 
government policies around mental health support and access for young people 
from ethnic minority groups, notably prioritising support for grassroots 
initiatives during times of crisis.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/bmjopen-2023-071903
PMCID: PMC10163329
PMID: 37147089 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


708. PLoS One. 2023 May 5;18(5):e0285275. doi: 10.1371/journal.pone.0285275. 
eCollection 2023.

Employees' support strategies for mental wellbeing during and beyond the 
COVID-19 pandemic: Recommendations for employers in the UK workforce.

Bailey K(1)(2), Scheutzow J(1), Cooke E(1), Taylor K(3), Silvestrin F(1)(2), 
Naumenko A(1), Hadley R(4), Huxley A(1), Ponzo S(1)(5).

Author information:
(1)Thrive Therapeutic Software, Warwickshire, England.
(2)University of East Anglia, School of Psychology, Norwich, England.
(3)University College London, Institute of Epidemiology & Health Care, London, 
England.
(4)University of Hertfordshire, School of Life and Medical Sciences, 
Hertfordshire, England.
(5)University College London, Institute of Health Informatics, London, England.

Throughout the COVID-19 pandemic, and beyond for many businesses, employees have 
had to adapt to new ways of working due to disruptions in traditional practices. 
It is therefore crucial to understand the new challenges that employees are 
facing when it comes to taking care of their mental wellbeing at work. To that 
end, we distributed a survey to full-time UK employees (N = 451) to explore how 
supported they felt throughout the pandemic, and to identify whether there are 
any additional types of support they would like to receive. We also compared 
employees' intentions to seek help before versus during the COVID-19 pandemic, 
and assessed their current attitudes toward mental health. Based on direct 
employee feedback, our results show remote workers felt more supported 
throughout the pandemic compared to hybrid workers. We also found that employees 
who had previously experienced an episode of anxiety or depression were 
significantly more likely to want extra support at work compared to those who 
had not. Furthermore, employees were significantly more likely to seek help for 
their mental health during the pandemic compared to before. Interestingly, the 
largest increase in intentions to seek help during the pandemic compared to 
before was with digital health solutions. Finally, we found that the strategies 
managers have adopted to better support their employees, an employee's mental 
health history, and their attitude to mental health all contributed to 
significantly increasing the likelihood that an employee would disclose a mental 
health concern to their line manager. We provide recommendations that encourage 
organisations to make changes to better support their employees, and we 
highlight the importance of mental health awareness training for both managers 
and employees. This work is of particular interest to organisations who are 
looking to tailor their current employee wellbeing offer to a post-pandemic 
world.

Copyright: © 2023 Bailey et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0285275
PMCID: PMC10162522
PMID: 37146016 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


709. Healthc Q. 2023 Apr;26(1):18-23. doi: 10.12927/hcq.2023.27056.

Beyond Housing: Supporting the Health and Well-Being of Individuals Residing in 
Toronto's Temporary Shelter Hotels.

Ecker J(1), Dada O(2), Pridham KF(3), Hwang SW(4).

Author information:
(1)Is a research manager at the MAP Centre for Urban Health Solutions, Unity 
Health Toronto, in Toronto, ON. He can be reached by e-mail at 
john.ecker@unityhealth.to.
(2)Is a research coordinator at the MAP Centre for Urban Health Solutions, Unity 
Health Toronto, in Toronto, ON.
(3)Is a research program manager at the MAP Centre for Urban Health Solutions, 
Unity Health Toronto, in Toronto, ON.
(4)Is a clinician-scientist at the MAP Centre for Urban Health Solutions, Unity 
Health Toronto, and a professor in the division of General Internal Medicine, 
Department of Medicine, University of Toronto, in Toronto, ON.

In response to the COVID-19 pandemic, the City of Toronto opened temporary 
shelter hotels with on-site supports for people previously living on the street, 
in encampments or in emergency shelters. The Beyond Housing program was created 
to enhance service offerings in the shelter hotel system and to support people 
not engaging with services. Using a Housing First approach, Beyond Housing 
offers three main interventions: (1) case management, (2) care coordination and 
(3) on-site and community-based mental health and social supports. This 
commentary explores the strengths and challenges of implementing Beyond Housing 
within temporary shelter hotels, and then discusses the lessons learned.

Copyright © 2023 Longwoods Publishing.

DOI: 10.12927/hcq.2023.27056
PMID: 37144697 [Indexed for MEDLINE]


710. PLoS One. 2023 May 4;18(5):e0285317. doi: 10.1371/journal.pone.0285317. 
eCollection 2023.

Impact of the COVID-19 pandemic on the mental and physical health and overall 
wellbeing of university students in Portugal.

Machado BC(1), Pinto E(2)(3), Silva M(2), Veiga E(1), Sá C(4), Kuhz S(4), Silva 
PO(5), Pimenta A(2), Gomes A(2), Almeida A(6), Sá L(6), Correia M(2).

Author information:
(1)Faculty of Education and Psychology, Research Centre for Human Development, 
Universidade Católica Portuguesa, Porto, Portugal.
(2)CBQF-Centro de Biotecnologia e Química Fina-Laboratório Associado, Escola 
Superior de Biotecnologia, Porto, Portugal.
(3)EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
(4)School of Arts, Research Center for the Science and Technology of the Arts, 
Universidade Católica Portuguesa, Porto, Portugal.
(5)Human Neurobehavioral Laboratory, Faculty of Education and Psychology, 
Research Centre for Human Development, Universidade Católica Portuguesa, Porto, 
Portugal.
(6)Instituto de Ciências da Saúde, Universidade Católica Portuguesa, Porto, 
Portugal.

Throughout the pandemic of COVID-19 caused by SARS-CoV-2, university students 
were considered a vulnerable risk group for mental health impairment and 
wellbeing deterioration. This study aimed at evaluating the pandemic's impact on 
the physical and mental health and wellbeing among students of a Portuguese 
university. This cross-sectional study included 913 participants and ran from 
June to October 2020. Data collected included sociodemographics, three mental 
health self-report questionnaires (Depression Anxiety Stress Scale, Eating 
Disorder Examination Questionnaire and Brief COPE) and lifestyle practices 
(eating and sleeping patterns, media, and entertainment habits) during the first 
months of the pandemic, which included a 72-day full national lockdown. 
Descriptive and correlational statistical analysis were conducted. Students' 
food habits changed during the pandemic, namely on the consumption of snacks and 
fast food and, overall, less balanced meals became more prevalent. Additionally, 
almost 70% of the students reported Body Mass Index changes, while 59% went 
through sleep pattern changes-these were more pronounced in women and younger 
students. Over half (67%) of the inquirees exhibited an increase in their 
stress, depression, and generalized anxiety symptoms. Also, the study 
demonstrates that students' lifestyles trended negatively during the pandemic 
and highlights how important regular psychological, health monitoring and 
emotional support is, amongst this somehow overlooked population throughout the 
pandemic. Universities should provide support to overcome challenges in future 
stressful situations. This study might have an impact on how universities and 
higher education systems approach their students in terms of mental and physical 
health monitoring and promotion in future situations, non-related with COVID. 
Moreover, it has a large sample of students well characterized in terms of 
mental and physical health, which might be of interest for future comparison 
with other worldwide group of students throughout stressful situations, such as 
tragic events, wars, pandemics.

Copyright: © 2023 Machado et al. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0285317
PMCID: PMC10159150
PMID: 37141328 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


711. Front Public Health. 2023 Apr 17;11:1126240. doi: 10.3389/fpubh.2023.1126240. 
eCollection 2023.

Are changes in physical activity during COVID-19 associated with mental health 
among Danish university students?

Petersen CB(1), Krüger C(2), Guldager JD(2)(3), Algren MH(1), Jervelund SS(4), 
Berg-Beckhoff G(2).

Author information:
(1)National Institute of Public Health, University of Southern Denmark, 
Copenhagen, Denmark.
(2)Unit for Health Promotion Research, Department of Public Health, University 
of Southern Denmark, Esbjerg, Denmark.
(3)Department of Physiotherapy, University College South Denmark, Esbjerg, 
Denmark.
(4)Section for Health Services Research, Department of Public Health, University 
of Copenhagen, Copenhagen, Denmark.

AIMS: The benefits associated with being physical active on mental health is 
well-established, but little is known on how rapid changes in physical activity 
are associated with mental health. This study investigated the association 
between changes in physical activity and mental health among Danish university 
students during the first COVID-19 lockdown.
METHODS: Online survey data were collected among 2,280 university students at 
the University of Southern Denmark and University of Copenhagen in May-June 2020 
as part the "COVID-19 International Student Well-being Study." Multiple linear 
regressions were used to analyze associations between changes in physical 
activity and mental health (depression and stress scores) adjusted for potential 
socio-economic confounders.
RESULTS: During the first COVID-19 lockdown, 40% decreased their moderate and 
44% their vigorous physical activity, while 16% increased their moderate and 13% 
their vigorous physical activity. Overall, students with a stable physical 
activity level had the lowest mean depressive and stress scores. Adjusted 
analyses showed that a decrease in vigorous and moderate physical activity level 
was significantly associated with a higher depression score (mean difference 
(vigorous): 1.36, p < 0.001 and mean difference (moderate): 1.55, p < 0.001). A 
decrease in vigorous physical activity and an increase in moderate physical 
activity was associated with a 1-point increase in the PSS-4 stress score 
(p < 0.001).
CONCLUSION: A substantial proportion of students changed their physical activity 
level during lockdown. Our findings emphasize the importance of staying 
physically active during COVID-19 lockdown. This knowledge might be important 
for relevant health authorities to bridle post-pandemic mental health 
challenges.

Copyright © 2023 Petersen, Krüger, Guldager, Algren, Jervelund and 
Berg-Beckhoff.

DOI: 10.3389/fpubh.2023.1126240
PMCID: PMC10149910
PMID: 37139380 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


712. Front Public Health. 2023 Apr 17;11:1142230. doi: 10.3389/fpubh.2023.1142230. 
eCollection 2023.

Protecting public's wellbeing against COVID-19 infodemic: The role of trust in 
information sources and rapid dissemination and transparency of information over 
time.

Zhou Y(1)(2)(3), Zhang A(2), Liu X(4), Tan X(5), Miao R(6), Zhang Y(3)(5), Wang 
J(3)(5)(7).

Author information:
(1)School of Sociology and Ethnology, University of Chinese Academy of Social 
Sciences, Beijing, China.
(2)Health and Biosecurity, CSIRO, Brisbane, QLD, Australia.
(3)School of Mental Health, Wenzhou Medical University, Wenzhou, China.
(4)Faculty of Ideological and Political Education and Moral Education, Beijing 
Institute of Education, Beijing, China.
(5)Institute of Sociology, Chinese Academy of Social Sciences, Beijing, China.
(6)Mental Health Education Center, Shijiazhuang Tiedao University, Shijiazhuang, 
China.
(7)School of Psychology, Inner Mongolia Normal University, Hohhot, China.

OBJECTIVES: This study examined how trust in the information about COVID-19 from 
social media and official media as well as how the information was disseminated 
affect public's wellbeing directly and indirectly through perceived safety over 
time.
METHODS: Two online surveys were conducted in China, with the first survey 
(Time1, N = 22,718) being at the early stage of the pandemic outbreak and the 
second one (Time 2, N = 2,901) two and a half years later during the zero-COVID 
policy lockdown period. Key measured variables include trust in official media 
and social media, perceived rapid dissemination and transparency of 
COVID-19-related information, perceived safety, and emotional responses toward 
the pandemic. Data analysis includes descriptive statistical analysis, 
independent samples t-test, Pearson correlations, and structural equation 
modeling.
RESULTS: Trust in official media, perceived rapid dissemination and transparency 
of COVID-19-related information, perceived safety, as well as positive emotional 
response toward COVID-19 increased over time, while trust in social media and 
depressive response decreased over time. Trust in social media and official 
media played different roles in affecting public's wellbeing over time. Trust in 
social media was positively associated with depressive emotions and negatively 
associated with positive emotion directly and indirectly through decreased 
perceived safety at Time 1. However, the negative effect of trust in social 
media on public's wellbeing was largely decreased at Time 2. In contrast, trust 
in official media was linked to reduced depressive response and increased 
positive response directly and indirectly through perceived safety at both 
times. Rapid dissemination and transparency of COVID-19 information contributed 
to enhanced trust in official media at both times.
CONCLUSION: The findings highlight the important role of fostering public trust 
in official media through rapid dissemination and transparency of information in 
mitigating the negative impact of COVID-19 infodemic on public's wellbeing over 
time.

Copyright © Zhou, Zhang, Liu, Tan, Miao, Zhang and Wang.

DOI: 10.3389/fpubh.2023.1142230
PMCID: PMC10149692
PMID: 37139363 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


713. Eur Respir Rev. 2023 May 3;32(168):220237. doi: 10.1183/16000617.0237-2022. 
Print 2023 Jun 30.

Quality of life in patients with chronic respiratory failure on home mechanical 
ventilation.

D'Cruz RF(1)(2), Kaltsakas G(3)(2), Suh ES(3)(4), Hart N(3)(2).

Author information:
(1)Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' 
Hospital, London, UK rebecca.dcruz@gstt.nhs.uk.
(2)Centre for Human and Applied Physiological Sciences, King's College London, 
London, UK.
(3)Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' 
Hospital, London, UK.
(4)Centre for Life Sciences, King's College London, London, UK.

Home mechanical ventilation (HMV) is a treatment for chronic respiratory failure 
that has shown clinical and cost effectiveness in patients with underlying COPD, 
obesity-related respiratory failure and neuromuscular disease (NMD). By treating 
chronic respiratory failure with adequate adherence to HMV, improvement in 
patient-reported outcomes including health-related quality of life (HRQoL) have 
been evaluated using general and disease-specific quantitative, semi-qualitative 
and qualitative methods. However, the treatment response in terms of trajectory 
of change in HRQoL is not uniform across the restrictive and obstructive disease 
groups. In this review, the effect of HMV on HRQoL across the domains of symptom 
perception, physical wellbeing, mental wellbeing, anxiety, depression, 
self-efficacy and sleep quality in stable and post-acute COPD, rapidly 
progressive NMD (such as amyotrophic lateral sclerosis), inherited NMD 
(including Duchenne muscular dystrophy) and obesity-related respiratory failure 
will be discussed.

Copyright ©The authors 2023.

DOI: 10.1183/16000617.0237-2022
PMCID: PMC10155047
PMID: 37137507 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest: R.F D'Cruz has received 
consulting fees from ResMed and AstraZeneca; and payment or honoraria from 
ResMed and Fisher & Paykel, all outside the submitted work. Conflict of 
interest: G. Kaltsakas has nothing to disclose. Conflict of interest: E-S. Suh 
has received grants or contracts from Philips Respironics; and consulting fees 
from Philips, all outside the submitted work. Conflict of interest: N. Hart has 
received consulting fees from ResMed and from Philips; payment or honoraria from 
Fisher & Paykel and Philips; and support for attending meetings and/or travel 
from Fisher & Paykel, all outside the submitted work; N. Hart has patents 
planned, issued or pending: Myotrace Patent, held by Guy's and St Thomas’ 
Foundation Trust.


714. J Homosex. 2024 Jun 6;71(7):1808-1835. doi: 10.1080/00918369.2023.2206935. Epub 
2023 May 2.

Effects of the COVID-19 Pandemic on the Wellbeing of LGBTQ+ Individuals in 
Moldova: A Mixed Methods Analysis.

Holliday N(1), Mulear V(2).

Author information:
(1)Faculty of Medicine, University of Freiburg, Freiburg, Germany.
(2)LGBT Health Coordinator at GENDERDOC-M, Chișinău, Moldova.

Research on the effects of the COVID-19 pandemic for LGBTQ+ people is limited, 
particularly in eastern Europe. This mixed methods study explored the direct and 
indirect effects of the pandemic on the mental and physical wellbeing of LGBTQ+ 
individuals in Moldova. From June to the end of July 2022, 86 surveys and 12 
interviews were completed by self-identified LGBTQ+ adults in Moldova. Survey 
data were analyzed with descriptive statistics and interviews were coded and 
analyzed using the grounded theory methodology. The two data sets were 
interpreted concurrently to identify emergent themes. Overall, data suggest 
LGBTQ+ people experienced both negative and positive effects on their mental 
wellbeing due to the pandemic. Participants expressed feelings of anxiety, 
loneliness, and depression, and an inability to be their authentic selves. 
Conversely, participants had more capacity to explore their identities and they 
demonstrated social support within the LGBTQ+ community. Regarding physical 
impacts, there were interruptions to transgender medical care and concerns about 
housing affordability. Findings highlight the unique impacts of the pandemic on 
LGBTQ+ people and stress the importance of further research in this area and 
policies and plans to address the needs of LGBTQ+ people in response to the 
pandemic and future health crises.

DOI: 10.1080/00918369.2023.2206935
PMID: 37129469 [Indexed for MEDLINE]


715. Health Expect. 2023 Aug;26(4):1679-1691. doi: 10.1111/hex.13773. Epub 2023 May 
1.

'Lifts your spirits, lifts your mind': A co-produced mixed-methods exploration 
of the benefits of green and blue spaces for mental wellbeing.

McCartan C(1)(2), Davidson G(2), Bradley L(3), Greer K(3), Knifton L(4), 
Mulholland A(3), Webb P(3), White C(4).

Author information:
(1)Regional Trauma Network, IMPACT Research Centre, Northern Health and Social 
Care Trust, Antrim, UK.
(2)School of Social Sciences, Education and Social Work, Queen's University 
Belfast, Belfast, UK.
(3)Praxis Care, Belfast, UK.
(4)Mental Health Foundation, Glasgow, UK.

INTRODUCTION: Mental health problems are a considerable public health issue and 
spending time in nature has been promoted as a way to access a range of 
psychological benefits leading to the development of nature-based interventions 
for people with severe and enduring mental health problems. Less, however, is 
understood about the potential benefits and efficacy of day-to-day routine 
access to outdoor green and blue spaces for mental health service users.
METHODS: Using a mixed-methods design between April and October 2021, we 
explored the benefits and barriers to spending time outdoors with a purposive 
sample of mental health service users (N = 11) using qualitative interviews and 
an online general population survey (N = 1791). Qualitative evidence highlighted 
the restorative benefits of nature and identified a number of barriers 
associated with fears around personal safety, social anxiety, fatigue and lack 
of motivation. COVID-19 had also restricted access to green and blue spaces. 
Having social contact and support encouraged people to spend time outdoors. In 
the quantitative survey, self-report and standardised measures (the Patient 
Health Questionnaire and the Warwick-Edinburgh Wellbeing Scale) were used to 
assess past and current mental wellbeing.
FINDINGS: Statistically significant differences were found between wellbeing and 
the use of green and blue spaces. Those with mental health problems spent time 
outdoors because they: felt guilty; wanted to reduce their anxiety; or rely on 
someone for encouragement. Those without mental health problems endorsed more 
positively framed reasons including relaxation, improving physical health or 
getting exercise. Barriers for people with mental health problems involved 
safety concerns, feeling anxious and having a poor self-image. These findings 
give insight into motivations for an outdoor activity to help inform the design 
of public mental health interventions.
CONCLUSION: Further work is required to improve access and safety to promote the 
benefits of green and blue spaces for everyone.
PATIENT OR PUBLIC CONTRIBUTION: The research team included expert experienced 
researchers with a mental health service provider (Praxis Care) and they were 
involved in the development of the research idea, funding application, design, 
data collection, analysis, writing up and dissemination activities.

© 2023 The Authors. Health Expectations published by John Wiley & Sons Ltd.

DOI: 10.1111/hex.13773
PMCID: PMC10349228
PMID: 37128668 [Indexed for MEDLINE]

Conflict of interest statement: Gavin Davidson's post at Queen's University 
Belfast is partly funded by Praxis Care which was one of the partners in this 
project. The remaining authors declare no conflict of interest.


716. J Gerontol Nurs. 2023 May;49(5):45-52. doi: 10.3928/00989134-20230414-05. Epub 
2023 May 1.

Long-Term Care Staff Perspectives on the Care of Persons Living With Dementia 
During the COVID-19 Pandemic in São Paulo State, Brazil.

de Melo RC, Schutz V, Wachholz PA, Villalonga-Olives E, Myer D, Corazzini K, 
Lepore M.

During the coronavirus disease 2019 (COVID-19) pandemic, the Brazilian long-term 
care (LTC) sector faced many challenges, which accentuated other common issues 
experienced by persons living with dementia (PLWD). The current pilot study 
evaluated staff perspectives regarding the care of institutionalized PLWD during 
the COVID-19 pandemic. Using an online survey, we collected the perspectives of 
24 workers from seven long-term care facilities (LTCFs) located in São Paulo 
State, Brazil, about the impact of COVID-19 in caring for PLWD. Results 
highlight concerns about challenges related to following precautionary measures 
and the negative effects of social distancing on PLWD. Aspects related to 
workforce and staffing and person-centered care approaches were recognized by 
staff as important to provide good care for PLWD. Future research is needed to 
consider how to support LTCFs in achieving a balance between the protection and 
well-being of PLWD. [Journal of Gerontological Nursing, 49(5), 45-52.].

DOI: 10.3928/00989134-20230414-05
PMID: 37126010 [Indexed for MEDLINE]


717. J Trauma Acute Care Surg. 2023 Nov 1;95(5):800-805. doi: 
10.1097/TA.0000000000003979. Epub 2023 May 1.

Financial toxicity after trauma and acute care surgery: From understanding to 
action.

Scott JW(1), Knowlton LM, Murphy P, Neiman PU, Martin RS, Staudenmayer K; AAST 
Health Economics Committee.

Author information:
(1)From the Department of Surgery (J.W.S.), Center for Health Outcomes and 
Policy, University of Michigan, Ann Arbor, Michigan; Department of Surgery 
(L.M.K., K.S.), Stanford University School of Medicine, Stanford, California; 
Department of Surgery (P.M.), Division of Trauma/Acute Care Surgery, Medical 
College of Wisconsin, Milwaukee, Wisconsin; Department of Surgery (P.U.N.), 
Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and 
Department of Surgery (R.S.M.), Wake Forest School of Medicine, Winston-Salem, 
North Carolina.

Gains in inpatient survival over the last five decades have shifted the burden 
of major injuries and surgical emergencies from the acute phase to their 
long-term sequelae. More attention has been placed on evaluation and 
optimization of long-term physical and mental health; however, the impact of 
major injuries and surgical emergencies on long-term financial well-being 
remains a critical blind spot for clinicians and researchers. The concept of 
financial toxicity encompasses both the objective financial consequences of 
illness and medical care as well as patients' subjective financial concerns. In 
this review, representatives of the Healthcare Economics Committee from the 
American Association for the Surgery of Trauma (1) provide a conceptual overview 
of financial toxicity after trauma or emergency surgery, (2) outline what is 
known regarding long-term economic outcomes among trauma and emergency surgery 
patients, (3) explore the bidirectional relationship between financial toxicity 
and long-term physical and mental health outcomes, (4) highlight policies and 
programs that may mitigate financial toxicity, and (5) identify the current 
knowledge gaps and critical next steps for clinicians and researchers engaged in 
this work.

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/TA.0000000000003979
PMID: 37125781 [Indexed for MEDLINE]


718. Br J Biomed Sci. 2023 Apr 12;80:11266. doi: 10.3389/bjbs.2023.11266. eCollection 
2023.

A Review of Clinical Laboratory Education, Training and Progression: Historical 
Challenges, the Impact of COVID-19 and Future Considerations.

Pearse C(1), Scott S(1).

Author information:
(1)School of Science and Technology, Nottingham Trent University, Nottingham, 
United Kingdom.

The COVID-19 pandemic had a wide global impact on society, including the 
clinical laboratory workforce. This historically underrepresented group of 
highly skilled professionals have now started to gain the attention they 
deserve. There had already been dramatic changes to laboratory training over the 
past 2 decades resulting from advances in technology, changes to service needs, 
and as a consequence of Pathology reform initiatives. The pandemic has had an 
additional impact. Higher education institutions and students adapted to 
emergency remote teaching. Clinical laboratories faced unprecedented challenges 
to meet COVID-19 testing demands and adjust to new ways of working whilst 
maintaining their usual high quality service provision. Training, assessment, 
and development arrangements had to convert to online platforms to maintain 
social distancing. The pandemic also had a global impact on mental health and 
wellbeing, further impacting learning/training. Despite these challenges, there 
have been many positive outcomes. This review highlights pre- and post-pandemic 
training and assessment for clinical laboratory professionals, with particular 
emphasis on Biomedical Scientists, outlining recent improvements among a history 
of challenges. There is increasing interest surrounding this vital workforce, 
accelerated thanks to the pandemic. This new public platform has emphasised the 
importance of quality diagnostic services in the patient pathway and in the 
response to national crises. The ability to maintain a quality service that is 
prepared for the future is grounded in the effective training and development of 
its staff. All of which can only be achieved with a workforce that is 
sustainable, invested in, and given a voice.

Copyright © 2023 Pearse and Scott.

DOI: 10.3389/bjbs.2023.11266
PMCID: PMC10130196
PMID: 37125390 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


719. Front Public Health. 2023 Apr 13;11:1156840. doi: 10.3389/fpubh.2023.1156840. 
eCollection 2023.

The impact of COVID-19 on the mental health of Lebanese pharmacists: A national 
cross-sectional study.

Safwan J(1)(2), Halat DH(3)(4), Akel M(2)(5)(6), Younes S(1)(2), Rahal M(4), 
Mourad N(2)(4), Akiki Z(2), Cherfane M(2)(7), Saade F(1)(8)(9), Bouraad 
E(1)(10), Dabbous M(5), Sakr F(1)(2)(11)(12).

Author information:
(1)Biomedical Sciences Department, School of Pharmacy, Lebanese International, 
University, Beirut, Lebanon.
(2)INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et 
de Toxicologie-Liban), Beirut, Lebanon.
(3)Academic Quality Department, QU Health, Qatar University, Doha, Qatar.
(4)Pharmaceutical Sciences Department, School of Pharmacy, Lebanese 
International, University, Beirut, Lebanon.
(5)Pharmacy Practice Department, School of Pharmacy, Lebanese International, 
University, Beirut, Lebanon.
(6)School of Education, Lebanese International University, Beirut, Lebanon.
(7)Population Health Division, Gilbert and Rose-Marie Chagoury School of 
Medicine, Lebanese American University, Byblos, Lebanon.
(8)Alice Ramez Chagoury School of Nursing, Lebanese American University, Byblos, 
Lebanon.
(9)Lebanese Order of Pharmacists, Beirut, Lebanon.
(10)Department of Epidemiology and Population Health, American University of 
Beirut, Beirut, Lebanon.
(11)UMR U955 INSERM, Institut Mondor de Recherche Biomédicale, Université 
Paris-Est, Créteil, France.
(12)École Doctorale Sciences de la Vie et de la Santé, Université Paris-Est, 
Créteil, France.

INTRODUCTION: The COVID-19 pandemic has induced a global mental health crisis 
with variable consequences. This study aimed to assess the psychological impact 
of COVID-19 regarding anxiety, insomnia, depression, and response to trauma on 
pharmacists in Lebanon during COVID-19, and to identify factors contributing to 
psychological distress.
METHODS: This was a cross-sectional study among pharmacists that involved the 
use of the 7-item Generalized Anxiety Disorder (GAD-7), 7-item Insomnia Severity 
Index (ISI), Patient Health Questionnaire 9-item depression module (PHQ-9), and 
Impact of Event Scale revised (IES-R) subscales. Descriptive statistical 
analyses were performed to determine the study distribution. The associations 
between the scores and the participants' characteristics were assessed using the 
Chi-square test. Four binary logistic regression models were used to evaluate 
the association between the scores and the potential confounders, followed by 
four multivariable logistic regressions. An alpha of 0.05 was used to determine 
statistical significance.
RESULTS: Participants comprised 311 pharmacists from all Lebanese districts, of 
whom 251 (80.7%) were females and 181 (58.2%) aged between 26 and 35 years. The 
majority of the participants were community pharmacists (n = 178, 57.2%). A 
considerable proportion of participants had symptoms of anxiety (n = 128, 
41.2%), insomnia (n = 64, 20.6%), depression (n = 157, 50.5%), and subjective 
stress (n = 227, 78.8%). Higher anxiety (aOR: 1.73, 95% CI: 1.08; 2.78, p-value: 
0.02), higher depression (aOR: 3.06, 95% CI: 1.73; 5.39, p-value: 0.001), and 
higher stress (aOR: 1.86, 95 percent CI: 1.11; 3.14, p-value: 0.02) scores were 
significantly associated with pharmacists who reported that their work involves 
contact with infected/suspected COVID-19 patients. Interestingly, pharmacists 
who expressed concern about contracting COVID-19 infection had significantly 
higher anxiety (aOR: 2.35, 95% CI: 1.40; 3.94, p-value: 0.001) and higher 
depression scores (aOR: 2.64, 95% CI: 1.49; 4.67, p-value: 0.001) respectively.
CONCLUSION: The preliminary results from pharmacists in Lebanon reflect increase 
in stress, burden, and frustration felt by pharmacists, creating a negative 
impact on their mental health and well-being during the global pandemic. As 
frontline healthcare workers, the role of pharmacists in the community should 
not be overlooked, and their mental health should be well investigated.

Copyright © 2023 Safwan, Hammoudi Halat, Akel, Younes, Rahal, Mourad, Akiki, 
Cherfane, Saade, Bouraad, Dabbous and Sakr.

DOI: 10.3389/fpubh.2023.1156840
PMCID: PMC10134900
PMID: 37124813 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


720. BMC Psychol. 2023 Apr 29;11(1):140. doi: 10.1186/s40359-023-01180-9.

Loneliness and trust issues reshape mental stress of expatriates during early 
COVID-19: a structural equation modelling approach.

Billah MA(1)(2), Akhtar S(3), Khan MN(4).

Author information:
(1)Faculty of Business, Economics and Social Development, Universiti Malaysia 
Terengganu, 21030 Kuala Nerus, Terengganu, Malaysia. 
arifbillah.pshrd2018@gmail.com.
(2)Health System and Population Studies Division, icddr,b, Dhaka, 1212, 
Bangladesh. arifbillah.pshrd2018@gmail.com.
(3)Faculty of Business, Economics and Social Development, Universiti Malaysia 
Terengganu, 21030 Kuala Nerus, Terengganu, Malaysia.
(4)Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, 
Trishal, Mymensingh, Bangladesh.

OBJECTIVES: To explore relationship among perceived stress regarding loneliness, 
interpersonal trust and institutional trust of expatriates during the early 
COVID-19 period (from 30th March to 30th May 2020).
METHODS: Data from  21,439 expatriates were extracted from COVIDiSTRESS global 
survey. The outcome variable was perceived stress. The explanatory variables 
were age, perceived loneliness, trust (interpersonal and institutional). 
Pairwise correlation, and structural equation modelling were used to determine 
relationship among outcome and explanatory variables.
RESULTS: The majority of the expatriates were female (73.85%), married (60.20%), 
had college degree (47.76%), and employed (48.72%). Over 63% of the total 
expatriates reported that the COVID-19 pandemic changed their lives. The average 
age of the respondents was 40.4 years (± 13.7), and the average score of 
perceived stress, loneliness, interpersonal and institutional trust were 25.5, 
7.4, 14.2 and 40.4, respectively. We found a moderate correlation of perceived 
stress with age, perceived loneliness, interpersonal trust and institutional 
trust (p < 0.001). They were also found moderately related to each other. 
Structural equation modelling evaluated that a lack of trust can cause 
loneliness among expatriates, which later lead to perceived stress. 
Interpersonal trust was more likely to be associated with stress than 
institutional trust, whereas perceived loneliness mediated between both trusts 
and perceived stress.
CONCLUSION: Perceived stress can be reduced through trusting others and 
alleviating the loneliness. Making strong linkage among migrants as well as 
between migrants and local community is important to ensure proper mental 
wellbeing of expatriates.

© 2023. The Author(s).

DOI: 10.1186/s40359-023-01180-9
PMCID: PMC10148631
PMID: 37120632 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


721. Disabil Health J. 2023 Jul;16(3):101472. doi: 10.1016/j.dhjo.2023.101472. Epub 
2023 Apr 6.

The experiences and attitudes of family caregivers of adults with intellectual 
and developmental disabilities at different timepoints in the COVID-19 pandemic.

Tarzi G(1), Mendoza O(1), Lunsky Y(2), St John L(1).

Author information:
(1)Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental 
Health, 1001 Queen St W, M6J 1H4, Toronto, ON, Canada.
(2)Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental 
Health, 1001 Queen St W, M6J 1H4, Toronto, ON, Canada; Department of Psychiatry, 
University of Toronto, Toronto, ON, Canada. Electronic address: 
yona.lunsky@camh.ca.

BACKGROUND: The COVID-19 pandemic has resulted in increased pressures for family 
caregivers of adults with intellectual and developmental disabilities (IDD). 
However, little is known about how their attitudes and perceptions have changed 
over the course of the pandemic.
OBJECTIVE: To compare the COVID-19 experiences and attitudes of two groups of 
family caregivers, reported at different timepoints in the pandemic: prior to 
vaccine availability and after.
METHODS: As part of a larger research study, family caregivers of adults with 
IDD from across Canada completed surveys on their COVID-19 experiences. Survey 
questions included responses about access to supports, stressors, self-efficacy, 
mental wellbeing, and pandemic impacts on their family member with IDD. 
Respondents were assigned to either of two groups based on the time of 
questionnaire completion: late 2020/early 2021 for Group 1 and mid 2022 for 
Group 2. Descriptive statistics and analysis between groups were reported.
RESULTS: Despite being surveyed at different timepoints in the pandemic, both 
groups indicated concerns regarding lack of professional support and resources, 
lack of programming, and experiences of loneliness for their family members. 
However, Group 2 reported greater self-efficacy dealing with COVID-19 related 
challenges and greater overall mental wellbeing, compared to Group 1. Group 2 
caregivers, after which vaccines were widely available in Canada, were largely 
vaccinated (96.4%).
CONCLUSIONS: Despite the COVID-19 pandemic persisting for over two years, family 
caregivers of adults with IDD reported facing the same challenges as families 
who reported on their experiences a year prior. Notwithstanding, family 
caregivers surveyed later in the pandemic described a greater sense of 
self-efficacy and mental wellbeing.

Copyright © 2023. Published by Elsevier Inc.

DOI: 10.1016/j.dhjo.2023.101472
PMCID: PMC10077762
PMID: 37120390 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of interest The authors have no 
conflict of interests to declare.


722. Appetite. 2023 Jul 1;186:106576. doi: 10.1016/j.appet.2023.106576. Epub 2023 Apr 
28.

Maternal mood, body image, and eating habits predict changes in feeding 
practices during the COVID-19 pandemic.

Rodgers RF(1), Sereno I(2), Zimmerman E(3).

Author information:
(1)APPEAR, Department of Applied Psychology, Northeastern University, Boston, 
USA; Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU 
Montpellier, France. Electronic address: r.rodgers@northeastern.edu.
(2)APPEAR, Department of Applied Psychology, Northeastern University, Boston, 
USA.
(3)Speech and Neurodevelopment Lab, Department of Communications Science and 
Disorders, Northeastern University, Boston, USA.

Maternal mood and eating habits are associated with food parenting practices, 
including non-responsive feeding practices, which in turn impact children's 
eating habits. The COVID-19 pandemic may have negatively impacted maternal mood 
due to the overall stress and challenges, contributing to changes in eating 
behaviors and food parenting practices. The present study examined how maternal 
mood, body image, and eating concerns were related to perceived changes in 
feeding practices during the pandemic. A total of 137 mothers participated in an 
online study. Participants retrospectively reported their mood, eating habits, 
body dissatisfaction, and non-responsive feeding practices, before and during 
the pandemic, and responded to open-ended questions regarding changes in eating 
and feeding patterns during the pandemic. Results suggested differences in 
non-responsive feeding practices, including higher use of food as a reward for 
behavior and lower use of standard meal settings during the pandemic. In 
addition, significant relationships were found between higher maternal stress 
and higher body dissatisfaction (r = 0.37; p < .01), restrained eating (r = 31; 
p < .01), emotional eating (r = 0.44; p < .01), and higher use of overt and 
covert restriction retrospectively and during the pandemic. Results revealed 
trends in the same direction for depression and anxiety. Finally, qualitative 
findings were consistent with the quantitative findings, suggesting 
relationships between maternal mood, eating habits, and feeding practices. These 
results provide support for previous findings suggesting that the pandemic 
negatively impacted maternal well-being, increasing the use of some 
non-responsive feeding practices. Further work exploring the impacts of the 
pandemic on well-being, child feeding, and eating patterns is warranted.

Copyright © 2023 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.appet.2023.106576
PMCID: PMC10139752
PMID: 37120069 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


723. BMC Psychol. 2023 Apr 28;11(1):138. doi: 10.1186/s40359-023-01189-0.

The development and effectiveness of web-based psychological capital 
intervention on the mental well-being of tourism workers during the COVID-19 
pandemic.

Sumalrot T(1), Suwanwong C(2), Pimthong S(3), Surakarn A(4), Chiangkhong A(5), 
Khunakorncharatphong A(6).

Author information:
(1)Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
(2)Behavioral Science Research Institute, Srinakharinwirot University, Bangkok, 
Thailand. charins@g.swu.ac.th.
(3)Behavioral Science Research Institute, Srinakharinwirot University, Bangkok, 
Thailand.
(4)Graduate School, Srinakharinwirot University, Bangkok, Thailand.
(5)Kuakarun Faculty of Nursing, Navamindradhiraj University, Bangkok, Thailand.
(6)International Health Policy Program (IHPP), Ministry of Public Health, 
Nonthaburi, Thailand.

The current COVID-19 situation has forced many tourism businesses to close. 
Tourism workers have suffered chronic stress, discouragement, despair, and 
failure to find solutions for their businesses, resulting in deteriorating 
mental health. A psychological capital intervention (PCI) is therefore deemed 
necessary as it promotes the mental well-being of tourism workers. This article 
reports the development of a web-based PCI for the mental well-being of tourism 
workers and an investigation of its effectiveness using a mixed-methods 
intervention design. A qualitative approach was used to develop the intervention 
by conducting interview techniques with 20 tourism entrepreneurs. A content 
analysis was carried out. The intervention was tested through an experimental 
research design. The sample comprised 600 tourism workers who undertook a 
web-based PCI. Data on their mental well-being were collected before the 
intervention and 1 month afterward and analyzed using ANCOVA. The research 
revealed that 4 themes are needed for the intervention: having a goal, tolerance 
of difficulties, inspiration from a role model, and the appropriate way of 
thinking. An effectiveness examination showed that the web-based PCI improves 
mental well-being scores significantly. In conclusion, this web-based PCI, which 
focuses on developing strengths, effectively improves the mental well-being of 
tourism workers facing difficulties during the COVID-19 pandemic.

© 2023. The Author(s).

DOI: 10.1186/s40359-023-01189-0
PMCID: PMC10144891
PMID: 37118838 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that there was no conflict 
of interest.


724. Community Health Equity Res Policy. 2024 Apr;44(3):253-263. doi: 
10.1177/2752535X231173527. Epub 2023 Apr 28.

Qualitative Analysis of Coping Strategies Among Older Persons During COVID-19 
Lockdown in Nigeria: Considerations for Community Health Promotion.

Adedeji IA(1), Lawal SA(2), Aluko-Arowolo S(3).

Author information:
(1)Department of Gerontology, Simon Fraser University, Burnaby, British 
Columbia, Canada.
(2)Department of Public Health, School of Public and Allied Health Babcock 
University, Ilishan-Remo, Nigeria.
(3)Department of Sociology, Olabisi Onabanjo University, Ago-Iwoye, Nigeria.

Background: The challenge of COVID-19 and the disease control restrictions in 
Nigeria directly affected social life. Older adults were disproportionately 
affected because of social vulnerabilities, socio-economic dependency, and the 
high risk of COVID-19 infectious disease in the population.Purpose: To this end, 
the study explored the instrumental coping strategies of older adults duirng the 
COVID-19 lockdown in Nigeria.Research Design: An exploratory research design 
using qualitative approach based on in-depth interviews was adopted.Study 
Sample: Twenty-seven (27) older adults aged 60 years and more in Ibadan, Nigeria 
were purposively selected for participation in the research.Data Collection 
and/or Analysis: Community living older adults participated in in-depth 
telephone interviews during the COVID-19 restrictions. Using Atlas ti 8.4, the 
27 transcripts were analyzed and validated through content analysis.Results: 
Older adults coped with fear, anxiety, depression, and other health challenges, 
and three major themes emerged as problem-focused coping strategies. Older 
adults explored spirituality, engaged in their social networks through 
telephones, and focused on a healthy diet and physical activities.Conclusions: 
Community health promotion strategies for older adults should explore the 
identified problem-focused coping strategies to optimize the health and 
wellbeing of older adults.

DOI: 10.1177/2752535X231173527
PMCID: PMC10149519
PMID: 37118649 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting InterestsThe 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


725. J R Coll Physicians Edinb. 2023 Jun;53(2):137-143. doi: 
10.1177/14782715231168208. Epub 2023 Apr 28.

Self care and wellbeing in the face of COVID-19: Multidisciplinary perspectives 
and interprofessional experiences.

Wheater K(1), Montgomery C(2), Clark R(3), Nimmo G(4).

Author information:
(1)Chaplaincy Centre, University of Edinburgh, Edinburgh, Scotland, UK.
(2)Chancellor's Fellow in Sociology of Biomedicine, Science, Technology and 
Innovation Studies, University of Edinburgh, Edinburgh, Scotland, UK.
(3)Welfare Lead & Consultant in Anaesthetics and Intensive Care Medicine, NHS 
Lothian, Edinburgh, Scotland, UK.
(4)Formerly MSc Critical Care, University of Edinburgh, Edinburgh, Scotland, UK.

The human toll which has resulted from the coronavirus disease 2019 pandemic is 
clearly recognised. No single event in recent times has had such profound 
effects on health services and their staff wellbeing around the world. Policy 
making has been led by the requirement for confinement and surveillance to limit 
spread of the disease, and in clinical settings the impact of the necessity for 
the use of personal protective measures has caused huge strains on practice 
clinically and professionally. In this paper we share experiences from the 
pandemic, explore the social and organisational factors at stake and make some 
suggestions for both personal wellbeing practice and a systems response to the 
ongoing staff wellbeing challenges of the pandemic.

DOI: 10.1177/14782715231168208
PMCID: PMC10140767
PMID: 37114378 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared the following potential 
conflicts of interest with respect to the research, authorship, and/or 
publication of this article: Kitty Wheater Belmont University, Payment to me for 
mindfulness workshop in private practice. Shepherd and Wedderburn (Services) 
Limited, Payment to me for mindfulness workshop in private practice Various, 
Payment to me for mindfulness teacher supervision in private practice. Cath 
Montgomery Medical Research Scotland COVID-19 Research Grant [CVG-1739-2020], 
Awarded to PI for the project ‘Caring, Learning And Pandemic response during 
COVID-19: Staff Experience of Working in Critical Care’. Rowena Clark Regional 
Rep and Lead for Wellbeing on the Council of the Scottish Intensive Care 
Society, Unpaid position. Graham Nimmo None.


726. Int J Environ Res Public Health. 2023 Apr 20;20(8):5590. doi: 
10.3390/ijerph20085590.

Alcohol Use, Anxiety and Depression among French Grandes Écoles Engineering 
Students during the COVID-19 Pandemic.

Pitel M(1), Phan O(2)(3)(4)(5), Bonnaire C(1)(2), Hamonniere T(3)(6).

Author information:
(1)Laboratoire de Psychopathologie et Processus de Santé, Université Paris Cité, 
F-92100 Boulogne Billancourt, France.
(2)Centre de Soins d'Accompagnement et de Prévention en Addictologie Pierre 
Nicole, Croix-Rouge Française, 75005 Paris, France.
(3)Service d'addictologie à l'adolescence, Clinique Dupré, Fondation Santé des 
Etudiants de France, Sceaux, 75005 Paris, France.
(4)CESP Unité INSERM, 75005 Paris, France.
(5)Laboratoire Parallélisme, UVSQ Paris, Saclay, 75005 Paris, France.
(6)UR Clipsyd, Université Paris Nanterre, 92001 Nanterre, France.

In French Grandes Écoles, heavy alcohol consumption seems to be generalized and 
largely tolerated, leading to particular concerns about Alcohol Use Disorder and 
harmful alcohol practices among students. The COVID-19 pandemic led to increased 
psychological difficulties, and two coexisting scenarios seemed to emerge 
regarding alcohol consumption: A decrease in alcohol consumption linked to the 
absence of festive events, and an increase in solitary alcohol consumption to 
cope with lockdowns. The aim of this exploratory study is to investigate the 
evolution of alcohol consumption, consumption motives and the relationship of 
these factors to the anxiety and the depression of French Grandes Écoles 
students during the COVID-19 pandemic, depending on their residential status. 
After the last lockdown, 353 students completed a questionnaire measuring 
alcohol consumption, motivation to drink, anxiety and depression during and 
after the COVID-19 period. Although students confined to campus were more likely 
to increase their alcohol use, they also presented higher well-being scores than 
those who lived off campus. A significant proportion of students were aware of 
their increased alcohol use due to the COVID-19 pandemic, and the motives 
attributed to their increased consumption highlight the need for vigilance and 
specialized support facilities.

DOI: 10.3390/ijerph20085590
PMCID: PMC10138594
PMID: 37107872 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


727. Int J Environ Res Public Health. 2023 Apr 20;20(8):5588. doi: 
10.3390/ijerph20085588.

Experiences of People with Cardiovascular Disease during COVID-19 in Sweden: A 
Qualitative Study.

Sjödahl Hammarlund C(1)(2), Norlander A(1)(3), Brogårdh C(1)(3).

Author information:
(1)Department of Health Sciences, Lund University, SE-22100 Lund, Sweden.
(2)The PRO-CARE Group, Faculty of Health Sciences, Kristianstad University, 
SE-29188 Kristianstad, Sweden.
(3)Department of Neurology, Rehabilitation Medicine, Memory Disorders and 
Geriatrics, Skåne University Hospital, SE-22185 Lund, Sweden.

Although people with cardiovascular conditions were subjected to more rigorous 
restrictions during the COVID-19 pandemic, there is limited knowledge of how the 
restrictions affected their lives and well-being. Thus, the aim of this study 
was to describe how people with cardiovascular conditions experienced their life 
situation and physical and mental health during the second wave of the pandemic 
in Sweden. Fifteen participants (median age 69 years; nine women) were 
individually interviewed, and data were analyzed with systematic text 
condensation. The findings revealed that some of the participants were fearful 
of contracting COVID-19 as their medical condition made them vulnerable. 
Additionally, the restrictions changed their daily routines and their ability to 
take part in social activities, as well as their access to specialized 
outpatient care (medical check-ups and physiotherapy). Although emotional and 
psychological distress were present, several participants found strategies that 
reduced their worries, such as exercising and meeting friends outdoors. However, 
some had adopted a more sedentary lifestyle and unhealthy diets. These findings 
indicate that healthcare professionals should provide individualized support to 
persons with cardiovascular diseases in order to find well-functioning emotion- 
and problem-focused strategies aimed at improving physical and mental health 
during crises such as pandemics.

DOI: 10.3390/ijerph20085588
PMCID: PMC10139106
PMID: 37107869 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
declare.


728. Int J Environ Res Public Health. 2023 Apr 10;20(8):5454. doi: 
10.3390/ijerph20085454.

Paternal Leave Entitlement and Workplace Culture: A Key Challenge to Paternal 
Mental Health.

Gheyoh Ndzi E(1), Holmes A(1).

Author information:
(1)York Business School, York St. John University, York YO31 7EX, UK.

Erratum in
    Int J Environ Res Public Health. 2024 Jan 17;21(1):

Paternal mental health continues to be a health concern in the UK. Paternal 
leave entitlement and workplace cultures have failed to support fathers in 
navigating the complexity of fatherhood, which has an impact on fathers' 
wellbeing. Interviewing twenty fathers in the York area, this study seeks to 
explore the impact of parental leave entitlements and workplace cultures on 
fathers' mental health. The findings demonstrate that the influence of gendered 
norms and hegemonic masculinity perceptions are ingrained in the current leave 
entitlement and workplace cultures. While fathers are entitled to take leave, 
the leave is significantly insufficient to allow them to forge a meaningful bond 
with a newborn or adapt to the change in routine brought about by the birth of a 
baby. Furthermore, workplace cultures fail to recognise the responsibilities 
that come with fatherhood and provide insufficient support for fathers. The 
COVID-19 lockdown presented fathers with a unique opportunity to be available 
and take on more family responsibilities. Fathers felt they did not have to 
navigate gendered and hegemonic perceptions to spend more time with the family. 
This paper challenges structural and cultural barriers that prevent fathers from 
taking leave and impacting negatively on fathers' mental health. The paper 
suggests a review of the current paternal leave entitlement and cultural change 
in the workplace.

DOI: 10.3390/ijerph20085454
PMCID: PMC10138670
PMID: 37107736 [Indexed for MEDLINE]

Conflict of interest statement: The author declares no conflict of interest.


729. Int J Environ Res Public Health. 2023 Apr 10;20(8):5451. doi: 
10.3390/ijerph20085451.

"Why Am I Even Here If I Can't Save the Patients?": The Frontline Healthcare 
Workers' Experience of Burnout during COVID-19 Pandemic in Mthatha, South 
Africa.

Fathuse N(1), Hlongwana KW(1)(2), Ginindza TG(1)(2).

Author information:
(1)Discipline of Public Health Medicine, School of Nursing & Public Health, 
University of KwaZulu-Natal, Durban 4041, South Africa.
(2)Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of 
Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa.

INTRODUCTION: Globally, the high prevalence of burnout in healthcare workers 
(HCWs) is of the utmost concern. Burnout is a state of emotional exhaustion, 
depersonalization and a decreased sense of personal accomplishment. While the 
2019 Coronavirus (COVID-19) exacerbated the burnout prevalence among HCWs, 
limited studies have explored this phenomenon using qualitative methodologies in 
the Eastern Cape Province and South Africa generally. This study explored how 
frontline healthcare workers experienced burnout during the COVID-19 pandemic in 
Mthatha Regional Hospital.
METHODS: Ten face-to-face in-depth interviews were conducted with 
non-specialized medical doctors and nurses who directly cared for 
COVID-19-infected patients during the pandemic in Mthatha Regional Hospital 
(MRH). In-depth interviews were digitally recorded and transcribed verbatim. 
Data were managed through NVIVO 12 software before being thematically analyzed 
using Colaizzi's analysis method.
RESULTS: Four main themes emerged from the analysis. These themes were burnout 
manifestation (emotional strain, detachment and irritability, 
uncertainty-induced fear, and anxiety, physical exhaustion, yet, low job 
accomplishment, dread and professional responsibility), precursors of burnout 
(occupational exposure to high mortality, staff shortages, elongated high 
patient volume and workload, disease uncertainties and consistent feeling of 
grief), alleviating factors of burnout (time off work, psychologist 
intervention, periods of low infection rate and additional staff), and the last 
theme was every cloud has a silver lining (improved infection prevention and 
control (IPC) measures, learning to be more empathetic, the passion remains and 
confidence grows).
CONCLUSION: The COVID-19 pandemic brought about a rapid change in the work 
environment of healthcare workers who are the backbone of efficient healthcare 
services, thereby rendering them vulnerable to increased burnout risks. This 
study provides strategic information for policymakers and managers on developing 
and strengthening welfare policies to promote and protect frontline health 
workers' well-being and work functioning.

DOI: 10.3390/ijerph20085451
PMCID: PMC10138325
PMID: 37107733 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interest.


730. Int J Environ Res Public Health. 2023 Apr 7;20(8):5437. doi: 
10.3390/ijerph20085437.

COVID-19 Racism and Chinese American Families' Mental Health: A Comparison 
between 2020 and 2021.

Cheah CSL(1), Ren H(1), Zong X(1), Wang C(2).

Author information:
(1)Department of Psychology, University of Maryland, Baltimore County, 
Baltimore, MD 21250, USA.
(2)Department of Counseling Psychology, Higher Education and Special Education, 
University of Maryland, College Park, MD 20742, USA.

This study compared rates of multiple forms of COVID-19 racism-related 
discrimination experiences, fear/worries, and their associations with mental 
health indices among Chinese American parents and youth between 2020 and 2021. 
Chinese American parents of 4- to 18-year-old children and a subsample of their 
10- to 18-year-old adolescents completed surveys in 2020 and 2021. A high 
percentage of Chinese American parents and their children continued to 
experience or witness anti-Chinese/Asian racism both online and in person in 
2021. Parents and youth experienced less vicarious discrimination in person but 
more direct discrimination (both online and in person) and reported poorer 
mental health in 2021 than in 2020. Associations with mental health were 
stronger in 2021 than in 2020 for parents' and/or youth's vicarious 
discrimination experiences, perceptions of Sinophobia, and government-related 
worries, but weaker only for parents' direct discrimination experiences. The 
spillover effect from parents' vicarious discrimination experiences and 
Sinophobia perceptions to all youth mental health indices were stronger in 2021 
than in 2020. Chinese American families experienced high rates of racial 
discrimination across multiple dimensions, and the detrimental impacts on their 
mental health were still salient in the second year of the pandemic. Vicarious 
and collective racism may have even stronger negative impacts on mental health 
and well-being later in the pandemic. Decreasing health disparities for Chinese 
Americans and other communities of color requires extensive, long-term national 
efforts to eliminate structural aspects of racism.

DOI: 10.3390/ijerph20085437
PMCID: PMC10138552
PMID: 37107719 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


731. Nurs Outlook. 2023 May-Jun;71(3):101970. doi: 10.1016/j.outlook.2023.101970. 
Epub 2023 Apr 25.

American Academy of Nursing Expert Panel Consensus Statement on leveraging 
equity in policy to improve recognition and treatment of mental health, 
substance use disorders, and nurse suicide.

Schimmels J(1), Groh C(2), Neft M(2), Wocial L(3), Young C(2), Davidson JE(2).

Author information:
(1)Psychiatric Mental Health and Substance Use Expert Panel, Detroit, MI; 
Military and Veterans Health Expert Panel. Electronic address: 
jemschimmels@gmail.com.
(2)Psychiatric Mental Health and Substance Use Expert Panel, Detroit, MI.
(3)Bioethics Expert Panel, Bloomington, IN.

Rates of nurse mental health and substance use disorders are high. Heightened by 
the COVID-19 pandemic, nurses are challenged to care for patients in ways that 
often jeopardize their own health and increase risks for their families. These 
trends exacerbate the epidemic of suicide in nursing underscored by several 
professional organization clarion calls to nurses' risk. Principles of health 
equity and trauma-informed care dictate urgent action. The purpose of this paper 
is to establish consensus among clinical and policy leaders from Expert Panels 
of the American Academy of Nursing about actions to address risks to mental 
health and factors contributing to nurse suicide. Recommendations for mitigating 
barriers drew from the CDC's 2022 Suicide Prevention Resource for Action 
strategies to guide the nursing community to inform policy, education, research, 
and clinical practice with the goals of greater health promotion, risk 
reduction, and sustainment of nurses' health and well-being are provided.

Copyright © 2023 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.outlook.2023.101970
PMCID: PMC10129051
PMID: 37104889 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest Statement The authors have 
no affiliations with or involvement in any organization or entity with any 
financial interest or non-financial interest in the subject matter or materials 
discussed in this manuscript.


732. PLoS One. 2023 Apr 27;18(4):e0285038. doi: 10.1371/journal.pone.0285038. 
eCollection 2023.

Is this the solution to wellbeing and burnout management for the critical care 
workforce? A parallel, interventional, feasibility and realist informed pilot 
randomized control trial protocol.

Adnan NBB(1), Dafny HA(1), Baldwin C(1), Beccaria G(2)(3), Chamberlain D(1).

Author information:
(1)Caring Futures Institute and College of Nursing and Health Sciences, Flinders 
University, Bedford Park, South Australia, Australia.
(2)School of Psychology and Wellbeing, University of Southern Queensland, 
Darling Heights, Queensland, Australia.
(3)Institute of Resilient Regions, University of Southern Queensland, Darling 
Heights, Queensland, Australia.

Critical care healthcare professionals are at high risk in developing burnout 
and mental health disorders including depression, anxiety, and post-traumatic 
stress disorder. High demands and the lack of resources lead to decreased job 
performance and organizational commitment, low work engagement, and increases 
emotional exhaustion and feelings of loneliness. Peer support and 
problem-solving approaches demonstrate promising evidence as it targets 
workplace loneliness, emotional exhaustion, promotes work engagement, and 
supports adaptive coping behaviors. Tailoring of interventions have also shown 
to be effective in influencing attitudes and behavior changes, attending to the 
individual experience and specific needs of end-users. The purpose of this study 
is to assess the feasibility and user-perceived acceptability of a combined 
intervention (Individualized Management Plan (IMP) and Professional 
Problem-Solving Peer (PPSP) debrief) in critical care healthcare professionals. 
This protocol was registered in the Australian and New Zealand Clinical Trials 
Registry (ACTRN12622000749707p). A two-arm randomized controlled trial, with 
pre-post-follow-up repeated measures intergroup design with 1:1 allocation ratio 
to either 1) treatment group-IMP and PPSP debrief, or 2) active control 
group-informal peer debrief. The primary outcomes will be conducted by assessing 
the recruitment process enrolment, intervention delivery, data collection, 
completion of assessment measures, user engagement and satisfaction. The 
secondary outcomes will explore preliminary effectiveness of the intervention 
using self-reported questionnaire instruments from baseline to 3-months. This 
study will provide the interventions' feasibility and acceptability data for 
critical care healthcare professionals and will be used to inform a future, 
large-scale trial testing efficacy.

Copyright: © 2023 Adnan et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0285038
PMCID: PMC10138256
PMID: 37104503 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


733. MMWR Suppl. 2023 Apr 28;72(1):13-21. doi: 10.15585/mmwr.su7201a2.

School Connectedness and Risk Behaviors and Experiences Among High School 
Students - Youth Risk Behavior Survey, United States, 2021.

Wilkins NJ, Krause KH, Verlenden JV, Szucs LE, Ussery EN, Allen CT, Stinson J, 
Michael SL, Ethier KA.

School connectedness, defined as students' belief that adults and peers in their 
school care about their learning as well as about them as persons, has been 
linked to positive educational, behavioral, and health outcomes in adolescence 
and into adulthood. Data from the 2021 nationally representative Youth Risk 
Behavior Survey, conducted during the COVID-19 pandemic, were used to estimate 
prevalence of students' perception of school connectedness and examine 
associations between school connectedness and seven risk behaviors and 
experiences: poor mental health, marijuana use, prescription opioid misuse, 
sexual intercourse, unprotected sex, experiencing forced sex, and missing school 
because of feeling unsafe. Prevalence estimates were generated and pairwise 
t-tests were used to detect differences among student subpopulations by sex, 
grade, race and ethnicity, and sexual identity; Wald chi-square tests were used 
to detect differences in risk behaviors by level of connectedness within a 
subpopulation. Logistic regression models were used to estimate prevalence 
ratios comparing the prevalence of risk behaviors and experiences of students 
with high connectedness with students with low connectedness, stratified by 
demographics. During 2021, 61.5% of U.S. high school students reported feeling 
connected to others at school. In addition, school connectedness was associated 
with lower prevalence of every risk behavior and experience examined in this 
study, although certain associations differed by race and ethnicity and sexual 
identity (e.g., school connectedness was associated with better mental health 
outcomes for youths with heterosexual, bisexual, and questioning or other sexual 
identities, but not for youths who identified as lesbian or gay). These findings 
can guide public health interventions that promote youth well-being by creating 
school environments where all youths have a sense of belonging and feel they are 
cared for and supported.

DOI: 10.15585/mmwr.su7201a2
PMCID: PMC10156161
PMID: 37104377 [Indexed for MEDLINE]

Conflict of interest statement: All authors have completed and submitted the 
International Committee of Medical Journal Editors form for disclosure of 
potential conflicts of interest. No potential conflicts of interest were 
disclosed.


734. PLoS Med. 2023 Apr 27;20(4):e1004214. doi: 10.1371/journal.pmed.1004214. 
eCollection 2023 Apr.

Home working and social and mental wellbeing at different stages of the COVID-19 
pandemic in the UK: Evidence from 7 longitudinal population surveys.

Wels J(1)(2), Wielgoszewska B(3), Moltrecht B(3), Booth C(3), Green MJ(4), 
Hamilton OK(4), Demou E(4), Di Gessa G(5), Huggins C(6), Zhu J(5), Santorelli 
G(7), Silverwood RJ(3), Kopasker D(4), Shaw RJ(4), Hughes A(1), Patalay P(1)(3), 
Steves C(8), Chaturvedi N(1), Porteous DJ(6), Rhead R(3), Katikireddi SV(4), 
Ploubidis GB(3).

Author information:
(1)MRC Unit for Lifelong Health and Ageing, University College London, London, 
United Kingdom.
(2)Centre Metices, Université libre de Bruxelles, Brussels, Belgium.
(3)Centre for Longitudinal Studies (CLS), Social Research Institute, University 
College London, London, United Kingdom.
(4)MRC/CSO Social and Public Health Sciences Unit, School of Health and 
Wellbeing, University of Glasgow, Clarice Pears Building, Glasgow, United 
Kingdom.
(5)Research Department of Epidemiology and Public Health, University College 
London, London, United Kingdom.
(6)Centre for Genomic and Experimental Medicine, The University of Edinburgh 
Western General Hospital, Edinburgh, United Kingdom.
(7)Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom.
(8)Twin Research & Genetic Epidemiology, King's College London, St Thomas' 
Hospital London, United Kingdom.

BACKGROUND: Home working has increased since the Coronavirus Disease 2019 
(COVID-19) pandemic's onset with concerns that it may have adverse health 
implications. We assessed the association between home working and social and 
mental wellbeing among the employed population aged 16 to 66 through harmonised 
analyses of 7 UK longitudinal studies.
METHODS AND FINDINGS: We estimated associations between home working and 
measures of psychological distress, low life satisfaction, poor self-rated 
health, low social contact, and loneliness across 3 different stages of the 
pandemic (T1 = April to June 2020 -first lockdown, T2 = July to October 2020 
-eased restrictions, T3 = November 2020 to March 2021 -second lockdown) using 
modified Poisson regression and meta-analyses to pool results across studies. We 
successively adjusted the model for sociodemographic characteristics (e.g., age, 
sex), job characteristics (e.g., sector of activity, pre-pandemic home working 
propensities), and pre-pandemic health. Among respectively 10,367, 11,585, and 
12,179 participants at T1, T2, and T3, we found higher rates of home working at 
T1 and T3 compared with T2, reflecting lockdown periods. Home working was not 
associated with psychological distress at T1 (RR = 0.92, 95% CI = 0.79 to 1.08) 
or T2 (RR = 0.99, 95% CI = 0.88 to 1.11), but a detrimental association was 
found with psychological distress at T3 (RR = 1.17, 95% CI = 1.05 to 1.30). 
Study limitations include the fact that pre-pandemic home working propensities 
were derived from external sources, no information was collected on home working 
dosage and possible reverse association between change in wellbeing and home 
working likelihood.
CONCLUSIONS: No clear evidence of an association between home working and mental 
wellbeing was found, apart from greater risk of psychological distress during 
the second lockdown, but differences across subgroups (e.g., by sex or level of 
education) may exist. Longer term shifts to home working might not have adverse 
impacts on population wellbeing in the absence of pandemic restrictions but 
further monitoring of health inequalities is required.

Copyright: © 2023 Wels et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pmed.1004214
PMCID: PMC10138202
PMID: 37104282 [Indexed for MEDLINE]

Conflict of interest statement: I have read the journal’s policy and the authors 
of this manuscript have the following competing interests: SVK is a member of 
the Scientific Advisory Group on Emergencies, the other authors report no 
competing interests.


735. BMC Health Serv Res. 2023 Apr 26;23(1):405. doi: 10.1186/s12913-023-09382-y.

Psychological wellbeing of Australian community health service staff during the 
COVID-19 pandemic: a longitudinal cohort study.

Holton S(1)(2), Wynter K(3)(4), Peeters A(5), Georgalas A(6), Yeomanson A(7), 
Rasmussen B(3)(4)(7)(8).

Author information:
(1)School of Nursing and Midwifery, Faculty of Health, Deakin University, 
Geelong, VIC, 3220, Australia. s.holton@deakin.edu.au.
(2)The Centre for Quality and Patient Safety Research in the Institute of Health 
Transformation, Deakin University - Western Health Partnership, St Albans, VIC, 
3021, Australia. s.holton@deakin.edu.au.
(3)School of Nursing and Midwifery, Faculty of Health, Deakin University, 
Geelong, VIC, 3220, Australia.
(4)The Centre for Quality and Patient Safety Research in the Institute of Health 
Transformation, Deakin University - Western Health Partnership, St Albans, VIC, 
3021, Australia.
(5)Institute of Health Transformation, Faculty of Health, Deakin University, 
Geelong, VIC, 3220, Australia.
(6)Victorian Healthcare Association, Melbourne, VIC, 3000, Australia.
(7)Faculty of Health Sciences, University of Southern Denmark and Steno Diabetes 
Center, Copenhagen, Denmark.
(8)Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 
Denmark.

BACKGROUND: Hospital clinical staff have reported poor psychosocial wellbeing 
during the COVID-19 pandemic. Little is known about community health service 
staff who undertake various roles including education, advocacy and clinical 
services, and work with a range of clients. Few studies have collected 
longitudinal data. The aim of this study was to assess the psychological 
wellbeing of community health service staff in Australia during the COVID-19 
pandemic at two time points in 2021.
METHODS: A prospective cohort design with an anonymous cross-sectional online 
survey administered at two time points (March/April 2021; n = 681 and 
September/October 2021; n = 479). Staff (clinical and non-clinical roles) were 
recruited from eight community health services in Victoria, Australia. 
Psychological wellbeing was assessed using the Depression, Anxiety and Stress 
Scale (DASS-21) and resilience using the Brief Resilience Scale (BRS). General 
linear models were used to measure the effects of survey time point, 
professional role and geographic location on DASS-21 subscale scores, adjusting 
for selected sociodemographic and health characteristics.
RESULTS: There were no significant differences in respondent sociodemographic 
characteristics between the two surveys. Staff's mental health declined as the 
pandemic continued. Adjusting for dependent children, professional role, general 
health status, geographic location, COVID-19 contact status and country of 
birth; depression, anxiety and stress scores were significantly higher for 
respondents in the second survey than the first (all p < 0.001). Professional 
role and geographic location were not statistically significantly associated 
with scores on any of the DASS-21 subscales. Higher levels of depression, 
anxiety and stress were reported among respondents who were younger, and had 
less resilience or poorer general health.
CONCLUSIONS: The psychological wellbeing of community health staff was 
significantly worse at the time of the second survey than the first. The 
findings indicate that the COVID-19 pandemic has had an ongoing and cumulative 
negative impact on staff wellbeing. Staff would benefit from continued wellbeing 
support.

© 2023. The Author(s).

DOI: 10.1186/s12913-023-09382-y
PMCID: PMC10131448
PMID: 37101142 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


736. Sci Rep. 2023 Apr 26;13(1):6785. doi: 10.1038/s41598-023-33783-y.

Prospective single-center study of health-related quality of life after COVID-19 
in ICU and non-ICU patients.

Herrmann J(1), Müller K(1), Notz Q(1), Hübsch M(1), Haas K(2), Horn A(2), 
Schmidt J(2), Heuschmann P(2)(3), Maschmann J(4), Frosch M(5), Deckert J(6), 
Einsele H(7), Ertl G(8), Frantz S(9), Meybohm P(1), Lotz C(10)(11).

Author information:
(1)Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, 
University Hospital Würzburg, Julius-Maximilians-University Wuerzburg, Würzburg, 
Germany.
(2)Institute for Clinical Epidemiology and Biometry, 
Julius-Maximilians-University Würzburg, Würzburg, Germany.
(3)Clinical Trial Center, University Hospital Wuerzburg, Würzburg, Germany.
(4)University Hospital Würzburg, Julius-Maximilians-University Würzburg, 
Würzburg, Germany.
(5)University Hospital Würzburg, Julius-Maximilians-University Wuerzburg, 
Würzburg, Germany.
(6)Department of Psychiatry, Psychosomatics and Psychotherapy, University 
Hospital Würzburg, Julius-Maximilians-University Würzburg, Würzburg, Germany.
(7)Department of Internal Medicine II, University Hospital Würzburg, 
Julius-Maximilians-University Würzburg, Würzburg, Germany.
(8)Comprehensive Heart Failure Center Würzburg (CHFC), University Hospital 
Würzburg, Julius-Maximilians-University Wuerzburg, Würzburg, Germany.
(9)Department of Internal Medicine I, University Hospital Würzburg, 
Julius-Maximilians-University Würzburg, Würzburg, Germany.
(10)Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, 
University Hospital Würzburg, Julius-Maximilians-University Wuerzburg, Würzburg, 
Germany. Lotz_C@ukw.de.
(11)Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, 
University Hospital Würzburg, Oberduerrbacherstr. 6, 97080, Würzburg, Germany. 
Lotz_C@ukw.de.

Long-term sequelae in hospitalized Coronavirus Disease 2019 (COVID-19) patients 
may result in limited quality of life. The current study aimed to determine 
health-related quality of life (HRQoL) after COVID-19 hospitalization in 
non-intensive care unit (ICU) and ICU patients. This is a single-center study at 
the University Hospital of Wuerzburg, Germany. Patients eligible were 
hospitalized with COVID-19 between March 2020 and December 2020. Patients were 
interviewed 3 and 12 months after hospital discharge. Questionnaires included 
the European Quality of Life 5 Dimensions 5 Level (EQ-5D-5L), patient health 
questionnaire-9 (PHQ-9), the generalized anxiety disorder 7 scale (GAD-7), FACIT 
fatigue scale, perceived stress scale (PSS-10) and posttraumatic symptom scale 
10 (PTSS-10). 85 patients were included in the study. The EQ5D-5L-Index 
significantly differed between non-ICU (0.78 ± 0.33 and 0.84 ± 0.23) and ICU 
(0.71 ± 0.27; 0.74 ± 0.2) patients after 3- and 12-months. Of non-ICU 87% and 
80% of ICU survivors lived at home without support after 12 months. One-third of 
ICU and half of the non-ICU patients returned to work. A higher percentage of 
ICU patients was limited in their activities of daily living compared to non-ICU 
patients. Depression and fatigue were present in one fifth of the ICU patients. 
Stress levels remained high with only 24% of non-ICU and 3% of ICU patients 
(p = 0.0186) having low perceived stress. Posttraumatic symptoms were present in 
5% of non-ICU and 10% of ICU patients. HRQoL is limited in COVID-19 ICU patients 
3- and 12-months post COVID-19 hospitalization, with significantly less 
improvement at 12-months compared to non-ICU patients. Mental disorders were 
common highlighting the complexity of post-COVID-19 symptoms as well as the 
necessity to educate patients and primary care providers about monitoring mental 
well-being post COVID-19.

© 2023. The Author(s).

DOI: 10.1038/s41598-023-33783-y
PMCID: PMC10133285
PMID: 37100832 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


737. PLoS One. 2023 Apr 26;18(4):e0284190. doi: 10.1371/journal.pone.0284190. 
eCollection 2023.

How are Brazilian university students coping with the COVID-19 pandemic? Results 
of an online survey on psychosocial well-being, perceived burdens, and attitudes 
toward social distancing and vaccination.

Prado ADS(1)(2)(3)(4), Kohls E(4)(5), Baldofski S(4), Bianchi AS(2), Trindade 
LIP(2), Freitas JL(2), Rummel-Kluge C(4)(5).

Author information:
(1)Faculty of Life Sciences, Wilhelm Wundt Institute for Psychology, Leipzig 
University, Leipzig, Sachsen, Germany.
(2)Department of Psychology, Federal University of Parana, Curitiba, Parana, 
Brazil.
(3)Campus Curitiba, Federal Institute of Education, Science and Technology of 
Parana, Curitiba, Parana, Brazil.
(4)Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig 
University, Leipzig, Sachsen, Germany.
(5)Department of Psychiatry and Psychotherapy, University of Leipzig Medical 
Center, Leipzig, Sachsen, Germany.

BACKGROUND: The COVID-19 pandemic caused significant disruption to education 
systems worldwide, increasing pre-existing concerns regarding university 
students' mental health. Brazil was among the countries most affected by 
COVID-19 cases and deaths and was considered a pandemic epicenter. This study 
aimed to investigate Brazilian university students' mental health status and 
perceived burdens during the COVID-19 pandemic.
MATERIAL AND METHODS: From November 2021 to March 2022, a cross-sectional and 
anonymous online survey was conducted among students of a Brazilian federal 
university. Mental health status (depressive symptoms, alcohol and drug 
consumption) and social and emotional aspects in the pandemic context (social 
support, perceived stress, loneliness, resilience, and self-efficacy) were 
assessed with standardized measures. Students' attitudes toward the COVID-19 
pandemic and vaccination and perceived burdens of the pandemic were also 
investigated.
RESULTS: A total of N = 2,437 students completed the online survey. The PHQ-9 
mean sum score was 12.85 (SD = 7.40), while n = 1,488 (61.10%) participants 
reported a sum score of 10 or more, indicating clinically relevant depressive 
symptoms. Further, n = 808 (33.1%) of the total sample reported suicidal 
thoughts. Levels of depressive symptoms, perceived stress, and loneliness were 
higher among undergraduate/bachelor students than doctoral students. Almost all 
participants (97.3%) reported being fully vaccinated against COVID-19. Multiple 
regression analyses showed that being single, having an income decreased during 
the pandemic, having a previous mental illness, having a chronic somatic 
condition, not finding positive aspects in the pandemic, lower self-efficacy, 
lower social support, lower resilience, and higher experienced loneliness were 
significantly associated with higher levels of depression.
CONCLUSIONS: The study showed high levels of depressive symptoms and suicidal 
ideation among Federal University of Parana students. Therefore, health care 
providers and universities need to recognize and address mental health issues; 
psychosocial policies must be enhanced to mitigate the impact of the pandemic on 
students' mental health and wellbeing.

Copyright: © 2023 Prado et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0284190
PMCID: PMC10132549
PMID: 37099492 [Indexed for MEDLINE]

Conflict of interest statement: “The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest. CRK received lecture honoraria 
from Recordati and Servier outside and independent of the submitted work. This 
does not alter our adherence to PLOS ONE policies on sharing data and materials.


738. Nurs Health Sci. 2023 Jun;25(2):216-230. doi: 10.1111/nhs.13018. Epub 2023 Apr 
25.

Protecting healthcare workers' mental health against COVID-19-related stress: 
The effects of stress mindset and psychological resilience.

Emirza S(1), Yılmaz Kozcu G(1).

Author information:
(1)Department of Business Administration, Dokuz Eylül University, İzmir, Turkey.

Healthcare workers have been on the frontline of the battle against COVID-19 
disease. However, this has taken a toll on them, resulting in elevated stress 
and poor mental health. We argue that healthcare workers' stress mindset and 
resilience could mitigate negative outcomes of COVID-19-related stress by 
helping them view this stressful situation in a more positive light and appraise 
it as a challenge rather than a threat. Accordingly, we hypothesized that both a 
stress-is-enhancing mindset about COVID-19-related stress and resilience would 
improve healthcare workers' appraisal of their personal resources and increase 
their challenge appraisals, positively contributing to their mental health. We 
collected data from 160 healthcare workers and performed structural equation 
modeling for hypothesis testing. The results indicate that both a 
stress-is-enhancing mindset about COVID-19-related stress and psychological 
resilience are indirectly related to better mental well-being and lower 
health-related anxiety through challenge appraisals. This study contributes to 
research in mental health by suggesting that protecting and promoting healthcare 
workers' mental health is possible by empowering them through increasing 
personal resources such as a positive mindset about stressful situations and 
resilience.

© 2023 The Authors. Nursing & Health Sciences published by John Wiley & Sons 
Australia, Ltd.

DOI: 10.1111/nhs.13018
PMID: 37098413 [Indexed for MEDLINE]


739. Psychiatr Pol. 2022 Dec 31;56(6):1269-1287. doi: 10.12740/PP/144111. Epub 2022 
Dec 31.

Subjective mental deterioration of healthcare workers during the first wave of 
the COVID-19 pandemic in Poland.

[Article in English, Polish]

Sokół-Szawłowska M(1), Mierzejewski P(2), Heitzman J(3).

Author information:
(1)Instytut Psychiatrii i Neurologii, Psychiatryczna Poradnia Przykliniczna.
(2)Instytut Psychiatrii i Neurologii, Zakład Psychofarmakologii.
(3)Instytut Psychiatrii i Neurologii, Klinika Psychiatrii Sądowej.

OBJECTIVES: The presented study is aimed at determining the subjective 
psychological reaction to the outbreak of pandemic in healthcare workers and is 
part of a wider research project covering successive waves of increasing number 
of SARS-CoV-2 infections during the COVID-19 pandemic in Poland.
METHODS: 664 respondents completed the anonymous online questionnaire in the 
period from March 12, 2020 to May 3, 2020. This is the period of the first 
lockdown in Poland. Data were collected using the snowball method (employees 
passed the questionnaire over the Internet to subsequent groups of employees in 
subsequent healthcare units).
RESULTS: The outbreak of pandemic had varying impact on the well-being of 96.7% 
of respondents. Subjectively perceived stress of varying intensity was reported 
by 97.3% of them, low mood was reported in 19.0%, and anxiety in 14.1% of the 
respondents. These results and other features of the psychological reaction 
(including sleep problems) to overload in healthcare workers may indicate mental 
deterioration in the first weeks of pandemic.
CONCLUSIONS: The results obtained in the study group may encourage further 
analyzes of healthcare workers' mental state and contribute to discussion on the 
COVID-19 pandemic.

DOI: 10.12740/PP/144111
PMID: 37098198 [Indexed for MEDLINE]


740. PLoS One. 2023 Apr 25;18(4):e0285078. doi: 10.1371/journal.pone.0285078. 
eCollection 2023.

Shaped by the COVID-19 pandemic: Psychological responses from a subjective 
perspective-A longitudinal mixed-methods study across five European countries.

Zrnić Novaković I(1)(2), Ajduković D(3), Bakić H(3), Borges C(4), 
Figueiredo-Braga M(4)(5), Lotzin A(6)(7), Anastassiou-Hadjicharalambous X(8), 
Lioupi C(8), Javakhishvili JD(9), Tsiskarishvili L(10), Lueger-Schuster B(1).

Author information:
(1)Department of Clinical and Health Psychology, Faculty of Psychology, 
University of Vienna, Vienna, Austria.
(2)Vienna Doctoral School in Cognition, Behaviour and Neuroscience, University 
of Vienna, Vienna, Austria.
(3)Department of Psychology, Faculty of Humanities and Social Sciences, 
University of Zagreb, Zagreb, Croatia.
(4)Trauma Observatory, Centre for Social Studies (CES) of the University of 
Coimbra, Coimbra, Portugal.
(5)Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, 
University of Porto, Porto, Portugal.
(6)Department of Psychiatry and Psychotherapy, University Medical Center 
Hamburg-Eppendorf, Hamburg, Germany.
(7)Department of Psychology, MSH Medical School Hamburg, Hamburg, Germany.
(8)Department of Social Sciences, School of Humanities, Social Sciences and Law, 
University of Nicosia, Nicosia, Cyprus.
(9)Institute of Addiction Studies, School of Arts and Sciences, Ilia State 
University, Tbilisi, Georgia.
(10)School of Arts and Sciences, Ilia State University, Tbilisi, Georgia.

BACKGROUND: Contextual factors are essential for understanding long-term 
adjustment to the COVID-19 pandemic. Therefore, the present study investigated 
changes in mental health outcomes and subjective pandemic-related experiences 
over time and across countries. The main objective was to explore how 
psychological responses vary in relation to individual and environmental 
factors.
METHODS: The sample consisted of N = 1070 participants from the general 
population of Austria, Croatia, Georgia, Greece, and Portugal. We applied a 
longitudinal mixed-methods approach, with baseline assessment in summer and 
autumn 2020 (T1) and follow-up assessment 12 months later (T2). Qualitative 
content analysis by Mayring was used to analyse open-ended questions about 
stressful events, positive and negative aspects of the pandemic, and 
recommendations on how to cope. Mental health outcomes were assessed with the 
Adjustment Disorder-New Module 8 (ADNM-8), the Primary Care PTSD Screen for 
DSM-5 (PC-PTSD-5), the Patient Health Questionnaire-2 (PHQ-2), and the 5-item 
World Health Organization Well-Being Index (WHO-5). The analyses were performed 
with SPSS Statistics Version 26 and MAXQDA 2022.
RESULTS: The mental health outcomes significantly differed over time and across 
countries, with e.g. Greek participants showing decrease in adjustment disorder 
symptoms (p = .007) between T1 and T2. Compared with other countries, we found 
better mental health outcomes in the Austrian and the Croatian sample at both 
timepoints (p < .05). Regarding qualitative data, some themes were equally 
represented at both timepoints (e.g. Restrictions and changes in daily life), 
while others were more prominent at T1 (e.g. Work and finances) or T2 (e.g. 
Vaccination issues).
CONCLUSIONS: Our findings indicate that people's reactions to the pandemic are 
largely shaped by the shifting context of the pandemic, country-specific 
factors, and individual characteristics and circumstances. Resource-oriented 
interventions focusing on psychological flexibility might promote resilience and 
mental health amidst the COVID-19 pandemic and other global crises.

Copyright: © 2023 Zrnić Novaković et al. This is an open access article 
distributed under the terms of the Creative Commons Attribution License, which 
permits unrestricted use, distribution, and reproduction in any medium, provided 
the original author and source are credited.

DOI: 10.1371/journal.pone.0285078
PMCID: PMC10128933
PMID: 37098092 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


741. J Pak Med Assoc. 2023 Feb;73(Suppl 2)(2):S46-S49. doi: 10.47391/JPMA.Ind-S2-11.

Relationship between anxiety and spiritual well-being of the elderly with 
hypertension during the COVID-19 pandemic.

Iswatun(1); Yusuf A(2), Efendi F(2), Susanto J(1), Dewi WK(3), Hidaayah N(4).

Author information:
(1)Department of Nursing and Vocational Studies, Universitas Airlangga, 
Surabaya, Indonesia.
(2)Department of Nursing, Airlangga University, Surabaya, Indonesia.
(3)Department of Vocational Studies, Universitas Airlangga, Surabaya, Indonesia.
(4)Department of Nursing and Midwifery, Universitas Nahdlatul Ulama Surabaya, 
Surabaya, Indonesia.

OBJECTIVES: To study the relationship between anxiety and the spiritual 
wellbeing of hypertensive elderly patients during the corona virus disease-2019 
pandemic.
METHOD: The cross-sectional, correlational, analytical study was conducted from 
March to May 2022 in Lamongan Regency, East Java, Indonesia, after approval from 
the Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia, and 
comprised elderly hypertensive subjects aged >45 years who had good cognitive 
skills. Data was collected using the Geriatric Anxiety Scale and the Spiritual 
Wellbeing Scale. Anxiety was the independent variable, while spiritual wellbeing 
was the dependent variable. Data was analysed using univariate and bivariate 
analyses.
RESULTS: Of the 200 subjects, 107(53.5%) were females and 93(46.5%) were males. 
Overall, 97(48.5%) were aged 45-49 years, 81(40.5%) had completed primary 
school, 96(48%) were farmers, 121(60.5%) had moderate anxiety and 80(40%) had 
moderate spiritual wellbeing. There was a significant relationship between 
anxiety and spiritual wellbeing (p<0.05). Age, education and occupation of the 
subjects had significant association with both anxiety and spiritual wellbeing 
(p<0.05).
CONCLUSIONS: The coronavirus disease-2019 led to decreased anxiety and increased 
spiritual wellbeing among the hypertensive elderly.

DOI: 10.47391/JPMA.Ind-S2-11
PMID: 37096701 [Indexed for MEDLINE]


742. Afr Health Sci. 2022 Dec;22(4):519-525. doi: 10.4314/ahs.v22i4.58.

Psychological impact of Covid-19 pandemic on dentists.

Pramod PB(1), Sannidhya M(1), Sanjna R(1), Chandrashekhar SS(2).

Author information:
(1)Dental Surgeon, Bharati Vidyapeeth Dental College, Navi Mumbai, Maharashtra, 
India.
(2)Associate Professor and Head of Department of Public Health Dentistry, 
Bharati Vidyapeeth Dental College, Navi Mumbai, Maharashtra, India.

BACKGROUND: The Covid-19 pandemic seems to have an incessant out-turn on the 
people in every field in some or the other way. It has been reported that 
maximum number of deaths in the countries during this pandemic are caused due to 
a term called death anxiety or phobia. There are certain parameters such as 
anxiety, apprehension, depression which if influence a person can alter one's 
well-being.
OBJECTIVE: The steadfast intent of this review article is to narrate the 
psychological impact of this pandemic on dentists. The eloquence and emergence 
of this topic will alarm all the medicos and paramedics to have a check on this 
scenario.
METHODS: The article consists of detailed study from several articles from 
PubMed publications. Articles written only in English language were referred. 
Various keywords such as "Covid-19 pandemic" or "Psychological Impact" were 
used.
RESULTS: The Covid-19 Pandemic has adversely affected all of us physically as 
well as psychologically. This article signifies the psychological impact of this 
pandemic on dentists.
CONCLUSION: The current studies that are carried out till date show an extensive 
impact on the psychology of the dental professionals. The following review 
article elaborates the importance of the same.

© 2022 Pramod PB et al.

DOI: 10.4314/ahs.v22i4.58
PMCID: PMC10117505
PMID: 37092098 [Indexed for MEDLINE]

Conflict of interest statement: The authors report no conflict of interest.


743. Public Health. 2023 Jun;219:22-30. doi: 10.1016/j.puhe.2023.03.007. Epub 2023 
Mar 17.

Population well-being and the COVID-19 vaccination program in Chile: evidence 
from Google Trends.

Díaz F(1), Henríquez PA(2), Hardy N(3), Ponce D(4).

Author information:
(1)Departamento de Ingeniería Comercial, Universidad Técnica Federico Santa 
María, Chile. Electronic address: fernando.diazh@usm.cl.
(2)Facultad de Administración y Economía, Universidad Diego Portales, Chile. 
Electronic address: pablo.henriquez@udp.cl.
(3)Facultad de Administración y Economía, Universidad Diego Portales, Chile. 
Electronic address: nicolas.hardy@udp.cl.
(4)Universidad Finis Terrae, Chile. Electronic address: 
daniela.ponce1@mail.udp.cl.

OBJECTIVE: We analyze the dynamics of the mental well-being of the Chilean 
population in response to the progress of the vaccination strategy implemented 
by the government.
STUDY DESIGN: This study aims at investigating the possibility of using Google 
Trends as an instrument for tracking mental well-being of the Chilean 
population.
METHODS: We use the volume of searches for keywords in Google Trends (GT) 
related to Anguish, Anxiety, Depression, and Stress as a proxy for population 
well-being. Using event study methods, we analyze social attention reactions to 
news about the vaccination program. We implement a 
Difference-in-Difference-in-Differences estimation to estimate changes in 
population welfare by socio-economic status induced by the progress of 
inoculation.
RESULTS: We show that social attention to mental health problems is sensitive to 
news about the vaccination program. Moreover, and most importantly, we find that 
mental well-being responds positively to the percentage of inoculated people. 
This phenomenon appear to be permanent and affected by socio-economic status, 
with the wealthier population experiencing greater improvements than the less 
wealthy.
CONCLUSIONS: During the COVID-19 vaccination program in Chile, social attention 
to mental health problems appears to be sensitive to news about the vaccination 
program. There is also strong evidence of socio-economic status-induced 
heterogeneity in population responses to program implementation. The above 
phenomena appears to be permanent and cannot be attributed to either 
socio-economic segregation in access to vaccines or to the highly stratified 
schedule of the vaccination program.

Copyright © 2023 The Royal Society for Public Health. Published by Elsevier Ltd. 
All rights reserved.

DOI: 10.1016/j.puhe.2023.03.007
PMCID: PMC10020036
PMID: 37087859 [Indexed for MEDLINE]

Conflict of interest statement: All authors declare no conflict of interest.


744. BMC Psychiatry. 2023 Apr 22;23(1):284. doi: 10.1186/s12888-023-04798-6.

Anxiety, depression and post-traumatic stress disorder in patients on 
hemodialysis in the setting of the pandemic, inflation, and the Beirut blast: a 
cross-sectional study.

Khoury R(1), Ghantous Z(2), Ibrahim R(3), Ghossoub E(4), Madaghjian P(5), Karam 
E(3), Karam G(3), Fares N(6), Karam S(7).

Author information:
(1)Department of Psychiatry, American University of Beirut, PO Box: 11-0236, 
Beirut, 1107, Riad El Solh, Lebanon. rk224@aub.edu.lb.
(2)Department of Psychiatry, Washington University in St. Louis, Clayton, 
Missouri, United States.
(3)Department of Psychiatry and Clinical Psychology, Saint Georges Hospital 
University Medical center, Beirut, Lebanon.
(4)Department of Psychiatry, American University of Beirut, PO Box: 11-0236, 
Beirut, 1107, Riad El Solh, Lebanon.
(5)Department of Nutrition, Saint Georges Hospital University Medical center, 
Beirut, Lebanon.
(6)Department of Internal Medicine, Division of Nephrology, Saint Georges 
Hospital University Medical center, Beirut, Lebanon.
(7)Division of Nephrology and Hypertension, University of Minnesota, 
Minneapolis, United States.

BACKGROUND: In 2020, Lebanon has witnessed its worst economic crisis, 
exacerbated by the COVID-19 pandemic and a massive explosion of its capital. 
Amidst these stressors, this study aims at assessing the prevalence of 
depression, anxiety, suicidality, post-traumatic stress disorder (PTSD) and 
cognitive impairment in patients undergoing hemodialysis in an academic hospital 
destroyed by the explosion.
METHODS: This cross-sectional study conducted 6 months after the blast included 
adults on hemodialysis, with no previous diagnoses of dementia or intellectual 
disability. It explores prevalence rates of psychiatric disorders, in addition 
to other medical and psychosocial variables such as frailty, malnutrition, 
sarcopenia, quality of life and religiosity.
RESULTS: Forty two patients (mean age 66.1; SD: 11.2 years) undergoing 
hemodialysis for 6.12 years (SD:7.22 years) were included. Anxiety and 
depression rates reached 54.8% and 57.1% using cut-offs of 6 and 7 respectively 
on the Hospital Anxiety and Depression rating Scale. 9.5% of the patients 
reported being in the hospital at the time of the blast and 7.1% reported being 
injured. 33.3% screened positively for PTSD using a cut-off of 23 on the PCL-5. 
26.2% had passive death wishes and 7.1% had suicide plans, however no one had 
attempted it. 23.8% were found cognitively impaired as shown by the Mini-Cog 
(<3). Around two-third of participants were moderately to severely malnourished 
per the GLIM criteria. One third suffered from frailty, according to the FRAIL 
screening tool. Around 60% suffered from sarcopenia, based on handgrip strength 
measures. These findings contrast with "acceptable to good" quality of life 
subjectively reported by participants on the Short Form 36 (SF-36) Health 
Survey. While one-third of participants participated in organizational religious 
activities, 88% reported significant subjective meaning of religion in their 
heart.
CONCLUSIONS: Rates of depression, anxiety, PTSD, suicidality, and cognitive 
impairment were found to be alarming in the setting of an urban dialysis unit 
following a major explosion. Psychiatric disorders were found to be compounded 
with increased prevalence of malnutrition, frailty, and sarcopenia. These 
findings urge healthcare providers to implement early diagnostic and 
intervention strategies to improve both mental and physical wellbeing of this 
vulnerable population, in similar settings.

© 2023. The Author(s).

DOI: 10.1186/s12888-023-04798-6
PMCID: PMC10122541
PMID: 37087412 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


745. Eval Program Plann. 2023 Jun;98:102239. doi: 10.1016/j.evalprogplan.2023.102239. 
Epub 2023 Jan 16.

Remotely and collaboratively evaluating a campus-based therapy dog program 
during the COVID-19 pandemic.

Fletcher-Hildebrand S(1), Williamson L(2), Lawson K(3), Dell C(4).

Author information:
(1)University of Saskatchewan, Room 191, 9 Campus Drive, Saskatoon, Saskatchewan 
S7N 5A5, Canada. Electronic address: shaneice.fletcher@usask.ca.
(2)University of Saskatchewan, Room 191, 9 Campus Drive, Saskatoon, Saskatchewan 
S7N 5A5, Canada.
(3)University of Saskatchewan, Room 154, 9 Campus Drive, Saskatoon, Saskatchewan 
S7N 5A5, Canada.
(4)University of Saskatchewan, Room 1109, 9 Campus Drive, Saskatoon, 
Saskatchewan S7N 5A5, Canada.

The COVID-19 pandemic adversely affected the wellbeing of university students 
and adults in general, emphasizing the need for mental health programming that 
was compliant with physical distancing mandates. The present evaluation 
investigated mental health and social connection within the context of COVID-19 
by remotely evaluating a virtual animal-assisted activity at the University of 
Saskatchewan - PAWS Your Stress. The purpose of this article is to outline our 
evaluation methods and findings, while calling specific attention to the 
collaborative strategies that were implemented within a remote, time-sensitive 
context. The evaluation findings revealed that remote animal-assisted 
programming can facilitate connections with humans and animals, and promote 
multiple mental health benefits, despite the lack of physical interaction with 
the animals. Our lessons learned indicate that remote program logic modelling 
workshops are feasible when suited to audience demographics. Further, our 
experience suggests that the Most Significant Change technique (a qualitative, 
participatory, storytelling method that elicits outcome data) can be useful in 
time-restricted evaluations, and the necessity of central steps in the process 
may vary depending on evaluation goals. This project has implications for future 
evaluation work, by demonstrating the effective use of remote methods that 
allowed for successful stakeholder collaboration.

Copyright © 2023 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.evalprogplan.2023.102239
PMCID: PMC9841739
PMID: 37086706 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests statement The authors 
declare that they have no competing interests.


746. J Med Internet Res. 2023 May 22;25:e46537. doi: 10.2196/46537.

Global Trends in Social Prescribing: Web-Based Crawling Approach.

Lee H(1)(2), Koh SB(3), Jo HS(4), Lee TH(5), Nam HK(3), Zhao B(2), Lim S(2), Lim 
JA(2), Lee HH(3), Hwang YS(4), Kim DH(6), Nam EW(1)(2).

Author information:
(1)Department of Health Administration, Software Digital Healthcare Convergence 
College, Yonsei University, Wonju, Republic of Korea.
(2)Yonsei Global Health Center, Yonsei University, Wonju, Republic of Korea.
(3)Department of Preventive Medicine, Wonju College of Medicine, Yonsei 
University, Wonju, Republic of Korea.
(4)Department of Health Policy and Management, Kangwon National University 
School of Medicine, Chuncheon, Republic of Korea.
(5)Korea Industry Development Institute, Gangneung, Republic of Korea.
(6)Department of Information Statistics, Yonsei University, Wonju, Republic of 
Korea.

BACKGROUND: Social loneliness is a prevalent issue in industrialized countries 
that can lead to adverse health outcomes, including a 26% increased risk of 
premature mortality, coronary heart disease, stroke, depression, cognitive 
impairment, and Alzheimer disease. The United Kingdom has implemented a strategy 
to address loneliness, including social prescribing-a health care model where 
physicians prescribe nonpharmacological interventions to tackle social 
loneliness. However, there is a need for evidence-based plans for global social 
prescribing dissemination.
OBJECTIVE: This study aims to identify global trends in social prescribing from 
2018. To this end, we intend to collect and analyze words related to social 
prescribing worldwide and evaluate various trends of related words by 
classifying the core areas of social prescribing.
METHODS: Google's searchable data were collected to analyze web-based data 
related to social prescribing. With the help of web crawling, 3796 news items 
were collected for the 5-year period from 2018 to 2022. Key topics were selected 
to identify keywords for each major topic related to social prescribing. The 
topics were grouped into 4 categories, namely Healthy, Program, Governance, and 
Target, and keywords for each topic were selected thereafter. Text mining was 
used to determine the importance of words collected from new data.
RESULTS: Word clouds were generated for words related to social prescribing, 
which collected 3796 words from Google News databases, including 128 in 2018, 
432 in 2019, 566 in 2020, 748 in 2021, and 1922 in 2022, increasing nearly 
15-fold between 2018 and 2022 (5 years). Words such as health, prescribing, and 
GPs (general practitioners) were the highest in terms of frequency in the list 
for all the years. Between 2020 and 2021, COVID, gardening, and UK were found to 
be highly related words. In 2022, NHS (National Health Service) and UK ranked 
high. This dissertation examines social prescribing-related term frequency and 
classification (2018-2022) in Healthy, Program, Governance, and Target 
categories. Key findings include increased "Healthy" terms from 2020, 
"gardening" prominence in "Program," "community" growth across categories, and 
"Target" term spikes in 2021.
CONCLUSIONS: This study's discussion highlights four key aspects: (1) the 
"Healthy" category trends emphasize mental health, cancer, and sleep; (2) the 
"Program" category prioritizes gardening, community, home-schooling, and digital 
initiatives; (3) "Governance" underscores the significance of community 
resources in social prescribing implementation; and (4) "Target" focuses on 4 
main groups: individuals with long-term conditions, low-level mental health 
issues, social isolation, or complex social needs impacting well-being. Social 
prescribing is gaining global acceptance and is becoming a global national 
policy, as the world is witnessing a sharp rise in the aging population, 
noncontagious diseases, and mental health problems. A successful and sustainable 
model of social prescribing can be achieved by introducing social prescribing 
schemes based on the understanding of roles and the impact of multisectoral 
partnerships.

©Hocheol Lee, Sang Baek Koh, Heui Sug Jo, Tae Ho Lee, Hae Kweun Nam, Bo Zhao, 
Subeen Lim, Joo Aeh Lim, Ho Hee Lee, Yu Seong Hwang, Dong Hyun Kim, Eun Woo Nam. 
Originally published in the Journal of Medical Internet Research 
(https://www.jmir.org), 22.05.2023.

DOI: 10.2196/46537
PMCID: PMC10242464
PMID: 37086427 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


747. J Am Acad Child Adolesc Psychiatry. 2023 Oct;62(10):1123-1133. doi: 
10.1016/j.jaac.2023.02.015. Epub 2023 Apr 19.

Neonatal Intensive Care Unit Latent Profiles of Maternal Distress: Associations 
With 5-Year Maternal and Child Mental Health Outcomes.

Njoroge WFM(1), Gerstein ED(2), Lean RE(3), Paul R(3), Smyser CD(3), Rogers 
CE(3).

Author information:
(1)Perelman School of Medicine at the University of Pennsylvania, Philadelphia, 
Pennsylvania; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; 
Policy Lab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; 
Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine, 
Philadelphia, Pennsylvania. Electronic address: njorogew@chop.edu.
(2)University of Missouri-St. Louis, St. Louis County, Missouri.
(3)Washington University School of Medicine, St. Louis, Missouri.

Comment in
    J Am Acad Child Adolesc Psychiatry. 2023 Oct;62(10):1089-1091.

OBJECTIVE: To examine profiles of distress of mothers of preterm infants in the 
neonatal intensive care unit (NICU) and relate profiles to maternal and child 
outcomes at child age 5 years.
METHOD: A racially and economically diverse sample of mothers (n = 94; 39% 
African American, 52% White) of preterm infants (≤30 weeks of gestation) 
completed validated questionnaires assessing depression, anxiety (state and 
trait), NICU stress, and life stress at NICU discharge of their infant. Mothers 
reported on their own and their children's symptomatology at child age 5. A 
latent profile analysis was conducted to categorize maternal symptomatology.
RESULTS: Latent profile analysis yielded 4 distinct maternal profiles: low 
symptomatology, high NICU stress, high depression and anxiety, and high state 
anxiety. Social determinants of health factors including age, education, 
neighborhood deprivation, and infant clinical risk distinguished the profiles. 
Mothers in the high depression and anxiety profile reported more anxiety and 
life stress at follow-up and reported their children experienced more 
anxious/depressed symptoms.
CONCLUSION: Existing literature has gaps related to examining multiple 
dimensions of NICU distress and understanding how patterns of mood/affective 
symptoms, life stressors, and related social determinants of health factors vary 
across mothers. In this study, one specific profile of maternal NICU distress 
demonstrated enduring risks for poorer maternal and child mental health 
outcomes. This new knowledge underscores sources of disparate health outcomes 
for mothers of preterm infants and the infants themselves. Universal screening 
is needed to identify at-risk dyads for poor health outcomes in need of 
individualized interventions that address both maternal and child well-being.
DIVERSITY & INCLUSION STATEMENT: We worked to ensure sex and gender balance in 
the recruitment of human participants. We worked to ensure race, ethnic, and/or 
other types of diversity in the recruitment of human participants. One or more 
of the authors of this paper self-identifies as a member of one or more 
historically underrepresented racial and/or ethnic groups in science. One or 
more of the authors of this paper self-identifies as a member of one or more 
historically underrepresented sexual and/or gender groups in science. We 
actively worked to promote inclusion of historically underrepresented racial 
and/or ethnic groups in science in our author group. While citing references 
scientifically relevant for this work, we also actively worked to promote sex 
and gender balance in our reference list. While citing references scientifically 
relevant for this work, we also actively worked to promote inclusion of 
historically underrepresented racial and/or ethnic groups in science in our 
reference list.

Copyright © 2023 American Academy of Child and Adolescent Psychiatry. Published 
by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jaac.2023.02.015
PMCID: PMC10543383
PMID: 37084882 [Indexed for MEDLINE]

Conflict of interest statement: Disclosure: Drs. Njoroge, Gerstein, Lean, 
Smyser, and Rogers and Ms. Paul have reported no biomedical financial interests 
or potential conflicts of interest.


748. PLoS One. 2023 Apr 20;18(4):e0283598. doi: 10.1371/journal.pone.0283598. 
eCollection 2023.

Supporting employers and their employees with Mental hEalth problems to remain 
eNgaged and producTive at wORk (MENTOR): A feasibility randomised controlled 
trial protocol.

Prudenzi A(1), Jadhakhan F(1), Gill K(1), MacArthur M(1), Patel K(2), 
Moukhtarian T(3), Kershaw C(3), Norton-Brown E(4), Johnston N(4), Daly G(5), 
Russell S(5)(6), Thomson L(7), Munir F(8), Blake H(9)(10), Meyer C(3), Marwaha 
S(1)(11).

Author information:
(1)Institute for Mental Health, School of Psychology, College of Life and 
Environmental Sciences, University of Birmingham, Birmingham, West Midlands, 
United Kingdom.
(2)Warwick Manufacturing Group (WMG), School of Engineering, University of 
Warwick, Coventry, West Midlands, United Kingdom.
(3)Warwick Medical School, Mental Health and Wellbeing Unit, University of 
Warwick, Coventry, West Midlands, United Kingdom.
(4)Community Programmes Team, Mind, London, United Kingdom.
(5)Faculty of Health and Life Sciences, Coventry University, Coventry, West 
Midlands, United Kingdom.
(6)West Midlands Combined Authority, Birmingham, West Midlands, United Kingdom.
(7)Centre for Organisational Health and Development, School of Medicine, 
University of Nottingham, Nottingham, West Midlands, United Kingdom.
(8)School of Sport, Exercise and Health Sciences, Loughborough University, 
Loughborough, West Midlands, United Kingdom.
(9)School of Health Sciences, University of Nottingham, Nottingham, United 
Kingdom.
(10)NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom.
(11)Specialist Mood Disorders Clinic, The Zinnia Centre, Birmingham and Solihull 
Mental Health NHS Foundation Trust, Birmingham, West Midlands, United Kingdom.

Employees with mental health problems often struggle to remain in employment. 
During the COVID-19 pandemic, these employees face multiple additional 
stressors, which are likely to worsen their mental health and work productivity. 
Currently, it is unclear how to best support employees with mental health 
problems (and their managers) to improve wellbeing and productivity. We aim to 
develop a new intervention (MENTOR) that will jointly involve employees, 
managers, and a new professional (mental health employment liaison worker, 
MHELW), to help employees who are still at work with a mental health condition 
and currently receiving professional support for their mental health. A 
feasibility pilot study will then be undertaken to examine the feasibility and 
acceptability of the intervention from the perspective of employees and line 
managers. The study involves a feasibility randomised controlled study comparing 
outcomes of participants randomised to receive the intervention (MENTOR) with 
wait-list controls. Participants allocated to the waitlist control group will 
receive the intervention after three months. We aim to randomise 56 
employee-manager pairs recruited from multiple organisations in the Midlands 
region of England. An intervention including 10 sessions for employees and 
managers (3 individual sessions and 4 joint sessions) will be delivered over 12 
weeks by trained MHELWs. Primary outcomes include measures of feasibility and 
acceptability of the intervention and work productivity. Secondary outcomes 
include mental health outcomes. Qualitative interviews will be undertaken with a 
purposively selected sub-sample of employees and line managers at three-month 
post-intervention assessment. To our knowledge, this will be the first trial 
with a joint employee-manager intervention delivered by MHELWs. Anticipated 
challenges are dual-level consent (employees and managers), participants' 
attrition, and recruitment strategies. If the intervention and trial processes 
are shown to be feasible and acceptable, the outcomes from this study will 
inform future randomised controlled trials. Trial registration: This trial is 
pre-registered with the ISRCTN registry, registration number: ISRCTN79256498. 
Protocol version: 3.0_March_2023. https://www.isrctn.com/ISRCTN79256498.

Copyright: © 2023 Prudenzi et al. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0283598
PMCID: PMC10118171
PMID: 37079506 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


749. Am J Community Psychol. 2024 Mar;73(1-2):66-77. doi: 10.1002/ajcp.12668. Epub 
2023 Apr 20.

Navigating COVID-19 and racial trauma as a Black student at predominantly White 
institutions.

Francois S(1), Blakey J(2), Stevenson R(3), Walker T(1), Davis C Jr(4).

Author information:
(1)School of Social Work, Tulane University.
(2)School of Social Work, University of Minnesota.
(3)School of Liberal Arts, Tulane University.
(4)School of Social Work, The University of Alabama.

Black students at predominantly White institutions (PWIs) contend with racial 
microaggressions that can lead to negative mental health and academic outcomes. 
The physical and mental health consequences of the novel coronavirus pandemic 
are well-known. What remains unknown is how targeted racial hate during a 
pandemic might have a compounded effect on Black essential workers. The current 
study examines how future essential workers in helping professions cope with 
dual crises as they navigate mostly White universities. Study participants were 
Black university students attending PWIs in the United States enrolled in social 
work, public health, or psychology programs during the 2020-2021 academic year. 
Participants completed an online survey that measured racial microaggressions, 
COVID distress, sense of belonging, engagement in activism, and well-being. 
Hierarchical regression models revealed COVID distress predicted poorer 
well-being. Also, COVID distress interacted with racial microaggressions to 
predict well-being. Findings have implications for developing decolonized 
learning communities with a liberation pedagogy in community psychology and 
other helping professions.

© 2023 The Authors. American Journal of Community Psychology published by Wiley 
Periodicals LLC on behalf of Society for Community Research and Action.

DOI: 10.1002/ajcp.12668
PMID: 37079437 [Indexed for MEDLINE]


750. J Health Psychol. 2023 Dec;28(14):1279-1292. doi: 10.1177/13591053231168040. 
Epub 2023 Apr 20.

Analysis of healthcare workers' mental health during the COVID-19 pandemic: 
Evidence from a three-wave longitudinal study.

Perego G(1)(2), Cugnata F(1), Brombin C(1), Milano F(3), Mazzetti M(2), Taranto 
P(2), Preti E(3), Di Pierro R(3), De Panfilis C(4), Madeddu F(3), Di Mattei 
VE(1)(2).

Author information:
(1)Vita-Salute San Raffaele University, Italy.
(2)IRCCS San Raffaele Scientific Institute, Italy.
(3)University of Milano-Bicocca, Italy.
(4)University of Parma, Italy.

The "Healthcare workers' wellbeing [Benessere Operatori]" project is an 
exploratory longitudinal study assessing healthcare workers' mental health at 
three different time points over a 14-month period during the COVID-19 pandemic. 
We collected socio-demographic and work-related information and assessed the 
perceived social support, coping strategies, and levels of depression, anxiety, 
insomnia, anger, burnout, and PTSD symptoms. In total, 325 Italian healthcare 
workers (i.e. physicians, nurses, other healthcare workers, and clerks) 
participated in the first initial survey and either the second or third 
subsequent survey. Participants reported subclinical levels of psychiatric 
symptoms that remained mostly unchanged across time, except for an increase in 
stress, depression, state anger, and emotional exhaustion symptoms. Despite 
subclinical levels, healthcare workers' distress can adversely affect the 
quality of care, patient satisfaction, and medical error rates. Therefore, 
implementing interventions to improve healthcare workers' wellbeing is required.

DOI: 10.1177/13591053231168040
PMCID: PMC10119662
PMID: 37078431 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of conflicting interestsThe authors 
declared no potential conflicts of interest with respect to the research, 
authorship, and/or publication of this article.


751. J Affect Disord. 2023 Jul 15;333:1-9. doi: 10.1016/j.jad.2023.04.034. Epub 2023 
Apr 17.

Prevalence of depressive symptoms and associated factors during the COVID-19 
pandemic: A national-based study.

Dong XX(1), Li DL(1), Miao YF(1), Zhang T(2), Wu Y(3), Pan CW(4).

Author information:
(1)School of Public Health, Medical College of Soochow University, Suzhou, 
China.
(2)School of Public Health, Medical College of Soochow University, Suzhou, 
China; Research Center for Psychology and Behavioral Sciences, Soochow 
University, Suzhou, China; Graduate School of Interdisciplinary Science and 
Engineering in Health Systems, Okayama University, Okayama, Japan. Electronic 
address: tyzhang@suda.edu.cn.
(3)School of Public Health, Peking University, Beijing, China. Electronic 
address: bimuwuyibo@outlook.com.
(4)School of Public Health, Medical College of Soochow University, Suzhou, 
China. Electronic address: pcwonly@gmail.com.

BACKGROUND: Previous studies have reported that the prevalence of depression and 
depressive symptoms was significantly higher than that before the COVID-19 
pandemic. This study aimed to explore the prevalence of depressive symptoms and 
evaluate the importance of influencing factors through Back Propagation Neural 
Network (BPNN).
METHODS: Data were sourced from the psychology and behavior investigation of 
Chinese residents (PBICR). A total of 21,916 individuals in China were included 
in the current study. Multiple logistic regression was applied to preliminarily 
identify potential risk factors for depressive symptoms. BPNN was used to 
explore the order of contributing factors of depressive symptoms.
RESULTS: The prevalence of depressive symptoms among the general population 
during the COVID-19 pandemic was 57.57 %. The top five important variables were 
determined based on the BPNN rank of importance: subjective sleep quality 
(100.00 %), loneliness (77.30 %), subjective well-being (67.90 %), stress 
(65.00 %), problematic internet use (51.20 %).
CONCLUSIONS: The prevalence of depressive symptoms in the general population was 
high during the COVID-19 pandemic. The BPNN model established has significant 
preventive and clinical meaning to identify depressive symptoms lay theoretical 
foundation for individualized and targeted psychological intervention in the 
future.

Copyright © 2023 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2023.04.034
PMCID: PMC10110280
PMID: 37075821 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest The authors declare that 
there are no conflicts of interest in relation to the subject of this study.


752. PLoS One. 2023 Apr 19;18(4):e0283962. doi: 10.1371/journal.pone.0283962. 
eCollection 2023.

The impact of physical environments on outpatient mental health recovery: A 
design-oriented qualitative study of patient perspectives.

Sui TY(1), McDermott S(2), Harris B(3), Hsin H(1).

Author information:
(1)Department of Adult Psychiatry, Kaiser Permanente San Jose, San Jose, CA, 
United States of America.
(2)Department of Graduate Medical Education, Kaiser Permanente Santa Rosa, Santa 
Rosa, CA, United States of America.
(3)Department of Graduate Medical Education, Kaiser Permanente San Jose, San 
Jose, CA, United States of America.

The physical environment has been shown to affect the emotional states of 
patients receiving mental health treatment, yet it remains unknown whether 
physical space design may play a role in optimizing the delivery of mental 
health care. Principles of architectural design and human-centered co-design 
have been applied to enhance the patient experience of facility environments; 
however, little is known about how patients view the impact of physical spaces 
on their recovery. In this qualitative study, we aimed to understand patient 
perspectives of how physical environments contribute to mental wellbeing and 
personal experiences of recovery, in the context of informing future design 
efforts. Semi-structured telephone interviews were conducted with 13 
participants receiving outpatient mental health treatment at the Kaiser 
Permanente San Jose Adult Psychiatry Clinic. Interviews were transcribed and 
themes were extracted that could inform future design concepts. The sample was 
comprised of nine female and three male participants, and one 
unidentified-gender participant, between the ages of 26-64, and across several 
self-reported racial/ethnic subgroups. We found four dimensions of physical 
environments that participants reported as impactful: 1) sensory design elements 
(colors, sounds, and textures), 2) engagement qualities (intensity of distracted 
activity such as crafting or commuting), 3) social relational aspects (privacy 
or connection), and 4) affective experiences evoked by being present in the 
space itself (feeling safe, calm, in control, self-aware, or creative was 
beneficial). Many of these elements were similarly noted across clinic and 
non-clinic environments. This study identifies key dimensions of physical 
environments that can serve as potential metrics of design success in supporting 
and facilitating mental health recovery. In the midst of the current COVID-19 
pandemic, where mental health treatment has increasingly shifted outside of 
traditional clinics, our findings can support patients and clinicians seeking to 
harness potential in situ therapeutic benefits of physical environments.

Copyright: © 2023 Sui et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0283962
PMCID: PMC10115290
PMID: 37075049 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


753. Psychiatr Pol. 2022 Oct 31;56(5):945-955. doi: 10.12740/PP/141830. Epub 2022 Oct 
31.

Novel psychopathological picture during the COVID-19 pandemic based on a first 
episode of psychotic depression.

[Article in English, Polish]

Cyran A(1), Łuc M(1), Szcześniak D(1), Rymaszewska J(1).

Author information:
(1)Uniwersytet Medyczny im. Piastów Śląskich we Wrocławiu, Katedra Psychiatrii.

The emerging SARS-CoV-2 pandemic is known to take a toll on both physical and 
mental health. We present a case of a patient with a first episode of severe 
depression with COVID-19-related psychotic features. A patient with no history 
of mental disorders was admitted to the Psychiatric Unit due to the symptoms of 
severe depressive episode with psychotic features. Progressive deterioration of 
his mental health, behavior and activity was observed in March of 2020. He was 
not infected nor exposed to infectious agents but presented delusions about 
being infected with SARS-CoV-2 and being a source of transmission to other 
people. He suffered from Hashimoto disease and recently diagnosed lymphoma which 
further diagnosis was postponed. He was administrated venlafaxine 150 mg and 
mirtazapine 45 mg with addition of olanzapine up to 20 mg and risperidone up to 
6 mg per day. No side effects were reported. The patient reached a full recovery 
with the exception of slightly blunted ability to feel pleasure, minor problems 
with concentration and occasional pessimistic thoughts. Discussion: The social 
distancing recommendations put a psychological strain related to alienation and 
negative emotions which can favor development of depressive symptoms. Analysis 
of psychological mechanisms related to the pandemic and restrictions is 
significant for limiting negative influence of global crisis on individual 
mental well-being. Conclusions: In this case the impact of global anxiety and 
its integration into the developing psychopathological symptoms is especially 
significant. The circumstances surrounding an episode of affective disorder may 
shape its course and thought content.

DOI: 10.12740/PP/141830
PMID: 37074848 [Indexed for MEDLINE]


754. BMJ Open. 2023 Apr 18;13(4):e062242. doi: 10.1136/bmjopen-2022-062242.

Impact of the COVID-19 pandemic on working conditions and mental well-being of 
mental health professionals in the Netherlands: a cross-sectional study.

van Doesum TJ(1), Shields-Zeeman LS(2)(3), Leone SS(1), van Meijel B(4)(5), 
Jabbarian LJ(6), van Bon-Martens M(1).

Author information:
(1)Department of Mental Health and Prevention, Trimbos Institute, Utrecht, 
Netherlands.
(2)Department of Mental Health and Prevention, Trimbos Institute, Utrecht, 
Netherlands l.s.shields-zeeman@uu.nl.
(3)Department of Interdisciplinary Social Science, Utrecht University, Utrecht, 
Netherlands.
(4)Department of Nursing, InHolland University of Applied Sciences, Diemen, 
Netherlands.
(5)Department of Psychiatry, Amsterdam UMC, Amsterdam, Netherlands.
(6)Department of Psychiatry, Erasmus MC, Rotterdam, Netherlands.

OBJECTIVES: To examine the extent of the impact of the COVID-19 pandemic on the 
mental health and well-being of mental health professionals (MHPs) in the 
Netherlands and understand their needs during the COVID-19 pandemic.
DESIGN AND SETTING: A cross-sectional, mixed-methods study was conducted with 
MHPs from the Netherlands from June 2020 to October 2020, consisting of an 
online survey and three online focus group discussions.
PARTICIPANTS: Participants were MHPs from various occupational groups 
(psychologists, social workers, mental health nurses, developmental education 
workers, etc).
PRIMARY AND SECONDARY OUTCOME MEASURES: The online survey included questions 
about work-related changes due to COVID-19 perceived resilience to stress, 
changes in lifestyle behaviours and mental health symptoms. The focus group 
discussions focused mostly on work experiences during the first wave of the 
COVID-19 pandemic.
RESULTS: MHP's reported an increase in experience workload during the pandemic 
(mean score 8.04 based on a scale of 1-10) compared to before the pandemic (mean 
score of 7). During the first wave of the pandemic, 50% of respondents reported 
increased stress, 32% increased sleeping problems and 24% increased mental 
health problems. Adverse occupational (eg, increased workload OR 1.72, 95% CI 
1.28-2.32), psychological (eg, life satisfaction OR 0.63, 95% CI 0.52-0.75), 
lifestyle (eg, increased sleep problems OR 2.80, 95% CI 2.07-3.80) and physical 
factors (decline in physical health OR 3.56, 95% CI 2.61-4.85) were associated 
with a decline in mental health. Participants expressed significant concern in 
the focus group discussions about the duration of the pandemic, the high 
workload, less work-life balance and lack of contact with colleagues. 
Suggestions to improve working conditions included ensuring clear communication 
about guidelines and facilitating worker contact and support via peer-to-peer 
coaching where experiences can be shared.
CONCLUSIONS: The current study indicates that MHP experienced a decline in 
mental health status during the first wave of the COVID-19 pandemic, which 
should be taken into consideration by employers, policymakers and researchers.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2022-062242
PMCID: PMC10123850
PMID: 37072369 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


755. J Korean Med Sci. 2023 Apr 17;38(15):e120. doi: 10.3346/jkms.2023.38.e120.

Gut Microbiota Dysbiosis Correlates With Long COVID-19 at One-Year After 
Discharge.

Zhang D(#)(1), Zhou Y(#)(1), Ma Y(#)(1), Chen P(#)(1), Tang J(1), Yang B(1), Li 
H(1), Liang M(1), Xue Y(1), Liu Y(1), Zhang J(2), Wang X(3).

Author information:
(1)Union Hospital, Tongji Medical College, Huazhong University of Science and 
Technology, Wuhan, China.
(2)Union Hospital, Tongji Medical College, Huazhong University of Science and 
Technology, Wuhan, China. zsn0928@163.com.
(3)Union Hospital, Tongji Medical College, Huazhong University of Science and 
Technology, Wuhan, China. rong-100@163.com.
(#)Contributed equally

BACKGROUND: Long coronavirus disease 2019 (COVID-19) in recovered patients (RPs) 
is gradually recognized by more people. However, how long it will last and the 
underlining mechanism remains unclear.
METHODS: We conducted a prospective follow-up study to evaluate the long-term 
symptoms and clinical indices of RPs at one-year after discharge from Union 
Hospital, Wuhan, China between December 2020 to May 2021. We also performed the 
16S rRNA sequencing of stool samples from RPs and healthy controls (HCs) and 
analyzed the correlation between the gut microbiota and long COVID-19.
RESULTS: In total, 187 RPs were enrolled, among them, 84 (44.9%) RPs reported 
long COVID-19 symptoms at one-year after discharge. The most common long-term 
symptoms were cardiopulmonary symptoms, including chest tightness after activity 
(39/187, 20.9%), palpitations on exercise (27/187, 14.4%), sputum (21/187, 
11.2%), cough (15/187, 8.0%) and chest pain (13/187, 7.0%), followed by systemic 
symptoms including fatigue (34/187, 18.2%) and myalgia (20/187, 10.7%), and 
digestive symptoms including constipation (14/187, 7.5%), anorexia (13/187, 
7.0%), and diarrhea (8/187, 4.3%). Sixty-six (35.9%) RPs presented either 
anxiety or depression (42/187 [22.8%] and 53/187 [28.8%] respectively), and the 
proportion of anxiety or depression in the long symptomatic group was 
significantly higher than that in the asymptomatic group (41/187 [50.6%] vs. 
25/187 [24.3%]). Compared with the asymptomatic group, scores of all nine 
36-Item Short Form General Health Survey domains were lower in the symptomatic 
group (all P < 0.05). One hundred thirty RPs and 32 HCs (non-severe acute 
respiratory syndrome coronavirus 2 infected subjects) performed fecal sample 
sequencing. Compared with HCs, symptomatic RPs had obvious gut microbiota 
dysbiosis including significantly reduced bacterial diversities and lower 
relative abundance of short-chain fatty acids (SCFAs)-producing salutary 
symbionts such as Eubacterium_hallii_group, Subdoligranulum, Ruminococcus, 
Dorea, Coprococcus, and Eubacterium_ventriosum_group. Meanwhile, the relative 
abundance of Eubacterium_hallii_group, Subdoligranulum, and Ruminococcus showed 
decreasing tendencies between HCs, the asymptomatic group, and the symptomatic 
group.
CONCLUSION: This study demonstrated the presence of long COVID-19 which 
correlates with gut microbiota dysbiosis in RPs at one-year after discharge, 
indicating gut microbiota may play an important role in long COVID-19.

© 2023 The Korean Academy of Medical Sciences.

DOI: 10.3346/jkms.2023.38.e120
PMCID: PMC10111044
PMID: 37069814 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no potential conflicts of 
interest to disclose.


756. Gerontology. 2023;69(7):839-851. doi: 10.1159/000530622. Epub 2023 Apr 17.

Caregiver Involvement and Concerns with Care of Residents of Assisted Living 
before and during the COVID-19 Pandemic.

Hoben M(1)(2), Li W(3), Dampf H(2), Hogan DB(4), Corbett K(2), Chamberlain 
SA(2), McGrail K(5), Griffith LE(6), Gruneir A(7)(8), Lane NE(8)(9), Baumbusch 
J(10), Maxwell C(8)(11)(12).

Author information:
(1)School of Health Policy and Management, Faculty of Health, York University, 
Toronto, Ontario, Canada.
(2)Faculty of Nursing, College of Health Sciences, University of Alberta, 
Edmonton, Alberta, Canada.
(3)School of Epidemiology and Public Health, University of Ottawa, Ottawa, 
Ontario, Canada.
(4)Division of Geriatric Medicine, Department of Medicine, Cumming School of 
Medicine, University of Calgary, Calgary, Alberta, Canada.
(5)Centre for Health Services and Policy Research, School of Population and 
Public Health, University of British Columbia, Vancouver, British Columbia, 
Canada.
(6)Department of Health Research Methods, Evidence and Impact, Faculty of Health 
Sciences, McMaster University, Hamilton, Ontario, Canada.
(7)Department of Family Medicine, Faculty of Medicine and Dentistry, College of 
Health Sciences, University of Alberta, Edmonton, Alberta, Canada.
(8)ICES, Toronto, Ontario, Canada.
(9)Department of Internal Medicine, University of British Columbia, Vancouver, 
British Columbia, Canada.
(10)School of Nursing, University of British Columbia, Vancouver, British 
Columbia, Canada.
(11)School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada.
(12)School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, 
Canada.

INTRODUCTION: Family/friend caregivers play an essential role in promoting the 
physical and mental health of older adults in need of care - especially during 
the COVID-19 pandemic and especially in assisted living (AL) homes, where 
resident care needs are similarly complex as in long-term care homes but fewer 
staffing resources and services are available. However, little research is 
available on caregiver involvement and concerns with care of AL residents prior 
to and during waves 1 and 2 of the COVID-19 pandemic. This study addressed this 
important knowledge gap.
METHODS: This prospective cohort study used baseline and follow-up online 
surveys with primary caregivers to AL residents in Western Canada who were 65 
years or older and had lived in the AL home for at least 3 months before Mar 1, 
2020. Surveys assessed the following outcomes in the 3 months prior to and 
during waves 1 and 2 of the pandemic: sociodemographics, 5 ways of visiting or 
communicating with residents, involvement in 16 care tasks, concerns with 9 
resident physical/mental health conditions, perceived lack of resident access to 
7 care services, and whether caregivers felt well informed and involved with 
resident care.
RESULTS: Based on 386 caregiver responses, in-person visits dropped 
significantly in wave 1 of the pandemic and so did caregiver involvement in 
nearly all care tasks. While these rates increased in wave 2, most did not 
return to pre-pandemic levels. Correspondingly, caregiver concerns (already high 
before the pandemic) substantially increased in wave 1 and stayed high in wave 
2. These were particularly elevated among caregivers who did not feel well 
informed/involved with resident care.
CONCLUSIONS: Restricted in-person visiting disrupted resident care and was 
associated with worse perceptions of resident health and well-being. Continued 
caregiver involvement in resident care and communication with caregivers even 
during lockdowns is key to mitigating these issues.

© 2023 S. Karger AG, Basel.

DOI: 10.1159/000530622
PMID: 37068467 [Indexed for MEDLINE]


757. J Youth Adolesc. 2023 Jun;52(6):1313-1324. doi: 10.1007/s10964-023-01775-w. Epub 
2023 Apr 17.

Social Isolation During the COVID-19 Pandemic Impacts the Link between Child 
Abuse and Adolescent Internalizing Problems.

Trucco EM(1)(2)(3), Fava NM(4)(5), Villar MG(4), Kumar M(4), Sutherland 
MT(6)(4).

Author information:
(1)Department of Psychology, Florida International University, 11200 SW 8th 
Street, Miami, FL, 33199, USA. etrucco@fiu.edu.
(2)Center for Children and Families, Florida International University, 11200 SW 
8th Street, AHC-1 Rm. 140, Miami, FL, USA. etrucco@fiu.edu.
(3)Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann 
Arbor, MI, 48109, USA. etrucco@fiu.edu.
(4)Center for Children and Families, Florida International University, 11200 SW 
8th Street, AHC-1 Rm. 140, Miami, FL, USA.
(5)Robert Stempel College of Public Health & Social Work, Florida International 
University, 11200 SW 8th Street, Miami, FL, 33199, USA.
(6)Department of Psychology, Florida International University, 11200 SW 8th 
Street, Miami, FL, 33199, USA.

Collective traumas have a notable impact on adolescent well-being. While some 
youth face increased risk for mental health problems (e.g., those with 
maltreatment histories), many demonstrate resilience following traumatic events. 
One contributing factor to well-being following trauma is the degree to which 
one isolates from others. Accordingly, we examined the association between 
maltreatment and internalizing problems during the COVID-19 pandemic as 
moderated by social isolation. Among adolescents reporting pre-pandemic 
emotional abuse, those experiencing less isolation reported the lowest levels of 
anxiety symptoms. Among adolescents reporting pre-pandemic physical abuse, those 
experiencing less isolation reported the greatest levels of anxiety and 
depressive symptoms. The findings highlight a public health-oriented approach to 
youth well-being during collective trauma that extends beyond mitigating disease 
transmission.

© 2023. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s10964-023-01775-w
PMCID: PMC10108819
PMID: 37067640 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


758. Front Public Health. 2023 Mar 30;11:1048283. doi: 10.3389/fpubh.2023.1048283. 
eCollection 2023.

Are we ready for the next pandemic? Lessons learned from healthcare 
professionals' perspectives during the COVID-19 pandemic.

Alsaeed D(1), Al-Ozairi A(1)(2)(3), Alsarraf H(1)(3), Albarrak F(4), Al-Ozairi 
E(1)(2).

Author information:
(1)Clinical Care Research and Trials Unit, Dasman Diabetes Institute, Kuwait 
City, Kuwait.
(2)Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.
(3)Ministry of Health, Amiri Hospital, Kuwait City, Kuwait.
(4)Primary Health Care, Ministry of Health, Shamiya Health Center, Kuwait City, 
Kuwait.

BACKGROUND: The mental health and wellbeing of people watching the Corona Virus 
Disease 2019 (COVID-19) pandemic unfold has been discussed widely, with many 
experiencing feelings of anxiety and depression. The state of mental health of 
medical staff on the frontlines providing care should be examined; medical staff 
are overworked to meet the demands of providing care to the rise in cases and 
deterioration in capacity to meet demands, and this has put them under great 
psychological pressure. This may lead to an increase in medical errors, affect 
quality of care, and reduce staff retention rates. Understanding the impact the 
pandemic has had on healthcare professionals is needed to provide 
recommendations to prepare for future crises.
OBJECTIVES: To be able to meet the needs of the medical workforce on the 
frontlines and inform psychological support interventions and strategies for 
future pandemics, we aim to identify and explore the psychological impact of 
COVID-19 in Kuwait on healthcare professionals in close contact with patients.
METHODS: Using semi-structured interviews, we conducted interviews between 
February and July 2021 with 20 healthcare professionals across Ministry of 
Health hospitals who were part of COVID teams. Interviews were transcribed 
verbatim, and analysis was conducted using principles of thematic framework 
analysis.
RESULTS: Three themes emerged to help prepare future healthcare frontline 
workers on an individual, organizational, and national level: enhance 
self-resilience, a better-equipped workforce and healthcare environment, and 
mitigate stigma and increase public awareness.
CONCLUSION: The results have assisted in highlighting areas of improvement to 
support the healthcare workforce in the current environment, as well as better 
prepare them for future pandemics. The findings have also provided insight to 
recommend targeted interventions. These should improve the psychological 
wellbeing and help in supporting healthcare professionals to reduce burnout, 
continue effective care of patients, and enhance resilience.

Copyright © 2023 Alsaeed, Al-Ozairi, Alsarraf, Albarrak and Al Ozairi.

DOI: 10.3389/fpubh.2023.1048283
PMCID: PMC10098093
PMID: 37064685 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


759. Brain Behav. 2023 May;13(5):e2990. doi: 10.1002/brb3.2990. Epub 2023 Apr 14.

Perceived changes in the mental well-being among Nigerians due to Ramadan 
Intermittent Fasting during the COVID-19 pandemic.

Sulaiman SK(1), Tsiga-Ahmed FI(2), Arora T(3), Faris ME(4), Musa MS(1), Kareem 
YA(5), Dayyab FM(6), Hussein A(7), Sale S(8)(9), Javaid SF(10), Khan MA(11)(12).

Author information:
(1)Department of Medicine, Yobe State University Teaching Hospital, Damaturu, 
Nigeria.
(2)Department of Community Medicine, Bayero University Kano/Aminu Kano Teaching 
Hospital, Kano, Nigeria.
(3)College of Natural & Health Sciences, Zayed University, Dubai, United Arab 
Emirates.
(4)Department of Clinical Nutrition and Dietetics, College of Health Sciences, 
University of Sharjah, Sharjah, United Arab Emirates.
(5)Department of General and Geriatric Psychiatry, Federal Neuropsychiatric 
Hospital, Maiduguri, Nigeria.
(6)HIV and Tuberculosis Unit, Infectious Diseases Hospital, Kano, Nigeria.
(7)Department of Family Medicine, Yobe State University Teaching Hospital, 
Damaturu, Nigeria.
(8)Department of Child Psychiatry, Federal Neuropsychiatric Hospital, Kware, 
Sokoto, Nigeria.
(9)Department of Psychiatry, Bayero University Kano, Kano, Nigeria.
(10)Health and Wellness Research Group, Department of Psychiatry and Behavioral 
Sciences, College of Medicine and Health Sciences, United Arab Emirates 
University, Al-Ain, United Arab Emirates.
(11)Health and Wellness Research Group, Department of Family Medicine, College 
of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United 
Arab Emirates.
(12)Primary Care, NHS North West London, London, United Kingdom.

INTRODUCTION: Muslims fast every year during the month of Ramadan from dawn 
until dusk. This study examined mental well-being and correlating factors among 
Nigerian adults who observed Ramadan intermittent fasting (RIF).
METHODS: A validated generalized anxiety disorder-2 and Patient Health 
Questionnaire-2, the four-item spiritual well-being index, and the Islamic 
intrinsic religiosity questionnaire were used to collect data about mental 
well-being (depression, anxiety), spirituality, and intrinsic 
religiosity through a web-based survey between the May 9, 2021 (27th of Ramadan, 
1442) and the June 4, 2021 (29th of Shawwal, 1442). We studied the mental 
well-being of respondents over a period of 4 weeks before Ramadan (BR) and 
during the 4 weeks of Ramadan between the April 12, 2021 and the May 12, 
2021(DR). Multinomial regression analysis was used to determine the factors 
associated with depression and anxiety. This research did not receive any grant 
or funding.
RESULTS: A total of 770 adult Nigerians who observed RIF study were included in 
this cross-sectional study. When compared to mental well-being BR, 
observing RIF by Nigerian adult respondents was associated with a significant 
improvement in their mental well-being. A higher proportion of respondents felt 
less depressed DR (61.3% vs. 56.5%. < .001). Interest and pleasure in doing 
things improved DR than BR (p= 0.007) and respondents felt less nervous and 
anxious (60.7% vs. 57.1%, respectively; p <.001). Mental well-being was 
independently associated with sociodemographic characteristics, physical 
activity, and perceived relationships.
CONCLUSIONS: This study found significant improvement in mental well-being DR 
compared to BR despite the ongoing COVID-19 pandemic. The effect of RIF on 
mental well-being needs further research with multicentric studies among 
different sets of ethnic populations.

© 2023 The Authors. Brain and Behavior published by Wiley Periodicals LLC.

DOI: 10.1002/brb3.2990
PMCID: PMC10175984
PMID: 37060182 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that there is no conflict of 
interest regarding the publication of this paper.


760. BMC Public Health. 2023 Apr 14;23(1):701. doi: 10.1186/s12889-023-15440-1.

Life in a time of COVID: retrospective examination of the association between 
physical activity and mental well-being in western Australians during and after 
lockdown.

Piggott B(1), Chivers P(2)(3)(4), Sarasjärvi KK(2)(5), Bhoyroo R(2)(6), Lambert 
M(3), Millar L(2)(7), Bulsara C(2), Codde J(2)(8).

Author information:
(1)School of Health Sciences, Faculty of Medicine, Midwifery & Health Sciences, 
The University of Notre Dame Australia, Nursing, Fremantle, Australia. 
benjamin.piggott@nd.edu.au.
(2)Institute for Health Research, The University of Notre Dame Australia, 
Fremantle, Australia.
(3)School of Medical and Health Sciences, Edith Cowan University, Joondalup, 
Australia.
(4)DATaR Consulting, Bridgetown, Australia.
(5)Faculty of Medicine, Doctoral Programme in Population Health, University of 
Helsinki, Helsinki, Finland.
(6)Discipline of Psychology and Exercise Science, Murdoch University, Murdoch, 
Australia.
(7)Telethon Kids Institute, Nedlands, Australia.
(8)Division of Obstetrics and Gynaecology, Faculty of Health and Medical 
Sciences, University of Western Australia, Crawley, Australia.

BACKGROUND: The aim of this study was to examine physical activity and sedentary 
behaviours during Western Australia's COVID-19 lockdown and their association 
with mental well-being.
METHODS: Participants completed activity related questions approximately two 
months after a three-month lockdown (which formed part of a larger 
cross-sectional study from August to October 2020) as part of a 25-minute 
questionnaire adapted from the Western Australia Health and Well-being 
Surveillance system. Open-ended questions explored key issues relating to 
physical activity behaviours.
RESULTS: During the lockdown period, 463 participants (female, n = 347; 75.3%) 
reported lower number of active days (W = 4.47 p < .001), higher 
non-work-related screen hours per week (W = 11.8 p < .001), and higher levels of 
sitting time (χ2=28.4 p < .001). Post lockdown body mass index was higher 
(U = 3.0 p = .003), with obese individuals reporting the highest 
non-work-related screen hours per week (Wald χ2= 8.9 p = .012). Inverse 
associations were found for mental well-being where higher lockdown scores of 
Kessler-10 (p = .011), Dass-21 anxiety (p = .027) and Dass-21 depression 
(p = .011) were associated with lower physical activity levels. A key 
qualitative message from participants was wanting to know how to stay healthy 
during lockdown.
CONCLUSIONS: Lockdown was associated with lower physical activity, higher 
non-work-related screen time and more sitting time compared to post lockdown 
which also reported higher body mass index. Lower levels of mental well-being 
were associated with lower physical activity levels during lockdown. Given the 
known positive affect of physical activity on mental well-being and obesity, and 
the detrimental associations shown in this study, a key public health message 
should be considered in an attempt to maintain healthy activity behaviours in 
future lockdowns and similar emergency situations to promote and maintain 
positive well-being. Furthermore, consideration should be given to the isolation 
of a community due to infectious disease outbreaks and to recognise the 
important role physical activity plays in maintaining weight and supporting good 
mental health.

© 2023. The Author(s).

DOI: 10.1186/s12889-023-15440-1
PMCID: PMC10103040
PMID: 37060048 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


761. BMC Womens Health. 2023 Apr 15;23(1):179. doi: 10.1186/s12905-023-02333-z.

"I stretch them out as long as possible:" U.S. women's experiences of menstrual 
product insecurity during the COVID-19 pandemic.

Schmitt ML(1), Dimond K(2), Maroko AR(3), Phillips-Howard PA(4), Gruer C(2), 
Berry A(3), Nash D(3), Kochhar S(3), Sommer M(2).

Author information:
(1)Mailman School of Public Health, Columbia University, 722 W 168Th St, New 
York, NY, 10032, USA. maggieschmitt@gmail.com.
(2)Mailman School of Public Health, Columbia University, 722 W 168Th St, New 
York, NY, 10032, USA.
(3)Institute for Implementation Science in Population Health, City University of 
New York (CUNY), New York City, NY, USA.
(4)Liverpool School of Tropical Medicine, Liverpool, UK.

BACKGROUND: A growing body of evidence highlights how the COVID-19 pandemic has 
exacerbated gender inequalities in the US. This resulted in women being more 
vulnerable to economic insecurity and decreases in their overall well-being. One 
relevant issue that has been less explored is that of women's menstrual health 
experiences, including how inconsistent access to menstrual products may 
negatively impact their daily lives.
METHODS: This qualitative study, conducted from March through May 2021, utilized 
in-depth interviews that were nested within a national prospective cohort study. 
The interviews (n = 25) were conducted with a sub-sample of cis-gender women 
living across the US who had reported challenges accessing products during the 
first year of the pandemic. The interviews sought to understand the barriers 
that contributed to experiencing menstrual product insecurity, and related 
coping mechanisms. Malterud's 'systematic text condensation', an inductive 
thematic analysis method, was utilized to analyze the qualitative transcripts.
RESULTS: Respondents came from 17 different states across the U.S. Three key 
themes were identified: financial and physical barriers existed to consistent 
menstrual product access; a range of coping strategies in response to menstrual 
product insecurity, including dependence on makeshift and poorer quality 
materials; and heightened experiences of menstrual-related anxiety and shame, 
especially regarding the disclosure of their menstruating status to others as a 
result of inadequate menstrual leak protection.
CONCLUSIONS: Addressing menstrual product insecurity is a critical step for 
ensuring that all people who menstruate can attain their most basic menstrual 
health needs. Key recommendations for mitigating the impact of menstrual product 
insecurity require national and state-level policy reform, such as the inclusion 
of menstrual products in existing safety net basic needs programs, and the 
reframing of menstrual products as essential items. Improved education and 
advocacy are needed to combat menstrual stigma.

© 2023. The Author(s).

DOI: 10.1186/s12905-023-02333-z
PMCID: PMC10104689
PMID: 37060006 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


762. Acad Psychiatry. 2023 Jun;47(3):251-257. doi: 10.1007/s40596-023-01763-z. Epub 
2023 Apr 14.

The Psychosocial Impact of Treating Patients with COVID-19 on Psychiatry 
Residents in a Community Hospital: a Qualitative Study.

Obele M(1), Mahmoudzadeh S(2), Parrill A(3), Ayyanar S(4), Anuniru O(5), Sekhri 
S(4), Bangar R(4), Korie I(6).

Author information:
(1)Nassau University Medical Center, East Meadow, NY, USA. 
wunmi.marusa@gmail.com.
(2)Irvine Medical Center, University of California, Irvine, CA, USA.
(3)Lake Erie College of Osteopathic Medicine, Erie, PA, USA.
(4)Nassau University Medical Center, East Meadow, NY, USA.
(5)Authority Health GME Consortium, Detroit, MI, USA.
(6)Henry Mayo Newhall Hospital, Santa Clarita, CA, USA.

OBJECTIVE: The authors explored the experiences of psychiatry residents caring 
for patients during the COVID-19 pandemic on a medical unit.
METHODS: From June 2020 through December 2020, structured, individual interviews 
were conducted with psychiatry residents deployed to internal medicine wards in 
a community hospital to provide medical care to COVID-19 patients for greater 
than or equal to 1 week. Interviews were recorded, transcribed verbatim, and 
analyzed using thematic analytical methods.
RESULTS: Psychiatry residents (n = 16) were interviewed individually for 
approximately 45 min each. During the interviews, many residents described 
emotions of fear, anxiety, uncertainty, lack of preparedness, and difficulty 
coping with high patient mortality rates. Many of the residents expressed 
concerns regarding insufficient personal protective equipment, with the 
subsequent worries of their own viral exposure and transmission to loved ones. 
Multiple residents expressed feeling ill-equipped to care for COVID-19 patients, 
in some cases stating that utilizing their expertise in mental health would have 
better addressed the mental health needs of colleagues and patients' families. 
Participants also described the benefits of processing emotions during 
supportive group sessions with their program director.
CONCLUSIONS: The COVID-19 pandemic represents a public health crisis with 
potential negative impacts on patient care, professionalism, and physicians' 
well-being and safety. The psychiatry residents and fellows described the 
overwhelmingly negative impact on their training. The knowledge gained from this 
study will help establish the role of the psychiatrist not only in future crises 
but in healthcare as a whole.

© 2023. The Author(s), under exclusive licence to American Association of Chairs 
of Departments of Psychiatry, American Association of Directors of Psychiatric 
Residency Training, Association for Academic Psychiatry and Association of 
Directors of Medical Student Education in Psychiatry.

DOI: 10.1007/s40596-023-01763-z
PMCID: PMC10104691
PMID: 37059966 [Indexed for MEDLINE]

Conflict of interest statement: On behalf of all authors, the corresponding 
author states that there is no conflict of interest.


763. Econ Hum Biol. 2023 Apr;49:101242. doi: 10.1016/j.ehb.2023.101242. Epub 2023 Apr 
6.

The impact of informal and formal care disruption on older adults' psychological 
distress during the COVID-19 pandemic in UK.

Di Novi C(1), Martini G(2), Sturaro C(2).

Author information:
(1)European Commission, Joint Research Centre (JRC), Ispra, Italy. Electronic 
address: Cinzia.DI-NOVI@ec.europa.eu.
(2)Department of Economics, University of Bergamo, Italy.

This paper investigates how formal and informal caregiving disruptions-due to 
the U.K. government's non-pharmaceutical interventions (NPIs) aimed at reducing 
transmission of the SARS-CoV-2 virus-may have affected the likelihood of 
psychological distress among older individuals. We model the association between 
disruption of formal and informal care and mental health of the elderly during 
the first wave of the COVID-19 pandemic using a recursive simultaneous - 
equation model for binary variables. Our findings reveal that public 
interventions, which are most essential for reducing the pandemic spread, 
influenced the provision of formal and informal care. The lack of adequate 
long-term care following the COVID-19 outbreak has also had negative 
repercussions on the psychological well-being of these adults.

Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.ehb.2023.101242
PMCID: PMC10079322
PMID: 37058982 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
report no declarations of interest.


764. Med Lav. 2023 Apr 13;114(2):e2023012. doi: 10.23749/mdl.v114i2.13829.

Differences in the Long-term Impact of the COVID-19 Pandemic on the Mental 
Health and Professional Quality of Life of Resident and Specialist Physicians.

Delle Donne V(1), Massaroni V(2), Ciccarelli N(3), Borghetti A(4), Ciccullo 
A(5), Baldin G(6), Giuliano G(7), Dusina A(8), Visconti E(9), Tamburrini E(10), 
Di Giambendetto S(11).

Author information:
(1)Infectious Diseases Institute, Department of Safety and Bioethics, Catholic 
University of Sacred Heart, Rome, Italy. valentina.delledonne1@unicatt.it.
(2)Infectious Diseases Institute, Department of Safety and Bioethics, Catholic 
University of Sacred Heart, Rome, Italy. valentina.massaroni@unicatt.it.
(3)Department of Psychology, Catholic University, Milan, Italy. 
nicoletta.ciccarelli@unicat.it.
(4)UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli 
IRCCS, Rome, Italy. albor86@gmail.com.
(5)UOC Infectious Diseases, Ospedale San Salvatore, L'Aquila, Italy. 
arturo.ciccullo@gmail.com.
(6)Olbia Mater Hospital, Olbia, Italy. gian.baldin@gmail.com.
(7)UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli 
IRCCS, Rome, Italy. gabriele.giuliano@policlinicogemelli.it.
(8)UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli 
IRCCS, Rome, Italy. alex.dusina01@gmail.com.
(9)UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli 
IRCCS, Rome, Italy. elena.visconti@policlinicogemelli.it.
(10)UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli 
IRCCS, Rome, Italy. enrica.tamburrini@unicat.it.
(11)Infectious Diseases Institute, Department of Safety and Bioethics, Catholic 
University of Sacred Heart, Rome, Italy. simona.digiambenedetto@unicat.it.

BACKGROUND: The COVID-19 pandemic created an extremely difficult situation for 
healthcare workers (HCWs) worldwide. We aimed to compare the mental health and 
professional quality of life of residents and specialist physicians in a cohort 
of Italian HCWs caring for patients with COVID-19 about two years after the 
start of the COVID-19 pandemic.
METHODS: In November 2021, an online survey investigating the emotional states 
of depression, anxiety, stress, compassion satisfaction and compassion fatigue 
was administered to HCWs (N= 78) at the Fondazione Policlinico Universitario A. 
Gemelli IRCCS, Rome.
RESULTS: Our findings suggest that from 5 to 20% of our cohort of HCWs still 
showed the effects of the adverse psychological impact of the pandemic and more 
than half of them experienced medium levels of compassion fatigue as well as a 
medium level of compassion satisfaction. Our results also show that those with 
fewer years of clinical practice might be at greater risk of burnout (p= 0.021), 
anxiety and stress symptoms (both ps= 0.027) and might develop a lower level of 
compassion satisfaction (p=0.018). Moreover, the factors that potentially 
contribute to poor mental health, compassion fatigue and compassion satisfaction 
seem to differ between residents and specialist physicians.
CONCLUSIONS: This overview presents one of the first pictures of the long-term 
effects of the pandemic on the mental health and professional quality of life of 
an Italian sample of HCWs. Moreover, it also helps identify professionals who 
are most in need of support and emphasises the importance of improving the 
psychological and professional wellbeing of these individuals especially during 
a pandemic-like crisis with long lasting effects.

DOI: 10.23749/mdl.v114i2.13829
PMCID: PMC10133772
PMID: 37057354 [Indexed for MEDLINE]

Conflict of interest statement: Alberto Borghetti received fee for advisory 
board by ViiV Healthcare, personal fee by Janssen Cilag. Simona Di Giambenedetto 
received speakers’ honoraria and support for travel to meetings from Gilead, 
Janssen-Cilag (JC), Merck Sharp & Dohme (MSD) and ViiV Healthcare. Arturo 
Ciccullo received travel grants and congress’ fee from ViiV Healthcare. All 
other authors: none to declare.


765. Clin Psychol Psychother. 2023 Sep-Oct;30(5):1013-1019. doi: 10.1002/cpp.2853. 
Epub 2023 Apr 13.

The relationship among psychological distress, well-being and excessive social 
media use during the outbreak of Covid-19: A longitudinal investigation.

Brailovskaia J(1), Margraf J(1), Ceccatelli S(2), Cosci F(2)(3).

Author information:
(1)Mental Health Research and Treatment Center, Department of Clinical 
Psychology and Psychotherapy, Ruhr-Universität Bochum, Bochum, Germany.
(2)Department of Health Sciences, University of Florence, Florence, Italy.
(3)Department of Psychiatry and Neuropsychology, Maastricht University, 
Maastricht, The Netherlands.

INTRODUCTION: The corona pandemic has been a life event causing negative 
consequences on mental health. Mental health consists of positive and negative 
dimensions. The present longitudinal study investigated how positive and 
negative dimensions changed over 15 months after the Covid-19 outbreak. 
Potential changes of excessive social media use (SMU) and its relationship with 
mental health were also investigated.
METHOD: Data (N = 189) on distress (measured overall and as depression, anxiety, 
and stress), well-being and excessive SMU were collected at three time points 
(baseline, BL; 3-month follow-up, FU1; 15-month follow-up, FU2) via online 
surveys in Italy. Repeated analyses of variance were used to test differences 
among the three measurement time points. Mediational models were applied.
RESULTS: Distress did not change over time, well-being decreased and excessive 
SMU increased significantly. The relationship between distress at BL and 
excessive SMU at FU2 was significant (total effect, c: p < .001). The 
relationship between distress at BL and well-being at FU1 (a: p < .001), and 
between well-being at FU1and excessive SMU at FU2 (b: p = .004) was significant. 
Including FU1 well-being in the model, the relationship between distress at BL 
and excessive SMU at FU2 was not significant (direct effect, c': p = .078). The 
indirect effect (ab) was significant.
CONCLUSION: Well-being mediated the relationship between baseline stress and 
excessive SMU. Enhanced stress may reduce well-being which, in turn, increases 
the risk of excessive SMU. This emphasizes the urgency of programmes that foster 
well-being, especially during stressful events such as a pandemic.

© 2023 The Authors. Clinical Psychology & Psychotherapy published by John Wiley 
& Sons Ltd.

DOI: 10.1002/cpp.2853
PMID: 37056167 [Indexed for MEDLINE]


766. BMC Psychol. 2023 Apr 13;11(1):111. doi: 10.1186/s40359-023-01132-3.

Experiences of burnout, anxiety, and empathy among health profession students in 
Qatar University during the COVID-19 pandemic: a cross-sectional study.

Sulaiman R(#)(1), Ismail S(#)(1), Shraim M(2), El Hajj MS(1), Kane T(3), 
El-Awaisi A(4).

Author information:
(1)Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, 
Qatar University, Doha, Qatar.
(2)Department of Public Health, College of Health Sciences, QU Health, Qatar 
University, Doha, Qatar.
(3)Department of Population Medicine, College of Medicine, QU Health, Qatar 
University, Doha, Qatar.
(4)Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, 
Qatar University, Doha, Qatar. elawaisi@qu.edu.qa.
(#)Contributed equally

BACKGROUND: The prevalence of burnout and anxiety is constantly increasing among 
health profession students worldwide. This study evaluates the prevalence of 
burnout and its relationship to anxiety and empathy during the COVID-19 pandemic 
among health profession students in the main governmental institution in Doha, 
Qatar using validated instruments.
METHODS: A cross-sectional survey of health profession students using validated 
instruments was employed. The Maslach Burnout Inventory-General Students Survey 
(MBI-GS(S)) to measure burnout; The Generalized Anxiety Disorder (GAD-7) to 
measure anxiety; and Interpersonal Reactivity Index (IRI) to measure empathy 
were utilized. Descriptive statistics and multivariable linear regression were 
used.
RESULTS: Of the 1268 eligible students, 272 (21.5%) completed the online survey. 
Burnout was found to be prevalent amongst the students. The mean scores for the 
MBI-GS(S) subscales of emotional exhaustion, cynicism, and professional efficacy 
were 4.07, 2.63, and 3.97, respectively. Anxiety was found to be a strong 
predictor for burnout and burnout was positively associated with empathy.
CONCLUSIONS: Findings from this study demonstrated relationships between health 
profession students' burnout, anxiety, and empathy. These findings might have an 
impact on the development of curriculum interventions to enhance student 
well-being. More burnout awareness and management programs that cater to the 
specific needs of health profession students are needed. Furthermore, findings 
of this study may have implications for future educational interventions during 
times of crisis or how this can be used to improve student experiences in normal 
times.

© 2023. The Author(s).

DOI: 10.1186/s40359-023-01132-3
PMCID: PMC10100621
PMID: 37055804 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


767. J Relig Health. 2023 Aug;62(4):2899-2915. doi: 10.1007/s10943-023-01790-y. Epub 
2023 Apr 13.

The Effects of Spiritual Wellbeing on Self-Perceived Health Changes Among 
Members of the Church of England During the COVID-19 Pandemic in England.

Village A(1), Francis LJ(2)(3).

Author information:
(1)School of Humanities, York St John University, York, UK.
(2)Centre for Educational Development, Appraisal and Research (CEDAR), 
University of Warwick, Coventry, CV4 7AL, UK. leslie.francis@warwick.ac.uk.
(3)World Religions and Education Research Unit (WRERU), Bishop Grosseteste 
University, Lincoln, UK. leslie.francis@warwick.ac.uk.

This paper tests whether changes in spiritual wellbeing were correlated with 
self-rated changes in mental and physical health after controlling for changes 
in psychological wellbeing in a sample from the Church of England taken during 
the third national COVID-19 lockdown in 2021. During the third lockdown in 
England an online survey, named Covid-19 and Church-21, was delivered through 
the Qualtrics XM platform from 22 January to 23 July 2021. The responses 
included 1878 Anglicans living in England. The change in spiritual wellbeing 
scale was produced using self-reported changes in the frequency of key spiritual 
practices (prayer and Bible reading), trust in God, the quality of spiritual 
life, and spiritual health. Changes in mental and physical health were assessed 
using single self-report items. Changes in psychological wellbeing were assessed 
using the Index of Balanced Affect Change (TIBACh). After controlling for 
changes in psychological wellbeing, better change in spiritual wellbeing was 
positively correlated with better change in both mental and physical health. 
Negative affect may have mediated the relationship between spiritual wellbeing 
and both mental and physical health, and positive affect may also have mediated 
the relationship with mental health. The results suggest changes in spiritual 
wellbeing, as defined within a Christian religious context, may have had 
positive effects in promoting better mental and physical health during a sudden 
crisis such as the COVID-19 pandemic.

© 2023. The Author(s).

DOI: 10.1007/s10943-023-01790-y
PMCID: PMC10099007
PMID: 37052805 [Indexed for MEDLINE]

Conflict of interest statement: No potential conflict of interest was reported 
by the author(s).


768. Sex Med Rev. 2022 Oct 1;10(4):714-753. doi: 10.1016/j.sxmr.2022.06.005.

Sexual Health During COVID-19: A Scoping Review.

Toldam NE(1)(2), Graugaard C(1), Meyer R(3), Thomsen L(4), Dreier S(4), Jannini 
EA(5), Giraldi A(2)(6).

Author information:
(1)Center for Sexology Research, Department of Clinical Medicine, Aalborg 
University, Denmark.
(2)Sexological Clinic, Mental Health Center, Copenhagen, Copenhagen University 
Hospital - Mental Health Services CPH, Copenhagen, Denmark.
(3)Clinical Pharmacology Unit, Zealand University Hospital, Roskilde, Denmark.
(4)Aalborg University Library, Aalborg, Denmark.
(5)Department of System Medicine, University of Rome Tor Vergata, Italy.
(6)Department of Clinical Medicine, University of Copenhagen, Copenhagen, 
Denmark.

INTRODUCTION: The COVID-19 pandemic impacted profoundly on the wellbeing and 
social interactions of the world population, and all dimensions of sexual health 
were potentially affected by globally implemented preventive measures.
OBJECTIVES: The scoping review aimed to compile existing research investigating 
possible effects of COVID-19 lockdowns on adult sexual health, that is, sexual 
behavior, functioning, and satisfaction. Further, studies on the interplay 
between mental health and sexual well-being during the pandemic were reviewed.
METHODS: The review was conducted in accordance with guidelines established by 
the Joanna Briggs Institute and the Extension for Scoping Reviews (PRISMA-ScR) 
Checklist. On October 11-12, 2021, PubMed, Embase, PsycInfo, Cinahl, Cochrane, 
Sociological Abstracts and Scopus were systematically searched for relevant 
peer-reviewed papers employing quantitative methodology. Additionally, 
unpublished ("grey") research studies on the subject were retrieved. The 
screening, data extraction, and analysis of evidence were conducted by 4 
independent reviewers using an iterative approach.
RESULTS: Based on 107 studies included, the scoping review showed that the 
pandemic had had a wide impact on all dimensions of sexual health. Except for 
solo sex activities, mainly negative COVID-19 implications were identified, 
although findings were, in sum, characterized by complexity and 
unpredictability. Thus, sexual behavior, functioning, and satisfaction during 
the pandemic appeared to be mitigated by a broad range of sociodemographic and 
contextual factors. Finally, sexual health seemed deeply entwined with overall 
mental health.
CONCLUSION: The scoping review revealed a broad range of COVID-19-related 
effects on sexual health, including an overall decline in partnered sex and a 
concurrent increase in solo sex activities. It also emphasized a need for future 
research to shed light on possible long-term consequences of the pandemic in 
various population groups and on all aspects of sexual health.

Copyright © 2022, International Society for Sexual Medicine. Published by 
Elsevier.

DOI: 10.1016/j.sxmr.2022.06.005
PMID: 37051956 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of interest: The authors report no 
conflicts of interest.


769. SAGE Open Nurs. 2023 Apr 4;9:23779608231167814. doi: 10.1177/23779608231167814. 
eCollection 2023 Jan-Dec.

Identifying Sources of Moral Distress Amongst Critical Care Staff During the 
Covid-19 Pandemic Using a Naturalistic Inquiry.

Scott M(1), Wade R(1), Tucker G(2), Unsworth J(3).

Author information:
(1)Northumbria Healthcare NHS Foundation Trust, Northumberland, UK.
(2)South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK.
(3)Northumbria University, Newcastle upon Tyne, UK.

INTRODUCTION: Moral distress can have a significant impact on the mental health 
and well-being of practitioners. Causes of moral distress in critical care have 
been identified as futile treatment, conflict between family members and staff, 
lack of resources, and dysfunctional teams.
OBJECTIVES: This study explores the sources of moral distress during the 
COVID-19 pandemic and the meaning that staff attached to these events. The study 
aims to examine whether the sources of moral distress are similar, or different, 
to those that commonly occur in critical care departments.
METHODS: Naturalistic inquiry using semi-structured individual interviews with 
17 participants drawn from nursing (n = 12), medicine (n = 3), and the allied 
health professions (n = 2). The interviews were recorded and transcribed 
verbatim. The transcripts were analyzed using reflexive thematic analysis.
RESULTS: The results suggested that while there were some similar sources of 
moral distress including caring for dying patients and not being able to provide 
the usual standard of care, the nature of the disease trajectory and frequency 
of death had a significant impact. In addition, the researchers found that 
providing care which was counter-intuitive, concerns about the risks to the 
staff and their families and the additional burdens associated with leading 
teams in times of uncertainty were identified as sources of moral distress.
CONCLUSION: This study explored the potential sources of moral distress during 
the pandemic and the meaning that practitioners attached to their experiences. 
There were some similarities with the sources of moral distress in critical care 
which occur outside of a pandemic. However, the frequency and intensity of the 
experiences are likely to be different during a pandemic, with staff describing 
high volumes of deaths without family members present. In addition, new sources 
of moral distress related to uncertainty, counter-intuitive care and concerns 
about personal and family risk of infection were identified.

© The Author(s) 2023.

DOI: 10.1177/23779608231167814
PMCID: PMC10084528
PMID: 37050934

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


770. Int J Environ Res Public Health. 2023 Mar 28;20(7):5286. doi: 
10.3390/ijerph20075286.

Study Conditions and University Students' Mental Health during the Pandemic: 
Results of the COVID-19 German Student Well-Being Study (C19 GSWS).

Heumann E(1), Trümmler J(2), Stock C(1)(3), Helmer SM(4), Busse H(5), Negash 
S(6), Pischke CR(2).

Author information:
(1)Institute of Health and Nursing Science, Charité-Universitätsmedizin Berlin, 
Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 
Augustenburger Platz 1, 13353 Berlin, Germany.
(2)Institute of Medical Sociology, Centre for Health and Society, Medical 
Faculty, Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany.
(3)Unit for Health Promotion Research, University of Southern Denmark, Degnevej 
14, 6705 Esbjerg, Denmark.
(4)Institute for Public Health and Nursing Research, University of Bremen, 28359 
Bremen, Germany.
(5)Department Prevention and Evaluation, Leibniz Institute for Prevention 
Research and Epidemiology-BIPS, 28359 Bremen, Germany.
(6)Institute for Medical Epidemiology, Biometrics and Informatics, 
Interdisciplinary Center for Health Sciences, Medical School of the 
Martin-Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany.

University students are generally vulnerable to mental health problems. This was 
exacerbated during the COVID-19 pandemic, when students experienced decisive 
changes and restrictions in their academic lives. Our study aimed at (a) 
analysing associations between study conditions and symptoms of depression and 
anxiety and (b) determining the extent of use and motivation to use student 
counselling services. The C19 GSWS is a cross-sectional study conducted at five 
universities in Germany (N = 7203). Descriptive analyses and linear regression 
models were performed to estimate the associations between study conditions and 
mental health outcomes. A total of 42.4% of the students felt down, depressed, 
or hopeless on several days over the past 14 days. Between a third and 44.1% of 
the students felt burdened by their study conditions. Worse perceived study 
conditions were associated with higher levels of depressive symptoms and 
anxiety. Only 7.1% indicated that they had utilised student counselling 
services, and female gender, enrolment in a bachelor's programme, and having 
more than 1 reason for utilisation were factors associated with use. The results 
of our research underline the need for universities to review their study 
conditions and to provide targeted intervention strategies and counselling 
services to promote students' mental well-being.

DOI: 10.3390/ijerph20075286
PMCID: PMC10094523
PMID: 37047902 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


771. Int J Environ Res Public Health. 2023 Mar 27;20(7):5278. doi: 
10.3390/ijerph20075278.

The Contribution of Environmental Science to Mental Health Research: A Scoping 
Review.

Roberts M(1), Colley K(1), Currie M(1), Eastwood A(1), Li KH(1), Avery LM(2), 
Beevers LC(3), Braithwaite I(4), Dallimer M(5), Davies ZG(6), Fisher HL(7)(8), 
Gidlow CJ(9), Memon A(10), Mudway IS(11)(12), Naylor LA(13), Reis S(14)(15), 
Smith P(16), Stansfeld SA(17), Wilkie S(18), Irvine KN(1).

Author information:
(1)Social, Economic and Geographical Sciences Department, The James Hutton 
Institute, Craigiebuckler, Aberdeen, Scotland AB15 8QH, UK.
(2)Environmental and Biochemical Sciences Department, The James Hutton 
Institute, Craigiebuckler, Aberdeen, Scotland AB15 8QH, UK.
(3)Institute of Infrastructure and Environment, School of Energy, Geoscience, 
Infrastructure and Society, Heriot-Watt University, Edinburgh EH14 4AS, UK.
(4)UCL Institute of Health Informatics, 222 Euston Road, London NW1 2DA, UK.
(5)Sustainability Research Institute, School of Earth and Environment, 
University of Leeds, Leeds LS2 9JT, UK.
(6)Durrell Institute of Conservation and Ecology (DICE), School of Anthropology 
and Conservation, University of Kent, Canterbury, Kent CT2 7NR, UK.
(7)King's College London, Social Genetic and Developmental Psychiatry Centre, 
Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London 
SE5 8AF, UK.
(8)Economic & Social Research Council (ESRC) Centre for Society and Mental 
Health, King's College London, 44-46 Aldwych, London WC2B 4LL, UK.
(9)Centre for Health and Development (CHAD), Staffordshire University, Leek 
Road, Stoke-on-Trent ST4 2DF, UK.
(10)Department of Primary Care and Public Health, Brighton and Sussex Medical 
School, Brighton BN1 9PH, UK.
(11)MRC Centre for Environment and Health, Imperial College London, White City 
Campus, London W12 0BZ, UK.
(12)NIHR Health Protection Research Units in Environmental Exposures and Health, 
and Chemical and Radiation Threats and Hazards, Imperial College London, White 
City Campus, London W12 0BZ, UK.
(13)School of Geographical & Earth Sciences, East Quadrangle, University of 
Glasgow, Glasgow G12 8QQ, UK.
(14)UK Centre for Ecology & Hydrology, Bush Estate, Penicuik EH26 0QB, UK.
(15)European Centre for Environment and Human Health, University of Exeter 
Medical School, Knowledge Spa, Truro, Cornwall TR1 3HD, UK.
(16)Institute of Biological and Environmental Sciences, University of Aberdeen, 
23 St Machar Drive, Aberdeen AB24 3UU, UK.
(17)Centre for Psychiatry, Barts and the London School of Medicine, Queen Mary 
University of London, Charterhouse Square, London EC1M 6BQ, UK.
(18)School of Psychology, Murray Library, City Campus, University of Sunderland, 
Sunderland SR1 3SD, UK.

Mental health is influenced by multiple complex and interacting genetic, 
psychological, social, and environmental factors. As such, developing 
state-of-the-art mental health knowledge requires collaboration across academic 
disciplines, including environmental science. To assess the current contribution 
of environmental science to this field, a scoping review of the literature on 
environmental influences on mental health (including conditions of cognitive 
development and decline) was conducted. The review protocol was developed in 
consultation with experts working across mental health and environmental 
science. The scoping review included 202 English-language papers, published 
between 2010 and 2020 (prior to the COVID-19 pandemic), on environmental themes 
that had not already been the subject of recent systematic reviews; 26 reviews 
on climate change, flooding, air pollution, and urban green space were 
additionally considered. Studies largely focused on populations in the USA, 
China, or Europe and involved limited environmental science input. Environmental 
science research methods are primarily focused on quantitative approaches 
utilising secondary datasets or field data. Mental health measurement was 
dominated by the use of self-report psychometric scales. Measures of 
environmental states or exposures were often lacking in specificity (e.g., 
limited to the presence or absence of an environmental state). Based on the 
scoping review findings and our synthesis of the recent reviews, a research 
agenda for environmental science's future contribution to mental health 
scholarship is set out. This includes recommendations to expand the geographical 
scope and broaden the representation of different environmental science areas, 
improve measurement of environmental exposure, prioritise experimental and 
longitudinal research designs, and giving greater consideration to variation 
between and within communities and the mediating pathways by which environment 
influences mental health. There is also considerable opportunity to increase 
interdisciplinarity within the field via the integration of conceptual models, 
the inclusion of mixed methods and qualitative approaches, as well as further 
consideration of the socio-political context and the environmental states that 
can help support good mental health. The findings were used to propose a 
conceptual model to parse contributions and connections between environmental 
science and mental health to inform future studies.

DOI: 10.3390/ijerph20075278
PMCID: PMC10094550
PMID: 37047894 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


772. Int J Environ Res Public Health. 2023 Mar 23;20(7):5245. doi: 
10.3390/ijerph20075245.

Family Bonds with Pets and Mental Health during COVID-19 in Australia: A Complex 
Picture.

Bennetts SK(1)(2), Howell T(3), Crawford S(1), Burgemeister F(1), Burke K(4), 
Nicholson JM(1).

Author information:
(1)Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, 
Bundoora, VIC 3086, Australia.
(2)Intergenerational Health Group, Murdoch Children's Research Institute, 
Parkville, VIC 3052, Australia.
(3)Anthrozoology Research Group, School of Psychology and Public Health, La 
Trobe University, Bendigo, VIC 3552, Australia.
(4)Metro North Mental Health, Metro North Health, Herston, QLD 4029, Australia.

The COVID-19 pandemic has drawn attention to the health-promoting features of 
human-animal relationships, particularly for families with children. Despite 
this, the World Health Organization's (1986) Ottawa Charter remains 
human-centric. Given the reciprocal health impacts of human-animal 
relationships, this paper aims to (i) describe perceived pet-related benefits, 
worries, and family activities; and to (ii) examine differences in perceived 
benefits, worries, and activities for parents and children with and without 
clinical mental health symptoms. We recruited 1034 Australian parents with a 
child < 18 years and a cat or dog via a national online survey between July and 
October 2020. Most parents reported their pet was helpful for their own (78%) 
and their child's mental health (80%). Adjusted logistic regression revealed 
parents with clinical psychological distress were 2.5 times more likely to be 
worried about their pet's care, well-being, and behaviour (OR = 2.56, p < 
0.001). Clinically anxious children were almost twice as likely to live in a 
family who engages frequently in pet-related activities (e.g., cooked treats, 
taught tricks, OR = 1.82, p < 0.01). Mental health and perceived benefits of 
having a pet were not strongly associated. Data support re-framing the Ottawa 
Charter to encompass human-animal relationships, which is an often-neglected 
aspect of a socioecological approach to health.

DOI: 10.3390/ijerph20075245
PMCID: PMC10094414
PMID: 37047861 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


773. Int J Environ Res Public Health. 2023 Mar 23;20(7):5231. doi: 
10.3390/ijerph20075231.

Predictors of Feeling of Threat Caused by COVID-19 Pandemic, the Distinctive 
Effects of Automatic vs. Reflective Emotions.

Pastwa M(1), Imbir KK(1), Wielgopolan A(1), Adach E(1).

Author information:
(1)Faculty of Psychology, University of Warsaw, 00-183 Warszawa, Poland.

The worldwide pandemic that started in December 2019 was a cause of a great rise 
in the feeling of threat in society. A feeling of threat and distress can be 
influenced by the span of emotions experienced by a person, and as it is rather 
clear, that the situation of pandemic evokes negative emotions, they can range 
from fear to depression, to even disgust. In this study, we wanted to verify the 
influence of the negative emotions of automatic origin, related to the 
well-being and homeostasis of the organism and the negative emotions of 
reflective origin, which are related to social constructs, on the feeling of 
threat caused by the pandemic outbreak. We expected automatic emotions to have a 
greater influence on the feeling of threat. We used an online questionnaire to 
measure the intensity of negative emotions and the feeling of threat among 
Polish participants in the time of the early outbreak of the pandemic 
(March-April 2020). Regression analyses were used to identify the predictors of 
the feeling of threat. The results show the distinctive effect of automatic and 
reflective groups of emotions. While automatic emotions always increased the 
feeling of threat, the reflective emotions suppressed the distress, especially 
in the group of middle-aged and elderly participants. As reflective emotions are 
developing in the process of socialization, the observed results could suggest, 
that young people do not process the situation of the pandemic in reflective 
categories, which leaves them more worried about the situation. We suggest, that 
promoting reflective thinking can be helpful in interventions in the cases of 
anxiety caused by the pandemic, as well as in social communication regarding the 
topic of the pandemic.

DOI: 10.3390/ijerph20075231
PMCID: PMC10094237
PMID: 37047847 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


774. BMJ Open. 2023 Apr 12;13(4):e067886. doi: 10.1136/bmjopen-2022-067886.

Examining the psychosocial impacts of the COVID-19 pandemic: an international 
cross-sectional study protocol.

Tanveer S(1), Schluter PJ(2)(3), Porter RJ(1), Boden J(1), Beaglehole B(1), 
Sulaiman-Hill R(1), Dean S(4), Bell R(5), Al-Hussainni WN(6), Arshi M(7), Amer 
Nordin AS(8), Dinç M(9), Khan MJ(10), Khoshnami MS(7), Majid Al-Masoodi MA(11), 
Moghanibashi-Mansourieh A(7), Noruzi S(12), Rahajeng A(13), Shaikh S(14), 
Tanveer N(15), Topçu F(9), Yapan S(9), Yunianto I(16), Zoellner LA(17), Bell 
C(18).

Author information:
(1)Department of Psychological Medicine, University of Otago Christchurch, 
Christchurch, New Zealand.
(2)Faculty of Health, University of Canterbury, Christchurch, New Zealand.
(3)School of Clinical Medicine, University of Queensland, Brisbane, Queensland, 
Australia.
(4)Department of Psychological Medicine, University of Otago, Wellington, New 
Zealand.
(5)Department of Anthropology, Australian National University, Canberra, 
Australian Capital Territory, Australia.
(6)Basic Sciences Deptartment, Ibn Sina University of Medical and Pharmaceutical 
Sciences, Baghdad, Iraq.
(7)Department of Social Work, University of Social Welfare and Rehabilitation 
Science, Tehran, Iran.
(8)Department of Psychological Medicine, University of Malaya, Kuala Lumpur, 
Malaysia.
(9)Department of Psychology, Hasan Kalyoncu University, Gaziantep, Turkey.
(10)Department of Psychology, International Islamic University, Islamabad, 
Pakistan.
(11)Department of Scholarships and Cultural Relations, Mustansiryah University, 
Baghdad, Iraq.
(12)Lorestan University of Medical Sciences, Khoram-Abad, Iran.
(13)Faculty of Economics and Business, Universitas Gadjah Mada, Yogyakarta, 
Indonesia.
(14)Department of Psychology, Islamabad Model College for Girls (PostGraduate), 
Islamabad, Pakistan.
(15)Department of Peace and Conflict Sciences, National Defence University, 
Islamabad, Pakistan.
(16)Faculty of Teacher Training and Education, Universitas Ahmad Dahlan, 
Yogyakarta, Indonesia.
(17)Department of Psychology, University of Washington, Washington, DC, USA.
(18)Department of Psychological Medicine, University of Otago Christchurch, 
Christchurch, New Zealand caroline.bell@otago.ac.nz.

INTRODUCTION: The COVID-19 pandemic exposed people to significant and prolonged 
stress. The psychosocial impacts of the pandemic have been well recognised and 
reported in high-income countries (HICs) but it is important to understand the 
unique challenges posed by COVID-19 in low- and middle-income countries (LMICs) 
where limited international comparisons have been undertaken. This protocol was 
therefore devised to study the psychosocial impacts of the COVID-19 pandemic in 
seven LMICs using scales that had been designed for or translated for this 
purpose.
METHODS AND ANALYSIS: This cross-sectional study uses an online survey to 
administer a novel COVID Psychosocial Impacts Scale (CPIS) alongside established 
measures of psychological distress, post-traumatic stress, well-being and 
post-traumatic growth in the appropriate language. Participants will include 
adults aged 18 years and above, recruited from Indonesia, Iraq, Iran, Malaysia, 
Pakistan, Somalia and Turkey, with a pragmatic target sample size of 500 in each 
country.Data will be analysed descriptively on sociodemographic and study 
variables. In addition, CPIS will be analysed psychometrically (for reliability 
and validity) to assess the suitability of use in a given context. Finally, 
within-subjects and between-subjects analyses will be carried out using 
multi-level mixed-effect models to examine associations between key 
sociodemographic and study variables.
ETHICS AND DISSEMINATION: Ethical approval was granted by the Human Ethics 
Committee, University of Otago, New Zealand (Ref. No. 21/102). In addition, 
international collaborators obtained local authorisation or ethical approval in 
their respective host universities before data collection commenced.Participants 
will give informed consent before taking part. Data will be collected and stored 
securely on the University of Otago, New Zealand Qualtrics platform using an 
auto-generated non-identifiable letter-number string. Data will be available on 
reasonable request. Findings will be disseminated by publications in scientific 
journals and/or conference presentations.
TRIAL REGISTRATION NUMBER: NCT05052333.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/bmjopen-2022-067886
PMCID: PMC10105919
PMID: 37045574 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


775. Health Promot Chronic Dis Prev Can. 2023 Apr;43(4):171-181. doi: 
10.24095/hpcdp.43.4.02.

Social isolation, loneliness and positive mental health among older adults in 
Canada during the COVID-19 pandemic.

Ooi LL(1), Liu L(1), Roberts KC(1), Gariépy G(2)(3)(4), Capaldi CA(1).

Author information:
(1)Public Health Agency of Canada, Ottawa, Ontario, Canada.
(2)Public Health Agency of Canada, Montréal, Quebec, Canada.
(3)Département de médecine sociale et préventive, École de santé publique, 
Université de Montréal, Montréal, Quebec, Canada.
(4)Centre de recherche de l'Institut universitaire en santé mentale de Montréal, 
Montréal, Quebec, Canada.

INTRODUCTION: Social isolation and loneliness are associated with poorer mental 
health among older adults. However, less is known about how these experiences 
are independently associated with positive mental health (PMH) during the 
COVID-19 pandemic.
METHODS: We analyzed data from the 2020 and 2021 cycles of the Survey on 
COVID-19 and Mental Health to provide estimates of social isolation (i.e. living 
alone), loneliness and PMH outcomes (i.e. high self-rated mental health, high 
community belonging, mean life satisfaction) in the overall older adult 
population (i.e. 65+ years) and across sociodemographic groups. We also 
conducted logistic and linear regressions to separately and simultaneously 
examine how social isolation and loneliness are associated with PMH.
RESULTS: Nearly 3 in 10 older adults reported living alone, and over a third 
reported feelings of loneliness due to the pandemic. When examined separately, 
living alone and loneliness were each associated with lower PMH. When assessed 
simultaneously, loneliness remained a significant independent factor associated 
with all three PMH outcomes (overall and across all sociodemographic groups), 
but living alone was only a significant factor for high community belonging in 
the overall population, for males and for those aged 65 to 74 years.
CONCLUSION: Overall, social isolation and loneliness were associated with poorer 
wellbeing among older adults in Canada during the pandemic. Loneliness remained 
a significant factor related to all PMH outcomes after adjusting for social 
isolation, but not vice versa. The findings highlight the need to appropriately 
identify and support lonely older adults during (and beyond) the pandemic.

Publisher: INTRODUCTION: L’isolement social et la solitude sont associés à une 
moins bonne santé mentale chez les aînés. Toutefois, on en sait moins sur la 
façon dont ces expériences sont associées de manière indépendante à une santé 
mentale positive pendant la pandémie de COVID‑19.
MÉTHODOLOGIE: Nous avons analysé les données des cycles de 2020 et de 2021 de 
l’Enquête sur la COVID-19 et la santé mentale pour être en mesure d’estimer le 
degré d’isolement social (le fait de vivre seul), la solitude et divers 
indicateurs d’une santé mentale positive (bonne santé mentale autoévaluée, fort 
sentiment d’appartenance à la communauté locale et satisfaction moyenne à 
l’égard de la vie) chez les aînés en général (65 ans ou plus) et en fonction de 
divers groupes sociodémographiques. Nous avons également effectué des 
régressions logistiques et linéaires pour analyser séparément et conjointement 
la façon dont l’isolement social et la solitude sont associés à une santé 
mentale positive.
RÉSULTATS: Près de 3 aînés sur 10 ont déclaré vivre seuls, et plus du tiers ont 
déclaré éprouver un sentiment de solitude en raison de la pandémie. Analysés 
séparément, le fait de vivre seul et le sentiment de solitude ont été associés à 
une santé mentale positive plus faible. Dans l’analyse conjointe, le sentiment 
de solitude est demeuré un important facteur indépendant associé aux trois 
indicateurs de santé mentale positive (globalement et dans tous les groupes 
sociodémographiques), mais le fait de vivre seul ne s’est révélé un facteur 
important que dans le cas d’un fort sentiment d’appartenance à la communauté 
locale dans la population globale, pour les hommes et pour les 65 à 74 ans.
CONCLUSION: De manière générale, l’isolement social et la solitude ont été 
associés à un bien-être inférieur chez les aînés au Canada pendant la pandémie. 
La solitude est demeurée un facteur important associé à tous les indicateurs de 
santé mentale positive après ajustement pour l’isolement social, mais non 
l’inverse. Ces résultats montrent qu’il faut repérer et soutenir adéquatement 
les aînés qui souffrent de solitude pendant (et après) une pandémie.

Plain Language Summary: This study examined the associations between social 
isolation (i.e. living alone) and loneliness and positive mental health among 
older adults in Canada during the COVID-19 pandemic. Nearly 3 in 10 older adults 
reported living alone, and more than one-third reported feelings of loneliness 
due to the pandemic. When examined separately, living alone and loneliness were 
each associated with poorer well-being; however, when examined simultaneously, 
only loneliness remained significantly associated with positive mental health, 
overall and across sociodemographic groups. Males and those aged 65 to 74 years 
who live alone (vs. who live with others) may also be more vulnerable to poorer 
mental health.

Plain Language Summary: Cette étude a porté sur les associations entre 
l’isolement social (le fait de vivre seul), la solitude et une santé mentale 
positive chez les aînés au Canada pendant la pandémie de COVID-19. Près de 3 
aînés sur 10 ont déclaré vivre seuls, et plus du tiers ont déclaré éprouver un 
sentiment de solitude en raison de la pandémie. Analysés séparément, le fait de 
vivre seul et la solitude ont été associés à un bien-être inférieur mais, dans 
l’analyse conjointe, seule la solitude s’est révélée associée de façon 
statistiquement significative à une santé mentale positive, de manière générale 
et dans les groupes sociodémographiques. Les hommes et les 65 à 74 ans vivant 
seuls (par opposition à ceux vivant avec une autre personne) sont également plus 
susceptibles d’avoir une moins bonne santé mentale.

DOI: 10.24095/hpcdp.43.4.02
PMCID: PMC10111573
PMID: 37043546 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest.


776. PLoS One. 2023 Apr 12;18(4):e0284306. doi: 10.1371/journal.pone.0284306. 
eCollection 2023.

Health and social care workers experiences of coping while working in the 
frontline during the COVID-19 pandemic: One year on.

Soubra K(1), Tamworth C(2), Kamal Z(2), Brook C(3), Langdon D(1), Billings J(2).

Author information:
(1)Department of Psychology, Royal Holloway University of London, London, United 
Kingdom.
(2)Division of Psychiatry, University College London, London, United Kingdom.
(3)Acorn Group Practice, Twickenham, United Kingdom.

BACKGROUND: The unprecedented pressure of working on the frontline during the 
Covid-19 pandemic had a demonstrable impact on the mental health and wellbeing 
of health and social care workers in the early stages of the pandemic, however, 
less research has focused on workers' experiences over the longer course of the 
pandemic.
AIMS: We set out to develop an explanatory model of the processes that helped 
and hindered the coping of HSCWs working over the course of the Covid-19 
pandemic.
METHOD: Twenty HSCWs based in the UK took part in the study. They completed 
semi-structured interviews 12-18 months after the peak of the first wave in the 
UK. Interviews were transcribed and analysed using grounded theory methodology.
RESULTS: The analysis identified eleven theoretical codes: personal context, 
organisational resources, organisational response, management, colleagues, 
decision-making and responsibilities, internal impacts, external impactors, 
safety, barriers to accessing support and temporal factors. The findings suggest 
that factors related to the individual themselves, their personal context, the 
organisation they work in, their managers, the support structures around them 
and their sense of safety impacted on HSCWs; ability to cope. Some factors 
changed over time throughout the first year of the pandemic, such as workload 
and staff illness, which further impacted HSCWs' coping. There were many 
barriers to accessing support that also impacted coping, including availability, 
awareness and time. The relationship between the factors that impacted coping 
are represented in an explanatory model.
CONCLUSIONS: The findings extend previous studies on the mental health impact on 
frontline HSCWs working during Covid-19, providing novel insight by developing 
an explanatory model illustrating the underlying factors that impacted their 
coping experiences over the course of the pandemic in the UK. The findings from 
this study may assist in the development of improved and more effective support 
for HSCWs going forwards.

Copyright: © 2023 Soubra et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0284306
PMCID: PMC10096225
PMID: 37043526 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


777. Occup Med (Lond). 2024 Feb 19;74(1):45-52. doi: 10.1093/occmed/kqad011.

Differential impact of COVID-19 on mental health and burnout.

Maniero C(1)(2), Ng SM(1), Collett G(2), Godec T(2), Siddiqui I(3)(4)(5), 
Antoniou S(1), Kumar A(6), Janmohamed A(7), Nair S(8), Kotecha A(9), Khan R(10), 
Khanji MY(1)(2)(11)(12), Kapil V(1)(2)(10), Gupta J(13), Gupta AK(1)(2)(10).

Author information:
(1)Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, 
London EC1A 7BE, UK.
(2)William Harvey Research Institute, Queen Mary University of London, London 
EC1M 6BQ, UK.
(3)Wellbeing Hub, Newham Training Hub, London E15 1HP, UK.
(4)Northeast London CCG, London E15 1DA, UK.
(5)Woodgrange Medical Practice, London E7 0QH, UK.
(6)Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan WN1 1XX, UK.
(7)St George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK.
(8)Glan Clwyd Hospital, Betsi Cadwaladr University Health Board, Wales LL18 5UJ, 
UK.
(9)Royal Devon and Exeter Hospital, Exeter, Devon EX2 5DW, UK.
(10)The Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK.
(11)UCLPartners, London W1T 7HA, UK.
(12)Newham University Hospital, Barts Health NHS Trust, London E13 8SL, UK.
(13)South West London and St George's Mental Health NHS Trust, London SW17 0YF, 
UK.

BACKGROUND: There may be differential impact of the COVID-19 pandemic on mental 
health and burnout rates of healthcare professionals (HCPs) performing different 
roles.
AIMS: To examine mental health and burnout rates, and possible drivers for any 
disparities between professional roles.
METHODS: In this cohort study, online surveys were distributed to HCPs in 
July-September 2020 (baseline) and re-sent 4 months later (follow-up; December 
2020) assessing for probable major depressive disorder (MDD), generalized 
anxiety disorder (GAD), insomnia, mental well-being and burnout (emotional 
exhaustion and depersonalization). Separate logistic regression models (at both 
phases) compared the risk of outcomes between roles: healthcare assistants 
(HCAs), nurses and midwives (nurses), allied health professionals (AHPs) and 
doctors (reference group). Separate linear regression models were also developed 
relating the change in scores to professional role.
RESULTS: At baseline (n = 1537), nurses had a 1.9-fold and 2.5-fold increased 
risk of MDD and insomnia, respectively. AHPs had a 1.7-fold and 1.4-fold 
increased risk of MDD and emotional exhaustion, respectively. At follow-up (n = 
736), the disproportionate risk between doctors and others worsened: nurses and 
HCAs were at 3.7-fold and 3.6-fold increased risk of insomnia, respectively. 
Nurses also had a significantly increased risk of MDD, GAD, poor mental 
well-being and burnout. Nurses also had significantly worsened anxiety, mental 
well-being and burnout scores over time, relative to doctors.
CONCLUSIONS: Nurses and AHPs had excess risk of adverse mental health and 
burnout during the pandemic, and this difference worsened over time (in nurses 
especially). Our findings support adoption of targeted strategies accounting for 
different HCP roles.

© The Author(s) 2023. Published by Oxford University Press on behalf of the 
Society of Occupational Medicine.

DOI: 10.1093/occmed/kqad011
PMCID: PMC10875923
PMID: 37040624 [Indexed for MEDLINE]

Conflict of interest statement: None declared.


778. Nurs Open. 2023 Aug;10(8):5177-5184. doi: 10.1002/nop2.1753. Epub 2023 Apr 10.

Lack of freedom predicted poor self-reported health among family caregivers of 
children with disabilities during the COVID-19 pandemic in Europe.

Savela RM(1), Nykänen I(2), Välimäki T(1).

Author information:
(1)Department of Nursing Science, University of Eastern Finland, Kuopio, 
Finland.
(2)Institute of Public Health and Clinical Nutrition, University of Eastern 
Finland, Kuopio, Finland.

AIM: We aim to assess the effects of the COVID-19 pandemic on self-reported 
health and quality of life among family caregivers of children with disabilities 
across Europe.
DESIGN: Cross-sectional study.
METHODS: Data from the survey by the Eurocarers and IRCCS-INRCA were used. The 
data were collected between November 2020 and March 2021 from 16 European 
countries. Data analysis was done using regression analysis to identify family 
caregivers' self-reported health and well-being predictors.
RESULTS: This study included 289 caregivers. The mean age of children was 
12 years. Their family caregiver's mean age was 44, and they were mainly women. 
Experience of lack of freedom predicted family caregivers' poor self-reported 
health and quality of life. Children's interrupted health and social services 
also predicted family caregivers' poor self-reported mental well-being. 
Longitudinal evidence on the pandemic's effects and a diverse view of family 
caregivers of children with disabilities are needed to plan effective 
post-pandemic health services and nursing practice. No Patient or Public 
Contribution.

© 2023 The Authors. Nursing Open published by John Wiley & Sons Ltd.

DOI: 10.1002/nop2.1753
PMCID: PMC10333825
PMID: 37036912 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflict of interest to 
declare.


779. PLoS One. 2023 Apr 10;18(4):e0284155. doi: 10.1371/journal.pone.0284155. 
eCollection 2023.

COVID-19 guidelines and its perceived effect on seafarers' health and wellbeing: 
A qualitative study.

Timilsina A(1)(2), Baygi F(3).

Author information:
(1)Central Department of Public Health, Tribhuvan University, Kathmandu, Nepal.
(2)Department of Public Health, University of Southern Denmark, Esbjerg, 
Denmark.
(3)Department of Public Health, Research Unit of General Practice, University of 
Southern Denmark, Odense, Denmark.

BACKGROUND: The COVID-19 pandemic and its guidelines have had a profound impact 
on the social life, health, and wellbeing of people around the world. Very 
little is known if the guidelines are put into action effectively by seafarers. 
Also, the effects of such guidelines on seafarers' health and wellbeing have not 
been studied so far. Therefore, this study aimed to explore the perceived 
effects of the COVID-19 guidelines on seafarers' health and wellbeing.
MATERIALS & METHODS: A qualitative research method was adopted using in-depth 
interviews. A total of 13 international male seafarers were interviewed until 
data saturation was achieved. Purposive sampling was used to recruit the 
respondents. The data was inductively coded using NVivo 12 and manifest content 
analysis was conducted.
RESULTS: Once seafarers had access to COVID-19 guidelines, seafarers followed 
the guideline as suggested by companies under the guidance of captain. The 
majority of the participants reported that available guidelines could decrease 
their stress and anxiety levels, while some reported that implementing the 
COVID-19 guidelines had no significant effect on their health and wellbeing. The 
results of this study also showed a delay in repatriation, which had an impact 
on the seafarers' mental health.
CONCLUSION: The guidelines could not address seafarers' psychological needs to 
ensure their good health and wellbeing. Therefore, it is recommended that 
shipping companies address the mental health needs of seafarers during the 
COVID-19 pandemic and similar infectious diseases emerging in the future.

Copyright: © 2023 Timilsina, Baygi. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0284155
PMCID: PMC10085033
PMID: 37036852 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


780. Health Policy Plan. 2023 Aug 2;38(7):777-788. doi: 10.1093/heapol/czad023.

Stress and coping in the face of COVID-19: a qualitative inquiry into early 
pandemic experiences and psychological well-being of health workers in Burkina 
Faso, Senegal and The Gambia.

Lohmann J(1)(2), Diallo M(3)(4), De Allegri M(2), Koulidiati JL(5), 
Martinez-Alvarez M(3)(4)(6).

Author information:
(1)Department of Global Health and Development, London School of Hygiene & 
Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
(2)Heidelberg Institute of Global Health, University Hospital and Medical 
Faculty, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg 69120, 
Germany.
(3)MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, 
Atlantic Boulevard, Fajara, PO Box 273, Banjul, The Gambia.
(4)Institut de Recherche en Santé, de Surveillance Epidémiologique et de 
Formation, 4 Rue 2 D1 Pole Urbain de Diamniado BP 7325, Dakar, Sénégal.
(5)Institut Supérieur des Sciences de la Santé, Université Nazi Boni, 01 BP 
1091, Bobo-Dioulasso, Burkina Faso.
(6)Université Cheikh Anta Diop, Fann Campus, Dakar BP 5005, Sénégal.

COVID-19 represented an unprecedented challenge for health workers around the 
world, resulting in strong concerns about impacts on their psychological 
well-being. To inform on-going support and future preparedness activities, this 
study documented health workers' experiences, well-being and coping throughout 
the first wave of the pandemic, in Burkina Faso, Senegal and The Gambia. We 
collected data from 68 primarily clinical staff from the COVID-19 treatment, 
maternity and emergency departments in 13 purposely hospitals and laboratories 
across the three countries. Following in-depth interviews via Zoom (mid-May to 
September 2020), we regularly followed up via WhatsApp until the end of 2020. We 
used a mixed deductive and inductive coding approach and a framework matrix to 
organize and analyse the material. All respondents initially assessed the 
situation as stressful and threatening. Major emotional reactions included fear 
of own infection, fear of being a risk to loved ones, guilt, compassion, and 
anxiety regarding the future. Many suffered from feeling left alone with the 
emerging crisis and feeling unvalued and unappreciated, particularly by their 
governments and ministries of health. Conversely, health workers drew much 
strength from support and valuation by direct supervisors and team members and, 
in part, also by patients, friends and family. We observed important 
heterogeneity between places of work and individual backgrounds. Respondents 
coped with the situation in various ways, particularly with strategies to manage 
adverse emotions, to minimize infection risk, to fortify health and to find 
meaning in the adverse circumstances. Coping strategies were primarily grounded 
in own resources rather than institutional support. Over time, the situation 
normalized and fears diminished for most respondents. With a view towards 
emergency preparedness, our findings underline the value of participation and 
transparent communication, institutional support and routine training to foster 
health workers' psychological preparedness, coping skill set and resilience more 
generally.

© The Author(s) 2023. Published by Oxford University Press in association with 
The London School of Hygiene and Tropical Medicine.

DOI: 10.1093/heapol/czad023
PMCID: PMC10394495
PMID: 37036713 [Indexed for MEDLINE]

Conflict of interest statement: None declared.


781. Curr Opin Pediatr. 2023 Jun 1;35(3):362-367. doi: 10.1097/MOP.0000000000001248. 
Epub 2023 Apr 10.

Impact of COVID-19 on adolescent health and use of social media.

Ramsey N(1), Obeidallah M(2), Abraham A(3).

Author information:
(1)School Health Program, Montefiore Medical Group, Bronx, New York.
(2)Department of Global Studies, Asian and Middle Eastern Studies Program, 
College of William and Mary, Williamsburg, Virginia.
(3)Division of Adolescent and Young Adult Medicine, Children's National 
Hospital, Washington, District of Columbia, USA.

PURPOSE OF REVIEW: The coronavirus disease 2019 (COVID-19) pandemic changed 
access to healthcare and decreased mental and physical wellbeing. It also 
significantly altered teens' relationship with social media. This article is a 
current review of the literature on the impact of COVID-19 on adolescent health 
overall. In addition, how social media use has both improved and worsened the 
impact of COVID-19, along with strategies providers should consider in wanting 
to address social media use with teens.
RECENT FINDINGS: The COVID-19 pandemic has affected adolescents through 
increased social isolation and decreased access to healthcare resources. Social 
media use has both positive and negative effects on adolescent health. Positive 
effects include sustained connection to friends, family and community while 
negative effects include lower self-esteem and increased incidence of eating 
disorders.
SUMMARY: Our findings underscore the multifaceted impact of social media on 
adolescent mental health, physical wellbeing, and healthcare access. Of 
particular relevance to the physician is the potential of leveraging social 
media to promote healthy behaviors in vulnerable age groups and populations. 
Social media can be used to connect teens with reputable websites where they can 
seek medical or health information that would otherwise not readily be 
available.

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/MOP.0000000000001248
PMCID: PMC10155612
PMID: 37036294 [Indexed for MEDLINE]

Conflict of interest statement: There are no conflicts of interest.


782. Front Public Health. 2023 Mar 23;11:1109446. doi: 10.3389/fpubh.2023.1109446. 
eCollection 2023.

Family context as a double-edged sword for psychological distress amid the 
COVID-19 pandemic with the mediating effect of individual fear and the 
moderating effect of household income.

Chen B(1), Gong W(2)(3), Lai AYK(4), Sit SMM(3)(4), Ho SY(3), Yu NX(1), Wang 
MP(4), Lam TH(3).

Author information:
(1)Department of Social and Behavioural Sciences, City University of Hong Kong, 
Kowloon, Hong Kong SAR, China.
(2)Department of General Practice, Medical School, Shenzhen University, 
Shenzhen, China.
(3)School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong 
SAR, China.
(4)School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong SAR, 
China.

BACKGROUND: The COVID-19 pandemic drives psychological distress. Previous 
studies have mostly focused on individual determinants but overlooked family 
factors. The present study aimed to examine the associations of individual and 
family factors with psychological distress, and the mediating effect of 
individual fear and the moderating role of household income on the above 
associations.
METHODS: We conducted a population-based cross-sectional survey on Chinese 
adults in Hong Kong from February to March 2021 (N = 2,251) to measure the 
independent variables of anti-epidemic fatigue, anti-epidemic confidence, 
individual and family members' fear of COVID-19, and family well-being (range 
0-10), and the dependent variable of psychological distress (through four-item 
Patient Health Questionnaire, range 0-4).
RESULTS: Hierarchical regression showed that anti-epidemic fatigue was 
positively (β = 0.23, 95% CI [0.18, 0.28]) while anti-epidemic confidence was 
negatively (β = -0.29, 95% CI [-0.36, -0.22]) associated with psychological 
distress. Family members' fear of COVID-19 was positively (β = 0.11, 95% CI 
[0.05, 0.16]) while family well-being was negatively (β = -0.57, 95% CI [-0.63, 
-0.51]) associated with psychological distress. Structural equation model showed 
that individual fear mediated the above associations except for family 
well-being. Multi-group analyses showed a non-significant direct effect of 
anti-epidemic confidence and a slightly stronger direct effect of family 
well-being on psychological distress among participants with lower incomes, 
compared to those with higher incomes.
CONCLUSION: We have first reported the double-edged effect of family context on 
psychological distress, with the positive association between family members' 
fear of COVID-19 and psychological distress fully mediated by individual fear 
and the negative association between family well-being and psychological 
distress moderated by income level. Future studies are warranted to investigate 
how the contagion of fear develops in the family and how the inequality of 
family resources impacts family members' mental health amid the pandemic.

Copyright © 2023 Chen, Gong, Lai, Sit, Ho, Yu, Wang and Lam.

DOI: 10.3389/fpubh.2023.1109446
PMCID: PMC10076528
PMID: 37033084 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


783. Front Public Health. 2023 Mar 23;11:1148758. doi: 10.3389/fpubh.2023.1148758. 
eCollection 2023.

Socio-ecological determinants of older people's mental health and well-being 
during COVID-19: A qualitative analysis within the Irish context.

Guzman V(1), Doyle F(1), Foley R(2), Craven P(3), Crowe N(3), Wilson P(3), Smith 
A(3), Hegarty G(3), Pertl MM(1).

Author information:
(1)Department of Health Psychology, School of Population Health, Royal College 
of Surgeons in Ireland, Dublin, Ireland.
(2)Department of Geography, Maynooth University, Maynooth, Ireland.
(3)Well-being, Interventions and Support During Epidemics (WISE) Study Research 
Advisory Group, Royal College of Surgeons in Ireland, Dublin, Ireland.

BACKGROUND: Evidence indicates that older people with biological and social 
vulnerabilities are at high risk of short- and long-term consequences related to 
the COVID-19 pandemic. However, studies have also highlighted that the crisis 
may present opportunities for personal growth if older individuals are met with 
appropriate resources and support.
OBJECTIVE: The aim of this study was to explore the perceptions of older people 
regarding how individual, social, and environmental factors have supported or 
hindered their well-being and health during COVID-19.
METHODS: We analyzed data collected between April-May and October-November 2021 
from the Well-being, Interventions and Support during Epidemics (WISE) study, a 
qualitative investigation of community-dwellers based in Ireland and aged 65 
years or over. Participants (n = 57) completed written submissions, narrative 
interviews and/or go-along interviews detailing their experiences during the 
pandemic. Framework analysis was carried out in NVivo 12 to identify 
determinants, linkages, and explanations within Bronfenbrenner's 
socio-ecological model.
RESULTS: The mean age of participants was 74.9 years, 53% were female, 45% lived 
alone, and 86% lived in areas with high urban influence. Our findings highlight 
the heterogeneous effect of COVID-19 across diverse older individuals who held 
distinct concerns, capabilities, and roles in society before and during the 
pandemic. Multi-scalar contextual characteristics such as individual's living 
arrangements, neighborhood social and built environments, as well as social 
expectations about aging and help seeking, had an influential role in 
participants' well-being and available supports. We identified mixed views 
regarding public health restrictions, but a consensus emerged questioning the 
suitability of one-size-fits-all approaches based on chronological age.
CONCLUSIONS: Our results suggest that some negative pandemic consequences could 
have been avoided by increasing collaboration with older people and with the 
provision of clearer communications. The interdependencies identified between 
individual characteristics and socio-ecological factors that influenced 
participants' availability of supports and development of adaptive strategies 
represent areas of opportunity for the development of age-friendly interventions 
during and beyond public health crises.

Copyright © 2023 Guzman, Doyle, Foley, Craven, Crowe, Wilson, Smith, Hegarty and 
Pertl.

DOI: 10.3389/fpubh.2023.1148758
PMCID: PMC10077967
PMID: 37033060 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


784. Med J Aust. 2023 May 1;218(8):361-367. doi: 10.5694/mja2.51918. Epub 2023 Apr 9.

Mental health and wellbeing of health and aged care workers in Australia, May 
2021 - June 2022: a longitudinal cohort study.

McGuinness SL(1)(2), Eades O(1)(2), Grantham KL(2), Zhong S(1)(2), Johnson 
J(1)(2), Cameron PA(2)(3), Forbes AB(2), Fisher JR(2), Hodgson CL(1)(2), Kasza 
J(2), Kelsall H(2), Kirkman M(2), Russell GM(2), Russo PL(2)(4), Sim MR(2), 
Singh K(5)(6), Skouteris H(7), Smith K(2)(8), Stuart RL(2)(9), Trauer JM(2), Udy 
A(1)(10), Zoungas S(2), Leder K(2)(11).

Author information:
(1)Alfred Health, Melbourne, VIC.
(2)Monash University, Melbourne, VIC.
(3)The Alfred Emergency and Trauma Centre, Alfred Health, Melbourne, VIC.
(4)Cabrini Health, Melbourne, VIC.
(5)The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC.
(6)Peninsula Health, Melbourne, VIC.
(7)Monash Centre for Health Research and Implementation, Monash University, 
Melbourne, VIC.
(8)Ambulance Service of Victoria, Melbourne, VIC.
(9)Monash Health, Melbourne, VIC.
(10)Australian and New Zealand Intensive Care Research Centre, Monash 
University, Melbourne, VIC.
(11)Royal Melbourne Hospital, Melbourne, VIC.

OBJECTIVES: To assess the mental health and wellbeing of health and aged care 
workers in Australia during the second and third years of the coronavirus 
disease 2019 (COVID-19) pandemic, overall and by occupation group.
DESIGN, SETTING, PARTICIPANTS: Longitudinal cohort study of health and aged care 
workers (ambulance, hospitals, primary care, residential aged care) in Victoria: 
May-July 2021 (survey 1), October-December 2021 (survey 2), and May-June 2022 
(survey 3).
MAIN OUTCOME MEASURES: Proportions of respondents (adjusted for age, gender, 
socio-economic status) reporting moderate to severe symptoms of depression 
(Patient Health Questionnaire-9, PHQ-9), anxiety (Generalized Anxiety Disorder 
scale, GAD-7), or post-traumatic stress (Impact of Event Scale-6, IES-6), 
burnout (abbreviated Maslach Burnout Inventory, aMBI), or high optimism 
(10-point visual analogue scale); mean scores (adjusted for age, gender, 
socio-economic status) for wellbeing (Personal Wellbeing Index-Adult, PWI-A) and 
resilience (Connor Davidson Resilience Scale 2, CD-RISC-2).
RESULTS: A total of 1667 people responded to at least one survey (survey 1, 989; 
survey 2, 1153; survey 3, 993; response rate, 3.3%). Overall, 1211 survey 
responses were from women (72.6%); most respondents were hospital workers (1289, 
77.3%) or ambulance staff (315, 18.9%). The adjusted proportions of respondents 
who reported moderate to severe symptoms of depression (survey 1, 16.4%; survey 
2, 22.6%; survey 3, 19.2%), anxiety (survey 1, 8.8%; survey 2, 16.0%; survey 3, 
11.0%), or post-traumatic stress (survey 1, 14.6%; survey 2, 35.1%; survey 3, 
14.9%) were each largest for survey 2. The adjusted proportions of participants 
who reported moderate to severe symptoms of burnout were higher in surveys 2 and 
3 than in survey 1, and the proportions who reported high optimism were smaller 
in surveys 2 and 3 than in survey 1. Adjusted mean scores for wellbeing and 
resilience were similar at surveys 2 and 3 and lower than at survey 1. The 
magnitude but not the patterns of change differed by occupation group.
CONCLUSION: Burnout was more frequently reported and mean wellbeing and 
resilience scores were lower in mid-2022 than in mid-2021 for Victorian health 
and aged care workers who participated in our study. Evidence-based mental 
health and wellbeing programs for workers in health care organisations are 
needed.
TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: 
ACTRN12621000533897 (observational study; retrospective).

© 2023 The Authors. Medical Journal of Australia published by John Wiley & Sons 
Australia, Ltd on behalf of AMPCo Pty Ltd.

DOI: 10.5694/mja2.51918
PMID: 37032118 [Indexed for MEDLINE]


785. Worldviews Evid Based Nurs. 2023 Apr;20(2):126-132. doi: 10.1111/wvn.12646. Epub 
2023 Apr 8.

Well-being in acute care nurse managers: A risk analysis of physical and mental 
health factors.

Martin SD(1), Urban RW(2), Foglia DC(3), Henson JS(4), George V(5), McCaslin 
T(3).

Author information:
(1)Texas Health Harris Methodist Fort Worth, Fort Worth, Texas, USA.
(2)Texas Health Arlington Memorial, Arlington, Texas, USA.
(3)Texas Health Frisco, Frisco, Texas, USA.
(4)Texas Health Resources, Arlington, Texas, USA.
(5)Department of Clinical Excellence, Nursing Professional Practice, Texas 
Health Resources, Plano, Texas, USA.

BACKGROUND: Nurse managers have experienced tremendous stress during the 
COVID-19 pandemic, contributing to negative psychological outcomes. Positive 
professional well-being is a construct that can be promoted to mitigate poor 
psychological outcomes and burnout in nurses. Little is known about the health, 
healthy behaviors, effects of stress on homelife, and well-being of nurse 
managers in the United States (U.S.).
AIMS: The aims of the study were to explore nurse managers' well-being related 
to self-reported stress and health perceptions and habits.
METHODS: A sample of 80 (41% response rate) nurse managers responded to a 
cross-sectional web-based survey sent via email in a southwestern U.S. 
13-hospital system. Nurses answered 39 quantitative questions about 
demographics, well-being (9-item Well-Being Index [WBI]), perceptions of stress 
affecting homelife, and perceptions of health and health-related behaviors.
RESULTS: Mean WBI (2.9 [2.7]) indicated risk for poor psychological outcomes. 
Managers (75%) reported stress from work affected their personal lives and a 
decline in overall health during the pandemic. Most (80%) reported burnout and 
emotional problems. Nurse managers had 8.1 times increased risk of poor WBI 
scores if stress from work affected their personal life than if they reported no 
spillover stress into their personal life (OR = 8.1, 95% CI [2.6, 25.0]).
LINKING EVIDENCE TO ACTION: Findings from this study add a nuanced understanding 
of nurse managers' well-being. The strongest risk factor for poor WBI scores was 
stress levels affecting personal life. Interventions to improve well-being in 
nurse managers are needed. Limitations are the convenience sampling, limited 
geographic location, and response rate of <50%. Further research is needed to 
support nurse managers in stress reduction and development of boundaries that 
prohibit the spillover effect of workplace stress. Organizations may consider a 
combination of administrative support and changes as well as provision of 
on-the-job training of interventions that support individual well-being.

© 2023 Sigma Theta Tau International.

DOI: 10.1111/wvn.12646
PMID: 37031350 [Indexed for MEDLINE]


786. Matern Child Health J. 2023 Jul;27(7):1254-1263. doi: 
10.1007/s10995-023-03657-w. Epub 2023 Apr 8.

Pregnant in a Pandemic: Mental Wellbeing and Associated Healthy Behaviors Among 
Pregnant People in California During COVID-19.

Phipps JE(1), Whipps MDM(#)(2), D'Souza I(2), LaSalle JM(3), Simmons LA(2).

Author information:
(1)Department of Human Ecology, Perinatal Origins of Disparities Center, 
University of California, Davis, 1 Shields Ave, Davis, CA, 95616, USA. 
jephipps@ucdavis.edu.
(2)Department of Human Ecology, Perinatal Origins of Disparities Center, 
University of California, Davis, 1 Shields Ave, Davis, CA, 95616, USA.
(3)Department of Medical Microbiology and Immunology, Perinatal Origins of 
Disparities Center, University of California, Davis, 1 Shields Ave, Davis, CA, 
95616, USA.
(#)Contributed equally

INTRODUCTION: Pregnancy is a time of increased vulnerability to mental health 
disorders. Additionally, the COVID-19 pandemic has increased the incidence of 
depression and anxiety. Thus, we aimed to assess mental health and associated 
healthy behaviors of pregnant people in California during the pandemic in order 
to contextualize prenatal well-being during the first pandemic of the 
twenty-first century.
METHODS: We conducted an online cross-sectional study of 433 pregnant people 
from June 6 through July 29, 2020. We explored 3 hypotheses: (1) mental health 
would be worse during the pandemic than in general pregnant samples to date; (2) 
first-time pregnant people would have worse mental health; and (3) healthy 
behaviors would be positively related to mental health.
RESULTS: Many of our participants (22%) reported clinically significant 
depressive symptoms and 31% reported clinically significant anxiety symptoms. 
Multiparous pregnant people were more likely to express worries about their own 
health and wellbeing and the process of childbirth than were primiparous 
pregnant people. Additionally, as pregnancy advanced, sleep and nutrition 
worsened, while physical activity increased. Lastly, anxious-depressive 
symptomology was significantly predictive of participant sleep behaviors, 
nutrition, and physical activity during the past week.
DISCUSSION: Pregnant people had worse mental health during the pandemic, and 
this was associated with worse health-promoting behaviors. Given that the 
COVID-19 pandemic and associated risks are likely to persist due to low 
vaccination rates and the emergence of variants with high infection rates, care 
that promotes mental and physical well-being for the pregnant population should 
be a public health priority.

© 2023. The Author(s).

DOI: 10.1007/s10995-023-03657-w
PMCID: PMC10083068
PMID: 37029891 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no financial or proprietary 
interests in any material discussed in this article.


787. Soc Psychiatry Psychiatr Epidemiol. 2023 Oct;58(10):1549-1559. doi: 
10.1007/s00127-023-02475-3. Epub 2023 Apr 8.

Post-traumatic stress symptoms and benefit finding: a longitudinal study among 
Italian health workers during the COVID-19 pandemic.

Negri L(1), Bassi M(2), Accardi R(3), Delle Fave A(4).

Author information:
(1)Department of Pathophysiology and Transplantation, Università degli Studi di 
Milano, Via F. Sforza 35, 20122, Milan, Italy. luca.negri@unimi.it.
(2)Department of Biomedical and Clinical Sciences, Università degli Studi di 
Milano, Milan, Italy.
(3)Health Professions Directorate, Fondazione I.R.C.C.S. Ca' Granda Ospedale 
Maggiore Policlinico, Milan, Italy.
(4)Department of Pathophysiology and Transplantation, Università degli Studi di 
Milano, Via F. Sforza 35, 20122, Milan, Italy.

PURPOSE: Research has highlighted that the exposure of healthcare professionals 
to the COVID-19 pandemic for over two years can lead to the development and 
persistence of symptoms characteristic of Post-Traumatic Stress Disorder (PTSD), 
with serious consequences on both the individual well-being and the quality of 
care provided. The present study was aimed at investigating the role of benefit 
finding in moderating post-traumatic stress symptoms (PTSS) over time.
METHODS: The longitudinal study, conducted between April and October 2020, 
involved 226 Italian health workers (44.7% nurses and midwives, 35% doctors, 
20.3% technical and rehabilitation professionals), who filled out an online 
survey at the beginning of the study (T1), after three months (T2), and after 
six months (T3). Participants (77.4% women; mean age = 41.93, SD = 12.06) 
completed the PTSD Checklist for DSM-5 (PCL-5) and Benefit Finding, a 17-item 
questionnaire measuring the perceived level of positive consequences derived 
from stressful experiences. A hierarchical regression analysis highlighted the 
moderating effect of benefit finding (T2) on the association between PTSS values 
at T1 and T3.
RESULTS: A buffering effect was observed, with higher benefit finding levels 
reducing the magnitude of the bivariate association between PTSS assessed at the 
beginning and at the end of the study.
CONCLUSION: Findings suggest the potential mental health related benefits of 
interventions allowing health professionals to identify positive aspects in the 
experience of working under prolonged emergency circumstances, such as the 
pandemic ones.

© 2023. The Author(s).

DOI: 10.1007/s00127-023-02475-3
PMCID: PMC10082687
PMID: 37029827 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no relevant financial or 
non-financial interests to disclose.


788. Alzheimer Dis Assoc Disord. 2023 Apr-Jun 01;37(2):156-159. doi: 
10.1097/WAD.0000000000000540. Epub 2023 Apr 1.

Behavioral and Brain Correlates of Emotional Distress in Older Adults During 
COVID-19 Quarantine.

Benari O(1)(2), Ravona Springer R(1)(3)(2), Almog G(1), Yore I(1), Zadok M(1), 
Lin HM(4), Ouyang Y(4), Sano M(5), Bendlin BB(6), Livny A(1)(7)(2), Heymann 
A(2)(8), Schnaider Beeri M(1)(5).

Author information:
(1)The Joseph Sagol Neuroscience Center.
(2)Sackler Faculty of Medicine, Tel Aviv University.
(3)Memory Clinic, Sheba Medical Center.
(4)Departments of Population Health Science and Policy.
(5)Psychiatry, The Icahn School of Medicine at Mount Sinai, New York, NY.
(6)Wisconsin Alzheimer's Disease Research Center, University of 
Wisconsin-Madison School of Medicine and Public Health, Madison, WI.
(7)Department of Diagnostic imaging, Sheba Medical Center, Tel Hashomer.
(8)Maccabi Healthcare Services, Tel Aviv, Israel.

COVID-19 led to unprecedented lockdowns and changes in older adults' lives, 
especially those with type 2 diabetes who have high risk of complications and 
mortality. We investigated the associations of cognitive and motor function and 
gray matter volumes (GMVs) with COVID-19 lockdown-related emotional distress of 
type 2 diabetes older adults, participating in the Israel Diabetes and Cognitive 
Decline Study. We administered a questionnaire to obtain information about 
anxiety, depression, general well-being, and optimism during a mandated 
lockdown. Lower grip strength before lockdown was associated with increased 
sadness, anxiety, and less optimism. Slower gait speed was associated with 
greater sadness. Lower GMV was related to greater anxiety during the lockdown 
when compared with anxiety levels before the COVID-19 outbreak. Yet, global 
cognition was not associated with any emotional distress measure. These results 
support the role of good motor function on emotional well-being during acute 
stress and GMV as a potential underlying mechanism.

Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

DOI: 10.1097/WAD.0000000000000540
PMCID: PMC10219644
PMID: 37027496 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


789. Medicine (Baltimore). 2023 Apr 7;102(14):e33487. doi: 
10.1097/MD.0000000000033487.

Impact of the COVID-19 pandemic on the psychological status of undergraduate 
medical students in Saudi Arabia: A cross-sectional double-scale study.

Ewid M(1)(2), Amal Y(1)(3), Billah SMB(4), Kalou Y(1), Zitoun OA(1), Alnaser 
AR(1)(5), Nashawi MO(1), Almazrou A(1).

Author information:
(1)College of Medicine, Sulaiman Al Rajhi University, Bukaryiah, Saudi Arabia.
(2)Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, 
Egypt.
(3)Department of Psychiatry, Mansoura University, Mansoura, Egypt.
(4)Department of Community Medicine, Sher-e Bangla Medical College, Barishal, 
Bangladesh.
(5)Department of Neurosurgery, Salford Royal Hospital, Northern Care Alliance 
NHS Foundation Trust, Manchester, United Kingdom.

The COVID-19 pandemic is a major health care catastrophe that affects people's 
physical and mental well-being worldwide. Medical students are at an increased 
risk of mental health hazards during the COVID-19 pandemic. Sulaiman Al Rajhi 
University (SRU), the site of our study, is located in Qassim province in the 
Kingdom of Saudi Arabia. We conducted this study to assess the prevalence of 
depression, stress and anxiety symptoms among SRU medical students during the 
quarantine and while learning online shortly after the announcement of 
documented COVID-19 cases in Kingdom of Saudi Arabia. In this cross-sectional 
study, an online questionnaire was sent to all medical students of SRU; 278 
students responded (71%). We collected participants' demographic, socioeconomic, 
and academic data. The Depression, Anxiety, and Stress scale and the Fear of 
COVID-19 Scale were used as the validated mental health assessment tools. 
Depression, anxiety and stress symptoms were found in 23%, 11%, and 6% of 
students, respectively. Females were more likely to have anxiety (P = .03) than 
males. Students who had close contact with COVID-19 cases, those whose lives 
were affected by COVID-19, and those with poor socioeconomic status had 
significantly higher levels of stress, anxiety, and depression compared to their 
counterparts (P = .004, .01, .01, respectively). Students from high-viral-load 
areas, unmarried students, and those who did not live with their families were 
more stressed (P = .06, .01, .01, respectively). The Fear of COVID-19 Scale was 
positively correlated with all Depression, Anxiety, and Stress components 
(depression: r = 0.36, anxiety: r = 0.45, and stress: r = 0.39, P < .001 for 
all). Medical students, especially female students, are at an increased risk of 
developing depression, anxiety, and stress symptoms with increased COVID-19 fear 
during the pandemic. The study highlights the importance of mental health 
screening for female students, students of low socioeconomic status, and 
relatives of COVID-19 cases. Our findings could help institutions adjust mental 
health services in the future amid such pandemics.

Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

DOI: 10.1097/MD.0000000000033487
PMCID: PMC10081927
PMID: 37026919 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
disclose.


790. Front Public Health. 2023 Mar 21;11:1116865. doi: 10.3389/fpubh.2023.1116865. 
eCollection 2023.

A participatory study of college students' mental health during the first year 
of the COVID-19 pandemic.

Park C(1), McClure Fuller M(1), Echevarria TM(1), Nguyen K(1), Perez D(1), 
Masood H(1), Alsharif T(1), Worthen M(1).

Author information:
(1)Department of Public Health and Recreation, San José State University, San 
José, CA, United States.

INTRODUCTION: The COVID-19 pandemic has negatively impacted college students' 
mental health and wellbeing. Even before the pandemic, young adults reported 
high mental health morbidity. During the pandemic, young adult college students 
faced unprecedented challenges, including campus closure and a pivot to fully 
online education.
METHODS: This study employed a novel participatory approach to a Course-based 
Undergraduate Research Experience (CURE) in an introductory epidemiology course 
to examine factors students considered important regarding their experience 
during the pandemic. Two groups of undergraduate students enrolled in this 
course (one in Fall 2020 and another in Spring 2021) and participated in the 
CURE. A sub-group of these students continued after the class and are authors of 
this article. Through repeated cross-sectional surveys of college students' peer 
groups in northern California in October 2020 and March 2021, this 
student/faculty collaborative research team evaluated depression, anxiety, 
suicidal ideation and several other topics related to mental health among the 
students' young adult community.
RESULTS: There was a high prevalence of anxiety (38.07% in October 2020 and 
40.65% in March 2021), depression (29.85% in October 2020 and 27.57% in March 
2021), and suicidal ideation (15.94% in October 2020 and 16.04% in March 2021). 
In addition, we identified the significant burden of loneliness for college 
students, with 58.06% of students reporting feeling lonely at least several days 
in the past two weeks. Strategies that students used to cope with the pandemic 
included watching shows, listening to music, or playing video games (69.01%), 
sleeping (56.70%), taking breaks (51.65%), and connecting with friends (52.31%) 
or family (51.21%). Many reported distressing household experiences: more than a 
third reporting loss of a job or income (34.27%) in the first year of the 
pandemic. We explain the participatory research approach and share empirical 
results of these studies.
DISCUSSION: We found this participatory CURE approach led to novel, 
experience-based research questions; increased student motivation; real-world 
benefits such as combatting imposter syndrome and supporting graduate school 
intentions; integration of teaching, research, and service; and development of 
stronger student-faculty relationships. We close with recommendations to support 
student wellbeing and promote student engagement in research.

Copyright © 2023 Park, McClure Fuller, Echevarria, Nguyen, Perez, Masood, 
Alsharif and Worthen.

DOI: 10.3389/fpubh.2023.1116865
PMCID: PMC10070728
PMID: 37026129 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


791. PLoS One. 2023 Apr 6;18(4):e0283948. doi: 10.1371/journal.pone.0283948. 
eCollection 2023.

Social and mental health impact of COVID-19 pandemic among health professionals 
of Gandaki Province, Nepal: A mixed method study.

Paudel S(1), Poudel S(2), Khatri D(3), Chalise A(4), Marahatta SB(5).

Author information:
(1)Department of Public Health, CiST College, Pokhara University, Kathmandu, 
Nepal.
(2)Nobel College, Pokhara University, Kathmandu, Nepal.
(3)School of Health and Allied Sciences, Pokhara University, Lekhnath, Kaski, 
Nepal.
(4)Center for Research on Environment, Health and Population Activities 
(CREHPA), Lalitpur, Nepal.
(5)Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal.

BACKGROUND: The frontline health workers are the key players in the fight 
against the COVID-19 pandemic, however, several incidences of attacks, 
stigmatization, and discrimination towards them have been reported throughout 
the world during the peak of infection. The social impact experienced by health 
professionals can alter their efficiency and also lead to mental distress. This 
study aimed to examine the extent of social impact experienced by health 
professionals currently working in Gandaki Province, Nepal along with the 
factors associated with their depression status.
METHODS: This was a mixed-method study where a cross-sectional online survey was 
executed among 418 health professionals followed by in-depth interviews with 14 
health professionals of Gandaki Province. The bivariate analysis and 
multivariate logistic regression were performed to identify the factors 
associated with depression at 5% level of significance. The information 
collected from the in-depth interviews was clustered into themes by the 
researchers.
RESULTS: Out of 418 health professionals, 304 (72.7%) expressed that COVID-19 
has impacted their family relationships, whereas 293 (70.1%) expressed that it 
impacted their relationships with friends and relatives, and 282 (68.1%) 
expressed it impacted their relationships with community people. The prevalence 
of depression among health professionals was noted at 39.0%. Being a female 
(aOR:1.425,95% CI:1.220-2.410), job dissatisfaction (aOR:1.826, 95% 
CI:1.105-3.016), COVID-19 impact on family relation (aOR:2.080, 95% 
CI:1.081-4.002), COVID-19 impact on relationship with friends and relatives 
(aOR:3.765, 95% CI:1.989-7.177), being badly treated (aOR:2.169, 95% 
CI:1.303-3.610) and experiencing moderate (aOR:1.655, 95% CI:1.036-2.645) and 
severe fear (aOR:2.395, 95% CI:1.116-5.137) of COVID-19 were found to the 
independent predictors of depression. It was noted that the pandemic has an 
effect on the social relations of health professionals in multiple ways.
CONCLUSION: This study noted that there is a significant impact of COVID-19 on 
health professionals in terms of their social and mental health aspects. The 
social impact experienced by health professionals is an important predictor of 
their mental health. The mental health and well-being of these vital workforces 
can be enhanced by focusing on the social aspect during the pandemic.

Copyright: © 2023 Paudel et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0283948
PMCID: PMC10079026
PMID: 37023012 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


792. PLoS One. 2023 Apr 6;18(4):e0283986. doi: 10.1371/journal.pone.0283986. 
eCollection 2023.

Investigating changes in mental health services utilisation in England and their 
impact on health outcomes and wellbeing during the COVID-19 pandemic: Protocol 
for a health data-linkage study.

Yu G(1)(2), Vale L(1)(2), McMeekin P(3), Ramsay SE(1), Fu Y(4).

Author information:
(1)Population Health Sciences Institute, Newcastle University, Newcastle upon 
Tyne, United Kingdom.
(2)NIHR Applied Research Collaboration North East and North Cumbria, St 
Nicholas' Hospital, Gosforth, Newcastle Upon Tyne, United Kingdom.
(3)Faculty of Health and Life Science, Northumbria University, Newcastle upon 
Tyne, United Kingdom.
(4)Department of Health Services Research, University of Liverpool, Liverpool, 
United Kingdom.

INTRODUCTION: Linking routinely collected health care system data records for 
the same individual across different services and over time has enormous 
potential for the NHS and its patients. The aims of this data linkage study are 
to quantify the changes to mental health services utilisation in responses to 
the COVID-19 pandemic and determine whether these changes were associated with 
health-related outcomes and wellbeing among people living in the most deprived 
communities in North East and North Cumbria, England.
METHODS AND ANALYSIS: We will assemble a retrospective cohort of people having 
referred or self-referred to NHS-funded mental health services or Improving 
Access to Psychological Therapies (IAPT) services between 23rd March 2019 and 
22nd March 2020 in the most deprived areas in England. We will link together 
data from retrospective routinely collected healthcare data including local 
general practitioner (GP) practice data, Hospital Episode Statistics admitted 
patient care outpatients, and A&E, Community Services Data Set, Mental Health 
Services Data Set, and Improving Access to Psychological Therapies Data Set. We 
will use these linked patient-level data to 1) describe the characteristics of 
the cohort prior to the lockdown; 2) investigate changes to mental health 
services utilised between multiple time periods of the COVID-19 lockdown 
including out of lockdown; 3) explore the relationship between these changes and 
health outcomes/wellbeing and factors that confound and mediate this 
relationship among this cohort.
STRENGTHS AND LIMITATIONS OF THIS STUDY: This study comprises a deprived 
population-based cohort of people having referred or self-referred to NHS-funded 
secondary mental health services or Improving Access to Psychological Therapies 
(IAPT) services over an extended period of the lockdown in England 
(2019-2022).This study will utilise a new longitudinal data resource that will 
link together detailed data from a cohort of individual participants and 
retrospective administrative data relating to the use of primary, secondary, and 
community care services.The study period covers pre-lockdown, different lockdown 
and post-lockdown, and out of lockdown periods up to March 2022.Routinely 
collected administrative data contain limited contextual information and 
represent an underestimate of total health outcomes for these 
individuals.Routinely collected datasets can often been incomplete or contain 
missing data, which can make it difficult to accurately analyse the data and 
draw meaningful conclusions.Intervention and treatment for mental health 
conditions are not wholly captured across these data sources and may impact 
health outcomes.

Copyright: © 2023 Yu et al. This is an open access article distributed under the 
terms of the Creative Commons Attribution License, which permits unrestricted 
use, distribution, and reproduction in any medium, provided the original author 
and source are credited.

DOI: 10.1371/journal.pone.0283986
PMCID: PMC10079107
PMID: 37023005 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


793. LGBT Health. 2023 Aug-Sep;10(6):416-428. doi: 10.1089/lgbt.2022.0249. Epub 2023 
Apr 5.

Investigating the Psychosocial Impact of COVID-19 Among the Sexual and Gender 
Minority Population: A Systematic Review and Meta-Analysis.

Batra K(1)(2), Pharr JR(3), Kachen A(4), Godbey S(5), Terry E(3).

Author information:
(1)Department of Medical Education, Kirk Kerkorian School of Medicine, 
University of Nevada, Las Vegas, Las Vegas, Nevada, USA.
(2)Office of Research, Kirk Kerkorian School of Medicine, University of Nevada, 
Las Vegas, Las Vegas, Nevada, USA.
(3)Department of Environmental and Occupational Health, School of Public Health, 
University of Nevada, Las Vegas, Las Vegas, Nevada, USA.
(4)School of Medicine, University of Reno, Reno, Nevada, USA.
(5)Library Liaison Program, University of Nevada, Las Vegas, Las Vegas, Nevada, 
USA.

Purpose: The purpose of this study was to utilize a systematic review and 
meta-analysis to assess the existing body of literature to understand the mental 
health impacts of the coronavirus disease-19 (COVID-19) pandemic among sexual 
and gender minority (SGM) people. Methods: The search strategy was developed by 
an experienced librarian and used five bibliographical databases, specifically 
PubMed, Embase, APA PsycINFO (EBSCO), Web of Science, and LGBTQ+ Source (EBSCO), 
for studies (published 2020 to June, 2021) examining the psychological impact of 
the COVID-19 pandemic among SGM people. Articles were screened by two reviewers. 
The quality of the articles was assessed using the National Institutes of Health 
quality assessment tool for observational studies. A double extraction method 
was used for data abstraction. Heterogeneity among studies was assessed by I2 
statistic. The random-effects model was utilized to obtain the pooled 
prevalence. Publication bias was assessed by Funnel plot and Egger's linear 
regression test. Results: Of a total of 37 studies, 15 studies were included in 
the meta-analysis with 17,973 SGM participants. Sixteen studies were U.S. based, 
seven studies were multinational studies, and the remaining studies were from 
Portugal, Brazil, Chile, Taiwan, the United Kingdom, France, Italy, Canada, and 
several other countries. A majority of studies used psychometric valid tools for 
the cross-sectional surveys. The pooled prevalence of anxiety, depression, 
psychological distress, and suicidal ideation was 58.6%, 57.6%, 52.7%, and 
28.8%, respectively. Conclusions: Findings of this study serve as evidence to 
develop appropriate interventions to promote psychological wellbeing among 
vulnerable population subgroups, such as SGM individuals.

DOI: 10.1089/lgbt.2022.0249
PMID: 37022764 [Indexed for MEDLINE]


794. Front Psychol. 2023 Mar 20;14:1113269. doi: 10.3389/fpsyg.2023.1113269. 
eCollection 2023.

Benefits of personal music listening for family caregivers of critically ill 
patients during the post-COVID era.

Yoo GE(1), Na S(2), Kim SJ(3), Kim J(2).

Author information:
(1)Department of Music Therapy, Graduate School, Ewha Womans University, Seoul, 
Republic of Korea.
(2)Department of Anesthesiology and Pain Medicine, Department of Anesthesia and 
Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic 
of Korea.
(3)Music Therapy Education, Graduate School of Education, Ewha Womans 
University, Seoul, Republic of Korea.

OBJECTIVE: This descriptive study surveyed family caregivers of patients in 
intensive care units (ICUs) during the COVID-19 pandemic to examine the impact 
of musical listening on their psychological well-being.
METHOD: The data collected in this study compared with collected from similar 
research conducted before the COVID-19 pandemic in 2017. The previous study had 
195 participants, and the current study had 92. To measure the participants' 
psychological well-being, the Korean version of the Center for Epidemiologic 
Studies Depression Scale and the World Health Organization Quality of Life Scale 
were administered. An investigator-constructed questionnaire was also used to 
collect information related to participants' engagement in music activities 
including music listening in their everyday lives and their perceptions of 
music's benefits.
RESULTS: A two-way ANOVA showed significant effects for time (e.g., before vs. 
during COVID-19) and involvement in personal music listening (yes vs. no) on 
current emotional state, with family caregivers reporting significantly greater 
negative emotions during COVID-19 than before and personal music listening 
having a positive effect on perceived emotions. For quality of life there was no 
significant time effect, while the listening effect was statistically 
significant, indicating a significantly higher quality of life in the group who 
engaged in music listening in their everyday lives compared to the group who did 
not. There were no significant time or listening effects for perceived level of 
depression.
CONCLUSION: Given the COVID-19 situation and the need to transition to a 
post-pandemic era, this study suggests that music listening can be an effective 
option for family caregivers to implement as a resource for attenuating 
emotional distress and enhancing self-care.

Copyright © 2023 Yoo, Na, Kim and Kim.

DOI: 10.3389/fpsyg.2023.1113269
PMCID: PMC10067627
PMID: 37020916

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


795. Aging Ment Health. 2023 Jul-Aug;27(8):1576-1583. doi: 
10.1080/13607863.2023.2193553. Epub 2023 Apr 5.

'I feel like this will never end': mental health during the COVID-19 pandemic 
among older adults with chronic conditions.

Kaba D(1), Salwi SM(1), Daniel NR(1), Polenick CA(1)(2).

Author information:
(1)Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
(2)Aging & Biopsychosocial Innovations Program, Survey Research Center, 
Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.

OBJECTIVES: The COVID-19 pandemic may have a negative impact on mental health, 
especially among older adults with chronic conditions who are more vulnerable to 
severe illness. In this qualitative study, we evaluated how the pandemic has 
impacted the ways that adults aged 50 and older with chronic conditions managed 
their mental health.
METHODS: A total of 492 adults (M = 64.95 years, SD = 8.91, range = 50-94) who 
lived in Michigan (82.1%) and 33 other U.S. states completed one anonymous 
online survey between 14 May 14 and 9 July 2020. Open-ended responses were coded 
to ascertain relevant concepts and were reduced to develop major themes.
RESULTS: We determined four main themes. The COVID-19 pandemic impacted how 
participants took care of their mental health through: (1) pandemic-related 
barriers to social interaction; (2) pandemic-related routine changes; (3) 
pandemic-related stress; and (4) pandemic-related changes to mental health 
service use.
CONCLUSION: This study indicates that older adults with chronic conditions 
experienced various challenges to managing their mental health in the early 
months of the COVID-19 pandemic, but also showed considerable resilience. The 
findings identify potential targets of personalized interventions to preserve 
their well-being during this pandemic and in future public health crises.

DOI: 10.1080/13607863.2023.2193553
PMCID: PMC10524161
PMID: 37020428 [Indexed for MEDLINE]


796. BMC Infect Dis. 2023 Apr 5;23(1):201. doi: 10.1186/s12879-023-08203-1.

Post-COVID-19 condition and persisting symptoms in English schoolchildren: 
repeated surveys to March 2022.

Warren-Gash C(1), Lacey A(2), Cook S(3)(4), Stocker D(2), Toon S(2), Lelii F(2), 
Ford B(2), Ireland G(5), Ladhani SN(5), Stephenson T(6), Nguipdop-Djomo P(7), 
Mangtani P(7); COVID-19 Schools Infection Survey 2 Study Group.

Collaborators: McClenahan E, McKay G, Phelan J, Lin LY, Lewin A, Judd A, Davies 
B, Saib A, McCrae J, Kelly J, Diamond I, Rourke E, Dawe F, Jones P.

Author information:
(1)Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology 
and Population Health, London School of Hygiene & Tropical Medicine, Keppel 
Street, WC1E 7HT, London, UK. charlotte.warren-gash1@lshtm.ac.uk.
(2)Office for National Statistics, Government Buildings, Newport, UK.
(3)Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology 
and Population Health, London School of Hygiene & Tropical Medicine, Keppel 
Street, WC1E 7HT, London, UK.
(4)School of Public Health, Imperial College London, London, UK.
(5)Public Health Programmes, UK Health Security Agency, London, UK.
(6)UCL Great Ormond Street Institute of Child Health, London, UK.
(7)Department of Infectious Disease Epidemiology, Faculty of Epidemiology and 
Population Health, London School of Hygiene & Tropical Medicine, London, UK.

BACKGROUND: Both post-COVID-19 condition (long COVID) and the presence of 
persisting symptoms that do not meet formal definitions of 
post-COVID-19-condition may adversely affect quality of life and function. 
However, their prevalence among children and young people in England is unclear.
METHODS: We used data from repeated surveys in a large cohort of English 
schoolchildren from the COVID-19 Schools Infection Survey (SIS) for the school 
year 2021/22 to describe the weighted prevalence of post-COVID-19-condition and 
compare persisting symptoms between individuals with a positive SARS-CoV-2 test 
and those with neither a positive test history nor suspected infection.
RESULTS: Among 7797 children from 173 schools, 1.8% of primary school pupils 
(aged 4 to 11 years), 4.5% of secondary school pupils in years 7-11 (aged 11 to 
16 years) and 6.9% of those in years 12-13 (aged 16 to 18 years) met a 
definition of post-COVID-19 condition in March 2022. Specific persisting 
symptoms such as anxiety or difficulty concentrating were frequently reported 
regardless of prior infection status and increased with age: 48.0% of primary 
school pupils, 52.9% of secondary school pupils in years 7-11 and 79.5% in years 
12-13 reporting at least one symptom lasting more than 12 weeks. Persisting loss 
of smell and taste, cardiovascular and some systemic symptoms were more 
frequently reported by those with a previous positive test.
CONCLUSIONS: We showed that ongoing symptoms were frequently reported by English 
schoolchildren regardless of SARS-CoV-2 test results and some specific symptoms 
such as loss of smell and taste were more prevalent in those with a positive 
test history. Our study emphasises the wide-ranging impacts of the COVID-19 
pandemic on the health and wellbeing of children and young people.

© 2023. The Author(s).

DOI: 10.1186/s12879-023-08203-1
PMCID: PMC10075149
PMID: 37020190 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


797. Aust N Z J Public Health. 2023 Jun;47(3):100033. doi: 
10.1016/j.anzjph.2023.100033. Epub 2023 Apr 3.

Racially minoritized people's experiences of racism during COVID-19 in 
Australia: A qualitative study.

Grant J(1), Biles J(2), Yashadhana A(3), Derbas A(4).

Author information:
(1)Charles Sturt University, Associate Dean Research Faculty of Science and 
Health, Panorama Avenue Bathurst 2795, Australia. Electronic address: 
jugrant@csu.edu.au.
(2)Charles Sturt University, Australia.
(3)Charles Sturt University, University of New South Wales, Australia.
(4)Charles Sturt University, Western Sydney University, Australia.

OBJECTIVE: Drawing from a broader study exploring how New South Wales community 
members from racially minoritized backgrounds experienced living through a 
pandemic, this paper reports specifically on experiences of racism during the 
COVID-19 pandemic in 2020.
METHODS: Using an in-depth, qualitative interpretive approach, 11 
semi-structured interviews and one focus group hosting three participants (n=14) 
were held via an online videoconferencing platform from September to December 
2020. Inductive thematic analysis was undertaken using QRS NVivo as a data 
management tool.
RESULTS: Racism was heightened during the pandemic and experienced in various 
ways by racially minoritized peoples in New South Wales. All participants in 
this research cited experiences of racism that impacted their wellbeing during 
COVID-19. These experiences are represented by the following four themes: 
experiencing racism is common; how racisms are experienced; increased fear of 
racism during COVID-19; and ways of coping with racisms.
CONCLUSIONS: Racism was heightened during the pandemic and generated fear and 
anxiety that prevented racially minoritized peoples from participating in 
everyday life.
IMPLICATIONS FOR PUBLIC HEALTH: Messaging from broader public platforms must be 
harnessed to stop the spread of moral panic so that during times of pandemic, 
public health strategies need only confirmation, not creation.

Copyright © 2023. Published by Elsevier B.V.

DOI: 10.1016/j.anzjph.2023.100033
PMCID: PMC10069636
PMID: 37019817 [Indexed for MEDLINE]


798. BMJ Open. 2023 Apr 5;13(4):e064144. doi: 10.1136/bmjopen-2022-064144.

Value of Schwartz Rounds in promoting the emotional well-being of healthcare 
workers: a qualitative study.

Ng L(1)(2), Schache K(3)(4), Young M(3), Sinclair J(5)(6).

Author information:
(1)Department of Psychological Medicine, The University of Auckland, Auckland, 
New Zealand lillian.ng@auckland.ac.nz.
(2)Mental Health and Addictions, Division of Psychiatry, Te Whatu Ora Health NZ 
Counties Manukau, Auckland, New Zealand.
(3)Department of Psychological Medicine, Te Whatu Ora Health NZ Counties 
Manukau, Auckland, New Zealand.
(4)Department of Critical Care, Te Whatu Ora Health NZ Counties Manukau, 
Auckland, New Zealand.
(5)Department of Anaesthesia and Pain Medicine, Te Whatu Ora Counties Manukau, 
Auckland, New Zealand.
(6)People and Culture Directorate, Te Whatu Ora Health NZ and Counties Manukau, 
Auckland, New Zealand.

OBJECTIVES: Schwartz Rounds are forums that enable healthcare staff to reflect 
on emotional and social dimensions of their work. In this study, we aimed to 
explore the experiences of Schwartz Rounds on emotional aspects of care and 
practice within a clinical environment.
DESIGN: Using qualitative methods, we interviewed participants individually and 
in focus groups. Interviews were recorded, transcribed and analysed by thematic 
analysis.
SETTING: The study was based at a public health service Te Whatu Ora Counties 
Manukau in Auckland, New Zealand's largest, most ethnically diverse population.
PARTICIPANTS: Participants were panellists who took part in successive Schwartz 
Rounds over a 10-month period. There were 17 participants with a range of 
experience (1-30 years) and occupations including clinical, allied, technical 
and administrative staff from medical specialties of plastic surgery, pain 
services, emergency medicine, intensive care, organ donation services, COVID-19 
response and palliative care services.
RESULTS: Three themes were identified: the need for emotional processing, 
valuing guided reflection and realising our humanity. The third theme 'realising 
our humanity' comprised altruism, connection and compassion. Schwartz Rounds 
provided staff with clear benefits: emotionally resonant experiences within an 
environment of psychological safety and connection to the wider organisation. 
The daunting nature of emotional disclosure was mitigated by a supportive 
audience.
CONCLUSION: There is an organisational imperative to ensure that staff have 
opportunities to process intense emotions associated with healthcare work. 
Schwartz Rounds are one means to attend to the emotional welfare of healthcare 
staff, enabling them to gain different perspectives in the care of their 
patients and colleagues within system constraints.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2022-064144
PMCID: PMC10083799
PMID: 37019482 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


799. Qual Life Res. 2023 Aug;32(8):2375-2390. doi: 10.1007/s11136-023-03400-6. Epub 
2023 Apr 4.

Physical and mental health of breast cancer patients and survivors before and 
during successive SARS-CoV-2-infection waves.

Bargon CA(1)(2), Mink van der Molen DR(3), Batenburg MCT(3), van Stam LE(3), van 
Dam IE(4), Baas IO(5), Veenendaal LM(6), Maarse W(7), Sier M(8)(9), 
Schoenmaeckers EJP(10), Burgmans JPJ(11), Bijlsma RM(5), van der Leij F(4), 
Doeksen A(8), Young-Afat DA(12), Verkooijen HM(13)(14).

Author information:
(1)Division of Imaging and Oncology, University Medical Centre Utrecht, Cancer 
Centre, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. 
claudia.bargon@gmail.com.
(2)Department of Surgery, St. Antonius Hospital, Utrecht, The Netherlands. 
claudia.bargon@gmail.com.
(3)Division of Imaging and Oncology, University Medical Centre Utrecht, Cancer 
Centre, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
(4)Department of Radiation Oncology, University Medical Centre Utrecht, Cancer 
Centre, Utrecht, The Netherlands.
(5)Department of Medical Oncology, University Medical Centre Utrecht, Cancer 
Centre, Utrecht, The Netherlands.
(6)Department of Surgery, Alexander Monro Hospital, Bilthoven, The Netherlands.
(7)Department of Plastic, Reconstructive and Hand Surgery, University Medical 
Centre Utrecht, Utrecht, The Netherlands.
(8)Department of Surgery, St. Antonius Hospital, Utrecht, The Netherlands.
(9)Department of Surgery, Rivierenland Hospital, Tiel, The Netherlands.
(10)Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands.
(11)Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands.
(12)Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University 
Medical Centre, Amsterdam, The Netherlands.
(13)Division of Imaging and Oncology, University Medical Centre Utrecht, Cancer 
Centre, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. 
H.M.Verkooijen@umcutrecht.nl.
(14)Utrecht University, Utrecht, The Netherlands. H.M.Verkooijen@umcutrecht.nl.

PURPOSE: During the first SARS-CoV-2-infection wave, a deterioration in 
emotional well-being and increased need for mental health care were observed 
among patients treated or being treated for breast cancer. In this follow-up 
study, we assessed patient-reported quality of life (QoL), physical functioning, 
and psychosocial well-being during the second SARS-CoV-2-infection wave in a 
large, representative cohort.
METHODS: This longitudinal cohort study was conducted within the prospective, 
multicenter UMBRELLA breast cancer cohort. To assess patient-reported QoL, 
physical functioning and psychosocial well-being, COVID-19-specific surveys were 
completed by patients during the first and second SARS-CoV-2-infection waves 
(April and November 2020, respectively). An identical survey was completed by a 
comparable reference population during the second SARS-CoV-2-infection waves. 
All surveys included the validated EORTC-QLQ-C30/BR23, HADS and "De 
Jong-Gierveld Loneliness" questionnaires. Pre-COVID-19 EORTC-QLQ-C30/BR23 and 
HADS outcomes were available from UMBRELLA. Response rates were 69.3% 
(n = 1106/1595) during the first SARS-CoV-2-infection wave and 50.9% 
(n = 822/1614) during the second wave. A total of 696 patients responded during 
both SARS-CoV-2-infection waves and were included in the analysis comparing 
patient-reported outcomes (PROs) during the second SARS-CoV-2-infection wave to 
PROs during the first wave. Moreover, PROs reported by all patients during the 
second SARS-CoV-2-infection wave (n = 822) were compared to PROs of a similar 
non-cancer reference population (n = 241) and to their pre-COVID-19 PROs.
RESULTS: Patient-reported QoL, physical functioning, and psychosocial well-being 
of patients treated or being treated for breast cancer remained stable or 
improved from the first to the second SARS-CoV-2-infection wave. The proportion 
of emotional loneliness reduced from 37.6 to 29.9% of patients. Compared to a 
similar non-cancer reference population, physical, emotional, and cognitive 
functioning, future perspectives and symptoms of dyspnea and insomnia were worse 
in patients treated or being treated for breast cancer during the second 
SARS-CoV-2-infection wave. PROs in the second wave were similar to pre-COVID-19 
PROs.
CONCLUSION: Although patients scored overall worse than individuals without 
breast cancer, QoL, physical functioning, and psychosocial well-being did not 
deteriorate between the first and second wave. During the second wave, PROs were 
similar to pre-COVID-19 values. Overall, current findings are cautiously 
reassuring for future mental health of patients treated or being treated for 
breast cancer.

© 2023. The Author(s).

DOI: 10.1007/s11136-023-03400-6
PMCID: PMC10072805
PMID: 37016089 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no financial or personal 
conflict of interest to disclose.


800. Attach Hum Dev. 2023 Apr;25(2):272-288. doi: 10.1080/14616734.2023.2179574.

eConnect: implementation and preliminary evaluation of a virtually delivered 
attachment-based parenting intervention during COVID-19.

Bao L(1), Moretti MM(1).

Author information:
(1)Department of Psychology, Simon Fraser University, Burnaby, Canada.

Connect, an attachment-based and trauma-informed parenting group intervention, 
has been demonstrated to improve adolescent mental health, parental wellbeing, 
and family functioning. We report on the online adaptation and delivery of 
Connect (eConnect) and pre-post treatment changes in parent, family and youth 
functioning in a clinical sample (N= 190) of parents of youth with serious 
mental health challenges. Consistent with research evaluating in-person Connect, 
parents reported significant reductions in youth internalizing and externalizing 
problems, attachment anxiety and avoidance, and aggression toward parents. 
Parents also reported significant reductions in caregiver strain and aggression 
toward their child. Unlike prior research, parent depressed mood did not 
decline, perhaps due to pandemic stressors. Program completion was remarkably 
high (84.7%), and parents reported high program satisfaction. Uptake by eConnect 
program facilitators and host agencies was extremely positive, suggesting good 
potential for sustainability and broadened program accessibility. Randomized 
clinical trials and implementation within diverse populations are needed.

DOI: 10.1080/14616734.2023.2179574
PMID: 37014110 [Indexed for MEDLINE]


801. Elife. 2023 Apr 4;12:e85679. doi: 10.7554/eLife.85679.

An umbrella review of systematic reviews on the impact of the COVID-19 pandemic 
on cancer prevention and management, and patient needs.

Muka T(1)(2)(3), Li JJX(4), Farahani SJ(5), Ioannidis JPA(2)(6)(7).

Author information:
(1)Institute of Social and Preventive Medicine, University of Bern, Bern, 
Switzerland.
(2)Meta-Research Innovation Center at Stanford (METRICS), Stanford University, 
Stanford, United States.
(3)Epistudia, Bern, Switzerland.
(4)Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, 
The Chinese University of Hong Kong, Sha Tin, Hong Kong.
(5)Department of Pathology and Laboratory Medicine, Stony Brook University, Long 
Island, New York, United States.
(6)Stanford Prevention Research Center, Department of Medicine, Stanford 
University School of Medicine, Stanford, United States.
(7)Department of Epidemiology and Population Health, Stanford University School 
of Medicine, Stanford, United States.

Update of
    doi: 10.1101/2022.12.18.22283642.

The relocation and reconstruction of health care resources and systems during 
the coronavirus disease 2019 (COVID-19) pandemic may have affected cancer care. 
An umbrella review was undertaken to summarize the findings from systematic 
reviews on impact of the COVID-19 pandemic on cancer treatment modification, 
delays, and cancellations; delays or cancellations in screening and diagnosis; 
psychosocial well-being, financial distress, and use of telemedicine as well as 
on other aspects of cancer care. Bibliographic databases were searched for 
relevant systematic reviews with or without meta-analysis published before 
November 29th, 2022. Abstract, full- text screening, and data extraction were 
performed by two independent reviewers. AMSTAR-2 was used for critical appraisal 
of included systematic reviews. Fifty-one systematic reviews were included in 
our analysis. Most reviews were based on observational studies judged to be at 
medium and high risk of bias. Only two reviews had high or moderate scores based 
on AMSTAR-2. Findings suggest treatment modifications in cancer care during the 
pandemic versus the pre-pandemic period were based on low level of evidence. 
Different degrees of delays and cancellations in cancer treatment, screening, 
and diagnosis were observed, with low- and- middle- income countries and 
countries that implemented lockdowns being disproportionally affected. A shift 
from in-person appointments to telemedicine use was observed, but utility of 
telemedicine, challenges in implementation and cost-effectiveness in cancer care 
were little explored. Evidence was consistent in suggesting psychosocial 
well-being of patients with cancer deteriorated, and cancer patients experienced 
financial distress, albeit results were in general not compared to pre-pandemic 
levels. Impact of cancer care disruption during the pandemic on cancer prognosis 
was little explored. In conclusion, substantial but heterogenous impact of 
COVID-19 pandemic on cancer care has been observed.

Plain Language Summary: The onset of the COVID-19 pandemic disrupted many 
aspects of human life, not least healthcare. As resources were redistributed 
towards the crisis, social isolation rules also limited access to medical 
professionals. In particular, these measures may have affected many aspects of 
cancer care, such as early detection or treatment. Many studies have aimed to 
capture the impact of these changes, but most have been observational, with 
researchers recording events without trying to impose a controlled design. These 
investigations also often faced limitations such as small sample sizes, or only 
focusing on one aspect of cancer care. Systemic reviews, which synthetize and 
assess existing research on a topic, have helped to bypass these constraints. 
However, they are themselves not devoid of biases. Overall, a clear, unified 
picture of the impact of COVID-19 on cancer care is yet to emerge. In response, 
Muka et al. carried an umbrella analysis of 51 systematic reviews on this topic. 
They used a well-known critical appraisal tool to assess the methodological 
rigor of each of these studies, while also summarising their findings. This work 
aimed to capture many aspects of the patients’ experience, from diagnosis to 
treatment and the financial, psychological, physical and social impact of the 
disease. The results confirmed that the pandemic had a substantial impact on 
cancer care, including delays in screening, diagnosis and treatment. Throughout 
this period cancer patients experienced increased rates of depression, 
post-traumatic stress and fear of their cancer progressing. The long-term 
consequences of these disruptions remain to be uncovered. However, Muka et al. 
also showed that, overall, these conclusions rely on low-quality studies which 
may have introduced unaccountable biases. In addition, their review highlights 
that most of the data currently available has been collected in high- and 
middle-income countries, with evidence lacking from regions of the world with 
more limited resources. In the short-term, these results indicate that 
interventions may be needed to mitigate the negative impact of the pandemic on 
cancer care; in the long-term, they also demonstrate the importance of rigorous 
systematic reviews in guiding decision making. By shining a light on the ripple 
effects of certain decisions about healthcare resources, this work could also 
help to shape the response to future pandemics.

© 2023, Muka et al.

DOI: 10.7554/eLife.85679
PMCID: PMC10156163
PMID: 37014058 [Indexed for MEDLINE]

Conflict of interest statement: TM, JL, SF, JI No competing interests declared


802. Rocz Panstw Zakl Hig. 2023;74(1):83-91. doi: 10.32394/rpzh.2023.0241.

Cyberchondria among information technology professionals of Bhubaneswar by using 
cyberchondria severity scale (CSS-15).

Satyarup D(1), Panda S(1), Nagarajappa R(2), Mohapatra U(1).

Author information:
(1)Department of Public Health Dentistry, Institute of Dental Sciences, Siksha 
'O' Anusandhan, (Deemed to be University), Sum Hospital Rd, Shampur, 
Bhubaneswar, Odisha, India.
(2)Dhruva Dental Care, Kasavanahalli, Bangalore, Karnataka, India.

BACKGROUND: Internet can act as an excellent resource for gaining valuable 
health related information. However, excessive online research and investigation 
about health-related issues may impose a negative impact. The term cyberchondria 
is used to describe a clinical condition in which frequent internet searches for 
health-related information leads to exaggerated anxieties about physical 
well-being.
OBJECTIVES: To determine the prevalence of cyberchondria and associated factors 
among the information technology professionals of Bhubaneswar in India.
MATERIALS AND METHODS: A cross-sectional study was carried out among 243 
software professionals in Bhubaneswar using a previously validated Cyberchondria 
Severity Scale (CSS-15) questionnaire. Descriptive statistics in terms of 
number, percentage, mean and standard deviation were presented. Independent 
t-test and one-way analysis of variance was applied to compare the cyberchondria 
score between two and more than two independent variables respectively.
RESULTS: From 243 individuals 130 (53.5%) were males and 113 (46.5%) were 
females with mean age 29.82±6.67 years. The prevalence of cyberchondria severity 
was found to be 46.5%. The mean cyberchondria score of all study subjects was 
43.80±10.62. It was significantly higher among those who spend more than 1 hour 
in the internet during night, feel fear and anxiety in visiting the doctor or 
dentist, interested in gaining the health-related information from other 
resources and agreed that gaining health related information has increased after 
COVID-19 pandemic (p˂0.05).
CONCLUSION: Cyberchondria is a growing issue with regard to mental health in 
developing countries and has the ability to cause anxiety and distress. 
Appropriate actions must be taken to prevent it on a societal level.

Publisher: National Institute of Public Health NIH - National Research 
Institute.

DOI: 10.32394/rpzh.2023.0241
PMID: 37013889 [Indexed for MEDLINE]

Conflict of interest statement: The authors acknowledge no conflict of interest


803. BMJ Lead. 2023 Mar;7(1):16-20. doi: 10.1136/leader-2021-000534. Epub 2022 Feb 
28.

Psychological impact of COVID-19 on healthcare leaders: a cross-sectional survey 
in Friuli-Venezia Giulia, Italy.

Scarpis E(1), Bravo G(2), Cocconi R(3), Brunelli L(2)(3).

Author information:
(1)Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Italy 
scarpis.enrico@gmail.com.
(2)Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Italy.
(3)Accreditamento e Gestione del Rischio Clinico, Azienda Sanitaria 
Universitaria Friuli Centrale, Udine, Italy.

INTRODUCTION: Although several studies highlighted the psychological burden of 
2019 coronavirus disease (COVID-19) pandemic, no data are available regarding 
professionals leading healthcare organisations. This study aims to assess the 
psychological impact of COVID-19 on healthcare leaders (HeLs), along with the 
leadership skills and coping strategies needed for successful leadership.
METHODS: A cross-sectional survey was conducted in Friuli-Venezia Giulia (Italy) 
between October and November 2020. We assessed the presence of depressive 
symptoms (DS), anxiety symptoms (AS), perceived stress (PS) and insomnia using 
internationally validated tools. Coping strategies and skills needed to overcome 
the crisis were examined, along with the most challenging phases.
RESULTS: A total of 48 HeLs participated. The prevalence of DS and AS was 14.6% 
and 12.5%, respectively. Moderate and severe insomnia was found in 12.5% and 
6.3% of them, respectively. Leaders showed moderate (45.8%) and high 4,2%) level 
of PS. The two most challenging phases were recognised in early recognition 
(45.2%) and peak phase (31.0%). Concerning healthcare leaders' skills required 
to manage with pandemic, the most reported were communication (35.1%) and 
decision-making (25.5%).
CONCLUSION: The high level of PS, insomnia, DS and AS experienced by healthcare 
leaders shows the COVID-19 pandemic's psychological impact. The two most 
challenging phases identified enhances the importance of public health 
surveillance and monitoring systems, and communication appeared a critical 
success skill for healthcare leaders. Given the key role these professional play 
in addressing the current crisis in healthcare organisations, their mental 
health and well-being deserve greater attention.

© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and 
permissions. Published by BMJ.

DOI: 10.1136/leader-2021-000534
PMID: 37013876 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


804. BMC Med. 2023 Apr 3;21(1):131. doi: 10.1186/s12916-023-02828-4.

Interventions to improve well-being among children and youth aged 6-17 years 
during the COVID-19 pandemic: a systematic review.

Moss SJ(1), Mizen SJ(1), Stelfox M(1), Mather RB(2), FitzGerald EA(1), Tutelman 
P(3), Racine N(4), Birnie KA(5)(6), Fiest KM(2)(6)(7), Stelfox HT(2)(7), Parsons 
Leigh J(8).

Author information:
(1)Faculty of Health, School of Health Administration, Dalhousie University, 
Halifax, NS, Canada.
(2)Cumming School of Medicine, Department of Critical Care Medicine, University 
of Calgary, Calgary, AB, Canada.
(3)Faculty of Science, Department of Psychology and Neuroscience, Dalhousie 
University, Halifax, NS, Canada.
(4)Faculty of Social Sciences, School of Psychology, University of Ottawa, 
Ottawa, ON, Canada.
(5)Cumming School of Medicine, Department of Anesthesiology, Perioperative and 
Pain Medicine, University of Calgary, Alberta, Canada.
(6)Cumming School of Medicine, Department of Community Health Sciences, Calgary, 
AB, Canada.
(7)O'Brien Institute for Public Health, University of Calgary, Calgary, AB, 
Canada.
(8)Faculty of Health, School of Health Administration, Dalhousie University, 
Halifax, NS, Canada. J.ParsonsLeigh@dal.ca.

BACKGROUND: The COVID-19 pandemic is an example of a global infectious disease 
outbreak that poses a threat to the well-being of children and youth (e.g., 
physical infection, psychological impacts). The consequences of challenges faced 
during COVID-19 may be longstanding and newly developed interventions are being 
deployed. We present a narrative synthesis of available evidence from the first 
2 years of the COVID-19 pandemic on the feasibility, accessibility, and effects 
of interventions to improve well-being among children and youth to inform the 
development and refinement of interventions relevant to post-pandemic recovery.
METHODS: Six databases were searched from inception to August 2022. A total of 
5484 records were screened, 39 were reviewed in full text, and 19 studies were 
included. The definition of well-being and the five domains of well-being as 
defined by the Partnership for Maternal, Newborn & Child Health and the World 
Health Organization in collaboration with the United Nations H6 + Technical 
Working Group on Adolescent Health and Well-Being were used.
RESULTS: Nineteen studies (74% randomized controlled trials) from 10 countries 
were identified, involving a total of 7492 children and youth (age range: 
8.2-17.2 years; 27.8-75.2% males) and 954 parents that occurred during the 
COVID-19 pandemic (March 2020 to March 2021). Nearly all interventions (n = 18, 
95%) targeted health and nutrition, followed by connectedness (n = 6, 32%), 
while fewer studies targeted agency and resilience (n = 5, 23%), learning and 
competence (n = 2, 11%), or safety and support (n = 1, 3%). Five interventions 
(26%) were self-guided while 13 interventions (68%) were guided synchronous by a 
trained professional, all of which targeted physical and mental health 
subdomains within health and nutrition; one intervention (5%) was unclear.
CONCLUSIONS: Studies deploying synchronous interventions most often reported 
improved well-being among children and youth largely in the domain of health and 
nutrition, specifically physical and mental health. Targeted approaches will be 
crucial to reach sub-groups of children and youth who are most at risk of 
negative well-being outcomes. Further research is needed to determine how 
interventions that best supported children and youth early in the pandemic are 
different from interventions that are required now as we enter into the 
post-pandemic phase.

© 2023. The Author(s).

DOI: 10.1186/s12916-023-02828-4
PMCID: PMC10069351
PMID: 37013542 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


805. BMC Public Health. 2023 Apr 3;23(1):634. doi: 10.1186/s12889-023-15536-8.

Psychosocial and behavioral outcomes in the adult workforce during the COVID-19 
pandemic: a 1-Year longitudinal survey.

Senerat AM(1)(2), Pope ZC(3)(4), Rydell SA(5), Mullan AF(6), Roger VL(7)(8), 
Pereira MA(5).

Author information:
(1)Formerly Well Living Lab, 221 1st Ave SW, Rochester, MN, 55902, 507-550-1139 
x664, USA. asenerat@gmail.com.
(2)Now with Urban Health Collaborative, Dornsife School of Public Health, Drexel 
University, 3600 Market Street, 7th Floor, Philadelphia, PA, 19104, USA. 
asenerat@gmail.com.
(3)Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 1st St 
SW, Rochester, MN, 55905, USA.
(4)Well Living Lab, 221 1st Ave. SW, Suite 100, Rochester, MN, 55902, USA.
(5)Division of Epidemiology & Community Health, School of Public Health, 
University of Minnesota, 1300 South Second Street, Suite 300, Minneapolis, MN, 
55454, USA.
(6)Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
(7)Formerly Department of Cardiovascular Diseases, College of Medicine, Mayo 
Clinic, Rochester, MN, USA.
(8)Now with Epidemiology and Community Health Branch, National Heart, Lung and 
Blood Institute, National Institutes of Health, Bethesda, USA.

BACKGROUND: Efforts to limit the spread of COVID-19 have included public space 
closures, mask usage, and quarantining. Studies regarding the impact of these 
measures on the psychosocial and behavioral health outcomes of the workforce 
have focused frequently on healthcare employees. To expand the literature base, 
we deployed a one-year longitudinal survey among mostly non-healthcare employees 
assessing changes in select psychosocial outcomes, health behaviors, and 
COVID-19-related transmission prevention behaviors and perceptions.
METHODS: We deployed the CAPTURE baseline survey across eight companies from 
November 20, 2020-February 8, 2021. The baseline survey included questions on 
psychosocial outcomes, health behaviors, and COVID-19 transmission prevention 
behaviors, with several questions containing a retrospective component to cover 
the time period prior to the pandemic. Additional questions on vaccination 
status and social support were subsequently added, and the updated survey 
deployed to the same baseline participants at three, six, and 12 months after 
baseline survey deployment. We analyzed data descriptively and performed 
Friedman's and subsequent Wilcoxon-signed rank tests, as appropriate, to compare 
data within and between time points.
RESULTS: A total of 3607, 1788, 1545, and 1687 employees completed the baseline, 
3-month, 6-month, and 12-month CAPTURE surveys, respectively, with 816 employees 
completing all four time points. Employees reported higher stress, anxiety, 
fatigue, and feelings of being unsafe across all time points compared to 
pre-pandemic. Time spent sleeping increased initially but returned to 
pre-pandemic levels at follow-up. Lower rates of physical activity and higher 
rates of non-work screen time and alcohol consumption relative to pre-pandemic 
were also reported. Over 90% of employees perceived wearing a mask, physical 
distancing, and receiving the COVID-19 vaccine as 'moderately' or 'very 
important' in preventing the spread of COVID-19 across all time points.
CONCLUSIONS: Relative to pre-pandemic, poorer psychosocial outcomes and worsened 
health behaviors were observed across all time points, with values worse at the 
baseline and 12-month time points when COVID-19 surges were highest. While 
COVID-19 prevention behaviors were consistently deemed to be important by 
employees, the psychosocial outcome and health behavior data suggest the 
potential for harmful long-term effects of the pandemic on the well-being of 
non-healthcare employees.

© 2023. The Author(s).

DOI: 10.1186/s12889-023-15536-8
PMCID: PMC10068713
PMID: 37013515 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


806. BMC Pregnancy Childbirth. 2023 Apr 3;23(1):223. doi: 10.1186/s12884-023-05520-w.

"I am scared, I do not want to lie": exploring the impacts of COVID-19 on 
engagement in care, perceived health, relationship dynamics, and parenting among 
postpartum women with HIV in South Africa.

Stanton AM(1)(2)(3), Blyler AP(4), Mosery N(5), Goodman GR(2)(3)(6), Vanderkruik 
R(2)(7), Sithole K(5), Bedoya CA(2)(7), Smit J(5), Psaros C(8)(9).

Author information:
(1)Department of Psychological and Brain Sciences, Boston University, Boston, 
MA, USA.
(2)Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
(3)The Fenway Institute, Fenway Health, Boston, MA, USA.
(4)Department of Psychology, Positive Psychology Center, University of 
Pennsylvania, Pennsylvania, PA, USA.
(5)Wits MatCH Research Unit (WMRU), Department of Obstetrics and Gynaecology, 
Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South 
Africa.
(6)Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, 
USA.
(7)Harvard Medical School, Boston, MA, USA.
(8)Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA. 
cpsaros@mgh.harvard.edu.
(9)Harvard Medical School, Boston, MA, USA. cpsaros@mgh.harvard.edu.

Update of
    Res Sq. 2023 Jan 20;:

BACKGROUND: COVID-19 and efforts to manage widespread infection may compromise 
HIV care engagement. The COVID-19-related factors linked to reduced HIV 
engagement have not been assessed among postpartum women with HIV, who are at 
heightened risk of attrition under non-pandemic circumstances. To mitigate the 
effects of the pandemic on care engagement and to prepare for future public 
health crises, it is critical to understand how COVID-19 has impacted (1) 
engagement in care and (2) factors that may act as barriers to care engagement.
METHODS: A quantitative assessment of COVID-19-related experiences was added to 
a longitudinal cohort study assessing predictors of postpartum attrition from 
HIV care among women in South Africa. Participants (N = 266) completed the 
assessment at 6, 12, 18, or 24 months postpartum between June and November of 
2020. Those who endorsed one or more challenge related to engagement in care 
(making or keeping HIV care appointments, procuring HIV medications, procuring 
contraception, and/or accessing immunization services for infants; n = 55) were 
invited to complete a brief qualitative interview, which explored the specific 
factors driving these challenges, as well as other impacts of COVID-19 on care 
engagement. Within this subset, 53 participants completed an interview; 
qualitative data were analyzed via rapid analysis.
RESULTS: Participants described key challenges that reduced their engagement in 
HIV care and identified four other domains of COVID-19-related impacts: physical 
health, mental health, relationship with a partner or with the father of the 
baby, and motherhood/caring for the new baby. Within these domains, specific 
themes and subthemes emerged, with some positive impacts of COVID-19 also 
reported (e.g., increased quality time, improved communication with partner, HIV 
disclosure). Coping strategies for COVID-19-related challenges (e.g., 
acceptance, spirituality, distraction) were also discussed.
CONCLUSIONS: About one in five participants reported challenges accessing HIV 
care, medications, or services, and they faced complex, multilayered barriers to 
remaining engaged. Physical health, mental health, relationships with partners, 
and ability to care for their infant were also affected. Given the dynamic 
nature of the pandemic and general uncertainty about its course, ongoing 
assessment of pandemic-related challenges among postpartum women is needed to 
avoid HIV care disruptions and to support wellbeing.

© 2023. The Author(s).

DOI: 10.1186/s12884-023-05520-w
PMCID: PMC10068701
PMID: 37013509 [Indexed for MEDLINE]

Conflict of interest statement: All authors certify that they have no 
affiliations with or involvement in any organization or entity with any 
financial interest or non-financial interest in the subject matter or materials 
discussed in this manuscript.


807. Leadersh Health Serv (Bradf Engl). 2023 Apr 5;ahead-of-print(ahead-of-print). 
doi: 10.1108/LHS-11-2022-0111.

Health-care providers' experiences during the COVID-19 pandemic: lessons for 
leaders.

Corcoran L(1), Perry B(1), Jay M(2), Edwards M(1), Jerry P(1).

Author information:
(1)Faculty of Health Disciplines, Athabasca University, Athabasca, Canada.
(2)Faculty of Humanities and Social Sciences, Athabasca University, Athabasca, 
Canada, and.

PURPOSE: The purpose of this qualitative research study is to explore 
health-care providers' perspectives and experiences with a specific focus on 
supports reported to be effective during the COVID-19 pandemic. The overarching 
goal of this study is to inform leaders and leadership regarding provision of 
supports that could be implemented during times of crisis and in the future 
beyond the pandemic.
DESIGN/METHODOLOGY/APPROACH: Data were collected by semi-structured, 
conversational interviews with a sample of 33 health-care professionals, 
including Registered Nurses, Nurse Practitioners, Registered Psychologists, 
Registered Dieticians and an Occupational Therapist.
FINDINGS: Three major themes emerged from the interview data: (1) professional 
and personal challenges for health-care providers, (2) physical and mental 
health impacts on health-care providers and (3) providing supports for 
health-care providers. The third theme was further delineated into three 
sub-theses: formal resources and supports, informal resources and supports and 
leadership strategies.
ORIGINALITY/VALUE: Health-care leaders are advised to pay attention to the 
voices of the people they are leading. It is important to know what supports 
health-care providers need in times of crisis. Situating the needs of 
health-care providers in the Carter and Bogue Model of Leadership Influence for 
Health Professional Wellbeing (2022) can assist leaders to deliberately focus on 
aspects of providers' wellbeing and remain cognizant of the supports needed both 
during a crisis and when circumstances are unremarkable.

© Emerald Publishing Limited.

DOI: 10.1108/LHS-11-2022-0111
PMID: 37010206 [Indexed for MEDLINE]


808. Eur J Neurol. 2023 Jul;30(7):1880-1890. doi: 10.1111/ene.15812. Epub 2023 Apr 
18.

Neurological and (neuro)psychological sequelae in intensive care and general 
ward COVID-19 survivors.

Klinkhammer S(1)(2), Horn J(3)(4), Duits AA(1)(5)(6), Visser-Meily JMA(7)(8)(9), 
Verwijk E(4)(10)(11), Slooter AJC(8)(12)(13), Postma AA(14)(15), van Heugten 
CM(1)(2)(16); NeNeSCo Study Group.

Collaborators: Aries MJH, van Bussel BCT, Jansen JFA, Janssen MLF, van Santen S, 
Magdelijns FJH, Posthuma R, Linden DEJ, van der Woude MCE, Dormans T, Otten A, 
Karakus A, Bronsveld I, Kaasjager KAH, Galenkamp N, Geurtsen GJ, Brouwer MC, 
Brinkman K, Kylstra WA, Koch DW, Beudel M.

Author information:
(1)Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and 
Life Sciences, School for Mental Health and Neuroscience, Maastricht University, 
Maastricht, The Netherlands.
(2)Limburg Brain Injury Center, Maastricht University, Maastricht, The 
Netherlands.
(3)Department of Intensive Care, Amsterdam University Medical Center, University 
of Amsterdam, Amsterdam, The Netherlands.
(4)Amsterdam Neuroscience, Amsterdam University Medical Center, University of 
Amsterdam, Amsterdam, The Netherlands.
(5)Department of Medical Psychology, Maastricht University Medical Center, 
Maastricht, The Netherlands.
(6)Department of Medical Psychology, Radboud University Medical Center, 
Nijmegen, The Netherlands.
(7)Department of Rehabilitation, Physical Therapy Science and Sports, University 
Medical Center Utrecht, Utrecht, The Netherlands.
(8)UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The 
Netherlands.
(9)Center of Excellence for Rehabilitation Medicine, Brain Center, University 
Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The 
Netherlands.
(10)Department of Medical Psychology, Amsterdam University Medical Center, 
Amsterdam, The Netherlands.
(11)Department of Psychology, Brain and Cognition, University of Amsterdam, 
Amsterdam, The Netherlands.
(12)Department of Psychiatry and Intensive Care Medicine, University Medical 
Center Utrecht, Utrecht, The Netherlands.
(13)Department of Neurology, UZ Brussel and Vrije Universiteit Brussel, Jette, 
Brussels Health Campus, Belgium.
(14)Department of Radiology and Nuclear Medicine, Maastricht University Medical 
Center, Maastricht, The Netherlands.
(15)Faculty of Health, Medicine and Life Sciences, School for Mental Health and 
Neuroscience, Maastricht University, Maastricht, The Netherlands.
(16)Department of Neuropsychology and Psychopharmacology, Faculty of Psychology 
and Neuroscience, Maastricht University, Maastricht, The Netherlands.

BACKGROUND AND PURPOSE: Coronavirus disease 2019 (COVID-19) affects the brain, 
leading to long-term complaints. Studies combining brain abnormalities with 
objective and subjective consequences are lacking. Long-term structural brain 
abnormalities, neurological and (neuro)psychological consequences in COVID-19 
patients admitted to the intensive care unit (ICU) or general ward were 
investigated. The aim was to create a multidisciplinary view on the impact of 
severe COVID-19 on functioning and to compare long-term consequences between ICU 
and general ward patients.
METHODS: This multicentre prospective cohort study assessed brain abnormalities 
(3 T magnetic resonance imaging), cognitive dysfunction (neuropsychological test 
battery), neurological symptoms, cognitive complaints, emotional distress and 
wellbeing (self-report questionnaires) in ICU and general ward (non-ICU) 
survivors.
RESULTS: In al, 101 ICU and 104 non-ICU patients participated 8-10 months 
post-hospital discharge. Significantly more ICU patients exhibited cerebral 
microbleeds (61% vs. 32%, p < 0.001) and had higher numbers of microbleeds 
(p < 0.001). No group differences were found in cognitive dysfunction, 
neurological symptoms, cognitive complaints, emotional distress or wellbeing. 
The number of microbleeds did not predict cognitive dysfunction. In the complete 
sample, cognitive screening suggested cognitive dysfunction in 41%, and standard 
neuropsychological testing showed cognitive dysfunction in 12%; 62% reported ≥3 
cognitive complaints. Clinically relevant scores of depression, anxiety and 
post-traumatic stress were found in 15%, 19% and 12%, respectively; 28% 
experienced insomnia and 51% severe fatigue.
CONCLUSION: Coronavirus disease 2019 ICU survivors had a higher prevalence for 
microbleeds but not for cognitive dysfunction compared to general ward 
survivors. Self-reported symptoms exceeded cognitive dysfunction. Cognitive 
complaints, neurological symptoms and severe fatigue were frequently reported in 
both groups, fitting the post-COVID-19 syndrome.

© 2023 The Authors. European Journal of Neurology published by John Wiley & Sons 
Ltd on behalf of European Academy of Neurology.

DOI: 10.1111/ene.15812
PMID: 37010152 [Indexed for MEDLINE]


809. BMC Health Serv Res. 2023 Apr 1;23(1):324. doi: 10.1186/s12913-023-09312-y.

Understanding peer support: a qualitative interview study of doctors one year 
after seeking support.

Horne IMT(1)(2), Veggeland F(3), Bååthe F(4), Drewes C(5), Rø KI(4).

Author information:
(1)Research Institute Modum Bad, Postbox 33, Vikersund, 3371, Norway. 
ingrid.horne@modum-bad.no.
(2)Institute for Studies of the Medical Profession, Oslo, Norway. 
ingrid.horne@modum-bad.no.
(3)Department of Organisation, Leadership and Management, Inland Norway 
University of Applied Sciences (HINN), Lillehammer, Norway.
(4)Institute for Studies of the Medical Profession, Oslo, Norway.
(5)Health Department, County Governor of Trøndelag, Trondheim, Norway.

BACKGROUND: Doctors' health is of importance for the quality and development of 
health care and to doctors themselves. As doctors are hesitant to seek medical 
treatment, peer support services, with an alleged lower threshold for seeking 
help, is provided in many countries. Peer support services may be the first 
place to which doctors turn when they search for support and advice relating to 
their own health and private or professional well-being. This paper explores how 
doctors perceive the peer support service and how it can meet their needs.
MATERIALS AND METHODS: Twelve doctors were interviewed a year after attending a 
peer support service which is accessible to all doctors in Norway. The 
qualitative, semi-structured interviews took place by on-line video meetings or 
over the phone (due to the COVID-19 pandemic) during 2020 and were audiotaped. 
Analysis was data-driven, and systematic text condensation was used as strategy 
for the qualitative analysis. The empirical material was further interpreted 
with the use of theories of organizational culture by Edgar Schein.
RESULTS: The doctors sought peer support due to a range of different needs 
including both occupational and personal challenges. They attended peer support 
to engage in dialogue with a fellow doctor outside of the workplace, some were 
in search of a combination of dialogue and mental health care. The doctors 
wanted peer support to have a different quality from that of a regular 
doctor/patient appointment. The doctors expressed they needed and got 
psychological safety and an open conversation in a flexible and informal 
setting. Some of these qualities are related to the formal structure of the 
service, whereas others are based on the way the service is practised.
CONCLUSIONS: Peer support seems to provide psychological safety through its 
flexible, informal, and confidential characteristics. The service thus offers 
doctors in need of support a valued and suitable space that is clearly distinct 
from a doctor/patient relationship. The doctors' needs are met to a high extent 
by the peer-support service, through such conditions that the doctors experience 
as beneficial.

© 2023. The Author(s).

DOI: 10.1186/s12913-023-09312-y
PMCID: PMC10066008
PMID: 37004074 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


810. Rev Colomb Psiquiatr (Engl Ed). 2023 Jan-Mar;52(1):45-50. doi: 
10.1016/j.rcpeng.2023.03.001. Epub 2023 Mar 30.

Design and implementation of the Professional Wellbeing Programme of the Medical 
Council of Uruguay.

Dapueto JJ(1), Klasse E(2), Campos N(3), Rodríguez Andrada B(4), Romero Agüit 
S(5), Braquehais MD(6), Tolchinsky G(7), Pereira MT(2), Sarubbo L(2), Ceroni 
C(2), Sánchez N(2), Blanc L(2).

Author information:
(1)Programa de Bienestar Profesional, Colegio Médico del Uruguay, Uruguay. 
Electronic address: jdapueto@hc.edu.uy.
(2)Programa de Bienestar Profesional, Colegio Médico del Uruguay, Uruguay.
(3)Expresidente del Colegio Médico del Uruguay, Uruguay.
(4)Presidente del Colegio Médico del Uruguay, Uruguay.
(5)Presidente de la Organización Médica Colegial, Spain.
(6)Programa de Atención Integral al Profesional de la Salud Enfermo, Clínica 
Galatea, Barcelona, Spain; Grupo de Investigación en Psiquiatría, Salud Mental y 
Adicciones, Institut de Recerca Vall d'Hebron, Universitat Autònoma de 
Barcelona, Barcelona, Spain.
(7)Col·legi Oficial de Metges de Barcelona, Barcelona, Spain.

Multiple studies have reported a high prevalence of mental health problems among 
male and female physicians. Although doctors are reluctant to seek professional 
help when suffering from a mental disorder, specialised services developed 
specifically to treat their mental health problems have reported promising 
results. The purpose of this article is to describe the design and 
implementation of the Professional Wellbeing Programme (Programa de Bienestar 
Profesional) of the Uruguayan Medical Council (Colegio Médico del Uruguay). The 
context, inputs, activities and some of the outputs are described according to a 
case study design. The main milestones in the implementation of the programme 
are also outlined, as well as the enabling elements, obstacles and main 
achievements. Emphasis will be placed on the importance of international 
collaboration to share experiences and models, how to design the care process to 
promote doctors' access to psychiatric and psychological care, the need for them 
to be flexible and dynamic in adapting to new and changing circumstances, such 
as the COVID-19 pandemic, and to work in parallel with the medical regulatory 
bodies. It is hoped that the experience described in this work may be of use to 
other Latin American institutions interested in developing mental health 
programmes for doctors.

Son múltiples los estudios que informan de una alta prevalencia de problemas de 
salud mental en médicos y médicas. Aunque los médicos presentan resistencias a 
la hora de solicitar ayuda profesional cuando están aquejados de trastornos 
mentales, los servicios especializados desarrollados específicamente para tratar 
sus problemas de salud mental han reportado resultados prometedores. El 
propósito de este artículo es describir el diseño y la implementación del 
Programa de Bienestar Profesional del Colegio Médico del Uruguay. El contexto, 
los insumos, las actividades y algunos de los productos se describen de acuerdo 
con el diseño de un estudio de caso. También se señalan los principales hitos en 
la puesta en marcha del programa, así como los elementos facilitadores, los 
obstáculos y los principales logros. Se enfatizará la importancia de la 
colaboración internacional para compartir experiencias y modelos, cómo articular 
el proceso asistencial para fomentar el acceso de los médicos a la atención 
psiquiátrica y psicológica, la necesidad de que sean flexibles y dinámicos para 
adaptarse a circunstancias novedosas y cambiantes como la pandemia por COVID-19 
y la necesidad de que vayan en paralelo con las exigencias de los organismos 
reguladores de la práctica médica. Se espera que la experiencia descrita en este 
trabajo pueda ser de utilidad a otros colectivos latinoamericanos interesados en 
desarrollar programas de salud mental para los médicos.

Copyright © 2021 Asociación Colombiana de Psiquiatría. Published by Elsevier 
España, S.L.U. All rights reserved.

DOI: 10.1016/j.rcpeng.2023.03.001
PMCID: PMC10063153
PMID: 37003958 [Indexed for MEDLINE]


811. Mymensingh Med J. 2023 Apr;32(2):527-533.

Impact of COVID-19 Pandemic on Family Life of Undergraduate and Postgraduate 
Medical Students.

Dip RI(1), Khan MK, Deepro AS.

Author information:
(1)Dr Rashidul Islam Dip, Assistant Professor, Department of Community Medicine, 
Ad-din Akij Medical College, Boyra, Khulna, Bangladesh; E-mail: 
rdipakmmc02@gmail.com.

The COVID-19 pandemic has taken a heavy toll in people's life all over the 
world. Not only it effected the physical aspect of normal life, it also affected 
the day to day life in every country. The objective of this study was to assess 
the impact of COVID-19 pandemic in family life of undergraduate and postgraduate 
medical students. This observational research was carried out on undergraduate 
and postgraduate students at Mymensingh Medical College in Bangladesh, and it is 
of a cross-sectional descriptive research design. This study enrolled 218 
undergraduate and 94 postgraduate students of Mymensingh Medical College. A 
self-administered semi-structured questionnaire survey was conducted to gather 
the views of participants on the impacts of COVID-19 pandemic. The pandemic had 
negatively impacted student's family life. The study found that a total of 
173(79.3%) undergraduate and 73(77.7%) postgraduate students reported that 
bondage among family member was strengthened; 101(46.3%) undergraduate and 
42(44.7%) postgraduate students reported their monthly family income had 
decreased remarkably; 156(71.6%) undergraduate and 55(58.5%) postgraduate 
students reported their household expenditure had increased; 145(66.5%) 
undergraduate and 55(58.5%) postgraduate students believed that the overall 
emotional wellbeing of their families had deteriorated during the pandemic; 
166(76.2%) undergraduate and 73(77.6%) postgraduate students reported that 
stress among their family members had increased; 174(79.8%) undergraduates and 
75(79.8%) postgraduates reported that uncertainties resulting from the COVID-19 
pandemic developed a sense of anxiety among their family members.This study 
found that conflict among family members had increased during COVID-19 pandemic. 
Among undergraduate students 131(60.1%) agreed and among postgraduate students 
44(46.8%) agreed to this; 127(58.2%) undergraduate and 54(57.4%) postgraduate 
students responded the same that they became more concerned about the health of 
their family members.

PMID: 37002767 [Indexed for MEDLINE]


812. Palliat Med. 2023 Jun;37(6):844-855. doi: 10.1177/02692163231165106. Epub 2023 
Mar 31.

The effect of an integrated palliative care intervention on quality of life and 
acute healthcare use in patients with COPD: Results of the COMPASSION cluster 
randomized controlled trial.

Broese J(1)(2), van der Kleij RM(1), Verschuur EM(2), Kerstjens HA(3), 
Bronkhorst EM(4), Engels Y(5), Chavannes NH(1).

Author information:
(1)Department of Public Health and Primary Care, Leiden University Medical 
Centre, Leiden, The Netherlands.
(2)Lung Alliance Netherlands, Amersfoort, The Netherlands.
(3)Department of Respiratory Medicine and Tuberculosis, University of Groningen 
and University Medical Centre Groningen, Groningen, The Netherlands.
(4)Health Evidence, Radboud University Medical Centre, Nijmegen, The 
Netherlands.
(5)Department of Anaesthesiology, Pain and Palliative Medicine, Radboud 
University Medical Centre, Nijmegen, The Netherlands.

BACKGROUND: COPD causes high morbidity and mortality, emphasizing the need for 
palliative care.
AIM: To assess the effectiveness of palliative care in patients with COPD.
DESIGN: Cluster randomized controlled trial (COMPASSION study; Netherlands Trial 
Register (NTR): NL7644, 07-04-2019). Healthcare providers within the 
intervention group were trained to implement palliative care components into 
routine COPD care. Patients completed questionnaires at baseline, after 3 and 
6 months; medical records were assessed after 12 months. The primary outcome was 
quality of life (FACIT-Pal). Secondary outcomes were anxiety, depression, 
spiritual well-being, satisfaction with care, acute healthcare use, 
documentation of life-sustaining treatment preferences and place of death. 
Generalized linear mixed modelling was used for analyses.
SETTING: Eight hospital regions in the Netherlands.
PARTICIPANTS: Patients hospitalized for an acute exacerbation of COPD and 
positive ProPal-COPD score.
RESULTS: Of 222 patients included, 106 responded to the questionnaire at 
6 months. Thirty-six of 98 intervention patients (36.7%) received the 
intervention. Intention-to-treat-analysis showed no effect on the primary 
outcome (adjusted difference: 1.09; 95% confidence interval: -5.44 to 7.60). In 
the intervention group, fewer intensive care admissions for COPD took place 
(adjusted odds ratio: 0.21; 95% confidence interval: 0.03-0.81) and strong 
indications were found for fewer hospitalizations (adjusted incidence rate 
ratio: 0.69; 95% confidence interval: 0.46-1.03).
CONCLUSIONS: We found no evidence that palliative care improves quality of life 
in patients with COPD. However, it can potentially reduce acute healthcare use. 
The consequences of the COVID-19 pandemic led to suboptimal implementation and 
insufficient power, and may have affected some of our findings.

DOI: 10.1177/02692163231165106
PMCID: PMC10227092
PMID: 37002561 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


813. PLoS One. 2023 Mar 31;18(3):e0282198. doi: 10.1371/journal.pone.0282198. 
eCollection 2023.

Impact of COVID-19 on depression and anxiety among healthcare professionals in 
Abu Dhabi.

Al Zarooni AAR(1), Alghfeli AK(1), Alremeithi HM(1), Almadhaani RA(1), Alketbi 
LB(1).

Author information:
(1)Ambulatory Healthcare Services, Abu Dhabi Health Services Company, Abu Dhabi, 
United Arab Emirates.

BACKGROUND: COVID-19 has affected Healthcare workers in many ways. One of the 
important areas is the psychological impact. This study aims to examine the 
effects of the COVID-19 outbreak on the mental health of Healthcare 
Professionals (HCP) and associated factors.
METHODS: A cross-sectional study was conducted among healthcare providers in the 
Emirates of Abu Dhabi, United Arab Emirates, between April 11th, and July 23rd, 
2020. The study was conducted by using an online anonymous Self-administered 
questionnaire through the survey monkey platform. A convenient sampling method 
was used to distribute the online survey link through the organization's email 
network admin list and smartphone messaging. Descriptive statistics, t-tests, 
and multivariant linear regression were used.
RESULTS: Anxiety and depression risk scores were measured in a total of 1268 
participants of healthcare providers. More than half of the participants 
reported symptoms of anxiety (51.5%). Depression symptoms were revealed in 38.3% 
of participating providers. A mild risk of anxiety was reported in 28.8% of the 
participants and 12.68% of the participants registered moderate anxiety risk 
scores and 9.95% reported a severe risk of anxiety. Among all participants, 4.3% 
and 2.7% reported moderately severe and severe risk of depression, respectively, 
while 22.5% and 8.8% of the participating healthcare providers documented mild 
and moderate depression risk. Anxiety and depression risk scores were 
significantly and negatively associated with age and working in primary health 
care.
CONCLUSIONS: The high prevalence of anxiety and depression recorded among HCP 
during the pandemic suggests that mental health intervention and support are 
necessary to ensure the psychological well-being of HCP.

Copyright: © 2023 Al Zarooni et al. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0282198
PMCID: PMC10065294
PMID: 37000791 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


814. Cureus. 2023 Feb 25;15(2):e35461. doi: 10.7759/cureus.35461. eCollection 2023 
Feb.

Outcomes of Patients Hospitalized for Acute Diverticulitis With Comorbid 
Generalized Anxiety Disorder.

Kaye AJ(1), Patel SJ(1), Meyers SR(2), Saiganesh P(1), Ahlawat S(3).

Author information:
(1)Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA.
(2)Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, USA.
(3)Gastroenterology and Hepatology, State University of New York Downstate 
Health Sciences University, Brooklyn, USA.

Introduction Diverticular disease and anxiety disorders are common in the 
general population. Prior research on diverticular disease showed that these 
patients have an increased frequency of anxiety and depression. The objective of 
this study was to explore the impact of generalized anxiety disorder (GAD) on 
the outcomes of adult patients admitted with acute diverticulitis. Methods Using 
the National Inpatient Sample database from the year 2014 and International 
Classification of Diseases, Ninth Edition Revision, Clinical Modification (ICD-9 
CM) codes, acute diverticulitis patients were selected. The outcomes of 
diverticulitis patients with and without GAD were explored. The outcomes of 
interest included inpatient mortality, hypotension/shock, acute respiratory 
failure, acute hepatic failure, sepsis, intestinal abscess, intestinal 
obstruction, myocardial infarction, acute renal failure, and colectomy. A 
multivariate logistic regression analysis was performed to determine if GAD is 
an independent predictor for the outcomes. Results Among 77,520 diverticulitis 
patients in the study, 8,484 had comorbid GAD. GAD was identified as a risk 
factor for intestinal obstruction (adjusted odds ratio (aOR) 1.22, 95% CI: 
1.05-1.43, p<0.05), and intestinal abscess (aOR 1.19, 95% CI: 1.10-1.29, 
p<0.05). GAD was found to be a protective factor for hypotension/shock (aOR 
0.83, 95% CI: 0.76-0.91, p<0.05) and acute respiratory failure (aOR 0.76, 95% 
CI: 0.62-0.93, p<0.05). The aORs of sepsis, inpatient mortality, myocardial 
infarction, acute renal failure, and colectomy were not statistically 
significant. Conclusions Patients with acute diverticulitis who are also 
diagnosed with GAD are at increased risk for intestinal obstruction and 
intestinal abscess, which may be due to the influence GAD has on the gut 
microbiota as well as the impact of GAD pharmacotherapy on gut motility. There 
was also a decreased risk for acute respiratory failure and hypotension/shock 
appreciated in the GAD cohort which may be attributable to the elevated 
healthcare resource utilization seen generally in GAD patients, which may allow 
for presentation to the emergency department, hospitalization, and treatment 
earlier in the diverticulitis disease course.

Copyright © 2023, Kaye et al.

DOI: 10.7759/cureus.35461
PMCID: PMC10042514
PMID: 36994277

Conflict of interest statement: The authors have declared that no competing 
interests exist.


815. Int J Public Health. 2023 Mar 13;68:1605230. doi: 10.3389/ijph.2023.1605230. 
eCollection 2023.

Between Care and Coercion: Asylum Seekers' Experiences With COVID-19 Containment 
and Mitigation Measures in German Reception Centres.

Rast E(1), Perplies C(1), Biddle L(1)(2), Bozorgmehr K(1)(2).

Author information:
(1)Section Health Equity Studies & Migration, Department of General Practice and 
Health Services Research, Heidelberg University Hospital, Heidelberg, Germany.
(2)Department of Population Medicine and Health Services Research, School of 
Public Health, Bielefeld University, Bielefeld, Germany.

Objectives: COVID-19 containment and mitigation measures have been criticised 
for amplifying pre-existing individual and structural vulnerabilities among 
asylum seekers. We qualitatively explored their experiences with and attitudes 
towards pandemic measures to inform people-centred responses in future health 
emergencies. Methods: We interviewed eleven asylum seekers in a German reception 
centre (July-December 2020). The semi-structured interviews were recorded, 
transcribed, and analysed thematically with an inductive-deductive approach. 
Results: Quarantine was experienced as burdensome by participants. Shortcomings 
in social support, everyday necessities, information, hygiene, and daily 
activities exacerbated the strains of quarantine. Interviewees held different 
opinions about the usefulness and appropriateness of the various containment and 
mitigation measures. These opinions differed by individual risk perception and 
the measures' comprehensibility and compatibility with personal needs. Power 
asymmetries related to the asylum system furthermore impacted on preventive 
behaviour. Conclusion: Quarantine can amplify mental health burdens and power 
asymmetries and can therefore constitute a considerable stressor for asylum 
seekers. Provision of diversity-sensitive information, daily necessities, and 
accessible psychosocial support is required to counteract adverse psychosocial 
impacts of pandemic measures and safeguard wellbeing in this population.

Copyright © 2023 Rast, Perplies, Biddle and Bozorgmehr.

DOI: 10.3389/ijph.2023.1605230
PMCID: PMC10041458
PMID: 36994090 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they do not have any 
conflicts of interest.


816. Front Public Health. 2023 Mar 13;11:1138915. doi: 10.3389/fpubh.2023.1138915. 
eCollection 2023.

Nature visits during the COVID-19 pandemic in Norway: Facilitators, motives, and 
associations with sociodemographic characteristics.

Litleskare S(1), Calogiuri G(1)(2).

Author information:
(1)Department of Public Health and Sport Sciences, Faculty of Social and Health 
Sciences, Inland Norway University of Applied Sciences, Elverum, Norway.
(2)Department of Nursing and Health Sciences, Centre for Health and Technology, 
University of South-Eastern Norway, Drammen, Norway.

INTRODUCTION: The COVID-19 pandemic has been linked to increased mental health 
issues and reduced well-being. Researchers also reports increased frequency of 
nature visits during the pandemic, proposing it may mitigate some of these 
negative consequences. Using the case of Norway, a country with ample access to 
nature and relatively low levels of pandemic-related restrictions, this study 
sought to (i) understand how the COVID-19 crisis impacted patterns of nature 
visits and specific nature-based activities, (ii) examine how these patterns 
varied among different population groups and levels of restrictions, and (iii) 
explore the motives and facilitators for increased frequency of nature visits.
METHODS: The data were retrieved from a national cross-sectional survey 
conducted in June 2021, which was designed to assess participants (n = 1,005, 
age > 15 years) habits in relation to nature visits and outdoor recreation since 
the beginning of the COVID-19 crisis, and associated factors.
RESULTS: The results showed that 32 % of participants increased their frequency 
of nature visits during the crisis, while 11 % experienced a decrease. 
Multivariate logistic regression revealed significant positive associations 
between increased frequency of nature visits and longer duration of lockdown 
restrictions (OR [95% CI] = 2.35 [1.28-4.29] and 4.92 [2.77-8.74] for a few 
weeks and several months of lockdown, respectively). Increased frequency of 
nature visits was also more likely among women, younger respondents, and 
individuals from high-income households. A Cochran's Q test showed that the most 
common motive for increased frequency of nature visits was "To be physically 
active" (74%). The most commonly reported facilitators were the possibility of 
using natural environments as an alternative to gyms and organized sports 
alongside having more time available (58 and 49%, respectively).
CONCLUSION: These findings suggest that nature visits provided important 
opportunities for physical activity during the COVID-19 crisis, but also that 
the mental health benefits of nature visits during such times may be 
under-communicated. This highlights the importance of access to natural 
environments to promote physical activity and health, but also suggests that 
campaigns that specifically communicate the beneficial effects of nature visits 
during lockdowns or similar stressful situations might help people cope with the 
situation.

Copyright © 2023 Litleskare and Calogiuri.

DOI: 10.3389/fpubh.2023.1138915
PMCID: PMC10040678
PMID: 36992896 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


817. Front Public Health. 2023 Mar 13;11:1096240. doi: 10.3389/fpubh.2023.1096240. 
eCollection 2023.

Psychosocial work environment stressors for school staff during the COVID-19 
pandemic: Barriers and facilitators for supporting wellbeing.

Rolf LR(1), Vestal L(1), Moore AC(1), Lobb Dougherty N(1), Mueller N(2), Newland 
JG(3).

Author information:
(1)Brown School Evaluation Center, Washington University in St. Louis, Saint 
Louis, MO, United States.
(2)Office of the Provost, Washington University in St. Louis, Saint Louis, MO, 
United States.
(3)Division of Pediatric Infectious Diseases, Department of Pediatrics, 
Washington University School of Medicine, Saint Louis, MO, United States.

INTRODUCTION: After periods of remote and/or hybrid learning as a result of the 
COVID-19 global pandemic, the return to in-person learning has been beneficial 
for both students and teachers, but it has not been without challenges. This 
study was designed to assess the impact of the return to in-person learning on 
the school experience, and efforts made to ease the transition in furthering a 
positive in-person learning environment.
MATERIALS AND METHODS: We conducted a series of listening sessions with 4 
stakeholder groups: students (n = 39), parents (n = 28), teachers/school staff 
(n = 41), and a combination of listening sessions and semi-structured interviews 
with building level and district administrators (n = 12), focusing on in-school 
experiences during the 2021-2022 school year amidst the COVID-19 pandemic. A 
primarily deductive qualitative analysis approach was employed to code the data 
followed by a primarily inductive thematic analysis, followed by thematic 
aggregation, thus providing depth and identification of nuances in the data.
RESULTS: Three main themes emerged around school staff experiences: (1) 
increased levels of stress and anxiety manifested in key ways, including 
students' challenges with personal behavior management contributing to increased 
aggression and staff shortages; (2) school staff described key contributors to 
stress and anxiety, including feeling excluded from decision making and 
challenges with clear and consistent communication; and (3) school staff 
described key facilitators that supported their management of anxiety and 
stress, including adaptability, heightened attention and resources to wellbeing, 
and leveraging interpersonal relationships.
DISCUSSION: School staff and students faced significant stress and anxiety 
during the 2021-2022 school year. Further exploration and identification of 
approaches to mitigate key contributors to increased stress and anxiety for 
school staff, along with increased opportunities for implementing key 
facilitators that were identified as important in managing and navigating the 
increased stress and anxiety offer valuable opportunities for helping to create 
a supportive work environment for school staff in the future.

Copyright © 2023 Rolf, Vestal, Moore, Lobb Dougherty, Mueller and Newland.

DOI: 10.3389/fpubh.2023.1096240
PMCID: PMC10040557
PMID: 36992895 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


818. East Asian Arch Psychiatry. 2023 Mar;33(1):21-27. doi: 10.12809/eaap2257.

Depressive Symptoms and Its Correlates in Undergraduates during the COVID-19 
Pandemic.

Sum MY(1), Wong GHY(2), Chan SKW(1).

Author information:
(1)Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China.
(2)The State Key Laboratory of Brain and Cognitive Sciences, The University of 
Hong Kong, Hong Kong SAR, China.

INTRODUCTION: This study aims to investigate depressive symptoms and its 
association with resilience, pessimistic bias of COVID-19, lifestyle changes, 
and family conflicts among undergraduates in a Hong Kong university.
METHODS: 1020 undergraduates in The University of Hong Kong completed the online 
survey between May and August 2020. Severity of depressive symptoms was assessed 
using the Patient Health Questionnaire-9. Resilience was assessed using the 
Connor-Davidson Resilience Scale. Pessimistic bias was assessed using two 
questions on the perceived risks of contracting COVID-19 and of dying from 
COVID-19. Changes in lifestyles and the presence of family conflicts were 
measured. Multivariable and mediation analyses were performed to examine 
association of depressive symptoms with other variables.
RESULTS: 61.7% of the respondents reported having mild to severe depressive 
symptoms. 18.5% of the variance in depressive symptoms was explained by 
resilience, pessimistic bias, changes in the frequency of sleep, studying at 
home, and family conflict. Pessimistic bias partially mediated the association 
between resilience and depressive symptoms.
CONCLUSION: The proportion of undergraduates with mild to severe depressive 
symptoms during the pandemic was high. Measures to reduce family conflict, 
maintain healthy daily habits, adjust pessimistic bias, and enhance resilience 
may help to improve the mental well-being of undergraduates during the pandemic.

DOI: 10.12809/eaap2257
PMID: 36991552 [Indexed for MEDLINE]

Conflict of interest statement: As the editor of the journal, SKWC was not 
involved in the peer review process. Other authors have disclosed no conflicts 
of interest.


819. J Psychiatr Res. 2023 May;161:310-315. doi: 10.1016/j.jpsychires.2023.03.024. 
Epub 2023 Mar 21.

Changes in mental well-being during the COVID-19 pandemic: A longitudinal study 
among Danes from 2019 to 2021.

Thygesen LC(1), Rosenkilde S(2), Møller SP(2), Ersbøll AK(2), Santini ZI(2), 
Dahl Nielsen MB(2), Grønbæk MK(2), Ekholm O(2).

Author information:
(1)National Institute of Public Health, University of Southern Denmark, 
Studiestræde 6, DK-1455, Copenhagen, Denmark. Electronic address: lct@sdu.dk.
(2)National Institute of Public Health, University of Southern Denmark, 
Studiestræde 6, DK-1455, Copenhagen, Denmark.

Numerous studies have shown that the COVID-19 pandemic had large influence on 
mental health during the first lockdown, but fewer studies have focused on the 
long-term influence on mental health. In a national longitudinal study, we 
examined mental well-being measured just before (fall 2019) and twice during 
(falls of 2020 and 2021) the COVID-19 pandemic. We utilized the Danish Health 
and Wellbeing Survey with questionnaires collected in 2019, 2020 and 2021 among 
the same study population consisting of 8179 persons. The outcome was mental 
well-being measured by the Short Warwick-Edinburgh Mental Well-Being Scale 
(SWEMWBS). Linear regression models were conducted to evaluate change in SWEMWBS 
from 2019 to 2021. The SWEMWBS distribution was similar in 2019, 2020 and 2021, 
although the distribution moved to lower scores in 2020 compared to 2019 and 
moved slightly to higher scores in 2021 compared to 2020. Mean SWEMWBS decreased 
from 24.8 (95%CI 24.7-25.0) in 2019 to 24.1 (24.0-24.2) in 2020 and increased to 
24.4 (24.3-24.6) in 2021 (p < 0.001). The mean decrease from 2019 to 2020 and 
increase from 2020 to 2021 was strongest among women, persons below age 75 
years, persons without depression and among persons with higher education and 
with employment. In conclusion, we find that mental well-being decreased from 
2019 to 2020 and slightly increased from 2020 to 2021 without reaching the 
pre-pandemic level. These changes are statistically significant but small and 
support that COVID-19 may only have had a small long-term influence on mental 
health in the general population.

Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.jpsychires.2023.03.024
PMCID: PMC10027709
PMID: 36989906 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest Regarding: 
Thygesen et al.: Changes in mental well-being during the COVID-19 pandemic: A 
longitudinal study among Danes from 2019 to 2021. Submitted to Journal of 
Psychiatric Research. All authors have no conflicts of interest to declare that 
are relevant to the content of this article.


820. Issues Ment Health Nurs. 2023 Apr;44(4):313-320. doi: 
10.1080/01612840.2023.2189957. Epub 2023 Mar 29.

Impact of Social Isolation and Digital Divide on Mental Health and Wellbeing in 
Patients with Mental Health Disorders during COVID-19: A Multiple Case Study.

Li H(1), Glecia A(2).

Author information:
(1)College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada.
(2)Department of Sociology, University of Saskatchewan, Saskatoon, SK, Canada.

The positive relationship between social connections and mental health and 
wellbeing has been widely documented. During the initial stage of the pandemic, 
COVID-19 associated restrictions had given rise to social isolation that had a 
negative effect on individuals' mental health and wellbeing, particularly among 
patients with preexisting mental health disorders. To abridge physical distance, 
digital technology had become a primary method of communication and social 
engagement. However, not everyone had access to internet and devices required to 
connect online due to the digital divide, especially among marginalized 
populations. The purpose of this multiple case study was to explore experiences 
of social isolation and the digital divide among patients with mental health 
disorders, and its impact on their mental health and wellbeing. Our findings 
revealed that social isolation was the major contributing factor to the 
intensification of mental health symptoms, while the digital divide (e.g., 
financial constraints and low proficiency in digital technology) was recognized 
as a barrier to making social connections via digital technologies. Nurses 
should engage with communities and policymakers in developing strategies to 
address the social determinants of health disparities during the current 
pandemic, other disruptive pandemics and beyond.

DOI: 10.1080/01612840.2023.2189957
PMID: 36989507 [Indexed for MEDLINE]


821. PLoS One. 2023 Mar 29;18(3):e0282479. doi: 10.1371/journal.pone.0282479. 
eCollection 2023.

COVID-19: Psychological distress, fear, and coping strategies among community 
members across the United Arab Emirates.

Al Dweik R(1), Rahman MA(2)(3), Ahamed FM(4), Ramada H(1), Al Sheble Y(5), 
ElTaher S(6), Cross W(2), Elsori D(7).

Author information:
(1)College of Health Sciences, Abu Dhabi University, Abu Dhabi, United Arab 
Emirates.
(2)Institute of Health and Wellbeing, Federation University Australia, Berwick, 
VIC, Australia.
(3)Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia.
(4)Al Ain Fertility Center, Abu Dhabi, United Arab Emirates.
(5)School of Dentistry, Queen's University Belfast, Belfast, United Kingdom.
(6)Epidemiology Department, American University of Beirut, Beirut, Lebanon.
(7)Faculty of Resilience, Rabdan Academy, Abu Dhabi, United Arab Emirates.

BACKGROUND: The COVID-19 pandemic impacted the psychosocial well-being of the 
United Arab Emirates [UAE] population like other communities internationally.
OBJECTIVES: We aimed to identify the factors associated with psychological 
distress, fear, and coping amongst community members across the UAE.
METHODS: We conducted a cross-sectional online survey across the UAE during 
November 2020. Adults aged ≥18 years, living in the UAE who were able to respond 
to an online questionnaire in English or Arabic were considered eligible to 
participate in the study. We used standard validated tools to measure 
psychological distress, fear and coping. Kessler Psychological Distress Scale 
[K10] was used to assess psychological distress, Fear of COVID-19 Scale 
[FCV-19S] was used to assess the level of fear, and Brief Resilient Coping Scale 
[BRCS] was used to assess the coping strategies.
RESULTS: A total of 417 individuals participated in this study with a mean age 
of 29 [± 10.7] years. More than half of the participants experienced high to 
very high levels of psychological distress [55%] and a quarter experienced high 
levels of fear of COVID-19 [23.3%] with almost a third of them [36.2%] having 
low resilient coping. About 37.4% of the participants had work-related mental 
health impacts and 32.4% were perceived to have moderate to a great deal of 
distress due to a change of employment status during the pandemic. One in ten 
participants [9.4%] reported increased smoking. Increased smoking [AOR 8.66, 95% 
CIs 1.08-69.1,], increased alcohol drinking [AOR 2.39, 95% CIs 1.05-5.47] and 
higher levels of fear of COVID-19 [AOR 2.93, 95% CIs 1.83-4.67] were associated 
with moderate to very high levels of psychological distress. Being female [AOR 
1.82, p = 0.030], having a pre-existing mental health condition [AOR 9.88, 95% p 
= 0.027], engaging in high-risk behaviors such as increased smoking [AOR 21.14, 
p = 0.003], increased alcohol drinking [AOR 1.48, p = 0.359] in the previous 
four weeks, and higher levels of fear of COVID-19 [AOR 4.18, p <0.001] were 
associated with moderate to very high levels of psychological distress. Also, 
being a smoker [AOR, 0.840, p = 0.011], and having a high level of fear [AOR 
0.372, p = 0.001] were found to be associated with low resilient coping.
CONCLUSION: Community members in the UAE are at a higher risk of psychosocial 
distress and fear during the COVID-19 pandemic. Thus, healthcare providers and 
policymakers would need to be more alert to provide specific mental health 
support strategies for their wellbeing.

Copyright: © 2023 Al Dweik et al. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0282479
PMCID: PMC10057807
PMID: 36989272 [Indexed for MEDLINE]

Conflict of interest statement: No competing interests.


822. PLoS One. 2023 Mar 29;18(3):e0283089. doi: 10.1371/journal.pone.0283089. 
eCollection 2023.

The impact of BMI on psychological health in oldest old individuals-Are there 
differences between women and men?

Jung FUCE(1), Gerhards S(1), Luppa M(1), Löbner M(1), Riedel-Heller SG(1).

Author information:
(1)Institute of Social Medicine, Occupational Health and Public Health, Faculty 
of Medicine, Leipzig University, Leipzig, D-Germany.

OBJECTIVE: The aim of this study was to determine the association of mental 
health issues associated with BMI and gender in the oldest old population 
(secondary data analyses).
METHOD: The data were taken from the second follow-up of a long-term study 
investigating the impact of the COVID-19 pandemic on health in oldest old 
individuals (range: 77-96 years). The response rate was 80.0%. Apart from 
sociodemographic characteristics (age, gender, weight and height); anxiety, 
depression, somatic complaints and social support were assessed in this survey.
RESULTS: Analyses revealed gender-specific differences, indicating that male 
participants with excess weight show more complaints compared to their 
counterparts without excess weight. According to regression results, BMI was 
associated with somatization, but not depression or anxiety.
CONCLUSION: High BMI contributed to more somatic complaints and men may be 
affected differently by BMI regarding their mental well-being. Longitudinal 
results are needed in order to confirm these findings and develop suitable 
interventions based on individual needs of the oldest old.

Copyright: © 2023 Jung et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0283089
PMCID: PMC10058076
PMID: 36989264 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


823. Nutrients. 2023 Mar 17;15(6):1461. doi: 10.3390/nu15061461.

Global Scientific Trends on Healthy Eating from 2002 to 2021: A Bibliometric and 
Visualized Analysis.

Fang T(1), Cao H(2), Wang Y(3), Gong Y(4), Wang Z(5).

Author information:
(1)Department of Anesthesiology, The First Affiliated Hospital of China Medical 
University, Shenyang 110001, China.
(2)Department of Pathology, College of Basic Medical Science, China Medical 
University, Shenyang 110001, China.
(3)Department of Clinical Nutrition, The First Affiliated Hospital of China 
Medical University, Shenyang 110001, China.
(4)School of Biomedical Informatics, The University of Texas Health Science 
Center at Houston, Houston, TX 77030, USA.
(5)Department of Information Center, The First Affiliated Hospital of China 
Medical University, No.155, Nanjing Street, Heping District, Shenyang 110001, 
China.

Diet has been recognized as a vital risk factor for non-communicable diseases 
(NCDs), climate changes, and increasing population, which has been reflected by 
a rapidly growing body of the literature related to healthy eating. To reveal a 
panorama of the topics related to healthy eating, this study aimed to 
characterize and visualize the knowledge structure, hotspots, and trends in this 
field over the past two decades through bibliometric analyses. Publications 
related to healthy eating between 1 January 2002 and 31 December 2021 were 
retrieved and extracted from the Web of Science database. The characteristics of 
articles including publication years, journals, authors, institutions, 
countries/regions, references, and keywords were assessed. The analyses on 
co-authorship, co-occurrence, and co-citation were performed and network 
visualization maps were constructed by VOSviewer. Major subdomains identified by 
bibliometrics were further discussed and analyzed. A total of 12,442 articles on 
healthy eating were identified. Over the past two decades, the annual global 
publications increased from 71 to 1764, showing a nearly 25-fold growth. The 
journal Nutrients published the most articles and The American Journal of 
Clinical Nutrition possessed the highest citations. The United States, Harvard 
University, and Hu, Frank B. were identified as the most productive and 
influential country, institution, and author, respectively. The co-occurrence 
cluster analysis of the top 100 keywords formed four clusters: (1) the food 
insecurity environment for youths highlighting the necessity and significance of 
implementing healthy eating in early life; (2) sustainable advantages of the 
Mediterranean diet; (3) the importance of an overall healthy lifestyle 
optimization leveraged by eHealth; (4) the challenges during the course of 
healthy eating against obesity, which are prominent in reflecting the knowledge 
structure, hotspots, and trends. Moreover, COVID-19, orthorexia nervosa, 
sustainability, microbiota, food insecurity, and e-health are identified 
keywords that represented the latest high-frequency keywords and indicated the 
emerging frontiers of healthy eating. This study indicates that the number of 
publications on healthy eating will increase in the future and that healthy 
dietary patterns and clinical applications of healthy eating will be the next 
hotspots in this research field.

DOI: 10.3390/nu15061461
PMCID: PMC10054585
PMID: 36986189 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


824. Int J Environ Res Public Health. 2023 Mar 15;20(6):5151. doi: 
10.3390/ijerph20065151.

Stuck in a Rut of Thought-That Is Just a Barrier: Dysfunctional Metacognitive 
Beliefs, Limitation on Individual Freedom and Well-Being of Adolescents during 
COVID-19 Lockdown.

Kajka N(1), Karakuła-Juchnowicz H(1), Kulik A(2), Szewczyk P(1), Hryniewicz 
K(3).

Author information:
(1)1st Department of Psychiatry, Psychotherapy and Early Intervention, Medical 
University of Lublin, 1 Gluska St., 20-439 Lublin, Poland.
(2)The Department of Psychotherapy and Health Psychology, The John Paul II 
Catholic University of Lublin, Al. Racławickie 14, 20-950 Lublin, Poland.
(3)Department of Marketing and Quantitative Methods, Faculty of Management and 
Quality Science, Gdynia Maritime University, 81-87 Morska St., 81-225 Gdynia, 
Poland.

BACKGROUND: The aim of the cross-sectional study was to conduct an exploratory 
analysis of identifying factors related to mood, metacognitive beliefs, and 
limitation on individual freedom associated with lockdown restrictions during 
COVID-19, and to determine whether they may be relevant to the deteriorating 
well-being of adolescents.
METHODS: A total of 387 adolescents (M = 15.37; SD = 1.62): 85 with depression 
(DG) and 302 without any psychiatric diagnosis group (WPDG) were examined using 
the health survey and the CDI-2 questionnaire to assess the symptoms and 
severity of depression and MCQ-A to measure the intensity of dysfunctional 
metacognitive beliefs.
RESULTS: The feeling of restriction of freedom had an influence on worsened 
well-being in the whole group of responders OR = 4.15; p < 0.001 but was more in 
the DG than the WPDG (OR = 20.00; p < 0.001 vs. OR = 4.77; p < 0.001). Positive 
metacognitive beliefs were related to well-being (DG), but no effect was 
observed in the WPDG (OR = 0.88; p < 0.05 vs. OR = 1.05; p = 0.136). The lower 
age of the WPDG negatively impacted well-being (OR = 1.20; p < 0.05).
CONCLUSIONS: Dysfunctional metacognitive beliefs and the feeling of restriction 
of freedom are important in the deterioration of adolescents' well-being, but 
these factors have a stronger impact on well-being in the DG.

DOI: 10.3390/ijerph20065151
PMCID: PMC10049271
PMID: 36982060 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript, or in the decision to 
publish the results.


825. Int J Environ Res Public Health. 2023 Mar 14;20(6):5112. doi: 
10.3390/ijerph20065112.

Engaging Youth and Young Adults in the COVID-19 Pandemic Response via the "It's 
Our Turn" Crowdsourcing Contest.

Evans LA(1), Gomez O(2), Jiménez DJ(2), Williamson HJ(2), Carver AT(3), 
Parthasarathy S(4), Sabo S(2).

Author information:
(1)Department of Health Promotion and Policy, University of Massachusetts, 
Amherst, MA 01003, USA.
(2)Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ 
86011, USA.
(3)Southwest Interdisciplinary Research Center, Arizona State University, 
Phoenix, AZ 85004, USA.
(4)Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University 
of Arizona, Tucson, AZ 85724, USA.

As the coronavirus disease (COVID-19) pandemic continued to progress into 2021, 
appeals were made to take a stronger focus on the perceptions and practices of 
youth and young adults (YYAs) regarding COVID-19 mitigation, as well as the 
impact of mitigation strategies on the overall wellbeing of YYAs. In this paper, 
we describe our efforts to increase YYA engagement in Arizona's COVID-19 
response by pairing embedded values from youth participatory action research 
(YPAR) with a crowdsourcing challenge contest design. The research protocol and 
implementation are described, followed by a thematic analysis of YYA-led 
messaging portrayed in 23 contest submissions and reflections formed by 223 
community voters after viewing contest submissions. The authors conclude that a 
YYA-led crowdsourcing contest presented an opportunity to (a.) investigate the 
perceptions and behaviors of YYAs and their networks regarding the COVID-19 
pandemic and mitigation efforts and (b.) amplify the voices of YYAs in the 
pandemic response. Perhaps even more importantly, this approach also offered 
insight into the exacerbated impact of the pandemic on YYA mental health and 
wellbeing, and the utility of YPAR in raising awareness of these effects among 
the contexts and social networks of YYAs.

DOI: 10.3390/ijerph20065112
PMCID: PMC10049566
PMID: 36982019 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


826. Int J Environ Res Public Health. 2023 Mar 14;20(6):5083. doi: 
10.3390/ijerph20065083.

The Impact of the Coronavirus Pandemic on the Contribution of Local Green Space 
and Nature Connection to Mental Health.

Wicks CL(1), Barton JL(2), Andrews L(1), Orbell S(3), Sandercock G(2), Wood 
CJ(2).

Author information:
(1)School of Health and Social Care, University of Essex, Colchester CO4 3SQ, 
UK.
(2)School of Sport, Rehabilitation and Exercise Science, University of Essex, 
Colchester CO4 3SQ, UK.
(3)Department of Psychology, University of Essex, Colchester CO4 3SQ, UK.

BACKGROUND: Exposure to green space and feeling connected to the natural 
environment have independently been associated with improved mental health 
outcomes. During the coronavirus pandemic, people experienced restrictions on 
access to the outdoors, and health data indicated a decline in mental health in 
the UK general population.
METHODS: Data available from two independent surveys conducted prior to and 
during the pandemic enabled a naturally occurring comparison of mental health 
and its correlates prior to and during the pandemic.
RESULTS: Survey responses from 877 UK residents were included in the analyses. 
Independent t-tests revealed significant declines in mental health scores during 
the pandemic. After controlling for age and gender, greater nature connection 
significantly predicted lower depression and stress and improved well-being. 
Percentage of green space did not significantly predict any mental health 
outcomes. Further, time point (pre- or during COVID) and the interaction of time 
point with green space and nature connection did not significantly predict any 
of the outcome measures. The findings indicate that nature connection may play 
an important role in promoting mental health. Strategies to improve mental 
health and reduce mental illness should consider the role of nature connection 
and the use of interventions that involve direct interaction with natural 
environments.

DOI: 10.3390/ijerph20065083
PMCID: PMC10049389
PMID: 36981991 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


827. Int J Environ Res Public Health. 2023 Mar 12;20(6):5024. doi: 
10.3390/ijerph20065024.

An Unusual College Experience: 16-Month Trajectories of Depressive Symptoms and 
Anxiety among Chinese New Undergraduate Students of 2019 during the COVID-19 
Pandemic.

Liu L(1), Chen J(1), Liang S(2), Peng X(1), Yang W(3), Huang A(1), Wang X(1), 
Fan F(4)(5), Zhao J(1)(6).

Author information:
(1)Department of Psychology, School of Public Health, Southern Medical 
University, Guangzhou 510515, China.
(2)Mental Health Education and Counseling Center, Guangzhou Academy of Fine 
Arts, Guangzhou 510260, China.
(3)Psychological Counseling Center, Department of Student Affairs, Yunnan 
University of Chinese Medicine, Kunming 650500, China.
(4)Key Laboratory of Brain, Cognition and Education Sciences, Ministry of 
Education, Guangzhou 510631, China.
(5)School of Psychology, Center for Studies of Psychological Application, 
Guangdong Key Laboratory of Mental Health and Cognitive Science, South China 
Normal University, Guangzhou 510631, China.
(6)Mental Health Center, School of Public Health, Southern Medical University, 
Guangzhou 510515, China.

BACKGROUND: This study examines the trajectories of the mental health conditions 
of 13,494 new undergraduate students who enrolled in 2019 in China from the 
beginning of the pandemic to the local recurrence of the pandemic, and found 
factors which may be associated with diverse trajectories.
METHODS: The trajectories of depression-anxiety outcomes were modeled using the 
growth mixture model. The multinomial logistic regression model was used to 
identify variables associated with different trajectory groups.
RESULTS: Both depression and anxiety in the new college students slightly 
increased during the 16-month period. The slopes of depression and anxiety were 
lower after the local outbreak. From the trajectories of depression and anxiety, 
five heterogeneous groups were identified: low-stable (64.3%), 
moderate-increased (18.2%), high-stable (11.1%), recovery (4.5%), and 
rapid-increased (1.8%). Environmental, somatic, and social factors were used to 
differentiate the low-stable group from the other groups. We found that college 
students with female gender, more conflict with parents, and feelings of 
loneliness during the pandemic were more likely to enter a high stability 
trajectory compared to a recovery trajectory.
CONCLUSION: Most participants showed a stable mental health status, while others 
experienced deteriorating or chronic mental health problems, especially those 
who had sleep disturbances, less social support before the pandemic, or 
conflicts with parents during the pandemic. These students may need additional 
support and monitoring from college mental health providers to improve their 
wellbeing.

DOI: 10.3390/ijerph20065024
PMCID: PMC10048813
PMID: 36981933 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


828. Int J Environ Res Public Health. 2023 Mar 10;20(6):4890. doi: 
10.3390/ijerph20064890.

Self-Compassion and Well-Being during the COVID-19 Pandemic: A Study of Greek 
College Students.

Karakasidou E(1), Raftopoulou G(1), Papadimitriou A(1), Stalikas A(1).

Author information:
(1)Department of Psychology, Panteion University of Social and Political 
Sciences, 176 71 Athens, Greece.

The present study examined the relationship between self-compassion (SC) and 
emotional well-being in college students during the COVID-19 pandemic. The 
theoretical framework for the study was that SC, defined as an understanding and 
caring response to one's suffering and limitations, may serve as a protective 
factor against negative mental health outcomes. A sample of college students (N 
= 101) completed self-report measures of SC, depression, anxiety, stress, life 
satisfaction and subjective happiness. Data were analysed using regression 
analysis to examine the prediction of emotional well-being variables by SC and 
moderation analysis to examine the moderating effect of SC on the relationships 
between emotional well-being variables. The study's results confirmed the 
hypothesis that SC would predict emotional well-being. SC significantly 
predicted all variables examined, including depression, anxiety, stress, life 
satisfaction (LS) and subjective happiness (SH). However, SC did not moderate 
the relationships between these variables. Isolation significantly moderated the 
relationship between SH and depression among college students. These findings 
support the idea that SC may serve as a protective factor against negative 
mental health outcomes and suggest that interventions aimed at increasing SC may 
improve mental health and overall well-being in college students during the 
COVID-19 pandemic. Further research is needed to understand these relationships' 
mechanisms and the factors that may influence them.

DOI: 10.3390/ijerph20064890
PMCID: PMC10049373
PMID: 36981798 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


829. Int J Environ Res Public Health. 2023 Mar 8;20(6):4791. doi: 
10.3390/ijerph20064791.

Experiences of the COVID-19 Lockdown and Telehealth in Aotearoa New Zealand: 
Lessons and Insights from Mental Health Clinicians.

Werkmeister BJ(1)(2)(3), Haase AM(1), Fleming T(1), Officer TN(4).

Author information:
(1)School of Health, Te Herenga Waka-Victoria University of Wellington, 
Wellington 6012, New Zealand.
(2)Te Whatu Ora-Health New Zealand, Psychological Medicine, Wellington 6021, New 
Zealand.
(3)Department of Psychological Medicine, University of Otago-Wellington, 
Wellington 6242, New Zealand.
(4)School of Nursing, Midwifery, and Health Practice, Te Herenga Waka-Victoria 
University of Wellington, Wellington 6021, New Zealand.

OBJECTIVE: The COVID-19 pandemic rapidly changed health service delivery and 
daily life. There is limited research exploring health professional experiences 
with these changes. This research explores mental health clinicians' experiences 
over the first COVID-19 lockdown in New Zealand to inform future pandemic 
responses and improve usual business practices.
METHOD: Thirty-three outpatient mental health clinicians in three Aotearoa New 
Zealand regions took part in semi-structured interviews. Interviews were 
analysed thematically applying an interpretive description methodology.
RESULTS: Three key themes emerged: (1) life in lockdown, (2) collegial support, 
and (3) maintaining well-being. Clinicians, fearful of contracting COVID-19, 
struggled to adapt to working from home while maintaining their well-being, due 
to a lack of resources, inadequate pandemic planning, and poor communication 
between management and clinicians. They were uncomfortable bringing clients 
notionally into their own homes, and found it difficult to separate home and 
work spheres. Māori clinicians reported feeling displaced from their clients and 
community.
CONCLUSION: Rapid changes in service delivery negatively impacted clinician 
well-being. This impact is not lessened by a return to normal work conditions. 
Additional support is required to improve clinician work conditions and ensure 
adequate resourcing and supervision to enable clinicians to work effectively 
within a pandemic context.

DOI: 10.3390/ijerph20064791
PMCID: PMC10049248
PMID: 36981699 [Indexed for MEDLINE]

Conflict of interest statement: The principle author is a psychiatric registrar 
(doctor in psychiatrist specialist training program) working in one of the 
outpatient mental health team studied. He has previously worked in some of the 
other teams involved in this study. The remaining authors declare that the 
research was conducted in the absence of any commercial or financial 
relationships that could be construed as a potential conflict of interest.


830. Int J Environ Res Public Health. 2023 Mar 8;20(6):4781. doi: 
10.3390/ijerph20064781.

Juggling during Lockdown: Balancing Telework and Family Life in Pandemic Times 
and Its Perceived Consequences for the Health and Wellbeing of Working Women.

Loezar-Hernández M(1)(2)(3), Briones-Vozmediano E(1)(2)(3), Ronda-Pérez E(4)(5), 
Otero-García L(5)(6).

Author information:
(1)Department of Nursing and Physiotherapy, Faculty of Nursing and 
Physiotherapy, University of Lleida, 25008 Lleida, Spain.
(2)Consolidated Research Group Society, Health, Education and Culture (GESEC), 
University of Lleida, 25008 Lleida, Spain.
(3)Research Group of Health Care (GRECS), Biomedical Research Institute (IRB), 
25003 Lleida, Spain.
(4)Department of Community Nursing, Preventive Medicine, Public Health and 
History of Science, University of Alicante, 03690 Alicante, Spain.
(5)Consortium for Biomedical Research in Epidemiology and Public Health 
(CIBERESP-ISCIII), 28029 Madrid, Spain.
(6)Department of Nursing, Faculty of Medicine, Universidad Autónoma de Madrid, 
28049 Madrid, Spain.

The COVID-19 pandemic disrupted work-family balance due to lockdown measures. 
The aim of this study was to explore the experiences of working mothers in Spain 
and the consequences of trying to balance work and family for their health and 
wellbeing. We conducted a qualitative study based on 18 semi-structured 
interviews with mothers of children under 10. Five themes were identified: (1) 
Telework-characteristics and challenges of a new labor scenario; (2) Survival 
and chaos-inability to work, look after children, and manage a household at the 
same time; (3) Is co-responsibility a matter of luck?-challenges when sharing 
housework during lockdown; (4) Breakdown of the care and social support system; 
and (5) decline in health of women trying to balance work and family life. 
Mothers who had to balance telework against family life suffered physical, 
mental, and social effects, such as anxiety, stress, sleep deprivation, and 
relationship problems. This study suggests that, in situations of crisis, gender 
inequality increases in the household, and women tend to shift back to 
traditional gendered roles. Governments and employers should be made aware of 
this, and public policies should be implemented to facilitate work-family 
reconciliation and co-responsibility within couples.

DOI: 10.3390/ijerph20064781
PMCID: PMC10049029
PMID: 36981690 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


831. Int J Environ Res Public Health. 2023 Mar 8;20(6):4749. doi: 
10.3390/ijerph20064749.

An Assessment of Austrian School Students' Mental Health and Their Wish for 
Support: A Mixed Methods Approach.

Haider K(1), Humer E(1), Weber M(1)(2), Pieh C(1), Ghorab T(1), Dale R(1), 
Dinhof C(1), Gächter A(1), Probst T(1), Jesser A(1).

Author information:
(1)Department of Psychosomatic Medicine and Psychotherapy, University for 
Continuing Education Krems, 3500 Krems, Austria.
(2)Department of Organizational Psychology, Private University of Schloss 
Seeburg, 5201 Seekirchen am Wallersee, Austria.

The mental health of school students has been severely impacted by the aftermath 
of the COVID-19 pandemic. The present study used a mixed methods approach to 
assess students' mental health and examine their wishes for support to improve 
their psychological well-being. We further investigated gender and age group 
differences in the amount of clinically relevant mental health problems and the 
roles that mental health and gender had on desired support. Between April and 
May 2022, a total of 616 Austrian students aged between 14 and 20 participated 
in a cross-sectional online survey (77.4% female; 19.8% male; 2.8% non-binary) 
assessing wishes for support regarding mental well-being and mental health 
indicators (depression: PHQ-9; anxiety: GAD-7; insomnia: ISI; stress: PSS-10; 
eating disorders: SCOFF; alcohol abuse: CAGE). A wish for support was expressed 
by 46.6% of the students. Qualitative content analysis revealed that the two 
most important categories of desired support types were "professional help" and 
"someone to talk to". The group of students with a wish for support in general 
significantly more often showed clinically relevant depression, anxiety, 
insomnia, eating disorders, or high stress symptoms. Students that wished for 
professional help significantly more often exceeded the cut-off for clinically 
relevant depression, anxiety, and high stress. Those who wished for someone to 
talk to significantly more often exceeded the cut-off for clinically relevant 
eating disorders. The results indicate a great need for support for young 
people's mental health problems and that this need is even more urgent for 
students.

DOI: 10.3390/ijerph20064749
PMCID: PMC10049003
PMID: 36981657 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


832. J Nepal Health Res Counc. 2023 Mar 9;20(3):593-598. doi: 
10.33314/jnhrc.v20i3.4155.

Health Status and Management Practices of Home Isolated COVID-19 Adult Patients.

Parajuli K(1), Silwal S(1), Acharya A(1), Poudyal A(1), Dhakal N(1), Pandey 
A(1), Neupane T(1), Bista B(1), Dhimal M(1), Gyanwali P(1).

Author information:
(1)Nepal Health Research Council, Ramshah Path, Kathmandu, Nepal.

BACKGROUND: The worldwide containment strategy for COVID-19 outbreak includes 
laboratory-confirmed cases, and their isolation and management in health care 
institutions or at home. The spread of the COVID-19 virus has mandated home 
isolation for mild cases, as recommended by the Government of Nepal. Isolation 
is a situation that can have a substantial influence on physical and mental 
health of isolated people. This study is aimed to assess physical and mental 
well-being of COVID-19 home isolated patients, and their home management 
practices.
METHODS: A descriptive cross-sectional research using quantitative methods was 
carried out. Purposive sampling was used to select COVID-19 patients. Total 536 
COVID-19 home isolated patients were included in this study. Telephonic 
interview was conducted to obtain the data. Descriptive analysis was done and 
interpreted.
RESULTS: About 34 % of the participants were symptomatic. The most common 
symptoms experienced were fever (22.6%), followed by cough (19.4%) and cold 
(16.1%). About 20 % indicated having difficulties isolating at home due to lack 
of separate room. Furthermore, 4 percent of the participants didn't have anyone 
to take care of them at home. Also almost 2 percent of participants didn't get 
family support when infected. Moreover, majorities of individuals had normal 
stress, depression and anxiety level.
CONCLUSIONS: Most of the participants' physical and mental health was found to 
be normal though some of them experienced difficulties for management during 
home isolation. Hence, Interventions should focus resilience building by 
improving communication to address fears and concerns, encouraging routines and 
physical activities, and taking measures to reduce loneliness.

DOI: 10.33314/jnhrc.v20i3.4155
PMID: 36974843 [Indexed for MEDLINE]


833. BMC Geriatr. 2023 Mar 27;23(1):178. doi: 10.1186/s12877-023-03856-8.

Older adult communication types and emotional well-being outcomes during 
COVID-19 pandemic.

Cone N(1), Lee JE(2).

Author information:
(1)Human Development and Family Studies, Iowa State University, 2222 Osborn Dr, 
Ames, IA, 50011-1084, United States of America. njcone@iastate.edu.
(2)Human Development and Family Studies, Iowa State University, 2222 Osborn Dr, 
Ames, IA, 50011-1084, United States of America.

BACKGROUND: The rationale for the present study is a result of the COVID-19 
pandemic, as there are fewer opportunities available for older adults to engage 
in face-to-face interaction and social activities, which may result in changes 
in the communication methods with their social contacts. The purpose of this 
study was to explore the relationship between methods of social connectedness 
and emotional well-being outcomes among older adults at the start of the 
pandemic.
METHODS: Two thousand five hundred and fifty-eight older adults Medicare 
beneficiaries (65 + years of age) in the National Health and Aging Trends Study 
at wave 10 (June 2020 to January 2021) were selected for cross-sectional 
analysis. Participants were measured on brief questionnaires regarding forms of 
communication with family and friends before and during the pandemic. Emotional 
well-being outcomes were measured on single items of sadness/depressed and 
loneliness; as well as a 6-item Likert scale of anxiety during the pandemic. 
Paired sample t-tests were utilized to examine the forms of communication 
between before and during pandemic. Hierarchical regressions were conducted to 
assess the relationship between forms of communication and emotional well-being 
outcomes.
RESULTS: We found that there were overall decreases in communication frequency 
during pandemic. Findings from regression analyses indicated information 
communication technology (ICT) are associated with negative emotional well-being 
outcomes, whereas in-person social contact are associated with lower levels of 
negative affect.
CONCLUSION: These findings suggest utilizing higher levels of ICT has negative 
implications for older adults' emotional well-being, contrasting with the 
positive implication of in-person contacts. These findings highlight the role of 
ICT in emotional well-being among older adults during pandemic.

© 2023. The Author(s).

DOI: 10.1186/s12877-023-03856-8
PMCID: PMC10042399
PMID: 36973663 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


834. J Pediatr Health Care. 2023 Sep-Oct;37(5):484-491. doi: 
10.1016/j.pedhc.2023.03.002. Epub 2023 Mar 13.

Impact of COVID-19 on Mental Health and Resiliency of Pregnant and Parenting 
Adolescents and Young Adults: A Qualitative Study.

Merriman B(1), Jarmoc G(2), van der Rijn M(3), Pierre-Joseph N(4).

Author information:
(1)Bridgette Merriman, Medical Student, Boston University Chobanian & Avedisian 
School of Medicine, Boston, MA.
(2)Grace Jarmoc, Medical Student, Boston University Chobanian & Avedisian School 
of Medicine, Boston, MA. Electronic address: gjarmoc@bu.edu.
(3)Madeleine van der Rijn, Medical Student, Boston University Chobanian & 
Avedisian School of Medicine, Boston, MA.
(4)Natalie Pierre-Joseph, Clinical Associate Professor of Pediatrics, Boston 
University Chobanian & Avedisian School of Medicine, Boston, MA.

INTRODUCTION: This study aimed to understand the impacts the COVID-19 pandemic 
has on the mental health and well-being of pregnant and parenting adolescents 
and young adults (AYA) to identify unique challenges they faced.
METHOD: Pregnant and parenting AYA from a teen and tot program at a safety-net 
hospital in the northeast participated in semistructured qualitative interviews. 
Interviews were audio-recorded, transcribed, and coded. Analysis was conducted 
using modified grounded theory and content analysis.
RESULTS: Fifteen pregnant and parenting AYA participated in interviews. 
Participants were aged 19-28 years (mean age, 22.6). Participants reported 
adverse mental health experiences, namely increased loneliness, depression, and 
anxiety, engagement in preventive measures to protect their children's health, 
positive attitudes toward telemedicine because of efficiency and safety, delayed 
attainment of personal and professional goals, and increased attitudes of 
resilience.
DISCUSSION: Health care professionals should offer expanded screening and 
support resources to pregnant and parenting AYA during this time.

Copyright © 2023 National Association of Pediatric Nurse Practitioners. 
Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.pedhc.2023.03.002
PMCID: PMC10008786
PMID: 36973102 [Indexed for MEDLINE]


835. PLoS One. 2023 Mar 27;18(3):e0283374. doi: 10.1371/journal.pone.0283374. 
eCollection 2023.

Psychosocial health of school-going adolescents during the COVID-19 pandemic: 
Findings from a nationwide survey in Bangladesh.

Koly KN(1), Islam MS(1), Potenza MN(2)(3)(4)(5), Mahumud RA(6)(7), Islam MS(8), 
Uddin MS(8), Sarwar MAH(8), Begum F(1), Reidpath DD(1)(9).

Author information:
(1)Health System & Population Studies Division, International Centre for 
Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh.
(2)Department of Psychiatry and Child Study Center, Yale School of Medicine, New 
Haven, CT, United States of America.
(3)Connecticut Mental Health Center, New Haven, CT, United States of America.
(4)Connecticut Council on Problem Gambling, Wethersfield, CT, United States of 
America.
(5)Department of Neuroscience and Wu Tsai Institute, Yale University, New Haven, 
CT, United States of America.
(6)Faculty of Medicine and Health, NHMRC Clinical Trials Centre, The University 
of Sydney, Camperdown, NSW, Australia.
(7)Centre for Health Research, University of Southern Queensland, Toowoomba, 
QLD, Australia.
(8)Aspire to Innovate (a2i), Information and Communication Technology Division, 
Agargaon, Dhaka, Bangladesh.
(9)Institute for Global Health and Development, Queen Margaret University, 
Edinburgh, Scotland.

BACKGROUND: Common psychosocial health problems (PHPs) have become more 
prevalent among adolescents globally during the COVID-19 pandemic. However, the 
psychosocial health of school-going adolescents has remained unexplored in 
Bangladesh due to limited research during the pandemic. The present study aimed 
to estimate the prevalence of PHPs (i.e., depression and anxiety) and assess 
associated lifestyle and behavioral factors among school-going adolescents in 
Bangladesh during the COVID-19 pandemic.
METHODS: A nationwide cross-sectional survey was conducted among 3,571 
school-going adolescents (male: 57.4%, mean age: 14.9±1.8 years; age range: 
10-19 years) covering all divisions, including 63 districts in Bangladesh. A 
semi-structured e-questionnaire, including informed consent and questions 
related to socio-demographics, lifestyle, academics, pandemic and PHPs, was used 
to collect data between May and July 2021.
RESULTS: The prevalence of moderate to severe depression and anxiety were 37.3% 
and 21.7%, respectively, ranging from 24.7% in the Sylhet Division to 47.5% in 
the Rajshahi Division for depression, and from 13.4% in the Sylhet Division to 
30.3% in the Rajshahi Division for anxiety. Depression and anxiety were 
associated with older age, reports of poor teacher cooperation in online 
classes, worries due to academic delays, parental comparison of academic 
performance with other classmates, difficulties coping with quarantine 
situations, changes in eating habits, weight gain, physical inactivity and 
having experienced cyberbullying. Moreover, being female was associated with 
higher odds of depression.
CONCLUSIONS: Adolescent psychosocial problems represent a public health problem. 
The findings suggest a need for generating improved empirically supported 
school-based psychosocial support programs involving parents and teachers to 
ensure the well-being of adolescents in Bangladesh. School-based prevention of 
psychosocial problems that promote environmental and policy changes related to 
lifestyle practices and active living should be developed, tested, and 
implemented.

Copyright: © 2023 Koly et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0283374
PMCID: PMC10042372
PMID: 36972260 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


836. Front Public Health. 2023 Mar 9;11:1092839. doi: 10.3389/fpubh.2023.1092839. 
eCollection 2023.

Teachers at risk: Depressive symptoms, emotional intelligence, and burnout 
during COVID-19.

Sánchez-Pujalte L(1), Gómez Yepes T(1), Etchezahar E(1)(2)(3)(4), Navarro Mateu 
D(1)(2).

Author information:
(1)Faculty of Education, International University of Valencia, Valencia, Spain.
(2)Department of Inclusive Education, Faculty of Education, Catholic University 
of Valencia, Valencia, Spain.
(3)Faculty of Psychology, University of Buenos Aires, Buenos Aires, Argentina.
(4)National Scientific and Technical Research Council, Buenos Aires, Argentina.

BACKGROUND: Previous studies indicated that depressive symptoms are common among 
teachers due to job stress and difficulty in managing emotions. The aim of this 
research was to determine the levels of depressive symptomatology in a sample of 
secondary school teachers who worked during the COVID-19 pandemic and to analyze 
the relationships with their levels of burnout and emotional intelligence.
METHODS: The study involved 430 secondary school teachers residing in Madrid 
(Spain) who worked during the COVID-19 pandemic. Participants' age was between 
25 and 60 (M = 41.40; SD = 11.07) and the gender distribution was 53.72% men and 
46.28% women. We used the Spanish version of the Patient Health Questionnaire 
(PHQ-9), the Maslach Burnout Inventory Educators Survey (MBI-ES) and the Trait 
Meta-Mood Scale (TMMS-24).
RESULTS: The main results indicated that teachers presented high means of 
depressive symptomatology, with women obtaining higher scores than men. 
Significant relationships were also observed between the levels of depressive 
symptomatology and the dimensions of burnout and emotional intelligence. 
Finally, the three dimensions of emotional intelligence would contribute to the 
depressive symptomatology of teachers, while of the burnout dimensions only 
Emotional Exhaustion would make a contribution.
CONCLUSION: The possible consequences of depressive symptomatology in teachers 
during the pandemic are discussed, as well as the need to enhance protective 
factors such as emotional intelligence and to study burnout levels.

Copyright © 2023 Sánchez-Pujalte, Gómez Yepes, Etchezahar and Navarro Mateu.

DOI: 10.3389/fpubh.2023.1092839
PMCID: PMC10034050
PMID: 36969688 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


837. Front Public Health. 2023 Mar 9;11:1155193. doi: 10.3389/fpubh.2023.1155193. 
eCollection 2023.

How do long COVID patients perceive their current life situation and 
occupational perspective? Results of a qualitative interview study in Germany.

Schmachtenberg T(1)(2), Müller F(1), Kranz J(1), Dragaqina A(1), Wegener G(1), 
Königs G(1), Roder S(1).

Author information:
(1)Department of General Practice, University Medical Center Göttingen, 
Göttingen, Germany.
(2)Department of Rheumatology and Immunology, Hannover Medical School, Hannover, 
Germany.

INTRODUCTION: Many people experience persistent or new-onset symptoms such as 
fatigue or cognitive problems after an acute infection with COVID-19. This 
phenomenon, known as long COVID, impacts physical and mental wellbeing, and may 
affect perceived quality of life and occupational perspectives likewise. The aim 
of this study is to gain a deeper understanding of how people with long COVID 
experience health-related restrictions in their daily life and their 
occupational situation, and to identify key challenges they face.
METHODS: Guided qualitative interviews were conducted with 25 people with long 
COVID. The interviews were transcribed according to Dresing/Pehl and Kuckartz 
and analyzed using qualitative content analysis. Afterward, a systematic 
comparison of the data and a reflection under consideration of 
lifeworld-theoretical approaches (Berger and Luckmann) were carried out.
RESULTS: The interviews revealed that many participants have severe symptoms 
which strongly impair them in perform daily and work-related activities, and in 
their personal interests. Many interviewees already reach their stress limit 
during routine household activities or childcare. Of the 25 participants, 19 
experienced limitations in pursuing leisure activities, and 10 of the 23 
interviewees with jobs reported being on sick leave for several months. Several 
respondents who had vocational reintegration are still affected by ongoing 
symptoms that affect their work performance considerably. This leads to 
uncertainty, role conflicts, a decline in social contacts, and decreased 
incomes, which contribute to an impairment in their quality of life.
CONCLUSIONS: This study shows the huge need for specific support for people with 
long COVID in different areas of life. To prevent people with long COVID from 
finding themselves in social and economic precarity, decision-makers should 
develop strategies to systematically support them in their sustainable 
reintegration into the workforce. The focus should be on creating long 
COVID-sensitive workplaces, compensating for decreased incomes, and improving 
access to relief services such as vocational reintegration. We argue, that a 
shift of perspectives is necessary and that long COVID should be considered 
rather as a "social disease" with considerably impairments in the social life of 
those affected.
TRIAL REGISTRATION: The study is registered in the German register for clinical 
trials (DRKS00026007).

Copyright © 2023 Schmachtenberg, Müller, Kranz, Dragaqina, Wegener, Königs and 
Roder.

DOI: 10.3389/fpubh.2023.1155193
PMCID: PMC10034079
PMID: 36969629 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


838. Soc Sci Med. 2023 Apr;323:115850. doi: 10.1016/j.socscimed.2023.115850. Epub 
2023 Mar 17.

Blurred border or safe harbor? Emotional well-being among sexual and gender 
minority adults working from home during COVID-19.

Amerikaner L(1), Yan HX(2), Sayer LC(2), Doan L(2), Fish JN(2), Drotning KJ(2), 
Rinderknecht RG(3).

Author information:
(1)University of Maryland, College Park, 3834 Campus Dr., College Park, MD, 
20742, USA. Electronic address: lamerika@terpmail.umd.edu.
(2)University of Maryland, College Park, 3834 Campus Dr., College Park, MD, 
20742, USA.
(3)Max Planck Institute for Demographic Research, Konrad-Zuse-Str. 1, 18057, 
Rostock, Germany.

During the COVID-19 pandemic, lesbian, gay, bisexual, transgender, and queer 
(LGBTQ) adults have experienced pronounced declines in well-being. However, less 
is known about how changes to daily routines and settings, such as the shift to 
remote work within many occupations, may be playing a role in well-being 
outcomes. Drawing on a unique time diary data source (N = 3515 respondents and 
7650 episodes) collected between April 2020-July 2021 through online 
crowdsourcing platforms, we conducted random effects analyses to examine how 
working from home has been associated with experienced well-being among LGBTQ 
and cisgender heterosexual workers in the United States during the pandemic. 
Findings indicate LGBTQ adults felt significantly less stressed and tired while 
doing paid work at home than while working at a workplace. In addition, working 
at a workplace, rather than working from home, appeared to be more detrimental 
to LGBTQ adults' well-being compared to their non-LGBTQ counterparts. Adjusting 
for work characteristics explained some of the difference, whereas adjusting for 
family characteristics had little impact on the results. It is possible that for 
LGBTQ employees, working from home mitigates some of the minority stressors 
experienced during paid work.

Copyright © 2023 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.socscimed.2023.115850
PMCID: PMC10022182
PMID: 36966549 [Indexed for MEDLINE]


839. J Women Aging. 2023 Nov-Dec;35(6):505-512. doi: 10.1080/08952841.2023.2188039. 
Epub 2023 Mar 26.

Psychological health among older adult women in the United States during the 
COVID-19 pandemic.

Marshall VB(1)(2), Hooper SC(1)(2), Becker CB(3), Keel PK(4), Kilpela 
LS(1)(2)(5).

Author information:
(1)ReACH Center, UT Health San Antonio, San Antonio, TX, USA.
(2)Barshop Institute, UT Health San Antonio, San Antonio, TX, USA.
(3)Department of Psychology, Trinity University, San Antonio, TX, USA.
(4)Department of Psychology, Florida State University, Tallahassee, FL, USA.
(5)South Texas VA Health System, Audie Murphy Veterans Hospital, San Antonio, 
TX, USA.

This study examined differences in mental health in older adult women before 
versus during the COVID-19 pandemic. Participants who were community dwelling 
(N = 227) included n = 67 women aged 60-94 in the pre-pandemic group and n = 160 
women aged 60-85 in the peri-pandemic group who completed self-report measures 
assessing mental health and quality of life (QOL). We compared mental health and 
QOL indices across the pre- and peri-pandemic groups. Results indicated that the 
peri-pandemic group reported higher anxiety (F = 4.94, p = .027) than the 
pre-pandemic group. No other significant differences emerged. Given the 
differential effects in this pandemic across SES, we conducted exploratory 
analyses investigating differences by income group. Controlling for education 
and race, within the pre-pandemic group, women with lower income reported worse 
physical function compared to the mid- and high-income groups. Within the 
peri-pandemic group, women with lower income reported worse anxiety, poorer 
sleep, and poorer QOL (physical function, role limitations due to physical 
problems, vitality, and pain) than high-income individuals. Overall, women who 
reported lower income reported worse mental health and QOL than those with 
high-income, especially during the pandemic. This indicates that income might 
act as a buffer for older women against negative psychological outcomes of the 
COVID-19 pandemic.

DOI: 10.1080/08952841.2023.2188039
PMCID: PMC10520218
PMID: 36966441 [Indexed for MEDLINE]


840. J Affect Disord. 2023 Jun 15;331:229-237. doi: 10.1016/j.jad.2023.03.056. Epub 
2023 Mar 23.

The beneficial role of personality in preserving well-being during the pandemic: 
A longitudinal population study.

Iles-Caven Y(1), Gregory S(2), Northstone K(2), Golding J(2), Nowicki S(3).

Author information:
(1)Population Health Sciences, Bristol Medical School, University of Bristol, 
UK. Electronic address: cdylic@bristol.ac.uk.
(2)Population Health Sciences, Bristol Medical School, University of Bristol, 
UK.
(3)Dept. Psychology, Emory University, Atlanta, GA, USA.

BACKGROUND: The COVID-19 pandemic resulted in increased rates of mental health 
problems. We examined the possible role of the personality characteristic, Locus 
of Control (LOC), in moderating pandemic-induced stress.
METHODS: The UK-based Avon Longitudinal Study of Parents & Children (ALSPAC), 
7021 adults (mean ages: women 57.6 (SD = 4.48); partners 60.5 (SD = 5.36)) 
responded to a 2020 questionnaire which included a generalised measure of LOC. 
Between March 2020-January 2021, questionnaires focussed on the pandemic were 
administered, which included measures of mental health. Over 60 % of respondents 
completed questionnaires at three timepoints of interest.
RESULTS: In those with an internal LOC higher rates of positive well-being and 
reduced likelihood of anxiety and depression were shown compared to those who 
were external, e.g. after adjustment for socioeconomic/demographic factors mean 
differences in well-being score for internal compared with external women was 
+2.01 (95%CI +1.02,+2.10) p = 0.0001; for their partners +2.52 (95%CI 
+1.22,+3.82) p = 0.0002. External women were more likely than internals to have 
depression (adjusted OR 3.41 [95%CI 1.77,6.57] p < 0.0005.
LIMITATIONS: Attrition is a problem in this 30-year-old longitudinal cohort. 
Those still participating are more likely to have higher education and SES 
levels, be female and have an internal LOC. This population suffers from a lack 
of ethnic diversity.
CONCLUSIONS: Having an internal LOC positively moderated the effects of 
pandemic-induced stress on the frequency of anxiety and depression in 
middle-age. Programmes geared to raise internality and coping strategies may 
have long-term benefits on well-being in stressful situations, especially for 
women and frontline health professionals.

Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2023.03.056
PMCID: PMC10035805
PMID: 36965624 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of interest YIC and SG are funded via 
a grant from the John Templeton Foundation (61917). JG, KN and SN have no 
competing interests (JG and SN are both retired).


841. Prof Inferm. 2022 Apr 1;75(1):51-58. doi: 10.7429/pi.2022.751058.

Impact of COVID-19 outbreak on ICU nurses' mental health. An Italian multicenter 
study.

[Article in English, Italian; Abstract available in Italian from the publisher]

Damico V(1), Demoro G(2), Bolgi S(3), Chirino A(4), Molina F(5), D'alessandro 
A(6), Murano L(7), Russello G(8), Cataldi G(9).

Author information:
(1)PhD, RN, Azienda Socio Sanitaria Territoriale di Lecco, Lecco.
(2)RN, Azienda Socio Sanitaria Sette Laghi di Varese, Varese.
(3)RN, Agenzia Di Tutela Della Salute Della Brianza, Monza.
(4)RN, MSN, Agenzia di Tutela della Salute dell'Insubria, Varese.
(5)RN, Ente per i Servizi Tecnico-Amministrativi di Area Vasta Centro Toscana, 
Firenze.
(6)RN, Presidio Ospedaliero Centrale - SS. Annunziata, Taranto.
(7)RN, MSN, Residenza Sanitaria Assistenziale, Madonna della Neve Premana Onlus, 
Lecco.
(8)RN, Presidio Ospedaliero di Sant'Elia, Caltanissetta.
(9)RN, Policlinico Santa Maria alle Scotte, Siena.

AIM: AIM: The aim of this study was to evaluate variations in ICU nurses ' 
mental health status over the COVID-19 outbreak by quantifying the extent of 
symptoms of depression, anxiety and PTSD over time.
METHODS: METHODS: This study was an Italian multicenter prospective cohort study 
assessing caseness of anxiety, depression and PTSD at 6 and 12 months from the 
beginning of the COVID-19 outbreak in Italy.
RESULTS: RESULTS: A total of 359 nurses, 233 (64.9%) were males and 126 (35.1%) 
were females were enrolled. At 6 months the caseness prevalence for anxiety, 
depression and PTSD were 31.3%, 32.1% and 18.7% respectively. At 12 months the 
caseness prevalence for anxiety, depression and PTSD were 34.8%, 36.4% and 24.1 
% respectively. No statistically significant increase between 6 and 12 months 
was recorded for the caseness prevalence anxiety (p= .29) and depression (p= 
.19). However, an increase for the caseness prevalence PTSD at 12 months was 
observed (p= .049). The significant risk factors for the 221 patients with at 
least one disorders were age 31-40 (RR= 1.44, IC= 1.25-1.89; p < .001), female 
gender (RR= 1.31, IC= 1.02-1.51; p=. 042) and had 0-5 years of professional 
experience (RR= 1.36, IC= 1.02-1.63; p = .031).
CONCLUSION: The results of our study may provide support for the implementation 
of some interventions for well-being in COVID-19 outbreak condition.

Publisher: SCOPO: Lo scopo di questo studio era valutare le variazioni dello 
stato di salute mentale degli infermieri in terapia intensiva durante l'epidemia 
di COVID-19 quantificando l'entità dei sintomi di depressione, ansia e PTSD nel 
tempo. METODI: Si tratta di uno studio di coorte prospettico multicentrico 
italiano che ha valutato la presenza di di ansia, depressione e PTSD a 6 e 12 
mesi dall'inizio dell'epidemia di COVID-19. RISULTATI: Sono stati arruolati un 
totale di 359 infermieri, 233 (64.9%) uomini e 126 (35.1%) donne. A 6 mesi 
dall’inizio della pandemia, la prevalenza di disturbi di ansia, depressione e 
disturbo da stress post-traumatico era rispettivamente del 31.3%, 32.1% e 18.7%. 
A 12 mesi la prevalenza per ansia, depressione e PTSD era rispettivamente del 
34.8%, 36.4% e 24.1%. Nessun aumento statisticamente significativo tra 6 e 12 
mesi è stato registrato per l’ansia (p = .29) o la depressione (p = .19). 
Tuttavia, è stato osservato un aumento del disturbo da stress post-traumatico a 
12 mesi (p = .049). I fattori di rischio significativi per i 221 pazienti con 
almeno un disturbo, erano un età di 31-40 (RR = 1.44, IC = 1.25-1.89; p < .001), 
sesso femminile (RR = 1.31, IC = 1.02-1.51; p = .042) e avere un esperienza 
professionale di 0-5 anni (RR = 1.36, IC = 1.02-1.63; p = .031). CONCLUSIONI: I 
risultati del nostro studio possono fornire supporto per l'implementazione di 
alcuni interventi per il benessere lavorativo nella condizione di epidemia di 
COVID-19.

DOI: 10.7429/pi.2022.751058
PMID: 36963110 [Indexed for MEDLINE]


842. PLoS One. 2023 Mar 24;18(3):e0283500. doi: 10.1371/journal.pone.0283500. 
eCollection 2023.

Factors associated with PTSD symptoms and quality of life among nurses during 
the COVID-19 pandemic: A cross-sectional study.

Lin CC(1), Yeh CB(1).

Author information:
(1)Department of Psychiatry, Tri-Service General Hospital, National Defense 
Medical Center, Taipei, Taiwan.

BACKGROUND: Healthcare workers, especially nurses, were one of the most 
vulnerable groups for developing posttraumatic stress disorder (PTSD) during the 
coronavirus disease 2019 (COVID-19) pandemic, which also affected their quality 
of life. However, only limited research has investigated the individual 
psychological factors as well as the environmental factors responsible for these 
effects of the pandemic. Demoralization is a state of loss of meaning and 
anhedonia, which we thought to be an important mediator between fear and PTSD 
among frontline nurses during the pandemic. This study aimed to explore the role 
of demoralization in the mechanisms of posttraumatic stress symptoms of nurses 
facing different infection risks and influencing factors on their well-being.
METHOD: A cross sectional study was conducted from September 16, 2021 to October 
8, 2021 in a medical center in Northern Taiwan. Online questionnaires were used 
to collect data, including age, sex, vaccination status, working years, previous 
quarantine experiences, psychiatric history, traumatic events and scales for 
measuring fear of COVID-19, demoralization, symptoms of posttraumatic stress, 
depression, anxiety and stress, burnout level, teamwork performance and quality 
of life. Hierarchical regression analysis and mediation analysis were utilized 
to identify associated risk factors and mechanisms.
RESULT: Among 351 included nurses, 148 worked in high-risk areas directly 
exposed to COVID-19 patients or patients with respiratory symptoms, while 203 
nurses worked in low-risk areas. Overall, nurses in the low-risk group had 
greater fear of COVID-19, and greater demoralization and burnout level, along 
with poorer teamwork and quality of life. Demoralization was found to have 
mediating effect in both the high-risk group and low-risk group on the 
relationships between fear of COVID-19 and posttraumatic stress symptoms. Levels 
of burnout and teamwork may serve as mediators between depression, anxiety, 
stress and quality of life.
CONCLUSION: Hospital-based nurses appear to be at high risk for developing 
posttraumatic stress disorder during the COVID-19 pandemic. Study findings 
demonstrated specific associated factors that should be the focus of nursing 
administration and hospital management while employing preventive measures, 
psychological resilience of nurses or systematic managements. Future 
longitudinal research is needed to improve management in pandemic conditions.

Copyright: © 2023 Lin, Yeh. This is an open access article distributed under the 
terms of the Creative Commons Attribution License, which permits unrestricted 
use, distribution, and reproduction in any medium, provided the original author 
and source are credited.

DOI: 10.1371/journal.pone.0283500
PMCID: PMC10038253
PMID: 36961813 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


843. PLoS One. 2023 Mar 24;18(3):e0283599. doi: 10.1371/journal.pone.0283599. 
eCollection 2023.

"We will need to build up the atmosphere of trust again": Service providers' 
perceptions of experiences of COVID-19 amongst resettled refugee adolescents.

Meyer SR(1), Seff I(2), Gillespie A(2), Brumbaum H(2), Qushua N(2), Stark L(2).

Author information:
(1)The Institute for Medical Information Processing, Biometry, and Epidemiology, 
University of Munich, Munich, Germany.
(2)The Brown School at Washington University in St. Louis, St. Louis, MO, United 
States of America.

Adolescent resettled refugees across the United States have been significantly 
impacted by the COVID-19 pandemic, through socio-economic stressors in 
households, disproportionate morbidity and mortality in immigrant communities, 
and social isolation and loss of learning due to school closures and the shift 
to online learning. The Study of Adolescent Lives after Migration to America 
[SALaMA] investigates the mental health and wellbeing of adolescents who come 
from-or who have parents who came from-the Middle East and North Africa [MENA] 
region and settled in the U.S. There is a gap in understanding of the 
experiences during the pandemic of MENA-background adolescents in the U.S. The 
objective of this study was to describe the perspective of educators and other 
school-affiliated service providers on the impact of the COVID-19 pandemic on 
mental health and wellbeing of adolescent resettled refugees and access to and 
quality of education and support services for adolescent resettled refugees. The 
researchers collected data using in-depth interviews with key informants in 
Chicago, Illinois; Harrisonburg, Virginia; and Detroit Metropolitan Area [DMA], 
Michigan, Key informants were school administrators, managers of English 
language learning services and programs, teachers, therapists, staff of 
non-governmental organizations and/ or community-based organizations, and case 
workers. Data analysis was conducted utilizing directed content analysis to 
develop an initial codebook and identify key themes in the data. Findings 
revealed a number of pathways through which the pandemic impacted adolescent 
refugees and immigrants' mental health and wellbeing, with online programming 
impacting students' engagement, motivation and social isolation in terms of peer 
and provider relationships. Specific dynamics in refugee adolescents' households 
increased stressors and reduced engagement through online learning, and access 
to space and resources needed to support learning during school closures were 
limited. Service providers emphasized multiple and overlapping impacts on 
service quality and access, resulting in reduced social supports and mental 
health prevention and response approaches. Due to the long-term impacts of 
school closures in the first two years of the pandemic, and ongoing disruption, 
these data both provide a snapshot of the impacts of the pandemic at a specific 
moment, as well as insights into ways forward in terms of adapting services and 
engaging students within restrictions and limitations due to the pandemic. These 
findings emphasize the need for educators and mental health service providers to 
rebuild and strengthen relationships with students and families. These findings 
indicate the need to consider, support and expand social support and mental 
health services, specifically for refugee adolescent students, in the context of 
learning and well-being during the COVID-19 pandemic.

Copyright: © 2023 Meyer et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0283599
PMCID: PMC10038302
PMID: 36961778 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


844. Int Health. 2023 Mar 24;15(Suppl 1):i110-i125. doi: 10.1093/inthealth/ihad005.

Exploring the impact of COVID-19 on frontline health workers through a 
photovoice study in Kaduna, Kwara and Ogun States, Nigeria.

Yahemba D(1), Chowdhury S(2), Olorunfemi T(1), Dubukumah L(1), David A(1), 
Umunnakwe C(1), Dalumo V(1), Haruna S(1), Dean L(2).

Author information:
(1)Sightsavers Nigeria, 800241 Kaduna, Nigeria.
(2)Department of International Public Health, Liverpool School of Tropical 
Medicine, L3 5QA, Liverpool, UK.

BACKGROUND: Described as the 'backbone of health systems', particularly in low- 
and middle-income countries, community health workers (CHWs) are a critical 
cadre on the frontline of any outbreak response. However, it is widely 
recognised that CHWs are frequently lacking in appropriate support from the 
health system due to inadequate physical, social and financial resources. 
Furthermore, despite their critical role in service delivery, the health and 
well-being of CHWs is seldom considered and the additional emotional and 
physical burdens that health systems shocks can present are frequently ignored. 
Thus a critical step in strengthening health systems to manage disease outbreaks 
or other system shocks is to ensure that CHWs are adequately supported. Within 
this study we document the experiences of CHWs within Nigeria during the 
coronavirus disease 2019 (COVID-19) outbreak to understand the impact of the 
pandemic on CHW well-being with a view to identifying strategies that could 
support CHWs during COVID-19 and subsequent health system shocks.
METHODS: This study was based in Ogun, Kaduna and Kwara States, Nigeria. We used 
the creative participatory methodology of photovoice with 30 CHWs (10 in each 
state). Participants were asked to take photos documenting their experiences of 
working and living through the pandemic. Participants sent photos with captions 
to the research team via WhatsApp following one-on-one discussions. Photos were 
co-analysed among participants in focus group discussions using thematic 
analysis.
RESULTS: Our findings reveal similar experiences of CHWs across Ogun, Kwara and 
Kaduna States in Nigeria, providing a unique insight into how the Nigerian 
health system was impacted and how this closely aligns to the performance and 
well-being of CHWs. CHW experiences related to three overarching themes: major 
stressors and challenges experienced due to COVID-19 (fear of contracting 
COVID-19, food insecurity, personal and gendered impacts), the impact of 
COVID-19 on providing routine care (stigma from community members, heavy 
workloads and inadequate equipment provision) and motivation and support from 
the community (pride in their roles and valued support from community leaders). 
The challenges highlighted through photovoice led to developing recommendations 
to address some of the challenges. This included training, adequate resource 
provision, routine supervision and peer support.
CONCLUSIONS: COVID-19 highlighted the burden health workers often face. 
Photovoice allowed a space for frontline health workers to come together to 
share common experiences, particularly the psychosocial impact of working during 
health system shocks and its impact on performance. This underlines the need to 
acknowledge mental health and prioritise the well-being of healthcare staff. 
Sharing stories from the perspectives of health workers provides a platform to 
share learning and strategies on how to best support health workers 
holistically, particularly during health system shocks.

© The Author(s) 2023. Published by Oxford University Press on behalf of Royal 
Society of Tropical Medicine and Hygiene.

DOI: 10.1093/inthealth/ihad005
PMCID: PMC10037267
PMID: 36960811 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no known conflicts of interest.


845. Am J Ind Med. 2023 Jun;66(6):500-509. doi: 10.1002/ajim.23478. Epub 2023 Apr 4.

Symptom characteristics of health care workers seeking outpatient psychiatric 
care during the COVID-19 pandemic.

Doukas A(1), DePierro J(1), Starkweather S(1), Sharma V(1), Marin DB(1), Charney 
DS(1)(2)(3).

Author information:
(1)Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, 
New York, USA.
(2)Department of Pharmacology, Icahn School of Medicine at Mount Sinai, New 
York, New York, USA.
(3)Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New 
York, New York, USA.

BACKGROUND: Though there is a growing body of research establishing a broad 
negative psychological impact of COVID-19 among healthcare workers (HCWs), there 
are comparably fewer studies evaluating symptom presentation and clinical 
diagnoses among treatment-seeking HCWs. The present report seeks to fill this 
gap in the literature by establishing the prevalence of anxiety, depression, 
post-traumatic stress, alcohol misuse, and well-being among treatment-seeking 
HCWs.
METHOD: Data were collected from 421 treatment-seeking HCWs in an outpatient 
hospital-based mental health setting. Both self-report measures and 
semi-structured interviews were utilized to assess symptom severity and render 
psychiatric diagnosis at intake.
RESULTS: Adjustment disorders were the most prevalent diagnosis at 44.2%. Of the 
347 who completed self-report measures, over 47% endorsed moderate-to-severe 
depressive symptoms, with 13% endorsing suicidal ideation (SI). Fifty-eight 
percent scored in the moderate-to-severe range for anxiety, and 19% screened 
positive for COVID-related post-traumatic stress disorder. Further analyses 
revealed that those in medical support roles endorsed significantly greater 
depression symptoms relative to other groups and also reported SI at greater 
frequency. Medical trainees also endorsed SI at higher frequencies.
CONCLUSIONS: These findings are consistent with previous research on the adverse 
impact of COVID-19 stressors on HCWs' mental health. We further identified 
vulnerable groups that are underrepresented in the literature. These findings 
highlight the need for targeted outreach and intervention among overlooked HCWs 
populations.

© 2023 Wiley Periodicals LLC.

DOI: 10.1002/ajim.23478
PMCID: PMC10636598
PMID: 36960643 [Indexed for MEDLINE]

Conflict of interest statement: DISCLOSURE BY AJIM EDITOR OF RECORD John Meyer 
declares that he has no conflict of interest in the review and publication 
decision regarding this article. CONFLICTS OF INTEREST STATEMENT The remaining 
authors declare that there are no conflicts of interest.


846. Can J Occup Ther. 2023 Jun;90(2):136-151. doi: 10.1177/00084174231160950. Epub 
2023 Mar 23.

Meaningful Activity, Psychosocial Wellbeing, and Poverty During COVID-19: A 
Longitudinal Study.

Marshall CA, Gewurtz R, Holmes J, Phillips B, Aryobi S, Smith-Carrier T.

Background: Only a few studies have explored experiences of meaningful activity 
and associations with psychosocial wellbeing during COVID-19. None reflect a 
Canadian context or focus on persons living in poverty. Purpose: To identify 
experiences and associations between meaningful activity and psychosocial 
wellbeing for persons living in poverty during the first year of COVID-19. 
Method: We delivered a quantitative survey at three time points during the first 
year of the pandemic supplemented by qualitative interviews at Time(T) 1 and 1 
year later at T3. Findings: One hundred and eight participants completed T1 
surveys, and 27 participated in qualitative interviews. Several statistically 
significant correlations between indices of meaningful activity engagement and 
psychosocial wellbeing were identified across T1-T3. Meaningful activity 
decreased from T1-T3 [X2 (2, n = 49) = 9.110, p < .05], with a significant 
decline from T2-T3 (z = -3.375, p < .001). In T1 qualitative interviews, 
participants indicated that physical distancing exacerbated exclusion from 
meaningful activities early in the pandemic. At T3 (1 year later), they 
described how classist and ableist physical distancing policies layered 
additional burdens on daily life. Implications: Meaningful activity engagement 
and psychosocial wellbeing are closely associated and need to be accounted for 
in the development of pandemic policies that affect persons living in low 
income. Occupational therapists have a key role in pandemic recovery.

Description. Quelques études seulement se sont penchées sur les activités 
significatives et leur lien avec le bien-être psychosocial durant la pandémie de 
COVID-19. Aucune d’entre elles ne reflète le contexte canadien ou ne se 
concentre sur les personnes en situation de pauvreté. But. Identifier les 
expériences et les associations entre les activités significatives et le 
bien-être psychosocial pour les personnes en situation de pauvreté durant la 
première année de la pandémie de COVID-19. Méthodologie. Nous avons réalisé une 
enquête quantitative à trois moments durant la première année de la pandémie, 
complétée par des entretiens qualitatifs au moment T1 et un an plus tard, au 
moment T3. Résultats. 108 participants ont répondu aux enquêtes T1 et 27 
personnes ont participé aux entretiens qualitatifs. Plusieurs corrélations 
statistiquement significatives entre les indices d’engagement dans des activités 
significatives et le bien-être psychosocial ont été identifiées entre T1 et T3. 
L’activité significative a diminué de T1 à T3 [X2 (2, n = 49) = 9,110, p < 
0,05], avec un déclin significatif de T2 à T3 (z = −3,375, p < 0,001). Lors des 
entretiens qualitatifs à T1, les participants ont indiqué que la distanciation 
physique avait exacerbé l’exclusion des activités significatives au début de la 
pandémie. À T3 (un an plus tard), ils ont décrit comment les politiques de 
distanciation physique classistes et capacitistes avaient ajouté au fardeau de 
la vie quotidienne. Conséquences. L’engagement dans des activités significatives 
et le bien-être psychosocial sont étroitement liés et doivent être pris en 
compte dans l’élaboration de politiques pandémiques qui affectent les personnes 
à faible revenu. Les ergothérapeutes ont un rôle clé à jouer dans le 
rétablissement en lien avec la pandémie.

DOI: 10.1177/00084174231160950
PMCID: PMC10040486
PMID: 36959694 [Indexed for MEDLINE]


847. Trials. 2023 Mar 23;24(1):220. doi: 10.1186/s13063-023-07238-8.

Promoting mental health and well-being in schools: examining mindfulness, 
relaxation and strategies for safety and well-being in English primary and 
secondary schools-study protocol for a multi-school, cluster randomised 
controlled trial (INSPIRE).

Hayes D(1), Moore A(1), Stapley E(1), Humphrey N(2), Mansfield R(2), Santos 
J(2), Ashworth E(2), Patalay P(3), Bonin EM(4), Evans-Lacko S(5), Moltrecht 
B(1), Nisbet K(1), Thornton E(6), Lange A(1), Stallard P(7), Thompson A(1), 
Boehnke JR(8), Deighton J(9).

Author information:
(1)Evidence Based Practice Unit (EBPU), University College London and Anna Freud 
National Centre for Children and Families (AFNCCF), London, UK.
(2)Institute of Education, The University of Manchester, Manchester, UK.
(3)MRC Unit for Lifelong Health and Ageing and the Centre for Longitudinal 
Studies, University College London, London, UK.
(4)Personal Social Services Research Unit, London School of Economics and 
Political Science, London, UK.
(5)Care Policy and Evaluation Centre (CPEC), London School of Economics and 
Political Science, London, UK.
(6)Manchester Institute of Education, The University of Manchester, Manchester, 
UK.
(7)Department for Health, University of Bath, Bath, UK.
(8)School of Nursing and Health Sciences, University of Dundee, Dundee, UK.
(9)Evidence Based Practice Unit (EBPU), University College London and Anna Freud 
National Centre for Children and Families (AFNCCF), London, UK. 
EBPU@annafreud.org.

There are increasing rates of internalising difficulties, particularly anxiety 
and depression, being reported in children and young people in England. 
School-based universal prevention programmes are thought to be one way of 
helping tackle such difficulties. This paper describes an update to a four-arm 
cluster randomised controlled trial ( http://www.isrctn.com/ISRCTN16386254 ), 
investigating the effectiveness of three different interventions when compared 
to usual provision, in English primary and secondary pupils. Due to the COVID-19 
pandemic, the trial was put on hold and subsequently prolonged. Data collection 
will now run until 2024. The key changes to the trial outlined here include 
clarification of the inclusion and exclusion criteria, an amended timeline 
reflecting changes to the recruitment period of the trial due to the COVID-19 
pandemic and clarification of the data that will be included in the statistical 
analysis, since the second wave of the trial was disrupted due to COVID-19.Trial 
registration ISRCTN Registry ISRCTN16386254. Registered on 30 August 2018.

© 2023. The Author(s).

DOI: 10.1186/s13063-023-07238-8
PMCID: PMC10034911
PMID: 36959662 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


848. J Nutr. 2023 Apr;153(4):1244-1252. doi: 10.1016/j.tjnut.2023.01.010. Epub 2023 
Mar 21.

Joint Food and Water Insecurity Had a Multiplicative Effect on Women's 
Depression in Urban Informal Settlements in Makassar, Indonesia during the 
COVID-19 Pandemic.

Charles I(1), Salinger A(2), Sweeney R(3), Batagol B(4), Barker SF(5), Nasir 
S(6), Taruc RR(7), Francis N(4), Clasen T(8), Sinharoy SS(2); RISE consortium.

Author information:
(1)Hubert Department of Global Health, Rollins School of Public Health, 1518 
Clifton Rd NE, Emory University, Atlanta, GA, USA. Electronic address: 
icharle@emory.edu.
(2)Hubert Department of Global Health, Rollins School of Public Health, 1518 
Clifton Rd NE, Emory University, Atlanta, GA, USA.
(3)Center for Health Economics, Monash Business School, Monash University, 
Melbourne, Australia.
(4)Monash Sustainable Development Institute and Faculty of Law, Monash 
University, Melbourne, Australia.
(5)School of Public Health and Preventative Medicine, Faculty of Medicine, 
Nursing and Health Sciences, Monash University, Melbourne, Australia.
(6)Faculty of Public Health, Hasanuddin University, Makassar, Indonesia; 
Universitas Hasanuddin, Centre of Excellence for Interdisciplinary and 
Sustainability Sciences, Makassar, Indonesia.
(7)Faculty of Public Health, Hasanuddin University, Makassar, Indonesia.
(8)Gangarosa Department of Environmental Health, Rollins School of Public 
Health, Emory University, Atlanta, GA, USA.

Comment in
    J Nutr. 2023 Apr;153(4):922-923.

BACKGROUND: Women living in urban informal settlements may be particularly 
vulnerable to the detrimental effects of the COVID-19 pandemic because of 
increased economic and psychosocial stressors in resource-limited environments.
OBJECTIVES: The objective of this study was to assess the associations between 
food and water insecurity during the pandemic and depression among women living 
in the urban informal settlements in Makassar, Indonesia.
METHODS: We implemented surveys at 3 time points among women enrolled in the 
Revitalizing Informal Settlements and their Environments trial. Depression was 
measured using the Center for Epidemiologic Studies Depression Scale-10 
(CESD-10) between November and December 2019 and again between February and 
March 2021. Food insecurity was measured using questions from the Innovation for 
Poverty Action's Research for Effective COVID-19 Reponses survey and water 
insecurity was measured using the Household Water Insecurity Experiences Short 
Form. Both were measured between August and September 2020. We built 3 
multivariate quantile linear regression models to assess the effects of water 
insecurity, food insecurity, and joint food and water insecurity during the 
COVID-19 pandemic on CESD-10 score.
RESULTS: In models with the full sample (n = 323), food insecurity (β: 1.48; 95% 
CI: 0.79, 2.17), water insecurity (β: 0.13; 95% CI: -0.01, 0.26), and joint food 
and water insecurity (β: 2.40; 95% CI: 1.43, 3.38) were positively associated 
with CESD-10 score. In subgroup analyses of respondents for whom we had 
prepandemic CESD-10 scores (n = 221), joint food and water insecurity (β: 1.96; 
95% CI: 0.78, 3.15) maintained the strongest relationship with CESD-10 score. A 
limitation of this study is that inconsistency in respondents from households 
across the survey waves reduced the sample size used for this study.
CONCLUSIONS: Our results find a larger association between depression and joint 
resource insecurity than with water or food insecurity alone, underlining the 
importance of addressing food and water insecurity together, particularly as 
they relate to women's mental health and well-being.

Copyright © 2023 American Society for Nutrition. Published by Elsevier Inc. All 
rights reserved.

DOI: 10.1016/j.tjnut.2023.01.010
PMCID: PMC10028453
PMID: 36959077 [Indexed for MEDLINE]


849. PLoS One. 2023 Mar 23;18(3):e0282076. doi: 10.1371/journal.pone.0282076. 
eCollection 2023.

The importance of trust in the relation between COVID-19 information from social 
media and well-being among adolescents and young adults.

Hoffman AJ(1), McGuire L(2), Mathews CJ(3), Joy A(4), Law F(2), Drews M(5), 
Rutland A(2), Hartstone-Rose A(6), Winterbottom M(7), Mulvey KL(4).

Author information:
(1)Department of Psychology, Cornell University, Ithaca, New York, United States 
of America.
(2)Department of Psychology, University of Exeter, Exeter, United Kingdom.
(3)Department of Psychology, University of Virginia, Charlottesville, Virginia, 
United States of America.
(4)Department of Psychology, North Carolina State University, Raleigh, North 
Carolina, United States of America.
(5)EdVenture, Columbia, South Carolina, United States of America.
(6)Department of Biological Sciences, North Carolina State University, Raleigh, 
North Carolina, United States of America.
(7)Faculty of Education, University of Cambridge, Cambridge, United Kingdom.

During the COVID-19 pandemic, young people have been exposed to distressing 
content about COVID-19 without knowing whether they can trust such content. This 
indicates a need to examine the effects of social media use on mental health and 
well-being. Existing research provides an inconsistent impression of such 
effects. Thus, we examined the relation between exposure to COVID-19 information 
on social media and well-being and assessed if trust in COVID-19 information on 
social media moderated this relationship. The sample consisted of 168 
adolescents and young adults from the U.K. and U.S. (Mage = 17.4 years). 
Participants completed measures of exposure to, and trust in, COVID-19 
information on social media platforms, and measures of emotional, psychological, 
and social well-being. Results revealed a null to positive relation between 
exposure to COVID-19 information on social media and well-being across measures. 
However, when trust was added to the models as a moderator, results indicated 
that, for adolescents with higher levels of trust in COVID-19 information found 
on social media, the relation between information encountered on social media 
and well-being was positive. In contrast, for adolescents with lower levels of 
trust, the association between information encountered on social media and 
well-being was null or sometimes negative. Given the lack of consensus about the 
impact of social media use on well-being, these results point to the importance 
of trust when assessing the relationship between exposure to COVID-19 
information and well-being.

Copyright: © 2023 Hoffman et al. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0282076
PMCID: PMC10035839
PMID: 36952559 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


850. J Asthma. 2023 Oct;60(10):1809-1815. doi: 10.1080/02770903.2023.2188565. Epub 
2023 Apr 21.

A hierarchical cluster analysis of the psycological impact of the COVID-19 
pandemic on Italian severe asthma patients.

Guarnieri G(1), Chiurato L(2), Baiardini I(3), Caminati M(4), Senna G(4)(5), 
Scarpa B(2), Vianello A(1).

Author information:
(1)Department of Cardiac-Thoracic-Vascular Sciences and Public Health, 
Respiratory Pathophysiology Division, University of Padova, Padova, Italy.
(2)Department of Statistical Sciences, University of Padova, Padova, Italy.
(3)Allergy & Respiratory Diseases Department, Azienda Ospedaliera Universitaria 
IRCCS San Martino, Genoa, Italy.
(4)Department of Medicine, University of Verona and Verona University Hospital, 
Verona, Italy.
(5)Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy.

INTRODUCTION: In the context of COVID-19 pandemic, a consistent medical concern 
raised among severe asthma patients, though the studies excluded an increased 
risk of severe disease as well as an increased susceptibility.The aim of the 
study was to apply the Psychological General Well-Being Index (PGWBI) 
questionnaire to severe asthmatics during the COVID-19 pandemic and to evaluate 
the data with a hierarchical cluster analysis.
METHODS: 114 severe asthmatics were asked to respond anonymously to the PGWBI 
questionnaire. The patients underwent a lung functional test, fractional exhaled 
nitric oxide (FeNO) measurement, Asthma Control Test (ACT), and Asthma Control 
Questionnaire (ACQ6). A hierarchical cluster analysis was performed using an 
agglomerative approach and complete linkage to evaluate the results.
RESULTS: The study population predominantly included female (60%), middle-aged 
patients, with normal lung function parameters, mild signs of airway, and 
satisfactory asthma control. The PGWBI score (82.46 ± 16.53) of the study 
population showed a good state of psychological well-being and was similar to 
that of a representative sample of healthy adult Italian subjects. Thus, 
Hierarchical cluster analysis identified 3 groups of patients: Cluster 1 (32%), 
Cluster 2 (64%), and Cluster 3 (4%). Whilst the Cluster 2 patients' PGWBI score 
fell within the normal range, the Cluster 1 patients had a significantly lower 
total score (68.57 ± 7.2; p < 0.05), suggesting moderate distress. The Cluster 3 
patients presented a total score markedly low.
CONCLUSION: Although the majority of the severe asthma patients studied 
demonstrated good mental well-being during the COVID-19 pandemic, some did 
indeed show moderate to severe psychological distress.

DOI: 10.1080/02770903.2023.2188565
PMID: 36951668 [Indexed for MEDLINE]


851. Sichuan Da Xue Xue Bao Yi Xue Ban. 2023 Mar;54(2):217-222. doi: 
10.12182/20230260301.

[Challenges of and Responses to Mental Health Problems in the Post-COVID-19 
Era].

[Article in Chinese]

Su SZ(1), Gong YM(2), Zhao YM(3)(4), Ni SY(3)(4), Shi L(1), Bao YP(3)(4), Lu 
L(1)(2)(3).

Author information:
(1)Peking University Sixth Hospital, Peking University Institute of Mental 
Health, Key Laboratory of Mental Health of the National Health Commission 
(Peking University), and National Clinical Research Center for Mental Disorders, 
Beijing 100191, China.
(2)Peking-Tsinghua Center for Life Sciences, Academy for Advanced 
Interdisciplinary Studies, Peking University, Beijing 100191, China.
(3)National Institute on Drug Dependence, Peking University, Beijing 100191, 
China.
(4)School of Public Health, Peking University, Beijing 100191, China.

Since the first outbreak of the coronavirus disease 2019 (COVID-19), prevention 
and control of the pandemic remains a grim issue because of the continuous 
emergence of new variants of the severe acute respiratory syndrome coronavirus 2 
(SARS-CoV-2), the virus causing COVID-19, and the constant emergence of new 
domestic outbreaks. During the COVID-19 pandemic, mental and psychological 
problems have increased significantly among different populations, including 
patients of COVID-19 and their families, health workers, college students, 
adolescents, children, and even the general population. At present, the COVID-19 
epidemic situation in China is rather complicated. The general population is 
confronted with a variety of challenges, including the threat of infection or 
reinfection, lower efficiency in study and work, and reduced incomes, and is 
hence experiencing many mental health problems related to the epidemic 
situation. Therefore, the relevant governmental departments and health 
institutions in China have attached high importance to the mental health issue 
in the process of implementing pandemic control measures of COVID-19. Close 
collaboration to implement the required epidemic prevention and control 
measures, improvements in the mental health services for public health 
emergencies in China, and commitment to the protection of the mental health and 
well-being of the people in the post-pandemic era have become the top priorities 
for now. Based on a review of the mental health problems related to COVID-19 
pandemic, we suggested strategies to deal with mental health problems in the 
post-COVID-19 era.

新型冠状病毒感染疫情（新冠疫情）暴发以来，新型冠状病毒持续变异，国内新发疫情不断出现，疫情防控形势依然严峻。新冠疫情不仅会影响患者的精神心理健康，还会导致家属、医务人员、大学生、青少年、儿童、甚至普通人群的精神心理问题明显增加。目前我国新冠疫情形势复杂，公众面临着病毒感染或再次感染的新威胁和疫情对个人的工作、学习、经济收入等各方面的严重影响，与疫情相关的精神心理问题仍非常突出。我国政府相关部门和卫生机构在实施疫情防控工作过程中，非常重视公众的心理健康工作，如何紧密配合我国疫情防控要求，提高我国突发公共卫生事件精神心理卫生服务水平，保证后疫情时代下公众的心理健康状况和幸福水平是当前的一项重要任务。本文在总结前期新冠疫情相关的精神心理问题的基础上，提出后疫情时代精神心理问题的应对策略。

Copyright© by Editorial Board of Journal of Sichuan University (Medical 
Sciences).

DOI: 10.12182/20230260301
PMCID: PMC10409176
PMID: 36949675 [Indexed for MEDLINE]

Conflict of interest statement: 利益冲突　所有作者均声明不存在利益冲突


852. BMC Psychiatry. 2023 Mar 22;23(1):188. doi: 10.1186/s12888-023-04687-y.

Impact of the COVID-19 pandemic on the mental health and well-being of Veterans' 
spouses: a cross sectional analysis.

Hansen KT(1)(2), Plouffe RA(3)(4), Walker DL(3)(5), Wanklyn SG(3)(6), Lamrock 
L(7), Maher P(7), Nazarov A(3)(4)(8), Richardson JD(3)(4)(6)(8).

Author information:
(1)MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, 
London, ON, Canada. Kevin.Hansen@sjhc.london.on.ca.
(2)Department of Psychiatry, Western University, London, ON, Canada. 
Kevin.Hansen@sjhc.london.on.ca.
(3)MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, 
London, ON, Canada.
(4)Department of Psychiatry, Western University, London, ON, Canada.
(5)Department of Psychology, Western University, London, ON, Canada.
(6)St. Joseph's OSI Clinic, Parkwood Institute, St. Joseph's Health Care London, 
London, ON, Canada.
(7)The Atlas Institute for Veterans and Families, Ottawa, ON, Canada.
(8)Department of Psychiatry and Behavioural Neurosciences, McMaster University, 
Hamilton, ON, Canada.

BACKGROUND: COVID-19 has negatively impacted the mental health and well-being of 
both Canadians and the world as a whole, with Veterans, in particular, showing 
increased rates of depression, anxiety, and PTSD. Spouses and common-law 
partners often serve as primary caregivers and sources of support for Veterans, 
which may have a deleterious effect on mental health and increase risk of 
burnout. Pandemic related stressors may increase burden and further exacerbate 
distress; yet the effect of the pandemic on the mental health and well-being of 
Veterans' spouses is currently unknown. This study explores the self-reported 
mental health and well-being of a group of spouses of Canadian Armed Forces 
Veterans and their adoption of new ways to access healthcare remotely 
(telehealth), using baseline data from an ongoing longitudinal survey.
METHODS: Between July 2020 and February 2021, 365 spouses of Veterans completed 
an online survey regarding their general mental health, lifestyle changes, and 
experiences relating to the COVID-19 pandemic. Also completed were questions 
relating to their use of and satisfaction with health-care treatment services 
during the pandemic.
RESULTS: Reported rates of probable major depressive disorder (MDD), generalized 
anxiety disorder (GAD), alcohol use disorder (AUD), and PTSD were higher than 
the general public, with 50-61% believing their symptoms either directly related 
to or were made worse by the pandemic. Those reporting being exposed to COVID-19 
were found to have significantly higher absolute scores on mental health 
measures than those reporting no exposure. Over 56% reported using telehealth 
during the pandemic, with over 70% stating they would continue its use 
post-pandemic.
CONCLUSIONS: This is the first Canadian study to examine the impact of the 
COVID-19 pandemic specifically on the mental health and well-being of Veterans' 
spouses. Subjectively, the pandemic negatively affected the mental health of 
this group, however, the pre-pandemic rate for mental health issues in this 
population is unknown. These results have important implications pertaining to 
future avenues of research and clinical/programme development post-pandemic, 
particularly relating to the potential need for increased support for spouses of 
Veterans, both as individuals and in their role as supports for Veterans.

© 2023. The Author(s).

DOI: 10.1186/s12888-023-04687-y
PMCID: PMC10032243
PMID: 36949446 [Indexed for MEDLINE]

Conflict of interest statement: No potential conflicts of interest were reported 
by the study’s authors.


853. BMJ Open. 2023 Mar 22;13(3):e067166. doi: 10.1136/bmjopen-2022-067166.

Social support, distress and well-being in individuals experiencing Long-COVID: 
a cross-sectional survey study.

Lüscher J(1), Scholz U(2)(3), Bierbauer W(2)(3).

Author information:
(1)Swiss Paraplegic Research, Nottwil, Switzerland 
janina.luescher@paraplegie.ch.
(2)Department of Psychology, University of Zurich, Zurich, Switzerland.
(3)University Research Priority Program "Dynamics of Healthy Aging", University 
of Zurich, Zurich, Switzerland.

OBJECTIVES: Increasingly attention of the COVID-19 pandemic is directed towards 
its long-term effects, also known as Long-COVID. So far, Long-COVID was examined 
mainly from a medical perspective, leaving psychosocial effects of Long-COVID 
understudied. The present study advances the current literature by examining 
social support in the context of Long-COVID. The study not only examines 
received support reported by individuals with Long-COVID, but also provided 
support reported by relatives of individuals with Long-COVID.
DESIGN: Cross-sectional study.
SETTING: The study was conducted from June to October 2021 in Austria, Germany 
and the German-speaking part of Switzerland.
PARTICIPANTS: We examined 256 individuals with Long-COVID (MAge=45.05 years, 
90.2% women) and 50 relatives of individuals with Long-COVID (MAge=48.34 years, 
66.1% female) in two separate online surveys, assessing social support, 
well-being and distress.
PRIMARY OUTCOME MEASURES: Primary outcomes were positive and negative affect, 
anxiety and depressive symptoms and perceived stress.
RESULTS: For individuals with Long-COVID, receiving emotional support was 
related to higher well-being (positive affect: b=0.29, p<0.01; negative affect: 
b=-0.31, p<0.05) and less distress (anxiety: b=-1.45, p<0.01; depressive 
symptoms: b=-1.04, p<0.05; perceived stress: b=-0.21, p<0.05) but no effects 
emerged for receiving practical support. For relatives of individuals with 
Long-COVID, providing emotional support was only related to lower depressive 
symptoms (b=-2.57, p<0.05). Again, provided practical support was unrelated to 
the outcomes considered.
CONCLUSIONS: Emotional support is likely to play an important role in well-being 
and distress of patients and relatives, whereas practical support does not seem 
to make a difference. Future research should clarify under what conditions 
different kinds of support unfold their positive effects on well-being and 
distress in the context of Long-COVID.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2022-067166
PMCID: PMC10039976
PMID: 36948566 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


854. J Psychiatr Res. 2023 May;161:273-281. doi: 10.1016/j.jpsychires.2023.03.021. 
Epub 2023 Mar 16.

Psychological distress experienced by parents caring for an immunosuppressed 
child during the COVID-19 pandemic.

Driessens C(1), Mills L(2), Patel R(2), Culliford D(3), Gbesemete D(4), Lee 
E(2), Shaunak M(2), Chappell H(2), Faust SN(4), de Graaf H(4); ImmunoCOVID19 
study group (Appendix A).

Author information:
(1)NIHR Applied Research Collaboration Wessex, University of Southampton, 2 
Venture Rd, Chilworth, Southampton, SO16 7NP, UK. Electronic address: 
c.m.driessens@soton.ac.uk.
(2)NIHR Southampton Clinical Research Facility and Biomedical Research Centre, 
University Hospital Southampton NHS Foundation Trust Mailpoint 218, University 
Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, 
UK.
(3)NIHR Applied Research Collaboration Wessex, University of Southampton, 2 
Venture Rd, Chilworth, Southampton, SO16 7NP, UK.
(4)NIHR Southampton Clinical Research Facility and Biomedical Research Centre, 
University Hospital Southampton NHS Foundation Trust Mailpoint 218, University 
Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, 
UK; Faculty of Medicine and Institute for Life Sciences, University of 
Southampton, Southampton, SO16 6YD, UK.

The COVID-19 pandemic has proved unique in both its unpredictability and the 
extent to which it has continued to impact on daily life since March 2020. Among 
the immunosuppressed population the challenges of the COVID-19 pandemic are 
cumulative to the ever-present challenges of living with a long-term condition. 
This prospective longitudinal study explored patterns of concern experienced by 
467 British parents caring for an immunosuppressed child during the first 2 
years of the COVID-19 pandemic and related this to parental mental wellbeing. 
Most parents slowly adapted or were resilient to the ever-changing stressors of 
the COVID-19 pandemic. However, 12% experienced high levels of concern 
throughout the first 2 years of the pandemic. This group was also more likely to 
report emotional mental health problems towards the end of this period. The 
experience of emotional mental health problems among parents caring for an 
immunosuppressed child was related to low household income, single parenting, 
difficult access to greenspace, and higher level of exposure to COVID positive 
cases and COVID restrictions (North of England). Parents reported that optimism, 
reduction of isolation, and support promoted coping and management of the 
challenges of the COVID-19 pandemic. More reliable COVID information and 
periodic medical-condition-specific guidance would have been appreciated. These 
findings can increase clinical awareness of high-risk parental groups and make 
an important contribution to the planning of appropriate targeted psychological 
family interventions.

Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.jpsychires.2023.03.021
PMCID: PMC10017167
PMID: 36947958 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare no conflict of interest.


855. OMICS. 2023 Apr;27(4):180-190. doi: 10.1089/omi.2022.0182. Epub 2023 Mar 22.

Oral Microbiome, Mental Health, and Sleep Outcomes During the COVID-19 Pandemic: 
An Observational Study in Chinese and Korean American Immigrants.

Richardson BN(1)(2), Noh HI(1)(2), Webster CI(1)(2), Zhang W(1)(2), Kim S(1)(2), 
Yang I(1)(2), Bai J(1)(2).

Author information:
(1)Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, 
USA.
(2)Winship Cancer Institute, Emory University, Atlanta, Georgia, USA.

COVID-19 is a systemic disease whose effects are not limited to the respiratory 
system. The oral microbiome (OM)-brain axis is of growing interest in 
understanding the broader, neuropsychiatric, impacts of the COVID-19 pandemic 
through a systems biology lens. In this context, mental health and sleep 
disturbance are often reported by Asian Americans. In a cross-sectional 
observational study design, we examined the associations of the oral microbiome 
with mental health among Asian Americans during the COVID-19 pandemic (between 
November 2020 and April 2021). Participants (n = 20) were adult Chinese and 
Korean American immigrants in Atlanta, Georgia, and primarily born outside the 
United States (60%) with a mean age of 34.8 years ±14 (standard deviation). 
Participants reported depressive symptoms, anxiety, and sleep disturbance, as 
measured by standard questionnaires. The OM was characterized by 16S rRNA V3-V4 
gene using saliva. Depressive symptoms and anxiety were reported by 60% (n = 12) 
of participants, whereas 35% (n = 7) reported sleep disturbance. The α-diversity 
was significantly associated with depressive symptoms, and marginally with 
anxiety. Participants with depressive symptoms and anxiety had enriched Rothia 
and Scardovia, respectively, whereas those without symptoms had enriched 
Fusobacterium. Individuals with sleep disturbance had enriched Kingella. In 
conclusion, this study suggests significant associations of the OM diversity 
with certain mental health dimensions such as depressive symptoms and anxiety. 
Specific taxa were associated with these symptoms. The present observations in a 
modest sample size suggest the possible relevance of the OM-brain axis in 
studies of mental health during COVID-19.

DOI: 10.1089/omi.2022.0182
PMCID: PMC10122216
PMID: 36946910 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare they have no conflicting 
financial interests.


856. Nursing. 2023 Apr 1;53(4):54-61. doi: 10.1097/01.NURSE.0000920444.46279.2c.

Longitudinal depression screening of frontline critical care nurses during the 
COVID-19 pandemic: A mixed-methods study.

Draganic K(1), Denke L, Atem FD, Kershaw C, Williams K, England V.

Author information:
(1)At the University of Texas, Southwestern Medical Center in Dallas, Tex., Keri 
Draganic is an acute care nurse practitioner, Linda Denke is a nurse scientist, 
Corey Kershaw is the medical director of the Medical ICU, Kandace Williams is an 
adult gerontology acute care nurse practitioner, and Folefac D. Atem is the lead 
statistician. Victoria England is a retired associate CNO.

PURPOSE: To evaluate the severity and longitudinal trends of depression in 
critical care nurses caring for patients with COVID-19 in the US during a global 
pandemic.
METHODS: The study employed longitudinal mixed methods. Using the Patient Health 
Questionnaire (PHQ-9), nurses were sent electronic surveys at baseline, 1 month, 
and between 3 and 6 months to measure the severity and trends of depression 
during the prevaccination stage of the COVID-19 pandemic. One-on-one interviews 
were conducted with critical care nurses to evaluate their depressive symptoms.
RESULTS: Forty-eight nurses completed the questionnaire at baseline, 40 
completed 1-month surveys, and 20 completed the 3 to 6 month surveys. The mean 
PHQ-9 score was 5.85, 6.20, and 8.30 at baseline, at 1 month, and at 3 to 6 
months, respectively. PHQ-9 scores increased significantly over time (estimate = 
1.120, P = .037). The probability of participants being moderately to severely 
depressed was 0.980 (P = .049) at baseline, 0.990 (P = .013) at 1 month, and 1.0 
(P = .002) at 3 to 6 months. Fourteen nurses were included in a single, 
one-on-one interview. Eight major themes were found in qualitative analyses. For 
example, nurses expressed fear of spreading COVID-19 to their loved one and 
community. Common themes identified within the interviews included uncertainty, 
limited human interaction, fluctuations in mood, life is in my hands, a threat 
to others, positive and negative coping, nurses as scapegoats, and emerging 
vulnerability to COVID-19 exposure. All 14 nurses who were interviewed denied 
accessing any mental health services.
CONCLUSIONS: More research is needed to evaluate critical care nurses who care 
for patients with COVID-19 and their levels of depression to improve practice at 
the bedside further and develop policies to promote their well-being.

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/01.NURSE.0000920444.46279.2c
PMID: 36946641 [Indexed for MEDLINE]


857. F1000Res. 2022 Mar 1;11:253. doi: 10.12688/f1000research.74190.2. eCollection 
2022.

Global research on syndemics: a meta-knowledge analysis (2001-2020).

Hossain MM(1)(2), Saha N(3), Rodela TT(4), Tasnim S(1)(2), Nuzhath T(1)(2), Roy 
TJ(5), Burdine JN(2), Ahmed HU(6), McKyer ELJ(2), Basu BK(7), Ma P(2).

Author information:
(1)EviSyn Health, Khulna, Bangladesh.
(2)Department of Health Promotion and Community Health Sciences, Texas A&M 
Health Science Center, College Stataion, Texas, 77840, USA.
(3)Institute of Nutrition and Food Science, University of Dhaka, Dhaka, 
Bangladesh.
(4)Department of Economics, Mawlana Bhashani Science and Technology University, 
Tangail, Bangladesh.
(5)Institute of Information and Communication Technology, Khulna, Bangladesh.
(6)National Institute of Mental Health and Hospital, Dhaka, Bangladesh.
(7)Gazi Medical College, Khulna, Bangladesh.

BACKGROUND: Syndemics or synergies of cooccurring epidemics are widely studied 
across health and social sciences in recent years.
METHODS: We conducted a meta-knowledge analysis of articles published between 
2001 to 2020 in this growing field of academic scholarship.
RESULTS: We found a total of 830 articles authored by 3025 authors, mostly from 
high-income countries. Publications on syndemics are gradually increasing since 
2003, with rapid development in 2013. Each article was cited more than 15 times 
on average, and most (n = 604) articles were original studies. Syndemics 
research focused on several areas, including HIV/AIDS, substance abuse, mental 
health, gender minority stressors, racism, violence, chronic physical and mental 
disorders, food insecurity, social determinants of health, and coronavirus 
disease 2019. Moreover, biopsychosocial interactions between multiple health 
problems were studied across medical, anthropological, public health, and other 
disciplines of science.
CONCLUSIONS: The limited yet rapidly evolving literature on syndemics informs 
transdisciplinary interests to understand complex coexisting health challenges 
in the context of systematic exclusion and structural violence in vulnerable 
populations. The findings also suggest applications of syndemic theory to 
evaluate clinical and public health problems, examine the socioecological 
dynamics of factors influencing health and wellbeing, and use the insights to 
alleviate health inequities in the intersections of synergistic epidemics and 
persistent contextual challenges for population health.

Copyright: © 2023 Hossain MM et al.

DOI: 10.12688/f1000research.74190.2
PMCID: PMC10015119
PMID: 36936050 [Indexed for MEDLINE]

Conflict of interest statement: No competing interests were disclosed.


858. Cyberpsychol Behav Soc Netw. 2023 Apr;26(4):309-317. doi: 
10.1089/cyber.2022.0246. Epub 2023 Mar 20.

Promoting Emotional and Psychological Well-Being During COVID-19 Pandemic: A 
Self-Help Virtual Reality Intervention for University Students.

Malighetti C(1), Bernardelli L(2), Pancini E(3), Riva G(4)(5), Villani D(3).

Author information:
(1)Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.
(2)BECOME Srl, Milan, Italy.
(3)Research Center in Communication Psychology, Department of Psychology, 
Università Cattolica del Sacro Cuore, Milan, Italy.
(4)Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico 
Italiano (IRCCS), Milano, Italy.
(5)Humane Technology Lab, Università Cattolica del Sacro Cuore, Milan, Italy.

Mental health problems are very common among university students, and the 
situation worsened during the COVID-19 pandemic. The closure of universities, 
the restrictions imposed, and the reduction of social activities led to 
considerable changes in students' lives, thus posing new mental health and 
emotional challenges. Within this context, promoting university students' 
general well-being, in particular emotional and psychological well-being, 
becomes essential. In addition to the possibility of online interventions aimed 
at overcoming distance limitations and reaching people at their home, other 
advanced technologies such as virtual reality (VR) have demonstrated the 
potential to improve people's well-being, quality of life, and positive 
experiences. The study reported in this article is aimed at exploring the 
feasibility and preliminary effectiveness of a self-help VR intervention lasting 
3 weeks in promoting emotional well-being in university students. Forty-two 
university students voluntarily participated in a six-session intervention. In 
each session, a different virtual scenario was presented: two relaxing 
experiences and four transformative experiences based on metaphors or metaphoric 
ones aimed at encouraging students to be aware of their emotions and positive 
resources. Students were randomly allocated to an experimental group and to a 
waiting list group that started the intervention after 3 weeks. Before and after 
the six sessions, participants completed an assessment by completing online 
questionnaires. Results showed a significant increase in both emotional 
well-being and psychological well-being in the experimental group compared to 
the waiting list group. The majority of participants said that they would 
recommend the experience to other students.

DOI: 10.1089/cyber.2022.0246
PMID: 36940285 [Indexed for MEDLINE]


859. Ann Behav Med. 2023 May 23;57(6):483-488. doi: 10.1093/abm/kaac079.

Meaning Salience and Meaning in Life Prospectively Predict Lower Distress During 
the COVID-19 Pandemic.

Boylan JM(1), Vagnini KM(2), Rush CL(2), Larson EK(1), Adams M(1), Wilson CL(2), 
Shaffer JA(2), Masters KS(2).

Author information:
(1)Department of Health and Behavioral Sciences, University of Colorado Denver, 
Denver, CO, USA.
(2)Department of Psychology, University of Colorado Denver, Denver, CO, USA.

BACKGROUND: The COVID-19 pandemic is a widespread source of stress with adverse 
mental health impacts. Meaning in life, both as a trait and as momentary 
awareness of what is personally meaningful (meaning salience), is associated 
with positive health outcomes and may buffer against the deleterious effects of 
stress.
PURPOSE: This project examines prospective associations between baseline meaning 
salience (daily, post-laboratory stressor) and meaning in life with perceived 
stress during COVID-19.
METHODS: A community sample of healthy adults (n = 147) completed a laboratory 
stress protocol in 2018-2019, where perceived stress, meaning in life, and 
meaning salience (daily, post-stressor) were assessed. During April and July 
2020 (n = 95, and 97, respectively), participants were re-contacted and reported 
perceived stress. General linear mixed-effects models accounting for repeated 
measures of stress during COVID-19 were conducted.
RESULTS: Partial correlations holding constant baseline perceived stress showed 
that COVID-19 perceived stress was correlated with daily meaning salience (r = 
-.28), post-stressor meaning salience (r = -.20), and meaning in life (r = 
-.22). In mixed-effects models, daily and post-stressor meaning salience and 
higher meaning in life, respectively, predicted lower perceived stress during 
COVID-19, controlling for age, gender, and baseline perceived stress.
CONCLUSIONS: Individuals more capable of accessing meaning when exposed to 
laboratory stress reported lower perceived stress during a global health crisis. 
Despite study limitations concerning generalizability, results support meaning 
in life and meaning salience as important aspects of psychological functioning 
that may promote well-being by affecting stress appraisals and available 
resources for coping.

Plain Language Summary: The COVID-19 pandemic is a widespread source of stress. 
Having a sense of meaning in life, or that you have goals in life and a sense 
that the things you do are worthwhile and significant, is an important part of 
psychological well-being and might help reduce stress. We collected data on 147 
healthy adults in 2018–2019 regarding their stress levels, sense of meaning in 
life, and how often they were aware of their life’s meaning on daily basis and 
after a stress task in the laboratory. We re-contacted these adults in both 
April and July 2020 to ask about their stress, and 95 adults responded. Adults 
who had higher meaning in life in 2018–2019 experienced less stress during the 
early months of the COVID-19 pandemic. Adults who were more aware of their 
life’s meaning each day and immediately after a stress task in the laboratory 
also experienced less stress during the COVID-19 pandemic. Results from this 
study provide evidence that having a strong sense of meaning in life overall and 
being aware of your life’s meaning each day and during times of stress, may 
promote psychological well-being and reduce stress during times when stress is 
widespread and abundant.

© Society of Behavioral Medicine 2023. All rights reserved. For permissions, 
please e-mail: journals.permissions@oup.com.

DOI: 10.1093/abm/kaac079
PMID: 36940243 [Indexed for MEDLINE]


860. PLoS One. 2023 Mar 20;18(3):e0282946. doi: 10.1371/journal.pone.0282946. 
eCollection 2023.

A thematic analysis of shared experiences of essential health and support 
personnel in the COVID-19 pandemic.

Copel LC(1), Smeltzer SC(1), Byrne CD(1), Chen MH(2), Havens DS(1), Kaufmann 
P(1), Brom H(1), Durning JD(1)(3), Maldonado L(1), Bradley PK(1), Mensinger 
J(4), Yost J(1).

Author information:
(1)M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, 
Pennsylvania, United States of America.
(2)Department of Mathematics and Statistics, Villanova University, Villanova, 
Pennsylvania, United States of America.
(3)School of Nursing, Massachusetts General Hospital Institute of Health 
Professions, Charlestown, Massachusetts, United States of America.
(4)Department of Clinical and School Psychology, Nova Southeastern University, 
Fort Lauderdale, Florida, United States of America.

AIMS AND OBJECTIVES: Studies have shown that the COVID-19 pandemic has taken a 
toll on individuals who interact with patients with SARS-CoV-2 but focused 
largely on clinicians in acute care settings. This qualitative descriptive study 
aimed to understand the experiences and well-being of essential workers across 
settings during the pandemic.
BACKGROUND: Multiple studies of the well-being of individuals who have cared for 
patients during the pandemic have included interviews of clinicians from acute 
care settings and revealed high levels of stress. However, other essential 
workers have not been included in most of those studies, yet they may also 
experience stress.
METHODS: Individuals who participated in an online study of anxiety, depression, 
traumatic distress, and insomnia, were invited to provide a free-text comment if 
they had anything to add. A total of 2,762 essential workers (e.g., nurses, 
physicians, chaplains, respiratory therapists, emergency medical technicians, 
housekeeping, and food service staff, etc.) participated in the study with 1,079 
(39%) providing text responses. Thematic analysis was used to analyze those 
responses.
RESULTS: Four themes with eight sub-themes were: Facing hopelessness, yet 
looking for hope; Witnessing frequent death; Experiencing disillusionment and 
disruption within the healthcare system, and Escalating emotional and physical 
health problems.
CONCLUSIONS: The study revealed major psychological and physical stress among 
essential workers. Understanding highly stressful experiences during the 
pandemic is essential to identify strategies that ameliorate stress and prevent 
its negative consequences. This study adds to the research on the psychological 
and physical impact of the pandemic on workers, including non-clinical support 
personnel often overlooked as experiencing major negative effects.
RELEVANCE TO CLINICAL PRACTICE: The magnitude of stress among all levels of 
essential workers suggests the need to develop strategies to prevent or 
alleviate stress across disciplines and all categories of workers.

Copyright: © 2023 Copel et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0282946
PMCID: PMC10027207
PMID: 36940223 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


861. Front Psychiatry. 2023 Mar 1;14:1083693. doi: 10.3389/fpsyt.2023.1083693. 
eCollection 2023.

The other side of COVID-19: A cross-sectional study on mental health in a sample 
of Italian nurses during the second wave.

Renzi E(1), Imeshtari V(1), Masud D(2), Baccolini V(1), Migliara G(1), Gasperini 
G(3)(4), De Vito C(1), Marzuillo C(1), Villari P(1), Massimi A(1).

Author information:
(1)Department of Public Health and Infectious Diseases, Sapienza University of 
Rome, Rome, Italy.
(2)Emergency Department, Sandro Pertini Hospital, Rome, Italy.
(3)Department of Translational and Precision Medicine, Umberto I Teaching 
Hospital, Rome, Italy.
(4)Department of Biomedicine and Prevention, University of Rome Tor Vergata, 
Rome, Italy.

INTRODUCTION: The COVID-19 pandemic has led to a drastic increase in the 
workload of healthcare professionals, particularly nurses, with serious 
consequences for their psychological well-being. Our study aimed to identify 
demographic and work-related factors, as well as clinical predictors of 
post-traumatic stress disorder (PTSD) and generalized anxiety disorder (GAD), in 
nurses employed during the COVID-19 pandemic.
METHODS: We carried out a cross-sectional study between December 2020 and April 
2021 on nurses employed during the COVID-19 second wave (October - December 
2020). We evaluated PTSD and GAD using two validated questionnaires: i) the 
Impact of Event Scale - Revised (IES-R); and ii) General Anxiety Disorder -7 
(GAD-7).
RESULTS: Overall, 400 nurses, whose mean age was 34.3 years (SD ± 11.7), were 
included in the study. Most were female (78.5%), unmarried (58.5%) and employed 
in the central (61.5%) regions of Italy. A total of 56.8% of all participants 
had clinical predictors of PTSD, recording a median IES-R score (IQR) of 37.0 
(22.0, 51.0) (range 1-84; cut-off >33 for PTSD). Furthermore, 50% of respondents 
reported moderate-to-severe symptoms consistent with GAD, recording a median 
GAD-7 score (IQR) of 9.5 (6.0,14.0) (range 0-21; cut-off >10 for GAD). 
Multivariable analysis showed that moderate-to-severe GAD (aOR = 4.54, 95% CI: 
2.93 - 7.05), being employed in the critical care area (aOR = 1.74, 95% CI: 1.01 
- 3.00) and being female (aOR= 1.88, 95% CI: 1.09 - 3.22) were significantly 
associated with the presence of clinical predictors of PTSD.
DISCUSSION: The levels of PTSD symptoms and anxiety among nurses were high 
during the pandemic. PTSD and GAD represent a public health problem that should 
be addressed in the post-pandemic period. Healthcare organizations need to 
activate specific support and rehabilitation networks and programs for 
healthcare professionals employed during the COVID-19 pandemic.

Copyright © 2023 Renzi, Imeshtari, Masud, Baccolini, Migliara, Gasperini, De 
Vito, Marzuillo, Villari and Massimi.

DOI: 10.3389/fpsyt.2023.1083693
PMCID: PMC10015892
PMID: 36937741

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


862. Front Public Health. 2023 Mar 1;11:1010264. doi: 10.3389/fpubh.2023.1010264. 
eCollection 2023.

A Bayesian network analysis of psychosocial risk and protective factors for 
suicidal ideation.

Delgadillo J(1), Budimir S(2)(3), Barkham M(1), Humer E(2), Pieh C(2), Probst 
T(2).

Author information:
(1)Clinical and Applied Psychology Unit, Department of Psychology, University of 
Sheffield, Sheffield, United Kingdom.
(2)Department for Psychosomatic Medicine and Psychotherapy, Danube University 
Krems, Krems an der Donau, Austria.
(3)Department of Work, Organization and Society, Ghent University, Ghent, 
Belgium.

BACKGROUND: The aim of this study was to investigate and model the interactions 
between a range of risk and protective factors for suicidal ideation using 
general population data collected during the critical phase of the COVID-19 
pandemic.
METHODS: Bayesian network analyses were applied to cross-sectional data 
collected 1 month after the COVID-19 lockdown measures were implemented in 
Austria and the United Kingdom. In nationally representative samples (n = 1,005 
Austria; n = 1,006 UK), sociodemographic features and a multi-domain battery of 
health, wellbeing and quality of life (QOL) measures were completed. Predictive 
accuracy was examined using the area under the curve (AUC) within-sample 
(country) and out-of-sample.
RESULTS: The AUC of the Bayesian network models were ≥ 0.84 within-sample and 
≥0.79 out-of-sample, explaining close to 50% of variability in suicidal 
ideation. In total, 15 interrelated risk and protective factors were identified. 
Seven of these factors were replicated in both countries: depressive symptoms, 
loneliness, anxiety symptoms, self-efficacy, resilience, QOL physical health, 
and QOL living environment.
CONCLUSIONS: Bayesian network models had high predictive accuracy. Several 
psychosocial risk and protective factors have complex interrelationships that 
influence suicidal ideation. It is possible to predict suicidal risk with high 
accuracy using this information.

Copyright © 2023 Delgadillo, Budimir, Barkham, Humer, Pieh and Probst.

DOI: 10.3389/fpubh.2023.1010264
PMCID: PMC10014716
PMID: 36935710 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


863. Front Public Health. 2023 Mar 2;11:1028443. doi: 10.3389/fpubh.2023.1028443. 
eCollection 2023.

Concerns, perceived impact, practices, preventive measures, and stress among 
healthcare workers during COVID-19 pandemic in Malaysia.

Pahrol MA(1), Ismail R(1), Mohamad N(1), Lim YC(1)(2), Muhamad Robat R(1), 
Rajendiran S(1), Syed Abu Thahir S(1), Abdul Shakor AS(3), Ramly N(1)(4), 
Shaharudin R(1).

Author information:
(1)Environmental Health Research Centre, Institute for Medical Research, 
National Institutes of Health, Ministry of Health of Malaysia, Shah Alam, 
Malaysia.
(2)Department of Social and Preventive Medicine, Faculty of Medicine, University 
of Malaya, Kuala Lumpur, Malaysia.
(3)Surveillance and Preparedness Unit, Public Health Division, Selangor State 
Health Department, Ministry of Health Malaysia, Shah Alam, Malaysia.
(4)Department of Community Health, Faculty of Medicine, Universiti Kebangsaan 
Malaysia, Kuala Lumpur, Malaysia.

INTRODUCTION: Healthcare workers (HCWs) have been continually exposed to 
patients with COVID-19 and are at higher risk of contracting the disease. Their 
psychological health is important for overall wellbeing and productivity, which 
could lead to a reduction in human errors during the pandemic crisis. This study 
aimed to measure the level of concerns, work practices, adequacy of preventive 
measures among HCWs, and the impacts on their life and work, including mental 
health status during the second wave of the COVID-19 pandemic in Malaysia.
METHODS: An online questionnaire was distributed randomly to 1,050 HCWs from the 
Ministry of Health facilities in the Klang Valley who were involved directly in 
managing or screening COVID-19 cases from May to August 2020. The questionnaire 
was divided into five domains, which were concerns, impact on life and work, 
practice, perceived adequacy of preventive measures, and Revised Impact of Event 
Scale (IES-R). Logistic regression was used to identify sociodemographic 
predictors of the five domains.
RESULTS: A total of 907 respondents (86.4%) participated in this survey. 
Approximately half of the respondents had a low concern (50.5%), most of them 
had a good practice (85.1%), with 67.5% perceiving there were adequate 
preventive measures, and they perceived the outbreak had a low impact (92%) on 
their life and work. From the IES-R domain, 18.6% of respondents potentially 
suffered from post-traumatic stress disorder (PTSD).
CONCLUSION: During the second wave of the COVID-19 outbreak in Malaysia, HCWs 
practiced high levels of precautions and preventive measures because they were 
aware of the risk of infection as an occupational hazard. With the adequate 
implementation of policy and control measures, the psychological wellbeing of 
the majority HCWs remained well and adequately supported.

Copyright © 2023 Pahrol, Ismail, Mohamad, Lim, Muhamad Robat, Rajendiran, Syed 
Abu Thahir, Abdul Shakor, Ramly and Shaharudin.

DOI: 10.3389/fpubh.2023.1028443
PMCID: PMC10018122
PMID: 36935685 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


864. Front Public Health. 2023 Mar 3;11:1049497. doi: 10.3389/fpubh.2023.1049497. 
eCollection 2023.

The mental wellbeing of prison staff in England during the COVID-19 pandemic: A 
cross-sectional study.

Johnson L(1), Czachorowski M(1)(2), Gutridge K(3), McGrath N(1)(4), Parkes J(1), 
Plugge E(1)(2).

Author information:
(1)School of Primary Care, Population Sciences and Medical Education, University 
of Southampton, Southampton, United Kingdom.
(2)Vulnerable People and Inclusion Health Directorate, UK Health Security 
Agency, London, United Kingdom.
(3)Division of Psychology and Mental Health, School of Health Sciences, Faculty 
of Biology, Medicine and Health, Centre for Women's Mental Health, Manchester 
Academic Health Science Centre, University of Manchester, Manchester, United 
Kingdom.
(4)Department of Social Statistics and Demography, Faculty of Social Sciences, 
University of Southampton, Southampton, United Kingdom.

BACKGROUND: COVID-19 is likely to have had an impact on the mental wellbeing of 
prison staff because of the high risk for infectious disease outbreaks in 
prisons and the pre-existing high burden of mental health issues among staff.
METHODS: A cross-sectional study of staff within 26 prisons in England was 
carried out between 20th July 2020 and 2nd October 2020. Mental wellbeing was 
measured using the Short-version of Warwick-Edinburgh Wellbeing Scale (SWEMWBS). 
Staff wellbeing was compared to that of the English population using indirectly 
standardised data from the Health Survey for England 2010-13 and a one-sample 
t-test. Multivariate linear regression modelling explored associations with 
mental wellbeing score.
RESULTS: Two thousand five hundred and thirty-four individuals were included 
(response rate 22.2%). The mean age was 44 years, 53% were female, and 93% were 
white. The sample mean SWEMWBS score was 23.84 and the standardised population 
mean score was 23.57. The difference in means was statistically significant (95% 
CI 0.09-0.46), but not of a clinically meaningful level. The multivariate linear 
regression model was adjusted for age category, sex, ethnicity, smoking status, 
occupation, and prison service region. Higher wellbeing was significantly 
associated with older age, male sex, Black/Black British ethnicity, never having 
smoked, working within the health staff team, and working in certain prison 
regions.
INTERPRETATION: Unexpectedly, prison staff wellbeing as measured by SWEMWBS was 
similar to that of the general population. Reasons for this are unclear but 
could include the reduction in violence within prisons since the start of the 
pandemic. Qualitative research across a diverse sample of prison settings would 
enrich understanding of staff wellbeing within the pandemic.

Copyright © 2023 Johnson, Czachorowski, Gutridge, McGrath, Parkes and Plugge.

DOI: 10.3389/fpubh.2023.1049497
PMCID: PMC10020237
PMID: 36935673 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


865. BMC Psychol. 2023 Mar 20;11(1):75. doi: 10.1186/s40359-023-01126-1.

A study of COVID anxiety, spiritual well-being and resilience levels in patients 
with cancer undergoing chemotherapy during the COVID-19 pandemic: a 
cross-sectional study in the south of Iran.

Khiyali Z(1), Naderi Z(2), Vakil M(3), Ghasemi H(4), Dehghan A(3), Bijani M(5).

Author information:
(1)Department of Gerontology, University of Social Welfare and Rehabilitation 
Science, Tehran, Iran.
(2)Department of Nursing, Sirjan School of Medical Sciences, Sirjan, Iran.
(3)Noncommunicable Diseases Research Center (NCDRC), Fasa University of Medical 
Sciences, Fasa, Iran.
(4)Department of Medical Surgical Nursing, School of Nursing, Fasa University of 
Medical Sciences, Fasa, 81936-13119, Iran.
(5)Department of Medical Surgical Nursing, School of Nursing, Fasa University of 
Medical Sciences, Fasa, 81936-13119, Iran. bizhani_mostafa@yahoo.com.

BACKGROUND: Patients with cancer are at higher risk of contracting COVID-19 with 
poor prognosis. Therefore, the present study was conducted to investigate 
anxiety, spiritual well-being, and resilience levels in patients with cancer 
undergoing chemotherapy during the COVID-19 pandemic in the south of Fars 
Province, Iran.
METHODS: This is a descriptive study with a cross-sectional design conducted on 
the patients undergoing chemotherapy at Dr. Ali Shariati Hospital in Fasa from 
November 2021 to February 2022. Cancer patients undergoing chemotherapy were 
included in the study by census method. Out of 210 patients, 155 participated in 
the study. Data were collected electronically using the standard instruments of 
Ellison's Spiritual Well-being Scale, COVID-19 anxiety questionnaire, and 
Connor-Davidson resilience scale. The collected data were analyzed in SPSS 22 
using descriptive statistics, Pearson correlation tests, T-test, ANOVA and 
multivariate linear regression at a level of significance of P < 0.05.
RESULTS: The participants' resilience mean score was 46.35 ± 26.51 and their 
spiritual well-being mean score was 69.58 ± 9.32. In addition, their COVID 
anxiety mean, score was found to be 16.85 ± 10.51. The results showed a 
significant direct correlation between the patients' spiritual well-being and 
resilience (r = 0.47, P < 0.001) and a significant inverse correlation between 
the patients' spiritual well-being and COVID-19-related anxiety (r = - 0.275, 
P < 0.001). In addition, there was a significant inverse correlation between the 
variables of resilience and COVID-19-related anxiety (r = - 0.637, P < 0.001). 
Based on multivariate linear regression, the most common predictors in 
resilience were age and history of infection with COVID-19, and in spiritual 
health and anxiety, was a history of infection with COVID-19.
CONCLUSION: Enhancement of spiritual well-being and resilience in patients 
should be an integral part of care as these qualities are valuable resources in 
fighting cancer and lowering patients' anxiety, especially during the COVID-19 
pandemic.

© 2023. The Author(s).

DOI: 10.1186/s40359-023-01126-1
PMCID: PMC10025065
PMID: 36935528 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


866. J Affect Disord. 2023 Jun 15;331:393-404. doi: 10.1016/j.jad.2023.03.027. Epub 
2023 Mar 16.

Suicide, self-harm, and suicide ideation in nurses and midwives: A systematic 
review of prevalence, contributory factors, and interventions.

Groves S(1), Lascelles K(1), Hawton K(2).

Author information:
(1)Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford OX3 7JX, 
United Kingdom of Great Britain and Northern Ireland.
(2)Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford OX3 7JX, 
United Kingdom of Great Britain and Northern Ireland; Centre for Suicide 
Research, University Department of Psychiatry, Warneford Hospital, Oxford OX3 
7JX, United Kingdom of Great Britain and Northern Ireland. Electronic address: 
keith.hawton@psych.ox.ac.uk.

BACKGROUND: Nurses have been identified as an occupational group at increased 
risk of suicide. This systematic review examines the prevalence of, and factors 
influencing, suicide and related behaviours among nurses and midwives (PROSPERO 
pre-registration CRD42021270297).
METHODS: MEDLINE, PsycINFO, and CINAHL were searched. Articles published from 
1996 onwards exploring suicidal thoughts and behaviours among nurses and 
midwives were included. Quality of included studies was assessed. Articles were 
subjected to narrative synthesis informed by suicide data examined, study 
design, and quality. PRISMA guidelines were followed.
RESULTS: A total of 100 studies were eligible for inclusion in the review. 
Articles examining suicide exclusively among midwives were absent from the 
literature. Several studies confirmed that nursing professionals, especially 
female, are at increased risk of suicide, particularly by self-poisoning. 
Factors contributing to risk include psychiatric disorders, alcohol and 
substance misuse, physical health problems, and occupational and interpersonal 
difficulties. In studies of non-fatal suicidal behaviours, including during the 
COVID-19 pandemic, psychiatric, psychological, physical and occupational factors 
were contributory. There has been little investigation of interventions for 
prevention of suicide in nurses.
LIMITATIONS: Only articles published in English language were reviewed.
CONCLUSIONS: The findings highlight the risk of suicide in nurses. They also 
show a combination of factors contribute to suicide and non-fatal suicidal 
behaviour in nurses, with psychiatric, psychological, physical health, 
occupational and substance misuse (especially alcohol) problems being 
particularly important. The limited evidence regarding prevention measures 
indicates a major need to develop primary and secondary interventions for this 
at-risk occupational group, for example, education regarding enhancing wellbeing 
and safe alcohol use, alongside accessible psychological support.

Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2023.03.027
PMID: 36933670 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest KH declares grants from the 
National Institute for Health Research and the Department of Health and Social 
Care. He is a member of the National Suicide Prevention Strategy for England 
Advisory Group and is a National Institute for Health Research (NIHR) Senior 
Investigator (Emeritus). All other authors declare no competing interests. The 
views expressed are those of the authors and not necessarily those of the NHS, 
NHSE, NIHR, or the Department of Health and Social Care.


867. BMC Psychiatry. 2023 Mar 17;23(1):178. doi: 10.1186/s12888-023-04665-4.

Cost-utility analysis of the UPRIGHT intervention promoting resilience in 
adolescents.

Mar J(1)(2)(3), Larrañaga I(4)(5), Ibarrondo O(4)(6), González-Pinto 
A(7)(8)(9)(10), Hayas CL(5)(11), Fullaondo A(5), Izco-Basurko I(5), Alonso 
J(11)(12)(13), Zorrilla I(8)(9)(10)(14), Fernández-Sevillano J(9)(10)(14), de 
Manuel E(5); UPRIGHT Consortium.

Collaborators: González N, Mateo-Abad M, Martínez PP, Vergara I, Gabrielli S, 
Rizzi S, Zwiefka A, Krzyżanowski D, Mazur I, Jakubowska L, Poteralska R, Czyż P, 
Andruszko U, Błasiak P, Krajewska K, Pytlarz G, Szczygieł-Grüdl I, Hjemdal O, 
Morote R, Anyan F, Gudmundsdottir DG, Karlsdottir S, Knoop HH, Ledertoug MM, 
Tidmand L, Olafsdottir AS, Arnfjord UB, Jonsdottir BJ.

Author information:
(1)Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, 
Research Unit, Arrasate-Mondragón, Spain. 
franciscojavier.marmedina@osakidetza.eus.
(2)Biodonostia Health Research Institute, Donostia-San Sebastián, Spain. 
franciscojavier.marmedina@osakidetza.eus.
(3)Kronikgune Institute for Health Services Research, Barakaldo, Spain. 
franciscojavier.marmedina@osakidetza.eus.
(4)Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, 
Research Unit, Arrasate-Mondragón, Spain.
(5)Kronikgune Institute for Health Services Research, Barakaldo, Spain.
(6)Biodonostia Health Research Institute, Donostia-San Sebastián, Spain.
(7)Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, 
Spain.
(8)University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain.
(9)CIBER en Salud Mental (CIBERSAM), Madrid, Spain.
(10)Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain.
(11)Health Services Research Group, IMIM- Institut Hospital del Mar 
d'Investigacions Mèdiques, Barcelona, Spain.
(12)CIBER en Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain.
(13)Pompeu Fabra University (UPF), Barcelona, Spain.
(14)University of Deusto, Department of Medicine, Bilbao, Spain.

BACKGROUND: As mental health in adulthood is related to mental status during 
adolescence, school-based interventions have been proposed to improve 
resilience. The objective of this study was to build a simulation model 
representing the natural history of mental disorders in childhood, adolescence 
and youth to estimate the cost-effectiveness of the UPRIGHT school-based 
intervention in promoting resilience and mental health in adolescence.
METHODS: We built a discrete event simulation model fed with real-world data 
(cumulative incidence disaggregated into eight clusters) from the Basque Health 
Service database (609,381 individuals) to calculate utilities (quality-adjusted 
life years [QALYs]) and costs for the general population in two scenarios (base 
case and intervention). The model translated changes in the wellbeing of 
adolescents into different risks of mental illnesses for a time horizon of 
30 years.
RESULTS: The number of cases of anxiety was estimated to fall by 5,125 or 9,592 
and those of depression by 1,269 and 2,165 if the effect of the intervention 
lasted 2 or 5 years respectively. From a healthcare system perspective, the 
intervention was cost-effective for all cases considered with incremental 
cost-utility ratios always lower than €10,000/QALY and dominant for some 
subgroups. The intervention was always dominant when including indirect and 
non-medical costs (societal perspective).
CONCLUSIONS: Although the primary analysis of the trial did not did not detect 
significant differences, the UPRIGHT intervention promoting positive mental 
health was dominant in the economic evaluation from the societal perspective. 
Promoting resilience was more cost-effective in the most deprived group. Despite 
a lack of information about the spillover effect in some sectors, the economic 
evaluation framework developed principally for pharmacoeconomics can be applied 
to interventions to promote resilience in adolescents. As prevention of mental 
health disorders is even more necessary in the post-coronavirus disease-19 era, 
such evaluation is essential to assess whether investment in mental health 
promotion would be good value for money by avoiding costs for healthcare 
providers and other stakeholders.

© 2023. The Author(s).

DOI: 10.1186/s12888-023-04665-4
PMCID: PMC10022565
PMID: 36932364 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no biomedical financial 
interests or potential conflicts of interest to declare.


868. BMJ Open. 2023 Mar 17;13(3):e066013. doi: 10.1136/bmjopen-2022-066013.

Effect of date seed (Phoenix dactylifera) supplementation as functional food on 
cardiometabolic risk factors, metabolic endotoxaemia and mental health in 
patients with type 2 diabetes mellitus: a blinded randomised controlled trial 
protocol.

Mohammadi Zadeh M(1), Dehghan P(2), Eslami Z(3).

Author information:
(1)Student Research Committee, Faculty of Nutrition and Food Science, Tabriz 
University of Medical Sciences, Tabriz, Iran.
(2)Nutrition Research Center, Department of Biochemistry and Diet Therapy, 
Faculty of Nutrition and Food Science, Tabriz University of Medical Sciences, 
Tabriz, Iran dehghan.nut@gmail.com.
(3)Department of Nutrition, Kerman University of Medical Sciences, Kerman, Iran.

INTRODUCTION: Recently, the improvement of chronic hyperglycaemia-related damage 
of type 2 diabetes mellitus (T2DM) through functional food consumption has 
attracted the attention of many clinicians. This study aims to determine the 
effectiveness of date seed powder (DSP) as a functional food (prebiotic) on the 
cardiometabolic risk factors, oxidative stress, anti-/inflammatory biomarkers, 
metabolic endotoxaemia (gut microbiota), adipokines, 
hypothalamic-pituitary-adrenal axis biomarkers, immune system, anthropometric 
indices and mental health in patients with T2DM.
METHODS: This study protocol will be conducted as randomised, triple-blind, 
placebo-controlled trial with the inclusion of 48 patients with T2DM. The 
participants will be randomly assigned into two equal groups of intervention 
(n=24) and placebo (n=24) and receive 5 g/day of DSP or placebo for 8 weeks, 
respectively. At baseline and post-intervention, fasting blood samples will be 
collected to assess the serum levels of lipid profile, glycaemic indices, 
antioxidant and oxidative stress, anti-/inflammatory biomarkers, 
lipopolysaccharide, 8-hydroxy-guanine, adipokines, 
hypothalamic-pituitary-adrenal axis biomarkers, immune system and mental health. 
Data will be analysed using the SPSS software (V.16.0). To compare the 
quantitative variables, paired and unpaired Student's t-tests and covariance 
analyses will be used.
DISCUSSION: In this study, the potential effects of DSP on patients with T2DM 
will be evaluated for the first time. It is hoped that the results would 
increase the body of scientific knowledge about DSP supplementation on the 
cardiometabolic risk factors, oxidative stress, anti-/inflammatory biomarkers, 
metabolic endotoxaemia, adipokines, hypothalamic-pituitary-adrenal axis 
biomarkers, immune system, anthropometric indices and mental health in patients 
with T2DM.
ETHICS AND DISSEMINATION: The study protocol was approved by the Ethical 
Committee of the Tabriz University of Medical Sciences, Tabriz, Iran (code: 
IR.TBZMED.REC.1400.752).
TRIAL REGISTRATION NUMBER: Iranian Registry of Clinical Trials 
(www.irct.ir/IRCT20150205020965N10).

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2022-066013
PMCID: PMC10030472
PMID: 36931666 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


869. Lancet. 2022 Nov;400 Suppl 1:S63. doi: 10.1016/S0140-6736(22)02273-5. Epub 2022 
Nov 24.

How did female survivors of abuse use the arts to support their mental health 
and wellbeing during the COVID-19 pandemic? A qualitative exploration of their 
views.

McKinlay AR(1), Collins L(2), Fancourt D(3), Burton A(3).

Author information:
(1)Research Department of Behavioural Science and Health, Institute of 
Epidemiology & Health Care, University College London, London, United Kingdom. 
Electronic address: a.mckinlay@ucl.ac.uk.
(2)Arts and Sciences Department, Faculty of Arts and Humanities, University 
College London, London, United Kingdom.
(3)Research Department of Behavioural Science and Health, Institute of 
Epidemiology & Health Care, University College London, London, United Kingdom.

BACKGROUND: Gender-based violence is an important public health issue that has 
been exacerbated by the COVID-19 pandemic. Survivors often face barriers when 
seeking support for mental health and wellbeing and some find therapeutic value 
in creative arts. We aimed to explore how women with experiences of abuse used 
art during the pandemic to support mental health and wellbeing.
METHODS: In two small, exploratory, qualitative studies, we conducted 
semi-structured online interviews with women aged 18 years or older, who had 
experienced gender-based violence, were currently safe from abuse, and were not 
living with someone who had been abusive. Women who were unable to speak, read, 
and understand study documentation in English were excluded. We recruited 
participants through our networks, third-sector services, and via social media. 
Interview questions asked participants about interest in the arts as a support 
tool for mental health after abuse and strategies used during the pandemic to 
support mental health or wellbeing. ARM analysed the dataset using reflexive 
thematic analysis using Nvivo.
FINDINGS: We enrolled 20 women aged 24-61 years; 17 participants (85%) 
identified as White British. Interviews were conducted between April 16, 2021, 
and March 1, 2022. Participants reported using drawing, writing, singing, music, 
painting, and online art or craft groups to support their mental health and 
wellbeing during the pandemic. Participants said they were motivated at the 
start of the first UK lockdown to engage with creative arts as a way of 
practising mindfulness and self-reflection; providing calmness, escapism, and 
distraction; reducing boredom; and combating loneliness and social isolation. 
Although self-isolating, the social element of online art groups provided 
valuable opportunities for chat with others who shared similar lived 
experiences.
INTERPRETATION: Creative arts provided a valuable resource for participants to 
self-manage their mental health and wellbeing during the pandemic. Connecting 
with others who had similar experiences of abuse supported coping and feelings 
of certainty. We conclude with a working example of how online platforms could 
provide avenues of support and community.
FUNDING: Wellcome Trust.

Copyright © 2022 Elsevier Ltd. All rights reserved.

DOI: 10.1016/S0140-6736(22)02273-5
PMCID: PMC9691072
PMID: 36930010 [Indexed for MEDLINE]


870. Lancet. 2022 Nov;400 Suppl 1:S59. doi: 10.1016/S0140-6736(22)02269-3. Epub 2022 
Nov 24.

Social return on investment of face-to-face versus online lifestyle coaching to 
improve mental wellbeing.

Makanjuola A(1), Lynch M(2), Hartfiel N(3), Cuthbert A(4), Wheeler HT(5), 
Edwards RT(3).

Author information:
(1)Centre for Health Economics and Medicines Evaluation, School of Human and 
Behavioural Sciences, Bangor University, Bangor, UK. Electronic address: 
a.makanjuola@bangor.ac.uk.
(2)Hamilton International Technology Park, University of West Scotland, South 
Lanarkshire, UK.
(3)Centre for Health Economics and Medicines Evaluation, School of Human and 
Behavioural Sciences, Bangor University, Bangor, UK.
(4)College of Biomedical and Life Sciences, School of Medicine, Cardiff 
University, Cardiff, UK.
(5)EmotionMind Dynamic, Llanelli, UK.

BACKGROUND: The percentage of people in Wales experiencing severe mental health 
issues more than doubled during the COVID-19 pandemic. Additionally, hundreds of 
people in Wales wait more than a year for help with their mental health. The 
EmotionMind Dynamic (EMD) programme is a six-session programme over 3 months 
involving self-reflective introspection, self-analysis, problem solving, goal 
setting, and action taking. Furthermore, this programme challenges negative 
self-perception and increases self-awareness, self-confidence, and self-esteem. 
We aimed to estimate the social return on investment of EMD lifestyle coaching, 
both face-to-face and online formats, by comparing the costs of running the 
programme with the social value generated from clients as measured by 
improvement in self-confidence and mental wellbeing.
METHODS: We included 15 clients from previous face-to-face EMD coaching and 17 
clients from a new online version of EMD. For face-to-face clients, quantitative 
data were collected retrospectively with a one-time only questionnaire. For new 
online clients, quantitative data were collected from baseline and follow-up 
questionnaires. Qualitative data were collected after intervention from 
interviews with both groups. Outcomes from questionnaires for both groups 
included changes in mental wellbeing measured with the Short Warwick Edinburgh 
Mental Wellbeing Scale (SWEMWBS) and self-efficacy assessed with the General 
Self-Efficacy Scale (GSES).
FINDINGS: For every £1 invested, lifestyle coaching generated social values 
ranging from £4·12 to £7·08 for face-to-face clients compared with £2·37 to 
£3·35 for online participants. Quantitative and qualitative data from 
questionnaires and interviews indicated that many clients had improved mental 
wellbeing and self-efficacy. All 15 face-to-face clients and 11 (65%) of 17 
online clients reported an increase of 5 points or more on the SWEMWBS 
questionnaire. Similarly, all 15 face-to-face clients and ten (59%) of 17 online 
clients reported an increase of 5 points or more on the GSES questionnaire.
INTERPRETATION: The results showed that both face-to-face and online formats of 
the EMD lifestyle coaching generated a positive social return on investment 
ratios. With continued long waiting lists for people with mental health 
challenges, face-to-face and online lifestyle coaching might become more 
essential across statutory, private, and third sectors to meet the growing 
demand for mental health support.
FUNDING: Accelerate: the Welsh Health Innovation and Technology Accelerator.

Copyright © 2022 Elsevier Ltd. All rights reserved.

DOI: 10.1016/S0140-6736(22)02269-3
PMCID: PMC9691048
PMID: 36930005 [Indexed for MEDLINE]


871. Lancet. 2022 Nov;400 Suppl 1:S43. doi: 10.1016/S0140-6736(22)02253-X. Epub 2022 
Nov 24.

Mental health of the nursing and midwifery workforce in Wales during the 
COVID-19 pandemic: a cross-sectional analysis.

Gray BJ(1), Kyle RG(2), Challenger A(3), Davies AR(4).

Author information:
(1)Research and Evaluation Division, Knowledge Directorate, Public Health Wales, 
Cardiff, UK. Electronic address: benjamin.gray@wales.nhs.uk.
(2)Academy of Nursing, University of Exeter, Exeter, UK.
(3)School of Psychology, Cardiff University, Cardiff, UK.
(4)Research and Evaluation Division, Knowledge Directorate, Public Health Wales, 
Cardiff, UK.

BACKGROUND: The mental health of the nursing and midwifery workforce in the UK 
became a public health concern before the COVID-19 pandemic. Poor mental health 
is a known factor for those considering leaving the profession, and workforce 
retention of younger members is crucial for the future of the sector. The aim of 
this study was to provide up-to-date estimates of mental wellbeing in this 
workforce in Wales during the COVID-19 pandemic.
METHODS: We did a cross-sectional analysis of demographics, work-related 
information, and health data from respondents to a national online survey of 
registered and student nurses and midwives and health-care support workers in 
Wales. The survey was open between June 23 and Aug 9, 2021, and 2910 people 
responded (approximately 7% of the workforce). Mental wellbeing was calculated 
using the Short Warwick Edinburgh Mental Wellbeing Score (SWEMWBS). We measured 
probable clinical depression (SWEMWBS <18) and possible mild depression (SWEMWBS 
18-20). We used χ2 analysis and multinomial logistic regression (adjusted for 
sex and staff grouping) to examine associations between age groups and mental 
wellbeing.
FINDINGS: We analysed data from 2781 (95·6%) of 2910 respondents (129 
respondents did not answer all seven SWEMWBS questions). Overall, 1622 (58·3%) 
of 2781 respondents had SWEMWBSs indicative of either probable clinical 
depression (863 [31·0%] of 2781) or possible mild depression (759 [27·3%] of 
2781). Probable clinical depression was highest among those aged 18-29 years 
(180 [33·8%] of 532), 30-39 years (250 [35·6%] of 703), and 40-49 years (233 
[33·5%] of 696). Respondents in these age groups were twice as likely to report 
SWEMWBSs indicative of probable clinical depression than respondents aged 60 
years and older (18-29 years adjusted odds ratio [aOR] 2·38 [95% CI 1·43-3·97], 
p=0·0009; 30-39 years aOR 2·86 [1·77-4·64], p<0·0001; 40-49 years aOR 2·49 
[1·54-4·02], p=0·0002).
INTERPRETATION: This study highlights the substantial burden of poor mental 
wellbeing among the nursing and midwifery workforce in Wales, especially in 
those aged 49 years and younger. These figures, higher than previous estimates, 
could reflect the mental health effect of responding to the pandemic and could 
have long-term implications on workforce retention.
FUNDING: None.

Copyright © 2022 Elsevier Ltd. All rights reserved.

DOI: 10.1016/S0140-6736(22)02253-X
PMCID: PMC9691053
PMID: 36929988 [Indexed for MEDLINE]


872. Lancet. 2022 Nov;400 Suppl 1:S17. doi: 10.1016/S0140-6736(22)02227-9. Epub 2022 
Nov 24.

Food insecurity among pregnant women living in high-income countries: a 
systematic review.

Andreae G(1), Scott S(1), Nguyen G(1), Bell Z(1), Mehmood H(1), Sermin-Reed 
L(1), Heslehurst N(2).

Author information:
(1)Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle 
University, Newcastle upon Tyne, UK.
(2)Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle 
University, Newcastle upon Tyne, UK. Electronic address: 
nicola.heslehurst@ncl.ac.uk.

BACKGROUND: Food insecurity is an increasingly important public health concern 
in high-income countries following the 2008 global financial crash, and recently 
with the COVID-19 pandemic. Food insecurity has been understood as a highly 
gendered issue, affecting more women than men. As women have more complex 
nutritional needs because of their menstrual cycle, pregnancy, and 
breastfeeding, the nutritional impact of food insecurity is also greater for 
women than for men. This systematic review aims to explore pregnant women's 
experiences of food insecurity in high-income countries and to understand how 
food insecurity affects their health, wellbeing, diet, and nutrition.
METHODS: We did a systematic review following PRISMA reporting guidelines. A 
comprehensive search strategy was developed using search terms such as "food 
insecurity" and "pregnancy outcomes". We searched seven databases (MEDLINE, 
Embase, Scopus, Web of Science, PsychInfo, ASSIA, and CINAHL), grey literature, 
reference lists, and citations, as well as contacted authors. No language 
restrictions were used, and only studies primarily containing data collected 
from Jan 1, 2008, onwards were included. Database searches were completed in 
April 2022; supplementary searches are ongoing. Inclusion criteria is based on 
PECOS. Screening, data extraction, and quality assessment were done by two 
authors independently. This systematic review is registered on PROSPERO, number 
CRD42022311669.
FINDINGS: 27 studies met the inclusion criteria, with all studies published 
between 2015 and 2022. 24 (89%) of 27 studies were done in the USA, two (7%) in 
Canada, and one (4%) in the UK. Outcomes reported include dietary intake or 
dietary quality during pregnancy (seven [26%] of 27), gestational weight gain 
(seven [26%]), mental health (five [19%]), pregnancy outcomes including 
pregnancy complications, preterm birth, or birthweight (five [19%]), and other 
health outcomes or combination of nutrition, health, and wellbeing (three 
[11%]). Evidence synthesis is ongoing and will be complete by August, 2022.
INTERPRETATION: This systematic review suggests that food insecurity experienced 
during pregnancy was associated with negative health and nutrition outcomes. The 
rigorous searches are strengths of this study. A limitation is the restricted 
focus on studies done from 2008 onward. More research to guide efficient 
interventions that address food insecurity among pregnant women is needed.
FUNDING: None.

Copyright © 2022 Elsevier Ltd. All rights reserved.

DOI: 10.1016/S0140-6736(22)02227-9
PMCID: PMC9691051
PMID: 36929959 [Indexed for MEDLINE]


873. Lancet. 2022 Nov;400 Suppl 1:S1. doi: 10.1016/S0140-6736(22)02211-5. Epub 2022 
Nov 24.

Shifting priorities and employment choices among workers in Wales during the 
COVID-19 pandemic: a longitudinal analysis.

Griffiths ML(1), Gray BJ(2), Kyle RG(3), Davies AR(4).

Author information:
(1)Research and Evaluation Division, Knowledge and Research Directorate, Public 
Health Wales, Cardiff, UK; National Centre for Population Health and Wellbeing 
Research, Swansea University, Swansea, UK. Electronic address: 
lois.griffiths@wales.nhs.uk.
(2)Research and Evaluation Division, Knowledge and Research Directorate, Public 
Health Wales, Cardiff, UK.
(3)Academy of Nursing, University of Exeter, Exeter, UK.
(4)Research and Evaluation Division, Knowledge and Research Directorate, Public 
Health Wales, Cardiff, UK; National Centre for Population Health and Wellbeing 
Research, Swansea University, Swansea, UK.

BACKGROUND: Employment is a determinant of health. The COVID-19 pandemic 
disrupted working lives, forcing individuals to adapt to new ways of working. 
These shifts might shape people's priorities and their consideration of changes 
for future work. We examined how these outcomes differed depending on 
self-reported health status.
METHODS: In this longitudinal analysis, we used data from the COVID-19 
Employment and Health in Wales Study; a nationally-representative household 
survey of workers aged 18-64 years. Timepoint 1 (T1) data were collected between 
May 27, 2020, and June 22, 2020, and timepoint 2 (T2) data between Nov 30, 2020, 
and Jan 29, 2021. Participants who responded at both timepoints were eligible. 
Respondents selected five employment priorities at both timepoints, and the 
employment changes they considered during the COVID-19 pandemic at T2 only. We 
used multivariable logistic regressions (including sociodemographics, current 
employment factors, and self-reported health) and examined associations with 
health firstly for employment priorities, and secondly for the consideration of 
employment changes. Health measures were self-reported general health, limiting 
pre-existing health conditions (both using National Survey for Wales validated 
questions), and mental wellbeing (using the shortened Warwick Edinburgh Mental 
Well-being Scale).
FINDINGS: We analysed data from 592 respondents (382 [65%] women). 766 (56%) of 
1358 T1 respondents were excluded as no T2 responses were provided. Those who 
self-reported poor general health were consistently more likely to prioritise 
flexible working arrangements than those rating fair or above (T1 adjusted odds 
ratio [aOR] 2·06 [95% CI 1·10-3·88], p=0·033; T2 aOR 1·87 [95% CI 1·05-3·33], 
p=0·034). Those with low (as opposed to average) mental wellbeing were more 
likely to consider securing a permanent contract (aOR 5·49 [95% CI 1·32-22·81], 
p=0·023, and those with limiting pre-existing conditions were four times more 
likely to consider becoming self-employed (aOR 4·00 [95% CI 1·35-11·84], 
p=0·011) than those without.
INTERPRETATION: Promoting the adoption of flexible working policies and 
supporting those in poor health to obtain flexible employment could benefit 
people in Wales. Those with low mental wellbeing might seek the security of 
permanent employment, and those with limiting pre-existing conditions might 
value the autonomy of self-employment.
FUNDING: None.

Copyright © 2022 Elsevier Ltd. All rights reserved.

DOI: 10.1016/S0140-6736(22)02211-5
PMCID: PMC9691049
PMID: 36929951 [Indexed for MEDLINE]


874. J Prev (2022). 2023 Jun;44(3):341-357. doi: 10.1007/s10935-023-00727-1. Epub 
2023 Mar 16.

Evaluating the Efficacy of the Family Check-Up Online to Improve Parent Mental 
Health and Family Functioning in Response to the COVID-19 Pandemic: A Randomized 
Clinical Trial.

Connell AM(1), Stormshak EA(2).

Author information:
(1)Department of Psychological Sciences, Case Western Reserve University, 44106, 
Cleveland, OH, USA. amc76@case.edu.
(2)University of Oregon, Eugene, USA.

This study evaluated the effects of an enhanced version of the Family Check-Up 
Online (FCU-O), adapted to address parent and family functioning in response to 
the COVID-19 pandemic. In order to increase accessibility, the FCU-O was 
delivered as a web-based application coupled with online coaching support, a 
service delivery model that is consistent with pandemic-related limitations for 
in-person intervention, as well as the limited staffing and resources available 
in many schools and health care settings despite the increased need for mental 
health services driven by the pandemic. This registered clinical trial (blinded) 
tested the effects of the intervention on parental mental health, parenting 
behaviors, and family functioning from pre-treatment to 2-month follow-up. 
Families were randomly assigned to receive the FCU-O (N = 74) or to a wait-list 
control condition (N = 87). Random assignment to the FCU-O was associated with 
significant improvements in parental well-being, including reduced anxiety, 
depression, and perceived stress. Further, the FCU-O predicted significant 
improvements in adaptive parenting skills (e.g. less negative/coercive 
parenting, greater proactive parenting), and enhancements in family-relational 
functioning (e.g. improved coparenting). Effect sizes were small to moderate in 
magnitude (partial eta squared values between 0.03 and 0.11). The results 
indicate that online delivery of a family-centered intervention may represent a 
promising approach for addressing pandemic-related impacts on parent and family 
functioning.

© 2023. The Author(s).

DOI: 10.1007/s10935-023-00727-1
PMCID: PMC10018613
PMID: 36929456 [Indexed for MEDLINE]


875. PLoS One. 2023 Mar 16;18(3):e0283227. doi: 10.1371/journal.pone.0283227. 
eCollection 2023.

The impact of the COVID-19 pandemic on the mental health of families dealing 
with attention-deficit hyperactivity disorder.

Winfield A(1), Sugar C(1), Fenesi B(1).

Author information:
(1)Faculty of Education, Western University, London, Ontario, Canada.

BACKGROUND: The COVID-19 pandemic uprooted regular routines forcing many 
children to learn from home, requiring many adults to work from home, and 
cutting families off from support outside the home. Public health restrictions 
associated with the pandemic caused widespread psychological distress including 
depression and anxiety, increased fear, panic, and stress. These trends are 
particularly concerning for families raising neuroatypical children such as 
those with Attention-Deficit Hyperactivity Disorder (ADHD), as these children 
are already more likely than their typically developing peers to experience 
comorbid mental health issues, and to experience greater distress when required 
to stay indoors. Families with children who have ADHD are also at greater risk 
for experiencing heightened familial stress due to the challenges associated 
with managing ADHD behavioural symptoms, greater parental discord and divorce, 
and greater financial difficulties compared to other families. The current study 
engaged families comprised of at least one child diagnosed with ADHD to 
elucidate 1) the unique ways that the COVID-19 pandemic affected their mental 
health and 2) the specific barriers these families faced to maintaining optimal 
mental wellbeing.
METHODS AND FINDINGS: A total of 33 participants (15 parent-child dyads) engaged 
in virtual interviews. Content analysis revealed that the most frequently 
identified mental health effects for families were increased child anxiety and 
disconnectedness, as well as deteriorating parental mental health. The most 
frequently identified barriers to maintaining optimal mental wellbeing were lack 
of routine, lack of social interaction and social supports, and uncertainty and 
fear.
CONCLUSIONS: Findings underscore areas of need during times of large-scale 
social isolation, specifically for families with children who have ADHD. This 
work contributes to a growing body of research aimed at creating safeguards to 
support mental wellbeing for vulnerable families during times of crisis.

Copyright: © 2023 Winfield et al. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0283227
PMCID: PMC10019744
PMID: 36928863 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


876. J Patient Rep Outcomes. 2023 Mar 16;7(1):29. doi: 10.1186/s41687-023-00571-1.

Perceived COVID-19 pandemic impact and protective factors predicting 
patient-reported depression and anxiety in individuals living with cancer.

Fortune EE(1), Zaleta AK(2), Morris VG(2).

Author information:
(1)Cancer Support Community, Research and Training Institute, 520 Walnut Street, 
Suite 1170, Philadelphia, PA, 19106, USA. efortune@cancersupportcommunity.org.
(2)Cancer Support Community, Research and Training Institute, 520 Walnut Street, 
Suite 1170, Philadelphia, PA, 19106, USA.

BACKGROUND: The COVID-19 pandemic presents a unique, amplified threat to those 
living with a cancer diagnosis, but personal factors may play a role in how this 
affects well-being. This cross-sectional study (1) describes the impacts of 
COVID-19 on cancer patients' lives, and (2) explores the extent to which 
specific impacts of COVID-19 and noted protective factors, hope and resilience, 
predict two crucial patient-reported outcomes, depression and anxiety, after 
controlling for relevant sociodemographic and clinical factors.
METHODS: 520 cancer patients and survivors in the U.S. completed an online 
survey during the first year of the pandemic and answered questions about 
COVID-19 areas of impact, psychological well-being, hope, and resilience. 
Hierarchical regression analyses were used to analyze the unique impact of each 
group of variables on patient-reported levels of depression and anxiety during 
the pandemic.
RESULTS: Participants strongly endorsed COVID-19 impact across several areas of 
life, especially social activity, well-being, and ability to acquire basic 
essentials. Regression models explained a substantial amount of variance in 
patient-reported depression (R2 = .50, p < .001) and anxiety (R2 = .44, 
p < .001), revealing COVID-19 financial impact as a significant predictor of 
depression (β = 0.07), and COVID-19 family impact as a significant predictor of 
anxiety (β = 0.14), even after controlling for the effects of relevant 
sociodemographic and clinical variables. Additionally, resilience and hope were 
the largest predictors of both depression (β = - 0.19 and - 0.37, respectively) 
and anxiety (β = - 0.18 and - 0.29), suggesting that they account for unique 
variance in patient-reported mental health during the COVID-19 pandemic and 
might serve as important protective factors.
CONCLUSIONS: The current results add to existing literature documenting the 
significant effect of COVID-19 on those living with cancer. COVID-19 impact, 
including financial and family well-being, as well as positive psychological 
constructs, hope and resilience, play a crucial role in levels of 
patient-reported depression and anxiety during the pandemic. As COVID-19 
continues to evolve, health care providers should routinely assess psychological 
well-being and needs related to COVID-19 financial and family impact in an 
effort to appropriately align individuals with resources and support, and 
consider how hope and resilience can be fostered to serve as psychological 
buffers during this time.

© 2023. The Author(s).

DOI: 10.1186/s41687-023-00571-1
PMCID: PMC10019398
PMID: 36928789 [Indexed for MEDLINE]

Conflict of interest statement: The authors report the following conflicts of 
interest. Institutional research support was granted to the Cancer Support 
Community and not individual study authors: Fortune: Institutional research 
funding from: AbbVie, Amgen Oncology, AstraZeneca, Astellas Pharma, Bristol 
Myers Squibb, Genentech, Gilead Sciences, Lilly Oncology, Merck & Co, Inc, 
Sumimoto Dainippon Pharma Co, Takeda Oncology. Zaleta: Institutional research 
funding from: Astellas Pharma, Gilead Sciences, Novartis, Pfizer Oncology, 
Seattle Genetics. Morris: None to disclose.


877. BMJ Open. 2023 Mar 16;13(3):e069533. doi: 10.1136/bmjopen-2022-069533.

Frail2Fit study protocol: a feasibility and acceptability study of a virtual 
multimodal intervention delivered by volunteers to improve functional outcomes 
in older adults with frailty after discharge from hospital.

Meredith SJ(1)(2), Roberts H(3)(2)(4), Grocott MPW(4)(5), Jack S(4)(5), Murphy 
J(6), Varkonyi-Sepp J(4)(5)(7), Bates A(5)(8), Lim SER(3)(2)(4).

Author information:
(1)Academic Geriatric Medicine, University of Southampton Faculty of Medicine, 
Southampton, Hampshire, UK s.j.meredith@soton.ac.uk.
(2)NIHR ARC Wessex, University of Southampton, Southampton, UK.
(3)Academic Geriatric Medicine, University of Southampton Faculty of Medicine, 
Southampton, Hampshire, UK.
(4)NIHR Southampton Biomedical Research Centre, University Hospital Southampton 
/ University of Southampton, Southampton, UK.
(5)Clinical and Experimental Science, University of Southampton, Southampton, 
UK.
(6)Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, 
UK.
(7)Clinical Health Psychology Service, University Hospital Southampton NHS 
Foundation Trust, Southampton, UK.
(8)Nursing, Midwifery, and Health, University of Southampton, Southampton, UK.

INTRODUCTION: Physical activity (PA) and replete nutritional status are key to 
maintaining independence and improving frailty status among frail older adults. 
In response to the COVID-19 pandemic, healthcare has increasingly turned to 
virtual modes of delivery and there is interest in the use of trained volunteers 
to deliver PA and nutrition interventions. We aim to evaluate the feasibility 
and acceptability of training hospital volunteers to deliver an online 
intervention, comprising exercise, behaviour change and nutrition support, to 
older people with frailty after discharge from hospital.
METHODS: We will use a quasi-experimental mixed methods approach. Hospital 
volunteers (n=6) will be trained to deliver an online, 3-month, multimodal 
intervention to frail (Clinical Frailty Scale ≥5) adults ≥65 years (n=30) after 
discharge from hospital. Feasibility will be assessed by determining the number 
of volunteers recruited, trained and retained at the end of the study; the 
proportion of intervention sessions delivered; participant recruitment, 
retention and adherence to the intervention. To determine the acceptability of 
the intervention, interviews will be conducted among a purposive sample of older 
adults, and volunteers. Secondary outcomes will include physical function, 
appetite, well-being, quality of life, anxiety and depression, self-efficacy for 
managing chronic disease and PA. Outcomes will be measured at baseline, 3 months 
and 6 months.
ANALYSIS: Descriptive statistics will be used to describe feasibility and 
adherence to the intervention. Secondary outcomes at baseline will be compared 
at 3 and 6 months. Interviews will be transcribed verbatim and analysed using 
thematic analysis.
ETHICS AND DISSEMINATION: Health Research Authority ethical approval was 
obtained on 30 May 2022 (reference: 22/WA/0155). Results will be disseminated 
through peer-reviewed journal articles, volunteer organisations, National Health 
Service communication systems and social media platforms. A toolkit will be 
developed to facilitate roll out of volunteer training.
TRIAL REGISTRATION NUMBER: NCT05384730.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2022-069533
PMCID: PMC10030662
PMID: 36927597 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


878. Public Health. 2023 Apr;217:212-217. doi: 10.1016/j.puhe.2023.02.006. Epub 2023 
Mar 14.

The road to postpandemic recovery in the USA: a repeated cross-sectional survey 
of multidimensional well-being over two years.

Cowden RG(1), Nakamura JS(2), de la Rosa Fernández Pacheco PA(3), Chen Y(4), 
Fulks J(5), Plake JF(6), VanderWeele TJ(4).

Author information:
(1)Human Flourishing Program, Institute for Quantitative Social Science, Harvard 
University, Cambridge, MA, USA. Electronic address: rcowden@fas.harvard.edu.
(2)Department of Psychology, University of British Columbia, Vancouver, BC, 
Canada.
(3)Human Flourishing Program, Institute for Quantitative Social Science, Harvard 
University, Cambridge, MA, USA.
(4)Human Flourishing Program, Institute for Quantitative Social Science, Harvard 
University, Cambridge, MA, USA; Department of Epidemiology, Harvard T.H. Chan 
School of Public Health, Boston, MA, USA.
(5)American Bible Society, Philadelphia, PA, USA; Evangel University, 
Springfield, MO, USA.
(6)American Bible Society, Philadelphia, PA, USA.

OBJECTIVES: Examine differences in multidimensional well-being from before 
(January 2020) to three timepoints during the COVID-19 pandemic (June 2020, 
January 2021, January 2022).
STUDY DESIGN: Repeated cross-sectional design.
METHODS: Nationally representative cross-sectional cohorts of US adults 
completed the Secure Flourish Index before (January 2020 cohort: N = 1010) and 
during the COVID-19 pandemic (June 2020 cohort: N = 3020; January 2021 cohort: 
N = 3366; January 2022 cohort: N = 2598). We estimated differences in 
indicators, domains, and composite well-being between the January 2020 cohort 
and each of the subsequent cohorts. We also explored whether changes in 
well-being between January 2020 and January 2022 varied based on age, gender, 
and race/ethnicity.
RESULTS: Initial declines in well-being observed by June 2020 were largely 
followed by a return to prepandemic levels in January 2022, with some 
exceptions. Notably, general declines in mental health have persisted through to 
January 2022. On the other hand, there was evidence of general improvements in 
character & virtue that exceeded prepandemic levels in January 2022. Young 
adults and racial/ethnic minorities reported lower financial & material 
stability in January 2022 compared to before the COVID-19 pandemic.
CONCLUSIONS: Although there are promising signs that the well-being of US adults 
has mostly recovered to prepandemic levels, a coordinated response is urgently 
needed to support population mental health and the financial security of 
vulnerable groups. As society continues the journey toward postpandemic 
recovery, continued tracking of multidimensional well-being will be important 
for making informed decisions about public health priorities.

Copyright © 2023 The Royal Society for Public Health. Published by Elsevier Ltd. 
All rights reserved.

DOI: 10.1016/j.puhe.2023.02.006
PMCID: PMC10010931
PMID: 36924673 [Indexed for MEDLINE]

Conflict of interest statement: None declared.


879. J Ment Health. 2023 Aug;32(4):752-760. doi: 10.1080/09638237.2023.2182423. Epub 
2023 Mar 16.

Pragmatic randomized controlled trial of the Mind Management Skills for Life 
Programme as an intervention for occupational burnout in mental healthcare 
professionals.

Laker V(1)(2), Simmonds-Buckley M(1)(2), Delgadillo J(1)(2), Palmer L(1), 
Barkham M(2).

Author information:
(1)Grounded Research, Rotherham Doncaster and South Humber NHS Foundation Trust, 
Doncaster, UK.
(2)Clinical and Applied Psychology Unit, Department of Psychology, University of 
Sheffield, Sheffield, UK.

BACKGROUND: Occupational burnout is highly prevalent in the mental healthcare 
workforce and associated with poorer job satisfaction, performance and outcomes.
AIMS: To evaluate the effects of the Mind Management Skills for Life Programme 
on burnout and wellbeing.
METHODS: N = 173 mental health nurses were recruited from the English National 
Health Service during the acute phase of the COVID-19 crisis. Participants were 
allocated to an immediate intervention or a delayed intervention control group, 
using a stepped wedge randomized controlled trial design. Measures of burnout 
(OLBI) and wellbeing (WEMWBS) were completed at four time-points: [1] baseline; 
[2] after the first group finished the intervention; [3] after the second group 
finished the intervention; and [4] six-months follow-up.
RESULTS: Between-group differences were compared at each time-point using ANCOVA 
adjusting for baseline severity. Statistically significant effects on burnout 
(d = 0.60) and wellbeing (d = -0.62) were found at time-point 2, favouring the 
intervention relative to waitlist control. No significant differences were found 
at subsequent time-points, indicating that both groups improved and maintained 
their gains after the intervention.
CONCLUSIONS: This intervention led to moderate improvements in burnout and 
wellbeing, despite the adverse circumstances of the COVID-19 pandemic at the 
time of the study.

DOI: 10.1080/09638237.2023.2182423
PMID: 36924140 [Indexed for MEDLINE]


880. BMC Health Serv Res. 2023 Mar 14;23(1):250. doi: 10.1186/s12913-023-09213-0.

A self-monitoring wellbeing screening methodology for keyworkers, 'My Personal 
Wellbeing', using an integrative wellbeing model.

Elvin G(1), Kurt Z(2), Kennedy A(3), Sice P(2), Walton L(2), Patel P(3).

Author information:
(1)Department of Computer and Information Sciences, University of Northumbria, 
Ellison Building, Newcastle Upon Tyne, NE1 8ST, UK. 
garry.elvin@northumbria.ac.uk.
(2)Department of Computer and Information Sciences, University of Northumbria, 
Newcastle Upon Tyne, UK.
(3)Cumbria, Northumberland, Tyne and Wear NHS Trust, Newcastle-upon-Tyne, UK.

BACKGROUND: The detrimental impact of Covid-19 has led to an urgent need to 
support the wellbeing of UK National Health Service and care workers. This 
research develops an online diary to support the wellbeing of staff in public 
healthcare in real-time, allowing the exploration of population wellbeing and 
pro-active responses to issues identified.
METHODS: The diary was co-produced by NHS and care stakeholders and university 
researchers. It was based on an integrative model monitoring mental health 
symptoms as well as wellbeing indicators. Diary users were encouraged to reflect 
on their experience confidentially, empowering them to monitor their wellbeing. 
The data collected was analysed using Mann-Whitney-Wilcoxon and Kruskal-Wallis 
statistical tests to determine any significant wellbeing trends and issues.
RESULTS: A statistically significant decline in wellbeing (P < 2.2E-16), and a 
significant increase in symptoms (P = 1.2E-14) was observed. For example, 
indicators of post-traumatic stress, including, flashbacks, dissociation, and 
bodily symptoms (Kruskal-Wallis P = 0.00081, 0.0083, and 0.027, respectively) 
became significantly worse and users reported issues with sleeping (51%), levels 
of alertness (46%), and burnout (41%).
CONCLUSIONS: The wellbeing diary indicated the value of providing ways to 
distinguish trends and wellbeing problems, thus, informing how staff wellbeing 
services can determine and respond to need with timely interventions. The 
results particularly emphasised the pressing need for interventions that help 
staff with burnout, self-compassion, and intrusive memories.

© 2023. The Author(s).

DOI: 10.1186/s12913-023-09213-0
PMCID: PMC10012319
PMID: 36918918 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that there is no competing / 
conflicts of interest.


881. Soc Psychiatry Psychiatr Epidemiol. 2023 Jul;58(7):1099-1108. doi: 
10.1007/s00127-023-02453-9. Epub 2023 Mar 14.

Patterns and predictors of depressive and anxiety symptoms within a 
population-based sample of adults diagnosed with COVID-19 in Michigan.

Titus AR(1), Mezuk B(2), Hirschtick JL(2), McKane P(3), Elliott MR(4)(5), 
Fleischer NL(2).

Author information:
(1)Department of Population Health, NYU Grossman School of Medicine, 180 Madison 
Avenue, New York, NY, 10016, USA. andrea.titus@nyulangone.org.
(2)Department of Epidemiology, School of Public Health, University of Michigan, 
Ann Arbor, MI, USA.
(3)Lifecourse Epidemiology and Genomics Division, Michigan Department of Health 
and Human Services, Lansing, MI, USA.
(4)Department of Biostatistics, School of Public Health, University of Michigan, 
Ann Arbor, MI, USA.
(5)Survey Research Center, Institute for Social Research, University of 
Michigan, Ann Arbor, MI, USA.

PURPOSE: The COVID-19 pandemic has had wide-ranging impacts on mental health, 
however, less is known about predictors of mental health outcomes among adults 
who have experienced a COVID-19 diagnosis. We examined the intersection of 
demographic, economic, and illness-related predictors of depressive and anxiety 
symptoms within a population-based sample of adults diagnosed with COVID-19 in 
the U.S. state of Michigan early in the pandemic.
METHODS: Data were from a population-based survey of Michigan adults who 
experienced a COVID-19 diagnosis prior to August 1, 2020 (N = 1087). We used 
weighted prevalence estimates and multinomial logistic regression to examine 
associations between mental health outcomes (depressive symptoms, anxiety 
symptoms, and comorbid depressive/anxiety symptoms) and demographic 
characteristics, pandemic-associated changes in accessing basic needs (accessing 
food/clean water and paying important bills), self-reported COVID-19 symptom 
severity, and symptom duration.
RESULTS: Relative risks for experiencing poor mental health outcomes varied by 
sex, age, race/ethnicity, and income. In adjusted models, experiencing a change 
in accessing basic needs associated with the pandemic was associated with higher 
relative risks for anxiety and comorbid anxiety/depressive symptoms. Worse 
COVID-19 symptom severity was associated with a higher burden of comorbid 
depressive/anxiety symptoms. "Long COVID" (symptom duration greater than 
60 days) was associated with all outcomes.
CONCLUSION: Adults diagnosed with COVID-19 may face overlapping risk factors for 
poor mental health outcomes, including pandemic-associated disruptions to 
household and economic wellbeing, as well as factors related to COVID-19 symptom 
severity and duration. An integrated approach to treating depressive/anxiety 
symptoms among COVID-19 survivors is warranted.

© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

DOI: 10.1007/s00127-023-02453-9
PMCID: PMC10013232
PMID: 36917277 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


882. Lancet Child Adolesc Health. 2023 May;7(5):347-357. doi: 
10.1016/S2352-4642(23)00022-6. Epub 2023 Mar 10.

Effect of the COVID-19 pandemic on adolescent mental health and substance use up 
to March, 2022, in Iceland: a repeated, cross-sectional, population-based study.

Thorisdottir IE(1), Agustsson G(2), Oskarsdottir SY(2), Kristjansson AL(3), 
Asgeirsdottir BB(4), Sigfusdottir ID(5), Valdimarsdottir HB(6), Allegrante 
JP(7), Halldorsdottir T(8).

Author information:
(1)Planet Youth, Reykjavik, Iceland.
(2)Department of Psychology, Reykjavik University, Reykjavik, Iceland.
(3)Department of Social and Behavioral Sciences, School of Public Health, West 
Virginia University, Morgantown, WV, USA; Icelandic Centre for Social Research 
and Analysis, Reykjavik, Iceland.
(4)Department of Psychology, Reykjavik University, Reykjavik, Iceland; Icelandic 
Centre for Social Research and Analysis, Reykjavik, Iceland.
(5)Department of Psychology, Reykjavik University, Reykjavik, Iceland; Icelandic 
Centre for Social Research and Analysis, Reykjavik, Iceland; Department of 
Health and Behavior Studies, Teachers College, Columbia University, New York, 
NY, USA.
(6)Department of Psychology, Reykjavik University, Reykjavik, Iceland; 
Department of Population Health Science and Policy, Icahn School of Medicine at 
Mount Sinai, New York, NY, USA.
(7)Department of Psychology, Reykjavik University, Reykjavik, Iceland; 
Department of Health and Behavior Studies, Teachers College, Columbia 
University, New York, NY, USA; Department of Sociomedical Sciences, Mailman 
School of Public Health, Columbia University, New York, NY, USA.
(8)Department of Psychology, Reykjavik University, Reykjavik, Iceland; Centre of 
Public Health Sciences, University of Iceland, Reykjavik, Iceland. Electronic 
address: thorhildurh@ru.is.

BACKGROUND: Poor mental health in the first year of the COVID-19 pandemic has 
been well documented in adolescents; however, less is known about the 
longer-term effect of the pandemic. We aimed to examine adolescent mental health 
and substance use as well as covariates associated with these outcomes 1 year or 
more into the pandemic.
METHODS: A nationwide sample of adolescents aged 13-18 years enrolled in school 
in Iceland were invited to complete surveys administered during October-November 
or February-March, 2018, October-November, 2020, February-March or 
October-November, 2021, and February-March 2022. The survey was in Icelandic for 
all administrations and offered to adolescents aged 13-15 years in English in 
2020 and 2022 and in Polish in 2022. Surveys assessed depressive symptoms 
(Symptom Checklist-90); mental wellbeing (Short Warwick Edinburgh Mental 
Wellbeing Scale); and the frequency of cigarette smoking, e-cigarette use, and 
alcohol intoxication. Covariates comprised age, gender, and migration status as 
determined by language spoken at home, level of social restrictions based on 
residency, parental social support, and sleep duration (≥8 h nightly). Weighted 
mixed-effect models were used to determine the effect of time and the covariates 
on mental health and substance use. The main outcomes were assessed in all 
participants with more than 80% of the necessary data, and multiple imputation 
was used to handle missing data. Bonferroni corrections were used to adjust for 
multiple testing and analyses were considered significant at a p value of 
<0·0017.
FINDINGS: 64 071 responses were submitted and analysed between 2018 and 2022. 
Elevated depressive symptoms and worsened mental wellbeing across girls and boys 
aged 13-18 years were observed to have been maintained up to 2 years into the 
pandemic (p>0·0017). Alcohol intoxication initially decreased during the 
pandemic but increased again as social restrictions eased (p<0·0001). No changes 
were observed in cigarette smoking and e-cigarette use during the COVID-19 
pandemic. Higher levels of parental social support and an average sleep duration 
of 8 h or more per night were associated with mental health better outcomes and 
less substance use (p<0·0001). Social restrictions and migration background were 
inconsistently associated with the outcomes.
INTERPRETATION: Population-level prevention targeting adolescent depressive 
symptoms should be prioritised in health policy in the wake of COVID-19.
FUNDING: Icelandic Research Fund.

Copyright © 2023 Elsevier Ltd. All rights reserved.

DOI: 10.1016/S2352-4642(23)00022-6
PMCID: PMC10005790
PMID: 36913961 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of interests IET is a staff member 
at Planet Youth, a youth substance use prevention service organisation that is 
distributed globally through sale of the Planet Youth Guidance Program, which is 
based on the Icelandic Prevention Model, from which she receives a salary. All 
other authors declare no competing interests.


883. J Alzheimers Dis. 2023;92(4):1473-1485. doi: 10.3233/JAD-221096.

In the Shadow of COVID-19: The Well-Being and Rights of People Living with 
Dementia in Finland During the Pandemic.

Ervasti K(1), Kotkas T(2), Issakainen M(1), Teiska M(3), Mäki-Petäjä-Leinonen 
A(1).

Author information:
(1)Law School, University of Eastern Finland, Joensuu, Finland.
(2)Faculty of Law, University of Helsinki, Helsinki, Finland.
(3)Muistiliitto ry, Helsinki, Finland.

BACKGROUND: Exceptional circumstances such as the COVID-19 pandemic increase the 
risk for vulnerability among people living with dementia.
OBJECTIVE: This article discusses the well-being and rights of people living 
with dementia in Finland during the pandemic and analyses the legal framework 
covering the restrictions of their rights during that period.
METHODS: The empirical research comprises a survey of persons with dementia 
(n = 31) and their family members (n = 168). The participants completed a total 
of 13 survey items involving questions about their well-being during the 
pandemic, restrictions on freedom, access to services, information on pandemic 
regulations and guidelines as well as possible problems with authorities. The 
survey included both multiple choice and open-ended questions.
RESULTS: According to people with dementia and their family members, by spring 
2021, the pandemic had reduced meaningful activities available to people living 
with dementia in Finland and decreased the number of meetings between them and 
other people. Many reported a decline in their physical and/or mental well-being 
or greater difficulty or delays in accessing social and health services. Over a 
third of respondents found that the right to meet people was restricted among 
people with dementia, and almost half of the respondents took the view that 
their freedom of movement was restricted. There were also major shortcomings in 
terms of information on restrictions.
CONCLUSION: The results highlight the importance of bearing in mind the negative 
effects that restrictions on mobility, meeting other people and meaningful 
activities can have on the well-being of people living with dementia. This 
should be considered, for example, when reforming legislation.

DOI: 10.3233/JAD-221096
PMCID: PMC10200203
PMID: 36911938 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflict of interest to 
report.


884. Front Public Health. 2023 Feb 24;11:1139786. doi: 10.3389/fpubh.2023.1139786. 
eCollection 2023.

Associations between eHealth literacy, mental health-seeking attitude, and 
mental wellbeing among young electronic media users in China during the COVID-19 
pandemic.

Xu RH(1)(2), Bao XL(3), Shi LS(3), Wang D(3)(4).

Author information:
(1)Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 
Kowloon, Hong Kong SAR, China.
(2)JC School of Public Health and Primary Care, The Chinese University of Hong 
Kong, Shatin, Hong Kong SAR, China.
(3)School of Health Management, Southern Medical University, Guangzhou, China.
(4)Institute of Health Management, Southern Medical University, Guangzhou, 
China.

OBJECTIVE: This study aimed to examine the associations among mental health 
related eHealth literacy (eHL), mental health-seeking attitude, and wellbeing 
among Chinese young electronic media users during the COVID-19 pandemic.
METHODS: A web-based cross-sectional survey was conducted in Guangzhou, China. 
The modified eHealth literacy Scale, Mental Help-Seeking Attitudes Scale, and 
Short Warwick-Edinburgh Mental Wellbeing Scale were used. Structural equation 
modeling (SEM) examined the associations between them and was adjusted by 
several controlled variables.
RESULTS: Totally, 1,008 participants completed the questionnaire and provided 
valid responses. The eHL showed a statistically significant and direct effect on 
mental wellbeing in this sample. The higher the level of eHL, the better 
wellbeing of the participants. The mental health-seeking attitude is also 
positively correlated with mental wellbeing, indicating that the more positive 
attitude toward seeking mental health services, the better the wellbeing 
participants reported. The higher level of eHL is significantly associated with 
a more positive attitude toward seeking mental health services.
CONCLUSION: Training to improve eHL may optimize young electronic media users' 
mental health outcomes. Development and use of a mental health specific eHL 
instrument in future studies should be encouraged.

Copyright © 2023 Xu, Bao, Shi and Wang.

DOI: 10.3389/fpubh.2023.1139786
PMCID: PMC9998951
PMID: 36908426 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


885. Chest. 2023 Jul;164(1):124-136. doi: 10.1016/j.chest.2023.03.008. Epub 2023 Mar 
11.

Critical Care Staffing in Pandemics and Disasters: A Consensus Report From a 
Subcommittee of the Task Force for Mass Critical Care - Systems Strategies to 
Sustain the Health Care Workforce.

Sprung CL(1), Devereaux AV(2), Ghazipura M(3), Burry LD(4), Hossain T(5), Hamele 
MT(6), Gist RE(7), Dempsey TM(8), Dichter JR(9), Henry KN(10), Niven AS(11), 
Alptunaer T(12), Huffines M(13), Bowden KR(14), Martland AMO(15), Felzer JR(11), 
Mitchell SH(16), Tosh PK(11), Persoff J(14), Mukherjee V(5), Downar J(17), Báez 
AA(18), Maves RC(19); Task Force for Mass Critical Care Writing Group.

Author information:
(1)Hadassah Medical Organization and Faculty of Medicine, Hebrew University of 
Jerusalem, Jerusalem, Israel. Electronic address: charless@ekmd.huji.ac.il.
(2)Sharp Coronado Hospital, Coronado, CA.
(3)ZS Associates, New York, NY.
(4)University of Toronto, Toronto, ON, Canada.
(5)New York University, Grossman School of Medicine, New York, NY.
(6)Tripler Army Medical Center, Honolulu, HI; Uniformed Services University, 
Bethesda, MD.
(7)SUNY Downstate Health Science University, Brooklyn, NY.
(8)David Grant Medical Center, US Air Force, Travis AFB, CA.
(9)University of Minnesota, Minneapolis, MN.
(10)MedStar Montgomery Medical Center, Olney, MD.
(11)Mayo Clinic, Rochester, MN.
(12)Uniformed Services University, Bethesda, MD; Leonard J. Chabert Medical 
Center, Houma, LA.
(13)University of Maryland, Baltimore, MD.
(14)University of Colorado School of Medicine, Aurora, CO.
(15)Scripps Health, San Diego, CA.
(16)University of Washington, Seattle, WA.
(17)University of Ottawa, Ottawa, ON, Canada.
(18)Medical College of Georgia, Augusta, GA.
(19)Wake Forest University School of Medicine, Winston-Salem, NC.

BACKGROUND: The COVID-19 pandemic has led to unprecedented mental health 
disturbances, burnout, and moral distress among health care workers, affecting 
their ability to care for themselves and their patients.
RESEARCH QUESTION: In health care workers, what are key systemic factors and 
interventions impacting mental health and burnout?
STUDY DESIGN AND METHODS: The Workforce Sustainment subcommittee of the Task 
Force for Mass Critical Care (TFMCC) utilized a consensus development process, 
incorporating evidence from literature review with expert opinion through a 
modified Delphi approach to determine factors affecting mental health, burnout, 
and moral distress in health care workers, to propose necessary actions to help 
prevent these issues and enhance workforce resilience, sustainment, and 
retention.
RESULTS: Consolidation of evidence gathered from literature review and expert 
opinion resulted in 197 total statements that were synthesized into 14 major 
suggestions. These suggestions were organized into three categories: (1) mental 
health and well-being for staff in medical settings; (2) system-level support 
and leadership; and (3) research priorities and gaps. Suggestions include both 
general and specific occupational interventions to support health care worker 
basic physical needs, lower psychological distress, reduce moral distress and 
burnout, and foster mental health and resilience.
INTERPRETATION: The Workforce Sustainment subcommittee of the TFMCC offers 
evidence-informed operational strategies to assist health care workers and 
hospitals plan, prevent, and treat the factors affecting health care worker 
mental health, burnout, and moral distress to improve resilience and retention 
following the COVID-19 pandemic.

Copyright © 2023 American College of Chest Physicians. All rights reserved.

DOI: 10.1016/j.chest.2023.03.008
PMCID: PMC10007715
PMID: 36907373 [Indexed for MEDLINE]

Conflict of interest statement: Financial/Nonfinancial Disclosures None 
declared.


886. Epilepsy Behav. 2023 Apr;141:109151. doi: 10.1016/j.yebeh.2023.109151. Epub 2023 
Feb 27.

Caregiver burden and COVID-19: How epilepsy caregivers experienced the pandemic.

Viny M(1), Trevino AY(2), Bouldin ED(3), Kalvesmaki A(4), Roghani A(5), Pugh 
MJ(6).

Author information:
(1)Department of Internal Medicine, University of Utah School of Medicine, Salt 
Lake City, UT, United States. Electronic address: mikayla.viny@cuanschutz.edu.
(2)Department of Internal Medicine, University of Utah School of Medicine, Salt 
Lake City, UT, United States; Department of Educational Psychology, University 
of Utah College of Education, Salt Lake City, UT, United States. Electronic 
address: amira.trevino@hsc.utah.edu.
(3)Department of Internal Medicine, University of Utah School of Medicine, Salt 
Lake City, UT, United States. Electronic address: erin.bouldin@hsc.utah.edu.
(4)Department of Internal Medicine, University of Utah School of Medicine, Salt 
Lake City, UT, United States; Informatics, Decision-Enhancement, and Analytic 
Sciences Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake 
City, UT, United States. Electronic address: andrea.kalvesmaki@hsc.utah.edu.
(5)Department of Internal Medicine, University of Utah School of Medicine, Salt 
Lake City, UT, United States. Electronic address: ali.roghani@hsc.utah.edu.
(6)Department of Internal Medicine, University of Utah School of Medicine, Salt 
Lake City, UT, United States; Informatics, Decision-Enhancement, and Analytic 
Sciences Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake 
City, UT, United States. Electronic address: maryjo.pugh@hsc.utah.edu.

INTRODUCTION: Caregivers of adults with epilepsy face unique challenges, yet 
most studies focus on the impact of epilepsy on those living with the condition, 
rather than the impact on caregivers. Our objective was to evaluate whether 
caregivers' pandemic-related changes and experiences - namely those related to 
their health, healthcare access, and well-being - were associated with their 
caregiving burden.
METHODS: Caregivers of adults with epilepsy (n = 261) were recruited through 
Qualtrics Panels to participate in an online survey examining health, 
well-being, COVID-19 experiences, and caregiver burden from October-December, 
2020. The burden was measured using the Zarit 12-item measure; the clinically 
significant burden was defined as a score greater than 16. Adjustments were made 
to account for burden scores related to exposures of interest. Chi-square tests, 
t-tests, and generalized linear regression models were used to compare 
cross-sectional associations between COVID-19 experiences and burden.
RESULTS: Over half (57.9%) of caregivers had clinically significant caregiver 
burden. Most reported increased anxiety (65%), stress (64%), and sense of social 
isolation (58%) during the pandemic. Many caregivers reported that their sense 
of control over their life (44%) and their use of healthcare changed (88%) due 
to COVID-19. In adjusted models, caregivers who reported increased anger, 
increased anxiety, decreased sense of control, or changes in healthcare 
utilization during COVID-19 had about twice the odds of having clinically 
significant caregiver burden compared to caregivers who did not report changes.
DISCUSSION: Changes experienced by caregivers of adults with epilepsy during the 
pandemic were strongly associated with clinically significant levels of 
caregiver burden. These findings demonstrate the link between mass-level events, 
such as a pandemic, the burden caregivers of adults with epilepsy may carry, and 
subsequent psychological outcomes.
CONCLUSION: Caregivers of adults with epilepsy may need support to reduce the 
negative impact of COVID-19-related experiences and should be connected to 
healthcare and resources that can help alleviate their burden.

Published by Elsevier Inc.

DOI: 10.1016/j.yebeh.2023.109151
PMCID: PMC9968611
PMID: 36907084 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare the following financial interests/personal relationships which may be 
considered as potential competing interests: None.


887. Int J Drug Policy. 2023 Apr;114:103998. doi: 10.1016/j.drugpo.2023.103998. Epub 
2023 Mar 6.

"You'll come in and dose even in a global pandemic": A qualitative study of 
adaptive opioid agonist treatment provision during the COVID-19 pandemic.

Conway A(1), Treloar C(2), Crawford S(3), Degenhardt L(4), Dore GJ(5), Farrell 
M(4), Hayllar J(6), Grebely J(5), Marshall AD(7).

Author information:
(1)The Kirby Institute, UNSW, Sydney, Australia; Centre for Social Research in 
Health, UNSW, Sydney, Australia. Electronic address: a.conway@unsw.edu.au.
(2)Centre for Social Research in Health, UNSW, Sydney, Australia.
(3)Harm Reduction Victoria, Melbourne, Australia.
(4)National Drug and Alcohol Research Centre, UNSW, Sydney, Australia.
(5)The Kirby Institute, UNSW, Sydney, Australia.
(6)Alcohol and Drug Service, Metro North Mental Health, Metro North Hospital and 
Health Service, Brisbane, Queensland, Australia.
(7)The Kirby Institute, UNSW, Sydney, Australia; Centre for Social Research in 
Health, UNSW, Sydney, Australia.

BACKGROUND: Opioid agonist treatment (OAT) improves multiple health and social 
outcomes, yet requirements to attend for supervised dosing can be burdensome and 
stigmatising. The COVID-19 pandemic and associated restrictions threatened 
continuity of care and the wellbeing of people receiving OAT, risking a parallel 
health crisis. This study sought to understand how adaptations in the complex 
system of OAT provision impacted and responded to risk environments of people 
receiving OAT during the COVID-19 pandemic.
METHODS: The analysis draws on semi-structured interviews with 40 people 
receiving and 29 people providing OAT located across Australia. The study 
considered the risk environments that produce COVID-19 transmission, treatment 
(non-)adherence, and adverse events for people receiving OAT. Drawing on 
theories of risk environments and complex adaptive systems, data were coded and 
analysed to understand how adaptations to the typically rigid system of OAT 
provision impacted and responded to risk environments during the COVID-19 
pandemic.
RESULTS: During COVID-19, the complex system of OAT provision demonstrated 
possibilities for responsive adaptation to the entangled features of risk 
environments of people receiving OAT. Structural stigma was evident in the 
services which stayed rigid during the pandemic, requiring people to attend for 
daily supervised dosing and risking fracturing therapeutic relationships. In 
parallel, there were several examples of services developing enabling 
environments by offering flexible care through increased takeaways, treatment 
subsidies, and home delivery.
CONCLUSIONS: Rigidity in the delivery of OAT has been an impediment to achieving 
health and wellbeing over past decades. To sustain health-promoting environments 
for people receiving OAT, the wider impacts of the complex system should be 
acknowledged beyond narrowly defined outcomes relating solely to the medication. 
Centring people receiving OAT in their own care plans will ensure adaptations in 
the complex system of OAT provision are responsive to the individual's risk 
environment.

Copyright © 2023. Published by Elsevier B.V.

DOI: 10.1016/j.drugpo.2023.103998
PMCID: PMC9986137
PMID: 36907071 [Indexed for MEDLINE]

Conflict of interest statement: Declarations of Interest The authors declare the 
following financial interests/personal relationships which may be considered as 
potential competing interests: CT has received speaker fees from Abbvie and 
Gilead and has received a research grant from Merck outside the submitted work. 
SC has received speaker fees from Abbvie outside the submitted work. JG is a 
consultant/advisor and has received research grants from AbbVie, Camurus, 
Cepheid, Gilead, Hologic, Indivior, and Merck outside the submitted work. GJD 
has received research grant funding from Gilead and Abbvie. In the past three 
years, MF and LD have received funding from Indivior, and Seqirus for studies of 
new opioid medications in Australia. AC and ADM have nothing to disclose.


888. Harm Reduct J. 2023 Mar 11;20(1):32. doi: 10.1186/s12954-023-00752-7.

"The new normal has become a nonstop crisis": a qualitative study of burnout 
among Philadelphia's harm reduction and substance use disorder treatment workers 
during the COVID-19 pandemic.

Unachukwu IC(1)(2), Abrams MP(3), Dolan A(3), Oyekemi K(4), Meisel ZF(3), South 
EC(4), Aronowitz SV(5).

Author information:
(1)Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. 
iu21@rwjms.rutgers.edu.
(2)Urban Health Lab, University of Pennsylvania, Philadelphia, PA, USA. 
iu21@rwjms.rutgers.edu.
(3)Center for Emergency Care Policy and Research, University of Pennsylvania, 
Philadelphia, PA, USA.
(4)Urban Health Lab, University of Pennsylvania, Philadelphia, PA, USA.
(5)University of Pennsylvania School of Nursing, Philadelphia, PA, USA.

BACKGROUND: The COVID-19 pandemic worsened the ongoing overdose crisis in the 
United States (US) and caused significant mental health strain and burnout among 
health care workers (HCW). Harm reduction, overdose prevention, and substance 
use disorder (SUD) workers may be especially impacted due to underfunding, 
resources shortages, and chaotic working environments. Existing research on HCW 
burnout primarily focuses on licensed HCWs in traditional environments and fails 
to account for the unique experiences of harm reduction workers, community 
organizers, and SUD treatment clinicians.
METHODS: We conducted a qualitative secondary analysis descriptive study of 30 
Philadelphia-based harm reduction workers, community organizers, and SUD 
treatment clinicians about their experiences working in their roles during the 
COVID-19 pandemic in July-August 2020. Our analysis was guided by Shanafelt and 
Noseworthy's model of key drivers of burnout and engagement. We aimed to assess 
the applicability of this model to the experiences of SUD and harm reduction 
workers in non-traditional settings.
RESULTS: We deductively coded our data in alignment with Shanafelt and 
Noseworthy's key drivers of burnout and engagement: (1) workload and job 
demands, (2) meaning in work, (3) control and flexibility, (4) work-life 
integration, (5) organizational culture and values, (6) efficiency and resources 
and (7) social support and community at work. While Shanafelt and Noseworthy's 
model broadly encompassed the experiences of our participants, it did not fully 
account for their concerns about safety at work, lack of control over the work 
environment, and experiences of task-shifting.
CONCLUSIONS: Burnout among healthcare providers is receiving increasing 
attention nationally. Much of this coverage and the existing research have 
focused on workers in traditional healthcare spaces and often do not consider 
the experiences of community-based SUD treatment, overdose prevention, and harm 
reduction providers. Our findings indicate a gap in existing frameworks for 
burnout and a need for models that encompass the full range of the harm 
reduction, overdose prevention, and SUD treatment workforce. As the US overdose 
crisis continues, it is vital that we address and mitigate experiences of 
burnout among harm reduction workers, community organizers, and SUD treatment 
clinicians to protect their wellbeing and to ensure the sustainability of their 
invaluable work.

© 2023. The Author(s).

DOI: 10.1186/s12954-023-00752-7
PMCID: PMC10008076
PMID: 36906576 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


889. Int J Environ Res Public Health. 2023 Mar 5;20(5):4613. doi: 
10.3390/ijerph20054613.

The Influence of the COVID-19 Pandemic Emergency on Alcohol Use: A Focus on a 
Cohort of Sicilian Workers.

Cannizzaro E(1), Cirrincione L(1), Malta G(1), Fruscione S(1), Mucci N(2), 
Martines F(3), Plescia F(1).

Author information:
(1)Department of Health Promotion Sciences, Maternal and Child Care, Internal 
Medicine and Medical Specialties 'Giuseppe D'Alessandro', University of Palermo, 
Via del Vespro 133, 90127 Palermo, Italy.
(2)Department of Experimental and Clinical Medicine, University of Florence, 
Largo Brambilla, 3, 50134 Florence, Italy.
(3)Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), 
Section of Audiology, University of Palermo, Via del Vespro 129, 90127 Palermo, 
Italy.

The period between the beginning and the end of the COVID-19 pandemic emergency 
generated a general state of stress, affecting both the mental state and 
physical well-being of the general population. Stress is the body's reaction to 
events or stimuli perceived as potentially harmful or distressing. Particularly 
when prolonged over time, it can promote the consumption of different 
psychotropic substances such as alcohol, and thus the genesis of various 
pathologies. Therefore, our research aimed to evaluate the differences in 
alcohol consumption in a cohort of 640 video workers who carried out activities 
in smart working, subjects particularly exposed to stressful situations due to 
the stringent rules of protection and prevention implemented during the 
pandemic. Furthermore, based on the results obtained from the administration of 
the AUDIT-C, we wanted to analyse the different modes of alcohol consumption 
(low, moderate, high, severe) to understand whether there is a difference in the 
amount of alcohol consumed that could predispose individuals to health problems. 
To this end, we administered the AUDIT-C questionnaire in two periods (T0 and 
T1), coinciding with annual occupational health specialist visits. The results 
of the present research showed an increase in the number of subjects consuming 
alcohol (p = 0.0005) and in their AUDIT-C scores (p < 0.0001) over the period 
considered. A significant decrease in subgroups who drink in a low-risk (p = 
0.0049) mode and an increase in those with high (p = 0.00012) and severe risk (p 
= 0.0002) were also detected. In addition, comparing the male and female 
populations, it emerged that males have drinking patterns that lead to a higher 
(p = 0.0067) health risk of experiencing alcohol-related diseases than female 
drinking patterns. Although this study provides further evidence of the negative 
impact of the stress generated by the pandemic emergency on alcohol consumption, 
the influence of many other factors cannot be ruled out. Further research is 
needed to better understand the relationship between the pandemic and alcohol 
consumption, including the underlying factors and mechanisms driving changes in 
drinking behaviour, as well as potential interventions and support strategies to 
address alcohol-related harm during and after the pandemic.

DOI: 10.3390/ijerph20054613
PMCID: PMC10001951
PMID: 36901622 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


890. Int J Environ Res Public Health. 2023 Mar 4;20(5):4562. doi: 
10.3390/ijerph20054562.

Development of an Online Mind-Body Physical Activity Intervention for Young 
Adults during COVID-19: A Pilot Study.

Strehli I(1), Burns RD(1), Bai Y(1), Ziegenfuss DH(2), Block ME(3), Brusseau 
TA(1).

Author information:
(1)Department of Health and Kinesiology, University of Utah, Salt Lake City, UT 
84112, USA.
(2)Marriot Library, University of Utah, Salt Lake City, UT 84112, USA.
(3)Department of Kinesiology, University of Virginia, Charlottesville, VA 22903, 
USA.

The purpose of this study was to examine the association between the 
implementation of an online mind-body physical activity (MBPA) intervention and 
physical activity (PA), stress, and well-being in young adults during COVID-19. 
The participants were a sample of college students (N = 21; 81% female). The 
MBPA intervention was organized in four online modules that were administered 
asynchronously for 8 weeks with three separate 10 min sessions per week. The 
intervention components consisted of traditional deep breathing, diaphragm 
mindful breathing, yoga poses, and walking meditation. Objective PA behaviors 
were assessed using wrist-worn ActiGraph accelerometers, and stress and 
well-being data were collected using validated self-report instruments. A 2 
(sex) × 3 (time) doubly multivariate analysis of variance test with a univariate 
follow-up showed that the % of wear time in light (LPA) and moderate-to-vigorous 
physical activity (MVPA) was significantly higher at the end of the intervention 
compared to baseline (LPA mean difference = 11.3%, p = 0.003, d = 0.70; MVPA 
mean difference = 2.9%, p < 0.001, d = 0.56). No significant differences were 
observed for perceived stress and well-being, and there was no moderating effect 
of sex. The MBPA intervention showed promise, as it was associated with higher 
PA in young adults during COVID-19. No improvements were observed for stress and 
well-being. These results warrant further testing of the intervention's 
effectiveness using larger samples.

DOI: 10.3390/ijerph20054562
PMCID: PMC10002143
PMID: 36901572 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


891. Int J Environ Res Public Health. 2023 Mar 3;20(5):4536. doi: 
10.3390/ijerph20054536.

Psychosocial Peer Support to Address Mental Health and Burnout of Health Care 
Workers Affected by COVID-19: A Qualitative Evaluation.

Simms L(1), Ottman KE(1), Griffith JL(1), Knight MG(2), Norris L(3), 
Karakcheyeva V(3), Kohrt BA(1).

Author information:
(1)Center for Global Mental Health Equity, Department of Psychiatry and 
Behavioral Sciences, George Washington University, Washington, DC 20037, USA.
(2)Medical Faculty Associates, George Washington University, Washington, DC 
20037, USA.
(3)GW Resiliency & Well-Being Center, School of Medicine and Health Sciences, 
George Washington University, Washington, DC 20037, USA.

Health care workers in the U.S. are experiencing alarming rates of burnout. 
Furthermore, the COVID-19 pandemic has worsened this issue. Psychosocial 
peer-support programs that address general distress and are tailored to health 
care systems are needed. A Care for Caregivers (CFC) Program was developed at an 
American metropolitan university hospital and outpatient health care system. The 
CFC program trains "Peer Caregivers" and managers and has four components: the 
identification of colleagues in need of support; psychological first aid; 
linkage to resources; and the promotion of hope among colleagues experiencing 
demoralization. Qualitative interviews (n = 18) were conducted with Peer 
Caregivers and Managers participating in the initial piloting of the program. 
Results suggest that the CFC program shifts the organizational culture, teaches 
staff skills for recognizing and supporting others in distress, and supports 
those staff who are already providing these services informally. Findings 
suggest that staff distress resulted primarily from external factors and 
secondarily from internal organizational stressors. External stressors were 
exacerbated by the COVID-19 pandemic. Although the program has promise for 
addressing staff burnout, other organizational efforts are needed to 
simultaneously promote staff wellness. Ultimately, psychosocial peer support 
programs for health care workers are feasible and potentially impactful, but 
also require other systemic changes within a health care system to improve and 
sustain staff well-being.

DOI: 10.3390/ijerph20054536
PMCID: PMC10002014
PMID: 36901545 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


892. Int J Environ Res Public Health. 2023 Mar 1;20(5):4414. doi: 
10.3390/ijerph20054414.

COVID-19 and Psychosocial Well-Being: Did COVID-19 Worsen U.S. Frontline 
Healthcare Workers' Burnout, Anxiety, and Depression?

Novilla MLB(1), Moxley VBA(2), Hanson CL(1), Redelfs AH(1), Glenn J(1), Donoso 
Naranjo PG(1), Smith JMS(1), Novilla LKB(1), Stone S(1), Lafitaga R(1).

Author information:
(1)Department of Public Health, Brigham Young University, Provo, UT 84602, USA.
(2)J. Reuben Clark Law School, Brigham Young University, Provo, UT 84602, USA.

Healthcare workers are highly regarded for their compassion, dedication, and 
composure. However, COVID-19 created unprecedented demands that rendered 
healthcare workers vulnerable to increased burnout, anxiety, and depression. 
This cross-sectional study assessed the psychosocial impact of COVID-19 on U.S. 
healthcare frontliners using a 38-item online survey administered by Reaction 
Data between September and December 2020. The survey included five validated 
scales to assess self-reported burnout (Maslach Summative Burnout Scale), 
anxiety (GAD-7), depression (PHQ-2), resilience (Brief Resilience Coping Scale), 
and self-efficacy (New Self-Efficacy Scale-8). We used regression to assess the 
relationships between demographic variables and the psychosocial scales index 
scores and found that COVID-19 amplified preexisting burnout (54.8%), anxiety 
(138.5%), and depression (166.7%), and reduced resilience (5.70%) and 
self-efficacy (6.5%) among 557 respondents (52.6% male, 47.5% female). High 
patient volume, extended work hours, staff shortages, and lack of personal 
protective equipment (PPE) and resources fueled burnout, anxiety, and 
depression. Respondents were anxious about the indefinite duration of the 
pandemic/uncertain return to normal (54.8%), were anxious of infecting family 
(48.3%), and felt conflicted about protecting themselves versus fulfilling their 
duty to patients (44.3%). Respondents derived strength from their capacity to 
perform well in tough times (74.15%), emotional support from family/friends 
(67.2%), and time off work (62.8%). Strategies to promote emotional well-being 
and job satisfaction can focus on multilevel resilience, safety, and social 
connectedness.

DOI: 10.3390/ijerph20054414
PMCID: PMC10002248
PMID: 36901432 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


893. Int J Environ Res Public Health. 2023 Mar 1;20(5):4408. doi: 
10.3390/ijerph20054408.

Paternal Perinatal Experiences during the COVID-19 Pandemic: A Framework 
Analysis of the Reddit Forum Predaddit.

Cameron EE(1), Simpson KM(1), Pierce SK(1), Penner KE(1), Beyak A(1), Gomez 
I(1), Bowes JM(2), Reynolds KA(1)(3)(4), Tomfohr-Madsen LM(5), Roos LE(1)(4)(6).

Author information:
(1)Department of Psychology, University of Manitoba, Winnipeg, MB R3T 2N2, 
Canada.
(2)Department of Community Health Sciences, University of Manitoba, Winnipeg, MB 
R3E 0W2, Canada.
(3)Department of Psychiatry, University of Manitoba, Winnipeg, MB R3E 3N4, 
Canada.
(4)Children's Hospital Research Institute of Manitoba, Winnipeg, MB R3E 0Z3, 
Canada.
(5)Faculty of Education, Educational and Counselling Psychology, and Special 
Education, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
(6)Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, 
MB R3A 1S1, Canada.

During the COVID-19 pandemic, new parents were disproportionately affected by 
public health restrictions changing service accessibility and increasing 
stressors. However, minimal research has examined pandemic-related stressors and 
experiences of perinatal fathers in naturalistic anonymous settings. An 
important and novel way parents seek connection and information is through 
online forums, which increased during COVID-19. The current study qualitatively 
analyzed the experiences of perinatal fathers from September to December 2020 
through the Framework Analytic Approach to identify unmet support needs during 
COVID-19 using the online forum predaddit on reddit. Five main themes in the 
thematic framework included forum use, COVID-19, psychosocial distress, family 
functioning, and child health and development, each with related subthemes. 
Findings highlight the utility of predaddit as a source of information for, and 
interactions of, fathers to inform mental health services. Overall, fathers used 
the forum to engage with other fathers during a time of social isolation and for 
support during the transition to parenthood. This manuscript highlights the 
unmet support needs of fathers during the perinatal period and the importance of 
including fathers in perinatal care, implementing routine perinatal mood 
screening for both parents, and developing programs to support fathers during 
this transition to promote family wellbeing.

DOI: 10.3390/ijerph20054408
PMCID: PMC10001997
PMID: 36901417 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


894. Int J Environ Res Public Health. 2023 Mar 1;20(5):4386. doi: 
10.3390/ijerph20054386.

Sleep Disturbances and Mental Well-Being of Preschool Children during the 
COVID-19 Pandemic in Mexico.

León Rojas D(1), Castorena Torres F(1), Alvarado Ramos S(1), Del Castillo 
Morales A(1), Rodríguez-de-Ita J(1)(2).

Author information:
(1)Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ave. 
Morones Prieto 3000, Monterrey 64710, NL, Mexico.
(2)Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, 
Hospital San José, TecSalud, Monterrey 64710, NL, Mexico.

COVID-19 pandemic confinement caused changes in families and children's routines 
worldwide. Studies conducted at the beginning of the pandemic have examined the 
harmful effects of these changes on mental health, including sleep disturbances. 
As sleep is essential for optimal childhood development, this study was designed 
to determine preschool-aged (3-6 years old) children's sleep parameters and 
mental well-being during the COVID-19 pandemic in Mexico. Using a 
cross-sectional design, a survey was applied to parents of preschool children, 
inquiring about their children's confinement status, routine changes, and 
electronics use. The parents responded to the Children's Sleep Habits 
Questionnaire and the Strengths and Difficulties Questionnaire to assess 
children's sleep and mental well-being. To provide objective sleep data, the 
children wore wrist actigraphy for seven days. Fifty-one participants completed 
the assessment. The children's mean age was 5.2 years, and the prevalence of 
sleep disturbances was 68.6%. The use of electronic tablets in the bedroom near 
bedtime and symptoms of mental health deterioration (i.e., emotional distress 
and behavioral difficulties) were associated with sleep disturbances and their 
severity. The COVID-19 pandemic's confinement-related routine changes greatly 
impacted preschool children's sleep and well-being. We recommend establishing 
age-tailored interventions to manage children at higher risk.

DOI: 10.3390/ijerph20054386
PMCID: PMC10002191
PMID: 36901397 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. All 
authors declare no support from any organization for the submitted work, no 
financial relationships with any organization that might have an interest in the 
submitted work, and no other influences. The funders had no role in the design 
of the study; in the collection, analyses, or interpretation of data; in the 
writing of the manuscript; or in the decision to publish the results.


895. Int J Environ Res Public Health. 2023 Feb 27;20(5):4255. doi: 
10.3390/ijerph20054255.

"We're Not Going to Be as Prepared": A Qualitative Study of Healthcare Trainees' 
Experiences after One Year of the COVID-19 Pandemic.

Blake H(1)(2), Brewer A(3), Chouliara N(3)(4).

Author information:
(1)School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK.
(2)NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH, UK.
(3)School of Medicine, University of Nottingham, Nottingham NG7 2UK, UK.
(4)NIHR Applied Research Collaboration East Midlands, Nottingham NG7 2TU, UK.

The COVID-19 pandemic had significant impacts on the mental health and academic 
experiences of healthcare trainees. Building on findings from earlier in the 
pandemic, we explore the impacts on healthcare trainees after a sustained 
pandemic period of 12-14 months, involving multiple lockdowns, changes in 
government COVID-19 regulations and the delivery of health education. A 
qualitative study was conducted between March-May 2021. Participants were 12 
healthcare trainees (10 women, 2 men) of medicine, nursing, and midwifery, 
registered at one of three higher education institutions in the United Kingdom. 
Interviews were fully transcribed, and data were thematically analysed using a 
combination of deductive and inductive approaches. We identified three key 
themes with eight subthemes: (i) academic experiences (adjustment to online 
learning, loss of clinical experience, confidence in the university), (ii) 
impacts on wellbeing (psychosocial impacts, physical impacts, pandemic duration 
and multiple lockdowns), and (iii) support frameworks (university preparedness 
for increased student support needs, importance of relationship with academic 
tutors). Findings shed light on the long-lasting and emerging impacts of the 
pandemic over time. We identify support needs for trainees both during their 
academic studies, and as they move forwards into professional roles within the 
healthcare workforce. Recommendations are made for higher education institutions 
and healthcare employers.

DOI: 10.3390/ijerph20054255
PMCID: PMC10002117
PMID: 36901267 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. 
This study is supported by the NIHR Applied Research Collaboration East Midlands 
(ARC EM). The views expressed are those of the author(s) and not necessarily 
those of the NIHR or the Department of Health and Social Care.


896. Int J Environ Res Public Health. 2023 Feb 27;20(5):4204. doi: 
10.3390/ijerph20054204.

Teacher Burnout in the Time of COVID-19: Antecedents and Psychological 
Consequences.

Padmanabhanunni A(1), Pretorius TB(1).

Author information:
(1)Department of Psychology, University of the Western Cape, Bellville 7530, 
South Africa.

The important, frontline role of teachers during the COVID-19 pandemic has often 
gone unrecognized, and attention to their mental health and well-being is often 
only the focus of scholarly research. The unprecedented challenges that teachers 
faced during the COVID-19 pandemic and the stresses and strains associated with 
it have severely impacted their psychological well-being. This study examined 
the predictors and the psychological consequences of burnout. Participants (N = 
355) were schoolteachers in South Africa who completed the Perceived 
Vulnerability to Disease Questionnaire, the Fear of COVID-19 Scale, the Role 
Orientation Questionnaire, the Maslach Burnout Inventory, the Centre for 
Epidemiological Depression Scale, the Beck Hopelessness Scale, the Satisfaction 
with Life Scale, and the trait scale of the State-Trait Anxiety Inventory. The 
results of a multiple regression showed that fear of COVID-19, role ambiguity, 
and role conflict were significant predictors of emotional exhaustion and 
depersonalization, while perceived infectability and role ambiguity 
significantly predicted personal accomplishment. Gender and age also predicted 
emotional exhaustion and depersonalization, respectively, and age was also a 
significant predictor of personal accomplishment. Generally, the dimensions of 
burnout were significant predictors of indices of psychological 
well-being-namely, depression, hopelessness, anxiety, and life satisfaction-with 
the exception of the association between depersonalization and life 
satisfaction. Our results suggest that intervention efforts to reduce burnout 
need to provide teachers with adequate job resources to buffer against the 
demands and stressors associated with their work.

DOI: 10.3390/ijerph20054204
PMCID: PMC10002371
PMID: 36901219 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


897. Int J Environ Res Public Health. 2023 Feb 25;20(5):4149. doi: 
10.3390/ijerph20054149.

Association between Familism and Mental Health in College Adolescents during the 
COVID-19 Pandemic.

Mayorga-Muñoz C(1), Riquelme-Segura L(1), Delvecchio E(2), Lee-Maturana S(3).

Author information:
(1)Departamento de Trabajo Social, Facultad de Educación, Ciencias Sociales y 
Humanidades, Universidad de La Frontera, Temuco 4780000, Chile.
(2)Department of Philosophy, Social and Human Sciences and Education, University 
of Perugia, 06123 Perugia, Italy.
(3)Escuela de Psicología y Filosofía, Universidad de Tarapacá, Arica 1000000, 
Chile.

Familism, also known in the literature as allocentrism, is the cultural 
propensity of a society to place the family at the center of its value system. 
Adherence to this value has been related to less depressive symptomatology in 
young people; however, these results are not conclusive, since it has also been 
found that the influence of familism on depressive symptoms is more indirect 
than direct. This study aimed to explore the direct relationships between 
familism (allocentrism and idiocentrism) and mental health (depression, anxiety, 
and stress). Methodologically, the study had a non-experimental, 
cross-sectional, descriptive, and correlational design. A sample of 451 Chilean 
university students responded to an instrument composed of the subscales 
allocentrism, idiocentrism, depression, anxiety, and stress during the COVID-19 
pandemic. The results showed that family allocentrism was positively and 
significantly associated with depression (γ = 0.112, p < 0.05), anxiety (γ = 
0.209, p < 0.001), and stress (γ = 0.212, p < 0.001), and family idiocentrism 
was negatively and significantly linked with depression (γ = -0.392, p < 0.001), 
anxiety (γ = -0.368, p < 0.001), and stress (γ = -0.408, p < 0.001). These 
findings contribute to supporting actions to reduce negative symptomatology and 
promote greater well-being in university students.

DOI: 10.3390/ijerph20054149
PMCID: PMC10001446
PMID: 36901159 [Indexed for MEDLINE]

Conflict of interest statement: The authors do not have any conflict of 
interest.


898. Int J Environ Res Public Health. 2023 Feb 25;20(5):4132. doi: 
10.3390/ijerph20054132.

Effects of a Multi-Professional Intervention on Mental Health of Middle-Aged 
Overweight Survivors of COVID-19: A Clinical Trial.

Ryal JJ(1)(2), Perli VAS(2)(3), Marques DCS(1)(2), Sordi AF(2), Marques 
MGS(1)(2), Camilo ML(2), Milani RG(1)(2), Mota J(4), Valdés-Badilla P(5)(6), 
Magnani Branco BH(1)(2)(3)(4).

Author information:
(1)Postgraduate Program in Health Promotion, Cesumar University, Maringa 
87050-390, Brazil.
(2)Interdisciplinary Laboratory of Intervention in Health Promotion, Cesumar 
Institute of Science, Technology and Innovation, Maringa 87050-390, Brazil.
(3)Medicine Course, Department of Health Sciences, Cesumar University, Maringa 
87050-390, Brazil.
(4)Research Centre of Physical Activity, Health, and Leisure, Laboratory for 
Integrative and Translational Research in Population Health (ITR), Faculty of 
Sports, University of Porto, 4200-450 Porto, Portugal.
(5)Department of Physical Activity Sciences, Faculty of Education Sciences, 
Universidad Catolica del Maule, Talca 3530-000, Chile.
(6)Sports Coach Career, School of Education, Universidad Viña del Mar, Viña del 
Mar 2520-000, Chile.

The present study aimed to investigate the effects of a multi-professional 
intervention model on the mental health of middle-aged, overweight survivors of 
COVID-19. A clinical trial study with parallel groups and repeated measures was 
conducted. For eight weeks, multi-professional interventions were conducted 
(psychoeducation, nutritional intervention, and physical exercises). One hundred 
and thirty-five overweight or obese patients aged 46.46 ± 12.77 years were 
distributed into four experimental groups: mild, moderate, severe COVID, and 
control group. The instruments were used: mental health continuum-MHC, revised 
impact scale-IES-r, generalized anxiety disorder-GAD-7, and Patient health 
questionnaire PHQ-9, before and after eight weeks. The main results indicated 
only a time effect, with a significant increase in global MHC scores, emotional 
well-being, social well-being, and psychological well-being, as well as detected 
a significant reduction in global IES-R scores, intrusion, avoidance, and 
hyperarousal, in addition to a reduction in GAD-7 and PHQ-9 scores (p < 0.05). 
In conclusion, it was possible to identify those psychoeducational interventions 
that effectively reduced anxiety, depression, and post-traumatic stress symptoms 
in post-COVID-19 patients, regardless of symptomatology, in addition to the 
control group. However, moderate and severe post-COVID-19 patients need to be 
monitored continuously since the results of these groups did not follow the 
response pattern of the mild and control groups.

DOI: 10.3390/ijerph20054132
PMCID: PMC10002443
PMID: 36901146 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


899. Int J Environ Res Public Health. 2023 Feb 25;20(5):4106. doi: 
10.3390/ijerph20054106.

Psychological Well-Being of Cancer Patients before and during the Pandemic: The 
Impact of COVID-19 Peritraumatic Distress.

Bochicchio I(1), La Rosa VL(2), Marino G(3), Craparo G(4), Commodari E(2), 
Deiana G(1), Sanseverino F(5), Tartarone A(5), Conca R(5), Lettini AR(1).

Author information:
(1)Unit of Clinical Psychology, Centro di Riferimento Oncologico della 
Basilicata (IRCCS-CROB), 85028 Rionero in Vulture, Italy.
(2)Department of Educational Sciences, University of Catania, 95124 Catania, 
Italy.
(3)Unit of Breast Surgery, Centro di Riferimento Oncologico della Basilicata 
(IRCCS-CROB), 85028 Rionero in Vulture, Italy.
(4)Faculty of Human and Social Sciences, Kore University of Enna, 94100 Enna, 
Italy.
(5)Unit of Oncological Gynecology, Centro di Riferimento Oncologico della 
Basilicata (IRCCS-CROB), 85028 Rionero in Vulture, Italy.

BACKGROUND: This study aimed to evaluate the psychological impact of the 
COVID-19 pandemic on cancer patients.
METHODS: Ninety cancer patients undergoing chemotherapy with antiblastics were 
recruited from a tertiary medical center and completed a battery of standardized 
questionnaires to assess anxiety, depression, peritraumatic stress, and quality 
of life before and during the pandemic.
RESULTS: Quality of life worsened significantly during the pandemic compared 
with the pre-pandemic period. Anxiety and depression levels also increased 
significantly during the pandemic. COVID-19 peritraumatic distress significantly 
predicted lower quality-of-life scores during the pandemic.
CONCLUSIONS: COVID-19 distress affected the overall quality of life of patients 
who already had lower levels of quality of life before the pandemic and who had 
advanced cancers. Cancer patients must receive adequate support from 
psychiatrists and psychologists to mitigate the psychological distress related 
to the pandemic.

DOI: 10.3390/ijerph20054106
PMCID: PMC10002171
PMID: 36901117 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


900. Int J Environ Res Public Health. 2023 Feb 23;20(5):3968. doi: 
10.3390/ijerph20053968.

COVID-19 Fear Impact on Israeli and Maltese Female "Help" Profession Students.

Yehudai M(1), Clark M(2), Azzopardi A(3), Romem Porat SL(1), Dagan A(1), Reznik 
A(1), Isralowitz R(1).

Author information:
(1)Regional Alcohol and Drug Abuse Research Center, Ben Gurion University of the 
Negev, Beer Sheva 84105, Israel.
(2)Department of Psychology, Faculty for Social Wellbeing, University of Malta, 
2080 Msida, Malta.
(3)Department of Youth and Community Studies, Faculty for Social Wellbeing, 
University of Malta, 2080 Msida, Malta.

BACKGROUND: The aim of this cross-sectional study was to examine the impact of 
COVID-19 fear on the well-being of Israeli and Maltese female "help" profession 
(e.g., social work and psychology) undergraduate students. This cross-national 
comparison includes factors of depression, anxiety, anger, loneliness, 
nervousness, substance use, eating behavior, burnout, and resilience. The study 
hypothesis is that country status, even with different social-cultural 
characteristics including religiosity, is not a significant factor associated 
with COVID-19 fear impact on select behavioral characteristics of female 
university students.
METHODS: A total of 453 female "help" profession students completed an online 
survey from January to July 2021. Various statistical methods of analysis 
including regression were used for this study.
RESULTS: The mean COVID-19 fear scores were the same among Israeli and Maltese 
students. Resilience was found to be higher among Israeli females; burnout was 
found to be higher among those from Malta. Substance use (i.e., tobacco, 
alcohol, cannabis, stimulants, or prescription drugs) in the last month was 
reported by 77.2% of the respondents. No significant differences were found for 
previous-month substance use based on country status. Regardless of country, 
respondents who reported more previous-month substance use had higher COVID-19 
fear and burnout scores, as well as lower resilience. Due to COVID-19, most 
respondents (74.3%) reported deterioration of their psycho-emotional well-being 
in the last month; however, no significant differences were found based on 
country and religiosity statuses. Furthermore, no significant differences were 
found for eating behavior changes and weight increase based on country and 
religiosity statuses.
CONCLUSION: Study findings showed the impact of COVID-19 fear on the well-being 
of Israeli and Maltese female "help" profession undergraduate students. This 
study examined only female students; however, additional research is needed to 
address male students and their experiences. Prevention and treatment 
intervention measures aimed to increase resilience and decrease burnout, 
including those that can be made available on campus, should be thought about by 
university administration personnel and student association leaders in 
consultation with mental health professionals.

DOI: 10.3390/ijerph20053968
PMCID: PMC10001741
PMID: 36900978 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


901. Int J Environ Res Public Health. 2023 Feb 23;20(5):3950. doi: 
10.3390/ijerph20053950.

How COVID-19 News Affect Older Adults' Mental Health-Evidence of a Positivity 
Bias.

Ng ZZ(1), Li G(2), Flynn S(3), Yow WQ(4).

Author information:
(1)Raffles Institution, 1 Raffles Institution Lane, Singapore 575954, Singapore.
(2)Palo Alto Senior High School, 50 Embarcadero Road, Palo Alto, CA 94301, USA.
(3)Department of Linguistics and Philosophy, School of Humanities, Arts, and 
Social Sciences, Massachusetts Institute of Technology, 77 Massachusetts Avenue, 
Cambridge, MA 02139, USA.
(4)Humanities, Arts and Social Sciences, Singapore University of Technology and 
Design, 8 Somapah Road, Singapore 487372, Singapore.

BACKGROUND: Media affects the trajectory of many individuals' mental health-with 
media news, individuals experience negative bias more than positive bias. 
However, there is also evidence of an age-related positivity effect, with 
negativity bias generally fading with age. With the rise of COVID-19 cases, 
older adults (aged 55 years and older) who consume media frequently are at a 
high risk for declining mental health. To date, there has been no research on 
the positivity vs. negativity bias of media news on older adults. Here, we 
investigated whether positivity or negativity bias plays a larger role in 
affecting how older adults react to COVID-19 news.
METHODS: Sixty-nine older adults (aged 55-95) answered questions about their 
weekly media consumption and how closely they followed news relating to 
COVID-19. They also completed a general health questionnaire. They were then 
randomly assigned to read either positive or negative COVID-19 news (n = 35 and 
34, respectively). The adults were asked if the news made them feel happy or 
fearful, and if they wanted to read more about the news or ignore the news.
RESULTS: An analysis revealed that the more often older adults consumed media 
and the more closely they followed COVID-19 news, the more they felt unhappy and 
depressed. Importantly, older adults who read positive news reported stronger 
responses than those who read negative news. Older adults appeared to have a 
strong positivity bias for COVID-19 news, reporting feeling happy and wanting to 
read about positive news. In contrast, negative COVID-19 news did not evoke 
similar levels of response from the older adults.
CONCLUSIONS: Media consumption of COVID-19 news does negatively impact the 
mental well-being of older adults, but older adults appear to have a strong 
positivity bias and a lack of negativity bias for COVID-19 news. These findings 
suggest that older adults can remain hopeful and positive during periods of 
public health crises and intense stress, which is essential to sustaining their 
mental well-being during difficult times.

DOI: 10.3390/ijerph20053950
PMCID: PMC10002267
PMID: 36900959 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


902. Int J Environ Res Public Health. 2023 Feb 22;20(5):3927. doi: 
10.3390/ijerph20053927.

Social Stigma, Mental Health, Stress, and Health-Related Quality of Life in 
People with Long COVID.

Scholz U(1)(2), Bierbauer W(1)(2), Lüscher J(3).

Author information:
(1)Applied Social and Health Psychology, Department of Psychology, University of 
Zurich, Binzmuehlestrasse 14/Box 14, 8050 Zurich, Switzerland.
(2)University Research Priority Program "Dynamics of Healthy Aging", University 
of Zurich, Stampfenbachstrasse 73l, 8006 Zurich, Switzerland.
(3)Swiss Paraplegic Research, Guido A. Zaech-Strasse 4, 6207 Nottwil, 
Switzerland.

A considerable amount of people who have been infected with SARS-CoV-2 
experience ongoing symptoms, a condition termed long COVID. This study examined 
nuanced experiences of social stigma in people with long COVID and their 
associations with perceived stress, depressive symptoms, anxiety, and mental and 
physical health-related quality of life (hrqol). A total of N = 253 participants 
with long COVID symptoms (mean age = 45.49, SD = 12.03; n = 224, 88.5% women) 
completed a cross-sectional online survey on overall social stigma and the 
subfacets enacted and perceived external stigma, disclosure concerns, and 
internalized stigma. Data were analysed using multiple regression and 
controlling for overall burden of consequences of long COVID, overall burden of 
symptoms of long COVID, and outcome-specific confounders. In line with our 
preregistered hypotheses, total social stigma was related to more perceived 
stress, more depressive symptoms, higher anxiety, and lower mental hrqol, but-in 
contrast to our hypothesis-it was unrelated to physical hrqol after controlling 
for confounders. The three subscales of social stigma resulted in differential 
associations with the outcomes. Social stigma experiences go hand in hand with 
worse mental health in people with long COVID. Future studies should examine 
potential protective factors to buffer the effects of social stigma on people's 
well-being.

DOI: 10.3390/ijerph20053927
PMCID: PMC10001775
PMID: 36900938 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


903. Am J Drug Alcohol Abuse. 2023 Jul 4;49(4):470-480. doi: 
10.1080/00952990.2023.2176234. Epub 2023 Mar 10.

Changes in frequency of cannabis use among people with HIV during the COVID-19 
pandemic: a multi-methods study to explore the underlying reasons for change.

Parisi CE(1), Wang Y(1), Varma DS(1), Vaddiparti K(1), Ibañez GE(2), Cruz 
Carrillo L(2), Cook RL(1).

Author information:
(1)Department of Epidemiology, University of Florida, Gainesville, FL, USA.
(2)Department of Epidemiology, Florida International University, Miami, FL, USA.

Background: People with HIV (PWH) report higher rates of cannabis use than the 
general population. It is unclear how cannabis use among PWH has been impacted 
by the COVID-19 pandemic and the implications for the health and wellbeing of 
PWH.Objectives: To describe changes in frequency of cannabis use among a sample 
of PWH during the pandemic, reasons for those changes, and implications of the 
findings.Methods: The data are cross-sectional and come from questions asked in 
a follow-up phone survey administered to a prospective cohort of PWH in Florida 
between May 2020 and March 2021. Participants who used cannabis were asked about 
changes in their frequency of cannabis use in a quantitative survey and reasons 
for changes in a qualitative open-ended question. Qualitative data were analyzed 
using thematic analysis.Results: Among 227 PWH (mean age 50, 50% men, 69% 
Black/African American, 14% Hispanic/Latino), 13% decreased frequency of 
cannabis, 11% increased frequency, and 76% reported no change. The most common 
reasons for increasing frequency of cannabis use were reducing anxiety/stress, 
trying to relax, coping with grief or reducing symptoms of depression, and 
reducing boredom during the pandemic. Supply or access issues, health concerns, 
and having already wanted to reduce cannabis use were common reasons for 
decreased frequency.Conclusion: Nearly 25% of the sample changed their cannabis 
use frequency during the pandemic. These findings shed light on the behaviors 
and motivations of PWH who use cannabis and can inform clinical practice and 
interventions during public health emergencies and beyond.

DOI: 10.1080/00952990.2023.2176234
PMCID: PMC10695005
PMID: 36898081 [Indexed for MEDLINE]


904. Occup Med (Lond). 2023 Apr 26;73(3):155-160. doi: 10.1093/occmed/kqad032.

Mental health of diplomatic personnel: scoping review.

Brooks SK(1), Patel D(2), Greenberg N(1).

Author information:
(1)Department of Psychological Medicine, King's College London, Weston Education 
Centre, London SE5 9RJ, UK.
(2)Overseas Health and Welfare, Foreign, Commonwealth and Development Office, 
King Charles Street, London SW1A 2AH, UK.

BACKGROUND: Diplomatic personnel frequently relocate as part of their roles, 
requiring them to adapt to various cultural and political conditions; many are 
also at risk of experiencing trauma from being deployed to high-threat postings. 
With diplomatic personnel having to balance the usual pressures of their work 
with the uncertainties of COVID-19 in recent years, it is particularly important 
now to understand how to protect their mental health.
AIMS: To synthesize existing literature on the well-being of diplomatic 
personnel to improve understanding of how to protect their mental health.
METHODS: A scoping review was carried out to explore what is already known about 
the well-being of staff working in diplomatic roles. Four databases were 
searched and reference lists, as well as one key journal, were hand-searched.
RESULTS: Fifteen relevant publications were included. There was little consensus 
as to how the psychological well-being of diplomatic personnel compares to other 
populations or which factors predict well-being. Diplomats' psychological 
responses to traumatic experiences appeared similar to those of other 
trauma-exposed occupational groups.
CONCLUSIONS: Further research is needed to better understand the well-being of 
diplomatic personnel, particularly those not deployed to high-threat posts.

© The Author(s) 2023. Published by Oxford University Press on behalf of the 
Society of Occupational Medicine.

DOI: 10.1093/occmed/kqad032
PMCID: PMC10132204
PMID: 36893355 [Indexed for MEDLINE]

Conflict of interest statement: D.P. works as the Chief Medical Officer for the 
Foreign, Commonwealth and Development Office. N.G. carries out occasional paid 
work for the Foreign, Commonwealth and Development Office which is unrelated to 
the current study. S.K.B. reports no competing interests.


905. PLoS One. 2023 Mar 9;18(3):e0282836. doi: 10.1371/journal.pone.0282836. 
eCollection 2023.

The impact of Covid-19 pandemic on overall well-being of practicing lawyers.

Fore M(1), Stevenson E(2).

Author information:
(1)College of Business, Eastern Kentucky University, Richmond, KY, United States 
of America.
(2)Eastern Kentucky University, Richmond, KY, United States of America.

Every day lawyers provide counsel and advocacy to individuals, groups, and 
businesses in a multitude of settings. From court room to board room, attorneys 
are relied upon to guide their clients through difficult situations. In doing 
this, attorneys all too often internalize the stresses of those that they help. 
The legal system has long been considered a stressful occupation. This stressful 
environment was further taxed by the wider societal disruptions in 2020 as we 
dealt with the onset of the COVID-19 pandemic. Beyond the illness itself, the 
pandemic forced widespread court closures and made it more difficult to 
communicate with clients. Based upon a survey of the membership of the Kentucky 
Bar Association, this paper considers the impact of the pandemic on attorney 
wellness in a variety of categories. These results demonstrated marked negative 
impacts on a variety of wellness measures which may result in significant 
reductions in service provision and efficacy for the people who need legal 
services. The pandemic made the practice of law harder and more stressful. 
Attorneys suffered increased incidence of substance abuse, alcohol consumption, 
and stress during the pandemic. These results were generally worse among those 
practicing in the areas of criminal law. In light of these adverse psychological 
effects facing attorneys, the authors argue the need for increased mental health 
support resources for attorneys, as well as establishing clear steps to raise 
awareness among the legal community about the importance of mental health and 
personal wellness.

Copyright: © 2023 Fore, Stevenson. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0282836
PMCID: PMC9997954
PMID: 36893196 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


906. PLoS One. 2023 Mar 9;18(3):e0282589. doi: 10.1371/journal.pone.0282589. 
eCollection 2023.

Psychometric evaluation of Korean version of COVID-19 fear scale (K-FS-8): A 
population based cross-sectional study.

Lee JJ(1), Choi HR(1), Choi EP(1), Ho MH(1), Fong DYT(1), Lok KYW(1), Ho M(1), 
Lin CC(1).

Author information:
(1)School of Nursing, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR.

COVID-19-related fear negatively affects the public's psychological well-being 
and health behaviours. Although psychological distress including depression and 
anxiety under COVID-19 is well-established in literature, research scarcely 
evaluated the fear of COVID-19 with a large sample using validated scale. This 
study aimed to validate a Korean version of fear scale(K-FS-8) using an existing 
fear scale(Breast Cancer Fear Scale; 8 items) and to measure the fear of 
COVID-19 in South Korea. A cross-sectional online survey was conducted with 2235 
Korean adults from August to September 2020. The Breast Cancer Fear Scale was 
translated from English into Korean using forward-backward translation, and then 
face validity was assessed. Patient Health Questionnaire-4 and Primary Care 
Post-Traumatic Stress Disorder Screen for DSM-5 were used for assessing 
convergent validity of K-FS-8, and item response theory analysis was also 
conducted to further validate the K-FS-8. This study confirmed the validity and 
reliability of the K-FS-8. The validity of the scale was confirmed by convergent 
validity, known-group validity and item response theory analysis, and internal 
consistency was also examined(Cronbach's α coefficient = 0.92). This study also 
identified that 84.6% participants had high COVID-19 fear; whilst 26.3%, 23.2% 
and 13.4% participants had high risk of post-traumatic stress disorder, 
depressive and anxiety symptoms, respectively. The K-FS-8 showed the 
acceptability measuring the fear of COVID-19 in the Korean population. The 
K-FS-8 can be applied to screen for fear of COVID-19 and related major public 
health crises identifying individuals with high levels of fear in primary care 
settings who will benefit from psychological support.

Copyright: © 2023 Lee et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0282589
PMCID: PMC9997981
PMID: 36893101 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


907. BMC Public Health. 2023 Mar 8;23(1):451. doi: 10.1186/s12889-023-15285-8.

A longitudinal study of capability-based quality of life and mental health in 
the first 5-months of lockdown restrictions in the UK.

White RG(1), Christiansen P(2), van der Boor C(3).

Author information:
(1)School of Psychology, Queen's University Belfast, David Keir Building, 8-30 
Malone Road, Belfast, BT9 5BN, UK. r.white@qub.ac.uk.
(2)Institute of Population Health, University of Liverpool, Brownlow Hill, 
Liverpool, L69 3GB, UK.
(3)Department for Health Services Research and Policy, London School of Hygiene 
and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.

BACKGROUND: COVID19, and associated lockdown restrictions, have impacted on 
people's daily lives. Understanding the mental health and wellbeing implications 
of these impacts has been identified as a public health research priority.
AIMS: Building on an earlier cross-sectional study, the current study sought to 
investigate whether capability-based quality of life changed during the first 
5-months of lock-down restrictions in the UK, and whether capability-based 
quality of life was predictive of future levels of depression and anxiety.
METHODS: An initial convenience sample of 594 participants were followed up at 
three different timepoints spanning a 20-week time-period between March 2020 and 
August 2020. Participants provided demographic information and completed the 
Oxford Capabilities Questionnaire - Mental Health (OxCAP-MH), and the Hospital 
Anxiety and Depression Scale (HADS).
RESULTS: The mean scores indicated that levels of both depression and anxiety 
decreased across the three timepoints, whereas capability-based QoL (as assessed 
by the OxCAP-MH) decreased over time. Capability-based QoL predicted additional 
levels of variance in both depression and anxiety levels when time and 
sociodemographic factors were controlled for. Cross-lagged panel model analyses 
indicated that capability-based QoL over a month into lockdown restrictions 
predicted levels of depression and anxiety 5 months into the restrictions.
CONCLUSIONS: The study findings suggest that the capability-limiting impact of 
public health emergencies and related lockdown restrictions are important for 
understanding peoples' levels of depression and anxiety. The implications that 
the findings have for the provision of support in the context of public health 
emergencies and associated restrictions are discussed.

© 2023. The Author(s).

DOI: 10.1186/s12889-023-15285-8
PMCID: PMC9993355
PMID: 36890497 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


908. Chronobiol Int. 2023 Apr;40(4):438-449. doi: 10.1080/07420528.2023.2186127. Epub 
2023 Mar 8.

Poor sleep quality during COVID-19 pandemic restrictions associated with reduced 
psychological wellbeing in healthcare students.

D'orsogna T(1), Halson SL(2), Oehmen R(1).

Author information:
(1)School of Medicine, University of Notre Dame Australia, Fremantle, Western 
Australia, Australia.
(2)School of Behavioural and Health Sciences, Australian Catholic University, 
Banyo, Australia.

Sleep is inexorably linked to both physiological and psychological wellbeing. 
Restrictions imposed to control the COVID-19 pandemic likely impacted upon daily 
and weekly routines, which can have a negative impact on a range of factors 
including sleep quality, and/or quantity and general wellbeing. The aim of this 
study was to investigate the effect of COVID-19 related restrictions on sleep 
patterns and psychological wellbeing of healthcare students. A survey was 
delivered to healthcare students across three faculties at a single institution. 
Participants completed questionnaires on the effect of COVID-19 restrictions on 
course delivery and clinical placements, its effect on sleep-wake times, sleep 
quality, sleep hygiene, psychological wellbeing, their current sleep knowledge 
and sleep education in their current course. Using the Pittsburgh Sleep Quality 
Index (PSQI), over 75% of participants were found to have poor sleep quality. 
Changes in sleep habits and sleep behaviours during COVID-19 restrictions were 
associated with poorer sleep quality, and this poor sleep quality was associated 
with poor psychological wellbeing, particularly, motivation, stress and fatigue. 
Increases in negative sleep hygiene behaviours were associated with a 
statistically significant increase in PSQI global score. Positive emotions were 
positively correlated with PSQI (r = 0.22-0.24, p < .001), negative emotions 
were negatively correlated with PSQI (r = -0.22 - -0.31, p < .001). Also, a 
self-perceived lack of sleep education was identified. This study illustrates 
the negative association between self-reported poor sleep behaviour and poor 
sleep quality during COVID-19 restrictions on university student mental health 
and wellbeing. Additionally, there is a self-perceived lack of sleep education 
with little to no time spent educating students in their current degree. Hence, 
appropriate sleep education may improve sleep behaviours and subsequent sleep 
quality, which may prove to be a protective factor against poor mental health in 
the face of unexpected changes to routines.

DOI: 10.1080/07420528.2023.2186127
PMID: 36883343 [Indexed for MEDLINE]


909. J Ment Health. 2023 Oct;32(5):890-898. doi: 10.1080/09638237.2023.2182414. Epub 
2023 Mar 8.

Moral injury and psychological wellbeing in UK healthcare staff.

Williamson V(1)(2), Lamb D(3), Hotopf M(4)(5), Raine R(3), Stevelink S(1)(4), 
Wessely S(4), Docherty M(4), Madan I(6), Murphy D(1)(7), Greenberg N(1).

Author information:
(1)Institute of Psychology, Psychiatry and Neuroscience, King's Centre for 
Military Health Research, King's College London, London, UK.
(2)Department of Experimental Psychology, Anna Watts Building, University of 
Oxford, Oxford, UK.
(3)Department of Applied Health Research, NIHR ARC North Thames, UCL, London, 
UK.
(4)Department of Psychological Medicine, Institute of Psychiatry Psychology and 
Neuroscience, King's College London, London, UK.
(5)South London and Maudsley NHS Foundation Trust, London, UK.
(6)Department of Occupational Health, Guy's and St Thomas' NHS Trust and King's 
College London, London, UK.
(7)Combat Stress, Tyrwhitt House, Leatherhead, UK.

BACKGROUND: Potentially morally injurious events (PMIEs) can negatively impact 
mental health. The COVID-19 pandemic may have placed healthcare staff at risk of 
moral injury.
AIM: To examine the impact of PMIE on healthcare staff wellbeing.
METHODS: Twelve thousand nine hundred and sixty-five healthcare staff (clinical 
and non-clinical) were recruited from 18 NHS-England trusts into a survey of 
PMIE exposure and wellbeing.
RESULTS: PMIEs were significantly associated with adverse mental health symptoms 
across healthcare staff. Specific work factors were significantly associated 
with experiences of moral injury, including being redeployed, lack of PPE, and 
having a colleague die of COVID-19. Nurses who reported symptoms of mental 
disorders were more likely to report all forms of PMIEs than those without 
symptoms (AOR 2.7; 95% CI 2.2, 3.3). Doctors who reported symptoms were only 
more likely to report betrayal events, such as breach of trust by colleagues 
(AOR 2.7, 95% CI 1.5, 4.9).
CONCLUSION: A considerable proportion of NHS healthcare staff in both clinical 
and non-clinical roles report exposure to PMIEs during the COVID-19 pandemic. 
Prospective research is needed to identify the direction of causation between 
moral injury and mental disorder as well as continuing to monitor the longer 
term outcomes of exposure to PMIEs.

DOI: 10.1080/09638237.2023.2182414
PMID: 36883341 [Indexed for MEDLINE]


910. J Pediatr Health Care. 2023 Jul-Aug;37(4):414-424. doi: 
10.1016/j.pedhc.2023.02.002. Epub 2023 Mar 5.

Pilot Study on the Impact of Gratitude Journaling or Cognitive Strategies on 
Health Care Workers.

Roche K, Mulchan S, Ayr-Volta L, Elias M, Brimacombe M, Morello C, Hinderer KA.

INTRODUCTION: The COVID-19 pandemic has significantly impacted the mental 
well-being of health care workers (HCWs). This study assessed the feasibility, 
acceptability, and preliminary efficacy of two psychological interventions, 
gratitude journaling or cognitive strategies, on pediatric HCWs.
METHOD: A pilot randomized parallel repeated measures design was used, with a 
convenience sample of 59 HCWs. Data were collected before and after the 
intervention period, 2 weeks after, and again 6 months later. Outcomes included 
depression, anxiety, meaning and purpose, feasibility, and acceptability.
RESULTS: Thirty-seven participants completed the study. The majority were nurses 
(registered nurses and advanced practice registered nurses) and physicians. In 
both groups, depression and anxiety scores diminished, but changes were not 
statistically significant. The study was feasible to conduct, and subjects 
reported high acceptability.
DISCUSSION: Gratitude journaling and cognitive strategies may help mental 
well-being in HCWs; however, future studies with larger samples are needed.

Copyright © 2023 National Association of Pediatric Nurse Practitioners. 
Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.pedhc.2023.02.002
PMCID: PMC9985770
PMID: 36882351 [Indexed for MEDLINE]


911. AACN Adv Crit Care. 2023 Mar 15;34(1):67-71. doi: 10.4037/aacnacc2023684.

Overcoming Stigma: Asking for and Receiving Mental Health Support.

Bergman A(1), Rushton CH(2).

Author information:
(1)Alanna Bergman is a PhD candidate, Johns Hopkins University School of 
Nursing, 525 N Wolf St, Baltimore, MD 21205 (Abergm13@jhu.edu).
(2)Cynda Hylton Rushton is the Anne and George Bunting Professor of Clinical 
Ethics, Johns Hopkins University Berman Institute of Bioethics & School of 
Nursing, Baltimore, Maryland.

The COVID-19 pandemic has taken a significant mental and emotional toll on 
critical care nurses. High patient acuity, staffing shortages, and increased 
care needs both in the hospital and in the community are contributing to 
increases in depression, anxiety, and overall burnout. Nurses who perceive, 
internalize, anticipate, and experience stigma may be hesitant to engage in 
mental health care and self-stewardship. Resultingly, stigma is a detriment to 
the mental health and overall well-being of critical care nurses. The American 
Nurses Association recognizes this stigma and is committed to dismantling stigma 
as a barrier to mental health care. Nurses may fear social and professional 
consequences associated with receiving mental health care. Nursing leaders and 
organizations can take steps to reduce stigma related to mental health care and 
support self-stewardship among critical care nurses.

DOI: 10.4037/aacnacc2023684
PMCID: PMC10329256
PMID: 36877645 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: The authors have no 
conflicts to disclose.


912. J Intensive Care Soc. 2023 Feb;24(1):117-120. doi: 10.1177/17511437221113239. 
Epub 2022 Jul 5.

Team Immediate Meet tool to help intensive care staff: Staff perception of an 
updated version and preliminary feedback following implementation.

Edmondson M(1), Guscoth L(1), Highfield J(2), Kelly FE(3).

Author information:
(1)Intensive Care Unit, Royal United Hospitals Bath NHS Foundation Trust, Bath, 
UK.
(2)Critical Care, University Hospital Wales, Cardiff, UK.
(3)Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS 
Foundation Trust, Bath, UK.

Intensive Care Unit staff deal with potentially traumatic cases throughout their 
careers. We designed and implemented a 'Team Immediate Meet' (TIM) tool, a 
communication aid designed to facilitate a two-minute 'hot debrief' after a 
critical event, provide the team with information about the normal reaction to 
such an event and signpost staff to strategies to help support their colleagues 
(and themselves). We describe our TIM tool awareness campaign, quality 
improvement project and subsequent feedback from staff who reported that the 
tool would be useful for navigating the aftermath of potentially traumatic 
events and could be transferable to other ICUs.

© The Intensive Care Society 2022.

DOI: 10.1177/17511437221113239
PMCID: PMC9975809
PMID: 36874285

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


913. Allergy Asthma Proc. 2023 Mar 1;44(2):115-121. doi: 10.2500/aap.2023.44.220096.

Hereditary Angioedema: Impact of COVID-19 pandemic stress upon disease related 
morbidity and well-being.

Christiansen SC(1), Lopes Veronez C(1), Smith TD(1), Riedl MA(1), Zuraw BL(1).

Author information:
(1)From the Division of Rheumatology, Allergy and Immunology, Department of 
Medicine, University of California San Diego, San Diego, California, and.

Background: Individuals with hereditary angioedema (HAE) experience 
stress-related sequelae, including enhanced disease morbidity and reduced 
quality of life. The pervasive societal strain that surround the coronavirus 
disease 2019 (COVID-19) pandemic may theoretically pose a disproportionate risk 
for patients with HAE. Objective: To dissect the interrelationship(s) among the 
COVID-19 pandemic, stress, and HAE disease-related morbidity and overall 
well-being. Methods: Subjects with HAE (either due to C1-inhibitor deficiency or 
with normal C1 inhibitor) as well as non-HAE household members (normal controls) 
completed online questionnaires that covered the impact of the COVID-19 pandemic 
on attack frequency, observed effectiveness of HAE medications, stress, and 
perceived quality of life and/or well-being. The subjects scored each of the 
questions to reflect their current status as well as their status before being 
aware of the pandemic. Results: Disease morbidity and psychologic stress 
outcomes were significantly worse in patients with HAE during the pandemic 
compared with before they were aware of the pandemic. A COVID-19 infection 
further increased attack frequency. Control subjects also experienced 
deterioration of well-being and optimism. A comorbid diagnosis of anxiety, 
depression, or posttraumatic stress disorder (PTSD) was generally associated 
with worse outcomes. Women consistently showed greater decrements in wellness 
during the pandemic compared with men. Women also reported higher levels of 
comorbid anxiety, depression, or PTSD than men and experienced a higher rate of 
job loss during the pandemic. Conclusion: The results implicated a deleterious 
impact of stress in the aftermath of COVID-19 awareness on HAE morbidity. The 
female subjects were universally more severely affected then were the male 
subjects. Overall well-being and/or quality of life, and optimism for the future 
deteriorated after awareness of the COVID-19 pandemic for the subjects with HAE 
and non-HAE household controls.

DOI: 10.2500/aap.2023.44.220096
PMCID: PMC9999437
PMID: 36872446 [Indexed for MEDLINE]


914. Anesthesiol Clin. 2023 Mar;41(1):303-316. doi: 10.1016/j.anclin.2022.10.009.

Health and Well-Being of Intensive Care Unit Physicians: How to Ensure the 
Longevity of a Critical Specialty.

Klick JC(1), Syed M(2), Leong R(3), Miranda H(4), Cotter EK(5).

Author information:
(1)Department of Anesthesiology, University of Vermont Medical Center, 
University of Vermont Larner College of Medicine, 111 Colchester Avenue, 
Burlington, VT 05401, USA.
(2)Department of Intensive Care & Resuscitation, Anesthesiology Institute, 
Cleveland Clinic Foundation, 9500 Euclid Avenue, Mail Code G58, Cleveland, OH 
44195, USA.
(3)Thomas Jefferson University Hospital, Sidney Kimmel Medial College, 111 South 
11th Street, Gibbon Building, Suite 8130, Philadelphia, PA 19107, USA.
(4)Department of Anesthesiology, Pain and Perioperative Medicine, University of 
Kansas Medical Center, 3901 Rainbow Boulevard, MS 1034, Kansas City, KS 66160, 
USA.
(5)Department of Anesthesiology, Pain and Perioperative Medicine, University of 
Kansas Medical Center, 3901 Rainbow Boulevard, MS 1034, Kansas City, KS 66160, 
USA. Electronic address: Ecotter2@kumc.edu.

A second epidemic of burnout, fatigue, anxiety, and moral distress has emerged 
concurrently with the coronavirus disease 2019 (COVID-19) pandemic, and critical 
care physicians are especially affected. This article reviews the history of 
burnout in health care workers, presents the signs and symptoms, discusses the 
specific impact of the COVID-19 pandemic on intensive care unit caregivers, and 
attempts to identify potential strategies to combat the Great Resignation 
disproportionately affecting health care workers. The article also focuses on 
how the specialty can amplify the voices and highlight the leadership potential 
of underrepresented minorities, physicians with disabilities, and the aging 
physician population.

Copyright © 2022 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.anclin.2022.10.009
PMCID: PMC9985495
PMID: 36872006 [Indexed for MEDLINE]


915. Scand J Psychol. 2023 Oct;64(5):543-551. doi: 10.1111/sjop.12911. Epub 2023 Mar 
5.

Mental health of Scandinavians during the first lockdown in the COVID-19 
pandemic: Psychosocial resources and coping strategies as protective or risk 
factors for anxiety and depression.

Pedersen HF(1)(2)(3), Stripp TK(4), Hvidt NC(4), Isene TA(2), la Cour P(2), 
Stålsett G(5), Danbolt LJ(2)(5).

Author information:
(1)Research Clinic for Functional Disorders, Aarhus University Hospital, Aarhus, 
Denmark.
(2)Research Center for Existential Health, Innlandet Hospital Trust, Brumunddal, 
Norway.
(3)Institute for Clinical Medicine, Aarhus University, Aarhus, Denmark.
(4)Research Unit of General Practice, Institute of Public Health, University of 
Southern Denmark, Odense, Denmark.
(5)MF Norwegian School of Theology, Religion and Society, Oslo, Norway.

BACKGROUND: The COVID-19 pandemic was a global health and economic crisis. In 
the early phase of the pandemic, studies found that populations were reporting 
lower levels of mental well-being and high levels of distress and worry. This 
study investigated potential protective and risk factors such as 
sociodemographics and psychological factors such as adaptation/coping.
METHODS: Two convenience samples from Norway and Denmark were recruited during 
the early phase of the first lockdown in May 2020 using snowball sampling 
primarily by social media. Measures included the Patient Health Questionnaire-4 
(PHQ-4) for screening anxiety and depression, COVID-19 distress, and coping 
strategies applied during the lockdown. Descriptive analyses were applied as 
well as bivariate correlations for associations between coping and mental health 
measures.
RESULTS: Levels of anxiety and depression were not alarmingly high, but being 
young, single, and female constituted a higher risk for poorer mental health. 
Applying positive reframing strategies was negatively associated with poor 
mental health and high COVID-19 stress, whereas distraction coping strategies 
were positively correlated with poor mental health and high COVID-19 stress.
CONCLUSION: Applying positive reframing as a coping strategy may constitute a 
protective factor for mental health in the early phase of a crisis such as a 
pandemic. This knowledge may inform public health agencies on how to promote 
mental health in similar situations in the future. However, longitudinal and 
qualitative studies are needed to investigate the long-term effects of the 
different coping strategies applied.

© 2023 The Authors. Scandinavian Journal of Psychology published by Scandinavian 
Psychological Associations and John Wiley & Sons Ltd.

DOI: 10.1111/sjop.12911
PMID: 36871196 [Indexed for MEDLINE]


916. J Gerontol B Psychol Sci Soc Sci. 2023 May 26;78(6):1109-1117. doi: 
10.1093/geronb/gbad040.

Agency and Mental Health Among Peruvian Older Adults During the COVID-19 
Lockdown.

Flores-Flores O(1)(2), Otero-Oyague D(1)(2)(3), Rey-Evangelista L(1)(2), 
Zevallos-Morales A(1)(2), Ramos-Bonilla G(4), Carrión I(1), Patiño V(2), Pollard 
SL(5), Parodi JF(1), Hurst JR(6), Gallo JJ(7)(8), Reynolds R(9).

Author information:
(1)Universidad de San Martín de Porres, Facultad de Medicina Humana, Centro de 
Investigación del Envejecimiento (CIEN), Lima, Peru.
(2)Asociación Benéfica PRISMA, Lima, Peru.
(3)Facultad de Psicología, Grupo de Investigación en Psicología Comunitaria 
(GIPC), Pontificia Universidad Católica del Perú, San Miguel, Peru.
(4)Facultad de Antropología, Grupo de Investigación Edades de la Vida y la 
Educación (EVE), Pontificia Universidad Católica del Perú, San Miguel, Peru.
(5)Center for Global Non-Communicable Disease Research and Training, School of 
Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
(6)UCL Respiratory, University College London, London, UK.
(7)Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 
Baltimore, Maryland, USA.
(8)Department of General Internal Medicine, School of Medicine, Johns Hopkins 
University, Baltimore, Maryland,USA.
(9)High Point University, Department of Sociology and Anthropology, High Point, 
North Carolina, USA.

OBJECTIVES: To explore the experiences of older Peruvian adults living in urban 
areas of Lima under lockdown due to the National COVID-19 Emergency, this study 
analyzes how older adults (aged 60 and older) exercise agency while also living 
with the negative impacts of coronavirus disease 2019 (COVID-19) and related 
control measures.
METHODS: Between August and December 2020, our research team conducted a 
telephone-based, qualitative study, in which we undertook semistructured 
interviews with a purposive sample of low-income older adults living with 
chronic multimorbidities and limited resources. Forty older adults, 24 women and 
16 men, with a mean age of 72 years, participated in the study. For data 
analysis, we employed thematic analysis with a predominantly inductive approach.
RESULTS: Older adults demonstrated several forms of agency to regulate emotions, 
maintain crucial bonds, foster social relationships, and seek economic and food 
security. Older adults experienced entertainment and support by caring for pets, 
undertaking farm work, and practicing their religious beliefs. For several 
participants and their families, quarantine was an opportunity to strengthen 
family relationships and learn new technologies. Older adults and their families 
reorganized themselves to assume new roles and perform activities that improved 
self-worth and confidence, thereby improving their well-being and mental health.
DISCUSSION: Peruvian older adults exerted agency in different ways to respond to 
and sustain their mental health during the COVID-19 lockdown. Policymakers 
should value and recognize the agency of older adults when planning future 
health responses.

© The Author(s) 2023. Published by Oxford University Press on behalf of The 
Gerontological Society of America. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/geronb/gbad040
PMCID: PMC10214643
PMID: 36869737 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they do not have 
conflict of interest.


917. J Clin Nurs. 2023 Sep;32(17-18):6287-6297. doi: 10.1111/jocn.16668. Epub 2023 
Mar 3.

Tragedy or transformation? Online survey of nurse spirituality during the COVID 
pandemic.

Taylor EJ(1), Ada HM(2), Dupée C(3), Jordan M(4)(5), Radovich P(6), Boyd KC(7), 
Dehom S(1).

Author information:
(1)School of Nursing, Loma Linda University, Loma Linda, California, USA.
(2)Education and Training, Adventist Health White Memorial, Los Angeles, 
California, USA.
(3)Pediatric Department, Children's Services, Pomona Valley Hospital Medical 
Center, Pomona, California, USA.
(4)Advanced Bioethics Consulting, LLC, Los Angeles, California, USA.
(5)Integrated Research and Bioethics, Adventist Health White Memorial, Los 
Angeles, California, USA.
(6)Nursing Research, Loma Linda University Health Hospitals, Loma Linda, 
California, USA.
(7)Department of Psychology, Loma Linda University, Loma Linda, California, USA.

AIM: To describe positive and negative spiritual responses to providing 
COVID-related nursing care among nurses working in hospitals.
BACKGROUND: The COVID pandemic has intensified and publicised the threats to 
nurse well-being. Absent from the recommendations for promoting nurse well-being 
is recognition of how nurses' spirituality and/or religiosity is affected by the 
strain of COVID caring or how it may be affecting their well-being.
DESIGN: Cross-sectional, descriptive observational, mixed methods study.
METHODS: Data were collected from 523 registered nurses employed in three 
Southern California hospitals during March-May, 2022 when these hospitals' COVID 
case counts were <15%. Using Online survey methods, data were obtained using the 
Religious/Spiritual Struggles Scale-Short Form, Moral Injury Symptom 
Scale-Healthcare Professionals, Post-traumatic Growth Inventory and demographic 
and work-related items. STROBE guidelines for cross-sectional observational 
studies were observed.
RESULTS: The mean for religious/spiritual struggles was 1.98 (range of 1-5, 
comparable to a little bit). Although roughly half of the sample reported the 
struggles were not experienced/did not apply, 23%-36.5% reported experiencing 
these struggles at least somewhat. The most frequent struggle was to find 
ultimate meaning. The mean observed for moral injury was 6.5 (range of 1-10); 
applying established criteria indicated it was troubling for at least 50%. The 
mean for post-traumatic growth was 4 (on a scale of 0-6); using established 
criteria, 41% experienced PTG. Quantitative findings were illustrated by the 
qualitative responses that occasionally expressed spiritual tragedy and 
transformation concurrently.
CONCLUSION: The professional work of nursing impacts nurses in invisible, 
spiritual ways that can be tragic and/or transformative.
RELEVANCE TO CLINICAL PRACTICE: Interventions to address nurses' mental health 
challenges must include attention to these invisible struggles. Nurses' mental 
health challenges must be met in part by addressing how they can surmount 
spiritual tragedy-and allow spiritual transformation.

© 2023 The Authors. Journal of Clinical Nursing published by John Wiley & Sons 
Ltd.

DOI: 10.1111/jocn.16668
PMID: 36869620 [Indexed for MEDLINE]


918. PLoS One. 2023 Mar 3;18(3):e0265046. doi: 10.1371/journal.pone.0265046. 
eCollection 2023.

Improving the mental health and well-being of healthcare providers using the 
transcendental meditation technique during the COVID-19 pandemic: A parallel 
population study.

Nestor MS(1)(2), Lawson A(1), Fischer D(1).

Author information:
(1)Center for Clinical and Cosmetic Research, Aventura, Florida, United States 
of America.
(2)Department of Dermatology and Cutaneous Surgery, Department of Surgery, 
Division of Plastic Surgery, University of Miami Miller School of Medicine, 
Miami, Florida, United States of America.

INTRODUCTION: Frontline Healthcare provider (HCP) burnout has dramatically 
increased due to the COVID 19 pandemic. Hospitals are supporting wellness 
programs and techniques to reduce burnout including the Transcendental 
Meditation (TM) technique. This study evaluated the use of TM on HCP symptoms of 
stress, burnout and wellness.
METHODS: A total of 65 HCPs at three South Florida hospitals were recruited and 
instructed in the TM technique which they practiced at home for 20 minutes twice 
a day. A parallel lifestyle as usual control group was enrolled. Validated 
measurement scales (Brief Symptom Inventory 18 (BSI-18), Insomnia Severity Index 
(ISI), Maslach Burnout Inventory-Human Services Survey [MBI-HSS (MP)] and the 
Warwick Edinburgh Mental Well Being Scale (WEMWBS) were administered at 
baseline, 2 weeks, one and three months.
RESULTS: No significant demographic differences were seen between the 2 groups; 
however, some baseline scales were higher in the TM group. TM average weekly 
session completion rate was very high at 83%. After 2-weeks, symptoms of 
somatization, depression, and anxiety in the TM group had all shown near 45% 
reductions, while insomnia, emotional exhaustion, and well-being had improved by 
33%, 16%, and 11% respectively (P = 0.02 for somatization and < .001 for all 
others); no significant change was noted in the LAU group. At 3-months, in the 
TM group, the improvement in symptoms showed a mean reduction of in anxiety, 
62%, somatization, 58%, depression, 50%, insomnia, 44%, emotional exhaustion 
40%, depersonalization, 42%, and improvement of well-being 18% (for all 
p<0.004). P-values for between-group differences in change from baseline, based 
upon repeated measures ANCOVA covarying for baseline measurements, showed 
significance for all scales at 3-months.
CONCLUSION: The study confirmed the reported significant and rapid benefits of 
the practice of TM and demonstrated its positive psychological impact on 
healthcare workers in a high stress setting.

Copyright: © 2023 Nestor et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0265046
PMCID: PMC9983866
PMID: 36867626 [Indexed for MEDLINE]

Conflict of interest statement: The authors have read the journal’s policy and 
have the following competing interests: MSN, AL, and DF are paid employees of 
the Center for Clinical and Cosmetic Research. There are no patents, products in 
development or marketed products associated with this research to declare.


919. PLoS One. 2023 Mar 3;18(3):e0280496. doi: 10.1371/journal.pone.0280496. 
eCollection 2023.

Seeking and receiving help for mental health services among pregnant women in 
Ghana.

Adjorlolo S(1).

Author information:
(1)Department of Mental Health Nursing, School of Nursing and Midwifery, College 
of Health Sciences, University of Ghana, Legon Accra, Ghana.

OBJECTIVE: The heightened vulnerability of women to mental health issues during 
the period of pregnancy implies that seeking and receiving support for mental 
health services is a crucial factor in improving the emotional and mental 
well-being of pregnant women. The current study investigates the prevalence and 
correlates of seeking and receiving help for mental health services initiated by 
pregnant women and health professionals during pregnancy.
DESIGN: Using a cross-sectional design and self-report questionnaires, data were 
collected from 702 pregnant women in the first, second and third trimesters from 
four health facilities in the Greater Accra region of Ghana. Data were analyzed 
using descriptive and inferential statistics.
RESULTS: It was observed that 18.9% of pregnant women self-initiated 
help-seeking for mental health services whereas 64.8% reported that health 
professionals asked about their mental well-being, of which 67.7% were offered 
mental health support by health professionals. Diagnosis of medical conditions 
in pregnancy (i.e., hypertension and diabetes), partner abuse, low social 
support, sleep difficulty and suicidal ideation significantly predicted the 
initiation of help-seeking for mental health services by pregnant women. Fear of 
vaginal delivery and COVID-19 concerns predicted the provision of mental health 
support to pregnant women by health professionals.
CONCLUSION: The low prevalence of individual-initiated help-seeking implies that 
health professionals have a high responsibility of supporting pregnant women 
achieve their mental health needs.

Copyright: © 2023 Samuel Adjorlolo. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0280496
PMCID: PMC9983869
PMID: 36867597 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


920. J Sch Health. 2024 Feb;94(2):200-203. doi: 10.1111/josh.13322. Epub 2023 Mar 3.

Using the Whole School, Whole Community, Whole Child Model to Support Mental 
Health in Schools.

Lever N(1), Orenstein S(2), Jaspers L(3), Bohnenkamp J(2), Chung J(4), Hager 
E(4).

Author information:
(1)Department of Psychiatry, University of Maryland School of Medicine, 
Baltimore, MD.
(2)National Center for School Mental Health, Department of Psychiatry, 
University of Maryland School of Medicine, Baltimore, MD.
(3)Anne Arundel County Public Schools, Annapolis, MD.
(4)Departments of Population, Family and Reproductive Health, Johns Hopkins 
Bloomberg School of Public Health, Baltimore, MD.

The COVID-19 pandemic increased already high rates of student mental health 
concerns and further underscored inequities and disparities in access to 
services and care. As schools continue to address the effects of the pandemic, 
they must prioritize student mental health and well-being. In this commentary, 
using feedback from the Maryland School Health Council, we present the 
connection between mental health in school and the Whole School, Whole 
Community, Whole Child (WSCC) model, a school health model commonly employed by 
schools and school districts. In doing so, we aim to highlight how school 
districts can use this model to address child mental health needs across a 
multi-tiered system of support.

© 2023, American School Health Association.

DOI: 10.1111/josh.13322
PMID: 36866745 [Indexed for MEDLINE]


921. J Affect Disord. 2023 Jun 1;330:283-290. doi: 10.1016/j.jad.2023.02.121. Epub 
2023 Feb 28.

Prevalence of depression, anxiety, and suicidal ideation during the Shanghai 
2022 Lockdown: A cross-sectional study.

Hall BJ(1), Li G(2), Chen W(3), Shelley D(4), Tang W(5).

Author information:
(1)Center for Global Healthy Equity, NYU Shanghai, Shanghai, China; New York 
University School of Global Public Health, New York, NY, USA; Health, Behavior, 
and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 
USA. Electronic address: brianhall@nyu.edu.
(2)Center for Global Healthy Equity, NYU Shanghai, Shanghai, China. Electronic 
address: gl2500@nyu.edu.
(3)Center for Global Healthy Equity, NYU Shanghai, Shanghai, China; Department 
of Medical Statistics, School of Public Health, Sun Yat-sen University, 
Guangzhou, Guangdong, China. Electronic address: chenw43@mail.sysu.edu.cn.
(4)Center for Global Healthy Equity, NYU Shanghai, Shanghai, China; New York 
University School of Global Public Health, New York, NY, USA. Electronic 
address: donna.shelley@nyu.edu.
(5)Center for Global Healthy Equity, NYU Shanghai, Shanghai, China; University 
of North Carolina Project-, China. Electronic address: weiming_tang@med.unc.edu.

BACKGROUND: Common mental disorders and suicidal ideation are associated with 
exposures to COVID-19 pandemic stressors, including lockdown. Limited data is 
available on the effect of city-wide lockdowns on population mental health. In 
April 2022, Shanghai entered a city-wide lockdown that sealed 24 million 
residents in their homes or residential compounds. The rapid initiation of the 
lockdown disrupted food systems, spurred economic losses, and widespread fear. 
The associated mental health effects of a lockdown of this magnitude are largely 
unknown. The purpose of this study is to estimate the prevalence of depression, 
anxiety, and suicidal ideation during this unprecedented lockdown.
METHODS: In this cross-sectional study, data were obtained via purposive 
sampling across 16 districts in Shanghai. Online surveys were distributed 
between April 29 and June 1, 2022. All participants were physically present and 
residents of Shanghai during the lockdown. Logistic regression was used to 
estimate the associations between lockdown-related stressors and study outcomes, 
adjusting for covariates.
FINDINGS: A total of 3230 Shanghai residents who personally experienced the 
lockdown participated the survey, with 1657 (55.5 %) men, 1563 (44.3 %) women, 
and 10 (0.02 %) other, and a median age of 32 (IQR 26-39), who were 
predominately 3242 (96.9 %) Han Chinese. The overall prevalence of depression 
based on PHQ-9 was 26.1 % (95 % CI, 24.8 %-27.4 %), 20.1 % (18.3 %-22.0 %) for 
anxiety based on GAD-7, and 3.8 % (2.9 %-4.8 %) for suicidal ideation based on 
ASQ. The prevalence of all outcomes was higher among younger adults, single 
people, lower income earners, migrants, those in poor health, and with a 
previous psychiatric diagnosis or suicide attempt. The odds of depression and 
anxiety were associated with job loss, income loss, and lockdown-related fear. 
Higher odds of anxiety and suicidal ideation were associated with being in close 
contact with a COVID-19 case. Moderate food insecurity was reported by 1731 
(51.8 %), and 498 (14.6 %) reported severe food insecurity. Moderate food 
insecurity was associated with a >3-fold increase in the odds of screening for 
depression and anxiety and reporting suicidal ideation (aOR from 3.15 to 3.84); 
severe food insecurity was associated with >5-fold increased odds for 
depression, anxiety, and suicidal ideation (aOR from 5.21 to 10.87), compared to 
being food secure.
INTERPRETATION: Lockdown stressors, including food insecurity, job and income 
loss, and lockdown-related fears, were associated with increased odds of mental 
health outcomes. COVID-19 elimination strategies including lockdowns should be 
balanced against the effects on population wellbeing. Strategies to avoid 
unneeded lockdown, and policies that can strengthen food systems and protect 
against economic shocks are needed.
FUNDING: Funding was provided by the NYU Shanghai Center for Global Health 
Equity.

Copyright © 2023. Published by Elsevier B.V.

DOI: 10.1016/j.jad.2023.02.121
PMCID: PMC9972774
PMID: 36863472 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest The authors report no 
conflicts of interest.


922. PLoS One. 2023 Mar 2;18(3):e0282287. doi: 10.1371/journal.pone.0282287. 
eCollection 2023.

Online education and its effect on teachers during COVID-19-A case study from 
India.

Dayal S(1).

Author information:
(1)Area of Humanities and Social Sciences, Indian Institute of Management 
Indore, Indore, Madhya Pradesh, India.

BACKGROUND: COVID pandemic resulted in an initially temporary and then long term 
closure of educational institutions, creating a need for adapting to online and 
remote learning. The transition to online education platforms presented 
unprecedented challenges for the teachers. The aim of this research was to 
investigate the effects of the transition to online education on teachers' 
wellbeing in India.
METHODS: The research was conducted on 1812 teachers working in schools, 
colleges, and coaching institutions from six different Indian states. 
Quantitative and qualitative data was collected via online survey and telephone 
interviews.
RESULTS: The results show that COVID pandemic exacerbated the existing 
widespread inequality in access to internet connectivity, smart devices, and 
teacher training required for an effective transition to an online mode of 
education. Teachers nonetheless adapted quickly to online teaching with the help 
of institutional training as well as self-learning tools. However, respondents 
expressed dissatisfaction with the effectiveness of online teaching and 
assessment methods, and exhibited a strong desire to return to traditional modes 
of learning. 82% respondents reported physical issues like neck pain, back pain, 
headache, and eyestrain. Additionally, 92% respondents faced mental issues like 
stress, anxiety, and loneliness due to online teaching.
CONCLUSION: As the effectiveness of online learning perforce taps on the 
existing infrastructure, not only has it widened the learning gap between the 
rich and the poor, it has also compromised the quality of education being 
imparted in general. Teachers faced increased physical and mental health issues 
due to long working hours and uncertainty associated with COVID lockdowns. There 
is a need to develop a sound strategy to address the gaps in access to digital 
learning and teachers' training to improve both the quality of education and the 
mental health of teachers.

Copyright: © 2023 Surbhi Dayal. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0282287
PMCID: PMC9980775
PMID: 36862704 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


923. West Afr J Med. 2023 Feb 28;40(2):227-231.

Psychosocial Impact of the Implementation of COVID-19 Protocols.

Ogundipe H(1), Buowari DY(2), Dosunmu K(3).

Author information:
(1)Department of Surgery, University College Hospital, Ibadan, Oyo State, 
Nigeria.
(2)Department of Accident and Emergency, University of Port Harcourt Teaching 
Hospital, Rivers State, Nigeria.
(3)Department of Psychology, Faculty of Social Sciences, University of Ibadan, 
Ibadan, Oyo State, Nigeria.

BACKGROUND: The COVID-19 pandemic has spread globally since the first case was 
diagnosed in Wuhan, China in December 2019 and we are now experiencing the 
fourth wave. Several measures are being taken to care for the infected and to 
curtail the spread of this novel infectious virus. The psychosocial impact of 
these measures on patients, relatives, caregivers, and medical personnel also 
needs to be assessed and catered for.
METHODS: This is a review article on the psychosocial impact of the 
implementation of COVID-19 protocols. The literature search was done using 
Google Scholar, PubMed, and Medline.
DISCUSSION: Modalities of transportation of the patient to isolation and 
quarantine centres have led to stigma and negative attitudes towards such 
individuals. When diagnosed with the infection, fear of dying from COVID-19, 
fear of infecting family members and close associates, fear of stigmatization, 
and loneliness are common among COVID-19 patients. Isolation and quarantine 
procedures also cause loneliness and depression, and the person is at risk of 
post-traumatic stress disorder. Caregivers are continually stressed out and have 
the constant fear of contracting SARS-CoV-2. Despite clear guidelines to help 
with closure for family members of people dying from COVID-19, inadequate 
resources make this unrealistic.
CONCLUSION: Mental and emotional distress resulting from fear of SARS-Cov-2 
infection, the mode of transmission, and consequences have a tremendous negative 
impact on the psychosocial well-being of those affected, their caregivers, and 
relatives. There is a need for the government, health institutions, and NGOs to 
establish platforms to cater to these concerns.

Publisher: CONTEXTE: La pandémie de SRAS-CoV-2 causée par le COVID-19 s’est 
propagée à l’échelle mondiale depuis que le premier cas a été diagnostiqué à 
Wuhan, en Chine, en décembre 2019, et nous vivons maintenant la quatrième vague. 
Plusieurs mesures sont prises pour prendre en charge les personnes infectées et 
freiner la propagation de ce nouveau virus infectieux. L’impact psychosocial de 
ces mesures sur les patients, les proches, les soignants et le personnel médical 
doit également être évalué et pris en compte.
MÉTHODES: Il s’agit d’un article de synthèse sur l’impact psychosocial de la 
mise en œuvre des protocoles COVID-19. La recherche documentaire a été effectuée 
à l’aide de Google Scholar, PubMed et Medline.
DISCUSSION: Les modalités de transport du patient vers les centres d’isolement 
et de quarantaine ont conduit à une stigmatisation et à des attitudes négatives 
envers ces personnes. Lorsque l’infection est diagnostiquée, la peur de mourir 
du COVID-19, la peur d’infecter les membres de la famille et les proches, la 
peur de la stigmatisation et la solitude sont courantes chez les patients 
atteints du COVID-19. Les procédures d’isolement et de quarantaine provoquent 
également la solitude et la dépression, et la personne risque de souffrir du 
syndrome de stress post-traumatique. Les soignants sont continuellement stressés 
et ont la crainte constante de contracter le SRAS-CoV-2. Malgré des directives 
claires visant à aider les membres de la famille des personnes décédées du 
COVID-19 à tourner la page, le manque de ressources rend cette démarche 
irréaliste.
CONCLUSION: La détresse mentale et émotionnelle résultant de la peur de 
l’infection par le SRAS-Cov-2, de son mode de transmission et de ses 
conséquences a un impact négatif considérable sur le bien-être psychosocial des 
personnes touchées, de leurs soignants et de leurs proches. Il est nécessaire 
que le gouvernement, les institutions de santé et les ONG mettent en place des 
plateformes pour répondre à ces préoccupations.
MOTS CLÉS: SRAS-CoV-2, COVID-19, impact psychologique, détresse mentale, 
stigmatisation.

Copyright © 2023 by West African Journal of Medicine.

PMID: 36861502 [Indexed for MEDLINE]

Conflict of interest statement: The Authors declare that no competing interest 
exists


924. BMC Public Health. 2023 Mar 1;23(1):413. doi: 10.1186/s12889-023-15302-w.

Digital technologies for mental health improvements in the COVID-19 pandemic: a 
scoping review.

Li J(1)(2).

Author information:
(1)School of Journalism and Communication, Jinan University, 601 Huangpu Ave 
West, 510632, Guangzhou, Guangdong, China. lijinhui@jnu.edu.cn.
(2)National Media Experimental Teaching Demonstration Center, Jinan University, 
601 Huangpu Ave West, 510632, Guangzhou, Guangdong, China. lijinhui@jnu.edu.cn.

Digital technologies have been used to support mental health services for two 
decades, but the COVID-19 pandemic created a particular opportunity for greater 
utilization and more data-driven assessment of these digital technologies. This 
research aims to offer a scoping review of the characteristics and effectiveness 
of digital interventions that were employed to improve mental health in the real 
context of COVID-19 pandemic. A combination of search terms was applied for 
automatic search of publications in the relevant databases. The key features of 
included studies were extracted, including the intervention, participant, and 
study details. A total of 20 eligible studies were included in the final review, 
which were conducted across different geographic regions and among diverse 
cultural groups. Among them, fourteen studies mainly reported the impact of 
digital technologies on general population, while only one published study 
developed specific interventions for the isolated COVID-19 depressed patients in 
hospitals. Digital technologies identified in this review were mainly developed 
via web-based and mobile-based platforms, such as social networking and video 
conferencing applications. But less than half of them were aligned with 
theoretical approaches from standardized psychological treatments. Most of the 
studies have reported positive effects of digital technologies, either on 
improving general mental and emotional well-being or addressing specific 
conditions (e.g., depression, stress, and anxiety). This scoping review suggests 
that digital technologies hold promise in bridging the mental health-care gap 
during and after the COVID-19 pandemic, and calls for more rigorous studies to 
identify pertinent features that are likely to achieve more effective mental 
health outcomes.

© 2023. The Author(s).

DOI: 10.1186/s12889-023-15302-w
PMCID: PMC9976664
PMID: 36859184 [Indexed for MEDLINE]

Conflict of interest statement: Not applicable.


925. BMJ Open. 2023 Mar 1;13(3):e067569. doi: 10.1136/bmjopen-2022-067569.

One virus, many lives: a qualitative study of lived experiences and quality of 
life of adults from diverse backgrounds living in the UK during the COVID-19 
pandemic.

Gogoi M(1), Chaloner J(2), Qureshi I(2), Wobi F(1)(3), Al-Oraibi A(1)(2), Wilson 
H(4), Suleman M(4)(5), Nellums L(2), Pareek M(6)(7)(8).

Author information:
(1)Department of Respiratory Sciences, University of Leicester, Leicester, UK.
(2)Lifespan and Population Health, School of Medicine, University of Nottingham, 
Nottingham, Nottinghamshire, UK.
(3)Public Health Institute, Liverpool John Moores University, Liverpool, 
Merseyside, UK.
(4)The Health Foundation, London, UK.
(5)The Ethox Centre and Wellcome Centre for Ethics and Humanities, Nuffield 
Department of Population Health, University of Oxford, Oxford, UK.
(6)Department of Respiratory Sciences, University of Leicester, Leicester, UK 
mp426@le.ac.uk.
(7)Department of Infection and HIV Medicine, University Hospitals of Leicester 
NHS Trust, Leicester, UK.
(8)NIHR Leicester BRC, Leicester, UK.

OBJECTIVES: The coronavirus disease 2019 (COVID-2019) pandemic has had 
far-reaching consequences for people's lives. In the UK, more than 23 million 
have been infected and nearly 185 000 have lost their lives. Previous research 
has looked at differential outcomes of COVID-19, based on socio-demographic 
factors such as age, sex, ethnicity and deprivation. We conducted a qualitative 
study with a diverse sample of adults living in the UK, to understand their 
lived experiences and quality of life (QoL) during the pandemic.
METHODS: Participants were recruited with the help of civil society partners and 
community organisations. Semi-structured interviews were conducted between May 
and July 2021. Interviews were recorded with permission and transcribed. 
Transcripts were analysed following an inductive analytical approach as outlined 
in the Framework Method.
RESULTS: 18 participants (≥16 years) representing different ethnicities, sexes, 
migration and employment statuses and educational qualifications took part. Five 
key themes and 14 subthemes were identified and presented using the QoL 
framework. The five key themes describe how COVID-19 affected the following 
aspects of QoL: (1) financial and economic, (2) physical health, (3) social, (4) 
mental health and (5) personal fulfilment and affective well-being. The 
narratives illustrated inequities in the impact of COVID-19 for individuals with 
intersecting social, economic, and health disparities.
CONCLUSION: Our findings demonstrate the multidimensional and differential 
impact of the pandemic on different population groups, with most of the negative 
economic impacts being borne by people in low-paid and insecure jobs. Similarly, 
adverse social, physical and mental health impacts particularly affected people 
already experiencing displacement, violence, physical and mental illnesses or 
even those living alone. These findings indicate that COVID-19 impacts have been 
influenced by intersecting health and socioeconomic inequalities, which 
pre-existed. These inequities should be taken into consideration while designing 
pandemic recovery and rebuilding packages.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2022-067569
PMCID: PMC9979590
PMID: 36858475 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: MP reports grants from 
Sanofi, grants and personal fees from Gilead Sciences and personal fees from 
QIAGEN, outside the submitted work. All other authors declare no conflict of 
interest.


926. Asian J Psychiatr. 2023 May;83:103529. doi: 10.1016/j.ajp.2023.103529. Epub 2023 
Feb 17.

Interpersonal distance regulation and psychological wellbeing during the 
COVID-19 pandemic: A comparison between the USA and Korea.

Lee HS(1), Baxter TM(1), Griffith TC(1), Rbeiz K(1), Park S(2).

Author information:
(1)Department of Psychology, Vanderbilt University, Nashville, USA.
(2)Department of Psychology, Vanderbilt University, Nashville, USA. Electronic 
address: sohee.park@vanderbilt.edu.

DOI: 10.1016/j.ajp.2023.103529
PMCID: PMC9936786
PMID: 36857869 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest statement Authors have no 
conflicts of interest to report.


927. Ann Fam Med. 2022 Apr 1;20(20 Suppl 1):2695. doi: 10.1370/afm.20.s1.2695.

Family physicians in kansas response to the COVID-19 pandemic.

Ofei-Dodoo S, Loo-Gross C, Kellerman R.

Introduction The novel coronavirus infectious disease (COVID-19) has spread 
rapidly with vast global implications. This study assessed how family physicians 
in Kansas responded to COVID-19 and the effects of the pandemic on the 
physicians' well-being. Methods. The authors conducted a cross-sectional survey 
of 113 family physicians in Kansas between May 22, 2020 and June 25, 2020. The 
study participants completed an anonymous, 18-item survey assessing family 
physicians' concerns about being exposed to COVID-19, levels of personal 
depression, anxiety, stress, and burnout in addition to demographic information. 
Results. There was a 45.6% response rate, with 50.4% (n=57) of the respondents 
reporting manifestations of burnout. The physicians who personally treated any 
presumptive or confirmed COVID-19 patient, compared to those who did not, were 
more likely to report at least one manifestation of burnout (odds 
ratio[OR]=3.96; 95% confidence interval [CI], 1.38-11.36; P = .011), experience 
emotional exhaustion (OR=3.21; 95% CI, 1.01-10.10; P<.05), and feel a higher 
level of personal stress (OR=1.13; 95% CI, 1.01-1.27; P=.011). Conclusion. Our 
findings demonstrate that the COVID-19 pandemic may be taking an emotional toll 
on family physicians in Kansas. This study provides a baseline from which to 
continue further monitoring of outcomes such as burnout, depression, anxiety, 
and stress, to determine the need for interventions, and influence the 
implementation of programs to support physician wellness. These data can help 
drive wellness and mental health support initiatives at local, state, and 
national levels to help diminish the negative impact of the COVID-19 pandemic on 
physicians.

© 2021 Annals of Family Medicine, Inc.

DOI: 10.1370/afm.20.s1.2695
PMCID: PMC10549114
PMID: 36856699 [Indexed for MEDLINE]

Conflict of interest statement: Authors report none


928. Clin Pediatr (Phila). 2023 Oct;62(10):1237-1244. doi: 10.1177/00099228231155004. 
Epub 2023 Mar 1.

Impact of 2019 Novel Coronavirus (2019-nCov) Pandemic and Lockdown on Parents 
and Caregivers in Ontario, Canada.

Shahid S(1)(2), Weisz J(2), Florez ID(3)(4).

Author information:
(1)Department of Health Research Methods, Evidence, and Impact, McMaster 
University, Hamilton, ON, Canada.
(2)Department of Pediatrics, McMaster Children's Hospital, McMaster University, 
Hamilton, ON, Canada.
(3)Department of Pediatrics, University of Antioquia, Medellin, Colombia.
(4)School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.

The COVID-19 pandemic has impacted parents' and children's well-being. This 
study aimed to evaluate the impact of the COVID-19 pandemic and its preventive 
measures on children's well-being and their parents' anxiety level. 
Parents/caregivers were invited to respond to a self-administered survey. The 
primary outcome was to assess the rate and severity of parental anxiety during 
the pandemic/lockdown. Four hundred and thirty parents completed the survey. 
Ninety-two (21%) and 10 (2%) parents reported that their children gained or lost 
weight during the pandemic, respectively. Eighty-one (19%) parents reported a 
regression in their children's developmental milestones, particularly in 
toileting, speech, and social interaction. The GAD-7 mean scores increased by 
2.9 points (95% CI [2.5, 3.25]; P < .001) in comparison with prepandemic scores. 
Adjusted multivariable analysis showed that having children with psychological 
conditions and a maternal education level less than a university degree were 
significantly associated with higher parental anxiety.

DOI: 10.1177/00099228231155004
PMCID: PMC9982414
PMID: 36856080 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


929. Int J Ment Health Nurs. 2023 Aug;32(4):1055-1071. doi: 10.1111/inm.13132. Epub 
2023 Feb 28.

Resilience and mental health nursing: An integrative review of updated evidence.

Bui MV(1)(2), McInnes E(1)(3), Ennis G(4), Foster K(1)(2).

Author information:
(1)School of Nursing, Midwifery and Paramedicine, Australian Catholic 
University, Fitzroy, Victoria, Australia.
(2)NorthWestern Mental Health, Melbourne Health, Parkville, Victoria, Australia.
(3)Nursing Research Institute-St Vincent's Health Network Sydney, St Vincent's 
Hospital Melbourne and Australian Catholic University, Fitzroy, Victoria, 
Australia.
(4)Northern Health, Epping, Victoria, Australia.

Mental health nursing work is challenging, and workplace stress can have 
negative impacts on nurses' well-being and practice. Resilience is a dynamic 
process of positive adaptation and recovery from adversity. The aims of this 
integrative review were to examine and update understandings and perspectives on 
resilience in mental health nursing research, and to explore and synthesize the 
state of empirical knowledge on mental health nurse resilience. This is an 
update of evidence from a previous review published in 2019. Using integrative 
review methodology, 15 articles were identified from a systematic search (July 
2018-June 2022). Data were extracted, analysed with constant comparison method, 
synthesized narratively and then compared with the findings from the original 
review. As an update of evidence, mental health nurse resilience was moderate to 
high across studies, was positively associated with psychological well-being, 
post-traumatic growth, compassion satisfaction and negatively associated with 
burnout, mental distress and emotional labour. Lack of support and resources 
from organizations could negatively impact nurses' ability to maintain 
resilience and manage workplace challenges through internal self-regulatory 
processes. A resilience programme improved mental health nurses' awareness of 
personal resilience levels, self-confidence, capacity to develop coping skills 
and professional relationships. Some studies continue to lack contemporary 
conceptualizations of resilience, and methodological quality varied from high to 
low. Further qualitative and interventional research is needed to investigate 
the role of resilience in mental health nursing practice, personal well-being, 
workforce sustainability and the ongoing impacts of the COVID-19 pandemic.

© 2023 The Authors. International Journal of Mental Health Nursing published by 
John Wiley & Sons Australia, Ltd.

DOI: 10.1111/inm.13132
PMID: 36854950 [Indexed for MEDLINE]


930. CMAJ Open. 2023 Feb 28;11(1):E191-E200. doi: 10.9778/cmajo.20220191. Print 2023 
Jan-Feb.

Perceived workplace support and mental health, well-being and burnout among 
health care professionals during the COVID-19 pandemic: a cohort analysis.

Siddiqui I(1), Gupta J(1), Collett G(1), McIntosh I(1), Komodromos C(1), Godec 
T(1), Ng S(1), Maniero C(1), Antoniou S(1), Khan R(1), Kapil V(1), Khanji MY(1), 
Gupta AK(2); CoPE-HCP clinical investigators.

Author information:
(1)Wellbeing Hub (Siddiqui), Newham Training Hub; NHS NorthEast London CCG 
(Siddiqui); Woodgrange Medical Practice (Siddiqui); South West London and St 
George's Mental Health NHS Trust (J. Gupta); William Harvey Research Institute 
(Collett, Godec, Maniero, Kapil, Khanji, A.K. Gupta), Queen Mary University of 
London; Camden & Islington Foundation Trust (McIntosh); Barnet, Enfield and 
Haringey Mental Health NHS Trust (Komodromos); Barts Heart Centre (Ng, Maniero, 
Antoniou, Kapil, Khanji, A.K. Gupta), St. Bartholomew's Hospital and The Royal 
London Hospital (Maniero, Khan, Kapil, A.K. Gupta), and Newham University 
Hospital (Khanji), Barts Health NHS Trust; National Heart and Lung Institute 
(A.K. Gupta), Imperial College London, London, UK.
(2)Wellbeing Hub (Siddiqui), Newham Training Hub; NHS NorthEast London CCG 
(Siddiqui); Woodgrange Medical Practice (Siddiqui); South West London and St 
George's Mental Health NHS Trust (J. Gupta); William Harvey Research Institute 
(Collett, Godec, Maniero, Kapil, Khanji, A.K. Gupta), Queen Mary University of 
London; Camden & Islington Foundation Trust (McIntosh); Barnet, Enfield and 
Haringey Mental Health NHS Trust (Komodromos); Barts Heart Centre (Ng, Maniero, 
Antoniou, Kapil, Khanji, A.K. Gupta), St. Bartholomew's Hospital and The Royal 
London Hospital (Maniero, Khan, Kapil, A.K. Gupta), and Newham University 
Hospital (Khanji), Barts Health NHS Trust; National Heart and Lung Institute 
(A.K. Gupta), Imperial College London, London, UK ajay.gupta@qmul.ac.uk.

BACKGROUND: Little is known about the relationship between workplace support and 
mental health and burnout among health care professionals (HCPs) during the 
COVID-19 pandemic. In this cohort study, we sought to evaluate the association 
between perceived level of (and changes to) workplace support and mental health 
and burnout among HCPs, and to identify what constitutes perceived effective 
workplace support.
METHODS: Online surveys at baseline (July-September 2020) and follow-up 4 months 
later assessed the presence of generalized anxiety disorder (using the 7-item 
Generalized Anxiety Disorder scale [GAD-7]), clinical insomnia, major depressive 
disorder (using the 9-item Patient Health Questionnaire), burnout (emotional 
exhaustion and depersonalization) and mental well-being (using the Short 
Warwick-Edinburgh Mental Wellbeing Score). Both surveys assessed self-reported 
level of workplace support (single-item Likert scale). For baseline and 
follow-up, independently, we developed separate logistic regression models to 
evaluate the association of the level of workplace support (tricohotomized as 
unsupported, neither supported nor unsupported and supported) with mental health 
and burnout. We also developed linear regression models to evaluate the 
association between the change in perceived level of workplace support and the 
change in mental health scores from baseline and follow-up. We used thematic 
analyses on free-text entries of the baseline survey to evaluate what 
constitutes effective support.
RESULTS: At baseline (n = 1422) and follow-up (n = 681), HCPs who felt supported 
had reduced risk of anxiety, depression, clinical insomnia, emotional exhaustion 
and depersonalization, compared with those who felt unsupported. Among those who 
responded to both surveys (n = 681), improved perceived level of workplace 
support over time was associated with significantly improved scores on measures 
of anxiety (adjusted β -0.13, 95% confidence interval [CI] -0.25 to -0.01), 
depression (adjusted β -0.17, 95% CI -0.29 to -0.04) and mental well-being 
(adjusted β 0.19, 95% CI 0.10 to 0.29), independent of baseline level of 
support. We identified 5 themes constituting effective workplace support, namely 
concern or understanding for welfare, information, tangible qualities of the 
workplace, leadership and peer support.
INTERPRETATION: We found a significant association between perceived level of 
(and changes in) workplace support and mental health and burnout of HCPs, and 
identified potential themes that constitute perceived workplace support. 
Collectively, these findings can inform changes in guidance and national 
policies to improve mental health and burnout among HCPs. Trial registration: 
ClinicalTrials.gov, no. NCT04433260.

© 2023 CMA Impact Inc. or its licensors.

DOI: 10.9778/cmajo.20220191
PMCID: PMC9981163
PMID: 36854456 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


931. Sci Rep. 2023 Feb 27;13(1):3335. doi: 10.1038/s41598-023-29815-2.

Risk perception and gratitude mediate the negative relationship between COVID-19 
management satisfaction and public anxiety.

Mei Y(1)(2), Tan L(1), Yang W(3), Luo J(4), Xu L(5), Lei Y(6), Li H(1).

Author information:
(1)Institution of Brain and Psychological Science, Sichuan Normal University, 
Chengdu, China.
(2)Faculty of Education and Psychology, University of Jyväskylä, Jyväskylä, 
Finland.
(3)Faculty of Psychology, Beijing Normal University, Beijing, China.
(4)School of Psychology, Guizhou Normal University, Guiyang, China.
(5)Institution of Brain and Psychological Science, Sichuan Normal University, 
Chengdu, China. xulei@sicnu.edu.cn.
(6)Institution of Brain and Psychological Science, Sichuan Normal University, 
Chengdu, China. leiyi821@vip.sina.com.

In this study, we explored whether satisfaction with government management, 
perception of risk, and gratitude influenced public anxiety during the COVID-19 
pandemic in China. Using a cross-sectional, anonymous and confidential online 
survey, a nationwide sample of Chinese adults (N = 876) was targeted between 
March 25-March 30, 2020, a period in which newly confirmed cases significantly 
declined in China. The anxiety level was decreased as compared to that assessed 
during the peak period. Multiple parallel mediation modeling demonstrated that 
risk perception and gratitude partially mediated the relationship between 
satisfaction with government management and public anxiety. Increasing 
satisfaction and gratitude, as well as reducing risk perception contribute to 
the public's mental health. The results may shed light on the positive factors 
for psychological well-being during the COVID-19 pandemic and may aid potential 
strategies for the policy maker, the public, and the clinic to regulate negative 
emotions or future emerging infectious diseases.

© 2023. The Author(s).

DOI: 10.1038/s41598-023-29815-2
PMCID: PMC9969377
PMID: 36849729 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


932. Ann Fam Med. 2023 Feb;21(Suppl 2):S100-S102. doi: 10.1370/afm.2933.

Supporting Mental Health and Psychological Resilience Among the Health Care 
Workforce: Gaps in the Evidence and Urgency for Action.

Akinnusotu O(1), Bhatti A(2), Doubeni CA(3), Williams M(4).

Author information:
(1)Department of Neurosurgery, Mayo Clinic Rochester, Minnesota 
oakinnusotu19@email.mmc.edu.
(2)Department of Neurosurgery, Mayo Clinic Rochester, Minnesota.
(3)Center for Health Equity, The Ohio State University Wexner Medical Center, 
Columbus, Ohio.
(4)Department of Psychiatry and Psychology, Mayo Clinic Rochester, Minnesota.

Since the COVID-19 pandemic started, health care workers have faced various 
challenges to their mental health due to extreme working conditions. Yet these 
workers have continued to deliver care in the face of stressors and death among 
their patients, family, and social networks. The pandemic highlighted weaknesses 
within our health care work environment, especially pertaining to a need to 
provide increased psychological resilience to clinicians. There has been little 
research to determine the best practices for psychological health in workplaces 
and interventions to improve psychological resilience. Although some studies 
have attempted to provide solutions, there are noteworthy gaps in the literature 
on effective interventions to use in the time of crisis. The most common include 
an absence of preintervention data concerning the overall mental well-being of 
health care workers, inconsistent application of interventions, and a lack of 
standard assessment tools across studies. There is an urgent need for 
system-level strategies that not only transform the way workplaces are 
organized, but also destigmatize, recognize, support, and treat mental health 
conditions among health care workers. There is also need for more evidence-based 
resources to improve resilience on the job, and thereby increase clinicians' 
capacity to address new medical crises. Doing so may mitigate rates of burnout 
and other psychological conditions in times of crisis among health care workers.

© 2023 Annals of Family Medicine, Inc.

DOI: 10.1370/afm.2933
PMCID: PMC9970679
PMID: 36849469 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of interest: authors report none.


933. J Epidemiol Community Health. 2023 May;77(5):293-297. doi: 
10.1136/jech-2022-219653. Epub 2023 Feb 27.

Creative leisure activities, mental health and well-being during 5 months of the 
COVID-19 pandemic: a fixed effects analysis of data from 3725 US adults.

Bone JK(1), Fancourt D(2), Sonke JK(3), Fluharty ME(2), Cohen R(4), Lee JB(3), 
Kolenic AJ(3), Radunovich H(5), Bu F(2).

Author information:
(1)Research Department of Behavioural Science and Health, Institute of 
Epidemiology & Health Care, University College London, London, UK 
jessica.bone@ucl.ac.uk.
(2)Research Department of Behavioural Science and Health, Institute of 
Epidemiology & Health Care, University College London, London, UK.
(3)Center for Arts in Medicine, University of Florida, Gainesville, Florida, 
USA.
(4)Americans for the Arts, Washington DC, Washington, USA.
(5)Family, Youth and Community Sciences, University of Florida, Gainesville, 
Florida, USA.

INTRODUCTION: We investigated whether changes in engagement in home-based 
creative activities were associated with changes in depressive symptoms, anxiety 
symptoms and life satisfaction during the COVID-19 pandemic, aiming to replicate 
findings from the UK in a USA sample.
METHODS: 3725 adults were included from the COVID-19 Social Study in the USA, a 
panel study collecting data weekly during the COVID-19 pandemic. We measured 
engagement in eight types of creative leisure activities on the previous weekday 
between April and September 2020. Data were analysed using fixed effects 
regression models.
RESULTS: Increased time spent gardening was associated with reductions in 
depressive and anxiety symptoms and enhanced life satisfaction. Spending more 
time doing woodwork/DIY and arts/crafts were also associated with enhanced life 
satisfaction. However, more time watching television, films or other similar 
media (not for information on COVID-19) was associated with increased depressive 
symptoms. Other creative activities were not associated with mental health or 
well-being.
CONCLUSION: Some findings differ from evidence obtained in the UK, demonstrating 
the importance of replicating research across countries. Our findings should 
also be considered when formulating guidelines for future stay-at-home 
directives, enabling individuals to stay well despite the closure of public 
resources.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/jech-2022-219653
PMCID: PMC10086468
PMID: 36849241 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


934. Intensive Crit Care Nurs. 2023 Jun;76:103388. doi: 10.1016/j.iccn.2023.103388. 
Epub 2023 Jan 16.

The early impact of COVID-19 on intensive care nurses' personal and professional 
well-being: A qualitative study.

Calkins K(1), Guttormson J(2), McAndrew NS(3), Losurdo H(4), Loonsfoot D(5), 
Schmitz S(6), Fitzgerald J(7).

Author information:
(1)Marquette University College of Nursing, PO Box 1881, Milwaukee, WI 53201. 
Electronic address: kelly.calkins@marquette.edu.
(2)Marquette University College of Nursing, PO Box 1881, Milwaukee, WI 53201. 
Electronic address: jill.guttormson@marquette.edu.
(3)College of Nursing, University of Wisconsin-Milwaukee, Cunningham Hall, 
Office 657, 1921 East Hartford Avenue, P.O. Box 413, Milwaukee, WI. Electronic 
address: mcandre3@uwm.edu.
(4)Marquette University College of Nursing, PO Box 1881, Milwaukee, WI 53201. 
Electronic address: holly.losurdo@marquette.edu.
(5)Marquette University College of Nursing, PO Box 1881, Milwaukee, WI 53201. 
Electronic address: danielle.loonsfoot@marquette.edu.
(6)College of Nursing, Spanish for the Health Professions, Sigma Delta Gamma, 
College of Business Administration, Marquette University College of Nursing, PO 
Box 1881, Milwaukee, WI 53201. Electronic address: shania.schmitz@marquette.edu.
(7)Department of Psychology, Marquette University, Cramer Hall, 604 N. 16th 
Street, Milwaukee, WI 53233. Electronic address: 
jacklynn.fitzgerald@marquette.edu.

OBJECTIVE: To describe the impact of the COVID-19 pandemic on intensive care 
nurses personal and professional well-being.
RESEARCH METHODOLOGY/DESIGN: A descriptive, qualitative design was used. Two 
nurse researchers conducted one-on-one interviews via Zoom or TEAMS using a 
semi-structured interview guide.
SETTING: Thirteen nurses who were working in an intensive care unit in the 
United States participated in the study. A convenience sample of nurses who 
completed a survey in the larger parent study provided an email and were 
contacted by the research team to participate in interviews to discuss their 
experiences.
MAIN OUTCOME MEASURES: An inductive approach to content analysis was used to 
develop categories.
FINDINGS: Five major categories emerged from the interviews: (1) We are not 
heroes, (2) inadequate support, (3) helplessness, (4) exhaustion, and (5) Nurses 
the second victim.
CONCLUSION: The COVID-19 pandemic has taken a physical and mental health toll on 
intensive care nurses. The impact of the pandemic on personal and professional 
well-being has serious implications for retaining and expanding the nursing 
workforce.
IMPLICATIONS FOR CLINICAL PRACTICE: This work highlights the importance for 
bedside nurses to advocate for systemic change to improve the work environment. 
It is imperative for nurses to have effective training including evidence-based 
practice and clinical skills. There needs to be systems in place to monitor and 
support nurses' mental health and encourage bedside nurses to use self-care 
methods and practices to prevent anxiety, depression, post-traumatic stress 
disorder and burnout.

Copyright © 2023. Published by Elsevier Ltd.

DOI: 10.1016/j.iccn.2023.103388
PMCID: PMC9841079
PMID: 36848704 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


935. JMIR Public Health Surveill. 2023 Mar 30;9:e43786. doi: 10.2196/43786.

Lifestyle Behavior Changes and Associated Risk Factors During the COVID-19 
Pandemic: Results from the Canadian COVIDiet Online Cohort Study.

Tessier AJ(1)(2), Moyen A(1), Lawson C(1), Rappaport AI(1), Yousif H(1), 
Fleurent-Grégoire C(1), Lalonde-Bester S(1), Brazeau AS(1), Chevalier S(1)(2).

Author information:
(1)School of Human Nutrition, Faculty of Agriculture and Environmental Sciences, 
McGill University, Sainte-Anne-de-Bellevue, QC, Canada.
(2)Research Institute of the McGill University Health Centre, Montréal, QC, 
Canada.

BACKGROUND: The COVID-19 pandemic and related lockdowns have impacted lifestyle 
behaviors, including eating habits and physical activity; yet, few studies have 
identified the emerging patterns of such changes and associated risk factors.
OBJECTIVE: This study aims to identify the patterns of weight and lifestyle 
behavior changes, and the potential risk factors, resulting from the pandemic in 
Canadian adults.
METHODS: Analyses were conducted on 1609 adults (18-89 years old; n=1450, 90.1%, 
women; n=1316, 81.8%, White) of the Canadian COVIDiet study baseline data 
(May-December 2020). Self-reported current and prepandemic weight, physical 
activity, smoking status, perceived eating habits, alcohol intake, and sleep 
quality were collected through online questionnaires. Based on these 6 indicator 
variables, latent class analysis (LCA) was used to identify lifestyle behavior 
change patterns. Associations with potential risk factors, including age, 
gender, ethnicity, education, income, chronic diseases, body image perception, 
and changes in the stress level, living situation, and work arrangement, were 
examined with logistic regressions.
RESULTS: Participants' mean BMI was 26.1 (SD 6.3) kg/m2. Of the 1609 
participants, 980 (60.9%) had a bachelor's degree or above. Since the pandemic, 
563 (35%) had decreased income and 788 (49%) changed their work arrangement. 
Most participants reported unchanged weight, sleep quality, physical activity 
level, and smoking and alcohol consumption, yet 708 (44%) reported a perceived 
decrease in eating habit quality. From LCA, 2 classes of lifestyle behavior 
change emerged: healthy and less healthy (probability: 0.605 and 0.395, 
respectively; Bayesian information criterion [BIC]=15574, entropy=4.8). The 
healthy lifestyle behavior change group more frequently reported unchanged 
weight, sleep quality, smoking and alcohol intake, unchanged/improved eating 
habits, and increased physical activity. The less healthy lifestyle behavior 
change group reported significant weight gain, deteriorated eating habits and 
sleep quality, unchanged/increased alcohol intake and smoking, and decreased 
physical activity. Among risk factors, body image dissatisfaction (odds ratio 
[OR] 8.8, 95% CI 5.3-14.7), depression (OR 1.8, 95% CI 1.3-2.5), increased 
stress level (OR 3.4, 95% CI 2.0-5.8), and gender minority identity (OR 5.5, 95% 
CI 1.3-22.3) were associated with adopting less healthy behaviors in adjusted 
models.
CONCLUSIONS: The COVID-19 pandemic has appeared to have influenced lifestyle 
behaviors unfavorably in some but favorably in others. Body image perception, 
change in stress level, and gender identity are factors associated with behavior 
change patterns; whether these will sustain over time remains to be studied. 
Findings provide insights into developing strategies for supporting adults with 
poorer mental well-being in the postpandemic context and promoting healthful 
behaviors during future disease outbreaks.
TRIAL REGISTRATION: ClinicalTrials.gov NCT04407533; 
https://clinicaltrials.gov/ct2/show/NCT04407533.

©Anne-Julie Tessier, Audrey Moyen, Claire Lawson, Aviva Ilysse Rappaport, Hiba 
Yousif, Chloé Fleurent-Grégoire, Sophie Lalonde-Bester, Anne-Sophie Brazeau, 
Stéphanie Chevalier. Originally published in JMIR Public Health and Surveillance 
(https://publichealth.jmir.org), 30.03.2023.

DOI: 10.2196/43786
PMCID: PMC10131911
PMID: 36848226 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


936. J Psychiatr Ment Health Nurs. 2023 Oct;30(5):952-962. doi: 10.1111/jpm.12914. 
Epub 2023 Mar 23.

The psychological well-being of people in a COVID-19 supervised quarantine 
facility: A mixed methods study.

Mitchell D(1)(2), Bressington D(2), Esler D(3), Straube K(1), Noel-Gough L(1), 
Vermeulen L(4), Stephens D(2)(5).

Author information:
(1)Royal Darwin Hospital, Darwin, Northern Territory, Australia.
(2)Charles Darwin University, Darwin, Northern Territory, Australia.
(3)Department of Health, Public Health Directorate, Darwin, Northern Territory, 
Australia.
(4)National Critical Care and Trauma Centre, Darwin, Northern Territory, 
Australia.
(5)Centre for National Resilience, Darwin, Northern Territory, Australia.

WHAT IS KNOWN ON THE SUBJECT?: Supervised Quarantine has been shown to impact 
the psychological well-being of those in quarantine both during the COVID-19 
pandemic and in previous pandemics. There are few studies regarding the 
psychological impact of supervised quarantine for the purpose of COVID-19 
mitigation. There is little research regarding the psychological well-being of 
professionals maintaining quarantine, despite the fact they risk potential 
psychological distress. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper 
addresses the paucity of knowledge regarding the psychological well-being of 
those undergoing quarantine in a purpose-built facility. The quarantined study 
population involved uniquely domestic arrivals and also professionals 
maintaining quarantine. Lack of control, isolation and miscommunication were 
perceived as challenging mental well-being. WHAT ARE THE IMPLICATIONS FOR 
PRACTICE?: Although psychological distress in Domestic arrivals appeared low, 
there are still identifiable stresses on mental well-being. Mental health 
workers need to be cognizant that point entry to COVID-19 quarantine (Domestic 
vs. International as well as specific regions) may influence risk of 
psychological distress. Mental Health nurses supporting those in quarantine 
should afford quarantined individuals a degree of choice, establish regular 
clear communication and consider how to establish peer support mechanisms within 
the quarantine environment.
ABSTRACT: INTRODUCTION: Supervised quarantine may compromise psychological 
well-being. There is equivocal evidence regarding psychological distress in 
compulsory supervised quarantine facilities.
AIMS: To evaluate the mental well-being of people undergoing and working in a 
supervised COVID-19 quarantine facility.
METHOD: Mixed methodology was used, including a cross-sectional analysis of 
psychological distress (DASS-21) and individual semi-structured interviews (10 
professionals maintaining quarantine and 10 quarantined persons).
RESULTS: Overall levels of psychological distress were low. Those quarantining 
from Victoria had significantly lower depression scores compared to all other 
departure points. Qualitative analysis identified distress being linked to a 
lack of control, isolation and miscommunication.
DISCUSSION: Quarantine was associated with low levels of psychological distress. 
This was lower in people travelling from Victoria, a state where there were 
higher rates of infections and restrictions. Interviews showed that 
psychological distress was conceptualized as being associated with supervised 
quarantine, but participants recognized the overall importance of quarantine.
IMPLICATIONS FOR PRACTICE: Mental health professionals supporting quarantined 
people should consider original departure points may predict levels of 
psychological distress. Implementing ways of gaining control through affording 
choice, improving communication channels and establishing peer support networks 
within quarantine settings may help maintain mental well-being.

© 2023 The Authors. Journal of Psychiatric and Mental Health Nursing published 
by John Wiley & Sons Ltd.

DOI: 10.1111/jpm.12914
PMID: 36843429 [Indexed for MEDLINE]


937. J Med Imaging Radiat Sci. 2023 Jun;54(2S):S62-S69. doi: 
10.1016/j.jmir.2023.01.010. Epub 2023 Feb 9.

COVID-19 pandemic experience of diagnostic radiographers: A Singapore survey.

Mohamed Afif A(1), Abdul Razak H(2), Choong A(2).

Author information:
(1)Radiography Department, Singapore General Hospital, Singapore. Electronic 
address: azizah.mohd.afif@sgh.com.sg.
(2)Department of Diagnostic Imaging, National University Hospital, Singapore.

INTRODUCTION: Diagnostic Radiographers (DR) are the frontline responders during 
the COVID-19 outbreak, providing essential diagnostic imaging services for 
screening and monitoring of suspected and confirmed patients. Understanding the 
experience and perceptions of DR towards the COVID-19 outbreak enables 
radiography leaders to guide changes in the approach to managing response to 
future health outbreaks. This study aims to document the experiences of DR in 
Singapore during the COVID-19 pandemic.
METHODS: All DR practising in Singapore institutions were invited to participate 
in an online survey, disseminated by the Singapore Society of Radiographers 
(SSR). The survey assessed the attitudes and perceptions of the respondents on 
the COVID-19 pandemic. The Holmes and Rahe Stress Scale was used to identify the 
respondents' life events closely related to the pandemic. Data collection took 
place from 5 July 2020 to 5 September 2020.
RESULTS: A total of 123 DR responded to the survey, where 89.4% of the 
respondents had been involved in the imaging of suspected or confirmed COVID-19 
patients. Those performing General Radiography had the highest number of cases - 
300 cases a month. The fear of transmitting COVID-19 to their family presented 
as the primary stressor (77.2%), followed by the lack of manpower (73.2%). The 
global themes that emerged from the study were (1) adapting to change and (2) 
quality of support.
CONCLUSION: Radiology departments in Singapore were able to cope with the high 
demands of the pandemic in terms of the provision of information, supplies, and 
physical equipment. However, they were less prepared to handle human factors 
such as mental health and staff morale. The safety and well-being of staff 
should not be compromised to reduce staff anxiety while performing their duties. 
Strategies to improve their ability to adapt to changes and provision of quality 
support are necessary measures in future pandemic situations.

INTRODUCTION: Les radiographes diagnosticiens (RD) sont les intervenants de 
première ligne pendant l'épidémie de COVID-19, fournissant des services 
d'imagerie diagnostique essentiels pour le dépistage et le suivi des patients 
suspects et confirmés. Comprendre l'expérience et les perceptions des 
radiographes face à l'épidémie de COVID-19 permet aux responsables de la 
radiographie de guider les changements dans l'approche de la gestion de la 
réponse aux futures épidémies. Cette étude vice à documenter les expériences des 
RD à Singapour pendant la pandémie de COVID-19.
MÉTHODOLOGIE: Tous les médecins pratiquant dans des établissements de Singapour 
ont été invités à participer à une enquête en ligne, diffusée par la Singapore 
Society of Radiographers (SSR). L'enquête évaluait les attitudes et les 
perceptions des répondants sur la pandémie de COVID-19. L'échelle de stress de 
Holmes et Rahe a été utilisée pour identifier les événements de vie des 
répondants étroitement liés à la pandémie. La collecte des données a eu lieu du 
5 juillet 2020 au 5 septembre 202.
RÉSULTATS: Un total de 123 RD ont répondu à l'enquête, dont 89,4% avaient été 
impliqués dans l'imagerie de patients suspects ou confirmés atteints de 
COVID-19. Ceux qui pratiquaient la radiographie générale avaient le plus grand 
nombre de cas - 300 cas par mois. La peur de transmettre la COVID-19 à leur 
famille se présentait comme le principal facteur de stress (77,2%), suivi par le 
manque de personnel (73,2%). Les thèmes globaux qui ont émergé de l'étude sont 
(1) l'adaptation au changement et (2) la qualité du soutien.
CONCLUSION: Les services de radiologie de Singapour ont été en mesure de faire 
face aux exigences élevées de la pandémie en termes d'information, de 
fournitures et d'équipement physique. Cependant, ils étaient moins bien préparés 
à gérer les facteurs humains tels que la santé mentale et le moral du personnel. 
La sécurité et le bien-être du personnel ne doivent pas être compromis pour 
réduire l'anxiété du personnel dans l'exercice de ses fonctions. Les stratégies 
visant à améliorer leur capacité à s'adapter aux changements et à fournir un 
soutien de qualité sont des mesures nécessaires dans les futures situations de 
pandémie.

Copyright © 2023. Published by Elsevier Inc.

DOI: 10.1016/j.jmir.2023.01.010
PMCID: PMC9910016
PMID: 36842892 [Indexed for MEDLINE]


938. Environ Res. 2023 May 15;225:115551. doi: 10.1016/j.envres.2023.115551. Epub 
2023 Feb 24.

Disparities in greenspace access during COVID-19 mobility restrictions.

Lusseau D(1), Baillie R(2).

Author information:
(1)National Institute for Aquatic Resources, Technical University of Denmark, 
Kgs. Lyngby, 2800, Denmark. Electronic address: davlu@dtu.dk.
(2)School of Biological Sciences, University of Aberdeen, Aberdeen, AB24 2 TZ, 
UK.

More than half of the human population lives in cities and therefore 
predominantly experience nature in urban greenspace, an important contributor to 
wellbeing. As the world faces a pandemic which threatens the physical and mental 
health of billions of people, it is crucial to understand that all have the 
possibility to access nature exposure to alleviate some of these challenges. 
Here, for the first time, we integrate data from Facebook, Twitter, and Google 
Search users to show that people looked for greenspace during COVID-19 mobility 
restrictions but may not have always managed to reach it. We used a longitudinal 
approach, replicated in three European cities, to assess whether people spent 
more time in locations with more greenspace, and whether this change in urban 
density remained for the whole pandemic, pre-vaccine, period. We coupled this 
human density study with a longitudinal study of web search patterns for Parks 
and online discussion about urban greenspace. People searched for Parks near 
them more during the pandemic, particularly when they were allowed to visit 
them. They discussed in positive terms greenspace particularly more at the start 
of the pandemic. People spent more time in areas with greenspace when they could 
and that depended on the level of multiple deprivation of their neighbourhood. 
Importantly, while people sought greenspace throughout the first 20 months of 
the pandemic, this preference intensified through the waves of lockdown. Living 
in an affluent area conferred a greenspace advantage in London and Paris but we 
find that in Berlin greenspace in more deprived neighbourhoods were used more. 
Overall, urban greenspace occupied a greater place in people's lives during the 
pandemic. Whether people could realise greenspace access depended on the 
deprivation level of the neighbourhood. Public greenspace access should be 
integrated in national indices of deprivation given its importance for 
wellbeing.

Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.envres.2023.115551
PMCID: PMC9951027
PMID: 36841525 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare the following financial interests/personal relationships which may be 
considered as potential competing interests:David Lusseau was funded by the 
Independent Research Fund for Denmark (Danmarks Frie Forskningsfond). Rosie 
Baillie was funded by a NERC QUADRAT PhD studentship NE/S007377/1.


939. Libyan J Med. 2023 Dec;18(1):2174291. doi: 10.1080/19932820.2023.2174291.

Psychosocial Effects of COVID-19 pandemic on Yemeni healthcare workers: A 
Web-based, Cross-sectional Survey.

Ghaleb Alrubaiee G(1)(2), Alsabri M(3), Abdulrahman Al-Qadasi F(4), Ali Hussein 
Al-Qalah T(1), Cole J(5), Abdullah Ghaleb Alburiahy Y(6).

Author information:
(1)Department of Community Health, College of Nursing, Ha'il University, Hail, 
KSA.
(2)Department of Community Health, Faculty of Medical Sciences, Al-Razi 
University, Sana'a City, Yemen.
(3)Emergency Department, Al-Thawra Modern General Teaching Hospital, Sana'a 
City, Yemen.
(4)Epidemiology and Medical Statistic, Health Officer, International 
Organization of Migration, Sana'a City, Yemen.
(5)Department of Health Studies, Royal Holloway University of London, Egham, UK.
(6)Emergency Department, Modern European Hospital, Sana'a City, Yemen.

Yemeni healthcare workers (HCWs) experience high levels of psychosocial stress. 
The current study provides a psychosocial assessment of Yemeni HCWs during the 
COVID19 pandemic and the factors that influence this. Between 6 November 2020, 
and 3 April 2021, 1220 HCWs inside Yemen self-reported levels of stress, 
anxiety, insomnia, depression and quality of life using a web-based, 
cross-sectional survey. According to the findings, 73.0%, 57.3%, 49.8%, 53.2%, 
and 85.2% of all HCWs reported moderate or severe stress, insomnia, anxiety, 
depression, and a lower quality of life, respectively. Significant positive 
correlations were found between stress and anxiety, insomnia, and depression 
scores, as well as anxiety and insomnia and depression, and insomnia and 
depression (p < 0.001). There was also a significant inverse relationship 
between wellbeing scores and stress, anxiety, insomnia, and depression scores 
(p < 0.001). A high percentage of respondents (85.8%) were 40 years old or 
younger and 72.7% had fewer than 10 years' experience, suggesting that 
experienced medics leave Yemen for safer and more secure jobs elsewhere. 
Psychosocial support to assist in building resilience to the prevailing 
conditions may need to be embedded in medical school training and continuing 
professional development to help support HCWs within Yemen and prevent even more 
from leaving the country.

DOI: 10.1080/19932820.2023.2174291
PMCID: PMC9970220
PMID: 36840952 [Indexed for MEDLINE]

Conflict of interest statement: No potential conflict of interest was reported 
by the author(s).


940. Matern Child Health J. 2023 Apr;27(4):632-640. doi: 10.1007/s10995-023-03626-3. 
Epub 2023 Feb 25.

Parental Worry About COVID-19 in Preschool Children's Mothers During the 
Pandemic Waves: The Role of Maternal Negative Feelings and Parenting Styles.

Yaffe Y(1).

Author information:
(1)Department of Education, Tel-Hai Academic College, Upper Galilee, 12208, 
Qiryat Shemona, Israel. yaffeyos@telhai.ac.il.

This cross-sectional study explores the relationship between maternal feelings, 
maternal parenting styles, and mothers' worry about COVID-19's detrimental 
consequences on preschool children's health and well-being. The study is among 
the first to concentrate on this reference specific group, whose characteristics 
might be particularly vulnerable to COVID-19's adversities. One hundred and four 
mothers of at least one preschool-age child completed an online questionnaire 
battery, which included the Parental Feelings Inventory, the Parenting Styles 
and Dimensions Questionnaire (PSDQ), and the parental worry about COVID-19 
scale. Negative maternal feelings (i.e., anger, anxiety/sadness) were associated 
with authoritarian and indulgent parenting practices, especially verbal 
hostility, while maternal happiness was associated with more authoritative 
practices, especially warmth and support. The hierarchical multiple regression 
model explained about 42% of variance of the overall maternal worry about 
COVID-19 from maternal negative feelings and parenting styles, with maternal 
authoritative parenting and maternal anxiety/sadness as the significant 
predictors that uniquely explain maternal worry about COVID-19. These results 
are discussed in terms of positive and negative maternal worry, which partially 
reflect the differences between overprotective and authoritative parenting in 
early childhood.

© 2023. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s10995-023-03626-3
PMCID: PMC9959943
PMID: 36840784 [Indexed for MEDLINE]

Conflict of interest statement: The author declared no potential conflict of 
interests with respect to the research, authorship, and/or publication of this 
article.


941. Nurs Open. 2023 Jun;10(6):3840-3853. doi: 10.1002/nop2.1642. Epub 2023 Feb 25.

Challenge, threat, coping potential: How primary and secondary appraisals of job 
demands predict nurses' affective states during the COVID-19 pandemic.

Fernandez De Henestrosa M(1), Sischka PE(1), Steffgen G(1).

Author information:
(1)Department of Behavioural and Cognitive Sciences, University of Luxembourg, 
Esch-sur-Alzette, Luxembourg.

AIM: The COVID-19 pandemic has led to a rapid raise of work-related stress among 
nurses, affecting their emotional well-being. This study examined how nurses 
appraise job demands (i.e. time pressure, emotional demands and physical 
demands) during the pandemic, and how primary (i.e. challenge and threat) and 
secondary appraisals (i.e. coping potential) of job demands predict nurses' 
affective states (i.e. positive affect, anger and anxiety).
DESIGN: A cross-sectional online survey.
METHODS: 419 nurses completed self-report measures of job demands and related 
appraisals. Data analyses comprised correlation analysis, factor analysis, 
hierarchical linear regression analysis and dominance analysis.
RESULTS: Emotional and physical demands correlated exclusively with threat 
appraisal, while time pressure correlated with challenge and threat appraisal. 
Time pressure, emotional demands and threat appraisals of job demands predicted 
negative affective states, while challenge appraisals of emotional and physical 
demands predicted positive affect. Coping potential was identified as the most 
important predictor variable of nurses' affective states.
PUBLIC CONTRIBUTION: The current study identified statistically significant risk 
and protective factors in view of nurses' affective states experienced during 
the COVID-19 pandemic.

© 2023 University of Luxembourg. Nursing Open published by John Wiley & Sons 
Ltd.

DOI: 10.1002/nop2.1642
PMCID: PMC10170884
PMID: 36840623 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


942. Int J Environ Res Public Health. 2023 Feb 18;20(4):3666. doi: 
10.3390/ijerph20043666.

The Impact of an Online Mindfulness-Based Practice Program on the Mental Health 
of Brazilian Nurses during the COVID-19 Pandemic.

Gherardi-Donato ECDS(1), Díaz-Serrano KV(2), Barbosa MR(3), Fernandes MNF(4), 
Gonçalves-Ferri WA(5), Camargo Júnior EB(6), Reisdorfer E(7).

Author information:
(1)Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 
14040-902, Brazil.
(2)School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão 
Preto 14040-904, Brazil.
(3)Faculty of Medicine, Federal University of Uberlândia, Uberlândia 38400-902, 
Brazil.
(4)Nursing Department, Federal University of Maranhão, Imperatriz 65915-240, 
Brazil.
(5)Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto 
14049-900, Brazil.
(6)Faculty of Nursing, Rio Verde University, Rio Verde 75901-970, Brazil.
(7)Department of Professional Nursing and Allied Health, Faculty of Nursing, 
MacEwan University, 10700 104 Ave NW, Edmonton, AB T5J 4S2, Canada.

This quantitative, before-after study was developed to evaluate the usefulness 
of an online mindfulness practices program to help nursing professionals deal 
with stress in the challenging context of the COVID-19 pandemic through the 
assessment of perceived stress, anxiety and depression, levels of mindfulness, 
and participants' satisfaction with the program. Eligible participants were 
assessed at baseline to receive the online mindfulness training program for 
eight weeks and were appraised again at the end of the program. Standardized 
measures of perceived stress, depression, anxiety, and one-dimensional and 
multidimensional mindfulness were performed. Participant satisfaction was also 
studied. Adherence to treatment was 70.12%. The perceived stress, depression, 
and anxiety scores were significantly lower after the intervention. The 
mindfulness measure increased significantly, as well as the sense of well-being 
and satisfaction with life, study, and/or work. The participants showed high 
satisfaction with the program and would recommend it to other professionals. Our 
results indicate that mindfulness-based interventions represent an effective 
strategy for nurses in the face of the need for self-care with mental health and 
mechanisms that guarantee the sustainability of their capacities to continue 
exercising health care.

DOI: 10.3390/ijerph20043666
PMCID: PMC9965119
PMID: 36834361 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript; or in the decision to 
publish the results.


943. Int J Environ Res Public Health. 2023 Feb 18;20(4):3642. doi: 
10.3390/ijerph20043642.

How Have Physical Activity and Sedentary Behavior, Changed during the COVID-19 
Pandemic? A Swedish Repeated Cross-Sectional Design Study.

Lindberg D(1), Elvén M(2), Nilsson KW(3)(4), Von Heideken Wågert P(2), Stier 
J(1), Dahlen M(5), Kerstis B(6).

Author information:
(1)Division of Social Work, School of Health, Care and Social Welfare, 
Mälardalen University, SE-72134 Västerås, Sweden.
(2)Division of Physiotherapy, School of Health, Care and Social Welfare, 
Mälardalen University, SE-72134 Västerås, Sweden.
(3)Center for Clinical Research, Central Hospital of Västerås, Uppsala 
University, SE-75236 Uppsala, Sweden.
(4)Division of Public Health Sciences, School of Health, Care and Social 
Welfare, Mälardalen University, SE-72134 Västerås, Sweden.
(5)Department of Marketing and Strategy, Stockholm School of Economics, SE-11383 
Stockholm, Sweden.
(6)Division of Caring Sciences, School of Health, Care and Social Welfare, 
Mälardalen University, SE-72134 Västerås, Sweden.

Physical activity (PA) and sedentary behavior (SB) affect people's physical and 
mental health. The aim was to examine changes in PA and SB in a Swedish 
population: at three time points: 2019, 2020, and 2022, i.e., before and during 
the COVID-19 pandemic. Pre-pandemic PA and SB, i.e., 2019, were assessed 
retrospectively in 2020. Associations between PA and SB with sex, age, 
occupation, COVID-19 history, weight change, health, and life satisfaction were 
also examined. The design was repeated cross-sectionally. The main findings 
demonstrate the PA levels decreased between 2019 and 2020, and between 2019 and 
2022, but not between 2020 and 2022. The SB increase was most evident between 
2019 and 2020. Between 2020 and 2022, results showed a decrease in SB, but SB 
did not reach pre-pandemic levels. Both sexes decreased their PA over time. 
Although men reported more PA sex, they did not have any association with PA 
changes. Two age groups, 19-29 years and 65-79 years, decreased their PA over 
time. Both PA and SB were associated with COVID-19, occupation, age, life 
satisfaction, health, and weight change. This study underlines the importance of 
monitoring changes in PA and SB as they have relevance for health and 
well-being. There is a risk that the levels of PA and SB do not return to 
pre-pandemic levels in the population.

DOI: 10.3390/ijerph20043642
PMCID: PMC9963654
PMID: 36834336 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
authors alone are responsible for the content and writing of the paper.


944. Int J Environ Res Public Health. 2023 Feb 17;20(4):3569. doi: 
10.3390/ijerph20043569.

The Work, Economic, and Remittance Stress and Distress of the COVID-19 Pandemic 
Containment Policies: The Case of Venezuelan Migrants in Argentina and Chile.

Del Real D(1), Crowhurst-Pons F(2), Olave L(3).

Author information:
(1)Sociology Department, University of Southern California, Los Angeles, CA 
90089, USA.
(2)Departamento de Ciencia Política y Políticas Públicas, Universidad del 
Desarrollo, Santiago 7610315, Chile.
(3)Escuela Interdisciplinaria de Estudios Sociales, Universidad Nacional de San 
Martín, San Martín 1650, Argentina.

According to the social stress process model, global crises are macro-level 
stressors that generate physiological stress and psychological distress. 
However, existing research has not identified immigrants' COVID-19 containment 
policy stressors or examined the social stress of sending remittances amid 
crises. Drawing on in-depth longitudinal interviews with 46 Venezuelan 
immigrants-half before and half during the pandemic-in Chile and Argentina, we 
identified the COVID-19 containment policies' stressors. We focused on 
Venezuelan immigrants because they constitute one of the largest internationally 
displaced populations, with most migrating within South America. We found that 
the governmental COVID-19 containment measures in both countries generated four 
stressors: employment loss, income loss, devaluation of employment status, and 
inability to send needed remittances. Moreover, sending remittances helped some 
migrants cope with concerns about loved ones in Venezuela. However, sending 
remittances became a social stressor when immigrants struggled to simultaneously 
sustain their livelihoods and send financial support to relatives experiencing 
hardships in Venezuela. For some immigrants, these adversities generated other 
stressors (e.g., housing instability) and symptoms of anxiety and depression. 
Broadly, for immigrants, the stressors of global crises transcend international 
borders and generate high stress, which strains their psychological well-being.

DOI: 10.3390/ijerph20043569
PMCID: PMC9960645
PMID: 36834263 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
sponsors had no role in the design, execution, interpretation, or writing of the 
study.


945. Int J Environ Res Public Health. 2023 Feb 17;20(4):3559. doi: 
10.3390/ijerph20043559.

Visiting Urban Green Space and Orientation to Nature Is Associated with Better 
Wellbeing during COVID-19.

Lin BB(1), Chang CC(2), Andersson E(3)(4)(5), Astell-Burt T(6)(7), Gardner J(1), 
Feng X(7)(8)(9).

Author information:
(1)CSIRO Land & Water, GPO Box 2583, Brisbane, QLD 4001, Australia.
(2)Department of Evolution and Ecology, University of California, Davis, CA 
94720, USA.
(3)Stockholm Resilience Centre, Stockholm University, 114 19 Stockholm, Sweden.
(4)Ecosystems and Environment Research Program, University of Helsinki, 00100 
Helsinki, Finland.
(5)Research Unit for Environmental Sciences and Management, North-West 
University, Potchefstroom 2531, South Africa.
(6)School of Health and Society, Faculty of Arts, Humanities and Social 
Sciences, University of Wollongong, Wollongong, NSW 2522, Australia.
(7)Population Wellbeing and Environment Research Lab (PowerLab), Sydney, NSW 
2000, Australia.
(8)School of Population Health, Faculty of Medicine and Health, University of 
New South Wales, Sydney, NSW 2052, Australia.
(9)The George Institute for Global Health, Sydney, NSW 2042, Australia.

The COVID-19 pandemic has severely challenged mental health and wellbeing. 
However, research has consistently reinforced the value of spending time in 
green space for better health and wellbeing outcomes. Factors such as an 
individual's nature orientation, used to describe one's affinity to nature, may 
influence an individual's green space visitation behaviour, and thus influence 
the wellbeing benefits gained. An online survey in Brisbane and Sydney, 
Australia (n = 2084), deployed during the COVID-19 pandemic (April 2021), 
explores if nature experiences and nature orientation are positively associated 
with personal wellbeing and if increased amounts of nature experiences are 
associated with improvement in wellbeing in the first year of the COVID-19 
pandemic. We found that both yard and public green space visitation, as well as 
nature orientation scores, were correlated with high personal wellbeing scores, 
and individuals who spent more time in green space compared to the previous year 
also experienced a positive change in their health and wellbeing. Consistently, 
people with stronger nature orientations are also more likely to experience 
positive change. We also found that age was positively correlated to a perceived 
improvement in wellbeing over the year, and income was negatively correlated 
with a decreased change in wellbeing over the year, supporting other COVID-19 
research that has shown that the effects of COVID-19 lifestyle changes were 
structurally unequal, with financially more established individuals experiencing 
better wellbeing. Such results highlight that spending time in nature and having 
high nature orientation are important for gaining those important health and 
wellbeing benefits and may provide a buffer for wellbeing during stressful 
periods of life that go beyond sociodemographic factors.

DOI: 10.3390/ijerph20043559
PMCID: PMC9959264
PMID: 36834254 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


946. Int J Environ Res Public Health. 2023 Feb 16;20(4):3477. doi: 
10.3390/ijerph20043477.

Non-Pharmacological Therapies for Post-Viral Syndromes, Including Long COVID: A 
Systematic Review.

Chandan JS(1), Brown KR(1)(2), Simms-Williams N(1), Bashir NZ(3), Camaradou 
J(4), Heining D(5), Turner GM(1)(6), Rivera SC(1)(6)(7), Hotham R(1), Minhas 
S(1), Nirantharakumar K(1)(8), Sivan M(9), Khunti K(10), Raindi D(11), Marwaha 
S(12)(13), Hughes SE(1)(6)(7)(14), McMullan C(1)(6), Marshall T(1), Calvert 
MJ(1)(6)(7)(14)(15)(16), Haroon S(1), Aiyegbusi OL(1)(6)(7)(14); TLC Study.

Author information:
(1)Institute of Applied Health Research, University of Birmingham, Birmingham 
B15 2TT, UK.
(2)School of Sport, Exercise and Rehabilitation Sciences, University of 
Birmingham, Birmingham B15 2TT, UK.
(3)School of Oral and Dental Sciences, University of Bristol, Bristol BS8 1TH, 
UK.
(4)School of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK.
(5)Department of Microbiology, Royal Wolverhampton NHS Trust, Wolverhampton WV10 
0QP, UK.
(6)Centre for Patient Reported Outcomes Research, Institute of Applied Health 
Research, University of Birmingham, Birmingham B15 2TT, UK.
(7)Birmingham Health Partners Centre for Regulatory Science and Innovation, 
University of Birmingham, Birmingham B15 2TT, UK.
(8)Midlands Health Data Research UK, Birmingham B15 2TT, UK.
(9)School of Medicine, University of Leeds, Leeds LS2 9JT, UK.
(10)Diabetes Research Centre, University of Leicester, Leicester LE1 7RH, UK.
(11)School of Dentistry, Institute of Clinical Sciences, University of 
Birmingham, Birmingham B5 7EG, UK.
(12)Institute for Mental Health, University of Birmingham, Birmingham B15 2TT, 
UK.
(13)Birmingham and Solihull Mental Health NHS Foundation Trust, Unit 1, B1, 50 
Summer Hill Road, Birmingham B1 3RB, UK.
(14)National Institute for Health Research (NIHR), Applied Research 
Collaboration, Birmingham B15 2TT, UK.
(15)NIHR Birmingham Biomedical Research Centre, University of Birmingham, 
Birmingham B15 2TT, UK.
(16)Health Data Research UK, London WC1E 6BT, UK.

BACKGROUND: Post-viral syndromes (PVS), including Long COVID, are symptoms 
sustained from weeks to years following an acute viral infection. 
Non-pharmacological treatments for these symptoms are poorly understood. This 
review summarises the evidence for the effectiveness of non-pharmacological 
treatments for PVS.
METHODS: We conducted a systematic review to evaluate the effectiveness of 
non-pharmacological interventions for PVS, as compared to either standard care, 
alternative non-pharmacological therapy, or placebo. The outcomes of interest 
were changes in symptoms, exercise capacity, quality of life (including mental 
health and wellbeing), and work capability. We searched five databases (Embase, 
MEDLINE, PsycINFO, CINAHL, MedRxiv) for randomised controlled trials (RCTs) 
published between 1 January 2001 to 29 October 2021. The relevant outcome data 
were extracted, the study quality was appraised using the Cochrane risk-of-bias 
tool, and the findings were synthesised narratively.
FINDINGS: Overall, five studies of five different interventions (Pilates, music 
therapy, telerehabilitation, resistance exercise, neuromodulation) met the 
inclusion criteria. Aside from music-based intervention, all other selected 
interventions demonstrated some support in the management of PVS in some 
patients.
INTERPRETATION: In this study, we observed a lack of robust evidence evaluating 
the non-pharmacological treatments for PVS, including Long COVID. Considering 
the prevalence of prolonged symptoms following acute viral infections, there is 
an urgent need for clinical trials evaluating the effectiveness and 
cost-effectiveness of non-pharmacological treatments for patients with PVS.
REGISTRATION: The study protocol was registered with PROSPERO [CRD42021282074] 
in October 2021 and published in BMJ Open in 2022.

DOI: 10.3390/ijerph20043477
PMCID: PMC9967466
PMID: 36834176 [Indexed for MEDLINE]

Conflict of interest statement: There are no conflict of interest among the 
authors relevant to this study. For note, J.C. is a member of the UK NICE 
COVID-10 expert panel, COVID-END evidence synthesis network and a member of 
European Academy of Neurology working group on autonomic disorders as a patient 
representative.


947. Int J Environ Res Public Health. 2023 Feb 16;20(4):3466. doi: 
10.3390/ijerph20043466.

The Psychological Impact of the COVID-19 Pandemic on Alcohol Abuse and 
Drunkorexia Behaviors in Young Adults.

Di Tata D(1), Bianchi D(1), Pompili S(1), Laghi F(1).

Author information:
(1)Department of Developmental and Social Psychology, Sapienza University of 
Rome, 00185 Rome, Italy.

The COVID-19 outbreak negatively affected young adults' psychological 
well-being, increasing their stress levels and symptoms of anxiety and 
depression, and potentially triggering health-risk behaviors. The present study 
was aimed at investigating the psychological impact of the COVID-19 pandemic on 
alcohol abuse and drunkorexia behaviors among young adults living in Italy. 
Participants were 370 emerging adults (63% women, 37% men; Mage = 21.00, SDage = 
2.96, range: 18-30) who were recruited through an online survey between November 
2021 and March 2022. Participants completed measures of alcohol abuse, 
drunkorexia behaviors, negative life experiences, and post-traumatic symptoms 
related to the COVID-19 outbreak. The results showed that the emotional impact 
and negative life experiences associated with the pandemic predicted both 
alcohol abuse and drunkorexia behaviors, albeit in different ways. Specifically, 
the number of negative life experiences during the pandemic and the tendency to 
avoid COVID-19-related negative thoughts positively predicted alcohol abuse; and 
the presence of intrusive thoughts associated with the pandemic significantly 
predicted the frequency of drunkorexia behaviors. Implications for research and 
clinical practice are discussed.

DOI: 10.3390/ijerph20043466
PMCID: PMC9967230
PMID: 36834161 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


948. Int J Environ Res Public Health. 2023 Feb 16;20(4):3452. doi: 
10.3390/ijerph20043452.

The Emotion Regulation Questionnaire: Psychometric Properties and Prediction of 
Posttraumatic Consequences during the COVID-19 Pandemic in Chilean Adults.

García FE(1), Vergara-Barra P(1), Concha-Ponce P(2), Andrades M(3), Rincón P(4), 
Valdivia-Devia M(5).

Author information:
(1)Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad 
de Concepción, Concepción 4070409, Chile.
(2)Facultad de Psicología, Universidad de Talca, Talca 3465548, Chile.
(3)Escuela de Psicología y Terapia Ocupacional, Universidad Central de Chile, 
Santiago 8370292, Chile.
(4)Departamento de Psicología, Facultad de Ciencias Sociales, Universidad de 
Concepción, Concepción 4070386, Chile.
(5)Academia de Ciencias Policiales, Carabineros de Chile, Santiago 7591168, 
Chile.

The Emotion Regulation Questionnaire (ERQ) is widely used to assess the use of 
cognitive reappraisal and expressive suppression strategies to regulate negative 
emotions. The present study evaluates the psychometric properties, reliability 
and validity of a Chilean adaptation of the ERQ in a large sample of 1543 
participants aged between 18 and 87 (38% male, 62% female). The results of the 
confirmatory factor analysis showed the expected two-factor structure and 
factorial invariance in relation to gender. Results also indicated adequate 
internal consistency, test-retest reliability, convergent and predictive 
validity in predicting posttraumatic stress symptoms and posttraumatic growth 
six months after the first measurement in a subsample of students exposed to the 
COVID-19 pandemic. The use of reappraisal was positively associated with general 
well-being, whereas the use of suppression was positively associated with 
depressive symptomatology. In terms of posttraumatic consequences, the use of 
reappraisal was negatively associated with posttraumatic symptomatology and 
positively associated with posttraumatic growth six months later; in turn, 
suppression was positively associated with posttraumatic symptomatology and 
negatively associated with posttraumatic growth six months later. This study 
demonstrates that the ERQ is a valid and reliable instrument to measure 
emotional regulation strategies in Chilean adults.

DOI: 10.3390/ijerph20043452
PMCID: PMC9967314
PMID: 36834148 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


949. Int J Environ Res Public Health. 2023 Feb 15;20(4):3431. doi: 
10.3390/ijerph20043431.

Impact of Social Support on Depressive Symptoms among Postgraduates during the 
Coronavirus Disease 2019 Pandemic: A Moderated Mediation Analysis.

Wan P(1), Hu J(1), Li Q(1).

Author information:
(1)School of Psychology, Liaoning Normal University, Dalian 116023, China.

The coronavirus disease (COVID-19) pandemic continues to spread worldwide, and 
its related stressors are causing a high prevalence of mental health problems 
among graduate students. This has the potential for long-term effects on their 
mental well-being. However, few large-scale studies have been conducted on 
multiple risk and protective factors. Therefore, we aimed to test the impact of 
social support on depressive symptoms among graduate students and analyze the 
mediating role of positive coping and the regulatory role of neuroticism. From 
1-8 October 2021, 1812 Chinese graduate students were surveyed online. We used a 
structural equation model to study the mediating role of positive coping in the 
relationship between social support and depressive symptoms and used the Hayes 
PROCESS macro to conduct mediating analysis. The incidence of depressive 
symptoms was 10.40%. These results showed that positive coping influenced the 
social support's influence on depression symptoms to some extent. Moreover, 
neuroticism regulates the indirect relationship between social support and 
depressive symptoms through active coping. Further research is needed to assess 
the impact of various forms of social support on graduate students' mental 
health and to develop strategies for maintaining their well-being, such as 
network mindfulness.

DOI: 10.3390/ijerph20043431
PMCID: PMC9964387
PMID: 36834129 [Indexed for MEDLINE]

Conflict of interest statement: All co-authors have expressed agreement with the 
authorship order and the manuscript’s contents. The authors have no conflict of 
interest to declare as influencing the research.


950. Int J Environ Res Public Health. 2023 Feb 15;20(4):3417. doi: 
10.3390/ijerph20043417.

The Moderating Role of Family Resilience on the Relationship between 
COVID-19-Related Psychological Distress and Mental Health among Caregivers of 
Individuals with Eating Disorders in Post-Pandemic China.

Wei Y(1), Li Z(1), Guo L(1), Zhang L(1), Lian C(1), Yuan C(1), Chen J(1).

Author information:
(1)Shanghai Mental Health Center, Shanghai Jiao Tong University School of 
Medicine, Shanghai 200030, China.

COVID-19 has amplified long-standing emotional distress for vulnerable families. 
While abundant research highlights the importance of resilience under adverse 
circumstances, little has been undertaken to understand its effectiveness in 
helping caregivers of individuals with eating disorders (ED) navigate 
pandemic-related challenges. This paper presents findings of a cross-sectional 
study investigating the effects of COVID-19-related life disruptions (COLD) and 
COVID-19-related psychological distress (CORPD) on caregivers' depression, 
anxiety and stress, as well as the moderation role of individual resilience (IR) 
and family resilience (FR) during the post-pandemic period in China. A total of 
201 caregivers of individuals experiencing ED participated in our online survey 
from May 2022 to June 2022. The association between pandemic-related stressors 
(i.e., COLD and CORPD) and mental health conditions were confirmed. FR moderated 
the relationship between CORPD and mental health outcomes, while IR 
independently contributed to low emotional distress. We call for intervention 
programs strengthening caregivers' FR and IR, which might benefit both patients 
and caregivers' well-being in the post-pandemic period.

DOI: 10.3390/ijerph20043417
PMCID: PMC9965091
PMID: 36834112 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


951. Int J Environ Res Public Health. 2023 Feb 14;20(4):3319. doi: 
10.3390/ijerph20043319.

Anxiety and Depression Levels and Coping Strategies among Polish Healthcare 
Workers during the COVID-19 Pandemic.

Budzyńska N(1), Moryś J(1).

Author information:
(1)Department of Clinical Psychology, Faculty of Health Sciences, Medical 
University of Gdańsk, 80-210 Gdańsk, Poland.

During the COVID-19 pandemic, medical staff were commonly exposed to stress, 
work under pressure, and long shifts, and may have experienced a fear of 
infecting loved ones or a fear for their own health. All of these factors may 
have increased the likelihood that healthcare workers will experience the 
symptoms of depression, anxiety, or other mental health disorders. In this 
cross-sectional study, a group of respondents was gathered from the employees of 
78 hospitals in Poland. A questionnaire was completed electronically by 282 
people, aged between 20 and 78 years. The study used the Hospital Anxiety and 
Depression Scale (HADS) and the MiniCOPE questionnaire to examine anxiety and 
depression symptoms, and coping strategies, respectively. With age, the 
respondents declared fewer symptoms of anxiety and tended to have milder 
symptoms of depression. Participants with chronic illnesses, mood disorders, or 
anxiety disorders also reported higher levels of anxiety and depression 
symptoms. More than 20% of healthcare workers felt the need to consult with a 
psychologist. In the entire group of healthcare professionals surveyed, the most 
commonly used strategies for coping with stress were "denial", "psychoactive 
drug and alcohol use", and "cessation of activities", while the least used 
strategy was "acceptance". Given the most commonly used strategies in the 
surveyed group of healthcare professionals, they may be predictors for a 
deterioration in mental state in the long run. The obtained results also suggest 
that it is likely that pre-existing health problems had a greater impact on the 
mental health of medical staff during the COVID-19 pandemic than the profession 
itself. Therefore, taking care of the well-being and mental health of healthcare 
workers should be a priority for employers.

DOI: 10.3390/ijerph20043319
PMCID: PMC9959847
PMID: 36834013 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript; or in the decision to 
publish the results.


952. Int J Environ Res Public Health. 2023 Feb 13;20(4):3275. doi: 
10.3390/ijerph20043275.

Physical Activity in the COVID-19 Era and Its Impact on Adolescents' Well-Being.

Bozzola E(1), Barni S(1), Ficari A(1), Villani A(1).

Author information:
(1)Pediatric Unit, IRCCS Bambino Gesù Children's Hospital, 00100 Rome, Italy.

Physical inactivity and sedentary habits are among the major risk factors for 
decreased physical and mental well-being. Since the onset of the COVID-19 
pandemic, normal daily routines changed, including physical activity (PA) 
habits. The aim of this manuscript is to review the literature according to the 
PRISMA guidelines in order to analyze the changes in PA and exercise practice 
after the onset of the COVID-19 pandemic and its impact on the well-being of 
adolescents. A PubMed search was performed using the keywords "Exercise" [Mesh]) 
AND "COVID-19" [Mesh], and filters to limit the research to pertain to 
adolescents (13-18 years) and English reports. Out of the search, 15 reports met 
the criteria for inclusion in the study. The main findings outlined a global 
decrease in PA levels associated with decreased well-being levels, modified 
eating habits and leisure time activity, and increased obesity, anxiety, and 
depression among adolescents. PA is a significant health determinant and should 
be improved through the awareness of the benefits of regular PA and of the risks 
of sedentary behavior, as well as through support from family, friends, and 
teachers. Providing PA at school, as a part of the academic program, increasing 
the availability of equipment and facilities, and promoting at-home PA options 
are suggested as support for increasing PA in all countries and settings.

DOI: 10.3390/ijerph20043275
PMCID: PMC9965268
PMID: 36833968 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


953. Int J Environ Res Public Health. 2023 Feb 13;20(4):3262. doi: 
10.3390/ijerph20043262.

COVID-19, Mental Health, and Chronic Illnesses: A Syndemic Perspective.

Saqib K(1), Qureshi AS(2), Butt ZA(1).

Author information:
(1)School of Public health Sciences, University of Waterloo, Waterloo, ON N2L 
3G1, Canada.
(2)Whiting School of Engineering, Johns Hopkins University, Baltimore, MD 21218, 
USA.

BACKGROUND: The COVID-19 pandemic is an epidemiological and psychological 
crisis; what it does to the body is quite well known by now, and more research 
is underway, but the syndemic impact of COVID-19 and mental health on underlying 
chronic illnesses among the general population is not completely understood.
METHODS: We carried out a literature review to identify the potential impact of 
COVID-19 and related mental health issues on underlying comorbidities that could 
affect the overall health of the population.
RESULTS: Many available studies have highlighted the impact of COVID-19 on 
mental health only, but how complex their interaction is in patients with 
comorbidities and COVID-19, the absolute risks, and how they connect with the 
interrelated risks in the general population, remain unknown. The COVID-19 
pandemic can be recognized as a syndemic due to; synergistic interactions among 
different diseases and other health conditions, increasing overall illness 
burden, emergence, spread, and interactions between infectious zoonotic diseases 
leading to new infectious zoonotic diseases; this is together with social and 
health interactions leading to increased risks in vulnerable populations and 
exacerbating clustering of multiple diseases.
CONCLUSION: There is a need to develop evidence to support appropriate and 
effective interventions for the overall improvement of health and psychosocial 
wellbeing of at-risk populations during this pandemic. The syndemic framework is 
an important framework that can be used to investigate and examine the potential 
benefits and impact of codesigning COVID-19/non-communicable diseases 
(NCDs)/mental health programming services which can tackle these epidemics 
concurrently.

DOI: 10.3390/ijerph20043262
PMCID: PMC9962717
PMID: 36833955 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


954. Int J Environ Res Public Health. 2023 Feb 10;20(4):3110. doi: 
10.3390/ijerph20043110.

Being a Parent of Children with Disabilities during the COVID-19 Pandemic: 
Multi-Method Study of Health, Social Life, and Occupational Situation.

Fortin-Bédard N(1)(2), Ladry NJ(1), Routhier F(1)(2), Lettre J(1), Bouchard 
D(1), Ouellet B(1)(2), Grandisson M(1)(2), Best KL(1)(2), Bussières ÈL(1)(3), 
Baron M(4), LeBlanc A(4)(5), Lamontagne ME(1)(2).

Author information:
(1)Center for Interdisciplinary Research in Rehabilitation and Social 
Integration, Centre Intégré Universitaire de Santé et de Services Sociaux de la 
Capitale-Nationale, Quebec, QC G1C 3S2, Canada.
(2)Department of Rehabilitation, Université Laval, Quebec, QC G1V 0A6, Canada.
(3)Department of Psychology, Université du Québec à Trois-Rivières, 
Trois-Rivieres, QC G8Z 4M3, Canada.
(4)VITAM Research Center on Sustainable Health, Centre Intégré Universitaire de 
Santé et de Services Sociaux de la Capitale-Nationale, Quebec, QC G1J 2G1, 
Canada.
(5)Department of Family and Emergency Medicine, Université Laval, Quebec, QC G1V 
0A6, Canada.

Parents of children with disabilities face challenges in their daily lives, but 
little is known about their experience of the COVID-19 pandemic. The objective 
of the study was to explore the experiences of parents of children with 
disabilities during the COVID-19 pandemic in Quebec, Canada. Forty parents of 
children with disabilities from Quebec, Canada (mean [SD] age: 41.2 [6.7]; 93% 
women) were selected from the Ma Vie et la pandémie (MAVIPAN) study. All 40 
parents completed the MAVIPAN online questionnaires including the Depression, 
Anxiety and Stress Scale (DASS-21), Warwick-Edinburgh Mental Wellbeing short 
7-item scale (WEMWBS), Social Provisions Scale-10 item (SPS-10), and the UCLA 
Loneliness Scale (UCLA-LS). A multi-method analysis was used to summarize 
questionnaires and thematically explore parents' experiences. Parents reported 
deterioration in their mental (50.0%) and physical (27.5%) health, with moderate 
levels of depression, stress, and anxiety, yet moderately positive well-being. 
Additional experiences included reduction in available supports (71.4%) and 
feelings of social isolation (51.4%). Our results highlighted reduced mental and 
physical health, limited and modified access to certain services, and reduction 
of social supports for some parents of children with disabilities. Health 
professionals, policymakers, and governments should be mindful of these 
challenges experienced by parents of children with disabilities.

DOI: 10.3390/ijerph20043110
PMCID: PMC9961490
PMID: 36833804 [Indexed for MEDLINE]

Conflict of interest statement: The authors report no conflict of interest.


955. Int J Environ Res Public Health. 2023 Feb 9;20(4):3042. doi: 
10.3390/ijerph20043042.

Centres of Excellence for Adolescent Health and Development: A Case Study from 
Uttar Pradesh, India.

Mehra D(1)(2), Rajak R(1), Deo S(3), Najmuddin Q(4), Devi KS(1), Rathi SK(5), 
Mehra S(1).

Author information:
(1)Department of Research and Innovation, MAMTA Health Institute for Mother and 
Child, New Delhi 110048, India.
(2)Social Medicine and Global Health, Department of Clinical Sciences, Lund 
University, 20502 Malmö, Sweden.
(3)Gynecology and Obstetrics Department, King George Medical University, Lucknow 
226003, India.
(4)Programe Division, MAMTA Health Institute for Mother and Child, Lucknow 
226021, India.
(5)Department of Central Research and Innovation, Sumandeep Vidyapeeth Deemed to 
Be University, Vadodara 391760, India.

Adolescents and young adult comprise a significant proportion of India's 
population. Although, this group of the population faces serious challenges to 
their health and well-being. To promote their health and well-being, Centre of 
Excellence (CoE) at King George's Medical University, Lucknow, India, serves as 
an advanced care facility for 10-24-year-old adolescents and young adult women. 
This paper reports the socio-demographic characteristics of, and health services 
availed to adolescents and young adults who are visiting the CoE in Lucknow, 
India. A total of 6038 beneficiaries received clinical services during June 
2018-March 2022. Out of total clinical services, 38.37% counselling and 37.53% 
referral services were utilised. Menstruation (46.29%), sexual and reproductive 
(28.19%), nutrition (5.91%), and mental health (1.67%) related problems were 
highly reported. The age of beneficiaries is classified into three categories, 
i.e., 10-14, 15-19, and 20-24 years. Prevalence of overweight was highest among 
adolescents aged 20-24 years compared to other age groups. Other than nutrition, 
late-adolescent girls (15-19) faced more health problems than their 
counterparts. The percentage of beneficiaries decreased significantly during and 
post the COVID-19 period (<0.001). Therefore, age-specific programs are 
currently needed, and interventions need to be designed accordingly.

DOI: 10.3390/ijerph20043042
PMCID: PMC9957491
PMID: 36833736 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


956. Int J Environ Res Public Health. 2023 Feb 8;20(4):2961. doi: 
10.3390/ijerph20042961.

Mental Health of Working Adults during the COVID-19 Pandemic: Does Physical 
Activity Level Matter?

Wut TM(1), Lee SW(1), Xu JB(1).

Author information:
(1)College of Professional and Continuing Education, The Hong Kong Polytechnic 
University, Hong Kong, China.

The purpose of this study is to investigate the associations between physical 
activity levels and the psychological outcomes of depression and anxiety. In 
2022, Hong Kong was still exercising strict measures to control the spread of 
COVID-19. In this connection, major events and almost all large-scale sports 
events were suspended. Most recreational facilities were closed and repurposed 
as vaccination venues. As a result, a reduction in physical activity was 
expected. A cross-sectional survey was conducted among 109 working adults in 
Hong Kong. The International Physical Activity Questionnaire-Short Form was 
adopted as it continues to be the most widely used scale to measure physical 
activity. Almost a quarter of respondents exercised regularly. On average, 
respondents engaged in less than an hour's physical activity per week. Findings 
showed that even low to moderate levels of physical activity were positively 
associated with perceived self-esteem and perceived mental well-being. More 
specifically, self-esteem and perceived mental well-being were negatively 
associated with depression and anxiety. A full mediation effect between 
engagement in low levels of physical activity and anxiety was found. Light 
exercises may ultimately lead to lower anxiety via an indirect effect, with 
perceived mental well-being acting as a mediator. There was no direct 
relationship between low levels of physical activity and anxiety. In a similar 
vein, moderate levels of physical activity may lead to amelioration of symptoms 
related to depression and anxiety through indirect effects, with self-esteem as 
a mediator. Apart from engagement in low levels of physical activity, moderate 
levels of physical activity, such as swimming, jogging, and dancing, which have 
associations with self-esteem and mental health, could also be considered for 
attention.

DOI: 10.3390/ijerph20042961
PMCID: PMC9966206
PMID: 36833655 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


957. Int J Environ Res Public Health. 2023 Feb 7;20(4):2909. doi: 
10.3390/ijerph20042909.

Crisis, What Crisis? The Effect of Economic Crises on Spending on Online and 
Offline Gambling in Spain: Implications for Preventing Gambling Disorder.

Chóliz M(1).

Author information:
(1)Gambling and Technological Addictions Research Unit, Psychology School, 
University of Valencia, 46010 Valencia, Spain.

(1) Background: In the period between 2008 and 2020, the world experienced two 
global economic crises that affected people's way of life and well-being: the 
financial crisis of 2008 and that precipitated by the COVID-19 pandemic. Despite 
the crises' radically different causes, their consequences for economic activity 
have been equally dramatic; (2) Methods: This article analyzes the consequences 
of both crises on gambling spending in Spain and compares traditional (offline) 
games with more recent online offerings. The data were collected from databases 
maintained by the Spanish government and gambling companies; (3) Results: The 
paper offers two main conclusions. The first is that, while traditional 
(offline) gambling has been significantly affected by economic crises, online 
gambling has exhibited consistent growth since its legalization. The second is 
that the measures implemented to resolve the two economic crises differed 
significantly and thus had different impacts on spending on the various types of 
gambling; (4) Conclusions: The key conclusion is that purchasing power (measured 
in terms of GDP) can only explain spending on less addictive gambling games, 
such as lotteries. However, the availability and accessibility of games are both 
directly related to spending on games of all types.

DOI: 10.3390/ijerph20042909
PMCID: PMC9957131
PMID: 36833606 [Indexed for MEDLINE]

Conflict of interest statement: The author declares no conflict of interest. The 
author endorsed the Auckland Code on the Ethical Gambling Research, H.E.A.R.T. 
(Honesty, Excellence, Accountabililty, Rigour, Transparency), Auckland, 2018.


958. Int J Environ Res Public Health. 2023 Feb 6;20(4):2870. doi: 
10.3390/ijerph20042870.

Which Aspects of Work Safety Satisfaction Are Important to Mental Health of 
Healthcare Workers during COVID-19 Pandemic in Poland?

Gustavsson K(1), Goetz-Kundera Z(2), Flaga-Łuczkiewicz M(3), Wichniak A(4).

Author information:
(1)Department of Clinical Neurophysiology, Institute of Psychiatry and 
Neurology, 02-957 Warsaw, Poland.
(2)Department of Psychiatry, Bielański Hospital, 01-809 Warsaw, Poland.
(3)Mental Health Center for Medical Doctors and Students, Dialog Therapy Centre, 
02-703 Warsaw, Poland.
(4)Third Department of Psychiatry, Institute of Psychiatry and Neurology, 02-957 
Warsaw, Poland.

The outbreak of the COVID-19 pandemic increased the occupational burden 
experienced by healthcare workers. The aim of this study was to investigate a 
change in work satisfaction during the pandemic and specific factors 
contributing to mental health among healthcare providers. We obtained data from 
367 healthcare professionals. Respondents were asked about their satisfaction 
with selected aspects of work (clarity of procedures, access to personal 
protective equipment, the flow of information, financial stability and general 
security) during the epidemic and retrospectively how satisfied they were before 
the outbreak. They also completed measures assessing mental health: the World 
Health Organization-Five Well-Being Index, the Patient Health Questionnaire-9, 
the Generalized Anxiety Disorder-7 scale and the Insomnia Severity Index. The 
results showed that satisfaction with all safety-related work aspects decreased 
during the pandemic. The flow of information and financial stability were 
significant predictors of WHO-5, PHQ-9 and ISI scores. GAD-7 scores were 
predicted by satisfaction with the clarity of procedures, the flow of 
information and financial stability. The COVID-19 pandemic significantly changed 
the lives of everyone. However, due to conditions of employment in Polish 
healthcare, the COVID-19 pandemic put a great financial strain in addition to 
pandemic stressors specific to medical staff.

DOI: 10.3390/ijerph20042870
PMCID: PMC9957319
PMID: 36833567 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funder had no role in the design of the study; in the collection, analysis, or 
interpretation of data; in the writing of the manuscript; or in the decision to 
publish the results.


959. Int J Environ Res Public Health. 2023 Feb 6;20(4):2866. doi: 
10.3390/ijerph20042866.

A Study of Psychometric Instruments and Constructs of Work-Related Stress among 
Seafarers: A Qualitative Approach.

Ali SNM(1), Cioca LI(2), Kayati RS(1), Saputra J(1), Adam M(3), Plesa R(4), 
Ibrahim RZAR(1).

Author information:
(1)Faculty of Business, Economics and Social Development, Universiti Malaysia 
Terengganu, Kuala Nerus 21030, Terengganu, Malaysia.
(2)Faculty of Engineering, Lucian Blaga University of Sibiu, 550025 Sibiu, 
Romania.
(3)Faculty of Economics and Business, Universitas Syiah Kuala, Syiah Kuala, 
Banda Aceh 23111, Indonesia.
(4)Faculty of Sciences, University of Petrosani, 332006 Petrosani, Romania.

Due to unpredictable and demanding working circumstances and the significant 
potential for dangers and accidents, seafaring has been characterised as one of 
the world's riskiest and stressful vocations that lead to physical and mental 
health problems. However, very few instruments measure work-related stress, 
particularly in a seafaring context. None of the instruments are 
psychometrically sound. Therefore, a valid and reliable instrument to measure 
seafaring work-related stress is indispensable. This study aims to review 
work-related stress instruments and to explore the work-related stress construct 
among seafarers in Malaysia. This study uses a systematic review and 
semi-structured interviews across two phases. In Phase 1, we conducted a 
systematic review of several databases: Academic Search Ultimate, Emerald 
Journal Premier, Journal Storage (JSTOR), ScienceDirect, Springer Link, Taylor 
and Francis Online, and Wiley Online Library based on Preferred Reporting Items 
for Systematic Review and Meta-analyses (PRISMA). In 8975 articles, only 4 
(four) studies used psychological instruments and 5 (five) studies used survey 
questionnaires to measure work-related stress. In Phase 2, we conducted a 
semi-structured interview with 25 (twenty-five) seafarers, online due to 
COVID-19 restrictions. The semi-structured interview indicated 6 (six) themes, 
namely, physical stress, personal issues, social living onboard, technostress, 
work factors, and the effect of the COVID-19 pandemic. In conclusion, the 
present study has identified three psychometric instruments for measuring 
work-related stress among seafarers: The Psychological General Well-Being Index, 
Perceived Stress Scale, and Job Content Questionnaire. We also found 
psychometric elements in some of the instruments are questionable, such as 
theoretical basis, construct development, and inadequate internal consistency 
value. In addition, this study also found that work-related stress is a 
multidimensional construct that needs to be studied based on work contexts. The 
findings of this study can contribute to the body of knowledge of a work-related 
stress construct in a seafaring context and could help to inform policy makers 
in the maritime industry. This study suggests a psychological instrument to 
measure work-related stress among seafarers in future studies.

DOI: 10.3390/ijerph20042866
PMCID: PMC9956373
PMID: 36833563 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


960. BMJ Open Respir Res. 2023 Feb;10(1):e001358. doi: 10.1136/bmjresp-2022-001358.

Clinical characteristics, diagnosis, outcomes and lung microbiome analysis of 
invasive pulmonary aspergillosis in the community-acquired pneumonia patients.

Ao Z(1), Xu H(2), Li M(1), Liu H(2), Deng M(1), Liu Y(3).

Author information:
(1)Department of Respiratory and Critical Care Medicine, The First Affiliated 
Hospital of Chongqing Medical University, Chongqing, China.
(2)Department of Scientific Affairs, Vision Medicals for Infection Diseases, 
Guangzhou, China.
(3)Department of Respiratory and Critical Care Medicine, The First Affiliated 
Hospital of Chongqing Medical University, Chongqing, China 37428643@qq.com.

BACKGROUND: Invasive pulmonary aspergillosis (IPA) remains underestimated in 
patients with community-acquired pneumonia (CAP). This study aims to describe 
clinical features and outcomes of IPA in CAP patients, assess diagnostic 
performance of metagenomic next-generation sequencing (mNGS) for IPA and analyse 
lung microbiome via mNGS data.
METHODS: This retrospective cohort study included CAP patients from 22 April 
2019 to 30 September 2021. Clinical and microbiological data were analysed. 
Diagnostic performance of mNGS was compared with traditional detection methods. 
The lung microbiome detected by mNGS was characterised and its association with 
clinical features was evaluated.
MAIN RESULTS: IPA was diagnosed in 26 (23.4%) of 111 CAP patients. Patients with 
IPA displayed depressed immunity, higher hospital mortality (30.8% vs 11.8%) and 
intensive care unit mortality (42.1% vs 17.5%) compared with patients without 
IPA. The galactomannan (GM) antigen test had the highest sensitivity (57.7%) in 
detecting the Aspergillus spp, followed by mNGS (42.3%), culture (30.8%) and 
smear (7.7%). The mNGS, culture and smear had 100% specificity, while GM test 
had 92.9% specificity. The microbial structure of IPA significantly differed 
from non-IPA patients (p<0.001; Wilcoxon test). Nineteen different species were 
significantly correlated with clinical outcomes and laboratory biomarkers, 
particularly for Streptococcus salivarius, Prevotella timonensis and Human 
betaherpesvirus 5.
CONCLUSIONS: Our results reveal that patients with Aspergillus infection tend to 
have a higher early mortality rate. The mNGS may be suggested as a complement to 
routine microbiological test in diagnosis of patients at risk of Aspergillus 
infection. The lung microbiota is associated with inflammatory, immune and 
metabolic conditions of IPA, and thus influences clinical outcomes.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjresp-2022-001358
PMCID: PMC9972439
PMID: 36828645 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


961. Dementia (London). 2023 May;22(4):760-782. doi: 10.1177/14713012231158215. Epub 
2023 Feb 24.

Navigating the coronavirus pandemic 2 years on: Experiences of people with 
dementia from the British IDEAL cohort.

Dawson E(1), Collins R(1), Pentecost C(1), Stapley S(1), Quinn C(2), Charlwood 
C(1), Victor C(3), Clare L(4).

Author information:
(1)University of Exeter Medical School, 3286University of Exeter, Exeter, UK.
(2)Centre for Applied Dementia Studies, 1905University of Bradford, Bradford, 
UK; Wolfson Centre for Applied Health Research, Bradford, UK.
(3)College of Health, Medicine and Life Sciences, 3890Brunel University London, 
UK.
(4)University of Exeter Medical School, 3286University of Exeter, Exeter, UK; 
NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK.

BACKGROUND AND OBJECTIVES: People with dementia have been affected in unique 
ways during the COVID-19 pandemic. It is not known whether the impact of the 
pandemic has changed with time or with the changes in social restrictions. This 
study explored how experiences of coping with the effects of the pandemic in the 
UK changed over time.
RESEARCH DESIGN AND METHODS: We conducted semi-structured interviews with people 
with dementia living in the community in England and Wales who had taken part in 
a qualitative interview at an earlier stage of the pandemic. We applied 
framework analysis to identify themes and compared these with interviewees' 
previous accounts.
FINDINGS: Nine people aged between 51 and 89 years were interviewed; four were 
female and five had early onset dementia. We identified three themes: 1. 
Navigating a changing world: Living with coronavirus; 2. A 'downward spiral': 
Managing advancing dementia; and 3. Availability, accessibility, and suitability 
of support. Findings reflect participants' ongoing caution about re-emerging 
from social restrictions to resume valued activities, and how this led to coping 
behaviours to minimise the impact on wellbeing in the absence of formal support 
and services.
DISCUSSION AND IMPLICATIONS: Despite easing of restrictions across the UK, the 
negative impact of the coronavirus pandemic on people with dementia continues. 
Whilst individuals and services have adapted to some of the challenges, there is 
now an opportunity to rebuild support networks and services to ensure people 
with dementia are suitably advised, supported and socially engaged to allow them 
to live as well as possible.

DOI: 10.1177/14713012231158215
PMCID: PMC9969185
PMID: 36827539 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


962. Medicine (Baltimore). 2023 Feb 22;102(8):e32934. doi: 
10.1097/MD.0000000000032934.

Importance of telemedicine in mild cognitive impairment and Alzheimer disease 
patients population during admission to emergency departments with COVID-19.

Corallo F(1), Maresca G, Bonanno L, Lo Buono V, De Caro J, Bonanno C, Formica C, 
Quartarone A, De Cola MC.

Author information:
(1)IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Sicily, Italy.

In March 2020, the World Health Organization declared a global pandemic due to 
the new coronavirus SARS-CoV-2, and several governments have planned a national 
quarantine to control the spread of the virus. Acute psychological effects 
during hospitalization in frail elderly individuals with special needs, such as 
patients with dementia, have been little studied. The greatest distress 
manifested by these kinds of patients was isolation from their families during 
hospitalization. Thus, structured video call interventions were carried out to 
family caregivers of patients diagnosed with dementia during their 
hospitalization in the COVID-19 ward. The purpose of this quasi-experimental 
study was to assess changes in cognitive and behavioral symptoms in both 
patients and caregivers. All study participants underwent psychological 
assessments. Specifically, the psychological well-being states of patients and 
their caregivers were measured at admission (T0) and discharge (T1) using 
psychometric tests and clinical scales. Each participant received an electronic 
device to access video calls in addition meetings were scheduled with the 
psychologist and medical team to keep caregivers updated on the health status of 
their relatives. A psychological support and cognitive rehabilitation service 
was also provided. Significant differences were found in all clinical variables 
of the caregiver group. Results showed a significant relationship in the quality 
of life score between the patient and caregiver groups. The results of this 
study has highlighted the importance of maintaining significantly effective 
relationships during the hospitalization period of patients admitted to COVID 
wards.

Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

DOI: 10.1097/MD.0000000000032934
PMCID: PMC9949366
PMID: 36827032 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
disclose.


963. Acta Obstet Gynecol Scand. 2023 Mar;102(3):270-281. doi: 10.1111/aogs.14525.

Impact of the COVID-19 pandemic on women's perinatal mental health and its 
association with personality traits: An observational study.

Birkelund KS(1)(2), Rasmussen SS(1)(2), Shwank SE(1)(2)(3), Johnson J(3), 
Acharya G(1)(2)(3)(4).

Author information:
(1)Women's Health and Perinatology Research Group, Department of Clinical 
Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, 
Tromsø, Norway.
(2)Department of Obstetrics and Gynecology, University Hospital of North Norway, 
Tromsø, Norway.
(3)Division of Obstetrics and Gynecology, Department of Clinical Science, 
Intervention & Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
(4)Department of Women's Health, Center for Fetal Medicine, Karolinska 
University Hospital, Stockholm, Sweden.

INTRODUCTION: The burden of perinatal mental health problems was expected to 
increase during the COVID-19 pandemic. We prospectively investigated the impact 
of the COVID-19 pandemic on the mental health of pregnant and postpartum women 
in Norway and explored associations with their sociodemographic characteristics 
and personality traits.
MATERIAL AND METHODS: Sociodemographic information and the self-reported impact 
of pandemic on wellbeing of pregnant women was collected using an online survey. 
To assess women's mental health, two validated questionnaires, the Edinburgh 
Postpartum Depression Scale (EPDS) and the Generalized Anxiety Disorder-7 item 
Scale (GAD-7), were used prenatally and postnatally. Personality traits were 
evaluated using HumanGuide, a web-based ipsative psychological evaluation 
instrument.
RESULTS: 772 women were included prenatally, of which 526 also responded to the 
survey 4-6 weeks postnatally. The median age was 29 years, 53.6% of the women 
were nulliparous when enrolled, and 35.1% worked in the healthcare sector. The 
median EPDS (6.0; interquartile range [IQR] 3.0-10.0 vs 6.0; IQR: 3.0-10.0) and 
the median GAD-7 (5.0; IQR 2.0-9.0 vs 5.0; IQR 2.0-9.0) were similar pre-and 
postnatally. Prenatally, the proportion of women scoring ≥13 on EPDS and ≥10 on 
GAD-7 was 14.5% (112/772) and 21.5% (166/772), whereas the postnatal figures 
were 15.6% (82/526) and 21.5% (113/526), respectively. The differences were not 
significant (P = 0.59 and P = 0.99). Being <25 years of age, being on 
pre-pregnancy psychotherapy or psychotropic medication, frequent voluntary 
isolation, perception of maternity care not proceeding normally, avoiding 
seeking medical assistance due to fear of infection and having negative economic 
consequences during the COVID19 pandemic significantly increased the risk of 
both anxiety (GAD-7 ≥10) and depression (EPDS ≥13). Nullipara had a higher risk 
of anxiety, whereas being a healthcare worker had a lower risk. The personality 
trait factors Power (P = 0.008), Quality (P = 0.008), Stability (P < 0.001) and 
Contacts (P < 0.001) were significant predictors of depression among pregnant 
women, whereas the Quality (P = 0.005) and Contacts (P = 0.003) were significant 
predictors of anxiety.
CONCLUSIONS: During the initial phase of the COVID-19 pandemic, the prevalence 
of depression (EPDS ≥ 13) and anxiety (GAD-7 ≥ 10) was 14.5% and 21.5%, 
respectively, among Norwegian pregnant women. Certain sociodemographic 
characteristics and personality traits were significant predictors of depression 
and anxiety.

© 2023 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by 
John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics 
and Gynecology (NFOG).

DOI: 10.1111/aogs.14525
PMCID: PMC9951299
PMID: 36825665 [Indexed for MEDLINE]

Conflict of interest statement: The authors have stated explicitly that there 
are no conflicts of interest in connection with this article.


964. J Clin Nurs. 2023 Oct;32(19-20):7125-7134. doi: 10.1111/jocn.16642. Epub 2023 
Feb 23.

Critical care nursing workforce in crisis: A discussion paper examining 
contributing factors, the impact of the COVID-19 pandemic and potential 
solutions.

Vogt KS(1)(2), Simms-Ellis R(1)(2), Grange A(1), Griffiths ME(3), Coleman 
R(1)(2), Harrison R(4), Shearman N(5), Horsfield C(5), Budworth L(1)(6), Marran 
J(1), Johnson J(1)(2)(7).

Author information:
(1)Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, 
UK.
(2)School of Psychology, University of Leeds, Leeds, UK.
(3)Royal Victoria Infirmary, Newcastle University Trust Hospital, Newcastle Upon 
Tyne, UK.
(4)Centre for Health Systems and Safety Research, Australian Institute of Health 
Innovation, Macquarie University, Sydney, New South Wales, Australia.
(5)Leeds Teaching Hospitals NHS Trust, Leeds, UK.
(6)School of Medicine, University of Leeds, Leeds, UK.
(7)School of Public Health and Community Medicine, University of New South 
Wales, Sydney, New South Wales, Australia.

AIMS AND OBJECTIVES: The critical care nursing workforce is in crisis, with 
one-third of critical care nurses worldwide intending to leave their roles. This 
paper aimed to examine the problem from a wellbeing perspective, offering 
implications for research, and potential solutions for organisations.
DESIGN: Discursive/Position paper.
METHOD: The discussion is based on the nursing and wellbeing literature. It is 
guided by the authors' collaborative expertise as both clinicians and 
researchers. Data were drawn from nursing and wellbeing peer-reviewed 
literature, such as reviews and empirical studies, national surveys and 
government and thinktank publications/reports.
RESULTS: Critical care nurses have been disproportionately affected by the 
COVID-19 pandemic with studies consistently showing critical care nurses to have 
the worst psychological outcomes on wellbeing measures, including depression, 
burnout and post-traumatic stress disorder (PTSD). These findings are not only 
concerning for the mental wellbeing of critical care nurses, they also raise 
significant issues for healthcare systems/organisations: poor wellbeing, 
increased burnout and PTSD are directly linked with critical care nurses 
intending to leave the profession. Thus, the wellbeing of critical care nurses 
must urgently be supported. Resilience has been identified as a protective 
mechanism against the development of PTSD and burnout, thus offering 
evidence-based interventions that address resilience and turnover have much to 
offer in tackling the workforce crisis. However, turnover data must be collected 
by studies evaluating resilience interventions, to further support their 
evidence base. Organisations cannot solely rely on the efficacy of these 
interventions to address their workforce crisis but must concomitantly engage in 
organisational change.
CONCLUSIONS: We conclude that critical care nurses are in urgent need of 
preventative, evidence-based wellbeing interventions, and make suggestions for 
research and practice.

© 2023 The Authors. Journal of Clinical Nursing published by John Wiley & Sons 
Ltd.

DOI: 10.1111/jocn.16642
PMID: 36823696 [Indexed for MEDLINE]


965. BMC Public Health. 2023 Feb 24;23(1):388. doi: 10.1186/s12889-023-15003-4.

Impact of the COVID-19 pandemic on maternal mental health, early childhood 
development, and parental practices: a global scoping review.

Penna AL(1), de Aquino CM(2), Pinheiro MSN(2), do Nascimento RLF(3), 
Farias-Antúnez S(4), Araújo DABS(2), Mita C(5), Machado MMT(2), Castro MC(6).

Author information:
(1)Department of Global Health and Population, Harvard T. H. Chan School of 
Public Health, Boston, USA. anapenna@g.harvard.edu.
(2)Department of Community Health, Federal University of Ceará, Fortaleza, 
Brazil.
(3)Pontifical Catholic University, Rio de Janeiro, Brazil.
(4)Department of Health Sciences, Federal University of Santa Catarina, 
Araranguá, Brazil.
(5)Countway Library, Harvard Medical School, Boston, USA.
(6)Department of Global Health and Population, Harvard T. H. Chan School of 
Public Health, Boston, USA.

BACKGROUND: In March 2020, the COVID-19 outbreak was declared a pandemic by the 
World Health Organization (WHO), generating stark economic and social 
repercussions that directly or indirectly affected families' wellbeing and 
health status.
AIMS: This review aims at mapping the existing evidence on the impact of the 
COVID-19 pandemic on maternal mental health, early childhood development, and 
parental practices, worldwide, to identify evidence gaps and better inform 
future delivery of care and health policy measures.
METHODS: Following the protocol defined by PRISMA-ScR, this scoping review has 
searched for relevant studies published between January 2020 and June 2021, 
selecting evidence sources based on pre-established criteria. From a total of 
2,308 articles, data were extracted from 537 publications from 35 countries on 
all three health domains.
RESULTS: The combined stressors brought forth by the pandemic have exerted a 
heavy burden on the mental health of mothers and the development of young 
children, partly mediated by its impact on parental practices.
CONCLUSIONS: Despite remaining gaps, we have identified sufficient evidence 
pointing to an urgent need for more concerted global research efforts and rapid 
policy responses to timely address severe and pervasive negative impacts to the 
mental health of mothers and children at a key developmental stage.

© 2023. The Author(s).

DOI: 10.1186/s12889-023-15003-4
PMCID: PMC9950022
PMID: 36823592 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no financial 
or non-financial competing interests.


966. J Relig Health. 2023 Apr;62(2):1379-1393. doi: 10.1007/s10943-023-01765-z. Epub 
2023 Feb 23.

Islamic Civilizations and Plagues: The Role of Religion, Faith and Psychology 
During Pandemics.

Awaad R(1), Nursoy-Demir M(2), Khalil A(3), Helal H(4).

Author information:
(1)Department of Psychiatry and Behavioral Sciences, Stanford University School 
of Medicine, 401 Quarry Rd., Stanford, CA, 94305, USA. rawaad@stanford.edu.
(2)Muslim Mental Health and Islamic Psychology Lab, Stanford University School 
of Medicine, Stanford, CA, USA.
(3)Oxford Medical School, University of Oxford, Oxford, UK.
(4)University of Toronto, Toronto, ON, Canada.

The current study seeks to analyze Muslim experiences of communicative diseases 
with a focus on the psychosocial impacts and public, communal, and personal 
responses of Muslim populations throughout history. By examining a selection of 
plague outbreaks between the 8-19th centuries across the lands broadly defined 
as the Islamic Mediterranean (Varlık, 2017), the guidelines and coping 
mechanisms that Muslims extracted from their traditional sources are 
highlighted. This historical perspective contributes to a better understanding 
of the psychological and social aspects of pandemics for the Muslim community, 
specifically for the role played by faith and spirituality as determinants of 
psychological well-being in Muslims' perceptions and responses. We suggest that 
such an understanding is especially useful for contemporary mental health 
practitioners working with Muslim patients through the global COVID-19 pandemic.

© 2023. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s10943-023-01765-z
PMCID: PMC9949692
PMID: 36823257 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
declare that are relevant to the content of this article.


967. Int J Food Sci Nutr. 2023 Mar;74(2):124-187. doi: 10.1080/09637486.2023.2180613. 
Epub 2023 Feb 23.

Nutritional changes during the COVID-19 pandemic: a rapid scoping review on the 
impact of psychological factors.

Van Laren A(1), Drießen M(1), Rasa S(1), Massar K(1), Ten Hoor GA(1).

Author information:
(1)Department Work and Social Psychology, Maastricht University, Maastricht, The 
Netherlands.

COVID-19 and the resulting measures to curb the spread of the virus have 
significantly changed our lives, including our nutritional choices. In this 
rapid scoping review an overview is provided of what psychological factors may 
be associated with peoples' eating behaviour during COVID-19 restrictions. 
Relevant literature was identified using PubMed, PsycInfo, CINAHL and MEDLINE 
databases from 2019 onwards. For included studies, information on study 
characteristics, eating behaviours, and psychological factors were extracted. 
118 articles were included, representing 30 countries. Findings indicated that 
most people consumed more and unhealthy food in times of COVID-19 restrictions, 
while some consumed less but often for the wrong reasons. Several psychological 
factors, related to (1) affective reactions, (2) anxiety, fear and worriers, (3) 
stress and (4) subjective and mental wellbeing were found to be associated with 
this increase in food consumption. These outcomes may help to be better inform 
future interventions, and with that, to be better prepared in case of future 
lockdown scenarios.

DOI: 10.1080/09637486.2023.2180613
PMID: 36823035 [Indexed for MEDLINE]


968. Prim Care Diabetes. 2023 Apr;17(2):141-147. doi: 10.1016/j.pcd.2023.02.002. Epub 
2023 Feb 16.

The impact of the covid-19 pandemic on diabetes care: the perspective of 
healthcare providers across Europe.

Van Grondelle SE(1), Van Bruggen S(2), Rauh SP(3), Van der Zwan M(3), Cebrian 
A(4), Seidu S(5), Rutten GEHM(6), Vos HMM(3), Numans ME(3), Vos RC(3).

Author information:
(1)Department of Public Health and Primary Care, Leiden University Medical 
Centre, Leiden, the Netherlands. Electronic address: s.e.van_grondelle@lumc.nl.
(2)Department of Public Health and Primary Care, Leiden University Medical 
Centre, Leiden, the Netherlands; Hadoks, The Hague, the Netherlands.
(3)Department of Public Health and Primary Care, Leiden University Medical 
Centre, Leiden, the Netherlands.
(4)Primary Care Research Group, Biomedical Research Institute of Murcia (IMIB), 
Murcia, Spain; Centro de Salud Casco Antiguo Cartagena, Murcia, Spain; Spanish 
Diabetes Association, Catholic University of Murcia, Servicio Murciano de Salud, 
Cartagena, Murcia, Spain.
(5)Diabetes Research Centre, University of Leicester, Leicester, UK.
(6)Julius Center for Health Sciences and Primary Care, University Medical Center 
Utrecht, the Netherlands.

AIMS: Covid-19 caused changes on the delivery of diabetes care. This study aimed 
to explore perceptions of healthcare providers across Europe concerning 1) the 
impact of covid-19 on delivery of diabetes care; 2) impact of changes in 
diabetes care on experienced workload; 3) experiences with video consultation in 
diabetes care.
METHODS: Cross-sectional survey among healthcare providers in the Netherlands, 
United Kingdom, Turkey, Ukraine and Sweden, with a focus on primary care.
RESULTS: The survey was completed by 180 healthcare providers. During the 
COVID-19 pandemic 57.1% of respondents provided less diabetes care and 72.8% 
observed a negative impact on people with diabetes. More than half of 
respondents (61.9%) expressed worries to some extent about getting overloaded by 
work. Although the vast majority considered their work meaningful (85.6%). 
Almost half of healthcare providers (49.4%) thought that after the pandemic 
video-consultation could be blended with face-to-face contact.
CONCLUSIONS: Less diabetes care was delivered and a negative impact on people 
with diabetes was observed by healthcare providers. Despite healthcare 
providers' feeling overloaded, mental wellbeing seemed unaffected. Video 
consultations were seen as having potential. Given the remaining covid-19 risks 
and from the interest of proactive management of people with diabetes, these 
findings urge for further exploration of incorporating video consultation in 
diabetes care.

Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.pcd.2023.02.002
PMCID: PMC9933343
PMID: 36822977 [Indexed for MEDLINE]

Conflict of interest statement: Van Grondelle SE (corresponding author): Author 
declares no competing interest. Van Bruggen S: Author declares no competing 
interest. Rauh SP: Author declares no competing interest. Van der Zwan M: Author 
declares no competing interest. Cebrian A: Author has the following financial 
relationships: advisor on scientific boards for Astra-Zeneca, Boehringer 
Ingelheim Pharmaceuticals Inc, Eli Lilly and Company, Merck Sharp & Dohme and 
Novo-Nordisk; lectures for Astra-Zeneca, Boehringer Ingelheim Pharmaceuticals 
Inc, Esteve, Janssen Pharmaceuticals, Eli Lilly and Company, Merck Sharp & 
Dohme, Mundipharma and Novo-Nordisk, and research activities for Astra-Zeneca, 
Merck Sharp & Dohme, Mundipharma, Novo-Nordisk and Eli Lilly and Company. No 
conflicts of interests regarding this article. Seidu S: Author reports personal 
fees from Amgen, AstraZeneca, Napp Pharmaceuticals, Eli Lilly, Merck Sharp & 
Dohme, Novartis, Novo Nordisk, Roche, Sanofi, and Boehringer Ingelheim. 
Additionally, SS reports grants from AstraZeneca, Sanofi, Servier, and Janssen. 
Rutten GEHM: Author declares no competing interest. Vos HMM: Author declares no 
competing interest. Numans ME: Author declares no competing interest. Vos RC: 
Author declares no competing interest.


969. BMJ Open. 2023 Feb 23;13(2):e064305. doi: 10.1136/bmjopen-2022-064305.

Use of mental health services in the aftermath of COVID-19 waves: a 
retrospective study conducted in a French Psychiatric and Neurosciences 
University Hospital.

Perozziello A(1), Sousa D(2), Aubriot B(3), Dauriac-Le Masson V(2).

Author information:
(1)Cellule épidémiologie, Groupe Hospitalier Universitaire Paris psychiatrie & 
neurosciences, Paris, France a.perozziello@ghu-paris.fr.
(2)Département d'Information Médicale, Groupe Hospitalier Universitaire Paris 
psychiatrie & neurosciences, Paris, France.
(3)DOMUS MEDICA, Groupe Hospitalier Universitaire Paris psychiatrie & 
neurosciences, Paris, France.

OBJECTIVE: The COVID-19 pandemic and the restrictive measures taken to prevent 
its propagation had profound effects on mental health and well-being, especially 
in children and young adults (<25 years old). This study aimed to analyse the 
medium and long-term impact of the COVID-19 pandemic on the use of the mental 
health services, by age groups and gender.
DESIGN: We conducted a retrospective study using the medical and administrative 
information system databases of patients, between 2019 and 2021.
SETTING: This study was conducted in the Groupe Hospitalier Universitaire Paris 
Psychiatry and Neurosciences.
OUTCOME MEASURES: We reported three indicators: the number of new patients 
attending outpatient clinics, the number of emergency department (ED) visits and 
the number of hospital admissions.
METHODS: We considered the weekly number of each indicator, by age groups and by 
gender. We also collected the reasons of ED visits and hospital admissions. The 
2020 and 2021 data were compared with the same period in 2019. The evolution of 
the indicators over the 3 years was analysed with interrupted time-series 
analysis.
RESULTS: All three indicators showed a dramatic decrease during the first 
lockdown period (March 2020) especially for the youngest. In 2021, the activity 
resumed but without reaching its prepandemic level. Moreover, mental healthcare 
seeking was significantly lower since the beginning of the pandemic compared 
with the prepandemic period for all age groups, except for young women (<25 
years old). Among them, there was a higher level of mental health services use 
in 2021, compared with 2019: +20% of new patients at the outpatient clinics, 
+39% of ED visits and+17% of hospital admissions.
CONCLUSIONS: The COVID-19 pandemic has had severe consequences on populations' 
mental health, especially among young women, which seem to persist months after 
the end of restrictive measures.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2022-064305
PMCID: PMC9950587
PMID: 36822810 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


970. Behav Neurol. 2023 Feb 9;2023:1094267. doi: 10.1155/2023/1094267. eCollection 
2023.

Systematic Review and Meta-Analysis of Clinically Relevant Executive Functions 
Tests Performance after COVID-19.

Velichkovsky BB(1)(2), Razvaliaeva AY(3), Khlebnikova AA(2), Manukyan PA(1)(2), 
Kasatkin VN(1), Barmin AV(4).

Author information:
(1)Research Institute for Brain Development and Peak Performance, Peoples' 
Friendship University of Russia, Moscow 117198, Russia.
(2)Lomonosov Moscow State University, Moscow 125009, Russia.
(3)Institute of Psychology, Russian Academy of Sciences, Moscow 129366, Russia.
(4)Cognitive Foundations of Communication Laboratory, Moscow State Linguistic 
University, Moscow 119034, Russia.

It is widely known that COVID-19 has a number of prolonged effects on general 
health, wellbeing, and cognitive functioning. However, studies using 
differentiated performance measures of cognitive functions are still not widely 
spread making it hard to assess the exact functions that get impaired. Taking 
into account the similarities between post-COVID 'brain fog' and chemofog, we 
hypothesized that executive functions (EF) would be impaired. Literature search 
yielded six studies with 14 effect sizes of interest; pooled effect size was 
small to medium (d = -0.35). Combined with a narrative synthesis of six studies 
without a comparison group, these results show that EF get impaired after 
COVID-19; although, in most cases the impairment is transient and does not seem 
to be severe. These results specify the picture of 'brain fog' and may help to 
discover its mechanisms and ways of helping people with long COVID.

Copyright © 2023 Boris B. Velichkovsky et al.

DOI: 10.1155/2023/1094267
PMCID: PMC9935808
PMID: 36815864 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declare(s) that they have no 
conflicts of interest.


971. J Spec Pediatr Nurs. 2023 Apr;28(2):e12403. doi: 10.1111/jspn.12403. Epub 2023 
Feb 23.

Adolescents with chronic conditions: Engagement with children's mental health 
systems during the Covid-19 pandemic.

Courtwright SE(1), Jones J(1), Barton A(1), Peterson K(1), Eigen K(2)(3), 
Feuerstein J(2)(3)(4), Pawa A(2)(5), Pawa A(2)(5), Northridge J(2)(4), Pall 
H(2)(5).

Author information:
(1)Office of Research and Scholarship, University of Colorado College of 
Nursing, Colorado, USA.
(2)Department of Pediatrics, Hackensack Meridian Health School of Medicine, 
Nutley, New Jersey, USA.
(3)Department of Emergency Medicine, Hackensack University Medical Center, 
Joseph M. Sanzari Children's Hospital, Hackensack, New Jersey, USA.
(4)Department of Adolescent Medicine, Hackensack University Medical Center, 
Joseph M. Sanzari Children's Hospital, Hackensack, New Jersey, USA.
(5)Department of Pediatrics, K. Hovnanian Children's Hospital, Jersey Shore 
University Medical Center, Hackensack, New Jersey, USA.

PURPOSE: The Covid-19 pandemic contributed to adverse adolescent mental health 
outcomes globally. Adolescents with chronic conditions have four times the odds 
of self-harm than peers. Little evidence exists to guide pediatric nurses on how 
to engage this vulnerable population with mental health support as the pandemic 
continues. In adults with chronic conditions, positive health assets (health 
access literacy, health self-efficacy, and emotional well-being) are directly 
related to improved patient engagement. The objective of this study was to gain 
a deeper understanding of engagement with mental health supports in adolescents 
with chronic conditions to inform practice.
DESIGN AND METHODS: Using mixed methods, we surveyed and interviewed adolescents 
with chronic conditions aged 10-20 years. Random sampling was applied to avoid 
bias. Valid and reliable scales were used to measure health access literacy, 
health self-efficacy, and emotional well-being. Textual data were collected 
using a semistructured interview guide. Integrated data analysis was conducted 
using structural equation models and interpretive phenomenology.
RESULTS: One hundred fifty-four participants provided numerical data and 17 
participants provided textual data (mean age 15.5 years; 56% female, 5.8% 
agender; 56% White; 16.9% Black or African American, 4.5% Asian; 51.9% Hispanic 
or Latinx; 23.4% LGBTQ+). The structural model was an acceptable fit for the 
data (comparative fit index [CFI] = 0.97, Tucker-Lewis index [TLI] = 0.95). 
Participants reported higher levels of health access literacy (M = 3.88, 
SD = 0.848) than health self-efficacy (M = 2.98, SD = 0.646), and engagement 
(M = 1.78, SD = 1.71). Health access literacy predicted emotional well-being 
(β = .33, p < .001, 95% confidence interval [CI] [.20, .50]) and health 
self-efficacy (β = .52, p < .001, 95% CI [0.42, .062]). Emotional well-being 
positively predicted health self-efficacy (β = .21, p < .003, 90% CI [0.10, 
0.033]). Health self-efficacy predicted engagement (β = .20, p < .01, 90% CI 
[0.07, 0.034]). Participants reported not engaging until "it was really, really 
bad" citing fear, stigma, and lack of connectedness with providers as barriers.
PRACTICE IMPLICATIONS: Regardless of health access literacy and health 
self-efficacy, adolescents with chronic conditions may not engage until crisis 
levels. Pediatric nurses can aim to engage with this vulnerable population 
proactively.

© 2023 Wiley Periodicals LLC.

DOI: 10.1111/jspn.12403
PMID: 36815596 [Indexed for MEDLINE]


972. BMC Nurs. 2023 Feb 23;22(1):48. doi: 10.1186/s12912-023-01213-z.

Post-traumatic growth in caregivers of children hospitalized in the PICU due to 
traffic accident: a qualitative study.

Ni ZH(#)(1), Lv HT(#)(2), Wu JH(2), Wang F(2).

Author information:
(1)Children's Hospital of Soochow University, No. 92, Zhong nan St, Suzhou, 
215025, China. nizhihong8888@163.com.
(2)Children's Hospital of Soochow University, No. 92, Zhong nan St, Suzhou, 
215025, China.
(#)Contributed equally

BACKGROUND: Globally, tens of millions of children are hospitalized every year 
for non-fatal traffic accident injuries, being confronted with an injured child 
can be extremely stressful for parents. Understandably, a significant level of 
psychological distress may ensue. Traumatic losses may lead parents to find new 
insights in life and develop a greater sense of spirituality and strength.
METHOD: Semi-structured interviews were conducted with caregivers of children 
who were hospitalized in the pediatric intensive care unit (PICU) with traffic 
accident injuries at children's hospitals in China between January and June 
2022. Caregivers were selected using a purposive sampling method until no new 
data were generated (n = 24).
RESULTS: We identified eleven sub-themes and four higher-order themes based on 
these sub-themes: (1) changes in their life philosophy, (2) personal strength 
enhancement, (3) relationship improvements, and (4) effective responses. The 
findings of our research contribute to a better understanding of the 
psychological status of the caregivers of children injured by traffic accidents.
CONCLUSION: Professionals should guide caregivers from a positive perspective, 
stimulate their strengths and potential, increase personnel support and 
communication, promote positive coping, formulate targeted management 
countermeasures to improve the PTG level of caregivers, and develop strategies 
to maintain stable mental health and well-being.

© 2023. The Author(s).

DOI: 10.1186/s12912-023-01213-z
PMCID: PMC9948375
PMID: 36814264

Conflict of interest statement: The authors declare no competing interests.


973. BMJ Open. 2023 Feb 22;13(2):e061531. doi: 10.1136/bmjopen-2022-061531.

General practitioner well-being during the COVID-19 pandemic: a qualitative 
interview study.

Jefferson L(1), Heathcote C(2), Bloor K(2).

Author information:
(1)Department of Health Sciences, University of York, York, North Yorkshire, UK 
laura.jefferson@york.ac.uk.
(2)Department of Health Sciences, University of York, York, North Yorkshire, UK.

OBJECTIVES: The COVID-19 pandemic presented new challenges for general 
practitioners' (GPs') mental health and well-being, with growing international 
evidence of its negative impact. While there has been a wide UK commentary on 
this topic, research evidence from a UK setting is lacking. This study sought to 
explore the lived experience of UK GPs during COVID-19, and the pandemic's 
impact on their psychological well-being.
DESIGN AND SETTING: In-depth qualitative interviews, conducted remotely by 
telephone or video call, with UK National Health Service GPs.
PARTICIPANTS: GPs were sampled purposively across three career stages (early 
career, established and late career or retired GPs) with variation in other key 
demographics. A comprehensive recruitment strategy used multiple channels. Data 
were analysed thematically using Framework Analysis.
RESULTS: We interviewed 40 GPs; most described generally negative sentiment and 
many displayed signs of psychological distress and burnout. Causes of stress and 
anxiety related to personal risk, workload, practice changes, public perceptions 
and leadership, team working and wider collaboration and personal challenges. 
GPs described potential facilitators of their well-being, including sources of 
support and plans to reduce clinical hours or change career path, and some 
described the pandemic as offering a catalyst for positive change.
CONCLUSIONS: A range of factors detrimentally affected the well-being of GPs 
during the pandemic and we highlight the potential impact of this on workforce 
retention and quality of care. As the pandemic progresses and general practice 
faces continued challenges, urgent policy measures are now needed.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2022-061531
PMCID: PMC9950583
PMID: 36813497 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


974. Curr Opin Psychol. 2023 Apr;50:101559. doi: 10.1016/j.copsyc.2023.101559. Epub 
2023 Jan 31.

Hope's relationship with resilience and mental health during the COVID-19 
pandemic.

Senger AR(1).

Author information:
(1)Department of Psychology, University of Houston, United States. Electronic 
address: asenger@uh.edu.

The COVID-19 pandemic has affected individuals financially, physically, and 
mentally during the past couple of years. Recent research has indicated that 
mental health concerns such as stress, anxiety, and depression have been on the 
rise due to the pandemic and its consequences. Fortunately, resilience factors 
such as hope have also been examined in the midst of the pandemic. Hope has been 
found to be a buffer against stress, anxiety, and depression over time during 
the COVID-19 pandemic. Hope has also been associated with positive outcomes such 
as posttraumatic growth and well-being. These results have been investigated in 
populations particularly affected by the pandemic such as healthcare 
professionals and patients with chronic illness and cross-culturally.

Copyright © 2023 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.copsyc.2023.101559
PMCID: PMC9886565
PMID: 36812769 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest statement Nothing declared.


975. Worldviews Evid Based Nurs. 2023 Apr;20(2):107-115. doi: 10.1111/wvn.12630. Epub 
2023 Feb 22.

An integrative review of factors and interventions affecting the well-being and 
safety of nurses during a global pandemic.

Boone LD(1), Rodgers MM(1), Baur A(1), Vitek E(1), Epstein C(1).

Author information:
(1)School of Nursing, University of North Carolina at Greensboro, Greensboro, 
NC, USA.

BACKGROUND: Nurses experienced physical and mental exhaustion during the 
COVID-19 pandemic. Understanding the impact of the pandemic on nurses and 
effective strategies to support them is critical for increasing nurse resilience 
and reducing burnout.
AIMS: The aims of this study were (1) to synthesize the literature examining how 
factors associated with the COVID-19 pandemic affected the well-being and safety 
of nurses (2) and to review interventions which may promote nurse mental health 
during crises.
METHODS: Using an integrative review approach, a comprehensive search of the 
literature was conducted in March 2022 using the following databases: PubMed, 
CINAHL, Scopus, and Cochrane. We included quantitative, qualitative, and 
mixed-method primary research articles published in English in peer-reviewed 
journals from March 2020 through February 2021. Included articles focused on 
nurses caring for COVID-19 patients and addressed psychological factors, 
supportive hospital leadership strategies, or interventions to support 
well-being. Studies were excluded if they focused on professions outside of 
nursing. Included articles were summarized and appraised for quality. Findings 
were synthesized using content analysis.
RESULTS: Of the 130 articles initially identified, 17 were included. Articles 
were quantitative (n = 11), qualitative (n = 5), and mixed methods (n = 1). 
Three themes were identified: (1) loss of life, hope, and professional identity; 
(2) lack of visible and supportive leadership; and (3) insufficient planning and 
response. These experiences contributed to increased symptoms of anxiety, 
stress, depression, and moral distress in nurses.

© 2023 The Authors. Worldviews on Evidence-based Nursing published by Wiley 
Periodicals LLC on behalf of Sigma Theta Tau International.

DOI: 10.1111/wvn.12630
PMID: 36811445 [Indexed for MEDLINE]


976. J Med Internet Res. 2023 Mar 16;25:e44965. doi: 10.2196/44965.

Emotional Distress During COVID-19 by Mental Health Conditions and Economic 
Vulnerability: Retrospective Analysis of Survey-Linked Twitter Data With a 
Semisupervised Machine Learning Algorithm.

Ueda M(1)(2), Watanabe K(3), Sueki H(4).

Author information:
(1)Department of Public Administration and International Affairs, The Maxwell 
School of Citizenship and Public Affairs, Syracuse University, Syracuse, NY, 
United States.
(2)Center for Policy Research, The Maxwell School of Citizenship and Public 
Affairs, Syracuse University, Syracuse, NY, United States.
(3)Waseda Institute for Advanced Study, Waseda University, Tokyo, Japan.
(4)Faculty of Human Sciences, Wako University, Tokyo, Japan.

Erratum in
    J Med Internet Res. 2023 Mar 27;25:e47549.

BACKGROUND: Monitoring the psychological conditions of social media users during 
rapidly developing public health crises, such as the COVID-19 pandemic, using 
their posts on social media has rapidly gained popularity as a relatively easy 
and cost-effective method. However, the characteristics of individuals who 
created these posts are largely unknown, making it difficult to identify groups 
of individuals most affected by such crises. In addition, large annotated data 
sets for mental health conditions are not easily available, and thus, supervised 
machine learning algorithms can be infeasible or too costly.
OBJECTIVE: This study proposes a machine learning framework for the real-time 
surveillance of mental health conditions that does not require extensive 
training data. Using survey-linked tweets, we tracked the level of emotional 
distress during the COVID-19 pandemic by the attributes and psychological 
conditions of social media users in Japan.
METHODS: We conducted online surveys of adults residing in Japan in May 2022 and 
collected their basic demographic information, socioeconomic status, and mental 
health conditions, along with their Twitter handles (N=2432). We computed 
emotional distress scores for all the tweets posted by the study participants 
between January 1, 2019, and May 30, 2022 (N=2,493,682) using a semisupervised 
algorithm called latent semantic scaling (LSS), with higher values indicating 
higher levels of emotional distress. After excluding users by age and other 
criteria, we examined 495,021 (19.85%) tweets generated by 560 (23.03%) 
individuals (age 18-49 years) in 2019 and 2020. We estimated fixed-effect 
regression models to examine their emotional distress levels in 2020 relative to 
the corresponding weeks in 2019 by the mental health conditions and 
characteristics of social media users.
RESULTS: The estimated level of emotional distress of our study participants 
increased in the week when school closure started (March 2020), and it peaked at 
the beginning of the state of emergency (estimated coefficient=0.219, 95% CI 
0.162-0.276) in early April 2020. Their level of emotional distress was 
unrelated to the number of COVID-19 cases. We found that the government-induced 
restrictions disproportionately affected the psychological conditions of 
vulnerable individuals, including those with low income, precarious employment, 
depressive symptoms, and suicidal ideation.
CONCLUSIONS: This study establishes a framework to implement near-real-time 
monitoring of the emotional distress level of social media users, highlighting a 
great potential to continuously monitor their well-being using survey-linked 
social media posts as a complement to administrative and large-scale survey 
data. Given its flexibility and adaptability, the proposed framework is easily 
extendable for other purposes, such as detecting suicidality among social media 
users, and can be used on streaming data for continuous measurement of the 
conditions and sentiment of any group of interest.

©Michiko Ueda, Kohei Watanabe, Hajime Sueki. Originally published in the Journal 
of Medical Internet Research (https://www.jmir.org), 16.03.2023.

DOI: 10.2196/44965
PMCID: PMC10022650
PMID: 36809798 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


977. Addict Behav. 2023 Jun;141:107660. doi: 10.1016/j.addbeh.2023.107660. Epub 2023 
Feb 12.

Moderating the impact of the COVID-19 pandemic on children's and adolescents' 
substance use, digital media use, and mental health: A randomized positive 
psychology addiction prevention program.

Kor A(1), Shoshani A(2).

Author information:
(1)Baruch Ivcher School of Psychology, Reichman University (IDC Herzliya), 
Israel; School of Medicine, Yale University, United States. Electronic address: 
arielk@ica.org.il.
(2)Baruch Ivcher School of Psychology, Reichman University (IDC Herzliya), 
Israel.

OBJECTIVE: Previous research suggests that well-being interventions are 
effective in moderating substance and digital media use and improving mental 
health. This study evaluated the feasibility and preliminary efficacy of a 
school-based Positive Psychology Addiction Prevention (PPAP) intervention aimed 
at reducing substance and digital media use and increasing the mental health of 
school children during the COVID-19 pandemic.
METHODS: The sample was composed of 1,670 children and adolescents (Mean 
age = 12.96, SD = 2.01) from six elementary and secondary schools in Israel who 
were randomly assigned to the PPAP intervention (n = 833) or the waiting-list 
control conditions (n = 837). A three-year longitudinal repeated-measures 
randomized control design was used to examine modifications in substance use, 
digital media use, and psychological symptoms in the intervention and control 
groups assessed on the pre-test (before the outbreak of COVID-19, September 
2019), the post-test (May 2021), and the 12-month follow-up (May 2022).
RESULTS: The 12-month prevalence of tobacco use, alcohol use, and cannabis use 
decreased significantly from the pre- to the follow-up period in the 
intervention group, and increased significantly in the control group. Daily 
digital media use increased during the pandemic period in both groups, with a 
significantly higher increase in the control group. The intervention group 
reported significantly lower psychological symptoms and negative emotions, and 
greater positive emotions and life satisfaction after the intervention and at 
follow-up compared to the control group.
CONCLUSIONS: The COVID-19 pandemic has profoundly disrupted the lives of 
children and adolescents. Well-being and addiction prevention interventions may 
be effective in improving the mental health of school children during pandemics 
and crisis periods.

Copyright © 2023 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.addbeh.2023.107660
PMCID: PMC9922204
PMID: 36809741 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


978. PLoS One. 2023 Feb 21;18(2):e0281833. doi: 10.1371/journal.pone.0281833. 
eCollection 2023.

The impact of higher levels of autistic traits on risk of hikikomori 
(pathological social withdrawal) in young adults.

Brosnan M(1), Gavin J(1).

Author information:
(1)Department of Psychology, Centre for Applied Autism Research, University of 
Bath, Bath, United Kingdom.

BACKGROUND: Hikikomori is an extreme state of social withdrawal, originally 
identified in Japan but more recently recognised internationally. Many countries 
imposed restrictions during the COVID-19 pandemic which may have had a 
detrimental impact on those at risk of hikikomori, specifically young adults and 
those with high levels of autistic traits.
AIMS: To explore whether levels of autistic traits mediate the relationship 
between psychological wellbeing and hikikomori risk. We also looked at whether 
autistic traits mediated between lockdown experiences (e.g. not leaving the 
house) and hikikomori risk.
METHODS: 646 young people (aged 16-24) from a wide range of countries completed 
an online questionnaire assessing psychological wellbeing, autistic traits and 
experiences of lockdown for this cross-sectional study.
RESULTS: Autistic traits mediated the relationship between both psychological 
wellbeing and hikikomori risk, as well as frequency of leaving the house during 
lockdown and hikikomori risk. Greater hikikomori risk was associated with poor 
psychological wellbeing, higher autistic traits and leaving the house less 
frequently during the COVID-19 pandemic.
CONCLUSIONS: These findings suggest similarities with Japanese hikikomori 
research and are consistent with suggestions that psychological wellbeing and 
COVID-19 restrictions are associated with increased hikikomori risk in young 
adults, and both associations are mediated by higher levels of autistic traits.

Copyright: © 2023 Brosnan, Gavin. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0281833
PMCID: PMC9942989
PMID: 36809281 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


979. Int J Ment Health Nurs. 2023 Aug;32(4):979-1007. doi: 10.1111/inm.13126. Epub 
2023 Feb 20.

Effectiveness of telehealth interventions on psychological outcomes and quality 
of life in community adults during the COVID-19 pandemic: A systematic review 
and meta-analysis.

Hao X(1), Qin Y(1), Lv M(1), Zhao X(1), Wu S(1), Li K(1).

Author information:
(1)School of Nursing, Jilin University, Changchun, China.

Physical distancing and contact restrictions have been implemented in most 
countries and territories due to the rapid spread of SARS-CoV-2. This has caused 
physical, emotional, and psychological distress for adults living in the 
community. Diversified telehealth interventions have been widely applied in 
health care and have proven to be cost-effective and well accepted by patients 
and health professionals. Currently, the effectiveness of telehealth 
interventions on psychological outcomes and quality of life among community 
adults during the COVID-19 pandemic remains unclear. A literature search was 
conducted using PubMed, PsycINFO, CINAHL, EMBASE, MEDLINE, and the Cochrane 
Library from 2019 to October 2022. Twenty-five randomized controlled trials with 
3228 subjects were finally included in this review. Two independent reviewers 
performed the screening, extraction of key data points, and appraisal of the 
methodological quality. There were positive effects of telehealth interventions 
on anxiety, stress, loneliness, and well-being among community adults. 
Participants who were women or older adults were more likely to recover from 
negative emotions, increase well-being, and improve quality of life. The 
real-time and interactive interventions and remote cognitive-behavioural therapy 
(CBT) may be better choices during the COVID-19 pandemic. Based on the findings 
of this review, health professionals have more options and alternatives for 
delivering telehealth interventions in the future. Rigorously designed 
randomized controlled trials (RCTs) with higher statistical power and long-term 
follow-up should be conducted in the future to strengthen the currently weak 
evidence.

© 2023 John Wiley & Sons Australia, Ltd.

DOI: 10.1111/inm.13126
PMID: 36808863 [Indexed for MEDLINE]


980. J Adv Nurs. 2023 Jul;79(7):2484-2501. doi: 10.1111/jan.15596. Epub 2023 Feb 21.

Factors contributing to nurse resignation during COVID-19: A qualitative 
descriptive study.

Jarden RJ(1)(2), Scott S(1), Rickard N(1), Long K(3), Burke S(1), Morrison M(1), 
Mills L(1), Barker E(1), Sharma K(1), Twomey B(1).

Author information:
(1)Austin Health, Heidelberg, Victoria, Australia.
(2)The University of Melbourne, Carlton, Victoria, Australia.
(3)The Royal Melbourne Hospital, Parkville, Melbourne, Australia.

AIMS: To explore and describe registered nurses' perceptions and experiences of 
work well-being extending from what inspired them to join the healthcare 
organization, what created a great day at work for them, through to what may 
have supported them to stay.
DESIGN: Qualitative descriptive study.
METHODS: Thirty-nine Australian nurses who resigned in 2021 from two 
metropolitan healthcare organizations in Victoria were interviewed in 2022, each 
for 30-60 min. The semi-structured interview transcripts were transcribed 
verbatim and analysed inductively and thematically.
RESULTS: Four themes were constructed for each of the key research questions. 
Inspiration to join the organizations transpired through organizational 
reputation, recruitment experiences, right position and right time, fit and 
feel. A great day at work was created through relationships with colleagues, 
experiences with managers, adequate resourcing and delivering quality care. 
Factors contributing to nurses resigning included COVID-19, uncertainty of role, 
workload and rostering, and finally, not feeling supported, respected and 
valued. Factors that may have supported the nurses to stay included flexible 
work patterns and opportunities, improved workplace relationships, workload 
management and support, and supportive systems and environments. Cutting across 
these themes were five threads: (1) relationships, (2) communication, (3) a 
desire to learn and develop, (4) work-life balance and (5) providing quality 
patient care.
CONCLUSIONS: Novel ways of working and supporting individuals, teams and 
organizations are needed to maintain and sustain nurses. The nurses' 
inspiration, what created a great day at work, and support needed to stay 
highlighted the importance of workplace initiatives to build nursing career 
pathways, provide equitable opportunities for professional development, workload 
and roster flexibility and implement professional relationship-enhancing actions 
to foster authentic civility.
IMPACT: This study contributes an in-depth exploration of the perceptions and 
experiences of nurses who resigned from two healthcare organizations and 
provides a description of (1) what inspired these nurses to initially join the 
organization, (2) what they perceived created a great day at work for them, (3) 
the factors contributing to their resignation and (4) what may have supported 
them to stay. The reasons nurses resign from an organization were identified as 
complex and multi-factorial, with opportunities for promoting nursing career 
pathways, addressing equity in opportunities and implementing professional 
relationship-enhancing actions. These contributions add both context and 
opportunity to strengthen organizational initiatives to attract, sustain and 
retain nurses.

© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons 
Ltd.

DOI: 10.1111/jan.15596
PMID: 36805610 [Indexed for MEDLINE]


981. BMC Psychol. 2023 Feb 17;11(1):48. doi: 10.1186/s40359-023-01058-w.

Rasch validation of the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) in 
community-dwelling adults.

Deng W(1), Carpentier S(1), Blackwood J(1), Van de Winckel A(2).

Author information:
(1)Division of Rehabilitation Science, Department of Rehabilitation Medicine, 
Medical School, University of Minnesota, Minneapolis, MN, USA.
(2)Division of Physical Therapy, Division of Rehabilitation Science, Department 
of Rehabilitation Medicine, Medical School, University of Minnesota, 420 
Delaware St SE (MMC 388), Rm 311, Minneapolis, MN, 55455, USA. avandewi@umn.edu.

BACKGROUND: With the ongoing global COVID-19 pandemic and the recent political 
divide in the United States (US), there is an urgent need to address the soaring 
mental well-being problems and promote positive well-being. The 
Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) measures the positive aspects 
of mental health. Previous studies confirmed its construct validity, 
reliability, and unidimensionality with confirmatory factor analysis. Six 
studies have performed a Rasch analysis on the WEMWBS, and only one evaluated 
young adults in the US. The goal of our study is to use Rasch analysis to 
validate the WEMBS in a wider age group of community-dwelling adults in the US.
METHODS: We used the Rasch unidimensional measurement model 2030 software to 
evaluate item and person fit, targeting, person separation reliability (PSR), 
and differential item functioning (DIF) for sample sizes of at least 200 persons 
in each subgroup.
RESULTS: After deleting two items, the WEMBS analyzed in our 553 
community-dwelling adults (average age 51.22 ± 17.18 years; 358 women) showed an 
excellent PSR = 0.91 as well as person and item fit, but the items are too easy 
for this population (person mean location = 2.17 ± 2.00). There was no DIF for 
sex, mental health, or practicing breathing exercises.
CONCLUSIONS: The WEMWBS had good item and person fit but the targeting is off 
when used in community-dwelling adults in the US. Adding more difficult items 
might improve the targeting and capture a broader range of positive mental 
well-being.

© 2023. The Author(s).

DOI: 10.1186/s40359-023-01058-w
PMCID: PMC9936469
PMID: 36803574 [Indexed for MEDLINE]

Conflict of interest statement: There is no financial competing interest in this 
study.


982. Dementia (London). 2023 May;22(4):783-806. doi: 10.1177/14713012231159156. Epub 
2023 Feb 20.

The digitalisation of finance management skills in dementia since the COVID-19 
pandemic: A qualitative study.

Giebel C(1), Halpin K(2), Tottie J(3), O'Connell L(1), Carton J(2).

Author information:
(1)Department of Primary Care and Mental Health, 4591University of Liverpool, 
Liverpool, UK; NIHR Applied Research Collaboration North West Coast, Liverpool, 
UK.
(2)NIHR Applied Research Collaboration North West Coast, Liverpool, UK.
(3)TIDE (Together In Dementia Everyday), Liverpool, UK.

OBJECTIVES: Engaging with finances has become increasingly digitalised in recent 
years, particularly since the COVID-19 pandemic, yet it is unknown how finance 
management has been affected in people living with dementia. The aim of this 
qualitative study was therefore to explore how digitalisation and the recent 
pandemic have affected finance management skills in people with dementia.
METHODS: Semi-structured interviews were conducted remotely with people with 
dementia and unpaid carers living in the UK via phone or Zoom between February 
and May 2022. Transcripts were coded by one of four different research team 
members, including two unpaid carers who were public advisers on the project. 
Data were analysed using inductive thematic analysis.
RESULTS: Thirty carers and people with dementia participated, and five 
overarching themes were identified. Managing finances has been both simplified 
and made more complicated by digitalising how money is spent and managed, with 
people with dementia and unpaid carers reporting advantages of using direct 
debits and debit cards, as well as digital illiteracy barriers for older 
relatives with dementia. Unpaid carers have received no support in managing 
their relative's finances, and were found to be burdened by the additional 
caring duties.
CONCLUSIONS: Carers need to be supported in managing their relative's finances 
as well as with their general well-being due to taking on additional caring 
duties. Digital systems for finance management need to be user-friendly for 
people with cognitive impairment, with a need for digital literacy training for 
middle-aged and older adults to avoid difficulties if they develop dementia, and 
improved access to a computer/tablet/smart phone.

DOI: 10.1177/14713012231159156
PMCID: PMC9944462
PMID: 36803284 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


983. Rural Remote Health. 2023 Jan;23(1):8142. doi: 10.22605/RRH8142. Epub 2023 Jan 
10.

Preliminary findings from the early phases of the Music and Movement for Health 
study: the feasibility of an arts-based health programme for older adults.

Clifford A(1), Byrne S(2), Ni Bhriain O(3), Cheung PS(4), Sheikhi A(5), Woods 
C(6), O'Neill D(7), Gowran R(8), Glynn L(9), Moss H(10), Louw Q(11), Thebane 
L(12), Coote S(13), Salsberg J(14).

Author information:
(1)University of Limerick, Castletroy, Limerick, Ireland amanda.clifford@ul.ie.
(2)University of Limerick, Castletroy, Limerick, Ireland steven.byrne@ul.ie.
(3)University of Limerick, Castletroy, Limerick, Ireland 
orfhlaith.nibhriain@ul.ie.
(4)University of Limerick, Castletroy, Limerick, Ireland puisze.cheung@ul.ie.
(5)University of Limerick, Castletroy, Limerick, Ireland ali.sheikhi@ul.ie.
(6)University of Limerick, Castletroy, Limerick, Ireland catherine.woods@ul.ie.
(7)Trinity College Dublin, Dublin, Ireland des.oneill@tcd.ie.
(8)University of Limerick, Castletroy, Limerick, Ireland rosie.gowran@ul.ie.
(9)University of Limerick, Castletroy, Limerick, Ireland liam.glynn@ul.ie.
(10)University of Limerick, Castletroy, Limerick, Ireland hilary.moss@ul.ie.
(11)Stellenbosch University, Stellenbosch, South Africa qalouw@sun.ac.za.
(12)Institute for Research on Aging, McMaster University, Hamilton, ON, Canada 
thabanl@mcmaster.ca.
(13)University of Limerick, Castletroy, Limerick, Ireland susan.coote@ul.ie.
(14)University of Limerick, Castletroy, Limerick, Ireland jon.salsberg@ul.ie.

Introduction (including aim): There is a lack of community-based programmes for 
older adults in Ireland. Such activities are vital to enable older people to 
(re)connect after COVID-19 measures, which had a detrimental effect on physical 
function, mental health and socialisation. The aims of the preliminary phases of 
the Music and Movement for Health study were to refine stakeholder informed 
eligibility criteria, recruitment pathways and obtain preliminary measures for 
feasibility of the study design and programme, which incorporates research 
evidence, practice expertise and participant involvement.
METHODS: Two Transparent Expert Consultations (TECs) (EHSREC No: 
2021_09_12_EHS), and Patient and Public Involvement (PPI) meetings were 
conducted to refine eligibility criteria and recruitment pathways. Participants 
from three geographical regions in the mid-west of Ireland will be recruited and 
randomised by cluster to participate in either a 12-week Music and Movement for 
Health programme or control. We will assess the feasibility and success of these 
recruitment strategies by reporting recruitment rates, retention rates and 
participation in the programme.
RESULTS: Both the TECs and PPIs provided stakeholder-informed specification on 
inclusion/ exclusion criteria and recruitment pathways. This feedback was vital 
in strengthening our community-based approach as well as effecting change at the 
local level. The success of these strategies from phase 1 (March-June) are 
pending.
DISCUSSION: Through engaging with relevant stakeholders, this research aims to 
strengthen community systems by embedding feasible, enjoyable, sustainable and 
cost-effective programmes for older adults to support community connection and 
enhance health and wellbeing. This will, in turn, reduce demands on the 
healthcare system.Note: We would like to thank and acknowledge those who 
participated in the PPIs for their time and invaluable feedback.

DOI: 10.22605/RRH8142
PMID: 36802717 [Indexed for MEDLINE]


984. Rural Remote Health. 2023 Jan;23(1):8162. doi: 10.22605/RRH8162. Epub 2023 Jan 
10.

Reducing rural isolation through music: telehealth music therapy for community 
dwelling people living with dementia and their family caregivers in rural 
Ireland.

Kelly L(1), Richardson I(2), Moss H(3).

Author information:
(1)University Of Limerick, Castletroy, Limerick, Ireland; Health Research 
Institute (HRI), University of Limerick, Castletroy, Limerick, Ireland; Lero - 
The Science Foundation Ireland Research Centre for Software, University of 
Limerick, Castletroy, Limerick, Ireland; and Ageing Research Centre, University 
of Limerick, Castletroy, Limerick, Ireland lisa.kelly@ul.ie.
(2)University Of Limerick, Castletroy, Limerick, Ireland; Health Research 
Institute (HRI), University of Limerick, Castletroy, Limerick, Ireland; Lero - 
The Science Foundation Ireland Research Centre for Software, University of 
Limerick, Castletroy, Limerick, Ireland; and Ageing Research Centre, University 
of Limerick, Castletroy, Limerick, Ireland ita.richardson@ul.ie.
(3)University Of Limerick, Castletroy, Limerick, Ireland; Health Research 
Institute (HRI), University of Limerick, Castletroy, Limerick, Ireland; and 
Ageing Research Centre, University of Limerick, Castletroy, Limerick, Ireland 
hilary.moss@ul.ie.

INTRODUCTION: Since the outset of COVID-19, we have become more reliant on 
technology to stay connected to others. Notable benefits of telehealth have been 
observed, including increased access to health and community support services 
for community dwelling people living with dementia and their family caregivers 
and diminishing barriers such as geographical location, mobility issues and 
increased cognitive decline. Music therapy is an evidence-based intervention for 
people living with dementia and has been proven to promote improved quality of 
life, increase social interaction and provide a form of meaningful communication 
and expression when language becomes difficult. This project is one of the first 
internationally to pilot telehealth music therapy for this population.
METHODS: This mixed methods action research project has six iterative phases of 
planning, research, action, evaluation, and monitoring. Public and Patient 
Involvement (PPI) has been sought from members of The Dementia Research Advisory 
Team at the Alzheimer Society of Ireland at all stages of the research process 
to ensure the research remains relevant and applicable to those with dementia. 
The presentation will briefly outline the phases of the project.
RESULTS: Preliminary results from this ongoing research suggest that there is 
feasibility for telehealth music therapy to provide psychosocial support to this 
population. Collaboration with PPI contributors resulted in the following 
research priorities: (1) ensuring a person-centered approach; (2) advanced care 
planning using music; and (3) the signposting of music related supports for 
community dwelling people living with dementia. Music therapy is being piloted 
currently and preliminary results will be outlined.
DISCUSSION: Telehealth music therapy has the potential to complement existing 
rural health and community services for people living with dementia, in 
particular addressing social isolation. Recommendations regarding the relevance 
of cultural and leisure pursuits on health and well-being of people living with 
dementia will be discussed, particularly the development of online access.

DOI: 10.22605/RRH8162
PMID: 36802704 [Indexed for MEDLINE]


985. Acad Psychiatry. 2023 Aug;47(4):385-389. doi: 10.1007/s40596-023-01754-0. Epub 
2023 Feb 16.

Using Project ECHO to Keep Professionals Well at Work: Individual and 
Organizational Outcomes.

Sprang G(1), Gusler S(2), LaJoie S(3), Eslinger J(2), Smith E(2).

Author information:
(1)University of Kentucky, Lexington, KY, USA. sprang@uky.edu.
(2)University of Kentucky, Lexington, KY, USA.
(3)University of Louisville, Louisville, KY, USA.

OBJECTIVE: The toll of COVID-19 stress on the mental health of the workforce has 
been well-documented. The present study examined the use of the Project ECHO 
framework to provide practices and resources on stress management and emotion 
regulation to increase individual and organizational health and well-being.
METHODS: Three independent ECHOs were designed and conducted over an 18-month 
period. Data was collected on the implementation of new learning and comparisons 
of organizational efforts toward being more secondary trauma responsive from 
baseline to post initiative, using cloud-based survey methods.
RESULTS: Findings suggest that the use of micro-interventions at the 
organizational level improved over time in the areas of resilience-building and 
policy-making, and that individuals were actively integrating skills related to 
managing their stress.
CONCLUSIONS: Lessons learned adapting and implementing ECHO strategies in the 
midst of a pandemic are offered, as well as how to cultivate wellness champions 
in the workforce.

© 2023. The Author(s), under exclusive licence to American Association of Chairs 
of Departments of Psychiatry, American Association of Directors of Psychiatric 
Residency Training, Association for Academic Psychiatry and Association of 
Directors of Medical Student Education in Psychiatry.

DOI: 10.1007/s40596-023-01754-0
PMCID: PMC9933790
PMID: 36795276 [Indexed for MEDLINE]

Conflict of interest statement: On behalf of all authors, the corresponding 
author states that there is no conflict of interest.


986. Jt Comm J Qual Patient Saf. 2023 Apr;49(4):207-212. doi: 
10.1016/j.jcjq.2023.01.008. Epub 2023 Jan 25.

CHaMP: A Model for Building a Center to Support Health Care Worker Well-Being 
After Experiencing an Adverse Event.

McIntosh MS, Garvan C, Kalynych CJ, Fallucco EM, Ventura AB, Chesire DJ.

BACKGROUND: With an already distressed health care workforce demonstrating high 
levels of burnout, depression, and suicide, access to behavioral health care, 
particularly after an adverse event, is critical. Unfortunately, clinicians 
identify multiple barriers to seeking behavioral support. In 2022 the National 
Academy of Medicine, in its National Plan for Health Workforce Well-Being, 
established "Support Mental Health and Reduce Stigma" as one of its seven 
priority areas.
FRAMEWORK: The authors developed a program called CHaMP (Center for Healthy 
Minds and Practice) guided by a multidisciplinary task force that developed the 
vision, plan, and algorithms to improve crisis response; build a peer support 
program; and remove barriers to accessing mental health care by establishing an 
on-campus behavioral health support center. This program was implemented using 
Kotter's 8-step Model of Change.
RESULTS: Within the first months of establishing this program, the support team 
responded to multiple activations of the crisis response plan, built a peer 
support program, and provided counseling services to 631 employees. During the 
COVID-19 pandemic, CHaMP played a central role in the support of all employees.
CONCLUSION: This program and its implementation based on Kotter's 8-Step Model 
of Change was a powerful and practical methodology to design and implement 
interventions to address system and individual factors that affect clinician 
well-being and resilience after an adverse event.

Copyright © 2023 The Joint Commission. Published by Elsevier Inc. All rights 
reserved.

DOI: 10.1016/j.jcjq.2023.01.008
PMID: 36792407 [Indexed for MEDLINE]


987. Eur Neuropsychopharmacol. 2023 Apr;69:79-83. doi: 
10.1016/j.euroneuro.2023.01.008. Epub 2023 Feb 2.

Initial response to the COVID-19 pandemic on real-life well-being, social 
contact and roaming behavior in patients with schizophrenia, major depression 
and healthy controls: A longitudinal ecological momentary assessment study.

Benedyk A(1), Moldavski A(1), Reichert M(2), Reinhard I(3), Lohr S(4), Schwarz 
K(1), Berhe O(1), Höflich A(1), Lautenbach S(5), von der Goltz C(6), 
Ebner-Priemer U(7), Zipf A(5), Tost H(1), Meyer-Lindenberg A(8).

Author information:
(1)Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central 
Institute of Mental Health, University of Heidelberg, J5, Mannheim, 
Baden-Wuerttemberg 68159, Germany.
(2)Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central 
Institute of Mental Health, University of Heidelberg, J5, Mannheim, 
Baden-Wuerttemberg 68159, Germany; Department of eHealth and Sports Analytics, 
Faculty of Sport Science, Ruhr University Bochum, Bochum, Germany; Mental 
mHealth Lab, Department of Applied Psychology, Institute of Sports and Sports 
Science, Karlsruhe Institute of Technology, Karlsruhe, Baden-Wuerttemberg, 
Germany.
(3)Department of Biostatistics, Medical Faculty Mannheim, Central Institute of 
Mental Health, University of Heidelberg, Mannheim, Baden-Wuerttemberg, Germany.
(4)Department of GIScience, Institute of Geography, University of Heidelberg, 
Heidelberg, Baden-Wuerttemberg, Germany.
(5)Department of GIScience, Institute of Geography, University of Heidelberg, 
Heidelberg, Baden-Wuerttemberg, Germany; HeiGIT (Heidelberg Institute for 
Geoinformation Technology) at Heidelberg University, Germany.
(6)H.Lundbeck A/S, Copenhagen, Denmark.
(7)Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central 
Institute of Mental Health, University of Heidelberg, J5, Mannheim, 
Baden-Wuerttemberg 68159, Germany; Mental mHealth Lab, Department of Applied 
Psychology, Institute of Sports and Sports Science, Karlsruhe Institute of 
Technology, Karlsruhe, Baden-Wuerttemberg, Germany.
(8)Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central 
Institute of Mental Health, University of Heidelberg, J5, Mannheim, 
Baden-Wuerttemberg 68159, Germany. Electronic address: 
Meyer-Lindenberg@zi-mannheim.de.

The COVID-19 pandemic strongly impacted people's daily lives. However, it 
remains unknown how the pandemic situation affects daily-life experiences of 
individuals with preexisting severe mental illnesses (SMI). In this real-life 
longitudinal study, the acute onset of the COVID-19 pandemic in Germany did not 
cause the already low everyday well-being of patients with schizophrenia (SZ) or 
major depression (MDD) to decrease further. On the contrary, healthy 
participants' well-being, anxiety, social isolation, and mobility worsened, 
especially in healthy individuals at risk for mental disorder, but remained 
above the levels seen in patients. Despite being stressful for healthy 
individuals at risk for mental disorder, the COVID-19 pandemic had little 
additional influence on daily-life well-being in psychiatric patients with SMI. 
This highlights the need for preventive action and targeted support of this 
vulnerable population.

Copyright © 2023. Published by Elsevier B.V.

DOI: 10.1016/j.euroneuro.2023.01.008
PMCID: PMC9892325
PMID: 36791492 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest AM-L has 
received consultant fees from Agence Nationale de la Recherche, Brainsway, CISSN 
(Catania International Summer School of Neuroscience), Daimler und Benz 
Stiftung, EPFL Brain Mind Institute, Fondation FondaMental, Hector Stiftung II, 
Janssen-Cilag GmbH, Lundbeck A/S, Lundbeckfonden, Lundbeck Int. Neuroscience 
Foundation, MedinCell, Sage Therapeutics, Techspert.io, The LOOP Zürich, 
University Medical Center Utrecht, von Behring Röntgen Stiftung; speaker fees 
from Ärztekammer Nordrhein, BAG Psychiatrie Oberbayern, Biotest AG, Forum 
Werkstatt Karlsruhe, International Society of Psychiatric Genetics, Brentwood, 
Klinik für Psychiatrie und Psychotherapie Ingolstadt, Lundbeck SAS France, med 
Update GmbH, Merz-Stiftung, Siemens Healthineers, Society of Biological 
Psychiatry and editorial and/or author fees from American Association for the 
Advancement of Science, ECNP, Thieme Verlag. UE-P reports consultancy for 
Boehringer-Ingelheim. The other authors report no biomedical financial interests 
or potential conflicts of interest.


988. Med Lav. 2023 Feb 14;114(1):e2023009. doi: 10.23749/mdl.v114i1.13918.

Psychometric Evaluation of GHQ-12 as a Screening Tool for Psychological 
Impairment of Healthcare Workers Facing COVID-19 Pandemic.

Comotti A(1), Fattori A(2), Greselin F(3), Bordini L(4), Brambilla P(5), Bonzini 
M(6).

Author information:
(1)Occupational Health Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore 
Policlinico, Milan, Italy. anna.comotti@policlinico.mi.it.
(2)Department of Clinical Science and Community Health, University of Milan, 
Milan, Italy. alice.fattori@unimi.it.
(3)Department of Statistics and Quantitative Methods, University of Milan 
Bicocca, Milan, Italy. francesca.greselin@unimib.it.
(4)Occupational Health Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore 
Policlinico, Milan, Italy. lorenzo.bordini@policlinico.mi.it.
(5)Department of Pathophysiology and Transplantation, University of Milan, 
Milan, Italy and Department of Neurosciences and Mental Health, Foundation IRCCS 
Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 
paolobrambilla.ter@gmail.com.
(6)Occupational Health Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore 
Policlinico, Milan, Italy and Department of Clinical Science and Community 
Health, University of Milan, Milan, Italy. matteo.bonzini@unimi.it.

BACKGROUND: The General Health Questionnaire (GHQ) is a widely used tool, both 
in clinical and research settings, due to its brevity and easy administration. 
Researchers often adopt a dichotomous measurement method, considering a total 
score above or below a certain threshold. This leads to an extreme 
simplification of the gathered data and therefore to the loss of clinical 
details. In a multi-step evaluation study aimed at assessing health care 
workers' mental health during the Covid-19 pandemic, GHQ-12 proved to be the 
most effective tool to detect psychological distress compared to other scales 
adopted. These results led to deepen the understanding of GHQ-12 properties 
through a statistical study by focusing on items' properties and 
characteristics.
METHODS: GHQ-12 responses were analyzed using Item Response Theory (IRT), a 
suitable method for scale assessment. Instead of considering the single overall 
score, in which each item accounts equally, it focuses on individual items' 
characteristics. Moreover, IRT models were applied combined with the latent 
class (LC) analysis, aiming to the determination of subgroups of individuals 
according to their level of psychological distress.
RESULTS: GHQ-12 was administered to 990 health-care workers and responses were 
scored using the binary method (0-0-1-1). We applied the two-parameter logistic 
(2-PL) model, finding that the items showed different ways of responses and 
features. The latent class analysis classified subjects into three sub-groups 
according to their responses to GHQ-12 only: 47% of individuals with general 
well-being, 38% expressing signs of discomfort without severity and 15% of 
subjects with a high level of impairment. This result almost reproduces 
subjects' classification obtained after administering the six questionnaires of 
the study protocol.
CONCLUSIONS: Accurate statistical techniques and a deep understanding of the 
latent factors underlying the GHQ-12 resulted in a more effective usage of such 
psychometric questionnaire - i.e. a more refined gathering of data and a 
significant time and resource efficiency. We underlined the need to maximize the 
extraction of data from questionnaires and the necessity of them being less 
lengthy and repetitive.

DOI: 10.23749/mdl.v114i1.13918
PMCID: PMC9987474
PMID: 36790406 [Indexed for MEDLINE]


989. BMC Psychol. 2023 Feb 14;11(1):45. doi: 10.1186/s40359-023-01082-w.

The role of resilience in the relationship between role stress and psychological 
well-being during the COVID-19 pandemic: a cross-sectional study.

Padmanabhanunni A(1)(2), Pretorius TB(3), Khamisa N(4).

Author information:
(1)Department of Psychology, University of the Western Cape, Bellville, South 
Africa. apadmana@uwc.ac.za.
(2)University of the Western Cape, Private Bag X17, 7535, Bellville, Republic of 
South Africa. apadmana@uwc.ac.za.
(3)Department of Psychology, University of the Western Cape, Bellville, South 
Africa.
(4)School of Public Health, University of the Witwatersrand, Johannesburg, South 
Africa.

BACKGROUND: Stress resistance resources, such as social support and resilience, 
have been found to be important in promoting psychological well-being during the 
COVID-19 pandemic. However, most prior research studies have conceptualized 
stress resistance resource variables as having a mediating or moderating role. 
Cooper (2018) proposed a model of the relationship between stress and health 
which posits that coping resources are always present and not only invoked in 
the face of adversity. Thus, we hypothesize that coping resources are causally 
antecedent to stressors and influence well-being indirectly via the stressor. We 
focused specifically on school teachers due to them being at the frontlines of 
service provision during the pandemic. Teaching was already identified as a 
highly stressful profession prior to COVID-19 and disease containment measures 
placed additional strain on teachers who had to adapt to emergency remote 
teaching.
AIM: The current study tests this hypothesis by examining the indirect effects 
of resilience on indices of psychological health via role stress.
METHODS: Participants (N = 355) were teachers who completed the Connor-Davidson 
Resilience Scale-10, the Role Stress Scale, the Satisfaction with Life Scale, 
the State-Trait Anxiety Inventory-Trait Scale, and the Center for 
Epidemiological Studies Depression Scale. An electronic version of the 
questionnaires was distributed to teachers via Facebook and to officials from 
the Department of Education, who assisted with distribution of the electronic 
link to the survey. Participants were mostly women (76.6%) and mean number of 
years in the teaching profession was 15.7.
RESULTS: Structural equation modelling results demonstrated significant direct 
effects of resilience on life satisfaction, anxiety, and depression, which 
indicates that resilience is beneficial for psychological health even in the 
absence of stress. Resilience also had a significant indirect effect on indices 
of psychological well-being via role ambiguity but not role conflict.
CONCLUSION: These findings have theoretical implications for the understanding 
of the role of resilience in promoting psychological health among educators. 
Practical implications include an empirical contribution to education policy and 
information that can inform interventions aimed to promote resilience among 
educators.

© 2023. The Author(s).

DOI: 10.1186/s40359-023-01082-w
PMCID: PMC9928139
PMID: 36788622 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


990. BMC Public Health. 2023 Feb 14;23(1):327. doi: 10.1186/s12889-023-15215-8.

Generalized anxiety disorder among rural primary and middle school students 
during the outbreak of COVID-19: a multicenter study in three southern Chinese 
cities.

Yang Z(#)(1)(2), Zhang Y(#)(3), Xu H(#)(3), Gan M(#)(3), Ma J(3), Liu J(3), Tan 
X(3), Hou W(3), Ye W(4), Li L(5)(6).

Author information:
(1)School of Public Health, Shantou University, Shantou, Guangdong Province, 
China.
(2)Injury Prevention Research Center, Shantou University Medical College, 
Shantou, Guangdong Province, China.
(3)Shantou University Medical College, Shantou, Guangdong, China.
(4)Cancer Hospital of Shantou University Medical College, Shantou, Guangdong 
Province, China.
(5)School of Public Health, Shantou University, Shantou, Guangdong Province, 
China. lpli@stu.edu.cn.
(6)Injury Prevention Research Center, Shantou University Medical College, 
Shantou, Guangdong Province, China. lpli@stu.edu.cn.
(#)Contributed equally

BACKGROUND: The major public health crisis caused by the rapid spread of the 
coronavirus disease 2019 (COVID-19) and the large-scale public health measures 
such as social isolation and school closures enforced by some countries have 
severely affected on the physical and mental wellbeing of children and 
adolescents globally. This study aimed to estimate the prevalence of the 
psychological impact and investigate the similarities and differences in the 
influential factors for generalized anxiety disorder among rural adolescents as 
a relatively lesser noticed population the outbreak of COVID-19.
METHODS: From May 11 to 22, 2020, a total of 1,179 adolescents, including Grade 
5-6 in primary school and Grade 7-8 in middle school, were selected by 
multistage sampling in three Southern Chinese cities (Shantou, Guangdong 
Province; Hezhou, Guangxi Province; Nanchong, Sichuan Province), and completed 
the questionnaires including sociodemographic, generalized anxiety disorder, 
academic stress, coronaphobia, knowledge of COVID-19, and precautionary 
measures. ANOVA, Chi-square test, Kruskalwallis H test and multivariate linear 
regression were performed in the statistical analysis.
RESULTS: The average scores of generalized anxiety disorder during the past two 
weeks were 3.43 (SD 4.46), 4.47 (SD 5.15), and 4.10 (SD 4.94) in Shantou, Hezhou 
and Nanchong, respectively. For the pooled data, academic stress (P < 0.001), 
coronaphobia (P < 0.001), and precautionary measures (P = 0.002) contributed to 
the prediction of anxiety scores. Academic stress was significantly associated 
to anxiety symptoms in all cities (P all < 0.001). Coronaphobia was also 
significantly associated to anxiety symptoms in all cities (P all < 0.001).
CONCLUSION: This study highlights the urgent need for researchers and 
policymakers to focus on the mental health of rural children and adolescents 
during the COVID-19 epidemic. The adolescents with academic stress and 
coronaphobia, the greater the risk that adolescents will suffer from anxiety, 
suggesting mental health counseling and professional family support are needed.

© 2023. The Author(s).

DOI: 10.1186/s12889-023-15215-8
PMCID: PMC9926433
PMID: 36788498 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


991. J Appl Res Intellect Disabil. 2023 May;36(3):507-515. doi: 10.1111/jar.13073. 
Epub 2023 Feb 14.

Moral distress in carers for people with an intellectual disability who died 
during the COVID-19 pandemic, a template analysis extending the Barlem and Ramos 
model of moral distress.

Kelly K(1), Margaret H(1), McCarron M(1), McCallion P(2), Burke E(1), Wormald 
AD(1).

Author information:
(1)School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.
(2)School of Social Work, Temple University, Albany, New York, USA.

BACKGROUND: This article aims to understand moral distress in carers of people 
with an intellectual disability during the COVID-19 pandemic.
METHOD: Nine staff carers of seven people with an intellectual disability, who 
had been participants of the IDS-TILDA study in Ireland, who died during the 
COVID-19 pandemic participated in in-depth, semi-structured telephone 
interviews. Template analysis was used to analyze the interviews.
RESULTS: Obstructions in performing their duties left carers feeling powerless 
and experiencing moral conflict distress, moral constraint distress and moral 
uncertainty distress. Most managed to connect to the moral dimension in their 
work through peer support, understanding they fulfilled the wishes of the 
deceased, and/or thinking about how they or others did the best they could for 
the person they were caring for.
CONCLUSIONS: This research demonstrates that while restrictions may have been 
effective in reducing the spread of COVID-19, they were potentially damaging to 
carer wellbeing.

© 2023 The Authors. Journal of Applied Research in Intellectual Disabilities 
published by John Wiley & Sons Ltd.

DOI: 10.1111/jar.13073
PMID: 36787919 [Indexed for MEDLINE]


992. Int J Occup Med Environ Health. 2023 Mar 2;36(1):139-150. doi: 
10.13075/ijomeh.1896.01944. Epub 2023 Feb 14.

Working conditions during the COVID-19 pandemic in primary and tertiary 
healthcare: a comparative cross-sectional study.

Aulanko I(1)(2)(3), Sanmark E(1)(4), Oksanen L(1)(2)(4), Oksanen S(5), 
Lahdentausta L(1)(6), Kivimäki A(6), Paju S(6), Pietiäinen M(6), Pussinen P(6), 
Geneid A(1)(4).

Author information:
(1)Helsinki University Hospital, Helsinki, Finland (COVID19VATEHY Research 
Group, Head and Neck Center).
(2)University of Helsinki, Helsinki, Finland (Doctoral Programme in Clinical 
Research).
(3)Joint Municipal Authority for Social and Healthcare in Central Uusimaa 
(Keusote), Hyvinkää, Finland.
(4)Helsinki University Hospital and University of Helsinki, Finland (Department 
of Otorhinolaryngology and Phoniatrics - Head and Neck Surgery).
(5)Aalto University, Helsinki, Finland (School of Business).
(6)Helsinki University Hospital and University of Helsinki, Helsinki, Finland 
(Department of Oral and Maxillofacial Diseases).

OBJECTIVES: The COVID-19 pandemic has globally affected healthcare workers' 
(HCWs) health and wellbeing. Most studies on COVID-19 have focused on tertiary 
healthcare. The aim of this study was to increase the knowledge on the effects 
of the pandemic on working conditions in tertiary and primary healthcare.
MATERIAL AND METHODS: The comparative cross-sectional study consisted of an 
online questionnaire sent to HCWs of the City of Helsinki (primary healthcare) 
and Helsinki University Hospital (tertiary healthcare). Altogether 1580 HCWs 
with direct patient contact participated in the study: 895 from tertiary and 685 
from primary healthcare. Statistical analysis used SPSS 25 from IBM. The tests 
used were the χ2 test, Fisher's exact test, and binary logistic regression 
analysis.
RESULTS: Primary HCWs were less likely to treat COVID-19 patients (OR = 0.45, 
95% CI: 0.37-0.56). However, both groups reported a similar number of COVID-19 
infections, primary HCWs 4.9% and tertiary HCWs 5.0%, and workrelated quarantine 
was significantly more prevalent (OR = 1.96, 95% CI: 1.38-2.79) among primary 
HCWs. In addition, work-related wellbeing was poorer among primary HCWs than 
tertiary HCWs in terms of feeling more stressed at work (OR = 3.20, 95% CI: 
2.55-4.02), not recovering from work (OR = 0.49, 95% CI: 0.39-0.62), reported 
mental wellbeing below normal levels (OR: 1.59, 95% CI: 1.26-2.00), and 
increased working hours (OR = 1.63, 95% CI: 1.25-2.12).
CONCLUSIONS: The study demonstrates how the pandemic has affected the wellbeing 
and working conditions of not only tertiary but also less studied primary HCWs. 
The authors' findings suggest that the challenges identified during the COVID-19 
pandemic in the health and wellbeing of healthcare workers are even greater in 
primary care than in tertiary care. Int J Occup Med Environ Health. 
2023;36(1):139-50.

This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL 
license.

DOI: 10.13075/ijomeh.1896.01944
PMCID: PMC10464802
PMID: 36786712 [Indexed for MEDLINE]


993. Ir J Psychol Med. 2023 Sep;40(3):402-410. doi: 10.1017/ipm.2023.1. Epub 2023 Feb 
14.

Wellbeing and mental health outcomes amongst hospital healthcare workers during 
COVID-19.

Lowry D(1), Hevey D(2), Wilson C(2), O' Doherty V(3), O' Sullivan S(4), Finnerty 
C(1)(2), Pender N(5), D'Alton P(6), Mulhern S(1).

Author information:
(1)Department of Psychology, Mater Misericordiae University Hospital, Dublin 7, 
Ireland.
(2)School of Psychology, Trinity College Dublin, Dublin 2, Ireland.
(3)Department of Psychology, Tallaght University Hospital, Dublin 24, Ireland.
(4)Department of Psychological Medicine, St James's Hospital, Dublin 8, Ireland.
(5)Department of Psychology, Beaumont University Hospital, Dublin 3, Ireland.
(6)Department of Psychology, St Vincent's University Hospital, Dublin 4, 
Ireland.

BACKGROUND: Global healthcare systems have been particularly impacted by the 
COVID-19 pandemic. Healthcare workers (HCWs) are widely reported to have 
experienced increased levels of baseline psychological distress relative to the 
general population, and the COVID-19 pandemic may have had an additive effect. 
However, previous studies are typically restricted to physicians and nurses with 
limited data available on hospital HCWs. We aimed to conduct a cross-sectional, 
psychological evaluation of Irish HCWs during COVID-19.
METHODS: HCWs across five adult acute level-4 Dublin-based hospitals completed 
an online survey of wellbeing and COVID-19 experience.
RESULTS: There were 1898 HCWs who commenced the survey representing 10% of the 
total employee base. The sample comprised nurses (33%), doctors (21%), Health 
and Social Care Professionals (HSCPs) (24%) and 'Other' disciplines (22%), and 
81% identified as female. Clinical levels of depression, anxiety and PTSD 
symptoms were endorsed by 31%, 34% and 28% of respondents, respectively. 
Professional grouping effects included: nurses reporting significantly greater 
levels of COVID-19 exposure, infection, COVID-fear, moral injury, and 
post-traumatic distress; HSCPs were significantly less likely to report mood 
dysfunction. In terms of gender, males were significantly less likely to report 
negative pandemic experiences, low resilience, and significantly more likely to 
endorse 'minimal' depression, anxiety, and traumatic distress. Logistic 
regression modelling revealed mental health outcomes (depression, anxiety and 
PTSD symptoms) were associated with increased frontline exposure, fewer career 
years' experience, elevated pre-pandemic stress, and female gender.
DISCUSSION: To our knowledge, this is the largest evaluation of psychological 
wellbeing amongst HCWs in acute hospitals in the Dublin region. Our findings 
have implications for healthcare workforce wellbeing and future service 
delivery.

DOI: 10.1017/ipm.2023.1
PMID: 36782404 [Indexed for MEDLINE]


994. BMC Public Health. 2023 Feb 13;23(1):319. doi: 10.1186/s12889-023-15249-y.

Stronger together: Coping behaviours and mental health changes of Canadian 
adolescents in early phases of the COVID-19 pandemic.

Riazi NA(1), Battista K(2), Duncan MJ(3), Wade TJ(3), Pickett W(3), Ferro MA(2), 
Leatherdale ST(2), Patte KA(3).

Author information:
(1)Department of Health Sciences, Brock University, 1812 Sir Isaac Brock Way, 
Saint Catharines, ON, L2S 3A1, Canada. nriazi@brocku.ca.
(2)School of Public Health Sciences, University of Waterloo, 200 University Ave 
West, Waterloo, ON, N2L 3G1, Canada.
(3)Department of Health Sciences, Brock University, 1812 Sir Isaac Brock Way, 
Saint Catharines, ON, L2S 3A1, Canada.

BACKGROUND: The impact of the COVID-19 pandemic and consequent public health 
restrictions on the mental health of adolescents is of global concern. The 
purpose of this study was to examine how Canadian adolescents coped during the 
early pandemic and whether different coping methods were associated with changes 
in mental health from before the pandemic to the early lockdown response.
METHODS: Using two-year linked survey data (2018-2020) from a prospective cohort 
of secondary school students (n = 3,577), linear regression models were used to 
examine whether changes in mental health (anxiety [Generalized Anxiety 
Disorder-7 scale], depression [Center for Epidemiologic Studies Depression 
10-item scale Revised], emotion regulation [Difficulties in Emotion Regulation 
Scale], psychosocial well-being [Flourishing scale]) were related to each coping 
behaviour.
RESULTS: The most common reported coping behaviours included staying connected 
with friends online (78.8%), playing video games, watching TV/movies, and/or 
surfing the internet/social media (76.2%), studying or working on schoolwork 
(71.0%), and getting exercise (65.2%). The use of positive coping mechanisms 
during the early pandemic period (e.g., keeping a regular schedule, time with 
family, time with friends online) was associated with less adverse mental health 
changes from before to during the early lockdown; whereas, negative coping 
mechanisms (e.g., spending time alone, eating junk food) were consistently 
associated with more adverse mental health changes.
CONCLUSION: This study demonstrates the importance of social support and 
connections with both friends and family, as well as keeping and maintaining a 
routine, over the pandemic. Interventions supporting positive relationships and 
engagement in these coping behaviours may be protective for adolescent mental 
health during disruptive events.

© 2023. The Author(s).

DOI: 10.1186/s12889-023-15249-y
PMCID: PMC9924880
PMID: 36782178 [Indexed for MEDLINE]

Conflict of interest statement: None to declare.


995. Drug Alcohol Depend. 2023 Mar 1;244:109802. doi: 
10.1016/j.drugalcdep.2023.109802. Epub 2023 Feb 9.

Temporal association of pre-pandemic perceived social support with psychological 
resilience and mental well-being during the COVID-19 pandemic among people with 
a history of injection drug use.

Patel EU(1), Astemborski J(1), Feder KA(2), Rudolph JE(1), Winiker A(3), 
Sosnowski DW(2), Kirk GD(1), Mehta SH(1), Genberg BL(4).

Author information:
(1)Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins 
University, Baltimore, MD, USA.
(2)Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins 
University, Baltimore, MD, USA.
(3)Department of Health, Behavior, and Society, Bloomberg School of Public 
Health, Johns Hopkins University, Baltimore, MD, USA.
(4)Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins 
University, Baltimore, MD, USA. Electronic address: bgenberg@jhu.edu.

BACKGROUND: There are limited data on whether modifiable social factors foster 
psychological resilience and mental well-being among people who use drugs 
following Big Events. We examined the temporal association of pre-pandemic 
perceived social support with psychological resilience and negative mental 
health symptoms during the COVID-19 pandemic among people with a history of 
injection drug use.
METHODS: Between June and September 2020, we conducted a telephone survey among 
545 participants in the AIDS Linked to the IntraVenous Experience (ALIVE) study: 
a community-based cohort of adults with a history of injection drug use. 
Leveraging data from study visits in 2018-early 2020, associations of 
pre-pandemic perceived social support with psychological resilience scores 
(range=1-5) and the probability of negative mental health symptoms during the 
pandemic were assessed using multivariable linear and modified Poisson 
regression models, respectively.
RESULTS: Participants' median age was 58 years, 38.2% were female, 83.3% 
identified as Black, and 30.3% were living with HIV. During the pandemic, 14.5% 
had low (<3) resilience scores, 36.1% experienced anxiety, and 35.8% reported 
increased loneliness. Compared to participants in the lowest tertile of 
pre-pandemic social support, participants in the highest tertile had higher mean 
resilience scores (β = 0.27 [95% CI = 0.12, 0.43]), a lower probability of 
anxiety (prevalence ratio [PR] = 0.71 [95% CI = 0.52, 0.96]), and a lower 
probability of increased loneliness (PR = 0.62 [95% CI = 0.45, 0.84]).
CONCLUSIONS: Pre-pandemic perceived social support was associated with greater 
psychological resilience and generally better mental well-being during the 
pandemic. Interventions that improve social support may foster psychological 
resilience and protect the mental well-being of people who use drugs, especially 
during periods of social disruption.

Copyright © 2023 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.drugalcdep.2023.109802
PMCID: PMC9908589
PMID: 36774804 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest statement None.


996. Sci Total Environ. 2023 May 1;871:162129. doi: 10.1016/j.scitotenv.2023.162129. 
Epub 2023 Feb 10.

Work accidents, climate change and COVID-19.

Santurtún A(1), Shaman J(2).

Author information:
(1)Unit of Legal Medicine, Department of Physiology and Pharmacology, University 
of Cantabria, IDIVAL, Santander, Spain. Electronic address: 
ana.santurtun@unican.es.
(2)Department of Environmental Health Sciences, Mailman School of Public Health, 
Columbia University, New York, NY, USA; Columbia Climate School, Columbia 
University, New York, NY, USA.

The effects brought by climate change and the pandemic upon worker health and 
wellbeing are varied and necessitate the identification and implementation of 
improved strategic interventions. This review aims, firstly, to assess how 
climate change affects occupational accidents, focusing on the impacts of 
extreme air temperatures and natural disasters; and, secondly, to analyze the 
role of the pandemic in this context. Our results show that the manifestations 
of climate change affect workers physically while on the job, psychologically, 
and by modifying the work environment and conditions; all these factors can 
cause stress, in turn increasing the risk of suffering a work accident. There is 
no consensus on the impact of the COVID-19 pandemic on work accidents; however, 
an increase in adverse mental effects on workers in contact with the public 
(specifically in healthcare) has been described. It has also been shown that 
this strain affects the risk of suffering an accident. During the pandemic, many 
people began to work remotely, and what initially appeared to be a provisional 
situation has been made permanent or semi-permanent in some positions and 
companies. However, we found no studies evaluating the working conditions of 
those who telework. In relation to the combined impact of climate change and the 
pandemic on occupational health, only publications focusing on the synergistic 
effect of heat due to the obligation to wear COVID-19-specific PPE, either 
outdoors or in poorly acclimatized indoor environments, were found. It is 
essential that preventive services establish new measures, train workers, and 
determine new priorities for adapting working conditions to these altered 
circumstances.

Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.scitotenv.2023.162129
PMCID: PMC9911145
PMID: 36773906 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare the following financial interests/personal relationships which may be 
considered as potential competing interests: Jeffrey Shaman reports a 
relationship with SK Analytics that includes: equity or stocks. Jeffrey Shaman 
discloses consulting for BNI.


997. Radiography (Lond). 2023 Mar;29(2):379-384. doi: 10.1016/j.radi.2023.01.018. 
Epub 2023 Feb 2.

Supporting radiography clinical placements in Ireland during the COVID-19 
pandemic: The practice educators perspective.

O'Connor M(1), Lunney A(2), Potocnik J(2), Kearney D(2), Grehan J(2).

Author information:
(1)Radiography and Diagnostic Imaging, School of Medicine, University College 
Dublin, Dublin Ireland. Electronic address: michelle.oconnor@ucd.ie.
(2)Radiography and Diagnostic Imaging, School of Medicine, University College 
Dublin, Dublin Ireland.

INTRODUCTION: The COVID-19 pandemic has significantly impacted healthcare 
services and the clinical learning environment. Several studies have 
investigated radiography students' experiences of clinical placement during the 
pandemic; however, few have investigated the Clinical Practice Educator's (CPEs) 
perspective. CPEs play a pivotal role in supporting clinical education.
METHOD: A qualitative study was conducted using a purposeful sample of 
twenty-two CPEs, each working in a different Irish hospital. Four 
semi-structured focus groups were used to gather data. To maintain reasonable 
homogeneity, CPEs who were new to the role (n = 8) were assigned a separate 
focus group from experienced CPEs (n = 14). Inductive thematic analysis was 
applied.
RESULTS: CPEs experienced role expansion, particularly in managerial and 
administrative aspects of the role. They described arranging COVID-19 
vaccinations locally for radiography students and the complexities of student 
rostering during the pandemic. CPEs perceived the pandemic to have impacted 
students' emotional wellbeing with 'high anxiety levels' and 'loneliness' being 
reported. They also perceived issues with clinical readiness and the student 
transition to clinical practice. Many challenges were faced by CPEs including 
arranging clinical recovery time for numerous students when sites were already 
at full capacity, fewer learning opportunities due to decreased patient 
throughput and range of imaging examinations, social distancing constraints, 
resistance from staff to student placements, and a shortage of staff for student 
supervision. Flexibility, communication, and multi-level support helped CPEs to 
fulfil their role.
CONCLUSION: The results provide insight into how CPEs supported radiography 
clinical placements during the pandemic and into the challenges faced by CPEs in 
their role. CPEs supported student placement through multi-level communication, 
teamwork, flexibility, and student advocacy.
IMPLICATIONS FOR PRACTICE: This will aid understanding of the support mechanisms 
needed by CPEs to provide quality clinical placements.

Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.radi.2023.01.018
PMCID: PMC9892332
PMID: 36773465 [Indexed for MEDLINE]


998. Int J Environ Res Public Health. 2023 Feb 3;20(3):2734. doi: 
10.3390/ijerph20032734.

Validation of the Recovery Experience Questionnaire in a Lithuanian Healthcare 
Personnel.

Kazlauskas E(1), Dumarkaite A(1), Gelezelyte O(1), Nomeikaite A(1), Zelviene 
P(1).

Author information:
(1)Center for Psychotraumatology, Institute of Psychology, Vilnius University, 
LT-01513 Vilnius, Lithuania.

Healthcare workers (HCWs) often experience high levels of stress, anxiety, and 
depression due to high workloads and responsibilities in their professional 
activities. Therefore, recovery from work-related stress is highly important in 
HCWs. The Recovery Experience Questionnaire (REQ) is a 16-item self-reported 
measure covering four stress recovery domains: psychological detachment from 
work, relaxation, mastery, and control. The current study aimed to test the 
REQ's psychometric properties in a sample of Lithuanian HCWs. In total, 471 HCWs 
from various healthcare institutions participated in this study. Confirmatory 
factor analysis (CFA) was used to test the structure of the REQ. We also used 
the Brief Patient Health Questionnaire (PHQ-4) and the World Health Organization 
Psychological Well-Being Index (WHO-5) to assess the mental health of the study 
participants. The CFA analysis supported the correlated four-factor structure of 
the REQ. Furthermore, we found significant correlations between the levels of 
REQ and anxiety, depression, and well-being. We conclude that the REQ is a valid 
measure that could be a useful tool in research on HCWs' mental health. It could 
also be used in healthcare settings for the evaluation of well-being among 
healthcare staff.

DOI: 10.3390/ijerph20032734
PMCID: PMC9915394
PMID: 36768099 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


999. Int J Environ Res Public Health. 2023 Feb 3;20(3):2725. doi: 
10.3390/ijerph20032725.

Older Worker-Orientated Human Resource Practices, Wellbeing and Leave 
Intentions: A Conservation of Resources Approach for Ageing Workforces.

Farr-Wharton B(1), Bentley T(2), Onnis LA(3), Caponecchia C(4), Neto AA(5), 
O'Neill S(6), Andrew C(7).

Author information:
(1)School of Business and Law, Edith Cowan University, Perth, WA 6027, 
Australia.
(2)Centre for Work + Wellbeing, Edith Cowan University, Perth, WA 6027, 
Australia.
(3)College of Business, Law & Governance, James Cook University, Cairns, QLD 
4870, Australia.
(4)School of Aviation, University of NSW, Sydney, NSW 2052, Australia.
(5)Centre for Work Health and Safety, NSW Government, Sydney, NSW 2000, 
Australia.
(6)School of Business, University of NSW, Canberra, ACT 2612, Australia.
(7)School of Health and Society, University of Wollongong, Wollongong, NSW 2500, 
Australia.

At a time where there are ageing populations, global shortages of skilled 
labour, and migration pathways impacted by the COVID-19 pandemic, retaining 
older workers presents as a vital strategic initiative for organizations 
globally. This study examines the role of Human Resource Practices (HRPs), which 
are oriented towards accommodating the needs of an ageing workforce in 
mitigating psychological distress and turnover intentions. The study collected 
self-reported survey data from 300 Australian employees over the age of 45, over 
two time points. Using structural equation modelling, the study analyzed the 
extent to which Older Worker-oriented Human Resources Practices (OW-HRPs) 
translate into employee psychological health and retention within organizations, 
through the mediation of ageism and work-life conflict. The results support our 
hypothesis that OW-HRPs are associated with lower ageism, better work-life 
balance; and in combination these reduce psychological distress and help retain 
older workers in the workforce. We conclude that OW-HRPs can foster work 
environments conducive to older worker wellbeing, supporting the retention of 
talent and maintaining effectiveness, in the face of substantial labour supply 
challenges brought on by the COVID-19 pandemic and an ageing population.

DOI: 10.3390/ijerph20032725
PMCID: PMC9915352
PMID: 36768090 [Indexed for MEDLINE]

Conflict of interest statement: The authors (B.F.-W., T.B., L.-a.O., C.C., S.O. 
and C.A.) declare no conflict of interest. Author A.D.A.N. declares that he is 
employed by the funding body and had a role in the design of the study; research 
discussions and reviewed the final manuscript but did not participate in the 
collection, analyses or interpretation of data. As such co-author A.D.A.N.’s 
position with the funder did not influence the final results reported for this 
study.


1000. Int J Environ Res Public Health. 2023 Feb 3;20(3):2724. doi: 
10.3390/ijerph20032724.

Beneficial Effects of an Online Mindfulness-Based Intervention on Sleep Quality 
in Italian Poor Sleepers during the COVID-19 Pandemic: A Randomized Trial.

Fazia T(1), Bubbico F(1), Nova A(1), Bruno S(2), Iozzi D(1), Calgan B(1), Caimi 
G(1), Terzaghi M(1)(3), Manni R(3), Bernardinelli L(1).

Author information:
(1)Department of Brain and Behavioral Sciences, University of Pavia, 27100 
Pavia, Italy.
(2)Istituto di Psicosintesi, 20124 Milano, Italy.
(3)Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, 27100 Pavia, 
Italy.

Sleep of inadequate quantity and quality is increasing in the present 24 h 
society, with a negative impact on physical and mental health. Mindfulness-based 
interventions (MBIs) generate a state of calm behavior that can reduce 
hyperactivity and improve sleep. We hypothesized that our specific MBI, 
administered online, may improve sleep quality and foster emotion regulation and 
mindfulness. The Pittsburgh Sleep Quality Index (PSQI), Sleep Condition 
Indicator (SCI), Arousal Predisposition Scale (APS), Ford Insomnia Response to 
Stress Test (FIRST), Sleep Hygiene Index (SHI) and Insomnia Severity Index (ISI) 
were used to measure sleep quality and stability. Emotion regulation and 
mindfulness were measured via the Emotion Regulation Questionnaire (ERQ) and 
Five Facet Mindfulness Questionnaire (FFMQ). Our MBI included 12 biweekly 
integral meditation (IM) classes, recorded IM training for individual practice, 
and dietary advice to promote sleep regulation. Fifty-six voluntary poor 
sleepers with a PSQI score of >5 were randomly allocated to treated (n = 28) and 
control (n = 28) groups. Linear mixed models were used to estimate the 
effectiveness of the intervention. Statistically significant results were 
observed in the FFMQ sub-domain non-reactivity to inner experience (β = 0.29 
[0.06; -0.52], p = 0.01), PSQI (β = -1.93 [-3.43; -0.43], p = 0.01), SCI (β = 
3.39 [0.66; 6.13], p = 0.02) and ISI (β = -3.50 [-5.86; -1.14], p = 0.004). 
These results confirm our hypothesis regarding the beneficial effects of our 
intervention on sleep quality.

DOI: 10.3390/ijerph20032724
PMCID: PMC9914977
PMID: 36768089 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1001. Int J Environ Res Public Health. 2023 Feb 2;20(3):2674. doi: 
10.3390/ijerph20032674.

Increased Substance Use among Nurses during the COVID-19 Pandemic.

Arble E(1), Manning D(1), Arnetz BB(2), Arnetz JE(2).

Author information:
(1)Department of Psychology, Eastern Michigan University, Ypsilanti, MI 48197, 
USA.
(2)Department of Family Medicine, College of Human Medicine, Michigan State 
University, Grand Rapids, MI 49503, USA.

There is growing evidence that the COVID-19 pandemic has had a severe impact on 
the nursing profession worldwide. Occupational strain has disrupted nurses' 
emotional wellbeing and may have led to negative coping behaviors, such as 
increased substance use, which could impair cognitive functioning. The aim of 
this study was to examine whether increased substance use in a sample of U.S. 
nurses during the pandemic was related to greater workplace cognitive failure. 
An online questionnaire was administered in May 2020 to Michigan nurses 
statewide via three nursing organizations (n = 695 respondents). A path model 
was used to test the direct effects of reported increased substance use on 
workplace cognitive failure and via parallel psychological mediators. The model 
had excellent fit to the observed data, with statistically significant, unique 
mediating effects of greater symptoms of anxiety (b = 0.236, z = 2.22, p = 
0.027), posttraumatic stress disorder (b = 0.507, z = 4.62, p < 0.001) and 
secondary trauma (b = 1.10, z = 2.82, p = 0.005). Importantly, the direct effect 
of increased substance use on workplace cognitive failure was not statistically 
significant independent of the mediators (b = 0.133, z = 0.56, p = 0.576; 95% 
confidence interval: -0.33, 0.60). These results point to the importance of 
further delineating the mechanistic pathways linking adverse stress to workplace 
cognitive failure. As we emerge from the pandemic, healthcare systems should 
focus resources on supporting cognitive health by addressing the psychological 
and emotional welfare of nurses, many of whom may be struggling with residual 
trauma and increased substance use.

DOI: 10.3390/ijerph20032674
PMCID: PMC9915151
PMID: 36768040 [Indexed for MEDLINE]

Conflict of interest statement: The work-related exhaustion scale is part of the 
QWC survey instrument that is owned and marketed by the Swedish company 
Springlife AB. Bengt Arnetz is the co-founder and co-owner of this company.


1002. Int J Environ Res Public Health. 2023 Jan 31;20(3):2562. doi: 
10.3390/ijerph20032562.

Applying a Goal-Directed Behavior Model to Determine Risk Perception of COVID-19 
and War on Potential Travelers' Behavioral Intentions.

Kim T(1), Ha J(2).

Author information:
(1)Department of Hotel & Restaurant Management, Kyonggi University, Seoul 03746, 
Republic of Korea.
(2)Department of Tourism Event Management, Kyonggi University, Seoul 03746, 
Republic of Korea.

The purpose of this study is to verify the influence of the relationship between 
risk perception of COVID-19 and the war-applied Model of Goal-directed Behavior 
(MGB) based on stimulus-organism-response (SOR) and potential travelers' 
behavioral intention. In addition, this study attempted to verify the 
relationship among uncertainty toward international travel, mental well-being 
toward international travel, and desire toward travelers' behavioral intention. 
Moreover, we examined the moderating effect of gender (female vs. male) among 
all variables for dependents. The survey was conducted on potential travelers in 
Korea. As for the survey period, a survey was conducted for one month beginning 
on 2 September 2022. Of the total 413 surveys, 361 surveys were used for the 
final analysis, and 52 unfaithful surveys were excluded. In addition, 
demographic, CFA, correlation analysis, structural equation modeling, and 
moderation effect analysis were verified using SPSS and AMOS. For the data 
analysis, we used SPSS 18.0 and Amos 20.0 to perform factor analysis and SEM. 
Significant effects were found in support for Hypotheses 1-5. Further, when it 
comes to the difference of gender on the relationship between all the variables, 
while no significant effect was found for Hypotheses 6a,c,e,g, a significant 
effect was found for Hypotheses 6b,d,f. Thus, H6a,c,e were rejected and H6b,d,f 
were supported. It was found that females had a greater influence on mental 
health and desire for overseas travel than males, but it was found that there 
was no difference between females and males in the relationship between desire 
and behavioral intention. Therefore, it was possible to verify that the MGB 
desire is an important psychological variable for both females and males. 
Furthermore, these findings offer academic practical implications to travel and 
tourism companies by presenting basic data based on the results of empirical 
research analysis in the context of the current dangerous situation.

DOI: 10.3390/ijerph20032562
PMCID: PMC9915888
PMID: 36767924 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1003. Int J Environ Res Public Health. 2023 Jan 31;20(3):2515. doi: 
10.3390/ijerph20032515.

'With a Little Help from My Friends': Emotional Intelligence, Social Support, 
and Distress during the COVID-19 Outbreak.

Kornas-Biela D(1), Martynowska K(1), Zysberg L(2).

Author information:
(1)Institute of Pedagogy, The John Paul Catholic University of Lublin, 20-950 
Lublin, Poland.
(2)The Graduate School, Gordon College of Education, Haifa 3465415, Israel.

The COVID-19 pandemic presented a global existential social and health 
challenge, with individuals suffering mentally and psychologically. College and 
university students are young adults, typically away from their natural support 
systems; with pandemic-imposed measures such as isolation, they may have been at 
higher risk of experiencing negative psychological outcomes. The study tested a 
model in which social support mediated the association between emotional 
intelligence (EI) and a latent factor representing general mental distress at 
the height of the COVID-19 crisis in Poland. One hundred and fifty-nine young 
adults filled in measures of trait EI, psychological and instrumental social 
support, three distress measures (depression, anxiety, and stress), and 
demographics. The results supported a model in which psychological social 
support (but not instrumental social support) mediated the association between 
trait EI and a factor representing all three distress measures. The results shed 
light on how individual and social resources work together to help maintain 
psychological integrity in times of crisis. They add to recent results on the 
differential effects of psychological-emotional and instrumental social support 
on distress and well-being.

DOI: 10.3390/ijerph20032515
PMCID: PMC9915446
PMID: 36767886 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflict of interest re this 
manuscript.


1004. Int J Environ Res Public Health. 2023 Jan 31;20(3):2504. doi: 
10.3390/ijerph20032504.

Coping as a Mediator and Moderator between Psychological Distress and Disordered 
Eating Behaviors and Weight Changes during the COVID-19 Pandemic.

Machado BC(1), Moreira CS(2), Correia M(3), Veiga E(1), Gonçalves S(4).

Author information:
(1)CEDH-Research Centre for Human Development, Faculdade de Educação e 
Psicologia, Universidade Católica Portuguesa, 4169-005 Porto, Portugal.
(2)Centre of Mathematics & Faculty of Sciences, University of Porto (CMUP & 
FCUP), 4169-007 Porto, Portugal.
(3)Escola Superior de Biotecnologia, Universidade Católica Portuguesa, 4169-005 
Porto, Portugal.
(4)School of Psychology, University of Minho, 4710-057 Braga, Portugal.

Previous research has already shown the negative impact of the COVID-19 pandemic 
on college students' well-being and mental health. Eating problems and weight 
gain due to changes in eating habits and physical activity experienced during 
this period have also been noticed. However, few studies have explored the role 
of students' resources as used during the COVID-19 pandemic, such as coping 
strategies. This study aimed to (1) explore the associations among psychological 
distress, disordered eating, coping strategies, and weight changes; (2) examine 
the moderating role of coping strategies in the process of weight gain and 
weight loss; and (3) study the mediating role of coping strategies in the 
process of weight gain and weight loss. The participants in this study were 772 
students at a Portuguese university. The data collected included 
sociodemographic data and three self-reported questionnaires (Depression, 
Anxiety, and Stress Scale; Eating Disorder Examination Questionnaire; Brief 
COPE) during the first few months of the pandemic, which included a 72-day full 
national lockdown. The results showed that depression, anxiety, stress, and 
disordered eating were related to increased weight. Guilt, denial, 
self-distraction, use of substances, and behavior disinvestment were also 
related to increased weight. Behavioral disinvestment had a strong mediating 
effect on weight gain. Additionally, planning, positive reframing, and 
acceptance all showed a moderating effect between psychological distress and 
weight changes. In conclusion, coping strategies allow for a better 
understanding of the mechanisms by which psychological distress and disordered 
eating were related to weight changes during the pandemic.

DOI: 10.3390/ijerph20032504
PMCID: PMC9915561
PMID: 36767871 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1005. Int J Environ Res Public Health. 2023 Jan 31;20(3):2498. doi: 
10.3390/ijerph20032498.

Learner Experience of an Online Co-Learning Model to Support Mental Health 
during the COVID-19 Pandemic: A Qualitative Study.

Briand C(1)(2), Hakin R(1), Macario de Medeiros J(1), Luconi F(3), Vachon 
B(1)(4), Drolet MJ(2), Boivin A(5), Vallée C(6)(7), Montminy S(1).

Author information:
(1)Research Center, Montreal University Institute of Mental Health, Montreal, QC 
H1N 3M5, Canada.
(2)Department of Occupational Therapy, University of Quebec at Trois-Rivières, 
Trois-Rivières, QC G8Z 4M3, Canada.
(3)Office for Continuing Professional Development, Faculty of Medicine and 
Health Sciences, McGill University, Montreal, QC H3G 2M1, Canada.
(4)School of Rehabilitation, Faculty of Medecine, University of Montreal, 
Montreal, QC H3N 1X7, Canada.
(5)Department of Family Medicine, Research Centre of University of Montreal 
Hospital Center, Montreal, QC H2X 0A9, Canada.
(6)Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec 
City, QC G1V 0A6, Canada.
(7)VITAM Research Centre on Sustainable Health, Laval University, Quebec City, 
QC G1V 0A6, Canada.

The COVID-19 pandemic has had a negative impact on the mental health of the 
population such as increased levels of anxiety, psychological distress, 
isolation, etc. Access to mental health services has been limited due to the 
"overflow" of demands. The Recovery College (RC) model, an education-based 
approach, has addressed this challenge and provided online well-being and mental 
health courses to at-risk populations. The RC model proposes a co-learning space 
in an adult education program where learners from diverse backgrounds 
collectively learn and empower themselves to better address psychological 
well-being and mental health issues. The aim of this study was to document the 
experience of learners who participated in online RC courses during the COVID-19 
pandemic and the perceived impact of these courses on their mental health. A 
qualitative interpretative descriptive study design was employed, and Miles and 
Huberman's stepwise content analysis method was used to mine the data for 
themes. Fourteen structured online interviews were conducted with a sample 
representative of the diversity of learners. Five categories of themes emerged: 
(1) updating and validating your mental health knowledge, (2) taking care of 
yourself and your mental health, (3) improving and modifying your behaviors and 
practices, (4) changing how you look at yourself and others, and (5) interacting 
and connecting with others. Results suggest that online RC courses can be an 
effective strategy for supporting individual self-regulation and empowerment, 
breaking social isolation, and reducing the effects of stress in times of social 
confinement measures and limited access to care.

DOI: 10.3390/ijerph20032498
PMCID: PMC9915127
PMID: 36767864 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no say in designing the study; collecting, analyzing, and 
interpreting the data; drafting the manuscript or deciding whether or not to 
publish results.


1006. Int J Environ Res Public Health. 2023 Jan 30;20(3):2472. doi: 
10.3390/ijerph20032472.

Impact of Facebook on Social Support and Emotional Wellbeing in Perinatal Women 
during Three Waves of the COVID-19 Pandemic in Mexico: A Descriptive Qualitative 
Study.

Lara MA(1), Navarrete L(1), Medina E(1), Patiño P(1), Tiburcio M(1).

Author information:
(1)Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto 
Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México 14370, 
México.

The COVID-19 pandemic affected the mental health of pregnant and postpartum 
women in unique, unprecedented ways. Given the impossibility of delivering 
face-to-face care, digital platforms emerged as a first-line solution to provide 
emotional support. This qualitative study sought to examine the role that a 
closed Facebook group (CFG) played in providing social support for Mexican 
perinatal women and to explore the concerns they shared during the COVID-19 
pandemic. A thematic analysis of all the posts in the CFG yielded nine main 
categories: (1) COVID-19 infections in participants and their families; (2) fear 
of infection; (3) infection prevention; (4) health services; (5) vaccines; (6) 
concerns about non-COVID-19-related health care; (7) effects of social 
isolation; (8) probable mental health cases; and (9) work outside the home. 
Participants faced stressful situations and demands that caused intense fear and 
worry. In addition to household tasks and perinatal care, they were responsible 
for adopting COVID-19 preventive measures and caring for infected family 
members. The main coping mechanism was their religious faith. The CFG was found 
to be a useful forum for supporting perinatal women, where they could share 
concerns, resolve doubts, and obtain information in a warm, compassionate, and 
empathetic atmosphere. Health providers would be advised to seek new social 
media to improve the quality of their services.

DOI: 10.3390/ijerph20032472
PMCID: PMC9916316
PMID: 36767838 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1007. Int J Environ Res Public Health. 2023 Jan 29;20(3):2365. doi: 
10.3390/ijerph20032365.

"I Carry the Trauma and Can Vividly Remember": Mental Health Impacts of the 
COVID-19 Pandemic on Frontline Health Care Workers in South Africa.

Mahlangu P(1)(2), Sikweyiya Y(1)(2), Gibbs A(1)(3)(4)(5), Shai N(1)(2), Machisa 
M(1)(2).

Author information:
(1)Gender and Health Research Unit, South African Medical Research Council, 
Pretoria 0001, South Africa.
(2)Faculty of Health Sciences, School of Public Health, University of 
Witwatersrand, Johannesburg 2193, South Africa.
(3)Department of Psychology, Faculty of Health and Life Sciences, University of 
Exeter, Exeter EX2 4QG, UK.
(4)Institute of Global Health, University College London, London WC1E 6BT, UK.
(5)Centre for Rural Health, University of KwaZulu-Natal, Durban 4041, South 
Africa.

We know from research that pandemics and disease outbreaks expose HCWs to an 
increased risk of short and long-term psychosocial and occupational impacts. We 
conducted qualitative research among 44 frontline health care workers (FHCWs) 
practicing in seven South African hospitals and clinics. FHCWs were interviewed 
on their experiences of working during the first-wave of the COVID-19 pandemic 
and its perceived impact on their wellness. In this study, FHCWs included the 
non-medical and medical professionals in direct contact with COVID-19 patients, 
providing health care and treatment services during the COVID-19 pandemic. Most 
of the FHCWs reported stressful and traumatic experiences relating to being 
exposed to a deadly virus and working in an emotionally taxing environment. They 
reported depression, anxiety, traumatic stress symptoms, demoralization, sleep 
difficulties, poor functioning, increased irritability and fear of being 
infected or dying from COVID-19. The mental health impacts of COVID-19 on HCWs 
were also associated with increased poor physical wellbeing, including fatigue, 
burnout, headache, and chest-pains. FHCWs reported professional commitment and 
their faith as critical intrinsic motivators that fostered adaptive coping while 
working on the frontline during the first-wave of the COVID-19 pandemic. Many 
alluded to gaps in workplace psychosocial support which they perceived as 
crucial for coping mentally. The findings point to a need to prioritize 
interventions to promote mental wellness among FHCWs to ensure the delivery of 
quality healthcare to patients during pandemics or deadly disease outbreaks.

DOI: 10.3390/ijerph20032365
PMCID: PMC9914980
PMID: 36767735 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1008. Int J Environ Res Public Health. 2023 Jan 29;20(3):2362. doi: 
10.3390/ijerph20032362.

The Influence of the COVID-19 Pandemic on Social Anxiety: A Systematic Review.

Kindred R(1), Bates GW(1).

Author information:
(1)Department of Psychological Sciences, Swinburne University of Technology, 
John St, Hawthorn, VIC 3122, Australia.

The COVID-19 pandemic has resulted in negative mental health outcomes throughout 
the world, and its impact on social interactions and relationships is likely to 
be evident in problematic social anxiety. This systematic review qualitatively 
synthesized data from studies that have reported on the effects of the pandemic 
on social anxiety. A systematic search of Web of Science Core Collection, 
Embase, PsychINFO, Scopus, EBSCOhost, Cochrane Central Register of Controlled 
Trials, and Proquest Central-Dissertations and Theses was conducted, with 
thirty-three studies meeting the inclusion criteria. The results suggest that 
social anxiety has been heightened in the general population due to the 
pandemic, with women and low-income earners being especially vulnerable. Other 
contributing factors include impaired coping strategies, lower socio-emotional 
well-being, limited support networks, and contraction of the SARS-CoV-2 virus. 
Individuals with a Social Anxiety Disorder diagnosis may be at risk of a 
deterioration of mental health in general. Limitations of the literature 
reviewed include the predominance of cross-sectional study designs, which limit 
causal inferences are limited. Additionally, associations may be inflated as 
many studies have not accounted for mediating variables. Taken together, the 
research suggests that social anxiety, either pre-pandemic or arising due to the 
pandemic environment, has contributed to a variety of negative mental health 
outcomes related to social anxiety.

DOI: 10.3390/ijerph20032362
PMCID: PMC9915904
PMID: 36767728 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1009. Int J Environ Res Public Health. 2023 Jan 28;20(3):2340. doi: 
10.3390/ijerph20032340.

How Confinement and Back to Normal Affected the Well-Being and Thus Sleep, 
Headaches and Temporomandibular Disorders.

Rosales Leal JI(1), Sánchez Vaca C(1), Ryaboshapka A(1), de Carlos Villafranca 
F(2), Rubio Escudero MÁ(3).

Author information:
(1)Department of Stomatology, Prosthodontics & Orofacial Pain Section, School of 
Dentistry, University of Granada, 18071 Granada, Spain.
(2)Department of Surgery and Medical-Surgical Specialties, Orthodontics Section, 
Faculty of Medicine, University of Oviedo, 33003 Oviedo, Spain.
(3)Department of Computational Science and Artificial Intelligence, School of 
Computer and Telecommunications Engineering, University of Granada, 18071 
Granada, Spain.

The COVID-19 pandemic is having negative consequences not only for people's 
general health but also for the masticatory system. This article aimed to assess 
confinement and its new normal impact on well-being, sleep, headaches, and 
temporomandibular disorders (TMD). An anonymous survey was distributed to a 
Spanish university community. Participants completed a well-being index (WHO-5), 
a questionnaire related to sleep quality (the BEARS test), a headache diagnostic 
test (the tension type headache (TTH) and migraine diagnosis test), and the 
DC-TMD questionnaire. Questions were addressed in three scenarios: before 
confinement, during confinement, and the new normal. A total of 436 responses 
were collected (70% women, 30% men). A reduction in well-being and sleep quality 
was recorded. Respondents reported more TTH and migraines during and after 
confinement. Overall, confinement and return to normal did not increase TMD 
symptoms, and only minor effects were observed, such as more intense joint pain 
and a higher incidence of muscle pain in women during confinement. Reduced 
well-being is correlated with sleep quality loss, headaches, and TMD symptoms. 
This study provides evidence that pandemics and confinement might have had a 
negative impact on population health. Well-being was strongly affected, as were 
sleep quality, depression risk, TTH, and migraine frequency. In contrast, the 
temporomandibular joint and muscles showed more resilience and were only 
slightly affected.

DOI: 10.3390/ijerph20032340
PMCID: PMC9915983
PMID: 36767704 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1010. Int J Environ Res Public Health. 2023 Jan 25;20(3):2173. doi: 
10.3390/ijerph20032173.

Lessons Learned during a Rapidly Evolving COVID-19 Pandemic: Aboriginal and 
Torres Strait Islander-Led Mental Health and Wellbeing Responses Are Key.

Dudgeon P(1), Collova JR(1), Derry K(1), Sutherland S(2).

Author information:
(1)Poche Centre for Indigenous Health, School of Indigenous Studies, University 
of Western Australia, Perth, WA 6009, Australia.
(2)College of Health and Medicine, Australian National University, Canberra, ACT 
2601, Australia.

As the world journeys towards the endemic phase that follows a pandemic, public 
health authorities are reviewing the efficacy of COVID-19 pandemic responses. 
The responses by Aboriginal and Torres Strait Islander communities in Australia 
have been heralded across the globe as an exemplary demonstration of how 
self-determination can achieve optimal health outcomes for Indigenous peoples. 
Despite this success, the impacts of pandemic stressors and public health 
responses on immediate and long-term mental health and wellbeing require 
examination. In December 2021, Aboriginal and Torres Strait Islander mental 
health and wellbeing leaders and allies (N = 50) attended a virtual roundtable 
to determine the key issues facing Aboriginal and Torres Strait Islander peoples 
and communities, and the actions required to address these issues. Roundtable 
attendees critically reviewed how the rapidly evolving pandemic context has 
impacted Aboriginal and Torres Strait Islander mental health and social and 
emotional wellbeing (SEWB). This paper presents an overview of this national 
collaborative consultation process, and a summary of the key issues and actions 
identified. These results build on evidence from other roundtables held in 
Australia during 2020, and the emerging consensus across the globe that 
Indigenous self-determination remains essential to Indigenous SEWB, especially 
during and following a pandemic.

DOI: 10.3390/ijerph20032173
PMCID: PMC9916274
PMID: 36767539 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1011. Int J Environ Res Public Health. 2023 Jan 25;20(3):2167. doi: 
10.3390/ijerph20032167.

Nature-Based Therapy in Individuals with Mental Health Disorders, with a Focus 
on Mental Well-Being and Connectedness to Nature-A Pilot Study.

Joschko L(1), Pálsdóttir AM(1), Grahn P(1), Hinse M(2).

Author information:
(1)Department of People and Society, The Swedish University of Agricultural 
Sciences, 234 22 Lomma, Sweden.
(2)Institute of Social Medicine, Epidemiology and Health Economics, 
Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.

In times of social and ecological crises, such as COVID-19 with lockdowns and 
implementing the impact of climate change, mental health degrades. Being 
outdoors in nature can be health-promoting, can decrease depression, and 
increase mental well-being. This pilot study investigated the relationships 
between nature-based therapy, mental health, and individuals' connectedness to 
nature. We hypothesize that nature-based therapy has a positive impact on 
individual mental health and connectedness to nature. A mixed-method approach 
was used to evaluate the effectiveness of nature-based therapy for young 
psychosomatic patients. The results demonstrated improvements in mental 
well-being and connectedness to nature through therapy. Additionally, depression 
scores decreased. Patients reported the importance of the therapist setting the 
space, the supportive environment, the poems that fostered the nature 
connection, improvement at the soul level, and overall doing something 
meaningful. Every patient experienced nature-based therapy as effective. To 
conclude, the study gives a first insight into the processes of nature-based 
therapy in the German population at work and the effectiveness of nature-based 
therapy. Further questions, e.g., season effects, longitudinal effects, and 
whether patients with low connectedness to nature gain more out of the 
intervention remain unanswered.

DOI: 10.3390/ijerph20032167
PMCID: PMC9914984
PMID: 36767534 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1012. Int J Environ Res Public Health. 2023 Jan 24;20(3):2132. doi: 
10.3390/ijerph20032132.

Impact of the COVID-19 Pandemic on Psychosocial Well-being and Adaptation in 
Children and Adolescents with Asperger's Syndrome.

Tremolada M(1)(2), Rosa M(3), Incardona RM(2), Taverna L(4), Guidi M(3).

Author information:
(1)Department of Developmental and Social Psychology, University of Padua, 35131 
Padua, Italy.
(2)Pediatric Hematology, Oncology and Stem Cell Transplant Center, Department of 
Woman's and Child's Health, University of Padua, 35128 Padua, Italy.
(3)Cooperativa Progetto Insieme, Via Cappello 44, Noventa Padovana, 35027 Padua, 
Italy.
(4)Faculty of Education, Free University of Bolzano-Bozen, 39100 Bolzano, Italy.

Mental health could worsen in children and adolescents with autism spectrum 
disorder during the COVID-19 pandemic. In addition, their parents could be more 
at risk for an increase in anxiety and depression symptomatology. This study 
aims to understand the adaptation and the psychosocial well-being in a sample of 
16 males aged 10-21 years old with Asperger's syndrome after the quarantine for 
COVID-19 when they return to school and partially to their activities in 
September 2020. The adopted approach is multi-informant with a battery of 
questionnaires on psychological health and adaptation given by a secure online 
web data Qualtrics both to adolescents and also to their parents. Paralleling 
matched peers with typical developments were assessed by adopting the same 
methodology. The results evidenced several difficulties in psychological health 
in population with Asperger's syndrome, especially in anxiety and socialization. 
Adaptation is put in crisis, even if they reported a good comprehension and 
adoption of the right behaviors anti-COVID-19. Parents of children with 
Asperger's syndrome reported similar psychological difficulties and general 
health to those of the group of children typically developing. Some clinical 
indications could be discussed for psychologists who follow children and 
adolescents with Asperger's syndrome.

DOI: 10.3390/ijerph20032132
PMCID: PMC9915274
PMID: 36767499 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1013. Int J Environ Res Public Health. 2023 Jan 24;20(3):2120. doi: 
10.3390/ijerph20032120.

Optimists and Realists: A Latent Class Analysis of Students Graduating from High 
School during COVID-19 and Impacts on Affect and Well-Being.

Zdravkovic A(1), Goldstein AL(1).

Author information:
(1)Applied Psychology and Human Development, Ontario Institute for Studies in 
Education, The University of Toronto, Toronto, ON M5S 1V6, Canada.

The Novel Coronavirus Disease (COVID-19) pandemic has had profound effects on 
physical and mental health worldwide. Students transitioning out of high school 
were uniquely impacted at the onset of the pandemic, having missed the 
opportunity to properly mark the end of their final year in the K-12 school 
system. The adverse effects of this loss on this population are still unknown. 
The purpose of the current study was to examine stress, wellbeing, and affect in 
a sample of 168 students (N = 168; Mage = 17.0, SD = 0.46; 60% female; 40% male) 
who were completing their final year of high school during the early stages of 
the pandemic when emergency stay-at-home orders were in place. Participants 
completed an online survey assessing the impact of COVID-19 on their life 
satisfaction (pre-COVID19, during COVID-19, and anticipated five years from 
now), stress, positive affect, and negative affect. Latent class analysis (LCA) 
was used to create classes of participants based on their responses to the 
pandemic. A two-subgroup solution provided the best model for the life 
satisfaction outcome variable. Subgroup 1, optimists, comprised 24% (N = 40) of 
the sample and reported high life satisfaction ratings one year prior to 
COVID-19 and a slight decrease in life satisfaction during COVID-19, and they 
anticipated an increase in life satisfaction 5 years from now. This group was 
characterized by low stress, low negative affect, and high positive affect 
during the pandemic. Subgroup 2, realists, comprised 76% of the population (N = 
128) and experienced similarly high retrospective ratings of pre-COVID life 
satisfaction but a larger decrease in life satisfaction during the pandemic and 
a smaller increase in five years. The realist group was characterized by low 
positive affect, high stress, and high negative affect during the pandemic. The 
findings suggest that during the pandemic, certain subsamples of adolescents had 
greater difficulty in managing this transitional period and experienced changes 
in mood and well-being (i.e., affect, stress) as compared to other adolescents 
(i.e., optimists). Future research should investigate the characteristics and 
coping mechanisms that are instrumental for increasing life satisfaction and 
positive affect while lowering stress in this population.

DOI: 10.3390/ijerph20032120
PMCID: PMC9915344
PMID: 36767487 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript; or in the decision to 
publish the results.


1014. Int J Environ Res Public Health. 2023 Jan 19;20(3):1838. doi: 
10.3390/ijerph20031838.

Stressors and Impact of the COVID-19 Pandemic on Vulnerable Hispanic Caregivers 
and Children.

Rodríguez-Rabassa M(1)(2)(3), Torres-Marrero E(1), López P(2), Muniz-Rodriguez 
K(4), Borges-Rodríguez M(4), Appleton AA(5), Avilés-Santa L(6), 
Alvarado-Domenech LI(3).

Author information:
(1)Clinical Psychology Program, Ponce Health Sciences University, P.O. Box 7004, 
Ponce, PR 00732, USA.
(2)RCMI Center for Research Resources, Ponce Health Sciences University, P.O. 
Box 7004, Ponce, PR 00732, USA.
(3)Department of Pediatrics, Ponce Health Sciences University, P.O. Box 7004, 
Ponce, PR 00732, USA.
(4)Ponce Research Institute, Ponce Health Sciences University, P.O. Box 7004, 
Ponce, PR 00732, USA.
(5)Department of Epidemiology and Biostatistics, University at Albany School of 
Public Health, State University of New York, 1 University Place, Rensselaer, NY 
12144, USA.
(6)Division of Clinical and Health Services Research, National Institute on 
Minority Health and Health Disparities, 6707 Democracy Blvd. Suite 800, 
Bethesda, MD 20892, USA.

Psychological sequelae are important elements of the burden of disease among 
caregivers. Recognition of the impact of adversity and stress biomarkers is 
important to prevent mental health problems that affect rearing practices and 
child well-being. This cross-sectional study explored social determinants of 
health (SDoH)-mediated stressors during COVID-19 and risks for mental health 
problems among caregivers of children with prenatal Zika virus exposure. 
Twenty-five Hispanic caregivers completed surveys assessing SDoH 
vulnerabilities, COVID-exposures and impact, post-traumatic stress disorder 
(PTSD) symptomatology, and provided a hair sample for cortisol concentration 
(HCC). Most caregivers had low education, household income < $15,000/year, and 
were unemployed. Stressors included disrupted child education and specialized 
services, and food insecurity. While most reported PTSD symptomatology, 
multivariate linear regression models adjusted for the caregiver's age, 
education, and the child's sex, revealed that caregivers with high 
symptomatology had significantly lower HCC than those with low symptomatology 
and those with food insecurity had significantly higher HCC than participants 
without food insecurity. The impact of COVID-19 on daily life was characterized 
on average between worse and better, suggesting variability in susceptibility 
and coping mechanisms, with the most resilient identifying community support and 
spirituality resources. SDoH-mediators provide opportunities to prevent adverse 
mental health outcomes for caregivers and their children.

DOI: 10.3390/ijerph20031838
PMCID: PMC9914744
PMID: 36767218 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
National Institutes of Health—National Institute of Minority Health and Health 
Disparities had no role in the design, execution, interpretation, or writing of 
the study. The opinions shared by the authors do not represent the opinions of 
the National Institute on Minority Health and Health Disparities, the National 
Institutes of Health, or the U.S. federal government.


1015. Int J Environ Res Public Health. 2023 Jan 19;20(3):1824. doi: 
10.3390/ijerph20031824.

Psychosocial Risk in COVID Context: The Impact of Economic Factors and Labour 
Protection Policy (ERTEs) in Spain.

Iglesias Martínez E(1), Yáñez Legaspi P(2), Agulló-Tomás E(3), Llosa JA(1).

Author information:
(1)Department of Social Education, Padre Ossó Faculty, University of Oviedo, 
33008 Oviedo, Spain.
(2)Faculty of Juridic Sciences, University Rovira i Virgili, 43002 Tarragona, 
Spain.
(3)Department of Psychology, University of Oviedo, 33003 Oviedo, Spain.

The pandemic and the current situation have caused working poverty and therefore 
social risk, which implies a deterioration in well-being, affecting mental 
health and anxiety. In this context, the employment situation tends to be 
regarded ignoring previous social differences, economic and mental components, 
which should be considered when establishing priorities to program a global 
action of various synergistic elements. The study involved 4686 people (3500 
women and 1186 men). They all completed a questionnaire that evaluated their 
anxiety, employment situation, income, changes of working status, and fears of 
becoming infected at the workplace. The results show the need to take into 
account the social determinants of mental health in vulnerable groups due to 
socioeconomic factors, job changes, contractual changes, age, or gender, 
considering the need to generate strategies to manage mental health and deal 
with it at a structural level, therefore displacing individual focus policies 
and interventions. An example of these policies are ERTEs (record of temporary 
employment regulation), constituting a perceived measure of protection and 
acting as an effective buffer against the economic crisis, thus reducing 
anxiety.

DOI: 10.3390/ijerph20031824
PMCID: PMC9914205
PMID: 36767191 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1016. Int J Environ Res Public Health. 2023 Jan 18;20(3):1802. doi: 
10.3390/ijerph20031802.

PTSD (Posttraumatic Stress Disorder) in Teachers: A Mini Meta-Analysis during 
COVID-19.

Idoiaga Mondragon N(1), Fernandez IL(2), Ozamiz-Etxebarria N(1), Villagrasa 
B(3), Santabárbara J(4)(5)(6).

Author information:
(1)Department of Developmental and Educational Psychology, University of the 
Basque Country UPV/EHU, 48940 Leioa, Spain.
(2)Department of Didactics and School Organization, University of the Basque 
Country UPV/EHU, 48940 Leioa, Spain.
(3)Psychogeriatry, CASM Benito Menni, 08830 Sant Boi de Llobregat, Spain.
(4)Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry 
of Science and Innovation, 28029 Madrid, Spain.
(5)Department of Microbiology, Pediatrics, Radiology and Public Health, 
University of Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Spain.
(6)Aragonese Institute of Health Sciences (IIS Aragón), 50009 Zaragoza, Spain.

BACKGROUND: Since March 2020, when the World Health Organization (WHO) declared 
the COVID-19 pandemic, in order to stop the spread of the virus, unprecedented 
measures were taken worldwide. One of the most important measures was the 
closure of schools and educational centers around the world in 2020, and very 
extreme health protocols have been in place in educational centers since they 
were reopened. From early childhood education to universities, teachers first 
had to adapt in a short period time to online classes and then continuously 
readapt to new protocols according to the pandemic situation. This academic 
environment, in addition to the pandemic situation itself, has favored the 
emergence of mental disorders such as Post-Traumatic Stress Disorder (PTSD).
MATERIALS AND METHODS: Medline via PubMed and other databases were searched for 
studies on the prevalence of PTSD in teachers from 1 December 2019 to 1 October 
2022. A total of five studies were included in this review. Our results show a 
prevalence of PTSD of 11% reported by teachers. No subgroups nor meta-regression 
analyses were performed due to the insufficient number of studies available.
CONCLUSIONS: The results suggest that teachers are suffering from PTSD, so it is 
important to carry out more studies worldwide. Similarly, measures to improve 
the mental health and well-being of teachers during the pandemic and 
post-pandemic periods are needed.

DOI: 10.3390/ijerph20031802
PMCID: PMC9914732
PMID: 36767168 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflicts 
of interest.


1017. J Occup Environ Med. 2023 Apr 1;65(4):e195-e203. doi: 
10.1097/JOM.0000000000002808. Epub 2023 Feb 11.

By Nature, We're Doers and Problem Solvers: Evolving Job Demands and Resources 
in Response to COVID-19 Among US-Based Fire Service Personnel (The RAPID Study 
II).

Castro KC(1), Fisher AB, Geczik AM, Boyer SL, Resick CJ, Lee J, Davis AL, Taylor 
JA, Allen JA.

Author information:
(1)From the Rocky Mountain Center for Occupational and Environmental Health 
(RMCOEH), University of Utah and Weber State University, Salt Lake City, Utah 
(K.C.C., J.A.A.); Department of Family and Preventative Medicine, University of 
Utah, Salt Lake City, Utah (K.C.C., J.A.A.); Center for Firefighter Injury 
Research and Safety Trends, Department of Environmental and Occupational Health, 
Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania 
(A.B.F., A.M.G., A.L.D., J.A.T.); School of Business and Economics, Moravian 
University, Bethlehem, Pennsylvania (S.L.B.); LeBow College of Business, Drexel 
University, Philadelphia, Pennsylvania (C.J.R.); and Department of Psychological 
Sciences, Kansas State University, Manhattan, Kansas (J.L.).

OBJECTIVE: The US fire service experienced increased demands due to COVID-19. 
This qualitative study explored the pandemic's impact on work-life balance and 
safety.
METHODS: Five interviews and 10 focus groups were conducted with 15 fire 
departments in the COVID-19 RAPID Mental Health Assessment. Coding and 
multilevel content analysis were conducted in NVivo.
RESULTS: Four department support themes were identified: emotional/social 
(33.1%), policy (28.4%), instrumental (22.9%), and informational (15.5%). Four 
work-life balance themes were identified: life (51.2%), children (18.1%), 
physiological (16.5%), and work (14.2%). We observed more departmental resources 
to help mitigate job demands within the work environment compared with those for 
work-life demands.
CONCLUSIONS: Job resources are needed to mitigate demands and improve safety 
culture and mental well-being of the fire service under normal conditions, and 
for the next pandemic, natural disaster, or long-term emergency.

Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on 
behalf of the American College of Occupational and Environmental Medicine.

DOI: 10.1097/JOM.0000000000002808
PMCID: PMC10090346
PMID: 36765448 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest: None declared.


1018. Child Abuse Negl. 2023 Apr;138:106076. doi: 10.1016/j.chiabu.2023.106076. Epub 
2023 Feb 3.

COVID-19 impacts and adolescent suicide: The mediating roles of child abuse and 
mental health conditions.

Liu J(1), Chai L(2), Zhu H(3), Han Z(4).

Author information:
(1)School of Political Science and Public Administration, Shandong University, 
Jinan, PR China; Institute of Public Safety Research (Center for Public Safety 
Strategy Research).
(2)Department of Sociology, University of Toronto, Toronto, Canada.
(3)China Center for Health Development Studies, Peking University, Beijing, PR 
China.
(4)School of Political Science and Public Administration, Shandong University, 
Jinan, PR China; Center for Crisis Management Research, Tsinghua University; 
Institute of Public Safety Research (Center for Public Safety Strategy 
Research). Electronic address: ziqiang.han@sdu.edu.cn.

BACKGROUND: Considerable research has established the harmful impacts of the 
COVID-19 pandemic on children's and adolescents' health and well-being. However, 
the literature has been constrained by studies using less representative 
samples, hindering the generalization of the findings.
OBJECTIVE: This study aimed to investigate the associations of employment 
disruption and school closures during the pandemic with suicidal ideation and 
behavior in children and adolescents-and to consider the potential mediating 
effects of child psychological and physical abuse and subsequent mental health 
conditions.
PARTICIPANTS AND SETTING: This study used the Adolescent Behaviors and 
Experiences data (n = 4692) - a nationally representative survey administered by 
the CDC of the United States from January to June 2021.
METHODS: Logistic regression models were conducted to investigate the 
associations. A series of multiple mediation models were performed.
RESULTS: School closures directly reduced child psychological and physical abuse 
and suicidal ideation and behavior. Employment disruption did not directly 
predict suicidal ideation and behavior but primarily through child abuse. Mental 
health's mediation role was significant in the associations between child 
psychological abuse and suicidal ideation and behavior, but no evidence 
suggested the same mediating pattern for the physical abuse-suicidal ideation 
and behavior relationship. Within the covariates, sexual orientation was the 
most consistent and highest risk factor.
CONCLUSIONS: This study contributes to current knowledge on disaster impact, 
child abuse, and suicidal ideation and behavior, and it can also provide policy 
and intervention awareness for social workers.

Copyright © 2023. Published by Elsevier Ltd.

DOI: 10.1016/j.chiabu.2023.106076
PMCID: PMC9894761
PMID: 36764172 [Indexed for MEDLINE]


1019. Aust J Rural Health. 2023 Jun;31(3):484-492. doi: 10.1111/ajr.12969. Epub 2023 
Feb 10.

Impact of the COVID-19 pandemic on student supervision and education in health 
care settings: A state-wide survey of health care workers.

Martin P(1)(2), Hulme A(3), Fallon T(4)(5), Kumar S(6), McGrail M(1), Argus 
G(7)(8), Gurney T(1), Kondalsamy-Chennakesavan S(1).

Author information:
(1)Rural Clinical School, Faculty of Medicine, The University of Queensland, 
Toowoomba, Queensland, Australia.
(2)Darling Downs Health, Baillie Henderson Hospital, Toowoomba, Queensland, 
Australia.
(3)Southern Queensland Rural Health, Faculty of Health and Behavioural Sciences, 
The University of Queensland, Toowoomba, Queensland, Australia.
(4)Faculty of Health and Behavioural Sciences, The University of Queensland, 
Toowoomba, Queensland, Australia.
(5)Centre for Health Research, University of Southern Queensland, Toowoomba, 
Queensland, Australia.
(6)Allied Health and Human Performance, University of South Australia, Adelaide, 
South Australia, Australia.
(7)Southern Queensland Rural Health, The University of Queensland, Toowoomba, 
Queensland, Australia.
(8)School of Psychology and Wellbeing, University of Southern Queensland, 
Toowoomba, Queensland, Australia.

OBJECTIVE: To investigate student supervisor experiences of supervising students 
on clinical placements since the onset of the COVID-19 pandemic.
BACKGROUND: Studies on the impact of COVID-19 on student clinical placements 
have focused largely on student reports and have been specific to individual 
professions or topic areas. There is a need to investigate student supervisor 
experiences. This study was conducted in Queensland (Australia) in four regional 
and rural public health services and four corresponding primary health networks.
METHODS: The anonymous, mixed methods online survey, consisting of 35 questions, 
was administered to student supervisors from allied health, medicine, nursing 
and midwifery between May and August 2021. Numerical data were analysed 
descriptively using chi-square tests. Free-text comments were analysed using 
content analysis.
RESULTS: Complete datasets were available for 167 respondents. Overall trends 
indicated perceived significant disruptions to student learning and support, 
plus mental health and well-being concerns for both students and supervisors. 
Extensive mask wearing was noted to be a barrier to building rapport, learning 
and teaching. Some positive impacts of the pandemic on student learning were 
also noted.
CONCLUSIONS: This study has highlighted the perceived impact of the pandemic on 
supervisors' mental health, and on the mental health, learning and work 
readiness of students. This study provides evidence of the pandemic impacts on 
student clinical placements from a supervisor point of view. Findings can assist 
in future-proofing clinical education and ensuring that students continue to 
receive learning experiences of benefit to them, meeting curriculum 
requirements, in the event of another pandemic.

© 2023 The Authors. Australian Journal of Rural Health published by John Wiley & 
Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.

DOI: 10.1111/ajr.12969
PMID: 36762896 [Indexed for MEDLINE]


1020. Front Public Health. 2023 Jan 25;11:1100546. doi: 10.3389/fpubh.2023.1100546. 
eCollection 2023.

Effectiveness of a stepped-care programme of WHO psychological interventions in 
migrant populations resettled in Italy: Study protocol for the RESPOND 
randomized controlled trial.

Purgato M(1), Turrini G(1), Tedeschi F(1), Serra R(1)(2), Tarsitani L(2), Compri 
B(1), Muriago G(1), Cadorin C(1), Ostuzzi G(1), Nicaise P(3), Lorant V(3), 
Sijbrandij M(4), Witteveen AB(4), Ayuso-Mateos JL(5)(6)(7), Mediavilla 
R(5)(6)(8), Haro JM(6)(9), Felez-Nobrega M(6)(9), Figueiredo N(10), Pollice 
G(10), McDaid D(11), Park AL(11), Kalisch R(12)(13), Petri-Romão P(13), 
Underhill J(14), Bryant RA(15), Nosè M(1), Barbui C(1).

Author information:
(1)Department of Neuroscience, Biomedicine, and Movement Sciences, Section of 
Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health 
and Service Evaluation, University of Verona, Verona, Italy.
(2)Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.
(3)Institute of Health and Society (IRSS) - UCLouvain, Brussels, Belgium.
(4)Department of Clinical, Neuro- and Developmental Psychology, WHO 
Collaborating Center for Research and Dissemination of Psychological 
Interventions, VU University, Amsterdam, Netherlands.
(5)Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, 
Spain.
(6)Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 
Instituto de Salud Carlos III, Madrid, Spain.
(7)Department of Psychiatry, La Princesa University Hospital, Instituto de 
Investigación Sanitaria La Princesa (IIS-Princesa), Madrid, Spain.
(8)Instituto de Investigación Sanitaria del Hospital Universitario La Paz 
(IdiPAZ), Madrid, Spain.
(9)Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, 
Spain.
(10)Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de 
Santé Publique, ERES, Paris, France.
(11)Care Policy and Evaluation Centre, Department of Health Policy, London 
School of Economics and Political Science, London, United Kingdom.
(12)Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), 
Johannes Gutenberg University Medical Center, Mainz, Germany.
(13)Leibniz Institute for Resilience Research, Mainz, Germany.
(14)Independent Research Consultant, Brighton, United Kingdom.
(15)School of Psychology, University of New South Wales, Sydney, NSW, Australia.

INTRODUCTION: Migrant populations, including workers, undocumented migrants, 
asylum seekers, refugees, internationally displaced persons, and other 
populations on the move, are exposed to a variety of stressors and potentially 
traumatic events before, during, and after the migration process. In recent 
years, the COVID-19 pandemic has represented an additional stressor, especially 
for migrants on the move. As a consequence, migration may increase vulnerability 
of individuals toward a worsening of subjective wellbeing, quality of life, and 
mental health, which, in turn, may increase the risk of developing mental health 
conditions. Against this background, we designed a stepped-care programme 
consisting of two scalable psychological interventions developed by the World 
Health Organization and locally adapted for migrant populations. The 
effectiveness and cost-effectiveness of this stepped-care programme will be 
assessed in terms of mental health outcomes, resilience, wellbeing, and costs to 
healthcare systems.
METHODS AND ANALYSIS: We present the study protocol for a pragmatic randomized 
study with a parallel-group design that will enroll participants with a migrant 
background and elevated level of psychological distress. Participants will be 
randomized to care as usual only or to care a usual plus a guided self-help 
stress management guide (Doing What Matters in Times of Stress, DWM) and a 
five-session cognitive behavioral intervention (Problem Management Plus, PM+). 
Participants will self-report all measures at baseline before random allocation, 
2 weeks after DWM delivery, 1 week after PM+ delivery and 2 months after PM+ 
delivery. All participants will receive a single-session of a support 
intervention, namely Psychological First Aid. We will include 212 participants. 
An intention-to-treat analysis using linear mixed models will be conducted to 
explore the programme's effect on anxiety and depression symptoms, as measured 
by the Patient Health Questionnaire-Anxiety and Depression Scale summary score 2 
months after PM+ delivery. Secondary outcomes include post-traumatic stress 
disorder symptoms, resilience, quality of life, resource utilization, cost, and 
cost-effectiveness.
DISCUSSION: This study is the first randomized controlled trial that combines 
two World Health Organization psychological interventions tailored for migrant 
populations with an elevated level of psychological distress. The present study 
will make available DWM/PM+ packages adapted for remote delivery following a 
task-shifting approach, and will generate evidence to inform policy responses 
based on a more efficient use of resources for improving resilience, wellbeing 
and mental health.
CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT04993534.

Copyright © 2023 Purgato, Turrini, Tedeschi, Serra, Tarsitani, Compri, Muriago, 
Cadorin, Ostuzzi, Nicaise, Lorant, Sijbrandij, Witteveen, Ayuso-Mateos, 
Mediavilla, Haro, Felez-Nobrega, Figueiredo, Pollice, McDaid, Park, Kalisch, 
Petri-Romão, Underhill, Bryant, Nosè and Barbui.

DOI: 10.3389/fpubh.2023.1100546
PMCID: PMC9905848
PMID: 36761135 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1021. J Am Med Dir Assoc. 2023 Apr;24(4):564-572. doi: 10.1016/j.jamda.2022.12.026. 
Epub 2023 Feb 6.

Fully Immersive Virtual Reality Using 360° Videos to Manage Well-Being in Older 
Adults: A Scoping Review.

Restout J(1), Bernache-Assollant I(1), Morizio C(1), Boujut A(2), Angelini L(3), 
Tchalla A(4), Perrochon A(5).

Author information:
(1)Université de Limoges, HAVAE, UR20217, Limoges, France.
(2)Université de Limoges, HAVAE, UR20217, Limoges, France; 3iL Groupe, Limoges, 
France.
(3)School of Management Fribourg, HES-SO, Fribourg, Switzerland; Humantech 
Institute, HES-SO, Fribourg, Switzerland.
(4)CHU de Limoges, Pôle HU gérontologie clinique, Limoges, France; Laboratoire 
VieSanté, UR 24134 (Vieillissement, Fragilité, Prévention, e-Santé), IFR OMEGA 
HEALTH, Université de Limoges, Limoges, France.
(5)Université de Limoges, HAVAE, UR20217, Limoges, France. Electronic address: 
anaick.perrochon@unilim.fr.

OBJECTIVE: The development of negative behavioral and psychosocial factors 
(depression, anxiety, apathy, etc) is associated with poor well-being, which can 
contribute to health issues in ageing, especially in the context of COVID-19. 
Despite its relative novelty, fully immersive virtual reality (VR) interventions 
through 360° immersive videos are becoming more accessible and flexible and 
constitute an emerging method to potentially enhance well-being. The aim of this 
scoping review is to assess the effectiveness of 360° interventions on 
well-being in older adults with or without cognitive impairment, as well as 
cybersickness and attitudes toward this technology.
DESIGN: Scoping review.
SETTING AND PARTICIPANTS: Older adults with or without cognitive impairment.
METHODS: The PRISMA-SR guideline was followed. Four databases were used, and we 
selected articles published until April 2022. We have analyzed the effect of 
360° videos on the well-being of older adults with respect to the study design, 
the population, the contents, the duration of intervention, and the outcomes.
RESULTS: A total of 2262 articles were screened, of which 10 articles were 
finally included in this review. Most of them are pilot studies and used mixed 
methods including scales and interviews. The material and content of VR are 
diversified. Many behavioral and psychological outcomes were assessed, including 
anxiety, apathy, loneliness, depression, social engagement, quality of life, and 
emotions. The results were positive or mixed, according to the outcomes. We 
recorded few adverse events, and the interviews show contrasting results 
concerning the participants' feelings (ie, degree of immersion, familiarity with 
technology, and VR content).
CONCLUSIONS AND IMPLICATIONS: The use of VR 360° videos seems feasible in 
community-dwelling older adults or residential aged care facilities, as they are 
safe and provide enjoyment. It constitutes an emerging and promising therapeutic 
tool to manage psychosocial disorders. This review provides key considerations 
for the design and implementation of interventions using VR 360° video in 
clinical practice.

Copyright © 2023 AMDA – The Society for Post-Acute and Long-Term Care Medicine. 
Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jamda.2022.12.026
PMID: 36758621 [Indexed for MEDLINE]


1022. Indian J Crit Care Med. 2022 Dec;26(12):1267-1274. doi: 
10.5005/jp-journals-10071-24370.

Depression and Anxiety among COVID-19 Indian Intensive Care Unit Survivors: A 
Prospective Observational Study.

Gunjiganvi M(1), Rai S(2), Awale RB(3), Mishra P(4), Gurjar M(5), Gupta D(6), 
Singh R(7).

Author information:
(1)Department of Trauma Surgery, Sanjay Gandhi Postgraduate Institute of Medical 
Sciences, Lucknow, Uttar Pradesh, India.
(2)Department of Physical Medicine and Rehabilitation, Sanjay Gandhi 
Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
(3)Department of Laboratory Medicine, Sanjay Gandhi Postgraduate Institute of 
Medical Sciences, Lucknow, Uttar Pradesh, India.
(4)Department of Biostatistics and Health Informatics, Sanjay Gandhi 
Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
(5)Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of 
Medical Sciences, Lucknow, Uttar Pradesh, India.
(6)Department of Anesthesiology, Sanjay Gandhi Postgraduate Institute of Medical 
Sciences, Lucknow, Uttar Pradesh, India.
(7)Department of Critical Care Medicine, Indira Gandhi Institute of Medical 
Sciences, Patna, Bihar, India.

BACKGROUND: Long-lasting physical, cognitive, and mental health sequelae 
including depression and anxiety are common in intensive care unit (ICU) 
survivors.
AIM: This study was aimed to assess the immediate and medium-term mental health 
sequelae-depression and anxiety among coronavirus disease-2019 (COVID-19) ICU 
survivors.
MATERIALS AND METHODS: The COVID-19 ICU survivors of a tertiary level ICU were 
recruited into this study from 1 July 2020 to 31 October 2020. Willing 
participants were circulated with an electronic questionnaire. It consisted of 
demographics and questionnaires related to COVID-19 disease, comorbidities, and 
a patient health questionnaire (PHQ-9) scale for depression, and generalized 
anxiety disorder (GAD-7) scale for anxiety. Responses were collected at the time 
of discharge. Follow-up was done at 2 weeks and 6 months.
RESULTS: Among the 133 COVID-19 ICU survivors contacted, 91 survivors submitted 
the baseline data at the time of discharge. Fourteen and another 11 survivors 
were lost to follow-up at 2 weeks and at 6 months. The median age was 52.75 and 
68.1% (n = 62/91) were male. The median PHQ-9 and GAD-7 scores showed a 
statistically significant decrease at 2 weeks and a non-significant decrease at 
6 months compared to baseline scores. The GAD-7 score was the same or worse 
between baselines to 2 weeks, but it reduced between baseline to 6 months for 
all variables and their subgroups.
CONCLUSION: This study revealed a high prevalence of anxiety and depression in 
the immediate post-discharge period. These findings suggest the need for better 
mental rehabilitation strategies to deal with the well-being of critically ill 
survivors in future pandemics.
HOW TO CITE THIS ARTICLE: Gunjiganvi M, Rai S, Awale RB, Mishra P, Gurjar M, 
Gupta D, et al. Depression and Anxiety among COVID-19 Indian Intensive Care Unit 
Survivors: A Prospective Observational Study. Indian J Crit Care Med 
2022;26(12):1267-1274.

Copyright © 2022; Jaypee Brothers Medical Publishers (P) Ltd.

DOI: 10.5005/jp-journals-10071-24370
PMCID: PMC9886014
PMID: 36755631

Conflict of interest statement: Source of support: Nil Conflict of interest: 
None


1023. J Psychiatr Res. 2023 Mar;159:230-239. doi: 10.1016/j.jpsychires.2023.01.029. 
Epub 2023 Jan 30.

Mental-health before and during the COVID-19 pandemic in adults with 
neurodevelopmental disorders.

Shakeshaft A(1), Blakey R(2), Kwong ASF(3), Riglin L(1), Davey Smith G(2), 
Stergiakouli E(2), Tilling K(2), Thapar A(4).

Author information:
(1)Division of Psychological Medicine and Clinical Neurosciences, Centre for 
Neuropsychiatric Genetics and Genomics, Cardiff University, UK; Wolfson Centre 
for Young People's Mental Health, Cardiff University, UK.
(2)Population Health Sciences and MRC Integrative Epidemiology Unit, University 
of Bristol, Bristol, UK.
(3)Population Health Sciences and MRC Integrative Epidemiology Unit, University 
of Bristol, Bristol, UK; Division of Psychiatry, University of Edinburgh, UK.
(4)Division of Psychological Medicine and Clinical Neurosciences, Centre for 
Neuropsychiatric Genetics and Genomics, Cardiff University, UK; Wolfson Centre 
for Young People's Mental Health, Cardiff University, UK. Electronic address: 
Thapar@cardiff.ac.uk.

The COVID-19 pandemic negatively impacted mental health globally. Individuals 
with neurodevelopmental disorders (NDDs), including autism spectrum disorder 
(ASD) and attention deficit hyperactivity disorder (ADHD), are at elevated risk 
of mental health difficulties. We investigated the impact of the pandemic on 
anxiety, depression and mental wellbeing in adults with NDDs using data from the 
Avon Longitudinal Study of Parents and Children (n = 3058). Mental health data 
were collected pre-pandemic (age 21-25) and at three timepoints during the 
pandemic (ages 27-28) using the Short Mood and Feelings Questionnaire, 
Generalized Anxiety Disorder Assessment-7, and Warwick Edinburgh Mental 
Wellbeing Scale. ADHD and ASD were defined using validated cut-points of the 
Strengths and Difficulties Questionnaire and Autism Spectrum Quotient, 
self-reported at age 25. We used multi-level mixed-effects models to investigate 
changes in mental health in those with elevated ADHD/ASD traits compared to 
those without. Prevalences of depression, anxiety and poor mental wellbeing were 
higher at all timepoints (pre-pandemic and during pandemic) in those with ADHD 
and ASD compared to those without. Anxiety increased to a greater extent in 
those with ADHD (β = 0.8 [0.2,1.4], p = 0.01) and ASD (β = 1.2 [-0.1,2.5], 
p = 0.07), while depression symptoms decreased, particularly in females with ASD 
(β = -3.1 [-4.6,-1.5], p = 0.0001). On average, mental wellbeing decreased in 
all, but to a lesser extent in those with ADHD (β = 1.3 [0.2,2.5], p = 0.03) and 
females with ASD (β = 3.0 [0.2,5.9], p = 0.04). To conclude, anxiety 
disproportionately increased in adults with NDDs during the pandemic, however, 
the related lockdowns may have provided a protective environment for depressive 
symptoms in the same individuals.

Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.jpsychires.2023.01.029
PMCID: PMC9885110
PMID: 36753897 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
report no conflicting interests.


1024. Am J Phys Med Rehabil. 2023 May 1;102(5):433-443. doi: 
10.1097/PHM.0000000000002197. Epub 2023 Feb 1.

Regular Exercise Is Associated With Low Fatigue Levels and Good Functional 
Outcomes After COVID-19: A Prospective Observational Study.

de Avila L(1), Price JK, Stepanova M, Lam B, Weinstein AA, Pham H, Austin P, Keo 
W, Younossi Z, Afendy M, Nader S, Terra K, Cable R, Younossi E, Golabi P, Verma 
M, Nader F, Racila A, Gerber LH, Younossi ZM.

Author information:
(1)From the Betty and Guy Beatty Center for Integrated Research, Inova Health 
System, Falls Church, Virginia (LdA, JKP, MS, BL, AAW, HP, PA, WK, ZY, MA, SN, 
RC, EY, PG, MV, FN, AR, LHG, ZMY); Center for Liver Disease, Department of 
Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia (MS, BL, HP, MA, 
KT, RC, PG, MV, FN, AR, LHG, ZMY); Department of Global and Community Health, 
George Mason University, Fairfax, Virginia (AAW); and Inova Medicine, Inova 
Health System, Falls Church, Virginia (PG, MV, FN, AR, LHG, ZMY).

OBJECTIVE: The aim of the study is to identify the impact of postacute 
SARS-CoV-2 infection on patient outcomes.
DESIGN: This is a prospective, repeated measure, observational study of 
consented adults with positive SARS-CoV-2 quantitative polymerase chain reaction 
or antigen test more than 28 days after infection. Only data from the initial 
study visit are reported, including disease history, symptoms checklist, patient 
questionnaires, cognitive tests, social/medical histories, vitals, grip 
strength, and 2-min walk distance.
RESULTS: Two hundred eighteen patients were studied: 100 hospitalized (57.3 ± 
15.4 yrs, 62% male, body mass index: 31.3 ± 8.0) and 118 nonhospitalized (46.2 ± 
14.6 yrs, 31% male, body mass index: 29.7 ± 7.5). Post-COVID patients reported 
mean 1.76 symptoms; ≥15% reported fatigue, memory loss, and shortness of breath. 
Grip strength was 14% lower than norms ( P < 0.0001). Fatigue (Functional 
Assessment of Chronic Illness Therapy-Fatigue), mood (Patient Health 
Questionnaire), and well-being (EuroQol 5 Dimension 5 Level) scores were lower 
than the population norms ( P < 0.05). Hospitalized versus nonhospitalized 
post-COVID patients performed worse on cognitive assessments (processing speed 
test-Wechsler Adult Intelligence Scale-Fourth Edition Symbol Search) and 
reported less regular exercise (≥30 mins ≥3× per week; P < 0.05). In addition, 
30% had severe fatigue (by the Functional Assessment of Chronic Illness 
Therapy-Fatigue); those patients reported less exercise ( P < 0.05). In 
multivariate models, lack of exercise was independently associated with multiple 
post-COVID-19 impairments.
CONCLUSIONS: Low levels of exercise are an independent risk factor for 
post-COVID sequelae. Patients who report less exercise have low grip strength, 
higher levels of fatigue, memory loss, shortness of breath, depression, and 
poorer quality of life.

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/PHM.0000000000002197
PMCID: PMC10125009
PMID: 36753451 [Indexed for MEDLINE]

Conflict of interest statement: Financial disclosure statements have been 
obtained, and no conflicts of interest have been reported by the authors or by 
any individuals in control of the content of this article.


1025. Adv Clin Exp Med. 2023 Apr;32(4):395-399. doi: 10.17219/acem/159477.

Microbiota-derived psychedelics: Lessons from COVID-19.

Sfera A(1)(2), Hazan S(3), Kozlakidis Z(4), Klein C(5).

Author information:
(1)Department of Psychiatry, Patton State Hospital, San Bernardino, USA.
(2)Department of Psychiatry, University of California Riverside, USA.
(3)ProgenaBiome, Ventura, USA.
(4)The International Agency for Research on Cancer, Lyon, France.
(5)Department of Psychiatry, Napa State Hospital, USA.

Emil Kraepelin believed that dementia praecox, the disorder we now call 
schizophrenia, was caused by the brain being poisoned with toxins generated in 
other parts of the body, especially the mouth, intestine or genitals. In this 
regard, Kraepelin hinted at the microbiome and conceptualized microbial 
molecules as drivers of severe psychiatric illness. However, it was not until 
the coronavirus disease (COVID-19) pandemic that Kraepelin's paradigm gained 
traction, particularly because this virus was associated with both gut barrier 
disruption and new-onset psychosis.Likewise, despite numerous studies linking 
severe psychiatric illness to genomic damage and dysfunctional DNA repair, this 
pathogenetic mechanism was underappreciated before the COVID-19 pandemic. The 
use of the psychotomimetic anesthetic, ketamine, for treatment-resistant 
depression has reawakened the interest in endogenous serotonergic hallucinogens, 
especially tryptamine and N,N-dimethyltryptamine (DMT), which are beneficial for 
depression but associated with psychosis.In this editorial, we take a closer 
look at the role of the microbiome in psychopathology, attempting to answer 2 
questions:1. Why may psychosis-predisposing serotonergic hallucinogens alleviate 
depression?2. Are microbiota-derived psychedelics part of an inbuilt 
antidepressant system similar to endogenous opioids?

DOI: 10.17219/acem/159477
PMID: 36753370 [Indexed for MEDLINE]


1026. Trials. 2023 Feb 7;24(1):95. doi: 10.1186/s13063-023-07130-5.

The effects of Digital Buddy programme on older adults' mental well-being: study 
protocol for a multi-centre, cluster randomized controlled trial.

Kwan RYC(1), Ng F(2), Lai M(3), Wong D(4), Chan S(5).

Author information:
(1)School of Nursing, Tung Wah College, Hong Kong SAR, China.
(2)School of Management, Tung Wah College, Hong Kong SAR, China.
(3)President's Office, Tung Wah College, Hong Kong SAR, China.
(4)JC School of Public Health and Primary Care, The Chinese University of Hong 
Kong, Hong Kong SAR, China.
(5)President's Office, Tung Wah College, Hong Kong SAR, China. 
sallychan@twc.edu.hk.

INTRODUCTION: Mental well-being is associated with many mental health symptoms, 
including depression and health-related quality of life. Digital divide could 
impact mental health, particularly during the COVID-19 pandemic. Information and 
communication technology (ICT)-based tools and interventions could effectively 
provide social support. Intergenerational mentoring between college students and 
older adults could promote eHealth literacy and self-efficacy, and it is 
advocated to bridge the digital divide for older adults. However, the 
effectiveness of an intervention which employs ICT-based tools and 
intergenerational mentoring strategies (i.e. Digital Buddy) on mental well-being 
is unclear.
METHODS: This study will employ a multi-centre, cluster-randomized, 
two-parallel-group, noninferiority, controlled trial design with a 1:1 group 
allocation ratio. In the intervention group, a Digital Buddy (i.e. a young 
volunteer) is assigned to a group of older adults in a 1:10 ratio. A series of 
training sessions for a minimum of 23 h will be provided to the older adults by 
Digital Buddy, who will also follow through the intervention period with the 
older participants. The training contents include ICT and mental health care 
knowledge and skills. The whole intervention period will last for 6 months 
between 14 sessions. In the control group, participants will receive the usual 
care. The primary outcome measure is mental well-being. We aim to recruit 292 
older participants. Generalized estimating equations (GEE) will be used to 
examine the effects of the intervention.
ETHICS AND DISSEMINATION: This trial has been registered at ClinicalTrials.gov 
(NCT05553730) on 23 September 2022, 
https://clinicaltrials.gov/ct2/show/NCT05553730 , and all items come from the 
World Health Organization Trial Registration Data Set. It has been approved by 
the Research Ethics Committee of Tung Wah College, Hong Kong (reference number: 
REC2022143). The findings will be disseminated in peer-reviewed journals and 
presented at international conferences relevant to the subject fields.

© 2023. The Author(s).

DOI: 10.1186/s13063-023-07130-5
PMCID: PMC9903273
PMID: 36750879 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1027. Int J Soc Psychiatry. 2023 Jun;69(4):1033-1042. doi: 10.1177/00207640231152209. 
Epub 2023 Feb 6.

Burnout, mental health, physical symptoms, and coping behaviors in healthcare 
workers in Belize amidst COVID-19 pandemic: A nationwide cross-sectional study.

Estephan L(1), Pu C(1)(2), Bermudez S(3), Waits A(1)(2).

Author information:
(1)International Health Program, National Yang Ming Chiao Tung University, 
Taipei.
(2)Institute of Public Health, National Yang Ming Chiao Tung University, Taipei.
(3)Epidemiology Unit, Karl Heusner Memorial Hospital Authority, Belize City, 
Belize.

BACKGROUND: Healthcare workers are vulnerable to burnout, especially during the 
COVID-19 pandemic in the low resource settings. Belize is a small Central 
American developing country known for its chronic healthcare worker shortage and 
this is the first study to assess burnout prevalence and its associated factors 
among healthcare workers in Belize.
AIM: To evaluate the prevalence of burnout and its associated factors in HCWs in 
Belize covering multiple domains (mental health, physical symptoms, and coping 
behaviors) during the COVID-19 pandemic.
METHODS: A cross-sectional survey that was developed and validated by a panel of 
experts was delivered online to all the healthcare workers in Belize from 
September to November 2021. Burnout was assessed using Copenhagen Burnout 
Inventory. Depression and anxiety screening was carried out using the Patient 
Health Questionnaire - 2 (PHQ-2) and Generalized Anxiety Disorder 2-item 
(GAD-2). Burnout associated factors were estimated using logistic regression 
models.
FINDINGS: Of the total of 263 participants, 27.76% had overall burnout: 56.65% 
had personal, 54.37% had work-related, and 19.39% had patient-related burnout. 
Burnout was positively associated with anxiety (OR: 3.14 [1.67, 5.92]), 
depression (OR: 4.45 [2.30, 8.61]), intentions of quitting their jobs (OR: 2.59 
[1.49, 4.51]), health status worsening (OR: 2.21 [1.26, 3.87]), multiple 
physical symptom presentation (OR: 1.19, [1.10, 1.29]), and use of multiple 
maladaptive coping behaviors (OR: 1.66, [1.30, 2.12]).
INTERPRETATION: Healthcare workers in Belize showed substantial levels of 
burnout which were significantly associated with using maladaptive coping 
behaviors, presenting multiple physical symptoms, quitting their jobs, health 
status worsening, and other mental health issues. These findings should be used 
to develop and implement programs such as regular health check-ups, health 
promotion awareness campaigns, and worker recruitment strategies which would 
improve the working conditions, quality of life, and psychological well-being of 
our healthcare workers.

DOI: 10.1177/00207640231152209
PMCID: PMC9908523
PMID: 36748178 [Indexed for MEDLINE]


1028. BMC Geriatr. 2023 Feb 6;23(1):76. doi: 10.1186/s12877-022-03678-0.

Musical and psychomotor interventions for cognitive, sensorimotor, and cerebral 
decline in patients with Mild Cognitive Impairment (COPE): a study protocol for 
a multicentric randomized controlled study.

James CE(1)(2), Stucker C(3), Junker-Tschopp C(4), Fernandes AM(3), Revol A(4), 
Mili ID(5), Kliegel M(6), Frisoni GB(7), Brioschi Guevara A(8), Marie D(3)(9).

Author information:
(1)Geneva School of Health Sciences, Geneva Musical Minds Lab (GEMMI lab), 
University of Applied Sciences and Arts Western Switzerland HES-SO, Avenue de 
Champel 47, 1206, Geneva, Switzerland. clara.james@hesge.ch.
(2)Faculty of Psychology and Educational Sciences, University of Geneva, 
Boulevard Carl-Vogt 101, 1205, Geneva, Switzerland. clara.james@hesge.ch.
(3)Geneva School of Health Sciences, Geneva Musical Minds Lab (GEMMI lab), 
University of Applied Sciences and Arts Western Switzerland HES-SO, Avenue de 
Champel 47, 1206, Geneva, Switzerland.
(4)Geneva School of Social Work, Department of Psychomotricity, University of 
Applied Sciences and Arts Western Switzerland HES-SO, Rue Prévost-Martin 28, 
1205, Geneva, Switzerland.
(5)Faculty of Psychology and Educational Sciences, Didactics of Arts and 
Movement Laboratory, University of Geneva, Switzerland. Boulevard Carl-Vogt 101, 
1205, Geneva, Switzerland.
(6)Faculty of Psychology and Educational Sciences, Center for the 
Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, 
Switzerland, Boulevard du Pont d'Arve 28, 1205, Geneva, Switzerland.
(7)University Hospitals and University of Geneva, Memory Center, Rue 
Gabrielle-Perret-Gentil 6, 1205, Geneva, Switzerland.
(8)Leenaards Memory Center, Lausanne University Hospital, Chemin de 
Mont-Paisible 16, 1011, Lausanne, Switzerland.
(9)CIBM Center for Biomedical Imaging, MRI HUG-UNIGE, University of Geneva, 
Geneva, Switzerland.

BACKGROUND: Regular cognitive training can boost or maintain cognitive and brain 
functions known to decline with age. Most studies administered such cognitive 
training on a computer and in a lab setting. However, everyday life activities, 
like musical practice or physical exercise that are complex and variable, might 
be more successful at inducing transfer effects to different cognitive domains 
and maintaining motivation. "Body-mind exercises", like Tai Chi or psychomotor 
exercise, may also positively affect cognitive functioning in the elderly. We 
will compare the influence of active music practice and psychomotor training 
over 6 months in Mild Cognitive Impairment patients from university hospital 
memory clinics on cognitive and sensorimotor performance and brain plasticity. 
The acronym of the study is COPE (Countervail cOgnitive imPairmEnt), 
illustrating the aim of the study: learning to better "cope" with cognitive 
decline.
METHODS: We aim to conduct a randomized controlled multicenter intervention 
study on 32 Mild Cognitive Impairment (MCI) patients (60-80 years), divided over 
2 experimental groups: 1) Music practice; 2) Psychomotor treatment. Controls 
will consist of a passive test-retest group of 16 age, gender and education 
level matched healthy volunteers. The training regimens take place twice a week 
for 45 min over 6 months in small groups, provided by professionals, and 
patients should exercise daily at home. Data collection takes place at baseline 
(before the interventions), 3, and 6 months after training onset, on cognitive 
and sensorimotor capacities, subjective well-being, daily living activities, and 
via functional and structural neuroimaging. Considering the current constraints 
of the COVID-19 pandemic, recruitment and data collection takes place in 3 
waves.
DISCUSSION: We will investigate whether musical practice contrasted to 
psychomotor exercise in small groups can improve cognitive, sensorimotor and 
brain functioning in MCI patients, and therefore provoke specific benefits for 
their daily life functioning and well-being.
TRIAL REGISTRATION: The full protocol was approved by the Commission cantonale 
d'éthique de la recherche sur l'être humain de Genève (CCER, no. 2020-00510) on 
04.05.2020, and an amendment by the CCER and the Commission cantonale d'éthique 
de la recherche sur l'être humain de Vaud (CER-VD) on 03.08.2021. The protocol 
was registered at clinicaltrials.gov (20.09.2020, no. NCT04546451).

© 2023. The Author(s).

DOI: 10.1186/s12877-022-03678-0
PMCID: PMC9900212
PMID: 36747142 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that there are no competing 
interests.


1029. J Affect Disord. 2023 Apr 14;327:391-396. doi: 10.1016/j.jad.2023.02.006. Epub 
2023 Feb 4.

The increase in suicide risk in older adults in Taiwan during the COVID-19 
outbreak.

Chen YY(1), Yang CT(2), Yip PSF(3).

Author information:
(1)Taipei City Psychiatric Centre, Taipei City Hospital, Taipei City, Taiwan; 
Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung 
University, Taipei City, Taiwan.
(2)Department of Statistics and Actuarial Science, The University of Hong Kong, 
Hong Kong.
(3)Department of Social Work and Social Administration, The University of Hong 
Kong, Hong Kong; The Hong Kong Jockey Club Centre for Suicide Research and 
Prevention, The University of Hong Kong, Hong Kong. Electronic address: 
sfpyip@hku.hk.

BACKGROUND: Studies from Western countries indicated that older adults were more 
resilient than younger ones to deteriorating mental health during the COVID-19 
pandemic. As high late-life suicide rates have been reported in East Asia, it is 
possible that the pandemic impact might differ between East and West. We 
investigated the pandemic impact on age-specific suicide patterns in Taiwan.
METHODS: Interrupted time-series analysis was used to model the overall, and 
age-stratified, monthly suicide rates before (January 1st, 2017 to December 
31st, 2019) and after (January 1st 2020 to December 31st 2021) the COVID-19 
outbreak. Associations between confirmed COVID-19 deaths and suicide rates were 
also assessed.
RESULTS: There was a significant decrease in overall suicide rates after the 
COVID-19 outbreak (p < 0.01) (annual average rates per 100,000 population of 
16.4 prior, 15.2 after). The overall decrease was driven by fewer suicide deaths 
in the young- and older-middle-aged groups (25-44 and 45-64 years). However 
suicide rates in younger-age group (<25 years) were already increasing 
pre-pandemic, a trend which continued after the outbreak. Suicide rates for 
older people (≥65 years) also increased along with the increasing number of 
COVID-19 deaths during the pandemic period.
LIMITATIONS: Under-reporting and/or misclassification of suicides were possible.
CONCLUSIONS: The overall suicide rates in Taiwan did not change after the 
COVID-19 outbreak; however, suicide in older adults increased. Public health 
measures to reduce COVID-19 infections may have unintended and adverse 
consequences on the psychological wellbeing of older citizens.

Copyright © 2023. Published by Elsevier B.V.

DOI: 10.1016/j.jad.2023.02.006
PMCID: PMC9898058
PMID: 36746245 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest None declared.


1030. Int J Nurs Stud. 2023 Mar;139:104446. doi: 10.1016/j.ijnurstu.2023.104446. Epub 
2023 Jan 21.

What interventions and programmes are available to support older nurses in the 
workplace? A literature review of available evidence.

Montayre J(1), Knaggs G(2), Harris C(2), Li W(2), Tang LM(3), de Almeida Neto 
A(4), Antoniou M(2).

Author information:
(1)The MARCS Institute for Brain, Behaviour and Development, Western Sydney 
University, Penrith, NSW 2751, Australia; School of Nursing and Midwifery, 
Western Sydney University, Penrith, NSW 2751, Australia. Electronic address: 
j.montayre@westernsydney.edu.au.
(2)The MARCS Institute for Brain, Behaviour and Development, Western Sydney 
University, Penrith, NSW 2751, Australia.
(3)School of Architecture and Built Environment, The University of Newcastle, 
Newcastle, NSW 2308, Australia.
(4)Centre for Work Health and Safety, NSW Government, Gosford, NSW 2250, 
Australia.

BACKGROUND: High exit rates, stalling entry rates, population ageing, and, most 
recently, the COVID-19 pandemic have placed significant strain on the world's 
nursing workforce. Both developed and developing countries face similar 
predicaments. Evidence-based programmes to support older nurses in the workplace 
are urgently needed to ensure the sustainability of a career in nursing for this 
group of healthcare professionals.
OBJECTIVES: To scope and synthesise available evidence on evaluated programmes 
and interventions implemented to support the ageing nursing workforce's health, 
wellbeing, and retention.
DESIGN: A literature review of available evidence using a systematic approach.
METHOD: Medline, Scopus, PsycINFO and CINAHL were searched for relevant 
peer-reviewed evidence. Data from the peer-reviewed literature were extracted 
separately into purpose designed-extraction spreadsheets. Information relevant 
to study design, intervention design, outcome constructs, intervention outcomes, 
and barriers and enablers to intervention success were collected. The protocol 
for this review was registered in PROSPERO [CRD42021274491].
RESULTS: Eighteen published studies were included in this review. We identified 
a range of interventions and programmes that have been implemented to support 
older nurses, which included flexible and reduced work arrangements, mentoring 
programmes, exercise and lifestyle interventions, continued professional 
development and purpose-designed remote retreats. We found limited evidence of 
evaluated outcomes from workplace support interventions that addresses the 
actual challenges faced by ageing nurses as reported in previous literature 
reviews. Interventions that were designed to promote a sense of purpose at work 
resulted in positive outcomes and appeared to more directly address the stated 
needs of older nurses. Holistic programmes and interventions that could 
potentially promote both physical well-being and psychological well-being 
required a broader, whole-of-organisation approach rather than more piecemeal 
interventions addressing individual physical and mental health concerns. 
Interventions which acknowledged older nurses' clinical expertise and experience 
(e.g., mentoring programmes) were linked to positive outcomes.
CONCLUSION: Future intervention efforts should acknowledge and balance 
intervention participation opportunities against existing everyday workload 
constraints faced by older nurses. Our review suggests the need for further 
intervention studies assessing specific outcomes such as psychological and 
emotional health, as well as interventions that more directly address the most 
pressing concerns that ageing nurses report at personal and organisational 
levels. A paradigm shift in productivity measurement in clinical nursing work is 
required in order to increase the value placed on the unique contribution of 
older nurses working clinically, particularly in sharing their acquired 
knowledge, skill, and expertise.

Copyright © 2023 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.ijnurstu.2023.104446
PMCID: PMC9862664
PMID: 36746012 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


1031. Eur Child Adolesc Psychiatry. 2023 Dec;32(12):2593-2609. doi: 
10.1007/s00787-023-02147-2. Epub 2023 Feb 4.

Almost 2 years into the COVID-19 pandemic: an update on parental stress, parent 
mental health, and the occurrence of child maltreatment.

Calvano C(1)(2), Engelke L(3), Holl-Etten AK(4), Renneberg B(#)(3), Winter 
SM(#)(4).

Author information:
(1)Clinical Child and Adolescent Psychology and Psychotherapy, Freie Universität 
Berlin, Habelschwerdter Allee 45, 14195, Berlin, Germany. 
Claudia.calvano@fu-berlin.de.
(2)Clinical Child and Adolescent Psychology, Christian-Albrechts-Universität zu 
Kiel, Olshausenstr. 62, 24118, Kiel, Germany. Claudia.calvano@fu-berlin.de.
(3)Clinical Psychology and Psychotherapy, Freie Universität Berlin, 
Habelschwerdter Allee 45, 14195, Berlin, Germany.
(4)Department of Child and Adolescent Psychiatry, Psychosomatics and 
Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie 
Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 
13353, Berlin, Germany.
(#)Contributed equally

Comment in
    Eur Child Adolesc Psychiatry. 2023 Dec;32(12):2385-2386.

Increased parental stress, poorer mental health, and an increase in the 
occurrence of child maltreatment (CM) have been reported in earlier phases of 
the COVID-19 pandemic. However, data from later phases of the pandemic are not 
yet available. We conducted a cross-sectional, representative survey among 1087 
parents (48.8% female; mean age 41.72 years, SD = 9.15) in Germany in December 
2021. Data were compared to a previous representative sample, assessed in August 
2020 (N = 1024), and to normative scores of the outcome measures. Predictors for 
the occurrence of CM were analyzed by logistic regression. Pandemic-related 
stress and general stress were higher and physical and mental health were poorer 
in the December 2021 sample than in the August 2020 sample. Occurrence rates of 
CM varied between 5 and 56%. Verbal emotional abuse (n = 607, 56%), witnessing 
domestic violence (n = 446, 41%), and emotional neglect (n = 435, 40%) were most 
frequently reported. For these subtypes, parental risk for alcohol abuse (OR 
2.1-2.7) and parental recent experience of violence (OR 2.1-5.1) were the 
strongest predictors. Across all subtypes of CM, parents reporting child 
maltreatment showed poorer scores on all stress outcomes, with 
medium-large-effect sizes. Results confirm a high burden within the families, 
almost 2 years into the pandemic. Occurrence rates of a broad spectrum of CM 
subtypes raise further concerns for the well-being of children. Family-oriented 
intervention efforts are needed to stabilize families and provide targeted 
support. Longitudinal studies are needed for a description of families at risk 
for poorer outcomes.

© 2023. The Author(s).

DOI: 10.1007/s00787-023-02147-2
PMCID: PMC9899111
PMID: 36739338 [Indexed for MEDLINE]

Conflict of interest statement: None.


1032. Psychiatry Res. 2023 Mar;321:115082. doi: 10.1016/j.psychres.2023.115082. Epub 
2023 Jan 28.

The impact of COVID-19 on youth mental health: A mixed methods survey.

Bell IH(1), Nicholas J(2), Broomhall A(3), Bailey E(2), Bendall S(2), Boland 
A(4), Robinson J(2), Adams S(5), McGorry P(2), Thompson A(6).

Author information:
(1)Orygen, Melbourne, Australia; Centre for Youth Mental Health, University of 
Melbourne, Australia. Electronic address: imogen.bell@orygen.org.au.
(2)Orygen, Melbourne, Australia; Centre for Youth Mental Health, University of 
Melbourne, Australia.
(3)Department of Psychology, Counselling and Therapy, La Trobe University, 
Australia.
(4)Department of Family Medicine & Community Health, University of 
Massachusetts, Medical School, Worcester, United States.
(5)Austin Health, Melbourne, Australia.
(6)Orygen, Melbourne, Australia; Centre for Youth Mental Health, University of 
Melbourne, Australia; Division of Mental Health and Wellbeing, University of 
Warwick, United Kingdom.

The COVID-19 pandemic has presented profound disruptions to young people at a 
critical period of psychosocial development. The current study aimed to explore 
the perceived negative and positive impacts of the COVID-19 pandemic on young 
people's mental health and wellbeing across a spectrum of clinical needs. A 
cross-sectional online survey including both quantitative and qualitative 
responses captured positive and negative impacts of COVID-19 across 593 young 
people with and without mental health care needs. Findings revealed high levels 
of clinical depression (48%), anxiety (51%), and loneliness in both samples. 
Approximately 75% of young people in primary mental health care services, and 
over 80% in the general population, reported a negative impact on work, non-work 
activities and mental health and wellbeing. Open-ended responses reflected 
positive impacts in the domains of greater capacity for self-care and reflection 
due to the decreased pressures of daily life. Negative impacts reflected 
worsening mental health, disruptions to key developmental milestones regarding 
relationships with self and others, and limited capacity for self-care. 
Together, these data highlight the critical need for early intervention support 
for the psychosocial impacts experienced by young people due to the pandemic, 
particularly among those with existing mental health care needs.

Copyright © 2023. Published by Elsevier B.V.

DOI: 10.1016/j.psychres.2023.115082
PMCID: PMC9883078
PMID: 36738592 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
state they have no conflict of interest to disclose


1033. Sociol Health Illn. 2023 May;45(4):791-809. doi: 10.1111/1467-9566.13612. Epub 
2023 Feb 4.

Practising care in a pandemic: Accounting for everyday life during COVID-19 
among people who inject drugs.

Rance J(1), Bryant J(1), Caruana T(1), Brener L(1).

Author information:
(1)Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, 
Australia.

From the outset of the COVID-19 pandemic, fears have been raised worldwide 
regarding the unique challenges facing socially marginalised people such as 
those who inject drugs. This article draws on in-depth interviews conducted 
during the first year of the pandemic with people who inject drugs living in 
urban and regional Australia. Perhaps the most surprising finding to emerge was 
the number of participants who reported minimal disruption to their everyday 
lives, even improved wellbeing in some instances. Attempting to make sense of 
this unanticipated finding, our analysis draws on the concept of 'care', not as 
a moral disposition or normative code but as something emergent, contingent and 
realised in practice. Working with Foucault's ethics and recent feminist 
insights on the politics of care from the field of Science and Technology 
Studies, we explore how care was enacted in the everyday lives of our 
participants. We examine how participants' daily routines became objects of care 
and changed practice in response to the pandemic; how their ongoing engagement 
with harm reduction services afforded not only clinical support but vital forms 
of social and affective connection; and how for some, care was realised through 
an ethos and practice of constrained sociality and solitude.

© 2023 The Authors. Sociology of Health & Illness published by John Wiley & Sons 
Ltd on behalf of Foundation for the Sociology of Health & Illness.

DOI: 10.1111/1467-9566.13612
PMID: 36738164 [Indexed for MEDLINE]


1034. BMC Geriatr. 2023 Feb 3;23(1):71. doi: 10.1186/s12877-023-03764-x.

Psychosocial changes during COVID-19 lockdown on nursing home residents, their 
relatives and clinical staff: a prospective observational study.

Oliveira ACS(1), Gallego MG(2), Martínez CG(1), Martínez EC(1)(3), Molina JM(3), 
Morante JJH(4)(5), Pérez PE(1).

Author information:
(1)Research Group of Nursing Languages in Social Context, Faculty of Nursing, 
UCAM Universidad Católica San Antonio de Murcia, Campus de Guadalupe, Murcia, 
Spain.
(2)Department of Neurology and Mental Health, Faculty of Nursing, UCAM 
Universidad Católica San Antonio de Murcia, Murcia, Spain.
(3)"Mensajeros de La Paz" Nursing Home Association, Murcia, Spain.
(4)Research Group of Nursing Languages in Social Context, Faculty of Nursing, 
UCAM Universidad Católica San Antonio de Murcia, Campus de Guadalupe, Murcia, 
Spain. jjhernandez@ucam.edu.
(5)Eating Disorders Research Unit, UCAM Universidad Católica San Antonio de 
Murcia, Campus de Guadalupe, s/n, 30107, Murcia, Spain. jjhernandez@ucam.edu.

BACKGROUND: Previous works have observed an increase of depression and other 
psychological disorders on nursing home residents as a consequence of 
coronavirus disease 2019 (COVID-19) lockdown; however, there are few studies 
that have performed a comprehensive evaluation of all people involved in nursing 
homes environment. The objective of the work was to analyse the impact of 
lockdown on psychosocial factors of nursing home residents, relatives and 
clinical staff and how these variables have influenced residents' survival.
METHODS: A prospective study was designed. Evaluations were performed at three 
different times: a) at the beginning of Spanish confinement, in March 2020; b) 
just before the second wave of the pandemic, with relaxation of security 
measures but in lockdown, and c) in January-February 2021, at the end of the 
second wave, when visits were already allowed. The study was conducted on three 
different nursing homes. Three hundred and one residents, 119 clinical staff and 
51 relatives took part in the study. Anxiety and depression were evaluated in 
all participants. A scale on the meaning of suffering was also performed. In 
addition, burnout status was also determined in the clinical staff.
RESULTS: All participants showed lower depression during lockdown, while at the 
beginning and at the end of the confinement, these values were significantly 
increased. In residents, these changes were dependent of cognitive status 
(p = 0.012). Anxiety was significantly higher in residents. The evolution of 
anxiety was similar than with depression, with lower values during confinement, 
although clinical staff showed higher anxiety levels at the beginning. The 
feeling of suffering was significantly lower in the clinical staff than in 
resident and relative groups. Residents' survival was dependent of cognitive 
status (p = 0.018) and voluntary confinement (p < 0.001).
CONCLUSIONS: During the first COVID-19 lockdown, psychological wellbeing of 
residents cared in nursing homes, their relatives and staff did not seem to be 
seriously affected. Previous mental health in relatives and staff together with 
a resilient approach to the adversity might partly be protecting factors. The 
lack of consequences on residents' anxiety, depression and perception of social 
support may reflect the special attention and care they received. Finally, as in 
the current study only data of the first two COVID-19 waves were analysed, its 
findings might be partly generalized to all the pandemic.

© 2023. The Author(s).

DOI: 10.1186/s12877-023-03764-x
PMCID: PMC9897885
PMID: 36737683 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1035. Nurs Outlook. 2023 Mar-Apr;71(2):101917. doi: 10.1016/j.outlook.2023.101917. 
Epub 2023 Feb 1.

American Academy of Nursing consensus recommendations to advance system level 
change for nurse well-being.

Naegle MA(1), Kelly LA(2), Embree JL(2), Valentine N(2), Sharp D(3), Grinspun 
D(2), Hines-Martin VP(3), Crawford CL(2), Rosa WE(4).

Author information:
(1)Psychiatric Mental Health and Substance Use Expert Panel, New York, NY. 
Electronic address: man1@nyu.edu.
(2)Building Health Care Systems Excellence Expert Panel.
(3)Psychiatric Mental Health and Substance Use Expert Panel, New York, NY.
(4)Global Health Expert Panel.

The COVID-19 pandemic has required close examination of workforce-related 
stressors that over decades have contributed to widespread burnout, negative 
health outcomes, including mental health outcomes, and the loss of the 
well-educated professionals who are the future of the nursing profession. In the 
United States and globally, evidence points to factors known to diminish 
well-being, including inequities, issues of minority status, persistent 
discrimination, and demanding work environments. The American Academy of Nursing 
(AAN), dedicated to organizational excellence, nursing leadership and 
evidence-based policy, develops statements reflecting its mission and those of 
its nursing affiliates and corporate member, The American Nurses Association. 
Within nursing, despite the efforts of its members toward advancement, 
professional fulfillment is often constrained by the systems in which nurses 
practice and workplace factors over which they have little control. Action by 
key organizations to initiate changes at systems levels in workplace safety, to 
increase professional mobility, and propel policies that increase access to 
health care resources could improve nurse well-being. This paper proposes 
recommendations from the AAN Expert Panels on Building Health Care System 
Excellence, Psychiatric Mental Health and Substance Use, and Global Health 
Expert Panels for the American Academy of Nursing to leverage related policy in 
the arenas of government and professional/healthcare organizations. Transforming 
health care work environments and advancing nurse well-being and equity can be 
accomplished through key, innovative policy changes. These will be achieved 
through collaboration among associations, organizations, nonprofit groups, and 
with the public and the media.

Copyright © 2023. Published by Elsevier Inc.

DOI: 10.1016/j.outlook.2023.101917
PMCID: PMC9889942
PMID: 36736029 [Indexed for MEDLINE]


1036. Int J Soc Psychiatry. 2023 Aug;69(5):1145-1156. doi: 10.1177/00207640231152208. 
Epub 2023 Feb 3.

Determinants of depression and anxiety in homeless people: A population survey 
of homeless people in Hong Kong.

Chan SM(1), Wong H(2), Chen Y(3), Tang MV(4).

Author information:
(1)Department of Social and Behavioural Sciences, City University of Hong Kong, 
Hong Kong SAR, China.
(2)Department of Social Work, The Chinese University of Hong Kong, Hong Kong 
SAR, China.
(3)Department of Educational Psychology, The Chinese University of Hong Kong, 
Hong Kong SAR, China.
(4)Asia-Pacific Institute of Ageing Studies, Lingnan University, Hong Kong SAR, 
China.

BACKGROUND: There are growing concerns about the homeless and mental health 
issues globally. This study aims to examine the mental health situation of 
homelessness and the determinants of anxiety and depression of them in Hong 
Kong.
METHOD: The data from the largest territory-wide study of the homeless 
population in 2021 was analyzed. Descriptive statistics and logistic regressions 
were used to investigate the association between mental health and socioeconomic 
variables, including demographic background, economic indicators, COVID-19 
worries, government measures, and respect by others. The symptoms of depression 
and anxiety were assessed using Patient Health Questionnaire (PHQ) and General 
Anxiety Disorder (GAD).
RESULTS: The results showed that being female, food insecurity, and chronic 
diseases were the risk factors for anxiety and depression. A high level of 
respect by others was the protective factor for depression (adjusted OR 0.37, 
95% CI [0.23, 0.61]) and anxiety (adjusted OR 0.40, 95% CI [0.24, 0.68]), 
compared to a low level of respect in the multivariate model.
CONCLUSIONS: Providing medical outreach services, additional resources for 
social services, implementation of homeless-friendly policies, and a progressive 
supply of public and transitional housing would help enhance the well-being of 
the homeless population.

DOI: 10.1177/00207640231152208
PMID: 36734241 [Indexed for MEDLINE]


1037. J Psychiatr Ment Health Nurs. 2023 Aug;30(4):679-698. doi: 10.1111/jpm.12909. 
Epub 2023 Feb 21.

Exploring the benefits and challenges of being a consumer educator in nursing 
education: A scoping review.

Yousiph T(1), Patterson C(1), Moxham L(1)(2)(3).

Author information:
(1)University of Wollongong, Wollongong, New South Wales, Australia.
(2)Illawarra Health and Medical Research Institute (IHMRI), Wollongong, 
Australia.
(3)Australian Health Services Research Institute (AHSRI), Wollongong, Australia.

WHAT IS KNOWN ON THE SUBJECT?: The mental health needs of individuals are 
increasing following the COVID-19 pandemic, with a need to focus on the 
education of nurses to be equipped to respond. Stigma around mental health still 
exists for nursing students, with the implementation of mental health education 
by an individual with lived experience having a known positive effect on 
stigmatizing attitudes. Research on consumer involvement in nursing education 
identifies that the consumer role is often varied and casual, with no existing 
review on the consumer experience. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: 
The study emphasizes the importance of consumer involvement in nursing 
education. Alongside the literature focussing on the student benefits, this 
review highlights both the benefits of being an educator, and the challenges of 
being an educator from the consumer's perspective. WHAT ARE THE IMPLICATIONS FOR 
PRACTICE: The knowledge around the consumer perspective mapped in this review 
has the potential to impact and transform education protocols for consumer 
involvement in education. This can maximize on the meaningful contribution that 
lived experience has within mental health nursing education. This review 
enforces the need for an awareness of the challenges consumers face in their 
role as an educator, and highlights the need for further understanding of how to 
overcome these challenges. There is also an opportunity to capitalize on the 
benefits identified by consumers in their role within nursing education and 
sharing their lived experience. ABSTRACT: Introduction While the mental health 
needs of populations are increasing, the targeted training of mental health 
professionals, specifically nurses, is required. Stigma surrounding mental 
health from nursing students exists, highlighting educational gaps. To address 
this, the involvement of consumers in undergraduate education has resulted in a 
positive effect on the stigmatizing attitudes of nursing students. There is 
still a limited understanding, however, of the consumers experience in this 
process. Aim To explore the experiences of individuals living with mental 
illness in educating nursing students. Methods The Joanna Brigg's Institute's 
(JBI) methodology for scoping reviews was used to search CINAHL, Medline, 
PsychInfo, Web of Science and Scopus including grey literature. The eligibility 
criteria for participants included individuals (a) diagnosed with a mental 
illness; (b) over 18 years of age; and (c) who participated in the educating of 
nursing students surrounding mental health in any context. Articles were only 
considered that were in the English language, and no time constraint was 
enforced during the search strategy for article selection. The search yielded 
2640 results, of which 26 articles were included. Results Results found two 
prominent categories, including both benefits and challenges of being the 
educator from the consumer perspective. The benefits included: (a) the person 
behind the diagnosis; (b) reciprocal relationships; (c) positive effects on 
well-being; (d) unique contribution; and (e) purpose in storytelling. Challenges 
identified included: (a) vulnerability; (b) voyeuristic; (c) lack of 
preparation; (d) negative effects on well-being; (e) support; (f) not a real 
consumer; (g) variation of involvement; and (h) acknowledging consumer 
perspective. Discussion As consumer-led education for mental health nursing 
curriculum becomes mandated, amplifying the voice of the consumer in nursing 
education is crucial. While the benefits and challenges voiced by consumers in 
their involvement in mental health nursing education have been outlined here, 
further knowledge focussed on the consumer's experience as an educator outside 
the classroom setting, and in clinical practicum, alongside consumer involvement 
in specialized mental health education sessions, could aid in transforming 
consumer involvement. Implications for practice This review offers an incentive 
for nurse educators to capitalize on the benefits of educating for consumers to 
promote a meaningful contribution, while also practicing with an awareness of 
voiced challenges.

© 2023 The Authors. Journal of Psychiatric and Mental Health Nursing published 
by John Wiley & Sons Ltd.

DOI: 10.1111/jpm.12909
PMID: 36734153 [Indexed for MEDLINE]


1038. Harm Reduct J. 2023 Feb 2;20(1):12. doi: 10.1186/s12954-023-00742-9.

The effects of COVID-19 on New York State's Drug User Health Hubs and syringe 
service programs: a qualitative study.

Ude M(1), Behrends CN(2), Kelly S(3), Schackman BR(2), Clear A(3), Goldberg 
R(3), Gelberg K(3), Kapadia SN(4)(5).

Author information:
(1)Weill Cornell Medical College, New York, NY, 10065, USA.
(2)Department of Population Health Sciences, Weill Cornell Medical College, New 
York, NY, 10065, USA.
(3)New York State Department of Health, New York, NY, 10007, USA.
(4)Department of Population Health Sciences, Weill Cornell Medical College, New 
York, NY, 10065, USA. shk9078@med.cornell.edu.
(5)Division of Infectious Diseases, Weill Cornell Medical College, New York, NY, 
10065, USA. shk9078@med.cornell.edu.

BACKGROUND: Syringe service programs (SSPs) deliver critical harm reduction 
services to people who inject drugs (PWID). Some SSPs in New York State received 
enhanced funding to provide additional services to combat opioid overdose 
fatalities. These SSPs, known as Drug User Health Hubs, provide buprenorphine 
for the treatment of opioid use disorder and other health-related services in 
addition to their syringe services. While the COVID-19 pandemic posed widespread 
challenges to the delivery of health services nationwide, the effect of the 
pandemic on SSPs uniquely impacts PWID. This study examines the impact of 
COVID-19 on service delivery of Drug User Health Hubs and stand-alone SSPs in 
New York State.
METHODS: Between July 2020 and September 2020, we performed eleven 
semi-structured virtual interviews with staff from three Health Hub SSPs and 
three stand-alone SSPs. The interviews explored the effect of the COVID-19 
pandemic on SSPs and their clients as well as the changes implemented in 
response. Interviews were recorded and transcribed. We performed content 
analysis to identify emerging themes from the data.
RESULTS: Due to the COVID-19 pandemic, some SSPs temporarily shut down while 
others limited their hours of operation. SSPs modified their service delivery to 
maintain syringe services and naloxone distribution over other services such as 
STI and HCV testing. They virtualized components of their services, including 
telemedicine for the provision of buprenorphine. While SSPs found virtualization 
to be important for maintaining their services, it negatively impacted the 
intimate nature of client interactions. Participants also described the impact 
of the pandemic on the well-being of PWID, including isolation, worsened mental 
health challenges, and increased drug overdoses.
CONCLUSIONS: In response to the COVID-19 pandemic, SSPs demonstrated innovation, 
adaptability, and togetherness. Despite the challenges posed by the pandemic, 
SSPs continued to be key players in maintaining access to sterile supplies, 
buprenorphine, and other services for PWID. In addition to adapting to COVID-19 
restrictions, they also responded to the dynamic needs of their clients. 
Sustainable funding and recognition of the critical role of SSPs in supporting 
PWID can help to improve outcomes for PWID.

© 2023. The Author(s).

DOI: 10.1186/s12954-023-00742-9
PMCID: PMC9893960
PMID: 36732773 [Indexed for MEDLINE]

Conflict of interest statement: Dr. Kapadia has received research grants to his 
institution from Gilead Sciences Inc unrelated to the current study. All other 
authors report no potential conflicts of interest.


1039. BMC Public Health. 2023 Feb 2;23(1):232. doi: 10.1186/s12889-023-15127-7.

The psychological burden of COVID-19 on the desire for parenthood in minoritized 
sexual identities: a study on depressive symptoms and family planning in 
Germany.

Batz F(1), Lermer E(2)(3), Lech S(4)(5), O'Malley G(6), Zati Zehni A(1), 
Zenz-Spitzweg D(7), Mahner S(1), Behr J(8)(9)(10), Thaler CJ(1), Buspavanich 
P(11)(12)(13).

Author information:
(1)Department of Obstetrics and Gynecology, Center for Gynecological 
Endocrinology and Reproductive Medicine, University Hospital, LMU Munich, 
Munich, Germany.
(2)Center for Leadership and People Management, LMU Munich, Munich, Germany.
(3)Department of Business Psychology, Augsburg University of Applied Sciences, 
Augsburg, Germany.
(4)Institute of Medical Sociology and Rehabilitation Science, Charité - 
Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and 
Humboldt- Universität zu Berlin, Berlin, Germany.
(5)Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin 
Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu 
Berlin, Berlin, Germany.
(6)Department of Paediatric Oncology/Haematology, Charité - Universitätsmedizin 
Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu 
Berlin, Berlin, Germany.
(7)Applied Business and Media Psychology, Ansbach University of Applied 
Sciences, Ansbach, Germany.
(8)Department of Psychiatry, Psychotherapy and Psychosomatics, Brandenburg 
Medical School Theodor Fontane, Fehrbelliner Str. 38, 16816, Neuruppin, Germany.
(9)Faculty of Health Sciences Brandenburg, Joint Faculty of the University of 
Potsdam, Brandenburg University of Technology Cottbus-Senftenberg and 
Brandenburg Medical School, Potsdam, Germany.
(10)Research Unit Gender in Medicine, Department of Psychiatry and 
Psychotherapy, Institute of Sexology and Sexual Medicine, Charité - 
Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and 
Humboldt-Universität zu Berlin, Berlin, Germany.
(11)Department of Psychiatry, Psychotherapy and Psychosomatics, Brandenburg 
Medical School Theodor Fontane, Fehrbelliner Str. 38, 16816, Neuruppin, Germany. 
pichit.buspavanich@charite.de.
(12)Faculty of Health Sciences Brandenburg, Joint Faculty of the University of 
Potsdam, Brandenburg University of Technology Cottbus-Senftenberg and 
Brandenburg Medical School, Potsdam, Germany. pichit.buspavanich@charite.de.
(13)Research Unit Gender in Medicine, Department of Psychiatry and 
Psychotherapy, Institute of Sexology and Sexual Medicine, Charité - 
Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and 
Humboldt-Universität zu Berlin, Berlin, Germany. pichit.buspavanich@charite.de.

Erratum in
    BMC Public Health. 2023 Mar 30;23(1):609.

BACKGROUND: The COVID-19 pandemic continues to spread across the globe and is 
associated with significant clinical and humanitarian burden. The desire for 
parenthood has been described to be positively correlated with psychological 
well-being: An unfulfilled wish for parenthood is associated with impaired 
mental health, and the wish for parenthood is a predictor for the development of 
depressive symptoms. While higher rates of anxiety and depression have been 
reported in individuals with minoritized sexual identities (compared to 
heterosexual individuals) during the COVID-19 pandemic, the specific impact of 
the pandemic and its social restriction measures on this population is poorly 
understood.
METHODS: From April to July 2020, we conducted an anonymous cross-sectional 
survey online among N = 2463 adults living in Germany. We screened for 
depressive symptoms (Patient Health Questionnaire-4; PHQ-4) and assessed 
individuals' desire for parenthood during the pandemic, and motives for or 
against the desire for parenthood (Leipzig questionnaire on motives for having a 
child, Version 20; LKM-20), with the aim of identifying differences between 
individuals with minoritized sexual identities and heterosexual individuals.
RESULTS: Compared to heterosexual individuals (n = 1304), individuals with 
minoritized sexual identities (n = 831) indicated higher levels of depressive 
symptoms. In our study sample the majority of all participants (81.9%) reported 
no change in the desire for parenthood since the COVID-19 pandemic.
CONCLUSION: The findings underline the unmet need for social, psychological and 
medical support in regard to family-planning and the desire for parenthood 
during a pandemic. Furthermore, future research should explore COVID-19-related 
psychological consequences on individuals' desire for parenthood and building a 
family.

© 2023. The Author(s).

DOI: 10.1186/s12889-023-15127-7
PMCID: PMC9894671
PMID: 36732703 [Indexed for MEDLINE]

Conflict of interest statement: Sven Mahner reports Research support, advisory 
board, honoraria and travel expenses from AbbVie, AstraZeneca, Clovis, Eisai, 
GlaxoSmithKline, Medac, MSD, Novartis, Olympus, PharmaMar, Pfizer, Roche, Sensor 
Kinesis, Teva, and Tesaro. All other authors have no conflict of interest to 
declare.


1040. J Occup Environ Med. 2023 Apr 1;65(4):e184-e194. doi: 
10.1097/JOM.0000000000002745. Epub 2022 Nov 16.

Assessing the Mental Health Impact of the COVID-19 Pandemic on US Fire-Based 
Emergency Medical Services Responders: A Tale of Two Samples (The RAPID Study 
I).

Raposa ME(1), Mullin G, Murray RM, Shepler LJ, Castro KC, Fisher AB, Gallogly 
VH, Davis AL, Resick CJ, Lee J, Allen JA, Taylor JA.

Author information:
(1)From the Department of Environmental and Occupational Health, Dornsife School 
of Public Health at Drexel University, Philadelphia, Pennsylvania (M.E.R., G.M., 
A.B.F., V.H.G., A.L.D., J.A.T.); Department of Health, Human Performance and 
Recreation at the College of Education and Health Professions at the University 
of Arkansas, Fayetteville, Arkansas (R.M.M.); Spaulding Rehabilitation Hospital, 
Harvard Medical School, Boston, Massachusetts (L.J.S.); Department of Family and 
Preventative Medicine, University of Utah, Salt Lake City, Utah (K.C.C., 
J.A.A.); Department of Management and Organizational Behavior, LeBow College of 
Business at Drexel University, Philadelphia, Pennsylvania (C.J.R.); and 
Department of Psychological Sciences, Kansas State University, Manhattan, Kansas 
(J.L.).

OBJECTIVE: This study aimed to examine the COVID-19 pandemic's impact on fire 
service safety culture, behavior and morale, levers of well-being, and 
well-being outcomes.
METHODS: Two samples (Stress and Violence against fire-based EMS Responders 
[SAVER], consisting of 3 metropolitan departments, and Fire service 
Organizational Culture of Safety [FOCUS], a geographically stratified random 
sample of 17 departments) were assessed monthly from May to October 2020. Fire 
department-specific and pooled scores were calculated. Linear regression was 
used to model trends.
RESULTS: We observed concerningly low and decreasing scores on management 
commitment to safety, leadership communication, supervisor sensegiving, and 
decision-making. We observed increasing and concerning scores for burnout, 
intent to leave the profession, and percentage at high risk for anxiety and 
depression.
CONCLUSIONS: Our findings suggest that organizational attributes remained 
generally stable but low during the pandemic and impacted well-being outcomes, 
job satisfaction, and engagement. Improving safety culture can address the 
mental health burden of this work.

Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on 
behalf of the American College of Occupational and Environmental Medicine.

DOI: 10.1097/JOM.0000000000002745
PMCID: PMC10090321
PMID: 36730580 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest: None declared.


1041. Anesth Analg. 2023 Aug 1;137(2):392-398. doi: 10.1213/ANE.0000000000006298. Epub 
2022 Dec 2.

Burnout Among Chinese Anesthesiologists After the COVID-19 Pandemic Peak: A 
National Survey.

Che L(1), Ma S, Zhang YL, Huang Y.

Author information:
(1)From the Department of Anesthesiology, Peking Union Medical College Hospital, 
Beijing, China.

BACKGROUND: Evidence has shown that large-scale pandemics can have prolonged 
psychological impacts on health care professionals. The current study aimed to 
evaluate the prevalence of burnout after the coronavirus disease 2019 (COVID-19) 
epidemic peak and to explore the prolonged impact of COVID-19 on burnout among 
Chinese anesthesiologists.
METHODS: From August 2021 to October 2021, a nationwide cross-sectional survey 
was conducted. Burnout was measured using the Maslach Burnout Inventory-Human 
Service Survey. Basic demographic information, exposure to COVID-19, and 
perceived institutional support were documented. Validated tools measuring 
mental health status, including anxiety, depression, post-traumatic stress 
disorder (PTSD) and resilience, were also used to provide additional information 
on psychological distress.
RESULTS: Of the 8850 anesthesiologists from the 218 institutions who were 
invited to participate, 6331 (74.93%) completed the surveys and were included in 
the analysis. A total of 52.7% (95% confidence interval [CI], 51.5-53.9) met the 
criteria for burnout. Depression, anxiety, and PTSD were positively associated 
with burnout. After pooled multivariate analysis adjusting for potential 
confounding factors, among the COVID-19 exposure parameters, redeployment 
outside normal professional boundaries remained associated with an increased 
risk of burnout (odds ratio, 0.84; 95% CI, 0.72-0.92; P = .039). Higher 
perceived institutional support and resilience could act as protective factors 
against burnout.
CONCLUSIONS: The impact of the COVID-19 epidemic on the psychological well-being 
of anesthesiologists still exists more than 1 year after the outbreak. Building 
better institutional support and cultivating stronger resilience may be helpful 
future intervention measures.

Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on 
behalf of the International Anesthesia Research Society.

DOI: 10.1213/ANE.0000000000006298
PMCID: PMC10319244
PMID: 36729947 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


1042. Early Hum Dev. 2023 Jan;176:105717. doi: 10.1016/j.earlhumdev.2023.105717. Epub 
2023 Jan 27.

Acceptability and feasibility of a digital educational intervention designed to 
improve the psychological well-being of parents with a preterm infant at the 
neonatal intensive care unit: A pilot project.

Collette K(1), Feeley N(2), Galipeau R(3), Lebel V(4).

Author information:
(1)Université du Québec en Outaouais, Nursing Department, 5 rue St-Joseph, 
St-Jérôme, Québec J7Z 0B7, Canada. Electronic address: colk04@uqo.ca.
(2)Ingram School of Nursing at McGill University, Montreal, Québec, Canada; 
Jewish General Hospital Centre for Nursing Research, Lady Davis Institute, 
Montreal, Québec, Canada.
(3)Université du Québec en Outaouais, Nursing Department, 5 rue St-Joseph, 
St-Jérôme, Québec J7Z 0B7, Canada.
(4)Université du Québec en Outaouais, Nursing Department, 5 rue St-Joseph, 
St-Jérôme, Québec J7Z 0B7, Canada. Electronic address: valerie.lebel@uqo.ca.

BACKGROUND: Families experience psychological distress when their preterm infant 
is in the Neonatal Intensive Care Unit. A tailored educational intervention may 
be beneficial for their psychological well-being. Unfortunately, existing 
websites have moderate to low information quality and there is no educational 
website for French-speaking parents.
AIM: To measure the acceptability and feasibility of a digital educational 
intervention designed to improve the psychological well-being of parents with a 
preterm infant, as well as the acceptability and feasibility of the study 
methods used.
METHODS: A pilot randomized controlled trial was conducted. Participants were 
randomized to have access to either an educational website or information 
pamphlet. They were invited to complete an online questionnaire about stress and 
depressive symptoms 2 and 4 weeks after recruitment. An online questionnaire 
regarding the acceptability of the intervention and the data collection process 
was completed 5 weeks after recruitment.
RESULTS: Twenty parents participated. All participants with access to the 
website considered it was acceptable in terms of the appropriateness, 
convenience, and efficiency to meet their informational needs. 85 % of 
participants assigned to the website viewed it 1 to 3 times per day during the 
data collection period and 69.4 % consulted the website for 5 to 20 min each 
time. The data collection process was acceptable for 85 % to 95 % of 
participants.
DISCUSSION: The educational website was an acceptable and feasible intervention 
and the data collection process used was acceptable according to participants.

Copyright © 2023 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.earlhumdev.2023.105717
PMID: 36724661 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare no conflict of interest.


1043. Cyberpsychol Behav Soc Netw. 2023 Feb;26(2):90-97. doi: 10.1089/cyber.2022.0281. 
Epub 2023 Jan 31.

Nostalgic Social Media Use and Psychological Well-Being During the COVID-19 
Pandemic.

Lee-Won RJ(1), Lee EJ(2), Lee JA(3).

Author information:
(1)School of Communication, The Ohio State University, Columbus, Ohio, USA.
(2)Department of Communication, Seoul National University, Seoul, Korea.
(3)Institute of Communication Research, Seoul National University, Seoul, Korea.

Physical and social distancing practices mandated during the COVID-19 pandemic 
posed serious threats to mental health on a global scale. Drawing upon the 
literature on nostalgia as a coping resource and the psychological benefits of 
nostalgic media use, we investigated the relationship between nostalgic social 
media use and psychological well-being amid the COVID-19 pandemic, considering 
perceived self-continuity as a mediator. An online survey conducted with a U.S. 
sample in June 2021 (Study 1; N = 485) showed that nostalgic social media use 
was positively associated with greater perceived self-continuity, which, in 
turn, positively predicted emotional well-being. These findings were replicated 
and extended by a follow-up online survey conducted with a South Korean sample 
in October 2021 (Study 2; N = 1,510). In addition to replicating the mediation 
results from Study 1, Study 2 demonstrated that the mediation was significantly 
moderated by household type (single-person vs. multiperson household). 
Specifically, those living alone, compared to those living with one or more 
cohabitants, were more likely to benefit from nostalgic social media use, 
maintaining higher levels of life satisfaction amid the global health crisis. 
Implications of these findings are discussed.

DOI: 10.1089/cyber.2022.0281
PMID: 36723518 [Indexed for MEDLINE]


1044. Wiad Lek. 2022;75(12):3109-3114. doi: 10.36740/WLek202212136.

INTERNET-DELIVERED LOW-INTENSITY CBT FOR PEOPLE WITH SOCIAL ANXIETY DISORDER IN 
A PERIOD OF COVID-19: RESULTS OF PILOT RESEARCH.

Avramchuk O(1), Nizdran-Fedorovych O(1), Blozva P(1), Plevachuk O(2).

Author information:
(1)UKRAINIAN CATHOLIC UNIVERSITY, LVIV, UKRAINE.
(2)DANYLO HALYTSKY LVIV NATIONAL MEDICAL UNIVERSITY, LVIV, UKRAINE.

OBJECTIVE: The aim: The study aims to provide evidence of the effectiveness of 
online low-intensity CBT-based psychological interventions on the psychological 
well-being of people with social anxiety disorders and related impairments in 
the COVID-19 pandemic.
PATIENTS AND METHODS: Materials and methods: 222 volunteers aged 18-35 years 
included in study: low-intensity CBT group (n=106) and control group (n=116). To 
assess the mental health prob¬lems were used International Neuropsychiatric 
Interview (MINI) and a set of IAPT scales. Analyses considered levels of 
pre-post intervention effect sizes and clinically significant improvement of 
symptoms of social anxiety disorder, generalized anxiety disorder, depression, 
and distress in maintaining general and work activity scores.
RESULTS: Results: Comparisons between the low-intensity interventions group and 
control (self-help guide psychological care as usual) indicated more reduction 
in the severity of symp¬toms of social anxiety disorder and comorbid impairments 
associated with depression or generalized anxiety disorder. Changes for social 
phobia and other outcomes indicate that the odds of relapse or exacerbation of 
symptoms in the control group are more significant than those after a CBT-based 
low-intensity psychosocial care program. Analysis showed a significant 
interaction between outcomes scores and the number of sessions: more than five 
online sessions and homework with a self-help guide improved outcome.
CONCLUSION: Conclusions: This pilot trial provides initial evidence that 
low-intensity online interventions based on CBT result in reductions in 
psychological problems for persons with a social anxiety disorder during the 
COVID-19 pandemic.

DOI: 10.36740/WLek202212136
PMID: 36723335 [Indexed for MEDLINE]


1045. Womens Health (Lond). 2023 Jan-Dec;19:17455057221150099. doi: 
10.1177/17455057221150099.

COVID-19-associated mental health impact on menstruation physiology: A survey 
study among medical students in Jordan.

Aolymat I(1), Al-Tamimi M(2), Almomani H(2), Abu-Hassan DW(3), Alzayadneh EM(3), 
Al-Husban N(4), Al Haj Mahmoud S(5), Alsheikh A(6).

Author information:
(1)Department of Anatomy, Physiology and Biochemistry, Faculty of Medicine, The 
Hashemite University, Zarqa, Jordan.
(2)Department of Microbiology, Pathology and Forensic Medicine, Faculty of 
Medicine, The Hashemite University, Zarqa, Jordan.
(3)Department of Physiology and Biochemistry, School of Medicine, The University 
of Jordan, Amman, Jordan.
(4)Department of Obstetrics and Gynecology, School of Medicine, The University 
of Jordan, Amman, Jordan.
(5)Department of Basic Medical Sciences, Faculty of Medicine, Al-Balqa Applied 
University, Al-Salt, Jordan.
(6)Department of Medical Laboratory Sciences, Faculty of Allied Medical 
Sciences, Zarqa University, Zarqa, Jordan.

BACKGROUND: The coronavirus disease 2019 pandemic has been an extraordinarily 
stressful situation in recent years. Stress is a physiological reaction to 
negative stimuli that is regulated by different neuroendocrine pathways. The 
female reproductive function is maintained by the menstrual cycle, which is 
negatively affected by hyperstimulation of stress signals.
OBJECTIVES: This study evaluates the effect of the coronavirus disease 2019 
outbreak on menstrual function and mental health, exploring the relationship 
between them.
DESIGN: The current study uses a cross-sectional, survey-based design.
METHODS: During this cross-sectional study, an online self-completion 
questionnaire was conducted among a sample of 385 Jordanian female medical 
students during the pandemic. The survey compared menstrual characteristics, 
depression, anxiety, and stress 10 months after the coronavirus disease 2019 
pandemic with 10 months prior. Paired t-test, McNemar's test, Pearson's 
correlation, and multiple linear regression model were employed to analyze data 
using SPSS software.
RESULTS: The mean age of female medical student respondents was 19.89 years. 
Data showed that the menstrual cycle length significantly increased during the 
coronavirus disease 2019 pandemic compared with 10 months prior (32.23 days 
versus 30.02 days, p = 0.019). The average number of heavy bleeding days also 
increased during the coronavirus disease 2019 pandemic (2.82 days versus 2.42 
days, p = 0.002). The proportion of females with heavy bleeding amount was more 
than doubled during the pandemic of coronavirus disease 2019 compared with 
before (27.3% versus 10.4%, p = 0.000). Unpleasant menstrual signs such as 
nausea and/or vomiting, breast pain, and urinary urgency were significantly 
increased during the pandemic (p = 0.000, p = 0.008, and p = 0.024, 
respectively). During coronavirus disease 2019, a positive association between 
total Depression, Anxiety, and Stress Scale-21 Questionnaire score and heavy 
bleeding was identified (p < 0.05). The findings also indicated that mental 
disorders and the incidence of amenorrhea, nausea and/or vomiting, and urinary 
urgency were positively correlated during the coronavirus disease 2019 pandemic. 
The multiple regression analysis revealed associations between several menstrual 
characteristics such as amenorrhea and severity of bleeding with coronavirus 
disease 2019-related depression, anxiety, and stress.
CONCLUSION: This study revealed that the stress related to the pandemic of 
coronavirus disease 2019 could affect the female menstrual cycle and hence the 
quality of women's life. Therefore, this study could serve as a baseline for 
planning and introducing stress mitigation interventions in crisis situations to 
improve the physiological and mental well-being of females and improve their 
quality of life.

DOI: 10.1177/17455057221150099
PMCID: PMC9892533
PMID: 36714969 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1046. Front Public Health. 2023 Jan 12;10:1057020. doi: 10.3389/fpubh.2022.1057020. 
eCollection 2022.

Brief repeated virtual nature contact for three weeks boosts university 
students' nature connectedness and psychological and physiological health during 
the COVID-19 pandemic: A pilot study.

Lau SSS(1)(2)(3)(4), Leung SSK(1)(5), Wong JWC(4)(6), Lee TCP(1)(2), Cartwright 
SR(1)(2), Wong JTC(1), Man J(1)(3), Cheung E(1)(3), Choi RPW(1).

Author information:
(1)Research Centre for Environment and Human Health, School of Continuing 
Education, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China.
(2)College of International Education, Hong Kong Baptist University, Kowloon, 
Hong Kong SAR, China.
(3)Multidisciplinary Research Centre, School of Continuing Education, Hong Kong 
Baptist University, Kowloon, Hong Kong SAR, China.
(4)Institute of Bioresources and Agriculture, Hong Kong Baptist University, 
Kowloon, Hong Kong SAR, China.
(5)Division of Nursing Education, School of Continuing Education, Hong Kong 
Baptist University, Kowloon, Hong Kong SAR, China.
(6)Department of Biology, Hong Kong Baptist University, Kowloon, Hong Kong SAR, 
China.

The COVID-19 pandemic and its associated uncertainties and restrictions have 
adverse impacts on university students' mental wellbeing. Evidence shows that 
virtual nature contact has mental health benefits. However, little is known 
about the potential beneficial health impacts of virtual nature contact during 
times of social distancing, when access to the natural environment is 
restricted. This pilot study aimed to examine the effectiveness of a 3-week 
virtual nature contact in improving nature connectedness and reducing 
psychophysiological stress. A sample of 56 university students in Hong Kong was 
randomly assigned to control and nature interventions using 2-D video played for 
15 min three times a week for 3 weeks. Nature connectedness, perceived 
restorativeness and psycho-physiological wellbeing were measured. Our findings 
show significant changes in psychological stress levels after nature 
interventions compared with the baseline, including increased happiness and 
stronger emotions of comfort and relaxation. When compared with the control 
group, the results show the nature intervention group has significantly higher 
levels of nature connectedness, happiness, and positive affect, but no 
significant effects on other psychological and physiological variables (e.g., 
cardiovascular responses). Our preliminary findings highlight the potential use 
of virtual nature contacts in bolstering university students' wellbeing at times 
of pandemic or when in-person visit to the natural environment is not feasible.

Copyright © 2023 Lau, Leung, Wong, Lee, Cartwright, Wong, Man, Cheung and Choi.

DOI: 10.3389/fpubh.2022.1057020
PMCID: PMC9878182
PMID: 36711407 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1047. Front Public Health. 2023 Jan 11;10:1062688. doi: 10.3389/fpubh.2022.1062688. 
eCollection 2022.

Social media use as a coping mechanism during the COVID-19 pandemic: A 
multidimensional perspective on adolescents' well-being.

Maftei A(1), Merlici IA(1), Dănilă O(1).

Author information:
(1)Faculty of Psychology and Education Sciences, Alexandru Ioan Cuza University, 
Iaşi, Romania.

INTRODUCTION: Social media use was previously characterized as both a 
maladaptive coping mechanism, and a source of engagement with peers, suggesting 
an ambivalent effect. The present study explored how adolescents might use 
social media as a coping mechanism during the COVID-19 pandemic, using a 
multidimensional perspective on well-being.
METHODS: Our sample consisted of 259 Romanian teenagers aged 11-16 (M = 13.38, 
SD = 0.93, 57% males). We investigated the potential indirect effect of social 
media use, i.e., its cognitive, affective, and behavioral dimensions on the 
relationship between depressive symptoms and adolescents' well-being.
RESULTS: Across all mediation analyses, our results suggested that social media 
use positively predicted adolescents' well-being. Given the multidimensional 
approach to both social media use and well-being, our findings suggested that 
adolescents' well-being was predicted not only by actual social media use 
behaviors but also by cognitions related to the expectation of receiving 
gratification on social media and the intense affective states related to the 
desire to use social media. Also, our data suggested that adolescents with high 
levels of depressive symptoms might be more likely to capitalize on social media 
use and have expectations related to receiving approval from others in the 
context of social media use.
DISCUSSION: Depressive symptoms might be more relevant when explaining the 
cognitive and affective involvement during social media use. However, their 
ability to predict the actual social media use behaviors may be limited. 
Furthermore, adolescents that present depressive symptoms might be more prone to 
use social media, in order to improve their well-being.

Copyright © 2023 Maftei, Merlici and Dănilă.

DOI: 10.3389/fpubh.2022.1062688
PMCID: PMC9875810
PMID: 36711382 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1048. Front Public Health. 2023 Jan 11;10:1052423. doi: 10.3389/fpubh.2022.1052423. 
eCollection 2022.

Digital health literacy and subjective wellbeing in the context of COVID-19: A 
cross-sectional study among university students in Ecuador.

Rivadeneira MF(1), Salvador C(2), Araujo L(3), Caicedo-Gallardo JD(1), Cóndor 
J(1), Torres-Castillo AL(1), Miranda-Velasco MJ(4), Dadaczynski K(5)(6), Okan 
O(7).

Author information:
(1)Faculty of Medicine, Public Health Institute, Pontificia Universidad Católica 
del Ecuador, Quito, Ecuador.
(2)Faculty of Medicine, Universidad Central del Ecuador, Quito, Ecuador.
(3)General Students Office, Pontificia Universidad Católica del Ecuador, Quito, 
Ecuador.
(4)Department of Education Sciences, Faculty of Teacher Training, University of 
Extremadura, Badajoz, Spain.
(5)Department of Health Science, Fulda University of Applied Sciences, Fulda, 
Germany.
(6)Centre for Applied Health Science, Leuphana University Lueneburg, Lüneburg, 
Germany.
(7)Department of Sport and Health Sciences, Technical University Munich, Munich, 
Germany.

BACKGROUND: The COVID-19 pandemic has generated an avalanche of information, 
which, if not properly addressed, generates uncertainty and limits healthy 
decision-making. On the other hand, the pandemic has exacerbated mental health 
problems among young people and adolescents, causing a worsening of their 
wellbeing. Previous studies have found that digital health literacy has a 
positive impact on people's attitudes toward the disease. This study aimed to 
analyze the association between digital health literacy on COVID-19 with 
subjective wellbeing in university students.
METHODS: A cross-sectional study was developed in 917 students from Ecuador. 
Subjective wellbeing was measured with the World Health Organization WellBeing 
Scale. Digital health literacy was assessed using the Spanish-translated version 
of the Digital Health Literacy Instrument adapted to the context of the COVID-19 
pandemic. Bivariate and multivariate linear regressions were performed.
RESULTS: Digital health literacy and subjective wellbeing proofed to be 
significantly higher among males and among students with higher social status. 
The association between digital health literacy and subjective wellbeing was 
significant; for each increase of one point in the digital health literacy 
scale, an average increase of 9.64 points could be observed on the subjective 
wellbeing scale (IC 95% 5.61 - 13.67, p-value <0.001). This correlation 
persisted after adjust by demographic and socioeconomic variables.
CONCLUSION: Improving digital health literacy in health would improve the 
subjective wellbeing of university students. It is suggested strengthen the 
digital health literacy through public and university policies that promote 
access, search skills and discernment of digital information. Socioeconomic and 
gender inequalities related to digital health literacy need to be further 
investigated.

Copyright © 2023 Rivadeneira, Salvador, Araujo, Caicedo-Gallardo, Cóndor, 
Torres-Castillo, Miranda-Velasco, Dadaczynski and Okan.

DOI: 10.3389/fpubh.2022.1052423
PMCID: PMC9874317
PMID: 36711373 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1049. J Sch Nurs. 2023 Apr;39(2):125-132. doi: 10.1177/10598405221150879. Epub 2023 
Jan 29.

Burnout and Mental Health and Well-Being of School Nurses After the First Wave 
of the COVID-19 Pandemic: A National Cross-Sectional Survey.

Chen HJ(1), Liao LL(2), Lin HL(1)(3)(4)(5), Chang LC(1)(3)(6).

Author information:
(1)School of Nursing, Chang Gung University of Science and Technology, Tao-Yuan 
City, Taiwan.
(2)Department of Health Management, IShou University, Kaohsiung City, Taiwan.
(3)School of Nursing, Chang Gung University, Tao-Yuan City, Taiwan.
(4)School of Nursing, Taipei Medical University, Taipei, Taiwan.
(5)Department of Nursing, Linkou Chang Gung Memorial Hospital, Tao-Yuan City, 
Taiwan.
(6)Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.

The aim of this study was to examine the associations between job stressors, 
COVID-19-related concerns, burnout, and mental health and well-being among 
school nurses, and whether any of these associations are mediated by burnout. 
Based on stratified proportional sampling, data collection was conducted by an 
online questionnaire distributed to 600 school nurses in Taiwan. A total of 256 
participants aged between 27 and 62 years (mean = 47.08; standard deviation = 
7.28) returned questionnaires. Results showed that burnout was the main 
mediating variable that fully mediated the relationship between COVID-19-related 
concerns and mental health and well-being. The effects of job stressors on 
mental health and well-being included direct negative effects (β = -.29) and 
indirect negative effects (β = -.67) through mediating factors. School health 
managers should be more aware of burnout and mental health and well-being among 
school nurses under the impact of COVID-19.

DOI: 10.1177/10598405221150879
PMCID: PMC9902806
PMID: 36710588 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1050. BMC Pregnancy Childbirth. 2023 Jan 28;23(1):76. doi: 10.1186/s12884-022-05243-4.

The prevalence of mental ill-health in women during pregnancy and after 
childbirth during the Covid-19 pandemic: a systematic review and Meta-analysis.

Delanerolle G(1)(2), McCauley M(3), Hirsch M(4)(5), Zeng Y(6), Cong X(6), 
Cavalini H(2), Sajid S(2), Shetty A(4)(7), Rathod S(2), Shi JQ(6)(8), Hapangama 
DK(9), Phiri P(10)(11).

Author information:
(1)Nuffield Department of Primary Health Care Sciences, Uuniversity of Oxford, 
Oxford, UK.
(2)Southern Health NHS Foundation Trust, Research and Innovation Department, 
Clinical Trials Facility, Tom Rudd Unit Moorgreen Hospital, Botley Road, West 
End, Southampton, SO30 3JB, UK.
(3)Liverpool Women's NHS Foundation Trust, Liverpool, UK.
(4)University College London, London, UK.
(5)Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
(6)Southern University of Science and Technology, Shenzhen, China.
(7)University College London Hospitals NHS Foundation Trust, London, UK.
(8)National Center for Applied Mathematics, Shenzhen, China.
(9)University of Liverpool, Liverpool, UK.
(10)Southern Health NHS Foundation Trust, Research and Innovation Department, 
Clinical Trials Facility, Tom Rudd Unit Moorgreen Hospital, Botley Road, West 
End, Southampton, SO30 3JB, UK. peter.phiri@southernhealth.nhs.uk.
(11)School of Psychology, Faculty of Environmental and Life Sciences, University 
of Southampton, Southampton, UK. peter.phiri@southernhealth.nhs.uk.

Comment in
    MCN Am J Matern Child Nurs. 2023 Nov-Dec 01;48(6):341.

BACKGROUND: This systematic review aims to explore the prevalence of the impact 
of the COVID-19, MERS, and SARS pandemics on the mental health of pregnant 
women.
METHODS: All COVID-19, SARS and MERS studies that evaluated the mental health of 
pregnant women with/without gynaecological conditions that were reported in 
English between December 2000 - July 2021 were included. The search criteria 
were developed based upon the research question using PubMed, Science Direct, 
Ovid PsycINFO and EMBASE databases. A wide search criterion was used to ensure 
the inclusion of all pregnant women with existing gynaecological conditions. The 
Newcastle-Ottawa-Scale was used to assess the risk of bias for all included 
studies. Random effects model with restricted maximum-likelihood estimation 
method was applied for the meta-analysis and I-square statistic was used to 
evaluate heterogeneity across studies. The pooled prevalence rates of symptoms 
of anxiety, depression, PTSD, stress, and sleep disorders with 95% confidence 
interval (CI) were computed.
RESULTS: This systematic review identified 217 studies which included 638,889 
pregnant women or women who had just given birth. There were no studies 
reporting the mental health impact due to MERS and SARS. Results showed that 
women who were pregnant or had just given birth displayed various symptoms of 
poor mental health including those relating to depression (24.9%), anxiety 
(32.8%), stress (29.44%), Post Traumatic Stress Disorder (PTSD) (27.93%), and 
sleep disorders (24.38%) during the COVID-19 pandemic.
DISCUSSION: It is important to note that studies included in this review used a 
range of outcome measures which does not allow for direct comparisons between 
findings. Most studies reported self-reported measure of symptoms without 
clinical diagnoses so conclusions can be made for symptom prevalence rather than 
of mental illness. The importance of managing mental health during pregnancy and 
after-delivery improves the quality of life and wellbeing of mothers hence 
developing an evidence-based approached as part of pandemic preparedness would 
improve mental health during challenging times.
OTHER: The work presented in this manuscript was not funded by any specific 
grants. A study protocol was developed and published in PROSPERO 
(CRD42021235356) to explore several key objectives.

© 2023. The Author(s).

DOI: 10.1186/s12884-022-05243-4
PMCID: PMC9883834
PMID: 36709255 [Indexed for MEDLINE]

Conflict of interest statement: PP has received research grant from Novo 
Nordisk, and other, educational from Queen Mary University of London, other from 
John Wiley & Sons, other from Otsuka, outside the submitted work. SR reports 
other from Janssen, Lundbeck and Otsuka outside the submitted work. All other 
authors report no conflict of interest. The views expressed are those of the 
authors and not necessarily those of the NHS, the National Institute for Health 
Research, the Department of Health and Social Care or the Academic institutions.


1051. Inquiry. 2023 Jan-Dec;60:469580221147377. doi: 10.1177/00469580221147377.

Anxiety, Stress, and Depression Among Healthcare Professionals During the 
COVID-19 Pandemic: A Cross-Sectional Study in Morocco.

Bouaddi O(1)(2)(3), Abdallahi NM(1), Fadel Abdi CM(4), Hassouni K(1), Jallal 
M(5), Benjelloun R(6), Belrhiti Z(1)(2), Nejjari C(1), Khalis M(1)(2)(3)(7).

Author information:
(1)International School of Public Health, Mohammed VӀ University of Health 
Sciences (UM6SS), Casablanca, Morocco.
(2)Knowledge for Health Policies Center, Casablanca, Morocco.
(3)Mohammed VI Center for Research and Innovation.
(4)Psychiatry Department, Ibn Al Hassan Hospital, Hassan ӀӀ, Fez, Morocco.
(5)Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
(6)Psychiatry Department, Cheikh Khalifa International University Hospital, 
Mohammed VӀ University of Health Sciences, Casablanca, Morocco.
(7)Higher Institute of Nursing Professions and Health Technology, Rabat, 
Morocco.

The COVID-19 pandemic has caused an enormous psychological impact worldwide. 
This study aimed to assess anxiety, depression, stress, and compensatory 
behaviors among Moroccan healthcare workers (HCWs) during COVID-19. This 
descriptive cross-sectional study was conducted using a snowball sampling 
strategy. This descriptive cross-sectional study was conducted using a snowball 
sampling strategy. Online surveys were sent to groups of HCWs working in 
Casablanca and Fez cities. Post-traumatic stress disorder (PTSD) was measured 
using the Impact of Event Scale revised (IES-R) scale, and the DASS-21 was used 
to measure anxiety, depression, and stress among participants. Compensatory 
behaviors used by HCWs to manage these symptoms were also investigated. The 
majority of participants (72.5%) experienced moderate to severe distress during 
the COVID-19 pandemic. The majority of participants (53.1%) reported symptoms of 
mild to extremely severe depression. Overall, nurses, female, and frontline HCWs 
experienced more stress, anxiety, and depression (P < .001). Leisure activities 
(29%), sport (19%), and drinking tea/coffee (19%) were the most common 
compensatory behaviors. Our findings suggest that psychological support and 
interventions targeting high-risk HCWs with heavy psychological distress are 
needed. It is of paramount importance to improve the psychological endurance and 
safeguard the mental and physical well-being of HCWs, who find themselves on the 
frontline of health and humanitarian crises, when they are needed the most.

DOI: 10.1177/00469580221147377
PMCID: PMC9892525
PMID: 36708313 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1052. Workplace Health Saf. 2023 Aug;71(8):384-394. doi: 10.1177/21650799221147814. 
Epub 2023 Jan 27.

Exploring University and Healthcare Workers' Physical Activity, Diet, and 
Well-Being During the COVID-19 Pandemic.

Gilbert A(1), Eyler A(1), Cesarone G(1), Harris J(1), Hayibor L(1), Evanoff 
B(1)(2).

Author information:
(1)Washington University.
(2)University of Iowa.

BACKGROUND: The COVID-19 pandemic affected well-being and health behaviors, 
especially among healthcare workers and employees in other fields. This is of 
public health concern because health behaviors and well-being influence 
long-term negative health outcomes. The purpose of this study was to explore 
health behaviors and well-being among university and medical center staff during 
COVID-19.
METHODS: EMPOWER (Employee Well-being during Epidemic Response) was a three-wave 
observational study (wave 1: 1,994; wave 2: 1,426; wave 3: 1,363) measuring 
health behaviors and well-being of university and medical center staff. Surveys 
were disseminated online to all employees between April and September 2020. 
Descriptive statistics explored trends across waves for health behaviors 
(physical activity [PA], diet), and well-being (mental well-being [MWB], 
depression, anxiety, and stress). Logistic regressions explored associations 
between health behaviors and well-being factors adjusting for demographics and 
clinical role. Interactions explored moderation by clinical role.
RESULTS: Most participants reported same/healthier changes in PA (54-65%) and 
diet (57-73%) and decreased MWB across waves (62%-69%). Nonclinical workers were 
less likely than clinical workers to experience worse MWB and moderate/severe 
anxiety and stress (odds ratios [ORs] ranged from 0.38 to 0.58 across waves and 
well-being outcomes). Participants who maintained/increased PA and diet were 
less likely to experience worse well-being (ORs ranged from 0.44 to 0.69 across 
waves and well-being outcomes). Interactions by clinical role were not 
significant.
CONCLUSION/APPLICATION TO PRACTICE: Maintaining/increasing health behaviors 
during COVID-19 may be protective of mental health/well-being in some healthcare 
workers. These findings support health promotion efforts focused on maintaining 
or improving diet and PA.

DOI: 10.1177/21650799221147814
PMCID: PMC9895304
PMID: 36708021 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1053. J Perinat Neonatal Nurs. 2023 Jan-Mar 01;37(1):68-76. doi: 
10.1097/JPN.0000000000000612. Epub 2022 Feb 9.

Parent Readiness for Their Preterm Infant's Neonatal Intensive Care Unit 
Discharge.

Franck LS(1), Kriz RM, Bisgaard R, Gay CL, Sossaman S, Sossaman J, Cormier DM, 
Joe P, Sasinski JK, Kim JH, Lin C, Sun Y.

Author information:
(1)Department of Family Health Care Nursing and the California Preterm Birth 
Initiative, University of California, San Francisco, San Francisco (Drs Franck 
and Gay and Ms Kriz); Intensive Care Nursery (Mss Bisgaard and S. Sossaman and 
Mr J. Sossaman) and Division of Neonatology (Dr Sun), UCSF Benioff Children's 
Hospital, San Francisco, California; Neonatal and Pediatrics, Community Regional 
Medical Center, Fresno, California (Dr Cormier); Division of Neonatology, UCSF 
Benioff Children's Hospital, Oakland, California (Dr Joe); Intensive Care 
Nursery, Santa Monica Medical Center, UCLA Health, Santa Monica, California (Ms 
Sasinski); Division of Neonatology, Perinatal Institute, Cincinnati Children's 
Hospital Medical Center, Cincinnati, Ohio (Dr Kim); and Division of Neonatology, 
Kaiser Permanente, Santa Clara, California (Dr Lin).

This study aims to examine the influence of hospital experience factors on 
parental discharge readiness, accounting for key background characteristics. 
Parents/guardians of infants 33 weeks of gestation or less at birth receiving 
neonatal intensive care at 6 sites were enrolled from April 2017 to August 2018. 
Participants completed surveys at enrollment, 3 weeks later, and at discharge. 
Multiple regression analysis assessed relationships between parental experience, 
well-being, and perceived readiness for infant discharge, adjusting for 
socioenvironmental, infant clinical, and parent demographic characteristics. 
Most (77%) of the 139 parents reported high levels of readiness for their 
infant's discharge and 92% reported high self-efficacy at discharge. The 
multiple regression model accounted for 40% of the variance in discharge 
readiness. Perceptions of family-centered care accounted for 12% of the 
variance; measures of parent well-being, anxiety, and parenting self-efficacy 
accounted for an additional 16% of the variance; parent characteristics 
accounted for an additional 9%; and infant characteristics accounted for less 
than 3% of the variance. Parental perceptions of the family-centeredness of the 
hospital experience, anxiety, and parenting self-efficacy accounted for a 
substantial proportion of the variance in readiness for discharge scores among 
parents of preterm infant. These influential perceptions are potentially 
modifiable by nursing-led interventions.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/JPN.0000000000000612
PMID: 36707751 [Indexed for MEDLINE]


1054. J Obstet Gynecol Neonatal Nurs. 2023 May;52(3):202-210. doi: 
10.1016/j.jogn.2022.12.006. Epub 2022 Dec 26.

Qualitative Study of the Experience of Caring for Women During Labor and Birth 
During the First Wave of the COVID-19 Pandemic.

Simonovich SD, Bush NM, Mueller Wiesemann L, Pineros-Leano M.

OBJECTIVE: To examine the experiences of labor and delivery (L&D) nurses and 
certified nurse-midwives who cared for women during labor and birth in the 
United States during the first wave of the COVID-19 pandemic.
DESIGN: Subgroup analysis of a larger study with a qualitative descriptive 
design.
SETTING: Telephone interviews.
PARTICIPANTS: The parent study included 100 nurses across various specialty 
areas who provided patient care during the first wave of COVID-19 in the United 
States. Our subgroup analysis included 19 participants: L&D nurses (n = 11) and 
certified nurse-midwives (n = 8).
METHODS: Semistructured interview guide.
RESULTS: Participants described their experiences providing patient care in L&D 
settings during the first wave of the COVID-19 pandemic. We identified five 
major themes: Separation of COVID-19-Positive Mothers and Newborns, Isolation of 
Women in Active Labor, Disparities in Access to Care, Barriers to Communication, 
and Effect on the Mental Health of Members of the Care Team.
CONCLUSION: Our findings captured the experiences of maternity care team members 
who worked during the COVID-19 pandemic when standards of quality maternity care 
were compromised. The challenges of caring for COVID-19-positive mothers, 
including isolation during active labor and infant removal from mothers at 
birth, affected their psychological well-being and their mental health and must 
now be addressed to prevent burnout and turnover.

Copyright © 2022 AWHONN, the Association of Women’s Health, Obstetric and 
Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jogn.2022.12.006
PMCID: PMC9790872
PMID: 36706795 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest The authors report no 
conflicts of interest or relevant financial relationships.


1055. J Occup Environ Med. 2023 May 1;65(5):419-427. doi: 
10.1097/JOM.0000000000002802. Epub 2023 Jan 25.

Addressing Psychosocial, Organizational, and Environmental Stressors Emerging 
From the COVID-19 Pandemic and Their Effect on Essential Workers' Mental Health 
and Well-being: A Literature Review.

Woods EH(1), Zhang Y, Roemer EC, Kent KB, Davis MF, Goetzel RZ.

Author information:
(1)From the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 
(E.H.W., Y.Z., M.F.D.); Institute for Health and Productivity Studies, Johns 
Hopkins Bloomberg School of Public Health, Baltimore, Maryland (E.C.R., K.B.K., 
R.Z.G.); Division of Infectious Diseases, Department of Molecular and 
Comparative Pathobiology, Johns Hopkins School of Medicine, Baltimore, Maryland 
(M.F.D.); Johns Hopkins P.O.E. Total Worker Health Center in Mental Health, 
Baltimore, Maryland (E.H.W., Y.Z., E.C.R., K.B.K., M.F.D., R.Z.G.).

OBJECTIVE: This study aimed to identify stressors faced by essential workers 
amid the coronavirus disease pandemic and effective interventions mitigating 
these stressors.
METHODS: We reviewed literature on psychosocial, organizational, and 
environmental stressors faced by essential workers during the pandemic, the 
consequences of those stressors, and interventions to improve worker health and 
well-being.
FINDINGS: Stressors included elevated risk of coronavirus disease 2019 exposure, 
fear of spreading the virus, lack of social and organizational supports, and 
financial insecurity. Negative outcomes included burnout, depression, and high 
turnover. Promising interventions included robust safety protocols, increased 
wages, childcare benefits, enhanced access to mental health services, and 
frequent leadership communications.
CONCLUSION: Stress has taken a heavy toll on essential workers' physical and 
emotional health, productivity, and job satisfaction. To effectively protect 
Total Worker Health, employers should adopt evidence-based interventions 
promoting psychosocial, organizational, and environmental health and safety.

Copyright © 2023 American College of Occupational and Environmental Medicine.

DOI: 10.1097/JOM.0000000000002802
PMCID: PMC10171099
PMID: 36701793 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest: None declared.


1056. J Public Health Res. 2023 Jan 20;12(1):22799036221147095. doi: 
10.1177/22799036221147095. eCollection 2023 Jan.

Stress among health care providers in NICU department, tertiary pediatric care 
hospital during COVID-19 pandemic in Egypt.

Hegazy AA(1), Abdel Hamid TA(2), Zein MM(1), Aboushady AT(3), Akmal DM(2).

Author information:
(1)Public Health and Community Medicine Department, Kasr Alainy School of 
Medicine, Cairo University, Cairo, Egypt.
(2)Pediatrics Department, Kasr Alainy School of Medicine, Cairo University, 
Cairo, Egypt.
(3)Faculty of Medicine, Alexandria University, Alexandria, Egypt.

BACKGROUND: Many of the pediatric health care workers (HCWs) suffered from sleep 
disturbance, anxiety, and potential stress disorder during the COVID-19 
pandemic. Work-related stress is a potential cause of concern in HCWs and is 
associated with decreased job satisfaction, anxiety, depression, medical errors, 
and near misses. This study aims to investigate the various psychological 
consequences on medical personnel working in the neonatal intensive care unit 
(NICU) in the context of the COVID-19 pandemic.
DESIGN AND METHODS: A cross-sectional analytical study was conducted on a 
convenient sample of doctors and nurses working in NICU in pediatric hospitals 
at Cairo University teaching hospitals, Egypt. Two anonymous self-administered 
validated questionnaires were used to assess the level of stress, and the 
COVID-19 Rapid Quantitative Assessment Tool to assess the knowledge, attitude, 
and perception about COVID-19.
RESULTS: Among 96 participants, 66.7% were nurses, and 33.3% were physicians, 
79.2% of the participants showed a reasonably safe level of stress. The mean 
work stress score was 43.89 ± 5.77. The mean score for commonly experienced 
stress symptoms was 7.53 ± 4.54, median 7, IQR (4, 10). Females and physicians 
were found to be with a statistically significantly higher median score of 
commonly experienced stress symptoms than males (p-value < 0.001 and 0.028 
simultaneously).
CONCLUSION: While such descriptive research provides valuable information on the 
scope of the problem, a strong theoretical framework is required to interpret 
these findings appropriately and develop preventive and therapeutic strategies. 
Particular attention should be warranted to the mental health well-being of 
women treating patients with COVID-19.

© The Author(s) 2022.

DOI: 10.1177/22799036221147095
PMCID: PMC9868485
PMID: 36699149

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1057. BMC Psychiatry. 2023 Jan 25;23(1):68. doi: 10.1186/s12888-022-04497-8.

The emotional well-being of Long COVID patients in relation to their symptoms, 
social support and stigmatization in social and health services: a qualitative 
study.

Samper-Pardo M(1), Oliván-Blázquez B(2)(3)(4), Magallón-Botaya R(1)(5)(6), 
Méndez-López F(1), Bartolomé-Moreno C(1)(5)(6), León-Herrera S(7).

Author information:
(1)Institute for Health Research Aragon (IISAragon), Zaragoza, Spain.
(2)Institute for Health Research Aragon (IISAragon), Zaragoza, Spain. 
barbaraolivan@gmail.com.
(3)Department of Psychology and Sociology, University of Zaragoza, Zaragoza, 
Spain. barbaraolivan@gmail.com.
(4)Network for Research on Chronicity, Primary Care, and Health Promotion 
(RICAPPS), Barcelona, Spain. barbaraolivan@gmail.com.
(5)Network for Research on Chronicity, Primary Care, and Health Promotion 
(RICAPPS), Barcelona, Spain.
(6)Department of Medicine, University of Zaragoza, Zaragoza, Spain.
(7)Department of Psychology and Sociology, University of Zaragoza, Zaragoza, 
Spain.

BACKGROUND: Long COVID patients have experienced a decline in their quality of 
life due to, in part but not wholly, its negative emotional impact. Some of the 
most prevalent mental health symptoms presented by long COVID patients are 
anxiety, depression, and sleep disorders. As such, the need has arisen to 
analyze the personal experiences of these patients to understand how they are 
managing their daily lives while dealing with the condition. The objective of 
this study is to increase understanding about the emotional well-being of people 
diagnosed with long COVID.
METHODS: A qualitative design was created and carried out using 35 patients, 
with 17 participants being interviewed individually and 18 of them taking part 
in two focus groups. The participating patients were recruited in November and 
December 2021 from Primary Health Care (PHC) centers in the city of Zaragoza 
(Northern Spain) and from the Association of Long COVID Patients in Aragon. The 
study topics were emotional well-being, social support networks, and experience 
of discrimination. All an inductive thematic content analyses were performed 
iteratively using NVivo software.
RESULTS: The Long COVID patients identified low levels of self-perceived 
well-being due to their persistent symptoms, as well as limitations in their 
daily lives that had been persistent for many months. Suicidal thoughts were 
also mentioned by several patients. They referred to anguish and anxiety about 
the future as well as a fear of reinfection or relapse and returning to work. 
Many of the participants reported that they have sought the help of a mental 
health professional. Most participants identified discriminatory situations in 
health care.
CONCLUSIONS: It is necessary to continue researching the impact that Long COVID 
has had on mental health, as well as to provide Primary Health Care 
professionals with evidence that can guide the emotional treatment of these 
patients.

© 2023. The Author(s).

DOI: 10.1186/s12888-022-04497-8
PMCID: PMC9875186
PMID: 36698111 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests


1058. Geriatr Gerontol Int. 2023 Mar;23(3):200-204. doi: 10.1111/ggi.14543. Epub 2023 
Jan 25.

Accelerated cognitive decline after the COVID-19 pandemic in a community 
population of older persons with cognitive impairment: A 4-year time series 
analysis in the Tokyo Metropolis area.

Matsui T(1)(2), Mitsuma S(1)(2), Nagata A(1), Matsushita S(3), Asahi T(4).

Author information:
(1)Medical Center for Dementia in the Northeastern Wards of Tokyo Metropolis, 
Oouchi Hospital, Heisei Medical Welfare Group, Tokyo, Japan.
(2)Department of Geriatric Medicine, Kyorin University School of Medicine, 
Tokyo, Japan.
(3)Medical Center for Dementia in Kanagawa Prefecture, National Hospital 
Organization, Kurihama Alcoholism Center, Kanagawa, Japan.
(4)Medical Center for Dementia in Chiba Prefecture, Asahi Neurology and 
Rehabilitation Hospital, Matsudo, Japan.

AIM: The coronavirus disease 2019 (COVID-19) pandemic has led to lifestyle 
restrictions and might be associated with long-term changes in cognitive 
function. The aim of the present study was to elucidate the overall effect of 
the COVID-19 pandemic on the cognitive trajectory of a cohort of patients with 
cognitive impairment.
METHODS: We enrolled 160 patients who had been making regular visits to a 
medical center for dementia. Cognitive function was assessed based on changes in 
scores on the Mini-Mental State Examination before and during the COVID-19 
pandemic throughout a 4-year period. The trajectory of cognitive decline was 
determined by carrying out a time series analysis using a state-space model.
RESULTS: Crude analysis showed that the Mini-Mental State Examination scores 
decreased from 20.9 ± 4.4 points (mean ± SD) at the time of the initial 
cognitive assessments to 17.5 ± 5.6 points at the time of the final assessments, 
and the decline rate was 1.15 ± 1.78 points per year (P < 0.0001). The time 
series analysis showed an accelerated cognitive trajectory after the COVID-19 
outbreak, and the average decline in the Mini-Mental State Examination scores 
was 0.46 points (95% confidence interval 0.034-0.91) per year before the 
COVID-19 pandemic, and a steeper decline of 1.87 points (95% confidence interval 
1.34-2.67) per year after the outbreak.
CONCLUSIONS: The COVID-19 pandemic accelerated the rate of cognitive decline in 
patients with cognitive impairment fourfold in comparison with before the 
pandemic. Specific strategies designed for cognitively older people in the "new 
normal" will reconcile both requirements, reducing the risk of infection, and 
maintaining their physical and psychological well-being. Geriatr Gerontol Int 
2023; 23: 200-204.

© 2023 Japan Geriatrics Society.

DOI: 10.1111/ggi.14543
PMID: 36697372 [Indexed for MEDLINE]


1059. Ann Fam Med. 2022 Apr 1;20(20 Suppl 1):2794. doi: 10.1370/afm.20.s1.2794.

A qualitative study of adolescent perspectives on COVID-19 pandemic: 
considerations in the provision of primary virtual care.

Grady C, Cote C, Gazendam N, Gazendam MK, Phillips S, Townend A.

Context: Amidst school shutdowns, sheltering in place, and social distancing, 
the COVID-19 pandemic uniquely affected adolescents. Understanding the 
experiences of adolescents with respect to social distancing, health changes, 
information sources and virtual care can inform effective health care for 
adolescents both during and after the pandemic. Objective: An exploration into 
their health care experiences during the beginning stage of the pandemic was 
undertaken to increase knowledge among family physicians to enable adjustments 
to the provision of care, primarily done virtually. Study Design: This was a 
qualitative study using semi-structured interviews. The interviews were used to 
understand the experiences of adolescents using virtual care during the 
pandemic, the impact of public health restrictions on their health, and their 
sources of information. Thematic analysis of interviews was conducted using a 
double-coding technique. Setting: This study took place in a family health team 
with eight primary care practices. Population studied: Adolescents, aged 14-17 
years who had at least one virtual care appointment with their family physician 
in the first three months of the pandemic were included. Eleven participants 
were interviewed. Results: Most participants were compliant with social 
distancing guidelines, motivated by protecting family and community. 
Participants described both positive and negative impacts on their mental 
health. Some noted an increase in marijuana use. Sexual activity in pre-pandemic 
relationships did not change and one participant noted a decrease in casual 
sexual activity. Participants enjoyed the convenience offered by virtual care 
but acknowledged privacy and communication challenges. Parents were described as 
the most trusted source of information about the pandemic. Conclusions: 
Adolescents primarily look to parents for guidance and the increased family time 
promoted well-being. Physicians that are able to help adolescents negotiate 
privacy and mitigate communication challenges are able to provide effective 
virtual care.

2021 Annals of Family Medicine, Inc.

DOI: 10.1370/afm.20.s1.2794
PMCID: PMC10549075
PMID: 36696677 [Indexed for MEDLINE]

Conflict of interest statement: Authors report none.


1060. Glob Public Health. 2022 Dec;17(12):3654-3669. doi: 
10.1080/17441692.2022.2129720. Epub 2023 Jan 24.

Substance use policy and practice in the COVID-19 pandemic: Learning from early 
pandemic responses through internationally comparative field data.

Aronowitz SV(1), Carroll JJ(2), Hansen H(3), Jauffret-Roustide M(4)(5), Parker 
CM(6), Suhail-Sindhu S(7), Albizu-Garcia C(8), Alegria M(9), Arrendondo J(10), 
Baldacchino A(11), Bluthenthal R(12), Bourgois P(13), Burraway J(14), Chen 
JS(15), Ekhtiari H(16), Elkhoy H(17), Farhoudian A(18), Friedman J(19), Jordan 
A(20), Kato L(21), Knight K(22), Martinez C(23), McNeil R(24), Murray H(25), 
Namirembe S(26), Radfar R(27), Roe L(28), Sarang A(29), Scherz C(30), Tay Wee 
Teck J(31), Textor L(19), Thi Hai Oanh K(32).

Author information:
(1)Leonard Davis Institute of Health Economics, University of Pennsylvania, 
Philadelphia, United States.
(2)Department of Anthropology, North Carolina State University, Raleigh, United 
States.
(3)UCLA Center for Social Medicine and Humanities, University of California Los 
Angeles, Los Angeles, United States.
(4)Centre d'étude des mouvements sociaux (Inserm U12/76/CNRS UMR 8044/EHESS), 
Paris, France.
(5)Baldy Center for Law and Social Policy, Buffalo University of Social Science, 
NY, USA.
(6)The University of Manchester, Manchester University, Manchester, United 
Kingdom of Great Britain and Northern Ireland.
(7)University of California Los Angeles, UCLA Center for Social Medicine and 
Humanities, Los Angeles, United States.
(8)Universidad de Puerto Rico, Graduate School of Public Health, San Juan, 
Puerto Rico.
(9)Massachusetts General Hospital, Disparities Research Unit, Boston, United 
States.
(10)Center for Research and Economic Teaching, Drug Policy Program, 
Aguascalientes, MX, Mexico.
(11)Medicine, University of St Andrews, St Andrews, United Kingdom of Great 
Britain and Northern Ireland.
(12)Population and Public Health Sciences, University of Southern California 
Keck School of Medicine, Los Angeles, United States.
(13)Center for Social Medicine and Humanities, University of California Los 
Angeles, Los Angeles, United States.
(14)Institute for Advanced Studies, University of Virginia, Charlottesville, 
United States.
(15)Institute of Science, Technology and Society, National Yang-Ming University, 
Hsinchu, Taiwan.
(16)Laureate Institute for Brain Research, The University of Oklahoma, Norman, 
United States.
(17)Neurology and Psychiatry, Ain Shams University, Cairo, Egypt.
(18)University of Social Welfare and Rehabilitation Sciences, Substance Abuse 
and Dependence Research Center, Tehran, Iran (the Islamic Republic of).
(19)David Geffen School of Medicine at UCLA, University of California Los 
Angeles, Los Angeles, United States.
(20)Psychiary, Yale University, New Haven, United States.
(21)Centers for Disease Control and Prevention, Overdose Response Strategy, 
Atlanta, United States.
(22)Humanities and Social Sciences, University of California San Francisco, San 
Francisco, United States.
(23)Medical Anthropology, University of California at Berkeley, Berkeley, USA.
(24)Addiction Medicine, Yale University, New Haven, United States.
(25)Anthropology, Universiteit van Amsterdam, Amsterdam, Netherlands.
(26)Independent Researcher, Uganda Recovery, Mukono, Uganda.
(27)Isfahan University of Medical Sciences, Thought, Culture and Health 
Institute, Isfahan, Iran (the Islamic Republic of).
(28)Social Anthropology, University of St Andrews, St Andrews, United Kingdom of 
Great Britain and Northern Ireland.
(29)Andrey Rylkov Foundation for Health and Social Justice, President, RU, 
Moscow, Russian Federation.
(30)Anthropology, University of Virginia, Charlottesville, United States.
(31)MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 
Glasgow, United Kingdom of Great Britain and Northern Ireland.
(32)Center for Supporting Community Development Initiatives, Executive Director, 
Hanoi, VN, Vietnam.

The COVID-19 pandemic has created an unprecedented natural experiment in drug 
policy, treatment delivery, and harm reduction strategies by exposing wide 
variation in public health infrastructures and social safety nets around the 
world. Using qualitative data including ethnographic methods, questionnaires, 
and semi-structured interviews with people who use drugs (PWUD) and 
Delphi-method with experts from field sites spanning 13 different countries, 
this paper compares national responses to substance use during the first wave of 
the COVID-19 pandemic. Field data was collected by the Substance Use x COVID-19 
(SU x COVID) Data Collaborative, an international network of social scientists, 
public health scientists, and community health practitioners convened to 
identify and contextualise health service delivery models and social protections 
that influence the health and wellbeing of PWUD during COVID-19. Findings 
suggest that countries with stronger social welfare systems pre-COVID introduced 
durable interventions targeting structural drivers of health. Countries with 
fragmented social service infrastructures implemented temporary initiatives for 
PWUD led by non-governmental organisations. The paper summarises the most 
successful early pandemic responses seen across countries and ends by calling 
for greater systemic investments in social protections for PWUD, diversion away 
from criminal-legal systems toward health interventions, and integrated harm 
reduction, treatment and recovery supports for PWUD.

DOI: 10.1080/17441692.2022.2129720
PMID: 36692903 [Indexed for MEDLINE]


1061. Ann Med. 2023 Dec;55(1):480-489. doi: 10.1080/07853890.2023.2169342.

Perceptions of COVID-19 risk during the pandemic: perspectives from people 
seeking medication for opioid use disorder.

Clingan SE(1), Cousins SJ(1)(2), Lin C(1), Nguyen TE(1)(2), Hser YI(1), Mooney 
LJ(1)(3).

Author information:
(1)Department of Psychiatry and Biobehavioral Sciences, University of 
California, Los Angeles, Los Angeles, CA, USA.
(2)Department of Community Health Sciences, University of California, Los 
Angeles, Los Angeles, CA, USA.
(3)VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.

INTRODUCTION: The Coronavirus Disease 2019 (COVID-19) pandemic has had 
devastating consequences for persons with opioid use disorder (OUD). Yet, little 
is known about how people seeking treatment for OUD perceive the risks of 
COVID-19 and how their perception interplays with their health behaviours.
METHODS: In-depth interviews were conducted from September 2021 to March 2022 
with 32 patients seeking medication treatment for OUD (MOUD) in Southern 
California. All interviews were conducted virtually and lasted between one and 
two hours. Interviews were recorded and transcribed verbatim. Two qualitative 
researchers independently conducted a content analysis of the transcripts to 
identify themes.
RESULTS: Three primary themes were identified: (1) perceptions and beliefs about 
COVID-19 susceptibility and severity; (2) perceptions of COVID-19 risk compared 
to substance use behaviours; and (3) vaccine hesitancy. Participants were mixed 
in their beliefs of susceptibility to contracting COVID-19 and the severity of 
the disease if contracted. Some participants reported taking precautions to 
mitigate their chances of acquiring COVID-19, and other participants reported 
that COVID was not a big concern as substance use took priority. For many of the 
participants, COVID-19 concerns were overshadowed by the risk of overdosing on 
substances and other risky substance use behaviour. Most of the participants 
(n = 23; 72%) had received at least one COVID-19 vaccine by the time of the 
interview, but over half (n = 19; 59%) expressed vaccine hesitancy. Vaccine 
hesitancy was driven by concerns about the unknown long-term side effects and 
potential interactions of the vaccine with MOUD.
CONCLUSIONS: Our study provides insight into COVID-19 prevention measures as 
well as vaccination perceptions and hesitancy among people who received 
treatment for OUD.Key messagesParticipants expressed diverse perceptions of the 
seriousness of COVID-19, with some taking precautions to mitigate their chances 
of acquiring COVID-19 and others perceiving that the risk of contracting 
COVID-19 was less than the risk of overdosing.Substance use, social isolation, 
vaccine hesitancy and COVID-19 risk behaviours should be studied as co-occurring 
phenomena that have potentially overlapping relationships that can influence 
behaviours that impact health and well-being.

DOI: 10.1080/07853890.2023.2169342
PMCID: PMC9879168
PMID: 36692029 [Indexed for MEDLINE]

Conflict of interest statement: No potential conflict of interest was reported 
by the author(s).


1062. J Affect Disord. 2023 Mar 15;325:739-746. doi: 10.1016/j.jad.2023.01.053. Epub 
2023 Jan 20.

Social and cognitive vulnerability to COVID-19-related stress in pregnancy: A 
case-matched-control study of antenatal mental health.

Songco A(1), Minihan S(1), Fox E(2), Ladouceur C(3), Mewton L(1), Moulds M(1), 
Pfeifer J(4), Van Harmelen AL(5), Schweizer S(6).

Author information:
(1)University of New South Wales, Sydney, Australia.
(2)University of Oxford, Oxford, United Kingdom.
(3)University of Pittsburgh, Pittsburgh, United States of America.
(4)University of Oregon, Oregon, United States of America.
(5)Leiden University, Leiden, the Netherlands.
(6)University of New South Wales, Sydney, Australia; University of Cambridge, 
Cambridge, United Kingdom. Electronic address: s.schweizer@unsw.edu.au.

Emerging evidence shows that compared to pre-pandemic norms pregnant women 
report significant increases in clinical levels of depressive and anxiety 
symptoms during COVID-19. This pre-registered study examined cognitive and 
social vulnerability factors for poor mental health in pregnancy during 
COVID-19. Understanding vulnerability profiles is key to identifying women at 
risk for deteriorating peripartum mental health. N = 742 pregnant women and 
N = 742 age and country-matched controls from the COVID-19 Risks Across the 
Lifespan Study were included. Using a case-match control design allowed us to 
explore whether the cognitive vulnerability profiles would differ between 
pregnant and non-pregnant women. The findings showed that COVID-19-related 
stress was associated with heightened levels of depression and anxiety during 
pregnancy. Its impact was greatest in women with cognitive (i.e., higher 
intolerance of uncertainty and tendency to worry) and social (i.e., higher level 
of self-reported loneliness) vulnerabilities. Importantly, our data show that 
the mental health impacts of the pandemic were greater in pregnant women 
compared to women who were not pregnant, especially those with cognitive and 
social vulnerabilities. The results highlight the urgent need to prioritize 
mental health care for pregnant women to mitigate the impact of COVID-19-related 
stress on women's postpartum mental health and their infants' well-being.

Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2023.01.053
PMCID: PMC9852264
PMID: 36690083 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest The authors declare no 
conflicts of interest.


1063. J Clin Child Adolesc Psychol. 2024 Jan-Feb;53(1):98-113. doi: 
10.1080/15374416.2022.2158839. Epub 2023 Jan 23.

Latinx LGBTQ Youth, COVID-19, and Psychological Well-Being: A Systematic Review.

Abreu RL(1), Barrita AM(2), Martin JA(1), Sostre J(1), Gonzalez KA(3).

Author information:
(1)Department of Psychology, University of Florida.
(2)Department of Psychology, University of Nevada.
(3)Department of Psychology, University of Tennessee.

OBJECTIVE: As a result of the COVID-19 pandemic, Latinx youth report high rates 
of negative mental health outcomes such as anxiety and depression. Similarly, 
research with lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth have 
documented increased negative mental health outcomes such as depression and 
anxiety as a result of the COVID-19 pandemic. However, the current literature 
has yet to systematically uncover the intersectional experiences of Latinx LGBTQ 
youth during this time.
METHOD: We conducted a systematic review to uncover the experiences of Latinx 
LGBTQ youth during the pandemic. Our systematic review resulted in 14 empirical 
studies that explored the challenges, stressors, and impact of the COVID-19 
pandemic on Latinx LGBTQ youth.
RESULTS: Findings revealed that most studies include cisgender, gender binary, 
heterosexual, Latinx youth. Findings across studies include: (a) impact from 
school closures, (b) pandemic stressors, (c) impact from online media, (d) 
family and Latinx cultural values as a source of support and stress, and (e) the 
implementation and evaluation of interventions during the COVID-19 pandemic.
DISCUSSION: We provide recommendations for clinicians working with Latinx LGBTQ 
youth including expanding their knowledge about the impact of the COVID-19 
pandemic on these communities, considering the experiences of Latinx LGBTQ youth 
as multifaceted, and considering the role of heterogeneity in the mental health 
of Latinx LGBTQ Youth.

DOI: 10.1080/15374416.2022.2158839
PMID: 36689641 [Indexed for MEDLINE]


1064. J Clin Child Adolesc Psychol. 2024 Jan-Feb;53(1):10-23. doi: 
10.1080/15374416.2022.2158837. Epub 2023 Jan 23.

Implications of Undocumented Status for Latinx Families During the COVID-19 
Pandemic: A Call to Action.

Garcini LM(1)(2), Vázquez AL(3), Abraham C(4), Abraham C(4), Sarabu V(5), Cruz 
PL(2).

Author information:
(1)Department of Psychological Sciences, Rice University.
(2)Center for the United States and Mexico, Baker Institute for Public Policy, 
Rice University.
(3)Department of Psychology, Utah State University.
(4)Department of Sciences, University of Texas at San Antonio.
(5)Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, 
University of Texas Health Science Center at San Antonio.

BACKGROUND: A disproportionate number of COVID-19 cases and deaths have been 
reported among Latinxs in the U.S. Among those most affected by the pandemic are 
marginalized families, including those that are undocumented and mixed-status, 
in which some, but not all members are undocumented. Undocumented and 
mixed-status families face multiple and chronic daily stressors that compromised 
their health and wellbeing. Salient stressors faced by undocumented Latinx 
families include poverty, social disadvantage, discrimination, dangerous living 
and working conditions, and limited access to healthcare. These stressors are 
frequently compounded with trauma, fear of detention, deportation, and family 
separation.
PURPOSE: Informed by the literature and insights from our community-based work 
to address the health needs of undocumented and mixed status Latinx families 
during the pandemic, this paper uses a social determinants of health lens to 
present a narrative summary that highlights four primary psychosocial stressors 
faced by these families and their implications for mental health.
DISCUSSION: These include stressors pertaining to (a) anti-immigrant rhetoric 
and actions; (b) family stressors and disruptions in family dynamics; (c) 
economic changes and financial losses; and (c) limited access to healthcare. 
Implications of the aforesaid stressors on the mental health of undocumented 
families and youth are also discussed. In addition, recommendations are provided 
for the provision of mental health services, best practices, and resources from 
a strengths-based approach.

INTRODUCCIÓN: Latinxs en los EE. UU. han experimentado un número 
desproporcionado de casos y muertes por el virus del COVID-19. Entre aquellos 
más afectados por la pandemia están las familias marginalizadas, incluyendo las 
que son indocumentadas y de estatus mixto, de los cuales algunos miembros, pero 
no todos, son indocumentados. Las familias indocumentadas y de estatus mixto 
enfrentan estresores múltiples y crónicos diarios que comprometen su salud y 
bienestar. Algunos de estos estresores incluyen la pobreza, la desventaja 
social, la discriminación, las condiciones residenciales y laborales peligrosas, 
y el acceso limitado a los servicios de salud. Frecuentemente, estos estresores 
son amplificados por el trauma, el miedo a la detención, la deportación, y la 
separación familiar.
PROPÓSITO: En este artículo, empleamos la literatura científica y nuestras 
perspectivas a partir de nuestro trabajo comunitario para abordar las 
necesidades de salud de las familias Latinxs indocumentadas y de estatus mixto 
durante la pandemia, y nos enfocamos en cuatro estresores psicosociales 
principales usando una perspectiva de determinantes de la salud.
DISCUSIÓN: Estos estresores incluyen: (a) la retórica y acciones 
anti-inmigrante; (b) la adversidad y disrupciones de las dinámicas familiares; 
(c) los cambios económicos y pérdidas financieras; y (d) el acceso limitado a 
los servicios de salud. También se discuten las consecuencias de estos 
estresores en la salud mental de las familias y juventud indocumentada. 
Adicionalmente, usamos una perspectiva basada en las fortalezas para ofrecer 
recomendaciones para la provisión de servicios de salud mental, mejores 
prácticas, y recursos.

DOI: 10.1080/15374416.2022.2158837
PMCID: PMC10710880
PMID: 36689639 [Indexed for MEDLINE]

Conflict of interest statement: Disclosure Statement No potential conflict of 
interest was reported by the authors.


1065. PLoS One. 2023 Jan 23;18(1):e0279205. doi: 10.1371/journal.pone.0279205. 
eCollection 2023.

A qualitative study of positive psychological experiences and helpful coping 
behaviours among young people and older adults in the UK during the COVID-19 
pandemic.

Ooi L(1), Paul E(1), Burton A(1), Fancourt D(1), McKinlay AR(1).

Author information:
(1)Research Department of Behavioural Science and Health, Institute of 
Epidemiology & Health Care, University College London, London, United Kingdom.

While much research has focused on challenges that younger and older people have 
faced during the COVID-19 pandemic, little attention has been given to the 
capacity for resilience among these groups. We therefore explored positive 
psychological experiences and coping behaviours that protected mental health and 
well-being. Participants were 40 young people (aged 13-24) and 28 older adults 
(aged 70+) living in the UK during the COVID-19 pandemic. Interviews were held 
between May 2020 and January 2021. We generated six themes using qualitative 
thematic analysis, including: engagement in self-fulfilling activities, 
increased sense of social cohesion, personal growth, use of problem-focused 
strategies to manage pandemic-related stressors, giving and receiving social and 
community support, and utilising strategies to regulate thoughts and emotions. 
While all six themes were relevant both to younger and older adults, there were 
nuances in how each was experienced and enacted. For example, many older adults 
adjusted their routines given worries about virus vulnerability, while some 
young people experienced greater personal growth amidst increased awareness of 
mental health as they navigated the various lockdown restrictions.

Copyright: © 2023 Ooi et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0279205
PMCID: PMC9870142
PMID: 36689484 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1066. PLoS One. 2023 Jan 23;18(1):e0280689. doi: 10.1371/journal.pone.0280689. 
eCollection 2023.

Mental health and wellbeing of further and higher education students returning 
to face-to-face learning after Covid-19 restrictions.

Liverpool S(1), Moinuddin M(1), Aithal S(1), Owen M(1), Bracegirdle K(1), 
Caravotta M(1)(2), Walker R(1), Murphy C(1), Karkou V(1).

Author information:
(1)Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, 
United Kingdom.
(2)Centre for Applied Human Rights, University of York, Heslington, United 
Kingdom.

AIM: This study aimed to examine the mental health and wellbeing of further and 
higher education students and the associating factors after returning to 
face-to-face (in-person) learning after Covid-19 restrictions.
METHODS: A cross-sectional study informed by student consultations was conducted 
using a survey design. Mental health and wellbeing were assessed using 
self-report items on the Depression, Anxiety and Stress Scale (DASS-21) and the 
Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS). Descriptive statistics 
and stepwise multiple linear regression analyses were conducted on data 
collected between December 2021 and June 2022.
RESULTS: N = 1160 students participated; 69.6% between 16 and 25 years, 67.9% 
studying in the UK, 66.5% studying away from home, 60.2% identified as she/her, 
59.8% studying at the undergraduate degree level, 42.5% belonging to non-White 
ethnic backgrounds, 29.6% identifying as having additional needs and 22.8% as 
sexual minority. Moderate anxiety (M = 13.67, SD = 9.92) and depression (M = 
17.04, SD = 11.56) scores were mainly reported. Wellbeing scores (M = 20.31, SD 
= 3.93) were lower than the estimate for the pre-pandemic general population. 
Gender expression, sexuality, age, ethnicity, having additional needs, and level 
and location of study was associated with mental health or wellbeing. Individual 
coping styles, levels of self-efficacy and physical activity were also 
associated with mental health or wellbeing.
CONCLUSIONS: Many students returning to further and higher education after 
Covid-19 restrictions experienced reduced mental health and wellbeing, and some 
students were at greater risk. Providing student-centred interventions focusing 
on self-efficacy, coping styles and physical activity may help improve the 
mental health and wellbeing of students.

Copyright: © 2023 Liverpool et al. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0280689
PMCID: PMC9870122
PMID: 36689440 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


1067. Mindfulness (N Y). 2023;14(1):218-229. doi: 10.1007/s12671-022-02060-w. Epub 
2023 Jan 9.

Exploring the Influence of a Mindfulness Intervention on the Experiences of 
Mothers with Infants in Neonatal Intensive Care Units.

Grieb SM(1), McAtee H(2), Sibinga E(1), Mendelson T(3).

Author information:
(1)Department of Pediatrics, Center for Child and Community Health Research, 
Johns Hopkins University School of Medicine, 5200 Eastern Ave., Mason F. Lord 
Center Bldg, Suite 4200, Baltimore, MD 21224 USA.
(2)General Pediatrics, Johns Hopkins All Children's Hospital, 601 5th Street 
South, St. Petersburg, FL 33701 USA.
(3)Department of Mental Health, Johns Hopkins University Bloomberg School of 
Public Health, 624 N. Broadway, Hampton House 853, Baltimore, MD 21205 USA.

OBJECTIVES: Mothers with infants in the neonatal intensive care unit (NICU) are 
at increased risk of psychological distress, which can have lasting negative 
impacts on both mother and infant. However, few interventions are available to 
promote these mothers' mental health and wellbeing. In the context of a pilot 
randomized controlled trial testing a mindfulness intervention for mothers with 
infants in the NICU, we explore the experiences of the mothers participating in 
the mindfulness-based intervention, with mothers in the control group as 
comparison, and the ways they felt it influenced their time in the NICU.
METHOD: Twenty-six participants (15 participants in the intervention arm and 11 
participants in the control arm) recruited from two NICUs in an urban center in 
Eastern United States completed semi-structured interviews. Interviews explored 
the mothers' NICU experience as well as experience with the mindfulness and 
health education (control) programs. Data was analyzed using an iterative, 
thematic constant comparison process informed by grounded theory.
RESULTS: Mothers reported that participation in the mindfulness intervention 
helped them to calm the chaos through recentering and fostering connections, 
find comfort through non-judgmental acceptance, gain perspective on the 
situation, and facilitate self-care. These were experienced only among the 
mothers in the intervention arm. These themes did not vary based on demographics 
of the mothers in the mindfulness study arm or their pre-study awareness of 
mindfulness.
CONCLUSIONS: Mindfulness interventions may foster new practices and perspectives 
for mothers with infants in the NICU, potentially leading to improved mental 
health wellbeing.

© The Author(s), under exclusive licence to Springer Science+Business Media, 
LLC, part of Springer Nature 2022, Springer Nature or its licensor (e.g. a 
society or other partner) holds exclusive rights to this article under a 
publishing agreement with the author(s) or other rightsholder(s); author 
self-archiving of the accepted manuscript version of this article is solely 
governed by the terms of such publishing agreement and applicable law.

DOI: 10.1007/s12671-022-02060-w
PMCID: PMC9838379
PMID: 36684062

Conflict of interest statement: Conflict of InterestThe authors declare no 
competing interests.


1068. Work. 2023;75(3):1-8. doi: 10.3233/WOR-220267.

Schoolteachers' well-being: A pilot study from the AVATAR project during 
COVID-19 school closure.

Mastorci F(1), Lazzeri MFL(1), Piaggi P(2), Doveri C(1), Trivellini G(1), Casu 
A(1), Marinaro I(1), Bianchin E(3), Pozzi M(3), Pingitore A(1).

Author information:
(1)Clinical Physiology Institute, CNR, Pisa Italy.
(2)Department of Information Engineering, University of Pisa, Pisa, Italy.
(3)Department of addictions, ASFO - Azienda Sanitaria Friuli Occidentale, 
Pordenone, Italy.

Erratum in
    Work. 2023;76(4):1629.

BACKGROUND: Teachers are a category at high risk for co-occurring mental 
diseases.
OBJECTIVES: The purpose was to assess well-being of schoolteachers and 
psychological effects of coronavirus disease 2019 (COVID-19).
METHOD: Data were collected in April 2021, during the partial re-opening of 
public schools in Italy, from 838 schoolteachers who complete a battery of 
psychological tests on a multimedia platform.
RESULTS: In females, school closure increases anxiety (BAI, p < 0.001), 
depression (BDI-II, p < 0.05), stress-related insomnia (FIRST, p < 0.001), and 
perceived stress (PSS, p < 0.05). In males, on the contrary, rises perceived 
health (p < 0.001) and vitality (p < 0.001), also in terms of total score (PWBI 
p < 0.05). In addition, having a family member with COVID in the past month 
increased anxiety (BAI, p < 0.05), reduced perceived physical health (PWBI, 
p < 0.05) and vitality (PWBI, p < 0.05).
CONCLUSION: The main results of this pilot study showed that female teachers had 
a worse well-being perception with respect to men, in terms of health and 
vitality and an increase in negative emotional reactivity, that impaired when a 
family member was affected by COVID. The results emphasize the need to invest in 
prevention and wellness promotion programs in this professional category.

DOI: 10.3233/WOR-220267
PMID: 36683483 [Indexed for MEDLINE]


1069. Can J Occup Ther. 2023 Jun;90(2):125-135. doi: 10.1177/00084174221145823. Epub 
2023 Jan 22.

Losing Life's Sparkle: Experiences of Canadian Choral Musicians During the 
COVID-19 Pandemic.

Lozano MJA, Churcher SL, Kirchner MJ, Slade TM.

Background. Singing in choirs, which previous research has identified as 
supporting wellbeing, has been restricted and altered during the COVID-19 
pandemic. Purpose. The purpose of this study is to investigate and describe the 
experience of music-making for musicians in professional and semi-professional 
choirs in Canada 18-22 months into the COVID-19 pandemic. Method. 
Semi-structured interviews were conducted with 11 participants and analyzed 
using interpretive description. Findings. Four themes: (1) increased negative 
feelings associated with the music-making experience due to COVID-19 
restrictions, (2) isolation and disconnection, (3) recognizing how music-making 
aids in their own mental health, the participants used music-making to help 
their communities cope with the pandemic, and (4) adapting in response to 
COVID-19 reinforced music-making's importance. Implications. Understanding how 
the COVID-19 pandemic has altered Canadian choral musicians' experience of 
music-making can help occupational therapists in supporting choral musicians 
return to this meaningful occupation.

Description. La pratique du chant choral, identifiée par les chercheurs comme 
étant favorable au bien-être, a été restreinte et al.térée durant la pandémie de 
COVID-19. But. Le but de cette étude est d’examiner et de décrire l’expérience 
de la pratique musicale chez des musiciens de chorales professionnelles et 
semi-professionnelles au Canada entre 18 et 22 mois après le début de la 
pandémie de COVID-19. Méthodologie. Des entrevues semi-structurées ont été 
réalisées auprès de 11 participants et analysées à l’aide d’une description 
interprétative. Résultats. Quatre thèmes ressortent : 1) L’augmentation des 
sentiments négatifs associés à l’expérience de la pratique musicale en raison 
des restrictions liées à la COVID-19; 2) L’isolement et la déconnexion; 3) 
Reconnaissant que la pratique musicale était utile à leur santé mentale, les 
participants ont utilisé la musique pour aider leurs communautés à passer à 
travers la pandémie; 4) L’adaptation en réponse à la COVID-19 a renforcé 
l’importance de la pratique musicale. Conséquences. Le fait de comprendre 
comment la pandémie de COVID-19 a altéré l’expérience de la pratique musicale 
pour les musiciens de chorale peut aider les ergothérapeutes à soutenir les 
musiciens dans leur retour à l’exercice de cette activité significative.

DOI: 10.1177/00084174221145823
PMCID: PMC9902788
PMID: 36683408 [Indexed for MEDLINE]


1070. Child Abuse Negl. 2023 Mar;137:106041. doi: 10.1016/j.chiabu.2023.106041. Epub 
2023 Jan 20.

From parental issues of job and finance to child well-being and maltreatment: A 
systematic review of the pandemic-related spillover effect.

Or PPL(1), Fang Y(2), Sun F(3), Poon ETC(4), Chan CKM(5), Chung LMY(6).

Author information:
(1)Department of Health and Physical Education, The Education University of Hong 
Kong, Hong Kong. Electronic address: peggyor@eduhk.hk.
(2)Department of Health and Physical Education, The Education University of Hong 
Kong, Hong Kong. Electronic address: lunajoef@gmail.com.
(3)Department of Health and Physical Education, The Education University of Hong 
Kong, Hong Kong. Electronic address: fhsun@eduhk.hk.
(4)Department of Health and Physical Education, The Education University of Hong 
Kong, Hong Kong. Electronic address: ericpoon@eduhk.hk.
(5)Department of Health and Physical Education, The Education University of Hong 
Kong, Hong Kong. Electronic address: kamanchan@eduhk.hk.
(6)Department of Health and Physical Education, The Education University of Hong 
Kong, Hong Kong. Electronic address: chungmy@eduhk.hk.

BACKGROUND: Covid-19 pandemic jeopardized family well-being at the population 
level internationally. Pandemic-related job/financial difficulties in parents 
have a spillover effect on their child's well-being and issues of child 
maltreatment.
OBJECTIVE: The current review sought to systematically summarize and analyze 
this pandemic-related spillover effect.
PARTICIPANTS AND SETTINGS: In the home setting, participants involved 11,100 
adolescents, 9144 parents/caregivers, and another 7927 parent-children dyads.
METHODS: An extensive literature search in 13 electronic databases was 
conducted. A total 21 eligible papers published from 2020 to 2022 were included 
for further thematic analysis.
RESULTS: A significant positive relationship between the pandemic-related 
spillover effect from parental job or financial issues to child maltreatment and 
child's mental/behavioral issues was established. The internal mechanisms 
demonstrated that this relationship was intermediated or moderated by the 
interactions of parental mental health issues, parenting practice, and family 
relationships. Families with particular factors may be more vulnerable and 
sensitive to the spillover effect during the pandemic. The work-from-home 
arrangement was found as positively related to enhanced parenting warmth and 
parent-child relationship in some cases who had relatively high familial 
social-economic status.
CONCLUSIONS: Findings of current review provided the evidences from empirical 
data. During the Covid-19 pandemic, spillover effect from parental job/financial 
issues significantly influenced the child well-being and family functioning. 
Future efforts for intervention/service design should be made to enhance 
familial protective factors and support those families with vulnerable factors.

Copyright © 2023 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.chiabu.2023.106041
PMCID: PMC9851830
PMID: 36682192 [Indexed for MEDLINE]


1071. BMC Pregnancy Childbirth. 2023 Jan 21;23(1):53. doi: 10.1186/s12884-023-05383-1.

Efforts and expectations of pregnant women against the impact of the COVID-19 
pandemic: a phenomenological study.

Dewi A(1), Safaria T(2), Supriyatiningsih S(3), Dewi DTK(4)(5).

Author information:
(1)Department of Public Health, Master of Hospital Administration, Universitas 
Muhammadiyah Yogyakarta, Yogyakarta, Indonesia. arlinadewi@umy.ac.id.
(2)Department of Psychology, Faculty of Psychology, Ahmad Dahlan University, 
Yogyakarta, Indonesia.
(3)Department of Obstetrics and Gynecology, Faculty of Medicine and Health 
Sciences, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia.
(4)Department of Public Health, Master of Hospital Administration, Universitas 
Muhammadiyah Yogyakarta, Yogyakarta, Indonesia.
(5)School of Nursing, College of Nursing, Taipei Medical University, Taipei, 
Taiwan.

BACKGROUND: COVID-19 is a global threat that directly impacts people's mental 
health and physical well-being. This study explored the efforts and expectations 
of pregnant women against the impact of the COVID-19 pandemic.
METHODS: This study was a qualitative study that used a phenomenological 
approach. The informants of this study were pregnant women (n = 20). Data 
analysis used content analysis with software assistance (Nvivo Release 1.5).
RESULTS: The results of this study identified three themes which were: 1) 
causative factors of pregnant women's anxiety regarding the impact of COVID-19 
including lack of knowledge regarding the impact of the COVID-19 virus and 
perceived susceptibility; 2) Efforts to reduce anxiety during the COVID-19 
pandemic including a spiritual approach, the role of family and COVID-19 
prevention; and 3) Expectation regarding healthcare services during COVID-19 
including virtual based Antenatal Care (ANC) Services and Private ANC Services.
CONCLUSION: A spiritual approach, the role of family, and COVID-19 prevention 
will help pregnant women reduce their anxiety about being infected with the 
COVID-19 virus. Furthermore, virtual-based ANC Services, and private ANC 
services, such as home visits and dividing ANC services and general services 
into two different tracks as a protective mechanism from being infected with the 
COVID-19 virus, would assist pregnant women feel safer and secure.

© 2023. The Author(s).

DOI: 10.1186/s12884-023-05383-1
PMCID: PMC9862243
PMID: 36681793 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no competing interests in this 
research.


1072. Medicina (Kaunas). 2022 Dec 24;59(1):38. doi: 10.3390/medicina59010038.

Factors Affecting Health-Related Quality of Life among Healthcare Workers during 
COVID-19: A Cross-Sectional Study.

Jung G(1), Oh J(2).

Author information:
(1)Department of Nursing, Jeonbuk Science College, Jeongeup 56204, Republic of 
Korea.
(2)Department of Nursing, College of Nursing and Health, Kongju National 
University, Kongju 32588, Republic of Korea.

Background and Objectives: Healthcare workers are threatened by psychological 
well-being and mental health problems in disasters related to new infectious 
diseases, such as COVID-19, and this can also have a negative impact on 
health-related quality of life. Health-related quality of life of healthcare 
workers should not be neglected because it is closely related to patient safety. 
This study aimed to identify the relationship between mental health problems, 
psychological safety, sleep quality, and health-related quality of life of 
healthcare workers and factors that influence health-related quality of life 
during the COVID-19 pandemic. Materials and Methods: Data were collected from 
301 healthcare workers working in five general hospitals with more than 300 beds 
in two provinces from 5 July 2021 to 16 July 2021. Data were analyzed using SPSS 
WIN 27.0. The data were analyzed using t-test, one-way analysis of variance, and 
stepwise multiple regression. Results: Our results showed that there was a 
significant difference in regular exercise, religion, economic status, and sleep 
quality. The DASS-21 stress, economic status, and alcohol consumption were 
factors affecting the total health-related quality of life. In the 
subcategories, the physical component score was influenced by DASS-21 stress and 
economic status, while the mental component score was influenced by DASS-21 
depression, economic status, alcohol consumption, and sleep quality. 
Conclusions: Health care workers need continuous and active monitoring of their 
health level and quality of life, as they are at a risk of increasing work 
burden and infection due to prolonged exposure to COVID-19 as well as mental 
health issues such as stress and depression. Additionally, at the individual 
level, active participation in various programs that can raise awareness of 
health-related quality of life along with physical health promotion activities 
should be encouraged. At the organizational level, it is necessary to prepare a 
compensation system, such as adjusting the workload of healthcare workers and 
ensuring break time; at the government level, disaster-related policies are 
needed to ensure a safe working environment for health care workers.

DOI: 10.3390/medicina59010038
PMCID: PMC9866756
PMID: 36676662 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1073. Int J Environ Res Public Health. 2023 Jan 13;20(2):1469. doi: 
10.3390/ijerph20021469.

Long-Term Effects of Mountain Hiking vs. Forest Therapy on Physical and Mental 
Health of Couples: A Randomized Controlled Trial.

Huber D(1), Freidl J(1), Pichler C(1), Bischof M(1), Kiem M(2), Weisböck-Erdheim 
R(1), Squarra G(3), De Nigris V(4), Resnyak S(4), Neberich M(1), Bordin S(1), 
Zechner R(1), Hartl A(1).

Author information:
(1)Institute of Ecomedicine, Paracelsus Medical University Salzburg, 5020 
Salzburg, Austria.
(2)Certified Nature and Forest Therapy Guide, 39010 Tisens, Italy.
(3)Certified Forest-Health-Trainer, 83435 Bad Reichenhall, Germany.
(4)Institute of Sports Medicine, South Tyrol Health Authority, 39100 Bozen, 
Italy.

BACKGROUND: Lifelong physical activity is related to longer health span, which 
is reflected at an individual level, and is of substantial socioeconomic 
relevance. Sedentary lifestyles, on the other hand, pose an increasingly major 
public health problem. In addition, the COVID-19 pandemic had a negative impact 
on activity levels and well-being. Previous research indicates that contact with 
nature might improve exercise levels as well as well-being.
METHODS: This randomized, controlled clinical trial (ANKER-study) investigated 
the effects of two types of nature-based therapies (forest therapy and mountain 
hiking) in couples (FTG: n = 23; HG: n = 22;) with a sedentary or inactive 
lifestyle on health-related quality of life, relationship quality and other 
psychological and physiological parameters.
RESULTS: The results of this study displayed that healthy and highly functioning 
women and men with sedentary lifestyles mentally benefit from contact with 
nature (quality of life, satisfaction with life, mood, internal and external 
health-related control beliefs). The gender-specific effect on women is most 
visible in the physiological outcomes (hemopoietic system, aerobic capacity, 
skeletal muscle mass and hydration) of mountain hiking. Men and women showed 
small improvements in blood pressure as a result of the interventions.
CONCLUSIONS: The ANKER-study provides a method for valid comparison of forest 
therapy interventions for the first time. Regarding the COVID-19 pandemic, the 
nature-based intervention presented could offer a multimodal contribution to 
maintaining a more active lifestyle, further contact with nature that affects 
peoples physical as well as mental health, and an improvement in social 
interaction.

DOI: 10.3390/ijerph20021469
PMCID: PMC9859399
PMID: 36674227 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study, the collection, analyses, or 
interpretation of data. Additionally, whether in the writing of the manuscript, 
nor in the decision to publish the results.


1074. Int J Environ Res Public Health. 2023 Jan 10;20(2):1280. doi: 
10.3390/ijerph20021280.

Leveraging Campus Landscapes for Public Health: A Pilot Study to Understand the 
Psychological Effects of Urban Sheep Grazing on College Campuses.

Kiers AH(1), Nishimura KM(2), Dewa CS(3).

Author information:
(1)Department of Human Ecology, University of California, Davis, CA 95616, USA.
(2)Office of Campus Planning, University of California, Davis, CA 95616, USA.
(3)Department of Public Health Sciences, University of California, Davis, CA 
95616, USA.

Since the 1980s, college students in the U.S. have self-reported a decline in 
their physical and emotional health. With these conditions compounded by the 
COVID-19 pandemic and its physical distancing restrictions, higher education 
institutions have an increased responsibility to establish strategic 
interventions and health-promoting programs for their students. Research 
collaborations between public health professionals and environmental designers 
have highlighted the benefits of environmental factors, such as wildlife, street 
trees, and public parks, on mental health. This pilot project aims to build upon 
the transdisciplinary dialogue between ecology, design, and public health by 
examining the social benefits of grazing lawnscape management, which is the 
practice of using herbivorous livestock to manage turfgrass areas. Through the 
design of an accessible central campus grazing space for a flock of 25 sheep and 
use of online questionnaires, a smartphone-based single-item survey, and 
open-ended feedback given via social media, the UC Davis Sheepmower Project 
addresses three primary questions: (1) Are there differences in self-reported 
stress levels and well-being between people who did not watch grazing sheep (no 
sheepmower group) compared with those who did watch grazing sheep (sheepmower 
group)? (2) Does holding sheep grazing events create opportunities for education 
about well-being and engagement with the campus community? (3) Can this type of 
urban grazing installation ultimately contribute to the overall identity of a 
college campus? Web-based questionnaire results indicate there is no significant 
difference in self-reported stress levels between the two groups; however, the 
moment-in-time smartphone-based single item question suggests that the presence 
of sheep provides temporary, noticeable relief and enhanced mood for those who 
observe the animals. Reflections posted on social media suggested that 
participants found the sheep grazing events fostered feelings of community and 
placemaking within the campus identity. However, the questionnaire sample 
indicated the grazing events did not have a significant effect on participants' 
sense of place or overall campus identity. This transdisciplinary effort breaks 
down traditionally siloed approaches to human and environmental health and is an 
example of a whole-systems approach to developing innovative solutions and 
encouraging applied collective action.

DOI: 10.3390/ijerph20021280
PMCID: PMC9859548
PMID: 36674034 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1075. Int J Environ Res Public Health. 2023 Jan 9;20(2):1185. doi: 
10.3390/ijerph20021185.

SOphrology Intervention to Improve WELL-Being in Hospital Staff (SO-WELL): 
Protocol for a Randomized Controlled Trial Study.

Dutheil F(1)(2), Parreira LM(2), Pereira B(3), Baldet M(4), Marson F(5), Chabaud 
C(6), Blot M(6), Baker JS(7), Zak M(8), Vallet G(9), Magnon V(9), Clinchamps 
M(1)(2), Altun S(1)(2).

Author information:
(1)Physiological and Psychosocial Stress, CNRS UMR 6024, LaPSCo, University 
Clermont Auvergne, WittyFit, 63000 Clermont-Ferrand, France.
(2)Preventive and Occupational Medicine, University Hospital of Clermont-Ferrand 
(CHU), 63000 Clermont-Ferrand, France.
(3)The Clinical Research and Innovation Direction, CHU Clermont-Ferrand, 63000 
Clermont-Ferrand, France.
(4)Pole REUNIRRH, University Hospital of Clermont-Ferrand (CHU), 63000 
Clermont-Ferrand, France.
(5)Pole MobEx (Mobility-Exercise), University Hospital of Clermont-Ferrand 
(CHU), 63000 Clermont-Ferrand, France.
(6)Sophrologist (Caycedo Method)-Trained in Neurolinguistic Programming (NLP), 
University Hospital of Clermont-Ferrand (CHU), 63000 Clermont-Ferrand, France.
(7)Centre for Health and Exercise Science Research, Department of Sport, 
Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong 
Kong.
(8)Faculty of Medicine and Health Sciences, Institute of Physiotherapy, The Jan 
Kochanowski University, 25-369 Kielce, Poland.
(9)Department of Psychology, CNRS UMR 6024, LaPSCo, University Clermont 
Auvergne, 63000 Clermont-Ferrand, France.

INTRODUCTION: Stress at work and psychosocial risks are a major public health 
problem. Sophrology and neurolinguistic programming (NLP) have demonstrated 
benefits in terms of mental, physical and social health, both in the general 
population and in patients, and both in and out of hospital settings. However, 
these approaches have never been provided at the hospital for the benefit of 
health professionals at risk of suffering at work. In general, we aim to 
demonstrate the effectiveness of a hospital sophrology/NLP intervention for 
health care professionals at risk of stress-related disorders. The secondary 
objectives are to study (i) within-group, and (ii) between-group): (1) effects 
on mental, physical, and social health; (2) persistence of effect; (3) 
relationships between job perception and mental, physical, and social health; 
(4) intervention success factors (personality and job perception, attendance and 
practice, other); (5) effects on other stress biomarkers (other measures of 
autonomic nervous system activity, DHEAS, cortisol, etc.).
METHODS: Our study will be a randomized controlled prospective study (research 
involving the human person of type 2). The study will be proposed to any 
health-care workers (HCW) or any non-HCW (NHCW) from a healthcare institution 
(such as CHU of Clermont-Ferrand, other hospitals, clinics, retirement homes). 
Participants will benefit from NLP and sophrology interventions at the hospital. 
For both groups: (i) heart rate variability, skin conductance and saliva 
biomarkers will be assessed once a week during the intervention period (6 to 8 
sophrology sessions) and once by month for the rest of the time; (ii) the short 
questionnaire will be collected once a week during the whole protocol (1-2 min); 
(iii) the long questionnaire will be assessed only 5 times: at baseline (M0), 
month 1 (M1), month 3 (M3), month 5 (M5) and end of the protocol (M7).
ETHICS AND DISSEMINATION: The protocol, information and consent form had 
received the favorable opinion from the Ethics Committee. Notification of the 
approval of the Ethics Committee was sent to the study sponsor and the competent 
authority (ANSM). The study is registered in ClinicalTrials.gov under the 
identification number NCT05425511 after the French Ethics Committee's approval. 
The results will be reported according to the CONSORT guidelines.
STRENGTHS AND LIMITATIONS OF THIS STUDY: The psychological questionnaires in 
this study are self-assessed. It is also possible that responses suffer from 
variation. For the study, participants need to attend 6 to 8 sophrology sessions 
and one visit per month for 7 months, which might seem demanding. Therefore, to 
make sure that participants will complete the protocol, two persons will be 
fully in charge of the participants' follow-up.

DOI: 10.3390/ijerph20021185
PMCID: PMC9859524
PMID: 36673939 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


1076. Pediatr Res. 2023 Aug;94(2):581-587. doi: 10.1038/s41390-023-02474-9. Epub 2023 
Jan 20.

Impact of the SARS-CoV-2 pandemic on pediatric subspecialists' well-being and 
perception of workplace value.

Gribben JL(#)(1), Kase SM(#)(2), Guttmann KF(3), Waldman ED(4), Weintraub AS(5).

Author information:
(1)Weill Department of Medicine, New York Presbyterian Hospital-Weill Cornell 
Medical Center, New York, NY, USA.
(2)Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, 
NY, USA.
(3)Division of Newborn Medicine, Department of Pediatrics, Icahn School of 
Medicine at Mount Sinai, New York, NY, USA.
(4)Division of Palliative Care, Lurie Children's Hospital of Chicago, Chicago, 
IL, USA.
(5)Division of Newborn Medicine, Department of Pediatrics, Icahn School of 
Medicine at Mount Sinai, New York, NY, USA. andrea.weintraub@mssm.edu.
(#)Contributed equally

OBJECTIVE: To explore pediatric subspecialist distress and well-being during the 
pandemic, with a particular focus on relationships between compassion fatigue 
(CF), burnout (BO), and compassion satisfaction (CS), and physicians' perception 
of "feeling valued" by their institution.
METHODS: The Compassion Fatigue and Satisfaction Self-Test and a questionnaire 
of personal/professional characteristics were distributed electronically to 
pediatric subspecialists. Content analysis was performed for responses to the 
question "How has your institution made you feel valued?"
RESULTS: During the 16-month study period, CF and BO scores significantly 
increased, and CS scores decreased over time. By Epoch 3, 52% of respondents did 
not feel valued by their employing institution. When controlling for the effect 
of time, CF and BO scores remained higher, and CS scores lower, in participants 
who did not feel valued by their institution. Themes from the content analysis 
of "value" included expressions of gratitude, perks vs. penalties, safety, and 
leadership. The same overture from leadership provoked disparate responses in 
recipients, seemingly over the sincerity behind the offering, which may reflect 
underlying workplace culture.
CONCLUSIONS: Increasingly, pediatric subspecialists are not feeling valued for 
their work. Institutional leadership must prioritize healthy workplace culture, 
and re-think emotional and mental health support within the health system.
IMPACT: A total of 52% of our study population did not "feel valued" by their 
employing institution by late 2021, which is cause for concern. This is the 
first longitudinal analysis of distress and well-being in a national cohort of 
pediatric subspecialists during the COVID-19 pandemic. The same overture or 
messaging from leadership sparked disparate responses in recipients, seemingly 
over the sincerity behind the offering, which relates to the underlying 
workplace culture of the department or institution. Institutional leadership 
must prioritize a healthy workplace culture, and re-think and re-invent 
emotional and mental health support within the health system.

© 2023. The Author(s), under exclusive licence to the International Pediatric 
Research Foundation, Inc.

DOI: 10.1038/s41390-023-02474-9
PMCID: PMC9857910
PMID: 36670160 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1077. Curr Oncol. 2023 Jan 1;30(1):586-597. doi: 10.3390/curroncol30010046.

COVID-19 Emotional and Mental Impact on Cancer Patients Receiving Radiotherapy: 
An Interpretation of Potential Explaining Descriptors.

Tolia M(1), Symvoulakis EK(2), Matalliotakis E(1), Kamekis A(3), Adamou M(4), 
Kountourakis P(5), Mauri D(6), Dakanalis A(7), Alexidis P(8), Varveris A(1), 
Antoniadis C(1), Matthaios D(9), Paraskeva M(9), Giaginis C(10), Kamposioras 
K(11).

Author information:
(1)Department of Radiation Oncology, School of Medicine, University of Crete, 
71300 Heraklion, Greece.
(2)Clinic of Social and Family Medicine, School of Medicine, University of 
Crete, 71300 Heraklion, Greece.
(3)School of Medicine, University of Crete, 71300 Heraklion, Greece.
(4)School of Human and Health Sciences, University of Huddersfield, Queensgate, 
Huddersfield HD1 3DH, UK.
(5)Department of Medical Oncology, Mediterranean Hospital of Cyprus, 3117 
Limassol, Cyprus.
(6)Medical Oncology, University of Ioannina, 45500 Ioannina, Greece.
(7)Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 
48, 20900 Monza, Italy.
(8)Department of Radiation Oncology, Papageorgiou Hospital, 56429 Thessaloniki, 
Greece.
(9)Oncology Department, General Hospital of Rhodes, 85133 Rhodes, Greece.
(10)Department of Food Science and Nutrition, School of Environment, University 
of the Aegean, Myrina, 81400 Lemnos, Greece.
(11)Department of Medical Oncology, The Christie NHS Foundation Trust, 
Manchester M20 4BX, UK.

Background: Significant changes in the accessibility and viability of health 
services have been observed during the COVID-19 period, particularly in 
vulnerable groups such as cancer patients. In this study, we described the 
impact of radical practice and perceived changes on cancer patients’ mental 
well-being and investigated potential outcome descriptors. Methods: Generalized 
anxiety disorder assessment (GAD-7), patient health (PHQ-9), and World Health 
Organization-five well-being index (WHO-5) questionnaires were used to assess 
anxiety, depression, and mental well-being. Information on participants, disease 
baseline information, and COVID-19-related questions were collected, and related 
explanatory variables were included for statistical analysis. Results: The mean 
score values for anxiety, depression, and mental well-being were 4.7 ± 5.53, 4.9 
± 6.42, and 72.2 ± 18.53, respectively. GAD-7 and PHQ-9 scores were 
statistically associated (p < 0.001), while high values of GAD-7 and PHQ-9 
questionnaires were related to low values of WHO-5 (p < 0.001).Using the GAD-7 
scale, 16.2% of participants were classified as having mild anxiety (GAD-7 
score: 5−9).Mild to more severe anxiety was significantly associated with a 
history of mental health conditions (p = 0.01, OR = 3.74, 95% CI [1.372−10.21]), 
and stage category (stage III/IV vs. I/II, p = 0.01, OR = 3.83, 95% CI 
[1.38−10.64]. From the participants, 36.2% were considered to have depression 
(PHQ-9 score ≥ 5). Depression was related with older patients (p = 0.05, OR = 
1.63, 95% CI [1.16−2.3]), those with previous mental health conditions (p = 
0.03, OR = 14.24, 95% CI [2.47−81.84]), those concerned about the COVID-19 
impact on their cancer treatment (p = 0.027, OR = 0.19, 95% CI [0.045−0.82]) or 
those who felt that COVID-19 pandemic has affected mental health (p = 0.013, OR 
= 3.56, 95% CI [1.30−9.72]). Additionally, most participants (86.7%) had a good 
well-being score (WHO-5 score ≥ 50). Mental well-being seemed more reduced among 
stage I−III patients than stage IV patients (p = 0.014, OR = 0.12, 95% CI 
[0.023−0.65]). Conclusion: There is a necessity for comprehensive cancer care 
improvement. These patients’ main concern related to cancer therapy, yet the 
group of patients who were mentally affected by the pandemic should be 
identified and supported.

DOI: 10.3390/curroncol30010046
PMCID: PMC9857784
PMID: 36661695 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1078. Curr Opin Pediatr. 2023 Apr 1;35(2):184-192. doi: 10.1097/MOP.0000000000001221. 
Epub 2023 Jan 23.

Diagnosis and management of post-COVID (Long COVID) in children: a moving 
target.

Morello R(1), Martino L(1), Buonsenso D(1)(2).

Author information:
(1)Department of Woman and Child Health and Public Health, Fondazione 
Policlinico Universitario A. Gemelli IRCCS.
(2)Centro di Salute Globale, Università Cattolica del Sacro Cuore, Rome, Italy.

PURPOSE OF REVIEW: This review describes recent findings about post-COVID 
condition (PCC, or Long COVID) in children, including current knowledge about 
its epidemiology, clinical presentation, pathogenesis and care.
RECENT FINDINGS: There is no internationally agreed definition of PCC, although 
now most researchers agree that it is a complex clinical symptomatology 
persisting for at least 3 months after COVID-19, without an alternative 
diagnosis. There are several uncertainties about paediatric PCC. So far, 
available literature suggest that 1-3% of recognized children with Severe Acute 
Respiratory Syndrome COronaVirus 2 (SARS-CoV-2) infection may develop PCC. Its 
pathogenesis is unknown, although there is increasing evidence about possible 
abnormalities in the immune responses, cellular metabolism and intestinal 
microbiota, along with chronic endothelitis.
SUMMARY: Management of PCC in children is complex and require a 
multidisciplinary approach, with the goal of offering the best care possible to 
support diagnostics, research, mental health and access to research projects.

Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

DOI: 10.1097/MOP.0000000000001221
PMCID: PMC9994801
PMID: 36660968 [Indexed for MEDLINE]

Conflict of interest statement: D.B. has received grants to study Long COVID by 
Pfizer and Roche Italia.


1079. Gerontologist. 2023 Sep 2;63(8):1279-1288. doi: 10.1093/geront/gnac191.

Creativity During COVID-19: Evaluating an Online TimeSlips Storytelling Program 
for People Living With Dementia During Quarantine in Colombia.

Fay SM(1), García-Toro M(2), Henao LH(3), Villegas ÁA(3), Lopera F(3).

Author information:
(1)Faculty of Arts and Social Sciences, School of Literature and Languages, 
University of Surrey, Guildford, UK.
(2)Facultad de Ciencias de la Salud, Grupo de Investigación en Neurociencias y 
Envejecimiento (GISAM), Corporación Universitaria Remington, Medellín, Colombia.
(3)Grupo de Neurociencias de Antioquia, Universidad de Antioquia, Medellín, 
Colombia.

BACKGROUND AND OBJECTIVES: Since its first implementation in 1998, evidence has 
been presented of the positive impact of the TimeSlips storytelling method for 
people with dementia in long-term care (LTC) settings. This article extends this 
evidence in important new directions: it is the longest TimeSlips study to date 
and the first to evaluate the feasibility of online delivery of the method (in 
response to the coronavirus disease 2019 [COVID-19] quarantine) and the impact 
of this on the personhood, quality of life, and psychological well-being of 
Spanish-speaking participants in non-LTC settings in the Global South.
RESEARCH DESIGN AND METHODS: Trained facilitators provided weekly, 1-hr 
TimeSlips sessions via Zoom over 32 consecutive weeks to 8 participants with 
dementia. Semistructured interviews of participants and care partners were 
conducted within 1 week of the final intervention. Thematic analysis evaluated 
the resultant qualitative data.
RESULTS: This online implementation of the TimeSlips creative expression (CE) 
method reinforced key facets of participants' personhood (self-expression and 
self-perception, which led in turn to increased care partner appreciation), had 
a positive impact on key domains of quality of life (mood, energy levels, and 
cognitive function), and stimulated a key aspect of psychological well-being 
(the formation and maintenance of social ties).
DISCUSSION AND IMPLICATIONS: The online delivery of the TimeSlips method to 
participants who remain in their own homes is feasible and effective. Future 
research should compare the benefits of online versus face-to-face delivery of 
this CE method.

© The Author(s) 2023. Published by Oxford University Press on behalf of The 
Gerontological Society of America. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/geront/gnac191
PMID: 36660858 [Indexed for MEDLINE]


1080. Int J Qual Stud Health Well-being. 2023 Dec;18(1):2167298. doi: 
10.1080/17482631.2023.2167298.

Wellness Warriors: a qualitative exploration of healthcare staff learning to 
support their colleagues in the aftermath of the Australian bushfires.

Knezevic A(1), Olcoń K(1), Smith L(2), Allan J(3), Pai P(4).

Author information:
(1)School of Health and Society, University of Wollongong, New South Wales, 
Australia.
(2)Deakin University.
(3)Rural Health Research Institute, Charles Sturt University, Orange, New South 
Wales, Australia.
(4)Illawarra Shoalhaven Local Health District.

PURPOSE: Healthcare staff are on the frontline during disasters despite any 
personal adversity and vicarious trauma they may be experiencing. Wellness 
Warrior training is a post-disaster intervention developed in response to the 
2019-2020 Australian bushfires to support staff in a rural hospital located on 
the South Coast of New South Wales, Australia.
METHOD: This study explored the experiences and perspectives of 18 healthcare 
staff who were trained to provide emotional and peer support to their colleagues 
in the aftermath of a crisis. All the Wellness Warriors participated in 
semi-structured interviews between March and April 2020. Data were analysed 
using the reflexive thematic approach.
RESULTS: Healthcare staff reported developing interpersonal skills around deep 
listening and connecting with others which allowed for hearing the core of their 
colleagues' concerns. The training also helped staff to feel differently about 
work and restored their faith in healthcare leadership.
CONCLUSION: Wellness Warrior training provided staff with knowledge and skills 
to support their colleagues in the aftermath of a natural disaster and later 
during the COVID-19 pandemic. As such, these findings suggest that peer support 
programs such as Wellness Warriors could be one way healthcare organisations can 
attempt to alleviate the psychological impact of natural disasters.

DOI: 10.1080/17482631.2023.2167298
PMCID: PMC9858529
PMID: 36656623 [Indexed for MEDLINE]

Conflict of interest statement: AK, KO, LS and JA report that there are no 
competing interests to declare. PP was employed by the health service where the 
research took place, but not at the research site.


1081. BMC Public Health. 2023 Jan 18;23(1):123. doi: 10.1186/s12889-023-14987-3.

How did UK social distancing restrictions affect the lives of women experiencing 
intimate partner violence during the COVID-19 pandemic? A qualitative 
exploration of survivor views.

McKinlay AR(1), Simon YR(2), May T(2), Fancourt D(2), Burton A(2).

Author information:
(1)Research Department of Behavioural Science and Health, Institute of 
Epidemiology & Health Care, University College London, 1-19 Torrington Place, 
London, WC1E 7HB, UK. a.mckinlay@ucl.ac.uk.
(2)Research Department of Behavioural Science and Health, Institute of 
Epidemiology & Health Care, University College London, 1-19 Torrington Place, 
London, WC1E 7HB, UK.

BACKGROUND: Increased numbers of domestic abuse cases were reported at the start 
of the COVID-19 pandemic. Many people experiencing abuse faced barriers to 
seeking support with service closures affecting the sector. Available evidence 
suggests women are overrepresented in the reported cases of intimate partner 
violence (IPV) and we aimed to learn more about how their lives were impacted by 
social distancing restrictions.
METHODS: We conducted an online qualitative interview study, using reflexive 
thematic analysis. Interviews were conducted between April 2021 and March 2022. 
18 women in the UK with past experiences of IPV provided informed consent and 
participated in this study.
RESULTS: During the analysis, we identified five themes relating to the impact 
of lockdown restrictions on participants' lives, including: (1) Lockdown meant 
being confined to a place where abuse was escalating, (2) Barriers to accessing 
support, including "cancelled" services and missed opportunities to intervene 
during interactions in lockdown with frontline workers. (3) Increased feelings 
of fear, isolation, and loss of control, particularly during the early stages of 
the pandemic from the combination of abuse and pandemic-related changes to daily 
life. (4) Some forms of support were more accessible during the pandemic, such 
as provision of online psychological support and social groups. Participants 
also accessed new forms of support for the first time during the pandemic, in 
some cases sparked by posts and content on social media about abuse awareness. 
(5) For some, psychosocial wellbeing transformed during the pandemic, with 
several participants using the word "freedom" when reflecting on their 
experience of simultaneously escaping abuse and living through the COVID-19 
pandemic.
CONCLUSIONS: In this study, we explored the views of female survivors of IPV in 
the UK during the COVID-19 pandemic. Our results highlight the importance of 
combined public awareness campaigns and community intervention points for 
victims to safely seek help during social distancing restrictions. Having the 
time and space to reflect on healing after escaping abuse was described by women 
in our study as a benefit from their lives in lockdown, which is a factor that 
could be incorporated into future initiatives developed to support people 
subjected to violence and abuse.

© 2023. The Author(s).

DOI: 10.1186/s12889-023-14987-3
PMCID: PMC9845821
PMID: 36653799 [Indexed for MEDLINE]

Conflict of interest statement: Non-financial. AM declares that she is a 
non-salaried trustee board member for a non-profit, community-based women’s 
centre that provides support to women who have experienced intimate partner 
violence. YS, TM, AB and DF declare they have no competing interests.


1082. Transl Psychiatry. 2023 Jan 19;13(1):12. doi: 10.1038/s41398-023-02315-7.

Trends in incident diagnoses and drug prescriptions for anxiety and depression 
during the COVID-19 pandemic: an 18-month follow-up study based on the UK 
Biobank.

Wang Y(1)(2)(3), Ge F(1)(2)(3), Wang J(1)(2), Yang H(1)(2), Han X(1)(2), Ying 
Z(1)(2), Hu Y(1)(2), Sun Y(1)(2), Qu Y(1)(2), Aspelund T(3), Hauksdóttir A(3), 
Zoega H(3)(4), Fang F(5), Valdimarsdóttir UA(#)(3)(5)(6), Song H(#)(7)(8)(9).

Author information:
(1)West China Biomedical Big Data Center, West China Hospital, Sichuan 
University, Chengdu, Sichuan, China.
(2)Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, China.
(3)Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, 
Reykjavík, Iceland.
(4)School of Population Health, Faculty of Medicine and Health, UNSW Sydney, 
Sydney, NSW, Australia.
(5)Institute of Environmental Medicine, Karolinska Institutet, Stockholm, 
Sweden.
(6)Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, 
MA, USA.
(7)West China Biomedical Big Data Center, West China Hospital, Sichuan 
University, Chengdu, Sichuan, China. songhuan@wchscu.cn.
(8)Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, China. 
songhuan@wchscu.cn.
(9)Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, 
Reykjavík, Iceland. songhuan@wchscu.cn.
(#)Contributed equally

Serious concerns have been raised about the negative effects of the COVID-19 
pandemic on population psychological well-being. However, limited data exist on 
the long-term effects of the pandemic on incident psychiatric morbidities among 
individuals with varying exposure to the pandemic. Leveraging prospective data 
from the community-based UK Biobank cohort, we included 308,400 participants 
free of diagnosis of anxiety or depression, as well as 213,757 participants free 
of anxiolytics or antidepressants prescriptions, to explore the trends in 
incident diagnoses and drug prescriptions for anxiety and depression from 16 
March 2020 to 31 August 2021, compared to the pre-pandemic period (i.e., 1 
January 2017 to 31 December 2019) and across populations with different exposure 
statuses (i.e., not tested for COVID-19, tested negative and tested positive). 
The age- and sex-standardized incidence ratios (SIRs) were calculated by month 
which indicated an increase in incident diagnoses of anxiety or depression among 
individuals who were tested for COVID-19 (tested negative: SIR 3.05 [95% 
confidence interval 2.88-3.22]; tested positive: 2.03 [1.76-2.34]), especially 
during the first six months of the pandemic (i.e., March-September 2020). 
Similar increases were also observed for incident prescriptions of anxiolytics 
or antidepressants (tested negative: 1.56 [1.47-1.67]; tested positive: 1.41 
[1.22-1.62]). In contrast, individuals not tested for COVID-19 had consistently 
lower incidence rates of both diagnoses of anxiety or depression (0.70 
[0.67-0.72]) and prescriptions of respective psychotropic medications (0.70 
[0.68-0.72]) during the pandemic period. These data suggest a distinct rise in 
health care needs for anxiety and depression among individuals tested for 
COVID-19, regardless of the test result, in contrast to a reduction in health 
care consumption for these disorders among individuals not tested for and, 
presumably, not directly exposed to the disease.

© 2023. The Author(s).

DOI: 10.1038/s41398-023-02315-7
PMCID: PMC9849101
PMID: 36653375 [Indexed for MEDLINE]

Conflict of interest statement: UAV has received grants for the current work 
from Nordforsk and grants outside the current work from the Icelandic Research 
Fund, Swedish Research Council, Swedish Cancer Society, and the European 
Research Council. HZ was an employee of the Centre for Big Data Research in 
Health at UNSW, which received a research grant from AbbVie Australia in 2020, 
unrelated to the current study. All other authors declare that they have no 
competing interests.


1083. J Adolesc Health. 2023 May;72(5):682-687. doi: 10.1016/j.jadohealth.2022.12.005. 
Epub 2023 Jan 16.

Adolescent Feelings on COVID-19 Distance Learning Support: Associations With 
Mental Health, Social-Emotional Health, Substance Use, and Delinquency.

Kwaning K(1), Ullah A(2), Biely C(3), Jackson N(4), Dosanjh KK(4), Galvez A(5), 
Arellano G(5), Dudovitz R(3).

Author information:
(1)David Geffen School of Medicine at UCLA, Los Angeles, California. Electronic 
address: kkwaning@mednet.ucla.edu.
(2)David Geffen School of Medicine at UCLA, Los Angeles, California.
(3)UCLA Department of Pediatrics and Children's Development and Innovation 
Institute, Los Angeles, California.
(4)UCLA Department of Medicine, General Internal Medicine and Health Services 
Research, Los Angeles, California.
(5)Los Angeles Unified School District, Los Angeles, California.

PURPOSE: School social support is associated with improved adolescent wellbeing. 
However, positive school relationships were potentially disrupted when schools 
transitioned to distance learning in 2020 to mitigate the spread of COVID-19. 
This study investigated associations among perceived distance learning school 
support, mental health, social-emotional wellbeing, substance use, and 
delinquency among low-income, public high school students.
METHODS: We analyzed longitudinal survey data, collected between June 2020 and 
June 2021, from 372 students attending five large urban public high schools. 
Mixed-effects regression models examined associations among changes in distance 
learning support and changes in mental health, social-emotional wellbeing, 
substance use, and delinquency, controlling for time, social-demographics, and 
baseline health.
RESULTS: In this predominantly Latinx (83%) sample, within-person increases in 
perceived distance learning support were associated with improved mental health, 
increased grit, increased self-efficacy, and decreased stress. Between-person 
differences in distance learning support indicated that students reporting 
greater support had improved mental and social-emotional outcomes. Although 
there were no within-person associations among distance learning support and 
hopelessness or delinquency, students with greater distance learning support 
(between-person) had lower levels of hopelessness and lower odds of engaging in 
any delinquent behavior. There were no associations between distance learning 
support and 30-day substance use.
DISCUSSION: School social support, even without students physically on campus, 
may be critical to adolescent health behaviors and social-emotional outcomes.

Copyright © 2023 Society for Adolescent Health and Medicine. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jadohealth.2022.12.005
PMCID: PMC9870620
PMID: 36653259 [Indexed for MEDLINE]


1084. Asian J Psychiatr. 2023 Mar;81:103452. doi: 10.1016/j.ajp.2023.103452. Epub 2023 
Jan 5.

The neglected spectrum of COVID-19 pandemic - postpartum depression among 
COVID-19 infected South-Indian women - a cohort study.

Senthil Kumar KV(1), Priyadharshini M(2), Naidu D(2), Shanmugam J(3), 
Priyadharshini S(4).

Author information:
(1)Department of Obstetrics and Gynaecology, KMCH Institute of Health Sciences 
and Research, Tamil Nadu, India; Department of Obstetrics and Gynaecology, 
Calderdale and Huddersfield NHS Foundation Trust, West Yorkshire, England, UK. 
Electronic address: drkrithi30@gmail.com.
(2)Department of Obstetrics and Gynaecology, KMCH Institute of Health Sciences 
and Research, Tamil Nadu, India.
(3)Department of Community Medicine and Biostatistics, KMCH Institute of Health 
Sciences and Research, Tamil Nadu, India.
(4)Department of Psychiatry, KMCH Institute of Health Sciences and Research, 
Tamil Nadu, India.

The study aims to explore the burden of postpartum depression among 
COVID-19-infected mothers and stressor factors. A single-centre observational 
cohort study was conducted in South India to evaluate postpartum depression 
among 106 COVID-19-infected women who delivered from December 2020 to May 2021. 
Also, stressor factors related to COVID-19 infection were figured out to analyse 
their role in depression. Almost half of the COVID-19-infected mothers had a 
global EPDS score ≥ 10 and were at risk of depression during the pandemic. The 
depressive symptoms were not confined to the immediate postpartum period, but 
significantly impacted mothers until 6 months following childbirth. SYNOPSIS: 
COVID-19 infection not only affects the physical well-being but also adversely 
affects the mental health of the infected persons. Postpartum mothers who 
require the utmost care and support, are facing social deprivation due to the 
COVID-19 pandemic. This triggers the already fragile mental state of postpartum 
women and may worsen the level of depression.

Copyright © 2023 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.ajp.2023.103452
PMCID: PMC9814275
PMID: 36652841 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest The authors have no 
relevant financial or non-financial interests to disclose. Authors have full 
control of all primary data.


1085. Gut Microbes. 2023 Jan-Dec;15(1):2162306. doi: 10.1080/19490976.2022.2162306.

The gut-microbiota-brain axis in a Spanish population in the aftermath of the 
COVID-19 pandemic: microbiota composition linked to anxiety, trauma, and 
depression profiles.

Malan-Müller S(1)(2)(3), Valles-Colomer M(4), Palomo T(2)(3), Leza JC(1)(2)(3).

Author information:
(1)Department of Pharmacology and Toxicology, Faculty of Medicine, University 
Complutense Madrid (UCM), Madrid, Spain.
(2)Biomedical Network Research Center of Mental Health (CIBERSAM), Institute of 
Health Carlos III, Madrid, Spain.
(3)Neurochemistry Research Institute UCM, Hospital 12 de Octubre Research 
Institute (Imas12), Madrid, Spain.
(4)Department of Cellular Computational and Integrative Biology, University of 
Trento, Trento, Italy.

The prevalence of anxiety and depression soared following the COVID-19 pandemic. 
To effectively treat these conditions, a comprehensive understanding of all 
etiological factors is needed. This study investigated fecal microbial features 
associated with mental health outcomes (symptoms of anxiety, depression, or 
posttraumatic stress disorder (PTSD)) in a Spanish cohort in the aftermath of 
the COVID-19 pandemic. Microbial communities from stool samples were profiled in 
198 individuals who completed validated, self-report questionnaires. 16S 
ribosomal RNA gene V3-4 amplicon sequencing was performed. Microbial diversity 
and community structure were analyzed, together with relative taxonomic 
abundance. In our cohort of N=198, 17.17% reported depressive symptoms, 37.37% 
state anxiety symptoms, 40.90% trait anxiety symptoms, and 8.08% PTSD symptoms, 
with high levels of comorbidity. Individuals with trait anxiety had lower 
Simpson's diversity. Fusicatenibacter saccharivorans was reduced in individuals 
with comorbid PTSD + depression + state and trait anxiety symptoms, whilst an 
expansion of Proteobacteria and depletion of Synergistetes phyla were noted in 
individuals with depressive symptoms. The relative abundance of Anaerostipes was 
positively correlated with childhood trauma, and higher levels of Turicibacter 
sanguinis and lower levels of Lentisphaerae were found in individuals who 
experienced life-threatening traumas. COVID-19 infection and vaccination 
influenced the overall microbial composition and were associated with distinct 
relative taxonomic abundance profiles. These findings will help lay the 
foundation for future studies to identify microbial role players in symptoms of 
anxiety, depression, and PTSD and provide future therapeutic targets to improve 
mental health outcomes.

DOI: 10.1080/19490976.2022.2162306
PMCID: PMC9851210
PMID: 36651663 [Indexed for MEDLINE]

Conflict of interest statement: The authors report there are no competing 
interests to declare.


1086. Australas Psychiatry. 2023 Feb;31(1):53-57. doi: 10.1177/10398562231151868. Epub 
2023 Jan 18.

A single-item measure of self-rated mental health and psychological distress. In 
what situations can a single-item measure be useful?

Stubbs JM(1), Achat HM(1).

Author information:
(1)Epidemiology and Health Analytics, 1760Western Sydney Local Health District, 
North Parramatta, NSW, Australia.

OBJECTIVE: To examine the association between self-rated mental health (SRMH) 
and psychological distress (PD) at multiple periods and subsequently assess the 
potential of SRMH as a screening tool.
METHOD: Staff working at a designated COVID-19 hospital in Sydney, Australia 
during March to May 2020 completed the SRMH and Kessler Psychological Distress 
Scale (K10) within a larger survey examining the pandemic's impact on health and 
well-being. SRMH was assessed before the pandemic (baseline), during its first 
peak in 2020 (time 2) and several months later (time 3). K10 was assessed for 
time 2 and time 3. All assessments took place at time 3.
RESULTS: At time 2, 80% of respondents with high PD and 25% with low PD reported 
poor SRMH (χ2 = 21.3, p < .0001). At time 3, 90% with low PD reported good SRMH. 
Risk of high PD was greater for respondents with persistently poor SRMH (time 2: 
OR = 18.2, 95% CI = 7.7-42.8; time 3: OR = 14.4, 95% CI = 6.9-29.9) and, to a 
lesser extent, for those whose SRMH declined (time 2: OR = 11.6, 95% CI = 
6.6-20.4; time 3: OR = 13.8, 95% CI = 2.9-66.9), compared to those with 
persistently good SRMH.
CONCLUSIONS: During a crisis SRMH can identify the majority of those most likely 
to benefit from additional assessment and support. Persistently poor SRMH 
indicates highest risk, detectable from routine screening.

DOI: 10.1177/10398562231151868
PMID: 36651330 [Indexed for MEDLINE]


1087. Sci Rep. 2023 Jan 17;13(1):871. doi: 10.1038/s41598-022-24007-w.

A mixed-method study on adolescents' well-being during the COVID-19 syndemic 
emergency.

Pepe A(1)(2), Farina E(3)(4).

Author information:
(1)"R.Massa" Department of Human Sciences for Education, University of 
Milano-Bicocca, Milan, Italy. alessandro.pepe1@unimib.it.
(2)LAB300, University of Milano-Bicocca, Milan, Italy. 
alessandro.pepe1@unimib.it.
(3)"R.Massa" Department of Human Sciences for Education, University of 
Milano-Bicocca, Milan, Italy.
(4)LAB300, University of Milano-Bicocca, Milan, Italy.

In this study, we set out to investigate adolescents' levels of perceived 
well-being and to map how they went about caring for their well-being during the 
COVID-19 syndemic. Participants were 229 Italian adolescent high school students 
(48.9% males, mean age = 16.64). The research design was based on an 
exploratory, parallel, mixed-method approach. A multi-method, student-centered, 
computer-assisted, semi-structured online interview was used as the data 
gathering tool, including both a standardized quantitative questionnaire on 
perceived well-being and an open-ended question about how adolescents were 
taking charge of their well-being during the COVID-19 health emergency. Main 
findings reveal general low levels of perceived well-being during the syndemic, 
especially in girls and in older adolescents. Higher levels of well-being are 
associated with more affiliative strategies (we-ness/togetherness) whereas low 
levels of well-being are linked with more individualistic strategies 
(I-ness/separatedness) in facing the health emergency. These findings identify 
access to social support as a strategy for coping with situational stress and 
raise reflection on the importance of balancing the need for physical distancing 
to protect from infection, and the need for social closeness to maintain good 
mental health.

© 2023. The Author(s).

DOI: 10.1038/s41598-022-24007-w
PMCID: PMC9843112
PMID: 36650194 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1088. PLoS One. 2023 Jan 17;18(1):e0280049. doi: 10.1371/journal.pone.0280049. 
eCollection 2023.

Mental toll on working women during the COVID-19 pandemic: An exploratory study 
using Reddit data.

Huang C(1), Bandyopadhyay A(1), Fan W(1), Miller A(2), Gilbertson-White S(3).

Author information:
(1)Department of Business Analytics, University of Iowa, Iowa City, Iowa, United 
States of America.
(2)Department of Internal Medicine, Roy J. and Lucille A. Carver College of 
Medicine, University of Iowa, Iowa City, Iowa, United States of America.
(3)College of Nursing, University of Iowa, Iowa City, Iowa, United States of 
America.

COVID-19 has led to an unprecedented surge in unemployment associated with 
increased anxiety, stress, and loneliness impacting the well-being of various 
groups of people (based on gender and age). Given the increased unemployment 
rate, this study intends to understand if the different dimensions of well-being 
change across age and gender. By quantifying sentiment, stress, and loneliness 
with natural language processing tools and one-way, between-group multivariate 
analysis of variance (MANOVA) using Reddit data, we assessed the differences in 
well-being characteristics for age groups and gender. We see a noticeable 
increase in the number of mental health-related subreddits for younger women 
since March 2020 and the trigger words used by them indicate poor mental health 
caused by relationship and career challenges posed by the pandemic. The MANOVA 
results show that women under 30 have significantly (p = 0.05) higher negative 
sentiment, stress, and loneliness levels than other age and gender groups. The 
results suggest that younger women express their vulnerability on social media 
more strongly than older women or men. The huge disruption of job routines 
caused by COVID-19 alongside inadequate relief and benefit programs has wrecked 
the economy and forced millions of women and families to the edge of bankruptcy. 
Women had to choose between being home managers and financial providers due to 
the countrywide shutdown of schools and day-cares. These findings open 
opportunities to reconsider how policy supports women's responsibilities.

Copyright: © 2023 Huang et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0280049
PMCID: PMC9844921
PMID: 36649225 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


1089. Dev Med Child Neurol. 2023 Jul;65(7):885-899. doi: 10.1111/dmcn.15503. Epub 2023 
Jan 17.

Impacts of health care service changes implemented due to COVID-19 on children 
and young people with long-term disability: A mapping review.

Merrick H(1), Driver H(1), Main C(1), Kenny RPW(2), Richmond C(2), Allard A(3), 
Bola K(4), Morris C(5), Parr JR(1)(6)(7), Pearson F(2), Pennington L(1); 
Resetting Services Team.

Collaborators: Exley C, Teare D, Yu G, Carr S, Haining S, Platts L, Gray L, 
Heslop P.

Author information:
(1)Population Health Sciences Institute, Newcastle University, Newcastle upon 
Tyne, UK.
(2)Evidence Synthesis Group, Population Health Sciences Institute, Newcastle 
University, Newcastle upon Tyne, UK.
(3)National Children's Bureau, London, UK.
(4)Bedford Borough Council, Bedford, UK.
(5)Peninsula Childhood Disability Research Unit, University of Exeter Medical 
School, University of Exeter, Exeter, UK.
(6)Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
(7)Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon 
Tyne, UK.

AIM: To identify the research on childhood disability service adaptations and 
their impact on children and young people with long-term disability during the 
COVID-19 pandemic.
METHOD: A mapping review was undertaken. We searched the World Health 
Organization Global COVID-19 database using the search terms 'children', 
'chronic/disabling conditions', and 'services/therapies'. Eligible papers 
reported service changes for children (0-19 years) with long-term disability in 
any geographical or clinical setting between 1st January 2020 and 26th January 
2022. Papers were charted across the effective practice and organization of care 
taxonomy of health system interventions and were narratively synthesized; an 
interactive map was produced.
RESULTS: Reduction of face-to-face care and usual provision had a huge impact on 
children and families. Adoption of telehealth provided continuity for the care 
and management of some conditions. There was limited evidence of changes to 
mental health services, transitions of care, social care, or child-reported 
satisfaction or acceptability of service changes.
INTERPRETATION: The long-term impacts of service change during the pandemic need 
full evaluation. However, widespread disruption seems to have had a profound 
impact on child and carer health and well-being. Service recovery needs to be 
specific to the individual needs of children with a disability and their 
families. This should be done through coproduction to ensure that service 
changes meet needs and are accessible and equitable.

© 2023 The Authors. Developmental Medicine & Child Neurology published by John 
Wiley & Sons Ltd on behalf of Mac Keith Press.

DOI: 10.1111/dmcn.15503
PMID: 36649197 [Indexed for MEDLINE]


1090. Kobe J Med Sci. 2022 Dec 21;68(1):E23-E29.

Increase in the Number and Duration of Sleep Episodes During Class After 
Reopening of Schools Following Closure due to COVID-19.

Kimura S(1)(2), Takaoka Y(2)(3), Sugano A(2)(4).

Author information:
(1)Children's Rehabilitation, Sleep & Development Medical Center, Hyogo 
Prefectural Rehabilitation Central Hospital, Kobe, Japan.
(2)Division of Medical Law and Ethics, Department of Medical Systems, Kobe 
University Graduate School of Medicine, Kobe, Japan.
(3)Data Science Center for Medicine and Hospital Management, Toyama University 
Hospital, Toyama, Japan.
(4)Center for Clinical Research, Toyama University Hospital, Toyama, Japan.

Sleep is important for the well-being of school-aged children. Almost all 
schools in Hyogo prefecture in Japan were closed from April 7 to May 31, 2020, 
owing to the coronavirus disease 2019 pandemic. The pandemic restrictions 
resulted in the disruption of the sleep routines of children. The number of 
children who experienced sleepiness in class after school closure increased. The 
number of children who visited our hospital 1 year before and after the closure 
was 208 (11.73 ± 3.24 years of age) and 155 (11.45 ± 3.30 years), respectively. 
The number of chief complaints of sleep-related symptoms at the first visits 
showed no significant difference between the two time periods. The percentage of 
patients who slept during class increased (but not significantly) after the 
school closure. However, the mean number and duration of sleep episodes during 
class significantly increased from 0.31 ± 0.76 to 1.04 ± 1.14 episodes/day and 
from 15.8 ± 38.6 to 45.7 ± 46.9 min/day (each P < 0.001) before and after school 
closure, respectively. The total number of patients in our hospital with the 
primary central disorders of hypersomnolence, i.e., narcolepsy, idiopathic 
hypersomnia, and Kleine-Levin syndrome, and the number of patients with 
insufficient sleep syndrome after the school closure significantly increased 
compared with those before closure (P = 0.034 and 0.048, respectively). School 
closure was associated with an increased incidence of sleeping during class; 
therefore, maintaining a stable daily routine for children with sleep disorders 
could have an alleviating effect.

PMCID: PMC10117627
PMID: 36647083 [Indexed for MEDLINE]

Conflict of interest statement: CONFLICT OF INTERESTS The authors declare no 
conflicts of interest in association with the present study.


1091. BMC Pregnancy Childbirth. 2023 Jan 16;23(1):33. doi: 10.1186/s12884-023-05349-3.

Pregnancy in the time of COVID-19: towards Fetal monitoring 4.0.

Kahankova R(1), Barnova K(1), Jaros R(2), Pavlicek J(3), Snasel V(4), Martinek 
R(1).

Author information:
(1)Department of Cybernetics and Biomedical Engineering, Faculty of Electrical 
Engineering and Computer Science, VSB-Technical University of Ostrava, Ostrava, 
Czechia.
(2)Department of Cybernetics and Biomedical Engineering, Faculty of Electrical 
Engineering and Computer Science, VSB-Technical University of Ostrava, Ostrava, 
Czechia. rene.jaros@vsb.cz.
(3)Department of Pediatrics, Faculty Hospital, Faculty of Medicine, Ostrava 
University, Ostrava, Czechia.
(4)Department of Computer Science, Faculty of Electrical Engineering and 
Computer Science, VSB-Technical University of Ostrava, Ostrava, Czechia.

On the outbreak of the global COVID-19 pandemic, high-risk and vulnerable groups 
in the population were at particular risk of severe disease progression. 
Pregnant women were one of these groups. The infectious disease endangered not 
only the physical health of pregnant women, but also their mental well-being. 
Improving the mental health of pregnant women and reducing their risk of an 
infectious disease could be achieved by using remote home monitoring solutions. 
These would allow the health of the mother and fetus to be monitored from the 
comfort of their home, a reduction in the number of physical visits to the 
doctor and thereby eliminate the need for the mother to venture into high-risk 
public places. The most commonly used technique in clinical practice, 
cardiotocography, suffers from low specificity and requires skilled personnel 
for the examination. For that and due to the intermittent and active nature of 
its measurements, it is inappropriate for continuous home monitoring. The 
pandemic has demonstrated that the future lies in accurate remote monitoring and 
it is therefore vital to search for an option for fetal monitoring based on 
state-of-the-art technology that would provide a safe, accurate, and reliable 
information regarding fetal and maternal health state. In this paper, we thus 
provide a technical and critical review of the latest literature and on this 
topic to provide the readers the insights to the applications and future 
directions in fetal monitoring. We extensively discuss the remaining challenges 
and obstacles in future research and in developing the fetal monitoring in the 
new era of Fetal monitoring 4.0, based on the pillars of Healthcare 4.0.

© 2023. The Author(s).

DOI: 10.1186/s12884-023-05349-3
PMCID: PMC9841500
PMID: 36647041 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1092. Am J Health Promot. 2023 Feb;37(2):282-288. doi: 10.1177/08901171221140641e.

The Impact of COVID-19 on Pregnant Women and Children: Recommendations for 
Health Promotion.

Witt WP(1), Harlaar N(2), Palmer A(3).

Author information:
(1)Highmark Health, USA.
(2)Westat, USA.
(3)NORC at the University of Chicago, USA.

COVID-19 continues to have severe repercussions on children and pregnant women. 
The repercussions include not only the direct impact of COVID-19 (ie, children 
getting infected by COVID-19) but also indirect impacts (eg, safeguarding from 
child maltreatment, obesogenic behaviors, language and socioemotional 
development, educational consequences [eg, interrupted learning]; social 
isolation; mental health; behavioral health [eg, increased substance use in 
adolescence]; health and economic impact of COVID-19 on caregivers and family 
relationships. It has also shed light on long-standing structural and 
socioeconomic issues, including equity in nutrition and food security, housing, 
childcare, and internet access. Using a socioecological, life course, and 
population health approach, we discuss the implications for pregnant women and 
children's health and well-being and give recommendations for mitigating the 
short and long-term deleterious impact COVID- 19 on women, children, and their 
families.

DOI: 10.1177/08901171221140641e
PMID: 36646662 [Indexed for MEDLINE]


1093. BMJ Paediatr Open. 2022 Sep;6(1):e001569. doi: 10.1136/bmjpo-2022-001569.

Financial stress during COVID-19: implications for parenting behaviour and child 
well-being.

McGill MG(1), Purkey E(2)(3), Davison CM(3), Watson A(2)(4), Bayoumi I(5)(3).

Author information:
(1)School of Medicine, Queen's University, Kingston, Ontario, Canada.
(2)Department of Family Medicine, Queen's University, Kingston, Ontario, Canada.
(3)Department of Public Health Sciences, Queen's University, Kingston, Ontario, 
Canada.
(4)Indigenous Health Council, Kingston, Ontario, Canada.
(5)Department of Family Medicine, Queen's University, Kingston, Ontario, Canada 
bayoumi@queensu.ca.

BACKGROUND: Family financial stress and parenting behaviours are each associated 
with child behaviours. We sought to explore the association between parent 
financial stress and child socioemotional and behavioural difficulties during 
the COVID-19 pandemic and examine parenting behaviour, including overreactive 
and lax parenting approaches, as a potential mediator to this relationship.
METHODS: Cross-sectional sample of parent and child data pairings in Ontario, 
Canada between April and November of 2020. Linear models were used to describe 
the relationships between financial worry, child Strengths and Difficulties 
Questionnaire (SDQ) total difficulties and parenting behaviours measured by the 
Parenting Scale 8-item (PS-8), which includes measures of both overreactive and 
lax parenting tendencies. Formal mediation testing was performed to assess the 
potential mediating role of parenting behaviour.
RESULTS: 528 parent and child pairs were enrolled from largely European ancestry 
(78%), female (93%) and varied household income levels. Analysis revealed 
increased financial worry during the COVID-19 pandemic was significantly 
associated with increased child SDQ total difficulties scores (β=0.23, SE=0.10, 
p=0.03). This relationship was mediated by reported parenting behaviour, 
independent of parent education, household income, parent age, parent sex, 
parent anxiety and child sex (total effect: β=0.69, p=0.02, average causal 
mediation effects: β=0.50, p=0.02, average direct effects: β=0.19, p=0.08).
CONCLUSION: Financial stress during the COVID-19 pandemic was associated with 
poorer child social and emotional well-being. Parenting behaviours measured by 
the PS-8 significantly mediated these effects. This work supports the importance 
of policies aimed to alleviate family financial stresses and highlights the 
potential impact such policies have on child well-being.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjpo-2022-001569
PMCID: PMC9462077
PMID: 36645755 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


1094. J Med Internet Res. 2023 Jan 16;25:e41859. doi: 10.2196/41859.

Evaluating the Effectiveness of the Supportive Parenting App on Parental 
Outcomes: Randomized Controlled Trial.

Shorey S(1), Law E(2); Thilagamangai(#)(3); Mathews J(4), Lim SH(5), Shi L(6), 
Chua JS(1), Du R(7), Chan YH(8), Tan TC(9), Chee C(2), Chong YS(8).

Author information:
(1)Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, 
National University of Singapore, Singapore, Singapore.
(2)National University Hospital, Singapore, Singapore.
(3)Division of Nursing, KK Women's and Children's Hospital, Singapore, 
Singapore.
(4)National University Polyclinics, Corporate Office, Singapore, Singapore.
(5)Singapore General Hospital, Singapore, Singapore.
(6)Singapore Clinical Research Institute, Singapore, Singapore.
(7)Biostatistics Unit, Yong Loo Lin School of Medicine, Singapore, Singapore.
(8)Yong Loo Lin School of Medicine, Singapore, Singapore.
(9)Mount Elizabeth Novena Specialist Centre, Singapore, Singapore.
(#)Contributed equally

BACKGROUND: Adjusting to new or additional parenting responsibilities increases 
stress and affects parental well-being. Existing research has highlighted both 
parents' desire to receive more support. It has also been found that receiving 
sufficient social support enhances parenting outcomes. With the increasing 
popularity of mobile health apps, a Supportive Parenting App (SPA) intervention 
was developed to fulfill the support needs of parents during the perinatal 
period.
OBJECTIVE: This study aimed to examine the effectiveness of the SPA on parental 
outcomes during the perinatal period.
METHODS: A 2-group pretest and repeated posttest randomized controlled trial was 
conducted wherein 200 couples (N=400 mothers and fathers) were recruited from 2 
public health care institutions in Singapore. Parents were randomly assigned to 
intervention (100/200, 50%) or control (100/200, 50%) groups. The SPA 
intervention consisted of a mobile app-based psychoeducation and peer support 
program to support parents from pregnancy to 6 months post partum. The outcome 
measures included postnatal depression, anxiety, parental bonding, parental 
self-efficacy, perceived social support, and parenting satisfaction. Data were 
collected at baseline (at >24 weeks of gestation-age of viability in Singapore) 
and at the first, second, fourth, sixth, ninth, and 12th month post partum. 
Linear mixed models were used to compare parental outcomes between the groups, 
and a linear mixed model for repeated measures was used to examine within-group 
changes.
RESULTS: Parents in the intervention group mostly showed better outcomes 
compared with those in the control group. Parents in the intervention group had 
higher perceived social support than those in the control group at the first 
(effect size=1.59, 95% CI 0.38-2.80; Cohen standardized effect size=1.31; 
P=.01), second (effect size=1.98, 95% CI 1.09-2.88; Cohen standardized effect 
size=2.21; P=.003), and fourth (effect size=2.57, 95% CI 1.62-3.51; Cohen 
standardized effect size=2.72; P=.048) months post partum. However, parents in 
the intervention group showed significantly poorer parental bonding (effect 
size=1.67, 95% CI 0.24-3.11; Cohen standardized effect size=1.16; P=.02). The 
other parental outcomes did not differ significantly between groups. The scores 
of mothers and fathers also differed significantly for all outcomes except 
parental self-efficacy.
CONCLUSIONS: Parents in the intervention group generally fared better, 
especially regarding perceived social support. However, the lack of statistical 
significance in most outcomes showed the limited effectiveness of the SPA 
intervention, which may be because of the COVID-19 pandemic. Parental 
differences in outcome scores suggest that mothers and fathers have different 
support needs; therefore, interventions should be tailored accordingly. Further 
improvements and evaluations are needed to examine the effectiveness of the SPA 
intervention in enhancing parental outcomes. Despite statistically insignificant 
results, limitations should be considered to further improve mobile health 
app-based interventions such as SPA, as they could serve as reliable and 
convenient sources of support for parents.
TRIAL REGISTRATION: Clinicaltrails.gov NCT4706442; 
https://clinicaltrials.gov/ct2/show/NCT04706442.

©Shefaly Shorey, Evelyn Law, Thilagamangai, Jancy Mathews, Siew Hoon Lim, Luming 
Shi, Jing Shi Chua, Ruochen Du, Yiong Huak Chan, Thiam Chye Tan, Cornelia Chee, 
Yap Seng Chong. Originally published in the Journal of Medical Internet Research 
(https://www.jmir.org), 16.01.2023.

DOI: 10.2196/41859
PMCID: PMC9887516
PMID: 36645699 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


1095. Mult Scler Relat Disord. 2023 Feb;70:104487. doi: 10.1016/j.msard.2022.104487. 
Epub 2022 Dec 24.

Quality of life and mental health in multiple sclerosis patients during the 
COVID-19 Pandemic.

Rodríguez-Agudelo Y(1), Nava-Adán J(2), Paz-Rodríguez F(1), Abundes-Corona A(3), 
Flores-Rivera J(3), Corona T(4).

Author information:
(1)Clinical Neuropsychology Laboratory, National Institute of Neurology and 
Neurosurgery, Mexico.
(2)Faculty of Medicine, National Autonomous University of Mexico, Mexico.
(3)Clinical Neurodegenerative Diseases Laboratory, National Institute of 
Neurology and Neurosurgery.
(4)Faculty of Medicine, National Autonomous University of Mexico, Mexico; 
Clinical Neurodegenerative Diseases Laboratory, National Institute of Neurology 
and Neurosurgery. Electronic address: coronav@unam.mx.

The COVID-19 pandemic had a profound impact on mental health symptoms and 
quality of life (QoL) in the general population due to necessary public health 
restrictions such as social distancing. The psychosocial effect of the pandemic 
on vulnerable groups such as people living with Multiple Sclerosis (PwMS) has 
been scarcely explored in countries with additional socioeconomical burdens such 
as access to healthcare disparities METHODS: A questionnaire exploring 
sociodemographic variables, quality of life, mental health determinants and 
sleep quality was applied to 92 PwMS to explore changes prior and during the 
pandemic regarding these domains RESULTS: 58.8% of the subjects were female, 
median age was 37.1 (± 8.5) years and relapsing-remitting MS was the predominant 
clinical subtype (83.5%). Unemployment rate significantly increased during the 
pandemic (12.3% vs 27.8%; p= 0.001). Only 46.4% received medical follow-up care 
during the pandemic. QoL was affected predominantly due to limitations in 
instrumented activities of daily life (IADL). Neuropsychiatric symptoms, 
requiring healthcare during the pandemic, anxiety prior to the pandemic and 
restricted IADL were predictors of MS-related physical impact worsening, while 
decreased physical/emotional wellbeing selfcare, neuropsychiatric symptoms, bad 
sleep quality, anxiety prior to the pandemic and restricted non-instrumental ADL 
predicted aggravation of MS-related psychological impact measured by the 
MSIS-29. Curiously, specific items regarding anxiety were more prevalent prior 
to the pandemic (anxious mood; p=0.02, helplessness; p=0.01), sleep problems; 
p=0.001 and cardiovascular symptoms; p=0.001, nevertheless, stability was 
observed for most items. Importantly, 77.3% of PwMS reported at least one 
neuropsychiatric symptom CONCLUSION: The deleterious effects of the COVID-19 
pandemic on psychosocial wellbeing in PwMS, QoL and mental health outcomes are 
frequently overseen in vulnerable populations such as PwMS. Albeit the 
limitations of this study, our results may help implement policies that prevent 
negative outcomes on psychosocial wellbeing due to public health measures (e.g., 
social distancing) in MS and other neurological diseases that inexorably need 
constant follow-up.

Copyright © 2022 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.msard.2022.104487
PMCID: PMC9789892
PMID: 36640561 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


1096. Epilepsy Behav. 2023 Feb;139:109071. doi: 10.1016/j.yebeh.2022.109071. Epub 2023 
Jan 2.

"Untold Distress" - How did the COVID-19 pandemic affect those who had 
previously experienced an epilepsy-related bereavement?

Donovan B(1), Ashby S(2), Hanna J(2), Cowdry T(2), Thorpe J(2), Hughes E(3), 
Kerr MP(4), Thomas RH(5).

Author information:
(1)SUDEP Action, 18, Newbury St., Wantage OX12 8DA, United Kingdom. Electronic 
address: ben.donovan@sudep.org.
(2)SUDEP Action, 18, Newbury St., Wantage OX12 8DA, United Kingdom.
(3)King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, 
United Kingdom; Evelina Children's Hospital, Westminster Bridge Rd, St Thomas' 
Hospital, London SE1 7EH, United Kingdom.
(4)Psychological Medicine and Clinical Neurosciences, Hadyn Ellis Building, 
Maindy Road, Cardiff CF24 4HQ, United Kingdom.
(5)Translational and Clinical Research Institute, Newcastle University, 
Newcastle upon Tyne NE2 4HH, United Kingdom; Royal Victoria Infirmary, Queen 
Victoria Road, Newcastle upon Tyne NE1 4LP, United Kingdom.

PURPOSE: This study explores the impact of the COVID-19 pandemic and lockdown on 
people with lived experience of sudden bereavement as a consequence of an 
epilepsy-related death.
METHOD: We developed an online survey with fixed choice and open-ended response 
formats to collect data on grief symptoms and well-being during the pandemic. A 
total of 275 people bereaved by epilepsy-related deaths between 1980-2020 
participated in this study: with 79 participants providing free-text responses 
for inductive thematic analysis.
RESULTS: In total, 84% of participants reported a bereavement following a sudden 
death of a person aged under 40, with 22% aged 19 and under. The majority (77% 
of participants) reported they had been thinking more about the person who died 
compared to before the COVID-19 outbreak and 54% had experienced more 
distressing flashbacks to the time of death. Additionally, 61% reported more 
difficulties falling asleep and staying asleep and 88% of participants reported 
that the outbreak and response measures had negatively impacted upon their 
mental health. Medication was being taken for a diagnosed mental health 
condition by 33% of participants at the time of the study. We categorized these 
negative experiences during COVID in to four main-themes - 'Family', 
'Lifestyle', 'Personal Well-being' and 'Health Services and Shielding 
Populations'. The 'Personal Well-being' theme was inextricably linked to grief 
symptoms including 'reflection on the death', 're-exposure to feeling', 'grief', 
'salience of sudden deaths in the media' and 'inability to commemorate 
anniversaries and rituals'. These findings were consistent for bereaved people 
irrespective of the recency of the death.
CONCLUSION: This study highlights the impact of the disruption caused by the 
pandemic on the grief-management of those bereaved by epilepsy-related death. 
Grief is not static and its management is connected to the psychosocial and 
formal support structures that were disrupted during the pandemic. The removal 
of these supports had an adverse effect upon the mental health and well-being of 
many bereaved. There is an urgent need for a system-wide transformation of 
epilepsy and mental health services to be inclusive of the needs and experiences 
of people impacted by sudden deaths in epilepsy and the contribution of the 
specialist service developed by families and clinicians to meet this gap.

Copyright © 2023 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.yebeh.2022.109071
PMCID: PMC9835558
PMID: 36640482 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare the following financial interests/personal relationships which may be 
considered as potential competing interests: Rhys H Thomas has received 
honoraria from Arvelle/Angelini, Bial, Eisai, GW Pharma/JAzz, Sanofi, UCB 
Pharma, UNEEG, Zogenix, and unrestricted research funding from Arvelle and 
UNEEG. Mike P Kerr has received honoraria from Zogenix and Angellina Pharma.


1097. BMJ Open. 2023 Jan 13;13(1):e070374. doi: 10.1136/bmjopen-2022-070374.

Mental health and well-being of unpaid caregivers: a cross-sectional survey 
protocol.

Parry M(1), Beleno R(2), Nissim R(3)(4), Baiden D(5), Baxter P(6), Betini R(7), 
Bjørnnes AK(8), Burnside H(5), Gaetano D(9), Hemani S(5), McCarthy J(10), 
Nickerson N(11), Norris C(12), Nylén-Eriksen M(8), Owadally T(5), Pilote 
L(13)(14), Warkentin K(15), Coupal A(16), Hasan S(17), Ho M(18), Kulbak O(19), 
Mohammed S(5), Mullaly L(20), Theriault J(21), Wayne N(22), Wu W(23), Yeboah 
EK(22), O'Hara A(5), Peter E(5).

Author information:
(1)Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, 
Ontario, Canada monica.parry@utoronto.ca.
(2)Patient Partner (Caregiver), AGE WELL, University Health Network, Toronto, 
Ontario, Canada.
(3)Department of Supportive Care, Princess Margaret Cancer Centre, University 
Health Network, Toronto, Ontario, Canada.
(4)Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
(5)Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, 
Ontario, Canada.
(6)School of Nursing, McMaster University, Hamilton, Ontario, Canada.
(7)Researcher, interRAI, Waterloo, Ontario, Canada.
(8)Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo 
Metropolitan University, Oslo, Norway.
(9)Patient Partner (Caregiver), Dementia Canada, Calgary, Alberta, Canada.
(10)Director, Programs and Services, The Ontario Caregiver Organization, 
Toronto, Ontario, Canada.
(11)Patient Partner (Caregiver), Canadian Women's Heart Health Alliance, 
Halifax, Nova Scotia, Canada.
(12)Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
(13)General Internal Medicine, McGill University, Montreal, Quebec, Canada.
(14)Centre for Outcomes Research and Evaluation, Research Institute of the 
McGill University Health Centre, Montreal, Quebec, Canada.
(15)Patient Partner (Caregiver), Gender Outcomes International Group, Vancouver, 
British Columbia, Canada.
(16)Chief Executive Officer, The Ontario Caregiver Organization, Toronto, 
Ontario, Canada.
(17)Executive Director, Council of Agencies Serving South Asians, Toronto, 
Ontario, Canada.
(18)Director, Education and Research, Yee Hong Centre for Geriatric Care, 
Scarborough, Ontario, Canada.
(19)Policy Analyst, Canadian Cancer Society, Toronto, Ontario, Canada.
(20)Manager, Knowledge Mobilization, Mental Health Commission of Canada, Ottawa, 
Ontario, Canada.
(21)Executive Director, Caregivers Nova Scotia, Halifax, Nova Scotia, Canada.
(22)Executive Director, Canadian Black Policy Network, Toronto, Ontario, Canada.
(23)Patient Partner (Caregiver), North York Toronto Health Partners, Toronto, 
Ontario, Canada.

INTRODUCTION: Unpaid caregiving, care provided by family/friends, is a public 
health issue of increasing importance. COVID-19 worsened the mental health 
conditions of unpaid caregivers, increasing substance/drug use and early 
development of chronic disease. The impact of the intersections of race and 
ethnicity, sex, age and gender along with unpaid care work and caregivers' 
health and well-being is unknown. The aim of this study is to describe the 
inequities of caregiver well-being across the intersections of race and 
ethnicity, sex, age and gender using a cross-sectional survey design.
METHODS AND ANALYSIS: We are collaborating with unpaid caregivers and community 
organisations to recruit a non-probability sample of unpaid caregivers over 18 
years of age (n=525). Recruitment will focus on a target sample of 305 South 
Asian, Chinese and Black people living in Canada, who represent 60% of the 
Canadian racial and ethnic populations. The following surveys will be combined 
into one survey: Participant Demographic Form, Caregiver Well-Being Index, 
interRAI Self-report of Carer Needs and the GENESIS (GENdEr and Sex DetermInantS 
of Cardiovascular Disease: From Bench to Beyond-Premature Acute Coronary 
Syndrome) PRAXY Questionnaire. Sample characteristics will be summarised using 
descriptive statistics. The scores from the Caregiver Well-Being Index will be 
dichotomised into fair/poor and good/excellent. A two-stage analytical strategy 
will be undertaken using logistic regression to model fair/poor well-being and 
good/excellent well-being according to the following axes of difference set a 
priori: sex, race and ethnicity, gender identity, age, gender relations, gender 
roles and institutionalised gender. The first stage of analysis will model the 
main effects of each factor and in the second stage of analysis, interaction 
terms will be added to each model.
ETHICS AND DISSEMINATION: The University of Toronto's Health Sciences Research 
Ethics Board granted approval on 9 August 2022 (protocol number: 42609). 
Knowledge will be disseminated in pamphlets/infographics/email 
listservs/newsletters and journal articles, conference presentation and public 
forums, social media and through the study website.
TRIAL REGISTRATION NUMBER: This is registered in the Open Sciences Framework 
with a Registration DOI as follows: https://doi.org/10.17605/OSF.IO/PB9TD.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2022-070374
PMCID: PMC9843178
PMID: 36639219 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


1098. Ann Epidemiol. 2023 Mar;79:19-23. doi: 10.1016/j.annepidem.2023.01.002. Epub 
2023 Jan 10.

Psychological distress and well-being among sensory impaired individuals during 
COVID-19 lockdown measures.

Merten N(1), Schultz AA(2), Walsh MC(2), van Landingham SW(3), Peppard PE(2), 
Ryff CDS(4), Malecki KC(2).

Author information:
(1)Department of Population Health Sciences, School of Medicine and Public 
Health, University of Wisconsin-Madison, Madison, WI; Division of Geriatrics and 
Gerontology, Department of Medicine, School of Medicine and Public Health, 
University of Wisconsin-Madison, Madison, WI; Wisconsin Alzheimer's Disease 
Research Center, School of Medicine and Public Health, University of 
Wisconsin-Madison, Madison, WI. Electronic address: natascha.merten@wisc.edu.
(2)Department of Population Health Sciences, School of Medicine and Public 
Health, University of Wisconsin-Madison, Madison, WI.
(3)Department of Ophthalmology and Visual Sciences, School of Medicine and 
Public Health, University of Wisconsin-Madison, Madison, WI.
(4)Institute on Aging/Psychology, University of Wisconsin-Madison, Madison, WI.

PURPOSE: Hearing and vision impairment are prevalent chronic conditions 
associated with poorer mental health. Limitations of in-person contacts during 
COVID-19-related lockdown measures may affect those with sensory impairments 
more severely exacerbating mental health problems. We aimed to determine whether 
hearing and/or visual impairment were associated with more psychological 
distress during a time of lockdown measures in Spring/Summer 2020 in Wisconsin.
METHODS: We included 1341(64% women, aged 20-92 years) Survey of the Health of 
Wisconsin COVID-19 survey participants (May 2020-July,2020). We assessed 
self-reported current mental health and well-being and vision and hearing 
impairment. Logistic regression models with sensory impairments as determinants 
and mental health outcomes were adjusted for age, gender, race, education, heart 
disease, hypertension, hyperlipidemia, and diabetes.
RESULTS: Vision impairment was associated with increased odds of generalized 
anxiety disorder (odds ratio = 2.10; 95% confidence interval = 1.32-3.29) and 
depressive symptoms (2.57;1.58-4.11), greater likelihood to report loneliness 
(1.65;1.00-2.64) and hopelessness (1.45;1.01-2.08). Hearing impaired individuals 
reported more loneliness (1.80;1.05-2.98) and hopelessness (1.42;0.99-2.03). 
Exploratory analyses revealed that sensory impaired individuals less often chose 
walking as a coping strategy during the pandemic.
CONCLUSIONS: Individuals with sensory impairment may represent a particularly 
vulnerable population during the COVID-19 pandemic. Future research should 
determine underlying reasons and interventions to mitigate this populations' 
disadvantages.

Copyright © 2023 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.annepidem.2023.01.002
PMCID: PMC9829601
PMID: 36639063 [Indexed for MEDLINE]


1099. J R Coll Physicians Edinb. 2023 Mar;53(1):81-82. doi: 10.1177/14782715221149625. 
Epub 2023 Jan 12.

Tackling the NHS mental health crisis of working through the COVID-19 pandemic; 
pilot creative writing programme has potential to support wellbeing of 
recovering healthcare workers.

Wakefield D(1), McEvoy M(1), Blackburn-Daniels S(2), Campbell S(2).

Author information:
(1)Specialist Palliative Care Team, North Tees and Hartlepool NHS Foundation 
Trust, Stockton-On-Tees, UK.
(2)Faculty of Arts and Social Sciences, The Open University, Milton Keynes, 
Buckinghamshire, UK.

DOI: 10.1177/14782715221149625
PMCID: PMC9843137
PMID: 36635934 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1100. Can J Nurs Res. 2023 Mar;55(1):78-90. doi: 10.1177/08445621221150946. Epub 2023 
Jan 12.

New Graduate Nurses Navigating Entry to Practice in the Covid-19 Pandemic.

McMillan K(1), Akoo C(1), Catigbe-Cates A(1).

Author information:
(1)School of Nursing, University of Ottawa, Ottawa, ON, Canada.

BACKGROUND: The Covid-19 pandemic has significantly impacted organizational life 
for nurses, with known physical and psychological impacts. New graduate nurses 
are a subset of nurses with unique needs and challenges as they transition into 
their registered nurse roles. However, this subset of nurses has yet to be 
explored in the context of the Covid-19 pandemic.
PURPOSE: To explore the experiences of new graduate nurses entering the 
profession in Ontario, Canada, during the Covid-19 pandemic approximately one 
year after entering the profession.
METHODS: Thorne's interpretive description method was utilized.
FINDINGS: All participants identified as completing second entry nursing 
programs, offering a unique perspective on new graduate nurse transition. Four 
themes emerged in the data: 'Virtual Didn't Cut It,' 'Go Where You Know,' 
'Picking Up the Pieces,' and 'Learning When to Say No and Let Go.' Participants 
felt ill prepared to enter the profession and were cognizant of the various 
challenges facing the nursing profession, and how these pre-existing challenges 
were exacerbated by the pandemic. They acknowledged the need to protect 
themselves against burnout and poor mental health, and as such, made calculated 
early career decisions - demonstrating strong socio-political knowing. Half of 
the participants had already left their first nursing job; citing unmet 
orientation, mental health, and wellbeing needs. However, all participants were 
steadfast in remaining in the nursing profession.
CONCLUSIONS: Second entry new graduate nurses remain a unique subset of nurses 
that require more scholarly attention as their transition experiences may differ 
from the traditional trajectory of new graduate nurses.

DOI: 10.1177/08445621221150946
PMCID: PMC9843155
PMID: 36635915 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1101. BMC Health Serv Res. 2023 Jan 12;23(1):28. doi: 10.1186/s12913-023-09042-1.

Surgeons' involvement in COVID-19 treatment: a practice by a regional core 
hospital in Japan to avoid physician burnout.

Matsui Y(1)(2), Yao S(3), Kumode T(1), Tanino K(1), Mizuno R(1), Ogoshi Y(1), 
Honma S(1), Murakami T(1), Kan T(1), Nakajima S(1), Harada T(1), Oh K(2)(4), 
Nakamura T(2)(5), Konishi H(2)(4), Arii S(1).

Author information:
(1)Department of Surgery, Kobe City Medical Center West Hospital, Kobe, Hyogo, 
Japan.
(2)COVID-19 Task Force, Kobe City Medical Center West Hospital, Kobe, Hyogo, 
Japan.
(3)Department of Surgery, Kobe City Medical Center West Hospital, Kobe, Hyogo, 
Japan. siyuan@kuhp.kyoto-u.ac.jp.
(4)Department of General Internal Medicine, Kobe City Medical Center West 
Hospital, Kobe, Hyogo, Japan.
(5)Department of Diabetes and Endocrinology, Kobe City Medical Center West 
Hospital, Kobe, Hyogo, Japan.

BACKGROUND: To prevent task accumulation on certain divisions, our institution 
developed a unique system of allocating inpatient treatment of COVID-19 patients 
to doctors who were not specialized in respiratory infections. The objective of 
this study was to investigate whether surgeons can be involved in the COVID-19 
inpatient treatment without negatively affecting patient outcome, and how such 
involvement can affect the wellbeing of surgeons.
METHODS: There were 300 patients diagnosed with COVID-19 and hospitalized from 
January to June 2021, and 160 of them were treated by the redeployed doctors. 
They were divided into 3 groups based on the affiliation of the treating doctor. 
Patient characteristics and outcomes were compared between the groups. In 
addition, the impact of COVID-19 duty on participating surgeons was investigated 
from multiple perspectives, and a postduty survey was conducted.
RESULTS: There were 43 patients assigned to the Department of Surgery. There 
were no differences in the backgrounds and outcomes of patients compared with 
other groups. The surgeon's overtime hours were significantly longer during the 
duty period, despite no change in the number of operations and the complication 
rate. The questionnaire revealed that there was a certain amount of mental and 
physical burden from the COVID-19 duty.
CONCLUSION: Surgeons can take part in inpatient COVID-19 treatment without 
affecting patient outcome. However, as such duty could negatively affect the 
surgeons' physical and mental wellbeing, further effort is needed to maintain 
the balance of fulfilling individual and institutional needs.

© 2023. The Author(s).

DOI: 10.1186/s12913-023-09042-1
PMCID: PMC9834681
PMID: 36635725 [Indexed for MEDLINE]

Conflict of interest statement: All authors have no conflicts of interest to 
disclose.


1102. Am J Orthopsychiatry. 2023;93(2):144-155. doi: 10.1037/ort0000664. Epub 2023 Jan 
12.

The impact of COVID-19 stressors on refugee mental health and well-being in the 
context of sustained displacement.

Hoffman J(1), Liddell BJ(1), Keegan D(2), Kashyap S(1), Diah Tricesaria AAI(2), 
Pestalozzi Z(3), Argadianti R(2), Nandyatama RW(4), Khakbaz M(2), Nilasari N(4), 
Nickerson A(1).

Author information:
(1)School of Psychology, UNSW Sydney.
(2)HOST International.
(3)Indonesian Civil Society Network for Refugee Rights Protection (SUAKA).
(4)School of International Relations, Universitas Gadjah Mada.

Refugees and asylum seekers in contexts of sustained displacement represent 
particularly vulnerable communities during the COVID-19 pandemic. The aim of 
this study was to identify profiles of COVID-19 stressors in refugees in a 
transit context (i.e., Indonesia) and examine the relationship between these 
profiles of stressors and mental health and well-being. Participants in this 
study included 913 refugees and asylum seekers living in Indonesia. The study 
was completed online in five languages (i.e., Arabic, Dari, Farsi, Somali, and 
English). A latent class analysis was implemented with 12 COVID-19 stressors 
representing indicator variables to identify profiles of COVID-19-related 
stressors experienced. Associations between COVID-19 classes and mental health 
(posttraumatic stress disorder, depression, anxiety) and well-being (physical 
and mental) outcomes were investigated. A five-class solution was identified as 
providing the best fit to the data as follows: (a) a high-COVID stressors class 
(18.1%), (b) a high access stressors class (13.2%), (c) an infection stressors 
class (22.7%), (d) a moderate access stressors class (23.1%), and (e) a 
low-COVID stressors class (22.8%). Membership of all classes reporting at least 
moderate levels of COVID-19 stressors was associated with greater mental health 
difficulties and lower physical and mental well-being than the low-COVID 
stressors class. Results indicated that the severity and type of stressors 
differed between groups suggesting heterogeneous experiences of the pandemic. 
Classes also differed according to contextual and social factors such as 
negative social support, language, and geographic area. (PsycInfo Database 
Record (c) 2023 APA, all rights reserved).

DOI: 10.1037/ort0000664
PMID: 36634011 [Indexed for MEDLINE]


1103. Emotion. 2023 Oct;23(7):1945-1959. doi: 10.1037/emo0001204. Epub 2023 Jan 12.

Do emotion intensity, variability, differentiation, co-occurrence, and 
positive-negative ratios make unique contributions to predicting longitudinal 
change in psychological distress and well-being?

Dawel A(1), Gulliver A(2), Farrer LM(2), Kalokerinos EK(3), Cherbuin N(4), 
Calear AL(2), McCallum S(2), Morse AR(2), Monaghan C(1).

Author information:
(1)School of Medicine and Psychology, Australian National University.
(2)Centre for Mental Health Research, National Centre for Epidemiology and 
Population Health, Australian National University.
(3)Melbourne School of Psychological Sciences, University of Melbourne.
(4)Centre for Research on Ageing, Health and Wellbeing, National Centre for 
Epidemiology and Population Health, Australian National University.

A burgeoning array of affective indices are proposed to capture features of 
affect that contribute to mental health and well-being. However, because indices 
are often investigated separately, it is unclear what-if any-unique role they 
have. The present study addresses this question in a high-stress naturalistic 
context by prospectively testing the relative contributions of eight affective 
indices to psychological outcomes during the first acute lockdown phase of the 
COVID-19 pandemic. Across six fortnightly waves of data collection, participants 
(N = 613, aged 19 to 87 years) reported how much they experienced five positive 
and five negative emotions in response to images showing the health and social 
impacts of the pandemic. We used these ratings to calculate participant-level 
indices of intensity, variability, and differentiation for positive and negative 
emotions separately, and positive-negative co-occurrence and ratios. 
Psychosocial outcome measures were general psychological distress, loneliness, 
work, and social impairment specifically due to the pandemic, well-being, and 
coping. On average, psychosocial functioning improved across the lockdown 
period, and, for most affective indices, bivariate relationships with 
psychosocial functioning supported existing theory and empirical work. However, 
multiple regression analyses suggested that the contributions of the individual 
indices were rarely unique, with most of the change in psychosocial functioning 
over time being explained by affect intensity and variability. These findings 
highlight that affective indices should be studied in concert to build a 
comprehensive and integrated understanding of their role in mental health and 
well-being. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

DOI: 10.1037/emo0001204
PMID: 36633999 [Indexed for MEDLINE]


1104. Int J Behav Med. 2023 Dec;30(6):790-800. doi: 10.1007/s12529-022-10151-0. Epub 
2023 Jan 11.

Can Resilience Buffer the Effects of Loneliness on Mental Distress Among 
Working-Age Adults in the United States During the COVID-19 Pandemic? A Latent 
Moderated Structural Modeling Analysis.

Zhang X(1), Brown AM(2), Rhubart DC(3).

Author information:
(1)Department of Human Development and Family Science, Falk College of Sport and 
Human Dynamics, Syracuse University, Syracuse, USA. xzhan147@syr.edu.
(2)Lerner Center for Public Health Promotion, Maxwell School of Citizenship and 
Public Affairs, Syracuse University, Syracuse, USA.
(3)Department of Biobehavioral Health, The Pennsylvania State University, State 
College, USA.

BACKGROUND: The profound health consequences of loneliness are well-established. 
However, less is known about the protective factors which may alleviate the 
effects of loneliness on mental health especially among working-age adults 
amidst the COVID-19 pandemic. We draw on the social ecology of resilience and 
examine whether resilience factors can buffer the effects of loneliness on 
mental distress.
METHODS: Data came from the National Well-being Survey-a national study of a 
demographically representative sample of U.S. working-age adults (N = 4014). We 
used (a) structural equation models with latent variables to examine the main 
effects of loneliness, psychological resilience, and perceived social support on 
mental distress, and (b) latent moderated structural equations to estimate the 
latent interaction effects.
RESULTS: Results revealed that (a) loneliness was positively associated with 
mental distress and psychological resilience was negatively related to mental 
distress, and (b) psychological resilience and perceived social support 
moderated the strength of the relationship between loneliness and mental 
distress.
CONCLUSIONS: Our study highlights the importance of psychological resilience and 
perceived social support as two protective factors in the relationship between 
loneliness and mental distress. Given that loneliness significantly predicts 
worse mental and physical health and higher mortality, identifying protective 
factors that might disrupt these connections is vital. As such, public health 
efforts to strengthen and expand familial and community social support networks 
and foster psychological resilience are urgently needed to support mental health 
among working-age adults during additional waves of the pandemic or future 
similar stressors.

© 2023. International Society of Behavioral Medicine.

DOI: 10.1007/s12529-022-10151-0
PMCID: PMC9838440
PMID: 36631701 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1105. Dementia (London). 2023 Apr;22(3):576-593. doi: 10.1177/14713012221150298. Epub 
2023 Jan 11.

Carers' experiences of caring for a friend or family member with dementia during 
the Covid-19 pandemic.

Herron DL(1), Runacres J(2), Danton I(3), Beardmore J(1).

Author information:
(1)Department of Psychology, School of Health, Science and Wellbeing, 
7703Staffordshire University, Stoke-on-Trent, UK.
(2)Midwifery and Allied Health, School of Health, Science and Wellbeing, Centre 
of Excellence in Healthcare Education, 7703Staffordshire University, 
Stoke-on-Trent, UK.
(3)School of Psychology, 2939University of Derby, Derby, UK.

OBJECTIVES: This study aimed to explore carers' experiences of supporting a 
family member or friend with dementia through COVID-19 and experiences of hope 
and resilience during this time.
METHODS: Qualitative longitudinal research was undertaken in the UK, with 13 
unpaid carers of people living with dementia who took part in two 
semi-structured interviews 8 weeks apart between June and October 2020. All 
transcripts were analysed using reflexive thematic analysis.
FINDINGS: Four themes were developed and included: COVID-19 impacted negatively 
upon everyday living; carer resilience: adapting to COVID-19; analysis of risk: 
safeguarding the person living with dementia; and thinking about the future with 
COVID-19.
CONCLUSIONS: The results illustrated how the sudden changes which occurred 
during the pandemic negatively impacted on carers and people living with 
dementia in several ways, including additional responsibilities and taking away 
hope. The importance of continued formal and informal support for carers and 
people living with dementia during COVID-19 were highlighted. Formal services, 
care homes, and organisations need to be supported to implement procedures to 
ensure a safe environment during future lockdowns or periods of social 
restrictions. This will enable carers to remain visiting their family members 
and increase their confidence in accessing services and allowing paid carers to 
support their family member with dementia. These results have also illustrated 
the resilience of carers, who adapted to sudden changes which impacted 
negatively on their wellbeing and the wellbeing of the person living with 
dementia.

DOI: 10.1177/14713012221150298
PMCID: PMC9843153
PMID: 36630524 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1106. Can J Anaesth. 2023 Mar;70(3):384-394. doi: 10.1007/s12630-022-02377-z. Epub 
2023 Jan 10.

A qualitative descriptive study of the impact of the COVID-19 pandemic on staff 
in a Canadian intensive care unit.

Parsons Leigh J(1)(2)(3)(4), Mizen SJ(5), Moss SJ(6)(5), Brundin-Mather R(7), de 
Grood C(7), Dodds A(7), Honarmand K(8), Shah S(9), Mehta S(9)(10).

Author information:
(1)School of Health Administration, Dalhousie University, Sir Charles Tupper 
Medical Building, 5850 College Street, Second Floor, 2A01, Office 2A08, PO Box 
15000, Halifax, NS, B3H 4R2, Canada. j.parsonsleigh@dal.ca.
(2)Department of Critical Care Medicine, University of Calgary and Alberta 
Health Services, Calgary, AB, Canada. j.parsonsleigh@dal.ca.
(3)Department of Community Health Sciences, University of Calgary, Calgary, AB, 
Canada. j.parsonsleigh@dal.ca.
(4)O'Brien Institute for Public Health, University of Calgary, Calgary, AB, 
Canada. j.parsonsleigh@dal.ca.
(5)School of Health Administration, Dalhousie University, Halifax, NS, Canada.
(6)The Clinical Research, Investigation, and Systems Modeling of Acute Illness 
(CRISMA) Center, University of Pittsburgh, Pittsburgh, PA, USA.
(7)Department of Critical Care Medicine, University of Calgary and Alberta 
Health Services, Calgary, AB, Canada.
(8)Division of Critical Care, Department of Medicine, Western University, 
London, ON, Canada.
(9)Department of Medicine, Sinai Health System, Toronto, ON, Canada.
(10)Interdepartmental Division of Critical Care Medicine, University of Toronto, 
Toronto, ON, Canada.

PURPOSE: We sought to explore the lived experiences of a professionally diverse 
sample of healthcare workers (HCWs) in a single intensive care unit (ICU) 
serving a large and generalizable Canadian population. We aimed to understand 
how working during the COVID-19 pandemic affected their professional and 
personal lives, including their perceptions of institutional support, to inform 
interventions to ameliorate impacts of the COVID-19 and future pandemics.
METHODS: In this qualitative descriptive study, 23 ICU HCWs, identified using 
convenience purposive sampling, took part in individual semistructured 
interviews between July and November 2020, shortly after the first wave of the 
pandemic in Ontario. We used inductive thematic analysis to identify major 
themes.
RESULTS: We identified five major themes related to the COVID-19 pandemic: 1) 
communication and informational needs (e.g., challenges communicating policy 
changes); 2) adjusting to restricted visitation (e.g., spending less time 
interacting with patients); 3) staffing and workplace supports (e.g., importance 
of positive team dynamics); 4) permeability of professional and personal lives 
(e.g., balancing shift work and childcare); and 5) a dynamic COVID-19 landscape 
(e.g., coping with constant change). The COVID-19 pandemic contributed to HCWs 
in the ICU experiencing varied negative repercussions on their work environment, 
including staffing and institutional support, which carried into their personal 
lives.
CONCLUSION: Healthcare workers in the ICU perceived that the COVID-19 pandemic 
had negative repercussions on their work environment, including staffing and 
institutional support, as well as their professional and personal lives. 
Understanding both the negative and positive experiences of all ICU HCWs working 
during the COVID-19 pandemic is critical to future pandemic preparedness. Their 
perspectives will help to inform the development of mental health and wellbeing 
interventions to support staff during the COVID-19 pandemic and beyond.

Publisher: RéSUMé: OBJECTIF: Nous avons cherché à explorer les expériences 
vécues par un échantillon varié de travailleurs de la santé (TS) dans une seule 
unité de soins intensifs (USI) desservant une population canadienne vaste et 
généralisable. Notre objectif était de comprendre comment le travail pendant la 
pandémie de COVID-19 a affecté leur vie professionnelle et personnelle, y 
compris leurs perceptions du soutien institutionnel, afin d’éclairer les 
interventions visant à atténuer les impacts de la COVID-19 et des pandémies 
futures. MéTHODE: Dans cette étude qualitative descriptive, 23 travailleurs de 
la santé en soins intensifs, identifiés à l’aide d’un échantillonnage raisonné 
de commodité, ont participé à des entrevues individuelles semi-structurées entre 
juillet et novembre 2020, peu après la première vague de la pandémie en Ontario. 
Nous avons utilisé l’analyse thématique inductive pour identifier les principaux 
thèmes. RéSULTATS: Nous avons cerné cinq grands thèmes liés à la pandémie de 
COVID-19 : 1) les besoins en matière de communication et d’information (p. ex., 
les difficultés à communiquer les changements de politiques); 2) l’adaptation 
aux visites restreintes (p. ex., le fait de passer moins de temps à interagir 
avec les patients); 3) le soutien à la dotation en personnel et au milieu de 
travail (p. ex., l’importance d’une dynamique d’équipe positive); 4) la 
perméabilité de la vie professionnelle et personnelle (p. ex., l’équilibre entre 
le travail en quarts et la garde des enfants); et 5) le paysage dynamique de la 
COVID-19 (p. ex., l’adaptation à des changements constants). La pandémie de 
COVID-19 a contribué à ce que les travailleurs de la santé de l’USI subissent 
divers impacts négatifs sur leur environnement de travail, y compris sur la 
dotation en personnel et le soutien institutionnel, qui se sont répercutés sur 
leur vie personnelle. CONCLUSION: Les travailleurs de la santé de l’USI ont 
perçu que la pandémie de COVID-19 avait eu des répercussions négatives sur leur 
environnement de travail, y compris sur la dotation en personnel et le soutien 
institutionnel, ainsi que sur leur vie professionnelle et personnelle. Il est 
essentiel de comprendre les expériences négatives et positives de tous les 
travailleurs de la santé des soins intensifs travaillant pendant la pandémie de 
COVID-19 pour bien se préparer aux pandémies futures. Leurs points de vue 
aideront à l’élaboration d’interventions en santé mentale et en bien-être pour 
soutenir le personnel pendant la pandémie de COVID-19 et au-delà.

© 2023. The Author(s).

DOI: 10.1007/s12630-022-02377-z
PMCID: PMC9831684
PMID: 36627462 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1107. J Affect Disord. 2023 Mar 15;325:282-288. doi: 10.1016/j.jad.2023.01.006. Epub 
2023 Jan 7.

COVID-19 pandemic impact on mental health in a large representative sample of 
older adults from the Lombardy region, Italy.

Amerio A(1), Stival C(2), Lugo A(3), Fanucchi T(4), d'Oro LC(5), Iacoviello 
L(6), Odone A(7), Stuckler D(8), Zucchi A(9), Serafini G(10), Gallus S(11); 
“LOST in Lombardia” Study Investigators.

Collaborators: Bosetti C(12), Jarach CM(13), Santucci C(14), Amore M(15), De 
Sena R(16), Ghislandi S(17), Wang Y(18), Bonaccio M(19), Gianfagna F(20), 
Signorelli C(21), Mosconi G(22), Vigezzi GP(23), Rognoni M(24), Paroni L(25), 
Ciampichini R(26).

Author information:
(1)Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal 
and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, 
Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy. Electronic address: 
andrea.amerio@unige.it.
(2)Department of Environmental Health Sciences, Istituto di Ricerche 
Farmacologiche Mario Negri IRCCS, Milan, Italy. Electronic address: 
chiara.stival@marionegri.it.
(3)Department of Environmental Health Sciences, Istituto di Ricerche 
Farmacologiche Mario Negri IRCCS, Milan, Italy. Electronic address: 
alessandra.lugo@marionegri.it.
(4)SOD Alcologia - Centro Alcologico Regionale Toscano, Azienda 
Ospedaliero-Universitaria Careggi, Florence, Italy. Electronic address: 
fanucchit@aou-careggi.toscana.it.
(5)ATS Brianza, Monza, Italy. Electronic address: 
luca.cavalieridoro@ats-brianza.it.
(6)School of Medicine, University of Insubria, Varese, Italy; IRCCS Neuromed, 
Pozzilli, Italy. Electronic address: licia.iacoviello@uninsubria.it.
(7)Department of Public Health, Experimental and Forensic Medicine, University 
of Pavia, Pavia, Italy; School of Medicine, Vita-Salute San Raffaele University, 
Milan, Italy. Electronic address: anna.odone@unipv.it.
(8)Department of Social Sciences and Politics, Bocconi University, Milan, Italy. 
Electronic address: david.stuckler@unibocconi.it.
(9)ATS Bergamo, Bergamo, Italy. Electronic address: alberto.zucchi@ats-bg.it.
(10)Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, 
Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 
Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy. Electronic 
address: gianluca.serafini@unige.it.
(11)Department of Environmental Health Sciences, Istituto di Ricerche 
Farmacologiche Mario Negri IRCCS, Milan, Italy. Electronic address: 
silvano.gallus@marionegri.it.
(12)Department of Environmental Health Sciences, Istituto di Ricerche 
Farmacologiche Mario Negri IRCCS, Milan, Italy. Electronic address: 
cristina.bosetti@marionegri.it.
(13)Department of Environmental Health Sciences, Istituto di Ricerche 
Farmacologiche Mario Negri IRCCS, Milan, Italy. Electronic address: 
carlotta.jarach@marionegri.it.
(14)Department of Environmental Health Sciences, Istituto di Ricerche 
Farmacologiche Mario Negri IRCCS, Milan, Italy. Electronic address: 
claudia.santucci@marionegri.it.
(15)Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, 
Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 
Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy. Electronic 
address: mario.amore@unige.it.
(16)Department of Social Sciences and Politics, Bocconi University, Milan, 
Italy. Electronic address: roberto.desena@bocconi.it.
(17)Department of Social Sciences and Politics, Bocconi University, Milan, 
Italy. Electronic address: simone.ghislandi@unibocconi.it.
(18)Department of Social Sciences and Politics, Bocconi University, Milan, 
Italy. Electronic address: yuxi.wang@unibocconi.it.
(19)School of Medicine, University of Insubria, Varese, Italy; IRCCS Neuromed, 
Pozzilli, Italy. Electronic address: marialaura.bonaccio@moli-sani.org.
(20)School of Medicine, University of Insubria, Varese, Italy; IRCCS Neuromed, 
Pozzilli, Italy. Electronic address: francesco.gianfagna@uninsubria.it.
(21)School of Medicine, Vita-Salute San Raffaele University, Milan, Italy. 
Electronic address: signorelli.carlo@hsr.it.
(22)Department of Public Health, Experimental and Forensic Medicine, University 
of Pavia, Pavia, Italy. Electronic address: giansanto@mosconi.com.
(23)Department of Public Health, Experimental and Forensic Medicine, University 
of Pavia, Pavia, Italy.
(24)ATS Brianza, Monza, Italy. Electronic address: magda.rognoni@ats-brianza.it.
(25)ATS Brianza, Monza, Italy. Electronic address: luca.paroni@aslmb.it.
(26)ATS Bergamo, Bergamo, Italy. Electronic address: 
roberta.ciampichini@ats-bg.it.

BACKGROUND: We aimed to assess the prevalence of depressive and anxiety 
symptoms, hopelessness and insomnia in the older adults before and during the 
COVID-19 pandemic identifying subgroups at higher risk of mental distress.
METHODS: Within the Lost in Lombardy project, a web-based cross-sectional study 
was conducted on a representative sample of 4400 older adults aged 65 years or 
more from the Lombardy region recruited between November 17th and 30th 2020.
RESULTS: The prevalence of depressive symptoms increased by +112 % during the 
pandemic, anxiety symptoms by +136 %, insufficient sleep by +12 %, 
unsatisfactory sleep by +15 %. Feelings of hopelessness were more frequent among 
women compared to men and increased with increasing age. A worsening in each of 
the four specific mental health outcomes was more frequently observed in women 
(OR = 1.50, depression; OR = 1.31, anxiety; OR = 1.57, sleep quality; OR = 1.38, 
sleep quantity), in subjects who decreased their physical activity during the 
pandemic (OR = 1.64, depression; OR = 1.48, anxiety; OR = 2.05, sleep quality; 
OR = 1.28, sleep quantity), and with increasing number of pre-existing chronic 
diseases. The use of at least one psychotropic drug - mostly 
antidepressants/anxiolytics - increased by +26 % compared to pre-pandemic.
LIMITATIONS: Pre-pandemic symptoms were retrospectively reported during the 
Covid pandemic. Potential information and recall bias should not be ruled out.
CONCLUSIONS: If confirmed by future longitudinal studies, our findings could 
support evidence-based health and welfare policies on responding to this 
pandemic and on how to promote mental health and wellbeing, should future waves 
of infection emerge.

Copyright © 2023 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2023.01.006
PMCID: PMC9824954
PMID: 36627059 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest Each author declares that 
he or she has no commercial associations (e.g. consultancies, stock ownership, 
equity interest, patent/licensing arrangement etc.) that might pose a conflict 
of interest in connection with the submitted article.


1108. West J Nurs Res. 2023 May;45(5):443-454. doi: 10.1177/01939459221148825. Epub 
2023 Jan 10.

Health Experiences of Nurses during the COVID-19 Pandemic: A Mixed Methods 
Study.

Harris ML(1)(2)(3), McLeod A(3)(4), Titler MG(3).

Author information:
(1)Center of Innovation to Accelerate Discovery and Practice Transformation 
(ADAPT), Durham VA Health Care System, Durham, NC, USA.
(2)Clinical and Translational Science Institute, Duke University, Durham, NC, 
USA.
(3)University of Michigan School of Nursing, Ann Arbor, MI, USA.
(4)University of Michigan, Michigan Medicine, Transplant Center, Ann Arbor, MI, 
USA.

This study characterizes the impact of the COVID-19 pandemic on the mental and 
physical health of nurses. Qualitative data (collected using semi-structured 
interviews) were integrated with quantitative data (collected concurrently using 
the SF-12 Health Survey). Nurses (N = 30) compared their health prior to and 
during the first pandemic wave (March-May 2020). Interviews were analyzed 
thematically; descriptive statistics and t-tests compared pre-pandemic to 
current SF-12 scores. Qualitative findings demonstrated an impact on nurses' 
mental health expressed as isolation, loss, intense emotions, and feelings of 
being expendable. Impact on nurses' physical health included exhaustion, 
personal protective equipment skin breakdown, limited breaks from work, and 
virus exposure. Quantitative results show nurses' experienced declines in 
overall mental health (p < .001), and multiple physical health domains: role 
limitations due to physical problems (p < .0001), bodily pain (p < .0001), and 
general health (p < .0001). Promotion of nurses' well-being and safety, as well 
as education in emergency preparedness, must be given precedence to protect 
nurses' health.

DOI: 10.1177/01939459221148825
PMCID: PMC9834626
PMID: 36625341 [Indexed for MEDLINE]

Conflict of interest statement: The authors declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1109. Nurs Outlook. 2023 Jan-Feb;71(1):101899. doi: 10.1016/j.outlook.2022.11.003. 
Epub 2022 Nov 17.

A scoping review of the literature addressing psychological well-being of racial 
and ethnic minority nurses during the COVID-19 pandemic.

Abrahim HL(1), Holman EA(2).

Author information:
(1)Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, 
CA.
(2)Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, 
CA. Electronic address: aholman@uci.edu.

BACKGROUND: The COVID-19 pandemic has affected the well-being of nursing 
professionals, especially long-term and acute care nurses, many of whom are 
nurses of color.
PURPOSE: We examine the evidence and gaps in the literature addressing 
psychological well-being of racial/ethnic minority RNs in the United States 
during COVID-19.
METHODS: We searched eight databases during March 2022 and used Joanna Briggs' 
Scoping Review Methodology and PRISMA-ScR reporting standards.
DISCUSSION: Seven studies met inclusion criteria. Two exclusively examined 
nurses; five reported findings from heterogeneous samples of health care 
workers. No significant racial/ethnic differences in well-being were reported 
among health care workers. Among nurses, if a difference existed, White nurses 
reported decreased psychological well-being relative to ethnic and racial 
minority nurses. Two studies report modest racial/ethnic differences in nurses' 
psychological well-being.
CONCLUSION: Significant gaps in the literature remain; future studies should 
analyze groups of health care workers separately, clearly identify racial and 
ethnic groups, and examine the role of respondents' work setting.

Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.outlook.2022.11.003
PMCID: PMC9671619
PMID: 36623985 [Indexed for MEDLINE]


1110. Psychiatry Res. 2023 Feb;320:115030. doi: 10.1016/j.psychres.2022.115030. Epub 
2022 Dec 26.

Longitudinal Mental Health Outcomes of Third-year Medical Students Rotating 
Through the Wards During COVID-19.

Stanislawski ER(1), Saali A(2), Magill EB(2), Deshpande R(3), Kumar V(4), Chan 
C(5), Hurtado A(2), Charney DS(2), Ripp J(6), Katz CL(2).

Author information:
(1)Department of Psychiatry, 22 Bramhall Street, Maine Medical Center, Portland, 
ME, United States of America; Department of Psychiatry, Icahn School of Medicine 
at Mount Sinai, 1 Gustave Levy Place, New York, NY, United States of America. 
Electronic address: emma.stanislawski@gmail.com.
(2)Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave 
Levy Place, New York, NY, United States of America.
(3)Department of Population Health Science & Policy, Icahn School of Medicine at 
Mount Sinai, 1 Gustave Levy Place, New York, NY, United States of America.
(4)Department of Psychiatry, Zucker Hillside Hospital, 75-59 263rd St, Glen 
Oaks, New York, United States of America.
(5)Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave 
Levy Place, New York, NY, United States of America; Mental Illness Research, 
Education, and Clinical Center, James J. Peters VA Medical Center, 130 W 
Kingsbridge Rd, Bronx, NY, United States of America.
(6)Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave 
Levy Place, New York, NY, United States of America.

This study investigated third year medical students' psychological well-being 
during clinical rotations at Mount Sinai hospitals in New York City during the 
COVID-19 pandemic. All students (n = 147) starting rotations (psychiatry, 
surgery, obstetrics-gynecology, neurology, pediatrics, and medicine) could 
participate in quarterly, online, anonymous surveys comprised of validated 
screeners for: psychological symptoms, risk, coping, and protective factors, 
demographics, COVID-19 worries, and stressful clerkship-related events. 
Associations between variables were examined with Chi-squared, Fisher's exact, 
t-, Wilcoxon Rank Sum, one-way ANOVA, and McNemar tests. Significant univariate 
predictors of psychological distress were included in stepwise multivariable 
linear regression models. The baseline survey was completed by 110 (74.8%) 
students; ninety-two (62.6%) completed at least one other survey. During the 
year, 68 (73.9%) students screened positive for depression, anxiety, or PTSD. 
The prevalence of psychiatric symptoms peaked in June 2020 without significant 
changes in average scores over time. COVID-19 worries decreased over time but 
did not influence psychological symptoms at year-end. Eighty-three students 
(90.2%) experienced stressful clerkship-related events, which were traumatic 
and/or COVID-19-related for 26 (28.3%) and 22 students (24.0%), respectively. 
Baseline psychological distress, childhood emotional abuse, and resilience 
predicted depression, anxiety, and/or PTSD by year-end. This study highlights 
the importance of recognizing psychological distress and implementing 
interventions to support students' well-being.

Copyright © 2022. Published by Elsevier B.V.

DOI: 10.1016/j.psychres.2022.115030
PMCID: PMC9791716
PMID: 36623426 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest The author(s) declare(s) 
that they have no competing interests. They would, however, like to disclose 
that Dr. Charney is named as co-inventor on patents filed by the Icahn School of 
Medicine at Mount Sinai (ISMMS) relating to the treatment for 
treatment-resistant depression, suicidal ideation and other disorders. ISMMS has 
entered into a licensing agreement with Janssen Pharmaceuticals, Inc. and it has 
and will receive payments from Janssen under the license agreement related to 
these patents for the treatment of treatment- resistant depression and suicidal 
ideation. Consistent with the ISMMS Faculty Handbook (the medical school 
policy), Dr. Charney is entitled to a portion of the payments received by the 
ISMMS. Since SPRAVATO has received regulatory approval for treatment-resistant 
depression, ISMMS and thus, through the ISMMS, Dr. Charney, will be entitled to 
additional payments, beyond those already received, under the license agreement. 
Dr. Charney is a named co-inventor on several patents filed by ISMMS for a 
cognitive training intervention to treat depression and related psychiatric 
disorders. The ISMMS has entered into a licensing agreement with Click 
Therapeutics, Inc. and has and will receive payments related to the use of this 
cognitive training intervention for the treatment of psychiatric disorders. In 
accordance with the ISMMS Faculty Handbook, Dr. Charney has received a portion 
of these payments and is entitled to a portion of any additional payments that 
the medical school might receive from this license with Click Therapeutics. Dr. 
Charney is a named co-inventor on a patent application filed by the ISMMS for 
the use of intranasally administered Neuropeptide Y (NPY) for the treatment of 
mood and anxiety disorders. This intellectual property has not been licensed. 
Dr. Charney is a named co-inventor on a patent application in the US, and 
several issued patents outside the US filed by the ISMMS related to the use of 
ketamine for the treatment of post-traumatic stress disorder (PTSD). This 
intellectual property has not been licensed. Dr. Charney is a named co-inventor 
on a patent application filed by ISMMS for systems and methods for providing a 
resilience building application to support mental health of subjects. This 
intellectual property has not been licensed.


1111. J Appl Gerontol. 2023 May;42(5):789-799. doi: 10.1177/07334648221147918. Epub 
2023 Jan 9.

"I Can't Take Any Chances": A Mixed Methods Study of Frailty, Isolation, Worry, 
and Loneliness Among Aging Adults During the COVID-19 Pandemic.

Joseph CA(1)(2), Kobayashi LC(1), Frain LN(3), Finlay JM(4).

Author information:
(1)Department of Epidemiology, 51329University of Michigan School of Public 
Health, Ann Arbor, MI, USA.
(2)College of Medicine, Central Michigan University, Mount Pleasant, MI, USA.
(3)Division of Aging, 1861Brigham and Women's Hospital, Boston, MA, USA.
(4)Social Environment and Health Program, Survey Research Center, Institute for 
Social Research, 51331University of Michigan, Ann Arbor, MI, USA.

Little is known about how frailty has shaped experiences of living through the 
COVID-19 pandemic. In this cross-sectional mixed methods study, we analyzed data 
from the nationwide COVID-19 Coping Study from December 2020 through January 
2021 (N = 2094 US adults aged ≥55) to investigate quantitative associations 
between frailty and the prevalence of physical isolation, worry about COVID-19, 
and loneliness. Reflexive thematic analysis explored aging adults' lived 
experiences of frailty during the pandemic. In multivariable-adjusted 
population-weighted modified Poisson regression models, we found that frailty 
was associated with increased prevalence of physical isolation, worry about 
COVID-19, and loneliness. Qualitative experiences of aging with frailty during 
the pandemic were diverse, and encompassed isolation, worry, and loneliness, as 
well as coping strategies and resilience. The findings may inform individualized 
multi-factorial strategies (e.g., physical activity, nutrition, and social 
interaction) to support well-being among adults aging with frailty during the 
pandemic.

DOI: 10.1177/07334648221147918
PMCID: PMC9850116
PMID: 36621930 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1112. J Affect Disord. 2023 Mar 1;324:616-623. doi: 10.1016/j.jad.2022.12.169. Epub 
2023 Jan 5.

Developing the HERO within: Evaluation of a brief intervention for increasing 
Psychological Capital (PsyCap) in Australian female students during the final 
year of school in the first year of COVID-19.

Finch J(1), Waters AM(2), Farrell LJ(3).

Author information:
(1)Griffith University, School of Applied Psychology, Gold Coast Campus, 
Australia. Electronic address: jules.finch@griffith.edu.au.
(2)Griffith University, School of Applied Psychology, Mt Gravatt Campus, 
Australia.
(3)Griffith University, School of Applied Psychology, Gold Coast Campus, 
Australia.

Academic stress is linked to adolescent distress and perfectionism during the 
final years at school, with girls being at greater risk. The onset of the 
COVID-19 pandemic was an additional stressor that impacted student learning on a 
global scale. The present study examines the effectiveness of an intervention 
targeting Psychological Capital (PsyCap), comprising hope, efficacy, resilience, 
and optimism (HERO) to increase these HERO resources and assess its impact on 
mental health symptoms and subjective wellbeing outcomes among a cohort of Year 
12 students (n = 82, Mage = 17.09, SD = 0.28, 99% identifying as female) from a 
girls school during the first year of the pandemic. Primary outcomes of anxiety 
symptoms, depressive symptoms, and flourishing and secondary outcomes of HERO 
variables and perfectionism were examined. There were no significant changes in 
primary outcomes. Significant changes in efficacy, optimism, omnibus PsyCap 
(HERO combined) and perfectionism were found at post-intervention. Findings 
indicate the intervention targeting HERO constructs may be promising for 
developing HERO capabilities in youth and reducing common areas of concern for 
students (e.g., perfectionism). Future research directions addressing 
limitations are discussed.

Copyright © 2023 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2022.12.169
PMCID: PMC9814284
PMID: 36621678 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest The authors declare no 
conflict of interest.


1113. Front Public Health. 2022 Dec 23;10:1056967. doi: 10.3389/fpubh.2022.1056967. 
eCollection 2022.

Health-related quality of life of children and adolescents with type 1 diabetes 
during the COVID-19 pandemic in Kuwait.

Al-Abdulrazzaq D(1)(2), Khalifa D(2), Alqaisi T(2), Al-Juailla F(2), Othman 
F(2), Qabazard S(2), Al-Kandari H(2)(3).

Author information:
(1)Department of Pediatrics, Faculty of Medicine, Kuwait University, Kuwait 
City, Kuwait.
(2)Department of Population Health, Dasman Diabetes Institute, Kuwait City, 
Kuwait.
(3)Department of Pediatrics, Al-Farwaniya Hospital, Kuwait City, Kuwait.

BACKGROUND: With the rapid transmission of COVID-19 globally, countries have 
implemented strict governmental measures and social distancing rules that aimed 
to minimize the spread of the virus. School closures, quarantine orders, and 
social isolation, coupled with a surge in family stress and lack of peer 
interactions, are probable causes of mental health complications and 
psychological symptoms faced by children. This study aims at comparing the HRQoL 
of children and adolescents with type 1 diabetes (T1D) and affected by COVID-19 
infection (personal or familial) and those who were not affected by COVID-19.
MATERIALS AND METHODS: A random sample was selected from children and 
adolescents diagnosed with T1D at the six major governmental diabetes centers in 
Kuwait. To measure HRQoL, parent-proxy and self-reports from the Pediatric 
Quality of Life Inventory (PedsQLTM) 3.0 Diabetes Module were used.
RESULTS: A sample of 455 children and adolescents with T1D diabetes (44.6% male 
participants and 41.98% affected by COVID-19 infection) was studied. The total 
score of the HRQoL self-reports was significantly higher compared with 
parent-proxy reports (79.06 ± 15.19 vs. 73.79 ± 15.17, p < 0.01). Children 
reported significantly higher HRQoL scores in the "treatment I" domain and 
"worry" domain and lower scores in the "diabetes" symptoms domain, compared with 
their parents' reports (p < 0.01). In the COVID-19-affected group, a major 
difference was noticed between the total scores of children and parent-proxy 
reports (77.04 ± 15.81 vs. 72.80±14.90, p = 0.047). The affected children 
reported significantly lower scores in "diabetes" symptoms (59.50) (p < 0.01) 
and higher scores in the "treatment I" domain (81.43) than their parent-proxy 
reports (72.05) (p < 0.01).
CONCLUSION: This is the first report on the health-related quality of life of 
children with T1D in Kuwait during the COVID-19 era. Parents' or caregivers' 
experience of caring for their children was negative, as they worried, and 
reported poorer HRQoL compared with their children's perceptions. There is a 
need to empower healthcare professionals to support parents and caregivers of 
children with chronic diseases such as T1D in promoting self-management, 
enhancing physical and psychological wellbeing, treatment adherence, and 
continuous health education during pandemics of any kind.

Copyright © 2022 Al-Abdulrazzaq, Khalifa, Alqaisi, Al-Juailla, Othman, Qabazard 
and Al-Kandari.

DOI: 10.3389/fpubh.2022.1056967
PMCID: PMC9816431
PMID: 36620301 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1114. Front Cell Infect Microbiol. 2022 Dec 22;12:983089. doi: 
10.3389/fcimb.2022.983089. eCollection 2022.

The contribution of gut-brain axis to development of neurological symptoms in 
COVID-19 recovered patients: A hypothesis and review of literature.

Vakili K(1), Fathi M(1), Yaghoobpoor S(1), Sayehmiri F(1), Nazerian Y(2), 
Nazerian A(3), Mohamadkhani A(4), Khodabakhsh P(5), Réus GZ(6), Hajibeygi R(7), 
Rezaei-Tavirani M(8).

Author information:
(1)Student Research Committee, Faculty of Medicine, Shahid Beheshti University 
of Medical Sciences, Tehran, Iran.
(2)School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, 
Iran.
(3)School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
(4)Digestive Disease Research Center, Tehran University of Medical Sciences, 
Tehran, Iran.
(5)Department of Pharmacology, School of Medicine, Shahid Beheshti University of 
Medical Sciences, Tehran, Iran.
(6)Translational Psychiatry Laboratory, Graduate Program in Health Sciences, 
University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil.
(7)Department of Cardiology, Faculty of Medicine, Tehran Medical Sciences, 
Islamic Azad University, Tehran, Iran.
(8)Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti 
University of Medical Sciences, Tehran, Iran.

The gut microbiota undergoes significant alterations in response to viral 
infections, particularly the novel SARS-CoV-2. As impaired gut microbiota can 
trigger numerous neurological disorders, we suggest that the long-term 
neurological symptoms of COVID-19 may be related to intestinal microbiota 
disorders in these patients. Thus, we have gathered available information on how 
the virus can affect the microbiota of gastrointestinal systems, both in the 
acute and the recovery phase of the disease, and described several mechanisms 
through which this gut dysbiosis can lead to long-term neurological disorders, 
such as Guillain-Barre syndrome, chronic fatigue, psychiatric disorders such as 
depression and anxiety, and even neurodegenerative diseases such as Alzheimer's 
and Parkinson's disease. These mechanisms may be mediated by inflammatory 
cytokines, as well as certain chemicals such as gastrointestinal hormones (e.g., 
CCK), neurotransmitters (e.g., 5-HT), etc. (e.g., short-chain fatty acids), and 
the autonomic nervous system. In addition to the direct influences of the virus, 
repurposed medications used for COVID-19 patients can also play a role in gut 
dysbiosis. In conclusion, although there are many dark spots in our current 
knowledge of the mechanism of COVID-19-related gut-brain axis disturbance, based 
on available evidence, we can hypothesize that these two phenomena are more than 
just a coincidence and highly recommend large-scale epidemiologic studies in the 
future.

Copyright © 2022 Vakili, Fathi, Yaghoobpoor, Sayehmiri, Nazerian, Nazerian, 
Mohamadkhani, Khodabakhsh, Réus, Hajibeygi and Rezaei-Tavirani.

DOI: 10.3389/fcimb.2022.983089
PMCID: PMC9815719
PMID: 36619768 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1115. Disabil Rehabil. 2024 Feb;46(3):489-496. doi: 10.1080/09638288.2022.2164366. 
Epub 2023 Jan 9.

Experiences of children and young people with attention deficit hyperactivity 
disorder (ADHD) during COVID-19 pandemic and lockdown restrictions.

Bailie V(1), Linden MA(2).

Author information:
(1)Warren Children's Centre, Lisburn, UK.
(2)School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.

PURPOSE: To explore the experiences of children and young people (CYP) with 
attention deficit hyperactivity disorder during the COVID-19 pandemic and lock 
down restrictions.
METHODS: Semi-structured, online interviews were conducted with 17 children and 
young people from the UK, Northern Ireland, aged 10-14 years with ADHD. Over 
half the participants had a co-existing diagnosis, such as autism spectrum 
disorder. Interviews were recorded and transcribed verbatim before being 
subjected to thematic analysis.
RESULTS: Four themes were identified; the emotional impact of the pandemic, 
adjustments to daily living, impact of remote learning and the effect on 
relationships. Many CYP citied feelings of sadness, loneliness and anxiety, 
others found the reduction in social demands favourable.
CONCLUSIONS: As one of few studies to capture the experiences of children and 
young people with ADHD during the COVID-19 pandemic, this research highlights 
the potential negative long-term impact on emotional welfare, schooling and 
relationships.Implications for rehabilitationHealth care professionals should be 
aware of the overall impact on health and well-being for children and young 
people with ADHD following the COVID-19 pandemic and lockdown restrictions to 
ensure that the effect of these are minimised and managed in the 
future.Educators and clinicians should be cognisant of the long term 
consequences of poor mental health during the COVID-19 pandemic and should put 
in place pro-active strategies to support children and young people with 
ADHD.Children and young people with ADHD may suffer greatly from reduced access 
to sports and leisure facilities. Policy makers should be conscious of the 
potential negative consequences of placing limitations on access to such 
facilities.

DOI: 10.1080/09638288.2022.2164366
PMID: 36617961 [Indexed for MEDLINE]


1116. Adv Gerontol. 2022;35(5):697-703.

[Time perspective, sleep and wellbeing of the elderly during COVID-19 
pandemic.].

[Article in Russian; Abstract available in Russian from the publisher]

Borisenkov MF(1), Popov SV(1), Smirnov VV(1), Bakutova LA(1), Vlasova AV(2), 
Samokhina EO(2), Konyshko NA(2), Merdenova LA(3), Takoeva EA(3), Nartikoeva 
MI(3), Pecherkina AA(4), Dorogina OI(4), Symaniuk EE(4).

Author information:
(1)Institute of Physiology of Komi Science Centre of the Ural Branch of Russian 
Academy of Sciences, FRC Komi SC UB RAS, 50 Pervomaiskaya str., Syktyvkar 
167982, Russian Federation, e-mail: borisenkov@physiol.komisc.ru.
(2)I.M.Sechenov First Moscow State Medical University, 8 build. 2 Trubetskaya 
str., Moscow 119991, Russian Federation.
(3)Institute of Biomedical Investigations - the Affiliate of Vladikavkaz 
Scientific Centre of RAS, 47 Pushkinskaya str., Vladikavkaz 362025, Russian 
Federation.
(4)Ural Institute of Humanity, Ural Federal University, 51 Lenin str., 
Yekaterinburg 620222, Russian Federation.

The purpose of this study was to analyze the association between the time 
perspective and the psychophysiological state of the elderly during the pandemic 
COVID-19. 433 residents from 11 Russian cities aged 60,8±9,8 years (range - 
50-94 years, women - 78,7%) took part in the study. During the online survey, 
each participant of the study provided personal data (place of residence, sex, 
age, height, and weight) and completed the Zimbardo Time Perspective Inventory, 
the Munich Chronotype Questionnaire, the Beck Depression Inventory and the Yale 
Food Addiction Scale. It was found that elderly people with a balanced time 
perspective had the lowest level of depression during the pandemic COVID-19 and 
less expressed sleep inertia at work days, while those with a past negative time 
perspective had the highest level of depression, high frequency of detection of 
food addiction and low sleep efficiency. The other types of time perspective 
(past positive, present hedonistic, present fatalistic and future) had 
intermediate values of indicators between these two extreme options. Thus, the 
conducted studies have shown that elderly people with a balanced time 
perspective showed the highest level of resistance to psychoemotional stress 
caused by the pandemic COVID-19.

Publisher: Цель исследования — изучение связи между временно́й перспективой и 
психофизиологическим состоянием пожилых людей во время пандемии COVID-19. В 
исследовании приняли участие 433 жителя 11 городов России в возрасте 60,8±9,8 
года (диапазон — 50–94 года, женщины — 78,7%). Каждый участник исследования во 
время онлайн-опроса указал личные данные (место проживания, пол, возраст, рост, 
массу тела) и заполнил тест Зимбардо для оценки временно́й перспективы, 
Мюнхенский тест для оценки хронотипа, шкалу депрессии Бека и Йельскую шкалу для 
оценки пищевой зависимости. Установлено, что у пожилых людей со сбалансированной 
временно́й перспективой во время пандемии COVID-19 наблюдался наименьший уровень 
депрессии и менее выраженная инерция сна в рабочие дни, в то время как у лиц с 
прошлой негативной временно́й перспективой отмечен наиболее высокий уровень 
депрессии, высокая частота выявления пищевой зависимости и низкая эффективность 
сна. Остальные типы временно́й перспективы (прошлая позитивная, настоящая 
гедонистическая, настоящая фаталистическая и будущая) имели промежуточные 
показатели между этими двумя крайними вариантами. Таким образом, проведенные 
исследования показали, что пожилые люди со сбалансированной временно́й 
перспективой проявили наиболее высокий уровень устойчивости к 
психоэмоциональному стрессу, вызванному пандемией COVID-19.

PMID: 36617324 [Indexed for MEDLINE]


1117. Int J Environ Res Public Health. 2023 Jan 3;20(1):859. doi: 
10.3390/ijerph20010859.

Teachers during the COVID-19 Era: The Mediation Role Played by Mentalizing 
Ability on the Relationship between Depressive Symptoms, Anxious Trait, and Job 
Burnout.

Levante A(1)(2), Petrocchi S(2)(3), Bianco F(4), Castelli I(4), Lecciso F(1)(2).

Author information:
(1)Department of Human and Social Sciences, University of Salento, 73100 Lecce, 
Italy.
(2)Lab of Applied Psychology, Department of Human and Social Sciences, 
University of Salento, 73100 Lecce, Italy.
(3)Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 
Lugano, Switzerland.
(4)Department of Human and Social Sciences, University of Bergamo, 24100 
Bergamo, Italy.

BACKGROUND: The COVID-19 outbreak caused severe changes in school activities 
over the past two years. Teachers underwent a re-planning of their teaching 
approaches, shifting from face-to-face teaching formats to remote ones. These 
challenges resulted in high levels of burnout. The identification of 
risk/protective factors contributing to burnout is crucial in order to inform 
intervention programs. Thus, we hypothesized a mediation role of teachers' 
mentalizing ability (processing of emotions, a component of mentalized 
affectivity) on the relationship between depression, anxiety, and 
depersonalization (burnout dimension). Two reverse models were computed. Job 
satisfaction, teachers' age and gender, school grade, and length of teaching 
experience served as covariates.
METHODS: 466 (M(sd) = 46.2 (10.4) years) online questionnaires were completed by 
Italian teachers of primary (n = 204) and middle (n = 242) schools. Measures of 
burnout, depression, anxiety, and mentalization were administered.
RESULTS: The findings corroborated our hypotheses: in all models, processing 
emotions served as a mediator on the relationship between depression, anxiety, 
and depersonalization, and on the reciprocal one. Job satisfaction positively 
impacted processing emotion, and negatively impacted depression and 
depersonalization; women teachers reported high levels of the anxious trait.
CONCLUSIONS: Overall, it can be concluded that the ability to mentalize has a 
beneficial impact on teachers' well-being. Policymaking, clinical, and research 
implications were discussed.

DOI: 10.3390/ijerph20010859
PMCID: PMC9820251
PMID: 36613181 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1118. Int J Environ Res Public Health. 2023 Jan 1;20(1):805. doi: 
10.3390/ijerph20010805.

Work-Related Stress of Polish School Principals during the COVID-19 Pandemic as 
a Risk Factor for Burnout.

Leksy K(1), Wójciak M(2), Gawron G(3), Muster R(3), Dadaczynski K(4)(5), Okan 
O(6).

Author information:
(1)Institute of Pedagogy, Department of Social Science, University of Silesia, 
40-126 Katowice, Poland.
(2)Department of Digital Economy Research, University of Economics, 40-287 
Katowice, Poland.
(3)Institute of Sociology, Department of Social Science, University of Silesia, 
40-007 Katowice, Poland.
(4)Department of Health Science, Fulda University of Applied Sciences, 36039 
Fulda, Germany.
(5)Center for Applied Health Science, Leuphana University Lueneburg, 21335 
Lueneburg, Germany.
(6)Department of Sport and Health Sciences, Technical University Munich, 80992 
Munich, Germany.

BACKGROUND: The ongoing COVID-19 pandemic has influenced educational systems 
worldwide. School principals coped with numerous significant challenges 
regarding school management during the epidemiological crisis that could 
generate a lot of work-related stress. Thus, the presented study examines Polish 
school principals' perceived stress and its association with exhaustion and 
psychosomatic complaints as burnout risk indicators. Principals' gender and age 
as sociodemographic control variables were also considered in this paper.
METHODS: A cross-sectional online study was conducted in eight provinces of 
Poland from June to December 2021. The study was part of a global COVID-HL 
school principal survey under the global COVID-Health Literacy Research Network. 
Two subscales of the Perceived Stress Scale (PSS-10) (perceived helplessness 
[PH] and perceived self-efficacy [PSE]) were considered independent variables in 
relation to school principals' mental and physical exhaustion and psychosomatic 
complaints. Regression models consisting of two equations were used to test the 
relationship between variables. The first equation consists of the control 
variables (age, gender), and in the second equation, the independent variables 
(PH and PSE) were included in addition to the control variables.
RESULTS: Almost 50% of school principals experienced a lack of control that 
caused anger and stress. Mental and physical exhaustion during the pandemic was 
often or always felt by 30% of respondents. Nearly half of Polish school 
principals experienced psychosomatic complaints in the form of muscle pain and 
headaches. PH, to a greater extent than PSE, was associated with mental and 
physical exhaustion and psychosomatic complaints. With age, the level of 
psychosomatic complaints and mental and physical exhaustion decreases, but it 
was higher among women. Regression analysis revealed significant associations 
between exhaustion and mental health outcomes, even after controlling for 
demographic variables Conclusion: This study showed that almost half of Polish 
school principals indicated a high frequency of perceived stress during the 
pandemic. PH was more substantially associated with mental and physical 
exhaustion in younger female principals than PSE. Younger female school 
principals reported more exhaustion and psychosomatic complaints. This finding 
should be the baseline information for policymakers to improve the wellbeing of 
Polish school principals and prevent the risk of burnout.

DOI: 10.3390/ijerph20010805
PMCID: PMC9820090
PMID: 36613126 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1119. Int J Environ Res Public Health. 2022 Dec 30;20(1):680. doi: 
10.3390/ijerph20010680.

COVID-19 Anxiety and Wellbeing at Work in Finland during 2020-2022: A 5-Wave 
Longitudinal Survey Study.

Oksanen A(1), Oksa R(1), Celuch M(1), Cvetkovic A(1), Savolainen I(1).

Author information:
(1)Faculty of Social Sciences, Tampere University, 33100 Tampere, Finland.

The COVID-19 pandemic impacted workers globally during 2020-2022 and it has had 
major psychological implications for workers' wellbeing. This longitudinal study 
analyzed risk and protective factors predicting COVID-19 anxiety among workers 
in Finland. Longitudinal national sample of Finnish workers (n = 685) 
participated in a five-wave study conducted in 2020-2022, covering multiple 
waves of the COVID-19 pandemic and its aftermath. Our outcome measure was 
COVID-19 anxiety. Predictors were psychological distress, work exhaustion, 
technostress, and loneliness. Models also controlled for self-regulation; social 
support at work and remote working; and socio-demographic background factors. 
Both within-person and between-person effects were analyzed using multilevel 
hybrid regression models. COVID-19 anxiety varied between time points which is 
explained by changes in circumstances during the pandemic. Highest anxiety was 
expressed in the middle of the Delta variant surge and lockdown in spring 2021. 
Within-person changes in psychological distress, work exhaustion, technostress, 
self-regulation, and perceived loneliness were all associated with COVID-19 
anxiety. Between-person results showed that distressed, exhausted, 
technostressed, and lonely workers expressed more anxiety than others. Remote 
workers reported higher anxiety over time than others. Those who had reported 
high self-regulation reported lower anxiety than others. Female gender and 
younger age were associated with higher anxiety. COVID-19 anxiety continues to 
be an important phenomenon with a magnitude of consequences on people and 
numerous industries. This study showed that general mental health and work 
stressors predict COVID-19 anxiety. Promoting social support and workers' 
self-regulation skills can be beneficial for overcoming anxiety during and after 
the pandemic.

DOI: 10.3390/ijerph20010680
PMCID: PMC9819787
PMID: 36612998 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1120. Int J Environ Res Public Health. 2022 Dec 30;20(1):637. doi: 
10.3390/ijerph20010637.

Well-Being of High-Level Managers during the Pandemic: The Role of Fear of 
Negative Appearance, Anxiety, and Eating Behaviors.

Hryniewicz A(1), Wilczyńska D(1), Krokosz D(1), Hryniewicz K(2), Lipowski M(1).

Author information:
(1)Faculty of Physical Education, Gdańsk University of Physical Education and 
Sport, 80-336 Gdansk, Poland.
(2)Department of Marketing and Quantitative Methods, Faculty of Management and 
Quality Science, Gdynia Maritime University, 81-225 Gdynia, Poland.

(1) Background: The COVID-19 pandemic has caused unprecedented changes in the 
contemporary world, significantly affecting the work of companies, especially 
management staff. This study investigated whether fear about one's health 
(caused by the pandemic, disordered eating attitudes, or concerns about one's 
body image) has a negative relationship with the well-being of managers. (2) 
Methods: N = 354 managers (222 women, 126 men, and 6 people with no gender 
identity) participated in the study. The following psychometric instruments were 
used: the psychological well-being scale, the coronavirus anxiety scale, the 
fear of negative appearance evaluation scale, and the eating attitude test-26. 
Results: the fear of negative appearance influenced the well-being of the 
studied managers. However, this relation was mediated by dieting as well as 
bulimia and food preoccupation. (4) Conclusions: the well-being level depended 
on the managers' positive body images, but only when mediated by healthy dieting 
and eating attitudes. While the well-being level of managers was high, it is 
worth further exploring how they can flourish and develop in life and work, 
which can also transfer to the quality of life of their co-workers and 
companies. However, the subject of the well-being of managers warrants more 
research; for example, by considering different moderators, such as job 
experience, gender, and age. Moreover, experimental studies examining the 
effectiveness of different interventions for the physical and mental health of 
managers could be worth investigating.

DOI: 10.3390/ijerph20010637
PMCID: PMC9819066
PMID: 36612958 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1121. Int J Environ Res Public Health. 2022 Dec 29;20(1):556. doi: 
10.3390/ijerph20010556.

Physical Activity versus Selected Health Behaviors, Subjective Physical and 
Psychological Health and Multimorbidity in a Large Cohort of Polish Seniors 
during the COVID-19 Pandemic (Results of the National Test for Poles' Health ).

Szychowska A(1), Zimny-Zając A(2), Dziankowska-Zaborszczyk E(3), Grodzicki T(4), 
Drygas W(5), Zdrojewski T(6).

Author information:
(1)Department of Social and Preventive Medicine, Medical University of Łódź, 
Żeligowskiego St. 7/9, 90-752 Łódź, Poland.
(2)Medonet, Ringier Axel Springer Poland, Domaniewska St. 49, 02-672 Warsaw, 
Poland.
(3)Department of Epidemiology and Biostatistics, Social and Preventive Medicine, 
Medical University of Łódź, Żeligowskiego St. 7/9, 90-752 Łódź, Poland.
(4)Department of Internal Medicine and Gerontology, Jagiellonian University 
Medical College, 2 Jakubowskiego St., 31-501 Kraków, Poland.
(5)Department of Epidemiology, Cardiovascular Disease Prevention and Health 
Promotion, National Institute of Cardiology, Alpejska St. 42, 04-628 Warsaw, 
Poland.
(6)Department of Preventive Medicine and Education, Medical University of 
Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland.

National Test for Poles' Health is an online study conducted on a large group of 
Polish Internet users. For the purpose of this study, 64,732 subjects (48.8% 
female) over 65 years old were included. Subjects provided answers on the level 
of physical activity (PA) they engage in, prevalence of non-communicable 
diseases (obesity, hypertension, diabetes, heart diseases, chronic obstructive 
pulmonary disease (COPD), depression, cancer) and subjective physical and 
psychological health. Additionally, their Body Mass Index (BMI) and prevalence 
of multimorbidity was assessed. We found that older people who engage in at 
least 2 h of physical activity/week had significantly lower prevalence of 
hypertension, obesity and heart diseases than those who engaged in 1-1.5 h/week 
or less than 1 h/week. Multimorbidity was present in 33.2% of subjects from the 
most active group and 52.6% of the least active ones. Subjective physical and 
psychological health was rated as "very good" by 26.6% and 41.2%, respectively, 
by subjects from the most active group. Only 9.1% of the least active subjects 
rated their physical health as "very good" and only 27.4% rated their 
psychological health as such. Regular physical activity may be a helpful tool in 
combating the reduced well-being of older people affected by the isolation 
caused by the COVID-19 pandemic. Unfortunately, over 65% of respondents claimed 
to engage in less than 1 h of PA a week or less.

DOI: 10.3390/ijerph20010556
PMCID: PMC9819469
PMID: 36612878 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1122. Int J Environ Res Public Health. 2022 Dec 27;20(1):421. doi: 
10.3390/ijerph20010421.

Estimation of Lockdowns' Impact on Well-Being in Selected Countries: An 
Application of Novel Bayesian Methods and Google Search Queries Data.

Drachal K(1), González Cortés D(2).

Author information:
(1)Faculty of Economic Sciences, University of Warsaw, 00-241 Warszawa, Poland.
(2)NEOMA Business School, 75013 Paris, France.

Lockdowns introduced in connection with the COVID-19 pandemic have had a 
significant impact on societies from an economic, psychological, and health 
perspective. This paper presents estimations of their impact on well-being, 
understood both from the perspective of mental health and considering economic 
security and similar factors. This is not an easy task because well-being is 
influenced by numerous factors and the changes happen dynamically. Moreover, 
there are some obstacles when using the control group. However, other studies 
show that in certain cases it is possible to approximate selected phenomena with 
Google search queries data. Secondly, the econometric issues related to the 
suitable modeling of such a problem can be solved, for example, by using 
Bayesian methods. In particular, herein the recently gaining in popularity 
Bayesian structural time series and Bayesian dynamic mixture models are used. 
Indeed, these methods have not been used in social sciences extensively. 
However, in the fields where they have been used, they have been very efficient. 
Especially, they are useful when short time series are analyzed and when there 
are many variables that potentially have a significant explanatory impact on the 
response variable. Finally, 15 culturally different and geographically widely 
scattered countries are analyzed (i.e., Belgium, Brazil, Canada, Chile, 
Colombia, Denmark, France, Germany, Italy, Japan, Mexico, the Netherlands, 
Spain, Sweden, and the United Kingdom). Little evidence of any substantial 
changes in the Internet search intensity on terms connected with negative 
aspects of well-being and mental health issues is found. For example, in Mexico, 
some evidence of a decrease in well-being after lockdown was found. However, in 
Italy, there was weak evidence of an increase in well-being. Nevertheless, the 
Bayesian structural time series method has been found to fit the data most 
accurately. Indeed, it was found to be a superior method for causal analysis 
over the commonly used difference-in-differences method or Bayesian dynamic 
mixture models.

DOI: 10.3390/ijerph20010421
PMCID: PMC9819235
PMID: 36612742 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript; or in the decision to 
publish the results.


1123. Int J Environ Res Public Health. 2022 Dec 21;20(1):48. doi: 
10.3390/ijerph20010048.

Work-From-Home in the New Normal: A Phenomenological Inquiry into Employees' 
Mental Health.

Memon MA(1), Shaikh S(2), Mirza MZ(1), Obaid A(1), Muenjohn N(3), Ting H(4).

Author information:
(1)NUST Business School, National University of Sciences and Technology, 
Islamabad 44000, Pakistan.
(2)Department of Management Sciences, National University of Modern Languages 
Hyderabad Campus, Hyderabad 71000, Pakistan.
(3)School of Management, College of Business and Law, RMIT University, Melbourne 
3000, Australia.
(4)Department of Tourism and Commerce, UCSI University, Kuching 93000, Malaysia.

The COVID-19 pandemic has forced employees to adapt and adjust to the new normal 
in an unprecedented way. While some employees have been able to move to 
work-from-home (WFH) relatively easily, many find it challenging. 
Notwithstanding the magnitude of change, little is known about the determinants 
of WFH employees' mental health during COVID-19. This study therefore aims to 
explore (1) the salient factors that contribute to the mental health issues of 
WFH employees and (2) strategies to overcome WFH challenges. A qualitative 
approach using phenomenological inquiry was adopted. Forty-one employees who 
worked from home in Pakistan were sampled using the purposive and snowball 
sampling techniques. Data was collected via semi-structured interviews and 
analyzed using thematic analysis. Overall, employees believe that organizations 
offer inadequate support in both work-related and non-work-related matters. Five 
themes were elicited and coded as factors that contribute to mental health 
issues among WFH employees. Technical issues and system complexities, the 
absence of flexible working arrangements, distractions, a lack of communication, 
and inadequate social support were found to obstruct WFH and cause mental 
distress. Behavioral and cognitive coping strategies were also determined to 
tackle these mental issues. This study complements the human resource literature 
by exploring the factors that obstruct WFH and cause mental health issues in the 
context of the pandemic crisis. As mental well-being is more intricate than 
administrative arrangements, the study is useful for organizations to develop a 
feasible mechanism that facilitates the smooth execution of WFH for employees 
while ensuring their mental health is preserved. Using a phenomenological 
inquiry, the present study is one of the few to explore the factors that 
contribute to the mental health of WFH employees in the context of the pandemic 
crisis. Apart from its contribution to knowledge on human resource management 
and organizational behavior, it provides useful implications for managers, 
policymakers, and practitioners to manage WFH employees more effectively.

DOI: 10.3390/ijerph20010048
PMCID: PMC9819185
PMID: 36612370 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1124. J Nurs Scholarsh. 2023 Sep;55(5):1068-1081. doi: 10.1111/jnu.12874. Epub 2023 
Jan 6.

The role of psychological flexibility in the relationships between burnout, job 
satisfaction, and mental health among nurses in combatting COVID-19: A 
two-region survey.

Chong YY(1), Frey E(2), Chien WT(1), Cheng HY(1), Gloster AT(2).

Author information:
(1)The Nethersole School of Nursing, Faculty of Medicine, The Chinese University 
of Hong Kong, Hong Kong SAR, China.
(2)Division of Clinical Psychology and Intervention Science, Faculty of 
Psychology, University of Basel, Switzerland.

BACKGROUND: A growing body of evidence suggests that the COVID-19 pandemic is 
adversely impacting the mental health and well-being of frontline nurses 
worldwide. It is therefore important to understand how such impact can be 
mitigated, including by studying psychological capacities that could help the 
nurses regulate and minimize the impact.
AIM: To examine the role of psychological flexibility in mitigating the adverse 
impacts of burnout and low job satisfaction on mental health problems (i.e., 
anxiety, depression, and stress) and well-being among the frontline nurses in 
Hong Kong and Switzerland during the COVID-19 pandemic.
DESIGN: Cross-sectional, two-region survey study.
METHOD: Four hundred fifty-two nurses from Hong Kong (n = 158) and Switzerland 
(n = 294) completed an online survey. An adjusted structured equation model was 
used to examine the interrelationship of the constructs.
RESULTS: Psychological flexibility was found to partially mediate the effects of 
job satisfaction on mental well-being (β = 0.32, 95% CI [0.19, 0.57], p = 0.001) 
and mental health problems (β = -0.79, 95% CI [-1.57, -0.44], p = 0.001), 
respectively. Similarly, this partial mediation was found in the effects of 
burnout on mental well-being (β = -0.35, 95% CI [-0.89, -0.15], p = 0.002) and 
mental health problems (β = 0.89, 95% CI [0.48, 3.65], p = 0.001).
CONCLUSION: Psychological flexibility could be a crucial psychological 
resilience factor against the adverse impact of nurses' burnout on their mental 
health problems and well-being during COVID-19.
CLINICAL RELEVANCE: Organizational measures should focus on fostering 
psychological flexibility in nurses through highly accessible, brief 
psychotherapeutic interventions, such as Acceptance and Commitment Therapy, to 
reduce the impact on mental health.

© 2023 Sigma Theta Tau International.

DOI: 10.1111/jnu.12874
PMID: 36610054 [Indexed for MEDLINE]


1125. Int J Soc Psychiatry. 2023 Jun;69(4):1043-1050. doi: 10.1177/00207640221139798. 
Epub 2023 Jan 6.

Therapeutic work with clients living in poverty.

Ballo E(1), Tribe R(2).

Author information:
(1)EDB Consultancy, London, UK.
(2)UEL and Queen Mary, University of London, UK.

Comment in
    Int J Soc Psychiatry. 2023 Jun;69(4):1055-1056.
    Int J Soc Psychiatry. 2023 Jun;69(4):1051-1052.
    Int J Soc Psychiatry. 2023 Jun;69(4):1053-1054.

BACKGROUND: Financial inequalities appear to be increasing and poverty is 
becoming ubiquitous. Poverty affects mental health but its impact on mental 
health and wellbeing is rarely highlighted within health research.
AIMS: The Covid-19 pandemic, the Ukrainian invasion and other international and 
national events have led to a cost-of-living crisis for many people. This is 
likely to lead to an increase in related referrals and therefore active 
consideration of the relevant issues relating to poverty appears vital. This 
paper reports a study which sought to understand how therapists experienced 
their work with clients who self-refer due to living in poverty.
METHOD: Eight therapists participated in semi-structured interviews analysed 
using Interpretative Phenomenological Analysis (IPA).
RESULTS: Three superordinate themes were elicited: firstly 'Resilience in the 
struggle to engage with therapeutic work', secondly 'Struggling to promote 
social activism' and thirdly, 'Navigating multiple challenges and barriers'. 
Each superordinate theme contains two or three sub themes.
CONCLUSIONS: Issues of structural inequality (including but not limited to 
poverty) impact significantly on people's lives but are often ignored or 
minimised in therapeutic work. It is important that therapists are aware of 
poverty and take this into account when working with clients.

DOI: 10.1177/00207640221139798
PMCID: PMC10240619
PMID: 36609182 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1126. Lancet Planet Health. 2023 Jan;7(1):e23-e32. doi: 10.1016/S2542-5196(22)00303-5.

Effects of a community gardening intervention on diet, physical activity, and 
anthropometry outcomes in the USA (CAPS): an observer-blind, randomised 
controlled trial.

Litt JS(1), Alaimo K(2), Harrall KK(3), Hamman RF(4), Hébert JR(5), Hurley 
TG(5), Leiferman JA(6), Li K(7), Villalobos A(8), Coringrato E(8), Courtney 
JB(9), Payton M(10), Glueck DH(11).

Author information:
(1)Department of Environmental Studies, University of Colorado Boulder, Boulder, 
CO, USA. Electronic address: jill.litt@colorado.edu.
(2)Department of Food Science and Human Nutrition, Michigan State University, 
East Lansing, MI, USA.
(3)Department of Epidemiology, University of Colorado Anschutz Medical Campus, 
Aurora, CO, USA; Lifecourse Epidemiology of Adiposity and Diabetes Center, 
University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
(4)Department of Epidemiology, University of Colorado Anschutz Medical Campus, 
Aurora, CO, USA.
(5)Department of Epidemiology and Biostatistics, Arnold School of Public Health, 
University of South Carolina, Columbia, SC, USA.
(6)Department of Community and Behavioural Health, University of Colorado 
Anschutz Medical Campus, Aurora, CO, USA.
(7)Department of Health and Exercise Science, College of Health and Human 
Sciences, Colorado State University, Fort Collins, CO, USA.
(8)Department of Environmental Studies, University of Colorado Boulder, Boulder, 
CO, USA.
(9)Department of Exercise and Sport Science, University of North Carolina at 
Chapel Hill, Chapel Hill, NC, USA.
(10)Urban Institute, Washington, DC, USA.
(11)Colorado School of Public Health and Department of Pediatrics, University of 
Colorado Anschutz Medical Campus, Aurora, CO, USA; University of Colorado School 
of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.

BACKGROUND: Unhealthy diet, physical inactivity, and social disconnection are 
important modifiable risk factors for non-communicable and other chronic 
diseases, which might be alleviated through nature-based community 
interventions. We tested whether a community gardening intervention could reduce 
these common health risks in an adult population that is diverse in terms of 
age, ethnicity, and socioeconomic status.
METHODS: In this observer-blind, randomised, controlled trial, we recruited 
individuals who were on Denver Urban Garden waiting lists for community gardens 
in Denver and Aurora (CO, USA), aged 18 years or older, and had not gardened in 
the past 2 years. Participants were randomly assigned (1:1), using a randomised 
block design in block sizes of two, four, or six, to receive a community garden 
plot (intervention group) or remain on a waiting list and not garden (control 
group). Researchers were masked to group allocation. Primary outcomes were diet, 
physical activity, and anthropometry; secondary outcomes were perceived stress 
and anxiety. During spring (April to early June, before randomisation; timepoint 
1 [T1]), autumn (late August to October; timepoint 2 [T2]), and winter (January 
to March, after the intervention; timepoint 3 [T3]), participants completed 
three diet recalls, 7-day accelerometry, surveys, and anthropometry. Analyses 
were done using the intention-to-treat principle (ie, including all participants 
randomly assigned to groups, and assessed as randomised). We used mixed models 
to test time-by-intervention hypotheses at an α level of 0·04, with T2 and T3 
intervention effects at an α level of 0·005 (99·5% CI). Due to potential effects 
of the COVID-19 pandemic on outcomes, we excluded all participant data collected 
after Feb 1, 2020. This study is registered with ClinicalTrials.gov, 
NCT03089177, and data collection is now complete.
FINDINGS: Between Jan 1, 2017, and June 15, 2019, 493 adults were screened and 
291 completed baseline measures and were randomly assigned to the intervention 
(n=145) or control (n=146) groups. Mean age was 41·5 years (SD 13·5), 238 (82%) 
of 291 participants were female, 52 (18%) were male, 99 (34%) identified as 
Hispanic, and 191 (66%) identified as non-Hispanic. 237 (81%) completed 
measurements before the beginning of the COVID-19 pandemic. One (<1%) 
participant in the intervention group had an adverse allergic event in the 
garden. Significant time-by-intervention effects were observed for fibre intake 
(p=0·034), with mean between-group difference (intervention minus control) at T2 
of 1·41 g per day (99·5% CI -2·09 to 4·92), and for moderate-to-vigorous 
physical activity (p=0·012), with mean between-group difference of 5·80 min per 
day (99·5% CI -4·44 to 16·05). We found no significant time-by-intervention 
interactions for combined fruit and vegetable intake, Healthy Eating Index 
(measured using Healthy Eating Index-2010), sedentary time, BMI, and waist 
circumference (all p>0·04). Difference score models showed greater reductions 
between T1 and T2 in perceived stress and anxiety among participants in the 
intervention group than among those in the control group.
INTERPRETATION: Community gardening can provide a nature-based solution, 
accessible to a diverse population including new gardeners, to improve wellbeing 
and important behavioural risk factors for non-communicable and chronic 
diseases.
FUNDING: American Cancer Society, University of Colorado Cancer Centre, 
University of Colorado Boulder, National Institutes of Health, US Department of 
Agriculture National Institute of Food and Agriculture, Michigan AgBioResearch 
Hatch projects.

Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open 
Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All 
rights reserved.

DOI: 10.1016/S2542-5196(22)00303-5
PMCID: PMC9936951
PMID: 36608945 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of interests JRH owns controlling 
interest in Connecting Health Innovations (CHI), a company that has licensed the 
right to his invention of the dietary inflammatory index (DII) and for which JRH 
and the University of South Carolina have secured a federally registered 
trademark for the DII. The CHI aims to develop computer and smartphone 
applications for patient counselling and dietary intervention in clinical 
settings. CHI owns all derivative products, including the energy-adjusted DII 
(E-DII). All CHI-related activity occurred outside the submitted work, which 
includes royalties paid to CHI. JRH confirms that the subject matter of this 
manuscript did not have any direct bearing on that work, nor has that activity 
exerted any influence on this project. All other authors declare no competing 
interests.


1127. J Health Organ Manag. 2023 Jan 9;ahead-of-print(ahead-of-print). doi: 
10.1108/JHOM-07-2022-0199.

How do shared values improve eudaimonic workplace well-being: role of perceived 
justice and emotional exhaustion among nurses.

Karaca G(1), Tanova C(1), Gokmenoglu K(1).

Author information:
(1)Eastern Mediterranean University, Famagusta, Turkey.

PURPOSE: This study aims to explore how shared values improve eudaimonic 
workplace well-being, the fulfillment that comes from personal development and 
the utilization of personal capabilities. The authors investigate the serial 
mediating role that perceived overall justice and emotional exhaustion play in 
how shared values relate to well-being.
DESIGN/METHODOLOGY/APPROACH: Using data collected from three hundred nurses in 
Turkish healthcare institutions during the COVID-19 pandemic (Male = 113, 
Female = 187). The age of participants ranged from 19 to 58 and the average age 
was 34. The snowball sampling method was used to form the sample and 
self-administered surveys that could be completed online were delivered to the 
sampled nurses.
FINDINGS: The authors analysis using partial least square structural equation 
modeling (PLS-SEM) supported the expected relationship between shared values and 
eudaimonic workplace well-being as well as the mediating role of perceived 
overall justice and emotional exhaustion. The authors also show a serial 
mediation where shared values are related to justice perceptions which in turn 
negatively relate to emotional exhaustion which subsequently relates to higher 
levels of eudaimonic workplace well-being.
ORIGINALITY/VALUE: The results of this study suggest that when the shared values 
between the healthcare institution and the employees are aligned, the eudaimonic 
well-being of employees is higher. The findings provide implications for the 
mental health of frontline employees in health organizations to have higher 
levels of eudaimonic well-being which is especially important in times of 
intense pressure such as the period during the COVID-19 pandemic.

© Emerald Publishing Limited.

DOI: 10.1108/JHOM-07-2022-0199
PMID: 36606549 [Indexed for MEDLINE]


1128. Anxiety Stress Coping. 2023 Nov;36(6):674-689. doi: 
10.1080/10615806.2022.2159947. Epub 2023 Jan 5.

Trait mindfulness, self-efficacy, and coping strategies during COVID-19.

Schmiedeler S(1), Reichhardt A(2), Schneider L(2), Niklas F(3).

Author information:
(1)Begabungspsychologische Beratungsstelle, University of Wuerzburg, Wuerzburg, 
Germany.
(2)Department of Psychology IV, University of Wuerzburg, Wuerzburg, Germany.
(3)Department of Psychology, University of Munich, Munich, Germany.

BACKGROUND: The worldwide COVID-19 pandemic may have negative impacts on 
individuals' mental health. At the same time, protective factors such as 
mindfulness, i.e., a moment-to-moment awareness of own experiences without 
judgment, may have positive effects on various psychological outcomes during the 
pandemic.
OBJECTIVES: The current study analyzed the associations between trait 
mindfulness and psychological outcomes during the COVID-19 pandemic at three 
measurement points, testing self-efficacy and coping strategies as further 
potential predictors.
DESIGN & METHODS: Altogether 207 students (85% female, mostly between 18 and 25 
years old) participated in a longitudinal online survey from May to July 2020. 
At t1, t2, and t3, trait mindfulness, COVID-19-specific psychological 
well-being, depressiveness, anxiety, and stress were assessed. In addition, 
coping strategies were measured at t1 and self-efficacy at t2.
RESULTS: Psychological outcomes at t1 were associated with trait mindfulness and 
coping strategies. The change in psychological outcomes between t2 and t3 was 
predicted by trait mindfulness and self-efficacy and to some extent by 
maladaptive coping. In a cross-lagged panel design, trait mindfulness was a 
better predictor of the psychological outcomes than vice versa.
CONCLUSIONS: Our results support the value of trait mindfulness for 
psychological outcomes during the COVID-19 pandemic.

DOI: 10.1080/10615806.2022.2159947
PMID: 36603120 [Indexed for MEDLINE]


1129. BMJ Open. 2022 Dec 9;12(12):e066389. doi: 10.1136/bmjopen-2022-066389.

National survey of mental health and life satisfaction of gig workers: the role 
of loneliness and financial precarity.

Wang S(1), Li LZ(2), Coutts A(3).

Author information:
(1)Department of Sociology, National University of Singapore, Singapore.
(2)Graduate School of Business, Stanford University, Stanford, California, USA 
lizixin@stanford.edu.
(3)Department of Sociology, University of Cambridge, Cambridge, UK.

OBJECTIVES: To compare the mental health and life satisfaction of those employed 
in the gig work and contingent work with those in full-time or part-time work 
and the unemployed in the UK during the COVID-19 pandemic. To explore the 
possible mechanisms of latent and manifest benefits of employment, such as 
financial precarity and loneliness.
DESIGN: Cross-sectional survey.
PARTICIPANTS: A representative sample of 17 722 employed and unemployed British 
adults, including 429 gig workers. People with disability, retirees and 
full-time students are not included in the sample.
MAIN OUTCOME MEASURES: Mental health (General Health Questionnaire-12 score) and 
life satisfaction (a direct question from UK Household Longitudinal Study 
(UKHLS)) as outcomes. Self-reported loneliness (four widely used questions from 
UKHLS) and financial precarity (a direct question from UKHLS) as mediators.
RESULTS: Gig workers reported mental health and life satisfaction worse than 
those employed full time and part time, but better than the unemployed. 
Mediation analyses showed that gig workers' worse mental health and life 
satisfaction than other workers were explained by their higher levels of 
loneliness and financial precarity, while gig workers' better mental health and 
life satisfaction than the unemployed were explained by their less financial 
precarity.
CONCLUSIONS: Informal and freelance economy provided manifest benefits of 
employment to gig workers compared with unemployment but lacked latent benefits 
of employment. Public policies should provide social support to freelance and 
contingent workers to reduce their loneliness and improve their psychological 
well-being, especially during the COVID-19 pandemic.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2022-066389
PMCID: PMC9743407
PMID: 36600336 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


1130. Neuropsychiatr. 2023 Sep;37(3):115-121. doi: 10.1007/s40211-022-00452-x. Epub 
2023 Jan 4.

Multinational perspectives on changes to psychiatric care during the COVID-19 
pandemic: a survey of practicing psychiatrists.

Jaywant A(1)(2), Aulitzky W(3), Avari J(4), Buchheim A(5), Dubin M(4), Galffy 
M(6), Khoodoruth MAS(7), Maytal G(4), Skelin M(8), Sperner-Unterweger B(6), 
Barnhill JW(4), Fleischhacker WW(6).

Author information:
(1)Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA. 
abj2006@med.cornell.edu.
(2)Weill Cornell Medicine/NewYork-Presbyterian Hospital, 525 E 68th St, Baker 
F-1232, 10065, New York, NY, USA. abj2006@med.cornell.edu.
(3)Open Medical Institute, Salzburg, Austria.
(4)Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.
(5)University of Innsbruck, Innsbruck, Austria.
(6)Medical University of Innsbruck, Innsbruck, Austria.
(7)Child and Adolescent Mental Health Services, Hamad Medical Corporation, Doha, 
Qatar.
(8)University Psychiatric Hospital Vrapce, Zagreb, Croatia.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has resulted in 
significant upheaval in psychiatric care. Despite survey data collected from 
psychiatric patients and broad samples of individuals in single countries, there 
is little quantitative or qualitative data on changes to psychiatric care from 
the perspective of mental health providers themselves across developing 
countries.
METHODS: To address this gap, we surveyed 27 practicing psychiatrists from 
Central and Eastern Europe, as well as Africa, the Middle East, and Latin 
America.
RESULTS: Respondents observed a marked increase in anxiety in their patients, 
with increased (though less prominent) symptoms of depression, somatization, and 
addiction. They reported largescale changes in the structure of psychiatric 
treatment, chiefly a decline in psychiatric admissions and closing/repurposing 
of psychiatric beds. Results supported strong "buy in" from clinicians regarding 
the use of telehealth, though some clinicians perceived a reduction in the 
ability to connect with, and build alliances with, their patients. Finally, 
clinicians described an improvement in the image and meaning of psychiatry in 
society, increased awareness of mental illness, and greater value placed on 
mental health in the general population.
CONCLUSIONS: These changes warrant further empirical study as to their potential 
long-term ramifications, particularly as the COVID-19 pandemic persists and new 
waves of infection occur periodically throughout the world. The increased 
psychiatric burden on the population coupled with the apparent salience of 
mental health and well-being in the public consciousness represents a global 
opportunity for psychiatry to advocate for further treatment, research, and 
education.

Publisher: ZUSAMMENFASSUNG: GRUNDLAGEN: Die COVID-19-Pandemie hat zu erheblichen 
Umwälzungen in der psychiatrischen Versorgung geführt. Trotz Umfragedaten, die 
bei Psychiatriepatienten und breiten Stichproben von Individuen in einzelnen 
Ländern erhoben wurden, gibt es nur wenige quantitative oder qualitative Daten 
über Veränderungen in der psychiatrischen Versorgung aus der Perspektive der 
Anbieter psychischer Gesundheitsleistungen in Entwicklungsländern.
METHODIK: Um diese Lücke zu schließen, befragten wir 27 praktizierende 
Psychiater aus Mittel- und Osteuropa sowie aus Afrika, dem Nahen Osten und 
Lateinamerika.
ERGEBNISSE: Die Befragten beobachteten bei ihren Patienten eine deutliche 
Zunahme von Angstzuständen und einen Anstieg (wenn auch weniger ausgeprägter) 
Symptome von Depressionen, Somatisierung und Suchtverhalten. Sie berichteten von 
weitreichenden Veränderungen in der Struktur der psychiatrischen Behandlung, vor 
allem von einem Rückgang der psychiatrischen Einweisungen und der 
Abschaffung/Neunutzung von psychiatrischen Betten. Die Ergebnisse belegen, dass 
die Kliniker den Einsatz von Telemedizin sehr befürworten, auch wenn einige von 
ihnen den Patientenkontakt und die Patientenbindung als beeinträchtigt 
empfanden. Schließlich beschrieben die Kliniker eine Verbesserung des Images und 
der Bedeutung der Psychiatrie in der Gesellschaft, ein größeres Bewusstsein für 
psychische Erkrankungen und einen höheren Stellenwert der psychischen Gesundheit 
in der Allgemeinbevölkerung.
SCHLUSSFOLGERUNGEN: Diese Veränderungen bedürfen weiterer empirischer 
Untersuchungen im Hinblick auf ihre potenziellen langfristigen Auswirkungen, 
insbesondere da die COVID-19-Pandemie anhält und weltweit regelmäßig neue 
Infektionswellen auftreten. Die zunehmende psychiatrische Belastung der 
Bevölkerung in Verbindung mit der offensichtlichen Bedeutung der psychischen 
Gesundheit und des Wohlbefindens im öffentlichen Bewusstsein stellt eine globale 
Chance für die Psychiatrie dar, sich für weitere Therapien, Forschung und 
Aufklärung einzusetzen.

© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, 
ein Teil von Springer Nature.

DOI: 10.1007/s40211-022-00452-x
PMCID: PMC9812354
PMID: 36600105 [Indexed for MEDLINE]

Conflict of interest statement: A. Jaywant, W. Aulitzky, J. Avari, A. Buchheim, 
M. Dubin, M. Galffy, M.A.S. Khoodoruth, G. Maytal, M. Skelin, 
B. Sperner-Unterweger, J.W. Barnhill and W.W. Fleischhacker declare that they 
have no competing interests.


1131. Arch Dis Child. 2023 Apr;108(4):289-295. doi: 10.1136/archdischild-2022-324656. 
Epub 2023 Jan 4.

Post-COVID-19 condition at 6 months and COVID-19 vaccination in non-hospitalised 
children and young people.

Pinto Pereira SM(1), Nugawela MD(2), Rojas NK(2), Shafran R(2), McOwat K(3), 
Simmons R(3), Ford T(4), Heyman I(2), Ladhani SN(3)(5), Cheung EY(2), Fox-Smith 
L(2), Dalrymple E(2), Stephenson T(2).

Author information:
(1)UCL Great Ormond Street Institute of Child Health, London, UK 
snehal.pereira@ucl.ac.uk.
(2)UCL Great Ormond Street Institute of Child Health, London, UK.
(3)Immunisation Department, Public Health England, London, UK.
(4)Department of Psychiatry, University of Cambridge, Cambridge, UK.
(5)Paediatric Infectious Diseases Research Group, St George's University, 
London, UK.

OBJECTIVES: To describe the physical and mental health of children and young 
people (CYP) 6 months after infection with SARS-CoV-2 and explore whether this 
varies by COVID-19 vaccination.
DESIGN: A non-hospitalised, national cohort of people aged 11-17 years old with 
PCR-confirmed SARS-CoV-2 infection and PCR negatives matched at study 
invitation, by age, sex, region and date of testing who completed questionnaires 
6 months after PCR testing. The questionnaire included 21 symptoms and 
standardised scales (eg, EQ-5D-Y and Chalder Fatigue Scale).
RESULTS: 6407 test-positive and 6542 test-negative CYP completed the 6-month 
questionnaire: 60.9% of test-positive vs 43.2% of test-negative CYP reported at 
least one symptom 6 months post-test; 27.6% of test-positive vs 15.9% of 
test-negative CYP reported 3+ symptoms. Common symptoms at 6 months were 
tiredness and shortness of breath among both test-positive and test-negative 
CYP; however, the prevalence of both was higher in test-positive (38.4% and 
22.8%, respectively) compared with test-negative CYP (26.7% and 10.9%, 
respectively). 24.5% test-positive vs 17.8% test-negative CYP met the Delphi 
research definition of long COVID. Mental health, well-being, fatigue and 
health-related quality of life scores were similar among test-positive and 
test-negative CYP 6 months post-test. Similarly, symptomatology was similar 
among COVID-19-vaccinated and COVID-19-unvaccinated test-positive and 
test-negative CYP.
CONCLUSIONS: Six-months post-PCR testing, CYP who tested positive for SARS-CoV-2 
had similar symptoms to those who tested negative, but test-positive CYP had 
higher symptom prevalence. Mental health, well-being, fatigue and health-related 
quality of life were similar among test-positive and test-negative CYP, and 
symptoms at 6 months were similar in COVID-19 vaccinated and unvaccinated.
TRIAL REGISTRATION NUMBER: ISRCTN 34804192.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/archdischild-2022-324656
PMCID: PMC10086284
PMID: 36599625 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: TS is Chair of the Health 
Research Authority and therefore recused himself from the Research Ethics 
Application. Trudie Chalder is a member of the National Institute for Health and 
Care Excellence committee for long COVID. She has written self-help books on 
chronic fatigue and has done workshops on chronic fatigue and post-infectious 
syndromes.


1132. Eur J Pediatr. 2023 Mar;182(3):1137-1142. doi: 10.1007/s00431-022-04773-5. Epub 
2023 Jan 4.

Adverse effect of lockdowns during the COVID-19 pandemic: increased incidence of 
pediatric crisis admissions due to eating disorders and adolescent 
intoxications.

Kersten JM(1), van Veen M(1), van Houten MA(2), Wieringa J(3), Noordzij JG(4), 
Bekhof J(5), Tramper-Stranders GA(6), Visser-Trip H(7), Vet NJ(8), Kruizinga 
MD(9).

Author information:
(1)Juliana Children's Hospital (Haga Teaching Hospital), Els Borst-Eilersplein 
275, 2545 AA, The Hague, The Netherlands.
(2)Department of Pediatrics, Spaarne Gasthuis, Hoofddorp/Haarlem, The 
Netherlands.
(3)Department of Pediatrics, Haaglanden Medical Centre, The Hague, The 
Netherlands.
(4)Department of Pediatrics, Reinier de Graaf Ziekenhuis, Delft, The 
Netherlands.
(5)Department of Pediatrics, Isala, Zwolle, the Netherlands.
(6)Department of Pediatrics, Franciscus Gasthuis & Vlietland, Rotterdam, The 
Netherlands.
(7)Department of Pediatrics, Groene Hart Ziekenhuis, Gouda, The Netherlands.
(8)Department of Pediatrics, St Antonius Ziekenhuis, Nieuwegein, The 
Netherlands.
(9)Juliana Children's Hospital (Haga Teaching Hospital), Els Borst-Eilersplein 
275, 2545 AA, The Hague, The Netherlands. m.kruizinga@hagaziekenhuis.nl.

During the COVID-19 pandemic, countries imposed (partial) lockdowns that reduced 
viral transmission. However, these interventions may have unfavorable effects on 
emotional and psychological well-being. The aim of this study was to quantify 
possible adverse effects of the COVID-19 pandemic on psychological wellbeing in 
children and adolescents. Hospital admission data between January 2017 and 
September 2021 from eight general hospitals in the Netherlands was collected, 
comparing the incidences of sub-categorized psychological diagnoses, more 
specifically eating disorders, intentional intoxications, accidental 
intoxications, and excessive crying, before (2017-2019) and during the pandemic 
(2020-2021). Data was summarized per month and per year, and the years 2020 and 
2021 were compared to 2017-2019. The relative increase or decrease in diagnoses 
since the start of the pandemic was calculated. Overall pediatric hospital 
admissions decreased with 28% since the start of the pandemic. Non-infectious 
diagnoses showed a decrease of 8%. Of these non-infectious diagnoses, overall 
psychosocial admissions were increased (+ 9%), mostly caused by an increase in 
admissions for eating disorders (+ 64%) and intoxications in adolescents 
(+ 24%). In addition, the proportion of admissions due to psychosocial diagnoses 
increased post-pandemic (6% vs 4%, p < 0.001). Overall admissions for 
intoxications in children (- 3%) and excessive crying (- 1%) did not increase, 
although peaks in incidence were found at the start of the second lockdown.
CONCLUSION: During the COVID-19 pandemic, admission rates for eating disorders 
and intentional intoxications showed a substantial increase, indicating a high 
burden of pediatric psychiatric diseases.
WHAT IS KNOWN: • The COVID-19 pandemic has had an impact on psychosocial 
wellbeing in children and adolescents.
WHAT IS NEW: • There was an increase in admissions due to psychosocial problems 
in the Netherlands in the period after the pandemic. • This was mainly caused by 
an increase in crisis admissions due to eating disorders and intoxications in 
adolescents.

© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, 
part of Springer Nature.

DOI: 10.1007/s00431-022-04773-5
PMCID: PMC9811038
PMID: 36598566 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1133. J Health Psychol. 2023 Aug;28(9):818-831. doi: 10.1177/13591053221140255. Epub 
2023 Jan 4.

'You get looked at like you're failing': A reflexive thematic analysis of 
experiences of mental health and wellbeing support for NHS staff.

Clarkson C(1), Scott HR(2), Hegarty S(2), Souliou E(2), Bhundia R(2), 
Gnanapragasam S(3), Docherty MJ(3), Raine R(1), Stevelink SA(2), Greenberg N(2), 
Hotopf M(2), Wessely S(2), Madan I(2), Rafferty AM(2), Lamb D(1).

Author information:
(1)University College London, UK.
(2)King's College London, UK.
(3)South London and Maudsley NHS Foundation Trust, UK.

Staff in the National Health Service (NHS) are under considerable strain, 
exacerbated by the COVID-19 pandemic; whilst NHS Trusts provide a variety of 
health and wellbeing support services, there has been little research 
investigating staff perceptions of these services. We interviewed 48 healthcare 
workers from 18 NHS Trusts in England about their experiences of workplace 
health and wellbeing support during the pandemic. Reflexive thematic analysis 
identified that perceived stigma around help-seeking, and staffing shortages due 
to wider socio-political contexts such as austerity, were barriers to using 
support services. Visible, caring leadership at all levels (CEO to line 
managers), peer support, easily accessible services, and clear communication 
about support offers were enablers. Our evidence suggests Trusts should have 
active strategies to improve help-seeking, such as manager training and peer 
support facilitated by building in time for this during working hours, but this 
will require long-term strategic planning to address workforce shortages.

DOI: 10.1177/13591053221140255
PMCID: PMC10387714
PMID: 36597919 [Indexed for MEDLINE]

Conflict of interest statement: The authors declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1134. Medicine (Baltimore). 2022 Dec 30;101(52):e32302. doi: 
10.1097/MD.0000000000032302.

Is it time to rethink education and training? Learning how to perform under 
pressure: An observational study.

Hinzmann D(1)(2), Haneveld J(3), Heininger SK(2), Spitznagel N(4).

Author information:
(1)Department of Anesthesiology and Intensive Care, University Hospital Klinikum 
Rechts Der Isar, Technical University of Munich (TUM), Munich, Germany.
(2)Association for Psychosocial Competence and Support in Acute Care - PSU-Akut, 
Munich, Germany.
(3)Psychotherapeutic Outpatient Clinic, Catholic University of 
Eichstätt-Ingolstadt (KU), Ingolstadt, Germany.
(4)Department of Anesthesiology and Intensive Care, Munich Municipal Hospital 
Group Klinik Harlaching, Munich, Germany.

Emergency medicine workers are exposed daily to various stressors, especially 
work-related stress, which have been aggravated by the current SARS-CoV 2 
pandemic and impact their physical and mental wellbeing. Nonetheless, although 
the efficacy of programs and strategies to improving the health of medical staff 
and patient care has been demonstrated, such programs and strategies are scarce. 
To assess the prevalence, types and consequences of stress in emergency medical 
workers in healthcare institutions and explore tools to cope with stressful 
situations at workplace. Two surveys were conducted. Survey 1 assessed the 
subjective stress levels and stressors of 21 emergency medicine professionals. 
Survey 2 was conducted amongst 103 healthcare workers at 3 hospitals in Germany. 
It comprised selected aspects of the German Mental Risk Assessment and a 
validated workload scale. None. The answer frequencies on Likert scales were 
descriptively evaluated. Survey 1: Emergency medical professionals experienced 
and reported the following high stress levels in acute situations: multitasking 
during a complex situation; factors associated with the work environment; fear 
of not appropriately controlling the situation; and lack of sleep. Survey 2: The 
highest stress levels were experienced in the areas "work environment" and "work 
organization." The highest scores on the workload scale were obtained for 
statements on work division, exhaustion, insufficient patient care due to time 
constraints, regulations, and lack of information. Approximately 80% of 
healthcare workers had experienced emotionally stressful situations at the 
workplace, and > 30% had lost a colleague to suicide. There are effective and 
proven methods to learn how to deal with stress that can easily be established 
in everyday clinical practice. Healthcare workers are subjected to numerous 
stressors in their work environment and observe the consequences of these 
stressors on their own and their colleagues' wellbeing. Coping strategies for 
high-pressure reduces and resists the job- immanent pressure and stress in 
healthcare workers.

Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

DOI: 10.1097/MD.0000000000032302
PMCID: PMC9803486
PMID: 36596063 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
disclose.


1135. Medicine (Baltimore). 2022 Dec 23;101(51):e32515. doi: 
10.1097/MD.0000000000032515.

Anxiety and depression among pregnant women undergoing IVF-ET and WeChat group 
peer support during the COVID-19 pandemic: Study protocol for a randomized 
controlled trial.

Cao JX(1), Jiang WJ(1), Yan MH(2), Wang DD(1), Hou JW(1), Song JY(1)(3), Sun 
ZG(1)(3).

Author information:
(1)The First Clinical College, Shandong University of Traditional Chinese 
Medicine, Jinan, China.
(2)College of Traditional Chinese Medicine, Shandong University of Traditional 
Chinese Medicine, Jinan, China.
(3)Reproductive Center of Integrated Medicine, The Affiliated Hospital of 
Shandong University of Traditional Chinese Medicine, Jinan, China.

INTRODUCTION: The psychological well-being of pregnant women following assisted 
reproductive has increasingly gained attention in recent years. Anxiety and 
depression may be associated to pregnancy outcomes. This study aims to determine 
whether peer support and the WeChat group platform will reduce anxiety and 
depression among in vitro fertilization and embryo transfer (IVF-ET) women.
METHODS AND ANALYSIS: In the present randomized controlled study, 296 patients 
with confirmed clinical pregnancy following IVF-ET will be randomly assigned to 
receive standard intervention support or WeChat peer support on a 1:1 basis. The 
levels of anxiety and depression are the primary endpoints. Assessments will be 
performed at baseline measurements, first trimester, second trimester, and third 
trimester, and data will be collected.
ETHICS AND DISSEMINATION: This study has been approved as ethical by the 
affiliated hospital of Shandong University of Traditional Chinese Medicine's 
Reproductive Ethics Committee. Each patient will sign a written statement of 
informed permission. All information and biological samples will be legally 
protected. A peer-reviewed academic journal will publish the findings of this 
investigation.
DISCUSSION: Given the inconvenience of visits due to the current pandemic of 
COVID-19, this study addresses the patient's visit needs by combining WeChat, 
the most widely used social software in China, with peer support, while helping 
improve maternal anxiety, depression, and pregnancy outcomes following IVF-ET.

Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

DOI: 10.1097/MD.0000000000032515
PMCID: PMC9794246
PMID: 36595832 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
disclose.


1136. Medicine (Baltimore). 2022 Dec 23;101(51):e31890. doi: 
10.1097/MD.0000000000031890.

Athletic disruptions caused by the COVID-19 pandemic negatively affect high 
school student-athletes social-emotional well-being.

Collins DP(1), Jagim AR(1), Sowders JP(2), Blessman JD(1), McLachlan ML(1), 
Miller NE(1), Garrison EG(3), Kuisle M(3), Asplund CA(1)(4), Garrison GM(1).

Author information:
(1)Department of Family Medicine, Mayo Clinic, Rochester, MN.
(2)Department of Behavioral Health, Mayo Clinic, Rochester, MN.
(3)Rochester Public Schools, Rochester, MN.
(4)Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.

To examine whether high school student-athletes who experienced more COVID-19 
disruptions had increased anxiety, increased dejection, increased anger, 
decreased excitement, and decreased happiness as measured by the validated 
Sports Emotion Questionnaire (SEQ). During the COVID-19 pandemic high school 
student-athletes faced disruptions which resulted in cancelation of 
competitions, reduced in-person training sessions, and quarantine of athletes. 
The impact of these disruptions on the mental health and well-being of 
student-athletes is unknown. An anonymous cross-sectional online survey was 
electronically distributed to high school student-athletes in one school 
district during the spring of the 2020 to 21 academic year. Basic demographic 
questions, sport information, and personal and team disruptions were collected. 
Multivariate linear regression was used to assess correlation between each 
emotional domain on the SEQ with independent variables such as personal or 
teammate quarantines, cancelations, season, sport gender, indoor or outdoor 
location, and level of competition. 125 surveys were returned representing 28 
different sports. Student-athletes who were personally quarantined (22.4%) 
during their athletic season experienced greater dejection (β = 0.78, P = .003) 
and greater anger (β = 0.78, P = .005). Those with teammates quarantined (61.6%) 
experienced more anxiety (β = 0.30, P = .048). Spring sports, which faced fewer 
restrictions, were associated with less anger (β = -0.48, P = .048). 
Student-athletes who were directly affected by COVID-19 disruptions experienced 
increased anxiety, more dejection, and more anger. Public health authorities and 
school districts should minimize disruptions to athletic participation using 
established COVID-19 safety protocols to avoid causing harm to athletes' 
social-emotional well-being. If athletics must be disrupted, student-athletes 
should receive wellness support and virtual or remote training options.

Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

DOI: 10.1097/MD.0000000000031890
PMCID: PMC9794343
PMID: 36595767 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
disclose.


1137. Medicine (Baltimore). 2022 Dec 23;101(51):e32336. doi: 
10.1097/MD.0000000000032336.

Anxiety, depression and post-traumatic stress disorder and related factors among 
Chinese population during the COVID-19 pandemic: A cross-sectional study.

Liu Y(1), Liu YF(1), Liu KX(2), Xie YJ(3), Li WG(4), Kong Y(5), Zhu HH(6), Zhu 
JM(1), Mi BB(7), Yang JQ(1), Huang Z(1), Du JW(8), He HG(9), Shen Q(1).

Author information:
(1)Department of Nursing, School of Medicine, Xiamen University, Xiamen, China.
(2)Department of Nursing, School of Medicine, Zhejiang University, Hangzhou, 
China.
(3)FG424, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, 
China.
(4)Discipline of Hepatobiliary Surgery, Department of Clinical Medicine, School 
of Medicine, Xiamen University, Xiamen, China.
(5)900th Hospital of Joint Service Support Force of Chinese People's Liberation 
Army, Fuzhou, China.
(6)Department of Nursing, The First Affiliated Hospital of Xiamen University, 
Xiamen, China.
(7)Department of Epidemiology and Biostatistics, School of Public Health and 
Global Health Institute, Xi'an Jiaotong University Health Science Center, Xi'an, 
China.
(8)Nursing Department, The University of Hong Kong - Shenzhen Hospital, 
Shenzhen, China.
(9)Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, 
National University of Singapore, Singapore; National University Health System, 
Singapore.

The sudden outbreak of coronavirus disease 2019 (COVID-19) has deep and wide 
negative mental impacts on the public, and studies on the impact of COVID-19 on 
social and mental well-being are necessary. This study aimed to evaluate mental 
distress, including anxiety, depression, and post-traumatic stress disorder 
(PTSD), and its related risk factors in Chinese adults in the early stages of 
the COVID-19 pandemic. This study used a large-scale cross-sectional design. A 
total of 2067 adult participants completed the online survey via REDcap from 1st 
to 15th of March 2020 during the COVID-19 outbreak in China. Anxiety, 
depression, PTSD, and related risk factors, including self-efficacy, coping 
style, and social support, were measured using valid and reliable instruments. 
The data were analyzed using multiple linear regression. We found that 201 
(9.7%) participants reported moderate-to-severe anxiety, 669 (33.8%) reported 
depression, and 368 (17.8%) reported symptoms of PTSD. Self-efficacy, coping 
style, and social support significantly affected anxiety, depression, and PTSD 
symptoms. Participants' sociodemographic characteristics, COVID-19 
pandemic-related factors, low self-efficacy, low social support, and negative 
coping were predictors of mental distress during the COVID-19 pandemic. Our 
study will help healthcare professionals carry out early predictions and 
identification of high-risk groups and provide appropriate interventions to 
target groups during public health emergencies that plague the world.

Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

DOI: 10.1097/MD.0000000000032336
PMCID: PMC9794280
PMID: 36595752 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
disclose.


1138. J Relig Health. 2023 Feb;62(1):510-543. doi: 10.1007/s10943-022-01703-5. Epub 
2023 Jan 2.

Turning to Religion During COVID-19 (Part I): A Systematic Review, Meta-analysis 
and Meta-regression of Studies on the Relationship Between Religious Coping and 
Mental Health Throughout COVID-19.

Pankowski D(1)(2), Wytrychiewicz-Pankowska K(3).

Author information:
(1)Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, 
Poland. d.pankowski87@gmail.com.
(2)University of Economics and Human Sciences in Warsaw, Warsaw, Poland. 
d.pankowski87@gmail.com.
(3)Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, 
Poland.

The COVID-19 pandemic and the many associated socio-economic changes constitute 
a stressful event that required adaptation to new, dynamic, and often 
threatening conditions. According to the literature, coping strategies are one 
of the factors that determine a person's degree of adaptation to stressful 
situations. A systematic review and meta-analysis was performed on the 
relationship between religious coping and selected indicators of mental health. 
Due to the large amount of data, this work has been divided into two parts: 
this first part discusses positive mental health indicators, while the second 
discusses negative mental health indicators (Pankowski & 
Wytrychiewicz-Pankowska, 2023). A systematic review of PubMed, Science Direct, 
the Cochrane Library, Google Scholar, the Database of Abstracts of Reviews of 
Effects, and Google Scholar databases was carried out. In addition to the 
synthesis of information obtained from the research, a meta-analysis of 
correlation was also performed to determine the strengths of the relationships 
between the analysed variables, and selected moderators were assessed using 
meta-regression. Quality of life, well-being, satisfaction with life, happiness, 
and post-traumatic growth were the positive mental health indicators considered. 
Meta-analyses indicated a statistically significant relationship between 
positive religious coping and flourishing (well-being) with overall correlation 
values of 0.35 [0.30; 0.40]. Further calculations also indicated a relationship 
between negative religious coping and flourishing - 0.25 [- 0.34; - 0.15]. Data 
synthesis shows associations between religious coping and such indicators as 
satisfaction with life and post-traumatic growth, but these issues require 
further investigation.

© 2022. The Author(s).

DOI: 10.1007/s10943-022-01703-5
PMCID: PMC9807105
PMID: 36592322 [Indexed for MEDLINE]

Conflict of interest statement: The authors have not disclosed any competing 
interests.


1139. Turk Psikiyatri Derg. 2022 Winter;33(4):293-294. doi: 10.5080/u27236.

A COLLABORATIVE, INTEGRATIVE MENTAL HEALTH APPROACH: "THE STEPPED CARE MODEL.

[Article in English, Turkish]

Hallaç S, Kaya B.

Dear Editor, In this paper, it is aimed to raise awareness about the stepped 
care model as an approach in the organization of mental health services related 
to the protection, development, care and treatment of mental health. Concerning 
mental health, World Health Organization emphasizes that "Mental Health is more 
than mental disorders. It is a state of well-being that includes using one's own 
abilities, self-realization, coping with the stresses in the natural flow of 
life, learning to be well and trying to heal, working efficiently and 
contributing to the society in which they live." (World Health Organization 
2022a). It has been reported that the disease burden of common mental disorders 
(depression, anxiety, post-traumatic stress disorder, psychoactive substance use 
disorders, suicide, etc.) is gradually increasing (World Health Organization 
2021). Especially in the last century, the importance and seriousness of endemic 
and pandemic events (HIV, SARS virus, and still continuing Covid-19, etc.) or 
non-communicable diseases (cancer, heart diseases, diabetes, etc.), climate 
changes, economic, socio-political dynamics and wars are noteworthy as a 
predisposition and/or precipitating factors in terms of mental health (World 
Health Organization 2022a, World Health Organization 2022b). Protection and 
improvement of mental health, together with individual, social, and structural 
mental health determinants, predict interventions that reduce risks, increase 
resilience, and create a supportive environment for mental health. These 
interventions are recommended to be designed individually, in a way to be 
disseminated to special groups across the community. Globally, one person dies 
by suicide every 40 seconds, and more than 18 million health workers are needed 
in terms of human resources.

DOI: 10.5080/u27236
PMID: 36592109 [Indexed for MEDLINE]


1140. Work. 2023;75(1):41-58. doi: 10.3233/WOR-220437.

Employment and accommodation needs and the effect of COVID-19 on men and women 
with traumatic brain injury.

Hanafy S(1)(2), Colantonio A(1)(2)(3)(4), Mollayeva T(1)(2)(3)(4), Munce 
S(1)(2)(4)(5), Lindsay S(1)(6)(4).

Author information:
(1)Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, 
Canada.
(2)KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, 
ON, Canada.
(3)Dalla Lana School of Public Health, University of Toronto, Toronto, ON, 
Canada.
(4)Department of Occupational Science and Occupational Therapy, University of 
Toronto, Toronto, ON, Canada.
(5)Institute of Health Policy, Management and Evaluation, University of Toronto, 
Toronto, ON, Canada.
(6)Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 
Toronto, ON, Canada.

BACKGROUND: Traumatic brain injury (TBI) impacts an individual's workforce 
involvement post-injury. Support services and workplace accommodations that can 
help with work re-integration post-TBI may differ based on a person's sex and 
gender. The added impact of COVID-19 remains under-explored.
OBJECTIVE: We aimed to investigate the support services and workplace 
accommodation needs and the impact of COVID-19 on work and mental health for 
persons with TBI, considering sex and gender.
METHODS: A cross-sectional online survey was distributed. Descriptive and 
regression analyses were applied to uncover sex and gender differences, along 
with content analysis for open-ended responses.
RESULTS: Thirty-two persons with TBI (62% women, 38% men) participated. 
Physiotherapy, occupational therapy, and counselling services were indicated as 
the most needed services by women and men. Modified hours/days and 
modified/different duties were the most needed workplace accommodations. Mental 
challenges impacting well-being was a highlighted concern for both men and 
women. Women scored poorer on the daily activity domain of the Quality of Life 
after Brain Injury - Overall Scale (p = 0.02). Assistance with daily activities 
was highlighted by women for a successful transition to work, including 
housekeeping and caregiving. Men were more likely than women to experience 
change in employment status because of COVID-19 (p = 0.02). Further, a higher 
percentage of men expressed concern about the inability to pay for living 
accommodations, losing their job, and not having future job prospects.
CONCLUSION: Findings reveal important differences between men and women when 
transitioning to work post-TBI and emphasize the need for sex and gender 
considerations.

DOI: 10.3233/WOR-220437
PMID: 36591690 [Indexed for MEDLINE]


1141. Front Public Health. 2022 Dec 14;10:1106216. doi: 10.3389/fpubh.2022.1106216. 
eCollection 2022.

Editorial: The impact of social isolation and loneliness on mental health and 
wellbeing.

Kadotani H(1), Okajima I(2), Yang K(3), Lim MH(4)(5).

Author information:
(1)Department of Psychiatry, Shiga University of Medical Science, Otsu, Japan.
(2)Behavioral Sleep Medicine and Sciences Laboratory, Department of 
Psychological Counseling, Faculty of Humanities, Tokyo Kasei University, Tokyo, 
Japan.
(3)Department of Sociology, Durham University, Durham, United Kingdom.
(4)Iverson Health Innovation Research Institute, Swinburne University of 
Technology, Hawthorn, VIC, Australia.
(5)Prevention Research Collaboration, Faculty of Medicine and Health, Sydney 
School of Public Health, University of Sydney, Sydney, NSW, Australia.

Comment on
    Editorial on the Research Topic The impact of social isolation and 
loneliness on mental health and wellbeing.

DOI: 10.3389/fpubh.2022.1106216
PMCID: PMC9795575
PMID: 36589932 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1142. Int J Health Policy Manag. 2023;12:8021. doi: 10.34172/ijhpm.2023.8021. Epub 
2023 Oct 10.

How the Stringency of the COVID-19 Restrictions Influences Motivation for 
Adherence and Well-Being: The Critical Role of Proportionality.

Waterschoot J(1), Morbée S(1), Van den Bergh O(2), Yzerbyt V(3), Raemdonck E(4), 
Brisbois M(3), Schmitz M(3), Klein O(4), Luminet O(3)(5), Oost PV(3), 
Vansteenkiste M(1).

Author information:
(1)Department of Developmental, Personality and Social Psychology, Ghent 
University, Ghent, Belgium.
(2)Health Psychology, Faculty of Psychology and Educational Sciences, University 
of Leuven, Leuven, Belgium.
(3)Institute for Research in the Psychological Sciences, Université Catholique 
de Louvain, Louvain-la-Neuve, Belgium.
(4)Faculty of Psychological Sciences and Education, Université libre de 
Bruxelles, Bruxelles, Belgium.
(5)Fund for Scientific Research (FRS-FNRS), Brussels, Belgium.

BACKGROUND: The stringency of the measures taken by governments to combat the 
COVID-19 pandemic varied considerably across countries and time. In the present 
study, we examined how the proportionality to the epidemiological situation is 
related to citizens'behavior, motivation and mental health.
METHODS: Across 421 days between March 2020 and March 2022, 273,722 Belgian 
participants (Mage = 49.47; 63.9% female; 33% single) completed an online 
questionnaire. Multiple linear mixed regression modeling was used to examine the 
interaction between the epidemiological situation, as indicated by the actual 
hospitalization numbers, and the stringency index to predict day-to-day 
variation in the variables of interest.
RESULTS: Systematic evidence emerged showing that disproportional situations, as 
opposed to proportional situations, were associated with a clear pattern of 
maladaptive outcomes. Specifically, when either strict or lenient measures were 
disproportional in relation to the epidemiological situation, people reported 
lower autonomous motivation, more controlled motivation and amotivation, less 
adherence to sanitary rules, higher perceived risk of infection, lower need 
satisfaction, and higher anxiety and depressive symptoms. Perceived risk 
severity especially covaried with the stringency of the measures. At the 
absolute level, citizens reported the highest need satisfaction and mental 
health during days with proportional lenient measures.
CONCLUSION: Stringent measures are not per se demotivating or compromising of 
people's well-being, nor are lenient measures as such motivating or enhancing 
well-being. Only proportional measures, that is, measures with a level of 
stringency that is aligned with the actual epidemiological situation, are 
associated with the greatest motivational, behavioral, and mental health 
benefits.

© 2023 The Author(s); Published by Kerman University of Medical Sciences This is 
an open-access article distributed under the terms of the Creative Commons 
Attribution License (http://creativecommons.org/licenses/by/4.0), which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original work is properly cited.

DOI: 10.34172/ijhpm.2023.8021
PMCID: PMC10699813
PMID: 38618783 [Indexed for MEDLINE]

Conflict of interest statement: Authors declare that they have no competing 
interests.


1143. Nutr Metab Cardiovasc Dis. 2023 Feb;33(2):388-398. doi: 
10.1016/j.numecd.2022.11.017. Epub 2022 Nov 17.

Associations of disordered eating with the intestinal microbiota and short-chain 
fatty acids among young adults with type 1 diabetes.

Igudesman D(1), Crandell J(2), Corbin KD(3), Zaharieva DP(4), Addala A(4), 
Thomas JM(5), Bulik CM(6), Pence BW(7), Pratley RE(3), Kosorok MR(2), Maahs 
DM(4), Carroll IM(5), Mayer-Davis EJ(8).

Author information:
(1)Department of Nutrition, Gillings School of Global Public Health, University 
of North Carolina at Chapel Hill, Chapel Hill, 27599, USA; AdventHealth 
Translational Research Institute, Orlando, 32804, USA. Electronic address: 
daria.igudesman@adventhealth.com.
(2)Department of Biostatistics, Gillings School of Global Public Health, 
University of North Carolina at Chapel Hill, Chapel Hill, 27599, USA.
(3)AdventHealth Translational Research Institute, Orlando, 32804, USA.
(4)Department of Pediatrics, Division of Endocrinology, Stanford University, 
Stanford, 94304, USA.
(5)Department of Nutrition, Gillings School of Global Public Health, University 
of North Carolina at Chapel Hill, Chapel Hill, 27599, USA.
(6)Department of Nutrition, Gillings School of Global Public Health, University 
of North Carolina at Chapel Hill, Chapel Hill, 27599, USA; Department of 
Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, USA; 
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 
Stockholm, Sweden.
(7)Department of Epidemiology, Gillings School of Global Public Health, 
University of North Carolina at Chapel Hill, Chapel Hill, 27599, USA.
(8)Department of Nutrition, Gillings School of Global Public Health, University 
of North Carolina at Chapel Hill, Chapel Hill, 27599, USA; Department of 
Medicine, University of North Carolina at Chapel Hill, Chapel Hill, 27599, USA.

BACKGROUND AND AIMS: Disordered eating (DE) in type 1 diabetes (T1D) includes 
insulin restriction for weight loss with serious complications. Gut 
microbiota-derived short chain fatty acids (SCFA) may benefit host metabolism 
but are reduced in T1D. We evaluated the hypothesis that DE and insulin 
restriction were associated with reduced SCFA-producing gut microbes, SCFA, and 
intestinal microbial diversity in adults with T1D.
METHODS AND RESULTS: We collected stool samples at four timepoints in a 
hypothesis-generating gut microbiome pilot study ancillary to a weight 
management pilot in young adults with T1D. 16S ribosomal RNA gene sequencing 
measured the normalized abundance of SCFA-producing intestinal microbes. 
Gas-chromatography mass-spectrometry measured SCFA (total, acetate, butyrate, 
and propionate). The Diabetes Eating Problem Survey-Revised (DEPS-R) assessed DE 
and insulin restriction. Covariate-adjusted and Bonferroni-corrected generalized 
estimating equations modeled the associations. COVID-19 interrupted data 
collection, so models were repeated restricted to pre-COVID-19 data. Data were 
available for 45 participants at 109 visits, which included 42 participants at 
65 visits pre-COVID-19. Participants reported restricting insulin "At least 
sometimes" at 53.3% of visits. Pre-COVID-19, each 5-point DEPS-R increase was 
associated with a -0.34 (95% CI -0.56, -0.13, p = 0.07) lower normalized 
abundance of genus Anaerostipes; and the normalized abundance of Lachnospira 
genus was -0.94 (95% CI -1.5, -0.42), p = 0.02 lower when insulin restriction 
was reported "At least sometimes" compared to "Rarely or Never".
CONCLUSION: DE and insulin restriction were associated with a reduced abundance 
of SCFA-producing gut microbes pre-COVID-19. Additional studies are needed to 
confirm these associations to inform microbiota-based therapies in T1D.

Copyright © 2022 The Italian Diabetes Society, the Italian Society for the Study 
of Atherosclerosis, the Italian Society of Human Nutrition and the Department of 
Clinical Medicine and Surgery, Federico II University. Published by Elsevier 
B.V. All rights reserved.

DOI: 10.1016/j.numecd.2022.11.017
PMCID: PMC9925402
PMID: 36586772 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest All authors 
declare no competing interests.


1144. Fam Process. 2023 Dec;62(4):1574-1591. doi: 10.1111/famp.12849. Epub 2022 Dec 
30.

Learning from adversity: What the COVID-19 pandemic can teach us about family 
resiliency.

Brock RL(1), Calkins FC(1), Hamburger ER(1), Kumar SA(1), Laifer LM(1), Phillips 
E(1), Ramsdell EL(1).

Author information:
(1)Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA.

The present study aimed to characterize the immediate impacts of the COVID-19 
pandemic on families with preschool age children and to identify pre-pandemic 
factors that explained unique family experiences. We leveraged an ongoing 
longitudinal study of relatively well-resourced community families who had 
reported on family functioning prior to the pandemic and completed surveys 
6 months after pandemic onset. Both parents of dual parenting households 
endorsed significant hardships as a direct result of the pandemic (e.g., 
disrupted family routines, challenges at work); however, families also reported 
aspects of flourishing (i.e., experiencing positive outcomes in response to 
adversity) such as spending more time together as a family. Families were prone 
to greater hardships and fewer opportunities for growth to the extent that 
parents were lower in psychological resources (i.e., greater stress and 
internalizing symptoms, poor well-being) and were not on the same page as a 
couple (i.e., interparental discord, low quality coparenting) prior to pandemic 
onset. Finally, greater pandemic hardships predicted poorer parental mental 
health, greater family dysfunction, and elevated child psychopathology, 
controlling for pre-pandemic levels. Parents who reported more family 
flourishing from the pandemic had a stronger interparental relationship. Results 
are intended to inform theories of family stress and family interventions that 
can be tailored to promote resiliency (i.e., adaptation to challenging life 
events) and prevent dysfunction when families face rapid change and adjustment 
and high degrees of uncertainty and stress.

© 2022 Family Process Institute.

DOI: 10.1111/famp.12849
PMCID: PMC9880619
PMID: 36585769 [Indexed for MEDLINE]


1145. BMJ Open. 2022 Dec 30;12(12):e064287. doi: 10.1136/bmjopen-2022-064287.

Impact of COVID-19 pandemic on the mental health of healthcare workers during 
the first wave in Portugal: a cross-sectional and correlational study.

Duarte I(#)(1)(2)(3), Pinho R(#)(3), Teixeira A(1)(2)(4), Martins V(5)(6), Nunes 
R(1)(3), Morgado H(2), Castro L(1)(2)(7), Serrão C(8)(9).

Author information:
(1)Department of Community Medicine, Information and Decision in Health 
(MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.
(2)Center for Health Technology and Services Research (CINTESIS), Faculty of 
Medicine, University of Porto, Porto, Portugal.
(3)Faculty of Medicine, University of Porto, Porto, Portugal.
(4)ADiT-LAB, Instituto Politécnico de Viana do Castelo, Viana do castelo, 
Portugal.
(5)Center for Health Technology and Services Research (CINTESIS), Porto, 
Portugal.
(6)Escola Superior de Saúde, Universidade de Aveiro, Aveiro, Portugal.
(7)School of Health, Polytechnic of Porto, Porto, Portugal.
(8)School of Education, Polytechnic Institute of Porto, Porto, Portugal 
carlaserrao@ese.ipp.pt.
(9)INED, Center for Research and Innovation in Education, Porto, Portugal.
(#)Contributed equally

OBJECTIVES: The COVID-19 pandemic has had a negative impact on the mental health 
of healthcare workers (HCWs) worldwide. This study aims to identify the degree 
to which sociodemographic variables and indicators of subjective well-being and 
psychological resilience are associated, positively and negatively, with the 
outcomes of burnout, stress, depression and anxiety among Portuguese HCWs 
observed during the first wave. It also aims to evaluate the strength of 
association of these variables and indicators with each outcome.
DESIGN: Cross-sectional quantitative study. The statistical methods used are 
simple logistic model, multiple logistic regression model and -2*log-likelihood 
statistic.
SETTING: Portuguese HCWs living in Portugal and working in the Portuguese 
healthcare system.
PARTICIPANTS: The study included 1535 professionals, with a mean age of 38 
years.
PRIMARY AND SECONDARY OUTCOMES MEASURES: Psychological variables were measured 
by Copenhagen Burnout Inventory, the Resilience Scale, the Depression, Anxiety 
and Stress Scales and the Satisfaction with Life Scale.
RESULTS: High levels of personal (55%; n=844), work-related (55.1%; n=846) and 
client-related burnout (35.4%; n=543) were found. Additionally, participants 
expressed substantial levels of depression (28.7%; n=441), stress (36.4%; n=558) 
and anxiety (33.1%; n=508). About 1202 participants (78.3%) demonstrated 
moderate-to-high levels of resilience. Profession, work regime during the 
pandemic, having a health problem, resilience and satisfaction with life are 
independent variables significantly associated with the outcomes of burnout, 
stress, depression and anxiety. Satisfaction with life was the independent 
variable that had a major association with all outcomes.
CONCLUSIONS: Governments and hospital administrations should take action to 
promote resilience and satisfaction with life as these variables are protective 
relating to mental health problems. Interventions as educational sessions, 
psychological support at work, programmes promoting resilience and coping 
mechanisms and better work conditions may improve mental health. The 
implementation of measures to protect healthcare students from developing 
prejudicial outcomes seams very adequate and important.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2022-064287
PMCID: PMC9808752
PMID: 36585138 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


1146. BMJ Glob Health. 2022 Dec;7(12):e010713. doi: 10.1136/bmjgh-2022-010713.

Indirect effects of COVID-19 on child and adolescent mental health: an overview 
of systematic reviews.

Harrison L(1), Carducci B(1)(2), Klein JD(3), Bhutta ZA(4)(2)(5).

Author information:
(1)Centre for Global Child Health, The Hospital for Sick Children, Toronto, 
Ontario, Canada.
(2)Department of Nutritional Sciences, University of Toronto Temerty Faculty of 
Medicine, Toronto, Ontario, Canada.
(3)Pediatrics, University of Illinois Chicago, Chicago, Illinois, USA.
(4)Centre for Global Child Health, The Hospital for Sick Children, Toronto, 
Ontario, Canada zulfiqar.bhutta@aku.edu.
(5)Center of Excellence in Women and Child Health, Aga Khan University, Karachi, 
Pakistan.

INTRODUCTION: To control the spread of COVID-19, mitigation strategies have been 
implemented globally, which may have unintended harmful effects on child and 
adolescent mental health. This study aims to synthesise the indirect mental 
health impacts on children and adolescents globally due to COVID-19 mitigation 
strategies.
METHODS: We included relevant reviews from MEDLINE, Embase, PsycINFO, LILACS, 
CINAHL, The Cochrane Library and Web of Science until January 2022 that examined 
the impact of COVID-19-related lockdown and stay-at-home measures on the mental 
health of children and adolescents. Data extraction and quality assessments were 
completed independently and in duplicate by BC and LH. A Measurement Tool to 
Assess Systematic Reviews-2 was used to assess the methodological quality.
RESULTS: Eighteen systematic reviews, comprising 366 primary studies, found a 
pooled prevalence of 32% for depression (95% CI: 27 to 38, n=161 673) and 32% 
for anxiety (95% CI: 27 to 37, n=143 928) in children and adolescents globally 
following COVID-19 mitigation measures. Subgroup analyses also uncovered 
important differences for both depression and anxiety by World Health 
Organization regions with few studies from Africa and relative high burden of 
anxiety and depression in the Eastern Mediterranean region.
CONCLUSIONS: Our findings reveal a high prevalence of depression and anxiety in 
children and adolescents during the COVID-19 pandemic, globally, compared with 
prepandemic estimates. These findings highlight the urgency for governments and 
policymakers to strengthen mental health systems in the COVID-19 recovery, 
especially in low-and middle-income countries where compounding psychological 
stress, access and affordability of care and discrepant reporting of mental 
health in this population remains a challenge. We also provide insight into how 
to alter mitigation strategies to reduce the unintended negative consequences 
for the health and well-being of children and adolescents in future pandemics.
PROSPERO REGISTRATION NUMBER: CRD42022309348.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjgh-2022-010713
PMCID: PMC9808753
PMID: 36585030 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


1147. J Am Med Dir Assoc. 2023 Feb;24(2):148-155. doi: 10.1016/j.jamda.2022.12.004. 
Epub 2022 Dec 27.

Changes in Health and Well-Being of Nursing Home Managers from a Prepandemic 
Baseline in February 2020 to December 2021.

Estabrooks CA(1), Duan Y(2), Cummings GG(3), Doupe M(4), Hoben M(5), Keefe J(6), 
Poss JW(7), Song Y(8), Squires JE(9), Wagg A(10), Norton PG(11).

Author information:
(1)Faculty of Nursing, College of Health Sciences, University of Alberta, 
Edmonton, Alberta, Canada. Electronic address: carole.estabrooks@ualberta.ca.
(2)Faculty of Nursing, College of Health Sciences, University of Alberta, 
Edmonton, Alberta, Canada.
(3)College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada.
(4)Max Rady College of Medicine, Community Health Science, University of 
Manitoba, Winnipeg, Manitoba, Canada.
(5)Faculty of Nursing, College of Health Sciences, University of Alberta, 
Edmonton, Alberta, Canada; School of Health Policy & Management, Faculty of 
Health, York University, Toronto, Ontario, Canada.
(6)Department of Family Studies & Gerontology, Mount Saint Vincent University, 
Halifax, Nova Scotia, Canada.
(7)School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, 
Canada.
(8)School of Nursing, Qingdao University, Qingdao, Shandong, China.
(9)School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, 
Ontario, Canada.
(10)Faculty of Medicine & Dentistry, College of Health Sciences, University of 
Alberta, Edmonton, Alberta, Canada.
(11)Department of Family Medicine, Cumming School of Medicine, University of 
Calgary, Calgary, Alberta, Canada.

OBJECTIVE: To evaluate changes in mental health and well-being (eg, quality of 
work life, health, intention to leave) among nursing home managers from a 
February 2020 prepandemic baseline to December 2021 in Alberta, Canada.
DESIGN: Repeated cross-sectional survey.
SETTING AND PARTICIPANTS: A random sample of nursing homes (n = 35) in urban 
areas of Alberta was selected on 3 strata (region, size, ownership). Care 
managers were invited to participate if they (1) managed a unit, (2) worked 
there for at least 3 months, and (3) worked at least 6 shifts per month.
METHODS: We measured various mental health and well-being outcomes, including 
job satisfaction (Michigan Organizational Assessment Questionnaire Job 
Satisfaction Subscale), burnout (Maslach Burnout Inventory-exhaustion, cynicism, 
efficacy), organizational citizenship behaviors (constructive efforts by 
individuals to implement changes to improve performance), mental and physical 
health (Short Form-8 Health Survey), burden of worry, and intention to leave. We 
use mixed effects regression to examine changes at the survey time points, 
controlling for staffing and resident acuity.
RESULTS: The final sample included 181 care managers (87 in the pre-COVID 
survey; 94 in the COVID survey). Response rates were 66.9% and 82.5% for the 
pre-COVID and COVID surveys, respectively. In the regression analysis, we found 
statistically significant negative changes in job satisfaction (mean 
difference -0.26, 95% CI -0.47 to -0.06; P = .011), cynicism (mean difference 
0.43, 95% CI 0.02-0.84; P = .041), exhaustion (mean difference 0.84, 95% CI 
0.41-1.27; P < .001), and SF-8 mental health (mean difference -6.49, 95% CI 
-9.60 to -3.39; P < .001).
CONCLUSIONS AND IMPLICATIONS: Mental health and well-being of nursing home 
managers worsened during the pandemic, potentially placing them at risk for 
leaving their jobs and in need of improved support. These findings should be a 
major concern for policy makers, particularly given serious prepandemic 
workforce shortages. Ongoing assessment and support of this understudied group 
are needed.

Copyright © 2022 AMDA – The Society for Post-Acute and Long-Term Care Medicine. 
Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jamda.2022.12.004
PMID: 36584970 [Indexed for MEDLINE]


1148. PLoS One. 2022 Dec 30;17(12):e0279963. doi: 10.1371/journal.pone.0279963. 
eCollection 2022.

Association between COVID-19 pandemic declaration and depression/anxiety among 
U.S. adults.

Adzrago D(1), Sulley S(2), Tagoe I(3), Odame E(4), Mamudu L(5), Williams F(6).

Author information:
(1)Center for Health Promotion and Prevention Research, The University of Texas 
School of Public Health, Houston, Texas, United States of America.
(2)National Healthy Start Association, Washington, DC, United States of America.
(3)School of Population Health, University of Toledo, Toledo, Ohio, United 
States of America.
(4)Department of Environmental Health Sciences, School of Public Health, 
University of Alabama at Birmingham, Birmingham, Alabama, United States of 
America.
(5)Department of Public Health, California State University, Fullerton, 
California, United States of America.
(6)Division of Intramural Research, National Institute on Minority Health and 
Health Disparities, National Institutes of Health, Bethesda, Maryland, United 
States of America.

BACKGROUND: Although studies have investigated the impact of the COVID-19 on 
mental health, few studies have attempted to compare the prevalence of 
depression/anxiety symptoms among U.S. adults before and after the COVID-19 
pandemic declaration. We examined the prevalence and association between 
depression/anxiety symptoms and COVID-19 pandemic declaration among U.S. adult 
population and subgroups.
METHODS: A nationally representative cross-sectional study of the Health 
Information National Trends Survey (HINTS 5, Cycle 4) assessing health-related 
information and behaviors in U.S. adults aged ≥18 years from February through 
June 2020. The primary dependent variable was current depression/anxiety derived 
from Patient Health Questionnaire-4. The main independent variable was responses 
before and after the COVID-19 pandemic declaration in addition to sexual 
identity heterosexual identity, /race/ethnicity and rural-urban commuting areas. 
Covariates were sociodemographic factors, and health risk behaviors. Weighted 
percentages, multivariable logistic regression, and Chi-square tests were used 
to establish the prevalence and association between current depression/anxiety 
and the independent variables and covariates.
RESULTS: A total of 3,865 participants completed the survey and included 35.3% 
of the participants before the COVID-19 pandemic declaration. Most of the sample 
were aged 50-64 years [33.0%]; males [51.0%]; and non-Hispanic Whites [70.1%]). 
The post-pandemic declaration included participants, aged 35-49 years [27.0%]; 
females [52.6%]; and non-Hispanic Whites [59.6%]). The prevalence of 
depression/anxiety was higher after the COVID-19 pandemic declaration (32.2%) 
than before the declaration (29.9%). Higher risks of depression/anxiety symptoms 
after the declaration were associated with being a sexual minority ([adjusted 
odds ratio] AOR, 2.91 [95% confidence interval (CI), 1.38-6.14]) and having 
fair/poor general health (AOR, 2.91 [95% CI, 1.76-4.83]). The probability of 
experiencing depression/anxiety symptoms after the declaration was highest among 
homosexuals/lesbians/gays (65.6%) compared to bisexuals (39.6%), and 
heterosexuals (30.1%).
CONCLUSIONS: In this study, young adults, non-Hispanic Whites, and those with 
fair/poor general health had a higher burden of depression/anxiety symptoms 
after the pandemic declaration. The development of psychological support 
strategies to promote wellbeing during the pandemic may reduce psychological 
distress in the population, especially among at-risk populations.

Copyright: This is an open access article, free of all copyright, and may be 
freely reproduced, distributed, transmitted, modified, built upon, or otherwise 
used by anyone for any lawful purpose. The work is made available under the 
Creative Commons CC0 public domain dedication.

DOI: 10.1371/journal.pone.0279963
PMCID: PMC9803300
PMID: 36584212 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


1149. PLoS One. 2022 Dec 30;17(12):e0279587. doi: 10.1371/journal.pone.0279587. 
eCollection 2022.

Media consumption and psychological distress among older adults in the United 
States.

Bauldry S(1), Stainback K(1).

Author information:
(1)Purdue University, West Lafayette, IN, United States of America.

The consumption of news media covering national and global events, particularly 
those that invoke fear or worry, such as pandemics or terrorist attacks, may 
affect older adults' mental wellbeing. Using the COVID-19 pandemic as a case 
study, this research analyzes nationally representative data from older adults 
in the US to address the following research questions: (1) What is the 
relationship between COVID-19-based media consumption and psychological 
distress? (2) Does any relationship between media consumption and psychological 
distress vary by gender, race/ethnicity, education, and marital status? Results 
indicate that (1) older adults who closely followed the news about the pandemic 
scored higher on psychological distress than those following less closely and 
(2) this relationship was more pronounced among Hispanic older adults. These 
findings are contextualized in the broader stress process model with a focus on 
a macro-level stressor and differential exposure and vulnerability resulting in 
variability in the relationship between the stressor and psychological distress.

Copyright: © 2022 Bauldry, Stainback. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0279587
PMCID: PMC9803103
PMID: 36584144 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


1150. PLoS One. 2022 Dec 30;17(12):e0279383. doi: 10.1371/journal.pone.0279383. 
eCollection 2022.

Understanding the factors affecting teachers' burnout during the COVID-19 
pandemic: A cross-sectional study.

Shimony O(1), Malin Y(2), Fogel-Grinvald H(1), Gumpel TP(2), Nahum M(1).

Author information:
(1)School of Occupational Therapy, Faculty of Medicine, The Hebrew University, 
Jerusalem, Israel.
(2)Seymour Fox School of Education, The Hebrew University, Jerusalem, Israel.

BACKGROUND: During the COVID-19 pandemic, which enforced social distancing and 
isolation, teachers were required to handle multiple challenges related to their 
work, including dealing with remote teaching, in addition to personal, medical 
and financial challenges. The goal of the current research was to examine 
factors that contributed to professional burnout and commitment to work among 
teachers during the first and second waves of the COVID-19 pandemic.
METHODS: A total of 344 elementary school teachers in Israel completed online 
self-report questionnaires, including assessments of stressors, anxiety, 
resilience, self-efficacy beliefs, and coping strategies. Structured Equation 
Modeling [SEM] was used to examine the contribution of these factors to 
professional burnout and commitment.
RESULTS: The gaps between needed and received support had a direct effect on 
teachers' burnout and commitment, and an indirect effect through anxiety and 
self-efficacy beliefs. Stress relating to remote teaching and support-gaps 
regarding remote teaching were the most significant of all the stressors and 
sources of support.
CONCLUSIONS: Collectively, these findings highlight the significance of remote 
teaching as the main cause of stress and professional burnout and suggest that 
proper preparation of teachers-before and during times of crisis, may have a 
significant impact on their mental and professional well-being.

Copyright: © 2022 Shimony et al. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0279383
PMCID: PMC9803224
PMID: 36584003 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


1151. West Afr J Med. 2022 Dec 29;39(12):1312-1315.

Health and Wellbeing amidst a Prolonged Pandemic: Implications for Physicians 
and Patients.

Erhabor GE(1), Bamigboye-Taiwo OT(2), Arawomo AO(3).

Author information:
(1)Department of Medicine, Obafemi Awolowo University/Obafemi Awolowo University 
Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria.
(2)Department of Paediatrics & Child Health, Obafemi Awolowo University/Obafemi 
Awolowo University Teaching Hospital, Ile-Ife, Osun State, Nigeria.
(3)New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, 
England.

Health is wealth, so goes the popular maxim. The 46th West African College of 
Physicians Annual General and Scientific Meeting focuses on Health and Wellbeing 
Amidst a Prolonged Pandemic. Health and wellbeing are closely related components 
critical to healthy living and cannot be considered independent of each other. 
While health is a state of total wellbeing; wellbeing is intricately linked with 
happiness and satisfaction in life. The COVID- 19 pandemic has significantly 
impacted the health and well-being of nations all over the world. In the wake of 
the pandemic came the COVID-19 recession which brought a crash in the global 
economy, reduction in productivity, rise in unemployment, massive layoffs, 
collapse of businesses and manufacturing industries, disruptions in 
transportation and much more. These harsh economic realities have placed a huge 
strain on global mental health resulting in physical, mental and social 
disorders. The workload of the average physician and other health care workers 
increased tremendously resulting in burnout and psychological stress with a 
consequent increase in the incidence of psychological disorders including 
anxiety, depression, suicide and suicidal ideation amongst others. The lack of 
preparedness for the pandemic and the inequality in strength of healthcare 
systems across the world prolonged the pandemic and its adverse consequences on 
health and wellbeing of the populace. Promotion of health and well-being of 
health care professionals and the populace at large is essential for the growth 
of any economy and is an essential consideration for stakeholders involved in 
disease prevention and health promotion.

Publisher: La santé est une richesse, dit la maxime populaire. La 46e réunion 
générale annuelle et scientifique du Collège des médecins d’Afrique de l’Ouest a 
pour thème la santé et le bien-être dans un contexte de pandémie prolongée. La 
santé et le bien-être sont des éléments étroitement liés et essentiels à une vie 
saine et ne peuvent être considérés comme indépendants l’un de l’autre. Alors 
que la santé est un état de bien-être total, le bien-être est intimement lié au 
bonheur et à la satisfaction dans la vie. La pandémie de COVID- 19 a eu un 
impact considérable sur la santé et le bien-être des nations du monde entier. 
Dans le sillage de la pandémie, la récession du COVID-19 a entraîné un 
effondrement de l’économie mondiale, une réduction de la productivité, une 
hausse du chômage, des licenciements massifs, l’effondrement des entreprises et 
des industries manufacturières, des perturbations dans les transports, etc. Ces 
dures réalités économiques ont exercé une pression énorme sur la santé mentale 
mondiale, entraînant des troubles physiques, mentaux et sociaux. La charge de 
travail du médecin moyen et des autres travailleurs de la santé a 
considérablement augmenté, entraînant un épuisement professionnel et un stress 
psychologique, avec pour conséquence une augmentation de l’incidence des 
troubles psychologiques, dont l’anxiété, la dépression, le suicide et les idées 
suicidaires, entre autres. Le manque de préparation à la pandémie et l’inégalité 
des systèmes de santé dans le monde ont prolongé la pandémie et ses conséquences 
négatives sur la santé et le bien-être de la population. La promotion de la 
santé et du bien-être des professionnels de la santé et de la population en 
général est essentielle à la croissance de toute économie et constitue une 
considération essentielle pour les acteurs impliqués dans la prévention des 
maladies et la promotion de la santé. Mots clés: Santé, Bien-être, Pandémie de 
COVID-19, Santé mentale, Prevention des maladies.

Copyright © 2022 by West African Journal of Medicine.

PMID: 36583953 [Indexed for MEDLINE]

Conflict of interest statement: The Authors declare that no competing interest 
exists.


1152. Ann Agric Environ Med. 2022 Dec 27;29(4):560-567. doi: 10.26444/aaem/153960. 
Epub 2022 Sep 21.

Impact of isolation on the biopsychosocial functioning of older people with 
COVID-19.

Wróblewska IM(1), Chmielewski JP(2), Wojciechowska M(3), Chmielowiec B(4), 
Nowak-Starz G(5), Szarpak L(6), Florek-Łuszczki M(7).

Author information:
(1)Department of Internal Nursing, Faculty of Health Sciences, Medical 
University, Wrocław, Poland.
(2)Institute of Environmental Protection - National Research Institute, Warsaw, 
Poland.
(3)Faculty of Pedagogy and Psychology, Jan Kochanowski University, Kielce, 
Poland.
(4)Office of the Patient Ombudsman, Poland.
(5)Collegium Medicum, Jan Kochanowski University, Kielce, Poland.
(6)Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, 
Poland.
(7)Institute of Rural Health, Lublin, Poland.

INTRODUCTION: COVID-19 is a highly contagious coronavirus disease that has had a 
significant impact on the functioning of society. On 11 March 2020, due to the 
rapid spread of the virus, the WHO declared a global pandemic. By the end of 
2021, 5 variants of SARS-CoV-2 had been identified since the beginning of the 
pandemic. The course of the disease varied depending on the age of the patients 
and the presence of possible comorbidities. Most patients were asymptomatic or 
sparsely symptomatic of the infection; however, in about 6% of cases, the course 
of the disease was critical. Typical symptoms of COVID-19 include: fever, muscle 
pain and headache, lack of smell and taste, cough, dyspnea, diarrhoea and 
nausea. According to epidemic guidelines, infected patients were subjected to 
isolation, which harmed their mental state, especially the elderly.
OBJECTIVE: The aim of the study was to assess the impact of isolation on the 
biopsychosocial functioning of elderly patients with COVID-19.
MATERIAL AND METHODS: The study was conducted among 360 elderly patients in 
hospital wards operating as a unit in a hospital complex dedicated to patients 
infected with the SARS-CoV-2 virus. Data were collected using standardized 
questionnaires: ADL Scale, IADL, GDS, SF-36 Quality of Life Scale, 
Multidimensional Scale of Perceived Social Support, and supplementary questions 
about, among others, the oxygen therapy provided, length of stay in the unit, 
and the support received from relatives.
RESULTS: Almost half (48%) of the subjects received oxygen therapy, and 36% had 
a length of disease of 7-14 days. A correlation was observed between the quality 
of life and the above-mentioned factors. Correlations of quality of life 
indicators with the length of illness were moderate (except for the level of 
pain) and positive, meaning that the longer the patients were ill, the lower 
their quality of life. Correlations of disease severity were moderate for pain, 
vitality, and emotional limitations, while vital for physical functioning and 
limitations and general and mental health. The intensity of oxygen therapy was 
moderately correlated with physical and emotional limitations and general health 
and strongly correlated with physical functioning, vitality and mental health. 
Correlations between functional status and mental status of elderly patients 
were also studied. Analysis of variance showed that the constructed model was an 
excellent fit to the data, F = 37.14; p < 0.001, explaining 42% of the variance 
in the dependent variable (R2= 0.42). As many as 80% of the respondents felt 
that isolation harmed their well-being. Examining the impact of quality of life 
on their well-being showed that most of the associations tested were 
statistically significant, and all were positive. Associations of moderate 
strength were shown for physical functioning, physical limitations and general 
health, while strong associations were shown for vitality, emotional limitations 
and mental health. Pain complaints were associated with changes in well-being at 
the level of statistical trend (p = 0.055). This means that the lower the 
patients' quality of life, especially in terms of vitality and mental health, 
the more significant the impact of isolation on their well-being. The study also 
investigated the effect of social support on mental state. The model proved to 
be an excellent fit to the data, F = 5.91, p = 0.002, and explained 23% of the 
variance in the dependent variable (Adjusted R² = 0.23). At the same time, 
support from friends turned out to be the only significant predictor (Beta = 
0.53), and this means that the more support the subjects received from them, the 
lower the level of depression they manifested.
CONCLUSIONS: 1) The better the functional state of a senior and the support 
received from relatives, the lower the severity of depression. 2) The lower the 
quality of a senior's life, especially in terms of mental state, the greater the 
negative impact on his/her well-being in isolation. 3) The low quality of life 
of a senior increased the likelihood of depression. 4) The quality of life of 
older Covid-19 patients was higher in those without chronic disease. 5) The 
quality-of-life level was lower in patients with a more severe course of 
COVID-19, and longer duration of disease and oxygen therapy.

DOI: 10.26444/aaem/153960
PMID: 36583324 [Indexed for MEDLINE]


1153. J Racial Ethn Health Disparities. 2024 Feb;11(1):62-71. doi: 
10.1007/s40615-022-01497-y. Epub 2022 Dec 28.

Psychological Well-Being and Substance Use During the COVID-19 Pandemic: 
Ethnic/Racial Identity, Discrimination, and Vigilance.

Tao X(1), Yip T(2), Fisher CB(2)(3).

Author information:
(1)Department of Psychology, Fordham University, Dealy Hall, 441 East Fordham 
Road, Bronx, NY, 10458, USA. xtao16@fordham.edu.
(2)Department of Psychology, Fordham University, Dealy Hall, 441 East Fordham 
Road, Bronx, NY, 10458, USA.
(3)Center for Ethics Education, Fordham University, Bronx, USA.

OBJECTIVES: Emerging evidence indicates that the COVID-19 pandemic has 
exacerbated mental health disparities among Black, Indigenous, and People of 
Color (BIPOC) through increased exposure to racism. Although ethnic/racial 
identity (ERI) and mental health were associated among BIPOC young adults 
pre-pandemic, it is unclear how these associations may differ in the exacerbated 
hostile racial environment of the pandemic. The current study examined the 
associations between ERI exploration and commitment within the context of 
ethnic/racial discrimination (ERD) and race-related vigilance with psychological 
well-being and substance use as explained by rumination.
METHODS: Data from a cross-sectional online survey of 450 AIAN, Asian, Black, 
and Latinx young adults (18-25 years) collected in April 2020 included 
demographic variables, standardized measures of ERI, ERD, race-related 
vigilance, rumination brooding and reflection, substance use, and psychological 
well-being.
RESULTS: Black respondents reported more exposure to ERD than AIAN and Asian 
young adults. ERI exploration and commitment were positively associated with 
well-being. ERI exploration, ERD, and rumination were associated with higher 
levels of substance use. An association between ERI exploration and more 
substance use and lower well-being was partially accounted for by higher levels 
of rumination. An association between ERI commitment and more substance use was 
fully accounted for by higher levels of rumination.
CONCLUSIONS: Although ERI exploration and commitment were associated with better 
psychological well-being among BIPOC young adults, a significant association was 
found between ERI commitment and more substance use as explained by rumination. 
Public health efforts should cultivate culturally sensitive mental health 
services to decrease rumination and its negative association with substance use 
and well-being.

© 2022. W. Montague Cobb-NMA Health Institute.

DOI: 10.1007/s40615-022-01497-y
PMCID: PMC9795950
PMID: 36576694 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1154. BMC Public Health. 2022 Dec 27;22(1):2430. doi: 10.1186/s12889-022-14690-9.

Towards a health promoting university: descriptive findings on health, wellbeing 
and academic performance amongst university students in Australia.

Sanci L(1), Williams I(2), Russell M(3), Chondros P(2), Duncan AM(2), Tarzia 
L(2), Peter D(2), Lim MSY(2), Tomyn A(4), Minas H(5).

Author information:
(1)Department of General Practice, Melbourne Medical School, The University of 
Melbourne, Melbourne, Australia. l.sanci@unimelb.edu.au.
(2)Department of General Practice, Melbourne Medical School, The University of 
Melbourne, Melbourne, Australia.
(3)Centre of Epidemiology and Biostatistics, Melbourne School of Population and 
Global Health, The University of Melbourne, Melbourne, Australia.
(4)School of Psychology, Deakin University, Melbourne, Australia.
(5)Melbourne School of Population and Global Health, The University of 
Melbourne, Melbourne, Australia.

BACKGROUND: Universities are increasingly recognised as institutions where 
health and wellbeing can be promoted to maximise academic outcomes, career 
transitions, and lifelong positive health behaviours. There is concern about the 
mental health of university students and other factors which affect academic 
outcomes particularly for subgroups such as international students. There are 
few cohort studies of the breadth of issues that can impact on mental health and 
academic outcomes for both local and international students. We conducted a 
baseline prevalence survey of students at a large Australian university covering 
health, academic, and social determinants of wellbeing. The purpose was to 
inform the university's new student health and wellbeing framework with a view 
to follow-up to determine predictors of mental ill-health and academic outcomes 
in the subsequent year. In this paper we present the baseline prevalence data 
and report on selected mental health and health care access issues for local and 
international students.
METHODS: The entire university population as of April 2019 of over 56,375 
students aged 18 or above were invited to complete the online survey. Questions 
explored eight domains: demographic characteristics, general health and 
wellbeing, mental health, risk taking behaviours, psychosocial stressors, 
learning and academic factors, social and cultural environment, and awareness of 
and access to health and wellbeing services. Records of academic results were 
also accessed and matched with survey data for a large subset of students 
providing consent.
RESULTS: Fourteen thousand eight hundred eighty (26.4%) students commenced our 
survey and were representative of the entire student population on demographic 
characteristics. Three quarters were aged between 18 to 25 years and one third 
were international students. Eighty-five percent consented to access of their 
academic records. Similar proportions of local and international students 
experienced symptoms of a depression or anxiety disorder, however international 
students were less aware of and less likely to access available health services 
both inside and external to the university. We also reported on the prevalence 
of: general lifestyle factors (diet, exercise, amount of daily sleep); 
risk-taking behaviours (including alcohol, tobacco and other drug use; 
unprotected sexual activity); psychosocial stressors (financial, intimate 
partner violence, discrimination, academic stressors, acculturative stress); 
subjects failed; resilience; social supports; social media use; and health 
services accessed online.
CONCLUSIONS: This rigorous and comprehensive examination of the health status of 
local and international students in an Australian university student population 
establishes the prevalence of mental health issues and other psychosocial 
determinants of health and wellbeing, along with academic performance. This 
study will inform a university-wide student wellbeing framework to guide health 
and wellbeing promotion and is a baseline for a 12-month follow-up of the cohort 
in 2020 during the COVID-19 pandemic.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-14690-9
PMCID: PMC9792939
PMID: 36575509 [Indexed for MEDLINE]

Conflict of interest statement: AT may be perceived as having a financial 
competing interest via his role at Bupa, where he is Senior Manager, Research & 
Analytics, Corporate & International. AT has contributed to the manuscript as an 
author as described below, in accordance with BMC’s editorial policies and ICMJE 
(2013) authorship criteria. The remaining authors declare that they have no 
competing interests.


1155. BMC Psychiatry. 2022 Dec 27;22(1):828. doi: 10.1186/s12888-022-04371-7.

Pediatric psychiatric emergency rooms during COVID-19: a multi-center study.

Erez G(1), Yakubovich S(2), Sadeh H(3), Shoval G(4), Schoen G(4), Meiri G(3), 
Hertz-Palmor N(5), Bretler T(6), Barzilai Y(2), Mosheva M(5), Gothelf D(5), 
Bloch Y(7).

Author information:
(1)Shalvata Mental Health Center and Tel Aviv University, Hod Hasharon, Israel.
(2)Shalvata Mental Health Center, Hod Hasharon, Israel.
(3)Soroka Medical Center and Ben-Gurion University of the Negev, Be'er Sheva, 
Israel.
(4)Geha Mental Health Center and Tel Aviv University, Petah Tikva, Israel.
(5)Sheba Medical Center and Tel Aviv University, Ramat Gan, Israel.
(6)Ziv Medical Center (Safed) and Bar-Ilan University, Safed, Israel.
(7)Shalvata Mental Health Center and Tel Aviv University, Hod Hasharon, Israel. 
Yuvalbloch10@gmail.com.

Erratum in
    BMC Psychiatry. 2023 Jan 26;23(1):71.

BACKGROUND: The COVID-19 (SARS-CoV-2) pandemic has been a major stressor for the 
mental health and well-being of children and adolescents. Surveys and reports 
from hotlines indicate a significant rise in mental health problems. As the 
psychiatric emergency room (ER) is a first-line free-of-charge facility for 
psychiatric emergencies, we expected to see a significant increase in visits, 
specifically of new patients suffering from anxiety, depression, or 
stress-related disorders.
METHODS: Data from two psychiatric hospital ERs and one general hospital were 
included. All visits of children and adolescents from the computerized files 
between March and December of 2019 were analyzed anonymously and compared to the 
same months in 2020, using multilevel linear modeling.
RESULTS: There was a significant decline in the total number of visits 
(p = .017), specifically among those diagnosed as suffering from stress-related, 
anxiety, and mood disorder groups (p = .017), and an incline in the proportion 
of visits of severe mental disorders (p = .029).
DISCUSSION: The limited use of child and adolescent psychiatric emergency 
facilities during the pandemic highlights the importance of tele-psychiatry as 
part of emergency services. It also suggests the importance of the timeline of 
the emergence of clinically relevant new psychiatric diagnoses related to the 
pandemic. Future studies are needed to establish the long-term effects of the 
pandemic and the expeditious use of tele-psychiatry.

© 2022. The Author(s).

DOI: 10.1186/s12888-022-04371-7
PMCID: PMC9793352
PMID: 36575441 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1156. BMC Public Health. 2022 Dec 27;22(1):2434. doi: 10.1186/s12889-022-14836-9.

A repeated cross-sectional and longitudinal study of mental health and wellbeing 
during COVID-19 lockdowns in Victoria, Australia.

Wright A(1)(2), De Livera A(3)(4)(5), Lee KH(4), Higgs C(6), Nicholson M(7), 
Gibbs L(3), Jorm A(3).

Author information:
(1)Department of Health, Victorian State Government, Melbourne, Australia. 
annemarie.wright@health.vic.gov.au.
(2)Melbourne School of Population and Global Health, The University of 
Melbourne, Melbourne, Australia. annemarie.wright@health.vic.gov.au.
(3)Melbourne School of Population and Global Health, The University of 
Melbourne, Melbourne, Australia.
(4)Mathematical Sciences, School of Science, RMIT University, Melbourne, 
Australia.
(5)Department of Mathematics and Statistics, La Trobe University, Melbourne, 
Australia.
(6)College of Design and Social Context, RMIT University, Melbourne, Australia.
(7)Monash University Malaysia, Kuala Lumpur, Malaysia.

Erratum in
    BMC Public Health. 2023 Jan 13;23(1):97.

BACKGROUND: Population surveys across the world have examined the impact of the 
COVID-19 pandemic on mental health. However, few have simultaneously examined 
independent cross-sectional data with longitudinal data, each of which have 
different strengths and weaknesses and facilitate the investigation of distinct 
research questions. This study aimed to investigate psychological distress and 
life satisfaction during the first and second lockdowns in the state of 
Victoria, Australia, and the social factors that may be affected by lockdowns 
and could affect mental health.
METHODS: The VicHealth Victorian Coronavirus Wellbeing Impact Study included two 
20-min opt-in online panel surveys conducted in May and September 2020 in 
Victoria, each with a sample of 2000 adults aged 18 + . A two-part study design 
was used: a repeated cross-sectional study of respondents who participated in 
Survey One and Survey Two, followed by a longitudinal nested cohort study. The 
primary exposures were social solidarity, social connectedness and staying 
connected with family and friends. Using logistic regression modelling, we 
explored the associations between our exposures and primary outcomes of 
psychological distress and life satisfaction with and without adjustment for 
covariates, both cross-sectionally and longitudinally. The results from the 
multivariable models were summarised using adjusted Odds Ratios (aOR), 95% 
Confidence Intervals (CI).
RESULTS: Cross-sectional results indicated that the percentage of participants 
with low life satisfaction was significantly higher in the second survey sample 
(53%) compared to the first (47%). The percentage of participants with high 
psychological distress was higher but not significantly different between the 
two survey samples (14% first survey vs 16% second survey). Longitudinal study 
results indicated that lower social connectedness was significantly associated 
with higher psychological distress (aOR:3.3; 95% CI: 1.3-8.4) and lower life 
satisfaction (aOR:0.2; 95% CI: 0.1-0.4). Younger adults had higher psychological 
distress compared to older adults (aOR:6.8; 95% CI:1.5-31.1). Unemployment at 
the time of the first survey was significantly associated with lower life 
satisfaction at the second survey (aOR:0.5; 95% CI: 0.3-0.9).
CONCLUSION: This study supports the findings of other international studies. 
It also highlights the need to promote increased social connection and maintain 
it at times of isolation and separation, particularly amongst younger adults.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-14836-9
PMCID: PMC9793381
PMID: 36575409 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare they have no competing 
interests.


1157. PLoS One. 2022 Dec 27;17(12):e0279698. doi: 10.1371/journal.pone.0279698. 
eCollection 2022.

Risks to mental health of higher degree by research (HDR) students during a 
global pandemic.

Brownlow C(1)(2), Eacersall D(3), Nelson CW(1), Parsons-Smith RL(4)(5), Terry 
PC(1)(2).

Author information:
(1)Graduate Research School, University of Southern Queensland, Toowoomba, 
Australia.
(2)Centre for Health Research, University of Southern Queensland, Toowoomba, 
Australia.
(3)Library Services, University of Southern Queensland, Toowoomba, Australia.
(4)School of Psychology and Wellbeing, University of Southern Queensland, 
Toowoomba, Australia.
(5)School of Health and Behavioural Sciences, University of the Sunshine Coast, 
Sippy Downs, Queensland, Australia.

The COVID-19 pandemic has affected university students globally. Our study 
investigated mental health indicators among higher degree by research (HDR) 
students at a regional university in Queensland, Australia. A total of 231 HDR 
students (female = 137, male = 94) completed the Brunel Mood Scale to assess the 
constructs of Tension, Depression, Anger, Vigor, Fatigue, and Confusion. A 
subset of 11 students participated in three focus groups to explore their 
experiences. Results showed that reported mood among HDR students was generally 
more negative than population norms, although more positive than moods reported 
previously during the pandemic. A total of 52 participants (22.5%) reported mood 
profiles that indicated elevated risk of mental ill-health. Mood profiles varied 
significantly by gender, age, study mode (full-time/part-time), location 
(on-campus/online), and citizenship (domestic/international). Quantitative data 
were supported by focus group findings, which identified mental health and 
wellbeing as key themes of concern to HDR students. Our findings indicate that 
support mechanisms to safeguard the mental health and wellbeing of HDR students 
should be a priority for universities.

Copyright: © 2022 Brownlow et al. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0279698
PMCID: PMC9794097
PMID: 36574430 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


1158. J Community Psychol. 2023 Apr;51(3):1217-1232. doi: 10.1002/jcop.22983. Epub 
2022 Dec 27.

Emotional wellbeing and coping among Latinx young adults in the time of 
COVID-19.

Wagner KM(1)(2), Chatham AA(2)(3), Prado K(3), Walsdorf AA(4)(5), Villatoro 
AP(6), Garcia D(7), de Snyder NS(5)(8), Valdez CR(2)(3).

Author information:
(1)Department of Educational Psychology, The University of Texas, Austin, Texas, 
USA.
(2)Department of Population Health, Dell Medical School, The University of 
Texas, Austin, Texas, USA.
(3)Steve Hicks School of Social Work, The University of Texas, Austin, Texas, 
USA.
(4)Couple and Family Therapy, Alliant International University, San Diego, 
California, USA.
(5)The Latino Research Institute, The University of Texas, Austin, Texas, USA.
(6)Public Health Program, Santa Clara University, Santa Clara, California, USA.
(7)Migrant Clinicians Network, Austin, Texas, USA.
(8)Instituto Nacional de Salud Pública, Cuernavaca, Mexico.

The COVID-19 pandemic has disrupted the wellbeing of the general US population, 
but even more so among Latinx young adults. The current study provides a 
detailed picture of the emotional wellbeing and coping of Latinx young adults 
during the first summer of the pandemic. Six virtual focus groups (n = 21) were 
conducted between May and August of 2020 with a community-based sample of Latinx 
young adults to explore (1) how the pandemic affected wellbeing and (2) how they 
coped with pandemic-related stress. Contextualistic thematic analysis identified 
important themes and subthemes. Perceived stressors impacting emotional 
wellbeing yielded one overarching theme: COVID-related disruptions in the 
participants' environment. To manage this heightened stress, another overarching 
theme was self-care and intentionality during the pandemic. Future studies 
should examine the wellbeing of young adults across social contexts and at more 
recent stages of the pandemic. Findings from this study suggest culturally- and 
developmentally-tailored interventions are needed as this population navigates 
contextual stress during a sensitive period in their life.

© 2022 Wiley Periodicals LLC.

DOI: 10.1002/jcop.22983
PMCID: PMC9880755
PMID: 36573877 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1159. Int J Soc Psychiatry. 2023 Jun;69(4):853-864. doi: 10.1177/00207640221140285. 
Epub 2022 Dec 26.

Unequal outcomes: The effects of the COVID-19 pandemic on mental health and 
wellbeing among Hispanic/Latinos with varying degrees of 'Belonging'.

Baxter T(1), Shenoy S(1), Lee HS(1), Griffith T(1), Rivas-Baxter A(1), Park 
S(1).

Author information:
(1)Department of Psychology, Vanderbilt University, Nashville, TN, USA.

BACKGROUND: The COVID-19 pandemic has brought disparities in mental and physical 
health faced by ethnic minorities to the forefront. In the U.S., Hispanic/Latino 
communities are plagued by elevated rates of psychiatric conditions and trauma. 
Exacerbating this burden, common discourse often implicates Hispanic/Latino 
ethnicity as a causal factor, despite clear evidence of systemic causes, 
including lack of access to resources, and discrimination.
AIMS: To parse apart Hispanic/Latino ethnicity from determinants of wellbeing 
(such as trauma, financial status, and loneliness), we examined mental and 
physical health during COVID-19 via an online, anonymous survey available in 
both English and Spanish.
METHODS: We examined wellbeing across three participant groups, including two 
groups of Hispanic/Latino adults with varying degrees of 'belonging' to the 
dominant culture in their country of residence: Hispanic/Latino individuals 
living in Spanish-speaking and/or Central or Latin American countries (Group 1), 
Hispanic/Latino individuals living in the U.S. (Group 2), and 
non-Hispanic/Latino individuals living in the U.S. (Group 3).
RESULTS: Results demonstrated there were significant differences between groups 
in specific aspects of wellbeing. Most importantly, results showed 
Hispanic/Latino ethnicity does not significantly predict psychosocial wellbeing 
or psychosis risk, and identified several predictors of these outcomes, 
including U.S. residence, trauma, loneliness, and age.
CONCLUSION: Our results demonstrate that Hispanic/Latino ethnicity itself is not 
a causal factor of poor psychosocial wellbeing or elevated psychosis risk and 
instead identify several social and systemic causal factors commonly faced by 
Hispanic/Latino Americans. We suggest that language reporting on minority mental 
health acknowledge systemic factors as contributing to poor outcome rather than 
referring to ethnicity as if it were a causal factor.

DOI: 10.1177/00207640221140285
PMCID: PMC9806202
PMID: 36573293 [Indexed for MEDLINE]


1160. BMC Psychol. 2022 Dec 27;10(1):319. doi: 10.1186/s40359-022-01030-0.

Psychological well-being among Saudi adults during the context of COVID-19 
lockdown: a psychometric analysis of the 12-item General Health Questionnaire.

Hamad EO(1).

Author information:
(1)Department of Psychology, King Abdulaziz University, Jeddah, Saudi Arabia. 
ehamad@kau.edu.sa.

BACKGROUND: Most communities' mental health and perceptions of psychological 
well-being are known to be profoundly disrupted by large-scale pandemics. 
Despite the wide range of available screening measures, few reliable and valid 
screening measures exist for assessing overall psychological well-being in 
nonclinical populations during a health emergency situation such as the COVID-19 
outbreak.
OBJECTIVE: This study aims to conduct a psychometric analysis of Goldberg's 
12-item General Health Questionnaire (GHQ-12) to validate its use among a sample 
of Saudi adults during the COVID-19 lockdown using reliability and factor 
analyses.
METHODS: A total of 473 individuals (aged 18 years and over) were recruited from 
the general Saudi population living in the Makkah (Western) Province of Saudi 
Arabia to complete the virtual format of the Arabic GHQ-12 (Ar-GHQ-12). In 
addition to a descriptive statistics measurement and reliability analysis, 
confirmatory factor analyses (CFA) were performed to examine the 
unidimensionality and validity of the Ar-GHQ-12.
RESULTS: In line with previous works from several cultures, the Ar-GHQ-12 with 
two-factor solution considered to be the best-fitting model because it fits the 
data better than the one-factor (unidimensional) model did, and adequate 
reliability indices were achieved for each factor (.83 for factor 1 and .65 for 
factor 2).
DISCUSSION: The Ar-GHQ-12 was determined to be suitable for assessing the 
overall psychological well-being of the general population in Saudi Arabia in 
emergency contexts and may be applied among Saudis and other Arabic-speaking 
populations in research and primary care settings.

© 2022. The Author(s).

DOI: 10.1186/s40359-022-01030-0
PMCID: PMC9792319
PMID: 36572926 [Indexed for MEDLINE]

Conflict of interest statement: The author has no conflicts of interest to 
declare that are relevant to the content of this study.


1161. Child Abuse Negl. 2023 Feb;136:106000. doi: 10.1016/j.chiabu.2022.106000. Epub 
2022 Dec 21.

Child welfare workers satisfaction and wellbeing during the COVID-19 pandemic: 
Perspectives of agency staff in Ohio.

Shadik JA(1), Perkins NH(2), Heller N(3).

Author information:
(1)Department of Social Work, Ohio University, Morton Hall 535, Athens, OH 
45701, United States of America. Electronic address: shadik@ohio.edu.
(2)School of Social Work, Loyola University Chicago, 820 N Michigan Ave., 
Chicago, IL 60611, United States of America. Electronic address: 
nperkins2@luc.edu.
(3)Communication Sciences and Disorders, Ohio University, Grover Center W218, 
Athens, OH 45701, United States of America. Electronic address: 
nh771814@ohio.edu.

BACKGROUND: The COVID-19 pandemic has impacted the lives of children and 
families, created additional stressors, and increased risks for maltreatment. 
The pandemic has changed the way child welfare agencies operate, requiring 
changes to policies and practice. Minimal research has considered the effects of 
the COVID-19 pandemic on child welfare workers wellbeing and job satisfaction.
OBJECTIVE: This mixed-methods research study seeks to understand CPS staff 
satisfaction, variables impacting satisfaction, and challenges that increased 
since the pandemic began for child welfare workers in Ohio.
PARTICIPANTS AND SETTING: A sample of staff members (n = 267) from 50 CPS 
agencies across Ohio participated in the study.
METHODS: This mixed-methods study used logistic regression, chi square analyses, 
and thematic analysis to analyze the data from a survey sent to child welfare 
agencies in Ohio.
RESULTS: Caring for minor children, primary role at work, and years in child 
welfare were significantly associated with job satisfaction. Those working in 
foster care/placement, adoption/permanency, family support/visitation, kinship 
were 7.57 times more likely than those doing intake/investigation work to be 
satisfied with their job (p = .007). Thematic analysis of staff issues that 
increased during the pandemic resulted in six themes: Stress and Anxiety, 
Feeling Overwhelmed, Burnout, All, Motivation, and Isolation and Disconnection.
CONCLUSIONS: The COVID-19 pandemic has created additional stressors for child 
welfare staff. Practice implications are discussed to help increase job 
satisfaction, staff wellbeing, and mitigate turnover.

Copyright © 2022 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.chiabu.2022.106000
PMCID: PMC9767888
PMID: 36565583 [Indexed for MEDLINE]


1162. Monaldi Arch Chest Dis. 2022 Dec 23;93(4). doi: 10.4081/monaldi.2022.2448.

The lived experience of hospitalized and non-hospitalized health care providers 
of COVID-19 pandemic: a qualitative study.

Abdulah DM(1), Piro RS(2), Liamputtong P(3).

Author information:
(1)College of Nursing, University of Duhok. deldarmorad@gmail.com.
(2)Pediatric and Psychiatric Nursing Unit, College of Nursing, University of 
Duhok. rasoul.piro@uod.ac.
(3)College of Health Sciences, VinUniversity, Hanoi. pranee.l@vinuni.edu.vn.

This paper explores the lived experience and any mental health issues of 
COVID-19 survivors throughout the disease crisis using a qualitative method. The 
semi-structured interviewing method was conducted with COVID-19 patients who 
were admitted and non-admitted to hospitals in Kurdistan, Iraq. The patients had 
positive and negative perceptions of the COVID-19 pandemic and disease, 
including beliefs and thoughts about COVID-19, conspiracy thinking, and concerns 
toward the family and their children. The patients were affected by the disease 
in different ways including physical consequences of COVID-19 infection, social 
isolation, life changes, and mental wellbeing. But they had some coping 
strategies to overcome the disease, such as seeking help, preventive measures, 
and coping techniques. The patients had some concerns about health settings and 
therapeutic procedures, including lack of sufficient care, receptiveness, 
hospital environment, and infection guidelines. This study showed that the 
COVID-19 disease had devastating effects on patients either physically or 
psychologically.

DOI: 10.4081/monaldi.2022.2448
PMID: 36562639 [Indexed for MEDLINE]


1163. Front Med (Lausanne). 2022 Dec 6;9:954519. doi: 10.3389/fmed.2022.954519. 
eCollection 2022.

Spirituality in people with advanced chronic obstructive pulmonary disease - 
challenge for more effective interventions, support, and healthcare education: 
Mini-review.

Kotlińska-Lemieszek A(1)(2), Fopka-Kowalczyk M(3), Krajnik M(4).

Author information:
(1)Pharmacotherapy in Palliative Care Laboratory, Chair and Department of 
Palliative Medicine, Poznań University of Medical Sciences, Poznań, Poland.
(2)Outpatient Palliative Medicine Clinic, Heliodor Swięcicki University 
Hospital, Poznań, Poland.
(3)Department of Philosophy and Social Sciences, Nicolaus Copernicus University 
in Toruń, Toruń, Poland.
(4)Department of Palliative Care, Collegium Medicum in Bydgoszcz, Nicolaus 
Copernicus University in Toruń, Bydgoszcz, Poland.

More recently there has been a growing interest in spirituality in medicine, 
especially in the field of palliative care, oncology, intensive care, and 
cardiology. However, according to literature, it seems to be a limited number of 
researches on how healthcare professionals should provide spiritual care (SC) 
for people with non-malignant lung diseases and what kind of education for them 
enables them to do it efficiently. This mini-review aims to provide an overview 
of current knowledge of an area of spirituality and SC for people with advanced 
chronic obstructive pulmonary disease, including spiritual well-being and 
religious/spiritual coping, their relations with the quality of life and symptom 
burden, exercise capacity and daily functioning, mental health, or medication 
adherence. It also analyses the use of interventions to meet patients' spiritual 
needs and patients' expectations regarding SC provided by professional careers. 
Based on the literature authors try to show the fields that should be improved 
and proposed future research directions.

Copyright © 2022 Kotlińska-Lemieszek, Fopka-Kowalczyk and Krajnik.

DOI: 10.3389/fmed.2022.954519
PMCID: PMC9763313
PMID: 36561722

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1164. Int J Environ Res Public Health. 2022 Dec 19;19(24):17071. doi: 
10.3390/ijerph192417071.

Job Satisfaction Goes a Long Way: The Mediating Role of Teaching Satisfaction in 
the Relationship between Role Stress and Indices of Psychological Well-Being in 
the Time of COVID-19.

Padmanabhanunni A(1), Pretorius TB(1).

Author information:
(1)Department of Psychology, University of the Western Cape, Bellville 7530, 
South Africa.

The COVID-19 pandemic and its containment measures has resulted in drastic 
changes in the educational landscape. Teachers had to rapidly adapt to shifts in 
their work-related roles and responsibilities. This situation likely led to role 
stress and affected the levels of job satisfaction, mental health and general 
life satisfaction. In this study, we examined the role of teachers' job 
satisfaction in the relationship between role stress and indices of 
psychological well-being. The participants were South African school teachers (N 
= 355) who completed the Role Orientation Questionnaire, the Teaching 
Satisfaction Scale, the Center for Epidemiological Studies Depression Scale, the 
trait scale of the State-Trait Anxiety Inventory and the Satisfaction with Life 
Scale. In addition to descriptive statistics and correlations, path analysis was 
performed to determine the mediating role of teaching satisfaction. Increased 
levels of teaching satisfaction were associated with decreased levels of 
depression and anxiety and increased levels of life satisfaction. Teaching 
satisfaction also mediated the relationship between role conflict, as well as 
role ambiguity and anxiety. The results indicated that teaching satisfaction is 
a critical protective factor for teachers. Thus, improving task significance and 
enhancing the meaning associated with the teaching profession may help promote 
the adaptive functioning of teachers.

DOI: 10.3390/ijerph192417071
PMCID: PMC9779460
PMID: 36554949 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1165. Int J Environ Res Public Health. 2022 Dec 19;19(24):17046. doi: 
10.3390/ijerph192417046.

'24/7' Caregiving: A Qualitative Analysis of an Emerging Phenomenon of Interest 
in Caregiving.

Chew EYH(1), Ong ZL(1), Glass GF Jr(1), Chan EY(1)(2).

Author information:
(1)Nursing Research Unit, Nursing Service, Centre for Healthcare Innovation, Tan 
Tock Seng Hospital, Singapore 308443, Singapore.
(2)Geriatric Education and Research Institute (GERI), Singapore 768024, 
Singapore.

The COVID-19 pandemic has exacerbated the difficulties faced by caregivers who 
have to provide continuous '24/7' care to persons with dementia with minimal 
formal and informal support. While caregivers have reported heightened levels of 
caregiving distress and burden during the pandemic, there remains a dearth of 
research pertaining to their lived experiences of providing continuous care with 
little respite and the corresponding physical, psychosocial and emotional 
impacts of caregiving '24/7'. The present study uses data obtained from 
interviews with dementia caregivers (N = seven) that were collected as part of a 
larger study on Carer Matters, a hospital-based holistic caregiver support 
program held during COVID-19, to conduct a secondary thematic analysis. The 
findings revealed three themes that defined the shared experiences of '24/7' 
caregivers: (1) A World Overturned, which refers to the increase in caregiving 
intensity and burden due to the pandemic; (2) Burning on Both Ends, which refers 
to the impossible balance between caregiving and their personal lives; and (3) 
At Wits' End, which refers to an overwhelming sense of hopelessness and 
helplessness over their caregiving situation. These findings highlight the 
challenges and unsustainability of '24/7' caregiving and the detrimental impact 
that round-the-clock care wields on caregivers' physical and mental well-being. 
Implications and recommendations are discussed in accordance with the cultural 
particularities of the study's Asian context (Singapore), with calls for greater 
caregiver support to be better integrated into society and the community, 
especially at the neighborhood and grassroots level, to alleviate caregiving 
burden and safeguard their well-being.

DOI: 10.3390/ijerph192417046
PMCID: PMC9779682
PMID: 36554924 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses or 
interpretation of data; in the writing of the manuscript; or in the decision to 
publish the results.


1166. Int J Environ Res Public Health. 2022 Dec 18;19(24):17021. doi: 
10.3390/ijerph192417021.

Division of Labour and Parental Mental Health and Relationship Well-Being during 
COVID-19 Pandemic-Mandated Homeschooling.

Elgendi MM(1), Stewart SH(1), DesRoches DI(1), Corkum P(1), Nogueira-Arjona 
R(2), Deacon SH(1).

Author information:
(1)Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS 
B3H 4R2, Canada.
(2)School of Psychology, University of Sussex, Falmer, Brighton BN1 9QH, UK.

While the COVID-19 pandemic has impacted the way parents partition tasks between 
one another, it is not clear how these division of labour arrangements affect 
well-being. Pre-pandemic research offers two hypotheses: economic theory argues 
optimal outcomes result from partners specialising in different tasks, whereas 
psychological theory argues for a more equitable division of labour. The 
question of which approach optimizes well-being is more pressing in recent 
times, with COVID-19 school closures leaving many couples with the burden of 
homeschooling. It is unknown whether specialisation or equity confer more 
benefits for mandated homeschoolers, relative to non-homeschoolers or voluntary 
homeschoolers. Couples (n = 962) with children in grades 1-5 completed measures 
of workload division and parental well-being. A linear mixed modelling in the 
total sample revealed that specialisation, but not equity, promoted increased 
parental emotional and relationship well-being. These relations were moderated 
by schooling status: voluntary homeschoolers' well-being benefitted from 
specialisation, whereas mandated homeschoolers' well-being did not benefit from 
either strategy; non-homeschoolers well-being benefitted from both strategies. 
Across the mixed-gender couples, mothers' and fathers' well-being both 
benefitted from specialisation; equity was only beneficial for mothers' 
well-being. Overall, couples might be advised to adopt highly equitable and 
specialised arrangements to promote both parents' well-being.

DOI: 10.3390/ijerph192417021
PMCID: PMC9779066
PMID: 36554900 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript; or in the decision to 
publish the results.


1167. Int J Environ Res Public Health. 2022 Dec 15;19(24):16878. doi: 
10.3390/ijerph192416878.

Longitudinal Study Comparing Mental Health Outcomes in Frontline Emergency 
Department Healthcare Workers through the Different Waves of the COVID-19 
Pandemic.

Th'ng F(1), Rao KA(1), Ge L(2), Neo HN(1), Molina JA(2), Lim WY(3), Mao D(1).

Author information:
(1)Acute & Emergency Care Department, Khoo Teck Puat Hospital, 90 Yishun 
Central, Singapore 768828, Singapore.
(2)Health Services and Outcomes Research, National Healthcare Group, 3 
Fusionopolis Link, Singapore 138543, Singapore.
(3)School of Medicine, University of Galway, University Road, Galway H91TK33, 
Ireland.

As countries transition from the COVID-19 pandemic to endemic status, healthcare 
systems continue to be under pressure. We aimed to quantify changes in 
depression, anxiety, stress and post-traumatic stress disorder (PTSD) between 3 
cohorts (2020, 2021 and 2022) of our Emergency Department (ED) healthcare 
workers (HCWs) and those who had worked through all 3 phases of the pandemic; 
and identify factors associated with poorer mental health outcomes (MHOs). In 
this longitudinal single-centre study in Singapore, three surveys were carried 
out yearly (2020, 2021 and 2022) since the COVID-19 outbreak. Depression, 
anxiety and stress were measured using DASS-21, and PTSD was measured using 
IES-R. A total of 327 HCWs (90.1%) participated in 2020, 279 (71.5%) in 2021 and 
397 (92.8%) in 2022. In 2022, ED HCWs had greater concerns about workload (Mean 
score ± SD: 2022: 4.81 ± 0.86, vs. 2021: 4.37 ± 0.89, vs. 2020: 4.04 ± 0.97) and 
perceived to have less workplace support (2022: 4.48 ± 0.76, vs. 2021: 4.66 ± 
0.70, vs. 2020: 4.80 ± 0.69). There was overall worsening depression (27.5% in 
2020, 29.7% in 2021 and 32.2% in 2022) and stress (12.2% in 2020, 14.0% in 2021 
and 17.4% in 2022). Healthcare assistants as a subgroup had improving MHOs. ED 
HCWs who were female and had psychiatric history, were living with the elderly, 
and had concerns about their working environment, workload and infection had 
poorer MHOs. This study will guide us in refining existing and devising more 
focused interventions to further support our ED HCWs' wellbeing.

DOI: 10.3390/ijerph192416878
PMCID: PMC9779183
PMID: 36554759 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript, or in the decision to 
publish the results.


1168. Int J Environ Res Public Health. 2022 Dec 15;19(24):16877. doi: 
10.3390/ijerph192416877.

Life Satisfaction and Academic Engagement in Chileans Undergraduate Students of 
the University of Atacama.

Burgos-Videla C(1), Jorquera-Gutiérrez R(2), López-Meneses E(3)(4), Bernal C(5).

Author information:
(1)Department of Primary Education, Institute for Research in Social Sciences 
and Education, Vice-Rectory for Research and Postgraduate, University of 
Atacama, Copiapó 1530000, Chile.
(2)Department of Psychology, University of Atacama, Copiapó 1531772, Chile.
(3)Department of Education and Social Psychology, Pablo de Olavide University, 
41013 Seville, Spain.
(4)Ecotec University, Km 13.5 Vía Samborondón, Samborondón 092302, Guayas, 
Ecuador.
(5)Department of Education Sciences, Language, Culture and Arts, Rey Juan Carlos 
University, 28032 Madrid, Spain.

The growing problem of mental health in the university population, as a 
consequence of the COVID-19 pandemic, has generated the need to consider 
positive variables to address this situation. Life satisfaction and academic 
engagement are two constructs that emerge as conceptual tools oriented in this 
direction. The present study sought to describe the effect of academic 
engagement on life satisfaction in a sample of Chilean university students. A 
cross-sectional co-relational design was used. A total of 370 university 
students participated, 72.4% female and 27.6% male, aged beitive effect of 
engagement on life satisfaction was demonstrated, where the dimensions vigor (β 
= 0.462; p < 0.01) and dedication (β = 0.465; p < 0.01) acted as significant 
predictors (χ2 = 87.077, gl = 32, p < 0.01; χ2/gl = 2.721; CFI = 975; TLI = 
0.964; RMSEA = 0.068). The proposed model showed factorial invariance according 
to sex. The usefulness of employing these constructs as a way to manage the 
well-being and mental health of students in university institutions is 
discussed.

DOI: 10.3390/ijerph192416877
PMCID: PMC9778642
PMID: 36554756 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1169. Int J Environ Res Public Health. 2022 Dec 15;19(24):16863. doi: 
10.3390/ijerph192416863.

A Rapid Systematic Review on the Experiences of Cancer Survivors Residing in 
Rural Areas during the COVID-19 Pandemic.

Nelson D(1)(2), Cooke S(3), McLeod B(4), Nanyonjo A(1), Kane R(3), Gussy 
M(1)(5).

Author information:
(1)Lincoln International Institute for Rural Health, University of Lincoln, 
Brayford Pool, Lincoln LN6 7TS, UK.
(2)Macmillan Cancer Support, London SE1 7UQ, UK.
(3)School of Health and Social Care, College of Social Science, University of 
Lincoln, Brayford Pool, Lincoln LN6 7TS, UK.
(4)Lincoln Medical School, College of Science, University of Nottingham and 
University of Lincoln, Lincoln LN6 7TS, UK.
(5)La Trobe Rural Health School, College of Science, Health and Engineering, La 
Trobe University, Bendigo, VIC 3086, Australia.

The COVID-19 pandemic has caused considerable disruption to cancer care and may 
have exacerbated existing challenges already faced by cancer survivors from 
rural areas. This has created a need for a rapid evidence synthesis to inform 
the development of tailored interventions that address the specific needs of 
rural cancer survivors who continue to be affected by the pandemic. The review 
was conducted following guidance from the Cochrane Rapid Review Methods Group. 
Database searches were performed via the EBSCOHost interface (includes MEDLINE, 
CINAHL, PsycINFO) on 25 May 2022 and supplemented with searches on Google 
Scholar. Peer-reviewed articles published after March 2020 that reported primary 
data on the experiences of cancer survivors residing in rural and remote 
settings during the pandemic were included. Findings were tabulated and written 
up narratively. Fourteen studies were included. The COVID-19 pandemic had a 
mostly detrimental impact on the experiences of rural cancer survivors. People's 
individual coping mechanisms were challenging for a range of reasons. 
Specifically, the pandemic impacted on their ability to access testing, 
treatment, check-ups and supportive care, their ability to maintain and access 
social support with close friends and family, as well as negative consequences 
to their finances and emotional wellbeing with some reporting feelings of 
psychological distress including depression and anxiety. This review provides 
important insight into the experiences of rural cancer survivors that may help 
inform tailored support in line with the needs and challenges faced because of 
the pandemic.

DOI: 10.3390/ijerph192416863
PMCID: PMC9778689
PMID: 36554740 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1170. Int J Environ Res Public Health. 2022 Dec 13;19(24):16745. doi: 
10.3390/ijerph192416745.

Well-Being amongst College Students during COVID-19 Pandemic: Evidence from a 
Developing Country.

Martinez L(1), Valenzuela LS(2), Soto VE(3).

Author information:
(1)Business School, Universidad Icesi & POLIS, Cali 760031, Colombia.
(2)Entrepreneurship Development Center, CDEE, Universidad Icesi, Cali 760031, 
Colombia.
(3)PROESA, Universidad Icesi, Cali 760031, Colombia.

College students face unique challenges that the consequences of COVID-19 might 
aggravate. To explore the pandemic's consequences on college students' 
well-being, we conducted an online survey with 634 students from a private 
university in Cali, Colombia. The study sought to assess students' well-being 
due to COVID-19, and to explore the mediating effects of optimism, gratitude, 
and emotional closeness on college students' well-being. Results showed that 
COVID-19 affected students' mental health and well-being. Being optimistic and 
grateful mediated with life satisfaction and happiness. Optimism, emotional 
closeness, and gratitude also mediated the negative effect of fear of infection 
and the pandemic's impact on students' academic performance. The results of this 
analysis will promote discussion of the implementation of coping strategies to 
help students thrive, promote resilience, and contribute to students' well-being 
and better mental health.

DOI: 10.3390/ijerph192416745
PMCID: PMC9779102
PMID: 36554626 [Indexed for MEDLINE]

Conflict of interest statement: No potential conflict of interest is reported by 
the author(s).


1171. Int J Environ Res Public Health. 2022 Dec 12;19(24):16696. doi: 
10.3390/ijerph192416696.

Associations between Depression and Self-Reported COVID-19 Symptoms among 
Adults: Results from Two Population-Based Seroprevalence Studies in Switzerland.

Piumatti G(1), Amati R(2), Richard A(3), Baysson H(4)(5), Purgato M(6)(7), 
Guessous I(4)(5), Stringhini S(4)(5), Albanese E(2)(3); SEROCoV-POP; 
Specchio-Covid Study Group, The Corona Immunitas Ticino Working Group.

Author information:
(1)Fondazione Agnelli, 10125 Turin, Italy.
(2)Institute of Public Health, Faculty of BioMedicine, Università della Svizzera 
Italiana, 6900 Lugano, Switzerland.
(3)Institute of Global Health, University of Geneva, 1202 Geneva, Switzerland.
(4)Division of Primary Care, Geneva University Hospitals, 1206 Geneva, 
Switzerland.
(5)Department of Health and Community Medicine, Faculty of Medicine, University 
of Geneva, 1211 Geneva, Switzerland.
(6)Section of Psychiatry, WHO Collaborating Centre for Research and Training in 
Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine, 
and Movement Sciences, University of Verona, 37134 Verona, Italy.
(7)Cochrane Global Mental Health, University of Verona, 37129 Verona, Italy.

(1) Mental health may modulate the perceived risk of SARS-CoV-2 infection. 
However, it is unclear how psychological symptoms may distort symptom perception 
of COVID-19 and SARS-CoV-2 infection. We assessed whether depressive symptoms 
predicted self-reported COVID-19 symptoms, independently of serologically 
confirmed SARS-CoV-2 infection. (2) Participants (aged 20-64) in the Geneva (N = 
576) and Ticino (N = 581) Swiss regions completed the Patient Health 
Questionnaire before being tested for anti-SARS-CoV-2 IgG antibodies and 
recalled COVID-19-compatible symptoms on two occasions: April-July 2020 
(baseline), and January-February 2021 (follow-up). We estimated prevalence 
ratios for COVID-19 symptoms by depression scores in interaction with 
serological status. (3) At baseline, in Geneva, higher depression predicted 
higher probability of reporting systemic, upper airways, and gastro-intestinal 
symptoms, and fever and/or cough; in Ticino, higher depression predicted 
systemic, upper airways, and gastro-intestinal symptoms, fever and/or cough, 
dyspnea, and headache. At follow-up, in Geneva, higher depression predicted 
higher probability of reporting systemic symptoms and dyspnea; in Ticino, higher 
depression predicted higher probability of reporting systemic and upper airways 
symptoms, dyspnea and headache (all p values < 0.05). (4) We found positive 
associations between depressive symptoms and COVID-19-compatible symptoms, 
independently of seropositivity. Mental wellbeing has relevant public health 
implications because it modulates self-reported infection symptoms that inform 
testing, self-medication, and containment measures, including quarantine and 
isolation.

DOI: 10.3390/ijerph192416696
PMCID: PMC9779289
PMID: 36554578 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1172. Int J Environ Res Public Health. 2022 Dec 10;19(24):16623. doi: 
10.3390/ijerph192416623.

Aging in Place: Connections, Relationships, Social Participation and Social 
Support in the Face of Crisis Situations.

Pinazo-Hernandis S(1), Blanco-Molina M(2), Ortega-Moreno R(2).

Author information:
(1)Social Psychology Department, Faculty of Psychology, University of Valencia, 
46010 Valencia, Spain.
(2)School of Psychology, Faculty of Social Science, National University, Heredia 
40101, Costa Rica.

OBJECTIVES: We seek to identify active coping strategies used by older adults to 
face the pandemic and to deal with daily stressors, and to clarify which factors 
had an effect on stress, positive emotions and depression in active and healthy 
community-dwelling older adults in the first and second year of the pandemic in 
Costa Rica.
METHODS: Participants were living in their own homes in Costa Rica (n = 218, 
mean age 69.96, 82.1% women). Participants were interviewed by phone and 
answered an online survey, which included socio-demographic information, mental 
health variables such as stressors (perceived health and fear of COVID-19, 
illness, perception of pandemic gravity), loneliness (whether they felt lonely 
and how often they felt lonely), access to Information and Communication 
Technologies, socio-emotional coping variables, social participation and 
physical activity level during the pandemic.
RESULTS: Positive socio-emotional indicators related to well-being such as 
self-efficacy, social support, perceived health and proactive behavior were 
high. Negative well-being indicators such as perceived stress, emotional 
COVID-19 fear and loneliness showed low values in the sample studied during both 
years. We found significant relations across the dependent variables (perceived 
stress, positive emotions and depression) by studying the psychological 
well-being coping strategies.
CONCLUSIONS: Findings highlight the importance of coping strategies and social 
participation in the capacity of older adults to mitigate the negative 
psychological consequences of crisis situations and provide evidence of "aging 
in place".

DOI: 10.3390/ijerph192416623
PMCID: PMC9779458
PMID: 36554504 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1173. Int J Environ Res Public Health. 2022 Dec 9;19(24):16553. doi: 
10.3390/ijerph192416553.

Understanding the Psychological Well-Being of International Arrivals in a 
Purpose-Designed Australian COVID-19 Quarantine Facility.

Mitchell D(1), Esler D(2), Straube KA(1), Thomas DP(3), Stephens D(4), 
Bressington D(5).

Author information:
(1)Top End Mental Health Service, Royal Darwin Hospital, Darwin, NT 0810, 
Australia.
(2)Public Health Directorate, NT Health, Darwin, NT 0800, Australia.
(3)Menzies School of Health Research, Charles Darwin University, Darwin, NT 
0810, Australia.
(4)CDU Menzies School of Medicine, Charles Darwin University, Ellengowan Drive, 
Darwin, NT 0909, Australia.
(5)College of Nursing and Midwifery, Charles Darwin University, Ellengowan 
Drive, Darwin, NT 0909, Australia.

Equivocal evidence suggests that mandatory supervised quarantine can negatively 
affect psychological well-being in some settings. It was unclear if COVID-19 
supervised quarantine was associated with psychological distress in Australia. 
The sociodemographic characteristics associated with distress and the lived 
experiences of quarantine are also poorly understood. Therefore, this study 
aimed to evaluate the mental well-being of international arrivals undergoing 
supervised COVID quarantine in a purpose designed facility in the Northern 
Territory, Australia. We conducted a concurrent triangulation mixed-methods 
study comprising of an observational cross-sectional survey (n = 117) and 
individual qualitative interviews (n = 26). The results revealed that several 
factors were associated with distress, including significantly higher levels of 
depression for those who smoked, drank alcohol, had pre-existing mental health 
conditions and had no social networks in quarantine. Levels of psychological 
distress were also related to waiting time for re-entry (the time between 
applying to repatriate and returning to Australia) and flight origin. 
Qualitative data showed that despite quarantine being viewed as necessary, 
unclear communication and a perception of lack of control were affecting 
emotional well-being. This information is useful to inform the further 
development of models to identify those at most risk and support psychological 
well-being in quarantine settings.

DOI: 10.3390/ijerph192416553
PMCID: PMC9779351
PMID: 36554434 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
study funding sponsors had no role in the design, execution, interpretation, or 
writing of the study.


1174. Int J Environ Res Public Health. 2022 Dec 7;19(24):16425. doi: 
10.3390/ijerph192416425.

How Do Shifts in Patients with Mental Health Problems' Formal and Informal Care 
Utilization Affect Informal Caregivers?: A COVID-19 Case Study.

Bremmers LGM(1), Hakkaart-van Roijen L(1), Gräler ES(1), Uyl-de Groot CA(1), 
Fabbricotti IN(1).

Author information:
(1)Erasmus School of Health Policy and Management, Erasmus University Rotterdam, 
P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.

(1) Background: This study investigated how potential shifts in patients' formal 
and informal care utilization during the COVID-19 pandemic impacted their 
informal caregivers in terms of their subjective burden, psychological 
wellbeing, and happiness. (2) Methods: A retrospective cohort study design was 
employed for a panel of Dutch informal caregivers of persons with mental health 
problems (n = 219) in June 2020. Descriptive statistics and differences between 
means were determined for the patients' informal and care utilization and 
informal caregivers' subjective burden, happiness, and psychological wellbeing. 
Three mediation analyses were conducted using the PROCESS macro. (3) Results: 
Informal caregivers reported significantly worse happiness and subjective burden 
scores during the COVID-19 pandemic compared with before the lockdown. There 
were minimal shifts in patient's care utilization reported, with the exception 
of a decrease in significant emotional and practical support provided by the 
informal caregiver. In the mediation analyses, there was not a significant 
indirect effect of shifts in patients' formal care utilization on informal 
caregivers' subjective burden, psychological wellbeing, and happiness through 
shifts in patients' informal care utilization. (4) Discussion and conclusion: 
Whilst we found that shifts in patients' care utilization during the first wave 
of the pandemic did not affect the informal caregiver in the short term, it is 
unclear what the long-term impact of the pandemic might be on informal 
caregivers. More research should be conducted to understand the implications of 
short- and long-term impact of substitution on informal caregivers of persons 
with mental health problems, with special consideration of the COVID-19 context 
and uptake of e-health technology.

DOI: 10.3390/ijerph192416425
PMCID: PMC9778175
PMID: 36554308 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1175. Medicine (Baltimore). 2022 Dec 16;101(50):e32054. doi: 
10.1097/MD.0000000000032054.

The pandemic's effect on a patient cohort with painful polyneuropathy in 2020: A 
longitudinal study on pain, mood, and everyday life.

Kersebaum D(1)(2), Sendel M(1), Fabig SC(1), Sachau J(1), Lassen J(1), Rehm 
S(1), Forstenpointner J(1), Rümenapp J(1), Vollert J(1), Hüllemann P(1), Baron 
R(1), Gierthmühlen J(3).

Author information:
(1)Division of Neurological Pain Research and Therapy, Department of Neurology, 
University Hospital of Schleswig-Holstein, Campus Kiel, Germany.
(2)Imland Clinic Rendsburg, Department of Psychiatry, Psychotherapy and 
Psychosomatics, Rendsburg, Germany.
(3)Interdisciplinary Pain and Palliative Care Division, Department of 
Anesthesiology and Intensive Care Medicine, Campus Kiel, Germany.

In the early phase of the COVID pandemic 2020, we demonstrated how patients with 
painful polyneuropathy, against our expectations, did not experience a 
deterioration of their neuropathic pain. We hypothesized that our assessed 
measures, that is, pain intensity and characteristics, emotional wellbeing, and 
everyday life, would deteriorate in the further course of the pandemic according 
to the phases of disaster management. Thus, the aim of our study was to 
investigate patients repeatedly under varying pandemic conditions from March 
until December 2020. Sixty-three patients were investigated with validated 
questionnaires (brief pain inventory [BPI], neuropathic pain symptom inventory 
[NPSI], pain catastrophizing scale [PCS], patient-reported outcomes measurement 
information system [PROMIS] pain interference/sleep disturbance/fatigue/ 
depression/anxiety, EuroQol 5 dimensions 5 level version [EQ-5D-5L]) and a 
pandemic-specific, self-designed questionnaire. The data from the beginning of 
the pandemic with severe restrictions, during summer with loosened regulations 
and from December 2020 with reinstalled, severe restrictions were compared with 
an observational design. Patients reported higher pain severity when 
restrictions were lower. Sleep, mood, and quality of life did not change in the 
course of the pandemic in the validated measures. Pain interference 
significantly decreased during the study independent from restrictions. Patients 
who reported medical disadvantages had a lower quality of life upon EuroQol 5 
dimension (EQ-5D) and were significantly more worried about their health. The 
perception of pain intensity was dependent on pandemic severity. Sleep, mood, 
and quality of life did not change significantly in validated measures. 
Continued medical care seems decisive to prevent worsening of pain and quality 
of life.

Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

DOI: 10.1097/MD.0000000000032054
PMCID: PMC9771215
PMID: 36550857 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
disclose.


1176. BMC Public Health. 2022 Dec 22;22(1):2414. doi: 10.1186/s12889-022-14878-z.

COVID-19 and its prevention in internally displaced person (IDP) camps in 
Somalia: impact on livelihood, food security and mental health.

Mumin FI(1), Wesonga FD(2), Handuleh JIM(3)(4), White RG(5), Mor SM(6)(7).

Author information:
(1)Faculty of Veterinary Medicine, Red Sea University, Bosaso, Somalia. 
farahissem@gmail.com.
(2)IGAD Sheikh Technical Veterinary School, Sheikh , Somaliland.
(3)Department of Psychiatry, Saint Paul's Hospital Millennium Medical College, 
Addis Ababa, Ethiopia.
(4)School of Public Health, Amoud University, Borama, Somaliland.
(5)School of Psychology, Queen's University Belfast, Belfast, UK.
(6)Institute of Infection, Veterinary and Ecological Sciences, University of 
Liverpool, Liverpool, UK.
(7)International Livestock Research Institute, Addis Ababa, Ethiopia.

BACKGROUND: Somalia has over 2.6 million internally displaced people (IDP) that 
depend on daily wages and humanitarian assistance for their livelihoods. This 
study investigated the impact of COVID-19 on livelihoods, food security and 
mental health of Somalia's IDPs.
METHODS: A questionnaire was conducted with "breadwinners" (n = 585) residing in 
15 randomly selected IDP camps. Mental health was assessed using the 5-item 
World Health Organization Wellbeing Index (WHO-5) and the Patient Health 
Questionnaire-9 (PHQ-9). Multivariable regression was used to explore the effect 
of depressive symptoms on soap use and ability to pay for food/medicine/rent.
RESULTS: Knowledge of COVID-19 symptoms, transmission and prevention was 
relatively high, however only 55% reported using soap for hand washing. Around 
one third perceived that prohibition of public gatherings had negatively 
impacted weekly earnings. Participants reported difficulty buying food (85%), 
medicine (82%) and paying rent (51%) because of COVID-19. The majority were 
assessed as having low wellbeing and high depressive symptoms (mean 
WHO-5 = 44.2/100; mean PHQ-9 = 18.6/27), with most (74%) indicating that they 
felt worse than before the pandemic. Compared to people with low depressive 
symptoms, people with high depressive symptoms were less likely to use soap 
(aOR = 0.3, 95% CI = 0.2, 0.7; P < 0.001) and more likely to report difficulty 
buying food (aOR = 2.2; 95% CI = 1.1, 4.3; P = 0.02).
CONCLUSION: COVID-19 and associated restrictions have negatively impacted 
Somalia's internally displaced population. Livelihood and mental health support 
is urgently needed in the recovery phase of the pandemic and should be factored 
into future pandemic planning.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-14878-z
PMCID: PMC9779940
PMID: 36550473 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1177. Sci Rep. 2022 Dec 22;12(1):22176. doi: 10.1038/s41598-022-26601-4.

Doctoral researchers' mental health and PhD training satisfaction during the 
German COVID-19 lockdown: results from an international research sample.

Naumann S(#)(1)(2), Matyjek M(#)(3)(4), Bögl K(#)(3)(4), Dziobek I(3)(4).

Author information:
(1)Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, 
Germany. sandra.naumann@hu-berlin.de.
(2)Department of Psychology, Institute of Life Sciences, Humboldt-Universität zu 
Berlin, Berlin, Germany. sandra.naumann@hu-berlin.de.
(3)Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, 
Germany.
(4)Department of Psychology, Institute of Life Sciences, Humboldt-Universität zu 
Berlin, Berlin, Germany.
(#)Contributed equally

Academia has been facing a mental health crisis particularly affecting early 
career researchers (ECRs). Moreover, the COVID-19 pandemic posed an 
unprecedented burden on the mental health of many individuals. Therefore, we 
cross-sectionally investigated how doctoral researchers (N = 222) evaluate their 
mental health status and satisfaction with their PhD training before and during 
the pandemic. As compared to self-reported, retrospective evaluations about the 
pre-pandemic state, we found decreased satisfaction with PhD training and 
overall well-being. The whole sample exhibited high levels of personal and 
work-related burnout, a fifth indicated clinically meaningful levels of 
depressive symptoms and almost 25% experienced severe loneliness. When exploring 
predictors of depression, anxiety, and burnout, we identified low satisfaction 
with PhD training as the most prominent predictor for poor mental health, 
suggesting a link between the doctoral work and their mental health status. 
Females vs. males and doctoral researchers in individual doctorate vs. 
structured PhD programs reported higher symptoms of burnout. Our study 
replicates previous findings of poor mental health in doctoral researchers and 
indicates further decreases of mental wellbeing under the influence of the 
pandemic. Systematic adjustments in academia are required to improve the mental 
health of ECRs.

© 2022. The Author(s).

DOI: 10.1038/s41598-022-26601-4
PMCID: PMC9778465
PMID: 36550297 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1178. Psychiatr Danub. 2022 Winter;34(4):743-751. doi: 10.24869/psyd.2022.743.

A Conceptual Model of Adolescents' Attachment and Resilience to Daily Stressors: 
Implications for COVID-19 Normalization Period and Afterwards.

Xing J(1).

Author information:
(1)Shanghai Normal University Tianhua College (STHU), No. 1661 North Shengxin 
Road, Jiading District, Postcode 201815, Shanghai, China, xjw2041@sthu.edu.cn; 
wxing@chapman.edu.

Resilience is a concept that has captured intensified attention since COVID-19. 
Over decades, resilience research has been done across diverse domains focused 
on stress responses to adversity. For adolescents who are undergoing a "storm 
and stress" phase in transition to adulthood, everyday stresses should be 
managed timely and properly so that resilience is in place when needed. Within 
the frameworks of attachment and resilience, the author conducted this narrative 
review proposing a conceptual model to discuss adolescents' attachment and 
resilience to daily stressors during and following the pandemic. Theoretical and 
empirical evidence showed building relationships and regulating emotions are 
instrumental in nurturing adolescents' resilience. This review may have 
implications for the prevention and intervention of adolescents' mental health 
during and after COVID-19, which may aid in the transition to adulthood and 
later life well-being.

DOI: 10.24869/psyd.2022.743
PMID: 36548897 [Indexed for MEDLINE]


1179. Harm Reduct J. 2022 Dec 22;19(1):145. doi: 10.1186/s12954-022-00709-2.

Accessing needle exchange services in disasters for remote areas of Aotearoa New 
Zealand.

Rijnink A(1), Blake D(2), Groot S(3), Brough C(4).

Author information:
(1)School of Psychology, Massey University, Wellington, Aotearoa New Zealand.
(2)School of Health, Te Herenga Waka-Victoria University of Wellington, 
Wellington, Aotearoa New Zealand. denise.blake@vuw.ac.nz.
(3)School of Psychology, University of Auckland, Auckland, Aotearoa New Zealand.
(4)NICHE, Nelson, Aotearoa New Zealand.

BACKGROUND: Needle Exchange Programme (NEP) mobile outreach services in Aotearoa 
New Zealand distribute injecting equipment to people who inject drugs (PWID) 
living in remote regions. In disasters, continued access to such services is 
imperative for the health and wellbeing of PWID. Disasters can compound existing 
inequities, particularly in regions characterised by poor or limited 
infrastructure, smaller populations, and challenging socioeconomic conditions. 
To gain insight into the barriers that prevent access to NEP harm-reduction 
services and understand the needs of PWID prior to and during disasters, this 
study foregrounds the voices of PWID based on the West Coast of the South 
Island, Aotearoa New Zealand.
METHODS: This qualitative study applied an interpretive phenomenological 
analysis approach, where 14 PWID and one key NEP staff member took part in 
semi-structured interviews. The interviews provided the opportunity for 
participants to share their experiences and perspectives about accessing sterile 
drug-injecting equipment during disasters, including the four-week COVID-19 
Level 4 lockdown in March 2020. In total five superordinate and 14 subordinate 
themes were identified from the interveiws.
RESULTS: This study focuses on four of the key themes that impacted 
accessibility to NEP services: infrastructural hazards and equipment costs; 
social capital and practical support from peers and key contact networks; social 
stigma in public locations, including NEP-based pharmacies and emergency 
centres; and potential solutions to NEP equipment accessibility as frequently 
suggested by participants.
CONCLUSIONS: Access to NEP services is essential during natural hazard and 
human-generated disasters, as such NEP mobile outreach services and disaster 
resilience efforts should focus on maintaining service continuity for PWID 
during adverse times. This study champions a needs-based, stigma free approach 
to inclusive harm-reduction and emergency management practices for groups with 
specific needs in a disaster context.

© 2022. The Author(s).

DOI: 10.1186/s12954-022-00709-2
PMCID: PMC9771773
PMID: 36544156 [Indexed for MEDLINE]

Conflict of interest statement: CB was the Manager of NICHE Nelson, Needle 
Exchange Programme.


1180. J Appl Gerontol. 2023 May;42(5):1118-1136. doi: 10.1177/07334648221146252. Epub 
2022 Dec 21.

Experiences of Healthcare Workers in Long-Term Care during COVID-19: A Scoping 
Review.

Boamah SA(1), Weldrick R(2), Havaei F(3), Irshad A(4), Hutchinson A(4).

Author information:
(1)School of Nursing, 62703McMaster University Faculty of Health Sciences, 
Hamilton, ON, Canada.
(2)Department of Gerontology, 1763Simon Fraser University, Vancouver, BC, 
Canada.
(3)70439University of British Columbia School of Nursing, Vancouver, BC, Canada.
(4)62703McMaster University Faculty of Health Sciences, Hamilton, ON, Canada.

Background: Although healthcare workers (HCWs) in long-term care (LTC) have 
experienced significant emotional and psychological distress throughout the 
pandemic, little is known about their unique experiences. Objective: This 
scoping review synthesizes existing research on the experiences of HCWs in LTC 
during the COVID-19 pandemic. Method: Following Arksey and O'Malley's framework, 
data published between March 2020 to June 2022, were extracted from six 
databases. Results: Among 3808 articles screened, 40 articles were included in 
the final analysis. Analyses revealed three interrelated themes: carrying the 
load (moral distress); building pressure and burning out (emotional exhaustion); 
and working through it (a sense of duty to care). Conclusion: Given the impacts 
of the pandemic on both HCW wellbeing and patient care, every effort must be 
made to address the LTC workforce crisis and evaluate best practices for 
supporting HCWs experiencing mental health concerns during and post-COVID-19.

DOI: 10.1177/07334648221146252
PMCID: PMC9780558
PMID: 36541274 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1181. BMC Psychiatry. 2022 Dec 20;22(1):808. doi: 10.1186/s12888-022-04471-4.

Videoconferencing-delivered psychological intervention for the treatment of 
COVID-19 related psychological distress in University students: study protocol 
for a randomised controlled trial in India.

Keyan D(1), Dawson K(2), Azevedo S(2), Yadav S(2), Choi-Christou J(2), Maliakkal 
DJ(3), Pillai MK(3), Thomas E(3), George TS(3), Bryant RA(2).

Author information:
(1)University of New South Wales, Sydney, Australia. d.keyan@unsw.edu.au.
(2)University of New South Wales, Sydney, Australia.
(3)CHRIST (Deemed to be University), Bangalore, India.

BACKGROUND: The mental health impacts of the COVID-19 pandemic have been 
profound. This paper outlines the study protocol for a trial that tests the 
efficacy of a brief group-based psychological intervention (Coping with COVID; 
CWC), relative to Supportive Counselling, to reduce distress associated with 
COVID-19 in a young adult population in Bangalore, India.
METHODS: A single-blind, parallel, randomized controlled trial will be carried 
out via video conferencing in a small group format. Following informed consent, 
adults that screen positive for levels of psychological distress (Kessler 10 
(K-10 score ≥ 20) and have access to a videoconferencing platform will be 
randomised to an adapted version of CWC (n = 90) or Supportive Counselling (SC) 
(n = 90). The primary outcome will be reduction in psychological distress 
including anxiety and depression at 2-months post treatment. Secondary outcomes 
include worry, positive wellbeing, and stress in relation to COVID-19.
DISCUSSION: This treatment trial will assess whether CWC will result in reduced 
distress relative to Supportive Counselling in a young adult population in 
Bangalore, India. This study will yield important insights into the role of 
nonspecific factors versus the intervention's components in impacting COVID-19 
related distress.
TRIAL REGISTRATION: This trial was prospectively registered on the Australian 
New Zealand Clinical Trials Registry (ACTRN12621001064897).
ETHICS AND DISSEMINATION: Ethics approval has been obtained from the 
participating institution, CHRIST University in Bangalore. Results of the trial 
will be submitted for publication in peer reviewed journals and findings 
presented at scientific conferences and to key service providers and policy 
makers.

© 2022. The Author(s).

DOI: 10.1186/s12888-022-04471-4
PMCID: PMC9763790
PMID: 36539730 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1182. Gerontology. 2023;69(6):684-693. doi: 10.1159/000528169. Epub 2023 Jan 10.

Association of Torquetenovirus Viremia with Physical Frailty and Cognitive 
Impairment in Three Independent European Cohorts.

Giacconi R(1), Laffon B(2)(3), Costa S(4)(5), Teixeira-Gomes A(4)(5), Maggi 
F(6), Macera L(7), Spezia PG(7), Piacenza F(1), Bürkle A(8), Moreno-Villanueva 
M(8)(9), Bonassi S(10)(11), Valdiglesias V(3)(12), Teixeira JP(4)(5), Dollé 
MET(13), Rietman ML(14), Jansen E(13), Grune T(15)(16), Gonos ES(17), Franceschi 
C(18)(19), Capri M(18)(20), Weinberger B(21), Sikora E(22), Stuetz W(23), 
Toussaint O(24), Debacq-Chainiaux F(24), Hervonen A(25), Hurme M(25), Slagboom 
PE(26), Schön C(27), Bernhardt J(27), Breusing N(28), Pásaro E(2)(3), Maseda 
A(29), Lorenzo-López L(29), Millán-Calenti JC(29), Provinciali M(1), Malavolta 
M(1).

Author information:
(1)Advanced Technology Center for Aging Research, IRCCS INRCA, Ancona, Italy.
(2)Grupo DICOMOSA, CICA - Centro Interdisciplinar de Química e Bioloxía, 
Departamento de Psicología, Facultad de Ciencias de la Educación, Campus Elviña 
s/n, Universidade da Coruña, A Coruña, Spain.
(3)Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
(4)Environmental Health Department, National Institute of Health Doutor Ricardo 
Jorge, Porto, Portugal.
(5)EPIUnit -Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
(6)Department of Medicine and Surgery, University of Insubria, Varese, Italy.
(7)Department of Translational Research, University of Pisa, Pisa, Italy.
(8)Molecular Toxicology Group, Department of Biology, University of Konstanz, 
Konstanz, Germany.
(9)Human Performance Research Centre, Department of Sport Science, University of 
Konstanz, Konstanz, Germany.
(10)Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, 
Rome, Italy.
(11)Department of Human Sciences and Quality of Life Promotion, San Raffaele 
University, Rome, Italy.
(12)Grupo NanoToxGen, CICA - Centro Interdisciplinar de Química e Bioloxía, 
Departamento de Biología, Facultad de Ciencias, Campus A Zapateira s/n, 
Universidade da Coruña, A Coruña, Spain.
(13)Centre for Protection, National Institute for Public Health and the 
Environment, Bilthoven, The Netherlands.
(14)Centre for Nutrition, Prevention and Health Services, National Institute for 
Public Health and the Environment, Bilthoven, The Netherlands.
(15)Department of Molecular Toxicology, German Institute of Human Nutrition 
Potsdam-Rehbruecke (DIfE), Nuthetal, Germany.
(16)Department of Physiological Chemistry, Faculty of Chemistry, University of 
Vienna, Vienna, Austria.
(17)National Hellenic Research Foundation, Institute of Biology, Medicinal 
Chemistry and Biotechnology, Athens, Greece.
(18)Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater 
Studiorum University of Bologna, Bologna, Italy.
(19)Institute of Information Technologies, Mathematics and Mechanics, 
Lobachevsky University, Nizhniy Novgorod, Russian Federation.
(20)Interdepartmental Center - Alma Mater Research Institute on Global 
Challenges and Climate Change - University of Bologna, Bologna, Italy.
(21)Institute for Biomedical Aging Research, University of Innsbruck, Innsbruck, 
Austria.
(22)Laboratory of the Molecular Bases of Ageing, Nencki Institute of 
Experimental Biology, Polish Academy of Sciences, Warsaw, Poland.
(23)Department of Food Biofunctionality, Institute of Nutritional Sciences, 
University of Hohenheim, Stuttgart, Germany.
(24)URBC-NARILIS, University of Namur, Namur, Belgium.
(25)Faculty of Medicine and Health Technology, Tampere University, Tampere, 
Finland.
(26)Department of Molecular Epidemiology, Leiden University Medical Centre, 
Leiden, The Netherlands.
(27)BioTeSys GmbH, Esslingen, Germany.
(28)Department of Applied Nutritional Science/Dietetics, Institute of 
Nutritional Medicine, University of Hohenheim, Stuttgart, Germany.
(29)Gerontology and Geriatrics Research Group, Instituto de Investigación 
Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña 
(CHUAC), Servizo Galego de Saúde (SERGAS), Universidade da Coruña, A Coruña, 
Spain.

INTRODUCTION: Immunosenescence and inflammaging have been implicated in the 
pathophysiology of frailty. Torquetenovirus (TTV), a single-stranded DNA 
anellovirus, the major component of the human blood virome, shows an increased 
replication rate with advancing age. An elevated TTV viremia has been associated 
with an impaired immune function and an increased risk of mortality in the older 
population. The objective of this study was to analyze the relation between TTV 
viremia, physical frailty, and cognitive impairment.
METHODS: TTV viremia was measured in 1,131 nonfrail, 45 physically frail, and 
113 cognitively impaired older adults recruited in the MARK-AGE study (overall 
mean age 64.7 ± 5.9 years), and then the results were checked in two other 
independent cohorts from Spain and Portugal, including 126 frail, 252 prefrail, 
and 141 nonfrail individuals (overall mean age: 77.5 ± 8.3 years).
RESULTS: TTV viremia ≥4log was associated with physical frailty (OR: 4.69; 95% 
CI: 2.06-10.67, p < 0.0001) and cognitive impairment (OR: 3.49, 95% CI: 
2.14-5.69, p < 0.0001) in the MARK-AGE population. The association between TTV 
DNA load and frailty status was confirmed in the Spanish cohort, while a slight 
association with cognitive impairment was observed (OR: 1.33; 95% CI: 
1.000-1.773), only in the unadjusted model. No association between TTV load and 
frailty or cognitive impairment was found in the Portuguese sample, although a 
negative association between TTV viremia and MMSE score was observed in Spanish 
and Portuguese females.
CONCLUSIONS: These findings demonstrate an association between TTV viremia and 
physical frailty, while the association with cognitive impairment was observed 
only in the younger population from the MARK-AGE study. Further research is 
necessary to clarify TTV's clinical relevance in the onset and progression of 
frailty and cognitive decline in older individuals.

© 2023 S. Karger AG, Basel.

DOI: 10.1159/000528169
PMID: 36538907 [Indexed for MEDLINE]


1183. AIDS Behav. 2023 Jul;27(7):2176-2189. doi: 10.1007/s10461-022-03950-9. Epub 2022 
Dec 20.

Mental Health, Social Connectedness, and Fear During the COVID-19 Pandemic: A 
Qualitative Perspective from Older Women with HIV.

Stanton AM(1)(2)(3), Goodman GR(1)(2)(4), Blyler A(5), Kirakosian N(6), Labbe 
AK(1), Robbins GK(7), Park ER(1)(8)(9), Psaros C(10)(11).

Author information:
(1)Department of Psychiatry, Massachusetts General Hospital, Harvard Medical 
School, Boston, MA, USA.
(2)The Fenway Institute, Fenway Health, Boston, MA, USA.
(3)Department of Psychological and Brain Sciences, Boston University, Boston, 
MA, USA.
(4)Department of Emergency Medicine, Brigham and Women's Hospital, Harvard 
Medical School, Boston, MA, USA.
(5)Positive Psychology Center, University of Pennsylvania, Philadelphia, PA, 
USA.
(6)Department of Psychology, University of Miami, Coral Gables, FL, USA.
(7)Division of Infectious Diseases, Massachusetts General Hospital, Harvard 
Medical School, Boston, MA, USA.
(8)Benson-Henry Institute for Mind Body Medicine, Massachusetts General 
Hospital, Boston, MA, USA.
(9)Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, 
MA, USA.
(10)Department of Psychiatry, Massachusetts General Hospital, Harvard Medical 
School, Boston, MA, USA. cpsaros@mgh.harvard.edu.
(11)One Bowdoin Square, 7th Floor, 02114, Boston, MA, USA. 
cpsaros@mgh.harvard.edu.

Older women with HIV (WWH) confront significant biopsychosocial challenges that 
may be exacerbated by the COVID-19 pandemic. Between May 2020 and April 2021, 
following a resiliency intervention conducted as part of a randomized parent 
trial, 24 cisgender WWH (M = 58 years old) completed quantitative assessments 
and qualitative interviews exploring the impact of COVID-19 on mental health. 
Qualitative data were analyzed via rapid analysis. Most participants were Black 
(62.5%) and non-Hispanic or Latina (87.5%). Emergent themes included (1) 
increased anxiety and depression; (2) a loss of social connectedness; (3) fear 
of unknown interactions among COVID-19, HIV, and other comorbidities; and (4) 
the use of largely adaptive strategies to cope with these issues. Findings 
suggest that older WWH face significant COVID-19-related mental health 
challenges, compounding existing stressors. As the pandemic persists, it will be 
important to assess the impact of these stressors on wellbeing, identify 
effective coping strategies, and provide increased support to mitigate 
COVID-19-related mental health issues over time. Trial Registration: 
ClinicalTrials.gov identifier: NCT03071887.

© 2022. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s10461-022-03950-9
PMCID: PMC9764305
PMID: 36538139 [Indexed for MEDLINE]

Conflict of interest statement: All authors certify that they have no 
affiliations with or involvement in any organization or entity with any 
financial interest or non-financial interest in the subject matter or materials 
discussed in this manuscript.


1184. Hum Reprod. 2023 Feb 1;38(2):247-255. doi: 10.1093/humrep/deac262.

COVID-19-related uncertainty: fertility staff experiences of its sources, 
processing, responses, and consequences.

Gameiro S(1), Armstrong K(2), Carluke N(1), Baccino G(3), Zegers-Hochschild 
F(4), Boivin J(1).

Author information:
(1)Cardiff Fertility Studies Group, School of Psychology, Cardiff University, 
Cardiff, UK.
(2)School of Medicine, Cardiff University, Cardiff, UK.
(3)NewLifeBank, Madrid, Spain.
(4)Program of Ethics and Public Policies in Human Reproduction, Faculty of 
Medicine, Universidad Diego Portales, Santiago, Chile.

STUDY QUESTION: What are fertility staff experiences of managing 
COVID-19-related uncertainty after fertility clinics re-opened?
SUMMARY ANSWER: Staff identified many COVID-19-related uncertainty sources, the 
main being the COVID-19 health threat, to which most clinics and staff responded 
effectively by implementing safety protocols and building strong collaborative 
environments that facilitated the acquisition and application of information to 
guide organizational responses during a rapidly changing situation, but with 
costs for staff and patients.
WHAT IS KNOWN ALREADY: COVID-19 created significant disruption in fertility care 
delivery, including temporary clinic closure and treatment delay. Patients 
experienced significant distress, including concerns regarding the impact of 
COVID-19 and its vaccine on fertility and pregnancy. Multiple studies show that 
COVID-19-related uncertainty is a major threat and burden for healthcare staff, 
but this has not been investigated in reproductive medicine.
STUDY DESIGN, SIZE, DURATION: A cross-sectional, online mixed-method bilingual 
(English, Spanish) survey (active 25 January-23 May 2021) was distributed to 
fertility staff across the UK, Latin America, and Africa.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Eligibility criteria were being a 
healthcare worker at a fertility clinic that had re-opened since its 
COVID-19-related closure, 18 years of age or older and ability to respond in 
English or Spanish. The survey was created in English, translated to Spanish, 
made available using Qualtrics, and consisted of four parts: (i) background and 
physical and mental wellbeing, (ii) open-ended questions regarding COVID-19 
uncertainty, (iii) appraisal items regarding perceptions and impact of 
uncertainty, and (iv) changes in the workplace. The British Fertility Society 
and the African Network and Registry of Assisted Reproduction circulated the 
survey across the UK and Africa via email hyperlinks and social media platforms. 
The Argentinian Society of Reproductive Medicine and the Latin American Network 
of Assisted Reproduction distributed the survey across Latin America in the same 
manner. Thematic analysis was performed on responses from open-ended question to 
produce basic codes. Deductive coding grouped sub-themes across questions into 
themes related to the theory of uncertainty management. Descriptive statistics 
and repeated measures analysis of variance were used on the quantitative data.
MAIN RESULTS AND THE ROLE OF CHANCE: In total, 382 staff consented to the 
survey, 107 did not complete (28% attrition), and 275 completed. Sixty-three 
percent were women, 69% were physicians, and 79% worked at private clinics. 
Thematic analysis produced 727 codes, organized in 92 sub-themes, and abstracted 
into 18 themes and one meta-theme reflecting that uncertainty is stressful but 
manageable. The types of uncertainties related to the threat of COVID-19 
(20.6%), unpredictability of the future (19.5%), failure of communication 
(11.4%), and change in the workplace (8.4%). Staff appraisals of negative and 
positive impact of uncertainty were significantly lower (P < 0.001) than 
appraisals of stress, controllability, and having what it takes to cope with 
uncertainty. To process uncertainty, clinics focused on information 
dissemination (30.8%) and building a collaborative work environment (5.8%), 
while staff employed proactive coping (41.8%) and emotional and cognitive 
processing (9.6%). Main organizational responses consisted on work restructuring 
(41.3%, e.g. safety protocols), adapting to adversity (9.5%, e.g. supplies, 
preparation), and welfare support (13.8%), though staff perceived lack of 
support (17.5%). Negative consequences of uncertainty were worse self- and 
patient welfare (12.1%) and worse communication due to virtual medicine and use 
of mask (9.6%). Positive consequences were work improvements (8.3%), 
organizational adaptation (8.3%), improved relationships (5.6%), and individual 
adaptation (3.2%). Ninety-two percent of participants thought changes 
experienced in the workplace due to COVID-19 were negative, 9.1% nor negative 
nor positive, and 14.9% positive. Most staff thought that their physical (92.4%) 
and mental health (89.5%) were good to excellent.
LIMITATIONS, REASONS FOR CAUTION: Participants were self-selected, and most were 
physicians and embryologists working at private clinics based in Latin America. 
The study did not account for how variability in national and regional COVID-19 
policy shaped staff experiences of uncertainty.
WIDER IMPLICATIONS OF THE FINDINGS: To address COVID-19 uncertainty, clinics 
need to promote collaborative (clinic, staff, patients) processing of 
uncertainty, clear team coordination and communication, organizational 
flexibility, and provision of support to staff and patients, with an emphasis on 
cognitive coping to decrease threat of and increase tolerance to uncertainty. 
Uncertainty management interventions bespoke to fertility care that integrate 
these components may increase clinics resilience to COVID-19-related and other 
types of uncertainty.
STUDY FUNDING/COMPETING INTERESTS: Cardiff University funded this research. S.G. 
reports consultancy fees from Ferring Pharmaceuticals A/S, speaker fees from 
Access Fertility, SONA-Pharm LLC, Meridiano Congress International, and Gedeon 
Richter, and grants from Merck Serono Ltd. F.Z.-H. reports speaker fees from 
Ferring Pharmaceuticals A/S and that he is a chair of the Latin American 
Registry of ART, Committee of Ethic and Public Policies, and Chilean Society of 
Obstetrics and Gynecology and a vice chair of the International Committee for 
monitoring ART. K.A., N.C., G.B., and J.B. report no conflict in relation to 
this work.
TRIAL REGISTRATION NUMBER: N/A.

© The Author(s) 2022. Published by Oxford University Press on behalf of European 
Society of Human Reproduction and Embryology.

DOI: 10.1093/humrep/deac262
PMCID: PMC9890239
PMID: 36534892 [Indexed for MEDLINE]


1185. Front Public Health. 2022 Dec 2;10:1058423. doi: 10.3389/fpubh.2022.1058423. 
eCollection 2022.

Cardiovascular consequences of aircraft noise exposure.

Ba̧czalska J(1), Wojciechowska W(1), Rojek M(1), Hahad O(2), Daiber A(2), Münzel 
T(2), Rajzer M(1).

Author information:
(1)First Department of Cardiology, Interventional Electrocardiology and Arterial 
Hypertension, Jagiellonian University Medical College, Kraków, Poland.
(2)Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg 
University, Mainz, Germany.

The results from epidemiological studies suggest that environmental noise 
including aircraft, railway, road traffic, wind turbine, and leisure-related 
noise is a growing public health concern. According to the WHO, at least 100 
million people in the European Union are affected by traffic noise levels above 
the WHO-recommended thresholds. Environmental noise can adversely affect 
physical and mental health, as well as wellbeing. Chronic low-level noise 
exposure typical for most environmental sources is associated with 
psychophysiological stress causing non-auditory or indirect noise effects 
leading ultimately to cardiovascular diseases. Among all environmental noise 
sources, aircraft noise is considered the most annoying, and its leading 
mechanism of action is autonomic system activation such as increases in heart 
rate and blood pressure. Previously, we observed that long-term exposure to 
aircraft noise was associated with increased diastolic blood pressure, arterial 
stiffness (as assessed by pulse wave velocity), and impaired left ventricular 
diastolic function. All mentioned above effects are early, subclinical, and 
potentially reversible changes which preceded late noise effects in the 
cardiovascular system, that is, established cardiovascular diseases such as 
myocardial infarction, stroke, and heart failure. However, even a short-term 
reduction in aircraft noise exposure as observed during the COVID-19 lockdown 
may reverse these negative effects on arterial stiffness and blood pressure and 
may decrease the prevalence of insomnia. In this review, we aimed to critically 
discuss our obtained results considering recent studies on the influence of 
aircraft noise (and other traffic noises) on cardiovascular diseases in the 
context of the WHO Environmental Noise Guidelines for the European Region.

Copyright © 2022 Ba̧czalska, Wojciechowska, Rojek, Hahad, Daiber, Münzel and 
Rajzer.

DOI: 10.3389/fpubh.2022.1058423
PMCID: PMC9755730
PMID: 36530719 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1186. Front Public Health. 2022 Dec 2;10:1052744. doi: 10.3389/fpubh.2022.1052744. 
eCollection 2022.

The impact of the COVID-19 pandemic on physical activity, life satisfaction, 
anxiety, stress perception and coping strategies in student-athletes: A 
comparison between Belarus and Poland-countries with a different approach of 
anti-pandemic measures.

Shpakou A(1), Sokołowska D(2), Krajewska-Kułak E(1), Cybulski M(1), Kowalewska 
B(1), Korpak F(3), Surkov S(4), Owoc J(5), Krakowiak J(6), Kowalczuk K(1).

Author information:
(1)Department of Integrated Medical Care, Medical University of Bialystok, 
Białystok, Poland.
(2)Department of Physical Education and Tourism, University of Finance and 
Management, Bialystok, Poland.
(3)Department of Recreation and Tourism, Faculty of Physical Education and 
Health in Biala Podlaska, Jozef Pilsudski University of Physical Education in 
Warsaw, Warsaw, Poland.
(4)Department of Athletics, Swimming and Skiing, Faculty of Physical Education 
and Sports, Brest State A.S. Pushkin University, Brest, Belarus.
(5)Department of Gerontology, Public Health and Education, National Institute of 
Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland.
(6)Department of Social Medicine, Medical University of Lodz, Lodz, Poland.

BACKGROUND: More than two years of the COVID-19 pandemic has changed lives of 
people around the world and had a profound impact on the field of sports. This 
has resulted in decreased physical activity (PA) and changes in mental health. 
The goal was to assess self-reported physical activity, life satisfaction, 
perceived stress, choice of coping strategies and their correlations among 
student athletes from two neighboring countries facing different anti-pandemic 
strategies.
METHODS: Cross-sectional surveys using standardized questionnaires: 
International Physical Activity Questionnaire-Short Form (IPAQ-SF), Satisfaction 
With Life Scale (SWLS), State-Trait Anxiety Inventory (STAI), Perceived Stress 
Scale (PSS-10), and Coping Orientation to Problems Experienced (Mini-COPE) to 
compare 600 students from Physical Education and Sports departments of 
universities in Belarus (n = 333), where restrictions were found to be less 
stringent than in neighboring Poland (n = 267).
RESULTS: Minor differences in physical activities between both countries 
indicate that student athletes have adapted fairly quickly and found ways to 
keep their PA at a fairly high level. Nevertheless, higher PA was reported in 
the group of student athletes from Belarus. PA levels correlated with life 
satisfaction, anxiety and stress levels. Female students from Poland reported 
lower satisfaction with their lives. Their perception of stress was twice as 
high as that of their Belarusian counterparts. The most common coping strategy 
in both groups was active coping. Polish respondents less frequently used 
strategies of avoiding problems and seeking outside support.
CONCLUSION: The level of physical activity and well-being of student athletes 
are associated with increased mental health and coping with stress. They also 
contribute to prevention of affective disorders during the COVID-19 pandemic. 
Moreover, it is dependent on the country's anti-pandemic policies.

Copyright © 2022 Shpakou, Sokołowska, Krajewska-Kułak, Cybulski, Kowalewska, 
Korpak, Surkov, Owoc, Krakowiak and Kowalczuk.

DOI: 10.3389/fpubh.2022.1052744
PMCID: PMC9755163
PMID: 36530658 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1187. J Pediatr Rehabil Med. 2022;15(4):677-689. doi: 10.3233/PRM-210002.

Pandemic decrease of in-person physiotherapy as a factor in parent perceived 
decline in function in children with neuromuscular disorders.

Stępień A(1), Sobińska M(1), Rekowski W(1), Krawczyk MJ(2).

Author information:
(1)Józef Piłsudski University of Physical Education in Warsaw, Warsaw, Poland.
(2)Institute of Psychiatry and Neurology, Warszawa, Poland.

PURPOSE: Restrictions related to the COVID-19 pandemic can negatively affect 
patients who require physiotherapy. This study aimed to analyze the consequences 
of limited physiotherapy on the functional state of children with neuromuscular 
diseases (NMD). In addition, the caregivers' well-being and caregiver opinions 
on physiotherapy were analyzed.
METHODS: A questionnaire was shared with parents of children with NMD 
immediately after the COVID-19 lockdown. The survey included questions regarding 
the physical and mental condition of children and parents before the pandemic 
and during lockdown as well as their views on physiotherapy and 
telephysiotherapy. Statistical analysis was performed using the Wilcoxon 
Matched-Pairs Signed Ranks test, Spearman's Rank Correlation test, McNemar test, 
and Chi-square test.
RESULTS: Parents of 235 children participated in the study. Results indicated 
that children devoted more time to physiotherapy before the pandemic than during 
the lockdown period, which was true for those living in cities and the 
countryside. The functional state of 50.2% of the children deteriorated during 
the lockdown, in the opinion of their parents. Significant correlations were 
found between limited physiotherapy time and the deterioration of children's 
functional condition, ability to maintain a standing position, and increased 
anxiety. The majority of parents reported increased levels of fear and anxiety 
(72.8%), fatigue (67.7%), and pain (53.2%). In-person physiotherapy was rated 
significantly higher than telephysiotherapy by parents.
CONCLUSIONS: Limited access to physiotherapy and shorter therapy times may lead 
to functional deterioration in children with NMD, but this assumption needs to 
be objectively confirmed. According to the parents' opinions, telephysiotherapy 
is less beneficial than direct physiotherapy but may support therapy conducted 
directly by a physiotherapist. Results based on subjective parental opinions may 
be helpful in planning future projects.

DOI: 10.3233/PRM-210002
PMID: 36530101 [Indexed for MEDLINE]


1188. Sci Rep. 2022 Dec 17;12(1):21828. doi: 10.1038/s41598-022-26281-0.

A longitudinal investigation on problematic Facebook use, psychological distress 
and well-being during the second wave of COVID-19 pandemic.

Bonfanti RC(1), Salerno L(2), Brugnera A(3), Lo Coco G(2).

Author information:
(1)Department of Psychology, Educational Science and Human Movement, University 
of Palermo, Viale delle Scienze, Edificio 15, 90128, Palermo, Italy. 
rubiniaceleste.bonfanti@unipa.it.
(2)Department of Psychology, Educational Science and Human Movement, University 
of Palermo, Viale delle Scienze, Edificio 15, 90128, Palermo, Italy.
(3)Department of Human and Social Sciences, University of Bergamo, Bergamo, 
Italy.

The social isolation and the subsequent, increased use of Social Networking 
Sites due to the COVID-19 pandemic have had an impact on subjective well-being 
around the world. The present longitudinal study examined whether changes in 
psychological distress and well-being during the Italian second wave of the 
pandemic differ among people with different levels of Problematic Facebook Use 
(PFU). A total of 493 participants (Mage = 24.55 ± 7.25; 80.3% females) 
completed measures of passive use of Facebook, social comparison orientation on 
Facebook, fear of missing out, psychological distress (depressive symptoms and 
fear of COVID-19 pandemic) and well-being across three waves. Latent class 
analysis (LCA) categorized participants into three groups with different PFU 
levels: healthy users, moderate PFU users, and high PFU users. Hierarchical 
linear modeling (HLM) showed that the between-person level (class membership) 
accounted for most of the variability in psychological distress and well-being. 
No significant changes were found in psychological distress and well-being over 
time, but the High PFU users showed greater levels of psychological distress and 
lower levels of well-being at each time point. The findings of this study 
suggest that the relationship between PFU, psychological distress and well-being 
may reflect trait-like time-invariant differences between individuals rather 
than state-like changes.

© 2022. The Author(s).

DOI: 10.1038/s41598-022-26281-0
PMCID: PMC9758466
PMID: 36528751 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1189. Intensive Crit Care Nurs. 2023 Apr;75:103366. doi: 10.1016/j.iccn.2022.103366. 
Epub 2022 Dec 7.

Physical, social, mental and spiritual functioning of COVID-19 intensive care 
unit-survivors and their family members one year after intensive care 
unit-discharge: A prospective cohort study.

Onrust M(1), Visser A(2), van Veenendaal N(3), Dieperink W(4), Luttik ML(5), 
Derksen MG(6), van der Voort PHJ(7), van der Meulen IC(8).

Author information:
(1)University of Groningen, University Medical Center Groningen, Department of 
Critical Care, the Netherlands. Electronic address: m.onrust@umcg.nl.
(2)University of Groningen, Faculty of Theology and Religious Studies, 
Department of Comparative Study of Religion, the Netherlands. Electronic 
address: a.visser-nieraeth@rug.nl.
(3)University of Groningen, University Medical Center Groningen, Department of 
Anesthesiology, the Netherlands. Electronic address: n.van.veenendaal@umcg.nl.
(4)University of Groningen, University Medical Center Groningen, Department of 
Critical Care, the Netherlands; Research Group Nursing Diagnostics, Hanze 
University of Applied Science Groningen, Groningen, the Netherlands. Electronic 
address: w.dieperink@umcg.nl.
(5)University of Groningen, University Medical Center Groningen, Department of 
Critical Care, the Netherlands; Research Group Nursing Diagnostics, Hanze 
University of Applied Science Groningen, Groningen, the Netherlands. Electronic 
address: m.l.a.luttik@pl.hanze.nl.
(6)University Medical Center Groningen, Department of Spiritual Care, the 
Netherlands. Electronic address: m.g.derksen@umcg.nl.
(7)University of Groningen, University Medical Center Groningen, Department of 
Critical Care, the Netherlands; TIAS School for Business and Society, Tilburg 
University, Tilburg, the Netherlands. Electronic address: 
p.h.j.van.der.voort@umcg.nl.
(8)University of Groningen, University Medical Center Groningen, Department of 
Critical Care, the Netherlands; Research Group Nursing Diagnostics, Hanze 
University of Applied Science Groningen, Groningen, the Netherlands. Electronic 
address: i.c.van.der.meulen@pl.hanze.nl.

OBJECTIVE: To describe the long-term functioning of patients who survived a 
COVID-19-related admission to the intensive care unit and their family members, 
in the physical, social, mental and spiritual domain.
DESIGN: A single-centre, prospective cohort study with a mixed-methods design.
SETTING: The intensive care unit of the University Medical Center Groningen in 
the Netherlands.
MAIN OUTCOME MEASURES: To study functioning 12 months after intensive care 
discharge several measurements were used, including a standardised list of 
physical problems, the Clinical Frailty Scale, the Medical Outcomes Study 
Short-Form General Health Survey, the McMaster Family Assessment Device, the 
Hospital Anxiety and Depression Scale, and the Spiritual Needs Questionnaire, as 
well as open questions and interviews with survivors and their family members.
RESULTS: A total of 56 survivors (77%) returned the 12-month questionnaire, 
whose median age was 62 (inter-quartile range [IQR]: 55.0-68.0). Moreover, 67 
family members (66%) returned the 12-month questionnaire, whose median age was 
58 (IQR: 43-66). At least one physical problem was reported by 93% of the 
survivors, with 22% reporting changes in their work-status. Both survivors (84%) 
and their family members (85%) reported at least one spiritual need. The need to 
feel connected with family was the strongest. The main theme was 'returning to 
normal' in the interviews with survivors and 'if the patient is well, I am well' 
in the interviews with family members.
CONCLUSIONS: One year after discharge, both COVID-19 intensive care survivors 
and their family members positively evaluate their health-status. Survivors 
experience physical impairments, and their family members' well-being is 
strongly impacted by the health of the survivor.

Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.iccn.2022.103366
PMCID: PMC9726690
PMID: 36528460 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


1190. Intensive Crit Care Nurs. 2023 Apr;75:103369. doi: 10.1016/j.iccn.2022.103369. 
Epub 2022 Dec 15.

The effects of a sensory stimulation intervention on psychosocial and clinical 
outcomes of critically ill patients and their families: A randomised controlled 
trial.

Liang S(1), Pak Chun Chau J(2), Hoi Shan Lo S(2), Chow Choi K(2), Bai L(3), Cai 
W(4).

Author information:
(1)Nursing Department, Shenzhen Hospital of Southern Medical University, 
Administrative Building, Xinhu Road, Shenzhen 518101, China.
(2)The Nethersole School of Nursing, The Chinese University of Hong Kong, 
Shatin, N.T., Hong Kong Special Administrative Region, China.
(3)Department of Critical Care Medicine, The First Affiliated Hospital, Sun 
Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China.
(4)Nursing Department, Shenzhen Hospital of Southern Medical University, 
Administrative Building, Xinhu Road, Shenzhen 518101, China. Electronic address: 
caiwzh@smu.edu.cn.

OBJECTIVES: To explore the effectiveness of a sensory stimulation intervention 
on intensive care unit patients' psychosocial, clinical, and family outcomes.
DESIGN: A prospective, assessor-blind, parallel-group randomised controlled 
trial.
SETTING: A surgical intensive care unit of one tertiary hospital in Guangzhou, 
mainland China.
INTERVENTION: Participants in the intervention group received a daily 30-minute 
auditory and visual stimulation session starting from recruitment and for a 
maximum of seven days while in the intensive care unit.
MEASUREMENT AND MAIN RESULTS: One hundred fifty-two patients and family 
caregiver dyads were recruited. Patients in the intervention group showed lower 
total scores of post-traumatic stress disorder (21.92 ± 6.34 vs 
27.62 ± 10.35,p = 0.001), depressive symptoms (3.76 ± 3.99 vs 
6.78 ± 4.75,p = 0.001) and delusional memories (0.47 ± 0.92 vs 
0.82 ± 1.23,p = 0.001) collected immediately post-intervention than those in the 
control group, while not on depressive symptoms at one-month post-intervention 
(3.32 ± 4.03 vs 3.28 ± 3.77,p = 0.800). Sensory stimulation did not 
significantly impact patients' unit length of stay and 30-day mortality 
(allp > 0.05). For family outcomes, family caregivers in the intervention group 
had greater satisfaction with care (127.12 ± 14.14 vs 114.38 ± 21.97,p = 0.001) 
and a lower level of anxiety (28.49 ± 6.48 vs 34.64 ± 7.68,p = 0.001) than 
family caregivers in the control group.
CONCLUSIONS: Sensory stimulation may benefit patients' and family caregivers' 
psychological well-being, and further well-designed multi-centre clustered 
randomized controlled trials could be considered to strengthen the evidence.

Copyright © 2022 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.iccn.2022.103369
PMID: 36528458 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


1191. Int J Nurs Stud. 2023 Feb;138:104408. doi: 10.1016/j.ijnurstu.2022.104408. Epub 
2022 Nov 24.

The efficacy of the internet-based stress recovery intervention FOREST for 
nurses amid the COVID-19 pandemic: A randomized controlled trial.

Dumarkaite A(1), Truskauskaite I(2), Andersson G(3), Jovarauskaite L(2), 
Jovaisiene I(4), Nomeikaite A(2), Kazlauskas E(2).

Author information:
(1)Center for Psychotraumatology, Institute of Psychology, Vilnius University, 
Lithuania. Electronic address: austeja.dumarkaite@fsf.vu.lt.
(2)Center for Psychotraumatology, Institute of Psychology, Vilnius University, 
Lithuania.
(3)Department of Behavioural Sciences and Learning, Linköping University, 
Sweden; Department of Biomedical and Clinical Sciences, Linköping University, 
Sweden; Department of Clinical Neuroscience, Karolinska Institute, Sweden.
(4)Clinic of Anesthesiology and Intensive Care, Institute of Clinical Medicine, 
Faculty of Medicine, Vilnius University, Lithuania.

BACKGROUND: The COVID-19 pandemic demanded exceptional physical and mental 
effort from healthcare workers worldwide. Since healthcare workers often refrain 
from seeking professional psychological support, internet-delivered 
interventions could serve as a viable alternative option.
OBJECTIVE: We aimed to investigate the effects of a therapist-guided six-week 
CBT-based internet-delivered stress recovery intervention among medical nurses 
using a randomized controlled trial design. We also aimed to assess program 
usability.
METHODS: 168 nurses working in a healthcare setting (Mage = 42.12, 
SDage = 11.38; 97 % female) were included in the study. The intervention group 
included 77 participants, and the waiting list control group had 91 
participants. Self-report data were collected online at three timepoints: 
pre-test, post-test, and three-month follow-up. The primary outcome was stress 
recovery. Secondary outcomes included measures of perceived stress, anxiety and 
depression symptoms, psychological well-being, posttraumatic stress and complex 
posttraumatic stress symptoms, and moral injury.
RESULTS: We found that the stress recovery intervention FOREST improved stress 
recovery, including psychological detachment (d = 0.83 [0.52; 1.15]), relaxation 
(d = 0.93 [0.61, 1.25]), mastery (d = 0.64 [0.33; 0.95]), and control (d = 0.46 
[0.15; 0.76]). The effects on psychological detachment, relaxation, and mastery 
remained stable at the three month follow-up. The intervention was also 
effective in reducing its users' stress (d = -0.49 [-0.80; -0.18]), anxiety 
symptoms (d = -0.31 [-0.62; -0.01]), depression symptoms (d = -0.49 [-0.80; 
-0.18]) and increasing psychological well-being (d = 0.53 [0.23; 0.84]) with the 
effects on perceived stress, depression symptoms, and well-being remaining 
stable at the three-month follow-up. High user satisfaction and good usability 
of the intervention were also reported.
CONCLUSIONS: The present study demonstrated that an internet-based intervention 
for healthcare staff could increase stress recovery skills, promote 
psychological well-being, and reduce stress, anxiety, and depression symptoms, 
with most of the effects being stable over three months.
TRIAL REGISTRATION: NCT04817995 
(https://clinicaltrials.gov/ct2/show/NCT04817995). Registration date: March 30, 
2021. Date of first recruitment: April 1, 2021.

Copyright © 2022 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.ijnurstu.2022.104408
PMCID: PMC9684088
PMID: 36527859 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


1192. Inquiry. 2022 Jan-Dec;59:469580221143630. doi: 10.1177/00469580221143630.

Health-Related Quality of Life Among Patients Recovered From COVID-19.

Huynh G(1), Nguyen BT(2), Nguyen HTN(3), Le NT(4), An PL(1), Tran TD(1).

Author information:
(1)University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, 
Vietnam.
(2)Tra Vinh University, Tra Vinh City, Tra Vinh Province, Vietnam.
(3)University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam.
(4)Tam Anh Hospital, Ho Chi Minh City, Vietnam.

The Coronavirus disease 2019 (COVID-19) has impacted the lives and well-being of 
individuals worldwide, affecting both short-term and long-term quality of life. 
This study aimed to assess health-related quality of life (HRQoL) and associated 
factors among patients who have recovered from COVID-19. A cross-sectional 
survey was conducted at 2 hospitals in Ho Chi Minh City, Vietnam between January 
and March 2022. Data were obtained from patients who recovered from COVID-19 
using a structured questionnaire which included the EuroQoL-5 Dimension-5 Level 
(EQ-5D-5L) scale to quantify problems in 5 health dimensions (mobility, 
self-care, usual activities, pain/discomfort, anxiety/depression) and the 
EuroQoL-Visual Analog Scale (EQ-VAS) to determine self-rated health status. 
Factors associated with HRQoL were determined using a generalized linear model 
(GLM). A total of 325 participants were included in the analysis. The overall 
mean score from the EQ-5D-5L and EQ-VAS was 0.86 (SD 0.21) and 78.6 (SD 19.9), 
respectively. Anxiety/Depression and Pain/Discomfort were the major problems 
experienced by the participants. Lower HRQoL scores were reported among those 
who were 60 years and older, female, had comorbidities, persistent symptoms, 
living alone and experiencing stress (all P < .05). This study showed that there 
was a significant reduction in HRQoL among individuals who recovered from 
COVID-19, compared with the general population. The findings suggest that more 
interventions need to be implemented to increase such individuals' quality of 
life, particularly for those who exhibit high-risk factors such as females, 
those with comorbidities, persistent symptoms, living alone and experiencing 
from stress.

DOI: 10.1177/00469580221143630
PMCID: PMC9760520
PMID: 36527371 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1193. BMC Psychol. 2022 Dec 16;10(1):312. doi: 10.1186/s40359-022-00986-3.

Impact of COVID-19 pandemic on the mental health of university students in the 
United Arab Emirates: a cross-sectional study.

Vajpeyi Misra A(1), Mamdouh HM(2)(3), Dani A(4), Mitchell V(5), Hussain HY(2), 
Ibrahim GM(2), Alnakhi WK(2)(6).

Author information:
(1)Department of Health Sciences- Social Work Program, Higher Colleges of 
Technology, Abu Dhabi, UAE. amisra@hct.ac.ae.
(2)Department of Data Analysis, Research and Studies, Dubai Health Authority, 
Dubai, UAE.
(3)Department of Family Health, High Institute of Public Health, Alexandria 
University, Alexandria, Egypt.
(4)General Academic Requirement (General Studies), Higher Colleges of 
Technology, Abu Dhabi, UAE.
(5)Department of Health Sciences- Social Work Program, Higher Colleges of 
Technology, Abu Dhabi, UAE.
(6)Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE.

BACKGROUND: The COVID-19 pandemic had a significant impact on the mental 
well-being of students worldwide. There is a scarcity of information on the 
mental health impact of the COVID-19 pandemic on university students in the 
United Arab Emirates (UAE). This study aimed to investigate the mental health 
impact of the COVID-19, including depression, anxiety and resilience among a 
sample of university students in the UAE.
METHODS: A cross-sectional study using an online survey was conducted from 
September to November 2021. The patient health questionnaire (PHQ-9), 
generalized anxiety disorder-7 (GAD-7) and Connor-Davidson Resilience Scale 
(CD-RISC-10) were used to assess depression, anxiety, and resilience. The 
COVID-19 impact was assessed using a list of questions.
RESULTS: Only, 798 students completed the survey and were analyzed for this 
study. Overall, 74.8% of the students were females, 91.2% were never married, 
and 66.3% were UAE-nationals. Based on PHQ-9 and GAD-7 cut-off scores (≥ 10), 
four out of ten of the students self-reported moderate to severe depression 
(40.9%) and anxiety (39.1%). Significantly higher mean PHQ-9 and GAD-7 scores 
were found among students who were impacted by COVID-19 than those non-impacted 
(mean PHQ-9 = 9.51 ± 6.39 and 6.80 ± 6.34; p = 0.001, respectively) and (mean 
GAD-7 = 9.03 ± 6.00 and 8.54 ± 6.02; respectively, p < 0.001). Female students 
who were impacted by COVID-19 had statistically significant higher depression 
and anxiety scores (mean PHQ-9 of 9.14 ± 5.86 vs. 6.83 ± 6.25, respectively; 
p < 0.001) than the non-impacted females (mean GAD-7 of 9.57 ± 6.32 vs. 
5.15 ± 3.88, respectively; p = 0.005). Never married students had significantly 
higher PHQ-9 and GAD-7 scores than ever-married (9.31 ± 6.37 vs. 6.93 ± 5.47, 
P = 0.003) and (8.89 ± 6.11 vs. 7.13 ± 5.49, respectively; p = 0.017).
CONCLUSIONS: The results of this study demonstrate that the COVID-19 pandemic 
has negatively impacted the mental health of this sample of university students 
in terms of depression and anxiety. The results highlight the need to adopt 
culturally appropriate interventions for university students and focus on 
vulnerable groups.

© 2022. The Author(s).

DOI: 10.1186/s40359-022-00986-3
PMCID: PMC9756732
PMID: 36527101 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1194. J Med Imaging Radiat Sci. 2023 Jun;54(2S):S29-S37. doi: 
10.1016/j.jmir.2022.11.014. Epub 2022 Dec 2.

Anxiety, depression, and stress among radiography undergraduates during the 
COVID-19 pandemic.

Weerakoon BS(1), Chandrasiri NR(2).

Author information:
(1)Department of Radiography/ Radiotherapy, Faculty of Allied Health Sciences, 
University of Peradeniya, Peradeniya 20400, Sri Lanka. Electronic address: 
bsw888@ahs.pdn.ac.lk.
(2)Department of Radiography/ Radiotherapy, Faculty of Allied Health Sciences, 
University of Peradeniya, Peradeniya 20400, Sri Lanka.

INTRODUCTION: The COVID-19 pandemic has severely impacted education and other 
aspects of life, causing psychological distress. The current study aims to 
identify anxiety, depression, and stress among radiography undergraduates during 
the COVID-19 pandemic.
METHOD: A descriptive, cross-sectional study was conducted between November and 
December 2021 on a sample of 140 radiography undergraduates at the Department of 
Radiography/Radiotherapy, Faculty of Allied Health Sciences, University of 
Peradeniya. An online survey with two sections: demographic characteristics and 
a psychometric scale (DASS-42) was used for data collection.
RESULTS: A total of 107 undergraduates responded to the questionnaire giving a 
response rate of 76.2%. The results revealed that the majority of radiography 
undergraduate students suffered from mild to extremely severe depression 
(87.85%), anxiety (92.52%), and stress (73.83%) levels. In addition, more than 
two-thirds of the students (>73% of participants) reported at least one symptom 
of depression, anxiety, or stress to varying degrees. Scores for depression, 
anxiety, and stress did not differ significantly across gender and academic 
year. However, a significant difference was observed between the two age groups, 
23-26 years and > 27 years, regarding depression. The older students reported 
severe depression, whereas younger students reported moderate depression.
CONCLUSION: A high prevalence of negative psychological impact was observed 
among radiography undergraduates during the COVID-19 pandemic. This necessitates 
taking proactive steps to address, safeguard, and nurture undergraduates' mental 
health and well-being during the current and future pandemic crises to mitigate 
the negative impacts.

INTRODUCTION: La pandémie de COVID-19 a eu de graves répercussions sur 
l'éducation et d'autres aspects de la vie, provoquant une détresse 
psychologique. La présente étude vise à identifier l'anxiété, la dépression et 
le stress chez les étudiants de premier cycle en radiographie pendant la 
pandémie de COVID-19.
MÉTHODE: : Une étude descriptive et transversale a été menée entre novembre et 
décembre 2021 sur un échantillon de 140 étudiants de premier cycle en 
radiographie au Département de radiographie/radiothérapie, Faculté des sciences 
paramédicales, Université de Peradeniya. Une enquête en ligne comportant deux 
sections : les caractéristiques démographiques et une échelle psychométrique 
(DASS-42) a été utilisée pour la collecte des données.
RÉSULTATS: Un total de 107 étudiants de premier cycle ont répondu au 
questionnaire, soit un taux de réponse de 76,2%. Les résultats ont révélé que la 
majorité des étudiants de premier cycle en radiographie souffraient de 
dépression légère à extrêmement sévère (87,85 %), d'anxiété (92,52 %) et de 
stress (73,83 %). En outre, plus des deux tiers des étudiants (>73 % des 
participants) ont signalé au moins un symptôme de dépression, d'anxiété ou de 
stress à des degrés divers. Les scores de dépression, d'anxiété et de stress ne 
différaient pas significativement selon le sexe et l'année universitaire. 
Cependant, une différence significative a été observée entre les deux groupes 
d'âge, 23-26 ans et > 27 ans, concernant la dépression. Les étudiants les plus 
âgés ont déclaré une dépression sévère, tandis que les plus jeunes ont déclaré 
une dépression modérée.
CONCLUSION: Une prévalence élevée d'impact psychologique négatif a été observée 
chez les étudiants de premier cycle en radiographie pendant la pandémie de 
COVID-19. Il est donc nécessaire de prendre des mesures proactives pour aborder, 
protéger et entretenir la santé mentale et le bien-être des étudiants de premier 
cycle pendant les crises pandémiques actuelles et futures afin d'atténuer les 
impacts négatifs.

Copyright © 2022. Published by Elsevier Inc.

DOI: 10.1016/j.jmir.2022.11.014
PMCID: PMC9715492
PMID: 36526572 [Indexed for MEDLINE]


1195. J Med Imaging Radiat Sci. 2023 Jun;54(2S):S77-S84. doi: 
10.1016/j.jmir.2022.11.012. Epub 2022 Dec 5.

Two years on and four waves later: Johannesburg diagnostic radiographers' 
experiences of COVID-19.

Lewis S(1).

Author information:
(1)Department of Medical Imaging and Radiation Sciences, Faculty of Health 
Sciences, University of Johannesburg, Johannesburg, South Africa. Electronic 
address: shantell@uj.ac.za.

INTRODUCTION: At the onset of COVID-19 diagnostic radiographers from Gauteng, 
South Africa, shared their experiences of the new workflow and operations, their 
well-being and their resilience during this time. They experienced emotional, 
physical and financial fatigue. It is now over two years later, and South Africa 
has experienced four waves of COVID-19. Therefore, this study explored 
diagnostic radiographers' experience of COVID-19 after two years and four waves.
METHODS: A qualitative explorative, descriptive and contextual study was 
conducted by collecting data through nine virtual individual in-depth 
interviews. Responses from the diagnostic radiographers in Johannesburg, 
Gauteng, South Africa, underwent thematic analysis.
RESULTS: Thematic analysis revealed two themes and related categories. Theme 
one: participants shared synchronistic experiences with the four COVID-19 waves, 
the heterogeneous vaccination ideologies and their support and coping skills. 
Theme two: lessons learnt and the way forward.
CONCLUSION: Participants shared feeling overwhelmed at the onset of COVID-19 and 
feared infecting their family, friends and colleagues. However, their anxiety 
and fear decreased with time. They experienced the Delta variant as the worst 
and felt supported by their colleagues more than by management. They recounted 
observations of vaccine hesitancy but acknowledged that vaccination had 
alleviated some of the fear and anxiety. Participants' coping skills varied, and 
reflecting on their experience, they shared the lessons learnt and the way 
forward.

INTRODUCTION: Au début de la pandémie de COVID-19, des radiographes de 
diagnostic de Gauteng, en Afrique du Sud, ont partagé leurs expériences du 
nouveau flux de travail et des nouvelles opérations, leur bien-être et leur 
résilience pendant cette période. Ils ont ressenti une fatigue émotionnelle, 
physique et financière. Plus de deux ans plus tard, l'Afrique du Sud a connu 
quatre vagues de COVID-19. Par conséquent, cette étude a exploré l'expérience 
des radiographes de diagnostic de COVID-19 après deux ans et quatre vagues.
MÉTHODOLOGIE: Une étude qualitative exploratoire, descriptive et contextuelle a 
été menée pour recueillir des données par le biais de neuf entretiens 
individuels virtuels en profondeur. Les réponses des radiographes diagnosticiens 
de Johannesburg, Gauteng, Afrique du Sud, ont fait l'objet d'une analyse 
thématique.
RÉSULTATS: L'analyse thématique a révélé deux thèmes et des catégories connexes. 
Premier thème : les participants ont partagé des expériences synchronisées avec 
les quatre vagues de COVID-19, les idéologies de vaccination hétérogènes et 
leurs capacités de soutien et d'adaptation. Deuxième thème : les leçons apprises 
et la voie à suivre.
CONCLUSION: Les participants ont dit s'être sentis dépassés par les événements 
au début du COVID-19 et avoir craint de contaminer leur famille, leurs amis et 
leurs collègues. Cependant, leur anxiété et leur peur ont diminué avec le temps. 
Ils ont vécu la variante Delta comme la pire et se sont sentis soutenus par 
leurs collègues plus que par la direction. Ils ont relaté des observations 
d'hésitation à se faire vacciner, mais ont reconnu que la vaccination avait 
atténué une partie de leur peur et de leur anxiété. Les capacités d'adaptation 
des participants variaient et, en réfléchissant à leur expérience, ils ont 
partagé les leçons apprises et la voie à suivre.

Copyright © 2022. Published by Elsevier Inc.

DOI: 10.1016/j.jmir.2022.11.012
PMCID: PMC9721282
PMID: 36526571 [Indexed for MEDLINE]


1196. BMJ Open. 2022 Dec 16;12(12):e054862. doi: 10.1136/bmjopen-2021-054862.

Machine-learning approaches to identify determining factors of happiness during 
the COVID-19 pandemic: retrospective cohort study.

Osawa I(1), Goto T(2)(3), Tabuchi T(4), Koga HK(5), Tsugawa Y(6)(7).

Author information:
(1)Department of Emergency and Critical Care Medicine, The University of Tokyo 
Hospital, Tokyo, Japan, Bunkyo, Tokyo, Japan ioosawa-tky@umin.ac.jp.
(2)Department of Clinical Epidemiology and Health Economics, School of Public 
Health, The University of Tokyo, Bunkyo, Tokyo, Japan.
(3)TXP Medical Co. Ltd, Chiyoda, Tokyo, Japan.
(4)Cancer Control Center, Osaka International Cancer Institute, Osaka, Osaka, 
Japan.
(5)Department of Social and Behavioral Sciences, Harvard T.H. Chan School of 
Public Health, Boston, Massachusetts, USA.
(6)Division of General Internal Medicine and Health Service Research, David 
Geffen School of Medicine at UCLA, Los Angeles, California, USA.
(7)Department of Health Policy and Management, UCLA Fielding School of Public 
Health, Los Angeles, California, USA.

OBJECTIVE: To investigate determining factors of happiness during the COVID-19 
pandemic.
DESIGN: Observational study.
SETTING: Large online surveys in Japan before and during the COVID-19 pandemic.
PARTICIPANTS: A random sample of 25 482 individuals who are representatives of 
the Japanese population.
MAIN OUTCOME MEASURE: Self-reported happiness measured using a 10-point Likert 
scale, where higher scores indicated higher levels of happiness. We defined 
participants with ≥8 on the scale as having high levels of happiness.
RESULTS: Among the 25 482 respondents, the median score of self-reported 
happiness was 7 (IQR 6-8), with 11 418 (45%) reporting high levels of happiness 
during the pandemic. The multivariable logistic regression model showed that 
meaning in life, having a spouse, trust in neighbours and female gender were 
positively associated with happiness (eg, adjusted OR (aOR) for meaning in life 
4.17; 95% CI 3.92 to 4.43; p<0.001). Conversely, self-reported poor health, 
anxiety about future household income, psychiatric diseases except depression 
and feeling isolated were negatively associated with happiness (eg, aOR for 
self-reported poor health 0.44; 95% CI 0.39 to 0.48; p<0.001). Using 
machine-learning methods, we found that meaning in life and social capital (eg, 
having a spouse and trust in communities) were the strongest positive 
determinants of happiness, whereas poor health, anxiety about future household 
income and feeling isolated were important negative determinants of happiness. 
Among 6965 subjects who responded to questionnaires both before and during the 
COVID-19 pandemic, there was no systemic difference in the patterns as to 
determinants of declined happiness during the pandemic.
CONCLUSION: Using machine-learning methods on data from large online surveys in 
Japan, we found that interventions that have a positive impact on social capital 
as well as successful pandemic control and economic stimuli may effectively 
improve the population-level psychological well-being during the COVID-19 
pandemic.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-054862
PMCID: PMC9764099
PMID: 36526317 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


1197. J Pain Symptom Manage. 2023 Apr;65(4):296-307. doi: 
10.1016/j.jpainsymman.2022.12.007. Epub 2022 Dec 14.

Effects of Spiritual Care on Well-Being of Intensive Care Family Surrogates: A 
Clinical Trial.

Torke AM(1), Varner-Perez SE(2), Burke ES(3), Taylor TA(3), Slaven JE(4), 
Kozinski KL(5), Maiko SM(6), Pfeffer BJ(7), Banks SK(8).

Author information:
(1)Indiana University School of Medicine (A.M.T., S.M.M., S.K.B.), Indianapolis, 
Indiana; Daniel F. Evans Center (A.M.T., S.E.V.P., S.M.M., B.J.P.), Indiana 
University Health, Indianapolis, Indiana; IU Center for Aging Research (A.M.T., 
S.E.V.P., E.S.B., T.A.T.), Regenstrief Institute, Indianapolis, Indiana. 
Electronic address: atorke@iu.edu.
(2)Daniel F. Evans Center (A.M.T., S.E.V.P., S.M.M., B.J.P.), Indiana University 
Health, Indianapolis, Indiana; IU Center for Aging Research (A.M.T., S.E.V.P., 
E.S.B., T.A.T.), Regenstrief Institute, Indianapolis, Indiana; Spiritual Care 
and Chaplaincy Department (S.E.V.P., B.J.P.), Indiana University Health, 
Indianapolis, Indiana.
(3)IU Center for Aging Research (A.M.T., S.E.V.P., E.S.B., T.A.T.), Regenstrief 
Institute, Indianapolis, Indiana.
(4)Department of Biostatistics and Health Data Science (J.E.S.), Indiana 
University School of Medicine, Indianapolis, Indiana.
(5)Maine General Health (K.L.K.), Augusta, Maine.
(6)Indiana University School of Medicine (A.M.T., S.M.M., S.K.B.), Indianapolis, 
Indiana; Daniel F. Evans Center (A.M.T., S.E.V.P., S.M.M., B.J.P.), Indiana 
University Health, Indianapolis, Indiana.
(7)Daniel F. Evans Center (A.M.T., S.E.V.P., S.M.M., B.J.P.), Indiana University 
Health, Indianapolis, Indiana; Spiritual Care and Chaplaincy Department 
(S.E.V.P., B.J.P.), Indiana University Health, Indianapolis, Indiana.
(8)Indiana University School of Medicine (A.M.T., S.M.M., S.K.B.), Indianapolis, 
Indiana.

CONTEXT: Critical illness of a family member is associated with high emotional 
and spiritual distress and difficult medical decisions.
OBJECTIVES: To determine if a semistructured spiritual care intervention 
improves the well-being of family surrogate decision makers in intensive care 
(ICU) settings.
METHODS: This study is a randomized, allocation-concealed, parallel group, usual 
care-controlled, single-blind trial of patient/surrogate dyads in five ICUs in 
one Midwest, academic medical center. Patients were 18 and older admitted to the 
ICU and unable to make medical decisions. The intervention involved proactive 
contact from the chaplain, scheduled, semi-structured visits, weekly follow-up, 
and bereavement calls. The control group received usual care. The primary 
endpoint was the surrogate's anxiety (Generalized Anxiety Disorders-7 scale), 
six to eight weeks after discharge.
RESULTS: Of 192 patient/surrogate dyads enrolled, 128 completed outcome 
assessments. At follow-up, anxiety in the intervention group was lower than 
control (median score 1 (interquartile range 0,6) vs. 4 (1,9), P = 0.0057). The 
proportion of patients with a minimal clinically important difference (MCID) in 
anxiety of 2+ was 65.2% in the intervention group vs. 49.2% in control. The odds 
of an MCID remained higher in adjusted analysis (Odds Ratio 3.11, 95% confidence 
interval 1.18, 8.21; P = 0.0218) The adjusted odds of an MCID were higher for 
spiritual well-being (OR 3.79, CI 1.41,10.17; P = 0.0081). Satisfaction with 
spiritual care was also higher (adjusted mean 3.5 ± 0.4 vs. 2.9 ± 0.1); P < 
.0001).
CONCLUSIONS: Proactive, semistructured spiritual care delivered by chaplains 
improves well-being for ICU surrogates. Results provide evidence for inclusion 
of chaplains in palliative and intensive care teams.

Copyright © 2022 American Academy of Hospice and Palliative Medicine. Published 
by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jpainsymman.2022.12.007
PMCID: PMC10129066
PMID: 36526251 [Indexed for MEDLINE]


1198. J Affect Disord. 2023 Feb 15;323:624-630. doi: 10.1016/j.jad.2022.12.015. Epub 
2022 Dec 12.

Telehealth treatment of patients with major depressive disorder during the 
COVID-19 pandemic: Comparative safety, patient satisfaction, and effectiveness 
to prepandemic in-person treatment.

Zimmerman M(1), D'Avanzato C(2), King BT(2).

Author information:
(1)Department of Psychiatry and Human Behavior, Brown Medical School, Rhode 
Island Hospital, Providence, RI, United States. Electronic address: 
mzimmerman@lifespan.org.
(2)Department of Psychiatry and Human Behavior, Brown Medical School, Rhode 
Island Hospital, Providence, RI, United States.

BACKGROUND: The COVID-19 pandemic impelled a transition from in-person to 
telehealth psychiatric treatment. There are no studies of partial hospital 
telehealth treatment for major depressive disorder (MDD). In the present report 
from the Rhode Island Methods to Improve Diagnostic Assessment and Services 
(MIDAS) project, we compared the effectiveness of partial hospital care of 
patients with MDD treated virtually versus in-person.
METHODS: Outcome was compared in 294 patients who were treated virtually from 
May 2020 to December 2021 to 542 patients who were treated in the in-person 
partial program in the 2 years prior to the pandemic. Patients completed 
self-administered measures of patient satisfaction, symptoms, coping ability, 
functioning, and general well-being.
RESULTS: In both the in-person and telehealth groups, patients with MDD were 
highly satisfied with treatment and reported a significant reduction in symptoms 
from admission to discharge. Both groups also reported a significant improvement 
in positive mental health, general well-being, coping ability, and functioning. 
A large effect size of treatment was found in both treatment groups. Contrary to 
our hypothesis, the small differences in outcome favored the telehealth-treated 
patients. The length of stay and the likelihood of staying in treatment until 
completion were significantly greater in the virtually treated patients.
LIMITATIONS: The treatment groups were ascertained sequentially, and telehealth 
treatment was initiated after the COVID-19 pandemic began. Outcome assessment 
was limited to a self-administered questionnaire.
CONCLUSIONS: In an intensive acute care setting, delivering treatment to 
patients with MDD using a virtual, telehealth platform was as effective as 
treating patients in-person.

Copyright © 2022 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2022.12.015
PMCID: PMC9742046
PMID: 36521663 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest None.


1199. Autism. 2023 Jul;27(5):1477-1491. doi: 10.1177/13623613221140759. Epub 2022 Dec 
15.

Autistic and non-autistic young people's and caregivers' perspectives on 
COVID-19-related schooling changes and their impact on emotional well-being: An 
opportunity for change?

Ozsivadjian A(1), Milner V(1), Pickard H(1), Hollocks MJ(1)(2), Gaigg SB(3), 
Colvert E(1), Happé F(1), Magiati I(4).

Author information:
(1)King's College London, UK.
(2)South London and Maudsley NHS Foundation Trust, UK.
(3)City, University of London, UK.
(4)The University of Western Australia, Australia.

Autistic young people experience poorer mental health and well-being compared to 
their non-autistic peers. Navigating the complex social, academic, procedural 
and sensory aspects of school may be particularly challenging for autistic young 
people and contribute to poorer mental well-being. The COVID-19 pandemic caused 
unprecedented school changes and provided a unique opportunity to gather 
caregiver's and young people's perspectives on the impact of school and 
pandemic-related school changes on the well-being of both autistic and 
non-autistic young people. We asked for the views of caregivers and young people 
aged 11-18 years gathered across three timepoints between May and December 2020. 
Their responses revealed both benefits and challenges associated with school 
changes. Insights into possible lessons from the pandemic and recommendations 
for more flexible, individualised and strengths-based educational practices are 
discussed.

DOI: 10.1177/13623613221140759
PMCID: PMC9760516
PMID: 36519246 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship and/or publication of this 
article.


1200. J Community Health. 2023 Jun;48(3):390-397. doi: 10.1007/s10900-022-01160-x. 
Epub 2022 Dec 14.

Parental and Other Caregiver Loss Due to COVID-19 in the United States: 
Prevalence by Race, State, Relationship, and Child Age.

Treglia D(1), Cutuli JJ(2), Arasteh K(2), Bridgeland J(3).

Author information:
(1)University of Pennsylvania, 3814 Walnut St, Philadelphia, PA, 19104, USA. 
dtreglia@upenn.edu.
(2)Nemours Children's Health, Wilmington, DE, USA.
(3)COVID Collaborative, Washington, DC, USA.

The more than one million COVID-19 deaths in the United States include parents, 
grandparents, and other caregivers for children. These losses can disrupt the 
social, emotional, and economic well-being of children, their families, and 
their communities, and understanding the number and characteristics of affected 
children is a critical step in responding. We estimate the number of children 
who lost a parent or other co-residing caregiver to COVID-19 in the U.S. and 
identify racial, ethnic, and geographic disparities by aligning COVID-19 death 
counts through mid-May 2022 with household information from a representative 
sample of individuals. We estimate that 216,617 children lost a co-residing 
caregiver to COVID-19; 77,283 lost a parent and more than 17,000 children lost 
the only caregiver with whom they lived. Non-White children were more than twice 
as likely as White children to experience caregiver loss, and children under 
14 years old experienced 70% of caregiver loss. These losses are a salient 
threat to the functioning of families and the communities in which COVID-19 
deaths are concentrated, compounding additional challenges to physical and 
mental health and economic stability disproportionately imposed by the pandemic 
on historically disadvantaged populations. Policymakers and systems should take 
steps to ensure access to appropriate supports.

© 2022. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s10900-022-01160-x
PMCID: PMC9749637
PMID: 36515763 [Indexed for MEDLINE]

Conflict of interest statement: Mr. Bridgeland is CEO of the COVID 
Collaborative, a national assembly of experts, leaders and institutions in 
health, education and the economy and associations representing the diversity of 
the country to turn the tide on the pandemic by supporting global, federal, 
state, and local COVID-19 response efforts. Drs. Treglia, Cutuli, and Arasteh 
received funding for this study through the COVID Collaborative and Social 
Policy Analytics. Dr. Treglia is CEO of Social Policy Analytics and an Expert 
Contributor to the COVID Collaborative, with whom he consults on COVID-19 
related caregiver loss.


1201. Prim Health Care Res Dev. 2022 Dec 14;23:e79. doi: 10.1017/S1463423622000755.

Barriers to healthcare and their relationship to well-being and social support 
for autistic adults during COVID-19.

Featherstone C(1), Sharpe RA(2)(3), Axford N(4), Asthana S(5), Ball S(6), Husk 
K(7).

Author information:
(1)NIHR Applied Research Collaboration (ARC) South West Peninsula, University of 
Plymouth, Plymouth, UK.
(2)Advanced Public Health Practitioner, Public Health, Cornwall Council TR1 3AY, 
UK.
(3)European Centre for Environment and Human Health, University of Exeter 
Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, 
UK.
(4)Associate Professor, NIHR Applied Research Collaboration (ARC) South West 
Peninsula, University of Plymouth, Plymouth, UK.
(5)Director of Plymouth Institute of Health and Care Research; Peninsula Medical 
School, University of Plymouth, Plymouth, UK.
(6)Senior Research Fellow in Medical Statistics, NIHR Applied Research 
Collaboration (ARC) South West Peninsula, University of Exeter, Exeter, UK.
(7)Senior Research Fellow, NIHR Applied Research Collaboration (ARC) South West 
Peninsula, University of Plymouth, Plymouth, UK.

AIM: The present study aimed to investigate barriers to healthcare and their 
relationships to social and emotional well-being and intersectional inequalities 
for autistic adults during COVID-19 restrictions in the UK.
BACKGROUND: Autistic adults experience severe health inequalities and report 
more barriers to accessing health services compared to other both disabled and 
non-disabled populations. The COVID-19 pandemic has impacted many areas of 
society that may have increased vulnerability of autistic people to social and 
health inequalities, including delivery of healthcare from in-person to remote 
methods.
METHOD: One hundred twenty-eight autistic adults who lived in the UK took part 
in an online survey. Measures included the Barriers to Healthcare Checklist 
(Short Form) and PROMIS outcome measure bank to assess emotional well-being and 
social support. Participants rated their agreement with items, retrospectively 
considering three different points of the trajectory of COVID-19 restrictions: 
before COVID-19, during the first lockdown in spring 2020, and in the month 
prior to taking the survey during autumn 2020. They completed a follow-up survey 
six months later to continue to assess change as restrictions in the UK were 
eased.
FINDINGS: The average number of barriers to healthcare showed no significant 
change between all four time points. However, the nature of barriers to 
healthcare changed at the point of lockdown and persisted beyond the easing of 
COVID-19 restrictions. Barriers to healthcare were associated with some social 
and emotional well-being variables and demographic groups including gender, 
education and presence of additional disabilities. The findings may help to 
identify areas to target to improve access to both remote and in-person health 
systems for autistic people as modes of delivery continue to change over time.

DOI: 10.1017/S1463423622000755
PMCID: PMC9817085
PMID: 36515013 [Indexed for MEDLINE]


1202. Trials. 2022 Dec 13;23(1):1013. doi: 10.1186/s13063-022-06964-9.

Effect of positive event recording based on positive psychology on healthy 
behaviors and readmission rate of patients after PCI: a study protocol for a 
prospective, randomized controlled trial.

Hu YY(#)(1), Jiang X(#)(2), Mao FY(3), Zhang J(3), Liu L(1), Gu J(1), Wu Q(4), 
Li C(5).

Author information:
(1)Department of Cardiology, the First Affiliated Hospital of Soochow 
University, Suzhou, China.
(2)Nursing Department, the Affiliated Wuxi People's Hospital of Nanjing Medical 
University, Wuxi, China.
(3)School of Nursing, Soochow University, Suzhou, China.
(4)Department of Cardiology, the First Affiliated Hospital of Soochow 
University, Suzhou, China. qwu@suda.edu.cn.
(5)Department of Cardiology, the First Affiliated Hospital of Soochow 
University, Suzhou, China. h20195231031@163.com.
(#)Contributed equally

BACKGROUND: Unhealthy behaviors of coronary heart disease (CHD) patients are 
closely related to the occurrence of major heart events, which increases the 
readmission rate and brings a heavy economic burden to families and society. 
Therefore, it is necessary for health care workers to take active preventive and 
therapeutic measures to keep or establish healthy behaviors of patients. 
Positive psychological intervention has been proved to be effective, but it has 
not been reported in the field of CHD in China. The purpose of this study is to 
explore the effects of positive event recording based on positive psychology on 
the healthy behaviors, readmission rate, and anxiety of patients with CHD, in 
order to provide new ideas for the development of secondary prevention 
strategies for CHD.
METHODS: This is a prospective, single-center, randomized controlled trial 
(RCT). The subjects will be enrolled from the Department of Cardiology, the 
First Affiliated Hospital of Soochow University. There are 80 cases in total; 
according to the random number table, the subjects are randomly divided into the 
intervention group (n = 40) and the control group (n = 40). The patients in the 
intervention group will receive the intervention of recording positive events 
once a week for 3 months, while the patients in the control group receive 
conventional nursing. The primary outcomes will include healthy behaviors, 
readmission rate, and anxiety, and the secondary outcomes will include 
psychological capital, subjective well-being, and corresponding clinical 
laboratory indicators. The protocol was approved by the Medical Ethics Committee 
of Soochow University (approval no. SUDA20200604H01) and is performed in strict 
accordance with the Declaration of Helsinki formulated by the World Medical 
Association. All participants provide written informed consent.
DISCUSSION: This study will verify whether positive event recording based on 
positive psychology can make patients maintain healthy behaviors, reduce 
readmission rate, and improve anxiety after PCI. Then, this study will provide 
new ideas and references for the development of secondary prevention strategies 
for patients with CHD.
TRIAL REGISTRATION: Chinese Clinical Trials Registry 2000034538. Registered on 
10 July 2020.

© 2022. The Author(s).

DOI: 10.1186/s13063-022-06964-9
PMCID: PMC9746175
PMID: 36514114 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1203. BMC Public Health. 2022 Dec 13;22(1):2331. doi: 10.1186/s12889-022-14775-5.

Students experiences of an 8-week mindfulness-based intervention at a college of 
opportunity: a qualitative investigation of the mindfulness-based college 
program.

Nardi WR(1), Elshabassi N(2), Spas J(2)(3), Zima A(4), Saadeh F(4), Loucks 
EB(2)(4).

Author information:
(1)Department of Behavioral and Social Sciences, Brown University School of 
Public Health, Providence, RI, USA. william_nardi@brown.edu.
(2)Department of Behavioral and Social Sciences, Brown University School of 
Public Health, Providence, RI, USA.
(3)Department of Psychology, Rhode Island College, Providence, RI, USA.
(4)Department of Epidemiology, Brown University School of Public Health, 
Providence, RI, USA.

BACKGROUND: Mindfulness-based programs have the potential to improve the 
well-being of undergraduate students by reducing anxiety, depression, and 
isolation in the wake of the COVID-19 pandemic. The aim of this qualitative 
study was to explore lived experiences of undergraduates in a mindfulness-based 
program at a "college of opportunity" that has high proportions of 
first-generation college students. Specifically, we sought to: (1) explore the 
application of mindfulness practices in students' daily lives; (2) explore how 
participants believe mindfulness training affected their health and well-being; 
(3) learn participants' recommendations and suggested changes for 
mindfulness-based interventions in future iterations.
METHODS: Students were recruited from XXX and consented to participate in 
semi-structured digitally conducting interviews after the completion of the 
8-week intervention in the Fall/Spring 2020 academic year. Data were analyzed 
using Applied Thematic Analysis and a codebook was constructed using a 
consensus-driven process using both a priori and emergent coding. All 
transcripts were double-coded, and concordance was achieved for all interviews.
RESULTS: Qualitative results indicated that the most applied practices were 
those that could be easily incorporated into a daily routine. Furthermore, 
students reported an increased ability to cope with a variety of stressors, 
decreased reactivity, and enhanced resilience specifically concerning mental 
health challenges. Additionally, engaging in mindfulness training improved 
students' ability to navigate social distancing measures, other 
COVID-19-specific stress, and enhanced motivation for self-care practices to 
sustain well-being. Concerning preferred intervention delivery modality, 
participants stated that due to multiple, growing responsibilities (e.g., 
pressures of commuting to class) they preferred in-person delivery, shorter 
sessions over a longer period, with classes in the morning or early afternoon.
CONCLUSIONS: Findings provide pragmatic and psychosocial insights into students' 
application of mindfulness training across personal, professional, and academic 
domains enhancing their well-being. This work builds on qualitative work 
concerning students' perceptions and applications of mindfulness while offering 
insights into the future of mindfulness programs among undergraduates.
TRIAL REGISTRATION: Clinicaltrials.gov NCT03124446.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-14775-5
PMCID: PMC9745283
PMID: 36514082 [Indexed for MEDLINE]

Conflict of interest statement: None.


1204. Sci Rep. 2022 Dec 13;12(1):21521. doi: 10.1038/s41598-022-26063-8.

Transcultural adaptation and psychometric validation of the Thai-Brief Resilient 
Coping Scale: a cross-sectional study during the coronavirus disease 2019 
pandemic in Thailand.

Nochaiwong S(1)(2), Ruengorn C(3)(4), Awiphan R(3)(4), Phosuya C(3)(4), Ruanta 
Y(3)(4), Kanjanarat P(3)(4), Wongpakaran N(5), Wongpakaran T(5), Thavorn 
K(4)(6)(7)(8).

Author information:
(1)Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai 
University, Chiang Mai, 50200, Thailand. surapon.nochaiwong@gmail.com.
(2)Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of 
Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand. 
surapon.nochaiwong@gmail.com.
(3)Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai 
University, Chiang Mai, 50200, Thailand.
(4)Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of 
Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand.
(5)Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang 
Mai, 50200, Thailand.
(6)Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, ON, K1H 8L6, 
Canada.
(7)Institute of Clinical and Evaluative Sciences, ICES uOttawa, Ottawa, ON, K1Y 
4E9, Canada.
(8)School of Epidemiology and Public Health, Faculty of Medicine, University of 
Ottawa, Ottawa, ON, K1G 5Z3, Canada.

This study aimed to examine the transcultural adaptation, construct validity, 
and psychometric properties of the Thai-Brief Resilient Coping Scale (BRCS) 
among the general population and college students through the coronavirus 
disease 2019 (COVID-19) pandemic in Thailand. We invited the 4004 participants 
to complete sets of anchor-based measurement tools, including depressive 
symptoms, anxiety symptoms, perceived stress, well-being, and perceived social 
support. The scale factor structure of the Thai-BRCS was assessed using factor 
analysis, and nonparametric item response theory (IRT) analysis. The 
psychometric properties of the Thai-BRCS for validity (convergent and 
discriminant) and reliability (internal consistency and reproducibility) were 
assessed. Based on the construct validity testing, factor analysis, and 
nonparametric IRT analysis reaffirmed the unidimensionality with a one-factor 
structure of the Thai-BRCS version. For convergent validity, the scale was 
significantly correlated with all sets of anchor-based measurement tools (all 
P < 0.001). The discriminant validity was satisfactory with a group of medium 
and low resilience and the risk of adverse mental outcomes. For scale 
reliability, it revealed excellent internal consistency (alpha = 0.84, 
omega = 0.85) and reproducibility (intraclass correlation = 0.91). The Thai-BRCS 
version fulfills transcultural adaptation with satisfactory psychometric 
properties to measure psychological resilience in the Thai population during the 
COVID-19 pandemic.

© 2022. The Author(s).

DOI: 10.1038/s41598-022-26063-8
PMCID: PMC9745707
PMID: 36513707 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1205. BMC Psychiatry. 2022 Dec 12;22(1):781. doi: 10.1186/s12888-022-04426-9.

Impact of high prebiotic and probiotic dietary education in the SARS-CoV-2 era: 
improved cardio-metabolic profile in schizophrenia spectrum disorders.

Sevillano-Jiménez A(1), Romero-Saldaña M(2), García-Mellado JA(3), 
Carrascal-Laso L(3), García-Rodríguez M(4)(5), Molina-Luque R(6), Molina-Recio 
G(6).

Author information:
(1)Montilla Community Mental Health Unit. Mental Health Clinical Management 
Unit. Reina Sofia University Hospital. Avda. Andalucía, nº11, 14550, Montilla 
(Córdoba), Spain.
(2)Department of Nursing, Pharmacology and Physiotherapy, University of Cordoba. 
Lifestyles, Innovation and Health (GA-16). Maimonides Biomedical Research 
Institute of Cordoba (IMIBIC), Avd Menéndez Pidal S/N, 14004, Córdoba, Spain. 
z92rosam@uco.es.
(3)Psychiatry Service, Zamora Provincial Hospital. Zamora Welfare Complex, 
C/Hernán Cortés, nº 40, 49021, Zamora, Spain.
(4)Department of Nursing and Nutrition, Biomedicine Sciences and Health Faculty, 
European University. C/Tajo S/N, 28670, Villaviciosa de Odón (Madrid), Spain.
(5)Lifestyles, Innovation and Health (GA-16), Maimonides Biomedical Research 
Institute of Cordoba (IMIBIC), Avd Menéndez Pidal S/N, 14004, Córdoba, Spain.
(6)Department of Nursing, Pharmacology and Physiotherapy, University of Cordoba. 
Lifestyles, Innovation and Health (GA-16). Maimonides Biomedical Research 
Institute of Cordoba (IMIBIC), Avd Menéndez Pidal S/N, 14004, Córdoba, Spain.

BACKGROUND: The development of new aetiological premises, such as the 
microbiota-gut-brain axis theory, evidences the influence of dietary and 
nutritional patterns on mental health, affecting the patient's quality of life 
in terms of physical and cardiovascular health. The aim was to determine the 
impact of a nutritional programme focused on increasing the intake of prebiotic 
and probiotic food on cardio-metabolic status in individuals with schizophrenia 
spectrum disorders in the contextual setting of the SARS-CoV-2 era.
METHODS: A randomised clinical trial (two-arm, double-blind, balanced-block, 
six-month intervention) was conducted in a group of 50 individuals diagnosed 
with schizophrenia spectrum disorder during the SARS-CoV-2 confinement period. 
The control group received conventional dietary counselling on an individual 
basis. In the intervention group, an individual nutritional education programme 
with a high content of prebiotics and probiotics (dairy and fermented foods, 
green leafy vegetables, high-fibre fruit, whole grains, etc.) was established. 
Data on cardiovascular status were collected at baseline, three and six months. 
In addition, anthropometric parameters were analysed monthly.
RESULTS: Forty-four subjects completed follow-up and were analysed. Statistical 
differences (p < 0.05) were found in all anthropometric variables at baseline 
and six months of intervention. A 27.4% reduction in the prevalence of metabolic 
syndrome risk factors in all its components was evidenced, leading to a 
clinically significant improvement (decrease in cardiovascular risk) in the 
intervention group at six months.
CONCLUSIONS: The development of a nutritional programme focused on increasing 
the dietary content of prebiotics and probiotics effectively improves the 
cardio-metabolic profile in schizophrenia spectrum disorders. Therefore, nursing 
assumes an essential role in the effectiveness of dietary interventions through 
nutritional education and the promotion of healthy lifestyles. Likewise, nursing 
acquires a relevant role in interdisciplinary coordination in confinement 
contexts.
TRIAL REGISTRATION: The study protocol complied with the Declaration of Helsinki 
for medical studies; the study received ethical approval from referral Research 
Ethics Committee in November 2019 (reg. no. 468) and retrospectively registered 
in clinicaltrials.gov (NCT04366401. First Submitted: 28th April 2020; First 
Registration: 25th June 2020).

© 2022. The Author(s).

DOI: 10.1186/s12888-022-04426-9
PMCID: PMC9743108
PMID: 36510155 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1206. Dev Psychopathol. 2024 Feb;36(1):366-378. doi: 10.1017/S0954579422001250. Epub 
2022 Dec 12.

Social experiences and youth psychopathology during the COVID-19 pandemic: A 
longitudinal study.

Rodman AM(1), Rosen ML(1), Kasparek SW(1), Mayes M(2), Lengua L(2), Meltzoff 
AN(2), McLaughlin KA(1).

Author information:
(1)Department of Psychology, Harvard University, Cambridge, MA, USA.
(2)Department of Psychology, University of Washington, Seattle, WA, USA.

The early stages of the COVID-19 pandemic and associated stay-at-home orders 
resulted in a stark reduction in daily social interactions for children and 
adolescents. Given that peer relationships are especially important during this 
developmental stage, it is crucial to understand the impact of the COVID-19 
pandemic on social behavior and risk for psychopathology in children and 
adolescents. In a longitudinal sample (N=224) of children (7-10y) and 
adolescents (13-15y) assessed at three strategic time points (before the 
pandemic, during the initial stay-at-home order period, and six months later 
after the initial stay-at-home order period was lifted), we examine whether 
certain social factors protect against increases in stress-related 
psychopathology during the pandemic, controlling for pre-pandemic symptoms. 
Youth who reported less in-person and digital socialization, greater social 
isolation, and less social support had worsened psychopathology during the 
pandemic. Greater social isolation and decreased digital socialization during 
the pandemic were associated with greater risk for psychopathology after 
experiencing pandemic-related stressors. In addition, children, but not 
adolescents, who maintained some in-person socialization were less likely to 
develop internalizing symptoms following exposure to pandemic-related stressors. 
We identify social factors that promote well-being and resilience in youth 
during this societal event.

DOI: 10.1017/S0954579422001250
PMCID: PMC10258229
PMID: 36503551 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of interest/Competing interests The 
authors report no conflicts of interest, competing interests, or disclosures.


1207. Sex Reprod Healthc. 2023 Mar;35:100805. doi: 10.1016/j.srhc.2022.100805. Epub 
2022 Dec 1.

Exploring the psychosocial impact of the Covid-19 pandemic on women's perinatal 
experiences and wellbeing: A qualitative study.

Mari F(1), Capasso M(2), Caso D(1).

Author information:
(1)Department of Humanities, University of Naples Federico II, Italy.
(2)Department of Humanities, University of Naples Federico II, Italy. Electronic 
address: miriam.capasso@unina.it.

OBJECTIVE: While many studies have investigated the clinical impact of the 
Covid-19 pandemic on pregnant women's mental health, little attention has been 
paid to the exploration of women's experiences during the perinatal period from 
a psychosocial perspective in the Italian context. Thus, the present study aimed 
to explore the psychosocial changes associated with the pandemic in the 
perinatal context.
METHODS: Twenty-one Italian women who gave birth between March and November 2020 
took part in this research by participating in semi-structured interviews, 
exploring their childbirth experiences. Our data were analysed using a Grounded 
Theory approach.
RESULTS: Our findings revealed the enhanced importance of social support as a 
protective factor against uncertainties, which strongly characterised all phases 
of the perinatal period during the pandemic. Such uncertainties were mainly 
linked to the discontinuity in intrapartum care, as well as to concerns of being 
infected with Covid-19 combined with other pregnancy-specific worries. The main 
sources of social support were represented by loved ones - most of all partners 
- along with health care staff and peer networks.
CONCLUSIONS: Our results suggest the importance of implementing evidence-based 
policies and interventions to improve women's wellbeing in the perinatal period 
during the pandemic, as well as of guaranteeing intrapartum care continuity and 
the presence of social support.

Copyright © 2022 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.srhc.2022.100805
PMCID: PMC9712141
PMID: 36502624 [Indexed for MEDLINE]


1208. Sensors (Basel). 2022 Nov 26;22(23):9214. doi: 10.3390/s22239214.

Intelligent System for Detecting Deterioration of Life Satisfaction as Tool for 
Remote Mental-Health Monitoring.

Prokopowicz P(1), Mikołajewski D(1)(2), Mikołajewska E(3).

Author information:
(1)Institute of Computer Science, Kazimierz Wielki University, 85-064 Bydgoszcz, 
Poland.
(2)Laboratory of Neurophysiological Research, Medical University of Lublin, 
20-059 Lublin, Poland.
(3)Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz, 
Nicolaus Copernicus University in Toruń, 87-100 Toruń, Poland.

The research described in this article is a continuation of work on a 
computational model of quality of life (QoL) satisfaction. In the proposed 
approach, overall life satisfaction is aggregated to personal life satisfaction 
(PLUS). The model described in the article is based on well-known and commonly 
used clinimetric scales (e.g., in psychiatry, psychology and physiotherapy). The 
simultaneous use of multiple scales, and the complexity of describing the 
quality of life with them, require complex fuzzy computational solutions. The 
aim of the study is twofold: (1) To develop a fuzzy model that allows for the 
detection of changes in life satisfaction scores (data on the influence of the 
COVID-19 pandemic and the war in the neighboring country were used). (2) To 
develop more detailed guidelines than the existing ones for further similar 
research on more advanced intelligent systems with computational models which 
allow for sensing, detecting and evaluating the psychical state. We are 
concerned with developing practical solutions with higher scientific and 
clinical utility for both small datasets and big data to use in remote patient 
monitoring. Two exemplary groups of specialists at risk of occupational burnout 
were assessed three times at different intervals in terms of life satisfaction. 
The aforementioned assessment was made on Polish citizens because the specific 
data could be gathered: before and during the pandemic and during the war in 
Ukraine (a neighboring country). That has a higher potential for presenting a 
better analysis and reflection on the practical application of the model. A 
research group (physiotherapists, n = 20) and a reference group (IT 
professionals, n = 20) participated in the study. Four clinimetric scales were 
used for assessment: the Perceived Stress Scale (PSS10), the Maslach Burnout 
Scale (MBI), the Satisfaction with Life Scale (SWLS), and the Nordic 
Musculoskeletal Questionnaire (NMQ). The assessment was complemented by 
statistical analyses and fuzzy models based on a hierarchical fuzzy system. 
Although several models for understanding changes in life satisfaction scores 
have been previously investigated, the novelty of this study lies in the use of 
data from three consecutive time points for the same individuals and the way 
they are analyzed, based on fuzzy logic. In addition, the new hierarchical 
structure of the model used in the study provides flexibility and transparency 
in the process of remotely monitoring changes in people's mental well-being and 
a quick response to observed changes. The aforementioned computational approach 
was used for the first time.

DOI: 10.3390/s22239214
PMCID: PMC9737854
PMID: 36501916 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1209. Int J Environ Res Public Health. 2022 Dec 5;19(23):16274. doi: 
10.3390/ijerph192316274.

Perception of Current Educational Environment, Clinical Competency, and 
Depression among Malaysian Medical Students in Clinical Clerkship: A 
Cross-Sectional Study.

Sudi R(1), Chang WL(1), Arshad NH(1), Zainal Abidin SN(1), Suderman U(1), Woon 
LS(1).

Author information:
(1)Department of Psychiatry, Faculty of Medicine, The National University of 
Malaysia, Kuala Lumpur 56000, Malaysia.

The COVID-19 pandemic has altered the educational environment of medical 
students in clinical clerkship, with potential impacts on clinical competency 
and reported increased prevalence of depression. This study aimed to determine 
the relationship between the perception of the educational environment, 
self-perceived clinical competency, and depression among them. Subjects (N = 
196) at the National University of Malaysia participated through convenience 
sampling in an online survey including sociodemographic data, COVID-19-related 
stressors, Dundee Ready Education Environment Measure (DREEM), self-perceived 
clinical competency, and Patient Health Questionnaire (PHQ-9). The cut-off point 
for depression was a PHQ-9 score ≥ 15. Multiple logistic regression followed 
bivariate analyses to identify factors for depression. The participants (mean 
age: 23.2 years, SD ± 0.98 years) were mainly female (71.9%) and Malay (59.2%). 
The prevalence of depression was 17.4% (95% CI: 12.3-23.4%). Most participants 
perceived the educational environment positively. In logistic regression, 
ethnicity (Adjusted OR = 3.1, 95% CI: 1.2-8.1) and DREEM score were 
significantly associated with depression, whereas self-perceived clinical 
competency was not. A higher DREEM score indicating a better perception of the 
educational environment was linked to a lower likelihood of depression (p = 
0.046). Besides ethnicity, perception of the educational environment emerged as 
a factor associated with depression. This relationship between the educational 
environment and mental well-being warrants further exploration.

DOI: 10.3390/ijerph192316274
PMCID: PMC9735451
PMID: 36498345 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1210. Int J Environ Res Public Health. 2022 Dec 3;19(23):16183. doi: 
10.3390/ijerph192316183.

Validation of the Spanish Version of the Fear of COVID-19 Scale (FCV-19S) in 
Long-Term Care Settings.

Cárdenas Soriano P(1), Rodriguez-Blazquez C(2), Forjaz MJ(3), Ayala A(4), 
Rojo-Perez F(5), Fernandez-Mayoralas G(5), Molina-Martinez MA(6), de Arenaza 
Escribano CP(5), Rodriguez-Rodriguez V(5).

Author information:
(1)Department of Preventive Medicine, University Hospital of Albacete, ES-02006 
Albacete, Spain.
(2)National Centre of Epidemiology and Network Centre for Biomedical Research in 
Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, ES-28029 
Madrid, Spain.
(3)National Centre of Epidemiology and Health Service Research Network on 
Chronic Diseases (REDISSEC) and Research Network on Chronicity, Primary Care and 
Health Promotion (RICAPPS), Carlos III Institute of Health, ES-28029 Madrid, 
Spain.
(4)Department of Statistics, University Carlos III of Madrid, and Health Service 
Research Network on Chronic Diseases (REDISSEC), Carlos III Institute of Health, 
ES-28029 Madrid, Spain.
(5)Grupo de Investigacion Sobre Envejecimiento (GIE), IEGD, CSIC, ES-28037 
Madrid, Spain.
(6)Faculty of Psychology, National University of Distance Education (UNED), 
ES-28037 Madrid, Spain.

Fear of coronavirus disease 2019 (COVID-19) is one of the main psychological 
impacts of the actual pandemic, especially among the population groups with 
higher mortality rates. The Fear of COVID-19 Scale (FCV-19S) has been used in 
different scenarios to assess fear associated with COVID-19, but this has not 
been done frequently in people living in long-term care (LTC) settings. The 
present study is aimed at measuring the psychometric properties of the Spanish 
version of the FCV-19S in residents in LTC settings, following both the 
classical test theory (CTT) and Rasch model frameworks. The participants (n = 
447), aged 60 years or older, were asked to complete the FCV-19S and to report, 
among other issues, their levels of depression, resilience, emotional wellbeing 
and health-related quality of life with validated scales. The mean FCV-19S score 
was 18.36 (SD 8.28, range 7−35), with higher scores for women, participants with 
lower education (primary or less) and higher adherence to preventive measures 
(all, p < 0.05). The Cronbach’s alpha for the FCV-19S was 0.94. After 
eliminating two items due to a lack of fit, the FCV-19S showed a good fit to the 
Rasch model (χ2 (20) = 30.24, p = 0.019, PSI = 0.87), with unidimensionality 
(binomial 95% CI 0.001 to 0.045) and item local independency. Question 5 showed 
differential item functioning by sex. The present study shows that the FCV-19S 
has satisfactory reliability and validity, which supports its use to effectively 
measure fear in older people living in LTC settings. This tool could help 
identify risk groups that may need specific health education and effective 
communication strategies to lower fear levels. This might have a beneficial 
impact on adherence to preventive measures.

DOI: 10.3390/ijerph192316183
PMCID: PMC9741095
PMID: 36498256 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study, in the collection, analyses, or 
interpretation of the data, in the writing of the manuscript or in the decision 
to publish the results.


1211. Int J Environ Res Public Health. 2022 Dec 3;19(23):16178. doi: 
10.3390/ijerph192316178.

The Associations of Communal Space with Sense of Place and Mental Health in 
Public Housing: Evidence from Guangzhou and Hong Kong.

Zhang T(1), Liu J(2), Chen H(3), Ng MK(4).

Author information:
(1)School of Architecture, Harbin Institute of Technology (Shenzhen), Shenzhen 
518055, China.
(2)Faculty of Construction and Environment, The Hong Kong Polytechnic 
University, Hong Kong, China.
(3)School of Architecture and Urban Planning, Guangdong University of 
Technology, Guangzhou 510090, China.
(4)Department of Geography and Resource Management, Chinese University of Hong 
Kong, Hong Kong, China.

Communal space is regarded as essential for human well-being in high-rise 
developments in Asia and increasing attention has been given to the underlying 
mechanism of its effects in light of the ongoing COVID-19 pandemic. From the 
perspective of person-place processes, this paper explores 'sense of place' and 
its possible mediating effects on the relationship between communal space and 
the mental health of residents in high-rise public housing. An analysis of data 
from a questionnaire survey conducted in Hong Kong and Guangzhou revealed 
differentiated mechanisms according to local context and age group. Sense of 
place and its subcomponents mediated the connection between communal space and 
mental health in Hong Kong but not in Guangzhou. More specifically, place 
identity, place attachment and place dependence had stronger effects among older 
residents in HK than younger ones. The findings from this study can inform 
evidence-based planning and decision-making for public housing policy for 
health-oriented environments in high-density cities.

DOI: 10.3390/ijerph192316178
PMCID: PMC9737858
PMID: 36498252 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript; or in the decision to 
publish the results.


1212. Int J Environ Res Public Health. 2022 Dec 1;19(23):16096. doi: 
10.3390/ijerph192316096.

The Impact of COVID-19 on the Health-Related Behaviours, Mental Well-Being, and 
Academic Engagement of a Cohort of Undergraduate Students in an Irish University 
Setting.

Sheedy O'Sullivan E(1), McCarthy KM(1), O'Neill C(1), Walton J(2), Bolger L(1), 
Bickerdike A(1).

Author information:
(1)Department of Sport, Leisure & Childhood Studies, Muster Technological 
University, Bishopstown, T12 P928 Cork, Ireland.
(2)Department of Biological Sciences, Muster Technological University, 
Bishopstown, T12 P928 Cork, Ireland.

Given the well-established impact of COVID-19 on university students' health and 
lifestyle parameters, the current study sought to investigate these impacts 
within an Irish university setting. A cross-sectional design was employed, with 
a 68-item questionnaire instrument disseminated to all Year 2 undergraduate 
students in the host institution (N = 2752), yielding a 9.7% response rate (n = 
266). This questionnaire elicited students' self-reported changes to 
health-related behaviours, mental well-being and academic engagement across 4 
defined time-points: (T0: prior to COVID-19, T1: initial onset of COVID-19, T2: 
during COVID-19, and T3: time of data collection). Many items were adapted from 
previous Irish research and additional validated scales included the Alcohol Use 
Disorders Identification Test (AUDIT-C) and the World Health Organisation's 
Well-being scale (WHO-5). Key findings revealed that at T1, substantially more 
males reported 'good/very good' general health than females (76.3% vs. 70.8%), 
while physical activity patterns followed a similar trend at both T0 (80% vs. 
66.1%) and T1 (66.7% vs. 61%). A total of 78.4% of participants reported a body 
mass gain from T0 to T3, thus reflecting the reduced physical activity levels 
and compromised nutritional patterns across this period. Worryingly, AUDIT-C 
scale data revealed hazardous drinking habits were evident in both males and 
females, while fruit and vegetable intake, physical activity levels, and mental 
well-being among this cohort remained notably sub-optimal. Ratings of positive 
academic engagement also decreased substantially between T0 (90.3%) and T3 
(30.4%). These findings substantiate the rationale for tailored health promotion 
interventions in university settings to support students' transition back to 
traditional programme delivery and, of equal importance, to improve general 
health and well-being post-COVID-19 within this cohort.

DOI: 10.3390/ijerph192316096
PMCID: PMC9740653
PMID: 36498169 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1213. Int J Environ Res Public Health. 2022 Nov 30;19(23):15975. doi: 
10.3390/ijerph192315975.

Can Homes Affect Well-Being? A Scoping Review among Housing Conditions, Indoor 
Environmental Quality, and Mental Health Outcomes.

Riva A(1), Rebecchi A(2), Capolongo S(2), Gola M(2).

Author information:
(1)School of Architecture, Urban Planning, Construction Engineering (AUIC) of 
Politecnico di Milano, 20133 Milano, Italy.
(2)Design & Health Lab., Department of Architecture, Built Environment and 
Construction Engineering (ABC) of Politecnico di Milano, 20133 Milano, Italy.

The purpose of the scoping review is to explore the relationship between housing 
conditions, indoor environmental quality (IEQ), and mental health implications 
on human well-being. In fact, time spent at home increased due to the recent 
COVID-19 lockdown period, and social-sanitary emergencies are expected to grow 
due to the urbanization phenomenon. Thus, the role of the physical environment 
in which we live, study, and work, has become of crucial importance, as the 
literature has recently highlighted. This scoping review, conducted on the 
electronic database Scopus, led to the identification of 366 articles. This, 
after the screening processes based on the inclusion criteria, led to the final 
inclusion of 31 papers related specifically to the OECD area. The review allowed 
the identification of five housing conditions [house type, age, and floor level; 
housing qualities; household composition; neighborhood; green spaces] that, by 
influencing the IEQ parameters, had impacts on the mental health outcomes 
addressed. By synthesizing the contributions of the review, a list of design 
recommendations has been provided. These will serve as a basis for future 
researchers, from which to develop measures to reduce inequalities in housing by 
making them healthier, more resilient, and salutogenic.

DOI: 10.3390/ijerph192315975
PMCID: PMC9736414
PMID: 36498051 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1214. Int J Environ Res Public Health. 2022 Nov 30;19(23):15947. doi: 
10.3390/ijerph192315947.

"COVID Is Another Layer of Problematic Things": Change, Vulnerability, and 
COVID-19 among University Students.

David I(1), Schatz E(2), Myroniuk TW(2), Teti M(2).

Author information:
(1)Department of Health and Rehabilitation Sciences, School of Health 
Professions, University of Missouri, Columbia, MO 65211, USA.
(2)Department of Public Health, School of Health Professions, University of 
Missouri, Columbia, MO 65211, USA.

The COVID-19 pandemic not only had detrimental effects on physical health but 
also had adverse effects on college students' mental health. This paper begins 
to fill a gap in knowledge related to the contextual factors that impacted 
college students' mental health during COVID. Using in-depth interviews with a 
diverse sample of 33 college students at a Midwestern university, during Spring 
2021, we highlight the pandemic's role in shaping college students' mental 
health and their outlook of the future. Thematic analysis revealed student 
reports of mental health decline during the pandemic attributed to campus 
closures and social distancing policies implemented by the institution to reduce 
the spread of COVID-19. Students shared that the pandemic created uncertainties 
about their future opportunities for education, career fulfillment, and 
employment. However, the interviews also suggested a general sense of adaptation 
to the pandemic's impact which was students achieved via a combination of active 
and passive coping strategies. Expanding institution-based mental health 
services to include a variety of modalities and off-line toolkits for students 
can help students cope with mental health challenges, whether in 'normal times' 
or during national crises. Future research should focus on identifying 
strategies for promoting mental wellness among college students and exploring 
post-pandemic mental health wellbeing.

DOI: 10.3390/ijerph192315947
PMCID: PMC9739650
PMID: 36498021 [Indexed for MEDLINE]

Conflict of interest statement: All authors certify that they have no 
affiliations with or involvement in any organization or entity with any 
financial interest or non-financial interest in the subject matter or materials 
discussed in this manuscript.


1215. Int J Environ Res Public Health. 2022 Nov 27;19(23):15777. doi: 
10.3390/ijerph192315777.

A Cross-Sectional Study of the Perceived Stress, Well-Being and Their Relations 
with Work-Related Behaviours among Hong Kong School Leaders during the COVID-19 
Pandemic.

Lau SSS(1)(2)(3)(4), Shum ENY(1), Man JOT(1)(2), Cheung ETH(1)(2), Amoah PA(5), 
Leung AYM(6), Okan O(7), Dadaczynski K(8)(9).

Author information:
(1)Research Centre for Environment and Human Health, School of Continuing 
Education, Hong Kong Baptist University, Hong Kong.
(2)Multidisciplinary Research Centre, School of Continuing Education, Hong Kong 
Baptist University, Hong Kong.
(3)College of International Education, Hong Kong Baptist University, Hong Kong.
(4)Institute of Bioresource and Agriculture, Hong Kong Baptist University, Hong 
Kong.
(5)School of Graduate Studies, Department of Applied Psychology, Institute of 
Policy Studies, Lingnan University, Hong Kong.
(6)School of Nursing, Hong Kong Polytechnic University, Hong Kong.
(7)Department of Sport and Health Sciences, Technical University Munich, 80333 
Munich, Germany.
(8)Public Health Centre Fulda, Fulda University of Applied Sciences, D-36039 
Fulda, Germany.
(9)Center for Applied Health Science, Leuphana University Lueneburg, 21335 
Lueneburg, Germany.

The health and well-being of school leaders during the COVID-19 pandemic have 
been largely neglected compared to the health and well-being of students and 
teachers. This study assessed the magnitude of perceived stress and well-being 
and the associated factors, including number of working hours, work-related 
sense of coherence (work-SoC), perceived stress, self-endangering work 
behaviour, secondary burnout symptoms, and satisfaction with work, among school 
leaders in Hong Kong, China during the COVID-19 pandemic. This cross-sectional, 
survey-based study collected demographic data and mental health measurements 
from 259 eligible school leaders in Hong Kong from April 2021 to February 2022. 
Pearson's correlation analyses, multilinear regression models, and 
independent-samples Student's t-tests were performed. The findings revealed that 
school leaders' perceived stress was negatively correlated with their well-being 
(r = -0.544, p < 0.01) and work-related SoC (r = -0.327, p < 0.01) but 
positively correlated with their extensification of work (r = 0.473, p < 0.01), 
exhaustion related to work situations (r = 0.559, p < 0.01), and psychosomatic 
complaints (r = 0.439, p < 0.01). In a model that adjusted for gender and age, 
student leaders with higher subjective well-being scores had a lower level of 
perceived stress (B = -0.031; 95% confidence interval [CI], -0.59, -0.02; p = 
0.034), whereas leaders in schools with a larger student population had a higher 
level of perceived stress (B = 0.002; 95% CI, 0.000, 0.003; p = 0.030). School 
leaders with a higher likelihood of performing the self-endangering work 
behaviour of 'intensification of work' had higher perceived stress levels (B = 
1.497; 95% CI, 0.717, 2.278; p < 0.001). School leaders with a higher 
work-related SoC (B = 4.20; 95% CI, 1.290, 7.106; p = 0.005) had a higher level 
of well-being. School leaders with higher levels of perceived stress (B = 
-0.734; 95% CI, -1.423, -0.044; p = 0.037), a higher likelihood of performing 
the self-endangering work behaviour of 'extensification of work' (B = -4.846; 
95% CI, -8.543, -1.149; p = 0.010), and a higher score for exhaustion related to 
work (B = -10.449; 95% CI, -13.864, -7.033; p = 0.000) showed lower levels of 
well-being. The finding of a high incidence of stress among school leadership 
justifies the need for more societal attention to the well-being of school 
leaders in Hong Kong. It is important that policies and initiatives are designed 
to enhance the well-being of school leaders and that they are supported in 
leading the management of schools and coping with stress in school settings.

DOI: 10.3390/ijerph192315777
PMCID: PMC9738316
PMID: 36497852 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1216. Int J Environ Res Public Health. 2022 Nov 25;19(23):15680. doi: 
10.3390/ijerph192315680.

The Influence of COVID-19 on University Students' Well-Being, Physical Activity, 
Body Composition, and Strength Endurance.

Podstawski R(1), Finn KJ(2), Borysławski K(3), Omelan AA(1), Podstawska AM(4), 
Skrzypczak AR(1), Pomianowski A(5).

Author information:
(1)Department of Tourism, Recreation and Ecology, University of Warmia and 
Mazury in Olsztyn, 10-957 Olsztyn, Poland.
(2)Department of Nutrition, Kinesiology, and Health, University of Central 
Missouri, Warrensburg, MO 64093, USA.
(3)Institute of Health, The Angelus Silesius University of Applied Sciences, 
58-300 Wałbrzych, Poland.
(4)Independent Researcher, 10-068 Olsztyn, Poland.
(5)Department of Internal Diseases with Clinic, University of Warmia and Mazury 
in Olsztyn, 10-719 Olsztyn, Poland.

BACKGROUND: Very few scientific studies have simultaneously evaluated changes in 
well-being (WB), physical activity (PA), and strength endurance (SE) based on 
results from before and during the COVID-19 pandemic.
AIM: The aim of the study was to assess WB, PA, and SE levels, as well as body 
composition parameters in university students before and during the pandemic.
METHODS: The study included 30 males and 30 females (mean age: 21.7 ± 2.51 and 
21.6 ± 2.34 years, respectively). Well-being using the Self-Perception 
Questionnaire (POMS), PA from the Polish regular version of the International 
Physical Activity Questionnaire (IPAQ), body composition parameters using the 
InBody 270 analyzer, and SE based on the results of a 12 min test involving a 
Concept 2PM-5 rowing ergometer were assessed before and during the pandemic.
RESULTS: An assessment of university students' WB revealed a significant 
increase in variables such as tension, depression, anger, confusion, and a 
significant decline in vigor (p < 0.05). In both sexes, PA and SE decreased 
significantly-from 2115.4 to 1822.8 METs-min/week and from 2184.5 to 2035 m, 
respectively, in males, and from 1793.5 to 1699.8 METs-min/week and from 2021.5 
to 1943.8 m, respectively, in females. At the same time, body mass and BMI 
values increased significantly (p < 0.001) in both females and males.
CONCLUSIONS: The COVID-19 pandemic caused a significant decrease in WB, PA and 
SE levels in young females and males, and led to a significant increase in their 
body mass and BMI.

DOI: 10.3390/ijerph192315680
PMCID: PMC9740601
PMID: 36497754 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that there is no conflict of 
interest regarding the paper or its publication.


1217. Int J Environ Res Public Health. 2022 Nov 24;19(23):15626. doi: 
10.3390/ijerph192315626.

A Culturally Responsive Trauma-Informed Public Health Emergency Framework for 
Aboriginal and Torres Strait Islander Communities in Australia, Developed during 
COVID-19.

Graham S(1), Kamitsis I(2), Kennedy M(3), Heris C(4), Bright T(2), Bennetts 
SK(5)(6), Jones KA(2), Fiolet R(2), Mohamed J(7), Atkinson C(8), Chamberlain 
C(2)(5)(7)(9).

Author information:
(1)Department of Infectious Diseases, Peter Doherty Institute for Infection and 
Immunity, University of Melbourne, Melbourne, VIC 3000, Australia.
(2)Indigenous Health Equity Unit, Melbourne School of Population and Global 
Health, The University of Melbourne, Melbourne, VIC 3000, Australia.
(3)School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 
2308, Australia.
(4)National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, 
National Centre for Epidemiology and Population Health, Australian National 
University, Canberra, ACT 2601, Australia.
(5)Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, 
Bundoora, VIC 3086, Australia.
(6)Intergenerational Health Group, Murdoch Children's Research Institute, 
Parkville, VIC 3000, Australia.
(7)The Lowitja Institute, Collingwood, VIC 3066, Australia.
(8)We Al-Li, Goolmangar, NSW 2480, Australia.
(9)NGANGK YIRA: Murdoch University Research Centre for Aboriginal Health and 
Social Equity, Murdoch University, Perth, WA 6150, Australia.

The Coronavirus Disease 2019 (COVID-19) pandemic impacted peoples' livelihoods 
and mental wellbeing. Aboriginal and Torres Strait Islander peoples in Australia 
continue to experience intergenerational trauma associated with colonization and 
may experience trauma-related distress in response to government responses to 
public health emergencies. We aimed to develop a culturally responsive 
trauma-informed public health emergency response framework for Aboriginal and 
Torres Strait Islander peoples. This Aboriginal and Torres Strait Islander-led 
study involved: (i) a review of trauma-informed public health emergency 
responses to develop a draft framework (ii) interviews with 110 Aboriginal and 
Torres Strait Islander parents about how COVID-19 impacted their lives, and 
(iii) a workshop with 36 stakeholders about pandemic experiences using framework 
analysis to refine a culturally responsive trauma-informed framework. The 
framework included: an overarching philosophy (cultural humility, safety and 
responsiveness); key enablers (local leadership and Eldership); supporting 
strategies (provision of basic needs and resources, well-functioning social 
systems, human rights, dignity, choice, justice and ethics, mutuality and 
collective responsibility, and strengthening of existing systems); 
interdependent core concepts (safety, transparency, and empowerment, holistic 
support, connectedness and collaboration, and compassion, protection and 
caring); and central goals (a sense of security, resilience, wellbeing, self- 
and collective-efficacy, hope, trust, resilience, and healing from grief and 
loss).

DOI: 10.3390/ijerph192315626
PMCID: PMC9738974
PMID: 36497699 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1218. Int J Environ Res Public Health. 2022 Nov 24;19(23):15617. doi: 
10.3390/ijerph192315617.

Association of Digital Health Literacy with Future Anxiety as Mediated by 
Information Satisfaction and Fear of COVID-19: A Pathway Analysis among 
Taiwanese Students.

Chen SC(1), Huy LD(2), Lin CY(3), Lai CF(4), Nguyen NTH(2)(5), Hoang NY(6), 
Nguyen TTP(7), Dang LT(8)(9), Truong NLT(10)(11), Phan TN(12)(13), Duong 
TV(6)(14).

Author information:
(1)Graduate Program of Digital Content and Technologies, College of 
Communication, National Chengchi University, Taipei 116-05, Taiwan.
(2)Health Personnel Training Institute, University of Medicine and Pharmacy, Hue 
University, Hue 491-20, Vietnam.
(3)Department of Radio, Television & Film, Shih Hsin University, Taipei 116-42, 
Taiwan.
(4)Department of Education, National Taichung University of Education, Taichung 
403-06, Taiwan.
(5)School of Health Care Administration, College of Management, Taipei Medical 
University, Taipei 110-31, Taiwan.
(6)School of Nutrition and Health Sciences, Taipei Medical University, Taipei 
110-31, Taiwan.
(7)Institute for Community Health Research, University of Medicine and Pharmacy, 
Hue University, Hue 491-20, Vietnam.
(8)Faculty of Nursing and Midwifery, Hanoi Medical University, Hanoi 115-20, 
Vietnam.
(9)School of Nursing, National Taipei University of Nursing and Health Sciences, 
Taipei 112-19, Taiwan.
(10)Pharmacy Department, School of Medicine, Vietnam National University, Ho Chi 
Minh City 700-00, Vietnam.
(11)Pharmacy Department, Thong Nhat Hospital, Ho Chi Minh City 721-18, Vietnam.
(12)Department of Tropical Diseases, Cho Ray Hospital, Ho Chi Minh City 727-13, 
Vietnam.
(13)International Health Program, College of Medicine, National Yang Ming Chiao 
Tung University, Taipei 112-304, Taiwan.
(14)International Master/Ph.D. Program in Medicine, College of Medicine, Taipei 
Medical University, Taipei 110-31, Taiwan.

Digital Health Literacy (DHL) helps online users with navigating the infodemic 
and co-existing conspiracy beliefs to avoid mental distress and maintain 
well-being. We aimed to investigate the association between DHL and future 
anxiety (FA); and examine the potential mediation roles of information 
satisfaction and fear of COVID-19 (F-CoV). A web-based cross-sectional survey 
was carried out among 1631 Taiwanese university students aged 18 years and above 
from June 2021 to March 2022. Data collected were socio-demographic 
characteristics (sex, age, social status, university location), information 
satisfaction, F-CoV, DHL and FA (using Future Dark scale). The linear regression 
model was used to explore factors associated with FA. The pathway analysis was 
further used to evaluate the direct and indirect relationship between DHL and 
FA. A higher score of DHL (B = -0.21; 95% CI, -0.37, -0.06; p = 0.006), and 
information satisfaction (B = -0.16; 95% CI, -0.24, -0.08; p < 0.001) were 
associated with a lower FA score, whereas a higher F-CoV score was associated 
with a higher FA score (B = 0.43; 95% CI, 0.36, 0.50; p < 0.001). DHL showed the 
direct impact (B = -0.1; 95% CI, -0.17, -0.04; p = 0.002) and indirect impact on 
FA as mediated by information satisfaction (B = -0.04; 95% CI, -0.06, -0.01; p = 
0.002) and F-CoV (B = -0.06, 95% CI, -0.08, -0.04; p < 0.001). Strategic 
approaches to promote DHL, information satisfaction, lower F-CoV are suggested 
to reduce FA among students.

DOI: 10.3390/ijerph192315617
PMCID: PMC9736687
PMID: 36497691 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1219. Int J Environ Res Public Health. 2022 Nov 23;19(23):15569. doi: 
10.3390/ijerph192315569.

Nurses' Work-Related Mental Health in 2017 and 2020-A Comparative Follow-Up 
Study before and during the COVID-19 Pandemic.

Nagel C(1)(2), Nilsson K(1)(2).

Author information:
(1)Division of Occupational and Environmental Medicine, Department of Laboratory 
Medicine, Lund University, 22184 Lund, Sweden.
(2)Division of Public Health, Kristianstad University, 29128 Kristianstad, 
Sweden.

The COVID-19 pandemic put a lot of strain on healthcare organizations. Nurses 
account for over 50% of healthcare staff, and how nurses perform in their work 
is influenced by a number of human and work environmental factors. However, to 
our knowledge, there has not been a previous study with the intention to look at 
all areas that affect a sustainable working life and how these impact nurses' 
mental well-being. The aim of this study is to investigate the association 
between, and the effect of, different factors in nurses' work situations 
associated with nurses' work-related mental-health diagnoses, before and during 
the COVID-19 pandemic. A questionnaire was sent out to all 9219 nurses in the 
Swedish county of Skane in the spring of 2017 and during wave two of the 
COVID-19 pandemic in the fall of 2020. The data were analyzed through logistic 
regression analysis. The results showed that lack of joy in the daily work, an 
increased workload and lack of support from co-workers had an increased 
association with work-related mental-health diagnoses. Future research regarding 
the long-term impact of COVID-19 on all areas of nurses' professional and 
personal lives is needed.

DOI: 10.3390/ijerph192315569
PMCID: PMC9738150
PMID: 36497643 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript, or in the decision to 
publish the results.


1220. Int J Behav Nutr Phys Act. 2022 Dec 9;19(1):146. doi: 
10.1186/s12966-022-01378-x.

Cook like a Boss Online: an adapted intervention during the COVID-19 pandemic 
that effectively improved children's perceived cooking competence, movement 
competence and wellbeing.

Hollywood L(1), Issartel J(2), Gaul D(3), McCloat A(4), Mooney E(4), Collins 
CE(5)(6), Lavelle F(7)(8).

Author information:
(1)Department of Hospitality and Tourism Management, Ulster University Business 
School, Ulster University, Belfast, UK.
(2)Multisensory Motor Learning Lab, School of Health and Human Performance, 
Dublin City University, Dublin, Ireland.
(3)Department of Business, Technological University Dublin, Dublin, Ireland.
(4)School of Home Economics, National Centre for Excellence for Home Economics, 
St. Angela's College Sligo, Sligo, Ireland.
(5)School of Health Sciences, College of Health, Medicine and Wellbeing, The 
University of Newcastle, 2308, Callaghan, NSW, Australia.
(6)Hunter Medical Research Institute, 2305, New Lambton Heights, NSW, Australia.
(7)Institute for Global Food Security, School of Biological Sciences, Queen's 
University Belfast, 19 Chlorine Gardens, BT9 5DL, Belfast, UK. 
flavelle01@qub.ac.uk.
(8)Department of Nutritional Sciences, School of Life Course & Population 
Sciences, King's College London, London, UK. flavelle01@qub.ac.uk.

BACKGROUND: The COVID-19 pandemic has further exacerbated physical inactivity, 
poor dietary intake and reduced mental wellbeing, contributing factors to 
non-communicable diseases in children. Cooking interventions are proposed as 
having a positive influence on children's diet quality. Motor skills have been 
highlighted as essential for performance of cooking skills, and this movement 
may contribute to wellbeing. Additionally, perceived competence is a motivator 
for behaviour performance and thus important for understanding intervention 
effectiveness. Therefore, this research aimed to assess the effectiveness of an 
adapted virtual theory-based cooking intervention on perceived cooking 
competence, perceived movement competence and wellbeing.
METHODS: The effective theory-driven and co-created 'Cook Like A Boss' was 
adapted to a virtual five day camp-styled intervention, with 248 children across 
the island of Ireland participating during the pandemic. Pre- and 
post-intervention assessments of perceived cooking competence, perceived 
movement competence and wellbeing using validated measurements were completed 
through online surveys. Bivariate Correlations, paired samples t-tests and 
Hierarchical multiple regression modelling was conducted using SPSS to 
understand the relationships between the variables and the effect of the 
intervention.
RESULTS: 210 participants had matched survey data and were included in analysis. 
Significant positive correlations were shown between perceived cooking 
competence, perceived movement competence and wellbeing (P < 0.05). Children's 
perceived cooking competence (P < 0.001, medium to large effect size), perceived 
movement competence (P < 0.001, small to medium effect size) and wellbeing 
(P = 0.013, small effect size) all significantly increased from pre to post 
intervention. For the Hierarchical regression, the final model explained 57% of 
the total variance in participants' post-intervention perceived cooking 
competence. Each model explained a significant amount of variance (P < 0.05). 
Pre-intervention perceived cooking competence, wellbeing, age and perceived 
movement competence were significant predictors for post-intervention perceived 
cooking competence in the final model.
CONCLUSION: The 'Cook Like A Boss' Online intervention was an adapted virtual 
outreach intervention. It provides initial evidence for the associations between 
perceived cooking competence, perceived movement and wellbeing as well as being 
effective in their improvement. This research shows the potential for cooking to 
be used as a mechanism for targeting improvements in not only diet quality but 
also movement and wellbeing.
TRIAL REGISTRATION: NCT05395234. Retrospectively registered on 26th May 2022.

© 2022. The Author(s).

DOI: 10.1186/s12966-022-01378-x
PMCID: PMC9733269
PMID: 36494840 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1221. Sci Rep. 2022 Dec 8;12(1):21253. doi: 10.1038/s41598-022-25107-3.

Differentiated mental health patterns in pregnancy during COVID-19 first two 
waves in Sweden: a mixed methods study using digital phenotyping.

Fransson E(#)(1)(2), Karalexi M(#)(1)(3), Kimmel M(1)(4), Bränn E(1), Kollia 
N(5), Tas A(6), van Zoest V(7), Nordling E(1), Skalkidou A(8), Papadopoulos 
FC(6).

Author information:
(1)Department of Women's and Children's Health, Uppsala University, 751 85, 
Uppsala, Sweden.
(2)Department of Microbiology, Tumor and Cell Biology, Centre for Translational 
Microbiome Research, Karolinska Institutet, 171 77, Stockholm, Sweden.
(3)Department of Hygiene and Epidemiology, School of Medicine, University of 
Ioannina, 45110, Ioannina, Greece.
(4)Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel 
Hill, NC, 27514, USA.
(5)Department of Nutrition and Dietetics, School of Health Science and 
Education, Harokopio University, 17676, Athens, Greece.
(6)Department of Neuroscience, Psychiatry, Uppsala University, 751 85, Uppsala, 
Sweden.
(7)Department of Information Technology, Uppsala University, 752 37, Uppsala, 
Sweden.
(8)Department of Women's and Children's Health, Uppsala University, 751 85, 
Uppsala, Sweden. Alkistis.skalkidou@kbh.uu.se.
(#)Contributed equally

To utilize modern tools to assess depressive and anxiety symptoms, wellbeing and 
life conditions in pregnant women during the first two waves of the COVID-19 
pandemic in Sweden. Pregnant women (n = 1577) were recruited through the mobile 
application Mom2B. Symptoms of depression, anxiety and wellbeing were assessed 
during January 2020-February 2021. Movement data was collected using the phone's 
sensor. Data on Google search volumes for "Corona" and Covid-related deaths were 
obtained. Qualitative analysis of free text responses regarding maternity care 
was performed. Two peaks were seen for depressive symptoms, corresponding to the 
two waves. Higher prevalence of anxiety was only noted during the first wave. A 
moderating effect of the two waves in the association of depression, anxiety, 
and well-being with Covid deaths was noted; positive associations during the 
first wave and attenuated or became negative during the second wave. Throughout, 
women reported on cancelled healthcare appointments and worry about partners not 
being allowed in hospital. The association of mental health outcomes with 
relevant covariates may vary during the different phases in a pandemic, possibly 
due to adaptation strategies on a personal and societal/healthcare level. 
Digital phenotyping can help healthcare providers and governmental bodies to in 
real time monitor high-risk groups during crises, and to adjust the support 
offered.

© 2022. The Author(s).

DOI: 10.1038/s41598-022-25107-3
PMCID: PMC9731976
PMID: 36481663 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1222. Am J Med. 2023 Mar;136(3):322-328. doi: 10.1016/j.amjmed.2022.11.007. Epub 2022 
Dec 5.

Sabbaticals in US Medical Schools.

Robiner WN(1), Buum HT(2), Eckerstorfer M(3), Kim MH(1), Kirsch JD(4).

Author information:
(1)Department of Medicine, University of Minnesota, Minneapolis; Department of 
Pediatrics, University of Minnesota, Minneapolis.
(2)Department of Medicine, University of Minnesota, Minneapolis.
(3)Faculty Affairs, University of Minnesota Medical School, Minneapolis.
(4)Department of Medicine, University of Minnesota, Minneapolis. Electronic 
address: kirsch@umn.edu.

BACKGROUND: Sabbaticals are an important feature of academia for faculty and 
their institutions. Whereas sabbaticals are common in institutions of higher 
learning, little is known about their role and utilization in US medical 
schools. This perspective piece examining sabbaticals in medical school faculty 
was undertaken at a time that well-being of health professionals was 
increasingly being recognized as a workforce health priority.
METHODS: We surveyed associate deans at US medical schools in 2021 about faculty 
who had taken sabbaticals within the past 3 years, the parameters of the 
sabbaticals, and institutional policies and respondents' predictions of future 
sabbatical use.
RESULTS: A total of 53% of respondents reported any faculty had taken 
sabbaticals in the past 3 years (M = 6.27; Median = 3; range = 1-60). 
Institutions rated enhancing research as the most important objective, while 
recognizing other benefits. Sabbaticals were more commonly taken by male, white, 
senior faculty PhDs. Details about sabbaticals, including eligibility, 
expectations, length, financial support, and benefits were reviewed. Most 
(54.8%) respondents expected no change in the number of faculty seeking 
sabbaticals. Nearly all anticipated the COVID-19 pandemic would not affect 
sabbatical policies.
CONCLUSION: In contrast to other institutions of higher learning, 
sabbatical-taking by medical school faculty is rare. We explore factors that may 
contribute to this phenomenon (eg, the tripartite mission, faculty clinical 
responsibilities, culture of medicine, and student debt). Despite financial and 
other barriers, a closer look at the benefits of sabbaticals is warranted as a 
mechanism that may support faculty well-being, retention, and mental health.

Copyright © 2022 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.amjmed.2022.11.007
PMID: 36481235 [Indexed for MEDLINE]


1223. Prog Cardiovasc Dis. 2023 Jan-Feb;76:76-83. doi: 10.1016/j.pcad.2022.11.019. 
Epub 2022 Dec 6.

The response to the COVID-19 pandemic: With hindsight what lessons can we learn?

Faghy M(1), Arena R(2), Hills AP(3), Yates J(2), Vermeesch AL(4), Franklin 
BA(5), Popovic D(6), Strieter L(7), Lavie CJ(8), Smith A(9).

Author information:
(1)School of Human Sciences, University of Derby, Derby, UK; Healthy Living for 
Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA. Electronic 
address: M.Faghy@Derby.ac.uk.
(2)School of Human Sciences, University of Derby, Derby, UK; Healthy Living for 
Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA.
(3)Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, 
IL, USA; School of Health Sciences, University of Tasmania, Tasmania, Australia.
(4)Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, 
IL, USA; Department of Family and Community Nursing, School of Nursing, 
University of North, Carolina Greensboro, Greensboro, NC, USA.
(5)Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, 
IL, USA; Preventive Cardiology and Cardiac Rehabilitation, Beaumont Health, 
Royal Oak, MI, USA.
(6)Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, 
IL, USA; University Clinical Center of Serbia, Clinic for Cardiology, Belgrade, 
Serbia; Mayo Clinic, Rochester, MN, USA.
(7)Department of Physical Therapy, College of Applied Sciences, University of 
Illinois at Chicago, Chicago, IL, USA; Healthy Living for Pandemic Event 
Protection (HL - PIVOT) Network, Chicago, IL, USA.
(8)Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, 
IL, USA; Department of Cardiovascular Diseases, John Ochsner Heart and Vascular 
Institute, Ochsner Clinical School-University of Queensland School of Medicine, 
New Orleans, LA, USA.
(9)Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, 
IL, USA.

The purpose of this paper is to put forward some evidence-based lessons that can 
be learned from how to respond to a Pandemic that relate to healthy living 
behaviours (HLB). A 4-step methodology was followed to conduct a narrative 
review of the literature and to present a professional practice vignette. The 
narrative review identified 8 lessons: 1) peer review; 2) historical 
perspectives; 3) investing in resilience and protection; 4) unintended 
consequences; 5) protecting physical activity; 6) school closures; 7) mental 
health; and 8) obesity. As in all probability there will be another Pandemic, it 
is important that the lessons learned over the last three years in relation to 
HLB are acted upon. Whilst there will not always be a consensus on what to 
emphasise, it is important that many evidence-based positions are presented. The 
authors of this paper recognise that this work is a starting point and that the 
lessons presented here will need to be revisited as new evidence becomes 
available.

Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.pcad.2022.11.019
PMCID: PMC9722239
PMID: 36481211 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest None.


1224. Prog Cardiovasc Dis. 2023 Jan-Feb;76:38-43. doi: 10.1016/j.pcad.2022.11.017. 
Epub 2022 Dec 5.

The impact of the COVID-19 pandemic on cardiovascular health behaviors and risk 
factors: A new troubling normal that may be here to stay.

Laddu DR(1), Biggs E(2), Kaar J(3), Khadanga S(4), Alman R(2), Arena R(5).

Author information:
(1)Department of Physical Therapy, College of Applied Science, University of 
Illinois Chicago, Chicago, IL, United States of America; Healthy Living for 
Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of 
America. Electronic address: dladdu@uic.edu.
(2)Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, 
IL, United States of America.
(3)Department of Pediatrics, School of Medicine, University of Colorado Anschutz 
Medical Campus, Aurora, CO, United States of America.
(4)Department of Medicine, Division of Cardiology, Larner College of Medicine, 
University of Vermont, Burlington, VT, United States of America.
(5)Department of Physical Therapy, College of Applied Science, University of 
Illinois Chicago, Chicago, IL, United States of America; Healthy Living for 
Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of 
America.

In March 2020, the Coronavirus disease 2019 (COVID-19) outbreak was officially 
declared a global pandemic, leading to closure of public facilities, enforced 
social distancing and stay-at-home mandates to limit exposures and reduce 
transmission rates. While the severity of this "lockdown" period varied by 
country, the disruptions of the pandemic on multiple facets of life (e.g., daily 
activities, education, the workplace) as well as the social, economic, and 
healthcare systems impacts were unprecedented. These disruptions and impacts are 
having a profound negative effect on multiple facets of behavioral health and 
psychosocial wellbeing that are inextricably linked to cardiometabolic health 
and associated with adverse outcomes of COVID-19. For example, adoption of 
various cardiometabolic risk behavior behaviors observed during the pandemic 
contributed to irretractable trends in weight gain and poor mental health, 
raising concerns on the possible long-term consequences of the pandemic on 
cardiometabolic disease risk, and vulnerabilities to future viral pandemics. The 
purpose of this review is to summarize the direct and indirect effects of the 
pandemic on cardiometabolic health risk behaviors, particularly related to poor 
diet quality, physical inactivity and sedentary behaviors, smoking, sleep 
patterns and mental health. Additional insights into how the pandemic has 
amplified cardiovascular risk behaviors, particularly in our most vulnerable 
populations, and the potential implications for the future if these modifiable 
risk behaviors do not become better controlled, are described.

Copyright © 2022 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.pcad.2022.11.017
PMCID: PMC9722238
PMID: 36481209 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest None.


1225. Arthritis Care Res (Hoboken). 2023 Aug;75(8):1849-1856. doi: 10.1002/acr.25065. 
Epub 2023 Feb 13.

Sleep Disturbance and SARS-CoV-2 Vaccinations in Patients With Chronic 
Inflammatory Disease.

Pawar N(1), Taylor KE(1), Yang M(1), Deepak P(2), Kim W(2), Paley MA(2), 
Matloubian M(1), Carvidi A(1), Ciorba MA(2), Demissie E(1), El-Qunni A(2), Huang 
K(2), Kinnett B(2), McMorrow LE(2), Paez D(1), Poole M(2), Rose A(2), Schriefer 
RE(2), Kim AHJ(2), Nakamura M(1), Katz P(1), Gensler LS(1).

Author information:
(1)University of California, San Francisco.
(2)Washington University School of Medicine in St. Louis, St. Louis, Missouri.

OBJECTIVE: Immunocompromised patients with chronic inflammatory disease (CID) 
may have experienced additional psychosocial burden during the COVID-19 pandemic 
due to their immunocompromised status. This study was undertaken to determine if 
vaccination would result in improved patient-reported outcomes longitudinally 
among individuals with CID undergoing SARS-CoV-2 vaccination regardless of 
baseline anxiety.
METHODS: Data are from a cohort of individuals with CID from 2 sites who 
underwent SARS-CoV-2 vaccination. Participants completed 3 study visits before 
and after 2 messenger RNA vaccine doses in the initial vaccination series when 
clinical data were collected. Patient-reported outcomes were measured using the 
Patient-Reported Outcomes Measurement Information System 29-item Health Profile 
and expressed as T scores, with 2 groups stratified by high and low baseline 
anxiety. Mixed-effects models were used to examine longitudinal changes, 
adjusting for age, sex, and study site.
RESULTS: A total of 72% of the cohort was female with a mean ± SD age of 
48.1 ± 15.5 years. Overall, sleep disturbance improved following both doses of 
SARS-CoV-2 vaccinations, and anxiety decreased after the second dose. Physical 
function scores worsened but did not meet the minimally important difference 
threshold. When stratifying by baseline anxiety, improvement in anxiety, 
fatigue, and social participation were greater in the high anxiety group. 
Physical function worsened slightly in both groups, and sleep disturbance 
improved significantly in the high anxiety group.
CONCLUSION: Sleep disturbance decreased in a significant and meaningful way in 
patients with CID upon vaccination. In patients with higher baseline anxiety, 
social participation increased, and anxiety, fatigue, and sleep disturbance 
decreased. Overall, results suggest that SARS-CoV-2 vaccination may improve 
mental health and well-being, particularly among those with greater anxiety.

© 2022 American College of Rheumatology.

DOI: 10.1002/acr.25065
PMCID: PMC9877722
PMID: 36479599 [Indexed for MEDLINE]


1226. Sci Rep. 2022 Dec 7;12(1):21195. doi: 10.1038/s41598-022-25357-1.

Possible contribution of COVID-19 vaccination to the subsequent mental 
well-being in Japan.

Chiang C(1), Morita S(2), Hirakawa Y(3), Priya FT(3), Matsumoto Y(2), Ota A(4), 
Yatsuya H(3), Tabuchi T(5).

Author information:
(1)Department of Public Health and Health Systems, Nagoya University Graduate 
School of Medicine, 65 Tsurumai-Cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan. 
keihatsu@med.nagoya-u.ac.jp.
(2)Nagoya University School of Medicine, 65 Tsurumai-Cho, Showa-ku, Nagoya, 
Aichi, 466-8550, Japan.
(3)Department of Public Health and Health Systems, Nagoya University Graduate 
School of Medicine, 65 Tsurumai-Cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
(4)Department of Public Health, Fujita Health University School of Medicine, 
Toyoake, Aichi, 470-1192, Japan.
(5)Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, 
Chuo-ku, Osaka-shi, Osaka, 541-8567, Japan.

The coronavirus disease 2019 (COVID-19) pandemic has had a severe impact on 
mental well-being. Vaccination may have played a pivotal role in enduring this 
mental health crisis. The present study aimed to longitudinally investigate the 
association between COVID-19 vaccination and mental health status among Japanese 
population in 2021. Longitudinal data of 17,089 individuals aged 15-79 years who 
participated in a nationwide online study were analyzed. Baseline and follow-up 
mental health statuses were assessed using the Kessler Psychological Distress 
Scale (K6). General linear and multivariable logistic regression models adjusted 
for baseline levels of mental distress were used to examine the association 
between vaccine receipt and follow-up levels of mental health. Mean K6 scores 
were lower in the vaccinated than in the non-vaccinated participants. Those who 
had received one or two doses of COVID-19 vaccines were associated with improved 
mental health at follow-up in subjects with psychological distress at baseline 
(odds ratio [OR] 1.31 and 1.35, respectively) and were inversely associated with 
deteriorated mental health status at follow-up in subjects without psychological 
distress at baseline (OR 0.66 and 0.70, respectively) compared with no 
vaccination groups, respectively. The present study would indicate that one or 
two doses of COVID-19 vaccinations contributed to mental well-being in Japan. 
This finding might provide evidence for promoting vaccination against COVID-19 
and emerging infectious diseases in the future.

© 2022. The Author(s).

DOI: 10.1038/s41598-022-25357-1
PMCID: PMC9729563
PMID: 36477701 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1227. Sex Reprod Health Matters. 2022 Dec;30(1):2144087. doi: 
10.1080/26410397.2022.2144087.

Mental health, economic well-being and health care access amid the COVID-19 
pandemic: a mixed methods study among urban men who have sex with men in India.

Chakrapani V(1), Newman PA(2), Sebastian A(3), Rawat S(4), Mittal S(5), Gupta 
V(6), Kaur M(7).

Author information:
(1)Chairperson, Centre for Sexuality and Health Research and Policy (C-SHaRP), 
Chennai, India; DBT/Wellcome Trust India Alliance Senior Fellow, The Humsafar 
Trust, Mumbai, India. Correspondence: cvenkatesan@c-sharp.in, 
venkatesan.chakrapani@gmail.com.
(2)Professor, Factor-Inwentash Faculty of Social Work, University of Toronto, 
Toronto, Canada.
(3)Assistant Professor, National Institute of Advanced Studies (NIAS), 
Bangalore, India.
(4)Research Manager, The Humsafar Trust, Mumbai, India.
(5)Deputy Director (Targeted Interventions), Chandigarh State AIDS Control 
Society (CSACS), Chandigarh, India.
(6)Project Director, Chandigarh State AIDS Control Society (CSACS), Chandigarh, 
India.
(7)Professor, Postgraduate Institute of Medical Education and Research (PGIMER), 
Chandigarh, India.

Scant empirical research from Asia has addressed the impact of COVID-19 on 
sexual minority health. We aimed to explore and understand the impact of 
COVID-19 on income security, mental health, HIV risk and access to health 
services among men who have sex with men (MSM) in India. We conducted a 
concurrent mixed methods study from April to June 2020, including a 
cross-sectional survey and in-depth semi-structured interviews with MSM 
recruited from three non-governmental organisations providing HIV prevention 
services in Chandigarh, India. We examined the associations of sexual minority 
stressors (sexual stigma, internalised homonegativity), economic stressors, and 
stress due to social distancing, with depression and anxiety, HIV risk, and 
access to health services. Survey findings (n = 132) indicated that internalised 
homonegativity and stress related to social distancing were significantly 
associated with depressive and anxiety symptoms. Results also showed reduced 
access to condoms, HIV testing and counselling services. Qualitative findings 
(n = 10) highlighted adverse economic impacts of COVID-19, including loss of 
employment/wages and engaging in survival sex work, which contributed to 
psychological distress and HIV risk. The COVID-19 pandemic has resulted in 
considerable psychological and financial distress among low socioeconomic status 
MSM in India, including those involved in sex work - communities already 
marginalised in economic, family and healthcare sectors. Structural 
interventions to improve access to mental health and HIV services and decrease 
financial burden are critical to mitigate the impact of COVID-19.

Peu de recherches empiriques ont abordé l’impact de la COVID-19 sur la santé des 
minorités sexuelles. Nous souhaitions explorer et comprendre les répercussions 
de la COVID-19 sur la sécurité de revenu, la santé mentale, le risque de VIH et 
l’accès aux services de santé chez les hommes ayant des rapports sexuels avec 
des hommes (HSH) en Inde. D’avril à juin 2020, nous avons mené une étude 
concomitante à méthodes mixtes avec notamment une enquête transversale et des 
entretiens approfondis semi-structurés avec des HSH recrutés auprès de trois 
organisations non gouvernementales assurant des services de prévention du VIH à 
Chandigarh, Inde. Nous avons examiné les associations des facteurs de stress 
(stigmatisation sexuelle, homonégativité internalisée), des facteurs de stress 
économiques et des tensions dues à la distanciation sociale avec la dépression 
et l’anxiété, le risque de contracter le VIH et l’accès aux services de santé. 
Les résultats de l’enquête (n = 132) ont indiqué que l’homonégativité 
internalisée et les tensions relatives à la distanciation sociale étaient 
associées de façon non négligeable à des symptômes de dépression et d’anxiété. 
Les résultats ont aussi révélé un accès réduit aux préservatifs, ainsi qu’aux 
services de dépistage du VIH et de conseil. Les résultats qualitatifs (n = 10) 
ont mis en lumière les conséquences économiques négatives de la COVID-19, 
notamment la perte de l’emploi/du salaire et le recours au commerce du sexe pour 
survivre, ce qui a contribué à une détresse psychologique et un risque de VIH. 
La pandémie de COVID-19 a causé une détresse psychologique et financière 
considérable chez les HSH à faible statut socioéconomique en Inde, y compris 
ceux qui participent au commerce du sexe – des communautés déjà marginalisées 
dans les secteurs économiques, familiaux et sanitaires. Des interventions 
structurelles pour élargir l’accès aux services de santé mentale et de lutte 
contre le VIH de même que pour alléger la charge financière sont capitales pour 
atténuer l’impact de la COVID-19.

Pocas investigaciones empíricas realizadas en Asia han abordado el impacto de 
COVID-19 en la salud de minorías sexuales. Procuramos explorar y entender el 
impacto de COVID-19 en la seguridad de ingresos, la salud mental, el riesgo de 
VIH y el acceso a servicios de salud entre hombres que tienen sexo con hombres 
(HSH) en India. Realizamos un estudio de métodos mixtos concurrente entre abril 
y junio de 2020, que incluía una encuesta transversal y entrevistas 
semiestructuradas a profundidad con HSH reclutados de tres organizaciones no 
gubernamentales que proporcionan servicios de prevención del VIH en Chandigarh, 
India. Examinamos las asociaciones de los estresores de minorías sexuales 
(estigma sexual, homonegatividad internalizada), estresores económicos y estrés 
debido al distanciamiento social, con depresión y ansiedad, riesgo de VIH y 
acceso a servicios de salud. Los hallazgos de la encuesta (n = 132) indicaron 
que la homonegatividad internalizada y el estrés relacionado con el 
distanciamiento social estaban asociados de manera significativa con síntomas de 
depresión y ansiedad. Además, los resultados mostraron menor acceso a condones, 
pruebas de VIH y servicios de consejería. Los hallazgos cualitativos (n = 10) 
destacaron impactos económicos adversos de COVID-19, tales como pérdida de 
empleo/sueldo y participación en trabajo sexual de supervivencia, que contribuía 
a angustia psicológica y al riesgo de VIH. La pandemia de COVID-19 ha causado 
considerable angustia psicológica y financiera entre HSH de bajo nivel 
socioeconómico en India, incluidos aquéllos involucrados en trabajo sexual, 
comunidades ya marginadas en sectores económicos, familiares y sanitarios. Las 
intervenciones estructurales para mejorar el acceso a servicios de salud mental 
y VIH y disminuir la carga financiera son esenciales para mitigar el impacto de 
COVID-19.

DOI: 10.1080/26410397.2022.2144087
PMCID: PMC9733688
PMID: 36476183 [Indexed for MEDLINE]

Conflict of interest statement: No potential conflict of interest was reported 
by the author(s).


1228. Disaster Med Public Health Prep. 2022 Dec 7;17:e339. doi: 10.1017/dmp.2022.271.

Differences in Household Preparedness and Adaptation for COVID-19.

Clay LA(1), Kendra J(2).

Author information:
(1)Department of Emergency Health Services, University of Maryland Baltimore 
County, Baltimore, MD.
(2)Disaster Research Center and Joseph R Biden (Jr) School of Public Policy and 
Administration, University of Delaware, Newark, DE.

OBJECTIVE: To quantify differences in preparedness for and adaptations to 
COVID-19 in a cohort sample of New York City residents.
METHODS: A proportional quota sample (n = 1020) of individuals residing in New 
York City during the COVID-19 pandemic participated in a Qualtrics web survey. 
Quotas were set for age, sex, race, and income to mirror the population of New 
York City based on the 2018 American Community Survey.
RESULTS: Low self-efficacy, low social support, and low sense of community 
increased the odds of securing provisions to prepare for COVID-19. Being an 
essential worker, poor mental health, and having children in the household 
reduced the likelihood of engaging in preparedness practices. Essential workers 
and individuals with probable serious mental illness were less likely to report 
preparedness planning for the pandemic.
CONCLUSIONS: The findings contribute to evolving theories of preparedness. There 
are differences across the sample in preparedness types, and different kinds of 
preparedness are associated with different household characteristics. Findings 
suggest that public officials and others concerned with population wellbeing 
might productively turn attention to education and outreach activities indexed 
to these characteristics.

DOI: 10.1017/dmp.2022.271
PMID: 36474401 [Indexed for MEDLINE]


1229. Women Birth. 2023 Mar;36(2):184-192. doi: 10.1016/j.wombi.2022.11.012. Epub 2022 
Nov 30.

Emotional wellbeing of student midwives during COVID-19.

Kuipers Y(1), Mestdagh E(2).

Author information:
(1)School of Health and Social Care, Edinburgh Napier University, Sighthill 
Campus, Edinburgh EH11 4BN, Scotland, UK; School of Health and Social Care, AP 
University of Applied Sciences, Noorderplaats 2, 2000 Antwerp, Belgium. 
Electronic address: y.kuipers@napier.ac.uk.
(2)School of Health and Social Care, AP University of Applied Sciences, 
Noorderplaats 2, 2000 Antwerp, Belgium.

BACKGROUND: Mental health of students in higher education was affected during 
the COVID-19 pandemic.
AIM: To examine the emotional wellbeing of midwifery students in the Netherlands 
and Flanders (Belgium) during COVID-19.
METHODS: A cross-sectional online-based survey with 619 Dutch and Flemish 
midwifery students. Sociodemographic details were obtained. Anxiety and 
depression were measured twice (T1, T2) during the COVID-19 pandemic.
FINDINGS: Flemish students had significantly higher mean depression and anxiety 
scores than Dutch students during the total period of study (p < .001; 
p < .001). Total group mean depression and anxiety scores were significantly 
higher at T2 compared to T1 (p < .001; p < .001). In the Dutch student group, 
there was a significant increase of depression from T1 to T2 (p < .001). In the 
Flemish student group, both depression and anxiety scores significantly 
increased from T1 to T2 (p < .001; p < .001). A history of psychological 
problems predicted both depression and anxiety, irrespective of COVID-19 period 
or country (p < .001; p < .001). Being single (p.015) and having a job (p.046) 
predicted depression, irrespective of period or country. A history of 
psychological problems predicted depression (p.004; p < .001) and anxiety 
(p.003; p.001) during the total period of study. Being single also predicted 
depression during T2 (p.024).
CONCLUSION: These findings inform how emotional wellbeing of midwifery students 
was affected during the COVID-19 pandemic and identify those students that might 
need extra attention after the pandemic, during another pandemic or similar 
situations with social restrictions.

Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.wombi.2022.11.012
PMCID: PMC9708611
PMID: 36473798 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper. Funding Interreg 2 Seas Mers Zeeën https://www.interreg2seas.eu/nl [grant 
number 2S05-002, 2019], Province Antwerp Service for Europe, Department of 
Economy, Local Policies and Europe [grant number BBSPATH 1564468860780, 2019].


1230. Am J Infect Control. 2023 Aug;51(8):890-894. doi: 10.1016/j.ajic.2022.11.021. 
Epub 2022 Dec 5.

An unheard voice: infection prevention professionals reflect on their 
experiences during the covid-19 pandemic.

Pintar PA(1), McAndrew NS(2).

Author information:
(1)Infection Prevention & Control Froedtert Health, Froedtert & the Medical 
College of Wisconsin, Milwaukee, WI. Electronic address: 
Paula.pintar@froedtert.com.
(2)College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI; 
Froedtert & the Medical College, Froedtert Hospital, Milwaukee, WI.

BACKGROUND: The COVID-19 pandemic required a shift away from the evidence-based 
practices known to infection prevention professionals' (IPP). Relaying these 
guidelines to beleaguered front line staff contributed to the experience of 
moral distress and burnout among IPPs.
METHODS: A mixed methods design was used to explore the experiences of IPPs 
during the COVID-19 pandemic. An electronic survey was sent to a convenience 
sample from the Wisconsin APIC membership. A subset of this sample completed 
additional semi-structured interviews.
RESULTS: A total of 61 IPPs responded to the survey, 18 agreed to interviews 
with 11 completions. Most respondents identified as female (n=58, 95.0%) and 
White (n=55, 90.1%). More than half of the respondents (n=39, 63.9 %) reported 
they experienced moral distress (MD). Themes from one-on-one interviews 
included: Feeling depleted, challenges to IPP role, validation of IPP expertise, 
value of peer support.
CONCLUSIONS: We found that IPPs endured significant distress and exhaustion 
during the COVID-19 pandemic regardless of their practice setting. The long-term 
effects on the IPP profession must be examined. IPPs are susceptible to high 
levels of stress and anxiety similar to other frontline healthcare workers. IPPs 
deserve recognition for their service during the pandemic and should have access 
to resources that can support their well-being.

Copyright © 2022 Association for Professionals in Infection Control and 
Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.ajic.2022.11.021
PMCID: PMC9719930
PMID: 36473616 [Indexed for MEDLINE]


1231. J Neurol Sci. 2023 Jan 15;444:120511. doi: 10.1016/j.jns.2022.120511. Epub 2022 
Nov 29.

Monitoring cognitive and psychological alterations in COVID-19 patients: A 
longitudinal neuropsychological study.

Diana L(1), Regazzoni R(2), Sozzi M(2), Piconi S(3), Borghesi L(3), Lazzaroni 
E(4), Basilico P(2), Aliprandi A(2), Bolognini N(5), Bonardi DR(6), Colombo 
D(6), Salmaggi A(7).

Author information:
(1)Neurology Unit, Ospedale "A. Manzoni", Lecco, Italy; Neuropsychology 
Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy.
(2)Neurology Unit, Ospedale "A. Manzoni", Lecco, Italy.
(3)Infectious Diseases Unit, Ospedale "A. Manzoni", Lecco, Italy.
(4)Department of Mental Health, Ospedale "A. Manzoni", Lecco, Italy.
(5)Neuropsychology Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy; 
Department of Psychology and NeuroMI, University of Milano-Bicocca, Milan, 
Italy.
(6)Respiratory Unit, IRCCS INRCA (Italian National Research Centre On Aging), 
Casatenovo, Italy.
(7)Neurology Unit, Ospedale "A. Manzoni", Lecco, Italy. Electronic address: 
a.salmaggi@asst-lecco.it.

BACKGROUND: SARS-COV-2 infection has been associated to long-lasting 
neuropsychiatric sequelae, including cognitive deficits, that persist after one 
year. However, longitudinal monitoring has been scarcely performed. Here, in a 
sample of COVID-19 patients, we monitor cognitive, psychological and quality of 
life-related profiles up to 22 months from resolution of respiratory disease.
METHODS: Out of 657 COVID-19 patients screened at Manzoni Hospital (Lecco, 
Italy), 22 underwent neuropsychological testing because of subjective cognitive 
disturbances at 6 months, 16 months, and 22 months. Tests of memory, attention, 
and executive functions were administered, along with questionnaires for 
depressive and Post-traumatic stress disorder (PTSD) symptoms, psychological 
well-being and quality of life. Cross-sectional descriptives, correlational, as 
well as longitudinal analyses considering COVID19-severity were carried out. A 
preliminary comparison with a sample of obstructive sleep apneas patients was 
also performed.
RESULTS: Around 50% of COVID-19 patients presented with cognitive deficits at 
t0. The most affected domain was verbal memory. Pathological scores diminished 
over time, but a high rate of borderline scores was still observable. 
Longitudinal analyses highlighted improvements in verbal and non-verbal long 
term memory, as well as attention, and executive functioning. Depression and 
PTSD-related symptoms were present in 30% of patients. The latter decreased over 
time and were associated to attentional-executive performance.
CONCLUSIONS: Cognitive dysfunctions in COVID-19 patients may extend over 1 year, 
yet showing a significant recovery in several cases. Cognitive alterations are 
accompanied by a significant psychological distress. Many patients displaying 
borderline scores, especially those at higher risk of dementia, deserve clinical 
monitoring.

Copyright © 2022 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jns.2022.120511
PMCID: PMC9707027
PMID: 36473347 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare no conflict of interest.


1232. Midwifery. 2023 Feb;117:103557. doi: 10.1016/j.midw.2022.103557. Epub 2022 Nov 
22.

Postnatal mental health during the COVID-19 pandemic: Impact on mothers' 
postnatal sense of security and on mother-to-infant bonding.

Schaming C(1), Wendland J(2).

Author information:
(1)Université Paris Cité, Laboratoire de Psychopathologie et Processus de Santé, 
F-92100 Boulogne-Billancourt, France; Maternity, René Dubos Hospital, F-95303 
Pontoise, France.
(2)Université Paris Cité, Laboratoire de Psychopathologie et Processus de Santé, 
F-92100 Boulogne-Billancourt, France. Electronic address: 
jaqueline.wendland@u-paris.fr.

BACKGROUND: The unprecedented COVID-19 pandemic context imposed new living 
conditions which greatly modified women's experience of the postpartum period 
and brought significant changes to postnatal care.
OBJECTIVE: The main objective of this study was to evaluate the impact of the 
COVID-19 pandemic context on maternal sense of security and on mother-to-child 
bonding in the postpartum.
DESIGN: This study had a mixed research design. We compared levels of 
mother-child bonding disturbances and of maternal emotional security amongst two 
samples of postnatal women recruited before and during the pandemic. Postnatal 
depression was also evaluated. A qualitative analysis of the participants' 
comments on the impact of the COVID-19 pandemic was performed with an 
open-coding approach.
PARTICIPANTS: Two samples of French-speaking mothers in the first six months 
after their childbirth, recruited before the pandemic (N=874) and during the 
pandemic (N=721).
FINDINGS: Mother-child bonding disturbances measured with PBQ and levels of 
emotional security levels evaluated with PPSSi did not differ significantly 
between the samples. A high prevalence of women at risk of postnatal depression 
was found in both samples. However, participants' comments on their postnatal 
experience during the pandemic contrasted with their quantitative data. Fears of 
contamination, social isolation, and lack of support were the main factors of 
insecurity. Lack of closeness with relatives and friends, limited presence of 
the partner in the maternity ward, and early interactions with the newborn with 
a mask appear to have altered mother-child bonding during this pandemic period.
CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The findings highlight the importance 
of considering social and environmental factors and needs when evaluating 
postnatal mental health and providing postnatal care to new mothers during a 
health crisis. Health services and professionals should pay particular attention 
to mothers' mental health and well-being and guarantee continuity of care to 
avoid parents' isolation in the sensitive postpartum period.

Copyright © 2022. Published by Elsevier Ltd.

DOI: 10.1016/j.midw.2022.103557
PMCID: PMC9678387
PMID: 36473335 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The author(s) 
declared no potential conflicts of interest with respect to the research, 
authorship, and/or publication of this article.


1233. J Occup Environ Med. 2022 Dec 1;64(12):1025-1035. doi: 
10.1097/JOM.0000000000002630.

Prepandemic Mental Health and Well-being: Differences Within the Health Care 
Workforce and the Need for Targeted Resources.

Silver SR(1), Li J, Marsh SM, Carbone EG.

Author information:
(1)From the Health Informatics Branch, Division of Field Studies and 
Engineering, National Institute for Occupational Safety and Health, Cincinnati, 
Ohio (Silver, Li); and Surveillance and Field Investigations Branch, Division of 
Safety Research, National Institute for Occupational Safety and Health, 
Morgantown, West Virginia (Marsh, Carbone).

BACKGROUND: Occupational stress and diminished well-being among health care 
workers were concerning even before the coronavirus disease 2019 pandemic 
exacerbated existing stressors and created new challenges for this workforce. 
Research on the mental health of health care workers has focused on physicians 
and nurses, with less attention to other occupations.
METHODS: To assess pre-coronavirus disease mental health and well-being among 
workers in multiple health care occupations, we used 2017 to 2019 data from the 
Behavioral Risk Factor Surveillance System.
RESULTS: Across the health care workforce, insufficient sleep (41.0%) and 
diagnosed depression (18.9%) were the most common conditions reported. 
Counselors had the highest prevalence of diagnosed depression. Health care 
support workers had elevated prevalences for most adverse health conditions.
CONCLUSIONS: Ensuring a robust health care workforce necessitates identifying 
and implementing effective occupation-specific prevention, intervention, and 
mitigation strategies that address organizational and personal conditions 
adversely affecting mental health.

Copyright © 2022 American College of Occupational and Environmental Medicine.

DOI: 10.1097/JOM.0000000000002630
PMCID: PMC9722331
PMID: 36472564 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest: None declared.


1234. BMC Psychol. 2022 Dec 5;10(1):289. doi: 10.1186/s40359-022-01008-y.

"…It just broke me…": exploring the psychological impact of the COVID-19 
pandemic on academics.

Thompson L(1), Christian C(2).

Author information:
(1)School of Humanities and Social Sciences, Faculty of Humanities and Social 
Sciences, The Independent Institute of Education, Cape Town, South Africa. 
lythompson@varsitycollege.co.za.
(2)School of Humanities and Social Sciences, Faculty of Humanities and Social 
Sciences, The Independent Institute of Education, Cape Town, South Africa.

BACKGROUND: The declaration of COVID-19 as a global pandemic by the World Health 
Organisation (WHO) in 2020 catapulted institutions of higher education into an 
emergency transition from face-to-face to online teaching. Given the nature of 
the COVID-19 pandemic and the continuing after-effects thereof, the study 
explored the psychological impact of the COVID-19 pandemic on academics.
METHODS: A qualitative phenomenological research design was used to explore the 
psychological impact of the COVID-19 pandemic on academics. Data were collected 
by means of semi-structured interviews from a sample of 11 full-time academics 
permanently employed at six public and private higher education institutions in 
South Africa in 2020 and 2021. The data were analysed by means of thematic 
analysis.
RESULTS: The study found that the COVID-19 pandemic and lockdown restrictions 
had a largely negative psychological impact on academics in higher education. 
The most dominant negative emotions reported by participants included stress, 
anxiety, fear and guilt either due to the threat of the virus itself, potential 
for loss of life, lockdown restrictions, a new working environment, and/or their 
perceived inability to assist their students. Participants also reported 
feelings of emotional isolation and an increase in levels of emotional fatigue.
CONCLUSION: In conclusion, institutions of higher education need to be aware of 
the negative psychological impact of COVID-19 on academics, and ensure they 
create and foster environments that promote mental well-being. Institutions may 
offer psychological services and/or emotional well-being initiatives to their 
academic staff. They must create spaces and cultures where academics feel 
comfortable to request and seek well-being opportunities. In addition to mental 
and emotional well-being initiatives, institutions must provide academics with 
tangible teaching and learning support as this would go a long way in reducing 
much of the stress experienced by academics during the pandemic.

© 2022. The Author(s).

DOI: 10.1186/s40359-022-01008-y
PMCID: PMC9724325
PMID: 36471439 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1235. Int J Psychiatry Clin Pract. 2022 Nov;26(4):330-336. doi: 
10.1080/13651501.2021.2022701. Epub 2022 Jan 4.

Prevalence of vitamin D deficiency among psychiatric inpatients: a systematic 
review.

Seiler N(1)(2), Tsiglopoulos J(1)(2), Keem M(3), Das S(3), Waterdrinker A(3).

Author information:
(1)Northern Hospital, Northern Health, Melbourne, Australia.
(2)Faculty of Medicine, Dentistry and Health Sciences, The University of 
Melbourne, Melbourne, Australia.
(3)Northern Area Mental Health Service, Melbourne Health, Melbourne, Australia.

Objectives: Vitamin D deficiency is associated with worse physical and mental 
health outcomes. Low vitamin D levels are more common among people who 
experience mental health issues. This is particularly vital due to the outdoor 
restrictions which arose from the COVID-19 pandemic. This systematic review 
assessed vitamin D deficiency and insufficiency among psychiatric 
inpatients.Methods: A literature search was performed using the key words 
'vitamin D', 'mental health', 'mental illness' and 'inpatient' and articles were 
selected by two independent reviewers. Eighteen studies were identified as 
eligible according to inclusion and exclusion criteria.Results: Vitamin D 
deficiency (29 - 96%) and insufficiency (20 - 63%) were common among psychiatric 
inpatients. Over half of the studies recommended or advised consideration of 
vitamin D level screening among psychiatric inpatients, while nine recommended 
consideration of vitamin D supplementation.Conclusions: Screening for vitamin D 
deficiency during psychiatric admission may be clinically indicated and improve 
patient wellbeing and outcomes.Key pointsLow vitamin D levels are very common 
among people admitted to inpatient mental health services.Vitamin D level 
screening upon inpatient psychiatric admission is warranted to optimise general 
health outcomes.Vitamin D supplementation should be considered among inpatients 
with vitamin D deficiency or insufficiency.

DOI: 10.1080/13651501.2021.2022701
PMID: 36469622 [Indexed for MEDLINE]


1236. Wien Klin Wochenschr. 2023 May;135(9-10):221-227. doi: 
10.1007/s00508-022-02113-z. Epub 2022 Dec 5.

Community engaged research to measure the impact of COVID-19 on vulnerable 
community member's well-being and health : A mixed methods approach.

Barwise AK(1)(2), Egginton J(3), Pacheco-Spann L(4)(5), Clift K(6), Albertie 
M(7), Johnson M(3), Batbold S(8), Phelan S(3)(9), Allyse M(4)(10).

Author information:
(1)Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First 
Street SW, 55905, Rochester, MN, USA. barwise.amelia@mayo.edu.
(2)Program in Biomedical Ethics Research, Mayo Clinic, Rochester, MN, USA. 
barwise.amelia@mayo.edu.
(3)Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, 
Mayo Clinic, Rochester, MN, USA.
(4)Program in Biomedical Ethics Research, Mayo Clinic, Rochester, MN, USA.
(5)Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA.
(6)Center for Individualized Medicine, Mayo Clinic, Jacksonville, FL, USA.
(7)Center for Health Equity and Community Engagement Research, Mayo Clinic, 
Jacksonville, FL, USA.
(8)Mayo Clinic Alix School of Medicine, Rochester, MN, USA.
(9)Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA.
(10)Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA.

BACKGROUND: The COVID-19 pandemic has exacerbated existing income inequality and 
health disparities in the United States (US). The objective of this study was to 
conduct timely, community-engaged research to understand the disproportionate 
impact of the COVID-19 pandemic on historically under-resourced communities with 
the goal of improving health equity. The initiative focused on priorities 
identified by Community Health Needs Assessments (CHNA) conducted every 3 years 
per Federal funding requirements. These were access to healthcare, 
maternal/child health, obesity/food insecurity/physical activity, and mental 
health/addiction.
METHODS: In the first three quarters of 2021, we developed and employed mixed 
methods in three simultaneous phases of data collection. In phase 1, we used 
purposive sampling to identify key informants from multiple stakeholder groups 
and conducted semi-structured interviews. In phase 2, we held focus groups with 
community members from historically marginalized demographics. In phase 3, we 
developed a survey using validated scales and distributed it to diverse 
communities residing in the geographic areas of our healthcare system across 
four states.
CONCLUSION: Healthcare systems may use the methodology outlined in this paper to 
conduct responsive community engagement during periods of instability and/or 
crisis and to address health equity issues. The results can inform sustainable 
approaches to collaborate with communities to build resilience and prepare for 
future crises.

© 2022. The Author(s).

DOI: 10.1007/s00508-022-02113-z
PMCID: PMC9734981
PMID: 36469122 [Indexed for MEDLINE]

Conflict of interest statement: A.K. Barwise, J. Egginton, L. Pacheco-Spann, 
K. Clift, M. Albertie, M. Johnson, S. Batbold, S. Phelan and M. Allyse declare 
that they have no competing interests.


1237. Nurs Stand. 2023 Jan 4;38(1):43-49. doi: 10.7748/ns.2022.e11967. Epub 2022 Dec 
5.

Promoting young people's mental health: the role of community nurses.

Heaslip V(1), Glendening N(2), Snowden J(2).

Author information:
(1)School of Health and Society, University of Salford, Manchester, England, and 
visiting associate professor, University of Stavanger, Stavanger, Norway.
(2)Department of Nursing Science, Bournemouth University, Bournemouth, England.

There are growing concerns about the mental health and well-being of young 
people, including how these have been negatively affected by factors such as the 
coronavirus disease 2019 (COVID-19) pandemic and social media. Community nurses 
are in an ideal position to promote positive mental health and ensure timely 
referral to appropriate services to enable young people to access the support 
they need. This article explores how the pandemic and social media have affected 
young people's mental health, particularly in relation to anxiety. It also 
explains how nurses can discuss these issues with young people and their parents 
or guardians.

© 2022 RCN Publishing Company Ltd. All rights reserved. Not to be copied, 
transmitted or recorded in any way, in whole or part, without prior permission 
of the publishers.

DOI: 10.7748/ns.2022.e11967
PMID: 36468176 [Indexed for MEDLINE]

Conflict of interest statement: None declared


1238. Front Public Health. 2022 Nov 16;10:1009027. doi: 10.3389/fpubh.2022.1009027. 
eCollection 2022.

COVID-19 burnout, resilience, and psychological distress among Chinese college 
students.

Sun Y(1), Zhu S(1), ChenHuang G(1), Zhu L(1), Yang S(1), Zhang X(1), Zheng Z(1).

Author information:
(1)Department of Psychology, School of Medicine & Holistic Integrative Medicine, 
Nanjing University of Chinese Medicine, Nanjing, China.

BACKGROUND: Since the outbreak of coronavirus disease 2019 (COVID-19), Chinese 
college students have spent 3 years dealing with infection prevention. Some 
students have undergone quarantine due to the detection of new variants of 
COVID-19 and the rise in cases. This study examines pandemic-related isolation 
and its psychological impact on Chinese college students and explores the 
relationships among COVID-19 burnout, resilience, and psychological distress in 
Chinese college students during the pandemic.
METHODS: The COVID-19 Burnout Scale, the Connor-Davidson Resilience Scale, and 
the Brief Symptom Inventory were used to investigate 388 college students from 
Nanjing City, China. All participants were enrolled in university after 2019, 
and they participated in the survey voluntarily via the Internet. Participants 
were divided into two groups (isolated group vs. non-isolated group) based on 
whether or not they had been isolated.
RESULTS: (1) Significantly lower scores were found for all factors in the 
isolated group; (2) COVID-19 burnout significantly negatively predicted 
resilience and significantly positively predicted psychological distress 
(anxiety, depression, and somatization symptoms), while resilience significantly 
negatively predicted psychological distress; and (3) Resilience mediated the 
relationship between COVID-19 burnout and psychological distress.
CONCLUSION: Isolation is a risk factor for psychological distress related to 
COVID-19. Resilience can buffer psychological distress and help improve Chinese 
college students' wellbeing during the COVID-19 pandemic.

Copyright © 2022 Sun, Zhu, ChenHuang, Zhu, Yang, Zhang and Zheng.

DOI: 10.3389/fpubh.2022.1009027
PMCID: PMC9709421
PMID: 36466458 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1239. J Nurs Scholarsh. 2023 Jan;55(1):226-238. doi: 10.1111/jnu.12855. Epub 2022 Dec 
4.

Care-home Nurses' responses to the COVID-19 pandemic: Managing ethical 
conundrums at personal cost: A qualitative study.

Birt L(1), Lane K(1), Corner J(1), Sanderson K(1), Bunn D(1).

Author information:
(1)School of Health Sciences, University of East Anglia, Norfolk, UK.

INTRODUCTION: The COVID-19 pandemic had an unprecedented effect on those living 
and working in care-homes for older people, as residents were particularly 
vulnerable to contracting the SARS-CoV-2 virus, associated with high morbidity 
and mortality. Often undervalued, care-home nurses (RNs) are leaders, managing 
complex care while working in isolation from their professional peers. The 
pandemic made this more apparent, when care and treatments for COVID-19 were 
initially unknown, isolation increased due to withdrawal of many professional 
health services, accompanied by staff shortages.
OBJECTIVE: To explore RNs' experiences of working in older people's care-homes 
during the COVID-19 pandemic.
DESIGN: Qualitative interview study.
SETTING: Care-homes for older people in England and Scotland, UK.
METHODS: Recruitment via direct contact with care-homes, social media, and links 
provided by national partners, then purposive sampling for age, gender, type of 
care-home, and location. Data collected through one-to-one online interviews 
using topic guide developed collaboratively with care-home nurses, focusing on 
how COVID-19 impacted on nurses' resilience and mental wellbeing. Data analyzed 
thematically using Tronto's ethics of care framework to guide development of 
interpretative themes.
RESULTS: Eighteen nurses (16 female; 16 adult, and two mental health nurses) 
were interviewed March-June 2021; majority aged 46-55 years; mean time 
registered with Nursing and Midwifery Council: 19 years; 17 had nursed residents 
with COVID-19. RNs' experiences resonated with Tronto's five tenets of ethical 
care: attentiveness, responsibility, competence, responsiveness, and solidarity. 
All nurses described being attentive to needs of others, but were less attentive 
to their own needs, which came at personal cost. RNs were aware of their 
professional and leadership responsibilities, being as responsive as they could 
be to resident needs, processing and sharing rapidly changing guidance and 
implementing appropriate infection control measures, but felt that relatives and 
regulatory bodies were not always appreciative. RNs developed enhanced clinical 
skills, increasing their professional standing, but reported having to 
compromise care, leading to moral distress. Broadly, participants reported a 
sense of solidarity across care-home staff and working together to cope with the 
crisis.
CONCLUSION: Care-home nurses felt unprepared for managing the COVID-19 pandemic, 
many experienced moral distress. Supporting care-home nurses to recover from the 
pandemic is essential to maintain a healthy, stable workforce and needs to be 
specific to care-home RNs, recognizing their unique pandemic experiences. 
Support for RNs will likely benefit other care-home workers either directly 
through wider roll-out, or indirectly through improved wellbeing of nurse 
leaders.
CLINICAL RELEVANCE: The COVID-19 pandemic, an international public health 
emergency, created many challenges for Registered Nurses (RNs) working in 
long-term care facilities for older people, as residents were particularly 
vulnerable to the impact of the SARS-CoV-2 virus. Care-home RNs faced challenges 
distinct from their hospital-based nursing peers and non-nursing social care 
colleagues due to their isolation, leadership roles, professional legal 
obligations, and ethical responsibilities, leading to psychological distress on 
the one hand, but also a newly found confidence in their existing and newly 
developed skills, and increased recognition by the wider health community of 
their specialisms.

© 2022 The Authors. Journal of Nursing Scholarship published by Wiley 
Periodicals LLC on behalf of Sigma Theta Tau International.

DOI: 10.1111/jnu.12855
PMCID: PMC9878168
PMID: 36464814 [Indexed for MEDLINE]

Conflict of interest statement: None of the authors declared any conflict of 
interests.


1240. Fam Pract. 2023 May 31;40(3):449-457. doi: 10.1093/fampra/cmac138.

Impacts of the 2019/20 bushfires and COVID-19 pandemic on the physical and 
mental health of older Australians: a cross-sectional survey.

Halcomb E(1), Thompson C(2), Morris D(2), James S(3), Dilworth T(4), Haynes 
K(4)(5), Batterham M(6).

Author information:
(1)School of Nursing, University of Wollongong, Wollongong, Australia.
(2)Australian Health Services Research Institute, University of Wollongong, 
Wollongong, Australia.
(3)School of Public Health and Preventive Medicine, Monash University, 
Melbourne, Australia.
(4)Centre for Environmental Risk Management of Bushfires, University of 
Wollongong, Wollongong, Australia.
(5)Natural Hazards Research Australia, Melbourne, Australia.
(6)National Institute for Applied Statistics Research Australia, University of 
Wollongong, Wollongong, Australia.

BACKGROUND: In 2019/20 major bushfires devastated Australia's East Coast. 
Shortly afterward the COVID-19 pandemic was declared. Older people are 
disproportionately affected by disasters and are at high risk from respiratory 
pandemics. However, little is known about how these events impact on older 
peoples' health and well-being and engagement with services such as primary 
care.
OBJECTIVE: To explore the health impacts of the 2019/20 bushfires and the 
COVID-19 pandemic on older Australians' health and well-being.
METHODS: One hundred and fifty-five people aged over 65 years living in 
South-eastern New South Wales, Australia participated in an online survey. The 
survey measured the impacts of the bushfires and COVID-19 on physical and mental 
health and the capacity of older people to manage these impacts.
RESULTS: Most respondents felt that the bushfires caused them to feel 
anxious/worried (86.2%) and negatively affected their physical (59.9%) and 
mental (57.2%) health. While many participants had similar feelings about 
COVID-19, significantly fewer felt these physical and mental health impacts than 
from the bushfires. A significantly greater perceived level of impact was 
observed for females and those with health problems. More respondents described 
negative mental health than physical health effects. Those who felt more 
impacted by the events had lower levels of resilience, social connection and 
support, and self-rated health.
CONCLUSION: The health impacts identified in this study represent an opportunity 
for primary care to intervene to both ensure that people with support needs are 
identified and provided timely support and that older people are prepared for 
future disasters.

© The Author(s) 2022. Published by Oxford University Press.

DOI: 10.1093/fampra/cmac138
PMCID: PMC10231380
PMID: 36462177 [Indexed for MEDLINE]

Conflict of interest statement: None declared.


1241. Int J Ment Health Nurs. 2023 Apr;32(2):420-445. doi: 10.1111/inm.13097. Epub 
2022 Dec 2.

The impact of COVID-19 on the mental health workforce: A rapid review.

Crocker KM(1), Gnatt I(1)(2), Haywood D(1)(3), Butterfield I(3), Bhat R(4), 
Lalitha ARN(5), Jenkins ZM(1)(6), Castle DJ(1)(7)(8).

Author information:
(1)Department of Mental Health, St Vincent's Hospital, Melbourne, Victoria, 
Australia.
(2)Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne 
University of Technology, Hawthorn, Victoria, Australia.
(3)School of Population Health, Curtin University, Perth, Western Australia, 
Australia.
(4)Department of Rural Health, University of Melbourne, Shepparton, Victoria, 
Australia.
(5)Department of Mental health, Grampians Area Mental Health & well-being 
Services, Ballarat, Victoria, Australia.
(6)Department of Psychiatry, University of Melbourne, Melbourne, Victoria, 
Australia.
(7)Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
(8)Centre for Complex Interventions, Centre for Addiction and Mental Health, 
Toronto, Ontario, Canada.

The COVID-19 pandemic led to significant adaptations to healthcare. Provision of 
mental healthcare in a changing environment presented healthcare workers with 
unique challenges and demands, including changes in workload and expectations. 
To inform current and future healthcare service responses, and adaptations, the 
current review aimed to collate and examine the impact of the pandemic on mental 
healthcare workers (MHWs). We conducted a rapid systematic review to examine the 
overall impact of the COVID-19 pandemic on MHWs. Searches were conducted in Ovid 
Medline and PsycInfo and restricted to articles published from 2020. Inclusion 
criteria specified articles written in English, published in peer-reviewed 
journals, and that examined any outcome of the impact of COVID-19 on MHWs; 55 
articles fulfilled these criteria. Outcomes were categorized into 'work-related 
outcomes' and 'personal outcomes'. Mental healthcare workers worldwide 
experienced a range of work-related and personal adversities during the 
pandemic. Key work-related outcomes included increased workload, changed roles, 
burnout, decreased job satisfaction, telehealth challenges, difficulties with 
work-life balance, altered job performance, vicarious trauma and increased 
workplace violence. Personal outcomes included decreased well-being, increased 
psychological distress and psychosocial difficulties. These outcomes differed 
between inpatient, outpatient and remote settings. The COVID-19 pandemic 
significantly altered the delivery of mental healthcare and MHWs experienced 
both work-related and personal adversities during the COVID-19 pandemic. With 
the continuation of changes introduced to healthcare in the initial stages of 
the pandemic, it will be important to maintain efforts to monitor negative 
outcomes and ensure supports for MHWs, going forward.

© 2022 John Wiley & Sons Australia, Ltd.

DOI: 10.1111/inm.13097
PMCID: PMC9878253
PMID: 36461629 [Indexed for MEDLINE]


1242. Sci Rep. 2022 Dec 2;12(1):20795. doi: 10.1038/s41598-022-24240-3.

Probable COVID-19 infection is associated with subsequent poorer mental health 
and greater loneliness in the UK COVID-19 Mental Health and Wellbeing study.

Wilding S(#)(1), O'Connor DB(#)(2), Ferguson E(3), Cleare S(4), Wetherall K(4), 
O'Carroll RE(5), Robb KA(6), O'Connor RC(6).

Author information:
(1)School of Psychology, University of Leeds, Leeds, UK.
(2)School of Psychology, University of Leeds, Leeds, UK. 
D.B.OConnor@leeds.ac.uk.
(3)School of Psychology, University of Nottingham, Nottingham, UK.
(4)Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, 
University of Glasgow, Glasgow, Scotland.
(5)Division of Psychology, University of Stirling, Stirling, Scotland.
(6)Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland.
(#)Contributed equally

The COVID-19 pandemic has been associated with psychological distress. In 
addition to physical effects including fatigue and cognitive impairment, 
contracting COVID-19 itself may also be related to subsequent negative mental 
health outcomes. The present study reports data from a longitudinal, national 
survey of the UK adult population investigating whether contracting suspected or 
confirmed COVID-19 at the early stages of the pandemic (March-May 2020) was 
associated with poorer mental health outcomes in May/June 2020, October/November 
2020 and June/July 2021. A quota survey design and a sampling frame that 
permitted recruitment of a national sample (n = 3077) were utilised. Experience 
of contracting COVID-19 during the first UK lockdown was assessed along with 
levels of depression, anxiety, mental wellbeing and loneliness. Around 9% of 
participants reported contracting COVID-19 in March/May 2020 (waves 1-3) with 
just under 13% of the overall sample reporting COVID-19 at any one of the first 
three time points. Compared to those without probable COVID-19 infection, 
participants with probable COVID-19 had poorer mental health outcomes at 
follow-up with these effects lasting up to 13 months (e.g., May/June 
2020:ORdepression = 1.70, p < 0.001; ORanxiety = 1.61, p = 0.002; Oct/Nov 2020, 
ORdepression = 1.82, p < 0.001; ORanxiety 1.56, p = 0.013; June/July 2021, 
ORdepression = 2.01, p < 0.001; ORanxiety = 1.67, p = 0.008). Having a 
pre-existing mental health condition was also associated with greater odds of 
having probable COVID-19 during the study (OR = 1.31, p = 0.016). The current 
study demonstrates that contracting probable COVID-19 at the early stage of the 
pandemic was related to long-lasting associations with mental health and the 
relationship between mental health status and probable COVID-19 is 
bidirectional.

© 2022. The Author(s).

DOI: 10.1038/s41598-022-24240-3
PMCID: PMC9718764
PMID: 36460665 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1243. Br J Educ Psychol. 2023 Jun;93(2):405-422. doi: 10.1111/bjep.12565. Epub 2022 
Dec 2.

The challenges and experiences of academics supporting psychological capital 
among students at the emergence of COVID-19: A qualitative investigation of 
award-winning educators at a British university.

Morris R(1), Hoelterhoff M(1), Argyros G(1).

Author information:
(1)University of Edinburgh, Edinburgh, UK.

BACKGROUND: Studies show that student mental health has continued to deteriorate 
over the years. Developing strengths-based approaches could aid educators in the 
development of Psychological Capital (PsyCap) and positive protective factors in 
students to support their mental well-being and aid in their success; however, 
little is known of the subject experience of educators who attempt this.
AIMS: This study aims to understand the experience of award-winning educators; 
both in their attempts to cultivate positive protective factors in students and 
in challenges to the pursuit of that goal during the shifting academic landscape 
at the emergence of COVID-19.
SAMPLE: Six award-winning educators from a British university.
METHODS: Participants were interviewed over video calls in this research design 
using semi-structured interviews. Thematic analysis was used to analyse the 
data.
RESULTS & DISCUSSION: The results showed two major themes; pressures for 
academics and strength-based approached to cultivating PsyCap. These themes 
reflected that educators saw an urgent need for students to develop resilience 
as they struggle to handle subjective failure and that students struggle with 
imposter syndrome. The educators identified the challenges as feeling taken for 
granted, having unmanageable workloads along high expectations placed on them.
CONCLUSION: COVID-19 has added significantly to the workloads of educators and 
demonstrated students' need for resilience. This research identifies the 
experiences of educators trying to improve strengths-based practice while 
identifying the challenges of pursuing that goal in the changing pedagogy 
post-COVID-19.

© 2022 The Authors. British Journal of Educational Psychology published by John 
Wiley & Sons Ltd on behalf of British Psychological Society.

DOI: 10.1111/bjep.12565
PMCID: PMC9877583
PMID: 36458569 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that there is no conflict of 
interest.


1244. BMC Psychol. 2022 Dec 1;10(1):284. doi: 10.1186/s40359-022-00998-z.

The psychological impact, risk factors and coping strategies to COVID-19 
pandemic on healthcare workers in the sub-Saharan Africa: a narrative review of 
existing literature.

Oyat FWD(1), Oloya JN(1)(2), Atim P(1)(3), Ikoona EN(4), Aloyo J(1)(5), Kitara 
DL(6)(7)(8).

Author information:
(1)Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu City, Uganda.
(2)Moroto Regional Referral Hospital, Moroto, Uganda.
(3)St. Joseph's Hospital, Kitgum District, Uganda.
(4)ICAP at Columbia University, Freetown, Sierra Leone.
(5)Rhites-N, Acholi, Gulu City, Uganda.
(6)Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu City, Uganda. 
klagoro2@gmail.com.
(7)Faculty of Medicine, Department of Surgery, Gulu University, P.O. Box 166, 
Gulu City, Uganda. klagoro2@gmail.com.
(8)Harvard University, Cambridge, USA. klagoro2@gmail.com.

BACKGROUND: The ongoing COVID-19 pandemic has significantly impacted the 
physical and mental health of the general population worldwide, with healthcare 
workers at particular risk. The pandemic's effect on healthcare workers' mental 
well-being has been characterized by depression, anxiety, work-related stress, 
sleep disturbances, and post-traumatic stress disorder. Hence, protecting the 
mental well-being of healthcare workers (HCWs) is a considerable priority. This 
review aimed to determine risk factors for adverse mental health outcomes and 
protective or coping measures to mitigate the harmful effects of the COVID-19 
crisis among HCWs in sub-Saharan Africa.
METHODS: We performed a literature search using PubMed, Google Scholar, Cochrane 
Library, and Embase for relevant materials. We obtained all articles published 
between March 2020 and April 2022 relevant to the subject of review and met 
pre-defined eligibility criteria. We selected 23 articles for initial screening 
and included 12 in the final review.
RESULT: A total of 5,323 participants in twelve studies, predominantly from 
Ethiopia (eight studies), one from Uganda, Cameroon, Mali, and Togo, fulfilled 
the eligibility criteria. Investigators found 16.3-71.9% of HCWs with depressive 
symptoms, 21.9-73.5% with anxiety symptoms, 15.5-63.7% experienced work-related 
stress symptoms, 12.4-77% experienced sleep disturbances, and 51.6-56.8% 
reported PTSD symptoms. Healthcare workers, working in emergency, intensive care 
units, pharmacies, and laboratories were at higher risk of adverse mental health 
impacts. HCWs had deep fear, anxious and stressed with the high transmission 
rate of the virus, high death rates, and lived in fear of infecting themselves 
and families. Other sources of fear and work-related stress were the lack of 
PPEs, availability of treatment and vaccines to protect themselves against the 
virus. HCWs faced stigma, abuse, financial problems, and lack of support from 
employers and communities.
CONCLUSION: The prevalence of depression, anxiety, insomnia, and PTSD in HCWs in 
sub-Saharan Africa during the COVID-19 pandemic has been high. Several 
organizational, community, and work-related challenges and interventions were 
identified, including improvement of workplace infrastructures, adoption of 
correct and shared infection control measures, provision of PPEs, social 
support, and implementation of resilience training programs. Setting up 
permanent multidisciplinary mental health teams at regional and national levels 
to deal with mental health and providing psychological support to HCWs, 
supported with long-term surveillance, are recommended.

© 2022. The Author(s).

DOI: 10.1186/s40359-022-00998-z
PMCID: PMC9714392
PMID: 36457038 [Indexed for MEDLINE]

Conflict of interest statement: All authors declare no conflict of interest.


1245. BMC Geriatr. 2022 Dec 1;22(1):927. doi: 10.1186/s12877-022-03544-z.

Anxiety and loneliness among older people living in residential care facilities 
or receiving home care services in Sweden during the COVID-19 pandemic: a 
national cross-sectional study.

Johansson-Pajala RM(1), Alam M(2), Gusdal A(3), Heideken Wågert PV(3), Löwenmark 
A(3), Boström AM(4)(5)(6), Hammar LM(3)(4)(7).

Author information:
(1)School of Health, Care and Social Welfare, Mälardalen University, P.O 325, 
SE-63105, Eskilstuna/Västerås, Sweden. rose-marie.johansson-pajala@mdu.se.
(2)School of Information and Engineering/Statistics, Dalarna University, Falun, 
Sweden.
(3)School of Health, Care and Social Welfare, Mälardalen University, P.O 325, 
SE-63105, Eskilstuna/Västerås, Sweden.
(4)Division of Nursing, Department of Neurobiology, Care Science and Society 
Karolinska Institute, Stockholm, Sweden.
(5)Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, 
Sweden.
(6)R&D unit, Stockholms Sjukhem, Stockholm, Sweden.
(7)School of Health and Welfare, Dalarna University, Falun, Sweden.

BACKGROUND: Older people were subjected to significant restrictions on physical 
contacts with others during the COVID-19 pandemic. Social distancing impacts 
older people's experiences of anxiety and loneliness. Despite a large body of 
research on the pandemic, there is little research on its effects on older 
people in residential care facilities (RCF) and in home care services (HCS), who 
are the frailest of the older population. We aimed to investigate the effect of 
the first wave of the COVID-19 pandemic in March-May 2020 on experiences of 
anxiety and loneliness among older people living in RCF or receiving HCS and the 
impact of the progression of the pandemic on these experiences.
METHODS: A retrospective cross-sectional design using data from the national 
user satisfaction survey (March - May 2020) by the Swedish National Board of 
Health and Welfare. Survey responses were retrieved from 27,872 older people in 
RCF (mean age 87 years) and 82,834 older people receiving HCS (mean age 84 
years). Proportional-odds (cumulative logit) model was used to estimate the 
degree of association between dependent and independent variables.
RESULTS: Loneliness and anxiety were more prevalent among the older persons 
living in RCF (loneliness: 69%, anxiety: 63%) than those receiving HCS (53% and 
47%, respectively). Proportional odds models revealed that among the RCF and HCS 
respondents, the cumulative odds ratio of experiencing higher degree of anxiety 
increased by 1.06% and 1.04%, respectively, and loneliness by 1.13% and 1.16%, 
respectively, for 1% increase in the COVID-19 infection rate. Poor self-rated 
health was the most influential factor for anxiety in both RCF and HCS. Living 
alone (with HCS) was the most influential factor affecting loneliness. 
Experiences of disrespect from staff were more strongly associated with anxiety 
and loneliness in RCF than in HCS.
CONCLUSION: Older people in RCF or receiving HCS experienced increasing levels 
of anxiety and loneliness as the first wave of the pandemic progressed. Older 
people' mental and social wellbeing should be recognized to a greater extent, 
such as by providing opportunities for social activities. Better preparedness 
for future similar events is needed, where restrictions on social interaction 
are balanced against the public health directives.

© 2022. The Author(s).

DOI: 10.1186/s12877-022-03544-z
PMCID: PMC9714409
PMID: 36456904 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1246. J Med Imaging Radiat Sci. 2023 Jun;54(2S):S85-S94. doi: 
10.1016/j.jmir.2022.11.008. Epub 2022 Nov 21.

Supporting MRT mental health: Through COVID-19 and beyond.

Corrente M(1), Zychla L(2), Given M(3), Mihailescu M(4).

Author information:
(1)University of Ottawa, ON. Electronic address: mcorrente@camrt.ca.
(2)Manager of Professional Practice and Research Canadian Association of Medical 
Radiation Technologists, Ottawa, ON.
(3)Director of Professional Practice and Research, Canadian Association of 
Medical Radiation Technologists, Ottawa, ON.
(4)University of Calgary, AB.

The COVID-19 pandemic has had an exceptional impact on the healthcare 
profession, and in particular, on the mental health and wellbeing of healthcare 
workers. The Canadian Association of Medical Radiation Technologists (CAMRT) has 
been working on ways to prioritize the mental health of their members while 
increasing advocacy efforts. Conducting a national survey on mental health and 
interviewing medical radiation technologists (MRTs) highlighted the challenges 
that exist while also informing which support system components are most needed 
to improve wellbeing. The purpose of the research is to share the lived 
experience of Canadian MRTs in relation to their mental health during the 
pandemic. It adds to the knowledge gained from the survey by exploring in depth 
accounts of what MRTs felt and experienced during COVID-19. Understanding this 
challenging time period may aid in developing additional resources and support 
for MRTs in the workplace. The overall message in healthcare should be, optimize 
your wellbeing and your patients will be taken care of too. Recommendations to 
foster this message includes empowering MRTs to advocate for their mental health 
and wellbeing, promoting timely and adequate supports, monitoring the mental 
health of our professional landscape and welcoming others to join the 
conversation. This paper examines what mental health supports are recommended by 
the MRTs who were interviewed, and the information gathered from the CAMRT 
Mental Health of Medical Radiation Technologists in Canada 2021 Survey.

La pandémie de COVID-19 a eu une incidence exceptionnelle sur la profession de 
la santé, et en particulier, sur la santé mentale et le bien-être des 
travailleurs de la santé. L'Association canadienne des technologues en radiation 
médicale (ACTRM) a cherché des moyens d'accorder la priorité à la santé mentale 
de ses membres tout en intensifiant ses efforts de défense. La réalisation d'un 
sondage national sur la santé mentale et d'entrevues avec des technologues en 
radiation médicale (TRM) a permis de mettre en lumière les défis qui existent, 
tout en indiquant quels éléments du système de soutien sont les plus nécessaires 
pour améliorer le bien-être. L'objectif de cette recherche est de partager 
l'expérience vécue des TRM canadiens en ce qui concerne leur santé mentale 
pendant la pandémie. Elle ajoute aux connaissances acquises dans le cadre du 
sondage en explorant les comptes rendus approfondis de ce que les TRM ont 
ressenti et vécu pendant la pandémie de COVID-19. La compréhension de cette 
période difficile peut aider à développer des ressources et un soutien 
supplémentaires pour les TRM sur le lieu de travail. Le message général dans le 
domaine des soins de santé devrait être le suivant : optimisez votre bien-être 
et vos patients seront également pris en charge. Les recommandations visant à 
favoriser ce message comprennent l'habilitation des TRM à défendre leur santé 
mentale et leur bien-être, la promotion de soutiens opportuns et adéquats, la 
surveillance de la santé mentale de notre paysage professionnel et l'invitation 
des autres à se joindre à la conversation. Le présent document examine les 
soutiens en matière de santé mentale recommandés par les TRM interrogés et 
l'information recueillie dans le cadre du Sondage sur la santé mentale des 
technologues en radiation médicale au Canada mené par l'ACTRM en 2021.

Copyright © 2022. Published by Elsevier Inc.

DOI: 10.1016/j.jmir.2022.11.008
PMCID: PMC9676169
PMID: 36456456 [Indexed for MEDLINE]


1247. J Acoust Soc Am. 2022 Nov;152(5):2570. doi: 10.1121/10.0014948.

A perception-based study of the indoor and outdoor acoustic environments in 
India during the COVID-19 pandemic.

Mimani A(1), Nama S(1).

Author information:
(1)Department of Mechanical Engineering, Indian Institute of Technology Kanpur, 
Kanpur 208 016, Uttar Pradesh, India.

This work presents the results of a perception-based study of changes in the 
local soundscape at residences across India during the last 2 years of the 
COVID-19 pandemic and their effects on well-being, productivity during work from 
home (WFH), online education, anxiety, and noise sensitivity. Using emails and 
social media platforms, an online cross-sectional survey was conducted involving 
942 participants. The responses showed that a greater percentage of participants 
felt that the indoor environment was noisier during the 2020 lockdown, which was 
attributed to increased home-entertainment usage, video-calling, and family 
interaction. The outdoor soundscape was much quieter during the 2020 lockdown 
due to drastically reduced traffic and commercial activities; however, during 
the 2021 lockdown, it was perceived to be comparable with pre-COVID times. While 
changes in indoor soundscape were shown to affect peace, happiness, and 
concentration while increasing annoyance, the reduction in outdoor noise 
positively impacted these aspects. The responses indicate that indoor soundscape 
changes adversely affected productivity and online education. Consequently, only 
15% of participants now prefer the WFH model, while 62% have reservations about 
online education. In some cases, the responses demonstrate a significant 
influence of demography and suggest the improvement of the acoustic design of 
residences to support work.

DOI: 10.1121/10.0014948
PMID: 36456252 [Indexed for MEDLINE]


1248. Am J Audiol. 2023 Mar;32(1):81-89. doi: 10.1044/2022_AJA-22-00055. Epub 2022 Dec 
1.

The Challenges Encountered by Conventional Hearing Aid and/or Cochlear Implant 
Users During the COVID-19 Pandemic.

Kabiş B(1), Yıldırım Gökay N(1), Tutar H(2), Karamert R(2), Gündüz B(1).

Author information:
(1)Department of Audiology, Faculty of Health Science, Gazi University, Ankara, 
Turkey.
(2)Department of Otorhinolaryngology/Head and Neck Surgery, Faculty of Medicine, 
Gazi University, Ankara, Turkey.

PURPOSE: The purpose of this study was to evaluate the stress, quality of life, 
and access to hearing health services experienced by adults and children who use 
hearing aid and/or cochlear implant and their families during the COVID-19 
pandemic.
METHOD: Perceived Stress Scale, Personal Wellbeing Index, and World Health 
Organization Quality of Life questionnaires were applied online to 30 adults 
with hearing loss and parents of 61 children with hearing loss. Also, a survey 
was conducted to acquire more about the demographics of people who use cochlear 
implants and conventional hearing aids, as well as the difficulties they 
encountered during the COVID-19 period.
RESULTS: Although child user families experienced more problems than adults 
during the COVID-19 period, the stress levels of child user families were higher 
than that of adult user families (p = .05). Even though there was no 
statistically significant difference, the families of pediatric users had lower 
quality of life than adult users.
CONCLUSIONS: The stress/anxiety problems that arise as a result of this are 
coming to the forefront of both patients and their relatives. The findings 
indicate that creative strategies should be developed to give individuals with 
hearing loss efficient access to hearing health services.

DOI: 10.1044/2022_AJA-22-00055
PMID: 36455137 [Indexed for MEDLINE]


1249. Med Probl Perform Art. 2022 Dec;37(4):259-268. doi: 10.21091/mppa.2022.4030.

Facilitating Access to Healthcare for Performing Artists Using Subsidized Health 
Services in Canada: An Interpretive Descriptive Study.

Li SA(1), Donn G.

Author information:
(1)Artists' Health Centre, University Health Network, 440 Bathurst Street, 3rd 
floor, Toronto, ON M6T 2S6, Canada. shellyanne.li@uhn.ca.

BACKGROUND: Performing artists are often confronted with job insecurity and 
insufficient health coverage. As a result, artists may not have access to 
non-publicly funded health services that are essential to their well-being. A 
health centre in Canada that specializes in providing healthcare to artists 
offers eligible artists subsidized health services, with the aim to treat acute 
health issues that impact an artists' ability to engage in their artistic 
practice.
PURPOSE: We evaluated the use of the subsidized health services and explored the 
subsidy recipients' and the selection committee's perspectives on the impact of 
these services on the health of performing artists.
METHODS: We applied an interpretive descriptive approach to our qualitative 
inquiry. We conducted individual, semi-structured interviews with recipients of 
the subsidy and a focus group with the selection committee that selected 
recipients of the subsidy. Data were analyzed using thematic analysis.
RESULTS: A total of 14 artists and all members of the selection committee (n=3) 
participated. Recipients and selection committee perceived that subsidized 
health services were critical in enabling consistent and timely diagnosis and 
treatment. Several themes emerged from the data: 1) need for universal health 
benefits to restore equity and offset healthcare insecurity, 2) the critical 
role of subsidies in accessing health services, 3) risks of abruptly ending 
health services when subsidy runs out, 4) barriers in applying for and accessing 
subsidies, 5) mental health challenges, and 6) importance of the subsidy in the 
context of the COVID-19 pandemic. All recipients saw noticeable improvement in 
health outcomes that they believed would have been otherwise unattainable if 
they did not have timely access to care.
CONCLUSIONS: Subsidized health services play an important role in ensuring that 
performing artists have access to care for injuries and health conditions that 
are related to their profession. Future research can examine the long-term 
impact of subsidized services on the recipients' health and employment outcomes.

DOI: 10.21091/mppa.2022.4030
PMID: 36455110 [Indexed for MEDLINE]


1250. PLoS One. 2022 Dec 1;17(12):e0278459. doi: 10.1371/journal.pone.0278459. 
eCollection 2022.

Providing Housing First services for an underserved population during the early 
wave of the COVID-19 pandemic: A qualitative study.

Mejia-Lancheros C(1)(2), Lachaud J(1), Gogosis E(1), Thulien N(1)(3), 
Stergiopoulos V(4)(5), Da Silva G(1), Nisenbaum R(1)(3)(6), O'Campo P(1)(3), 
Hwang S(1)(3)(7).

Author information:
(1)MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. 
Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.
(2)Research Group in Nursing Care and Practice, Family Health Nursing and Health 
Measures; Nursing Faculty, Universidad Nacional de Colombia, Bogotá, Colombia.
(3)Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, 
Canada.
(4)Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
(5)Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
(6)Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's 
Hospital, Unity Health Toronto, Toronto, Ontario, Canada.
(7)Division of General Internal Medicine, Department of Medicine, University of 
Toronto, Toronto, Ontario, Canada.

OBJECTIVE: We assessed the critical role of Housing First (HF) programs and 
frontline workers in responding to challenges faced during the first wave of the 
COVID-19 pandemic.
METHOD: Semi-structured interviews were conducted with nine HF frontline workers 
from three HF programs between May 2020 and July 2020, in Toronto, Canada. 
Information was collected on challenges and adjustments needed to provide 
services to HF clients (people experiencing homelessness and mental disorders). 
We applied the Analytical Framework method and thematic analysis to our data.
RESULTS: Inability to provide in-person support and socializing activities, 
barriers to appropriate mental health assessments, and limited virtual 
communication due to clients' lack of access to digital devices were among the 
most salient challenges that HF frontline workers reported during the COVID-19 
pandemic. Implementing virtual support services, provision of urgent in-office 
or in-field support, distributing food aid, connecting clients with online 
healthcare services, increasing harm reduction education and referral, and 
meeting urgent housing needs were some of the strategies implemented by HF 
frontline workers to support the complex needs of their clients during the 
pandemic. HF frontline workers experienced workload burden, job insecurity and 
mental health problems (e.g. distress, worry, anxiety) as a consequence of their 
services during the first wave of the COVID-19 pandemic.
CONCLUSION: Despite the several work-, programming- and structural-related 
challenges experienced by HF frontline workers when responding to the needs of 
their clients during the first wave of the COVID-19 pandemic, they played a 
critical role in meeting the communication, food, housing and health needs of 
their clients during the pandemic, even when it negatively affected their 
well-being. A more coordinated, integrated, innovative, sustainable, effective 
and well-funded support response is required to meet the intersecting and 
complex social, housing, health and financial needs of underserved and 
socio-economically excluded groups during and beyond health emergencies.

Copyright: © 2022 Mejia-Lancheros et al. This is an open access article 
distributed under the terms of the Creative Commons Attribution License, which 
permits unrestricted use, distribution, and reproduction in any medium, provided 
the original author and source are credited.

DOI: 10.1371/journal.pone.0278459
PMCID: PMC9714853
PMID: 36454981 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


1251. JAMA Netw Open. 2022 Dec 1;5(12):e2244486. doi: 
10.1001/jamanetworkopen.2022.44486.

Association of Initial SARS-CoV-2 Test Positivity With Patient-Reported 
Well-being 3 Months After a Symptomatic Illness.

Wisk LE(1)(2), Gottlieb MA(3), Spatz ES(4)(5), Yu H(4)(5), Wang RC(6), Slovis 
BH(7), Saydah S(8), Plumb ID(8), O'Laughlin KN(9)(10), Montoy JCC(6), McDonald 
SA(11)(12), Lin Z(4)(5), Lin JS(13), Koo K(14), Idris AH(11)(15), Huebinger 
RM(16), Hill MJ(16), Gentile NL(17)(18), Chang AM(7), Anderson J(19), Hota 
B(20), Venkatesh AK(5)(21), Weinstein RA(22)(23), Elmore JG(1)(2), Nichol 
G(9)(19); INSPIRE Group.

Collaborators: Santangelo M, Ulrich A, Li SX, Kinsman J, Krumholz H, Dorney J, 
Stephens KA, Black K, Morse D, Morse S, Fernandes A, Sharma A, Stober T, Geyer 
RE, Lyon V, Adams K, Willis M, Ruiz L, Park J, Malone K, Shughart H, Schaeffer 
KW, Shughart LA, Arab AI, Grau DT, Patel A, Watts PB, Kelly M, Hunt A, 
Hannikainen P, Chalfin M, Cheng D, Miao J, Shutty C, Chavez S, Kane A, Marella 
P, Gallegos GD, Martin KR, L'Hommedieu M, Chandler CW, Diaz Roldan K, Villegas 
N, Moreno R, Eguchi M, Rodriguez R, Kemball R, Chan V, Chavez CL, Wong A, Hall 
AJ, Briggs-Hagen M.

Author information:
(1)Division of General Internal Medicine and Health Services Research, David 
Geffen School of Medicine at the University of California, Los Angeles, Los 
Angeles.
(2)Department of Health Policy and Management, Fielding School of Public Health 
at the University of California, Los Angeles, Los Angeles.
(3)Department of Emergency Medicine, Rush University Medical Center, Chicago, 
Illinois.
(4)Section of Cardiovascular Medicine, Department of Internal Medicine, Yale 
School of Medicine, New Haven, Connecticut.
(5)Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New 
Haven, Connecticut.
(6)Department of Emergency Medicine, University of California, San Francisco, 
San Francisco.
(7)Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, 
Pennsylvania.
(8)National Center for Immunization and Respiratory Diseases, Centers for 
Disease Control and Prevention, Atlanta, Georgia.
(9)Department of Emergency Medicine, University of Washington, Seattle.
(10)Department of Global Health, University of Washington, Seattle.
(11)Department of Emergency Medicine, University of Texas Southwestern Medical 
Center, Dallas.
(12)Clinical Informatics Center, University of Texas Southwestern Medical 
Center, Dallas.
(13)National Center for Emerging and Zoonotic Infectious Diseases, Centers for 
Disease Control and Prevention, Atlanta, Georgia.
(14)Department of Internal Medicine, Rush University Medical Center, Chicago, 
Illinois.
(15)Department of Internal Medicine, University of Texas Southwestern Medical 
Center, Dallas.
(16)Department of Emergency Medicine, McGovern Medical School, UTHealth Houston, 
Houston, Texas.
(17)Department of Family Medicine, University of Washington, Seattle.
(18)Department of Laboratory Medicine and Pathology, University of Washington, 
Seattle.
(19)Department of Medicine, Harborview Center for Prehospital Emergency Care, 
University of Washington, Seattle.
(20)Tendo Systems, Chicago, Illinois.
(21)Department of Emergency Medicine, Yale School of Medicine, New Haven, 
Connecticut.
(22)Department of Medicine, Rush University Medical Center, Chicago, Illinois.
(23)Division of Infectious Diseases, Cook County Health, Chicago, Illinois.

IMPORTANCE: Long-term sequelae after symptomatic SARS-CoV-2 infection may impact 
well-being, yet existing data primarily focus on discrete symptoms and/or health 
care use.
OBJECTIVE: To compare patient-reported outcomes of physical, mental, and social 
well-being among adults with symptomatic illness who received a positive vs 
negative test result for SARS-CoV-2 infection.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study was a planned interim 
analysis of an ongoing multicenter prospective longitudinal registry study (the 
Innovative Support for Patients With SARS-CoV-2 Infections Registry [INSPIRE]). 
Participants were enrolled from December 11, 2020, to September 10, 2021, and 
comprised adults (aged ≥18 years) with acute symptoms suggestive of SARS-CoV-2 
infection at the time of receipt of a SARS-CoV-2 test approved by the US Food 
and Drug Administration. The analysis included the first 1000 participants who 
completed baseline and 3-month follow-up surveys consisting of questions from 
the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29; 
7 subscales, including physical function, anxiety, depression, fatigue, social 
participation, sleep disturbance, and pain interference) and the PROMIS Short 
Form-Cognitive Function 8a scale, for which population-normed T scores were 
reported.
EXPOSURES: SARS-CoV-2 status (positive or negative test result) at enrollment.
MAIN OUTCOMES AND MEASURES: Mean PROMIS scores for participants with positive 
COVID-19 tests vs negative COVID-19 tests were compared descriptively and using 
multivariable regression analysis.
RESULTS: Among 1000 participants, 722 (72.2%) received a positive COVID-19 
result and 278 (27.8%) received a negative result; 406 of 998 participants 
(40.7%) were aged 18 to 34 years, 644 of 972 (66.3%) were female, 833 of 984 
(84.7%) were non-Hispanic, and 685 of 974 (70.3%) were White. A total of 282 of 
712 participants (39.6%) in the COVID-19-positive group and 147 of 275 
participants (53.5%) in the COVID-19-negative group reported persistently poor 
physical, mental, or social well-being at 3-month follow-up. After adjustment, 
improvements in well-being were statistically and clinically greater for 
participants in the COVID-19-positive group vs the COVID-19-negative group only 
for social participation (β = 3.32; 95% CI, 1.84-4.80; P < .001); changes in 
other well-being domains were not clinically different between groups. 
Improvements in well-being in the COVID-19-positive group were concentrated 
among participants aged 18 to 34 years (eg, social participation: β = 3.90; 95% 
CI, 1.75-6.05; P < .001) and those who presented for COVID-19 testing in an 
ambulatory setting (eg, social participation: β = 4.16; 95% CI, 2.12-6.20; 
P < .001).
CONCLUSIONS AND RELEVANCE: In this study, participants in both the 
COVID-19-positive and COVID-19-negative groups reported persistently poor 
physical, mental, or social well-being at 3-month follow-up. Although some 
individuals had clinically meaningful improvements over time, many reported 
moderate to severe impairments in well-being 3 months later. These results 
highlight the importance of including a control group of participants with 
negative COVID-19 results for comparison when examining the sequelae of 
COVID-19.

DOI: 10.1001/jamanetworkopen.2022.44486
PMCID: PMC9716377
PMID: 36454572 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest Disclosures: Dr Gottlieb 
reported receiving funding from the Rush Center for Emerging Infectious Diseases 
Research Grant, the Society of Academic Emergency Medicine Foundation Research 
Grant, the Emergency Medicine Foundation/Council of Residency Directors in 
Emergency Medicine Education Research Grant, the Emergency Medicine: Reviews and 
Perspectives Medical Education Research Grant, and the University of Ottawa 
Department of Medicine Education Grant. Dr Spatz reported receiving personal 
fees from Regeneron Pharmaceuticals outside the submitted work. Dr Idris 
reported receiving grants from the University of Texas Southwestern Medical 
Center during the conduct of the study and being a member of the Stryker Belfast 
Clinical Advisory Board outside the submitted work. Dr Huebinger reported 
receiving grants from UTHealth Houston during the conduct of the study. Dr 
Gentile reported being the primary care and family medicine medical director of 
the Post-COVID Rehabilitation and Recovery Clinic at the University of 
Washington outside the submitted work. Dr Chang reported receiving grants from 
Abbott Laboratories and Siemens and being a current employee of CSL Behring 
outside the submitted work. Dr Venkatesh reported receiving grants from the 
Agency for Healthcare Research and Quality and the SAEM Foundation outside the 
submitted work. Dr Elmore reported serving as an editor in chief of adult 
primary care topics for UpToDate outside the submitted work. Dr Nichol reported 
receiving salary support from the Medic One Foundation; receiving research 
contracts from Abiomed, Vapotherm, and ZOLL Medical Corporation; serving as a 
consultant for Cellphire Therapeutics, CPR Therapeutics, Heartbeam, Invero 
Health, Orixha, and ZOLL Circulation; owning a patent for a method of measuring 
blood flow during cardiopulmonary resuscitation (licensed to the University of 
Washington); and having a patent pending for a combination drug device to modify 
reperfusion injury (licensed to the University of Washington) outside the 
submitted work. No other disclosures were reported.


1252. Neuroimage Clin. 2022;36:103253. doi: 10.1016/j.nicl.2022.103253. Epub 2022 Nov 
7.

Hospitalisation for COVID-19 predicts long lasting cerebrovascular impairment: A 
prospective observational cohort study.

Tsvetanov KA(1), Spindler LRB(2), Stamatakis EA(2), Newcombe VFJ(3), Lupson 
VC(3), Chatfield DA(4), Manktelow AE(4), Outtrim JG(4), Elmer A(5), Kingston 
N(6), Bradley JR(7), Bullmore ET(8), Rowe JB(9), Menon DK(10); Cambridge 
NeuroCOVID Group; NIHR COVID-19 BioResource; Cambridge NIHR Clinical Research 
Facility; CITIID-NIHR BioResource COVID-19 Collaboration.

Author information:
(1)Department of Clinical Neurosciences, University of Cambridge, Cambridge, 
United Kingdom; Department of Psychology, University of Cambridge, Cambridge, 
United Kingdom. Electronic address: kat35@cam.ac.uk.
(2)Department of Clinical Neurosciences, University of Cambridge, Cambridge, 
United Kingdom; Division of Anaesthesia, Department of Medicine, University 
Cambridge, Cambridge, United Kingdom.
(3)Division of Anaesthesia, Department of Medicine, University Cambridge, 
Cambridge, United Kingdom; Wolfson Brain Imaging Centre, University of 
Cambridge, Cambridge, United Kingdom.
(4)Division of Anaesthesia, Department of Medicine, University Cambridge, 
Cambridge, United Kingdom.
(5)Cambridge Clinical Research Centre, NIHR Clinical Research Facility, 
Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, 
Cambridge, United Kingdom.
(6)NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge 
Biomedical Campus, Cambridge, United Kingdom; Department of Haematology, School 
of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, 
Cambridge, United Kingdom.
(7)NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge 
Biomedical Campus, Cambridge, United Kingdom; Department of Medicine, University 
of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom.
(8)Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, United 
Kingdom; Department of Psychiatry, University of Cambridge, Cambridge Biomedical 
Campus, Cambridge, United Kingdom.
(9)Department of Clinical Neurosciences, University of Cambridge, Cambridge, 
United Kingdom; Medical Research Council Cognition and Brain Sciences Unit, 
Department of Psychiatry, Cambridge, United Kingdom.
(10)Division of Anaesthesia, Department of Medicine, University Cambridge, 
Cambridge, United Kingdom; Wolfson Brain Imaging Centre, University of 
Cambridge, Cambridge, United Kingdom; Cambridge Clinical Research Centre, NIHR 
Clinical Research Facility, Cambridge University Hospitals NHS Foundation Trust, 
Addenbrooke's Hospital, Cambridge, United Kingdom; Department of Medicine, 
University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom.

Human coronavirus disease 2019 (COVID-19) due to severe acute respiratory 
syndrome coronavirus-2 (SARS-CoV-2) has multiple neurological consequences, but 
its long-term effect on brain health is still uncertain. The cerebrovascular 
consequences of COVID-19 may also affect brain health. We studied the chronic 
effect of COVID-19 on cerebrovascular health, in relation to acute severity, 
adverse clinical outcomes and in contrast to control group data. Here we assess 
cerebrovascular health in 45 patients six months after hospitalisation for acute 
COVID-19 using the resting state fluctuation amplitudes (RSFA) from functional 
magnetic resonance imaging, in relation to disease severity and in contrast with 
42 controls. Acute COVID-19 severity was indexed by COVID-19 WHO Progression 
Scale, inflammatory and coagulatory biomarkers. Chronic widespread changes in 
frontoparietal RSFA were related to the severity of the acute COVID-19 episode. 
This relationship was not explained by chronic cardiorespiratory dysfunction, 
age, or sex. The level of cerebrovascular dysfunction was associated with 
cognitive, mental, and physical health at follow-up. The principal findings were 
consistent across univariate and multivariate approaches. The results indicate 
chronic cerebrovascular impairment following severe acute COVID-19, with the 
potential for long-term consequences on cognitive function and mental wellbeing.

Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.nicl.2022.103253
PMCID: PMC9639388
PMID: 36451358 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


1253. J Sch Health. 2023 Apr;93(4):266-278. doi: 10.1111/josh.13264. Epub 2022 Nov 30.

Implementation of COVID-19 Preventive Measures and Staff Well-Being in a Sample 
of English Schools 2020-2021.

Sundaram N(1), Abramsky T(2), Oswald WE(3), Cook S(4), Halliday KE(3), 
Nguipdop-Djomo P(5), Sturgess J(6), Ireland G(7), Ladhani SN(8), Mangtani P(5), 
Langan SM(9), Hargreaves JR(1), Bonell C(1); COVID-19 Schools Infection Survey 
Study Group.

Author information:
(1)Department of Public Health, Environments and Society, London School of 
Hygiene & Tropical Medicine, WC1H 9SH, London, UK.
(2)Department of Global Health and Development, London School of Hygiene & 
Tropical Medicine, WC1H 9SH, London, UK.
(3)Department of Disease Control, London School of Hygiene & Tropical Medicine, 
WC1E 7HT, London, UK.
(4)Department of Non-communicable Disease Epidemiology, London School of Hygiene 
& Tropical Medicine, London WC1E 7HT; National Heart and Lung Institute, 
Imperial College London, London, UK.
(5)Department of Infectious Disease Epidemiology, London School of Hygiene & 
Tropical Medicine, WC1E 7HT, London, UK.
(6)Department of Medical Statistics, London School of Hygiene & Tropical 
Medicine, WC1E 7HT, London, UK.
(7)Public Health Programmes, UK Health Security Agency, London, UK.
(8)Public Health Programmes, UK Health Security Agency; Paediatric Infectious 
Diseases Research Group, St George's University of London, London, UK.
(9)Department of Non-communicable Disease Epidemiology, London School of Hygiene 
& Tropical Medicine, WC1E 7HT, London, UK.

BACKGROUND: We examined fidelity and feasibility of implementation of COVID-19 
preventive measures in schools, and explored associations between adherence to 
these measures and staff well-being, to inform policy on sustainable 
implementation and staff wellbeing.
METHODS: Surveys were conducted across 128 schools in England with 107 
headteachers and 2698 staff-members with reference to autumn term 2020, 
examining school-level implementation of preventive measures, adherence, and 
teacher burnout (response rates for headteacher and staff surveys were 84% and 
59%, respectively).
RESULTS: The median number of measures implemented in primary and secondary 
schools was 33 (range 23-41), and 32 (range 22-40), respectively; most measures 
presented challenges. No differences were found regarding number of measures 
implemented by school-level socio-economic disadvantage. High adherence was 
reported for staff wearing face-coverings, staff regularly washing their hands, 
(secondary only) desks facing forwards, and (primary only) increased cleaning of 
surfaces and student hand-washing. Adherence to most measures was reported as 
higher in primary than secondary schools. Over half of school leaders and 42% 
(517/1234) of other teaching staff suffered from high emotional exhaustion. 
Higher teacher-reported school-wide adherence with measures was consistently 
associated with lower burnout for leaders and other teaching staff.
CONCLUSIONS: Findings indicate a tremendous effort in implementing preventive 
measures and an urgent need to support investments in improving teacher 
wellbeing.

© 2022 The Authors. Journal of School Health published by Wiley Periodicals LLC 
on behalf of American School Health Association.

DOI: 10.1111/josh.13264
PMCID: PMC9877738
PMID: 36450450 [Indexed for MEDLINE]

Conflict of interest statement: All authors have no conflicts of interest to 
disclose.


1254. Arch Dis Child. 2023 Mar;108(3):198-203. doi: 10.1136/archdischild-2022-324905. 
Epub 2022 Nov 30.

Experiences and support needs of parents/caregivers of children with cancer 
through the COVID-19 pandemic in the UK: a longitudinal study.

Collaço N(1), Gamble A(2), Morgan JE(3)(4), Phillips B(3)(4), Culliford D(5), 
Darlington AS(6).

Author information:
(1)School of Health Sciences, University of Southampton, Southampton, UK 
N.B.Collaco@soton.ac.uk.
(2)Children's Cancer and Leukaemia Group, Leicester, UK.
(3)Centre for Reviews and Dissemination, University of York, York, UK.
(4)Leeds Children's Hospital, Leeds, UK.
(5)NIHR Applied Research Collaboration Wessex, University of Southampton, 
Southampton, UK.
(6)School of Health Sciences, University of Southampton, Southampton, UK.

Comment in
    Evid Based Nurs. 2023 Oct;26(4):145.

OBJECTIVE: To explore the experiences, information and support needs of 
parents/caregivers of children with cancer and how these changed as the COVID-19 
pandemic evolved.
DESIGN: Online surveys containing closed and free-text questions on experiences, 
information and support needs were completed at four time points (between April 
2020 and October 2021) during the COVID-19 pandemic. Descriptive statistics of 
closed items and content analysis of qualitative data were conducted.
SETTING: Online.
PARTICIPANTS: Parents/caregivers of children with cancer.
RESULTS: 335 parents/caregivers completed the survey over four time points. 
Findings revealed that parents'/caregivers' worry about the virus and vigilance 
about their child's virus symptoms decreased over time. Parents reporting the 
need for support on how to reduce their worries and/or family members during the 
virus outbreak were low, however parents reported a slight increase in need for 
support at T3 when schools reopened. Qualitative findings reported the following 
themes: (1) Psychological well-being of parents/caregivers, (2) Changing 
perceptions of risks/priorities, (3) Adjusting to COVID-19: Living with 
continued caution, (4) Healthcare and treatment provision, (5) Information 
seeking and needs during COVID-19.
CONCLUSIONS: The COVID-19 pandemic disrupted people's lives and routines in 
relation to access to support, finances, education and social lives, leading to 
psychological distress. Parents highlighted the need for timely, up-to-date and 
personalised information in relation to COVID-19 and their child with cancer. 
Further consideration of the development of technology-based health solutions 
may provide an efficient and safe way to connect with and support 
parent/caregivers.

© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and 
permissions. Published by BMJ.

DOI: 10.1136/archdischild-2022-324905
PMID: 36450442 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


1255. J Prim Care Community Health. 2022 Jan-Dec;13:21501319221138425. doi: 
10.1177/21501319221138425.

Effect of an Online Mindfulness Course for Hospital Doctors During COVID-19 
Pandemic on Resilience and Coping.

Hanson P(1)(2), Villarreal M(2), Khan M(2), Dale J(2), Sankar S(1)(2).

Author information:
(1)University Hospitals of Coventry and Warwickshire, Coventry, UK.
(2)University of Warwick, Coventry, UK.

INTRODUCTION: Physicians' wellbeing is a priority to prevent increasing rates of 
poor mental health and burnout, exacerbated by caregiving during the COVID-19 
pandemic. Structured mindfulness courses have been shown to be beneficial, but 
face-to-face delivery is not always feasible in the context of busy health 
services. Remotely delivered structured mindfulness courses could enable wider 
participation, particularly at time when social distancing to prevent infection 
transmission is necessary. Our objective was to test the feasibility of a 
remotely delivered structured mindfulness course for hospital doctors during the 
COVID-19 pandemic.
METHODS: This was a feasibility study run at one English hospital between 
January and March 2021, when COVID-19 admissions were at a high. Interested 
doctors participated in a 6-session remotely delivered mindfulness course. 
Sessions lasted 90 min and could be attended on-line or the recording watched at 
later time. Main outcome measures were data on interest, course attendance and 
engagement, together with validated psychological outcome measures at baseline 
and follow-up after course completion.
RESULTS: 20 doctors expressed interest to participate and 16 started the course. 
Of these, 12 completed at least 3 sessions (median = 4); difficulty attending 
resulted from conflicting clinical commitments and rosters. Twelve participants 
completed the follow-up survey. They rated the course highly and all perceived 
it to have been useful, with statistically significant (P < .01) improvements in 
wellbeing and mindfulness scores. They all stated that they would recommend this 
course to their colleagues and most (10/12) were interested in follow-up 
mindfulness sessions.
CONCLUSION: Remotely delivered structured mindfulness training for hospital 
doctors was feasible, but there is a need to address the difficulties that 
affected attendance in order to optimize accessibility and completion of such 
programs.

DOI: 10.1177/21501319221138425
PMCID: PMC9716630
PMID: 36448091 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1256. BMC Public Health. 2022 Nov 30;22(1):2227. doi: 10.1186/s12889-022-14698-1.

The impact of changing nonimmigrant visa policies on international students' 
psychological adjustment and well-being in the United States during the COVID-19 
pandemic: a qualitative study.

Park C(1), Shimada S(2).

Author information:
(1)Department of Public Health and Recreation, San José State University, 1 
Washington Sq, San Jose, CA, 95192, USA. charles.park@sjsu.edu.
(2)Department of Public Health and Recreation, San José State University, 1 
Washington Sq, San Jose, CA, 95192, USA.

BACKGROUND: Since the Immigration and Nationality Act of 1952, the number of 
international students in the United States had been gradually increasing. 
However, the total numbers have begun to decrease since 2019-2020 school year 
due to the Trump administration's policy and COVID-19. Still, little is known 
about how international students' psychological adjustment and well-being have 
been affected by changing nonimmigrant visa policy and the COVID-19 pandemic.  
METHODS: We conducted a total of 34 online semi-structured in-depth interviews 
with international students from 18 countries of origin studying in the San 
Francisco Bay Area, California. More than 60% of the participants (21 out of 34) 
were aged 21 to 25. Among our 34 participants, gender and 18 were male and 16 
were female, and 19 were undergraduate students and 15 were master's students. 
The majority of the participants were first-generation college students (22/34, 
64.71%). Verbatim transcription was done for all interviews. NVivo was used for 
both deductive and inductive approaches to the qualitative analysis.
RESULTS: Overall, the recent political climate negatively impacted participants' 
psychology of adjustment and well-being. July 6, 2020 Policy Directive for 
international students caused severe uncertainty about whether they can continue 
studying in the United States. There were many resources or services needed to 
overcome this period, such as extended mental and emotional support from the 
counseling services as well as financial and informational support from the 
international student office and university. Although international students had 
the benefit of the university's food assistance program, they were not eligible 
to receive any external support outside of the university and financial aid at 
the local and federal levels. Whether maintaining F-1 visa status was one of 
their major concerns. Due to COVID-19, job opportunities were limited, which 
made international students difficult to obtain Curricular Practical Training 
(CPT) and secure a job in the United States within the 90-day unemployment limit 
of Optical Practical Training (OPT). H-1B visa and permanent residency were 
other challenges to go through, but participants saw positive perspectives from 
the Biden administration.
CONCLUSIONS: Uncertain policy changes due to COVID-19 and presidential 
transitions impacted international students' psychological well-being and 
adjustment. International students are important populations in the United 
States who have supported jobs that are high in demand and economically 
contributed to the United States. It is expected that future policies at various 
levels support international students' life and improve their health equity and 
mental health.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-14698-1
PMCID: PMC9708122
PMID: 36447205 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1257. J Contin Educ Nurs. 2022 Dec;53(12):533-543. doi: 10.3928/00220124-20221107-05. 
Epub 2022 Dec 1.

Resilience, Stress, Anxiety, and Depression: Exploring the Mental Health of New 
Graduate Nurses Transitioning to Practice During COVID-19.

Urban RW, Rogers MR, Eades TL, Allard PM, Porter MT, Cipher DJ.

Background Transitioning to practice during the COVID-19 pandemic multiplied the 
stressors and challenges typically encountered by new graduate nurses (NGNs), 
yet research exploring mental health variables of this subset of nurses remains 
sparse. Method This study used an observational design and convenience sampling. 
NGN alumni (n = 192) from a pre-licensure nursing program were surveyed during 
the summer of 2021 regarding their experiences with resilience, anxiety, 
depression, and stress while transitioning to practice during the COVID-19 
pandemic. Results Participants reported moderate to severe levels of stress 
(76%), anxiety (27.6%), and depression (31.2%) while transitioning to practice. 
Most (79%) described themselves as resilient. The highest mean scores for 
stress, anxiety, and depression occurred during the fourth to eighth month of 
practice. Conclusion Nursing professional development specialists, managers, and 
other stakeholders need effective strategies to monitor and promote NGNs' 
well-being and mental health to prevent burnout and turnover throughout the 
first year of practice. [J Contin Educ Nurs. 2022;53(12):533-543.].

DOI: 10.3928/00220124-20221107-05
PMID: 36445275 [Indexed for MEDLINE]


1258. J Consult Clin Psychol. 2022 Dec;90(12):942-949. doi: 10.1037/ccp0000776. Epub 
2022 Nov 28.

Long-term effects of a prenatal mindfulness intervention on depressive symptoms 
in a diverse sample of women.

Roubinov DS(1), Epel ES(1), Coccia M(1), Coleman-Phox K(2), Vieten C(3), Adler 
NE(1), Laraia B(4), Bush NR(1).

Author information:
(1)Department of Psychiatry and Behavioral Sciences, Center for Health and 
Community.
(2)Department of Obstetrics, Gynecology, and Reproductive Sciences.
(3)Arthur C. Clarke Center for Human Imagination, Division of Physical Sciences.
(4)School of Public Health.

OBJECTIVE: Depression is a public health crisis, and scalable, affordable 
interventions are needed. Although many psychosocial interventions are 
effective, there is little research investigating their sustained, long-term 
influence on well-being. The purpose of this study was to examine whether a 
prenatal mindfulness intervention with demonstrated benefit for women's 
depressive symptoms during the early postpartum period would exert effects 
through 8 years.
METHOD: The sample of 162 lower income women was racially and ethnically 
diverse. Women were assigned to receive an 8-week mindfulness-based intervention 
during pregnancy (MIND) or treatment as usual (TAU). Repeated assessments of 
depressive symptoms were collected using the Patient Health Questionnaire-9 at 
baseline, postintervention, and following childbirth (1, 2, 3-4, 5, 6, and 8 
years from baseline). The most recent assessment of depressive symptoms was 
collected during the COVID-19 pandemic.
RESULTS: MIND and TAU women were equivalent on sociodemographic factors and 
depressive symptoms at baseline. Depressive symptoms at all follow-up 
assessments through 8 years were significantly lower among women in MIND 
compared to TAU. The odds of moderate or higher depressive symptoms were greater 
among TAU compared to MIND women at all time points except the 6-year 
assessment. By Year 8, 12% of women in MIND reported moderate or more severe 
depressive symptoms compared to 25% of women in TAU.
CONCLUSIONS: Results suggest the effects of a group-based psychosocial 
intervention during pregnancy may endure for years, well beyond the initial 
perinatal period. Investing in prevention and intervention efforts for mental 
health during pregnancy may have sustained benefits for the well-being of women. 
(PsycInfo Database Record (c) 2023 APA, all rights reserved).

DOI: 10.1037/ccp0000776
PMCID: PMC9892277
PMID: 36441994 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest Disclosures: None


1259. J Racial Ethn Health Disparities. 2023 Dec;10(6):2802-2815. doi: 
10.1007/s40615-022-01457-6. Epub 2022 Nov 28.

Revisiting the Black-White Mental Health Paradox During the Coronavirus 
Pandemic.

LaMotte ME(1), Elliott M(2), Mouzon DM(3).

Author information:
(1)Interdisciplinary Social Psychology Program, University of Nevada, Reno, 1664 
N Virginia St, Reno, NV, 89557, USA. mlamotte@nevada.unr.edu.
(2)Department of Sociology, University of Nevada, Reno, Reno, NV, USA.
(3)Department of Sociology, Rutgers, The State University of New Jersey, New 
Brunswick, NJ, USA.

Black Americans have lower rates of depression and anxiety than Whites, despite 
greater exposure to stressors known to negatively impact mental health, 
characterized as the Black-White mental health paradox. This study revisited the 
paradox during the coronavirus pandemic. Drawing on stress process theory, 
minority stress theory, and the rejection-identification model of 
discrimination, in-group identity, and well-being, we analyzed original survey 
data from a quota sample of African American and White adults (N = 594). The 
survey included a range of stressors and coping resources, including those 
relevant to the pandemic (e.g., COVID-19 illness) and race (e.g., witnessing 
anti-Black police violence). Results indicate that despite African Americans' 
greater exposure and vulnerability to racial discrimination, the Black-White 
mental health paradox holds, owing in part to protective effects of African 
American's higher self-esteem. Directions for future exploration of the paradox 
are presented based on this study's findings.

© 2022. W. Montague Cobb-NMA Health Institute.

DOI: 10.1007/s40615-022-01457-6
PMCID: PMC9707209
PMID: 36441494 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1260. PeerJ. 2022 Nov 22;10:e14382. doi: 10.7717/peerj.14382. eCollection 2022.

"Double whammy": a rapid review of rural vs urban psychosocial cancer 
experiences and telehealth service in five countries during the COVID-19 
pandemic.

Barnes M(1), Rice K(1), Murray C(1), Thorsteinsson E(1).

Author information:
(1)School of Psychology, University of New England, Armidale, New South Wales, 
Australia.

BACKGROUND: Cancer is a long-term condition with biopsychosocial components. 
People with cancer living in rural areas can have poorer treatment outcomes and 
higher rates of unmet psychosocial needs than those in urban areas. Cancer, as 
opposed to other chronic conditions, poses a unique challenge in this current 
COVID-19 pandemic context, given immunocompromised states of patients and 
long-term survivor treatment effects. The disaggregated impact of psychosocial 
issues potentiated by the pandemic on rural vs. urban cancer populations is yet 
to be quantified. This rapid review investigates whether (i) people with cancer 
are experiencing pandemic-related psychosocial impacts, (ii) these impacts are 
equivalent in urban and rural locations, and (iii) whether the rapid uptake of 
telehealth mitigates or reinforces any identified impacts.
METHOD: A rapid review was conducted for literature published between December 
2019 and 13 August 2021.
RESULTS: Fifteen papers were included, incorporating evidence from five 
countries. The available literature suggests people affected by cancer living in 
rural areas are evidencing disproportionate psychosocial impacts of COVID-19, 
compounding cancer experiences. Despite its widespread and necessary use during 
the pandemic, telehealth was identified as an additional challenge for rural 
people with cancer.
CONCLUSIONS: Clinicians working with rural people affected by cancer should 
ensure recognition of the greater risks of psychosocial concerns in their rural 
patients, and reduced access to health services. Whilst telehealth and other 
remote technologies are useful and necessary in this pandemic era, clinicians 
should consider whether its use benefits their rural clients or reinforces 
existing disparities.

© 2022 Barnes et al.

DOI: 10.7717/peerj.14382
PMCID: PMC9695491
PMID: 36438575 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1261. Front Public Health. 2022 Nov 9;10:982389. doi: 10.3389/fpubh.2022.982389. 
eCollection 2022.

A narrative-based approach to understand the impact of COVID-19 on the mental 
health of stranded immigrants in four border cities in Mexico.

Cruz Piñeiro R(1), Ibarra CS(2).

Author information:
(1)Population Studies Department, El Colegio de la Frontera Norte, Tijuana, 
Mexico.
(2)El Colegio de la Frontera Norte, Tijuana, Mexico.

OBJECTIVE: This paper describes the impact that the different COVID-19 related 
restrictions have had on the mental health and wellbeing of 57 Central American 
and Caribbean immigrants stranded in Mexico due to the pandemic.
METHODS: Ethnographic data was obtained through the application of in-depth 
interviews centered on topics such as migration history, personal experience 
with COVID-19 and beliefs about the pandemic. This information was further 
analyzed through a narrative approach and Atlas Ti.
MAIN FINDINGS: US Title 42 and the Migrant Protection Protocols (MPP) have 
stranded thousands of individuals in the US-Mexico border region, a situation 
that has overcrowded the available shelters in the area and forced many of the 
immigrants to live on the streets and in improvised encampments. Thus, exposing 
them to a higher risk of contagion. Furthermore, the majority of the interviewed 
Central American and Caribbean immigrants consider that Mexico is more lenient 
when it comes to the enforcement of sanitary measures, especially when compared 
to their countries of origin. Finally, vaccination hesitancy was low among the 
interviewees, mainly due to the operative aspects of the vaccination effort in 
Mexico and the fear of ruining their chances to attain asylum in the US. These 
findings are backed up by the discovery of five recurring narratives among the 
interviewees regarding: (1) The pandemic's psychological impact. (2) The 
uncertainty of being stranded in Mexico and the long wait. (3) Their fear of 
violence over the fear of contagion. (4) The perceived leniency of Mexico with 
the pandemic when compared to their countries of origin, and (5) their beliefs 
about the pandemic and vaccines.
KEY FINDING: The mental health of stranded Central American and Caribbean 
immigrants in Mexico during the COVID-19 pandemic is mostly affected by their 
inability to make it across the US-Mexico border using legal means.

Copyright © 2022 Cruz Piñeiro and Ibarra.

DOI: 10.3389/fpubh.2022.982389
PMCID: PMC9682118
PMID: 36438232 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1262. Front Public Health. 2022 Nov 10;10:992466. doi: 10.3389/fpubh.2022.992466. 
eCollection 2022.

The relationship between nurses' risk assessment and management, fear 
perception, and mental wellbeing during the COVID-19 pandemic in Saudi Arabia.

Al-Dossary RN(1), AlMahmoud S(1), Banakhar MA(2), Alamri M(3), Albaqawi H(4), Al 
Hosis K(5), Aljohani MS(6), Alrasheadi B(7), Falatah R(8), Almadani N(9), 
Aljohani K(10), Alharbi J(11), Almazan JU(12).

Author information:
(1)Nursing Education Department, Nursing College, Imam Abdulrahman Bin Faisal 
University, Dammam, Saudi Arabia.
(2)Public Health Nursing Department, Faculty of Nursing, King Abdul-Aziz 
University, Jeddah, Saudi Arabia.
(3)Nursing Department, College of Applied Medical Sciences, University of Hafr 
Al Batin, Hafar Al Batin, Saudi Arabia.
(4)College of Nursing, University of Hail, Hail, Saudi Arabia.
(5)Department of Nursing Education, Nursing College, Qassim University, 
Buraydah, Saudi Arabia.
(6)Medical and Surgical Department, Nursing College, Taibah University, Medina, 
Saudi Arabia.
(7)Nursing Department, College of Applied Medical Sciences, Majmaah University, 
Al Majma'ah, Saudi Arabia.
(8)Nursing Administration and Education Department, College of Nursing, King 
Saud University, Riyadh, Saudi Arabia.
(9)Community Health Nursing Department, College of Nursing, Princess Nourah Bint 
Abdulrahman University, Riyadh, Saudi Arabia.
(10)Community Health Nursing Department, Nursing College, Taibah University, 
Medina, Saudi Arabia.
(11)Nursing Department, College of Applied Medical Sciences, University of Hafr 
Albatin, Hafar Al Batin, Saudi Arabia.
(12)Medicine Department, Nazarbayev University School of Medicine, Nazarbayev 
University, Astana, Kazakhstan.

During this pandemic, it is crucial to implement early interventions to help 
nurses manage their mental wellbeing by providing them with information 
regarding coping skills, preventive risk assessment approaches (such as hospital 
preparedness and rapid risk assessment), and the ability to respond. This study 
evaluated the effect of fear and risk assessment management on nurses' mental 
wellbeing during the COVID-19 pandemic in Saudi Arabia. A total of 507 nurses 
who worked in tertiary public hospitals were asked to take a descriptive design 
survey. Three survey scales were used to assess the survey: the Risk Assessment 
Scale, the Fear of COVID-19 Scale, and the Warwick-Edinburgh Mental Wellbeing 
Scale. Independent t-tests and a one-way ANOVA were used to examine the 
association between fear of COVID-19 and nurses' demographic characteristics on 
their mental wellbeing. A multiple regression analysis was performed to examine 
the predictors associated with mental wellbeing. Findings revealed that almost 
half of the participants showed moderate positive mental wellbeing, 49.7%, while 
only 14% had low levels of fear on the Warwick-Edinburgh Mental Well being 
Scale. Most of the respondents had low levels of fear on the Fear of COVID-19 
Scale, 45%, while only 15% had high levels of fear on the scale. Then, some 
demographic variables, such as "age," "nationality," "total years of experience 
in the current hospital," and "region you work at" had statistically significant 
differences with p < 0.5. Meanwhile, risk assessment is also associated with 
mental wellbeing scores. All items on the Fear of COVID-19 Scale showed no 
significant difference with a P > 0.05. In conclusion, most nurses providing 
direct patient care to a patient with COVID-19 emphasized the importance of 
wearing PPE and performing hand hygiene before and after any clean or aseptic 
procedure. Meanwhile, although almost all nurses were vaccinated, they were 
still afraid of a COVID-19 infection. Additionally, the results reported that 
the older the nurses are, the better their mental wellbeing scores. Non-Saudi 
nurses had higher perceived mental wellbeing scores than Saudi nurses, and 
different working environments corresponded to different mental wellbeing 
scores. Finally, nurses' risk assessment was associated with mental wellbeing 
scores.

Copyright © 2022 Al-Dossary, AlMahmoud, Banakhar, Alamri, Albaqawi, Al Hosis, 
Aljohani, Alrasheadi, Falatah, Almadani, Aljohani, Alharbi and Almazan.

DOI: 10.3389/fpubh.2022.992466
PMCID: PMC9685659
PMID: 36438216 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1263. Int J Mol Sci. 2022 Nov 11;23(22):13932. doi: 10.3390/ijms232213932.

Maternal Distress during Pregnancy and the Postpartum Period: Underlying 
Mechanisms and Child's Developmental Outcomes-A Narrative Review.

Jeličić L(1)(2), Veselinović A(1)(2), Ćirović M(1)(2), Jakovljević V(3)(4), 
Raičević S(5)(6), Subotić M(1).

Author information:
(1)Cognitive Neuroscience Department, Research and Development Institute "Life 
Activities Advancement Institute", 11000 Belgrade, Serbia.
(2)Department of Speech, Language and Hearing Sciences, Institute for 
Experimental Phonetics and Speech Pathology, 11000 Belgrade, Serbia.
(3)Department of Physiology, Faculty of Medical Sciences, University of 
Kragujevac, 34000 Kragujevac, Serbia.
(4)Department of Human Pathology, I.M. Sechenov First Moscow State Medical 
University, 119991 Moscow, Russia.
(5)Department of Gynecology and Obstetrics, Faculty of Medicine, University of 
Montenegro, 81000 Podgorica, Montenegro.
(6)Clinic of Gynecology and Obstetrics, Clinical Center of Montenegro, 81000 
Podgorica, Montenegro.

Maternal mental health may be considered a determining factor influencing fetal 
and child development. An essential factor with potentially negative 
consequences for a child's psychophysiological development is the presence of 
maternal distress during pregnancy and the postpartum period. The review is 
organized and presented to explore and describe the effects of anxiety, stress, 
and depression in pregnancy and the postpartum period on adverse child 
developmental outcomes. The neurobiology of maternal distress and the 
transmission mechanisms at the molecular level to the fetus and child are noted. 
In addition, the paper discusses the findings of longitudinal studies in which 
early child development is monitored concerning the presence of maternal 
distress in pregnancy and the postpartum period. This topic gained importance in 
the COVID-19 pandemic context, during which a higher frequency of maternal 
psychological disorders was observed. The need for further interdisciplinary 
research on the relationship between maternal mental health and fetal/child 
development was highlighted, especially on the biological mechanisms underlying 
the transmission of maternal distress to the (unborn) child, to achieve positive 
developmental outcomes and improve maternal and child well-being.

DOI: 10.3390/ijms232213932
PMCID: PMC9692872
PMID: 36430406 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1264. Int J Environ Res Public Health. 2022 Nov 21;19(22):15381. doi: 
10.3390/ijerph192215381.

Expanding the Focus of Occupational Safety and Health: Lessons from a Series of 
Linked Scientific Meetings.

Schulte PA(1), Delclos GL(2), Felknor SA(3), Streit JMK(4), McDaniel M(2), 
Chosewood LC(3), Newman LS(5), Bhojani FA(6), Pana-Cryan R(7), Swanson NG(4).

Author information:
(1)Advanced Technologies and Laboratories International, Inc., Gaithersburg, MD 
20878, USA.
(2)Southwest Center for Occupational and Environmental Health, The University of 
Texas Health Science Center at Houston School of Public Health, Houston, TX 
77030, USA.
(3)National Institute for Occupational Safety and Health, Atlanta, GA 30333, 
USA.
(4)National Institute for Occupational Safety and Health, Cincinnati, OH 45226, 
USA.
(5)Center for Health, Work & Environment and Department of Environmental and 
Occupational Health, Colorado School of Public Health, CU Anschutz, University 
of Colorado, Aurora, CO 80045, USA.
(6)Shell USA, Inc., Houston, TX 77079, USA.
(7)National Institute for Occupational Safety and Health, Washington, DC 20024, 
USA.

There is widespread recognition that the world of work is changing, and 
agreement is growing that the occupational safety and health (OSH) field must 
change to contribute to the protection of workers now and in the future. 
Discourse on the evolution of OSH has been active for many decades, but 
formalized support of an expanded focus for OSH has greatly increased over the 
past 20 years. Development of approaches such as the National Institute for 
Occupational Safety and Health (NIOSH)'s Total Worker Health® concept and the 
World Health Organization (WHO)'s Healthy Workplace Framework are concrete 
examples of how OSH can incorporate a new focus with a wider view. In 2019, 
NIOSH initiated a multi-year effort to explore an expanded focus for OSH. This 
paper is a report on the outputs of a three-year cooperative agreement between 
NIOSH and The University of Texas School of Public Health, which led to subject 
matter expert workshops in 2020 and an international conference of global 
interest groups in 2021. This article traces the background of these meetings 
and identifies and assesses the lessons learned. It also reviews ten thematic 
topics that emerged from the meetings: worker health inequalities; training new 
OSH professionals; future OSH research and practice; tools to measure well-being 
of workers; psychosocial hazards and adverse mental health effects; skilling, 
upskilling and improving job quality; socioeconomic influences; climate change; 
COVID-19 pandemic influences; and strategic foresight. Cross-cutting these 
themes is the need for systems and transdisciplinary thinking and 
operationalization of the concept of well-being to prepare the OSH field for the 
work of the future.

DOI: 10.3390/ijerph192215381
PMCID: PMC9690540
PMID: 36430096 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1265. Int J Environ Res Public Health. 2022 Nov 21;19(22):15371. doi: 
10.3390/ijerph192215371.

Well-Being and Mental Health in Teachers: The Life Impact of COVID-19.

Flores J(1)(2), Caqueo-Urízar A(3), Escobar M(4), Irarrázaval M(5).

Author information:
(1)Escuela de Psicología y Filosofía, Universidad de Tarapacá, Arica 1010069, 
Chile.
(2)Centro de Justicia Educacional, CJE, Arica 1010069, Chile.
(3)Instituto de Alta Investigación, Universidad de Tarapacá, Arica 1001236, 
Chile.
(4)Centro de Investigación e Intervención Psicosocial, CEINPSI, Universidad de 
Tarapacá, Arica 1010069, Chile.
(5)Millennium Institute for Research in Depression and Personality, MIDAP, 
Santiago 8380453, Chile.

The impact of the pandemic on teachers' mental health has also been an important 
issue. The aim of the study was to analyze the vital impact of COVID-19, 
spirituality, and the use of social-emotional strategies on teacher well-being, 
mediated by mental health. The sample was non-random, inviting all teachers in a 
city North of Chile to participate in the study. The sample consisted of 624 
teachers. A total of 74.4% were women and 25.6% were men. The mean age was 44.1 
and the standard deviation was 11.9. A total of 56.4% belonged to public schools 
and 43.6% belonged to subsidized schools. Structural equations were used to 
analyze the data, finding a mental health mediating effect between the death of 
a close person, affected areas and family history with life satisfaction. 
Spirituality and the use of socio-emotional strategies self-applied by the 
teachers had no direct relationship with their mental health, so their mediating 
effect in relation to life satisfaction was discarded. Teachers who used 
social-emotional strategies, as well as those who reported higher levels of 
spirituality, obtained greater satisfaction with life, both general and 
specifically. Women had higher levels of depression, anxiety and stress 
symptomatology, but also higher levels of life satisfaction. The implications 
are discussed.

DOI: 10.3390/ijerph192215371
PMCID: PMC9690509
PMID: 36430087 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1266. Int J Environ Res Public Health. 2022 Nov 17;19(22):15149. doi: 
10.3390/ijerph192215149.

Caregiving Responsibilities and Mental Health Outcomes in Young Adult Carers 
during the COVID-19 Pandemic: A Longitudinal Study.

Landi G(1)(2), Pakenham KI(3), Cattivelli R(1)(2), Grandi S(1)(2), Tossani 
E(1)(2).

Author information:
(1)Department of Psychology "Renzo Canestrari", University of Bologna, 40127 
Bologna, Italy.
(2)Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, 
University of Bologna, 47521 Cesena, Italy.
(3)School of Psychology, The University of Queensland, Brisbane, QLD 4072, 
Australia.

This study investigated caregiving responsibilities and associated mental health 
outcomes in young adult carers during the COVID-19 pandemic and had three aims: 
(1) to investigate differences in caregiving responsibilities across two groups 
of young adult carers (parental illness context vs. ill non-parent family member 
context) relative to non-carers, (2) to identify COVID-19/lockdown correlates of 
caregiving responsibilities, and (3) to examine the longitudinal associations 
between caregiving responsibilities and mental health outcomes. Of the 1048 
Italians aged 18-29 (Mage = 24.48, SDage = 2.80; 74.33% female) who consented to 
complete online surveys at Time 1, 813 reported no ill family member 
(non-carers). Young adult carers included 162 with an ill parent and 73 with an 
ill non-parent family member. The study included 3 time points: 740 participants 
completed Time 2 assessment (Mage = 24.35, SDage = 2.81; 76.76% female), while 
279 completed Time 3 assessment (Mage = 24.78, SDage = 2.72; 79.93% female). Key 
variables measured were 13 COVID-19/lockdown factors at Times 1 and 2, 
caregiving responsibilities at Time 2, and mental health outcomes at Time 3 
(fear of COVID-19, anxiety, depression, wellbeing). Two COVID-19/lockdown 
factors were significantly correlated with higher caregiving responsibilities: 
insufficient home space, and greater time spent working and learning from home. 
As predicted, young adult carers reported higher caregiving responsibilities 
than non-carers, and this effect was greater in young adults caring for an ill 
parent compared to young adults caring for an ill non-parent family member. As 
expected, irrespective of family health status, caregiving responsibilities were 
longitudinally related to poorer mental health outcomes, operationalised as 
higher fear of COVID-19, anxiety, and depression, and lower wellbeing. Elevated 
young adult caregiving is an emerging significant public health issue that 
should be addressed through a multipronged approach that includes education 
about young adult carer needs for personnel across all relevant sectors and 
flexible care plans for ill family members that include a 'whole family' 
biopsychosocial approach.

DOI: 10.3390/ijerph192215149
PMCID: PMC9690746
PMID: 36429866 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1267. Int J Environ Res Public Health. 2022 Nov 16;19(22):15117. doi: 
10.3390/ijerph192215117.

The Impacts of the COVID-19 Pandemic on Hong Kong Nursing Students' Mental 
Health and Quality of Life.

Hung MSY(1), Ng WWM(2), Choi EKY(3).

Author information:
(1)School of Health Sciences, Caritas Institute of Higher Education, Hong Kong, 
China.
(2)Division of Science, Engineering and Health Studies, College of Professional 
and Continuing Education, The Hong Kong Polytechnic University, Hong Kong, 
China.
(3)Chinese Language Education and Assessment Centre, Lingnan University, Hong 
Kong, China.

Evidence shows that university students, especially healthcare students, 
experienced considerable health impacts during COVID-19. This study examined 
Hong Kong general nursing students' mental health and quality of life during the 
COVID-19 pandemic. An online questionnaire composed of personal demographics, 
the Fear of COVID-19 scale (FCV-19S), the Depression Anxiety Stress Scale short 
version (DASS21), and the World Health Organization Quality of Life-BREF 
(WHOQOL-BREF) was used for data collection in early 2021. Among 380 respondents, 
170 (45%) did not attend clinical practicum during the pandemic. Students who 
did not participate in clinical training scored lower in FCV-19S but higher in 
WHOQOL-BREF than those who participated (p = 0.001 or p < 0.001). FCV-19S and 
WHOQOL-BREF were negatively correlated (r = -0.623 to -0.446, p < 0.001). Slight 
negative correlations were found between the FCV-19S and DASS-21 scores. 
Although there were no significant differences in DASS21 (p = 0.294-0.931) 
between these two student groups, there was a considerably high prevalence rate 
of depression (57.1%), anxiety (47.6%), and stress (39.5%). Hong Kong nursing 
students, especially those who attended clinical practicum during the pandemic, 
experienced substantial emotional and quality of life implications. Local 
universities are recommended to organize appropriate interventions to prepare 
and support nursing students' wellbeing and health in coping with future 
disasters.

DOI: 10.3390/ijerph192215117
PMCID: PMC9690710
PMID: 36429837 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1268. Int J Environ Res Public Health. 2022 Nov 15;19(22):15001. doi: 
10.3390/ijerph192215001.

Family Health among Families with Primary School Children during the COVID 
Pandemic in Thailand, 2022.

Pudpong N(1), Julchoo S(2), Sinam P(2), Uansri S(2), Kunpeuk W(2), Suphanchaimat 
R(2)(3).

Author information:
(1)Sirindron College of Public Health, Chonburi 20000, Thailand.
(2)International Health Policy Program, Ministry of Public Health, Nonthaburi 
11000, Thailand.
(3)Department of Disease Control, Division of Epidemiology, Nonthaburi 11000, 
Thailand.

Despite evidence suggesting that the COVID pandemic has negatively affected the 
mental health and well-being of school aged children and parents, there are 
limited studies describing the state of family well-being. This study aimed to 
use the family health lens to assess the well-being of Thai families with 
primary school children and to identify its associated factors. A 
cross-sectional survey was conducted during January and March 2022, a period of 
school closure when onsite education was replaced by online education from time 
to time. The family health scale (FHS) questionnaire survey was carried out 
among 701 parents of Thai families with primary school children. The 
questionnaire comprised 10 questions regarding family belief, health, 
relationships, financial security, and housing environment. Independent 
variables included: (1) parental/household factors; (2) online learning related 
issues; (3) children's mental health; and (4) parents' health behaviors. 
Multinomial logistic regression was undertaken. Results showed that half of Thai 
families (54.6%) reported having moderate health status. Factors that were 
associated with lower levels of family health, such as poor or moderate levels, 
included families with a child that had mental health problems (adjusted odd 
ratio (AOR) = 5.0 [95% CI = 2.6-9.5] for poor v. excellent, and AOR = 2.7 [95% 
CI = 1.9-4.0] for moderate v. excellent), single parents (AOR = 2.5 [95% CI = 
1.2-5.2] for poor v. excellent), a higher number (≥3) of children (AOR = 2.1 
[95% CI = 1.0-4.0] for moderate v. excellent), and smoking parents (AOR = 6.5 
[95% CI =1.2-34.8] for poor v. excellent). During health emergencies, health 
policy for providing adequate assistance to single parents, especially those 
that have a child with mental health problems, is of utmost importance. The 
design of health promotion activities and interventions should be targeted not 
only at single families, but also families with higher numbers of children and 
parents who smoke at home.

DOI: 10.3390/ijerph192215001
PMCID: PMC9690226
PMID: 36429719 [Indexed for MEDLINE]

Conflict of interest statement: The authors report no conflict of interest in 
this work.


1269. Int J Environ Res Public Health. 2022 Nov 13;19(22):14937. doi: 
10.3390/ijerph192214937.

What Is Next for Public Health after COVID-19 in Italy? Adopting a Youth-Centred 
Care Approach in Mental Health Services.

Ussai S(1), Castelpietra G(2)(3), Mariani I(4), Casale A(5), Missoni E(5)(6), 
Pistis M(7), Monasta L(8), Armocida B(9).

Author information:
(1)Clinical Pharmacology and Toxicology, University of Cagliari, 09124 Cagliari, 
Italy.
(2)Central Health Directorate, Inpatient and Outpatient Care Service, Friuli 
Venezia Giulia Region, 34121 Trieste, Italy.
(3)Department of Medicine, Surgery and Health Science, University of Trieste, 
34127 Trieste, Italy.
(4)WHO Collaborating Centre, Institute for Maternal and Child Health-IRCCS 
"Burlo Garofolo", 34137 Trieste, Italy.
(5)Saluteglobale.it Associazione di Promozione Sociale, 25121 Brescia, Italy.
(6)CERGAS-Centre for Research on Health and Social Care Management, Bocconi 
University, 20100 Milano, Italy.
(7)Department of Biomedical Sciences, Section of Neuroscience and Clinical 
Pharmacology, University of Cagliari, 09124 Cagliari, Italy.
(8)Clinical Epidemiology and Public Health Research Unit, Institute for Maternal 
and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy.
(9)Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, 
Istituto Superiore di Sanità, 00161 Rome, Italy.

Although endeavours to protect mental well-being during the COVID-19 pandemic 
were taken at national and regional levels, e.g., mental support in school, a 
COVID-19 emergency toll-free number for psychological support, these were 
sporadic conjunctural financing interventions. In this Communication, the 
authors conducted a systematic search for programmatic and policy documents and 
reports with a solid literature and policy analysis concerning the main 
objective, which is to analyse the appropriateness in implementing gender- and 
age-sensitive, integrated, youth-centred mental health services in Italy. The 
Italian National Action Plan for Mental Health reports a highly fragmented 
situation in the Child and Adolescent Neuropsychiatry services, in terms of an 
integrated and comprehensive regional network of services for the diagnosis, 
treatment, and rehabilitation of neuropsychological disorders in young people. 
Wide-ranging interventions, systemic actions should be implemented, funded, and 
included in an overall structural strengthening of the healthcare system, 
including those dedicated to transition support services. In this context, the 
National Recovery and Resilience Plan (NRRP), may represent an opportunity to 
leverage specific funds for mental health in general, and for youth in 
particular. Finally, mental health service governance should be harmonized at 
both national and regional EU levels-with the adoption of best practices 
implemented by other Member States. This includes, among others, health 
information system and data collection, which is critical for analysing 
epidemiological trends and for monitoring and evaluating services, to offer a 
public and integrated system for the care and protection of young people, in 
line with the Convention on the Rights of the Child.

DOI: 10.3390/ijerph192214937
PMCID: PMC9690019
PMID: 36429653 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1270. Int J Environ Res Public Health. 2022 Nov 12;19(22):14905. doi: 
10.3390/ijerph192214905.

The Feasibility and Impact of Practising Online Forest Bathing to Improve 
Anxiety, Rumination, Social Connection and Long-COVID Symptoms: A Pilot Study.

McEwan K(1), Collett H(2), Nairn J(3), Bird J(1), Faghy MA(4)(5), Pfeifer 
E(6)(7), Jackson JE(1), Cook C(8), Bond A(9).

Author information:
(1)College of Health, Psychology and Social Care, University of Derby, Kedleston 
Road, Derby DE22 1GB, UK.
(2)Kindred Soil, Bristol BS6 5BP, UK.
(3)Woodlands Breathing, Edinburgh EH27 8BW, UK.
(4)Biomedical Research Theme, School of Human Sciences, University of Derby, 
Derby DE22 1GB, UK.
(5)Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL 
60612, USA.
(6)Catholic University of Applied Sciences, Karlstr. 63, 79104 Freiburg, 
Germany.
(7)Faculty of Psychotherapy Science, Sigmund Freud University Vienna, 1020 
Vienna, Austria.
(8)Well with Nature, Dronfield, Derbyshire S18 4AX, UK.
(9)Wild Edgewalker Forest Therapy, Jersey JE3 8AF, UK.

BACKGROUND: Long-COVID affects over 144 million people globally. In the absence 
of treatments, there is a need to establish the efficacy of therapies that 
improve patient outcomes. Forest bathing has been demonstrated to improve 
physical and mental outcomes but there is no evidence in Long-COVID patients. 
Accordingly, this pilot study sought to determine the feasibility and 
effectiveness of online forest bathing in adults with Long-COVID.
METHODS: Feasibility was assessed by monitoring retention rates and participant 
feedback. In a waitlist controlled, repeated measures design, 22 Long-COVID 
patients completed weekly online surveys during a four-week waitlist control 
period, before engaging in four weekly online forest bathing sessions, 
completing post-intervention surveys following each session.
RESULTS: In terms of retention, 27% did not provide post-intervention data, 
reasons for non-adherence were: feeling too ill, having medical appointments, or 
having career responsibilities. Compared with the waitlist control period, there 
were statistically significant improvements in Anxiety (49% decrease), 
Rumination (48% decrease), Social Connection (78% increase), and Long-COVID 
symptoms (22% decrease). Written qualitative comments indicated that 
participants experienced feelings of calm and joy, felt more connected socially 
and with nature, and experienced a break from the pain and rumination 
surrounding their illness.
CONCLUSIONS: Online Forest bathing resulted in significant improvements in 
well-being and symptom severity and could be considered an accessible and 
inexpensive adjunct therapy for Long-COVID patients. Where people have limited 
access to in-person nature, virtual nature may offer an alternative to improve 
health and well-being outcomes.

DOI: 10.3390/ijerph192214905
PMCID: PMC9691063
PMID: 36429623 [Indexed for MEDLINE]

Conflict of interest statement: Three of the authors are forest bathing guides 
who delivered the intervention. To reduce the risk of bias, these authors were 
not involved in analysis of the data or the initial drafting of the manuscript.


1271. Int J Environ Res Public Health. 2022 Nov 10;19(22):14784. doi: 
10.3390/ijerph192214784.

Physical Activity during the COVID-19 Pandemic in the UK: A Qualitative Analysis 
of Free-Text Survey Data.

Hailey V(1), Burton A(1), Hamer M(2), Fancourt D(1), Fisher A(1).

Author information:
(1)Department of Behavioural Science and Health, University College London, 
London WC1E 6BT, UK.
(2)Institute Sport Exercise & Health, Division Surgery & Interventional Science, 
University College London, London W1T 7HA, UK.

BACKGROUND: Several quantitative studies have found a decline in physical 
activity in response to COVID-19 pandemic restrictions. The aim of the present 
study was to use large-scale free text survey data to qualitatively gain a more 
in-depth understanding of the impact of the COVID-19 pandemic on physical 
activity, then map barriers and facilitators to the Capability, Opportunity, 
Motivation, and Behaviour (COM-B) Model of Behaviour to aid future intervention 
development.
METHODS: 17,082 participants provided a response to the free text module, and 
data from those who mentioned a physical activity related word in any context 
were included. Data were analysed using thematic analysis and key themes 
identified.
RESULTS: 5396 participants provided 7490 quotes related to physical activity. 
The sample were predominately female (84%), white (British/Irish/Other) (97%) 
and aged <60 years (57%). Seven key themes were identified: the importance of 
outdoor space, changes in daily routine, COVID-19 restrictions prevented 
participation, perceived risks or threats to participation, the importance of 
physical health, the importance of physical activity for mental health and the 
use of technology.
CONCLUSION: Future physical activity interventions could encourage people to 
walk outdoors, which is low cost, flexible, and accessible to many. Developing 
online resources to promote and support physical activity provides a flexible 
way to deliver quality content to a large audience.

DOI: 10.3390/ijerph192214784
PMCID: PMC9690793
PMID: 36429501 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


1272. Int J Environ Res Public Health. 2022 Nov 8;19(22):14661. doi: 
10.3390/ijerph192214661.

Teachers' Well-Being and Associated Factors during the COVID-19 Pandemic: A 
Cross-Sectional Study in Hong Kong, China.

Lau SSS(1)(2)(3)(4), Shum ENY(1), Man JOT(1)(2), Cheung ETH(1)(2), Amoah PA(5), 
Leung AYM(6), Okan O(7), Dadaczynski K(8)(9).

Author information:
(1)Research Centre for Environment and Human Health, School of Continuing 
Education, Hong Kong Baptist University, Hong Kong, China.
(2)Multidisciplinary Research Centre, School of Continuing Education, Hong Kong 
Baptist University, Hong Kong, China.
(3)College of International Education, Hong Kong Baptist University, Hong Kong, 
China.
(4)Institute of Bioresource and Agriculture, Hong Kong Baptist University, Hong 
Kong, China.
(5)School of Graduate Studies, Department of Applied Psychology, Institute of 
Policy Studies, Lingnan University, Hong Kong, China.
(6)School of Nursing, Hong Kong Polytechnic University, Hong Kong, China.
(7)Department of Sport and Health Sciences, Technical University Munich, 80333 
Munich, Germany.
(8)Public Health Centre Fulda, Fulda University of Applied Sciences, 36037 
Fulda, Germany.
(9)Center for Applied Health Science, Leuphana University Lueneburg, 21335 
Lueneburg, Germany.

School teachers have faced many challenges due to the coronavirus disease-2019 
(COVID-19) pandemic and public health-related containment measures. Recent 
studies have demonstrated high levels of stress and mental health issues among 
school teachers. To better understand teacher well-being and inform practices to 
support them in the face of the ongoing pandemic, we aimed to assess perceived 
stress, well-being and associated factors among school teachers in Hong Kong, 
China. For this cross-sectional study, we employed a self-reported questionnaire 
to assess teacher well-being as an indicator of mental health. Drawing on 
quantitative data obtained from 336 teachers in Hong Kong from April 2021 to 
February 2022, we assessed workloads, work-related sense of coherence, perceived 
stress, secondary burnout symptoms (i.e. intensification of work and exhaustion 
related to work situation), self-endangering work behaviours and satisfaction 
with work. Bivariate and multivariate analyses were performed to examine the 
associations between well-being, demographic and work characteristics. A high 
percentage (87.6%) of teachers had high levels of perceived stress, which was 
positively associated with extensification of work (r = 0.571, p < 0.01), 
intensification of work (r = 0.640, p < 0.01) and exhaustion related to work 
situation (r = 0.554, p < 0.01). A multilinear regression model adjusted for age 
and gender was computed to detect predictors of teachers' well-being index 
values (F(12, 296) = 41.405, p < 0.001, R2 = 0.627). A higher WHO-5 score was 
associated with (1) higher teaching hours (B = 0.235, 95% CI = 0.093, 0.413, p = 
0.002); (2) higher work-related sense of coherence (B = 2.490, 95% CI = 0.209, 
4.770, p = 0.032); (3) higher work satisfaction (B = 5.410, 95% CI = 2.979, 
7.841, p < 0.001); (4) lower level of exhaustion related to work situations (B = 
-9.677, 95% CI = -12.279, -7.075, p < 0.001); and (5) lower level of 
psychosomatic complaints (B = -4.167, 95% CI = -6.739, -7.075, p = 0.002). These 
findings highlight the critical need to allocate more attention and resources to 
improve the mental health of school teachers in Hong Kong. The findings can also 
inform the development of psychological and organisational interventions and 
support mechanisms for teachers during the prolonged COVID-19 pandemic and in 
preparation for future stressful scenarios. Safeguarding the well-being and 
mental health of teachers is important for improving the quality of teaching and 
learning environments and the mental health of school students.

DOI: 10.3390/ijerph192214661
PMCID: PMC9691177
PMID: 36429378 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1273. Nurs Crit Care. 2024 Mar;29(2):303-306. doi: 10.1111/nicc.12860. Epub 2022 Nov 
25.

Evaluating a brief online compassion-focused intervention for intensive care 
nurses.

Corrigan JP(1), Browne D(1), Gilsenan J(2), Irons C(3).

Author information:
(1)Department of Clinical Psychology, Occupational Health Service, Belfast 
Health and Social Care Trust, Belfast, Northern Ireland.
(2)Department of Psychology, Queens University Belfast, Belfast, Northern 
Ireland.
(3)Balanced Minds, London, UK.

BACKGROUND: High levels of stress have been found within health care staff, 
particularly in the nursing population, which is somewhat attributed to the 
Covid-19 pandemic. The development of self-compassion, a protective 
psychological construct, may promote well-being in the health care staff 
population. As part of a service development project, the authors delivered and 
evaluated a brief online compassion-focused intervention with nurses working 
within Intensive Care Units (ICUs).
AIMS: Aims were to explore feasibility within the ICU nursing population and 
consider potential benefits to psychological well-being.
METHODS: ICU nurses registered for an online, 4 week, compassion-focused 
intervention as part of a service development project. Measures of compassion, 
burnout, trauma, and the emotional climate of their work environment were 
analysed in two groups; those who completed the intervention and those who did 
not. Baseline and post-intervention measures were analysed to infer the 
potential benefits of the intervention.
RESULTS: Compared with their baseline scores, those who completed the 
intervention showed improvements on measures of compassion, soothing in 
emotional climate, and reductions in burnout, trauma and threat in emotional 
climate. At baseline, those who did not complete the intervention scored lower 
on measures of compassion and soothing within their emotional climate, as well 
as higher levels of trauma and threat within the emotional climate, compared 
with those who engaged with the intervention.
CONCLUSIONS: Brief online compassion-focused interventions may be a useful 
platform to promote well-being in ICU nurses, but possibly only for those who 
have a pre-established level of self-compassion.
RELEVANCE TO CLINICAL PRACTICE: This study demonstrates the value of offering 
online interventions to improve the mental health of nursing staff. The findings 
suggest that nurses may benefit from being offered online interventions as welll 
as traditional psychological interventions. This may shape further service 
provision by offering nurses who require support a wider range of treatment 
options.

© 2022 British Association of Critical Care Nurses.

DOI: 10.1111/nicc.12860
PMID: 36428235 [Indexed for MEDLINE]


1274. J Hum Nutr Diet. 2023 Jun;36(3):1011-1018. doi: 10.1111/jhn.13120. Epub 2022 Dec 
12.

The impact of living through COVID-19 pandemic on mental health, food 
insecurity, loneliness and health behaviours in people with obesity.

Brown A(1)(2)(3), Flint SW(4)(5), Dicken SJ(1), Kalea AZ(6)(7), O'Kane M(8), 
Williams S(9), Wong E(1), Batterham RL(1)(2)(3).

Author information:
(1)Centre for Obesity Research, University College London, London, UK.
(2)Bariatric Centre for Weight Management and Metabolic Surgery, University 
College London Hospital NHS Trust, London, UK.
(3)UCLH Biomedical Research Centre, National Institute of Health Research, 
London, UK.
(4)School of Psychology, University of Leeds, Leeds, UK.
(5)Scaled Insights, Nexus, University of Leeds, Leeds, UK.
(6)Division of Medicine, University College London, London, UK.
(7)Institute of Cardiovascular Science, University College London, London, UK.
(8)Nutrition and Dietetics, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
(9)Institute of Management and Health, University of Wales Trinity Saint David, 
Carmarthen, Wales, UK.

BACKGROUND: The COVID-19 pandemic has negatively impacted people living with 
obesity. The aim was to examine the continued impact of the COVID-19 pandemic on 
the mental health of people living with obesity and associations with food 
insecurity, loneliness and health-related behaviours.
METHODS: The study recruited 1187 UK adults living with obesity who completed an 
online survey, which examined mental health and associations with food 
insecurity, loneliness and health-related behaviours from July 2020 (end of the 
first lockdown in the United Kingdom) to the point they completed the survey in 
2021. Regression analyses were used to examine relationships between outcome 
variables and demographic factors, and hierarchical linear regression models 
were used to assess levels of loneliness, depression and well-being.
RESULTS: Participants reported worse loneliness, depression, well-being and food 
insecurity compared to pre-COVID. However, participants reported attempting to 
lose weight, healthier food shopping, diet and increased physical activity. 
Quality and quantity of sleep deteriorated compared to prior to COVID-19.
CONCLUSIONS: Adults living with obesity in the United Kingdom report a continued 
negative impact of the COVID-19 pandemic upon their mental health together with 
increased loneliness and food insecurity. However, our findings suggest that UK 
adults living with obesity have increased their engagement in positive health 
behaviours and were attempting to lose weight.

© 2022 The Authors. Journal of Human Nutrition and Dietetics published by John 
Wiley & Sons Ltd on behalf of British Dietetic Association.

DOI: 10.1111/jhn.13120
PMID: 36428232 [Indexed for MEDLINE]


1275. AIDS Rev. 2022 Dec 28;24(4):183-196. doi: 10.24875/AIDSRev.22000025.

Is SARS-CoV-2 the only cause of long-COVID?

Pintos-Pascual I(1), Moreno-Torres V(1)(2), Ibánez-Estéllez F(1), 
Corrales-Rodriguez P(1), Treviño A(2), Corpas M(3), Corral O(2), Soriano V(2), 
de Mendoza C(1).

Author information:
(1)Department of Internal Medicine, Hospital Universitario Puerta de Hierro, 
Majadahonda, Spain.
(2)UNIR Health Sciences School, Madrid, Spain.
(3)Cambridge Precision Medicine, Cambridge, UK.

Around 10% of adults infected with SARS-CoV-2 that survive a first episode of 
COVID-19 appear to experience long-term clinical manifestations. The signs and 
symptoms of this post-acute COVID-19 syndrome (PACS) include fatigue, dyspnea, 
joint pain, myalgia, chest pain, cough, anosmia, dysgeusia, headache, 
depression, anxiety, memory loss, concentration difficulties, and insomnia. 
These sequelae remind the constellation of clinical manifestations previously 
recognized as myalgic encephalomyelitis (ME) or chronic fatigue syndrome (CFS). 
This condition has been described following distinct infectious events, mostly 
acute viral illnesses. In this way, the pathophysiology of PACS might overlap 
with mechanisms involved in other post-infectious fatigue syndromes. The risk of 
PACS is more frequent in women than men. Additional host genetic factors could 
be involved. There is a dysregulation of multiple body organs and systems, 
involving the immune system, the coagulation cascade, endocrine organs, 
autonomic nervous system, microbiota-gut-brain axis, 
hypothalamic-pituitary-adrenal axis, hypothalamic-pituitary-thyroid axis, etc. 
Hypothetically, an abnormal response to certain infectious agents could trigger 
the development of postinfectious fatigue syndromes.

DOI: 10.24875/AIDSRev.22000025
PMID: 36427058 [Indexed for MEDLINE]


1276. Front Public Health. 2022 Nov 8;10:1011539. doi: 10.3389/fpubh.2022.1011539. 
eCollection 2022.

Mental health in Austrian psychotherapists during the COVID-19 pandemic.

Schaffler Y(1), Kaltschik S(1), Probst T(1), Jesser A(1), Pieh C(1), Humer E(1).

Author information:
(1)Department for Psychosomatic Medicine and Psychotherapy, University for 
Continuing Education Krems, Krems, Austria.

Although the impact of the COVID-19 pandemic on mental health has been reported 
in different communities, little is known about the mental health of 
psychotherapists during the COVID-19 pandemic. This study aimed to assess mental 
health during the COVID-19 pandemic in Austrian psychotherapists and compare it 
with the general population. A total of n = 513 psychotherapists (80.5% women; 
mean age: 53.06 ± 9.94 years) took part in an online survey conducted from April 
to June 2022. At the same time, a representative sample (N = 1,031) of the 
Austrian general population was surveyed online. Indicators of mental health 
were mental wellbeing (WHO-5), depression (PHQ-2), anxiety (GAD-2), insomnia 
(ISI-2), and stress (PSS-10). The general population sample was matched 
according to age and gender with the psychotherapist's data using propensity 
scores, yielding a final sample of n = 513 (80.5% women; mean age: 52.33 ± 13.39 
years). Psychotherapists showed lower odds for exceeding cut-offs for clinically 
relevant depressive, anxiety, insomnia and stress symptoms (0.34-0.58) compared 
to the general population. Further studies should elucidate the protective 
factors underlying these findings.

Copyright © 2022 Schaffler, Kaltschik, Probst, Jesser, Pieh and Humer.

DOI: 10.3389/fpubh.2022.1011539
PMCID: PMC9679414
PMID: 36424964 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1277. Front Public Health. 2022 Nov 7;10:1020053. doi: 10.3389/fpubh.2022.1020053. 
eCollection 2022.

Experience of nature and times of silence as a resource to cope with the 
COVID-19 pandemic and their effects on psychological wellbeing-Findings from a 
continuous cross-sectional survey in Germany.

Büssing A(1)(2), Recchia DR(3), Baumann K(4).

Author information:
(1)Professorship Quality of Life, Spirituality and Coping, Faculty of Health, 
Witten/Herdecke University, Herdecke, Germany.
(2)IUNCTUS - Competence Center for Christian Spirituality, 
Philosophical-Theological Academy, Münster, Germany.
(3)Department of Research Methods and Statistics in Psychology, Faculty of 
Health, Witten/Herdecke University, Witten, Germany.
(4)Caritas Science and Christian Social Work, Faculty of Theology, 
Albert-Ludwig-University, Freiburg, Germany.

BACKGROUND: The COVID-19 pandemic with its lockdowns affected social relations 
and mental health conditions of people worldwide. We aimed to analyze the 
relevance of nature and times of silence as resources to cope with the pandemic. 
Of interest were how experiences of nature and times of silence are related to 
the perception of wondering awe and gratitude and psychological wellbeing and 
how these have changed during the different phases of the pandemic. Finally, we 
asked whether Nature/Silence would mediate the link between Awe/Gratitude and 
wellbeing.
METHODS: A cross-sectional survey with standardized questionnaires (i.e., PCQ, 
GrAw-7, BMLSS-10, WHO-5) enrolling participants during the different phases of 
the COVID-19 pandemic was conducted. The total sample of 5,155 participants from 
Germany consisted of 65% women and 34% men, with a mean age of 45.0 ± 14.0 
years.
RESULTS: Directly after the first lockdown, Nature/Silence and Awe/Gratitude 
scores were high and decreased along with wellbeing with the onset of the second 
lockdown in winter 2020, while perceived burden constantly increased. 
Nature/Silence was rated lowest by people with reduced wellbeing (eta2 = 0.058) 
and feeling lonely or socially isolated (eta2 = 0.042). Predictor analyses 
revealed that wellbeing as a dependent variable was predicted best by 
corona-related perception of burden, Awe/Gratitude, reflection of life, and 
Nature/Silence and further by perceived changes in terms of relationships and 
spirituality (R2 = 0.55). In mediation analyses, Awe/Gratitude proved to be a 
significant predictor for Nature/Silence (β = 0.55, p< 0.0001) and wellbeing (β 
= 0.05, p < 0.0001). The mediation analysis explained 37% of the variability in 
the data. The direct influence of Awe/Gratitude on wellbeing was estimated as β 
= 0.09 (p < 0.0001), and the mediation effect of Nature/Silence on the link 
between Awe/Gratitude and wellbeing was significant, too (β = 0.03, p < 0.0001), 
explaining 25% of the total effect.
CONCLUSION: Nature/Silence and Awe/Gratitude were used as relevant resources 
during the pandemic, although they cannot fully buffer the negative effects of 
the social restrictions that resulted in decreases in wellbeing and increases in 
perceived burden. Perception of nature as a sensitizer of positive experiences 
particularly during difficult phases of life could be trained to stabilize 
wellbeing and thus to contribute to public health.

Copyright © 2022 Büssing, Recchia and Baumann.

DOI: 10.3389/fpubh.2022.1020053
PMCID: PMC9678082
PMID: 36420008 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1278. Behav Neurol. 2022 Nov 14;2022:1816537. doi: 10.1155/2022/1816537. eCollection 
2022.

Postpandemic Stress Disorder among Health Care Personnel: A Cross-Sectional 
Study (Silesia, Poland).

Grajek M(1), Szlacheta P(2), Sobczyk K(3), Krupa-Kotara K(4), Łabuz-Roszak B(5), 
Korzonek-Szlacheta I(6).

Author information:
(1)Department of Public Health, Faculty of Health Sciences in Bytom, Medical 
University of Silesia in Katowice, 41902 Bytom, Poland.
(2)Department of Toxicology and Health Protection, Faculty of Health Sciences in 
Bytom, Medical University of Silesia in Katowice, 41902 Bytom, Poland.
(3)Department of Prevention of Metabolic Diseases, Faculty of Health Sciences in 
Bytom, Medical University of Silesia in Katowice, 41902 Bytom, Poland.
(4)Department of Health Economics and Health Management, Faculty of Health 
Sciences in Bytom, Medical University of Silesia in Katowice, 41902 Bytom, 
Poland.
(5)Department of Neurology, Institute of Medical Sciences, University of Opole, 
Opole, Poland.
(6)Department of Epidemiology, Faculty of Health Sciences in Bytom, Medical 
University of Silesia in Katowice, 41902 Bytom, Poland.

BACKGROUND: Postpandemic stress disorder (PPSD) is an unofficial term that 
refers to posttraumatic stress disorder (PTSD), a mental disorder resulting from 
increased stress, anxiety, and trauma associated with unpleasant life 
experiences. Many scientific studies indicate that symptoms of increased stress, 
job burnout, anxiety, and depressive disorders are associated with medical 
personnel performing their professional duties around COVID-19 patients.
OBJECTIVE: The purpose of this study was to assess the prevalence of symptoms 
that may indicate the presence of PPSD symptoms-depression, anxiety, and 
stress-in medical personnel. Material and Methods. The survey included 300 
people, representatives of medical personnel. The group was divided into two 
sections. The first section numbered 150 and consisted of personnel in direct 
contact with COVID-19 patients (FR); the second group also consisted of 150 
medical professionals, who but no longer directly involved in helping with 
COVID-19 cases (SR). The survey was conducted by indirect survey method using 
CAWI (computer-assisted web interview). The survey used a questionnaire 
technique. A proprietary tool enriched with standardized psychometric scales: 
BDI, GAD-7, FCV-19S, and PSS-10 was used. Kruskal-Wallis and Mann-Whitney U 
statistical tests were used in the statistical processing of the data. The 
probability level was 0.05.
RESULTS: Statistical inference made it clear that mental health problems that 
may indicate trauma are mainly present in the FR group. These symptoms decreased 
slightly in comparison between periods 2020 and 2021 (p < 0.05).
CONCLUSIONS: The COVID-19 pandemic significantly increased the prevalence of 
depression, anxiety, and stress among first responders. To ensure the 
psychological well-being of first responders, early assessment and care of mild 
depression, anxiety, and stress should be promoted to prevent the development of 
moderate and severe forms.

Copyright © 2022 Mateusz Grajek et al.

DOI: 10.1155/2022/1816537
PMCID: PMC9678449
PMID: 36419590 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflicts 
of interest.


1279. Int J Qual Stud Health Well-being. 2023 Dec;18(1):2149097. doi: 
10.1080/17482631.2022.2149097.

Implications of time and space factors related with youth substance use 
prevention: a conceptual review and case study of the Icelandic Prevention Model 
being implemented in the context of the COVID-19 pandemic.

Halsall T(1)(2), Mahmoud K(3), Iyer SN(4), Orpana H(5), Zeni M(6), Matheson 
K(2).

Author information:
(1)Youth Research Unit, University of Ottawa Institute of Mental Health Research 
at The Royal, Ottawa, Ontario, Canada.
(2)Department of Neuroscience, Carleton University, Ottawa, Ontario, Canada.
(3)Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
(4)Department of Psychiatry, McGill University, Montréal, Québec, Canada.
(5)Centre for Surveillance and Applied Research, Public Health Agency of Canada, 
Ottawa, Ontario, Canada.
(6)Faculty of Education, University of British Columbia, Vancouver, British 
Columbia, Canada.

PURPOSE: This research examines the implementation of the Icelandic Prevention 
Model (IPM) in Canada to identify opportunities revealed by the COVID-19 
pandemic to re-design our social eco-system to promote wellbeing. This paper has 
two objectives: 1) to provide a conceptual review of research that applies the 
bioecological model to youth substance use prevention with a focus on the 
concepts of time and physical space use and 2) to describe a case study that 
examines the implementation of the IPM in Canada within the context of the 
COVID-19 pandemic.
METHOD: Study data were collected through semi-structured qualitative interviews 
with key stakeholders involved in implementing the IPM.
RESULTS: Findings are organized within three over-arching themes derived from a 
thematic analysis: 1) Issues that influence time and space use patterns and 
youth substance use, 2) Family and community cohesion and influences on 
developmental context and time use and 3) Opportunities presented by the 
pandemic that can promote youth wellbeing.
CONCLUSION: We apply the findings to research on the IPM as well as the pandemic 
to examine opportunities that may support primary prevention and overall youth 
wellbeing. We use the concepts of time and space as a foundation to discuss 
implications for policy and practice going forward.

DOI: 10.1080/17482631.2022.2149097
PMCID: PMC9704084
PMID: 36419342 [Indexed for MEDLINE]

Conflict of interest statement: No potential conflict of interest was reported 
by the author(s).


1280. BMC Public Health. 2022 Nov 23;22(1):2151. doi: 10.1186/s12889-022-14572-0.

Do we cope similarly with different adversities? COVID-19 versus armed conflict.

Kimhi S(1)(2), Marciano H(2)(3), Eshel Y(2)(4), Adini B(5)(6).

Author information:
(1)ResWell Research Collaboration, Tel Aviv University, Tel Aviv, Israel.
(2)Stress and Resilience Research Center, Tel-Hai College, Tel-Hai, Israel.
(3)The Institute of Information Processing and Decision Making, University of 
Haifa, Haifa, Israel.
(4)The Psychology Department, University of Haifa, Haifa, Israel.
(5)ResWell Research Collaboration, Tel Aviv University, Tel Aviv, Israel. 
adini@tauex.tau.ac.il.
(6)Department of Emergency and Disaster Management, School of Public Health, 
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 
adini@tauex.tau.ac.il.

BACKGROUND: Varied populations may react differently to similar crises, 
depending on their social, cultural, and personal backgrounds; conversely, the 
same populations may respond differently to varied adversities. The current 
study aimed to examine three types of resilience (individual, community, and 
societal resilience) predicting six coping mechanisms (sense of danger, anxiety 
and depressive symptoms, well-being, hope, and morale) among the same sample of 
people that faced across two different adversities-COVID-19 and an armed 
conflict.
METHODS: Two repeated measurements of the same Israeli sample (N = 593) were 
employed, through an internet panel. The research variables were examined 
through a structured, quantitative questionnaire that consisted of nine scales, 
based on validated and reliable questionnaires.
RESULTS: Results indicated that: (a) respondents reported more difficulties in 
coping with the COVID-19 crisis, compared to the armed conflict, in all 
variables but morale. (b) similar patterns of correlations among the study 
variables were found in both measurements. (c) path's analysis indicated similar 
patterns of prediction of distress and well-being by individual and societal 
resilience. Use of the coping mechanism varied depending on the perception of 
the threat: COVID -19 is perceived as a less familiar and predictable adversity, 
which is harder to cope with, compared with the more familiar risk - an armed 
conflict, which is a recurrent threat in Israel. The correlations between the 
investigated psychological responses and the impacts of resilience on the coping 
and distress mechanism were similar in both adversities.
CONCLUSIONS: The results indicate that respondents tend to react in a similar 
pattern of associations among resilience, distress, and well-being across 
different adversities, such as COVID and armed conflict. However, individuals 
tend to regard unfamiliar, less predictable adversities as more complex to cope 
with, compared to better-known crises. Furthermore, respondents tend to 
underestimate the risks of potential familiar adversities. Healthcare 
professionals must be aware of and understand the coping mechanisms of 
individuals during adversities, to appropriately design policies for the 
provision of medical and psychological care during varied emergencies.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-14572-0
PMCID: PMC9684926
PMID: 36419033 [Indexed for MEDLINE]

Conflict of interest statement: There are no conflicts of interest for any of 
the authors.


1281. BMC Pregnancy Childbirth. 2022 Nov 23;22(1):868. doi: 
10.1186/s12884-022-05208-7.

Learning from a crisis: a qualitative study of the impact on mothers' emotional 
wellbeing of changes to maternity care during the COVID-19 pandemic in England, 
using the National Maternity Survey 2020.

McLeish J(1), Harrison S(2), Quigley M(2), Alderdice F(2).

Author information:
(1)NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National 
Perinatal Epidemiology Unit, Nuffield Department of Population Health, 
University of Oxford, Oxford, UK. jenny.mcleish@npeu.ox.ac.uk.
(2)NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National 
Perinatal Epidemiology Unit, Nuffield Department of Population Health, 
University of Oxford, Oxford, UK.

BACKGROUND: Pregnancy and the postnatal period can be times of psychosocial 
stress and insecurity, but high quality maternity care and social support can 
help mothers cope with stress and feel more secure. The COVID-19 pandemic and 
associated social and economic disruption increased rates of antenatal and 
postnatal stress, anxiety and depression, and also had profound impacts on the 
organisation of maternity services in England.
METHODS: This was a qualitative descriptive study of the impact of 
pandemic-related changes to maternity care on mothers' emotional wellbeing, 
using inductive thematic analysis of open text responses to the National 
Maternity Survey (NMS) 2020 in England. A random sample of 16,050 mothers who 
gave birth 11-24th May 2020 were invited to take part in the survey, and 4,611 
responded, with 4,384 answering at least one open text question.
RESULTS: There were three themes: 'Chaos: impact of uncertainty', 'Abandoned: 
impact of reduction in care', and 'Alone: impact of loss of social support'. 
Mothers valued maternity care and many experienced additional stress from 
chaotic changes and reduction in care during the pandemic; from health 
professionals' own uncertainty and anxiety; and from restrictions on essential 
social support during pregnancy, labour and birth. Others felt that health 
professionals had communicated and cared for them well despite the changes and 
restrictions, and these mothers felt psychologically safe.
CONCLUSIONS: Planning for future crises should include considering how necessary 
adaptations to care can be implemented and communicated to minimise distress; 
ensuring that mothers are not deprived of social support at the time when they 
are at their most vulnerable; and supporting the psychological welfare of staff 
at a time of enormous pressure. There are also lessons for maternity care in 
'normal' times: that care is highly valued, but trust is easily lost; that some 
mothers come into the maternity system with vulnerabilities that can be 
ameliorated or intensified by the attitudes of staff; that every effort should 
be made to welcome a mother's partner or chosen companion into maternity care; 
and that high quality postnatal care can make a real difference to mothers' 
wellbeing.

© 2022. The Author(s).

DOI: 10.1186/s12884-022-05208-7
PMCID: PMC9684911
PMID: 36419009 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare they have no competing 
interests.


1282. BMC Public Health. 2022 Nov 22;22(1):2145. doi: 10.1186/s12889-022-14368-2.

Exploring the impact of shielding advice on the wellbeing of individuals 
identified as clinically extremely vulnerable amid the COVID-19 pandemic: a 
mixed-methods evaluation.

Lasseter G(#)(1), Compston P(#)(2), Robin C(3)(4)(5)(6), Lambert H(3), Hickman 
M(3), Denford S(3)(7), Reynolds R(3), Zhang J(8), Cai S(8), Zhang T(8), Smith 
LE(9)(10), Rubin GJ(9)(10), Yardley L(3)(7)(11), Amlôt R(3)(12), Oliver I(3)(2).

Author information:
(1)NIHR Health Protection Research Unit (HPRU) in Behavioural Science and 
Evaluation, Bristol Medical School, Population Health Sciences, University of 
Bristol, Bristol, BS8 2BN, UK. gemma.lasseter@bristol.ac.uk.
(2)Field Epidemiology Service, UK Health Security Agency, Cambridge, UK.
(3)NIHR Health Protection Research Unit (HPRU) in Behavioural Science and 
Evaluation, Bristol Medical School, Population Health Sciences, University of 
Bristol, Bristol, BS8 2BN, UK.
(4)Field Epidemiology, Field Service, National Infection Service, UK Health 
Security Agency, Liverpool, UK.
(5)NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, 
University of Liverpool, Liverpool, UK.
(6)NIHR Health Protection Research Unit in Gastrointestinal Infections, 
University of Liverpool, Liverpool, UK.
(7)School of Psychological Science, University of Bristol, Bristol, UK.
(8)Population Health Sciences, Bristol Medical School, University of Bristol, 
Bristol, UK.
(9)NIHR Health Protection Research Unit in Emergency Preparedness and Response, 
King's College London, London, UK.
(10)Department of Psychological Medicine, King's College London, London, UK.
(11)Psychology Department, University of Southampton, Southampton, UK.
(12)Behavioural Science and Insights Unit, UK Health Security Agency, Salisbury, 
UK.
(#)Contributed equally

BACKGROUND: The national shielding programme was introduced by UK Government at 
the beginning of the COVID-19 pandemic, with individuals identified as 
clinically extremely vulnerable (CEV) offered advice and support to stay at home 
and avoid all non-essential contact. This study aimed to explore the impact and 
responses of "shielding" on the health and wellbeing of CEV individuals in 
Southwest England during the first COVID-19 lockdown.
METHODS: A two-stage mixed methods study, including a structured survey (7 
August-23 October 2020) and semi-structured telephone interviews (26 August-30 
September 2020) with a sample of individuals who had been identified as CEV and 
advised to "shield" by Bristol, North Somerset & South Gloucestershire (BNSSG) 
Clinical Commissioning Group (CCG).
RESULTS: The survey was completed by 203 people (57% female, 54% > 69 years, 94% 
White British, 64% retired) in Southwest England identified as CEV by BNSSG CCG. 
Thirteen survey respondents participated in follow-up interviews (53% female, 
40% > 69 years, 100% White British, 61% retired). Receipt of 'official' 
communication from NHS England or General Practitioner (GP) was considered by 
participants as the legitimate start of shielding. 80% of survey responders felt 
they received all relevant advice needed to shield, yet interviewees criticised 
the timing of advice and often sought supplementary information. Shielding 
behaviours were nuanced, adapted to suit personal circumstances, and waned over 
time. Few interviewees received community support, although food boxes and 
informal social support were obtained by some. Worrying about COVID-19 was 
common for survey responders (90%). Since shielding had begun, physical and 
mental health reportedly worsened for 35% and 42% of survey responders 
respectively. 21% of survey responders scored ≥ 10 on the PHQ-9 questionnaire 
indicating possible depression and 15% scored ≥ 10 on the GAD-7 questionnaire 
indicating possible anxiety.
CONCLUSIONS: This research highlights the difficulties in providing generic 
messaging that is applicable and appropriate given the diversity of individuals 
identified as CEV and the importance of sharing tailored and timely advice to 
inform shielding decisions. Providing messages that reinforce self-determined 
action and assistance from support services could reduce the negative impact of 
shielding on mental health and feelings of social isolation.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-14368-2
PMCID: PMC9685010
PMID: 36418978 [Indexed for MEDLINE]

Conflict of interest statement: None to declare.


1283. BMJ Open Qual. 2022 Nov;11(4):e002011. doi: 10.1136/bmjoq-2022-002011.

Practical resiliency training for healthcare workers during COVID-19: results 
from a randomised controlled trial testing the Community Resiliency Model for 
well-being support.

Duva IM(1), Higgins MK(2), Baird M(3), Lawson D(4), Murphy JR(2), Grabbe L(2).

Author information:
(1)Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, 
USA ihopkin@emory.edu.
(2)Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, 
USA.
(3)Decatur Hospital, Emory Healthcare, Atlanta, Georgia, USA.
(4)Department of Hematology and Medical Oncology, Emory University School of 
Medicine, Atlanta, Georgia, USA.

OBJECTIVE: To introduce the Community Resiliency Model (CRM) as mental 
well-being support for healthcare workers working through the height of the 
COVID-19 pandemic.
DESIGN: Randomised controlled trial with a no treatment control group.
SETTING: Two large urban health systems in the Southern United States between 
October 2020 and June 2021.
PARTICIPANTS: Eligible participants were currently employed as healthcare 
workers within the participating healthcare systems. 275 employees registered 
and consented electronically in response to email invitations. 253 participants 
completed the baseline survey necessary to be randomised and included in 
analyses.
INTERVENTION: Participants were assigned 1:1 to the control or intervention 
group at the time of registration. Intervention participants were then invited 
to 1-hour virtual CRM class teaching skills to increase somatic awareness in the 
context of self and other care.
MAIN OUTCOME MEASURES: Self-reported data were collected rating somatic 
awareness, well-being, symptoms of stress, work engagement and interprofessional 
teamwork.
RESULTS: Baseline data on the total sample of 275 (53% nurses) revealed higher 
symptoms of stress and lower well-being than the general population. The 
intervention participants who attended a CRM class (56) provided follow-up 
survey data at 1 week (44) and 3 months (36). Significant improvement for the 
intervention group at 3 months was reported for the well-being measures (WHO-5, 
p<0.0087, d=0.66; Warwick-Edinburgh Mental Well-Being Scale, p<0.0004, d=0.66), 
teamwork measure (p≤0.0002, d=0.41) and stress (Secondary Traumatic Stress 
Scale, p=0.0058, d=46).
CONCLUSION: Baseline results indicate mental health is a concern for healthcare 
workers. Post intervention findings suggest that CRM is a practical approach to 
support well-being for healthcare workers during a crisis such as this pandemic. 
The simple tools that comprise the model can serve as a starting point for or 
complement self-care strategies to enhance individual resilience and buffer the 
effects of working in an increasingly stressful work environment.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjoq-2022-002011
PMCID: PMC9684284
PMID: 36418068 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


1284. PLoS One. 2022 Nov 23;17(11):e0277562. doi: 10.1371/journal.pone.0277562. 
eCollection 2022.

Mental health during the COVID-19 pandemic: Impacts of disease, social 
isolation, and financial stressors.

Kraut RE(1), Li H(2), Zhu H(3).

Author information:
(1)Human-Computer Interaction Institute & Tepper School of Business, Carnegie 
Mellon University, Pittsburgh, Pennsylvania, United States of America.
(2)School of Journalism, Fudan University, Shanghai, China.
(3)Human-Computer Interaction Institute, Carnegie Mellon University, Pittsburgh, 
Pennsylvania, United States of America.

BACKGROUND: Although research shows that the Covid-19 pandemic has led to 
declines in mental health, the existing research has not identified the pathways 
through which this decline happens.
AIMS: The current study identifies the distinct pathways through which 
COVID-induced stressors (i.e., social distancing, disease risk, and financial 
stressors) trigger mental distress and examines the causal impact of these 
stressors on mental distress.
METHODS: We combined evidence of objective pandemic-related stressors collected 
at the county level (e.g., lack of social contact, infection rates, and 
unemployment rates) with self-reported survey data from over 11.5 million adult 
respondents in the United States collected daily for eight months. We used 
mediation analysis to examine the extent to which the objective stressors 
influenced mental health by influencing individual respondents' behavior and 
fears.
RESULTS: County-level, day-to-day social distancing predicted significantly 
greater mental distress, both directly and indirectly through its effects on 
individual social contacts, worries about getting ill, and concerns about 
finances. Economic hardships were indirectly linked to increased mental distress 
by elevating people's concerns about their household's finances. Disease threats 
were both directly linked to mental distress and indirectly through its effects 
on individual worries about getting ill. Although one might expect that social 
distancing from people outside the home would have a greater influence on people 
who live alone, sub-analyses based on household composition do not support this 
expectation.
CONCLUSION: This research provides evidence consistent with the thesis that the 
COVID-19 pandemic harmed the mental well-being of adults in the United States 
and identifies specific stressors associated with the pandemic that are 
responsible for increasing mental distress.

Copyright: © 2022 Kraut et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0277562
PMCID: PMC9683625
PMID: 36417414 [Indexed for MEDLINE]

Conflict of interest statement: I have read the journal’s policy and the authors 
of this manuscript have the following competing interests: Robert Kraut is a 
part-time employee of Meta, the company that partnered with Carnegie Mellon 
University to collect the data. Kraut had no role in data collection and as part 
of the data-use agreement was not allowed direct access to the data.


1285. Ir J Med Sci. 2023 Oct;192(5):2033-2040. doi: 10.1007/s11845-022-03220-6. Epub 
2022 Nov 23.

The impact of the COVID-19 pandemic on non-national doctors in Ireland.

Carroll HK(1), Moore S(2), Farooq AR(3), Iqbal S(3), Hadi DK(3), O'Reilly 
S(3)(4).

Author information:
(1)Department of Medical Oncology, Cork University Hospital, Wilton, Cork, 
Ireland. hailey.k.carroll@gmail.com.
(2)Centre for Policy Studies, Cork University Business School, University 
College Cork, Cork, Ireland.
(3)Department of Medical Oncology, Cork University Hospital, Wilton, Cork, 
Ireland.
(4)Cancer Research @UCC, University College Cork, Cork, Ireland.

BACKGROUND: International doctors make up nearly half of the physicians working 
in Ireland and are an integral part of the health service. The COVID-19 pandemic 
declared in March 2020 led to a global healthcare emergency. Resulting national 
lockdowns precluded travel at a time of need for family support.
AIM: We aimed to measure the professional, psychosocial, and financial impact of 
the COVID-19 pandemic on non-EEA doctors working in Ireland.
METHODS: An 88-item online survey of demographics, well-being, and financial 
resilience was circulated nationally between November 2021 and January 2022. The 
results were analysed using RStudio and Microsoft Excel 365.
RESULTS: One hundred thirty-eight responses were received. Sixty-two percent of 
responders reported wishing to stay in Ireland long-term and 44% had applied for 
citizenship. Despite 80% of responders working in their desired speciality, only 
36% were on a specialist training scheme. Forty-seven percent felt their career 
was affected by the COVID-19 pandemic. Seventy-three percent of respondents 
reported missing significant events in their home country. Over 50% reported 
significant mental health issues personally or in their families; however, only 
a minority sought professional help. Financial issues were a source of anxiety 
for 15% of respondents. Financial resilience was poor, 20% of respondents cited 
a 1-month financial reserve, 10% had a personal pension, and 9% had made a will.
CONCLUSIONS: The COVID-19 pandemic has had a multifactorial negative impact on 
non-national doctors working in Ireland. More must be done to offer 
multidimensional support to this cohort who are a crucial part of the 
underserviced Irish healthcare system.

© 2022. The Author(s), under exclusive licence to Royal Academy of Medicine in 
Ireland.

DOI: 10.1007/s11845-022-03220-6
PMCID: PMC9685081
PMID: 36417108 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1286. J Clin Nurs. 2024 Jan;33(1):381-392. doi: 10.1111/jocn.16591. Epub 2022 Nov 22.

'All we've ever known is Covid': A follow-up study with newly qualified nurses 
who worked as student nurses during the pandemic.

Godbold R(1), Whiting L(1), Adams C(1), Chokeepermal-Naidu Y(1)(2).

Author information:
(1)University of Hertfordshire, Hertfordshire, UK.
(2)Faculty of Health, Social Care and Education, Kingston University and St 
George's University of London, Kingston Hill Campus, Kingston Upon Thames, UK.

AIMS AND OBJECTIVES: To explore the experiences of nursing students in England 
who had worked through the first wave and transitioned to qualification in the 
ongoing pandemic.
BACKGROUND: Experiences of health professionals and student nurses during the 
pandemic are now well documented, but the transition of students to 
qualification is less well understood. In Summer 2020, we interviewed 16 student 
nurses who had worked as health care assistants on paid extended placements as 
part of the COVID-19 response in the East of England, finding surprisingly 
positive experiences, including perceived heightened preparedness for 
qualification. A year later, we re-interviewed 12 participants from the original 
study to hear about transitioning to qualification during the ongoing pandemic. 
This study provides novel insights into their experiences.
DESIGN: A qualitative study design was used.
METHODS: Twelve newly qualified nurses who had participated in the original 
study took part in qualitative, online interviews where they shared their 
experiences of working and transitioning to qualification during the ongoing 
pandemic since we spoke to them a year earlier. The data was analysed using 
thematic analysis. COREQ guidelines were used in developing and reporting this 
study.
RESULTS: Three themes were identified. Constant change: in the clinical 
environment and arising out of the transition to newly qualified nurse, mental 
health and well-being and reflecting on the past to learn for the future.
CONCLUSIONS: Participants experienced a unique transition to qualification. The 
perceived heightened preparedness for qualification that participants who had 
worked as students during the first wave of the pandemic had become a reality, 
ameliorating some of the known effects of transition. However, increased 
expectations and added responsibilities in extremely busy, fluctuating clinical 
environments with minimal support add weight to calls for mandatory 
preceptorship programmes. While heightened resilience was evident, provision of 
ongoing mental health and well-being support is strongly recommended.
RELEVANCE TO CLINICAL PRACTICE: We need a partnership approach with nurse 
educators and practice colleagues which ensures preparation for qualified 
practice is appropriate. If we do not effectively prepare students for qualified 
nurse posts, patient care will almost certainly be compromised.

© 2022 The Authors. Journal of Clinical Nursing published by John Wiley & Sons 
Ltd.

DOI: 10.1111/jocn.16591
PMID: 36414397 [Indexed for MEDLINE]


1287. Oncol Nurs Forum. 2022 Oct 20;49(6):491-499. doi: 10.1188/22.ONF.491-499.

Struggling, Adapting, and Holding Each Other Up: A Qualitative Study of Oncology 
Nurses During the First Year of the COVID-19 Pandemic.

Knobf MT(1), Hwang Y(1), Sumpio C(2), Barbarotta L(3), Slusser K(4).

Author information:
(1)Yale University.
(2)Yale New Haven.
(3)Smilow Cancer Hospital at Yale-New Haven.
(4)Duke Cancer Institute.

PURPOSE: To explore the experience of oncology nurses during the first year of 
the COVID-19 pandemic.
PARTICIPANTS &AMP; SETTING: 21 RNs, advanced practice RNs, and physician 
associates from inpatient and ambulatory care settings at a comprehensive cancer 
center in the northeastern United States.
METHODOLOGIC APPROACH: A qualitative study using interpretive description was 
conducted through semistructured interviews. Data were recorded and transcribed 
verbatim, reviewed for accuracy, and coded into themes following an iterative 
process of analysis.
FINDINGS: The theme of "Doing It Together: Struggling, Adapting, and Holding 
Each Other Up" describes the experience of oncology nurses during the first year 
of the COVID-19 pandemic. The following three themes provide further insight: 
"Struggling With Constant Change and Uncertainty," "Managing Workload 
Intensity," and "Experiencing Emotional Distress." As the year progressed, 
"Identifying Benefits and Finding Hope" began to emerge.
IMPLICATIONS FOR NURSING: The findings suggest a need for programs to help 
nurses cope with the continuing effects of the COVID-19 pandemic, mental health 
and well-being resources, and nursing guidelines for telehealth and relocation 
to other units.

DOI: 10.1188/22.ONF.491-499
PMID: 36413730 [Indexed for MEDLINE]


1288. Neurosci Bull. 2023 Apr;39(4):675-684. doi: 10.1007/s12264-022-00970-2. Epub 
2022 Nov 21.

Depression and Anxiety During the COVID-19 Pandemic: Epidemiology, Mechanism, 
and Treatment.

Zhu C(#)(1)(2)(3), Zhang T(#)(4), Li Q(4), Chen X(5), Wang K(6)(7)(8)(9)(10).

Author information:
(1)School of Mental Health and Psychological Sciences, Anhui Medical University, 
Hefei, 230032, China.
(2)Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, 
Hefei, 230032, China.
(3)Collaborative Innovation Center of Neuropsychiatric Disorders and Mental 
Health, Hefei, 230032, China.
(4)Department of Psychiatry, The First Affiliated Hospital of Anhui Medical 
University, Hefei, 230032, China.
(5)Department of Neurology, The First Affiliated Hospital of Anhui Medical 
University, Hefei, 230032, China.
(6)School of Mental Health and Psychological Sciences, Anhui Medical University, 
Hefei, 230032, China. wangkai1964@126.com.
(7)Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, 
Hefei, 230032, China. wangkai1964@126.com.
(8)Collaborative Innovation Center of Neuropsychiatric Disorders and Mental 
Health, Hefei, 230032, China. wangkai1964@126.com.
(9)Department of Neurology, The First Affiliated Hospital of Anhui Medical 
University, Hefei, 230032, China. wangkai1964@126.com.
(10)Institute of Artificial Intelligence, Hefei Comprehensive National Science 
Center, Hefei, 230032, China. wangkai1964@126.com.
(#)Contributed equally

The Coronavirus Disease 2019 (COVID-19) pandemic has had an adverse impact on 
the physical and mental health of the public worldwide. In addition to illness 
in patients with COVID-19, isolated people and the general population have 
experienced mental health problems due to social distancing policies, mandatory 
lockdown, and other psychosocial factors, and the prevalence of depression and 
anxiety significantly increased during the pandemic. The purpose of this review 
is to elucidate the epidemiology, contributing factors, and pathogenesis of 
depression and anxiety. during the pandemic. These findings indicate that 
physicians and psychiatrists should pay more attention to and identify those 
with a high risk for mental problems, such as females, younger people, unmarried 
people, and those with a low educational level. In addition, researchers should 
focus on identifying the neural and neuroimmune mechanisms involved in 
depression and anxiety, and assess the intestinal microbiome to identify 
effective biomarkers. We also provide an overview of various intervention 
methods, including pharmacological treatment, psychological therapy, and 
physiotherapy, to provide a reference for different populations to guide the 
development of optimized intervention methods.

© 2022. The Author(s).

DOI: 10.1007/s12264-022-00970-2
PMCID: PMC9685018
PMID: 36411394 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflicts 
of interest.


1289. Psychol Health Med. 2023 Apr;28(4):964-979. doi: 10.1080/13548506.2022.2148698. 
Epub 2022 Nov 21.

Frontline experiences of delivering remote mental health supports during the 
COVID-19 pandemic in Scotland: innovations, insights and lessons learned from 
mental health workers.

Griffith B(1), Archbold H(1), Sáez Berruga I(1), Smith S(1), Deakin K(1), Cogan 
N(1), Tanner G(1), Flowers P(1).

Author information:
(1)School of Psychological Sciences and Health, University of Strathclyde, 
Glasgow, UK.

COVID-19 restrictions drove rapid adaptations to service delivery and new ways 
of working within Scotland's mental health sector. This study explores mental 
health workers' (MHWs') experiences of delivering their services remotely. 
Twenty participants, who had worked in mental health professions in the National 
Health Service (NHS) in Scotland throughout the COVID-19 pandemic, took part in 
online semi-structured interviews. Data was transcribed then analysed using an 
inductive thematic analysis. Two major themes are reported: (1) 'Improved 
Flexibility for both MHWs and Service Users' and (2) 'Teletherapies Challenge 
Therapeutic Boundaries'. In relation to (1) virtual platforms were seen as vital 
in maintaining patient care throughout the COVID-19 pandemic and a valuable 
resource for service users (SUs) who had previously struggled with mobility or 
social anxieties when accessing face-to-face services. Some MHWs' also noted 
benefits for their productivity and comfort. Regarding (2) MHWs highlighted that 
whilst conducting teletherapies from home, work-life boundaries became blurred 
and, in some instances, typically comforting spaces became associated with the 
traumatic content discussed by SUs. These stressors seemed to be compounded by 
MHWs' isolation, as they were less able to draw upon their colleagues for 
support. Further, confidentiality could not be assured, as MHWs and SUs alike 
had to accommodate their family members. These findings highlight important 
insights from MHWs in adapting to rapid changes in mental health working 
practices, particularly in relation to the challenges of delivering quality, 
safe and equitable services and the increased use of teletherapies. Such 
insights are vital in informing service developments and supporting future 
pandemic preparedness across a range of healthcare contexts and countries 
seeking to adopt hybrid models of mental health service delivery.

DOI: 10.1080/13548506.2022.2148698
PMID: 36408950 [Indexed for MEDLINE]


1290. Tijdschr Gerontol Geriatr. 2022 Jul 10;53(3). doi: 
10.36613/tgg.1875-6832/2022.03.01. eCollection 2022 Jul 10.

[Did the COVID-19 pandemic change the care situation of older adults?].

[Article in Dutch; Abstract available in Dutch from the publisher]

Tange M(1), Broese van Groenou MI(1).

Author information:
(1)Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

The study examined changes in giving and receiving care by community-dwelling 
older adults during the COVID-19 pandemic in 2020 compared to a period about two 
years before. Using data collected in two waves by the Longitudinal Aging Study 
Amsterdam (N = 1013), we study how many and which older adults report a change 
in care use and provision and how these changes impact on psychological 
well-being. The results show that only for a small part of the sample changes 
occurred. The large majority provides no care (73%) or uses no care (62%) in 
both waves. 7% stayed a care provider during the pandemic, where 15% quitted 
care provision and 5% started care provision. 17% remained a care user, where 
15% did not receive care anymore and 6% started to use care. The informal carers 
mainly consisted of women and younger elderly in good health and the care 
recipients were mainly women and older elderly in poorer health. Using care had 
a negative impact on psychological well-being, but providing care was not 
related to wellbeing during the pandemic. The results imply that the pandemic 
and the measures taken affected the care situation of only a small part of the 
older adults.

Publisher: Dit onderzoek vergelijkt het geven en het ontvangen van zorg aan huis 
door ouderen ten tijde van de COVID-19 pandemie in 2020 met een periode ongeveer 
twee jaar daarvoor. Middels data verzameld op twee waarnemingen van de 
Longitudinal Aging Study Amsterdam (N = 1013) wordt onderzocht hoeveel en welke 
ouderen een verandering rapporteren, en wat de invloed van deze veranderingen is 
op het psychisch welbevinden. De resultaten tonen dat er weinig is veranderd in 
de zorgsituatie van ouderen. De overgrote meerderheid geeft op beide metingen 
geen zorg (73%) of krijgt geen zorg (62%). 7% is zorg aan anderen blijven geven, 
terwijl 15% daarmee is gestopt en 5% met zorgverlening is gestart. 17% bleef 
zorg ontvangen, terwijl 15% geen zorg meer kreeg, en 6% voor het eerst zorg 
ontving. De mantelzorgers bestaan voornamelijk uit vrouwen en jongere ouderen 
met een goede gezondheid en de zorgontvangers zijn voornamelijk vrouwen en 
oudere ouderen met een slechtere gezondheid. Het krijgen van zorg heeft een 
significant negatieve invloed op het psychisch welbevinden, maar het geven van 
zorg heeft geen effect op welbevinden. De resultaten impliceren dat de pandemie 
en de maatregelen maar bij een kleine groep invloed hadden op de zorgverlening 
van en door ouderen.

DOI: 10.36613/tgg.1875-6832/2022.03.01
PMID: 36408751 [Indexed for MEDLINE]


1291. Cureus. 2022 Oct 14;14(10):e30307. doi: 10.7759/cureus.30307. eCollection 2022 
Oct.

Trauma-Informed Care in the Neonatal Intensive Care Unit: Through the Lens of 
the COVID-19 Pandemic.

Arya S(1)(2), Zutshi A(3)(4).

Author information:
(1)Department of Pediatrics, Wright State University Boonshoft School of 
Medicine, Dayton, USA.
(2)Division of Neonatal-Perinatal Medicine, Dayton Children's Hospital, Dayton, 
USA.
(3)Department of Psychiatry and Behavioral Neuroscience, University of 
Cincinnati College of Medicine, Cincinnati, USA.
(4)Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital 
Medical Center, Cincinnati, USA.

Trauma is rooted in an individual's experience of an event that leads to 
physical or mental harm and can have a long-lasting, unfavorable effect on their 
well-being and functioning. Being aware of the effects of trauma, recognizing 
its signs, understanding how it informs individual responses, and actively 
trying to prevent re-traumatization are the tenets of trauma-informed care. 
Admission to the neonatal intensive care unit (NICU) is widely considered to be 
an extremely stressful time for parents and infants alike. With the emergence of 
the coronavirus disease 2019 (COVID-19) pandemic, there were significant changes 
in healthcare delivery. Widespread closures, restrictions due to infection 
control measures, the spread of misinformation, increased psychosocial 
hardships, and amplification of cultural, gender, and racial biases intensified 
NICU-related stressors. Adoption of the principles of trauma-informed care, as 
defined by the Substance Abuse Mental Health Services Administration, to the 
NICU can help buffer some of these stressors. We present a review of these 
principles viewed through the lens of the COVID-19 pandemic. The lessons learned 
will help inform practices and policies and allow us to navigate similar 
challenges more effectively in the future.

Copyright © 2022, Arya et al.

DOI: 10.7759/cureus.30307
PMCID: PMC9659422
PMID: 36407229

Conflict of interest statement: The authors have declared that no competing 
interests exist.


1292. Harm Reduct J. 2022 Nov 19;19(1):128. doi: 10.1186/s12954-022-00710-9.

Attitudes toward harm reduction and low-threshold healthcare during the COVID-19 
pandemic: qualitative interviews with people who use drugs in rural southern 
Illinois.

Rains A(1), York M(2), Bolinski R(2), Ezell J(3)(4), Ouellet LJ(5), Jenkins 
WD(6), Pho MT(7).

Author information:
(1)Department of Medicine, University of Chicago, Chicago, IL, USA. 
alex.rains@uchospitals.edu.
(2)Department of Sociology, Southern Illinois University, Carbondale, IL, USA.
(3)Africana Studies and Research Center, Cornell University, Ithaca, NY, USA.
(4)Center for Cultural Humility, Cornell University, Ithaca, NY, USA.
(5)Division of Epidemiology and Biostatistics, School of Public Health, 
University of Illinois Chicago, Chicago, IL, USA.
(6)Department of Epidemiology and Biostatistics, SIU School of Medicine, 
Springfield, IL, USA.
(7)Department of Medicine, University of Chicago, Chicago, IL, USA.

BACKGROUND: Chronic health conditions associated with long-term drug use may 
pose additional risks to people who use drugs (PWUD) when coupled with COVID-19 
infection. Despite this, PWUD, especially those living in rural areas, may be 
less likely to seek out health services. Previous research has highlighted the 
increased disease burden of COVID-19 among PWUD. Our manuscript supplements this 
literature by exploring unique attitudes of PWUD living in rural areas toward 
the pandemic, COVID-19 vaccination, and the role of harm reduction (HR) 
organizations in raising health awareness among PWUD.
METHODS: Semi-structured interviews were conducted with 20 PWUD living in rural 
southern Illinois. Audio recordings were professionally transcribed. A 
preliminary codebook was created based on interview domains. Two trained coders 
conducted iterative coding of the transcripts, and new codes were added through 
line-by-line coding and thematic grouping.
RESULTS: Twenty participants (45% female, mean age of 38) completed interviews 
between June and November 2021. Participants reported negative impacts of the 
pandemic on mental health, financial wellbeing, and drug quality. However, the 
health impacts of COVID-19 were often described as less concerning than its 
impacts on these other aspects of life. Many expressed doubt in the severity of 
COVID-19 infection. Among the 16 unvaccinated participants who reported 
receiving most of their information from the internet or word of mouth, 
uncertainty about vaccine contents and distrust of healthcare and government 
institutions engendered wariness of the vaccination. Distrust of healthcare 
providers was related to past stigmatization and judgement, but did not extend 
to the local HR organization, which was unanimously endorsed as a positive 
institution. Among participants who did not access services directly from the HR 
organization, secondary distribution of HR supplies by other PWUD was a 
universally cited form of health maintenance. Participants expressed interest in 
low-threshold healthcare, including COVID-19 vaccination, should it be offered 
in the local HR organization's office and mobile units.
CONCLUSION: COVID-19 and related public health measures have affected this 
community in numerous ways. Integrating healthcare services into harm reduction 
infrastructures and mobilizing secondary distributors of supplies may promote 
greater engagement with vaccination programs and other healthcare services.
TRIAL NUMBER: NCT04427202.

© 2022. The Author(s).

DOI: 10.1186/s12954-022-00710-9
PMCID: PMC9675127
PMID: 36403075 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1293. Med Clin North Am. 2023 Jan;107(1):131-142. doi: 10.1016/j.mcna.2022.04.004.

Psychiatric Issues Among Health Professionals.

Braquehais MD(1), Vargas-Cáceres S(2).

Author information:
(1)Integral Care Program for Health Care Professionals, Galatea Foundation, 
Galatea Clinic, Palafolls Street, 15-19, 08017, Barcelona, Spain; Mental Health 
and Addiction Research Group, Vall d'Hebron Research Institute (VHIR), Vall 
d'Hebron University Hospital, Vall Hebron Hospital Campus, Passeig Vall 
d'Hebron, 119-129, 08035, Barcelona, Spain. Electronic address: 
mdbraquehais.paimm@comb.cat.
(2)Adult Mental Health Service, Benito Menni Mental Health Services, Santiago 
Ramon y Cajal Street, 27-29, 080902, L'Hospitalet de Llobregat, Catalonia, 
Spain.

COVID-19 has increased the interest in the wellbeing of health professionals 
(HPs) as they have experienced stress, loss, and fatigue-related symptoms. 
Research evidence from previous epidemics points to an increase in the 
prevalence of affective, anxiety, and addictive disorders among them. HPs are 
trained to care for others and to recover from severe stressors. However, they 
tend to neglect self-care and have difficulties in seeking appropriate help when 
need it. This new scenario becomes an opportunity to promote a new culture of 
professionalism whereby caring for the caregivers becomes a priority both at a 
personal and institutional level.

Copyright © 2022 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.mcna.2022.04.004
PMCID: PMC9671527
PMID: 36402495 [Indexed for MEDLINE]

Conflict of interest statement: Disclosure The authors have nothing to disclose.


1294. Ann N Y Acad Sci. 2023 Jan;1519(1):186-198. doi: 10.1111/nyas.14931. Epub 2022 
Nov 19.

Music engagement is negatively correlated with depressive symptoms during the 
COVID-19 pandemic via reward-related mechanisms.

Mas-Herrero E(1)(2), Singer N(3)(4)(5), Ferreri L(6)(7), McPhee M(8)(9)(10), 
Zatorre RJ(3)(4), Ripollés P(8)(9)(10).

Author information:
(1)Department of Cognition, Development and Education Psychology, Institute of 
Neurosciences, University of Barcelona, Barcelona, Spain.
(2)Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute, 
L'Hospitalet de Llobregat, Barcelona, Spain.
(3)Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.
(4)International Laboratory for Brain, Music and Sound Research (BRAMS) and 
Center for Research in Brain, Language and Music (CRBLM), Montreal, Quebec, 
Canada.
(5)Sagol Brain Institute and Department of Neurology, Tel Aviv Sourasky Medical 
Center, Tel Aviv, Israel.
(6)Department of Brain and Behavioral Sciences, University of Pavia, Pavia, 
Italy.
(7)Laboratoire d'Étude des Mécanismes Cognitifs, Université Lumière Lyon 2, 
Lyon, France.
(8)Department of Psychology, New York University, New York, New York, USA.
(9)Music and Auditory Research Laboratory (MARL), New York University, New York, 
New York, USA.
(10)Center for Language, Music, and Emotion (CLaME), New York University, New 
York, New York, USA.

The COVID-19 pandemic has deeply affected the mental health of millions of 
people. We assessed which of many leisure activities correlated with positive 
mental health outputs, with particular attention to music, which has been 
reported to be important for coping with the psychological burden of the 
pandemic. Questionnaire data from about 1000 individuals primarily from Italy, 
Spain, and the United States during May-June 2020 show that people picked music 
activities (listening to, playing, singing, etc.) most often as the leisure 
experiences that helped them the most to cope with psychological distress 
related with the pandemic. During the pandemic, hours of engagement in music and 
food-related activities were associated with lower depressive symptoms. The 
negative correlation between music and depression was mediated by individual 
differences in sensitivity to reward, whereas the correlation between 
food-related activities and improved mental health outputs was explained by 
differences in emotion suppression strategies. Our results, while correlational, 
suggest that engaging in music activities could be related to improved 
well-being with the underlying mechanism being related to reward, consistent 
with neuroscience findings. Our data have practical significance in pointing to 
effective strategies to cope with mental health issues beyond those related to 
the COVID-19 pandemic.

© 2022 New York Academy of Sciences.

DOI: 10.1111/nyas.14931
PMID: 36401802 [Indexed for MEDLINE]


1295. PLoS One. 2022 Nov 18;17(11):e0277883. doi: 10.1371/journal.pone.0277883. 
eCollection 2022.

Dissociative experiences among Lebanese university students: Association with 
mental health issues, the economic crisis, the COVID-19 pandemic, and the Beirut 
port explosion.

Mhanna M(1), El Zouki CJ(1), Chahine A(1), Obeid S(2), Hallit S(1)(3)(4).

Author information:
(1)School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, 
Jounieh, Lebanon.
(2)Social and Education Sciences Department, School of Arts and Sciences, 
Lebanese American University, Jbeil, Lebanon.
(3)Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
(4)Applied Science Research Center, Applied Science Private University, Amman, 
Jordan.

BACKGROUND: Dissociative experiences are psychological manifestations 
characterized by a loss of connection and continuity between thoughts, emotions, 
environment, behavior, and identity. Lebanon has been facing indescribable 
events in the last few years, including the COVID-19 pandemic, the Beirut 
explosion, a crushing economic crisis with the highest inflation rate the 
country has known in over three decades. The aim of this study was to evaluate 
the correlation between dissociative experiences and post-traumatic stress 
symptoms from the economic crisis, the Beirut blast, the COVID-19 pandemic, and 
other mental health issues in a sample of Lebanese university students.
METHODS: This cross-sectional study enrolled 419 active university students 
(18-35 years) from all over Lebanon (May and August 2021). The respondents 
received the online soft copy of a survey by a snowball sampling technique 
through social media and messaging apps. The questionnaire included 
sociodemographic data, the Dissociative Experience Scale (DES-II), the PTSD 
Checklist Specific Version (PCL-S), the Financial Wellbeing Scale, the Beirut 
Distress Scale, the Lebanese Anxiety Scale, the Patient Health Questionnaire.
RESULTS: The two-factor model of the DES fitted best according to CFI, RMSEA and 
χ2/df values, but modestly according to TLI. The two factors were absorption and 
amnesia/depersonalization. Higher stress (Beta = 0.95) and more PTSD from the 
Beirut blast (Beta = 0.29) and from the economic crisis (Beta = 0.23) were 
significantly associated with more absorption. A personal history of depression 
(Beta = 6.03), higher stress (Beta = 0.36) and more PTSD from the Beirut blast 
(Beta = 0.27) and from the COVID-19 pandemic (Beta = 0.16) were significantly 
associated with more amnesia/depersonalization.
CONCLUSION: Significant rates of dissociative experiences and their 
sub-manifestations (amnesia/depersonalization and absorption) were found among 
Lebanese university students, with remarkable co-occurrence of a 
traumatic/stressful pattern, whether on an individual (history of PTSD) or a 
collective level (Post-traumatic manifestations from Beirut blast, COVID-19 
pandemic and/or economic crisis), or whether correlated to an acute single event 
or to certain chronic stressors, or even to a personal history of depression. 
Such findings must raise the attention to serious mental and psychosocial 
alteration in the Lebanese national identity.

Copyright: © 2022 Mhanna et al. This is an open access article distributed under 
the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0277883
PMCID: PMC9674130
PMID: 36399459 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


1296. PLoS One. 2022 Nov 18;17(11):e0276767. doi: 10.1371/journal.pone.0276767. 
eCollection 2022.

Artificial intelligence-based analytics for impacts of COVID-19 and online 
learning on college students' mental health.

Rezapour M(1), Elmshaeuser SK(1).

Author information:
(1)Department of Mathematics, Wake Forest University, Winston-Salem, NC, United 
States of America.

COVID-19, the disease caused by the novel coronavirus (SARS-CoV-2), first 
emerged in Wuhan, China late in December 2019. Not long after, the virus spread 
worldwide and was declared a pandemic by the World Health Organization in March 
2020. This caused many changes around the world and in the United States, 
including an educational shift towards online learning. In this paper, we seek 
to understand how the COVID-19 pandemic and the increase in online learning 
impact college students' emotional wellbeing. We use several machine learning 
and statistical models to analyze data collected by the Faculty of Public 
Administration at the University of Ljubljana, Slovenia in conjunction with an 
international consortium of universities, other higher education institutions, 
and students' associations. Our results indicate that features related to 
students' academic life have the largest impact on their emotional wellbeing. 
Other important factors include students' satisfaction with their university's 
and government's handling of the pandemic as well as students' financial 
security.

Copyright: © 2022 Rezapour, Elmshaeuser. This is an open access article 
distributed under the terms of the Creative Commons Attribution License, which 
permits unrestricted use, distribution, and reproduction in any medium, provided 
the original author and source are credited.

DOI: 10.1371/journal.pone.0276767
PMCID: PMC9674166
PMID: 36399458 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


1297. J Health Psychol. 2023 Jul;28(8):726-738. doi: 10.1177/13591053221134848. Epub 
2022 Nov 17.

Longitudinal assessment of COVID-19 fear and psychological wellbeing in the 
United Kingdom.

Quigley M(1), Whiteford S(1), Cameron G(1), Zuj DV(1)(2), Dymond S(1)(3).

Author information:
(1)Swansea University, UK.
(2)University of Tasmania, Australia.
(3)Reykjavík University, Iceland.

The COVID-19 pandemic continues to impact global psychological wellbeing. To 
investigate the sustained impact of COVID-19 on wellbeing, the current study 
longitudinally assessed fear of COVID-19, anxiety, depression, intolerance of 
uncertainty, worry, sleep quality, loneliness and alcohol use during the 
pandemic in the United Kingdom. Timepoint 1 (T1; N = 445) took place in February 
2021 following the highest number of pandemic-related deaths in the UK. 
Timepoint 2 (T2, N = 198) took place in June 2021 when pandemic-related deaths 
had declined considerably, and many had been vaccinated. At T1, COVID-19 fear 
predicted elevated levels of anxiety, depression, intolerance of uncertainty, 
worry, sleep quality and loneliness. At T2, we observed that levels of COVID-19 
fear, depression, loneliness and sleep quality decreased. However, COVID-19 fear 
continued to predict elevated intolerance of uncertainty, worry and impaired 
sleep quality. These findings demonstrate the longitudinal impact of COVID-19 
fear on psychological wellbeing.

DOI: 10.1177/13591053221134848
PMCID: PMC9679309
PMID: 36397647 [Indexed for MEDLINE]

Conflict of interest statement: The authors declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1298. Mini Rev Med Chem. 2023;23(7):852-868. doi: 10.2174/1389557523666221116154907.

Gastrointestinal, Liver, Pancreas, Oral and Psychological Long-term Symptoms of 
COVID-19 After Recovery: A Review.

Afrisham R(1), Jadidi Y(1), Davoudi M(1), Moayedi K(2), Soliemanifar O(3), Eleni 
Xirouchaki C(4)(5), Ashtary-Larky D(6), Seyyedebrahimi S(2), Alizadeh S(7).

Author information:
(1)Department of Clinical Laboratory Sciences, School of Allied Medicine, Tehran 
University of Medical Sciences, Tehran, Iran.
(2)Department of Clinical Biochemistry, Faculty of Medicine, Tehran University 
of Medical Sciences, Tehran, Iran.
(3)Department of Education in the City of Khorramshahr, General Department of 
Education in Khuzestan Province, Iran.
(4)Monash Biomedicine Discovery Institute, Monash University, Clayton, 
Victoria-3800, Australia.
(5)Department of Biochemistry and Molecular Biology, Monash University, Clayton, 
Victoria-3800, Australia.
(6)Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur 
University of Medical Sciences, Ahvaz, Iran.
(7)Department of Hematology, School of Allied Medicine, Tehran University of 
Medical Sciences, Tehran, Iran.

Due to the importance of control and prevention of COVID-19-correlated long-term 
symptoms, the present review article has summarized what has been currently 
known regarding the molecular and cellular mechanisms linking COVID-19 to 
important long-term complications including psychological complications, liver 
and gastrointestinal manifestations, oral signs as well as even diabetes. 
COVID-19 can directly affect the body cells through their Angiotensin-converting 
enzyme 2 (ACE-2) to induce inflammatory responses and cytokine storm. The 
cytokines cause the release of reactive oxygen species (ROS) and subsequently 
initiate and promote cell injuries. Another way, COVID-19-associated dysbiosis 
may be involved in GI pathogenesis. In addition, SARS-CoV-2 reduces 
butyrate-secreting bacteria and leads to the induction of hyperinflammation. 
Moreover, SARS-CoV-2-mediated endoplasmic reticulum stress induces de novo 
lipogenesis in hepatocytes, which leads to hepatic steatosis and inhibits 
autophagy via increasing mTOR. In pancreas tissue, the virus damages beta-cells 
and impairs insulin secretion. SARS-COV-2 may change the ACE2 activity by 
modifying ANGII levels in taste buds which leads to gustatory dysfunction. 
SARS-CoV-2 infection and its resulting stress can lead to severe inflammation 
that can subsequently alter neurotransmitter signals. This, in turn, negatively 
affects the structure of neurons and leads to mood and anxiety disorders. In 
conclusion, all the pathways mentioned earlier can play a crucial role in the 
disease's pathogenesis and related comorbidities. However, more studies are 
needed to clarify the underlying mechanism of the pathogenesis of the new coming 
virus.

Copyright© Bentham Science Publishers; For any queries, please email at 
epub@benthamscience.net.

DOI: 10.2174/1389557523666221116154907
PMID: 36397624 [Indexed for MEDLINE]


1299. Int Immunopharmacol. 2022 Dec;113(Pt B):109436. doi: 
10.1016/j.intimp.2022.109436. Epub 2022 Nov 14.

Pexidartinib (PLX3397) through restoring hippocampal synaptic plasticity 
ameliorates social isolation-induced mood disorders.

Wang L(1), Wang X(1), Deng L(1), Zhang H(1), He B(1), Cao W(2), Cui Y(3).

Author information:
(1)Neuroscience and Behavioral Research Center, Academician Workstation, 
Changsha Medical University, Changsha, Hunan 410219, China; Hunan Key Laboratory 
of the Research and Development of Novel Pharmaceutical Preparations, Changsha 
Medical University, Changsha, Hunan 410219, China.
(2)Clinical Anatomy & Reproductive Medicine Application Institute, Hengyang 
Medical School, University of South China, Hengyang, Hunan 421001, China. 
Electronic address: marksman0@163.com.
(3)Neuroscience and Behavioral Research Center, Academician Workstation, 
Changsha Medical University, Changsha, Hunan 410219, China; Center of 
Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, 
Hunan 410008, China. Electronic address: cuiyanhui0110@163.com.

Social behavior is essential for the well-being and survival of individuals. 
However, social isolation is a serious public health issue, especially during 
the COVID-19 pandemic, affecting a significant number of people worldwide, and 
can lead to serious psychological crises. Microglia, innate immune cells in the 
brain, are strongly implicated in the development of psychiatry. Although many 
microglial inhibitors have been used to treat depression, there is no literature 
report on pexidartinib (PLX3397) and social isolation. Herein, we adopted 
PLX3397 to investigate the role of microglia in the modulation of social 
isolation. Our results found that social isolation during adolescence caused 
depressive-like, but not anxiety-like behavior in mice in adulthood, with 
enhanced expression of the microglial marker Iba1 in the hippocampus. In 
addition, treatment with PLX3397 reduced the expression of the microglial marker 
Iba1, decreased the mRNA expression of IL-1β, increased the mRNA expression of 
Arg1, elevated the protein levels of DCX and GluR1 and restored the dendritic 
spine branches and density, ultimately mitigating depressive-like behavior in 
mice. These findings suggest that inhibition of microglia in the hippocampus 
could ameliorate mood disorders in mice, providing a new perspective for the 
treatment of psychiatric disorders such as depression.

Copyright © 2022 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.intimp.2022.109436
PMCID: PMC9661988
PMID: 36395673 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


1300. Alcohol Clin Exp Res. 2022 Nov;46(11):1930-1943. doi: 10.1111/acer.14936. Epub 
2022 Nov 17.

Alcohol use disorder as a potential risk factor for COVID-19 severity: A 
narrative review.

Forsyth CB(1)(2)(3)(4), Voigt RM(1)(2)(3)(4), Swanson GR(1)(2)(3)(4), Bishehsari 
F(1)(2)(3)(4), Shaikh M(2), Zhang L(2), Engen P(2), Keshavarzian A(1)(2)(3)(4).

Author information:
(1)Department of Internal Medicine, Section of Gastroenterology, Rush University 
Medical Center, Chicago, Illinois, USA.
(2)Rush Center for Integrated Microbiome and Chronobiology Research, Rush 
University Medical Center, Chicago, Illinois, USA.
(3)Department of Anatomy and Cell Biology, Rush University Medical Center, 
Chicago, Illinois, USA.
(4)Rush University Graduate College, Rush University Medical Center, Chicago, 
Illinois, USA.

In Dec. 2019-January 2020, a pneumonia illness originating in Wuhan, China, 
designated as coronavirus disease 2019 (COVID-19) was shown to be caused by a 
novel RNA coronavirus designated as severe acute respiratory syndrome 
coronavirus 2 (SARS-CoV-2). People with advanced age, male sex, and/or 
underlying health conditions (obesity, type 2 diabetes, cardiovascular disease, 
hypertension, chronic kidney disease, and chronic lung disease) are especially 
vulnerable to severe COVID-19 symptoms and death. These risk factors impact the 
immune system and are also associated with poor health, chronic illness, and 
shortened longevity. However, a large percent of patients without these known 
risk factors also develops severe COVID-19 disease that can result in death. 
Thus, there must exist risk factors that promote exaggerated inflammatory and 
immune response to the SARS-CoV-2 virus leading to death. One such risk factor 
may be alcohol misuse and alcohol use disorder because these can exacerbate 
viral lung infections like SARS, influenza, and pneumonia. Thus, it is highly 
plausible that alcohol misuse is a risk factor for either increased infection 
rate when individuals are exposed to SARS-CoV-2 virus and/or more severe 
COVID-19 in infected patients. Alcohol use is a well-known risk factor for lung 
diseases and ARDS in SARS patients. We propose that alcohol has three key 
pathogenic elements in common with other COVID-19 severity risk factors: namely, 
inflammatory microbiota dysbiosis, leaky gut, and systemic activation of the 
NLRP3 inflammasome. We also propose that these three elements represent targets 
for therapy for severe COVID-19.

© 2022 Research Society on Alcoholism.

DOI: 10.1111/acer.14936
PMCID: PMC9722573
PMID: 36394508 [Indexed for MEDLINE]

Conflict of interest statement: Authorship statement and disclosure of COI 
statement. All authors have read the journal’s policy on disclosure of potential 
conflicts of interest and have none to disclose.


1301. Front Public Health. 2022 Oct 31;10:981270. doi: 10.3389/fpubh.2022.981270. 
eCollection 2022.

Health impacts with telework on workers: A scoping review before the COVID-19 
pandemic.

Furuya Y(1), Nakazawa S(1), Fukai K(1), Tatemichi M(1).

Author information:
(1)Department of Preventive Medicine, Tokai University School of Medicine, 
Isehara, Japan.

BACKGROUND: Telework has dramatically increased due to the coronavirus disease 
2019 (COVID-19) pandemic, and the health impacts related to telework have become 
major concerns. Some studies have shown that telework has both positive and 
negative impacts. However, during the pandemic, the influence of COVID-19 is too 
strong to estimate the health effects of telework. Therefore, this scoping 
review investigated a comprehensive overview of those impacts based on studies 
conducted before the COVID-19 pandemic.
METHODS: We searched keywords related to telework in five databases: PubMed, 
Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), 
Cochrane Library, and Ichu-Shi Web. We included articles written in English and 
Japanese and published from January 2009 to December 2020. One author extracted 
data, and four authors were paired into two groups. All authors independently 
conducted the first and second screening and checked the results in pairs. Any 
disagreements were resolved by reaching a consensus among all authors. All 
screening and strategies were performed with the consent of all authors.
RESULTS: Twenty-nine quantitative studies published in 12 countries were 
extracted. The outcomes included 10 studies on physical and lifestyle outcomes, 
25 studies on stress and mental health outcomes, and 13 studies on 
quality-of-life and wellbeing outcomes. Telework increased sitting time in one 
study, and two studies showed improvement in behavior, such as reducing smoking 
or drinking due to telework. While six studies reported subjective stress levels 
improved by telework, the results for depression, anxiety, and other disorders 
varied across those studies, and the social or individual factors further 
complicated the situation.
CONCLUSION: Telework is potentially associated with a shift to healthier 
lifestyles but also the potential for inverse correlation to extend sedentary 
time. Mental stress indicators depend on the social and individual situations, 
and very few intervention studies on teleworking existed prior to the COVID-19 
pandemic. Our review identified a lack of intervention and comparative research 
on health problems with telework and revealed a need to conduct research with 
clear comparisons in post-COVID-19 studies.
SYSTEMATIC REVIEW REGISTRATION: 
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021203104, 
identifier: CRD42021203104.

Copyright © 2022 Furuya, Nakazawa, Fukai and Tatemichi.

DOI: 10.3389/fpubh.2022.981270
PMCID: PMC9660232
PMID: 36388332 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1302. Front Public Health. 2022 Oct 31;10:1040169. doi: 10.3389/fpubh.2022.1040169. 
eCollection 2022.

Social networking use, mental health, and quality of life of Hong Kong 
adolescents during the COVID-19 pandemic.

Yu L(1), Du M(1).

Author information:
(1)Department of Applied Social Sciences, The Hong Kong Polytechnic University, 
Kowloon, Hong Kong SAR, China.

BACKGROUND: During the COVID-19 pandemic, adolescents' use of social networking 
sites/apps has surged, and their mental health and quality of life have also 
been significantly affected by the pandemic and its associated social-protection 
measures. The present study first examined the prevalence of social networking 
sites/apps use and social networking addiction, the mental health status, and 
the health-related quality of life among Hong Kong adolescent students. We 
further investigated the associations of the youths' daily use of social 
networking sites/apps and their social networking addiction with their mental 
health and quality of life during the pandemic.
METHODS: A total of 1,147 students (age = 15.20 ± 0.53 years) recruited from 12 
randomly selected local secondary schools in Hong Kong participated in a 
questionnaire survey in classroom settings between January and June, 2020, right 
after the COVID-19 outbreak. The questionnaire includes demographic 
characteristics and scales that measure social networking sites/apps use and 
social networking addiction, mental health, and quality of life.
RESULTS: Approximately 46.4% of the participants reported using social 
networking sites/apps often or very often, and 7.8% met the criteria for social 
networking addiction using Bergen's Social Media Addiction Scale. The prevalence 
of mild to extremely severe depression, anxiety, and stress among the 
adolescents stood at 39.6, 37.5, 48.8%, respectively, and the participants' 
physical, social, and school functioning were lower than the norms of healthy 
adolescents before the pandemic. Participants who used social networking 
sites/apps but for <3 h per day (excluding students who never used social 
networking sites/apps) showed significantly fewer problems of depression, 
anxiety, and stress than did those who spent more than 3 h per day on social 
networking sites/apps. Social networking addiction was found to be consistently 
associated with poor mental health and health-related quality of life.
CONCLUSION: This study provides important evidence supporting the potential 
protective effect of guiding adolescents to use social networking sites/apps 
appropriately in order to mitigate their negative emotions during contexts such 
as that of the pandemic; it further points to the need to provide extra support 
to promote the well-being of young people, especially those in disadvantaged 
situations (e.g., non-intact family) during and after the pandemic.

Copyright © 2022 Yu and Du.

DOI: 10.3389/fpubh.2022.1040169
PMCID: PMC9659958
PMID: 36388293 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1303. Front Public Health. 2022 Nov 1;10:986158. doi: 10.3389/fpubh.2022.986158. 
eCollection 2022.

Relationship between physical activity levels of Portuguese physical therapists 
and mental health during a COVID-19 pandemic: Being active is the key.

Almeida LC(1)(2), Grilo A(3)(4), Carolino E(3), Tomás MT(3).

Author information:
(1)Unidade de Cuidados Continuados Integrados de Portel-Unidade de Média Duração 
e Reabilitação e Unidade de Longa Duração e Manutenção, Santa Casa da 
Misericórdia de Portel, Portel, Portugal.
(2)ESTeSL - Escola Superior de Tecnologia da Saude de Lisboa, Instituto 
Politécnico de Lisboa, Lisboa, Portugal.
(3)H&TRC - Health and Technology Research Center, ESTeSL - Escola Superior de 
Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisboa, Portugal.
(4)CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da 
Universidade, Lisboa, Portugal.

INTRODUCTION: Physical activity is essential for a healthy life and quality of 
life, representing a fundamental role in individuals' physical and mental 
health. Concomitantly, the physical therapist, through the promotion of physical 
activity and exercise, can improve mental health, an essential factor in the 
current pandemic, triggering anxiety, fear, and depression crisis.
OBJECTIVE: To verify physical activity among Portuguese physical therapists and 
its association with mental health during pandemic times.
METHODS: An online questionnaire was applied through social media to all 
Portuguese physical therapists between October 21, 2021, and January 14, 2022. 
It contained general characterization questions of the sample, the IPAQ-SF 
questionnaire to assess physical activity levels, the Goldberg General Health 
Questionnaire (GHQ-28), which assesses the levels of mental health and the WHO 
Well-Being Index (WHO-5) to assess the subjective wellbeing.
RESULTS: The sample totaled 286 respondents (82% female), with a mean age of 33. 
Of the total answers, 82% practiced physical activity, 45% had moderate levels 
of physical activity, and 19% vigorous. Physical therapists in these categories 
had lower values in the GHQ-28 and higher in the WHO-5. Those with better mental 
health also showed better subjective wellbeing (r = -0.571, p = 0.000).
CONCLUSION: The data obtained showed that physical therapists mostly have 
moderate and vigorous levels of physical activity and that physical activity 
positively influences individuals' mental health and wellbeing, which proved to 
be a key factor due to the pandemic situation.

Copyright © 2022 Almeida, Grilo, Carolino and Tomás.

DOI: 10.3389/fpubh.2022.986158
PMCID: PMC9665837
PMID: 36388292 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1304. BMC Health Serv Res. 2022 Nov 16;22(1):1360. doi: 10.1186/s12913-022-08776-8.

The impact of COVID-19 on psychiatric and mental health services in Europe: 
suffering experienced by professionals.

Kane H(#)(1), Baumgart JG(#)(2), Rusch E(2), Deloyer J(3), Fuenzalida C(4), 
Kelemen G(5), Krzystanek M(6), Marazziti D(7)(8), Moraitou M(9), Reunanen M(10), 
Shyhrete R(11), Thome J(12), Verwaest W(13), Fond-Harmant L(14)(15), Denis F(2).

Author information:
(1)EA 75-05 Laboratory of Education, Ethics, Health, Faculty of Medicine, 
François Rabelais University, Boulevard Tonnellé, Tours, France. 
helene.kane@gmail.com.
(2)EA 75-05 Laboratory of Education, Ethics, Health, Faculty of Medicine, 
François Rabelais University, Boulevard Tonnellé, Tours, France.
(3)St-Martin Neuro Psychiatric Center, Namur, Belgium.
(4)Intrafamily Therapy Center, Elche, Spain.
(5)Faculty of Education, Psychology and Social Sciences, Aurel Vlaicu 
University, Arad, Romania.
(6)Clinic of Psychiatric Rehabilitation, Faculty of Medical Sciences, Medical 
University of Silesia, Katowice, Poland.
(7)Department of Clinical and Experimental Medicine, University of Pisa, Pisa, 
Italy.
(8)Saint Camillus International, UniCamillus, University of Health Sciences and 
Medicine, Rome, Italy.
(9)Social and Educational Support Center, Kepsipi, Korydallos, Greece.
(10)Step-Education, Pieksämäki, Finland.
(11)School of Nursing Sciences, HES-SO University of Applied Sciences Western 
Switzerland, Lausanne, Switzerland.
(12)Psychiatry Department, Rostock University, Rostock, Germany.
(13)Neuro-Psychiatric Hospital Center of Luxembourg, Ettelbruck, Luxembourg.
(14)Agency for Europe-Africa Scientific Cooperation, Luxembourg, Luxembourg.
(15)EA 3412 Education and Healthcare Practices Laboratories, Sorbonne Paris Nord 
University, Paris, France.
(#)Contributed equally

BACKGROUND: The COVID-19 pandemic has not only impacted intensive care units, 
but all healthcare services generally. This PsyGipo2C project specifically 
investigates how psychiatry and mental health professionals have been affected 
by the reorganizations and constraints imposed, which have reshaped their often 
already difficult working conditions.
METHODS: Our research combined quantitative and qualitative methods, surveying 
and interviewing health professionals of all occupations working in psychiatric 
and mental health services. A questionnaire was completed by 1241 professionals 
from 10 European countries, and 13 group interviews were conducted across 5 
countries. In addition to this, 31 individual interviews were conducted in 
Belgium and France.
RESULTS: Among the questionnaire respondents, 70.2% felt that their workload had 
increased, particularly due to their tasks being diversified and due to 
increased complexity in the provision of care. 48.9% felt that finding a 
work-life balance had become more difficult, and 59.5% felt their health had 
been affected by the crisis. The impact of the health crisis nevertheless varied 
across professions: our data provides insight into how the health measures have 
had a differential impact on professional tasks and roles across the various 
categories of occupations, obliging professionals to make various adaptations. 
The distress incurred has been linked not only to these new constraints in their 
work, but also to the combination of these with other pressures in their 
personal lives, which has consequently compromised their well-being and their 
ability to cope with multiple demands.
DISCUSSION: The COVID-19 health crisis has had varying impacts depending on the 
profession and access to remote work, sometimes leading to conflicts within the 
teams. The suffering expressed by the professionals was tied to their values and 
patterns of investment in work. Our research also highlights how these 
professionals made little use of the psychological supports offered, probably 
due to a reluctance to acknowledge that their mental health was affected.

© 2022. The Author(s).

DOI: 10.1186/s12913-022-08776-8
PMCID: PMC9667832
PMID: 36384661 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1305. Epidemiol Prev. 2022 Sep-Dec;46(5-6):333-352. doi: 10.19191/EP22.5-6.A542.089.

School closures and mental health, wellbeing and health behaviours among 
children and adolescents during the second COVID-19 wave: a systematic review of 
the literature.

[Article in English]

Saulle R(1), De Sario M(2), Bena A(3), Capra P(4), Culasso M(2), Davoli M(2), De 
Lorenzo A(5), Lattke LS(5), Marra M(6), Mitrova Z(2), Paduano S(7), Rabaglietti 
E(5), Sartini M(8), Minozzi S(2).

Author information:
(1)Department of Epidemiology, Lazio Regional Health Service, Local Health Unit 
Roma 1, Rome (Italy); r.saulle@deplazio.it.
(2)Department of Epidemiology, Lazio Regional Health Service, Local Health Unit 
Roma 1, Rome (Italy).
(3)Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco, Turin 
(Italy).
(4)DoRS - Piedmont Regional Centre of Documentation for Health Promotion, 
Grugliasco, Turin (Italy).
(5)University of Turin, Department of Psychology, SE-CREA Research Group, Turin 
(Italy).
(6)Euro Office for Investments for Health and Development, World Health 
Organization, Geneva (Switzerland).
(7)Department of Biomedical, Metabolic, and Neural Sciences, University of 
Modena and Reggio Emilia, Modena (Italy).
(8)Department of Health Science (DISSAL), University of Genoa, Genoa (Italy).

OBJECTIVES: to evaluate the impact of school closures, as a measure to contain 
the transmission of SARS-CoV-2 infection, on the psychological well-being of 
students of all levels starting from the 2020-2021 school year.
DESIGN: a systematic literature review was conducted according to the PRISMA 
2020 Guidelines. The literature search was conducted on 4 different databases: 
MedLine, Embase, PsycINFO, and L.OVE Platform. Quantitative observational 
studies published until 10.01.2022 were included. Studies conducted during the 
first pandemic wave, i.e., during the 2019-2020 school year and/or during the 
mandatory lockdown or confinement period, were excluded. The methodological 
quality of the studies was assessed with validated scales. Study selection, data 
extraction, and quality assessment were carried out independently by two 
authors.
SETTING AND PARTICIPANTS: children, adolescents, and young people attending all 
levels of education (including universities) and, for reasons related to 
COVID-19, having a suspension of "in presence" school or attending classes 
remotely.
MAIN OUTCOME MEASURES: a. outcomes directly related to mental health: suicides, 
emergency department visits, and hospitalizations for psychiatric problems; 
anxiety and depression, emotional difficulties, feelings of loneliness and 
isolation; b. well-being outcomes: sleep quality, perceived well-being (by 
child/adolescent/youth or referred by parents); c. health-related behaviours: 
tobacco smoking, alcohol, drug use. Outcomes related to school/academic 
performance, physical health, and those related to parents were not considered.
RESULTS: after having removed duplicate articles, 2,830 records were retrieved 
with the bibliographic search. Twelve studies (2 uncontrolled before-after 
studies and 10 cross sectional surveys) were included, involving a total of 
27,787 participants. Three studies involved university students, 2 involved high 
school students, and the remaining involved a mixed population of students 
attending primary and middle schools. The studies were conducted between 
September 2020 and April 2021. The methodological quality was rated as high in 
five studies and intermediate in the remaining studies. Due to the high 
heterogeneity of outcome measures and statistical analyses performed among the 
included studies, it was not possible to conduct a meta-analysis of the results 
of the considered publications. Nevertheless, the present review showed a clear 
signal of increase in mental health problems in relation to school closure or 
virtual instruction. In particular, results suggest evidence of association 
between school closure and risk of suicidal attempts or thoughts, mental health 
symptoms such as anxiety, depression, emotional disorders, psychological stress. 
Sleeping problems, drug and alcohol addiction were poorly studied.
CONCLUSIONS: despite the limitations of the included studies and possible 
residual confounding and contamination due to restrictive measures and social 
isolation implemented during the pandemic, the available evidence confirms the 
negative impact on students' mental health associated with school closures and 
distance learning. Given the availability of vaccination also for young 
children, a long period of school closure should be avoided also in the case of 
the emergence of new pandemic waves.

DOI: 10.19191/EP22.5-6.A542.089
PMID: 36384255 [Indexed for MEDLINE]


1306. PLoS One. 2022 Nov 16;17(11):e0275973. doi: 10.1371/journal.pone.0275973. 
eCollection 2022.

Economic precarity, loneliness, and suicidal ideation during the COVID-19 
pandemic.

Raifman J(1), Ettman CK(2), Dean LT(2), Abdalla SM(1), Skinner A(3), Barry 
CL(4), Galea S(1).

Author information:
(1)Boston University School of Public Health, Boston, MA, United States of 
America.
(2)Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, 
United States of America.
(3)Brown University School of Public Health, Providence, RI, United States of 
America.
(4)Cornell Jeb E. Brooks School of Public Policy, Ithaca, NY, United States of 
America.

The US population faced stressors associated with suicide brought on by the 
COVID-19 pandemic. Understanding the relationship between stressors and suicidal 
ideation in the context of the pandemic may inform policies and programs to 
prevent suicidality and suicide. We compared suicidal ideation between two 
cross-sectional, nationally representative surveys of adults in the United 
States: the 2017-2018 National Health and Nutrition Examination Survey (NHANES) 
and the 2020 COVID-19 and Life Stressors Impact on Mental Health and Well-being 
(CLIMB) study (conducted March 31 to April 13). We estimated the association 
between stressors and suicidal ideation in bivariable and multivariable Poisson 
regression models with robust variance to generate unadjusted and adjusted 
prevalence ratios (PR and aPR). Suicidal ideation increased from 3.4% in the 
2017-2018 NHANES to 16.3% in the 2020 CLIMB survey, and from 5.8% to 26.4% among 
participants in low-income households. In the multivariable model, difficulty 
paying rent (aPR: 1.5, 95% CI: 1.2-2.1) and feeling alone (aPR: 1.9, 95% CI: 
1.5-2.4) were associated with suicidal ideation but job loss was not (aPR: 0.9, 
95% CI: 0.6 to 1.2). Suicidal ideation increased by 12.9 percentage points and 
was almost 4.8 times higher during the COVID-19 pandemic. Suicidal ideation was 
more prevalent among people facing difficulty paying rent (31.5%), job loss 
(24.1%), and loneliness (25.1%), with each stressor associated with suicidal 
ideation in bivariable models. Difficulty paying rent and loneliness were most 
associated with suicidal ideation. Policies and programs to support people 
experiencing economic precarity and loneliness may contribute to suicide 
prevention.

Copyright: © 2022 Raifman et al. This is an open access article distributed 
under the terms of the Creative Commons Attribution License, which permits 
unrestricted use, distribution, and reproduction in any medium, provided the 
original author and source are credited.

DOI: 10.1371/journal.pone.0275973
PMCID: PMC9668199
PMID: 36383566 [Indexed for MEDLINE]

Conflict of interest statement: We have read the journal’s policy and the 
authors of this manuscript have the following competing interests: SG reports 
serving as a consultant for Sharecare and Tivity Health. This does not alter our 
adherence to PLOS ONE policies on sharing data and materials. All other authors 
declare that no competing interests exist.


1307. BMC Health Serv Res. 2022 Nov 15;22(1):1352. doi: 10.1186/s12913-022-08729-1.

The experiences and perceptions of wellbeing provision among English ambulance 
services staff: a multi-method qualitative study.

Phung VH(1), Sanderson K(2), Pritchard G(2), Bell F(3), Hird K(3), Wankhade 
P(4), Asghar Z(5), Siriwardena N(5).

Author information:
(1)Community and Health Research Unit, School of Health and Social Care, 
University of Lincoln, Lincoln, United Kingdom. vphung@lincoln.ac.uk.
(2)School of Health Sciences, University of East Anglia, Norwich, United 
Kingdom.
(3)Yorkshire Ambulance Service NHS Trust, Wakefield, United Kingdom.
(4)Edge Hill University Business School, Edge Hill University, Ormskirk, United 
Kingdom.
(5)Community and Health Research Unit, School of Health and Social Care, 
University of Lincoln, Lincoln, United Kingdom.

BACKGROUND: NHS ambulance service staff are at risk of poor physical and mental 
wellbeing because of the likelihood of encountering stressful and traumatic 
incidents. While reducing sickness absence and improving wellbeing support to 
ambulance staff is a key NHS priority, few studies have empirically documented a 
national picture to inform policy and service re-design. The study aimed to 
understand how ambulance service trusts in England deal with staff health and 
wellbeing, as well as how the staff perceive and use wellbeing services.
METHODS: To achieve our aim, we undertook semi-structured telephone interviews 
with health and wellbeing leads and patient-facing ambulance staff, as well as 
undertaking documentary analysis of ambulance trust policies on wellbeing. The 
study was conducted both before and during the UK first COVID-19 pandemic wave. 
The University of Lincoln ethics committee and the Health Research Authority 
(HRA) granted ethical approval. Overall, we analysed 57 staff wellbeing policy 
documents across all Trusts. Additionally, we interviewed a Health and Wellbeing 
Lead in eight Trusts as well as 25 ambulance and control room staff across three 
Trusts.
RESULTS: The study highlighted clear variations between organisational and 
individual actions to support wellbeing across Trust policies. Wellbeing leads 
acknowledged real 'tensions' between individual and organisational 
responsibility for wellbeing. Behaviour changes around diet and exercise were 
perceived to have a positive effect on the overall mental health of their 
workforce. Wellbeing leads generally agreed that mental health was given primacy 
over other wellbeing initiatives. Variable experiences of health and wellbeing 
support were partly contingent on the levels of management support, impacted by 
organisational culture and service delivery challenges for staff.
CONCLUSION: Ambulance service work can impact upon physical and mental health, 
which necessitates effective support for staff mental health and wellbeing. 
Increasing the knowledge of line managers around the availability of services 
could improve engagement.

© 2022. The Author(s).

DOI: 10.1186/s12913-022-08729-1
PMCID: PMC9664049
PMID: 36380295 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1308. BMJ Open. 2022 Aug 5;12(8):e059873. doi: 10.1136/bmjopen-2021-059873.

Global impact of COVID-19 on surgeons and team members (GlobalCOST): a 
cross-sectional study.

Jaffry Z(1), Raj S(2), Sallam A(3), Lyman S(4), Negida A(5), Yiu CFA(6), Sobti 
A(6), Bua N(7), Field RE(8), Abdalla H(9), Hammad R(9), Qazi N(9), Singh B(10), 
Brennan PA(11), Hussein A(12), Narvani A(6), Jones A(13), Imam MA(6)(9); 
OrthoGlobe Collaborative.

Collaborators: Abbas G, Adeyeye AA, Althaher AN, Arnaout F, Arnaud AP, Elhadi M, 
Freitas AVC, Govindarajan KK, Kale SY, Lakshmi HN, Nakano LCU, Nasir AA, Pata F, 
Ravichandran C, Roslani AC, Yau EL, Zanin LFS.

Author information:
(1)Barts Health NHS Trust, London, UK zahra.jaffry@doctors.org.uk.
(2)King's College London, London, UK.
(3)Suez Canal University Hospitals, Ismailia, Egypt.
(4)Cornell University, Ithaca, New York, USA.
(5)University of Portsmouth, Portsmouth, UK.
(6)Ashford and St Peter's Hospitals, Surrey, UK.
(7)Barnet Hospital, Barnet, UK.
(8)South West London Elective Orthopaedic Centre, Epsom, UK.
(9)University of East London, London, UK.
(10)Medway NHS Foundation Trust, Gillingham, UK.
(11)Queen Alexandra Hospital, Portsmouth, UK.
(12)Royal Surrey Country Hospital, Surrey, UK.
(13)Norfolk and Norwich University Hospitals, Norwich, UK.

OBJECTIVES: To investigate the impact of COVID-19 on the well-being of surgeons 
and allied health professionals as well as the support provided by their 
institutions.
DESIGN: This cross-sectional study involved distributing an online survey 
through medical organisations, social media platforms and collaborators.
SETTING: It included all staff based in an operating theatre environment around 
the world.
PARTICIPANTS: 1590 complete responses were received from 54 countries between 15 
July and 15 December 2020. The average age of participants was 30-40 years old, 
64.9% were men and 32.5% of a white ethnic background. 79.5% were surgeons with 
the remainder being nurses, assistants, anaesthetists, operating department 
practitioners or classified other.
MAIN OUTCOME MEASURES: Participants that had experienced any physical illness, 
changes in mental health, salary or time with family since the start of the 
pandemic as well as support available based on published recommendations.
RESULTS: 32.0% reported becoming physically ill. This was more likely in those 
with reduced access to personal protective equipment (OR 4.62; CI 2.82 to 7.56; 
p&lt;0.001) and regular breaks (OR 1.56; CI 1.18 to 2.06; p=0.002). Those with a 
decrease in salary (29.0%) were more likely to have an increase in anxiety (OR 
1.50; CI 1.19 to 1.89; p=0.001) and depression (OR 1.84; CI 1.40 to 2.43; 
p&lt;0.001) and those who spent less time with family (35.2%) were more likely 
to have an increase in depression (OR 1.74; CI 1.34 to 2.26; p&lt;0.001). Only 
36.0% had easy access to occupational health, 44.0% to mental health services, 
16.5% to 24/7 rest facilities and 14.2% to 24/7 food and drink facilities. Fewer 
measures were available in countries with a low Human Development Index.
CONCLUSIONS: This work has highlighted a need and strategies to improve 
conditions for the healthcare workforce, ultimately benefiting patient care.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-059873
PMCID: PMC9361744
PMID: 36378650 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


1309. Holist Nurs Pract. 2023 Jan-Feb 01;37(1):34-44. doi: 
10.1097/HNP.0000000000000561.

Effect of Telehealth Nursing Intervention on Psychological Status and Coping 
Strategies Among Parents During COVID-19 Pandemic.

Ebrahem SM(1), Badawy SA, Hassan RA, Radwan HA, Shokr EA, Hussein AA.

Author information:
(1)Faculty of Nursing, Menoufia University, Menoufia Governorate, Egypt.

Given the serious threats posed by the COVID-19 virus, preventive measures and 
coping strategies are critical in lowering infection rates, managing disease 
transmission, and improving people's psychological well-being. This study aimed 
to evaluate the effect of telehealth nursing intervention on psychological 
status and coping strategies among parents during the second wave of COVID-19. A 
quasi-experimental (one group pre-/posttest) design was used. A purposive sample 
of 209 parents in Menoufia governorate, Egypt, was collected using Google Form. 
Tools: (1) Structured questionnaire for parents (a) Demographic data (b) 
Parents' knowledge regarding COVID-19. (2) Parents' preventive practices of the 
COVID-19 questionnaire. (3) Parents" coping strategies with COVID-19 pandemic 
questionnaire. (4) Depression, Anxiety, and Stress Scale (Arabic DASS-21). 
Approximately 82.8% of the participants had normal to mild depression after the 
telehealth nursing intervention compared with 62.6% before the telehealth 
nursing intervention. Approximately 55.4% of them had moderate to extremely 
severe level of anxiety before the telehealth nursing intervention compared with 
(21.6%) after the telehealth nursing intervention. Approximately 85.2% reported 
a normal level of stress after the telehealth nursing intervention compared with 
(62.7%) before the telehealth nursing. Telehealth nursing intervention was 
effective for improving parents' knowledge, preventive practice, and coping 
strategies during the second wave of COVID-19.

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/HNP.0000000000000561
PMID: 36378090 [Indexed for MEDLINE]


1310. Cyberpsychol Behav Soc Netw. 2022 Dec;25(12):776-783. doi: 
10.1089/cyber.2022.0010. Epub 2022 Nov 14.

The More COVID-19 Information We Shared; the More Anxious We Got? The 
Associations Among Social Media Use, Anxiety, and Coping Strategies.

Yu SC(1).

Author information:
(1)Department of Counseling and Applied Psychology, National Taichung University 
of Education, Taichung, Taiwan.

Social media (SM) are crucial channels for the spread of information on 
COVID-19. However, they have rarely been explored. This study examined three 
types of social media use (SMU): SM usage time, passive SMU (PSMU), active SMU 
(ASMU) and investigated the relationships among three type of SMU, anxiety, and 
coping strategies. We recruited 1,150 adults in Taiwan for this study. Although 
past research found that ASMU is associated with well-being and that PSMU is 
associated with negative emotions, the findings of this study indicated that 
only ASMU could significantly predict anxiety; PSMU and SM usage time could not 
predict anxiety. The reason may be that individuals with unmet basic needs may 
depend on ASMU to satisfy their need for relatedness, competence, and autonomy. 
However, compared with PSMU, ASMU is more likely to be immersed anxiety due to 
its continuous exposure to COVID-19 news. The results regarding the paths 
between SMU and coping strategies were similar; a greater predictive coefficient 
existed between ASMU and avoidant coping, whereas the other two types of SMU 
were non-significant or weak predictors of coping strategies. Individuals may 
post things indicating that the pandemic is slowing down or is not scary to 
reduce their anxiety, deny the severity of issues, and cope with stress. On the 
whole, this study found that ASMU involving the pandemic can be used to predict 
psychological consequences and avoidant coping.

DOI: 10.1089/cyber.2022.0010
PMID: 36374255 [Indexed for MEDLINE]


1311. Int J Soc Psychiatry. 2023 May;69(3):774-783. doi: 10.1177/00207640221136795. 
Epub 2022 Nov 14.

Changes in household debt due to COVID-19 and mental health concerns among 
adults in Ontario, Canada.

Nigatu YT(1), Elton-Marshall T(1)(2)(3)(4)(5), Hamilton HA(1)(3)(4).

Author information:
(1)Institute for Mental Health Policy Research, Centre for Addiction and Mental 
Health, Toronto, ON, Canada.
(2)School of Epidemiology and Public Health, Faculty of Medicine, University of 
Ottawa, Ottawa, ON, Canada.
(3)Dalla Lana School of Public Health, University of Toronto, Toronto, ON, 
Canada.
(4)Campbell Family Mental Health Research Institute, Centre for Addiction and 
Mental Health, Toronto, ON, Canada.
(5)Department of Epidemiology and Biostatistics, Schulich School of Medicine and 
Dentistry, Western University, London, ON, Canada.

BACKGROUND: Canadian households experienced unexpected changes in their economic 
well-being during the COVID-19 pandemic. The extent of the impact of the 
pandemic on household debt and its effect on health and mental health remains 
unknown.
AIM: The aim of the study was to examine the associations of change in household 
debt due to COVID-19 with serious psychological distress (SPD) and general 
health measures.
METHODS: Data were from the 2020 Monitor study, a repeated cross-sectional 
survey of adults 18 years and older in Ontario, Canada. The 2020 cycle employed 
a web-based panel survey of 3,033 adults. The survey included measures of change 
in household debt due to the COVID-19 pandemic, mental and general health. Odds 
ratios (OR) were estimated from logistic regression models accounting for 
sociodemographic factors.
RESULTS: Overall, 17.5% of respondents reported that their household debt 
increased due to the COVID-19 pandemic. Such an increase in household debt was 
significantly associated with SPD (OR = 2.92, 95% CI, 2.05-4.16), fair/poor 
mental health (OR = 2.02, 95% CI, 1.59-2.56), frequent mental distress days 
(OR = 1.80, 95% CI, 1.31-2.48), fair/poor general health (OR = 1.93, 95% CI, 
1.47-2.52), and suicidal ideation (OR = 3.71, 95% CI, 2.41-5.70) after adjusting 
for potential confounders including education, income and employment.
CONCLUSIONS: Household debt during the COVID-19 pandemic is an important 
determinant of health. Individuals who reported an increase in household debt 
due to COVID-19 were more likely to report serious mental health concerns 
including suicidal ideation. This suggests that debt-related interventions may 
be needed to alleviate the adverse effects of indebtedness on health.

DOI: 10.1177/00207640221136795
PMCID: PMC9666416
PMID: 36373945 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1312. Br J Soc Psychol. 2023 Apr;62(2):845-865. doi: 10.1111/bjso.12600. Epub 2022 Nov 
13.

Identity-based social support predicts mental and physical health outcomes 
during COVID-19.

Carter H(1), Dennis A(1), Williams N(1), Weston D(1).

Author information:
(1)Behavioural Science and Insights Unit, UK Health Security Agency, Salisbury, 
UK.

During the COVID-19 pandemic, the United Kingdom implemented physical distancing 
measures to minimize viral transmission, which may have adversely impacted 
health and wellbeing. Evidence suggests that social support may be key to 
mitigating against adverse health impacts of such measures, particularly when 
such social support is identity-based. In this longitudinal study, we examined 
the role of social identity and perceived social support in mental and physical 
health outcomes during the COVID-19 pandemic. Participants completed a survey at 
4 time points during the first year of the pandemic: May/June 2020 (T1; 
N = 443); September/October 2020 (T2; N = 235); December 2020/January 2021 (T3; 
N = 243); and April 2021 (T4; N = 206). Results showed that at each time point, 
social support was predicted by identification with multiple groups before 
COVID-19, identity continuity, and identification with communities. Higher 
identity continuity and identification with communities both predicted greater 
mental and physical health at the same time point, mediated by perceived social 
support. Interestingly, higher identity continuity and identification with 
communities predicted higher social support at the same time point, which in 
turn predicted worse mental and physical health outcomes at the subsequent time 
point. Findings are discussed in relation to the context of the first year of 
the pandemic and the changing nature of societal restrictions across the four 
survey time points.

© 2022 The Authors. British Journal of Social Psychology published by John Wiley 
& Sons Ltd on behalf of British Psychological Society.

DOI: 10.1111/bjso.12600
PMCID: PMC9877754
PMID: 36372928 [Indexed for MEDLINE]

Conflict of interest statement: No competing interests.


1313. J Paediatr Child Health. 2022 Nov;58(11):2051-2057. doi: 10.1111/jpc.16155. Epub 
2022 Aug 12.

Parenting stress, maternal depression and child mental health in a Melbourne 
cohort before and during the COVID-19 pandemic.

Galbally M(1)(2)(3), Watson SJ(1)(2)(3), Lewis AJ(4), van IJzendoorn MH(5)(6).

Author information:
(1)School of Clinical Sciences, Monash University, Melbourne, Victoria, 
Australia.
(2)Health Futures Institute, Murdoch University, Perth, Western Australia, 
Australia.
(3)School of Medicine, University of Notre Dame, Fremantle, Western Australia, 
Australia.
(4)Institute of Health and Wellbeing, Federation University, Ballarat, Victoria, 
Australia.
(5)Department of Psychology, Education and Child Studies, Erasmus University 
Rotterdam, Rotterdam, the Netherlands.
(6)Department of Clinical, Educational and Health Psychology, Faculty of Brain 
Sciences, UCL, London, United Kingdom.

Comment in
    J Paediatr Child Health. 2023 Mar;59(3):597-598.

AIM: This paper aims to examine the maternal and child mental health and 
parenting outcomes in the context of COVID-19 pandemic conditions using a sample 
from Melbourne, Australia - a city exposed to one of the longest lockdowns 
world-wide in response to the pandemic.
METHODS: This study utilises observational data from a prospective, pregnancy 
cohort, Mercy Pregnancy Emotional Wellbeing Study and includes 468 women and 
their children followed up in Melbourne to 3-4 years postpartum pre-COVID 
pandemic and compared to those followed up during the COVID-19 pandemic.
RESULTS: When compared to mothers followed up at 3-4 years postpartum 
pre-pandemic, those followed up during the COVID-19 pandemic showed higher 
depressive symptoms with a steep incline in their symptom trajectory 
(EMMdifference  = 1.72, Bonferroni-corrected P < 0.01, d = 0.35) and had a three 
times higher risk of scoring 13 or above on the EPDS (aRR = 3.22, 
Bonferroni-corrected P < 0.01). Although this increase was not associated with 
the variation in the duration of exposure to pandemic conditions, the steep 
increase in depressive symptoms was more pronounced in those with pre-existing 
depressive disorders. There was no difference in parenting stress or adjusted 
childhood mental health symptoms or disorder.
CONCLUSIONS: Our findings highlight the vulnerability of those with pre-existing 
clinical mental health disorders and the need for adequate clinical care for 
this vulnerable group. Equally, our study indicates the possibility that  
parenting and early childhood mental health outcomes, at least in the short 
term, may be resilient.

© 2022 The Authors. Journal of Paediatrics and Child Health published by John 
Wiley & Sons Australia, Ltd on behalf of Paediatrics and Child Health Division 
(The Royal Australasian College of Physicians).

DOI: 10.1111/jpc.16155
PMCID: PMC9537807
PMID: 36371627 [Indexed for MEDLINE]


1314. Aust Crit Care. 2023 Jan;36(1):44-51. doi: 10.1016/j.aucc.2022.10.001. Epub 2022 
Oct 11.

The impact of the COVID-19 pandemic on critical care healthcare professionals' 
work practices and wellbeing: A qualitative study.

Elliott R(1), Crowe L(2), Pollock W(3), Hammond NE(4).

Author information:
(1)Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital and 
Centre for Nursing and Midwifery Research, Northern Sydney Local Health 
District, Pacific Highway, St Leonards NSW 2065 Australia; Faculty of Health, 
University of Technology, Ultimo NSW 2007 Australia. Electronic address: 
Rosalind.Elliott@health.nsw.gov.au.
(2)School of Medicine, Brisbane, The University of Queensland, 20 Weightman 
Street, Herston QLD 4006 Australia; Queensland Children's Hospital, 501 Stanley 
Street, South Brisbane, QLD 4101 Australia. Electronic address: 
Liz.Crowe@health.qld.gov.au.
(3)Faculty of Medicine, Nursing and Health Sciences, Monash University, 35 
Rainforest Walk, Clayton, VIC 3800, Australia; Department of Nursing, Midwifery 
and Health, Northumbria University, Benton, Newcastle-upon-Tyne, NE7 7XA, UK. 
Electronic address: wendy.pollock@monash.edu.
(4)Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital and 
Centre for Nursing and Midwifery Research, Northern Sydney Local Health 
District, Pacific Highway, St Leonards NSW 2065 Australia; Critical Care 
Division, The George Institute for Global Health and University of NSW, Level 5, 
1 King Street, Newtown NSW 2042 Australia. Electronic address: 
nhammond@georgeinstitute.org.au.

BACKGROUND: Burnout and other psychological comorbidities were evident prior to 
the COVID-19 pandemic for critical care healthcare professionals (HCPs) who have 
been at the forefront of the health response. Current research suggests an 
escalation or worsening of these impacts as a result of the COVID-19 pandemic.
OBJECTIVES: The objective of this study was to undertake an in-depth exploration 
of the impact of the evolving COVID-19 pandemic on the wellbeing of HCPs working 
in critical care.
METHODS: This was a qualitative study using online focus groups (n = 5) with 
critical care HCPs (n = 31, 7 medical doctors and 24 nurses) in 2021: one with 
United Kingdom-based participants (n = 11) and four with Australia-based 
participants (n = 20). Thematic analysis of qualitative data from focus groups 
was performed using Gibbs framework.
FINDINGS: Five themes were synthesised: transformation of anxiety and fear 
throughout the pandemic, the burden of responsibility, moral distress, COVID-19 
intruding into all aspects of life, and strategies and factors that sustained 
wellbeing during the pandemic. Moral distress was a dominant feature, and 
intrusiveness of the pandemic into all aspects of life was a novel finding.
CONCLUSIONS: The COVID-19 pandemic has adversely impacted critical care HCPs and 
their work experience and wellbeing. The intrusiveness of the pandemic into all 
aspects of life was a novel finding. Moral distress was a predominate feature of 
their experience. Leaders of healthcare organisations should ensure that 
interventions to improve and maintain the wellbeing of HCPs are implemented.

Crown Copyright © 2022. Published by Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.aucc.2022.10.001
PMCID: PMC9550671
PMID: 36371294 [Indexed for MEDLINE]


1315. Aust Crit Care. 2023 Sep;36(5):793-798. doi: 10.1016/j.aucc.2022.09.006. Epub 
2022 Nov 9.

Psychological stress and associated factors in caring for patients with delirium 
among intensive care unit nurses: A cross-sectional study.

Wang Y(1), Li L(2), Tan S(3), Guan Y(4), Luo X(5).

Author information:
(1)Xiangya School of Nursing, Central South University, Changsha, Hunan 
province, 410013, China. Electronic address: wyy150380@163.com.
(2)Xiangya School of Nursing, Central South University, Changsha, Hunan 
province, 410013, China. Electronic address: lilezhi@csu.edu.cn.
(3)Xiangya School of Nursing, Central South University, Changsha, Hunan 
province, 410013, China. Electronic address: simintan@csu.edu.cn.
(4)Nursing Department, Lanzhou University Second Hospital, Lanzhou, Gansu 
province, 730030, China. Electronic address: 1424826371@qq.com.
(5)The Second Xiangya Hospital, Central South University, Changsha, Hunan 
province, 410013, China. Electronic address: 410678849@qq.com.

BACKGROUND: Caring for patients with delirium is challenging and overwhelming 
for intensive care unit (ICU) nurses. Investigating the psychological impact of 
delirium care on ICU nurses is crucial to maintaining their psychological health 
and improving the quality of care.
OBJECTIVE: The objective of this study was to investigate the psychological 
stress of ICU nurses in caring for patients with delirium and potential factors.
METHODS: A total of 355 nurses from three tertiary care hospitals in Hunan 
Province, China, participated in this cross-sectional survey. Data were 
collected using the demographic sheet, Impact of Event Scale-Revised, 
Connor-Davidson Resilience Scale, and Occupational Coping Self-Efficacy Scale 
for Nurses. Descriptive and multiple linear regression analyses were used to 
examine the factors associated with psychological stress.
RESULTS: ICU nurses suffered moderate psychological stress related to delirium 
care. The recent time to care for patients with delirium (P < 0.001), 
familiarity with delirium-related knowledge (P = 0.002), satisfaction with 
delirium-related support (P = 0.046), psychological resilience (P < 0.001), and 
occupational coping self-efficacy (P < 0.001) were significant contributors to 
psychological stress.
CONCLUSION: Nurse managers and researchers need to focus on the psychological 
well-being of ICU nurses in caring for patients with delirium, especially those 
who are currently caring for patients with delirium, and provide tailored 
support, increase their knowledge of delirium, and also boost psychological 
resilience and coping skills.

Copyright © 2022 Australian College of Critical Care Nurses Ltd. Published by 
Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.aucc.2022.09.006
PMID: 36371293 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest The authors declare that 
there is no conflict of interest regarding the publication of this manuscript.


1316. Br J Nurs. 2022 Nov 10;31(20):1058-1062. doi: 10.12968/bjon.2022.31.20.1058.

Supporting nursing, midwifery and allied health professional teams through 
restorative clinical supervision.

Baldwin S(1), Coyne T(2), Kelly P(3).

Author information:
(1)Clinical Academic Lead (Nursing & Midwifery), London North West University 
Healthcare Trust.
(2)Service & Practice Development Facilitator/Preceptorship & Restorative 
Supervision Lead, London North West University Healthcare Trust.
(3)Service and Practice Development Facilitator, London North West University 
Healthcare Trust.

The mental health and wellbeing of healthcare staff have been significantly 
affected by the demands resulting from the recent COVID-19 pandemic. Restorative 
supervision is a type of clinical supervision that supports reflective practice 
that can help build practitioners' resilience by focusing on the individual's 
experience, aiming to sustain their wellbeing and their motivation at work. This 
model has been shown to reduce stress and burnout and increase compassion 
satisfaction. This article discusses the implementation of a restorative 
clinical supervision programme used to support staff wellbeing in nursing, 
midwifery and allied health professional teams in a large London-based NHS 
trust.

DOI: 10.12968/bjon.2022.31.20.1058
PMID: 36370404 [Indexed for MEDLINE]


1317. Int J Obes (Lond). 2023 Jan;47(1):51-59. doi: 10.1038/s41366-022-01232-x. Epub 
2022 Nov 11.

Supporting Weight Management during COVID-19 (SWiM-C): twelve-month follow-up of 
a randomised controlled trial of a web-based, ACT-based, guided self-help 
intervention.

Mueller J(1), Richards R(2), Jones RA(2), Whittle F(2), Woolston J(2), Stubbings 
M(2), Sharp SJ(2), Griffin SJ(2)(3), Bostock J(4), Hughes CA(5)(6), Hill AJ(7), 
Boothby CE(2), Ahern AL(2).

Author information:
(1)MRC Epidemiology Unit, University of Cambridge, Cambridge, UK. 
Julia.Mueller@mrc-epid.cam.ac.uk.
(2)MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
(3)Primary Care Unit, Department of Public Health and Primary Care, University 
of Cambridge, Cambridge, UK.
(4)Patient and Public Involvement representative, Cambridge, UK.
(5)Fakenham Medical Practice, Fakenham, UK.
(6)Medical School, University of East Anglia, Norwich, UK.
(7)Division of Psychological and Social Medicine, School of Medicine, University 
of Leeds, Leeds, UK.

Erratum in
    Int J Obes (Lond). 2023 Sep;47(9):882.

OBJECTIVES: We developed a guided self-help intervention (Supporting Weight 
Management during COVID-19, "SWiM-C") to support adults with overweight or 
obesity in their weight management during the COVID-19 pandemic. This parallel, 
two-group trial (ISRCTN12107048) evaluated the effect of SWiM-C on weight and 
determinants of weight management over twelve months.
METHODS: Participants (≥18 years, body-mass-index ≥25 kg/m2) were randomised to 
the SWiM-C intervention or to a standard advice group (unblinded). Participants 
completed online questionnaires at baseline, four months, and twelve months. The 
primary outcome was change in self-reported weight from baseline to twelve 
months; secondary outcomes were eating behaviour (uncontrolled eating, emotional 
eating, cognitive restraint of food intake), experiential avoidance, depression, 
anxiety, stress, wellbeing and physical activity.
INTERVENTIONS: SWiM-C is based on acceptance and commitment therapy (ACT). 
Participants had access to an online web platform with 12 weekly modules and 
email and telephone contact with a trained, non-specialist coach. Standard 
advice was a leaflet on managing weight and mood during the COVID-19 pandemic.
RESULTS: 388 participants were randomised (SWiM-C: n = 192, standard advice: 
n = 196). The baseline-adjusted difference in weight change between SWiM-C 
(n = 119) and standard advice (n = 147) was -0.81 kg (95% CI: -2.24 to 0.61 kg). 
SWiM-C participants reported a reduction in experiential avoidance (-2.45 
[scale:10-70], 95% CI: -4.75 to -0.15), uncontrolled eating (-3.36 [scale: 
0-100], 95% CI: -5.66 to -1.06), and emotional eating (-4.14 [scale:0-100], 95% 
CI: -7.25 to -1.02) and an increase in physical activity (8.96 [MET-min/week], 
95% CI: 0.29 to 17.62) compared to standard advice participants. We found no 
evidence of an effect on remaining outcomes. No adverse events/side effects were 
reported.
CONCLUSIONS: Whilst we were unable to conclude that the intervention had an 
effect on weight, SWiM-C improved eating behaviours, experiential avoidance and 
physical activity. Further refinement of the intervention is necessary to ensure 
meaningful effects on weight prior to implementation in practice.
TRIAL REGISTRATION NUMBER: ISRCTN 12107048.

© 2022. The Author(s).

DOI: 10.1038/s41366-022-01232-x
PMCID: PMC9651901
PMID: 36369513 [Indexed for MEDLINE]

Conflict of interest statement: RAJ, FW, JW, MS, SJS and JB report no conflicts 
of interest. AJH has consulted for Slimming World. CAH reports payment or 
honoraria from Ethicon, NovoNordisk and International Medical Press for 
lectures, presentations, speakers bureaus, manuscript writing or educational 
events. JM and RR are Trustees for the Association of the Study of Obesity 
(unpaid roles). ALA and SJG are the chief investigators on two publicly funded 
(MRC, NIHR) trials where the intervention is provided by WW (formerly Weight 
Watchers) at no cost outside the submitted work. ALA is a member of the 
Scientific Advisory Board for WW.


1318. J Community Health. 2023 Apr;48(2):218-227. doi: 10.1007/s10900-022-01166-5. 
Epub 2022 Nov 11.

Experiences with Eviction, House Foreclosure, and Homelessness Among COVID-19 
Infected Adults and Their Relation to Mental Health in a Large U.S. City.

Tsai J(1)(2), Grace A(3), Vazquez M(3).

Author information:
(1)School of Public Health, University of Texas Health Science Center at 
Houston, 7411 John Smith Drive, Suite 1100, San Antonio, TX, 78229, USA. 
Jack.Tsai@uth.tmc.edu.
(2)National Center on Homelessness Among Veterans, Homeless Programs Office, 
U.S. Department of Veterans Affairs Central Office, Washington, DC, USA. 
Jack.Tsai@uth.tmc.edu.
(3)School of Public Health, University of Texas Health Science Center at 
Houston, 7411 John Smith Drive, Suite 1100, San Antonio, TX, 78229, USA.

This study examined experiences with eviction, house foreclosures, and 
homelessness in a large U.S. city sample of adults with Coronavirus Disease-2019 
(COVID-19). A total of 3595 adults with COVID-19 participated in an assessment 
of health and well-being after completing contact tracing activities. The sample 
had a 5.7% lifetime prevalence of eviction, 3.7% lifetime prevalence of house 
foreclosure, and 8.2% lifetime prevalence of homelessness. Relative importance 
analyses revealed drug use was the most important variable associated with any 
lifetime eviction, lifetime house foreclosure, lifetime homelessness, and being 
currently at-risk of eviction or recently evicted. Loneliness was also 
relatively strongly associated with any lifetime eviction or homelessness, while 
socioeconomic characteristics were the most importance variables associated with 
late mortgage payments in the past month. Treatment for addiction problems may 
be important for in the aftermath of the COVID-19 pandemic and adults with 
histories of housing instability may be particularly at risk.

© 2022. This is a U.S. Government work and not under copyright protection in the 
US; foreign copyright protection may apply.

DOI: 10.1007/s10900-022-01166-5
PMCID: PMC9651872
PMID: 36369286 [Indexed for MEDLINE]

Conflict of interest statement: None of the authors reports any conflicts of 
interest with this work.


1319. Health Promot Int. 2022 Dec 1;37(6):daac134. doi: 10.1093/heapro/daac134.

Predicted and observed impacts of COVID-19 lockdowns: two Health Impact 
Assessments in Scotland and Wales.

Green L(1)(2), Ashton K(1)(2), Bellis M(1)(3), Clements T(3), Douglas M(4)(5).

Author information:
(1)Policy and International Health, WHO Collaborating Centre on 'Investment in 
Health and Well-being', Public Health Wales, Number 2 Capital Quarter, Tyndall 
Street, Cardiff CF10 4BZ, UK.
(2)Department of International Health, Care and Public Health Research Institute 
- CAPHRI, Maastricht University, Maastricht, The Netherlands.
(3)Department of Public Health and Life Sciences, Bangor University, College 
Road, Bangor LL57 2DG, UK.
(4)Usher Institute, University of Edinburgh, Medical School, Teviot Place, 
Edinburgh EH8 9AG, UK.
(5)Public Health Scotland, Gyle Square, Edinburgh EH12 9EB, UK.

Health Impact Assessment is a key approach used internationally to identify 
positive or negative impacts of policies, plans and proposals on health and 
well-being. In 2020, HIAs were undertaken in Scotland and Wales to identify the 
potential health and well-being impacts of the 'stay at home' and physical 
distancing measures implemented at the start of the coronavirus disease 
(COVID-19) pandemic. There is sparse evidence evaluating whether the impacts 
predicted in HIAs occur following policy implementation. This paper evaluates 
the impacts anticipated in the COVID-19 HIAs against actual observed trends. The 
processes undertaken were compared and predicted impacts were tabulated by 
population groups and main determinants of health. Routine data and literature 
evidence were collated to compare predicted and observed impacts. Nearly all 
health impacts anticipated in both HIAs have occurred in the direction 
predicted. There have been significant adverse impacts through multiple direct 
and indirect pathways including loss of income, social isolation, disruption to 
education and services, and psychosocial effects. This research demonstrates the 
value of prediction in impact assessment and fills a gap in the literature by 
comparing the predicted impacts identified within the HIAs with observed trends. 
Post-COVID-19 recovery should centre health and well-being within future 
policies and decisions. Processes like HIA can support this as part of a 'health 
in all policies' approach to improve the health and well-being of populations.

Plain Language Summary: Health Impact Assessment (HIA) is an approach used to 
identify positive or negative impacts of policies, plans and proposals on health 
and well-being. In 2020, HIAs were undertaken in Scotland and Wales to identify 
the potential health and well-being impacts of the ‘stay at home’ and physical 
distancing measures (commonly called ‘lockdown’) which were put in place at the 
start of the COVID-19 pandemic. This paper evaluates whether these assessments 
were correct in their predictions. It finds that most of the health impacts 
anticipated in both assessments have occurred. These include significant impacts 
on income, employment and mental health. Using HIAs can help policymakers to 
take full account of these wider impacts on health and develop policies that 
benefit health and health equity.

© The Author(s) 2022. Published by Oxford University Press.

DOI: 10.1093/heapro/daac134
PMCID: PMC9651036
PMID: 36367421 [Indexed for MEDLINE]


1320. Int J Environ Res Public Health. 2022 Nov 3;19(21):14410. doi: 
10.3390/ijerph192114410.

The Impact of the COVID-19 Crisis on the Practices and Mental Health of 
Psychologists in Belgium: Between Exhaustion and Resilience.

Glowacz F(1), Schmits E(1), Kinard A(1).

Author information:
(1)Department of Psychology-Adaptation Resilience and Change Research Unit 
(ARCh), University of Liege-Belgium, Place des Orateurs, 1-B33, 4000 Liège, 
Belgium.

While the COVID-19 pandemic has created psychological distress in the general 
population and increased the need for psychological care, little research has 
been done on how mental health practitioners (MHP) have been affected by the 
pandemic, and these health professionals have received little attention from 
public authorities. In this article, we focus on psychologists and the impact 
that the pandemic has had on their mental health and practices by exploring the 
adaptive and innovative responses generated. This study is based on an online 
survey (including multiple choice questions, several validated scales, and eight 
free text items) completed by 187 psychologists (86% female) one year after the 
beginning of the COVID-19 pandemic in Belgium (February-April 2021). Most 
participants considered that the crisis had an impact on their well-being and 
mental health. However, the prevalence of symptoms of depression and anxiety was 
relatively low (17%; 12%). On the other hand, the majority of psychologists 
(72%) suffered from a medium level of burnout (BO), 7% suffered from a high 
level of BO, and only 21% had low levels of BO. Psychologists working in 
face-to-face settings had the highest scores on the "exhaustion" subscale of the 
BO, and those working primarily with patients in precarious situations had 
significantly higher scores of BO and exhaustion. Qualitative analysis of free 
text items showed that MHP were resilience and developed new frameworks and 
modes for proactive interventions in order to reach their patients, meet the 
psychological and social population's needs, and maintain their relationships 
with the network. In a crisis or pandemic context, public policies should take 
into account the psychological and social needs of the most socially precarious 
populations in reinforcing and supporting mental health professionals working in 
this sector.

DOI: 10.3390/ijerph192114410
PMCID: PMC9655206
PMID: 36361297 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1321. Int J Environ Res Public Health. 2022 Nov 3;19(21):14419. doi: 
10.3390/ijerph192114419.

Moderating Effects of Religious Tourism Activities on Environmental Risk, 
Leisure Satisfaction, Physical and Mental Health and Well-Being among the 
Elderly in the Context of COVID-19.

Lin HH(1), Lin TY(2), Hsu CW(3), Chen CH(4), Li QY(5), Wu PH(6).

Author information:
(1)Department of Leisure Industry Management, National Chin-Yi University of 
Technology, Taichung 41170, Taiwan.
(2)Department of Sport Information and Communication, National Taiwan University 
of Sport, Taichung 404401, Taiwan.
(3)College of History, Culture and Tourism, Yulin Normal University, Yulin 
537000, China.
(4)Department of Sport Performance, National Taiwan University of Sport, 
Taichung 404401, Taiwan.
(5)School of Physical Education, Jiaying University, Meizhou 514015, China.
(6)Department of Environmental Science and Engineering, National Pingtung 
University of Science and Technology, Pingtung 912301, Taiwan.

The purpose of this study is to explore whether religious tourism activities can 
create a safe leisure environment and improve the well-being of the elderly 
during the COVID-19 pandemic, with the participants in the Baishatun Mazu 
pilgrimage in Taiwan as the subjects of this study. A mixed research method was 
used. First, statistical software and the Pearson product-moment correlation 
coefficient were used to analyze the data. Then the respondents' opinions were 
collected. Finally, a multivariate analysis method was used to discuss the 
results of analysis. The findings showed that the elderly respondents thought 
that the epidemic prevention information and leisure space planning for the 
pilgrimage made them feel secure. The elderly believed the scenery, religious 
atmosphere, and commodities en route could reduce the perception of 
environmental risks to tourists, relieve pressure on the brain, and increase 
social opportunities. Therefore, the friendlier the leisure environment around 
the pilgrimage, the greater the leisure satisfaction among the elderly 
respondents. The happier the elderly felt, the less they considered the 
concentration of airborne contaminants, including viruses. The better their 
physical and mental health was, the less likely they were to want to ask for 
religious goods.

DOI: 10.3390/ijerph192114419
PMCID: PMC9658456
PMID: 36361295 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1322. Int J Environ Res Public Health. 2022 Oct 31;19(21):14231. doi: 
10.3390/ijerph192114231.

Workplace Wellbeing and Quality of Life Perceived by Portuguese Nurses during 
the COVID-19 Pandemic: The Role of Protective Factors and Stressors.

Sampaio F(1)(2), Salgado R(3), Antonini M(3), Delmas P(3), Oulevey Bachmann 
A(3), Gilles I(4), Ortoleva Bucher C(3).

Author information:
(1)Higher School of Health Fernando Pessoa, Rua Delfim Maia, 334, 4200-253 
Porto, Portugal.
(2)CINTESIS@RISE-Center for Health Technology and Services Research/Health 
Research Network from the Lab to the Community, Rua Dr. Plácido da Costa, 
4200-450 Porto, Portugal.
(3)La Source School of Nursing, HES-SO University of Applied Sciences and Arts 
Western Switzerland, Av. Vinet 30, 1004 Lausanne, Switzerland.
(4)Epidemiology and Health Systems, Center for Primary Care and Public Health, 
1010 Lausanne, Switzerland.

During the COVID-19 pandemic, nurses were exposed to many stressors, which may 
have been associated with some mental health problems. However, most of the 
studies carried out on nurses' quality of life and workplace wellbeing during 
the COVID-19 pandemic took a pathogenic approach. Given that current scientific 
knowledge in this field presented too many gaps to properly inform preventive 
and therapeutic action, the aim of this study was to explore whether protective 
factors (resilience, perceived social support, and professional identification) 
and stressors (perceived stress and psychosocial risks in the workplace) 
influenced the quality of life and workplace wellbeing perceived by Portuguese 
nurses during the COVID-19 pandemic. Data for this cross-sectional study was 
collected through online self-administered questionnaires. Linear regression 
models were used to analyze the relationships between variables. Results showed 
that perceived stress, resilience and job satisfaction were associated with 
quality of life and workplace wellbeing among Portuguese nurses. The study's 
findings could serve to inform health policy and should draw the attention of 
nursing managers to the needs and difficulties reported by nurses, to the 
importance of providing them with emotional support, and to the relevance of 
promoting a good work environment.

DOI: 10.3390/ijerph192114231
PMCID: PMC9657238
PMID: 36361111 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1323. Int J Environ Res Public Health. 2022 Oct 31;19(21):14224. doi: 
10.3390/ijerph192114224.

Prevalence of Insomnia in the Early Post-COVID-19 Recovery Period.

Pudlo R(1), Jaworska I(2), Szczegielniak A(1), Niedziela J(3)(4), Kułaczkowska 
Z(3), Nowowiejska-Wiewióra A(3), Jaroszewicz J(5), Gąsior M(3)(4).

Author information:
(1)Department of Psychoprophylaxis, Faculty of Medical Sciences in Zabrze, 
Medical University of Silesia, 40-055 Katowice, Poland.
(2)Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, 
Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 
Katowice, Poland.
(3)3rd Department of Cardiology, Silesian Center for Heart Disease, 41-800 
Zabrze, Poland.
(4)3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical 
University of Silesia, 40-055 Katowice, Poland.
(5)Department of Infectious Diseases and Hepatology, Faculty of Medical Sciences 
in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland.

BACKGROUND: Sleep is a complex, reversible process that is responsible for the 
modulation of various physiological mechanisms. COVID-19-related sleep disorders 
are affecting different populations with a heterogenous prevalence, yet high 
rates among infected patients are frequently reported. The aim of the study is 
to assess the prevalence of insomnia in the early post-COVID-19 recovery period 
and explore the differences in the results acquired by the Athens Insomnia Scale 
(AIS) by gender and selected infection severity parameters.
METHODS: The data presented in the paper come from a prospective, observational 
study on COVID-19 complications (SILCOV-19) consisting of 200 COVID-19 patients. 
The AIS was used for the quantitative measurement of insomnia symptoms based on 
ICD-10 criteria.
RESULTS: 32% (n = 64) of all patients in the study group obtained results 
indicating sleep disturbances (>5 points on the scale), while 21.5% (n = 43) 
obtained results indicating insomnia (>10 points on the scale). The analysis of 
the results obtained by all patients in the AIS showed a significant correlation 
with the duration of symptoms (Spearman's rank-order: R = 0.18; p < 0.05), but 
not with the number of days spent in the hospital or age. Women achieved a 
higher score in overall AIS, as well as in questions assessing total sleep time, 
well-being the next day, physical and mental fitness the next day, and 
sleepiness during the day (p < 0.05).
CONCLUSIONS: the prevalence of insomnia in the early post-COVID-19 recovery 
period is high.

DOI: 10.3390/ijerph192114224
PMCID: PMC9654654
PMID: 36361102 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript, or in the decision to 
publish the results.


1324. Int J Environ Res Public Health. 2022 Oct 29;19(21):14159. doi: 
10.3390/ijerph192114159.

Help Needs among Parents and Families in Times of the COVID-19 Pandemic Lockdown 
in Germany.

Baldus C(1), Franz S(1), Thomasius R(1).

Author information:
(1)German Centre for Addiction Research in Childhood and Adolescence, University 
Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.

BACKGROUND: The COVID-19 pandemic was accompanied by multiple disruptions in the 
everyday lives of families. Previous research has underlined the negative impact 
of the pandemic on stress among parents and identified factors related to 
heightened levels of stress. Yet, several potential stressors have not been 
taken into account. Moreover, little is known about how general and 
pandemic-related stressors impacted help-seeking intentions for personal or 
family problems.
METHODS: We recruited N = 602 parents and their children (n = 101) for a 
cross-sectional online survey on parent, child and family well-being, stress and 
help need after the first wave of COVID-19 infections in Germany. Data were 
analysed using multinomial regression analyses to predict family help need, 
taking into account pre-pandemic help-seeking.
RESULTS: Parents showed high levels of stress, which were associated with 
pre-pandemic mental health, family functioning, pandemic related worries about 
finances, household workload and health worries. While 76.2% of families 
reported no during-pandemic help need, 11.3% reported a help need before and 
during the pandemic and 12.5% of families without prior help needs reported a 
new help need during the pandemic.
CONCLUSIONS: The results of the present study underline the need for help 
service providers to adapt their offers.

DOI: 10.3390/ijerph192114159
PMCID: PMC9655952
PMID: 36361040 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1325. Int J Environ Res Public Health. 2022 Oct 28;19(21):14040. doi: 
10.3390/ijerph192114040.

Remote Interventions to Support Students' Psychological Well-Being during the 
COVID-19 Pandemic: A Narrative Review of Recent Approaches.

Rutkowska A(1).

Author information:
(1)Department of Physical Education and Physiotherapy, Opole University of 
Technology, 45-758 Opole, Poland.

The COVID-19 pandemic has negatively affected students' mental health, and it is 
important to implement mental health management strategies. The purpose of this 
study was to present current findings on the implementation of remote mental 
health interventions in students during the pandemic. The PubMed and Web of 
Science electronic databases were searched and, from a total of 174 articles, 
106 records were excluded according to the inclusion criteria and 23 were 
assessed as full texts. After the full-text screening, 12 studies were included 
in the review. The included publications were randomized clinical trials focused 
on remote mental support interventions among students from 10 countries, 
representing both genders, and were in the average age range of 17-55 years with 
an overall number of 892 participants. The included studies covered the 
effectiveness of strictly psychotherapeutic programs, such as 
cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT), as 
well as other techniques such as mindfulness, laughter therapy, the brain wave 
modulation technique (BWM-T), and physical activity-based interventions. This 
narrative review provides an overview of studies with a wide range of types of 
remote mental health support interventions. Each of the forms of intervention 
analyzed in this review resulted in positive changes in students' mental health, 
which indicates hope for widespread help via various forms of intervention 
implemented remotely.

DOI: 10.3390/ijerph192114040
PMCID: PMC9656822
PMID: 36360919 [Indexed for MEDLINE]

Conflict of interest statement: The author declares no conflict of interest.


1326. Int J Environ Res Public Health. 2022 Oct 26;19(21):13928. doi: 
10.3390/ijerph192113928.

Social Health and Psychological Safety of Students Involved in Online Education 
during the COVID-19 Pandemic.

Korneeva E(1)(2), Strielkowski W(3), Krayneva R(1), Sherstobitova A(2).

Author information:
(1)Department of Mass Communications and Media Business, Financial University 
under the Government of the Russian Federation, Leningradsky Prospekt, 49, 
125993 Moscow, Russia.
(2)Institute of Finance, Economics and Management, Togliatti State University, 
Belorusskaya str. 14, 445020 Togliatti, Russia.
(3)Department of Trade and Finance, Faculty of Economics and Management, Czech 
University of Life Sciences Prague, Kamýcká 129, 16500 Prague, Czech Republic.

Our paper focuses on the issues of social health and psychological safety of 
university students involved in digital sustainable education during the 
COVID-19 pandemic. Currently, modern education is becoming inclusive due to the 
advancements in information and communication technologies (ICT), and it is 
important not only to stress the relevance of sustainable development and the 
use of digital technologies, but also their impact on students at schools and 
universities worldwide. Digital literacy is a newly emerging feature that 
results from the attitude of team members in the field of digital technologies. 
This paper explores the impacts of the COVID-19 pandemic on students' learning 
and well-being and outlines the potential considerations for educational systems 
as they support students through the recovery period and beyond. Our study is 
based on the results of our own survey that was administered using a snowball 
and convenient sample of 1524 respondents (aged 19-26 years; 56.2% females and 
43.8% males) from the Czech Republic (N = 804) and Russia (N = 720). We employed 
the ANOVA and Dirichlet Process mixtures of Generalized Linear Models (DP-GLM) 
in order to explain the causes of stress and anxiety after grouping variables 
represented by gender and the study specializations. Our results demonstrate 
that more than 87% of the students in the sample expressed a medium to high 
vulnerability to stress, while 58% of the respondents were affected by severe 
anxiety during their online education engagement. The most important factors 
that emerged as significant were the fear of getting infected and social 
distancing, while the best strategy to cope with the stress was self-control. 
These results allow us to provide practical recommendations for effectively 
coping with and controlling stress and anxiety among students in the 
post-pandemic era. In addition, our findings might contribute considerably to 
the study of the overall long-term effect of the COVID-19 pandemic on the 
university students, in general, and the use of digital technologies in higher 
education, as well as on the public health.

DOI: 10.3390/ijerph192113928
PMCID: PMC9655240
PMID: 36360806 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1327. Int J Environ Res Public Health. 2022 Oct 22;19(21):13759. doi: 
10.3390/ijerph192113759.

Emotion-Focused Mobile App for Promoting Self-Compassion, Self-Protection, and 
Self-Criticism.

Halamová J(1), Mihaľo J(1), Bakoš L(1).

Author information:
(1)Institute of Applied Psychology, Faculty of Social and Economic Sciences, 
Comenius University in Bratislava, Mlynské luhy 4, 821 05 Bratislava, Slovakia.

The COVID-19 pandemic has changed our daily lives and restricted access to 
traditional psychological interventions. Hence there is an immediate and growing 
demand for accessible and scalable mental health solutions. Emotion-focused 
training for self-compassion and self-protection was developed and distributed 
using mobile phone technologies, and its effectiveness was tested. The available 
research sample consisted of 97 participants with a mean age of 26.06 years and 
a standard deviation of 10.53. Participants using the mobile app underwent a 
14-day program aimed at reducing self-criticism while increasing self-compassion 
and self-protection. Pre- and post-measurements were collected. The results 
showed a statistically significant medium effect on self-compassion, 
self-criticism, and self-protection performance and a significant small effect 
on self-protection distress. The finding that a 14-day mobile app was able to 
foster well-being in the form of self-compassion, self-protection, and 
self-criticism is promising. It indicates the potential for individuals to 
obtain help through the use of remote tools such as MHapps for a fraction of the 
usual cost, at their own pace, and without other restrictions.

DOI: 10.3390/ijerph192113759
PMCID: PMC9658678
PMID: 36360637 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no potential 
conflict of interest.


1328. BMC Psychol. 2022 Nov 10;10(1):261. doi: 10.1186/s40359-022-00971-w.

Understanding the role of stress, personality and coping on learning motivation 
and mental health in university students during a pandemic.

Gibbons C(1).

Author information:
(1)School of Psychology, Queen's University Belfast, Belfast, BT7 1NN, UK. 
c.gibbons@qub.ac.uk.

The aims explored the associations between stress, personality and coping on 
student mental health and compared defensive-pessimism and optimism as 
influences on learning motivation. Most research construes 'stress' as 
'distress', with little attempt to measure the stress that enhances motivation 
and wellbeing. Undergraduate psychology students (N = 162) were surveyed on 
student and pandemic-related stressors, personality, support, control, mental 
health and learning motivation. Overall, adverse mental health was high and the 
lack of motivation acute. While positive ratings of teaching and optimistic 
thinking were associated with good mental health, context control was key. 
Adverse ratings of teaching quality lowered learning motivation. Support and 
conscientiousness bolstered learning motivation and conscientiousness buffered 
against the adverse impact of stress on motivation. Openness was associated with 
the stress involved in learning. For those anxious-prone, defensive-pessimism 
was as effective as optimism was in stimulating learning motivation. Developing 
context control, support and strategies linked to personality could bolster 
student resilience during and post Covid-19.

© 2022. Crown.

DOI: 10.1186/s40359-022-00971-w
PMCID: PMC9648443
PMID: 36357950 [Indexed for MEDLINE]

Conflict of interest statement: The author has no competing interests.


1329. Obstet Gynecol. 2023 Jan 1;141(1):176-187. doi: 10.1097/AOG.0000000000005010. 
Epub 2022 Oct 27.

Coronavirus Disease 2019 (COVID-19)-Related Stress and Menstrual Changes.

Anto-Ocrah M(1), Valachovic T, Chen M, Tiffany K, DeSplinter L, Kaukeinen K, 
Glantz JC, Hollenbach S.

Author information:
(1)Division of General Internal Medicine, Department of Medicine, University of 
Pittsburgh, Pittsburgh, Pennsylvania; and the School of Medicine and Dentistry, 
the Department of Biostatistics and Computational Biology, and the Department of 
Obstetrics & Gynecology, University of Rochester, Nazareth College, and the 
University of Rochester, Rochester, New York.

OBJECTIVE: To evaluate how stress related to the coronavirus disease 2019 
(COVID-19) pandemic has affected women's menstrual cycles. We hypothesized that 
women with high levels of COVID-19-related stress would have more menstrual 
changes compared with those with lower levels of stress.
METHODS: Using a cross-sectional study design, we recruited a representative 
sample of U.S. adult women of reproductive age (18-45 years) using nonhormonal 
birth control to participate in an online REDCap (Research Electronic Data 
Capture, Vanderbilt University) survey. COVID-19-related stress was assessed 
with the PSS-10-C (COVID-19 Pandemic-related Perceived Stress Scale) and 
dichotomized as low stress (scores lower than 25) and high stress (scores 25 or 
higher). Self-reported menstrual outcomes were identified as changes in cycle 
length, duration, or flow and increased frequency of spotting between cycles. We 
used χ 2 and Fisher exact tests to compare differences in outcome between the 
two stress groups and logistic regression models for effect estimates.
RESULTS: A total of 354 women of reproductive age across the United States 
completed both the menstrual and COVID-19-related stress components of our 
survey. More than half of these women reported at least one change in their 
menstrual cycles since the start of the pandemic (n=191), and 10.5% reported 
high COVID-19-related stress (n=37). Compared with those with low 
COVID-19-related stress, a greater proportion of women with high 
COVID-19-related stress reported changes in cycle length (shorter or longer; P 
=.008), changes in period duration (shorter or longer; P <.001), heavier 
menstrual flow ( P =.035), and increased frequency of spotting between cycles ( 
P =.006) compared with prepandemic times. After adjusting for age, smoking 
history, obesity, education, and mental health history, high COVID-19-related 
stress was associated with increased odds of changes in menstrual cycle length 
(adjusted odds ratio [aOR] 2.32; 95% CI 1.12-4.85), duration (aOR 2.38; 95% CI 
1.14-4.98), and spotting (aOR 2.32; 95% CI 1.03-5.22). Our data also 
demonstrated a nonsignificant trend of heavier menstrual flow among women with 
high COVID-19-related stress (aOR 1.61; 95% CI 0.77-3.34).
CONCLUSION: High COVID-19-related stress is associated with significant changes 
in menstrual cycle length, alterations in period duration, and increased 
intermenstrual spotting as compared with before the pandemic. Given that 
menstrual health is frequently an indicator of women's overall well-being, 
clinicians, researchers, and public health officials must consider the 
association between COVID-19-related stress and menstrual disturbances.

Copyright © 2022 by the American College of Obstetricians and Gynecologists. 
Published by Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/AOG.0000000000005010
PMCID: PMC9892200
PMID: 36357930 [Indexed for MEDLINE]

Conflict of interest statement: Financial Disclosure The authors did not report 
any potential conflicts of interest.


1330. J Womens Health (Larchmt). 2022 Nov;31(11):1529-1539. doi: 
10.1089/jwh.2022.0115.

Sex and Gender Impact Mental and Emotional Well-Being During COVID-19 Pandemic: 
A European Countries Experience.

Gisinger T(1), Dev R(2), Kautzky A(3), Harreiter J(1), Raparelli V(2)(4)(5), 
Kublickiene K(6), Trinidad Herrero M(7), Norris CM(3)(8), Lavoie KL(9), Pilote 
L(10), Kautzky-Willer A(1)(11).

Author information:
(1)Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of 
Internal Medicine III, Medical University of Vienna, Vienna, Austria.
(2)Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
(3)Department of Psychiatrics and Psychotherapy, Medical University of Vienna, 
Vienna, Austria.
(4)Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
(5)University Center for Studies on Gender Medicine, University of Ferrara, 
Ferrara, Italy.
(6)Section for Renal Medicine, Department of Clinical Science, Intervention, and 
Technology (CLINTEC), Karolinska Institute and Karolinska University Hospital, 
Stockholm, Sweden.
(7)Clinical and Experimental Neuroscience (NiCE-IMIB-IUIE), School of Medicine, 
University of Murcia, Murcia, Spain.
(8)Heart and Stroke Strategic Clinical Networks-Alberta Health Services, 
Alberta, Canada.
(9)Department of Psychology, University of Quebec at Montreal (UQAM) and 
Montreal Behavioural Medicine Center, CIUSSS-NIM, Hopital du Sacre-Coeur de 
Montreal, Montreal, Canada.
(10)Divisions of Clinical Epidemiology and General Internal Medicine, McGill 
University Health Centre Research Institute, Montreal, Canada.
(11)Gender Institute La Pura, Gars am Kamp, Austria.

Objective: The COVID-19 pandemic influences mental health drastically. 
Therefore, our aim was to investigate whether biological sex and gender-related 
factors are associated with mental health during the COVID-19 pandemic. 
Materials and Methods: The International COVID-19 Awareness and Responses 
Evaluation Study is an international multiwave cross-sectional observational 
cohort study of public awareness, attitudes, and responses to public health 
policies (www.mbmc- cmcm.ca/covid19). The study is led by the Montreal 
Behavioural Medicine Centre in collaboration with 200 international 
collaborators from 42 countries. It has received research ethics board approval 
from the Comité d'éthique de recherche du CIUSSS-NIM (Centre intégré 
universitaire de santé et de services sociaux du Nord- de-l'île-de-Montréal), 
approval no.: 2020-2099/25-03-2020. Recruitment began on March 27, 2020, and the 
survey is available in 34 languages. The associations between biological sex, 
sociocultural gender, and mental health were assessed in multivariate logistic 
regression models only for the European population (n = 12,300). Results: 
Positive correlations were found between female sex and "feeling nervous, 
anxious or worried" (OR = 3.2, p < 0.001, 95% CI 1.87-5.63) and "feeling sad, 
depressed or hopeless" (OR 1.8, p = 0.031, CI 1.05-3.05). Male sex was related 
to more frequently "feeling irritable, frustrated, and angry" (OR = 1.8, 
p = 0.04, 95% CI 1.03-2.99). Concerning gender, a negative correlation between 
being employed and "feeling lonely or isolated" (OR = 0.26, p < 0.001, 95% CI 
0.11-0.59) was observed in the female cohort. Conclusion: Sex and gender 
differences exist in the emotional responses during the COVID-19 pandemic. 
Especially, within the female cohort, unemployment is negatively associated with 
mental health. Therefore, this study suggests more targeted psychological and 
social support for females during the pandemic.

DOI: 10.1089/jwh.2022.0115
PMID: 36356181 [Indexed for MEDLINE]


1331. Lupus. 2022 Dec;31(14):1808-1815. doi: 10.1177/09612033221134203. Epub 2022 Nov 
10.

Psychological and quality of life effects of vaccination against COVID-19 in 
patients with systemic autoimmune diseases.

Montero-López E(1), Peralta-Ramírez MI(2)(3), Ortego-Centeno N(4)(5)(6), 
Callejas-Rubio JL(5)(6), Ríos-Fernández R(5)(6), Santos-Ruiz A(7)(8).

Author information:
(1)Department of Developmental and Educational Psychology, 16741University of 
Granada, Granada, Spain.
(2)Department of Clinical Psychology, 16718University of Granada, Granada, 
Spain.
(3)Mind, Brain, 16581Behavior Research Center (CIMCYC), Granada, Spain.
(4)Department of Medicine, 16741University of Granada, Granada, Spain.
(5)Systemic Autoimmune Diseases Unit, San Cecilio Clinical Hospital, Granada, 
Spain.
(6)Biohealth Research Institute (IBS), Granada, Spain.
(7)Department of of Health Psychology, 16741University of Alicante, Alicante, 
Spain.
(8)Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.

To verify the psychological and quality of life benefits of vaccination against 
COVID-19 in patients with systemic autoimmune diseases. In this study, levels of 
psychological stress, psychopathological symptoms, quality of life, and 
satisfaction with life were compared in patients with systemic autoimmune 
diseases vaccinated against COVID-19 (n = 132) versus unvaccinated patients (n = 
254). To this end, we used the Perceived Stress Scale (PSS), Symptom 
Checklist-90-Revised (SCL-90-R), EUROQoL-5Q health questionnaire, and 
Satisfaction with Life Scale (SWLS), respectively. Statistically significant 
differences were found with better scores in the vaccinated group in the 
following quality of life dimensions: mobility (p ≤ 0.010), domestic activities 
(p ≤ 0.004), pain/discomfort (p ≤ 0.001), and anxiety/depression (p≤ 0.005). The 
scores were also significantly higher in the vaccinated group for the total 
values of quality of life (p ≤ 0.001), health status self-assessment on the 
EUROQoL-5Q (p ≤ 0.043), and satisfaction with life (p ≤ 0.015). In addition, the 
unvaccinated group presented higher scores with clinically pathological levels 
in depression and psychoticism for somatizations (p ≤ 0.006), depression (p ≤ 
0.015), anxiety (p ≤ 0.003), and phobic anxiety (p ≤ 0.001). Finally, 
participants vaccinated with the complete regimen showed better levels of 
psychological well-being than those who were not vaccinated or those that had 
not completed the vaccination regimen. Our results reflect and confirm the 
positive effects reported elsewhere of the COVID-19 vaccine in autoimmune 
patients with systemic diseases, both in terms of quality and satisfaction with 
life as well as psychopathological symptoms and perceived stress. These benefits 
increased as the patients completed their vaccination schedule.

DOI: 10.1177/09612033221134203
PMCID: PMC9659700
PMID: 36355914 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1332. PLoS One. 2022 Nov 10;17(11):e0277525. doi: 10.1371/journal.pone.0277525. 
eCollection 2022.

Where there are challenges, there are opportunities: An undergraduate medical 
students' teaching concept for mental health in times of COVID-19.

Herrmann-Werner A(1)(2), Erschens R(2), Zipfel S(2), Festl-Wietek T(1).

Author information:
(1)Medical Faculty Tuebingen, TIME (Tübingen Institute for Medical Education), 
Tuebingen, Germany.
(2)Department of Internal Medicine VI/Psychosomatic Medicine and Psychotherapy, 
University Hospital Tuebingen, Tuebingen, Germany.

COVID-19 had a tremendous effect on medical education. Most teaching sessions 
had to be shifted online, posing additional stress and potential isolation on 
medical students. However, it also offered the promotion of innovative digital 
teaching concepts. In this article, an approach to undergraduate mental health 
training is presented and evaluated. The curriculum was designed according to 
Kern's six-step approach and consisted of asynchronous online material as well 
synchronous digital teaching and was accompanied by a plethora of newly 
developed teaching material (videos, fact sheets, etc.). Content covered the 
whole spectrum of diseases seen in a service of psychosomatic medicine and 
psychotherapy (i.e. anxiety, depression, trauma, somatoform and eating 
disorders, as well as motivational interviewing). Feedback from participants was 
collected, and exam results (written and practical) were compared to 
pre-COVID-19 times using t-tests for dependent and independent samples. Students 
were highly satisfied with the teaching (rating of 1.3 ± 0.6, n = 139 students). 
There was no significant difference from course evaluations before COVID-19 (1.5 
± 0.5, p &gt; .05). The teaching also received an award in the students' 
competition "best digital teaching concept in summer term 2020". In the written 
exams, there was no significant difference between before COVID-19 (2.4 ± 0.45) 
and during COVID-19 times (1.6 ± 0.39; p &gt; .05). In the practical objective 
structured clinical examination (OSCE), there was also no significant difference 
between students' judgement of the difficulty of the station (1.9 ± 0.22 vs 1.9 
± 0.31; p &gt; .05) or how well-prepared they felt for the exam (2.0 ± 0.24 vs 
2.0 ± 0.31; p &gt; .05). However, there was a significant difference in terms of 
grades, with the pre-COVID-19 grades being significantly better (2.7 ± 0.37 vs 
2.0 ± 0.44; p &lt; .05), which reflects the difficulty of transferring practical 
skills training to an online setting. Students particularly valued the 
possibility of self-directed learning combined with personal guidance by 
departmental experts, reflecting the importance of wellbeing-centred medical 
education. The pandemic triggered overnight challenges for teaching mental 
health that may also offer the opportunity to think about worldwide teaching 
standards with easily accessible material and courses online. This may offer the 
opportunity to enthral medical students to become mental health specialists 
themselves.

Copyright: © 2022 Herrmann-Werner et al. This is an open access article 
distributed under the terms of the Creative Commons Attribution License, which 
permits unrestricted use, distribution, and reproduction in any medium, provided 
the original author and source are credited.

DOI: 10.1371/journal.pone.0277525
PMCID: PMC9648749
PMID: 36355852 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


1333. BMC Med Educ. 2022 Nov 9;22(1):770. doi: 10.1186/s12909-022-03803-y.

A scoping review of the literature on the impact of the COVID-19 quarantine on 
the psychological wellbeing of medical students.

Vythilingam DI(1), Prakash A(2), Nourianpour M(2), Atiomo WU(3).

Author information:
(1)Medical Student, School of Medicine, University of Nottingham, B Floor, 
Medical School, Queen's Medical Centre, NG7 2UH, Nottingham, UK.
(2)Medical Student, College of Medicine, Mohammed Bin Rashid University of 
Medicine and Health Sciences, Dubai, United Arab Emirates.
(3)College of Medicine, Mohammed Bin Rashid University of Medicine and Health 
Sciences, Dubai, United Arab Emirates. William.atiomo@mbru.ac.ae.

BACKGROUND: The goal of this study was to identify the nature and extent of the 
available published research on the impact of social isolation, on the 
psychological wellbeing of medical students, who had to quarantine due to the 
COVID-19 pandemic.
METHODS: Design. Scoping review.
SEARCH STRATEGY: The PRISMA-ScR (Preferred Reporting Items for Systematic 
reviews and Meta-Analyses extension for Scoping Reviews), guideline, was used to 
structure this study. A search strategy was carried out across six bibliographic 
databases. PubMed, Embase, ERIC, Scopus, Cochrane Database of Systematic Reviews 
and Web of Science. The following search terms were used, "medical student*" AND 
"impact" AND "quarantine" AND "COVID-19". Searches were initially confined to 
articles published (excluding conference abstracts) between 1 January 2019- 21 
August 2021 but updated in September 2022 with the original search terms 
expanded to include "isolation" or "lockdown" as well as "quarantine" and the 
period of search extended to 21 August 2022. A search of secondary references 
was conducted. Data from the selected studies were extracted, and the following 
variables recorded; first author and year of publication, country of study, 
study design, sample size, participants, mode of analysing impact of quarantine 
from COVID-19 on mental health and results of the studies.
RESULTS: A total of 223 articles were identified in the original search in 2021 
and 387 articles, in the updated search in 2022. Following the exclusion of 
duplicates and application of the agreed inclusion and exclusion criteria, 31 
full-text articles were identified for the final review, most of which were 
cross sectional studies. Sample sizes ranged from 13 to 4193 students and most 
studies used a variety of self-administered questionnaires to measure 
psychological wellbeing. Overall, 26 of the 31 articles showed that quarantine 
had a negative impact on the psychological well-being of medical students. 
However, two studies showed no impact, and three studies showed an improvement.
CONCLUSION: The evidence is growing. Quarantine because of the COVID-19 pandemic 
may have had a negative impact on the psychological wellbeing of medical 
students, but this is not certain. There is therefore a need for more studies to 
further evaluate this research question.

© 2022. The Author(s).

DOI: 10.1186/s12909-022-03803-y
PMCID: PMC9645342
PMID: 36352435 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1334. Matern Child Health J. 2023 Jan;27(1):117-125. doi: 10.1007/s10995-022-03537-9. 
Epub 2022 Nov 9.

Living with the Threat of Covid-19: Exploring the Psychological Impact of 
Covid-19 in Those who Conceived Through ART Versus Spontaneously.

Carroll K(1)(2), Pottinger AM(3), Bailey A(4), Watson T(5), Frederick S(5).

Author information:
(1)Department of Child and Adolescent Health, University Hospital of the West 
Indies, Kingston, Jamaica. kamali.carroll@uwimona.edu.jm.
(2)The Hugh Wynter Fertility Management Unit, The University of the West Indies 
Mona Campus, Mona, Jamaica. kamali.carroll@uwimona.edu.jm.
(3)Department of Community Health and Psychiatry, University of the West Indies, 
Kingston, Jamaica.
(4)Department of Obstetrics and Gynaecology, University of the West Indies, 
Kingston, Jamaica.
(5)The Hugh Wynter Fertility Management Unit, University of the West Indies, 
Kingston, W.I, Jamaica.

OBJECTIVES: To explore and compare anxiety relating to the threat of Covid-19 in 
pregnancy by women who conceived through assisted reproductive technology (ART) 
and spontaneously. We also examined the psychological coping strategies used and 
lived experience for both groups.
METHODS: A total of 21 women who conceived through ART at a private university 
based IVF and a matched sample of women who conceived spontaneously were 
enrolled from July 2020 to February 2021. This was a mixed methods study. 
Covid-19-specific anxiety was measured using the coronavirus anxiety scale (CAS) 
as well as a validating qualitative data model with the use of open-ended 
questions to expand on quantitative findings.
RESULTS: In both groups of women the level of anxiety detected by the CAS was 
low and mixed coping strategies (emotion-focused and problem-solving) were 
utilized. The ART group expressed more positive feelings towards pregnancy 
during the Covid-19 pandemic.
CONCLUSION: The vulnerable ART group is no more at risk for negative emotional 
well-being during the Covid-19 pandemic. Additionally, healthcare providers 
ought to be knowledgeable of various Covid-19 coping strategies that may provide 
emotionally protective measures for all women of reproductive age. This is of 
particular importance as effective coping may ultimately prevent disruptions 
that could compromise prenatal care during the covid-19 pandemic.

© 2022. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s10995-022-03537-9
PMCID: PMC9646256
PMID: 36352290 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
declare.


1335. J Community Psychol. 2023 May;51(4):1803-1819. doi: 10.1002/jcop.22966. Epub 
2022 Nov 9.

So far but yet so near: Examining the buffering effect of perceived social 
support on the psychological impact of Spanish lockdown.

Dopico-Casal C(1), Montes C(1), Fraga I(1), Vieitez L(1), Padrón I(1), Romero 
E(2).

Author information:
(1)Department of Social Psychology, Basic Psychology, and Methodology, Cognitive 
Processes & Behavior Research Group, University of Santiago de Compostela, 
Santiago de Compostela, Spain.
(2)Department of Clinical Psychology and Psychobiology, UNDERISK, University of 
Santiago de Compostela, Santiago de Compostela, Spain.

The main objective of this study was to examine the moderating or buffering 
effect of social support (SS) perceived by university students on the 
psychological impact of lockdown on mental health. Specifically, a total of 826 
participants (622 women) completed an online survey that included standardized 
measures of anxiety (Generalised Anxiety Disorder-7), depression (Patient Health 
Questionnaire-9), and irritability (Brief Irritability Test), as well as 
measures of stressors, perceived SS, and self-perceived change in mental health. 
The results of hierarchical regression analyses suggest that SS contributes 
toward attenuating the negative impact of academic stressors, general overload, 
and interpersonal conflict on the indicators of psychological well-being; 
however, moderation analysis only confirms the buffering effect for symptoms of 
anxiety. In conclusion, it is suggested that SS networks need to be strengthened 
as a basic means of protecting health and well-being during unexpected 
disasters.

© 2022 The Authors. Journal of Community Psychology published by Wiley 
Periodicals LLC.

DOI: 10.1002/jcop.22966
PMID: 36350844 [Indexed for MEDLINE]


1336. Psychiatr Q. 2022 Dec;93(4):1017-1030. doi: 10.1007/s11126-022-10006-7. Epub 
2022 Nov 9.

Loneliness in Elderly Inpatients.

Just SA(#)(1), Seethaler M(#)(2), Sarpeah R(2), Waßmuth N(2), Bermpohl F(2), 
Brandl EJ(2).

Author information:
(1)Department of Psychiatry and Psychotherapy, Campus Charité Mitte (Psychiatric 
University Hospital of Charité at St. Hedwig Hospital), 
Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität 
Berlin, Humboldt- Universität zu Berlin, Berlin Institute of Health, Große 
Hamburger Str. 5-11, 10115, Berlin, Germany. sandra-anna.just@charite.de.
(2)Department of Psychiatry and Psychotherapy, Campus Charité Mitte (Psychiatric 
University Hospital of Charité at St. Hedwig Hospital), 
Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität 
Berlin, Humboldt- Universität zu Berlin, Berlin Institute of Health, Große 
Hamburger Str. 5-11, 10115, Berlin, Germany.
(#)Contributed equally

Erratum in
    Psychiatr Q. 2023 Jun;94(2):343.

PURPOSE: Loneliness among the elderly is a widespread phenomenon and is 
connected to various negative health outcomes. Nevertheless, loneliness among 
elderly inpatients, especially those with a psychiatric diagnosis, has hardly 
been examined. Our study assessed loneliness in elderly inpatients, identified 
predictors, and compared levels of loneliness between inpatients on psychiatric 
and somatic wards.
METHODS: N = 100 elderly inpatients of a somatic and psychiatric ward were 
included. Levels of loneliness were assessed, as were potential predictors such 
as depression, psychological resilience, severity of mental illness, well-being, 
daily functioning, and psychiatric diagnosis. Analyses of group differences and 
hierarchical multiple regression analysis were conducted.
RESULTS: 37% of all inpatients reported elevated levels of loneliness. 
Significant predictor variables were self-reported depressive symptoms, 
well-being, severity of mental illness, being single and living with a 
caregiver. Hierarchical multiple regression analysis revealed that the full 
model explained 58% of variance in loneliness. Psychiatric inpatients' 
loneliness was significantly higher than loneliness in somatic inpatients. When 
analyzing group differences between inpatients with different main psychiatric 
diagnoses, highest levels were found in patients with an affective disorder, 
followed by those treated for organic mental disorder. Since the study took 
place during the COVID-19 pandemic, potential influence of different measurement 
points (lockdown vs. no lockdown) were analyzed: Differences in loneliness 
depending on the phase of the pandemic were non-significant.
CONCLUSION: Elderly inpatients experience high levels of loneliness, especially 
those with a mental disorder. Interventions to reduce loneliness in this 
population should address predictors of loneliness, preferably through 
multiprofessional interventions.

© 2022. The Author(s).

DOI: 10.1007/s11126-022-10006-7
PMCID: PMC9644385
PMID: 36350482 [Indexed for MEDLINE]

Conflict of interest statement: EJB received speaker fees from Medice.


1337. Matern Child Health J. 2022 Dec;26(12):2377-2384. doi: 
10.1007/s10995-022-03527-x. Epub 2022 Nov 8.

Supporting Parents' Services Access During the COVID-19 Pandemic Through the 
Infant-Toddler Court Team Program.

Casanueva C(1), Kluckman M(2), Harris S(2), Brown J(2), Fraser JG(3).

Author information:
(1)RTI International, 3040 East Cornwallis Rd, PO Box 12194, 27709-2194, 
Research Triangle Park, NC, United States. ccasanueva@rti.org.
(2)RTI International, 3040 East Cornwallis Rd, PO Box 12194, 27709-2194, 
Research Triangle Park, NC, United States.
(3)ZERO TO THREE, 2445 M St NW, Washington, DC, United States, 20037.

INTRODUCTION: Infant-Toddler Court Teams (ITCTs) are a collaborative practice 
designed to improve timely identification and receipt of needed services for 
families of infants and toddlers involved in the child welfare system and their 
families. The goal of the study was to explore the impact of the first year of 
COVID compared to the previous year, in the context of ITCT support, on: (1) 
parents' access to services; (2) parents' services receipt and access within 30 
days and within 14 days from referral; and (3) predictors of services access and 
receipt.
METHODS: Overall, 897 instances of services needs were analyzed, 411 pre-COVID 
and 486 during COVID. Logistic regression models were used to test for 
differences pre- and during COVID, controlling for covariates.
RESULTS: A reduction in service access was found across all services during 
COVID (OR = 0.2, CI: 0.1-0.3, p < .0001). Nevertheless, if a service was still 
available, parents were able to maintain similar levels of receipt within 30 
days and within 14 days as before COVID. Moreover, a higher percentage of 
parents in need received mental health services in 30 or fewer days and 
substance use disorder services in both 14 and 30 or fewer days during COVID 
compared to pre-COVID.
DISCUSSION: This success is notable given the significant disruption to the 
availability of services and barriers to accessing services caused by the 
pandemic. ITCTs provided a robust platform for supporting the health and 
well-being of families with very young children in the face of a severely 
reduced service landscape due to COVID-19.

© 2022. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s10995-022-03527-x
PMCID: PMC9643928
PMID: 36346566 [Indexed for MEDLINE]

Conflict of interest statement: None.


1338. Psychol Med. 2023 Oct;53(13):6403-6414. doi: 10.1017/S0033291722003348. Epub 
2022 Nov 8.

Generational, sex, and socioeconomic inequalities in mental and social wellbeing 
during the COVID-19 pandemic: prospective longitudinal observational study of 
five UK cohorts.

Moreno-Agostino D(1)(2), Fisher HL(2)(3), Hatch SL(2)(4), Morgan C(2)(5), 
Ploubidis GB(1)(2), Das-Munshi J(2)(4).

Author information:
(1)Centre for Longitudinal Studies, UCL Social Research Institute, University 
College London, 55-59 Gordon Square, London WC1H 0NU, UK.
(2)ESRC Centre for Society and Mental Health, King's College London, Melbourne 
House, 44-46 Aldwych, London WC2B 4LL, UK.
(3)King's College London, Social, Genetic & Developmental Psychiatry Centre, 
Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, 
London SE5 8AF, UK.
(4)Department of Psychological Medicine, King's College London, Institute of 
Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London SE5 8AF, UK.
(5)Health Service and Population Research Department, King's College London, 
Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, 
London SE5 8AF, UK.

BACKGROUND: Research suggests that there have been inequalities in the impact of 
the coronavirus disease 2019 (COVID-19) pandemic and related non-pharmaceutical 
interventions on population mental health. We explored generational, sex, and 
socioeconomic inequalities during the first year of the pandemic using 
nationally representative cohorts from the UK.
METHODS: We analysed data from 26772 participants from five longitudinal cohorts 
representing generations born between 1946 and 2000, collected in May 2020, 
September-October 2020, and February-March 2021 across all five cohorts. We used 
a multilevel growth curve modelling approach to investigate generational, sex, 
and socioeconomic differences in levels of anxiety and depressive 
symptomatology, loneliness, and life satisfaction (LS) over time.
RESULTS: Younger generations had worse levels of mental and social wellbeing 
throughout the first year of the pandemic. Whereas these generational 
inequalities narrowed between the first and last observation periods for LS 
[-0.33 (95% CI -0.51 to -0.15)], they became larger for anxiety [0.22 (0.10, 
0.33)]. Generational inequalities in depression and loneliness did not change 
between the first and last observation periods, but initial depression levels of 
the youngest cohort were worse than expected if the generational inequalities 
had not accelerated. Women and those experiencing financial difficulties had 
worse initial mental and social wellbeing levels than men and those financially 
living comfortably, respectively, and these gaps did not substantially differ 
between the first and last observation periods.
CONCLUSIONS: By March 2021, mental and social wellbeing inequalities persisted 
in the UK adult population. Pre-existing generational inequalities may have been 
exacerbated with the pandemic onset. Policies aimed at protecting vulnerable 
groups are needed.

DOI: 10.1017/S0033291722003348
PMCID: PMC9874037
PMID: 36345141 [Indexed for MEDLINE]

Conflict of interest statement: None.


1339. J Adolesc. 2023 Feb;95(2):336-353. doi: 10.1002/jad.12117. Epub 2022 Nov 7.

Daily affect intensity and variability of adolescents and their parents before 
and during a COVID-19 lockdown.

de Vries LP(1)(2), Bülow A(3), Pelt DHM(1)(2), Boele S(3), Bartels M(1)(2), 
Keijsers L(3).

Author information:
(1)Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, 
The Netherlands.
(2)Amsterdam Public Health Research Institute, Amsterdam University Medical 
Centres, Amsterdam, The Netherlands.
(3)Department of Psychology, Education and Child Studies, Erasmus University 
Rotterdam, Rotterdam, The Netherlands.

INTRODUCTION: The corona virus (COVID-19) pandemic may have a prolonged impact 
on people's lives, with multiple waves of infections and lockdowns, but how a 
lockdown may alter emotional functioning is still hardly understood.
METHODS: In this 100-daily diaries study, we examined how to affect intensity 
and variability of adolescents (N = 159, Mage  = 13.3, 61.6% female) and parents 
(N = 159, Mage  = 45.3, 79.9% female) changed after the onset and during (>50 
days) the second COVID-19 lockdown in the Netherlands, using preregistered 
piecewise growth models.
RESULTS: We found only an unexpected increase in parents' positive affect 
intensity after the lockdown onset, but no immediate changes in negative affect 
intensity or variability. However, both adolescents and parents reported gradual 
increases in negative affect intensity and variability as the lockdown 
prolonged. Lockdown effects did not differ between adolescents and parents. 
However, within groups, individuals differed. The individual differences in the 
effects were partly explained by life satisfaction, depressive symptoms, and 
self-reported lockdown impact.
CONCLUSIONS: Overall, these findings suggests that a lockdown triggers changes 
in daily affective well-being especially as the lockdown prolongs. Individual 
differences in the effects indicate heterogeneity in the impact of the lockdown 
on daily affect that was partly explained by baseline life satisfaction and 
depressive symptoms. However, more knowledge on the causes of this heterogeneity 
is needed to be able to increase resilience to lockdown effects in the 
population.

© 2022 The Authors. Journal of Adolescence published by Wiley Periodicals LLC on 
behalf of Foundation for Professionals in Services to Adolescents.

DOI: 10.1002/jad.12117
PMCID: PMC10100109
PMID: 36344879 [Indexed for MEDLINE]


1340. BMJ Open. 2022 Nov 7;12(11):e061317. doi: 10.1136/bmjopen-2022-061317.

Interventions to support the mental health and well-being of front-line 
healthcare workers in hospitals during pandemics: an evidence review and 
synthesis.

Robins-Browne K(1), Lewis M(1)(2), Burchill LJ(2)(3)(4), Gilbert C(5), Johnson 
C(1)(2), O'Donnell M(6), Kotevski A(3), Poonian J(7), Palmer VJ(8)(2).

Author information:
(1)Primary Care Mental Health Research Program, Department of General Practice, 
Melbourne Medical School, The University of Melbourne Faculty of Medicine, 
Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.
(2)The ALIVE National Centre for Mental Health Research Translation, Department 
of General Practice, Melbourne Medical School, The University of Melbourne 
Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, 
Australia.
(3)Department of Medicine, University of Melbourne, Melbourne, Victoria, 
Australia.
(4)Department of Cardiology, The Royal Melbourne Hospital, Parkville, Victoria, 
Australia.
(5)The Centre for Digital Transformation of Health Faculty of Medicine, 
Dentistry and Health Sciences, The University of Melbourne, Parkville, Vic, 
Australia.
(6)The Department of Psychiatry, Melbourne Medical School, Facutly of Medicine, 
Dentistry and Health Sciences, The University of Melbourne, Parkville, Vic, 
Australia.
(7)Emergency Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, 
Australia.
(8)Primary Care Mental Health Research Program, Department of General Practice, 
Melbourne Medical School, The University of Melbourne Faculty of Medicine, 
Dentistry and Health Sciences, University of Melbourne, Victoria, Australia 
v.palmer@unimelb.edu.au.

OBJECTIVE: Pandemics negatively impact healthcare workers' (HCW's) mental health 
and well-being causing additional feelings of anxiety, depression, moral 
distress and post-traumatic stress. A comprehensive review and evidence 
synthesis of HCW's mental health and well-being interventions through pandemics 
reporting mental health outcomes was conducted addressing two questions: (1) 
What mental health support interventions have been reported in recent pandemics, 
and have they been effective in improving the mental health and well-being of 
HCWs? (2) Have any mobile apps been designed and implemented to support HCWs' 
mental health and well-being during pandemics?
DESIGN: A narrative evidence synthesis was conducted using Cochrane criteria for 
synthesising and presenting findings when systematic review and pooling data for 
statistical analysis are not suitable due to the heterogeneity of the studies.
DATA SOURCES: Evidence summary resources, bibliographic databases, grey 
literature sources, clinical trial registries and protocol registries were 
searched.
ELIGIBILITY CRITERIA: Subject heading terms and keywords covering three key 
concepts were searched: SARS-CoV-2 coronavirus (or similar infectious diseases) 
epidemics, health workforce and mental health support interventions. Searches 
were limited to English-language items published from 1 January 2000 to 14 June 
2022. No publication-type limit was used.
DATA EXTRACTION AND SYNTHESIS: Two authors determined eligibility and extracted 
data from identified manuscripts. Data was synthesised into tables and refined 
by coauthors.
RESULTS: 2694 studies were identified and 27 papers were included. Interventions 
were directed at individuals and/or organisations and most were COVID-19 
focused. Interventions had some positive impacts on HCW's mental health and 
well-being, but variable study quality, low sample sizes and lack of control 
conditions were limitations. Two mobile apps were identified with mixed 
outcomes.
CONCLUSION: HCW interventions were rapidly designed and implemented with few 
comprehensively described or evaluated. Tailored interventions that respond to 
HCWs' needs using experience co-design for mental health and well-being are 
required with process and outcome evaluation.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2022-061317
PMCID: PMC9644079
PMID: 36344001 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


1341. Health Aff (Millwood). 2022 Nov;41(11):1583-1589. doi: 
10.1377/hlthaff.2022.00750.

State Eviction Moratoriums During The COVID-19 Pandemic Were Associated With 
Improved Mental Health Among People Who Rent.

Ali AK(1), Wehby GL(2).

Author information:
(1)Abdinasir K. Ali, University of Iowa, Iowa City, Iowa.
(2)George L. Wehby (george-wehby@uiowa.edu), University of Iowa; and National 
Bureau of Economic Research, Cambridge, Massachusetts.

In response to the COVID-19 pandemic, many US states implemented eviction 
moratoriums in 2020. Evidence from eviction filings from that year shows 
short-term declines in eviction filings. This study examined the short-term 
effects of these state eviction moratoriums in 2020 on the mental health status 
of renters. It employed nationally representative data from the Behavioral Risk 
Factor Surveillance System and a triple-difference design that compared renters 
with homeowners while leveraging state differences in moratoriums over time. 
During 2020 forty-three states and Washington, D.C., implemented eviction 
moratoriums of varying scope and enforcement. Some moratoriums targeted the 
whole eviction process, including early stages, whereas others focused on the 
later stages of eviction. We found that state moratoriums were associated with 
an improvement in mental health, including fewer days not in good mental health 
in the past thirty days and a lower likelihood of frequent mental distress 
(fourteen or more days not in good mental health in the past thirty days). 
Overall, there is some evidence from this study pointing to potential short-term 
benefits from state eviction moratoriums in 2020 to the mental health and 
well-being of renters, which would be important to consider when formulating 
policies that affect residential stability.

DOI: 10.1377/hlthaff.2022.00750
PMID: 36343323 [Indexed for MEDLINE]


1342. Health Aff (Millwood). 2022 Nov;41(11):1598-1606. doi: 
10.1377/hlthaff.2022.00741.

Racial And Ethnic Disparities In Pandemic-Era Unemployment Insurance Access: 
Implications For Health And Well-Being.

Ananat EO(1), Daniels B(2), Fitz-Henley Ii J 2nd(3), Gassman-Pines A(4).

Author information:
(1)Elizabeth Oltmans Ananat, Barnard College, New York, New York.
(2)Becca Daniels, Duke University, Durham, North Carolina.
(3)John Fitz-Henley II, Duke University.
(4)Anna Gassman-Pines (agassman.pines@duke.edu), Duke University.

Research demonstrates that receiving unemployment insurance decreases mental 
health problems. But researchers have also found racial and ethnic disparities 
in unemployment insurance receipt resulting from differences in work history and 
location. We examined a population disproportionately affected by job loss and 
unemployment insurance exclusions, using a survey of service workers from a 
single city who were parents of young children and who overwhelmingly had 
eligible work histories. During the COVID-19 pandemic, workers not identifying 
as White non-Hispanic in our sample were more likely to get laid off than White 
workers. Among those who were laid off, these workers and White workers 
experienced similar increases in material and mental health difficulties and 
similar gains when they received unemployment insurance. However, these workers 
were less likely than White workers to receive unemployment insurance at all. 
These results indicate that unemployment insurance has unrealized potential to 
reduce material and health disparities. Policies should be implemented to make 
this coverage more effective and equitable through increased access.

DOI: 10.1377/hlthaff.2022.00741
PMCID: PMC10353345
PMID: 36343319 [Indexed for MEDLINE]


1343. J Nurs Educ. 2022 Nov;61(11):641-645. doi: 10.3928/01484834-20220912-06. Epub 
2022 Nov 1.

Effects of the Perceived Risk of Contracting COVID-19 on Nursing Students' 
Well-Being.

Graves RJ, Harrell M, Barinas JL, Taylor SE, Fruh SM, Williams SG, McDermott R, 
Hall HR, Hauff C, Sittig S, Campbell M, Hudson G, Bernadette MM.

BACKGROUND: Although mental health symptoms increased during the coronavirus 
disease 2019 (COVID-19) pandemic, little is known about the associations between 
nursing students' perceived risk of contracting COVID-19 and their academic and 
psychological well-being. This study examined associations between perceived 
COVID-19 risk, likelihood of completing nursing education, and mental health 
factors of nursing students.
METHOD: A total of 979 nursing students completed self-report measures of 
perceived COVID-19 risk, anticipated academic completion, anxiety and depressive 
symptoms, stress, coping self-efficacy, hope, and social support.
RESULTS: Students with higher perceived COVID-19 risk reported increased anxiety 
and depression as well as decreased likelihood of graduating, coping 
self-efficacy, and levels of social support.
CONCLUSION: Findings indicate the need for increased mental health support for 
nursing students for successful completion of their programs. Educators should 
increase support and proactively strengthen positive psychology factors to 
mitigate the effects of COVID-19 and other crises on nursing students' 
well-being. [J Nurs Educ. 2022;61(11):641-645.].

DOI: 10.3928/01484834-20220912-06
PMCID: PMC9782991
PMID: 36343194 [Indexed for MEDLINE]

Conflict of interest statement: Disclosure: The authors have disclosed no 
potential conflicts of interest, financial or otherwise. Research reported in 
this publication was supported by the National Center for Advancing 
Translational Sciences of the National Institutes of Health under award number 
UL1TR003096. The content is solely the responsibility of the authors and does 
not necessarily represent the official views of the National Institutes of 
Health.


1344. Front Public Health. 2022 Oct 20;10:991572. doi: 10.3389/fpubh.2022.991572. 
eCollection 2022.

Health-related quality of life in persons post-COVID-19 infection in comparison 
to normative controls and chronic pain patients.

Moens M(1)(2)(3)(4)(5), Duarte RV(6), De Smedt A(1)(3)(7), Putman K(8), Callens 
J(1), Billot M(9), Roulaud M(9), Rigoard P(9)(10)(11), Goudman 
L(1)(2)(3)(4)(12).

Author information:
(1)STIMULUS Research Group (reSearch and TeachIng neuroModULation Uz bruSsel), 
Vrije Universiteit Brussel, Brussels, Belgium.
(2)Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, 
Belgium.
(3)Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, 
Belgium.
(4)Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human 
Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije 
Universiteit Brussel, Brussels, Belgium.
(5)Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium.
(6)Liverpool Reviews and Implementation Group, University of Liverpool, 
Liverpool, United Kingdom.
(7)Department of Physical Medicine and Rehabilitation, Universitair Ziekenhuis 
Brussel, Brussels, Belgium.
(8)Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, 
Interuniversity Centre for Health Economics Research (I-CHER), Vrije 
Universiteit Brussel, Brussels, Belgium.
(9)PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and 
Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, 
France.
(10)Department of Spine Surgery & Neuromodulation, Poitiers University Hospital, 
Poitiers, France.
(11)Pprime Institute UPR 3346, CNRS, ISAE-ENSMA, University of Poitiers, 
Chasseneuil-du-Poitou, France.
(12)Research Foundation-Flanders (FWO), Brussels, Belgium.

The Coronavirus disease 2019 (COVID-19) pandemic exerted a tremendous pressure 
on the healthcare system, people's social life, mental health and financial 
status with profound implications for the general population. The exact impact 
of the pandemic on the overall physical, mental and social wellbeing of COVID-19 
infection survivors on the long term has not yet been explored in a thorough 
way. Based on the reporting of persistent pain, fatigue and dyspnea symptoms by 
these survivors, it is our hypothesis that their quality of life will be 
extremely impacted, as is observed in patients with chronic pain. Therefore, the 
first aim of this study was to perform an in-depth evaluation of the quality of 
life of post-COVID-19 infected persons. The second aim was to compare the 
quality of life of these persons with a normative population and with patients 
with chronic pain. Health-related quality of life, as a measure for a person's 
overall physical, mental, and social wellbeing, was measured with the 3-level 
EQ5D in 547 post-COVID-19 infected persons. These data were compared to 
reference data from normal population records for Belgium and to data from 
patients with chronic pain after spinal surgery with two-way analyses of 
variance. In total, 89.58% of the post-COVID-19 infected persons reported 
pain/discomfort and 82.45% indicated limitations when performing usual 
activities, when evaluated 287 days (SD: 150) after the infection. Self-care was 
preserved in most post-COVID-19 persons, whereby only 13.16% indicated problems. 
The mean EQ5D-3L index score was 0.57 (SD: 0.23) and EQ5D VAS mean score was 
56.6 (SD: 18.2). The mean index score for the normative population was 
significantly higher than for COVID-19 infected persons [mean difference of 0.31 
(95% from 0.29 to 0.33), p < 0.01] while the mean score of chronic pain patients 
was significantly lower than the score of COVID-19 infected persons [mean 
difference of -0.31 (95% from -0.29 to -0.33), p < 0.01]. Compared to age-and 
sex adjusted reference data, health-related quality of life of persons with long 
COVID is severely impacted. In relation to patients with chronic pain after 
spinal surgery, the quality of life of post-COVID-19 infected persons seemed to 
be better.
CLINICAL TRIAL REGISTRATION: https://www.clinicaltrials.gov/, identifier: 
NCT04912778.

Copyright © 2022 Moens, Duarte, De Smedt, Putman, Callens, Billot, Roulaud, 
Rigoard and Goudman.

DOI: 10.3389/fpubh.2022.991572
PMCID: PMC9632164
PMID: 36339175 [Indexed for MEDLINE]

Conflict of interest statement: LG is a postdoctoral research fellow funded by 
the Research Foundation Flanders (FWO), Belgium (project number 12ZF622N). PR 
reports grants and consultant fees from Medtronic, Abbott, and Boston 
Scientific, outside the submitted work. MM has received speaker fees from 
Medtronic, Nevro, and Saluda Medical. STIMULUS received independent research 
grants from Medtronic. The remaining authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1345. Saudi J Anaesth. 2022 Oct-Dec;16(4):452-456. doi: 10.4103/sja.sja_563_22. Epub 
2022 Sep 3.

"The show must go on": Aftermath of Covid-19 on anesthesiology residency 
programs.

Jaju R(1), Saxena M(2), Paliwal N(3), Bihani P(3), Tharu V(3).

Author information:
(1)Department of Anaesthesiology, AIIMS, Deoghar, Jharkhand, India.
(2)Department of Anaesthesiology, AIIMS, Jodhpur, Rajasthan, India.
(3)Department of Anaesthesiology, Dr. S. N. Medical College, Jodhpur, Rajasthan, 
India.

COVID-19 has caused tectonic changes in the personal and professional lives of 
anesthesiologists and, among several aspects, anesthesiology residency and 
sub-specialty training has also undergone an unforeseen overhaul. We read the 
articles published on the impact of COVID-19 on training of anesthesiologists 
and set out to extract and narrate all the significant observations. At the 
outset, we begin by explaining how this pandemic posed a threat to the safety of 
the residents and mitigating measures like PPE and barriers that have now become 
'the new normal'. Sub-specialties like critical care, cardiac anesthesia, pain 
and palliative care have also faced difficulty in imparting training due to an 
initial dearth in elective surgery case load but have adapted innovative 
measures to overcome that. Initially, conducting thesis and research became 
difficult due to problems in achieving the desires sample size needed to get 
significant results, but this pandemic has emerged as a dynamic laboratory where 
topics like 'psychological impact of COVID-19' and 'development of artificial 
intelligence models in COVID -19 ICUs' came into the fore. Pattern of 
examination has also become virtual and webinars showed how knowledge, with the 
right medium, has the potential of global outreach. As the pandemic took a toll 
on the mental health of the residents, attention was paid to this previously 
neglected aspect and ensuring their emotional well-being became a priority to 
avoid the issue of burn-out. We comment on how what initially was considered a 
scary problem, actually paved way for growth. It brought attention to safety, 
innovation, new tools for training, finding solutions within constraints, 
continuing developing our residents into future leaders who were also trained 
for mitigating disasters. Changes like online education, research on 
socio-economic impact, priority to mental health and artificial intelligence are 
here to stay and by imbibing it, we ensure that 'the show must go on'.

Copyright: © 2022 Saudi Journal of Anesthesia.

DOI: 10.4103/sja.sja_563_22
PMCID: PMC9630703
PMID: 36337394

Conflict of interest statement: There are no conflicts of interest.


1346. J Child Adolesc Psychiatr Nurs. 2023 Feb;36(1):44-54. doi: 10.1111/jcap.12399. 
Epub 2022 Nov 6.

Family lifestyle is related to low-income preschoolers' emotional well-being 
during COVID-19 pandemic.

Ling J(1), Kao TA(1), Robbins LB(1), Wahman CL(2).

Author information:
(1)Michigan State University College of Nursing, East Lansing, Michigan, USA.
(2)Department of Counseling, Educational Psychology and Special Education, 
Michigan State University, East Lansing, Michigan, USA.

PROBLEM: COVID-19 has profoundly impacted children's behavioral and psychosocial 
development, especially young children from low-income families. This study 
examined how caregivers' and preschoolers' lifestyle behaviors (sleep, screen 
time, physical activity, eating behavior) were related to preschoolers' 
emotional well-being (sadness, fear, anger, and positive affect).
METHODS: Using a cross-sectional design, we recruited low-income caregivers from 
Head Start organizations and the Qualtrics panel. Participants provided consent 
and completed an online survey.
FINDINGS: A total of 408 caregivers (mean age = 31) participated: 17% Hispanic, 
21% Black, 49% separated/single, 44% unemployed, and 39% with ≤high school 
education. After adjusting for demographics and preschoolers' lifestyle 
behaviors, caregivers' sleep disturbance was positively correlated with 
preschoolers' anger, fear, and sadness, while negatively related to positive 
affect. Similarly, caregivers' sleep time was positively correlated with 
preschoolers' sadness and negatively related to positive affect. Preschoolers' 
sleep time was negatively related to fear and positively related to positive 
affect. Likewise, preschoolers' physical activity was negatively correlated with 
fear, sadness, and positively correlated with positive affect. Additionally, 
preschoolers' fruit/vegetable intake was negatively associated with anger, fear, 
sadness, and positively associated with positive affect.
CONCLUSIONS: The identified behavior-emotion connection provides a foundation 
for developing family-based lifestyle interventions in promoting mental health 
among preschoolers.

© 2022 Wiley Periodicals LLC.

DOI: 10.1111/jcap.12399
PMID: 36336402 [Indexed for MEDLINE]


1347. Sci Rep. 2022 Nov 5;12(1):18761. doi: 10.1038/s41598-022-23676-x.

Quality of life questionnaires validate a remote approach to ophthalmic 
management of primary Sjögren's syndrome.

Greenan E(1)(2)(3), Pilson Q(4), Ní Gabhann-Dromgoole J(5)(6), Murphy 
CC(1)(2)(3).

Author information:
(1)Royal Victoria Eye and Ear Hospital, Adelaide Rd, Dublin 2, D02 XK51, 
Ireland.
(2)Department of Ophthalmology, RCSI, University of Medicine and Health 
Sciences, 123 St Stephen's Green, Dublin 2, D02 YN77, Ireland.
(3)School of Pharmacy and Biomolecular Sciences, RCSI, University of Medicine 
and Health Sciences, 123 St Stephen's Green, Dublin 2, D02 YN77, Ireland.
(4)Department of Ophthalmology, Stepping Hill Hospital, Poplar Grove, Stockport, 
Cheshire, SK2 7JE, England.
(5)Department of Ophthalmology, RCSI, University of Medicine and Health 
Sciences, 123 St Stephen's Green, Dublin 2, D02 YN77, Ireland. 
joannigabhann@rcsi.ie.
(6)School of Pharmacy and Biomolecular Sciences, RCSI, University of Medicine 
and Health Sciences, 123 St Stephen's Green, Dublin 2, D02 YN77, Ireland. 
joannigabhann@rcsi.ie.

Those with underlying autoimmune conditions were met with unparalleled 
challenges and were disproportionately affected by the COVID-19 pandemic. As 
such, we aimed to measure the impact of the pandemic on symptoms and the health 
and vision related quality of life (HR-QoL, VR-QoL) in patients with Primary 
Sjögren's Syndrome (pSS). Nineteen (55.9%) participants returned questionnaires 
for analysis, (17 female and 2 male, 61.6 years ± 9.9). There was no significant 
change in participants HR-QoL or VR-QoL, indicating that those with pSS remained 
resilient with regard to their physical and mental health throughout the 
pandemic. Furthermore, QoL was maintained despite 73.7% of participants having 
had outpatient appointments cancelled, delayed or rescheduled. Participants 
reported a lower QoL and feeling tenser in the COV19-QoL (3.3 ± 1.4 and 
3.2 ± 1.3) representing feelings of apprehension and stress felt amongst the 
general population since the pandemic. Overall, and in spite of the concern 
caused by the COVID-19 pandemic for patients with autoimmune diseases, the 
health and well-being of patients with pSS remained stable. These findings 
strongly support the use of validated HR and VR-QoL questionnaires as an adjunct 
to the telemedicine consultation when assessing patients with pSS, offering an 
alternative to face-to-face consultations in post-pandemic era.

© 2022. The Author(s).

DOI: 10.1038/s41598-022-23676-x
PMCID: PMC9637217
PMID: 36335260 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1348. Am J Health Behav. 2022 Oct 17;46(5):576-585. doi: 10.5993/AJHB.46.5.8.

A Pilot Study of Virtual Reality (VR) Tai Chi Program on Mental Health among 
Older Adults during the COVID-19 Pandemic.

Kim J(1), Kim Y(1), Chang PS(2), Min Oh S(1), Han S(3).

Author information:
(1)Department of Health & Wellness Design, Indiana University, Bloomington, IN, 
United States.
(2)Department of Community Health Systems, Indiana University, Bloomington, IN, 
United States.
(3)Department of Health & Wellness Design, Indiana University Bloomington, IN, 
United States.

OBJECTIVES: Tai Chi, an ancient Chinese martial art, has been credited for 
improving the physical and mental health of community-dwelling older adults. 
Virtual reality (VR) has developed as a therapeutic technique for improving 
health and well-being in older adults. Previous research on exercise-based VR 
interventions in older adults has focused primarily on the physical and 
cognitive health effects. The extent to which a program integrating the ancient 
practice of Tai Chi with virtual reality might benefit older individuals' 
physical and mental health is an unknown entity. In this pilot study, we 
examined potential advantages of the virtual Tai Chi program in terms of health 
outcomes, as well as to gather qualitative data on the barriers to VR program 
participation.
METHODS: We conducted semi-structured, in-depth interviews with 5 participants 
who had participated at least 5 years in traditional Tai Chi.
RESULTS: Three key salient themes emerged as beneficial results of VR 
experiences: (1) mindfulness/ meditation, (2) enjoyment, and (3) physical 
exercise. Participants also reported 3 main challenges: (1) some difficulties 
with controllers and functions, (2) cybersickness/pain, and (3) absence of group 
synergy.
CONCLUSIONS: These challenges suggest further avenues of investigation for 
researchers in refining this approach.

DOI: 10.5993/AJHB.46.5.8
PMID: 36333829 [Indexed for MEDLINE]


1349. Child Abuse Negl. 2022 Dec;134:105926. doi: 10.1016/j.chiabu.2022.105926. Epub 
2022 Nov 1.

Child sexual abuse survivors: Differential complex multimodal treatment outcomes 
for pre-COVID and COVID era cohorts.

Reeson M(1), Polzin W(2), Pazderka H(1), Agyapong V(1), Greenshaw AJ(1), Hnatko 
G(3), Wei Y(1), Szymanski L(2), Silverstone PH(4).

Author information:
(1)Department of Psychiatry, University of Alberta, 1E1 Walter Mackenzie Health 
Sciences Center (WMC), 8440 112 St NW, Edmonton, Canada.
(2)Little Warriors Be Brave Ranch, Edmonton, Alberta, Canada(1).
(3)CASA Child Treatment Center, 10645 63 Ave NW, Edmonton, Canada.
(4)Department of Psychiatry, University of Alberta, 1E1 Walter Mackenzie Health 
Sciences Center (WMC), 8440 112 St NW, Edmonton, Canada. Electronic address: 
peter.silverstone@ualberta.ca.

BACKGROUND: Child sexual abuse (CSA) is a form of early-life trauma that affects 
youth worldwide. In the midst of the current COVID-19 pandemic, it is imperative 
to investigate the potential impact of added stress on already vulnerable 
populations.
OBJECTIVE: The aim of this study was to evaluate the effectiveness of a 
multimodal treatment program on mental health outcomes for youth CSA survivors 
aged 8-17. Secondary to this, we explored the potential impact of the COVID-19 
on treatment outcomes.
PARTICIPANTS AND SETTING: Participants of this study were children and youth 
aged 8-17 who were engaged in a complex multimodal treatment program 
specifically designed for youth CSA survivors.
METHODS: Participants were asked to complete self-report surveys at baseline and 
at the end of two subsequent treatment rounds. Surveys consisted of measures 
pertaining to: (1) PTSD, (2) depression, (3) anxiety, (4) quality of life, and 
(5) self-esteem.
RESULTS: Median scores improved for all groups at all timepoints for all five 
domains. For the pre-Covid participants, the largest improvements in the child 
program were reported in depression (36.6 %, p = 0.05); in the adolescent 
program anxiety showed the largest improvement (-35.7 %, p = 0.006). 
Improvements were generally maintained or increased at the end of round two. In 
almost every domain, the improvements of the pre-COVID group were greater than 
those of the COVID-I group.
CONCLUSIONS: A complex multimodal treatment program specifically designed for 
youth CSA survivors has the capacity to improve a number of relevant 
determinants of mental health and well-being. The COVID-19 pandemic may have 
retraumatized participants, resulting in treatment resistance.

Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.chiabu.2022.105926
PMCID: PMC9624116
PMID: 36332320 [Indexed for MEDLINE]


1350. Int J Ment Health Nurs. 2023 Apr;32(2):479-489. doi: 10.1111/inm.13086. Epub 
2022 Nov 3.

Psychological disorders among Spanish Nursing students three months after 
COVID-19 lockdown: A cross-sectional study.

Mendez-Pinto I(1), Antuña-Casal M(1), Mosteiro-Diaz MP(1).

Author information:
(1)Postgraduate International Center, University of Oviedo, Oviedo, Spain.

The COVID-19 pandemic had a notable impact on the psychological well-being of a 
large part of the population, putting them at risk of developing depressive 
symptoms, different levels of anxiety disorders, and posttraumatic stress 
disorder (PTSD). One group considered to be at high risk are Nursing students; 
they were affected as learning strategies changed and clinical practices were 
cancelled. This study attempts to assess the psychological impact COVID-19 
pandemic had on Nursing students and to explore the sociodemographic differences 
that can be risk factors for mental health disturbance. The psychological impact 
was evaluated using the Impact of Event Scale-Revised (IES-R) and Hospital 
Anxiety and Depression Scale (HADS). The study took place 4 months after the 
state of alarm was declared over in Spain. From a total sample of 304 Nursing 
students, 26.7%, 39.8%, and 15.5% showed PTSD, anxiety, and depression symptoms, 
respectively. Severe levels of psychological impact have been associated with 
being a female, a smoker, and feeling fear and stress. Having a relative test 
positive has been linked to lower anxiety levels while being afraid or stressed 
to higher anxiety levels. Being a female, co-habit with friends and feeling 
stress have been associated with higher depression levels.

© 2022 The Authors. International Journal of Mental Health Nursing published by 
John Wiley & Sons Australia, Ltd.

DOI: 10.1111/inm.13086
PMCID: PMC9877867
PMID: 36330581 [Indexed for MEDLINE]


1351. PLoS One. 2022 Nov 3;17(11):e0276590. doi: 10.1371/journal.pone.0276590. 
eCollection 2022.

Effects of social isolation on quality of life in elderly adults.

Newman-Norlund RD(1), Newman-Norlund SE(1), Sayers S(1), McLain AC(2), Riccardi 
N(3), Fridriksson J(1).

Author information:
(1)Department of Communication Sciences, Arnold School of Public Health, 
University of South Carolina, Columbia, South Carolina, United States of 
America.
(2)Department of Epidemiology and Biostatistics, Arnold School of Public Health, 
University of South Carolina, Columbia, South Carolina, United States of 
America.
(3)Department of Psychology, College of Arts and Sciences, University of South 
Carolina, Columbia, South Carolina, United States of America.

Prolonged periods of social isolation are known to have significant negative 
health consequences and reduce quality of life, an effect that is particularly 
pronounced in older populations. Despite the known deleterious effects of social 
isolation, a key component of the response to the COVID-19 pandemic has been the 
issuance of stay at home and/or shelter in place orders. Relatively little is 
known about the potential effects these periods of social isolation could have 
on older adults, and less still is known about potential risk factors or 
protective factors that modulate these effects. Here, we describe results from a 
longitudinal study in which we measured quality of life both prior to and 
immediately following a one-month period of social isolation associated with the 
issuance and revocation of a shelter in place order (April 6, 2020 through May 
4, 2020) in the state of South Carolina. Healthy adult participants (N = 62) 
between the ages of 60 and 80 who had already completed quality of life 
questionnaires prior to isolation again completed the questionnaires following a 
one-month order to shelter in place. Quality of life significantly decreased 
during the social isolation period, with older participants showing the greatest 
declines. Participants with higher levels of physical activity and better 
physical/mental health going into the isolation period tended to show greater 
decreases in quality of life over time. These results highlight the negative 
consequences of even short bouts of social isolation for the elderly and suggest 
that reductions in social contact related to COVID-19 may have significant 
effects on mental health and emotional well-being, at least among older 
individuals.

DOI: 10.1371/journal.pone.0276590
PMCID: PMC9632793
PMID: 36327259 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


1352. PLoS One. 2022 Nov 3;17(11):e0277062. doi: 10.1371/journal.pone.0277062. 
eCollection 2022.

Uptake and effects of psychological first aid training for healthcare workers' 
wellbeing in nursing homes: A UK national survey.

Schoultz M(1), McGrogan C(1), Beattie M(2), Macaden L(2), Carolan C(2), Dickens 
GL(1).

Author information:
(1)School of Health and Life Sciences, Northumbria University, Newcastle, United 
Kingdom.
(2)Centre for Health Sciences, University of the Highlands and Islands, 
Inverness, Scotland.

AIMS: Psychological First Aid is a brief intervention based on international 
guidance from the World Health Organisation. Free to access online training in 
the intervention was introduced during the COVID-19 pandemic in UK. We aimed to 
determine the uptake of Psychological First Aid training among healthcare 
workers in care homes in the UK and to assess its effects on their wellbeing.
DESIGN: This was a sequential mixed methods design.
METHODS: Healthcare workers (nurses and carers) working in care homes in the UK 
were surveyed about their uptake of Psychological First Aid, their stress, 
coping efficacy and the key concepts of Psychological First Aid (safety, 
calmness, hopefulness, connectedness, and accomplishment). Those that completed 
the Psychological First Aid training were asked to share their experiences via 
qualitative survey. Data collection was conducted between June and October 2021. 
Analyses included descriptive statistics and regression analysis. A six step 
thematic analysis was used to interpret the qualitative data.
RESULTS: 388 participants responded to the survey. The uptake of Psychological 
First Aid training was 37 (9.5%). Psychological first aid was a significant 
predictor for coping efficacy (β = 17.54, p = .001). Participants with a 
physical or mental health condition experienced higher stress and lower coping 
regardless of PFA training. Four themes were identified from the qualitative 
analysis: self-awareness and growth, relationships with others, overcoming 
stress and accessibility.
CONCLUSION: While this study suggests some benefits to healthcare workers in 
care home settings undergoing PFA the poor uptake of the training warrants 
further investigation.
IMPACT: Care home staff need psychological support. This gap remains as few 
completed PFA training. This is the first study in UK and worldwide to look at 
the effects of psychological first aid on stress and coping in this population 
and it warrants further investigation.

DOI: 10.1371/journal.pone.0277062
PMCID: PMC9632887
PMID: 36327237 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


1353. Brain Behav. 2022 Dec;12(12):e2803. doi: 10.1002/brb3.2803. Epub 2022 Nov 3.

Mental health symptoms and sleep quality of asymptomatic/mild 
SARS-CoV-2 infected individuals during the Omicron wave of the COVID-19 pandemic 
in Shanghai China.

Hou Z(1), Huang Y(2), Ma S(3), Feng H(4), Fu C(5), Li H(6), Yuan Y(7), Yuan 
Y(1).

Author information:
(1)Department of Psychosomatics & Psychiatry, Affiliated Zhongda Hospital, 
School of Medicine, Southeast University, Nanjing, China.
(2)Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, 
Southeast University, Nanjing, China.
(3)Department of Emergency and Critical Care Medicine, Zhongda Hospital, School 
of Medicine, Southeast University, Nanjing, China.
(4)Department of Traditional Chinese Medicine, Zhongda Hospital, School of 
Medicine, Southeast University, Nanjing, China.
(5)Department of Respiratory and Critical Care Medicine, Zhongda Hospital, 
School of Medicine, Southeast University, Nanjing, China.
(6)Department of Pediatrics, Zhongda Hospital, School of Medicine, Southeast 
University, Nanjing, China.
(7)Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School 
of Medicine, Southeast University, Nanjing, China.

OBJECTIVE: To investigate mental health symptoms (anxiety, depression, and sleep 
status) and their associated factors among people infected with the SARS-CoV-2 
omicron variant during the quarantine period in Shanghai.
METHODS: To investigate the mental health symptoms among participants with 
SARS-CoV-2 omicron infection, an anonymous online survey questionnaire was used. 
The survey panel included the 9-item Patient Health Questionnaire-9 (PHQ-9), 
7-item Generalized Anxiety Disorder Scale (GAD-7), Pittsburgh Sleep Quality 
Index (PSQI), and 22-item Ruminative Responses Scale (RRS). Group comparisons 
and correlation analyses were employed to explore the epidemiological 
characteristics of patients and factors related to depression and anxiety 
symptoms.
RESULTS: A total of 960 participants completed the survey. Of the total 
respondents, 583 participants (60.7%) were male, and the mean (SD) age was 34.33 
(9.21) years (95% CI: 33.74-34.91). The prevalence of depressive and anxiety 
symptoms among the participants was 13.7% (n = 151, 95% CI: 11.6%-15.7%) and 
8.6% (n = 90, 95% CI: 6.9%-10.3%), respectively. Age-stratified analysis showed 
that the prevalence of anxiety among the 36- to 45-year-old group (12.9%; 
n = 35, 8.9%-16.9%) was significantly higher than that of the 18- to 15-year-old 
group (7.4%; n = 42, 5.3%-9.6%, p = .011). Spearman's correlation analyses 
showed that rumination (assessed by the RRS) was significantly and positively 
correlated with depression (rho = .706, p < .001) and anxiety symptoms 
(rho = .758, p < .001).
CONCLUSION: The results suggest that female and middle-aged populations manifest 
higher susceptibility to mental health distress during the current Omicron wave 
of the COVID-19 pandemic. Population-specific psychological crisis intervention 
is warranted to improve the quality of epidemic prevention methods and to 
promote the mental well-being of the public.

© 2022 The Authors. Brain and Behavior published by Wiley Periodicals LLC.

DOI: 10.1002/brb3.2803
PMCID: PMC9759130
PMID: 36326125 [Indexed for MEDLINE]

Conflict of interest statement: No disclosure of conflict of interest.


1354. Disaster Med Public Health Prep. 2022 Nov 3;17:e282. doi: 10.1017/dmp.2022.256.

Pre-COVID-19 Physician Awareness of Mental Health Resources During and After 
Natural and Human-Made Disasters.

Sood N(1), Hazelton JP(2), Boehmer S(3), Olympia RP(4).

Author information:
(1)Pennsylvania State College of Medicine, Hershey, PA, USA.
(2)Division of Trauma, Acute Care and Critical Care Surgery, Pennsylvania State 
Health Milton S. Hershey Medical Center, Hershey, PA, USA.
(3)Department of Public Health Sciences, Division of Biostatistics, Pennsylvania 
State College of Medicine, Hershey, PA, USA.
(4)Department of Emergency Medicine and Pediatrics, Pennsylvania State Hershey 
Medical Center, Hershey, PA, USA.

OBJECTIVE: Physician mental health is critical during the recovery of natural 
and human-made disasters (NHDs), yet the accessibility of mental health 
resources to physicians has not been characterized. This study examined 
emergency medicine and trauma physician knowledge of and access to mental health 
resources in NHD settings.
METHODS: The survey was electronically disseminated to the American College of 
Emergency Physicians and the American Association of the Surgery of Trauma 
between February 4, 2020, and March 9, 2020. The 17-question survey assessed 
physician awareness and access to emergency preparedness resources at their 
institutions.
RESULTS: Of the responders, 86% (n = 229) were aware of written emergency 
response plans for their facility. While 31% were aware of the hospital's mental 
health policies and resources outside of the emergency response plan, only 25% 
knew how to access these resources during and after NHDs. Finally, 10% reported 
the incorporation of mental health resources during institutional practice 
drills.
CONCLUSIONS: Physicians reported knowledge of emergency preparedness policies; 
however, significant gaps remain in physician knowledge and access to mental 
health resources NHD settings. As NHDs increase on a global scale, it is 
critical for health systems to ensure accessible infrastructure to support the 
mental well-being of health professionals.

DOI: 10.1017/dmp.2022.256
PMCID: PMC9837416
PMID: 36325828 [Indexed for MEDLINE]


1355. Int J Drug Policy. 2022 Dec;110:103895. doi: 10.1016/j.drugpo.2022.103895. Epub 
2022 Oct 20.

How Covid-19 restrictions affected young people's well-being and drinking 
practices: Analyzing interviews with a socio-material approach.

Törrönen J(1), Månsson J(2), Samuelsson E(3), Roumeliotis F(4), Svensson J(4), 
Kraus L(5), Room R(6).

Author information:
(1)Department of Public Health Sciences, Stockholm University, Sweden. 
Electronic address: jukka.torronen@su.se.
(2)Department of Social Work, Stockholm University, Stockholm, Sweden.
(3)Department of Public Health Sciences, Stockholm University, Sweden; 
Department of Social Work, Stockholm University, Stockholm, Sweden.
(4)Department of Public Health Sciences, Stockholm University, Sweden.
(5)Department of Public Health Sciences, Stockholm University, Sweden; IFT 
Institut für Therapieforschung, Leopoldstraße 175, 80804 München, Germany.
(6)Department of Public Health Sciences, Stockholm University, Sweden; Centre 
for Alcohol Policy Research, La Trobe University, Melbourne, Australia.

BACKGROUND: The Covid-19 restrictions - as they made young people's practices in 
their everyday life visible for reflection and reformation - provide a 
productive opportunity to study how changing conditions affected young people's 
well-being and drinking practices.
METHODS: The data is based on qualitative interviews with 18- to 24-year-old 
Swedes (n=33) collected in the Autumn 2021. By drawing on the socio-material 
approach, the paper traces actants, assemblages and trajectories that moved the 
participants towards increased or decreased well-being during the lockdown.
RESULTS: The Covid-19 restrictions made the participants reorganize their 
everyday life practices emphatically around the home and communication 
technologies. The restrictions gave rise to both worsened and improved 
well-being trajectories. In the worsened well-being trajectories, the pandemic 
restrictions moved the participants towards loneliness, loss of routines, 
passivity, physical barriers, self-centered thoughts, negative effects of 
digital technology, sleep deficit, identity crisis, anxiety, depression, and 
stress. In the improved well-being trajectories, the Covid-19 restrictions 
brought about freedom to study from a distance, more time for significant 
others, oneself and for one's own hobbies, new productive practices at home and 
a better understanding of what kind of person one is. Both worsened and improved 
well-being trajectories were related to the aim to perform well, and in them 
drinking practices either diminished or increased the participants' capacities 
and competencies for well-being.
CONCLUSIONS: The results suggest that material domestic spaces, communication 
technologies and performance are important actants both for alcohol consumption 
and well-being among young people. These actants may increase or decrease young 
people's drinking and well-being depending on what kinds of relations become 
assembled.

Copyright © 2022. Published by Elsevier B.V.

DOI: 10.1016/j.drugpo.2022.103895
PMCID: PMC9581798
PMID: 36323187 [Indexed for MEDLINE]

Conflict of interest statement: Declarations of Interest None.


1356. PLoS One. 2022 Nov 2;17(11):e0275095. doi: 10.1371/journal.pone.0275095. 
eCollection 2022.

Chronic pain: Evidence from the national child development study.

Blanchflower DG(1), Bryson A(2).

Author information:
(1)Adam Smith School of Business, Dartmouth College, University of Glasgow and 
NBER, Hanover, NH, United States of America.
(2)UCL Social Research Institute, University College London, London, United 
Kingdom.

Using data from all those born in a single week in 1958 in Britain we track 
associations between short pain and chronic pain in mid-life (age 44) and 
subsequent health, wellbeing and labor market outcomes in later life. We focus 
on data taken at age 50 in 2008, when the Great Recession hit and then five 
years later at age 55 in 2013 and again at age 62 in 2021 during the Covid 
pandemic. We find those suffering both short-term and chronic pain at age 44 
continue to report pain and poor general health in their 50s and 60s. However, 
the associations are much stronger for those with chronic pain. Furthermore, 
chronic pain at age 44 is associated with a range of poor mental health 
outcomes, pessimism about the future and joblessness at age 55 whereas 
short-duration pain at age 44 is not. Pain has strong predictive power for pain 
later in life: pain in childhood predicts pain in mid-life, even when one 
controls for pain in early adulthood. Pain appears to reflect other 
vulnerabilities as we find that chronic pain at age 44 predicts whether or not a 
respondent has Covid nearly twenty years later.

DOI: 10.1371/journal.pone.0275095
PMCID: PMC9629596
PMID: 36322526 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


1357. J Trauma Stress. 2022 Dec;35(6):1756-1768. doi: 10.1002/jts.22884. Epub 2022 Nov 
2.

Posttraumatic growth related to the COVID-19 pandemic among individuals with 
lived experience of psychiatric disorder.

Lewis C(1), Lewis K(1), Edwards B(2), Evison C(1), John A(3), Pearce H(1), 
Raisanen L(1), Richards N(1), Roberts A(1), Jones I(1), Bisson JI(1).

Author information:
(1)National Centre for Mental Health, Division of Psychological Medicine and 
Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, United 
Kingdom.
(2)National Centre for Mental Health, PÂR, Cardiff University School of 
Medicine, Cardiff, United Kingdom.
(3)National Centre for Mental Health, Population Data Science, Swansea 
University Medical School, Swansea, United Kingdom.

Although the COVID-19 pandemic has been shown to be detrimental to mental 
health, it may hold a parallel potential for positive change. Little is known 
about posttraumatic growth (PTG) as a potential outcome for individuals with 
lived experience of psychiatric disorders following trauma exposure, especially 
in the context of the COVID-19 pandemic. Participants were 1,424 adults with 
lived experience of a psychiatric disorder who took part in a longitudinal study 
of mental health during the COVID-19 pandemic conducted by the National Centre 
for Mental Health. PTG was measured using the Posttraumatic Growth 
Inventory-Short Form (PTGI-SF). Factors hypothesized to be associated with PTG 
were investigated using linear regression. The mean participant PTGI score was 
12.64 (SD = 11.01). On average, participants reported the highest scores on 
items related to appreciation of life and lowest on those related to spiritual 
change subscale. We found the strongest evidence of associations between higher 
levels of PTG and higher scores on assessment items related to perceived social 
support, B = 2.86; perceptions of the pandemic as traumatic, B = 4.89; and 
higher psychological well-being, B = 0.40. Taken together, we did not observe 
evidence of widespread PTG related to the COVID-19 pandemic among individuals 
with lived experiences of psychiatric disorders.

© 2022 The Authors. Journal of Traumatic Stress published by Wiley Periodicals 
LLC on behalf of International Society for Traumatic Stress Studies.

DOI: 10.1002/jts.22884
PMCID: PMC9877956
PMID: 36322379 [Indexed for MEDLINE]


1358. Asia Pac J Public Health. 2023 Jan;35(1):73-76. doi: 10.1177/10105395221136179. 
Epub 2022 Nov 2.

Mental Well-Being of Health Care Workers in Vietnam During the Fourth Wave of 
COVID-19 Pandemic: Impact of COVID-19 Exposure, Anxiety, and Resilience 
Capacity.

Hoang HXT(1), Quach HL(2), Nguyen TH(1).

Author information:
(1)Faculty of Nursing, Phenikaa University, Hanoi, Vietnam.
(2)Center for Ageing Research and Education, Duke-NUS Medical School, Singapore, 
Singapore.

DOI: 10.1177/10105395221136179
PMCID: PMC9637928
PMID: 36321511 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1359. Rev Esp Salud Publica. 2022 Nov 2;96:e202211083.

[State of mind in adolescents in Barcelona province (Spain): Evolution, 
associated factors and impact of the pandemic.].

[Article in Spanish; Abstract available in Spanish from the publisher]

Camprubí Condom L(1), Valero Coppin O(2), Chavero Bellido S(1), Frías Trigo 
C(1).

Author information:
(1)Servicio de Salud Pública, Diputació de Barcelona. Barcelona. España.
(2)Servicio de Estadística Aplicada, Universidad Autónoma de Barcelona. 
Cerdanyola del Vallès (Barcelona). España.

OBJECTIVE: To analyse the evolution of state of mind in adolescents in the 
province of Barcelona for the last six years and the specific impact of the 
pandemic and its experience. Likewise, analyse the associated factors both in 
pre-pandemic period and during.
METHODS: Since 2015/2016 a Questionnaire on health related habits was carried 
out among 4th year high school students to which a COVID-19 chapter was added in 
the 2020/2021 academic year. There was a representative provincial pre-pandemic 
sample (N=15,118) and a sample during the pandemic (N=4,966). The dichotomous 
aggregate variable of positive/negative state of mind was constructed with six 
specific items to which the bivariate analyses and a multivariate generalized 
mixed linear model were carried out for both periods. Analysis performed with 
SAS.
RESULTS: The pandemic significantly intensified the trend of worsening the state 
of mind adolescents, and widened the gender gap. Boys went from 17.9% 
(pre-pandemic) to 25.7% (during pandemic) with a negative mood, while girls from 
31.9% to 52.9%. In modelling during pandemic, socioeconomic and family factors 
appeared relevant and significant. Sex, perceived poor health, being victim of 
harassment, self-perception of weight, excessive use of the internet and a poor 
perception of the residential environment remained significant as in the 
pre-pandemic model.
CONCLUSIONS: The specific negative impact of the pandemic on adolescents' mental 
well-being is perceived, but it is too early to tell whether it is reversible or 
not and to assess the effectiveness of interventions to tackle it.

Publisher: OBJETIVO: Se considera relevante analizar la evolución del estado 
anímico en adolescentes de la provincia de Barcelona en los últimos seis años y 
el impacto específico de la pandemia y su vivencia. Así como los factores 
asociados tanto en el periodo prepandemia como durante.
METODOS: Desde 2015/2016 se realizó una encuesta de hábitos relacionados con la 
salud a alumnos de 4º de Enseñanza Secundaria Obligatoria (ESO). En el curso 
2020/2021 se le añadió un bloque sobre la COVID-19. Hubo una muestra 
representativa provincial prepandemia (N=15.118) y una muestra durante la 
pandemia (N=4.966). A partir de seis ítems específicos se construyó la variable 
agregada dicotómica de estado anímico positivo/negativo a la que se realizaron 
los análisis bivariados y multivariantes a cada periodo. Análisis realizados con 
SAS.
RESULTADOS: La pandemia intensificó significativamente la tendencia de 
empeoramiento en el estado anímico de la población adolescente y agrandó la 
brecha de género. Los chicos pasaron del 17,9% (prepandemia) al 25,7% (durante 
pandemia), con estado anímico negativo, mientras que las chicas variaron del 
31,9% al 52,9%. En la modelización durante pandemia aparecieron relevantes y 
significativos los factores socioeconómicos y familiares, mientras que se 
mantuvieron como en prepandemia el sexo, la mala salud percibida, ser víctima de 
acoso, la autopercepción del peso, el uso excesivo de internet y la mala 
percepción del entorno residencial.
CONCLUSIONES: El impacto negativo específico de la pandemia en el estado anímico 
de los adolescentes es apreciable, pero aún es pronto para saber si es o no 
reversible y para conocer la efectividad de las intervenciones al respecto.

PMID: 36321510 [Indexed for MEDLINE]

Conflict of interest statement: Disclosure The authors report no conflicts of 
interest in this work.


1360. Psychiatr Serv. 2023 Apr 1;74(4):434-436. doi: 10.1176/appi.ps.20220281. Epub 
2022 Nov 2.

Navigating Supported Employment and Education Services for Youths During 
COVID-19 and Severe Weather Events.

Kwan A(1), Conroy K(1), Barron K(1), Nandlall N(1), Iyer SN(1), Henderson JL(1), 
Barbic S(1).

Author information:
(1)Department of Occupational Science and Occupational Therapy, Faculty of 
Medicine, University of British Columbia, Vancouver (Kwan, Barbic); Foundry 
Penticton, Penticton, British Columbia (Conroy, Barron); Margaret and Wallace 
McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and 
Mental Health, Toronto (Nandlall, Henderson); Department of Psychiatry, McGill 
University, and ACCESS Open Minds, Douglas Research Centre, Montreal (Iyer); 
Foundry, Providence Health Care, Vancouver (Barbic).

In 2021, the British Columbia (BC) Interior experienced a series of 
unprecedented disasters, ranging from extreme heat and wildfires to catastrophic 
flooding and evacuations. Along with these severe weather events, BC was 
affected by COVID-19 outbreaks and public health restrictions. Despite these 
challenges, communities worked to ensure that youths who are at risk for 
increased mental health challenges continued to have access to services that 
promote well-being, such as individual placement and support programs for 
supported employment and education. This Open Forum presents program 
considerations and adaptations in Foundry Penticton, one of 12 province-wide 
integrated youth hubs, to ensure service delivery during acute and chronic 
disasters.

DOI: 10.1176/appi.ps.20220281
PMID: 36321317 [Indexed for MEDLINE]


1361. Int J Adolesc Med Health. 2022 Nov 2;35(1):41-60. doi: 10.1515/ijamh-2022-0058. 
eCollection 2023 Feb 1.

Adolescent mental health during covid-19 pandemics: a systematic review.

Alamolhoda SH(1), Zare E(1), Atena HakimZadeh(2), Zalpour A(2), Vakili F(2), 
Razie Mohammadi Chermahini(2), Ebadifard R(2), Masoumi M(2), Niayesh 
Khaleghi(2), Malihe Nasiri(3).

Author information:
(1)Midwifery and Reproductive Health Research Center, Department of Midwifery 
and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti 
University of Medical Sciences, Tehran, Iran.
(2)School of nursing and midwifery, Shahid Beheshti University of Medical 
Sciences, Tehran, Iran.
(3)Department of biostatistics, school of Nursing and Midwifery, Shahid Beheshti 
University of Medical Sciences, Tehran, Iran.

OBJECTIVES: The outbreak of the COVID-19 pandemic has had wide-ranging outcomes 
on adolescents' well-being. However, less attention has been paid to the 
adolescent's mental health during the pandemic. The pandemic may impair 
adolescents' mental health through stress spillover from other family members, 
contextual and policy changes, and the disruption of everyday life routines. 
Therefore, our research is motivated by a need to address the relative scarcity 
of research examining adolescent mental health during the pandemic.
CONTENT: This systematic review was conducted through the medical database, Web 
of Science, Scopus, Medline, Embase, Google Scholar, and Cochrane databases for 
peer-reviewed, cross-sectional, cohort studies assessing the mental health 
status of adolescents during the Covid-19 virus pandemic from May 2020 till Dec 
2022 without language restriction. Keywords were selected based on the Mesh 
terms and Emtree.
SUMMARY: Studies on coronavirus have revealed many significant psychological 
effects on teens of all ages. The most commom problems were on the stress and 
anxiety, sleep disorders, depression, post-traumatic stress disorder. Risk 
factors were concidered as prior mental health problem, female sexuality, fear 
of covid-19, nutrition, physical activity and listening the covid 19 news.
OUTLOOK: Considering the critical age of teenagers, the role of parents is 
vital. Health policy maker should support parents as a key factors to approprate 
care for adolescent. Parents should be educated on parenting methods during the 
covid pandemic to avoid irreparable damage of adolescent's mental health.

© 2022 Walter de Gruyter GmbH, Berlin/Boston.

DOI: 10.1515/ijamh-2022-0058
PMID: 36318718 [Indexed for MEDLINE]


1362. West J Nurs Res. 2023 Apr;45(4):327-334. doi: 10.1177/01939459221129944. Epub 
2022 Oct 31.

The Experience of Frontline Nurses during the COVID-19 Pandemic: A 
Phenomenological Study.

Phillips J(1)(2), Alipio JK(3), Hoskins JL(3), Cohen MZ(4).

Author information:
(1)Nursing Administration, Rush University Medical Center, Chicago, IL, USA.
(2)Rush University College of Nursing, Chicago, IL, USA.
(3)Professional Nursing Staff, Rush University Medical Center, Chicago, 
Illinois, USA.
(4)University of Nebraska Medical Center, College of Nursing, Omaha, NE, USA.

The purpose of this phenomenological study was to describe the experience of 
frontline nurses working during the COVID-19 pandemic. The first author 
conducted two individual audiotaped interviews with 23 qualified staff nurses. 
All the authors analyzed the professionally transcribed data according to 
hermeneutic principles. The researchers identified five major themes: (a) we are 
family; (b) heroes work here; (c) fear of contagion; (d) mental health and 
well-being; and (e) new reality. Given the uncertainties of working during the 
COVID-19 pandemic, findings revealed the value of supportive collegial 
relationships and the need to support the mental health and well-being needs of 
frontline nurses during the pandemic. Nurses need supportive environments to 
help ease the challenges associated with serving on the frontline during times 
of crisis. Findings have implications for future public health preparedness and 
response efforts.

DOI: 10.1177/01939459221129944
PMCID: PMC9623405
PMID: 36317232 [Indexed for MEDLINE]

Conflict of interest statement: The authors declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1363. BMC Public Health. 2022 Oct 31;22(1):1987. doi: 10.1186/s12889-022-14349-5.

Mental and physical health and well-being of canadian employees who were working 
from home during the COVID-19 pandemic.

Somasundram KG(1), Hackney A(1), Yung M(1), Du B(1), Oakman J(2), Nowrouzi-Kia 
B(3), Yazdani A(4)(5)(6).

Author information:
(1)Canadian Institute for Safety, Wellness & Performance, School of Business, 
Conestoga College Institute of Technology and Advanced Learning, Kitchener, ON, 
Canada.
(2)Centre for Ergonomics and Human Factors, School of Psychology & Public 
Health, La Trobe University, Bundoora, Australia.
(3)Department of Occupational Science and Occupational Therapy, University of 
Toronto, Toronto, ON, Canada.
(4)Canadian Institute for Safety, Wellness & Performance, School of Business, 
Conestoga College Institute of Technology and Advanced Learning, Kitchener, ON, 
Canada. ayazdani@conestogac.on.ca.
(5)School of Public Health and Health Systems, University of Waterloo, Waterloo, 
ON, Canada. ayazdani@conestogac.on.ca.
(6)School of Geographic and Earth Sciences, McMaster University, Hamilton, ON, 
Canada. ayazdani@conestogac.on.ca.

BACKGROUND: The COVID-19 pandemic has drastically changed various aspects of our 
lives, including how we work. Since the start of the pandemic, numerous 
organizations in Canada have mandated their employees to work from home (WFH) on 
a full-time basis. The rapid rise in the number of remote workers and the 
possibility for WFH continuing in the future signifies the importance of 
understanding the health and well-being of employees working from home over the 
course of the pandemic in Canada. We present the findings of two surveys 
(initial and 6-month follow-up) to examine the health and well-being of WFH 
employees during the COVID-19 pandemic in Canada. We analyzed the changes in 
mental and physical health and well-being of employees who were working from 
home between two time points during the pandemic.
METHODS: Initial survey was completed between October 2020 and December 2020 
(n = 1617); follow-up survey was completed between May 2021 and June 2021 
(n = 382). We calculated the frequencies for survey questions involving 
demographics, WFH preferences, workstation setup training, employment situation, 
provision of hardware technologies, provision and usage of software 
technologies, and organization's return to work plan. We conducted Wilcoxon 
signed-rank tests to analyze the within-individual changes in mental and 
physical health and well-being of the 382 respondents who completed both the 
initial and follow-up surveys.
RESULTS: Our analyses showed significant changes in various aspects of employee 
mental and physical health and well-being. Burnout, stress, general mental 
health, and job insecurity levels significantly decreased between the two time 
periods. Work-related sedentary behaviour reduced over time; however, the 
average proportion of time spent sitting during work hours was more than 80% in 
both surveys. Employees received more help and feedback from their colleagues 
and experienced a better sense of community with their co-workers over time.
CONCLUSION: The findings can inform workers and organizations on the changes in 
mental and physical health and well-being of employees working from home during 
the pandemic. By understanding the changes in worker health and well-being, 
employers can develop effective strategies and implement policies that help 
protect employees' health and well-being.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-14349-5
PMCID: PMC9619010
PMID: 36316683 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1364. BMC Public Health. 2022 Oct 31;22(1):1988. doi: 10.1186/s12889-022-14285-4.

The COVID-19 pandemic's intersectional impact on work life, home life and 
wellbeing: an exploratory mixed-methods analysis of Georgia women's experiences 
during the pandemic.

McCool-Myers M(1), Grasso D(2), Kozlowski D(3), Cordes S(3), Jean V(3), Gold 
H(3), Goedken P(3).

Author information:
(1)Department of Gynecology and Obstetrics, Emory University School of Medicine, 
46 Armstrong St SE, 30303, Atlanta, GA, USA. Megan.myers@emory.edu.
(2)Department of Psychiatry, University of Connecticut Health, Connecticut, USA.
(3)Department of Gynecology and Obstetrics, Emory University School of Medicine, 
46 Armstrong St SE, 30303, Atlanta, GA, USA.

BACKGROUND: Women have been especially impacted by the COVID-19 pandemic. This 
exploratory study aimed to characterize women's adverse experiences related to 
their work, home lives, and wellbeing during the height of the COVID-19 pandemic 
and to describe demographic differences of those lived experiences.
METHODS: Using the validated Epidemic-Pandemic Impacts Inventory, we collected 
data from reproductive-aged women in the state of Georgia about their exposure 
to adverse events during the pandemic. A latent class analysis (LCA) was 
performed to identify subgroups of women reporting similar adverse experiences 
and describe their sociodemographic characteristics. An optional open-ended 
question yielded qualitative data that were analyzed thematically and merged 
with subgroup findings. Data were collected from September 2020 to January 2021.
RESULTS: 423 individuals aged 18-49 completed the survey with 314 (74.2%) 
providing qualitative responses. The LCA yielded 4 subgroups: (1) a "low 
exposure" subgroup (n = 123, 29.1%) with relatively low probability of adverse 
experiences across domains (e.g. financial insecurity, health challenges, 
barriers to access to healthcare, intimate partner violence (IPV)); (2) a "high 
exposure" subgroup (n = 46, 10.9%) with high probability of experiencing 
multiple adversities across domains including the loss of loved ones to 
COVID-19; (3) a "caregiving stress" subgroup (n = 104, 24.6%) with high 
probability of experiencing challenges with home and work life including 
increased partner conflict; and (4) a "mental health changes" subgroup (n = 150, 
35.5%) characterized by relatively low probability of adverse experiences but 
high probability of negative changes in mental health and lifestyle. Individuals 
in subgroups 1 and 4, which had low probabilities of adverse experiences, were 
significantly more likely to be non-Hispanic white. Individuals in subgroup 2 
were more likely to identify with a sexual or racial/ethnic minority population. 
Inductive coding of qualitative data yielded themes such as stress, mental 
health, financial impact, and adaptation/resilience, providing context for 
pandemic-related adversity.
CONCLUSION: Though many individuals in our sample experienced hardship, minority 
populations were unequally impacted by pandemic-related adversity in work life, 
home life, and wellbeing. Recovery and future emergency preparedness efforts in 
Georgia must incorporate support mechanisms for mental health and IPV, focusing 
especially on the intersectional needs of racial, ethnic, and sexual minorities.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-14285-4
PMCID: PMC9619013
PMID: 36316668 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1365. Anaesthesia. 2023 Feb;78(2):197-206. doi: 10.1111/anae.15879. Epub 2022 Oct 31.

Mental health and well-being of anaesthetists during the COVID-19 pandemic: a 
scoping review.

Paterson E(1), Paterson NAB(2)(3), Ferris LJ(4)(1).

Author information:
(1)School of Psychology, University of Queensland, Brisbane, QLD, Australia.
(2)School of Clinical Medicine, University of Queensland, Brisbane, QLD, 
Australia.
(3)Anaesthesia and Pain Management Services, Queensland Children's Hospital, 
Brisbane, QLD, Australia.
(4)School of Business, University of Queensland, Brisbane, QLD, Australia.

The COVID-19 pandemic has imposed substantial burdens on clinicians and there is 
a need to better understand the impact on mental health and well-being. This 
scoping review investigates the prevalence of mental health concerns in 
anaesthetists, risk and protective factors for mental well-being, and 
anaesthetists' pandemic-related concerns and support. We searched online 
databases for articles published between January 2020 and May 2022, using search 
terms related to: anaesthesia; burnout, well-being, mental health or stress; and 
COVID-19. We identified 20 articles comprising 19 different populations of 
anaesthetists (n = 8680) from 14 countries. Studies identified the prevalence of 
the following condition in anaesthetists: burnout (14-59%); stress (50-71%); 
anxiety (11-74%); depression (12-67%); post-traumatic stress (17-25%); 
psychological distress (52%); and insomnia (17-61%). Significant risk factors 
for poorer mental health included: direct COVID-19-related issues (fear of self 
and family exposure to infection; requirement for quarantine); practitioner 
health factors (insomnia; comorbidities); psychosocial factors (loneliness; 
isolation; perceived lack of support at home and work); demographic factors 
(female gender; non-white ethnicity; LGBTQIA+); and workplace factors 
(redeployment outside area of clinical practice; increased work effort; personal 
protective equipment shortages). Protective factors identified included: job 
satisfaction; perceived organisational justice; older age; and male sex. 
Anaesthetists' self-reported concerns related to: personal protective equipment; 
resource allocation; fear of infection; fear of financial loss; increased 
workload; and effective communication of protocols for patient treatment. 
Support from family, colleagues and hospital management was identified as an 
important coping mechanism. Findings from this review may support the design of 
interventions to enhance anaesthetists' psychological health during pandemic 
conditions and beyond. Future research should include consistent psychological 
outcome measures and rigorous experimental design beyond cross-sectional 
studies.

© 2022 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of 
Association of Anaesthetists.

DOI: 10.1111/anae.15879
PMCID: PMC9874483
PMID: 36314294 [Indexed for MEDLINE]


1366. Front Public Health. 2022 Oct 13;10:949403. doi: 10.3389/fpubh.2022.949403. 
eCollection 2022.

Experiencing, anticipating, and witnessing discrimination during the COVID-19 
pandemic: Implications for health and wellbeing among Asian Americans.

Dhanani LY(1), Franz B(2), Pham CT(3).

Author information:
(1)School of Management and Labor Relations, Rutgers University, Piscataway, NJ, 
United States.
(2)Heritage College of Osteopathic Medicine, Appalachian Institute to Advance 
Health Equity Science, Ohio University, Athens, OH, United States.
(3)Psychology Department, DePaul University, Chicago, IL, United States.

The onset of the COVID-19 pandemic spurred increased racial animus toward Asians 
and Asian Americans (A/AA) who have since been contending with increased racism 
and violence. While some of the harm associated with this increased prejudice 
may derive from personally experienced discrimination, the COVID-19 pandemic has 
also been marked by an increase in vicarious exposure to discrimination as well 
as increased anticipation of discrimination, both of which may be taxing for the 
mental and physical health of A/AA. The goal of this study, accordingly, was to 
examine the effects of personal experiences of discrimination, vicarious 
exposure to discrimination, and anticipated discrimination on depressive 
symptoms, physical health symptoms, sleep quality, and sleep disturbances among 
A/AA. Results from our two-wave field survey demonstrated that experiencing and 
anticipating discrimination were associated with mental and physical health 
symptoms as well as sleep disturbances. Further, personal experiences of 
discrimination interacted with vicarious discrimination to determine physical 
health symptoms such that greater vicarious exposure weakened the relationship 
between experienced discrimination and physical health symptoms. These findings 
demonstrate the need to mobilize resources to combat the multipronged, negative 
implications of the recent rise in anti-Asian prejudice during the COVID-19 
pandemic.

Copyright © 2022 Dhanani, Franz and Pham.

DOI: 10.3389/fpubh.2022.949403
PMCID: PMC9608515
PMID: 36311624 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1367. J Autism Dev Disord. 2024 Jan;54(1):293-300. doi: 10.1007/s10803-022-05792-9. 
Epub 2022 Oct 30.

The Impact of the COVID-19 Pandemic Quarantine on Adults with Autism Spectrum 
Disorders and Intellectual Disability: A Longitudinal Study.

Jodra M(1), García-Villamisar D(2).

Author information:
(1)Department of Personality, Evaluation and Clinical Psychology, Universidad 
Complutense de Madrid, Rector Royo Villanova s/n, Ciudad Universitaria, 28040, 
Madrid, Spain. majodra@ucm.es.
(2)Department of Personality, Evaluation and Clinical Psychology, Universidad 
Complutense de Madrid, Rector Royo Villanova s/n, Ciudad Universitaria, 28040, 
Madrid, Spain.

The impact of the pandemic is being very significant psychologically, especially 
for people who were already vulnerable in these aspects, such as adults with 
Autism Spectrum Disorders (ASD) and Intellectual Disability (ID). A longitudinal 
analysis of motor aspects such as balance and gait, executive functions in daily 
life, severity of symptoms characteristic of autism, and degree of subjective 
well-being was performed in 53 adults with ASD and ID. A repeated measures ANOVA 
was performed and three measures were taken, the first in December 2019, the 
second in March 2020, and the last in July 2020. The results demonstrated a 
significant decrease in balance on the latter measure, along with a 
deterioration in well-being and ASD symptoms in the period of seclusion and an 
improvement in executive functions after seclusion.

© 2022. The Author(s).

DOI: 10.1007/s10803-022-05792-9
PMCID: PMC9618270
PMID: 36309900 [Indexed for MEDLINE]

Conflict of interest statement: All authors declare that they have no conflict 
of interests.


1368. Int J Qual Stud Health Well-being. 2022 Dec;17(1):2136090. doi: 
10.1080/17482631.2022.2136090.

Mental health challenges during COVID-19: perspectives from parents with 
children with neurodevelopmental disabilities.

Currie G(1)(2), Finlay B(1), Seth A(1), Roth C(1), Elsabbagh M(3), Hudon A(4), 
Hunt M(5), Jodoin S(6), Lach L(7), Lencucha R(5), Nicholas DB(8), Shakako K(5), 
Zwicker J(9).

Author information:
(1)School of Public Policy, University of Calgary, Calgary, AB, Canada.
(2)School of Nursing and Midwifery, Mount Royal University, Calgary, AB, Canada.
(3)Faculty of Medicine, McGill University, Montreal, Que., Canada.
(4)Faculty of Medicine, Universite de Montreal, Montreal, Que., Canada.
(5)Faculty of Medicine and Health Sciences School of Physical and Occupational 
Therapy, McGill University, Montreal, Que., Canada.
(6)Faculty of Law, McGill University, Montreal, Que., Canada.
(7)School of Social Work, McGill University, Montreal, Que., Canada.
(8)Faculty of Social Work, University of Calgary, Calgary, AB, Canada.
(9)School of Public Policy; Faculty of Kinesiology, University of Calgary, 
Calgary, AB, Canada.

BACKGROUND: The global pandemic and subsequent denials, delays, and disruptions 
in essential daily activities created significant challenges for children with 
neurodevelopmental disorders (NDDs) and their parents. Public health 
restrictions during the COVID-19 pandemic limited access to supports and 
services required by children with NDDs to maintain their health and well-being.
OBJECTIVE: This study sought to understand the impacts of these public health 
measures and restrictions on mental health from the perspective of parents with 
children with NDDs to inform pathways for public health policies responsive to 
the needs of this population.
METHOD: Interpretive descriptive design was used to guide data collection and 
data analysis. Forty caregivers were interviewed about their experience with 
pandemic restrictions.
FINDINGS: Generic policy measures contributed to many gaps in families' social 
support systems and contributed to mental health challenges for children and 
their parents. Four themes emerged: 1) lack of social networks and activities, 
2) lack of access to health and social supports, 3) tension in the family unit, 
and 4) impact on mental health for children and their parents.
RECOMMENDATIONS: Emergency preparedness planning requires a disability inclusive 
approach allocating resources for family supports in the home and community. 
Families identified supports to minimize further pandemic disruptions and 
enhance recovery.

DOI: 10.1080/17482631.2022.2136090
PMCID: PMC9629071
PMID: 36309898 [Indexed for MEDLINE]

Conflict of interest statement: No potential conflict of interest was reported 
by the author(s).


1369. PLoS One. 2022 Oct 27;17(10):e0276180. doi: 10.1371/journal.pone.0276180. 
eCollection 2022.

Participatory peer research exploring the experience of learning during Covid-19 
for allied health and healthcare science students.

Daly Lynn J(1), Ramsey L(2), Marley J(3), Rohde J(4), McGuigan TM(4), Reaney 
A(4), O'Neill B(3), Jones A(5), Kerr D(3), Hughes C(6), McFadden S(7).

Author information:
(1)Lecturer in Psychology, School of Health Science, Ulster University, Ulster, 
Northern Ireland.
(2)Lecturer in Occupational Therapy, School of Health Science, Ulster 
University, Ulster, Northern Ireland.
(3)Lecturer in Physiotherapy, School of Health Science, Ulster University, 
Ulster, Northern Ireland.
(4)Peer Researcher, School of Health Science, Ulster University, Ulster, 
Northern Ireland.
(5)Lecturer in Podiatry, School of Health Science, Ulster University, Ulster, 
Northern Ireland.
(6)Associate Research Director, School of Nursing and School of Health Science, 
Ulster University, Ulster, Northern Ireland.
(7)Senior Lecturer in Diagnostic Radiography, School of Health Science, Ulster 
University, Ulster, Northern Ireland.

INTRODUCTION: The teaching and learning experience of allied health and 
healthcare science students has altered because of the Covid-19 pandemic. 
Limited research has explored the experience on the future healthcare workforce 
using participatory research design. The aim of this study was to explore the 
impact of a global pandemic on the clinical and academic experiences of 
healthcare student using a co-production approach with student peer researchers.
METHODS: A participatory research approach adopting online focus groups 
facilitated by students trained as peer researchers was adopted. First, second 
and final year students from occupational therapy, physiotherapy, podiatry, 
healthcare science, diagnostic radiography and imaging, radiotherapy and 
oncology, and speech and language therapy were recruited to six focus groups. 
Data generated through focus groups were analysed thematically using the DEPICT 
model to support a partnership approach.
RESULTS: Twenty-three participants took part in six focus groups. The themes 
identified were: rapid changes to learning; living alongside Covid-19 and 
psychological impact. Students preferred blended learning approaches when 
available, as reduced peer interaction, studying and sleeping in the same space, 
and technology fatigue decreased motivation.
CONCLUSION: Due to rapid changes in learning and the stress, anxiety and 
isolation created by the pandemic, managing study, personal life and placement 
resulted in a gap in confidence in clinical skills development for students. 
Students took their professional identity seriously, engaged in behaviours to 
reduce transmission of Covid-19 and employed a range of coping strategies to 
protect wellbeing. A challenge with the move to online delivery was the absence 
of informal peer learning and students indicated that moving forward they would 
value a hybrid approach to delivery. Higher Education should capitalise on 
innovative learning experiences developed during the pandemic however it is 
important to research the impact this has on student skill acquisition and 
learning experience.

DOI: 10.1371/journal.pone.0276180
PMCID: PMC9612578
PMID: 36301988 [Indexed for MEDLINE]

Conflict of interest statement: The authors report there are no competing 
interests to declare.


1370. J Nurs Adm. 2022 Nov 1;52(11):598-607. doi: 10.1097/NNA.0000000000001216.

Factors Associated With Burnout Among Nurses Providing Direct Patient Care 
During the COVID-19 Pandemic.

Cohen B(1), DePierro J, Chan CC, Tolan E, Deshpande R, Feder A, Feingold JH, 
Peccoralo L, Pietrzak RH, Ripp J.

Author information:
(1)Author Affiliations: Associate Professor, Department of Geriatric and 
Palliative Medicine, and Director, Center for Nursing Research and Innovation 
(Dr Cohen); Assistant Professor, Department of Psychiatry, and Director, Center 
for Stress, Resilience and Personal Growth (Dr DePierro); Assistant Professor, 
Department of Psychiatry (Dr Chan); Nurse Practitioner, Vascular Surgery, The 
Mount Sinai Hospital (Ms Tolan); Biostatistician, Center for Biostatistics (Ms 
Deshpande); Associate Professor, Department of Psychiatry, and Director, Trauma 
and Resilience Program (Dr Feder); Psychiatry Resident, Department of Psychiatry 
(Dr Feingold); Associate Professor, Department of Medicine, and Senior Associate 
Dean of Faculty Well-being and Development (Dr Peccoralo); and Chief Wellness 
Officer (Dr Ripp), Icahn School of Medicine at Mount Sinai, Mount Sinai Health 
System, New York; and Professor of Psychiatry, Yale School of Medicine, 
Professor of Public Health, Department of Social and Behavioral Sciences, Yale 
School of Public Health, and Director, Translational Psychiatric Epidemiology 
Laboratory Clinical Neurosciences Division, National Center for PTSD, VA 
Connecticut Healthcare System, New Haven (Dr Pietrzak).

OBJECTIVE: This study aimed to identify factors associated with burnout in 
nurses and nurses' opinions regarding interventions to promote well-being during 
crisis conditions such as those experienced during the COVID-19 pandemic.
BACKGROUND: Burnout among nurses is prevalent under usual conditions and may 
increase during crises such as COVID-19.
METHODS: Researchers conducted a survey of 1103 frontline nurses in a single New 
York City hospital during the first (spring 2020) and second (fall 2020/winter 
2021) local waves of COVID-19.
RESULTS: Burnout prevalence increased from 45% to 52% between the first and 
second wave. Younger age, female gender, posttraumatic stress, anxiety or 
depressive symptoms, history of burnout, feeling less valued by hospital 
leadership, less informed of responsibilities, less certain about duration of 
enhanced workload, and prepared by prepandemic experience were predictive of 
burnout in multivariable analyses.
CONCLUSIONS: Although some identified risk factors for burnout were 
nonmodifiable, others may be modifiable by hospital leadership.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/NNA.0000000000001216
PMCID: PMC10624218
PMID: 36301869 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


1371. J Nurs Adm. 2022 Nov 1;52(11):574-576. doi: 10.1097/NNA.0000000000001212.

Future Catastrophic Event Preparation: Recommendations From Clinical Nurses 
Aligning With the Future of Nursing 2020-2030 Report.

Robinson KR(1), Gierach M, Wolles B, McClellan C, Bartelt S, Hodge J.

Author information:
(1)Author Affiliations: Nurse Research Consultant (Dr Robinson), Nurse Practice 
Specialist (Ms Bartelt), and Clinical Nurse (Ms Hodge), Office of Nursing 
Practice, Sanford Health, Fargo; Associate Professor (Dr Gierach), Nursing, 
Augustana University; and Clinical Nurse Leader (Ms Wolles), Medical Oncology, 
Sanford Health, Sioux Falls; and Clinical Nurse (Ms McClellan), Nursing, Sanford 
Health, Bismarck, North Dakota.

Nurses play an important role in pandemic and disaster response, often at a 
personal cost to their overall well-being. Interviews with 19 frontline COVID-19 
nurses helped illuminate priority focus areas involving nurses in the planning 
process, providing clear communication and offering mental health services. 
These recommendations align with and reinforce conclusions and recommendations 
from The Future of Nursing 2020-2030 Report.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/NNA.0000000000001212
PMID: 36301867 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


1372. WMJ. 2022 Oct;121(3):E34-E37.

Posttraumatic Stress Disorder in a Physician Assistant After Working in an ICU 
During COVID-19.

Vadlamudi A(1), Srikanth K(1), Driscoll D(1), Ramaswamy S(2).

Author information:
(1)Creighton School of Medicine, Omaha, Nebraska.
(2)Creighton School of Medicine, Omaha, Nebraska, sriramramaswamy@creighton.edu.

INTRODUCTION: We present a case report of a physician assistant who experiences 
posttraumatic stress disorder (PTSD) from providing care to patients affected 
with COVID-19. We believe this case is important as it will reveal the 
unfortunate impact COVID-19 has on the mental health of health care 
professionals.
CASE PRESENTATION: A 51-year-old White woman presented to our clinic with a 
1-year history of panic attacks, mood swings, difficulty sleeping, nightmares, 
social withdrawal, guilt, and depression.
DISCUSSION: Cross-sectional, survey-based studies have highlighted PTSD rates in 
health care workers during the pandemic, but these studies have not explored how 
exactly PTSD presents on the individual level.
CONCLUSIONS: This case presents a compelling reflection on what could be a 
larger trend of increasing mental health issues as a direct result of the 
COVID-19 pandemic and emphasizes the need for better mental health support and 
infrastructure to be in place for the well-being of the health care workers in 
this country.

Copyright© Board of Regents of the University of Wisconsin System and The 
Medical College of Wisconsin, Inc.

PMID: 36301655 [Indexed for MEDLINE]


1373. Health Informatics J. 2022 Oct-Dec;28(4):14604582221135440. doi: 
10.1177/14604582221135440.

Online intervention to prevent postnatal depression and anxiety in Chilean new 
mothers: Protocol for a feasibility trial.

Pérez JC(1), Aldoney D(2), García MI(2), Olhaberry M(3), Fernández O(4), Alamo 
N(5), Franco P(3), Pérez F(6), Fisher J(7), Rowe H(7), Coo S(2).

Author information:
(1)Millennium Institute for Research on Depression and Personality (MIDAP), 
Santiago, Chile; 28071Facultad de Psicología. Universidad del Desarrollo (UDD), 
Santiago, Chile.
(2)Facultad de Psicología, 28071Universidad del Desarrollo (UDD), Santiago, 
Chile.
(3)Millennium Institute for Research on Depression and Personality (MIDAP), 
Santiago, Chile; School of Psychology, 28033Pontificia Universidad Católica de 
Chile, Santiago, Chile.
(4)Millennium Institute for Research on Depression and Personality (MIDAP), 
Santiago, Chile; 14655Universidad de Chile, Santiago, Chile.
(5)Millennium Institute for Research on Depression and Personality (MIDAP), 
Santiago, Chile; School of Social Work, 28033Pontificia Universidad Católica de 
Chile, Santiago, Chile.
(6)Millennium Institute for Research on Depression and Personality (MIDAP), 
Santiago, Chile; 28038Universidad Alberto Hurtado, Santiago, Chile.
(7)School of Public Health and Preventive Medicine, 2541Monash University, 
Melbourne, VIC, Australia.

Symptoms of postpartum depression and anxiety in new mothers are prevalent and 
negatively impact maternal emotional wellbeing and infant development. Barriers 
to accessing treatment prevent women from receiving mental health care, a 
situation that has worsened due to the COVID-19 pandemic. mHealth interventions 
hold the potential to support women during the transition to parenthood despite 
these barriers and to promote the use of preventive interventions. This study 
uses a mixed methods design to assess the feasibility and preliminary 
effectiveness of a psychoeducational, guided mHealth intervention to prevent 
postpartum mental health difficulties in women who receive care in primary 
health centers in Chile. The study will contribute to evidence-based research on 
the effectiveness of mHealth interventions for new mothers from an understudied 
cultural background. The findings will also enable the development of a larger 
randomized controlled trial to assess the effectiveness of the intervention, 
which, if effective, could significantly contribute to the emotional wellbeing 
of women and their families.

DOI: 10.1177/14604582221135440
PMID: 36300324 [Indexed for MEDLINE]


1374. Front Public Health. 2022 Oct 10;10:958857. doi: 10.3389/fpubh.2022.958857. 
eCollection 2022.

Measuring Asian hate: Discordant reporting of race-based hate incidents and 
unfair treatment and association with measures of wellbeing.

Ponce NA(1)(2)(3), Adia AC(3), Banawa RA(1)(2)(3), Tan S(1), Sabado-Liwag 
MD(3)(4).

Author information:
(1)UCLA Center for Health Policy Research, Los Angeles, CA, United States.
(2)Department of Health Policy and Management, Fielding School of Public Health, 
University of California, Los Angeles, Los Angeles, CA, United States.
(3)Filipinx/a/o Community Health Association, Los Angeles, CA, United States.
(4)Department of Public Health, California State University, Los Angeles, CA, 
United States.

BACKGROUND: During COVID-19, anti-Asian discrimination increased in attention. 
Hate and unfair treatment are related but do not completely overlap. We expect 
those who report a hate incident would also report race-based unfair treatment, 
yet feelings of social desirability or self-blame may lead to under-reporting of 
unfair treatment.
OBJECTIVES: To describe reporting of an experience of race-based hate but not an 
experience of race-based unfair treatment among Asians in California and explore 
the association between this reporting discordance with (1) serious 
psychological distress, (2) forgoing needed medical care, (3) increased 
household interpersonal conflict, and (4) feeling unsafe in their neighborhood.
METHODS: We used the 2020 California Health Interview Survey's AANHPI COVID 
Module, conducted weighted descriptive and multivariate analyses, and computed 
adjusted relative risks (RR). The multivariate models controlled for Asian 
subgroup, age, gender, immigrant status, education level, poverty, and English 
proficiency.
RESULTS: Among Asians who reported race-based hate (6.9% overall), 62.4% 
reported not experiencing race-based unfair treatment. Compared to Asians not 
reporting a hate incident, this "discordant" group was more likely to experience 
serious psychological distress (RR = 6.9), forgo necessary medical care (RR = 
2.4), increased household interpersonal conflicts (RR = 2.7), and feel unsafe in 
their neighborhoods (RR = 3.0). The "concordant" group did not post significant 
effects for severe psychological distress nor forgoing necessary medical care.
DISCUSSION: Most Asians reporting hate did not report race-based unfair 
treatment, and this group is most affected by the consequences of a hate 
incident. We indicate future directions for research and policy.

Copyright © 2022 Ponce, Adia, Banawa, Tan and Sabado-Liwag.

DOI: 10.3389/fpubh.2022.958857
PMCID: PMC9589279
PMID: 36299752 [Indexed for MEDLINE]

Conflict of interest statement: At time of submission, AA was employed by 
Precision Advisors, a for-profit healthcare consulting firm. The remaining 
authors declare that the research was conducted in the absence of any commercial 
or financial relationships that could be construed as a potential conflict of 
interest.


1375. Medicina (Kaunas). 2022 Sep 30;58(10):1375. doi: 10.3390/medicina58101375.

Effects of COVID-19 in Endocrine Patients: A Cross-Sectional Study.

Morini E(1), Maresca G(1), Bonanno L(1), Corallo F(1), Lo Buono V(1), De Cola 
MC(1).

Author information:
(1)IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 
98124 Messina, Italy.

Introduction: Home confinement due to COVID-19 lockdown led to changes in daily 
routines, including social interactions, as well as restrictions on the 
possibility of playing sports and eating habits. These changes could have a 
greater impact on patients suffering from chronic diseases, such as endocrine 
patients, especially in emotional and behavioral dimensions. Materials and 
Methods: This study aimed to assess the effects of COVID-19-induced quarantine 
on daily habits in a group of patients with endocrine disorders, focusing on 
food consumption, eating habits and sleep during the confinement. Eighty-five 
endocrine patients were enrolled. A structured interview was administered to 
investigate socio-demographic information, general medical conditions, and 
habits adopted during quarantine. All patients underwent the Spielberger State 
Anxiety Inventory (STAI-Y1) to assess state anxiety. Result: Results showed that 
subjects mainly had a sedentary lifestyle. We found a significant increase in 
the number of cigarettes in smokers and in meals consumed during confinement, as 
well as a high rate of sleep disturbance, especially insomnia. Notably, physical 
well-being resulted to be a predictive factor (OR = 0.38; 95%CI = [0.95,0.66]), 
whereas anxiety was a risk factor for sleep disorder (OR = 1.22; 95%CI = 
[1.10,1.40]), as was working in public and private offices and being a student. 
Conclusions: Changes in daily habits were likely due to the alterations in 
routine, resulting in greater boredom and inactivity during the day. In 
addition, future research should focus on the importance of patient adherence to 
therapy.

DOI: 10.3390/medicina58101375
PMCID: PMC9607263
PMID: 36295536 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest to 
disclose.


1376. Int J Environ Res Public Health. 2022 Oct 21;19(20):13712. doi: 
10.3390/ijerph192013712.

Prevalence of Psychopathological Symptoms and Their Determinants in Four 
Healthcare Workers' Categories during the Second Year of COVID-19 Pandemic.

Gorini A(1)(2), Giuliani M(3), Fiabane E(4), Bonomi A(3), Gabanelli P(5), 
Pierobon A(6), Moretta P(7), Pagliarulo G(7), Spaccavento S(8), Vaudo G(9)(10), 
Pirro M(11), Mannarino MR(11), Milani L(12), Caruso MP(13), Baiardi P(14), Dalla 
Vecchia LA(1), La Rovere MT(15), Pistarini C(16), Baldassarre D(3)(17).

Author information:
(1)Department of Clinical Sciences and Community Health, University of Milan, 
20122 Milan, Italy.
(2)Istituti Clinici Scientifici Maugeri IRCCS, Milano-Camaldoli, 64, 20138 
Milan, Italy.
(3)Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy.
(4)Department of Physical and Rehabilitation Medicine, Istituti Clinici 
Scientifici Maugeri IRCCS, 16167 Genoa, Italy.
(5)Istituti Clinici Scientifici Maugeri IRCCS, Psychology Unit of Pavia 
Institute, 27100 Pavia, Italy.
(6)Istituti Clinici Scientifici Maugeri IRCCS, Psychology Unit of Montescano 
Institute, 27040 Montescano, Italy.
(7)Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation Unit 
of Teleselezioni Terme Institute, 82037 Telese Terme, Italy.
(8)Istituti Clinici Scientifici Maugeri IRCCS, Psychology Unit of Bari 
Institute, 70124 Bari, Italy.
(9)Department of Medicine and Surgery, University of Perugia, 06123 Perugia, 
Italy.
(10)Unit of Internal Medicine, "Santa Maria" Terni University Hospital, 05100 
Terni, Italy.
(11)Unit of Internal Medicine, Department of Medicine, University of Perugia, 
06132 Perugia, Italy.
(12)ASST Crema, 26013 Crema, Italy.
(13)SITRA, Policlinico San Donato, 20097 Milan, Italy.
(14)Istituti Clinici Scientifici Maugeri IRCCS, Direzione Scientifica Centrale 
of Pavia Institute, 27100 Pavia, Italy.
(15)Istituti Clinici Scientifici Maugeri IRCCS, Department of Cardiology of 
Montescano Institute, 27040 Montescano, Italy.
(16)Istituti Clinici Scientifici Maugeri IRCCS, Department of 
Neurorehabilitation of Pavia Institute, 27100 Pavia, Italy.
(17)Department of Medical Biotechnology and Translational Medicine, University 
of Milan, 20122 Milan, Italy.

Highly stressful situations, such as the current COVID-19 pandemic, induce 
constant changes in the mental state of people who experience them. In the 
present study, we analyzed the prevalence of some psychological symptoms and 
their determinants in four different categories of healthcare workers during the 
second year of the pandemic. A total of 265 physicians, 176 nurses, 184 other 
healthcare professionals, and 48 administrative employees, working in different 
Italian healthcare contexts, answered a questionnaire including variables about 
their mental status and experience with the pandemic. The mean scores for 
anxiety and depressive symptoms measured more than one year after the onset of 
the pandemic did not reach the pathological threshold. In contrast, 
post-traumatic and burnout symptoms tended toward the critical threshold, 
especially in physicians. The main determinant of psychological distress was 
perceived stress, followed by job satisfaction, the impact of COVID-19 on daily 
work, and a lack of recreational activities. These results increase the 
knowledge of which determinants of mental distress would be important to act on 
when particularly stressful conditions exist in the workplace that persist over 
time. If well-implemented, specific interventions focused on these determinants 
could lead to an improvement in employee well-being and in the quality of care 
provided.

DOI: 10.3390/ijerph192013712
PMCID: PMC9602535
PMID: 36294291 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1377. Int J Environ Res Public Health. 2022 Oct 20;19(20):13581. doi: 
10.3390/ijerph192013581.

Latent Classes of Adverse and Benevolent Childhood Experiences in a 
Multinational Sample of Parents and Their Relation to Parent, Child, and Family 
Functioning during the COVID-19 Pandemic.

Johnson D(1), Browne DT(2), Meade RD(3)(4), Prime H(5), Wade M(1).

Author information:
(1)Department of Applied Psychology and Human Development, University of 
Toronto, Toronto, ON M5S 1V6, Canada.
(2)Centre for Mental Health Research and Treatment, Department of Psychology, 
University of Waterloo, Waterloo, ON N2L 3G1, Canada.
(3)Human and Environmental Physiology Research Unit, School of Human Kinetics, 
University of Ottawa, Ottawa, ON K1N 6N5, Canada.
(4)Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 
02115, USA.
(5)Department of Psychology, York University, Toronto, ON M3J 1P3, Canada.

Adverse Childhood Experiences (ACEs) are known to contribute to later mental 
health. Conversely, Benevolent Childhood Experiences (BCEs) may buffer against 
mental health difficulties. The importance of ACEs and BCEs for mental health of 
both parents and children may be most obvious during periods of stress, with 
potential consequences for functioning of the family. Subgroups of ACEs and BCEs 
in parents during the COVID-19 pandemic were investigated and validated in 
relation to indices of parent, child, and family well-being. In May 2020, 
ACEs/BCEs were assessed in 547 parents of 5-18-year-old children from the U.K., 
U.S., Canada, and Australia. Subgroups of parents with varying levels of ACEs 
and BCEs were identified via latent class analysis. The subgroups were validated 
by examining associations between class membership and indices of parent and 
child mental health and family well-being. Four latent classes were identified: 
low-ACEs/high-BCEs, moderate-ACEs/high-BCEs, moderate-ACEs/low-BCEs, and 
high-ACEs/moderate-BCEs. Regardless of the extent of BCEs, there was an 
increased risk of parent and child mental health difficulties and family 
dysfunction among those reporting moderate-to-high levels of ACEs. Parents' 
history of adversity may influence the mental health of their family. These 
findings highlight the importance of public health interventions for preventing 
early-life adversity.

DOI: 10.3390/ijerph192013581
PMCID: PMC9603677
PMID: 36294161 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1378. Int J Environ Res Public Health. 2022 Oct 18;19(20):13430. doi: 
10.3390/ijerph192013430.

Examining the Relationship between Death Anxiety and Well-Being of Frontline 
Medical Staff during the COVID-19 Pandemic.

Zhao N(1), Liu B(1), Wang Y(1).

Author information:
(1)Department of Psychology, School of Sociology and Psychology, Central 
University of Finance and Economics, Beijing 100081, China.

To examine the well-being of medical staff during the COVID-19 pandemic, we 
conducted a survey of 705 medical staff who were involved in anti-epidemic work 
in China from 20 February to 16 March 2020. The findings of the present study 
showed a "psychological typhoon eye" effect in which the medical staff in areas 
with a high contagion rate showed a significantly lower level of death anxiety 
than those in low-contagion regions. We also found a significant negative 
relationship between death anxiety and hedonic well-being, but there was no 
relationship between death anxiety and eudaimonic well-being. Moreover, the 
results revealed that a narcissistic personality moderates the relationships 
between death anxiety and the two types of well-being. For those who had higher 
narcissistic personality scores, death anxiety had no negative effect on their 
well-being. The findings of the present study can help us to better understand 
the life profiles of medical staff and can also provide some practical 
implications for understanding the life conditions of medical staff when facing 
a great health crisis.

DOI: 10.3390/ijerph192013430
PMCID: PMC9603769
PMID: 36294046 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1379. Int J Environ Res Public Health. 2022 Oct 18;19(20):13466. doi: 
10.3390/ijerph192013466.

COVID-19 and Mental Health of Minority Arab Higher-Education Students in Israel: 
Social, Economic, and Academic Factors.

Alfayumi-Zeadna S(1)(2), Gnaim-Abu Touma L(3), Weinreich M(4), O'Rourke N(5)(6).

Author information:
(1)Nursing Department, School of Health Sciences, Ashkelon Academic College, 
Ashkelon 78211, Israel.
(2)MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, 
Michael's Hospital, Unity Health Toronto, Toronto, ON M5B 1W8, Canada.
(3)Department of Education, Al-Qasemi Academic College of Education, 
Baqa-El-Gharbia 30100, Israel.
(4)Medical School for International Health, Faculty of Health Sciences, 
Ben-Gurion University of the Negev, Beer Sheva 84105, Israel.
(5)School of Public Health and Multidisciplinary Center for Research on Aging, 
Ben-Gurion University of the Negev, Beer Sheva 84105, Israel.
(6)Department of Psychology, Ben-Gurion University of the Negev, Beer Sheva 
84105, Israel.

The mental health and well-being of higher-education students is a topic of 
growing interest. COVID-19 impacted higher education in many ways and the 
challenges were especially pronounced for minority students. This study examines 
the impact of COVID-19 on the mental health of Arab minority students in Israel 
in relation to social, academic, and financial factors. We recruited 420 Arab 
higher-education students enrolled in academic colleges or universities in 
Israel who completed a battery of online questionnaires. Mental health status 
was measured by the Depression, Anxiety, and Stress Scale 21 (DASS-21). Moderate 
to severe symptoms of depression, anxiety, and stress were reported by 49.3%, 
45.2%, and 54% of Arab students, respectively. Analyses indicate that low 
quality of online learning, academic difficulties, and negative economic effects 
of COVID-19 predicted stress, anxiety, and depression. Women reported higher 
levels of depression and stress; job loss predicted depression and anxiety; low 
income predicted depression; and COVID-19-related health concerns predicted 
anxiety. This study highlights the unique and multiple challenges faced by 
minority students from disadvantaged backgrounds. Campus programs are needed to 
address the emotional needs of students. Longitudinal research is needed to more 
fully understand the impact of COVID-19 on higher-education students.

DOI: 10.3390/ijerph192013466
PMCID: PMC9602490
PMID: 36294042 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1380. Int J Environ Res Public Health. 2022 Oct 14;19(20):13213. doi: 
10.3390/ijerph192013213.

Toxic Habits and Well-Being Measures in Spanish Healthcare University Students 
during the COVID-19 Pandemic.

Zapata I(1), Maté-Muñoz JL(2), Higueras A(3), Hernández-Lougedo J(4), 
Martín-Fidalgo N(1), García-Fernández P(2)(5), Redondo-Vega MV(1), Ruiz-Tovar 
J(1).

Author information:
(1)Department of Medicine, Alfonso X El Sabio University, 28691 Madrid, Spain.
(2)Department of Radiology, Rehabilitation and Physiotherapy, Complutense 
University of Madrid, 28040 Madrid, Spain.
(3)Independent Researcher, 28691 Madrid, Spain.
(4)Department of Physical Activity and Sports Science, Alfonso X El Sabio 
University, 28691 Madrid, Spain.
(5)IdISSC, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, 
28040 Madrid, Spain.

BACKGROUND: Unhealthy lifestyles are strongly entrenched in healthcare 
universities and have sometimes been linked to stress or lack of sleep. This 
study investigated the prevalence of toxic habits (smoking, patterns of harmful 
alcohol use, and illicit drug use), stress levels, perceived health status, and 
sleep duration and assessed the connections between toxic habits and said 
well-being measures, as well as healthcare students' perception of the influence 
of the COVID-19 pandemic on these health-related behaviors.
METHODS: In a cross-sectional study, healthcare students from Alfonso X 
University (Spain) completed a health survey composed of Alcohol Use Disorders 
Identification Test (AUDIT-C), Perceived Stress Scale (PSS-10), self-perceived 
health status, and the number of hours of sleep.
RESULTS: A total of 997 healthcare students completed the survey, of which 982 
were analyzed. Being a smoker (32.2%) was associated with worse health status 
and insufficient sleep. Risk drinkers (33.2%) were associated with being female, 
and the consumption of cannabinoids (6.7%), with being male. These three toxic 
habits were related to each other. High levels of stress (28.2%) were correlated 
with worse ratings in the perception of health status (29.2%) and with 
insufficient sleep (45.8%), and all of them were associated with the female sex. 
Respectively, 49.3% and 44.2% of students recognized a worsening in their 
perception of stress and their sleep habits during the pandemic.
CONCLUSION: Healthcare universities must carry out health promotion programs for 
stress management, sleep habits, and unhealthy lifestyles.

DOI: 10.3390/ijerph192013213
PMCID: PMC9603594
PMID: 36293793 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interest.


1381. Int J Environ Res Public Health. 2022 Oct 13;19(20):13204. doi: 
10.3390/ijerph192013204.

A Narrative Inquiry into the Practices of Healthcare Workers' Wellness Program: 
The SEED Experience in New South Wales, Australia.

Olcoń K(1), Allan J(2), Fox M(1), Everingham R(1)(3), Pai P(3), Keevers L(1), 
Mackay M(4), Degeling C(1), Cutmore SA(1)(5), Finlay S(1), Falzon K(5).

Author information:
(1)School of Health and Society, The University of Wollongong, Northfields Ave, 
Wollongong, NSW 2522, Australia.
(2)Rural Health Research Institute, Charles Sturt University, Leeds Pd, Orange, 
NSW 2800, Australia.
(3)Illawarra Shoalhaven Local Health District, 67-71 King Street, Warrawong, NSW 
2502, Australia.
(4)School of Nursing, The University of Wollongong, Northfields Ave, Wollongong, 
NSW 2522, Australia.
(5)Waminda South Coast Women's Health and Welfare Aboriginal Corporation, 122 
Kinghorne St, Nowra, NSW 2541, Australia.

The 2019-2020 Australian bushfires followed by the COVID-19 pandemic brought the 
significant mental health implications of working in healthcare to the fore. The 
importance of appropriate support services to ensure the resilience and recovery 
of healthcare workers has been highlighted. In response to healthcare staff 
experiences during the bushfires, the SEED Wellness Program was created in 2020 
in the Illawarra Shoalhaven Local Health District in New South Wales, Australia. 
SEED used a participant-led design to engage healthcare staff in workplace-based 
restorative activities. Guided by practice theory, this study aimed to identify 
and describe SEED wellness practices that supported healthcare staff. 
Thirty-three healthcare workers participated in focus groups or individual 
interviews between June 2021 and March 2022. The analysis involved inductive 
thematic individual and collective exploration of SEED practices, including 
co-analysis with participants. Eight core practices that supported participants' 
wellbeing were identified, including responsive and compassionate leading, 
engaging staff at every stage of the recovery process, creating a sense of 
connection with others, and collective caring. The study found that workplace 
wellness initiatives are optimised when they are place-based and grounded in 
local knowledge, needs, and resources incorporating a collective and supportive 
team approach. Moreover, to ensure engagement in, and sustainability of these 
initiatives, both bottom-up and top-down commitment is required.

DOI: 10.3390/ijerph192013204
PMCID: PMC9603759
PMID: 36293786 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1382. Int J Environ Res Public Health. 2022 Oct 12;19(20):13136. doi: 
10.3390/ijerph192013136.

Is This All COVID-19's Fault? A Study on Trainees in One of the Most Affected 
Italian Cities.

Manfredi P(1).

Author information:
(1)Department of Clinical and Experimental Sciences, University of Brescia, 
25123 Brescia, Italy.

Many studies have investigated the state of the health of healthcare workers 
during the acute period of the pandemic. Yet, few studies have assessed the 
health of such professionals after the pandemic and in a less dramatic period. 
This study involved a particular sample represented by residents in 
anaesthesia-resuscitation and psychiatry at a university in northern Italy 
particularly affected by the pandemic. The objectives were to investigate some 
indicators of health and well-being and compare the two groups of trainees. 
Using Google Forms, the following tests were proposed: the General Health 
Questionnaire, Maslach Burnout Inventory, Subjective Happiness Scale, 
Satisfaction with Life Scale, Coping Inventory for Stressful Situations, Brief 
Resilience Scale, State-Trait Anxiety Inventory, as well as an ad hoc 
questionnaire. A qualifying element of the work was the discussion of the 
results with the trainees. Various strengths have emerged, such as high values 
of resilience and job satisfaction; a positive assessment of the support 
received from the work team; an articulate use of coping strategies; and good 
levels of happiness and satisfaction with life, in both specialities. However, a 
widespread anxiety also emerged, which appears to be more attributable to 
concerns about professional evaluation, rather than the pandemic itself. In 
summary, the trainees seem to have found a fair amount of personal balance, 
whereas the relationship with the patient seems to be more compromised. In the 
comparison between specialities, the only significant differences are the levels 
of depersonalisation and resilience, both of which are higher in anaesthetists.

DOI: 10.3390/ijerph192013136
PMCID: PMC9603377
PMID: 36293715 [Indexed for MEDLINE]

Conflict of interest statement: The author declares no conflict of interest.


1383. Int J Environ Res Public Health. 2022 Oct 12;19(20):13112. doi: 
10.3390/ijerph192013112.

Tourism as a Tool in Nature-Based Mental Health: Progress and Prospects 
Post-Pandemic.

Buckley RC(1), Cooper MA(2).

Author information:
(1)School of Environment & Sciences, Griffith University, Southport, QLD 4215, 
Australia.
(2)Instituto Profesional de la Fundacion Duoc UC de la Pontificia, Universidad 
Católica, Viña del Mar 2336, Chile.

Comment in
    Nature. 2022 Dec;612(7938):33.

The healthcare sector recognises the role of nature in mental health. The 
tourism sector is equipped to take people to national parks. The conservation 
sector gains support from visitors. Theoretical frameworks for mental health 
benefits from nature tourism include: tourism destinations and activities; 
tourist personalities and life histories; sensory and emotional components of 
tourist experiences; and intensity and duration of memories. Mental health 
deteriorated worldwide during the COVID-19 pandemic. Recovery of global economic 
productivity requires immediate, accessible, affordable mental health measures 
at national scales, and nature-based approaches provide the best option. 
Different countries have adopted a variety of public, private, or voluntary 
mechanisms. Some focus on design of activities, others on provision of 
facilities. Costs and implementation depend on key research questions: marginal 
benefits of nature tour guides or psychologists compared to self-guided nature 
experiences; comparisons between repeated brief visits and one-off nature 
holidays; effects of biodiversity, flagship species, and scenic or wilderness 
quality; and differences between individuals, depending on personalities, life 
histories, and mental health status and symptoms.

DOI: 10.3390/ijerph192013112
PMCID: PMC9602562
PMID: 36293691 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1384. Int J Environ Res Public Health. 2022 Oct 11;19(20):13023. doi: 
10.3390/ijerph192013023.

Psychological Resilience and Adverse Mental Health Issues in the Thai Population 
during the Coronavirus Disease 2019 Pandemic.

Ruengorn C(1)(2), Awiphan R(1)(2), Phosuya C(1)(2), Ruanta Y(1)(2), Wongpakaran 
N(3), Wongpakaran T(3), Thavorn K(2)(4)(5)(6), Nochaiwong S(1)(2).

Author information:
(1)Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai 
University, Chiang Mai 50200, Thailand.
(2)Pharmacoepidemiology and Statistics Research Center (PESRC), Chiang Mai 
University, Chiang Mai 50200, Thailand.
(3)Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang 
Mai 50200, Thailand.
(4)Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, ON K1H 8L6, 
Canada.
(5)ICES uOttawa, Ottawa, ON K1Y 4E9, Canada.
(6)School of Epidemiology and Public Health, Faculty of Medicine, University of 
Ottawa, Ottawa, ON K1G 5Z3, Canada.

In light of the coronavirus disease 2019 (COVID-19) pandemic and the enormous 
amount of uncertainty caused by it, mental health issues have become a great 
concern. Evidence regarding the effects of psychological resilience on the Thai 
population is scarce. We evaluated psychological resilience during the first 
wave of the COVID-19 pandemic and its association with the risk of mental health 
outcomes, such as depression, anxiety, stress, and health-related well-being. 
This cross-sectional study was a part of the HOME-COVID-19 project, which 
conducted an online survey of 4004 members of the general population in Thailand 
using the Brief Resilience Coping Scale. Logistic regression was performed to 
identify the association between psychological resilience and mental health 
issues and well-being. Groups with prevalence rates of 43.9%, 39.2%, and 16.9% 
were classified as low, moderate, and high resilient copers, respectively. Using 
high resilient copers as a reference group, the low resilient copers had a 
higher chance of having mental health adversities. The adjusted odds ratio (OR) 
was 1.89 (95% confidence interval [CI], 1.39-2.56; p < 0.001) for depression, 
2.13 (95% CI, 1.45-3.14; p < 0.001) for anxiety, 4.61 (95% CI, 3.30-6.45; p < 
0.001) for perceived stress, and 3.18 (95% CI, 2.31-4.38; p < 0.001) for low 
well-being. For the medium resilient copers, only low well-being was found to be 
statistically significant (OR, 1.60; 95% CI, 1.16-2.20; p = 0.004). It is 
important that resilience be considered in the development of strategies for 
managing the COVID-19 pandemic to prevent or reduce adverse mental health 
outcomes.

DOI: 10.3390/ijerph192013023
PMCID: PMC9602542
PMID: 36293610 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1385. Int J Environ Res Public Health. 2022 Oct 11;19(20):12988. doi: 
10.3390/ijerph192012988.

Eating Disorders in Hospitalized School-Aged Children and Adolescents during the 
COVID-19 Pandemic: A Cross-Sectional Study of Discharge Records in Developmental 
Ages in Italy.

Giacomini G(1), Elhadidy HSMA(1), Paladini G(1), Onorati R(2), Sciurpa E(1), 
Gianino MM(1), Borraccino A(1).

Author information:
(1)Department of Public Health Sciences and Pediatrics, Università di Torino, 
10126 Torino, Italy.
(2)Regional Public Health Observatory, Epidemiology Unit, Local Health Board 
TO3, Piedmont Region, 10195 Grugliasco, Italy.

Eating disorders (EDs) are characterized by behavioral and cognitive aspects 
that result in a significant impairment of an individual's well-being. COVID-19 
pandemic consequences negatively impacted healthcare services and people's 
mental health. Particularly, in developmental ages, difficulties in coping with 
the situation could have had an impact on eating behaviors. Therefore, the aim 
of this study was to assess EDs' hospitalization trend before, during and after 
the pandemic peak to evaluate whether it has been influenced. A retrospective 
cross-sectional study was conducted on the hospital discharge forms of patients 
from 5 to 19 years old in Piedmont, which is a region in northern Italy. 
Overall, hospitalization, age, and gender-specific rates due to EDs that 
occurred in 2020 and 2021 were compared to those that occurred in 2018-2019. 
Since 2020, there has been a 55% reduction in overall hospitalizations, while 
the total proportion of EDs admissions has doubled from 2020 to 2021 (from 13.9‱ 
to 22.2‱). Significant hospitalization rate increases were observed both in 
15-19 and in 10-14 females' age groups in 2021. Non-significant increases were 
observed in all males' age groups. The increase in hospitalizations for EDs 
should be further investigated, as it might be the tip of an iceberg not yet 
acknowledged.

DOI: 10.3390/ijerph192012988
PMCID: PMC9602016
PMID: 36293569 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1386. Sci Rep. 2022 Oct 26;12(1):17945. doi: 10.1038/s41598-022-22994-4.

Psychological well-being during the COVID-19 pandemic in Italy assessed in a 
four-waves survey.

de Girolamo G(#)(1), Ferrari C(#)(2), Candini V(3), Buizza C(3), Calamandrei 
G(4), Caserotti M(5), Gavaruzzi T(5), Girardi P(5)(6), Habersaat KB(7), Lotto 
L(5), Scherzer M(7), Starace F(8), Tasso A(9), Zamparini M(3), Zarbo C(3).

Author information:
(1)Psychiatric Epidemiology and Evaluation Unit, IRCCS Istituto Centro San 
Giovanni Di Dio Fatebenefratelli, Via Pilastroni 4, 25125, Brescia, Italy. 
gdegirolamo@fatebenefratelli.eu.
(2)Service of Statistics, IRCCS Istituto Centro San Giovanni Di Dio 
Fatebenefratelli, Brescia, Italy.
(3)Psychiatric Epidemiology and Evaluation Unit, IRCCS Istituto Centro San 
Giovanni Di Dio Fatebenefratelli, Via Pilastroni 4, 25125, Brescia, Italy.
(4)Centre for Behavioral Science and Mental Health, Istituto Superiore Di 
Sanità, Roma, Italy.
(5)Department of Developmental Psychology and Socialization, University of 
Padova, Padova, Italy.
(6)Department of Statistical Sciences, University of Padova, Padova, Italy.
(7)World Health Organization, Regional Office for Europe, Copenhagen, Denmark.
(8)Department of Mental Health and Drug Abuse, AUSL Modena, Modena, Italy.
(9)Department of Humanities, University of Ferrara, Ferrara, Italy.
(#)Contributed equally

COVID-19 pandemic had a negative impact on the mental health and well-being (WB) 
of citizens. This cross-sectional study included 4 waves of data collection 
aimed at identifying profiles of individuals with different levels of WB. The 
study included a representative stratified sample of 10,013 respondents in 
Italy. The WHO 5-item well-being scale (WHO-5) was used for the assessment of 
WB. Different supervised machine learning approaches (multinomial logistic 
regression, partial least-square discriminant analysis-PLS-DA-, classification 
tree-CT-) were applied to identify individual characteristics with different WB 
scores, first in waves 1-2 and, subsequently, in waves 3 and 4. Forty-one 
percent of participants reported "Good WB", 30% "Poor WB", and 28% "Depression". 
Findings carried out using multinomial logistic regression show that Resilience 
was the most important variable able for discriminating the WB across all waves. 
Through the PLS-DA, Increased Unhealthy Behaviours proved to be the more 
important feature in the first two waves, while Financial Situation gained most 
relevance in the last two. COVID-19 Perceived Risk was relevant, but less than 
the other variables, across all waves. Interestingly, using the CT we were able 
to establish a cut-off for Resilience (equal to 4.5) that discriminated good WB 
with a probability of 65% in wave 4. Concluding, we found that COVID-19 had 
negative implications for WB. Governments should support evidence-based 
strategies considering factors that influence WB (i.e., Resilience, Perceived 
Risk, Healthy Behaviours, and Financial Situation).

© 2022. The Author(s).

DOI: 10.1038/s41598-022-22994-4
PMCID: PMC9606283
PMID: 36289273 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1387. BMJ Open. 2022 Oct 26;12(10):e066190. doi: 10.1136/bmjopen-2022-066190.

Cross-sectional survey of the Mental health and Addictions effects, Service 
impacts and Care needs of children, youth and families during the COVID-19 
pandemic: the COVID-19 MASC study protocol.

Markoulakis R(1)(2), Khalid M(3), Da Silva A(3), Kodeeswaran S(4), Sinyor 
M(3)(2)(4), Cheung A(3)(2)(4), Redelmeier D(3)(2)(4), MacKillop J(5), Scarpitti 
M(6), Laird H(7), Foot J(8), Levitt A(3)(2)(4).

Author information:
(1)Sunnybrook Research Institute, Toronto, Ontario, Canada 
roula.markoulakis@sunnybrook.ca.
(2)Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
(3)Sunnybrook Research Institute, Toronto, Ontario, Canada.
(4)Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
(5)Peter Boris Centre for Addictions Research, McMaster University, Hamilton, 
Ontario, Canada.
(6)Canadian Mental Health Association Ontario Division, Toronto, Ontario, 
Canada.
(7)Youth Advisory Council, Family Navigation Project at Sunnybrook, Toronto, 
Ontario, Canada.
(8)Family Advisory Council, Family Navigation Project at Sunnybrook, Toronto, 
Ontario, Canada.

INTRODUCTION: The COVID-19 pandemic has had a tremendous negative effect on the 
mental health and well-being of Canadians. These mental health challenges are 
especially acute among vulnerable Canadian populations. People living in 
Canada's most populous province, Ontario, have spent prolonged time in lockdown 
and under public health measures and there is a gap in our understanding of how 
this has impacted the mental health system. This protocol describes the Mental 
health and Addictions Service and Care Study that will use a repeated 
cross-sectional design to examine the effects, impacts, and needs of Ontario 
adults during the COVID-19 pandemic.
METHODS AND ANALYSIS: A cross-sectional survey of Ontario adults 18 years or 
older, representative of the provincial population based on age, gender and 
location was conducted using Delvinia's AskingCanadians panel from January to 
March 2022. Study sample was 2500 in phases 1 and 2, and 5000 in phase 3. The 
Alcohol, Smoking and Substance Involvement Screening Test and Diagnostic 
Statistical Manual-5 Self-Rated Level 1 Cross-Cutting Symptom Measure-Adult were 
used to assess for substance and mental health concerns. Participants were asked 
about mental health and addiction service-seeking and/or accessing prior to and 
during the pandemic. Analyses to be conducted include: predictors of service 
access (ie, sociodemographics, mental illness and/or addiction, and social 
supports) before and during the pandemic, and χ2 tests and logistic regressions 
to analyse for significant associations between variables and within subgroups.
ETHICS AND DISSEMINATION: Ethics approval was obtained from the Sunnybrook 
Research Ethics Board. Dissemination plans include scientific publications and 
conferences, and online products for stakeholders and the general public.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2022-066190
PMCID: PMC9615177
PMID: 36288837 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: JM is a principal in Beam 
Diagnostics and a consultant to Clairvoyant Therapeutics.


1388. Adv Sci (Weinh). 2022 Dec;9(35):e2203707. doi: 10.1002/advs.202203707. Epub 2022 
Oct 26.

Toward a Deeper Understanding of Gut Microbiome in Depression: The Promise of 
Clinical Applicability.

Liu L(1)(2)(3), Wang H(2)(4), Zhang H(2)(3), Chen X(2), Zhang Y(2)(3), Wu 
J(2)(3), Zhao L(1), Wang D(2), Pu J(2)(3), Ji P(4), Xie P(1)(2)(3)(4).

Author information:
(1)Department of Neurology, Yongchuan Hospital of Chongqing Medical University, 
Chongqing, 402160, China.
(2)NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, 
The First Affiliated Hospital of Chongqing Medical University, Chongqing, 
400016, China.
(3)Department of Neurology, The First Affiliated Hospital of Chongqing Medical 
University, Chongqing, 400016, China.
(4)College of Stomatology and Affiliated Stomatological Hospital of Chongqing 
Medical University, Chongqing, 401147, China.

The emergence of the coronavirus disease 2019 pandemic has dramatically 
increased the global prevalence of depression. Unfortunately, antidepressant 
drugs benefit only a small minority of patients. Thus, there is an urgent need 
to develop new interventions. Accumulating evidence supports a causal 
relationship between gut microbiota dysbiosis and depression. To advance 
microbiota-based diagnostics and therapeutics of depression, a comprehensive 
overview of microbial alterations in depression is presented to identify 
effector microbial biomarkers. This procedure generated 215 bacterial taxa from 
humans and 312 from animal models. Compared to controls, depression shows 
significant differences in β-diversity, but no changes in microbial richness and 
diversity. Additionally, species-specific microbial changes are identified like 
increased Eggerthella in humans and decreased Acetatifactor in rodent models. 
Moreover, a disrupted microbiome balance and functional changes, characterized 
by an enrichment of pro-inflammatory bacteria (e.g., Desulfovibrio and 
Escherichia/Shigella) and depletion of anti-inflammatory butyrate-producing 
bacteria (e.g., Bifidobacterium and Faecalibacterium) are consistently shared 
across species. Confounding effects of geographical region, depression type, and 
intestinal segments are also investigated. Ultimately, a total of 178 species 
and subspecies probiotics are identified to alleviate the depressive phenotypes. 
Current findings provide a foundation for developing microbiota-based 
diagnostics and therapeutics and advancing microbiota-oriented precision 
medicine for depression.

© 2022 The Authors. Advanced Science published by Wiley-VCH GmbH.

DOI: 10.1002/advs.202203707
PMCID: PMC9762301
PMID: 36285702 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1389. Health Soc Care Community. 2022 Nov;30(6):e6366-e6375. doi: 10.1111/hsc.14078. 
Epub 2022 Oct 25.

Exploring young people's perspectives on mental health support: A qualitative 
study across three geographical areas in England, UK.

Holding E(1), Crowder M(1), Woodrow N(1), Griffin N(2), Knights N(3), Goyder 
E(1), McKeown R(4), Fairbrother H(5).

Author information:
(1)School of Health and Related Research (ScHARR), University of Sheffield, 
Sheffield, UK.
(2)Population Health Sciences Institute, Newcastle University, Newcastle, UK.
(3)Social Sciences, Cavendish Campus, University of Westminster, London, UK.
(4)The Association for Young People's Health, London, UK.
(5)Health Sciences School, University of Sheffield, Sheffield, UK.

Improving young people's (YP) mental health and well-being is a global public 
health priority. Despite continued commitment within the UK policy agenda to 
improve the mental health and well-being of YP, the incidence of mental health 
issues continues to rise. This has been further compounded by the outbreak of 
COVID-19 which has disproportionately affected YP in the most socioeconomically 
disadvantaged areas. Understanding YP's perspectives on what supports their 
mental health is important to develop policies that meet their needs. We 
conducted focus groups (n = 18 with 42 YP aged 13-21) in three geographical 
areas with high levels of deprivation in England, UK. Recruited through six 
local youth organisations, each group of YP took part in three interlinked focus 
groups designed to explore their perceptions of what impacts their health in 
their local area, and their understandings of health inequalities through 
participatory methods. Throughout their discussions, YP foregrounded the 
significance of mental health and mental health support structures. YP perceived 
challenges to accessing mental health provision and an unmet need for support 
within their local communities. Alongside this, YP consistently highlighted the 
importance of youth groups for promoting good mental health and mitigating 
challenges to poor mental health. However, ongoing cuts to the voluntary sector 
and universal services continue to impact areas and individuals in the greatest 
need. In the face of deficits in formal mental health support, our findings 
highlight the pressing need for increased investment in services focused on 
prevention (such as youth groups) in areas of high deprivation.

© 2022 The Authors. Health and Social Care in the Community published by John 
Wiley & Sons Ltd.

DOI: 10.1111/hsc.14078
PMCID: PMC10092552
PMID: 36285377 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1390. Health Expect. 2022 Dec;25(6):3274-3286. doi: 10.1111/hex.13635. Epub 2022 Oct 
25.

Recovery in Mind: A Recovery College's journey through the Covid-19 pandemic.

Yoeli H(1)(2), Ryan A(3), Hensby C(3)(4), Habermehl F(3)(4), Burton S(3), Sin 
J(1).

Author information:
(1)School of Health and Psychological Sciences, City, University of London, 
London, UK.
(2)Northern Lights Research Associates, Newcastle upon Tyne, UK.
(3)Recovery in Mind, Newbury, UK.
(4)Berkshire Healthcare NHS Foundation Trust, Bracknell, UK.

INTRODUCTION: The Covid-19 restrictions of 2020-2021 are known to have 
undermined the UK population's mental health. Working alongside staff, peer 
trainers and students at Recovery in Mind (RiM), a Recovery College (RC) in West 
Berkshire, England, this mixed-methods study is amongst the first to investigate 
how an RC has responded to the pandemic.
METHODS: Working in co-production with RiM staff and peer-trainers, this study 
employed a mixed-methods design, gathering Warwick-Edinburgh Mental Wellbeing 
Scale (WEMWBS) well-being outcome measures by questionnaire and student 
experience, learning and co-production by interviews.
FINDINGS: This research found that RiM continued to produce demonstrable 
improvements in student mental health. Students welcomed the way that RiM 
adapted to offering online and socially distanced provisions. Students valued 
the skills that RiM taught and the way that RiM courses reinforced prior 
learning; above this, however, they valued the mutual support and sense of 
community that participation provided.
CONCLUSION: This study underlines the value of RCs maintaining 'hidden 
curriculums' of peer support and community involvement. This research emphasizes 
co-production as not only a tool for empowerment or service improvement but as a 
valuable skill for personal mental health recovery. Even when operating under 
the most unforeseen or challenging of conditions, RCs should always endeavour to 
prioritize and maintain co-production.
PATIENT OR PUBLIC CONTRIBUTION: In accordance with the RC ethos, this was an 
entirely co-produced study, with academic researchers and RiM staff and peer 
trainers working democratically in partnership with one another to design and 
manage the study and to write up and disseminate findings. To ensure the 
independence and rigour of findings, data analysis was undertaken by external 
academic researchers.

© 2022 The Authors. Health Expectations published by John Wiley & Sons Ltd.

DOI: 10.1111/hex.13635
PMCID: PMC9700130
PMID: 36285350 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1391. J Affect Disord. 2023 Jan 15;321:59-65. doi: 10.1016/j.jad.2022.10.037. Epub 
2022 Oct 22.

The experience of COVID-19 among people with depression: Impact on daily life 
and coping strategies.

Sanchez K(1), Hall LR(2), da Graca B(2), Bennett MM(2), Powers MB(3), Warren 
AM(3).

Author information:
(1)Baylor Scott & White Research Institute, Dallas, TX, United States of 
America; University of Texas at Arlington, School of Social Work, Arlington, TX, 
United States of America. Electronic address: Katherine.Sanchez@bswhealth.org.
(2)Baylor Scott & White Research Institute, Dallas, TX, United States of 
America.
(3)Baylor Scott & White Research Institute, Dallas, TX, United States of 
America; Baylor University Medical Center, Dallas, TX, United States of America; 
Texas A&M University - College of Medicine, Dallas, TX, United States of 
America.

BACKGROUND: The prevalence of depression symptoms among U.S. adults increased 
dramatically during the early months of the COVID-19 pandemic. We sought to 
understand the impact of the pandemic on people with a history of depression.
METHODS: In June 2020, a national sample of 5023 U.S. adults, including 760 
reporting past/current diagnoses of depression, completed survey measures 
related to the COVID experience, coping, anxiety, depression, and PTSD.
RESULTS: After adjusting for sociodemographic characteristics, a history of 
depression increased the odds of negative effects of pandemic on multiple 
aspects of life: routines, access to mental health treatment, alcohol use, 
prescription painkiller use, and other drug use. Those with a history of 
depression also scored significantly higher on the PHQ-8, GAD-7, and PDS-5 (all 
ps < 0.0001). Greater use of adaptive coping strategies was significantly 
associated with lower scores, and greater use of maladaptive strategies with 
higher scores. Individuals reporting a history of depression reported greater 
use of both adaptive and maladaptive strategies.
CONCLUSIONS: Adaptive coping strategies appear to be protective and help 
regulate symptomatology, suggesting that particular focus during the clinical 
encounter on developing tools to promote well-being, alleviate stress, and 
decrease perceptions of helplessness could mitigate the effects.

Copyright © 2022 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2022.10.037
PMCID: PMC9595490
PMID: 36283536 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


1392. Midwifery. 2023 Jan;116:103516. doi: 10.1016/j.midw.2022.103516. Epub 2022 Oct 
17.

Understanding the challenges and impact of training on referral of postnatal 
women to a community physical activity programme by health professionals: A 
qualitative study using the COM-B model.

Allin L(1), Haighton C(2), Dalkin S(2), Das J(2), Allen G(2).

Author information:
(1)Faculty of Health and Life Sciences, Northumbria University, Newcastle upon 
Tyne, NE18ST UK. Electronic address: linda.allin@northumbria.ac.uk.
(2)Faculty of Health and Life Sciences, Northumbria University, Newcastle upon 
Tyne, NE18ST UK.

OBJECTIVE: To understand the value of training for health professionals for 
improving their ability to effectively refer postnatal women to a targeted 
community physical activity programme. The study also sought to understand 
challenges to effective referral of postnatal women from deprived areas.
DESIGN, SETTING AND PARTICIPANTS: Semi-structured interviews were conducted in 
January-February 2020 with early years practitioners (n = 4), health visitors 
(n = 1) and community midwives (n = 2) who had participated in a training 
workshop implemented as part of a targeted community physical activity referral 
programme for postnatal women from deprived areas in the North East of England. 
Two follow up interviews were also conducted with one midwife and one early 
years practitioner during the Covid-19 pandemic. Data were analysed thematically 
and the Capability, Opportunity, Motivation, Behaviour (COM-B) model was 
employed to facilitate identification of the impact of training and the 
challenges in referral from the health professionals' perspective.
FINDINGS: The training increased capability to refer by improving knowledge and 
confidence of health professionals in being able to give appropriate guidance to 
postnatal women about physical activity without having to refer to other 
professionals. Health professionals reported adequate opportunities to engage 
with postnatal women, were motivated to refer and perceived this to be part of 
their role. The timing and method of message delivery were key contexts for 
perceived successful referral, particularly for midwives who wanted to ensure 
the messaging began in the antenatal period. Low staffing levels, limited 
interprofessional collaboration and finding strategies to engage women from 
deprived areas were key challenges to effective delivery of physical activity 
messages. These challenges were exacerbated during Covid-19, with increased 
mental health issues amongst postnatal women.
KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Training health professionals for 
physical activity messaging can be a useful way to increase capability, 
opportunity, and motivation to refer to physical activity interventions for 
postnatal women in deprived areas to potentially increase physical wellbeing and 
reduce postnatal depression. The COM-B is a relevant framework to underpin 
training. A clearly identified referral pathway and staffing issues need to be 
addressed to improve referrals by health professionals.

Copyright © 2022. Published by Elsevier Ltd.

DOI: 10.1016/j.midw.2022.103516
PMID: 36283295 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest None declared


1393. Med Lav. 2022 Oct 24;113(5):e2022040. doi: 10.23749/mdl.v113i5.13377.

Long-term COVID symptoms, work ability and fitness to work in healthcare workers 
hospitalized for Sars-CoV-2 infection.

Mendola M(1), Leoni M(2), Cozzi Y(3), Manzari A(4), Tonelli F(5), Metruccio 
F(6), Tosti L(7), Battini V(8), Cucchi I(9), Costa MC(10), Carrer P(11).

Author information:
(1)Occupational Health Unit, Fatebenefratelli Sacco University Hospital, Milan. 
mendola.marco@asst-fbf-sacco.it.
(2)School of Occupational Medicine, University of Milan, Milan, Italy. 
leoni.marco@asst-fbf-sacco.it.
(3)School of Occupational Medicine, University of Milan, Milan, Italy. 
cozzi.ylenia@asst-fbf-sacco.it.
(4)School of Occupational Medicine, University of Milan, Milan, Italy. 
manzari.andrea@asst-fbf-sacco.it.
(5)Occupational Health Unit, Fatebenefratelli Sacco University Hospital, Milan. 
tonelli.fabio@asst-fbf-sacco.it.
(6)International Centre for Pesticides and Health Risk Prevention, 
Fatebenefratelli Sacco University Hospital, Milan. 
metruccio.francesca@asst-fbf-sacco.it.
(7)International Centre for Pesticides and Health Risk Prevention, 
Fatebenefratelli Sacco University Hospital, Milan. tosti.luca@asst-fbf-sacco.it.
(8)Unit of Clinical Pharmacology, Department of Biomedical and Clinical 
Sciences, University of Milan, Milan, Italy. vera.battini@unimi.it.
(9)Occupational Health Unit, Fatebenefratelli Sacco University Hospital, Milan. 
cucchi.isabella@asst-fbf-sacco.it.
(10)Occupational Health Unit, Fatebenefratelli Sacco University Hospital, Milan. 
mariacristina.costa@asst-fbf-sacco.it.
(11)Occupational Health Unit, Fatebenefratelli Sacco University Hospital, Milan; 
Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, 
Milan, Italy. carrer.paolo@asst-fbf-sacco.it.

BACKGROUND: COVID-19 can affect the persistence of symptoms and work ability 
(WA), hence the fitness to work of healthcare workers (HCW). We describe the 
effects of COVID-19 in hospitalized HCWs of a large Hospital in Lombardy and 
their implications on WA and fitness to work.
METHODS: Fifty-six HCWs of Fatebenefratelli-Sacco Hospital have been 
hospitalized for COVID-19 since March 2020. Clinical and fitness-to-work data 
were acquired from Occupational Health Surveillance Program. A structured 
questionnaire was administered to 53/56 HCWs 18 months after infection to 
investigate Long-COVID symptoms and WA.
RESULTS: Symptoms most reported at recovery (rhino-pharyngeal swab-NPS-negative) 
were exertional dyspnea (86.8%), asthenia (86.8%), arthro-myalgia (71.7%), sleep 
disorders (64.2%), resting dyspnea (62.3%), cough (56.6%). 69.6% underwent 
evaluation at out-patient clinics experienced in Long-COVID. Ten months after 
recovery, symptoms related to physical well-being decreased while memory and 
anxiety/depression were more persistent. At recovery, the WA score decreased 
from 10 to 8, and then an improvement from 8 to 9 was noted during the survey. 
At the return-to-work examination, fit-to-work judgements with restrictions 
increased from 31.4% to 58.7%; then, a slight decrease in the rate of judgements 
with restrictions was observed at the survey's time.
CONCLUSION: Post-COVID-19 symptoms can persist for a long time and could impact 
WA and fitness-to-work of HCW. Adequate health surveillance protocols should 
guarantee the health protection of HCW with persistent disorders after COVID-19.

DOI: 10.23749/mdl.v113i5.13377
PMCID: PMC9632671
PMID: 36282031 [Indexed for MEDLINE]


1394. Curr Pediatr Rev. 2024;20(1):59-65. doi: 10.2174/1573396319666221021154949.

Impact of "Long Covid" on Children: Global and Hong Kong Perspectives.

Hon KLE(1), Leung AKC(2), Leung KKY(1), Wong AHC(3).

Author information:
(1)Department of Paediatrics and Adolescent Medicine, Hong Kong Children's 
Hospital, Hong Kong SAR, China.
(2)Department of Pediatrics, The Alberta Children's Hospital and The University 
of Calgary, Calgary, Alberta, Canada.
(3)Department of Family Medicine, University of Calgary, Calgary, Alberta, 
Canada.

BACKGROUND: The coronavirus disease (COVID-19) pandemic spares no nation or 
city, and the virus is responsible for the escalating incidence and mortality 
worldwide.
OBJECTIVE: This article reviews the impact of "Long Covid" on Children.
METHODS: A PubMed search was conducted in December 2021 in Clinical Queries 
using the key terms "COVID-19" OR "long COVID". The search was restricted to 
children and adolescent aged < 18 years and English literature.
RESULTS: Many large-scale studies have provided strong scientific evidence as to 
the detrimental and irreversible sequelae of COVID-19 on the health, psychology, 
and development of affected children. Many insights into managing this disease 
can be obtained from comparing the management of influenza. COVID-19 is 
generally a mild respiratory disease in children. Several syndromes, such as 
multisystem inflammatory syndrome in children (MIS-C) and COVID toe, are 
probably not specific to SARS-CoV-2. "Long COVID", or the long-term effects of 
SARS-CoV-2 infection, or the prolonged isolation and containment strategies on 
education and psychosocial influences on children associated with the pandemic, 
are significant.
CONCLUSION: Healthcare providers must be aware of the potential effects of 
quarantine on children's mental health. More importantly, healthcare providers 
must appreciate the importance of the decisions and actions made by governments, 
non-governmental organizations, the community, schools, and parents in reducing 
the possible effects of this situation. Multifaceted age-specific and 
developmentally appropriate strategies must be adopted by healthcare authorities 
to lessen the negative impact of quarantine on the psychological well-being of 
children.

Copyright© Bentham Science Publishers; For any queries, please email at 
epub@benthamscience.net.

DOI: 10.2174/1573396319666221021154949
PMID: 36281870 [Indexed for MEDLINE]


1395. Health Place. 2022 Nov;78:102928. doi: 10.1016/j.healthplace.2022.102928. Epub 
2022 Oct 18.

The experience of individuals affected by Australia's international border 
closure during the COVID-19 pandemic.

Oster C(1), Ali K(2), Iasiello M(3), Muir-Cochrane E(4), Fassnacht DB(5).

Author information:
(1)College of Medicine and Public Health, Flinders University, Sturt Road, 
Bedford Park, South Australia, 5042, Australia; College of Nursing and Health 
Science, Flinders University, Sturt Road, Bedford Park, South Australia, 5042, 
Australia. Electronic address: candice.oster@flinders.edu.au.
(2)College of Education, Psychology and Social Work, Flinders University, Sturt 
Road, Bedford Park, South Australia, 5042, Australia; Órama Institute for Mental 
Health & Wellbeing, Flinders University, Sturt Road, Bedford Park, South 
Australia, 5042, Australia. Electronic address: kathina.ali@flinders.edu.au.
(3)Wellbeing and Resilience Centre, Lifelong Health Theme, South Australian 
Health and Medical Research Institute, North Terrace, Adelaide, South Australia, 
5000, Australia; College of Nursing and Health Science, Flinders University, 
Sturt Road, Bedford Park, South Australia, 5042, Australia. Electronic address: 
matthew.iasiello@sahmri.com.
(4)College of Nursing and Health Science, Flinders University, Sturt Road, 
Bedford Park, South Australia, 5042, Australia. Electronic address: 
eimear.muircochrane@flinders.edu.au.
(5)College of Education, Psychology and Social Work, Flinders University, Sturt 
Road, Bedford Park, South Australia, 5042, Australia; Órama Institute for Mental 
Health & Wellbeing, Flinders University, Sturt Road, Bedford Park, South 
Australia, 5042, Australia. Electronic address: dan.fassnacht@flinders.edu.au.

This study explored the experiences of individuals who reported being negatively 
affected by Australia's international border closure during the COVID-19 
pandemic. Qualitative data from 1930 adults who responded to a cross-sectional 
online survey exploring the mental health and wellbeing of individuals affected 
by border closure were analysed using theoretical thematic analysis, drawing on 
understandings of the relationship between place and wellbeing. Four themes were 
identified: 'Disconnection from family and social connections', 'Disconnection 
from a sense of home and belonging', 'Disconnection and sense of self', and 'A 
desire for reconnection'. Results provide a rich illustration of the 
relationship between disconnection from place and wellbeing during COVID-19 and 
highlight the need to support those affected and consider these adverse effects 
in future public health planning.

Copyright © 2022 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.healthplace.2022.102928
PMCID: PMC9576689
PMID: 36279757 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare no conflict of interest.


1396. J Psychiatr Ment Health Nurs. 2023 Jun;30(3):326-340. doi: 10.1111/jpm.12880. 
Epub 2022 Nov 1.

Analysis of mental health effects among nurses working during the COVID-19 
pandemic: A systematic review.

García-Vivar C(1)(2), Rodríguez-Matesanz I(1)(3), San Martín-Rodríguez L(1)(2), 
Soto-Ruiz N(1)(2), Ferraz-Torres M(1)(2), Escalada-Hernández P(1)(2).

Author information:
(1)Department of Health Sciences, Public University of Navarre (UPNA), Pamplona, 
Spain.
(2)IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.
(3)Primary Care Research Group, BioDonostia Health Research Institute, IIS 
Biodonostia, Donostia - San Sebastián, Spain.

WHAT IS KNOWN ON THE SUBJECT?: Working on the frontline during the pandemic has 
had a negative impact on the mental health of health professionals. A 
significant proportion experienced anxiety, insomnia, posttraumatic stress or 
depression. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Analysis and synthesis 
of the evidence of the impact of the COVID-19 pandemic on the mental health of 
nurses based on their work context. There exists a gap in the literature as no 
studies were found that analysed the effects on nurses' mental health according 
to the level of care they worked in (hospital-primary care-nursing home). WHAT 
ARE THE IMPLICATIONS FOR PRACTICE?: There is an urgent need to assess and 
respond to the impact of COVID-19 on the physical and mental well-being of 
nurses, and to monitor international policies for the improvement of nurses' 
working conditions. ABSTRACT: Introduction Health professionals have suffered 
negative consequences during the COVID-19 pandemic. No review has specifically 
addressed the impact of the pandemic on the mental health of nurses exclusively 
according to the work context. Aim To analyse the impact of the COVID-19 
pandemic on the mental health of nurses who have worked in hospitals, primary 
care centres and social health centres. Method PubMed, CINAHL, PsychINFO and 
Cochrane databases were searched (Prospero number: CRD42021249513). Out of 706 
papers, 31 studies (2020-2021) were included in the systematic review. A 
qualitative synthesis method was used to analyse the data. Results Most studies 
were conducted in hospitals or frontline settings. The prevalence of 
moderate-to-severe symptoms was for anxiety 29.55%, depression 38.79%, 
posttraumatic stress disorder 29.8%, and insomnia 40.66%. Discussion This review 
highlights the mental health effects among nurses working in acute hospital 
settings. It also evidences a data gap on mental health effects among nurses 
working in primary health care and in nursing homes. Implications for practice 
In the post phase of the pandemic, there is an urgent need to assess and respond 
to the impact on the mental well-being of nurses, and to monitor international 
policies for the improvement of nurses' working conditions.

© 2022 The Authors. Journal of Psychiatric and Mental Health Nursing published 
by John Wiley & Sons Ltd.

DOI: 10.1111/jpm.12880
PMCID: PMC9874873
PMID: 36270926 [Indexed for MEDLINE]


1397. Psychol Psychother. 2023 Mar;96(1):172-188. doi: 10.1111/papt.12432. Epub 2022 
Oct 20.

Predictors of psychological distress during self-isolation.

Kent JN(1), Kilby CJ(1).

Author information:
(1)The School of Psychology, Counselling, and Psychotherapy, The Cairnmillar 
Institute, Melbourne, Victoria, Australia.

OBJECTIVES: Global pandemics, such as the current COVID-19 pandemic, are 
predicted to increase in prevalence in the future. Transmission suppression 
techniques such as social distancing and stay-at-home restrictions have 
introduced an abundance of additional stressors while simultaneously reducing 
our capacity to cope with stress, thus increasing the collective burden of the 
pandemic. Numerous psychosocial factors have been identified to protect against 
distress in difficult circumstances. However, it is unknown whether these 
factors will continue to be protective in the pandemic context.
DESIGN: The aim of the current study was to determine whether locus of control 
(LOC), coping style or self-compassion were debilitating or protective factors 
towards psychological well-being (depression, anxiety, stress and positive and 
negative affect) during the COVID-19 pandemic.
METHODS: In the current study, Australian adults (N = 176) completed a 
longitudinal online survey (two time points, 2 weeks apart) incorporating 
measures of demographics, locus of control, coping, self-compassion (measured at 
T1), depression, anxiety, stress and positive and negative affect (measured at 
T1 and T2) throughout June-August 2020, during the height of lockdown in 
Australia.
RESULTS: Multiple regression analyses suggested that avoidant coping was 
predictive of increases in stress and negative affect across time points. 
Additionally, self-compassion was predictive of increased positive affect across 
time points.
CONCLUSIONS: These results suggest that the pandemic context represents a unique 
stressor, demanding a distinctive set of strategies and psychosocial 
characteristics to cope. Interventions targeted at reducing avoidant coping 
behaviours and promoting self-compassion may contribute to improvements in 
psychological well-being during the COVID-19 pandemic as well as future 
pandemics.

© 2022 The British Psychological Society.

DOI: 10.1111/papt.12432
PMID: 36263939 [Indexed for MEDLINE]


1398. J Agromedicine. 2023 Jul;28(3):346-364. doi: 10.1080/1059924X.2022.2137616. Epub 
2022 Nov 3.

The Impact of COVID-19 on Farmers' Mental Health: A Case Study of the UK.

Rose DC(1)(2), Shortland F(2), Hall J(3), Hurley P(4), Little R(5), Nye C(6), 
Lobley M(6).

Author information:
(1)School of Water, Energy, and the Environment, Cranfield University, Bedford 
MK43 0AL, UK.
(2)School of Agriculture, Policy and Development, University of Reading, Reading 
RG6 6BZ, UK.
(3)SPSN: Supporting the People Who Support Nature, UK.
(4)Geography and Environmental Science, Building 44, University of Southampton, 
Southampton SO17 1BJ, UK.
(5)Department of Geography, University of Sheffield, Sheffield S3 7ND, UK.
(6)Centre for Rural Policy Research, Department of Social and Political 
Sciences, Philosophy and Anthropology, Faculty of Humanities, Arts and Social 
Sciences, Exeter EX4 4PJ, UK.

OBJECTIVES: In this paper, we use a UK case study to explore how the COVID-19 
pandemic affected the mental health (emotional, psychological, social wellbeing) 
of farmers. We outline the drivers of poor farming mental health, the manifold 
impacts of the pandemic at a time of policy and environmental change, and 
identify lessons that can be learned to develop resilience in farming 
communities against future shocks.
METHODS: We undertook a survey answered by 207 farmers across the UK, focusing 
on drivers of poor mental health and the effect of the COVID-19 pandemic. We 
also conducted 22 in-depth interviews with individuals in England, Scotland and 
Wales who provide mental health support to farmers. These explored how and why 
the COVID-19 pandemic affected the mental health of farmers. These interviews 
were supplemented by 93 survey responses from a similar group of support 
providers (UK-wide).
RESULTS: We found that the pandemic exacerbated underlying drivers of poor 
mental health and wellbeing in farming communities. 67% of farmers surveyed 
reported feeling more stressed, 63% felt more anxious, 38% felt more depressed, 
and 12% felt more suicidal. The primary drivers of poor mental health identified 
by farmers during the pandemic included decreased social contact and loneliness, 
issues with the general public on private land, and moving online for social 
events. Support providers also highlighted relationship and financial issues, 
illness, and government inspections as drivers of poor mental health. Some 
farmers, conversely, outlined positive impacts of the pandemic.
CONCLUSION: The COVID-19 pandemic is just one of many potential stressors 
associated with poor farming mental health and its impacts are likely to be 
long-lasting and delayed. Multiple stressors affecting farmers at the same time 
can create a tipping point. Therefore, there is a need for long-term support and 
ongoing evaluation of the drivers of poor mental health in farming families.

DOI: 10.1080/1059924X.2022.2137616
PMID: 36263759 [Indexed for MEDLINE]


1399. Front Public Health. 2022 Oct 3;10:860863. doi: 10.3389/fpubh.2022.860863. 
eCollection 2022.

Psychological well-being in times of COVID-19: Associated factors and levels in 
the general population.

Ebling S(1), Ebrahimi OV(2)(3), Johnson SU(2)(3), Skjerdingstad N(2), Hoffart 
A(2)(3).

Author information:
(1)Department of Psychology, University of Bergen, Bergen, Norway.
(2)Department of Psychology, University of Oslo, Oslo, Norway.
(3)Modum Bad Psychiatric Hospital, Vikersund, Norway.

The COVID-19 pandemic and living under social distancing restrictions have been 
hypothesized to impact well-being and mental health in the general population. 
This study investigated the general Norwegian adult population's well-being 
after implementing and lifting strict social distancing restrictions. The study 
was conducted through digital surveys; during the implementation of strict 
social distancing restrictions in March 2020 (T1) and 3 months later, when the 
preponderance of strict distancing restrictions was discontinued (T2). 
Well-being was measured at T2. Four thousand nine hundred twenty-one individuals 
participated, and a sensitivity analysis was conducted to ensure that the sample 
reflects the true Norwegian adult population. Hierarchical regression analyses 
show that contemporaneous employment status and positive metacognitions at T2 
were associated with higher well-being. Negative metacognitions and the use of 
unhelpful coping strategies at T2 had a contemporaneous association with lower 
mental well-being. Negative metacognitions at T1 were associated with lower 
well-being scores, while positive metacognitions at T1 were positively 
associated with higher well-being. An indirect association between social 
distancing and lower well-being was found through heightened depressive 
symptoms. These results contribute to understanding how social distancing 
restrictions relate to general well-being, which may further contribute to 
designing proper strategies to strengthen mental health and well-being during 
challenging and unavoidable societal conditions.

Copyright © 2022 Ebling, Ebrahimi, Johnson, Skjerdingstad and Hoffart.

DOI: 10.3389/fpubh.2022.860863
PMCID: PMC9574009
PMID: 36262228 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1400. Psychiatry Res. 2022 Nov;317:114890. doi: 10.1016/j.psychres.2022.114890. Epub 
2022 Oct 8.

Post-traumatic stress in healthcare workers during the COVID-19 pandemic: A 
systematic review and meta-analysis.

Andhavarapu S(1), Yardi I(1), Bzhilyanskaya V(1), Lurie T(1), Bhinder M(1), 
Patel P(1), Pourmand A(2), Tran QK(3).

Author information:
(1)The Research Associate Program, Department of Emergency Medicine, University 
of Maryland School of Medicine, Baltimore, MD, United States.
(2)Department of Emergency Medicine, George Washington University School of 
Medicine and Health Sciences, Washington, DC, United States.
(3)Department of Emergency Medicine, University of Maryland School of Medicine, 
22 South Greene Street, Suite T3N45, Baltimore, MD 21043, United States; Program 
in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School 
of Medicine, Baltimore, MD, United States. Electronic address: 
qtran@som.umaryland.edu.

The SARS-CoV-2 (COVID-19) pandemic has increased healthcare worker (HCW) 
susceptibility to mental illness. We conducted a meta-analysis to investigate 
the prevalence and possible factors associated with post-traumatic stress 
disorder (PTSD) symptoms among HCW during the COVID-19 pandemic. We searched 
PubMed, SCOPUS and EMBASE databases up to May 4th, 2022. We performed random 
effects meta-analysis and moderator analyses for the prevalence of PTSD-relevant 
symptoms and severe PTSD symptoms. We identified 1276 studies, reviewed 209 
full-text articles, and included 119 studies (117,143 participants) with a total 
of 121 data points in our final analysis. 34 studies (24,541 participants) 
reported prevalence of severe PTSD symptoms. Approximately 25.2% of participants 
were physicians, 42.8% nurses, 12.4% allied health professionals, 8.9% auxiliary 
health professionals, and 10.8% "other". The pooled prevalence of PTSD symptoms 
among HCWs was 34% (95% CI, 0.30-0.39, I2 >90%), and 14% for severe PTSD (95% 
CI, 0.11 - 0.17, I2 >90%). The introduction of COVID vaccines was associated 
with a sharp decline in the prevalence of PTSD, and new virus variants were 
associated with small increases in PTSD rates. It is important that policies 
work towards allocating adequate resources towards protecting the well-being of 
healthcare workers to minimize adverse consequences of PTSD.

Copyright © 2022 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.psychres.2022.114890
PMCID: PMC9573911
PMID: 36260970 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare no competing interests.


1401. Nurs Ethics. 2023 Feb;30(1):46-57. doi: 10.1177/09697330221114329. Epub 2022 Oct 
19.

Double distress: women healthcare providers and moral distress during COVID-19.

Smith J(1), Korzuchowski A(1), Memmott C(2), Oveisi N(3), Tan HL(2), Morgan 
R(2).

Author information:
(1)Faculty of Health Sciences, 1763Simon Fraser University, Burnaby, BC, CA.
(2)Bloomberg School of Public Health, 1466Johns Hopkins University, Baltimore, 
ML, USA.
(3)Pharmaceutical Studies, 8166University of British Columbia, Vancouver, BC, 
CA.

Background: COVID-19 pandemic has led to heightened moral distress among 
healthcare providers. Despite evidence of gendered differences in experiences, 
there is limited feminist analysis of moral distress.Objectives: To identify 
types of moral distress among women healthcare providers during the COVID-19 
pandemic; to explore how feminist political economy might be integrated into the 
study of moral distress.Research Design: This research draws on interviews and 
focus groups, the transcripts of which were analyzed using framework 
analysis.Research Participants and Context: 88 healthcare providers, based in 
British Columbia Canada, participated virtually.Ethical Considerations: The 
study received ethical approval from Simon Fraser University.Findings: 
Healthcare providers experienced moral dilemmas related to ability to provide 
quality and compassionate care while maintaining COVID-19 protocols. Moral 
constraints were exacerbated by staffing shortages and lack of access to PPE. 
Moral conflicts emerged when women tried to engage decision-makers to improve 
care, and moral uncertainty resulted from lack of clear and consistent 
information. At home, women experienced moral constraints related to inability 
to support children's education and wellbeing. Moral conflicts related to lack 
of flexible work environments and moral dilemmas developed between unpaid care 
responsibilities and COVID-19 risks. Women healthcare providers resisted moral 
residue and structural constraints by organizing for better working conditions, 
childcare, and access to PPE, engaging mental health support and drawing on 
professional pride.Discussion: COVID-19 has led to new and heightened 
experiences of moral distress among HCP in response to both paid and unpaid care 
work. While many of the experiences of moral distress at work were not 
explicitly gendered, implicit gender norms structured moral events. Women HCP 
had to take it upon themselves to organize, seek out resources, and resist moral 
residue.Conclusion: A feminist political economy lens illuminates how women 
healthcare providers faced and resisted a double layering of moral distress 
during the pandemic.

DOI: 10.1177/09697330221114329
PMCID: PMC9582741
PMID: 36260872 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1402. Harefuah. 2022 Mar;161(3):188-192.

["I WOULD COME HOME WITH TEARS IN MY EYES:" THE CLINICIAN AS A SECOND VICTIM ON 
A DAY-TO-DAY ROUTINE AND AT THE COVID-19 PANDEMIC].

[Article in Hebrew]

Zuckerman S(1).

Author information:
(1)Inbal Insurance Company, the Division of Medical Risk Management.

BACKGROUND: Until the onset of the new millennium, the focus of medicine in 
general and patient safety in particular was the patient. In the past two 
decades, the well-being of the clinician is becoming more apparent in the 
professional literature. This article will focus on the physician who shows 
signs of distress, depression and burnout, or even trauma. This is the second 
victim of a medical error or adverse event.
METHODS: The author will review the literature of the past decade dealing with 
this phenomenon, often related to as a syndrome, in day-to-day routine and at a 
pandemic and emergency situation. I will start by the definition and description 
of symptoms of the syndrome, then move on to its scope, risk factors and various 
sources.
CONCLUSIONS: I will conclude by describing the situation in Israel and provide 
some practical tools that have proved efficient for confronting the phenomenon.
DISCUSSION: The author will focus on the four origins of stress leading to the 
syndrome: the physical-psychological, institutional-cultural, cognitive and 
moral. I will emphasize the latter, which deserves further exploration given the 
evidence to its significant contribution to stress and trauma of health 
professionals. I will then discuss the interventions and tools suggested and 
implemented for support of the second victim in relation to the four origins.

PMID: 36259406 [Indexed for MEDLINE]


1403. Nat Hum Behav. 2022 Oct;6(10):1333-1343. doi: 10.1038/s41562-022-01453-0. Epub 
2022 Oct 18.

Social isolation and the brain in the pandemic era.

Bzdok D(1), Dunbar RIM(2).

Author information:
(1)The Neuro-Montreal Neurological Institute (MNI), McConnell Brain-Imaging 
Centre (BIC), Department of Biomedical Engineering, Faculty of Medicine, McGill 
University, Montreal, Quebec, Canada. danilo.bzdok@mcgill.ca.
(2)Department of Experimental Psychology, University of Oxford, Oxford, UK. 
robin.dunbar@psy.ox.ac.uk.

Intense sociality has been a catalyst for human culture and civilization, and 
our social relationships at a personal level play a pivotal role in our health 
and well-being. These relationships are, however, sensitive to the time we 
invest in them. To understand how and why this should be, we first outline the 
evolutionary background in primate sociality from which our human social world 
has emerged. We then review defining features of that human sociality, putting 
forward a framework within which one can understand the consequences of mass 
social isolation during the COVID-19 pandemic, including mental health 
deterioration, stress, sleep disturbance and substance misuse. We outline recent 
research on the neural basis of prolonged social isolation, highlighting 
especially higher-order neural circuits such as the default mode network. Our 
survey of studies covers the negative effects of prolonged social deprivation 
and the multifaceted drivers of day-to-day pandemic experiences.

© 2022. Springer Nature Limited.

DOI: 10.1038/s41562-022-01453-0
PMID: 36258130 [Indexed for MEDLINE]


1404. Psychiatr Danub. 2022 Fall;34(3):572-577. doi: 10.24869/psyd.2022.572.

Prognostic Assessment of Stress-Related Factors in Healthcare Workers During the 
COVID-19 Pandemic.

Pinchuk I(1), Pishel V, Polyvіanaia M, Chumak S, Ilnytska T, Stepanova N, 
Filimonova N, Kopchak O, Yachnik Y, Kolodezhny O, Solonskyi A.

Author information:
(1)Taras Shevchenko National University of Kyiv, Lomonosova str., 36, Kyiv, 
03022, Ukraine, irina.pinchuk0311@gmail.com.

INTRODUCTION: The COVID-19 pandemic is an extraordinary challenge for all 
countries and affects the psychological wellbeing of healthcare professionals 
working with people suffering from COVID-19 and puts them at a high risk of 
mental health problems. The aim of the study was to identify stress-related 
factors that affect the mental health of healthcare workers during the COVID-19 
pandemic in Ukraine.
SUBJECTS AND METHODS: A total of 1098 Ukrainian healthcare workers were surveyed 
using an online questionnaire consisting of questions relating to a) 
socio-demographic characteristics; b) perceptions of the COVID-19 related 
situation; and c) stress and protective factors. Respondents were divided into 
two groups, depending on whether they provided care to the patients with 
COVID-19 or not.
RESULTS: Of the 1087 healthcare workers, 863 (79.4%) were found to have anxiety 
/ fear caused by the COVID-19. No significant difference was detected between 
professionals who did and did not provide personal assistance to patients with 
COVID-19 concerning anxiety / fear related to COVID-19 (p=0.0776). Based on 
logistic regression model (χ2(6)=263.70, p=0.000) the most significant 
predictive factors for anxiety / fear caused by the COVID-19 were factors 
related to safety and risk perception (the risk of getting infected, dying, 
infecting loved ones, perception of the threat of the epidemic spread), 
information factors (constant news about COVID-19), as well as factors related 
to the organisation of care (lack of staff in health care facilities).
CONCLUSIONS: Negative risk perception, high consumption of COVID-19 news, and 
shortage of staff in health care facilities were significant predictors of 
anxiety / fear caused by the COVID-19.

DOI: 10.24869/psyd.2022.572
PMID: 36257009 [Indexed for MEDLINE]


1405. Psychiatr Danub. 2022 Fall;34(3):564-571. doi: 10.24869/psyd.2022.564.

Mental Health Support Program for Healthcare Professionals in a Pandemic 
Hospital in Turkey and Its Results on Anxiety, Depression, Insomnia and Sexual 
Disorders.

Tuna Ö(1), Ermis C.

Author information:
(1)Kanuni Sultan Süleyman Training and Research Hospital, Department of Adult 
Psychiatry, Atakent Mh, Turgut Özal Bulvari No:46/1, 34303, Küçükçekmece, 
İstanbul, Turkey, ozgecantuna@gmail.com.

BACKGROUND: The COVID-19 pandemic has put enormous stress on the health care 
workers, threatening not only their physical health but also their mental 
well-being. No mental health support program (MHSP) addressing depression and 
anxiety in healthcare workers (HCWs), has been shown to be effective in Turkey 
previously. We aimed to measure the effect of our MHSP among healthcare workers 
who applied for psychological help associated with the COVID-19 pandemic.
SUBJECTS AND METHODS: An MHSP has been created for healthcare professionals 
working in a pandemic hospital during the COVID-19 period. Health workers were 
recruited between July and September 2020. Anxiety, depression, and insomnia 
levels were evaluated with HAM-A (Hamilton Anxiety Scale), HDRS (Hamilton 
Depression Scale), and Insomnia Severity Index (ISI) before and after the 
intervention. Sexual complaints were questioned by a consultant psychiatrist. 
MHSP (n=31), and treatment as usual (TAU, n=27) groups were compared using 
repeated-measures ANOVA.
RESULTS: Sociodemographic data, medical history of COVID-19, and psychiatric 
diagnoses were similar between the groups. There was no difference in baseline 
HAM-A, HDRS, and ISI scores (p>0.05). At the end of the study, there was a 
significant difference between study groups regarding anxiety scores (For 
post-treatment, MHSP=8.0±2.6 vs. TAU=17.9±3.1, p<0.001) and depression symptoms 
(For post-treatment, MHSP=8.8±2.7 vs. TAU=20.0±2.4, p<0.001) but not in insomnia 
levels (For post-treatment, MHSP=6.5±2.4 vs. TAU=7.3±2.4, p=0.499). Likewise, 
both groups reported similar levels of improvement in reduced sexual drive.
CONCLUSIONS: Our study results suggest that the MHSP effectively alleviates the 
psychiatric complaints of healthcare professionals. It is recommended to have 
mental support teams for healthcare professionals in hospitals.

DOI: 10.24869/psyd.2022.564
PMID: 36257008 [Indexed for MEDLINE]


1406. Rheumatol Int. 2023 Jan;43(1):59-68. doi: 10.1007/s00296-022-05225-x. Epub 2022 
Oct 18.

Impact of COVID-19 pandemic on rheumatology trainees: an online survey.

Chandwar K(1), Mukherjee S(1), Ekbote D(1), Kishor K(1), Dogga P(1), Dixit J(1), 
Kumar P(1), Dhakad U(2).

Author information:
(1)Department of Clinical Immunology and Rheumatology, King George's Medical 
University, Lucknow, Uttar Pradesh, 226003, India.
(2)Department of Clinical Immunology and Rheumatology, King George's Medical 
University, Lucknow, Uttar Pradesh, 226003, India. drurmiladhakad@gmail.com.

To assess the impact of the COVID-19 pandemic on the training of rheumatology 
trainees. We conducted an observational cross-sectional study using an online 
survey-based questionnaire sent to rheumatology trainees in India. Rheumatology 
trainees from India, including DM/DNB residents and fellows, were included. A 
total of 78 trainees from 24 institutes in 12 states participated in the study. 
An overwhelming majority of residents (84%) felt COVID-19 Pandemic Negatively 
impacted their residency and their Physical (65%), Mental (74%) and Social 
well-being (80%); 79% of trainees felt burnt out. Majority of trainees felt the 
pandemic negatively impacted their training with clinical teaching (91%), 
Clinical examination skills (74%), current (80%) and future (70%) research 
opportunities suffering during the pandemic. Most had significant reduction in 
the overall footfall (72%) of patients in rheumatology including OPD (77%) and 
indoor (67%) admissions along with academics (35%), procedures (66%) and 
exposure to musculoskeletal ultrasound (71%). Almost 60% and 40% of trainees had 
OPDs, and indoor admissions stopped during COVID-19 pandemic of these 20% had 
OPDs, and Admissions closed for more than 6 months. 85% of participants had one 
or the other psychological symptoms with almost half experiencing anxiety (44%), 
low mood (47%) or lack of sleep (41%). We found The COVID-19 Pandemic has 
significantly affected the physical, social and mental well-being of 
Rheumatology trainees. Academic and clinical training reduced, current and 
future Research became difficult, disruptions in OPDs and Admissions, recurrent 
COVID postings and reduction in patient footfall, procedures and MSK-US have 
been detrimental to trainees.

© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, 
part of Springer Nature.

DOI: 10.1007/s00296-022-05225-x
PMCID: PMC9579629
PMID: 36255483 [Indexed for MEDLINE]

Conflict of interest statement: All authors disclose that they do not have any 
direct or indirect interests (dual commitments), financial or otherwise, that 
might affect or be perceived to affect the conduct or reporting of the work they 
have submitted.


1407. J Pastoral Care Counsel. 2023 Mar;77(1):12-18. doi: 10.1177/15423050221126469. 
Epub 2022 Oct 18.

Psychological Well-Being of Prospective Counselors from the Faith-Based 
Educational Institution in the COVID-19 Outbreak.

Amalia C(1), Aliifah J(1), Jati P(1), Adi Pangestu YPD(1), Elias MA(1), Mamahit 
HC(1), Setia Wati CL(1), Biondi Situmorang DD(1).

Author information:
(1)Department of Guidance and Counseling, 64732Atma Jaya Catholic University of 
Indonesia, Indonesia.

This study aims to analyze the Psychological Well-Being among prospective 
counselors from the Faith-Based Educational Institution during the COVID-19 
pandemic. The approach of this study was quantitative with a descriptive method. 
The Psychological Well-Being among prospective counselors is at a high 
classification level, namely 84%. The components of Psychological Well-Being 
that are above the total average score are Positive Relationship with Other 
People and components of Self-Growth.

DOI: 10.1177/15423050221126469
PMCID: PMC9577817
PMID: 36254534 [Indexed for MEDLINE]

Conflict of interest statement: The authors declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1408. Stress Health. 2023 Aug;39(3):562-575. doi: 10.1002/smi.3204. Epub 2022 Nov 5.

The role of emotion regulation in mental health during the COVID-19 outbreak: A 
10-wave longitudinal study.

Brenning K(1), Waterschoot J(1), Dieleman L(1), Morbée S(1), Vermote B(1), 
Soenens B(1), Van der Kaap-Deeder J(1), van den Bogaard D(1), Vansteenkiste 
M(1).

Author information:
(1)Department of Developmental, Personality and Social Psychology, Ghent 
University, Ghent, Belgium.

The COVID-19 pandemic elicited a lot of concerns among citizens, thereby 
potentially compromising their well-being. This study sought to examine the role 
of individuals' emotion regulation styles (i.e., emotional dysregulation, 
emotional suppression, and emotional integration) in handling these concerns and 
their experiences of well-being (i.e., satisfaction with life and sleep quality) 
and ill-being (i.e., anxiety and depressive symptoms). The study had a unique 
10-wave longitudinal design (N = 986; Mage  = 41.28; 76% female) and was 
conducted during the outbreak of the pandemic in March-May 2020. Multilevel 
analyses showed, first, that weekly variation in COVID-19 related concerns 
related negatively to weekly variation in well-being and positively to weekly 
variation in ill-being. Second, at the between-person level, emotional 
dysregulation and suppression related positively to between-person vulnerability 
in ill-being and lower well-being (across all waves). Third, between-person 
differences in emotional dysregulation amplified the strength of the 
within-person association between concerns and depressive complaints and lowered 
life satisfaction. Unexpectedly, integrative emotion regulation amplified the 
strength of the within-person association between concerns and anxiety. The 
discussion focuses on the critical role of emotion regulation in handling the 
uncertainty elicited by the pandemic and provides directions for further 
research.

© 2022 John Wiley & Sons Ltd.

DOI: 10.1002/smi.3204
PMCID: PMC9874444
PMID: 36252954 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


1409. Ann Intern Med. 2022 Nov;175(11):1560-1571. doi: 10.7326/M22-1507. Epub 2022 Oct 
18.

The Impact of the COVID-19 Pandemic and Associated Control Measures on the 
Mental Health of the General Population : A Systematic Review and Dose-Response 
Meta-analysis.

Salanti G(1), Peter N(2), Tonia T(1), Holloway A(1), White IR(3), Darwish L(2), 
Low N(1), Egger M(4), Haas AD(1), Fazel S(5), Kessler RC(6), Herrman H(7), 
Kieling C(8), De Quervain DJF(9), Vigod SN(10), Patel V(11), Li T(12), Cuijpers 
P(13), Cipriani A(5), Furukawa TA(14), Leucht S(2); MHCOVID Crowd Investigators; 
Sambo AU, Onishi A, Sato A, Rodolico A, Oliveira Solis AC, Antoniou A, 
Kapfhammer A, Ceraso A, O'Mahony A, Lasserre AM, Ipekci AM, Concerto C, Zangani 
C, Igwesi-Chidobe C, Diehm C, Demir DD, Wang D, Ostinelli EG, Sahker E, Beraldi 
GH, Erzin G, Nelson H, Elkis H, Imai H, Wu H, Kamitsis I, Filis I, Michopoulos 
I, Bighelli I, Hong JSW, Ballesteros J, Smith KA, Yoshida K, Omae K, Trivella M, 
Tada M, Reinhard MA, Ostacher MJ, Müller M, Jaramillo NG, Ferentinos PP, 
Toyomoto R, Cortese S, Kishimoto S, Covarrubias-Castillo SA, Siafis S, Thompson 
T, Karageorgiou V, Chiocchia V, Zhu Y, Honda Y; MHCOVID Crowd Investigators†.

Collaborators: Sambo AU, Onishi A, Sato A, Rodolico A, Oliveira Solis AC, 
Antoniou A, Kapfhammer A, Ceraso A, O'Mahony A, Lasserre AM, Ipekci AM, Concerto 
C, Zangani C, Igwesi-Chidobe C, Diehm C, Demir DD, Wang D, Ostinelli EG, Sahker 
E, Beraldi GH, Erzin G, Nelson H, Elkis H, Imai H, Wu H, Kamitsis I, Filis I, 
Michopoulos I, Bighelli I, Hong JSW, Ballesteros J, Smith KA, Yoshida K, Omae K, 
Trivella M, Tada M, Reinhard MA, Ostacher MJ, Müller M, Jaramillo NG, Ferentinos 
PP, Toyomoto R, Cortese S, Kishimoto S, Covarrubias-Castillo SA, Siafis S, 
Thompson T, Karageorgiou V, Chiocchia V, Zhu Y, Honda Y.

Author information:
(1)Institute of Social and Preventive Medicine, University of Bern, Bern, 
Switzerland (G.S., T.T., A.H., N.L., A.D.H.).
(2)Department of Psychiatry and Psychotherapy, Klinikum Rechts der Isar, School 
of Medicine, Technical University of Munich, Munich, Germany (N.P., L.D., S.L.).
(3)University College London, London, United Kingdom (I.R.W.).
(4)Institute of Social and Preventive Medicine, University of Bern, Bern, 
Switzerland, and Population Health Sciences, Bristol Medical School, University 
of Bristol, Bristol, United Kingdom (M.E.).
(5)Department of Psychiatry, University of Oxford, Oxford Precision Psychiatry 
Lab, National Institute for Health and Care Research Oxford Health Biomedical 
Research Centre, and Oxford Health National Health Service Foundation Trust, 
Warneford Hospital, Oxford, United Kingdom (A.C., S.F.).
(6)Department of Health Care Policy, Harvard Medical School, Boston, 
Massachusetts (R.C.K.).
(7)Orygen National Centre for Excellence in Youth Mental Health, University of 
Melbourne, Melbourne, Victoria, Australia (H.H.).
(8)Department of Psychiatry, School of Medicine, Universidade Federal do Rio 
Grande do Sul, and Child and Adolescent Psychiatry Division, Hospital de 
Clinicas de Porto Alegre, Porto Alegre, Brazil (C.K.).
(9)Division of Cognitive Neuroscience, University of Basel, Basel, Switzerland 
(D.J.F.Q.).
(10)Women's College Hospital, Women's College Research Institute and Department 
of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, 
Ontario, Canada (S.N.V.).
(11)Department of Global Health and Social Medicine, Harvard Medical School, 
Boston, Massachusetts (V.P.).
(12)Department of Ophthalmology, School of Medicine, University of Colorado 
Anschutz Medical Campus, Aurora, Colorado (T.L.).
(13)Department of Clinical, Neuro- and Developmental Psychology, Amsterdam 
Public Health Research Institute, Vrije Universiteit Amsterdam, and World Health 
Organization Collaborating Centre for Research and Dissemination of 
Psychological Interventions, Vrije Universiteit, Amsterdam, the Netherlands 
(P.C.).
(14)Department of Health Promotion and Human Behaviour, Graduate School of 
Medicine and School of Public Health, Kyoto University, Kyoto, Japan (T.A.F.).

BACKGROUND: To what extent the COVID-19 pandemic and its containment measures 
influenced mental health in the general population is still unclear.
PURPOSE: To assess the trajectory of mental health symptoms during the first 
year of the pandemic and examine dose-response relations with characteristics of 
the pandemic and its containment.
DATA SOURCES: Relevant articles were identified from the living evidence 
database of the COVID-19 Open Access Project, which indexes COVID-19-related 
publications from MEDLINE via PubMed, Embase via Ovid, and PsycInfo. Preprint 
publications were not considered.
STUDY SELECTION: Longitudinal studies that reported data on the general 
population's mental health using validated scales and that were published before 
31 March 2021 were eligible.
DATA EXTRACTION: An international crowd of 109 trained reviewers screened 
references and extracted study characteristics, participant characteristics, and 
symptom scores at each timepoint. Data were also included for the following 
country-specific variables: days since the first case of SARS-CoV-2 infection, 
the stringency of governmental containment measures, and the cumulative numbers 
of cases and deaths.
DATA SYNTHESIS: In a total of 43 studies (331 628 participants), changes in 
symptoms of psychological distress, sleep disturbances, and mental well-being 
varied substantially across studies. On average, depression and anxiety symptoms 
worsened in the first 2 months of the pandemic (standardized mean difference at 
60 days, -0.39 [95% credible interval, -0.76 to -0.03]); thereafter, the 
trajectories were heterogeneous. There was a linear association of worsening 
depression and anxiety with increasing numbers of reported cases of SARS-CoV-2 
infection and increasing stringency in governmental measures. Gender, age, 
country, deprivation, inequalities, risk of bias, and study design did not 
modify these associations.
LIMITATIONS: The certainty of the evidence was low because of the high risk of 
bias in included studies and the large amount of heterogeneity. Stringency 
measures and surges in cases were strongly correlated and changed over time. The 
observed associations should not be interpreted as causal relationships.
CONCLUSION: Although an initial increase in average symptoms of depression and 
anxiety and an association between higher numbers of reported cases and more 
stringent measures were found, changes in mental health symptoms varied 
substantially across studies after the first 2 months of the pandemic. This 
suggests that different populations responded differently to the psychological 
stress generated by the pandemic and its containment measures.
PRIMARY FUNDING SOURCE: Swiss National Science Foundation. (PROSPERO: 
CRD42020180049).

DOI: 10.7326/M22-1507
PMCID: PMC9579966
PMID: 36252247 [Indexed for MEDLINE]

Conflict of interest statement: Disclosures: Disclosures can be viewed at 
www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M22-1507.


1410. Public Health Nurs. 2023 Jan;40(1):17-27. doi: 10.1111/phn.13136. Epub 2022 Oct 
17.

Coping during the COVID-19 pandemic among young adults experiencing homelessness 
and unstable housing: A qualitative study.

Gibbs KD(1)(2), Jones JT(1), LaMark W(1), Abdulmooti S(1), Bretz L(3), Kearney 
KD(1), Narendorf SC(4), Santa Maria DM(1).

Author information:
(1)Cizik School of Nursing, University of Texas Health Science Center at 
Houston, Houston, Texas.
(2)Texas Children's Hospital, Houston, Texas.
(3)Baylor College of Medicine, Section of Adolescent Medicine, Houston, Texas.
(4)Graduate College of Social Work, University of Houston School, Houston, 
Texas.

BACKGROUND: Young adults experiencing homelessness (YAEH) experience more 
stressors compared to housed peers, yet little is known about the impact of the 
COVID-19 pandemic on these youth. The purpose of this qualitative study was to 
explore how YAEH perceived the pandemic's impact on their well-being and coping.
METHODS: YAEH were recruited from those participating in an HIV prevention 
study. Semi-structured interviews were conducted and analysis was guided by 
Lazarus and Folkman's transactional theory of stress and coping.
RESULTS: Four major themes were identified from interviews with 40 youth: (1) 
ongoing harms, (2) COVID-19 as a stressor, (3) mental health impacts, and (4) 
coping strategies. Participants described unmet basic needs, emotions of 
frustration and anxiety, and several coping strategies including substance use.
CONCLUSION: Many YAEH reported experiencing continued challenges that were 
compounded by the stressors related to the COVID-19 pandemic. Special 
considerations are needed to address pandemic-related exacerbations of mental 
health symptoms and substance use among YAEH.

© 2022 Wiley Periodicals LLC.

DOI: 10.1111/phn.13136
PMCID: PMC9844081
PMID: 36251216 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
disclose.


1411. Front Public Health. 2022 Sep 29;10:965664. doi: 10.3389/fpubh.2022.965664. 
eCollection 2022.

Organizational responses to the COVID-19 pandemic in Victoria, Australia: A 
qualitative study across four healthcare settings.

McGuinness SL(1)(2), Josphin J(1), Eades O(1), Clifford S(1), Fisher J(1), 
Kirkman M(1), Russell G(1), Hodgson CL(1)(2), Kelsall HL(1), Lane R(1), 
Skouteris H(1), Smith KL(1)(3), Leder K(1)(4).

Author information:
(1)School of Public Health and Preventive Medicine, Monash University, 
Melbourne, VIC, Australia.
(2)Alfred Health, Melbourne, VIC, Australia.
(3)Ambulance Victoria, Melbourne, VIC, Australia.
(4)Royal Melbourne Hospital, Melbourne, VIC, Australia.

OBJECTIVE: Organizational responses that support healthcare workers (HCWs) and 
mitigate health risks are necessary to offset the impact of the COVID-19 
pandemic. We aimed to understand how HCWs and key personnel working in 
healthcare settings in Melbourne, Australia perceived their employing 
organizations' responses to the COVID-19 pandemic.
METHOD: In this qualitative study, conducted May-July 2021 as part of the 
longitudinal Coronavirus in Victorian Healthcare and Aged Care Workers 
(COVIC-HA) study, we purposively sampled and interviewed HCWs and key personnel 
from healthcare organizations across hospital, ambulance, aged care and primary 
care (general practice) settings. We also examined HCWs' free-text responses to 
a question about organizational resources and/or supports from the COVIC-HA 
Study's baseline survey. We thematically analyzed data using an iterative 
process.
RESULTS: We analyzed data from interviews with 28 HCWs and 21 key personnel and 
free-text responses from 365 HCWs, yielding three major themes: navigating a 
changing and uncertain environment, maintaining service delivery during a 
pandemic, and meeting the safety and psychological needs of staff . HCWs valued 
organizational efforts to engage openly and honesty with staff, and proactive 
responses such as strategies to enhance workplace safety (e.g., personal 
protective equipment spotters). Suggestions for improvement identified in the 
themes included streamlined information processes, greater involvement of HCWs 
in decision-making, increased investment in staff wellbeing initiatives and 
sustainable approaches to strengthen the healthcare workforce.
CONCLUSIONS: This study provides in-depth insights into the challenges and 
successes of organizational responses across four healthcare settings in the 
uncertain environment of a pandemic. Future efforts to mitigate the impact of 
acute stressors on HCWs should include a strong focus on bidirectional 
communication, effective and realistic strategies to strengthen and sustain the 
healthcare workforce, and greater investment in flexible and meaningful 
psychological support and wellbeing initiatives for HCWs.

Copyright © 2022 McGuinness, Josphin, Eades, Clifford, Fisher, Kirkman, Russell, 
Hodgson, Kelsall, Lane, Skouteris, Smith and Leder.

DOI: 10.3389/fpubh.2022.965664
PMCID: PMC9557753
PMID: 36249244 [Indexed for MEDLINE]

Conflict of interest statement: KL (APP115500) and CH (APP1173271) were 
supported by National Health and Medical Research Fellowships. The remaining 
authors declare that the research was conducted in the absence of any commercial 
or financial relationships that could be construed as a potential conflict of 
interest.


1412. Front Public Health. 2022 Sep 20;10:917581. doi: 10.3389/fpubh.2022.917581. 
eCollection 2022.

The influence of college students' academic stressors on mental health during 
COVID-19: The mediating effect of social support, social well-being, and 
self-identity.

Li P(1)(2), Yang J(3), Zhou Z(2), Zhao Z(2), Liu T(1)(2)(4).

Author information:
(1)Key Research Base of Humanities and Social Sciences of the Ministry of 
Education, Academy of Psychology and Behavior, Tianjin Normal University, 
Tianjin, China.
(2)Faculty of Psychology, Tianjin Normal University, Tianjin, China.
(3)Collaborative Innovation Center of Assessment Toward Basic Education Quality, 
Beijing Normal University, Beijing, China.
(4)Tianjin Social Science Laboratory of Students' Mental Development and 
Learning, Tianjin Normal University, Tianjin, China.

COVID-19 caused harmful mental consequences to the public, and mental health 
problems were very common among college students during the outbreak of 
COVID-19. Academic stressors were the main stress for college students, and 
social support, social well-being, and self-identity were widely known as 
protective factors for mental health. Therefore, the study aimed to investigate 
the influence of academic stressors on mental health and the mediating effect of 
social support, social well-being, and self-identity among college students 
during the outbreak of COVID-19. With 900 college students as subjects, using 
the college students' academic stressors questionnaire, social support 
questionnaire, social well-being scale, self-identity scale, and depression 
anxiety stress scales (DASS-21), the results showed that: (1) academic stressors 
had a significantly negative correlation with social support, social well-being, 
and self-identity while having a significantly positive correlation with mental 
health; (2) academic stressors could positively predict mental health; (3) this 
effect was mediated by social support, social well-being, and self-identity; (4) 
work stressor was an important stressor during COVID-19, and had the same role 
as academic stressors in the structural equation model. The results of this 
study suggested that adjusting the academic stressors or work stressors of 
college students and enhancing social support could improve social well-being 
and self-identity, and might effectively protect their mental health under the 
COVID-19 pandemic environment.

Copyright © 2022 Li, Yang, Zhou, Zhao and Liu.

DOI: 10.3389/fpubh.2022.917581
PMCID: PMC9558906
PMID: 36249242 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1413. Front Public Health. 2022 Sep 29;10:1010720. doi: 10.3389/fpubh.2022.1010720. 
eCollection 2022.

COVID-19-related stigma and its relationship with mental wellbeing: A 
cross-sectional analysis of a cohort study in Japan.

Sawaguchi E(1), Nakamura S(1)(2), Watanabe K(2)(3), Tsuno K(1), Ikegami H(2)(4), 
Shinmura N(2)(4), Saito Y(2)(5), Narimatsu H(1)(2)(3).

Author information:
(1)Graduate School of Health Innovation, Kanagawa University of Human Services, 
Kawasaki, Japan.
(2)Cancer Prevention and Control Division, Kanagawa Cancer Center Research 
Institute, Yokohama, Japan.
(3)Department of Genetic Medicine, Kanagawa Cancer Center, Yokohama, Japan.
(4)Hygeia Communication General Incorporated Association, Kawasaki, Japan.
(5)Faculty of Sport Management, Nippon Sport Science University, Yokohama, 
Japan.

OBJECTIVE: Social stigma related to coronavirus disease (COVID-19), i. e., 
COVID-19 stigma, forms a burden on people socially, economically, and mentally. 
This study assessed COVID-19 stigma using a scale to identify a population 
likely to exhibit higher prejudice against COVID-19 itself as well as those 
infected with COVID-19.
METHODS: We adapted and modified the Cancer Stigma Scale to assess COVID-19 
stigma and used it as the baseline survey of a cohort study in Japan. The 
questionnaire was disseminated to 1,573 participants (51.7% men) between 
December 2020 and March 2021. The questionnaire items included the infection 
status of individuals close to the respondent and their preventive behaviors 
related to COVID-19, quality of life (QOL; using the EuroQoL 5-Dimension 5-Level 
[EQ-5D-5L]), and psychological distress (using the 6-item Kessler Psychological 
Distress Scale [K6]). Exploratory and confirmatory factor analyses were 
performed to validate the COVID-19 stigma scale, and we further used the 
structural equation modeling (SEM) to assess the relationship with QOL and 
psychological distress.
RESULTS: COVID-19 stigma was calculated for the 257 (16.3%) participants who 
responded to the questionnaire. The mean age (standard deviation) was 54.5 
(14.4) years, and 50.2% were men. Factor analysis revealed a five-factor model: 
Awkwardness (feeling uncomfortable being with a person infected before), 
Severity (fear of not being able to return to normal after infection), Avoidance 
(attitude of avoiding infected persons), Policy Opposition (expecting more 
public funding investment), and Personal Responsibility (believing that infected 
persons themselves are responsible for their infection). Participants > 70 years 
had the highest scores among other age groups considering all factors except for 
Policy Opposition. Standardized coefficients in SEM for COVID-19 stigma (latent 
variable) was highest for Severity (beta = 0.86). Regression coefficients of 
COVID-19 stigma on K6 and QOL were 0.21 (95% confidence interval [CI] 
0.074-0.342) and -0.159 (95% CI -0.295-0.022), respectively.
CONCLUSION: People aged ≥ 70 years are more likely to exhibit COVID-19 stigma. 
Additionally, the results indicate that COVID-19 stigma impacts QOL and 
psychological distress.

Copyright © 2022 Sawaguchi, Nakamura, Watanabe, Tsuno, Ikegami, Shinmura, Saito 
and Narimatsu.

DOI: 10.3389/fpubh.2022.1010720
PMCID: PMC9558281
PMID: 36249227 [Indexed for MEDLINE]

Conflict of interest statement: Authors HI and NS are members of Hygeia 
Communication General Incorporated Association. The remaining authors declare 
that the research was conducted in the absence of any commercial or financial 
relationships that could be construed as a potential conflict of interest.


1414. Front Public Health. 2022 Sep 29;10:968789. doi: 10.3389/fpubh.2022.968789. 
eCollection 2022.

Determinants of emotional distress in neonatal healthcare professionals: An 
exploratory analysis.

Nazzari S(1), Grumi S(2), Ciotti S(3)(4), Merusi I(3)(4), Provenzi L(1)(2), 
Gagliardi L(3)(4).

Author information:
(1)Department of Brain and Behavioral Sciences, University of Pavia, Pavia, 
Italy.
(2)Developmental Psychobiology Lab, IRCCS Mondino Foundation, Pavia, Italy.
(3)Division of Neonatology and Pediatrics, Ospedale Versilia, Viareggio, Italy.
(4)AUSL Toscana Nord Ovest, Pisa, Italy.

BACKGROUND: High levels of mental health problems have been consistently 
reported among neonatal healthcare professionals. While studies suggest that 
personality, coping strategies and safety culture might contribute to the 
psychological wellbeing of healthcare professionals, they have not been 
systematically investigated in low-risk (i.e., neonatal wards; NWs) and 
high-risk (i.e., neonatal intensive care units; NICUs) neonatal contexts. The 
current study investigated potential predictors of professionals' emotional 
distress and whether they differ according to the work setting (i.e., NICUs vs. 
NWs).
METHODS: Healthcare professionals (N = 314) from 7 level-3 (i.e., NICUs) and 6 
level-2 (i.e., NWs) neonatal units in Tuscany were included. Emotional distress 
(i.e., anxiety, depression, psychosomatic, post-traumatic stress symptoms and 
emotional exhaustion), Behavioral Inhibition System (BIS) and Behavioral 
Approach System (BAS) sensitivity, coping strategies and safety culture were 
assessed through well-validated, self-reported questionnaires.
RESULTS: Greater BIS/BAS sensitivity, avoidance coping strategies and a 
sub-dimension of safety culture (i.e., stress recognition) were significantly 
associated with greater risk of emotional distress, whereas job satisfaction 
emerged as a protective factor. Three specific profiles of professionals in term 
of personality, coping and safety culture were identified and further predicted 
emotional distress. Neonatal wards and NICUs personnel presented different 
associations between personality, coping and safety culture.
CONCLUSION: These findings highlighted significant modifiable contributors of 
neonatal mental healthcare professionals' wellbeing. Institutional initiatives 
that target these factors and, particularly, job satisfaction may promote 
professionals' emotional wellbeing and thus improve caring processes.

Copyright © 2022 Nazzari, Grumi, Ciotti, Merusi, Provenzi and Gagliardi.

DOI: 10.3389/fpubh.2022.968789
PMCID: PMC9556841
PMID: 36249219 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1415. Work. 2023;74(1):31-45. doi: 10.3233/WOR-220136.

The effects of the COVID-19 pandemic on the mental health of workers and the 
associated social-economic aspects: A narrative review.

Wang H(1), Farokhnia F(2), Sanchuli N(3).

Author information:
(1)School of Tourism, Hainan University, Haikou, China.
(2)Department of Pediatrics, Kermanshah University of Medical Sciences, 
Kermanshah, Iran.
(3)Department of Education Sciences, Islamic Azad University of Gorgan, Gorgan, 
Iran.

BACKGROUND: The COVID-19 pandemic has struck nations worldwide, pushing 
worldwide health and socio-economic systems to extreme limits. Upon exposure to 
an exceeding number of patients and supply shortages, the resilience of 
healthcare resources has been broadly challenged.
OBJECTIVE: We will firstly discuss the mental health turmoil during the COVID-19 
pandemic as the primary focus of this study and delve into the mental health 
repercussions among the workforce. Also, we debate the risk factors, 
particularly highlighting the impact of social behaviors and media exposure. We 
examine the pandemic's impact on occupational health services. Secondly, we 
thoroughly discuss the effect of socio-economic and race disparities in the 
COVID-19 contraction and the related psychologic sequelae. Economic outcomes are 
also highlighted, particularly alterations in poverty rates and occupational 
sectors.
METHODS: Peer-reviewed reports were extracted through Embase, PubMed, and Google 
Scholar until June 2022.
RESULTS: A constellation of untoward spillover effects of the pandemic, 
including dramatic changes in public and workplace environments, enduring 
curfew, and low wages, have put socio-economic aspects of daily life under 
exuberant strain. Indeed, occupational and public health stakeholders presume a 
coinciding social crisis to occur, provided the pandemic's implications on 
socioeconomics and psychological wellbeing are not addressed well with 
evidence-based approaches and peer services.
CONCLUSION: Evaluating the socio-economic and mental health impact is imperative 
to cope with the pandemic. Also, we should assess the predisposing and 
protecting factors in a broad array of life aspects associated with COVID-19.

DOI: 10.3233/WOR-220136
PMID: 36245355 [Indexed for MEDLINE]


1416. J Health Care Poor Underserved. 2022;33(3):1275-1290. doi: 
10.1353/hpu.2022.0112.

Effects of the COVID-19 Pandemic on Black Veterans' Mental Health: A Qualitative 
Investigation.

Matthias MS, Adams J, Burgess DJ, Daggy J, Gowan TM, Perkins AJ, Eliacin J.

Although the disproportionate effects of the COVID-19 pandemic on Black 
Americans are well-documented, we know little about its effects on their 
day-to-day lives and sense of wellbeing, especially for those who have served in 
the military. We conducted qualitative interviews with 21 Black veterans to 
understand their experiences with the pandemic and administered questionnaires 
about mental health and pandemic impact. Questionnaires indicated mild 
depression, moderate anxiety and loneliness, and pandemic effects on social 
support and health care. Interviews revealed that heightened anxiety and stress 
were driven by not trusting others to take the pandemic seriously, workplace 
anxiety, comorbidities, and the pandemic's pronounced effects on Black 
communities. Participants shared insights into these effects, including lack of 
caution on the part of some and the role of systemic racism. Findings enhance 
our understanding of how Black veterans have experienced the pandemic and may 
have important implications for other underserved groups.

DOI: 10.1353/hpu.2022.0112
PMID: 36245163 [Indexed for MEDLINE]


1417. Rural Remote Health. 2022 Oct;22(4):7231. doi: 10.22605/RRH7231. Epub 2022 Oct 
15.

Impact of COVID-19 on lifestyle and mental wellbeing in a drought-affected rural 
Australian population.

Chan K(1), Xue H(2), Carlson J(3), Gray JM(4), Bailey J(5), Vines R(6).

Author information:
(1)School of Medicine, Western Sydney University, Building 30 Goldsmith Avenue, 
Campbelltown, NSW, Australia; and Bathurst Rural Clinical School, Western Sydney 
University, Bathurst, NSW, Australia kevindotchan@gmail.com.
(2)School of Medicine, Western Sydney University, Building 30 Goldsmith Avenue, 
Campbelltown, NSW, Australia; and Bathurst Rural Clinical School, Western Sydney 
University, Bathurst, NSW, Australia houston.xue@health.nsw.gov.au.
(3)School of Medicine, Western Sydney University, Building 30 Goldsmith Avenue, 
Campbelltown, NSW, Australia; and Bathurst Rural Clinical School, Western Sydney 
University, Bathurst, NSW, Australia jack@dcarlson.com.au.
(4)School of Medicine, Western Sydney University, Building 30 Goldsmith Avenue, 
Campbelltown, NSW, Australia; and Bathurst Rural Clinical School, Western Sydney 
University, Bathurst, NSW, Australia jonahgray98@gmail.com.
(5)School of Medicine, Western Sydney University, Building 30 Goldsmith Avenue, 
Campbelltown, NSW, Australia; and Bathurst Rural Clinical School, Western Sydney 
University, Bathurst, NSW, Australia jannine.bailey@westernsydney.edu.au.
(6)School of Medicine, Western Sydney University, Building 30 Goldsmith Avenue, 
Campbelltown, NSW, Australia; and Bathurst Rural Clinical School, Western Sydney 
University, Bathurst, NSW, Australia r.vines@westernsydney.edu.au.

INTRODUCTION: The SARS-CoV-2 (COVID-19) pandemic has caused unprecedented social 
and economic disruption, accompanied by the enactment of a multitude of public 
health measures to restrain disease transmission. These public health and social 
measures have had a considerable impact on lifestyle and mental wellbeing, which 
has been well studied with metropolitan populations. However, limited literature 
concerning such effects on a selectively rural population is presently 
available. Additionally, the use of a standardised scoring system for lifestyle 
may be valuable for an overall assessment of lifestyle that may be incorporated 
into clinical practice.
METHODS: This study examined the associations between psychological distress and 
changes in SNAPS health behaviours (smoking, nutrition, alcohol, physical 
activity, sleep) since the onset of COVID-19 in Australia. A cross-sectional 
anonymous survey was distributed online to adults in the Western New South Wales 
Primary Health Network in August 2020 and included measures of psychological 
distress, income, disposition and lifestyle factors during the pandemic as well 
as changes to lifestyle due to COVID-19. A novel Global Lifestyle Score (GLS) 
was generated as a holistic assessment of lifestyle across multiple domains.
RESULTS: The survey was completed by 304 individuals (modal age group 45-54 
years, 86.8% female). High distress on the Kessler-5 scale was present in over 
one-third of participants (n=95, 33.7%). Detrimental change was reported for 
sleep (22.7%), nutrition (14.5%), alcohol (16.7%), physical exercise (34.0%) and 
smoking (24.7%) since the onset of the pandemic. Changes in sleep, nutrition, 
physical activity and smoking were associated with distress. Participants with a 
poor lifestyle (GLS) during the pandemic were significantly more distressed. 
Perceived COVID-19 impact was associated with high distress, drought impact and 
loss of income. Participants who reported negative impact from both COVID-19 and 
drought were significantly more distressed than those reporting a negative 
impact from drought alone or neither event.
CONCLUSION: High rates of distress among rural Australians during the COVID-19 
pandemic was linked to low GLS, worsening lifestyles and loss of income. Healthy 
lifestyle strategies should be considered by health professionals for the 
management of crisis-related distress. Further research may explore the impact 
of COVID-19 on a larger study population with a greater proportion of male 
participants and to examine the effect of modifying lifestyle factors in 
reducing distress in the context of a stressor such as this pandemic.

DOI: 10.22605/RRH7231
PMID: 36242783 [Indexed for MEDLINE]


1418. Eur J Oncol Nurs. 2022 Dec;61:102207. doi: 10.1016/j.ejon.2022.102207. Epub 2022 
Oct 2.

Impact of Covid-19 on lung cancer and mesothelioma specialist nurses: A survey 
of experiences and perceptions.

Hargreaves S(1), Clayton K(2), Creech L(3), Darlison L(4), Ejegi-Memeh S(5), 
Fenemore J(6), Gardiner C(5), Taylor B(5), Tod A(5).

Author information:
(1)Mesothelioma UK Research Centre, University of Sheffield, UK. Electronic 
address: sarah.hargreaves@sheffield.ac.uk.
(2)East Cheshire NHS Trust (UK), & LCNUK (Lung Cancer Nursing UK), UK.
(3)Mesothelioma, UK.
(4)University Hospitals of Leicester (UK), & Mesothelioma UK, UK.
(5)Mesothelioma UK Research Centre, University of Sheffield, UK.
(6)The Christie Hospital (Manchester, UK), and LCNUK (lung Cancer Nursing UK), 
UK.

PURPOSE: The covid-19 global pandemic has impacted on nurses who have rapidly 
adapted to new ways of working, and experienced negative impacts due to 
over-stretched services. Two surveys captured the experiences of lung cancer and 
mesothelioma specialist nurses in the United Kingdom (UK) in 2020, but the 
impact of later stages of the pandemic was unknown. This study aimed to explore 
the impact of covid-19 on lung Cancer and mesothelioma nurses since January 
2021, the second wave of the pandemic.
METHODS: An online cross-sectional survey with both open and closed questions 
explored the impact of covid-19 on ways of working and workload, quality of 
care, and health and wellbeing. The survey was open to UK based lung cancer and 
mesothelioma advanced or specialist nurses.
RESULTS: 85 nurses responded to the survey. The majority were Clinical Nurse 
Specialists, based in England. Respondents reported changes in ways of working 
due to redeployment, staff shortages, and home working. Widespread adoption of 
virtual working practices led to concerns of negative impacts. Perceived 
excessive workload impacted on care with two-thirds of the sample (57, 67%) 
reporting they had been unable to provide the same quality of care to patients. 
Impacts on nurses' health and wellbeing were reported with two-thirds of the 
sample (56, 66%) reporting a deterioration in emotional wellbeing and mental 
health. Coping mechanisms employed included online team support to share 
experiences and increased uptake of exercise; however, impacts on lifestyle and 
access to coping mechanisms varied.
CONCLUSION: Nurses have stepped up to the challenges of the pandemic with 
teamwork and innovation, but pressure arising from the pandemic and high 
workloads led to negative impacts on wellbeing. The authors have provided 
recommendations to improve patient care and support the wellbeing of nurses, 
which will be key to a resilient workforce living with covid-19. Whilst this 
study focussed on lung cancer and mesothelioma specialists, the findings have 
wider implications for other cancer specialties.

Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.ejon.2022.102207
PMCID: PMC9526868
PMID: 36240682 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


1419. PLoS One. 2022 Oct 14;17(10):e0275486. doi: 10.1371/journal.pone.0275486. 
eCollection 2022.

Impact of the COVID-19 pandemic on community-dwelling older adults: A 
longitudinal qualitative study of participants from the Hertfordshire Cohort 
Study.

Bloom I(1)(2), Zhang J(1)(2), Hammond J(1), Bevilacqua G(1), Lawrence W(1)(2), 
Ward KA(1)(2), Cooper C(1)(3), Dennison EM(1)(4).

Author information:
(1)MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, 
United Kingdom.
(2)NIHR Southampton Biomedical Research Centre, University of Southampton and 
University Hospital Southampton NHS Foundation Trust, Southampton, United 
Kingdom.
(3)NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, 
United Kingdom.
(4)Victoria University of Wellington, Wellington, New Zealand.

BACKGROUND: Older adults have been especially vulnerable to adverse effects from 
the COVID-19 pandemic including higher mortality and more severe disease 
complications. At the same time, social isolation, malnutrition and physical 
inactivity are serious concerns among older adults. The pandemic and associated 
restrictions may serve to exacerbate these issues, presenting increased risks to 
physical and mental health. The aims of this qualitative study were: i) to 
explore how community-living older people in the UK experienced the first wave 
of the COVID-19 pandemic, specifically how it impacted their well-being and 
associated health behaviours; ii) to explore how older people's experiences and 
behaviours changed over time throughout the first wave.
METHODS: Qualitative data were collected by conducting serial telephone 
interviews, with an interval of approximately three months. Participants were 
from the Hertfordshire Cohort Study, all aged over 80 years. Discussions were 
audio-recorded, information related to the COVID-19 pandemic was transcribed 
verbatim and transcripts analysed thematically. Interviews were conducted from 
March to October 2020.
RESULTS: Data for twelve participants (7 men and 5 women) from a total of 35 
interviews were used, comprising two or three timepoints per participant. 
Analysis identified five overarching themes: 1) shopping strategies and food 
accessibility, 2) limitations on activities and going out, 3) disruption to 
healthcare, 4) social and psychological repercussions, and 5) coping strategies. 
Findings highlight challenges associated with accessing shops, healthcare, and 
usual activities due to pandemic-related restrictions. Longitudinal findings 
showed that for some, the ongoing pandemic and related restrictions appeared to 
aggravate mental health issues (low mood, anxiety) over time, as well as greater 
feelings of isolation or loneliness, reduced activity and functional 
limitations; this was despite some relaxation of restrictions later on. Coping 
strategies used by participants included finding ways to keep busy and to do 
physical activity safely, maintaining social contact remotely, and having an 
optimistic or positive outlook, a 'do what you can' attitude.
CONCLUSIONS: Interventions are likely to be needed in the wake of the COVID-19 
pandemic to support health behaviours, such as increasing physical activity, 
social engagement and improving mental health among community-living older 
adults.

DOI: 10.1371/journal.pone.0275486
PMCID: PMC9565385
PMID: 36240147 [Indexed for MEDLINE]

Conflict of interest statement: IB, JZ, JH, GB, WTL and KAW have no conflict of 
interest. EMD has received consultancy or speaker fees from Lilly, UCB, Pfizer 
and Viatris outside of the submitted work. CC has received lecture fees and 
honoraria from Amgen, Danone, Eli Lilly, GSK, Kyowa Kirin, Medtronic, Merck, 
Nestlé, Novartis, Pfizer, Roche, Servier, Shire, Takeda and UCB outside of the 
submitted work. This does not alter our adherence to PLOS ONE policies on 
sharing data and materials.


1420. Dementia (London). 2023 Jan;22(1):5-27. doi: 10.1177/14713012221124995. Epub 
2022 Oct 14.

Prevalence, causes, and consequences of moral distress in healthcare providers 
caring for people living with dementia in long-term care during a pandemic.

Haslam-Larmer L(1), Grigorovich A(1)(2), Quirt H(1), Engel K(1), Stewart S(1), 
Rodrigues K(1), Kontos P(1)(3), Astell A(1)(4)(5), McMurray J(6), Levy A(6), 
Bingham KS(7), Flint AJ(7), Maxwell C(8), Iaboni A(1)(9).

Author information:
(1)KITE Research Institute, University Health Network, 7961Toronto.
(2)Recreation and Leisure Studies, 104266Brock University, St. Catherines, ON, 
Canada.
(3)Dalla Lana School of Public Health, 7961University of Toronto, Toronto, ON, 
Canada.
(4)Departments of Occupational Sciences & Occupational Therapy and Psychiatry, 
7938University of Toronto, Toronto, ON, Canada.
(5)School of Psychology & Clinical Language Sciences, University of Reading, UK.
(6)192321Lazaridis School of Business & Economics Wilfrid Laurier University, 
Brantford, ON, Canada.
(7)Department of Psychiatry, Center of Mental Health, Temerty Faculty of 
Medicine, 7938University of Toronto, Toronto, ON, Canada.
(8)Schools of Pharmacy and Public Health Sciences, 8430University of Waterloo, 
Waterloo, ON, Canada.
(9)Department of Psychiatry, Temerty Faculty of Medicine, 7938University of 
Toronto, Toronto, ON, Canada.

Healthcare providers caring for people living with dementia may experience moral 
distress when faced with ethically challenging situations, such as the inability 
to provide care that is consistent with their values. The COVID-19 pandemic 
produced conditions in long-term care homes (hereafter referred to as 'care 
homes') that could potentially contribute to moral distress. We conducted an 
online survey to examine changes in moral distress during the pandemic, its 
contributing factors and correlates, and its impact on the well-being of care 
home staff. Survey participants (n = 227) working in care homes across Ontario, 
Canada were recruited through provincial care home organizations. Using a 
Bayesian approach, we examined the association between moral distress and staff 
demographics and roles, and characteristics of the long-term care home. We 
performed a qualitative analysis of the survey's free-text responses. More than 
80% of care home healthcare providers working with people with dementia reported 
an increase in moral distress since the start of the pandemic. There was no 
difference in the severity of distress by age, sex, role, or years of 
experience. The most common factors associated with moral distress were lack of 
activities and family visits, insufficient staffing and high turnover, and 
having to follow policies and procedures that were perceived to harm residents 
with dementia. At least two-thirds of respondents reported feelings of physical 
exhaustion, sadness/anxiety, frustration, powerlessness, and guilt due to the 
moral distress experienced during the pandemic. Respondents working in 
not-for-profit or municipal homes reported less sadness/anxiety and feelings of 
not wanting to go to work than those in for-profit homes. Front-line staff were 
more likely to report not wanting to work than those in management or 
administrative positions. Overall, we found that increases in moral distress 
during the pandemic negatively affected the well-being of healthcare providers 
in care homes, with preliminary evidence suggesting that individual and systemic 
factors may intensify the negative effect.

DOI: 10.1177/14713012221124995
PMCID: PMC9574526
PMID: 36240074 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared the following potential 
conflicts of interest with respect to the research, authorship, and/or 
publication of this article: The author A.J. Flint discloses grant support from 
the U.S. National Institutes of Health, Patient-Centered Outcomes Research 
Institute, Canadian Institutes of Health Research, Brain Canada, Ontario Brain 
Institute, AGE-WELL, and the Canadian Foundation for Healthcare Improvement. The 
remaining authors have no conflicts of interest to report.


1421. Front Public Health. 2022 Sep 27;10:992658. doi: 10.3389/fpubh.2022.992658. 
eCollection 2022.

Mental health impact of COVID-19 on Saudi families and children with special 
educational needs and disabilities in Saudi Arabia: A national perspective.

Alenezi S(1)(2)(3), Temsah MH(4), Alyahya AS(5), Almadani AH(1)(2)(3), 
Almarshedi A(6), Algazlan MS(2), Alnemary F(7), Bashiri FA(8), Alkhawashki 
SH(1)(2)(3), Altuwariqi MH(1)(2)(3), Alsedrani R(7), Alkhiri A(9), Alarabi 
M(1)(2)(3).

Author information:
(1)Department of Psychiatry, College of Medicine, King Saud University, Riyadh, 
Saudi Arabia.
(2)Department of Psychiatry, King Saud University Medical City, King Saud 
University, Riyadh, Saudi Arabia.
(3)SABIC Psychological Health Research and Applications Chair, Department of 
Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
(4)Pediatric Department, King Saud University Medical City, King Saud 
University, Riyadh, Saudi Arabia.
(5)Department of Psychiatry, Eradah Complex for Mental Health, Riyadh, Saudi 
Arabia.
(6)Psychiatry Department, Prince Sultan Military Medical City, Riyadh, Saudi 
Arabia.
(7)Autism Center of Excellence, Riyadh, Saudi Arabia.
(8)Pediatric Neurology Division, Department of Pediatrics, College of Medicine, 
King Saud University, Riyadh, Saudi Arabia.
(9)Department of Mental Health, Al Qunfudah General Hospital, Al Qunfudah, Saudi 
Arabia.

INTRODUCTION: The COVID-19 pandemic revealed a multidimensional impact on mental 
health due to health concerns, social distancing and lockdowns, job loss, and 
limits in institutional support. Accordingly, COVID-19 may disproportionally 
impact families with special educational needs and disabilities (SEND) due to 
the already high prevalence of mental health conditions in children with SEND 
and their parents. Hence, it is essential to determine the short-term impact of 
the pandemic on the mental health of families with SEND to identify their 
ongoing health, including psychological wellbeing and support needs. The current 
study examines the anxiety level and concerns of children with SEND and their 
parents living in Saudi Arabia.
METHODOLOGY: A cross-sectional national study design was utilized as a part of 
an international consortium using an online Arabic survey. Data were collected 
from the Ministry of Human Resources and Social Development beneficiaries from 
May to July 2020. The sample consisted of 1,848 parents of children with SEND 
aged between 1 and 18 years (mean = 9.66; SD = 4.31). A descriptive and 
bivariant analysis is reported.
RESULTS: Parental worries on all those concerns when the pandemic started were 
significantly higher than before the pandemic, p < 0.050. Parental-perceived 
general anxiety had risen significantly across time, p < 0.001, and their 
perceived anxiety when the pandemic started exceeded their anxiety before the 
pandemic, p < 0.001. The general anxiety of children with SEND had risen 
significantly across time (from before the pandemic to when it had started to 
during the pandemic), p < 0.001. The children's general worries at the start of 
the pandemic had correlated significantly and positively with their anxiety, 
adaptive, maladaptive, and coping efficacies, and parental anxiety scores, p < 
0.010 each.
CONCLUSION: Anxiety levels were high in SEND and their caregivers before and 
during COVID-19. At the start of the pandemic, the anxiety, adaptive, 
maladaptive, coping efficacies, and parental anxiety scores of children with 
SEND were significantly and favorably correlated. These findings support the 
notion of SEND-specific anxiety and patterns of coping in SEND and their 
caregivers. The notion also attests to the institutional support required for 
this specifically vulnerable population during epidemics.

Copyright © 2022 Alenezi, Temsah, Alyahya, Almadani, Almarshedi, Algazlan, 
Alnemary, Bashiri, Alkhawashki, Altuwariqi, Alsedrani, Alkhiri and Alarabi.

DOI: 10.3389/fpubh.2022.992658
PMCID: PMC9551570
PMID: 36238239 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1422. Int J Environ Res Public Health. 2022 Oct 9;19(19):12908. doi: 
10.3390/ijerph191912908.

Incorporating the Co-Creation Method into Social Innovation Design to Promote 
Intergenerational Integration: A Case Study of a Public Square.

Wu J(1), Zhang L(1), Ren X(1).

Author information:
(1)School of Design, Jiangnan University, Wuxi 214000, China.

With the COVID-19 pandemic sweeping the world, there is an increased focus on 
intergenerational relationships, community mental health issues, and well-being 
in community contexts. This paper assesses the effectiveness of a co-creation 
approach for intergenerational integration at the theoretical level. The study 
used a collaborative co-creation design method in the community design process 
to explore whether the participation of community residents of all ages in 
addressing community issues promoted communication and alleviated stereotyping 
between the various generations. This study was conducted in Shanghai's Hongqiao 
New Village square, where we conducted participatory research and co-creation 
workshops in response to the demand for the use of the public space as a 
location for social interactions. The results showed that intervention in 
community creation through collaborative design is conducive to promoting 
friendly relations among different age groups, forming a sense of social 
security and thus enhancing social well-being. Finally, this paper combines 
practical cases and theoretical models of collaborative co-creative design 
approaches to promote the intergenerational integration of communities and is 
summarized from the input and output parts as well as the influencing factors 
and constraints of the collaborative co-creative. In addition, it provides new 
ideas on how to improve intergenerational relationships and form a positive and 
sustainable community mental health environment in the future.

DOI: 10.3390/ijerph191912908
PMCID: PMC9564664
PMID: 36232208 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1423. Int J Environ Res Public Health. 2022 Oct 8;19(19):12882. doi: 
10.3390/ijerph191912882.

Families, Schools, and the Longitudinal Changes in Psychological Distress among 
College Students during the First Year of the COVID-19 Pandemic: Evidence from a 
National Panel Survey in China.

Zhu F(1), Zhang Y(2), Li Q(1), Xu Y(1), Liu B(3).

Author information:
(1)Department of Sociology, School of Philosophy and Social Development, 
Shandong University, Jinan 250100, China.
(2)Department of Sociology, School of Humanities, Social Sciences & Law, Harbin 
Institute of Technology, Harbin 150001, China.
(3)Institute of Sociology, Chinese Academy of Social Science, Beijing 100732, 
China.

BACKGROUND: The psychological well-being of students in higher education has 
become an increasingly important concern in the context of the COVID-19 
pandemic. The majority of prior studies were cross-sectional and thereby failed 
to capture the individual changes in mental health over time. Moreover, few 
studies have explored whether and how socioeconomic and education backgrounds 
could be related to college students' mental health changes. This study aimed to 
fill these gaps.
METHODS: Data were from a nationwide, two-wave panel survey of college students 
in China. Baseline information was collected in November 2019, i.e., before the 
outbreak of the COVID-19 epidemic in China. A follow-up survey was conducted in 
November and December 2020, when the epidemic was effectively contained in 
mainland China. In both waves, mental health was assessed with the 10-item 
Kessler Psychological Distress Scale (K10). The between-wave changes in 
psychological distress were measured and categorized.
RESULTS: Overall, 13.5% of students experienced at least a 
one-standard-deviation increase in psychological distress over the one-year 
follow-up. Results from both bivariate and multivariable analysis showed that 
this marked distress increase was more pronounced among vocational college 
students (vs. academic undergraduate and postgraduate students) and those with 
lower levels of academic performance. In contrast, family socioeconomic status 
(as measured by parental education, family economic condition, and current 
residence) was not associated with distress changes over time.
CONCLUSIONS: These findings highlight the importance of the educational 
disparities within the higher education system in understanding the mental 
health dynamics of college students in the context of the COVID-19 pandemic.

DOI: 10.3390/ijerph191912882
PMCID: PMC9566168
PMID: 36232181 [Indexed for MEDLINE]

Conflict of interest statement: We declare that the research was conducted in 
the absence of any commercial or financial relationships that could be construed 
as a potential conflict of interest.


1424. Int J Environ Res Public Health. 2022 Oct 5;19(19):12751. doi: 
10.3390/ijerph191912751.

Examining the Relationship between Paternal Mental Health and Informal Support 
Networks: Reflections on the Impact of the COVID-19 Pandemic.

Gheyoh Ndzi E(1), Holmes A(1).

Author information:
(1)York Business School, York St John University, York YO31 7EX, UK.

Paternal mental health remains an under-researched area in the UK. Consequently, 
father-focused formal and informal support provisions fail to address the 
complex emotional and psychological wellbeing needs of fathers. Drawing on data 
from twenty semi-structured interviews with fathers in the York area, this study 
seeks to better understand how access to and participation in informal support 
networks is influenced by gendered perceptions and the impact hegemonic 
perceptions of masculinity have on fathers' access to support prior and during 
the COVID-19 pandemic. The findings demonstrate that fathers internalise 
stereotypical masculine tropes, such as stoicism, which prevent them from 
actively seeking support. While fathers value informal support network, they 
generally struggle to engage in mental health talks. The COVID-19 lockdown 
exacerbated fathers' struggles to access informal support or prioritise their 
mental health. Fathers felt the pandemic presented a unique challenge that only 
people that became parents at the time understood. This meant that fathers could 
not rely on their parents or other parents who did not have similar experiences 
of the COVID-19 pandemic. This paper aims at challenging structural and cultural 
barriers that inhibit fathers' participation in informal support networks, and 
to promote more meaningful, supportive engagement with peer groups.

DOI: 10.3390/ijerph191912751
PMCID: PMC9566537
PMID: 36232050 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1425. Int J Environ Res Public Health. 2022 Oct 2;19(19):12602. doi: 
10.3390/ijerph191912602.

Validation of the Hungarian Version of the COVID Stress Scale (CSS-H).

Pálvölgyi Á(1), Morvay-Sey K(2), Ács P(2), Paár D(2).

Author information:
(1)Doctoral School of Health Sciences, Faculty of Health Sciences, University of 
Pécs, Vörösmarty u.4., 7621 Pécs, Hungary.
(2)Institute of Physiotherapy and Sport Sciences, Faculty of Health Sciences, 
University of Pécs, Vörösmarty u.3., 7621 Pécs, Hungary.

(1) Background: The COVID-19 pandemic is unprecedented and has affected every 
social class. The prevalence of moderate-to-severe stress and anxiety levels in 
the general population was reported to be 25%. This study aimed to describe the 
validation of the Hungarian version of the COVID Stress Scale. (2) Methods: The 
research study was a cross-section validation study with a representative sample 
(N = 1200) and a non-representative student sample (N = 350). The translation 
procedure was a four-step procedure. The interviewers conducted the data 
collection. (3) Results: The reliability of the Hungarian CSS was assessed using 
Cronbach's alpha. Convergent validity was evaluated by correlating the CSS with 
the PSS and WHO-WBI5. The Cronbach's alpha coefficient of the CSS-H factors was 
between 0.844 and 0.907 (representative sample) and between 0.878 and 0.936 
(student sample), which qualified as very good. The reliability of the internal 
consistency was good for all six factors in both samples. The CSS-H total and 
all-domain scores significantly and positively correlated with the PSS total 
score and negatively correlated with well-being. (4) Conclusions: The Hungarian 
COVID Stress Scale is a valid, reliable instrument to measure COVID-19-related 
distress in the Hungarian population.

DOI: 10.3390/ijerph191912602
PMCID: PMC9566199
PMID: 36231901 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1426. Int J Environ Res Public Health. 2022 Oct 2;19(19):12588. doi: 
10.3390/ijerph191912588.

Exploring the Mental, Social, and Lifestyle Effects of a Positive COVID-19 
Infection on Syrian Refugees in Jordan: A Qualitative Study.

Kheirallah KA(1), Ababneh BF(1), Bendak H(2), Alsuwaidi AR(3), Elbarazi I(4).

Author information:
(1)Department of Public Health, Medical School of Jordan, University of Science 
and Technology, Irbid 22110, Jordan.
(2)Clinical Psychology Department, Swinburne University of Technology, Melbourne 
3122, Australia.
(3)Department of Pediatrics, College of Medicine & Health Science, United Arab 
Emirates University, Al Ain P.O. Box 15551, United Arab Emirates.
(4)Institute of Public Health, College of Medicine & Health Science, United Arab 
Emirates University, Al Ain P.O. Box 15551, United Arab Emirates.

Migrants and refugees are among the vulnerable populations that suffered 
disproportionately from the COVID-19 crisis. However, their experiences with 
COVID-19 positivity status have not been investigated. This study explored the 
physical, mental, and psychosocial impacts of a positive COVID-19 diagnosis on 
Syrian refugees living in Jordan. Using a qualitative approach, twenty phone 
interviews were conducted with ten adult Syrian refugees living within the camp 
and ten refugees living in non-camp (host community) settings in Jordan. 
Follow-up interviews with five health care providers at a refugee camp were 
conducted to explore the services and support provided to the refugees with 
COVID-19 infection. The findings were thematically analyzed and grouped into 
major themes, subthemes, and emerging themes. Refugees living within camp 
settings had better access to testing, healthcare, and disease management and 
did not experience fear of being deported. Refugees in both settings suffered 
mental and psychosocial health impacts, social isolation, fear of death, and 
disease complications. COVID-19 infection has negatively impacted refugees' 
well-being with noticeable disparities across the different living conditions. 
Refugees living within host community settings may need more support for 
managing their condition, accessibility to free testing, as well as treatment 
and healthcare services.

DOI: 10.3390/ijerph191912588
PMCID: PMC9566814
PMID: 36231888 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1427. Int J Environ Res Public Health. 2022 Oct 1;19(19):12560. doi: 
10.3390/ijerph191912560.

Digital and Non-Digital Solidarity between Older Parents and Their Middle-Aged 
Children: Associations with Mental Health during the COVID-19 Pandemic.

Hwang W(1), Fu X(2), Brown MT(3)(4), Silverstein M(2)(4)(5).

Author information:
(1)Department of Human Development and Family Sciences, Texas Tech University, 
Lubbock, TX 79409, USA.
(2)Department of Human Development and Family Science, Syracuse University, 
Syracuse, NY 13244, USA.
(3)School of Social Work, Syracuse University, Syracuse, NY 13244, USA.
(4)Aging Studies Institute, Syracuse University, Syracuse, NY 13244, USA.
(5)Department of Sociology, Syracuse University, Syracuse, NY 13244, USA.

We incorporated intergenerational digital communication (frequency of texting, 
video call, and social media interaction) into the intergenerational solidarity 
paradigm and identified new types of intergenerational and digital solidarity 
with adult children among older parents during the COVID-19 pandemic. In 
addition, we examined whether those types are associated with older parents' 
mental health (depressive symptoms, psychological well-being, and self-esteem). 
We used the 2021/2022 wave of the Longitudinal Study of Generations (LSOG), and 
a sample of 519 older parents (mean age = 69 years). Latent class analysis 
identified four classes describing intergenerational and digital solidarity with 
adult children (distant-but-digitally connected, tight-knit-traditional, 
detached, and ambivalent). We found that older parents who had 
distant-but-digitally connected and tight-knit-traditional relationships with 
their adult children reported better mental health, compared to those who had 
detached and ambivalent relationships with their adult children during the 
COVID-19 pandemic. Our findings suggest that intergenerational digital 
communication should be considered as a digital solidarity in intergenerational 
solidarity paradigm, which is useful for measuring multidimension of 
intergenerational relationships within family members during and after the 
pandemic.

DOI: 10.3390/ijerph191912560
PMCID: PMC9566078
PMID: 36231855 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1428. Int J Environ Res Public Health. 2022 Sep 28;19(19):12365. doi: 
10.3390/ijerph191912365.

Variation in Public Trust, Perceived Societal Fairness, and Well-Being before 
and after COVID-19 Onset-Evidence from the China Family Panel Studies.

Wei C(1)(2), Li Q(3), Lian Z(4), Luo Y(4), Song S(5), Chen H(4)(6)(7).

Author information:
(1)Center for Studies of Education and Psychology of Ethnic Minorities in 
Southwest China, Southwest University, Chongqing 400715, China.
(2)Psychological Development Guidance Center, Guangxi University, Nanning 
530004, China.
(3)School of Psychology, Central China Normal University, Wuhan 430079, China.
(4)Faculty of Psychology, Southwest University, Chongqing 400715, China.
(5)School of Psychology, Shaanxi Normal University, Xi'an 710062, China.
(6)Key Laboratory of Cognition and Personality of Ministry of Education, 
Southwest University, Chongqing 400715, China.
(7)Chongqing Key Research Bases in Humanities and Social Sciences, Chongqing 
400715, China.

The sudden onset of the COVID-19 pandemic had a significant impact on all 
aspects of people's lives, including their attitudes toward society and 
psychological well-being. This study aimed to analyze the variation in public 
trust, perceived societal fairness, and well-being before and after the outbreak 
of the coronavirus disease 2019 (COVID-19). This study used two-wave 
longitudinal data of 15,487 residents (2018, T1; 2020, T2) derived from the 
Chinese Family Panel Studies (CFPS). A repeated measures analysis of variance 
showed that (a) public trust, perceived societal fairness, and subjective 
well-being significantly improved and (b) depression significantly increased. 
Linear regression analysis showed that education and socioeconomic status had a 
significant predictive effect on public trust, perceived societal fairness, and 
depression; socioeconomic status had a significant predictive effect on 
subjective well-being. This study provides evidence and direction for current 
social governance, namely, policy implementation and pandemic response.

DOI: 10.3390/ijerph191912365
PMCID: PMC9566506
PMID: 36231662 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no known 
competing financial interests or personal relationships that could have appeared 
to influence the work reported in this paper.


1429. Int J Environ Res Public Health. 2022 Sep 26;19(19):12186. doi: 
10.3390/ijerph191912186.

A Dyadic Pain Management Program for Community-Dwelling Older Adults with 
Chronic Pain: Study Protocol for a Cluster Randomized Controlled Trial.

Tse MMY(1), Ng SSM(2), Lou V(3), Lo R(4), Cheung DSK(5), Lee P(6), Tang ASK(7).

Author information:
(1)School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong 
Kong, China.
(2)Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 
Hong Kong, China.
(3)Department of Social Work and Social Administration, The University of Hong 
Kong, Hong Kong, China.
(4)Geriatrics and Palliative Medicine, Shatin Hospital, Hong Kong, China.
(5)School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.
(6)Department of Health Sciences, University of Leicester, Leicester LE1 7RH, 
UK.
(7)School of Nursing, Caritas Medical Centre, Hospital Authority, Hong Kong, 
China.

Community-dwelling older adults suffer from chronic pain. Pain negatively 
affects their physical and psychosocial wellbeing. The majority of pain 
management education and programs focus only on older adults. Their informal 
caregivers should be involved in pain management. A dyadic pain management 
program for reducing pain and psychological health symptoms, and improving pain 
self-efficacy, quality of life, and physical function in older adults is 
proposed for evaluation of its effectiveness. This will be a cluster randomized 
controlled trial. Community-dwelling older adults aged 60 or above and their 
informal caregivers will be recruited. The dyadic pain management program will 
be an eight-week group-based program. The participants in the experimental group 
will receive four weeks of center-based, face-to-face activities and four weeks 
of digital-based activities via a WhatsApp group. The control group will receive 
the usual care and a pain management pamphlet. Data will be collected at 
baseline, and at the eighth-week and sixteenth-week follow-up session. The 
outcome measurements will include pain intensity, pain self-efficacy, perceived 
quality of life, depression, anxiety, and stress levels. Data on the caregiver 
burden will be collected from the informal caregivers. Because of the COVID-19 
pandemic, all social activities have been suspended. In the near future, as the 
pandemic subsides, the dyadic pain management program will be launched to 
benefit community-dwelling older adults and informal caregivers and to reduce 
their pain and the care burden, respectively.

DOI: 10.3390/ijerph191912186
PMCID: PMC9565005
PMID: 36231486 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1430. Int J Environ Res Public Health. 2022 Sep 26;19(19):12172. doi: 
10.3390/ijerph191912172.

Multi-Impacts of Spatial Self-Policing during COVID-19: Evidence from a Chinese 
University.

Sun Y(1), Wang Z(1), Qiu Z(1), Zhou C(1).

Author information:
(1)College of Civil Engineering and Architecture, Zhejiang University, Hangzhou 
310058, China.

Current research has focused on the impacts of the COVID-19 pandemic on 
university students' physical and mental health conditions but has rarely 
examined the secondary effects caused by school management and prevention 
policies. Chinese universities generally took a self-policing strategy to 
address the COVID-19 pandemic. This study aimed to examine how the self-policing 
effect fluctuated during the pandemic, assessed from the perspective of 
university students. We collected monthly data from January 2020 to August 2022 
from Zhejiang University's online forum CC98 and analyzed the monthly frequency 
of keywords in the online posts' titles. The dataset covered five topics: 
pandemic situations, epidemic prevention policies, campus access control, campus 
space use, and emotional conditions. The results showed that university students 
have expressed concern about the pandemic over the past thirty-two months, which 
still has an unignorable influence on their lives and studies. They paid more 
attention to the epidemic prevention policies, which directly affected their 
social connections, spatial use, and psychological well-being. University 
students gradually questioned their duty to obey and showed impatience and 
resistance toward school self-policing management, especially during the second 
Omicron wave. Additionally, the findings investigated an introverted trend for 
university students living in a gated campus environment. In conclusion, we call 
for reflections on the current Chinese campus self-policing strategy to cope 
with future long-term and normalized pandemic situations. The concerns of 
university students should be taken into account as we move toward a 
post-COVID-19 world.

DOI: 10.3390/ijerph191912172
PMCID: PMC9564975
PMID: 36231473 [Indexed for MEDLINE]

Conflict of interest statement: The funders had no role in the design of the 
study; in the collection, analyses, or interpretation of data; in the writing of 
the manuscript; or in the decision to publish the results.


1431. Int J Environ Res Public Health. 2022 Sep 23;19(19):12038. doi: 
10.3390/ijerph191912038.

The Impact of Time Spent in Natural Outdoor Spaces on Children's Language, 
Communication and Social Skills: A Systematic Review Protocol.

Scott S(1)(2), Gray T(3), Charlton J(4), Millard S(5).

Author information:
(1)Shropshire Community Health NHS Trust, Coral House, Longbow Close, Shrewsbury 
SY1 3GZ, UK.
(2)School of Nursing and Midwifery, The University of Birmingham, Edgbaston, 
Birmingham B15 2TT, UK.
(3)Centre for Educational Research, Western Sydney University, Sydney, NSW 2751, 
Australia.
(4)School of Education, Newcastle University, Newcastle upon Tyne NE1 7RU, UK.
(5)Michael Palin Centre for Stammering, 13-15 Pine Street, London EC1R 0JG, UK.

There has been increasing interest over the past decade with regard to the 
health and wellbeing implications of time spent outdoors in nature for children. 
Universal systematic reviews of evidence report benefits to physical health, 
social-emotional mental health and wellbeing, cognition and academic learning. 
Internationally, there is indicative evidence to suggest outdoor engagement with 
nature may also impact children's language and communication skills, skills that 
are critical to development, education, social relationships and life 
opportunities. Yet, at present such evidence has not been synthesised. Despite 
evidence for the benefits of the outdoors, the amount of time children are 
spending outdoors is in rapid decline, and has been further exacerbated by the 
COVID-19 pandemic. Alongside this are increasing numbers of children starting 
primary education with significant speech, language and communication needs 
(SLCN) which remain persistent over time. With established wide-reaching 
benefits of nature to children's physical and mental health and psychological 
development, there is a need to further explore the more specific impacts of the 
natural environment on children's language, communication and social skills, 
which could provide a unique opportunity to consider nature as a universal 
public health intervention for SLCN. The current review will aim to synthesise 
existing qualitative and quantitative evidence of the impact of time spent in 
natural outdoor spaces on the language, communication and social skills of 
2-11-year-old children. Literature will be searched across seven databases and 
considered for inclusion against inclusion and exclusion criteria. Potential 
implications of the review include informing public health practice and policy 
for child development and education, informing priorities for speech, language, 
and communication interventions, and providing directions for future 
international research.

DOI: 10.3390/ijerph191912038
PMCID: PMC9566327
PMID: 36231338 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1432. Int J Environ Res Public Health. 2022 Sep 21;19(19):11929. doi: 
10.3390/ijerph191911929.

Climate Changes, Natural Resources Depletion, COVID-19 Pandemic, and 
Russian-Ukrainian War: What Is the Impact on Habits Change and Mental Health?

Barchielli B(1), Cricenti C(2), Gallè F(3), Sabella EA(4), Liguori F(5), Da 
Molin G(4), Liguori G(3), Orsi GB(6), Giannini AM(2), Ferracuti S(7), Napoli 
C(8).

Author information:
(1)Department of Dynamic, Clinical Psychology and Health, "Sapienza" University 
of Rome, Via degli Apuli 1, 00185 Rome, Italy.
(2)Department of Psychology, "Sapienza" University of Rome, Via dei Marsi 78, 
00185 Rome, Italy.
(3)Department of Movement Sciences and Wellbeing, University of Naples 
"Parthenope", Via Medina 40, 80133 Naples, Italy.
(4)Inter-University Research Centre "Population, Environment and Health", 
University of Bari Aldo Moro, Piazza Cesare Battisti 1, 70122 Bari, Italy.
(5)Family Psychotherapy Academy, Via Raffaele Morghen 181, 80129 Naples, Italy.
(6)Department of Public Health and Infectious Diseases, "Sapienza" University of 
Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy.
(7)Department of Human Neuroscience, "Sapienza" University of Rome, Piazzale 
Aldo Moro, 5, 00185 Rome, Italy.
(8)Department of Medical Surgical Sciences and Translational Medicine, 
"Sapienza" University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy.

Climate Change, Natural Resources Depletion, COVID-19, and Wars are some of the 
great challenges of our time. The consequences will affect psychological 
well-being and could have a harmful impact on mental health. This study aimed to 
assess the level of preoccupation and fears surrounding issues of the 
21st-century and the implication for psychological well-being of the general 
population from Central/Southern Italy among different age groups. A 
questionnaire that included sociodemographic characteristics, topics formulated 
ad-hoc about preoccupation, fears, habits, and willingness to change habits in 
the future related to the 21st-century challenges, and the Depression Anxiety 
Stress Scales 21 (DASS-21) was administered online. A sample of 1831 
participants (61% F; mean age 47.71 ± 17.30) was obtained. Results showed that 
young adults and older adults, respectively, reported greater and less 
psychological well-being. Young adults reported higher scores for preoccupation, 
changing habits, and willingness to change habits in the future, while older 
adults reported the lowest scores except for changing habits, also controlling 
for gender. Results for this variable, as well as correlations between the many 
variables described, rely on the specificity of age, and 21st-century 
challenges. Moreover, the main fears related to the 21st-century concerns were 
different based on both age and gender. In conclusion, the various stresses of 
the 21st-century discussed in this study have a relationship with personal 
well-being, and it is important to consider potential global mental health 
issues resulting from these stressors.

DOI: 10.3390/ijerph191911929
PMCID: PMC9565033
PMID: 36231229 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1433. Eur J Public Health. 2022 Nov 29;32(6):871-876. doi: 10.1093/eurpub/ckac150.

Mental wellbeing among Danish employees during the COVID-19 pandemic: results 
from a longitudinal study on the role of industry and working environment.

Nielsen MBD(1), Ekholm O(1), Møller SP(1), Ersbøll AK(1), Santini ZI(1), Grønbæk 
MK(1), Thygesen LC(1).

Author information:
(1)National Institute of Public Health, University of Southern Denmark, 
Copenhagen, Denmark.

BACKGROUND: The COVID-19 pandemic has had a profound impact on working life. 
Previous studies have primarily focused on the mental health and wellbeing of 
healthcare workers and are mostly based on cross-sectional data from 
non-representative samples. The aim of this study was to investigate mental 
wellbeing trajectories among employees from different industries, and to 
longitudinally identify factors that affect mental wellbeing during the COVID-19 
pandemic, including job insecurity, fear of COVID-19, working from home or being 
discharged with wage compensation and management quality.
METHODS: Baseline data were obtained from the Danish Health and Wellbeing Survey 
in 2019 (September-December), with follow-up in September-November 2020. We 
included 1995 respondents, who completed the questionnaire in both waves and 
were employed in 2020 and measured mental wellbeing using the Short 
Warwick-Edinburgh Mental Well-Being Scale.
RESULTS: Mental wellbeing declined among employees in all industries. Employees 
working from home and employees unsatisfied with management experienced a 
greater decline in mental wellbeing. We found no differences in mental wellbeing 
trajectories in relation to fear of infecting others or contracting COVID-19, 
job insecurity and being discharged with wage compensation.
CONCLUSIONS: Mental wellbeing declined among employees in all industries with no 
difference between industries. Employees working from home may have been 
particularly vulnerable, and the analyses show that managers play a key role in 
mitigating the negative consequences of the pandemic by ensuring adequate 
information and involvement of employees.

© The Author(s) 2022. Published by Oxford University Press on behalf of the 
European Public Health Association.

DOI: 10.1093/eurpub/ckac150
PMCID: PMC9619695
PMID: 36228122 [Indexed for MEDLINE]


1434. Int J Occup Med Environ Health. 2022 Dec 15;35(6):707-718. doi: 
10.13075/ijomeh.1896.01940. Epub 2022 Oct 13.

Mental well-being of healthcare workers in 2 hospital districts during the first 
wave of the COVID-19 pandemic in Finland: a cross-sectional study.

Rantanen N(1)(2), Lieslehto J(3), Oksanen LAH(1)(4), Oksanen SA(5), Anttila 
VJ(1)(6), Lehtonen L(1)(7), Geneid A(1)(4), Sanmark E(1)(4).

Author information:
(1)University of Helsinki, Helsinki, Finland (Faculty of Medicine).
(2)Helsinki University Hospital (HUS), Helsinki, Finland (Clinical Research 
Institute HUCH).
(3)University of Eastern Finland, Kuopio, Finland (Niuvanniemi Hospital).
(4)Helsinki University Hospital (HUS), Helsinki, Finland (Department of 
Otorhinolaryngology and Phoniatrics - Head and Neck Surgery).
(5)BeeHealthy, Helsinki, Finland.
(6)Helsinki University Hospital (HUS), Helsinki, Finland (HUS Inflammation 
Center).
(7)Helsinki University Hospital (HUS), Helsinki, Finland (HUS Diagnostic Center, 
HUSLAB).

OBJECTIVES: The COVID-19 pandemic has caused unseen pressure on healthcare 
systems in many countries, jeopardizing the mental well-being of healthcare 
workers. The authors aimed to assess the mental well-being of Finnish healthcare 
workers from 2 hospital districts (Helsinki University Hospital [HUS] and Social 
and Health Services in Kymenlaakso [Kymsote]) with differing COVID-19 incidence 
rates during the first wave of the COVID-19 pandemic in spring 2020.
MATERIAL AND METHODS: A total number of 996 healthcare workers (HUS N = 862, 
Kymsote N = 134) participated in this prospectively conducted survey study 
during summer 2020. Symptom criteria of self-reported mental health symptoms 
followed ICD-10 classification, excluding duration criteria. Participants were 
divided into symptom categories "often/sometimes", and "rarely/never". These 
groups were compared to sociodemographic factors and factors related to work, 
workload, and well-being.
RESULTS: The degree of mental health symptoms did not differ between the 2 
healthcare districts despite differing COVID-19 incidences (p = 1). The authors 
observed a significant relationship between self-reported diagnostic mental 
health symptoms and experiences of insufficient instructions for protection 
against COVID-19 (in HUS cohort p < 0.001), insufficient recovery from work (p < 
0.001), and subjective increased workload (p < 0.001).
CONCLUSIONS: The authors' results show the importance of well-planned and 
sufficient instructions for protection from SARS-CoV-2 for healthcare workers, 
indicating their need to feel safe and protected at work. The workload of 
healthcare workers should be carefully monitored to keep it moderate and ensure 
sufficient recovery. Sufficient control of the epidemic to keep the burden of 
the healthcare system low is vital for healthcare workers' well-being. Int J 
Occup Med Environ Health. 2022;35(6):708-18.

This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL 
license.

DOI: 10.13075/ijomeh.1896.01940
PMCID: PMC10464805
PMID: 36226940 [Indexed for MEDLINE]


1435. Gerontol Geriatr Educ. 2024 Jan 2;45(1):67-85. doi: 
10.1080/02701960.2022.2132241. Epub 2022 Oct 13.

"I loved interacting with this younger generation": Exploring the impact of a 
virtual service-learning program on social connectedness among older adults 
during the COVID-19 pandemic.

Beausoleil K(1), Garbarino J(1), Lewis LF(1).

Author information:
(1)Department of Nursing, University of Vermont, Burlington, VT, US.

Pervasive feelings of social isolation and loneliness have been longstanding 
among up to half of older adults, and have received increased attention amid the 
COVID-19 pandemic. Programs to address loneliness and facilitate meaningful 
connections are vital for physical and mental wellbeing. The purpose of this 
study was to explore older adults' experiences participating as volunteers in 
the Aging is Very Personal (AIVP) service-learning program in relation to 
feelings of social connectedness. As part of an interprofessional gerontology 
course, 112 undergraduate students interviewed 55 older adult volunteers via 
Zoom on the lived experience of aging. Older adult volunteers were surveyed on 
their experiences with the COVID-19 pandemic and the virtual AIVP program. Data 
were analyzed using descriptive statistics and reflexive thematic analysis of 
open-ended questions. Participants reported participation in AIVP had a positive 
effect on their mood (86%) and made them feel more socially connected (71%). Six 
themes summarized their experiences: reduced feelings of social isolation; 
brought me joy; created meaningful intergenerational relationships; gave me a 
sense of purpose; facilitated genuine engagement; and created important learning 
opportunities for future health professionals. Virtual AIVP was identified as a 
valuable program to improve mood and feelings of social connectedness.

DOI: 10.1080/02701960.2022.2132241
PMID: 36226696 [Indexed for MEDLINE]


1436. Front Public Health. 2022 Sep 26;10:998890. doi: 10.3389/fpubh.2022.998890. 
eCollection 2022.

Effect of physical activity and sedentary sitting time on psychological quality 
of life of people with and without disabilities; A survey from Saudi Arabia.

Zahra A(1), Hassan SU(2), Hassan MS(3), Parveen N(4), Park JH(5), Iqbal N(4), 
Khatoon F(6), Atteya MR(7).

Author information:
(1)Department of Family and Community Medicine, College of Medicine, University 
of Ha'il, Ha'il, Saudi Arabia.
(2)College of Public Health and Health Informatics, University of Ha'il, Ha'il, 
Saudi Arabia.
(3)College of Medical Rehabilitation Sciences, Taibah University, Madinah, Saudi 
Arabia.
(4)Department of Obstetrics and Gynecology, College of Medicine, University of 
Ha'il, Ha'il, Saudi Arabia.
(5)Samsung Biomedical Research Institute, Sungkyunkwan University, Jangan-gu, 
Suwon, South Korea.
(6)Department of Biochemistry, College of Medicine, University of Ha'il, Ha'il, 
Saudi Arabia.
(7)Department of Physical Therapy, College of Applied Medical Sciences, 
University of Ha'il, Ha'il, Saudi Arabia.

BACKGROUND: Mental and psychological health issues are on the rise globally. 
People with disabilities are at greater risk of poor psychological quality of 
life especially after covid-19 pandemic. Along with other factors physical 
activity (PA) may have a significant effect on mental health. This study aims to 
analyze the difference of PA participation and sitting time among people with 
and without disabilities and their association with psychological quality of 
life.
METHODS: A standard questionnaire was used to collect the data from disabled and 
non-disabled participants above 15 years of age. Bivariate and multivariate 
analysis was performed to yield statistical results.
RESULTS: Total study sample consisted of 359 participants (67.7% without 
disability and 32.3% with disability). Participants without disabilities 
reported a significantly better psychological quality of life (QOL) (Mean score 
= 68) as compared to the ones with disabilities (Mean score = 61), (p < 0.01). 
There was significant difference between the sitting time of two groups with 
longer sitting time among people with disabilities (6.1 h/day) as compared to 
non-disabled (5.3 h). Optimum level of PA was strongly associated with better 
psychological quality of life among individuals without disabilities (p = 0.00). 
Younger age (p = 0.00) and being single (p = 0.01) were significant predictors 
of poor psychological health among non-disables. Increase in sedentary sitting 
time was significantly associated with poor psychological quality of life among 
both groups.
CONCLUSIONS: Tailored health policies to encourage PA and reduce sitting hours 
should be formulated to improve psychological health with special focus on 
individuals with disabilities. Future studies with large sample size are 
recommended to validate the current results and further explore the difference 
in association of PA and psychological wellbeing in people with and without 
disabilities.

Copyright © 2022 Zahra, Hassan, Hassan, Parveen, Park, Iqbal, Khatoon and 
Atteya.

DOI: 10.3389/fpubh.2022.998890
PMCID: PMC9548647
PMID: 36225781 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1437. J Public Health Manag Pract. 2023 Jan-Feb 01;29(Suppl 1):S14-S21. doi: 
10.1097/PHH.0000000000001645. Epub 2022 Oct 12.

Seven Years, 3 Surveys, a Changed World: The State Public Health Workforce 
2014-2021.

Bogaert K(1), Papillon G, Wyche Etheridge K, Plescia M, Gambatese M, Pearsol JL, 
Mason A.

Author information:
(1)Performance Excellence (Ms Bogaert), Population Health and Innovation (Mr 
Papillon), Health Equity and Diversity Initiatives (Dr Wyche Etheridge), 
Executive Office (Dr Plescia), Workforce Development (Ms Pearsol), Leadership 
and Organizational Performance (Ms Mason), Association of State and Territorial 
Health Officials, Arlington, Virginia; and Gambatese Consulting, Wappingers 
Falls, New York (Ms Gambatese).

CONTEXT: The COVID-19 pandemic and other public health challenges have increased 
the need for longitudinal data quantifying the changes in the state public 
health workforce.
OBJECTIVE: To characterize the state of governmental public health workforce 
among state health agency (SHA) staff across the United States and provide 
longitudinal comparisons to 2 prior fieldings of the survey.
DESIGN: State health agency leaders were invited to have their workforce to 
participate in PH WINS 2021. As in prior fieldings, participating agencies 
provided staff lists used to send e-mail invitations to employees to participate 
in this electronic survey.
SETTING AND PARTICIPANTS: State health agency staff.
MAIN OUTCOME MEASURES: PH WINS 2021 maintains the 4 primary domains from 2014 
and 2017 (ie, workplace engagement, training needs assessment, emerging public 
health concepts, and demographics) and includes new questions related to the 
mental and emotional well-being; the impact of the COVID-19 pandemic on staff 
retention; and the workforce's awareness of and confidence in emerging public 
health concepts.
RESULTS: The percentage of SHA staff who self-identify as Black, Indigenous, and 
people of color increased from 30% (95% confidence interval [CI]: 29%-32%) to 
35% (95% CI: 35%-37%) between 2014 and 2021. Staff younger than 31 years 
accounted for 11% (95% CI: 10%-12%) of the SHA workforce in 2021 compared with 
8% in 2014 (95% CI: 8%-9%). From 2014 to 2021, staff who self-identify as a 
woman increased from 72% (95% CI: 71%-74%) to 76% (95% CI: 75%-77%). Overall, 
22% (95% CI: 21%-23%) of the SHA workforce rated their mental health as 
poor/fair.
CONCLUSION: The 2021 PH WINS results represent unique and current perspectives 
on the SHA workforce and can inform future public health infrastructure 
investments, research, and field practice to ensure a strong public health 
system.

Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc.

DOI: 10.1097/PHH.0000000000001645
PMCID: PMC10573087
PMID: 36223501 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


1438. JMIR Mhealth Uhealth. 2022 Oct 12;10(10):e41282. doi: 10.2196/41282.

Mental Health Mobile Apps in the French App Store: Assessment Study of 
Functionality and Quality.

Carrouel F(#)(1), du Sartz de Vigneulles B(#)(1), Bourgeois D(1)(2), Kabuth 
B(3)(4), Baltenneck N(5), Nusbaum F(1), Burge V(3)(4), Roy S(1), Buchheit 
S(3)(4), Carrion-Martinaud ML(6), Massoubre C(7), Fraticelli L(#)(1), Dussart 
C(#)(1)(2).

Author information:
(1)Health Systemic Process, Research Unit UR4129, University Claude Bernard Lyon 
1, University of Lyon, Lyon, France.
(2)Hospices Civils de Lyon, Lyon, France.
(3)Prisme Team, Interpsy Laboratory, Research Unit EA4432, University of 
Lorraine, Nancy, France.
(4)Nancy Psychotherapeutic Center, Laxou, France.
(5)Development, Individual, Process, Disability, University Lyon 2, Lyon, 
France.
(6)The Constellation, Health and Wellness Center, Rive-de-Gier, France.
(7)Department of Psychiatry, Research Unit EA7423, Saint-Etienne University 
Hospital Center of Saint Etienne, University Jean Monnet, Saint Etienne, France.
(#)Contributed equally

BACKGROUND: Approximately 800 million people, representing 11% of the world's 
population, are affected by mental health problems. The COVID-19 pandemic 
exacerbated problems and triggered a decline in well-being, with drastic 
increase in the incidence of conditions such as anxiety, depression, and stress. 
Approximately 20,000 mental health apps are listed in mobile app stores. 
However, no significant evaluation of mental health apps in French, spoken by 
approximately 300 million people, has been identified in the literature yet.
OBJECTIVE: This study aims to review the mental health mobile apps currently 
available on the French Apple App Store and Google Play Store and to evaluate 
their quality using Mobile App Rating Scale-French (MARS-F).
METHODS: Screening of mental health apps was conducted from June 10, 2022, to 
June 17, 2022, on the French Apple App Store and Google Play Store. A shortlist 
of 12 apps was identified using the criteria of selection and assessed using 
MARS-F by 9 mental health professionals. Intraclass correlation was used to 
evaluate interrater agreement. Mean (SD) scores and their distributions for each 
section and item were calculated.
RESULTS: The highest scores for MARS-F quality were obtained by Soutien psy avec 
Mon Sherpa (mean 3.85, SD 0.48), Evoluno (mean 3.54, SD 0.72), and Teale (mean 
3.53, SD 0.87). Mean engagement scores (section A) ranged from 2.33 (SD 0.69) 
for Reflexe reussite to 3.80 (SD 0.61) for Soutien psy avec Mon Sherpa. Mean 
aesthetics scores (section C) ranged from 2.52 (SD 0.62) for Mental Booster to 
3.89 (SD 0.69) for Soutien psy avec Mon Sherpa. Mean information scores (section 
D) ranged from 2.00 (SD 0.75) for Mental Booster to 3.46 (SD 0.77) for Soutien 
psy avec Mon Sherpa. Mean Mobile App Rating Scale subjective quality (section E) 
score varied from 1.22 (SD 0.26) for VOS - journal de l'humeur to 2.69 (SD 0.84) 
for Soutien psy avec Mon Sherpa. Mean app specificity (section F) score varied 
from 1.56 (SD 0.97) for Mental Booster to 3.31 (SD 1.22) for Evoluno. For all 
the mental health apps studied, except Soutien psy avec Mon Sherpa (11/12, 92%), 
the subjective quality score was always lower than the app specificity score, 
which was always lower than the MARS-F quality score, and that was lower than 
the rating score from the iPhone Operating System or Android app stores.
CONCLUSIONS: Mental health professionals assessed that, despite the lack of 
scientific evidence, the mental health mobile apps available on the French Apple 
App Store and Google Play Store were of good quality. However, they are 
reluctant to use them in their professional practice. Additional investigations 
are needed to assess their compliance with recommendations and their long-term 
impact on users.

©Florence Carrouel, Benjamin du Sartz de Vigneulles, Denis Bourgeois, Bernard 
Kabuth, Nicolas Baltenneck, Fanny Nusbaum, Valérie Burge, Sylvain Roy, Sophie 
Buchheit, Marie-Line Carrion-Martinaud, Catherine Massoubre, Laurie Fraticelli, 
Claude Dussart. Originally published in JMIR mHealth and uHealth 
(https://mhealth.jmir.org), 12.10.2022.

DOI: 10.2196/41282
PMCID: PMC9607929
PMID: 36223178 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


1439. Health Promot Chronic Dis Prev Can. 2023 Jan 18;43(1):27-39. doi: 
10.24095/hpcdp.43.1.03. Epub 2022 Oct 12.

Stressors and symptoms associated with a history of adverse childhood 
experiences among older adolescents and young adults during the COVID-19 
pandemic in Manitoba, Canada.

Salmon S(1), Taillieu TL(1), Stewart-Tufescu A(2), MacMillan HL(3)(4), Tonmyr 
L(5), Gonzalez A(3), Afifi TO(1)(6).

Author information:
(1)Department of Community Health Sciences, University of Manitoba, Winnipeg, 
Manitoba, Canada.
(2)Faculty of Social Work, University of Manitoba, Winnipeg, Manitoba, Canada.
(3)Department of Psychiatry and Behavioural Neurosciences, McMaster University, 
Hamilton, Ontario, Canada.
(4)Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
(5)Public Health Agency of Canada, Ottawa, Ontario, Canada.
(6)Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.

INTRODUCTION: The COVID-19 pandemic has had major economic, social and 
psychological consequences for adolescents and young adults. It is unclear 
whether those with a history of adverse childhood experiences (ACEs) were 
particularly vulnerable. We examined whether a history of ACEs was associated 
with financial difficulties, lack of emotional support, feeling 
stressed/anxious, feeling down/depressed, increased alcohol and/or cannabis use 
and increased conflict with parents, siblings and/or intimate partners among 16- 
to 21-year-olds during the pandemic.
METHODS: Data were collected in November and December 2020 from respondents aged 
16 to 21 years (n = 664) participating in the longitudinal and intergenerational 
Well-being and Experiences Study (Wave 3) conducted in Manitoba, Canada. 
Age-stratified associations between ACEs and pandemic-related stressors/symptoms 
were examined with binary and multinomial logistic regression.
RESULTS: A history of ACEs was associated with pandemic-related financial 
difficulties (adjusted relative risk ratio [aRRR] range: 2.44-7.55); lack of 
emotional support (aRRR range: 2.13-26.77); higher levels of feeling 
stressed/anxious and down/depressed (adjusted odds ratio [aOR] range: 
1.78-5.05); increased alcohol and cannabis use (aOR range: 1.99-8.02); and 
increased relationship conflict (aOR range: 1.98-22.59). Fewer associations 
emerged for older adolescents and these were not to the same degree as for young 
adults.
CONCLUSION: Adolescents and young adults with a history of ACEs reported 
increased odds of pandemic-related stressors and symptoms, and may need more 
resources and greater support compared to peers without an ACE history. 
Differences in results for adolescents and young adults suggest that 
interventions should be tailored to the needs of each age group.

Publisher: INTRODUCTION: La pandémie de COVID-19 a eu d’importantes conséquences 
économiques, sociales et psychologiques pour les adolescents et les jeunes 
adultes, sans que l’on sache si ceux ayant des antécédents d’expériences 
négatives dans l’enfance (ENE) étaient particulièrement vulnérables. Nous avons 
donc vérifié si des antécédents d’ENE étaient associés chez les jeunes de 16 à 
21 ans, pendant la pandémie, à des difficultés financières, à un manque de 
soutien psychologique, à un sentiment de stress ou d’anxiété, à une baisse de 
moral ou une dépression, à une consommation accrue d’alcool ou de cannabis et à 
une hausse des conflits avec les parents, la fratrie ou les partenaires intimes.
MÉTHODOLOGIE: Les données ont été recueillies en novembre et décembre 2020 
auprès de répondants âgés de 16 à 21 ans (n = 664) participant au cycle 3 de 
l’étude longitudinale et intergénérationnelle WES (Well-being and Experience 
Study), menée au Manitoba (Canada). Les associations, stratifiées par âge, entre 
les ENE et les facteurs de stress ou symptômes liés à la pandémie ont été 
analysées par régression logistique binaire et multinomiale.
RÉSULTATS: Les antécédents d’ENE sont associés aux facteurs liés à la pandémie 
suivants : difficultés financières (plage du rapport de risque relatif ajusté 
[RRRa] : 2,44 à 7,55), manque de soutien psychologique (plage du RRRa : 2,13 à 
26,77), niveau accru de stress ou d’anxiété et de baisse de moral ou dépression 
(plage du rapport de cotes ajusté [RCa] : 1,78 à 5,05), consommation accrue 
d’alcool et de cannabis (plage du RCa : 1,99 à 8,02) et hausse des conflits 
relationnels (plage du RCa : 1,98 à 22,59). Les grands adolescents ont présenté 
un moins grand nombre d’associations et d’ampleur plus faible que les jeunes 
adultes.
CONCLUSION: Les adolescents et les jeunes adultes ayant des antécédents d’ENE 
ont fait état d’une probabilité accrue de facteurs de stress et de symptômes 
liés à la pandémie. Ils pourraient donc avoir besoin de plus de ressources et de 
soutien que leurs pairs sans antécédents d’ENE. Les différences entre les 
résultats des adolescents et ceux des jeunes adultes indiquent que les 
interventions devraient être adaptées aux besoins de chaque groupe d’âge.

Plain Language Summary: The COVID-19 pandemic has exacerbated financial, social 
and psychological difficulties for young people. Older adolescents and young 
adults with a history of adverse childhood experiences (ACEs) were more 
vulnerable to pandemic-related stressors and symptoms compared to their peers 
without an ACEs history. Young adults with a history of ACEs may need additional 
resources that provide financial assistance, address mental health concerns, 
foster emotional support, reduce substance use and facilitate positive 
relationships. Older adolescents with a history of ACEs may benefit from 
interventions that improve feelings of depression and foster emotional support 
and healthy relationships with parents. Psychological first aid that provides 
practical and emotional support may be a suitable approach for supporting 
recovery from the pandemic.

Plain Language Summary: La pandémie de COVID-19 a exacerbé les difficultés 
financières, sociales et psychologiques des jeunes. Les grands adolescents et 
les jeunes adultes ayant des antécédents d’ENE étaient plus vulnérables aux 
facteurs de stress et aux symptômes liés à la pandémie que leurs pairs sans 
antécédents d’ENE. Les jeunes adultes ayant des antécédents d’ENE pourraient 
avoir besoin de ressources supplémentaires pour leur fournir de l’aide 
financière, traiter les problèmes de santé mentale, favoriser le soutien 
psychologique, réduire la toxicomanie et faciliter les relations positives. Les 
grands adolescents ayant des antécédents d’ENE pourraient bénéficier 
d’interventions améliorant les sentiments dépressifs et favorisant le soutien 
psychologique ainsi que les relations saines avec les parents. Des premiers 
soins psychologiques offrant un soutien pratique et psychologique semblent 
constituer une première approche appropriée pour soutenir le rétablissement 
après la pandémie.

DOI: 10.24095/hpcdp.43.1.03
PMCID: PMC9894295
PMID: 36223143 [Indexed for MEDLINE]

Conflict of interest statement: Tracie O. Afifi is an Associate Scientific 
Editor with Health Promotion and Chronic Disease Prevention in Canada, but has 
recused herself from the review process for this article. The authors have no 
conflicts of interest.


1440. JAMA Psychiatry. 2022 Dec 1;79(12):1232-1240. doi: 
10.1001/jamapsychiatry.2022.3109.

Association of Major Disease Outbreaks With Adolescent and Youth Mental Health 
in Low- and Middle-Income Countries: A Systematic Scoping Review.

Kumar M(1)(2), Akbarialiabad H(3), Kouhanjani MF(4), Kiburi S(5), Shidhaye P(6), 
Taghrir MH(3), Shidhaye R(7).

Author information:
(1)Brain and Mind Institute, Aga Khan University, Nairobi, Kenya.
(2)Department of Psychiatry, University of Nairobi, Nairobi, Kenya.
(3)Trauma Research Center, Rajaee Trauma Hospital, Shiraz University of Medical 
Sciences, Shiraz, Iran.
(4)Professor Alborzi Clinical Microbiology Research Center, Shiraz University of 
Medical Sciences, Namazi Hospital, Shiraz, Iran.
(5)Mbagathi Hospital, Nairobi, Kenya.
(6)Scientist B, National Aids Research Institute, Pune, India.
(7)Psychiatry, Pravara Institute of Medical Sciences, Loni, Maharashtra, India.

IMPORTANCE: Adolescents and young people have been historically understudied 
populations, and previous studies indicate that during epidemics, these 
populations, especially in low- and middle-income countries (LMICs), are at high 
risk of developing mental disturbances.
OBJECTIVE: To identify the existing evidence regarding the association of mental 
health with outbreaks of the influenza A (H1N1), Zika, Ebola, and SARS-CoV-2 
virus in exposed youth and adolescents in LMICs.
EVIDENCE REVIEW: Across 6 databases (Embase, Cochrane Library, PubMed, PsycINFO, 
Scopus, and Web of Science), the mental health outcomes of adolescents and youth 
(aged 10-24 years) associated with 4 major pandemic outbreaks from January 2009 
to January 2021 in LMICs were reviewed. A group of 3 authors at each stage 
carried out the screening, selection, and quality assessment using Joanna Briggs 
Institute checklists. The social determinants of adolescent well-being framework 
was used as a guide to organizing the review.
FINDINGS: A total of 57 studies fulfilled the search criteria, 55 related to the 
SARS-CoV-2 (COVID-19) pandemic and 2 covered the H1N1 influenza epidemics. There 
were no studies associated with Zika or Ebola outbreaks that met screening 
criteria. The studies reported high rates of anxiety and depressive symptoms 
among adolescents, including posttraumatic stress disorder, general stress, and 
health-related anxiety. Potential risk factors associated with poor mental 
health outcomes included female sex; home residence in areas with strict 
lockdown limitations on social and physical movement; reduced physical activity; 
poor parental, family, or social support; previous exposure to COVID-19 
infection; or being part of an already vulnerable group (eg, previous 
psychiatric conditions, childhood trauma, or HIV infection).
CONCLUSIONS AND RELEVANCE: Results of this systematic scoping review suggest 
that the COVID-19 pandemic and H1N1 epidemic were associated with adverse mental 
health among adolescents and youth from LMICs. Vulnerable youth and adolescents 
may be at higher risk of developing mental health-related complications, 
requiring more responsive interventions and further research. Geographically 
localized disease outbreaks such as Ebola, Zika, and H1N1 influenza are highly 
understudied and warrant future investigation.

DOI: 10.1001/jamapsychiatry.2022.3109
PMID: 36223094 [Indexed for MEDLINE]


1441. Australas Psychiatry. 2022 Dec;30(6):728-731. doi: 10.1177/10398562221131154. 
Epub 2022 Oct 12.

The impact of the COVID-19 pandemic on the mental health and wellbeing of 
refugees and asylum seekers-A Narrative Review of the Literature.

El Tatary G(1)(2), Gill N(3)(4)(5).

Author information:
(1)Advanced trainee in Child & Adolescent Psychiatry, Royal Australian and New 
Zealand College of Psychiatrists, Gold Coast, QLD, Australia.
(2)585497Lives Lived Well, headspace Early Psychosis, Gold Coast, QLD, 
Australia.
(3)Mental Health and Specialist Services, Gold Coast Health, Gold Coast, QLD, 
Australia.
(4)School of Medicine and Dentistry, 97562Griffith University, Southport, QLD, 
Australia.
(5)Health Research Institute, University of Canberra, Canberra, ACT, Australia.

OBJECTIVE: To identify the factors affecting refugees and asylum seekers mental 
health and wellbeing during the COVID-19 pandemic.
METHODS: A narrative review of available international research literature from 
January 2020 to June 2021 was conducted to identify these factors.
RESULTS: Seven factors were identified: pre-existing physical health 
vulnerabilities, pre-existing mental health vulnerabilities, environmental, 
social, cultural-specific, economic and legal/welfare challenges.
CONCLUSION: Multiple interacting bio-psycho-socio-economic-cultural-ecological 
factors lead to greater impact of COVID-19 pandemic on refugee and asylum 
seekers wellbeing than the general population.

DOI: 10.1177/10398562221131154
PMCID: PMC9557269
PMID: 36222224 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1442. J Affect Disord. 2023 Jan 1;320:568-575. doi: 10.1016/j.jad.2022.09.158. Epub 
2022 Oct 8.

Anxiety and depressive symptoms of German university students 20 months after 
the COVID-19 outbreak - A cross-sectional study.

Heumann E(1), Helmer SM(2), Busse H(3), Negash S(4), Horn J(4), Pischke CR(5), 
Niephaus Y(6), Stock C(7).

Author information:
(1)Institute of Health and Nursing Science, Charité - Universitätsmedizin 
Berlin, Berlin, Germany. Electronic address: eileen.heumann@charite.de.
(2)Human and Health Sciences, University of Bremen, Bremen, Germany.
(3)Department Prevention and Evaluation, Leibniz-Institute for Prevention 
Research and Epidemiology-BIPS, Bremen, Germany.
(4)Institute for Medical Epidemiology, Biometrics and Informatics, 
Interdisciplinary Center for Health Sciences, Medical School of the 
Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany.
(5)Institute of Medical, Sociology, Centre for Health and Society, Medical 
Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
(6)Department of Social Sciences, University of Siegen, Siegen, Germany.
(7)Institute of Health and Nursing Science, Charité - Universitätsmedizin 
Berlin, Berlin, Germany; Unit for Health Promotion Research, University of 
Southern Denmark, Esbjerg, Denmark.

BACKGROUND: Given the long duration of the COVID-19 pandemic, monitoring mental 
health remains important. This study aimed to determine (1) the prevalence of 
anxiety and depressive symptoms among university students 20 months after the 
first COVID-19 restrictions and (2) which factors were associated with these 
outcomes.
METHODS: The cross-sectional COVID-19 German Student Well-being Study (C19 GSWS) 
collected data of 7025 students at five German universities. Associations 
between anxiety and depressive symptoms with sociodemographic and other factors 
were analysed using multivariable logistic regression models.
RESULTS: The mean age of the participants was 23.9 years (SD = 4.9), 67 % were 
female and 31 % male. The prevalence for depressive symptoms was 29 % (PHQ-2) 
and 12 % (CES-D 8) and 32 % for anxiety. A complicated relationship status, the 
lack of a trusted person, and financial difficulties were associated with 
anxiety and depressive symptoms. University students who were worried about 
(re-) infection with COVID-19 had a 1.37-times higher chance for reporting 
anxiety (GAD-2: OR, 95 % CI: 1.09-1.71). Those with pre-existing cardiovascular 
health conditions had an up to 3.21-times higher chance for reporting depressive 
symptoms (OR, CESD-D 8, 95 % CI: 1.44-7.14).
LIMITATIONS: The study design is cross-sectional and uses self-reported 
outcomes.
CONCLUSIONS: Concepts for prevention and counselling to tackle mental health 
problems in students are needed and programmes should take specific stressors 
related to the pandemic into account.

Copyright © 2022 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2022.09.158
PMCID: PMC9547656
PMID: 36220498 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest None.


1443. Eur Child Adolesc Psychiatry. 2024 Apr;33(4):1209-1210. doi: 
10.1007/s00787-022-02099-z. Epub 2022 Oct 11.

Response to: Child and family factors associated with child mental health and 
well-being during COVID-19 by McArthur et al.

Eisenberg K(1), Hechtman L(2), Lonergan M(3), McIntyre A(2), Feizi S(4), Ali 
Qadri SR(2), Brunet A(2).

Author information:
(1)Department of Psychiatry, McGill University, Montreal, Canada. 
kayla.eisenberg@mail.mcgill.ca.
(2)Department of Psychiatry, McGill University, Montreal, Canada.
(3)School of Psychology, University of Ottawa, Ottawa, Canada.
(4)Department of Psychology, McGill University, Montreal, Canada.

DOI: 10.1007/s00787-022-02099-z
PMCID: PMC9552135
PMID: 36219326 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflict of interest to 
declare.


1444. J Nurs Scholarsh. 2023 Jan;55(1):97-111. doi: 10.1111/jnu.12824. Epub 2022 Oct 
11.

The impact of COVID-19 on the psychosocial well-being of older adults: A 
literature review.

Seckman C(1).

Author information:
(1)University of Maryland, Baltimore, School of Nursing and Aging and 
Thanatology Program, Baltimore, Maryland, USA.

INTRODUCTION: The novel coronavirus SARS-CoV2 (COVID-19) was declared a global 
pandemic in 2020 with the greatest risk to older adults. Prolonged restrictions 
and isolation threaten the social and emotional welfare of vulnerable groups 
with concerns focused on the long-term impact of this pandemic on the health and 
well-being of aging populations.
PURPOSE: Using the Socioemotional Selectivity Theory (STT) as a conceptual 
framework, the purpose of this literature review was to explore the impact of 
COVID-19 on the psychological and social well-being of older adults.
METHODS: Numerous academic and healthcare-related databases were searched to 
yield 24 relevant primary research articles, published during the pandemic 
(2020-2022), for analysis.
RESULTS/CONCLUSIONS: Overall results indicated the pandemic had a significant 
negative affect on the psychological and social well-being of older adults to 
include those with cognitive impairments and dementia despite perceptions of 
reduced awareness. There were significant differences between age groups with 
older adults reporting greater emotional stability and coping skills than 
younger cohorts. Although supportive services and the use of technology-enhanced 
well-being these resources were reduced during the pandemic due to lack of 
trained staff, funding, and other socioeconomic or political barriers. The SST 
proposes that feelings of satisfaction, a sense of belonging, and purpose are 
important for emotional well-being but the pandemic challenged these goals and, 
for many, resulted in stress, anxiety, and depression.
CLINICAL RELEVANCE: Healthcare providers and policymakers need to be aware of 
the negative consequences triggered by the prolonged pandemic and take measures 
to provide services that support the psychosocial well-being of older adults.

© 2022 Sigma Theta Tau International.

DOI: 10.1111/jnu.12824
PMCID: PMC9874600
PMID: 36218196 [Indexed for MEDLINE]

Conflict of interest statement: There is no conflict of interest associated with 
this paper.


1445. Ideggyogy Sz. 2022 Sep 30;75(9-10):307-315. doi: 10.18071/isz.75.0307.

[COVID-19 and chronic pain: online survey in the domestic population].

[Article in Hungarian; Abstract available in Hungarian from the publisher]

Nemes A(1)(2), Csabai M(1), Szok D(2).

Author information:
(1)Szegedi Tudományegyetem, Bölcsészet- és Társadalomtudományi Kar, 
Pszichológiai Intézet, Szeged.
(2)Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Neurológiai 
Klinika, Szeged.

BACKGROUND AND PURPOSE: The problems caused by the COVID-19 epidemic have the 
worst impact on chronic patient populations. People with chronic pain are one of 
the most vulnerable groups due to stress, disruption of daily routine, family 
problems, illness and difficulty in hospital care. It is therefore essential to 
assess the situation and mental well-being of this group. The aim of this survey 
was to assess chronic pain patients during the COVID-19 pandemic, addressing 
psychological background factors that might affect pain symptoms, such as 
depression, emotion regulation, alexithymia, well-being, health literacy and 
social support.
METHODS: 158 people participated in the survey, reporting pain for at least 3 
months but had not received medical treatment. Data was collected at two dates: 
February and December 2021. Participants completed an online questionnaire due 
to the pandemic situation. The following six psychological questionnaires were 
used in the survey: Toronto Alexithymia Scale, Beck Depression Inventory 9-item 
version, Difficulty in Emotion Regulation Scale, Multidimensional Scale of 
Perceived Social Support, Chew-questions measuring health literacy, WHO 
Well-being Index.
RESULTS: The participants ranged from 20 to 80 years in age, of whom 140 (88%) 
were female. 42 participants (27%) achieved severe alexithymia. 118 people (75%) 
had depression, of which 72 people (46%) had mild depression, 26 (16%) had 
moderate depression, and 20 (13%) had severe depression. The degree of pain and 
alexithy-mia (r(158) = 0.16, p = 0.004), depression (r(158) = 0.41, p < 0.001), 
difficulties in emotion regulation (r(158) = 0.26, p = 0.004), and health 
literacy, and difficulties in emotion regulation (r(158) = 0.25, p = 0.001) were 
positively and significantly related.
CONCLUSION: In addition to the characteristic comorbidities of people living 
with pain (e.g. anxiety, emotion disorder, sleep disorder), the epidemic-induced 
prolonged social isolation, stress and fear of illness may explain the 
proportion of high depression, emotion regulation difficulties or health 
literacy problems in the study sample which exacerbate alexithymia and the 
degree of pain. Based on these results it is important to draw the attention of 
professionals to the appropriate health care and educational needs of those 
affected.

Publisher: BACKGROUND AND PURPOSE: A Covid-19-járvánnyal járó problémák a 
krónikusbeteg-populációkra vannak a legrosszabb hatással. A stressz, a 
mindennapi rutin felbomlása, családi problémák, a megbetegedés és az ellátás 
nehezítettsége miatt a krónikus fájdalommal élők az egyik kiemelkedően 
veszélyeztetett csoport. Ezért elengedhetetlen felmérni ennek a csoportnak a 
helyzetét, pszichés jóllétét. A jelen kérdőíves felmérés célja a következő volt: 
a krónikus fájdalommal élő személyek felmérése a Covid-19-pan­dé­mia alatt, 
kitérve a fájdalommal összefüggésbe hozható pszichés háttértényezőkre, mint a 
depresszió, az érzelemszabályozás, az alexithymia, a jóllét, az egészségértés és 
a társas támogatás.
METHODS: A felmérés 158 főt vizsgált, akiknél legalább 3 hónapja állt fenn 
valamilyen fájdalom, de orvosi ellátásban nem részesültek. Az adatfelvétel két 
időpontban zaj­lott: 2021. februárban és decemberben. A pandémiára való 
tekintettel a felmérés online, kérdőíves módszerrel zajlott. A felmérés során a 
következő hat pszichológiai tesztet alkalmaztuk: Torontói Alexithymia Skála, 
Beck Dep­resszió Kérdőív rövidített változata, Érzelemszabályozási Nehézségek 
Kérdőív, Multidimenzionális Észlelt Társas Támogatás Kérdőív, az egészségértést 
mérő Chew-kér­dé­sek és a WHO Jóllét Kérdőív.
RESULTS: A vizsgálati személyek életkora 20–80 év közötti, 140 (88%) nő. 
Negyvenkét fő (27%) érte el a súlyos alexithymia mértékét. Depresszió 118 főnél 
(75%) volt kimutatható, melyből 72 fő (46%) enyhe, 26 fő (16%) közepesen súlyos 
és 20 fő (13%) súlyos depresszióval érintett. A fájdalom mértéke és az 
alexithymia [r(158) = 0,16, p = 0,004], a depresszió [r(158) = 0,41, p < 0,001], 
az érzelemszabályozási nehézségek [r(158) = 0,26, p = 0,004], az egészségértési 
és érzelemszabályozási nehézségek [r(158) = 0,25, p = 0,001] között pozitív, 
szignifikáns korreláció volt kimutatható.
CONCLUSION: A fájdalommal élő személyeket jellemző komorbiditások (szorongás, 
hangulatzavar, alvászavar) mellett a járvány indukálta hosszan tartó szociális 
izoláció, stressz és a félelem magyarázhatja a depresszió, az 
ér­ze­lemszabályozási nehézségek és az egészségértési problémák magas arányát a 
vizsgált mintában, amik tovább súlyosbítják az alexithymia és a fájdalom 
mértékét. Ezek alapján fontos felhívni a szakemberek figyelmét az érintett 
személyek megfelelő egészségügyi ellátására és edukációs szükségleteire.

DOI: 10.18071/isz.75.0307
PMID: 36218118 [Indexed for MEDLINE]


1446. BMC Public Health. 2022 Oct 10;22(1):1887. doi: 10.1186/s12889-022-14282-7.

Lifting lockdown: Renewed access to arts and cultural activities.

Worsley J(1), Billington J(2), Balabanova E(3), Chapple M(4).

Author information:
(1)Department of Primary Care and Mental Health, University of Liverpool, 
Liverpool, UK. jworsley@liverpool.ac.uk.
(2)Department of English, University of Liverpool, Liverpool, UK.
(3)Department of Communication and Media, University of Liverpool, Liverpool, 
UK.
(4)Department of Primary Care and Mental Health, University of Liverpool, 
Liverpool, UK.

BACKGROUND: The effects of COVID-19 on mental health are profound. While there 
is a growing body of evidence on arts supporting mental health, the 
re-engagement with in-person arts and cultural activity has remained slow 
following the lifting of restrictions.
METHODS: Interviews with 14 representatives, including providers and 
practitioners, from 12 arts and cultural organisations within the Liverpool City 
Region (LCR) were conducted. The aim was to examine the impact of COVID-19 
restrictions easing on arts and cultural provision in the LCR, and on the mental 
health and wellbeing of those whom arts and cultural organisations serve, 
including those who would usually access arts through formal healthcare routes 
(e.g., those usually served via arts organisations' partnership with health or 
social care providers). Data were analysed using framework analysis.
RESULTS: Three overarching themes were identified: The new normal: 'Out of 
crisis comes innovation'; Complexities of operating 'in the new COVID world'; 
and Reimagining arts in mental healthcare.
CONCLUSION: As engagement in community and cultural activities plays a public 
health role, a hybrid delivery of arts and culture - ensuring continued online 
access alongside in-person provision - will be vital for people's recovery. 
Alongside efforts to reimagine arts in mental healthcare in the wake of the 
crisis caused by the pandemic, the role of arts and culture in providing 
stigma-free environments to reconnect the vulnerable and isolated is more 
critical than ever. Recommendations on the role of arts and culture in 
sustaining the mental health and wellbeing of the population and embedding the 
arts within clinical care and public health prevention schemes are provided.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-14282-7
PMCID: PMC9549849
PMID: 36217129 [Indexed for MEDLINE]

Conflict of interest statement: None.


1447. BMJ Open. 2022 Oct 10;12(10):e062775. doi: 10.1136/bmjopen-2022-062775.

Why do ambulance employees (not) seek organisational help for mental health 
support? A mixed-methods systematic review protocol of organisational support 
available and barriers/facilitators to uptake.

Johnston S(1)(2), Sanderson K(3), Bowes L(2), Wild J(2)(4).

Author information:
(1)South Western Ambulance Service NHS Foundation Trust, Bristol, UK 
sasha.johnston@psy.ox.ac.uk.
(2)Department of Experimental Psychology, University of Oxford, Oxford, UK.
(3)School of Health Sciences, University of East Anglia, Norwich, United 
Kingdom, Norwich, UK.
(4)Oxford Health NIHR Biomedical Research Centre, Oxford, UK.

INTRODUCTION: The COVID-19 pandemic is exacerbating a wide range of symptoms of 
poor mental health among emergency medical service (EMS) ambulance populations. 
Evidence suggests that using organisational support can improve employee 
outcomes and in turn, patient outcomes. Understanding why EMS staff do and do 
not use support services is therefore critical to improving uptake, ensuring 
equitable access, and potentially influencing workforce well-being, 
organisational sustainability and patient care delivery. This systematic review 
aims to identify what support is available and any perceived barriers and 
facilitators to accessing and utilising organisational support.
METHODS AND ANALYSIS: Searches performed between 18 February 2022 and 23 
February 2022 will be used to identify studies that report barriers and 
facilitators to EMS employee support among all government/state commissioned EMS 
ambulance systems. Electronic databases, AMED, CINAHL, Cochrane Central Register 
of Controlled Trials, Cochrane Database of Systematic Reviews, EMBASE, EMCARE, 
HMIC, Medline and PsycINFO will be searched. All relevant English-language 
studies of adult employees of government/state commissioned EMS ambulance 
organisations published since December 2004 will be screened and relevant data 
extracted by two independent reviewers. A third reviewer will resolve any 
disagreements.The primary outcome is the identification of perceived barriers or 
facilitators to EMS staff using organisational support for mental health. The 
secondary outcome is the identification of supportive interventions offered 
through or by ambulance trusts. Study selection will follow Preferred Reporting 
Items for Systematic Reviews and Meta-Analyses guidelines, and the 
methodological quality of included studies will be appraised by administering 
rating checklists. A narrative synthesis will be conducted to report qualitative 
and quantitative data and will include population characteristics, 
methodological approach and information about barriers and facilitators.
ETHICS AND DISSEMINATION: Ethical approval is not required because only 
available published data will be analysed. Findings will be disseminated through 
peer-reviewed publication and conference presentation.
PROSPERO REGISTRATION NUMBER: CRD42022299650.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/bmjopen-2022-062775
PMCID: PMC9557302
PMID: 36216429 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


1448. Psychiatry Res. 2022 Nov;317:114876. doi: 10.1016/j.psychres.2022.114876. Epub 
2022 Oct 2.

Information seeking, mental health and loneliness: Longitudinal analyses of 
adults in the UK COVID-19 mental health and wellbeing study.

Wilding S(1), O'Connor DB(2), Ferguson E(3), Wetherall K(4), Cleare S(4), 
O'Carroll RE(5), Robb KA(6), O'Connor RC(6).

Author information:
(1)School of Psychology, University of Leeds, Leeds, United Kingdom.
(2)School of Psychology, University of Leeds, Leeds, United Kingdom. Electronic 
address: d.b.oconnor@leeds.ac.uk.
(3)School of Psychology, University of Nottingham, Nottingham, United Kingdom.
(4)Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, 
University of Glasgow, Glasgow, United Kingdom.
(5)Division of Psychology, University of Stirling, Stirling, United Kingdom.
(6)Institute of Health and Wellbeing, University of Glasgow, Glasgow, United 
Kingdom.

Information seeking has generally been seen as an adaptive response to the 
COVID-19 pandemic. However, it may also result in negative outcomes on mental 
health. The present study tests whether reporting COVID-related information 
seeking throughout the pandemic is associated with subsequently poorer mental 
health outcomes. A quota-based, non-probability-sampling methodology was used to 
recruit a nationally representative sample. COVID-related information seeking 
was assessed at six waves along with symptoms of depression, anxiety, mental 
wellbeing and loneliness (N = 1945). Hierarchical linear modelling was used to 
assess the relationship between COVID-related information seeking and mental 
health outcomes. Information seeking was found to reduce over time. Overall, 
women, older and higher socioeconomic group individuals reported higher levels 
of information seeking. At waves 1-4 (March-June 2020) the majority of 
participants reported that they sought information on Covid 1-5 times per day, 
this decreased to less than once per day in waves 5 and 6 (July-November 2020). 
Higher levels of information seeking were associated with poorer mental health 
outcomes, particularly clinically significant levels of anxiety. Use of a 
non-probability sampling method may have been a study limitation, nevertheless, 
reducing or managing information seeking behaviour may be one method to reduce 
anxiety during pandemics and other public health crises.

Copyright © 2022. Published by Elsevier B.V.

DOI: 10.1016/j.psychres.2022.114876
PMCID: PMC9526871
PMID: 36215778 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest None of the 
authors have any conflict of interest to declare.


1449. F1000Res. 2022 Aug 17;11:944. doi: 10.12688/f1000research.124768.2. eCollection 
2022.

The social prescribing of psychosocial interventions in the treatment of 
addictions and substance use disorders with military veterans: a reclamation of 
identity and belonging.

Mottershead R(1).

Author information:
(1)RAK College of Nursing, Ras al Khaimah Medical and Health Sciences 
University, Ras Al Khaimah, United Arab Emirates.

Social prescribing is a way of connecting individuals to a source of support 
within the community to help improve their health and well-being. Social 
prescribing programmes are being widely promoted within the United Kingdom (UK) 
and United States as non-pharmaceutical interventions for those living with 
addiction and substance misuse needs. These needs have been exasperated by the 
recent COVID-19 pandemic and global economic crisis, with emerging research 
indicating short-term and long-term detrimental effects on physical and mental 
health due to substance misuse and addictions. Psychosocial interventions 
utilize psychological or social factors rather than an overreliance on 
biological interventions to treat the health impacts of mental illnesses such as 
addictions and substance use disorder. In this paper, I will discuss the 
associated determinants of addictions and substance for the military veteran 
population, as well as how the social prescribing of psychosocial interventions 
could be used to reaffirm participant's identity and enhance their sense of 
belonging for military veterans, using a real-world example in Wales, UK.

Copyright: © 2022 Mottershead R.

DOI: 10.12688/f1000research.124768.2
PMCID: PMC9513413
PMID: 36203746 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: Dr. Richard Mottershead has 
gifted his farm to Woody's Lodge for the support of military veterans, 
reservists and emergency service personnel and their families.


1450. Nurs Forum. 2022 Nov;57(6):1314-1320. doi: 10.1111/nuf.12808. Epub 2022 Oct 9.

Psychological distress among the nursing workforce in the United Arab Emirates: 
Comparing levels before and during the COVID-19 pandemic.

Al-Yateem N(1)(2), Ahmed FR(1), Alameddine M(2)(3), Dias JM(1), Saifan AR(4), 
Subu MA(1), Hijazi H(2)(5), AbuRuz ME(4).

Author information:
(1)Nursing Department, College of Health Sciences, University of Sharjah, 
Sharjah, UAE.
(2)Research Institute of Medical & Health Sciences - Health and Workforce 
Studies Research Group, University of Sharjah, Sharjah, United Arab Emirates.
(3)Health Service Administration Department, Faculty of Health Sciences, 
University of Sharjah, Sharjah, UAE.
(4)Clinical Nursing Department, Applied Science Private University, Amman, 
Jordan.
(5)Department of Health Management and Policy, Faculty of Medicine, Jordan 
University of Science and Technology, Irbid, Jordan.

BACKGROUND: Nurses make up the majority of the healthcare workforce. They 
contribute to the development of healthcare systems and the provision of 
high-quality, effective, and patient-centered healthcare services. However, 
nurses need good mental and emotional well-being to provide adequate care and 
the necessary physical and mental health support for their clients. This study 
aimed to determine the level of generalized psychological distress among nurses 
in the United Arab Emirates. As this study was initiated before the coronavirus 
disease 2019 (COVID-19) pandemic, we were able to compare data gathered before 
and during the pandemic.
METHOD: This study used a cross-sectional correlational design. The Kessler 
Psychological Distress Scale (K10) was used to measure generalized psychological 
distress. Nurses' distress levels were measured and compared before and during 
the COVID-19 pandemic.
RESULTS: In total, 988 participants completed the questionnaire. The majority 
(n = 629, 63.7%) were employed in hospitals and the remainder worked in primary 
healthcare settings (n = 359, 36.3%). The mean distress score was 27.1 ± 13.7; 
42.1% (n = 416) of participants had a severe level of distress, and only 36.4% 
(n = 360) reported no distress. More participants had severe stress levels 
before COVID-19 (59.5%, n = 386) compared with during COVID-19 (10.9%, n = 30).
CONCLUSIONS: Participants' K10 scores suggest that nurses experience significant 
distress, which may compromise their ability to care for their clients. This 
study emphasizes the importance of supporting nurses as a preliminary step to 
improving patient care. Despite the pressure of working during the COVID-19 
pandemic, participants' general distress scores were lower during than before 
the pandemic. Organizational, governmental, and global support and appreciation 
may have contributed to relieving the distress nurses experienced. This may be a 
useful ongoing approach for enhancing healthcare systems.

© 2022 Wiley Periodicals LLC.

DOI: 10.1111/nuf.12808
PMCID: PMC9874575
PMID: 36210355 [Indexed for MEDLINE]


1451. Psych J. 2023 Apr;12(2):297-306. doi: 10.1002/pchj.599. Epub 2022 Oct 9.

Posttraumatic growth levels of healthcare workers in two periods with different 
intensities of COVID-19 pandemic.

Yılmaz-Karaman İG(1), Yastıbaş-Kaçar C(2), Ece İnce F(1).

Author information:
(1)Department of Psychiatry, Faculty of Medicine, Eskişehir Osmangazi 
University, Eskişehir, Turkey.
(2)Department of Psychology, Faculty of Literature, Dokuz Eylül University, 
İzmir, Turkey.

The COVID-19 pandemic threatens health-care workers' (HCW) mental health and 
well-being. Although traumatic life events may result in psychiatric disorders, 
occasionally they give rise to positive changes, such as post-traumatic growth. 
Accordingly, the present study evaluated the traumatic stress, anxiety, and 
depression levels of HCWs and their post-traumatic growth levels during the 
pandemic. In addition, the study aimed to assess the changes in psychological 
outcomes during the pandemic. For this aim, the data were collected in two 
different periods. The first data-collection period was between May and July 
2020, and the second period started in November 2020 and ended in January 2021. 
The sociodemographic data form, Impact of Events Scale-Revised (IES-R), 
Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), 
and Post-traumatic Growth Inventory (PTGI) were used to collect data. Sixty-six 
HCWs participated in the study. No significant differences appeared between the 
baseline scores and 6-month follow-up in the depression, anxiety, and traumatic 
stress levels of HCWs. Furthermore, the PTGI scores decreased significantly over 
time. Although the change in the psychological distress scores was not 
statistically significant, the depression and post-traumatic stress scores 
increased over time. Previous research specified an inverse-parabolic 
relationship between traumatic stress and PTGI. Our results support previous 
research; as the exposure to the stressors continues, individual traumatic 
stress levels increase, psychiatric disorders become frequent, and affirmative 
changes (like post-traumatic growth) decline.

© 2022 Institute of Psychology, Chinese Academy of Sciences and John Wiley & 
Sons Australia, Ltd.

DOI: 10.1002/pchj.599
PMCID: PMC9874446
PMID: 36210343 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


1452. Semin Oncol. 2022 Oct;49(5):383-388. doi: 10.1053/j.seminoncol.2022.09.002. Epub 
2022 Sep 8.

Impact of the COVID-19 Pandemic on the Wellbeing of International Oncology and 
Hematology Fellows at the Princess Margaret Cancer Center (PMCC).

Stecca CE(1), Alt M(1), Jiang DM(1), Michelis G(2), Fallah-Rad N(1), Gill S(3), 
Elliot M(4), Sridhar SS(5).

Author information:
(1)Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, 
Toronto, ON, Canada.
(2)Department of Psychiatry Instituto de Psiquiatria, Florianopolis, SC, Brazil.
(3)BC Cancer Agency, Vancouver, BC, Canada.
(4)Division of Psychiatry, Princess Margaret Cancer Centre, Toronto, ON, Canada.
(5)Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, 
Toronto, ON, Canada. Electronic address: srikala.sridhar@uhn.ca.

BACKGROUND: The COVID-19 pandemic has led to significant disruptions across all 
levels of medical training. International fellows in subspecialty training 
programs are essential members of the frontline physician workforce, but may 
face additional and unique challenges as a result of being away from their home 
country. In this study, we aimed to understand the impact of the COVID-19 
pandemic on the wellbeing of international fellows in the Hematology and/or 
Oncology fellowship program at the PMCC.
METHODS: In collaboration with our staff psychiatrist, we conducted an online 
survey of hematology and/or oncology fellows at the PMCC from July 6 to August 
10, 2020. The survey consisted of 60 questions divided into 4 sections: 
demographics, wellbeing assessment using the validated Short Warwick Edinburgh 
Mental Wellbeing Scale (SWEMWBS), fellowship specific questions (personal and 
professional) and coping strategies using the validated brief COPE scale.
RESULTS: Overall 24/52 (46%) fellows completed the survey: 21/24 were 
international fellows with 48% from Asia, 3/24 were Canadian fellows but away 
from home; 54% were male; 48% were aged 31-35 years; 65% were married, 48% had 
children. Mean SWEMWBS score was 21, indicating lower overall wellbeing than the 
general population who had a score of 23.6. Compared to their pre-COVID status, 
many reported a decline in their wellbeing (63%), sense of guilt for not being 
with their family (45%) or helping their country (41%), stress in personal 
relationships (26%), fatigue (50%), sleep disorders (38%) and loss of interest 
in daily activities (38%). Personal events were altered by almost 80%; and 20% 
planned to extend their fellowship. According to the Brief-COPE scale, during 
the pandemic, most fellows used more adaptive coping mechanisms (mean score 
39.2) as opposed to maladaptive ones (mean score 21.8).
CONCLUSIONS: The ongoing COVID-19 pandemic has negatively affected the overall 
wellbeing of international fellows. Understanding the specific challenges and 
coping mechanisms used by international fellows may help institutions develop 
better targeted strategies to promote wellbeing, professional development and 
ensure high-quality patient care during unprecedented times like the COVID 
pandemic.

Copyright © 2022 Elsevier Inc. All rights reserved.

DOI: 10.1053/j.seminoncol.2022.09.002
PMCID: PMC9452400
PMID: 36210226 [Indexed for MEDLINE]


1453. J Nurs Scholarsh. 2023 Jan;55(1):112-122. doi: 10.1111/jnu.12820. Epub 2022 Oct 
8.

Puerto Rican healthcare workers' perspectives on the impact of COVID-19 pandemic 
on their role, patient care, and mental health.

Alvarez C(1)(2), Diaz-Ramos N(3), Quiles R(4), Sanchez-Roman MJ(5), Weeks 
K(2)(6), Cooper LA(2)(7).

Author information:
(1)School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, 
USA.
(2)Johns Hopkins Center for Health Equity, Baltimore, Maryland, USA.
(3)Medical Sciences Campus, University of Puerto Rico, School of Nursing, San 
Juan, Puerto Rico.
(4)Division of Geriatric Medicine and Gerontology, Johns Hopkins University 
School of Medicine, Baltimore, Maryland, USA.
(5)College of Public Health, Department of Health Promotion, University of 
Nebraska Medical Center, Omaha, Nebraska, USA.
(6)Amstrong Institute of Patient Safety & Quality, Johns Hopkins University 
School of Medicine, School of Medicine, Baltimore, Maryland, USA.
(7)General Internal Medicine, Johns Hopkins University School of Medicine, 
Baltimore, Maryland, USA.

PURPOSE: To explore the personal and work-related stressors of healthcare 
workers in Puerto Rico and the organizational support they received during the 
pandemic.
DESIGN AND METHODS: We used a qualitative descriptive design and from April - 
November, 2021, conducted semi-structured individual interviews with Puerto 
Rican frontline healthcare workers (n = 12) and supervisors (n = 5).
FINDINGS: Thematic analysis revealed five major themes: (a) Organizations' 
response to COVID-19; (b) increased complexity of patients; (c) intensified work 
and psychological demand for nurses; (d) overwhelmed and overworked; and (e) 
recommendations for healthcare leadership. Participants explained that their 
organizations' responses to COVID-19 were insufficient for  meeting the demands 
and acuity of the patients. Closure of outpatient services contributed to people 
presenting to hospitals with exacerbated chronic conditions - especially the 
elderly. With COVID-19 precautions prohibiting family visitation, nurses became 
responsible for total care, including emotional support of patients. In 
addition, the shortage of staff contributed to nurses assuming greater 
workloads, feeling overwhelmed and overworked, and healthcare worker 
resignations. Given their experiences, healthcare workers recommended that 
healthcare leadership show more appreciation for staff, demonstrate empathy, 
include frontline workers in decision-making, and provide mental health 
resources for staff.
CONCLUSIONS: This study with Puerto Rican frontline workers and supervisors 
uncovers the multiple stressors experienced during the COVID-19 pandemic. Our 
findings underscore the need for prioritizing the well-being of healthcare 
workers, preparing healthcare leadership on how to support staff, and mandating 
nurse-to-patient ratios.
CLINICAL RELEVANCE: Healthcare workers explained the barriers they experienced 
for providing quality care to their patients. They also presented 
recommendations for healthcare leadership to facilitate supporting frontline 
workers, which ultimately contributes to optimal patient care.

© 2022 Sigma Theta Tau International.

DOI: 10.1111/jnu.12820
PMCID: PMC9874530
PMID: 36209359 [Indexed for MEDLINE]

Conflict of interest statement: There are no conflicts of interest to declare.


1454. Int Rev Neurobiol. 2022;165:229-249. doi: 10.1016/bs.irn.2022.03.004. Epub 2022 
Apr 27.

Parkinson's disease and Covid-19: Is there an impact of ethnicity and the need 
for palliative care.

Rukavina K(1), McConvey V(2), Ray Chaudhuri K(3), Miyasaki J(4).

Author information:
(1)Institute of Psychiatry, Psychology &amp; Neuroscience at King's College 
London and King's College Hospital NHS Foundation Trust, London, United Kingdom; 
Parkinson's Foundation Centre of Excellence, King's College Hospital NHS 
Foundation Trust, London, United Kingdom. Electronic address: 
katarina.rukavina@kcl.ac.uk.
(2)Fight Parkinson's, Surrey Hills, VIC, Australia.
(3)Institute of Psychiatry, Psychology &amp; Neuroscience at King's College 
London and King's College Hospital NHS Foundation Trust, London, United Kingdom; 
Parkinson's Foundation Centre of Excellence, King's College Hospital NHS 
Foundation Trust, London, United Kingdom.
(4)Parkinson and Movement Disorders Program and the Complex Neurologic Symptoms 
Clinic (Neuropalliative Care), University of Alberta, Edmonton, AB, Canada.

Under the traditional models of care for People with Parkinson's Disease (PD, 
PwP), many of their needs remain unmet and a substantial burden of motor and 
non-motor symptoms they experience may not be tackled sufficiently. An 
introduction of palliative care (PC) interventions early in the course of PD 
offers profound benefits: it may improve quality of life of patients, their 
families and caregivers through the prevention and relief of medical symptoms, 
while, at the same time, emphasizing their emotional needs and spiritual 
wellbeing, establishing goals of care, and engaging in the advance care planning 
(ACP). The ongoing Coronavirus Disease 2019 (Covid-19) pandemic poses an 
unprecedented set of challenges for PwP and has in many ways (both directly and 
indirectly) magnified their suffering, thus rapidly raising the demand for PC 
interventions. Covid-19, as well as the repercussions of prolonged mobility 
restrictions and limited health-care access might exacerbate the severity of PD 
motor symptoms and interact negatively with a range of non-motor symptoms, with 
a detrimental effect on quality of life. Greater motor disability, higher amount 
of levodopa-induced motor fluctuations with an increased daily off-time, 
fatigue, anxiety, depression, sleep disturbances, pain and worsening of 
cognitive complaints might dominate the clinical presentation in PwP during the 
Covid-19 pandemic, alongside raising psychological and spiritual concerns and 
anticipatory grief. Here, we aim to provide a foundation for pragmatic and 
clinically orientated PC approach to improve quality of life and relieve 
suffering of PwP in the context of the current, ongoing Covid-19 pandemic.

Copyright © 2022 Elsevier Inc. All rights reserved.

DOI: 10.1016/bs.irn.2022.03.004
PMCID: PMC9042419
PMID: 36208902 [Indexed for MEDLINE]


1455. Alcohol Alcohol. 2023 Jan 9;58(1):84-92. doi: 10.1093/alcalc/agac047.

Chemosensory Alterations and Impact on Quality of Life in Persistent Alcohol 
Drinkers.

Agarwal K(1)(2), Luk JW(3), Manza P(4), McDuffie C(1)(3), To L(1), Jaime-Lara 
RB(1)(2), Stangl BL(5), Schwandt ML(3), Momenan R(6), Goldman D(3)(7), 
Diazgranados N(3), Ramchandani VA(5), Joseph PV(1)(2).

Author information:
(1)Section of Sensory Science and Metabolism, National Institute on Alcohol 
Abuse and Alcoholism, Bethesda, MD 20892, USA.
(2)National Institute of Nursing Research, Bethesda, MD, 20892 USA.
(3)Office of the Clinical Director, National Institute on Alcohol Abuse and 
Alcoholism, Bethesda, MD 20892, USA.
(4)Laboratory of Neuroimaging, National Institute on Alcohol Abuse and 
Alcoholism, Bethesda, MD 20892, USA.
(5)Human Psychopharmacology Laboratory, National Institute on Alcohol Abuse and 
Alcoholism, Bethesda, MD 20892, USA.
(6)Clinical NeuroImaging Research Core, National Institute on Alcohol Abuse and 
Alcoholism, Bethesda, MD 20892, USA.
(7)Laboratory of Neurogenetics, National Institute on Alcohol Abuse and 
Alcoholism, Rockville, Maryland 20892, USA.

BACKGROUND: Heavy alcohol consumption-associated chemosensory dysfunction is 
understudied, and early detection can help predict disease-associated 
comorbidities, especially those related to four quality of life (QOL) domains 
(physical, psychological, social and environment). We examined self-reports of 
chemosensory ability of individuals with different alcohol drinking behaviors 
and their association with changes in QOL domains.
METHODS: Participants (n = 466) were recruited between June 2020 and September 
2021 into the NIAAA COVID-19 Pandemic Impact on Alcohol study. Group-based 
trajectory modeling was used to categorize participants without any known 
COVID-19 infection into three groups (non-drinkers, moderate drinkers and heavy 
drinkers) based on their Alcohol Use Disorders Identification Test consumption 
scores at four different time points (at enrollment, week 4, week 8 and week 
12). Linear mixed models were used to examine chemosensory differences between 
these groups. The associations between chemosensory abilities and QOL were 
determined in each group.
RESULTS: We observed significant impairment in self-reported smell ability of 
heavy drinking individuals compared to non-drinkers. In contrast, taste ability 
showed marginal impairment between these groups. There were no significant 
differences in smell and taste abilities between the moderate and non-drinking 
groups. Heavy drinkers' impairment in smell and taste abilities was 
significantly associated with deterioration in their physical, psychological, 
social and environmental QOL.
CONCLUSION: Persistent heavy drinking was associated with lower chemosensory 
ability. Heavy drinkers' reduced smell and taste function and association with 
poorer QOL indicate that early assessment of chemosensory changes may be crucial 
in identifying poorer well-being outcomes in heavy drinkers at risk for alcohol 
use disorder.

© The Author(s) 2022. Medical Council on Alcohol and Oxford University Press. 
All rights reserved.

DOI: 10.1093/alcalc/agac047
PMCID: PMC9619625
PMID: 36208183 [Indexed for MEDLINE]


1456. Psychosom Med. 2023 Jan 1;85(1):42-52. doi: 10.1097/PSY.0000000000001146. Epub 
2022 Sep 30.

The Association of Age With Depression, Anxiety, and Posttraumatic Stress 
Symptoms During the COVID-19 Pandemic in Spain: The Role of Loneliness and 
Prepandemic Mental Disorder.

Gabarrell-Pascuet A(1), Koyanagi A, Felez-Nobrega M, Cristóbal-Narváez P, 
Mortier P, Vilagut G, Olaya B, Alonso J, Haro JM, Domènech-Abella J.

Author information:
(1)From the Teaching, Research & Innovation Unit (Gabarrell-Pascuet, Koyanagi, 
Félez-Nobrega, Cristóbal-Narváez, Olaya, Haro, Domènech-Abella), Parc Sanitari 
Sant Joan de Déu, Sant Boi de Llobregat, Barcelona; Instituto de Salud Carlos 
III (Koyanagi, Cristóbal-Narváez, Olaya, Haro, Domènech-Abella), Centro de 
Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid; Institució 
Catalana de Recerca i Estudis Avançats (ICREA) (Koyanagi); Health Services 
Research Unit (Mortier, Vilagut, Alonso), IMIM (Hospital del Mar Medical 
Research Institute); Department of Experimental and Health Sciences (Alonso), 
Pompeu Fabra University (UPF), Barcelona; Instituto de Salud Carlos III 
(Mortier, Vilagut, Alonso), Centro de Investigación Biomédica en Red de 
Epidemiología y Salud Pública (CIBERESP); Instituto de Investigación Sanitaria 
Princesa (IP) (Haro), Madrid; Department of Sociology (Domènech-Abella), 
Universitat de Barcelona, Barcelona, Spain.

OBJECTIVE: Older adults may be at lower risk of common mental disorders than 
younger adults during the coronavirus disease 2019 (COVID-19) pandemic. Previous 
research has shown shown differences by age in psychosocial well-being during 
the pandemic and have highlighted the moderating effect of prepandemic mental 
disorders on that association. In this line, we examined the association of age 
with self-reported symptoms of loneliness, depression, anxiety, and 
posttraumatic stress, as well as potential roles of loneliness symptoms and 
prepandemic mental disorders on the association between age and mental disorder 
symptoms.
METHODS: Cross-sectional data of 2000 adults in Spain interviewed by telephone 
during the COVID-19 pandemic (February-March 2021) were analyzed. Depression, 
anxiety, and posttraumatic stress were measured with the eight-item Patient 
Health Questionnaire, the seven-item Generalized Anxiety Disorder Scale, and the 
four-item checklist for Diagnostic and Statistical Manual of Mental Disorders 
(Fifth Edition), respectively. Loneliness was measured with the three-item 
University of California at Los Angeles Loneliness Scale. Several regression 
models were constructed to assess factors related to loneliness and mental 
disorders.
RESULTS: According to cutoff points used, 12.4% of participants revealed 
depression, 11.9% revealed anxiety, and 11.6% revealed posttraumatic stress. Age 
was negatively related to mental disorder symptoms and loneliness. Loneliness 
was associated with higher levels of mental disorder symptoms. This association 
was stronger in younger adults without prepandemic mental disorders and in older 
adults with them. The association between age and loneliness was stronger in 
those with prepandemic mental disorders. Loneliness mediated the association of 
age with mental disorder symptoms.
CONCLUSIONS: Interventions focused on loneliness could alleviate the impact of 
the COVID-19 pandemic on mental health.

Copyright © 2022 by the American Psychosomatic Society.

DOI: 10.1097/PSY.0000000000001146
PMID: 36201774 [Indexed for MEDLINE]


1457. PLoS One. 2022 Oct 6;17(10):e0272738. doi: 10.1371/journal.pone.0272738. 
eCollection 2022.

"I'm tired of black boxes!": A systematic comparison of faculty well-being and 
need satisfaction before and during the COVID-19 crisis.

Schwab C(1), Frenzel AC(1), Daumiller M(2), Dresel M(2), Dickhäuser O(3), Janke 
S(3), Marx AKG(1).

Author information:
(1)Department of Psychology, University of Munich, Munich, Germany.
(2)Department of Psychology, University of Augsburg, Augsburg, Germany.
(3)Department of Psychology, University of Mannheim, Mannheim Germany.

As of today, surprisingly little is known about the subjective well-being of 
faculty in general, but especially when teaching online and during a time of 
pandemic during lockdowns in particular. To narrow this research gap, the 
present study systematically compared the subjective well-being of faculty 
teaching face-to-face before to those teaching online during the COVID-19 
pandemic, adopting a self-determination theory framework. The data reported here 
stem from a study conducted before the pandemic (Sample 1, n = 101) and which 
repeated-measures survey design we replicated to collect corresponding data 
during the pandemic (Sample 2, n = 71). Results showed that faculty teaching 
online during the pandemic reported impaired satisfaction of all three basic 
needs, that is reduced autonomy, competence, and especially relatedness, as well 
as impaired subjective well-being (clearly reduced enjoyment and reduced 
teaching satisfaction; increased anger and a tendency towards more shame) 
compared to faculty teaching face-to-face before the pandemic. Yet pride, 
anxiety, and boredom were experienced to a similar extent across both samples. 
The effects of the teaching format on the different aspects of subjective 
well-being were overall mediated in self-determination-theory-congruent ways by 
the satisfaction of the basic needs for autonomy, competence, and relatedness. 
We conclude for a post-pandemic future that online teaching will supplement 
rather than replace face-to-face teaching in higher education institutions, as 
their importance for building relationships and satisfying social interactions 
not only for students but also for faculty seem to have been underestimated so 
far.

DOI: 10.1371/journal.pone.0272738
PMCID: PMC9536586
PMID: 36201409 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


1458. Sci Rep. 2022 Oct 5;12(1):16659. doi: 10.1038/s41598-022-21053-2.

The impact of the initial COVID-19 outbreak on young adults' mental health: a 
longitudinal study of risk and resilience factors.

Wiedemann A(1)(2)(3), Stochl J(4)(5)(6), Neufeld SAS(4), Fritz J(4)(7), Bhatti 
J(4), Hook RW(4); NSPN Consortium; Goodyer IM(4), Dolan RJ(8), Bullmore ET(4), 
Chamberlain SR(9)(10), Fonagy P(11), Perez J(4)(12)(5)(13)(14), Jones 
PB(4)(12)(5).

Collaborators: Bullmore E, Dolan R, Goodyer I, Fonagy P, Jones P, Moutoussis M, 
Hauser T, Neufeld S, Romero-Garcia R, Clair MS, Vértes P, Whitaker K, Inkster B, 
Prabhu G, Ooi C, Toseeb U, Widmer B, Bhatti J, Villis L, Alrumaithi A, Birt S, 
Bowler A, Cleridou K, Dadabhoy H, Davies E, Firkins A, Granville S, Harding E, 
Hopkins A, Isaacs D, King J, Kokorikou D, Maurice C, McIntosh C, Memarzia J, 
Mills H, O'Donnell C, Pantaleone S, Scott J, Kiddle B, Polek E, Fearon P, 
Suckling J, van Harmelen AL, Kievit R, Chamberlain S, Bethlehem RAI.

Author information:
(1)Department of Psychiatry, University of Cambridge, Douglas House, 18B 
Trumpington Road, Cambridge, CB2 8AH, UK. aw778@medschl.cam.ac.uk.
(2)Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK. 
aw778@medschl.cam.ac.uk.
(3)National Institute for Health Research, Applied Research Collaboration, East 
of England, Cambridge, UK. aw778@medschl.cam.ac.uk.
(4)Department of Psychiatry, University of Cambridge, Douglas House, 18B 
Trumpington Road, Cambridge, CB2 8AH, UK.
(5)National Institute for Health Research, Applied Research Collaboration, East 
of England, Cambridge, UK.
(6)Department of Kinanthropology and Humanities, Charles University, Prague, 
Czechia.
(7)Department of Clinical Psychology, Philipps University of Marburg, Marburg, 
Germany.
(8)Max Planck UCL Centre for Computational Psychiatry and Ageing Research, 
London, UK.
(9)Department of Psychiatry, Faculty of Medicine, University of Southampton, 
Southampton, UK.
(10)Southern Health NHS Foundation Trust, Southampton, UK.
(11)Research Department of Clinical, Educational and Health Psychology, 
University College London, London, UK.
(12)Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
(13)Norwich Medical School, University of East Anglia, Norwich, UK.
(14)Department of Medicine, Institute of Biomedical Research (IBSAL), University 
of Salamanca, Salamanca, Spain.

Few studies assessing the effects of COVID-19 on mental health include 
prospective markers of risk and resilience necessary to understand and mitigate 
the combined impacts of the pandemic, lockdowns, and other societal responses. 
This population-based study of young adults includes individuals from the 
Neuroscience in Psychiatry Network (n = 2403) recruited from English primary 
care services and schools in 2012-2013 when aged 14-24. Participants were 
followed up three times thereafter, most recently during the initial outbreak of 
the COVID-19 outbreak when they were aged between 19 and 34. Repeated measures 
of psychological distress (K6) and mental wellbeing (SWEMWBS) were supplemented 
at the latest assessment by clinical measures of depression (PHQ-9) and anxiety 
(GAD-7). A total of 1000 participants, 42% of the original cohort, returned to 
take part in the COVID-19 follow-up; 737 completed all four assessments [mean 
age (SD), 25.6 (3.2) years; 65.4% female; 79.1% White]. Our findings show that 
the pandemic led to pronounced deviations from existing mental health-related 
trajectories compared to expected levels over approximately seven years. About 
three-in-ten young adults reported clinically significant depression (28.8%) or 
anxiety (27.6%) under current NHS guidelines; two-in-ten met clinical cut-offs 
for both. About 9% reported levels of psychological distress likely to be 
associated with serious functional impairments that substantially interfere with 
major life activities; an increase by 3% compared to pre-pandemic levels. 
Deviations from personal trajectories were not necessarily restricted to 
conventional risk factors; however, individuals with pre-existing health 
conditions suffered disproportionately during the initial outbreak of the 
COVID-19 pandemic. Resilience factors known to support mental health, 
particularly in response to adverse events, were at best mildly protective of 
individual psychological responses to the pandemic. Our findings underline the 
importance of monitoring the long-term effects of the ongoing pandemic on young 
adults' mental health, an age group at particular risk for the emergence of 
psychopathologies. Our findings further suggest that maintaining access to 
mental health care services during future waves, or potential new pandemics, is 
particularly crucial for those with pre-existing health conditions. Even though 
resilience factors known to support mental health were only mildly protective 
during the initial outbreak of the COVID-19 pandemic, it remains to be seen 
whether these factors facilitate mental health in the long term.

© 2022. The Author(s).

DOI: 10.1038/s41598-022-21053-2
PMCID: PMC9533974
PMID: 36198725 [Indexed for MEDLINE]

Conflict of interest statement: ETB serves on the scientific advisory board of 
Sosei Heptares and as a consultant for GlaxoSmithKline and Monument 
Therapeutics. SRC receives honoraria from Elsevier for editorial work outside of 
the submitted work. Previously, he also consulted for Promentis. All other 
authors declare no competing interests.


1459. J Epidemiol Glob Health. 2022 Dec;12(4):441-448. doi: 
10.1007/s44197-022-00062-4. Epub 2022 Oct 5.

Effects of Physical Activity on College Students' Subjective Well-Being During 
COVID-19.

Yuan S(1), You M(2).

Author information:
(1)College of Physical Education of China University of Geosciences, Wuhan, 
Hubei, China.
(2)College of Physical Education of China University of Geosciences, Wuhan, 
Hubei, China. youmaolin@126.com.

BACKGROUND: The COVID-19 outbreak has caused widespread psychological distress 
to Chinese college students. To explore the beneficial psychological effects of 
physical activity, this study accessed the relationship of Physical Activity 
(PA) and Subjective Well-being (SWB) among Chinese college students during the 
pandemic.
METHODS: A total of 1198 college students (aged between 17 and 40) from 8 
universities in Wuhan, China, volunteered to finish the online questionnaire 
survey from February 17 to 20, 2020. General Well-Being Schedule (GWBS) was used 
to evaluate SWB, and Physical Activity Rating Scale-3 (PARS-3) was used to 
measure PA. The Mann-Whitney U test, χ2 test, t test, and analysis of variance 
were used to compare the differences between groups based on different data 
types. A multi-factor linear regression analysis was performed on the factors 
affecting college students' participation in physical activity during the 
pandemic. Differences were considered statistically significant when p < .05.
RESULTS: It found that: (1) The quality of physical activity during COVID-19 
significantly and positively predicted subjective well-being (B = 2.512, 
p < .001), indicating that physical activity can effectively alleviate adverse 
mental health effects caused by the pandemic. (2) The pandemic has had a greater 
impact on the mental health of specific groups (such as seniors and rural 
college students). Supporting and encouraging them to participate in a certain 
level of sports activities can improve their subjective well-being, which is 
helpful for countering the pandemic's adverse effects. (3) People should be 
encouraged to participate in sports at moderate or high levels.
CONCLUSION: PA can effectively alleviate the negative psychological impact of 
the pandemic. In general, during major public health emergencies, people should 
be supported and encouraged to regularly participate in physical activities at 
moderate or higher levels, to improve their subjective well-being, and maintain 
positive anti-pandemic attitudes and behavior.

© 2022. The Author(s).

DOI: 10.1007/s44197-022-00062-4
PMCID: PMC9533984
PMID: 36197597 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflicts 
of interest. The funders had no role in the design of the study; in the 
collection, analyses, or interpretation of data; in the writing of the 
manuscript, or in the decision to publish the results.


1460. Appetite. 2023 Jan 1;180:106331. doi: 10.1016/j.appet.2022.106331. Epub 2022 Oct 
1.

A longitudinal study on changes in food parenting practices during COVID-19 and 
the role of parental well-being.

Larsen JK(1), van den Broek N(2), Verhagen M(2), Burk WJ(2), Vink JM(2).

Author information:
(1)Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands. 
Electronic address: junilla.larsen@ru.nl.
(2)Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands.

The COVID-19 pandemic may negatively influence food parenting practices, also 
among parents of adolescents. Parental well-being (stress and depressive 
symptoms) may explain these COVID-19 related changes in food parenting practices 
(snack structure, healthy structure, modeling, autonomy support, and coercive 
control). However, most previous studies performed before or during the COVID-19 
pandemic have been limited by cross-sectional designs. The aim of the current 
study among parents of adolescent children was twofold. First, we aimed to 
examine prospective differences in food parenting practices comparing the 
situation before and during COVID-19. Second, we aimed to examine both 
cross-sectional and longitudinal associations between parental well-being and 
the dimensions of food parenting, while additionally examining whether these 
prospective associations were more pronounced in parents who had experienced 
more COVID-19 stressful life events. Parents (N = 290; 74.9% female; at 
baseline: Mage = 46.9; SDage = 4.3) of adolescent children (at baseline: 
Mage = 14.3; SDage = 0.6) completed online surveys about parental well-being and 
food parenting twice: One year before the COVID-19 pandemic (spring 2019) and 
during the COVID-19 pandemic, 1.5 years after the first measurement (autumn 
2020). In general, we found consistent evidence for an average decrease in food 
autonomy support and an increase in coercive control during COVID-19. However, 
parental well-being did not seem to explain (changes in) food parenting 
practices during COVID-19, also not in combination with stressful life events. 
Our findings suggest that, regardless of parental well-being, the general 
COVID-19 situation had some small negative influences on autonomy support and 
coercive control among parents of adolescents. These findings might be explained 
by parents being more often confronted with unhealthy eating occasions in the 
COVID-19 home context, triggering these negative parental responses.

Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.appet.2022.106331
PMCID: PMC9525240
PMID: 36195190 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


1461. PLoS One. 2022 Oct 4;17(10):e0275494. doi: 10.1371/journal.pone.0275494. 
eCollection 2022.

Second victim experiences and moral injury as predictors of hospitalist burnout 
before and during the COVID-19 pandemic.

Chandrabhatla T(1), Asgedom H(2), Gaudiano ZP(1), de Avila L(3), Roach KL(1), 
Venkatesan C(1), Weinstein AA(2)(3)(4), Younossi ZM(1)(4).

Author information:
(1)Department of Medicine, Inova Fairfax Hospital, Fairfax, VA, United States of 
America.
(2)Department of Global and Community Health, College of Health and Human 
Services, George Mason University, Fairfax, VA, United States of America.
(3)Betty and Guy Beatty Center for Integrated Research, Inova Health System, 
Falls Church, VA, United States of America.
(4)Center for the Advancement of Well-Being, George Mason University, Fairfax, 
VA, United States of America.

BACKGROUND: The increasing number of physicians leaving practice, especially 
hospitalists, has been well-documented. The most commonly examined factor 
associated with this exodus has been burnout. The COVID-19 pandemic has put a 
unique and unprecedented stress on hospitalists who have been at the front lines 
of patient care. Therefore, the investigation of burnout and its related factors 
in hospitalists is essential to preventing future physician shortages.
OBJECTIVE: This study examined the relationship between burnout, second victim, 
and moral injury experiences before and during the COVID-19 pandemic among 
hospitalists.
METHODS: Two anonymous cross-sectional surveys of hospitalists from a community 
hospital in the metropolitan Washington, DC area were conducted. One was 
conducted pre-COVID-19 (September-November 2019) and one was conducted during 
COVID-19 (July-August 2020). The surveys were sent to all full-time hospitalists 
via an online survey platform. A variety of areas were assessed including 
demographic (e.g., age, gender), work information (e.g., hours per week, years 
of experience), burnout, second victim experiences, well-being, and moral 
injury.
RESULTS: Burnout rates among providers during these two time periods were 
similar. Second victim experiences remained prevalent in those who experienced 
burnout both pre and during COVID-19, but interestingly the prevalence increased 
in those without burnout during COVID-19. Moral injury was predictive of burnout 
during COVID-19.
CONCLUSION: While there were some factors that predicted burnout that were 
similar both pre- and during-pandemic, moral injury was unique to predicting 
burnout during COVID-19. With burnout as a contributing factor to future 
physician shortages, it is imperative that predictive factors in a variety of 
different environments are well understood to prevent future shortages. 
Hospitalists may be an excellent barometer of these factors given their presence 
on the front line during the pandemic, and their experiences need to be further 
explored so that targeted interventions aimed at addressing those factors may be 
created.

DOI: 10.1371/journal.pone.0275494
PMCID: PMC9531782
PMID: 36194588 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


1462. BMJ Open. 2022 Sep 2;12(9):e063455. doi: 10.1136/bmjopen-2022-063455.

Running on empty: a longitudinal global study of psychological well-being among 
runners during the COVID-19 pandemic.

Vistisen HT(1)(2), Sønderskov KM(3)(4), Dinesen PT(5)(6), Brund RBK(7), Nielsen 
RØ(8)(9), Østergaard SD(10)(2).

Author information:
(1)Department of Affective Disorders, Aarhus University Hospital, Aarhus, 
Denmark.
(2)Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
(3)Department of Political Science, Aarhus University, Aarhus, Denmark.
(4)Centre for the Experimental-Philosophical Study of Discrimination, Aarhus 
University, Aarhus, Denmark.
(5)Department of Political Science, University of Copenhagen, Copenhagen, 
Denmark.
(6)Department of Political Science, University College London, London, UK.
(7)Sport Sciences, Department of Health Science and Technology, Aalborg 
University, Aalborg, Denmark.
(8)Department of Public Health, Aarhus University, Aarhus, Denmark.
(9)Research Unit for General Practice, Aarhus University, Aarhus, Denmark.
(10)Department of Affective Disorders, Aarhus University Hospital, Aarhus, 
Denmark soeoes@rm.dk.

OBJECTIVES: There are indications that the COVID-19 pandemic has had a profound 
negative effect on psychological well-being. Here, we investigated this 
hypothesis using longitudinal data from a large global cohort of runners, 
providing unprecedented leverage for understanding how the temporal development 
in the pandemic pressure relates to well-being across countries.
DESIGN: Prospective cohort study.
SETTING: Global.
PARTICIPANTS: We used data from the worldwide Garmin-RUNSAFE cohort that 
recruited runners with a Garmin Connect account, which is used for storing 
running activities tracked by a Garmin device. A total of 7808 Garmin Connect 
users from 86 countries participated.
PRIMARY AND SECONDARY OUTCOME MEASURES: From 1 August 2019 (prepandemic) to 31 
December 2020, participants completed surveys every second week that included 
the five-item WHO Well-Being Index (WHO-5). Pandemic pressure was proxied by the 
number of COVID-19-related deaths per country, retrieved from the Coronavirus 
Resource Centre at Johns Hopkins University. Panel data regression including 
individual- and time-fixed effects was used to study the association between 
country-level COVID-19-related deaths over the past 14 days and individual-level 
self-reported well-being over the past 14 days.
RESULTS: The 7808 participants completed a total of 125 409 WHO-5 records over 
the study period. We found a statistically significant inverse relationship 
between the number of COVID-19-related deaths and the level of psychological 
well-being-independent of running activity and running injuries (a reduction of 
1.42 WHO-5 points per COVID-19-related death per 10 000 individuals, p<0.001).
CONCLUSIONS: This study suggests that the COVID-19 pandemic has had a negative 
effect on the psychological well-being of the affected populations, which is 
concerning from a global mental health perspective.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2022-063455
PMCID: PMC9441734
PMID: 36194449 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: SDØ received the 2020 
Lundbeck Foundation Young Investigator Prize. Furthermore, SDØ owns units of 
mutual funds with stock tickers DKIGI and WEKAFKI, as well as units of exchange 
traded funds with stock tickers TRET and EUNL. The remaining authors report no 
conflicts of interest.


1463. Acta Psychol (Amst). 2022 Oct;230:103759. doi: 10.1016/j.actpsy.2022.103759. 
Epub 2022 Sep 28.

Impact of COVID-19 anxiety on loneliness and sleep quality of students and 
professionals in Bangladesh.

Bakul F(1), Heanoy EZ(2).

Author information:
(1)Department of Psychology, 2nd Floor, Arts Building, University of Dhaka, 
Nilkhet-1000, Bangladesh. Electronic address: fariea.bakul@du.ac.bd.
(2)Department of Psychology, University of Alberta, Edmonton, AB T6G2E9, Canada. 
Electronic address: heanoy@ualberta.ca.

The COVID-19 pandemic has globally affected almost every aspect of people's 
lives, especially, their physical and mental well-being. The degree of its 
impact, however, is different from place-to-place and person-to-person. Although 
there is a growing literature on the variable impact of the pandemic on the 
quality of sleep, loneliness, and mood across different populations (e.g., 
students, health-workers), little is known about how COVID-19-specific anxiety 
affects the loneliness feeling and sleep quality among students and employees, 
specifically, in a low-resource region like Bangladesh. The present study aimed 
to investigate the effect of COVID-related anxiety on the feeling of loneliness 
and sleep quality of students and professionals in Bangladesh. Additionally, we 
were interested in comparing the level of COVID-specific anxiety, loneliness, 
and quality of sleep between these two groups. In total, 211 Bangladeshi 
students and professionals participated in an online survey in August 2021 when 
the restriction was still in place. Measures of COVID-19 anxiety, loneliness, 
and sleep quality scales were used. Regression analysis indicated that overall 
loneliness and poor sleep quality were strongly predicted by COVID-specific 
anxiety regardless of being a student or professional. Almost half of the study 
population (48.3 %) felt severe loneliness and 70.01 % were bad sleepers. 
Mann-Whitney U test revealed that professionals felt more emotionally lonely, 
had a higher level of COVID-19-specific anxiety, and had poorer sleep quality 
than students. A better support structure should be implemented to help the 
population, particularly, the professionals to lessen their COVID-19-related 
anxiety and loneliness, and promote better sleep for alleviating stress and 
improved well-being.

Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.actpsy.2022.103759
PMCID: PMC9515348
PMID: 36191482 [Indexed for MEDLINE]

Conflict of interest statement: Competing interest The authors declare no 
competing interests.


1464. Front Public Health. 2022 Sep 14;10:952269. doi: 10.3389/fpubh.2022.952269. 
eCollection 2022.

Burnout, negative emotions, and wellbeing among social workers in China after 
community lockdowns during the COVID-19 pandemic: Mediating roles of trait 
mindfulness.

Wu Y(1), Wei Y(2), Li Y(1), Pang J(3), Su Y(4).

Author information:
(1)Beijing Huilongguan Hospital Clinical Department III, Peking University 
Huilongguan Medical College, Beijing, China.
(2)Zhongke Boai (Beijing) Institute of Psychological Medicine, Beijing, China.
(3)Guangzhou Juenian Consulting Co., Ltd., Guangzhou, China.
(4)Hainan Mindfulness Education Technology Co., Ltd., Haikou, China.

OBJECTIVE: This study aimed to investigate burnout situation of social workers 
(SWs) who experienced the COVID-19 pandemic-related community lockdown 1 year 
before, and to assess the protective value of trait mindfulness (TM) in states 
of burnout.
METHOD: We surveyed the burnout, trait mindfulness, negative emotions (NEs) and 
wellbeing (WB) of 182 social workers provided services to Wuhan lockdowns 
community by COVID-19 one year before. Burnout were measured using the Maslach 
Burnout Inventory-Human Services Survey; TM using the Mindful Attention 
Awareness Scale; NEs using the Depression Anxiety and Stress Scale-21; and WB 
using the General Wellbeing Schedule. We also performed correlation regression 
analysis and mediation test for burnout, TM, NEs, and WB.
RESULTS: Among the 182 respondents, 75 (41.2%) still suffered from severe 
burnout. TM was negatively correlated with burnout (r = -0.623), negatively 
correlated with NEs (r = -0.560), and positively correlated with WB (r = 0.617). 
Burnout had a significantly positive correlation with NEs (r = 0.544) and a 
significantly negative correlation with WB (r = -0.666). Further, WB had 
significantly negative correlation with NEs (r = -0.758). After controlling for 
age, gender, marital status, educational level, and years of employment, burnout 
had a significantly positive predictive effect on NEs (β = 0.509), whereas TM 
had a significantly negative predictive effect on NEs (β = -0.334). TM played a 
partial mediating role in the effect of burnout on NEs, with a mediating effect 
and effect ratio of 0.088 and 39.7%, respectively. Burnout had a significantly 
negative predictive effect on WB (β = -0.598), whereas TM had a significantly 
positive predictive effect on WB (β = 0.299). TM played a partial mediating role 
in the effect of burnout on NEs, with a mediating effect and effect ratio of 
-0.164 and 30.3%, respectively. WB had a significantly negative predictive 
effect on NEs (β = -0.711), and it played a partial mediating role in the effect 
of burnout on NEs, with a mediating effect and effect ratio of 0.185 and 83.3%, 
respectively.
CONCLUSION: The current levels of burnout among local SWs remained high 1 year 
after the community lockdowns. TM played a mediating role in the relationship 
between burnout, NEs, and WB. Concomitantly, WB played a mediating role in the 
relationship between burnout and NEs. Therefore, in the context of burnout, TM 
is a protective factor for reducing emotional stress and risks of developing 
psychiatric disorders through the enhancement of WB.

Copyright © 2022 Wu, Wei, Li, Pang and Su.

DOI: 10.3389/fpubh.2022.952269
PMCID: PMC9516329
PMID: 36187705 [Indexed for MEDLINE]

Conflict of interest statement: Author JP was employed by Guangzhou Juenian 
Consulting Co., Ltd. Author YS was employed by Hainan Mindfulness Education 
Technology Co., Ltd. The remaining authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1465. Front Pediatr. 2022 Sep 15;10:909210. doi: 10.3389/fped.2022.909210. eCollection 
2022.

The parental psychological distress caused by separation from their critically 
ill child during the COVID-19 pandemic: A tale of two cities.

Camporesi A(1), Abecasis F(2), Torres EM(2), Zoia E(1), Izzo F(1), Ferrario 
S(1), Melloni EMT(3)(4).

Author information:
(1)Department of Pediatric Anesthesia and Intensive Care, Children's Hospital 
"Vittore Buzzi", Milan, Italy.
(2)Pediatric Intensive Care Unit, Centro Hospitalar Universitário Lisboa Norte, 
Lisbon, Portugal.
(3)Psychiatry & Clinical Psychobiology Unit, Division of Neuroscience, 
Scientific Institute Ospedale San Raffaele, Milan, Italy.
(4)University Vita-Salute San Raffaele, Milan, Italy.

INTRODUCTION: A child's critical illness is a stressful event for the entire 
family, causing significant emotional distress among parents and changes to 
family functioning. The Severe Acute Respiratory Syndrome-Related Coronavirus 2 
(SARS-CoV-2) pandemic has abruptly caused modifications in visitation policies 
of Pediatric Intensive Care Units (PICUs) in many countries. We hypothesized 
that caregivers with no or severely restricted access to PICUs would demonstrate 
increased psychological distress as compared to those who had limitless access 
(LA) to PICUs.
METHODS: Sociodemographic variables, levels of psychological distress, ratings 
of family functioning, and ability to cope with stressful events were collected 
with an online survey in a group of caregivers after their child's 
hospitalization. Ratings of psychological distress were compared between 
caregivers with no/severely restricted (NA) and with LA to PICUs.
RESULTS: Measures of depression, anxiety, and global severity index (GSI) of 
psychological distress were significantly higher in NA caregivers as compared to 
LA. Among demographic characteristics of the sample, only gender influenced the 
severity of psychological symptoms: women showed an increased score on levels of 
somatization, depression, anxiety, and GSI. Avoidant coping style positively 
correlated with measures of depression. Univariate General Linear Model (GLM) 
analyses of the effects of sex, age, visitation policies of PICUs, and score of 
avoidant coping strategies on measures of psychological distress confirmed a 
significant univariate effect of no access to PICUs on parents' 
psychopathological scores.
CONCLUSION: Restrictions imposed on visitation policies in PICU during the 
pandemic negatively impacted families' psychological wellbeing. A balance 
between the safety of patients, families, and health care professionals and 
meeting the needs of families is of utmost importance.

Copyright © 2022 Camporesi, Abecasis, Torres, Zoia, Izzo, Ferrario and Melloni.

DOI: 10.3389/fped.2022.909210
PMCID: PMC9520916
PMID: 36186626

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1466. Health Soc Care Community. 2022 Nov;30(6):e6163-e6174. doi: 10.1111/hsc.14053. 
Epub 2022 Oct 2.

Adaptive responding to prolonged stress exposure: A binational study on the 
impact of flexibility on latent profiles of cognitive, emotional and behavioural 
responses to the COVID-19 pandemic.

Hemi A(1), Sopp MR(1)(2), Schäfer SK(3), Michael T(2), Levy-Gigi E(1)(4).

Author information:
(1)Faculty of Education, Bar Ilan University, Israel.
(2)Division of Clinical Psychology and Psychotherapy, Department of Psychology, 
Saarland University, Saarbrücken, Germany.
(3)Leibniz Institute for Resilience Research (LIR), Berlin, Germany.
(4)The Gonda Multidisciplinary Brain Research Center, Bar Ilan University, 
Israel.

The high level of uncertainty brought about by the COVID-19 pandemic has 
affected the general population's well-being and capacity for adaptive 
responding. Studies indicate that flexibility, defined as the ability to choose 
and employ a variety of emotional, cognitive and behavioural strategies in 
accordance with changing contextual demands, may significantly contribute to 
adaptive responding to long-term stressors such as COVID-19. In the current 
study, we aimed to investigate which facets of flexibility predict different 
latent profiles of adaptive responding to the COVID-19 pandemic in Israel and 
Germany. A total of 2330 Israelis and 743 Germans completed online 
questionnaires measuring cognitive and coping regulatory flexibility and 
cognitive, emotional and behavioural responding to the COVID-19 pandemic. 
Analyses revealed three distinct response profiles in each country (high, medium 
and low). These profiles differed in both anxiety and depression symptoms with 
the non-adaptive response group experiencing clinically relevant symptoms both 
in Israel and Germany. Additionally, cognitive flexibility and coping 
flexibility emerged as significant predictors of response profiles in both 
countries. Training cognitive and coping flexibility may thus help individuals 
respond more adaptively to psychosocial stressors such as COVID-19. Such 
training could be selectively administered to less flexible subpopulations as 
well as adapted to the specific population characteristics.

© 2022 The Authors. Health and Social Care in the Community published by John 
Wiley & Sons Ltd.

DOI: 10.1111/hsc.14053
PMCID: PMC10092359
PMID: 36184793 [Indexed for MEDLINE]

Conflict of interest statement: We have no conflict of interest to disclose.


1467. Women Birth. 2023 May;36(3):305-313. doi: 10.1016/j.wombi.2022.09.007. Epub 2022 
Sep 30.

Maternity care during a pandemic: Can a hybrid telehealth model comprising group 
interdisciplinary education support maternal psychological health?

Buultjens M(1), Gill J(2), Fielding J(2), Lambert KA(2), Vondeling K(2), Mastwyk 
SE(3), Sloane S(3), Fedele W(3), Karimi L(4), Milgrom J(5), von Treuer K(6), 
Erbas B(2).

Author information:
(1)School of Psychology and Public Health, La Trobe University, Melbourne, 
Australia. Electronic address: M.Buultjens@latrobe.edu.au.
(2)School of Psychology and Public Health, La Trobe University, Melbourne, 
Australia.
(3)School of Allied Health, Human Services and Sport, La Trobe University, 
Melbourne, Australia.
(4)School of Applied Health, Psychology Department, RMIT University, Melbourne, 
Australia. Electronic address: leila.karimi@rmit.edu.au.
(5)Parent-Infant Research Institute (PIRI), Australia and Melbourne School of 
Psychological Science, University of Melbourne, Australia.
(6)Cairnmillar Institute, Melbourne, Australia.

BACKGROUND: The transition to parenthood is one of the most challenging across 
the life course, with profound changes that can impact psychological health. In 
response to the coronavirus disease 2019 (COVID-19), came the rapid 
implementation of remote antenatal care, i.e., telehealth, with fewer in-person 
consultations. A change in service delivery in addition to the cancellation of 
antenatal education represented a potential threat to a woman's experience - 
with likely adverse effects on mental health and wellbeing.
AIM: To explore a hybrid model of pregnancy care, i.e., telehealth and fewer 
in-person health assessments, coupled with concurrent small group 
interdisciplinary education delivered via video conferencing, extending into the 
postnatal period.
METHODS: Using a quasi-experimental design with an interrupted time series and a 
control group, this population-based study recruited low-risk women booking for 
maternity care at one community health site affiliated with a large public 
hospital in Victoria, Australia.
FINDINGS: Whilst there was no difference in stress and anxiety scores, a 
significant interactive effect of the hybrid model of care with time was seen in 
the DASS depression score (-1.17, 95% CI: -1.81, -0.53) and the EPDS (-0.83, 95% 
CI: -1.5, -0.15).
DISCUSSION: The analyses provide important exploratory findings regarding the 
positive effects of a hybrid model of care with interdisciplinary education in 
supporting mental health of first-time mothers.
CONCLUSION: This study demonstrates that small group online education scheduled 
in conjunction with individual pregnancy health assessments can be executed 
within a busy antenatal clinic with promising results and modest but dedicated 
staff support.

Copyright © 2022 Australian College of Midwives. Published by Elsevier Ltd. All 
rights reserved.

DOI: 10.1016/j.wombi.2022.09.007
PMCID: PMC9551992
PMID: 36184532 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest The authors declare no 
conflict of interest.


1468. Prev Med. 2022 Dec;165(Pt A):107280. doi: 10.1016/j.ypmed.2022.107280. Epub 2022 
Sep 29.

Gun violence in K-12 schools in the United States: Moving towards a preventive 
(versus reactive) framework.

Rajan S(1), Reeping PM(2), Ladhani Z(3), Vasudevan LM(4), Branas CC(2).

Author information:
(1)Department of Health and Behavior Studies, Teachers College, Columbia 
University., United States of America; Department of Epidemiology, Mailman 
School of Public Health, Columbia University., United States of America. 
Electronic address: sr2345@tc.columbia.edu.
(2)Department of Epidemiology, Mailman School of Public Health, Columbia 
University., United States of America.
(3)Department of Health and Behavior Studies, Teachers College, Columbia 
University., United States of America.
(4)Department of Mathematics, Science, and Technology, Teachers College, 
Columbia University., United States of America.

Intentional shootings in K-12 schools in the U.S. persist as a public health 
problem. The number of shootings in K-12 schools has increased precipitously 
since 2017. And with approximately 100,000 K-12 public schools nationally 
serving 51 million children, investing in a comprehensive gun violence 
prevention strategy is critical. Unfortunately, our current school gun violence 
prevention approach almost exclusively centers reactive strategies that are in 
place to respond to acts of gun violence in the moment, rather than preventive 
strategies that would prevent them from occurring at all. Reliance on these 
strategies alone, however, is not sufficient. In line with the core tenets of 
public health prevention and the Whole School, Whole Child, Whole Community 
model, we present a more expansive school gun violence prevention framework that 
broadens the spectrum of what constitutes "school gun violence prevention." Our 
work highlights how enhancing basic neighborhood and school structures-including 
investments in public libraries, affordable housing, and universal school-based 
violence prevention programs-are key to both preventing gun violence and 
promoting well-being. We also highlight the role of stricter gun laws, 
reasonable school security efforts, bystander interventions, building awareness 
within school communities, and meaningful investments in early interventions and 
mental health services. Children, who have been tragically exposed to any number 
of adverse experiences in the wake of the COVID-19 pandemic, deserve more 
reasoned choices and large-scale investments in understanding and cutting off 
the root causes of school gun violence; not just a reliance on strategies that 
focus on what to do in the moment of a violent act. As gun violence in K-12 
schools persists, we must reframe the discourse about school gun violence around 
prevention, not reaction.

Copyright © 2022 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.ypmed.2022.107280
PMID: 36183796 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


1469. Nutrition. 2022 Nov-Dec;103-104:111825. doi: 10.1016/j.nut.2022.111825. Epub 
2022 Aug 20.

Emotional eating and depression during the pandemic: QuarantEat, an Italian 
nationwide survey.

Lo Moro G(1), Bert F(1), Catozzi D(1), Scacchi A(2), Siliquini R(1).

Author information:
(1)Department of Public Health Sciences, University of Torino, Torino, Italy.
(2)Department of Public Health Sciences, University of Torino, Torino, Italy. 
Electronic address: alessandro.scacchi@unito.it.

OBJECTIVES: This study aimed to explore the consequences of the pandemic 
lockdown among the Italian general population by focusing on depression and 
emotional overeating (EO).
METHODS: QuarantEat was an Italian, nationwide, cross-sectional study conducted 
using a computer-assisted web interview method (May 6-31, 2020). The 40-item 
questionnaire included the five-item World Health Organization Wellbeing Index 
and EO Questionnaire-5. Multivariable logistic regressions were performed.
RESULTS: A total of 1865 adults participated in the study. Depression and EO 
were reported by 57.6% and 49.3%, respectively, of the sample. When considering 
multivariable models, women, students, participants who smoked more/equal during 
lockdown, and individuals with EO were more likely to report depression. 
Following a healthier diet or exercising during lockdown reduced the probability 
of depression. The likelihood of EO was higher for participants who were female, 
consumed more food, had a less healthy diet, were overweight and obese, consumed 
more chocolate, consumed more snacks between meals or before going to 
sleep/during the night, and were at risk for depression. Increasing age, having 
a relationship, and not having increased television/computer watching time while 
eating reduced the odds of EO.
CONCLUSIONS: QuarantEat highlighted high levels of depression and EO right after 
the end of pandemic lockdown measures, and outlined the importance of the 
relationships between mental health and health risk behaviors, such as smoking, 
exercise, diet, and changes in eating behaviors due to the pandemic lockdown. 
Planning interventions using a holistic approach and reaching every individual 
to overcome the limits caused by the restrictive lockdown measures is essential.

Copyright © 2022 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.nut.2022.111825
PMID: 36183485 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


1470. Intern Emerg Med. 2023 Jan;18(1):53-65. doi: 10.1007/s11739-022-03108-4. Epub 
2022 Oct 1.

The impact of COVID-19 pandemic on well-being of Italian physicians: a report 
from the Italian Society of Internal Medicine (SIMI) national survey.

Romiti GF(#)(1), Bencivenga L(#)(2)(3), Villani R(4), Cicco S(5), Cimellaro 
A(6), Dalbeni A(7), Talerico G(8), Pietrangelo A(9), Sesti G(10), Zaccone V(11); 
Giovani Internisti SIMI (GIS).

Collaborators: Armentaro G, Arnone MI, Barone M, Bencivenga L, Bertolino L, 
Bianco S, Binello N, Brancati S, Buzzetti E, Capeci W, Cicco S, Cordeddu W, 
Curcio R, Dalbeni A, D'Abbondanza M, D'Agnano S, D'Ardes D, De Feo M, Di Marca 
S, Donnarumma E, Fei M, Filippini E, Gambino CG, Lombardi R, Marra AM, Mattioli 
M, Miceli G, Noviello S, Olivieri G, Padula D, Parente R, Pes C, Piano S, 
Pignataro FS, Poma S, Porceddu E, Ricchio M, Romiti GF, Sabena A, Salice M, 
Salzano A, Sangineto M, Savona A, Savrié C, Stabile M, Susca N, Talerico G, 
Teatini T, Tombolini E, Traversa M, Vettore E, Vignali A, Villani R, Vilardi L, 
Zaccone V.

Author information:
(1)Department of Translational and Precision Medicine, Sapienza - University of 
Rome, Rome, Italy.
(2)Dipartimento Di Scienze Biomediche Avanzate, Università Degli Studi Di Napoli 
"Federico II", Naples, Italy.
(3)Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, 
Toulouse, France.
(4)Liver Unit - Dipartimento Di Scienze Mediche E Chirurgiche, Università Degli 
Studi Di Foggia, Foggia, Italy.
(5)Unit of Internal Medicine "Guido Baccelli", Department of Biomedical Sciences 
and Human Oncology, University of Bari, Piazza Giulio Cesare, 11, 70124, Bari, 
Italy. sebacicco@gmail.com.
(6)UOC Medicina Generale - Azienda Ospedaliera "Pugliese Ciaccio", Catanzaro, 
Italy.
(7)Sezione Di Medicina Interna C E Liver Unit, Dipartimento Di Medicina, Azienda 
Ospedaliero Universitaria Di Verona, Verona, Italy.
(8)UOC Medicina Interna - Policlinico Casilino, Rome, Italy.
(9)Department of Surgical and Medical Sciences for Children and Adults, Internal 
Medicine Unit, University of Modena and Reggio Emilia, Modena, Italy.
(10)Department of Clinical and Molecular Medicine, Sapienza University, Rome, 
Italy.
(11)Medicina Interna Generale E Subintensiva - Azienda Ospedaliera Universitaria 
Ospedali Riuniti, Ancona, Italy.
(#)Contributed equally

Over the past few years, COVID-19 pandemic has imposed a high toll worldwide, 
with a high burden of morbidity and mortality. Healthcare practitioners (HCPs) 
have been in the frontline since the beginning of the outbreak, and the high 
level of stress have affected their physical and mental status, as well as their 
relationships. We aimed at exploring the self-reported changes in comprehensive 
well-being in a cohort of Italian physicians. An online-based survey was 
administered to the members of the Italian Society of Internal Medicine (SIMI) 
between March and June 2021. The survey was based on 32 multiple-choice 
questions exploring self-reported physical and mental well-being, as well as 
changes in workloads, work-related feelings and physicians' relationship with 
patients, colleagues and families. 228 physicians (mean age: 35.7 ± 9.8 years) 
participated in the survey; 120 (52.6%) were residents, 196 (86.0%) worked in 
COVID-19 units and 65 (28.5%) had COVID-19 during the pandemic. A significant 
proportion of respondents reported to have experience onset or worsening of 
physical and mental symptoms, with insomnia/sleep disorders (58.3%) and mood 
swings (47.8%) being the most common, respectively. The burden of physical and 
mental consequences was broadly higher among residents compared to specialists, 
with the former reporting more frequently an increase in the number of worked 
hours (p = 0.020) and being more frequently infected with COVID-19 (35.0% vs. 
21.3, p = 0.032). Moreover, familiar and doctor-patient relationships were also 
considerably affected. Physicians have been suffering a wide spectrum of 
physical, mental and relational consequences during COVID-19 pandemic, with 
youngest doctors being more likely to present several physical and mental health 
symptoms. Further studies are needed to evaluate long-term consequences of 
COVID-19 pandemic on the well-being of HCPs, and potential preventive 
strategies.

© 2022. The Author(s).

DOI: 10.1007/s11739-022-03108-4
PMCID: PMC9526381
PMID: 36183031 [Indexed for MEDLINE]

Conflict of interest statement: None reported.


1471. Sci Rep. 2022 Oct 1;12(1):16484. doi: 10.1038/s41598-022-20977-z.

Exploring the over-time, multifaceted impacts of three COVID-19 lockdowns on 
aspects of capability, wellbeing and mental health across vulnerabilities in 
Austria.

Helter TM(1), Łaszewska A(2), Simon J(2)(3).

Author information:
(1)Department of Health Economics, Center for Public Health, Medical University 
of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria. 
timea.helter@meduniwien.ac.at.
(2)Department of Health Economics, Center for Public Health, Medical University 
of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria.
(3)Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, 
OX3 7JX, UK.

The Austrian government imposed multiple major lockdowns during the COVID-19 
pandemic, but the relevant measures and their perceptions varied over time. The 
aim of this study was to compare the over-time impacts of the three COVID-19 
lockdowns between March 2020 and December 2021 for (capability) wellbeing and 
mental health in Austria. Adult Austrian residents (n = 87) completed an online 
survey about their experiences during three COVID-19 lockdowns, including 
capabilities (OxCAP-MH), depression and anxiety (HADS), and general wellbeing 
(WHO-5). Differences across the baseline and follow-up scores of these 
instruments were summarised by demographic/socioeconomic characteristics. 
Longitudinal comparisons of the impacts of the lockdowns were conducted using 
random effect models on panel data for overall instrument scores and individual 
capability items. The levels of (capability) wellbeing and mental health 
decreased for most respondents across the three lockdowns: average 2.4% 
reduction in OxCAP-MH scores, 18.8% and 9% increases in HADS depression and 
anxiety subscale scores respectively, and 19.7% reduction in WHO-5 score between 
the first and third lockdowns. Mental health treatment prior to the pandemic, 
social support and satisfaction with government measures were the most 
influential characteristics that determine the association with impacts of the 
chain of lockdowns. Our study is the first to assess the differential capability 
limiting aspects of lockdowns over time alongside their impacts on mental health 
and general wellbeing and calls for special attention for mental health 
patients, isolation and satisfaction with government measures.

© 2022. The Author(s).

DOI: 10.1038/s41598-022-20977-z
PMCID: PMC9526204
PMID: 36182966 [Indexed for MEDLINE]

Conflict of interest statement: JS has led the development of the OxCAP-MH 
measure. The remaining authors declare that they have no conflict of interest.


1472. Sociol Health Illn. 2023 Jan;45(1):145-162. doi: 10.1111/1467-9566.13557. Epub 
2022 Oct 1.

Impact of COVID-19 inequalities on children: An intersectional analysis.

Lemkow-Tovías G(1), Lemkow L(2), Cash-Gibson L(3)(4)(5), Teixidó-Compañó E(6), 
Benach J(3)(4)(5)(7).

Author information:
(1)Facultat de Ciències Socials de Manresa, Universitat Vic-Universitat Central 
de Catalunya (UVic-UCC), Manresa, Spain.
(2)Institut de Ciència i Tecnologia Ambientals, Universitat Autònoma de 
Barcelona, Barcelona, Spain.
(3)Research Group on Health Inequalities, Environment, Employment Conditions 
Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, 
Universitat Pompeu Fabra, Barcelona, Catalonia, Spain.
(4)Johns Hopkins University - Pompeu Fabra University Public Policy Center 
(UPF-BSM), Barcelona, Catalonia, Spain.
(5)Pompeu Fabra University-UPF Barcelona School of Management (UPF-BSM), 
Barcelona, Spain.
(6)Facultat de Ciències de la Salut de Manresa, Universitat Vic-Universitat 
Central de Catalunya (UVic-UCC), Manresa, Spain.
(7)Ecological Humanities Research Group (GHECO), Universidad Autónoma, Madrid, 
Spain.

Societal concerns about the effects of the COVID-19 pandemic have largely 
focussed on the social groups most directly affected, such as the elderly and 
health workers. However, less focus has been placed on understanding the effects 
on other collectives, such as children. While children's physical health appears 
to be less affected than the adult population, their mental health, learning and 
wellbeing is likely to have been significantly negatively affected during the 
pandemic due to the varying policy restrictions, such as withdrawal from face to 
face schooling, limited peer-to-peer interactions and mobility and increased 
exposure to the digital world amongst other things. Children from vulnerable 
social backgrounds, and especially girls, will be most negatively affected by 
the impact of COVID-19, given their different intersecting realities and the 
power structures already negatively affecting them. To strengthen the 
understanding of the social determinants of the COVID-19 crisis that unequally 
influence children's health and wellbeing, this article presents a conceptual 
framework that considers the multiple axes of inequalities and power relations. 
This understanding can then be used to inform analyses and impact assessments, 
and in turn inform the development of effective and equitable mitigation 
strategies as well as assist to be better prepared for future pandemics.

© 2022 The Authors. Sociology of Health & Illness published by John Wiley & Sons 
Ltd on behalf of Foundation for the Sociology of Health & Illness.

DOI: 10.1111/1467-9566.13557
PMCID: PMC9538856
PMID: 36181484 [Indexed for MEDLINE]


1473. Early Interv Psychiatry. 2023 Mar;17(3):331-334. doi: 10.1111/eip.13358. Epub 
2022 Oct 1.

Help-seeking attitudes and behaviours for mental health problems in adolescents 
before and during the first COVID-19 school closures in Germany.

Lustig S(1)(2), Koenig J(3)(4)(5)(6), Bauer S(7), Moessner M(7), Bonnet S(2), 
Becker K(8)(9), Diestelkamp S(10), Eschenbeck H(11), Hiery A(8), Kohls E(12), 
Lehner L(11), Rummel-Kluge C(12), Thomasius R(10), Kaess M(2)(6); 
the ProHEAD Consortium.

Author information:
(1)Institute of Psychology, University of Heidelberg, Heidelberg, Germany.
(2)Department of Child and Adolescent Psychiatry, University Hospital 
Heidelberg, Heidelberg, Germany.
(3)Department of Child and Adolescent Psychiatry, Psychosomatics and 
Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany.
(4)Clinic and Polyclinic for Child and Adolescent Psychiatry, Psychosomatics and 
Psychotherapy, University Hospital Cologne, Cologne, Germany.
(5)Section for Experimental Child and Adolescent Psychiatry, Department of Child 
and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany.
(6)University Hospital of Child and Adolescent Psychiatry and Psychotherapy, 
University of Bern, Bern, Switzerland.
(7)Center for Psychotherapy Research, University Hospital Heidelberg, 
Heidelberg, Germany.
(8)Department of Child and Adolescent Psychiatry, Psychosomatics and 
Psychotherapy, Philipps-University of Marburg, Marburg, Germany.
(9)Marburg Center for Mind, Brain and Behavior, Philipps-University of Marburg, 
Marburg, Germany.
(10)German Center for Addiction Research in Childhood and Adolescence, 
University Hospital Hamburg-Eppendorf, Hamburg, Germany.
(11)Department of Psychology, University of Education Schwäbisch Gmünd, 
Schwäbisch Gmünd, Germany.
(12)Department of Psychiatry and Psychotherapy, University Leipzig, Leipzig, 
Germany.

AIM: Comparing measures of psychological wellbeing and help-seeking in youths 
before and within the first school closures due to the coronavirus disease 2019 
(COVID-19) pandemic enables a better understanding of the effects the pandemic 
has for those seeking professional help for mental health problems.
METHODS: Data were obtained from the Germany-based ProHEAD school study. 
Pre-lockdown and lockdown samples (n = 648) were compared regarding pupils' 
psychological wellbeing, help-seeking attitudes and help-seeking behaviour.
RESULTS: Participants from the lockdown sample showed greater positive attitudes 
towards seeking professional help, whereas psychological wellbeing and 
help-seeking behaviour remained stable.
CONCLUSIONS: Possible explanations may include an increased public discourse on 
mental health or self-selection bias for participation during lockdown.

© 2022 The Authors. Early Intervention in Psychiatry published by John Wiley & 
Sons Australia, Ltd.

DOI: 10.1111/eip.13358
PMID: 36181354 [Indexed for MEDLINE]


1474. BMJ Open. 2022 Sep 30;12(9):e064963. doi: 10.1136/bmjopen-2022-064963.

Understanding eating behaviours, mental health and weight change in young 
adults: protocol paper for an international longitudinal study.

Whatnall M(1)(2), Fozard T(3), Kolokotroni KZ(3), Marwood J(4), Evans T(4), Ells 
LJ(4), Burrows T(5)(2).

Author information:
(1)School of Health Sciences, College of Health, Medicine and Wellbeing, The 
University of Newcastle, Callaghan, New South Wales, Australia.
(2)Food and Nutrition Program, Hunter Medical Research Institute, New Lambton 
Heights, NSW, Australia.
(3)Centre for Psychological Research, School of Health Sciences, Leeds Beckett 
University, Leeds, UK.
(4)Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK.
(5)School of Health Sciences, College of Health, Medicine and Wellbeing, The 
University of Newcastle, Callaghan, New South Wales, Australia 
Tracy.Burrows@newcastle.edu.au.

INTRODUCTION: Understanding the complexities of change in eating behaviours, 
mental health, well-being and weight is crucial to inform healthcare and service 
provision, particularly in light of the exacerbating effects of the COVID-19 
pandemic. This study aims to address the need for more comprehensive 
cross-sectional and longitudinal evidence, by tracking eating behaviours, mental 
health, health related behaviours and weight over a 12-month period, in a sample 
of young adults (18-35 years) in the UK and Australia.
METHODS AND ANALYSIS: Online surveys administered via the Prolific online 
research platform will be used for data collection at baseline, 6 months and 
12 months. The survey (approximately 45 min) measures demographics, the impact 
of COVID-19, body mass index (BMI), weight management and health service usage, 
eating behaviours, personality, mental health, and health-related behaviours. An 
optional substudy component at each time point aims to validate self-reported 
weight in the main survey through images. Study inclusion criteria are; aged 
18-34 years at baseline, BMI ≥20 kg/m2, and residing in the UK or Australia. A 
target of 500 participants at baseline was set, recruited through Prolific, and 
with recruitment stratified by BMI, sex and country. The proposed analyses 
include creating static predictive models using baseline data (eg, using latent 
class analysis, factor analysis or similar), and mapping changes longitudinally 
(eg, using multivariate regressions). These analyses will enable changes in the 
study measures to be identified, as well as predictors and outcomes of change.
ETHICS AND DISSEMINATION: Ethical approval was granted by Leeds Beckett 
University, UK (reference number 86004) and the University of Newcastle, 
Australia (reference number H-2022-0110). Study findings will be disseminated 
through scientific journals, conferences, institute websites and social media, 
and briefings tailored to policy, practice and the public, with the intention to 
help inform the future development of health and well-being care and support for 
young adults across Australia and the UK.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2022-064963
PMCID: PMC9528627
PMID: 36180119 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


1475. J Psychosoc Nurs Ment Health Serv. 2022 Oct;60(10):2-3. doi: 
10.3928/02793695-20220909-02. Epub 2022 Oct 1.

The COVID-19 Pandemic Persists: What Do We Do To Preserve Mental Health and 
Well-Being of Populations?

Oruche UM(1).

Author information:
(1)Gordon Keller Professor of Nursing University of South Florida, College of 
Nursing Tampa, Florida.

DOI: 10.3928/02793695-20220909-02
PMID: 36179054 [Indexed for MEDLINE]


1476. Psychol Med. 2023 Aug;53(11):5356-5358. doi: 10.1017/S0033291722003208. Epub 
2022 Sep 30.

Internet use and psychological wellbeing among older adults in England: a 
difference-in-differences analysis over the COVID-19 pandemic.

Kung CSJ(1), Steptoe A(1).

Author information:
(1)Research Department of Epidemiology and Public Health, University College 
London, London, UK.

BACKGROUND: Longitudinal evidence on how Internet use affects the psychological 
wellbeing of older adults has been mixed. As policymakers invest in efforts to 
reduce the digital divide, it is important to have robust evidence on whether 
encouraging Internet use among older adults is beneficial, or potentially 
detrimental, to their wellbeing.
METHODS: We observe depressive symptoms and loneliness of adults aged 50 + in 
the nationally representative English Longitudinal Study of Ageing, from before 
(2018/19) to during the coronavirus disease 2019 (COVID-19) pandemic (June/July 
and November/December 2020). Our quasi-experimental difference-in-differences 
strategy compares within-individual wellbeing changes between older adults who 
desired to use the Internet more but experienced barriers including lack of 
skills, access, and equipment, with regular Internet users who did not desire to 
use the Internet more. To reduce selection bias, we match both groups on 
demographic and socioeconomic characteristics that are predictive of Internet 
use. We assume that in the absence of COVID-19 - a period of increased reliance 
on the Internet - the wellbeing trajectories of both groups would have followed 
a common trend.
RESULTS: Compared with matched controls (N = 2983), participants reporting 
barriers to Internet use (N = 802) experienced a greater increase in the 
likelihood of depressive symptoms from before to during the pandemic, but not 
worse loneliness levels. This effect was stronger for women, those aged above 65 
years, and those from lower-income households.
CONCLUSIONS: Besides enabling access to digital services, efforts to ensure 
older adults continue to be engaged members of an increasingly digital society 
could deliver returns in terms of a buffer against psychological distress.

DOI: 10.1017/S0033291722003208
PMCID: PMC9551182
PMID: 36177888 [Indexed for MEDLINE]


1477. Aust Health Rev. 2023 Feb;47(1):124-130. doi: 10.1071/AH22110.

Worsening general health and psychosocial wellbeing of Australian hospital 
allied health practitioners during the COVID-19 pandemic.

Hitch D(1), Booth S(2), Wynter K(3), Said CM(4), Haines K(2), Rasmussen B(5), 
Holton S(3).

Author information:
(1)Allied Health, Western Health, St. Albans, Vic., Australia; and Occupational 
Science and Therapy, Deakin University, Geelong, Vic., Australia; and Public 
Health, Faculty of Health and Medical Sciences, University of Copenhagen, 
Denmark.
(2)Allied Health, Western Health, St. Albans, Vic., Australia.
(3)Nursing and Midwifery, Deakin University, Burwood, Vic., Australia; and 
Centre of Quality and Patient Safety Research in the Institute for Health 
Transformation - Western Health Partnership, Deakin University, Burwood, Vic., 
Australia.
(4)Allied Health, Western Health, St. Albans, Vic., Australia; and 
Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, 
Parkville, Vic., Australia; and Australian Institute of Musculoskeletal Science, 
St. Albans, Vic., Australia.
(5)Public Health, Faculty of Health and Medical Sciences, University of 
Copenhagen, Denmark; and Nursing and Midwifery, Deakin University, Burwood, 
Vic., Australia; and Centre of Quality and Patient Safety Research in the 
Institute for Health Transformation - Western Health Partnership, Deakin 
University, Burwood, Vic., Australia; and Faculty of Health Services, University 
of Southern Denmark, Odense M, Denmark.

Objective To describe self-reported general and psychological health for allied 
health practitioners at an Australian acute public health service over three 
time points within the coronavirus disease 2019 (COVID-19) pandemic. Methods 
This study collected data from cross-sectional online surveys at three time 
points: May-June 2020 (T 1 ), October-November 2020 (T 2 ) and November-December 
2021 (T 3 ). The self-report questionnaire consisted of demographic questions, a 
general health question and the 21-item version of the Depression Anxiety Stress 
Scales (DASS-21). Results A total of 308 responses were received (T 1 n  = 135, 
T 2 n  = 78, T 3 n  = 95) from representatives of eight allied health 
professions. The proportion of allied health practitioners reporting poor 
general health significantly increased over time, as did mean scores on all 
DASS-21 sub-scales. General health status was also significantly associated with 
DASS-21 subscale scores. Anxiety scores increased significantly between T 1 and 
T 2 , while depression scores increased significantly between T 2 and T 3 . 
Significant increases in stress scores were recorded across all time intervals. 
Between T 1 and T 3 , the proportion of allied health practitioners reporting 
moderate, severe, or extremely severe symptoms increased for depression 
(10.3-30.9%), anxiety (5.2-18.2%) and stress (13.3-36.3%). Conclusion The 
general and psychological health of allied health practitioners appears to be 
worsening as the COVID-19 pandemic continues. Organisational strategies to 
support the health of the allied health workforce in acute care settings must 
address the cumulative effects of prolonged pressure on their general and 
psychosocial health. Support strategies need to be responsive to changes in 
psychological wellbeing at different phases of the pandemic.

DOI: 10.1071/AH22110
PMID: 36175130 [Indexed for MEDLINE]


1478. BMJ Open. 2022 Sep 29;12(9):e063846. doi: 10.1136/bmjopen-2022-063846.

Protocol for a systematic review of interventions targeting mental health, 
cognition or psychological well-being among individuals with long COVID.

Hawke LD(1)(2), Brown EE(2)(3), Rodak T(4), Rossell S(5), Ski CF(6), Strudwick 
G(7)(8), Thompson DR(9), Wang W(7), Xu D(7), Castle D(7)(2).

Author information:
(1)Centre for Complex Interventions, Centre for Addiction and Mental Health, 
Toronto, Ontario, Canada lisa.hawke@camh.ca.
(2)Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
(3)Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and 
Mental Health, Toronto, Ontario, Canada.
(4)CAMH Library, Department of Education, Centre for Addiction and Mental 
Health, Toronto, Ontario, Canada.
(5)Centre for Mental Health, Swinburne University of Technology, Hawthorn, 
Victoria, Australia.
(6)Integrated Care Academy, University of Suffolk, Ipswich, UK.
(7)Centre for Complex Interventions, Centre for Addiction and Mental Health, 
Toronto, Ontario, Canada.
(8)Institute of Health Policy, Management and Evaluation, University of Toronto, 
Toronto, Ontario, Canada.
(9)School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.

INTRODUCTION: For some people, COVID-19 infection leads to negative health 
impacts that can last into the medium or long term. The long-term sequelae of 
COVID-19 infection, or 'long COVID', negatively affects not only physical 
health, but also mental health, cognition or psychological well-being. Complex, 
integrated interventions are recommended for long COVID, including psychological 
components; however, the effectiveness of such interventions has yet to be 
critically evaluated. This protocol describes a systematic review to be 
conducted of scientific literature reporting on clinical trials of interventions 
to promote mental health, cognition or psychological well-being among 
individuals with long COVID.
METHODS AND ANALYSIS: The Preferred Reporting Items for Systematic Reviews and 
Meta-Analyses guidelines will be followed. A health sciences librarian will 
identify the relevant literature through comprehensive systematic searches of 
Medline, Embase, APA PsycINFO, Cumulative Index to Nursing and Allied Health 
Literature, medRxiv, PsyArXiv, China National Knowledge Internet and WANFANG 
Data databases, as well as The Cochrane Central Register of Controlled Trials, 
clinicaltrials.gov and the WHO International Clinical Trials Registry Platform. 
Studies will be selected through a title and abstract review, followed by a 
full-text review using inclusion and exclusion criteria. Data extracted will 
include intervention descriptions and efficacy metrics. Data will be narratively 
synthesised; if the data allow, a meta-analysis will be conducted. Risk of bias 
assessment will be conducted using the Cochrane Risk of Bias 2.0 tool.
ETHICS AND DISSEMINATION: Ethical approval for systematic reviews is not 
required. As researchers and clinicians respond to the new clinical entity that 
long COVID represents, this review will synthesise a rapidly emerging evidence 
base describing and testing interventions to promote mental health, cognition or 
psychological well-being. Results will therefore be disseminated through an 
open-access peer-reviewed publication and conference presentations to inform 
research and clinical practice.
PROSPERO REGISTRATION NUMBER: CRD42022318678.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2022-063846
PMCID: PMC9527745
PMID: 36175088 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: DC has received grant 
monies for research from Servier, Boehringer Ingelheim; travel support and 
honoraria for talks and consultancy from Servier, Seqirus, Lundbeck. He is a 
founder of the Optimal Health Program (OHP), and holds 50% of the IP for OHP; 
and is part owner of Clarity Healthcare. He does not knowingly have stocks or 
shares in any pharmaceutical company.


1479. Am J Orthopsychiatry. 2022;92(6):748-755. doi: 10.1037/ort0000647. Epub 2022 Sep 
29.

Paradoxical effects of ethnic identification on threat and anxiety during 
COVID-19 pandemic. A study of ethnic minority and immigrant groups.

Bilewicz M(1), Mirucka M(1), Olko J(2).

Author information:
(1)Faculty of Psychology.
(2)Faculty of "Artes Liberales".

Studies based on the "social cure" hypothesis suggest the positive role of 
strong social identifications for well-being and mental health during the 
COVID-19 pandemic. Based on the three-factorial model of identification that 
distinguishes ingroup centrality, ingroup affect, and ingroup ties as separate 
aspects of group identification, we propose that their impact on 
COVID-19-related stress and anxiety would be more complex. In a set of three 
studies carried out among ethnic minorities in Poland (Lemkos, Kashubs, and 
Silesians) and a study of a large immigrant group (Ukrainians in Poland), we 
found that higher levels of ingroup centrality generate more COVID-19-related 
threats and higher levels of anxiety, whereas ingroup ties tend to reduce 
anxiety during the pandemic. Based on this evidence we propose that the more 
exclusive aspects of identification (ingroup centrality) pose a risk to mental 
health during the time of the pandemic, whereas the more binding ones (ingroup 
ties) serve as a true "social cure." (PsycInfo Database Record (c) 2022 APA, all 
rights reserved).

DOI: 10.1037/ort0000647
PMID: 36174137 [Indexed for MEDLINE]


1480. PLoS One. 2022 Sep 29;17(9):e0269396. doi: 10.1371/journal.pone.0269396. 
eCollection 2022.

Time perspective predicts levels of anxiety and depression during the COVID-19 
outbreak: A cross-cultural study.

Micillo L(1), Rioux PA(2), Mendoza E(2), Kübel SL(3)(4), Cellini N(1)(5)(6), Van 
Wassenhove V(7), Grondin S(2), Mioni G(1).

Author information:
(1)Department of General Psychology, University of Padova, Padova, Italy.
(2)École de Psychologie, Université Laval, Québec, QC, Canada.
(3)Institute for Frontier Areas of Psychology and Mental Health, Freiburg, 
Germany.
(4)Max Planck Institute for the Study of Crime, Security and Law, Freiburg, 
Germany.
(5)Padova Neuroscience Center, University of Padova, Padova, Italy.
(6)Human Inspired Technology Center, University of Padova, Padova, Italy.
(7)Cognitive Neuroimaging Unit, NeuroSpin, CEA, INSERM, CNRS, Université 
Paris-Saclay, Gif/Yvette, France.

The COVID-19 outbreak and governmental measures to keep the population safe had 
a great impact on many aspects of society, including well-being. Using data from 
N = 1281 participants from six countries (Argentina, France, Greece, Italy, 
Japan, and Turkey), we first explored differences in anxiety, depression 
(measured with the Hospital Anxiety and Depression Scale; HADS), and time 
perspectives (Zimbardo Time Perspective Inventory; ZTPI), between these 
countries during the first weeks of the pandemic. We observed that Turkish 
participants reported the highest levels of anxiety, and Japanese and Greek the 
lowest. For depression symptoms, the Japanese scored highest and Italians 
lowest. Next, for each country, we investigated how well the relatively 
time-stable personality traits of time perspectives, chronotype (reduced 
Morningness-Eveningness Questionnaire; rMEQ), and Big Five personality traits 
(short Big Five Inventory; BFI) predicted the levels of anxiety and depression 
(HADS). The regression analyses showed that negative attitudes towards the past 
predicted the levels of both anxiety and depression in most of the countries we 
analyzed. Additionally, in many countries, a Past Positive orientation 
negatively predicted depression whereas the Present Fatalistic subscale 
predicted anxiety and depression. The chronotype did not contribute additionally 
to the models. The Big Five traits (and particularly neuroticism) showed 
substantial incremental explanatory power for anxiety in some countries but did 
not consistently predict anxiety levels. For depression, the additional variance 
accounted for by including the BFI as predictors was rather small. Importantly, 
the ZTPI subscales were retained as significant predictors in the model still 
when the BFI and rMEQ were considered as potential predictors. Our results yield 
evidence that the ZTPI time perspectives are valuable predictors for anxiety and 
depression levels during the first period of the pandemic.

DOI: 10.1371/journal.pone.0269396
PMCID: PMC9521906
PMID: 36174058 [Indexed for MEDLINE]

Conflict of interest statement: NO authors have competing interests Enter: The 
authors have declared that no competing interests exist.


1481. Clin Pediatr (Phila). 2023 May;62(4):295-300. doi: 10.1177/00099228221124680. 
Epub 2022 Sep 28.

Increase in Rate of Hospitalizations for Pediatric Intentional Acetaminophen 
Ingestion at a Single Center During the COVID-19 Pandemic.

Moss RE(1), Hertzberg EH(2), Person H(3), Stoffels G(4), Zackai S(1), Bucuvalas 
J(5), Gillen JK(1).

Author information:
(1)Division of Pediatric Critical Care, Department of Pediatrics, Icahn School 
of Medicine at Mount Sinai, New York City, NY, USA.
(2)Division of Pediatric Hospital Medicine, Department of Pediatrics, Icahn 
School of Medicine at Mount Sinai, New York City, NY, USA.
(3)Division of Pediatric Gastroenterology and Hepatology, Department of 
Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
(4)Department of Biostatistical Support, Icahn School of Medicine at Mount 
Sinai, New York City, NY, USA.
(5)Division of Pediatric Hepatology, Department of Pediatrics, Icahn School of 
Medicine at Mount Sinai, New York City, NY, USA.

OBJECTIVES: Social disruption due to COVID-19 has detrimentally affected 
American adolescents' emotional well-being. Within our system, pediatric 
acetaminophen ingestions increased in 2020, compared with previous years. We 
sought to evaluate the rate of hospitalizations for acetaminophen self-harm 
ingestions and self-harm of adolescents during the COVID-19 pandemic.
STUDY DESIGN: We identified patients (aged 0-23) from billing data with 
diagnosis of acetaminophen ingestion with self-harm intent (ICD-10 code 
T391X2A), from a multicenter urban, quaternary health care system. We performed 
retrospective chart review from 2016 to 2020 and performed statistics using a 
generalized estimating equation (GEE) logistic regression model.
RESULTS: From 2016 to 2020, there were 25 790 discharges of adolescents with 65 
acetaminophen self-harm ingestion and 148 self-harm discharges. Of the 65 
acetaminophen patients, 75% identified as female and 54% identified as 
non-white; 71% with Medicaid insurance. The proportion of acetaminophen 
ingestion and self-harm admissions increased from 0.13% in 2016 to 0.46% by 2020 
and 0.42% in 2016 to 0.73% by 2020, respectively. The odds of acetaminophen 
ingestion admission increased by 28% each additional year (odds ratio = 1.28; 
95% confidence interval: 1.08, 1.53; P = .006). There was not enough evidence to 
conclude that the log-odds of a self-harm ingestion were linearly related to 
time (P = .06).
CONCLUSIONS: Acetaminophen ingestion for self-harm has significantly increased, 
while overall self-harm has increased to a lesser, nonsignificant degree. 
Primarily females of color and those with Medicaid insurance are affected. It is 
important to note this growing, disturbing trend, and to continue to screen for 
depression in our adolescent community and ensure access to mental health 
resources.

DOI: 10.1177/00099228221124680
PMCID: PMC10102816
PMID: 36171731 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1482. Psychiatr Danub. 2022 Sep;34(Suppl 8):81-89.

Association between Lifestyle- and Circadian Rhythm-Related Changes, and 
Different Depression Symptom Clusters during COVID-19.

Vadon NB(1), Elek LP, Szigeti M, Erdelyi-Hamza B, Smirnova D, Fountoulakis KN, 
Gonda X.

Author information:
(1)Department of Psychiatry and Psychotherapy, Semmelweis University, St. Rokus 
Clinical Centre, Gyulai Pál utca 2., Budapest, 1085, Hungary.

BACKGROUND: The COVID-19 pandemic brought along a new situation for the 
population worldwide. The most important safety measures and lockdown expected 
extreme adaptability and flexibility impacting mental well-being. The aim of our 
study was to identify associations between changes in lifestyle and circadian 
rhythm and depression during the pandemic.
SUBJECTS AND METHODS: Our analysis has been carried out on the Hungarian data 
set of the COMET-G study including information on lifestyle and circadian 
rhythm-associated factors and severity of depression and its 3 symptom clusters. 
Associations were assessed using linear regression models adjusted for age and 
sex.
RESULTS: All variables reflecting changes in quality and quantity of sleep 
showed significant associations with overall depression scores and the three 
distinct symptom cluster scores. All variables reflecting importance and changes 
in physical activity during the pandemic were similarly significantly associated 
with all depression measures. However, only changes in quality of diet, but not 
quantity was associated with depression scores.
CONCLUSIONS: Our results may confirm the association of circadian rhythm and 
lifestyle-related environmental factors in deterioration of mental health during 
COVID and help devise prevention and intervention methods and targets for 
similar situations.

PMID: 36170708 [Indexed for MEDLINE]


1483. BMJ Lead. 2022 Sep;6(3):237-239. doi: 10.1136/leader-2021-000518. Epub 2022 Jan 
12.

Moral injury and well-being in essential workers during the COVID-19 pandemic: 
local survey findings.

Guy C(1)(2), Kunonga E(3), Kennedy A(4), Patel P(3).

Author information:
(1)Medical Directorate, West Park Hospital, Tees Esk and Wear Valleys NHS Trust, 
Darlington, UK catherineguy2@nhs.net.
(2)Public Health England, Newcastle, UK.
(3)Tees Esk and Wear Valleys NHS Foundation Trust, Darlington, UK.
(4)Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon 
Tyne, UK.

BACKGROUND: Essential workers have faced many difficult situations working 
during the pandemic. Staff may feel that they, or other people, have acted 
wrongly and be distressed by this. This represents moral injury, which has been 
linked with significant mental ill health.
METHODS: This survey asked essential workers in County Durham and Darlington 
about their experiences during the first wave of the pandemic and anything they 
felt would help. Well-being and moral injury were rated using sliders.
RESULTS: There were 566 responses. A majority of respondents reported feeling 
troubled by other people's actions they felt were wrong (60% scored over 40, 
where 0 is 'not at all troubled' and 100 'very troubled', median score=52.5). 
Respondents were generally less troubled by their own actions (median score=3). 
Well-being and moral injury scores varied by employment sector (eg, National 
Health Service (NHS) staff were more troubled by the actions of others than 
non-NHS staff).Staff suggestions included regular supervisor check-ins, ensuring 
kindness from everyone, fair rules and enforcement and improving communication 
and processes. Respondents offered simple, practical actions that could be taken 
by leaders at team, organisation, societal and governmental levels to tackle 
moral injury and the underlying causes of moral injurious environments.
CONCLUSION: Using these findings to develop a strategy to address moral injury 
is important, not only for staff well-being, but staff retention and continued 
delivery of vital services in these challenging times. Working together, we can 
seek to reduce and mitigate 'moral injury' the same way we do for other physical 
workplace 'injuries'.

© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and 
permissions. Published by BMJ.

DOI: 10.1136/leader-2021-000518
PMID: 36170482 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


1484. Soc Psychiatry Psychiatr Epidemiol. 2023 Mar;58(3):453-465. doi: 
10.1007/s00127-022-02367-y. Epub 2022 Sep 28.

Pre-pandemic resilience to trauma and mental health outcomes during COVID-19.

Choi KW(#)(1)(2), Nishimi K(#)(3)(4), Jha SC(5), Sampson L(5), Hahn J(5), Kang 
JH(6), Koenen KC(7)(5)(8), Kubzansky LD(9).

Author information:
(1)Center for Precision Psychiatry, Department of Psychiatry, Massachusetts 
General Hospital, Boston, MA, USA. kwchoi@mgh.harvard.edu.
(2)Psychiatric & Neurodevelopment Genetics Unit, Center for Genomic Medicine, 
Massachusetts General Hospital, Boston, MA, USA. kwchoi@mgh.harvard.edu.
(3)Mental Health Service, San Francisco Veterans Affairs Health Care System, San 
Francisco, CA, USA. kristen.nishimi@ucsf.edu.
(4)Department of Psychiatry and Behavioral Sciences, University of California 
San Francisco, San Francisco, CA, USA. kristen.nishimi@ucsf.edu.
(5)Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, 
MA, USA.
(6)Channing Division of Network Medicine, Department of Medicine, Brigham and 
Women's Hospital and Harvard Medical School, Boston, MA, USA.
(7)Center for Precision Psychiatry, Department of Psychiatry, Massachusetts 
General Hospital, Boston, MA, USA.
(8)Department of Social and Behavioral Sciences, Harvard TH Chan School of 
Public Health, Boston, MA, USA.
(9)Department of Social and Behavioral Sciences and Lee Kum Sheung Center for 
Health and Happiness, Harvard TH Chan School of Public Health, Boston, MA, USA.
(#)Contributed equally

PURPOSE: The stress-sensitization hypothesis posits that individuals with prior 
trauma are at elevated risk for poor mental health when faced with subsequent 
stressors. Little work has examined whether those who have demonstrated 
psychological resilience to prior trauma would show either increased resilience 
or vulnerability to subsequent stressors. We examined pre-pandemic psychological 
resilience to lifetime trauma in relation to mental health outcomes amid the 
coronavirus disease 2019 (COVID-19) pandemic, a major societal stressor.
METHODS: The sample included 16,900 trauma-exposed women from the Nurses' Health 
Study II. Pre-pandemic resilience was defined by psychological health in 
2017-2019 (characterized by levels of both distress and positive emotional 
well-being) relative to lifetime trauma. Resilience was defined categorically by 
cross-classifying unfavorable, adequate, and favorable psychological 
health by higher versus lower trauma burden, and continuously as the residual 
difference in predicted versus actual psychological health regressed on trauma 
burden. Mental health outcomes as of May-August 2020 included psychological 
distress symptoms and overall positive emotional well-being. Associations were 
assessed using covariate-adjusted regression models.
RESULTS: Pre-pandemic resilience was associated with lower distress and higher 
well-being early in the COVID-19 pandemic. Relative to the women showing highest 
resilience (favorable psychological health despite higher trauma), only those 
with lower trauma and favorable prior psychological health had significantly 
lower distress and higher positive emotional well-being during the pandemic. 
Higher continuous pre-pandemic resilience was also significantly associated with 
lower distress and higher positive emotional well-being during the pandemic.
CONCLUSION: Preventing mental health problems following trauma may contribute to 
protecting population well-being amid major stressors.

© 2022. This is a U.S. Government work and not under copyright protection in the 
US; foreign copyright protection may apply.

DOI: 10.1007/s00127-022-02367-y
PMCID: PMC9514982
PMID: 36169684 [Indexed for MEDLINE]


1485. Stress. 2022 Jan;25(1):323-330. doi: 10.1080/10253890.2022.2125798.

Cortisol changes in healthy children and adolescents during the COVID-19 
pandemic.

Fung MH(1), Taylor BK(1)(2), Embury CM(1), Spooner RK(1), Johnson HJ(1), Willett 
MP(1), Frenzel MR(1), Badura-Brack AS(3), White SF(1)(2), Wilson TW(1)(2).

Author information:
(1)Institute for Human Neuroscience, Boys Town National Research Hospital, 
Omaha, NE, USA.
(2)Department of Pharmacology & Neuroscience, Creighton University, Omaha, NE, 
USA.
(3)Department of Psychological Science, Creighton University, Omaha, NE, USA.

The Coronavirus Disease 2019 (COVID-19) pandemic has caused massive disruptions 
to daily life in the United States, closing schools and businesses and 
increasing physical and social isolation, leading to deteriorations in mental 
health and well-being in people of all ages. Many studies have linked chronic 
stress with long-term changes in cortisol secretion, which has been implicated 
in many stress-related physical and mental health problems that commonly emerge 
in adolescence. However, the physiological consequences of the pandemic in youth 
remain understudied. Using hair cortisol concentrations (HCC), we quantified 
average longitudinal changes in cortisol secretion across a four-month period 
capturing before, during, and after the transition to pandemic-lockdown 
conditions in a sample of healthy youth (n = 49). Longitudinal changes in HCC 
were analyzed using linear mixed-effects models. Perceived levels of 
pandemic-related stress were measured and compared to the physiological changes 
in HCC. In children and adolescents, cortisol levels significantly increased 
across the course of the pandemic. These youth reported a multitude of stressors 
during this time, although changes in HCC were not associated with self-reported 
levels of COVID-19-related distress. We provide evidence that youth are 
experiencing significant physiological changes in cortisol activity across the 
COVID-19 pandemic, yet these biological responses are not associated with 
perceived stress levels. Youth may be especially vulnerable to the deleterious 
impacts of chronic cortisol exposure due to their current status in the 
sensitive periods for development, and the incongruency between biological and 
psychological stress responses may further complicate these developmental 
problems.

DOI: 10.1080/10253890.2022.2125798
PMCID: PMC9744629
PMID: 36168664 [Indexed for MEDLINE]

Conflict of interest statement: All authors report no financial interests or 
conflicts of interest.


1486. Sci Rep. 2022 Sep 27;12(1):16114. doi: 10.1038/s41598-022-19692-6.

COVID-19 pandemic fatigue and its sociodemographic and psycho-behavioral 
correlates: a population-based cross-sectional study in Hong Kong.

Leung HT(#)(1), Gong WJ(#)(1)(2), Sit SMM(1), Lai AYK(3), Ho SY(4), Wang MP(5), 
Lam TH(1).

Author information:
(1)School of Public Health, The University of Hong Kong, Hong Kong, China.
(2)Department of General Practice, Health Science Center, Shenzhen University, 
Guangdong, China.
(3)School of Nursing, The University of Hong Kong, Hong Kong, China.
(4)School of Public Health, The University of Hong Kong, Hong Kong, China. 
syho@hku.hk.
(5)School of Nursing, The University of Hong Kong, Hong Kong, China. 
mpwang@hku.hk.
(#)Contributed equally

Pandemic fatigue is a growing public health concern of the lingering COVID-19 
pandemic. Despite its widespread mass media coverage, systematic empirical 
investigations are scarce. Under the Hong Kong Jockey Club SMART Family-Link 
Project, we conducted online and telephone surveys amid the pandemic in February 
to March 2021 to assess self-reported pandemic fatigue (range 0-10) in Hong Kong 
adults (N = 4726) and its associations with sociodemographic and 
psycho-behavioral (high vs low to moderate) variables. Data were weighted by 
sex, age, and education of the general population. Binary logistic regression 
models yielded adjusted odds ratios (aORs) for high pandemic fatigue (score ≥ 7) 
for sociodemographic and psycho-behavioral variables. 43.7% reported high 
pandemic fatigue. It was less common in older people (55-64 years: aOR 0.56, 95% 
CI 0.39-0.82; 65 + years: 0.33, 0.21-0.52) versus age group 18-24 years, but 
more common in those with tertiary education (1.36, 1.15-1.62) versus secondary 
or below. High pandemic fatigue was positively associated with depressive 
symptoms (aOR 1.83, 95% CI 1.55-2.17), anxiety symptoms (1.87, 1.58-2.20), 
loneliness (1.75, 1.32-2.31), personal fear of COVID-19 (2.61, 2.12-3.23), 
family fear of COVID-19 (2.03, 1.67-2.47), and current alcohol use (1.16, 
1.00-1.33), but negatively associated with self-rated health (0.79, 0.68-0.92), 
personal happiness (0.63, 0.55-0.72), personal adversity coping capability 
(0.71, 0.63-0.81), family adversity coping capability (0.79, 0.69-0.90), family 
well-being (0.84, 0.73-0.97), family communication quality (0.86, 0.75-0.98), 
and frequent home exercise (0.82, 0.69-0.96; versus less frequent). We first 
used a single-item tool to measure COVID-19 pandemic fatigue, showing that it 
was common and associated with worse mental health, lower levels of personal and 
family well-being and alcohol use.

© 2022. The Author(s).

DOI: 10.1038/s41598-022-19692-6
PMCID: PMC9514690
PMID: 36167729 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1487. BMJ Glob Health. 2022 Sep;7(9):e009550. doi: 10.1136/bmjgh-2022-009550.

The human toll and humanitarian crisis of the Russia-Ukraine war: the first 162 
days.

Haque U(1), Naeem A(2), Wang S(3), Espinoza J(4), Holovanova I(5), Gutor T(6), 
Bazyka D(7), Galindo R(3), Sharma S(8), Kaidashev IP(5), Chumachenko D(9), 
Linnikov S(10), Annan E(3), Lubinda J(11), Korol N(7), Bazyka K(7), Zhyvotovska 
L(12), Zimenkovsky A(6), Nguyen UDT(3).

Author information:
(1)Department of Biostatistics and Epidemiology, University of North Texas 
Health Science Center, Fort Worth, TX, USA ubydul.kth@gmail.com.
(2)Department of Statistics, Quaid-i-Azam University, Islamabad, Pakistan.
(3)Department of Biostatistics and Epidemiology, University of North Texas 
Health Science Center, Fort Worth, TX, USA.
(4)Children's Hospital Los Angeles, Los Angeles, CA, USA.
(5)Poltava State Medical University, Poltava, Ukraine.
(6)Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
(7)National Research Centre for Radiation Medicine, Kyiv, Ukraine.
(8)School of Health Professions, University of Southern Mississippi, 
Hattiesburg, MA, USA.
(9)Department of mathematical modeling and artificial intelligence, National 
Aerospace University, Kharkiv, Ukraine.
(10)Department of health promotion, Odesa Regional Center for Public Health, 
Odesa, Ukraine.
(11)Telethon Kids Institute, Nedlands, Perth, Australia.
(12)Department of Psychiatry, Narcology and Medical Psychology, Poltava State 
Medical University, Poltava, Ukraine.

BACKGROUND: We examined the human toll and subsequent humanitarian crisis 
resulting from the Russian invasion of Ukraine, which began on 24 February 2022.
METHOD: We extracted and analysed data resulting from Russian military attacks 
on Ukrainians between 24 February and 4 August 2022. The data tracked direct 
deaths and injuries, damage to healthcare infrastructure and the impact on 
health, the destruction of residences, infrastructure, communication systems, 
and utility services - all of which disrupted the lives of Ukrainians.
RESULTS: As of 4 August 2022, 5552 civilians were killed outright and 8513 
injured in Ukraine as a result of Russian attacks. Local officials estimate as 
many as 24 328 people were also killed in mass atrocities, with Mariupol being 
the largest (n=22 000) such example. Aside from wide swaths of homes, schools, 
roads, and bridges destroyed, hospitals and health facilities from 21 cities 
across Ukraine came under attack. The disruption to water, gas, electricity, and 
internet services also extended to affect supplies of medications and other 
supplies owing to destroyed facilities or production that ceased due to the war. 
The data also show that Ukraine saw an increase in cases of HIV/AIDS, 
tuberculosis, and Coronavirus (COVID-19).
CONCLUSIONS: The 2022 Russia-Ukraine War not only resulted in deaths and 
injuries but also impacted the lives and safety of Ukrainians through 
destruction of healthcare facilities and disrupted delivery of healthcare and 
supplies. The war is an ongoing humanitarian crisis given the continuing 
destruction of infrastructure and services that directly impact the well-being 
of human lives. The devastation, trauma and human cost of war will impact 
generations of Ukrainians to come.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjgh-2022-009550
PMCID: PMC9511605
PMID: 36167408 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


1488. J Nurs Adm. 2022 Oct 1;52(10):525-535. doi: 10.1097/NNA.0000000000001194.

The Impact of Traumatic Stress, Resilience, and Threats to Core Values on Nurses 
During a Pandemic.

Swavely D(1), Romig B, Weissinger G, Holtz H, Alderfer M, Lynn L, Adil T, 
Rushton CH.

Author information:
(1)Author Affiliations: Senior Director (Dr Swavely), Nursing Clinical Inquiry 
and Research; and Vice President, Chief Nursing Officer (Dr Romig), Reading 
Hospital; and Assistant Professor (Dr Weissinger), Villanova University, 
Pennsylvania; Assistant Professor (Dr Holtz), Goldfarb School of Nursing Barnes 
Jewish College, Saint Louis, Missouri; and Johns Hopkins Clinical Research 
Network Liaison (Ms Alderfer) and Critical Care Clinical Nurse Level 5 (Ms 
Lynn), and Director, Spiritual Services (Rev Adil), Reading Hospital, West 
Reading, Pennsylvania; and Anne and George L. Bunting Professor of Clinical 
Ethics and Professor of Nursing and Pediatrics (Dr Rushton), Johns Hopkins 
University, Baltimore, Maryland.

OBJECTIVE: The aim of this study was to understand the traumatic stress and 
resilience of nurses who cared for patients with COVID-19.
BACKGROUND: Studies have shown a high proportion of healthcare workers are at 
risk for developing posttraumatic stress disorder after a pandemic. Resilience 
factors are believed to play an important role in the well-being of healthcare 
professionals.
METHODS: This was a triangulated mixed methods study; a phenomenological 
qualitative approach with survey data was used to triangulate the findings, and 
sensemaking was used as the theoretical framework.
RESULTS: Four themes emerged from the study: 1) phases of traumatic stress 
response to perceived threats; 2) honoring their sacrifice; 3) professional 
self-identity; and 4) sustaining resilience in a stressful work environment. 
Quantitative results on traumatic stress, general resilience, and moral 
resilience supported the themes.
CONCLUSIONS: The findings will help leaders understand the potential for 
postpandemic mental health problems and the role of resilience in maintaining 
well-being.

Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.

DOI: 10.1097/NNA.0000000000001194
PMCID: PMC9512236
PMID: 36166631 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


1489. Health Soc Care Community. 2022 Nov;30(6):e3696-e3715. doi: 10.1111/hsc.14039. 
Epub 2022 Sep 27.

Occupational violence and aggression in urgent and critical care in rural health 
service settings: A systematic review of mixed studies.

Grant SL(1), Hartanto S(2), Sivasubramaniam D(1), Heritage K(3).

Author information:
(1)Department of Psychological Sciences, Swinburne University of Technology, 
Hawthorn, Victoria, Australia.
(2)University of Melbourne, Parkville, Victoria, Australia.
(3)Institute of Health and Wellbeing, Federation University Australia, Ballarat, 
Victoria, Australia.

Rural/remote health services are vulnerable to occupational violence and 
aggression due to factors such as weapon accessibility, poor network coverage 
and distance to backup. This systematic review investigated (1) the nature of 
occupational violence and aggression perpetrated in rural/remote health service 
urgent care settings and (2) the availability and effectiveness of 
policies/interventions/recommendations that address occupational violence and 
aggression in this context. We searched Business Source Complete, CINAHL 
Complete, Health & Society, APAIS Health, Health Collection, PsycINFO, PubMed, 
Scopus, SocIndex and Web of Science. Included articles (peer-reviewed, no grey 
literature and English language) addressed occupational violence and aggression 
in rural health service urgent care settings. Fifteen articles matched these 
criteria (total [rural/remote only, where specified] N ~ 2555) and were included 
in the final analysis. The Mixed Methods Appraisal Tool was applied to assess 
the risk of bias. A data extraction table and narrative synthesis are presented. 
The most common occupational violence and aggression type was verbal aggression. 
The primary perpetrator was patients. Risk factors reflected practitioner age, 
remoteness, sector, staffing, shift type and area of practice. Precipitating 
factors were alcohol/drugs, dissatisfaction and mental health conditions. Policy 
content and limitations and education/training programme effectiveness were not 
addressed. Community collaboration supported occupational violence and 
aggression prevention/management. Organisational culture should promote 
reporting, debriefing and post-incident care for staff well-being. Work 
environment and job/task design are priorities for safety, but with possible 
limitations for traumatised clients. Occupational violence and aggression 
policies/interventions in rural health settings must be systematically evaluated 
to inform best practices. Co-funded by Swinburne Social Innovation Research 
Institute Interdisciplinary Seed Funding Scheme and SMART Rural Health Network.

© 2022 The Authors. Health and Social Care in the Community published by John 
Wiley & Sons Ltd.

DOI: 10.1111/hsc.14039
PMCID: PMC10086783
PMID: 36165419 [Indexed for MEDLINE]

Conflict of interest statement: On behalf of all authors, the corresponding 
author states that there is no conflict of interest.


1490. Curr Opin Gastroenterol. 2022 Nov 1;38(6):555-561. doi: 
10.1097/MOG.0000000000000876. Epub 2022 Sep 9.

Gastrointestinal symptoms in COVID-19: the long and the short of it.

Freedberg DE(1), Chang L(2).

Author information:
(1)Columbia University Irving Medical Center, Division of Digestive and Liver 
Diseases and the Columbia Mailman School of Public Health, New York, NY.
(2)David Geffen School of Medicine at UCLA, Vatche and Tamar Manoukian Division 
of Digestive Diseases and the G. Oppenheimer Center for Neurobiology of Stress 
and Resilience, Los Angeles, CA, US.

PURPOSE OF REVIEW: A large and growing number of patients have persistent 
gastrointestinal symptoms that they attribute to COVID-19. SARS-CoV-2, the virus 
that causes COVID-19, replicates within the gut and acute COVID-19 is associated 
with alteration of the gut microbiome. This article reviews recent observational 
data related to gastrointestinal symptoms in 'long COVID' and discusses 
pathophysiologic mechanisms that might explain persistent post-COVID 
gastrointestinal symptoms.
RECENT FINDINGS: Gastrointestinal symptoms are present in half of the patients 
with acute COVID-19, persist 6 months after COVID-19 in 10-25% of patients, and 
are rated as the most bothersome symptom in 11% of all patients. These symptoms 
include heartburn, constipation, diarrhoea and abdominal pain and decline in 
prevalence with the passage of time. Long COVID gastrointestinal symptoms are 
associated with mental health symptoms (anxiety and depression) that predate 
COVID-19 and also with mental health symptoms that are concurrent, after 
recovery from COVID-19. The cause of long COVID gastrointestinal symptoms is 
unknown and hypotheses include the SARS-CoV-2 virus itself, which infects the 
gastrointestinal tract; COVID-19, which can be accompanied by gut microbiome 
changes, a profound systemic inflammatory response and critical illness; and/or 
effects of pandemic stress on gastrointestinal function and symptom perception, 
which may be unrelated to either SARS-CoV-2 or to COVID-19.
SUMMARY: New, persistent gastrointestinal symptoms are commonly reported after 
recovery from COVID-19. The pathophysiology of these symptoms is unknown but 
likely to be multifactorial.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/MOG.0000000000000876
PMID: 36165028 [Indexed for MEDLINE]


1491. J Affect Disord. 2022 Dec 15;319:437-445. doi: 10.1016/j.jad.2022.09.062. Epub 
2022 Sep 23.

The association of mindfulness and psychological well-being among individuals 
who have recovered from COVID-19 in Jianghan District, Wuhan, China: A 
cross-sectional study.

Dai Z(1), Wang H(2), Xiao W(2), Huang Y(2), Si M(2), Fu J(2), Chen X(2), Jia 
M(3), Leng Z(4), Cui D(5), Dong L(6), Mak WWS(7), Su X(8).

Author information:
(1)School of Population Medicine and Public Health, Chinese Academy of Medical 
Sciences & Peking Union Medical College, Beijing, China. Electronic address: 
daizhenwei@student.pumc.edu.cn.
(2)School of Population Medicine and Public Health, Chinese Academy of Medical 
Sciences & Peking Union Medical College, Beijing, China.
(3)School of Population Medicine and Public Health, Chinese Academy of Medical 
Sciences & Peking Union Medical College, Beijing, China. Electronic address: 
jiamengmeng@cams.cn.
(4)School of Population Medicine and Public Health, Chinese Academy of Medical 
Sciences & Peking Union Medical College, Beijing, China. Electronic address: 
lengzhiwei@cams.cn.
(5)National Clinical Research Center for Respiratory Diseases, China-Japan 
Friendship Hospital, Beijing, China; The 2nd Affiliated Hospital of Harbin 
Medical University, Harbin Medical University, Harbin, China.
(6)School of Population Medicine and Public Health, Chinese Academy of Medical 
Sciences & Peking Union Medical College, Beijing, China. Electronic address: 
dongliming@cams.cn.
(7)Diversity and Well-Being Laboratory, Department of Psychology, The Chinese 
University of Hong Kong, Shatin, NT, Hong Kong. Electronic address: 
wwsmak@cuhk.edu.hk.
(8)School of Population Medicine and Public Health, Chinese Academy of Medical 
Sciences & Peking Union Medical College, Beijing, China. Electronic address: 
suxiaoyou@pumc.edu.cn.

BACKGROUND: In the global pandemic of the coronavirus disease 2019 (COVID-19), 
depression and post-traumatic stress disorder (PTSD) have commonly occurred 
among COVID-19 patients, whose experiences of infection and subsequent treatment 
might develop negative consequences on their mental well-being even after 
recovery. Despite the general recognition of efficacy of mindfulness-based 
interventions in reducing psychological distress among various populations, 
there were insufficient studies on the relationship between mindfulness and 
mental health among individuals who have recovered from COVID-19.
OBJECTIVE: The current study aims to identify the prevalence of common mental 
health challenges among recovered COVID-19 patients in Jianghan District, Wuhan, 
China and to explore the potential mechanism through which mindfulness alleviate 
depression and PTSD.
METHODS: A cross-sectional survey on mental health was conducted among a 
convenience sample of adults recovered from COVID-19 in Jianghan District, 
Wuhan, China. The study participants completed questionnaires under the 
assistance of trained investigators. The questionnaire included Chinese version 
of Five Facets of Mindfulness Questionnaire-Short Form (FFMQ-SF), Generalized 
Anxiety Disorder Questionnaire (GAD-7), Resilience Style Questionnaire (RSQ), 
Impact of Events Scale-Revised (IES-R), and Patient Health Questionnaire (PHQ-9) 
to measure mindfulness, anxiety, resilience, PTSD, and depression respectively. 
Structural equation modeling was used to explore the relationship between 
mindfulness and mental health outcomes of this population.
RESULTS: 1541 respondents (654 [42.4 %] men and 887 [57.6 %] women) completed 
the questionnaire between June 10 and July 25, 2021, of whom 36.2 % and 27.1 % 
had mild and severe levels of depressive and anxiety symptoms respectively, and 
15.2 % was indicated with PTSD. The average score of mindfulness of the study 
participants was (3.100 ± 0.387), and that of resilience was (3.560 ± 0.877). 
The structural equation model fit the data well, demonstrating that mindfulness 
was negatively associated with depressive symptoms directly (β = -0.031, 
P = 0.021) or indirectly through the mediation effect of resilience (β = -0.019, 
P = 0.009) and anxiety symptoms (β = -0.208, P < 0.001), and was negatively 
associated with PTSD through the mediation effect of anxiety symptoms 
(β = -0.142, P < 0.001).
CONCLUSION: Individuals who have recovered from COVID-19 commonly experienced 
psychological distress. Mindfulness is associated with alleviation of depressive 
and PTSD symptoms directly or indirectly. Interventions based on mindfulness are 
suggested to improve the mental well-being of this population.

Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2022.09.062
PMCID: PMC9502442
PMID: 36162667 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest None.


1492. Public Health. 2022 Nov;212:4-6. doi: 10.1016/j.puhe.2022.08.009. Epub 2022 Aug 
23.

Trends in negative emotions throughout the COVID-19 pandemic in the United 
States.

Hagen D(1), Lai AY(2), Goldmann E(3).

Author information:
(1)Department of Epidemiology, New York University School of Global Public 
Health, New York, NY, USA.
(2)Department of Public Health Policy and Management, New York University School 
of Global Public Health, New York, NY, USA.
(3)Department of Epidemiology, New York University School of Global Public 
Health, New York, NY, USA. Electronic address: esg236@nyu.edu.

OBJECTIVES: This study aimed to identify trends in the prevalence of negative 
emotions in the United States throughout the COVID-19 pandemic between March 
2020 and November 2021.
STUDY DESIGN: This was a descriptive, repeated cross-sectional analysis of 
nationally representative survey data.
METHODS: Data originated from Gallup's COVID-19 web survey, encompassing 156,684 
observations. Prevalence estimates for self-reported prior-day experience of 
sadness, worry, stress, anger, loneliness, depression, and anxiety were 
computed, plotted using descriptive trend graphs, and compared with 2019 
estimates from the Gallup World Poll. Differences between estimates were 
evaluated by inspecting confidence intervals.
RESULTS: Stress and worry were the most commonly experienced negative emotions 
between March 2020 and November 2021; worry and anger were significantly more 
prevalent than prepandemic. The prevalence of sadness, worry, stress, and anger 
fluctuated considerably over time and declined steadily to prepandemic levels by 
mid-2021. Distinctive spikes in the prevalence of several negative emotions, 
especially sadness and anger, were observed following the murder of George 
Floyd.
CONCLUSIONS: Several negative emotions exhibited excess prevalence during the 
pandemic, especially in spring/summer 2020. Despite recent reductions to 
prepandemic levels, continued monitoring is necessary to inform policies and 
interventions to promote population well-being.

Copyright © 2022 The Royal Society for Public Health. Published by Elsevier Ltd. 
All rights reserved.

DOI: 10.1016/j.puhe.2022.08.009
PMCID: PMC9395287
PMID: 36162396 [Indexed for MEDLINE]


1493. Zoo Biol. 2023 Mar;42(2):194-208. doi: 10.1002/zoo.21736. Epub 2022 Sep 25.

Dither: A unifying model of the effects of visitor numbers on zoo animal 
behavior.

Krebs BL(1), Eschmann CL(1), Watters JV(1).

Author information:
(1)San Francisco Zoological Society, San Francisco, California, USA.

Interest in the impact of human presence on the behavior and well-being of zoo 
and aquarium animals is increasing. Previous work has conceptualized the 
presence of zoo visitors as having one of three impacts on the behavior of 
animals in zoos: positive, negative, or neutral. Research suggests the same 
species may exhibit all three responses under different conditions, calling into 
question whether the positive/negative/neutral framework is the most useful way 
of considering visitor impact on animal behavior. Here we present a model of 
visitor effects that unifies these three predictions. Our model suggests that 
zoo-goers may provide a "dither effect" for some animals living in zoos. We 
posit animals may show nonlinear behavioral responses over a range of visitor 
densities, effectively exhibiting changes in both comfortable and anxiety-like 
behaviors under different levels of human presence. We tested this model during 
two COVID-19 related closures at the San Francisco Zoo, studying seven species 
for evidence of nonlinear relationships between visitor numbers and animal 
behavior. Our results support the dither effect acting in several species 
observed.

© 2022 Wiley Periodicals LLC.

DOI: 10.1002/zoo.21736
PMID: 36161730 [Indexed for MEDLINE]


1494. Front Cell Infect Microbiol. 2022 Sep 9;12:966361. doi: 
10.3389/fcimb.2022.966361. eCollection 2022.

Gut and oral microbiota associations with viral mitigation behaviors during the 
COVID-19 pandemic.

Li K(1)(2), Methé BA(1)(2), Fitch A(1)(2), Gentry H(1)(2), Kessinger C(1)(2), 
Patel A(1)(2), Petraglia V(1)(2), Swamy P(1)(2), Morris A(1)(2).

Author information:
(1)Center for Medicine and the Microbiome, University of Pittsburgh School of 
Medicine, Pittsburgh, PA, United States.
(2)Division of Pulmonary, Allergy and Critical Care Medicine, Department of 
Medicine, University of Pittsburgh School of Medicine and University of 
Pittsburgh Medical Center, Pittsburgh, PA, United States.

Imposition of social and health behavior mitigations are important control 
measures in response to the coronavirus disease 2019 (COVID-19) pandemic caused 
by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Although 
postulated that these measures may impact the human microbiota including losses 
in diversity from heightened hygiene and social distancing measures, this 
hypothesis remains to be tested. Other impacts on the microbiota and host mental 
and physical health status associations from these measures are also not 
well-studied. Here we examine changes in stool and oral microbiota by analyzing 
16S rRNA gene sequence taxonomic profiles from the same individuals during 
pre-pandemic (before March 2020) and early pandemic (May-November 2020) phases. 
During the early pandemic phase, individuals were also surveyed using 
questionnaires to report health histories, anxiety, depression, sleep and other 
lifestyle behaviors in a cohort of predominantly Caucasian adults (mean age = 
61.5 years) with the majority reporting at least one underlying co-morbidity. We 
identified changes in microbiota (stool n = 288; oral n = 89) between 
pre-pandemic and early pandemic time points from the same subject and associated 
these differences with questionnaire responses using linear statistical models 
and hierarchical clustering of microbiota composition coupled to logistic 
regression. While a trend in loss of diversity was identified between 
pre-pandemic and early pandemic time points it was not statistically 
significant. Paired difference analyses between individuals identified fewer 
significant changes between pre-pandemic and early pandemic microbiota in those 
who reported fewer comorbidities. Cluster transition analyses of stool and 
saliva microbiota determined most individuals remained in the same cluster 
assignments from the pre-pandemic to early pandemic period. Individuals with 
microbiota that shifted in composition, causing them to depart a pre-pandemic 
cluster, reported more health issues and pandemic-associated worries. 
Collectively, our study identified that stool and saliva microbiota from the 
pre-pandemic to early pandemic periods largely exhibited ecological stability 
(especially stool microbiota) with most associations in loss of diversity or 
changes in composition related to more reported health issues and 
pandemic-associated worries. Longitudinal observational cohorts are necessary to 
monitor the microbiome in response to pandemics and changes in public health 
measures.

Copyright © 2022 Li, Methé, Fitch, Gentry, Kessinger, Patel, Petraglia, Swamy 
and Morris.

DOI: 10.3389/fcimb.2022.966361
PMCID: PMC9500509
PMID: 36159641 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1495. Pan Afr Med J. 2022 Jun 11;41(Suppl 2):11. doi: 
10.11604/pamj.supp.2022.41.2.29032. eCollection 2022.

Mental health and psychosocial support concerns among frontline workers within 
the Eastern and Southern Africa COVID-19 response.

Diop NM(1), Andersen I(2), Gwezera B(3), Fihn JJ(1), Gohar F(1), Morgos D(1), 
Baingana F(4).

Author information:
(1)UNICEF East and Southern Africa Regional Office, Nairobi, Kenya.
(2)International Committee of the Red Cross, Geneva, Switzerland.
(3)Regional Psychosocial Support Initiative, Randburg, South Africa.
(4)World Health Organization, Brazzaville, Republic of Congo.

We carried out a mental health assessment survey of frontline workers in Eastern 
and Southern Africa regarding COVID-19 pandemic in the region. A total of 723 
people responded to the anonymous survey which was available in English, French 
and Portuguese. Two thirds of respondents felt overwhelmed and the remaining one 
third expressed fear of the pandemic. Concern about self and one´s wellbeing was 
associated with the feeling of being supported by one´s supervisor. Frontline 
workers that acknowledged supervisor support also expressed a significantly 
better wellbeing than others that did not receive supportive supervision. It is 
important to strengthen supervisors´ capacity for psychological support to their 
subordinates. It is also necessary to emphasise the importance of giving 
attention to staff mental health concerns. Supervisors should provide 
information on referral opportunities and encourage their staff to take 
advantage of them when in need of specialised services. While frontline workers 
have been celebrated worldwide for their efforts during the COVID-19 pandemic, 
reports also indicate that some of them are exposed to stigma, discrimination 
and even violence within their communities, at workplace and surroundings. 
Further studies will improve current understanding of the mental health and 
psychological concerns other categories of professional caregivers experienced 
while responding to the pandemic.

Copyright: Ndeye Marie Diop et al.

DOI: 10.11604/pamj.supp.2022.41.2.29032
PMCID: PMC9474953
PMID: 36159023 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1496. Clin Interv Aging. 2022 Sep 17;17:1365-1378. doi: 10.2147/CIA.S376519. 
eCollection 2022.

Geriatric Health Care During the COVID-19 Pandemic: Managing the Health Crisis.

Zhu Y(#)(1)(2), Liu Y(#)(1)(2), Jiang H(1)(2).

Author information:
(1)Department of Geriatrics, Shanghai East Hospital, Tongji University School of 
Medicine, Shanghai, 200123, People's Republic of China.
(2)Department of General Medicine, Shanghai East Hospital, Tongji University 
School of Medicine, Shanghai, 200123, People's Republic of China.
(#)Contributed equally

COVID-19 pandemic significantly threatens the health and well-being of older 
adults. Aging-related changes, including multimorbidity, weakened immunity and 
frailty, may make older people more susceptible to severe infection and place 
them at higher risk of morbidity and mortality from COVID-19. Various quarantine 
measures have been implemented to control the spread of COVID-19. Nevertheless, 
such social distancing has disrupted routine health care practices, such as 
accessibility of medical services and long-term continuous care services. The 
medical management of older adults with multimorbidity is significantly 
afflicted by COVID-19. Older persons with frailty or multiple chronic disease 
may poorly adapt to the altered health care system, having detrimental 
consequences on their physical and mental health. COVID-19 pandemic has posed 
great challenges to the health of older adults. We highlighted the difficulties 
and obstacles of older adults during this unprecedented time. Also, we provided 
potential strategies and recommendations for actions to mitigate the COVID-19 
pandemic threats. Certain strategies like community primary health care, 
medication delivery and home care support are adopted by many health facilities 
and caregivers, whereas other services such as internet hospital and virtual 
medical care are promoted to be accessible in many regions. However, guidelines 
and policies based on high-quality data are still needed for better health 
promotion of older groups with increasing resilience during the COVID-19 
pandemic.

© 2022 Zhu et al.

DOI: 10.2147/CIA.S376519
PMCID: PMC9491878
PMID: 36158515 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest in 
this work.


1497. Scand J Psychol. 2023 Apr;64(2):150-159. doi: 10.1111/sjop.12871. Epub 2022 Sep 
25.

Queers in quarantine: Young LGBTQ+ people's experiences during the COVID-19 
pandemic in Sweden.

Malmquist A(1), Bredenberg C(1), Melin J(1), Wurm M(2), Tasker F(3), Gato 
J(4)(5).

Author information:
(1)Department of Behavioural Sciences and Learning, Linköping University, 
Linköping, Sweden.
(2)Department of Law, Psychology and Social Work, Örebro University, Örebro, 
Sweden.
(3)Department of Psychological Sciences, Birkbeck, University of London, London, 
UK.
(4)Faculty of Psychology and Education Sciences, University of Porto, Porto, 
Portugal.
(5)Centre for Psychology at the University of Porto, Porto, Portugal.

The COVID-19 pandemic led to major restrictions of everyday life activities. 
This worsened the social situation of many people, and marginalized groups have 
been especially affected. This article explores how LGBTQ+ young adults in 
Sweden have been affected by the COVID-19 pandemic and the subsequent 
recommendations and restrictions. Fifteen participants between 20-29 years, who 
self-identified as lesbian, gay, bisexual, transgender, and queer (LGBTQ+), were 
interviewed about their experiences. A thematic analysis of the data showed that 
the participants perceived their psychological wellbeing to have been greatly 
affected by the pandemic. Several reported symptoms of clinical depression, as 
well as anxiety, worry, rumination, and a heightened sensitivity to stress. 
Stressors included fear of the disease itself, and fear of spreading the virus, 
as well as the negative consequences of adhering to the recommendations of 
social distancing, which constantly interplayed with the marginalized position 
of being a young LGBTQ+ person. Most participants experienced a decrease in 
minority stress in face-to-face interaction with social distancing measures in 
place, but an increase in minority stress online. Those who faced minority 
stress at home experienced the isolation as particularly stressful. Limited 
access to the LGBTQ+ community was a common stressor. For transgender 
participants, the effects on transgender healthcare, such as prolonged waiting 
times for gender dysphoria assessment and hormone treatment, were a major 
challenge. Our results have added valuable knowledge to research indicating how 
vulnerable young adults were highly affected by the COVID-19 pandemic 
restrictions.

© 2022 The Authors. Scandinavian Journal of Psychology published by Scandinavian 
Psychological Associations and John Wiley & Sons Ltd.

DOI: 10.1111/sjop.12871
PMCID: PMC9538029
PMID: 36153699 [Indexed for MEDLINE]


1498. Matern Child Health J. 2022 Nov;26(11):2308-2317. doi: 
10.1007/s10995-022-03540-0. Epub 2022 Sep 24.

Post-partum Women's Anxiety and Parenting Stress: Home-Visiting Protective 
Effect During the COVID-19 Pandemic.

Roberti E(1), Giacchero R(2), Grumi S(1), Biasucci G(3), Cuzzani L(2), 
Decembrino L(4), Magnani ML(5), Motta M(6), Nacinovich R(7)(8), Pisoni C(9), 
Scelsa B(10), Provenzi L(11)(12); MOM-COPE study group.

Collaborators: Altieri L, Benedetta P, Bettiga E, Bonini R, Borgatti R, 
Cavallini A, Falcone R, Fazzi E, Gardella B, Guerini P, Orcesi S, Pantaleo D, 
Prefumo F, Previtali R, Riva L, Spinillo A, Vergani P, Viganò MG.

Author information:
(1)Developmental Psychobiology Lab, IRCCS Mondino Foundation, via Mondino 2, 
27100, Pavia, Italy.
(2)Department of Pediatrics, ASST Lodi, Lodi, Italy.
(3)Obstetrics and Gynecology Unit, Guglielmo da Saliceto Hospital, Piacenza, 
Italy.
(4)ASST Pavia, Unità Operativa di Pediatria e Nido, Ospedale Civile di Vigevano, 
Vigevano, PV, Italy.
(5)ASST Pavia, Unità Operativa di Pediatria e Nido, Ospedale Civile di Voghera, 
Voghera, PV, Italy.
(6)Department of Neonatology and Neonatal Intensive Care Unit, ASST Spedali 
Civili, Brescia, Italy.
(7)Clinic of Child and Adolescent Neuropsychiatry, San Gerardo Hospital, ASST 
Monza, Monza, Italy.
(8)Department of Medicine and Surgery, University of Milano Bicocca, Milan, 
Italy.
(9)Neonatal Intensive Care Unit, IRCCS Foundation Policlinico San Matteo, Pavia, 
Italy.
(10)Unit of Pediatric Neurology, Buzzi Children's Hospital, Milan, Italy.
(11)Developmental Psychobiology Lab, IRCCS Mondino Foundation, via Mondino 2, 
27100, Pavia, Italy. livio.provenzi@unipv.it.
(12)Department of Brain and Behavioral Sciences, University of Pavia, Pavia, 
Italy. livio.provenzi@unipv.it.

OBJECTIVES: The COVID-19 pandemic resulted in a particularly adverse and 
stressful environment for expecting mothers, possibly enhancing feelings of 
anxiety and parenting stress. The present work assesses mothers' anxiety levels 
at delivery and parenting stress after 3 months as moderated by home-visiting 
sessions.
METHODS: Women (n = 177) in their second or third trimester of pregnancy during 
the COVID-19 lockdown were enrolled in northern Italy and split into those who 
did and did not receive home visits. After 3 months, the association between 
anxiety at delivery and parenting stress was assessed with bivariate 
correlations in the whole sample and comparing the two groups.
RESULTS: Higher anxiety at birth correlated with greater perceived stress after 
3 months. Mothers who received at least one home-visiting session reported lower 
parenting stress at 3 months than counterparts who did not receive home visits. 
CONCLUSIONS FOR PRACTICE: The perinatal period is a sensitive time window for 
mother-infant health, especially during a critical time like the COVID-19 
pandemic. We suggest that home-visiting programs could be beneficial during 
global healthcare emergencies to promote maternal well-being after delivery.

© 2022. The Author(s).

DOI: 10.1007/s10995-022-03540-0
PMCID: PMC9510513
PMID: 36153448 [Indexed for MEDLINE]

Conflict of interest statement: All authors declares that they have no conflict 
of interest to disclose.


1499. Sci Rep. 2022 Sep 24;12(1):15945. doi: 10.1038/s41598-022-19907-w.

Implications of the COVID-19 pandemic on self-reported health status and noise 
annoyance in rural and non-rural Canada.

Michaud DS(1), Marro L(2), Denning A(3), Shackleton S(4), Toutant N(5), 
Cameron-Blake E(6), McNamee JP(3).

Author information:
(1)Health Canada, Environmental and Radiation Health Sciences Directorate, 
Consumer and Clinical Radiation Protection Bureau, Non-Ionizing Radiation Health 
Sciences Division, 775 Brookfield Road, Ottawa, ON, K1A1C1, Canada. 
david.michaud@hc-sc.gc.ca.
(2)Biostatistics Section, Health Canada, Environmental and Radiation Health 
Sciences Directorate, Environmental Health Science and Research Bureau, 251 Sir 
Frederick Banting Driveway, Tunney's Pasture, Ottawa, ON, K1A0K9, Canada.
(3)Health Canada, Environmental and Radiation Health Sciences Directorate, 
Consumer and Clinical Radiation Protection Bureau, Non-Ionizing Radiation Health 
Sciences Division, 775 Brookfield Road, Ottawa, ON, K1A1C1, Canada.
(4)Public Engagement, Research and Analysis Division, Health Canada, 
Communications and Public Affairs Branch, 200 Eglantine Driveway, Tunney's 
Pasture, Ottawa, ON, K1A 0K9, Canada.
(5)Advanis, Inc., 3981 Boulevard Saint-Laurent, Suite 200, Montréal, QC, H2W 
1Y5, Canada.
(6)Blavatnik School of Government, University of Oxford, Radcliffe Observatory 
Quarter, Woodstock Road, Oxford, OX2 6GG, UK.

The Canadian Perspectives on Environmental Noise Survey (CPENS), conducted 
between April 12th, 2021 and May 25th, 2021 coincided with the third wave of the 
COVID-19 pandemic. Canadians 18 years of age and older (n = 6647) reported the 
degree to which the pandemic affected their physical health, mental health, 
stress, annoyance toward environmental and indoor noise, and overall well-being. 
Depending on the outcome evaluated, between 18 and 67% of respondents reported 
the measure as "somewhat" or "much worse" due to the pandemic. Stress was most 
affected, followed by mental health, overall well-being, physical health, 
annoyance toward environmental noise and annoyance toward indoor noise. Logistic 
regression models indicated that province, geographic region (rural/remote, 
suburban, urban), age, gender, poor physical/mental health, heart disease, a 
history of high sleep disturbance (in general) or diagnosed sleep disorders, 
anxiety/depression, working/schooling from home, and being retired significantly 
impacted the odds of reporting a worsening by the pandemic to varying degrees 
and directions, depending on the outcome. Indigenous status was unrelated to any 
of the modelled outcomes. Future research could address some of the noted study 
limitations and provide the data to determine if the observations on the 
reported measures of health are temporary, or long-lasting.

© 2022. Crown.

DOI: 10.1038/s41598-022-19907-w
PMCID: PMC9509391
PMID: 36153388 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1500. Intensive Crit Care Nurs. 2023 Feb;74:103313. doi: 10.1016/j.iccn.2022.103313. 
Epub 2022 Aug 22.

Mental well-being of intensive care unit nurses after the second surge of the 
COVID-19 pandemic: A cross-sectional and longitudinal study.

Heesakkers H(1), Zegers M(2), van Mol MMC(3), van den Boogaard M(2).

Author information:
(1)Radboud University Medical Center, Radboud Institute for Health Sciences, 
Department Intensive Care, Nijmegen, The Netherlands. Electronic address: 
hidde.heesakkers@radboudumc.nl.
(2)Radboud University Medical Center, Radboud Institute for Health Sciences, 
Department Intensive Care, Nijmegen, The Netherlands.
(3)Erasmus MC, University Medical Center Rotterdam, Department of Intensive Care 
Adults, The Netherlands.

OBJECTIVES: To determine the impact of the second surge of the COVID-19 pandemic 
(October 2020 to June 2021) on mental well-being of intensive care unit nurses 
and factors associated with mental health outcomes.
METHODS: An online survey was available for Dutch intensive care unit nurses in 
October 2021, measuring mental health symptoms; anxiety, depression (Hospital 
Anxiety and Depression Scale), and post-traumatic stress disorder (Impact of 
Event Scale-6). Additionally, work-related fatigue was measured using the Need 
For Recovery-11 questionnaire. Previous data from the first surge (March until 
June 2020) were used to study mental well-being longitudinally in a subgroup of 
intensive care unit nurses. Logistic regression analyses were performed to 
determine factors associated with mental health symptoms.
RESULTS: In total, 589 nurses (mean age 44.8 [SD, 11.9], 430 [73.8 %] females) 
participated, of whom 164 also completed the questionnaire in 2020. After the 
second surge, 225/589 (38.2 %) nurses experienced one or more mental health 
symptoms and 294/589 (49.9 %) experienced work-related fatigue. Compared to the 
first measurement, the occurrence of mental health symptoms remained high 
(55/164 [33.5 %] vs 63/164 [38.4 %], p = 0.36) and work-related fatigue was 
significantly higher (66/164 [40.2 %] vs 83/164 [50.6 %], p = 0.02). Granted 
holidays as requested (aOR, 0.54; 95 % CI, 0.37-0.79), being more confident 
about the future (aOR, 0.59; 95 % CI, 0.37-0.93) and a better perceived 
work-life balance (aOR, 0.42; 95 % CI, 0.27-0.65) were significantly associated 
with less symptoms.
CONCLUSION: The second surge of the COVID-19 pandemic further drained the mental 
reserves of intensive care unit nurses, resulting in more work-related fatigue.

Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.iccn.2022.103313
PMCID: PMC9393155
PMID: 36153185 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


1501. Soc Sci Med. 2022 Nov;312:115373. doi: 10.1016/j.socscimed.2022.115373. Epub 
2022 Sep 17.

Poverty, parental work intensity and child emotional and conduct problems.

Treanor M(1), Troncoso P(2).

Author information:
(1)Institute for Social Policy, Housing, Equalities Research, Heriot-Watt 
University, UK.
(2)Institute for Social Policy, Housing, Equalities Research, Heriot-Watt 
University, UK. Electronic address: p.troncoso@hw.ac.uk.

Poverty is known to be associated with poorer child mental wellbeing. Relatedly, 
the security and quality of employment are reported to affect adult wellbeing. 
Less is known about how both poverty and parental employment affect children's 
mental wellbeing. This paper uses nine waves (2005/06-2017/18) of the Growing Up 
in Scotland (GUS) study to examine how the longitudinal trajectories of poverty 
and work intensity are associated with the longitudinal trajectories of mental 
wellbeing in a nationally representative sample of 3994 children (ages 0 to 12). 
This analysis was conducted via a bivariate multilevel non-linear growth curve 
model for the widely used Strengths and Difficulties Questionnaire (SDQ) 
subscales of conduct problems and emotional symptoms. Results show that unstable 
work intensity and poverty trajectories arising from the 2008 financial crisis 
are associated with substantial changes in the trajectories of conduct and 
emotional problems, but with key differences between the individual outcomes: 
increasing work intensity is associated with around a fifth of a standard 
deviation increase in conduct problems; decreasing work intensity over time is 
associated with around a fifth of a standard deviation increase in emotional 
problems; material deprivation is associated with an increase in both conduct 
and emotional problems, at around a tenth of a standard deviation; and 
longitudinal income poverty trajectories are associated with up to around a 
fifth of a standard deviation increase in conduct problems, but not emotional 
symptoms. These findings are discussed with the purpose of informing policies to 
tackle the effects of unstable and/or changing socioeconomic circumstances on 
children's mental health wellbeing in the context of an economic crisis, as well 
as its implications for the contemporary socioeconomic landscape and the 
devastating effects expected of the COVID-19 crisis.

Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.socscimed.2022.115373
PMID: 36152585 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest We have no 
conflicts of interest to disclose.


1502. Int Rev Psychiatry. 2022 May-Jun;34(3-4):432-438. doi: 
10.1080/09540261.2021.2019686. Epub 2021 Dec 30.

Mental health and well-being of LGBTQ+ people during the COVID-19 pandemic.

Sampogna G(1), Ventriglio A(2), Di Vincenzo M(1), Del Vecchio V(1), Giallonardo 
V(1), Bianchini V(3), Fiorillo A(1).

Author information:
(1)Department of Psychiatry, University of Campania Luigi Vanvitelli, Largo 
Madonna delle Grazie, Naples, Italy.
(2)Department of Clinical and Experimental Medicine, University of Foggia, 
Foggia, Italy.
(3)Department of Life, Health and Environmental Sciences, Psychiatric Unit: 
Trattamenti Riabilitativi Psicosociali, Interventi Precoci, TRIP, Psychosocial 
Rehabilitation Treatment, Early Interventions University Unit, University of 
L'Aquila, L'Aquila, Italy.

The COVID-19 pandemic has had a profound negative impact on the mental health of 
the general population. The COVID-19 pandemic and its related containment 
measures have increased structural disadvantages faced by marginalized 
communities, such as LGBTQ+ people. LGBTQ+ is an acronym used to identify 
lesbian, gay, bisexual, transgender and queer people plus all community members 
using different terms to describe their sexual orientation or gender identity. 
It is likely that the COVID-19 pandemic has exposed them to increased minority 
stress, which can also affect their physical health. Since the beginning of the 
pandemic, the few available studies on the mental health of LGBTQ+ have reported 
frequent worries about the future, negative emotions, and feelings of 
uncertainty. Moreover, they have faced further difficulties such as undertaking 
hormone therapy, accessing to health facilities or living with family members 
not accepting their condition. The COVID-19 pandemic has added a significant 
burden to the well-being of LGBTQ+ people, and therefore there is the need to 
provide them with dedicated supportive interventions in order to promote the 
early detection of mental health problems or of full-blown mental disorders.

DOI: 10.1080/09540261.2021.2019686
PMID: 36151840 [Indexed for MEDLINE]


1503. J Obstet Gynaecol. 2022 Oct;42(7):3328-3335. doi: 10.1080/01443615.2022.2125292. 
Epub 2022 Sep 24.

The potential impact of COVID-19 on women's reproductive and mental health: a 
questionnaire study.

Tripathy S(1), A P(2), R SK(1), M A(1), Mohapatra S(3).

Author information:
(1)Department of Obstetrics and Gynaecology, SRM Medical College Hospital and 
Research Centre, Kattankulathur, Tamil Nadu, India.
(2)Center for Clinical Trials and Research, SRM Medical College Hospital and 
Research Center, Kattankulathur, Tamil Nadu, India.
(3)Department of Pharmacology, SRM Medical College Hospital and Research Centre, 
Kattankulathur, Tamil Nadu, India.

The pandemic has transformed the social and economic certainties of people's 
lives imposing stay-at-home necessities which began in mid-March 2020. This 
cross-sectional observational study was performed to study the impact of 
COVID-19 on the reproductive and mental health of women before and after the 
pandemic. A digital survey form of 50 questions was developed using the Google 
platform andshared over 4 weeks in August 2021. Paired t-test was used to 
compare the variables before and after the COVID-19. Of the 450 respondents, 
443(98.44%) completed the questionnaire. There was a significant difference in 
the average duration of menstruation and the proportion of women with a cycle 
length of 35-45 days increased from 5 to 8% of women after the pandemic. Painful 
periods (28.5 to 59.5%, p = .002) and weight increased (39.2%, p < .001) after 
the pandemic. Stress also increased after the pandemic (p < .001). The pandemic 
has significantly impacted the reproductive and mental health of women. The 
long-term health significances of this are yet to be determined.Impact 
StatementWhat is already known on this subject? The pandemic has transformed the 
social and economic certainties of people's lives, mainly women. Women's health 
significantly mental health is affected by the lack of adequate domestic and 
emotional support which may further consequences like the risk of anxiety and 
depression.What do the results of this study add? Our study shows the effect of 
COVID-19 on women's reproductive and mental health before and after the 
pandemic. Inadvertent forfeits women's health and well-being and instabilities 
in reproductive function as raised pressure causes irregularities in the 
menstrual cycle.What are the implications of these findings for clinical 
practice and/or further research? Women have suffered from significant mental 
and reproductive problems during the first and second waves of the COVID-19 
pandemic. But, the long-term effects of these are not unknown. Upcoming work 
should comprise study throughout the pandemic and the long-term impact on 
women's health.

DOI: 10.1080/01443615.2022.2125292
PMID: 36151782 [Indexed for MEDLINE]


1504. J Nurs Manag. 2022 Oct;30(7):2585-2596. doi: 10.1111/jonm.13814. Epub 2022 Oct 
4.

A year after COVID-19: Its impact on nurses' psychological well-being.

Aloweni F(1), Ayre TC(2), Teo I(3)(4)(5), Tan HK(6)(7)(8), Lim SH(1).

Author information:
(1)Division of Nursing, Singapore General Hospital, Singapore.
(2)Group Nursing, SingHealth, Singapore.
(3)Programme in Health Services and Systems Research, Duke-NUS Medical School, 
Singapore.
(4)Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.
(5)Department of Psychosocial Oncology, National Cancer Centre Singapore, 
Singapore.
(6)Division of Surgery and Surgical Oncology, Singapore General Hospital and 
National Cancer Centre Singapore, Singapore.
(7)Singapore General Hospital, Singapore.
(8)SingHealth Duke-NUS Global Health Institute, Singapore.

BACKGROUND: Nurses' burnout and psychological well-being are a significant 
concern during the pandemic.
AIMS: The aim of this study is to (i) examine the level of burnout, anxiety, 
depression, perceived stress and self-rated health for nurses at two 
time-points, 2020 and 2021, and (ii) examine the socio-demographic 
characteristics, work-related factors and perceived workplace support factors in 
relation to the level of burnout.
METHODS: This is a cross-sectional study with a longitudinal approach. A 
convenience sample of registered nurses who worked in an acute care tertiary 
hospital in Singapore were surveyed during two time-points. Participants' 
health, socio-demographic characteristics, work-related factors and perceived 
workplace support factors were collected.
RESULTS: Among the 179 nurses, there was a significant increase in burnout 
level, poorer self-rated health and reduced job dedication. A decrease in the 
percentage of nurses who felt appreciated at work was reported in 2021 
(p = 0.04). Nurses who felt their team was not working well together were 3.30 
times more likely to experience burnout (95% CI 1.12 to 9.69; p = 0.03). Nurses 
who reported that they never felt appreciated by their department/hospital were 
8.84 times more likely to experience burnout (95% CI 2.67 to 29.21; p < 0.001). 
Nurses with poorer self-rated health were more likely to report burnout (95% CI: 
1.32-6.03; p = 0.008).
CONCLUSION: Nurses had an increased experience of burnout, reduced job 
dedication and poorer self-rated health after the outbreak.
IMPLICATIONS FOR NURSING MANAGEMENT: Interventions at the departmental and 
organizational levels are needed to improve the workplace support. Strategies to 
support nurses' psychological well-being during the aftermath of COVID-19 are 
vital to managing nurses' burnout and improving job dedication and self-rated 
health.

© 2022 John Wiley & Sons Ltd.

DOI: 10.1111/jonm.13814
PMCID: PMC9538098
PMID: 36150900 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflict of interest to 
disclose.


1505. J Prof Nurs. 2022 Sep-Oct;42:301-307. doi: 10.1016/j.profnurs.2022.07.020. Epub 
2022 Aug 11.

Clinical learning during the pandemic: Experiences of LPN-BN undergraduate 
nursing students.

Bryan V(1), Corcoran L(2), Dewart G(3), Thirsk LM(4), Bowers E(5).

Author information:
(1)Faculty of Health Disciplines, Athabasca University, 1 University Dr., 
Athabasca, AB T9S 3A3, Canada. Electronic address: vbryan@athabascau.ca.
(2)Faculty of Health Disciplines, Athabasca University, 1 University Dr., 
Athabasca, AB T9S 3A3, Canada. Electronic address: lynnc@athabascau.ca.
(3)Faculty of Health Disciplines, Athabasca University, 1 University Dr., 
Athabasca, AB T9S 3A3, Canada. Electronic address: gdewart@athabascau.ca.
(4)Faculty of Health Disciplines, Athabasca University, 1 University Dr., 
Athabasca, AB T9S 3A3, Canada. Electronic address: lthirsk@athabascau.ca.
(5)Faculty of Health Disciplines, Athabasca University, 1 University Dr., 
Athabasca, AB T9S 3A3, Canada. Electronic address: ebowers@athabascau.ca.

BACKGROUND: When the COVID-19 pandemic was declared in March 2020, nursing 
programs made rapid decisions regarding clinical placement experiences for 
students. In many nursing programs, this meant ending clinical placements early, 
delaying clinical courses, and moving clinical courses to simulation.
PURPOSE: The purpose of this study was to explore LPN-BN students' experiences 
in clinical courses during the COVID-19 pandemic.
METHOD: A qualitative descriptive approach was employed in this study. Fifteen 
semi-structured conversational interviews with nursing students and recent 
graduates were conducted. Inductive content analysis was used to analyse the 
data.
RESULTS: Four main concepts were identified: (1) logistics of learning; (2) 
shifts in clinical learning; (3) mental health matters; (4) readiness to 
practice.
CONCLUSION: It is important to understand the experience of nursing students as 
this is an inordinately stressful and impressionable time for them. Insight into 
the student experience, will inform educators in the areas of curriculum and 
competency-based evaluation as well as supports for student mental health and 
well-being.

Copyright © 2022 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.profnurs.2022.07.020
PMCID: PMC9368157
PMID: 36150874 [Indexed for MEDLINE]


1506. Nurse Educ Today. 2022 Dec;119:105560. doi: 10.1016/j.nedt.2022.105560. Epub 
2022 Sep 17.

Coping with COVID-19. Work life experiences of nursing, midwifery and paramedic 
academics: An international interview study.

Brown J(1), Slatyer S(2), Jakimowicz S(3), Maben J(4), Calleja P(5), Donovan 
H(6), Cusack L(7), Cameron D(8), Cope V(2), Levett-Jones T(3), Williamson M(5), 
Klockner K(5), Walsh A(7), Arnold-Chamney M(7), Hollingdrake O(6), Thoms D(6), 
Duggan R(9).

Author information:
(1)Curtin University, Australia. Electronic address: janie.brown@curtin.edu.au.
(2)Murdoch University, Australia.
(3)University of Technology Sydney, Australia.
(4)University of Surrey, UK.
(5)Central Queensland University, Australia.
(6)Queensland University of Technology, Australia.
(7)University of Adelaide, Australia.
(8)University of the West of Scotland, UK.
(9)Curtin University, Australia.

BACKGROUND: The COVID-19 global pandemic was declared in March 2020. By June 
2022, the total deaths worldwide attributed to COVID-19 numbered over 6.3 
million. Health professionals have been significantly impacted worldwide 
primarily those working on the frontline but also those working in other areas 
including nursing, midwifery, and paramedic higher education. Studies of 
occupational stress have focused on the clinical health professional roles but 
scant attention has been drawn to the pressures on university-based academic 
staff supporting and preparing professionals for frontline health work.
DESIGN AND OBJECTIVES: This qualitative study sought to explore the challenges 
experienced by health academics (nurses, midwives and paramedics), during 
COVID-19 and identify strategies enlisted.
SETTING AND PARTICIPANTS: Six Australian and two United Kingdom universities 
collaborated, from which 34 health academics were individually interviewed via 
video or teleconference, using six broad questions. Ethical approval was 
obtained from the lead site and each participating University.
DATA ANALYSIS: Thematic analysis of the data was employed collaboratively across 
institutions, using Braun and Clarke's method.
RESULTS: Data analysis generated four major themes describing academics': 
Experiences of change; perceptions of organisational responses; professional and 
personal impacts; and strategies to support wellbeing. Stress, anxiety and 
uncertainty of working from home and teaching in a different way were reported. 
Strategies included setting workday routine, establishing physical boundaries 
for home-working and regular online contact with colleagues.
CONCLUSIONS: The ability of nursing, midwifery and, paramedic academic staff to 
adapt to a sudden increase in workload, change in teaching practices and 
technology, while being removed from their work environment, and collegial, 
academic and technological supports is highlighted. It was recognised that these 
changes will continue post-COVID and that the way academics deliver education is 
forever altered.

Copyright © 2022 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.nedt.2022.105560
PMCID: PMC9482167
PMID: 36150292 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


1507. J Obstet Gynaecol. 2022 Oct;42(7):2970-2978. doi: 10.1080/01443615.2022.2124850. 
Epub 2022 Sep 23.

The relationship of probable clinical anxiety with attitude-behaviour, coping 
styles and social support in healthy pregnant women during the late period 
COVID-19 pandemic.

Kılıç A(1), Gök K(2), Kökrek Z(3), Kapudere B(2), Tüten N(4), Bostancı MS(2), 
Özden S(2).

Author information:
(1)Department of Psychiatry, Faculty of Medicine, Istanbul Medipol University, 
İstanbul, Turkey.
(2)Department of Obstetrics and Gynecology, Faculty of Medicine, Sakarya 
University, Sakarya, Turkey.
(3)Department of Psychology, Faculty of Humanities and Social Sciences, Istanbul 
Ticaret University, Istanbul, Turkey.
(4)Department of Obstetrics and Gynecology, Kanuni Sultan Süleyman Training and 
Research Hospital, Istanbul, Turkey.

The aim of the study is to investigate the prevalence of state and trait 
probable clinical anxiety and their relationship with socio-demographic factors, 
attitude-behaviour, coping styles and social support level in high-risk pregnant 
women in the late period of COVID-19 pandemic. The pregnant women followed up in 
the gynaecological outpatient clinic were evaluated during their admissions. 
About 191 healthy pregnant women were included in the study. Data were collected 
using the socio-demographic and pregnancy attitude-behaviour data form, STAI 
(Spielberger's State-Trait Anxiety Inventory), the Coping Styles Scale Brief 
Form (Brief-COPE) and the Multidimensional Scale of Perceived Social Support 
(MSPSS). Our study found that pregnant women had high anxiety levels 
(STAI-S:37.90 ± 8.88; STAI-T:42.46 ± 7.80) and probable clinical anxiety 
prevalences (STAI-S:81(42.4%); STAI-T:123(64.4%)) in the late period of the 
COVID-19 pandemic. The fact that COVID-19 determined the preference of the birth 
method and the level of knowledge about COVID-19 predicted state probable 
clinical anxiety. Educational status, concern for COVID-19 transmission to the 
baby during pregnancy/birth, behavioural disengagement, focussing on and venting 
emotions predicted trait probable clinical anxiety. Our results have emphasised 
the factors that should be taken into account and coping styles that may be 
functional to protect the mental well-being of healthy pregnants.IMPACT 
STATEMENTWhat is already known on this subject? The COVID-19 pandemic has been 
shown to increase the symptoms of stress, anxiety and depression of the general 
population and healthcare workers. There is limited studies about pregnant 
women.What do the results of this study add? According to our study, we can say 
that approximately half of the pregnant women in a pandemic need psychiatric 
evaluation due to probable clinical anxiety. The relationship between anxiety in 
the pandemic process and birth preference has been shown and coping styles in 
healthy pregnant women have been investigated for the first time, effective and 
ineffective coping styles have been shown. In addition, it has been found that 
the social support of pregnant women is effective in managing the pandemic 
process.What are the implications of these findings for clinical practice and/or 
further research? According to our current findings, a multidisciplinary 
approach in which pregnant women are screened with self-report psychiatry tests 
and appropriate pregnant women are consulted to psychiatry during pandemic 
processes will make it easier for obstetricians to manage the patient. 
Especially strengthening effective coping styles and social support will have a 
great effect in mental rehabilitation. In this respect, further studies on 
pregnant women are needed.

DOI: 10.1080/01443615.2022.2124850
PMID: 36149662 [Indexed for MEDLINE]


1508. Int J Public Health. 2022 Sep 6;67:1604359. doi: 10.3389/ijph.2022.1604359. 
eCollection 2022.

"About Navigating Chaos": Latin American and Caribbean Mental Health Workers' 
Personal Impact Due to SARS-CoV-2 in the First Hundred Days.

Agrest M(1), Rosales M(2), Fernández M(2), Kankan T(3), Matkovich A(4), 
Velzi-Díaz A(4), Ardila-Gómez S(2).

Author information:
(1)Proyecto Suma, Asistencia y Rehabilitación en Salud Mental, Buenos Aires, 
Argentina.
(2)Instituto de Investigaciones, Facultad de Psicología, Universidad de Buenos 
Aires, Buenos Aires, Argentina.
(3)Teachers College, Columbia University, New York, NY, United States.
(4)Facultad de Psicología, Universidad Nacional de Rosario, Santa Fe, Argentina.

Objectives: The personal impact of COVID-19 on mental health care workers (MHWs) 
has received scarce attention despite their work addressing the emotional 
wellbeing of those affected by the pandemic. This study aims to analyze Latin 
American and Caribbean's MHWs' subjective impact in connection to working during 
the initial times of the pandemic. Methods: One hundred and fifty-five persons 
(n = 155) from seventeen countries were contacted in May-June 2020 through a 
snowball approach. Complementary methodological strategies of analysis used for 
data triangulation included content analysis, thematic analysis, and 
interpretative phenomenological analysis. Results: Participants reported 
feelings of fear, anxiety, anguish, and fatigue. Milder negative impacts (e.g., 
uncertainty, concern), and complex feelings (e.g., ambivalence) were also 
frequent. One third of participants acknowledged their capacity to learn from 
this situation and/or experience satisfaction. Conclusion: Mental health of MHWs 
in Latin America and the Caribbean were under severe strain and the ongoing 
mental health reforms at risk during the pandemic's beginning. More research and 
additional care may be needed to offer support to those involved in caring for 
the wellbeing of others.

Copyright © 2022 Agrest, Rosales, Fernández, Kankan, Matkovich, Velzi-Díaz and 
Ardila-Gómez.

DOI: 10.3389/ijph.2022.1604359
PMCID: PMC9485453
PMID: 36147883 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1509. Int J Environ Res Public Health. 2022 Sep 18;19(18):11777. doi: 
10.3390/ijerph191811777.

Health and Care Dependency of Older Adults in Dresden, Germany: Results from the 
LAB60+ Study.

Romero Starke K(1), Hegewald J(1)(2), Schmauder S(1), Kaboth P(1), Uhlmann 
LM(3), Reissig D(1), Kaufmann KK(4), Wegge J(3), Marquardt G(5), Seidler A(1).

Author information:
(1)Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty 
of Medicine, Technische Universität Dresden, 01307 Dresden, Germany.
(2)Federal Institute for Occupational Safety and Health (BAuA), 10317 Berlin, 
Germany.
(3)Work and Organisational Psychology, Technische Universität Dresden, 01069 
Dresden, Germany.
(4)Social Affairs, Health and Housing Division, 10117 Berlin, Germany.
(5)Social and Health Care Buildings and Design, Technische Universität Dresden, 
01069 Dresden, Germany.

As the population in Europe ages, an increased focus on the health of older 
adults is necessary. The purpose of the population-based LAB60+ study was to 
examine the current health and care situation of the population of older adults 
in Dresden, Germany, and to assess the effect of age, gender, and socioeconomic 
status (SES) on health outcomes. In the first half of 2021, 2399 out of 6004 
randomly sampled residents of Dresden aged 60 years or older answered questions 
on their chronic conditions, care dependency, health-related quality of life 
(HRQoL), and well-being, among others. Of the participants, 91.6% were afflicted 
with at least one chronic condition, and 73.1% had multimorbidities. More than 
one-tenth (11.3%) of participants were care dependent. Lower levels of HRQoL and 
well-being were observed compared to a published German reference population, 
perhaps because of the ongoing COVID-19 pandemic. Gender differences were 
observed for some chronic health conditions, and women had a higher risk for 
lower HRQoL, well-being, and depressivity compared to men. A low SES was 
associated with a higher risk of the vast majority of health outcomes. 
Particularly, socioeconomic factors and gender-related inequalities should be 
considered for the development of prevention and health-promoting measures 
during late life.

DOI: 10.3390/ijerph191811777
PMCID: PMC9517330
PMID: 36142050 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript, or in the decision to 
publish the results.


1510. Int J Environ Res Public Health. 2022 Sep 16;19(18):11672. doi: 
10.3390/ijerph191811672.

Consequences of COVID-19 on Employees in Remote Working: Challenges, Risks and 
Opportunities An Evidence-Based Literature Review.

De Vincenzi C(1), Pansini M(1), Ferrara B(1), Buonomo I(1), Benevene P(1).

Author information:
(1)Department of Human Studies, Libera Università Maria SS. Assunta, 00193 Rome, 
Italy.

The COVID-19 pandemic forced organizations across all sectors and sizes to 
undertake crucial changes in order to remain productive during the emergency. 
Among these, the shift towards remote working arrangements is still present in 
our workplaces, impacting employees' well-being and productivity. This 
systematic review aims to describe the pandemic's consequences on work 
organization by analyzing whether and how the shift towards remote or 
home-working impacted employees' productivity, performance, and well-being. 
Furthermore, it describes the role of individual and organizational factors in 
determining employees' adjustment to remote work. Sixty-seven peer-reviewed 
papers published from 2020 to 2022, written in English, were selected through 
the preferred reporting items for systematic reviews and meta-analyses (PRISMA) 
guidelines. Findings describe how remote working arrangements, the workplace and 
organizational factors, and the employees' individual traits and skills impacted 
employees' productivity and well-being. Furthermore, they provide a description 
of the organizational enforcement actions reported in the literature. Managerial 
and practical implications, such as enforcement actions, team management 
strategies, and initiatives to promote employees' physical and mental health, 
will be discussed in the paper.

DOI: 10.3390/ijerph191811672
PMCID: PMC9517495
PMID: 36141948 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1511. Int J Environ Res Public Health. 2022 Sep 15;19(18):11612. doi: 
10.3390/ijerph191811612.

A Review of the Effectiveness, Feasibility, and Acceptability of Art Therapy for 
Children and Adolescents during the COVID-19 Pandemic.

Le Vu MN(1), Do AL(2), Boyer L(3), Tran QC(4), Kohler S(5), Ahmed SI(6), Molnar 
A(7), Vu TS(2), Vo NTH(2), Nguyen LMV(2), Vu LG(1)(8), Dam VAT(1)(8), Duong 
T(2), Do DLN(2), Do NM(9), Mclntyre RS(10), Latkin C(11), Ho RCM(12)(13), Ho 
CSH(12).

Author information:
(1)Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, 
Vietnam.
(2)Institute of Health Economics and Technology, Hanoi 100000, Vietnam.
(3)Research Centre on Health Services and Quality of Life, Aix Marseille 
University, 13385 Marseille, France.
(4)High School for Gifted Students, Hanoi University of Science, Hanoi 100000, 
Vietnam.
(5)Heidelberg Institute of Global Health, Heidelberg University, 69120 
Heidelberg, Germany.
(6)Department of Computer Science, University of Toronto, Toronto, ON M5T 2S8, 
Canada.
(7)Department of Computer Science and Software Engineering, School of Software 
and Electrical Engineering, Swinburne University of Technology, Melbourne, VIC 
3122, Australia.
(8)Faculty of Medicine, Duy Tan University, Da Nang 550000, Vietnam.
(9)Vinschool Education System, Hanoi 100000, Vietnam.
(10)Institute of Medical Sciences, University of Toronto, Toronto, ON M5T 2S8, 
Canada.
(11)Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 
21205, USA.
(12)Department of Psychological Medicine, Yong Loo Lin School of Medicine, 
National University of Singapore, Singapore 119228, Singapore.
(13)Institute for Health Innovation and Technology (iHealthtech), National 
University of Singapore, Singapore 119077, Singapore.

Art therapy has been widely offered to reduce symptoms of psychological 
disturbance. Pooled evidence about its effectiveness in epidemic contexts, 
particularly during the COVID-19 pandemic, has not been yet established. This 
study reviewed the effectiveness, feasibility, and acceptability of art therapy 
on children and adolescents during the COVID-19 pandemic and past epidemics. We 
searched PubMed/Medline, PsycINFO, CENTRAL (Cochrane Library), and CINAHL for 
articles on art therapy during COVID-19. Included studies reported improvements 
in measures of mental health, sleep quality, and psychological well-being in 
children with or without disabilities in the epidemic context. Results also 
showed that art therapy was highly feasible and accepted by children and 
adolescents as well as their families during epidemics in reviewed studies. Art 
therapy can be effective at improving various aspects of mental health, sleep 
quality, and psychological well-being. More empirical evidence is needed with 
larger sample sizes and longer duration of interventions.

DOI: 10.3390/ijerph191811612
PMCID: PMC9517402
PMID: 36141885 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1512. Int J Environ Res Public Health. 2022 Sep 14;19(18):11587. doi: 
10.3390/ijerph191811587.

Adaptation and Preliminary Validation of the Fear of Coronavirus Vaccination 
Scale in the Prospective Study among a Representative Sample of Polish, Israeli, 
Slovenian, and German Adults during the COVID-19 Pandemic.

Ochnik D(1), Rogowska AM(2), Benatov J(3), Arzenšek A(4).

Author information:
(1)Faculty of Medicine, University of Technology, 40-555 Katowice, Poland.
(2)Institute of Psychology, University of Opole, 45-052 Opole, Poland.
(3)Department of Special Education, University of Haifa, Haifa 3498838, Israel.
(4)Faculty of Management, University of Primorska, 6101 Koper, Slovenia.

Although concerns about harm and side effects are among the most important 
factors determining vaccine hesitancy, research on the fear of vaccination is 
sparse. The purpose of this study is a validation the Fear of Coronavirus 
Vaccination Scale (FoCVVS), adapted from the Fear of COVID-19 Scale. A 
representative sample of 1723 young adults aged 20-40 from Poland, Israel, 
Slovenia, and Germany participated during two time-points of the third COVID-19 
pandemic wave. The online survey included demographic variables and several 
well-being dimensions, including gender, vaccination status, fear of coronavirus 
(FoCV-19S), physical health (GSRH), life satisfaction (SWLS), and perceived 
stress (PSS-10), anxiety (GAD-7), and depression (PHQ-9). Exploratory factor 
analysis (EFA) was performed at T1, and confirmatory analysis (CFA) at T2. The 
second-order two-factor structure demonstrated the best fit and very good 
discriminant and convergent validation. The general factor of the FoCVVS 
included two subscales assessing the emotional and physiological symptoms of 
fear of vaccination. Unvaccinated people showed higher levels of fear of 
vaccination than those vaccinated. A vaccination status, fear of vaccination T1, 
and fear of COVID-19 T1 were significant predictors of fear of vaccination T2. 
Vaccination-promoting programs should be focused on decreasing fear and 
enhancing the beneficial effects of vaccination.

DOI: 10.3390/ijerph191811587
PMCID: PMC9517357
PMID: 36141859 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1513. Int J Environ Res Public Health. 2022 Sep 13;19(18):11537. doi: 
10.3390/ijerph191811537.

LGBTQ+ Students' Peer Victimization and Mental Health before and during the 
COVID-19 Pandemic.

Gill EK(1), McQuillan MT(1).

Author information:
(1)Department of Educational Leadership and Policy Analysis, University of 
Wisconsin-Madison, Madison, WI 53706, USA.

Given the well-established health disparities between lesbian, gay, bisexual, 
transgender, queer, and gender-expansive (LGBTQ+) and cisgender, straight youth, 
scholars predicted the COVID-19 pandemic would disproportionately impact LGBTQ+ 
students. Yet, few studies have described changes in LGBTQ+ students' school 
experiences and well-being during the pandemic. Using survey data from 40,904 
middle and high school students, we examined changes from before (2018) to 
during (2021) the pandemic in peer victimization, anxiety, and suicide attempts. 
We conducted bivariate and multivariate regression analyses to assess changes 
between the two time points among LGBTQ+ and cisgender, straight students. We 
found LGBTQ+ students experienced more peer victimization, anxiety, and suicide 
attempts at both points, before and during the pandemic, than cisgender, 
straight youth. However, LGBTQ+ students reported increased anxiety, decreased 
peer victimization, and decreased suicide attempts in 2021, during the pandemic, 
compared to pre-pandemic 2018 reports. These findings suggest pandemic-related 
school disruptions may have provided LGBTQ+ students some relief from the 
harmful effects of poor, in-person school climates.

DOI: 10.3390/ijerph191811537
PMCID: PMC9517503
PMID: 36141809 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1514. Int J Environ Res Public Health. 2022 Sep 13;19(18):11529. doi: 
10.3390/ijerph191811529.

The Relationship between Social Mentality and Health in Promoting Well-Being and 
Sustainable City.

Liu Z(1), Han G(1), Yan J(1), Liu Z(2), Osmani M(3).

Author information:
(1)School of Design, South China University of Technology, Guangzhou 510006, 
China.
(2)Management School, Guangzhou City University of Technology, Guangzhou 510800, 
China.
(3)School of Architecture, Building and Civil Engineering, Loughborough 
University, Loughborough LE11 3TU, UK.

In the context of the coronavirus disease 2019 (COVID-19), people's social 
mentality and mental health have been severely affected, which has hindered or 
even reversed the achievement of the United Nations Sustainable Development 
Goals (SDGs). However, there is a lack of investigation into the potential 
relationship between social mentality and health, as well as of the comparison 
between different databases worldwide and in China, in the current context of 
COVID-19. Hence, the aim of this paper is to explore the research hotspots and 
development trends of social mentality and health in China and worldwide, while 
improving people's health, building a sustainable society, and facilitating the 
achieving of the SDGs. A bibliometric method is employed in this paper from a 
macro-quantitative and micro-qualitative perspective to explore the research 
hotspots and trends of social mentality and health in the world and China from 
the two databases, namely the English-language Web of Science (WOS) and the 
Chinese-language China National Knowledge Infrastructure (CNKI). The results 
indicate that: (1) By using keyword co-occurrence and clustering analysis via 
the CiteSpace software bibliometric tool, 11 current research hotspots have been 
identified and studies are increasing in terms of using the Chinese language and 
the English language. (2) The current studies in the CNKI database mainly focus 
on the macro social environmental factors affecting social mentality and 
population research, while the studies in the WOS database pay more attention to 
social mentality and health in the context of the COVID-19 epidemic situation 
and a variety of professions. Hence, future research could explore the 
influencing factors and cultivation methods toward a healthy social mentality 
from the perspective of methodology and toward achieving SDG 3, providing 
healthy lives and promote well-being for all at all ages, and SDG 11, building 
sustainable cities and communities in the post-pandemic COVID-19 era.

DOI: 10.3390/ijerph191811529
PMCID: PMC9516980
PMID: 36141799 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that there is no conflict of 
interest.


1515. Int J Environ Res Public Health. 2022 Sep 11;19(18):11441. doi: 
10.3390/ijerph191811441.

Mindfulness-Based Intervention for the Reduction of Compassion Fatigue and 
Burnout in Nurse Caregivers of Institutionalized Older Persons with Dementia: A 
Randomized Controlled Trial.

Pérez V(1), Menéndez-Crispín EJ(2), Sarabia-Cobo C(3), de Lorena P(1), 
Fernández-Rodríguez A(4), González-Vaca J(5).

Author information:
(1)Institute CR Santa Lucía, 28001 Madrid, Spain.
(2)Centro Interdisdiplinar de Psicoterapia, 28001 Madrid, Spain.
(3)Facultad de Enfermería, IDIVAL, Universidad de Cantabria, Avda Valdecilla 
s/n, 39011 Santander, Spain.
(4)CAD Santander, IDIVAL, 39008 Santander, Spain.
(5)Nursing Research Group (GRIN) from the IDIBELL Translational Medicine Area, 
University of Barcelona, 08007 Barcelona, Spain.

The recent COVID-19 pandemic has severely impacted the mental health of nurses 
caring for institutionalized older people. Caring in this environment can be 
complex, with higher levels of burnout and compassion fatigue in staff. It is 
therefore important to find interventions to increase the well-being of staff. 
Mindfulness training is known to be effective in treating a variety of physical 
and mental health conditions. This study sought to conduct a direct evaluation 
of the effectiveness of a combined online training in two types of 
mindfulness-based therapies for the reduction of compassion fatigue and burnout 
in geriatric nurses caring for institutionalized elderly people with dementia. 
In a randomized controlled trial (n = 39 experimental group, n = 35 control 
group), we explored whether individuals with high levels of burnout and 
compassion fatigue would benefit more from an online mindfulness training 
program. The outcome variable was the ProQoL professional quality of life scale, 
which was collected at baseline, at six weeks, and at three months after 
completion of the intervention. Significant differences were found between both 
groups for the subscales Compassion Fatigue and Burnout (p < 0.05), with a 
significant improvement in the experimental group (significant effect size). 
These findings were maintained at three months after the end of the intervention 
for both compassion fatigue (F1,28 = 18.14, p = 0.003) and burnout (F1,28 = 
7.25, p = 0.040). However, there were no differences between groups for the 
satisfaction subscale. The effect of time and the effects of comparing the two 
groups after controlling for time were statistically significant for all three 
subscales of the questionnaire (all p values < 0.001), with effect sizes ranging 
from small to large (R2 change 0.10-0.47). These data indicate that the 
experimental condition was more effective, explaining between 10 and 18% more of 
the variance. A short, online intervention based on mindfulness training appears 
to be effective for reducing compassion fatigue and burnout in geriatric nurses, 
with sustained effects over time.

DOI: 10.3390/ijerph191811441
PMCID: PMC9517410
PMID: 36141714 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1516. Int J Environ Res Public Health. 2022 Sep 7;19(18):11258. doi: 
10.3390/ijerph191811258.

Stressors, Psychological States, and Relationship Quality among East Malaysian 
Adults with Partners Amid the COVID-19 Lockdown.

Mutang JA(1), Chua BS(1), Hon KY(1), Siau CS(2), Wider W(3), Ismail R(4).

Author information:
(1)Faculty of Psychology and Education, Universiti Malaysia Sabah, Kota Kinabalu 
88400, Sabah, Malaysia.
(2)Centre for Community Health Studies, Universiti Kebangsaan Malaysia, Bangi 
43600, Selangor, Malaysia.
(3)Faculty of Business and Communications, INTI International University, Nilai 
71800, Negeri Sembilan, Malaysia.
(4)Faculty of Allied Health Sciences, University of Cyberjaya, Persiaran 
Bestari, Cyber 11, Cyberjaya 63000, Selangor, Malaysia.

The COVID-19 pandemic has had a huge impact not only on healthcare systems and 
economic threats but also on relationships. Due to the massive measures of the 
Movement Control Order, such as social distancing, strictly limited physical 
activities, and making adjustments to working from home-merged with the 
pandemic's fear-romantic partners may face challenges that affect the quality of 
their relationships. The purpose of this study was to (i) identify stressors 
experienced by participants during the COVID-19 lockdown, (ii) evaluate 
participants'psychological well-being before and during the lockdown, and (iii) 
see if participants' perceived relationship quality differed before and during 
the lockdown. An online self-report questionnaire was used to recruit 334 adults 
(58.1 percent female, 41.9 percent male) with partners (married = 304, engaged = 
12, and in committed relationships = 17). Participants were asked about 
stressors they encountered as a result of COVID-19 using an open-ended question. 
The Depression Anxiety Stress Scales (DASS-21) were used to assess mental 
health, and the Perceived Relationship Quality Component (PRQC) Inventory was 
used to assess relationship quality. According to the findings, the top three 
common stressors reported by participants were financial problems, restricted 
movement, and fear of COVID-19 infection. Participants reported significantly 
higher levels of stress, anxiety, and depression during the lockdown than 
before. The findings also revealed that participants' relationship quality 
improved during the lockdown compared to before the lockdown. The current study 
contributes by providing information on the impact of the COVID-19 pandemic on 
mental health and the quality of couples' relationships during the pandemic.

DOI: 10.3390/ijerph191811258
PMCID: PMC9516986
PMID: 36141527 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1517. Int J Environ Res Public Health. 2022 Sep 7;19(18):11234. doi: 
10.3390/ijerph191811234.

Physical Activity Levels and Psychological Well-Being during COVID-19 Lockdown 
among University Students and Employees.

De la Rosa A(1), Monterrosa Quintero A(2), Camacho-Villa MA(1), Arc-Chagnaud 
C(3), Andrade AGP(4), Reyes-Correa S(1), Quintero-Bernal R(5), Fuentes-García 
JP(6).

Author information:
(1)Laboratory of Exercise Physiology, Sports Science and Innovation Research 
Group (GICED), Unidades Tecnológicas de Santander (UTS), Bucaramanga 680006, 
Santander, Colombia.
(2)Research Group SER-SICIDE, Department of Physical Education and Sports, 
Universidad Católica de Oriente (UCO), Rionegro 054040, Antioquia, Colombia.
(3)Laboratoire MOVE, Faculté des Sciences du Sport, Université de Poitiers, 
F-86000 Poitiers, France.
(4)Biomechanics Laboratory, Universidade Federal de Minas Gerais, Belo Horizonte 
31270-901, Brazil.
(5)Physical Activity and Sport Program, Sports Science and Innovation Research 
Group (GICED), Unidades Tecnológicas de Santander (UTS), Bucaramanga 680006, 
Santander, Colombia.
(6)Didactic and Behavioral Analysis of Sports Research Group (ADICODE), Faculty 
of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain.

During the lockdown for the coronavirus disease 2019 (COVID-19), entire 
populations were instructed to live in home confinement. We investigated the 
effects of the COVID-19 lockdown on the physical activity (PA) and mental health 
of students and employees in a Colombian University. A cross-sectional study was 
conducted through an online survey during the first isolation. A total of 431 
respondents (192 males) aged 18-60 years old (28.1 ± 11.1 years) participated. 
The international Physical Activity Questionnaire (IPAQ) and the short version 
of the Psychological General Well-Being Index (PGWBI-S) were used. The lockdown 
had a negative effect on PA levels, with students exhibiting the greatest 
decrease (~34%; p ˂ 0.001) compared to employees (~24%; p ˂ 0.01). The analysis 
showed a greater change in PA behavior before and during the lockdown in highly 
active student participants (5750 vs. 5141 MET min/week; p < 0.05). 
Additionally, the psychological assessment revealed a lower score in students 
compared to employees in the male (70.1 vs. 82.6) and female groups (60.2 vs. 
79.6). Moreover, the results revealed an influence of sex, with only the female 
students exhibiting a state of distress. Self-reported PA and psychological 
well-being were compromised during the COVID-19 lockdown in the academic 
community, with students and females being more affected.

DOI: 10.3390/ijerph191811234
PMCID: PMC9517636
PMID: 36141525 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1518. Int J Environ Res Public Health. 2022 Sep 6;19(18):11177. doi: 
10.3390/ijerph191811177.

The Well-Being of Primary School Teachers during COVID-19.

Sigursteinsdottir H(1), Rafnsdottir GL(2).

Author information:
(1)Faculty of Business Administration, University of Akureyri, Nordurslod 2, 600 
Akureyri, Iceland.
(2)Faculty of Social and Human Science, University of Iceland, Saemundargotu 2, 
102 Reykjavik, Iceland.

This study examines the self-rated health and well-being of Icelandic teachers 
just before and over a year after COVID-19 first appeared. We ask, what was the 
stress level in 2021 compared to 2019 and the impact of mental and physical 
health and health symptoms on perceived stress? Were there any changes in 
self-assessed mental and physical health? Were there any changes in 
self-assessed mental and physical health symptoms? The study is based on an 
online survey conducted in 2019 and 2021. A total of 920 primary school teachers 
answered the questionnaire in part or in full, after three reminders. The main 
findings show increased stress, worsening mental and physical health, and 
increasing mental and physical symptoms in 2021 compared to 2019. The results 
also show a higher percentage of women than men reporting high stress, with 
women scoring higher on the PSS scale, but the gender patterns for mental and 
physical health are less clear. The results show that the COVID-19 pandemic had 
negative consequences on the health and well-being of the teachers. The study 
demonstrates the importance of school authorities keeping an exceptionally 
watchful eye on the welfare and well-being of teachers in the wake of the 
COVID-19 pandemic.

DOI: 10.3390/ijerph191811177
PMCID: PMC9517649
PMID: 36141464 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1519. Int J Equity Health. 2022 Sep 22;21(1):137. doi: 10.1186/s12939-022-01743-z.

COVID-19 impact on mental health, healthcare access and social wellbeing - a 
black community needs assessment.

Okoro O(1), Vosen EC(2), Allen K(3), Kennedy J(4), Roberts R(5), Aremu T(5).

Author information:
(1)University of Minnesota, College of Pharmacy, Duluth, MN, USA. 
ookoro@d.umn.edu.
(2)Department of Global, Cultural, and Language Studies, The College of St. 
Scholastica, Duluth, MN, USA.
(3), Duluth, MN, USA.
(4)Healthy Alliances Matter for All LLC, Duluth, MN, USA.
(5)University of Minnesota, College of Pharmacy, Minneapolis, MN, USA.

BACKGROUND: The COVID-19 pandemic has had a disproportionate effect on the 
Black/African American population. In addition to the higher infection rates and 
the worse outcomes, there were other unintended consequences of the pandemic. 
The study objective was to determine the impact of COVID-19 on the Black/African 
American community.
METHODS: A needs assessment was conducted using a mixed-methods approach. To 
address this specific study objective, an item included in the survey 
questionnaire asked respondents (n = 183) about their greatest worry related to 
CODID-19. Interviews and focus group discussions were conducted to further 
explore individual and community perceptions.
RESULTS: The areas of greatest concern were Health (41.0%), Family (25.1%), 
Finances (8.2%), and Education (4.9%). The needs assessment revealed that the 
COVID-19 pandemic had a profound impact on the mental health and wellness, 
healthcare access and utilization, and social aspects of life the Black 
community. Emerging themes revealed that there was worsening mental health for 
many, limited healthcare access and under-utilization, and profound disruption 
of the social cohesive identity of the Black/African American community.
CONCLUSION: Pre-existing structural inequities are implicated in the mental 
health impact, as well as the under-utilization of and limited access to 
healthcare services in the Black/African American population. The impact on 
social well-being emphasizes the important role of culture in the population 
health of communities of color, further supporting the need for 
culturally-responsive public health interventions when targeting these 
communities.

© 2022. The Author(s).

DOI: 10.1186/s12939-022-01743-z
PMCID: PMC9493150
PMID: 36138403 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1520. Child Abuse Negl. 2023 Aug;142(Pt 1):105852. doi: 10.1016/j.chiabu.2022.105852. 
Epub 2022 Sep 20.

Addressing challenges at the intersection of early intervention and child 
welfare.

Munger KF(1), Stegenga SM(2), Storie SO(3), Wennerstrom EK(4).

Author information:
(1)Research and Development, FuelEd Schools, United States of America. 
Electronic address: Kelley.munger@fueledschools.org.
(2)Department of Special Education, University of Utah, United States of 
America.
(3)Department of Special Education and Child Development, University of North 
Carolina-Charlotte, United States of America.
(4)Department of Special Education and Clinical Sciences, University of Oregon, 
United States of America.

BACKGROUND: The Keep Children and Families Safe Act amendment to the Child Abuse 
Prevention and Treatment Act (CAPTA) of 2003 mandated children under age three 
who are involved with Child Welfare (CW) to receive a referral to the system for 
early intervention (EI). While there is strong rationale for providing 
developmental services to young children and families impacted by maltreatment, 
the early implementation of this policy brought about many challenges related to 
interagency coordination and readiness of providers to provide cross-systems 
care. Currently, as the system and providers within the system recover from the 
effects of Covid-19, a predicted increase in need of services may exacerbate 
historical gaps in the provision of services to families involved with CW.
PARTICIPANTS AND SETTING: This policy-focused paper explores issues impacting CW 
and EI providers who coordinate care between CW and EI services.
METHODS: This paper provides a historical examination of these challenges and 
proposes an approach for improving developmental services for families referred 
from CW, specifically through the lens of addressing resources and supports 
available to providers.
RESULTS: The proposed approach includes an increase and reprioritization of 
resources to support provider readiness and well-being.
CONCLUSIONS: By focusing on support for providers, the authors propose a 
reduction of stress and improvement of services at each level of the 
"well-being" system.

Copyright © 2022 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.chiabu.2022.105852
PMID: 36137817 [Indexed for MEDLINE]


1521. Appl Psychol Health Well Being. 2023 May;15(2):650-668. doi: 10.1111/aphw.12402. 
Epub 2022 Sep 22.

Well-being and experiences of adults in German federal states under pandemic 
conditions.

Wolgast A(1), Bruns K(1), Werner L(1), Reinhaus D(1).

Author information:
(1)University of Applied Sciences FHM, Hanover, Germany.

Research on people's experiences during the Covid-19-pandemic provides growing 
evidence on subjective well-being and distress under pandemic conditions, 
however mainly at a country, not state level. The relationship between positive 
and negative experiences is described in Diener's conceptualization of 
subjective well-being. We assumed that people who experience well-being and 
positive affect through connectedness with nature, and social support during the 
pandemic feel relatively less alone, distressed, depressed, self-focused, and 
thoughtless. We further assumed changes in these constructs during the pandemic. 
The aim of this research was to examine the concurrent relationships between 
these positive and negative experiences of German adults simultaneously as well 
as their changes over 3 weeks in 2020. Owing to German federalism, we expected 
these changes to differ between German states. A sample of 1,038 adults 
responded to an online questionnaire twice (April and May 2020). A structural 
equation model including 16 factors and 12 covariates yielded the expected 
negative relationships and different mild change effects between the German 
states. For example, adults' connectedness with nature increased while 
loneliness and distress decreased in Saxony, whereas thoughtlessness increased 
in Bavaria. The results imply a new finding that different changes in adults' 
positive and negative experiences during the pandemic exist.

© 2022 The Authors. Applied Psychology: Health and Well-Being published by John 
Wiley & Sons Ltd on behalf of International Association of Applied Psychology.

DOI: 10.1111/aphw.12402
PMID: 36135223 [Indexed for MEDLINE]


1522. Psychol Rep. 2022 Dec;125(6):3069-3083. doi: 10.1177/00332941221129131. Epub 
2022 Sep 22.

Research of the Coronavirus Anxiety, Post-Traumatic Stress, Generalized Anxiety 
Disorder, Quality of Life, and Stress Coping Styles in COVID-19 Survivors.

Korkut S(1).

Author information:
(1)Department of Psychiatry, 218503Antalya Training and Research Hospital, 
Antalya, Turkey.

The COVID-19 survivors suffer from severe psychosocial challenges related to the 
current pandemic. In this context, it was aimed to evaluate the coronavirus 
anxiety, generalized anxiety disorder (GAD), and post-traumatic stress symptoms 
(PTSS) and also determine the quality of life (QOL), and coping styles with 
stress in survivors by comparing them with non-COVID controls (NCs). This study 
was conducted from April 15 to October 15, 2021, as a cross-sectional study 
design. The study included 339 survivors who were confirmed with COVID-19 
through clinical tests in the last 3 months and 321 NCs who had not been 
infected with COVID-19. Besides sociodemographic and clinical data, a set of 
valid and reliable assessment tools were used to measure outcomes of coronavirus 
anxiety, coping styles, post-traumatic stress, generalized anxiety, and quality 
of life. The total scores of IES-R, GAD-7, and CAS were significantly higher in 
survivors than in the NCs. These results revealed that survivors manifested 
higher levels of coronavirus anxiety, generalized anxiety, and post-traumatic 
stress symptoms (p < 0.05). In survivors,  the rates of GAD and coronavirus 
anxiety were found to be 59.3% and 25.7%, respectively. Additionally, the 
majority of survivors (89.4%) reported the severity of anxiety as moderate to 
severe, and also almost two-thirds of them reported the psychological impact of 
the pandemic as moderate to severe. Furthermore, survivors were found to have a 
lower quality of life. The findings of this study indicate that survivors 
experienced higher levels of coronavirus anxiety, generalized anxiety, and 
post-traumatic stress, and had lower QOL. In addition, it was determined that 
survivors haven't been using active styles adequately in coping with stress. 
Thus, psychological intervention studies should be conducted and public mental 
health strategies should be developed. Providing psychosocial support and 
psychological guidance will contribute to mental health well-being, and improve 
the QOL and coping strategies.

DOI: 10.1177/00332941221129131
PMCID: PMC9500426
PMID: 36134735 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1523. J Appl Res Intellect Disabil. 2023 Jan;36(1):68-77. doi: 10.1111/jar.13035. Epub 
2022 Sep 22.

Effects of the COVID-19 pandemic on quality of life among relatives of 
individuals with intellectual disabilities: A longitudinal study.

Zonneveld E(1), van Schelven F(1), Boeije H(1).

Author information:
(1)Department Perspective of patients and clients in healthcare, Netherlands 
Institute for Health Services Research (Nivel), Utrecht, the Netherlands.

BACKGROUND: The COVID-19 pandemic poses risks to the quality of life (QoL) of 
relatives of individuals with intellectual disabilities. This paper investigates 
relatives' QoL and associated risk and buffering factors before and during the 
pandemic.
METHOD: Surveys were administered to three samples of relatives in the 
Netherlands in 2019 (N = 105) and during the first waves of COVID-19 in June 
(N = 207) and October 2020 (N = 332). Associations between QoL and care burden, 
care competence, social support, and resilience, and changes over time were 
analysed using (logistic) regressions.
RESULTS: No significant changes in overall QoL nor its domains were found. Care 
burden was negatively associated with QoL and increased during the pandemic. 
Care competence was lower than in 2019. Competence, social support, and 
resilience were positively associated with QoL.
CONCLUSIONS: Although relatives' QoL remained stable, the pandemic poses 
non-negligible risks to their wellbeing. It is, therefore, crucial to provide 
relatives with adequate support.

© 2022 The Authors. Journal of Applied Research in Intellectual Disabilities 
published by John Wiley & Sons Ltd.

DOI: 10.1111/jar.13035
PMCID: PMC9539069
PMID: 36134473 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
declare.


1524. J Occup Health. 2022 Jan;64(1):e12361. doi: 10.1002/1348-9585.12361.

Mental health and wellbeing of seafaring personnel during COVID-19: Scoping 
review.

Brooks SK(1), Greenberg N(1).

Author information:
(1)Department of Psychological Medicine, King's College London, Weston Education 
Centre, London, UK.

OBJECTIVES: We aimed to synthesize published literature on seafarers' mental 
health and wellbeing during the COVID-19 pandemic.
METHODS: This scoping review searched four electronic databases for literature 
on the mental health and wellbeing of seafarers during the COVID-19 pandemic.
RESULTS: Fourteen studies were included in the review. Few reported on the 
prevalence of mental health conditions. Only one compared mental health data 
gathered during the pandemic to pre-pandemic matched samples, suggesting 
symptoms of depression and anxiety were greater during the pandemic. There was 
some evidence that mental health worsened with longer stays on board during the 
pandemic and being on board longer than expected. Crew exchange difficulties 
forced many participants to extend their contracts or delay repatriation, often 
with little information as to when they might get to go home, leading them to 
feel they had no control over their lives and causing concern about fatigue and 
the potential for accidents and injuries. Participants described other 
challenges such as denial of shore leave; concerns about finances and future 
employment; loneliness and isolation; fears of COVID-19 infection; limited 
access to essential supplies; and feeling unsupported by management.
CONCLUSIONS: Maritime organizations must understand how best to support their 
staff in the aftermath of the COVID-19 pandemic and in any other prolonged 
crises that may arise in the future. Recommendations include ensuring that staff 
feel valued by their organization; enhancing work-related autonomy; ensuring 
that communication is accurate, consistent, and timely; and using lessons 
learned from the COVID-19 pandemic to inform emergency preparedness policies.

© 2022 The Authors. Journal of Occupational Health published by John Wiley & 
Sons Australia, Ltd on behalf of The Japan Society for Occupational Health.

DOI: 10.1002/1348-9585.12361
PMCID: PMC9494025
PMID: 36134469 [Indexed for MEDLINE]

Conflict of interest statement: Authors declare no conflict of Interests for 
this article.


1525. Fam Process. 2023 Sep;62(3):1134-1146. doi: 10.1111/famp.12823. Epub 2022 Sep 
21.

Trajectories of parent and child well-being across the pandemic year: Role of 
financial strain, social distancing, and COVID-19 prevalence.

Le Y(1), Mogle JA(2), Feinberg ME(2).

Author information:
(1)Department of Human Development and Family Studies, The Pennsylvania State 
University, University Park, Pennsylvania, USA.
(2)Edna Bennett Pierce Prevention Research Center, The Pennsylvania State 
University, University Park, Pennsylvania, USA.

Existing research demonstrated large deteriorations in parent, child, and family 
well-being within 2 months after the onset of the COVID-19 pandemic. Yet, little 
is known about the trajectories of families' adjustment in the following months, 
including what risk factors are associated with changes in families' adjustment. 
The current study examined (1) change in the parent, child, and family 
well-being over time; (2) associations of pandemic-related stressors, financial 
and social distancing-associated stress, with well-being between and within 
families; and (3) the role of local COVID-19 prevalence, prior participation in 
family-focused prevention, and parent gender. From April 2020 to January 2021, 
393 parents from 235 families reported five times on parent mental health, child 
behavior problems, family relationships, and pandemic-related stressors. 
Findings indicate that, across all domains of well-being, there was either 
little change across the 8 months or a small degree of recovery followed by a 
shift to further deterioration. On average, parents experiencing greater 
pandemic-related stressors also reported poorer functioning in all domains; 
monthly fluctuations in pandemic-related stressors were also associated with 
fluctuations in parent mental health and child behavior problems. In some 
domains, the links between pandemic-related stressors and parent and child 
well-being were stronger among families living in areas with overall higher 
COVID-19 prevalence rates. Parents' experiences during the pandemic did not 
differ systematically across prior intervention participation or parent gender. 
Taken together, findings suggest a need for supportive interventions to help 
families navigate extended periods of crisis.

Publisher: 
已有的研究文献表明，在新冠疫情大流行开始后的最初两个月内，家长、孩子和家庭的福祉出现较大程度的恶化。然而，人们关于在随后几个月家庭调适的发展情况，包括哪些风险因素与家庭调适的变化相关仍旧知之甚少。本研究调查以下几方面的内容:(1)父母、孩子和家庭幸福感随时间的变化;(2)与疫情相关的压力源，包括与经济和保持社交距离相关的压力，与家庭之间和家庭内部幸福感的关联;(3)当地新冠流行情况，之前是否参与过以家庭为重点的预防措施以及父母性别的调节作用。从2020年4月到2021年1月，来自235个家庭的393名父母五次报告了父母的心理健康、儿童行为问题、家庭关系和与疫情大流行相关的压力源。研究结果表明，就幸福相关的所有领域而言，在8个月的时间里，要么没有什么变化，要么有轻微的恢复，然后转向进一步恶化。平均而言，经历更大的疫情相关压力源的父母在所有领域的福祉也较差;与疫情相关的压力源每月的波动也与父母心理健康和儿童行为问题的波动有关。在某些领域，在新冠疫情总体严重程度较高的地区，与疫情相关的压力源与父母和儿童福祉之间的联系更强。父母在疫情期间的经历没有因为之前参与过干预而存在系统差异，也没有系统性的性别差异。综上所述，研究结果表明，有必要采取支持性干预措施，帮助家庭度过较长时期的危机。.

© 2022 Family Process Institute.

DOI: 10.1111/famp.12823
PMCID: PMC9538657
PMID: 36131362 [Indexed for MEDLINE]


1526. Salud Publica Mex. 2022 Jun 13;64:S14-S21. doi: 10.21149/12786.

How the Covid-19 pandemic has drawn attention to the issue of active mobility 
and co-benefits in Latin American cities.

Peden M(1), Puvanachandra P(2), Keller ME(3), Rodrigues EM(4), Quistberg A(5), 
Jagnoor J(6).

Author information:
(1)The George Institute for Global Health UK. London, United Kingdom/Imperial 
College London, School of Public Health. London, United Kingdom/University of 
New South Wales, School of Population Health. Sydney, Australia/WHO 
Collaborating Centre on Injury Prevention and Trauma Care. Sydney, Australia. 
mpeden@georgeinstitute.org.uk.
(2)The George Institute for Global Health UK. London, United Kingdom/Imperial 
College London, School of Public Health. London, United Kingdom/University of 
New South Wales, School of Population Health. Sydney, Australia/WHO 
Collaborating Centre on Injury Prevention and Trauma Care. Sydney, Australia. 
pattwood@georgeinstitute.org.uk.
(3)Pan American Health Organization. Buenos Aires, Argentina. 
kellermar@paho.org.
(4)Pan American Health Organization. Washington DC, United StatesPan American 
Health Organization. Washington DC, United States. gena10.rodrigues@gmail.com.
(5)Drexel University, Urban Health Collaborative, Dornsife School of Public 
Health. Philadelphia, USA/University of Washington, Harborview Injury Prevention 
Research Center. Seattle, USA. daq26@drexel.edu.
(6)University of New South Wales, School of Population Health. Sydney, 
Australia/WHO Collaborating Centre on Injury Prevention and Trauma Care. Sydney, 
Australia/The George Institute for Global Health. Sydney, Australia. 
jjagnoor@georgeinstitute.org.au.

The Covid-19 pandemic has brought to the fore many issues that will impact 
public health for years to come -one such impact is on the nexus between 
transportation and health. Promoting safe, active transport is an activity that 
has many physical and mental health benefits. During lockdowns, many cities in 
Latin America imposed infrastructural and legislative changes in order to abide 
with public health and social mea-sures to reduce virus spread. These ranged 
from additional bike lanes to reduced speed limits or incentives to purchase 
bicycles. These cities showed reduced motorized transport, improved air quality 
and increased active transport, all of which have multiple health and equity 
benefits. As countries "build back better", promoting active transport offers 
the most value for investment and improves health and well-being while 
continuing to offer social distancing. Quantified case studies are needed to 
have a more comprehensive under-standing of the impact of active transport in 
various contexts.

La pandemia de Covid-19 ha puesto de manifiesto muchas cuestiones que tendrán 
repercusiones en la salud pública durante los próximos años; una de ellas es el 
vínculo entre el transporte y la salud. Promover el transporte activo y seguro 
tiene muchos beneficios para la salud física y mental. Durante los periodos de 
confinamiento, muchas ciudades de América Latina implementaron cambios 
legislativos y en la infraestructura para cumplir con las medidas sociales y de 
salud pública con la finalidad de reducir la propagación del virus. Dichas 
medidas iban desde carriles exclusivos para bicicletas hasta límites de 
velocidad reducidos o incentivos para la compra de bicicletas. Estas ciudades 
obtuvieron una reducción de los viajes en transporte motorizado, una mejora de 
la calidad del aire y un aumento del transporte activo, lo que tiene múltiples 
beneficios para la salud y la equidad. Mientras los países “reconstruyen mejor”, 
la promoción del transporte activo ofrece el mayor retorno sobre la inversión y 
mejora la salud y el bienestar de la población al tiempo que promueve el 
distanciamiento social. Se necesitan estudios de caso cuantificados para tener 
una comprensión más completa del impacto del transporte activo en diversos 
contextos.

DOI: 10.21149/12786
PMCID: PMC9494289
PMID: 36130399 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of conflict of interests. The 
authors declare that they have no conflict of interests.


1527. PLoS One. 2022 Sep 21;17(9):e0274036. doi: 10.1371/journal.pone.0274036. 
eCollection 2022.

Wellbeing and coping of UK nurses, midwives and allied health professionals 
during COVID-19-a cross-sectional study.

Gillen P(1)(2), Neill RD(3), Mallett J(4), Moriarty J(5), Manthorpe J(6), 
Schroder H(7), Currie D(7), McGrory S(1), Nicholl P(5), Ravalier J(8), McFadden 
P(3).

Author information:
(1)School of Nursing Jordanstown Campus, Ulster University, Newtownabbey, 
Northern Ireland, United Kingdom.
(2)Southern Health and Social Care Trust, Portadown, Northern Ireland, United 
Kingdom.
(3)School of Applied Social and Policy Sciences, Ulster University, 
Derry-Londonderry, Northern Ireland, United Kingdom.
(4)School of Psychology, Ulster University, Coleraine, Northern Ireland, United 
Kingdom.
(5)School of Social Sciences, Education and Social Work, Queen's University 
Belfast, Belfast, Northern Ireland, United Kingdom.
(6)NIHR Policy Research Unit in Health and Social Care Workforce, King's College 
London, London, United Kingdom.
(7)Queen's Management School, Queen's University Belfast, Belfast, Northern 
Ireland, United Kingdom.
(8)School of Science, Bath Spa University, Bath, United Kingdom.

Nurse, Midwives and Allied Health Professionals (AHPs), along with other health 
and social care colleagues are the backbone of healthcare services. They have 
played a key role in responding to the increased demands on healthcare during 
the COVID-19 pandemic. This paper compares cross-sectional data on quality of 
working life, wellbeing, coping and burnout of nurses, midwives and AHPs in the 
United Kingdom (UK) at two time points during the COVID-19 pandemic. An 
anonymous online repeated cross-sectional survey was conducted at two 
timepoints, Phase 1 (7th May 2020-3rd July 2020); Phase 2 (17th November 
2020-1st February 2021). The survey consisted of the Short Warwick-Edinburgh 
Mental Wellbeing Scale, the Work-Related Quality of Life Scale, and the 
Copenhagen Burnout Inventory (Phase 2 only) to measure wellbeing, quality of 
working life and burnout. The Brief COPE scale and Strategies for Coping with 
Work and Family Stressors scale assessed coping strategies. Descriptive 
statistics and multiple linear regressions examined the effects of coping 
strategies and demographic and work-related variables on wellbeing and quality 
of working life. A total of 1839 nurses, midwives and AHPs responded to the 
first or second survey, with a final sample of 1410 respondents -586 from Phase 
1; 824 from Phase 2, (422 nurses, 192 midwives and 796 AHPs). Wellbeing and 
quality of working life scores were significantly lower in the Phase 2 sample 
compared to respondents in Phase 1 (p<0.001). The COVID-19 pandemic had a 
significant effect on psychological wellbeing and quality of working life which 
decreased while the use of negative coping and burnout of these healthcare 
professionals increased. Health services are now trying to respond to the needs 
of patients with COVID-19 variants while rebuilding services and tackling the 
backlog of normal care provision. This workforce would benefit from additional 
support/services to prevent further deterioration in mental health and wellbeing 
and optimise workforce retention.

DOI: 10.1371/journal.pone.0274036
PMCID: PMC9491587
PMID: 36129890 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript, or in the decision to 
publish the results.


1528. J Med Internet Res. 2022 Sep 21;24(9):e38497. doi: 10.2196/38497.

Preliminary Investigation of Shift, a Novel Smartphone App to Support Junior 
Doctors' Mental Health and Well-being: Examination of Symptom Progression, 
Usability, and Acceptability After 1 Month of Use.

Sanatkar S(1)(2), Counson I(1)(2), Mackinnon A(1), Bartholomew A(1), Glozier 
N(3), Harvey S(1)(2).

Author information:
(1)Black Dog Institute, Randwick, Australia.
(2)School of Psychiatry, Faculty of Medicine, University of New South Wales 
Sydney, Kensington, Australia.
(3)Central Clinical School, Faculty of Medicine and Health, University of 
Sydney, Camperdown, Australia.

Erratum in
    J Med Internet Res. 2023 Apr 3;25:e47277.

BACKGROUND: Shift is a novel smartphone app for providing a digital-first mental 
health resource to junior doctors. It contains psychoeducational material, 
cognitive behavioral modules, guided mediations, information on common work 
stressors, and a section on help-seeking options for psychological problems 
through workplace and private avenues.
OBJECTIVE: This study aimed to conduct a preliminary investigation of the use 
and potential effectiveness of Shift on depressive and anxiety symptoms (primary 
outcomes) and work and social functioning, COVID-19 safety concerns, and help 
seeking (secondary outcomes). This study also sought feedback on whether Shift 
was seen as an acceptable tool.
METHODS: Junior doctors in New South Wales, Australia, were approached through 
promotional activities from the Ministry of Health, specialist medical colleges, 
and social media advertisements between June and August 2020. Consenting 
participants provided web-based baseline data, used the Shift app for 30 days, 
and were asked to complete a poststudy web-based questionnaire. Outcomes were 
analyzed under the intention-to-treat principle.
RESULTS: A total of 222 (n=156 female, 70.3%; mean age 29.2, SD 4.61 years) 
junior doctors provided full baseline data. Of these, 89.2% (198/222) downloaded 
the app, logged into the app approximately 6 times (mean 5.68, SD 7.51), 
completed 4 in-app activities (mean 3.77, SD 4.36), and spent a total of 1 hour 
on in-app activities (mean 52:23, SD 6:00:18) over 30 days. Postintervention and 
app use data were provided by 24.3% (54/222) of participants. Depressive and 
anxiety symptoms significantly decreased between the pre- and postassessment 
points as expected; however, physicians' COVID-19 safety concerns significantly 
increased. Work and social functioning, COVID-19 concerns for family and 
friends, and help seeking did not change significantly. There was no significant 
relationship between symptom changes and app use (number of log-ins, days 
between first and last log-in, and total activity time). Most poststudy 
completers (31/54, 57%) rated Shift highly or very highly.
CONCLUSIONS: Despite high levels of nonresponse to the poststudy assessment and 
increases in COVID-19 safety concerns, junior doctors who used the app reported 
some improvements in depression and anxiety, which warrant further exploration 
in a robust manner.

©Samineh Sanatkar, Isabelle Counson, Andrew Mackinnon, Alexandra Bartholomew, 
Nick Glozier, Samuel Harvey. Originally published in the Journal of Medical 
Internet Research (https://www.jmir.org), 21.09.2022.

DOI: 10.2196/38497
PMCID: PMC9536518
PMID: 36129745 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: Intellectual property for 
the Shift app is owned by the Black Dog Institute; however, the Shift app does 
not currently produce any income, and the authors do not receive any financial 
gain from this intellectual property.


1529. BMJ Open. 2022 Sep 20;12(9):e060276. doi: 10.1136/bmjopen-2021-060276.

COVID-19 in French nursing homes during the second pandemic wave: a 
mixed-methods cross-sectional study.

Dujmovic M(#)(1), Roederer T(#)(2), Frison S(1), Melki C(3), Lauvin T(3), 
Grellety E(1).

Author information:
(1)Department of Epidemiology and Training, Epicentre, Paris, France.
(2)Department of Epidemiology and Training, Epicentre, Paris, France 
thomas.roederer@epicentre.msf.org.
(3)Emergency Cell, Médecins Sans Frontières, Paris, France.
(#)Contributed equally

INTRODUCTION: French nursing homes were deeply affected by the first wave of the 
COVID-19 pandemic, with 38% of all residents infected and 5% dying. Yet, little 
was done to prepare these facilities for the second pandemic wave, and 
subsequent outbreak response strategies largely duplicated what had been done in 
the spring of 2020, regardless of the unique needs of the care home environment.
METHODS: A cross-sectional, mixed-methods study using a retrospective, 
quantitative data from residents of 14 nursing homes between November 2020 and 
mid-January 2021. Four facilities were purposively selected as qualitative study 
sites for additional in-person, in-depth interviews in January and February 
2021.
RESULTS: The average attack rate in the 14 participating nursing facilities was 
39% among staff and 61% among residents. One-fifth (20) of infected residents 
ultimately died from COVID-19 and its complications. Failure to thrive syndrome 
(FTTS) was diagnosed in 23% of COVID-19-positive residents. Those at highest 
risk of death were men (HR=1.78; 95% CI: 1.18 to 2.70; p=0.006), with FTTS 
(HR=4.04; 95% CI: 1.93 to 8.48; p<0.001) or in facilities with delayed 
implementation of universal FFP2 masking policies (HR=1.05; 95% CI: 1.02 to 
1.07; p<0.001). The lowest mortality was found in residents of facilities with a 
partial (HR=0.30; 95% CI: 0.18 to 0.51; p<0.001) or full-time physician on staff 
(HR=0.20; 95% CI: 0.08 to 0.53; p=0.001). Significant themes emerging from 
qualitative analysis centred on (1) the structural, chronic neglect of nursing 
homes, (2) the negative effects of the top-down, bureaucratic nature of COVID-19 
crisis response, and (3) the counterproductive effects of lockdowns on both 
residents and staff.
CONCLUSION: Despite high resident mortality during the first pandemic wave, 
French nursing homes were ill-prepared for the second, with risk factors 
(especially staffing, lack of medical support, isolation/quarantine policy, etc) 
that affected case fatality and residents' and caregivers' overall well-being 
and mental health.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-060276
PMCID: PMC9490301
PMID: 36127110 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


1530. BMJ Open. 2022 Sep 20;12(9):e061876. doi: 10.1136/bmjopen-2022-061876.

Effect of intensive care unit-specific virtual reality (ICU-VR) to improve 
psychological well-being in ICU survivors: study protocol for an international, 
multicentre, randomised controlled trial-the HORIZON-IC study.

Vlake JH(1)(2), van Bommel J(1), Wils EJ(2), Korevaar TI(3)(4), Taccone F(5), 
Schut AF(6), Elderman JH(7), Labout JA(8), Raben AM(9), Dijkstra A(10), 
Achterberg S(11), Jurriens AL(1), Van Mol MM(1), Gommers D(1), Van Genderen 
ME(12).

Author information:
(1)Intensive Care, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands.
(2)Intensive Care, Franciscus Gasthuis en Vlietland, Rotterdam, Zuid-Holland, 
Netherlands.
(3)Internal Medicine, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands.
(4)Academic Centre for Thyroid Diseases, Erasmus MC, Rotterdam, Zuid-Holland, 
Netherlands.
(5)Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Brussels, 
Belgium.
(6)Intensive Care, Ikazia Hospital, Rotterdam, Zuid-Holland, Netherlands.
(7)Intensive Care, IJsselland Hospital, Capelle aan den IJssel, Zuid-Holland, 
Netherlands.
(8)Intensive Care, Maasstad Hospital, Rotterdam, Zuid-Holland, Netherlands.
(9)Intensive Care, Groene Hart Ziekenhuis, Gouda, Zuid-Holland, Netherlands.
(10)Intensive Care, Van Weel-Bethesda Hospital, Middelharnis, 
Goeree-Overflakkee, Netherlands.
(11)Intensive Care, Haaglanden MC, Den Haag, Zuid-Holland, Netherlands.
(12)Intensive Care, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands 
m.vangenderen@erasmusmc.nl.

INTRODUCTION: A substantial proportion of intensive care unit (ICU) survivors 
develop psychological impairments after ICU treatment, part of the postintensive 
care syndrome, resulting in a decreased quality of life. Recent data suggest 
that an ICU-specific virtual reality intervention (ICU-VR) for post-ICU patients 
is feasible and safe, improves satisfaction with ICU aftercare, and might 
improve psychological sequelae. In the present trial, we firstly aim to 
determine whether ICU-VR is effective in mitigating post-traumatic stress 
disorder (PTSD)-related symptoms and secondly to determine the optimal timing 
for initiation with ICU-VR.
METHODS AND ANALYSIS: This international, multicentre, randomised controlled 
trial will be conducted in 10 hospitals. Between December 2021 and April 2023, 
we aim to include 300 patients who have been admitted to the ICU ≥72 hours and 
were mechanically ventilated ≥24 hours. Patients will be followed for 12 
consecutive months. Patients will be randomised in a 1:1:1 ratio to the early 
ICU-VR group, the late ICU-VR group, or the usual care group. All patients will 
receive usual care, including a mandatory ICU follow-up clinic visit 3 months 
after ICU discharge. Patients in the early ICU-VR group will receive ICU-VR 
within 2 weeks after ICU discharge. Patients in the late VR group will receive 
ICU-VR during the post-ICU follow-up visit. The primary objective is to assess 
the effect of ICU-VR on PTSD-related symptoms. Secondary objectives are to 
determine optimal timing for ICU-VR, to assess the effects on anxiety-related 
and depression-related symptoms and health-related quality of life, and to 
assess patient satisfaction with ICU aftercare and perspectives on ICU-VR.
ETHICS AND DISSEMINATION: The Medical Ethics Committee United, Nieuwegein, the 
Netherlands, approved this study and local approval was obtained from each 
participating centre (NL78555.100.21). Our findings will be disseminated by 
presentation of the results at (inter)national conferences and publication in 
scientific, peer-reviewed journals.
TRIAL REGISTRATION NUMBER: NL9812.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2022-061876
PMCID: PMC9490570
PMID: 36127077 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: DG has received speaker 
fees and travel expenses from Dräger, GE Healthcare (medical advisory board 
2009–12), Maquet, and Novalung (medical advisory board 2015–18). TK has received 
speaker fees from Quidel, IBSA, Merck, Berlin Chemie, and Goodlife Healthcare. 
All other authors declare no competing interests.


1531. BMC Public Health. 2022 Sep 20;22(1):1778. doi: 10.1186/s12889-022-13943-x.

Factors that influence mental health of university and college students in the 
UK: a systematic review.

Campbell F(1), Blank L(2), Cantrell A(2), Baxter S(2), Blackmore C(2), Dixon 
J(2), Goyder E(2).

Author information:
(1)University of Sheffield, Sheffield, UK. f.campbell@sheffield.ac.uk.
(2)University of Sheffield, Sheffield, UK.

BACKGROUND: Worsening mental health of students in higher education is a public 
policy concern and the impact of measures to reduce transmission of COVID-19 has 
heightened awareness of this issue. Preventing poor mental health and supporting 
positive mental wellbeing needs to be based on an evidence informed 
understanding what factors influence the mental health of students.
OBJECTIVES: To identify factors associated with mental health of students in 
higher education.
METHODS: We undertook a systematic review of observational studies that measured 
factors associated with student mental wellbeing and poor mental health. 
Extensive searches were undertaken across five databases. We included studies 
undertaken in the UK and published within the last decade (2010-2020). Due to 
heterogeneity of factors, and diversity of outcomes used to measure wellbeing 
and poor mental health the findings were analysed and described narratively.
FINDINGS: We included 31 studies, most of which were cross sectional in design. 
Those factors most strongly and consistently associated with increased risk of 
developing poor mental health included students with experiences of trauma in 
childhood, those that identify as LGBTQ and students with autism. Factors that 
promote wellbeing include developing strong and supportive social networks. 
Students who are prepared and able to adjust to the changes that moving into 
higher education presents also experience better mental health. Some behaviours 
that are associated with poor mental health include lack of engagement both with 
learning and leisure activities and poor mental health literacy.
CONCLUSION: Improved knowledge of factors associated with poor mental health and 
also those that increase mental wellbeing can provide a foundation for designing 
strategies and specific interventions that can prevent poor mental health and 
ensuring targeted support is available for students at increased risk.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-13943-x
PMCID: PMC9484851
PMID: 36123714 [Indexed for MEDLINE]

Conflict of interest statement: None of the authors have competing interests or 
other interests that might be perceived to influence the results and/or 
discussion reported in this paper.


1532. BMC Public Health. 2022 Sep 20;22(1):1777. doi: 10.1186/s12889-022-14103-x.

Life under stay-at-home orders: a panel study of change in social interaction 
and emotional wellbeing among older Americans during COVID-19 pandemic.

Lin J(1), Zajdel M(2), Keller KR(2), Gilpin Macfoy FO(2), Shaw P(3), Curtis 
B(4), Ungar L(5), Koehly L(2).

Author information:
(1)Social Network Methods Section, Social and Behavioral Research Branch, 
National Human Genome Research Institute, 31 Center Drive, Building 31, Room 
B1B37, Bethesda, MD, 20892, USA. jielu.lin@nih.gov.
(2)Social Network Methods Section, Social and Behavioral Research Branch, 
National Human Genome Research Institute, 31 Center Drive, Building 31, Room 
B1B37, Bethesda, MD, 20892, USA.
(3)Neurobehavioral Clinical Research Section, Social and Behavioral Research 
Branch, National Human Genome Research Institute, Bethesda, MD, USA.
(4)Technology and Translational Research Unit, Translational Addiction Medicine 
Branch, National Institute On Drug Abuse, Baltimore, MD, USA.
(5)Department of Computer and Information Science, University of Pennsylvania, 
Philadelphia, PA, USA.

BACKGROUND: Recent research has shown the mental health consequence of social 
distancing during the COVID-19 pandemic, but longitudinal data are relatively 
scarce. It is unclear whether the pattern of isolation and elevated stress seen 
at the beginning of the pandemic persists over time. This study evaluates change 
in social interaction over six months and its impact on emotional wellbeing 
among older adults.
METHODS: We drew data from a panel study with six repeated assessments of social 
interaction and emotional wellbeing conducted monthly May through October 2020. 
The sample included a total of 380 White, Black and Hispanic participants aged 
50 and over, of whom 33% had low income, who residing in fourteen U.S. states 
with active stay-at-home orders in May 2020. The analysis examined how change in 
living arrangement, in-person interaction outside the household, quality of 
relationship with family and friends, and perceived social support affected 
trajectories of isolation stress, COVID worry and sadness.
RESULTS: While their living arrangements (Odds Ratio [OR] = 0.95, 95% Confidence 
Interval [CI] = 0.87, 1.03) and relationship quality (OR = 0.94, 95% CI = 0.82, 
1.01) remained stable, older adults experienced fluctuations in perceived social 
support (linear Slope b = -1.42, s.e. = 0.16, p < .001, quadratic slope 
b = 0.50, s.e. = 0.08, p < .001, cubic slope b = -0.04, s.e. = 0.01, p < .001) 
and increases in in-person conversations outside the household (OR = 1.19, 95% 
CI = 1.09, 1.29). Living with a spouse/partner stabilized isolation stress 
(change in linear slope b = 1.16, s.e. = 0.48, p < .05, in quadratic slope 
b = -0.62, s.e. = 0.26, p < .05, and in cubic slope = 0.09, s.e. = 0.04, 
p < .05) and COVID worry (change in quadratic slope b = -0.66, s.e. = 0.32, 
p < .05 and in cubic slope = 0.09, s.e. = 0.04, p < .05) over time. Individuals 
with better relationship quality with friends had decreased sadness over time 
(OR = 0.90, 95% CI = 0.82, 0.99). Changes in social support were associated with 
greater fluctuations in isolation stress and COVID worry.
CONCLUSIONS: During the pandemic, social interactions are protective and lack of 
stability in feeling supported makes older adults vulnerable to stress. Efforts 
should focus on (re)building and maintaining companionship and support to 
mitigate the pandemic's negative impact.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-14103-x
PMCID: PMC9484850
PMID: 36123662 [Indexed for MEDLINE]

Conflict of interest statement: None.


1533. J Gen Intern Med. 2022 Dec;37(16):4233-4240. doi: 10.1007/s11606-022-07792-y. 
Epub 2022 Sep 19.

Frontline Physician Perspectives on Their Experiences Working During the First 
Wave of the COVID-19 Pandemic.

Gonzalez CM(1)(2), Hossain O(3), Peek ME(4).

Author information:
(1)Albert Einstein College of Medicine, Bronx, NY, USA. crgonzal@montefiore.org.
(2)Weiler Division, Montefiore Medical Center, 1825 Eastchester Road, DOM 2-76, 
Bronx, NY, 10461, USA. crgonzal@montefiore.org.
(3)Albert Einstein College of Medicine, Bronx, NY, USA.
(4)University of Chicago, Chicago, IL, USA.

BACKGROUND: During the first wave of the COVID-19 pandemic physicians worked on 
the front lines, immersed in uncertainty. Research into perspectives of 
frontline physicians has lagged behind clinical innovation throughout the 
pandemic.
OBJECTIVE: To inform ongoing and future efforts in the COVID-19 pandemic, we 
conducted a qualitative exploration of physician perspectives of the effects of 
policies and procedures as well as lessons learned while caring for patients 
during the height of the first wave in the spring of 2020.
DESIGN: A confidential survey was emailed to a convenience sample. Survey 
questions included demographic data, participant role in the pandemic, and 
geographic location. Eleven open-ended questions explored their perspectives and 
advice they would give going forward. Broad areas covered included 
COVID-19-specific education, discharge planning, unintended consequences for 
patient care, mental health conditions to anticipate, and personal/institutional 
factors influencing workforce well-being amid the crisis.
PARTICIPANTS: We received fifty-five surveys from May through July 2020. 
Demographic data demonstrated sampling of frontline physicians working in 
various epicenters in the USA, and diversity in gender, race/ethnicity, and 
clinical specialty.
APPROACH: Inductive thematic analysis.
KEY RESULTS: Four themes emerged through data analysis: (1) Leadership can make 
or break morale; (2) Leadership should engage frontline workers throughout 
decision-making processes; (3) Novelty of COVID-19 led to unintended 
consequences in care delivery; and (4) Mental health sequelae will be profound 
and pervasive.
CONCLUSIONS: Our participants demonstrated the benefit of engaging frontline 
physicians as important stakeholders in policy generation, evaluation, and 
revision; they highlighted challenges, successes, unintended consequences, and 
lessons learned from various epicenters in the first wave of the COVID-19 
pandemic. There is much to be learned from the early COVID-19 pandemic crisis; 
our participants' insights elucidate opportunities to examine institutional 
performance, effect policy change, and improve crisis management in order to 
better prepare for this and future pandemics.

© 2022. The Author(s), under exclusive licence to Society of General Internal 
Medicine.

DOI: 10.1007/s11606-022-07792-y
PMCID: PMC9484839
PMID: 36123437 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they do not have a 
conflict of interest.


1534. JDR Clin Trans Res. 2022 Oct;7(1_suppl):5S-15S. doi: 10.1177/23800844221116832.

Sociodemographic Changes and Oral Health Inequities: Dental Workforce 
Considerations.

Inglehart MR(1), Albino J(2), Feine JS(3), Okunseri C(4).

Author information:
(1)Department of Periodontics and Oral Medicine, School of Dentistry and 
Department of Psychology, College of Literature, Science & Arts, University of 
Michigan, Ann Arbor, MI, USA.
(2)Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, USA.
(3)Faculty of Dental Medicine and Oral Health Sciences, McGill University, 
Montreal, Canada.
(4)Marquette University School of Dentistry, Milwaukee, WI, USA.

BACKGROUND: By midcentury, the US population will be remarkably more racially 
and ethnically diverse, with a dramatic increase in the proportion of older 
adults. This report addresses ongoing oral health disparities and inequitable 
access to care related to these changes, with emphasis on implications for the 
workforce, taking note of effects of the COVID-19 pandemic.
RELEVANT CONSIDERATIONS: Considering that social determinants shape health 
behaviors, reflection on the most effective type of dental workforce should take 
into account population characteristics and the relationship of oral health with 
overall health and general well-being. The dental workforce composition will 
need to mirror changing demographics, and effective dental health teams will be 
characterized by cultural competence, humility, readiness, and capacity to adapt 
to changes. In addition, the influence of social histories and the pandemic on 
health and dental care utilization is important. Equally important are the 
inclusion of oral health literacy in treatment planning and disease prevention, 
as well as oral health-related quality of life in considering outcomes of care. 
Providing patient-centered care for a diverse population requires tailored 
treatment modalities, as well as intra- and interprofessional approaches. In 
this way, the whole person can be cared for, including those with special health 
care needs, whether related to chronic disease, mental health conditions, or 
behavioral, physical, and social differences.
CONCLUSIONS: Changing demographics will affect the delivery of oral health care, 
including who can best provide care and how, what the needs are, and in what 
ways prevention and treatment can most effectively be accomplished. The 
education of dentists must address unmet population needs, including for those 
with special health care concerns and older adults. These population groups are 
influenced by a variety of social determinants, and provision of services may 
need to occur in alternative care delivery settings. Identifying and addressing 
the needs of every patient within this broad array of new requirements will 
challenge dental professionals to redefine what it means to be a health care 
practitioner.
KNOWLEDGE TRANSFER STATEMENT: This article describes how sociodemographic 
changes in the United States will challenge the dental workforce in new ways and 
points to research and practice needs to address these challenges. Oral health 
disparities and the changing oral health care needs of patients from diverse and 
underserved groups are discussed, with a focus on the implications for delivery 
of care and policies that are needed to improve oral health outcomes for all.

DOI: 10.1177/23800844221116832
PMID: 36121138 [Indexed for MEDLINE]


1535. Int J Public Health. 2022 Sep 2;67:1604517. doi: 10.3389/ijph.2022.1604517. 
eCollection 2022.

Risk Perception Related to COVID-19 and Future Affective Responses Among 
Healthcare Workers in Switzerland: A Mixed-Methods Longitudinal Study.

Grazioli VS(1), Tzartzas K(1), Blaser J(1), Graells M(1), Schmutz E(1), 
Petitgenet I(1), Favrat B(1), Zozaya JS(1), Kokkinakis I(1), Marion-Veyron R(1), 
Bodenmann P(1).

Author information:
(1)Center for Primary Care and Public Health, University Center of General 
Medicine and Public Health, Lausanne, Switzerland.

Objectives: Whereas early findings suggest that risk perceptions related to 
COVID-19 affect psychological well-being in healthcare workers (HCWs), the 
temporal associations between these variables need to be clarified and HCWs 
lived experience further explored. This study proposes a mixed evaluation of 
COVID-19-related risk perception and affective responses among HCWs. Methods: A 
longitudinal mixed-method study was conducted. HCWs (N = 138) completed measures 
of COVID-19 risk perceptions, depression, anxiety, burnout and secondary 
traumatic stress (STS) at baseline and 6 months later. A subsample (n = 20) 
participated in semi-structured interviews exploring both risk perceptions and 
affective responses. Results: Main quantitative findings showed positive 
associations between worry to contaminate others and depression (IRR = 1.04, p < 
0.05), anxiety (IRR = 1.03, p < 0.01), STS (b = 0.3, p < 0.05), and perceptions 
of lacking protection (IRR = 1.04, p < 0.05) with anxiety scores. Four themes 
emerged from the thematic content analysis: 1) life was turned upside down; 2) 
skills were put in quarantine; 3) dealing with patient discomfort; 4) balance to 
be found between protection and restrictions. Conclusion: These findings 
emphasize the importance to develop tailored interventions, such as group 
discussion sessions, to optimize risk perception and help manage uncertainty.

Copyright © 2022 Grazioli, Tzartzas, Blaser, Graells, Schmutz, Petitgenet, 
Favrat, Zozaya, Kokkinakis, Marion-Veyron and Bodenmann.

DOI: 10.3389/ijph.2022.1604517
PMCID: PMC9478025
PMID: 36119446 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1536. Front Public Health. 2022 Aug 31;10:888741. doi: 10.3389/fpubh.2022.888741. 
eCollection 2022.

Determinants of mental and financial health during COVID-19: Evidence from data 
of a developing country.

Khan F(1)(2), Siddiqui MA(1)(2), Imtiaz S(3), Shaikh SA(4), Chen CL(5)(6)(7), Wu 
CM(7).

Author information:
(1)FAST School of Management, Islamabad, Pakistan.
(2)National University of Computer and Emerging Sciences, Islamabad, Pakistan.
(3)Department of Software Engineering, International Islamic University, 
Islamabad, Pakistan.
(4)Electrical Engineering Department, Sukkur IBA University, Sukkur, Pakistan.
(5)School of Information Engineering, Changchun Sci-Tech University, Changchun, 
China.
(6)Department of Computer Science and Information Engineering, Chaoyang 
University of Technology, Taichung, Taiwan.
(7)School of Civil Engineering and Architecture, Xiamen University of 
Technology, Xiamen, China.

Mental and emotional issues are the top-level concerns of public health 
worldwide. These issues surged during Coronavirus (COVID-19) pandemic due to 
varied medical, social, and personal reasons. The social determinants 
highlighted in the literature mainly focus on household solutions rather than on 
increasing the financial wellbeing of individuals, especially for the most 
vulnerable groups where the psychological distress coming from the social 
inequalities cannot be entirely treated. Hence, this study attempts to 
familiarize the financial capability (the financial literacy, attitude, skills 
and behavior required for effective financial management) construct into public 
health domain in the times of COVID-19 as a determinant of psychological 
distress, and also explores the role of gender in it. The study uses Ordinary 
Least Square (OLS) regression analysis and employs mental distress questions and 
Organization for Economic Cooperation and Development (OECD) 2018 financial 
capability toolkit to collect data from a large sample of households from all 
over Pakistan. It is inferred that the higher the financial capability, the 
lower the financial and mental distress during COVID-19. Additionally, females 
are less financially knowledgeable, depict poor financial behaviors, and face 
more psychological issues than their counterparts. Age and education are also 
linked to mental stress during COVID-19. Finally, gender plays a moderating role 
in financial behavior, and financial and mental stress of households. As 
evident, COVID-19 is not going away soon hence the findings are relevant for 
policymakers to proactively plan for the pandemic's upcoming waves and help 
people be better financially equipped to fight against this or any upcoming 
crisis, and achieve better mental and physical health.

Copyright © 2022 Khan, Siddiqui, Imtiaz, Shaikh, Chen and Wu.

DOI: 10.3389/fpubh.2022.888741
PMCID: PMC9471958
PMID: 36117608 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1537. Front Public Health. 2022 Aug 31;10:925475. doi: 10.3389/fpubh.2022.925475. 
eCollection 2022.

Bibliometric analysis of research themes and trends in childhood autism spectrum 
disorders from 2012 to 2021.

Zhao J(1)(2), Lu Y(1), Wu X(2), Zhou F(3), Fei F(4), Wu X(4), Ding X(4), Wang 
M(5).

Author information:
(1)Department of Nursing, Xinxiang Medical University, Xinxiang, China.
(2)Department of Medical Engineering, Xinxiang Medical University, Xinxiang, 
China.
(3)Department of Children Rehabilitation, The First Affiliated Hospital of 
Xinxiang Medical University, Xinxiang, China.
(4)Department of Nursing, Huzhou Maternal and Child Health Care Hospital, 
Huzhou, China.
(5)Department of Nursing, The First Affiliated Hospital of Huzhou University, 
Huzhou, China.

Erratum in
    Front Public Health. 2022 Nov 28;10:1058389.

BACKGROUND: Autism spectrum disorders (ASD) are heterogeneous neurodevelopmental 
conditions that affect people worldwide. Early diagnosis and clinical support 
help achieve good outcomes. However, medical system structure and restricted 
resource availability create challenges that increase the risk of poor outcomes. 
Understanding the research progress of childhood ASD in recent years, based on 
clinical literature reports, can give relevant researchers and rehabilitation 
therapists more resonable research guides.
OBJECTIVE: This bibliometric study aimed to summarize themes and trends in 
research on childhood ASD and to suggest directions for future enquiry.
METHODS: Citations were downloaded from the Web of Science Core Collection 
database on childhood ASD published from 1 January 2012, to 31 December 2021. 
The retrieved information was analyzed using CiteSpace.5.8. R3, and VOS viewer.
RESULTS: A total of 7,611 papers were published across 103 areas. The United 
States was the leading source of publications. The clusters that have continued 
into 2020 include coronavirus disease 2019, gut microbiota, and physical 
activity, which represent key research topics. Keywords with frequency spikes 
during 2018-2021 were "disabilities monitoring network," "United States," and 
"caregiver."
CONCLUSIONS: The Autism and Developmental Disabilities Monitoring Network in the 
United States can be used as a reference for relevant workers worldwide. An 
intelligent medical assistant system is being developed. Further studies are 
required to elucidate challenges associated with caring for a child with ASD.

Copyright © 2022 Zhao, Lu, Wu, Zhou, Fei, Wu, Ding and Wang.

DOI: 10.3389/fpubh.2022.925475
PMCID: PMC9470932
PMID: 36117596 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1538. J Adv Nurs. 2023 Jan;79(1):113-124. doi: 10.1111/jan.15445. Epub 2022 Sep 18.

Postpartum depression, social support and maternal self-efficacy between 
adolescent and adult mothers during the COVID-19 pandemic: A comparative 
cross-sectional study.

Sangsawang N(1), Sangsawang B(1).

Author information:
(1)Department of Maternal-Child Nursing and Midwifery, Faculty of Nursing, 
Srinakharinwirot University, Nakhonnayok, Thailand.

AIMS: To determine the rate and level of postpartum depression (PPD), as well as 
to examine and compare PPD, social support and maternal self-efficacy between 
adolescent and adult mothers at 8 weeks postpartum during the COVID-19 pandemic.
BACKGROUND: Policy measures to reduce the rapid spread of COVID-19 have 
disrupted many aspects of life and decreased social connections, which 
negatively impacts psychological well-being of the general population. However, 
studies focused on the impact of COVID-19 on mental health and maternal 
self-efficacy in postpartum mothers, particularly adolescent mothers, are 
limited.
DESIGN: A comparative cross-sectional study was carried out following the STROBE 
guidelines.
METHODS: An online questionnaire was administered from February to March 2021. 
Data were collected by the Edinburgh Postnatal Depression Scale (EPDS), the 
Postpartum Support Questionnaire (PSQ) and the Parenting Sense of Competence 
(PSOC) at 8 weeks postpartum. One-way MANOVA was used to analyse the data.
RESULTS: Data from 63 adolescent mothers and 63 adult mothers were analysed. 
There were significant correlations between PPD, social support and maternal 
self-efficacy of the COVID-19 pandemic. Both adolescent and adult mothers had 
significantly negative impacts from the pandemic on mental health, social 
support and maternal self-efficacy. However, the adolescent mothers had higher 
rates of depressive symptoms (36.5% and 23.8%, respectively) as well as lower 
PSQ score (121.25 and 130.52, respectively) and PSOC scores (62.54 and 70.94, 
respectively) compared with adult mothers in the first 8 weeks postpartum during 
the pandemic.
CONCLUSION: Adolescent mothers had a significantly higher rate of depressive 
symptoms and significantly lower social support and maternal self-efficacy 
scores compared to adult mothers at 8 weeks postpartum during the COVID-19 
pandemic.
IMPACT: Midwives or nurses should emphasize the negative mental health impacts 
during the COVID-19 situation and routinely screen for depressive symptoms, 
especially in adolescent mothers, which could help identify the at-risk mothers 
for developing PPD.
PATIENT OR PUBLIC CONTRIBUTION: Neither patients nor the public were directly 
involved in the study.

© 2022 John Wiley & Sons Ltd.

DOI: 10.1111/jan.15445
PMID: 36117329 [Indexed for MEDLINE]


1539. J Anxiety Disord. 2022 Dec;92:102633. doi: 10.1016/j.janxdis.2022.102633. Epub 
2022 Sep 12.

Anxiety among older adults during the COVID-19 pandemic.

Gosselin P(1), Castonguay C(2), Goyette M(2), Lambert R(2), Brisson M(2), 
Landreville P(3), Grenier S(4).

Author information:
(1)Department of Psychology, Université de Sherbrooke, Sherbrooke, Québec, 
Canada; Institut universitaire de première ligne en santé et services sociaux - 
Centre intégré universitaire en santé et services sociaux de l'Estrie - CHUS 
(CIUSSS de l'Estrie-CHUS), Sherbrooke, Québec, Canada. Electronic address: 
Patrick.Gosselin@USherbrooke.ca.
(2)Department of Psychology, Université de Sherbrooke, Sherbrooke, Québec, 
Canada; Institut universitaire de première ligne en santé et services sociaux - 
Centre intégré universitaire en santé et services sociaux de l'Estrie - CHUS 
(CIUSSS de l'Estrie-CHUS), Sherbrooke, Québec, Canada.
(3)School of Psychology, Université Laval, Québec, Québec, Canada; Centre 
d'excellence sur le vieillissement de Québec, Québec, Québec, Canada.
(4)Department of Psychology, Université de Montréal, Montréal, Québec, Canada; 
Centre de recherche de l'Institut universitaire de gériatrie de Montréal 
(CRIUGM), Montréal, Québec, Canada.

A growing body of research examines the COVID-19 pandemic's effects on 
well-being. Only few studies focus on older adults or explore the predictors of 
COVID-19-related anxiety. Intolerance of uncertainty (IU) and some behaviors 
(e.g., avoidance, procrastination) are linked to anxiety among older adults and 
could both be relevant to consider in a pandemic context. This study measured 
the occurrence and anxiety levels among older adults and verified the possible 
role of IU and behaviors in predicting anxiety symptoms, impairment and distress 
related to COVID-19 health standards. It also examined the indirect effect of IU 
on symptoms, impairment and distress through behaviors. Participants aged 60 and 
over (N = 356) were recruited and administered questionnaires. Anxiety levels 
and symptom impairment were high and appeared to have increased since the 
beginning of the pandemic. IU and behavioral manifestations of anxiety were 
associated with higher anxiety symptoms, impairment and distress related to 
COVID-19 health standards. The indirect effects of IU on the tendency to worry 
and COVID-19-related anxiety through behavioral manifestations of anxiety were 
confirmed. This study provides knowledge on the relationship between COVID-19 
and anxiety in older adults and identifies predictors relevant to this 
population.

Copyright © 2022 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.janxdis.2022.102633
PMCID: PMC9465474
PMID: 36115079 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest We have no known conflict 
of interest to disclose.


1540. BMC Public Health. 2022 Sep 16;22(1):1761. doi: 10.1186/s12889-022-14024-9.

Worries about inadequate medical treatment in case of a COVID-19 infection: the 
role of social inequalities, COVID-19 prevalence and healthcare infrastructure.

Schmitz A(1), Garten C(2), Kühne S(3), Brandt M(2).

Author information:
(1)TU Dortmund University, Faculty of Social Sciences, Emil-Figge-Str. 50, 
44227, Dortmund, Germany. alina.schmitz@tu-dortmund.de.
(2)TU Dortmund University, Faculty of Social Sciences, Emil-Figge-Str. 50, 
44227, Dortmund, Germany.
(3)Bielefeld University, Faculty of Sociology, Universitätsstr. 25, 33615, 
Bielefeld, Germany.

BACKGROUND: This study investigates individual and regional determinants of 
worries about inadequate medical treatment in case of a COVID-19 infection, an 
important indicator of mental wellbeing in pandemic times as it potentially 
affects the compliance with mitigation measures and the willingness to get 
vaccinated. The analyses shed light on the following questions: Are there social 
inequalities in worries about inadequate medical treatment in case of a COVID-19 
infection? What is the role of the regional spread of COVID-19 infections and 
regional healthcare capacities?
METHODS: Based on data derived from the German Socioeconomic Panel (SOEP), a 
representative sample of the German population aged 18 years and over, we 
estimated multilevel logistic regression models with individual-level (level 1) 
and regional-level (level 2) variables. The regional variables of interest were 
(a) the number of COVID-19 infections, (b) the number of hospital beds as an 
overall measure of the regional healthcare capacities, and (c) the number of 
free intensive care units as a measure of the actual capacities for treating 
patients with severe courses of COVID-19.
RESULTS: Women, older respondents, persons with migrant background and those 
with a lower socioeconomic status were more likely to report worries about 
inadequate medical treatment in case of a COVID-19 infection. Moreover, 
respondents with chronic illness, lower subjective health and those who consider 
COVID-19 as a threat for their own health were more likely to report worries. In 
addition, also regional characteristics were relevant. Worries were more common 
in poorer regions with higher COVID-19 infections and worse health 
infrastructure as indicated by the number of hospital beds.
CONCLUSIONS: The analysis not only indicates that several social groups are more 
concerned about inadequate medical treatment in case of a COVID-19 infection, 
but also highlights the need for considering regional-level influences, such as 
the spread of the virus, poverty rates and healthcare infrastructure, when 
analyzing the social and health-related consequences of the pandemic.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-14024-9
PMCID: PMC9482236
PMID: 36114486 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that there is no conflict of 
interest.


1541. Public Health Rep. 2023 Jan-Feb;138(1):174-182. doi: 10.1177/00333549221121667. 
Epub 2022 Sep 16.

Assessment of Mental Health and Coping Disparities Among Racial and Ethnic 
Groups Amid COVID-19 From the "How Right Now" Campaign.

Burke-Garcia A(1), Berktold J(1), Rabinowitz L(1), Wagstaff L(1), W Thomas C(2), 
Crick C(2), Walsh MS(2), Mitchell EW(2), Verlenden JMV(2), Puddy R(2), Mercado 
MC(2), Xia K(1), Aina T(1), Caicedo L(3), Nelson Ba P(4).

Author information:
(1)NORC at the University of Chicago, Chicago, IL, USA.
(2)Centers for Disease Control and Prevention, Atlanta, GA, USA.
(3)TMNCorp, Rockville, MD, USA.
(4)CDC Foundation, Atlanta, GA, USA.

OBJECTIVES: How Right Now (HRN) is an evidence-based, culturally responsive 
communication campaign developed to facilitate coping and resilience among US 
groups disproportionately affected by the COVID-19 pandemic. To inform the 
development of this campaign, we examined patterns in emotional health, stress, 
and coping strategies among HRN's audiences, focusing on differences among 
racial and ethnic groups.
METHODS: We used a national probability panel, AmeriSpeak, to collect survey 
data from HRN's priority audience members in English and Spanish at 2 time 
points (May 2020 and May 2021). We conducted statistical testing to examine 
differences between time points for each subgroup (Hispanic, non-Hispanic Black, 
and non-Hispanic White) and differences among subgroups at each time point.
RESULTS: We found disparities in COVID-19-related mental health challenges and 
differences in coping strategies. Non-Hispanic Black respondents were more 
likely than non-Hispanic White respondents to report challenges related to the 
social determinants of health, such as affording food and housing (26.4% vs 9.4% 
in May 2020) and experiencing personal financial loss (46.6% vs 29.2% in May 
2020). In May 2021, 30.6% of Hispanic respondents reported being unable to meet 
basic food or housing needs versus 8.2% of non-Hispanic White respondents, and 
51.6% reported personal financial loss versus 26.5% of non-Hispanic White 
respondents.
CONCLUSIONS: Our study further illuminates what is needed to build emotional 
well-being pathways for people who historically have been economically and 
socially marginalized. Our findings underscore the need for public health 
interventions to provide culturally responsive mental health support to 
populations disproportionately affected by COVID-19 during the pandemic and into 
the future, with a focus on racial and ethnic disparities.

DOI: 10.1177/00333549221121667
PMCID: PMC9482876
PMID: 36113112 [Indexed for MEDLINE]

Conflict of interest statement: The authors declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1542. Res Gerontol Nurs. 2022 Sep-Oct;15(5):217-228. doi: 
10.3928/19404921-20220829-01. Epub 2022 Sep 1.

"Please Don't Forget Us": A Descriptive Qualitative Study of Caregivers of Older 
Adults With Alzheimer's Disease and Related Dementias During the COVID-19 
Pandemic.

Richards KC, Radhakrishnan K, Britt KC, Vanags-Louredo A, Park E, Gooneratne NS, 
Fry L.

The current descriptive qualitative study explored the perceived impact of the 
coronavirus disease 2019 pandemic on sleep disturbances and nighttime agitation; 
the reported use of antipsychotics and other sedating medications; and the 
overall well-being of older adults with Alzheimer's disease and related 
dementias (ADRD) and their caregivers. One investigator conducted in-depth, 
phone interviews with caregivers of nursing home residents with ADRD (four 
family caregivers [FCs], three nurse practitioners [NPs]) and seven FCs of older 
adults with ADRD who lived with them at home. Caregivers described multiple 
sleep disturbances. Nighttime agitation symptoms were perceived to continue or 
worsen, and sedating medications and nonpharmacological interventions were 
required. Adverse impacts on reported well-being were significant, and impacts 
were grouped into emotional, social, and physical themes. Caregivers said, 
"Please don't forget us," and requested telehealth support for those at home and 
technology and human resources for nursing homes to reduce adverse impacts. 
[Research in Gerontological Nursing, 15(5), 217-228.].

DOI: 10.3928/19404921-20220829-01
PMCID: PMC10187068
PMID: 36113012 [Indexed for MEDLINE]

Conflict of interest statement: Disclosure: The authors have disclosed no 
potential conflicts of interest, financial or otherwise.


1543. PLoS One. 2022 Sep 16;17(9):e0274322. doi: 10.1371/journal.pone.0274322. 
eCollection 2022.

The moderating role of sociodemographic and work-related variables in burnout 
and mental health levels of Mexican medical residents.

Dominguez-Espinosa ADC(1), Montes de Oca-Mayagoitia SI(1), Sáez-Jiménez AP(1), 
de la Fuente-Zepeda J(1), Monroy Ramírez de Arellano L(2).

Author information:
(1)Psychology Department, Universidad Iberoamericana, Mexico City, Mexico.
(2)SEDESA, Dirección de Formación, Actualización Médica e Investigación, 
Secretaria de Salud, Mexico City, Mexico.

OBJECTIVE: To explore the moderating effects of sociodemographic and 
work-related variables on levels of burnout and mental health among medical 
residents.
METHOD: A cross-sectional online survey was administered at the beginning of the 
second wave of COVID-19 at different public teaching hospitals where medical 
residents practiced in Mexico City. A total of 201 medical residents of 
different years completed the survey.
RESULTS: Different univariate inferential analyses on the level of burnout and 
mental health indices showed significant differences between sex, marital 
status, previous reports of physical illness or psychological conditions, and 
residency ranking. However, the effect sizes of those differences were of low to 
medium size. A predictive path analysis revealed that the three stages of 
burnout (emotional exhaustion, depersonalization, and achievement 
dissatisfaction) negatively affect psychological wellbeing and positively affect 
psychological distress. Finally, even though sociodemographic variables showed 
some significant variation, the effect sizes were small and did not moderate the 
direct effect of burnout on mental health indices.
CONCLUSIONS: Medical residents deling with every day medical situations, will be 
exposed to stressors that might increase the probability to experience emotional 
exhaustion. This would negatively affect levels of wellbeing and positively 
affect distress, despite their sociodemographic characteristics.

DOI: 10.1371/journal.pone.0274322
PMCID: PMC9481024
PMID: 36112642 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


1544. F1000Res. 2022 Apr 4;11:390. doi: 10.12688/f1000research.110090.1. eCollection 
2022.

Machine learning techniques for predicting depression and anxiety in pregnant 
and postpartum women during the COVID-19 pandemic: a cross-sectional regional 
study.

Qasrawi R(1)(2), Amro M(1), VicunaPolo S(1), Abu Al-Halawa D(3), Agha H(3), Abu 
Seir R(4), Hoteit M(5)(6)(7), Hoteit R(8), Allehdan S(9), Behzad N(10), Bookari 
K(11)(12), AlKhalaf M(12), Al-Sabbah H(13), Badran E(14), Tayyem R(15)(16).

Author information:
(1)Department of Computer Science, Al- Quds University, Jerusalem, Palestinian 
Territory.
(2)Dpertment of Computer Engineering, Istinye University, Istanbul, 34010, 
Turkey.
(3)Department of Faculty of Medicine, Al- Quds University, Jerusalem, 
Palestinian Territory.
(4)Department of Medical Laboratory Sciences, Al-Quds University, Jerusalem, 
Palestinian Territory.
(5)Faculty of Public Health, Lebanese University, Beirut, Lebanon.
(6)PHENOL Research Group (Public Health Nutrition Program Lebanon), Faculty of 
Public Health, Lebanese University, Beirut, Lebanon.
(7)Lebanese University Nutrition Surveillance Center (LUNSC), Lebanese Food 
Drugs and Chemical Administrations, Lebanese University, Beirut, Lebanon.
(8)Clinical Research Institute, American University of Beirut, Bliss Street, 
Riad El Solh 1107 2020, Beirut, Lebanon.
(9)Department of Biology, College of Science, University of Bahrain, Zallaq, 
Bahrain.
(10)Salmaniya Medical Complex, Ministry of Health, Manama, Bahrain.
(11)Department of Clinical Nutrition, Faculty of Applied Medical Sciences, 
Taibah University, Medna, Saudi Arabia.
(12)National Nutrition Committee (NNC), Saudi Food and Drug Authority (Saudi 
FDA), Riyadh, Saudi Arabia.
(13)Department of Health Sciences, Zayed University, Dubai, United Arab 
Emirates.
(14)Faculty of Medicine, University of Jordan, Amman, Jordan.
(15)Department of Human Nutrition, College of Health Sciences, Qatar University, 
Doha, Qatar.
(16)Department of Nutrition and Food Technology, Faculty of Agriculture, The 
University of Jordan, Amman, 11942, Jordan.

Background: Maternal depression and anxiety are significant public health 
concerns that play an important role in the health and well-being of mothers and 
children. The COVID-19 pandemic, the consequential lockdowns and related safety 
restrictions worldwide negatively affected the mental health of pregnant and 
postpartum women. Methods: This regional study aimed to develop a machine 
learning (ML) model for the prediction of maternal depression and anxiety. The 
study used a dataset collected from five Arab countries during the COVID-19 
pandemic between July to December 2020. The population sample included 3569 
women (1939 pregnant and 1630 postpartum) from five countries (Jordan, 
Palestine, Lebanon, Saudi Arabia, and Bahrain). The performance of seven machine 
learning algorithms was assessed for the prediction of depression and anxiety 
symptoms. Results: The Gradient Boosting (GB) and Random Forest (RF) models 
outperformed other studied ML algorithms with accuracy values of 83.3% and 83.2% 
for depression, respectively, and values of 82.9% and 81.3% for anxiety, 
respectively. The Mathew's Correlation Coefficient was evaluated for the ML 
models; the Naïve Bayes (NB) and GB models presented the highest performance 
measures (0.63 and 0.59) for depression and (0.74 and 0.73) for anxiety, 
respectively. The features' importance ranking was evaluated, the results showed 
that stress during pregnancy, family support, financial issues, income, and 
social support were the most significant values in predicting anxiety and 
depression. Conclusion: Overall, the study evidenced the power of ML models in 
predicting maternal depression and anxiety and proved to be an efficient tool 
for identifying and predicting the associated risk factors that influence 
maternal mental health. The deployment of machine learning models for screening 
and early detection of depression and anxiety among pregnant and postpartum 
women might facilitate the development of health prevention and intervention 
programs that will enhance maternal and child health in low- and middle-income 
countries.

Copyright: © 2022 Qasrawi R et al.

DOI: 10.12688/f1000research.110090.1
PMCID: PMC9445566
PMID: 36111217 [Indexed for MEDLINE]

Conflict of interest statement: No competing interests were disclosed.


1545. BMC Psychol. 2022 Sep 15;10(1):217. doi: 10.1186/s40359-022-00920-7.

Effect of an online resourcefulness training in improving psychological 
well-being of front-line medical staff: a quasi-experimental study.

Zhang D(1)(2), Jia Y(1), Chen Y(2), Meng G(1), Zhuang X(1), Chen L(2), Wang 
D(2), Zhang YP(3).

Author information:
(1)School of Nursing, Xi'an Jiaotong University Health Science Center, No. 76, 
Yanta West Road, Xi'an, 710061, Shaanxi, China.
(2)Institute of Clinical Research, Affiliated Nanhua Hospital, Hengyang Medical 
School, University of South China, 336 Dongfeng Road, Zhuhui District, Hengyang, 
421002, Hunan, China.
(3)School of Nursing, Xi'an Jiaotong University Health Science Center, No. 76, 
Yanta West Road, Xi'an, 710061, Shaanxi, China. cathyzh@mai1.xjtu.edu.cn.

BACKGROUND: The global COVID-19 pandemic is still not under effective control, 
and strong workplace supports with comprehensive mental health interventions are 
urgently needed to help medical staff effectively respond to the pandemic. This 
study aimed to verify the effect of an online resourcefulness training program 
on the resourcefulness, and psychological variables of front-line medical staff 
working in the COVID-19 isolation ward.
DESIGN: A pre-test and post-test quasi-experimental design with control group 
was employed.
PARTICIPANTS: A total of 60 participants working in two isolation wards were 
recruited via convenience sampling. The two isolation wards were randomly 
assigned to the control group (isolation ward 1, n = 30) and the intervention 
group (isolation ward 2, n = 30).
INTERVENTION: The participants were trained online by video conferences and 
WeChat. The control group received conventional training (e.g., psychological 
training, psychological counseling), while the intervention group received a 4-h 
online resourcefulness training. Both groups learned updated guidelines of 
COVID-19 simultaneously via video conference. The primary outcomes 
(resourcefulness, anxiety, depression and coping styles) and the secondary 
outcome (psychological resilience) were measured before intervention and three 
time points after intervention.
RESULTS: After the intervention and one week after the intervention, the 
resourcefulness, resilience, and positive response scores of the participants in 
the intervention group were significantly higher than those of the control 
group. The anxiety and negative response scores in the intervention group were 
significantly lower than those of the control group (all p < 0.05). One month 
after the intervention, the scores of resourcefulness, tenacity, and positive 
response of the intervention group were higher than those of the control group 
(all p < 0.05). Repeated measures analysis of variance showed that the two 
groups of participants had statistically significant changes in the time-based 
effect and group-based effect in resourcefulness, resilience, anxiety scores and 
coping styles (p < 0.01).
CONCLUSION: The results showed that our online resourcefulness training can 
significantly improve the resourcefulness, resilience, and positive response 
scores and effectively reduce anxiety and depression scores of front-line 
medical staff. This demonstrates that online resourcefulness training would be 
an effective tool for the psychological adjustment of front-line medical staff 
in fighting against COVID-19.

© 2022. The Author(s).

DOI: 10.1186/s40359-022-00920-7
PMCID: PMC9477167
PMID: 36109821 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that there are no conflicts 
of interest.


1546. J Occup Environ Med. 2023 Feb 1;65(2):172-183. doi: 
10.1097/JOM.0000000000002711. Epub 2022 Sep 15.

Understanding the Mental Health Impacts of the COVID-19 Pandemic on Railway 
Workers: Risks and Protective Factors.

Cogan N(1), McGibbon M, Gardiner A, Morton L.

Author information:
(1)From the School of Psychological Sciences and Health, University of 
Strathclyde, Glasgow, United Kingdom.

OBJECTIVE: Railway workers have provided an essential service throughout the 
COVID-19 pandemic. This study explored the effects of COVID-19 on the mental 
well-being of railway workers (N = 906) in the United Kingdom during the third 
lockdown period.
METHOD: The online survey included measures of COVID-19-related risk factors 
(perceived risk, stress, burnout, trauma) and protective factors (resilience 
coping, team resilience, general help seeking) associated with mental 
well-being. Responses were analyzed using multiple regression and content 
analysis.
RESULTS: COVID-19-related risk factors negatively predicted well-being. Higher 
scores on adaptive resilience, intentions to seek help, and team resilience 
significantly predicted higher mental well-being scores. Mental health decline 
throughout the COVID-19 pandemic and concerns for the future were reported.
CONCLUSIONS: Building a resilient railway workforce requires attention to staff 
mental well-being and to ensuring that support systems are robust and 
accessible.

Copyright © 2022 American College of Occupational and Environmental Medicine.

DOI: 10.1097/JOM.0000000000002711
PMCID: PMC9897125
PMID: 36109012 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of interest: None declared.


1547. J Psychiatr Res. 2022 Nov;155:232-240. doi: 10.1016/j.jpsychires.2022.09.001. 
Epub 2022 Sep 7.

How the COVID-19 pandemic divides society: Towards a better understanding of 
differences between supporters and opponents of the COVID-19 pandemic lockdown 
in Germany.

Jung S(1), Krüger THC(2).

Author information:
(1)Department of Psychiatry, Social Psychiatry and Psychotherapy, Division of 
Clinical Psychology and Sexual Medicine, Hannover Medical School, 
Carl-Neuberg-Str. 1, 30625, Hannover, Germany. Electronic address: 
dr.s.jung@outlook.de.
(2)Department of Psychiatry, Social Psychiatry and Psychotherapy, Division of 
Clinical Psychology and Sexual Medicine, Hannover Medical School, 
Carl-Neuberg-Str. 1, 30625, Hannover, Germany; Center for Systems Neuroscience, 
Hanover, Germany. Electronic address: krueger.tillmann@mh-hannover.de.

Implemented COVID-19 containment measures have been fiercely discussed in 
Germany and corona-related protests have emerged. We assessed mental health in 
response to the lockdown in Germany and aimed at detecting factors 
differentiating opponents and supporters of the COVID-19 containment measures. 
Using a cross-sectional online survey (n = 1219) with a mixed-methods approach, 
we found increased levels of anxiety and depressive symptoms (PHQ-4 and GAD-7), 
overall lower well-being (WHO-5), worsened sleep, increased prevalence of 
interpersonal violence (5.2%) as well as more pronounced irritability including 
anger and aggression compared to pre-COVID-19 times for all participants. 
Moreover, opponents demonstrated a more pronounced mental burden with more 
depression and anxiety, more anger and coping difficulties compared to 
supporters. In line with previous research, we found opponents to be 
well-educated, financially stable and strongly estranged by their political 
institutions. Additionally, applying regression analysis, we found anxiety and 
negative self-concept to differentiate between opponents and supporters of the 
COVID-19 pandemic lockdown. Qualitative data confirms an increase in mental 
burden. Taken together, we identify a more vulnerable group opposing COVID-19 
containment measures. Our results inform the public about opponents' motives, 
concerns and needs and open another perspective on the effects of the COVID-19 
pandemic and its related containment measures.

Copyright © 2022 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.jpsychires.2022.09.001
PMCID: PMC9450499
PMID: 36108430 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare no conflict of interest.


1548. J Cosmet Dermatol. 2022 Dec;21(12):6557-6561. doi: 10.1111/jocd.15386. Epub 2022 
Sep 26.

The COVID-19 pandemic and its impact on esthetic dermatology.

Aryanian Z(1)(2), Ehsani A(1)(3), Razavi Z(1)(3), Hamzelou S(3), Mohseni Afshar 
Z(4), Hatami P(1).

Author information:
(1)Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University 
of Medical Sciences, Tehran, Iran.
(2)Department of Dermatology, Babol University of Medical Sciences, Babol, Iran.
(3)Department of Dermatology, School of Medicine, Razi Hospital, Tehran 
University of Medical Sciences, Tehran, Iran.
(4)Clinical Research Development Center, Imam Reza Hospital, Kermanshah 
University of Medical Sciences, Kermanshah, Iran.

In general, the world population interest has increased for maintaining 
youthfulness and having better appearance since this leads to a better mental 
wellbeing and self-estimate. The coronavirus disease 2019 (COVID-19) pandemic 
has revolutionized every field of medicine. As every specialty has been affected 
by limitations caused by the severe acute respiratory syndrome coronavirus 2 
(SARS-CoV-2), this branch of medicine has also needed certain precautions for 
safer practice in the COVID era. With the global vaccination program against 
COVID-19, reports of some cutaneous reactions in patients have been undergone 
various esthetic procedures including filler or botox injection would be 
increasingly demonstrated. Although the end of pandemic was announced, the 
necessity of continuing COVID vaccination in future mandates gathering data 
regarding safety of vaccines. Herein, we presented a comprehensive review on 
various aspects of association between esthetic medicine or cosmetic dermatology 
and COVID-19.

© 2022 Wiley Periodicals LLC.

DOI: 10.1111/jocd.15386
PMCID: PMC9538429
PMID: 36106524 [Indexed for MEDLINE]

Conflict of interest statement: All the authors declare that there is no 
conflict of interest.


1549. Int J Obes (Lond). 2022 Dec;46(12):2120-2127. doi: 10.1038/s41366-022-01220-1. 
Epub 2022 Sep 14.

Perceived weight-related stigma, loneliness, and mental wellbeing during 
COVID-19 in people with obesity: A cross-sectional study from ten European 
countries.

Jones RA(1), Christiansen P(2), Maloney NG(2), Duckworth JJ(2)(3), Hugh-Jones 
S(3), Ahern AL(4), Richards R(4), Brown A(5)(6)(7), Flint SW(3)(8), Robinson 
E(2), Bryant S(9), Halford JCG(2)(3)(9), Hardman CA(2).

Author information:
(1)MRC Epidemiology Unit, University of Cambridge, Cambridge, CB2 0QQ, UK. 
rj397@cam.ac.uk.
(2)Department of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK.
(3)School of Psychology, University of Leeds, Leeds, LS2 9JT, UK.
(4)MRC Epidemiology Unit, University of Cambridge, Cambridge, CB2 0QQ, UK.
(5)Centre for Obesity Research, University College London, London, WC1E 6JF, UK.
(6)Bariatric Centre for Weight Management and Metabolic Surgery, University 
College London Hospital NHS Trust, London, UK.
(7)National Institute of Health Research, UCLH Biomedical Research Centre, 
London, UK.
(8)Scaled Insights, Leeds, LS2 3AA, UK.
(9)The European Association for the Study of Obesity, Teddington, TW11 8GT, UK.

BACKGROUND: Increased weight-related stigma during the COVID-19 pandemic has 
amplified the need to minimise the impacts on mental wellbeing. We investigated 
the relationship between the perceived changes in the representation of obesity 
in the media and mental wellbeing during the pandemic in a sample of people with 
obesity across 10 European countries. We also investigated the potential 
moderating effect of loneliness.
METHODS: Between September to December 2020 during the COVID-19 pandemic, 
participants reported data on demographics, mental wellbeing (measured by World 
Health Organisation Five Wellbeing Index and Patient Health Questionaire-4), 
loneliness (measured by De Jong Gierveld short scale), and perceived change in 
the representation of obesity in media (measured by a study-specific question) 
using the online, cross-sectional EURopean Obesity PatiEnt pANdemic Survey 
(EUROPEANS). Data were analysed using linear mixed-effects models, controlling 
for age, gender, body mass index, and shielding status, with random incept for 
country.
RESULTS: The survey was completed by 2882 respondents. Most identified as female 
(56%) and reported their ethnicity as White or White-mix (92%). The total sample 
had a mean age of 41 years and a BMI of 35.4 kg/m2. During the peak of the 
pandemic, compared to pre-pandemic, perceiving more negative representation of 
people with obesity on social media was associated with worse psychological 
distress, depression, and wellbeing. Perceiving more positive representation, 
compared to no change in representation, of people with obesity on television 
was associated with greater wellbeing, yet also higher psychological distress 
and anxiety. Loneliness, as a moderator, explained ≤0.3% of the variance in 
outcomes in any of the models.
CONCLUSIONS: Perceiving negative representation of obesity on social media was 
associated with poorer mental wellbeing outcomes during the pandemic; positive 
representation on television was associated with both positive and negative 
mental wellbeing outcomes. We encourage greater media accountability when 
representing people with obesity.

© 2022. The Author(s).

DOI: 10.1038/s41366-022-01220-1
PMCID: PMC9472193
PMID: 36104431 [Indexed for MEDLINE]

Conflict of interest statement: CAH, PC, NGM, and JCGH have received research 
funding from the American Beverage Association. CAH has received speaker fees 
from the International Sweeteners Association and the International Food 
Information Council for work outside of the present manuscript. ALA is the chief 
investigators on two publicly funded (MRC, NIHR) trials where the intervention 
is provided by WW (formerly Weight Watchers) at no cost. JCGH has received 
speaker fees from Novo Nordisk and consultancy from Dupont, International 
Sweeteners Association, Mars, Novo Nordisk for work outside of the present 
manuscript. AB has received funding for investigator-initiated research, travel 
grants, speaker fees and support to attend an obesity conference from Novo 
Nordisk for work outside this present manuscript. and is on the scientific 
advisory board and shareholder of Reset Health Clinics Ltd. SWF reports research 
grants from Johnson and Johnson, research grants from Novo Nordisk, and personal 
fees to support attendance at meetings from Johnson and Johnson and Novo 
Nordisk, outside of the submitted work. RJ, SHJ, SB, RR, and JD declare no 
competing interests.


1550. Ann Med. 2022 Dec;54(1):2477-2485. doi: 10.1080/07853890.2022.2121852.

The impacts of the COVID-19 pandemic on treatment-resistant schizophrenia 
patients having followed virtual reality therapy or cognitive behavioural 
therapy: a content analysis.

Hudon A(1)(2), Léveillé N(2), Sanchez-Schicharew K(2), Dellazizzo L(1)(2), 
Phraxayavong K(3), Dumais A(1)(2)(3)(4).

Author information:
(1)Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, 
Montreal, Canada.
(2)Department of Psychiatry and Addictology, Faculty of Medicine, Université de 
Montréal, Montreal, Canada.
(3)Services et Recherches Psychiatriques AD, Montreal, Canada.
(4)Institut national de Psychiatrie Légale Philippe-Pinel, Montreal, Canada.

PURPOSE: The COVID-19 pandemic led to exacerbation of mental health symptoms and 
deterioration in psychological well-being in individuals suffering from 
schizophrenia. The primary objective of this study is to evaluate the impacts of 
the COVID-19 pandemic on patients suffering from treatment-resistant 
schizophrenia (TRS) with auditory verbal hallucinations (AVH) having undergone 
virtual reality therapy (VRT) or cognitive behavioural therapy (CBT) on their 
symptomatology. The secondary objective is to identify the differences and 
similarities in relation to the response to the COVID 19 pandemic between these 
two groups of patients.
METHODS: Qualitative analysis of semi-structured interviews was conducted with 
42 patients suffering from TRS who had previously followed VRT or CBT. All 
interviews were recorded, transcribed, and analysed.
RESULTS: Four themes emerged in this study: Psychotherapeutic Interventions, 
Impact of COVID-19 and Public health and safety policies, Substance use and 
Psychiatric follow-up. Participants from both groups reported that their therapy 
was beneficial in controlling AVH. Patients having followed CBT reported more 
depressive symptoms whereas patients having followed VRT reported more anxious 
symptoms.
CONCLUSIONS: This study offers a first qualitative insight in patients suffering 
from TRS and the impacts of COVID-19 on them and opens the door to the 
protective factors of CBT and VRT for this specific population.

DOI: 10.1080/07853890.2022.2121852
PMCID: PMC9481136
PMID: 36102593 [Indexed for MEDLINE]

Conflict of interest statement: No potential conflict of interest was reported 
by the author(s).


1551. J Affect Disord. 2022 Dec 1;318:272-282. doi: 10.1016/j.jad.2022.09.003. Epub 
2022 Sep 10.

Prevalence of anxiety during the COVID-19 pandemic: A systematic review and 
meta-analysis of over 2 million people.

Delpino FM(1), da Silva CN(2), Jerônimo JS(3), Mulling ES(3), da Cunha LL(3), 
Weymar MK(3), Alt R(4), Caputo EL(3), Feter N(5).

Author information:
(1)Postgraduate Program in Nursing, Federal University of Pelotas, Rio Grande do 
Sul, Brazil. Electronic address: fmdsocial@outlook.com.
(2)Postgraduate Program in Health Sciences, Federal University of Rio Grande, 
Rio Grande do Sul, Brazil.
(3)Postgraduate Program in Physical Education, Federal University of Pelotas, 
Rio Grande do Sul, Brazil.
(4)Postgraduate Program in Epidemiology, Federal University of Pelotas, Rio 
Grande do Sul, Brazil.
(5)Postgraduate Program in Epidemiology, Federal University of Rio Grande do 
Sul, Rio Grande do Sul, Brazil.

INTRODUCTION: Uncertainty, disruptions in daily routines, and concerns for the 
health and well-being during the COVID-19 pandemic are likely associated with 
increases in generalized anxiety. The present study aimed to systematically 
review the literature in order to identify the update prevalence of anxiety in 
the general population during the COVID-19 pandemic.
METHODS: A systematic review and meta-analysis. It included studies that 
assessed the prevalence of anxiety among the general population during the 
COVID-19 pandemic.
RESULTS: In total, we included 194 studies. The general prevalence of anxiety 
was 35.1 %, affecting approximately 851,000 participants. The prevalence in low 
and middle-income countries (35.1 %; 95%CI: 29.5 % to 41.0 %) was similar 
compared to high-income countries (34.7 %; 95%CI: 29.6 % to 40.1 %). In studies 
that provided the proportion of cases in each level of anxiety disorder, 
mild-to-moderate anxiety affected one quarter of the participants. One in ten 
cases with anxiety during the COVID-19 may be living with severe or extremely 
anxiety disorder. Most instruments estimated similar prevalence of anxiety 
disorders with notable difference in the prevalence estimated by the Generalized 
Anxiety Disorder 2-item (GAD-2), Zung Self-Rating Anxiety Scale (SAS), and 
State-Trait Anxiety Inventory (STAI).
CONCLUSION: One in three adults were living with anxiety disorder during the 
COVID-19 pandemic worldwide.

Copyright © 2022 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2022.09.003
PMCID: PMC9462928
PMID: 36096370 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest The authors declare no 
conflict of interest.


1552. Eur J Public Health. 2022 Oct 3;32(5):766-772. doi: 10.1093/eurpub/ckac124.

Factors associated with changing alcohol consumption during the first UK 
lockdown.

McAloney-Kocaman K(1), McPherson KE(1), McGlinchey E(2), Armour C(2).

Author information:
(1)Department of Psychology, Glasgow Caledonian University, Glasgow G4 0BA, UK.
(2)Stress Trauma and Related Conditions (STARC) Research Lab, School of 
Psychology, Queen's University Belfast, Belfast BT9 5BN, UK.

BACKGROUND: In response to COVID-19 there have been lockdowns and restrictions 
to hospitality services. Drinking behaviours often change in response to 
traumatic events and changes in the drinking environment, and this is influenced 
by a range of factors. This study explores self-reported changes in alcohol 
consumption in the third month of the UK lockdown, associations with 
socio-demographics factors and with COVID-19-related concerns, and mental health 
and wellbeing.
METHODS: The COVID-19 Psychological Wellbeing Study was a longitudinal, online, 
three-wave survey of 1958 UK adults. Data were collected during the first UK 
lockdown; wave 1 launched 23 March 2020, wave 2 was 1 month after and wave 3 2 
months after completion of wave 1A hierarchical multinomial regression model was 
estimated to investigate factors associated with changes in perceived alcohol 
consumption in the third month of the lockdown.
RESULTS: The majority of participants reported changes in drinking (62%) with 
over one-third indicating increased consumption. Student status and worries 
about the financial implications of COVID-19 were associated with lower odds of 
decreased alcohol consumption. Those with above average income and those with 
children in the household had lower odds of increased alcohol consumption, while 
younger adults had higher odds of increased alcohol consumption.
CONCLUSIONS: This study adds to the growing body of research showing changes in 
alcohol consumption behaviours during the COVID-19 lockdown restrictions, and 
identifies risk and protective factors which can aid in targeting intervention 
at those most in need of support.

© The Author(s) 2022. Published by Oxford University Press on behalf of the 
European Public Health Association.

DOI: 10.1093/eurpub/ckac124
PMCID: PMC9494400
PMID: 36094148 [Indexed for MEDLINE]


1553. Int J Public Health. 2022 Aug 25;67:1604591. doi: 10.3389/ijph.2022.1604591. 
eCollection 2022.

Financial Distress and Psychological Well-Being During the COVID-19 Pandemic.

Borrescio-Higa F(1), Droller F(2), Valenzuela P(3).

Author information:
(1)Business School, Universidad Adolfo Ibañez, Santiago, Chile.
(2)Departamento de Economía, Universidad de Santiago de Chile, Santiago, Chile.
(3)Facultad de Ingeniería y Ciencias Aplicadas, Universidad de los Andes, 
Santiago, Chile.

Objective: We examine the impact of financial distress caused by the COVID-19 
pandemic on mental health and psychological well-being. Methods: We analyze 
cross-sectional survey data (n = 2,545) from the Life during Pandemic study in 
Chile. We estimate linear probability models to analyze the relationship between 
economic fragility, financial distress, and psychological well-being. Results: 
Our findings show unemployment and income loss are highly predictive of 
experiencing a range of financial problems, such as a lack of savings, as well 
as difficulties paying bills, consumer debt, and mortgage loans. In turn, 
financial distress leads to a higher prevalence of poor well-being and mental 
health deterioration, and sleep problems. Conclusion: Expansion of mental health 
assistance services are needed, as new diagnosis of mental health conditions has 
increased, but treatment has not, pointing to a barrier in the access to some 
mental health care services during the pandemic. Policies designed with the 
objective of improving financial education are necessary to increase 
precautionary savings and financial resilience, and alleviate the psychological 
burden of debt in the future.

Copyright © 2022 Borrescio-Higa, Droller and Valenzuela.

DOI: 10.3389/ijph.2022.1604591
PMCID: PMC9453756
PMID: 36090842 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1554. BMC Public Health. 2022 Sep 10;22(1):1719. doi: 10.1186/s12889-022-14135-3.

Locked up at home: a cross-sectional study into the effects of COVID-19 
lockdowns on domestic violence in households with children in Belgium.

Fomenko E(1), De Schrijver L(1), Vandeviver C(2), Keygnaert I(3).

Author information:
(1)ICRH - Faculty of Medicine & Health Sciences, Ghent University, Ghent, 
Belgium.
(2)IRCP - Faculty of Law & Criminology, Ghent University, Ghent, Belgium.
(3)ICRH - Faculty of Medicine & Health Sciences, Ghent University, Ghent, 
Belgium. Ines.Keygnaert@UGent.be.

BACKGROUND: Policymakers worldwide took measures to limit the spread of the 
COVID-19-virus. While these sanitary measures were necessary to fight the spread 
of the virus, several experts warned for a significant impact on mental health 
and a potential increase in domestic violence. To study the impact of the 
COVID-19 measures in Belgium, and the factors influencing the occurrence of 
domestic violence, we set up the study on relationships, stress, and aggression. 
In this study, we evaluate the prevalence of domestic violence victimization 
during the COVID-19 lockdown in Belgian children aged zero to seventeen years 
and the associations of the parents' financial status, relationships, mental 
health, and previous victimization to the child's victimization.
METHODS: A stepwise forward binary logistic regression was used to analyse the 
association between multiple risk factors of domestic violence and victimization 
of the respondent's child. The respondent being an assailant, the respondent's 
age, and the age of the children in the household were added as moderators.
RESULTS: In this model an association with domestic child abuse was found for 
the age of the respondent, the household's size, the presence of children 
between zero and five years in the household, the perceived stress level of the 
respondent, and victimization of the respondent during the first wave of the 
sanitary measures, as well as victimization before the COVID-19 pandemic. None 
of the interacting effects were found to be significant.
CONCLUSION: It is advisable to make extra efforts to improve well-being when 
maintaining sanitary measures by providing appropriate assistance and helping 
households struggling with increased or acute stress to install positive coping 
strategies - especially in larger households with children between six and 
17 years. Besides, our findings draw attention to the clustering of risk of 
child and adult violence exposure in lockdown situations as well as to the 
potential cumulative impact of exposure to violence across the lifespan and 
across generations. It is key to invest in training healthcare workers and staff 
at schools to screen for and assess risks of domestic violence development and 
ongoing or past occurrence in order to detect, refer and follow-up on families 
at risk.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-14135-3
PMCID: PMC9463669
PMID: 36088357 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1555. Lancet Planet Health. 2022 Sep;6(9):e726-e738. doi: 
10.1016/S2542-5196(22)00172-3.

Psychological responses, mental health, and sense of agency for the dual 
challenges of climate change and the COVID-19 pandemic in young people in the 
UK: an online survey study.

Lawrance EL(1), Jennings N(2), Kioupi V(3), Thompson R(4), Diffey J(5), 
Vercammen A(6).

Author information:
(1)Institute of Global Health Innovation, Imperial College London, London, UK; 
Grantham Institute-Climate Change and Environment, Imperial College London, 
London, UK; Mental Health Innovations, London, UK. Electronic address: 
e.lawrance@imperial.ac.uk.
(2)Grantham Institute-Climate Change and Environment, Imperial College London, 
London, UK.
(3)Centre for Environmental Policy, Imperial College London, London, UK.
(4)School of Public Health, Imperial College London, London, UK.
(5)Institute of Global Health Innovation, Imperial College London, London, UK.
(6)Centre for Environmental Policy, Imperial College London, London, UK; School 
of Communication and Arts, The University of Queensland, Brisbane, QSL, 
Australia.

BACKGROUND: The COVID-19 pandemic and climate change are both significant and 
pressing global challenges, posing threats to public health and wellbeing. Young 
people are particularly vulnerable to the distress both crises can cause, but 
understanding of the varied psychological responses to both issues is poor. We 
aimed to investigate these responses and their links with mental health 
conditions and feelings of agency.
METHODS: We conducted an online survey between Aug 5 and Oct 26, 2020, targeting 
a diverse sample of young people (aged 16-24 years, n=530) in the UK. The survey 
was distributed using a combination of a survey panel (panel sample) and direct 
approaches to youth groups and schools who shared the survey with young people 
in their networks (community sample). We collected data on respondents' 
psychological responses to both climate change and the COVID-19 pandemic, their 
sense of agency to respond to each crisis, and the range of impacts on their 
lives. We also collected demographics data and screened for mental health and 
wellbeing indicators. We used non-parametric tests for most statistical 
comparisons. For paired samples, we used Wilcoxon's signed-rank test, and used 
Mann-Whitney U-tests or Kruskal-Wallis tests for two or more independent 
samples. Summed scale scores were considered as interval-level data and analysed 
with Student's t tests and ANOVAs. Effect sizes are reported as Cohen's d and 
partial eta-squared (η·2p), respectively.
FINDINGS: After excluding 18 suspected bots and 94 incomplete responses, 530 
responses were retained for analysis. Of the 518 respondents who provided 
demographic data, 63% were female, 71·4% were White, and the mean family 
affluence score was 8·22 (SD 2·29). Most participants (n=343; 70%) did not 
report a history of diagnosis or treatment for a mental health disorder, but 
mental health scores indicated a common experience of (relatively mild) symptoms 
of anxiety, depression, and stress. Although UK youth reported more life 
disruption and concern for their future due to the COVID-19 pandemic, climate 
change was associated with significantly greater distress overall, particularly 
for individuals with low levels of generalised anxiety. The COVID-19 pandemic 
was more associated with feelings of anxiety, isolation, disconnection, and 
frustration; distress around loss and grief; and effects on quality of life. 
Climate change was more likely to evoke emotions such as interest and 
engagement, guilt, shame, anger, and disgust. The greater distress attributed to 
climate change overall was due, in particular, to higher levels of guilt, sense 
of personal responsibility, and greater distress triggered by upsetting media 
coverage. Agency to address climate change was associated with greater climate 
distress, but pandemic-related distress and agency were unrelated.
INTERPRETATION: The COVID-19 pandemic and climate change are affecting the 
wellbeing of UK young people in distinct ways, with implications for health 
service, policy, and research responses. There is a need for mental health 
practitioners, policy makers, and other societal actors to account for the 
complex relationship between climate agency, distress, and mental wellbeing in 
young people.
FUNDING: Imperial College London.

Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open 
Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. 
All rights reserved.

DOI: 10.1016/S2542-5196(22)00172-3
PMCID: PMC9451498
PMID: 36087603 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of interests We declare no competing 
interests.


1556. Nurse Educ Today. 2022 Nov;118:105520. doi: 10.1016/j.nedt.2022.105520. Epub 
2022 Sep 3.

Pre-registration nursing students' anxiety and academic concerns after the 
second wave of COVID-19 pandemic in Italy: A cross-sectional study.

Comparcini D(1), Tomietto M(2), Cicolini G(3), Dickens GL(4), Mthimunye K(5), 
Marcelli S(6), Simonetti V(7).

Author information:
(1)Politecnica delle Marche University of Ancona, Ancona, Italy; Azienda 
Ospedaliera Universitaria "Ospedali Riuniti" di Ancona, Ancona, Italy. 
Electronic address: dania.comparcini@staff.univpm.it.
(2)Department of Nursing, Midwifery and Health, Faculty of Health and Life 
Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom; Adjunct 
Professor, Research Unit of Nursing Science and Health Management, University of 
Oulu, Oulu, Finland; Visiting Professor, Università degli Studi di Bari "Aldo 
Moro", Bari, Italy. Electronic address: marco.tomietto@northumbria.ac.uk.
(3)Department of Biomedical Science and Human Oncology, Università degli Studi 
di Bari "Aldo Moro", Bari, Italy. Electronic address: 
giancarlo.cicolini@uniba.it.
(4)Department of Nursing, Midwifery and Health, Faculty of Health and Life 
Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom; Adjunct 
Professor, Western Sydney University, Australia. Electronic address: 
geoffrey.dickens@northumbria.ac.uk.
(5)Department of Nursing, Midwifery and Health, Faculty of Health and Life 
Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom. 
Electronic address: katlego.mthimunye@northumbria.ac.uk.
(6)Politecnica delle Marche University, Ascoli Piceno, Italy. Electronic 
address: s.marcelli@staff.univpm.it.
(7)Department of Biomedical Science and Human Oncology, Università degli Studi 
di Bari "Aldo Moro", Bari, Italy. Electronic address: 
valentina.simonetti@uniba.it.

BACKGROUND: The pandemic and its related social restrictions have led to many 
uncertainties in nurse education, including the fear of infection in clinical 
learning settings and the challenge of remote learning. The modification of 
clinical and academic environments generated anxiety and academic concerns among 
nursing students.
OBJECTIVES: To explore the main determinants of anxiety related to the clinical 
and classroom environments in nurse education after the second wave of the 
COVID-19 Pandemic.
DESIGN: Multicentre cross-sectional study.
SETTINGS: Ten universities offering nursing bachelor programs in central and 
southern Italy.
PARTICIPANTS: A convenience sample of 842 nursing students.
METHODS: From April to July 2021, the Self-Rating Anxiety Scale and the Altered 
Student Study Environment Tool were administered to assess, respectively, 
students' anxiety and their concerns about the study environment. A regression 
model was tested.
RESULTS: Most of the nursing students were female (76.6 %), living with family 
(70.9 %), and full-time students (85.7 %); 44.6 % were third-year of Bachelor in 
Nursing students. The majority of the participants (88.5 %) showed a level of 
anxiety. The statistically significant predictors of anxiety levels were 
concerns about grade attainment (β=0.42, p < 0.001) in the total sample, and, 
among the first-year students, the completion of clinical placement (β=0.14, 
p = 0.047).
CONCLUSIONS: Results suggest a need for the redesign of teaching activities and 
clinical learning experiences to ensure academic outcomes and to preserve 
students' psychological well-being. Models of learning environments' dynamic 
adaptation and ongoing psychological support should be implemented to develop 
tailored interventions.

Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.nedt.2022.105520
PMCID: PMC9439862
PMID: 36084449 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
have no conflict of interests to declare.


1557. Stress Health. 2023 Apr;39(2):460-473. doi: 10.1002/smi.3196. Epub 2022 Sep 16.

Coping profiles and differences in well-being during the COVID-19 pandemic: A 
latent profile analysis.

Kenntemich L(1)(2), von Hülsen L(1), Schäfer I(1), Böttche M(3)(4), Lotzin 
A(1)(2).

Author information:
(1)Department of Psychiatry and Psychotherapy, University Medical Center Hamburg 
Eppendorf, Hamburg, Germany.
(2)Department of Psychology, MSH Medical School Hamburg, Hamburg, Germany.
(3)Forschungsabteilung, Zentrum ÜBERLEBEN, Berlin, Germany.
(4)Division of Clinical Psychological Intervention, Freie Universität Berlin, 
Berlin, Germany.

During the current COVID-19 pandemic, people need to cope with multiple 
stressors which may affect their well-being. This study aimed (1) to identify 
latent coping profiles in the German general population, and (2) to investigate 
differences between these profiles in well-being. In total, N = 2326 German 
participants were recruited as part of the European Society of Traumatic Stress 
Studies (ESTSS) ADJUST study from June to September 2020 using an online survey. 
Coping strategies were assessed using the Brief-COPE and the Pandemic Coping 
Scale; well-being was assessed using the WHO-5 Well-Being Index. Coping profiles 
were identified using latent profile analysis; differences between profiles were 
examined using the automatic BCH method and multiple group analyses. Five coping 
profiles were identified that included different types and numbers of coping 
strategies: (1) High functional coping (17.84%), (2) Moderate functional coping 
(40.63%), (3) High functional and religious coping (9.07%), (4) Low functional 
coping (22.06%), (5) Moderate functional and dysfunctional coping (10.40%). The 
identified profiles significantly differed in well-being (χ2  = 503.68, 
p <0.001). Coping profiles indicating high functional coping were associated 
with greater well-being compared to coping profiles indicating low (χ2  = 82.21, 
p <0.001) or primarily dysfunctional (χ2  = 354.33, p <0.001) coping. These 
results provide insight into how people differ in their coping strategies when 
dealing with stressors in an early phase of the COVID-19 pandemic. The study 
indicates higher levels of well-being in coping profiles with more frequent use 
of functional strategies. To promote well-being in the general population, it 
might be beneficial to train functional coping strategies in appropriate 
interventions that are associated with increased well-being.

© 2022 The Authors. Stress and Health published by John Wiley & Sons Ltd.

DOI: 10.1002/smi.3196
PMCID: PMC9539043
PMID: 36083785 [Indexed for MEDLINE]

Conflict of interest statement: No potential conflict of interest was reported 
by the authors.


1558. J Am Geriatr Soc. 2023 Jan;71(1):198-205. doi: 10.1111/jgs.18024. Epub 2022 Sep 
9.

Cracks in the foundation: The experience of care aides in long-term care homes 
during the COVID-19 pandemic.

Titley HK(1), Young S(1), Savage A(1), Thorne T(1), Spiers J(1), Estabrooks 
CA(1).

Author information:
(1)Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.

BACKGROUND: Care aides (certified nursing assistants, personal support workers) 
are the largest workforce in long-term care (LTC) homes (nursing homes). They 
provide as much as 90% of direct care to residents. Their health and well-being 
directly affect both quality of care and quality of life for residents. The aim 
of this study was to understand the impact of COVID-19 on care aides working in 
LTC homes during the first year of the pandemic.
METHODS: We conducted semi-structured interviews with a convenience sample of 52 
care aides from 8 LTC homes in Alberta and one in British Columbia, Canada, 
between January and April 2021. Nursing homes were purposively selected across: 
(1) ownership model and (2) COVID impact (the rate of COVID infections reported 
from March to December 2020). Interviews were recorded and analyzed using 
inductive content analysis.
RESULTS: Care aides were mainly female (94%) and older (74% aged 40 years or 
older). Most spoke English as an additional language (76%), 54% worked full-time 
in LTC homes, and 37% worked multiple positions before "one worksite policies" 
were implemented. Two themes emerged from our analysis: (1) Care aides 
experienced mental and emotional distress from enforcing resident isolation, 
grief related to resident deaths, fear of contracting and spreading COVID-19, 
increased workload combined with staffing shortages, and rapidly changing 
policies. (2) Care aides' resilience was supported by their strong 
relationships, faith and community, and capacity to maintain positive attitudes.
CONCLUSIONS: These findings suggest significant, ongoing adverse effects for 
care aides in LTC homes from working through the COVID-19 pandemic. Our data 
demonstrate the considerable strength of this occupational group. Our results 
emphasize the urgent need to appropriately and meaningfully support care aides' 
mental health and well-being and adequately resource this workforce. We 
recommend improved policy guidelines and interventions.

© 2022 The American Geriatrics Society.

DOI: 10.1111/jgs.18024
PMCID: PMC9538008
PMID: 36082802 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that there is no conflict of 
interest.


1559. Rev Med Liege. 2022 Sep;77(9):494-499.

[The impact of the COVID-19 health crisis on the well-being of women giving 
birth].

[Article in French; Abstract available in French from the publisher]

Prudhomme L(1), Claudot A(1), Hannick S(2).

Author information:
(1)Service de Gynécologie, Hôpital Vivalia, Arlon, Belgique.
(2)Service de Liaison interne de Psychiatrie, Hôpital Vivalia, Arlon, Belgique.

The objective of this work is to investigate the impact of COVID-19 health 
crisis on the psychological status in the first few days after giving birth. 
Three hundred and sixty women who gave birth in 2020 at Vivalia Hospital in 
Arlon (Belgium) responded to an objective data questionnaire as well as to the 
Edinburgh Postnatal Depression Scale (EPDS) self-questionnaire translated into 
French, a tool recognized in the aids in screening for postpartum depression. 
According to their due date, the patients were divided into three conditions, a 
control group and two experimental groups. The aim of this exploratory study was 
to assess the impact of social restrictions associated with COVID-19 on the 
well-being of women giving birth. The results show that the EPDS score in the 
immediate postpartum period for women who gave birth during the two waves of 
COVID-19 in 2020, associated with a strict limitation of visits, is lower 
(corresponding to less depression) than that of women who gave birth outside the 
COVID-19 period or during the partial deconfinement phase.

Publisher: Le but de ce travail est d’étudier l’impact de la crise sanitaire 
COVID-19 sur l’état psychologique des femmes venant d’accoucher. Trois cent 
soixante femmes ayant accouché en 2020 à l’hôpital Vivalia d’Arlon (Belgique) 
ont répondu à un questionnaire comprenant l’auto-questionnaire Edinburgh 
Postnatal Depression Scale (EPDS), un outil reconnu dans l’aide au dépistage de 
la dépression du post-partum. Selon leur date d’accouchement, les patientes 
étaient réparties dans trois conditions, un groupe contrôle et deux groupes 
expérimentaux. Le but de cette étude était d’évaluer l’impact de crise sanitaire 
de la COVID-19 sur le bien-être des accouchées. Les résultats de l’EPDS 
dépistent moins de risque de dépression du post-partum chez les femmes ayant 
accouché durant les deux vagues de COVID-19 en 2020, imposant une limitation 
stricte des visites, que chez les femmes ayant accouché hors période COVID-19 ou 
lors de la phase de déconfinement partiel.

PMID: 36082594 [Indexed for MEDLINE]


1560. Front Public Health. 2022 Aug 23;10:965306. doi: 10.3389/fpubh.2022.965306. 
eCollection 2022.

Exclusive breastfeeding and women's psychological well-being during the first 
wave of COVID-19 pandemic in Italy.

Ravaldi C(1), Mosconi L(1), Wilson AN(2), Amir LH(3)(4), Bonaiuti R(1), Ricca 
V(5), Vannacci A(1).

Author information:
(1)Perinatal Research Laboratory, PeaRL, CiaoLapo Foundation for Perinatal 
Health, Department of Neurosciences, Psychology, Drug Research and Child Health, 
University of Florence, Florence, Italy.
(2)Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, 
VIC, Australia.
(3)Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, 
Bundoora, VIC, Australia.
(4)Breastfeeding Service, Royal Women's Hospital, Parkville, VIC, Australia.
(5)Psychiatry Unit, Department of Health Sciences, University of Florence, 
Florence, Italy.

BACKGROUND: At the onset of the COVID-19 pandemic, support for breastfeeding was 
disrupted in many countries. Italy was severely impacted by the pandemic and is 
known to have the lowest exclusive breastfeeding rate of all European countries. 
Considering the inverse association between anxiety and breastfeeding, maternal 
concerns about the COVID-19 emergency could reduce breastfeeding rates. The aim 
of the study is to explore the association between infant feeding practices and 
maternal COVID-19 concerns.
METHODS: This paper is a secondary analysis of the cross-sectional study 
COVID-ASSESS conducted in Italy in 2020. The original survey was administered in 
two phases: during the first lockdown and during the reopening. The survey 
included five sections: socio-demographic, medical history, concerns about the 
COVID-19 pandemic, infant feeding practices and psychometric evaluation. 
Participants were considered eligible for the post-hoc analyses if they were 
exclusively breastfeeding or they were feeding with infant formula (either alone 
or with breastfeeding) at the time of the interview.
RESULTS: Between phase 1 and phase 2 there was a decrease in anxiety and 
concerns about the danger of COVID-19 to general health, except for concerns 
about their baby's health. Women using formula were more concerned about all the 
health topics investigated. Moreover, they showed higher levels of stress, state 
anxiety, somatization and PTSD symptoms.
CONCLUSION: Breastfeeding during the first pandemic lockdown in Italy seems to 
have been an independent factor associated with lower anxiety about COVID-19, 
fewer psychopathological symptoms, and a positive experience of infant feeding.

Copyright © 2022 Ravaldi, Mosconi, Wilson, Amir, Bonaiuti, Ricca and Vannacci.

DOI: 10.3389/fpubh.2022.965306
PMCID: PMC9445494
PMID: 36081482 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1561. Palliat Med. 2022 Dec;36(10):1483-1492. doi: 10.1177/02692163221122269. Epub 
2022 Sep 8.

'There's something about admitting that you are lonely' - prevalence, impact and 
solutions to loneliness in terminal illness: An explanatory sequential 
multi-methods study.

Hanna JR(1), McConnell T(2), Harrison C(2), Patynowska KA(2), Finucane AM(3), 
Hudson B(4), Paradine S(4), McCullagh A(4), Reid J(1).

Author information:
(1)Queen's University Belfast, Belfast, UK.
(2)Marie Curie Hospice Belfast, Belfast, UK.
(3)Marie Curie Hospice Edinburgh, Edinburgh, UK.
(4)Marie Curie, London, UK.

Comment in
    Evid Based Nurs. 2023 Apr;26(2):84.

BACKGROUND: Loneliness is a prevalent societal issue and can impact on a 
person's physical and mental health. It is unclear how loneliness impacts on end 
of life experiences or how such feelings can be alleviated.
AIM: To explore the perceived prevalence, impact and possible solutions to 
loneliness among people who are terminally ill and their carers in Northern 
Ireland through the lens of health and social care professionals.
DESIGN: An explanatory multi-method study.
SETTING/PARTICIPANTS: An online survey (n = 68, response rate 30%) followed by 
three online focus groups with palliative and end of life care health and social 
care professionals (n = 14). Data were analysed using descriptive statistics and 
thematic analysis.
RESULTS: Loneliness was perceived by professionals as highly prevalent for 
people with a terminal illness (92.6%) and their carers (86.8%). Loneliness was 
considered a taboo subject and impacts on symptoms including pain and 
breathlessness and overall wellbeing at end of life. Social support was viewed 
as central towards alleviating feelings of loneliness and promoting 
connectedness at end of life. Four themes were identified: (1) the stigma of 
loneliness, (2) COVID-19: The loneliness pandemic (3) impact of loneliness 
across physical and mental health domains and (4) the power of social networks.
CONCLUSION: There is a need for greater investment for social support 
initiatives to tackle experiences of loneliness at end of life. These services 
must be co-produced with people impacted by terminal illness to ensure they meet 
the needs of this population.

DOI: 10.1177/02692163221122269
PMCID: PMC9749015
PMID: 36081273 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1562. Int J Environ Res Public Health. 2022 Sep 5;19(17):11104. doi: 
10.3390/ijerph191711104.

Factors Affecting Perceived Work Environment, Wellbeing, and Coping Styles: A 
Comparison between Physicians and Nurses during the COVID-19 Pandemic.

Costa C(1), Teodoro M(2), De Vita A(2), Giambò F(2), Mento C(3), Muscatello 
MRA(4), Alibrandi A(5), Italia S(2), Fenga C(2).

Author information:
(1)Clinical and Experimental Medicine Department, University of Messina, 98125 
Messina, Italy.
(2)Department of Biomedical and Dental Sciences and Morphofunctional Imaging, 
Occupational Medicine Section, University of Messina, 98125 Messina, Italy.
(3)Psychiatric Unit, Department of Biomedical and Dental Sciences and 
Morphofunctional Imaging, Clinical Psychology, University of Messina, 98125 
Messina, Italy.
(4)Psychiatric Unit, Department of Biomedical and Dental Sciences and 
Morphofunctional Imaging, University of Messina, 98125 Messina, Italy.
(5)Department of Economics, University of Messina, 98125 Messina, Italy.

The COVID-19 pandemic is a current emergency worldwide. All the consequent 
changes in sanitary systems have negatively affected the work-life balance. In 
particular, healthcare workers suffered from anxiety, stress, and depression, 
mostly nurses compared to physicians. To handle this situation, the adoption of 
different coping strategies has played a strategic role in psychophysical 
wellbeing. Our main goal is to the assess the perception of work environment and 
wellbeing (EQ-5D questionnaire), as well as to analyze possible differences in 
coping styles between physicians and nurses (brief COPE questionnaire). The 
arising differences were compared between the two groups, and associations with 
variables were assessed through a bivariate correlation analysis. This 
cross-sectional study was conducted from November to December 2020 through an 
online survey. A total of 172 respondents (117 physicians and 55 nurses), of 
which 102 were women and 70 were men, accepted to join the study. Our results 
showed that physicians referred a higher perception of wellbeing, and nurses 
reported an increased perception of work activity and efficiency, along with an 
unchanged economic status. The most frequently adopted coping strategies were 
Active and Planning (self-sufficient coping). Physicians showed a greater 
tendency to use avoidant coping strategies. More-experienced nurses and 
physicians were less prone to adopt socially supported coping strategies, 
emphasizing the need for novel organizational measures at the social dimension 
that favored sharing and interaction between peers. Future research should aim 
to further investigate the relationship between the perception of work 
environment and coping strategies in order to identify risk factors to be 
prevented by promoting adequate measures at an organizational level.

DOI: 10.3390/ijerph191711104
PMCID: PMC9518450
PMID: 36078818 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1563. Int J Environ Res Public Health. 2022 Sep 5;19(17):11086. doi: 
10.3390/ijerph191711086.

The Role of Physical Activity in the Reduction of Generalised Anxiety Disorder 
in Young Adults in the Context of COVID-19 Pandemic.

Czenczek-Lewandowska E(1), Leszczak J(1), Wyszyńska J(1), Baran J(1), Weres 
A(1), Lewandowski B(2).

Author information:
(1)Institute of Health Sciences, Medical College, University of Rzeszów, ul. 
Kopisto 2a, 35-959 Rzeszow, Poland.
(2)Institute of Medical Sciences, Medical College, University of Rzeszów, ul. 
Kopisto 2a, 35-959 Rzeszow, Poland.

Physical activity is critically important not only for physical but also for 
mental health. Exercise may be a beneficial form of therapy for young adults 
with anxiety disorders. The global outbreak of the COVID-19 pandemic adversely 
affected the public, including young adults, in terms of their mental well-being 
and opportunities for physical activity. The study aimed to identify the 
influence of physical activity (PA) on generalised anxiety in young adults. It 
also assessed the changes which occurred in the level of PA and in generalised 
anxiety in young adults as a result of COVID-19 pandemic. A cross-sectional 
survey was carried out online with 506 young adults aged 18 to 34 years (=24.67 
years ± 4.23 years). Respondents provided two answers to each question, i.e., 
information relating to the last 7 days during the pandemic (first hard 
lockdown), and to a period of 7 days before the pandemic (retrospective). The 
levels of physical activity were measured using 7-item International Physical 
Activity Questionnaire-Short Form (IPAQ-SF), whereas the level of generalised 
anxiety was assessed using the Generalised Anxiety Disorder 7 (GAD-7) 
questionnaire. During the pandemic there was a significant correlation between 
the level of generalised anxiety and the level of physical activity reported by 
the respondents (p = 0.048). A higher level of physical activity corresponded to 
lower level of generalized anxiety in young adults. During the pandemic, young 
adults spent significantly less time performing physical activity (8752.5 vs. 
6174.6 metabolic equivalents (MET) min/week, p < 0.001), they spent more time 
engaging in sedentary behaviours (Me = 240 vs. Me = 300 min/day, p < 0.001), and 
they walked much less (from Me = 6930.0 (MET) min/week vs. 3861.0 (MET) min/week 
(44.29% decrease). Furthermore, after the outbreak of the pandemic the level of 
perceived generalised anxiety increased significantly (p < 0.001). Physical 
activity may play an important role in reducing anxiety disorder in young 
adults. During the COVID-19 pandemic young adults were significantly less 
involved in PA, which adversely affected their physical and mental condition. 
The importance of sufficient PA should be emphasised during this specific 
period, particularly among young adults.

DOI: 10.3390/ijerph191711086
PMCID: PMC9517910
PMID: 36078815 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1564. Int J Environ Res Public Health. 2022 Sep 3;19(17):11022. doi: 
10.3390/ijerph191711022.

The Role of Psychobiotics to Ensure Mental Health during the COVID-19 Pandemic-A 
Current State of Knowledge.

Zielińska D(1), Karbowiak M(1), Brzezicka A(2).

Author information:
(1)Department of Food Gastronomy and Food Hygiene, Institute of Human Nutrition 
Sciences, Warsaw University of Life Sciences (WULS-SGGW), Nowoursynowska 159C 
Str., (Building No. 32), 02-776 Warsaw, Poland.
(2)Neurocognitive Research Center, SWPS University of Social Sciences and 
Humanities, Chodakowska Str. 19/31, 03-815 Warsaw, Poland.

Psychobiotics are defined as probiotics, mainly of the genus Lactobacillus and 
Bifidobacterium, that confer mental health benefits to the host when consumed in 
a particular quantity through the interaction with commensal gut microbiota. The 
gut microbiota, which means a diverse and dynamic population of microorganisms 
harboring the gastrointestinal tract, communicates with the brain and vice versa 
through the brain-gut axis. The mechanisms of action of psychobiotics may be 
divided into four groups: synthesis of neurotransmitters and neurochemicals, 
regulation of the HPA axis, influence on the immune system, and synthesis of 
metabolites. Recent years showed that the COVID-19 pandemic affected not only 
physical, but also mental health. Social isolation, fear of infection, the lack 
of adequate vaccine, disinformation, increased number of deaths, financial loss, 
quarantine, and lockdown are all factors can cause psychiatric problems. The aim 
of this review was to discuss the potential role of psychobiotic in light of the 
current problems, based on in vitro and in vivo studies, meta-analyses, clinical 
trials evidence, and registered studies assessing probiotics' therapeutic 
administration in the prevention or treatment of symptoms or side effects of 
COVID-19.

DOI: 10.3390/ijerph191711022
PMCID: PMC9518511
PMID: 36078738 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1565. Int J Environ Res Public Health. 2022 Sep 2;19(17):10954. doi: 
10.3390/ijerph191710954.

Associations of Work-Family Conflict with Family-Specific, Work-Specific, and 
Well-Being-Related Variables in a Sample of Polish and Ukrainian Adults during 
the Second Wave of the COVID-19 Pandemic: A Cross-Sectional Study.

Kuśnierz C(1), Rogowska AM(2), Chilicka K(3), Pavlova I(4), Ochnik D(5).

Author information:
(1)Faculty of Physical Education and Physiotherapy, Opole University of 
Technology, 45-758 Opole, Poland.
(2)Institute of Psychology, University of Opole, 45-040 Opole, Poland.
(3)Department of Health Sciences, University of Opole, 45-040 Opole, Poland.
(4)Department of Theory and Methods of Physical Culture, Lviv State University 
of Physical Culture, 79007 Lviv, Ukraine.
(5)Faculty of Medicine, University of Technology, 40-555 Katowice, Poland.

The conflict between work and family demands increased during the COVID-19 
pandemic due to changes in lifestyle related to the lockdown. This study 
examines the associations between work-family conflict (WFC) and family-work 
conflict (FWC) with work-specific, family-specific, and well-being-related 
variables during the second wave of the COVID-19 pandemic. The results may be 
used in practice to improve the well-being of employees by adjusting home-based 
work and family areas of life to dynamic changes during the pandemic. The sample 
of 736 adults from Poland (53.26%) and Ukraine (46.74%), aged between 19 and 72 
(M = 39.40; SD = 10.80), participated in the study. The cross-sectional study 
was performed using an online survey, including sociodemographic variables, 
measures of WFC, time pressure, remote work assessment (RWAS), physical health 
(GSRH), life satisfaction (SWLS), perceived stress (PSS-10), anxiety (GAD-7), 
and depression (PHQ-9). This study showed numerous inter-group differences in 
all variables across the country, gender, relationship status, parenthood, 
caring for children under 12, and remote working status. A high WFC is more 
likely among Polish workers (than Ukrainian workers), people with a low level of 
self-perceived time pressure, and high symptoms of stress. Caring for children 
under 12, low self-perceived time pressure, and high stress can predict FWC. 
Various paths lead from perceived stress via WFC and FWC, physical health, 
anxiety, and depression to life satisfaction, as suggested by the structural 
equation modeling analysis. Parents of children under 12 and women are the most 
vulnerable groups for increased WFC, FWC, and worse mental health and 
well-being. Prevention programs should focus on reducing stress, anxiety, and 
work demands in these adult populations. A unique contribution to the existing 
knowledge revealed patterns of associations between WFC and FWC in relation to 
well-being dimensions in a cross-cultural context during the pandemic.

DOI: 10.3390/ijerph191710954
PMCID: PMC9517904
PMID: 36078672 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1566. Int J Environ Res Public Health. 2022 Sep 2;19(17):10955. doi: 
10.3390/ijerph191710955.

Working Conditions and Wellbeing among Prison Nurses during the COVID-19 
Pandemic in Comparison to Community Nurses.

Guardiano M(1), Boy P(1), Shapirshteyn G(2), Dobrozdravic L(2), Chen L(3), Yang 
H(4), Robbins W(1)(5), Li J(1)(5).

Author information:
(1)School of Nursing, University of California Los Angeles, Los Angeles, CA 
90095, USA.
(2)Quality Management Support Unit, Avenal State Prison, Avenal, CA 93204, USA.
(3)Department of Epidemiology, Fielding School of Public Health, University of 
California Los Angeles, Los Angeles, CA 90095, USA.
(4)Center for Occupational and Environmental Health, University of California 
Irvine, Irvine, CA 92617, USA.
(5)Department of Environmental Health Sciences, Fielding School of Public 
Health, University of California Los Angeles, Los Angeles, CA 90095, USA.

The psychological health and work challenges of nurses working in prisons during 
the COVID-19 pandemic are understudied. We evaluated the work and wellbeing 
characteristics of a California prison nurse group, with a comparison to those 
of a community nurse group. From May to November 2020, an online survey measured 
psychosocial and organizational work factors, sleep habits, psychological 
characteristics, COVID-19 impacts, and pre-pandemic recall among 62 prison 
nurses and 47 community nurses. Prison nurses had significantly longer work 
hours (54.73 ± 14.52, p < 0.0001), higher pandemic-related work demands, and 
less sleep hours (5.36 ± 1.30, p < 0.0001) than community nurses. Community 
nurses had significantly higher pandemic-related fear levels (work infection: p 
= 0.0115, general: p = 0.0025) and lower perceived personal protective equipment 
(PPE) supply (p = 0.0103). Between pre-pandemic and pandemic periods, both 
groups had significantly increased night shift assignments and decreased sleep 
hours, but the prison group had increased work hours. Although not statistically 
significant, both groups had high occupational stress and prevalence of 
post-traumatic stress symptoms. Our results indicate that prison nurses 
experienced work and wellbeing challenges during the pandemic. Future research 
and practice ought to address nurses' workload, PPE, and psychological resources 
in correctional facilities and healthcare organizations.

DOI: 10.3390/ijerph191710955
PMCID: PMC9518550
PMID: 36078669 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1567. Int J Environ Res Public Health. 2022 Sep 1;19(17):10913. doi: 
10.3390/ijerph191710913.

Predictive Factors of Anxiety, Depression, and Health-Related Quality of Life in 
Community-Dwelling and Institutionalized Elderly during the COVID-19 Pandemic.

Pascut S(1)(2)(3), Feruglio S(1)(2), Crescentini C(1)(4), Matiz A(1)(2).

Author information:
(1)Department of Languages and Literatures, Communication, Education and 
Society, University of Udine, 33100 Udine, Italy.
(2)Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy.
(3)WHO Healthy Cities Project, Municipality of Udine, 33100 Udine, Italy.
(4)Institute of Mechanical Intelligence, Scuola Superiore Sant'Anna, 56127 Pisa, 
Italy.

The COVID-19 health emergency and restrictive measures have increased 
psychological problems, particularly anxiety and depression, in the general 
population. However, little is known about mental health conditions and the 
possible risk and protective factors of specific population groups, such as 
institutionalized vs. community-dwelling elderly. We investigated the 
abovementioned aspects in a sample of 65-89-year-old people during the third 
wave of COVID-19 in Italy. We employed a sociodemographic survey and four 
questionnaires on health-related quality of life (SF-36), loneliness (UCLA), 
spirituality (FACIT-Sp), and anxiety/depression (HADS). Our findings suggest 
that the physical, psychological, and spiritual well-being of the elderly had 
not been seriously impaired by the events related to the pandemic, although most 
of the participants reported a worsening of their social life and a 
moderate/high fear of COVID-19. In regression analyses, these two latter aspects 
turned out to be predictors of higher anxiety, while spiritual well-being and 
the possibility to get out of the house/institution emerged as protective 
factors against anxiety and for preserving quality of life, respectively. Our 
findings help refine the picture of the condition of the elderly in the 
aftermath of the pandemic, giving some hints about how to continue supporting 
their well-being and quality of life.

DOI: 10.3390/ijerph191710913
PMCID: PMC9518057
PMID: 36078630 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1568. Int J Environ Res Public Health. 2022 Aug 26;19(17):10658. doi: 
10.3390/ijerph191710658.

A Social Return on Investment Evaluation of the Pilot Social Prescribing 
EmotionMind Dynamic Coaching Programme to Improve Mental Wellbeing and 
Self-Confidence.

Makanjuola A(1), Lynch M(2), Hartfiel N(1), Cuthbert A(3), Wheeler HT(4), 
Edwards RT(1).

Author information:
(1)Centre for Health Economics and Medicines Evaluation, Bangor University 
College of Health and Behavioural Sciences, Bangor LL57 2PZ, UK.
(2)Lanarkshire Campus, Hamilton International Technology Park, University of 
West Scotland, South Lanarkshire, Paisley G72 0LH, UK.
(3)School of Medicine Cardiff, Cardiff University College of Biomedical and Life 
Sciences, Cardiff CF14 4EP, UK.
(4)EmotionMind Dynamic, Hayley T Wheeler Ltd., Llanelli SA15 1BQ, UK.

The COVID-19 pandemic contributed to longer waiting lists for people seeking to 
access mental health services. The NHS Five Year Forward View encourages the 
development of empowerment-based social prescribing interventions to supplement 
existing mental health programmes. Based in South Wales, EmotionMind Dynamic 
(EMD) is a lifestyle coaching programme that supports individuals suffering from 
anxiety or depression. In this evaluation of lifestyle coaching, a mixed-method 
social return on investment (SROI) methodology was used to value quantitative 
and qualitative data from face-to-face and online participants. Data collection 
took place between June 2021 and January 2022. Participants included both 
self-referred clients and those referred from health services. Mental wellbeing 
data were collected at baseline and at the end of the programme using the short 
Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS) and the General Self-Efficacy 
Scale (GSES). Baseline and follow-up data were available for 15 face-to-face 
participants and 17 online clients. Wellbeing valuation quantified and valued 
outcomes from participants. Results indicated that for every GBP 1 invested, 
lifestyle coaching generated social values ranging from GBP 4.12-GBP 7.08 for 
face-to-face clients compared with GBP 2.37-GBP 3.35 for online participants. 
Overall, lifestyle coaching generated positive social value ratios for both 
face-to-face and online clients.

DOI: 10.3390/ijerph191710658
PMCID: PMC9518074
PMID: 36078373 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1569. Int J Environ Res Public Health. 2022 Aug 24;19(17):10515. doi: 
10.3390/ijerph191710515.

Safety Culture and the Positive Association of Being a Primary Care Training 
Practice during COVID-19: The Results of the Multi-Country European PRICOV-19 
Study.

Silva B(1), Ožvačić Adžić Z(2)(3), Vanden Bussche P(1), Van Poel E(1), Seifert 
B(4), Heaster C(5), Collins C(6), Tuz Yilmaz C(7), Knights F(8), de la Cruz 
Gomez Pellin M(9), Astier Peña MP(10)(11), Stylianou N(12)(13), Gomez Bravo 
R(14)(15), Cerovečki V(2)(3), Klemenc Ketis Z(16)(17)(18), Willems S(1).

Author information:
(1)Department of Public Health and Primary Care, Ghent University, 9000 Ghent, 
Belgium.
(2)Department of Family Medicine, School of Medicine, University of Zagreb, 
10000 Zagreb, Croatia.
(3)Health Centre Zagreb-Centar, 10000 Zagreb, Croatia.
(4)Institute of General Practice, First Medical Faculty, Charles University, 
CZ-121 08 Prague, Czech Republic.
(5)Department of Family Medicine, Faculty of Medicine, Riga Stradiņš University, 
LV-1007 Riga, Latvia.
(6)Research Centre, Irish College of General Practitioners, D02 XR68 Dublin, 
Ireland.
(7)Family Medicine Department, Bursa Uludag University, 16130 Bursa, Turkey.
(8)Population Health Research Institute, St George's University of London, 
London SW17 0RE, UK.
(9)Department of Social and Preventive Medicine, Medical University of Vienna, 
1090 Vienna, Austria.
(10)Primary Health Centre Universitas, Aragon Health Services, 50009 Zaragoza, 
Spain.
(11)Medical School, Universidad de Zaragoza, GIBA-ISS-Aragón, 50009 Zaragoza, 
Spain.
(12)RTD Talos, 2404 Nicosia, Cyprus.
(13)International Institute for Compassionate Care, 2415 Nicosia, Cyprus.
(14)CHNP, Rehaklinik, L-9002 Ettelbruck, Luxembourg.
(15)Research Group Self-Regulation and Health, Institute for Health and 
Behaviour, Department of Behavioural and Cognitive Sciences, Faculty of 
Humanities, Education and Social Sciences, University of Luxembourg, L-4366 
Esch-sur-Alzette, Luxembourg.
(16)Ljubljana Community Health Centre, 1000 Ljubljana, Slovenia.
(17)Department of Family Medicine, Medical Faculty, University of Maribor, 2000 
Maribor, Slovenia.
(18)Department of Family Medicine, Medical Faculty, University of Ljubljana, 
1000 Ljubljana, Slovenia.

The day-to-day work of primary care (PC) was substantially changed by the 
COVID-19 pandemic. Teaching practices needed to adapt both clinical work and 
teaching in a way that enabled the teaching process to continue, while 
maintaining safe and high-quality care. Our study aims to investigate the effect 
of being a training practice on a number of different outcomes related to the 
safety culture of PC practices. PRICOV-19 is a multi-country cross-sectional 
study that researches how PC practices were organized in 38 countries during the 
pandemic. Data was collected from November 2020 to December 2021. We categorized 
practices into training and non-training and selected outcomes relating to 
safety culture: safe practice management, community outreach, professional 
well-being and adherence to protocols. Mixed-effects regression models were 
built to analyze the effect of being a training practice for each of the 
outcomes, while controlling for relevant confounders. Of the participating 
practices, 2886 (56%) were non-training practices and 2272 (44%) were training 
practices. Being a training practice was significantly associated with a lower 
risk for adverse mental health events (OR: 0.83; CI: 0.70-0.99), a higher number 
of safety measures related to patient flow (Beta: 0.17; CI: 0.07-0.28), a higher 
number of safety incidents reported (RR: 1.12; CI: 1.06-1.19) and more protected 
time for meetings (Beta: 0.08; CI: 0.01-0.15). No significant associations were 
found for outreach initiatives, availability of triage information, use of a 
phone protocol or infection prevention measures and equipment availability. 
Training practices were found to have a stronger safety culture than 
non-training practices. These results have important policy implications, since 
involving more PC practices in education may be an effective way to improve 
quality and safety in general practice.

DOI: 10.3390/ijerph191710515
PMCID: PMC9518383
PMID: 36078230 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study, in the collection, analyses, or 
interpretation of data, in the writing of the manuscript, or in the decision to 
publish the results. The company had no role in the design of the study; in the 
collection, analyses, or interpretation of data; in the writing of the 
manuscript, or in the decision to publish the results.


1570. Int J Environ Res Public Health. 2022 Aug 23;19(17):10483. doi: 
10.3390/ijerph191710483.

A Qualitative Investigation of the Impact of COVID-19 on United States' 
Frontline Health Care Workers and the Perceived Impact on Their Family Members.

Schaffer GE(1), Kilanowski L(2), Lee BEC(2).

Author information:
(1)Department of Counseling and School Psychology, College of Education, Niagara 
University, Lewiston, NY 14109, USA.
(2)School of Psychology, Deakin University, Melbourne, VIC 3125, Australia.

Although previous research has documented the mental and physical health impacts 
that COVID-19 had on frontline health workers in the United States, little is 
known about how the pandemic affected their families. This study sought to 
explore the impact COVID-19 had on the individual functioning of frontline 
health care workers in the USA and the perceived impact it had on their family 
members during the initial nine months of the pandemic. More specifically, this 
study sought to explore if and how family roles, routines, rules, and 
social-emotional well-being changed as a result of COVID-19. Twenty-eight 
frontline health care workers across the United States who were parents to at 
least one child residing in the home under 24 were interviewed. Data were 
analyzed using reflexive thematic analysis. From the analysis, four major themes 
emerged with regard to the changes and perceived impact to family functioning, 
family experiences of new hygiene practices, and stigma related to being a 
health care practitioner or having a family member working in health care, and 
psychological distress. The results of this study can be used by mental health 
clinicians to inform policy, develop practice guidelines, and help identify and 
target interventions for health care workers and their family members.

DOI: 10.3390/ijerph191710483
PMCID: PMC9517839
PMID: 36078199 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


1571. Int J Environ Res Public Health. 2022 Aug 23;19(17):10464. doi: 
10.3390/ijerph191710464.

A Cross-Sectional Study to Examine the Psychological Impact of the COVID-19 
Pandemic on Healthcare Workers in Kuwait.

AlKandari S(1), Salman A(2), Al-Ghadban F(3)(4), Ahmad R(1).

Author information:
(1)Immunology and Microbiology Department, Dasman Diabetes Institute, Dasman 
15462, Kuwait.
(2)Ministry of Health, Safat 13001, Kuwait.
(3)College of Public Health and Human Sciences, Oregon State University, 
Corvallis, OR 97331, USA.
(4)Department of Public Health Practice, Faculty of Public Health, Kuwait 
University, Safat 13110, Kuwait.

In this study, we aimed to evaluate the psychological impact of the COVID-19 
pandemic on healthcare workers to determine the prevalence of symptoms of 
depression, anxiety, and well-being, and to identify the factors associated with 
adverse psychological effects. This study was conducted 5 months into the 
COVID-19 pandemic. We used an online questionnaire to collect data from 378 
healthcare workers. To examine the psychological impact, three standardized 
questionnaires were utilized. This includes the Patient Health Questionnaire 
(PHQ-9), the Generalized Anxiety Disorder Scale (GAD-7), and the WHO Well-Being 
Scale (WHO-5) to measure depression, anxiety, and quality of life, respectively. 
More than half of the participants (52.9%) exhibited moderate or high levels of 
depression, and 40.5% reported moderate or high levels of anxiety. Unmarried 
HCWs reported more severe levels of depression; moderately severe depression 
(24.0% vs. 16.1%) and severe depression (12.4% vs. 6.8%). Unmarried HCWs also 
reported more severity of anxiety as well as lower overall wellbeing. 
Understanding how personal factors such as marital status can influence the 
degree of psychological distress can allow us to make better investments in 
supporting the mental health needs of HCWs in Kuwait. Governments and 
organizations must establish protective measures, such as continually assessing 
the mental health status of HCWs throughout the pandemic and providing support 
services for HCWs in need to minimize adverse consequences and ensure optimal 
health system operation.

DOI: 10.3390/ijerph191710464
PMCID: PMC9518443
PMID: 36078180 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1572. J Psychiatr Pract. 2022 Sep 1;28(5):354-361. doi: 10.1097/PRA.0000000000000661.

Posttraumatic Stress Disorder Among Health Care Workers During the COVID-19 
Pandemic.

Bayazit H, Ozel M, Arac S, Dulgeroglu-Bayazit D, Joshi A.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has taken a significant toll on 
people worldwide, and in particular, on the health care workers (HCWs) who have 
worked on the frontlines in the fight against the pandemic. The goal of this 
study was to investigate the prevalence of posttraumatic stress disorder (PTSD) 
and related factors in HCWs in the era of COVID-19.
METHODS: This cross-sectional survey study was conducted between September 15, 
and October 15, 2020, among HCWs in Turkey. The survey consisted of 
self-administered questionnaires, which included questions about 
sociodemographic variables, experiences caring for patients with COVID-19, and 
the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), a trauma 
screening tool. The online survey was completed by 1833 HCWs. Univariate and 
multivariate logistic regression analyses were used to identify independent 
predictors of PTSD.
RESULTS: The mean age of the participants was 32.7±7.0 years; 81.9% were 
physicians, and 56.5% were female. The rates of COVID-19 history in the 
respondents, a family member, or a coworker were 13.6%, 32.3%, and 12.6%, 
respectively. Among the HCWs who participated, 39.9% met the criteria for PTSD. 
Compared with the physicians, the nonphysician HCWs had a higher rate of PTSD 
(49.5% vs. 36%) (P<0.001) and higher PCL-5 scores (53.31±19.6 vs. 42.5±20.3) 
(P<0.001). In addition, 9.7% of the surveyed HCWs reported having suicidal 
ideation during the COVID-19 pandemic. Independent predictors of PTSD in HCWs 
were working on a COVID-19 unit, feeling isolated, suicidal ideation, being a 
nonphysician HCW, fear of spreading coronavirus to family, female sex, and a 
history of having COVID-19.
CONCLUSIONS: HCWs were at risk for impairment in mental well-being in the era of 
COVID-19, with a significant number experiencing PTSD as well as suicidal 
ideation. Therefore, HCWs, especially those who are working on a COVID-19 unit 
and are female, should be monitored regularly for PTSD.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/PRA.0000000000000661
PMCID: PMC9451609
PMID: 36074104 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


1573. Int J Qual Stud Health Well-being. 2022 Dec;17(1):2122135. doi: 
10.1080/17482631.2022.2122135.

Influences on the physical and mental health of people with serious mental 
ill-health during the COVID-19 pandemic: a qualitative interview study.

Newbronner E(1), Walker L(1), Wadman R(1), Crosland S(1), Johnston G(2), Heron 
P(1), Spanakis P(1), Gilbody S(1), Peckham E(1).

Author information:
(1)Mental Health and Addiction Research Group, Department of Health Sciences, 
University of York, York, UK.
(2)Independent Researcher, Clackmannan, UK.

PURPOSE: People with severe mental ill-health (SMI) experience profound health 
inequalities. The Optimizing Wellbeing in Self-isolation study (OWLS) explored 
the effects of the COVID-19 pandemic restrictions on people with SMI, including 
how and why their physical and mental health may have changed during the 
pandemic.
METHODS: The OLWS study comprised two surveys and two nested qualitative 
studies. Of 367 people recruited to the study, 235 expressed interest in taking 
part in a qualitative interview. In the first qualitative study eighteen 
interviews were conducted with a purposive sample of participants.
RESULTS: We identified six factors which influenced peoples' health, positively 
and negatively: Staying Physically Active; Maintaining a Balanced and Healthy 
Diet; Work or Not Working; Daily Routine and Good Sleep; Staying Connected to 
Family, Friends and the Local Community; and Habits, Addictions and Coping with 
Anxiety Created by the Pandemic.
CONCLUSIONS: Different aspects of lifestyle are highly interconnected. For 
people with SMI, loss of routine and good sleep, poor diet and lack of exercise 
can compound each other, leading to a decline in physical and mental health. If 
people are supported to understand what helps them stay well, they can establish 
their own frameworks to draw on during difficult times.

DOI: 10.1080/17482631.2022.2122135
PMCID: PMC9467576
PMID: 36073745 [Indexed for MEDLINE]

Conflict of interest statement: No potential conflict of interest was reported 
by the author(s).


1574. Psychooncology. 2023 Jan;32(1):58-67. doi: 10.1002/pon.6030. Epub 2022 Sep 14.

Financial toxicity and mental well-being of the oral cancer survivors residing 
in a developing country in the era of COVID 19 pandemic - A cross-sectional 
study.

Thaduri A(1), Garg PK(2), Malhotra M(1), Singh MP(3), Poonia DR(4), Priya M(1), 
Tyagi A(1), Kumar A(1), Bhardwaj A(1), Jat B(1), Panuganti A(1), Majumdar K(1), 
Usmani S(1), Vikramjit Singh(1).

Author information:
(1)Department of ENT and Head Neck Surgery, All India Institute of Medical 
Sciences, Rishikesh, India.
(2)Department of Surgical Oncology, Shri Guru Ram Rai Institute of Medical & 
Health Sciences, Dehradun, India.
(3)Jawaharlal Nehru Cancer Hospital & Research Centre, Bhopal, India.
(4)Department of Surgical Oncology, All India Institute of Medical Sciences, 
Jodhpur, India.

OBJECTIVES: The primary outcome measures evaluated the financial toxicity and 
mental well-being of the oral cancer survivors.
METHODS: A cross-sectional study of oral cancer survivors who were disease-free 
for more than 6 months after treatment and visited the hospital for a routine 
follow-up is included in the study. Mental well-being and financial toxicity 
were evaluated using the Depression, Anxiety, and Stress Scale - 21 (DASS 21) 
and Comprehensive Score for financial Toxicity (COST- Functional Assessment of 
Chronic Illness Therapy) questionnaires. A literature review was done to compare 
the results with financial toxicity and mental health in cancer patients from 
the pre-pandemic era.
RESULTS: A total of 79 oral cancer survivors were included in the study, 
predominantly males (M: F = 10:1). The age ranged from 26 to 75 years (The 
median age is 49). The full-time employment dropped from 83.5% in the 
pre-treatment period to 21.5% post-treatment. Depression was observed in 58.2% 
and anxiety in 72.2%. Unemployed survivors were observed to have more depression 
(OR = 1.3, 95% confidence interval (CI) = 0.3-5.4, p = 0.6), anxiety (OR = 3.5, 
95% CI = 0.3-21.2, p = 0.1) and stress (OR = 1.6, 95% CI = 0.3-6.6, p = 0.5) 
than rest of the cohort. On univariate analysis, unemployed survivors 
(M = 11.8 ± 3.8, p = 0.01) had significantly poorer financial toxicity scores. 
Survivors with depression (M = 16.4 ± 7.1, p = 0.06) and stress (M = 14.4 ± 6.8, 
p = 0.002) had poor financial toxicity scores. On multifactorial analysis of 
variance, current employment (p = 0.04) and treatment modality (p = 0.05) were 
significant factors impacting the financial toxicity.
CONCLUSION: There is a trend towards increased incidence of depression, anxiety, 
and stress among oral cancer survivors compared to the literature from the 
pre-COVID era. There is significant financial toxicity among either unemployed 
or part-time workers. This calls for urgent public/government intervention to 
prevent the long-term impact of financial toxicity on survival and quality of 
life.

© 2022 John Wiley & Sons Ltd.

DOI: 10.1002/pon.6030
PMCID: PMC9539264
PMID: 36073555 [Indexed for MEDLINE]

Conflict of interest statement: The author declares that there is no conflict of 
interest that could be perceived as prejudicing the impartiality of the research 
reported.


1575. Stud Health Technol Inform. 2022 Sep 2;297:323-330. doi: 10.3233/SHTI220856.

Healthcare Facilities and Dementia Development of a Framework to Assess Design 
Quality.

Mangili S(1), Capolongo S(1).

Author information:
(1)Politecnico di Milano, Department of Architecture, Built environment and 
Construction engineering.

In recent years, thanks to advances in medicine and the role of prevention, life 
expectancy has experienced rapid growth (from 77.6 to 81.3 years), resulting in 
an increase in Non-Communicable Diseases (NCDs) and years lived with disability. 
One of these is dementia, with about 7 million people currently affected in 
Europe while the number is set to double by 2050. These patients are complex due 
to the serious changes in their cognitive sphere, altering perceptions of their 
physical space. Because of age and multimorbidity, they are the most frequent 
users of healthcare facilities, but these structures often are not suitable to 
them. For example, during the COVID-19 pandemic, healthcare facilities 
demonstrated criticalities in structural and social issues. To this end, a 
rethinking of these spaces is urgent, and the use of Evidence-Based Design (EBD, 
the design based on findings from scientific research) can be a method to create 
safe and suitable environments. This study aims to develop an evaluation 
framework to assess the design quality of healthcare facilities for people with 
dementia. A systematic literature review was conducted to define a set of 
requirements that the space must have to be prosthetic for the patient. The 
framework consists of three macro areas (i.e., physical, social, and cognitive 
aspects), seven criteria, and 24 sub criteria. The proposed framework is a 
starting point for the development of inclusive projects for people with 
dementia and cognitive disabilities. Architecture has recently begun to approach 
the topic of dementia, especially in Italy. Therefore, it is urgent to 
investigate which are the main aspects to be considered in the design and 
renovations of facilities to make them as therapeutic and prosthetic as 
possible, creating places where the wellbeing of patients is the priority, both 
physical and psychological. To this end, EBD needs to become a habit for 
designers to create facilities suitable for people with both cognitive 
impairments and for every user, in line with the principles of Universal Design.

DOI: 10.3233/SHTI220856
PMID: 36073410 [Indexed for MEDLINE]


1576. S Afr J Commun Disord. 2022 Aug 8;69(2):e1-e11. doi: 10.4102/sajcd.v69i2.913.

When uncertainty becomes the norm: The Chris Hani Baragwanath Academic 
Hospital's Speech Therapy and Audiology Department's response to the COVID-19 
pandemic.

Balton S(1), Vallabhjee AL, Pillay SC.

Author information:
(1)Department of Speech Therapy and Audiology, Chris Hani Baragwanath Academic 
Hospital, Johannesburg. mwsadna@mweb.co.za.

BACKGROUND:  In March 2020 the World Health Organization declared the 
coronavirus disease 2019 (COVID-19) a pandemic. Management of this pandemic had 
significant implications for clinical departments across the world. Healthcare 
systems were urgently required to reorganise and redesign patient care as well 
as repurpose staff.
OBJECTIVES:  We will share the lived experience of our response as speech 
therapy and audiology (STA) clinicians to the COVID-19 pandemic.
METHOD:  This study adopted an autoethnographic approach within Bronfenbrenner's 
bioecological model to describe STA clinicians' response to the COVID-19 
pandemic.
RESULTS:  Adaptations to practice were made to continue service provision whilst 
adhering to COVID-19 regulations. We assisted in other areas to meet the 
immediate needs of the hospital. Service delivery strategies consisted of a 
review of clinical and quality assurance protocols. We developed a telehealth 
service package which included a hybrid approach, within a context of digital 
poverty. We created resources to ensure continuity of care. Collaboration within 
our systems facilitated innovative solutions. Mental health and well-being of 
staff members were key to the response developed.
CONCLUSION:  South African healthcare systems' inequalities were highlighted by 
the pandemic. The response showed that the needs of vulnerable populations were 
not accounted for when developing this public health response. Lessons learnt 
included the importance of adaptability, becoming comfortable with uncertainty 
and maintaining open and transparent communication. Consultation and 
collaboration within various levels of our healthcare system were critical in 
responding to the needs of patients. Commitment to compassionate leadership and 
staff well-being were crucial.

DOI: 10.4102/sajcd.v69i2.913
PMCID: PMC9452927
PMID: 36073072 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no financial 
or personal relationships that may have inappropriately influenced them in 
writing this article.


1577. S Afr J Commun Disord. 2022 Aug 4;69(2):e1-e9. doi: 10.4102/sajcd.v69i2.920.

The effects of COVID-19 on the rehabilitation of persons with aphasia: A scoping 
review.

Masuku KP(1), Khumalo G, Shabangu N.

Author information:
(1)Department of Speech Pathology, Faculty of Humanities, University of the 
Witwatersrand, Johannesburg. khetsiwe.masuku@wits.ac.za.

BACKGROUND:  The impact of the Coronavirus disease 2019 (COVID-19) pandemic was 
more pronounced on the well-being of persons with disabilities, especially in 
low- and middle-income countries. There is documented evidence of the rippling 
effects of COVID-19 on persons with disabilities. However, not much is known 
about the impact of COVID-19 on the rehabilitation of persons with aphasia.
OBJECTIVE:  The scoping review explores how COVID-19 affected the rehabilitation 
of persons living with aphasia.
METHOD:  A scoping review was conducted using Arksey and O'Malley's framework. A 
search was conducted on Science Direct, PubMed, Medline, Scopus, ProQuest and 
Google Scholar, to identify relevant studies published between 2019 and 2022. 
Data were analysed using thematic analysis.
RESULTS:  Most studies regarding the effects of COVID-19 on persons living with 
aphasia were conducted in the United Kingdom. Five themes emerged from the data, 
namely, (1) negative impact on rehabilitative care, (2) telehealth and its 
limitations, (3) impact on social participation, (4) compromised caregiver 
involvement and (5) mental health challenges.
CONCLUSIONS:  Findings highlight the need for healthcare professionals to pursue 
innovative ways in which aphasia rehabilitation and conversational support 
programmes can be made accessible to persons with aphasia, despite the 
limitations brought about by a pandemic. Telerehabilitation programmes need to 
be tailored to the needs of persons with aphasia if they are to be successful. 
This study highlights the importance and need for the prioritisation of mental 
health services for persons with aphasia and their caregivers during a pandemic.

DOI: 10.4102/sajcd.v69i2.920
PMCID: PMC9452926
PMID: 36073071 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no financial 
or personal relationships that may have inappropriately influenced them in 
writing this article.


1578. Syst Rev. 2022 Sep 7;11(1):196. doi: 10.1186/s13643-022-02065-5.

Loneliness in pregnant and postpartum people and parents of children aged 
5 years or younger: a scoping review.

Kent-Marvick J(1), Simonsen S(2), Pentecost R(2), Taylor E(2), McFarland MM(3).

Author information:
(1)University of Utah College of Nursing, University of Utah, 10 2000 E, Salt 
Lake City, UT, 84112, USA. jacqueline.kent-marvick@utah.edu.
(2)University of Utah College of Nursing, University of Utah, 10 2000 E, Salt 
Lake City, UT, 84112, USA.
(3)Eccles Health Sciences Library, Salt Lake City, UT, USA.

BACKGROUND: Despite evidence that loneliness increases during times of 
transition, and that the incidence of loneliness is highest in young adults, 
loneliness during pregnancy and new parenthood has not been developed as a 
program of research. Because loneliness research has primarily focused on older 
adults and other high-risk populations, the concept of loneliness and its 
effects on this population are not well understood, leaving a gap in our 
understanding of the psychosocial needs and health risks of loneliness on 
pregnant people and new parents. A scoping review has been completed in order to 
map and synthesize the literature on loneliness experienced during pregnancy and 
the first 5 years of parenthood prior to the COVID-19 pandemic.
METHODS: To address the aim of this review, a wide net was cast in order to 
detect experiences of perinatal or parental loneliness and/or instances where 
loneliness was measured in this population. Among the inclusion criteria were 
loneliness in people who were pregnant, who were parents in the postpartum 
period, or who had children aged 5 years or younger. A search for literature was 
conducted in December 2020 using nine databases: MEDLINE (Ovid), EMBASE 
(Elsevier), SCOPUS (Elsevier), Cochrane Library including CENTRAL (Wiley), 
CINAHL (Ebscohost), PsycINFO (Ebscohost), Dissertations & Theses Global 
(ProQuest) and Sociological Abstracts (ProQuest), and the Web of Science Core 
Collection (Clarivate).
RESULTS: Perinatal and parental loneliness studies are limited and have rarely 
been targeted and developed through a program of research. Loneliness inquiry in 
this population was frequently studied in relation to other concepts of interest 
(e.g., postpartum depression). Alternatively, the importance of loneliness 
emerged from study participants as relevant to the research topic during 
qualitative inquiry. Across studies, the prevalence of loneliness ranged from 32 
to 100%. Loneliness was commonly experienced alongside parenting difficulties, 
with parents feeling as though they were alone in their struggles.
CONCLUSIONS: As loneliness has been called a sensitive indicator of mental 
wellbeing, we believe screening will help healthcare professionals identify 
common difficulties and early signs of depression experienced during pregnancy 
and parenthood.
SYSTEMATIC REVIEW REGISTRATION: The protocol is available on Open Science 
Framework at DOI 10.17605/OSF.IO/BFVPZ.

© 2022. The Author(s).

DOI: 10.1186/s13643-022-02065-5
PMCID: PMC9451126
PMID: 36071448 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1579. Child Abuse Negl. 2022 Nov;133:105866. doi: 10.1016/j.chiabu.2022.105866. Epub 
2022 Sep 2.

The impacts of COVID-19 on LGBTQ+ foster youth alumni.

Washburn M(1), Yu M(2), LaBrenz C(3), Palmer AN(4).

Author information:
(1)University of Texas at Arlington, 211 S. Cooper St., Arlington, TX 76019, 
United States of America. Electronic address: micki.washburn@uta.edu.
(2)University of Texas at Arlington, 211 S. Cooper St., Arlington, TX 76019, 
United States of America. Electronic address: miao.yu@uta.edu.
(3)University of Texas at Arlington, 211 S. Cooper St., Arlington, TX 76019, 
United States of America. Electronic address: catherine.labrenz@uta.edu.
(4)University of Texas at Arlington, 211 S. Cooper St., Arlington, TX 76019, 
United States of America; Texas Christian University. Electronic address: 
ashley.palmer@tcu.edu.

BACKGROUND: LGBTQ+ youth frequently experience disparities in outcomes related 
to permanency and overall well-being while in out-of-home care. These negative 
outcomes often persist after youth have transitioned out of care, particularly 
in the domains of housing, education, employment, and mental health. Initial 
research has found that the ongoing COVID-19 pandemic has exacerbated negative 
physical and mental health outcomes, as well as decreased economic stability 
among transition age youth.
OBJECTIVE: This study seeks to determine if COVID-19 has resulted in unique 
impacts on foster care alumni, and if these impacts are the same for LGBTQ+ and 
non-LGBTQ+ transition age youth.
PARTICIPANTS AND SETTING: This study used data from the 2020 Jim Casey Youth 
Opportunities Initiative Opportunity Passport Survey to explore these questions.
METHODS: This survey was administered electronically to a national sample of 
1223 youth ages 18-26 with lived experience in foster care.
RESULTS: Results indicate that relative to non-LGBTQ+ foster care alumni, LGBTQ+ 
foster care alumni experienced more negative outcomes in housing stability, 
employment, and mental health/trauma due to COVID-19. No significant differences 
were found for education-related impacts. Outcomes varied by sex assigned at 
birth, ethnicity, and sexual orientation, gender identity and expression (SOGIE) 
of respondents, with female respondents, black, indigenous and other people of 
color (BIPOC) youth and LGBTQ+ youth being most frequently impacted.
CONCLUSIONS: Results indicate that relative to non-LGBTQ+ foster care alumni, 
LGBTQ+ foster care alumni experienced more negative outcomes in housing 
stability, employment, and mental health/trauma due to COVID-19. No significant 
differences were found for education-related impacts. Outcomes varied by sex 
assigned at birth, ethnicity, and sexual orientation, gender identity and 
expression (SOGIE) of respondents, with female respondents, BIPOC youth and 
LGBTQ+ youth being most frequently impacted. Implications for practice and 
policy are explored.

Copyright © 2022 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.chiabu.2022.105866
PMCID: PMC9436895
PMID: 36070665 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
report there are no competing interests to declare.


1580. Stress Health. 2023 Apr;39(2):414-428. doi: 10.1002/smi.3198. Epub 2022 Sep 13.

Experiences of COVID-19 pandemic-related stress among sexual and gender minority 
emerging adult migrants in the United States.

Alessi EJ(1), Cheung SP(1), Sarna V(2), Dentato MP(2), Eaton A(3), Craig SL(4).

Author information:
(1)Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA.
(2)Loyola University Chicago, Chicago, Illinois, USA.
(3)University of Regina, Regina, Saskatchewan, Canada.
(4)University of Toronto, Toronto, Ontario, Canada.

There is a dearth of research that examines COVID-19-related stress among 
multiply marginalised individuals who are in the developmental phase of emerging 
adulthood. This qualitative study investigated how the intersection of emerging 
adulthood, sexual and gender minority (SGM) identity, and migrant status were 
reflected in the experiences of SGM individuals (n = 37; ages 20-25 years old) 
who migrated to various parts of the United States in the last 5 years. Data 
were collected online using semi-structured interviews. Thematic analysis 
revealed that participants' developmental processes (e.g., identity exploration, 
building financial independence) were shaped by pandemic-related stressors, 
especially unemployment and financial instability. Participants who were able to 
maintain employment did so but at the risk of their health and safety. Findings 
also showed that participants experienced feelings of anxiety and depression due 
to social isolation, but online communication played an important role in 
combatting loneliness. Findings highlight the potential for trauma-informed and 
intersectional approaches to practice with SGM emerging adult migrants and 
expanded health services and temporary entitlement programs to mitigate the 
pandemic's effects on this population's psychosocial and financial well-being.

© 2022 The Authors. Stress and Health published by John Wiley & Sons Ltd.

DOI: 10.1002/smi.3198
PMCID: PMC9539256
PMID: 36070206 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that there is no conflict of 
interest.


1581. Health Soc Care Community. 2022 Nov;30(6):e6656-e6673. doi: 10.1111/hsc.13992. 
Epub 2022 Sep 6.

ENACT study: What has helped health and social care workers maintain their 
mental well-being during the COVID-19 pandemic?

Cogan N(1), Kennedy C(1), Beck Z(1), McInnes L(1), MacIntyre G(2), Morton L(1), 
Tanner G(1), Kolacz J(3).

Author information:
(1)School of Psychological Sciences & Health, University of Strathclyde, 
Glasgow, UK.
(2)School of Social Work & Social Policy, University of Strathclyde, Glasgow, 
UK.
(3)Traumatic Stress Research Consortium (TSRC), Kinsey Institute, Indiana 
University, Bloomington, Indiana, USA.

A growing body of research has highlighted the adverse impact of COVID-19 
stressors on health and social care workers' (HSCWs) mental health. 
Complementing this work, we report on the psychosocial factors that have had 
both a positive and negative impact on the mental well-being of HSCWs during the 
third lockdown period in Scotland. Using a cross-sectional design, participants 
(n = 1364) completed an online survey providing quantitative data and free 
open-text responses. A multi-method approach to analysis was used. The majority 
of HSCWs were found to have low well-being scores, high levels of COVID-19 
stress, worry, burnout and risk perception scores and almost half of HSCWs met 
the clinical cut-off for acute stress (indicative of PTSD). HSCWs with higher 
scores on adaptive coping strategies and team resilience reported higher scores 
on mental well-being. HSCWs were significantly more likely to seek informal 
support for dealing with personal or emotional problems compared to formal 
supports. Barriers to formal help-seeking were identified including stigma and 
fear of the consequences of disclosure. HSCWs mostly valued peer support, 
workplace supports, visible leadership and teamwork in maintaining their mental 
well-being. Our findings illuminate the complexity of the effects of the 
COVID-19 pandemic on HSCWs' well-being and will inform future intervention 
development seeking to increase positive adaptation and improve staff 
well-being. Addressing barriers to mental health help-seeking among HSCWs is 
essential. The implications emphasise the importance of lessons learned across 
health and social care contexts, planning and preparedness for future pandemics.

© 2022 The Authors. Health and Social Care in the Community published by John 
Wiley & Sons Ltd.

DOI: 10.1111/hsc.13992
PMCID: PMC9539329
PMID: 36068667 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no relevant financial or 
non‐financial interests to disclose.


1582. Elife. 2022 Sep 6;11:e69960. doi: 10.7554/eLife.69960.

Mental health in medical and biomedical doctoral students during the 2020 
COVID-19 pandemic and racial protests.

Schad A(#)(1), Layton RL(#)(1), Ragland D(1), Cook JG(1)(2).

Author information:
(1)Office of Medical Education, University of North Carolina at Chapel Hill 
School of Medicine, Chapel Hill, United States.
(2)Department of Biochemistry and Biophysics, University of North Carolina at 
Chapel Hill School of Medicine, Chapel Hill, United States.
(#)Contributed equally

Concerns about the mental health of students, trainees and staff at universities 
and medical schools have been growing for many years. Recently, these have been 
exacerbated by the COVID-19 pandemic and a period of heightened reckoning and 
protests about systemic racism in the United States in 2020. To better 
understand the mental health of medical students and biomedical doctoral 
students at the University of North Carolina at Chapel Hill during this 
challenging period, we performed a cross-sectional study (n=957) using 
institutional annual survey data on measures of depression, anxiety, hazardous 
alcohol use, problems related to substance use, and suicidal ideation. These 
data were collected in 2019 and 2020, and were analyzed by type of training 
program, race/ethnicity, gender, sexual orientation, and survey year. Results 
indicated significant differences for rates of depression, anxiety, and suicidal 
ideation, with biomedical doctoral students showing greater incidence than 
medical students, and historically excluded students (e.g., people of color, 
women, LGBQ+ trainees) showing greater incidence compared to their peers. Of 
note, mental health remained poor for biomedical doctoral students in 2020 and 
declined for those belonging to historically excluded populations. The high 
rates of depression, anxiety, and suicidal ideation reported suggest that 
training environments need to be improved and support for mental health 
increased.

© 2022, Schad, Layton et al.

DOI: 10.7554/eLife.69960
PMCID: PMC9448322
PMID: 36066348 [Indexed for MEDLINE]

Conflict of interest statement: AS, RL, DR, JC No competing interests declared


1583. Ann Clin Transl Neurol. 2022 Oct;9(10):1504-1513. doi: 10.1002/acn3.51616. Epub 
2022 Sep 6.

Impact of COVID-19 pandemic on patients with Parkinson's disease: A 
meta-analysis of 13,878 patients.

Mai AS(1), Yong JH(1), Tan BJ(2), Xiao B(2), Tan EK(2)(3).

Author information:
(1)Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
(2)Department of Neurology, Singapore General Hospital Campus, National 
Neuroscience Institute, Singapore.
(3)Neuroscience and Behavioural Disorders, Duke-NUS Medical School, Singapore.

BACKGROUND: The clinical, neuropsychological, and socioeconomic factors 
affecting Parkinson's disease (PD) during COVID-19 pandemic across different 
populations have not been systematically studied. To address this, we conducted 
a meta-analysis of factors that impact the well-being of PD patients during the 
pandemic.
METHODS: Medline and Embase were searched for articles published between 2020 
and 2022. We conducted random-effects pooling of estimates and meta-regression.
RESULTS: Twenty-seven studies involving 13,878 patients from America, Europe, 
Asia, and Africa were included. There is a high prevalence of decreased physical 
activity and exercise, and worsening motor and neuropsychiatric symptoms 
(17-56%). Patients in lower-income countries more frequently reported worsening 
anxiety (adjusted OR [aOR] 8.94, 95% confidence interval [CI] 1.62-49.28, 
p = 0.012), sleep (aOR 5.16, 95% CI 1.15-23.17, p = 0.032), and PD symptoms (aOR 
3.57, 95% CI 0.96-13.34, p = 0.058). Lockdown was associated with decreased 
exercise levels (aOR 0.13, 95% CI 0.02-0.78, p = 0.025) and worsening mood (aOR 
0.48, 95% CI 0.24-0.95, p = 0.035). Younger age correlated with decreased 
physical activity (β -0.30, 95% CI -0.53 to -0.07, p = 0.012), exercise (β 
-0.11, 95% CI -0.15 to -0.07, p &lt; 0.001), worsening PD symptoms (β -0.08, 95% 
CI -0.15 to -0.01, p = 0.018), and sleep (β -0.14, 95% CI -0.27 to 0, 
p = 0.044). Female PD patients reported a greater decrease in physical activity 
(β 11.94, 95% CI 2.17-21.71, p = 0.017) and worse sleep (β 10.76, 95% CI 
2.81-18.70, p = 0.008).
CONCLUSION: This large meta-analysis of PD patients in diverse populations 
identified a high prevalence of physical and mental worsening during the 
COVID-19 pandemic, with patients in lower-income countries being exceptionally 
vulnerable.

© 2022 The Authors. Annals of Clinical and Translational Neurology published by 
Wiley Periodicals LLC on behalf of American Neurological Association.

DOI: 10.1002/acn3.51616
PMCID: PMC9538738
PMID: 36065787 [Indexed for MEDLINE]

Conflict of interest statement: The authors do not have any competing financial 
interests or personal relationships that could have appeared to influence the 
work reported in this paper.


1584. Allergy Asthma Proc. 2022 Sep 1;43(5):368-374. doi: 10.2500/aap.2022.43.220059.

The long COVID syndrome: A conundrum for the allergist/immunologist.

Bellanti JA(1).

Author information:
(1)From the Departments of Pediatrics and.

Background: The long coronavirus disease 2019 (COVID-19) syndrome includes a 
group of patients who, after infection with severe acute respiratory syndrome 
coronavirus 2 (SARS-CoV-2) exhibit lingering mild-to-moderate symptoms and 
develop medical complications that can have lasting health problems. Objective: 
The purpose of this report was to examine the current body of evidence that 
deals with the relationship of COVID-19 infection with the long COVID syndrome 
to define the possible immunologic mechanisms involved in the pathogenesis of 
long COVID and to describe potential strategies for the diagnosis and clinical 
management of the condition. Methods: Extensive research was conducted in 
medical literature data bases by applying terms such as long COVID, 
post-COVID-19 condition, pathogenesis of long COVID, management of the long 
COVID syndrome. Results: The post-COVID conditions, a more recent and less 
anxiety-inducing term for the patient than long COVID or "long haul," is an 
umbrella term for a wide range of physical and mental health symptoms similar to 
those seen in patients with the myalgic encephalomyelitis/chronic fatigue 
syndrome (ME/CFS), experienced by some patients and are present ≥ 4 weeks after 
SARS-CoV-2 infection. Although the precise reason why long COVID develops is 
unknown, one of the major causes is thought to be related to chronic 
inflammation with overproduction of inflammatory cytokines responsible for the 
symptoms of the disorder. Conclusion: Long COVID is a growing burden for 
millions of patients, health-care providers, and global health-care systems, and 
is a particular challenge for the allergist/immunologist. Many survivors of 
COVID-19 struggle with multiple symptoms, increased disability, reduced 
function, and poor quality of life. The allergist/immunologist can assist the 
total health-care team's efforts in providing a comprehensive and coordinated 
approach to the management of these patients by promoting comprehensive 
vaccination and rehabilitation and social services that focus on improving 
physical, mental, and social well-being, and by establishing partnerships with 
specialists and other health-care professionals who can provide behavioral, 
lifestyle, and integrative approaches that may have much to offer in helping 
patients cope with their symptoms.

DOI: 10.2500/aap.2022.43.220059
PMCID: PMC9465643
PMID: 36065103 [Indexed for MEDLINE]

Conflict of interest statement: The author has no conflicts of interest to 
declare pertaining to this article


1585. Trials. 2022 Sep 5;23(1):741. doi: 10.1186/s13063-022-06512-5.

Building Emotional Awareness and Mental Health (BEAM): study protocol for a 
phase III randomized controlled trial of the BEAM app-based program for mothers 
of children 18-36 months.

Xie EB(1), Simpson KM(2), Reynolds KA(2), Giuliano RJ(2), Protudjer JLP(2)(3), 
Soderstrom M(2), Sauer-Zavala S(4), Giesbrecht GF(5), Lebel C(5), Mackinnon 
AL(5), Rioux C(5)(2)(3), Penner-Goeke L(2), Freeman M(5), Salisbury MR(6), 
Tomfohr-Madsen L(#)(5), Roos LE(#)(2)(3).

Author information:
(1)Department of Psychology, University of Calgary, 2500 University Dr. NW, 
Calgary, AB, T2N 1N4, Canada. elisabeth.xie@ucalgary.ca.
(2)University of Manitoba, Winnipeg, Canada.
(3)Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.
(4)University of Kentucky, Lexington, USA.
(5)Department of Psychology, University of Calgary, 2500 University Dr. NW, 
Calgary, AB, T2N 1N4, Canada.
(6)York University, Toronto, Canada.
(#)Contributed equally

Erratum in
    Trials. 2022 Sep 30;23(1):832.

BACKGROUND: The prevalence of maternal depression and anxiety has increased 
during the COVID-19 pandemic, and pregnant individuals are experiencing 
concerningly elevated levels of mental health symptoms worldwide. Many 
individuals may now be at heightened risk of postpartum mental health disorders. 
There are significant concerns that a cohort of children may be at-risk for 
impaired self-regulation and mental illness due to elevated exposure to 
perinatal mental illness. With both an increased prevalence of depression and 
limited availability of services due to the pandemic, there is an urgent need 
for accessible eHealth interventions for mothers of young children. The aims of 
this trial are to evaluate the efficacy of the Building Emotion Awareness and 
Mental Health (BEAM) app-based program for reducing maternal depression symptoms 
(primary outcome) and improve anxiety symptoms, parenting stress, family 
relationships, and mother and child functioning (secondary outcomes) compared to 
treatment as usual (TAU).
METHODS: A two-arm randomized controlled trial (RCT) with repeated measures will 
be used to evaluate the efficacy of the BEAM intervention compared to TAU among 
a sample of 140 mothers with children aged 18 to 36 months, who self-report 
moderate-to-severe symptoms of depression and/or anxiety. Individuals will be 
recruited online, and those randomized to the treatment group will participate 
in 10 weeks of psychoeducation modules, an online social support forum, and 
weekly group teletherapy sessions. Assessments will occur at 18-36 months 
postpartum (pre-test, T1), immediately after the last week of the BEAM 
intervention (post-test, T2), and at 3 months after the intervention (follow-up, 
T3).
DISCUSSION: eHealth interventions have the potential to address elevated 
maternal mental health symptoms, parenting stress, and child functioning 
concerns during and after the COVID-19 pandemic and to provide accessible 
programming to mothers who are in need of support. This RCT will build on an 
open pilot trial of the BEAM program and provide further evaluation of this 
evidence-based intervention. Findings will increase our understanding of 
depression in mothers with young children and reveal the potential for long-term 
improvements in maternal and child health and family well-being.
TRIAL REGISTRATION: ClinicalTrials.gov NCT05306626 . Registered on April 1, 
2022.

© 2022. The Author(s).

DOI: 10.1186/s13063-022-06512-5
PMCID: PMC9441821
PMID: 36064436 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1586. J Sch Psychol. 2022 Oct;94:66-82. doi: 10.1016/j.jsp.2022.08.003. Epub 2022 Aug 
15.

Prospering in the midst of the COVID-19 pandemic: The effects of PROSPER-based 
intervention on psychological outcomes among preschool teachers.

Datu JAD(1), Lee ASY(2), Fung WK(3), Cheung RYM(4), Chung KKH(5).

Author information:
(1)Department of Special Education and Counselling, The Education University of 
Hong Kong, Hong Kong, China.
(2)Centre for Child and Family Science, The Education University of Hong Kong, 
Hong Kong, China. Electronic address: alfredlee@eduhk.hk.
(3)School of Education, Liverpool Hope University, UK.
(4)Centre for Child and Family Science, The Education University of Hong Kong, 
Hong Kong, China; Division of Educational Psychology, Hong Kong Psychological 
Society, Hong Kong, China.
(5)Centre for Child and Family Science, The Education University of Hong Kong, 
Hong Kong, China; Department of Early Childhood Education, The Education 
University of Hong Kong, Hong Kong, China.

The growing concerns regarding the risks of transmitting the COVID-19 virus have 
intensified the job-related stressors commonly encountered by teachers in 
various cultural contexts. Evidence shows how the COVID-19 crisis has negatively 
impacted teachers' mental health outcomes such as stress, depression, and 
quality of life, which highlights the significance of designing psychological 
programs to boost teachers' well-being. This study examined the effects of a 
well-being intervention based on the Positivity, Relationship, Outcomes, 
Strength, Purpose, Engagement, and Resilience (PROSPER) framework on well-being 
outcomes among 76 in-service teachers (Mage = 26.05 years, SD = 4.71, 
range = 20-45; female = 93.4%) in Hong Kong. Participants completed survey 
measures associated with the seven PROSPER outcomes at baseline and 2-month 
follow-up. Multivariate regression analysis indicated that there were 
statistically significant multivariate effects for intervention conditions, 
Wilks' Lambda F(7, 58) = 4.50, p = .01. Results demonstrated that teachers who 
were assigned to the intervention condition (n = 36) had significantly higher 
scores than those in the control condition (n = 40) on positivity (b = 0.41, 95% 
CI [0.16, 0.65], p = .01), strength (b = 0.62, 95% CI [0.23, 1.01], p = .01), 
purpose (b = 0.61, 95% CI [0.18, 1.04], p = .01), and resilience (b = 0.57, 95% 
CI [0.07, 1.07], p = .04). Our findings provide evidence on the mental health 
benefits of the PROSPER-based psychological intervention program for preschool 
teachers.

Copyright © 2022 Society for the Study of School Psychology. Published by 
Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.jsp.2022.08.003
PMCID: PMC9376344
PMID: 36064216 [Indexed for MEDLINE]


1587. Int J Soc Psychiatry. 2022 Sep;68(6):1270-1276. doi: 10.1177/00207640221121717. 
Epub 2022 Sep 3.

The impact of covid-19: Anxiety, depression, and wellbeing among medical 
students.

Chumakov E(1), Petrova N(1), Mamatkhodjaeva T(1), Ventriglio A(2), Bhugra D(3).

Author information:
(1)St. Petersburg State University, Saint Petersburg, Russian Federation.
(2)Department of Clinical and Experimental Medicine, University of Foggia, 
Foggia, Italy.
(3)Institute of Psychiatry, King's College London, London, UK.

BACKGROUND: Medical students have been considered as a vulnerable group at 
higher risk of mental health issues during the COVID-19 outbreak.
AIMS: We set out to detect symptoms of depression and anxiety in medical 
students in St. Petersburg (Russia) during the first wave of COVID-19 outbreak 
and explore the associations between psychosocial factors related to the 
pandemic and students' psychological well-being.
METHOD: An anonymous online survey of medical students was conducted in May-June 
2020. The Hospital Anxiety and Depression Scale (HADS) was used for screening 
anxiety and depression symptoms. The final sample consisted of 144 students 
(78.5% females).
RESULTS: About 69.4% of respondents reported that COVID-19 pandemic and social 
restrictions were a new source of stress in their lives. More than one-third 
(38.9%) of respondents reported a need for psychological (emotional) support due 
to a change in their daily life during the COVID-19 pandemic, with the vast 
majority (83.9%) of these respondents indicated an increased need for support in 
this specific period. Symptoms of anxiety were reported by 55.8% of females 
(HADS score: 9.05 ± 4.69) and 48.4% of males (8.09 ± 5.0), and symptoms of 
depression were found in 38.9% of females (6.40 ± 3.57) and 41.9% of males 
(6.16 ± 3.21).
CONCLUSIONS: These findings indicate that it is necessary to develop additional 
measures for the prevention and early diagnosis of mental disorders along with 
right levels of support for wellbeing and mental health of medical students in 
this ongoing pandemic.

DOI: 10.1177/00207640221121717
PMID: 36062424 [Indexed for MEDLINE]


1588. Front Public Health. 2022 Aug 19;10:947593. doi: 10.3389/fpubh.2022.947593. 
eCollection 2022.

COVID-19 infection prevention and control procedures and institutional trust: 
Perceptions of Palestinian healthcare workers.

El Sharif N(1), Ahmead M(1), Imam A(1).

Author information:
(1)Faculty of Public Health, Al Quds University, Jerusalem, Palestine.

BACKGROUND: Lack of trust in institutional control measures during Coronavirus 
disease 2019 (COVID-19) outbreaks may affect healthcare workers' (HCWs) levels 
of stress and wellbeing, and as a consequence, may influence their trust and 
confidence in their organization. This study aims to understand factors 
associated with healthcare workers perceptions of trust in organizational 
preparedness, communication, and infection risk during the COVID-19 pandemic.
METHODS: A cross-sectional study was conducted among HCWs (n = 876) in 16 COVID 
19 healthcare facilities between October and December 2020 in Palestine (Gaza 
Strip, West Bank and East Jerusalem). A stratified purposive sample using an 
online self-administered Arabic version of a questionnaire was used for data 
collection. The questionnaire used for this study was adapted from the World 
Health Organization Blueprint Novel Coronavirus Perceptions of healthcare 
workers regarding local infection prevention and control procedures for a 
COVID-19 research protocol.Data were analyzed using Statistical Package for 
Social Sciences software version 23. In the bivariate analysis, T-test, one-way 
ANOVA and χ2 test were used at a significant p-value < 0.05. In the 
multivariable logistic regression analyses, the adjusted odds ratios and its 95% 
confidence intervals are presented.
RESULTS: Findings showed that confidence in the systems' ability to manage 
COVID-19 cases, encouragement and support from senior medical/nursing staff to 
apply recommended IPC measures, and good levels of mental health increased trust 
in the organization. Additionally, receiving proper training on IPC procedures 
for other communicable diseases, having access to clear policies and procedures 
related to IPC procedures for COVID-19, and providing PPE during the previous 
clinical shift also increased trust. However, the intention to use recommended 
PPE when treating patients with suspected or confirmed COVID-19 when having 
access to it and feeling emotional was negatively correlated with this trust.
CONCLUSIONS: HCWs should be provided with clear, accessible communications about 
policies and protocols, as well as training about infection prevention and 
control, personal protective equipment, and support during pandemics to increase 
their trust in the healthcare system. Additionally, the improvement in HCWs' 
wellbeing can be attributed to a greater sense of trust in institutions.

Copyright © 2022 El Sharif, Ahmead and Imam.

DOI: 10.3389/fpubh.2022.947593
PMCID: PMC9437519
PMID: 36062099 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1589. Br J Nutr. 2023 Jun 14;129(11):1897-1907. doi: 10.1017/S000711452200232X. Epub 
2022 Sep 5.

Effects of inulin supplementation on inflammatory biomarkers and clinical 
symptoms of women with obesity and depression on a calorie-restricted diet: a 
randomised controlled clinical trial.

Vaghef-Mehrabani E(1)(2)(3), Harouni R(3), Behrooz M(3), Ranjbar F(4), 
Asghari-Jafarabadi M(5)(6)(7), Ebrahimi-Mameghani M(3).

Author information:
(1)Alberta Children's Hospital Research Institute, University of Calgary, 
Calgary, AB, Canada.
(2)Department of Pediatrics, University of Calgary, Calgary, AB, Canada.
(3)Department of Biochemistry and Diet Therapy, School of Nutrition & Food 
Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
(4)Research Center of Psychiatry & Behavioral Sciences, Tabriz University of 
Medical Sciences, Tabriz, Iran.
(5)Cabrini Research, Cabrini Health, VIC3144, Australia.
(6)School of Public Health and Preventative Medicine, Faculty of Medicine, 
Nursing and Health Sciences, Monash University, VIC3800, Australia.
(7)Road Traffic Injury Research Center, Faculty of Health, Tabriz University of 
Medical Sciences, Tabriz, Iran.

Major depressive disorder (MDD) is regarded as an inflammatory disorder. Gut 
microbiota dysbiosis, observed in both MDD and obesity, leads to endotoxemia and 
inflammatory status, eventually exacerbating depressive symptoms. Manipulation 
of gut microbiota by prebiotics might help alleviate depression. The present 
study aimed to investigate the effects of inulin supplementation on 
psychological outcomes and biomarkers of gut permeability, endotoxemia, 
inflammation, and brain-derived neurotrophic factor (BDNF) in women with obesity 
and depression on a calorie-restricted diet. In a double-blind randomised 
clinical trial, forty-five women with obesity and MDD were allocated to receive 
10 g/d of either inulin or maltodextrin for 8 weeks; all the patients followed a 
healthy calorie restricted diet as well. Anthropometric measures, dietary 
intakes, depression, and serum levels of zonulin, lipopolysaccharide (LPS), 
inflammatory biomarkers (TNF-α, IL-10, monocyte chemoattractant protein-1, 
toll-like receptor-4 and high-sensitivity C-reactive protein), and BDNF were 
assessed at baseline and end of the study. Weight and Hamilton Depression Rating 
Scale (HDRS) scores decreased in both groups; between-group differences were 
non-significant by the end of study (P = 0·333 for body weight and P = 0·500 for 
HDRS). No between-group differences were observed for the other psychological 
outcomes and serum biomarkers (P > 0·05). In this short-term study, prebiotic 
supplementation had no significant beneficial effects on depressive symptoms, 
gut permeability, or inflammatory biomarkers in women with obesity and 
depression.

DOI: 10.1017/S000711452200232X
PMID: 36059088 [Indexed for MEDLINE]


1590. Prev Med. 2022 Nov;164:107239. doi: 10.1016/j.ypmed.2022.107239. Epub 2022 Sep 
1.

State-level unemployment and negative emotions throughout the Covid-19 pandemic 
in the United States.

Hagen D(1), Lai AY(2), Goldmann E(3).

Author information:
(1)Department of Epidemiology, New York University School of Global Public 
Health, NY, New York, USA.
(2)Department of Public Health Policy and Management, New York University School 
of Global Public Health, NY, New York, USA.
(3)Department of Epidemiology, New York University School of Global Public 
Health, NY, New York, USA. Electronic address: esg236@nyu.edu.

Although prior research has assessed public mental health in the U.S. throughout 
the COVID-19 pandemic, it is unclear how area-level unemployment impacted 
psychological well-being; moreover, studies that examine potential effect 
heterogeneity of the impact of area-level unemployment on well-being by 
employment status are lacking. To address these shortcomings, this study 
utilized data from Gallup's repeated cross-sectional, nationally representative 
COVID-19 web survey collected between April 2020 and July 2021 (n = 132,971). 
Survey modified Poisson regression models were estimated to determine the 
association between current unemployment rate in respondents' state of residence 
and experience of each of the following negative emotions during a lot of the 
prior day: sadness, worry, stress, anger, loneliness, depression, and anxiety. 
These models were stratified by employment status and sequentially adjusted for 
individual-level covariates, state fixed effects, and current state-level 
COVID-19 mortality. State-level unemployment was most strongly associated with 
sadness, followed by worry, anger, loneliness, stress, and anxiety; no 
associations were observed for depression. For sadness, worry, and stress, 
associations were strongest among full-time employed and retired individuals, 
and weakest among unemployed respondents and homemakers. Moreover, there was 
some evidence that state-level unemployment was negatively associated with the 
experience of anger in the early stages of the pandemic, and positively in its 
later stages. In sum, these findings suggest that Americans' emotional 
experience during the COVID-19 pandemic was considerably impacted by the state 
of the economy, highlighting the need for risk-buffering social policies.

Copyright © 2022 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.ypmed.2022.107239
PMCID: PMC9434949
PMID: 36058381 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


1591. J Nurs Manag. 2022 Oct;30(7):2568-2576. doi: 10.1111/jonm.13784. Epub 2022 Sep 
20.

Experiences of patients with rheumatoid arthritis during and after 
COVID-19-induced quarantine in terms of physical activity and health status: A 
qualitative study.

Ramos-Petersen L(1)(2), García-Campos J(3)(4), Banwell G(5), Ortega-Ávila 
AB(5)(6), Gijon-Nogueron G(5)(6), Reinoso-Cobo A(5).

Author information:
(1)Department of Podiatry, Faculty of Health Sciences, Universidad Católica San 
Antonio de Murcia, Campus de Los Jerónimos, Murcia, Spain.
(2)Research Team PODUMA, University of Malaga, Malaga, Spain.
(3)Department of Behavioral Sciences and Health, Faculty of Medicine, Miguel 
Hernandez University, Alicante, Spain.
(4)Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.
(5)Department of Nursing and Podiatry, Faculty of Health Sciences, University of 
Malaga, Malaga, Spain.
(6)IBIMA, Malaga, Spain.

AIM: The aim of this study was to explore experiences of people with rheumatoid 
arthritis during and after COVID-19-induced quarantine in terms of physical 
activity and health status.
BACKGROUND: Rheumatoid arthritis affects multiple facets of the person, both 
physically and psychologically. Physical activity is considered a safe and 
effective intervention to improve symptoms and systemic manifestations of 
rheumatoid arthritis. In the context of the COVID-19, countries like Spain were 
forced to impose restrictions on mobility, prohibiting outings even to perform 
physical activity.
METHODS: Structured interviews were conducted and developed using the Tampa 
Scale for Kinesiophobia-11 questionnaire. Data were analysed using a six-step 
thematic analysis.
RESULTS: The results make it clear that even though the patients declared that 
physical activity is essential for them to deal with their disease, most of the 
participants affirmed that they significatively reduced their levels of physical 
activity during the pandemic.
CONCLUSIONS: Physical activity should be promoted in people, even in difficult 
times, to improve disease outcomes, well-being and mental health.
IMPLICATIONS FOR NURSING MANAGEMENT: Knowing the experiences of these patients 
enables nursing managers to develop interventions that ensure the delivery of 
comprehensive nursing care regarding physical activity and health status, in 
future situations like this pandemic.

© 2022 The Authors. Journal of Nursing Management published by John Wiley & Sons 
Ltd.

DOI: 10.1111/jonm.13784
PMCID: PMC9538776
PMID: 36057281 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1592. J Dent Educ. 2023 Jan;87(1):101-109. doi: 10.1002/jdd.13099. Epub 2022 Sep 3.

Dental trainees' mental health changes, sources of stress, coping strategies, 
and suggestions for mental health improvement 1 year into the pandemic.

Hill CM(1), Moore E(1), Randall CL(1), Chi DL(1).

Author information:
(1)Department of Oral Health Sciences, University of Washington, Seattle, 
Washington, USA.

OBJECTIVES: The goal of this study was to assess how the mental health of dental 
trainees has changed during the pandemic and to identify the most stressful 
aspects of trainees' programs, stress coping strategies, and suggestions for 
individual and institution-driven solutions to improve wellness.
METHODS: The study focused on dental trainees at the University of Washington 
who completed a wellness survey in fall 2020 (n = 126; response rate = 35.5%) 
and spring 2021 (n = 105; response rate = 29.6%). The survey included 
self-report measures assessing four mental health outcomes: depression, anxiety, 
isolation from peers, and burnout. Stressful aspects of the training program, 
coping strategies, and institution-driven solutions were measured with 
open-ended survey items. The chi-square test was used to compare mental health 
outcome measures between fall and spring and open-ended survey responses were 
inductively coded.
RESULTS: The prevalence of self-reported depression and anxiety did not change 
between fall 2020 and spring 2021 (17.2% vs. 21.1%, p = 0.473; 22.4% vs. 23.7%, 
p = 0.818). Isolation from peers and burnout each significantly increased by 
almost 20% from fall 2020 to spring 2021 (46.8% vs. 64.3%; p = 0.009 and 26.6% 
vs. 43.9%; p = 0.017). Trainees identified workload as the most stressful aspect 
of their program and described using exercise and social support to cope with 
stress. Trainees suggested institution-supported increases in social events and 
mental health resources.
CONCLUSIONS: One year into the coronavirus disease 2019 pandemic, poor mental 
health outcomes were common among dental trainees because of high workload and 
isolation from peers. Dental schools should promote targeted programs and 
services aimed at improving dental trainees' well-being.

© 2022 American Dental Education Association.

DOI: 10.1002/jdd.13099
PMCID: PMC10395322
PMID: 36057035 [Indexed for MEDLINE]

Conflict of interest statement: CONFLICT OF INTEREST The authors declare that 
they have no conflict of interest.


1593. Biol Res Nurs. 2023 Jan;25(1):150-160. doi: 10.1177/10998004221124273. Epub 2022 
Sep 2.

A Pilot Study of the Gut Microbiota Associated With Depressive Symptoms and 
Sleep Disturbance Among Chinese and Korean Immigrants in the United States.

Hope C(1), Shen N(2), Zhang W(1), Noh HI(1), Hertzberg VS(1), Kim S(1), Bai 
J(1)(3).

Author information:
(1)Nell Hodgson Woodruff School of Nursing, 1371Emory University, Atlanta, GA, 
USA.
(2)Rollins School of Public Health, 25798Emory University, Atlanta, GA, USA.
(3)Winship Cancer Institute, 1371Emory University, Atlanta, GA, USA.

CONTEXT: Depression is prevalent among Asian Americans (AsA) during the COVID-19 
pandemic, and depression often leads to sleep disturbance in this population. 
The gut microbiota (GM) plays a critical role in mental health and sleep 
quality, and the composition of the GM is largely unknown among AsA.
OBJECTIVES: Examine associations of the GM with depressive symptoms and sleep 
disturbance among Chinese and Korean American immigrants.
METHODS: Depressive symptoms (PROMIS Short Form-Depression) and sleep quality 
(Pittsburgh Sleep Quality Index [PSQI]) were collected via surveys. PROMIS 
measure T-score > 55 indicates positive depressive symptoms, and a total PSQI 
score > 5 indicates sleep disturbance. 16S rRNA V3-V4 gene regions were 
sequenced from fecal specimens to measure GM. Permutational multivariate 
analysis of variance and linear discriminant analysis effect size were applied 
to examine associations of the GM with symptoms.
RESULTS: Among 20 participants, 55% (n = 11) reported depressive symptoms and 
35% (n = 7) reported sleep disturbance. A higher α-diversity was marginally 
associated with lower depressive symptoms: Chao1 (r = -0.39, p = 0.09) and 
Shannon index (r = -0.41, p = 0.08); β-diversity distinguished participants 
between categories of depressive symptoms (weighted UniFrac, p=0.04) or sleep 
disturbance (Jaccard, p=0.05). Those with depressive symptoms showed a higher 
abundance of Actinobacteria, while those without depressive symptoms had a 
higher abundance of Bacteroidetes. No significant taxa were identified for sleep 
disturbance.
CONCLUSIONS: Gut microbial diversity showed promising associations with 
depressive symptoms and sleep disturbance among Chinese and Korean immigrants. 
Specific taxa were identified as associated with depressive symptoms. Future 
studies with a larger sample size are warranted to confirm our findings.

DOI: 10.1177/10998004221124273
PMCID: PMC10068504
PMID: 36056574 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1594. Infancy. 2023 Jan;28(1):9-33. doi: 10.1111/infa.12497. Epub 2022 Sep 2.

Infant regulation during the pandemic: Associations with maternal response to 
the COVID-19 pandemic, well-being, and socio-emotional investment.

Reinelt T(1), Suppiger D(1), Frey C(1), Oertel R(1), Natalucci G(1).

Author information:
(1)Department of Neonatology, Family Larsson-Rosenquist Foundation Center for 
Neurodevelopment, Growth, and Nutrition of the Newborn, University Hospital 
Zurich, University of Zurich, Zurich, Switzerland.

In the transition to parenthood, the COVID-19 pandemic poses an additional 
strain on parental well-being. Confirmed infections or having to quarantine, as 
well as public health measures negatively affect parents and infants. Contrary 
to previous studies mainly focusing on the well-being of school-aged children 
and their parents during lockdown periods, the present study investigated how 
mothers of infants respond to the COVID-19 pandemic and whether this is related 
to maternal well-being, maternal socio-emotional investment, and infant 
regulation. Between April and June 2021, 206 mothers of infants (Mage 
 = 7.14 months, SDage  = 3.75 months) reported on COVID-19 infections, their 
response to the COVID-19 pandemic, their well-being, socio-emotional investment, 
and their infant's regulation. Exploratory factor analyses yielded five 
dimensions of maternal response to the COVID-19 pandemic: social distancing, 
worrying about the child, birth anxiety, distancing from the child, and 
information on COVID-19-related parenting behavior and support. These dimensions 
were related to mother-reported infant regulatory problems. Path analyses 
revealed paths via reduced maternal well-being and maternal socio-emotional 
investment. Maternal perceptions of infant regulatory problems are related to 
how the mothers respond to the COVID-19 pandemic. Better information about 
COVID-19-related parenting behavior and support might buffer against these 
effects.

© 2022 The Authors. Infancy published by Wiley Periodicals LLC on behalf of 
International Congress of Infant Studies.

DOI: 10.1111/infa.12497
PMCID: PMC9539181
PMID: 36056543 [Indexed for MEDLINE]


1595. Nutrition. 2022 Nov-Dec;103-104:111794. doi: 10.1016/j.nut.2022.111794. Epub 
2022 Jul 17.

Psychological distress and its association with intake of sugar-sweetened 
beverages, discretionary foods, and alcohol in women during the COVID-19 
pandemic in Australia.

Grieger JA(1), Habibi N(2), O'Reilly SL(3), Harrison CL(4), Moran LJ(5), Vo 
H(6), Sabir S BSc(Hons, Statistics), MSc(Statistics)(7), Enticott J(4), Teede H 
PhD(4), Lim S MND, PhD(8).

Author information:
(1)Robinson Research Institute, University of Adelaide, North Adelaide, 
Australia; Adelaide Medical School, University of Adelaide, North Adelaide, 
Australia. Electronic address: jessica.grieger@adelaide.edu.au.
(2)Robinson Research Institute, University of Adelaide, North Adelaide, 
Australia; Adelaide Medical School, University of Adelaide, North Adelaide, 
Australia. Electronic address: nahal.habibi@adelaide.edu.au.
(3)UCD Institute of Food and Health and School of Agriculture and Food Science, 
University College Dublin, Belfield, Dublin, Ireland.
(4)Monash Centre for Health Research and Implementation, Monash University, 
Clayton, Australia.
(5)Robinson Research Institute, University of Adelaide, North Adelaide, 
Australia; Monash Centre for Health Research and Implementation, Monash 
University, Clayton, Australia.
(6)Austin Health, Performance Reporting and Decision Support, Heidelberg, 
Australia.
(7)Ambulance Victoria, Doncaster, Australia.
(8)Monash Centre for Health Research and Implementation, Monash University, 
Clayton, Australia; Eastern Health Clinical School, Monash University, Boxhill, 
Australia. Electronic address: siew.lim1@monash.edu.

Comment in
    Nutrition. 2023 Apr;108:111981.

OBJECTIVES: This study aimed to explore psychological distress, lifestyle, and 
demographic factors, as well as their relationship to discretionary choices in 
women of reproductive age during the coronavirus disease 2019 pandemic in 
Australia.
METHODS: Reproductive-aged women (18-50 y) in Australia participated in a 
national online survey. Psychological distress score (using a validated 10-item 
Kessler Psychological Distress Scale questionnaire) was the primary exposure of 
interest, and key outcomes were frequencies of discretionary choices 
(sugar-sweetened beverages [SSBs], alcohol, and discretionary foods). 
Sociodemographic and physical activity data were also collected. Logistic 
regression was used to report adjusted odds ratio (aOR) and 95% confidence 
interval to predict SSBs (less than weekly; most days/daily), total 
discretionary foods (none/&lt;2 times/d; ≥3 times/d), and alcohol use 
(never/less than monthly; most weeks/daily).
RESULTS: A total of 1005 women were included in the study, of whom 40% had a 
high level of psychological distress. Women with high psychological distress 
(aOR: 1.96; 95% CI, 1.32-2.91) and those who gained weight during the pandemic 
(aOR: 1.71; 95% CI, 1.10-2.65) were more likely to consume discretionary foods 
≥3 times/d. There was no association between psychological distress and SSB 
intake or alcohol; however, Australian, New Zealander, or Pacific Islander 
background (aOR: 1.68; 95% CI, 1.21-2.33) and more hours of sitting time (aOR: 
1.88; 95% CI, 1.07-3.29) were associated with SSB consumption on most 
days/daily. Older age (aOR: 1.70; 95% CI, 1.00-2.89), higher household income 
(aOR: 1.44; 95% CI, 1.08-1.92), and moderate or high physical activity (aOR: 
1.75; 95% CI, 1.10-2.80) were associated with alcohol intake on most 
weeks/daily.
CONCLUSIONS: Public health messaging to promote healthy eating should take into 
account the effect of psychological distress on health behavior. Messages aimed 
at maintaining a positive relationship between food intake and mental wellbeing, 
particularly among vulnerable groups, are warranted.

Copyright © 2022 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.nut.2022.111794
PMCID: PMC9427120
PMID: 36055124 [Indexed for MEDLINE]


1596. J Paediatr Child Health. 2022 Nov;58(11):2068-2075. doi: 10.1111/jpc.16170. Epub 
2022 Aug 30.

Impact of current Australian paid parental leave on families of preterm and sick 
infants.

Eeles AL(1)(2)(3)(4), Olsen JE(1)(2), Cameron KL(1)(3), McKinnon CT(1), Rawnsley 
KL(1)(3), Cruz M(5), Pussell K(5), Dubois K(5), Hunt RW(1)(4)(6), Cheong 
JL(1)(2)(7), Spittle AJ(1)(2)(3).

Author information:
(1)Clinical Sciences Theme, Murdoch Children's Research Institute, Melbourne, 
Victoria, Australia.
(2)Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia.
(3)Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, 
Australia.
(4)Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.
(5)Miracle Babies Foundation, Sydney, New South Wales, Australia.
(6)Department of Paediatrics, University of Melbourne, Melbourne, Victoria, 
Australia.
(7)Neonatal Services, The Royal Women's Hospital, Melbourne, Victoria, 
Australia.

AIM: Parents of preterm or sick infants are at increased risk of mental health 
problems. The financial stress associated with an infant's prolonged hospital 
stay can have an additional negative effect on families' wellbeing and child 
development. This study explores parent use of Australian paid parental leave 
(PPL) and the financial impact of having an infant requiring neonatal care.
METHODS: Retrospective, cross-sectional, online survey study conducted from 
November 2020 to February 2021. Participants were parents of babies born from 1 
January 2013, admitted to a neonatal intensive care unit or special care nursery 
in Australia. The survey explored use of Australian Government and private 
sector PPL, and financial stress. Parent-reported anxiety and depression were 
measured using the EuroQol Group 5D-5L Anxiety and Stress Subscale.
RESULTS: Two hundred and thirty-one parents responded of which 93% had a preterm 
infant. Seventy-three percent of infants were hospitalised for more than 
1 month, and 34% were readmitted to hospital within the first year following 
discharge home. Eighty-three percent of parents reported moderate, severe or 
extreme levels of anxiety or depression. Seventy-six percent reported that 
having a child in hospital had a moderate-very large financial impact on their 
family. Parents identified main costs to be travel, food, inability to work and 
direct medical costs.
CONCLUSIONS: Having an infant born preterm or sick has significant emotional and 
financial implications for families. The current Australian Government PPL 
scheme does not adequately support parents of preterm or sick infants, and a 
change is urgently needed to improve outcomes for this vulnerable population.

© 2022 The Authors. Journal of Paediatrics and Child Health published by John 
Wiley & Sons Australia, Ltd on behalf of Paediatrics and Child Health Division 
(The Royal Australasian College of Physicians).

DOI: 10.1111/jpc.16170
PMCID: PMC9805188
PMID: 36054633 [Indexed for MEDLINE]


1597. Drug Alcohol Rev. 2023 Jan;42(1):203-212. doi: 10.1111/dar.13531. Epub 2022 Aug 
31.

People engaged in opioid agonist treatment as a counterpublic during the 
COVID-19 pandemic in Australia: A qualitative study.

Conway A(1)(2), Treloar C(2), Crawford S(3), Grebely J(1), Marshall AD(1)(2).

Author information:
(1)The Kirby Institute, UNSW Sydney, Sydney, Australia.
(2)Centre for Social Research in Health, UNSW Sydney, Sydney, Australia.
(3)Harm Reduction Victoria, Melbourne, Australia.

INTRODUCTION: People receiving opioid agonist treatment (OAT) are at higher risk 
of comorbidities, poverty and discrimination, which Big Events like the COVID-19 
pandemic may exacerbate. The behaviours of people receiving OAT do not always 
align with normative behaviours as conceived by ruling institutions and laws, 
and so the group becomes a counterpublic, not imagined in mainstream public 
discourse. The aim of this study was to understand how people receiving OAT, as 
a counterpublic, implemented practises of care to mitigate negative health 
outcomes during COVID-19.
METHODS: Participants were recruited via eight peer-led organisations across 
Australia. In-depth, semi-structured interviews were completed between August 
and December 2020 with 40 people receiving OAT. The analysis centres practises 
of care, allowing interactions that influence the health of participants, to be 
understood in their unique contexts.
RESULTS: Aspects of the COVID-19 state response were designed for an idealised 
public, demonstrated by the increased policing that accompanied enforcement of 
restrictions which was detrimental to the wellbeing of people receiving OAT. 
Counterpublic health strategies employed by people receiving OAT were disrupted, 
but participants were often able to adapt to the changing context.
DISCUSSION AND CONCLUSION: This study elucidates how practises of care among 
people receiving OAT are enacted and disrupted during a Big Event, with 
implications beyond the COVID-19 pandemic for future Big Events. The study 
findings evidence the need for policies that mitigate the impact of Big Events 
such as supporting re-groupment within the counterpublic, legitimising 
counterpublic health strategies and stopping the criminalisation of people who 
use drugs.

© 2022 The Authors. Drug and Alcohol Review published by John Wiley & Sons 
Australia, Ltd on behalf of Australasian Professional Society on Alcohol and 
other Drugs.

DOI: 10.1111/dar.13531
PMCID: PMC9538012
PMID: 36054577 [Indexed for MEDLINE]

Conflict of interest statement: The CHOICE Study was funded through a National 
Health and Medical Research Council (NHMRC) Investigator Grant (1176131). NHMRC 
had no role in study design; in the collection, analysis and interpretation of 
data; in the writing of the report; or in the decision to submit the article for 
publication. Carla Treloar has received speaker fees from Abbvie and Gilead and 
has received a research grant from Merck outside the submitted work. Sione 
Crawford has received speaker fees from Abbvie outside the submitted work. Jason 
Grebely is a consultant/advisor and has received research grants from AbbVie, 
Camurus, Cepheid, Gilead, Hologic, Indivior and Merck outside the submitted 
work. Anna Conway and Alison D. Marshall have no competing interests to 
disclose.


1598. PLoS One. 2022 Sep 2;17(9):e0274020. doi: 10.1371/journal.pone.0274020. 
eCollection 2022.

Food security and well-being among older, rural Americans before and during the 
COVID-19 pandemic.

Giroux S(1), Waldman K(2), Burris M(3), Valliant JCD(1), Babb AM(1), Stafford 
P(4), Fobi D(2), Czebotar K(2), Knudsen DC(2).

Author information:
(1)Ostrom Workshop, Indiana University, Bloomington, Indiana, United States of 
America.
(2)Department of Geography, Indiana University, Bloomington, Indiana, United 
States of America.
(3)Department of Anthropology, Indiana University, Bloomington, Indiana, United 
States of America.
(4)CoDesign Commons, Bloomington, Indiana, United States of America.

The COVID-19 pandemic has impacted many aspects of our lives. Older adults, 
those with less income or fewer resources, and those living in rural parts of 
the United States are potentially more vulnerable. To understand the negative 
impact of COVID-19 on perceived food security, physical and mental health, and 
loneliness in a sample of older, rural, low-income adults in the United States, 
we use results from a mailed survey in which residents of four Indiana counties 
contrasted their status during the early period of the pandemic to their typical 
pre-pandemic status. We test for significant changes in status and what predicts 
negative impacts to food security, health, and loneliness. We asked respondents 
to report on both pre-pandemic and since-pandemic experiences in the instrument, 
which was administered after the pandemic had begun, in May 2020. We measure 
food security using the U.S. Household Food Security Survey Module (six-item 
short form; HFSSM), physical and mental health using the Centers for Disease 
Control's Healthy Days Measures (HRQOL-4), and loneliness using the UCLA Revised 
Loneliness Scale. A binomial test identified significant declines in status for 
all three measures. Logistic regressions identified factors associated with each 
of the measures worsening. Fear of going to the store or food pantry was 
associated with all three measures. Decreased store hours and closed food 
pantries were associated with lower food security. More education, fewer years 
of age, being female, decreased income, and stockpiling were associated with 
more reported days of poor physical or mental health. Fewer years of age, lack 
of transportation, and eating less often with others were associated with 
perceived increased loneliness. The pandemic had a negative impact on 
respondents' food security, unhealthy days, and loneliness, but different 
factors were associated with each measure for this population. Our findings 
provide insight for targeted recovery efforts.

DOI: 10.1371/journal.pone.0274020
PMCID: PMC9439215
PMID: 36054130 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that no competing interests 
exist. This study was approved by Indiana University’s Institutional Review 
Board (#2008204182) and all respondents received a study information sheet 
(mailed with the paper survey) that informed them of the purpose of the study, 
provided a statement that their participation is voluntary, and contact 
information for the principal investigator. This does not alter our adherence to 
PLOS ONE policies on sharing data and materials.


1599. BMJ Paediatr Open. 2022 Mar;6(1):e001285. doi: 10.1136/bmjpo-2021-001285.

Primary and secondary care approach to paediatric mental health conditions: a 
novel model of care.

Power E(1)(2), Taaffe S(3), McLoughlin P(4), Sharif F(2)(5)(6).

Author information:
(1)University Hospital Limerick, Dooradoyle, Limerick, Ireland 
edmond.power@ucdconnect.ie.
(2)Department of Paediatrics, UCD School of Medicine, Dublin, Ireland.
(3)Irish College of General Practitioners, Dublin, Ireland.
(4)HSE, Dublin, Ireland.
(5)Department of Paediatrics, Midland Regional Hospital Mullingar, Mullingar, 
Westmeath, Ireland.
(6)Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin, 
Ireland.

The enforced isolation caused by the COVID-19 pandemic has led to an increase in 
mental health issues and severity of presentations to emergency departments in 
Ireland. Long waiting lists for both Psychology and Psychiatry are further 
impacting on children's mental well-being. We proposed the creation of a 
'Happiness Toolkit' that can be given to children on presentation to their 
primary or secondary care provider with a mental health issue. The toolkit is 
comprised of six evidence-based techniques that are proven to boost self-esteem, 
develop resilience and promote positive mental health. A leaflet detailing the 
practices along with a physical 'box' that the children must make were created. 
This resource may therefore provide immediate support to those children that may 
endure long waiting periods, sometimes greater than a year and a half, for 
referral to tertiary services. Our toolkit allows children and their families to 
engage in positive mental health practices that may prevent regression during 
this waiting period and lead to improved mental health or cessation of symptoms.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjpo-2021-001285
PMCID: PMC8905931
PMID: 36053655 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


1600. BMJ Paediatr Open. 2022 Jul;6(1):e001468. doi: 10.1136/bmjpo-2022-001468.

Parents and school-aged children's mental well-being after prolonged school 
closures and confinement during the COVID-19 pandemic in Mexico: a 
cross-sectional online survey study.

Leon Rojas D(1), Castorena Torres F(1), Garza-Ornelas BM(1), Castillo Tarquino 
AM(1), Salinas Silva CA(1), Almanza Chanona JL(1), Rodríguez-de-Ita J(2)(3).

Author information:
(1)Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ave. 
Morones Prieto 3000, Monterrey, Nuevo Leon, Mexico.
(2)Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ave. 
Morones Prieto 3000, Monterrey, Nuevo Leon, Mexico julyrdz@tec.mx.
(3)Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, 
Hospital San José, TecSalud, Monterrey, Nuevo Leon, Mexico.

OBJECTIVE: This study aimed to determine parents' and school-aged children's 
mental well-being after experiencing confinement and prolonged school closures 
during the COVID-19 pandemic.
DESIGN: Using a cross-sectional design, an online survey was applied to parents 
of school-aged children inquiring about their mental well-being and COVID-19 
pandemic changes in their home and working lives. To assess the presence of 
depression, anxiety and stress in parents, the participants responded to the 
Depression, Anxiety and Stress Scale - 21 scale. To assess psychosocial 
dysfunction and sleep disturbances in children, participants responded to the 
Pediatric Symptom Checklist and the Children Sleep Habits Questionnaire.
RESULTS: A total of 209 parents answered the questionnaire, most of them were 
female (87.1%) with a mean age of 40 years. The prevalence of anxiety, stress 
and parental depression symptoms were 35.9%, 28.2% and 25.4%, respectively. 
Children's mean age was 8.9 years, the prevalence of children's psychosocial 
dysfunction was 12%, while their sleep disturbance symptoms were 59.8%. 10.5% of 
children were suffering both outcomes. We found a bidirectional relationship 
between parents' and children's mental health outcomes. Parental depression 
symptoms were associated with experiencing COVID-19 infection within the 
household, having children with pre-existing medical diagnoses, children's 
psychosocial dysfunction and sleep disturbances. Children's psychosocial 
dysfunction was associated with parental depression and changes in their school 
routine. Children's sleep disturbances were associated with parental anxiety, 
younger age, increased use of electronic devices, night-time awakenings and 
shorter sleep time.
CONCLUSION: Our results support the impact of long confinement and school 
closure due to the COVID-19 pandemic in Mexican children and parents' mental 
well-being. We advocate for specific mental health interventions tailored to 
respond to parents and children at risk of mental well-being distress.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjpo-2022-001468
PMCID: PMC9257864
PMID: 36053635 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: No, there are no competing 
interests.


1601. BMJ Paediatr Open. 2022 Jun;6(1):e001509. doi: 10.1136/bmjpo-2022-001509.

Mental health of children with and without special healthcare needs and of their 
caregivers during COVID-19: a cross-sectional study.

Geweniger A(1), Haddad A(2), Barth M(2), Högl H(3), Mund A(3), Insan S(4), 
Langer T(4).

Author information:
(1)Department of Neuropediatrics and Muscle Disease, Medical Center - University 
of Freiburg, Freiburg, Germany anne.geweniger@uniklinik-freiburg.de.
(2)Department of General Pediatrics, Adolescent Medicine and Neonatology, 
Medical Center - University of Freiburg, Freiburg, Germany.
(3)Kindernetzwerk eV, Mainaschaff, Germany.
(4)Department of Neuropediatrics and Muscle Disease, Medical Center - University 
of Freiburg, Freiburg, Germany.

OBJECTIVE: To describe mental health outcomes and measures of pandemic burden of 
children with and without special healthcare needs, and their caregivers 
following the second wave of the COVID-19 pandemic in Germany.
DESIGN: This is the second of a sequential series of cross-sectional online 
surveys conducted among caregivers of children ≤18 years since the onset of the 
COVID-19 pandemic, administrated between 2 April 2021 and 31 July 2021.
MAIN OUTCOME MEASURES: Child and parental mental health were assessed using the 
Strengths and Difficulties Questionnaire and WHO-5 Well-being index. Children 
with Special Healthcare Needs (CSHCN) were identified using the CSHCN-Screener. 
Descriptive statistics, linear and hierarchical logistic regression modelling 
assessed associations between parent-reported child mental health problems and 
measures of pandemic burden, disease complexity, caregiver mental well-being and 
socioeconomic status.
RESULTS: 521 participants were included in the final sample. There was a high 
prevalence of parent-reported mental health problems in n=302 (66.7%) children, 
particularly in CSHCN. Among caregivers, n=372 (72.5%) screened positive for 
depression. Logistic regression modelling showed a strong association of child 
mental health problems and disease complexity, parental mental well-being, 
increase in family conflict and inadequate social support.
CONCLUSIONS: Our study identifies CSHCN as a particularly vulnerable group in 
terms of mental health outcomes. Psychosocial factors were important predictors 
of parent-reported child mental health problems. Policy measures should consider 
the importance of social support systems for vulnerable children and their 
families, and aim to provide accessible mental health support for caregivers.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjpo-2022-001509
PMCID: PMC9247324
PMID: 36053611 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: The authors declare that 
the research was conducted in the absence of any commercial or financial 
relationships that could be construed as a potential conflict of interest.


1602. BMJ Paediatr Open. 2022 Jun;6(1):e001444. doi: 10.1136/bmjpo-2022-001444.

Exploring children's knowledge of COVID-19 and stress levels associated with the 
pandemic in Nigeria: a mixed-method study.

Asemota OA(1), Napier-Raman S(2), Takeuchi H(3), Raman S(4), Asemota EA(5), 
Nonye E(6)(7).

Author information:
(1)Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, 
Cross River, Nigeria samsie10@gmail.com.
(2)School of Medical and Health Sciences, The University of Sydney, Sydney, New 
South Wales, Australia.
(3)Faculty of Social Welfare, Bukkyo University, Kyoto, Japan.
(4)Community Paediatrics, Southwest Sydney Local Health District, sydney, New 
South Wales, Australia.
(5)Department of Heamatology, University of Calabar, Calabar, Cross River, 
Nigeria.
(6)Department of Paediatrics, New Cross Hospital, Wolverhampton, UK.
(7)Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, 
Cross River State, Nigeria.

BACKGROUND: Children have been relatively spared from the direct effects of 
COVID-19 globally, but there are significant concerns about indirect effects on 
the most vulnerable children's well-being. Nigeria is the largest African 
nation, but little is known about children's experience of the COVID-19 
pandemic. Our aims were to determine children's knowledge of COVID-19 and their 
mental health responses to the pandemic.
METHODS: Children aged 6-17 years living in Calabar, Nigeria, were surveyed 
using a combination of online data collection assisted by parents and on-site 
data collection at schools. Parents filled out sociodemographic details, while 
children answered questions about COVID-19 knowledge and preventive measures. An 
adapted version of the 'Perceived Stress Scale for Children' was used to assess 
stress with additional free text space for expression of views and experiences 
of COVID-19.
RESULTS: A total of 265 children completed questionnaires, mean age was 12.5 
years, 52.1% were girls. All children knew about the virus and over two-thirds 
(67.8%) had good knowledge of COVID-19 transmission. Children identified 
television (60.8%), parents (44.2%) and social media (32.8%), as main sources of 
COVID-19 information. The overall mean stress score among the children was 
20.47. Children mentioned the following as stressors: fear of the COVID-19 
disease, effect of pandemic restrictions on schooling and social interactions as 
well as home/family tensions. Parental love and support were overwhelmingly 
reported as strengths.
CONCLUSIONS: Nigerian children in this study had good knowledge and 
understanding of the COVID-19 pandemic and preventive measures to counter the 
virus. Children had high stress levels and expressed pandemic-related concerns 
but parental love and support were mitigating factors. Government and child 
health service providers need to tailor health and support services in response 
to children's needs and concerns.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjpo-2022-001444
PMCID: PMC9226462
PMID: 36053587 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: No, there are no competing 
interests.


1603. Dementia (London). 2022 Nov;21(8):2499-2516. doi: 10.1177/14713012221124863. 
Epub 2022 Sep 2.

Art box deliveries: The experiences of people with dementia and their carers 
during the Covid 19 lockdown.

Armstrong C(1), Archer A(2), Critten V(3), Critten S(3).

Author information:
(1)4903University of the Arts London, London, UK.
(2)3769University of Hertfordshire, Hatfield, UK.
(3)5488Open University, Milton Keynes, UK.

Art workshops have been looked at before in terms of impact for people with 
dementia but never those conducted remotely during a pandemic lockdown. Two 
artists, working with local museums, provided Art workshops for people with 
dementia and their caregivers. Due to the first Covid 19 lockdown in the UK, the 
artists set up a weekly delivery service of Home Art Boxes to thirty-three 
people with dementia and their caregivers over a period spanning 11 months. The 
artists received funding from local organisations and the Community Lottery 
Fund. Thematic analysis of the feedback from the participants regarding the 
project and the artists themselves provided the data for this evaluation of the 
project. Seven main themes were identified: organisation of the project; 
community and connections; supporting the caregivers; enjoyment and enrichment; 
well-being and cognitive benefits of the projects; equipment and instructions; 
and drawbacks within the project. The participants' feedback enabled the artists 
to improve the contents and instructions given each week so that they were able 
to adjust the activities for those people with dementia whose condition was 
declining. Implications are that remote Art workshops are possible during 
lockdown restrictions, but that personal communication is equally important.

DOI: 10.1177/14713012221124863
PMCID: PMC9583286
PMID: 36053501 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1604. Int J Geriatr Psychiatry. 2022 Oct;37(10):10.1002/gps.5803. doi: 
10.1002/gps.5803.

'Pushing back': People newly diagnosed with dementia and their experiences of 
the Covid-19 pandemic restrictions in England.

Dixon J(1), Hicks B(2), Gridley K(3), Perach R(4), Baxter K(3), Birks Y(3), 
Colclough C(4), Storey B(5), Russell A(2), Karim A(2), Tipping E(2), Banerjee 
S(6); DETERMIND team.

Author information:
(1)Care Policy and Evaluation Centre, London School of Economics and Political 
Science, London, UK.
(2)Brighton and Sussex Medical School, University of Sussex, Brighton, UK.
(3)Social Policy Research Unit, University of York, York, UK.
(4)School of Psychology, University of Sussex, Brighton, UK.
(5)Gateshead Health NHS Foundation Trust, Gateshead, UK.
(6)Faculty of Health, University of Plymouth, Plymouth, UK.

BACKGROUND AND OBJECTIVES: Research into people with dementia's experiences of 
the Covid-19 pandemic has tended to focus on vulnerabilities and negative 
outcomes, with the risk of reproducing a discourse in which people with dementia 
are positioned as passive. Informed by concepts positioning people with dementia 
as 'active social agents', we aimed to identify the pandemic-related challenges 
faced by people recently diagnosed with dementia and examine the ways in which 
they actively coped with, and adapted to, these challenges.
RESEARCH DESIGN AND METHODS: In-depth interviews with 21 people recently 
diagnosed with dementia, recruited through an existing national cohort. Data was 
analysed thematically using Framework.
FINDINGS: Key challenges included reduced social contact, loneliness and loss of 
social routines; difficulties accessing and trusting health services; 
dementia-unfriendly practices; and disparate experiences of being able to 'get 
out' into the physical neighbourhood. People with dementia responded to 
challenges by maintaining and extending their social networks and making the 
most of 'nodding acquaintances'; learning new skills, for communication and 
hobbies; supporting others, engaging in reciprocal exchange and valuing 
connection with peers; seeking help and advocacy and challenging and resisting 
dementia-unfriendly practices; maintaining and adapting habitual spatial 
practices and being determined to 'get out'; and employing similar emotional 
coping strategies for the pandemic and dementia.
CONCLUSIONS: Support for people with dementia, especially during public health 
crises when carers and services are under pressure, should involve utilising 
existing capacities, appropriately supporting the acquisition of new knowledge 
and skills, 'safety-netting' through the availability of a named professional, 
advocacy and support and use of 'check-in calls' and creating supportive social 
and environmental circumstances for people with dementia to sustain their own 
well-being.

© 2022 The Authors. International Journal of Geriatric Psychiatry published by 
John Wiley & Sons Ltd.

DOI: 10.1002/gps.5803
PMCID: PMC9539182
PMID: 36052759 [Indexed for MEDLINE]

Conflict of interest statement: We have no conflict of interest to declare.


1605. Clin Transl Gastroenterol. 2022 Oct 1;13(10):e00524. doi: 
10.14309/ctg.0000000000000524.

Decreased Gut Microbiome Tryptophan Metabolism and Serotonergic Signaling in 
Patients With Persistent Mental Health and Gastrointestinal Symptoms After 
COVID-19.

Blackett JW(1), Sun Y(2)(3), Purpura L(4), Margolis KG(5)(6), Elkind MSV(7), 
O'Byrne S(6), Wainberg M(8), Abrams JA(6)(9), Wang HH(3)(6)(10), Chang L(11), 
Freedberg DE(6)(9).

Author information:
(1)Division of Digestive and Liver Diseases, Mayo Clinic, Rochester, Minnesota, 
USA.
(2)Program in Biomedical Informatics, Columbia University Irving Medical Center, 
New York, New York, USA.
(3)Department of Systems Biology, Columbia University Irving Medical Center, New 
York, New York, USA.
(4)Division of Infectious Diseases, Columbia University Irving Medical Center, 
New York, New York, USA.
(5)Department of Pediatrics, Columbia University Irving Medical Center, New 
York, New York, USA.
(6)Columbia University Digestive and Liver Diseases Research Center New York, 
New York, USA.
(7)Department of Neurology, Vagelos College of Physicians and Surgeons, and 
Department of Epidemiology, Mailman School of Public Health, Columbia 
University, New York, New York, USA.
(8)Department of Psychiatry, Columbia University Irving Medical Center and the 
New York State Psychiatric Institute; New York, New York, USA.
(9)Division of Digestive and Liver Diseases, Columbia University Irving Medical 
Center, New York, New York, USA.
(10)Department of Pathology and Cell Biology, Columbia University Irving Medical 
Center, New York, New York, USA.
(11)Vatche and Tamar Manoukian Division of Digestive Diseases and G. Oppenheimer 
Center for Neurobiology of Stress and Resilience, David Geffen School of 
Medicine at UCLA, Los Angeles, California, USA.

INTRODUCTION: An estimated 15%-29% of patients report new gastrointestinal (GI) 
symptoms after coronavirus-19 disease (COVID-19) while 4%-31% report new 
depressive symptoms. These symptoms may be secondary to gut microbiome 
tryptophan metabolism and 5-hydroxytryptamine (5-HT)-based signaling.
METHODS: This study used specimens from 2 patient cohorts: (i) fecal samples 
from patients with acute COVID-19 who participated in a randomized controlled 
trial testing prebiotic fiber and (ii) blood samples from patients with acute 
COVID-19. Six months after recovering from COVID-19, both cohorts answered 
questions related to GI symptoms and anxiety or depression. Microbiome 
composition and function, focusing on tryptophan metabolism-associated pathways, 
and plasma 5-HT were assessed.
RESULTS: In the first cohort (n = 13), gut microbiome L-tryptophan biosynthesis 
during acute COVID-19 was decreased among those who developed more severe GI 
symptoms (2.0-fold lower log activity comparing those with the most severe GI 
symptoms vs those with no symptoms, P = 0.06). All tryptophan pathways showed 
decreased activity among those with more GI symptoms. The same pathways were 
also decreased in those with the most severe mental health symptoms after 
COVID-19. In an untargeted analysis, 5 additional metabolic pathways 
significantly differed based on subsequent development of GI symptoms. In the 
second cohort (n = 39), plasma 5-HT concentration at the time of COVID-19 was 
increased 5.1-fold in those with GI symptoms alone compared with those with 
mental health symptoms alone ( P = 0.02).
DISCUSSION: Acute gut microbiome-mediated reduction in 5-HT signaling may 
contribute to long-term GI and mental health symptoms after COVID-19. Future 
studies should explore modification of 5-HT signaling to reduce post-COVID 
symptoms.

Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on 
behalf of The American College of Gastroenterology.

DOI: 10.14309/ctg.0000000000000524
PMCID: PMC9624499
PMID: 36049050 [Indexed for MEDLINE]

Conflict of interest statement: Guarantor of the article: Daniel E. Freedberg, 
MD, MS. Specific author contributions: J.W.B.: investigation, analysis, writing 
original draft, and review and editing. Y.S.: investigation, data analysis, 
methodology, and review and editing. L.P.: methodology and review and editing. 
K.G.M.: conceptualization, analysis, and review and editing. M.S.V.E.: 
conceptualization, analysis, and review and editing. S.O.B.: investigation and 
review and editing. M.W.: analysis and review and editing. J.A.A.: 
conceptualization, analysis, and review and editing. H.H.W.: conceptualization, 
analysis, and review and editing. L.C.: conceptualization, analysis, and review 
and editing. D.E.F.: conceptualization, investigation, analysis, methodology, 
writing original draft, and review and editing. All authors approved the final 
draft of this manuscript. Financial support: This work was funded by a 2022 
Clinical Trial Award from the American College of Gastroenterology and by a 
Columbia University Division of Digestive and Liver Diseases Research Center 
Pilot Award. Dr. Margolis was funded in part by NIH NIDDK 1RO1DK130518-01, NIH 
NIDDK RO1DK126644, NIHNINDS4RO1NS015547, DoD PR160365, the NASPGHAN Takeda 
Innovator Award, and the Seidenberg Family Foundation. Dr Wang was funded in 
part by the Hirschl Research Scientist Award and Burroughs Welcome Fund PATH 
(1,016,691). Dr Chang was funded in part by NIH grants U54 DK123755 and SPARC 
OT2OD024899. Dr. Freedberg was funded in part by a Columbia University Irving 
Scholar Award and by the Department of Defense PR181960. Potential competing 
interests: We have no relevant conflicts to disclose.


1606. Res Child Adolesc Psychopathol. 2022 Dec;50(12):1543-1555. doi: 
10.1007/s10802-022-00967-5. Epub 2022 Sep 1.

Increases in Circulating Cortisol during the COVID-19 Pandemic are Associated 
with Changes in Perceived Positive and Negative Affect among Adolescents.

Taylor BK(1)(2), Fung MH(3), Frenzel MR(3), Johnson HJ(3), Willett MP(3), 
Badura-Brack AS(4), White SF(3)(5), Wilson TW(3)(5).

Author information:
(1)Institute for Human Neuroscience, Boys Town National Research Hospital, 378 
Bucher Circle, Boys Town, Omaha, NE, 68010, USA. Brittany.K.TaylorPhD@gmail.com.
(2)Department of Pharmacology and Neuroscience, Creighton University, Omaha, NE, 
USA. Brittany.K.TaylorPhD@gmail.com.
(3)Institute for Human Neuroscience, Boys Town National Research Hospital, 378 
Bucher Circle, Boys Town, Omaha, NE, 68010, USA.
(4)Department of Psychological Science, Creighton University, Omaha, NE, USA.
(5)Department of Pharmacology and Neuroscience, Creighton University, Omaha, NE, 
USA.

The Coronavirus Disease 2019 (COVID-19) pandemic has spread across the world and 
resulted in over 5 million deaths to date, as well as countless lockdowns, 
disruptions to daily life, and extended period of social distancing and 
isolation. The impacts on youth in particular are astounding, with shifts in 
learning platforms, limited social outlets, and prolonged uncertainty about the 
future. Surveys have shown that mental health among youth has severely suffered 
during the pandemic. However, limited research to date has reported on 
physiological indices of stress surrounding the pandemic, such as cortisol. 
Cortisol is a stress hormone that typically increases during stressful 
situations and can have deleterious effects on mental and physical health when 
chronically heightened. The present study leveraged hair cortisol concentration 
measurements, which allowed the retrospectiveinvestigation of circulating 
cortisol prior to- versus after pandemic-related local lockdowns during the 
first wave of the pandemic. A final sample of 44 youth ages 10- to 18-years-old 
provided hair samples and reported on their perceived affective well-being and 
level of concern regarding pandemic-related stressors between May and June of 
2020. We found significant levels of concern and decreases in affective 
well-being following local lockdowns. Moreover, we saw that cortisol robustly 
increased following local lockdowns, and those increases were predictive of 
changes in affect. These findings provide critical insights into the underlying 
neuroendocrinology of stress during the pandemic and support the need for 
resources to support youths' mental health and well-being during this globally 
significant event.

© 2022. The Author(s).

DOI: 10.1007/s10802-022-00967-5
PMCID: PMC9435427
PMID: 36048374 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no relevant financial or 
non-financial interests to disclose.


1607. Int J Soc Psychiatry. 2022 Sep;68(6):1232-1237. doi: 10.1177/00207640221116812. 
Epub 2022 Sep 1.

Burnout prevalence and degree among undergraduate medical students in Indonesia 
during 1 month of the COVID-19 pandemic: A cross-sectional descriptive survey.

Cipta DA(1), Wijovi F(2), Melisa L(3), Lili R(4), Marcella E(2), Tancherla A(2), 
Siswanto FG(5), Adiya DAKL(2), Chen S(2), Dermawan GJCI(5), Louis MI(5), 
Citraningtyas T(4)(6), Molodynski A(7).

Author information:
(1)Department of Psychiatry, Pelita Harapan University, Tangerang, Indonesia.
(2)Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia.
(3)Department of Psychiatry, Universitas Indonesia, Jakarta, Indonesia.
(4)Personality and Human Relations Indonesia, Jakarta, Indonesia.
(5)Asian Medical Student Association Indonesia, Jakarta, Indonesia.
(6)Department of Psychiatry, Krida Wacana University, Jakarta, Indonesia.
(7)Department of Psychiatry, Oxford University, UK.

BACKGROUND: Medical students are under high pressure to perform academically and 
also face the impact of the COVID-19 pandemic, putting them at risk of 
developing burnout.
AIMS: This study aims to evaluate the prevalence and degree of burnout among 
medical students in Indonesia during 1 month of the COVID-19 pandemic.
METHODS: From April to May 2021, we conducted an online survey of Indonesian 
medical students to assess burnout (using Maslach Burnout Inventory-Student 
Survey, MBI-SS).
RESULTS: A total of 1,947 students from 27 universities participated in the 
study. About 35.5% had burnout, 41.7% with a moderate to high level of emotional 
exhaustion, 45% had moderate to high level of depersonalization and 66.7% had a 
low level of personal accomplishment.
CONCLUSION: A total of 35.5% of medical students in our sample experienced 
burnout. We suggest further research to explore and identify factors related to 
these findings and the need for potential interventions at global and national 
level to enhance the well-being of medical students.

DOI: 10.1177/00207640221116812
PMID: 36047053 [Indexed for MEDLINE]


1608. Aust J Gen Pract. 2022 Sep;51(9):705-711. doi: 10.31128/AJGP-10-21-6223.

How mindful self-care practices changed during the winter 2020 COVID-19 lockdown 
in Western Sydney.

Bakhshi S(1), Brennan ME(2), Verdonk B(3), Vukasovic M(4), Coggins A(5).

Author information:
(1)BSc, BAppSc (DiagRadiog)(Hons), School of Medicine, The University of Notre 
Dame Australia, Sydney, NSW.
(2)BMed, FRACGP, PhD, Medical Educator, School of Medicine, The University of 
Notre Dame Australia, Sydney, NSW; Sydney Medical School, The University of 
Sydney, NSW.
(3)BS, MD, Junior Medical Officer, COVID-19 Clinic, Westmead Hospital, NSW.
(4)MBBS, FACEM, Staff Specialist Emergency Physician, Emergency Department, 
Westmead Hospital, NSW.
(5)MBChB, FRCP, FRCEM, FACEM, Staff Specialist Emergency Physician, Emergency 
Department, Westmead Hospital, NSW.

BACKGROUND AND OBJECTIVES: Self-care strategies are important to maintain 
psychological wellbeing. The aim of this study was to explore how self-care 
changed during the first COVID-19 lockdown in winter 2020 and identify 
targets for interventions.
METHOD: This was a cross-sectional study. Participants attending a COVID-19 
testing clinic completed the Mindful Self-Care Scale (MSCS) and Hospital 
Anxiety and Depression Scale (HADS).
RESULTS: A total of 332 participants completed questionnaires (mean age 38 
years, 55% female). Self-care strategies used less frequently during lockdown 
when compared with pre-lockdown were in MSCS domains of Physical Care 
(P <0.001), Supportive Relationships (P <0.001), Supportive Structures 
(P <0.001) and Mindful Awareness (P <0.001). Mean anxiety and depression scores 
were 5.97 (standard deviation [SD] = 4.36) and 4.12 (SD = 3.594).
DISCUSSION: Several pre-pandemic strategies were used less frequently, including 
individual activities not restricted during lockdown ('listening'; 'using 
images' to relax). This study provides insight into activities that are 
practised and reduced during a lockdown, which can guide wellbeing interventions 
to assist people in isolation.

DOI: 10.31128/AJGP-10-21-6223
PMID: 36045628 [Indexed for MEDLINE]


1609. BMC Public Health. 2022 Aug 31;22(1):1654. doi: 10.1186/s12889-022-14055-2.

The public health impact of loneliness during the COVID-19 pandemic.

Allen J(1), Darlington O(2), Hughes K(3)(4), Bellis MA(3)(4).

Author information:
(1)World Health Organization Collaborating Centre On Investment for Health and 
Well-Being, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, 
CF10 4BZ, UK. james.allen@wales.nhs.uk.
(2)World Health Organization Collaborating Centre On Investment for Health and 
Well-Being, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, 
CF10 4BZ, UK.
(3)World Health Organization Collaborating Centre On Investment for Health and 
Well-Being, Public Health Wales, Wrexham, UK.
(4)Public Health Collaborating Unit, School of Medical and Health Sciences, 
Bangor University, Wrexham, UK.

BACKGROUND: Social distancing measures have been effective in mitigating the 
spread of COVID-19; however, they have imposed a significant burden on 
population mental health and well-being. This study aimed to identify factors 
associated with loneliness during the COVID-19 pandemic, and to describe the 
relationship between loneliness and the risk of worsening health outcomes and 
behaviours.
METHODS: Data for 8,960 adults were drawn from a national cross-sectional survey 
undertaken in Wales between January and June 2021. Participants self-reported 
changes to health and behaviour since the start of the pandemic. Logistic 
regression was used to identify factors associated with loneliness, and the 
impact of loneliness on self-reported changes in physical health, physical 
fitness, mental health, weight, alcohol consumption and social relations in 
comparison with pre-pandemic experiences.
RESULTS: Groups most at risk of loneliness were those aged < 35 years, women 
(odds ratio [95% confidence interval]: 1.86 [1.70-2.05]), those with chronic 
health conditions (1.43 [1.29-1.58]) and the unemployed (2.18 [1.76-2.70]). 
Loneliness was a strong predictor of worsening health outcomes and behaviours, 
with those reporting often feeling lonely being at increased odds of worsening 
physical health (3.29 [2.80-3.86]), physical fitness (2.22 [1.90-2.60]), mental 
health (8.33 [6.95-9.99]), weight (1.39 [1.19-1.62]), alcohol consumption (1.37 
[1.12,-1.66]) and social relations (2.45 [2.07-2.89]) during the pandemic.
CONCLUSION: This study established an association between loneliness and 
self-reported worsening health during the pandemic, and identified factors 
increasing the risk of loneliness. The effect that social control measures have 
on loneliness should influence the design of future public health policy.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-14055-2
PMCID: PMC9433133
PMID: 36045422 [Indexed for MEDLINE]

Conflict of interest statement: None declared.


1610. PLoS One. 2022 Aug 31;17(8):e0273829. doi: 10.1371/journal.pone.0273829. 
eCollection 2022.

Comparisons of home-based arts engagement across three national lockdowns during 
the COVID-19 pandemic in England.

Mak HW(1), Bu F(1), Fancourt D(1).

Author information:
(1)Department of Behavioral Science and Health, Institute of Epidemiology & 
Health Care, University College London, United Kingdom.

Between March 2020 and March 2021, the United Kingdom (UK) experienced three 
lockdowns due to the COVID-19 pandemic. Given the evident association between 
arts engagement and wellbeing, this study was designed to compare the predictors 
and patterns of home-based arts engagement during these lockdowns. Data analysed 
in this study were from the UK COVID-19 Social Study run by University College 
London. Multinomial logistic regression was used to identify predictors of arts 
engagement and compare (i) respondents' engagement levels during the first 
lockdown in April/May 2020 and their levels in pre-pandemic times (N = 23,086), 
(ii) their engagement levels during the second lockdown in November/December 
2020 with their levels during the first lockdown (N = 11,481), and (iii) their 
engagement levels during the third lockdown in January/February 2021 with their 
levels during the first lockdown (N = 13,270). During first lockdown, 1 in 4 
increased their arts engagement and 1 in 6 decreased it. Of those who increased, 
2 in 5 maintained or further increased their engagement in subsequent lockdowns, 
but just 7% of those who had decreased their engagement increased it. Younger 
adults (aged 18-29) showed initial increases in first lockdown, whilst people 
who were not employed and those with a physical health condition showed 
decreases and people with a mental health condition showed changes during the 
first lockdown (both increases and decreases). Females and people with higher 
education showed continuous changes across the three lockdowns, with women being 
more likely to increase their engagement and those with higher education being 
less likely to decrease. People of ethnic minorities and those with higher 
income declined their engagement in the third lockdown. This study provides 
insight into levels of arts engagement across the three national lockdowns in 
the UK and suggests that the pandemic may have affected long-term cultural 
behaviours for some groups.

DOI: 10.1371/journal.pone.0273829
PMCID: PMC9432750
PMID: 36044522 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


1611. Singapore Med J. 2022 May;63(5):229-235. doi: 10.11622/smedj.2020111. Epub 2020 
Jul 30.

Psychological sequelae within different populations during the COVID-19 
pandemic: a rapid review of extant evidence.

Tng XJJ(1)(2), Chew QH(1)(2), Sim K(3).

Author information:
(1)Research Department, Institute of Mental Health, Singapore.
(2)These two authors contributed equally as first authors in this work.
(3)West Region, Institute of Mental Health, Singapore.

The rapid spread of COVID-19 has a potentially significant impact on not only 
physical health but also psychological well-being. To the best of our knowledge, 
no review thus far has consolidated the psychological impact of COVID-19 across 
different subpopulations. A systematic search of the literature until 15 June 
2020 found 150 empirical papers pertinent to the mental health consequences of 
the pandemic. The majority (87.3%) were from China (45.3%), the rest of Asia 
(22.0%) and Europe (20.0%), and mostly examined the general population (37.3%), 
healthcare workers (31.3%) and those with pre-existing mental and physical 
illnesses (14.7%). The most common psychological responses across these 
subpopulations were anxiety (overall range 24.8%-49.5%), depression (overall 
range 18.6%-42.6%) and traumatic stress symptoms (overall range 12.7%-31.6%). 
Healthcare workers and those with pre-existing physical and mental illnesses 
were more severely affected. Future studies are needed on underexamined 
subgroups such as the elderly and patients who recovered from COVID-19.

Copyright: © Singapore Medical Association.

DOI: 10.11622/smedj.2020111
PMCID: PMC9297191
PMID: 36043286 [Indexed for MEDLINE]


1612. J Pediatr Nurs. 2022 Nov-Dec;67:e135-e149. doi: 10.1016/j.pedn.2022.08.014. Epub 
2022 Aug 28.

Scoping review of interventions to support families with preterm infants 
post-NICU discharge.

Griffith T(1), Singh A(2), Naber M(3), Hummel P(3), Bartholomew C(3), Amin S(3), 
White-Traut R(4), Garfield L(2).

Author information:
(1)Department of Family and Community Health Nursing, Marcella Niehoff School of 
Nursing, Loyola University Chicago, Maywood, IL, USA. Electronic address: 
tgriffith1@luc.edu.
(2)Department of Family and Community Health Nursing, Marcella Niehoff School of 
Nursing, Loyola University Chicago, Maywood, IL, USA.
(3)Division of Neonatology, Loyola University Medical Center, Maywood, IL, USA.
(4)Nursing Research, Children's Wisconsin, Milwaukee, WI, United States of 
America; Women, Children and Family Health Science, College of Nursing, 
University of Illinois at Chicago, Chicago, IL, United States of America.

Comment in
    J Pediatr Nurs. 2023 Sep-Oct;72:207-208.

BACKGROUND: A successful transition from the NICU to home is fundamental for the 
long-term health and well-being of preterm infants. Post-NICU discharge, parents 
may experience a lack of support and resources during the transition to home. 
The purpose of this scoping review was to identify post-NICU discharge 
interventions that may reduce parental stress and provide support to families 
with preterm infants.
METHOD: Systematic searches of databases, i.e., PubMed, Web of Science, and 
CINAHL. Inclusion criteria were data-based articles: 1) published in English 
between 2011 and 2021, 2) published in peer-reviewed journals, (3) focused on 
families with preterm infants, and (4) focused on interventions to reduce 
parental stress and provide support to families with preterm infants post-NICU 
discharge.
RESULTS: 26 articles were included and synthesized. We identified the following 
face-to-face and remote communication interventions: in-person home visits, 
phone/video calls, text messages, periodic email questionnaires, mobile/website 
apps, and online social networking sites.
DISCUSSION: Families may highly benefit from a comprehensive family-focused 
post-NICU discharge follow-up intervention that includes face-to-face and remote 
communication and support. Post-NICU discharge interventions are imperative to 
provide education related to infant care and health, increase parental 
confidence and competency, increase parent-infant relationship, promote 
emotional and social support, reduce unplanned hospital visits, parental stress, 
and maternal post-partum depression.

Copyright © 2022 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.pedn.2022.08.014
PMCID: PMC9729411
PMID: 36041959 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


1613. Prev Sci. 2024 Feb;25(2):267-278. doi: 10.1007/s11121-022-01418-9. Epub 2022 Aug 
30.

Family Strengthening in the Context of COVID-19: Adapting a Community-Based 
Intervention from Kenya to the United States.

Puffer ES(1)(2), Johnson SL(3)(4), Quick KN(4), Rieder AD(4), Mansoor M(4), 
Proeschold-Bell RJ(4), Jones S(3), Moore-Lawrence S(5), Rasmussen JD(3), 
Cucuzzella C(3), Burwell F(5), Dowdy L(5), Moore F(5), Rosales N(5), Sanyal 
A(3)(4), Ramachandran P(4), Duerr E(3), Tice L(4), Ayuku D(6), Boone WJ(5).

Author information:
(1)Department of Psychology and Neuroscience, Duke University, Durham, NC, USA. 
eve.puffer@duke.edu.
(2)Duke Global Health Institute, Duke University, Durham, NC, USA. 
eve.puffer@duke.edu.
(3)Department of Psychology and Neuroscience, Duke University, Durham, NC, USA.
(4)Duke Global Health Institute, Duke University, Durham, NC, USA.
(5)Together for Resilient Youth, Durham, NC, USA.
(6)Department of Behavioral Sciences, Moi University, Eldoret, Kenya.

COVID-19 led to widespread disruption of services that promote family 
well-being. Families impacted most were those already experiencing disparities 
due to structural and systemic barriers. Existing support systems faded into the 
background as families became more isolated. New approaches were needed to 
deliver evidence-based, low-cost interventions to reach families within 
communities. We adapted a family strengthening intervention developed in Kenya 
("Tuko Pamoja") for the United States. We tested a three-phase participatory 
adaptation process. In phase 1, we conducted community focus groups including 11 
organizations to identify needs and a community partner. In phase 2, the 
academic-community partner team collaboratively adapted the intervention. We 
held a development workshop and trained community health workers to deliver the 
program using an accelerated process combining training, feedback, and iterative 
revisions. In phase 3, we piloted Coping Together with 18 families, collecting 
feedback through session-specific surveys and participant focus groups. 
Community focus groups confirmed that concepts from Tuko Pamoja were relevant, 
and adaptation resulted in a contextualized intervention-"Coping Together"-an 
8-session virtual program for multiple families. As in Tuko Pamoja, 
communication skills are central and applied for developing family values, 
visions, and goals. Problem-solving and coping skills then equip families to 
reach goals, while positive emotion-focused activities promote openness to 
change. Sessions are interactive, emphasizing skills practice. Participants 
reported high acceptability and appropriateness, and focus groups suggested that 
most content was understood and applied in ways consistent with the theory of 
change. The accelerated reciprocal adaptation process and intervention could 
apply across resource-constrained settings.

© 2022. Society for Prevention Research.

DOI: 10.1007/s11121-022-01418-9
PMCID: PMC9425799
PMID: 36040621 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1614. Br J Psychiatry. 2023 Feb;222(2):58-66. doi: 10.1192/bjp.2022.103.

Multicentre, England-wide randomised controlled trial of the 'Foundations' 
smartphone application in improving mental health and well-being in a healthcare 
worker population.

Gnanapragasam SN(1), Tinch-Taylor R(2), Scott HR(3), Hegarty S(3), Souliou E(3), 
Bhundia R(3), Lamb D(4), Weston D(3), Greenberg N(3), Madan I(5), Stevelink 
S(3), Raine R(4), Carter B(2), Wessely S(3).

Author information:
(1)Department of Psychological Medicine, Institute of Psychiatry Psychology and 
Neuroscience, King's College London, Weston Education Centre, UK and South 
London and Maudsley NHS Foundation Trust, UK.
(2)Department of Biostatistics and Health Informatics and King's Clinical Trials 
Unit, Institute of Psychiatry Psychology and Neuroscience, King's College 
London, UK.
(3)Department of Psychological Medicine, Institute of Psychiatry Psychology and 
Neuroscience, King's College London, Weston Education Centre, UK.
(4)Department of Applied Health Research, University College London, UK.
(5)Department of Occupational Health, Guy's and St Thomas' NHS Foundation Trust, 
UK.

BACKGROUND: Healthcare workers (HCWs) have faced considerable pressures during 
the COVID-19 pandemic. For some, this has resulted in mental health distress and 
disorder. Although interventions have sought to support HCWs, few have been 
evaluated.
AIMS: We aimed to determine the effectiveness of the 'Foundations' application 
(app) on general (non-psychotic) psychiatric morbidity.
METHOD: We conducted a multicentre randomised controlled trial of HCWs at 16 NHS 
trusts (trial registration number: EudraCT: 2021-001279-18). Participants were 
randomly assigned to the app or wait-list control group. Measures were assessed 
at baseline, after 4 and 8 weeks. The primary outcome was general psychiatric 
morbidity (using the General Health Questionnaire). Secondary outcomes included: 
well-being; presenteeism; anxiety; depression and insomnia. The primary analysis 
used mixed-effects multivariable regression, presented as adjusted mean 
differences (aMD).
RESULTS: Between 22 March and 3 June 2021, 1002 participants were randomised 
(500:502), and 894 (89.2%) followed-up. The sample was predominately women 
(754/894, 84.3%), with a mean age of 44⋅3 years (interquartile range (IQR) 
34-53). Participants randomised to the app had a reduction in psychiatric 
morbidity symptoms (aMD = -1.39, 95% CI -2.05 to -0.74), improvement in 
well-being (aMD = 0⋅54, 95% CI 0⋅20 to 0⋅89) and reduction in insomnia (adjusted 
odds ratio (aOR) = 0⋅36, 95% CI 0⋅21 to 0⋅60). No other significant findings 
were found, or adverse events reported.
CONCLUSIONS: The app had an effect in reducing psychiatric morbidity symptoms in 
a sample of HCWs. Given it is scalable with no adverse effects, the app may be 
used as part of an organisation's tiered staff support package. Further evidence 
is needed on long-term effectiveness and cost-effectiveness.

DOI: 10.1192/bjp.2022.103
PMCID: PMC10895508
PMID: 36040419 [Indexed for MEDLINE]

Conflict of interest statement: N.G. runs a psychological health consultancy 
that provides resilience training for a wide range of organisations, including a 
few NHS teams. All other authors declare no competing interests.


1615. Tijdschr Psychiatr. 2022;64(7):403-410.

[Parental experiences of distance schooling during the COVID-19 pandemic: 
Effects on children with and without mental health problems].

[Article in Dutch]

Staff AI, Fuermaier ABM, van den Hoofdakker BJ, Luman M, Thorell LB, Dekkers TJ.

BACKGROUND: In some lockdowns during the COVID-19 pandemic in 2020 and 2021, 
schools were closed and children attended distance learning.
AIM: To investigate parental experiences of the effects of distance learning on 
the wellbeing of child and parent(s), and whether this differed between children 
with and without mental health problems and their parents.
METHOD: Parents of children with (n = 192) and without (n = 271) mental health 
problems reported their experiences with distance learning. We investigated 
whether experiences differed between groups of parents, and whether experiences 
were influenced by characteristics of parents.
RESULTS: Parents of children with mental health problems reported the quality of 
distance learning and the ability of their child to participate as lower 
relative to other parents. These differences increased when parents themselves 
were in higher need of support. General experiences and the levels of stress 
reported by parents did not differ between groups. Parents reported an increase 
in their child&rsquo;s digital media use, particularly for children with mental 
health problems.
CONCLUSION: Children with mental health problems seem more negatively affected 
by distance learning, especially when parents have problems themselves. These 
findings are in line with multiple recent studies and argue for minimizing 
distance learning.

PMID: 36040079 [Indexed for MEDLINE]


1616. Health Care Manage Rev. 2022 Oct-Dec 01;47(4):350-359. doi: 
10.1097/HMR.0000000000000345. Epub 2022 Apr 5.

Rethinking how health care professionals cope with stress: A process model for 
COVID-19 and beyond.

Harley JM, Montreuil TC, Lou NM, Feldman LS, Fried GM, Lavoie-Tremblay M, Bhanji 
F, Kennedy H.

ISSUE: Prior to the COVID-19 pandemic, there was evidence of challenges 
surrounding the psychological well-being of health care professionals (HCPs). 
HCPs already frayed psychological ability to cope risks being further 
compromised by COVID-19-related stresses.
CRITICAL THEORETICAL ANALYSIS: Most research on stress, psychological distress, 
and coping among HCPs is done in a piecemeal manner without a theoretical model 
connecting these different but related phenomena. This critical advancement 
article aims to apply and extend Wheaton and Montazer's model of stressors, 
stress, and distress to the literature on HCPs, generally, and COVID-19, 
specifically, to summarize past and guide future research on HCPs' mental 
health, resilience, and coping. Our model describes how different sources of 
support buffer the effect of stressors on stress and how coping strategies 
moderate the effect of stress on psychological distress.
ADVANCE: We extended the model by (a) distinguishing context from the support in 
HCPs' environment; (b) distinguishing adaptive from maladaptive coping 
strategies and their relationships with antecedents and outcomes; (c) describing 
the adverse impacts that psychological distress has on patients, HCPs, and 
health services; and (d) describing how such outcomes can become stressors, in 
turn, further contributing to HCPs' stress in a vicious cycle.
PRACTICE IMPLICATIONS: Our model provides a broader perspective of HCPs' 
work-related mental health and helps guide the creation, implementation, and 
evaluation of different sources of support and promote adaptive coping 
strategies. This model helps HCPs, researchers, and health services managers 
better understand and respond to the well-being crisis HCPs are facing, 
especially during the pandemic.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/HMR.0000000000000345
PMID: 36036897 [Indexed for MEDLINE]


1617. Exp Aging Res. 2023 Jul-Sep;49(4):389-406. doi: 10.1080/0361073X.2022.2115739. 
Epub 2022 Aug 29.

Overload and Emotional Wellbeing in a Sample of Spanish Caregivers of 
Alzheimer's Patients during COVID-19 pandemic.

Rodríguez-Mora Á(1)(2), Mateo Guirola T(2), Mestre JM(1)(2)(3).

Author information:
(1)Instituto Universitario para el Desarrollo Social y Sostenible, Universidad 
de Cádiz, Cádiz, Spain.
(2)Department of Psychology, Universidad de Cádiz, Cádiz, Spain.
(3)Instituto de Investigación e Innovación Biomédica de Cádiz, Universidad de 
Cádiz, Cádiz, Spain.

INTRODUCTION: Carers of Alzheimer's suffer from caregiver overload, anxiety and 
depression. Changes in caregiving brought about by pandemic restrictions 
(COVID-19) may play a role. The aim was to explore the caregiver profile and 
assess the influence of the pandemic on informal and formal caregivers in a 
Spanish sample.
METHOD: Sixty caregivers participated. An ad hoc questionnaire, ZBI, STAI and 
BDI were administered.
RESULTS: Informal caregivers were more overloaded, anxious and depressed than 
professional caregivers. Both groups perceived themselves to be more sad, 
worried and stressed than in the pre-pandemic situation. The pandemic-generated 
variables associated with caregiving did not influence caregiver overload in 
both groups. In informal caregivers, worsening of the patient with stress and 
changes in perceived social support with anxiety and depression. In professional 
caregivers, changes in routine were associated with stress and lower depression 
and changes in perceived social support with higher caregiver strain. Changes in 
caregiving routine and changes in perceived social support were predictors of 
overload and emotional distress in both caregivers.
CONCLUSIONS: Overload was not influenced by the pandemic situation. Changes in 
caregiving routine and lack of social support were found to be predictors of 
overload and emotional distress in both types of caregivers.

DOI: 10.1080/0361073X.2022.2115739
PMID: 36036728 [Indexed for MEDLINE]


1618. Pan Afr Med J. 2022 Jun 14;42:120. doi: 10.11604/pamj.2022.42.120.33774. 
eCollection 2022.

Impact of COVID-19 pandemic in adolescents on HIV treatment.

Wyk BV(1), Mayman Y(1).

Author information:
(1)School of Public Health, University of the Western Cape, Bellville, South 
Africa.

The COVID-19 pandemic and concomitant lockdown restrictions in South Africa pose 
critical challenges for adolescents living with HIV (ALHIV) and on ART, 
impacting their ability to remain engaged in care and adherent to antiretroviral 
therapy (ART). Not only has this pandemic directly impacted the health care that 
ALHIV receive, but it has also consequently had devastating effects on society 
and has negatively affected the mental health and well-being of ALHIV. The 
challenges associated with the impact of the COVID-19 pandemic on disadvantaged 
groups such as ALHIV on ART need to be further explored as it may offer hope to 
ALHIV and restore confidence in the health system.

Copyright: Brian Van Wyk et al.

DOI: 10.11604/pamj.2022.42.120.33774
PMCID: PMC9392010
PMID: 36034018 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1619. Front Public Health. 2022 Aug 10;10:921196. doi: 10.3389/fpubh.2022.921196. 
eCollection 2022.

The coronavirus pandemic: Psychosocial burden, risk-perception, and attitudes in 
the Austrian population and its relation to media consumption.

Schabus M(1), Eigl ES(1), Widauer SS(1).

Author information:
(1)Department of Psychology, University of Salzburg, Salzburg, Austria.

OBJECTIVE: The aim was to assess the psychosocial burden, risk-perception and 
attitudes regarding the coronavirus pandemic among the Austrian population after 
the second infection wave in Austria.
METHODS: A self-designed questionnaire was available online from 17th January to 
19th February 2021. Knowledge, attitudes, fears, and psychosocial burdens were 
collected in a comprehensive convenience sample of 3,848 adults from the 
Austrian general population.
RESULTS: 67.2% reported their greatest fear was that a close relative could be 
infected; the fear of dying from COVID-19 oneself, however, was mentioned least 
frequently (15.2%). Isolation from family and friends (78%), homeschooling for 
parents (68.4%), and economic consequences (67.7%) were perceived as most 
stressful factors during the pandemic. Personal risk for COVID-19-associated 
(ICU) hospitalization was overestimated 3- to 97-fold depending on age group. 
Depending on the media mainly consumed, the sample could be divided into two 
subsamples whose estimates were remarkably opposite to each other, with regular 
public media users overestimating hospitalization risk substantially more.
CONCLUSION: The results show a high degree of psychosocial burden in the 
Austrian population and emphasize the need for more objective risk communication 
in order to counteract individually perceived risk and consequently anxiety. 
Altogether data call for a stronger focus and immediate action for supporting 
mental well-being and general health in the aftermath of the coronavirus 
pandemic.

Copyright © 2022 Schabus, Eigl and Widauer.

DOI: 10.3389/fpubh.2022.921196
PMCID: PMC9399513
PMID: 36033772 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1620. Data Brief. 2022 Oct;44:108551. doi: 10.1016/j.dib.2022.108551. Epub 2022 Aug 
23.

Working conditions and stressors data during Covid-19 and mental well-being in 
Iranian healthcare workers.

Kangarlou MB(1), Fatemi F(2), Dehdashti A(2)(3), Paknazar F(3).

Author information:
(1)Student Research Committee, Semnan University of Medical Sciences, Semnan, 
Iran.
(2)Research Center of Health Sciences and Technologies, Semnan University of 
Medical Sciences, Semnan, Iran.
(3)Social Determinants of Health Research Center, Semnan University of Medical 
Sciences, Semnan, Iran.

The current Covid-19 pandemic has affected the physical and mental stressors of 
hospital-based healthcare workers, but the extent of such effects are required 
to be quantified. This survey looked at data on nurses' perception across 
teaching hospitals to assess the impacts of Covid-19 on working conditions, 
exposure to stressors, and mental health symptoms. We implemented a population 
survey with a cross-sectional design in teaching hospitals affiliated with 
Medical Sciences Universities in Iran from April to November 2021. Participants 
were about 1200 health care workers, including hospital nursing staff, 
assistants, and technicians. Final data were assembled from 831 hospital nurses 
across surgery, dialysis, intensive care, emergency care, cardiac care, internal 
medicine, gynecology, and pediatric wards. Self-reported data were collected 
directly from survey participants. We collected information on variables 
including gender, marital status, employment status, occupational health 
training, evaluation of work environment stressors, fear of Covid-19, and 
occupational burnout constructs, specifically reflecting emotional exhaustion, 
depersonalization, and personal accomplishment. Focus groups of faculties 
evaluated and edited items to test the content wording and to define the content 
that are valid measures of the variables. The questionnaires were assessed for 
their reliability. Manual data entries were double-checked for errors. Data were 
recorded and categorized consistently to ensure the replicability of the data in 
the future. Statistical descriptive and analytical analyses were performed on 
the data. Data reported on the frequencies and mean values of responses and the 
variations of mental health in terms of worktime schedules. Chi- square, ANOVA, 
and correlation analyses determined relations between variables. The compiled 
data shed light on the exposure and response to physical and psychosocial 
factors and mental health symptoms among nurses during the pandemic. The data 
files detailed in this article can be further reused to inform workplace 
determinants of health in hospital settings. The obtained scores and existing 
dataset on mental health outcomes can help future studies to consider resilience 
strategies that should be provided among nurses.

© 2022 Published by Elsevier Inc.

DOI: 10.1016/j.dib.2022.108551
PMCID: PMC9395226
PMID: 36033371

Conflict of interest statement: The authors declare that they have no known 
competing financial interests or personal relationships that could have appeared 
to influence the work reported in this paper.


1621. Sex Med Rev. 2022 Oct;10(4):714-753. doi: 10.1016/j.sxmr.2022.06.005. Epub 2022 
Jun 30.

Sexual Health During COVID-19: A Scoping Review.

Toldam NE(1), Graugaard C(2), Meyer R(3), Thomsen L(4), Dreier S(4), Jannini 
EA(5), Giraldi A(6).

Author information:
(1)Center for Sexology Research, Department of Clinical Medicine, Aalborg 
University, Denmark; Sexological Clinic, Mental Health Center, Copenhagen, 
Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, 
Denmark.
(2)Center for Sexology Research, Department of Clinical Medicine, Aalborg 
University, Denmark.
(3)Clinical Pharmacology Unit, Zealand University Hospital, Roskilde, Denmark.
(4)Aalborg University Library, Aalborg, Denmark.
(5)Department of System Medicine, University of Rome Tor Vergata, Italy.
(6)Sexological Clinic, Mental Health Center, Copenhagen, Copenhagen University 
Hospital - Mental Health Services CPH, Copenhagen, Denmark; Department of 
Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Electronic 
address: annamaria.giraldi@regionh.dk.

INTRODUCTION: The COVID-19 pandemic impacted profoundly on the wellbeing and 
social interactions of the world population, and all dimensions of sexual health 
were potentially affected by globally implemented preventive measures.
OBJECTIVES: The scoping review aimed to compile existing research investigating 
possible effects of COVID-19 lockdowns on adult sexual health, that is, sexual 
behavior, functioning, and satisfaction. Further, studies on the interplay 
between mental health and sexual well-being during the pandemic were reviewed.
METHODS: The review was conducted in accordance with guidelines established by 
the Joanna Briggs Institute and the Extension for Scoping Reviews (PRISMA-ScR) 
Checklist. On October 11-12, 2021, PubMed, Embase, PsycInfo, Cinahl, Cochrane, 
Sociological Abstracts and Scopus were systematically searched for relevant 
peer-reviewed papers employing quantitative methodology. Additionally, 
unpublished ("grey") research studies on the subject were retrieved. The 
screening, data extraction, and analysis of evidence were conducted by 4 
independent reviewers using an iterative approach.
RESULTS: Based on 107 studies included, the scoping review showed that the 
pandemic had had a wide impact on all dimensions of sexual health. Except for 
solo sex activities, mainly negative COVID-19 implications were identified, 
although findings were, in sum, characterized by complexity and 
unpredictability. Thus, sexual behavior, functioning, and satisfaction during 
the pandemic appeared to be mitigated by a broad range of sociodemographic and 
contextual factors. Finally, sexual health seemed deeply entwined with overall 
mental health.
CONCLUSION: The scoping review revealed a broad range of COVID-19-related 
effects on sexual health, including an overall decline in partnered sex and a 
concurrent increase in solo sex activities. It also emphasized a need for future 
research to shed light on possible long-term consequences of the pandemic in 
various population groups and on all aspects of sexual health. Toldam NE, 
Graugaard C, Meyer R, et al. Sexual Health During COVID-19: A Scoping Review. 
Sex Med Rev 2022;10:714-753.

Copyright © 2022 International Society for Sexual Medicine. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.sxmr.2022.06.005
PMCID: PMC9242892
PMID: 36030177 [Indexed for MEDLINE]


1622. J Affect Disord. 2022 Nov 15;317:84-90. doi: 10.1016/j.jad.2022.08.086. Epub 
2022 Aug 24.

Psychological impact of COVID-19 after hospital discharge: A follow-up study on 
Italian recovered patients.

Spada MS(1), Biffi AM(2), Belotti L(2), Cremaschi L(3), Palumbo C(4), Locatelli 
C(4), Cesana BM(5), Bondi E(4).

Author information:
(1)Department of Psychology, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy. 
Electronic address: sspada@asst-pg23.it.
(2)Department of Psychology, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy.
(3)University of Milan, Department of Mental Health, Department of Biomedical 
and Clinical Sciences Luigi Sacco, Milan, Italy.
(4)Department of Psychiatry, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy.
(5)Department of Clinical Sciences and Community Health, Unit of Medical 
Statistics, Biometry and Bioinformatics "Giulio A. Maccacaro", Faculty of 
Medicine and Surgery, University of Milan, Milan, Italy.

BACKGROUND: Since COVID-19 outbreak, clinical experience on its management 
during the acute phase has rapidly grown, including potential effects on the 
psychopathological dimension. However, still few data are available regarding 
the impact on survivors' mental health over the long-term.
METHODS: A sample of 1457 COVID-19 patients underwent a multidisciplinary 
follow-up protocol, approximately 3 months after hospital discharge, including a 
psychological evaluation. The primary outcomes were anxiety, depression, 
resilience, post-traumatic symptoms, and health-related quality of life. 
Furthermore, we examined the potential role of hospitalization and delay in the 
follow-up assessment on the increased burden of illness.
RESULTS: Although a general high level of resilience emerged, suggesting most 
patients relied on their individual and interpersonal resources to face 
difficulties related to the pandemic, almost one third of the sample reported 
signs of psychological distress over time, especially post-traumatic symptoms, 
with anxiety being more represented than depression. Furthermore, 
hospitalization - regardless of the setting of care - and promptness in 
follow-up evaluation were found to play a protective role on patients' recovery 
and mental wellbeing.
LIMITATIONS: Selection bias of patients exclusively admitted to the hospital; 
absence of a control group; psychological assessment relying on self-reported 
instruments.
CONCLUSIONS: The current crisis demands resilience and adjustment resources, 
either in the acute and post-acute phase. Thus, the clinical effort should aim 
at relieving the traumatic impact of such condition through timely 
interventions. Further investigation may address potential predictors of 
developing a traumatic stress response, in order to identify and promptly treat 
at-risk subpopulations.

Copyright © 2022 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2022.08.086
PMCID: PMC9400369
PMID: 36029882 [Indexed for MEDLINE]


1623. BMC Geriatr. 2022 Aug 26;22(1):707. doi: 10.1186/s12877-022-03396-7.

Loneliness, loneliness literacy, and change in loneliness during the COVID-19 
pandemic among older adults: a cross-sectional study.

Hsu HC(1)(2), Chao SF(3).

Author information:
(1)School of Public Health, Taipei Medical University, No.250, Wuxing Street, 
11031, Taipei, Taiwan, R.O.C.. gingerhsu@tmu.edu.tw.
(2)Research Center of Health Equity, College of Public Health, Taipei Medical 
University, Taipei, Taiwan, R.O.C.. gingerhsu@tmu.edu.tw.
(3)Department of Social Work, National Taiwan University, Taipei, Taiwan, R.O.C.

BACKGROUND: Loneliness has become a significant public health concern for older 
people. However, little is known about the association of loneliness, loneliness 
literacy, and changes in loneliness during the COVID-19 pandemic with mental 
well-being. The purpose of this study was to explore whether loneliness literacy 
is related to a lower risk of loneliness, increased loneliness during the 
COVID-19 pandemic, and improved mental well-being for community-based older 
adults.
METHODS: A telephone survey was conducted to collect data from older adults aged 
65 years or older in Taiwan (n = 804). Loneliness, change in loneliness during 
COVID-19, and loneliness literacy were the main variables. Mental well-being was 
assessed by depressive symptoms and life satisfaction. Related factors included 
personal level (demographics, health conditions, health behaviors, and 
problem-focused/ emotion-focused coping strategies), interpersonal level 
(marital status, living arrangements, social support, social participation, 
leisure activities, and social interactions during COVID-19), and societal level 
(areas and regions) factors.
RESULTS: Four dimensions of loneliness literacy were identified by factor 
analysis: self-efficacy, social support, socialization, and in-home support. 
Self-efficacy and in-home support were related to lower loneliness. Lower 
self-efficacy, higher social support, and higher socialization were related to 
changes (increases) in loneliness during COVID-19. In-home support may prevent 
depressive symptoms, while self-efficacy was beneficial for better life 
satisfaction. In addition, emotion-focused coping may increase loneliness during 
COVID-19, while satisfaction with family support would be a protective factor 
against loneliness.
CONCLUSION: Loneliness literacy is related to loneliness and increased 
loneliness during the COVID-19 pandemic. Building up an age-friendly community 
with embedded services/information and learning positive coping and mental 
resilience strategies are suggested.

© 2022. The Author(s).

DOI: 10.1186/s12877-022-03396-7
PMCID: PMC9412798
PMID: 36028799 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1624. Schmerz. 2022 Dec;36(6):429-436. doi: 10.1007/s00482-022-00663-9. Epub 2022 Aug 
26.

[Chronic pain in elderly people during the COVID-19 pandemic].

[Article in German; Abstract available in German from the publisher]

Teichmüller K(1), Bast L(2), Rittner HL(3), Kindl G(3).

Author information:
(1)Zentrum für interdisziplinäre Schmerzmedizin (ZiS), Klinik für 
Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, 
Universitätsklinikum Würzburg, Straubmühlweg 2a - Haus A9, 97078, Würzburg, 
Deutschland. teichmuell_k@ukw.de.
(2)Abteilung Interventionspsychologie, Lehrstuhl für Psychologie I, Institut für 
Psychologie, Universität Würzburg, Würzburg, Deutschland.
(3)Zentrum für interdisziplinäre Schmerzmedizin (ZiS), Klinik für 
Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, 
Universitätsklinikum Würzburg, Straubmühlweg 2a - Haus A9, 97078, Würzburg, 
Deutschland.

BACKGROUND: International studies have shown negative effects of the COVID-19 
pandemic on mood and levels of distress. Correlations between the pandemic and 
higher levels of pain as well as greater pain-related disability have also been 
found; however, studies report ambiguous results about whether elderly people 
cope differently with the pandemic and its effects.
METHODS: The University Hospital of Würzburg offers multimodal pain therapy for 
older adults. The current study performed a retrospective analysis of routine 
data measured during an interdisciplinary multimodal assessment. We compared 
n = 75 patients taking part in the therapy during 2018 and 2019 to 
n = 42 patients assessed in 2020-2021. We measured pain, mental distress and 
physical functioning using the German Pain Questionnaire, clinical diagnosis, 
and geriatric tests of physical fitness.
RESULTS: Both subgroups did not differ in demographic characteristics, neither 
did we find significant differences regarding pain intensity, pain-related 
disability, and mental health; however, patients before the pandemic reported 
a higher number of days on which they felt limited due to pain. In the physical 
performance test, we even found significantly better results during the COVID-19 
pandemic.
DISCUSSION: The current data do not support an aggravation of pain or mental and 
physical well-being. Possible explanations could be better resilience in elderly 
people due to their experience of life, financial security or less change in 
their daily life.

Publisher: ZUSAMMENFASSUNG: HINTERGRUND: Internationale Studien belegen negative 
Auswirkungen der COVID-19-Pandemie auf Stimmung und Stresslevel befragter 
Personen. Auch konnten Zusammenhänge zwischen der Pandemie und höheren 
Schmerzstärken sowie stärkerer schmerzbedingter Beeinträchtigung nachgewiesen 
werden. Die Studienlage dazu, ob ältere Menschen besser oder schlechter mit der 
Pandemie und ihren Auswirkungen umgehen können als jüngere Personen, ist aber 
uneindeutig.
METHODIK: Seit einigen Jahren bietet das Universitätsklinikum Würzburg ein 
multimodales Schmerztherapieprogramm für SeniorInnen an. Für die vorliegende 
Arbeit wurden retrospektiv klinische Routinedaten zum Zeitpunkt des 
interdisziplinären multimodalen Assessments von n = 75 TeilnehmerInnen in den 
Jahren 2018 und 2019 mit denen von n = 42 Patientinnen während der 
COVID-19-Pandemie 2020–2021 verglichen. Wir untersuchten Schmerz, psychische 
Belastung und körperliches Funktionsniveau mithilfe des Deutschen 
Schmerzfragebogens, klinischer Diagnostik und geriatrischer Funktionstests.
ERGEBNISSE: Die beiden Teilstichproben unterschieden sich nicht in 
demografischen Merkmalen. Bezüglich Schmerzintensität und Beeinträchtigung sowie 
der psychischen Belastung fanden sich ebenfalls keine signifikanten 
Unterschiede. Lediglich die Anzahl der schmerzbedingt beeinträchtigten Tage war 
vor Corona signifikant höher. Die geriatrischen Funktionstests zeigten 
signifikant bessere Werte während der Pandemie an.
DISKUSSION: Die vorliegenden Daten zeigen keine Verschlechterung von Schmerz und 
körperlichem sowie psychischem Wohlbefinden bei SeniorInnen vor dem Hintergrund 
der Pandemie. Weitere Studien sollten die möglichen Gründe dafür untersuchen. 
Diese könnten in einer höheren Resilienz der SeniorInnen basierend auf ihrer 
Lebenserfahrung, finanziellen Sicherheit oder einer geringeren Veränderung des 
Lebensalltags liegen.

© 2022. The Author(s).

DOI: 10.1007/s00482-022-00663-9
PMCID: PMC9415256
PMID: 36028630 [Indexed for MEDLINE]


1625. Int J Health Plann Manage. 2023 Jan;38(1):85-104. doi: 10.1002/hpm.3564. Epub 
2022 Aug 26.

An investigation into managerial support for the psychological wellbeing of 
national health service doctors during the Covid-19 pandemic: A cross sectional 
study.

Jabbar SAA(1), Marshall C(1).

Author information:
(1)Stirling Management School, University of Stirling, Stirling, Scotland, UK.

AIM: This study investigates the psychological wellbeing of United Kingdom 
National Health Service doctors during the Covid-19 pandemic and evaluates how 
they have been supported managerially.
METHOD: A mixed-method sequential study design of online surveys and 
semi-structured interviews was employed between July-August 2020, with a 
response rate of 273/300 and 4/4 respectively. The Warwick-Edinburgh Mental 
Wellbeing Scale (WEMWBS) and Health and Safety Executive Management Standards 
(HSE MS) were used as measuring tools. The Jobs Demands Resource (JD-R) model 
and its relation to psychological wellbeing was determined. Survey findings 
informed semi-structured interviews, coded using thematic analysis.
RESULTS: Overall mean WEMWBS, 43.2 (SD = 9.44), was low as was mean managerial 
support, 2.38 (SD = 0.78). Overall mean clinical demand score was high (2.6 on 
reverse scale). First year female trainee respondents from frontline specialties 
were found to have low psychological wellbeing scores. Key correlations were 
found between high managerial support, low clinical demands and low 
psychological wellbeing (r > 0.6). Core themes emerged: (1) breakdown of 
leadership, (2) vulnerability of wellbeing without support, (3) suboptimal 
navigation through change and (4) poor physical and human resource management.
CONCLUSION: Maintaining the psychological wellbeing of doctors requires physical 
and psychological resources to meet clinical demands and the enhancement of 
fundamental managerial principles of control, communication, change management 
and leadership through adversity.

© 2022 The Authors. The International Journal of Health Planning and Management 
published by John Wiley & Sons Ltd.

DOI: 10.1002/hpm.3564
PMCID: PMC9538314
PMID: 36018276 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


1626. Soc Work Public Health. 2023 Apr 3;38(3):182-192. doi: 
10.1080/19371918.2022.2117254. Epub 2022 Aug 26.

Depression, Anxiety, and Stress During COVID-19 Pandemic Among Females Who Live 
in Kuwait.

Al-Ma'Seb HB(1), Al-Sejari MM(1).

Author information:
(1)College of Social Sciences, Kuwait University, Kuwait City, Kuwait.

Health regulations to constrain the progress of the pandemic such as lockdowns, 
curfews, and quarantines made radical alterations in every aspect of 
individuals' lives, causing significant impact on their mental health and 
well-being. The current study aimed to examine whether there are significant 
differences in participants' sociodemographic variables in reported cases of 
depression, anxiety, and stress among women who lived in Kuwait during the 
curfew and lockdown caused by COVID-19 pandemic. This study used a 
cross-sectional method. A nonrandom sample of 596 participants was recruited. 
The current study found that women at higher risk of reporting more incidents of 
depression, anxiety, and stress during the lockdown and curfew were from the 
older age group above 50 years old, hold higher educational certificates, and 
own private businesses. High rates of reported depression and anxiety were 
detected significantly among Kuwaiti women. The findings of this study reveal 
the significant impact of an uncomfortable and distressful environment during 
the COVID-19 pandemic, which may negatively affected individuals' mental health 
and generated diverse forms of psychosocial illness.

DOI: 10.1080/19371918.2022.2117254
PMID: 36018072 [Indexed for MEDLINE]


1627. Int J Public Health. 2022 Aug 9;67:1604720. doi: 10.3389/ijph.2022.1604720. 
eCollection 2022.

Employee Mental Health During COVID-19 Adaptation: Observations of Occupational 
Safety and Health/Human Resource Professionals in Ireland.

Chen Y(1), Ingram C(1), Downey V(1), Roe M(1), Drummond A(1), Sripaiboonkij 
P(1), Buckley C(2)(3), Alvarez E(4), Perrotta C(1), Buggy C(1).

Author information:
(1)School of Public Health, Physiotherapy and Sports Science, University College 
Dublin, Dublin, Ireland.
(2)Health Service Executive, Dublin, Ireland.
(3)School of Public Health, University College Cork, Cork, Ireland.
(4)Department of Health Research Methods, Evidence and Impact, McMaster 
University, Hamilton, ON, Canada.

Objectives: This study aims to understand mental health issues among Irish 
employees arising from COVID-19 adaptation from the perspective of Occupational 
Safety and Health (OSH) and/or Human Resource (HR) professionals. Methods: 
Fifteen focus groups including 60 OSH/HR professionals from various sectors were 
conducted covering four predetermined themes. The data were transcribed 
verbatim, with transcripts entered into Nvivo for thematic analysis 
incorporating intercoder reliability testing. Results: The mental health impacts 
among employees are identified from three stages: pre-adaptation, during 
adaptation, and post-adaptation. Most issues were reported during the second 
stage when working conditions dramatically changed to follow emerging COVID-19 
policies. The identified mental health support from participating organizations 
included providing timely and reliable information, Employee Assistance 
Programme (EAP), informal communication channels, hybrid work schedules and 
reinforcement of control measures. Conclusion: This study explores the 
challenges facing employees during the different stages of COVID-19 adaptation 
and the associated mental health impacts. Gender's influence on mental health 
consultations should be considered when planning for public health emergencies, 
and further research conducted in male dominated industries.

Copyright © 2022 Chen, Ingram, Downey, Roe, Drummond, Sripaiboonkij, Buckley, 
Alvarez, Perrotta and Buggy.

DOI: 10.3389/ijph.2022.1604720
PMCID: PMC9396539
PMID: 36016962 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1628. Front Public Health. 2022 Aug 9;10:943435. doi: 10.3389/fpubh.2022.943435. 
eCollection 2022.

Thirty years of research on physical activity, mental health, and wellbeing: A 
scientometric analysis of hotspots and trends.

Sabe M(1), Chen C(2), Sentissi O(1), Deenik J(3)(4), Vancampfort D(5)(6), Firth 
J(7)(8), Smith L(9), Stubbs B(10)(11), Rosenbaum S(12)(13), Schuch FB(14), Solmi 
M(15)(16)(17)(18).

Author information:
(1)Division of Adult Psychiatry, Department of Psychiatry, University Hospitals 
of Geneva, Thonex, Switzerland.
(2)College of Computing and Informatics, Drexel University, Philadelphia, PA, 
United States.
(3)Scientific Research Department, GGz Centraal, Amersfoort, Netherlands.
(4)School for Mental Health and Neuroscience, Maastricht University, Maastricht, 
Netherlands.
(5)Katholieke Universiteit Leuven Department of Rehabilitation Sciences, Leuven, 
Belgium.
(6)University Psychiatric Center Katholieke Universiteit Leuven, Leuven, 
Belgium.
(7)Division of Psychology and Mental Health, Manchester Academic Health Science 
Centre, University of Manchester, Manchester, United Kingdom.
(8)Greater Manchester Mental Health National Health Service Foundation Trust, 
Manchester Academic Health Science Centre, Manchester, United Kingdom.
(9)Centre for Health, Performance and Wellbeing, Anglia Ruskin University, 
Cambridge, United Kingdom.
(10)Physiotherapy Department, South London and Maudsley National Health Service 
Foundation Trust, London, United Kingdom.
(11)Department of Psychological Medicine, Institute of Psychiatry, Psychology 
and Neuroscience, King's College London, London, United Kingdom.
(12)Discipline of Psychiatry and Mental Health, Medicine and Health, University 
of New South Wales, Kensington, NSW, Australia.
(13)School of Health Sciences, Medicine and Health, University of New South 
Wales, Kensington, NSW, Australia.
(14)Department of Sports Methods and Techniques, Federal University of Santa 
Maria, Santa Maria, Brazil.
(15)Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.
(16)Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada.
(17)Ottawa Hospital Research Institute, Clinical Epidemiology Program, 
University of Ottawa, Ottawa, ON, Canada.
(18)Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, 
Berlin, Germany.

Erratum in
    Front Public Health. 2023 Mar 14;11:1178895.

The sheer volume of research publications on physical activity, mental health, 
and wellbeing is overwhelming. The aim of this study was to perform a 
broad-ranging scientometric analysis to evaluate key themes and trends over the 
past decades, informing future lines of research. We searched the Web of Science 
Core Collection from inception until December 7, 2021, using the appropriate 
search terms such as "physical activity" or "mental health," with no limitation 
of language or time. Eligible studies were articles, reviews, editorial 
material, and proceeding papers. We retrieved 55,353 documents published between 
1905 and 2021. The annual scientific production is exponential with a mean 
annual growth rate of 6.8% since 1989. The 1988-2021 co-cited reference network 
identified 50 distinct clusters that presented significant modularity and 
silhouette scores indicating highly credible clusters (Q = 0.848, S = 0.939). 
This network identified 6 major research trends on physical activity, namely 
cardiovascular diseases, somatic disorders, cognitive decline/dementia, mental 
illness, athletes' performance, related health issues, and eating disorders, and 
the COVID-19 pandemic. A focus on the latest research trends found that 
greenness/urbanicity (2014), concussion/chronic traumatic encephalopathy (2015), 
and COVID-19 (2019) were the most active clusters of research. The USA research 
network was the most central, and the Chinese research network, although 
important in size, was relatively isolated. Our results strengthen and expand 
the central role of physical activity in public health, calling for the 
systematic involvement of physical activity professionals as stakeholders in 
public health decision-making process.

Copyright © 2022 Sabe, Chen, Sentissi, Deenik, Vancampfort, Firth, Smith, 
Stubbs, Rosenbaum, Schuch and Solmi.

DOI: 10.3389/fpubh.2022.943435
PMCID: PMC9396383
PMID: 36016904 [Indexed for MEDLINE]

Conflict of interest statement: Author OS has received advisory board honoraria 
from Otsuka, Lilly, Lundbeck, Sandoz, and Janssen in an institutional account 
for research and teaching. Author JF has received consultancy fees from 
Parachute BH for a separate project. Author BS is on the Editorial Board of 
Ageing Research Reviews, Mental Health and Physical Activity, the Journal of 
Evidence Based Medicine and the Brazilian Journal of Psychiatry. Author BS has 
received honorarium from a co-edited a book on exercise and mental illness, 
advisory work from ASICS & ParachuteBH for unrelated work. Author MSo has 
received honoraria/has been a consultant for Angelini, Lundbeck and Otsuka. The 
remaining authors declare that the research was conducted in the absence of any 
commercial or financial relationships that could be construed as a potential 
conflict of interest.


1629. Int J Environ Res Public Health. 2022 Aug 22;19(16):10442. doi: 
10.3390/ijerph191610442.

Promoting University Students' Mental Health through an Online Multicomponent 
Intervention during the COVID-19 Pandemic.

Theurel A(1)(2), Witt A(2), Shankland R(3).

Author information:
(1)Instance Régionale D'éducation et de Promotion de la Santé, 21000 Dijon, 
France.
(2)LEAD-CNRS (UMR 5022), Université Bourgogne Franche-Comté, 21000 Dijon, 
France.
(3)Laboratory DIPHE, Department of Psychology, Education and Vulnerabilities, 
Université Lumière Lyon 2, 69676 Bron, France.

The mental health of university students is a serious public health issue. The 
alarming trend of high levels of untreated psychological distress observed 
during the COVID-19 pandemic highlights the need for prevention programs. 
Digital tools are a promising means of delivering such programs. Web-based 
programs are acceptable and effective at improving mental health problems and 
general mental well-being. However, the usefulness of such digital prevention 
approaches to address the multiple issues raised by the COVID-19 pandemic needs 
to be tested. The current study assessed the effectiveness of an 8-week online 
intervention, integrating a variety of evidence-based strategies for improving 
French university students' mental health. Students were assigned to: (1) the 
online self-help program ETUCARE (n = 53), or (2) the control condition (n = 
50). All the participants completed pre- and post-intervention questionnaires 
that assessed mental health problems and psychological well-being. The findings 
revealed that, compared to the control group, participation in the online 
program was associated with higher levels of psychological well-being post-test 
and fewer clinical symptoms of psychological distress, anxiety, and alcohol 
consumption. These preliminary findings suggest that the ETUCARE program is a 
promising multicomponent intervention to buffer the mental health consequences 
of the COVID-19 pandemic in French university students.

DOI: 10.3390/ijerph191610442
PMCID: PMC9407816
PMID: 36012078 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1630. Int J Environ Res Public Health. 2022 Aug 22;19(16):10435. doi: 
10.3390/ijerph191610435.

Uncertainty and Well-Being amongst Homeworkers in the COVID-19 Pandemic: A 
Longitudinal Study of University Staff.

Wood S(1), Michaelides G(2), Daniels K(2), Niven K(3).

Author information:
(1)School of Business, University of Leicester, Brookfield, London Road, 
Leicester LE2 1RQ, UK.
(2)Norwich Business School, University of East Anglia, Norwich NR4 7TJ, UK.
(3)Sheffield University Management School, University of Sheffield, Sheffield 
S10 1FL, UK.

The COVID-19 pandemic heightened uncertainties in people's lives-and was itself 
a source of fresh uncertainty. We report a study of homeworkers on whether such 
uncertainties, and particularly those related to their work environment, are 
associated with lower levels of well-being and whether this association is 
exacerbated by prior poor well-being. We focus on five uncertainties surrounding 
the pandemic and employment-the virus, the job quality, workload, logistics of 
work lives, and support from the employer. Our empirical tests show that 
uncertainties around the virus, employer support, and their job quality have the 
strongest negative associations with well-being. These are based on data 
collected over three time periods in the first year of the pandemic from a 
sample of university staff (academics and non-academics) and well-being is 
measured on two continua, anxiety-contentment and depression-enthusiasm. The 
effects of uncertainties around workload and logistics are less pronounced, but 
more apparent among employees with better (not poorer) past well-being, at 
various times of the recession. The study adds to our understanding of the 
pandemic and highlights the need to link uncertainty to mental health more than 
it has in the past.

DOI: 10.3390/ijerph191610435
PMCID: PMC9408406
PMID: 36012069 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1631. Int J Environ Res Public Health. 2022 Aug 21;19(16):10422. doi: 
10.3390/ijerph191610422.

Does COVID-19 Fear Induce Employee Innovation Performance Deficiency? Examining 
the Mediating Role of Psychological Stress and Moderating Role of Organizational 
Career Support.

Hossin MA(1), Chen L(1), Hosain MS(2), Asante IO(3).

Author information:
(1)School of Innovation and Entrepreneurship, Chengdu University, No. 2025, 
Chengluo Avenue, Chengdu 610106, China.
(2)Business School, Sichuan University, Chengdu 610065, China.
(3)School of Economics and Management, Southwest Jiaotong University, No. 111, 
Section 1, North Second Ring Road, Chengdu 610031, China.

With the immense, short/long-term, and multidirectional effects of the 
coronavirus disease (COVID-19) pandemic on work performance, industry 
activities, and the national/global economy, it has adversely affected 
employees' psychological well-being due to its elevated stress and anxiety that 
have substantially affected employee innovation performance (deficiency) 
(EIP(D)). The goal of this empirical paper is to identify how COVID-19 induces 
EIPD by examining the mediating role of psychological stress (PS) on the 
relationship between fear of infection with COVID-19 (FIC) and EIPD based on 
affective events theory (AET) and the moderating effect of organizational career 
support (OCS) on the relationship between PS and EIPD. Based on 865 survey 
responses provided by mid-level managers from Chinese manufacturing firms and 
the covariance-based structural equation modeling (SEM) technique using AMOS 25, 
we identified that FIC has a positive relationship with EIPD while PS can fully 
mediate the link between FIC and EIPD and OCS weakens the positive relationship 
between PS and EIPD (that is, in the presence of OCS, EIPD decreases despite the 
presence of PS among the employees). The findings of our empirical study will 
theoretically and practically contribute to the pandemic-related existing 
literature by providing an in-depth understanding of these variables. 
Furthermore, policymakers can also benefit by boosting their EIP from the 
outcomes revealed and suggestions provided.

DOI: 10.3390/ijerph191610422
PMCID: PMC9407891
PMID: 36012056 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1632. Int J Environ Res Public Health. 2022 Aug 17;19(16):10231. doi: 
10.3390/ijerph191610231.

How Can Apartment-Complex Landscaping Space Improve Residents' Psychological 
Well-Being?: The Case of the Capital Region in South Korea.

Tae J(1), Jeong D(2), Chon J(1).

Author information:
(1)Division of Environmental Science & Ecological Engineering, Korea University, 
Seoul 02841, Korea.
(2)Division of Co-Prosperity & Balanced Development, Gyeonggi Research 
Institute, Suwon 16202, Korea.

Urban green spaces have a positive impact on citizens' mental health and have 
contributed to improving their quality of life during the COVID-19 pandemic. In 
South Korea, where more than 50% of all households live in apartments, 
apartment-complex landscaping space plays the role of urban green space. This 
study aimed to investigate the relationships among a perceived restorative 
environment, restorative experience, life satisfaction, and psychological 
well-being by conducting a survey between residents living in apartments with 
landscape space. More specifically, an online survey was conducted from 8 to 15 
June 2021 among residents in apartment complexes (500 households or more) 
located in the capital region in South Korea. We applied partial least squares 
structural equation modelling (PLS-SEM) using 220 samples to test the causal 
relationship presented in the conceptual model of this study. The results 
revealed that residents' perceptions of the restorative environment of landscape 
space, including fascination, being away, and coherence had positive effects on 
restorative attention. Among the restorative environmental factors, the higher 
the "being away", the greater the effect on restorative attention. Second, the 
effects of fascination and coherence on life satisfaction were mediated by 
restorative attention. Third, restorative attention and life satisfaction 
significantly influenced psychological well-being. Additionally, life 
satisfaction acts as a mediator in the relationship between restorative 
attention and psychological well-being. In summary, this study has theoretical 
implications, in that it explores the effects of apartment complex landscaping 
space as urban green spaces on residents' mental health.

DOI: 10.3390/ijerph191610231
PMCID: PMC9408058
PMID: 36011865 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1633. Int J Environ Res Public Health. 2022 Aug 17;19(16):10189. doi: 
10.3390/ijerph191610189.

Detection of Intestinal Dysbiosis in Post-COVID-19 Patients One to Eight Months 
after Acute Disease Resolution.

Ferreira-Junior AS(1), Borgonovi TF(2), De Salis LVV(1), Leite AZ(1), Dantas 
AS(3), De Salis GVV(3), Cruz GNF(4), De Oliveira LFV(4), Gomes E(1), Penna 
ALB(1)(2), De Oliveira GLV(1)(2).

Author information:
(1)Microbiology Program, Institute of Biosciences, Humanities and Exact Sciences 
(IBILCE), Sao Jose do Rio Preto 15054-000, Brazil.
(2)Food Engineering and Technology Department, Sao Paulo State University 
(UNESP), Sao Jose do Rio Preto 15054-000, Brazil.
(3)Barretos Board of Health, Emergency Care Unit, Barretos 14780-900, Brazil.
(4)BiomeHub Research and Development, Florianopolis 88054-700, Brazil.

The intestinal microbiota plays an important role in the immune response against 
viral infections, modulating both innate and adaptive immune responses. The 
cytokine storm is associated with COVID-19 severity, and the patient's immune 
status is influenced by the intestinal microbiota in a gut-lung bidirectional 
interaction. In this study, we evaluate the intestinal microbiota of Brazilian 
patients in different post-COVID-19 periods, and correlate this with clinical 
data and the antibiotic therapy used during the acute phase. DNA extracted from 
stool samples was sequenced and total anti-SARS-CoV-2 antibodies and C-reactive 
protein were quantified. Compared with controls, there were significant 
differences in the microbiota diversity in post-COVID-19 patients, suggesting an 
intestinal dysbiosis even several months after acute disease resolution. 
Additionally, we detected some genera possibly associated with the post-COVID-19 
dysbiosis, including Desulfovibrio, Haemophillus, Dialister, and Prevotella, in 
addition to decreased beneficial microbes, associated with antibiotic-induced 
dysbiosis, such as Bifidobacterium and Akkermansia. Therefore, our hypothesis is 
that dysbiosis and the indiscriminate use of antibiotics during the pandemic may 
be associated with post-COVID-19 clinical manifestations. In our study, 39% (n = 
58) of patients reported symptoms, including fatigue, dyspnea, myalgia, 
alopecia, anxiety, memory loss, and depression. These data suggest that 
microbiota modulation may represent a target for recovery from acute COVID-19 
and a therapeutic approach for post-COVID-19 sequelae.

DOI: 10.3390/ijerph191610189
PMCID: PMC9408204
PMID: 36011823 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1634. Int J Environ Res Public Health. 2022 Aug 17;19(16):10172. doi: 
10.3390/ijerph191610172.

Changes in Canadian Adolescent Well-Being since the COVID-19 Pandemic: The Role 
of Prior Child Maltreatment.

Dion J(1), Hamel C(1), Clermont C(1), Blackburn MÈ(1)(2), Hébert M(3), Paquette 
L(1), Lalande D(1), Bergeron S(4).

Author information:
(1)Département des Sciences de la Santé, Université du Québec à Chicoutimi, 555 
bl. Université, Chicoutimi, QC G7H 2B1, Canada.
(2)ÉCOBES-Recherche et Transfert, Cégep de Jonquière, Pavillon Manicouagan, 3791 
de la Fabrique St., Jonquière, QC G7X 7W2, Canada.
(3)Département de Sexologie, Université du Québec à Montréal, C.P. 8888, 
Succursale Centre-Ville, Montréal, QC H2L 2C4, Canada.
(4)Département de Psychologie, Université de Montréal, C.P. 6128, Succursale 
Centre-Ville, Montréal, QC H3C 3J7, Canada.

Adolescents may be particularly vulnerable to the negative impact of the 
coronavirus disease 2019 (COVID-19) pandemic, given their increased 
socialization needs during this developmental period. This prospective study 
examined the potential changes in adolescents' well-being from before to during 
the pandemic, and the moderating role of a history of child maltreatment (CM), 
COVID-19-related distress, and gender among 1,802 adolescents (55.5% 
participants identified as boy, 42.2% as girl, and 1.5% as nonbinary; Mage 14.74 
years). Another aim was to determine whether COVID-19-related distress mediated 
the relationship between CM and well-being. Results revealed that 
COVID-19-related distress was associated with lower well-being (i.e., higher 
levels of internalized and externalized behaviors, and lower levels of 
self-esteem and life satisfaction). Boys experienced a greater decrease in life 
satisfaction and self-esteem than girls. A history of CM had a moderation 
effect, with the pandemic having a lesser impact on the outcomes of adolescents 
with such a history. However, it was also associated with more COVID-19-related 
distress, which in turn was associated with lower levels of internalized and 
externalized behaviors, self-esteem, and life satisfaction. These unexpected 
results with regard to CM might indicate that the social restrictions during the 
pandemic could have had a relieving effect on adolescents with particular 
challenges associated with CM.

DOI: 10.3390/ijerph191610172
PMCID: PMC9407783
PMID: 36011806 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript; or in the decision to 
publish the results.


1635. Int J Environ Res Public Health. 2022 Aug 16;19(16):10151. doi: 
10.3390/ijerph191610151.

Learning Stress, Involvement, Academic Concerns, and Mental Health among 
University Students during a Pandemic: Influence of Fear and Moderation of 
Self-Efficacy.

Yang J(1), Xiang L(2), Zheng S(1), Liang H(1).

Author information:
(1)School of Journalism and Communication, Guangzhou University, Guangzhou 
510006, China.
(2)School of Shipping Economics and Trade, Guangzhou Maritime University, 
Guangzhou 510725, China.

COVID-19 has had a profound impact on the mental health and well-being of 
students. An effective method that can enable students to cope with difficult 
times is to help them realize their inner potential. Following the 
stimulus-organism-response model, this study developed a theoretical framework 
that deepens our understanding of an environmental stimulus (fear of COVID-19) 
that is experienced by students; struggle within the organism (learning stress, 
learning involvement, and academic concerns); and the psychological response 
(psychological well-being). The findings clarified how the fear of COVID-19 
affects the psychological well-being of university students and revealed the 
moderate role of academic self-efficacy in this process. Some systematic 
practical advice was provided to higher education institutions to develop 
effective interventions to protect the mental health of college students and 
establish strategies to promote their inner potential.

DOI: 10.3390/ijerph191610151
PMCID: PMC9408668
PMID: 36011786 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1636. Int J Environ Res Public Health. 2022 Aug 16;19(16):10106. doi: 
10.3390/ijerph191610106.

Psychometric Properties of the WHO-5 Well-Being Index among Nurses during the 
COVID-19 Pandemic: A Cross-Sectional Study in Three Countries.

Lara-Cabrera ML(1)(2), Betancort M(3), Muñoz-Rubilar A(4), Rodríguez-Novo N(5), 
Bjerkeset O(6), De Las Cuevas C(7)(8).

Author information:
(1)Department of Mental Health, Faculty of Medicine and Health Sciences, 
Norwegian University of Science and Technology (NTNU), 7091 Trondheim, Norway.
(2)Nidelv Community Mental Health Centre, Division of Psychiatry, St Olavs 
Hospital Trondheim University Hospital, 7006 Trondheim, Norway.
(3)Department of Clinical Psychology, Psychobiology and Methodology, Universidad 
de La Laguna, 38200 San Cristóbal de La Laguna, Spain.
(4)Faculty of Health Sciences, Universidad Central de Chile, Santiago 8370178, 
Chile.
(5)Departament of Nursing, Universidad de La Laguna, 38200 San Cristóbal de La 
Laguna, Spain.
(6)Faculty of Nursing and Health Sciences, Nord University, Levanger Campus, 
8026 Levanger, Norway.
(7)Department of Internal Medicine, Dermatology and Psychiatry, Universidad de 
La Laguna, 38200 San Cristóbal de La Laguna, Spain.
(8)Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, 
38200 San Cristóbal de La Laguna, Spain.

Nurses' well-being has been increasingly recognised due to the ongoing pandemic. 
However, no validation scales measuring nurses' well-being currently exist. 
Thus, we aimed to validate the WHO-5 Well-Being Index (WHO-5) in a sample of 
nurses. A cross-sectional multinational study was conducted, and a total of 678 
nurses who worked during the COVID-19 pandemic in Spain (36.9%), Chile (40.0%) 
and Norway (23.1%) participated in this study. The nurses completed the WHO-5, 
the Patient Health Questionnaire-2 (PHQ-2), the Generalized Anxiety Disorder-2 
(GAD-2) and three questions about the quality of life (QoL). The WHO-5 
demonstrated good reliability and validity in the three countries. Cronbach's 
alphas ranged from 0.81 to 0.90. High correlations were found between the WHO-5 
and the psychological well-being dimension of QoL, and negative correlations 
between the WHO-5 and PHQ-2. The unidimensional scale structure was confirmed in 
all the countries, explaining more than 68% of the variance. The item response 
theory likelihood ratio model did not show discernible differences in the WHO-5 
across the countries. To conclude, the WHO-5 is a psychometrically sound scale 
for measuring nurses' well-being during a pandemic. The scale showed strong 
construct validity for cross-cultural comparisons; however, more research is 
required with larger sample sizes.

DOI: 10.3390/ijerph191610106
PMCID: PMC9407690
PMID: 36011741 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1637. Int J Environ Res Public Health. 2022 Aug 16;19(16):10104. doi: 
10.3390/ijerph191610104.

And Still She Rises: Policies for Improving Women's Health for a More Equitable 
Post-Pandemic World.

Shroff FM(1)(2), Tsang R(3), Schwartz N(4), Alkhadragy R(5), Vora K(6).

Author information:
(1)T.H. Chan School of Public Health, Department of Global Health and 
Population, Harvard University, Cambridge, MA 02138, USA.
(2)Maternal and Infant Health Canada, Vancouver, BC V6T 1Z3, Canada.
(3)Department of Medicine, Faculty of Medicine, University of British Columbia, 
Vancouver, BC V6T 1Z4, Canada.
(4)El Colegio de la Frontera Norte, Tijuana 22560, Mexico.
(5)Department of Medical Education, Faculty of Medicine, Suez Canal University, 
Ismailia 8366004, Egypt.
(6)Indian Institute of Public Health Gandhinagar, Gandhinagar 382042, India.

The COVID-19 pandemic has spawned crises of violence, hunger and impoverishment. 
Maternal and Infant Health Canada (MIHCan) conducted this policy action study to 
explore how changes that have arisen during the COVID-19 pandemic may catalyze 
potential improvements in global women's health toward the creation of a more 
equitable post-pandemic world. In this mixed methods study, 280 experts in 
women's health responded to our survey and 65 subsequently participated in focus 
groups, including professionals from India, Egypt/Sudan, Canada and the United 
States/Mexico. From the results of this study, our recommendations include 
augmenting mental health through more open dialogue, valuing and compensating 
those working on the frontlines through living wages, paid sick leave and 
enhanced benefits and expanding digital technology that facilitates flexible 
work locations, thereby freeing time for improving the wellbeing of caregivers 
and families and offering telemedicine and telecounseling, which delivers 
greater access to care. We also recommend bridging the digital divide through 
the widespread provision of reliable and affordable internet services and 
digital literacy training. These policy recommendations for employers, 
governments and health authorities aim to improve mental and physical wellbeing 
and working conditions, while leveraging the potential of digital technology for 
healthcare provision for those who identify as women, knowing that others will 
benefit. MIHCan took action on the recommendation to improve mental health 
through open conversation by facilitating campaigns in all study regions. 
Despite the devastation of the pandemic on global women's health, implementing 
these changes could yield improvements for years to come.

DOI: 10.3390/ijerph191610104
PMCID: PMC9408478
PMID: 36011740 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1638. Int J Environ Res Public Health. 2022 Aug 16;19(16):10103. doi: 
10.3390/ijerph191610103.

Psychosocial Wellbeing of Schoolchildren during the COVID-19 Pandemic in Berlin, 
Germany, June 2020 to March 2021.

Theuring S(1), van Loon W(1), Hommes F(1), Bethke N(2), Mall MA(3), Kurth T(4), 
Seybold J(2), Mockenhaupt FP(1).

Author information:
(1)Institute of Tropical Medicine and International Health, 
Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin 
and Humboldt-Universität zu Berlin, 13353 Berlin, Germany.
(2)Medical Directorate, Charité-Universitätsmedizin Berlin, Corporate Member of 
Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, 
Germany.
(3)Department of Pediatric Respiratory Medicine, Immunology and Critical Care 
Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie 
Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany.
(4)Institute of Public Health, Charité-Universitätsmedizin Berlin, Corporate 
Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 
Berlin, Germany.

The COVID-19 pandemic and related restrictions have affected the wellbeing of 
schoolchildren worldwide, but the extent and duration of specific problems are 
still not completely understood. We aimed to describe students’ psychosocial and 
behavioral parameters and associated factors during the COVID-19 pandemic in 
Berlin, Germany. Our longitudinal study included 384 students from 24 randomly 
selected Berlin primary and secondary schools, assessing psychosocial wellbeing 
at four time points between June 2020 and March 2021. We analyzed temporal 
changes in the proportions of anxiety, fear of infection, reduced health-related 
quality of life (HRQoL), physical activity and social contacts, as well as 
sociodemographic and economic factors associated with anxiety, fear of infection 
and HRQoL. During the observation period, the presence of anxiety symptoms 
increased from 26.2% (96/367) to 34.6% (62/179), and fear of infection from 
28.6% (108/377) to 40.6% (73/180). The proportion of children with limited 
social contacts (<1/week) increased from 16.4% (61/373) to 23.5% (42/179). Low 
physical activity (<3 times sports/week) was consistent over time. Low HRQoL was 
observed among 44% (77/174) of children. Factors associated with anxiety were 
female sex, increasing age, secondary school attendance, lower household income, 
and the presence of adults with anxiety symptoms in the student´s household. 
Fear of infection and low HRQoL were associated with anxiety. A substantial 
proportion of schoolchildren experienced unfavorable psychosocial conditions 
during the COVID-19 pandemic in 2020/2021. Students from households with limited 
social and financial resilience require special attention.

DOI: 10.3390/ijerph191610103
PMCID: PMC9407732
PMID: 36011738 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest with 
the specific matter of this manuscript. Outside of the work, Kurth reported 
receiving research grants from the German Federal Joint Committee (G-BA) and the 
Federal Ministry of Health (BMG). He reported receiving personal compensation 
from Eli Lilly & Company, Teva Pharmaceuticals, TotalEnergies S.E., the BMJ, and 
Frontiers. The funders had no role in the design of the study; in the 
collection, analyses, or interpretation of data; in the writing of the 
manuscript; or in the decision to publish the results.


1639. Int J Environ Res Public Health. 2022 Aug 12;19(16):9977. doi: 
10.3390/ijerph19169977.

Hoping for a Better Future during COVID-19: How Migration Plans Are Protective 
of Depressive Symptoms for Haitian Migrants Living in Chile.

Chen Y(1), Rafful C(2)(3), Mercado M(4), Carte L(5), Morales-Miranda S(6), 
Cheristil J(7), Rocha-Jiménez T(8)(9).

Author information:
(1)Department of Sociomedical Sciences, Mailman School of Public Health, 
Columbia University, 722 W 168th St, New York, NY 10032, USA.
(2)Faculty of Psychology, Universidad Nacional Autonoma de Mexico, Circuito 
Ciudad Universitaria Avenida, C.U., Mexico City 04510, Mexico.
(3)Center for Global Mental Health, National Institute of Psychiatry, Calz 
México-Xochimilco 101, Colonia, Huipulco, Tlalpan, Mexico City 14370, Mexico.
(4)Faculty of Psychology, Universidad Diego Portales, Santiago 8320000, Chile.
(5)Núcleo de Ciencias Sociales y Humanidades, Universidad de la Frontera, 
Francisco Salazar 1450, Temuco 4811230, Chile.
(6)Consorcio de Investigación sobre VIH SIDA TB CISIDAT, Dwight W. Morrow 8, 
Apt. 7, Centro, Cuernavaca 62000, Mexico.
(7)Project "When Reality Overcomes the Intention", Las Condes 7560908, Chile.
(8)Society and Health Research Center, Facultad de Ciencias Sociales y Artes, 
Universidad Mayor, Las Condes 4780000, Chile.
(9)Millennium Nucleus on Sociomedicine (SocioMed), Las Condes 7560908, Chile.

This paper explores the migration experiences, perceived COVID-19 impacts, and 
depression symptoms among Haitian migrants living in Santiago, Chile. 
Ninety-five participants from eight neighborhoods with a high density of Haitian 
migrants were recruited. Descriptive statistics, univariate analysis, and 
logistic regression analysis were conducted. Chi-squared tests were used to 
confirm univariate results. We found that 22% of participants had major 
depressive symptoms based on the CESD-R-20 scale, 87% reported major life 
changes due to COVID-19, and 78% said their migration plans had changed due to 
the pandemic. Factors associated with more depressive symptoms were being in 
debt (OR = 3.43) and experiencing discrimination (ORs: 0.60 to 6.19). Factors 
associated with less odds of depressive symptoms were social support (ORs: 0.06 
to 0.25), change in migration plans due to COVID-19 (OR = 0.30), and planning to 
leave Chile (OR = 0.20). After accounting for relevant factors, planning to 
leave Chile is significantly predictive of fewer symptoms of depression. Haitian 
migrants living in Chile had a high prevalence of depression. Planning to leave 
Chile was a significant protector against depressive symptoms. Future studies 
should explore how nuanced experiences of uncertainty play out in migrants' 
lives, mental well-being, and planning for their future.

DOI: 10.3390/ijerph19169977
PMCID: PMC9408526
PMID: 36011611 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript, or in the decision to 
publish the results.


1640. Int J Environ Res Public Health. 2022 Aug 12;19(16):9949. doi: 
10.3390/ijerph19169949.

Fear of COVID-19 Impact on Professional Quality of Life among Mental Health 
Workers.

Stefanatou P(1), Xenaki LA(1), Karagiorgas I(1), Ntigrintaki AA(1), Giannouli 
E(1), Malogiannis IA(1), Konstantakopoulos G(1).

Author information:
(1)First Department of Psychiatry, Eginition Hospital, School of Medicine, 
National and Kapodistrian University of Athens, 11528 Athens, Greece.

Several studies have examined the impact of the COVID-19 pandemic on healthcare 
workers' mental health, but only a few have investigated its detrimental effect 
on the mental well-being of mental health workers (MHWs).
BACKGROUND: The current study aimed to explore the effect of the fear of 
COVID-19 (FCV-19) on professional quality of life dimensions, namely compassion 
satisfaction (CS), burnout (BO), and secondary traumatic stress (STS) in MHWs 
above and beyond sociodemographic and professional factors.
METHODS: Hierarchical linear regression models were employed to examine the 
relationship of extreme FCV-19 with CS, BO, and STS in MHWs (n = 224), after 
considering sociodemographic variables as potential confounding factors. Extreme 
FCV-19 was operationalized as a binary variable with a cut-off score of ≥16.5 
considered as extreme fear.
RESULTS: We found that extreme FCV-19 in MHWs is linked with increased 
compassion fatigue (BO and STS), and this relationship is exacerbated by younger 
age in regard to BO and by female gender concerning STS. CS remains unaffected 
by severe FCV-19, and it is higher in older participants.
CONCLUSION: Organizational support is required to protect MHWs' mental 
well-being and ensure the quality of care they provide during prolonged crises, 
such as the COVID-19 pandemic. Measures that intensify a sense of safety, 
protection, and control against COVID-19 infections in mental health services 
should be included in the recommendations that may reduce BO and STS among MHWs.

DOI: 10.3390/ijerph19169949
PMCID: PMC9408175
PMID: 36011583 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1641. Int J Environ Res Public Health. 2022 Aug 9;19(16):9809. doi: 
10.3390/ijerph19169809.

The Effectiveness of a Leadership Subject Using a Hybrid Teaching Mode during 
the Pandemic: Objective Outcome and Subjective Outcome Evaluation.

Chai W(1), Li X(1), Shek DTL(1).

Author information:
(1)Department of Applied Social Sciences, The Hong Kong Polytechnic University, 
Hong Kong, China.

Positive youth development (PYD) is an innovative approach to protect students 
from mental health problems and promote their positive and holistic development. 
Although there are many studies on the beneficial effects of PYD programs on 
youth in high school and community contexts, it is not clear whether subjects 
adopting PYD principles can promote positive development for university 
students. Moreover, it is unclear whether such subjects are effective under 
COVID-19, where subjects are commonly taught via the "hybrid" mode (i.e., 
face-to-face plus online teaching). The present study examined students' changes 
in the PYD, wellbeing, and desired graduate attributes after they had taken a 
leadership subject utilizing PYD principles taught by the "hybrid" mode (N = 
630). Adopting the one-group pre-test and post-test design (i.e., objective 
outcome evaluation), we found that students showed significant positive 
improvement in PYD indicators, wellbeing, as well as desired graduate 
attributes. Additionally, students had high satisfaction with the course design 
and teaching staff, and perceived many benefits from this subject based on the 
subjective outcome evaluation conducted at the end of the subject. Results also 
showed that students' satisfaction with the curriculum significantly and 
positively predicted their positive change in PYD indicators, indicating the 
convergence of subjective outcome evaluation and objective outcome evaluation. 
The results highlight the positive impacts of the hybrid mode leadership subject 
with PYD principles in higher education.

DOI: 10.3390/ijerph19169809
PMCID: PMC9408400
PMID: 36011436 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1642. Int J Environ Res Public Health. 2022 Aug 9;19(16):9793. doi: 
10.3390/ijerph19169793.

Immersive Therapy for Improving Anxiety in Health Professionals of a Regional 
Hospital during the COVID-19 Pandemic: A Quasi-Experimental Pilot Study.

Linares-Chamorro M(1), Domènech-Oller N(2), Jerez-Roig J(3), Piqué-Buisan J(2).

Author information:
(1)Department of Psychology, Fundació Hospital d'Olot i Comarcal de la Garrotxa, 
17800 Olot, Spain.
(2)Department of Knowledge and Innovation, Fundació Hospital d'Olot i Comarcal 
de la Garrotxa, 17800 Olot, Spain.
(3)Centre for Health and Social Care Research (CESS), Research Group on 
Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), 
Faculty of Health Sciences and Welfare, University of Vic-Central University of 
Catalonia (UVic-UCC), 08500 Vic, Spain.

Background: Immersive therapy through virtual reality represents a novel 
strategy used in psychological interventions, but there is still a need to 
strengthen the evidence on its effects on health professionals’ mental health. 
Objective: To analyze the results of immersive therapy through virtual reality 
on the levels of anxiety and well-being of the health professionals working in a 
regional hospital in Olot (Spain). Methods: Pilot quasi-experimental study 
including a group of 35 female (mean age = 45.7, SD = 8.43) health professionals 
who undertook immersive therapy for 8 weeks. The intervention was implemented 
through virtual reality, and its effect on anxiety levels and well-being was 
evaluated through the Hamilton and Eudemon scales, respectively. Data on age, 
gender, active pharmacological or psychological treatment, mental health 
disorders and number of sessions were also collected. Results: A statistically 
significant (p < 0.001) improvement in anxiety and well-being was found, with 
large and moderate effect sizes (0.90 and 0.63 respectively). In addition, these 
changes were clinically significant. No significant associations were found 
between the improvements and the different variables, but a greater trend was 
identified among the group of professionals with untreated or unidentified 
levels of anxiety. Conclusion: This group of health professionals showed a 
statistically and clinically significant improvement in anxiety and well-being 
after the application of immersive therapy using virtual reality. Further 
studies with a control group are necessary to further analyze this novel 
intervention.

DOI: 10.3390/ijerph19169793
PMCID: PMC9407751
PMID: 36011433 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1643. Radiography (Lond). 2022 Oct;28 Suppl 1:S68-S76. doi: 
10.1016/j.radi.2022.07.006. Epub 2022 Aug 9.

The lessons learned working in diagnostic and therapeutic radiography 
departments through the COVID-19 pandemic in Northern Ireland, UK. What can we 
do differently the next time?

Mc Fadden S(1), Flood T(2), Watson A(3), Shepherd P(4).

Author information:
(1)Diagnostic Radiography and Imaging School of Health Sciences University of 
Ulster Shore Road Newtownabbey Co. Antrim, BT37 OQB, UK. Electronic address: 
s.mcfadden@ulster.ac.uk.
(2)Radiotherapy and OncologySchool of Health Sciences, Ulster University, BT37 
0QB, UK. Electronic address: t.flood@ulster.ac.uk.
(3)School of Health Sciences, Ulster University, BT37 0QB, UK. Electronic 
address: Watson-A15@ulster.ac.u.
(4)Radiotherapy and Oncology School of Health Sciences, Ulster University, 
Jordanstown Campus, Newtownabbey, BT37 0QB, UK. Electronic address: 
ph.shepherd@ulster.ac.uk.

INTRODUCTION: Following the emergence of the COVID-19 pandemic in January 2020, 
a radical restructure of NHS services occurred, prioritising the acute needs of 
infected patients. This included suspending routine procedures, leading to an 
inevitable resurgence in the future, placing increased demands on the NHS, 
including diagnostic and therapeutic radiographers. With radiography departments 
already experiencing staff shortages due to COVID-19 related illnesses and 
vulnerable staff shielding, there is a need to implement plans within 
radiography departments to ensure their sustainability in the future.
METHODS: A mixed methods study was undertaken in Northern Ireland, involving 
distribution of a survey to diagnostic and therapeutic radiographers alongside 
conducting interviews with radiography department managers.
RESULTS: 106 radiographers completed the survey, with 9 radiography managers and 
2 band eight superintendents participating in interviews. Over 60% of 
participants felt that morale declined in their departments, with the majority 
feeling that the pandemic had a negative impact on their physical or mental 
health and wellbeing. Managers felt that to improve staff morale and motivation, 
incentives need to be offered including remuneration, flexible working and 
support for professional development.
CONCLUSION: Whilst predicting when the next wave of a COVID-19 variant or the 
next pandemic will occur is impossible, preparation and planning will help 
manage the situation better. This requires identifying clinical areas for 
expansion/retraction and having access to additional staff to meet the demands 
on the service to ensure all patients receive care not just those acutely ill.
IMPLICATIONS FOR PRACTICE: This study has identified key lessons learned from 
the pandemic within the radiography departments. This will enable preparation 
and strategic planning for future pandemics.

Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.radi.2022.07.006
PMCID: PMC9359931
PMID: 36008264 [Indexed for MEDLINE]


1644. BMJ Open. 2022 Aug 24;12(8):e061993. doi: 10.1136/bmjopen-2022-061993.

Changes in life satisfaction, depression, general health and sleep quality of 
Spanish older women during COVID-19 lockdown and their relationship with 
lifestyle: an observational follow-up study.

Marcos-Pardo PJ(1)(2)(3), Abelleira-Lamela T(4), Vaquero-Cristobal R(5)(4), 
González-Gálvez N(3)(4).

Author information:
(1)SPORT Research Group (CTS-1024), CERNEP Research Center, Universidad de 
Almeria, Almeria, Andalucía, Spain.
(2)Department of Education, Faculty of Education Sciences, University of 
Almería, Almería, Spain.
(3)Active Aging, Exercise and Health/HEALTHY-AGE Network, Consejo Superior de 
Deportes, Madrid, Spain.
(4)Injury prevention in sport Research Group (PRELEDE), Faculty of Sport, 
Universidad Católica San Antonio de Murcia, Murcia, Spain.
(5)Active Aging, Exercise and Health/HEALTHY-AGE Network, Consejo Superior de 
Deportes, Madrid, Spain rvaquero@ucam.edu.

OBJETIVES: To analyse the effects of COVID-19 lockdown on mental well-being 
variables of older women, and to determine the influence of lifestyle and age on 
such effects. The hypothesis of the study was that all parameters related to 
mental well-being would worsen in older women during the COVID-19 lockdown.
DESIGN: Observational follow-up study. Pre lockdown measurements were taken 
before the lockdown. Post lockdown measurements were taken as soon as began the 
de-escalation.
SETTING: Senior centres in the Region of Murcia (Spain).
PARTICIPANTS: The sample was composed of 40 older women volunteers, over 54 
years of age (mean age=62.35±8.15 years).
PRIMARY AND SECONDARY OUTCOME MEASURES: Pre lockdown and post lockdown 
evaluations were carried out face to face. The following questionnaires were 
completed: Satisfaction with Life Scale, The Center for Epidemiologic Studies 
Depression Scale, The Short Form 36 Health Survey, The Pittsburgh Sleep Quality 
Index, the Global Physical Activity Questionnaire and Prevention with 
Mediterranean Diet.
RESULTS: Post lockdown, a worsening was found in the variables of life 
satisfaction (p=0.001); depression (p<0.001), quality of life in physical role 
(p=0.006), pain (p=0.004), emotional role (p<0.001) and mental health (p<0.001); 
and sleep quality (p=0.018), sleep latency (p=0.004), sleep disturbances 
(p=0.002) and global sleep quality score (p=0.002). It was found how age 
influenced the variables of pain (p=0.003) and social role (p=0.047), as well as 
the influence of a healthy lifestyle on the variables analysed (F=6.214; 
p=0.017). Adherence to the Mediterranean diet was shown to be a protective 
factor against increased depression (p=0.03). Spending time sitting was shown to 
be a risk factor for physical role health (p=0.002), as was advanced age on 
health due to worsening pain (p=0.005), or an unhealthy lifestyle on increased 
consumption of sleeping aids (p=0.017).
CONCLUSION: The lockdown had a great negative impact on Spanish older women on 
mental well-being variables.
TRIAL REGISTRATION NUMBER: NCT04958499.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2022-061993
PMCID: PMC9412044
PMID: 36002204 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


1645. J Health Psychol. 2023 Apr;28(5):462-476. doi: 10.1177/13591053221116627. Epub 
2022 Aug 23.

Do healthy habits regulate the relationship between psychosocial dysfunction by 
COVID-19 and bidimensional mental health?

Rico-Bordera P(1), Falcó R(1), Vidal-Arenas V(2), Piqueras JA(1).

Author information:
(1)Miguel Hernández University of Elche, Spain.
(2)Universitat Jaume I, Spain.

COVID-19 has affected mental health and well-being. Lifestyles are relevant to 
understand the impact of psychosocial dysfunctions. The objective was to examine 
the role of healthy habits in the relations between psychosocial dysfunction and 
psychological well-being/distress during COVID-19. Participants completed 
measures of psychosocial dysfunction, healthy habits, life satisfaction, 
well-being, depression, and anxiety symptoms. Psychosocial dysfunction was 
associated with distress symptoms, while health habits were associated with 
well-being. Healthy habits were mediators: greater psychosocial dysfunction was 
associated with less healthy habits, which in turn were associated with lower 
overall well-being, and greater depression. Programs addressing healthy habits 
can be of great utility.

DOI: 10.1177/13591053221116627
PMCID: PMC10076176
PMID: 36000211 [Indexed for MEDLINE]

Conflict of interest statement: The authors declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1646. BMJ Open. 2022 Aug 23;12(8):e059493. doi: 10.1136/bmjopen-2021-059493.

Examining the mental health adversity among healthcare providers during the two 
waves of the COVID-19 pandemic: results from a cross-sectional, survey-based 
study.

Dezso F(#)(1), Birkás B(#)(2), Vizin G(#)(3)(4), Váncsa S(5)(6), Szőcs H(3), 
Erőss A(1), Lex D(1), Gede N(5), Molnar Z(6)(7), Hegyi P(#)(5)(6)(8), Csathó 
Á(#)(9).

Author information:
(1)Department of Anaesthesiology and Intensive Therapy, Hungarian Defence Forces 
Medical Centre, Budapest, Hungary.
(2)Department of Behavioral Sciences, University of Pécs Medical School, Pécs, 
Hungary.
(3)Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.
(4)Department of Clinical Psychology, Semmelweis University, Budapest, Hungary.
(5)Institute for Translational Medicine, Szentágothai Research Centre, 
University of Pecs Medical School, Pécs, Hungary.
(6)Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
(7)Department of Anesthesiology and Intensive Therapy, Semmelweis University, 
Budapest, Hungary.
(8)Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis 
University, Budapest, Hungary.
(9)Department of Behavioral Sciences, University of Pécs Medical School, Pécs, 
Hungary arpad.csatho@aok.pte.hu.
(#)Contributed equally

OBJECTIVES: The current global health crisis of the COVID-19 pandemic has 
drastically affected the whole population, but healthcare workers are 
particularly exposed to high levels of physical and mental stress. This enormous 
burden requires both the continuous monitoring of their health conditions and 
research into various protective factors.
DESIGN: Cross-sectional surveys.
SETTING AND PARTICIPANTS: Self-administered questionnaires were constructed 
assessing COVID-19-related worries of health workers in Hungary. The surveys 
were conducted during two consecutive waves of the COVID-19 pandemic (N-first 
wave=376, N-second wave=406), between 17 July 2020 and 31 December 2020.
PRIMARY AND SECONDARY OUTCOME MEASURES: COVID-19-related worry, well-being and 
distress levels of healthcare workers. We also tested whether psychological 
resilience mediates the association of worry with well-being and distress. 
Multiple linear regression analyses were performed.
RESULTS: The results indicated that healthcare workers had high levels of worry 
and distress in both pandemic waves. When comparing the two waves, enhanced 
levels of worry (Wald's χ2=4.36, p=0.04) and distress (Wald's χ2=25.18, 
p<0.001), as well as compromised well-being (Wald's χ2=58.64, p<0.001), were 
found in the second wave. However, not all types of worries worsened to the same 
extent across the waves drawing attention to some specific COVID-19-sensitive 
concerns. Finally, the protective role of psychological resilience was shown by 
a mediator analysis suggesting the importance of increasing resilience as a key 
factor in maintaining the mental health of healthcare workers in the burden of 
the COVID-19 pandemic.
CONCLUSIONS: Our results render the need for regular psychological surveillance 
in healthcare workers.
REGISTRATION: Hungarian Scientific and Research Ethics Committee of the Medical 
Research Council (IV/5079-2/2020/EKU).

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-059493
PMCID: PMC9402445
PMID: 35998961 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


1647. BMJ Open. 2022 Aug 23;12(8):e061331. doi: 10.1136/bmjopen-2022-061331.

Relationship between working conditions and psychological distress experienced 
by junior doctors in the UK during the COVID-19 pandemic: a cross-sectional 
survey study.

Dunning A(1), Teoh K(2), Martin J(3), Spiers J(4), Buszewicz M(5), Chew-Graham 
C(6), Taylor AK(7), Gopfert A(8), Van Hove M(9), Appleby L(10), Riley R(11).

Author information:
(1)Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK 
alice.dunning@bthft.nhs.uk.
(2)Department of Organizational Psychology, Birkbeck University of London, 
London, UK.
(3)Institute of Applied Health Research, University of Birmingham, Birmingham, 
UK.
(4)College of Medical and Dental Sciences, University of Birmingham, Birmingham, 
UK.
(5)Research Department of Primary Care and Population Health, University College 
London, London, UK.
(6)School of Medicine, Keele University, Keele, UK.
(7)School of Medicine, University of Leeds, Leeds, UK.
(8)School of Medicine, Oxford University Hospitals NHS Trust, Oxford, UK.
(9)London School of Hygiene & Tropical Medicine, London, UK.
(10)Department of Psychiatry & Behavioral Sciences, The University of Manchester 
Faculty of Medical and Human Sciences, Manchester, UK.
(11)School of Health Sciences, University of Surrey, Guildford, UK.

OBJECTIVES: This paper explored the self-reported prevalence of depression, 
anxiety and stress among junior doctors during the COVID-19 pandemic. It also 
reports the association between working conditions and psychological distress 
experienced by junior doctors.
DESIGN: A cross-sectional online survey study was conducted, using the 21-item 
Depression, Anxiety and Stress Scale and Health and Safety Executive scale to 
measure psychological well-being and working cultures of junior doctors.
SETTING: The National Health Service in the UK.
PARTICIPANTS: A sample of 456 UK junior doctors was recruited online during the 
COVID-19 pandemic from March 2020 to January 2021.
RESULTS: Junior doctors reported poor mental health, with over 40% scoring 
extremely severely depressed (45.2%), anxious (63.2%) and stressed (40.2%). Both 
gender and ethnicity were found to have a significant influence on levels of 
anxiety. Hierarchical multiple linear regression analysis outlined the specific 
working conditions which significantly predicted depression (increased demands 
(β=0.101), relationships (β=0.27), unsupportive manager (β=-0.111)), anxiety 
(relationships (β=0.31), change (β=0.18), demands (β=0.179)) and stress 
(relationships (β=0.18), demands (β=0.28), role (β=0.11)).
CONCLUSIONS: The findings illustrate the importance of working conditions for 
junior doctors' mental health, as they were significant predictors for 
depression, anxiety and stress. Therefore, if the mental health of junior 
doctors is to be improved, it is important that changes or interventions 
specifically target the working environment rather than factors within the 
individual clinician.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/bmjopen-2022-061331
PMCID: PMC9402444
PMID: 35998957 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


1648. J Psychiatr Res. 2022 Nov;155:90-99. doi: 10.1016/j.jpsychires.2022.07.068. Epub 
2022 Aug 10.

Fear learning and generalization during pandemic fear: How COVID-19-related 
anxiety affects classical fear conditioning with traumatic film clips.

Hauck A(1), Michael T(1), Ferreira de Sá DS(2).

Author information:
(1)Division of Clinical Psychology and Psychotherapy, Department of Psychology, 
Saarland University, Saarbrücken, Germany.
(2)Division of Clinical Psychology and Psychotherapy, Department of Psychology, 
Saarland University, Saarbrücken, Germany. Electronic address: 
diana.ferreira@uni-saarland.de.

The COVID-19 pandemic greatly disrupted our daily lives. Worldwide, people were 
confronted with health, financial, and existential fears or trauma-like 
experiences. Recent studies have identified an increase in stress, anxiety, and 
fear symptoms in connection with the pandemic. Furthermore, fear learning 
processes are central mechanisms in the development and maintenance of anxiety 
disorders. Patients commonly show impairments not only in fear learning but also 
in its generalization. Thus, pandemic-related anxiety may constitute a risk 
factor for both enhanced fear acquisition and generalization. In a 
pre-registered online study with a final sample of 220 healthy university 
students, we investigated whether participants with higher COVID-19-related 
anxiety (COVID-Anxiety) show impaired fear learning and generalization. For this 
purpose, we used a differential fear conditioning paradigm with a traumatic film 
clip as the unconditioned stimulus (US) and collected US-expectancy as the main 
measure of interest. Participants with high COVID-Anxiety show a tendency toward 
poorer discrimination between the reinforced conditioned stimulus (CS+) and the 
unreinforced conditioned stimulus (CS-) during acquisition and significantly 
poorer discrimination patterns during generalization. Furthermore, participants 
with high COVID-Anxiety show greater general fear throughout the whole 
experiment. Our results show that the subjective effects of the COVID-19 
pandemic on psychological well-being are associated with impairments in both 
fear learning and fear generalization. As expected, high COVID-Anxiety leads to 
poorer performance in stimulus discrimination and greater levels of fear, which 
might contribute to a higher risk of anxiety disorders. GERMAN CLINICAL TRIAL 
REGISTER: DRKS00022761.

Copyright © 2022 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.jpsychires.2022.07.068
PMCID: PMC9365308
PMID: 35998471 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest All authors 
declare no conflicts of interest.


1649. PLoS One. 2022 Aug 23;17(8):e0264886. doi: 10.1371/journal.pone.0264886. 
eCollection 2022.

Psychosocial factors associated with mental health and quality of life during 
the COVID-19 pandemic among low-income urban dwellers in Peninsular Malaysia.

Min Fui W(1)(2), Abdul Majid H(2)(3), Ismail R(4), Su TT(5), Maw Pin T(6), Said 
MA(7).

Author information:
(1)Training Management Division, Ministry of Health, Putrajaya, Malaysia.
(2)Centre for Population Health (CePH), Department of Social and Preventive 
Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
(3)Department of Nutrition, Faculty of Public Health, Universitas Airlangga, 
Jawa Timur, Indonesia.
(4)Psychology and Human Well-being Research Centre, Faculty of Social Sciences 
and Humanities, University Kebangsaan, Bangi, Malaysia.
(5)South East Asia Community Observatory (SEACO) and Global Public Health, 
Jeffrey Cheah School of Medicine & Health Sciences, Monash University, Bandar 
Sunway, Subang Jaya, Malaysia.
(6)Department of Medicine, Faculty of Medicine, University of Malaya, Kuala 
Lumpur, Malaysia.
(7)Centre for Epidemiology and Evidence-Based Practice, Department of Social and 
Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, 
Malaysia.

BACKGROUND AND AIMS: Mental well-being among low-income urban populations is 
arguably challenged more than any other population amid the COVID-19 pandemic. 
This study investigates factors associated with depression and anxiety symptoms 
and quality of life among Malaysia's multi-ethnic urban lower-income 
communities.
METHODS: This is a community-based house-to-house survey conducted from 
September to November 2020 at the Petaling district in Selangor, Malaysia. Five 
hundred and four households were identified using random sampling, and heads of 
eligible households were recruited. Inclusion criteria were age ≥18 years with a 
monthly household income ≤RM6960 (estimated $1600) without acute psychiatric 
illness. The PHQ-9, GAD-7 and EQ-5D were used for depression, anxiety, and 
quality of life, respectively. Multivariable logistic regression was performed 
for the final analysis.
RESULTS: A total of 432 (85.7%) respondents with a mean age of 43.1 years 
completed the survey. Mild to severe depression was detected in 29.6%, mild to 
severe anxiety in 14.7%, and problematic quality of life in 27.8% of 
respondents. Factors associated with mild to severe depression were younger age, 
chronic health conditions, past stressful events, lack of communication gadgets 
and lack of assets or commercial property. While respiratory diseases, marital 
status, workplace issues, financial constraints, absence of investments, 
substance use and lack of rental income were associated with mild to severe 
anxiety. Attributing poverty to structural issues, help-seeking from 
professionals, and self-stigma were barriers, while resiliency facilitated good 
psychological health. Problematic quality of life was associated with 
depression, older age, unemployment, cash shortage, hypertension, diabetes, 
stressful life events and low health literacy.
CONCLUSIONS: A high proportion of the sampled urban poor population reported 
mild to severe anxiety and depression symptoms. The psychosocial determinants 
should inform policymakers and shape future work within this underserved 
population.

DOI: 10.1371/journal.pone.0264886
PMCID: PMC9398022
PMID: 35998193 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


1650. Womens Health (Lond). 2022 Jan-Dec;18:17455057221114274. doi: 
10.1177/17455057221114274.

Self-reported mental well-being of mothers with young children during the first 
wave of the COVID-19 pandemic in Germany: A mixed-methods study.

Wandschneider L(1), Batram-Zantvoort S(1), Alaze A(1), Niehues V(1), Spallek 
J(2), Razum O(1), Miani C(1).

Author information:
(1)Department of Epidemiology and International Public Health, School of Public 
Health, Bielefeld University, Bielefeld, Germany.
(2)Department of Public Health, Institute for Health, Brandenburg University of 
Technology Cottbus-Senftenberg, Senftenberg, Germany.

OBJECTIVES: Mothers of young children have been identified as a particularly 
vulnerable group during the COVID-19 pandemic. We aimed to explore how 
occupational, psychosocial and partnership-related factors were associated with 
their self-reported mental well-being during the first COVID-19 wave.
METHODS: Five hundred fifty participants of the BaBi cohort study (est. 2013, 
Bielefeld, North-Rhine Westphalia, Germany) were invited to complete an online 
survey and to take part in email interviews (April-May 2020). With survey data, 
we assessed self-reported mental well-being through validated instruments 
(eight-item Patient Health Questionnaire; short version of the Symptom 
Checklist) and ran linear regression models for occupational, psychosocial and 
partnership-related factors. We performed content analysis on the interviews' 
data to further understand the determinants of the women's mental well-being.
RESULTS: One hundred twenty-four women participated in the survey; of which 17 
also participated in the interviews. A perceived lack of support in childcare 
was associated with higher levels of depressive symptoms, while having a higher 
internal locus of control was associated with lower levels. Psychological 
distress was higher in those reporting lack of emotional or childcare support. 
Interviews confirmed the interplay of potential stressors and highlighted the 
difficulties to reconcile different expectations of motherhood.
DISCUSSION: Occupational, psychosocial and partner-related factors can act (to 
varying degree) both as resources and stressors to the self-reported mental 
well-being of mothers of young children. These impacts took different forms and 
created opportunities or challenges, depending on specific life circumstances, 
such as work or family situations, relationships and own psychosocial resources. 
Although not representative, our study contributes to building the COVID-19 
evidence base, delineating the mental health toll of the pandemic on mothers of 
young children and the factors that contribute to it.

DOI: 10.1177/17455057221114274
PMCID: PMC9424892
PMID: 35997231 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: The author(s) declared no 
potential conflicts of interest with respect to the research, authorship and/or 
publication of this article.


1651. PLoS One. 2022 Aug 22;17(8):e0273502. doi: 10.1371/journal.pone.0273502. 
eCollection 2022.

"I feel like I'm in a revolving door, and COVID has made it spin a lot faster": 
The impact of the COVID-19 pandemic on youth experiencing homelessness in 
Toronto, Canada.

Noble A(1)(2), Owens B(2), Thulien N(3)(4)(5), Suleiman A(2).

Author information:
(1)Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, 
Ontario, Canada.
(2)Research and Evaluation Department, Covenant House Toronto, Toronto, Ontario, 
Canada.
(3)MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St 
Michael's Hospital, Toronto, Ontario, Canada.
(4)Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, 
Canada.
(5)Centre for Critical Qualitative Health Research, University of Toronto, 
Toronto, Ontario, Canada.

PURPOSE: Research has shown that youth experiencing homelessness (YEH) face 
barriers to social inclusion and are at risk for poor mental health. With the 
COVID-19 pandemic threatening the health, wellbeing, and economic circumstances 
of people around the world, this study aims to assess the impacts of the 
pandemic on YEH in Toronto, Ontario, as well as to identify recommendations for 
future waves of COVID-19.
METHODS: Semi-structured interviews were conducted with YEH (ages 16-24, n = 45) 
and staff who work in one of four downtown emergency shelters for youth (n = 31) 
in Toronto, Ontario.
RESULTS: YEH experienced both structural changes and psychosocial impacts 
resulting from the pandemic. Structural changes included a reduction in 
services, barriers to employment and housing, and changes to routines. 
Psychosocial outcomes included isolation, worsened mental health, and increased 
substance use. Impacts were magnified and distinct for subpopulations of youth, 
including for youth that identified as Black, 2SLGBTQ+, or those new to Canada.
CONCLUSIONS: The COVID-19 pandemic increased distress among YEH while also 
limiting access to services. There is therefore a need to balance health and 
safety with continued access to in-person services, and to shift the response to 
youth homelessness to focus on prevention, housing, and equitable supports for 
subpopulations of youth.

DOI: 10.1371/journal.pone.0273502
PMCID: PMC9394800
PMID: 35994505 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


1652. J Psychosoc Nurs Ment Health Serv. 2023 Mar;61(3):27-31. doi: 
10.3928/02793695-20220809-01. Epub 2022 Aug 22.

University Student Health Services, Local Experience, and Emerging Needs: 
Bridging the Past With the Future.

Thireos E, Markaki A, Symvoulakis EK, Lionis C.

University students' health and well-being is critical, especially in the 
aftermath of the coronavirus disease 2019 pandemic; however, a comprehensive and 
integrated approach in academic institutions remains neglected. In this context, 
the local experience from a pilot university-based Student Health Center at an 
urban campus in Greece is presented. Select health promotion and disease 
prevention screening and monitoring initiatives are summarized from the 
viewpoint of a Strengths, Weaknesses, Opportunities, and Threats analysis, with 
emerging health needs and policy implications. Long-term sustainability is 
feasible, only if synergies and close collaboration with other university units 
and local health authorities are developed. A post-pandemic call to action for 
intervention programs that integrate physical and mental health care, as well as 
raise awareness among university stakeholders and health policy makers, is 
issued. [Journal of Psychosocial Nursing and Mental Health Services, 61(3), 
27-31.].

DOI: 10.3928/02793695-20220809-01
PMID: 35993727 [Indexed for MEDLINE]


1653. Eur Rev Med Pharmacol Sci. 2022 Aug;26(15):5562-5567. doi: 
10.26355/eurrev_202208_29427.

Beneficial effects of a program of Mindfulness by remote during COVID-19 
lockdown.

Borghi S(1), Nisticò A, Marano G, Janiri L, Sani G, Mazza M.

Author information:
(1)Department of Geriatrics, Neuroscience and Orthopedics, Institute of 
Psychiatry and Psychology, Fondazione Policlinico Universitario A. Gemelli 
IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy. 
marianna.mazza@policlinicogemelli.it.

OBJECTIVE: In the emergency context of COVID-19 pandemic and lockdown, 
mindfulness relaxation techniques can provide a safe and effective strategy to 
obtain in a reasonably short time some degree of relief from suffering and to 
guarantee a greater confidence with emotional reactions in the general 
population.
SUBJECTS AND METHODS: The Mindfulness-Based Stress Reduction program for coping 
with COVID-19 emergency was designed as an 8-week program during the early phase 
of lockdown consisting in practice meditation exercises at least once a day 
guided and structured by certified instructors entered on a free online 
platform. At the end of the program all participants completed a survey.
RESULTS: A total of 108 surveys were completed (67.6% male; 32.4% female). 
Despite the difficult moment of lockdown and the fear linked to the pandemic, 
61.9% of interviewed subjects declared a state of general well-being from fair 
to good linked to the practice of mindfulness. Female subjects (p=0.001), 
married subjects (p=0.05) and people taking pharmacologic therapy demonstrated 
(p=0.009) significant improvement in daily management of emotions and practical 
requests during the early phase of the COVID-19 outbreak.
CONCLUSIONS: Mindfulness meditation may be effective in helping people to 
regulate emotions and to support their mental health during this period of worry 
and uncertainty.

DOI: 10.26355/eurrev_202208_29427
PMID: 35993653 [Indexed for MEDLINE]


1654. Radiography (Lond). 2022 Oct;28 Suppl 1:S50-S58. doi: 
10.1016/j.radi.2022.07.009. Epub 2022 Jul 19.

The radiography students' perspective of the impact of COVID-19 on education and 
training internationally: a across sectional survey of the UK Devolved Nations 
(UKDN) and the United Arab Emirates (UAE).

Elshami W(1), Abuzaid MM(2), McConnell J(3), Stewart S(4), Floyd M(5), Hughes 
D(6), McClintick C(7), Eckloff K(5), Leishman L(8), McFadden S(9).

Author information:
(1)Medical Diagnostic Imaging Department, College of Health Sciences, University 
of Sharjah, Sharjah, United Arab Emirates. Electronic address: 
welshami@sharjah.ac.ae.
(2)Medical Diagnostic Imaging Department, College of Health Sciences, University 
of Sharjah, Sharjah, United Arab Emirates.
(3)Leeds Teaching Hospitals NHS Trust, UK.
(4)Caledonian University, UK.
(5)Cardiff University, UK.
(6)Bangor University, UK.
(7)Queen Margaret University, UK.
(8)Robert Gordon University, UK.
(9)Diagnostic Radiography and Imaging School of Health Sciences, University of 
Ulster Shore Road Newtownabbey Co. Antrim, BT37 OQB, UK.

INTRODUCTION: The overnight change in hospital practice and service delivery 
during the COVID-19 pandemic raises the question whether undergraduate 
radiography students received an adequate clinical experience. Many students had 
their clinical placements cancelled, deferred or replaced with simulated 
learning. As a way of dealing with the pandemic some hospitals were dedicated to 
COVID-19 patients only resulting in many elective procedures being cancelled. 
Many patients also chose to stay away from the hospital out of fear of infection 
or the desire to reduce the burden on staff. This resulted in a limited range of 
examinations and clinical experience for those students who were able to 
complete their clinical placement.
AIM: This study aims to investigate the impact of COVID-19 on the education and 
training of radiography students internationally in the United Kingdom Devolved 
Nations (UKDN) and the United Arab Emirates (UAE), to determine any possible 
impact on their future careers.
METHOD: Ethical permission was sought and granted from the Research Ethics 
Committees (ID: 21-04-12-02 and ID:21/0032). An online survey was developed 
using Google Forms and link was shared with students via email.
RESULTS: 262 students participated in the study [UAE (n = 60, 23%) and UKDN 
(n = 202, 77%)]. 72% stated that their clinical skills have improved and 82% 
were confident in the choice of radiography as a career. Participants from UAE 
displayed a higher tendency towards anxiety (p = 0.009). Students who were on 
clinical placements during the COVID-19 pandemic and worked with COVID-19 
positive patients displayed less ongoing concern relating to COVID-19 
(p = 0.004). 78% of the participants did not require wellbeing advice or request 
any type of wellbeing support from the higher education institutions (HEIs). 
Nevertheless, the study found that wellbeing of students was found to be 
negatively affected during the pandemic.
CONCLUSION: Completing clinical placement during the COVID-19 pandemic allowed 
the continuation of education as students were allowed to improve their skills, 
confidence and resilience in coping with uncertainties and challenges. 
Undergraduate students should not be excluded from the clinical department 
during subsequent waves of COVID-19 or future pandemics to ensure continued 
workforce planning is possible.
IMPLICATIONS FOR PRACTICE: HEIs should find solutions to compensate students for 
the loss of practical experience and skills due to the decreased number of 
patients in some areas of radiography practice. Providing academic and career 
counselling can assist students achieve their professional objectives and 
decrease the risk of attrition and problems upon qualification.

Copyright © 2022 The College of Radiographers. Published by Elsevier Ltd. All 
rights reserved.

DOI: 10.1016/j.radi.2022.07.009
PMCID: PMC9293787
PMID: 35989145 [Indexed for MEDLINE]


1655. Psychiatr Pol. 2022 Apr 30;56(2):277-288. doi: 10.12740/PP/127006. Epub 2022 Apr 
30.

Concerns, attitudes and comparison of the COVID-19 epidemic impact on the mental 
state of medical and nonmedical employees.

[Article in English, Polish]

Podwalski P(1), Szczygieł K(1), Tyburski E(2), Samochowiec A(3), Samochowiec 
J(1).

Author information:
(1)Pomorski Uniwersytet Medyczny w Szczecinie, Katedra i Klinika Psychiatrii.
(2)Zakład Psychologii Zdrowia, Pomorski Uniwersytet Medyczny w Szczecinie.
(3)Uniwersytet Szczeciński, Instytut Psychologii Klinicznej.

OBJECTIVES: The aim of this study is to compare the manifestation of anxiety and 
depressive disorders as well as attempt to identify factors influencing their 
occurrence among healthcare system employees and nonmedical staff.
METHODS: A survey was conducted with participation of 921 people using the 
Hospital Anxiety and Depression Scale - Modified (HADS-M) and a survey prepared 
to assess the attitudes of the respondents towards the epidemic..
RESULTS: The obtained results allow to state that the examined groups do not 
differ in the level of perceived anxiety or the level of depression, however, 
they had different attitudes towards the epidemic. Anumber of factors increasing 
the risk of occurrence of these disorders have been identified. Among medical 
professions, nurses are the professional group particularly vulnerable to 
anxiety disorders.
CONCLUSIONS: The epidemic has a significant impact on human mental well-being. 
Recognizing the factors increasing the risk of mental disorders and their 
prevalence during an epidemic can help identify individuals who are particularly 
at risk of developing them. The knowledge resulting from empirical explorations 
is the basis for implementing preventive and therapeutic measures among people 
affected by mental disorders during the pandemic.

DOI: 10.12740/PP/127006
PMID: 35988074 [Indexed for MEDLINE]


1656. Radiography (Lond). 2022 Oct;28 Suppl 1:S59-S67. doi: 
10.1016/j.radi.2022.07.012. Epub 2022 Aug 18.

The Impact of COVID-19 on the Clinical Experience and Training of Undergraduate 
Student Radiographers internationally: The Clinical Tutors' perspective.

Elshami W(1), Abuzaid MM(2), McConnell J(3), Floyd M(4), Hughes D(5), Stewart 
S(6), McFadden S(7).

Author information:
(1)Medical Diagnostic Imaging Department, College of Health Sciences, University 
of Sharjah, Sharjah, United Arab Emirates. Electronic address: 
welshami@sharjah.ac.ae.
(2)Medical Diagnostic Imaging Department, College of Health Sciences, University 
of Sharjah, Sharjah, United Arab Emirates.
(3)Leeds Teaching Hospitals NHS Trust, UK.
(4)Cardiff University, UK.
(5)Bangor University, UK.
(6)Caledonian University, UK.
(7)Diagnostic Radiography and Imaging School of Health Sciences, University of 
Ulster Shore Road Newtownabbey Co. Antrim, BT37 OQB, UK.

INTRODUCTION: The impact on the clinical training and education of healthcare 
students by COVID-19 has been documented. However, the thoughts and experiences 
of clinical tutors (CTs) about radiography students attending for clinical 
training and education during this now elongated period beyond first recognition 
of the virus has not been explored. This paper will discuss data collected from 
CTs in the UK Devolved Nations (UKDN) and the United Arab Emirates (UAE) who 
were compared because of their similarities in delivery based on individual 
'rules of engagement' devised by their various health departments.
AIM: The purpose of this study was to examine the clinical tutors' thoughts and 
experiences of supervising radiography students attending clinical placement 
during the COVID-19 pandemic.
METHODS: The UK Devolved Nations (UKDN) and the United Arab Emirates (UAE) were 
selected for comparison on an international level as they are geographically 
distinct with a comparable population and education accredited/acknowledged by 
the Society and College of Radiographers (SCoR). Data was collected data from 
CTs across the UKDN and the UAE. The study used an online questionnaire (Google 
Forms) with closed questions in four themes including: students' experiences, 
impact on students' clinical placement, attitude of the clinical staff and the 
potential effects of COVID-19 on future graduates' skills and competencies. 
Further data was gathered on the experience of CTs mentoring students during the 
COVID-19 pandemic.
RESULTS: Data were collected from 59 CTs (81%, n = 48) from UKDN and (19%, 
n = 11) UAE. Twenty-seven (46%) respondents reported that COVID-19 had a 
negative impact on clinical practical experience. However, 32 (54%) identified 
that COVID-19 had no impact on student supervision/feedback or on clinical 
achievements. Eleven (19%) respondents thought that students should not have 
been on clinical placement during the pandemic but a further 51% (n = 30) were 
happy with the students on placement and expressed willingness to delegate work 
to students. Interestingly, 58% (n = 34) of CTs suggested that future graduates 
may need a longer preceptorship after they graduate due to receiving decreased 
clinical experience during the pandemic. Overall, 78% (n = 46) of respondents 
thought that students improved their clinical confidence by working directly 
with COVID-19 positive patients.
CONCLUSION: The current study has identified conflicting opinions across CTs in 
different clinical departments. Whilst some felt that students should not be in 
the hospital during the pandemic, others reported that working directly with 
COVID-19 patients had a positive impact on students as it improved their 
clinical confidence. Despite the challenges presented by COVID-19, CTs were able 
to provide direct clinical supervision and feedback to students on clinical 
placement throughout the pandemic. Nevertheless, future graduates may need a 
longer preceptorship period due to decreased clinical experience during the 
pandemic.
IMPLICATIONS FOR PRACTICE: Clinical placements should continue during subsequent 
COVID-19 waves of infection or future pandemics to ensure development of skills 
in resilience and adaptability. Underdeveloped skills due to a decreased range 
of examinations can be rectified when any wave of the infection subsides by 
providing tailored training based on individual student's needs.

Copyright © 2022 The College of Radiographers. Published by Elsevier Ltd. All 
rights reserved.

DOI: 10.1016/j.radi.2022.07.012
PMCID: PMC9385275
PMID: 35987883 [Indexed for MEDLINE]


1657. BMC Public Health. 2022 Aug 20;22(1):1590. doi: 10.1186/s12889-022-13964-6.

Sheds for life: health and wellbeing outcomes of a tailored community-based 
health promotion initiative for men's sheds in Ireland.

McGrath A(1), Murphy N(2), Egan T(3), Richardson N(4).

Author information:
(1)School of Health Sciences, Waterford Institute of Technology, X91 K0EK, 
Waterford, Ireland. aisling.mcgrath@wit.ie.
(2)School of Health Sciences, Waterford Institute of Technology, X91 K0EK, 
Waterford, Ireland.
(3)School of Business, Waterford Institute of Technology, X91 K0EK, Waterford, 
Ireland.
(4)National Centre for Men's Health, Institute of Technology Carlow, R93 V960, 
Carlow, Ireland.

BACKGROUND: Gender is increasingly recognised as a critical factor in designing 
community-based health promotion programmes. Men's Sheds ('Sheds') are 
community-based informal environments that represent a safe space in which to 
engage cohorts of hard-to-reach (HTR) men in health promotion. Sheds for Life 
(SFL), the first structured health promotion initiative evaluated globally in 
Sheds, is a 10-week initiative co-designed with Shed Members (Shedders) and 
delivered directly in the Shed setting in Ireland. This research describes the 
health and wellbeing outcomes experienced by SFL participants.
METHODS: Purposive sampling was used to recruit a diverse representation of 
Shedders (n = 421) participating in SFL alongside a wait list control (n = 86). 
Questionnaires assessing constructs of health and wellbeing were administered 
one-to-one in Sheds at baseline, 3, 6 and 12 months. Descriptive data for health 
outcomes were generated for each time point and assessed for significant changes 
using inferential testing, while considering COVID-19 impact.
RESULTS: Outcomes related to subjective wellbeing, mental wellbeing, physical 
activity, social capital and healthy eating significantly increased post SFL 
(p < 0.05). Mental wellbeing scores (SWEMWBS) post SFL remained significantly 
higher than baseline despite COVID-19 impact (p < 0.05). Binary logistic 
regression indicated that the odds of a meaningful SWEMWBS change was 
significantly higher for shedders that had lower SWEMWBS (OR 0.804), less 
loneliness (OR 0.638) and lived alone (OR 0.456) at baseline. Shedders with 
lower SWEMBWS had higher odds of experiencing positive changes in life 
satisfaction (OR 0.911) and trust (OR 0.928), while Shedders who lived alone had 
also higher odds of experience positive changes in healthy eating (OR 0.481). 
Finally, inactive Shedders at baseline had higher odds of experiencing increased 
levels of physical activity (OR 0.582).
CONCLUSIONS: Findings suggest that the inclusive, community-based SFL model is 
effective in engaging Shedders and facilitating positive and sustained changes 
in health and wellbeing outcomes. Using gender-specific approaches in the 
informal and safe environment of the Shed are effective in engaging men in 
structured health and wellbeing initiatives, particularly those who may be more 
vulnerable, isolated or lonely.
TRIAL REGISTRATION: This study has been retrospectively registered with the 
'International Standard Randomised Controlled Trial Number' registry 
(ISRCTN79921361) as of 05/03/2021.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-13964-6
PMCID: PMC9392583
PMID: 35987612 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1658. Midwifery. 2022 Nov;114:103457. doi: 10.1016/j.midw.2022.103457. Epub 2022 Aug 
10.

Effectiveness of mobile application-based perinatal interventions in improving 
parenting outcomes: A systematic review.

Chua JYX(1), Shorey S(2).

Author information:
(1)Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, 
National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 
10 Medical Drive 117597, Singapore.
(2)Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, 
National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 
10 Medical Drive 117597, Singapore. Electronic address: nurssh@nus.edu.sg.

OBJECTIVE: Parents face many challenges during the perinatal period and are at 
risk for mental health issues, especially during the current coronavirus 
(COVID-19) pandemic. Mobile application-based interventions can help parents to 
improve their psychosocial well-being in a convenient and accessible manner. 
This review aims to examine the effectiveness of mobile application-based 
perinatal interventions in improving parenting self-efficacy, anxiety, and 
depression (primary outcomes), as well as stress, social support, and 
parent-child bonding (secondary outcomes) among parents.
METHODS: Seven electronic databases (PubMed, Embase, CINAHL, PsycINFO, Web of 
Science, Scopus, and ProQuest Thesis and Dissertations) were searched from their 
respective inception dates until August 2021. The Cochrane Risk of Bias-2 tool 
was used to conduct quality appraisals. Results were narratively synthesized due 
to the high heterogeneity of intervention and participant types.
FINDINGS: A total of 6164 articles were retrieved from the seven electronic 
databases and citation searching. After excluding duplicate records and 
irrelevant titles/abstracts, 105 full texts were examined. Full-text screening 
excluded another 93 articles, leaving 12 included studies in this review. All 
studies were rated as having some concerns or a high overall risk of bias. 
Mobile application-based interventions were found to be feasible and promising 
in improving parents' overall well-being post-intervention during the perinatal 
period. Further research would be needed to determine their long-term effects.
KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Parental well-being was shown to 
improve using the following intervention components: educational resources on 
perinatal and infant care, psychotherapy, and support from peers and healthcare 
professionals. Hence, future interventions could aim to include these components 
and evaluate all inter-related parenting outcomes (parenting self-efficacy, 
stress, anxiety, depression, social support, and parent-child bonding). Parents 
could be provided with experiential learning exposure by using computer 
animations and virtual reality. Future research could be conducted on more 
fathers and parents from varied geographical regions.

Copyright © 2022. Published by Elsevier Ltd.

DOI: 10.1016/j.midw.2022.103457
PMCID: PMC9364944
PMID: 35985142 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


1659. Medicine (Baltimore). 2022 Aug 19;101(33):e29938. doi: 
10.1097/MD.0000000000029938.

Assessing the general health, increase in mental and physical workload among 
administrative staff of the University of Nigeria due to the COVID-19 pandemic.

Edikpa EC(1), Chigbu BC(1), Onu AE(1), Ogakwu VN(2), Aneke MC(1), Nwafor BN(1), 
Diara CF(1), Chibuko H(1), Oguejiofor CN(3), Anigbogu GN(1), Adepoju EB(1), 
Igbokwe CI(3).

Author information:
(1)Department of Educational Foundations, University of Nigeria, Nsukka, 
Nigeria.
(2)Institute for Development Studies, University of Nigeria, Enugu Campus, 
Enugu, Nigeria.
(3)Department of Educational Management and Policy, Faculty of Education, Nnamdi 
Azikiwe University, Awka, Nigeria.

The coronavirus disease 2019 (COVID-19) pandemic has changed the global 
workloads and general well-being of employees, especially in the university 
system. The object of this study is to evaluate the mental health and effect of 
increase in workload on the general well-being of the administrative staff of 
the University of Nigeria, Nsukka, on the resumption of academic activities 
after the lockdown due to COVID-19. A total of 73 randomly selected 
administrative staff were involved in the study. Three sets of instruments, the 
demographic questionnaire, National Aeronautics and Space Administration-Task 
Load Index, and General Health Questionnaire, were used to obtain information on 
the demographic characteristics, workload, and level of mental disorder among 
the respondents due to COVID-19. The generalized linear regression model, 1-way 
analysis of variance, independent samples t test, and contingency coefficient 
were used to analyze the data. The results revealed that high workload is 
significantly associated with high risk of mental and general health disorders 
among the respondents. The married, divorced, widowed, older, and females staff 
with >2 children are the most vulnerable to mental disorder, physical workload, 
frustration, and general health challenges. The younger staff, those with at 
most 2 children, and those who are still single experience lower mental and 
general health disorder and are more resilient. Significant and comprehensive 
health and administrative support should be provided for the overall well-being 
of the staff.

Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

DOI: 10.1097/MD.0000000000029938
PMCID: PMC9387663
PMID: 35984134 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no funding and conflicts of 
interest to disclose.


1660. Radiography (Lond). 2022 Oct;28 Suppl 1:S41-S49. doi: 
10.1016/j.radi.2022.07.001. Epub 2022 Jul 18.

The gendered impact of the COVID-19 pandemic on academics working in medical 
imaging and radiation therapy.

O'Donoghue K(1), Malamateniou C(1), Walton L(1), England A(1), Moore N(1), 
McEntee MF(2).

Author information:
(1)The Discipline of Medical Imaging and Radiation Science, School of Medicine, 
UGF 12 ASSERT, Brookfield Health Sciences, University College Cork, College 
Road, Cork, T12 AK54, Ireland.
(2)The Discipline of Medical Imaging and Radiation Science, School of Medicine, 
UGF 12 ASSERT, Brookfield Health Sciences, University College Cork, College 
Road, Cork, T12 AK54, Ireland. Electronic address: mark.mcentee@ucc.ie.

INTRODUCTION: Healthcare workers have been particularly impacted by the COVID-19 
pandemic, as have those educating them, albeit differently. Several papers have 
identified a gendered difference in the impact of the pandemic. This study aims 
to determine impact of COVID-19 on the health and wellbeing of Medical Imaging 
and Radiation Therapy (MIRT) academics.
METHODS: An electronic survey was designed in English on Qualtrics and 
distributed via email and online platforms to MIRT academics. Fifty-one 
questions were used; demographic (n = 9), work patterns (n = 11), general health 
(n = 8), mental health (n = 2), physical health (n = 10), and workload (n = 11). 
Overall, 46 were quantitative and five were qualitative 'open-ended' questions. 
The survey was open between 3rd March 2021 to 1st May 2021. Quantitative 
analysis was carried out using MS Excel v 16.61.1ss and SPSS v26.
RESULTS: The survey reached 32 countries globally and 412 participants; 23.5% 
identified as men (n = 97) and 76.5% as women (n = 315). Women reported worse 
sleep quality than men and overwhelmingly felt they would not like to work 
remotely again if given a choice. A higher percentage of males, 73% versus 40.5% 
of females reported getting outdoors less. The CORE-10 validated questionnaire 
found that 10.3% of males (n = 42) and 2.7% of females (n = 11) experienced 
severe psychological distress the week immediately before the survey was 
conducted.
CONCLUSION: While the study has identified some gender-related differences in 
the impact of COVID-19 on the mental and physical health of MIRT academics, both 
males and females have experienced significant deterioration in health and 
wellbeing due to the pandemic.
IMPLICATION FOR PRACTICE: Developing mental health support for MIRT academics 
and defining optimum methods for raising awareness is recommended.

Copyright © 2022. Published by Elsevier Ltd.

DOI: 10.1016/j.radi.2022.07.001
PMCID: PMC9288971
PMID: 35981944 [Indexed for MEDLINE]


1661. PLoS One. 2022 Aug 18;17(8):e0272162. doi: 10.1371/journal.pone.0272162. 
eCollection 2022.

Real world effectiveness of digital mental health services during the COVID-19 
pandemic.

Prescott MR(1), Sagui-Henson SJ(1), Welcome Chamberlain CE(1), Castro Sweet 
C(1), Altman M(1)(2).

Author information:
(1)Modern Health, San Francisco, California, United States of America.
(2)Clinical Excellence Research Center, Stanford School of Medicine, Palo Alto, 
California, United States of America.

BACKGROUND: The COVID-19 pandemic created an unprecedented need for mental 
health services that can be remotely delivered. Digital mental health services 
that offer personalized care recommendations hold promise to efficiently expand 
service, but evidence of the effectiveness of digitally delivered mental health 
care in real-world settings remains limited.
METHODS: A retrospective cohort of adults (N = 1,852) receiving care through a 
digital mental health platform with elevated depressive symptoms during the 
COVID-19 pandemic was analyzed to estimate changes in subjective well-being and 
clinical improvement in depressive symptoms (using the World Health 
Organization-Five [WHO-5] Well-Being Index), as well as compare the relative 
effectiveness and cost of different care utilization patterns.
RESULTS: The average improvement in WHO-5 score was 10.1 points (CI: 9.3-10.9, 
p<0.001) at follow-up, which constituted a medium effect size (d = 0.73). The 
odds of clinical improvement in depressive symptoms were significantly greater 
among those who utilized telecoaching (aOR = 2.45, 95%CI: 1.91-3.15, p < .001), 
teletherapy (aOR = 2.01, 95%CI: 1.57-2.57, p < .001), and both services (aOR = 
2.28, 95%CI: 1.67-3.11, p < .001) compared to those who only utilized 
assessments, adjusting for baseline WHO-5 score, age, sex, and number of days 
between baseline and follow-up assessments. The average estimated cost of care 
for telecoaching was $124 per individual, which was significantly less than 
teletherapy ($413) or both services ($559).
CONCLUSION: Digitally delivered care with a therapist and/or coach was effective 
in improving subjective well-being and clinical improvement in depressive 
symptoms. Although clinical outcomes were similar across utilization patterns, 
the cost of care was lowest among those utilizing telecoaching.

DOI: 10.1371/journal.pone.0272162
PMCID: PMC9387818
PMID: 35980879 [Indexed for MEDLINE]

Conflict of interest statement: The authors have read the journal’s policy and 
have the following competing interests: SJSH, CEWC, CCS, and MA are paid 
employees of Modern Health and MRP was a paid employee of Modern Health at the 
time of manuscript submission. This does not alter our adherence to PLOS ONE 
policies on sharing data and materials. There are no patents, products in 
development or marketed products associated with this research to declare.


1662. Psychol Health Med. 2023 Feb;28(2):517-528. doi: 10.1080/13548506.2022.2113104. 
Epub 2022 Aug 17.

Demoralization during the Italian quarantine due to 2019 coronavirus disease 
pandemic: prevalence and association with psychological well-being and coping 
strategies.

Botto R(1), Galante M(2), Miniotti M(1), Leombruni P(1).

Author information:
(1)Clinical Psychology Unit, Department of Neuroscience, University of Turin, 
"Città della Salute e della Scienza" Hospital of Turin, Turin, Italy.
(2)Independent researcher, Turin, Italy.

The aims of the study were to investigate demoralization in a sample of Italian 
citizens during the Italian quarantine due to COVID-19 pandemic and to explore 
its associations with psychological well-being, coping strategies, participants' 
socio-demographic characteristics and COVID-19-related factors. Italian citizens 
aged over 18 and quarantined in Italy were recruited. A cross-sectional online 
survey was launched through a snow-ball sampling and 1123 surveys were 
collected. Participants answered ad hoc questions and completed the 
Psychological General Well-Being Index, the Demoralization Scale, and the Coping 
Orientation to Problems Experienced-New Italian Version. Disheartenment, 
dysphoria, and sense of failure were the subdimensions of demoralization with 
higher scores. Demoralization was associated with depressed mood, positive 
well-being, self-control, general health, vitality, problem-solving, and 
avoidance and religious coping strategies. Individuals who were female, older, 
without children and not working during quarantine had higher demoralization. 
Quarantine-related changes can elicit demoralization that is associated to lower 
psychological well-being. Problem-solving and religious coping can protect 
against demoralization, while avoidant coping strategies can exacerbate it. 
Assessing and treating demoralization, especially in the categories of citizens 
most at risk of developing it, could be useful to provide adequate care against 
COVID-19-related distress.

DOI: 10.1080/13548506.2022.2113104
PMID: 35979591 [Indexed for MEDLINE]


1663. Eur J Psychotraumatol. 2022 Aug 11;13(2):2107810. doi: 
10.1080/20008066.2022.2107810. eCollection 2022.

Shared sources and mechanisms of healthcare worker distress in COVID-19: a 
comparative qualitative study in Canada and the UK.

Berkhout SG(1)(2), Billings J(3), Abou Seif N(3), Singleton D(3), Stein H(1), 
Hegarty S(3), Ondruskova T(3), Soulios E(3), Bloomfield MAP(3), Greene T(3)(4), 
Seto A(2), Abbey S(1)(2), Sheehan K(1)(2).

Author information:
(1)Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
(2)University Health Network, Toronto, Canada.
(3)Division of Psychiatry, University College London, London, UK.
(4)Department of Community Mental Health, University of Haifa, Haifa, Israel.

Background: COVID-19 has had a significant impact on the wellbeing of healthcare 
workers, with quantitative studies identifying increased stress, anxiety, 
depression, insomnia, and PTSD in a wide range of settings. Limited qualitative 
data so far has offered in-depth details concerning what underlies these 
challenges, but none provide comprehensive comparison across different 
healthcare systems. Objective: To explore qualitative findings relating to 
healthcare worker distress from two different countries to understand the 
nuanced similarities and differences with respect to the sources and impact of 
distress relating to COVID-19. Method: A comparative interpretive thematic 
analysis was carried out between two qualitative data sets examining healthcare 
workers' experiences of distress during the COVID-19 pandemic. Data from Canada 
and the UK were collected in parallel and analyzed in an iterative, 
collaborative process. Results: A number of sources of distress cut across both 
study settings including concerns about safety and patient care, challenges at 
home or in one's personal life, communication issues, work environment, media 
and public perception, and government responses to the pandemic. These sit on a 
spectrum from individual to institutional sources and were mutually reinforcing. 
Our analysis also suggested that common mechanisms such as exacerbations in 
uncertainty, hypervigilance, and moral injury underpinned these sources, which 
contributed to how they were experienced as distressing. Conclusion: This is the 
first international collaboration utilising qualitative data to examine this 
pressing issue. Despite differences in the political, social, health service, 
and pandemic-related context, the sources and mechanisms of distress experienced 
by healthcare workers in Canada and the UK were remarkably similar. HIGHLIGHTS 
This international comparative qualitative study explores how mechanisms that 
lead to distress are shared across different geographies and cultures, even as 
the local context shapes the sources of distress themselves.

Publisher: Antecedentes: La COVID-19 ha tenido un impacto significativo en el 
bienestar de los trabajadores de la salud, con estudios cuantitativos que 
identifican un aumento del estrés, la ansiedad, la depresión, el insomnio, y el 
TEPT en una amplia variedad de entornos. Hasta ahora, los datos cualitativos son 
limitados y han ofrecido un profundo detalle sobre lo que subyace a estos 
desafíos, pero ninguno proporciona una comparación exhaustiva entre los 
diferentes sistemas de atención de salud.Objetivo: Explorar los hallazgos 
cualitativos relacionados con la angustia de los trabajadores de la salud de dos 
países diferentes para comprender las sutiles similitudes y diferencias con 
respecto a las fuentes y el impacto de la angustia relacionada con la 
COVID-19.Método: Se llevó a cabo un análisis temático interpretativo comparativo 
entre dos conjuntos de datos cualitativos que examinaron las experiencias de 
angustia de los trabajadores de la salud durante la pandemia de la COVID-19. Los 
datos de Canadá y el Reino Unido se recopilaron en paralelo y se analizaron en 
un proceso colaborativo iterativo.Resultados: Una serie de fuentes de angustia 
atraviesan ambos entornos de estudio, incluidas las preocupaciones sobre la 
seguridad y el cuidado del paciente, los desafíos en el hogar o en la vida 
personal, los problemas de comunicación, el entorno laboral, la percepción 
pública y de los medios de comunicación, y las respuestas gubernamentales a la 
pandemia. Estos se ubican en un espectro desde fuentes individuales hasta 
institucionales y se reforzaron mutuamente. Nuestro análisis también sugirió que 
mecanismos comunes como las exacerbaciones de la incertidumbre, la 
hipervigilancia, y el daño moral sustentaban estas fuentes, lo que contribuyó a 
que se experimentaran como angustiosas.Conclusión: Esta es la primera 
colaboración internacional que utiliza datos cualitativos para examinar este 
apremiante problema. A pesar de las diferencias en el contexto político, social, 
de servicios de salud y relacionado con la pandemia, las fuentes y los 
mecanismos de angustia experimentados por los trabajadores de la salud en Canadá 
y el Reino Unido fueron notablemente similares.

Publisher: 背景：COVID-19 对医护人员的福祉产生了重大影响，定量研究发现在广泛的环境中应激、焦虑、抑郁、失眠和 PTSD 
增加。迄今为止，有限的定性数据提供了有关这些挑战背后的详细信息，但没有提供跨不同医疗保健系统的综合比较。目的：探究来自两个不同国家的与医护人员痛苦相关的定性研究结果，以了解 
COVID-19 相关痛苦的来源和影响方面的细微相似性和差异。方法：在两个考查COVID-19 
疫情期间医护人员痛苦经历的定性数据集之间进行了比较解释性主题分析。来自加拿大和英国的数据并行收集，并在一个迭代、协作的过程中进行分析。结果：两个研究环境中都有许多困扰的来源，包括对安全和患者护理的担忧、家庭或个人生活中的挑战、沟通问题、工作环境、媒体和公众认知，以及政府对疫情的反应。这些遍布从个人到机构的来源谱系，并且相互增强。我们的分析还表明，不确定性加剧、高警觉和道德伤害等导致人们感到痛苦的常见机制是这些来源的基础。结论：这是第一次利用定性数据来研究这一紧迫问题的国际合作。尽管在政治、社会、卫生服务和疫情相关的背景下存在差异，加拿大和英国的医护人员所经历的痛苦来源和机制非常相似。.

© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor &amp; 
Francis Group.

DOI: 10.1080/20008066.2022.2107810
PMCID: PMC9377263
PMID: 35979505 [Indexed for MEDLINE]

Conflict of interest statement: No potential conflict of interest was reported 
by the author(s).


1664. Eur J Pediatr. 2022 Oct;181(10):3753-3766. doi: 10.1007/s00431-022-04580-y. Epub 
2022 Aug 17.

Longitudinal changes in wellbeing amongst breastfeeding women in Australia and 
New Zealand during the COVID-19 pandemic.

Sakalidis VS(1), Rea A(2), Perrella SL(1)(3), McEachran J(1), Collis G(3), 
Miraudo J(3), Prosser SA(3)(4), Gibson LY(5)(4)(6), Silva D(5)(4)(7)(8), Geddes 
DT(9)(10).

Author information:
(1)School of Molecular Sciences, University of Western Australia, Perth, WA, 
6009, Australia.
(2)Mathematics and Statistics, Murdoch University, Perth, WA, Australia.
(3)One For Women, Perth, WA, Australia.
(4)The University of Western Australia, Perth, WA, Australia.
(5)Telethon Kids Institute, Perth, WA, Australia.
(6)School of Health and Medical Sciences, Edith Cowan University, Perth, WA, 
Australia.
(7)Health and Medical Sciences, The University of Western Australia, Perth, WA, 
Australia.
(8)Joondalup Health Campus, Perth, WA, Australia.
(9)School of Molecular Sciences, University of Western Australia, Perth, WA, 
6009, Australia. donna.geddes@uwa.edu.au.
(10)Telethon Kids Institute, Perth, WA, Australia. donna.geddes@uwa.edu.au.

The COVID-19 pandemic has impacted new mothers' wellbeing and breastfeeding 
experience. Women have experienced changes in birth and postnatal care and 
restricted access to their support network. It is unclear how these impacts may 
have changed over time with shifting rates of infection and policies restricting 
movement and access to services in Australia and New Zealand. This study 
investigated the longitudinal effect of the COVID-19 pandemic on breastfeeding 
and maternal wellbeing in Australia and New Zealand. Mothers (n = 246) completed 
an online survey every 4 weeks for 6 months that examined feeding methods, 
maternal mental wellbeing, worries, challenges, and positive experiences during 
the pandemic. Mothers maintained high full breastfeeding rates at 4 months (81%) 
which decreased to 37% at 6 months. Perceived low milk supply contributed to the 
earlier cessation of full breastfeeding. Poor infant sleep was associated with 
stress, perinatal anxiety, mental wellbeing, and breastfeeding status. Although 
mothers initially reported that lockdowns helped with family bonding and less 
pressure, prolonged lockdowns appeared to have adverse effects on access to 
social networks and extended family support.    Conclusion: The results 
highlight the changing dynamic of the pandemic and the need for adaptable 
perinatal services which allow mothers access to in-person services and their 
support network even in lockdowns. Similarly, access to continuous education and 
clinical care remains critical for women experiencing concerns about their milk 
supply, infant sleep, and their own wellbeing. What is Known: • The COVID-19 
pandemic and lockdown restrictions have significantly affected perinatal mental 
health, disrupted maternal services, and subsequent breastfeeding. What is New: 
• In Australia and New Zealand, breastfeeding women experienced challenges to 
their mental wellbeing, sleep, and breastfeeding, which was likely exacerbated 
over time by the pandemic. Lockdowns, while initially beneficial for some 
families, became detrimental to maternal support and wellbeing.

© 2022. The Author(s).

DOI: 10.1007/s00431-022-04580-y
PMCID: PMC9382010
PMID: 35976413 [Indexed for MEDLINE]

Conflict of interest statement: Donna T Geddes, Sharon L Perrella and Jacki 
McEachran receive funding from an unrestricted research grant from Medela AG, 
administered by The University of Western Australia. Donna T Geddes, Sharon L 
Perrella, and Jacki McEachran receive funding from an unrestricted research 
grant from Medela AG, administered by The University of Western Australia.


1665. CNS Neurosci Ther. 2022 Dec;28(12):1953-1963. doi: 10.1111/cns.13938. Epub 2022 
Aug 16.

Multidimensional phenotyping of the post-COVID-19 syndrome: A Swiss survey 
study.

Diem L(1), Schwarzwald A(1), Friedli C(1), Hammer H(1), Gomes-Fregolente 
L(1)(2), Warncke J(1), Weber L(1), Kamber N(1), Chan A(1), Bassetti C(1), Salmen 
A(1), Hoepner R(1).

Author information:
(1)Department of Neurology, Inselspital, Bern University Hospital and University 
of Bern, Bern, Switzerland.
(2)Graduate School for Health Sciences, University of Bern, Bern, Switzerland.

INTRODUCTION: Post-COVID-19 syndrome affects approximately 10-25% of people 
after a COVID-19 infection, irrespective of initial COVID-19 severity. The aim 
of this project was to assess the clinical characteristics, course, and 
prognosis of post-COVID-19 syndrome using a systematic multidimensional 
approach.
PATIENTS AND METHODS: An online survey of people with suspected and confirmed 
COVID-19 and post-COVID-19 syndrome, distributed via Swiss COVID-19 support 
groups, social media, and our post-COVID-19 consultation, was performed. A total 
of 8 post-infectious domains were assessed with 120 questions. Data were 
collected from October 15 to December 12, 2021, and 309 participants were 
included. Analysis of clinical phenomenology of post-COVID-19 syndrome was 
performed using comparative statistics.
RESULTS: The three most prevalent post-COVID-19 symptoms in our survey cohort 
were fatigue (288/309, 93.2%), pain including headache (218/309, 70.6%), and 
sleep-wake disturbances (mainly insomnia and excessive daytime sleepiness, 
145/309, 46.9%). Post-COVID-19 syndrome had an impact on work ability, as more 
than half of the respondents (168/268, 62.7%) reported an inability to work, 
which lasted on average 26.6 weeks (95% CI 23.5-29.6, range 1-94, n = 168). 
Quality of life measured by WHO-5 Well-being Index was overall low in 
respondents with post-COVID-19 syndrome (mean, 95% CI 9.1 [8.5-9.8], range 1-25, 
n = 239).
CONCLUSION: Fatigue, pain, and sleep-wake disturbances were the main symptoms of 
the post-COVID-19 syndrome in our cohort and had an impact on the quality of 
life and ability to work in a majority of patients. However, survey respondents 
reported a significant reduction in symptoms over 12 months. Post-COVID-19 
syndrome remains a significant challenge. Further studies to characterize this 
syndrome and to explore therapeutic options are therefore urgently needed.

© 2022 The Authors. CNS Neuroscience & Therapeutics published by John Wiley & 
Sons Ltd.

DOI: 10.1111/cns.13938
PMCID: PMC9538958
PMID: 35975339 [Indexed for MEDLINE]

Conflict of interest statement: Diem Lara received travel grants from Merck, 
Biogen, Roche, and Bayer Switzerland. She also received speaker's honoraria from 
Biogen and Merck. Schwarzwald Anina, Gomes Fregolente Livia, Warncke Jan, and 
Weber Lea declare no conflict of interest related to this manuscript. Friedli 
Christoph received speaker honoraria and/or travel compensation for activities 
with Biogen, Sanofi Genzyme, Novartis, and Merck and research support from 
Chiesi, not related to this work. Hammer Helly received research support and 
travel grants from Biogen, Merck, Roche & BMS. Kamber Nicole received travel 
and/or speaker honoraria and served on advisory boards for Alexion, Biogen, 
Merck, Sanofi Genzyme, and Roche and received research support from Biogen. Chan 
Andrew received speakers'/board honoraria from Actelion (Janssen/J&J), Almirall, 
Bayer, Biogen, Celgene (BMS), Genzyme, Merck KGaA (Darmstadt, Germany), 
Novartis, Roche, and Teva, all for hospital research funds. He received research 
support from Biogen, Genzyme, and UCB, the European Union, and the Swiss 
National Foundation. He serves as associate editor of the European Journal of 
Neurology, on the editorial board for Clinical and Translational Neuroscience 
and as topic editor for the Journal of International Medical Research. Bassetti 
Claudio received speaker/advisor honoraria from JAZZ, Bioprojet, Takeda, Biogen, 
Rehaklinik Zihlschlacht and research support from the Swiss National Science 
Foundation (SNF) and the University of Bern. No conflicts of interest with this 
work. Salmen, Anke received speaker honoraria and/or travel compensation for 
activities with Bristol‐Myers Squibb, CSL Behring, Novartis, and Roche, and 
research support by the Baasch Medicus Foundation, the Medical Faculty of the 
University of Bern and the Swiss MS Society, not related to this work. Hoepner 
Robert received speaker/advisor honorary from Merck, Novartis, Roche, Biogen, 
Alexion, Sanofi, Janssen, Bristol‐Myers Squibb, and Almirall. He received 
research support within the last 5 years from Roche, Merck, Sanofi, Biogen, 
Chiesi, and Bristol‐Myers Squibb. He also received research grants from the 
Swiss MS Society and is a member of the Advisory Board of the Swiss MS Society. 
He also serves as associated editor for Journal of Central Nervous System 
disease. All conflicts are not related to this work.


1666. Immunohorizons. 2022 Aug 16;6(8):600-613. doi: 10.4049/immunohorizons.2200032.

IL-27 Promotes Intestinal Barrier Integrity following Ethanol Intoxication and 
Burn Injury.

Luck ME(1)(2)(3), Li X(1)(2)(4), Herrnreiter CJ(1)(2)(5), Cannon AR(1)(2)(4), 
Choudhry MA(6)(2)(3)(4)(7).

Author information:
(1)Alcohol Research Program, Stritch School of Medicine, Loyola University 
Chicago Health Sciences Division, Maywood, IL.
(2)Burn and Shock Trauma Research Institute, Stritch School of Medicine, Loyola 
University Chicago Health Sciences Division, Maywood, IL.
(3)Integrative Cell Biology Program, Stritch School of Medicine, Loyola 
University Chicago Health Sciences Division, Maywood, IL.
(4)Department of Surgery, Stritch School of Medicine, Loyola University Chicago 
Health Sciences Division, Maywood, IL.
(5)Biochemistry and Molecular Biology Program, Stritch School of Medicine, 
Loyola University Chicago Health Sciences Division, Maywood, IL; and.
(6)Alcohol Research Program, Stritch School of Medicine, Loyola University 
Chicago Health Sciences Division, Maywood, IL; mchoudhry@luc.edu.
(7)Department of Microbiology and Immunology, Stritch School of Medicine, Loyola 
University Chicago Health Sciences Division, Maywood, IL.

Alcohol intoxication combined with burn injury can lead to life-threatening 
complications, including sepsis, multiple organ failure, and death. After an 
acute burn, the gastrointestinal system becomes hypoxic because of fluid loss 
and reduction of intestinal blood flow. This can cause perturbations in the 
intestinal epithelial barrier, immune function, and the composition of the gut 
microbiome. Increased gut permeability leads to proinflammatory signaling, 
contributing to further damage to the intestinal barrier. Recent studies have 
suggested that IL-27 plays an anti-inflammatory role, which may be beneficial in 
intestinal barrier repair. Therefore, in this study, we examined the effect of 
ethanol and burn injury on IL-27 in the small intestine, as well as the 
potential beneficial role of IL-27 in restoring the intestinal barrier after 
intoxication and burn. Male C57BL/6 mice were gavaged with 2.9 g/kg ethanol 
before receiving a ∼12.5% total body surface area scald burn with or without 
rIL-27 in resuscitation fluid. Our results demonstrate that IL-27-producing 
cells are reduced in the small intestine after injury. When IL-27 is 
supplemented in resuscitation fluid, we were able to restore intestinal barrier 
integrity and transit, mediated through increased intestinal epithelial cell 
proliferation, reduced inflammatory cytokines, and increased anti-inflammatory 
cytokine IL-10. We also observed increased gene expression of tight junction 
proteins. These findings suggest that IL-27 may be a contributor to maintaining 
proper intestinal barrier function after injury through multiple mechanisms, 
including preventing excess inflammation and promoting intestinal epithelial 
cell proliferation and tight junction integrity.

Copyright © 2022 The Authors.

DOI: 10.4049/immunohorizons.2200032
PMID: 35973751 [Indexed for MEDLINE]


1667. Pediatr Res. 2023 Apr;93(5):1177-1187. doi: 10.1038/s41390-022-02254-x. Epub 
2022 Aug 15.

SARS-CoV-2 infection in children and implications for vaccination.

Nathanielsz J(1)(2)(3), Toh ZQ(3)(4), Do LAH(3)(4), Mulholland K(3)(4)(5), 
Licciardi PV(6)(7).

Author information:
(1)School of Medicine, Deakin University, Geelong, VIC, Australia.
(2)Department of Medicine, Alfred Health, Melbourne, VIC, Australia.
(3)Infection and Immunity, Murdoch Children's Research Institute, Melbourne, 
VIC, Australia.
(4)Department of Paediatrics, The University of Melbourne, Melbourne, VIC, 
Australia.
(5)Department of Infectious Diseases Epidemiology, London School of Hygiene and 
Tropical Medicine, London, UK.
(6)Infection and Immunity, Murdoch Children's Research Institute, Melbourne, 
VIC, Australia. paul.licciardi@mcri.edu.au.
(7)Department of Paediatrics, The University of Melbourne, Melbourne, VIC, 
Australia. paul.licciardi@mcri.edu.au.

The COVID-19 pandemic caused by novel severe acute respiratory syndrome 
coronavirus-2 (SARS-CoV-2) is responsible for more than 500 million cases 
worldwide as of April 2022. Initial estimates in 2020 found that children were 
less likely to become infected with SARS-CoV-2 and more likely to be 
asymptomatic or display mild COVID-19 symptoms. Our early understanding of 
COVID-19 transmission and disease in children led to a range of public health 
measures including school closures that have indirectly impacted child health 
and wellbeing. The emergence of variants of concern (particularly Delta and 
Omicron) has raised new issues about transmissibility in children, as 
preliminary data suggest that children may be at increased risk of infection, 
especially if unvaccinated. Global national prevalence data show that SARS-CoV-2 
infection in children and adolescents is rising due to COVID-19 vaccination 
among adults and increased circulation of Delta and Omicron variants. To 
mitigate this, childhood immunisation programmes are being implemented globally 
to prevent direct and indirect consequences of COVID-19 including severe 
complications (e.g., MIS-C), debilitating long-COVID symptoms, and the indirect 
impacts of prolonged community and school closures on childhood education, 
social and behavioural development and mental health. This review explores the 
current state of knowledge on COVID-19 in children including COVID-19 
vaccination strategies. IMPACT: Provides an up-to-date account of SARS-CoV-2 
infections in children. Discusses the direct and indirect effects of COVID-19 in 
children. Provides the latest information on the current state of global 
COVID-19 vaccination in children.

© 2022. The Author(s), under exclusive licence to the International Pediatric 
Research Foundation, Inc.

DOI: 10.1038/s41390-022-02254-x
PMCID: PMC9376896
PMID: 35970935 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1668. Front Public Health. 2022 Jul 29;10:813664. doi: 10.3389/fpubh.2022.813664. 
eCollection 2022.

Perceived Stress, Resilience, and Wellbeing in Seasoned Isha Yoga Practitioners 
Compared to Matched Controls During the COVID-19 Pandemic.

Upadhyay P(1), Narayanan S(1), Khera T(1), Kelly L(1), Mathur PA(1), Shanker 
A(1), Novack L(1), Pérez-Robles R(1), Hoffman KA(2), Sadhasivam SK(3), 
Subramaniam B(1).

Author information:
(1)Beth Israel Deaconess Medical Center, Boston, MA, United States.
(2)Oregon Health and Science University-Portland State University School of 
Public Health, Portland, OR, United States.
(3)Riley's Children's Hospital, Indiana University, Bloomington, IN, United 
States.

BACKGROUND: Yoga practices, including breathing, meditation, and posture 
protocols (asanas), have been shown to facilitate physical and mental wellbeing.
METHODS: Seasoned yoga practitioners were recruited from the Isha Foundation. 
Recruitment of the comparison group was achieved using snowball sampling and 
were not yoga practitioners. Participants in the non-yoga group were randomized 
to a 3-min Isha practice or a comparator group asked to perform 15-min of daily 
reading. Participants completed a series of web-based surveys (REDCap) at 
baseline, 6, and 12 weeks. These surveys include validated scales and objective 
questions on COVID-19 infection and medical history. The validated 
questionnaires assess for: perceived stress (PSS), mood states [anxiety and 
depression (PHQ-4), joy (DPES-Joy subscale)], mindfulness attention and 
awareness (MAAS), resilience (BRS), mental wellbeing (WEMWBS) and recovery from 
traumatic event (PTGI). Weekly activity diaries were employed as a tool for 
collecting compliance information from study participants. Perceived stress 
scale scores were identified as primary outcome for this study.
FINDINGS: The median Perceived Stress Scale (PSS) score for the yoga 
practitioners compared to the active and placebo comparators was significantly 
lower at all time-points: baseline: 11 [IQR 7-15] vs. 16 [IQR 12-21] in both the 
active and placebo comparators (p < 0.0001); 6 weeks: 9 [IQR 6-13] vs. 12 [IQR 
8-17] in the active comparator and 14 [IQR 9-18] in the placebo comparator (p < 
0.0001); and 12 weeks: 9 [IQR 5-13] vs. 11.5 [IQR 8-16] in the active 
comparators and 13 [IQR 8-17] in the placebo comparator (p < 0.0001). Among the 
randomized participants that were compliant for the full 12 weeks, the active 
comparators had significantly lower median PSS scores than the placebo 
comparators 12 weeks [10 (IQR 5-14) vs. 13 (IQR 8-17), p = 0.017]. Further, yoga 
practitioners had significantly lower anxiety at all three-time points (p < 
0.0001), lower depression at baseline and 6 weeks (p < 0.0003), and 
significantly higher wellbeing (p < 0.0001) and joy (p < 0.0001) at all 
three-time points, compared to the active and placebo comparator groups.
INTERPRETATION: The lower levels of stress, anxiety, depression, and higher 
level of wellbeing and joy seen in the yoga practitioners compared to the active 
and placebo comparators illustrate the impact of regular yoga practices on 
mental health even during the pandemic.
TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT04498442.

Copyright © 2022 Upadhyay, Narayanan, Khera, Kelly, Mathur, Shanker, Novack, 
Pérez-Robles, Hoffman, Sadhasivam and Subramaniam.

DOI: 10.3389/fpubh.2022.813664
PMCID: PMC9372270
PMID: 35968476 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1669. Front Public Health. 2022 Jul 28;10:879183. doi: 10.3389/fpubh.2022.879183. 
eCollection 2022.

Measuring, Modeling, and Forecasting the Mental Wealth of Nations.

Occhipinti JA(1)(2), Buchanan J(3), Skinner A(1), Song YJC(1), Tran K(1), 
Rosenberg S(1), Fels A(4), Doraiswamy PM(5), Meier P(6), Prodan A(2)(7), Hickie 
IB(1).

Author information:
(1)Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, 
Sydney, NSW, Australia.
(2)Computer Simulation and Advanced Research Technologies, Sydney, NSW, 
Australia.
(3)Mental Wealth Initiative, University of Sydney, Sydney, NSW, Australia.
(4)Melbourne Institute of Applied Economic and Social Research, Melbourne Law 
School, University of Melbourne, Melbourne, VIC, Australia.
(5)Departments of Psychiatry and Medicine, Duke University School of Medicine, 
Duke University, Durham, NC, United States.
(6)Systems Science in Public Health, University of Glasgow, Glasgow, United 
Kingdom.
(7)School of Computer, Data and Mathematical Sciences, Western Sydney 
University, Penrith, NSW, Australia.

The COVID-19 pandemic has exposed the deep links and fragility of economic, 
health and social systems. Discussions of reconstruction include renewed 
interest in moving beyond GDP and recognizing "human capital", "brain capital", 
"mental capital", and "wellbeing" as assets fundamental to economic reimagining, 
productivity, and prosperity. This paper describes how the conceptualization of 
Mental Wealth provides an important framing for measuring and shaping social and 
economic renewal to underpin healthy, productive, resilient, and thriving 
communities. We propose a transdisciplinary application of systems modeling to 
forecast a nation's Mental Wealth and understand the extent to which 
policy-mediated changes in economic, social, and health sectors could enhance 
collective mental health and wellbeing, social cohesion, and national 
prosperity. Specifically, simulation will allow comparison of the projected 
impacts of a range of cross-sector strategies (education sector, mental health 
system, labor market, and macroeconomic reforms) on GDP and national Mental 
Wealth, and provide decision support capability for future investments and 
actions to foster Mental Wealth. Finally, this paper introduces the Mental 
Wealth Initiative that is harnessing complex systems science to examine the 
interrelationships between social, commercial, and structural determinants of 
mental health and wellbeing, and working to empirically challenge the notion 
that fostering universal social prosperity is at odds with economic and 
commercial interests.

Copyright © 2022 Occhipinti, Buchanan, Skinner, Song, Tran, Rosenberg, Fels, 
Doraiswamy, Meier, Prodan and Hickie.

DOI: 10.3389/fpubh.2022.879183
PMCID: PMC9368578
PMID: 35968431 [Indexed for MEDLINE]

Conflict of interest statement: JO is Co-Director of the Mental Wealth 
Initiative and Head of Systems Modelling, Simulation and Data Science at the 
University of Sydney's Brain and Mind Centre. She holds a non-salaried position 
as Managing Director of Computer Simulation and Advanced Research Technologies 
(CSART), a registered charity. She also serves on the World Economic Forum's 
Global Future Council on Mental Health. JB is Professor in the Discipline of 
Business Information Systems in the University of Sydney Business School. He is 
Co-Director of the Mental Wealth Initiative. He is also on the advisory board 
(voluntary) for two non-government organizations: (i) the People Development 
Council of Dairy Australia (the peak organization for dairy farmers and 
processes in Australia), and (ii) the Centre for Future Work. AF is Chair of 
Mind Australia (an NGO) and a Board Member of the Haven Foundation (an NGO). PD 
is Co-Chair of the World Economic Forum's Global Future Council on Mental Health 
and has received travel support from the World Economic Forum. He serves on the 
boards of Live Love Laugh Foundation and Goldie Hawn Foundation which work to 
enhance mental health. He has received the following: research grants from the 
NIH, DOD, Eli Lilly, Avanir, Avid, Cure Alzheimer's Fund, Karen L Wrenn Trust 
and Steve Aoki Foundation; advisory fees from Vitakey, Lumos Labs, Otsuka, 
Apollo, Transposon, Sermo, and Neuroglee; stock in Evidation Health and UMethod 
(whose products are not discussed here). His also co-inventor, through Duke, of 
patents for diagnosis or treatment of various disorders. AP holds a non-salaried 
position as an Independent Director of Computer Simulation and Advanced Research 
Technologies Ltd. (CSART), a registered charity. IH serves on the World Economic 
Forum's Global Future Council on Mental Health. He was an inaugural Commissioner 
on Australia's National Mental Health Commission (2012–18). He is Co-Director, 
Health and Policy at the Brain and Mind Centre (BMC), University of Sydney, 
Australia. The BMC operates an early-intervention youth services at Camperdown 
under contract to headspace. He is also the Chief Scientific Advisor to, and a 
5% equity shareholder in, InnoWell Pty Ltd. InnoWell was formed by the 
University of Sydney (45% equity) and PwC (Australia; 45% equity) to deliver the 
$30M Australian Government-funded Project Synergy (2017–20; a 3-year program for 
the transformation of mental health services) and to lead transformation of 
mental health services internationally through the use of innovative 
technologies. The remaining authors declare that the research was conducted in 
the absence of any commercial or financial relationships that could be construed 
as a potential conflict of interest.


1670. Health Soc Care Community. 2022 Nov;30(6):e3493-e3506. doi: 10.1111/hsc.13969. 
Epub 2022 Aug 13.

The implications of COVID-19 on health and social care personnel in long-term 
care facilities for older people: An international scoping review.

Jones K(1), Schnitzler K(1), Borgstrom E(1).

Author information:
(1)Department of Health and Social Care, Faculty of Well-being, Well-being and 
Language Studies, The Open University, Milton Keynes, Buckinghamshire, UK.

This scoping review mapped out the existing literature pertaining to health and 
social care personnel experiences during the coronavirus disease-2019 (COVID-19) 
pandemic and their work in a long-term care setting for older people. This 
review identified the gaps in the implications of health and social care 
personnel's own health and well-being during the pandemic as well as the ethical 
dilemmas inherent in providing care during the COVID-19 pandemic. The authors 
utilised the PRISMA checklist for undertaking scoping reviews. The Databases 
Medline, PsychINFO, CINAHL, SCOPUS, Web of Science and Google Scholar were 
searched for relevant articles in English that were published between March 28, 
2020 and June 1, 2022. This time period was selected to focus specifically on 
the COVID-19 pandemic. In the context of this review, long-term care facilities 
were defined to include institutions such as nursing homes, skilled nursing 
facilities, retirement homes and residential care homes. The gaps identified 
were a paucity of research on the experiences of health and social care 
personnel in long-term care facilities, the impact on their mental health, and 
the wider challenges experienced during the COVID-19 pandemic is discussed. The 
findings of this scoping review indicate a need for adequate preparedness during 
a pandemic within the health and social care sector to protect health and social 
care personnel and the individuals they care for.

© 2022 The Authors. Health and Social Care in the Community published by John 
Wiley & Sons Ltd.

DOI: 10.1111/hsc.13969
PMCID: PMC9538825
PMID: 35962650 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no competing interests.


1671. BMC Psychiatry. 2022 Aug 12;22(1):553. doi: 10.1186/s12888-022-04198-2.

Adversity coping capability and its associations with mental health and family 
wellbeing amid the COVID-19 pandemic in Hong Kong.

Gong WJ(1)(2), Sit SMM(2)(3), Lai AYK(3), Yu NX(4), Wang MP(5), Ho SY(2), Lam 
TH(2).

Author information:
(1)Department of General Practice, Health Science Center, Shenzhen University, 
Shenzhen, China.
(2)School of Public Health, The University of Hong Kong, Hong Kong, China.
(3)School of Nursing, The University of Hong Kong, Hong Kong, China.
(4)Department of Social and Behavioral Sciences, City University of Hong Kong, 
Hong Kong, China.
(5)School of Nursing, The University of Hong Kong, Hong Kong, China. 
mpwang@hku.hk.

BACKGROUND: Adversity coping capability (ACC) is important amid the COVID-19 
pandemic. We examined the associations of ACC as measured by our one-item ACC 
scale (ACC-1) with mental health, family well-being and validity of ACC-1 in 
Hong Kong.
METHODS: A cross-sectional survey was conducted on Hong Kong Chinese adults 
aged ≥ 18 years by landline, mobile phone, and online survey from February to 
March 2021, when the fourth wave of COVID-19 was under control. ACC-1 consisted 
of the question: "How do you rate your capability to cope with adversities?" 
with higher scores (0-10) indicating stronger ACC. The associations of ACC with 
socioeconomic characteristics, resilience, mental health, and family wellbeing 
were examined by linear regression coefficients (βs). Data were weighted by sex, 
age, and education of the general population.
RESULTS: Of 7441 respondents, after weighing, 52.2% were female and 79.1% were 
aged 18 to 64 years. ACC-1 showed good construct validity, with higher ACC being 
associated with higher levels of resilience (adjusted β = 0.29), personal 
happiness (0.55), family happiness (0.42), family wellbeing (0.41), and family 
communication quality (0.41), and lower levels of depressive symptoms (-0.30), 
anxiety (-0.30), loneliness (-0.15); incremental validity with additional 
contributions of ACC to mental health and family wellbeing; and known-group 
validity with older age and favorable socioeconomic characteristics showing 
higher ACC (all P < 0.02). Females (mean ± standard deviation: 6.04 ± 1.82 vs 
6.15 ± 1.96 [male]) and unemployed respondents (5.30 ± 1.99 vs 6.11 ± 2.03 [in 
paid employment]) had lower ACC (all P ≤ 0.02).
CONCLUSIONS: We have first shown that stronger ACC was associated with better 
mental health and family wellbeing, and the results support ACC-1 as a simple 
and valid measure of ACC.

© 2022. The Author(s).

DOI: 10.1186/s12888-022-04198-2
PMCID: PMC9373882
PMID: 35962361 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1672. BMC Geriatr. 2022 Aug 12;22(1):662. doi: 10.1186/s12877-022-03294-y.

Prevalence and correlates of anxiety and depression in caregivers to assisted 
living residents during COVID-19: a cross-sectional study.

Lane NE(1)(2), Hoben M(3), Amuah JE(4), Hogan DB(5), Baumbusch J(6), Gruneir 
A(1)(7), Chamberlain SA(7), Griffith LE(8), McGrail KM(9), Corbett K(3), Maxwell 
CJ(10)(11)(12).

Author information:
(1)ICES, Toronto, ON, Canada.
(2)Department of Internal Medicine, University of British Columbia, Vancouver, 
BC, Canada.
(3)Faculty of Nursing, College of Health Sciences, University of Alberta, 
Edmonton, AB, Canada.
(4)School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, 
Canada.
(5)Division of Geriatric Medicine, Department of Medicine, Cumming School of 
Medicine, University of Calgary, Calgary, AB, Canada.
(6)School of Nursing, University of British Columbia, Vancouver, BC, Canada.
(7)Department of Family Medicine, Faculty of Medicine and Dentistry, College of 
Health Sciences, University of Alberta, Edmonton, AB, Canada.
(8)Department of Health Research Methods, Evidence and Impact, Faculty of Health 
Sciences, McMaster University, Hamilton, ON, Canada.
(9)School of Population and Public Health, Centre for Health Services and Policy 
Research, University of British Columbia, Vancouver, BC, Canada.
(10)ICES, Toronto, ON, Canada. colleen.maxwell@uwaterloo.ca.
(11)School of Pharmacy, University of Waterloo, ON, N2L 3G1, Waterloo, Canada. 
colleen.maxwell@uwaterloo.ca.
(12)School of Public Health Sciences, University of Waterloo, Waterloo, ON, 
Canada. colleen.maxwell@uwaterloo.ca.

BACKGROUND: Family and friend caregivers play significant roles in advocating 
for and ensuring quality health and social care of residents in Assisted Living 
(AL) homes. However, little is known about how the COVID-19 pandemic and related 
visitor restrictions affected their health and mental well-being. We examined 
the prevalence and correlates of anxiety and depressive symptoms among 
caregivers of AL residents during the initial wave of COVID-19 in two Canadian 
provinces.
METHODS: A cross-sectional web-based survey was conducted among family/friend 
caregivers of AL residents in Alberta and British Columbia (Oct 28, 2020-Mar 31, 
2021) to collect data on their sociodemographic, health and caregiving 
characteristics, as well as concerns about residents' health and social care 
before and during the first wave of the pandemic. A clinically significant 
anxiety disorder and depressive symptoms were assessed with the GAD-7 and 
CES-D10 instruments, respectively. Separate multivariable (modified) Poisson 
regression models identified caregiver correlates of each mental health 
condition.
RESULTS: Among the 673 caregivers completing the survey (81% for Alberta 
residents), most were women (77%), white (90%) and aged ≥ 55 years (81%). 
Clinically significant anxiety and depression were present in 28.6% and 38.8% of 
caregivers respectively. Both personal stressors (comorbidity level, income 
reduction, low social support) and caregiving stressors exacerbated by the 
pandemic were independently associated with caregiver anxiety and depression. 
The latter included increased concern about the care recipients' depression 
(adjusted risk ratio [adjRR] = 1.84, 95% confidence interval [CI] 1.19-2.85 for 
caregiver anxiety and adjRR = 1.75, 95% CI 1.26-2.44 for caregiver depressive 
symptoms) and reported intention to withdraw the resident from AL because of 
COVID-19 (adjRR = 1.24, 95%CI 0.95-1.63 for caregiver anxiety and adjRR = 1.37, 
95%CI 1.13-1.67 for caregiver depressive symptoms).
CONCLUSIONS: Caregivers of residents in AL homes reported significant personal 
and caregiving-related stressors during the initial wave of COVID-19 that were 
independently associated with an increased likelihood of experiencing clinically 
significant anxiety and depressive symptoms. Healthcare providers and AL staff 
should be aware of the prevalence and varied correlates of caregivers' mental 
health during public health crises so that appropriate screening and support may 
identified and implemented.

© 2022. The Author(s).

DOI: 10.1186/s12877-022-03294-y
PMCID: PMC9372518
PMID: 35962356 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1673. Eur Child Adolesc Psychiatry. 2023 Jun;32(6):995-1013. doi: 
10.1007/s00787-022-02060-0. Epub 2022 Aug 12.

A systematic review of the mental health changes of children and young people 
before and during the COVID-19 pandemic.

Kauhanen L(#)(1), Wan Mohd Yunus WMA(#)(1)(2)(3), Lempinen L(1)(2), Peltonen 
K(1)(2), Gyllenberg D(1)(2)(4)(5), Mishina K(1)(2), Gilbert S(1)(2), Bastola 
K(4), Brown JSL(6), Sourander A(7)(8)(9).

Author information:
(1)Research Centre for Child Psychiatry, University of Turku, Turku, Finland.
(2)INVEST Research Flagship, University of Turku, Turku, Finland.
(3)Department of Psychology, Faculty of Social Sciences and Humanities, 
Universiti Teknologi Malaysia, Johor, Malaysia.
(4)National Institute for Health and Welfare, Helsinki, Finland.
(5)Department of Adolescent Psychiatry, Helsinki University Central Hospital, 
Helsinki, Finland.
(6)Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience 
(IoPPN), King's College London, England, London, UK.
(7)Research Centre for Child Psychiatry, University of Turku, Turku, Finland. 
andsou@utu.fi.
(8)INVEST Research Flagship, University of Turku, Turku, Finland. andsou@utu.fi.
(9)Department of Child Psychiatry, Turku University Hospital, Turku, Finland. 
andsou@utu.fi.
(#)Contributed equally

There is increasing knowledge that the COVID-19 pandemic has had an impact on 
mental health of children and young people. However, the global evidence of 
mental health changes before compared to during the COVID-19 pandemic focusing 
on children and young people has not been systematically reviewed. This 
systematic review examined longitudinal and repeated cross-sectional studies 
comparing before and during COVID-19 pandemic data to determine whether the 
mental health of children and young people had changed before and during the 
COVID-19 pandemic. The Web of Science, PubMed, Embase and PsycINFO databases 
were searched to identify peer-reviewed studies that had been published in 
English and focused on children and young people between 0 and 24 years of age. 
This identified 21 studies from 11 countries, covering more than 96,000 subjects 
from 3 to 24 years of age. Pre-pandemic and pandemic data were compared. Most 
studies reported longitudinal deterioration in the mental health of adolescents 
and young people, with increased depression, anxiety and psychological distress 
after the pandemic started. Other findings included deteriorated negative 
affect, mental well-being and increased loneliness. Comparing data for pandemic 
and pre-pandemic periods showed that the COVID-19 pandemic may negatively impact 
the mental health of children and young people. There is an urgent need for 
high-quality research to address the impact, risks and protective factors of the 
pandemic on their mental health, as this will provide a good foundation for 
dealing with future health emergencies and other crises.

© 2022. The Author(s).

DOI: 10.1007/s00787-022-02060-0
PMCID: PMC9373888
PMID: 35962147 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


1674. Eur J Health Econ. 2023 Jul;24(5):679-699. doi: 10.1007/s10198-022-01490-6. Epub 
2022 Aug 12.

The 'welcomed lockdown' hypothesis? Mental wellbeing and mobility restrictions.

Costa-Font J(1), Knapp M(2), Vilaplana-Prieto C(3).

Author information:
(1)Department of Health Policy, London School of Economics and Political Science 
(LSE), CESIFo & IZA, London, UK. j.costa-font@lse.ac.uk.
(2)Department of Health Policy, London School of Economics and Political 
Science, London, UK.
(3)University of Murcia, Murcia, Spain.

The COVID-19 pandemic and its mobility restrictions have been an external shock, 
influencing mental wellbeing. However, does risk exposure to COVID-19 affect the 
mental wellbeing effect of lockdowns? This paper examines the 'welcomed 
lockdown' hypothesis, namely the extent to which there is a level of risk where 
mobility restrictions are not a hindrance to mental wellbeing. We exploit the 
differential timing of exposure the pandemic, and the different stringency of 
lockdown policies across European countries and we focus on the effects on two 
mental health conditions, namely anxiety and depression. We study whether 
differences in the individual symptoms of anxiety and depression are explained 
by the combination of pandemic mortality and stringency of lockdown. We draw on 
an event study approach, complemented with a Difference-in-Difference (DiD), and 
Regression Discontinuity Design (RDD). Our estimates suggest an average increase 
in depression (3.95%) and anxiety (10%) symptoms relative to the mean level on 
the day that lockdown took effect. However, such effects are wiped out when a 
country's exhibits high mortality ('pandemic category 5'). Hence, we conclude 
that in an environment of high mortality, lockdowns no longer give rise to a 
reduction in mental wellbeing consistent with the 'welcome lockdown' hypothesis.

© 2022. The Author(s).

DOI: 10.1007/s10198-022-01490-6
PMCID: PMC9371965
PMID: 35960372 [Indexed for MEDLINE]


1675. J Obstet Gynaecol. 2022 Oct;42(7):2799-2804. doi: 10.1080/01443615.2022.2109410. 
Epub 2022 Aug 12.

Psychosocial outcomes of the COVID-19 pandemic on pregnant women.

Erin R(1), Baki Erin K(1), Kulaksız D(1), Bayoğlu Tekin Y(1).

Author information:
(1)Department of Obstetrics and Gynecology, Trabzon Kanuni Health Practice and 
Research Center, University of Health Sciences, Trabzon, Turkey.

The aim of this study was to compare the levels of anxiety and social support 
evaluated in pregnancy before and during the COVID-19 pandemic. This study was 
designed prospectively and observationally. Participants were asked to fill in 
two different questionnaire forms for the Multidimensional Scale of Perceived 
Social Support and The State-Trait Anxiety Inventory. Independent t-test and 
Pearson correlation analysis were used for statistical analysis. The mean age of 
386 pregnant was 29.1 ± 4.91 years, and the gestational week was 29.12 ± 4.54. 
The values of the total social support scale were determined 
61.52 ± 5.53-51.15 ± 5.86 before and during the pandemic, while the total state 
anxiety scale was found 39.81 ± 9.04 and 63.38 ± 10.55, respectively. The total 
trait anxiety scale was found at 38.23 ± 7.39 and 53.22 ± 8.74 in the same 
respect. A significant difference was obtained in the data between before and 
during the pandemic (p < .05). The study showed that pregnant are deprived of 
social support and their anxiety levels increase during the COVID-19 
pandemic.IMPACT STATEMENTWhat is already known on this subject? During the 
COVID-19 pandemic, the prevalence of depression and anxiety in pregnant women 
have been reported as 25.6 and 30.5%, respectively. Social support is an 
important determinant of physical and psychological well-being, especially 
during pregnancy when individuals take on new responsibilities and roles.What do 
the results of this study add? The study showed that pregnant women were 
deprived of social support and their anxiety levels increased during this 
pandemic. The results highlight that there is a high need to mitigate mental 
health risks and adjust interventions under pandemic conditions.What are the 
implications of these findings for clinical practice and/or further research? It 
is necessary to provide social support from family, friends, and close circles. 
States and health professionals need to put forward serious programs and studies 
to reduce the stress and anxiety experienced by the society and especially 
pregnant women and to provide accurate information about COVID-19.

DOI: 10.1080/01443615.2022.2109410
PMID: 35959791 [Indexed for MEDLINE]


1676. Front Endocrinol (Lausanne). 2022 Jul 22;13:948716. doi: 
10.3389/fendo.2022.948716. eCollection 2022.

Cardio-Metabolic and Mental Health Outcomes Before and During the COVID-19 
Pandemic in a Cohort of Women With Gestational Diabetes Mellitus in Switzerland.

Quansah DY(1), Gilbert L(1), Kosinski C(2), Le Dizès O(2), Horsch A(3)(4), 
Benhalima K(5), Cosson E(6)(7), Puder JJ(1).

Author information:
(1)Obstetric Service, Department Woman-Mother-Child, Lausanne University 
Hospital, Lausanne, Switzerland.
(2)Service of Endocrinology, Diabetes and Metabolism, Department of Medicine, 
Lausanne University Hospital, Lausanne, Switzerland.
(3)Institute of Higher Education and Research in Healthcare (IUFRS), University 
of Lausanne, Lausanne, Switzerland.
(4)Neonatology Service, Department Woman-Mother-Child, Lausanne University 
Hospital, Lausanne, Switzerland.
(5)Department of Endocrinology, UZ Gasthuisberg, KU Leuven, Leuven, Belgium.
(6)Department of Endocrinology-Diabetology-Nutrition, AP-HP, Avicenne Hospital, 
Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bobigny, France.
(7)Sorbonne Paris Cité, UMR U1153 Inserm/U1125 Inra/Cnam/Université Paris 13, 
Bobigny, France.

BACKGROUND: The COVID-19 pandemic has been associated with worsened metabolic 
and mental health in the general and perinatal population. The postpartum is a 
critical moment regarding these outcomes particularly in women with gestational 
diabetes mellitus (GDM). We investigated the cardio-metabolic and mental health 
outcomes before and during the pandemic in this population.
METHODS: This cohort study included 418 women with GDM, recruited during two 
distinct periods. This included 180 women exposed to the pandemic (E+) and 
recruited between May 2020-April 2021 and 238 women who were not exposed to the 
pandemic during their postpartum period (attended a year before=non-exposed 
(E-)) and recruited between January-December 2019. Among the E+, a 
nested-subcohort of 120 women were exposed both during pregnancy and postpartum. 
During the pandemic, we adopted a hybrid follow-up of women that consisted of 
in-person consultations, regular contact via phone calls (35%), sent recorded 
exercise guide to patients to follow at home and linked to our website. We 
specifically focused on maintaining motivation and keeping a strong focus on 
healthy lifestyle behaviors. Obstetric, neonatal, cardio-metabolic and mental 
health outcomes were assessed during pregnancy and postpartum.
RESULTS: The pandemic was not associated with worsened weight, weight retention, 
glucose tolerance, metabolic syndrome, well-being or depression in the 
postpartum with the exception of a minimally increased HbA1c, diastolic blood 
pressure and lower emotional eating scores in E+ women (all p ≤ 0.046). In the 
nested subcohort, E+ women had a slightly increased HbA1c at the first GDM visit 
and a higher need for glucose-lowering medication (both p ≤ 0.014), but HbA1c at 
the end of pregnancy and other cardio-metabolic, mental health, obstetric and 
neonatal outcomes during pregnancy were similar.
CONCLUSIONS: The pandemic was not associated with any clinically relevant 
worsening of cardio-metabolic, mental health, obstetrical and neonatal outcomes 
in our GDM cohort. This was possibly due to a continued hybrid follow-up, and 
the partial lockdown in Switzerland.

Copyright © 2022 Quansah, Gilbert, Kosinski, Le Dizès, Horsch, Benhalima, Cosson 
and Puder.

DOI: 10.3389/fendo.2022.948716
PMCID: PMC9361046
PMID: 35957818 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1677. Int J Environ Res Public Health. 2022 Aug 8;19(15):9773. doi: 
10.3390/ijerph19159773.

Psychological Burdens among Teachers in Germany during the SARS-CoV-2 
Pandemic-Subgroup Analysis from a Nationwide Cross-Sectional Online Survey.

Koestner C(1), Eggert V(1), Dicks T(1), Kalo K(2), Zähme C(1), Dietz P(1), 
Letzel S(1)(3), Beutel T(3).

Author information:
(1)Institute of Occupational, Social and Environmental Medicine, University 
Medical Center of the Johannes Gutenberg University of Mainz, Obere Zahlbacher 
Str. 67, 55131 Mainz, Germany.
(2)Department of Sports Medicine, Disease Prevention and Rehabilitation, 
Johannes Gutenberg University Mainz, Albert-Schweitzer-Strasse 22, 55128 Mainz, 
Germany.
(3)Institute for Teachers' Health, University Medical Center of the Johannes 
Gutenberg University of Mainz, Kupferbergterrasse 17-19, 55116 Mainz, Germany.

BACKGROUND: Schools underwent massive changes during the SARS-CoV-2 pandemic 
worldwide. Besides existing occupational health challenges, teachers had to deal 
with biological and psychological burdens that had the potential to impact their 
psychological well-being. The aim of the present study was to (i) assess the 
current state of psychological burdens in German teachers and (ii) identify 
highly burdened subgroups to derive and address interventions.
METHODS: A nationwide cross-sectional online survey was conducted among teachers 
at all school types in Germany in March 2021. Data on psychological strains were 
assessed using established (e.g., PHQ-4) and new-pandemic-specific-(e.g., 
COVID-19-associated anxieties) instruments. ANOVAs and Tukey's post hoc tests 
were used to identify highly burdened subgroups (e.g., gender, age, and number 
of risk factors for severe courses of COVID-19) of teachers.
RESULTS: Psychological burdens in German teachers (N = 31.089) exceeded the 
level of the general population, for example, regarding symptoms of depression 
(PHQ-2, M = 1.93 vs. 1.24) or generalized anxiety (GAD-2, M = 1.72 vs. 1.03). 
Subgroup analysis revealed that psychological burdens were unevenly distributed 
among different groups of teachers; for example, younger teachers (18-30 years) 
showed more depression symptoms compared with their older colleagues (56-67 
years) (PHQ-2, M = 2.01 vs. 1.78).
CONCLUSIONS: The online survey was conducted during the "third wave" of 
SARS-CoV-2 in Germany, which might have influenced risk perception and 
psychological strains. Future studies at different times, ideally longitudinal 
monitoring of the mental health of teachers, are recommended. Based on our 
results, evidence-based subgroup-specific interventions should be implemented to 
sustain teachers' mental health; for example, younger teachers or teachers with 
risk factors for a severe course of COVID-19 should receive special attention 
and support. Teachers from special needs schools whose mental health is, on 
average, good could also be a starting point for identifying the health 
promotion structural elements of this school type (e.g., fewer students per 
teacher). However, beyond the specific pandemic-related psychological burdens, 
the classic occupational health challenges of physical, biological, and chemical 
stress and their resulting strains should not be disregarded.

DOI: 10.3390/ijerph19159773
PMCID: PMC9367983
PMID: 35955127 [Indexed for MEDLINE]

Conflict of interest statement: The funder and other parties had no influence on 
study design, data collection and analysis, presentation and interpretation of 
the results or the present manuscript.


1678. Int J Environ Res Public Health. 2022 Aug 7;19(15):9725. doi: 
10.3390/ijerph19159725.

Mental Health and Physical Activity of Female Higher Education Students during 
the COVID-19 Pandemic: A Comparative Cross-Sectional Study from Lithuania.

Baranauskas M(1), Kupčiūnaitė I(1), Stukas R(2).

Author information:
(1)Faculty of Biomedical Sciences, Panevėžys University of Applied Sciences, 
35200 Panevėžys, Lithuania.
(2)Institute of Health Sciences, Faculty of Medicine, Department of Public 
Health, Vilnius University, 01513 Vilnius, Lithuania.

During emerging adulthood (EA), higher education medical students undergo a 
higher risk of anxiety and depression compared to the general population. The 
aim of this comparative cross-sectional study was to compare the proportions of 
three mental disorders, namely anxiety, depression and somatisation in terms of 
their symptoms and self-reported physical activity (PA) levels across the 
cohorts of biomedical and non-biomedical female students as well as to assess 
the association between the mental health outcomes and PA use. Between September 
2021 and January 2022, a total of 1231 female higher education students aged 
between 18 and 29 years old were recruited for the study. Severe symptoms of 
anxiety and depression, as well as unexplained somatic complaints, were suffered 
by 51.9%, 11% and 23% of female students, respectively. Non-biomedical female 
students, compared to medicine and health sciences students, were more 
vulnerable due to the increased prevalence of negative mental health outcomes. 
The relationship between increased sports activity as a potential trigger for 
mental well-being and decreased severity of depressive symptoms was identified 
in the cohorts of both biomedical (adjusted odd ratio (ORadj) 0.4; 95% 
confidence interval (CI): 0.1-1.0) and non-biomedical (ORadj 0.4; 95% CI: 
0.2-0.9) female students. The current research highlights the importance of 
increasing sports activity by involving students in regular physical exercise of 
specific types for decreasing the severity of depressive symptoms in 
student-aged female populations.

DOI: 10.3390/ijerph19159725
PMCID: PMC9367914
PMID: 35955080 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1679. Int J Environ Res Public Health. 2022 Aug 4;19(15):9615. doi: 
10.3390/ijerph19159615.

"Seeing and Being Seen" or Just "Seeing" in a Smart Classroom Context When 
Videoconferencing: A User Experience-Based Qualitative Research on the Use of 
Cameras.

Petchamé J(1), Iriondo I(1), Azanza G(2).

Author information:
(1)Department of Engineering, Universitat Ramon Llull (URL), La Salle, 08022 
Barcelona, Spain.
(2)Department of Social Sciences, University of Deusto, Avenida de las 
Universidad, 24, 48007 Bilbao, Spain.

This research examines the form in which undergraduates use video cameras during 
videoconferencing class sessions in a Smart Classroom context and, more 
specifically, the reasons why a considerable number of students opt to turn off 
their cameras when videoconferencing during the sessions while others keep them 
on. The study was carried out in an institution that had previously switched 
from face-to-face teaching to an Emergency Remote Teaching solution, initially 
adopted in 2019-2020 to cope with the COVID-19 pandemic restrictions. Findings 
suggest that using cameras when videoconferencing is associated with increasing 
and enhancing the interaction between the student and the rest of the class, 
although not all students agreed with this conclusion. In addition, having the 
video cameras switched fomented socialization and improved the overall online 
learning experience for students. However, the surveyed students pointed out 
diverse negative elements, such as why they had to turn on their personal 
cameras, privacy concerns, and limitations derived from the available technology 
infrastructure, in addition to other factors such as distractions, anxiety, and 
cognitive load. This work discusses how these elements can influence the 
well-being and the user experience of the students, both positively and 
negatively.

DOI: 10.3390/ijerph19159615
PMCID: PMC9367911
PMID: 35954978 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1680. Int J Environ Res Public Health. 2022 Aug 4;19(15):9590. doi: 
10.3390/ijerph19159590.

Adapted Physical Activity Protocol for Lower Limb Functional and Strength 
Recovery in a Young Athlete with Cutaneous Melanoma: Feasibility and Efficacy 
during COVID-19 Pandemic.

Carretti G(1), Mirandola D(1), Germano S(1), Manetti M(1), Marini M(1).

Author information:
(1)Department of Experimental and Clinical Medicine, Section of Anatomy and 
Histology, University of Florence, 50134 Florence, Italy.

Adapted physical activity (APA) can improve psychophysical wellbeing and quality 
of life (QoL) in cancer survivors, a vulnerable population requiring a global 
management, especially during the recent pandemic. On this basis, we 
investigated for the first time the impact of a tailored APA intervention on a 
melanoma-affected 18-year-old female athlete to counteract treatment sequelae 
and promote lower limb functional and strength recovery. Patient was evaluated 
at baseline and post-protocol by a test battery focusing on mobility, muscle 
strength measured by dynamometry, and lower limb girths assessed at specific 
anatomical points. Moreover, health-related QoL, depression/anxiety, 
psychological distress and pain intensity were evaluated by Functional 
Assessment of Cancer Therapy-Melanoma (FACT-M), Hospital Anxiety and Depression 
Scale (HADS), distress thermometer, and numerical rating scale (NRS) 
questionnaires, respectively. An almost doubled up increase in lower limb 
strength, along with hip mobility improvement, and post-surgical edema and pain 
reduction were observed following the protocol. Concerning the QoL assessment, a 
moderate post-intervention improvement in physical and emotional wellbeing was 
detected, while depression state worsened though remaining within the normality 
range. Our findings show that a specialist-supervised structured APA protocol 
based on a patient-centered multidisciplinary approach may represent an 
effective strategy to recover functional and psychophysical efficiency, thus 
promoting a quick return to daily life activities and offering a concrete chance 
of resuming competitive sport practice.

DOI: 10.3390/ijerph19159590
PMCID: PMC9367956
PMID: 35954946 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1681. Int J Environ Res Public Health. 2022 Aug 2;19(15):9451. doi: 
10.3390/ijerph19159451.

Brief Screening for Distress among Healthcare Professionals: Psychometric 
Properties of the Physician Well-Being Index-Spanish Version.

Robles R(1), Fresán A(2), Alcocer-Castillejos N(3), Real-Ramírez J(4), 
Morales-Chainé S(5).

Author information:
(1)Global Mental Health Research Center, Ramón de la Fuente Muñiz National 
Institute of Psychiatry, Mexico City 14370, Mexico.
(2)Laboratory of Clinical Epidemiology, Subdirectorate of Clinical Research, 
Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City 14370, 
Mexico.
(3)Neurology and Psychiatry Department, Salvador Zubirán National Institute of 
Medical Sciences and Nutrition, Mexico City 14080, Mexico.
(4)School of Public Health of Mexico, National Institute of Public Health, 
Mexico City 62100, Mexico.
(5)Psychology Faculty, National Autonomous University of Mexico, Mexico City 
04510, Mexico.

BACKGROUND: The Physician Well-Being Index (PWBI) is a brief, valid, reliable 
self-assessment instrument to identify health professionals' distress and those 
in need of an intervention.
OBJECTIVE: to evaluate the construct, predictive validity (of depression, 
suicidal ideation, insomnia, and generalized anxiety), and internal consistency 
of the 7-item Spanish version of the PWBI (PWBI-S).
METHODS: out of a national population of approximately 1 million Mexican 
healthcare professionals, a sample of 3506 subjects (42.0% physicians, 28.7% 
nurses and 29.3% psychologists) completed an online survey between 17 April and 
7 May 2020, at the time of the COVID-19 case cluster transmission scenario in 
Mexico.
RESULTS: In the three sub-samples, PWBI-S's Confirmatory factor analyses (adding 
residual covariances) exhibited adequate goodness of fit indices for the PWBS 
original unidimensional model. Overall Cronbach's alphas were 0.89 for 
physicians, 0.90 for nurses, and 0.86 for psychologists. Univariate logistic 
regression models showed that a cutoff point of 3 on the total score of the 
PWBI-S was generally related to the presence of depression, suicidal ideation, 
and insomnia, but not with generalized anxiety among nurses and psychologists. 
When trying with a cutoff point of 3, a relationship with GA was shown in 
psychologists, but not in nurses.
CONCLUSIONS: our findings suggest that PWBI-S is a valid, reliable measure for 
clinical and research purposes in the field.

DOI: 10.3390/ijerph19159451
PMCID: PMC9368125
PMID: 35954808 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1682. Int J Environ Res Public Health. 2022 Jul 30;19(15):9365. doi: 
10.3390/ijerph19159365.

Should We Be Worried about Smartphone Addiction? An Examination of Canadian 
Adolescents' Feelings of Social Disconnection in the Time of COVID-19.

Parent N(1), Xiao B(1), Hein-Salvi C(1), Shapka J(1).

Author information:
(1)Educational and Counselling Psychology and Special Education, The University 
of British Columbia, Vancouver, BC V6T 1Z4, Canada.

As the COVID-19 global pandemic limited face-to-face social contact, mental 
health concerns increased for adolescents. Additionally, many adolescents turned 
to technology to communicate with their peers, which also raised concerns about 
adolescent smartphone addiction. However, research has yet to examine how mental 
health and technology engagement are related to adolescents' feelings of social 
connection-an important developmental predictor of wellbeing across the 
lifespan. Specifically, little is known regarding the relative risk of 
adolescents' mental health concerns, a known risk factor for social 
disconnection and isolation and smartphone addiction in contributing to feelings 
of social disconnection in the time of COVID-19. The present study investigated 
how mental health outcomes and smartphone addiction contributed to Canadian 
adolescents' (n = 1753) feelings of social disconnection during COVID-19. 
Between October 2020 and May 2021, data were collected from five secondary 
schools in and around the lower mainland of British Columbia using an 
online-administered self-report questionnaire. Adolescents responded to 
questions about their smartphone addiction, internalizing problems, and an 
open-ended question about their feelings of connection to others. Findings from 
logistic regression analyses indicated that depression was a predictor of 
feeling socially disconnected: however, smartphone addiction was not associated 
with feelings of social disconnection during COVID-19. Implications of these 
findings can help inform the development of prevention programs targeting 
adolescents at risk for social disconnection in times of increased social 
isolation (e.g., a global pandemic). Specifically, these findings suggest that 
adolescents higher in depressive symptoms, and not those higher in smartphone 
addiction, are the ones most at risk.

DOI: 10.3390/ijerph19159365
PMCID: PMC9367791
PMID: 35954718 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1683. Int J Environ Res Public Health. 2022 Jul 30;19(15):9322. doi: 
10.3390/ijerph19159322.

University Students' Mental Health and Well-Being during the COVID-19 Pandemic: 
Findings from the UniCoVac Qualitative Study.

Gogoi M(1), Webb A(2), Pareek M(1)(3), Bayliss CD(2), Gies L(4).

Author information:
(1)Department of Respiratory Sciences, University of Leicester, Leicester LE1 
9HN, UK.
(2)Department of Genetics and Genome Biology, University of Leicester, Leicester 
LE1 7RH, UK.
(3)Department of Infection and HIV Medicine, University Hospitals of Leicester 
NHS Trust, Leicester LE1 5WW, UK.
(4)School of Media, Communication and Sociology, University of Leicester, 
Leicester LE1 7RH, UK.

The worldwide spread of the coronavirus disease 2019 (COVID-19) pandemic in 
early 2020 affected all major sectors, including higher education. The measures 
to contain the spread of this deadly disease led to the closure of colleges and 
universities across the globe, disrupting the lives of millions of students and 
subjecting them to a new world of online learning. These sudden disturbances 
coupled with the demands of a new learning system and the experiences of living 
through a pandemic have placed additional strains on the mental health of 
university students. Research on university students' mental health, conducted 
during the pandemic, have found high levels of stress, anxiety and depression 
among students. In this qualitative study, we aimed to understand how pandemic 
experiences have affected student well-being by conducting in-depth interviews 
with 34 undergraduate students enrolled in a UK university. All interviews were 
conducted through Microsoft Teams and recorded with prior permission. 
Transcripts of recorded interviews were thematically analysed which identified 
two broad themes: (i) University students' mental health and well-being 
experiences during the pandemic; (ii) factors that influenced students' mental 
health and well-being. These factors were further distributed across six 
sub-themes: (a) isolation; (b) health and well-being; (c) bereavement; (d) 
academic concerns; (e) financial worries and; (f) support, coping, and 
resilience. Our study identifies the importance of mental health support to 
university students during pandemics and calls for measures to improve access to 
support services through these crisis points by universities. Findings can also 
inform students' mental health and risk assessments in the aftermath of the 
pandemic.

DOI: 10.3390/ijerph19159322
PMCID: PMC9367732
PMID: 35954680 [Indexed for MEDLINE]

Conflict of interest statement: All other authors declare that they have no 
known financial interests or personal relationships that could have appeared to 
influence the work reported in this paper. The funders had no role in the design 
of the study; in the collection, analyses, or interpretation of data; in the 
writing of the manuscript, or in the decision to publish the results.


1684. Int J Environ Res Public Health. 2022 Jul 28;19(15):9261. doi: 
10.3390/ijerph19159261.

Focus on High School: Factors Associated with Creating Harmony between the 
Educational Transition and Adolescents' Well-Being.

Assavanopakun P(1), Sirikul W(1)(2), Promkutkao T(1), Promkutkeo S(3), 
Panumasvivat J(1).

Author information:
(1)Department of Community Medicine, Faculty of Medicine, Chiang Mai University, 
Chiang Mai 50200, Thailand.
(2)Center of Data Analytics and Knowledge Synthesis for Health Care, Chiang Mai 
University, Chiang Mai 50200, Thailand.
(3)School of Economics, Chiang Mai University, Chiang Mai 50200, Thailand.

The transition from online to on-site education was difficult due to a lack of 
standardized school guidance for school reopening. Even though schools have 
reopened, uncertainty about the COVID-19 situation and the capacity of the 
school to maintain safe school operations to mitigate risks may increase 
hesitancy among students and parents to participate in on-site studying. 
Rapid-response surveys of students and parents can provide information to 
stakeholders on how learning and well-being can best be supported during the 
educational transition in each context. The aim of this study was to explore the 
hesitancy of high-school students and the factors that influenced their 
hesitancy to return to school on site. An online cross-sectional survey was 
distributed to high-school students in an urban district of Chiang Mai, 
Thailand, during the fourth wave of the pandemic from 17 November to 13 December 
2021. A multivariable logistic regression was performed to explore factors 
related to the students' hesitancy to attend on-site education. With a response 
rate of 10.2% of the targeted study population, the 1266 participants revealed 
that 15.9% of them had very-high- and extremely high-level hesitancy to study on 
site, which was associated with less negative moods while studying online (aOR, 
1.69; p, 0.016) and a greater fear of infection after returning to school (aOR, 
2.95; p, 0.001). Increased readiness to return to school on site (aOR, 0.28; p, 
0.001) and discussing COVID-19 prevention with family or friends (aOR, 0.71; p, 
0.016) were also associated with a lower hesitancy of students. Only 5.6% of the 
students reported being hesitant to receive the COVID-19 vaccination. However, 
no significant associations were found between schooling hesitancy and their 
willingness to get vaccinated, nor the frequency of students' outside 
activities. High-school students who experience negative moods during online 
studying should be monitored and receive additional support if the reopening is 
postponed. More opportunities to discuss COVID-19 prevention with family or 
friends, as well as a higher level of readiness, may increase the willingness to 
return to school on site. Local authorities and schools need to strengthen 
communication and coordination mechanisms to reduce parents' and students' 
schooling hesitancy by providing explicit information about the COVID-19 
situation and risk-mitigation measures, along with normalizing messages about 
fear and anxiety.

DOI: 10.3390/ijerph19159261
PMCID: PMC9368253
PMID: 35954614 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1685. Int J Environ Res Public Health. 2022 Jul 28;19(15):9253. doi: 
10.3390/ijerph19159253.

ePSICONUT: An e-Health Programme to Improve Emotional Health and Lifestyle in 
University Students.

Cantisano LM(1)(2), Gonzalez-Soltero R(2), Blanco-Fernández A(2), 
Belando-Pedreño N(3).

Author information:
(1)School of Psychology, Pontificia Universidad Católica Madre y Maestra 
(PUCMM), Santiago De Los Caballeros 51000, Dominican Republic.
(2)Department of Medicine, Faculty of Biomedical and Health Sciences, 
Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain.
(3)Faculty of Sports Sciences, Department of Physical Activity and Sport, 
Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain.

The use of information and communication technologies in the health field is 
known as eHealth. Nowadays, the application of technological and digital tools 
for maintaining/improving physical and mental health is experiencing an 
exponential boom. These tools have been perceived as a powerful support for 
face-to-face therapies and lifestyle changes. Nevertheless, there is not enough 
scientific research that analyses the impact and consequences of eHealth 
interventions. More studies are needed to validate its application. Therefore, 
the aim of this study was to evaluate the impact of eHealth tools in a programme 
called ePSICONUT. This programme was created to promote healthy lifestyle habits 
in university students. The sample consisted of 16 university students from the 
Dominican Republic aged 18−24 years (x¯ = 20.69; s = 1.74). ePSICONUT was 
developed in 12 weeks and its impact was analyzed by comparing the initial and 
the final psychological and lifestyle tests results, which were completed online 
by the participants. Results reported that the professionally supervised use of 
eHealth tools was associated with better psychological well-being, lees anxiety 
and depression, and better lifestyle habits (such as diet quality), even in 
stressful and changing situations such as the COVID-19 pandemic circumstances. 
However, more studies are needed to validate and promote the use of 
eHealth-based intervention programmes.

DOI: 10.3390/ijerph19159253
PMCID: PMC9368425
PMID: 35954601 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1686. Int J Environ Res Public Health. 2022 Jul 28;19(15):9217. doi: 
10.3390/ijerph19159217.

"We Were Afraid": Mental Health Effects of the COVID-19 Pandemic in Two South 
African Districts.

Rwafa-Ponela T(1), Price J(2), Nyatela A(3), Nqakala S(3), Mosam A(1), Erzse 
A(1), Lalla-Edward ST(3), Hove J(2), Kahn K(2), Tollman S(2), Hofman K(1), 
Goldstein S(1).

Author information:
(1)SAMRC/Wits Centre for Health Economics and Decision Science-PRICELESS SA, 
School of Public Health, Faculty of Health Sciences, University of the 
Witwatersrand, Johannesburg 2193, South Africa.
(2)MRC/Wits Rural Public Health and Health Transitions Research Unit 
(Agincourt), School of Public Health, Faculty of Health Sciences, University of 
the Witwatersrand, Johannesburg 2193, South Africa.
(3)Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, 
Johannesburg 2193, South Africa.

The impacts of pandemics are recognized to go beyond infection, physical 
suffering, and socio-economic disruptions. Other consequences include 
psychological responses. Using a mental wellbeing lens, we analyzed 
COVID-19-related stressors in healthcare workers (HCWs) and community members 
who provided and regularly accessed health services in South Africa, 
respectively. From February to September 2021, during the second COVID-19 wave 
we conducted a qualitative study in one urban and one rural district. In-depth 
interviews and focus group discussions were used to collect data among 43 HCWs 
and 51 community members purposely and conveniently selected. Most participants 
experienced mental health challenges regarding multiple aspects of the COVID-19 
pandemic and its resulting lockdown, with a few reporting positive adjustments 
to change. COVID-19 impacts on mental health were consistent among both HCWs and 
community members in urban and rural alike. Participants' COVID-19-induced 
psychological responses included anxiety and fear of the unknown, perceived risk 
of infection, fear of hospitalization, and fear of dying. Physical effects of 
the pandemic on participants included COVID-19 infection and associated 
symptoms, possibilities of severe illness and discomfort of using personal 
protective equipment. These distresses were exacerbated by social repercussions 
related to concerns for family wellbeing and infection stigma. Lockdown 
regulations also intensified anxieties about financial insecurities and social 
isolation. At times when common coping mechanisms such as family support were 
inaccessible, cultural consequences related to lack of spiritual gatherings and 
limited funeral rites posed additional stress on participants. In preparation 
for future public health emergencies, recognition needs to be given to mental 
health support and treatment.

DOI: 10.3390/ijerph19159217
PMCID: PMC9368439
PMID: 35954573 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1687. Int J Environ Res Public Health. 2022 Jul 27;19(15):9151. doi: 
10.3390/ijerph19159151.

What Levers to Promote Teachers' Wellbeing during the COVID-19 Pandemic and 
Beyond: Lessons Learned from a 2021 Online Study in Six Countries.

Billaudeau N(1), Alexander S(1), Magnard L(2), Temam S(1), Vercambre MN(1).

Author information:
(1)MGEN Foundation for Public Health, 75015 Paris, France.
(2)Education and Solidarity Network, 1000 Brussels, Belgium.

To highlight effective levers to promote teachers' wellbeing worldwide, 
particularly during difficult times such as the COVID-19 pandemic, we 
investigated work-related factors associated with teacher wellbeing, across 
borders and cultures. In six countries/territories, we examined the factors that 
were most consistently and strongly associated with two indicators of wellbeing 
at work: (i) job satisfaction; and (ii) work/life balance, and three indicators 
of general wellbeing: (i) subjective health; (ii) mental health; and (iii) life 
satisfaction. Between May and July 2021, after 18 months of the pandemic, 8000 
teachers answered the first edition of the International Barometer of Education 
Personnel's Health and Wellbeing (I-BEST): 3646 teachers from France, 2349 from 
Québec, 1268 from Belgium, 302 from Morocco, 222 from The Gambia, and 215 from 
Mexico. For each country/territory and each wellbeing indicator, we used a 
forward stepwise regression procedure to identify important determinants among a 
carefully selected set of 31 sociodemographic, private, and professional life 
factors. Aside from healthcare access, the factors most consistently and 
strongly associated with teacher wellbeing in France, Québec and Belgium 
(samples whose size were ≥1000) were related to the psychosocial and the 
organizational dimensions of work, namely: feeling of safety at school, autonomy 
at work, and the quality of relationships with superiors and quality of 
relationships with students. In the smaller samples of teachers from the three 
remaining countries (Morocco, The Gambia and Mexico), exploratory analyses 
showed that the feeling of safety and autonomy at work were, there too, 
consistently associated with wellbeing indicators. During the COVID-19 pandemic, 
the factors most consistently associated with teachers' wellbeing across 
countries were related to security and autonomy at work, supporting the 
importance to consider these aspects in a continuous, structural way at school. 
Factors associated with teachers' wellbeing in very different contexts require 
further cross-cultural study.

DOI: 10.3390/ijerph19159151
PMCID: PMC9368544
PMID: 35954521 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1688. Int J Environ Res Public Health. 2022 Jul 27;19(15):9154. doi: 
10.3390/ijerph19159154.

Examining Perceived Stress and Coping Strategies of University Students during 
COVID-19: A Cross-Sectional Study in Jordan.

Alduais F(1)(2), Samara AI(1), Al-Jalabneh HM(3), Alduais A(4), Alfadda H(5), 
Alaudan R(5).

Author information:
(1)Department of Accounting, Philadelphia University, Jarash Road, 20 KM, Amman 
19392, Jordan.
(2)Department of Accounting, National Institute of Administrative Sciences, Ibb 
70270, Yemen.
(3)Department of Business Administration, Philadelphia University, Jarash Road, 
20 KM, Amman 19392, Jordan.
(4)Department of Human Sciences (Psychology), University of Verona, 37129 
Verona, Italy.
(5)Department of Curriculum and Instruction, King Saud University, Riyadh 11451, 
Saudi Arabia.

COVID-19 has changed our lives in all arenas, including higher education and 
psychological well-being. Three objectives were set forth in this study. We 
started by examining issues related to online education during the pandemic in 
Jordan, particularly for students pursuing business studies. Second, we assessed 
academic, behavioural, and financial stressors that business students experience 
at Jordanian higher education institutions. Lastly, we examined the possible 
coping methods students employed to cope and adapt during the pandemic. A 
descriptive cross-sectional study was conducted based on the perceived stress 
scale distributed to 473 Jordanian undergraduate students (18-27 years of age), 
across both public and private universities. Results showed an association 
between academic, behavioural, and financial stressors and students' perceived 
stress. While students perceived various levels and types of stress during 
COVID-19, including academic, behavioural, and financial, they also experienced 
new online skills. However, despite coping with stress, some students 
(especially females) displayed more stress because of the deficient course 
content, which added to their perceived stress and left them feeling 
unmotivated. This study contributes to bettering the university students' mental 
health.

DOI: 10.3390/ijerph19159154
PMCID: PMC9368044
PMID: 35954508 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1689. PLoS One. 2022 Aug 11;17(8):e0272925. doi: 10.1371/journal.pone.0272925. 
eCollection 2022.

Determinants of adolescents' Health-Related Quality of Life and psychological 
distress during the COVID-19 pandemic.

Dumont R(1), Richard V(1), Baysson H(1)(2), Lorthe E(1), Piumatti G(3)(4), 
Schrempft S(1), Wisniak A(1)(5), Barbe RP(6), Posfay-Barbe KM(7), Guessous 
I(2)(8), Stringhini S(1)(2)(9); Specchio-COVID19 study group.

Author information:
(1)Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva 
University Hospitals, Geneva, Switzerland.
(2)Department of Health and Community Medicine, Faculty of Medicine, University 
of Geneva, Geneva, Switzerland.
(3)Institute of Public Health, Faculty of BioMedicine, Università della Svizzera 
Italiana, Lugano, Switzerland.
(4)Fondazione Agnelli, Turin, Italy.
(5)Institute of Global Health, Faculty of Medicine, University of Geneva, 
Geneva, Switzerland.
(6)Division of Child and Adolescent Psychiatry, Department of Woman, Child, and 
Adolescent Medicine, Geneva University Hospitals, Geneva, Switzerland.
(7)Division of General Pediatrics, Department of Woman, Child, and Adolescent 
Medicine, Geneva University Hospitals, Geneva, Switzerland.
(8)Division and Department of Primary Care Medicine, Geneva University 
Hospitals, Geneva, Switzerland.
(9)University Center for General Medicine and Public Health, University of 
Lausanne, Lausanne, Switzerland.

BACKGROUND: We examined the determinants of adolescents' Health-Related Quality 
of Life (HRQoL) and psychological distress (self-reported and parent-reported) 
during the COVID-19 pandemic, using a random sample of the population of Geneva, 
Switzerland.
METHODS: Data was drawn from participants aged 14-17 years, who participated 
with their families to a serosurvey conducted in November and December 2020. 
Adolescents' HRQoL was evaluated using the validated adolescent-reported 
KIDSCREEN-10 and parent-reported KINDL® scales. Psychological distress was 
assessed with self-reported sadness and loneliness, and using the KINDL® 
emotional well-being scale. Using generalized estimating equations, we examined 
the role of socio-demographic, family and behavioural characteristics in 
influencing adolescents' mental health status and wellbeing.
RESULTS: Among 240 adolescents, 11% had a low HRQoL, 35% reported sadness and 
23% reported loneliness. Based on parents' perception, 12% of the adolescents 
had a low HRQoL and 16% a low emotional well-being. Being a girl (aOR = 3.20; 
95%CI: 1.67-6.16), increased time on social media (aOR = 2.07; 95%CI: 
1.08-3.97), parents' average to poor mood (aOR = 2.62; 95%CI: 1.10-6.23) and 
average to poor household financial situation (aOR = 2.31; IC95%: 1.01-6.10) 
were associated with an increased risk of sadness. Mismatches between 
adolescents' and their parents' perception of HRQoL were more likely for girls 
(aOR = 2.88; 95%CI: 1.54-5.41) and in households with lower family well-being 
(aOR = 0.91; 95%CI: 0.86-0.96).
CONCLUSIONS: A meaningful proportion of adolescents experienced low well-being 
during the second wave of COVID-19, and average well-being was lower than 
pre-pandemic estimates. Adolescents living in underprivileged or distressed 
families seemed particularly affected. Monitoring is necessary to evaluate the 
long-term effects of the pandemic on adolescents.

DOI: 10.1371/journal.pone.0272925
PMCID: PMC9371327
PMID: 35951623 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declare that they have no 
competing interests.


1690. Psychol Health Med. 2022 Jan-Dec;27(sup1):239-255. doi: 
10.1080/13548506.2022.2108087. Epub 2022 Aug 11.

Predictors of COVID-related changes in mental health in a South African sample 
of adolescents and young adults.

Haag K(1), Du Toit S(2), Skeen S(2), Steventon Roberts K(1), Chideya Y(2), 
Notholi V(2), Sambudla A(2), Gordon S(2), Sherr L(1), Tomlinson M(2)(3).

Author information:
(1)Institute for Global Health, University College London, London, UK.
(2)Institute for Life Course Health Research, Department of Global Health, 
Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, 
South Africa.
(3)School of Nursing and Midwifery, Queens University, Belfast, UK.

The COVID-19 pandemic has substantially affected the lives of young people 
living in sub-Saharan Africa (SSA), leading to poorer short-term mental health 
outcomes. However, longitudinal data investigating changes in mental health from 
pre-COVID levels and their predictors are lacking. Our longitudinal sample 
comprised N = 233 young people (mean age: 17.8 years at baseline, 55.6% female) 
living in a deprived neighbourhood near Cape Town, South Africa. Symptoms of 
depression (PHQ-9), anxiety (GAD-7) and alcohol use (AUDIT) were assessed during 
two waves of data collection, pre-pandemic (2018/19) and via phone interviews in 
June to October 2020, during South Africa's first COVID wave and subsequent case 
decline. Latent change score models were used to investigate predictors of 
changes in mental health. Controlling for baseline levels, we found increases in 
depression and anxiety but not alcohol use symptoms during the COVID-19 
pandemic. Higher baseline symptoms were associated with smaller increases on all 
measures. Socio-economic deprivation (lack of household income, food insecurity) 
before and during COVID were associated with higher anxiety and depression 
symptom increases. Having had more positive experiences during COVID was 
associated with lower post-COVID onset anxiety and depression increases, and 
marginally with less alcohol use, while negative experiences (household 
arguments, worries) were linked to stronger symptom increases. Overall, in a 
sample of young people from an adverse environment in South Africa, we found 
increased mental health difficulties during the COVID-19 pandemic, though higher 
baseline symptoms did not necessarily predict stronger increases. Several 
factors pre- and post-COVID onset were identified that could be relevant for 
determining risk and resilience. In the long term, it will be key to address 
these structural drivers of well-being and to ensure mental health needs of 
young people are being met to support SSA countries in building back 
successfully from COVID-19 and preparing for future shock events.

DOI: 10.1080/13548506.2022.2108087
PMID: 35950705 [Indexed for MEDLINE]


1691. Environ Res. 2022 Nov;214(Pt 3):114020. doi: 10.1016/j.envres.2022.114020. Epub 
2022 Aug 7.

Economic and mental health impacts of multiple adverse events: Hurricane Harvey, 
other flooding events, and the COVID-19 pandemic.

Callender R(1), Canales JM(1), Avendano C(2), Craft E(3), Ensor KB(4), Miranda 
ML(5).

Author information:
(1)Children's Environmental Health Initiative, Rice University, Houston, TX, 
USA.
(2)Children's Environmental Health Initiative, University of Notre Dame, South 
Bend, IN, USA.
(3)Environmental Defense Fund, Austin, TX, USA.
(4)Department of Statistics, Rice University, Houston, TX, USA.
(5)Children's Environmental Health Initiative, University of Notre Dame, South 
Bend, IN, USA; Department of Applied and Computational Mathematics and 
Statistics, University of Notre Dame, South Bend, IN, USA. Electronic address: 
mlm@nd.edu.

OBJECTIVES: To assess the economic and mental health impacts of COVID-19 in the 
presence of previous exposure to flooding events.
METHODS: Starting in April 2018, the Texas Flood Registry (TFR) invited 
residents to complete an online survey regarding their experiences with 
Hurricane Harvey and subsequent flooding events. Starting in April 2020, 
participants nationwide were invited to complete a brief online survey on their 
experiences during the pandemic. This study includes participants in the TFR 
(N = 20,754) and the COVID-19 Registry (N = 8568) through October 2020 (joint 
N = 2929). Logistic regression and generalized estimating equations were used to 
examine the relationship between exposure to flooding events and the economic 
and mental health impacts of COVID-19.
RESULTS: Among COVID-19 registrants, 21% experienced moderate to severe anxiety 
during the pandemic, and 7% and 12% of households had difficulty paying rent and 
bills, respectively. Approximately 17% of Black and 15% of Hispanic households 
had difficulty paying rent, compared to 5% of non-Hispanic white households. The 
odds of COVID-19 income loss are 1.20 (1.02, 1.40) times higher for those who 
previously had storm-related home damage compared to those who did not and 3.84 
(3.25-4.55) times higher for those who experienced Harvey income loss compared 
to those who did not. For registrants for whom Harvey was a severe impact event, 
the odds of having more severe anxiety during the pandemic are 5.14 (4.02, 6.58) 
times higher than among registrants for whom Harvey was a no meaningful impact 
event.
CONCLUSIONS: Multiple crises can jointly and cumulatively shape health and 
wellbeing outcomes. This knowledge can help craft emergency preparation and 
intervention programs.

Copyright © 2022 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.envres.2022.114020
PMCID: PMC9357442
PMID: 35948147 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


1692. J Nepal Health Res Counc. 2022 Jun 2;20(1):234-240. doi: 
10.33314/jnhrc.v20i01.4063.

Psychological Distress and Coping among Pregnant Women during the COVID 19 
Pandemic.

Rimal SP(1), Thapa K(2), Shrestha R(1).

Author information:
(1)Department of Obstetrics and Gynecology, BP Koirala Institute of Health 
Sciences, Dharan, Nepal.
(2)Department of Psychiatric Nursing, BP Koirala Institute of Health Sciences, 
Dharan, Nepal.

BACKGROUND: Mental health of pregnant individuals has been profoundly affected 
by the COVID-19 pandemic. Effective coping strategies are found to be associated 
with better psychological wellbeing during the COVID-19 pandemic. The objective 
of the present study is to assess psychological distress and coping among 
pregnant women during the COVID-19 pandemic.
METHODS: A descriptive cross sectional study was conducted from May 2020 to July 
2020 among 115 pregnant women attending obstetric unit of a tertiary care centre 
using convenience sampling technique. Ethical approval was obtained from the 
Institutional Review Committee of the Institute. Covid-19 Peritraumatic Distress 
Index and Brief COPE inventory was used to collect the data. Data entry was done 
in Microsoft Office Excel 2007 and analysed in SPSS version 16.
RESULTS: Psychological distress was found in 2.6% of the participants. 
Psychological distress was significantly associated with occupation, fear of ANC 
visit, fear of visit to hospital for other health problems and fear of being 
alone or without help around delivery. Emotion focused coping was the most 
commonly used coping strategies among the pregnant women with the mean score of 
21.37±3.130. Psychological distress and over all coping strategies had a 
positive correlation (<0.001).
CONCLUSIONS: Psychological distress was found to be low among the pregnant women 
in this study. Fear of being without help and fear of contacting the virus 
during the visit to the hospital during the Covid-19 pandemic were the likely 
reasons of the psychological distress in the pregnant women.

DOI: 10.33314/jnhrc.v20i01.4063
PMID: 35945882 [Indexed for MEDLINE]


1693. J Autism Dev Disord. 2023 Oct;53(10):3968-3979. doi: 10.1007/s10803-022-05628-6. 
Epub 2022 Aug 9.

Silver linings of the Covid-19 pandemic… for some! Comparing Experiences and 
Social demographic characteristics of autistic and non-autistic children with 
SEND in England.

Castro-Kemp S(1)(2), Orcid AM(3).

Author information:
(1)UCL Institute of Education, London, United Kingdom. s.castro-kemp@ucl.ac.uk.
(2)Psychology and Human Development, 26 Woburn Square, WC1H 0AA, London, United 
Kingdom. s.castro-kemp@ucl.ac.uk.
(3)School of Education, University of Roehampton, London, United Kingdom.

Several studies on the impact of Covid-19 on children's wellbeing have been 
published, including for those with Special Educational Needs and Disabilities. 
However, limited evidence is available on who these children may be, their 
socioeconomic background, age, gender or type of school attended. This study 
examines the role of socio-demographic characteristics on the experiences of 
Autistic Children, compared to non-Autistic children, to assess the detrimental 
impact of the pandemic, but also potential silver linings. Primary-school aged 
Autistic children were more likely to mention a silver lining (for mental 
health), as well as younger non-Autistic children from more affluent 
backgrounds. Similar effects were observed for older non-Autistic boys with 
special needs attending mainstream settings (regarding physical health).

© 2022. The Author(s).

DOI: 10.1007/s10803-022-05628-6
PMCID: PMC9362987
PMID: 35945387 [Indexed for MEDLINE]

Conflict of interest statement: • The authors have no relevant financial or 
non-financial interests to disclose. • The authors have no competing interests 
to declare that are relevant to the content of this article. • All authors 
certify that they have no affiliations with or involvement in any organization 
or entity with any financial interest or non-financial interest in the subject 
matter or materials discussed in this manuscript. • The authors have no 
financial or proprietary interests in any material discussed in this article.


1694. Psychiatry Res. 2022 Oct;316:114748. doi: 10.1016/j.psychres.2022.114748. Epub 
2022 Jul 25.

International PRISMA scoping review to understand mental health interventions 
for depression in COVID-19 patients.

Chennapragada L(1), Sullivan SR(2), Hamerling-Potts KK(3), Tran H(3), Szeszko 
J(3), Wrobleski J(3), Mitchell EL(3), Walsh S(4), Goodman M(5).

Author information:
(1)VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), 
James J. Peters Veterans Affairs Medical Center, Bronx, NY, United States. 
Electronic address: Lakshmi.Chennapragada@va.gov.
(2)VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), 
James J. Peters Veterans Affairs Medical Center, Bronx, NY, United States; 
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 
United States; Department of Psychology, Health Psychology and Clinical Science, 
CUNY New York, New York, NY, United States.
(3)VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), 
James J. Peters Veterans Affairs Medical Center, Bronx, NY, United States.
(4)Icahn School of Medicine Library at Mt. Sinai Hospital, New York, NY, United 
States.
(5)VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), 
James J. Peters Veterans Affairs Medical Center, Bronx, NY, United States; 
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 
United States.

Preliminary research indicates that the COVID-19 illness affects the mental 
well-being of patients. This scoping review, thus, aims to examine the current 
state of research into mental health treatments for depression symptoms in 
COVID-19 patients. Select databases were searched on 7/1/2021. Full-text 
articles involved (1) mental health treatment (2) suicide and/or depression 
outcomes, (3) a quasi-experimental research trial, and (4) a primary analysis. 
11 articles were included in this review. The studies spanned 5 countries, and 
demonstrated immediate positive effects of mental health treatments and 
tele-health as a treatment modality for depression in COVID-19 patients. 6 
studies were randomized controlled trials. Various treatments were administered, 
including cognitive behavior therapy, mindfulness, and muscle relaxation. Most 
interventions were conducted in in-patient units and focused on acute symptoms. 
There were limitations in the design and description of methodology in many 
studies, which affects the generalizability and replicability of positive 
findings. Only two studies included a post-intervention follow-up and one study 
assessed suicide risk. Thus, this review found there is a pressing need for more 
research in the area, with greater rigor in study methodology, and for 
treatments targeting long-term symptoms and suicidality, and outpatient 
services.

Copyright © 2022. Published by Elsevier B.V.

DOI: 10.1016/j.psychres.2022.114748
PMCID: PMC9313534
PMID: 35944370 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest None.


1695. J Am Vet Med Assoc. 2022 Jul 1;260(12):1547-1553. doi: 10.2460/javma.22.03.0134.

Executive summary of the Merck Animal Health Veterinarian Wellbeing Study III 
and Veterinary Support Staff Study.

Volk JO(1), Schimmack U(2), Strand EB(3), Reinhard A(4), Vasconcelos J(5), Hahn 
J(5), Stiefelmeyer K(6), Probyn-Smith K(6).

Author information:
(1)1Brakke Consulting, Greensboro, NC.
(2)2Department of Psychology, University of Toronto, Mississauga, ON, Canada.
(3)3College of Social Work and the College of Veterinary Medicine, University of 
Tennessee, Knoxville, TN.
(4)4MentorVet, Lexington, KY.
(5)5Merck Animal Health, Madison, NJ.
(6)6Kynetec, Guelph, ON, Canada.

Comment in
    J Am Vet Med Assoc. 2022 Dec 01;260(15):1915.

OBJECTIVE: Merck Animal Health Veterinarian Wellbeing Study III was conducted to 
continue to monitor mental health and well being within the veterinary 
profession in the US and to identify factors associated with high levels of 
wellbeing and lack of serious psychological distress.
METHODS: A questionnaire consisting of several instruments and questions for 
measurement of mental health and wellbeing was completed by 2,495 veterinarians 
and 448 veterinary support staff. Results for veterinarians were weighted to the 
US AVMA membership.
RESULTS: This study revealed that wellbeing and mental health of some 
veterinarians declined over the past 2 years, driven in part by the COVID-19 
pandemic and extreme labor shortages. Burnout remained at a high level, but 
there was no increase in suicide ideation. A new companion survey of veterinary 
support staff demonstrated that staff scored lower in wellbeing and mental 
health, and higher in burnout than veterinarians.
CLINICAL RELEVANCE: Importantly, these studies identified techniques that both 
individuals and employers may find useful in fostering wellbeing and good mental 
health. A healthy method for coping with stress and good work-life balance was 
important, as was engaging a financial adviser for those with student debt or 
other financial stresses. Employers should create safe environments where 
employees feel comfortable seeking help, reducing the stigma associated with 
mental health issues. In addition, employers can provide Employee Assistance 
Programs and health insurance that covers mental health treatment. Fostering a 
healthy work culture was also important, one with good communication, teamwork, 
trust, and adequate time allotted to provide quality patient care.

DOI: 10.2460/javma.22.03.0134
PMID: 35943942 [Indexed for MEDLINE]


1696. BMC Public Health. 2022 Aug 8;22(1):1509. doi: 10.1186/s12889-022-13825-2.

Validation of a COVID-19 mental health and wellness survey questionnaire.

El Tantawi M(1), Folayan MO(2), Nguyen AL(3), Aly NM(4), Ezechi O(5), Uzochukwu 
BSC(6), Alaba OA(7)(8), Brown B(9).

Author information:
(1)Department of Pediatric Dentistry and Dental Public Health, Faculty of 
Dentistry, Alexandria University, Champolion St., Azarita, Alexandria, 21521, 
Egypt. maha_tantawy@hotmail.com.
(2)Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, 
Nigeria.
(3)Department of Family Medicine, Keck School of Medicine, University of 
Southern California, Los Angeles, CA, USA.
(4)Department of Pediatric Dentistry and Dental Public Health, Faculty of 
Dentistry, Alexandria University, Champolion St., Azarita, Alexandria, 21521, 
Egypt.
(5)Clinical Sciences Department, Nigerian Institute of Medical Research, Yaba 
Lagos, Nigeria.
(6)Department of Community Medicine, University of Nigeria, Nsukka, Nigeria.
(7)Institute of Public Health, Obafemi Awolowo University, Ile-Ife, Nigeria.
(8)Department of Employment and Labor Relations, Indiana University of 
Pennsylvania, Indiana, PA, USA.
(9)Center for Healthy Communities, Department of Social Medicine, Population and 
Public Health, University of California, Riverside School of Medicine, 
Riverside, USA.

BACKGROUND AND AIM: COVID-19 affected mental health and wellbeing. Research is 
needed to assess its impact using validated tools. The study assessed the 
content validity, reliability and dimensionality of a multidimensional tool for 
assessing the mental health and wellbeing of adults.
METHODS: An online questionnaire collected data in the second half of 2020 from 
adults in different countries. The questionnaire included nine sections 
assessing: COVID-19 experience and sociodemographic profile; health and memory; 
pandemic stress (pandemic stress index, PSI); financial and lifestyle impact; 
social support; post-traumatic stress disorder (PTSD); coping strategies; 
self-care and HIV profile over 57 questions. Content validity was assessed 
(content validity index, CVI) and participants evaluated the test-retest 
reliability (Kappa statistic and intra-class correlation coefficient, ICC). 
Internal consistency of scales was assessed (Cronbach α). The dimensionality of 
the PSI sections and self-care strategies was assessed by multiple 
correspondence analysis (MCA) using all responses and SPSS. For qualitative 
validation, we used a semi-structured interview and NVivo was used for coding 
and thematic analysis.
RESULTS: The overall CVI = 0.83 with lower values for the memory items. Cronbach 
α for the memory items = 0.94 and ICC = 0.71. Cronbach α for PTSD items was 0.93 
and ICC = 0.89. Test-retest scores varied by section. The 2-dimensions solution 
of MCA for the PSI behavior section explained 33.6% (precautionary measures 
dimension), 11.4% (response to impact dimension) and overall variance = 45%. The 
2-dimensions of the PSI psychosocial impact explained 23.5% (psychosocial impact 
of the pandemic dimension), 8.3% (psychosocial impact of the precautionary 
measures of the pandemic dimension) and overall variance = 31.8%. The 
2-dimensions of self-care explained 32.9% (dimension of self-care strategies by 
people who prefer to stay at home and avoid others), 9% (dimension of self-care 
strategies by outward-going people) and overall variance = 41.9%. Qualitative 
analysis showed that participants agreed that the multidimensional assessment 
assessed the effect of the pandemic and that it was better suited to the 
well-educated.
CONCLUSION: The questionnaire has good content validity and can be used to 
assess the impact of the pandemic in cross-sectional studies especially as 
individual items. The PSI and self-care strategies need revision to ensure the 
inclusion of items with strong discrimination.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-13825-2
PMCID: PMC9358641
PMID: 35941580 [Indexed for MEDLINE]

Conflict of interest statement: All authors do not have competing interest.


1697. J Adolesc Health. 2022 Oct;71(4):414-422. doi: 10.1016/j.jadohealth.2022.06.006. 
Epub 2022 Jun 22.

Tracking Mental Wellbeing of Dutch Adolescents During the First Year of the 
COVID-19 Lockdown: A Longitudinal Study.

van der Laan SEI(1), Lenters VC(2), Finkenauer C(3), van Harmelen AL(4), van der 
Ent CK(5), Nijhof SL(6).

Author information:
(1)Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, 
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; 
Julius Center for Health Sciences and Primary Care, University Medical Center 
Utrecht, Utrecht, the Netherlands. Electronic address: 
s.e.i.vanderlaan-4@umcutrecht.nl.
(2)Julius Center for Health Sciences and Primary Care, University Medical Center 
Utrecht, Utrecht, the Netherlands.
(3)Department of Interdisciplinary Social Sciences, Utrecht University, Utrecht, 
the Netherlands.
(4)Education and Child Studies, Leiden University, Leiden, the Netherlands; 
Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
(5)Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, 
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
(6)Department of Pediatrics, Wilhelmina Children's Hospital, University Medical 
Center Utrecht, Utrecht University, Utrecht, the Netherlands.

PURPOSE: Adolescents might be susceptible to the effects of the COVID-19 
lockdown. We assessed changes in mental wellbeing throughout the first year of 
the pandemic and compared these with prepandemic levels.
METHODS: This five-wave prospective study among Dutch adolescents aged 
12-17 years used data collected before the pandemic (n = 224) (T0), in May (T1), 
July (T2), and October 2020 (T3), and in February 2021 (T4). Generalized 
estimating equations were used to assess the association between stringency of 
the lockdown with mental wellbeing.
RESULTS: Adolescents had a lower life satisfaction during the first full 
lockdown (T1) [adjusted β: -0.36, 95% confidence interval (CI): -0.58 to -0.13], 
during the partial lockdown (T3) (adjusted β: -0.37, 95% CI: -0.63 to -0.12), 
and during the second full lockdown (T4) (adjusted β: -0.79, 95% CI: -1.07 
to -0.52) compared to before the pandemic (T0). Adolescents reported more 
internalizing symptoms during only the second full lockdown (T4) (adjusted β: 
2.58, 95% CI: 0.41-4.75). During the pandemic [at T1 (adjusted β: 0.29, 95% CI: 
0.20-0.38), T2 (adjusted β: 0.36, 95% CI: 0.26-0.46), T3 (adjusted β: 0.33, 95% 
CI: 0.22-0.45), and T4 (adjusted β: 0.20, 95% CI: 0.07-0.34)], adolescents 
reported a better psychosomatic health, partly attributable to less trouble 
falling asleep (p < .01).
DISCUSSION: The COVID-19 lockdown measures have had both a negative and positive 
impact on mental wellbeing of Dutch adolescents. However, mental wellbeing was 
most impacted during the second full lockdown compared to before the pandemic.

Copyright © 2022 Society for Adolescent Health and Medicine. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jadohealth.2022.06.006
PMCID: PMC9217158
PMID: 35941018 [Indexed for MEDLINE]


1698. J Neurol. 2022 Dec;269(12):6202-6210. doi: 10.1007/s00415-022-11295-5. Epub 2022 
Aug 8.

The late onset of emotional distress in people with progressive multiple 
sclerosis during the Covid-19 pandemic: longitudinal findings from the CogEx 
study.

Feinstein A(1)(2), Amato MP(3)(4), Brichetto G(5)(6), Chataway J(7)(8), 
Chiaravalloti ND(9)(10), Cutter G(11), Dalgas U(12), DeLuca J(9)(10), Farrell 
R(7)(8), Feys P(13), Filippi M(14)(15)(16)(17)(18), Freeman J(19), Inglese 
M(20)(21), Meza C(22), Motl RW(23), Rocca MA(14)(15), Sandroff BM(9)(10), Salter 
A(24); CogEx Research Team.

Author information:
(1)Department of Psychiatry, University of Toronto and Sunnybrook Health 
Sciences Centre, Toronto, ON, M5R 3B6, Canada. ant.feinstein@utoronto.ca.
(2)Department of Psychiatry, Sunnybrook Research Institute, 2075 Bayview Ave., 
FG 16, Toronto, ON, M4N 3M5, USA. ant.feinstein@utoronto.ca.
(3)Department NEUROFARBA, Section Neurosciences, University of Florence, 
Florence, Italy.
(4)IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.
(5)Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), via 
Operai 40, 16149, Genoa, Italy.
(6)AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, 
Italy.
(7)Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, 
Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University 
College London, London, WC1B 5EH, UK.
(8)Biomedical Research Centre, National Institute for Health Research, 
University College London Hospitals, London, UK.
(9)Kessler Foundation, East Hanover, NJ, USA.
(10)Department of Physical Medicine and Rehabilitation, Rutgers New Jersey 
Medical School, Newark, NJ, USA.
(11)Department of Biostatistics, University of Alabama at Birmingham, 
Birmingham, USA.
(12)Exercise Biology, Department of Public Health, Aarhus University, Dalgas 
Avenue 4, 8000, Aarhus, Denmark.
(13)REVAL. Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, 
Belgium.
(14)Neuroimaging Research Unit, Institute of Experimental Neurology, Division of 
Neuroscience, IRCSS San Raffaele Scientific Institute, Milan, Italy.
(15)Neurology Unit, IRCSS San Raffaele Scientific Institute, Milan, Italy.
(16)Neurorehabilitation Unit, IRCSS San Raffaele Scientific Institute, Milan, 
Italy.
(17)Neurophysiology Service, IRCSS San Raffaele Scientific Institute, Milan, 
Italy.
(18)Vita-Salute San Raffaele University, Milan, Italy.
(19)Faculty of Health, School of Health Professions, University of Plymouth, 
Devon, UK.
(20)Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, 
Maternal and Child Health, and Center of Excellence for Biomedical Research, 
University of Genoa, Genoa, Italy.
(21)Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.
(22)Department of Psychiatry, University of Toronto and Sunnybrook Health 
Sciences Centre, Toronto, ON, M5R 3B6, Canada.
(23)Department of Kinesiology and Nutrition, University of Illinois Chicago, 
Chicago, IL, USA.
(24)Department of Neurology, Section on Statistical Planning and Analysis, UT 
Southwestern Medical Center, Dallas, TX, USA.

OBJECTIVE: An earlier follow-up study from the CogEx rehabilitation trial showed 
little change in symptoms of depression, anxiety and psychological distress 
during the first COVID-19 lockdown compared to pre-pandemic measurements. Here, 
we provide a second follow-up set of behavioral data on the CogEx sample.
METHODS: This was an ancillary, longitudinal follow-up study in CogEx, a 
randomized controlled trial of exercise and cognitive rehabilitation in people 
with progressive MS involving 11 centres in North America and Europe. Only 
individuals impaired on the Symbol Digit Modalities Test (SDMT) were included. 
Participants repeated the COVID Impact survey administered approximately a year 
later and completed self-report measures of depression, anxiety and MS symptoms 
that had been obtained at the trial baseline and during the first COVID Impact 
survey. Participants who completed the second COVID Impact follow-up were 
included. To identify predictors of the participants' ratings of their mental 
and physical well-being, step-wise linear regression was conducted.
RESULTS: Of the 131 participants who completed the first COVID impact survey, 74 
participants completed the second follow-up survey (mean age 52 (SD = 6.4) 
years, 62.2% female, mean disease duration 16.4 (SD = 9.0) years, median EDSS 
6.0). Pandemic restrictions prevented data collection from sites in Denmark and 
England (n = 57). The average time between measurements was 11.4 (SD = 5.56) 
months. There were no significant differences in age, sex, EDSS, disease course 
and duration between those who participated in the current follow-up study 
(n = 74) and the group that could not (n = 57). One participant had COVID in the 
time between assessments. Participants now took a more negative view of their 
mental/psychological well-being (p = 0.0001), physical well-being (p = 0.0009) 
and disease course (p = 0.005) compared to their last assessment. Depression 
scores increased on the HADS-depression scale (p = 0.01) and now exceeded the 
clinically significant threshold of ≥ 8.0 for the first time. Anxiety scores on 
the HADS remained unchanged. Poorer mental well-being was predicted by HADS 
depression scores (p = 0.012) and a secondary-progressive disease course 
(p = 0.0004).
CONCLUSIONS: A longer follow-up period revealed the later onset of clinically 
significant depressive symptoms on the HADS and a decline in self-perceptions of 
mental and physical well-being associated with the COVID-19 pandemic relative to 
the first follow-up data point.
TRIAL REGISTRATION: The trial was registered on September 20th 2018 at www.
CLINICALTRIALS: gov having identifier NCT03679468. Registration was performed 
before recruitment was initiated.

© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

DOI: 10.1007/s00415-022-11295-5
PMCID: PMC9358370
PMID: 35939096 [Indexed for MEDLINE]

Conflict of interest statement: Anthony Feinstein is on Advisory Boards for 
Akili Interactive and Roche, and reports grants from the MS Society of Canada, 
book royalties from Johns Hopkins University Press, Cambridge University Press, 
Amadeus Press and Glitterati Editions, and speaker’s honoraria from Novartis, 
Biogen, Roche and Sanofi-Genzyme. Maria Pia Amato received compensation for 
consulting services and/or speaking activities from Bayer, Biogen Idec, 
Merck-Serono, Novartis, Roche, Sanofi Genzyme, and Teva Pharmaceutical 
Industries; and received research support from Biogen Idec, Merck-Serono, Roche, 
Pharmaceutical Industries and Fondazione Italiana Sclerosi Multiplav. Giampaolo 
Brichetto has been awarded and received research support from Coloplast, 
Novartis, Roche, Fondazione Italiana Sclerosi Multipla, ARSEP, H2020 EU Call, 
Italian Ministry of Health. Jeremy Chataway has received support from the 
Efficacy and Evaluation (EME) Programme, a Medical Research Council (MRC) and 
National Institute for Health Research (NIHR) partnership and the Health 
Technology Assessment (HTA) Programme (NIHR), the UK MS Society, the US National 
MS Society and the Rosetrees Trust. He is supported in part by the National 
Institute for Health Research, University College London Hospitals, Biomedical 
Research Centre, London, UK. He has been a local principal investigator for 
commercial trials funded by: Actelion, Biogen, Novartis and Roche; has received 
an investigator grant from Novartis; and has taken part in advisory 
boards/consultancy for Azadyne, Biogen, Celgene, MedDay, Merck and Roche. Nancy 
D. Chiaravalloti is on an Advisory Board for Akili Interactive and is a member 
of the Editorial Boards of Multiple Sclerosis Journal and Frontiers in 
NeuroTrauma. Ulrik Dalgas has received research support, travel grants, and/or 
teaching honorary from Biogen Idec, Merck Serono, Novartis, Bayer Schering, and 
Sanofi Aventis as well as honoraria from serving on scientific advisory boards 
of Biogen Idec and Genzyme. John DeLuca is an Associate Editor of the Archives 
of Physical Medicine and Rehabilitation, received compensation for consulting 
services and/or speaking activities from Biogen Idec, Bristol Myers Squibb, 
Celgene, MedRhythms, Jansssen Roche and Novartis; and receives research support 
from Biogen Idec, National Multiple Sclerosis Society, Consortium of Multiple 
Sclerosis Centers, National Academy of Neuropsychology and National Institutes 
of Health. Cecilia Meza has no disclosures to report. Peter Feys is editorial 
board member of NNR and MSJ, provides consultancy to NeuroCompass and was board 
of advisory board meetings for BIOGEN. Massimo Filippi is Editor-in-Chief of the 
Journal of Neurology and Associate Editor of Human Brain Mapping, Neurological 
Sciences, and Radiology, received compensation for consulting services and/or 
speaking activities from Alexion, Almirall, Bayer, Biogen, Celgene, Eli Lilly, 
Genzyme, Merck-Serono, Novartis, Roche, Sanofi, Takeda, and Teva Pharmaceutical 
Industries, and receives research support from Biogen Idec, Merck-Serono, 
Novartis, Roche, Teva Pharmaceutical Industries, the Italian Ministry of Health, 
Fondazione Italiana Sclerosi Multipla, and ARiSLA (Fondazione Italiana di 
Ricerca per la SLA). Jennifer Freeman has been awarded research grants from the 
NIHR, UK. Matilde Inglese is Co-Editor for Controversies for Multiple Sclerosis 
Journal; received compensation for consulting services and/or speaking 
activities from Biogen Idec, Merck-Serono, Novartis, Roche, Sanofi Genzyme; and 
received research support from NIH, NMSS, the MS Society of Canada, the Italian 
Ministry of Health, Fondazione Italiana Sclerosi Multipla, H2020 EU Call. Robert 
W. Motl has no disclosures to report. Maria Assunta Rocca received speaker 
honoraria from Bayer, Biogen, Bristol Myers Squibb, Celgene, Genzyme, Merck 
Serono, Novartis, Roche, and Teva and research support from the Canadian MS 
Society and Fondazione Italiana Sclerosi Multipla. Brian Sandroff has no 
disclosures to report. Gary Cutter is a member of Data and Safety Monitoring 
Boards for Astra-Zeneca, Avexis Pharmaceuticals, Biolinerx, Brainstorm Cell 
Therapeutics, Bristol Meyers Squibb/Celgene, CSL Behring, Galmed 
Pharmaceuticals, Horizon Pharmaceuticals, Hisun Pharmaceuticals, Mapi 
Pharmaceuticals LTD, Merck, Merck/Pfizer, Opko Biologics, OncoImmune, Neurim, 
Novartis, Ophazyme, Sanofi-Aventis, Reata Pharmaceuticals, Teva pharmaceuticals, 
VielaBio Inc, Vivus, NHLBI (Protocol Review Committee), NICHD (OPRU oversight 
committee). He is on Consulting or Advisory Boards for Biodelivery Sciences 
International, Biogen, Click Therapeutics, Genzyme, Genentech, GW 
Pharmaceuticals, Klein-Buendel Incorporated, Medimmune, Medday, Neurogenesis 
LTD, Novartis, Osmotica Pharmaceuticals, Perception Neurosciences, 
Recursion/Cerexis Pharmaceuticals, Roche, TG Therapeutics. Dr. Cutter is 
employed by the University of Alabama at Birmingham and President of Pythagoras, 
Inc. a private consulting company located in Birmingham AL. Amber Salter is a 
statistical editor for Circulation: Cardiovascular Imaging.


1699. Int J Ment Health Nurs. 2022 Dec;31(6):1457-1466. doi: 10.1111/inm.13046. Epub 
2022 Aug 8.

The influence of emotional burnout and resilience on the psychological distress 
of nursing students during the COVID-19 pandemic.

Merino-Godoy MÁ(1), Yot-Domínguez C(2), Conde-Jiménez J(3), Ramírez Martín P(4), 
Lunar-Valle PM(5).

Author information:
(1)Department of Nursing, Faculty of Nursing, University of Huelva, Huelva, 
Spain.
(2)Department of Didactics and Educational Organisation, Faculty of Education, 
University of Seville, Sevilla, Spain.
(3)Department of Theory and History of Education and Social Pedagogy, Faculty of 
Education, University of Seville, Sevilla, Spain.
(4)Clínica HLA Los Naranjos y Diaverum Servicios Renales, Huelva, Spain.
(5)Hospital Minas de Riotinto, Huelva, Spain.

The aim of this study was to measure and analyse the association of emotional 
burnout and resilience with the psychological distress of students who finished 
their nursing studies after the peak of the COVID-19 pandemic. The mental health 
of nursing students was affected during the pandemic, and resilience seems to 
counteract the negative effects. This is a cross-sectional study. The data 
(quantitative) were gathered at the beginning of the second term of the academic 
year 2020/2021. The study was carried out in the Spanish university context. 
Self-reported measures were gathered using three one-dimensional, valid, and 
reliable scales: the Psychological Distress Scale (K-10), the Emotional Burnout 
Scale (EBS), and the short version of the Connor-Davidson Resilience Scale 
(CD-RISC10). A total of 393 students of different Spanish universities 
participated in this study. A valid linear regression model was obtained, which 
allowed verifying that psychological distress is explained, with 37% variance, 
by emotional burnout and resilience. The total score in emotional burnout has 
more relevance than the total score in resilience, and the latter has a negative 
tendency. Facing the factors that generate emotional burnout in students in the 
academic scope and promoting resilience in them are fundamental aspects that 
contribute to their psychological well-being. The reflection should be extended 
to clinical practices. Universities are urged to think about last-year students, 
their experiences, perceptions, and feelings, to determine how their 
susceptibility to emotional burnout and psychological distress can be minimized 
in their future clinical practices. Strategies to promote their resilience 
should also be studied.

© 2022 The Authors. International Journal of Mental Health Nursing published by 
John Wiley & Sons Australia, Ltd.

DOI: 10.1111/inm.13046
PMCID: PMC9538541
PMID: 35938942 [Indexed for MEDLINE]


1700. Int J Qual Stud Health Well-being. 2022 Dec;17(1):2110669. doi: 
10.1080/17482631.2022.2110669.

Keys to well-being in older adults during the COVID-19 pandemic: personality, 
coping and meaning.

Mau M(1)(2)(3), Fabricius AM(4), Klausen SH(4).

Author information:
(1)Department of Psychology, University of Southern Denmark, Odense, Denmark.
(2)Health, Social Work and Welfare Research, UCL University College, Odense, 
Denmark.
(3)Health Sciences Research Centre, UCL University College, Odense, Denmark.
(4)Department for the Study of Culture, University of Southern Denmark, Odense, 
Denmark.

PURPOSE: During the COVID-19 pandemic, older adults were portrayed as an at-risk 
group. While this may have been true in some respects, empirical studies on 
mental health, including well-being were conflicting. Some studies found that 
older adults demonstrated a notable emotional resilience against the impacts of 
the pandemic. In this study, we qualitatively examine how older adults 
understand well-being and how they approached pandemic's potential influence on 
their well-being.
METHODS: 17 older adults participated in the study, out of which 14 were 
interviewed and three provided written responses to a set of questions.
RESULTS AND CONCLUSIONS: Through Interpretative Phenomenological Analysis, three 
themes emerged:adaptation, control, and a sense of community. We use them to 
discuss three central questions within well-being theory and research: How far 
does well-being depend on personal traits and how far does it depend on the 
environment? How far do people adapt to changed circumstances, and how far is 
such adaption conducive to maintaining genuine well-being and not just a 
lowering of standards of comparison? How far does subjective well-being depend 
on individual and momentary experiences and how far does it depend on the larger 
temporal and social context of an individual?

DOI: 10.1080/17482631.2022.2110669
PMCID: PMC9756878
PMID: 35938705 [Indexed for MEDLINE]

Conflict of interest statement: No potential conflict of interest was reported 
by the author(s).


1701. J Health Serv Res Policy. 2023 Apr;28(2):119-127. doi: 
10.1177/13558196221116298. Epub 2022 Aug 8.

Impact of COVID-19 in mental health trusts.

Mannion R(1), Konteh FH(2), Jacobs R(3).

Author information:
(1)Professor of Health Systems, Health Services Management Centre, 
1724University of Birmingham, Birmingham, UK.
(2)Research Fellow, Health Services Management Centre, 1724University of 
Birmingham, Birmingham, UK.
(3)Professor of Health Economics, Centre for Health Economics, 8748University of 
York, Birmingham, UK.

OBJECTIVE: To explore how mental health trusts in England adapted and responded 
to the challenges posed by the COVID-19 pandemic, with the aim of identifying 
lessons that can be learned during and beyond the pandemic.
METHODS: Following a scoping study, we undertook 52 semi-structured interviews 
with senior managers, clinicians, patient representatives and commissioning 
staff across four case study sites. These sites varied in size, location and 
grading awarded by a national regulatory body. We explored how services have 
been repurposed and reorganized in response to the pandemic and the 
participants' perceptions of the impact of these changes on quality of care and 
the wellbeing of staff.
RESULTS: Mental health trusts have shown great flexibility and resilience in 
rapidly implementing new models of care and developing creative digital 
solutions at speed. New collaborative arrangements have been stimulated by a 
shared sense of urgency and enabled by additional funding and a more permissive 
policy environment. But there has also been a significant negative impact on the 
wellbeing of staff, particularly those staff from a minority ethnic background. 
Also, there were concerns that digital technology could effectively 
disenfranchise some vulnerable groups and exacerbate existing health 
inequalities.
CONCLUSIONS: Many of the service changes and digital innovations undertaken 
during the pandemic appear promising. Nevertheless, those changes need to be 
urgently and rigorously appraised to assure their effectiveness and to assess 
their impact on social exclusion and health inequalities.

DOI: 10.1177/13558196221116298
PMCID: PMC9361030
PMID: 35938487 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1702. Ir J Psychol Med. 2023 Sep;40(3):508-512. doi: 10.1017/ipm.2022.35. Epub 2022 
Aug 8.

Psychological distress among healthcare workers post COVID-19 pandemic: from the 
resilience of individuals to healthcare systems.

O'Donnell S(1)(2), Quigley E(3), Hayden J(4), Adamis D(5), Gavin B(6), 
McNicholas F(6)(7)(8).

Author information:
(1)School of Medicine and Medical Science (SMMS), University College Dublin, 
Belfield, Dublin 4, Ireland.
(2)School of Sociology, University College Dublin, Dublin 4, Ireland.
(3)National University of Ireland, Maynooth University, Department of Law, 
Maynooth, Ireland.
(4)RCSI School of Pharmacy and Biomolecular Sciences (PBS), Dublin, Ireland.
(5)HSE Sligo Mental Health Services, Sligo, Ireland.
(6)Department of Child & Adolescent Psychiatry, School of Medicine and Medical 
Science (SMMS), University College Dublin, Dublin, Ireland.
(7)Children Health Ireland, Crumlin, Dublin 12, Ireland.
(8)Lucena Clinic Rathgar, Dublin 6, Ireland.

Since the emergence of the COVID-19 pandemic, there has been increased interest 
in identifying ways of protecting the mental well-being of healthcare workers 
(HCWs). Much of this has been directed towards promoting and enhancing the 
resilience of those deemed as frontline workers. Based on a review of the extant 
literature, this paper seeks to problematise aspects of how 'frontline work' and 
'resilience' are currently conceptualised. Firstly, frontline work is 
arbitrarily defined and often narrowly focused on acute, hospital-based 
settings, leading to the needs of HCWs in other sectors of the healthcare system 
being overlooked. Secondly, dominant narratives are often underpinned by a 
reductionist understanding of the concept of resilience, whereby solutions are 
built around addressing the perceived deficiencies of (frontline) HCWs rather 
than the structural antecedents of distress. The paper concludes by considering 
what interventions are appropriate to minimise the risk of burnout across all 
sectors of the healthcare system in a post-pandemic environment.

DOI: 10.1017/ipm.2022.35
PMID: 35938227 [Indexed for MEDLINE]


1703. Eur J Psychotraumatol. 2022 Aug 2;13(2):2101346. doi: 
10.1080/20008198.2022.2101346. eCollection 2022.

Psychopathological states among Congolese health workers during the first wave 
of COVID-19 pandemic: links with emotion regulation and social support.

Bapolisi A(1)(2), Maurage P(3), Rubambura RB(1), Tumaini HM(1), Baguma M(1)(4), 
Cikomola C(1), Maheshe G(1), Bisimwa G(1)(5), Petit G(2), de Timary P(2).

Author information:
(1)Hôpital Provincial Général de Référence de Bukavu, Université Catholique de 
Bukavu, Bukavu, Democratic Republic of the Congo.
(2)Adult Psychiatry, Department and Institute of Neuroscience, Cliniques 
Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
(3)Louvain Experimental Psychopathology research group (LEP), Psychological 
Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium.
(4)Center for Tropical Diseases and Global Health (CTDGH), Université Catholique 
de Bukavu, Bukavu, Democratic Republic of the Congo.
(5)Ecole régionale de santé publique, Bukavu, Democratic Republic of Congo.

Background: The COVID-19 pandemic is an unprecedented stressor for frontline 
healthcare workers, notably increasing acute stress disorder and depression 
rates. Emotion regulation and social support could be major protective factors 
against such psychopathological states, but their role has not been explored 
outside Western contexts. Objective: To assess the association between emotion 
regulation, social support, acute stress disorder, and depression among 
healthcare workers directly confronted with the first wave of COVID-19 pandemic 
in the eastern Democratic Republic of the Congo. Method: A cross-sectional study 
assessed acute stress disorder, depression, adaptive (i.e. acceptance, positive 
refocusing, …) and maladaptive (i.e. self-blame, rumination, catastrophizing, …) 
emotion regulation strategies, social support (instrumental, emotional, and 
informational levels), as well as self-reported situations and feelings related 
to COVID-19, in a population of 252 frontline healthcare workers (121 women; 131 
men; mean age: 39 ± 11 years old) at the Referral General Hospital of Bukavu. We 
also explored the relations between these variables through bivariate and 
multivariate logistic regression. Results: Forty percent of participants 
presented symptoms of depression, and 16% presented acute stress disorder. In 
bivariate logistic regression, these psychiatric outcomes were associated with 
the availability of a COVID-19 protection kit [OR = 0.24 (0.12-0.98)], hostility 
toward health workers [OR = 3.21 (1.23-4.21)], putting into perspective 
[OR = 0.91 (0.43-0.98)], self-blame [OR = 1.44 (1.11-2.39)], catastrophizing 
[OR = 1.85 (1.01-4.28)], blaming others [OR = 1.77 (1.04-3.32)], emotional 
support [OR = 0.83 (0.49-0.98)], instrumental support [OR = 0.74 (0.28-0.94)], 
and informational support [OR = 0.73 (0.43-0.98)]. In multivariate logistic 
regression, hostility [OR = 2.21 (1.54-3.78)], self-blame [OR = 1.57 
(1.02-2.11)], rumination [OR = 1.49 (1.11-3.13)] and emotional support 
[OR = 0.94 (0.65-0.98)] remained significantly associated with psychiatric 
outcomes. Conclusion: Depression and acute stress disorder were highly prevalent 
among Congolese healthcare workers during the first wave of the COVID-19 health 
pandemic. Hostility, self-blame, rumination, and social support were associated 
with depression and/or acute stress disorder and should be targeted by 
interventions aiming to support health workers' wellbeing.
HIGHLIGHTS: Frontline health workers presented high prevalence of acute stress 
disorder (16%) and depression (40%) during the first wave of COVID-19 pandemic 
in the Eastern Democratic Republic of the Congo, as they were working in hostile 
environment without enough protection kits.Acute stress disorder and depression 
were negatively associated with adaptive emotion regulation and social support; 
and positively with maladaptive emotion regulation.Intervention aiming to 
support health workers in pandemics should target emotion regulation and social 
support.

Publisher: Antecedentes: La pandemia de COVID-19 es un factor estresante sin 
precedentes para los trabajadores de atención médica de primera línea, que 
aumenta notablemente las tasas de trastorno por estrés agudo y depresión. La 
regulación de las emociones y el apoyo social podrían ser factores protectores 
importantes contra tales estados psicopatológicos, pero su papel no ha sido 
explorado fuera de los contextos occidentales.Objetivo: Evaluar la asociación 
entre la regulación de las emociones, el apoyo social, el trastorno de estrés 
agudo y la depresión entre los trabajadores de la salud que confrontaron 
directamente la primera ola de la pandemia de COVID-19 en el este de la 
República Democrática del Congo.Método: Un estudio transversal evaluó el 
trastorno de estrés agudo, la depresión, estrategias de regulación emocional 
adaptativas (es decir, aceptación, refocalización positiva, …) y desadaptativas 
(es decir, autoculpabilización, rumiación, catastrofización, …), apoyo social 
(niveles instrumental, emocional, e informacional), así como situaciones y 
sentimientos autoinformados relacionados con el COVID-19, en una población de 
252 trabajadores de salud de primera línea (121 mujeres; 131 hombres; edad 
media: 39 ± 11 años) en el Hospital General de Referencia de Bukavu. También 
exploramos las relaciones entre estas variables mediante regresión logística 
bivariada y multivariada.Resultados: Cuarenta por ciento de los participantes 
presentó síntomas de depresión y el dieciséis por ciento presentó trastorno de 
estrés agudo. En regresión logística bivariada, estos resultados psiquiátricos 
se asociaron con la disponibilidad de un kit de protección COVID-19 [OR = 0.24 
(0.12–0.98)], hostilidad hacia los trabajadores de la salud [OR = 3.21 
(1.23–4.21)], postura en perspectiva [ OR = 0.91 (0.43–0.98)], 
autoculpabilización [OR = 1.44 (1.11–2.39)], catastrofización [OR = 1.85 
(1.01–4.28)], heteroculpabilización [OR = 1.77 (1.04–3.32)], apoyo emocional 
[OR = 0.83 (0.49–0.98)], apoyo instrumental [OR = 0.74 (0.28–0.94)] y apoyo 
informativo [OR = 0.73 (0.43–0.98)]. En la regresión logística multivariada, 
hostilidad [OR = 2.21 (1.54–3.78)], autoculpabilización [OR = 1.57 (1.02–2.11)], 
rumiación [OR = 1.49 (1.11–3.13)] y apoyo emocional [OR = 0.94 (0.65–0.98)] 
permanecieron significativamente asociados con los resultados 
psiquiátricos.Conclusión: La depresión y el trastorno de estrés agudo fueron muy 
frecuentes entre los trabajadores de la salud congoleños durante la primera ola 
de la pandemia sanitaria de COVID-19. La hostilidad, la autoculpabilización, la 
rumiación y el apoyo social se asociaron con depresión y/o trastorno de estrés 
agudo y deberían ser el objetivo de las intervenciones destinadas a apoyar el 
bienestar de los trabajadores de la salud.

Publisher: 背景：COVID-19 
疫情对一线医护人员是前所未有的应激源，显著提高了急性应激障碍和抑郁障碍的发病率。情绪调节和社会支持可能是对抗这种精神病状态的主要保护因素，但它们的作用尚未在西方背景之外进行探索。目的：评估了在刚果民主共和国东部直接面对第一波 
COVID-19 疫情医护人员中情绪调节、社会支持、急性应激障碍和抑郁之间的关系。方法：在转诊布卡武综合医院的 252 名一线医护人员（121 名女性；131 
名男性；平均年龄：39 ± 11 
岁）人群中，由一项横断面研究评估了急性应激障碍、抑郁、适应性（即接受、积极重新聚焦 …  … ）和适应不良（即自责、反刍、灾难化 …  … ）情绪调节策略、社会支持（工具、情感和信息水平），以及自我报告的 
COVID-19 相关情况和感受。我们还通过双变量和多变量逻辑回归探讨了这些变量之间的关系。结果：40% 的参与者出现抑郁症状，16% 
出现急性应激障碍。在双变量逻辑回归中，这些精神病学结果与 COVID-19 保护装备的可用性 [OR = 0.24 (0.12–0.98)]、对健康工作者的敌意 
[OR = 3.21 (1.23–4.21)]，正确看待 [ OR = 0.91 (0.43–0.98)]、自责 [OR = 1.44 
(1.11–2.39)]、灾难化 [OR = 1.85 (1.01–4.28)]、责备他人 [OR = 1.77 (1.04–3.32)]、情感支持 
[OR = 0.83 (0.49–0.98)]、工具支持 [OR = 0.74 (0.28–0.94)] 和信息支持 [OR = 0.73 
(0.43–0.98)] 相关。在多元逻辑回归中，敌意 [OR = 2.21 (1.54–3.78)]、自责 [OR = 1.57 
(1.02–2.11)]、反刍 [OR = 1.49 (1.11–3.13)] 和情感支持 [OR = 0.94 (0.65–0.98)] 
仍然与精神病学结果显著相关。结论：在第一波 COVID-19 
健康疫情期间的刚果医护人员中，抑郁障碍和急性应激障碍非常普遍。敌意、自责、反刍和社会支持与抑郁障碍和/或急性应激障碍相关，应作为旨在支持健康工作者福祉的干预措施靶点。.

© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor &amp; 
Francis Group.

DOI: 10.1080/20008198.2022.2101346
PMCID: PMC9351560
PMID: 35936869 [Indexed for MEDLINE]

Conflict of interest statement: No potential conflict of interest was reported 
by the author(s).


1704. Worldviews Evid Based Nurs. 2022 Oct;19(5):352-358. doi: 10.1111/wvn.12601. Epub 
2022 Aug 7.

Trends in mental health indicators among nurses participating in healthy nurse, 
healthy nation from 2017 to 2021.

Cuccia AF(1)(2), Peterson C(1), Melnyk BM(3), Boston-Leary K(1).

Author information:
(1)Nursing Programs Department, American Nurses Association, Silver Spring, 
Maryland, USA.
(2)Department of Prevention and Community Health, The George Washington 
University Milken Institute of Public Health, Washington, District of Columbia, 
USA.
(3)The Ohio State University, Columbus, Ohio, USA.

BACKGROUND: American healthcare workers face unprecedented stress and trauma in 
the workplace during COVID-19, putting nurses at increased risk for poor mental 
health. Examining trends of mental health from before and during COVID-19 can 
illuminate the toll of the pandemic on nurses well-being.
METHODS: Nurses enrolled in Healthy Nurse, Healthy Nation receive a prompt to 
take an annual survey (n = 24,289). Mental health was assessed by active 
diagnoses of anxiety and depressive disorder, and feeling sad, down or depressed 
for two or more weeks in the past year. Logistic regression models were used to 
calculate predictive probabilities of health outcomes in year 4 (May 1, 2020 - 
April 30, 2021) compared to years 1-3 (each from May 1 to April 30), controlling 
for age, sex, race/ethnicity, and nurse type. Models were also stratified by 
work setting and nurse type.
RESULTS: In year 4, nurses had a 19.8% probability of anxiety disorder, 
significantly higher than year 3 (16.3%, p < .001), year 2 (13.7%, p < .001), 
and year 1 (14.0%, p < .001). Similarly, nurses had a 16.7% probability of 
depression disorder in year 4, significantly higher than year 2 (12.9%, 
p < .001) and year 1 (13.9%, p < .01). Year 4 nurses had a 34.4% probability of 
feeling sad, down or depressed for two weeks, significantly higher than previous 
years (year 1 = 26.8%, year 2 = 25.9%, year 3 = 29.7%, p < .001). Trends in 
probabilities of mental health indicators were similar among each nurse type and 
work setting. Nurses in medical/surgical work settings and those with licensed 
practical nurse and licensed vocational nurse titles consistently had the 
highest probability of poor mental health.
LINKING ACTION TO EVIDENCE: In 2020-2021, nurses faced challenges unlike any 
experienced in previous years. Unsurprisingly, nurses reported increased 
instances of poor mental health indicators. Positive disruptive strategies are 
needed to systemically change organizational culture and policy to prioritize 
and support nurses' well-being.

© 2022 Sigma Theta Tau International.

DOI: 10.1111/wvn.12601
PMID: 35934812 [Indexed for MEDLINE]


1705. Soc Sci Med. 2022 Sep;308:115226. doi: 10.1016/j.socscimed.2022.115226. Epub 
2022 Jul 20.

Mental and social wellbeing and the UK coronavirus job retention scheme: 
Evidence from nine longitudinal studies.

Jacques Wels(1), Booth C(2), Wielgoszewska B(2), Green MJ(3), Di Gessa G(4), 
Huggins CF(5), Griffith GJ(6), Kwong ASF(6), Bowyer RCE(7), Maddock J(8), 
Patalay P(9), Silverwood RJ(2), Fitzsimons E(2), Shaw R(3), Thompson EJ(7), 
Steptoe A(4), Hughes A(8), Chaturvedi N(8), Steves CJ(7), Katikireddi SV(3), 
Ploubidis GB(2).

Author information:
(1)MRC Unit for Lifelong Health and Ageing, University College London, UK. 
Electronic address: w.jacques@ucl.ac.uk.
(2)Centre for Longitudinal Studies, Social Research Institute, University 
College London, UK.
(3)MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, UK.
(4)Institute of Epidemiology and Health Care, University College London, UK.
(5)Centre for Genomic and Experimental Medicine, University of Edinburgh, UK.
(6)MRC Integrative Epidemiology Unit, University of Bristol, UK.
(7)Department of Twin Research & Genetic Epidemiology, King's College London, 
UK.
(8)MRC Unit for Lifelong Health and Ageing, University College London, UK.
(9)MRC Unit for Lifelong Health and Ageing, University College London, UK; 
Centre for Longitudinal Studies, Social Research Institute, University College 
London, UK.

BACKGROUND: The COVID-19 pandemic has led to major economic disruptions. In 
March 2020, the UK implemented the Coronavirus Job Retention Scheme - known as 
furlough - to minimize the impact of job losses. We investigate associations 
between change in employment status and mental and social wellbeing during the 
early stages of the pandemic.
METHODS: Data were from 25,670 respondents, aged 17-66, across nine UK 
longitudinal studies. Furlough and other employment changes were defined using 
employment status pre-pandemic and during the first lockdown (April-June 2020). 
Mental and social wellbeing outcomes included psychological distress, life 
satisfaction, self-rated health, social contact, and loneliness. Study-specific 
modified Poisson regression estimates, adjusting for socio-demographic 
characteristics and pre-pandemic mental and social wellbeing, were pooled using 
meta-analysis. Associations were also stratified by sex, age, education, and 
household composition.
RESULTS: Compared to those who remained working, furloughed workers were at 
greater risk of psychological distress (adjusted risk ratio, ARR = 1.12; 95%CI: 
0.97, 1.29), low life satisfaction (ARR = 1.14; 95%CI: 1.07, 1.22), loneliness 
(ARR = 1.12; 95%CI: 1.01, 1.23), and poor self-rated health (ARR = 1.26; 95%CI: 
1.05, 1.50). Nevertheless, compared to furloughed workers, those who became 
unemployed had greater risk of psychological distress (ARR = 1.30; 95%CI: 1.12, 
1.52), low life satisfaction (ARR = 1.16; 95%CI: 0.98, 1.38), and loneliness 
(ARR = 1.67; 95%CI: 1.08, 2.59). Effects were not uniform across all sub-groups.
CONCLUSIONS: During the early stages of the pandemic, those furloughed had 
increased risk of poor mental and social wellbeing, but furloughed workers fared 
better than those who became unemployed, suggesting that furlough may have 
partly mitigated poorer outcomes.

Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.socscimed.2022.115226
PMCID: PMC9296227
PMID: 35932537 [Indexed for MEDLINE]

Conflict of interest statement: No conflicts of interest were declared by the 
authors, except SVK who is a member of the Scientific Advisory Group on 
Emergencies.


1706. BMC Public Health. 2022 Aug 5;22(1):1495. doi: 10.1186/s12889-022-13888-1.

Life in lockdown: a longitudinal study investigating the impact of the UK 
COVID-19 lockdown measures on lifestyle behaviours and mental health.

Solomon-Moore E(1), Lambert J(2), Grey E(1)(3), Gillison F(1), Townsend N(1), 
Busam B(4)(5), Velemis K(4), Millen C(1), Baber F(4), Griffin T(1).

Author information:
(1)Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK.
(2)Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK. 
jl2426@bath.ac.uk.
(3)Bristol Medical School (Population Health Sciences), University of Bristol, 
Bristol, UK.
(4)Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, 
UK.
(5)Department of Psychology, University of Heidelberg, Grabengasse 1, 69117, 
Heidelberg, Germany.

BACKGROUND: The COVID-19 pandemic led to the UK government enforcing lockdown 
restrictions to control virus transmission. Such restrictions present 
opportunities and barriers for physical activity and healthy eating. Emerging 
research suggests that in the early stages of the pandemic, physical activity 
levels decreased, consumption of unhealthy foods increased, while levels of 
mental distress increased. Our aims were to understand patterns of diet, 
physical activity, and mental health during the first lockdown, how these had 
changed twelve-months later, and the factors associated with change.
METHODS: An online survey was conducted with UK adults (N = 636; 78% female) 
during the first national lockdown (May-June 2020). The survey collected 
information on demographics, physical activity, diet, mental health, and how 
participants perceived lifestyle behaviours had changed from before the 
pandemic. Participants who provided contact details were invited to complete a 
twelve-month follow-up survey (May-June 2021), 160 adults completed the survey 
at both time-points. Descriptive statistics, T-tests and McNemar Chi Square 
statistics were used to assess patterns of diet, physical activity, and mental 
health at baseline and change in behaviours between baseline and follow-up. 
Linear regression models were conducted to explore prospective associations 
between demographic and psycho-social variables at baseline with change in 
healthy eating habit, anxiety, and wellbeing respectively.
RESULTS: Between baseline and follow-up, healthy eating habit strength, and the 
importance of and confidence in eating healthily reduced. Self-rated health 
(positively) and confidence in eating healthily (negatively) were associated 
with change in healthy eating habit. There were no differences between baseline 
and follow-up for depression or physical activity. Mean anxiety score reduced, 
and wellbeing increased, from baseline to follow-up. Living with children aged 
12-17 (compared to living alone) was associated with an increase in anxiety, 
while perceiving mental health to have worsened during the first lockdown 
(compared to staying the same) was associated with reduced anxiety and an 
increase in mental wellbeing.
CONCLUSIONS: While healthy eating habits worsened in the 12 months since the 
onset of the pandemic, anxiety and mental wellbeing improved. However, anxiety 
may have increased for parents of secondary school aged children.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-13888-1
PMCID: PMC9354438
PMID: 35932040 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1707. BMC Psychiatry. 2022 Aug 5;22(1):532. doi: 10.1186/s12888-022-04180-y.

Rate and correlates of post-traumatic stress disorder (PTSD) following the 
Beirut blast and the economic crisis among Lebanese University students: a 
cross-sectional study.

El Zouki CJ(#)(1), Chahine A(#)(1), Mhanna M(#)(1), Obeid S(#)(2), Hallit 
S(#)(3)(4)(5).

Author information:
(1)School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, 
P.O. Box 446, Jounieh, Lebanon.
(2)School of Arts and Sciences, Social and Education Sciences Department, 
Lebanese American University, Jbeil, Lebanon. saharobeid23@hotmail.com.
(3)School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, 
P.O. Box 446, Jounieh, Lebanon. souheilhallit@hotmail.com.
(4)Psychology Department, College of Humanities, Effat University, Jeddah, 
21478, Saudi Arabia. souheilhallit@hotmail.com.
(5)Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon. 
souheilhallit@hotmail.com.
(#)Contributed equally

BACKGROUND: Post-traumatic stress disorder (PTSD) is a mental illness that 
develops in some people after they have experienced a stunning, scary, or 
dangerous incident. Due to major disasters like as the Economic Crisis and the 
Beirut Blast, Lebanese people are struggling with a variety of mental health 
issues. The study objectives were to find the rate of PTSD and its association 
with stress, anxiety, depression, financial well-being and coping strategies 
among university students in Lebanon.
METHODS: This is a cross-sectional study, conducted between May and August 2021, 
which enrolled 419 university students from all districts of Lebanon. The PTSD 
Checklist-Specific Version (PCL-S) was used to evaluate manifestation of PSTD.
RESULTS: The results showed that 132 (31.5%), 109 (26.0%) and 169 (40.3%) had 
PTSD from COVID, Beirut blast and economic crisis respectively. More avoidant 
coping (Beta = 0.52) and more anxiety (Beta = 0.62) were significantly 
associated with more PTSD from the Beirut Blast. More avoidant coping 
(Beta = 0.56), depression (Beta = 0.40) and anxiety (Beta = 0.49) were 
significantly associated with more PTSD from the economic crisis, whereas more 
financial wellbeing (Beta = - 0.31) was significantly associated with less PTSD 
from the economic crisis.
CONCLUSION: Significant rates of PTSD were found in our sample of Lebanese 
university students, whether from the Beirut blast, or from the current economic 
crisis. Significant correlations of these PTSD rates were found with factors 
such as avoidant coping, depression, anxiety and financial wellbeing. Such 
findings must raise the attention to serious mental and psychosocial alteration 
endured by Lebanese youth that are still under fatal cumulative traumatic 
events, that were and even may be, intergenerationally and unintentionally 
transmissible, therefore, affecting not only the present, but also the future of 
a whole nation.

© 2022. The Author(s).

DOI: 10.1186/s12888-022-04180-y
PMCID: PMC9356397
PMID: 35931970 [Indexed for MEDLINE]

Conflict of interest statement: The authors have nothing to disclose.


1708. Autism Res. 2022 Sep;15(9):1621-1635. doi: 10.1002/aur.2787. Epub 2022 Aug 5.

Continuity and change in loneliness and stress during the COVID-19 pandemic: A 
longitudinal study of autistic and non-autistic adults.

Scheeren AM(1), Howlin P(2), Pellicano L(3), Magiati I(4), Begeer S(1).

Author information:
(1)Faculty of Behavioural and Movement Sciences, VU University Amsterdam, 
Amsterdam, The Netherlands.
(2)Institute of Psychiatry, Psychology and Neuroscience, King's College, London, 
UK.
(3)Macquarie School of Education, Macquarie University, Sydney, New South Wales, 
Australia.
(4)School of Psychological Science, The University of Western Australia, Perth, 
Western Australia, Australia.

Previous studies have suggested that autistic adults may be negatively affected 
by the COVID-19 pandemic and its associated restrictions. In this study, we 
examined continuity and change in loneliness and stress, and their predictors, 
in 448 autistic and 70 non-autistic adults living in the Netherlands. Autistic 
participants were assessed on three occasions using the de Jong Gierveld 
Loneliness Scale and Perceived Stress Scale (pre-lockdown (T0), first lockdown 
(T1), and second lockdown (T2)); non-autistic participants were assessed twice 
(T1 and T2). Autistic adults' loneliness and stress levels remained stable 
across all three time points over 8 months, but were consistently higher than 
those of non-autistic adults. Other predictors of higher loneliness and stress 
levels at the first lockdown (T1) included low perceived social support and high 
levels of COVID-19 related worries. Although loneliness and stress were stable 
at the group level, the wellbeing of some autistic adults worsened over the 
course of the pandemic, while others improved. For instance, adults with a 
mental health diagnosis (other than autism) prior to the pandemic were more 
likely to increase in stress over time, whereas adults with higher perceived 
social support were more likely to decrease in stress over time (from T1 to T2). 
Factors contributing to variability in outcome require further examination. 
Moreover, the relatively high loneliness and stress levels in autistic adults 
call for attention from clinicians and service providers. LAY SUMMARY: In our 
study, autistic adults reported feeling more lonely and stressed than 
non-autistic adults during the COVID-19 pandemic. People who missed support from 
their social network also felt more lonely and stressed. On average, people did 
not change substantially in their degree of loneliness or stress over time. Yet, 
we noted large person-to-person differences in the wellbeing of autistic adults 
during the pandemic.

© 2022 The Authors. Autism Research published by International Society for 
Autism Research and Wiley Periodicals LLC.

DOI: 10.1002/aur.2787
PMCID: PMC9538450
PMID: 35930166 [Indexed for MEDLINE]


1709. Geriatr Psychol Neuropsychiatr Vieil. 2022 Jun 1;20(2):219-233. doi: 
10.1684/pnv.2022.1038.

[The relationship to the face: from the normal subject to the Alzheimer patient, 
from the naked face to the masked face, from a humanistic neuropsychology to an 
embodied ethics].

[Article in French; Abstract available in French from the publisher]

Gil R(1), Arroyo-Anllo EM(2).

Author information:
(1)Université de Poitiers, Espace régional de réflexion éthique de 
Nouvelle-Aquitaine-site de Poitiers, CHU, Poitiers, France
(2)Département de psychobiologie, Institut de neurosciences de Castille-Leon, 
Université de Salamanque, Salamanque, Espagne

The relationship to the face weaves close links with identity and otherness. It 
is not just a means of inter-human knowledge; it is also a major means of 
self/other communication underpinned by those mentalization networks that open 
up the attribution of intentions and emotions to others (theory of mind) as well 
as that particular disposition known as empathy, which enables us to put 
ourselves in another person’s shoes by feeling and understanding what they are 
experiencing while remaining ourselves. Neuropsychology attempts to shed light 
on the brain processes that underlie this encounter with the face and that may 
be altered by neurodegenerative diseases, and in particular by Alzheimer’s 
disease. The pandemic period also leads us to examine the clinical consequences 
of wearing a mask both in normal subjects and in subjects suffering from 
diseases that affect the relationship with the face of others. A humanistic 
neuropsychology must integrate an embodied ethics that attempts to discern what, 
in the perception of the Other, contributes to hindering the expression of 
otherness, which is inseparable from the human condition. In the pandemic 
context linked to Covid-19, neuropsychology with its clinical requirements and 
ethics with its performative aim on care practices, can thus cross-fertilize 
each other to propose compromises that are certainly attentive to public health 
but also to the well-being of each human being, especially the most vulnerable.

Publisher: La relation au visage tisse des liens étroits avec l'identité et avec 
l'altérité. Elle n'est pas qu'un dispositif de connaissance interhumaine ; elle 
est aussi un dispositif majeur de la communication soi-autrui sous-tendue par 
ces réseaux de mentalisation qui ouvrent à l'attribution à autrui d'intentions 
et d'émotions (théorie de l'esprit) comme à cette disposition particulière 
qu'est l'empathie, qui permet de se mettre à la place d'autrui en ressentant et 
en comprenant ce qu'il éprouve tout en restant soi. La neuropsychologie tente 
d'éclairer les processus cérébraux qui sous-tendent cette rencontre du visage et 
qui peuvent être altérés par les maladies neurodégénératives, et en particulier 
par la maladie d'Alzheimer. La période pandémique conduit aussi à s'interroger 
sur les conséquences cliniques du port du masque tant chez les sujets normaux 
que chez les sujets atteints de maladies qui affecte la relation au visage 
d'autrui. Une neuropsychologie humaniste doit intégrer une éthique incarnée qui 
tente de discerner ce qui, dans la perception d'autrui, contribue à entraver 
l'expression de l'altérité, indissociable de la condition humaine. Dans le 
contexte pandémique lié à la Covid-19, la neuropsychologie, avec ses exigences 
cliniques, et l'éthique, avec sa visée performative sur les pratiques de soins, 
peuvent ainsi se féconder mutuellement pour proposer des compromis attentifs 
certes à la santé publique mais aussi au bien-être de chaque être humain et 
notamment des plus vulnérables.

DOI: 10.1684/pnv.2022.1038
PMID: 35929388 [Indexed for MEDLINE]


1710. J Pers. 2023 Jun;91(3):638-652. doi: 10.1111/jopy.12764. Epub 2022 Aug 21.

Boredom belief moderates the mental health impact of boredom among young people: 
Correlational and multi-wave longitudinal evidence gathered during the COVID-19 
pandemic.

Tam KYY(1)(2), Chan CS(1), van Tilburg WAP(3), Lavi I(4)(5), Lau JYF(2)(6).

Author information:
(1)Department of Psychology, The University of Hong Kong, Hong Kong, China.
(2)Department of Psychology, King's College London, London, UK.
(3)Department of Psychology, University of Essex, Colchester, UK.
(4)Department of Psychology, University of Bath, Bath, UK.
(5)School of Social Work, University of Haifa, Haifa, Israel.
(6)Youth Resilience Unit, Wolfson Institute of Population Health, Queen Mary 
University of London, London, UK.

OBJECTIVES: Young people's experience of boredom and its psychological health 
sequelae have been exacerbated by the COVID-19 pandemic. The present study 
examined the moderating role of boredom beliefs-the extent to which one 
affectively dislikes boredom (boredom dislike) and cognitively accepts it 
(boredom normalcy)-on the association between boredom experience and mental 
well-being. We also validated a new measure of boredom beliefs in two different 
samples of young people.
METHOD: We report data from a correlational study with British young people aged 
12-25 (Study 1; N = 2495) and a 16-week eight-wave within-subject study with 
Israeli adolescents aged 12-18 (Study 2; N = 314).
RESULTS: Across both studies, disliking boredom was associated with higher 
frequency and intensity of boredom. Boredom dislike moderated the negative 
association between boredom and mental well-being, such that the association was 
more salient among those who strongly disliked boredom. Normalizing boredom was 
positively associated with mental well-being. The measure of boredom beliefs 
demonstrated fair validity and reliability.
CONCLUSION: Results provide novel insights into the potential buffering effect 
of boredom beliefs against the mental health impact of boredom, particularly at 
a time of reduced activity. These findings generalize across two different 
countries.

© 2022 The Authors. Journal of Personality published by Wiley Periodicals LLC.

DOI: 10.1111/jopy.12764
PMCID: PMC9537911
PMID: 35927788 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflict of interest to 
declare.


1711. BMC Public Health. 2022 Aug 4;22(1):1481. doi: 10.1186/s12889-022-13208-7.

Measuring the effects of the COVID-19 pandemic on Diné and White Mountain Apache 
school personnel, families, and students: protocol for a prospective 
longitudinal cohort study.

Allison-Burbank JD(1), Ingalls A(2), Rebman P(2), Chambers R(2), Begay R(2), 
Grass R(2), Tsosie A(2), Archuleta S(2), Barlow A(#)(2), Larzelere F(2), Hammitt 
L(#)(2), Tingey L(2), Haroz E(#)(2).

Author information:
(1)Center for American Indian Health, Department of International Health, Johns 
Hopkins Bloomberg School of Public Health, 415 N. Washington St., 4th Floor, 
Baltimore, MD, 21231, USA. jalliso8@jhu.edu.
(2)Center for American Indian Health, Department of International Health, Johns 
Hopkins Bloomberg School of Public Health, 415 N. Washington St., 4th Floor, 
Baltimore, MD, 21231, USA.
(#)Contributed equally

BACKGROUND: This paper describes the protocol for a longitudinal cohort study, 
"Project SafeSchools" (PSS), which focuses on measuring the effects of COVID-19 
and the return to in-person learning on Diné (Navajo) and White Mountain Apache 
(Apache) youth, parents, and educators. The early surges of the COVID-19 
pandemic led to the closure of most reservation and border town schools serving 
Diné and Apache communities. This study aims to: (1) understand the barriers and 
facilitators to school re-opening and in-person school attendance from the 
perspective of multiple stakeholders in Diné and Apache communities; and (2) 
evaluate the educational, social, emotional, physical, and mental health impacts 
of returning to in-person learning for caregivers and youth ages 4-16 who reside 
or work on the Diné Nation and the White Mountain Apache Tribal lands.
METHODS: We aim to recruit up to N = 200 primary caregivers of Diné and Apache 
youth ages 4-16 and up to N = 120 school personnel. In addition, up to n = 120 
of these primary caregivers and their children, ages 11-16, will be selected to 
participate in qualitative interviews to learn more about the effects of the 
pandemic on their health and wellbeing. Data from caregiver and school personnel 
participants will be collected in three waves via self-report surveys that 
measure COVID-19 related behaviors and attitudes, mental health, educational 
attitudes, and cultural practices and beliefs for both themselves and their 
child (caregiver participants only). We hypothesize that an individual's 
engagement with a variety of cultural activities during school closures and as 
school re-opened will have a protective effect on adult and youth mental health 
as they return to in-person learning.
DISCUSSION: The results of this study will inform the development or 
implementation of preventative interventions that may help Diné and Apache youth 
and their families recover from the negative impact of the COVID-19 pandemic, 
and positively impact their health and wellness.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-13208-7
PMCID: PMC9351121
PMID: 35927650 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1712. Psychol Trauma. 2023 Mar;15(3):422-430. doi: 10.1037/tra0001336. Epub 2022 Aug 
4.

Adding fuel to the fire? Examining exposure to potentially stressful or 
traumatic events before and during the COVID-19 pandemic in low-income, Black 
families.

McGuire AB(1), Jackson Y(2), McDonald J(3).

Author information:
(1)Clinical Child Psychology Program.
(2)Department of Psychology.
(3)Bureau of Child Research.

OBJECTIVE: The COVID-19 pandemic has upended the lives of many individuals. 
While emerging evidence has begun to document health (e.g., infection) and 
financial (e.g., job loss) consequences, less is known about the day-to-day 
experiences of some of the country's most vulnerable populations. The current 
study sought to address this gap in understanding by examining exposure to 
potentially stressful or traumatic experiences (PSTEs) and their relation to 
mental health among predominately low-income, African American/Black 
individuals.
METHOD: Adult caregivers (N = 110) from an ongoing longitudinal research project 
occurring prior the pandemic completed surveys about their exposure to 
COVID-19-specific PSTEs during the initial months of the pandemic. Information 
on participants was combined with pre-COVID-19 PSTE exposure and examined in 
relation to current mental health functioning (e.g., depression).
RESULTS: Findings indicated that participants experienced several different 
types of COVID-19-specific PSTEs across multiple domains, including home, work, 
social life, and health and well-being. Results from model testing indicated 
that COVID-19-specific PSTEs were only associated with worry about 
COVID-19-specifically. Adulthood PSTEs prior to COVID-19 were also associated 
with current anxiety symptoms.
CONCLUSIONS: Among low-income, African American/Black individuals with a history 
of exposure to PSTEs, additional PSTEs experienced during the COVID-19 pandemic 
may not contribute significantly to general mental health functioning above and 
beyond pre-COVID-19 PSTE exposures. Taken together, research on PSTE exposure 
from the pandemic should make attempts to account for lifetime PSTE exposure to 
most accurately evaluate current mental health concerns, especially among 
marginalized populations. (PsycInfo Database Record (c) 2023 APA, all rights 
reserved).

DOI: 10.1037/tra0001336
PMCID: PMC10208752
PMID: 35925692 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest: The authors declare that 
they have no conflict of interest.


1713. Respir Care. 2022 Dec;67(12):1588-1596. doi: 10.4187/respcare.10094. Epub 2022 
Aug 3.

Well-Being Among Respiratory Therapists in an Academic Medical Center During the 
COVID-19 Pandemic.

Roberts KJ(1), Silvestri JA(2), Klaiman T(2), Gutsche JT(3), Jablonski J(4), 
Fuchs BD(5), Kerlin MP(6), Mikkelsen ME(7).

Author information:
(1)Department of Respiratory Care, Hospital of the University of Pennsylvania, 
Philadelphia, Pennsylvania. karsten.j.roberts@gmail.com.
(2)Palliative and Advanced Illness Research Center, Philadelphia, Pennsylvania.
(3)Department of Anesthesia, Perelman School of Medicine, University of 
Pennsylvania, Philadelphia, Pennsylvania.
(4)University of Pennsylvania Health System, Philadelphia, Pennsylvania.
(5)Department of Respiratory Care, Hospital of the University of Pennsylvania, 
Philadelphia, Pennsylvania; and Division of Pulmonary and Critical Care 
Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, 
Pennsylvania.
(6)Palliative and Advanced Illness Research Center, Philadelphia, Pennsylvania; 
and Division of Pulmonary and Critical Care Medicine, Perelman School of 
Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
(7)Palliative and Advanced Illness Research Center, Philadelphia, Pennsylvania; 
and Division of Pulmonary Sciences and Critical Care Medicine, Anschutz School 
of Medicine, University of Colorado, Aurora, Colorado.

BACKGROUND: Recent studies have revealed high rates of burnout among respiratory 
therapists (RTs), which has implications for patient care and outcomes as well 
as for the health care workforce. We sought to better understand RT well-being 
during the COVID-19 pandemic. The purpose of this study was to determine rates 
and identify determinants of well-being, including burnout and professional 
fulfillment, among RTs in ICUs.
METHODS: We conducted a mixed-methods study comprised of a survey administered 
quarterly from July 2020-May 2021 to critical-care health care professionals and 
semi-structured interviews from April-May 2021 with 10 ICU RTs within a single 
health center. We performed multivariable analyses to compare RT well-being to 
other professional groups and to evaluate changes in well-being over time. We 
analyzed qualitative interview data using thematic analysis, followed by mapping 
themes to the Maslow needs hierarchy.
RESULTS: One hundred eight RTs responded to at least one quarterly survey. 
Eighty-two (75%) experienced burnout; 39 (36%) experienced professional 
fulfillment, and 62 (58%) reported symptoms of depression. Compared to 
clinicians of other professions in multivariable analyses, RTs were 
significantly more likely to experience burnout (odds ratio 2.32 [95% CI 
1.41-3.81]) and depression (odds ratio 2.73 [95% CI 1.65-4.51]) and less likely 
to experience fulfillment (odds ratio 0.51 [95% CI 0.31-0.85]). We found that 
staffing challenges, safety concerns, workplace conflict, and lack of work-life 
balance led to burnout. Patient care, use of specialized skills, appreciation 
and a sense of community at work, and purpose fostered professional fulfillment. 
Themes identified were mapped to Maslow's hierarchy of needs; met needs led to 
professional fulfillment, and unmet needs led to burnout.
CONCLUSIONS: ICU RTs experienced burnout during the pandemic at rates higher 
than other professions. To address RT needs, institutions should design and 
implement strategies to reduce burnout across all levels.

Copyright © 2022 by Daedalus Enterprises.

DOI: 10.4187/respcare.10094
PMID: 35922070 [Indexed for MEDLINE]

Conflict of interest statement: The authors have disclosed no conflicts of 
interest.


1714. Respir Care. 2022 Dec;67(12):1578-1587. doi: 10.4187/respcare.10144. Epub 2022 
Aug 3.

Burnout Among Respiratory Therapists Amid the COVID-19 Pandemic.

Strickland SL(1), Roberts KJ(2), Smith BJ(3), Hoerr CA(4), Burr KL(5), Hinkson 
CR(6), Rehder KJ(7), Miller AG(7).

Author information:
(1)American Epilepsy Society, Chicago, Illinois; and Rush University, Chicago, 
Illinois. Shawna_L_Strickland@rush.edu.
(2)Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
(3)University of California, Davis, Sacramento, California.
(4)Phelps Health, Rolla, Missouri.
(5)Nemours Children's Health, Wilmington, Delaware.
(6)Providence Regional Medical Center, Everett, Washington.
(7)Duke University Medical Center, Durham, North Carolina.

BACKGROUND: Burnout is a major challenge in health care and is associated with 
poor overall well-being, increased medical errors, worse patient outcomes, and 
low job satisfaction. There is scant literature focused on the respiratory 
therapist's (RT) experience of burnout, and a thorough exploration of RTs' 
perception of factors associated with burnout has not been reported. The aim of 
this qualitative study was to understand the factors associated with burnout as 
experienced by RTs amid the COVID-19 pandemic.
METHODS: We performed a post hoc, qualitative analysis of free-text responses 
from a survey of burnout prevalence in RTs.
RESULTS: There were 1,114 total and 220 free-text responses. Five overarching 
themes emerged from the analysis: staffing, workload, physical/emotional 
consequences, lack of effective leadership, and lack of respect. Respondents 
discussed feelings of anxiety, depression, and compassion fatigue as well as 
concerns that lack of adequate staffing, high workload assignments, and 
inadequate support from leadership contributed to feelings of burnout. Specific 
instances of higher patient acuity, surge in critically ill patients, rapidly 
evolving changes in treatment recommendations, and minimal training and 
preparation for an extended scope of practice were reported as stressors that 
led to burnout. Some respondents stated that they felt a lack of respect for 
both the RT profession and the contribution of RTs to patient care.
CONCLUSIONS: Themes associated with burnout in RTs included staffing, workload, 
physical and emotional exhaustion, lack of effective leadership, and lack of 
respect. These results provide potential targets for interventions to combat 
burnout among RTs.

Copyright © 2022 by Daedalus Enterprises.

DOI: 10.4187/respcare.10144
PMID: 35922068 [Indexed for MEDLINE]

Conflict of interest statement: Mr Miller discloses a relationship with Saxe 
Communications. Mr Miller is a section editor for Respiratory Care. The 
remaining authors have disclosed no conflicts of interest.


1715. J Caring Sci. 2022 Apr 17;11(2):118-125. doi: 10.34172/jcs.2022.14. eCollection 
2022 May.

Psychological Impacts among Health Care Personnel during COVID-19 Pandemic: A 
Systematic Review.

Balai MK(1), Avasthi RD(1), Va R(1), Jonwal A(1).

Author information:
(1)College of Nursing, All India Institute of Medical Sciences, Jodhpur, India.

Introduction: The COVID-19 outbreak is a health emergency, in which health care 
personnel (HCP) face psychological consequences, working as frontline workers. 
Therefore, we conducted this study to find out associated psychological impacts 
among HCP during COVID-19 pandemic. Methods: This systematic review follows the 
Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 
guideline. The reviewed studies were searched from PubMed, MEDLINE, CINAHL and 
Google scholar electronic database using the Medical Subject Heading (MeSH) 
terms. Results: We searched through 2676 articles, 19 of which were finally 
included, most of them were cross-sectional and descriptive studies with 12910 
participants. HCP were found to be exposed to a variety of psychological 
problems; anxiety symptoms were reported in 33% (3081 of 9269), depression 28% 
(2681 of 9487), post-traumatic stress disorder (PTSD) 41% (2933 of 7167), sleep 
problems 26% (903 of 3442), stress 13% (487 of 3496) and fear 67.3% (392 of 
582). The severity of impacts was often mild to moderate. The nurses were twice 
as likely to develop these symptoms. The factors associated with psychological 
impacts were fear of infection to self and family members, lack of resources and 
facilities at workplace, demanding work conditions, working closely with 
COVID-19 clients in intensive care unit and pre-existing medical and 
psychological problems. Conclusion: Psychological impacts was mild to moderate 
among majority of HCP during COVID-19 pandemic. The outcome of this review is to 
provide some utilitarian information for making supportive policies and 
strategies to improve the psychological wellbeing of frontline HCP during this 
pandemic.

© 2022 The Author(s).

DOI: 10.34172/jcs.2022.14
PMCID: PMC9339130
PMID: 35919274

Conflict of interest statement: The authors declare no conflict of interest in 
this study.


1716. J Clin Nurs. 2023 Mar;32(5-6):653-665. doi: 10.1111/jocn.16475. Epub 2022 Aug 2.

Burnout and impostor phenomenon in nursing and newly licensed registered nurses: 
A scoping review.

Edwards-Maddox S(1)(2).

Author information:
(1)College of Nursing, University of Houston, Sugar Land, Texas, USA.
(2)Texas Woman's University, Denton, Texas, USA.

AIMS AND OBJECTIVE: To identify the prevalence and severity of impostor 
phenomenon and burnout in newly licensed registered nurses, map the current 
literature on impostor phenomenon in nursing, and identify related factors 
affecting the new nurse's transition to practice.
BACKGROUND: Impostor phenomenon is an internalised intellectual phoniness 
resulting in persistent self-doubt despite prior success. It can evoke feelings 
of emotional exhaustion associated with burnout, negatively affecting employee 
retention. Due to changes in nursing education resulting from COVID-19, 
self-doubt and uncertainty among new nurses are expected to be heightened, 
leading to burnout which adversely effects nurse well-being, patient care and 
retention.
DESIGN: The scoping review follows the methodological framework developed by 
Arksey and O'Malley (2005) and the Reporting Checklist for Scoping Reviews 
(PRISMA-ScR) guidelines.
METHODS: The literature search was conducted utilising PubMed, CINAHL and 
PsycINFO. Inclusion criteria were studies published between 2011 and 2021, 
written in English, peer-reviewed, and focused on newly licensed registered 
nurses. Eighteen articles were reviewed.
RESULTS: Studies on impostor phenomenon in nursing are limited to nursing 
students and clinical nurse specialists. Prevalence of impostor feelings in 
these populations range from 36% to 75%, and 12.3% to 46% of new nurses report 
burnout. Impostor feelings arise from role ambiguity, lack of self-compassion, 
transitions, and minimal clinical experience. Burnout was associated with 
stress, feeling unprepared, inadequate socialisation, and lack of 
self-compassion. Overlap in these factors could increase impostor feelings and 
burnout in new nurses.
CONCLUSIONS: Effects of impostor phenomenon and burnout can negatively impact 
the well-being of the new nurse. Currently, no studies simultaneously examine 
impostor phenomenon and burnout in new nurses. Further research on the 
relationship between these phenomena should be conducted.
RELEVANCE TO CLINICAL PRACTICE: Understanding the impact of impostor phenomenon 
and burnout on new nurses could help mitigate challenges they face transitioning 
into practice.

© 2022 John Wiley & Sons Ltd.

DOI: 10.1111/jocn.16475
PMID: 35918887 [Indexed for MEDLINE]


1717. BMC Public Health. 2022 Aug 2;22(1):1475. doi: 10.1186/s12889-022-13834-1.

The TROLLEY Study: assessing travel, health, and equity impacts of a new light 
rail transit investment during the COVID-19 pandemic.

Crist K(1), Benmarhnia T(2), Frank LD(3), Song D(3), Zunshine E(4), Sallis 
JF(5)(6).

Author information:
(1)Department of Urban Studies & Planning, UC San Diego, 9500 Gilman Drive, La 
Jolla, San Diego, CA, 92093, USA. kcrist@ucsd.edu.
(2)Scripps Institution of Oceanography, UC San Diego, 9500 Gilman Drive, La 
Jolla, San Diego, CA, 92093, USA.
(3)Department of Urban Studies & Planning, UC San Diego, 9500 Gilman Drive, La 
Jolla, San Diego, CA, 92093, USA.
(4)Moores Cancer Center, UC San Diego, 9500 Gilman Drive, La Jolla, San Diego, 
CA, 92093, USA.
(5)Herbert Wertheim School of Public Health and Human Longevity Science, UC San 
Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093, USA.
(6)Mary MacKillop Institute for Health Research, Australian Catholic University, 
Melbourne, Australia.

BACKGROUND: The COVID-19 pandemic disrupted life in extraordinary ways impacting 
health and daily mobility. Public transit provides a strategy to improve 
individual and population health through increased active travel and reduced 
vehicle dependency, while ensuring equitable access to jobs, healthcare, 
education, and mitigating climate change. However, health safety concerns during 
the COVID-19 pandemic eroded ridership, which could have longstanding negative 
consequences. Research is needed to understand how mobility and health change as 
the pandemic recedes and how transit investments impact health and equity 
outcomes.
METHODS: The TROLLEY (TRansit Opportunities for HeaLth, Livability, Exercise and 
EquitY) study will prospectively investigate a diverse cohort of university 
employees after the opening of a new light rail transit (LRT) line and the 
easing of campus COVID-19 restrictions. Participants are current staff who live 
either < 1 mile, 1-2 miles, or  > 2 miles from LRT, with equal distribution 
across economic and racial/ethnic strata. The primary aim is to assess change in 
physical activity, travel mode, and vehicle miles travelled using accelerometer 
and GPS devices. Equity outcomes include household transportation and 
health-related expenditures. Change in health outcomes, including depressive 
symptoms, stress, quality of life, body mass index and behavior change 
constructs related to transit use will be assessed via self-report. Pre-pandemic 
variables will be retrospectively collected. Participants will be measured at 3 
times over 2 years of follow up. Longitudinal changes in outcomes will be 
assessed using multilevel mixed effects models. Analyses will evaluate whether 
proximity to LRT, sociodemographic, and environmental factors modify change in 
outcomes over time.
DISCUSSION: The TROLLEY study will utilize rigorous methods to advance our 
understanding of health, well-being, and equity-oriented outcomes of new LRT 
infrastructure through the COVID-19 recovery period, in a sample of 
demographically diverse adult workers whose employment location is accessed by 
new transit. Results will inform land use, transportation and health 
investments, and workplace interventions. Findings have the potential to elevate 
LRT as a public health priority and provide insight on how to ensure public 
transit meets the needs of vulnerable users and is more resilient in the face of 
future health pandemics.
TRIAL REGISTRATION: The TROLLEY study was registered at ClinicalTrials.gov ( 
NCT04940481 ) June 17, 2021, and OSF Registries ( 
https://doi.org/10.17605/OSF.IO/PGEHU ) June 24, 2021, prior to participant 
enrollment.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-13834-1
PMCID: PMC9344230
PMID: 35918683 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare they have no competing 
interests.


1718. Arts Health. 2023 Oct;15(3):275-291. doi: 10.1080/17533015.2022.2107033. Epub 
2022 Aug 2.

A randomised controlled trial (RCT) exploring the impact of a photography 
intervention on wellbeing and posttraumatic growth during the COVID-19 pandemic.

Read RK(1), Mason OJ(1), Jones CJ(1).

Author information:
(1)School of Psychology, University of Surrey, Guildford, UK.

BACKGROUND: Emerging evidence points to rising levels of psychological distress 
resulting from the COVID-19 pandemic. There is a need for self-administered, 
low-cost, and accessible interventions that facilitate wellbeing and growth.
METHODS: This study used a randomised controlled trial (RCT) design to 
investigate the effects of a two-week positivity-oriented photography 
intervention on wellbeing and posttraumatic growth in comparison to a control 
group. Participants were adults between the ages of 21 and 80 living in the UK 
recruited between May and August 2020 (n = 109).
RESULTS: After adjusting for baseline wellbeing, both wellbeing and PTG were 
significantly higher in the intervention group compared to the control group 
following intervention completion, with this effect remaining similar at 
one-month follow-up.
CONCLUSIONS: The study offers preliminary evidence that a brief 
self-administered photography intervention could hold therapeutic value.

DOI: 10.1080/17533015.2022.2107033
PMID: 35918101 [Indexed for MEDLINE]


1719. Psychiatry Res. 2022 Oct;316:114739. doi: 10.1016/j.psychres.2022.114739. Epub 
2022 Jul 26.

Longitudinal assessment of physician wellness during the COVID-19 pandemic.

Patel R(1), Foster T(2).

Author information:
(1)Ascension Peyton Manning Children's Hospital, Pediatrics. Electronic address: 
rita.patel@ascension.org.
(2)Ascension-St. Vincent Hospital-Indianapolis, Graduate Medical Education.

Physician wellness was greatly impacted during the COVID-19 pandemic. Busy 
clinical services, personal safety concerns, changing guidelines, and compassion 
fatigue weighed on physicians. Although studies have examined physician 
wellness, few have studied how it changed over time. A survey about wellness was 
distributed to 299 physicians at Ascension St. Vincent Hospital-Indianapolis 
March 2020, July 2020, November 2020, and March 2021. Physicians also 
free-texted about their well-being during the pandemic. Participation rates over 
the four time periods averaged 22.23%. Responses were compared among the time 
periods using Pearson Chi-Square and Fisher's Exact Tests. Six wellness factors 
(anxiety, worry about becoming ill, worry about infecting family, worry about 
caring for children, concern about personal finances) were reported as worse 
after the pandemic began, but statistically significantly improved over the 
course of the study. In contrast, seven wellness measures (increased issues with 
depression, frustration, hopelessness, fatigue, dread going to work, worry about 
missing work, worry about caring for family), that also worsened after the 
pandemic began, did not statistically improve over time. Physician wellness was 
impacted by the pandemic; however, not all measures followed the same course 
over time. Longitudinal assessments of wellness can help inform programs to best 
support physicians.

Copyright © 2022 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.psychres.2022.114739
PMCID: PMC9323205
PMID: 35917651 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


1720. J Sch Health. 2022 Dec;92(12):1137-1147. doi: 10.1111/josh.13232. Epub 2022 Aug 
2.

The Impact of Distance Education during the COVID-19 Pandemic on Physical 
Activity and Well-Being of Czech and Polish Adolescents.

Frömel K(1), Groffik D(2), Valach P(3), ŠafáŘ M(4), MitáŠ J(4).

Author information:
(1)Faculty of Physical Culture, Palacký University Olomouc, třída Míru, 771 11, 
Olomouc, Czech Republic; Faculty of Physical Education, The Jerzy Kukuczka 
Academy of Physical Education in Katowice, Mikołowska 72a, 40-065 Katowice, 
Poland.
(2)Faculty of Physical Education, The Jerzy Kukuczka Academy of Physical 
Education in Katowice, Mikołowska 72a, 40-065, Katowice, Poland.
(3)Faculty of Education, University of West Bohemia, Univerzitní 2732/8, 301 00, 
Pilsen, Czech Republic.
(4)Faculty of Physical Culture, Palacký University Olomouc, třída Míru, 771 11, 
Olomouc, Czech Republic.

BACKGROUND: The aim of this study was to identify the changes in the structure 
of weekly physical activity (PA) and well-being among adolescent boys and girls 
between habitual education (HE) and distance education (DE) during the pandemic 
in secondary schools.
METHODS: The research was carried out in 12 Czech and 18 Polish schools during 
2019 to 2020 academic session for HE and 2020 to 2021 academic session for DE. 
The research involved 723 girls and 626 boys aged 15 to 18 years. The structure 
of the weekly PA was assessed using the International Physical Activity 
Questionnaire-Long Form, while well-being was assessed using the World Health 
Organization-5 Well-Being Index.
RESULTS: There was a statistically significant decrease of PA among boys in 
school PA, transportation PA, recreation PA, vigorous PA, moderate PA, walking, 
and overall weekly PA during the DE resulting from the pandemic. In girls, 
during DE, a decrease was observed in school PA, vigorous PA, and overall PA. 
During DE, a high level of well-being was reported by only 34.9% of girls (43.8% 
during HE) and 50% of boys (65.6% during HE).
CONCLUSIONS: The observed low PA and high incidence of depressive symptoms in 
adolescents in distance education during pandemic constraints are a challenge 
for schools to change in supporting physical activity, eliminating similar 
negative impacts on school life in the future.

© 2022 The Authors. Journal of School Health published by Wiley Periodicals LLC 
on behalf of American School Health Association.

DOI: 10.1111/josh.13232
PMCID: PMC9539205
PMID: 35916129 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


1721. J Intellect Disabil Res. 2022 Aug;66(8-9):677-689. doi: 10.1111/jir.12965. Epub 
2022 Aug 1.

Mental health and COVID-19: The impact of a virtual course for family caregivers 
of adults with intellectual and developmental disabilities.

Lake JK(1)(2), Volpe T(1), St John L(1), Thakur A(1)(2)(3), Steel L(1), Baskin 
A(1), Durbin A(4), Chacra MA(1), Lunsky Y(1)(2).

Author information:
(1)Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health 
Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.
(2)Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, 
Toronto, Canada.
(3)Surrey Place, Toronto, Canada.
(4)Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.

BACKGROUND: The COVID-19 pandemic has significantly impacted family caregivers 
of adults with intellectual and developmental disabilities (IDD). This study 
evaluated a virtual course for family caregivers from across Canada, focused on 
supporting the mental health and well-being of adults with IDD and their 
families. The evaluation examined the feasibility and acceptability of the 
course, as well as the impact of the intervention on participants' overall 
health and well-being.
METHODS: The 6-week virtual course, informed by a parallel Extension for 
Community Healthcare Outcomes (ECHO) course for service providers, combined 
didactic instruction with applied activities. A total of 126 family caregiver 
course participants consented to be part of the research evaluation delivered 
over three cycles between October 2020 and April 2021. Attendance was measured 
at each weekly session. Satisfaction was assessed weekly and post-program. 
Learning, self-efficacy, and well-being were assessed pre- and post-course, and 
again at follow-up (8 weeks post-course). Mixed-effects models assessed changes 
between and within individuals across time.
RESULTS: Participants had consistent attendance, low-dropout rates, and reported 
high satisfaction, with 93% of participants reporting that their expectations 
for the course were met. Compared with pre-course, participants reported 
improved self-efficacy and well-being post-course, which were maintained at 
follow-up.
CONCLUSIONS: An interactive and applied virtual education course delivered to a 
large group of family caregivers of adults with IDD was both feasible and 
acceptable. It positively impacted participants' well-being by offering much 
needed mental health support and creating a peer-led community of practice.

© 2022 MENCAP and International Association of the Scientific Study of 
Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

DOI: 10.1111/jir.12965
PMCID: PMC9539047
PMID: 35915874 [Indexed for MEDLINE]

Conflict of interest statement: No conflict of interest was reported by the 
authors.


1722. BMC Public Health. 2022 Aug 2;22(1):1470. doi: 10.1186/s12889-022-13792-8.

Mixed-methods process evaluation of a residence-based SARS-CoV-2 testing 
participation pilot on a UK university campus during the COVID-19 pandemic.

Blake H(1)(2), Carlisle S(3), Fothergill L(4), Hassard J(3), Favier A(5), Corner 
J(5), Ball JK(6), Denning C(3)(7).

Author information:
(1)School of Health Sciences, University of Nottingham, Nottingham, UK. 
holly.blake@nottingham.ac.uk.
(2)NIHR Nottingham Biomedical Research Centre, Nottingham, UK. 
holly.blake@nottingham.ac.uk.
(3)School of Medicine, University of Nottingham, Nottingham, UK.
(4)School of Health Sciences, University of Nottingham, Nottingham, UK.
(5)Faculty of Registrars, University of Nottingham, Nottingham, UK.
(6)School of Life Sciences, University of Nottingham, Nottingham, UK.
(7)Biodiscovery Institute, University of Nottingham, Nottingham, UK.

BACKGROUND: Regular testing for Severe Acute Respiratory Syndrome Coronavirus 2 
(SARS-CoV-2) is an important strategy for controlling virus outbreaks on 
university campuses during the COVID-19 pandemic but testing participation rates 
can be low. The Residence-Based Testing Participation Pilot (RB-TPP) was a novel 
intervention implemented at two student residences on a large UK university 
campus over 4 weeks. The aim of the pilot was to increase the frequency of 
asymptomatic SARS-CoV-2 saliva testing onsite. This process evaluation aimed to 
determine whether RB-TPP was implemented as planned and identify implementation 
barriers and facilitators.
METHODS: A mixed-methods process evaluation was conducted alongside the RB-TPP. 
Evaluation participants were students (opting in, or out of RB-TPP) and staff 
with a role in service provision or student support. Monitoring data were 
collected from the intervention delivery team and meeting records. Data were 
collected from students via online survey (n = 152) and seven focus groups 
(n = 30), and from staff via individual interviews (n = 13). Quantitative data 
were analysed descriptively and qualitative data thematically. Barriers and 
facilitators to implementation were mapped to the 'Capability, Opportunity, 
Motivation-Behaviour' (COM-B) behaviour change framework.
RESULTS: Four hundred sixty-four students opted to participate in RB-TPP (98% of 
students living onsite). RB-TPP was implemented broadly as planned but relaxed 
social distancing was terminated early due to concerns relating to national 
escalation of the COVID-19 Delta variant, albeit testing continued. Most 
students (97.9%) perceived the period of relaxed social distancing within 
residences positively. The majority engaged in asymptomatic testing (88%); 46% 
(52% of testers) were fully compliant with pre-determined testing frequency. 
Implementation was facilitated by convenience and efficiency of testing, and 
reduction in the negative impacts of isolation through opportunities for 
students to socialise. Main barriers to implementation were perceived 
mixed-messages about the rules, ambivalent attitudes, and lack of adherence to 
COVID-19 protective measures in the minority.
CONCLUSIONS: This process evaluation identifies factors that help or hinder the 
success of university residence-based outbreak prevention and management 
strategies. RB-TPP led to increased rates of SARS-CoV-2 testing participation 
among students in university residences. Perceived normalisation of university 
life significantly enhanced student mental wellbeing. The complexity and 
challenge generated by multiple lines of communication and rapid adaptions to a 
changing pandemic context was evident.
TRIAL REGISTRATION NUMBER: UKAS 307727-02-01; Pre-results.
CLINICALTRIALS: gov Identifier: NCT05045989 ; post-results (first posted, 
16/09/21).
ETHICAL APPROVAL: Faculty of Medicine & Health Sciences Research Ethics 
Committee, University of Nottingham (Ref: FMHS 96-0920).

© 2022. The Author(s).

DOI: 10.1186/s12889-022-13792-8
PMCID: PMC9343222
PMID: 35915479 [Indexed for MEDLINE]

Conflict of interest statement: CD is Academic Lead and cofounder of the 
University of Nottingham Asymptomatic Testing Service (UoN ATS). AF and JKB are 
cofounders of UoN ATS. JC sits on the University of Nottingham Executive Board. 
None were involved in process evaluation data collection or analysis. HB is a 
behavioural advisor for the ATS; JKB is ATS virology advisor. Neither were 
involved in service delivery. SC, LF, JH reported no potential conflicts of 
interests.


1723. Emotion. 2023 Apr;23(3):753-763. doi: 10.1037/emo0001122. Epub 2022 Aug 1.

I feel you: Prepandemic physiological synchrony and emotional contagion during 
COVID-19.

Mayo O(1), Horesh D(1), Korisky A(2), Milstein N(1), Zadok E(1), Tomashin A(2), 
Gordon I(1).

Author information:
(1)Department of Psychology.
(2)Gonda Multidisciplinary Brain Research Center.

The COVID-19 pandemic has a major impact on mental well-being and interpersonal 
relationships. Nonetheless, little is known about the complex interactions 
between one's overall perceived interpersonal closeness and physiological or 
psychological aspects of interpersonal functioning. This study aimed to 
understand the interaction between perceived interpersonal closeness during 
COVID-19 and interpersonal mechanisms in predicting well-being. We focused on 
two interpersonal mechanisms, one physiological and the other psychological: (a) 
prepandemic physiological synchrony, a physiological measure of interpersonal 
coupling, and (b) peripandemic emotional contagion, one's tendency to "catch" 
others' emotions. One hundred fifty-five participants took part in the study. 
Cardiological interbeat interval synchrony was collected 1.5 to 3 years prior to 
the beginning of the COVID pandemic in two previous lab studies. Participants 
were recontacted during the pandemic, this time to complete several 
questionnaires tapping into perceived interpersonal closeness, tendency for 
emotional contagion, and psychological well-being during COVID. As hypothesized, 
overall perceived interpersonal closeness was positively related to well-being. 
Moreover, this effect was moderated by one's tendency for emotional contagion or 
by physiological synchrony. Thus, individuals with higher emotional contagion 
scores or higher physiological synchrony had higher well-being if their 
interpersonal closeness was perceived as greater. Conversely, their well-being 
was lower if they perceived their interpersonal closeness as weaker. These 
results emphasize that individuals may be differentially susceptible to the 
effects of their relationships on their well-being. Future mental health 
interventions should consider both the quality of one's perceived interpersonal 
closeness and the extent to which one is sensitive to others' emotional 
experiences. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

DOI: 10.1037/emo0001122
PMID: 35913856 [Indexed for MEDLINE]


1724. Clin Nurs Res. 2023 Jan;32(1):94-104. doi: 10.1177/10547738221115239. Epub 2022 
Jul 30.

Religion, Spirituality, and Coping During the Pandemic: Perspectives of Dementia 
Caregivers.

Britt KC(1), Richards KC(1), Radhakrishnan K(1), Vanags-Louredo A(2), Park E(1), 
Gooneratne NS(3), Fry L(1).

Author information:
(1)The University of Texas at Austin, USA.
(2)Baylor College of Medicine, Houston, TX, USA.
(3)University of Pennsylvania, Philadelphia, USA.

Religious and spiritual (R/S) practices support individuals during difficult 
situations. The COVID-19 social distancing restrictions may have limited access 
to R/S practices for older adults with Alzheimer's disease related dementia 
(ADRD) and their caregivers, affecting coping and well-being. This qualitative 
study explored the impact of social distancing on R/S practices and coping in 
ADRD-caregiver dyads from the perspective of caregivers. Interviews were 
conducted with 11 family caregivers of older adults with ADRD residing in 
nursing homes (n = 4) or private homes (n = 7). Caregivers continued individual 
and started virtual R/S practices which improved their ability to cope. However, 
organized R/S practices were unavailable for those with ADRD, but they used 
prayer and read religious texts which noticeably improved their mood. Healthcare 
professionals' sharing of individual and community R/S resources available for 
ADRD-caregiver dyads could decrease anxiety and agitation, while improving their 
ability to cope with increased isolation.

DOI: 10.1177/10547738221115239
PMCID: PMC9772110
PMID: 35912847 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1725. Work. 2022;73(1):29-40. doi: 10.3233/WOR-210791.

Healthy workplace onboard: Insights gained from the COVID-19 impact on mental 
health and wellbeing of seafarers.

Carrera-Arce M(1), Bartusevičienė I(1), Divari P(1).

Author information:
(1)World Maritime University, Malmö, Sweden.

BACKGROUND: Seafarers' mental health is seriously affected by COVID-19. The 
pandemic could act as a catalyst for change with respect to seafarers' mental 
health protection and promotion.
OBJECTIVE: The study explores the main factors contributing to the mental health 
and wellbeing of seafarers. Moreover, elements to help seafarers lessen the 
impact of the pandemic on their work and life onboard are analyzed, and their 
role in developing a positive psychosocial environment and promoting a healthy 
workplace onboard are discussed.
METHODS: The study involved the use of an ad hoc questionnaire and the adoption 
of both quantitative and qualitative methods. The sample included one hundred 
and five active seafarers.
RESULTS: Ninety-six percent of the sample stated that mental health is a very or 
extremely important part of their general health. Seafarers perceive that their 
mental health has been seriously impacted by COVID-19. Major factors 
contributing to seafarers' mental health and wellbeing reveal three groups of 
factors: rest and spare time-related factors, communication/relationship with 
the external world, and interaction and social life on board factors.
CONCLUSIONS: Strategies suggested by seafarers for coping with "inevitable" 
psychological stress produced by COVID-19 and promoting their wellbeing include 
managerial, emotional, facilities-related (including communication 
infrastructure), physical, and social elements to promote wellbeing. Economic, 
intellectual, and spiritual elements also have to be taken into consideration 
and require further investigation. Building on seafarers' insights and 
experiences, a healthy environment onboard should cultivate holistically the 
four main spheres of a healthy workplace (physical work environment, 
psychosocial work environment, personal health resources, and enterprise 
community involvement) and the five features of a healthy psychosocial 
environment (social, emotional, physical, intellectual and spiritual) under all 
circumstances, whether exceptional or ordinary.

DOI: 10.3233/WOR-210791
PMID: 35912771 [Indexed for MEDLINE]


1726. Inquiry. 2022 Jan-Dec;59:469580221109677. doi: 10.1177/00469580221109677.

Investigating the Impacts of Information Overload on Psychological Well-being of 
Healthcare Professionals: Role of COVID-19 Stressor.

Li W(1)(2), Khan AN(1).

Author information:
(1)School of Economics and Management Wuhan University, Wuhan, Hubei, PR China.
(2)Research Center of Hubei Micro & Small Enterprises Development, School of 
Economics and Management, Hubei Engineering University, Xiaogan, People's 
Republic of China.

While past research has focused on the benefits of social media during 
pandemics, this study emphasizes the possible negative effects of social media 
use among healthcare professionals. It has been stated that healthcare 
professionals are exposed to COVID-19 and its impacts on the mental health of 
these workers. Even though recognizing the importance of healthcare 
professionals during the pandemic, the impacts of COVID-19 on the mental health 
of healthcare professionals have been rarely considered for investigation by 
researchers. By applying differential susceptibility to the media effects model 
(DSMM), the current article investigated the effect of COVID-19 information 
overload (CIO) on psychological and mental well-being and underline mechanisms. 
Time-wave technique was applied to collect the data. This study tested moderated 
mediation model by collecting data from 314 healthcare professionals. The 
findings stated that COVID-19 information overload impacted COVID-19 fatalism 
and COVID-19 exhaustion directly. Likewise, COVID-19 fatalism mediated the 
association between CIO and COVID-19 exhaustion. Moreover, the COVID-19 stressor 
moderated this mediating relationship. This study proposes several practical 
recommendations for healthcare professionals, social media platform providers, 
health authorities, organizations, and institutions on how to use social media 
effectively and sustainably during the global COVID-19 epidemic.

DOI: 10.1177/00469580221109677
PMCID: PMC9340904
PMID: 35912469 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


1727. Front Public Health. 2022 Jul 13;10:857472. doi: 10.3389/fpubh.2022.857472. 
eCollection 2022.

The Effect of Regional Factors on the Mental Health Status of Frontline Nurses 
and Patients With COVID-19 During COVID-19: The Role of Depression and Anxiety.

Zhao S(1), Long F(2), Wei X(3)(4), Tuo J(4), Wang H(5), Ni X(4), Wang X(6).

Author information:
(1)Centre for Sport and Exercise Sciences, Universiti Malaya, Kuala Lumpur, 
Malaysia.
(2)Department of Psychology, Nanjing University, Nanjing, China.
(3)Institute of Information Engineering, Xi'an Eurasia University, Xi'an, China.
(4)Institute of Social Psychology, School of Humanities and Social Sciences, 
Xi'an Jiaotong University, Xi'an, China.
(5)Department of the Psychology of Military Medicine, Air Force Medical 
University, Xi'an, China.
(6)Strategic Support Force Medical Center, Beijing, China.

At the end of 2019, Wuhan, Hubei Province, China, experienced the ravages of 
Coronavirus disease 2019 (COVID-19). In a few months, infected people rose to 
tens of thousands. This study aimed to explore the mental health status of 
military nurse personnel assisting (non-Hubei area) in the fight against 
COVID-19 and local nurse personnel (in the Wuhan area), as well as the 
differences in mental health status between nurses and COVID-19 patients that 
provide a reference basis for psychological crisis intervention. A convenience 
sampling method was used to select frontline nurses and COVID-19 patients 
(sample size 1,000+) from two mobile cabin hospitals from January to March 2020. 
The questionnaire consists of socio-demographic information, Patient Health 
Questionnaire 9 (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7), General Mental 
Health Service Questionnaire and Work Intensity and Physical Status 
Questionnaire. The results showed that depression was present in 117 nurses 
(19.73%) and 101 patients (23.33%) with PHQ-9 scores >10; anxiety was present in 
60 nurses (10.12%) and 54 patients (12.47%) with GAD-7 >10. The anxiety and 
depression levels of nurses in Wuhan area were higher than those in non-Hubei 
area. The differences in PHQ-9 and GAD-7 scores were also statistically 
significant (p < 0.001) when comparing patients from different regions, with 
anxiety and depression rates of 30.19 and 16.04% in local patients and 16.74 and 
9.50% in foreign patients. The comparison between nurses and patients showed 
that the nurses were more depressed than the patients, while the patients were 
more anxious. Local nurses in Wuhan had a higher workload intensity than aid 
nurses (77.72 vs. 57.29%). Over 95% of frontline nurses and patients reported 
that they had not received any form of psychological counseling before the 
COVID-19 outbreak. 12.87% (26/194) of frontline nurses in Wuhan had a history of 
taking hypnotic drugs. However, fewer patients (16/212, 7.55%) took medication 
than frontline nurses. Anxiety and depression levels were far higher among local 
nurses and patients in Wuhan than in non-Hubei areas. The nurses had higher 
levels of depression, while the patients had higher anxiety levels. Providing 
targeted mental health services to healthcare professionals and patients is 
necessary when experiencing the impact of a major event.

Copyright © 2022 Zhao, Long, Wei, Tuo, Wang, Ni and Wang.

DOI: 10.3389/fpubh.2022.857472
PMCID: PMC9326255
PMID: 35910907 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1728. Front Public Health. 2022 Jul 13;10:880339. doi: 10.3389/fpubh.2022.880339. 
eCollection 2022.

Preconception Mental Health, Socioeconomic Status, and Pregnancy Outcomes in 
Primiparous Women.

Björkstedt SM(1)(2), Koponen H(3), Kautiainen H(4)(5), Gissler M(6)(7), Pennanen 
P(8), Eriksson JG(1)(4)(9)(10), Laine MK(1)(4).

Author information:
(1)Department of General Practice and Primary Health Care, University of 
Helsinki and Helsinki University Hospital, Helsinki, Finland.
(2)Social Services and Health Care Division, Helsinki, Finland.
(3)Department of Psychiatry, University of Helsinki and Helsinki University 
Hospital, Helsinki, Finland.
(4)Folkhälsan Research Center, Helsinki, Finland.
(5)Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland.
(6)Finnish Institute for Health and Welfare, Helsinki, Finland.
(7)Karolinska Institute and Region Stockholm, Stockholm, Sweden.
(8)Vantaa Health Center, Vantaa, Finland.
(9)Department of Obstetrics and Gynecology and Human Potential Translational 
Research Program, Yong Loo Lin School of Medicine, National University 
Singapore, Singapore, Singapore.
(10)Agency for Science, Technology and Research (ASTAR), Singapore Institute for 
Clinical Sciences (SICS), Singapore, Singapore.

BACKGROUND: One in four women of childbearing age has some degree of mental 
disorders and are, therefore, prone to both pregnancy complications and adverse 
health outcomes in their offspring. We aimed to evaluate the impact of 
preconception severe mental disorders on pregnancy outcomes in primiparous 
women.
METHODS: The study cohort was composed of 6,189 Finnish primiparous women 
without previously diagnosed diabetes, who delivered between 2009 and 2015, 
living in the city of Vantaa, Finland. Women were classified to have a 
preconception severe mental disorder if they had one or more outpatient visits 
to a psychiatrist or hospitalization with a psychiatric diagnosis 1 year before 
conception. Data on pregnancies, diagnoses, and pregnancy outcomes were obtained 
from national registers at an individual level.
RESULTS: Primiparous women with preconception severe psychiatric diagnosis were 
younger, more often living alone, smokers, and had lower educational attainment 
and lower taxable income than women without psychiatric diagnosis (for all p < 
0.001). Of all women, 3.4% had at least one psychiatric diagnosis. The most 
common psychiatric diagnoses were depression and anxiety disorders. The most 
common comorbidity was the combination of depression and anxiety disorders. 
There were no differences in the need for respiratory treatments, admissions to 
the neonatal intensive care unit, or antibiotic treatments between the 
offspring's groups.
CONCLUSION: Although primiparous women had severe mental disorders, the 
well-being of newborns was good. The most common severe mental health disorders 
were depression and anxiety disorders, and psychiatric comorbidity was common. 
Women with severe mental disorders more often belonged to lower socioeconomic 
groups.

Copyright © 2022 Björkstedt, Koponen, Kautiainen, Gissler, Pennanen, Eriksson 
and Laine.

DOI: 10.3389/fpubh.2022.880339
PMCID: PMC9326245
PMID: 35910895 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1729. Front Public Health. 2022 Jul 15;10:876883. doi: 10.3389/fpubh.2022.876883. 
eCollection 2022.

Examining the Mental Health, Wellbeing, Work Participation and Engagement of 
Medical Laboratory Professionals in Ontario, Canada: An Exploratory Study.

Nowrouzi-Kia B(1)(2)(3), Dong J(4), Gohar B(3)(5), Hoad M(6).

Author information:
(1)Department of Occupational Science and Occupational Therapy, Temerty Faculty 
of Medicine, University of Toronto, Toronto, ON, Canada.
(2)Krembil Research Institute, University Health Network, Toronto, ON, Canada.
(3)Centre for Research in Occupational Safety and Health, Laurentian University, 
Sudbury, ON, Canada.
(4)School of Public Health, Shanghai Jiao Tong University, Shanghai, China.
(5)Department of Population Medicine, The University of Guelph, Guelph, ON, 
Canada.
(6)Medical Laboratory Professionals Association of Ontario, Hamilton, ON, 
Canada.

OBJECTIVES: The overall objective of this proposed project is to examine the 
impact of the COVID-19 pandemic on the mental health, functioning and wellbeing 
of medical laboratory technologists (MLT) and medical laboratory 
technicians/assistants (MLT/A) in Ontario, Canada.
METHODS: A cross-sectional study included a self-reported questionnaire for MLT 
and MLT/A in Ontario. The questionnaire included questions about demographics 
and occupational characteristics. Questions about mental health, functioning, 
well-being and psychosocial work environments were also included using validated 
questionnaires.
RESULTS: There were 551 MLT and 401 MLT/A in the analytic sample. Most of the 
respondents were women. The mean age and standard deviation of the overall 
sample were 42.0 ± 11.8. MLT demonstrated higher quantitative demands, 
possibilities for development, and organizational justice compared to MLT/A. The 
scores of work pace, emotional demands, role conflicts, job insecurity, 
insecurity over working conditions and negative acts were higher for MLT/A than 
MLT. The WHODAS 2.0 scores of the respondents were 20.80 ± 6.68, higher than 
approximately 92% average people. For both groups, most respondents scored the 
COPSOQ-III domains as worse since COVID-19.
CONCLUSION: The study provides preliminary evidence regarding the workplace 
mental health outcomes of medical laboratory professionals in Ontario, Canada. 
The findings suggest that MLT and MLT/A experience psychosocial work conditions 
that impact mental health, functioning and disability. Accordingly, additional 
research is necessary to understand the experiences of medical laboratory 
professionals.

Copyright © 2022 Nowrouzi-Kia, Dong, Gohar and Hoad.

DOI: 10.3389/fpubh.2022.876883
PMCID: PMC9334856
PMID: 35910881 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1730. Eat Behav. 2022 Aug;46:101654. doi: 10.1016/j.eatbeh.2022.101654. Epub 2022 Jul 
19.

The associations among psychological distress, stressors of the COVID-19 
pandemic, and disinhibited eating of parents of three- to five-year-old 
children.

Herzog NK(1), Sherrard A(2), Kemmerley TC(2), Tan CC(3).

Author information:
(1)Department of Psychology, The University of Toledo, United States of America. 
Electronic address: noelle.herzog@utoledo.edu.
(2)Department of Psychology, The University of Toledo, United States of America.
(3)Department of Psychology, The University of Toledo, United States of America. 
Electronic address: cincin.tan@utoledo.edu.

Individuals' psychological distress is associated with disinhibited eating 
(external and emotional eating). The aim of the current study was to examine the 
moderating associations of COVID-19-related stress on parents' psychological 
distress (anxiety, hostility, depression) and external and emotional eating. One 
hundred and sixty U.S. parents of three- to five-year-old children 
(Mage = 34.08, SD = 6.76; 89 females) completed an online survey. After 
accounting for participant characteristics (i.e., age, BMI, sex), regression 
analyses showed that COVID-19 stress moderated the effects of anxiety, 
hostility, and depression on external eating. Additionally, findings showed that 
COVID-19 stress moderated hostility (but not anxiety or depression) on emotional 
eating. These findings suggest that unexpected stressors from the COVID-19 
pandemic may exacerbate disinhibited eating among those individuals who 
experience psychological distress. This presents support for providing 
interventions that focus on healthy coping strategies and family well-being, 
support groups, and community resources (e.g., financial assistance) to 
alleviate external pressures during unprecedented times.

Copyright © 2022 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.eatbeh.2022.101654
PMCID: PMC9295320
PMID: 35908518 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare no conflicts of interest in preparing this article.


1731. Ir J Med Sci. 2023 Jun;192(3):1015-1020. doi: 10.1007/s11845-022-03118-3. Epub 
2022 Jul 30.

Assessing medical students' perception and educational experience during 
COVID-19 pandemic.

Low EZ(1), O'Sullivan NJ(2), Sharma V(2), Sebastian I(2), Meagher R(2), Alomairi 
D(2), Alhouti EH(2), Donohoe CL(2), Kelly ME(2).

Author information:
(1)Trinity College Dublin, St. James's Hospital, Dublin, Ireland. lowe@tcd.ie.
(2)Trinity College Dublin, St. James's Hospital, Dublin, Ireland.

INTRODUCTION: The COVID-19 pandemic has significantly impacted the traditional 
delivery of medical education. Medical education programmes have had to cope 
with limitations on face-to-face learning, and accelerate the adoption of 
digital learning. In addition, the pandemic has potential serious implications 
on the psychological well-being of medical students. We aim to assess the 
changes in perceptions and experiences of medical students as a consequence of 
this pandemic.
METHODS: Cross-sectional survey of medical students at Trinity College Dublin 
(TCD) between March and April 2022 was performed. The survey explored student 
satisfaction with the current education program, teaching delivery and the 
impact of COVID-19 on education and student well-being.
RESULTS: 175 medical students participated in the survey. Overall, the majority 
of students were happy/neutral with their medical education. 93 (53.1%) felt 
tutorials and problem-based learning (PBL) to be the most effective method of 
teaching, followed by laboratory and clinical placements in 78 participants 
(44.6%) and hybrid-learning in 85 participants (48.6%). There was a mixed 
reaction to the changes in the delivery of education brought about by the 
pandemic. 67 participants (40.6%) felt happy with the changes, another 64 
participants (38.8%) felt neutral, whilst only 34 participants (20.6%) were 
unhappy. However, most participants felt the pandemic negatively impacted their 
mental health, with 96 participants (55.8%) reporting negative responses. 58% of 
participants (n = 102/175) reported utilising the student support services at 
university campus and 49% (n = 50) were satisfied with their services.
CONCLUSION: Digital content and delivery confer the benefit of greater 
flexibility in learning, the ability to learn at one's own pace and in a 
preferred environment, however lacks the advantage of bedside teaching and 
hands-on training. Our findings reinforce the potential advantages of online 
learning.

© 2022. The Author(s).

DOI: 10.1007/s11845-022-03118-3
PMCID: PMC9362516
PMID: 35908145 [Indexed for MEDLINE]


1732. Dimens Crit Care Nurs. 2022 Sep-Oct 01;41(5):256-263. doi: 
10.1097/DCC.0000000000000539.

The Effect of Intensive Care Unit Diaries on Posttraumatic Stress Disorder, 
Anxiety, and Depression: A Systematic Review and Meta-analysis of Randomized 
Controlled Trials.

Gazzato A, Scquizzato T, Imbriaco G, Negro A, Caballo Garrido MC, Landoni G, 
Zangrillo A, Borghi G.

INTRODUCTION: Patients discharged from the intensive care unit (ICU) suffer from 
long-term symptoms affecting the physical, psychological, and cognitive 
well-being and cannot understand memories and dreams. Intensive care unit 
diaries describe daily events about the patient and may allow them to 
reconstruct their experience.
OBJECTIVE: We conducted a systematic review and meta-analysis of randomized 
controlled trials (RCTs) to investigate the effects of ICU diaries on 
posttraumatic stress disorder (PTSD), depression, and anxiety.
METHODS: Five electronic databases were searched up to May 6, 2022. We included 
RCTs comparing patients admitted to the ICU who received a diary to those who 
did not receive a diary. The primary outcome was the rate of PTSD. Secondary 
outcomes were rates of depression and anxiety.
RESULTS: We included 7 RCTs. Patients who received a diary during the ICU 
admission had reduced rate of PTSD (78/432 [18%] vs 106/422 [25%]; risk ratio 
[RR], 0.73; 95% confidence interval [CI], 0.57-0.94; P = .02; I2 = 0%; trial 
sequential analysis-adjusted CI, 0.55-0.97) when compared with patients who did 
not receive a diary. We found a non-statistically significant difference toward 
a reduction in the rate of depression (38/232 [16%] vs 54/224 [24%]; RR, 0.70; 
95% CI, 0.49-1.01; P = .06; I2 = 0%) and anxiety (63/232 [27%] vs 70/224 [31%]; 
RR, 0.64; 95% CI, 0.29-1.40; P = .26; I2 = 67%).
CONCLUSIONS: Providing an ICU diary to patients admitted to the ICU reduced the 
rate of PTSD symptoms compared with usual care.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/DCC.0000000000000539
PMID: 35905428 [Indexed for MEDLINE]


1733. Ann Fam Med. 2022 Apr 1;20(20 Suppl 1):2742. doi: 10.1370/afm.20.s1.2742.

Cost of COVID-19: Using life course theory as a lens to understand the 
consequences of the pandemic.

Purkey E, Bayoumi O, Watson A, Fu M, Davison C.

CONTEXT: The COVID-19 pandemic and associated countermeasures have had broad 
implications across society which will have implications for physical and mental 
health for years to come. Understanding these experiences through the lens of 
life course constructs may help communities, service providers including family 
doctors, and governments to recognize and respond more effectively to the 
lasting impacts.
OBJECTIVE: To use life course theory to explore the impacts of the COVID-19 
pandemic and associated countermeasures on child and family mental, social, and 
emotional well-being.
STUDY DESIGN: Qualitative study including anonymous micro-narrative collection 
using Spryng.io software (n=210); in-depth interviews with health and social 
service providers (n=30). Directed content analysis was used to examine the 
experiences of the COVID-19 pandemic as they relate to key constructs in life 
course theory.
SETTING: Kingston, Frontenac, Lennox and Addington counties in South-Eastern 
Ontario (pop. 210,000).
POPULATION STUDIED: Participants were recruited to the micronarrative collection 
through convenience sampling using the online data collection tool, as well as 
through intentional sampling targeting Indigenous people and people experiencing 
socio economic deprivation and homelessness. Participants for the in-depth 
interviews were intentionally recruited as key informants from local health and 
social service organizations.
RESULTS: All of the key constructs of life course theory were relevant when 
applied to our findings. Our data identified meaningful impacts on life course 
trajectory components including transitions, turning points, and social 
pathways, as well as using the principles of agency, life span development, 
linked lives, timing, and time and place.
CONCLUSIONS: Our data illustrate the pervasive impact of the COVID-19 pandemic 
on all aspects of the life course. While service providers and policy makers are 
attuned to the acute crises currently unfolding, the long term impacts of life 
course disruption will play out over years, or potentially over the entire 
lifespan of this cohort. Responses to the pandemic cannot limit themselves to 
crisis management in the next 12-18 months, but will need to integrate an 
understanding of life course theory to support long term healing of individuals 
and communities.

2021 Annals of Family Medicine, Inc.

DOI: 10.1370/afm.20.s1.2742
PMCID: PMC10548978
PMID: 35904938 [Indexed for MEDLINE]

Conflict of interest statement: Authors report none


1734. Sci Rep. 2022 Jul 28;12(1):12964. doi: 10.1038/s41598-022-13205-1.

Identifying potential mechanisms between childhood trauma and the psychological 
response to the COVID-19 pandemic in Germany: a longitudinal study.

Rek SV(1)(2), Reinhard MA(3), Bühner M(4), Freeman D(5), Adorjan K(3), Falkai 
P(3), Padberg F(3).

Author information:
(1)Department of Psychiatry and Psychotherapy, University Hospital, Ludwig 
Maximilians University of Munich, Nussbaumstraße 7, Munich, Germany. 
s.rek@med.uni-muenchen.de.
(2)International Max Planck Research School for Translational Psychiatry 
(IMPRS-TP), Munich, Germany. s.rek@med.uni-muenchen.de.
(3)Department of Psychiatry and Psychotherapy, University Hospital, Ludwig 
Maximilians University of Munich, Nussbaumstraße 7, Munich, Germany.
(4)Department of Psychology, LMU Munich, Munich, Germany.
(5)Department of Psychiatry, University of Oxford, Oxford, UK.

Childhood maltreatment (CM) has been associated with adverse psychosocial 
outcomes during the pandemic, but the underlying mechanisms are unclear. In a 
prospective online study using baseline and 10-week follow-up data of 391 German 
participants, we applied multiple mediation analyses to test to what extent 
COVID-19 perceived stressors mediate the association between CM and later 
adverse psychosocial outcomes compared to established mediators of rumination 
and insecure attachment. We also explored the relative importance of different 
COVID-19 related stressors in predicting adverse psychological trajectories 
using elastic net regression. Results showed that CM was longitudinally 
associated with all adverse psychosocial outcome. COVID-19 perceived stressors, 
rumination, and insecure attachment mediated this relationship and full 
mediation was observed for the outcomes anxiety, stress and psychological 
well-being. COVID-19-related concerns about the future was most strongly and 
consistently associated with adverse psychosocial functioning. These findings 
provide preliminary evidence that COVID-19 perceived stressors, in particular 
concerns about the future, may be a key mechanism underlying the development of 
adverse psychosocial outcomes in individuals with a CM history. Thus, COVID-19 
perceived stressors may require a higher priority for prevention and treatment 
efforts in vulnerable groups. Our results warrant replication in more 
representative cross-cultural samples.

© 2022. The Author(s).

DOI: 10.1038/s41598-022-13205-1
PMCID: PMC9333057
PMID: 35902702 [Indexed for MEDLINE]

Conflict of interest statement: Prof. Padberg reports personal fees and 
non-financial support from Mag & More GmbH, Munich, Germany, personal fees and 
non-financial support from Brainsway Inc., Jerusalem, Israel, personal fees and 
non-financial support from neuroConn GmbH, Ilmenau, Germany, outside the 
submitted work. The other authors declare no competing interests.


1735. Midwifery. 2022 Oct;113:103434. doi: 10.1016/j.midw.2022.103434. Epub 2022 Jul 
16.

The experience of fathers during the covid-19 UK maternity care restrictions.

Andrews K(1), Ayers S(2), Williams LR(2).

Author information:
(1)Community Midwives, Women's Health, University College Hospital, 2nd floor 
North, 250 Euston Road, London, NW1 2PG. Electronic address: 
Kathryn.Andrews6@nhs.net.
(2)School of Health Sciences, City, University of London, Northampton Square, 
London, EC1V 0HB.

Comment in
    Evid Based Nurs. 2023 Jul;26(3):109.

OBJECTIVE: During the COVID-19 pandemic fathers in the UK were excluded from 
many aspects of maternity care to reduce escalating transmission rates. This 
study explores the experiences of fathers who had a baby during the pandemic to 
understand what effect these maternity restrictions had on them and their 
relationship to the baby.
DESIGN: A qualitative interview study of the experiences of fathers whose baby 
was born during the pandemic-related UK maternity restrictions.
PARTICIPANTS AND SETTING: Non-probability voluntary response sampling of 20 
fathers: including 13 primiparous fathers and 7 multiparous fathers. Eligibility 
criteria were that fathers lived in the UK and had a baby born on or after the 
23rd March 2020; the start of the most severe COVID-19 maternity restrictions. 
Participants were interviewed remotely via telephone using semi-structured 
interviews which were transcribed and analysed using thematic analysis.
FINDINGS: Four themes, including ten sub-themes, were identified that described 
fathers' experiences of the maternity restrictions and the father-baby 
relationship. The themes were: (1) The impact on paternal experience: this theme 
describes a collective negative paternal maternity experience as a result of the 
restrictions. Notably, father exclusion produced feelings of isolation and a 
sense of loss, along with a disconnection from the pregnancy. (2) The impact on 
the father-baby relationship: this theme discusses the adverse consequence of 
the restrictions on initial father-baby bonding. (3) Observed impact on mothers: 
the observed detrimental impact that excluding fathers had on maternal mental 
health and well-being. Finally, (4) Fatherhood in the 'new normal': the change 
of daily living during the pandemic aided profound family relationship building, 
improving long-term father-baby bonding, compared to pre-pandemic conditions.
KEY CONCLUSIONS: The findings provide evidence of undesirable consequences the 
pandemic-related UK maternity restrictions had on birth partners. With 
restrictions to maternity care implemented across the globe, these concerns may 
be applicable at an international scale.
IMPLICATIONS FOR PRACTICE: This study adds to other contemporary literature on 
this subject and can inform discussion among maternity services of the 
importance of including fathers for improved parental well-being and initial 
infant bonding.

Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.midw.2022.103434
PMCID: PMC9288266
PMID: 35901609 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest There are no actual or 
potential conflictions of interest.


1736. Afr J AIDS Res. 2022 Jul;21(2):207-212. doi: 10.2989/16085906.2022.2091464.

Effect of COVID-19 on older adults 50 years and above living with HIV in a 
less-developed country.

Nyashanu M(1), Lusota DA(2), Muddu M(3), Mbalinda SN(2).

Author information:
(1)Department of Health & Allied Professions, School of Social Science, 
Nottingham Trent University, United Kingdom.
(2)Department of Nursing, College of Health Sciences, Makerere University, 
Uganda.
(3)Makerere University Joint AIDS Program, Kampala, Uganda.

Introduction: Globally, control measures have been communicated to reverse the 
COVID-19 pandemic. In Uganda, as soon as the first case of COVID-19 was 
identified, strict lockdown measures were enforced, including a ban on all 
public and private transport, night curfew, closure of schools, and suspension 
of religious and social gatherings and closure of non-essential shops and 
markets. These measures affected access to health services, which could have 
been worse for older people living with HIV (PLHIV). In this study, we explored 
how COVID-19 affected the health and social life of older PLHIV.Methods: We 
conducted a qualitative study in HIV clinics of two hospitals in Uganda. We 
completed 40 in-depth interviews with adults above 50 years who had lived with 
HIV for more than 10 years. The interviews explored the effect of COVID-19 on 
their health and social life during the lockdown. We analysed data 
thematically.Results: The overarching themes regarding the effects of COVID-19 
on older adults living with HIV were fear and anxiety during the lockdown, lack 
of access to health care leading to missing HIV clinic appointments and not 
taking their ART medicines, financial burden, loss of loved ones, and effect on 
children's education. Some patients overcame health-related challenges by 
sending motorcycles to their health facilities with their identifying documents 
to get the medicines refilled. Some health care providers took the ART medicines 
to their patients' homes.Conclusion: The COVID-19 lockdown negatively affected 
the health and social well-being of older PLHIV. This calls for strategies to 
improve HIV care and treatment access during the lockdown to sustain the HIV 
program gains in this vulnerable population.

DOI: 10.2989/16085906.2022.2091464
PMID: 35901298 [Indexed for MEDLINE]


1737. PLoS One. 2022 Jul 28;17(7):e0272152. doi: 10.1371/journal.pone.0272152. 
eCollection 2022.

Using prosocial behavior to safeguard mental health and foster emotional 
well-being during the COVID-19 pandemic: A registered report of a randomized 
trial.

Miles A(1), Andiappan M(2), Upenieks L(3), Orfanidis C(4).

Author information:
(1)Department of Sociology, University of Toronto, Toronto, Canada.
(2)Institute of Health Policy, Management, and Evaluation, University of 
Toronto, Toronto, Canada.
(3)Department of Sociology, Baylor University, Waco, TX, United States of 
America.
(4)Ontario Institute for Studies in Education, University of Toronto, Toronto, 
Canada.

Update of
    PLoS One. 2021 Jan 27;16(1):e0245865.

BACKGROUND: The COVID-19 pandemic, the accompanying lockdown measures, and their 
possible long-term effects have made mental health a pressing public health 
concern. Acts that focus on benefiting others-known as prosocial behaviors-offer 
one promising intervention that is both flexible and low cost. However, neither 
the range of emotional states prosocial acts impact nor the size of those 
effects is currently clear-both of which directly influence its attractiveness 
as a treatment option.
OBJECTIVE: To assess the effect of prosocial activity on emotional well-being 
(happiness, belief that one's life is valuable) and mental health (anxiety, 
depression).
METHODS: 1,234 respondents from the United States and Canada were recruited from 
Amazon's Mechanical Turk and randomly assigned (by computer software) to perform 
prosocial (N = 411), self-focused (N = 423), or neutral (N = 400) behaviors 
three times a week for three weeks. A follow-up assessment was given two weeks 
after the intervention. Participants were blind to alternative conditions. 
Analyses were based on 1052 participants (Nprosocial = 347, Nself = 365, 
Nneutral = 340).
FINDINGS: Those in the prosocial condition did not differ on any outcome from 
those in the self-focused or neutral acts conditions during the intervention or 
at follow-up, nor did prosocial effects differ for those who had been negatively 
affected socially or economically by the pandemic (all p's > 0.05). Exploratory 
analyses that more tightly controlled for study compliance found that prosocial 
acts reduced anxiety relative to neutral acts control (β = -0.12 [95% CI: -0.22 
to -0.02]) and increased the belief that one's life is valuable (β = 0.11 [95% 
CI: 0.03 to 0.19]). These effects persisted throughout the intervention and at 
follow-up.
CONCLUSION: Prosocial acts may provide small, lasting benefits to emotional 
well-being and mental health. Future work should replicate these results using 
tighter, pre-registered controls on study compliance.

DOI: 10.1371/journal.pone.0272152
PMCID: PMC9333215
PMID: 35901118 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


1738. Eur Child Adolesc Psychiatry. 2023 Jun;32(6):1015-1024. doi: 
10.1007/s00787-022-02032-4. Epub 2022 Jul 28.

Mental health burden of high school students, and suggestions for psychosocial 
support, 1.5 years into the COVID-19 pandemic in Austria.

Dale R(#)(1), Jesser A(#)(2), Pieh C(2), O'Rourke T(2), Probst T(2), Humer E(2).

Author information:
(1)Department for Psychosomatic Medicine and Psychotherapy, University for 
Continuing Education Krems, Krems an der Donau, Austria. 
rachel.dale@donau-uni.ac.at.
(2)Department for Psychosomatic Medicine and Psychotherapy, University for 
Continuing Education Krems, Krems an der Donau, Austria.
(#)Contributed equally

The COVID-19 pandemic and containment efforts seem to be particularly 
challenging for adolescents. This study assessed mental health in high school 
students 1.5 years after the pandemic began in Austria. A cross-sectional survey 
was carried out from September to November 2021. Well-being (WHO-5), depressive 
symptoms, anxiety symptoms and sleep quality were assessed. A total of 1505 
adolescents participated (78% girls). The cut-offs for clinically relevant 
symptoms were exceeded by 62% girls and 38.1% boys for depression (PHQ-9 
score ≥ 11), 49% girls and 29% boys for anxiety (GAD-7 score ≥ 11) and 28% girls 
and 17% boys for insomnia (ISI score ≥ 15). The prevalence of suicidal ideation 
(item 9 of the PHQ-9) within the last 2 weeks was 47% in girls and 32% in boys. 
These data collected in autumn 2021 (the start of the second semester of 
reopened schools; t2) were compared to data collected in February 2021 (one 
semester after remote schooling; t1). A matched pairs analysis according to age, 
gender, region, school type and migration background resulted in a total sample 
size of N = 2514 adolescents. Results showed small deteriorations in mental 
health (i.e., well-being, depression, insomnia, suicidal ideation) in girls at 
t2 compared to t1, and an increase in suicidal thoughts in boys (all 
p-values < 0.05). Qualitative data show that young people have a need for more 
psychological support, both professional and informal, as well as increased 
mental health literacy. Results suggest that mental health burden in adolescents 
remains high 1.5 years into the pandemic and highlight the need to implement 
timely psychological support.

© 2022. The Author(s).

DOI: 10.1007/s00787-022-02032-4
PMCID: PMC9330952
PMID: 35900473 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interest.


1739. Psychol Health Med. 2023 Feb;28(2):486-493. doi: 10.1080/13548506.2022.2104887. 
Epub 2022 Jul 28.

Physical and psychological fatigue, and work performance among Brazilian workers 
during the SARS-CoV-2 (COVID-19) pandemic in Brazil.

Barbosa MA(1), Coelho Junior FA(2), Mourão L(3), Marques-Quinteiro P(4), Faiad 
C(5).

Author information:
(1)Department of Administration at the University of Brasília, Brasília, Brazil.
(2)Department of Administration, Post-Graduate Program in Administration and 
Research Center in Assessment and Social Technologies at the University of 
Brasília, Brasília, Brazil.
(3)Department of Psychology, Post-Graduate Program in Psychology at the 
University Salgado de Oliveira, Niterói, Brazil.
(4)Department of Psychology, Transdisciplinary Research Center of Innovation & 
Entrepreneurship Ecosystems (Trie)/universidade Lusófona, Lisboa, Portugal.
(5)Department of Clinical Psychology, Post-Graduate Program in Social, Work and 
Organizational Psychology and Research Center in Assessment and Social 
Technologies at the University of Brasília, Brasília, Brazil.

The lockdown requirement, caused by SARS-CoV-2 (COVID-19), led to people having 
to follow a work from home regime. This pandemic made workers more vulnerable, 
causing emotional disorders that impacted their work performance. This online 
survey aimed to identify the psychological and emotional impacts of the COVID-19 
pandemic on Brazilian workers, testing the predictive effect between physical 
and emotional fatigue factors, and expectations about their performance. The 
participants were 153 workers from different sectors or departments of the 
University of Brasilia following the work from home modality. To achieve the 
main aim of this study, the questionnaire 'Feeling Fatigue Scale' by Yoshitake, 
and the nine items of the 'Achievement' factor of the 'Well-being at Work' 
questionnaire by Paschoal and Tamayowere applied. Study data were collected 
between February and August 2020. Statistically significant differences were 
found between cognitive aspects (difficulties in attention to work, p = .001,) 
expectations regarding performance (p = .035), and the impact of fatigue on the 
body (p = .021) when comparing the profile of workers from the areas of exact 
sciences, health, and social and human sciences. Workers who reported more 
extreme difficulty in attention had lower expectations regarding the performance 
achieved in the exercise of their duties (R2 adjusted = .271, p < .001). The 
results demonstrate the importance of planning public policies aimed at 
promoting mental and physical health at work.

DOI: 10.1080/13548506.2022.2104887
PMID: 35899965 [Indexed for MEDLINE]


1740. J Appl Res Intellect Disabil. 2022 Nov;35(6):1360-1369. doi: 10.1111/jar.13024. 
Epub 2022 Jul 28.

'More together than apart': The evaluation of a virtual course to improve mental 
health and well-being of adults with intellectual disabilities during the 
COVID-19 pandemic.

St John L(1), Volpe T(1), Jiwa MI(1), Durbin A(2)(3), Safar Y(1), Formuli F(1), 
Thakur A(1)(3), Lake J(1)(3), Lunsky Y(1)(3).

Author information:
(1)Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental 
Health, Toronto, Canada.
(2)MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.
(3)Department of Psychiatry, Temertry Faculty of Medicine, University of 
Toronto, Toronto, Canada.

BACKGROUND: To address the growing concerns over poor mental health experienced 
by adults with intellectual disabilities due to the COVID-19 pandemic, a 
national virtual mental health course was delivered and evaluated.
METHODS: This mixed methods study utilized both qualitative and quantitative 
assessments. Participants were 27 adults with intellectual disabilities who 
participated in the 6-week course. Participants completed measures of 
self-efficacy and well-being at three time points and qualitative satisfaction 
measures at post and follow-up.
RESULTS: Attendance was high and the course was feasible and acceptable to 
participants. Positive changes related to mental health self-efficacy were 
detected (p = .01), though mental well-being did not improve.
CONCLUSION: The study provided evidence for the feasibility and value of the 
course for this population. Future research should examine how virtual courses 
could support the population in terms of pandemic recovery and how courses may 
work for individuals who are less independent.

© 2022 John Wiley & Sons Ltd.

DOI: 10.1111/jar.13024
PMCID: PMC9353296
PMID: 35899843 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1741. Front Public Health. 2022 Jul 11;10:856228. doi: 10.3389/fpubh.2022.856228. 
eCollection 2022.

The Effect of Knowledge Levels of Breastfeeding Mothers About the Disease on 
Their Levels of Anxiety During the COVID-19 Pandemic Process.

Tekiner SA(1), Çullas Ilarslan NE(2), Günay F(3), Ceyhun Peker GA(1).

Author information:
(1)Department of Family Medicine, Ankara University School of Medicine, Ankara, 
Turkey.
(2)Department of Pediatrics, Ankara Memorial Hospital, Ankara, Turkey.
(3)Department of Pediatrics, Ankara University School of Medicine, Ankara, 
Turkey.

BACKGROUND: The health impact of severe acute respiratory syndrome-coronavirus-2 
(SARS-CoV-2) spans across all age groups including mothers and their newly born 
infants; and breastfeeding women during this pandemic deserves special attention 
due to its short and long-term health implications. When planning the current 
study, our hypothesis was that the anxiety of transmitting the COVID-19 disease 
to the baby through breastfeeding would increase among breastfeeding women and 
it would predominantly be state anxiety. The current study aims to investigate 
the relationship between the knowledge levels of breastfeeding mothers about 
COVID-19 and their anxiety levels.
MATERIALS AND METHODS: This is a cross-sectional study and we aimed to reach all 
mothers with babies between 0 and 24 months of age who applied to the Healthy 
Child Care Policlinic of Ankara University Faculty of Medicine Hospital between 
July 1 and August 31, 2020 Questionnaires measuring the level of knowledge about 
COVID-19 disease and breast milk and questionnaires measuring anxiety levels 
were administered to mothers. The state-trait anxiety levels and knowledge 
levels of breastfeeding mothers about COVID-19 disease, as well as their 
knowledge levels about breast milk and sociodemographic characteristics were 
compared.
RESULTS: A total of 145 breastfeeding mothers were included in the study. The 
trait anxiety was found to be either absent or mild in 89 (61.4%), moderate in 
28 (19.3%), and advanced in 28 (19.3%) mothers. The state anxiety level, 
however, was found to be either absent or mild in 51 (35.2%), moderate in 42 
(29%), and advanced in 52 (35.9%) mothers. When mothers' trait and state anxiety 
levels and their knowledge levels about breast milk, their knowledge levels 
about COVID-19 disease and their sociodemographic characteristics were compared, 
it was determined that mothers with 0-6 months old infants had lower state 
anxiety levels compared to mothers with older infants. However, the anxiety 
levels of mothers whose children were >12 months old were mostly moderate (p < 
0.05). There was no statistically significant difference in terms of other 
variables (p < 0.05). A positive correlation was found between the child age and 
state anxiety level (p = 0.027).
CONCLUSION: Moderate and advanced level of state anxiety was found to be higher 
than level of trait anxiety parallel to our hypothesis. Among breastfeeding 
mothers, those with the lowest state anxiety scores were those who had babies 
between 0 and 6 months. It is important to support breastfeeding mothers in 
promoting breastfeeding, especially after 6 months of birth. Policymakers, 
obstetricians and especially the family physicians should be aware that adverse 
life events may put a higher burden on the emotional wellbeing of breastfeeding 
women especially after 6 months of birth of the babies. So, breastfeeding 
promotion, protection and support strategies should be reconsidered specially 
after 6 months.

Copyright © 2022 Tekiner, Çullas Ilarslan, Günay and Ceyhun Peker.

DOI: 10.3389/fpubh.2022.856228
PMCID: PMC9309883
PMID: 35899173 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1742. Int J Environ Res Public Health. 2022 Jul 23;19(15):8966. doi: 
10.3390/ijerph19158966.

Buffering the Effects of Burnout on Healthcare Professionals' Health-The 
Mediating Role of Compassionate Relationships at Work in the COVID Era.

Buonomo I(1), Santoro PE(2)(3), Benevene P(1), Borrelli I(2), Angelini G(1), 
Fiorilli C(1), Gualano MR(4), Moscato U(2)(3).

Author information:
(1)Department of Human Sciences, LUMSA University, 00193 Rome, Italy.
(2)Department of Life Sciences and Public Health, Catholic University of the 
Sacred Heart, 00168 Rome, Italy.
(3)Department of Women, Children and Public Health Sciences, Fondazione 
Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy.
(4)Department of Public Health Sciences, University of Turin, 10124 Turin, 
Italy.

Managing the COVID-19 pandemic posed several challenges for healthcare 
professionals, which likely heightened their risk of burnout (Amanullah and 
Ramesh Shankar, 2020) and, consequently, their general physical and mental 
health. Although it may not be possible to address and eliminate the causes of 
burnout, current research informs healthcare organizations about protective 
strategies to reduce its detrimental consequences. The promotion of 
compassionate interactions among healthcare professionals may play such a role. 
Compassion within healthcare organizations positively affects individual 
performance and well-being. Building on these considerations and within the 
framework of the Conservation of Resources theory, this study explores the 
relationships among burnout dimensions, received compassion at work, and general 
health in 711 Italian healthcare professionals (68.5% female), aged between 21 
and 73 years (Mage = 36.4, SD = 11.2). Analyses were conducted to investigate 
the association between burnout and general well-being (H1) and between burnout 
symptoms and perceived compassion at work (H2); and the mediational role of 
compassion in the relationship between burnout symptoms and general well-being. 
H1 and H2 were confirmed (r < 0.01 for both), and a SEM model showed the 
mediating role of compassion at work in the association between burnout symptoms 
and general well-being (RMSEA < 0.08, SRMR < 0.08, CFI and TLI > 0.90). 
Theoretical and practical implications of the findings are discussed in the 
paper.

DOI: 10.3390/ijerph19158966
PMCID: PMC9332033
PMID: 35897337 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1743. Int J Environ Res Public Health. 2022 Jul 23;19(15):8957. doi: 
10.3390/ijerph19158957.

Mental Health during the Early Stage of the COVID-19 Pandemic: A Hong Kong 
Study.

Cheung PK(1), Wu J(1), Chui WH(2).

Author information:
(1)Department of Social and Behavioural Sciences, City University of Hong Kong, 
Kowloon Tong, Kowloon, Hong Kong, China.
(2)Department of Applied Social Sciences, The Hong Kong Polytechnic University, 
Hung Hom, Kowloon, Hong Kong, China.

This study addressed the impact on mental health and wellbeing in relation to 
views of the self, the world, and the future during the early stage of the 
global novel coronavirus (COVID-19) pandemic outbreak. An online survey battery 
included the 21-item Depression Anxiety and Stress Scale (DASS-21), Subjective 
Happiness Scale, Self-Compassion Scale, Adult Hope Scale, and two 
specifically-written items measuring the valence quality and quantity of the 
impact of the pandemic. A total of 345 Hong Kong residents (54% females) 
responded; 17.1%, 24.7%, and 19.7% reported elevated levels of depression, 
anxiety, and stress, respectively. The prevalence of these issues was lower in 
this Hong Kong sample than reported in other COVID-19 studies, possibly due to 
the past experience of the severe acute respiratory syndrome (SARS) outbreak in 
Hong Kong in promoting the voluntary wearing of masks in public places and 
introducing social distancing measures during the early first wave of the 
pandemic. Correlational analyses showed associations between positive views 
about the self (higher self-compassion), the world (higher positive valence), 
and the future (more hope) and better mental health and psychological wellbeing 
(fewer depression, anxiety, and stress symptoms; more happiness). Regression 
analyses indicated a differential predicting power of the three views on the 
four selected mental health and psychological wellbeing indicators. Intervention 
programs to alleviate distress and/or promote better wellbeing should be matched 
to the specific problems encountered by the sufferers.

DOI: 10.3390/ijerph19158957
PMCID: PMC9330738
PMID: 35897328 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1744. Int J Environ Res Public Health. 2022 Jul 22;19(15):8924. doi: 
10.3390/ijerph19158924.

Increase in Referrals of Children and Adolescents to the Psychiatric Emergency 
Room Is Evident Only in the Second Year of the COVID-19 Pandemic-Evaluating 9156 
Visits from 2010 through 2021 in a Single Psychiatric Emergency Room.

Dror C(1)(2), Hertz-Palmor N(3)(4), Yadan-Barzilai Y(1), Saker T(1)(2), 
Kritchmann-Lupo M(1)(2), Bloch Y(1)(2).

Author information:
(1)Shalvata Mental Health Center, Hod Hasharon 45100, Israel.
(2)Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
(3)The Child and Adolescent Psychiatry Division, Sheba Medical Center, Edmund 
and Lily Safra's Children Hospital, Ramat Gan 52621, Israel.
(4)School of Psychological Sciences, Tel Aviv University, Tel Aviv 69978, 
Israel.

Introduction: The COVID-19 pandemic affected the wellbeing of children and 
adolescents. The psychiatric emergency room (ER) is the hub of psychiatric 
emergencies and reflects clinically significant mental problems. Previous 
studies compared 2019 and 2020 and observed a decline in ER referrals. The 
current study focused on the continuous trend of referrals from 2010 to the end 
of 2021. Method: In our observational retrospective study, we procured data from 
9156 child and adolescent referrals to our psychiatric ER. The comparison was 
made based on similar months of each year. Results: There was a significant 
positive trend in monthly referrals between 2010 and 2021, representing a 
similar increase in referrals per month in comparison to that month in the 
preceding year (unstandardized β = 4.21, 95% CI = 3.44 to 4.98, p < 0.0001). 
Between March 2020 and February 2021 (monthly visits = 72.5 + 16.6 [median = 
79.5], annual referrals = 870), we observed no additive effect beyond this 
general trend after controlling for population growth. Conversely, between March 
and December 2021 (monthly referrals = 106.1 + 31.8 [median = 105.5], overall 
referrals = 1061) we observed a significant additive effect beyond the projected 
incline, as predicted by previous years (β = 21.61, 95% CI = 12.12 to 31.06, p < 
0.0001). Conclusions: The first year of the COVID-19 pandemic was no different 
from the continuous decade long rise of referrals to the children and 
adolescents’ psychiatric ER. Conversely, the second year showed an additional 
incline beyond the general trend. The complexity in this rising need demands the 
awareness of clinicians and policy makers alike.

DOI: 10.3390/ijerph19158924
PMCID: PMC9332552
PMID: 35897293 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1745. West J Nurs Res. 2023 Feb;45(2):152-160. doi: 10.1177/01939459221114634. Epub 
2022 Jul 27.

Psychological Impact of COVID-19 on Oncology Patients: Perceptions of Oncology 
Health Care Providers.

Chavez MN(1), Marshall VK(2), Martinez Tyson D(1), Mason TM(3), Rechenberg K(2).

Author information:
(1)College of Public Health, University of South Florida, Tampa, FL, USA.
(2)College of Nursing, University of South Florida, Tampa, FL, USA.
(3)H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.

The COVID-19 pandemic profoundly impacted psychological well-being worldwide. 
Oncology health care professionals' (OHCPs') perceptions of psychological 
effects of COVID-19 among people in active cancer treatment were explored. 
Semi-structured interviews with a purposive sample of OHCPs actively providing 
care were conducted. Interviews were audio-recorded, transcribed, and coded 
using Atlas.ti v8 and thematic analysis. In total, 30 OHCPs participated. Most 
were registered nurses (70%), worked in outpatient setting (56.7%) and were in 
their current position 1-5 years (53.3%). Overarching themes are as follows: (a) 
cancer treatment disrupted due to patients' fear of exposure to COVID-19; (b) 
social distancing restrictions caused discontinued social support and supportive 
services that exacerbated psychological distress; (c) pandemic-related stressors 
led to overwhelmed coping skills; and (d) OHCPs played a vital role in providing 
emotional support and connecting patients with family/friends through 
technology. Behavioral health interventions should focus within the "new world 
of COVID-19" of reduced face-to-face support and increased online support for 
patients.

DOI: 10.1177/01939459221114634
PMCID: PMC10079896
PMID: 35897163 [Indexed for MEDLINE]

Conflict of interest statement: The authors declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1746. PLoS One. 2022 Jul 27;17(7):e0271873. doi: 10.1371/journal.pone.0271873. 
eCollection 2022.

Academic, clinical and personal experiences of undergraduate healthcare students 
during the COVID-19 pandemic: A prospective cohort study.

McFadden S(1), Guille S(1), Daly-Lynn J(1), O'Neill B(1), Marley J(1), Hanratty 
C(1), Shepherd P(1), Ramsey L(1), Breen C(1), Duffy O(1), Jones A(1), Kerr D(1), 
Hughes C(1).

Author information:
(1)School of Health Sciences, Institute of Nursing and Health Research, Ulster 
University Jordanstown Campus, County Antrim, Northern Ireland.

BACKGROUND: Coronavirus disease 2019 has impacted upon the role and safety of 
healthcare workers, with the potential to have a lasting effect on their 
wellbeing. Limited research has been conducted during previous pandemics 
exploring how student healthcare workers are impacted as they study and train 
for their professional careers.
OBJECTIVE: The aim of the current study was to examine the specific impact of 
COVID-19 on the academic, clinical and personal experiences of healthcare 
students.
METHOD: Undergraduate students across three year groups within the School of 
Health Sciences at Ulster University completed online Qualtrics surveys at three 
timepoints during one academic year (2020/2021). Quantitative survey data was 
downloaded from Qualtrics into SPSS Version 25 for descriptive analysis of each 
cross-sectional sample. Qualitative survey data was downloaded into text format, 
which was thematically analysed using content analysis.
RESULTS: 412 students completed the survey at Time 1 (October 2020), n = 309 at 
Time 2 (December 2020) and n = 259 at Time 3 (April 2021). Academically, the 
pandemic had mostly a negative impact on the learning environment, the 
development of practical skills, the assessment process and opportunities for 
peer learning and support. Students reported increased stress and challenges 
managing their workload and maintaining a sense of motivation and routine. 
Clinically, they felt unprepared by the university for placement where the 
pandemic had an increasingly negative impact over time on learning and skill 
development. In terms of personal experiences, despite the majority of students 
taking steps to keep physically and mentally well, negative impacts on 
friendships, mental wellbeing and concerns for family were reported. The 
pandemic had not impacted upon career choice for most students.
CONCLUSION: Consideration must be given to the development of practical skills 
so students feel prepared for their professional careers given the practical 
nature of their roles. Programme coordinators should adopt a holistic approach 
to student wellbeing.

DOI: 10.1371/journal.pone.0271873
PMCID: PMC9328508
PMID: 35895730 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


1747. Int J Environ Res Public Health. 2022 Jul 21;19(14):8859. doi: 
10.3390/ijerph19148859.

Linking Self-Control, Hope, Positivity Ratio, Anxiety and Handwashing Habits 
during the Coronavirus Outbreak.

Bukchin-Peles S(1)(2)(3), Ronen T(4).

Author information:
(1)Department of Agricultural & Resource Economics, University of California, 
Berkeley, CA 94720-3310, USA.
(2)Department of Geography, The Hebrew University of Jerusalem, Jerusalem 91905, 
Israel.
(3)The Glocal Program in International Development, The Hebrew University of 
Jerusalem, Jerusalem 91905, Israel.
(4)Department of Social Work, Tel-Aviv University, Tel-Aviv 69978, Israel.

The novel COVID-19 is an infectious disease caused by the coronavirus. In the 
early stages of the pandemic, Israel struggled to contain its local outbreak 
through various measures that have virtually halted daily life and placed tens 
of thousands of people into quarantine. This study explored the role played by 
self-control and hope for obtaining two desired outcomes: (1) maintaining one's 
positivity ratio (having more positive than negative affect-an indicator of 
wellbeing) and (2) increasing one's contagion-preventing behavior (in this 
study-handwashing habits). Path analysis was conducted using survey data 
collected from 537 Israeli adults. Our findings suggest that self-control's 
association with the positivity ratio is mediated through hope and anxiety 
levels. Self-control positively correlates with hope levels and negatively 
correlates with anxiety levels. Higher hope levels correlate with a higher 
positivity ratio, while lower anxiety levels correlate with a higher positivity 
ratio. The relationship between self-control and handwashing habits was mediated 
by hope, anxiety, and existing handwashing habits. This study brings research a 
step forward in demonstrating the vital role of positive components in achieving 
desired psychological and behavioral outcomes during an anxiety-provoking 
epidemic outbreak. In addition to its theoretical innovation, the importance of 
this study lies in its practical value: We focus on variables that are 
influenced by policy, education, and communication.

DOI: 10.3390/ijerph19148859
PMCID: PMC9323159
PMID: 35886724 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


1748. Int J Environ Res Public Health. 2022 Jul 21;19(14):8849. doi: 
10.3390/ijerph19148849.

Difference between Impacts of COVID-19 on Women and Men's Psychological, Social, 
Vulnerable Work Situations, and Economic Well-Being.

Iglesias Martínez E(1), Roces García J(2), Jiménez Arberas E(3), Llosa JA(1).

Author information:
(1)Social Education, Faculty Padre Ossó, University of Oviedo, 33008 Oviedo, 
Spain.
(2)Polytechnic School of Engineering of Gijón, University of Oviedo, 33204 
Gijón, Spain.
(3)Occupational Therapy, Faculty Padre Ossó, University of Oviedo, 33008 Oviedo, 
Spain.

The SARS-CoV-2 virus changed social reality worldwide, affecting people's health 
and work life, particularly their anxiety levels. The purpose of this study is 
to verify the situation of women in terms of anxiety and social determinants in 
Spain during the pandemic. The sample consisted of 4686 people (3500 women and 
1186 men). The tools used were the State-Trait Anxiety Inventory (STAI) and an 
ad hoc questionnaire to assess the work and mental situation of the 
participants. The results indicate a higher rate of anxiety among women than 
among men and reveal a relationship between higher levels of anxiety and more 
vulnerable work situations in terms of higher unemployment rates, contract 
changes, etc. Furthermore, there was a higher percentage of women than men in 
the sectors where the health crisis has had a greater impact and presence, with 
repercussions on the physical, mental, and social health of the entire 
population and especially on women. It is necessary to take into account the 
social determinants of health, not only at the structural level, in terms of the 
socio-economic and political contexts, to avoid and limit the axes of inequality 
such as gender.

DOI: 10.3390/ijerph19148849
PMCID: PMC9320173
PMID: 35886699 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1749. Int J Environ Res Public Health. 2022 Jul 12;19(14):8528. doi: 
10.3390/ijerph19148528.

Prevalence of Health-Risk Behaviors and Mental Well-Being of ASEAN University 
Students in COVID-19 Pandemic.

Rahman HA(1)(2), Amornsriwatanakul A(3)(4), Abdul-Mumin KH(1)(5), Agustiningsih 
D(6), Chaiyasong S(7), Chia M(8), Chupradit S(9), Huy LQ(10), Ivanovitch K(11), 
Nurmala I(12), Majid HBA(13), Nazan AINM(14), Rodjarkpai Y(15), de la Cruz 
MHTO(16), Mahmudiono T(12), Sriboonma K(17), Sudnongbua S(18), Vidiawati D(19), 
Wattanapisit A(20), Charoenwattana S(15), Cahyani N(19), Car J(21), Ho MR(22), 
Rosenberg M(3)(4).

Author information:
(1)Centre of Advanced Research (CARe), Universiti Brunei Darussalam, Bandar Seri 
Begawan BE1410, Brunei.
(2)School of Nursing and Statistics Online Computational Resource, University of 
Michigan, Ann Arbor, MI 48109, USA.
(3)College of Sports and Technology, Mahidol University, Nakhon Pathom 73170, 
Thailand.
(4)School of Human Sciences (Sport Science, Exercise and Health), University of 
Western Australia, Crawley, WA 6009, Australia.
(5)School of Nursing and Midwifery, La Trobe University, Bundoora, Melbourne, 
VIC 3086, Australia.
(6)Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, 
Yogyakarta 55281, Indonesia.
(7)Faculty of Pharmacy, Mahasarakham University, Maha Sarakham 44150, Thailand.
(8)Physical Education & Sports Science, National Institute of Education, Nanyang 
Technological University, Singapore 639798, Singapore.
(9)Department of Occupational Therapy, Faculty of Associated Medical Sciences, 
Chiang Mai University, Chiang Mai 50200, Thailand.
(10)School of Medicine, Vietnam National University, Ho Chi Minh City 700000, 
Vietnam.
(11)Faculty of Public Health, Thammasat University (Rangsit Campus), Pathum 
Thani 12120, Thailand.
(12)Health Promotion and Behavior, Faculty of Public Health, Universitas 
Airlangga, Surabaya 60286, Indonesia.
(13)Department of Social and Preventive Medicine, Faculty of Medicine, 
University of Malaya, Kuala Lumpur 50603, Malaysia.
(14)Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 
43400, Malaysia.
(15)Faculty of Public Health, Burapha University, Chonburi 20131, Thailand.
(16)Office of Health Services, Ateneo School of Medicine and Public Health, 
Ateneo de Manila University, Quezon City 1108, Philippines.
(17)Department of Teacher Training in Civil Engineering, Faculty of Technical 
Education, King Mongkut's University of Technology North Bangkok, Bangkok 10800, 
Thailand.
(18)Faculty of Public Health, Naresuan University, Phitsanulok 65000, Thailand.
(19)Faculty of Medicine, Universitas Indonesia, Depok City 16424, Indonesia.
(20)School of Medicine, Walailak University, Nakhon Si Thammarat 80160, 
Thailand.
(21)Centre for Population Health Sciences, Lee Kong Chian School of Medicine, 
Nanyang Technological University, Singapore 636921, Singapore.
(22)School of Social Sciences, Nanyang Technological University, Singapore 
639798, Singapore.

The prevalence of epidemiological health-risk behaviors and mental well-being in 
the COVID-19 pandemic, stratified by sociodemographic factors in Association of 
South East Asian Nations (ASEAN) university students, were examined in the 
research. Data were collected in March-June 2021 via an online survey from 
15,366 university students from 17 universities in seven ASEAN countries. 
Analyzed data comprised results on physical activity, health-related behaviors, 
mental well-being, and sociodemographic information. A large proportion of 
university students consumed sugar-sweetened beverages (82.0%; 95%CI: 81.4, 
82.6) and snacks/fast food daily (65.2%; 95%CI: 64.4, 66.0). About half (52.2%; 
95%CI: 51.4, 53.0) consumed less than the recommended daily amounts of 
fruit/vegetable and had high salt intake (54%; 95%CI: 53.3, 54.8). Physical 
inactivity was estimated at 39.7% (95%CI: 38.9, 40.5). A minority (16.7%; 95%CI: 
16.1, 17.3) had low mental well-being, smoked (8.9%; 95%CI: 8.4, 9.3), and drank 
alcohol (13.4%; 95%CI: 12.8, 13.9). Country and body mass index had a 
significant correlation with many health-risk behaviors and mental well-being. 
The research provided important baseline data for guidance and for the 
monitoring of health outcomes among ASEAN university students and concludes that 
healthy diet, physical activity, and mental well-being should be key priority 
health areas for promotion among university students.

DOI: 10.3390/ijerph19148528
PMCID: PMC9320216
PMID: 35886375 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript, or in the decision to 
publish the results.


1750. Int J Environ Res Public Health. 2022 Jul 8;19(14):8349. doi: 
10.3390/ijerph19148349.

Moral Distress Events and Emotional Trajectories in Nursing Narratives during 
the COVID-19 Pandemic.

Lemmo D(1), Vitale R(1), Girardi C(1), Salsano R(1), Auriemma E(1).

Author information:
(1)Department of Humanities, University of Naples Federico II, 80100 Naples, 
Italy.

The COVID-19 pandemic produced several ethical challenges for nurses, impacting 
their mental health and moral distress. In the moral distress model the 
categories of events related to moral distress are: constraint, dilemma, 
uncertainty, conflict, and tension, each one related to different emotions. This 
study explored moral events' memories and emotions in narratives of a sample of 
43 Italian nurses who worked during the COVID-19 pandemic. We constructed an 
ad-hoc narrative interview asking nurses to narrate the memory, and the 
associated emotion, of an event in which they felt they could not do the right 
thing for the patient. We conducted a theory-driven analysis, using the 
categories proposed by the literature, identifying the main emotion for each 
category. Results show that 36 memories of events are representative of moral 
distress; among these, 7 are representative of none of the categories 
considered, and we categorized them as moral compromise. The main emotional 
trajectories are powerlessness, worthlessness, anger, sadness, guilt, and 
helplessness. From a clinical psychological point of view, our findings 
highlight the narration of the memories of moral events as a tool to use in the 
ethical sense-making of critical experiences, in order to promote well-being and 
moral resilience among nurses in emergency situations.

DOI: 10.3390/ijerph19148349
PMCID: PMC9316292
PMID: 35886199 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1751. Int J Environ Res Public Health. 2022 Jul 6;19(14):8274. doi: 
10.3390/ijerph19148274.

Physical Activity and Stress of Children and Adolescents during the COVID-19 
Pandemic in Germany-A Cross-Sectional Study in Rural Areas.

Braksiek M(1), Lindemann U(2), Pahmeier I(1).

Author information:
(1)Department of Sport Science, University of Vechta, 49377 Vechta, Germany.
(2)Department of Sport Science, Bielefeld University, 33615 Bielefeld, Germany.

Although infection with SARS-CoV-2 appears to be less dangerous for children and 
adolescents, research indicates that the measures to contain the COVID-19 
pandemic have had and continue to have negative effects on children's and 
adolescents' mental health and physical activity (PA). Due to the different 
health policies, country-specific studies as well as studies in different phases 
of the pandemic are important to obtain a differentiated picture of the effects 
of the pandemic. This study set out to investigate children's and adolescents' 
PA, stress, and well-being as well as the associations between these two 
variables during a phase of a gradual decline in measure to contain the pandemic 
in Germany. For this purpose, 1293 children and adolescents in a rural area of a 
federal state in Germany were investigated. The results indicated that children 
and adolescents felt sadder and less well during this period than children and 
adolescents before the pandemic. Results also revealed that they were more 
physically active than children and adolescents before the pandemic as well as 
in the second lockdown but less active than in the first lockdown. Both 
well-being and sadness were positively associated with the PA. The study 
contributes to a more comprehensive understanding of the situation of children 
and adolescents during the COVID-19 pandemic.

DOI: 10.3390/ijerph19148274
PMCID: PMC9321660
PMID: 35886126 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1752. Children (Basel). 2022 Jun 26;9(7):958. doi: 10.3390/children9070958.

Parents' Views with Music Therapy in the Pediatric Intensive Care Unit: A 
Retrospective Cohort Study.

Cousin VL(1), Colau H(1), Barcos-Munoz F(1), Rimensberger PC(1), Polito A(1).

Author information:
(1)Pediatric and Neonatal Intensive Care Unit, Department of Pediatrics, 
Gynecology and Obstetrics, Geneva University Hospitals, University of Geneva, 
Rue Willy Donzé 6, 1205 Geneva, Switzerland.

PURPOSE: Music therapy intervention (MT) could be used as an adjunctive therapy 
in PICU for anxiety and pain management. The aim of the study was to examine the 
perception of MT by children's parents in a PICU of a tertiary care teaching 
hospital.
METHODS: This is a retrospective cohort study summarizing the results of an 
institutional quality improvement initiative. Questionnaires were distributed to 
parents whose children were exposed to MT.
RESULTS: From April 2019 to July 2021, 263 patients received a total of 603 h of 
MT. Twenty-five questionnaires were distributed to parents over a 4-month period 
(February-June 2021). A total of 19 (76%) parents completed the questionnaire. 
The majority of parents thought that MT helped their child to communicate (89%), 
feel less isolated (100%) and cope with stress during hospitalization (100%). 
The majority of parents also thought that MT contributed to physical recovery 
(90%) and alleviated feelings of anxiety (90%). Parents also believed that MT 
should be offered as an out-patient service.
CONCLUSIONS: Our study agrees with other studies on the positive potentials of 
MT in PICU. Music therapy intervention could be used to promote children's and 
parents' psychological well-being. Further studies are warranted to evaluate the 
impact of MT on long-term post-ICU outcomes.

DOI: 10.3390/children9070958
PMCID: PMC9317819
PMID: 35883942

Conflict of interest statement: The authors declare no conflict of interest.


1753. Fortschr Neurol Psychiatr. 2023 Jan;91(1-02):32-44. doi: 10.1055/a-1871-9628. 
Epub 2022 Jul 26.

[COVID-19 and Bipolar Affective Disorder: Subjective Changes in Lifestyle 
Variables During the First Lockdown During the COVID-19 Pandemic in Austria].

[Article in German; Abstract available in German from the publisher]

Ortner J(1), Bengesser SA(1), Wagner-Skacel J(2), Fellendorf FT(1), Fleischmann 
E(1), Ratzenhofer M(1), Lenger M(1), Queissner R(1), Tmava-Berisha A(1), Platzer 
M(1), Maget A(1), Pilz R(1)(3), Birner A(1), Reininghaus E(1), Dalkner N(1).

Author information:
(1)Psychiatry, Medical University Graz, Austria Universitätsklinik für 
Psychiatrie und Psychotherapeutische Medizin, Medizinische Universität Graz, 
Österreich.
(2)Universitätsklinik für Medizinische Psychologie und Psychotherapie, 
Medizinische Universität Graz, Österreich.
(3)FH JOANNEUM, Diätologie, Graz, Austria.

INTRODUCTION: The COVID-19 pandemic with its protective measures (e. g. 
lockdown) had far-reaching effects on everyone's well-being. The aim of this 
study was to examine lifestyle variables during the first Austrian lockdown in 
patients with bipolar disorder in comparison to a healthy control group and to 
assess subjective changes caused by the pandemic.
METHOD: At the beginning of April 2020, an online survey of n=75 participants 
(35 people with bipolar disorder and 40 healthy controls) with standardized 
questionnaires (Beck Depression Inventory-2, Food Craving Inventory, Altman Self 
Rating Mania Scale) as well as non-standardized COVID-19-specific questions on 
the subject of "Psychological stress and effects of the COVID-19 pandemic in 
bipolar disorder" was created and distributed via LimeSurvey.
RESULTS: Both groups reported a negative impact on their mental health. The 
participants with bipolar disorder showed significantly higher values in the 
Beck Depression Inventory-2 score (p<0,001), in emotional distress due to social 
distancing (p=0,003) and significantly lower values in muscle-strengthening 
exercise (p=0,039) and in sport units (p=0,003) compared to the control group. 
In addition, patients with bipolar disorder smoked more often than individuals 
of the control group. People with bipolar disorder were 42,9% more likely to 
report they were less efficient during the pandemic, and 22,9% experienced 
weight gain compared to before the pandemic. The control group, on the other 
hand, was less efficient at 17,5% and 5,0% reported weight gain. However, a 
comparison with pre-pandemic data showed a decrease in food craving in both 
groups.
CONCLUSION: This study provided first evidence of self-reported adverse effects 
on mental stress and lifestyle in people with bipolar disorder at the beginning 
of the COVID-19 pandemic. Psychiatric care and early interventions for patients 
with bipolar disorder would be particularly important in times of crisis in 
order to help maintain a healthy lifestyle and thus counteract unfavourable 
developments.

Publisher: HINTERGRUND: Die COVID-19-Pandemie mit ihren Schutzmaßnahmen (z. B. 
Lockdown) hat einen weitreichenden Einfluss auf die Befindlichkeit aller 
Menschen. Das Ziel dieser Studie war es, Lebensstilvariablen während des ersten 
österreichischen Lockdowns bei Patient*innen mit bipolarer Erkrankung im 
Vergleich zu einer gesunden Kontrollgruppe zu untersuchen und subjektive 
Veränderungen durch die Pandemie zu erheben.
METHODE: Anfang April 2020 wurde eine Online-Befragung mit 75 Teilnehmer*innen 
(35 Patient*innen und 40 Kontrollpersonen) mit standardisierten Fragebögen (Beck 
Depression Inventory-2, Food Craving Inventory, Altman Self Rating Mania Scale) 
sowie nicht-standardisierten COVID-19-spezifischen Fragen zum Thema „Psychische 
Belastung und Auswirkungen der COVID-19-Pandemie bei bipolarer Störung“ per 
LimeSurvey durchgeführt.
ERGEBNISSE: Beide Gruppen gaben an, dass sich die Pandemie negativ auf ihre 
psychische Gesundheit ausgewirkt habe. Die Studienteilnehmer*innen mit bipolarer 
Störung zeigten signifikant höhere Werte im Beck Depression Inventory-2 
(p<0,001), in der emotionalen Belastung durch die räumliche Distanzierung 
(p=0,003) und signifikant niedrigere Werte im Kraftsport (p=0,039) sowie im 
Sport generell (p=0,003) im Vergleich zur Kontrollgruppe. Außerdem rauchten 
Patient*innen mit bipolarer Erkrankung während dieser Zeit kompensatorisch mehr 
als Personen der Kontrollgruppe. Personen mit bipolarer Störung gaben mit 42,9% 
häufiger an, während der Pandemie weniger leistungsfähig zu sein, und 22,9% 
verzeichneten eine Gewichtszunahme im Vergleich zu vor der Pandemie. Die 
Kontrollgruppe war hingegen mit 17,5% weniger leistungsfähig und 5,0% 
berichteten über eine Gewichtszunahme. Ein Vergleich mit Prä-Pandemie-Daten 
zeigte jedoch eine Abnahme im Food Craving in beiden Gruppen.
KONKLUSION: Diese Studie lieferte erste Hinweise auf die psychische Belastung 
und auf die ungünstigen Auswirkungen auf den Lebensstil von Menschen mit einer 
bipolaren Störung zu Beginn der COVID-19-Pandemie. Eine psychiatrische Betreuung 
und Erste-Hilfe-Maßnahmen für Patient*innen mit psychischer Störung wären gerade 
in Krisenzeiten wichtig, um einen gesunden Lebensstil zu pflegen und so 
ungünstigen Entwicklungen gegenzusteuern.

The Author(s). This is an open access article published by Thieme under the 
terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, 
permitting copying and reproduction so long as the original work is given 
appropriate credit. Contents may not be used for commercial purposes, or 
adapted, remixed, transformed or built upon. 
(https://creativecommons.org/licenses/by-nc-nd/4.0/).

DOI: 10.1055/a-1871-9628
PMCID: PMC9873412
PMID: 35882365 [Indexed for MEDLINE]

Conflict of interest statement: Alle Autorinnen/Autoren dieser Studie erklären 
keinen Interessenkonflikt.


1754. Elife. 2022 Jul 26;11:e75705. doi: 10.7554/eLife.75705.

Surveying the experience of postdocs in the United States before and during the 
COVID-19 pandemic.

Morin A(#)(1), Helling BA(#)(1), Krishnan S(#)(2), Risner LE(3), Walker ND(4), 
Schwartz NB(5).

Author information:
(1)Department of Human Genetics, University of Chicago, Chicago, United States.
(2)Department of Neurobiology and Institute for Neuroscience, University of 
Chicago, Chicago, United States.
(3)Department of Pediatrics, University of Chicago, Chicago, United States.
(4)Ben May Department for Cancer Research, University of Chicago, Chicago, 
United States.
(5)Department of Pediatrics and the Department of Biochemistry and Molecular 
Biology, University of Chicago, Chicago, United States.
(#)Contributed equally

In the interest of advocating for the postdoctoral community in the United 
States (US), we compared the results of surveys of postdocs carried out in 2019 
and in late 2020. We found that respondents' mental health and wellness were 
significantly impacted by the pandemic irrespective of their gender, race, 
citizenship, or other identities. Career trajectories and progression were also 
affected, as respondents reported being less confident about achieving career 
goals, and having more negative perceptions of the job market compared to before 
the pandemic. Postdocs working in the US on temporary visas reported 
experiencing increased stress levels due to changes in immigration policy. 
Access to institutional Postdoctoral Offices or Associations positively impacted 
well-being and helped mitigate some of the personal and professional stresses 
caused by the pandemic.

© 2022, Morin, Helling, Krishnan et al.

DOI: 10.7554/eLife.75705
PMCID: PMC9322995
PMID: 35880738 [Indexed for MEDLINE]

Conflict of interest statement: AM, BH, SK, LR, NW, NS No competing interests 
declared


1755. Glob Health Promot. 2023 Mar;30(1):33-41. doi: 10.1177/17579759221102192. Epub 
2022 Jul 25.

Repercussions of perceived threat to health in the Spanish population.

Molero Jurado MDM(1), Martos Martínez Á(1), Pérez-Fuentes MDC(1), Simón Márquez 
MDM(1), Méndez Mateo I(2), Barragán Martín AB(1), Gázquez Linares JJ(3).

Author information:
(1)University of Almería, Almeria, Andalucía, Spain.
(2)Universidad de Murcia, Murcia, Spain.
(3)Universidad Autónoma de Chile, Temuco, Chile.

Comment on
    Lancet Reg Health Eur. 2021 Mar;2:100020.

Studies have shown that COVID-19 has had a worldwide psychological impact. 
Confinement due to COVID-19 has had important repercussions on the mental health 
of the general population, with high levels of stress, anxiety, depressive 
symptoms, post-traumatic stress disorder, and so forth. Similarly, important 
labor, economic and social changes taking place are affecting people's 
well-being. The objective of this study was to analyze the repercussions of 
perceived threat from COVID-19 on the mental health of the population, and to 
evaluate the mediating role of perceived economic impact. The participants were 
1160 adult residents of Spain aged 18 to 82, 69.9% of whom were women. A 
sociodemographic questionnaire, the Questionnaire on Perception of Threat from 
COVID-19 and the General Health Questionnaire were administered. Perceived 
threat had a positive direct effect on all four health dimensions analyzed. 
Among the indirect effects, the perceived economic impact of COVID-19 mediated 
in the relationship between perceived threat and each of the health dimensions. 
The results of this study have demonstrated the need to promote joint action 
promoting public mental health to minimize the psychological repercussions of 
new outbreaks.

DOI: 10.1177/17579759221102192
PMID: 35879839 [Indexed for MEDLINE]


1756. BMC Pregnancy Childbirth. 2022 Jul 25;22(1):591. doi: 
10.1186/s12884-022-04913-7.

'Beyond the Bump': an online wellbeing and lifestyle pilot program during 
COVID-19 for first year postpartum mothers: a research article.

Christie HE(1)(2), Roach LA(1)(2), Kennedy M(1)(3), Beetham K(4), Meyer 
BJ(1)(2), Schoenaker D(5)(6), Francois M(7)(8).

Author information:
(1)School of Medical, Indigenous and Health Sciences, The University of 
Wollongong, Wollongong, NSW, Australia.
(2)Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia.
(3)Illawarra Diabetes Service, Illawarra and Shoalhaven Local Health District, 
Wollongong, NSW, Australia.
(4)School of Behavioural and Health Sciences, Australian Catholic University, 
Banyo, QLD, Australia.
(5)School of Primary Care, Population Sciences and Medical Education, Faculty of 
Medicine, University of Southampton, Southampton, UK.
(6)NIHR Southampton Biomedical Research Centre, University of Southampton and 
University Hospital Southampton NHS Foundation Trust, Southampton, UK.
(7)School of Medical, Indigenous and Health Sciences, The University of 
Wollongong, Wollongong, NSW, Australia. francois@uow.edu.au.
(8)Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia. 
francois@uow.edu.au.

Erratum in
    BMC Pregnancy Childbirth. 2022 Oct 7;22(1):753.

BACKGROUND: Establishing a healthy lifestyle post-delivery is pivotal to reduce 
the incidence of chronic diseases. Due to COVID-19 restrictions, access to 
postpartum health programs has been increasingly difficult. The aim of this 
study was to inform, develop and evaluate Beyond the Bump (BtB); an online 
program to improve access to health and wellbeing education and support for 
physical activity in the postpartum.
METHODS: A three-phase mixed-methods design of a 10-week Australia-wide online 
pilot program during COVID-19 with women less than 1 year postpartum and their 
primary care health professionals was utilised. Phase-one: needs assessment 
focus groups and interviews. Phase-two: BtB program implementation pre-post 
health measures survey, attendance and engagement with the program. Phase-three: 
program evaluation with feedback surveys and interviews.
RESULTS: Women (n = 12) and health professionals (n = 16) expressed strong need 
for a postpartum program with access to education from experts on exercise, 
pelvic floor, sleep and baby nutrition. Despite BtB being developed from women's 
suggestions (including time-of-day 'morning'), attendance to all ten sessions 
was poor (of 162 registrations; 23% participated in the first session and 5% in 
the last session). Barriers to attendance included 'too busy',' forgot' and 
'topic not relevant for age of child'. 88% of women reported the education as 
the most enjoyable component of the program. 100% (n = 26) of women interviewed 
would recommend the program to a friend.
CONCLUSIONS: There is a continuing need for postpartum support. Online programs 
with access to expert education and exercise were reported to be of significant 
interest and value. However, more research is needed to improve the uptake and 
value placed on mothers' wellbeing and physical activity.

© 2022. The Author(s).

DOI: 10.1186/s12884-022-04913-7
PMCID: PMC9310358
PMID: 35879694 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interest.


1757. BMJ Open. 2022 Jul 25;12(7):e062413. doi: 10.1136/bmjopen-2022-062413.

Strategies to mitigate the impact of the COVID-19 pandemic on child and youth 
well-being: a scoping review protocol.

Moss SJ(1), Lorenzetti DL(2), FitzGerald EA(1), Smith S(3), Harley M(4), 
Tutelman PR(5)(6), Birnie K(7), Mizen SJ(1), Anglin MC(8), Stelfox HT(8), Fiest 
KM(8), Parsons Leigh J(9).

Author information:
(1)Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada.
(2)Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
(3)Young Canadians Roundtable on Health, Toronto, Ontario, Canada.
(4)Frayme, Ottawa, Ontario, Canada.
(5)Department of Psychology and Neuroscience, Dalhousie University, Halifax, 
Nova Scotia, Canada.
(6)Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, 
Canada.
(7)Departments of Anesthesiology, Perioperative and Pain Medicine and Community 
Health Sciences, University of Calgary, Calgary, Alberta, Canada.
(8)Critical Care Medicine, University of Calgary Cumming School of Medicine, 
Calgary, Alberta, Canada.
(9)Department of Medicine, Schulich School of Medicine and Dentistry, Western 
University, London, Ontario, Canada j.parsonsleigh@dal.ca.

INTRODUCTION: Children and youth are often more vulnerable than adults to 
emotional impacts of trauma. Wide-ranging negative effects (eg, social 
isolation, lack of physical activity) of the COVID-19 pandemic on children and 
youth are well established. This scoping review will identify, describe and 
categorise strategies taken to mitigate potentially deleterious impacts of the 
COVID-19 pandemic on children, youth and their families.
METHODS AND ANALYSIS: We will conduct a scoping review following the 
Arksey-O'Malley five-stage scoping review method and the Scoping Review Methods 
Manual by the Joanna Briggs Institute. Well-being will be operationalised 
according to pre-established domains (health and nutrition, connectedness, 
safety and support, learning and competence, and agency and resilience). 
Articles in all languages for this review will be identified in CINAHL, Cochrane 
CENTRAL Register of Controlled Trials, EMBASE, ERIC, Education Research 
Complete, MEDLINE and APA PsycINFO. The search strategy will be restricted to 
articles published on or after 1 December 2019. We will include primary 
empirical and non-empirical methodologies, excluding protocols, reports, 
opinions and editorials, to identify new data for a broad range of strategies to 
mitigate potentially deleterious impacts of the COVID-19 pandemic on child and 
youth well-being. Two reviewers will calibrate screening criteria and the data 
abstraction form and will independently screen records and abstract data. Data 
synthesis will be performed according to the convergent integrated approach 
described by the Joanna Briggs Institute.
ETHICS AND DISSEMINATION: Ethical approval is not applicable as this review will 
be conducted on published data. Findings of this study will be disseminated at 
national and international conferences and will inform our pan-Canadian 
multidisciplinary team of researchers, public, health professionals and 
knowledge users to codesign and pilot test a digital psychoeducational health 
tool-an interactive, web-based tool to help Canadian youth and their families 
address poor mental well-being resulting from and persisting beyond the COVID-19 
pandemic.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2022-062413
PMCID: PMC9327437
PMID: 35879014 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


1758. J Affect Disord. 2022 Oct 1;314:357-364. doi: 10.1016/j.jad.2022.07.022. Epub 
2022 Jul 22.

Testing positive, losing a loved one, and financial hardship: Real-world impacts 
of COVID-19 on US college student distress.

ElTohamy A(1), Hyun S(2), Macaranas AR(3), Chen JA(4), Stevens C(5), Liu CH(6).

Author information:
(1)Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA; Department of 
Psychiatry, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115, 
USA.
(2)Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 
Boston, MA 02115, USA.
(3)Harvard University, Cambridge, MA 02138, USA.
(4)Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA; Department of 
Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA.
(5)Department of Psychology, Willamette University, Salem, OR 97301, USA.
(6)Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA; Department of 
Psychiatry, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115, 
USA; Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 
Boston, MA 02115, USA. Electronic address: chliu@bwh.harvard.edu.

BACKGROUND: The COVID-19 pandemic has taken a particularly heavy toll on U.S. 
college students. In addition to facing academic-related stress and social 
pressures, these individuals are now increasingly susceptible to experiences 
such as contracting the virus, losing loved ones to COVID-19, or facing 
financial hardship due to the pandemic. The effects of such personal, 
pandemic-related experiences on young adult mental health - and the inherent 
racial disparities within these outcomes - remain largely understudied.
METHODS: We analyzed 65,568 undergraduate students from the Spring 2021 American 
College Health Association-National College Health Assessment (ACHA-NCHA).
RESULTS: The rates of the aforementioned COVID-19-related stressors were 
unevenly distributed across racial groups. A logistic regression analysis to 
identify predictors of moderate and serious psychological distress revealed that 
participants who had experienced the death of a loved one had 1.14 times greater 
odds of developing psychological distress (p < 0.0001). Those who experienced 
financial hardship had an odds ratio of 1.78 (p < 0.0001). Surprisingly, testing 
positive for COVID-19 was associated with an odds ratio of 0.82 of psychological 
distress (p < 0.0001).
LIMITATIONS: Self-reported measures are susceptible to recall bias and 
misinterpretation. Exposure and outcome variables were measured simultaneously 
in this cross-sectional study which limits inference on causality.
CONCLUSIONS: Financial burdens and bereavement are especially impactful 
stressors among college students during the pandemic, whereas contracting 
COVID-19 seemingly exhibits less impact on distress levels. When addressing 
student wellbeing, institutions should consider prioritizing the implementation 
of resources to support individuals affected by pandemic-related financial and 
familial losses.

Copyright © 2022 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2022.07.022
PMCID: PMC9304338
PMID: 35878829 [Indexed for MEDLINE]


1759. PLoS One. 2022 Jul 25;17(7):e0271687. doi: 10.1371/journal.pone.0271687. 
eCollection 2022.

Parent and child mental health during COVID-19 in Australia: The role of pet 
attachment.

Bennetts SK(1)(2), Crawford SB(1), Howell TJ(3), Burgemeister F(1), Chamberlain 
C(1)(4), Burke K(5), Nicholson JM(1).

Author information:
(1)Judith Lumley Centre, La Trobe University, Melbourne, Australia.
(2)Intergenerational Health Group, Murdoch Children's Research Institute, 
Melbourne, Australia.
(3)Anthrozoology Research Group, School of Psychology and Public Health, La 
Trobe University, Bendigo, Victoria, Australia.
(4)NGANGK YIRA: Murdoch University Research Centre for Aboriginal Health and 
Social Equity, Perth, Australia.
(5)Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, 
Queensland, Australia.

Restrictions, social isolation, and uncertainty related to the global COVID-19 
pandemic have disrupted the ways that parents and children maintain family 
routines, health, and wellbeing. Companion animals (pets) can be a critical 
source of comfort during traumatic experiences, although changes to family 
routines, such as those caused by COVID-19, can also bring about challenges like 
managing undesirable pet behaviours or pet-human interactions. We aimed to 
examine the relationship between pet attachment and mental health for both 
parents and their children during the COVID-19 pandemic in Australia. A total of 
1,034 parents living with a child under 18 years and a cat or dog completed an 
online cross-sectional survey between July and October 2020. Path analysis using 
multivariate linear regression was conducted to examine associations between 
objective COVID-19 impacts, subjective worry about COVID-19, human-pet 
attachment, and mental health. After adjusting for core demographic factors, 
stronger pet-child attachment was associated with greater child anxiety 
(parent-reported, p < .001). Parent-pet attachment was not associated with 
self-reported psychological distress (p = .42), however, parents who reported a 
strong emotional closeness with their pet reported greater psychological 
distress (p = .002). Findings highlight the role of pets during times of change 
and uncertainty. It is possible that families are turning to animals as a source 
of comfort, during a time when traditional social supports are less accessible. 
Alternatively, strong pet attachment is likely to reflect high levels of 
empathy, which might increase vulnerability to psychological distress. 
Longitudinal evidence is required to delineate the mechanisms underpinning pet 
attachment and mental health.

DOI: 10.1371/journal.pone.0271687
PMCID: PMC9312405
PMID: 35877660 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


1760. Front Public Health. 2022 Jul 8;10:907797. doi: 10.3389/fpubh.2022.907797. 
eCollection 2022.

Psychological Wellbeing and Employability of Retrenched Workforce During 
COVID-19: A Qualitative Study Exploring the Mitigations for Post Pandemic 
Recovery Phase.

Ke GN(1), Grajfoner D(2), Carter S(3), DeLima N(1), Khairudin R(4), Lau WY(5), 
Kamal KA(6), Lee SC(6).

Author information:
(1)Department of Psychology, School of Social Sciences, Heriot-Watt University 
Malaysia, Putrajaya, Malaysia.
(2)Department of Psychology, School of Social Sciences, Heriot-Watt University, 
Edinburgh, United Kingdom.
(3)Edinburgh Business School, Heriot-Watt University, Edinburgh, United Kingdom.
(4)Centre for Research in Psychology and Human Well-Being, Faculty of Social 
Sciences and Humanities, National University of Malaysia, Bangi, Malaysia.
(5)Department of Applied Statistics, Faculty of Economics and Administration, 
University of Malaya, Kuala Lumpur, Malaysia.
(6)Malaysian Institute of Economic Research (MIER), Kuala Lumpur, Malaysia.

The ongoing COVID-19 pandemic has triggered several employment-related issues, 
followed by different response strategies. With retrenchment measures being a 
common response strategy during economic downturns, many individuals have been 
faced with unemployment. This study aimed to explore the effect of the COVID-19 
pandemic related retrenchment on the psychological wellbeing of the Malaysian 
workforce, using a qualitative research approach and based on the 
Latent-deprivation Model. A purposive sample of 30 retrenched participants was 
interviewed via telephone during Malaysia's Movement Control Order (MCO). 
Thematic analysis was subsequently conducted to identify key themes in the data 
set. Six themes emerged from the thematic analysis: (1) Retrenchment leading to 
the deterioration of psychological wellbeing; (2) Unemployment, financial strain 
and economic uncertainty; (3) Emotions related to the COVID-19 virus; (4) Coping 
with lifestyle change; (5) Recommendations to improve the psychological 
wellbeing and mental health of the retrenched workforce, and (6) Career and 
financial support at the recovery phase. The present study provides valuable 
insight into the wellbeing of retrenched workforce who are forced to cope with 
both unemployment and a global pandemic, and workforce perspectives regarding 
types of support needed during the recovery phase.

Copyright © 2022 Ke, Grajfoner, Carter, DeLima, Khairudin, Lau, Kamal and Lee.

DOI: 10.3389/fpubh.2022.907797
PMCID: PMC9304802
PMID: 35875037 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1761. J Glob Health. 2022 Jul 25;12:05028. doi: 10.7189/jogh.12.05028.

Prevalence of depression, anxiety, and stress among first responders for medical 
emergencies during COVID-19 pandemic: A meta-analysis.

Huang G(1)(2)(3), Chu H(4)(5), Chen R(6)(7)(8), Liu D(8)(9)(10), Banda 
KJ(8)(11), O'Brien AP(12)(13), Jen HJ(6)(8), Chiang KJ(8)(14)(15), Chiou 
JF(16)(17), Chou KR(6)(8)(10)(18)(19).

Author information:
(1)School of Health Care Administration, College of Management, Taipei Medical 
University, Taipei, Taiwan.
(2)Australasian College of Paramedicine, Australia.
(3)Australian Institute of Project Management, Australia.
(4)Institute of Aerospace and Undersea Medicine, School of Medicine, National 
Defense Medical Center, Taipei, Taiwan.
(5)Department of Neurology, Tri-Service General Hospital, National Defense 
Medical Center, Taipei, Taiwan.
(6)Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New 
Taipei, Taiwan.
(7)Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical 
University, Taipei, Taiwan.
(8)School of Nursing, College of Nursing, Taipei Medical University, Taipei, 
Taiwan.
(9)Department of Nursing, Wan Fang Hospital, Taipei Medical University.
(10)Center for Nursing and Healthcare Research in Clinical Practice Application, 
Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
(11)Endoscopy Unit, Surgery Department, Kamuzu Central Hospital, Lilongwe, 
Malawi.
(12)Clinical Nursing, Centre for Practice Opportunity and Development, 
Australia.
(13)School of Nursing and Midwifery, Peninsula campus, Monash University, 
Frankston, Victoria, Australia.
(14)Department of Nursing, Tri-Service General Hospital Taipei, Taiwan.
(15)School of Nursing, National Defense Medical Center, Taipei, Taiwan.
(16)Department of Radiology, School of Medicine, College of Medicine, Taipei 
Medical University, Taipei, Taiwan.
(17)Department of Radiation Oncology, Taipei Medical University Hospital, 
Taipei, Taiwan.
(18)Psychiatric Research Center, Taipei Medical University Hospital, Taipei, 
Taiwan.
(19)Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan.

BACKGROUND: The COVID-19 pandemic has been shown to cause enormous psychological 
burden among health care workers, including first responders. However, 
psychological well-being of first responders, essential in the fight against 
COVID-19 pandemic, has often been ignored. We performed the first meta-analysis 
to explore the prevalence of 1) depression, 2) anxiety, and 3) stress among 
first responders for medical emergencies during the COVID-19 pandemic.
METHODS: A comprehensive search was conducted in Embase, CINAHL, Web of Science, 
PsychInfo, PubMed, and the WHO COVID-19 database from 2020. The Freeman-Tukey 
double-arcsine transformation model in R-software determined the pooled 
prevalence and Comprehensive Meta-Analysis for associated factors of depression, 
anxiety, and stress with corresponding 95% confidence intervals (CI). The 
Cochrane Q, τ2, and I2 statistics were used to examine heterogeneity. Sub-group 
analysis was conducted to identify moderator variables.
RESULTS: We identified 765 records, from which 17 studies were included with 
8096 first responders. The pooled prevalence was 31% (95% CI = 21%-41%) for 
depression; 67% (95% CI = 64%-70%) for mild depression, 24% (95% CI = 17%-31%) 
for moderate depression, and 16% (95% CI = 4%-34%) for severe depression. The 
pooled prevalence for anxiety was 32% (95% CI = 20%-44%); 60% (95% CI = 46%-73%) 
for mild anxiety, 27% (95% CI = 14%-42%) for moderate anxiety, and 14% (95% 
CI = 7%-22%) for severe anxiety. The pooled prevalence for stress was 17% (95% 
CI = 4%-34%); 58% (95% CI = 38%-77%) for mild stress, 22% (95% CI = 5%-44%) for 
moderate stress, and 19% (95% CI = 5%-37%) for severe stress. The prevalence of 
depression was 37% (95% CI = 25%-52%) for paramedics, 28% (95% CI = 12%-54%) for 
EMS personnel and 22% (95% CI = 13%-33%) for police. Similarly, the prevalence 
of anxiety was 38% (95% CI = 20%-60%) for paramedics, 28% (95% CI = 11%-53%) for 
EMS personnel, and 19% (95% CI = 10%-32%) for police. Married responders were 
likely at risk for depression (1.50, 95% CI = 1.26-1.78) and anxiety (1.94, 95% 
CI = 1.62-2.33), while unmarried responders were less likely at risk for 
depression (0.67, 95% CI = 0.56-0.79) and anxiety (0.50, 95% CI = 0.43-0.63).
CONCLUSIONS: High prevalence of depression, anxiety, and stress during the 
COVID-19 pandemic among first responders for medical emergencies emphasizes the 
need for monitoring their psychological well-being. Early assessment and 
management of mild depression, anxiety, and stress among first responders are 
crucial in preventing progression into moderate and severe types.

Copyright © 2022 by the Journal of Global Health. All rights reserved.

DOI: 10.7189/jogh.12.05028
PMCID: PMC9309001
PMID: 35871411 [Indexed for MEDLINE]

Conflict of interest statement: Disclosure of interest: The authors completed 
the ICMJE Declaration of Interest Form (available upon request from the 
corresponding author) and declare no relevant interests.


1762. J Clin Nurs. 2024 Jan;33(1):368-380. doi: 10.1111/jocn.16467. Epub 2022 Jul 24.

The impact of COVID-19 on nurse alcohol consumption: A qualitative exploration.

Searby A(1), Burr D(1), Redley B(1).

Author information:
(1)Deakin University, Institute for Health Transformation, School of Nursing & 
Midwifery, Geelong, Australia.

AIMS AND OBJECTIVES: To explore the long-term impact of the COVID-19 pandemic on 
nurse alcohol consumption.
BACKGROUND: The COVID-19 pandemic has caused immense disruption to healthcare 
services worldwide, and nurses have not been immune, experiencing burnout, 
declining mental health and ultimately, attrition from the profession. Increases 
in alcohol consumption have been reported across subsections of society, 
including those with pre-existing mental ill health and experiencing high 
stress, and exploring this phenomenon in nurses is essential for workforce 
well-being and sustainability.
DESIGN: Qualitative descriptive study design.
METHODS: Secondary analysis of individual, semi-structured interviews with 
nurses (N = 42) from diverse settings across Australia, including community, 
primary and hospital settings, conducted in July and August 2021. Data were 
analysed using structural coding and reported in accordance with the CORE-Q 
guidelines.
FINDINGS: Two key themes were found after analysis of the data: (1) factors 
influencing alcohol consumption (subthemes: workplace factors and external 
factors), and (2) the pandemic's influence on alcohol consumption (subthemes: 
increased consumption, moderation of consumption and alcohol as a reward).
CONCLUSIONS: Several participants described increased alcohol consumption 
because of the COVID-19 pandemic, particularly due to the stress of working in 
an environment where resources were scarce. Workplace factors such as overtime, 
missed breaks and heightened workload were all described as driving stress, and 
in turn increased alcohol consumption.
RELEVANCE TO CLINICAL PRACTICE: Increased alcohol consumption has been 
associated with burnout, absenteeism and intention to leave. The nursing 
profession is currently undergoing significant continuing stress providing care 
and management to patients with the SARS-CoV-2 virus, and increased alcohol 
consumption is a significant threat to personal and workforce well-being, 
workforce sustainability and quality nursing care.

© 2022 The Authors. Journal of Clinical Nursing published by John Wiley & Sons 
Ltd.

DOI: 10.1111/jocn.16467
PMCID: PMC9350011
PMID: 35871283 [Indexed for MEDLINE]

Conflict of interest statement: None to declare. No external funding was 
received by any authors for this study.


1763. BMC Psychiatry. 2022 Jul 23;22(1):495. doi: 10.1186/s12888-022-04144-2.

The impact of the COVID-19 pandemic on the mental health of children with 
psychiatric diagnoses - multidimensional CCPCA Model.

Kalenik AM(1), Topolski M(2), Górnik J(3), Wolańczyk T(3).

Author information:
(1)Department of Child Psychiatry, Medical University of Warsaw, Żwirki i Wigury 
63A, 02-191, Warsaw, Poland. anna.kalenik@uckwum.pl.
(2)Faculty of Information and Communication Technology, Wrocław University of 
Science and Technology, Wybrzeże Wyspiańskiego 27, 50-370, Wroclaw, Poland.
(3)Department of Child Psychiatry, Medical University of Warsaw, Żwirki i Wigury 
63A, 02-191, Warsaw, Poland.

BACKGROUND: The study aimed to assess the severity of symptoms of anxiety and 
depression in children with previously diagnosed psychiatric disorders during 
the COVID-19 pandemic in Poland.
METHODS: Online questionnaires were used to investigate three groups of 
subjects: patients with a psychiatric diagnosis, primary school pupils, and 
children from children's homes. A total of 167 children with their parents or 
guardians participated in the study. In addition to basic statistics, a 
multidimensional Centroid Class Principal Component Analysis (CCPCA) model was 
used.
RESULTS: It was found that the strongest fear of the coronavirus was experienced 
by children from children's homes, while the most severe depressive symptoms and 
state anxiety were observed among patients diagnosed with psychiatric disorders. 
Parental care by assisting with school education and lack of close contact with 
other people (less than two metres) at parents/guardians' work had the most 
potent protective effect in reducing the fear of COVID-19.
CONCLUSIONS: There is a need for further research in children and adolescents to 
develop effective strategies for protecting their mental well-being when faced 
with social isolation or disease.

© 2022. The Author(s).

DOI: 10.1186/s12888-022-04144-2
PMCID: PMC9308485
PMID: 35870970 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1764. J Gerontol B Psychol Sci Soc Sci. 2022 Dec 29;77(12):e203-e215. doi: 
10.1093/geronb/gbac098.

Racial Differences in the Dementia Caregiving Experience During the COVID-19 
Pandemic: Findings From the National Health and Aging Trends Study (NHATS).

Moon HE(1), Rote SM(1), Sears J(2), Schepens Niemiec SL(3).

Author information:
(1)Kent School of Social Work & Family Science, University of Louisville, 
Kentucky, USA.
(2)Department of Human Services, Bowling Green State University, Ohio, USA.
(3)Chan Division of Occupational Science and Occupational Therapy, University of 
Southern California, California, USA.

OBJECTIVES: Given racial disparities in both dementia and coronavirus disease 
2019 (COVID-19), non-Hispanic Black (Black) dementia caregivers (CGs) may be at 
greater risk for care burden during the COVID-19 pandemic than non-Hispanic 
White (White) CGs. This study investigates the impact of dementia care provision 
on CGs' quality of life by race using the 2020 National Health and Aging Trends 
Study Family Members and Friends COVID-19 data (FF).
METHODS: This study features a secondary analysis of FF data (2020-2021), 
including 216 Black and 1,204 White CGs. We used ANOVA to determine differences 
in caregiving stressors (i.e., changes in providing help with activities of 
daily living [ADL], instrumental ADL [IADL], and emotional support). Ordinary 
least square regression was used to investigate the moderating effects of 
dementia care on the associations of race with perceived well-being, care 
burden, and self-reported health and to conduct subgroups analyses of Black and 
White dementia CGs.
RESULTS: Black dementia CGs provided significantly more help with ADL before and 
during the COVID-19 pandemic than Black nondementia, White dementia, and White 
nondementia CGs. Dementia care status did not moderate the associations between 
race and CG outcomes. For Black dementia CGs, changes in objective stressors 
(assistance with ADL and IADL) were associated with care burden and well-being. 
For White CGs, the provision of emotional support was associated with care 
burden and well-being.
DISCUSSION: This study highlights that increased caregiving demands during the 
pandemic amplified racial differences in CG stress. Findings suggest that 
outreach to reduce CG stress and burden is critical for Black dementia CGs.

© The Author(s) 2022. Published by Oxford University Press on behalf of The 
Gerontological Society of America. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/geronb/gbac098
PMCID: PMC9384524
PMID: 35869747 [Indexed for MEDLINE]


1765. J Clin Nurs. 2024 Jan;33(1):273-287. doi: 10.1111/jocn.16451. Epub 2022 Jul 22.

The insomnia, fatigue, and psychological well-being of hospital nurses 18 months 
after the COVID-19 pandemic began: A cross-sectional study.

Sagherian K(1), Cho H(2), Steege LM(2).

Author information:
(1)College of Nursing, The University of Tennessee Knoxville, Knoxville, 
Tennessee, USA.
(2)School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA.

Comment in
    J Clin Nurs. 2023 Dec;32(23-24):8155.

BACKGROUND: Research has shown sleep problems, elevated fatigue, and high cases 
of burnout, as well as signs of post-traumatic stress and psychological distress 
among nurses during the COVID-19 pandemic. Many US hospitals attempted to 
minimise its impact on staff by providing basic resources, mental health 
services, and wellness programs. Therefore, it is critical to re-evaluate these 
well-being indices and guide future administrative efforts.
PURPOSE: To determine the long-term impact of the COVID-19 pandemic after 
18 months on hospital nurses' insomnia, fatigue, burnout, post-traumatic stress, 
and psychological distress.
DESIGN: Cross-sectional.
METHODS: Data were collected online mainly through state board and nursing 
association listservs between July-September 2021 (N = 2488). The survey had 
psychometrically tested instruments (Insomnia Severity Index, Occupational 
Fatigue Exhaustion Recovery Scale, Maslach Burnout Inventory, Short 
Post-Traumatic Stress Disorder, and Patient Health Questionnaire-4) and sections 
on demographics, health, and work. The STrengthening the Reporting of 
Observational studies in Epidemiology checklist was followed for reporting.
RESULTS: Nurses had subthreshold insomnia, moderate-to-high chronic fatigue, 
high acute fatigue, and low-to-moderate intershift recovery. Regarding burnout, 
they experienced increased emotional exhaustion and personal accomplishment, and 
some depersonalisation. Nurses had mild psychological distress but scored high 
on post-traumatic stress. Nurses who frequently cared for patients with COVID-19 
in the past months scored significantly worse in all measures than their 
co-workers. Factors such as nursing experience, shift length, and frequency of 
rest breaks were significantly related to all well-being indices.
CONCLUSION: Nurses' experiences were similar to findings from the early pandemic 
but with minor improvements in psychological distress. Nurses who frequently 
provided COVID-19 patient care, worked ≥12 h per shift, and skipped rest breaks 
scored worse on almost all well-being indices.
RELEVANCE TO CLINICAL PRACTICE: Administration can help nurses' recovery by 
providing psychological support, mental health services, and treatment options 
for insomnia, as well as re-structure current work schedules and ensure that 
rest breaks are taken.

© 2022 The Authors. Journal of Clinical Nursing published by John Wiley & Sons 
Ltd.

DOI: 10.1111/jocn.16451
PMCID: PMC9349539
PMID: 35869416 [Indexed for MEDLINE]

Conflict of interest statement: No conflict of interest has been declared by the 
authors.


1766. Health Policy. 2022 Sep;126(9):865-871. doi: 10.1016/j.healthpol.2022.07.001. 
Epub 2022 Jul 10.

Effect of the COVID-19 pandemic on depression in older adults: A panel data 
analysis.

Gaggero A(1), Fernández-Pérez Á(2), Jiménez-Rubio D(3).

Author information:
(1)Department of Quantitative Methods for Economics and Business, University of 
Granada, Campus Universitario de Cartuja, Granada 18071, Spain.
(2)Department of Applied Economics, University of Granada, Campus Universitario 
de Cartuja, Granada 18071, Spain.
(3)Department of Applied Economics, University of Granada, Campus Universitario 
de Cartuja, Granada 18071, Spain. Electronic address: dolores@ugr.es.

BACKGROUND: This paper investigates the impact of the COVID-19 pandemic on 
depression in the older population, an especially vulnerable group for which to 
date there is limited empirical research.
METHODS: We employ a panel data consisting of seven waves of the English 
Longitudinal Study of Ageing (2010-2020). The breadth and depth of the data 
considered enabled us to control for individual fixed effects, to adjust for 
pre-pandemic trends in depression levels and to perform a heterogeneity 
analysis, depending on the intensity of the lockdown measures implemented and 
relevant socioeconomic characteristics.
RESULTS: We find that, following the COVID-19 pandemic, study participants 
reported a statistically significant increase in the depressive symptoms by 
around 0.7 over 8 points as measured by the Centre for Epidemiologic Studies 
Depression (CES-D) index. The estimated coefficients were larger in November 
than in July, for individuals who lost their job, retired and women. 
Interestingly, we observed that mental health has worsened substantially 
relative to the pre-pandemic period across all income groups of the older 
population, suggesting a limited role of income as a protective mechanism for 
mental health.
CONCLUSIONS: Our findings provide compelling evidence that depression levels 
amongst older adults have worsened considerably following the COVID-19 pandemic, 
and that factors other than income, such as social interactions, may be highly 
relevant for well-being in later life.

Copyright © 2022. Published by Elsevier B.V.

DOI: 10.1016/j.healthpol.2022.07.001
PMCID: PMC9271012
PMID: 35868871 [Indexed for MEDLINE]

Conflict of interest statement: None.


1767. J Youth Adolesc. 2022 Nov;51(11):2173-2189. doi: 10.1007/s10964-022-01656-8. 
Epub 2022 Jul 22.

Promoting Daily Well-being in Adolescents using mHealth.

Mens MMJ(1)(2), Keijsers L(3), Dietvorst E(4), Koval S(4), Legerstee JS(4), 
Hillegers MHJ(4).

Author information:
(1)Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC 
University Medical Center Rotterdam, Rotterdam, The Netherlands. 
mmens@hsph.harvard.edu.
(2)Department of Epidemiology, Harvard T.H. Chan School of Public Health, 
Boston, MA, USA. mmens@hsph.harvard.edu.
(3)Department of Psychology, Education & Child Studies/Clinical Child and Family 
Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands.
(4)Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC 
University Medical Center Rotterdam, Rotterdam, The Netherlands.

Adolescents are at increased risk for developing mental health problems. The 
Grow It! app is an mHealth intervention aimed at preventing mental health 
problems through improving coping by cognitive behavioral therapy (CBT)-inspired 
challenges as well as self-monitoring of emotions through Experience Sampling 
Methods (ESM). Yet, little is known about daily changes in well-being and coping 
during a stressful period, like the COVID-19 pandemic. The current study aimed 
to elucidate daily changes in positive and negative affect, and adaptive coping, 
and to better understand the within-person's mechanisms of the Grow It! app. The 
sample consisted of 12-25-year old Dutch adolescents in two independent cohorts 
(cohort 1: N = 476, Mage = 16.24, 76.1% female, 88.7% Dutch; cohort 2: N = 814, 
Mage = 18.45, 82.8% female, 97.2% Dutch). ESM were used to measure daily 
positive and negative affect and coping (cohort 1: 42 days, 210 assessments per 
person; cohort 2: 21 days, 105 assessments). The results showed that, on 
average, adolescents decreased in daily positive affect and adaptive coping, and 
increased in their experienced negative affect. A positive relation between 
adaptive coping and positive affect was found, although independent of the 
CBT-based challenges. Latent class analysis identified two heterogeneous 
trajectories for both positive and negative affect, indicating that the majority 
of participants with low to moderate-risk on developing mental health problems 
were likely to benefit from the Grow It! app.

© 2022. The Author(s).

DOI: 10.1007/s10964-022-01656-8
PMCID: PMC9306228
PMID: 35867325 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1768. Front Public Health. 2022 Jul 4;10:913126. doi: 10.3389/fpubh.2022.913126. 
eCollection 2022.

Characteristics of Hospital Workers Using a Wellbeing Center Implemented During 
the COVID-19 Pandemic to Prevent the Emotional Impacts of the Crisis.

d'Ussel M(1), Adam F(2), Fels A(3), Chatellier G(3)(4), Philippart F(5).

Author information:
(1)Chronic Pain Unit, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
(2)Department of Anesthesia, Groupe Hospitalier Paris Saint-Joseph, Paris, 
France.
(3)Clinical Research Department, Groupe Hospitalier Paris Saint-Joseph, Paris, 
France.
(4)Université Paris Cité, Paris, France.
(5)Department of Intensive Care Medicine and Reanimation, Groupe Hospitalier 
Paris Saint-Joseph, Paris, France.

INTRODUCTION: The COVID-19 pandemic has posed an unprecedented challenge 
worldwide for healthcare workers (HCWs) and other hospital employees. 
Disruptions in work and personal life may have led to mental health problems. To 
prevent or limit the severity of such issues, a local initiative has been 
implemented in a French hospital: a dedicated lounge, also called "Bulle" 
(literally bubble and meaning safe space) has been created to provide a quiet 
caring environment and health support. Other similar wellbeing centers have been 
implemented in other countries, but very little data are available on their 
practical effectiveness. The purpose of our study was to assess what type of 
hospital workers have frequented the Bulle and to describe their psychological 
state in terms of anxiety, depression, and post-traumatic stress disorder (PTSD) 
just after the first wave, compared to those who had not come to the Bulle.
METHODS: From 15 July to 1 October 2020, a cross-sectional survey was conducted 
among all workers, collecting demographic information, professional data 
(experience and satisfaction), emotional experience during the first wave of 
COVID-19, and psychological specificities, including a history of burnout or 
symptoms of anxiety, depression, and PTSD. We asked them if they had accessed 
the Bulle or not.
RESULTS: A total of 675 employees (out of 2,408; 28.0%) fully completed the 
survey. Approximately 199 respondents (29%) reported having accessed the Bulle 
during the first wave of the pandemic. Significant symptoms of anxiety, 
depression, and PTSD were reported by, respectively, 41, 20, and 14% of the 
participants. Logistic regression analysis showed no relationship between the 
use of the Bulle and the prevalence of later psychological symptoms. However, 
employees who benefit from the solicitation of the psychological support team in 
their hospital unit were secondarily more prone to come to the Bulle [odds ratio 
(OR), 2.24; 95% confidence interval (95% CI): 1.09; 4.59].
CONCLUSION: Anxiety, depression, and PTSD were common after the first part of 
the COVID-19 pandemic, and the attendance in quiet and wellbeing spaces seemed 
easier with direct internal proactive intervention by psychological teams.

Copyright © 2022 d'Ussel, Adam, Fels, Chatellier and Philippart.

DOI: 10.3389/fpubh.2022.913126
PMCID: PMC9289445
PMID: 35859769 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1769. Indian J Med Res. 2022 Jan;155(1):197-199. doi: 10.4103/ijmr.ijmr_1034_21.

Learning from telepsychiatry during COVID-19 pandemic in India: Boon for public 
mental health in low- & middle-income countries.

Ganesh R(1), Verma R(1), Deb KS(1), Chadda RK(1).

Author information:
(1)Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, 
India.

Novel coronavirus disease (COVID-19) pandemic has affected the mental well-being 
of the population and posed many challenges in availing mental healthcare. 
Telepsychiatry has been proven to be an effective route for the delivery of 
mental healthcare. We share our experience of using the telemedicine approach in 
providing mental health services at a tertiarycare hospital in India during the 
COVID-19 pandemic, following the break in routine outpatient services during the 
national lockdown. The telepsychiatry approach helped in ensuring the 
maintenance of mental healthcare. The utility of telepsychiatry as an option for 
such future situations and for its use in routine follow up care in indicated 
cases, have also been discussed.

DOI: 10.4103/ijmr.ijmr_1034_21
PMCID: PMC9552382
PMID: 35859444 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None.


1770. BMC Public Health. 2022 Jul 20;22(1):1396. doi: 10.1186/s12889-022-13761-1.

Public health emergency and psychological distress among healthcare workers: a 
scoping review.

Palmer J(1), Ku M(2), Wang H(2), Crosse K(3), Bennett A(4), Lee E(2), Simmons 
A(3), Duffy L(2), Montanaro J(2), Bazaid K(5).

Author information:
(1)Co-Primary Investigator, Royal Ottawa Mental Health Centre, Ottawa, ON, 
Canada.
(2)Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
(3)Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
(4)School of Epidemiology and Public Health, Faculty of Medicine, University of 
Ottawa, Ottawa, ON, Canada.
(5)Co-Primary Investigator, Royal Ottawa Mental Health Centre, Ottawa, ON, 
Canada. khalid.bazaid@theroyal.ca.

BACKGROUND: Pandemics and natural disasters are immensely stressful events for 
frontline healthcare workers, as they provide patient care to a population 
undergoing the impacts of the disaster while experiencing such impacts to their 
personal lives themselves. With increased stressors to an already demanding job, 
frontline healthcare workers are at a higher risk of adverse effects to their 
mental health. The current COVID-19 pandemic has already shown to have had 
significant impact on the mental health of healthcare workers with increased 
rates of burnout, anxiety and depression. There is already literature showing 
the utility of individual programs at improving mental health, however, 
interventions at the organizational level are not well explored. This scoping 
review aims to provide an overview and determine the utility of a systematic 
review of the current body of literature assessing the effectiveness of mental 
health interventions at the organizational level for healthcare workers during 
or after a public health emergency.
METHODS: Electronic databases such as Medline on OVID, CENTRAL, PsycINFO on OVID 
and Embase on OVID were searched. A targeted search of the grey literature was 
conducted to identify any non-indexed studies. The population, concept and 
context approach was used to develop the eligibility criteria. Articles were 
included if (1) they assessed the impact of interventions to improve wellbeing 
or reduce the distress on healthcare personnel, first responders or military 
actively providing medical care; (2) provided quantitative or qualitative data 
with clearly defined outcomes that focused on established mental health 
indicators or qualitative descriptions on distress and wellbeing, validated 
scales and workplace indicators; (3) focused on organizational level 
interventions that occurred in a public health crisis.
RESULTS: The literature search resulted in 4007 citations and 115 potentially 
relevant full-text papers. All except 5 were excluded. There were four review 
articles and one experimental study. There were no other unpublished reports 
that warranted inclusion.
CONCLUSIONS: There is a distinct lack of research examining organizational 
interventions addressing mental resilience and well-being in healthcare workers 
in disaster settings. A systematic review in this area would be low yield. There 
is a clear need for further research in this area.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-13761-1
PMCID: PMC9299961
PMID: 35858867 [Indexed for MEDLINE]

Conflict of interest statement: Not applicable.


1771. Qual Life Res. 2022 Nov;31(11):3229-3239. doi: 10.1007/s11136-022-03184-1. Epub 
2022 Jul 20.

Functional and psychosocial impact of COVID-19 pandemic on rheumatic patients' 
quality of life in Saudi Arabia.

Hassen LM(1)(2), Albarrak RA(1), Albahlal RA(1), Alsaqabi DK(3), Hassen IM(4), 
Daghestani MH(2), Alqurtas EM(1), Alkhalaf AT(1), Bedaiwi MK(1), Omair MA(1), 
Almaghlouth IA(5)(6).

Author information:
(1)Department of Medicine, College of Medicine, King Saud University, Riyadh, 
Saudi Arabia.
(2)Department of Zoology, College of Sciences, King Saud University, Riyadh, 
Saudi Arabia.
(3)College of Medicine Research Center, College of Medicine, King Saud 
University, Riyadh, Saudi Arabia.
(4)School of Nursing, University of Maryland, Baltimore, MD, USA.
(5)Department of Medicine, College of Medicine, King Saud University, Riyadh, 
Saudi Arabia. ialmaghlouth@ksu.edu.sa.
(6)College of Medicine Research Center, College of Medicine, King Saud 
University, Riyadh, Saudi Arabia. ialmaghlouth@ksu.edu.sa.

PURPOSE: The COVID-19 pandemic might add to the stressors experienced by people 
living with rheumatic diseases. This study aimed to examine rheumatic patients' 
functional and psychosocial states during the pandemic and assess its impact on 
their quality of life.
METHODS: Our time-series study included a patient-centered electronic survey, 
sampling adult rheumatic patients living in Saudi Arabia at different time 
points from March to August 2020. Patient-reported outcomes included physical 
function, anxiety, depression, fatigue, sleep disturbance, ability to 
participate in social roles, and pain interference domains were measured using 
the Patient-Reported Outcomes Measurement Information System (PROMIS-29 Profile 
v2.1).
RESULTS: A total of 1278 respondents were enrolled. Results showed significant 
variation in patients' experiences. Our analyses revealed that the physical 
well-being of rheumatic patients was significantly impacted, and such effect was 
persistent over time irrespective of public health measures to control the 
COVID-19 outbreak.
CONCLUSION: Our findings consistently demonstrated the need for psychological 
and social consideration to improve rheumatic patients' quality of life. 
Nevertheless, there is still a lot to be learned about the extent of COVID-19 
impact on rheumatic patients and the implications it has on long-term disease 
outcomes.

© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland 
AG.

DOI: 10.1007/s11136-022-03184-1
PMCID: PMC9297668
PMID: 35857205 [Indexed for MEDLINE]

Conflict of interest statement: The authors declared that they have no conflict 
of interest.


1772. Curr Opin Psychiatry. 2022 Sep 1;35(5):311-316. doi: 
10.1097/YCO.0000000000000805. Epub 2022 Jul 18.

The mental health of healthcare workers during the COVID-19 pandemic: a 
narrative review.

De Kock JH(1), Latham HA(2), Cowden RG(3).

Author information:
(1)Department of Clinical Psychology, New Craigs Psychiatric Hospital.
(2)Nairn Town and Country Hospital, NHS Highland, Nairn, UK.
(3)Human Flourishing Program, Harvard University, Cambridge, Massachusetts, USA.

PURPOSE OF REVIEW: Mental health (MH) problems among healthcare workers (HCWs) 
have the potential to impact negatively on the capacity of health systems to 
respond effectively to COVID-19. A thorough understanding of the factors that 
degrade or promote the MH of HCWs is needed to design and implement suitable 
intervention strategies to support the wellbeing of this population.
RECENT FINDINGS: MH problems among HCWs were elevated prior to the COVID-19 
pandemic. Accumulating evidence indicates that this public health crisis has had 
a disproportionately negative impact on the MH of specialised populations, 
including HCWs. Literature from prior health pandemics suggests that the adverse 
effects of the COVID-19 pandemic on the MH of HCWs are likely to persist in the 
aftermath of the public health crisis. Primary and secondary risk factors for 
adverse MH outcomes have been identified and should be considered when 
implementing interventions to protect the MH of HCWs.
SUMMARY: The MH of HCWs has been negatively impacted by the COVID-19 pandemic, 
which is having a detrimental influence on the public health response to 
COVID-19. Protecting the MH of HCWs both during and beyond this public health 
crisis should remain a top priority, with particular emphasis on multifaceted 
interventions that aim to balance the psychological needs of individual HCWs 
with organisational-level strategies that could be targeted to promote their 
wellbeing.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/YCO.0000000000000805
PMID: 35855506 [Indexed for MEDLINE]


1773. Can J Psychiatry. 2023 Jan;68(1):43-53. doi: 10.1177/07067437221111372. Epub 
2022 Jul 19.

"Don't Just Study our Distress, Do Something": Implementing and Evaluating a 
Modified Stepped-Care Model for Health Care Worker Mental Health During the 
COVID-19 Pandemic.

Sheehan KA(1)(2), Schulz-Quach C(1)(2)(3), Ruttan LA(4)(5), MacGillivray 
L(1)(2), McKay MS(4), Seto A(2), Li A(4)(6), Stewart DE(1)(2), Abbey SE(1)(2), 
Berkhout SG(1)(2).

Author information:
(1)Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
(2)Centre for Mental Health, 7989University Health Network, Toronto, Ontario, 
Canada.
(3)Princess Margaret Cancer Centre, 7989University Health Network, Toronto, 
Ontario, Canada.
(4)7961Toronto Rehabilitation Institute, 7989University Health Network, Toronto, 
Ontario, Canada.
(5)Graduate Department of Psychological Clinical Science, 33530University of 
Toronto, Scarborough, Ontario, Canada.
(6)7991York University, Toronto, Ontario, Canada.

OBJECTIVE: Throughout the COVID-19 pandemic, there have been concerns about the 
mental health of health care workers (HCW). Although numerous studies have 
investigated the level of distress among HCW, few studies have explored programs 
to improve their mental well-being. In this paper, we describe the 
implementation and evaluation of a program to support the mental health of HCW 
at University Health Network (UHN), Canada's largest healthcare network.
METHODS: Using a quality improvement approach, we conducted a needs assessment 
and then created and evaluated a modified stepped-care model to address HCW 
mental health during the pandemic. This included: online resources focused on 
psychoeducation and self-management, access to online support and 
psychotherapeutic groups, and self-referral for individual care from a 
psychologist or psychiatrist. We used ongoing mixed-methods evaluation, 
combining quantitative and qualitative analysis, to improve program quality.
RESULTS: The program is ongoing, running continuously throughout the pandemic. 
We present data up to November 30, 2021. There were over 12,000 hits to the 
UHN's COVID mental health intranet web page, which included self-management 
resources and information on group support. One hundred and sixty-six people 
self-referred for individual psychological or psychiatric care. The mean wait 
time from referral to initial appointment was 5.4 days, with an average of seven 
appointments for each service user. The majority had moderate to severe symptoms 
of depression and anxiety at referral, with over 20% expressing thoughts of 
self-harm or suicide. Post-care user feedback, collected through self-report 
surveys and semistructured interviews, indicated that the program is effective 
and valued.
CONCLUSIONS: Development of a high-quality internal mental health support for 
HCW program is feasible, effective, and highly valued. By using early and 
frequent feedback from multiple perspectives and stakeholders to address demand 
and implement changes responsively, the program was adjusted to meet HCW mental 
health needs as the pandemic evolved.

OBJECTIF: Durant la pandémie de la COVID-19, des préoccupations ont été 
soulevées au sujet de la santé mentale des travailleurs de la santé (TLS). Bien 
que de nombreuses études aient investigué le niveau de détresse chez les TLS, 
peu d’entre elles ont exploré les programmes en vue d’améliorer leur bien-être 
mental. Dans le présent article, nous décrivons la mise en œuvre et l’évaluation 
d’un programme de soutien de la santé mentale des TLS au Réseau universitaire de 
santé (RUS), le plus vaste réseau de santé du Canada.
MÉTHODE: À l’aide d’une approche d’amélioration de la qualité, nous avons mené 
une évaluation des besoins puis créé et évalué un modèle modifié de soins 
échelonnés pour aborder la santé mentale des TLS durant la pandémie. Cela 
comportait des ressources en ligne portant sur la psychoéducation et 
l’autogestion, l’accès au soutien en ligne et aux groupes thérapeutiques, et 
l’auto-orientation à des soins individuels d’un psychologue ou d’un psychiatre. 
Nous avons utilisé l’évaluation constante par méthodes mixtes, combinant 
l’analyse quantitative et qualitative, afin d’améliorer la qualité du programme.
RÉSULTATS: Le programme est en cours, et se poursuit continuellement durant la 
pandémie. Nous présentons des données jusqu’au 30 novembre 2021. Il y a eu plus 
de 12,000 visites à la page Web de l’intranet de santé mentale de la COVID du 
RUS, qui comportait des ressources d’autogestion et de l’information sur le 
soutien des groupes. Cent soixante-six personnes se sont auto-orientées à des 
soins psychologiques ou psychiatriques individuels. Le temps d’attente moyen de 
la référence au premier rendez-vous était de 5,4 jours, avec en moyenne 7 
rendez-vous pour chaque utilisateur du service. La majorité avait des symptômes 
de modérés à graves de dépression et d’anxiété à la référence, et plus de 20 % 
exprimaient des idées d’autodestruction ou de suicide. La rétroaction des 
utilisateurs post-soins, recueillie par des sondages auto-déclarés et des 
entrevues semi-structurées, a indiqué que le programme est efficace et valorisé.
CONCLUSIONS: L’élaboration d’un programme interne de grande qualité de soutien 
de la santé mentale du RUS est faisable, efficace, et hautement valorisé. En 
utilisant la rétroaction précoce et fréquente de multiples perspectives et 
intervenants afin de répondre à la demande et de mettre en œuvre des changements 
de façon responsable, le programme a été ajusté pour répondre aux besoins de 
santé mentale du RUS à mesure que progressait la pandémie.

DOI: 10.1177/07067437221111372
PMCID: PMC9301355
PMID: 35854421 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1774. BMC Psychol. 2022 Jul 19;10(1):178. doi: 10.1186/s40359-022-00876-8.

Evaluating the effectiveness of a 6-week hybrid mindfulness-based intervention 
in reducing the stress among caregivers of patients with dementia during 
COVID-19 pandemic: protocol of a randomized controlled trial.

Kor PPK(1), Li ML(2), Kwok DKS(2), Leung AYM(2)(3), Lai DLL(4), Liu JYW(2).

Author information:
(1)School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China. 
patrick.kor@polyu.edu.hk.
(2)School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.
(3)WHO Collaborating Centre for Community Health Services, The Hong Kong 
Polytechnic University, Hong Kong, China.
(4)Hospital Authority, Hong Kong, China.

BACKGROUND: Mindfulness-based intervention (MBI), an emotion-focused approach, 
has been shown promising and sustainable effects on enhancing the well-being of 
caregivers of patients with dementia (PWD). However, the conventional MBI was 
quite demanding, had high rates of attrition and inconsistent long-term effect. 
The social distancing measures introduced during the COVID-19 pandemic also 
restricted face-to-face psychosocial intervention. The study aims to evaluate 
the effectiveness of a 6-week hybrid MBI in caregivers of PWD over a 6-month 
follow up.
METHODS: This is a single-blinded, parallel-group randomized controlled trial 
(RCT). Eligible participants from three local nongovernmental organizations 
(NGOs) will be randomly divided into intervention groups and control groups in a 
ratio of 1:1. The participants in the intervention group will receive 6 weekly 
90-min group-based sessions delivered through a face-to-face and online 
approach. The participants in the control group will receive brief education on 
dementia care with the same group size, duration, and frequency as the sessions 
in the intervention group. Immediately after the intervention and at the 6-month 
follow-up, caring stress and other outcomes will be assessed. Besides, a focus 
group interview will be conducted to identify the strengths, limitations, and 
therapeutic components of the intervention from their perspectives. For 
quantitative data, intention-to-treat analysis and Generalized Estimating 
Equations (GEE) will be used. For qualitative data, content analysis will be 
used.
DISCUSSION: This proposed hybrid model of MBI has several advantages, such as 
lower duration, longer follow-up period and easier access by family caregivers. 
Also, physiological indicators (e.g., heart rate viability and neuropsychiatric 
symptoms) will be measured in this study to show the body change after MBI. The 
quantitative and qualitative data of this research can also benefit the 
development of online or hybrid MBI for caregivers of PWD during the COVID-19 
pandemic. Despite these strengths, it does have practical challenges and 
limitations. However, this proposed intervention has the potential to benefit 
not only the participants, but also the researcher as well as public health 
providers.
TRIAL REGISTRATION: NCT05242614. Registered on 2022-02-16, 
https://clinicaltrials.gov/ct2/show/NCT05242614.

© 2022. The Author(s).

DOI: 10.1186/s40359-022-00876-8
PMCID: PMC9295093
PMID: 35854347 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1775. Aust J Prim Health. 2022 Oct;28(5):387-398. doi: 10.1071/PY21308.

Mental health symptoms in Australian general practitioners during the COVID-19 
pandemic.

Ng I(1), Robins-Browne K(2), Putland M(3), Pascoe A(4), Paul E(5), Willis K(6), 
Smallwood N(7).

Author information:
(1)Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, 
Grattan Street, Parkville, Vic. 3050, Australia; and Centre for Integrated 
Critical Care, Melbourne Medical School, The University of Melbourne, Grattan 
Street, Parkville, Vic. 3050, Australia.
(2)Department of General Practice, The University of Melbourne, Elizabeth 
Street, Melbourne, Vic. 3004, Australia.
(3)Department of Emergency Services, Royal Melbourne Hospital, Grattan Street, 
Parkville, Vic. 3050, Australia; and Department of Critical Care, Faculty of 
Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne, 
Australia.
(4)Department of Allergy, Immunology and Respiratory Medicine, Central Clinical 
School, The Alfred Hospital, Monash University, Melbourne, Vic. 3004, Australia.
(5)Department of Epidemiology and Preventive Medicine, School of Public Health 
and Preventive Medicine, Monash University, Melbourne, Vic. 3004, Australia.
(6)Public Health, College of Health and Biomedicine, Victoria University, 
Footscray Park, Vic. 3011, Australia; and Division of Critical Care and 
Investigative Services, Royal Melbourne Hospital, Grattan Street, Parkville, 
Vic. 3050, Australia.
(7)Department of Allergy, Immunology and Respiratory Medicine, Central Clinical 
School, The Alfred Hospital, Monash University, Melbourne, Vic. 3004, Australia; 
and Department of Respiratory Medicine, The Alfred Hospital, 55 Commercial Road, 
Prahran, Vic. 3004, Australia.

BACKGROUND: General practitioners (GPs) play a central role during the COVID-19 
pandemic, and yet awareness of their mental health is limited.
METHODS: A nationwide online survey of self-identified frontline healthcare 
workers was conducted between 27 August and 23 October 2020. Participants were 
recruited through health and professional organisations, colleges, universities, 
government contacts, and media. A subset of the findings on GPs and hospital 
medical staff (HMS) was used for this study.
RESULTS: Of 9518 responses, there were 389 (4%) GPs and 1966 (21%) HMS. Compared 
with HMS, GPs received significantly less training on personal protective 
equipment usage or care for COVID-19 patients, and less support or communication 
within their workplace. GPs were significantly more concerned about household 
income, disease transmission to family and being blamed by colleagues if they 
became infected, all of which were associated with worse psychological outcomes. 
Significantly more GPs reported burnout, and experienced moderate-to-severe 
emotional exhaustion than HMS. Both groups used similar coping strategies, 
except fewer GPs than HMS used digital health applications or increased alcohol 
consumption. Less than 25% of either group sought professional help.
CONCLUSIONS: GPs are vital in our healthcare systems, yet face unique workplace 
challenges and mental health stressors during the pandemic. Targeted workplace 
and psychological support is essential to protect wellbeing among the primary 
care workforce.

DOI: 10.1071/PY21308
PMID: 35851466 [Indexed for MEDLINE]


1776. BMC Pregnancy Childbirth. 2022 Jul 18;22(1):572. doi: 
10.1186/s12884-022-04876-9.

A qualitative analysis of feelings and experiences associated with perinatal 
distress during the COVID-19 pandemic.

Jones K(1), Harrison V(2), Moulds ML(3), Lazard L(2).

Author information:
(1)School of Psychology and Counselling, The Open University, Milton Keynes, UK. 
katie.jones@open.ac.uk.
(2)School of Psychology and Counselling, The Open University, Milton Keynes, UK.
(3)School of Psychology, UNSW Sydney, Sydney, Australia.

BACKGROUND: Rates of perinatal mental health difficulties (experienced during 
pregnancy and the 12-months postpartum) increased worldwide during the COVID-19 
pandemic. In the UK, anxiety and depression were estimated to affect more than 
half of perinatal women during the first national lockdown. However, little is 
known about women's qualitative experiences of distress. This study aimed to 
extend published quantitative findings resulting from the same data set 
(Harrison et al., Women Birth xxxx, 2021;  Harrison et al., J Reprod Infant 
Psychol 1-16, 2021) to qualitatively explore: 1) the feelings and symptoms 
associated with maternal perinatal distress during the COVID-19 pandemic; and 2) 
the associated sources of distress.
METHODS: As part of an online survey during May 2020, 424 perinatal women 
responded to an open-ended question regarding a recent experience of distress. 
Qualitative data were analysed using an initial content analysis, followed by an 
inductive thematic analysis adopting a realist approach. Data were explored in 
the context of self-reported perinatal anxiety and depression symptoms.
RESULTS: Initial content analysis of the data identified twelve distinct 
categories depicting participants' feelings and symptoms associated with 
psychological distress. Despite the high rates of probable depression in the 
sample, women's descriptions were more indicative of anxiety and general 
distress, than of symptoms traditionally related to depression. In terms of the 
associated psychosocial stressors, a thematic analysis identified five themes: 
Family wellbeing; Lack of support; Mothering challenges; Loss of control due to 
COVID-19; and Work and finances. Unsurprisingly given the context, isolation was 
a common challenge. Additionally, psychological conflict between maternal 
expectations and the reality of pregnancy and motherhood, loss of autonomy and 
control, and fears surrounding family health, safety, and wellbeing underlay 
many of the themes.
CONCLUSIONS: This study presents an array of feelings and symptoms expressed by 
perinatal mothers which may be useful to consider in relation to perinatal 
wellbeing. Furthermore, our data highlights several common sources of distress, 
including multiple COVID-19 specific factors. However, many were related to more 
general perinatal/maternal experiences. Our findings also point to 
considerations that may be useful in alleviating distress in pregnancy and early 
motherhood, including social support, realistic perinatal/maternal expectations, 
and support for those with perceived perinatal trauma.

© 2022. The Author(s).

DOI: 10.1186/s12884-022-04876-9
PMCID: PMC9294838
PMID: 35850668 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1777. Int J Yoga Therap. 2022 Jan 1;32(2022):Article 8. doi: 10.17761/2022-D-22-00013.

Effect of Yoga on the Stress, Anxiety, and Depression of COVID-19-Positive 
Patients: A Quasi-Randomized Controlled Study.

Sharma N(1), Sahni PS(2), Sharma US(3), Kumar J(4), Garg R(5).

Author information:
(1)Research Scholar, National Resource Centre for Value Education in 
Engineering, Indian Institute of Technology Delhi, New Delhi, India.
(2)National Resource Centre for Value Education in Engineering, Indian Institute 
of Technology Delhi, New Delhi, India.
(3)NPCDCS, AYUSH, Mahatma Gandhi Hospital Bhilwara, Rajasthan, India.
(4)Department of Design; and National Resource Centre for Value Education in 
Engineering, Indian Institute of Technology Delhi, New Delhi, India.
(5)Department of Computer Science and Engineering; and National Resource Centre 
for Value Education in Engineering, Indian Institute of Technology Delhi, New 
Delhi, India.

The spread of COVID-19 has resulted in reports of increase in stress, anxiety, 
and depression across society, especially in people who have tested positive for 
COVID-19, which affects their mental health and well-being. This article reports 
a quasi-randomized controlled study conducted in the COVID wards of a hospital 
to examine the efficacy of add-on yoga intervention in reducing stress, anxiety, 
and depression in COVID-affected patients under quarantine. The peripheral 
capillary oxygen saturation level and heart rate of the COVID-19-affected 
patients were also measured. A total of 62 COVID-19-positive patients 
participated in the study. The participants were randomized into a control group 
(n = 31), which received conventional medical treatment alone, and a yoga 
intervention group (n = 31), which received 50 minutes of yoga intervention 
along with the conventional medical treatment. Standardized Hospital Anxiety and 
Depression Scale, Generalized Anxiety Disorder-7 Item, Patient Health 
Questionnaire-9, and Perceived Stress Scale were administered at the beginning 
and end of the quarantine period. A significant decrease in stress, anxiety, and 
depression was observed in the patients who undertook the add-on yoga 
intervention. There was also a significant decrease in anxiety in the control 
group, but the intervention group had a larger decrease compared to the control 
group. Further significant improvements in oxygen saturation and heart rate 
levels were observed in the group of patients who were practicing yoga, but no 
significant improvement was observed in the control group. Findings of this 
study suggest that yoga intervention can be an effective add-on practice in 
reducing stress, anxiety, and depression levels of COVID-19 patients.

DOI: 10.17761/2022-D-22-00013
PMID: 35850136 [Indexed for MEDLINE]


1778. J Gerontol B Psychol Sci Soc Sci. 2023 Mar 13;78(Suppl 1):S81-S90. doi: 
10.1093/geronb/gbac089.

COVID-19-Related Changes in Assistance Networks for U.S. Older Adults With and 
Without Dementia.

Brown MJ(1)(2)(3)(4), Wang H(5), Lin IF(6), Gan D(7), Oyeyemi D(8), Manning 
M(9), Freedman VA(10).

Author information:
(1)Department of Epidemiology and Biostatistics, Arnold School of Public Health, 
University of South Carolina, Columbia, South Carolina, USA.
(2)South Carolina SmartState Center for Healthcare Quality, Arnold School of 
Public Health, University of South Carolina, Columbia, South Carolina, USA.
(3)Rural and Minority Health Research Center, Arnold School of Public Health, 
University of South Carolina, Columbia, South Carolina, USA.
(4)Office for the Study of Aging, Arnold School of Public Health, University of 
South Carolina, Columbia, South Carolina, USA.
(5)Population Research Institute, Pennsylvania State University, University 
Park, Pennsylvania, USA.
(6)Department of Sociology, Bowling Green State University, Bowling Green, Ohio, 
USA.
(7)Gerontology Research Centre, Simon Fraser University, Burnaby, British 
Columbia, Canada.
(8)Department of Internal Medicine, Yale School of Medicine, New Haven, 
Connecticut, USA.
(9)Department of Psychology, Oakland University, Rochester, Michigan, USA.
(10)Institute for Social Research, University of Michigan, Ann Arbor, Michigan, 
USA.

OBJECTIVES: Prepandemic research suggests assistance networks for older adults 
grow over time and are larger for those living with dementia. We examined how 
assistance networks of older adults changed in response to the onset of the 
coronavirus disease 2019 (COVID-19) pandemic and whether these changes differed 
for those with and without dementia.
METHODS: We used 3 rounds of the National Health and Aging Trends Study. We 
estimated multinomial logistic regression models to test whether changes in 
assistance networks during COVID-19 (2019-2020)-defined as expansion, 
contraction, and adaptation-differed from changes prior to COVID-19 (2018-2019). 
We also estimated ordinary least squares regression models to test differences 
in the numbers of helpers assisting with one (specialist) versus multiple 
(generalist) domains before and during COVID-19. For both sets of outcomes, we 
investigated whether pandemic-related changes differed for those with and 
without dementia.
RESULTS: Over all activity domains, a greater proportion of assistance networks 
adapted during COVID-19 compared to the pre-COVID-19 period (relative risk ratio 
= 1.19, p < .05). Contractions in networks occurred for those without dementia. 
Transportation assistance contracted for those with and without dementia, and 
mobility/self-care assistance contracted for those with dementia. The average 
number of generalist helpers decreased during COVID-19 (β = -0.09, p < .001).
DISCUSSION: Early in the pandemic, assistance networks of older adults adapted 
by substituting helpers, by contracting to reduce exposures with more intimate 
tasks for recipients with dementia, and by reducing transportation assistance. 
Future research should explore the impact of such changes on the well-being of 
older adults and their assistance networks.

© The Author(s) 2022. Published by Oxford University Press on behalf of The 
Gerontological Society of America. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/geronb/gbac089
PMCID: PMC9384500
PMID: 35849106 [Indexed for MEDLINE]


1779. Ann Work Expo Health. 2023 Jan 12;67(1):87-100. doi: 10.1093/annweh/wxac048.

Understanding the Impacts of the COVID-19 Pandemic on Small Businesses and 
Workers Using Quantitative and Qualitative Methods.

Honan J(1), Ingram M(2), Quijada C(1), Chaires M(1), Fimbres J(1), Ornelas C(1), 
Sneed S(1), Stauber L(1), Spitz R(3), Sandoval F(3), Carvajal S(2), Billheimer 
D(4), Wolf AM(3), Beamer P(1).

Author information:
(1)Department of Community, Environment, and Policy, Mel and Enid Zuckerman 
College of Public Health, University of Arizona, Tucson, AZ, USA.
(2)Department of Health Promotion Sciences, Mel and Enid Zuckerman College of 
Public Health, University of Arizona, Tucson, AZ, USA.
(3)Sonora Environmental Research Institute, Tucson, AZ, USA.
(4)Department of Epidemiology and Biostatitics, Mel and Enid Zuckerman College 
of Public Health, University of Arizona, Tucson, AZ, USA.

The COVID-19 pandemic has simultaneously exacerbated and elucidated inequities 
in resource distribution for small businesses across the United States in terms 
of worker health and the financial stability of both owners and employees. This 
disparity was further intensified by the constantly changing and sometimes 
opposing health and safety guidelines and recommendations to businesses from the 
local, state, and federal government agencies. To better understand how the 
pandemic has impacted small businesses, a cross-sectional survey was 
administered to owners, managers, and workers (n = 45) in the beauty and auto 
shop sectors from Southern Arizona. The survey identified barriers to safe 
operation that these businesses faced during the pandemic, illuminated worker 
concerns about COVID-19, and elicited perceptions of how workplaces have changed 
since the novel coronavirus outbreak of 2019. A combination of open-ended and 
close-ended questions explored how businesses adapted to the moving target of 
pandemic safety recommendations, as well as how the pandemic affected businesses 
and workers more generally. Almost all the beauty salons surveyed had to close 
their doors (22/25), either temporarily or permanently, due to COVID-19, while 
most of the auto repair shops were able to stay open (13/20). Beauty salons were 
more likely to implement exposure controls meant to limit transmission with 
customers and coworkers, such as wearing face masks and disallowing walk-ins, 
and were also more likely to be affected by pandemic-related issues, such as 
reduced client load and sourcing difficulties. Auto shops, designated by the 
state of Arizona to be 'essential' businesses, were less likely to have 
experienced financial precarity due to the pandemic. Content analysis of 
open-ended questions using the social-ecological model documented current and 
future worker concerns, namely financial hardships from lockdowns and the 
long-term viability of their business, unwillingness of employees to return to 
work, uncertainty regarding the progression of the pandemic, conflict over 
suitable health and safety protocols, and personal or family health and 
well-being (including anxiety and/or stress). Findings from the survey indicate 
that small businesses did not have clear guidance from policymakers during the 
pandemic and that the enacted regulations and guidelines focused on either 
health and safety or finances, but rarely both. Businesses often improvised and 
made potentially life-changing decisions with little to no support. This 
analysis can be used to inform future pandemic preparedness plans for small 
businesses that are cost-efficient, effective at reducing environmental 
exposures, and ultimately more likely to be implemented by the workers.

© The Author(s) 2022. Published by Oxford University Press on behalf of the 
British Occupational Hygiene Society.

DOI: 10.1093/annweh/wxac048
PMCID: PMC9384486
PMID: 35849088 [Indexed for MEDLINE]


1780. Workplace Health Saf. 2022 Nov;70(11):509-514. doi: 10.1177/21650799221108490. 
Epub 2022 Jul 17.

Frontline, Essential, and Invisible: The Needs of Low-Wage Workers in Hospital 
Settings During COVID-19.

Zerden LS(1), Richman EL(2), Lombardi B(3), Forte AB(1).

Author information:
(1)School of Social Work, The University of North Carolina at Chapel Hill.
(2)Cecil G. Sheps Center for Health Services Research, The University of North 
Carolina at Chapel Hill.
(3)Department of Family Medicine, Cecil G. Sheps Center for Health Services 
Research, The University of North Carolina at Chapel Hill.

BACKGROUND: Frontline health care workers are particularly vulnerable to burnout 
and diminished well-being as they endure COVID-19 pandemic-related stressors. 
While physicians and nurses are the public face of those experiencing burnout in 
hospitals, these stressors also affect low-wage workers such as food and 
housekeeping/janitorial service workers whose roles largely remain "invisible" 
when conceptualizing the essential health workforce and understanding their 
needs. This study sought to understand the experiences of frontline essential 
workers to better support them and prevent burnout.
METHODS: Using a semi-structured interview guide, we conducted 20 in-depth 
qualitative interviews with workers in three U.S. states. Thematic content 
analysis was conducted to code and analyze interviews.
RESULTS: Workers had an average of 5.8 years in their jobs, which included food 
services, housekeeping/janitorial, and patient transport roles. Analysis 
revealed four prominent stressors contributing to worker burnout: changes in 
duties and staff shortages, fear of contracting or transmitting COVID-19, desire 
for recognition of their job-related risk, and unclear communication on safety 
precautions and resources. Protective factors included paid time-off, mental 
health supports, sense of workplace pride, and self-coping strategies.
CONCLUSION/APPLICATION TO PRACTICE: As health systems continue to grapple with 
care delivery in the context of COVID-19, identifying best practices to support 
all workers and prevent burnout is vital to the functioning and safety of 
hospitals. Further consideration is warranted to create policies and 
multipronged interventions to meet workers' tangible needs while shifting the 
culture, so all members of the health workforce are seen and valued.

DOI: 10.1177/21650799221108490
PMCID: PMC9630952
PMID: 35848495 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1781. BMC Psychol. 2022 Jul 17;10(1):176. doi: 10.1186/s40359-022-00882-w.

Predictive factors of Quality of Life in older adults during the COVID-19 
pandemic.

Khorani H(1), Mohammadi F(2), Hosseinkhani Z(3), Motalebi SA(4).

Author information:
(1)Student Research Committee, Qazvin University of Medical Sciences, Qazvin, 
Iran.
(2)Social Determinants of Health Research Center, Research Institute for 
Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, 
Qazvin, Iran.
(3)Metabolic Diseases Research Center, Research Institute for Prevention of 
Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
(4)Social Determinants of Health Research Center, Research Institute for 
Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, 
Qazvin, Iran. ammotalebi@yahoo.com.

BACKGROUND: Given the vulnerability of older people to COVID-19, it is important 
to consider their physical and mental wellbeing and quality of life (QoL) in the 
COVID-19 pandemic. Therefore, the present study was aimed to identify the QoL 
and its predictive factors among a sample of Iranian older adults during the 
COVID-19 pandemic.
METHODS: This descriptive and cross-sectional study was conducted on 500 older 
people residing in Qazvin, Iran, from May 22th to November 21rd, 2021. 
Multistage cluster sampling method was used for selecting the eligible older 
adults. Data were collected using the demographic checklist, fear of COVID-19 
scale, and Elderly Quality of Life Questionnaire (LIPAD). The multivariate 
regression model was used for determining the predictive factors of QoL in older 
people.
RESULTS: The mean age of older participants was 69.17 ± 6.75 years old. The 
results of multivariate regression model showed that fear of COVID-19, age, 
marital status, level of education, living arrangement, and economic situation 
were the significant predictors of QoL in the older adults during the COVID-19 
pandemic.
CONCLUSIONS: It is recommended to pay close attention to divorced, lonely, and 
illiterate older people and those with low economic situation during the 
COVID-19 pandemic.

© 2022. The Author(s).

DOI: 10.1186/s40359-022-00882-w
PMCID: PMC9288663
PMID: 35843952 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1782. Am J Infect Control. 2023 Jan;51(1):62-69. doi: 10.1016/j.ajic.2022.04.004. Epub 
2022 Jul 14.

Associations among infection prevention professionals' mental/physical health, 
lifestyle behaviors, shift length, race, and workplace wellness support during 
COVID-19.

Melnyk BM(1), Hsieh AP(2), Mu J(2), Jopp DA(3), Miller S(3).

Author information:
(1)Chief Wellness Officer, Ohio State University, OH; College of Nursing, Ohio 
State University, OH. Electronic address: Melnyk.15@osu.edu.
(2)College of Nursing, Ohio State University, OH.
(3)Association for Professionals in Infection Control and Epidemiology, VA.

BACKGROUND: COVID-19 added stress to infection prevention professionals' (IPs) 
work-life that may have impacted their well-being. This study aimed to describe 
IPs' mental and physical health and lifestyle behaviors during the pandemic and 
their associations with IP role, perceived worksite wellness support, shift 
length, and race and/or ethnicity.
METHODS: A random sample of Association for Professionals in Infection Control 
and Epidemiology members (6,000) were emailed a survey assessing mental and 
physical well-being, lifestyle behaviors, and perceived worksite wellness 
support.
RESULTS: A total of 926 IPs responded (15% response rate). Few met guidelines 
for sleep (34.1%), physical activity (18.8%), and fruit and vegetable 
consumption (7.3%). Rates of depression, anxiety, and burnout were 21.5%, 29.8%, 
and 65%. Front line and practicing IPs and IP administrators and directors had 
more negative mental health impacts than IPs in other roles. IPs with 
organizational wellness support were less likely to report negative COVID-19 
impacts. IPs working 9-11+ hours/day were more likely to report worsening 
physical and mental health due to COVID-19. There were no significant 
differences in odds of negative COVID-19 impacts on lifestyle behaviors between 
white and racial and ethnically diverse IPs.
CONCLUSIONS: IPs who worked shorter shifts and had more organizational wellness 
support had better well-being outcomes. Organizations must fix system issues 
that result in poor health and invest in workforce wellness.

Copyright © 2022 Association for Professionals in Infection Control and 
Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.ajic.2022.04.004
PMCID: PMC9279141
PMID: 35843751 [Indexed for MEDLINE]


1783. J Psychiatr Res. 2022 Sep;153:254-259. doi: 10.1016/j.jpsychires.2022.06.040. 
Epub 2022 Jun 29.

Psychological wellbeing in the English population during the COVID-19 pandemic: 
A series of cross-sectional surveys.

Smith LE(1), Amlȏt R(2), Fear NT(3), Michie S(4), Rubin GJ(5), Potts HWW(6).

Author information:
(1)King's College London, Institute of Psychiatry, Psychology and Neuroscience, 
United Kingdom; NIHR Health Protection Research Unit in Emergency Preparedness 
and Response, United Kingdom. Electronic address: louise.e.smith@kcl.ac.uk.
(2)NIHR Health Protection Research Unit in Emergency Preparedness and Response, 
United Kingdom; UK Health Security Agency, Behavioural Science and Insights 
Unit, United Kingdom.
(3)King's College London, Institute of Psychiatry, Psychology and Neuroscience, 
United Kingdom; King's Centre for Military Health Research and Academic 
Department of Military Mental Health, United Kingdom.
(4)University College London, Centre for Behaviour Change, United Kingdom.
(5)King's College London, Institute of Psychiatry, Psychology and Neuroscience, 
United Kingdom; NIHR Health Protection Research Unit in Emergency Preparedness 
and Response, United Kingdom.
(6)University College London, Institute of Health Informatics, United Kingdom.

Psychological distress has been elevated during the COVID-19 pandemic. However, 
few studies published to date have investigated distress after the first wave of 
infections (Spring - Summer 2020). We investigated distress and wellbeing 
between April 2020 and April 2022 in England through a series of cross-sectional 
online surveys. People aged 16 years or over living in the UK were eligible for 
the surveys; for this study we selected only those living in England due to 
differences in restrictions between UK nations. Distress was measured using the 
PHQ4 (n = 60,921 responses), while wellbeing was measured using the Short 
Warwick-Edinburgh Mental Wellbeing Scale (n = 61,152 responses). Throughout, 
approximately 50%-60% of women and 40%-50% of men reported distress, higher than 
the 25%-30% of women, and 20%-25% of men reported in normative data. Wellbeing 
was also worse than population norms, with women reporting lower wellbeing than 
men. Rates of distress in the English population have been consistently high 
throughout the pandemic. Patterns of distress have broadly mirrored the pattern 
of restrictions and case numbers, but there are notable exceptions which 
indicate that other factors may play a part in population mental health.

Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.jpsychires.2022.06.040
PMCID: PMC9239838
PMID: 35843066 [Indexed for MEDLINE]

Conflict of interest statement: All authors had financial support from NIHR for 
the submitted work; RA is an employee of the UK Health Security Agency; HWWP has 
received additional salary support from Public Health England and NHS England; 
HWWP receives consultancy fees to his employer from Ipsos MORI and has a PhD 
student who works at and has fees paid by AstraZeneca; NTF is a participant of 
an independent group advising NHS Digital on the release of patient data. At the 
time of writing GJR is acting as an expert witness in an unrelated case 
involving Bayer PLC, supported by LS. All authors were participants of the UK's 
Scientific Advisory Group for Emergencies or its subgroups.


1784. BMC Psychiatry. 2022 Jul 16;22(1):476. doi: 10.1186/s12888-022-04111-x.

Web-based treatment for depression in pregnancy: a feasibility study of 
Mum2BMoodBooster.

Gemmill AW(#)(1), Oliva JL(#)(2), Ericksen J(3), Holt C(3), Holt CJ(4), Milgrom 
J(3)(5).

Author information:
(1)Parent-Infant Research Institute, Heidelberg Repatriation Hospital, 
Heidelberg Heights, VIC, 3081, Australia. alan.gemmill@austin.org.au.
(2)Department of Psychology, College of Health Care Science, James Cook 
University, Townsville, QLD, Australia.
(3)Parent-Infant Research Institute, Heidelberg Repatriation Hospital, 
Heidelberg Heights, VIC, 3081, Australia.
(4)Australian College of Applied Professions, Melbourne, VIC, 3000, Australia.
(5)Melbourne School of Psychological Sciences, University of Melbourne, VIC, 
3010, Australia.
(#)Contributed equally

BACKGROUND: Depression in pregnancy is prevalent, under-treated, and has serious 
impacts on the wellbeing of women and on child development. Internet programs 
can reach women who may not access traditional treatments due to distance, 
stigma or concern about taking medication. We adapted our online postnatal 
depression program, MumMoodBooster, for antenatal use. We aimed to trial 
feasibility, acceptability, and potential efficacy of the new Mum2BMoodBooster 
intervention with depressed pregnant women.
METHODS: Twenty-seven pregnant women with Edinburgh Postnatal Depression Scale 
score > 11 used the program in a feasibility trial. Twenty-one had current 
diagnoses of major or minor depression on the Structured Clinical Interview for 
the DSM-IV. Assessment of symptoms occurred at screening/baseline, post-test 
(8 weeks post-enrollment), and at follow-up (3 months postpartum) using the 
Patient Health Questionnaire (PHQ-9) and the Depression Anxiety Stress Scales 
(DASS-21).
RESULTS: In this feasibility trial, depression scores on both the PHQ-9 and the 
DASS-21, showed significant reductions representing large effects, with average 
symptom scores reduced by > 50%, and maintained in the 'minimal or no 
depression' range at 3 month follow-up. Anxiety scores also decreased 
significantly. Program usage was high with 74% of women visiting all six 
sessions. Program acceptability ratings were moderate to high.
CONCLUSIONS: Findings paralleled the magnitude of symptom reductions seen in 
randomised trials of the postnatal MumMoodBooster program, suggesting that 
Mum2BMoodBooster is an effective treatment for depressed pregnant women. 
Effective internet therapies are likely to become increasingly important as the 
COVID-19 pandemic continues to make face-to-face access to health care 
problematic during 'lockdowns'.

© 2022. The Author(s).

DOI: 10.1186/s12888-022-04111-x
PMCID: PMC9287696
PMID: 35842616 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1785. Healthc (Amst). 2022 Sep;10(3):100640. doi: 10.1016/j.hjdsi.2022.100640. Epub 
2022 Jul 6.

COBALT: Supporting the mental well-being of the health care workforce with 
technology-facilitated care during Covid-19 and beyond.

Livesey C(1), Kugler K(1), Huang JJ(1), Burton E(1), Rangnekar A(1), Vojta G(1), 
Oquendo MA(1), Bellini L(1), Asch DA(2).

Author information:
(1)From the University of Pennsylvania, Yale University (GV), UnitedHealth Group 
(CL), USA.
(2)From the University of Pennsylvania, Yale University (GV), UnitedHealth Group 
(CL), USA. Electronic address: asch@wharton.upenn.edu.

Two-thirds of health professionals facing the clinical demands of responding to 
the Covid-19 pandemic experience psychiatric symptoms, including post-traumatic 
stress, anxiety, substance use, depression, insomnia, and suicide.1,2 
Compounding matters, access to mental health services is poor, quality is 
variable, and stigma is prevalent. COBALT, a digital mental health and wellness 
platform developed at Penn Medicine, was designed to support health care 
workers, offering a combination of self-directed resources, virtual group 
sessions, and individual appointments with a stepped care model of providers, 
including peers, resilience coaches, psychotherapists, and psychiatrists. In 
COBALT's first 11 months, the platform saw approximately 10,000 users, 200,000 
page views, 1,400 one-on-one appointment bookings, over 1,000 group appointment 
reservations, and 158 interceptions of employees contemplating self-harm. COBALT 
reveals the unmet demand for mental health support among health professionals 
and provides a model for both expanding the supply of and streamlining access to 
services.

Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.hjdsi.2022.100640
PMCID: PMC9257144
PMID: 35841839 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare the following financial 
interests/personal relationships which may be considered as potential competing 
interests: Cecilia Livesey reports financial support was provided by Optum Labs. 
David A Asch reports financial support was provided by Optum Labs. Cecilia 
Livesey reports a relationship with UnitedHealth Group that includes: employment 
and equity or stocks.


1786. J Prev (2022). 2022 Oct;43(5):697-717. doi: 10.1007/s10935-022-00695-y. Epub 
2022 Jul 16.

Development and Cultural Adaptation of Psychological First Aid for COVID-19 
Frontline Workers in American Indian/Alaska Native Communities.

Grubin F(1), Maudrie TL(2), Neuner S(2), Conrad M(2), Waugh E(2), Barlow A(2), 
Coser A(3), Hill K(4), Pioche S(2), Haroz EE(#)(2), O'Keefe VM(#)(2).

Author information:
(1)Department of International Health, Social and Behavioral Interventions, 
Center for American Indian Health, Johns Hopkins Bloomberg School of Public 
Health, 415 N. Washington St. 4th Floor, Baltimore, MD, 21231, USA. 
fgrubin1@jhu.edu.
(2)Department of International Health, Social and Behavioral Interventions, 
Center for American Indian Health, Johns Hopkins Bloomberg School of Public 
Health, 415 N. Washington St. 4th Floor, Baltimore, MD, 21231, USA.
(3)Tribal Community Behavioral Health, Tahlequah, USA.
(4)Department of Indigenous Health, School of Medicine and Health Sciences, 
University of North Dakota, Grand Forks, USA.
(#)Contributed equally

The coronavirus disease 19 (COVID-19) pandemic is broadly affecting the mental 
health and well-being of people around the world, and disproportionately 
affecting some groups with already pre-existing health inequities. Two groups at 
greater risk of physical and/or mental health detriments from COVID-19 and more 
profoundly impacted by the pandemic include frontline workers and American 
Indian/Alaska Native (AI/AN) communities. To provide support and prevent 
long-term mental health problems, we culturally adapted a psychological first 
aid guide specifically for COVID-19 frontline workers serving AI/AN communities. 
We engaged a diverse, collaborative work group to steer the adaptation content 
and process. We also held two focus group discussions with frontline workers in 
AI/AN communities to incorporate their perspectives into the adapted guide. 
Results from the group discussions and the collaborative work group were 
compiled, analyzed to extract themes and suggestions, and integrated into the 
adapted content of the guide. Main adaptations included updating language (i.e., 
to be more culturally appropriate, less prescriptive, and less text heavy), 
framing the guide from a harm-reduction lens, incorporating cultural activities, 
values, and teachings common across diverse AI/AN communities (e.g., importance 
of being a good relative), and validating feelings and experiences of frontline 
workers. The resulting adapted guide includes four modules and is available as a 
free online training. Our adaptation process may serve as a guiding framework 
for future adaptations of similar resources for specific groups. The adapted 
guide may stand as an enduring resource to support mental well-being, the 
prevention of mental health problems, and reduction of health inequities during 
the pandemic and beyond.

© 2022. The Author(s).

DOI: 10.1007/s10935-022-00695-y
PMCID: PMC9288204
PMID: 35841432 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no relevant financial or 
non-financial interests to disclose. The Johns Hopkins Bloomberg School of 
Public Health Institutional Review Board has confirmed that this study does not 
qualify as human subjects research and that no ethical approval is required.


1787. Harm Reduct J. 2022 Jul 15;19(1):78. doi: 10.1186/s12954-022-00661-1.

"We were building the plane as we were flying it, and we somehow made it to the 
other end": syringe service program staff experiences and well-being during the 
COVID-19 pandemic.

Wang A(1), Jawa R(2)(3), Mackin S(4), Whynott L(5), Buchholz C(6), Childs E(7), 
Bazzi AR(8)(9).

Author information:
(1)Boston University School of Medicine, Boston, MA, USA.
(2)Grayken Center for Addiction, Clinical Addiction Research and Education Unit, 
Section of General Internal Medicine, Boston Medical Center, Boston, MA, USA.
(3)Section of Infectious Disease, Boston Medical Center, Boston, MA, USA.
(4)Access, Harm Reduction, Overdose Prevention and Education (AHOPE), Boston, 
MA, USA.
(5)Tapestry, Springfield, MA, USA.
(6)Department of Community Health Sciences, Boston University School of Public 
Health, Boston, MA, USA.
(7)Abt Associates, Rockville, MD, USA.
(8)Department of Community Health Sciences, Boston University School of Public 
Health, Boston, MA, USA. abazzi@health.ucsd.edu.
(9)Herbert Wertheim School of Public Health, University of California, San 
Diego, 9500 Gilman Drive, MTF 265E (Mail Code 0725), La Jolla, CA, 92161, USA. 
abazzi@health.ucsd.edu.

BACKGROUND: Syringe service programs (SSPs) provide essential harm reduction and 
prevention services for people who inject drugs in the USA, where SSP coverage 
is expanding. During the COVID-19 pandemic, US SSPs underwent unprecedented 
shifts in operational procedures (e.g., closures of physical sites, staff 
redeployment into pandemic response efforts). Given the critical role of US SSP 
workers in the pandemic, we sought to explore the occupational experiences and 
well-being of SSP staff to inform future emergency response efforts.
METHODS: From July-October 2020, we conducted semi-structured interviews with 
staff members of four SSPs in diverse regions of Massachusetts. Trained 
interviewers administered qualitative interviews virtually. Interviews were 
coded in NVivo v12 and thematic analysis identified common occupational 
experiences and related impacts on staff well-being in the context of the 
COVID-19 pandemic.
RESULTS: Among 18 participants, 12 (67%) had client-facing roles such as harm 
reduction specialists and six (33%) worked in program management or leadership. 
We found that staff were frequently anxious about SARS-CoV-2 transmission, which 
contributed to staff turnover. SSPs rapidly adapted and expanded their services 
to meet increasing client needs during the pandemic (e.g., food distribution, 
COVID-19 testing), leading to staff overexertion. Simultaneously, public health 
measures such as physical distancing led to staff concerns about reduced social 
connections with clients and coworkers. Through these challenges, SSPs worked to 
protect staff well-being by implementing flexible and tangible COVID-19-related 
policies (e.g., paid sick leave), mental health resources, and frequent 
communication regarding pandemic-related operational changes.
CONCLUSION: SSPs in the USA adapted to the COVID-19 pandemic out of necessity, 
resulting in operational changes that threatened staff well-being. Despite the 
protective factors revealed in some narratives, our findings suggest that during 
prolonged, complex public health emergencies, SSPs may benefit from enhanced 
occupational supports to prevent burnout and promote wellness for this essential 
public health workforce.

© 2022. The Author(s).

DOI: 10.1186/s12954-022-00661-1
PMCID: PMC9284956
PMID: 35841101 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1788. OTJR (Thorofare N J). 2023 Apr;43(2):188-193. doi: 10.1177/15394492221111733. 
Epub 2022 Jul 15.

Health, Well-Being, and Health-Related Quality of Life Following COVID-19.

Cavaliere C(1), Damiao J(2), Pizzi M(3), Fau L(1).

Author information:
(1)Dominican University of New York, Orangeburg, NY, USA.
(2)Pace University, New York, NY, USA.
(3)New York Institute of Technology, Old Westbury, USA.

Coronavirus disease 2019 (COVID-19 may have serious effects on health, 
well-being, and quality of life (QoL). This study explores the perceptions of 
health, well-being, and QoL in those who contracted the COVID-19 virus compared 
with those who did not. A convergent mixed-methods design with convenience 
sampling (n = 41) was conducted between December 2020 and January 2021. The 
outcome measures included the Short Form-36 and the Pizzi Health and Wellness 
Assessment. There were no statistically significant differences in perceived 
health, well-being, and QoL. However, qualitative analysis revealed mental, 
physical, social, and family health impacts across both groups, with the 
COVID-19 survivors reporting greater feelings of isolation and fear, resulting 
in decreased social and family participation. The results indicate that all 
persons who have experienced the COVID-19 pandemic have experienced negative 
health-related impacts, but those who actually contracted the virus experienced 
greater impacts on QoL in areas related to occupational health and 
participation.

DOI: 10.1177/15394492221111733
PMCID: PMC10076232
PMID: 35838353 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1789. Womens Health (Lond). 2022 Jan-Dec;18:17455057221111326. doi: 
10.1177/17455057221111326.

Psychosocial issues and coping mechanisms of pregnant and postnatal women 
diagnosed with COVID-19: A qualitative study.

Kabwe JC(1)(2), Lubeya MK(2)(3)(4)(5), Phiri CC(2)(6), Mulenga M(2), Siulapwa 
N(2)(6), Kaonga P(7)(8), Price JT(9)(10), Phiri SN(3)(5), Jacobs C(7).

Author information:
(1)Department of Anaesthesia and Critical Care, National Heart Hospital, 
Chongwe, Zambia.
(2)Young Emerging Scientists, Lusaka, Zambia.
(3)Department of Obstetrics and Gynaecology, School of Medicine, The University 
of Zambia, Lusaka, Zambia.
(4)School of Public Health, University of Witwatersrand, Johannesburg, South 
Africa.
(5)Women and Newborn Hospital, University Teaching Hospitals, Lusaka, Zambia.
(6)Levy Mwanawasa University Teaching Hospital, Lusaka, Zambia.
(7)Department of Epidemiology and Biostatistics, School of Public Health, 
University of Zambia, Lusaka, Zambia.
(8)Department of Bioethics, Bloomberg School of Public Health, Johns Hopkins 
University, Baltimore, MD, USA.
(9)UNC Global Projects - Zambia, LLC, Lusaka, Zambia.
(10)Department of Obstetrics and Gynecology, University of North Carolina School 
of Medicine, Chapel Hill, NC, USA.

OBJECTIVE: There is a paucity of data on the psychosocial issues and coping 
mechanisms among pregnant and postnatal women with COVID-19 infection. We, 
therefore, aimed to explore the psychosocial issues and coping mechanisms of 
pregnant and postnatal women diagnosed with COVID-19 at tertiary-level 
hospitals.
METHODS: This was a qualitative phenomenological study conducted in 2021 with a 
sample size of 16 women admitted at two referral hospitals serving as COVID-19 
admission facilities for pregnant and postnatal women in Lusaka, Zambia. 
In-depth interviews were conducted via telephone to understand what these women 
experienced when diagnosed with COVID-19. All the interviews were audio-recorded 
and transcribed verbatim. Thematic analysis was conducted using the six steps 
approach to develop emerging themes.
RESULTS: Two major themes emerged: psychosocial issues and coping mechanisms. 
The primary psychosocial issues were worry and stigma. Women worried about 
infecting their unborn baby or neonate, being separated from the baby, the 
general safety of the baby, and the health of other family members. Women also 
worried about the attitude of health care providers and faced discrimination or 
stigma because of their infection. Thus, some coping mechanisms were developed 
that helped them, such as a positive attitude, keeping the disease secret, 
reliance on family members for support and using positive information from 
social media.
CONCLUSION: This study provides unique insights into the psychosocial 
experiences of pregnant and postnatal women diagnosed with COVID-19. Women were 
particularly concerned about the unborn baby's well-being and 
discrimination.This study suggests the need for policy and clinical practice to 
consider the integration of effective mental health services into the provision 
of maternal health and COVID-19 services.

DOI: 10.1177/17455057221111326
PMCID: PMC9289908
PMID: 35838184 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of conflicting interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


1790. Eur J Cancer Care (Engl). 2022 Nov;31(6):e13657. doi: 10.1111/ecc.13657. Epub 
2022 Jul 15.

Perspectives of cancer patients during the COVID-19 outbreak in Israel: The 
long-term implications on support and well-being in an exploratory qualitative 
study.

Bashkin O(1), Nahmias R(1), Attar S(1), Moshe R(1), Asna N(2).

Author information:
(1)Department of Public Health, Ashkelon Academic College, Ashkelon, Israel.
(2)Oncology Department, Shaare Zedek Medical Center, Jerusalem, Israel.

OBJECTIVES: The COVID-19 pandemic's ongoing effects and long-term implications 
for the mental and social state of cancer patients are not yet fully known. The 
current study examined cancer patients' feelings about the pandemic's long-term 
impact on daily life 1 year after its outbreak in Israel and after the patient's 
vaccination against the virus.
METHODS: Ten in-depth semi-structured interviews were conducted with cancer 
patients between February and April 2021.
RESULTS AND CONCLUSIONS: Findings indicated four main themes: (1) managing 
medical care and support from the medical staff, (2) the effect of the pandemic 
on social interactions; (3) the impact of the pandemic on family and social 
support and (4) the patients' psychological well-being. Despite the patients 
being vaccinated, the full impact of the pandemic on cancer patients' mental and 
social states is still fully apparent. The findings reflect the need to assess 
and monitor the patients' mental state and social and medical needs during this 
complex time and the importance of developing external support networks.

© 2022 John Wiley & Sons Ltd.

DOI: 10.1111/ecc.13657
PMCID: PMC9350153
PMID: 35838182 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare they have no conflict of 
interest.


1791. J Child Psychol Psychiatry. 2023 Jan;64(1):71-82. doi: 10.1111/jcpp.13668. Epub 
2022 Jul 15.

Supporting parenting among Syrian refugees in Lebanon: a randomized controlled 
trial of the caregiver support intervention.

Miller KE(1)(2), Chen A(3), Koppenol-Gonzalez GV(2), Bakolis I(4), Arnous M(5), 
Tossyeh F(5), El Hassan A(5), Saleh A(5), Saade J(5), Nahas N(6), Abboud M(5), 
Jawad L(5), Jordans MJD(3)(4)(7).

Author information:
(1)Department of Educational and Counselling Psychology, and Special Education, 
The University of British Columbia, Vancouver, BC, Canada.
(2)War Child, Research and Development Department, Amsterdam, The Netherlands.
(3)Department of Psychology, Harvard University, Cambridge, MA, USA.
(4)Health Service and Population Research Department, Institute of Psychiatry, 
Psychology, and Neuroscience, King's College London, London, UK.
(5)War Child Lebanon, Beirut, Lebanon.
(6)Department of Psychology, University of Balamand, Tripoli, Lebanon.
(7)Amsterdam Institute of Social Science Research, University of Amsterdam, 
Amsterdam, The Netherlands.

BACKGROUND: Parenting interventions in humanitarian settings have prioritized 
the acquisition of parenting knowledge and skills, while overlooking the adverse 
effects of stress and distress on parenting-a key mediator of refugee children's 
mental health. We evaluated the effectiveness of the Caregiver Support 
Intervention (CSI), which emphasizes caregiver wellbeing together with training 
in positive parenting.
METHODS: We conducted a two-arm randomized controlled trial of the CSI with 
Syrian refugees in Lebanon, with an intent-to-treat design, from September 
2019-December 2020. A total of 480 caregivers from 240 families were randomized 
to the CSI or a waitlist control group (1:1). Retention from baseline to endline 
was 93%. Data on parenting and caregiver psychological wellbeing were collected 
at baseline, endline, and three-month follow-up. Prospective trial registration: 
ISRCTN22321773.
RESULTS: We did not find a significant change on overall parenting skills at 
endline (primary outcome endpoint) (d = .11, p = .126) or at follow-up (Cohen's 
d = .15, p = .054). We did find a significant effect on overall parenting skills 
among participants receiving the full intervention-the sub-sample not 
interrupted by (COVID-19) (d = 0.25, p < .05). The CSI showed beneficial effects 
in the full sample at endline and follow-up on harsh parenting (d = -.17, 
p < .05; d = .19, p < .05), parenting knowledge (d = .63, p < .001; d = .50, 
p < .001), and caregiver distress (d = -.33, p < .001; d = .23, p < .01). We 
found no effects on parental warmth and responsiveness, psychosocial wellbeing, 
stress, or stress management. Changes in caregiver wellbeing partially mediated 
the impact of the CSI on harsh parenting, accounting for 37% of the reduction in 
harsh parenting.
CONCLUSIONS: The CSI reduced harsh parenting and caregiver distress, and 
demonstrated the value of addressing caregiver wellbeing as a pathway to 
strengthening parenting in adversity. These effects were achieved despite a 
pandemic-related lockdown that impacted implementation, a severe economic 
crisis, and widespread social unrest. Replication under less extreme conditions 
may more accurately demonstrate the intervention's full potential.

© 2022 The Authors. Journal of Child Psychology and Psychiatry published by John 
Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental 
Health.

DOI: 10.1111/jcpp.13668
PMCID: PMC10083936
PMID: 35837815 [Indexed for MEDLINE]


1792. Nord J Psychiatry. 2023 Apr;77(3):293-303. doi: 10.1080/08039488.2022.2099581. 
Epub 2022 Jul 14.

Symptom severity and well-being of patients with mental illness during the 
COVID-19 pandemic: a two-wave survey.

Kølbæk P(1)(2)(3), Gil Y(1), Schmidt FCL(1), Speed M(1)(3), Østergaard SD(2)(3).

Author information:
(1)Department of Affective Disorders, Aarhus University Hospital-Psychiatry, 
Aarhus, Denmark.
(2)Psychosis Research Unit, Aarhus University Hospital-Psychiatry, Aarhus, 
Denmark.
(3)Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.

PURPOSE OF THE ARTICLE: To examine changes in symptom severity and well-being 
during the coronavirus disease 2019 (COVID-19) pandemic among individuals with 
pre-existing mental illness.
MATERIALS AND METHODS: In February 2021, we conducted a follow-up 
questionnaire-based survey among adults with mental illness, who responded to a 
similar survey on mental health in June 2020. The participants completed the 
18-item Brief Symptom Inventory (BSI-18), the five-item World Health 
Organization Well-Being Index (WHO-5), and 14 questions evaluating worsening or 
improvement in mental health using the pre-pandemic period as reference. The 
survey data were merged with sociodemographic and clinical data from the medical 
records of all invitees to the first survey, enabling analysis of attrition and 
weighting of the results.
RESULTS: A total of 613 of 992 (62%) invitees participated in the follow-up wave 
of the survey. The weighted mean WHO-5 and BSI-18 scores were 38 and 27, 
respectively, and did not differ statistically significantly from the first 
wave. Multivariate logistic regression showed that having a vocational education 
(skilled worker/craftsman) was positively associated with reporting 
deterioration in psychological well-being (OR: 2.95, 95%CI: 1.14-7.81), while 
being unemployed was negatively associated with reporting deterioration in 
psychological well-being (OR: 0.20, 95%CI: 0.07-0.56) from the first to the 
second survey wave. The most common reason for self-reported deterioration in 
mental health was loneliness (70%).
CONCLUSIONS: Approximately one year into the COVID-19 pandemic, the level of 
symptoms remained high, whereas the level of psychological well-being remained 
low among patients with mental illness.

DOI: 10.1080/08039488.2022.2099581
PMID: 35834531 [Indexed for MEDLINE]


1793. PLoS One. 2022 Jul 14;17(7):e0269341. doi: 10.1371/journal.pone.0269341. 
eCollection 2022.

Period poverty: The perceptions and experiences of impoverished women living in 
an inner-city area of Northwest England.

Boyers M(1)(2), Garikipati S(3), Biggane A(1), Douglas E(4), Hawkes N(5), Kiely 
C(1), Giddings C(1), Kelly J(6), Exley D(7), Phillips-Howard PA(1), Mason L(1).

Author information:
(1)Department of Clinical Sciences, Liverpool School of Tropical Medicine, 
Liverpool, England.
(2)Liverpool Women's Hospital, Liverpool, England.
(3)University of Liverpool Management School, Liverpool, England.
(4)The Whitechapel Centre, Liverpool, England.
(5)South Liverpool Foodbank, Liverpool, England.
(6)Adelaide House, Liverpool, England.
(7)Brownlow Health, Liverpool, England.

BACKGROUND: The menstrual needs of girls and women are important to health, 
education, and well-being. Unmet need and harm from poor menstrual health in 
low-and- middle-income countries have been documented, but with little empirical 
research undertaken in high income countries. Continuing austerity in the UK 
suggests menstruators are likely more vulnerable to 'period poverty' than 
previously, with the COVID-19 pandemic assumed to exacerbate the situation.
AIM: To explore the menstrual experiences and perceptions of women in the UK who 
are living under circumstances of deprivation, alongside views of staff working 
in organisations supporting these women, to understand whether women's menstrual 
needs are met.
METHODS: A qualitative study was conducted in an inner-city in NW England. Three 
focus group discussions and 14 in-depth interviews were conducted across three 
study sites supporting impoverished women. Data was analysed thematically.
RESULTS: Themes were: reflections on menstruation; affordability of products; 
access to public facilities; organisational support; potential solutions. Many 
women perceived menstruation as a burden in three aspects: physical discomfort 
and pain; psychological anxiety; and shame and stigma. Managing menstruation was 
difficult due to cost relative to low incomes, with food, heating and lighting 
prioritised, leaving women improvising with materials or wearing products for 
longer than desired. Most suggested that products should be free, often 
remarking if men required similar items this would happen. Most women were 
unaware supporting organisations provided free products. Staff felt the small 
range of products offered did not meet client needs and were ill-prepared to 
have conversations on products and clients' menstrual needs.
CONCLUSION: Impoverished women lack the necessary resources to manage their 
menses well which negatively impacts their health and brings stress, 
embarrassment, and shame. Support, including access to free products, is needed 
at both local and national level to help impoverished women manage their 
menstrual hygiene.

DOI: 10.1371/journal.pone.0269341
PMCID: PMC9282460
PMID: 35834506 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


1794. J Prim Care Community Health. 2022 Jan-Dec;13:21501319221112585. doi: 
10.1177/21501319221112585.

Responding to COVID-19 While Serving Veterans Experiencing Homelessness: The 
Pandemic Experiences of Healthcare and Housing Providers.

Gin JL(1), Balut MD(1), Alenkin NR(1), Dobalian A(1)(2).

Author information:
(1)Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of 
Veterans Affairs, North Hills, CA, USA.
(2)Division of Health Services Management and Policy, The Ohio State University 
College of Public Health, Columbus, OH, USA.

The U.S. Department of Veterans Affairs (VA) provides essential care through 
transitional housing and healthcare for Veterans experiencing homelessness 
through the Grant and Per Diem (GPD) program and the Homeless Patient Aligned 
Care Team (HPACT), respectively. At the onset of the SARS-CoV-2 pandemic, GPD 
organizations and HPACT clinics faced the challenge of being essential providers 
tasked with ensuring the well-being of Veterans under their care. Through 
semi-structured interviews with 13 providers (6 HPACT health care providers 
representing 2 HPACT programs, and 7 GPD staff members) across the U.S., this 
study explored their experiences navigating the tasks of keeping Veterans safe 
and providing ongoing care from the start of the pandemic up to the 2021 
interview dates. Both GPD and HPACT providers reported amplified safety concerns 
about COVID-19 infection among staff at the start of the pandemic, which 
diminished to a lower, stable level after a few months as adaptations made for 
safety became embedded in their routines. However, ongoing challenges included 
isolation and mental health challenges among Veterans, inherent limitations of 
telehealth as a care delivery avenue, provider frustration and burnout due to 
increased workload and frequent change, and the logistics of administering 
testing for Veterans to enter GPD housing. Enhanced pandemic preparedness 
planning for GPD organizations, funding for personal protective equipment (PPE) 
and providing technology to facilitate Veterans' telehealth access, and 
strategies for preventing provider burnout are critical to both sustaining 
homeless providers' capabilities during this pandemic and enhancing readiness to 
respond to the next public health emergency.

DOI: 10.1177/21501319221112585
PMCID: PMC9289898
PMID: 35833646 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


1795. HERD. 2022 Oct;15(4):343-353. doi: 10.1177/19375867221111530. Epub 2022 Jul 13.

Hospital Outdoor Spaces as Respite Areas for Healthcare Staff During the 
COVID-19 Pandemic.

Iqbal SA(1), Abubakar IR(2).

Author information:
(1)Department of Educational Policy Studies, Faculty of Education, University of 
Alberta, Edmonton, Canada.
(2)College of Architecture and Planning, Imam Abdulrahman Bin Faisal University 
(Formerly, University of Dammam), Dammam, Saudi Arabia.

The COVID-19 pandemic has created considerable implications for healthcare staff 
around the globe. During the pandemic, the frontline healthcare workers 
experience intense anxiety, stress, burnout, and psychological breakdown, with 
severe implications on their mental and physical well-being. In addition to 
these implications, anxiety and stress can hinder their productivity and ability 
to perform their duties efficiently. The literature indicates that hospital 
gardens and contact with nature can help alleviate psychological distress among 
hospital staff. However, few studies investigated the role of outdoor spaces as 
areas for respite and work breaks in healthcare facilities during the pandemic. 
The present opinion paper highlights the challenges of job stress and 
psychological distress health workers face during the pandemic. This article 
also underscores the role of hospital outdoor spaces and garden facilities in 
coping with the challenges. While other measures to reduce stress among hospital 
staff and ensure their health and safety are important, hospital administrators 
and relevant government agencies should also emphasize the provision of gardens 
and open spaces in healthcare facilities. These spaces can act as potential 
areas for respite for hospital staff to help them cope with the stress and 
anxiety accumulated through working under crises.

DOI: 10.1177/19375867221111530
PMID: 35831995 [Indexed for MEDLINE]


1796. PLoS One. 2022 Jul 13;17(7):e0266153. doi: 10.1371/journal.pone.0266153. 
eCollection 2022.

Characteristics of mental health stability during COVID-19: An online survey 
with people residing in a city region of the North West of England.

Ujhelyi Gomez K(1), Corcoran R(1), Ring A(1), Hassan S(1), Abba K(1), Downing 
J(1), Goodall M(1), Gabbay M(1), Clarke P(1), Moran P(2), Obe DA(2), Bennett 
KM(3).

Author information:
(1)Department of Primary Care & Mental Health, University of Liverpool, 
Liverpool, United Kingdom.
(2)Public Advisor at the University of Liverpool, Liverpool, United Kingdom.
(3)Department of Psychology, University of Liverpool, Liverpool, United Kingdom.

BACKGROUND AND AIM: Despite the significant mental health challenges the 
COVID-19 pandemic and its associated government measures have presented, 
research has shown that the majority of people have adapted and coped well. The 
aim of this study was i) to determine the proportion of people with mental 
stability and volatility during the pandemic in a North West England city region 
sample and ii) to establish group differences in psychosocial variables. Mental 
stability and volatility refer to the extent to which individuals reported 
change in levels of common mental health symptoms over the course of 12 weeks. 
No change in mental health over the 12 weeks reflected mental stability whilst 
change in mental health reflected mental volatility.
METHOD: A two-wave-online survey (N = 163) was used to explore the psychological 
and social impact of the pandemic on relatively disadvantaged neighbourhoods 
within the region. The data collected represents 12 weeks of individual pandemic 
experience between mid-June and mid-December 2020. A three-level composite 
common mental health change variable was created combining self-reported anxiety 
and depression to group stable, volatile, and very volatile individuals in terms 
of the changeability of their mental health. Kruskal-Wallis with post-hoc tests 
were used to determine how people with mental stability and volatility differed 
on factors categorised within an ecological framework of resilience (individual, 
community, societal, and COVID-19 specific).
RESULTS: Individuals categorised as 'stable' in terms of mental health symptoms 
(63.6%) had better mental and physical health; were more tolerant of 
uncertainty; and reported higher levels of resilience and wellbeing compared to 
'very volatile' people (19.8%). These individuals also reported feeling less 
socially isolated, experienced a greater sense of belonging to their community 
which was more likely to fulfil their needs, and were more likely to have access 
to green space nearby for their recommended daily exercise. 'Stable' individuals 
did not report worrying any more during the pandemic than usual and tolerated 
uncertainty better compared to those in the 'volatile' group.
IMPLICATIONS: The majority of participants in this sample were mentally stable 
and coping well with the challenges presented by the pandemic. The resilience of 
these individuals was related to key place-based factors such as a strong sense 
of community and useable local assets. The data showcase the role of place-based 
social determinants in supporting resilience and thereby highlight key 
preventative measures for public mental health during times of international 
crisis.

DOI: 10.1371/journal.pone.0266153
PMCID: PMC9278749
PMID: 35830445 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


1797. Health Promot Chronic Dis Prev Can. 2022 Jul;42(7):272-287. doi: 
10.24095/hpcdp.42.7.02.

Experiences, impacts and service needs of injured and ill workers in the WSIB 
process: evidence from Thunder Bay and District (Ontario, Canada).

Noël C(1), Scharf D(1)(2), Hawkins J(1), Lund J(1), Kozik J(3), Péfoyo Koné 
A(2).

Author information:
(1)Department of Psychology, Lakehead University, Thunder Bay, Ontario, Canada.
(2)Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, 
Canada.
(3)Northern Ontario School of Medicine, Lakehead University, Thunder Bay, 
Ontario, Canada.

INTRODUCTION: Individuals experience negative physical, social and psychological 
ramifications when they are hurt or become ill at work. Ontario's Workplace 
Safety and Insurance Board (WSIB) is intended to mitigate these effects, yet the 
WSIB process can be difficult. Supports for injured workers can be fragmented 
and scarce, especially in underserved areas. We describe the experiences and 
mental health needs of injured and ill Northwestern Ontario workers in the WSIB 
process, in order to promote system improvements.
METHODS: Community-recruited injured and ill workers (n = 40) from Thunder Bay 
and District completed an online survey about their mental health, social 
service and legal system needs while involved with WSIB. Additional Northwestern 
Ontario injured and ill workers (n = 16) and community service providers 
experienced with WSIB processes (n = 8) completed interviews addressing similar 
themes.
RESULTS: Northwestern Ontario workers described the impacts of workplace injury 
and illness on their professional, family, financial and social functioning, and 
on their physical and mental health. Many also reported incremental negative 
impacts of the WSIB processes themselves, including regional issues such as 
"small town" privacy concerns and the cost burden of travel required by the 
WSIB, especially during COVID-19. Workers and service providers suggested 
streamlining and explicating WSIB processes, increasing WSIB continuity of care, 
and region-specific actions such as improving access to regional support 
services through arm's-length navigators.
CONCLUSION: Northwestern Ontario workers experienced negative effects from 
workplace injuries and illness and the WSIB process itself. Stakeholders can use 
these findings to improve processes and outcomes for injured and ill workers, 
with special considerations for the North.

Publisher: INTRODUCTION: Les accidents du travail et les maladies 
professionnelles ont des répercussions physiques, sociales et psychologiques 
négatives sur les personnes qui en sont victimes. Bien que la Commission de la 
sécurité professionnelle et de l’assurance contre les accidents du travail 
(WSIB) de l’Ontario ait pour mandat d’atténuer ces effets, son processus de 
fonctionnement peut conduire à des difficultés. Les soutiens qui sont offerts 
aux travailleurs blessés peuvent être fragmentés et rares, notamment dans les 
régions qui sont mal desservies. Nous décrivons les expériences vécues par des 
travailleurs blessés ou malades du Nord­Ouest de l’Ontario dans le cadre de 
leurs démarches auprès de la WSIB, de même que les besoins en santé mentale de 
ces travailleurs, dans le but de promouvoir l’amélioration du système en place.
MÉTHODOLOGIE: Des travailleurs blessés et malades (n = 40) recrutés dans la 
collectivité de Thunder Bay et son district ont répondu à un sondage en ligne 
sur leurs besoins en matière de santé mentale, de services sociaux et de 
services juridiques lors de leurs démarches auprès de la WSIB. Des entrevues 
portant sur des thèmes similaires ont aussi été réalisées avec 16 autres 
travailleurs blessés et malades ailleurs dans le Nord-Ouest de l’Ontario ainsi 
qu’avec 8 fournisseurs de services communautaires connaissant bien le 
fonctionnement de la WSIB.
RÉSULTATS: Les travailleurs du Nord­Ouest de l’Ontario ont décrit les 
répercussions que leur accident du travail ou leur maladie professionnelle avait 
eues sur leur situation professionnelle, familiale, financière et sociale, ainsi 
que sur leur santé physique et mentale. Beaucoup ont aussi souligné les effets 
négatifs accrus attribuables aux processus mêmes de la WSIB, notamment les 
problèmes locaux liés à la protection de la vie privée dans les « petites villes 
» et le fardeau financier associé aux déplacements exigés par la WSIB, en 
particulier durant la pandémie de COVID­19. Les travailleurs et les fournisseurs 
de services ont proposé de rationaliser et de clarifier les processus de la 
WSIB, d’améliorer la continuité des soins offerts par la WSIB et de mettre en 
place des mesures spécifiques à la région, telles que l’amélioration de l’accès 
aux services de soutien régionaux par l’intermédiaire d’intervenants­pivots 
indépendants.
CONCLUSION: Les travailleurs du Nord­Ouest de l’Ontario subissent des effets 
négatifs dus à la fois aux blessures ou maladies professionnelles et au 
fonctionnement de la WSIB. Les intervenants pourront utiliser les constatations 
de cette recherche afin d’améliorer les démarches et la situation des 
travailleurs blessés et malades, en tenant compte plus particulièrement de la 
région du Nord.

Plain Language Summary: Individuals in Northwestern Ontario who were hurt or 
became ill at work experienced negative effects on their physical, financial, 
social and psychological well-being, including some related to or worsened by 
the WSIB process. This is consistent with research conducted elsewhere in the 
province. Injured and ill workers in Northwestern Ontario may face additional 
regional barriers to proper care and recovery, including limited employment 
opportunities, “small town” privacy concerns and the costs and burden of 
care-related travel, especially during public health crises such as the COVID-19 
pandemic. Suggestions to improve the WSIB process provided by Northwestern 
Ontario injured workers and service providers included general system 
improvements (e.g. streamlining and explicating WSIB processes, increasing WSIB 
continuity of care, designating an arm’s length system navigator), and several 
suggestions particular to the northern context.

Plain Language Summary: Les travailleurs du Nord­Ouest de l’Ontario qui ont été 
victimes d’un accident du travail ou d’une maladie professionnelle ont fait état 
d’effets négatifs sur leur bien­être physique, financier, social et 
psychologique, dont certains effets causés ou exacerbés par les processus de la 
Commission de la sécurité professionnelle et de l’assurance contre les accidents 
du travail (WSIB). Ces résultats concordent avec ceux de recherches menées 
ailleurs dans la province. Les travailleurs blessés et malades du Nord­Ouest de 
l’Ontario sont susceptibles de faire face à des difficultés locales 
supplémentaires qui les empêchent d’obtenir des soins appropriés et de se 
rétablir adéquatement, qu’il s’agisse de possibilités d’emploi limitées, de 
préoccupations relatives à la protection de la vie privée dans les « petites 
villes » ou de coûts et de fardeau associés aux déplacements, en particulier 
durant une crise de santé publique comme la pandémie de COVID­19. Les 
suggestions formulées par les travailleurs blessés et les fournisseurs de 
services du Nord­Ouest de l’Ontario en vue d’améliorer les processus de la WSIB 
ont porté sur des améliorations visant le système dans son ensemble (comme 
l’harmonisation et la clarification des processus de la WSIB, l’amélioration de 
la continuité des soins offerts par la WSIB, la désignation d’un 
intervenant­pivot indépendant) ainsi que sur des améliorations visant plus 
spécifiquement le contexte du Nord.

DOI: 10.24095/hpcdp.42.7.02
PMCID: PMC9436453
PMID: 35830217 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of interest: through her part-time 
private practice, Dr. Scharf provides psychological services to injured and ill 
workers whose care is paid for by the WSIB.


1798. Community Ment Health J. 2023 Feb;59(2):233-242. doi: 
10.1007/s10597-022-01001-0. Epub 2022 Jul 13.

Prevalence of Poor Mental Health Days and Adverse Childhood Experience Reporting 
in U.S. Adults Before and After COVID-19.

Kapp JM(1)(2), Micheas L(3), Holmes S(4), Stormont M(5), Reinke WM(6).

Author information:
(1)Department of Health Management and Informatics, School of Medicine, 
University of Missouri, CE 717 CS&E Building, One Hospital Drive, Columbia, MO, 
65212, USA. kappj@health.missouri.edu.
(2)Harry S Truman School of Public Affairs, University of Missouri, Columbia, 
MO, 65212, USA. kappj@health.missouri.edu.
(3)Department of Statistics, Social Science Statistics Center, University of 
Missouri, Columbia, MO, 65211, USA.
(4)Department of Educational, School & Counseling Psychology, College of 
Education & Human Development, Missouri Prevention Science Institute, University 
of Missouri, 16 Hill Hall, Columbia, MO, 65211, USA.
(5)Department of Special Education, College of Education & Human Development, 
Missouri Prevention Science Institute, University of Missouri, 311N Townsend 
Hall, Columbia, MO, 65211, USA.
(6)Department of Educational, School & Counseling Psychology, College of 
Education & Human Development, Missouri Prevention Science Institute, University 
of Missouri, Columbia, MO, 65211, USA.

This is the first study of US adults to examine change in the prevalence of 
psychological burden (i.e., self-reported poor mental health days in the past 
30 days, and ACEs recollections) before compared to after COVID-19 started. We 
analyzed the prevalence of self-reported poor mental health days, and ACEs 
recollections from 17 states using the Behavioral Risk Factor Surveillance 
System. Adjusted models identified an increase in prevalence from before 
compared to after COVID-19 onset in those married or partnered reporting 48% 
more poor mental health days in the past 30 days; persons of color reporting 
living with anyone with mental illness during childhood by 73% and reporting 
more ACEs by 35%; those employed or self-employed reporting childhood sexual 
abuse by 45%. This ecological-level analysis revealed population-level changes 
in psychological well-being reporting of U.S. adults from before compared to 
after the pandemic onset.

© 2022. The Author(s).

DOI: 10.1007/s10597-022-01001-0
PMCID: PMC9859877
PMID: 35829803 [Indexed for MEDLINE]


1799. Health Econ. 2022 Oct;31(10):2208-2228. doi: 10.1002/hec.4571. Epub 2022 Jul 13.

The impact of COVID-related economic shocks on household mental health in 
Pakistan.

Baranov V(1), Grosjean P(2), Khan FJ(2), Walker S(2).

Author information:
(1)Department of Economics, University of Melbourne, Parkville, Victoria, 
Australia.
(2)University of New South Wales, School of Economics, Sydney, New South Wales, 
Australia.

We combine data collected just prior to the unfolding of COVID-19 with follow-up 
data from July 2020 to document the adverse economic effects of the pandemic and 
resulting impact on parental and child mental well-being in peri-urban Pakistan. 
22% of the households in our sample are affected by job loss, with monthly 
income down 38% on average. Our difference-in-difference results show that job 
loss is associated with a 0.88 standard deviation (SD) increase in adult mental 
distress scores (K10), a 0.43 SD reduction in a Hope index of children's 
aspirations, agency and future pathways, and a 0.39 SD increase in children's 
depression symptoms. In addition, we observe higher levels of parental stress 
and anger reported by children, as well as an increase in reported prevalence of 
domestic violence. Overall, we document that the pandemic has disproportionately 
and negatively affected the economic and mental well-being of the most 
vulnerable households in our sample.

© 2022 The Authors. Health Economics published by John Wiley & Sons Ltd.

DOI: 10.1002/hec.4571
PMCID: PMC9350311
PMID: 35822574 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflict of interest to 
disclose.


1800. Aging Ment Health. 2023 Mar;27(3):547-562. doi: 10.1080/13607863.2022.2084510. 
Epub 2022 Jul 12.

The early impacts of COVID-19 on unpaid carers of people living with dementia: 
part II of a mixed-methods systematic review.

Giebel C(1)(2), Talbot CV(3), Wharton E(2)(4), Lorenz-Dant K(5), Suárez-González 
A(6), Cannon J(7), Tetlow H(2)(8), Lion KM(9), Thyrian JR(10)(11).

Author information:
(1)Department of Primary Care & Mental Health, University of Liverpool, 
Liverpool, UK.
(2)NIHR ARC NWC, Liverpool, UK.
(3)Faculty of Science & Technology, Bournemouth University, Poole, UK.
(4)School for Sport and Exercise Science, Liverpool John Moore's University, 
Liverpool, UK.
(5)Care Policy and Evaluation Centre, Department of Health Policy, London School 
of Economics and Political Science, London, UK.
(6)UCL Queen Square Institute of Neurology, Dementia Research Centre, London, 
UK.
(7)Lewy Body Society, Wigan, UK.
(8)SURF Liverpool, Liverpool, UK.
(9)Menzies Health Institute Queensland, Griffith University, Brisbane, 
Australia.
(10)German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, 
Greifswald, Germany.
(11)Institute for Community Medicine, University Medicine Greifswald, 
Greifswald, Germany.

OBJECTIVES: With a lack of existing comprehensive reviews, the aim of this 
mixed-method systematic review was to synthesise the evidence on the early 
impacts of the pandemic on unpaid dementia carers across the globe.
METHODS: This review was registered on PROSPERO [CDR42021248050]. PubMed, 
CINAHL, Embase, Scopus and Web of Science were searched from 2020 to July 2021. 
Studies were included if they reported on the different impacts of the pandemic 
on unpaid dementia carers aged 18+, with papers published in English, German, 
Polish, or Spanish. A number of research team members were involved in the 
selection of studies following PRISMA guidance.
RESULTS: Thirty-six studies (43 papers) from 18 countries reported on the early 
impact of the pandemic on unpaid dementia carers. Impacts were noted on 
accessing care and support; carer burden; and well-being. Studies found that 
carers had limited access to care and support services, increased workload, 
enhanced feelings of social isolation, and reduced wellbeing. Specifically, 
reductions in access to care and support increased carer's unpaid caring tasks, 
removing any opportunities for temporary respite, and thus further increasing 
carer burden and reducing mental well-being in many.
CONCLUSIONS: The needs of unpaid dementia carers appear to have increased during 
the pandemic, without adequate support provided. Policy initiatives need to 
enable better mental health support and formal care provision for unpaid carers 
and their relatives with dementia, whilst future research needs to explore the 
long-term implications of carer needs in light of care home restrictions and 
care delivery.

DOI: 10.1080/13607863.2022.2084510
PMID: 35818800 [Indexed for MEDLINE]


1801. Nurse Educ Pract. 2022 Aug;63:103388. doi: 10.1016/j.nepr.2022.103388. Epub 2022 
Jun 23.

Life during lockdown: Coping strategies used by preregistration nursing students 
during COVID-19.

Moxham L(1), Fernandez R(2), Lord H(3), Halcomb E(4), Middleton R(5).

Author information:
(1)School of Nursing, Faculty of Science Medicine and Health, University of 
Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia; Illawarra 
Health and Medical Research Institute, Northfields Avenue, Wollongong, NSW 2522, 
Australia. Electronic address: lmoxham@uow.edu.au.
(2)School of Nursing, Faculty of Science Medicine and Health, University of 
Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia; Centre for 
Research in Nursing and Health, St George Hospital, South Street, Kogarah NSW 
2217, Australia; Illawarra Health and Medical Research Institute, Northfields 
Avenue, Wollongong, NSW 2522, Australia.
(3)Centre for Research in Nursing and Health, St George Hospital, South Street, 
Kogarah NSW 2217, Australia.
(4)School of Nursing, Faculty of Science Medicine and Health, University of 
Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia; Illawarra 
Health and Medical Research Institute, Northfields Avenue, Wollongong, NSW 2522, 
Australia.
(5)School of Nursing, Faculty of Science Medicine and Health, University of 
Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia.

AIM: To explore the coping strategies used by Australian preregistration nursing 
students during the COVID-19 pandemic 'lockdown' period.
BACKGROUND: COVID-19 has had a significant impact on preregistration nursing 
students, both physically and psychologically. As campuses closed and online 
learning commenced, clinical placement access was reduced, with heightened 
concern about personal and family safety. As such, nursing students were forced 
to adopt coping strategies to manage their self and the environment.
DESIGN: A descriptive qualitative study.
METHODS: One hundred and fifty-five preregistration nursing students enrolled at 
a regional Australian university completed a self-administered online survey.
RESULTS: Overwhelmingly, student responses revealed that staying connected was 
the key coping strategy to ensure emotional and mental health wellbeing. 
Heightened vigilance in infection control measures was also evident, personally 
and for others. Routines, including exercise, facilitated physical and mental 
wellbeing. Overall, coping strategies identified by nursing students 
demonstrated applied resilience during the isolation period.
CONCLUSIONS: Understanding the adaptive coping strategies used by nursing 
students can enable nurse academics to understand how to best provide support. 
This study emphasises the importance of recognising that not all students are 
able to adapt and 'cope' without supports in place. Future studies should 
investigate the longer-term impact of COVID-19 within the broader 
preregistration nursing experience and how this might impact nursing students' 
future careers.

Copyright © 2022 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.nepr.2022.103388
PMCID: PMC9222489
PMID: 35816921 [Indexed for MEDLINE]


1802. Occup Med (Lond). 2022 Dec 7;72(8):508-514. doi: 10.1093/occmed/kqac060.

Health service COVID-19 wellbeing and support initiatives: a mixed-methods 
evaluation.

Holton S(1)(2), Wright A(3), Wynter K(1)(2), Hall L(3), Wintle J(3), Lambis 
E(3), Cooke L(3), McNally C(3), Pavlovski M(3), Bruce S(3), Rasmussen 
B(1)(2)(4)(5).

Author information:
(1)School of Nursing and Midwifery; Centre for Quality and Patient Safety 
Research in The Institute for Health Transformation, Geelong, VIC, Australia.
(2)Deakin University Centre for Quality and Patient Safety Research - Western 
Health Partnership, St Albans, VIC, Australia.
(3)People, Culture and Communications, Western Health, Footscray, VIC, 
Australia.
(4)Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 
Denmark.
(5)Faculty of Health Sciences, University of Southern Denmark and Steno Diabetes 
Centre, Odense, Denmark.

BACKGROUND: Health services implemented a range of initiatives during the 
COVID-19 pandemic to support employee wellbeing and assist employees to manage 
the professional and personal challenges they experienced. However, it is not 
known if such initiatives were acceptable to employees or met their needs.
AIMS: To evaluate the wellbeing and support initiatives implemented at an 
Australian health service during the COVID-19 pandemic from the perspectives of 
employees (both users and non-users) and key stakeholders.
METHODS: A mixed-methods design (survey, interviews and data audit) to 
investigate employees' and key stakeholders' perceptions, experiences and use of 
the wellbeing and support initiatives implemented at a large tertiary 
metropolitan health service in Melbourne, Australia.
RESULTS: Ten employees participated in an interview and 907 completed a survey. 
The initiatives were well used and appreciated by staff. There was no 
significant difference in the proportion of clinical staff who had used the 
initiatives compared to non-clinical staff (44% versus 39%; P=0.223). Survey 
respondents reported the initiatives improved their mental health (n = 223, 8%), 
ability to cope with COVID-19 related stress and anxiety (n = 206, 79%), do 
their work (n = 200, 77%) and relationships with colleagues (n = 174, 67%). 
Staff would like many of the initiatives (with some modifications) to continue 
after the COVID-19 pandemic.
CONCLUSIONS: The findings suggest a high level of staff satisfaction with the 
implemented wellbeing and support initiatives, and confirm the need for, and 
importance of, developing and implementing initiatives to support health service 
staff during outbreaks of infectious diseases such as the COVID-19 pandemic.

© The Author(s) 2022. Published by Oxford University Press on behalf of the 
Society of Occupational Medicine. All rights reserved. For Permissions, please 
email: journals.permissions@oup.com.

DOI: 10.1093/occmed/kqac060
PMCID: PMC9278257
PMID: 35815913 [Indexed for MEDLINE]


1803. J Nurs Adm. 2022 Jul-Aug 01;52(7-8):392-398. doi: 10.1097/NNA.0000000000001171. 
Epub 2022 Jul 9.

Moral Injury, Nurse Well-being, and Resilience Among Nurses Practicing During 
the COVID-19 Pandemic.

Fitzpatrick JJ(1), Pignatiello G, Kim M, Jun J, O'Mathúna DP, Duah HO, Taibl J, 
Tucker S.

Author information:
(1)Author Affiliations: Director, Marian K. Shaughnessy Nurse Leadership 
Academy, Elizabeth Brooks Ford Professor of Nursing, and Distinguished 
University Professor (Dr Fitzpatrick), Frances Payne Bolton School of Nursing, 
Case Western Reserve University; and Instructor (Dr Pignatiello), Frances Payne 
Bolton School of Nursing, Case Western Reserve University, Cleveland: Assistant 
Professor (Dr Kim), College of Nursing, University of Cincinnati, Cincinnati; 
Assistant Professor (Dr Jun) and Associate Professor (Dr O'Mathúna), College of 
Nursing, The Ohio State University, Columbus; PhD Student (Mr Duah), College of 
Nursing, University of Cincinnati, Cincinnati; DNP Student (Ms Taibl), Frances 
Payne Bolton School of Nursing, Case Western Reserve University, Cleveland; and 
Grayce Sills Endowed Professor in Psychiatric Mental Health Nursing, Director of 
DNP Nurse Executive Core, and Director of Implementation Science Core (Dr 
Tucker), Fuld EBP Institute, College of Nursing, The Ohio State University, 
Columbus.

OBJECTIVE: The aim of this study was to determine relationships between moral 
injury (MI), well-being, and resilience among staff nurses and nurse leaders 
practicing during the COVID-19 (coronavirus disease 2019) pandemic.
BACKGROUND: Attention to MI among health professionals, including nurses, 
increased in 2021, particularly related to the pandemic. Few studies examined 
MI, well-being, and resilience; even fewer provided implications for 
leadership/management.
METHODS: The sample included 676 RNs practicing in Ohio. The electronic survey 
included assessments of MI, well-being, and resilience distributed via the Ohio 
Nurses Association and the schools of nursing alumni Listservs.
RESULTS: There was a significant association between MI and negative well-being 
and negative association between MI and resilience. Differences were observed 
between staff nurses and leaders.
CONCLUSIONS: This is the first study relating MI, resilience, and well-bring 
among nurses and nurse leaders during the pandemic. There is a need for 
additional research to further our understanding about nurses' health and 
well-being during the pandemic and beyond.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/NNA.0000000000001171
PMID: 35815868 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


1804. Scand J Public Health. 2022 Aug;50(6):660-661. doi: 10.1177/14034948221110409. 
Epub 2022 Jul 10.

The Children of Risk Communication.

Paakkari L(1), Okan O(2).

Author information:
(1)University of Jyväskylä, Faculty of Sport and Health Sciences, Research 
Center for Health Promotion, University of Jyväskylä, Finland.
(2)Department of Sport and Health Sciences, Technical University Munich, 
Germany.

For the management of the COVID-19 pandemic, risk communication has been a 
much-needed preventive and educative action to support citizens - including 
children - to adopt preventive and health protective measures. However, the 
COVID-19 pandemic is not the only health concern at hand that has raised 
concerns about the health status of children and required disease-preventive 
strategies. Bearing in mind the mental health problems and learning losses 
reported during the pandemic, in this commentary, we will argue that by now, it 
is time to consider critically if there could be more space for positive 
communication and education, both alongside and as an integral part of risk 
communication, to help adolescents not just to survive but also to live the 
fullest possible life now and in the future. Otherwise, the adolescents of 
COVID-19 could become 'the children of risk communication' to the detriment of 
their health and well-being.

DOI: 10.1177/14034948221110409
PMCID: PMC9361418
PMID: 35815538 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of conflicting interests: The 
authors declared no potential conflicts of interest with respect to the 
research, authorship and/or publication of this article.


1805. Int J Public Health. 2022 Jun 24;67:1604735. doi: 10.3389/ijph.2022.1604735. 
eCollection 2022.

Assessing Changes in Anxiety, Empowerment, Stigma and Wellbeing in Participants 
Attending an Online-Based Recovery College in Quebec During the Covid-19 
Pandemic: A Pre-Experimental Study.

Rapisarda F(1), Macario de Medeiros J(1), Briand C(1)(2), Boivin A(3), 
Monthuy-Blanc J(1)(4), Vallée C(5)(6)(7), Drolet MJ(2), Vachon B(1)(8), Luconi 
F(9).

Author information:
(1)Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, 
Montréal, QC, Canada.
(2)Département d'Ergothérapie, Université du Québec à Trois-Rivières, 
Trois-Rivières, QC, Canada.
(3)Departement of Family Medicine, Centre de Recherche du CHUM, Centre 
hospitalier de l'Université de Montréal, Montréal, QC, Canada.
(4)Groupe de Recherche Loricorps, Université du Québec à Trois-Rivières, 
Trois-Rivières, QC, Canada.
(5)Department of Rehabilitation, Faculty of Medicine, Laval University, Québec, 
QC, Canada.
(6)VITAM Research Centre on Sustainable Health, Laval University, Québec, QC, 
Canada.
(7)Cervo Brain Research Centre, Laval University, Laval, QC, Canada.
(8)École de Réadaptation, Faculté de Médecine, Université de Montréal, Montréal, 
QC, Canada.
(9)Office for Continuing Professional Development, Faculty of Medicine and 
Health Sciences, McGill University, Montréal, QC, Canada.

Objectives: The present study aims to evaluate the effect of an online Recovery 
College (RC) program implemented in Quebec (Canada) during the COVID-19 
pandemic. From October 2020 to June 2021, 27 training groups were conducted with 
a total of 362 attendees. Methods: Outcome was evaluated using a single group 
repeated measure design, assessing participants prior the training (T0), after 
the training (T1) and at follow up (T2). 107 learners of the Quebec RC program 
attended three two-hour sessions agreed to participate to the research. Results: 
Overall findings show at T1 a small but statistically significant reduction of 
anxiety and increase in empowerment, and below threshold reduction of 
stigmatizing attitudes and increase of wellbeing. Conversely, the medium-term 
changes at follow up were non-significant for all the outcome dimension except 
for anxiety. Conclusion: Findings suggest that the RC online program can be 
considered as a potential effective strategy to support self-regulation and 
empowerment of individuals and to reduce anxiety in the context of crisis for 
the general population.

Copyright © 2022 Rapisarda, Macario de Medeiros, Briand, Boivin, Monthuy-Blanc, 
Vallée, Drolet, Vachon and Luconi.

DOI: 10.3389/ijph.2022.1604735
PMCID: PMC9263090
PMID: 35814737 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1806. J Psychosom Res. 2022 Sep;160:110959. doi: 10.1016/j.jpsychores.2022.110959. 
Epub 2022 Jun 3.

Stratified changes in emotional distress during the COVID-19 pandemic: Evidence 
from a longitudinal survey of residents in Hubei province, China.

Chen X(1), Lin F(2), Gao H(3), Zou Y(4).

Author information:
(1)Department of Sociology and Social Policy, Lingnan University, Hong Kong, 
China. Electronic address: chenxi424@gmail.com.
(2)Department of Media and Communication, City University of Hong Kong, Hong 
Kong, China. Electronic address: fenlin@cityu.edu.hk.
(3)Faculty of Humanities and Social Sciences, Beijing University of Technology, 
China.
(4)Institute of Sociology, Chinese Academy of Social Sciences, China.

BACKGROUND: The COVID-19 pandemic has had a significant impact on individuals' 
emotional wellbeing and mental health. However, little research has examined 
emotional resilience during the pandemic. This study investigated the changes in 
emotional distress among residents in Hubei, the epicenter of the pandemic in 
China during the early stage of the pandemic, and we examined the 
sociodemographic differences in their emotional recovery.
METHODS: We undertook a two-wave panel survey of 3816 residents aged ≥18 in 
Hubei, China. The baseline survey was conducted during early February 2020, the 
peak of the outbreak. The follow-up survey was carried out when the pandemic was 
mainly under control. The data enabled us to investigate the within-person 
changes in COVID-19-related negative emotions. Mixed-effect regression models 
with a random effect for participants were used to accommodate repeated 
measures.
RESULTS: Respondents reported high levels of emotional distress at the peak of 
the pandemic and experienced a decline in emotional distress when the pandemic 
was under control. Moreover, respondents aged 35-49, with a college education or 
above, were employed, and having better self-rated health experienced a more 
substantial decrease in negative emotions during the COVID-19 pandemic.
CONCLUSION: This study identified vulnerable populations who may experience 
prolonged emotional distress during the COVID-19 pandemic in China. The results 
suggest that respondents who aged over 50, with no college education, were not 
employed, and with worse self-rated health were less resilient during the 
COVID-19 pandemic in China.

Copyright © 2022. Published by Elsevier Inc.

DOI: 10.1016/j.jpsychores.2022.110959
PMCID: PMC9164624
PMID: 35810504 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that there are no conflicts 
of interest.


1807. Asian J Psychiatr. 2022 Aug;74:103194. doi: 10.1016/j.ajp.2022.103194. Epub 2022 
Jun 21.

COVID-19, adversities and depression among older adolescents in urban slums of 
India.

Daniel M(1), Prashad L(2), Kaur A(3), Kallakuri S(4), Devarapalli S(5), Sagar 
R(6), Maulik PK(7).

Author information:
(1)The George Institute for Global Health, India. Electronic address: 
mdaniel@georgeinstitute.org.in.
(2)The George Institute for Global Health, India. Electronic address: 
lprashad@georgeinstitute.org.in.
(3)The George Institute for Global Health, India. Electronic address: 
dramanpreet.cp@gmail.com.
(4)The George Institute for Global Health, India. Electronic address: 
skallakuri1@georgeinstitute.org.in.
(5)The George Institute for Global Health, India. Electronic address: 
devarapalli@georgeinstitute.org.in.
(6)Department of psychiatry, All India Institute of Medical Sciences, Ansari 
Nagar, Ansari Nagar East, New Delhi, 110029, India. Electronic address: 
rsagar29@gmail.com.
(7)The George Institute for Global Health, India; University of New South Wales, 
Sydney; Prasanna School of Public Health, Manipal Academy of Higher Education, 
Madhav Nagar, Eshwar Nagar, Manipal, Karnataka 576104, India. Electronic 
address: pmaulik@georgeinstitute.org.in.

PURPOSE: We report findings from a survey on the mental health impact of 
COVID-19 factoring environmental adversities among older adolescents (15-19 
years) living in urban slums in India.
METHODS: We report survey results of 3490 older adolescents. Patient Health 
Questionnaire-9 was used to assess depression, slum adversity questionnaire for 
slum conditions, and for COVID-19 infection we recorded self-reported positivity 
status. Sociodemographic details were also collected. Additional sub-group 
analyses of sample who had depression and tested positive for COVID-19 infection 
was conducted. We used univariate and multivariate logistic regression models to 
identify factors and COVID-19 infection that were associated with depression.
RESULTS: Adolescents with adversities were three times more likely to report 
depression. Adolescents who reported COVID-19 infection were about two times 
more likely to have depression. Sub-group analyses showed that adolescents 
having experienced adversities and girls were more likely to report depression 
following COVID-19 infection.
CONCLUSIONS: There is a need for an intersectional research framework that 
incorporates stress arising out of a pandemic, social disadvantage, and systemic 
inequities. Such a framework will help to assess mental health issues of 
developmentally vulnerable groups residing in disadvantageous conditions.

Copyright © 2022 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.ajp.2022.103194
PMCID: PMC9214822
PMID: 35809537 [Indexed for MEDLINE]

Conflict of interest statement: The George Institute has a part-owned social 
enterprise, George Health Enterprises, which has commercial relationships 
involving digital health innovations. PKM is partially supported through 
NHMRC/GACD grant (SMART Mental Health- APP1143911) and UKRI/MRC grant 
MR/S023224/1 - Adolescents' Resilience and Treatment nEeds for Mental health in 
Indian Slums (ARTEMIS), MD, SD, SK and AK are partially or wholly supported 
through the SMART Mental Health NHMRC/GACD grant. AK is partially supported by 
Indigo Partnership (MR/R023697/1) award. LP is wholly supported through the ICMR 
ad hoc grant (2019–0531).


1808. Psychiatry Res. 2022 Sep;315:114705. doi: 10.1016/j.psychres.2022.114705. Epub 
2022 Jul 2.

Effects of the COVID-19 pandemic on psychological health in a sample of Italian 
adults: A three-wave longitudinal study.

Fioravanti G(1), Bocci Benucci S(2), Prostamo A(2), Banchi V(2), Casale S(2).

Author information:
(1)Department of Health Sciences, Psychology Unit, University of Florence, via 
di San Salvi 12, Florence 50100, Italy. Electronic address: 
giulia.fioravanti@unifi.it.
(2)Department of Health Sciences, Psychology Unit, University of Florence, via 
di San Salvi 12, Florence 50100, Italy.

The COVID-19 pandemic and the resulting societal restrictions have had negative 
implications for mental health in the general population. The aims of the 
present longitudinal study were (i) to investigate changes in psychopathological 
symptoms and psychological well-being in a sample of Italian individuals 
surveyed at different points of the pandemic and (ii) to evaluate the potential 
risk and protective factors associated with the psychopathological outcomes. 
Self-reported data on psychiatric symptoms, and psychological well-being were 
collected in March 2020 (T0, the lockdown phase), in May 2020 (T1, the end of 
the lockdown phase), and in November 2020 (T2, the second wave of COVID-19 
infection). 1258 participants (Mage=23.43, SDage=6.45; 75.4% female) were 
recruited at T0. Of these, 712 also completed the T1 survey, and 369 also 
completed the T2 survey. A significant decrease in anxiety, depressive, 
posttraumatic, and obsessive-compulsive symptoms and a significant increase in 
psychological well-being were observed from T0 to T1. All psychopathological 
symptoms increased, and psychological well-being decreased significantly from T1 
to T2. Several demographic, psychological and COVID-19-related factors emerged 
as predictors over the course of the pandemic. The current findings indicated 
that psychological health covaried with the intensity of the COVID-19 pandemic 
and the associated societal restrictions.

Copyright © 2022 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.psychres.2022.114705
PMCID: PMC9250412
PMID: 35809495 [Indexed for MEDLINE]

Conflict of interest statement: None.


1809. Int J Environ Res Public Health. 2022 Jul 5;19(13):8218. doi: 
10.3390/ijerph19138218.

A Conceptual Framework for Blockchain Enhanced Information Modeling for Healing 
and Therapeutic Design.

Liu Z(1), Yang Z(1), Liang M(1), Liu Y(2), Osmani M(3), Demian P(3).

Author information:
(1)School of Design, South China University of Technology, Guangzhou 510006, 
China.
(2)School of Innovation, Guangzhou Academy of Fine Arts, No. 257 Changgang Road, 
Guangzhou 510261, China.
(3)School of Architecture, Building and Civil Engineering, Loughborough 
University, Loughborough LE11 3TU, UK.

In the face of the health challenges caused by the COVID-19 pandemic, healing 
and therapeutic design (HTD) as interventions can help with improving people's 
health. It is considered to have great potential to promote health in the forms 
of art, architecture, landscape, space, and environment. However, there are 
insufficient design approaches to address the challenges during the HTD process. 
An increased number of studies have shown that emerging information modeling 
(IM) such as building information modeling (BIM), landscape information modeling 
(LIM), and city information modeling (CIM) coupled with blockchain (BC) 
functionalities have the potential to enhance designers' HTD by considering 
important design elements, namely design variables, design knowledge, and design 
decision. It can also address challenges during the design process, such as 
design changes, conflicts in design requirements, the lack of design evaluation 
tools and frameworks, and incomplete design information. Therefore, this paper 
aims to develop a conceptual BC enhanced IM for HTD (BC-HTD) framework that 
addresses the challenges in the HTD and promotes health and well-being. The 
structure of BC-HTD framework is twofold: (1) a conceptual high-level framework 
comprising three levels: user; system; and information, (2) a conceptual 
low-level framework of detailed content at the system level, which has been 
constructed using a mixed quantitative and qualitative method of literature 
analysis, and validated via a pre-interview questionnaire survey and follow-up 
interviews with industry experts and academics. This paper analyzes the process 
of BC enhanced HTD and the knowledge management of HTD to aid design decisions 
in managing design information. This paper is the first attempt to apply the 
advantages of BC enabled IM to enhance the HTD process. The results of this 
study can foster and propel new research pathways and knowledge on the value of 
design in the form of non-fungible token (NFT) based on the extended advantages 
of BC in the field of design, which can fully mobilize the healing and 
therapeutic behaviors of designers and the advantage potential of HTD to promote 
health, and realize the vision of Health Metaverse in the context of sustainable 
development.

DOI: 10.3390/ijerph19138218
PMCID: PMC9266876
PMID: 35805875 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that there is no conflict of 
interest.


1810. Int J Environ Res Public Health. 2022 Jun 30;19(13):8046. doi: 
10.3390/ijerph19138046.

The Multi-Sites Trial on the Effects of Therapeutic Gardening on Mental Health 
and Well-Being.

Yang Y(1)(2), Ro E(1)(2), Lee TJ(3), An BC(4), Hong KP(5), Yun HJ(6), Park 
EY(7), Cho HR(8), Yun SY(9), Park M(10), Yun YJ(11), Lee AR(12), Jeon JI(13), 
Jung S(14), Ahn TH(14), Jin HY(14), Lee KJ(15), Choi KH(1)(2).

Author information:
(1)School of Psychology, Korea University, Seoul 02841, Korea.
(2)KU Mind Health Institute, Korea University, Seoul 02841, Korea.
(3)Hantaek Botanical Garden, Yongin 17183, Korea.
(4)Division of Forest & Landscape Architecture, Wonkwang University, Iksan 
54538, Korea.
(5)Korea Institute of Garden Design, Seoul 07995, Korea.
(6)Landscape Yeoleum, Seoul 04026, Korea.
(7)Department of Environmental Landscape Architecture, Joongbu University, 
Geumsan 32713, Korea.
(8)Seoul Green Trust, Seoul 04766, Korea.
(9)Department of Landscape Architecture, Daegu Catholic University, Gyeongsan 
38430, Korea.
(10)Department of Smart Green City Industry Convergence, Korea Nazarene 
University, Cheonan 31172, Korea.
(11)Department of Ecological Landscape Architecture Design, Kangwon National 
University, Chuncheon 24341, Korea.
(12)Department of Human Environment Design, Cheongju University, Cheongju 28503, 
Korea.
(13)Shingu Botanic Garden, Shingu College, Seongnam 13443, Korea.
(14)Gardens and Education Research Division, Korea National Arboretum, Pocheon 
11186, Korea.
(15)Integrative Obstetrics & Gynecology, Institute for Occupational & 
Environmental Health, Korea University, Seoul 02841, Korea.

Although many people affected by COVID-19 suffer from some form of psychological 
distress, access to proper treatment or psychosocial interventions has been 
limited. This study aimed to examine the feasibility and preliminary effects of 
a therapeutic gardening program conducted during the COVID-19 pandemic. The 
program consisted of 30 sessions and was conducted at 10 nationwide sites in 
Korea from June to November 2021. Mental health and well-being were assessed 
using the Mental Health Screening Tool for Depressive Disorders, Mental Health 
Screening Tool for Anxiety Disorders, Engagement in Daily Activity Scale, brief 
version of World Health Organization Quality of Life, and Mindful Attention 
Awareness Scale. Cohen's d value was calculated for the effect size, and a 
multilevel analysis was used to determine the longitudinal effects of 
therapeutic gardening. The effect sizes for depression, anxiety, daily 
activities, quality of life, and mindfulness were 0.84, 0.72, 0.61, 0.64, and 
0.40, respectively. Multilevel analyses showed that all five mental health 
variables improved significantly over time as the therapeutic gardening program 
progressed. Therapeutic gardening is promising and applicable as a nature-based 
intervention to improve the mental health of individuals experiencing 
psychological distress especially in the COVID-19 pandemic.

DOI: 10.3390/ijerph19138046
PMCID: PMC9266122
PMID: 35805706 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1811. Int J Environ Res Public Health. 2022 Jun 30;19(13):8023. doi: 
10.3390/ijerph19138023.

The Impact of the COVID-19 Pandemic on Healthy Lifestyle Behaviors and Perceived 
Mental and Physical Health of People Living with Non-Communicable Diseases: An 
International Cross-Sectional Survey.

Azzouzi S(1)(2), Stratton C(3), Muñoz-Velasco LP(4), Wang K(3), Fourtassi M(5), 
Hong BY(6), Cooper R(7), Balikuddembe JK(8), Palomba A(9), Peterson M(10), 
Pandiyan U(11), Krassioukov A(12)(13)(14), Tripathi DR(15), Tuakli-Wosornu 
YA(3), Hajjioui A(1)(2).

Author information:
(1)Clinical Neuroscience Laboratory, Faculty of Medicine, Pharmacy and 
Dentistry, University Sidi Mohamed Ben Abdellah, Fez 30050, Morocco.
(2)Department of Physical and Rehabilitation Medicine, University Hospital 
Hassan II of Fez, Fez 30050, Morocco.
(3)Department of Chronic Disease and Epidemiology, Yale School of Public Health, 
New Haven, CT 06510, USA.
(4)Amputee Rehabilitation Department, National Institute of Rehabilitation, 
Mexico City 14389, Mexico.
(5)Laboratory of Life and Health Sciences, Faculty of Medicine of Tangier, 
Abdelmalek Essaâdi University, Tetouan 90100, Morocco.
(6)Department of Rehabilitation Medicine, St. Vincent's Hospital, College of 
Medicine, The Catholic University of Korea, Seoul 06591, Korea.
(7)Human Engineering Research Laboratories (HERL), US Department of Veteran 
Affairs, School of Health and Rehabilitation Sciences, University of Pittsburgh, 
Pittsburgh, PA 15206, USA.
(8)Department of Disaster Health Sciences, Institute for Disaster Management and 
Reconstruction, Si Chuan University-Hong Kong Polytechnic University, Chengdu 
610207, China.
(9)Department of Medical and Surgical Specialties and Dentistry, University of 
Campania "Luigi Vanvitelli", 80138 Naples, Italy.
(10)Department of Physical Medicine and Rehabilitation, Michigan Medicine 
Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI 48109, USA.
(11)Qatar Rehabilitation Institute, Hamad Medical Corporation, Doha 3050, Qatar.
(12)International Collaboration on Repair Discoveries, Faculty of Medicine, 
University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
(13)Division of Physical Medicine and Rehabilitation, Department of Medicine, 
University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
(14)G.F. Strong Rehabilitation Centre, Vancouver, BC V5Z 2G9, Canada.
(15)Dr. Ram Manohar Lohia Hospital and Post Graduate Institute of Medical 
Education and Research (PGIMER), New Delhi 110001, India.

The huge burden and vulnerability imposed by non-communicable diseases (NCDs) 
during the COVID-19 pandemic highlighted how healthy lifestyle behaviors and the 
well-being of people living with NCDs need to be prioritized. The aim of our 
study is to better understand the impact of the COVID-19 pandemic on healthy 
lifestyle behaviors and perceived mental and physical health among adults living 
with NCDs, as compared to people without NCDs. We conducted a cross-sectional 
study using a global online survey through Qualtrics. Over four months, 3550 
participants from 65 countries worldwide responded to the survey. The study 
included 3079 surveys with no missing data (complete survey responses) that were 
used for analysis. People with NCDs were more likely to report statistically 
significant worsening physical health (p = 0.001) and statistically 
insignificant worsening mental health (p = 0.354) when compared to pre-pandemic 
levels. They reported lower rates of smoking during the pandemic than those 
without NCDs, and a statistically significant (p < 0.001) relationship was found 
between weight gain and NCDs. Therefore, the perceived physical and mental 
health, including changes in body weight and tobacco consumption, of people with 
NCDs were significantly impacted during the pandemic. In conclusion, this study 
indicates that the pandemic had a significant impact on perceived physical and 
mental health, changes in body weight, and tobacco consumption among people with 
NCDs.

DOI: 10.3390/ijerph19138023
PMCID: PMC9265593
PMID: 35805680 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1812. Int J Environ Res Public Health. 2022 Jun 28;19(13):7914. doi: 
10.3390/ijerph19137914.

Post-Migration Stressors and Mental Health for African Migrants in South 
Australia: A Qualitative Study.

Mwanri L(1), Fauk NK(1)(2), Ziersch A(3), Gesesew HA(1)(4), Asa GA(1), Ward 
PR(1).

Author information:
(1)Research Centre for Public Health Policy, Torrens University Australia, 
Adelaide, SA 5000, Australia.
(2)Institute of Resource Governance and Social Change, Kupang 85227, Indonesia.
(3)College of Medicine and Public Health, Flinders University, Adelaide, SA 
5001, Australia.
(4)College of Health Sciences, Mekelle University, Mekelle P.O. Box 231, Tigray, 
Ethiopia.

We conducted a qualitative study involving African migrants (n = 20) and service 
providers (n = 10) in South Australia to explore mental health stressors, access 
to mental health services and how to improve mental health services for African 
migrant populations. This paper presents the views and experiences of African 
migrants about the post-migration stressors they faced in resettlement that pose 
mental health challenges. The participants were recruited using the snowball 
sampling technique. To align with the COVID-19 pandemic protocol, the data 
collection was conducted using one-on-one online interviews through Zoom or 
WhatsApp video calls. Data analysis was guided by the framework analysis. The 
post-migration stressors, including separation from family members and 
significant others, especially spouses, imposed significant difficulties on care 
provision and in managing children's attitudes and behavior-related troubles at 
school. African cultural practices involving the community, especially elders in 
care provision and disciplining children, were not consistent with Australian 
norms, compounding the mental health stressors for all involved. The African 
cultural norms, that do not allow young unmarried people to live together, also 
contributed to child-parent conflicts, enhancing parental mental stressors. 
Additionally, poor economic conditions and employment-related difficulties were 
post-migration stressors that the participants faced. The findings indicate the 
need for policy and intervention programs that address the above challenges. The 
provision of interventions, including social support such as subsidized or free 
childcare services, could help leverage their time and scheduled paid 
employment, creating time for effective parenting and improving their mental 
health and wellbeing. Future studies exploring what needs to be achieved by 
government and non-governmental institutions to support enhanced access to 
social and employment opportunities for the African migrant population are also 
recommended.

DOI: 10.3390/ijerph19137914
PMCID: PMC9265307
PMID: 35805574 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no potential conflict of 
interest with respect to the research, authorship and/or publication of this 
article.


1813. Int J Environ Res Public Health. 2022 Jun 27;19(13):7868. doi: 
10.3390/ijerph19137868.

Designing the Well-Being of Romanians by Achieving Mental Health with Digital 
Methods and Public Health Promotion.

Brătucu G(1), Tudor AIM(1), Litră AV(1), Nichifor E(1), Chițu IB(1), Brătucu 
TO(2).

Author information:
(1)Faculty of Economic Sciences and Business Administration, Transilvania 
University of Brașov, Colina Universității Street No. 1, Building A, 500068 
Brașov, Romania.
(2)The School Center for Inclusive Education Brasov, 125 Bd. 13 Decembrie, 
500164 Brașov, Romania.

Taking care of mental health is a state of mind. Amid the challenges of the 
current context, mental health has become one of the problems with the greatest 
impact on citizens and the evolution of any economy. Due to the COVID-19 
pandemic, people have become more anxious, solitary, preoccupied with 
themselves, and depressed because their entire universe has changed, by 
restricting their social and professional life; the increase in concern caused 
by a possible illness of them or those close to them made to isolate themselves. 
Two qualitative (group and in-depth interviews) and one survey-based 
quantitative research were carried out, which allowed the quantification of the 
opinions, perceptions, and attitudes of Romanians regarding the effectiveness of 
policies for the prevention and treatment of depression. Quantitative research 
revealed that most of the subjects had never participated in a mental health 
assessment, and a quarter of them had visited a mental health specialist more 
than two years ago. Based on the results, proposals were elaborated, which have 
been addressed both to the specialists from the Ministry of Health and to those 
from the academic environment, that may have an impact on the elaboration of 
some public mental health programs.

DOI: 10.3390/ijerph19137868
PMCID: PMC9265539
PMID: 35805527 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1814. Int J Environ Res Public Health. 2022 Jun 25;19(13):7801. doi: 
10.3390/ijerph19137801.

The Critical Need for a Meaning-Centered Team-Level Intervention to Address 
Healthcare Provider Distress Now.

Rosa WE(1), Roberts KE(2), Schlak AE(3), Applebaum AJ(1), Breitbart WS(1), 
Kantoff EH(1), Pessin H(1), Lichtenthal WG(1).

Author information:
(1)Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering 
Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY 10022, USA.
(2)Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park 
Avenue, Bronx, New York, NY 10461, USA.
(3)School of Nursing, Columbia University, 560 West 168th Street, New York, NY 
10032, USA.

COVID-19 has unveiled and amplified the burnout, grief, and other forms of 
distress among healthcare providers (HCPs) that long preceded the pandemic. The 
suffering of the healthcare workforce cannot be simply and sufficiently 
addressed with a single psychotherapeutic intervention. Nevertheless, the 
National Academies of Sciences, Engineering, and Medicine Studies recommended 
prioritizing interventions that generate an increased sense of meaning in life 
and in work to reduce burnout and cultivate clinician wellbeing. Despite their 
guidance, there is a dearth of interventions for HCPs specifically targeting 
meaning and purpose as an avenue to reduce HCP distress. In a time when such an 
intervention has never been more essential, Meaning-Centered Pyschotherapy 
(MCP), a brief, evidence-based intervention designed for patients with advanced 
cancer may be key. This piece describes the principles underlying MCP and how it 
might be adapted and applied to ameliorate burnout among HCPs while providing a 
rationale to support future empirical studies in this area. Importantly, the 
systemic factors that contribute to the emotional and mental health burdens of 
HCPs are discussed, emphasizing the need for systems-level changes that are 
needed to leverage the potential outcomes of MCP for HCPs.

DOI: 10.3390/ijerph19137801
PMCID: PMC9265276
PMID: 35805459 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1815. Int J Environ Res Public Health. 2022 Jun 22;19(13):7631. doi: 
10.3390/ijerph19137631.

Exploring the Psychological Impacts of COVID-19 Social Restrictions on 
International University Students: A Qualitative Study.

Al-Oraibi A(1)(2), Fothergill L(3), Yildirim M(4), Knight H(1), Carlisle S(1), 
O'Connor M(4), Briggs L(4), Morling JR(1)(5), Corner J(6), Ball JK(7)(8), 
Denning C(7)(8), Vedhara K(1), Blake H(4)(5).

Author information:
(1)School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK.
(2)Department of Respiratory Sciences, University of Leicester, Leicester LE1 
9HN, UK.
(3)Division of Health Research, Lancaster University, Lancaster LA1 4AG, UK.
(4)School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK.
(5)NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH, UK.
(6)University Executive Board, University of Nottingham, Nottingham NG7 2RD, UK.
(7)School of Life Sciences, University of Nottingham, Nottingham NG7 2UH, UK.
(8)Biodiscovery Institute, University of Nottingham, Nottingham NG7 2RD, UK.

The global COVID-19 pandemic has impacted on the mental well-being of university 
students, but little attention has been given to international students, who may 
have a unique experience and perspective. The aim of this study was to explore 
the views of international students and university staff towards COVID-19 
restrictions, self-isolation, their well-being, and support needs, through eight 
online focus groups with international students (n = 29) and semi-structured 
interviews with university staff (n = 17) at a higher education institution in 
England. Data were analysed using an inductive thematic approach, revealing 
three key themes and six subthemes: (1) practical, academic, and psychological 
challenges faced during self-isolation and the COVID-19 pandemic; (2) coping 
strategies to self-isolation and life during the pandemic; and (3) views on 
further support needed for international students. International students faced 
practical, academic, and psychological challenges during the COVID-19 pandemic, 
particularly relating to the rapid transition to online learning and the impact 
of social restrictions on integration with peers and well-being. Online social 
connections with peers, family, or new acquaintances reduced feelings of 
isolation and encouraged involvement in university life. Despite raising mental 
health concerns, most international students did not access mental health 
support services. Staff related this to perceived stigma around mental health in 
certain cultural groups. In conclusion, international students experienced 
specific practical and emotional challenges during the pandemic, and are at risk 
of mental ill-health, but may not actively seek out support from university 
services. Proactive and personalised approaches to student support will be 
important for positive student experiences and the retention of students who are 
studying abroad in the UK higher education system.

DOI: 10.3390/ijerph19137631
PMCID: PMC9266157
PMID: 35805287 [Indexed for MEDLINE]

Conflict of interest statement: All authors were employees of the University of 
Nottingham, the institution at which data were collected. No other conflicts of 
interest were declared.


1816. Int J Environ Res Public Health. 2022 Jun 21;19(13):7573. doi: 
10.3390/ijerph19137573.

Exploring the Impacts of Preventative Health Behaviors with Respect to COVID-19: 
An Altruistic Perspective.

Luo YF(1)(2), Yang SC(1), Hung SC(1)(3), Chou KY(1).

Author information:
(1)Intelligent Electronic Commerce Research Center, Institute of Education, 
National Sun Yat-Sen University, Kaohsiung 80424, Taiwan.
(2)Center for Teaching and Learning Development, National Kaohsiung University 
of Science and Technology, Kaohsiung 805301, Taiwan.
(3)Department of Information and Communication, Southern Taiwan University of 
Science and Technology, Tainan 710301, Taiwan.

This study aims to explore the impact of gender and anxiety on various 
preventative health behaviors, and the relationships among these preventative 
health behaviors, individual well-being and depression, from the perspective of 
altruism. This study employed an online questionnaire survey, and 136 males and 
204 females participated in the survey. The results of this study showed that 
females exhibited better preventative health behaviors than males, including 
hygiene habits, social distancing and behaviors intended to help others mitigate 
the epidemic. Anxiety regarding COVID-19 infection encouraged individuals to 
adopt hygienic habits and social distancing measures rather than to help others 
mitigate the epidemic. Hygiene habits improved the individual's psychological 
well-being. Helping others mitigate the epidemic improved the individual's 
psychological well-being and social well-being and contributed to reducing 
individual depression. However, the preventative health behavior involved in 
social distancing was not conducive to emotional well-being or social 
well-being. Affective elements are related to individual behaviors. Therefore, 
the use of prosocial, altruistic language may play an important role with 
respect to encouraging people to comply with preventative health behaviors in 
the context of COVID-19. In addition, it is worth noting that different 
preventative health behaviors may have different effects on people's mental 
health, especially when implementing social distancing-related epidemic 
mitigation behaviors. The question of how to prevent negative psychological 
effects in restricted actors must be answered, and the degree of life 
satisfaction experienced by those actors must also be taken into account.

DOI: 10.3390/ijerph19137573
PMCID: PMC9265907
PMID: 35805228 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as potential conflict of interest.


1817. Reprod Health. 2022 Jul 8;19(1):158. doi: 10.1186/s12978-022-01446-2.

Accessing Antenatal Care (ANC) services during the COVID-19 first wave: insights 
into decision-making in rural India.

Bankar S(1), Ghosh D(2).

Author information:
(1)Centre for Social and Behaviour Change, Ashoka University, Haryana, India. 
shwetabankar@gmail.com.
(2)Centre for Social and Behaviour Change, Ashoka University, Haryana, India.

BACKGROUND: Antenatal care (ANC) services are a prime focus of the Government of 
India's National Health Mission (NHM), of which a key pillar is the promotion of 
maternal and child health. To ensure uninterrupted service delivery at the last 
mile, a cadre of Frontline Health Workers (FLHWs) has been appointed and health 
centres established at the village level. However, the onset of the COVID-19 
pandemic and the nationwide lockdown from late March to June 2020 impacted 
pregnant women's access to institutional antenatal care services.
METHODS: Using a qualitative research design, data was collected through 12 
in-depth interviews (IDIs) with pregnant women and 17 IDIs with frontline health 
workers in the selected six districts under study. The narratives were analysed 
using inductive coding in Atlas.ti.
RESULTS: During the first wave of the COVID-19 pandemic, pregnant women, most of 
whom belonged to poor and marginalised groups, were left with limited access to 
health centres and FLHWs. Respondents from the study areas of rural Jharkhand, 
Madhya Pradesh and Uttar Pradesh extensively reported concerns stemming from the 
lockdown that influenced their decision to access ANC services. These included 
anxieties around meeting their families' daily needs due to a loss of livelihood 
(in particular, abject food insecurity), inability to access healthcare, and a 
sense of mistrust in public health systems and functionaries. All of these, 
coupled with the real threat to health posed by COVID-19, disrupted their plans 
for pregnancy and delivery, further compunding the risk to their health and 
wellbeing.
CONCLUSION: This study identified several social, behavioural and structural 
facets of the communities that contributed to the confusion, anxiety and 
helplessness experienced during the COVID-19 first wave by both groups, viz. 
pregnant women and FLHWs. In planning and implementing initiaves to ensure the 
delivery and uptake of ANC services in this and similar contexts during times of 
crisis, these facets must be considered.

Plain Language Summary: This article highlights the status of ANC services 
during the nationwide lockdown imposed in the first wave of the COVID-19 
pandemic in the Indian states of Jharkhand, Madhya Pradesh and Uttar Pradesh. 
Data was collected through 12 in-depth interviews with pregnant women and 17 
in-depth interviews with frontline health workers. Findings suggest that 
pregnant women were aware of the unprecedented threat of COVID-19 and 
recommended protective measures through trusted sources of information, 
including their local Accredited Social Health Activist (ASHA). However, both 
pregnant women and FLHWs believed that the information they received on the 
health risks of the pandemic and strategies to address these was inadequate. 
Temporary suspension of health services in the rural countryside meant that 
pregnant women could not track the foetus's health status, resulting in 
confusion and distress. Limited or no interaction with FLHWs, coupled with a 
reported lack of attention to conditions unrelated to COVID-19 and 
discrimination at healthcare institutions increased the uncertainty around 
institutional deliveries. This was further heightened by the loss of livelihoods 
due to the shutdown of businesses during the lockdown, as the respondents could 
not turn to private hospitals for childbirth. This resulted in the collapse of 
the trust of pregnant women and their families in the public healthcare system. 
To bridge this gap and alleviate the sense of mistrust the pandemic has created 
in its end-users, strategies to improve the utilisation of health services 
should respond to the barriers identified in this study.

© 2022. The Author(s).

DOI: 10.1186/s12978-022-01446-2
PMCID: PMC9264734
PMID: 35804394 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1818. Radiography (Lond). 2022 Oct;28 Suppl 1:S27-S34. doi: 
10.1016/j.radi.2022.06.011. Epub 2022 Jun 27.

The impact of COVID-19 on the mental health of radiography staff and managers in 
Northern Ireland, UK: The radiography managers' perspective.

Flood T(1), McFadden S(2), Shepherd P(3).

Author information:
(1)Radiotherapy and Oncology, School of Health Sciences, Ulster University, UK. 
Electronic address: t.flood@ulster.ac.uk.
(2)Diagnostic Imaging, School of Health Sciences, Ulster University, UK.
(3)Radiotherapy and Oncology, School of Health Sciences, Ulster University, UK.

INTRODUCTION: Increasing evidence suggests that the COVID-19 pandemic has 
influenced the mental health of health professionals, including radiographers. 
Less is known about the effect of the pandemic on the mental health of 
radiography managers. Radiography managers have led their teams through the 
pandemic, making unpopular decisions to safeguard staff and patients. This study 
explores radiography managers' perceptions regarding the impact of the COVID-19 
pandemic on the mental health of themselves and their staff.
METHODS: Ethical approval was obtained from the NHS Research Ethics Committee 
(ID 287032). Eleven interviews were conducted with therapeutic and diagnostic 
radiography managers between March-April 2021. Written information was also 
included from a paediatric diagnostic radiography manager. Data was analysed 
independently by 2 researchers using thematic analysis.
RESULTS: Three central themes emerged: 1) Factors perceived to have negatively 
influenced mental health, which included changing PPE guidance, restructuring of 
work conditions, social isolation, challenges to patient care and lack of 
quality vacation leave. 2) Factors perceived to have positively influenced 
mental health, which included witnessing staff resilience and team camaraderie. 
3) Support provided for mental health.
CONCLUSION: Managers felt that they had implemented appropriate strategies to 
support their staff throughout the first year of the pandemic and expressed 
feeling responsible for the wellbeing of their staff. Strong empathy was evident 
towards staff and their experiences. Despite the availability of mental health 
support services, managers felt that resources were underutilised by radiography 
teams.
IMPLICATIONS FOR PRACTICE: Managers should be proactive in communicating their 
appreciation for their staff in an era where remote working can add to 
disconnect between staff and management. Mental health support services should 
be promoted and continually reviewed, to ensure that appropriate support 
services are maintained.

Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.radi.2022.06.011
PMCID: PMC9234019
PMID: 35803870 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest The authors declare that 
they have no conflict of interest and received no financial support to write 
this article.


1819. Birth. 2023 Jun;50(2):407-417. doi: 10.1111/birt.12664. Epub 2022 Jul 8.

Latent class analysis of health, social, and behavioral profiles associated with 
psychological distress among pregnant and postpartum women during the COVID-19 
pandemic in the United States.

Goldstein E(1), Brown RL(2), Lennon RP(3), Zgierska AE(3)(4)(5).

Author information:
(1)Department Population Health Nursing Science, University of Illinois at 
Chicago College of Nursing, Chicago, Illinois, USA.
(2)University of Wisconsin-Madison Schools of Nursing, Medicine and Public 
Health - Design and Statistics Unit, Madison, Wisconsin, USA.
(3)Department of Family and Community Medicine, Pennsylvania State University 
College of Medicine, Hershey, Pennsylvania, USA.
(4)Department of Anesthesiology and Perioperative Medicine, Pennsylvania State 
University College of Medicine, Hershey, Pennsylvania, USA.
(5)Department of Public Health Sciences, Pennsylvania State University College 
of Medicine, Hershey, Pennsylvania, USA.

BACKGROUND: There is a growing body of literature documenting negative mental 
health impacts from the COVID-19 pandemic. The purpose of this study was to 
identify risk and protective factors associated with mental health and 
well-being among pregnant and postpartum women during the pandemic.
METHODS: This was a cross-sectional, anonymous online survey study distributed 
to pregnant and postpartum (within 6 months) women identified through electronic 
health records from two large healthcare systems in the Northeastern and 
Midwestern United States. Survey questions explored perinatal and postpartum 
experiences related to the pandemic, including social support, coping, and 
health care needs and access. Latent class analysis was performed to identify 
classes among 13 distinct health, social, and behavioral variables. Outcomes of 
depression, anxiety, and stress were examined using propensity-weighted 
regression modeling.
RESULTS: Fit indices demonstrated a three-class solution as the best fitting 
model. Respondents (N = 616) from both regions comprised three classes, which 
significantly differed on sleep- and exercise-related health, social behaviors, 
and mental health: Higher Psychological Distress (31.8%), Moderate Psychological 
Distress (49.8%), and Lower Psychological Distress (18.4%). The largest 
discriminatory issue was support from one's social network. Significant 
differences in depression, anxiety, and stress severity scores were observed 
across these three classes. Reported need for mental health services was greater 
than reported access.
CONCLUSIONS: Mental health outcomes were largely predicted by the lack or 
presence of social support, which can inform public health decisions and 
measures to buffer the psychological impact of ongoing waves of the COVID-19 
pandemic on pregnant and postpartum women. Targeted early intervention among 
those in higher distress categories may help improve maternal and child health.

© 2022 The Authors. Birth published by Wiley Periodicals LLC.

DOI: 10.1111/birt.12664
PMCID: PMC9349739
PMID: 35802785 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
declare that are relevant to the content of this article.


1820. Women Birth. 2023 Feb;36(1):47-55. doi: 10.1016/j.wombi.2022.06.005. Epub 2022 
Jun 17.

The effect of COVID-19 lockdowns on women's perinatal mental health: a 
systematic review.

Wall S(1), Dempsey M(2).

Author information:
(1)School of Applied Psychology, University College Cork, Cork, Ireland. 
Electronic address: 120225734@umail.ucc.ie.
(2)School of Applied Psychology, University College Cork, Cork, Ireland.

BACKGROUND: Risk factors for poor maternal perinatal mental health include a 
previous mental health diagnosis, reduced access to perinatal services, economic 
concerns and decreased levels of social support. Adverse maternal perinatal 
mental health can negatively influence the psychological wellbeing of infants. 
The outbreak of the COVID-19 pandemic presented an additional stressor. While 
literature on the impact of COVID-19 on perinatal mental health exists, no 
systematic review has focused specifically on maternal perinatal mental health 
during periods of COVID-19 lockdown.
AIMS: This systematic review explores how periods of COVID-19 lockdown impacted 
women's perinatal mental health.
METHODS: Searches of CINAHL, PsycARTICLES, PsycINFO, PubMed, Scopus and Web of 
Science were conducted for literature from 1st January 2020-25th May 2021. 
Quantitative, peer-reviewed, cross-sectional studies published in English with 
perinatal women as participants, and data collected during a period of lockdown, 
were included. Data was assessed for quality and narratively synthesized.
FINDINGS: Sixteen articles from nine countries met the inclusion criteria. 
COVID-19 lockdowns negatively impacted perinatal mental health. Risk factors for 
negative perinatal mental health noted in previous literature were confirmed. In 
addition, resilience, educational attainment, trimester, and ethnicity were 
identified as other variables which may influence mental health during perinatal 
periods experienced during lockdown. Understanding nuance in experience and 
harnessing intra and interpersonal support could advance options for 
intervention.
CONCLUSION: Developing resources for perinatal women that integrate informal 
sources of support may aid them when normal routine is challenged, and may 
mediate potential long-term impacts of poor perinatal maternal health on 
infants.

Copyright © 2023 Australian College of Midwives. Published by Elsevier Ltd. All 
rights reserved.

DOI: 10.1016/j.wombi.2022.06.005
PMCID: PMC9212959
PMID: 35798661 [Indexed for MEDLINE]


1821. Nature. 2022 Jul;607(7919):512-520. doi: 10.1038/s41586-022-04907-7. Epub 2022 
Jul 6.

A synergistic mindsets intervention protects adolescents from stress.

Yeager DS(1), Bryan CJ(2), Gross JJ(3), Murray JS(4)(5), Krettek Cobb D(6), H F 
Santos P(4), Gravelding H(7), Johnson M(8), Jamieson JP(9).

Author information:
(1)Department of Psychology and Behavioral Science and Policy Institute, 
University of Texas at Austin, Austin, TX, USA. dyeager@utexas.edu.
(2)Department of Business, Government, and Society and Behavioral Science and 
Policy Institute, University of Texas at Austin, Austin, TX, USA. 
Christopher.Bryan@mccombs.utexas.edu.
(3)Department of Psychology, Stanford University, Stanford, CA, USA.
(4)Department of Information, Risk and Operations Management, University of 
Texas at Austin, Austin, TX, USA.
(5)Department of Statistics and Data Sciences, University of Texas at Austin, 
Austin, TX, USA.
(6)Empathy Lab, Google, Mountain View, CA, USA.
(7)Department of Psychology, University of Rochester, Rochester, NY, USA.
(8)Department of Psychology and Behavioral Science and Policy Institute, 
University of Texas at Austin, Austin, TX, USA.
(9)Department of Psychology, University of Rochester, Rochester, NY, USA. 
jeremy.jamieson@rochester.edu.

Update of
    Res Sq. 2021 May 28;:

Social-evaluative stressors-experiences in which people feel they could be 
judged negatively-pose a major threat to adolescent mental health1-3 and can 
cause young people to disengage from stressful pursuits, resulting in missed 
opportunities to acquire valuable skills. Here we show that replicable benefits 
for the stress responses of adolescents can be achieved with a short (around 
30-min), scalable 'synergistic mindsets' intervention. This intervention, which 
is a self-administered online training module, synergistically targets both 
growth mindsets4 (the idea that intelligence can be developed) and 
stress-can-be-enhancing mindsets5 (the idea that one's physiological stress 
response can fuel optimal performance). In six double-blind, randomized, 
controlled experiments that were conducted with secondary and post-secondary 
students in the United States, the synergistic mindsets intervention improved 
stress-related cognitions (study 1, n = 2,717; study 2, n = 755), cardiovascular 
reactivity (study 3, n = 160; study 4, n = 200), daily cortisol levels (study 5, 
n = 118 students, n = 1,213 observations), psychological well-being (studies 4 
and 5), academic success (study 5) and anxiety symptoms during the 2020 COVID-19 
lockdowns (study 6, n = 341). Heterogeneity analyses (studies 3, 5 and 6) and a 
four-cell experiment (study 4) showed that the benefits of the intervention 
depended on addressing both mindsets-growth and stress-synergistically. 
Confidence in these conclusions comes from a conservative, Bayesian 
machine-learning statistical method for detecting heterogeneous effects6. Thus, 
our research has identified a treatment for adolescent stress that could, in 
principle, be scaled nationally at low cost.

© 2022. The Author(s).

DOI: 10.1038/s41586-022-04907-7
PMCID: PMC9258473
PMID: 35794485 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests for 
this study. D.S.Y. has disseminated growth mindset research to public audiences 
and has complied with institutional financial disclosure requirements; no 
financial conflicts of interest have been identified. D.K.C. is employed by 
Google, which owns technology products designed to support well-being, but does 
not currently make or sell any product based on the research presented here. 
None of the study funders accessed the raw data, nor did they influence the data 
collection, analysis or reporting.


1822. Qual Life Res. 2022 Nov;31(11):3139-3151. doi: 10.1007/s11136-022-03177-0. Epub 
2022 Jul 5.

Conspiracy mentality among informal caregivers as a risk factor for caregiver 
burden, mental health, perceived loneliness and social isolation during the 
COVID-19 pandemic: findings of a representative online study from Germany.

Zwar L(1), König HH(2), Hajek A(2).

Author information:
(1)Department of Health Economics and Health Services Research, University 
Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany. 
l.zwar@uke.de.
(2)Department of Health Economics and Health Services Research, University 
Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.

PURPOSE: This study aims to analyze if and how conspiracy mentality is 
associated with mental health, burden and perceived social isolation and 
loneliness of informal caregivers of older individuals with care needs.
METHODS: A quantitative, cross-sectional study was conducted. Participants had 
to be at least 40 years of age and were drawn randomly from the German online 
panel forsa.omninet and questioned between the 4th and 19th of March 2021. A 
sample of 489 informal caregivers (relatives and non-relatives supporting 
individuals aged ≥ 60 years) was questioned. Conspiracy mentality, depressive 
symptoms, loneliness and social exclusion were measured with validated 
instruments (e.g., The Conspiracy Mentality Questionnaire). Questions referred 
to the last three months prior to assessment. Multiple linear regression 
analyses, adjusted for sociodemographic, economic and health factors and 
indicators of the pandemic, were conducted.
RESULTS: Findings indicate a significant positive association between conspiracy 
mentality and caregiver burden, loneliness, social exclusion, and depressive 
symptoms. No gender differences were found for any outcome.
CONCLUSIONS: The results indicate that conspiracy mentality could be a risk 
factor for mental health, perceived social isolation and loneliness, and 
contribute to increased caregiver burden among informal caregivers of older care 
recipients during the COVID-19 pandemic. Accordingly, informal caregivers could 
benefit from actions focused on reducing conspiracy mentality during a health 
crisis, which could improve psychosocial health and wellbeing in this vulnerable 
group.

© 2022. The Author(s).

DOI: 10.1007/s11136-022-03177-0
PMCID: PMC9255449
PMID: 35789451 [Indexed for MEDLINE]

Conflict of interest statement: The authors have not disclosed any competing 
interests.


1823. J Youth Adolesc. 2022 Sep;51(9):1679-1692. doi: 10.1007/s10964-022-01648-8. Epub 
2022 Jul 4.

Living with COVID-19: Subjective Well-Being in the Second Phase of the Pandemic.

Henseke G(1), Green F(2), Schoon I(2).

Author information:
(1)University College London, Institute of Education, LLAKES Centre, 20 Bedford 
Way, London, WC1H 0AL, UK. g.henseke@ucl.ac.uk.
(2)University College London, Institute of Education, LLAKES Centre, 20 Bedford 
Way, London, WC1H 0AL, UK.

While there is ample evidence of the decline in mental health among youth during 
the onset of the COVID-19 pandemic, less is known about the determinants of 
recovery, which is the focus of this study. Drawing on a stress process 
framework, this study examines the associations of changes in direct, 
pandemic-related, and indirect, lockdown-related stressors with life 
satisfaction. A novel representative, longitudinal sample of British 
16-25-year-olds is used, drawing on 6 data collections between February 2021 to 
May 2022 (N = 6000, 51% female, 24% ethnic minority, 46% in work, 35% with 
higher education). Using linear fixed-effects regression models, the findings 
suggest a substantial improvement in life satisfaction among youth. An 
increasing frequency of social contacts, receding worries about career prospects 
and job skills learning contributed significantly to increases in life 
satisfaction, whereas direct, health-related COVID-19 stressors did not affect 
life satisfaction. Sub-group analysis suggests that women's, adolescents', and 
students' life satisfaction responded more strongly to the stressors considered 
in this study. The findings highlight the positive effects of less stringent 
lockdown restrictions, economic recovery, and opportunities for job skills 
learning on youth's happiness.

© 2022. The Author(s).

DOI: 10.1007/s10964-022-01648-8
PMCID: PMC9252564
PMID: 35788856 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1824. Perspect Public Health. 2023 Sep;143(5):275-284. doi: 10.1177/17579139221104973. 
Epub 2022 Jul 5.

Mental health and wellbeing among people with informal caring responsibilities 
across different time points during the COVID-19 pandemic: a population-based 
propensity score matching analysis.

Mak HW(1), Bu F(1), Fancourt D(2).

Author information:
(1)Department of Behavioural Science and Health, University College London, 
London, UK.
(2)Department of Behavioural Science and Health, University College London, 1-19 
Torrington Place, London WC1E 7HB, UK.

AIMS: Due to a prolonged period of national and regional lockdown measures 
during the coronavirus (COVID-19) pandemic, there has been an increase reliance 
on informal care for informal carers. In light of this, the current study 
compared the experiences of carers and non-carers on various mental health and 
wellbeing measures across six key time points during the pandemic.
METHODS: Data analysed were from the University College London (UCL) COVID -19 
Social Study. Our study focused on six time points in England: (1) the first 
national lockdown (March-April 2020); (2) the beginning of first lockdown rules 
easing (May 2020); (3) the second national lockdown (November 2020); (4) the 
third national lockdown (January 2021); (5) the easing of the third lockdown 
(March 2021); and (6) the end of restrictions (July-August 2021). We considered 
five mental health and wellbeing measures: depressive symptoms, anxiety 
symptoms, loneliness, life satisfaction, and sense of being worthwhile. 
Propensity score matching was applied for the analyses.
RESULTS: We found that informal carers experienced higher levels of depressive 
and anxiety symptoms than non-carers across much of the pandemic. During the 
first national lockdown, carers also experienced a higher sense of life being 
worthwhile. No association was found between informal caring responsibilities 
and levels of loneliness and life satisfaction.
CONCLUSION: Given that carers are an essential national healthcare support, 
especially during a pandemic, it is crucial to integrate carers' needs into 
healthcare planning and delivery. These results highlight that there is a 
pressing need to provide adequate and targeted mental health support for carers 
during and following this pandemic.

DOI: 10.1177/17579139221104973
PMCID: PMC10576404
PMID: 35787706 [Indexed for MEDLINE]

Conflict of interest statement: Conflict Of InterestThe author(s) declared no 
potential conflicts of interest with respect to the research, authorship, and/or 
publication of this article.


1825. Gerontol Geriatr Educ. 2023 Oct 2;44(4):513-522. doi: 
10.1080/02701960.2022.2096602. Epub 2022 Jul 4.

Addressing isolation, loneliness and mental health during COVID: A university 
training partnership with senior living communities.

Sheperis DS(1), Gomez R(2), Wathen C(1), Frank M(2), Brown LM(2).

Author information:
(1)Counseling Department, Palo Alto University, Palo Alto, California, USA.
(2)Psychology Department, Palo Alto University, Palo Alto, California, USA.

Older adults living in congregate housing have been uniquely impacted by the 
COVID-19 pandemic. The sudden interruption of routine activities, social 
isolation, and support adversely affected the wellbeing of residents in 
retirement facilities around the country and world. The stress of social 
isolation was fueled by the interruption of routine activities and support that 
in turn, adversely affected the wellbeing, mood, and cognition of many 
residents. Therefore, university clinical programs in psychology and counseling 
can address the needs of community older residents by preparing student 
clinicians to work with the aging population and to engage in telehealth models 
of outreach and interventions. This manuscript outlines a model of partnership 
between long-term care assisted living organizations and clinical training 
programs at a west coast university to meet community and educational needs of 
older residents.

DOI: 10.1080/02701960.2022.2096602
PMID: 35786372 [Indexed for MEDLINE]


1826. J Ment Health. 2022 Aug;31(4):597-604. doi: 10.1080/09638237.2022.2091766. Epub 
2022 Jul 3.

The impact of the COVID-19 pandemic on student mental health and wellbeing in UK 
university students: a multiyear cross-sectional analysis.

Bennett J(1), Heron J(1), Gunnell D(1), Purdy S(1), Linton MJ(1).

Author information:
(1)Population Health Sciences, University of Bristol, Bristol, UK.

BACKGROUND: Ongoing concern for the unique mental health challenges faced by 
university students has been magnified by the disruption of the global COVID-19 
pandemic since March 2020.
AIMS: This study aimed to investigate changes in mental health and wellbeing 
outcomes for UK university students since the pandemic began, and to examine 
whether more vulnerable groups were disproportionately impacted.
METHODS: Students at a UK university responded to anonymous online 
cross-sectional surveys in 2019 (N = 2637), 2020 (N = 3693), and 2021 
(N = 2772). Students completed measures of depression, anxiety and subjective 
wellbeing (SWB). Multivariable logistic regression models investigated 
associations of survey year and sociodemographic characteristics with mental 
health and SWB.
RESULTS: Compared to 2019, fewer students showed high levels of depression and 
anxiety symptoms in 2020. However, there was evidence of worsened levels of 
anxiety and SWB in 2021 compared to 2019. Interaction effects indicated that 
students from a Black, Asian or minority ethnicity background and students 
previously diagnosed with a mental health difficulty showed improved outcomes in 
2021 compared to previous years.
CONCLUSIONS: There is a need for sector-wide strategies including preventative 
approaches, appropriate treatment options for students already experiencing 
difficulties and ongoing monitoring post-pandemic.

DOI: 10.1080/09638237.2022.2091766
PMID: 35786110 [Indexed for MEDLINE]


1827. Front Public Health. 2022 Jun 17;10:919049. doi: 10.3389/fpubh.2022.919049. 
eCollection 2022.

Suggestions on Relieving Physical Anxiety of Medical Workers and Improving 
Physical and Mental Health Under the COVID-19 Epidemic-A Case Study of Meizhou 
City.

Lu ZC(1), Tseng CH(2), Lin HH(1)(3), Perng YS(4), Tseng YH(4)(5).

Author information:
(1)School of Physical Education, Jiaying University, Meizhou, China.
(2)Department of Recreation and Sport Management, Shu-Te University, Kaohsiung, 
Taiwan.
(3)Department of Leisure Industry Management, National Chin-Yi University of 
Technology, Taichung, Taiwan.
(4)Department of Forestry, National Chung Hsing University, Taichung, Taiwan.
(5)Department of Tourism Leisure and Health Management, Chung Chou University of 
Science and Technology, Yuanlin City, Taiwan.

The study examined the effects of swimming pools on healthcare professionals' 
willingness to engage in recreational activities, physical anxiety, and physical 
and mental well-being in the context of COVID-19. The research adopted the mixed 
research method, used SPSS 26.0 statistical software to test the reliability of 
the questionnaire, and then collected 840 valid questionnaires; first analyzed 
the data with basic statistics, t-test, ANOVA, and PPMCC test methods, and then 
used the interview method to collect expert opinions. A multi-check approach 
assembled all data and discussions. The study found that the use of personnel 
dynamic tracking systems or measures, combined with sodium hypochlorite and 
repeated filtration to stabilize water quality, could maintain the confidence of 
most medical workers in the swimming pool sports environment for epidemic 
prevention and avoid violations. The government could formulate safety 
prevention and control mechanisms in traffic and establish appropriate traffic 
routes. Next, formulated a prescription for swimming or other physical activity 
mechanisms for men aged 31-50 and redesigned measures for medical staff over 51 
years old to have tense head issues and physical fatigue, promote blood 
circulation and improve sleep quality. This will promote the purpose of 
relieving stress and regulating the physical and mental health of medical staff 
after engaging in swimming.

Copyright © 2022 Lu, Tseng, Lin, Perng and Tseng.

DOI: 10.3389/fpubh.2022.919049
PMCID: PMC9247186
PMID: 35784226 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1828. Elife. 2022 Jul 4;11:e75893. doi: 10.7554/eLife.75893.

Investigating the relationship of COVID-19 related stress and media consumption 
with schizotypy, depression, and anxiety in cross-sectional surveys repeated 
throughout the pandemic in Germany and the UK.

Daimer S(1), Mihatsch LL(2)(3), Neufeld SAS(4), Murray GK(4)(5), Knolle F(1)(4).

Author information:
(1)Department of Diagnostic and Interventional Neuroradiology, School of 
Medicine, Technical University of Munich, Munich, Germany.
(2)Department of Anaesthesiology and Intensive Care Medicine, 
Ludwig-Maximilians-Universität München, Munich, Germany.
(3)Institute for Medical Information Processing, Biometry and Epidemiology, 
Ludwig-Maximilians-Universität München, Munich, Germany.
(4)Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
(5)Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United 
Kingdom.

BACKGROUND: Studies report a strong impact of the COVID-19 pandemic and related 
stressors on the mental well-being of the general population. In this paper, we 
investigated whether COVID-19 related concerns and social adversity affected 
schizotypal traits, anxiety, and depression using structural equational 
modelling. In mediation analyses, we furthermore explored whether these 
associations were mediated by healthy (sleep and physical exercise) or unhealthy 
behaviours (drug and alcohol consumption, excessive media use).
METHODS: We assessed schizotypy, depression, and anxiety as well as healthy and 
unhealthy behaviours and a wide range of sociodemographic scores using online 
surveys from residents of Germany and the United Kingdom over 1 year during the 
COVID-19 pandemic. Four independent samples were collected (April/May 2020: 
N=781, September/October 2020: N=498, January/February 2021: N=544, May 2021: 
N=486). The degree of schizotypy was measured using the Schizotypal Personality 
Questionnaire (SPQ), anxiety, and depression symptoms were surveyed with the 
Symptom Checklist (SCL-27), and healthy and unhealthy behaviours were assessed 
with the Coronavirus Health Impact Survey (CRISIS). Structural equation models 
were used to consider the influence of COVID-19 related concerns and social 
adversity on depressive and anxiety-related symptoms and schizotypal traits in 
relation to certain healthy (sleep and exercise) and unhealthy behaviours 
(alcohol and drug consumption, excessive media use).
RESULTS: The results revealed that COVID-19 related life concerns were 
significantly associated with schizotypy in the September/October 2020 and May 
2021 surveys, with anxiety in the September/October 2020, January/February 2021, 
and May 2021 surveys, and with depressive symptoms in all surveys. Social 
adversity significantly affected the expression of schizotypal traits and 
depressive and anxiety symptoms in all four surveys. Importantly, we found that 
excessive media consumption (>4 hr per day) fully mediated the relationship 
between COVID-19 related life concerns and schizotypal traits in the 
January/February 2021 survey. Furthermore, several of the surveys showed that 
excessive media consumption was associated with increased depressive and 
anxiety-related symptoms in people burdened by COVID-19 related life.
CONCLUSIONS: The ongoing uncertainties of the pandemic and the restrictions on 
social life have a strong impact on mental well-being and especially the 
expression of schizotypal traits. The negative impact is further boosted by 
excessive media consumption, which is especially critical for people with high 
schizotypal traits.
FUNDING: FK received funding from the European Union's Horizon 2020 (Grant 
number 754,462). SN received funding from the Cundill Centre for Child and Youth 
Depression at the Centre for Addiction and Mental Health, Toronto, Canada and 
the Wellcome Trust Institutional Strategic Support Fund from the University of 
Cambridge.

Plain Language Summary: The 2020 COVID-19 pandemic, and the measures different 
governments took to contain it, harmed many people’s mental well-being. The 
restrictions, combined with pandemic-related uncertainty, caused many 
individuals to experience increased stress, depression, and anxiety. Many people 
turned to unhealthy behaviours to cope, including consuming more alcohol or 
drugs, using media excessively, developing poor sleeping habits, or reducing the 
amount of exercise they did. Stress, drugs, poor sleep, and uncertainty can 
increase an individual’s risk of developing psychotic symptoms, including 
delusions, hallucinations, or difficulty thinking clearly. These symptoms may be 
temporary or part of a more lasting condition, like schizophrenia. The risk of 
developing these symptoms increases in people with ‘schizotypal traits’, such as 
a lack of close relationships, paranoia, or unusual or implausible beliefs. 
These individuals may be especially vulnerable to the harmful mental health 
effects of the pandemic. Daimer et al. demonstrated that people who were more 
worried about their life stability or financial situation during the 2020 
COVID-19 pandemic had worse mental well-being than those who felt secure. In the 
experiments, volunteers completed a series of online mental health 
questionnaires at four different time points during the pandemic. People who 
reported feeling lonely, having negative thoughts, or experiencing fewer 
positive social interactions had more symptoms of mental illness. People who 
experienced more life disruptions also reported more anxiety or depression 
symptoms and more schizotypal traits. Daily consumption of at least four hours 
of digital media exacerbated negative mental health symptoms, and people with 
more pandemic-related life concerns also spent more time on digital media Daimer 
et al. suggest that increased media consumption among people with 
pandemic-related hardships may have increased mental health symptoms and 
schizotypal traits in these individuals. The survey results suggest that 
maintaining a healthy lifestyle, including meaningful relationships, is 
essential to staying mentally healthy during extreme situations like a global 
pandemic. Protective interventions – such as strengthening social support 
networks, providing mental health education, or increasing mental healthcare 
provisions – are essential to prevent poor mental health outcomes during future 
crises.

© 2022, Daimer et al.

DOI: 10.7554/eLife.75893
PMCID: PMC9252577
PMID: 35781372 [Indexed for MEDLINE]

Conflict of interest statement: SD, LM, SN, GM, FK No competing interests 
declared


1829. Perspect Psychiatr Care. 2022 Oct;58(4):2897-2909. doi: 10.1111/ppc.13138. Epub 
2022 Jul 3.

The effect of mindfulness-based mandala activity on anxiety and spiritual 
well-being levels of senior nursing students: A randomized controlled study.

Sari Ozturk C(1), Kilicarslan Toruner E(1).

Author information:
(1)Department of Nursing, Faculty of Health Sciences, Gazi University, Ankara, 
Turkey.

PURPOSE: This study aimed to determine the effectiveness of mindfulness-based 
mandala activity on the anxiety levels and spiritual well-being of nursing 
students who started clinical practice after distance education during COVID-19 
period.
DESIGN AND METHODS: This study is a randomized controlled study employing a 
pre-/posttest design with a single-blind, parallel group. The study was 
completed with a total of 170 participants (n = 84, intervention group; n = 86, 
control group). Data were collected using the Descriptive Characteristics Form, 
State-trait Anxiety Inventory, Spirituality Well-Being Scale, and Scale of 
Positive and Negative Experience. The intervention group participated in three 
mindfulness-based mandala sessions. This study was registered with 
ClinicalTrials.gov as NCT05053178.
FINDINGS: In three sessions, there was a significant decrease in the 
intervention group compared with the control group regarding the mean values of 
pretest and posttest anxiety levels. Evaluation of the mean scores Spiritual 
Well-Being Scale before and after the intervention showed a significant decrease 
in the scores between groups (p < 0.05).
PRACTICE IMPLICATIONS: With mindfulness-based mandala activity, the well-being 
of nursing students can be increased.

© 2022 Wiley Periodicals LLC.

DOI: 10.1111/ppc.13138
PMID: 35780483 [Indexed for MEDLINE]


1830. Stress Health. 2023 Apr;39(2):272-284. doi: 10.1002/smi.3181. Epub 2022 Jul 11.

Heterogeneity in mental health change during the COVID-19 pandemic in Germany: 
The role of social factors.

Reis D(1), Krautter K(1), Hart A(1), Friese M(1).

Author information:
(1)Saarland University, Saarbrücken, Germany.

The COVID-19 pandemic constitutes a prolonged global crisis, but its effects on 
mental health seem inconsistent. This inconsistency highlights the importance of 
considering the differential impact of the pandemic on individuals. There is 
some evidence that mental health trajectories are heterogeneous and that both 
sociodemographic and personal characteristics are associated with higher risk 
for mental health issues. By contrast, information on the role of social factors 
as potential determinants of initial reactions to the pandemic and on 
heterogeneous trajectories over time is lacking. We analysed seven assessments 
of a large-scale (N = 2203) longitudinal study across 1.5 years, beginning in 
March 2020. Using self-report data on mental health and life satisfaction, we 
applied latent change models to examine initial reactions and mean changes 
across the pandemic. In addition, we applied latent class growth analyses to 
investigate whether there were distinct groups with different patterns of 
change. Results showed that on average, levels of life satisfaction and anxiety 
decreased (d = -0.31 and d = -0.11, respectively), levels of depressive symptoms 
increased (d = 0.13), and stress levels remained unchanged (d = -0.01) during 
the first year of the pandemic. For each outcome, we identified four distinct 
mental health trajectories. Between 5% (for anxiety) and 11% (for life 
satisfaction) of the sample reported consistently high-and even 
increasing-impairments in mental health and well-being. The trajectories of a 
sizeable number of people covaried with the course of the pandemic, such that 
people experienced better mental health when the number of COVID cases was low 
and when fewer restrictions were placed on public life. Low emotional support, 
high instrumental support, and the tendency to compare oneself with others were 
associated with more mental health issues. Findings show that whereas a 
substantial portion of people were largely unaffected by the pandemic, some 
individuals experienced consistently high levels of psychological distress. 
Social factors appear to play a crucial role in the maintenance of well-being.

© 2022 The Authors. Stress and Health published by John Wiley & Sons Ltd.

DOI: 10.1002/smi.3181
PMCID: PMC9350024
PMID: 35778965 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that they have no 
conflict of interest.


1831. Sci Rep. 2022 Jul 1;12(1):11152. doi: 10.1038/s41598-022-15357-6.

Impact of COVID-19 emergency on the psychological well-being of susceptible 
individuals.

Stufano A(#)(1), Lucchese G(#)(2), Stahl B(2)(3)(4)(5), Grattagliano I(6), 
Dassisti L(6), Lovreglio P(7), Flöel A(2), Iavicoli I(8).

Author information:
(1)Interdisciplinary Department of Medicine, Section of Occupational Medicine 
'EC Vigliani', University of Bari, Policlinico, Piazza G. Cesare 11, 70124, 
Bari, Italy.
(2)Department of Neurology, Universitätsmedizin Greifswald, Greifswald, Germany.
(3)Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany.
(4)Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, 
Germany.
(5)Faculty of Science, Medical School Berlin, Berlin, Germany.
(6)Department of Education Science, Psychology, Communication Science, 
University of Bari, Bari, Italy.
(7)Interdisciplinary Department of Medicine, Section of Occupational Medicine 
'EC Vigliani', University of Bari, Policlinico, Piazza G. Cesare 11, 70124, 
Bari, Italy. piero.lovreglio@uniba.it.
(8)Department of Public Health, Section of Occupational Medicine, University of 
Naples Federico II, Naples, Italy.
(#)Contributed equally

The current pandemic has exerted an unprecedented psychological impact on the 
world population, and its effects on mental health are a growing concern. The 
present study aims to evaluate psychological well-being (PWB) during the 
COVID-19 crisis in university workers with one or more diseases likely to 
increase the risk of severe outcomes in the event of SARS-CoV-2 infection, 
defined as susceptible. 210 susceptible employees of an Italian University (aged 
25-71 years) were recruited during the COVID-19 second wave (October-December 
2020). A group comprising 90 healthy university employees (aged 26-69 years) was 
also recruited. The self-report Psychological General Well Being Index (PGWBI) 
was used to assess global PWB and the influence on six sub-domains: anxiety, 
depressed mood, positive well-being, self-control, general health, and vitality. 
We applied non-linear dimension-reduction techniques and regression methods to 
45 variables in order to assess the main demographic, occupational, and 
general-health-related factors predicting PWB during the COVID-19 crisis. PGWBI 
score was higher in susceptible than in healthy workers, both as total score 
(mean 77.8 vs 71.3) and across almost all subscales. Age and jobs involving high 
social interaction before the pandemic were inversely associated with the PWB 
total score, general health, and self-control subscores. The current data 
suggest no decline in PWB during the second wave of COVID-19 health emergency in 
susceptible individuals of working age. Critically, higher risk for 
mental-health issues appears to be inversely related to age, particularly among 
individuals deprived of their previous level of social interaction at work.

© 2022. The Author(s).

DOI: 10.1038/s41598-022-15357-6
PMCID: PMC9247931
PMID: 35778530 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1832. Psychogeriatrics. 2022 Sep;22(5):642-650. doi: 10.1111/psyg.12866. Epub 2022 Jul 
1.

The impact of the COVID-19 pandemic on well-being of seniors attending online 
programs at University of the Third Age: a follow-up study.

Kayhan Koçak FÖ(1), Çavdar S(1), Savas S(1), Akçiçek SF(1).

Author information:
(1)Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, 
Ege University, Izmir, Turkey.

BACKGROUND: Reports on psychological effects of quarantine during past outbreaks 
and pandemics showed that quarantined people were more likely to experience 
psychological problems than those who were not. It was also shown that there was 
an increase in anxiety, depression, and stress in all age groups during the 
COVID-19 pandemic. So, we investigated emotional states and quality of life as 
components of general well-being in older participants of University of the 
Third Age (U3A) attending online programs during the second year of the 
pandemic, and compared them with the pre-pandemic COVID-19 period.
METHODS: This study was conducted among 27 participants of a U3A program. Data 
on sociodemographics, Charlson comorbidity index, the Geriatric Depression Scale 
Short Form (GDS-SF), The Geriatric Anxiety Scale (GAS), and Turkish version of 
World Health Organization Quality of Life Instrument Older Adults Module 
(WHOQOL-OLD) were taken in September 2019 and September 2021.
RESULTS: The median age of the participants was 68 (60-75) years (81.5% female). 
In the COVID-19 pandemic period; 'Death and dying' (except for 'Fear of pain 
before death' score), 'Intimacy' domain, and 'Social participation' domain 
scores of WHOQOL-OLD decreased compared to the pre-pandemic period (P < 0.001, 
P = 0.011, and P < 0.001, respectively) whereas the scores for GAS and GDS-SF 
were higher (P < 0.001 and P = 0.011). The reason for the decrease in 'Social 
participation' domain scores was the decrease in 'Satisfaction with opportunity 
to participate in community'. There was no significant difference in 'Autonomy' 
domain of WHOQOL-OLD (P = 0.598).
CONCLUSION: Although there was no change in 'Autonomy' domain among the 
participants of U3A before and during the pandemic period, anxiety and 
depression scores were higher in the second year of the COVID pandemic. Only a 
decrease in satisfaction with opportunity to participate in community might have 
significant impact on social participation.

© 2022 Japanese Psychogeriatric Society.

DOI: 10.1111/psyg.12866
PMCID: PMC9349604
PMID: 35778367 [Indexed for MEDLINE]


1833. Res Child Adolesc Psychopathol. 2023 Jan;51(1):103-117. doi: 
10.1007/s10802-022-00954-w. Epub 2022 Jul 1.

Trajectories and Associations Between Maternal Depressive Symptoms, Household 
Chaos and Children's Adjustment through the COVID-19 Pandemic: A Four-Wave 
Longitudinal Study.

Gordon-Hacker A(1), Bar-Shachar Y(1), Egotubov A(1), Uzefovsky F(1)(2), 
Gueron-Sela N(3)(4).

Author information:
(1)Department of Psychology, Ben Gurion University of the Negev, Be'er-Sheva, 
Israel.
(2)Zlotowski Center for Neuroscience, Ben Gurion University of the Negev, 
Be'er-Sheva, Israel.
(3)Department of Psychology, Ben Gurion University of the Negev, Be'er-Sheva, 
Israel. gueron@bgu.ac.il.
(4)Zlotowski Center for Neuroscience, Ben Gurion University of the Negev, 
Be'er-Sheva, Israel. gueron@bgu.ac.il.

The COVID-19 pandemic and associated public health measures have adversely 
affected the lives of people worldwide, raising concern over the pandemic's 
mental health consequences. Guided by a systemic model of family functioning 
during the COVID-19 pandemic (Prime et al., 2020), the current study aimed to 
examine how caregiver well-being (i.e., maternal depressive symptoms) and family 
organization (i.e., household chaos) are related to longitudinal trajectories of 
children's emotional and behavioral problems. Data were collected at four time 
points during and after home lockdown periods. Mothers of children (N = 230; 55% 
male) between the ages of two to five years were asked to complete 
questionnaires via an Israeli online research platform. Results indicated that 
emotional and behavioral problems, household chaos, and maternal depressive 
symptoms were the highest during the first lockdown assessment and dropped in 
the post-lockdown periods. Multilevel models further revealed that at the 
between-participants level, maternal depressive symptoms and household chaos 
positively predicted children's emotional and behavioral problems. At the 
within-participants level, household chaos fluctuations positively predicted 
fluctuations in child behavioral but not emotional problems. Our findings 
suggest that lockdowns have adverse effects on both maternal and child mental 
health. Screening for depressive symptoms among mothers of young children and 
maintaining household structure are important targets for future interventions 
to assist parents in navigating the multiple challenges brought upon by the 
COVID-19 pandemic.

© 2022. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s10802-022-00954-w
PMCID: PMC9247896
PMID: 35776297 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interests.


1834. J Biol Rhythms. 2022 Aug;37(4):358-384. doi: 10.1177/07487304221103376. Epub 
2022 Jun 30.

Sleep of Healthcare Workers During the COVID-19 Pandemic and the Role of 
Atypical Work Schedules: A Scoping Review.

Power N(1), Perreault M(1)(2), Ferrari M(1)(2), Boudreau P(1)(2)(3), Boivin 
DB(1)(2)(3).

Author information:
(1)Douglas Mental Health University Institute, Montreal, QC, Canada.
(2)Department of Psychiatry, McGill University, Montreal QC, Canada.
(3)Centre for Study and Treatment of Circadian Rhythms, Douglas Mental Health 
University Institute, Montreal, QC, Canada.

The COVID-19 pandemic has negatively impacted the well-being of healthcare 
workers (HCWs). HCWs are highly exposed to shift work and their work schedules 
have been subject to increasing unpredictability since the start of the 
pandemic. This review aims to: (1) map the studies providing information about 
factors associated with sleep characteristics in HCWs working in the context of 
the COVID-19 pandemic during the first and second waves and (2) examine the 
state of the evidence base in terms of the availability of information on the 
influence of atypical work schedules. A literature search was performed in 
PubMed. Studies containing information about factors (demographic; 
psychological; occupational; COVID-19-specific; work schedule; lifestyle; 
medical; or other) associated with various sleep characteristics among HCWs 
working in the context of the COVID-19 pandemic were included. Particular 
attention was paid to the availability of information on the role of atypical 
work schedules on HCW sleep. Fifty-seven articles met the inclusion criteria. 
Most studies were reports of quantitative cross-sectional surveys using 
self-report measures. Associations between female sex, frontline HCW status, 
psychological factors, and poorer sleep were observed. Six studies included a 
measure of shift work in their analyses, 5 of which reported an association 
between shift work status and sleep. A wide range of factors were investigated, 
with female sex, frontline HCW status, and psychological factors repeatedly 
demonstrating associations with poorer sleep. Sleep was predominantly measured 
in terms of self-reported sleep quality or insomnia symptoms. Few studies 
investigated the influence of atypical work schedules on HCW sleep in the 
context of the COVID-19 pandemic. Research on this topic is lacking in terms of 
reliable and consistent measurements of sleep outcomes, longitudinal data, and 
knowledge about the influence of covariates such atypical work schedules, 
comorbidity, and medical history on HCW sleep.

DOI: 10.1177/07487304221103376
PMID: 35773789 [Indexed for MEDLINE]


1835. BMC Womens Health. 2022 Jun 30;22(1):267. doi: 10.1186/s12905-022-01840-9.

The impact of COVID-19 pandemic on mental and physical wellbeing in women with 
fibromyalgia: a longitudinal mixed-methods study.

Lazaridou A(#)(1)(2), Paschali M(#)(3), Vilsmark ES(3), Wilkins T(4), Napadow 
V(3)(5), Edwards R(3).

Author information:
(1)Department of Anesthesiology, Harvard Medical School, Brigham & Women's 
Hospital, Pain Management Center, 850 Boylston St, Suite 302, Chestnut Hill, MA, 
02467, USA. alazaridou@bwh.harvard.edu.
(2)Fielding Graduate University, Santa Barbara, CA, USA. 
alazaridou@bwh.harvard.edu.
(3)Department of Anesthesiology, Harvard Medical School, Brigham & Women's 
Hospital, Pain Management Center, 850 Boylston St, Suite 302, Chestnut Hill, MA, 
02467, USA.
(4)Fielding Graduate University, Santa Barbara, CA, USA.
(5)MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, 
MA, USA.
(#)Contributed equally

OBJECTIVE: The COVID-19 pandemic has strongly influenced psychological and 
physical health worldwide. The aim of this study was to examine the impact of 
the pandemic on women with fibromyalgia.
METHODS: This mixed methods pilot study explored measures of pain severity and 
interference, as well as pain catastrophizing and level of fibromyalgia impact 
among women with fibromyalgia before and during the COVID-19 pandemic in the 
USA. Fibromyalgia patients completed demographic, pain-related, and other 
validated psychosocial questionnaires prior to the onset of the COVID-19 
pandemic, and then were re-assessed with those questionnaires, as well as a 
pandemic-related questionnaire assessing the impact of the pandemic on the 
patients' life, during the pandemic.
RESULTS: When comparing data reported before the pandemic to data collected 
3-6 months into the pandemic, women with fibromyalgia reported a general 
worsening of their pain and pain-related symptoms. During the pandemic, pain 
catastrophizing (p ≤ 0.05) and fibromyalgia impact (p ≤ 0.05) increased 
significantly compared to before the pandemic. The increase in pain 
catastrophizing scores was highly correlated with the impact of the pandemic on 
the participants' ability to cope with pain and on their mental health. 
Qualitative analysis corroborated the significant impact of the pandemic on 
patients' mental health, with the vast majority reporting a worsening of their 
mood. Other impacted domains included anxiety, level of activity and sleep.
CONCLUSIONS: Collectively, the pandemic appears to have produced a substantive 
worsening of pain-related symptomatology among women with fibromyalgia, which 
should be addressed by targeted interventions.

© 2022. The Author(s).

DOI: 10.1186/s12905-022-01840-9
PMCID: PMC9245870
PMID: 35773702 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest or 
competing interests.


1836. Child Abuse Negl. 2022 Sep;131:105770. doi: 10.1016/j.chiabu.2022.105770. Epub 
2022 Jun 27.

Making meaning of irreconcilable destruction of innocence: National humanitarian 
professionals exposed to cybercrime child sexual exploitation in the 
Philippines.

McCormack L(1), Lowe B(2).

Author information:
(1)University of Newcastle, Australia. Electronic address: 
lynne.mccormack@newcastle.edu.au.
(2)University of Newcastle, Australia. Electronic address: 
Brendan.Lowe@uon.edu.au.

BACKGROUND: Sex-cybercrimes against children in the Philippines rose by over 
400 % during the first year of the Covid-19 pandemic exponentially increasing 
challenges for carers of children, law enforcers, and prosecutors.
OBJECTIVE: Burnout, primary, and secondary traumatic stress are some of the 
potential mental health risks for child protection carers. How longevity of 
career is sustained, is unknown.
PARTICIPANTS AND SETTING: This idiographic study explored both positive and 
negative interpretations of frontline workers in the Philippines exposed to 
sex-cybercrimes against children.
METHODS: The protocols of Interpretative Phenomenological Analysis guided data 
collection through semi-structured interviews, transcription, and analysis.
RESULTS: One superordinate theme: Irreconcilable destruction of innocence, mercy 
and justice, and the passionate self; highlights the integral struggle that 
emerged from these participants' roles in child protection. Their faith 
philosophy of compassion and forgiveness contrasted with the unfathomable 
corruption and exploitation they witnessed, and their role in removing child 
victims from perpetrator family members to serve justice. These internal 
conflicts necessitated a critical need to self-care against psychological 
vulnerability. Longevity of career emerged from a co-existence of traumatic 
distress and psychological growth allowing them to redefine their faith and 
confront the unfathomable with hope, self-valuing, and purpose.
CONCLUSIONS: Justice and mercy were juxtaposed integral conflicts threatening 
the psychological wellbeing of these participants. Ineffective organisational 
support aggravated their traumatic distress as did the lethargy with which world 
governments' engage in effective controls against online crimes of child sexual 
exploitation which has meteorically risen as a result of the global coronavirus 
pandemic.

Copyright © 2022 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.chiabu.2022.105770
PMID: 35772331 [Indexed for MEDLINE]


1837. J Assoc Nurses AIDS Care. 2022 Jul-Aug 01;33(4):386-394. doi: 
10.1097/JNC.0000000000000303. Epub 2021 Oct 26.

Exploration of the Impact of Coronavirus Disease 2019 on People Living With HIV 
in Kerman, Iran: A Qualitative Study.

Jaafari Z(1), Eybpoosh S, Sharifi H, Karamouzian M.

Author information:
(1)Zahra Jaafari, MSc, is a Master of Science of Epidemiology and a Research 
Scientist, HIV/STI Surveillance Research Center, and WHO Collaborating Center 
for HIV Surveillance, Institute for Futures Studies in Health, Kerman University 
of Medical Sciences, Kerman, Iran. Sana Eybpoosh, PhD, is an Assistant Professor 
of Epidemiology, Department of Epidemiology and Biostatistics, Research Center 
for Emerging and Re-emerging Infectious Diseases, Pasteur Institute of Iran, 
Tehran, Iran. Hamid Sharifi, PhD, is a Professor in Epidemiology, HIV/STI 
Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, 
Institute for Futures Studies in Health, Kerman University of Medical Sciences, 
Kerman, Iran. Mohammad Karamouzian , DVM, MSc, is a PhD Candidate at the School 
of Population and Public Health, Faculty of Medicine, University of British 
Columbia, Vancouver, BC, Canada, and a Research Scientist at HIV/STI 
Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, 
Institute for Futures Studies in Health, Kerman University of Medical Sciences, 
Kerman, Iran.

We explored the impact of the coronavirus disease 2019 (COVID-19) pandemic on 
people living with HIV (PLWH) in Kerman, Iran. A convenience sample of 18 PLWH 
from a voluntary counseling and testing (VCT) center (August-October 2020) were 
invited to participate in face-to-face interviews. Inductive content analysis 
was performed with MAXQDA software. Six themes were identified: COVID-19-related 
knowledge and preventive practices, misconceptions about COVID-19, fear of 
seeking health care services, psychosocial effects, limited or inconvenient 
access to health care services, and the impact of COVID-19 on socioeconomic 
status. Although participants generally understood COVID-19 preventative 
measures, some held misconceptions. COVID-19 negatively affected PLWHs' mental 
health, financial stability, and use of and access to health care services. Our 
findings support expansion of services related to HIV care/treatment and mental 
health to promote health and well-being during the COVID-19 pandemic.

Copyright © 2021 Association of Nurses in AIDS Care.

DOI: 10.1097/JNC.0000000000000303
PMID: 35772075 [Indexed for MEDLINE]


1838. PLoS One. 2022 Jun 30;17(6):e0270644. doi: 10.1371/journal.pone.0270644. 
eCollection 2022.

Mental well-being in young people with psychiatric disorders during the early 
phase of COVID-19 lockdown.

Orfeuvre E(1), Franck N(1)(2)(3), Plasse J(1), Haesebaert F(4)(5).

Author information:
(1)Centre Ressource de Réhabilitation Psychosociale, CH Le Vinatier, Lyon, 
France.
(2)CH Le Vinatier, Pôle Centre Rive Gauche, Bron, France.
(3)UMR 5229, CNRS & Université Lyon 1, Université de Lyon, Lyon, France.
(4)SUR-CL3R-PEPS, CH Vinatier, Bron, Rhône-Alpes, France.
(5)INSERM U1028, CNRS, UMR5292, PSYR2 Team, Lyon Neuroscience Research Center, 
Université Claude Bernard Lyon 1, Lyon, France.

BACKGROUND: Mental health and well-being were seriously impacted by the COVID-19 
lockdown especially among young people and people with psychiatric disorders. 
This study aimed to identify factors associated with well-being in young people 
with psychiatric disorders, during early phase of COVID-19 lockdown in France.
METHODS: A national cross-sectional online study started on the 8th day of 
COVID-19 lockdown in France (during March 25-30, 2020). We included young people 
aged from 16 to 29 who responded to the questionnaire, living and being confined 
in France, with past or current psychiatric treatment. The questionnaire was 
accessible online and explored demographics and clinical factors, well-being, 
stress, situation during lockdown. Well-being was measured by the 
Warwick-Edinburg Mental Well-Being Scale (WEMWBS). Simple and multiple linear 
regression analyses were carried out.
RESULTS: 439 individuals were included with 262 (59.7%) previously treated and 
177 (40.3%) currently treated. WEMWBS total score were 42.48 (9.05). Feeling of 
useful was the most affected dimension. Well-being was positively correlated 
with: currently working on site, physical activity, abilities to cope with 
difficulties, family and social supports (p<0.05). It was negatively correlated 
with: elevated stress level, anxious ruminations, dissatisfaction with 
information, difficulties to sleep or reorganize daily life, feeling supported 
by medicines (p<0.05). No individual factor was correlated with well-being. The 
stepwise linear multivariate model had simple R2 coefficient of determination of 
0.535.
CONCLUSION: In the specific population of young people with psychiatric 
disorders, factors associated with well-being at early stage of lockdown were 
mainly psychosocial and related to brutal disorganisation of daily life.

DOI: 10.1371/journal.pone.0270644
PMCID: PMC9246141
PMID: 35771900 [Indexed for MEDLINE]

Conflict of interest statement: F. Haesebaert reports receipt of personal fees 
or nonfinancial support from Janssen, Lundbeck, and Otsuka. Other authors 
declare that they have no competing interests. This does not alter our adherence 
to PLOS ONE policies on sharing data and materials.


1839. Int J Nurs Pract. 2022 Oct;28(5):e13077. doi: 10.1111/ijn.13077. Epub 2022 Jun 
30.

Nurses' job burnout and its association with work environment, empowerment and 
psychological stress during COVID-19 pandemic.

Al Sabei SD(1), Al-Rawajfah O(2)(3), AbuAlRub R(4), Labrague LJ(5), Burney 
IA(6).

Author information:
(1)Fundamentals and Administration Department, College of nursing, Sultan Qaboos 
University, Muscat, Oman.
(2)Adult and Critical Care Department, College of Nursing, Sultan Qaboos 
University, Muscat, Oman.
(3)College of Nursing, Al al-Bayt University, Mafraq, Jordan.
(4)Community and Mental Health Nursing Department, Faculty of Nursing, Jordan 
University of Science and Technology, Irbid, Jordan.
(5)Fundamentals and Administration Department, College of Nursing, Sultan Qaboos 
University, Muscat, Oman.
(6)The Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, 
Oman.

AIM: The aim of this study was to assess the influence of perceived work 
environment, empowerment and psychological stress on job burnout among nurses 
working at the time of the COVID-19 pandemic.
BACKGROUND: Nurses experienced high levels of job burnout during the pandemic, 
which impacted their mental health and well-being. Studies investigating the 
influence of work environment, empowerment and stress on burnout during the time 
of COVID-19 are limited.
DESIGN: The study utilized a cross-sectional design.
METHODS: Data were collected from 351 nurses in Oman between January and March 
2021. The Maslach Burnout Inventory, the Practice Environment Scale of the 
Nursing Work Index, the Conditions of Work Effectiveness Questionnaire and the 
Perceived Stress Scale were used to assess study variables.
RESULTS: About two-thirds of the nurses (65.6%) reported high levels of job 
burnout. Nurse managers' ability, leadership and support; staffing and resources 
adequacy; and nurses' access to support were significant factors associated with 
a reduced level of burnout.
CONCLUSION: Supporting nurses during the crisis, ensuring adequate staffing 
levels and providing sufficient resources are critical to lower job burnout. 
Creating a positive and empowered work environment is vital to enhance nurses' 
retention during the pandemic.

© 2022 John Wiley & Sons Australia, Ltd.

DOI: 10.1111/ijn.13077
PMCID: PMC9349741
PMID: 35770445 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1840. Psychol Med. 2022 Oct;52(13):2426-2440. doi: 10.1017/S0033291722002203. Epub 
2022 Jun 30.

Interventions for mental health, cognition, and psychological wellbeing in long 
COVID: a systematic review of registered trials.

Hawke LD(1)(2), Nguyen ATP(1), Ski CF(3), Thompson DR(4), Ma C(1)(2), Castle 
D(1)(2).

Author information:
(1)Centre for Complex Interventions, Centre for Addiction and Mental Health, 
Toronto, ON, Canada.
(2)Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
(3)Integrated Care Academy, University of Suffolk, Ipswich, UK.
(4)School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.

BACKGROUND: Among patients diagnosed with COVID-19, a substantial proportion are 
experiencing ongoing symptoms for months after infection, known as 'long COVID'. 
Long COVID is associated with a wide range of physical and neuropsychological 
symptoms, including impacts on mental health, cognition, and psychological 
wellbeing. However, intervention research is only beginning to emerge. This 
systematic review synthesizes currently registered trials examining 
interventions for mental health, cognition, and psychological wellbeing in 
patients with long COVID.
METHODS: Standard systematic review guidelines were followed. Trials registered 
in two large trial registries in 2020 to May 2022 were reviewed. Included 
studies were narratively synthesized by type of intervention and a risk-of-bias 
assessment was conducted.
RESULTS: Forty-two registered trials were included, with a total target sample 
size of 5814 participants. These include 11 psychological interventions, five 
pharmacological and other medical interventions, and five evaluating herbal, 
nutritional, or natural supplement interventions. An additional nine trials are 
examining cognitive and neurorehabilitation interventions and 12 are examining 
physiotherapy or physical rehabilitation. Most trials are randomized, but many 
are feasibility trials; trials are evaluating a wide spectrum of outcomes.
CONCLUSIONS: While there is a newly emerging body of research testing 
interventions for mental health, cognition, and psychological wellbeing in long 
COVID, the breadth and scope of the research remains limited. It is urgently 
incumbent on researchers to expand upon the intervention research currently 
under way, in order to generate high-quality evidence on a wide range of 
candidate interventions for diverse long COVID patient populations.

DOI: 10.1017/S0033291722002203
PMCID: PMC9300978
PMID: 35768406 [Indexed for MEDLINE]

Conflict of interest statement: David Castle has received grant monies for 
research from Servier, Boehringer Ingelheim; Travel Support and Honoraria for 
Talks and Consultancy from Servier, Seqirus, Lundbeck. He is a founder of the 
Optimal Health Program (OHP), and holds 50% of the IP for OHP; and is part owner 
of Clarity Healthcare. He does not knowingly have stocks or shares in any 
pharmaceutical company. Other authors have no conflict of interest to declare.


1841. Anat Sci Educ. 2022 Aug;15(5):928-942. doi: 10.1002/ase.2208. Epub 2022 Jul 18.

Medical students' perceptions and performance in an online regional anatomy 
course during the Covid-19 pandemic.

Zhang JF(1), Zilundu PLM(2)(3), Fu R(3)(4), Zheng XF(1), Zhou LH(3)(4), Guo 
GQ(1).

Author information:
(1)Department of Anatomy, Basic Medical College, Jinan University, Guangzhou, 
People's Republic of China.
(2)College of Dentistry, Ajman University, Ajman Emirate, United Arab Emirates.
(3)Department of Anatomy, Sun Yat-sen School of Medicine, Sun Yat-sen 
University, Shenzhen, People's Republic of China.
(4)Department of Anatomy, Zhongshan School of Medicine, Sun Yat-sen University, 
Guangzhou, People's Republic of China.

The present study evaluated the students' psychological well-being, experiences, 
performance, and perception of learning regional anatomy remotely. A regional 
anatomy remote learning curriculum was designed and learning materials were 
delivered virtually to 120 undergraduate medical students at Jinan University, 
China. All the students consented and voluntarily participated in this study by 
completing self-administered online questionnaires including the Zung's 
Self-Rating Anxiety and Depression Scales at the beginning and end of the 
learning session. A subset participated in focus group discussions. Most of the 
students (90.0%) positively evaluated the current distance learning model. More 
than 80% were satisfied with the content arrangement and coverage. Many students 
preferred virtual lectures (68.2%) and videos showing dissections (70.6%) during 
the distance learning sessions. However, writing laboratory reports and 
case-based learning were the least preferred modes of learning as they were only 
preferred by 23.2% and 14.1% of the students, respectively. There was no 
significant lockdown-related anxiety or depression reported by students using 
depression and anxiety scales as well as feedback from focus group discussions. 
The surveyed students' confidence scores in distance learning were significantly 
higher after 5 weeks than at the beginning of the session (3.05 ± 0.83 vs. 
3.70 ± 0.71, P < 0.05). Furthermore, the present results showed no significant 
differences between the current group's academic performance in the unit tests 
as well as the final overall evaluation for different parts of the course 
compared to that of the previous year's cohort. The findings above were 
congruent with focus group discussion data that the use of the online teaching 
platform for regional anatomy significantly improved the students' confidence in 
virtual and self-directed learning and did not negatively affect their academic 
performance.

© 2022 American Association for Anatomy.

DOI: 10.1002/ase.2208
PMID: 35766990 [Indexed for MEDLINE]


1842. Med Lav. 2022 Jun 28;113(3):e2022027. doi: 10.23749/mdl.v113i3.12661.

Cyberchondria, Covid-19 phobia, and well-being: a relational study on teachers.

Karakaş N(1), Tekin Ç(2), Bentli R(3), Demir E(4).

Author information:
(1)Malatya Turgut Ozal University. nese.karakas@ozal.edu.tr.
(2)İnönü Üniversity. cigdem.tekin@inonu.edu.tr.
(3)İnönü University. recep.bentli@inonu.edu.tr.
(4)Malatya Natıonal Education Directorate,Malatya,Turkey. kkadir44@yahoo.com.

BACKGROUND: This study aims at investigating level and contributor factors of 
Cyberchondria, Covid-19-related Phobia, and Well-Being in a sample of teachers 
in Turkey.
METHODS: The study was conducted on teachers (n=1000) working in a province in 
eastern Turkey. Data for the study were collected using a form that included 
participants' descriptive characteristics, the Covid-19 Phobia Scale (C19P-SE), 
the Cyberchondria Severity Scale, and the World Health Organization-5 Well-Being 
Index (WHO-5). Spearman correlation analysis, Mann-Whitney U test, and Kruskal 
Wallis analysis of variance were used to analyze the data.
RESULTS: As participant's cyberchondria levels rose, C19P-SE scores increased 
(r=0.271, p<0.001), and WHO-5 scores decreased (r=-0.224, p<0.05). Corona-phobia 
was higher in those who used social media than in those who did not (p<0.05). 
Cyberchondria scale scores were higher among those who had taken medications 
without a physician's recommendation during the pandemic. Participants who had a 
disabled person or a person in need of care in their household had higher scores 
for distrust of the physician and C19P-SE than for the cyberchondria severity 
scale sub-dimension, and the WHO-5 mean scores were lower (p<0.001, P=0.016, and 
P=0.020, respectively).
CONCLUSIONS: The study results show that increasing levels of cyberchondria 
trigger Covid-19 phobias in teachers during the Covid-19 pandemic and negatively 
affect their well-being. This descriptive study can help understand the risk 
group for cyberchondria, the influencing factors, and the health and economic 
consequences, and identify strategies for effective combating with 
cyberchondria.

DOI: 10.23749/mdl.v113i3.12661
PMCID: PMC9437657
PMID: 35766648 [Indexed for MEDLINE]


1843. Global Health. 2022 Jun 28;18(1):67. doi: 10.1186/s12992-022-00856-y.

Analysis of mHealth research: mapping the relationship between mobile apps 
technology and healthcare during COVID-19 outbreak.

El-Sherif DM(1), Abouzid M(2)(3).

Author information:
(1)National Institute of Oceanography and Fisheries (NIOF), Cairo, Egypt. 
dm.nagib@niof.sci.eg.
(2)Department of Physical Pharmacy and Pharmacokinetics, Poznan University of 
Medical Sciences, 60-781, Poznan, Poland.
(3)Doctoral School, Poznan University of Medical Sciences, 60-781, Poznan, 
Poland.

BACKGROUND: Mobile health applications (mHealth apps) offer enormous promise for 
illness monitoring and treatment to improve the provided medical care and 
promote health and wellbeing.
OBJECTIVE: We applied bibliometric quantitative analysis and network 
visualization to highlight research trends and areas of particular interest. We 
expect by summarizing the trends in mHealth app research, our work will serve as 
a roadmap for future investigations.
METHODS: Relevant English publications were extracted from the Scopus database. 
VOSviewer (version 1.6.17) was used to build coauthorship networks of authors, 
countries, and the co-occurrence networks of author keywords.
RESULTS: We analyzed 550 published articles on mHealth apps from 2020 to 
February 1, 2021. The yearly publications increased from 130 to 390 in 2021. 
JMIR mHealth and uHealth (33/550, 6.0%), J. Med. Internet Res. (27/550, 4.9%), 
JMIR Res. Protoc. (22/550, 4.0%) were the widest journals for these 
publications. The United States has the largest number of publications (143/550, 
26.0%), and England ranks second (96/550, 17.5%). The top three productive 
authors were: Giansanti D., Samuel G., Lucivero F., and Zhang L. Frequent 
authors' keywords have formed major 4 clusters representing the hot topics in 
the field: (1) artificial intelligence and telehealthcare; (2) digital contact 
tracing apps, privacy and security concerns; (3) mHealth apps and mental health; 
(4) mHealth apps in public health and health promotion.
CONCLUSIONS: mHealth apps undergo current developments, and they remain hot 
topics in COVID-19. These findings might be useful in determining future 
perspectives to improve infectious disease control and present innovative 
solutions for healthcare.

© 2022. The Author(s).

DOI: 10.1186/s12992-022-00856-y
PMCID: PMC9238163
PMID: 35765078 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflicts 
of interest.


1844. BMC Psychiatry. 2022 Jun 28;22(1):438. doi: 10.1186/s12888-022-04052-5.

Psychological reactions to the coronavirus pandemic: a comparative study of 
Holocaust survivors and other older adults in Israel.

Carmel S(1)(2), Bachner YG(3)(4), Cohn-Schwartz E(3)(4).

Author information:
(1)Center for Multidisciplinary Research in Aging, Ben-Gurion University of the 
Negev, P.O. Box 653, 8410501, Beer-Sheva, Israel. sara@bgu.ac.il.
(2)Department of Public Health, Ben-Gurion University of the Negev, Be'er Sheva, 
Israel. sara@bgu.ac.il.
(3)Center for Multidisciplinary Research in Aging, Ben-Gurion University of the 
Negev, P.O. Box 653, 8410501, Beer-Sheva, Israel.
(4)Department of Public Health, Ben-Gurion University of the Negev, Be'er Sheva, 
Israel.

BACKGROUND: The current study examines psychological reactions to the COVID-19 
pandemic among older adults living in Israel. Based on the 'life events, stress, 
coping and health theory,' we hypothesized that due to their traumatic early 
life history and dearth of emotional and physical coping resources, Holocaust 
survivors would be more vulnerable than other older adults to the negative 
effects of this difficult and prolonged life event on their mental health.
METHODS: Based on structured questionnaires with closed questions, we 
interviewed 306 Holocaust survivors and non-survivors aged 75 + during the 
COVID-19 pandemic.
RESULTS: Univariate data analysis showed that Holocaust survivors had fewer 
coping resources in terms of health status and educational level than 
non-survivors. As expected, Holocaust survivors also reported a greater extent 
of COVID-19-related anxiety, and more depression, which worsened during the 
pandemic. However, both groups did not differ in their will to live, which is an 
indicator of general well-being and commitment to continue living. In 
multivariate analyses conducted to explain COVID-19 anxiety in the entire sample 
and separately on each of the two groups, the best explanatory variables were 
other psychological variables especially increased depression.
CONCLUSIONS: It seems that Holocaust survivors are more emotionally vulnerable 
to the pandemic's negative effects than other older adults, in support of the 
'life events, stress, coping and health theory,' but despite this, they show 
resilience in their will to continue living. Policy makers and practitioners are 
recommended to identify Holocaust survivors and other vulnerable older people 
and investigate their specific needs. Interventions should include practices for 
maintaining and boosting resilience and well-being by increasing appropriate 
emotional and cognitive internal and external coping resources, especially 
during prolonged periods of hardship.

© 2022. The Author(s).

DOI: 10.1186/s12888-022-04052-5
PMCID: PMC9238250
PMID: 35765017 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1845. Proc Natl Acad Sci U S A. 2022 Jul 5;119(27):e2200816119. doi: 
10.1073/pnas.2200816119. Epub 2022 Jun 28.

Mental health, financial, and social outcomes among older adults with probable 
COVID-19 infection: A longitudinal cohort study.

Iob E(1), Steptoe A(1), Zaninotto P(2).

Author information:
(1)Department of Behavioural Science and Health, University College London, WC1E 
7HB, London, United Kingdom.
(2)Department of Epidemiology and Public Health, University College London, WC1E 
7HB, London, United Kingdom.

We investigated the immediate and longer-term impact (over 4-6 months) of 
probable COVID-19 infection on mental health, wellbeing, financial hardship, and 
social interactions among older people living in England. Data were analysed 
from 5146 older adults participating in the English Longitudinal Study of Ageing 
who provided data before the pandemic (2018-19) and at two COVID-19 assessments 
in 2020 (June-July and November-December). The associations of probable COVID-19 
infection (first COVID-19 assessment) with depression, anxiety, poor quality of 
life (QoL), loneliness, financial hardship, and social contact with 
family/friends at the first and second COVID-19 assessments were tested using 
linear/logistic regression and were adjusted for pre-pandemic outcome measures. 
Participants with probable infection had higher levels of depression and 
anxiety, poorer QoL, and greater loneliness scores compared with those without 
probable infection at both the first (ORdepression = 1.62, P-value = 0.005; 
ORanxiety = 1.59, P-value = 0.049; bpoorQoL = 1.34, P < 0.001; bloneliness = 
0.49, P < 0.001) and second (ORdepression = 1.56, P-value = 0.003; ORanxiety = 
1.55, P-value = 0.041; bpoorQoL = 1.38, P-value < 0.001; bloneliness = 0.31, 
P-value = 0.024) COVID-19 assessments. Participants with probable infection also 
experienced greater financial difficulties than those without infection at the 
first assessment (OR = 1.50, P-value = 0.011). Probable COVID-19 infection is 
associated with longer-term deterioration of mental health and wellbeing and 
short-term increases in financial hardship among older adults. It is important 
to monitor the mental health of older people affected by COVID-19 and provide 
additional support to those in need.

DOI: 10.1073/pnas.2200816119
PMCID: PMC9271189
PMID: 35763577 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interest.


1846. Aging Ment Health. 2023 Mar;27(3):533-546. doi: 10.1080/13607863.2022.2084509. 
Epub 2022 Jun 28.

The early impacts of COVID-19 on people living with dementia: part I of 
a mixed-methods systematic review.

Giebel C(1)(2), Lion KM(3), Lorenz-Dant K(4), Suárez-González A(5), Talbot C(6), 
Wharton E(2)(7), Cannon J(7), Tetlow H(2)(8), Thyrian JR(8)(9)(10)(11).

Author information:
(1)Department of Primary Care & Mental Health, University of Liverpool, 
Liverpool, UK.
(2)NIHR ARC NWC, Liverpool, UK.
(3)Menzies Health Institute Queensland, Griffith University, Brisbane, 
Australia.
(4)Care Policy and Evaluation Centre, Department of Health Policy, London School 
of Economics and Political Science, London, UK.
(5)Dementia Research Centre, UCL Queen Square Institute of Neurology, London, 
UK.
(6)Faculty of Science & Technology, Bournemouth University, Poole, UK.
(7)School of Sport and Exercise Sciences, Liverpool John Moore's University, 
Liverpool, UK.
(8)Lewy Body Society, Wigan, UK.
(9)SURF Liverpool, Liverpool, UK.
(10)German Centre for Neurodegenerative Diseases (DZNE), Greifswald, Germany.
(11)Institute for Community Medicine, University of Greifswald, Greifswald, 
Germany.

Objectives: The aim of this Part I systematic review was to understand the 
impact of the COVID-19 pandemic on the lives of people with dementia living in 
the community or in residential care. Part II focused on unpaid carers.Methods: 
This review was registered on PROSPERO [CRD42021248050]. Five data bases 
(PubMed, CINAHL, Embase, Scopus, Web of Science) were searched in July 2021. 
Studies were included if they reported on the impacts of the pandemic on people 
living with dementia, either in the community or residential settings, and 
published in English, German, Polish, or Spanish. Risk of bias was assessed 
using the Standard Quality Assessment QualSyst.Results: Forty papers from 33 
studies reported on the effects of COVID-19 on people with dementia. Included 
studies were conducted across 15 countries, focusing on single-country 
evaluations except in one study. Three studies focused on care homes, whilst the 
remainder reported on the community. Studies were categorised into five impacts: 
Cognition; Independence and physical functioning; Behavioural symptoms; 
Well-being; and Access to care. All studies evidenced the negative pandemic 
impacts, including faster cognitive, physical, and behavioural deterioration, 
limited access to care, and poorer mental and social health.Conclusions: Future 
restrictions need to consider the need for people with dementia to stay 
cognitively, physically, and socially stimulated to live well, and this review 
provides a call for a future pandemic strategy for dementia. Longitudinal 
research is required on the long-term impacts of the pandemic on the lives of 
people with dementia, including time to care home entry.

DOI: 10.1080/13607863.2022.2084509
PMID: 35763444 [Indexed for MEDLINE]


1847. J Prim Care Community Health. 2022 Jan-Dec;13:21501319221098519. doi: 
10.1177/21501319221098519.

An Examination of the Impact of Social and Cultural Traditions Contributing to 
Overweight and Obesity Among Black Women.

Spinner JR(1).

Author information:
(1)Morgan State University, Baltimore, MD, USA.

Black women living in Prince George's (PG) County, Maryland, have high rates of 
overweight and obesity. Obesity significantly impacts Black women, leading to 
poor physical and mental health, decreased social well-being, and a financial 
strain on the healthcare system. Despite living in an affluent area and having 
middle to high incomes and high education levels, Black women living in PG 
County have difficulty managing their weight. This study explores how social and 
cultural factors and social networks impact the weight of Black women living in 
PG County, Maryland. A qualitative case study design guided by social cognitive 
theory was employed to conduct semi-structured interviews and focus groups with 
15 women. Key social and cultural factors (income, family network, peer network, 
and living in PG County) influenced participants' attitudes and behaviors toward 
their weight and strategies to manage their weight. Additionally, participants 
expressed that Black culture is more accepting of larger and curvier body types, 
and this reinforces a positive body image and less desire to achieve an ideal 
BMI. Participants also expressed that COVID-19 impacted their weight management 
strategies. This study adds to the literature by better explaining some of the 
underlying factors that influence decision-making around weight management among 
Black women who live in PG County, Maryland.

DOI: 10.1177/21501319221098519
PMCID: PMC9244922
PMID: 35762645 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The author 
declared no potential conflicts of interest with respect to the research, 
authorship, and/or publication of this article.


1848. BMC Psychol. 2022 Jun 27;10(1):163. doi: 10.1186/s40359-022-00869-7.

Role of positive mental health in reducing fears related to COVID-19 and general 
anxiety disorder in Khyber Pakhtunkhwa, Pakistan.

Mahmood QK(1), Sohail MM(2), Qureshi WA(3), Zakar R(4), Wrona KJ(5), Fischer 
F(6)(7).

Author information:
(1)Department of Gender Studies, University of the Punjab, Lahore, Pakistan.
(2)Department of Sociology, University of Chakwal, Punjab, Pakistan.
(3)Department of Sociology, Anadolu Üniversitesi Yeşiltepe, Eskişehir, Turkey.
(4)Institute of Social and Cultural Studies, University of the Punjab, Lahore, 
Pakistan.
(5)School of Public Health, Bielefeld University, Bielefeld, Germany.
(6)Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, 
Germany. florian.fischer1@charite.de.
(7)Bavarian Research Center for Digital Health and Social Care, Kempten 
University of Applied Sciences, Kempten, Germany. florian.fischer1@charite.de.

BACKGROUND: The outbreak of the novel coronavirus disease (COVID-19) has posed 
multiple challenges to healthcare systems. Evidence suggests that mental 
well-being is badly affected due to compliance with preventative measures in 
containing the COVID-19 pandemic. This study aims to explore the role of 
positive mental health (subjective sense of wellbeing) to cope with fears 
related to COVID-19 and general anxiety disorder in the Pashtun community in 
Pakistan.
METHODS: A cross-sectional survey was conducted among 501 respondents from 
Khyber Pakhtunkhwa participating in an online-based study. We performed 
correlational analysis, hierarchical linear regression and structural equational 
modeling (SEM) to analyze the role of mental health in reducing fears and 
general anxiety disorder.
RESULTS: The results of the SEM show that positive mental health has direct 
effects in reducing the fear related to COVID-19 (β = - 0.244, p < 0.001) and 
general anxiety (β = - 0.210, p < 0.001). Fears of COVID-19 has a direct effect 
on increasing general anxiety (β = 0.480). In addition, positive mental health 
also has an indirect effect (β = - 0.117, p < 0.001) on general anxiety 
(R2 = 0.32, p < 0.001) through reducing fear of coronavirus.
CONCLUSION: Based on these findings, there is a need to develop community health 
policies emphasizing on promotive and preventive mental health strategies for 
people practicing social/physical distancing.

© 2022. The Author(s).

DOI: 10.1186/s40359-022-00869-7
PMCID: PMC9238220
PMID: 35761390 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1849. Trials. 2022 Jun 27;23(1):533. doi: 10.1186/s13063-022-06454-y.

A multicomponent family support intervention in intensive care units: study 
protocol for a multicenter cluster-randomized trial (FICUS Trial).

Naef R(1)(2), Filipovic M(3), Jeitziner MM(4), von Felten S(5), Safford J(6), 
Riguzzi M(7)(8), Rufer M(9)(10).

Author information:
(1)Institute for Implementation Science in Health Care, Faculty of Medicine, 
University of Zurich, Universitätsstrasse 84, 8006, Zurich, Switzerland. 
rahel.naef@uzh.ch.
(2)Centre of Clinical Nursing Science, University Hospital Zurich, Rämistrasse 
100, 8091, Zurich, Switzerland. rahel.naef@uzh.ch.
(3)Surgical Intensive Care Unit, Division of Anesthesiology, Intensive Care, 
Rescue and Pain Medicine, Cantonal Hospital of St. Gallen, Rorschacher Strasse 
95, 9007, St. Gallen, Switzerland.
(4)Department of Intensive Care Medicine, University Hospital Bern, Inselspital, 
University of Bern, Freiburgstrasse 16, CH10, Bern, Switzerland.
(5)Department of Biostatistics, Epidemiology, Biostatistics, and Prevention 
Institute, Faculty of Medicine, University of Zurich, Hirschengraben 84, 8001, 
Zurich, Switzerland.
(6), Bern, Switzerland.
(7)Institute for Implementation Science in Health Care, Faculty of Medicine, 
University of Zurich, Universitätsstrasse 84, 8006, Zurich, Switzerland.
(8)Centre of Clinical Nursing Science, University Hospital Zurich, Rämistrasse 
100, 8091, Zurich, Switzerland.
(9)Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric 
University Hospital Zurich, University of Zurich, Zurich, Switzerland.
(10)Center for Psychiatry and Psychotherapy, Clinic Zugersee, Triaplus AG, 
Widenstrasse 55, 6317, Oberwil-Zug, Switzerland.

BACKGROUND: Family members of critically ill patients face considerable 
uncertainty and distress during their close others' intensive care unit (ICU) 
stay. About 20-60% of family members experience adverse mental health outcomes 
post-ICU, such as symptoms of anxiety, depression, and posttraumatic stress. 
Guidelines recommend structured family inclusion, communication, and support, 
but the existing evidence base around protocolized family support interventions 
is modest and requires substantiation.
METHODS: To test the clinical effectiveness and explore the implementation of a 
multicomponent, nurse-led family support intervention in ICUs, we will undertake 
a parallel, cluster-randomized, controlled, multicenter superiority hybrid-type 
1 trial. It will include eight clusters (ICUs) per study arm, with a projected 
total sample size of 896 family members of adult, critically ill patients 
treated in the German-speaking part of Switzerland. The trial targets family 
members of critically ill patients with an expected ICU stay of 48 h or longer. 
Families in the intervention arm will receive a family support intervention in 
addition to usual care. The intervention consists of specialist nurse support 
that is mapped to the patient pathway with follow-up care and includes 
psycho-educational and relationship-focused family interventions, and 
structured, interprofessional communication, and shared decision-making with 
families. Families in the control arm will receive usual care. The primary study 
endpoint is quality of family care, operationalized as family members' 
satisfaction with ICU care at discharge. Secondary endpoints include quality of 
communication and nurse support, family management of critical illness 
(functioning, resilience), and family members' mental health (well-being, 
psychological distress) measured at admission, discharge, and after 3, 6, and 12 
months. Data of all participants, regardless of protocol adherence, will be 
analyzed using linear mixed-effects models, with the individual participant as 
the unit of inference.
DISCUSSION: This trial will examine the effectiveness of the family support 
intervention and generate knowledge of its implementability. Both types of 
evidence are necessary to determine whether the intervention works as intended 
in clinical practice and could be scaled up to other ICUs. The study findings 
will make a significant contribution to the current body of knowledge on 
effective ICU care that promotes family participation and well-being.
TRIAL REGISTRATION: ClinicalTrials.gov NCT05280691 . Prospectively registered on 
20 February 2022.

© 2022. The Author(s).

DOI: 10.1186/s13063-022-06454-y
PMCID: PMC9235279
PMID: 35761343 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1850. Swiss Med Wkly. 2022 Jun 27;152:w30192. doi: 10.4414/smw.2022.w30192. 
eCollection 2022 Jun 20.

Changes in mental and sexual health among MSM using HIV pre-exposure prophylaxis 
during the SARS-CoV-2 pandemic: longitudinal analysis of the SwissPrEPared 
cohort study.

Winter BL(1)(2), Hovaguimian F(1)(3), Kouyos RD(3)(4), Schmidt AJ(5)(6), 
Bernasconi E(7), Braun DL(3)(4), Calmy A(8), Notter J(5), Stoeckle M(9), Surial 
B(10), Christinet V(11), Cavassini M(12), Depmeier C(13), Läuchli S(14), Boffi 
El Amari E(15), Reinacher M(1), Rasi M(1), Bruggmann P(16), Haerry D(17), Bize 
R(18), Low N(19), Lehner A(20), Quednow BB(2), Fehr JS(1), Hampel B(1)(21).

Author information:
(1)Department of Public and Global Health, Epidemiology, Biostatistics and 
Prevention Institute, University of Zurich, Zurich, Switzerland.
(2)Experimental and Clinical Pharmacopsychology, Department of Psychiatry, 
Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 
Zurich, Switzerland.
(3)Division of Infectious Diseases and Hospital Epidemiology, University 
Hospital of Zurich, Zurich, Switzerland.
(4)Institute of Medical Virology, University of Zurich, Zurich, Switzerland.
(5)Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital 
St. Gallen, St. Gallen, Switzerland.
(6)Sigma Research, London School of Hygiene and Tropical Medicine, London, 
United Kingdom.
(7)Division of Infectious Diseases, Regional Hospital Lugano, University of 
Geneva and University of Southern Switzerland, Lugano, Switzerland.
(8)HIV/AIDS Unit, Division of Infectious Diseases, Geneva University Hospital, 
Geneva, Switzerland.
(9)Division of Infectious Diseases and Hospital Epidemiology, University 
Hospital Basel, University of Basel, Basel, Switzerland.
(10)Department of Infectious Diseases, Bern University Hospital, University of 
Bern, Bern, Switzerland.
(11)Checkpoint Vaud, Lausanne, Switzerland.
(12)Division of Infectious Diseases, University Hospital of Lausanne, Lausanne, 
Switzerland.
(13)Private Practice Kalkbreite, Zurich, Switzerland.
(14)Dermatological Centre Zurich, Zurich, Switzerland.
(15)Infectious Diseases and Internal Medicine Private Practice, Geneva, 
Switzerland.
(16)Arud Centre for Addiction Medicine, Zurich, Switzerland.
(17)Positive Council, Zurich, Switzerland.
(18)Department of Epidemiology and Health Systems, Centre for Primary Care and 
Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
(19)Institue of Social and Preventive Medicine, University of Bern, Bern, 
Switzerland.
(20)Swiss AIDS Federation, Zurich, Switzerland.
(21)Checkpoint Zurich, Zurich, Switzerland.

BACKGROUND: Changes in mental and sexual health among men having sex with men 
(MSM) due to the SARS-CoV-2 pandemic remain unclear.
METHODS: Design: Longitudinal analysis of an ongoing, multicentre, pre-exposure 
prophylaxis (PrEP) cohort (NCT03893188) in Switzerland. Participants: 
HIV-negative MSM aged ≥18 who completed at least one questionnaire before and 
one after the start of the SARS-CoV-2 pandemic. Outcomes: Primary: mental 
health, defined as anxiety and depression scores assessed by the Patient Health 
Questionnaire-4. Secondary: sexual behaviour, well-being, PrEP use and 
disruption of care. Outcomes were assessed over seven periods corresponding to 
different SARS-CoV-2 prevention measures in Switzerland. We performed pairwise 
comparisons between periods (Wilcoxon signed rank test).
RESULTS: Data from 1,043 participants were included. Whilst anxiety scores 
remained stable over time, depression scores worsened in the second wave and the 
second lockdown period compared to pre-pandemic scores. This was confirmed by 
pairwise comparisons (pre-SARS-CoV-2/second wave and pre-SARS-CoV-2/second 
lockdown: p <0.001). Downward trends in sexual activity,sexualized substance 
use, and a switch from daily to "event-driven" PrEP were found. Disruption of 
care affected 42.6% (790/1856) of daily PrEP users' follow-up visits.
CONCLUSION: In this longitudinal analysis of a PrEP cohort enrolling MSM, 
depression scores worsened in the second wave and the second lockdown compared 
to the pre-pandemic period.

DOI: 10.4414/smw.2022.w30192
PMID: 35758418 [Indexed for MEDLINE]


1851. Aust N Z J Psychiatry. 2023 Apr;57(4):511-519. doi: 10.1177/00048674221106677. 
Epub 2022 Jun 25.

The comparative mental health of Australian doctors before and during COVID-19: 
A population-based approach.

Hoang KTA(1), Morris RW(2)(3)(4), Naehrig DN(2)(3), Glozier N(2)(3)(5).

Author information:
(1)Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia.
(2)Central Clinical School, Faculty of Medicine and Health, The University of 
Sydney, Camperdown, NSW, Australia.
(3)ARC Centre of Excellence for Children and Families over the Life Course, 
Brisbane, QLD, Australia.
(4)School of Psychology, Faculty of Science, The University of Sydney, 
Camperdown, NSW, Australia.
(5)Professor Marie Bashir Centre, Sydney LHD, Camperdown, NSW, Australia.

OBJECTIVE: Occupational surveys of doctors consistently show higher rates of 
depression and anxiety than reported in general population surveys, findings 
replicated in all other occupational groups, suggesting potential selection 
bias. We evaluated the comparative mental health of different occupations in 
Australia from the same sampling frame over the past 6 years and assessed 
whether COVID-19 differentially affected different occupational groups.
METHODS: We analysed six annual data waves (2015-2020) from the nationally 
representative 'Household, Income, and Labour Dynamics in Australia' study. 
Mental health (Mental Health Inventory-5 from the 36-Item Short Form Survey) and 
life satisfaction scores of doctors over this period were compared with five 
other professions and all other employees. Regression models were adjusted for 
age, gender, income and work hours. Two-way analysis of variance examined the 
comparative changes in mental health among occupations between 2019 and after 
exposure to the COVID-19 pandemic in late 2020.
RESULTS: The sample of 15,174 employed respondents included 106 doctors. The 
5-year mean mental health score for doctors (M = 78.7; SD = 13.1) was 
significantly higher than that for teachers (M = 75.6; SD = 14.9), nurses and 
midwives (M = 76.6; SD = 15.9), lawyers (M = 74.2; SD = 16.1), accountants 
(M = 74.2; SD = 16.5) and all other employed respondents (M = 73.1, SD = 16.7) 
(p < 0.001). Cognitive wellbeing comparisons were similar. There were no 
significant changes in professionals' mental health over this period except for 
an improvement in engineers and a decline for teachers. From 2019 to 2020, all 
occupations suffered mental health declines without any significant 
inter-occupational differences.
CONCLUSION: Australian doctors identified from a population-based sample rather 
than occupational surveys reported better levels of mental health and greater 
life satisfaction than most professions prior to COVID-19 without experiencing 
the worsening seen in the general employed population over the past 5 years. 
From 2020, there was a mental health decline in all of the employed population, 
not disproportionately affecting doctors. Although over-representing Australian 
trained general practitioners, the results from both this sample and other 
tentative findings challenge the discourse in medical advocacy, but need more 
formal comparative studies to confirm.

DOI: 10.1177/00048674221106677
PMCID: PMC10037126
PMID: 35757939 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship and/or publication of this 
article.


1852. Front Public Health. 2022 Jun 10;10:896843. doi: 10.3389/fpubh.2022.896843. 
eCollection 2022.

The Association Between Exposure to COVID-19 and Mental Health Outcomes Among 
Healthcare Workers.

Czepiel D(1)(2), Hoek HW(1)(3)(4), van der Markt A(5), Rutten BPF(6), Veling 
W(3), Schirmbeck F(7), Mascayano F(4)(8), Susser ES(4)(8), van der Ven E(2).

Author information:
(1)Parnassia Groep, Parnassia Psychiatric Institute, The Hague, Netherlands.
(2)Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, 
Amsterdam, Netherlands.
(3)University of Groningen, University Medical Center Groningen, University 
Center of Psychiatry, Groningen, Netherlands.
(4)Department of Epidemiology, Mailman School of Public Health, Columbia 
University, New York, NY, United States.
(5)Department of Psychiatry, Amsterdam Public Health Research Institute, 
Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, 
Netherlands.
(6)Department of Psychiatry and Neuropsychology, School for Mental Health and 
Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands.
(7)Academic Medical Center, Department of Psychiatry, University of Amsterdam, 
Amsterdam, Netherlands.
(8)Division of Behavioral Health Services and Policies, New York State 
Psychiatric Institute, New York, NY, United States.

Due to the unprecedented impact of the COVID-19 pandemic on health care systems, 
there has been great interest in the mental wellbeing of healthcare workers. 
While most studies investigated mental health outcomes among frontline vs. 
non-frontline healthcare workers, little is known about the impact of various 
work-related variables. The present study aimed to examine the association 
between work-related [i.e., having contact with COVID-19 patients, being 
redeployed due to the pandemic and availability of sufficient personal 
protective equipment (PPE)] and subjective (i.e., worries about getting infected 
or infecting others) exposures and self-reported mental health outcomes (i.e., 
psychological distress, depressive symptoms, and posttraumatic stress symptoms). 
Between February and May 2021, 994 healthcare workers employed at a variety of 
healthcare settings in the Netherlands filled out an online survey as part of 
the COVID-19 HEalth caRe wOrkErS (HEROES) study. Mental health outcomes were 
measured using the General Health Questionnaire-12, the Patient Health 
Questionnaire-9, and the Primary Care PTSD Screen for DSM-5. Approximately 13% 
reported depressive symptoms, 37% experienced psychological distress, and 20% 
reported posttraumatic stress symptoms. Multilevel linear models consisted of 
three levels: individual (work-related and subjective exposures), healthcare 
center (aggregated redeployment and availability of sufficient PPE), and 
regional (cumulative COVID-19 infection and death rates). Worries about 
infection were associated with all three mental health outcomes, whereas 
insufficient PPE was associated with psychological distress and depressive 
symptoms. There were no differences in outcomes between healthcare centers or 
provinces with different COVID-19 infection and death rates. Our findings 
highlight the importance of adequate PPE provision and the subjective experience 
of the COVID-19 pandemic. These factors should be part of interventions aimed at 
mitigating adverse mental health outcomes among healthcare workers during the 
COVID-19 pandemic.

Copyright © 2022 Czepiel, Hoek, van der Markt, Rutten, Veling, Schirmbeck, 
Mascayano, Susser and van der Ven.

DOI: 10.3389/fpubh.2022.896843
PMCID: PMC9226479
PMID: 35757645 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1853. BMC Palliat Care. 2022 Jun 27;21(1):114. doi: 10.1186/s12904-022-01008-0.

Family caregivers' concerns about advance care planning for home-dwelling people 
with dementia: a cross-sectional observational study in Japan.

Nakanishi M(1)(2), Nakashima T(3), Miyamoto Y(4), Yamasaki S(5), Nishida A(5).

Author information:
(1)Department of Psychiatric Nursing, Tohoku University Graduate School of 
Medicine, Miyagi, Japan. mnakanishi-tky@umin.ac.jp.
(2)Research Center for Social Science & Medicine, Tokyo Metropolitan Institute 
of Medical Science, Tokyo, Japan. mnakanishi-tky@umin.ac.jp.
(3)Department of Social Healthcare and Business, Nihon Fukushi University, 
Aichi, Japan.
(4)Department of Psychiatric Nursing, Graduate School of Medicine, The 
University of Tokyo, Tokyo, Japan.
(5)Research Center for Social Science & Medicine, Tokyo Metropolitan Institute 
of Medical Science, Tokyo, Japan.

BACKGROUND: The importance of advance care planning for people with dementia has 
increased during the Coronavirus Disease 2019 Pandemic. However, family 
caregivers may have concerns about having conversations regarding advance care 
planning with their loved ones, which may hinder the initiation of such 
planning. This study investigated family caregivers' concerns regarding 
conducting advance care planning for home-dwelling individuals with dementia.
METHODS: A prospective cross-sectional study compared the level of 
family-caregiver concern between those who had initiated advance care planning 
and those who did not. In June 2021, an internet-based questionnaire survey was 
administered to Japan-based family caregivers of persons with dementia. 
Registered members of a Japan-based survey company were recruited; inclusion 
criteria were being aged 40 years or older and having been a primary, 
non-professional caregiver of a family member with dementia. Respondents rated 
their level of agreement with six statements regarding 
advance-care-planning-related concerns. Respondents also reported their 
psychological well-being using the WHO-5 Well-Being Index.
RESULTS: Overall, 379 family caregivers participated in this survey. Of these, 
155 (40.9%) reported that their loved ones had initiated advance care planning, 
of whom 88 (56.8%) stated that care professionals were involved in the 
advance-care-planning conversations. The level of family-caregiver concern was 
significantly lower when the loved one initiated the conversation concerning 
advance care planning. After adjusting for the characteristics of persons with 
dementia and their caregivers, family caregivers with lower psychological 
well-being showed significantly higher levels of concern.
CONCLUSIONS: Family caregivers reported concerns regarding conducting advance 
care planning. There is a need for educational and clinical strategies that 
encourage professionals to address the psychological needs of family caregivers.

© 2022. The Author(s).

DOI: 10.1186/s12904-022-01008-0
PMCID: PMC9235165
PMID: 35754050 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflicts 
of interest.


1854. BMC Psychiatry. 2022 Jun 25;22(1):430. doi: 10.1186/s12888-022-04080-1.

Mental health-related communication in a virtual community: text mining analysis 
of a digital exchange platform during the Covid-19 pandemic.

Golz C(1), Richter D(2)(3), Sprecher N(2), Gurtner C(2).

Author information:
(1)Department of Health Professions, Bern University of Applied Sciences, 
Murtenstrasse 10, 3008, Bern, Switzerland. Christoph.golz@bfh.ch.
(2)Department of Health Professions, Bern University of Applied Sciences, 
Murtenstrasse 10, 3008, Bern, Switzerland.
(3)Center for Psychiatric Rehabilitation, Bern University Hospital for Mental 
Health, Bern, Switzerland.

BACKGROUND: Virtual communities played an important role in mental health and 
well-being during the Covid-19 pandemic by providing access to others and 
thereby preventing loneliness. The pandemic has accelerated the urge for digital 
solutions for people with pre-existing mental health problems. So far, it 
remains unclear how the people concerned communicate with each other and benefit 
from peer-to-peer support on a moderated digital platform.
OBJECTIVE: The aim of the project was to identify and describe the communication 
patterns and verbal expression of users on the inCLOUsiv platform during the 
first lockdown in 2020.
METHODS: Discussions in forums and live chats on inCLOUsiv were analysed using 
text mining, which included frequency, correlation, n-gram and sentiment 
analyses.
RESULTS: The communication behaviour of users on inCLOUsiv was benevolent and 
supportive; and 72% of the identified sentiments were positive. Users addressed 
the topics of 'corona', 'anxiety' and 'crisis' and shared coping strategies.
CONCLUSIONS: The benevolent interaction between users on inCLOUsiv is in line 
with other virtual communities for Covid-19 and the potential for peer-to-peer 
support. Users can benefit from each other's experiences and support each other. 
Virtual communities can be used as an adjuvant to existing therapy, particularly 
in times of reduced access to local health services.

© 2022. The Author(s).

DOI: 10.1186/s12888-022-04080-1
PMCID: PMC9233821
PMID: 35752758 [Indexed for MEDLINE]

Conflict of interest statement: The authors report no conflict of interest. The 
authors alone are responsible for the content and writing of the paper.


1855. Soc Sci Med. 2022 Aug;306:115153. doi: 10.1016/j.socscimed.2022.115153. Epub 
2022 Jun 16.

Rural older adults' resilience in the context of COVID-19.

Herron RV(1), Lawrence BC(2), Newall NEG(3), Ramsey D(4), Waddell-Henowitch 
CM(5), Dauphinais J(6).

Author information:
(1)Department of Geography and Environment, Brandon University, Canada. 
Electronic address: herronr@brandonu.ca.
(2)Educational Psychology, Brandon University, Canada.
(3)Department of Psychology, Brandon University, Canada.
(4)Department of Rural Development, Brandon University, Canada.
(5)Department of Psychiatric Nursing, Brandon University, Canada.
(6)Centre for Critical Studies of Rural Mental Health, Canada.

Public health and media discourses have often portrayed older adults as a 
vulnerable group during the COVID-19 pandemic. Yet, some emerging research is 
showing that older adults are faring better in terms of their mental health when 
compared to their younger counterparts. Understanding older adults' mental 
well-being during the pandemic requires in-depth exploration of the different 
place-based resources and systems around them. In particular, rural older adults 
face distinct challenges and opportunities related to accessing valued resources 
to promote their well-being. Drawing together research on aging and 
multi-systemic resilience, we explored what strategies, resources, and processes 
rural older adults valued in the initial stages of the COVID-19 pandemic. A 
series of 51 semi-structured telephone interviews were conducted from May to 
August 2020 with 26 rural older adults in Manitoba, Canada. Despite adversities, 
participants drew on and developed resources at the individual, local, 
community, institutional, and societal level to support their well-being. 
Specifically, they identified individual strategies (e.g., positivity, 
acceptance, and gratitude), resources in their immediate environments (e.g., 
opportunities to keep busy, connect with friends, family and neighbours, and 
outdoor visits), and community organizations that contributed to their 
well-being. They also identified broader systems that shaped their resilience 
processes, such as access to health services, opportunities to volunteer and 
support others, media stories, reliable information, and public health policies 
and practices that value older adult lives. Importantly, some resources were 
less accessible to some participants, highlighting the need to develop 
strategies that address inequitable resources at different levels. By describing 
rural older adults' resilience we seek to advance the growing body of research 
in relation to social ecological resilience that moves beyond a focus on 
individual characteristics to include understanding of the role of material, 
social, and cultural contexts.

Copyright © 2022. Published by Elsevier Ltd.

DOI: 10.1016/j.socscimed.2022.115153
PMCID: PMC9212856
PMID: 35751990 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1856. J Relig Health. 2022 Oct;61(5):4189-4204. doi: 10.1007/s10943-022-01602-9. Epub 
2022 Jun 25.

Investigation of the Relationship Between the Spiritual Orientation and 
Psychological Well-Being Levels of Inpatients with a Diagnosis of COVID-19 In 
Turkey: A Cross-Sectional Study.

Şahin Altun Ö(1), Özer D(2), Satılmış M(3), Şahin F(4).

Author information:
(1)Department of Psychiatric Nursing, Faculty of Nursing, Ataturk University, 
Erzurum, Turkey.
(2)Department of Psychiatry, Sultan II. Abdulhamid Han Training and Research 
Hospital, University of Health Sciences, Istanbul, Turkey. 
duyguozer2016@hotmail.com.
(3)Bayburt State Hospital, Bayburt, Turkey.
(4)Department of Nursing, Faculty of Health Sciences, Mus Alparslan University, 
Muş, Turkey.

This study was carried out to determine the relationship between the spiritual 
orientation and psychological well-being levels of inpatients diagnosed with 
COVID-19 and the factors affecting the psychological well-being of patients. 
This cross-sectional study was conducted with 136 patients diagnosed with 
COVID-19 who were hospitalized in the COVID-19 clinics of a state hospital 
between May and July 2021 and volunteered to participate in the study. To 
collect the study data, the Personal Information Form, Spiritual Orientation 
Scale (SOS) and Psychological Well-Being Scale (PWBS) were used. There was a 
positive correlation between the mean scores obtained from the overall SOS and 
PWBS (r = .335, p < .001). Of the participants, those who were women, who were 
over 65-year-old patients, who were hospitalized for 8-14 days and who had 
chronic diseases had lower levels of psychological well-being. The inpatients 
with a diagnosis of COVID-19 had high levels of spirituality and psychological 
well-being. It was found that there is a relationship between the spiritual 
orientation and psychological well-being of inpatients hospitalized with the 
diagnosis of COVID-19. The fact that nurses take spirituality into account while 
providing care to patients diagnosed with COVID-19 may be effective in 
protecting their patients' mental health.

© 2022. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s10943-022-01602-9
PMCID: PMC9244415
PMID: 35751719 [Indexed for MEDLINE]

Conflict of interest statement: The authors report no actual or potential 
conflicts of interest.


1857. J Foot Ankle Res. 2022 Jun 24;15(1):49. doi: 10.1186/s13047-022-00555-2.

Impact of COVID-19 pandemic on foot care services in Ontario, Canada.

Lu SH(1)(2), McLaren AM(3)(4), Pinsker E(5).

Author information:
(1)Wound Care Team, Surgery & Critical Care Program, Unity Health Toronto - St. 
Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. 
Suzanne.Lu@unityhealth.to.
(2)Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada. 
Suzanne.Lu@unityhealth.to.
(3)Wound Care Team, Surgery & Critical Care Program, Unity Health Toronto - St. 
Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
(4)Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada.
(5)Division of Orthopaedic Surgery, University of Toronto, Unity Health Toronto 
- St. Michael's Hospital, Toronto, ON, Canada.

BACKGROUND: The COVID-19 pandemic has directly affected the delivery of health 
care services in Canada, including foot care. The goal of this descriptive study 
was to understand the impact of the early COVID-19 pandemic (March 2020 to April 
2021) on chiropodists' and podiatrists' clinical practices and foot care service 
delivery in Ontario, Canada.
METHODS: A web-survey was completed by participating chiropodists and 
podiatrists registered with the College of Chiropodists of Ontario. The survey 
consisted of 31 multiple choice and open-ended items on clinical practice 
characteristics, foot care service delivery changes, perceived barriers during 
the pandemic, and its impact on clinicians. Descriptive statistics were used to 
characterize the sample and examine clinicians' responses, and qualitative 
content analysis was used to explore opened-ended items.
RESULTS: Of the 773 eligible clinicians, 279 participated for a response rate of 
36.1%. Most respondents reported a decline in patient volume, an increase in 
urgent foot health problems, a financial impact on their clinical practices, an 
emotional impact, and substantial changes to how they provided foot care 
services, such as incorporating telehealth/virtual care into patient care. 
Factors that impact clinicians' perception of future pandemic preparedness are 
identified.
CONCLUSION: This study describes foot care service delivery in Ontario, Canada 
during the COVID-19 pandemic. The COVID-19 pandemic saw an increase in urgent 
foot health problems, decline in patient volume, and impacted clinicians' mental 
health and emotional well-being. Future studies should examine patients' 
experiences of foot care service delivery and maintaining their foot health 
during the pandemic, and further examination of factors that impact clinicians' 
perception of pandemic preparedness.

© 2022. The Author(s).

DOI: 10.1186/s13047-022-00555-2
PMCID: PMC9226266
PMID: 35751101 [Indexed for MEDLINE]

Conflict of interest statement: All authors declare that they have no competing 
interests.


1858. J Res Adolesc. 2023 Mar;33(1):43-58. doi: 10.1111/jora.12776. Epub 2022 Jun 24.

Family Well-Being During the COVID-19 Pandemic: The Risks of Financial 
Insecurity and Coping.

Gonzalez MR(1), Brown SA(1), Pelham WE 3rd(1), Bodison SC(2), McCabe C(3), Baker 
FC(4), Baskin-Sommers A(5), Dick AS(6), Dowling GJ(7), Gebreselassie S(1)(8), 
Guillaume M(9), Marshall AT(10)(11), Sheth C(11), Sowell ER(10)(12), Van 
Rinsveld A(9), Tapert SF(1).

Author information:
(1)University of California.
(2)University of Florida.
(3)University of Washington.
(4)SRI International.
(5)Yale University.
(6)Florida International University.
(7)National Institute on Drug Abuse.
(8)Northwestern University.
(9)Stanford University.
(10)Children's Hospital Los Angeles.
(11)University of Utah.
(12)University of Southern California.

During the COVID-19 pandemic, families have experienced unprecedented financial 
and social disruptions. We studied the impact of preexisting psychosocial 
factors and pandemic-related financial and social disruptions in relation to 
family well-being among N = 4091 adolescents and parents during early summer 
2020, participating in the Adolescent Brain Cognitive DevelopmentSM Study. 
Poorer family well-being was linked to prepandemic psychosocial and financial 
adversity and was associated with pandemic-related material hardship and social 
disruptions to routines. Parental alcohol use increased risk for worsening of 
family relationships, while a greater endorsement of coping strategies was 
mainly associated with overall better family well-being. Financial and mental 
health support may be critical for family well-being during and after a 
widespread crisis, such as the COVID-19 pandemic.

© 2022 The Authors. Journal of Research on Adolescence published by Wiley 
Periodicals LLC on behalf of Society for Research on Adolescence.

DOI: 10.1111/jora.12776
PMCID: PMC9349420
PMID: 35748113 [Indexed for MEDLINE]

Conflict of interest statement: We have no conflicts of interest.


1859. Int J Environ Res Public Health. 2022 Jun 20;19(12):7532. doi: 
10.3390/ijerph19127532.

COVID-19 Pandemic Psychological Impact and Volunteering Experience Perceptions 
of Medical Students after 2 Years.

Gómez-Durán EL(1)(2), Fumadó CM(1)(3), Gassó AM(1), Díaz S(1), 
Miranda-Mendizabal A(1), Forero CG(1), Virumbrales M(1).

Author information:
(1)School of Medicine, Universitat Internacional de Catalunya, 08017 Barcelona, 
Spain.
(2)Integral Care Program for Sick Health Professionals, Galatea Clinic, Galatea 
Foundation, 08017 Barcelona, Spain.
(3)Professional Liability and Legal Medicine, Universitat Autònoma de Barcelona, 
08017 Barcelona, Spain.

Undergraduate healthcare students were mobilized to support healthcare systems 
during the COVID-19 pandemic, but we have scarce information regarding their 
experience and its impact on their wellbeing. An anonymous online survey was 
conducted among undergraduate students and recently graduated physicians of a 
medical university in Spain, regarding their symptoms and volunteering 
experience during the initial months of the Spanish COVID-19 pandemic. 
Respondents showed a high prevalence of perceived stress, anxiety, and 
depressive symptoms, measured by the PHQ-9 and GAD-7. 14.5% reported 
healthcare-related volunteering tasks. Volunteering was a satisfactory 
experience for most of the respondents and the majority felt ready to do 
volunteering tasks (66.6%). Yet, 16.6% acknowledged not getting appropriate 
specific-task education before starting, 20.8% reported not having appropriate 
supervision, and 33.3% feel they did not have proper protective equipment. More 
than half of volunteers feared getting infected, more than 70% feared infecting 
their relatives or friends, and 54.2% reported stigmatization. Volunteers showed 
significantly higher stress, anxiety, and depression scores than the rest of the 
respondents, and 32% reported a highly traumatic event during volunteering, with 
high scores on the IES-R in the 16% of volunteers. Our results should help guide 
future potential volunteering processes in emergencies, enhance academic 
programs at medical schools and provide valuable data for psychological support 
services.

DOI: 10.3390/ijerph19127532
PMCID: PMC9223586
PMID: 35742780 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1860. Int J Environ Res Public Health. 2022 Jun 20;19(12):7525. doi: 
10.3390/ijerph19127525.

Anxiety towards COVID-19, Fear of Negative Appearance, Healthy Lifestyle, and 
Their Relationship with Well-Being during the Pandemic: A Cross-Cultural Study 
between Indonesia and Poland.

Novita S(1), Andriani D(1), Erika(2), Lipowski M(3), Lipowska M(4).

Author information:
(1)Centre for Psychological Innovation and Research, Faculty of Psychology, 
Universitas Padjadjaran, Jl. Raya Bandung Sumedang KM 21, Sumedang 45363, 
Indonesia.
(2)Faculty of Nursing, Universitas Riau, Jl. Pattimura No. 9, Pekanbaru 28133, 
Indonesia.
(3)Department of Psychology, Gdansk University of Physical Education and Sport, 
1 Kazimierza Gorskiego Street, 80-336 Gdańsk, Poland.
(4)Institute of Psychology, University of Gdańsk, 80-309 Gdańsk, Poland.

The COVID-19 pandemic has led to massive changes in almost all aspects of human 
life, including emotional states such as anxiety and fear, perspectives about 
healthy lifestyles, and psychological outcomes. This study aimed to disentangle 
the mechanisms that underlie the relationships of anxiety towards COVID-19 and 
fear of negative appearance with well-being, we also investigated the effects of 
cultural variations on levels of anxiety, fear of negative appearance, healthy 
lifestyles, and well-being. A total of 881 Indonesians (n = 172) and Poles (n = 
709) participated in this study. Participants completed self-report measures of 
psychological well-being, anxiety, fear of negative appearance, compulsive 
exercise, and eating disorders. Multigroup structural equation modelling (SEM) 
was used. The results showed no statistically meaningful relationship between 
anxiety towards COVID-19 and well-being. However, it was found that, in the 
Polish sample, compulsive exercise and eating disorders mediated the 
relationship between fear of negative appearance and well-being. Cultural 
differences were also found in the mean scores of all examined constructs, with 
eating disorders being an exception. Therefore, this study highlights cultural 
aspects that determine emotional states, healthy lifestyles, and well-being.

DOI: 10.3390/ijerph19127525
PMCID: PMC9223822
PMID: 35742773 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1861. Int J Environ Res Public Health. 2022 Jun 19;19(12):7513. doi: 
10.3390/ijerph19127513.

Distinguishing the Effect of Time Spent at Home during COVID-19 Pandemic on the 
Mental Health of Urban and Suburban College Students Using Cell Phone 
Geolocation.

Ayranci P(1), Bandera C(1), Phan N(1), Jin R(2), Li D(2), Kenne D(3).

Author information:
(1)Martin Tuckman School of Management, New Jersey Institute of Technology, 
Newark, NJ 07102, USA.
(2)Department of Computer Science, Kent State University, Kent, OH 44240, USA.
(3)College of Public Health, Kent State University, Kent, OH 44240, USA.

The aim of this study was to assess the correlation of depression and anxiety 
with time spent at home among students at two universities-one urban and the 
other suburban-during the COVID-19 pandemic.
METHODS: Geolocation data from the smartphones of 124 participants were 
collected between February 2021 and May 2021. The level of depression was 
estimated by the PHQ-9 and PHQ-2 screening tools, and anxiety scores were 
estimated by the GAD-2 and GAD-7 screening tools.
RESULTS: 51% of participants in the PHQ-9 surveys indicated mild to severe 
depression. Participants spent on average 75% of their time at home during 
COVID. Time spent at home had a positive correlation with the mental health of 
urban students but a negative correlation with suburban students. The relation 
between the time at home with mental health was stronger among female 
participants than among male participants. Correlations between female 
depression, anxiety, and time at home were significant.
CONCLUSIONS: Lockdown and distance learning contributed to the high levels of 
depression in university students. This research highlights the importance of 
time spent at home for mental health being during the pandemic and the 
importance of distinguishing between urban and suburban settings when 
formulating public health recommendations. Quality of time spent at home versus 
time spent outside differentiated the mental well-being of students located in 
different environments. Staying at home may be recommended for students without 
access to safe outdoor places as it is associated with lower levels of 
depression.

DOI: 10.3390/ijerph19127513
PMCID: PMC9223414
PMID: 35742760 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1862. Int J Environ Res Public Health. 2022 Jun 17;19(12):7438. doi: 
10.3390/ijerph19127438.

Comparing Mental Health, Wellbeing and Flourishing in Undergraduate Students 
Pre- and during the COVID-19 Pandemic.

Graham MA(1), Eloff I(2).

Author information:
(1)Department of Science, Mathematics and Technology Education, University of 
Pretoria, Pretoria 0002, South Africa.
(2)Department of Educational Psychology, University of Pretoria, Pretoria 0002, 
South Africa.

There has been a preponderance of studies on student mental health, wellbeing 
and flourishing during the COVID-19 pandemic. Few studies have compared data on 
student mental health and wellbeing before and during the pandemic. The purpose 
of the current study was to compare mental health and wellbeing in undergraduate 
students before and during the COVID-19 pandemic. Survey research was conducted 
with three groups of undergraduate students (n = 905) from diverse scientific 
fields at a large, urban university in South Africa. Data was collected by means 
of electronic surveys, combining full-scale items from three instruments, the 
Mental Health Continuum Short Form, the Flourishing Scale and the Fragility of 
Happiness Scale. Data was analysed by the Statistical Package for the Social 
Sciences (SPSS), the Analysis of Moment Structures (AMOS) and R software. The 
results indicate that while the mental health and wellbeing of students declined 
during the pandemic concerning their perceived ability to contribute to society, 
having supportive and rewarding social relationships and them being engaged and 
interested in their daily activities, it also improved in terms of their 
perceived ability to manage their daily lives (environmental mastery), being 
challenged to grow (personal growth) and in terms of their views that society 
was becoming better (social growth/actualisation).

DOI: 10.3390/ijerph19127438
PMCID: PMC9224479
PMID: 35742686 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1863. Int J Environ Res Public Health. 2022 Jun 12;19(12):7207. doi: 
10.3390/ijerph19127207.

Longitudinal Predictors of Coronavirus-Related PTSD among Young Adults from 
Poland, Germany, Slovenia, and Israel.

Ochnik D(1), Rogowska AM(2), Arzenšek A(3), Benatov J(4).

Author information:
(1)Faculty of Medicine, University of Technology, 40-555 Katowice, Poland.
(2)Institute of Psychology, University of Opole, 45-052 Opole, Poland.
(3)Faculty of Management, University of Primorska, 6101 Koper, Slovenia.
(4)Department of Special Education, University of Haifa, Haifa 3498838, Israel.

The aim of this study was to reveal longitudinal predictors of 
coronavirus-related PTSD and the moderating roles of country, sex, age, and 
student status among young adults from Poland, Germany, Slovenia, and Israel. We 
included the following predictors: perceived stress, exposure to COVID-19, 
perceived impact of COVID-19 on well-being in socioeconomic status (PNIC-SES) 
and social relationships (PNIC-SR), fear of COVID-19, fear of vaccination, and 
trust in institutions. We conducted the study online among a representative 
sample of 1723 young adults aged 20-40 (M = 30.74, SD = 5.74) years in February 
2021 (T1) and May-June 2021 (T2). We used McNemar's χ2 and the paired samples 
Student's t-test to test differences over time. We assessed the relationships 
between variables using Pearson's correlation. We performed structural equation 
modeling (SEM) to examine the associations between variables at T1 and T2. We 
used a lagged regression model to examine the causal influences between 
variables across different time points (T1 and T2). The results showed that all 
variables decreased over time, except exposure to COVID-19. The rates of 
infected, tested, and under-quarantine participants increased. The rates of 
those who lost a job and experienced worsening economic status decreased. The 
rate of hospitalized participants and those experiencing the loss of close ones 
did not change. Higher perceived stress, fear of COVID-19, fear of vaccination, 
and trust in institutions were significant longitudinal predictors of 
coronavirus-related PTSD regardless of country, sex, age, and student status. 
Institutions should provide more accurate programs for public health, so trust 
in institutions can be a protective and not a risk factor in future traumatic 
events.

DOI: 10.3390/ijerph19127207
PMCID: PMC9222994
PMID: 35742455 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1864. Int J Environ Res Public Health. 2022 Jun 9;19(12):7073. doi: 
10.3390/ijerph19127073.

Factors Predicting Post-Traumatic Positive and Negative Psychological Changes 
Experienced by Nurses during a Pandemic COVID-19: A Cross-Sectional Study.

Nowicki GJ(1), Ślusarska B(1), Zboina B(2), Jędrzejewska A(1), Kotus M(3).

Author information:
(1)Department of Family and Geriatric Nursing, Medical University of Lublin, 
Staszica 6 Str., PL-20-081 Lublin, Poland.
(2)Department of Pedagogy and Health Sciences, College of Business and 
Entreprise, Akademicka 20 Str., PL-27-400 Ostrowiec Świetokrzyski, Poland.
(3)Department of Anaesthesiological and Intensive Care Nursing, Medical 
University of Lublin, Chodźki 7 Str., PL-20-093 Lublin, Poland.

It is common knowledge that COVID-19 affects physiopathological changes in all 
systems of the human body. On the other hand, events related to the COVID-19 
pandemic also have a significant impact on the social and mental sphere of human 
functioning. The aim of this study is to determine the relationship between 
selected sociodemographic variables and selected subjective cognitive resources, 
and the positive and negative perception of the consequences of the COVID-19 
pandemic in a group of nurses working in Poland. The computer-assisted web 
interviewing method was conducted between 1 and 15 May 2020. Participants were 
requested to complete the following questionnaires: The Changes in Outlook 
Questionnaire (CIOQ), The Impact Event Scale-Revised (IES-R), The 
Multidimensional Scale of Perceived Social Support (MSPSS), The Safety 
Experience Questionnaire (SEQ), and The Meaning in Life Questionnaire (MLQ). 
Three-hundred and twenty fivenurses working all over Poland participated in the 
study. Their mean age was 39.18 ± 11.16 years. A higher average level was noted 
among the surveyed nurses in the Positive Change subscale (18.56 ± 4.04). In a 
multivariate model, taking into account both sociodemographic and cognitive 
variables, the level of perceived traumatic stress, the level of social support, 
a sense of security, reflection on safety and a sense of meaning and meaning in 
life were independent predictors of a positive perception of the consequences of 
the COVID-19 pandemic. Those variables explained as much as 37% of the dependent 
variable, and the nature of the relationship was positive. While we are still a 
long way from understanding the full range of the long-term impact of the 
COVID-19 pandemic on mental health and psychosocial well-being, it is possible 
that in this challenging context there are many individual resources available 
to perceive the effects of the current pandemic positively. Therefore, they 
should be strengthened through the development and implementation of 
intervention programs to improve the mental state of nurses.

DOI: 10.3390/ijerph19127073
PMCID: PMC9223076
PMID: 35742321 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflicts 
of interest.


1865. Int J Environ Res Public Health. 2022 Jun 7;19(12):6985. doi: 
10.3390/ijerph19126985.

Mental Well-Being and Sexual Intimacy among Men and Gender Diverse People Who 
Have Sex with Men during the First UK COVID-19 Lockdown: A Mixed-Methods Study.

Edelman NL(1)(2), Witzel TC(3)(4), Samba P(4)(5), Nutland W(4)(5), Nadarzynski 
T(6).

Author information:
(1)School of Sport & Health Sciences, University of Brighton, Brighton BN1 9PH, 
UK.
(2)Primary Care & Public Health, Brighton & Sussex Medical School, Brighton BN1 
9PX, UK.
(3)Institute for Global Health, University College London, London NW2 2QG, UK.
(4)Department of Public Health, Environments and Society, London School of 
Hygiene and Tropical Medicine, London WC1H 9SH, UK.
(5)PrEPster, The Love Tank, London E1 4AQ, UK.
(6)School of Social Sciences, University of Westminster, London W1B 2HW, UK.

This mixed-methods study aimed to explore mental well-being, circumstances and 
strategies around managing sexual intimacy and risk during the first UK COVID-19 
lockdown (Spring 2020) among men and gender diverse people who have sex with men 
(MGDPSM), commencing while lockdown was in progress. n = 1429 MGDPSM completed 
the survey and 14 undertook an in-depth interview. Low mental well-being was 
reported by 49.6% of the survey participants. Low mental well-being was not 
predicted by relationship and living circumstance, sexual networking app use, or 
by casual sexual partners. Low mental well-being was associated with more 
frequent COVID-19 anxiety (OR = 5.08 CI: 3.74, 6.88 p < 0.001) and with younger 
age (18−24 years OR = 2.23 CI:1.41−3.53 p = 0.001, 25−34 years OR = 1.45 
CI:1.04−2.02 p = 0.029, 35−44 years OR = 1.41 CI:1.00−1.99 p = 0.052). The 
interview participants understood their lockdown experiences as being relative 
to normalcy, and those experiencing more dramatic changes faced greater 
challenges. Living with partners was felt to protect well-being. Many 
participants reported intimacy interruption challenges. The findings indicate 
that mental well-being is predicted by age and COVID-19 impact, highlighting 
opportunities for targeting MGDPSM who are most vulnerable to poor mental 
health. Services that support MGDPSM during COVID-19 recovery efforts must 
provide non-judgemental and affirming support.

DOI: 10.3390/ijerph19126985
PMCID: PMC9222884
PMID: 35742234 [Indexed for MEDLINE]

Conflict of interest statement: W.N. and P.S. are employed by The Love Tank 
Community Interest Company, as was T.C.W. previously. The Love Tank received no 
funding or donors with a financial interest in this study. Other authors declare 
no conflict of interest. The funders of The Love Tank had no role in the design 
of the study; in the collection, analyses, or interpretation of data; in the 
writing of the manuscript, or in the decision to publish the results.


1866. BMJ Open. 2022 Jun 23;12(6):e055804. doi: 10.1136/bmjopen-2021-055804.

Exploring the psychological impact of working during COVID-19 on medical and 
nursing students: a qualitative study.

Griffin L(1), Riley R(2).

Author information:
(1)College of Medical and Dental Sciences, University of Birmingham, Birmingham, 
UK LMG715@student.bham.ac.uk.
(2)School of Health Sciences, Faculty of Health and Medical Sciences, University 
of Surrey, Guilford, UK.

OBJECTIVES: To identify the psychological impact of working during the COVID-19 
pandemic on medical and nursing students' psychological well-being. To inform 
recommendations for the provision of future student well-being support.
DESIGN: An interpretative qualitative, semistructured interview study employing 
maximum variation sampling, snowball sampling and a thematic analysis.
SETTING: A large West Midlands (UK) university with medical and nursing 
undergraduate and postgraduate programmes. Study undertaken between January and 
May 2020.
PARTICIPANTS: A purposive sample of eight medical (six women and two men) and 
seven nursing (all women) students who worked >2 weeks in a healthcare setting 
during the COVID-19 pandemic (from 1 March 2020 onwards).
RESULTS: Four core themes with corresponding subthemes were identified: (1) 
COVID-19 sources of distress-working conditions, exposure to suffering, death 
and dying, relationships and teams, individual inexperience and student 
identity, (2) negative impact on mental health and well-being-psychological and 
emotional distress, delayed distress, exhaustion, mental ill health, (3) 
protective factors from distress-access to support, environment, preparation and 
induction, recognition and reward, time for breaks and rest and (4) positive 
experiences and meaningful outcomes.
CONCLUSIONS: Student pandemic deployment has had a significant negative impact 
on students' psychological well-being, as a result of demanding working 
conditions, unprecedented exposure to death and suffering and lack of 
preparation for new job roles. Universities and healthcare organisations must 
formally acknowledge this impact and provide well-being support for distressed 
students working in such challenging contexts. They must also establish more 
supportive and inclusive healthcare environments for medical and nursing 
students in future pandemic and postpandemic circumstances, through the 
implementation of support systems and adequate preparation.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-055804
PMCID: PMC9226460
PMID: 35738645 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


1867. Soc Sci Med. 2022 Aug;306:115157. doi: 10.1016/j.socscimed.2022.115157. Epub 
2022 Jun 18.

A post-lockdown study of burnout risk amongst New Zealand essential workers.

Haar J(1), O'Kane C(2).

Author information:
(1)Department of Management, Auckland University of Technology, Private Bag 
92006, Auckland, 1142, New Zealand. Electronic address: jarrod.haar@aut.ac.nz.
(2)Department of Management, Otago University, Otago, New Zealand. Electronic 
address: conor.okane@otago.ac.nz.

BACKGROUND AND RATIONALE: Job burnout is an essential topic for researchers and 
a pressing issue for employers and employees. However, the most popular tool has 
become widely critiqued, and a new measure of burnout - the Burnout Assessment 
Tool (BAT) - is used here. The BAT is helpful because it provides a cut-off 
threshold score representing high burnout risk. This study provides one of the 
first BAT studies post Covid-19 pandemic and focuses on comparing high burnout 
risk rates between essential and non-essential workers after the first lockdown 
in New Zealand (May 2020).
METHODS AND RESULTS: Using representative data from 955 employees across a wide 
range of occupations, sectors, and industries, we calculate an overall burnout 
risk of 11.1%, with essential workers higher (14%) than non-essential workers 
(9%). The odds ratios of burnout risk and having high levels of mental health 
complaints were 10-20 times higher for burnout risk workers. For essential 
workers, they were significantly higher for high job depression risk (35 times). 
Building on these results, to develop a deeper understanding of the factors 
contributing to burnout risk, we report on a qualitative analysis of comments 
(n = 213) provided by essential workers on their lockdown work experiences.
CONCLUSIONS: Findings provide evidence that while a range of (1) health-related 
concerns (i.e., increased risk of getting and spreading covid) and (2) employee- 
and employer-specific pressures related to challenging lockdown work practices 
contribute to essential worker burnout risk, an unwavering sense of pride and 
purpose in the value of their essential work serves to reduce this risk. We 
discuss the implications, highlighting the unique issues facing essential 
workers.

Copyright © 2022 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.socscimed.2022.115157
PMID: 35738197 [Indexed for MEDLINE]


1868. PLoS Med. 2022 Jun 23;19(6):e1004025. doi: 10.1371/journal.pmed.1004025. 
eCollection 2022 Jun.

Effects of a WHO-guided digital health intervention for depression in Syrian 
refugees in Lebanon: A randomized controlled trial.

Cuijpers P(1)(2), Heim E(3)(4), Abi Ramia J(1)(5), Burchert S(6), Carswell K(7), 
Cornelisz I(8), Knaevelsrud C(6), Noun P(3), van Klaveren C(8), Van't Hof E(7), 
Zoghbi E(9), van Ommeren M(7), El Chammay R(5)(10).

Author information:
(1)Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public 
Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands.
(2)Babeş-Bolyai University, International Institute for Psychotherapy, 
Cluj-Napoca, Romania.
(3)Department of Psychology, University of Lausanne, Lausanne, Switzerland.
(4)Institute of Psychology, University of Zurich, Zurich, Switzerland.
(5)National Mental Health Programme, Ministry of Public Health of Lebanon, 
Beirut, Lebanon.
(6)Department of Education and Psychology, Division of Clinical Psychological 
Intervention, Freie Universität Berlin, Berlin, Germany.
(7)Department of Mental Health and Substance Use, World Health Organization, 
Geneva, Switzerland.
(8)Department of Educational and Family Studies, Amsterdam Center for Learning 
Analytics, Vrije Universiteit Amsterdam, the Netherlands.
(9)Country Office for Lebanon, World Health Organization, Beirut, Lebanon.
(10)Psychiatry Department, Faculty of Medicine, Saint Joseph University, Beirut, 
Lebanon.

Erratum in
    PLoS Med. 2023 Apr 14;20(4):e1004231.

BACKGROUND: Most displaced people with mental disorders in low- and 
middle-income countries do not receive effective care, and their access to care 
has deteriorated during the Coronavirus Disease 2019 (COVID-19) pandemic. 
Digital mental health interventions are scalable when digital access is 
adequate, and they can be safely delivered during the COVID-19 pandemic. We 
examined whether a new WHO-guided digital mental health intervention, 
Step-by-Step, in which participants were supported by a nonspecialist helper, 
was effective in reducing depression among displaced people in Lebanon.
METHODS AND FINDINGS: We conducted a single-blind, 2-arm pragmatic randomized 
clinical trial, comparing guided Step-by-Step with enhanced care as usual (ECAU) 
among displaced Syrians suffering from depression and impaired functioning in 
Lebanon. Primary outcomes were depression (Patient Health Questionnaire, PHQ-9) 
and impaired functioning (WHO Disability Assessment Schedule-12, WHODAS) at 
posttreatment. Secondary outcomes included subjective well-being, anxiety, 
post-traumatic stress, and self-described problems. A total of 569 displaced 
people from Syria with depression (PHQ-9 ≥ 10) and impaired functioning (WHODAS 
> 16) were randomized to Step-by-Step (N = 283; lost to follow-up: N = 167) or 
ECAU (N = 286; lost to follow-up: 133). Participants were considered to be lost 
to follow-up when they did not fill in the outcome measures at posttest or 
follow-up. Recruitment started on December 9, 2019 and was completed on July 9, 
2020. The last follow-up assessments were collected in December 2020. The study 
team had access to the online platform, where they could see treatment arm 
assignment for each participant. All questionnaires were completed by 
participants online. Intention-to-treat (ITT) analyses showed intervention 
effects on depression (standardized mean differences [SMDs]: 0.48; 95% CI: 0.26; 
0.70; p < 0.001), impaired functioning (SMD: 0.35; 95% CI: 0.14; 0.56; p < 
0.001), post-traumatic stress (SMD: 0.36; 95% CI: 0.16; 0.56; p < 0.001), 
anxiety (SMD: 0.46; 95% CI: 0.24; 0.68; p < 0.001), subjective well-being (SMD: 
0.47; 95% CI: 0.26; 0.68; p < 0.001), and self-identified personal problems 
(SMD: 0.49; 95% CI 0.28; 0.70; p < 0.001). Significant effects on all outcomes 
were maintained at 3 months follow-up. During the trial, one serious adverse 
event occurred, unrelated to the intervention. The main limitation of the 
current trial is the high dropout rate.
CONCLUSIONS: In this study, we found that a guided, digital intervention was 
effective in reducing depression in displaced people in Lebanon. The guided WHO 
Step-by-Step intervention we examined should be made available to communities of 
displaced people that have digital access.
TRIAL REGISTRATION: ClinicalTrials.gov NCT03720769.

DOI: 10.1371/journal.pmed.1004025
PMCID: PMC9223343
PMID: 35737665 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


1869. Telemed J E Health. 2023 Jan;29(1):60-71. doi: 10.1089/tmj.2021.0485. Epub 2022 
Jun 23.

Americans' Awareness of Access Changes and Utilization of Telehealth During 
COVID-19: A Survey in the United States.

Cook J(1), Pittaoulis M(2), Alderfer J(3), Gilchrist K(4), Sapia M(2).

Author information:
(1)Viatris, New York, New York, USA.
(2)NERA Economic Consulting, Philadelphia, Pennsylvania, USA.
(3)Pfizer, Inc., Collegeville, Pennsylvania, USA.
(4)Viatris, Canonsburg, Pennsylvania, USA.

Background: We examine how and why Americans have experienced interrupted health 
care during the COVID-19 pandemic and measure awareness and usage of expanded 
benefits offered by health insurers and employers. We use an expanded concept of 
health literacy to include knowledge of access conditions and consider if 
patients' knowledge of the health system may relate to utilization of care. 
Methods: We conducted an online survey of 451 U.S. adults in September 2020, 
asking respondents about their health care experiences since March 1, 2020. This 
survey measured usage of medical care and awareness of the efforts made by 
government, private insurers, and employers to increase access to benefits such 
as telehealth services, well-being and mental health programs, and new 
prescription options. Results: The most common reasons cited for postponing or 
skipping medical appointments included fears over COVID-19 exposure, following 
local restrictions, or wanting to preserve resources for those with COVID-19. 
Our survey also finds that many Americans are largely unaware of whether they 
have access to expanded benefits implemented during the pandemic. Critically, 
respondents who recalled telehealth and prescription medication benefits being 
promoted were more likely to report using such benefits. Conclusion: This 
research suggests that greater attention to health literacy can help promote 
participation in the system by patients and has the potential to lead to 
improved health outcomes and greater adherence to treatment plans. Telehealth 
may offer patients increased opportunities to consult with their physicians for 
ailments that they might otherwise have delayed seeking care.

DOI: 10.1089/tmj.2021.0485
PMID: 35736782 [Indexed for MEDLINE]


1870. Acad Psychiatry. 2022 Dec;46(6):710-717. doi: 10.1007/s40596-022-01674-5. Epub 
2022 Jun 22.

The Impact of the COVID-19 Pandemic on Iranian Psychiatric Trainees' and Early 
Career Psychiatrists' Well-being, Work Conditions, and Education.

Eissazade N(1), Shalbafan M(2), Saeed F(3), Hemmati D(1), Askari S(1), Sayed 
Mirramazani M(4), Eftekhar Ardebili M(1), Gondek TM(5), Pinto da Costa M(6)(7).

Author information:
(1)Iran University of Medical Sciences, Tehran, Iran.
(2)Iran University of Medical Sciences, Tehran, Iran. Shalbafan.mr@iums.ac.ir.
(3)University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
(4)Isfahan University of Medical Sciences, Isfahan, Iran.
(5)Polish Psychiatric Association, Wroclaw, Poland.
(6)King's College London, London, UK. mariana.pintodacosta@gmail.com.
(7)University of Porto, Porto, Portugal. mariana.pintodacosta@gmail.com.

OBJECTIVES: This study was conducted to investigate the impact of the COVID-19 
pandemic on psychiatric trainees and early career psychiatrists in Iran.
METHODS: In this cross-sectional survey, the authors used a 24-item 
questionnaire inquiring about the sociodemographic characteristics of the 
participants, their views on the impact of the COVID-19 pandemic on their 
professional careers, methods of education, workplace environment, well-being 
and mental health, and the use of telepsychiatry in Iran.
RESULTS: A total of 159 responses were received. The majority (n=124, 78.0%) 
reported that "some but not all obligatory activities have been converted to 
online activities." Most of the participants (n=103, 64.8%) stated that the 
pandemic had not affected the duration of their training. Less than half (n=61, 
38.4%) reported that their well-being had been affected rather negatively. Some 
(n=59, 37.1%) reported that their supervisors or coworkers had no significant 
impact on their well-being, whereas others (n=53, 33.3%) reported a rather 
positive impact. Almost half of the participants (n=78, 49.0%) did not have 
access to free psychological counseling. In addition, more than half (n=89, 
56.0%) reported that there were no recommendations on how to proceed with 
telepsychiatry.
CONCLUSIONS: This study calls for improvements in the education and well-being 
of psychiatric trainees and early career psychiatrists in Iran amid the COVID-19 
pandemic. Additional research should be carried out to maximize learning, 
provide mental health care, and use telepsychiatry.

© 2022. The Author(s), under exclusive licence to American Association of Chairs 
of Departments of Psychiatry, American Association of Directors of Psychiatric 
Residency Training, Association for Academic Psychiatry and Association of 
Directors of Medical Student Education in Psychiatry.

DOI: 10.1007/s40596-022-01674-5
PMCID: PMC9217116
PMID: 35732923 [Indexed for MEDLINE]

Conflict of interest statement: On behalf of all authors, the corresponding 
author states that there is no conflict of interest.


1871. Ir J Med Sci. 2023 Jun;192(3):1293-1302. doi: 10.1007/s11845-022-03056-0. Epub 
2022 Jun 22.

Dublin hospital workers' mental health during the peak of Ireland's COVID-19 
pandemic.

Brady C(1), Fenton C(1), Loughran O(1), Hayes B(2), Hennessy M(3), Higgins A(4), 
McLoughlin DM(5).

Author information:
(1)Dept. of Psychiatry and Trinity College Institute of Neuroscience, Trinity 
College Dublin, St Patrick's University Hospital, Dublin 8, Ireland.
(2)Beaumont Hospital, Dublin 9, Royal College of Surgeons, Dublin 2, Ireland.
(3)WellcomeTrust/Health Research Board Clinical Research Facility, Trinity 
College Dublin, St James's Hospital, Dublin 8, Ireland.
(4)School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.
(5)Dept. of Psychiatry and Trinity College Institute of Neuroscience, Trinity 
College Dublin, St Patrick's University Hospital, Dublin 8, Ireland. 
d.mcloughlin@tcd.ie.

BACKGROUND: Hospital-based healthcare workers have experienced significant 
psychological stressors during the COVID-19 pandemic.
AIM: To evaluate the mental health of hospital workers during the third wave of 
the COVID-19 pandemic in Dublin, Ireland.
METHODS: Cross-sectional anonymous online survey of hospital workers (n = 377; 
181 doctors (48.0%), 166 nurses (44.0%), 30 radiographers (8.0%)), collecting 
demographic information, COVID-19 exposure history and mental health measures.
RESULTS: There were significant differences between profession groups in gender, 
experience, COVID-19 infection history, exposure to COVID-19 positive 
acquaintances, and work areas. Moderate-severe post-traumatic stress disorder 
(PTSD) symptoms were found in 45.1% (95% CI 40.1-50.1%) of all participants; 
significantly fewer doctors reported moderate-severe PTSD symptoms (26%; 95% CI 
22-36%). A World Health Organisation-5 Wellbeing Index (WHO-5) score ≤ 32, 
indicating low mood, was reported by 52% (95% CI 47-57%) of participants; 
significantly fewer doctors reported low mood (46%; 95% CI 39-53%). One-week 
suicidal ideation and planning were reported respectively by 13% (95% CI 10-16%) 
and 5% (95% CI 3-7%) of participants with no between-group differences. Doctors 
reported significantly less moral injury than other groups. There were no 
significant between-group differences regarding coping styles. Work ability was 
insufficient in 39% (95% CI 34-44%) of staff; no between-group differences.
CONCLUSIONS: Dublin hospital workers reported high levels of PTSD symptoms, mood 
disturbance, and moral injury during the COVID-19 pandemic. Concerning levels of 
suicidal ideation and planning existed in this cohort. Differences in degrees of 
post-traumatic stress, moral injury, and wellbeing were found between profession 
groups, which should be considered when planning any supports.

© 2022. The Author(s).

DOI: 10.1007/s11845-022-03056-0
PMCID: PMC9217120
PMID: 35732873 [Indexed for MEDLINE]

Conflict of interest statement: DMM has received speaker’s honoraria from MECTA 
and Otsuka and an honorarium from Janssen for participating in an esketamine 
advisory board meeting. The other authors report no conflicts of interest.


1872. Sci Rep. 2022 Jun 22;12(1):10580. doi: 10.1038/s41598-022-15004-0.

Longitudinal associations between going outdoors and mental health and wellbeing 
during a COVID-19 lockdown in the UK.

Stock S(1), Bu F(1), Fancourt D(1), Mak HW(2).

Author information:
(1)Department of Behavioral Science and Health, Institute of Epidemiology and 
Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, 
UK.
(2)Department of Behavioral Science and Health, Institute of Epidemiology and 
Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, 
UK. hei.mak@ucl.ac.uk.

The COVID-19 pandemic led to national lockdowns in countries around the world. 
Whilst lockdowns were shown to be effective in reducing the spread of disease, 
they were also associated with adverse effects on people's mental health and 
wellbeing. Previous studies have suggested that time spent outside may have 
played a role in mitigating these negative effects, but research on this topic 
remains limited. Therefore, this study was designed to explore the longitudinal 
associations between going outdoors and people's mental health and wellbeing 
during the first national lockdown (March-May 2020) in the UK. Data from 35,301 
participants from the COVID-19 Social Study were analysed. Fixed effects 
regression was used to explore the longitudinal association between changes in 
going outdoors (the number of days spent outside) and changes in depressive 
symptoms, anxiety symptoms, life satisfaction and loneliness. A range of 
household and neighbourhood moderators were examined. Results show that an 
increase in the number of days spent outside was associated with decreases in 
depressive and anxiety symptoms and an increase in life satisfaction. 
Associations were more salient amongst people living with others, and those with 
greater satisfaction with their neighbourhood walkability and green spaces. No 
longitudinal association was found with loneliness. Overall, our analyses showed 
a positive association between going outdoors and improved mental health and 
wellbeing during the first COVID-19 lockdown in the UK. These findings are 
important for formulating guidance for people to stay well at home during 
pandemics and for the on-going nature-based social prescribing scheme.

© 2022. The Author(s).

DOI: 10.1038/s41598-022-15004-0
PMCID: PMC9216298
PMID: 35732816 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1873. J Clin Child Adolesc Psychol. 2022 Jul-Aug;51(4):577-592. doi: 
10.1080/15374416.2022.2084744. Epub 2022 Jun 22.

Future Directions on BIPOC Youth Mental Health: The Importance of Cultural 
Rituals in the COVID-19 Pandemic.

Causadias JM(1), Alcalá L(2), Morris KS(1), Yaylaci FT(3), Zhang N(4).

Author information:
(1)School of Social and Family Dynamics, Arizona State University.
(2)Department of Psychology, California State University.
(3)Department of Psychology, Fatih Sultan Mehmet Vakıf University.
(4)Human Development and Family Sciences, University of Connecticut.

Culture plays an important role in the development of mental health, especially 
during childhood and adolescence. However, less is known about how participation 
in cultural rituals is related to the wellbeing of youth who are Black, 
Indigenous, and People of Color (BIPOC), and part of the Global Majority. This 
is crucial amid the COVID-19 pandemic, a global event that has disproportionally 
affected BIPOC youth and disrupted participation in rituals. The goal of this 
paper is to promote advances in clinical child and adolescent psychology focused 
on rituals. We begin by defining culture and rituals and examining their role on 
development. We illustrate these issues with the Lunar New Year in China, Maya 
rituals in México, Ramadan in Turkey, and Black graduations and Latinx funerals 
in the United States. We discuss how the pandemic has affected participation in 
these rituals and their potential impact on BIPOC children and adolescents' 
mental health. We propose future directions and recommendations for research.

DOI: 10.1080/15374416.2022.2084744
PMCID: PMC10036168
PMID: 35731555 [Indexed for MEDLINE]

Conflict of interest statement: We declare no conflict of interest.


1874. Matern Child Health J. 2022 Aug;26(8):1732-1740. doi: 
10.1007/s10995-022-03405-6. Epub 2022 Jun 22.

"Hey child, why were you born when the world is almost over?": An analysis of 
first-time mothers' postpartum experiences during the early stages of the 
COVID-19 pandemic in Coatepec, Veracruz, Mexico.

Wolfe-Sherrie EJ(1), Perroni-Marañón AG(2), Núñez-de la Mora A(2), Piperata 
BA(3).

Author information:
(1)Anthropology Department, The Ohio State University, Columbus, OH, USA. 
Wolfe-sherrie.1@osu.edu.
(2)Instituto de Investigaciones Psicológicas, Universidad Veracruzana, Xalapa, 
Veracruz, MX, Mexico.
(3)Anthropology Department, The Ohio State University, Columbus, OH, USA.

INTRODUCTION: In Coatepec, Mexico, the immediate postpartum is considered a 
special time, called the cuarentena, when postpartum women receive critical 
social support and observe diet and activity pre- and proscriptions-all intended 
to enhance maternal-child health. This study examined how public health mandates 
aimed at containing COVID-19, which instructed people to socially isolate, 
affected women's postpartum experiences, including observing the cuarentena.
METHODS: We recruited first-time mothers from the local public health clinic and 
collected qualitative data via a verbally administered survey that covered 
knowledge/perceived threat of COVID-19 and its effect on the cuarentena and 
maternal mood. We used content analysis to analyze the data.
RESULTS: We conducted 33 telephonic interviews from March to December 2020. 
Overall, women were knowledgeable about and receptive to public health messaging 
regarding COVID-19 risks and safety measures. Despite knowledge and receptivity, 
most followed their original cuarentena plans to observe culturally prescribed 
postpartum practices, even when doing so contradicted public health mandates. 
However, the mandates that limited socialization with friends and extended 
family during the cuarentena negatively affected maternal mood.
DISCUSSION: Postpartum women, especially in under-studied low- and middle-income 
countries, merit research attention. Emergent from this study is that public 
health messaging should speak to its target audience in a way that makes sense 
within local contexts, which includes consideration of highly valued health 
practices. Future studies aimed at understanding how to achieve this goal will 
facilitate development of stronger programs that address public health needs and 
protect individual well-being.

© 2022. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s10995-022-03405-6
PMCID: PMC9213642
PMID: 35731361 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


1875. Surg Endosc. 2023 Feb;37(2):1537-1542. doi: 10.1007/s00464-022-09377-6. Epub 
2022 Jun 22.

The impact of COVID-19 on medium term weight loss and comorbidities in patients 
undergoing bariatric surgery and its association with psychological wellbeing.

Talledo O(1), Carroll R(1), Worden E(1), Greenwood AM(1), Alexander H(1), 
Karlsdottir B(1), Lehmann R(1), Peoples R(1), Smith J(1), Thompson D(1), Zhang 
KA(1), Nau P(2).

Author information:
(1)Roy J. and Lucille A. Carver College of Medicine, MIS, Bariatric and GI 
Surgery, 200 Hawkins Drive 4634 JCP, Iowa City, IA, 52242-1086, USA.
(2)Roy J. and Lucille A. Carver College of Medicine, MIS, Bariatric and GI 
Surgery, 200 Hawkins Drive 4634 JCP, Iowa City, IA, 52242-1086, USA. 
peter-nau@uiowa.edu.

BACKGROUND: The COVID-19 epidemic imposed significant stressors on individuals 
and changed how medical care is delivered. The affect that this stress has 
placed on the field of bariatric surgery and the associated outcomes is not well 
established.
METHODS: A retrospective review of a prospectively collected database from a 
single academic institution was conducted. Weight loss and comorbidity outcomes 
were compared between a cohort of patients operated on during the pandemic and a 
matched group operated on prior to COVID-19. GAD-7 and PHQ-9 questionnaires were 
used to assess for anxiety and depression, respectively.
RESULTS: A total of 329 and 155 patients were enrolled in the pre-pandemic and 
COVID-19 groups respectively. There were no significant differences in 
pre-operative BMI (p = 0.437) or comorbidities: Type II DM (p = 0.810), 
hypertension (p = 0.879), sleep apnea (p = 0.502), and hyperlipidemia 
(p = 0.227). Post-operatively, weight loss was comparable at all time points out 
to 1 year. Type II DM resolution rates were higher in the control cohort at 
6 months (p = 0.007), but not at 12 months (p = 1.000). There was no 
statistically significant difference in resolution rates between the control 
group and the COVID-19 group for the other measured comorbidities. There was no 
difference in objective measures of anxiety and depression when comparing the 
two groups (both p > 0.05).
CONCLUSIONS: The COVID-19 pandemic has fundamentally changed how society and 
medical systems function. Focusing on pre-operative dietary training and 
screening for inadequately managed psychological comorbidities yielded similar 
weight loss outcomes notwithstanding the significant societal and individual 
stressors with which patients were faced.

© 2022. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s00464-022-09377-6
PMCID: PMC9215154
PMID: 35731301 [Indexed for MEDLINE]

Conflict of interest statement: Oscar Talledo, Rory Carroll, Erin Worden, Anna 
Marie Greenwood, Hart Alexander, Bergljot Karlsdottir, Ryan Lehmann, Rebecca 
Peoples, Jessica Smith, Dakota Thompson, Ke Anne Zhang and Peter Nau have no 
conflicts of interest or financial ties to disclose.


1876. Eur Rev Med Pharmacol Sci. 2022 Jun;26(11):4140-4147. doi: 
10.26355/eurrev_202206_28987.

Pharmacists' mental health during the SARS-CoV-2 pandemic in Italy.

Buomprisco G(1), Cedrone F, Vitali M, Protano C, Cammalleri V, Pocino RN, Perri 
R, Lapteva E, De Sio S.

Author information:
(1)R.U. of Occupational Medicine, "Sapienza" University of Rome, Rome, Italy. 
simone.desio@uniroma1.it.

OBJECTIVE: The year 2020 was characterized by the outbreak of a new pandemic 
caused by a novel coronavirus named SARS-CoV-2. To face the pandemic, many 
countries worldwide imposed general lockdowns, closing all non-essential 
businesses. As primary care services, pharmacies had to remain open, thus 
putting pharmacy staff at significant risk of viral infection and overwork. This 
study aimed to assess the mental health of Italian Pharmacists, considering 
demographic and occupational characteristics, lifestyle, and habits, during the 
SARS-CoV-2 outbreak and the subsequent lockdown period (March-May 2020).
MATERIALS AND METHODS: A web-based survey was created using Google® Forms to 
collect data from March 30, 2020, to June 1, 2020. The questionnaire consisted 
of three sections investigating: (1) demographic and occupational variables, (2) 
lifestyle and habits variables, (3) psychological distress and perceived 
well-being.
RESULTS: A total of 401 participants completed the questionnaire. Older workers 
and those with more work experience reported more psychological stress. Older 
and female workers, who felt lonely at home and reported psychological stress, 
perceived poor well-being.
CONCLUSIONS: Our findings demonstrate that the Sars-CoV-2 outbreak and 
subsequent lockdown rules affected pharmacists' mental health and that it is 
important to put in place preventive measures against the occurrence of mental 
disorders among them.

DOI: 10.26355/eurrev_202206_28987
PMID: 35731087 [Indexed for MEDLINE]


1877. J Pediatr Psychol. 2022 Sep 15;47(9):981-990. doi: 10.1093/jpepsy/jsac057.

Pandemic-Related Social Disruption and Well-Being in Pediatric Gastrointestinal 
Diseases.

Robbertz AS(1), Cohen LL(1), Armistead LP(1), Reed B(2).

Author information:
(1)Department of Psychology, Georgia State University, USA.
(2)Division of Gastroenterology, Hepatology, &amp; Nutrition, Emory University 
School of Medicine, USA.

Erratum in
    J Pediatr Psychol. 2024 Mar 07;:

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has impacted 
everyone, but there are few data regarding how the pandemic has influenced the 
lives of children with gastrointestinal (GI) conditions. This cross-sectional 
study assessed pandemic-related social disruption (PRSD) in children with 
inflammatory bowel disease (IBD), celiac disease (CD), and irritable bowel 
syndrome (IBS), and the potential buffering effect of the parent-child 
relationship.
METHODS: A survey completed between September and December 2020 asked 146 
children (ages 8-17) diagnosed with IBD (n = 44), CD (n = 81), or IBS (n = 51) 
and 185 parents how the pandemic has contributed to social disruption (i.e., 
financial stability, COVID-19 exposure, school changes, GI needs, and isolation) 
and their social-emotional well-being. Structural equation modeling was used to 
examine the role of social disruption on well-being, and the moderating effect 
of the parent-child relationship.
RESULTS: Increased social disruption predicted worse parent, β = 0.24, p = .02, 
and child well-being, β = 0.38, p &lt; .01. The parent-child relationship 
moderated the relationship between parent and child well-being, β = 0.21, 
p = .03. Strong parent-child relationships predicted a positive association 
between parent and child well-being, β = 0.23, p = .003, whereas medium, 
β = 0.09, p = .14, and poor, β = -0.06, p = .52, relationships did not.
CONCLUSIONS: PRSD negatively impacted the well-being of children with GI 
conditions, and the parent-child relationship moderated this relationship. These 
findings are relevant to pediatric psychologists treating the physical and 
mental health needs of children with GI conditions and their parents.

© The Author(s) 2022. Published by Oxford University Press on behalf of the 
Society of Pediatric Psychology. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/jpepsy/jsac057
PMCID: PMC9384296
PMID: 35730966 [Indexed for MEDLINE]


1878. BMC Psychol. 2022 Jun 21;10(1):158. doi: 10.1186/s40359-022-00867-9.

Factors influencing suicidal tendencies during COVID-19 pandemic in Korean 
multicultural adolescents: a cross-sectional study.

Park JY(1), Lee I(2).

Author information:
(1)College of Nursing, Konyang University, Deajeon City, Republic of Korea.
(2)Department of Nursing, Changwon National University, 20 Changwon Daehak-ro, 
Uichang-gu, Changwon, Gyeongnam, 51140, Republic of Korea. 
dobest75@changwon.ac.kr.

BACKGROUND: There is concern that the COVID-19 pandemic has had a negative 
impact on the psychological wellbeing of many populations, including increase of 
fear, anxiety, and uncertainty. Since the start of the COVID-19 pandemic, 
adolescents specifically have experienced direct and indirect impacts on their 
mentally, resulting in severe depression, self-harm and suicide. This study 
aimed to identify factors influencing suicidal tendencies and the mental health 
status of multicultural adolescents in Korea during the COVID-19 pandemic.
METHODS: This cross-sectional study was conducted with 784 multicultural 
adolescents (Korean fathers and foreign mothers) who participated in the 16th 
national Korean Youth Risk Behaviour online survey. Research variables were 
measured using self-reported questionnaires for mental health and suicidal 
tendencies. Data was analysed using SPSS 26.0 program.
RESULTS: The factors influencing suicidal tendencies (contemplating suicide, 
suicidal plans, and suicide attempts) were sexual intercourse experience 
(adjusted odds ratio [aOR], 7.67, 5.04, 7.10), depressive mood (aOR 1.03, 0.98, 
0.97, 0.90), and unhappiness (aOR 13.00, 7.28, 5.56).
CONCLUSIONS: In conclusion, the factors that affect suicidal tendencies showed 
sexual intercourse experience, depressive mood and unhappiness. Screening for 
suicidal tendencies and suicide prevention programs that consider the 
significant factors that affect suicidal tendencies should be developed for 
multicultural adolescents. School health professions and mental health 
counselors at schools need to emphasize the mental health and psychosocial 
support needs of senior high school students.

© 2022. The Author(s).

DOI: 10.1186/s40359-022-00867-9
PMCID: PMC9212200
PMID: 35729606 [Indexed for MEDLINE]

Conflict of interest statement: All authors declare that they have no all 
financial and non-financial competing interests concerning the research, 
authorship, and/or publication of this article.


1879. N Z Med J. 2022 Feb 25;135(1550):133-139.

Structural discrimination in the COVID-19 vaccination programme for people with 
mental health and addiction issues: now is the time to be equally well.

Every-Palmer S(1), Koning A(2), Smith L(3), Cunningham R(4), Lacey C(5), 
Peterson D(6), Jury A(7), Scott KM(8), Dowell T(9), Lockett H(10).

Author information:
(1)Head of Department, Department of Psychological Medicine, University of 
Otago, Wellington | Te Whare Wānanga o Otāgo ki Poneke, Wellington.
(2)Principal Advisor Addiction, Te Pou, Auckland.
(3)Consumer Advisor, Canterbury District Health Board | Te Poari Hauora ō 
Waitaha, Christchurch.
(4)Senior Research Fellow, Director EleMent Research Group, Department of Public 
Health, University of Otago, Wellington | Te Whare Wānanga o Otāgo ki Poneke, 
Wellington.
(5)Senior Lecturer, Māori Indigenous Health Institute (MIHI), University of 
Otago, Christchurch |Te Whare Wānanga o Otāgo ki Ōtautahi, Christchurch.
(6)Senior Research Fellow Department of Public Health, University of Otago, 
Wellington | Te Whare Wānanga o Otāgo ki Poneke, Wellington.
(7)Research Manager, Te Pou, Auckland.
(8)Head of Department, Department of Psychological Medicine, University of Otago 
| Te Whare Wānanga o Otāgo, Dunedin.
(9)Professor of Primary Health Care and General Practice, University of Otago, 
Wellington | Te Whare Wānanga o Otāgo ki Poneke, Wellington.
(10)Strategic Policy Advisor, the Wise Group, Hamilton; Honorary Senior Research 
Fellow, Department of Public Health, University of Otago, Wellington | Te Whare 
Wānanga o Otāgo ki Poneke, Wellington.

People with mental health and substance use issues (tāngata whai ora katoa), 
regardless of ethnicity, are much more likely to be hospitalised or die from 
COVID-19 and were identified as a priority population (Priority Group 3) in 
Aotearoa New Zealand's vaccination roll-out plan. Data released by the Ministry 
of Health show that, despite tāngata whai ora katoa being a priority group, 
their vaccination rates are well below those of the general population. These 
inequities are pronounced for Māori with mental health and addiction issues 
(tāngata whai ora Māori). This is not acceptable. To support tāngata whai ora 
physical health and wellbeing, the onus is on all of us in the health system to 
actively reach out, have conversations, be supportive and provide accessible 
vaccination for people with mental health and addiction issues. Urgent action is 
needed. Now is the time to ensure tāngata whai ora katoa can be equally well.

PMID: 35728158 [Indexed for MEDLINE]

Conflict of interest statement: The authors are part of Aotearoa Equally Well, 
an evidence-informed collaborative taking action across the health and 
health-related systems to achieve physical health equity for people who 
experience mental health and addiction issues.


1880. PLoS One. 2022 Jun 21;17(6):e0269237. doi: 10.1371/journal.pone.0269237. 
eCollection 2022.

Effects of changes in physical and sedentary behaviors on mental health and life 
satisfaction during the COVID-19 pandemic: Evidence from China.

Chen X(1), Gao H(2), Shu B(3), Zou Y(4).

Author information:
(1)The Jockey Club School of Public Health and Primary Care, The Chinese 
University of Hong Kong, Hong Kong, Hong Kong.
(2)Faculty of Humanities and Social Sciences, Beijing University of Technology, 
Chaoyang, China.
(3)Department of Sociology, Shenzhen University, Shenzhen, China.
(4)Institute of Sociology, Chinese Academy of Social Sciences, Beijing, China.

BACKGROUND: While restriction measures are critical in containing the COVID-19 
outbreak, limited studies have investigated the behavioral and psychological 
impact of these measures. This study aimed to investigate the effects of 
physical and sedentary behavioral changes and online behavior during the 
COVID-19 pandemic on mental health and life satisfaction among the Chinese 
population.
METHODS: The data were obtained from a cross-sectional survey of 2145 residents 
aged between 18 and 80 in Hubei province, China between March 23, 2020, and 
April 9, 2020.
RESULTS: Participants who had high frequencies of physical activities before or 
during the COVID-19 outbreak exhibited higher levels of life satisfaction. 
Participants who increased their sitting time during the pandemic or kept 
sitting for more than eight hours before and during the pandemic reported worse 
mental health than those who maintained less sedentary behavior. Besides, 
participants who used the Internet for information seeking, communication, and 
entertainment more frequently reported better mental health and life 
satisfaction. In contrast, there was a positive association between commercial 
use of the Internet and symptoms of mental disorders.
CONCLUSION: Given the link between physical and sedentary behavioral changes 
with worse mental wellbeing, strategies to reduce sedentariness and increase 
physical activity during the COVID-19 pandemic are needed.

DOI: 10.1371/journal.pone.0269237
PMCID: PMC9212146
PMID: 35727743 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


1881. Soc Sci Med. 2022 Aug;306:115105. doi: 10.1016/j.socscimed.2022.115105. Epub 
2022 Jun 2.

Racial and ethnic differences in perseverative cognition at the onset of the 
COVID-19 pandemic.

Williams DP(1), Jones NM(1), Holman EA(2).

Author information:
(1)Department of Psychological Science, University of California, Irvine, USA.
(2)Department of Psychological Science, University of California, Irvine, USA; 
Sue & Bill Gross School of Nursing, University of California, Irvine, USA. 
Electronic address: aholman@uci.edu.

RATIONALE: Coronavirus (COVID-19) disproportionately affects people of color 
(e.g., Black and Latinx individuals) in the U.S., increasing their morbidity and 
mortality relative to White people. Despite this greater threat to their 
well-being, the mental health impact of COVID-19 on people of color remains 
poorly understood. Perseverative cognition (PC; i.e., excessive worry and/or 
rumination), is a common psychological response to such threats that 
independently associates with poor mental and physical health.
OBJECTIVE: To examine patterns of PC across race/ethnicity when the COVID-19 
pandemic began.
METHODS: This study surveyed 6,514 respondents from the NORC AmeriSpeak panel, a 
probability-based representative national sample of U.S. adults between 
3/18/20-4/18/20. We employed traditional statistical analyses and natural 
language processing of open-ended data to examine pandemic-related worries.
RESULTS: Weighted regression analyses with relevant covariates revealed group 
differences across specific domains of COVID-related worry. Relative to White 
respondents, Hispanic/Latino respondents reported more worries about social 
disarray, meeting basic needs, experiencing economic impacts, obtaining 
healthcare, and contracting COVID-19. Black respondents reported more worry 
about economic impacts relative to Whites. Additional group differences in worry 
emerged in open-ended data: Black respondents perseverated about death from 
COVID-19, whereas Hispanic/Latino respondents reported concerns about COVID-19 
spread, and people refusing to uphold mitigation mandates. In contrast, White 
respondents expressed worry over compromised immune systems and economic 
collapse.
CONCLUSIONS: Results identify significant group differences in COVID-19 related 
PC, suggesting that people of color faced greater threat to mental well-being at 
the onset of the pandemic, and may be at greater risk for downstream PC-related 
physical health consequences.

Copyright © 2022 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.socscimed.2022.115105
PMCID: PMC9161684
PMID: 35724589 [Indexed for MEDLINE]


1882. J Psychiatr Res. 2022 Aug;152:152-159. doi: 10.1016/j.jpsychires.2022.06.017. 
Epub 2022 Jun 14.

A prospective study revealing a compounded burden of COVID-19, sex, and clinical 
diagnosis of alcohol use disorder and HIV infection on quality of life, anxiety, 
and alcohol use.

Lannoy S(1), Fama R(2), Sassoon SA(3), Le Berre AP(4), Asok P(3), Zahr NM(2), 
Pfefferbaum A(2), Sullivan EV(5).

Author information:
(1)Stanford University School of Medicine, Department of Psychiatry and 
Behavioral Sciences, Stanford, CA, 94305, USA; Virginia Commonwealth University 
School of Medicine, Department of Psychiatry, Virginia Institute for Psychiatric 
and Behavioral Genetics, Richmond, VA, 23298, USA.
(2)Stanford University School of Medicine, Department of Psychiatry and 
Behavioral Sciences, Stanford, CA, 94305, USA; SRI International, Menlo Park, 
CA, 94025, USA.
(3)SRI International, Menlo Park, CA, 94025, USA.
(4)Stanford University School of Medicine, Department of Psychiatry and 
Behavioral Sciences, Stanford, CA, 94305, USA.
(5)Stanford University School of Medicine, Department of Psychiatry and 
Behavioral Sciences, Stanford, CA, 94305, USA; SRI International, Menlo Park, 
CA, 94025, USA. Electronic address: edie@stanford.edu.

The COVID-19 pandemic led to unprecedented restrictions to mitigate disease 
spread, leading to consequences affecting mental health. Many studies examining 
COVID-19 pandemic effects on well-being and mental health initiated inquiry 
after the pandemic onset, whereas we used self-report questionnaires obtained 
before the pandemic to re-assess the same functions during the pandemic. 
Participants were drawn from our ongoing longitudinal studies of people with HIV 
infection, alcohol use disorder (AUD), HIV + AUD comorbidity, and controls. We 
used phone or mail contact to invite all to participate in our COVID phone 
survey, which included three self-report questionnaires: Health-related Quality 
of Life (QoL), State-Trait Anxiety Inventory (STAI), and Alcohol Use Disorder 
Identification Test (AUDIT). Of 218 eligible participants, 86 responded (July 
2020-March 2021): clinical (29 men, 23 women; 17 AUD, 21 HIV, 14 HIV + AUD); 
control (17 men, 17 women). QoL scores declined, and anxiety symptoms increased 
from pre-COVID surveys in all groups; clinical women reported greater negative 
changes than the other groups. QoL subscales revealed COVID-related declines in 
emotional well-being in all groups, with clinical women reporting additional 
declines in energy, physical and social functioning, health, and pain increase. 
Clinical men also reported health declines. Although AUDIT scores were stable in 
all groups between assessments, changes in AUDIT scores were inversely 
correlated with QoL scores in clinical women; in clinical men, changes in STAI 
scores were inversely correlated with QoL scores. Although all groups were 
adversely affected by the pandemic, the negative effects were greater in the 
clinical group regardless of diagnosis and greatest in clinical women.

Copyright © 2022 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.jpsychires.2022.06.017
PMCID: PMC9192099
PMID: 35724497 [Indexed for MEDLINE]

Conflict of interest statement: None.


1883. Sante Publique. 2022;33(6):979-989. doi: 10.3917/spub.216.0979.

COVID-19 et pratiques professionnelles dans les milieux institutionnels fermés.

[Article in French]

Dumais Michaud AA, Lemieux AJ, Dufour M, Plante L, Crocker AG.

INTRODUCTION: While governments have focused efforts on implementing health 
measures such as physical distancing and confinement to protect communities from 
the spread of COVID-19, some researchers focused on the significant impact of 
these measures on mental health and well-being. Persons with mental disorders 
who are both institutionalized and justice-involved in psychiatric and forensic 
hospitals find themselves more vulnerable to these measures and more limited in 
their movements and activities.
AIMS: The purpose of this paper is to examine the changes in practice in 
response to the pandemic and their potential impact on individuals in 
institutional settings.
RESULTS: A rapid review including 69 publications identified nine major themes 
in the literature, which will serve as a framework to analyze the experience of 
one forensic psychiatry institution in Canada. These themes are: 
1) population-specific vulnerability factors; 2) staff management and training; 
3) early discharge, parole, and community integration; 4) management of 
contagion in closed spaces; 5) sanitary measures and personal protective 
equipment; 6) care and service continuity; 7) use of technology to maintain 
social ties and services; 8) legal mechanisms and individual rights; and 
9) post-pandemic realities.
CONCLUSION: Although this is the first pandemic of such international magnitude, 
experts point to an increase in epidemics over the past decade and continued 
growth in the coming decades. It is thus essential to learn from this health 
crisis in order to be prepared and minimize their potential impact on vulnerable 
populations in the future. The reflections presented here could be contrasted 
with the lived-experiences of people in institutions in order to nuance the data 
and propose new strategies.

DOI: 10.3917/spub.216.0979
PMID: 35724202 [Indexed for MEDLINE]


1884. Sante Publique. 2022;33(6):905-909. doi: 10.3917/spub.216.0905.

L’impact de la COVID-19 sur la santé des enfants, groupe « protégé » de 
l’infection.

[Article in French]

Saurel-Cubizolles MJ, Aujard Y, Claudet I, Desbiolles A, Com-Ruelle L, Tilly AL, 
Vandewalle H, Lang T.

OBJECTIVE: This article underlines that a viral epidemic and strategies to deal 
with it 1) have a major impact on groups that are a priori spared by the disease 
itself, in this case children, and 2) can generate health problems beyond the 
disease and lead to major social, economic and educational difficulties and an 
increase of social inequalities in health.
METHOD: The observations presented are based on the scientific literature 
available in the first half of 2020 and on discussions with actors in the field, 
experts and heads of institutions, conducted by a working group of the Haut 
Conseil de la Santé Publique reflecting on a global and concerted policy for 
children's health.
RESULTS: The health crisis and its management have had an impact on children's 
development and their quality of life. They have been more exposed to sedentary 
lifestyles, screens, accidents, and violence at home. The closure of schools and 
leisure facilities has led to difficulties in school, socialization, 
psychological well-being and mental health. Curative or preventive care has been 
postponed. These effects occurred with significant social and territorial 
inequalities.
CONCLUSION: Any health crisis management requires an assessment of the overall 
impact of the epidemic and the proposed measures on health, economic, social, 
and educational indicators. This crisis shows the need for a coordinated 
children's policy, which is not currently the case in France.

DOI: 10.3917/spub.216.0905
PMID: 35724195 [Indexed for MEDLINE]


1885. Front Psychiatry. 2022 Jun 1;13:826277. doi: 10.3389/fpsyt.2022.826277. 
eCollection 2022.

The Evolution of Psychological and Behavioral Consequences of Self-Isolation 
During Lockdown: A Longitudinal Study Across United Kingdom and Italy.

Zaninotto F(1), Bossi F(2), Terry P(1), Riccaboni M(3), Galli G(1).

Author information:
(1)Department of Psychology, Kingston University, Kingston upon Thames, United 
Kingdom.
(2)MoMiLab, IMT School for Advanced Studies Lucca, Lucca, Italy.
(3)Axes, IMT School for Advanced Studies Lucca, Lucca, Italy.

INTRODUCTION: Several countries imposed nationwide or partial lockdowns to limit 
the spread of COVID-19 and avoid overwhelming hospitals and intensive care 
units. Lockdown may involve restriction of movement, stay-at-home orders and 
self-isolation, which may have dramatic consequences on mental health. Recent 
studies demonstrated that the negative impact of lockdown restrictions depends 
on a wide range of psychological and socio-demographic factors.
AIMS: This longitudinal study aimed to understand how internal factors such as 
personality and mindfulness traits, and external factors, such as daily habits 
and house features, affect anxiety, depression and general wellbeing indicators, 
as well as cognitive functions, during the course of a lockdown.
METHODS: To address these questions, 96 participants in Italy and the United 
Kingdom filled out a survey, once a week for 4 weeks, during the first-wave 
lockdowns. The survey included questions related to their habits and features of 
the house, as well as validated questionnaires to measure personality traits, 
mindful attitude and post-traumatic symptoms. Indicators of wellbeing were the 
affective state, anxiety, stress and psychopathological indices. We also 
measured the emotional impact of the pandemic on cognitive ability by using two 
online behavioral tasks [emotional Stroop task (EST) and visual search].
RESULTS: We found that internal factors influenced participants' wellbeing 
during the first week of the study, while external factors affected participants 
in the last weeks. In the first week, internal variables such as openness, 
conscientiousness and being non-judgmental toward one's own thoughts and 
emotions were positively associated with wellbeing; instead, neuroticism and the 
tendency to observe and describe one's own thoughts and emotions had detrimental 
effects on wellbeing. Toward the end of the study, external variables such as 
watching television and movies, browsing the internet, walking the dog, and 
having a balcony showed a protective value, while social networking and engaging 
in video calls predicted lower values of wellbeing. We did not find any effects 
of wellbeing on cognitive functioning.
CONCLUSION: Recognizing specific traits and habits affecting individuals' 
wellbeing (in both short and long terms) during social isolation is crucial to 
identify people at risk of developing psychological distress and help refine 
current guidelines to alleviate the psychological consequences of prolonged 
lockdowns.

Copyright © 2022 Zaninotto, Bossi, Terry, Riccaboni and Galli.

DOI: 10.3389/fpsyt.2022.826277
PMCID: PMC9198491
PMID: 35722571

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1886. Pan Afr Med J. 2022 Mar 17;41:224. doi: 10.11604/pamj.2022.41.224.33941. 
eCollection 2022.

Internet gaming disorder in an adolescent during the COVID-19 pandemic: a case 
report.

Rahmawati NA(1)(2), Setiawati Y(3), Ardani GAI(4), Zain E(5), Pereira-Sanchez 
V(6)(7)(8)(9).

Author information:
(1)Department of Psychiatry, Faculty of Medicine, Universitas Airlangga, 
Surabaya, Indonesia.
(2)Public Health Office, Kota Kediri, Jawa Timur, Indonesia.
(3)Division of Child and Adolescence, Department of Psychiatry, Faculty of 
Medicine, Universitas Airlangga, Surabaya, Indonesia.
(4)Division of Child and Adolescence, Department of Psychiatry, Faculty of 
Medicine, Universitas Udayana, Bali, Indonesia.
(5)Department of Psychiatry, Faculty of Medicine, Mulawarman University, 
Samarinda, Indonesia.
(6)Department of Psychiatry, Columbia University, New York, United States.
(7)Division of Translational Epidemiology, New York State Psychiatric Institute, 
New York, United States.
(8)Department of Child and Adolescent Psychiatry, NYU Grossman School of 
Medicine, New York, United States.
(9)Department of Psychiatry, Amoud University, Borama, Somaliland, Somalia.

The internet has become an indispensable tool in people´s daily lives during the 
COVID-19 pandemic. Internet and video game use are experiencing rapid growth in 
the youth and adult populations as a major source of entertainment. However, 
excessive gaming may cause addiction and negatively impact mental health, 
entailing low psychosocial well-being, poor social skills, and decreased 
academic achievement. We report the case of a 16-year-old student with a 
"typical" pattern of internet gaming disorder (IGD) developed during the 
pandemic, which improved after weeks of treatment with pharmacotherapy and 
psychosocial interventions. This case highlights that it is essential for the 
mental health professionals to know the psychopathology of IGD and multimodal 
approaches to treat it.

Copyright: Novi Agung Rahmawati et al.

DOI: 10.11604/pamj.2022.41.224.33941
PMCID: PMC9167486
PMID: 35721634 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1887. Int J Public Health. 2022 Jun 1;67:1604326. doi: 10.3389/ijph.2022.1604326. 
eCollection 2022.

Distress and Well-Being Among Psychiatric Patients in the Aftermath of the First 
COVID-19 Lockdown in Israel: A Longitudinal Study.

Grossman-Giron A(1)(2), Tzur Bitan D(1)(2), Mendlovic S(2), Shemesh S(2), Bloch 
Y(2).

Author information:
(1)Department of Behavioral Sciences, Ariel University, Ariel, Israel.
(2)Shalvata Mental Health Center, Hod HaSharon, Israel.

Objectives: Studies assessing the effect of the COVID-19 pandemic on psychiatric 
patients have mostly focused on cross-sectional evaluations of differences in 
levels of distress. In this study, we aimed to assess changes in distress and 
well-being following the COVID-19 pandemic outbreak as compared with 
pre-pandemic levels, as well as potential predictors of symptomatic 
deterioration, among psychiatric outpatients treated in a public mental health 
hospital in Israel. Methods: Patients evaluated for distress and well-being 
before the pandemic (n = 55) were re-evaluated at the end of the first lockdown 
in Israel. Results: Analyses revealed a significant decrease in the patients' 
sense of personal growth. Increases in distress were significantly associated 
with fear of COVID-19 beyond patient characteristics. Conclusion: These results 
suggest that the pandemic has a short-term effect on patients' well-being, and 
that fear of the pandemic is associated with elevations in distress.

Copyright © 2022 Grossman-Giron, Tzur Bitan, Mendlovic, Shemesh and Bloch.

DOI: 10.3389/ijph.2022.1604326
PMCID: PMC9198221
PMID: 35719737 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1888. Health Expect. 2022 Aug;25(4):1954-1966. doi: 10.1111/hex.13552. Epub 2022 Jun 
18.

Rapid development of a COVID-19 care planning decision-aid for family carers of 
people living with dementia.

West E(1), Nair P(2), Aker N(2), Sampson EL(1)(3), Moore K(1)(4), Manthorpe 
J(5)(6), Rait G(2), Walters K(2), Kupeli N(1), Davies N(1)(2).

Author information:
(1)Marie Curie Palliative Care Research Department, University College London, 
London, UK.
(2)Department of Primary Care and Population Health, Centre for Ageing 
Population Studies, Royal Free Campus, University College London, London, UK.
(3)Department of Psychological Medicine, Royal London Hospital, East London NHS 
Foundation Trust, London, UK.
(4)National Ageing Research Institute, Parkville, Victoria, Australia.
(5)NIHR Policy Research Unit in Health and Social Care Workforce, King's College 
London, Strand, London, UK.
(6)NIHR Applied Research Collaborative (ARC) South London, King's College 
London, Strand, London, UK.

INTRODUCTION: COVID-19 has disproportionately affected people living with 
dementia and their carers. Its effects on health and social care systems 
necessitated a rapid-response approach to care planning and decision-making in 
this population, with reflexivity and responsiveness to changing individual and 
system needs at its core. Considering this, a decision-aid to help families of 
persons with dementia was developed.
OBJECTIVES: To coproduce with people living with dementia, and the people who 
care for them, a decision-aid for family carers of people living with dementia, 
to support decisions during the COVID-19 pandemic and beyond.
METHODS: Semi-structured interviews were undertaken in 2020 with: (1) staff from 
two English national end-of-life and supportive care organizations; and (2) 
people living with dementia and family carers. Simultaneously, a rapid review of 
current evidence on making decisions with older people at the end of life was 
undertaken. Evidence from these inputs was combined to shape the decision-aid 
through a series of workshops with key stakeholders, including our patient and 
public involvement group, which consisted of a person living with dementia and 
family carers; a group of clinical and academic experts and a group of policy 
and charity leads.
RESULTS: The rapid review of existing evidence highlighted the need to consider 
both process and outcome elements of decision-making and their effects on people 
living with dementia and their families. The qualitative interviews discussed a 
wide range of topics, including trust, agency and confusion in making decisions 
in the context of COVID-19. The decision-aid primarily focussed on care moves, 
legal matters, carer wellbeing and help-seeking.
CONCLUSIONS: Combining different sources and forms of evidence was a robust and 
systematic process that proved efficient and valuable in creating a novel 
decision-aid for family carers within the context of COVID-19. The output from 
this process is an evidence-based practical decision-aid coproduced with people 
living with dementia, family carers, clinical and academic experts and leading 
national dementia and palliative care organizations.
PATIENT OR PUBLIC CONTRIBUTION: We worked with people living with dementia and 
family carers and other key stakeholders throughout this study, from study 
development and design to inclusion in stakeholder workshops and dissemination.

© 2022 The Authors. Health Expectations published by John Wiley & Sons Ltd.

DOI: 10.1111/hex.13552
PMCID: PMC9327830
PMID: 35716078 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1889. J Adolesc Health. 2022 Sep;71(3):270-276. doi: 10.1016/j.jadohealth.2022.05.020. 
Epub 2022 Jun 15.

Impact of the COVID-19 Pandemic on Korean Adolescents' Mental Health and 
Lifestyle Factors.

Lee J(1), Ko YH(1), Chi S(2), Lee MS(2), Yoon HK(3).

Author information:
(1)Department of Psychiatry, Korea University Ansan Hospital, Ansan, Republic of 
Korea.
(2)Department of Psychiatry, Korea University Guro Hospital, Guro, Republic of 
Korea.
(3)Department of Psychiatry, Korea University Ansan Hospital, Ansan, Republic of 
Korea. Electronic address: hkhkgogo@korea.ac.kr.

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has caused changes in 
the daily lives of Korean adolescents and affected their emotional well-being. 
This study compared lifestyle factors and the mental health status of 
adolescents before and during the COVID-19 pandemic.
METHODS: We conducted a secondary analysis using data from a national 
cross-sectional cohort (Korean Youth Risk Behavior Web-based Survey, KYRBS) 
collected in 2019 before the COVID-19 outbreak and in 2020 during the pandemic. 
This study included 57,303 students from the 2019 KYRBS and 54,948 from the 2020 
KYRBS. Lifestyle factors such as dietary habits, physical activity levels, time 
spent studying, duration of Internet use, and mental health status, including 
perceived stress, experience of depressive mood, and suicidal ideation and 
attempts, were included in the analyses.
RESULTS: The perceived stress levels, self-reported depressive mood, and 
suicidal thoughts and attempts were lower in the students surveyed in 2020 
during the COVID-19 pandemic than in the students surveyed in 2019 before the 
COVID-19 outbreak. The time spent studying and sleep duration decreased compared 
to before the pandemic, and sleep satisfaction increased during the COVID-19 
pandemic.
DISCUSSION: Our results showed an improvement in mental health status in Korean 
adolescents during the pandemic, but caution is needed when interpreting these 
results. Future research is needed to determine the effects of a long-lasting 
pandemic on mental health and lifestyle factors in adolescents.

Copyright © 2022 Society for Adolescent Health and Medicine. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jadohealth.2022.05.020
PMCID: PMC9197584
PMID: 35715347 [Indexed for MEDLINE]


1890. Stress. 2022 Jan;25(1):246-257. doi: 10.1080/10253890.2022.2082280.

The effect of COVID-19 lockdown on mental health, gut microbiota composition and 
serum cortisol levels.

Šik Novak K(1), Bogataj Jontez N(1), Kenig S(1), Hladnik M(2), Baruca Arbeiter 
A(2), Bandelj D(2), Černelič Bizjak M(1), Petelin A(1), Mohorko N(1), Jenko 
Pražnikar Z(1).

Author information:
(1)Faculty of Health Sciences, University of Primorska, Izola, Slovenia.
(2)Faculty of Mathematics, Natural Sciences and Information Technologies, 
University of Primorska, Koper, Slovenia.

The aim of this study was to assess changes in mental health, gut microbiota 
composition, and stress marker serum cortisol due to COVID-19 lockdown in 
asymptomatic individuals. Healthy adults participated in anthropometric 
measurements, blood and stool sample collection pre-lockdown and post-lockdown 
(n = 38, 63.2% females), lifestyle and psychological questionnaires were 
included in pre-lockdown measurement and lockdown survey (n = 46, 67.4% 
females). Subjects reported significantly higher body dissatisfaction 
(p = 0.007) and anxiety (p = 0.002), and significantly lower positive affect 
(p = 0.001) during lockdown compared with pre-lockdown. According to perceived 
stress, 51.6% of females and 20% of males experienced moderate to high stress. 
This was reflected in serum cortisol levels that significantly increased only in 
females (p = 0.006) post-lockdown and correlated with perceived stress 
(p = 0.037) and anxiety (p = 0.031). In addition to psychological measures, 
changes in gut microbiota composition were observed. Gut microbial alpha 
diversity significantly decreased (p = 0.033), whereas relative abundance of 
Proteobacteria significantly increased (p = 0.043) post-lockdown. Depression 
during lockdown was moderately positively correlated with changes in 
Bacteroidetes abundance (p = 0.015) and negatively with changes in Firmicutes 
abundance (p = 0.008). Alistipes abundance post-lockdown was moderately 
positively correlated with anxiety (p = 0.004) and negative affect (p = 0.005) 
during lockdown. Despite a small sample size and not being able to perform 
objective measurements during lockdown, the results confirm the effect of 
lockdown on mental health and gut microbiota composition that could have a great 
impact on our health (ClinicalTrials identifier: NCT04347213).

DOI: 10.1080/10253890.2022.2082280
PMID: 35713539 [Indexed for MEDLINE]


1891. Indian J Crit Care Med. 2022 Feb;26(2):174-178. doi: 
10.5005/jp-journals-10071-24119.

Mental Health Outcomes of Perceived Stress, Anxiety, Fear and Insomnia, and the 
Resilience among Frontline Nurses Caring for Critical COVID-19 Patients in 
Intensive Care Units.

Jose S(1), Cyriac MC(2), Dhandapani M(3), Mehra A(4), Sharma N(5).

Author information:
(1)Department of Community Medicine and School of Public Health, Postgraduate 
Institute of Medical Education and Research, Chandigarh, India.
(2)Bel-Air College of Nursing, Panchgani, Maharashtra, India.
(3)National Institute of Nursing Education, Postgraduate Institute of Medical 
Education and Research, Chandigarh, India.
(4)Department of Psychiatry, Postgraduate Institute of Medical Education and 
Research, Chandigarh, India.
(5)Department of Internal Medicine, Postgraduate Institute of Medical Education 
and Research, Chandigarh, India.

BACKGROUND: The coronavirus disease-2019 (COVID-19) pandemic has led to a 
significant disruption in healthcare delivery and poses a unique long-term 
stressor among frontline nurses. Hence, the investigators planned to explore the 
adverse mental health outcomes and the resilience of frontline nurses caring for 
COVID-19 patients admitted in intensive care units (ICUs).
MATERIALS AND METHODS: A cross-sectional online survey using Google form 
consisted of questionnaires on perceived stress scale (PSS-10), generalized 
anxiety disorder scale (GAD-7), Fear Scale for Healthcare Professionals 
regarding the COVID-19 pandemic, insomnia severity index, and the 
Connor-Davidson Resilience Scale-10 (CD-RISC) were administered among the nurses 
working in COVID ICUs of a tertiary care center in North India.
RESULTS: A considerable number of subjects in the study reported symptoms of 
distress (68.5%), anxiety (54.7%), fear (44%), and insomnia (31%). Resilience 
among the frontline nurses demonstrated a moderate to a high level with a mean 
percentage score of 77.5 (31.23 ± 4.68). A negative correlation was found 
between resilience and adverse mental outcomes; hence, resilience is a reliable 
tool to mitigate the adverse psychological consequences of the COVID-19 
pandemic.
CONCLUSION: Emphasizing the well-being of the nurses caring for critical 
COVID-19 patients during the pandemic is necessary to enable them to provide 
high-quality nursing care.
HOW TO CITE THIS ARTICLE: Jose S, Cyriac MC, Dhandapani M, Mehra A, Sharma N. 
Mental Health Outcomes of Perceived Stress, Anxiety, Fear and Insomnia, and the 
Resilience among Frontline Nurses Caring for Critical COVID-19 Patients in 
Intensive Care Units. Indian J Crit Care Med 2022;26(2):174-178.

Copyright © 2022; The Author(s).

DOI: 10.5005/jp-journals-10071-24119
PMCID: PMC8857709
PMID: 35712741

Conflict of interest statement: Source of support: Nil Conflict of interest: 
None


1892. J Gen Intern Med. 2022 Jul;37(9):2156-2164. doi: 10.1007/s11606-022-07497-2. 
Epub 2022 Jun 16.

Impact of the Early Phase of the COVID-19 Pandemic on Medical Student 
Well-Being: a Multisite Survey.

Alkureishi ML(1), Jaishankar D(2), Dave S(2), Tatineni S(2), Zhu M(3), Chretien 
KC(4), Woodruff JN(3), Pincavage A(3), Lee WW(5)(6); Medical Student Well-being 
Being Research Consortium.

Author information:
(1)Section of Academic Pediatrics, University of Chicago Medical Center, 
Chicago, IL, USA.
(2)Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
(3)Section of General Internal Medicine, University of Chicago Medical Center, 
Chicago, IL, USA.
(4)Division of Hospital Medicine, Department of Medicine, The Johns Hopkins 
University School of Medicine, Baltimore, USA.
(5)Section of General Internal Medicine, University of Chicago Medical Center, 
Chicago, IL, USA. wlee6@uchicago.edu.
(6)Department of Medicine, University of Chicago, 5841 S. Maryland Avenue MC 
3051, Chicago, IL, 60637, USA. wlee6@uchicago.edu.

BACKGROUND: The COVID-19 pandemic drastically impacted medical student 
experiences. Little is known about the impact of the pandemic on student 
well-being and protective factors for burnout.
OBJECTIVE: Assess US medical student burnout, stress, and loneliness during the 
initial phase of the pandemic, compare results to pre-pandemic data, and 
identify risk factors for distress and protective factors to inform support 
interventions.
DESIGN: Cross-sectional survey of medical students conducted between May and 
July 2020.
PARTICIPANTS: 3826 students from 22 medical schools.
MAIN MEASURES: Burnout (MBI-HSS), stress (PSS-10), loneliness (UCLA scale), and 
student experiences. Compared burnout and stress to pre-pandemic studies 
(2010-2020).
KEY RESULTS: Of 12,389 students, 3826 responded (31%). Compared to pre-pandemic 
studies, burnout was lower (50% vs. 52%, P = 0.03) while mean stress was higher 
(18.9 vs. 16.0, P < 0.001). Half (1609/3247) reported high (≥ 6/9) loneliness 
scores. Significant differences were found in burnout and stress by class year 
(P = 0.002 and P < 0.001) and race (P = 0.004 and P < 0.001), with the highest 
levels in second- and third-year students and Black, Asian, or other racial 
minority students. Students experiencing financial strain or racism had higher 
burnout and stress (P < 0.001 for all). Respondents with COVID-19 diagnoses in 
themselves or family members had higher stress (P < 0.001). Nearly half 
(1756/3569) volunteered during the pandemic, with volunteers reporting lower 
burnout [48% (782/1639) vs. 52% (853/1656), P = 0.03].
CONCLUSIONS: While stress was higher compared to pre-pandemic data, burnout was 
significantly lower. Higher burnout and stress among Black, Asian, and other 
racial minority students and those who experienced financial strain, racism, or 
COVID-19 diagnoses likely reflect underlying racial and socioeconomic 
inequalities exacerbated by the pandemic and concurrent national racial 
injustice events. Volunteer engagement may be protective against burnout. 
Schools should proactively support vulnerable students during periods of stress.

© 2022. The Author(s) under exclusive licence to Society of General Internal 
Medicine.

DOI: 10.1007/s11606-022-07497-2
PMCID: PMC9202979
PMID: 35710675 [Indexed for MEDLINE]

Conflict of interest statement: Authors have no conflict of interests to 
disclose.


1893. BMC Med Educ. 2022 Jun 16;22(1):463. doi: 10.1186/s12909-022-03517-1.

Predicting nursing students' psychological well-being: network analysis based on 
a model of thriving through relationships.

Zhou L(1)(2), Sukpasjaroen K(1), Wu Y(3), Wang L(2), Chankoson T(1)(4), Cai 
E(5).

Author information:
(1)Chakrabongse Bhuvanarth International Institute for Interdisciplinary 
Studies, Rajamangala University of Technology Tawan-OK, Chonburi, Bangkok, 
Thailand.
(2)School of Nursing, Yunnan University of Chinese Medicine, Kunming, Yunnan, 
China.
(3)School of Medicine, Yunnan University of Chinese Medicine, Kunming, Yunnan, 
China.
(4)Faculty of Business Administration for Society, Srinakharinwirot University, 
Bangkok, Thailand.
(5)School of Nursing, Yunnan University of Chinese Medicine, Kunming, Yunnan, 
China. caienliycm@sina.cn.

BACKGROUND: Psychological well-being plays a vital role in nursing students' 
mental health and affects their decisions to stay in the nursing profession, 
particularly during the COVID-19 outbreak. Close relationships are undeniably 
linked to psychological well-being, but it is unknown how the specific pathways 
through which close relationships are related to each other and which are most 
strongly linked to nursing students' psychological well-being.
AIMS: To explore the network structure, central and bridge factors among 
well-being characteristics, and predictors based on a model of thriving through 
relationships.
METHODS: A cross-sectional research design was used with a sample of 
undergraduate nursing students (531 participants from the Southwest part of 
China). We used a network model to analyze the network structure of perceived 
social support, mindfulness, self-integrity, self-compassion, professional 
self-concept, savoring, intentional self-regulation, non-relational 
self-expansion, relational self-expansion, attachment insecurity, and 
psychological well-being.
RESULTS:  A highly interconnected network of psychological well-being featured 
predictors and traits were formed. Node 8 (self-kindness), node 9 
(self-judgment), and node 23 (non-relational self-expansion) were the predictors 
with the highest centrality in the network. Perceived social support and 
professional self-concept were most central in linking predictors to 
psychological well-being traits. Attachment insecurity was a non-supportive 
factor for predicting psychological well-being among female nursing students.
CONCLUSIONS: Interventions based on these supportive/non-supportive predictors, 
which operate on different psychological levels, hold promise to achieve 
positive effects on psychological well-being among nursing students.

© 2022. The Author(s).

DOI: 10.1186/s12909-022-03517-1
PMCID: PMC9202322
PMID: 35710399 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1894. BMC Pregnancy Childbirth. 2022 Jun 16;22(1):493. doi: 
10.1186/s12884-022-04802-z.

Pregnant at the start of the pandemic: a content analysis of COVID-19-related 
posts on online pregnancy discussion boards.

Choi R(1), Nagappan A(1), Kopyto D(1), Wexler A(2).

Author information:
(1)Department of Medical Ethics and Health Policy, University of Pennsylvania, 
Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA.
(2)Department of Medical Ethics and Health Policy, University of Pennsylvania, 
Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA. 
awex@pennmedicine.upenn.edu.

BACKGROUND: A growing body of evidence indicates that the COVID-19 pandemic has 
had detrimental mental health effects for pregnant women. However, little is 
known about the specific stressors that increased anxiety for pregnant women at 
the start of the pandemic. The present study aimed to better understand the 
concerns of pregnant women during the beginning COVID-19 pandemic by analyzing 
content posted during the month of March 2020 on online pregnancy message boards 
hosted on WhatToExpect.com.
METHODS: All posts published between March 1-31, 2020 on nine different due-date 
specific WhatToExpect.com message boards were reviewed for COVID-19 relevance. 
Posts mentioning COVID-19 or its direct effects (e.g., "quarantine" or 
"stay-at-home order") were included in our final sample. Data were coded by 
three authors according to a codebook developed inductively by all four authors. 
Posts were analyzed by overall frequency of appearance, by trimester, and 
temporally across the month of March 2020.
RESULTS: Across the 5,541 posts included in our final sample, the most common 
topics were fear of COVID-19 exposure, concerns with labor and delivery, 
navigating social interactions, and disruptions to prenatal care. The most 
dominant topics by trimester were disruptions to prenatal care (first 
trimester), fear of COVID-19 exposure (second trimester), and concerns about 
labor and delivery (third trimester).
CONCLUSION: Our findings add to prior literature by demonstrating the salience 
of social concerns, which was the third largest COVID-19 topic in our sample. 
Emotional distress was most salient with regard to restrictions on birthing 
partners, but was apparent in everything from disruptions to pregnancy 
announcements, to cancelled baby showers, and limitations on newborn visitors. 
Given that anxiety during pregnancy is associated with worse maternal-fetal 
health outcomes, in the early stages of future pandemics healthcare providers 
should focus not only on strictly health-related concerns expressed by pregnant 
women, but also more broadly on other sources of anxiety that may be impacting 
the well-being and mental health of their patients.

© 2022. The Author(s).

DOI: 10.1186/s12884-022-04802-z
PMCID: PMC9201795
PMID: 35710387 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1895. Acta Paediatr. 2022 Sep;111(9):1771-1778. doi: 10.1111/apa.16455. Epub 2022 Jun 
26.

COVID-19 restrictions and psychological well-being of fathers with infants 
admitted to NICU-An exploratory cross-sectional study.

Adama EA(1), Koliouli F(2), Provenzi L(3)(4), Feeley N(5), van Teijlingen E(6), 
Ireland J(7), Thomson-Salo F(8), Khashu M(9); FINESSE Group.

Author information:
(1)School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western 
Australia, Australia.
(2)Laboratory of Qualitative Research in Psychology and Mental Health, 
Department of Psychology, School of Philosophy, National and Kapodistrian 
University of Athens, Athens, Greece.
(3)Department of Brain and Behavioral Sciences, University of Pavia, Pavia, 
Italy.
(4)Developmental Psychobiology Research Center, IRCCS Mondino Foundation, Pavia, 
Italy.
(5)Ingram School of Nursing, and Centre for Nursing Research, & Lady Davis 
Institute for Medical Research, Jewish General Hospital, McGill University, 
Montreal, Quebec, Canada.
(6)Bournemouth University, Poole, UK.
(7)University Hospitals Dorset NHS Foundation Trust, Poole, UK.
(8)Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
(9)University Hospitals Dorset and Bournemouth University, Poole, UK.

AIM: To describe the impact of the COVID-19 restrictions on the caregiving 
activities and psychological well-being of fathers with infants admitted to 
neonatal units.
METHODS: Cross-sectional study using adapted COPE-IS and COPE-IU tools. 
Participants' recruitment occurred online via social media and parents' 
associations. Online survey in English, French and Italian were distributed and 
promoted via websites and social media platforms of parent's associations. The 
study was undertaken across 12 countries in Asia, Australia, Africa and Europe.
RESULTS: A total of 108 fathers of NICU infants completed the survey. COVID-19 
related restrictions were categorised into 3 types: no restrictions, partial and 
severe restrictions. Fathers who experienced partial restrictions reported more 
involvement in caregiving activities but high levels of emotional difficulties 
and sleeping problems compared to those who experienced full or no restrictions.
CONCLUSION: Given the impact on the psychological well-being of fathers, 
restrictions should be avoided as much as possible in the neonatal unit and 
fathers given free access to their infants if they follow appropriate infection 
control precautions.

© 2022 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on 
behalf of Foundation Acta Paediatrica.

DOI: 10.1111/apa.16455
PMCID: PMC9349861
PMID: 35708125 [Indexed for MEDLINE]

Conflict of interest statement: No conflict of interest has been declared by all 
the authors.


1896. Curr Sports Med Rep. 2022 Jun 1;21(6):196-204. doi: 
10.1249/JSR.0000000000000966.

Impact of COVID on Sports Injury Patterns, Changes in Mental Well-Being, and 
Strategies to Prepare for Future Pandemics in Sport.

Vincent HK(1), Patel S, Zaremski JL.

Author information:
(1)Department of Physical Medicine and Rehabilitation, College of Medicine, 
University of Florida, Gainesville, FL.

This review describes the available evidence of the acute respiratory syndrome 
coronavirus 2 (SARS-CoV-2, referred to COVID-19) pandemic on musculoskeletal 
injury patterns and prevalence in athletes. A brief overview of the epidemiology 
of COVID-19 and prevalence in active populations from youth through professional 
are provided. Responses to COVID-19 regarding sport participation at regional, 
national, and international organizations are summarized. Downstream effects of 
complete or partial training shutdown on injury risk and mental health are 
discussed. Strategies to maintain athletic potential and overall well-being 
include maintaining safe access to training facilities and resources, 
implementation of injury prevention programs, organization of athlete support 
networks, and incorporation of resilience and coping training.

Copyright © 2022 by the American College of Sports Medicine.

DOI: 10.1249/JSR.0000000000000966
PMID: 35703746 [Indexed for MEDLINE]


1897. Epidemiol Psychiatr Sci. 2022 Jun 15;31:e43. doi: 10.1017/S2045796022000270.

The effect of the COVID-19 lockdown on mental health care use in South Africa: 
an interrupted time-series analysis.

Wettstein A(1)(2), Tlali M(3), Joska JA(4), Cornell M(3), Skrivankova VW(1), 
Seedat S(5), Mouton JP(3)(6), van den Heuvel LL(5), Maxwell N(3), Davies MA(3), 
Maartens G(6), Egger M(1)(3)(7), Haas AD(1).

Author information:
(1)Institute of Social and Preventive Medicine, University of Bern, Bern, 
Switzerland.
(2)Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
(3)Centre for Infectious Disease Epidemiology and Research, School of Public 
Health & Family Medicine, University of Cape Town, Cape Town, South Africa.
(4)HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, 
Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
(5)South African Medical Research Council / Stellenbosch University Genomics of 
Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, 
Stellenbosch University, Cape Town, South Africa.
(6)Division of Clinical Pharmacology, Department of Medicine, University of Cape 
Town, Cape Town, South Africa.
(7)Population Health Sciences, Bristol Medical School, University of Bristol, 
Bristol, UK.

AIMS: The coronavirus disease 2019 (COVID-19) pandemic and ensuing restrictions 
have negatively affected the mental health and well-being of the general 
population, and there is increasing evidence suggesting that lockdowns have led 
to a disruption of health services. In March 2020, South Africa introduced a 
lockdown in response to the COVID-19 pandemic, entailing the suspension of all 
non-essential activities and a complete ban of tobacco and alcohol sales. We 
studied the effect of the lockdown on mental health care utilisation rates in 
private-sector care in South Africa.
METHODS: We conducted an interrupted time-series analysis using insurance claims 
from 1 January 2017 to 1 June 2020 of beneficiaries 18 years or older from a 
large private sector medical insurance scheme. We calculated weekly outpatient 
consultation and hospital admission rates for organic mental disorders, 
substance use disorders, serious mental disorders, depression, anxiety, other 
mental disorders, any mental disorder and alcohol withdrawal syndrome. We 
calculated adjusted odds ratios (OR) for the effect of the lockdown on weekly 
outpatient consultation and hospital admission rates and the weekly change in 
rates during the lockdown until 1 June 2020.
RESULTS: 710 367 persons were followed up for a median of 153 weeks. Hospital 
admission rates (OR 0.38; 95% confidence interval (CI) 0.33-0.44) and outpatient 
consultation rates (OR 0.74; 95% CI 0.63-0.87) for any mental disorder decreased 
substantially after the introduction of the lockdown and did not recover to 
pre-lockdown levels by 1 June 2020. Health care utilisation rates for alcohol 
withdrawal syndrome doubled after the introduction of the lockdown, but the 
statistical uncertainty around the estimates was large (OR 2.24; 95% CI 
0.69-7.24).
CONCLUSIONS: Mental health care utilisation rates for inpatient and outpatient 
services decreased substantially after the introduction of the lockdown. 
Hospital admissions and outpatient consultations for alcohol withdrawal syndrome 
increased after the introduction of the lockdown, but statistical uncertainty 
precludes strong conclusions about a potential unintended effect of the alcohol 
sales ban. Governments should integrate strategies for ensuring access and 
continuity of essential mental health services during lockdowns in pandemic 
preparedness planning.

DOI: 10.1017/S2045796022000270
PMCID: PMC9245492
PMID: 35703078 [Indexed for MEDLINE]

Conflict of interest statement: None.


1898. BMC Health Serv Res. 2022 Jun 14;22(1):780. doi: 10.1186/s12913-022-08131-x.

Providers' perspectives on implementing resilience coaching for healthcare 
workers during the COVID-19 pandemic.

Rosen B(1)(2), Preisman M(3)(4), Read H(5)(6), Chaukos D(3)(4), Greenberg 
RA(3)(7), Jeffs L(3)(8), Maunder R(3)(4), Wiesenfeld L(3)(4).

Author information:
(1)Sinai Health, Toronto, Canada. benjamin.rosen@sinaihealth.ca.
(2)Department of Psychiatry, University of Toronto, Toronto, Canada. 
benjamin.rosen@sinaihealth.ca.
(3)Sinai Health, Toronto, Canada.
(4)Department of Psychiatry, University of Toronto, Toronto, Canada.
(5)Sinai Health, Toronto, Canada. Heather.read@sinaihealth.ca.
(6)Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada. 
Heather.read@sinaihealth.ca.
(7)Department of Paediatrics, University of Toronto, Toronto, Canada.
(8)Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada.

BACKGROUND: The COVID-19 pandemic severely exacerbated workplace stress for 
healthcare workers (HCWs) worldwide. The pandemic also magnified the need for 
mechanisms to support the psychological wellbeing of HCWs. This study is a 
qualitative inquiry into the implementation of a HCW support program called 
Resilience Coaching at a general hospital. Resilience Coaching was delivered by 
an interdisciplinary team, including: psychiatrists, mental health nurses allied 
health and a senior bioethicist. The study focuses specifically on the 
experiences of those who provided the intervention.
METHODS: Resilience Coaching was implemented at, an academic hospital in 
Toronto, Canada in April 2020 and is ongoing. As part of a larger qualitative 
evaluation, 13 Resilience Coaches were interviewed about their experiences 
providing psychosocial support to colleagues. Interviews were recorded, 
transcribed, and analyzed for themes by the research team. Interviews were 
conducted between February and June 2021.
RESULTS: Coaches were motivated by opportunities to support colleagues and 
contribute to the overall health system response to COVID-19. Challenges 
included finding time within busy work schedules, balancing role tensions and 
working while experiencing burnout.
CONCLUSIONS: Hospital-based mental health professionals are well-positioned to 
support colleagues' wellness during acute crises and can find this work 
meaningful, but note important challenges to the role. Paired-coaches and peer 
support among the coaching group may mitigate some of these challenges. 
Perspectives from those providing support to HCWs are an important consideration 
in developing support programs that leverage internal teams.

© 2022. The Author(s).

DOI: 10.1186/s12913-022-08131-x
PMCID: PMC9194890
PMID: 35701756 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1899. Respir Care. 2022 Oct;67(10):1236-1245. doi: 10.4187/respcare.10081. Epub 2022 
Jun 14.

Factors Associated With a Positive View of Respiratory Care Leadership.

Burr KL(1), Hinkson CR(2), Smith BJ(3), Roberts KJ(4), Strickland SL(5), Hoerr 
CA(6), Rehder KJ(7), Miller AG(8).

Author information:
(1)Respiratory Care Services, Nemours Children's Health, Wilmington, Delaware. 
Katlyn.burr@nemours.org.
(2)Respiratory Care, Providence Regional Medical Center, Everett, Washington.
(3)Respiratory Care, University of California, Davis, Davis, California.
(4)Respiratory Care, Hospital of the University of Pennsylvania, Philadelphia, 
Pennsylvania.
(5)Health Sciences, Rush University, Chicago, Illinois; and American Epilepsy 
Society, Chicago, Illinois.
(6)Respiratory Care, Phelps Health, Rolla, Missouri.
(7)Division of Pediatric Critical Care Medicine, Duke University Medical Center, 
Durham, North Carolina.
(8)Division of Pediatric Critical Care Medicine and Respiratory Care Services, 
Duke University Medical Center, Durham, North Carolina.

Comment in
    Respir Care. 2022 Oct;67(10):1366-1367.

BACKGROUND: Burnout within health care is prevalent, and its effects are 
detrimental to patient outcomes, organizations, and individuals. Effects 
stemming from burnout include anxiety, depression, excessive alcohol and drug 
use, cardiovascular problems, time off work, and worse patient outcomes. 
Published data have suggested up to 50% of health care workers experience 
burnout and 79% of respiratory therapists (RTs) experience burnout. Leadership 
has been cited as a key driver of burnout among RTs. We aimed to identify 
factors associated with a positive or negative leadership perception.
METHODS: A post hoc analysis of an institutional review board-approved survey to 
evaluate RT burnout, administered via REDCap by convenience sample to 26 health 
care centers (3,124 potential respondents) from January 17-March 15, 2021, was 
performed to identify factors associated with a positive view of leadership. 
Survey questions included validated tools to measure leadership, burnout, 
staffing, COVID-19 exposure, and demographics. Data analysis was descriptive, 
and logistic regression was performed to evaluate factors associated with 
leadership perception.
RESULTS: Of 1,080 respondents, 710 (66%) had a positive view of leadership. 
Univariate analysis revealed those with a positive view of leadership were more 
likely to be working with adequate staffing, were rarely unable to complete all 
work, were less likely to be burned out, disagreed that people in this work 
environment were burned out, were less likely to miss work for any reason, more 
likely to be in a leadership position, worked fewer hours in intensive care, 
worked in a center affiliated with a medical school, worked day shift, were less 
likely to care for adult patients, and were more likely to be male. Logistic 
regression revealed providing care to patients with COVID-19 (odds ratio [OR] 
5.8-10.5, P < .001-.006) was the only factor associated with a positive view of 
leadership, whereas working without adequate staffing (OR 0.27-0.28, P = 
.002-.006), staff RTs (OR 0.33, P < .001), work environment (OR 0.42, P = .003), 
missing work for any reason (OR 0.69, P = .003), and burnout score (OR 0.98, P < 
.001) were associated with a negative view of leadership.
CONCLUSIONS: Most RTs had a positive view of their leadership. A negative 
leadership score was associated with higher burnout and missing work. This 
relationship requires further investigation to evaluate if changes in leadership 
practices can improve employee well-being and reduce burnout.

Copyright © 2022 by Daedalus Enterprises.

DOI: 10.4187/respcare.10081
PMID: 35701175 [Indexed for MEDLINE]

Conflict of interest statement: Ms Burr discloses a relationship with Hill-Rom. 
Ms Hoerr and Mr Hinkson disclose a relationship with the American Association of 
Respiratory Care. Mr Miller is Section Editor for Respiratory Care and discloses 
a relationship with Saxe Communications. The remaining authors have disclosed no 
conflicts of interest.


1900. Econ Hum Biol. 2022 Aug;46:101152. doi: 10.1016/j.ehb.2022.101152. Epub 2022 Jun 
7.

Visiting parents in times of COVID-19: The impact of parent-adult child contacts 
on the psychological health of the elderly.

Brugiavini A(1), Di Novi C(2), Orso CE(3).

Author information:
(1)Department of Economics, Ca' Foscari University of Venice, Italy.
(2)European Commission, Joint Research Centre (JRC), Ispra, Italy. Electronic 
address: Cinzia.DI-NOVI@ec.europa.eu.
(3)Department of Law, Economics, and Cultures, Insubria University, Como, Italy.

Using the 8th wave of the SHARE and the SHARE Corona Survey, we investigated 
whether the disruption of parent-adult child contacts due to social distancing 
restrictions increased the symptoms of depression among old age individuals 
during the first wave of the COVID-19 pandemic. We model the relationship 
between the disruption of parent-adult child contacts and the mental health of 
the elderly using a recursive simultaneous equation model for binary variables. 
Our findings show that the likelihood of disruption of parent-adult child 
contacts was higher with adult children who do not live with or close to their 
parents (i.e., in the same household or in the same building) for whom contact 
disruption increases about 15 %. The duration of restrictions to movement and 
lockdowns also has a positive and significant effect on parent-child contact 
disruption: an additional week of lockdown significantly increases the 
probability of parent-child contact disruption, by about 1.5 %. The 
interventions deemed essential to reduce the spread of the pandemic, such as the 
"stay-at-home" order, necessarily disrupted personal parent-child contacts and 
the social processes that facilitate psychological well-being, increasing the 
probability of suffering from a deepening depressed mood by about 17 % for 
elderly parents.

Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.ehb.2022.101152
PMCID: PMC9172389
PMID: 35700656 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests. The 
views expressed are purely those of the authors and may not in any circumstances 
be regarded as stating any official position of the European Commission.


1901. Stress Health. 2023 Feb;39(1):4-34. doi: 10.1002/smi.3171. Epub 2022 Jun 24.

Impact of COVID-19 pandemic on sleep of undergraduate students: A systematic 
literature review.

Valenzuela RLG(1), Velasco RIB(1), Jorge MPPC 2nd(1)(2).

Author information:
(1)College of Medicine, University of the Philippines Manila, Manila, 
Philippines.
(2)Department of Physiology, College of Medicine, University of the Philippines 
Manila, Manila, Philippines.

The 2019 coronavirus pandemic forced the shift to distance education aggravating 
mental and physical vulnerabilities of undergraduate students, including sleep. 
This review aims to describe sleep problem rates and prevalence, sleep pattern 
disruption, sleep duration, sleep quality, insomnia symptoms, psychological and 
socio-economic factors affecting sleep of undergraduates in 22 countries. A 
systematic search for articles published from 2020 to 2021 using 'COVID-19,' 
'Coronavirus,' 'Pandemic,' 'Sleep,' 'Mental Health,' and 'Students' from PubMed, 
Scopus, and Cochrane yielded 2550 articles, where 72 were included. Selection 
criteria were: English full-text available articles, undergraduates and not 
postgraduates, reported sleep outcomes, and participants not from allied health 
courses. Risk of bias was assessed using various Joanna Briggs Institute 
checklists and outcomes were descriptively synthesized. Prevalence of sleep 
problems was notable, while longitudinal studies showed increased rates. There 
was significantly increased sleep duration, and sleep pattern disruption during 
lockdowns. Several psychological, behavioural, environmental, demographic, and 
socio-economic factors were found to be associated with sleep changes. These 
highlight the pandemic's impact on sleep of undergraduate students and reveal 
opportunities for institutions to intervene with policies and programs to 
promote the well-being of undergraduates. Limitations include recall bias and 
underrepresentation of other countries. This study is self-funded with 
registration number RGAO-2021-0071.

© 2022 John Wiley & Sons Ltd.

DOI: 10.1002/smi.3171
PMID: 35699687 [Indexed for MEDLINE]


1902. J Nurs Manag. 2022 Oct;30(7):2495-2502. doi: 10.1111/jonm.13705. Epub 2022 Jun 
30.

The importance of management in promoting hospital staff's mental well-being 
during the COVID-19 pandemic-A survey.

Peltokoski J(1), Kaunonen M(2)(3), Helminen M(2)(4), Neva MH(5), Parkkila 
AK(3)(6), Mattila E(3)(6).

Author information:
(1)Administration Services, Central Finland Health Care District, Jyväskylä, 
Finland.
(2)Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, 
Finland.
(3)General Administration, Pirkanmaa Hospital District, Tampere, Finland.
(4)Tays Research Services, Tampere University Hospital, Tampere, Finland.
(5)Musculoskeletal Theatre Department, Department of Orthopaedics and Trauma, 
Tampere University Hospital, Tampere, Finland.
(6)Pirkanmaa Hospital District, Tampere, Finland.

AIM: To describe hospital staff's experiences of management actions to promote 
their mental well-being during the COVID-19 pandemic. Mental well-being was 
examined on the basis of four entities: level of anxiety, support and 
encouragement from the manager, and the opportunity to discuss concerns about 
COVID-19 with the manager.
BACKGROUND: The workload of COVID-19 affects the mental well-being of staff. 
However, there is limited data on managers' actions to promote their mental 
well-being during the pandemic.
METHODS: A cross-sectional study was used to collect survey data (n = 1995) 
among staff working in two specialized medical care hospitals. To gain deeper 
understanding related issues, the survey included open questions, which were 
answered by 178 participants.
RESULTS: The results indicate that those staff who felt they had received 
support, encouragement, and the opportunity to discuss of COVID-19 worries with 
a manager experienced less anxiety.
CONCLUSIONS: The study provides an insight into managers' actions to promote 
staff's mental well-being during the COVID-19 pandemic.
IMPLICATIONS FOR NURSING MANAGEMENT: The manager's actions have a significant 
effect on the anxiety levels of staff. During the pandemic, the well-being of 
staff is a priority that should be visible to both hospital administrators and 
policymakers.

© 2022 John Wiley & Sons Ltd.

DOI: 10.1111/jonm.13705
PMCID: PMC9350196
PMID: 35698438 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


1903. J Racial Ethn Health Disparities. 2023 Jun;10(3):1499-1507. doi: 
10.1007/s40615-022-01335-1. Epub 2022 Jun 13.

Anxiety and Stress due to COVID-19 Pandemic and Associated Factors Among 
Healthcare Workers in West Guji Zone Southern Ethiopia.

Wayessa ZJ(1), Melesse GT(2), Hadona EA(3).

Author information:
(1)Departement of Midwifery, College of Health and Medical Sciences, Bule Hora 
University, Bule Hora, Oromia Regional State, Ethiopia. 
zelalemjebessa@gmail.com.
(2)Departement of Midwifery, College of Health and Medical Sciences, Bule Hora 
University, Bule Hora, Oromia Regional State, Ethiopia.
(3)Departement of Public Health, College of Health and Medical Sciences, Bule 
Hora University, Bule Hora, Oromia Regional State, Ethiopia.

BACKGROUND: The COVID-19 pandemic caused a dramatic loss of life around the 
world and has caused mental and social problems that affect every country in the 
world. Healthcare workers involved in providing care are at high risk of 
developing mental health problems as they face heavy workloads, life-and-death 
decisions, and the risk of infection is high. This study aimed to assess the 
prevalence of COVID-19-related anxiety and stress and their associated factors 
among healthcare workers in Southern Ethiopia.
METHODS: A cross-sectional survey was conducted in public health facility 
located in the West Guji district. A simple random sampling technique was used 
to select 283 study participants. Descriptive, binary, and multiple logistic 
regression statistics were used. Odds ratios adjusted with 95% CI were used, and 
statistical significance was declared with a p-value of < 0.05.
RESULTS: A total of 275 participants were included, with a response rate of 
97.2%. The prevalence of anxiety and stress were 25.5% and 9.1%, respectively. 
Factors associated with anxiety symptoms were age, psychoactive drug use, 
alcohol use, and monthly income, and stress symptoms were alcohol use, medical 
illness, and knowledge of healthcare workers due to COVID-19 pandemic.
CONCLUSION: The prevalence of anxiety and stress among healthcare workers due to 
COVID-19 were an average compared with studies in low-income and high-income 
countries. Health institutions must focus on the well-being of healthcare 
workers during the fighting for COVID-19 and comprehensive psychological 
assistance to support the mental well-being of healthcare workers by giving 
different training.

© 2022. W. Montague Cobb-NMA Health Institute.

DOI: 10.1007/s40615-022-01335-1
PMCID: PMC9191531
PMID: 35697903 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1904. J Nurs Manag. 2022 Oct;30(7):3074-3082. doi: 10.1111/jonm.13710. Epub 2022 Jul 
11.

Exploring midwives' coping and functioning in the labour wards during the 
Covid-19 pandemic from the Labour Ward Head Nurses' perspective: A qualitative 
study.

Halperin O(1), Noble A(2), Yakov G(1), Raz I(3), Liebergall-Wischnitzer M(2).

Author information:
(1)Health Systems Management Department, The Max Stern Academic College of 
Emek-Yezreel, Emek Yezreel, Israel.
(2)Department of Nursing, Henrietta Szold Hadassah/Hebrew University, Jerusalem, 
Israel.
(3)Soroka Medical Center, Beer-Sheba, Israel.

AIM: The aim of this study is to explore midwives' coping and functioning in the 
labour wards during the Covid-19 pandemic from the Labour Ward Head Nurses' 
perspective.
BACKGROUND: The World Health Organization announced the Covid-19 outbreak to be 
a pandemic in March 2020. Midwives worldwide were affected by this outbreak, 
working in risky environments, confronting the anxiety and fear of childbearing 
women.
METHODS: A qualitative study using thematic analysis was conducted using 
semi-structured interviews done over the telephone. Thirteen Labour Ward Head 
Nurses were interviewed, and the texts were analysed. The study took place in 
April 2020 during the first Covid-19 lockdown in Israel.
RESULTS: Three main themes were generated in the coding process: (a) stress, 
fear and anxiety, (b) joint efforts and (c) frustration.
CONCLUSION: Our study illustrates the difficulties that arose at the beginning 
of the pandemic, a new and unfamiliar chaotic period. Midwives' managers can use 
the current research to learn about actions that may assist in improving staff 
resilience and cohesion during times of crisis.
IMPLICATIONS FOR NURSING MANAGEMENT: Understanding the psychological impact of 
the Covid-19 pandemic among health care professionals is crucial for guiding 
policies and interventions to maintain staff's psychological well-being.

© 2022 John Wiley & Sons Ltd.

DOI: 10.1111/jonm.13710
PMCID: PMC9349910
PMID: 35695044 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflict of interest to 
disclose.


1905. Front Public Health. 2022 May 19;10:850376. doi: 10.3389/fpubh.2022.850376. 
eCollection 2022.

Anxiety and Coping Stress Strategies in Researchers During COVID-19 Pandemic.

Batista P(1)(2), Afonso A(3)(4), Lopes M(5)(6), Fonseca C(5)(6), Oliveira-Silva 
P(1), Pereira A(7), Pinho L(5)(6).

Author information:
(1)Universidade Católica Portuguesa, Research Centre for Human Development, 
Human Neurobehavioral Laboratory, Porto, Portugal.
(2)Universidade Católica Portuguesa, CBQF - Centro de Biotecnologia e Química 
Fina - Laboratório Associado, Escola Superior de Biotecnologia, Porto, Portugal.
(3)Department of Mathematics, School of Science and Technology, University of 
Évora, Évora, Portugal.
(4)Center for Research in Mathematics and Applications (CIMA), Institute for 
Advanced Studies and Research, Évora, Portugal.
(5)S. João de Deus School of Nursing, University of Évora, Évora, Portugal.
(6)Comprehensive Health Research Centre (CHRC), Évora, Portugal.
(7)Education and Psychology Department, Campus Universitário de Santiago, 
University of Aveiro, Aveiro, Portugal.

The current COVID-19 pandemic has affected the whole world, leading to changes 
in one's personal and working life. Researchers have undergone extensive changes 
in their roles, mainly in the area of health care, with research into the virus 
now the priority.
AIM: To assess the anxiety, depression, stress, fears, and coping strategies of 
Portuguese researchers during the COVID-19 pandemic.
PARTICIPANTS AND METHODS: A total of 243 researchers, with an average age of 
37.9 ± 9.6, participated in an online questionnaire. The study was performed 
between 1 June 2021 and 11 August 2021. The questionnaire included depression, 
anxiety, and stress (DASS-21), fear of COVID-19 scale (FCV-19S), and coping 
inventory for stressful situations (CISS).
RESULTS: The findings suggest being female and younger seem to be related to 
more significant fears. Singles and younger researchers showed higher values of 
stress, depression, and anxiety. Research areas, such as medical and health 
sciences, presented higher levels in the DASS-21 depression and stress scale (p 
< 0.05). Also, the results showed a moderate or moderate strong significant 
positive linear relationship between the scales (p < 0.001): DASS-21 stress, 
DASS-21 anxiety, and DASS-21 depression (r > 0.70); CISS-21 emotional-oriented 
with DASS-21 stress (r = 0.683), DASS-21 depression (r = 0.622), and DASS-21 
anxiety (r = 0.557); and emotional fear and cognitive fear (r = 0.652).
CONCLUSION: The findings of this study support the growing concern for the 
psychological well-being of researchers and the need for intervention with more 
extensive and diverse studies.

Copyright © 2022 Batista, Afonso, Lopes, Fonseca, Oliveira-Silva, Pereira and 
Pinho.

DOI: 10.3389/fpubh.2022.850376
PMCID: PMC9175237
PMID: 35692345 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1906. Curr Diabetes Rev. 2023;19(5):e090622205804. doi: 
10.2174/1573399818666220609154132.

Psychological Outcomes of the COVID-19 Pandemic on People with Type 1 Diabetes 
Globally: A Scoping Review.

Maizel JL(1), Dixon BN(2), Walker AF(2)(3).

Author information:
(1)College of Public Health and Health Professions, University of Florida, 
Gainesville, FL, United States.
(2)Department of Health Services Research, Management, and Policy, University of 
Florida, Gainesville, FL, United States.
(3)University of Florida Diabetes Institute, Gainesville, FL, United States.

BACKGROUND: People with type 1 diabetes (T1D) face heightened risks for 
morbidity and mortality from the 2019 Coronavirus (COVID-19). They also have 
elevated risks for disparate psychological outcomes during the COVID-19 
pandemic, given their predisposition to mental health disorders, including 
anxiety and depression, and skyrocketing rates of these conditions among the 
general population.
METHODS: To investigate the psychological ramifications of the COVID-19 pandemic 
on people with T1D globally, we conducted a scoping review of recent literature 
across eight online databases. Articles were screened via a rigorous process, 
and data pertaining to psychological outcomes were coded into thematic areas for 
analysis.
RESULTS: Forty articles presenting data from 27 countries and 14 categories of 
psychological outcomes affecting people with T1D were included in this review. 
Psychological outcomes, in order of most to least frequently identified, 
included: stress, anxiety, social factors, worry, distress, fear, sleep habits, 
quality of life, depression, attitudes regarding COVID-19, other psychological 
issues, mental health services utilization, burnout, and temperament. Recurring 
findings demonstrated significant increases in the prevalence of mental health 
conditions, changes in sleeping habits, reductions of social support, and 
extensive psychosocial concerns among people with T1D. Associations between 
patients' psychological issues and demographic characteristics, diabetes 
self-management behaviors, glycemic control, and overall wellbeing were evident.
CONCLUSION: During the COVID-19 pandemic, people with T1D experienced pervasive 
psychological burdens. This review calls for further research examining the 
long-term impacts of the pandemic and strengthens awareness of the need for 
interventions to offset psychological challenges affecting people with T1D.

Copyright© Bentham Science Publishers; For any queries, please email at 
epub@benthamscience.net.

DOI: 10.2174/1573399818666220609154132
PMID: 35692128 [Indexed for MEDLINE]


1907. BMC Public Health. 2022 Jun 11;22(1):1168. doi: 10.1186/s12889-022-13561-7.

Residential secondhand smoke in a densely populated urban setting: a qualitative 
exploration of psychosocial impacts, views and experiences.

Tan GPP(1), Teo O(1), van der Eijk Y(2).

Author information:
(1)Saw Swee Hock School of Public Health, National University of Singapore, MD1 
Tahir Foundation Building 12 Science Drive 2 #09-01C, 117549, Singapore, 
Singapore.
(2)Saw Swee Hock School of Public Health, National University of Singapore, MD1 
Tahir Foundation Building 12 Science Drive 2 #09-01C, 117549, Singapore, 
Singapore. yvette.eijk@nus.edu.sg.

BACKGROUND: People remain exposed to secondhand smoke, a serious health hazard, 
inside their home as households face challenges in setting no-smoking rules or 
are exposed to secondhand smoke drifting in from neighbouring homes. This study 
explores the psychosocial impacts, views, and experiences with residential 
secondhand smoke in a densely populated urban setting.  METHODS: In-depth online 
or face to face interviews with 18 key informants who had been involved in 
public discourse, policy, advocacy or handling complaints related to residential 
secondhand smoke, 14 smokers, and 16 non-smokers exposed to secondhand smoke 
inside their home. All participants were residents of Singapore, a densely 
populated, multi-ethnic city-state. Interview transcripts were coded in NVivo 
using a deductive and inductive coding process.
FINDINGS: Secondhand smoke has wide-reaching impacts on physical and 
psychosocial wellbeing, even if smokers tried to minimise secondhand smoke. 
Feelings of anxiety and stress are generally tied to feeling discomfort in one's 
personal space, a perceived lack of control over the situation, resentment 
towards smokers, and concerns over the health effects. Family, community, and 
cultural dynamics add complexities to tackling the issue, especially in 
patriarchal households. Secondhand smoke exposure from neighbours is considered 
a widespread issue, exacerbated by structural factors such as building layout 
and the COVID-19 pandemic. Resolving the issue amicably is considered 
challenging due to the absence of regulations and a reluctance to stir up 
conflict with neighbours. While smokers took measures to reduce secondhand 
smoke, these were described as ineffective by other participants. Smokers 
appeared to have contrasting views from other participants on what it means to 
smoke in a socially responsible manner.
CONCLUSION: Given the wide-reaching psychosocial impacts of residential 
secondhand smoke, there is a case for stronger interventions, especially in 
densely populated urban settings where it is more difficult to avoid.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-13561-7
PMCID: PMC9187883
PMID: 35690740 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1908. Clin Child Psychol Psychiatry. 2023 Jan;28(1):279-306. doi: 
10.1177/13591045221106608. Epub 2022 Jun 10.

Using TikTok for public and youth mental health - A systematic review and 
content analysis.

McCashin D(1), Murphy CM(1).

Author information:
(1)8818Dublin City University, Dublin, Ireland.

Globally, TikTok is now the fastest growing social media platform among children 
and young people; but it remains surprisingly under-researched in psychology and 
psychiatry. This is despite the fact that social media platforms have been 
subject to intense academic and societal scrutiny regarding their potentially 
adverse effects on youth mental health and wellbeing, notwithstanding the 
inconsistent findings across the literature. In this two part study, we 
conducted a systematic review concerning studies that have examined TikTok for 
any public health or mental health purpose; and a follow-up content analysis of 
TikTok within an Irish context. For study 1, a predetermined search strategy 
covering representative public and mental health terminology was applied to six 
databases - PSYCINFO, Google Scholar, PUBMED, Wiley, Journal of Medical Internet 
Research, ACM - within the period 2016 to 2021. Included studies were limited to 
English-speaking publications of any design where TikTok was the primary focus 
of the study. The quality appraisal tool by Dunne et al., (2018) was applied to 
all included studies. For study 2, we replicated our search strategy from study 
1, and converted this terminology to TikTok hashtags to search within TikTok in 
combination with Irish-specific hashtags. As quantified by the app, the top two 
"most liked" videos were selected for inclusion across the following three 
targeted groups: official public health accounts; registered Irish charities; 
and personal TikTok creators. A full descriptive analysis was applied in both 
studies. Study 1 found 24 studies that covered a range of public and mental 
health issues: COVID-19 (n = 10), dermatology (n = 7), eating disorders (n = 1), 
cancer (n = 1), tics (n = 1), radiology (n = 1), sexual health (n = 1), DNA (n = 
1), and public health promotion (n = 1). Studies were predominately from the 
USA, applied a content analysis design, and were of acceptable quality overall. 
In study 2, 29 Irish TikTok accounts were analysed, including the accounts of 
public health authorities (n = 2), charity or non-profit (n = 5), and personal 
TikTok creators (n = 22). The overall engagement data from these accounts 
represented a significant outreach to younger populations: total likes n = 
2,588,181; total comments n = 13,775; and total shares n = 21,254. TikTok has 
been utilised for a range of public health purposes, but remains poorly engaged 
by institutional accounts. The various mechanisms for connecting with younger 
audiences presents a unique opportunity for youth mental health practitioners to 
consider, yet there were distinct differences in how TikTok accounts used 
platform features to interact. Overall, there is an absence of high quality 
mixed methodological evaluations of TikTok content for public and mental health, 
despite it being the most used platform for children and young people.

DOI: 10.1177/13591045221106608
PMCID: PMC9902978
PMID: 35689365 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1909. BMC Womens Health. 2022 Jun 10;22(1):218. doi: 10.1186/s12905-022-01812-z.

"Even if I'm undetectable, I just feel like I would die": a qualitative study to 
understand the psychological and socioeconomic impacts of the COVID-19 pandemic 
on women living with HIV (WLWH) in Chicago, IL.

Devlin SA(1), Johnson AK(2)(3), McNulty MC(4), Joseph OL(4), Hall A(4), Ridgway 
JP(4).

Author information:
(1)Department of Medicine, University of Chicago, 5837 S. Maryland Avenue, 
L-038, Chicago, IL, 60637, USA. sdevlin1@medicine.bsd.uchicago.edu.
(2)Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
(3)Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
(4)Department of Medicine, University of Chicago, 5837 S. Maryland Avenue, 
L-038, Chicago, IL, 60637, USA.

BACKGROUND: The COVID-19 pandemic has affected the health and well-being of 
people worldwide, yet few studies have qualitatively examined its cumulative 
effects on ciswomen living with HIV (WLWH). We aimed to explore how the pandemic 
has impacted WLWH, including challenges related to HIV care, employment, 
finances, and childcare. We also investigated how HIV status and different 
psychosocial stressors affected their mental health.
METHODS: We performed 25 semi-structured qualitative interviews with WLWH 
regarding the ways in which COVID-19 impacted their social determinants of 
health and physical well-being during the pandemic. 19 WLWH who received care at 
the University of Chicago Medicine (UCM) and 6 women who received care at Howard 
Brown Health, a federally qualified health center (FQHC) in Chicago, were 
interviewed remotely from June 2020 to April 2021. All interviews were audio 
recorded and transcribed. Interviews were thematically analyzed for 
commonalities regarding HIV-specific and general experiences of WLWH during the 
pandemic.
RESULTS: The majority of participants reported COVID-19 impacted their HIV care, 
such as appointment cancellations and difficulties adhering to antiretroviral 
therapy. In addition to HIV care obstacles, almost all participants described 
perceived heightened vulnerability to or fear of COVID-19. The pandemic also 
affected the socioeconomic well-being of participants, with reported financial 
strains and employment disruptions. Some mothers took on additional childcare 
responsibilities, such as homeschooling. Increased mental health concerns and 
negative psychological effects from the social isolation associated with the 
pandemic were also experienced by most participants.
CONCLUSIONS: We gained invaluable insight into how WLWH were challenged by and 
adapted to the COVID-19 pandemic, including its destabilizing effects on their 
HIV care and mental health. Women described how they undertook additional 
childcare responsibilities during the pandemic and how their HIV status 
compounded their concerns (e.g., perceived heightened vulnerability to 
COVID-19). Strategies to better support WLWH in maintaining their overall health 
throughout the pandemic include childcare assistance, access to affordable 
mental health services, support groups, and education from HIV care providers. 
These findings have significant implications for examining future health crises 
through the perspective of potential gender inequalities.

© 2022. The Author(s).

DOI: 10.1186/s12905-022-01812-z
PMCID: PMC9185710
PMID: 35689277 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no relevant financial or 
non-financial interests to disclose.


1910. Ann Intensive Care. 2022 Jun 10;12(1):49. doi: 10.1186/s13613-022-01019-3.

Corporeal rehabilitation to manage acute stress in critically ill patients.

Bourgeon-Ghittori I(#)(1)(2)(3), Couette M(#)(1)(4), Marini S(4), Ouedraogo 
R(4), Alves A(4), Razazi K(1)(2)(4), Carras D(4), Pallud AC(4), Kentish-Barnes 
N(5), Mekontso Dessap A(6)(7)(8).

Author information:
(1)Groupe de recherche CARMAS, Univ Paris Est Créteil, 94010, Créteil, France.
(2)INSERM, IMRB, Univ Paris Est Créteil, 94010, Créteil, France.
(3)DMU SAPHIRE, AP-HP, Hôpitaux Universitaires Henri-Mondor, 94010, Créteil, 
France.
(4)Service de Médecine Intensive Réanimation, Hôpitaux Universitaires 
Henri-Mondor, AP-HP, 1 Rue Gustavec Eiffel, 94010, Créteil, France.
(5)Groupe de Recherche Famiréa, Service de Médecine Intensive Réanimation, CHU 
Saint-Louis, AP-HP, 94010, Paris, France.
(6)Groupe de recherche CARMAS, Univ Paris Est Créteil, 94010, Créteil, France. 
armand.dessap@aphp.fr.
(7)INSERM, IMRB, Univ Paris Est Créteil, 94010, Créteil, France. 
armand.dessap@aphp.fr.
(8)Service de Médecine Intensive Réanimation, Hôpitaux Universitaires 
Henri-Mondor, AP-HP, 1 Rue Gustavec Eiffel, 94010, Créteil, France. 
armand.dessap@aphp.fr.
(#)Contributed equally

BACKGROUND: Intensive care unit (ICU) patients often endure discomfort and 
distress brought about by their medical environment and the subjective 
experience of their stay. Distress, pain, and loss of control are important 
predictors of future neuropsychiatric disorders. Depression, anxiety, and 
post-traumatic stress are common after discharge. We aimed at mitigating acute 
stress and discomfort via a novel intervention based on body image 
rehabilitation and rehabilitation of senses performed following a holistic 
approach guided by positive communication (corporeal rehabilitation care, CRC).
RESULTS: We conducted a prospective observational study on 297 consecutively 
enrolled patients participating in at least one CRC session. Benefits of CRC 
were assessed on both subjective analogical scales of stress, pain, and 
well-being criteria, and objective clinical measures of dyspnea, respiratory 
rate, and systolic arterial pressure, just after CRC and long after (a median of 
72 min later) to estimate its remote effect. Results showed that CRC had a 
positive effect on all overt measures of distress (acute stress, pain, 
discomfort) just after CRC and remotely. This beneficial effect was also 
observed on dyspnea and respiratory rate. Results also showed that best CRC 
responders had higher baseline values of stress and heart rate and lower 
baseline values of well-being score, indicating that the care targeted the 
population most at risk of developing psychological sequelae. Interestingly, a 
positive CRC response was associated with a better survival even after 
adjustment for physiologic severity, indicating a potential to identify patients 
prompt to better respond to other therapeutics and/or rehabilitation.
CONCLUSION: This study demonstrated the feasibility of an innovative holistic 
patient-centered care approach and its short-term positive effects on critical 
parameters that are considered risk factors for post-intensive care syndrome. 
Further studies are warranted to study long-term benefits for patients, and 
overall benefits for relatives as well as ICU staff.

© 2022. The Author(s).

DOI: 10.1186/s13613-022-01019-3
PMCID: PMC9187824
PMID: 35689146

Conflict of interest statement: The authors have no conflict of interest to 
disclose.


1911. BMJ Open. 2022 Jun 10;12(6):e060272. doi: 10.1136/bmjopen-2021-060272.

Acceptance commitment therapy (ACT) for psychological distress associated with 
inflammatory bowel disease (IBD): protocol for a feasibility trial of the 
ACTforIBD programme.

Evans S(1), Olive L(2), Dober M(3), Knowles S(4), Fuller-Tyszkiewicz M(3), O 
E(5), Gibson P(6), Raven L(7), Gearry R(8), McCombie A(9), van Niekerk L(10), 
Chesterman S(2), Romano D(2), Mikocka-Walus A(11).

Author information:
(1)Psychology, Deakin University Faculty of Health, Burwood, Victoria, Australia 
subhadra.evans@deakin.edu.au.
(2)School of Pyschology, Deakin, Geelong, Victoria, Australia.
(3)School of Psychology, Deakin University, Burwood, Victoria, Australia.
(4)School of Health Sciences, Swinburne University of Technology, Hawthorn, 
Victoria, Australia.
(5)Faculty of Health, Deakin University, Burwood, Victoria, Australia.
(6)Gastroenterology, Monash University Faculty of Medicine Nursing and Health 
Sciences, Clayton, Victoria, Australia.
(7)Crohn's and Colitis Australia, Camberwell, Victoria, Australia.
(8)Department of Medicine, Christchurch School of Medicine and Health Sciences, 
Medicine, Christchurch, New Zealand.
(9)Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New 
Zealand.
(10)School of Psychological Sciences, University of Tasmania, Hobart, Tasmania, 
Australia.
(11)Psychology, Deakin University Faculty of Health, Burwood, Victoria, 
Australia.

INTRODUCTION: Inflammatory bowel disease (IBD) involves an abnormal immune 
response to healthy gut bacteria. When a person develops IBD, their 
susceptibility to anxiety and/or depression increases. The ACTforIBD programme, 
specifically designed for people with IBD and comorbid psychological distress, 
draws on acceptance and commitment therapy (ACT), which promotes acceptance of 
situations that cannot be solved such as persistent physical symptoms. There are 
no ACT trials for IBD using an active control group or a telemedicine approach, 
which is important to improve accessibility, particularly in the context of the 
ongoing COVID-19 pandemic. The ACTforIBD programme is administered online with a 
4-hour therapist involvement per participant only; if successful it can be 
widely implemented to improve the well-being of many individuals with IBD.
METHODS AND ANALYSIS: Our team have codesigned with consumers the ACTforIBD 
programme, an 8-week intervention of 1-hour sessions, with the first three 
sessions and the last session delivered one-to-one by a psychologist, and the 
other sessions self-directed online. This study aims to evaluate the feasibility 
and preliminary efficacy of ACTforIBD to reduce psychological distress in 
patients with IBD. Using a randomised controlled trial, 25 participants will be 
randomised to ACTforIBD, and 25 patients to an active control condition.
ETHICS AND DISSEMINATION: This protocol has been approved by Deakin University 
Research Ethics Committee in September 2021 (Ref. 2021-263) and the New Zealand 
Central Health and Disability Ethics Committee in December 2021 (Ref. 2021 EXP 
11384). The results of this research will be published in peer-reviewed journals 
and shared with various stakeholders, including community members, policy-makers 
and researchers, through local and international conferences.
TRIAL REGISTRATION NUMBER: ACTRN12621001316897.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-060272
PMCID: PMC9189839
PMID: 35688593 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: We do not have any 
conflicts of interest in relation to the present study, however, outside this 
work, SK has served as an educational speaker for Janssen, Ferring and Takeda. 
PG has served as a speaker, a consultant and an advisory board member for 
Allergan, Janssen, MSD, Pfizer, Anatara, Atmo Biosciences, Immunic Therapeutics, 
Novozymes and Takeda and Bristol-Meyers Squibb, and has received research 
funding from from MSD and Atmo Biosciences; and RG owns stocks and shares in 
Atmo Biosciences. LR served on the Roche International Patient Advisory Council 
and the Takeda IBD Patient Expert Council. RG has served on advisory boards for 
AbbVie New Zealand and Australia, Zespri New Zealand and Jannsen New Zealand and 
has received research funding from AbbVie. AM-W has served as an educational 
speaker for Janssen and Ferring.


1912. Ecohealth. 2022 Jun;19(2):154-158. doi: 10.1007/s10393-022-01598-4. Epub 2022 
Jun 10.

Outdoor Activity Associated with Higher Self-Reported Emotional Well-Being 
During COVID-19.

Fernandez MP(1)(2)(3), Ernst KC(4), Bron GM(5), Berry K(6), Diuk-Wasser MA(2), 
Hayden MH(7).

Author information:
(1)Earth Institute, Columbia University, New York, NY, USA.
(2)Department of Ecology, Evolution and Environmental Biology, Columbia 
University, New York, NY, USA.
(3)Paul G. Allen School for Global Health, Washington State University, Pullman, 
WA, USA.
(4)Department of Epidemiology and Biostatistics, University of Arizona, Arizona, 
AZ, USA.
(5)Department of Entomology, University of Wisconsin-Madison, Madison, WI, USA.
(6)College of Business and Public Policy, University of Alaska Anchorage, 
Anchorage, AK, USA.
(7)Lyda Hill Institute for Human Resilience at UCCS, 4863 North Nevada Avenue, 
Fourth floor, Colorado Springs, CO, 80918, USA. mhayden@uccs.edu.

Shifts in activity patterns during the COVID-19 pandemic might have impacted the 
benefits of outdoor activities for mental health. By leveraging an existing 
mobile application, we collected self-reported data on daily outdoor activities, 
emotional well-being, and the influence of COVID-19 on participant's outdoor 
activity levels during April-July 2020. Individuals reporting outdoor 
activities, in greenspaces or in their residence, had higher well-being scores 
and this effect increased with age. Self-reported impacts of COVID-19 on 
emotional well-being were associated with lower well-being scores. This work 
suggests that outdoor activities may have improved mental health during the 
COVID-19 pandemic.

© 2022. EcoHealth Alliance.

DOI: 10.1007/s10393-022-01598-4
PMCID: PMC9186007
PMID: 35687197 [Indexed for MEDLINE]


1913. Womens Health (Lond). 2022 Jan-Dec;18:17455057221103101. doi: 
10.1177/17455057221103101.

The psychological impact of the COVID-19 pandemic and a SARS-CoV-2 testing 
programme on obstetric patients and healthcare workers.

Ross AM(1), Ramlawi S(2), Fakhraei R(2), Murphy MS(2), Ducharme R(2), 
Dingwall-Harvey AL(2), White RR(2)(3), Ritchie K(4)(5), Muldoon K(2)(6), 
El-Chaâr D(2)(3)(6).

Author information:
(1)Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
(2)Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, 
ON, Canada.
(3)Department of Obstetrics, Gynaecology and Newborn Care, The Ottawa Hospital, 
Ottawa, ON, Canada.
(4)Ottawa Hospital Research Institute, Psychiatry, The Ottawa Hospital, Ottawa, 
ON, Canada.
(5)School of Psychology, University of Ottawa, Ottawa, ON, Canada.
(6)Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, 
Canada.

OBJECTIVES: The aim of this study was to describe the psychological impact of 
the COVID-19 pandemic and the specific impact of a universal SARS-CoV-2 testing 
programme on obstetric patients and healthcare workers at The Ottawa Hospital.
METHODS: This was a follow-up survey study of obstetric healthcare workers and 
then-pregnant patients who participated in a SARS-CoV-2 testing programme 
conducted in The Ottawa Hospital obstetrical triage units from 19 October to 17 
November 2020. Surveys explored the effects of the COVID-19 pandemic and the 
testing programme on participants' psychological well-being. Responses were 
collected from April to September 2021. Descriptive summary statistics were 
calculated for both groups.
RESULTS: During hospitalization for delivery, obstetric patients (n = 143) 
worried about giving COVID-19 to their new baby (88.11%), catching COVID-19 
(83.22%), and giving COVID-19 to their partner (76.22%). Patients felt relief at 
being tested for COVID-19 during the universal testing programme (24.65%) and at 
getting their results (28.87%). Patients also believed that universal SARS-CoV-2 
testing was a good way to slow COVID-19 spread (79.72%), reduce anxiety 
(75.52%), and increase relief (76.22%). In addition, patients felt good about 
participating in research that could help others (91.61%). Among obstetric 
healthcare workers (n = 94), job satisfaction decreased and job stress increased 
during the COVID-19 pandemic. The universal testing programme led to minor 
increases in healthcare worker job stress and burden, particularly among nurses, 
but the majority (85.23%) believed it was a valuable research initiative.
CONCLUSION: The COVID-19 pandemic has had a negative psychological impact on 
obstetric patients and healthcare workers. Universal SARS-CoV-2 testing was 
generally viewed favourably and may serve as an effective strategy for 
estimating COVID-19 prevalence without adding undue stress onto patients and 
healthcare workers during the pandemic.

DOI: 10.1177/17455057221103101
PMCID: PMC9189525
PMID: 35686846 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of conflicting interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


1914. Int J Environ Res Public Health. 2022 Jun 4;19(11):6900. doi: 
10.3390/ijerph19116900.

COVID-19 Pandemic-Related Sleep and Mental Health Disparities among Students at 
a Hispanic and Minority-Serving Institution.

Becerra MB(1), Gumasana RJ(1), Mitchell JA(1), Truong JB(1), Becerra BJ(1).

Author information:
(1)Center for Health Equity, California State University-San Bernardino, San 
Bernardino, CA 92407, USA.

BACKGROUND: The COVID-19 pandemic has impacted nearly all sectors of our 
population, including college students, who continue to share disproportionate 
rate of disparities. In this study, we aimed to identity key sleep health 
characteristics, including markers for obstructive sleep apnea, as well as its 
relation to mental health, physical health, and academic performance.
METHODS: A cross-sectional study design with online survey dissemination was 
used. Descriptive, bivariate, and multivariable binary logistic regression 
analyses were conducted among a predominantly minority population.
RESULTS: Results show that nearly 78% of the population reported that the 
pandemic impacted their mental or physical health, while over 83% reported 
daytime tiredness/fatigue/sleepiness, and another 61% reported sleeping less 
than seven hours during weekdays. Among other associations, pandemic-related 
poor sleep health, including sleeping less than seven hours, was associated with 
daytime tiredness/fatigue/sleepiness, psychological distress, as well as low 
mental health and physical health. A severe marker for obstructive sleep apnea, 
having stopped breathing during sleep, was also associated with psychological 
distress during the pandemic.
CONCLUSIONS: Sleep health interventions are critical for optimizing college 
student health and well-being, including improving mental health outcomes.

DOI: 10.3390/ijerph19116900
PMCID: PMC9180365
PMID: 35682482 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1915. Int J Environ Res Public Health. 2022 Jun 2;19(11):6840. doi: 
10.3390/ijerph19116840.

Seroprevalence of COVID-19 and Psychological Distress among Front Liners at the 
Universiti Malaysia Sabah Campus during the Third Wave of COVID-19.

Hijazi MHA(1), Jeffree MS(1), Pang NTP(1), Rahim SSSA(1), Omar A(1), Ahmedy 
F(1), Hijazi MHA(2), Hassan MR(3), Hod R(3), Nawi AM(3), Daim S(1), Wider W(4).

Author information:
(1)Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota 
Kinabalu 88400, Sabah, Malaysia.
(2)Faculty of Computing & Informatics, Universiti Malaysia Sabah, Kota Kinabalu 
88400, Sabah, Malaysia.
(3)Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 
56000, Selangor, Malaysia.
(4)Faculty of Business and Communication, INTI International University, Nilai 
71800, Negeri Sembilan, Malaysia.

In 2020, the COVID-19 pandemic struck the globe and disrupted various aspects of 
psychological wellbeing, more so in frontline workers. Research on assessing the 
seroprevalence of COVID-19 has been scarce; in addition, there are limited 
studies assessing the association between the seroprevalence of COVID-19 and 
psychological distress. Therefore, this study aimed to determine the 
seroprevalence of COVID-19 and the prevalence of psychological distress and to 
determine whether sociodemographic variables, occupational information 
variables, coping styles, and psychological processes might contribute to the 
development of psychological distress. A cross-sectional study involving 168 
Universiti Malaysia Sabah (UMS) front liners was carried out to assess these 
issues. The Depression, Anxiety and Stress Scale (DASS-21) was employed to 
assess psychological distress, together with the COVID-19 Rapid Test Kit 
Antibody (RTK Ab) and a series of questionnaires, including a sociodemographic 
and occupational information questionnaire, the Balanced Index of Psychological 
Mindedness (BIPM) questionnaire, the Mindfulness Attention and Awareness Scale 
(MAAS), the Acceptance and Action Questionnaire (AAQ-II), and the Brief COPE 
questionnaire. The results demonstrated a seroprevalence of COVID-19 at 8.3% 
(95% CI = 5.0-14.0). Non-healthcare workers (HCWs) had a higher COVID-19 
prevalence. Meanwhile, the prevalence of depression, anxiety, and stress among 
front liners was low (3.0%, 3.6%, and 1.2%, respectively). Younger people (aged 
30 years old or less) and HCWs had a higher prevalence of psychological 
distress; being a HCW was significantly associated with a higher level of 
anxiety. Dysfunctional coping and psychological inflexibility were consistently 
found to be predictors for higher levels of the three psychological distress 
variables. This study suggested some alternatives that could be explored by 
mental health providers to address mental health issues among front liners at 
universities.

DOI: 10.3390/ijerph19116840
PMCID: PMC9180452
PMID: 35682422 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript; or in the decision to 
publish the results.


1916. Int J Environ Res Public Health. 2022 Jun 2;19(11):6811. doi: 
10.3390/ijerph19116811.

Return to Work of Healthcare Workers after SARS-CoV-2 Infection: Determinants of 
Physical and Mental Health.

Grazzini M(1), Lulli LG(2)(3), Mucci N(2), Paolini D(1), Baldassarre A(2), 
Gallinoro V(4), Chiarelli A(5), Niccolini F(1), Arcangeli G(2).

Author information:
(1)Health Direction, Careggi University Hospital, 50134 Florence, Italy.
(2)Department of Experimental and Clinical Medicine, University of Florence, 
50134 Florence, Italy.
(3)Occupational Medicine School, University of Florence, 50134 Florence, Italy.
(4)Medical Specialization School of Hygiene and Preventive Medicine, University 
of Florence, 50134 Florence, Italy.
(5)Occupational Medicine Unit, Careggi University Hospital, 50134 Florence, 
Italy.

Introduction. The SARS-CoV-2 pandemic has involved healthcare workers (HCWs) 
both as caregivers and as patients. This study is a retrospective 
cross-sectional analysis of the HCWs working in a third-level hospital in 
Central Italy who were infected with COVID-19 from March 2020 to April 2021. 
This research aims at identifying the physical and mental health outcomes of 
HCWs infected with COVID-19 who returned to work after the infection, the 
determinants of those outcomes, such as age and sex, and the identification of 
possible vulnerable professional groups. Methods. A questionnaire about the 
acute illness, the experience of returning to work, and health perceptions after 
the disease was administered to 427 healthcare workers 3 months after recovering 
from the SARS-CoV-2 infection. Results. The majority interviewed (84.5%) 
reported symptoms at the time of the positive test, with no significant 
differences regarding age or sex, while a significant difference in the mean age 
was found regarding hospitalization (p < 0.001). At 3 months after the 
infection, females (p = 0.001), older workers (p < 0.001), and healthcare 
assistants (p < 0.001) were more likely to report persistent symptoms. Sex (p = 
0.02) and age (p = 0.006) influenced the quality of sleep after the infection. 
At work, the nurses group reported increase in workload (p = 0.03) and worse 
relationships (p = 0.028). At 3 months after the infection, female workers 
perceived worse physical (p = 0.002) and mental (p < 0.001) health status 
according to the SF-12. A negative correlation was found between age and PCS 
score (p < 0.001) but not MCS score (p = 0.86). A significant difference in PCS 
score was found between nurses and physicians (p = 0.04) and between residents 
and all other groups (p < 0.001). Finally, the group of workers reporting sleep 
alterations showed lower PCS and MCS scores (p < 0.001) and working 
relationships had an impact on MCS scores (p < 0.001). Conclusions. Age, sex, 
and type of job had an impact on physical and mental outcomes. Organizing 
specific interventions, also tailored to professional sub-groups, should be a 
target for healthcare systems to protect and boost the physical and mental 
health of their workers.

DOI: 10.3390/ijerph19116811
PMCID: PMC9180816
PMID: 35682394 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1917. Int J Environ Res Public Health. 2022 Jun 2;19(11):6805. doi: 
10.3390/ijerph19116805.

Use of an Online Platform to Evaluate the Impact of Social Distancing Measures 
on Psycho-Physical Well-Being in the COVID-19 Era.

Scuri S(1), Tesauro M(2), Petrelli F(1), Argento N(1), Damasco G(1), Cangelosi 
G(3), Nguyen CTT(4), Savva D(5), Grappasonni I(1).

Author information:
(1)School of Medicinal and Health Products Sciences, University of Camerino, 
62032 Macerata, Italy.
(2)Department of Biomedical, Surgical and Dental Sciences, University of Milan, 
20122 Milan, Italy.
(3)Units of Diabetology, ASUR Marche, Area Vasta 4, 63900 Fermo, Italy.
(4)Department of Pharmaceutical Administration and Economics, Hanoi University 
of Pharmacy, Hanoi 10000, Vietnam.
(5)Plastic Reconstructive and Aesthetic Surgery, Nicosia General Hospital, 
Nicosia 2029, Cyprus.

Background: The SARS-CoV-2 pandemic (Severe Acute Respiratory Syndrome 
Coronavirus 2) and the worldwide health crisis have significantly changed both 
people's habits and lifestyles. Most of the studies found in the literature were 
carried out on specific professional categories in the socio-health sector, 
taking into consideration psychological disorders in relation to work. The 
purpose of this study was to analyze the psychological impact on a portion of 
the normal population subjected to lockdown. Methods: A questionnaire was 
distributed in the period between 23 March 2020 and 18 May 2020 (during Italian 
lockdown) using an online platform. The scales GAD-7, IES-r, PHQ-9 and MANSA 
were used to investigate the level of anxiety, the presence of post-traumatic 
stress disorder, the severity of depression and the perceived quality of life, 
respectively. Results: Four hundred and eight Italian subjects responded. 
Females and younger people were more affected by anxiety and depression. 
Post-traumatic stress disorder affected about 40% of the population sample, 
significantly young people and women, thus attesting to an important 
psychopathological response. About one-fifth of the sample population recorded 
an unsatisfactory quality of life. Conclusions: The results highlight the need 
to set up preventive interventions (primary and secondary), trying to focus on 
the most fragile group of subjects from a psychosocial point of view, in order 
to obtain a significant reduction in psychophysical damage in terms of relapses 
and outcomes.

DOI: 10.3390/ijerph19116805
PMCID: PMC9180038
PMID: 35682388 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


1918. Int J Environ Res Public Health. 2022 Jun 1;19(11):6768. doi: 
10.3390/ijerph19116768.

Impact of School and Peer Connectedness on Adolescent Mental Health and 
Well-Being Outcomes during the COVID-19 Pandemic: A Longitudinal Panel Survey.

Widnall E(1), Winstone L(1), Plackett R(2), Adams EA(3), Haworth CMA(4), Mars 
B(1), Kidger J(1).

Author information:
(1)Population Health Sciences, Bristol Medical School, University of Bristol, 
Bristol BS8 2PS, UK.
(2)Division of Primary Care and Population Health, University College London, 
London NW3 2PF, UK.
(3)Population Health Sciences Institute, Newcastle University, Newcastle upon 
Tyne NE3 4ES, UK.
(4)School of Psychological Science, University of Bristol, Bristol BS8 1TU, UK.

School closures and social distancing measures during the pandemic have 
disrupted young people's daily routines and social relationships. We explored 
patterns of change in adolescent mental health and tested the relationship 
between pre-pandemic levels of school and peer connectedness and changes in 
mental health and well-being between the first lockdown and the return to 
school. This is a secondary analysis of a longitudinal 3-wave panel survey. The 
study sample included 603 students (aged 13-14) in 17 secondary schools across 
south-west England. Students completed a survey pre-pandemic (October 2019), 
during lockdown (May 2020) and shortly after returning to school (October 2020). 
Multilevel models, with random effects, were conducted for anxiety, depression 
and well-being outcomes with school and peer connectedness as predictor 
variables. Symptoms of anxiety decreased from pre-pandemic to during the first 
UK lockdown and increased on the return to school; anxious symptoms decreased 
the most for students reporting feeling least connected to school pre-pandemic. 
Students reporting low levels of school and peer connectedness pre-pandemic 
experienced poorer mental health and well-being at all time points. Low school 
connectedness pre-pandemic was associated with a greater increase in anxious and 
depressive symptoms between lockdown and the return to school when compared to 
students with medium levels of school connectedness. No associations were found 
with high school connectedness or with low/high peer connectedness. For 
adolescents with poor school connectedness, the enforced time away from school 
that the pandemic caused led to reduced anxiety. Going forwards, we need to 
consider ways in which to promote connection with school as a way of supporting 
mental health and well-being.

DOI: 10.3390/ijerph19116768
PMCID: PMC9180617
PMID: 35682350 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1919. Int J Environ Res Public Health. 2022 May 29;19(11):6618. doi: 
10.3390/ijerph19116618.

Utilization of Mind-Body Intervention for Integrative Health Care of COVID-19 
Patients and Survivors.

Yang HJ(1)(2), Setou N(3), Koh E(4).

Author information:
(1)Korea Institute of Brain Science, Seoul 06022, Korea.
(2)Department of Integrative Health Care, University of Brain Education, Cheonan 
31228, Korea.
(3)Department of Disaster Psychiatry, Fukushima Medical University, Fukushima 
960-1295, Japan.
(4)Temasek Life Sciences Laboratories, Singapore 117604, Singapore.

Recent findings suggest a correlation between COVID-19 and diabetes, although 
the underlying causes are still little understood. COVID-19 infection tends to 
induce severe symptoms in patients with underlying diabetes, increasing their 
mortality rate. Moreover, COVID-19 itself appears to be a diabetogenic factor. 
In addition, mental health conditions, such as depression due to lockdown and 
anxiety about infection, were found to affect glycemic control and immunity, 
highlighting the importance of mental health care during the pandemic. Mind-Body 
Intervention (MBI), which includes meditation, yoga, and qigong, has emerged as 
a tool for mental health management due to its effects on stress reduction and 
the promotion of mental and physical well-being. Here, we review the latest 
randomized controlled trials to determine the effects of MBI on glycemic control 
and the immune system and discuss the underlying mechanisms by which MBI 
facilitates the virtuous cycle of stress management, glycemic control, and 
immune modulation. Furthermore, we examine the actual utilization of MBI during 
the COVID-19 pandemic era through recent studies. With proper online education, 
non-pharmacological MBI may be more widely used as an important tool for 
self-health care that complements the usual treatment of COVID-19 patients and 
survivors.

DOI: 10.3390/ijerph19116618
PMCID: PMC9180827
PMID: 35682203 [Indexed for MEDLINE]

Conflict of interest statement: The author declares no conflict of interest.


1920. Int J Environ Res Public Health. 2022 May 28;19(11):6584. doi: 
10.3390/ijerph19116584.

The Impact of Physical Activity on Mental Health during COVID-19 Pandemic in 
China: A Systematic Review.

Li M(1), Wang Q(1), Shen J(1).

Author information:
(1)Department of Physical Education, China University of Geosciences (Beijing), 
No. 29, Xueyuan Road, Haidian District, Beijing 100083, China.

The outbreak and spread of novel coronavirus disease (COVID-19) in 2019 was a 
public health emergency of global concern. As an important health behavior, 
physical activity (PA) and its impact on mental health have been increasingly 
explored during the epidemic period. The keywords and references were searched 
on PubMed, Web of Science, Scopus, Cochrane Library, EBSCO, and CNKI since the 
inception of an electronic bibliographic database until October 2021. A total of 
2979 articles were identified, of which 23 were eligible for inclusion to 
examine the relationship between PA and mental health during the COVID-19 
epidemic. Residents with regular PA, high-intensity PA, and PA duration of 30-60 
min or more per day were associated with a lower risk of anxiety, depression, 
and negative emotions. In contrast, residents with no exercise and physical 
inactivity were more likely to have anxiety, depression, sleep disturbances, and 
lower subjective well-being. In addition, the dose-response curve between PA and 
negative emotions indicated a U-shaped relationship, and there were urban-rural 
differences in the relationship between emotional status and the levels of PA in 
adolescents. The findings have significant implications for addressing mental 
health issues during the current pandemic and future pandemics. Future studies 
adopting an experimental study design, conducting objective PA measures, and 
focusing on the vulnerable subpopulations are warranted to further explore the 
association of PA on mental health during the COVID-19 pandemic.

DOI: 10.3390/ijerph19116584
PMCID: PMC9180501
PMID: 35682172 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1921. Int J Environ Res Public Health. 2022 May 27;19(11):6545. doi: 
10.3390/ijerph19116545.

Individual Stress Burden and Mental Health in Health Care Workers during the 
COVID-19 Pandemic: Moderating and Mediating Effects of Resilience.

Schmuck J(1), Hiebel N(1), Kriegsmann-Rabe M(1), Schneider J(1), Matthias JK(1), 
Erim Y(2), Morawa E(2), Jerg-Bretzke L(3), Beschoner P(3), Albus C(4), Weidner 
K(5), Radbruch L(6), Hauschildt E(7), Geiser F(1).

Author information:
(1)Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, 
University Hospital Bonn, 53127 Bonn, Germany.
(2)Department of Psychosomatic Medicine and Psychotherapy, University Hospital 
of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 
Erlangen, Germany.
(3)Department of Psychosomatic Medicine and Psychotherapy, Ulm University 
Medical Center, University Ulm, 89081 Ulm, Germany.
(4)Department of Psychosomatics and Psychotherapy, University Hospital Cologne, 
University of Cologne, 50923 Cologne, Germany.
(5)Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, 
Technische Universität Dresden, 01069 Dresden, Germany.
(6)Department of Palliative Medicine, University Hospital Bonn, 53127 Bonn, 
Germany.
(7)Faculty of Protestant Theology, University of Bonn, 53113 Bonn, Germany.

Introduction: The COVID-19 pandemic generated a significant burden on the German 
health care system, affecting the mental health of health care workers (HCW) in 
particular. Resilience may serve as an essential protective factor for 
individuals' well-being. Objective: Our objective was to identify demographic 
and work-related correlates of individual resilience and to investigate the 
association between pandemic-related stress, resilience and mental health using 
different resilience models. Methods: Our sample comprised 1034 German HCW in 
different medical professions who completed an online survey from 20 April to 1 
July 2020. Resilience was assessed using the Resilience Scale-5 (RS-5). The 
pandemic-related self-reported stress burden was captured by a single item, 
while depression and anxiety symptoms were measured with the PHQ-2 and GAD-2, 
respectively. Additionally, various sociodemographic and work-related factors 
were assessed. Results: Overall, we found high levels of resilience in the 
sample compared to a German sample before the pandemic, which were significantly 
associated only with the older age of participants and having children in both 
univariate and multivariate analyses. Regarding mechanisms of resilience, 
moderation analysis revealed that low individual resilience and high 
pandemic-related stress burden independently contributed to both anxiety and 
depression symptoms while resilience additionally moderated the relationship 
between stress burden and anxiety symptoms. The link between self-reported 
stress burden and mental health symptoms was also partially mediated by 
individual resilience. Conclusion: Taken together, the findings based on the 
present sample during the COVID-19 pandemic suggest that resilience plays a 
central role in the mental health of healthcare workers and that 
resilience-building interventions should be expanded, especially with a focus on 
younger employees.

DOI: 10.3390/ijerph19116545
PMCID: PMC9180092
PMID: 35682131 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


1922. Int J Environ Res Public Health. 2022 May 24;19(11):6401. doi: 
10.3390/ijerph19116401.

Effects of Sedentary Behavior Interventions on Mental Well-Being and Work 
Performance While Working from Home during the COVID-19 Pandemic: A Pilot 
Randomized Controlled Trial.

Falk GE(1), Mailey EL(2), Okut H(3), Rosenkranz SK(4), Rosenkranz RR(4), Montney 
JL(2), Ablah E(3).

Author information:
(1)School of Medicine, University of Kansas School of Medicine, Wichita, KS 
67214, USA.
(2)Department of Kinesiology, College of Health and Human Sciences, Kansas State 
University, Manhattan, KS 66506, USA.
(3)Department of Population Health, University of Kansas School of Medicine, 
Wichita, KS 67214, USA.
(4)Department of Food, Nutrition, Dietetics and Health, College of Health and 
Human Sciences, Kansas State University, Manhattan, KS 66506, USA.

Sedentary behavior negatively impacts mental health, which can decrease employee 
productivity. Employee mental well-being and work performance may improve with 
sedentary reduction interventions, especially strategies that include 
environmental workplace modifications and behavior-changing strategies. However, 
such interventions have not been examined among employees working remotely 
during the COVID-19 pandemic. As part of the Stand Up Kansas program, 95 
sedentary university employees working from home were randomized into one of 
four intervention arms: height-adjustable desk provision (Desk Only), online 
sedentary behavior modification program (Program Only), Desk + Program, or 
Control. The outcomes were measured at a baseline (November 2020) and following 
the 12-week intervention (February 2021). Employees reported mood (positive and 
negative affect), stress, fatigue (duration, interference with activities and 
severity) and work performance (irritability, focus, work satisfaction, non-work 
satisfaction and productivity) were measured using established self-report 
instruments. The effect sizes, by comparing the Control arm to the Desk + 
Program arm, revealed large improvements in mood (positive affect, d = 1.106). 
Moderate improvements were also seen in fatigue (duration, d = -0.533, and 
interference with activities, d = -0.648) and several aspects of work 
performance (focus, d = 0.702, work satisfaction, d = 0.751, and productivity, d 
= 0.572). Moderate effect sizes were also seen for positive affect (d = 0.566) 
and fatigue severity (d = 0.577) among the Program Only arm, whereas no 
noteworthy effect sizes were observed among the Desk Only arm. Combining an 
online sedentary behavior modification program with height-adjustable desk 
provisions appeared to positively affect mental well-being and work performance 
among remote employees.

DOI: 10.3390/ijerph19116401
PMCID: PMC9180109
PMID: 35681986 [Indexed for MEDLINE]

Conflict of interest statement: Varidesk (www.vari.com (accessed on 12 May 
2022)) donated the desks and mats used in this study. Varidesk had no role in 
the intervention design, delivery, data analysis, interpretation of the results 
or manuscript preparation. There is no other conflict of interest or 
disclosures.


1923. Int J Environ Res Public Health. 2022 May 24;19(11):6380. doi: 
10.3390/ijerph19116380.

The Psychological Well-Being of Southeast Asian Frontline Healthcare Workers 
during COVID-19: A Multi-Country Study.

Teo I(1)(2)(3), Nadarajan GD(4)(5), Ng S(2), Bhaskar A(2), Sung SC(1)(6), Cheung 
YB(1)(7)(8), Pan FT(2), Haedar A(9), Gaerlan FJ(10), Ong SF(11), Riyapan S(12), 
Do SN(13)(14)(15), Luong CQ(14)(15)(16), Rao V(5)(17), Soh LM(18), Tan 
HK(5)(19), Ong MEH(1)(4).

Author information:
(1)Programme in Health Services & Systems Research, Duke-NUS Medical School, 
Singapore 169857, Singapore.
(2)Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore 169857, 
Singapore.
(3)Department of Psychosocial Oncology, National Cancer Centre Singapore, 
Singapore 169610, Singapore.
(4)Department of Emergency Medicine, Singapore General Hospital, Singapore 
169608, Singapore.
(5)SingHealth Duke-NUS Global Health Institute, Singapore 169857, Singapore.
(6)Department of Developmental Psychiatry, Institute of Mental Health, Singapore 
539747, Singapore.
(7)Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore 169857, 
Singapore.
(8)Centre for Child Health Research, Tampere University, 33100 Tampere, Finland.
(9)Saiful Anwar General Hospital, Faculty of Medicine Universitas Brawijaya, 
Kota Malang 65145, Jawa Timur, Indonesia.
(10)Philippine College of Emergency Medicine and University of the 
Philippines-Philippine General Hospital, Metro Manila 1000, Philippines.
(11)Emergency & Trauma Department, Hospital Sultanah Bahiyah, Kedah 05460, 
Malaysia.
(12)Department of Emergency Medicine, Faculty of Medicine Siriraj Hospital, 
Mahidol University, Bangkok 10700, Thailand.
(13)Center for Critical Care Medicine, Bach Mai Hospital, Hanoi 100000, Vietnam.
(14)Department of Emergency and Critical Care Medicine, Hanoi Medical 
University, Hanoi 100000, Vietnam.
(15)Faculty of Medicine, School of Medicine and Pharmacy, Vietnam National 
University, Hanoi 100000, Vietnam.
(16)Center for Emergency Medicine, Bach Mai Hospital, Hanoi 100000, Vietnam.
(17)Singhealth International Collaboration Office, Singapore 168753, Singapore.
(18)Yale-NUS College, Singapore 138527, Singapore.
(19)Division of Surgery and Surgical Oncology, Singapore General Hospital and 
National Cancer Centre Singapore, Singapore 169610, Singapore.

OBJECTIVES: This study examined the prevalence of anxiety, depression, and job 
burnout among frontline healthcare workers (HCWs) across six Southeast Asian 
countries (Indonesia, Malaysia, Philippines, Singapore, Thailand, Vietnam) 
during the COVID-19 pandemic in 2021. We also investigated the associated risk 
and protective factors.
METHODS: Frontline HCWs (N = 1381) from the participating countries participated 
between 4 January and 14 June 2021. The participants completed self-reported 
surveys on anxiety (GAD-7), depression (PHQ-8), and job burnout (PWLS). 
Multivariate logistic regressions were performed with anxiety, depression, and 
job burnout as outcomes and sociodemographic and job characteristics and HCW 
perceptions as predictors.
RESULTS: The average proportion of HCWs reporting moderate anxiety, moderately 
severe depression, and job burnout across all countries were 10%, 4%, and 20%, 
respectively. Working longer hours than usual (Odds ratio [OR] = 1.82; 3.51), 
perceived high job risk (1.98; 2.22), and inadequate personal protective 
equipment (1.89; 2.11) were associated with increased odds of anxiety and job 
burnout while working night shifts was associated with increased risk of 
depression (3.23). Perceived good teamwork was associated with lower odds of 
anxiety (0.46), depression (0.43), and job burnout (0.39).
CONCLUSION: Job burnout remains a foremost issue among HCWs. Potential 
opportunities to improve HCW wellness are discussed.

DOI: 10.3390/ijerph19116380
PMCID: PMC9180104
PMID: 35681966 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


1924. BMJ Open. 2022 Jun 9;12(6):e059047. doi: 10.1136/bmjopen-2021-059047.

Are free school meals failing families? Exploring the relationship between child 
food insecurity, child mental health and free school meal status during 
COVID-19: national cross-sectional surveys.

Yang TC(1), Power M(2), Moss RH(3), Lockyer B(3), Burton W(2), Doherty B(4), 
Bryant M(2)(5).

Author information:
(1)Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK 
tiffany.yang@bthft.nhs.uk.
(2)Health Sciences, University of York, York, North Yorkshire, UK.
(3)Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
(4)The York Management School, University of York, York, UK.
(5)York Hull Medical School, University of York, York, UK.

OBJECTIVE: Food insecurity is linked to poor health and well-being in children 
and rising prevalence rates have been exacerbated by COVID-19. Free school meals 
(FSM) are considered a critical tool for reducing the adverse effects of poverty 
but apply a highly restrictive eligibility criteria. This study examined levels 
of food security and FSM status to support decision-making regarding increasing 
the current eligibility criteria.
DESIGN: Two cross-sectional national surveys administered in August-September 
2020 and January-February 2021 were used to examine the impact of COVID-19 on 
the food experiences of children and young people.
SETTING: UK.
PARTICIPANTS: 2166 children (aged 7-17 years) and parents/guardians.
MAIN OUTCOME MEASURES: Participant characteristics were described by food 
security and FSM status; estimated marginal means were calculated to obtain the 
probability of poor mental health, expressed as children reporting feeling 
stressed or worried in the past month, by food security status and FSM status.
RESULTS: We observed food insecurity among both children who did and did not 
receive of FSM: 23% of children not receiving FSM were food insecure. Children 
who were food insecure had a higher probability of poor mental health (31%, 95% 
CI: 23%, 40%) than children who were food secure (10%, 95% CI: 7%, 14%). Food 
insecure children receiving FSM had a higher probability of poor mental health 
(51%, 95% CI: 37%, 65%) than those who were food insecure and not receiving FSM 
(29%, 95% CI: 19%, 42%).
CONCLUSION: Many children experienced food insecurity regardless of whether they 
received FSM, suggesting the eligibility criteria needs to be widened to prevent 
overlooking those in need.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/bmjopen-2021-059047
PMCID: PMC9184996
PMID: 35680269 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


1925. Am J Public Health. 2022 Jun;112(S3):S271-S274. doi: 10.2105/AJPH.2022.306821.

A Nurse-Led, Well-Being Promotion Using the Community Resiliency Model, Atlanta, 
2020-2021.

Duva IM(1), Murphy JR(1), Grabbe L(1).

Author information:
(1)Ingrid M. Duva and Linda Grabbe are with the Nell Hodgson Woodruff School of 
Nursing, Emory University, Atlanta, GA. Jordan R. Murphy is with Community 
Advanced Practice Nurses Inc, Atlanta.

Comment in
    Am J Public Health. 2022 Jun;112(S3):S224-S225.

The wrath of COVID-19 includes a co-occurring global mental health pandemic, 
raising the urgency for our health care sector to implement strategies 
supporting public mental health. In Georgia, a successful nurse-led response to 
this crisis capitalized on statewide organizations' existing efforts to bolster 
well-being and reduce trauma. Partnerships were formed and joint aims identified 
to disseminate a self-care modality, the Community Resiliency Model, to 
organizations and communities throughout the state. (Am J Public Health. 
2022;112(S3):S271-S274. https://doi.org/10.2105/AJPH.2022.306821).

DOI: 10.2105/AJPH.2022.306821
PMCID: PMC9184890
PMID: 35679550 [Indexed for MEDLINE]


1926. Korean J Med Educ. 2022 Jun;34(2):95-106. doi: 10.3946/kjme.2022.222. Epub 2022 
May 31.

An exploratory study on the challenges faced and coping strategies used by 
preclinical medical students during the COVID-19 crisis.

Sam CP(1), Mamat NH(2), Nadarajah VD(3).

Author information:
(1)Department of Clinical Skills & Simulation Center, International Medical 
University, Kuala Lumpur, Malaysia.
(2)IMU Center for Education, International Medical University, Kuala Lumpur, 
Malaysia.
(3)Education & Institutional Development Office, International Medical 
University, Kuala Lumpur, Malaysia.

PURPOSE: The impact of the coronavirus disease 2019 crisis on medical education 
includes reduced clinical training, a significant loss of learning time and a 
probable decline in confidence of being a doctor. These recent changes will have 
significant effect on the well-being of medical students and interventional 
support needs to be given early. This study explores the challenges faced and 
coping strategies used by preclinical medical students during the crisis.
METHODS: A qualitative study involving 13 preclinical medical students was 
conducted between August and September 2020 at a medical school in Malaysia. An 
in-depth individual interview via Microsoft Teams (Microsoft Corp.) with 
semi-structured questions was conducted. The recorded interview data were 
thematically analyzed using the six phases of Braun and Clarke's Thematic 
Analysis.
RESULTS: The challenges faced were identified under three themes: psychosocial 
impact of lockdown, significant lifestyle changes, and impact on professional 
progression. Meanwhile, four themes emerged in coping strategies that include 
behavioral strategies, re-appraisal of the uncertainties of situation, active 
coping mechanisms, and regulation of emotion with coping reserve. There are 
indications that personality traits determine strategies to cope with challenges 
faced during the crisis which may either lead to resilience building or 
experiencing burnout.
CONCLUSION: The findings of the study highlighted the urgent need to develop 
early preventive and intervention strategies to address the mental health of 
medical students to mitigate stress and promote positive well-being in times of 
crisis.

DOI: 10.3946/kjme.2022.222
PMCID: PMC9178257
PMID: 35676877 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of interest No potential conflict of 
interest relevant to this article was reported. The authors alone are 
responsible for the content and writing of the article.


1927. PLoS One. 2022 Jun 8;17(6):e0267778. doi: 10.1371/journal.pone.0267778. 
eCollection 2022.

Probiotics for Reduction of Examination Stress in Students (PRESS) study: A 
randomized, double-blind, placebo-controlled trial of the probiotic 
Lacticaseibacillus rhamnosus HN001.

Slykerman RF(1), Li E(2), Mitchell EA(3).

Author information:
(1)Department of Psychological Medicine, University of Auckland, Auckland, New 
Zealand.
(2)A Better Start - National Science Challenge University of Auckland, New 
Zealand.
(3)Department of Pediatrics, Child & Youth Health, University of Auckland, New 
Zealand.

BACKGROUND: Studies suggest that bioactive compounds such as probiotics may 
positively influence psychological health. This study aimed to determine whether 
supplementation with the probiotic Lacticaseibacillus rhamnosus HN001 reduced 
stress and improve psychological wellbeing in university students sitting 
examinations.
METHODS: In this randomized, double-blind, placebo-controlled study, 483 
undergraduate students received either the probiotic L. rhamnosus HN001, or 
placebo, daily during a university semester. Students completed measures of 
stress, anxiety, and psychological wellbeing at baseline and post-intervention 
before examinations. Mann Whitney U tests compared the change in psychological 
outcomes between groups.
RESULTS: Of the 483 students, 391 (81.0%) completed the post-intervention 
questions. There was no significant difference between the probiotic and placebo 
supplemented groups in psychological health outcomes. The COVID19 pandemic 
restrictions may have influenced the typical trajectory of stress leading up to 
examinations.
CONCLUSION: We found no evidence of significant benefit of probiotics on the 
psychological health of university students. These findings highlight the 
challenges of conducting probiotic trials in human populations where the 
potential for contextual factors such as COVID19 response, and participant 
adherence to the intervention may influence results.

DOI: 10.1371/journal.pone.0267778
PMCID: PMC9176810
PMID: 35675229 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


1928. J Fam Nurs. 2022 Aug;28(3):195-204. doi: 10.1177/10748407221102465. Epub 2022 
Jun 8.

Experiences of Black American Dementia Caregivers During the COVID-19 Pandemic.

Oliver S(1), Alexander K(1), Bennett SG(1)(2), Hepburn K(1), Henry J(3), 
Clevenger CK(1), Epps F(1).

Author information:
(1)Emory University, Atlanta, GA, USA.
(2)Emory Healthcare, Atlanta, GA, USA.
(3)Grand Canyon University, Phoenix, AZ, USA.

Dementia caregivers are responsible for the daily care and management of 
individuals who are among the most vulnerable to the serious consequences of 
COVID-19. This qualitative study explores the experience of Black dementia 
caregivers during the COVID-19 pandemic in the United States. Nineteen Black 
dementia caregivers were recruited to participate in semi-structured focus 
groups held in April 2021. Four overarching themes were constructed during 
analysis: social isolation, decreased well-being, the good and bad of 
telehealth, and challenges fulfilling health care needs. The results indicate 
the experience of Black dementia caregivers overlaps with existing literature on 
the experiences of dementia caregivers of other races during COVID-19. These 
results can assist in addressing the specific needs and improving the 
experiences of dementia caregivers in current and future public health crises.

DOI: 10.1177/10748407221102465
PMCID: PMC9280120
PMID: 35674329 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


1929. J Fam Nurs. 2022 Aug;28(3):183-194. doi: 10.1177/10748407221100284. Epub 2022 
Jun 8.

Exploring the Impacts of COVID-19 Public Health Measures on Community-Dwelling 
People Living With Dementia and Their Family Caregivers: A Longitudinal, 
Qualitative Study.

Baumbusch J(1), Cooke HA(1), Seetharaman K(2), Khan A(1), Khan KB(1).

Author information:
(1)The University of British Columbia, Vancouver, Canada.
(2)Simon Fraser University, Burnaby, British Columbia, Canada.

Since the onset of the COVID-19 pandemic, community-dwelling people living with 
dementia and their family caregivers have experienced many challenges. The 
unanticipated consequences of public health measures have impacted these 
families in a myriad of ways. In this interpretive policy analysis, which used a 
longitudinal, qualitative methodology, we purposively recruited 12 families in 
British Columbia, Canada, to explore the impacts of pandemic public health 
measures over time. Semi-structured interviews were conducted every 3 months and 
participants completed diary entries. Twenty-eight interviews and 34 diary 
entries were thematically analyzed. The findings explore ways that families 
adopted and adapted to public health measures, loss of supports, both formal and 
informal, and the subsequent consequences for their mental and physical 
well-being. Within the ongoing context of the pandemic, as well as potential 
future wide-spread emergencies, it is imperative that programs and supports are 
restarted and maintained to avoid further harm to these families.

DOI: 10.1177/10748407221100284
PMCID: PMC9280696
PMID: 35674313 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


1930. Disaster Med Public Health Prep. 2022 Jun 8;17:e171. doi: 10.1017/dmp.2022.138.

Sociodemographic and Psychological Predictors of Resilience Among Frontline 
Nurses Fighting the COVID-19 Pandemic.

Zhang Y(1), Xiong Y(2), Zhang L(3), Jiang X(4), Zhuang X(4), Meng L(4), Peng 
L(4), Wu J(5).

Author information:
(1)Obstetrical Department, Hunan Provincial People's Hospital, The First 
Affiliated Hospital of Hunan Normal University, Changsha, Hunan Province, China.
(2)International Medical Center, Xiangya Hospital, Central South University, 
Hunan Province, China.
(3)Department of Intensive Care Medicine, Xiangya Hospital, Central South 
University, Changsha, Hunan Province, China.
(4)Orthopedics Department, Xiangya Hospital, Central South University, Changsha, 
Hunan Province, China.
(5)Medical Department, Xiangya Hospital, Central South University, Changsha, 
Hunan Province, China.

OBJECTIVE: According to a WHO report, the number of patients with coronavirus 
disease 2019 (COVID-19) has reached 456,797,217 worldwide as of 15 March, 2022. 
In Wuhan, China, large teams of health-care personnel were dispatched to respond 
to the COVID-19 emergency. This study aimed to determine the sociodemographic 
and psychological predictors of resilience among frontline nurses fighting the 
current pandemic.
METHODS: A total of 143 nurses were recruited from February 15 to February 20, 
2020, to participate in this study. The 10-item Connor-Davidson Resilience Scale 
and the 21-item Depression Anxiety Stress Scale were used to estimate the 
participants' resilience and mental wellbeing.
RESULTS: Results showed that the nurses displayed a moderate resilience level. 
Their median depression, anxiety, and stress scores were 1, 2, and 3, 
respectively, which were negatively correlated with resilience. Female gender, 
being dispatched to Wuhan, and depression levels were the significant predictors 
of resilience.
CONCLUSIONS: The results suggest that particular attention should be given to 
nurses who were dispatched to Wuhan and who exhibited depression symptoms, and 
appropriate measures should be taken to boost their resilience.

DOI: 10.1017/dmp.2022.138
PMCID: PMC9273726
PMID: 35673807 [Indexed for MEDLINE]


1931. J Occup Environ Med. 2022 Aug 1;64(8):642-648. doi: 
10.1097/JOM.0000000000002587. Epub 2022 Jun 9.

Determinants of Stress, Depression, Quality of Life, and Intent to Leave in 
Washington State Emergency Medical Technicians During COVID-19.

Srikanth P(1), Monsey LM, Meischke HW, Baker MG.

Author information:
(1)From the Department of Environmental and Occupational Health Sciences, 
University of Washington School of Public Health, Seattle, Washington (Mr 
Srikanth, Ms Monsey, Dr Baker); and Department of Health Systems and Population 
Health, University of Washington School of Public Health, Seattle, Washington 
(Dr Meischke).

OBJECTIVES: This study characterizes determinants of stress, depression, quality 
of life, and intent to leave among emergency medical technicians (EMTs) in the 
Puget Sound region, Washington, during the COVID-19 pandemic and identifies 
areas for intervention on these outcomes.
METHODS: A cross-sectional survey measured stress, depression, quality of life, 
and intent to leave among EMTs ( N = 123). Regression models were developed for 
these outcomes.
RESULTS: A total of 23.8% of respondents were very likely to leave their 
position in the next 6 months. Job demands predicted stress and depression, and 
financial security predicted stress and quality of life. Intent to leave was 
predicted by stress, manager support, and length of employment.
CONCLUSIONS: Increased exposure to hazards has impacted EMT mental health. 
Emergency medical technicians are vital to healthcare, so improving EMT health 
and well-being is important, as attrition during a pandemic could impact public 
health.

Copyright © 2022 American College of Occupational and Environmental Medicine.

DOI: 10.1097/JOM.0000000000002587
PMCID: PMC9377359
PMID: 35673703 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of interest: M.G.B. provided 
consulting on COVID-19 occupational hygiene protocols and received compensation 
through Mercer Total Healthcare Management; there was no overlap with the work 
presented here. Baker, Srikanth, Monsey, and Meischke have no 
relationships/conditions/circumstances that present potential conflict of 
interest.


1932. Sultan Qaboos Univ Med J. 2022 May;22(2):179-197. doi: 
10.18295/squmj.6.2021.081. Epub 2022 May 26.

The Psychological Well-Being of University Students amidst COVID-19 Pandemic: 
Scoping review, systematic review and meta-analysis.

Ebrahim AH(1)(2), Dhahi A(1), Husain MA(3), Jahrami H(1)(4).

Author information:
(1)Ministry of Health, Manama, Bahrain.
(2)College of Graduate Studies and Research, Ahlia University, Manama, Bahrain.
(3)College of Health and Sport Science (CHSS), University of Bahrain, Sakheer, 
Bahrain.
(4)College of Medicine and Medical Sciences, Arabian Gulf University, Manama, 
Bahrain.

This review aimed to summarise the current evidence relating to university 
students' psychological well-being amidst the COVID-19 pandemic. A scoping 
review, using the Preferred Reporting Items for Systematic Reviews and 
Meta-Analyses extension for Scoping Reviews guidelines, was first conducted to 
determine if the evidence can be systematically reviewed and meta-analysed. The 
search was performed via Google Scholar, MEDLINE/PubMed, Science Direct, Scopus 
and Web of Science. A total of 90 original articles were selected for the 
scoping review. Meta-analysis of a total of 46,284 cases revealed an overall 
pooled prevalence rate of 29.1% (95% confidence interval [CI]: 20.9-39.0; K = 9, 
N = 22357) for anxiety symptoms and 23.2% (95% CI: 15.7-32.9; K = 12, N = 23927) 
for depression symptoms. This data revealed that COVID-19 had a significant 
impact on university students' psychological well-being.

© Copyright 2022, Sultan Qaboos University Medical Journal, All Rights Reserved.

DOI: 10.18295/squmj.6.2021.081
PMCID: PMC9155030
PMID: 35673293 [Indexed for MEDLINE]


1933. BMC Public Health. 2022 Jun 7;22(1):1144. doi: 10.1186/s12889-022-13511-3.

Knowledge deficit and fear of COVID-19 among higher education students during 
the first wave of the pandemic and implications for public health: a 
multi-country cross-sectional survey.

Berhe NM(1), Van de Velde S(2), Rabiee-Khan F(3), van der Heijde C(4), Vonk 
P(4), Buffel V(2), Wouters E(2), Van Hal G(5).

Author information:
(1)Department of Epidemiology, Medicine & Health Sciences Faculty, University of 
Antwerp, Antwerp, Belgium. neaminmichael@gmail.com.
(2)Centre for Population, Family and Health, Department of Sociology, University 
of Antwerp, Antwerp, Belgium.
(3)Faculty of Health, Education & Life Sciences, Birmingham City University, 
Birmingham, UK.
(4)Department of Student Health Services, University of Amsterdam, Amsterdam, 
Netherlands.
(5)Department of Social Epidemiology and Health Policy, University of Antwerp, 
Antwerp, Belgium.

BACKGROUND: Public health measures such as physical distancing and distance 
learning have been implemented during the COVID-19 pandemic. COVID-19 related 
knowledge deficit can increase fear that leads to negative mental health and 
COVID-19, especially among adolescents. Therefore, our study aimed to assess 
COVID-19 related knowledge deficit and its association with fear among higher 
education (HE) students during the first wave of COVID-19.
METHODS: A cross-sectional survey, COVID-19 International Students Well-being 
Study (C-19 ISWS) was conducted in 133 Higher Education Institutions (HEIs) in 
26 countries between April 27 and July 7, 2020. A stratified convenience 
sampling technique was used. Descriptive, bivariate, mixed-effect logistic 
regression analyses were conducted using R software.
RESULTS: Out of 127,362 respondents, 72.1% were female, and 76.5% did not report 
a previous history of confirmed COVID-19. The majority of those without the 
previous infection 81,645 (83.7%) were from 21 European countries while the rest 
15,850 (16.3%) were from 5 non-European countries. The most frequent correct 
response to COVID-19 related knowledge questions among respondents was having 
the virus without having symptoms (94.3%). Compared to participants with good 
knowledge, the odds of being afraid of acquiring SARS-COV-2 infection among 
those with poor knowledge was 1.05 (95%CI:1.03,1.08) and the odds of being 
afraid of contracting severe COVID-19 was 1.36 (95%CI:1.31,1.40).
CONCLUSION: COVID-19 related knowledge was independently associated with both 
fear of acquiring SARS-COV-2 infection as well as contracting severe COVID-19. 
Our findings will serve as a basis for public health response for both the 
current and similar future pandemics by highlighting the need for addressing the 
COVID-19 knowledge deficit to fight the infodemic and prevent negative mental 
health outcomes.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-13511-3
PMCID: PMC9172614
PMID: 35672723 [Indexed for MEDLINE]

Conflict of interest statement: We declare no potential conflicts of interest 
with respect to the research, authorship, and/or publication of this article.


1934. Clin Child Psychol Psychiatry. 2023 Jan;28(1):323-337. doi: 
10.1177/13591045221092884. Epub 2022 Jun 7.

Exploring adolescents' perspectives on social media and mental health and 
well-being - A qualitative literature review.

Popat A(1), Tarrant C(2).

Author information:
(1)School of Medicine, University of Leicester, Leicester, UK.
(2)Department of Health Sciences, University of Leicester, Leicester, UK.

Many quantitative studies have supported the association between social media 
use and poorer mental health, with less known about adolescents' perspectives on 
social media's impact on their mental health and wellbeing. This narrative 
literature review aimed to explore their perspectives, focusing on adolescents 
aged between 13 and 17. It reviewed qualitative studies published between 
January 2014 and December 2020, retrieved from four databases: APA Psychinfo, 
Web of Science, PubMed and Google Scholar. The literature search obtained 24 
research papers. Five main themes were identified: 1) Self-expression and 
validation, 2) Appearance comparison and body ideals, 3) Pressure to stay 
connected, 4) Social engagement and peer support and 5) Exposure to bullying and 
harmful content. This review has highlighted how social media use can contribute 
to poor mental health - through validation-seeking practices, fear of judgement, 
body comparison, addiction and cyberbullying. It also demonstrates social 
media's positive impact on adolescent wellbeing - through connection, support 
and discussion forums for those with similar diagnoses. Future research should 
consider adolescent views on improvements to social media, studying younger 
participants, and the impact of COVID-19 on social media use and its associated 
mental health implications.

DOI: 10.1177/13591045221092884
PMCID: PMC9902994
PMID: 35670473 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


1935. Autism. 2023 Jan;27(1):188-199. doi: 10.1177/13623613221086997. Epub 2022 Jun 6.

A longitudinal study of the mental health of autistic children and adolescents 
and their parents during COVID-19: Part 2, qualitative findings.

Asbury K(1), Toseeb U(1).

Author information:
(1)University of York, UK.

We know that autistic children and young people, and their caregivers, are at 
increased risk of mental ill health. We asked whether the first 6 months of 
COVID-19 exacerbated that risk, and whether the implications were different for 
autistic pupils and their caregivers, than for those with other special 
educational needs and difficulties. In a linked paper, we found that caregivers 
of autistic pupils reported higher levels of depression and anxiety symptoms in 
their children than parents of children with other special educational needs and 
difficulties (Toseeb & Asbury, 2022). For pupils with other special educational 
needs and difficulties, their parent-reported anxiety symptoms eased over time 
while remaining high throughout for autistic pupils. There were no differences 
in mental health and wellbeing between caregivers of autistic pupils and those 
with other special educational needs and difficulties. Here, we used parents' 
written descriptions of their own and their child's mental health during the 
first 6 months of COVID-19 to explore these linked findings in greater depth. We 
identified strong evidence of worry and distress for all, but most prominently 
autistic children and young people. Our finding that worry and distress declined 
over time for pupils with other special educational needs and difficulties, but 
not for autistic pupils, was supported and we observed a few differences between 
caregivers. We also found evidence of wellbeing throughout the sample, and 
examples of some (mainly autistic) pupils benefitting from a reduction in 
demands (e.g. going to school). This has implications for our understanding of 
the school experience for autistic pupils. Findings suggest that the mental 
health of autistic children and young people may have been disproportionately 
affected during the first 6 months of COVID-19 and that careful consideration of 
optimal support, from both health and education perspectives, is vital.

DOI: 10.1177/13623613221086997
PMCID: PMC9805927
PMID: 35669990 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship and/or publication of this 
article.


1936. Mol Psychiatry. 2023 Jan;28(1):423-433. doi: 10.1038/s41380-022-01614-7. Epub 
2022 Jun 6.

A systematic review and meta-analysis of long term physical and mental sequelae 
of COVID-19 pandemic: call for research priority and action.

Zeng N(#)(1)(2)(3), Zhao YM(#)(1)(2), Yan W(#)(4), Li C(3), Lu QD(1)(2), Liu 
L(1)(2), Ni SY(1)(2), Mei H(1)(2), Yuan K(4), Shi L(4), Li P(4), Fan TT(4), Yuan 
JL(4), Vitiello MV(5), Kosten T(6), Kondratiuk AL(7), Sun HQ(4), Tang XD(8), Liu 
MY(9), Lalvani A(7), Shi J(10), Bao YP(11)(12), Lu L(13)(14)(15).

Author information:
(1)National Institute on Drug Dependence and Beijing Key Laboratory of Drug 
Dependence, Peking University, Beijing, China.
(2)School of Public Health, Peking University, Beijing, China.
(3)Beijing Friendship Hospital, Capital Medical University, Beijing, China.
(4)Peking University Sixth Hospital, Peking University Institute of Mental 
Health, NHC Key Laboratory of Mental Health (Peking University), National 
Clinical Research Center for Mental Disorders (Peking University Sixth 
Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), 
Peking University, Beijing, 100191, China.
(5)Department of Psychiatry and Behavioral Sciences, University of Washington, 
Seattle, WA, USA.
(6)Department of Psychiatry, Pharmacology, Neuroscience, Immunology, Baylor 
College of Medicine, Houston, TX, 77030, USA.
(7)NIHR Health Protection Research Unit in Respiratory Infections, National 
Heart and Lung Institute, Imperial College, London, W2 1NY, UK.
(8)Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, 
Mental Health Center and Translational Neuroscience Center, State Key Laboratory 
of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
(9)Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
(10)National Institute on Drug Dependence and Beijing Key Laboratory of Drug 
Dependence, Peking University, Beijing, China. shijie@bjmu.edu.cn.
(11)National Institute on Drug Dependence and Beijing Key Laboratory of Drug 
Dependence, Peking University, Beijing, China. baoyp@bjmu.edu.cn.
(12)School of Public Health, Peking University, Beijing, China. 
baoyp@bjmu.edu.cn.
(13)National Institute on Drug Dependence and Beijing Key Laboratory of Drug 
Dependence, Peking University, Beijing, China. linlu@bjmu.edu.cn.
(14)Peking University Sixth Hospital, Peking University Institute of Mental 
Health, NHC Key Laboratory of Mental Health (Peking University), National 
Clinical Research Center for Mental Disorders (Peking University Sixth 
Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), 
Peking University, Beijing, 100191, China. linlu@bjmu.edu.cn.
(15)Peking-Tsinghua Centre for Life Sciences and PKU-IDG/McGovern Institute for 
Brain Research, Peking University, Beijing, China. linlu@bjmu.edu.cn.
(#)Contributed equally

The long-term physical and mental sequelae of COVID-19 are a growing public 
health concern, yet there is considerable uncertainty about their prevalence, 
persistence and predictors. We conducted a comprehensive, up-to-date 
meta-analysis of survivors' health consequences and sequelae for COVID-19. 
PubMed, Embase and the Cochrane Library were searched through Sep 30th, 2021. 
Observational studies that reported the prevalence of sequelae of COVID-19 were 
included. Two reviewers independently undertook the data extraction and quality 
assessment. Of the 36,625 records identified, a total of 151 studies were 
included involving 1,285,407 participants from thirty-two countries. At least 
one sequelae symptom occurred in 50.1% (95% CI 45.4-54.8) of COVID-19 survivors 
for up to 12 months after infection. The most common investigation findings 
included abnormalities on lung CT (56.9%, 95% CI 46.2-67.3) and abnormal 
pulmonary function tests (45.6%, 95% CI 36.3-55.0), followed by generalized 
symptoms, such as fatigue (28.7%, 95% CI 21.0-37.0), psychiatric symptoms 
(19.7%, 95% CI 16.1-23.6) mainly depression (18.3%, 95% CI 13.3-23.8) and PTSD 
(17.9%, 95% CI 11.6-25.3), and neurological symptoms (18.7%, 95% CI 16.2-21.4), 
such as cognitive deficits (19.7%, 95% CI 8.8-33.4) and memory impairment 
(17.5%, 95% CI 8.1-29.6). Subgroup analysis showed that participants with a 
higher risk of long-term sequelae were older, mostly male, living in a 
high-income country, with more severe status at acute infection. Individuals 
with severe infection suffered more from PTSD, sleep disturbance, cognitive 
deficits, concentration impairment, and gustatory dysfunction. Survivors with 
mild infection had high burden of anxiety and memory impairment after recovery. 
Our findings suggest that after recovery from acute COVID-19, half of survivors 
still have a high burden of either physical or mental sequelae up to at least 12 
months. It is important to provide urgent and appropriate prevention and 
intervention management to preclude persistent or emerging long-term sequelae 
and to promote the physical and psychiatric wellbeing of COVID-19 survivors.

© 2022. The Author(s), under exclusive licence to Springer Nature Limited.

DOI: 10.1038/s41380-022-01614-7
PMCID: PMC9168643
PMID: 35668159 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1937. Mol Psychiatry. 2022 Aug;27(8):3214-3222. doi: 10.1038/s41380-022-01638-z. Epub 
2022 Jun 6.

A systematic review and meta-analysis on prevalence of and risk factors 
associated with depression, anxiety and insomnia in infectious diseases, 
including COVID-19: a call to action.

Yuan K(#)(1), Zheng YB(#)(1)(2), Wang YJ(#)(2), Sun YK(#)(1), Gong YM(1), Huang 
YT(1), Chen X(3), Liu XX(1), Zhong Y(1)(2), Su SZ(1), Gao N(3), Lu YL(4), Wang 
Z(1), Liu WJ(1), Que JY(1), Yang YB(3), Zhang AY(1), Jing MN(5), Yuan CW(6), 
Zeng N(7)(8)(9), Vitiello MV(10), Patel V(11), Fazel S(12), Minas H(13), 
Thornicroft G(14), Fan TT(1), Lin X(1), Yan W(1), Shi L(1), Shi J(7), Kosten 
T(15), Bao YP(16)(17), Lu L(18)(19)(20).

Author information:
(1)Peking University Sixth Hospital, Peking University Institute of Mental 
Health, NHC Key Laboratory of Mental Health (Peking University), National 
Clinical Research Center for Mental Disorders (Peking University Sixth 
Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), 
Peking University, Beijing, China.
(2)Peking-Tsinghua Centre for Life Sciences and PKU-IDG/McGovern Institute for 
Brain Research, Peking University, Beijing, China.
(3)The First Affiliated Hospital of Xinxiang Medical University, Henan, China.
(4)School of Psychological and Cognitive Sciences, Peking University, Beijing, 
China.
(5)Department of Psychology, Renmin University of China, Beijing, China.
(6)Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
(7)National Institute on Drug Dependence and Beijing Key Laboratory of Drug 
Dependence, Peking University, Beijing, China.
(8)School of Public Health, Peking University, Beijing, China.
(9)Beijing Friendship Hospital, Capital Medical University, Beijing, China.
(10)Department of Psychiatry and Behavioral Sciences, University of Washington, 
Seattle, WA, 98195, USA.
(11)Department of Global Health and Social Medicine, Harvard Medical School, 
Boston, MA, USA.
(12)Department of Psychiatry, University of Oxford, Oxford, UK.
(13)Global and Cultural Mental Health Unit, Centre for Mental Health, School of 
Population and Global Health, University of Melbourne, Melbourne, VIC, 
Australia.
(14)Centre for Global Mental Health and Centre for Implementation Science, 
Institute of Psychiatry, Psychology and Neuroscience, King's College London, 
London, UK.
(15)Department of Psychiatry, Pharmacology, Neuroscience, Immunology, Baylor 
College of Medicine, Houston, TX, USA. kosten@bcm.edu.
(16)National Institute on Drug Dependence and Beijing Key Laboratory of Drug 
Dependence, Peking University, Beijing, China. baoyp@bjmu.edu.cn.
(17)School of Public Health, Peking University, Beijing, China. 
baoyp@bjmu.edu.cn.
(18)Peking University Sixth Hospital, Peking University Institute of Mental 
Health, NHC Key Laboratory of Mental Health (Peking University), National 
Clinical Research Center for Mental Disorders (Peking University Sixth 
Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), 
Peking University, Beijing, China. linlu@bjmu.edu.cn.
(19)Peking-Tsinghua Centre for Life Sciences and PKU-IDG/McGovern Institute for 
Brain Research, Peking University, Beijing, China. linlu@bjmu.edu.cn.
(20)National Institute on Drug Dependence and Beijing Key Laboratory of Drug 
Dependence, Peking University, Beijing, China. linlu@bjmu.edu.cn.
(#)Contributed equally

Infectious disease epidemics have become more frequent and more complex during 
the 21st century, posing a health threat to the general public and leading to 
psychological symptoms. The current study was designed to investigate the 
prevalence of and risk factors associated with depression, anxiety and insomnia 
symptoms during epidemic outbreaks, including COVID-19. We systematically 
searched the PubMed, Embase, Web of Science, OVID, Medline, Cochrane databases, 
bioRxiv and medRxiv to identify studies that reported the prevalence of 
depression, anxiety or insomnia during infectious disease epidemics, up to 
August 14th, 2020. Prevalence of mental symptoms among different populations 
including the general public, health workers, university students, older adults, 
infected patients, survivors of infection, and pregnant women across all types 
of epidemics was pooled. In addition, prevalence of mental symptoms during 
COVID-19 was estimated by time using meta-regression analysis. A total of 17,506 
papers were initially retrieved, and a final of 283 studies met the inclusion 
criteria, representing a total of 948,882 individuals. The pooled prevalence of 
depression ranged from 23.1%, 95% confidential intervals (95% CI: [13.9-32.2]) 
in survivors to 43.3% (95% CI: [27.1-59.6]) in university students, the pooled 
prevalence of anxiety ranged from 25.0% (95% CI: [12.0-38.0]) in older adults to 
43.3% (95% CI: [23.3-63.3]) in pregnant women, and insomnia symptoms ranged from 
29.7% (95% CI: [24.4-34.9]) in the general public to 58.4% (95% CI: [28.1-88.6]) 
in university students. Prevalence of moderate-to-severe mental symptoms was 
lower but had substantial variation across different populations. The prevalence 
of mental problems increased over time during the COVID-19 pandemic among the 
general public, health workers and university students, and decreased among 
infected patients. Factors associated with increased prevalence for all three 
mental health symptoms included female sex, and having physical disorders, 
psychiatric disorders, COVID infection, colleagues or family members infected, 
experience of frontline work, close contact with infected patients, high 
exposure risk, quarantine experience and high concern about epidemics. Frequent 
exercise and good social support were associated with lower risk for these three 
mental symptoms. In conclusion, mental symptoms are common during epidemics with 
substantial variation across populations. The population-specific psychological 
crisis management are needed to decrease the burden of psychological problem and 
improve the mental wellbeing during epidemic.

© 2022. The Author(s), under exclusive licence to Springer Nature Limited.

DOI: 10.1038/s41380-022-01638-z
PMCID: PMC9168354
PMID: 35668158 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1938. BMJ Open. 2022 Jun 6;12(6):e053800. doi: 10.1136/bmjopen-2021-053800.

COVID-19 in the context of pregnancy, infancy and parenting (CoCoPIP) study: 
protocol for a longitudinal study of parental mental health, social 
interactions, physical growth and cognitive development of infants during the 
pandemic.

Aydin E(1)(2), Weiss SM(3), Glasgow KA(4), Barlow J(5), Austin T(6)(7), Johnson 
MH(3), Lloyd-Fox S(3).

Author information:
(1)Department of Psychology, University of Cambridge, Cambridge, UK 
ea420@cam.ac.uk.
(2)Department of Psychiatry, Columbia University, New York City, NY, USA.
(3)Department of Psychology, University of Cambridge, Cambridge, UK.
(4)Department of Education, University of Cambridge, Cambridge, UK.
(5)Department of Social Policy, University of Oxford, Oxford, Oxfordshire, UK.
(6)Rosie Hospital, Cambridge, Cambridgeshire, UK.
(7)NIHR Cambridge Biomedical Research Centre, Cambridge, Cambridgeshire, UK.

INTRODUCTION: While the secondary impact of the COVID-19 pandemic on the 
psychological well-being of pregnant women and parents has become apparent over 
the past year, the impact of these changes on early social interactions, 
physical growth and cognitive development of their infants is unknown, as is the 
way in which a range of COVID-19-related changes have mediated this impact. This 
study (CoCoPIP) will investigate: (1) how parent's experiences of the social, 
medical and financial changes during the pandemic have impacted prenatal and 
postnatal parental mental health and parent-infant social interaction; and (2) 
the extent to which these COVID-19-related changes in parental prenatal and 
postnatal mental health and social interaction are associated with fetal and 
infant development.
METHODS AND ANALYSIS: The CoCoPIP study is a national online survey initiated in 
July 2020. This ongoing study (n=1700 families currently enrolled as of 6 May 
2021) involves both quantitative and qualitative data being collected across 
pregnancy and infancy. It is designed to identify the longitudinal impact of the 
pandemic from pregnancy to 2 years of age as assessed using a range of parent- 
and self-report measures, with the aim of identifying if stress-associated 
moderators (ie, loss of income, COVID-19 illness, access to ante/postnatal 
support) appear to impact parental mental health, and in turn, infant 
development. In addition, we aim to document individual differences in social 
and cognitive development in toddlers who were born during restrictions intended 
to mitigate COVID-19 spread (eg, social distancing, national lockdowns).
ETHICS AND DISSEMINATION: Ethical approval was given by the University of 
Cambridge, Psychology Research Ethics Committee (PRE.2020.077). Findings will be 
made available via community engagement, public forums (eg, social media,) and 
to national (eg, NHS England) and local (Cambridge Universities Hospitals NHS 
Foundation Trust) healthcare partners. Results will be submitted for publication 
in peer-reviews journals.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/bmjopen-2021-053800
PMCID: PMC9170803
PMID: 35667736 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


1939. J UOEH. 2022;44(2):151-159. doi: 10.7888/juoeh.44.151.

Impact of the COVID-19 Pandemic on the Mental Health of Users with Mental 
Illness of Home Visit Nursing Services in Japan.

Kodama T(1), Takaki S(1).

Author information:
(1)School of Health Sciences, University of Occupational and Environmental 
Health, Japan. Yahatanishi-ku, Kitakyushu 807-8555, Japan.

This study aims to clarify the impact of COVID-19 on the mental health of users 
with mental illness of home visit nursing services. We sent a questionnaire to 
1,740 home visit nursing station managers, 374 (21.5%) of whom responded. The 
total number of valid responses was 328, which amounted to 87.7% of the returned 
surveys. In total, 103 (31.4%) stations reported that their users' mental health 
deteriorated owing to the spread of COVID-19. Eighty-nine (86.4%) stations 
reported that their users' anxiety increased. More than 80% of the stations 
explained infection control measures to their users, but 194 (59.1%) stations 
answered that their users found it challenging to practice cleanliness. A total 
of 207 (63.1%) stations answered that the promotion of strategies for coping 
with stress is necessary for their users. Users with mental illness are 
vulnerable to stress and have a higher risk of death due to COVID-19. Thus, they 
should be carefully observed and referred to facilities if required. Home visit 
nursing staff have an important role to play in the preservation of the 
well-being of their users with mental illness during the COVID-19 pandemic.

DOI: 10.7888/juoeh.44.151
PMID: 35660680 [Indexed for MEDLINE]


1940. J Med Imaging Radiat Sci. 2022 Sep;53(3):384-395. doi: 
10.1016/j.jmir.2022.05.006. Epub 2022 May 18.

An evaluation of the impact of the Coronavirus (COVID 19) pandemic on 
interventional radiographers' wellbeing.

Murphy M(1), Moore N(1), Leamy B(2), England A(3), O'Connor OJ(4), McEntee 
MF(1).

Author information:
(1)Discipline of Medical Imaging & Radiation Therapy, University College Cork.
(2)Cork University Hospital.
(3)Discipline of Medical Imaging & Radiation Therapy, University College Cork. 
Electronic address: aengland@ucc.ie.
(4)Cork University Hospital; Mercy University Hospital; Department of Medicine, 
University College Cork.

BACKGROUND: Interventional radiographers have substantially contributed to 
patient care during the pandemic by providing imaging guidance during minimally 
invasive procedures. The aim of this research is to quantify the impact of the 
pandemic on an interventional radiographers' wellbeing during the COVID-19 
pandemic.
METHODS: Ethical approval was obtained at the outset of this study. An 
explanatory sequential mixed methods approach, using questionnaires and 
interviews, was used to explore and evaluate interventional radiographers' 
wellbeing; physical, mental and social. An electronic self-administered 
questionnaire was administered to interventional radiographers and a 
semi-structured interview was conducted on two respondents.
RESULTS: Responses were received from 40 interventional radiographers. Physical, 
mental and social wellbeing of interventional radiographers deteriorated since 
the onset of COVID-19. All forms of wellbeing were negatively impacted during 
the pandemic with mental wellbeing (82.5%) the most impacted, closely followed 
by physical (75%) and social wellbeing (50%). Half of responding interventional 
radiographers reported being "highly stressed" while working during COVID-19. 
Physical activity levels decreased, caffeine consumption increased and 
consumption of a healthy diet decreased. Almost all interventional radiographers 
(95%) had anxiety about passing the virus onto family or friends and 60% of 
noted a deterioration in relationship with friends. Three key themes identified 
included the importance of teamwork, the physical demand and mental impacts of 
working in interventional radiology during the pandemic.
CONCLUSIONS: The COVID-19 pandemic has had a negative effect on interventional 
radiographers' wellbeing. The implications of staff having a diminished sense of 
wellbeing is that productivity is likely to have been reduced and potentially 
related burnout can lead to illness. This research highlights the need to focus 
on identifying methods of addressing the shortcomings in support services and 
identifying the specific needs of interventional radiographers to improve their 
wellbeing.

CONTEXTE: Les radiographes d'intervention ont largement contribué aux soins des 
patients pendant la pandémie en fournissant des conseils d'imagerie pendant les 
procédures peu invasives. L'objectif de cette recherche est de quantifier 
l'impact de la pandémie sur le bien-être des radiographes d'intervention pendant 
la pandémie de COVID-19.
MÉTHODOLOGIE: L'approbation éthique a été obtenue dès le début de cette étude. 
Une approche séquentielle explicative de méthodes mixtes, utilisant des 
questionnaires et des entretiens, a été utilisée pour explorer et évaluer le 
bien-être physique, mental et social des radiographes interventionnels. Un 
questionnaire électronique auto-administré a été administré aux radiographes 
d'intervention et un entretien semi-structuré a été mené auprès de deux 
répondants.
RÉSULTATS: Des réponses ont été reçues de 40 radiographes d'intervention. Le 
bien-être physique, mental et social des radiographes d'intervention s'est 
détérioré depuis le début de la pandémie de COVID-19. Toutes les formes de 
bien-être ont été affectées négativement pendant la pandémie, le bien-être 
mental (82,5 %) étant le plus touché, suivi de près par le bien-être physique 
(75 %) et social (50 %). La moitié des radiographes d'intervention ayant répondu 
à l'enquête ont déclaré avoir été « très stressés » en travaillant pendant la 
pandémie. Le niveau d'activité physique a diminué, la consommation de caféine a 
augmenté et la consommation d'une alimentation saine a diminué. Presque tous les 
radiographes d'intervention (95 %) étaient anxieux à l'idée de transmettre le 
virus à leur famille ou à leurs amis et 60 % d'entre eux ont noté une 
détérioration de leurs relations avec leurs amis. Trois thèmes clés ont été 
identifiés : l'importance du travail en équipe, la demande physique et les 
impacts mentaux du travail en radiologie interventionnelle pendant la pandémie.
CONCLUSION: La pandémie de COVID-19 a eu un effet négatif sur le bien-être des 
radiologues interventionnels. Les implications d'un personnel ayant un sentiment 
de bien-être diminué sont que la productivité est susceptible d'avoir été 
réduite et que l'épuisement professionnel potentiellement lié peut conduire à la 
maladie. Cette recherche met en évidence la nécessité de se concentrer sur 
l'identification des méthodes permettant de combler les lacunes des services de 
soutien et d'identifier les besoins spécifiques des radiographes d'intervention 
pour améliorer leur bien-être.

Copyright © 2022. Published by Elsevier Inc.

DOI: 10.1016/j.jmir.2022.05.006
PMCID: PMC9114273
PMID: 35660274 [Indexed for MEDLINE]


1941. Public Health. 2022 Jul;208:1-8. doi: 10.1016/j.puhe.2022.04.006. Epub 2022 May 
2.

Teachers' emotional well-being during the SARS-CoV-2 pandemic with long school 
closures: a large-scale cross-sectional survey in Northern Italy.

Keim R(1), Pfitscher G(2), Leitner S(2), Burger K(2), Giacomoni F(2), Wiedermann 
CJ(3).

Author information:
(1)Südtiroler Sanitätsbetrieb, Azienda Sanitaria dell'Alto Adige, Service of 
Psychology, Brixen Bressanone BZ, Italy. Electronic address: 
roland.keim@yahoo.de.
(2)Südtiroler Sanitätsbetrieb, Azienda Sanitaria dell'Alto Adige, Service of 
Psychology, Brixen Bressanone BZ, Italy.
(3)Department of Public Health, Medical Decision Making and HTA, University of 
Health Sciences, Medical Informatics and Technoloy, Hall in Tyrol, Austria; 
Institute of General Practice, College of Health Care Professions Claudiana 
Bolzano/Bozen, Italy.

OBJECTIVES: This study aimed to evaluate the magnitude of emotional burden on 
teaching staff during the SARS-CoV-2 pandemic in a significantly impacted 
region. In addition, the correlates of emotional burden were analysed to enable 
the design of targeted interventions.
STUDY DESIGN: This study was a cross-sectional survey.
METHODS: An electronic survey was administered to the teaching staff at public 
schools and kindergartens in a specific geographical area. Cross-sectional 
assessments of pandemic-specific variables were performed using the Pandemic 
Fatigue Scale, the Depression Anxiety Stress Scale (DASS)-21, the Satisfaction 
with Life Scale, and the Resilient Coping Scale. DASS-21 results were compared 
with results from a parallel survey that was representative of the local general 
population.
RESULTS: In total, 3251 teaching staff members participated in the survey. 
Teachers showed a higher emotional burden for depression, anxiety and stress 
than the general population during the pandemic. According to a linear 
regression model, this burden is correlated with the language in which the 
questionnaires were answered, mistrust towards institutions, specific SARS-CoV-2 
anxiety, past infection with SARS-CoV-2, avoidance of information about the 
pandemic and pandemic fatigue; emotional burden was negatively correlated with 
measures for life satisfaction, resilience and team atmosphere. Some independent 
variables were shown to contribute differentially to the variance of depression, 
anxiety or stress.
CONCLUSIONS: Emotional distress during the pandemic among teachers is higher 
than in the general population and correlates with variables that could, at 
least in principle, be targeted for specific interventions.

Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.puhe.2022.04.006
PMCID: PMC9058056
PMID: 35659680 [Indexed for MEDLINE]


1942. BMC Pregnancy Childbirth. 2022 Jun 4;22(1):468. doi: 10.1186/s12884-022-04795-9.

Associations between COVID-19 lockdown and post-lockdown on the mental health of 
pregnant women, postpartum women and their partners from the Queensland family 
cohort prospective study.

Clifton VL(1), Kumar S(2), Borg D(2), Rae KM(2)(3), Boyd RN(4), Whittingham 
K(4), Moritz KM(5), Carter HE(6)(7), McPhail SM(6)(7), Gannon B(8), Ware R(9), 
Dixson BJW(10)(11), Bora S(2), Hurst C(12).

Author information:
(1)Mater Research Institute, The University of Queensland, Raymond Terrace, 
Level 3, Aubigny Place, South Brisbane, QLD, 4101, Australia. 
vicki.clifton@mater.uq.edu.au.
(2)Mater Research Institute, The University of Queensland, Raymond Terrace, 
Level 3, Aubigny Place, South Brisbane, QLD, 4101, Australia.
(3)Faculty of Medicine, The University of Queensland, Brisbane, Australia.
(4)Faculty of Medicine, Queensland Cerebral Palsy and Rehabilitation Research 
Centre, Child Health Research Centre, The University of Queensland, Brisbane, 
Australia.
(5)School of Biomedical Sciences, the Child Health Research Centre, The 
University of Queensland, Brisbane, Australia.
(6)Australian Centre for Health Services Innovation and Centre for Healthcare 
Transformation, School of Public Health and Social Work, Queensland University 
of Technology, Brisbane, Australia.
(7)Clinical Informatics Directorate, Metro South Health, Brisbane, Australia.
(8)Centre for the Business and Economics of Health and School of Economics, The 
University of Queensland, Brisbane, Australia.
(9)Menzies Health Institute Queensland, Griffith University, Brisbane, 
Australia.
(10)School of Health and Behavioural Sciences, University of the Sunshine Coast, 
Queensland, Australia.
(11)School of Psychology, The University of Queensland, Queensland, Australia.
(12)Molly Wardaguga Research Centre, Charles Darwin University, Queensland, 
Australia.

BACKGROUND: There are very few developed countries where physical isolation and 
low community transmission has been reported for COVID-19 but this has been the 
experience of Australia. The impact of physical isolation combined with low 
disease transmission on the mental health of pregnant women is currently unknown 
and there have been no studies examining the psychological experience for 
partners of pregnant women during lockdown. The aim of the current study was to 
examine the impact of the first COVID-19 lockdown in March 2020 and post 
lockdown from August 2020 on the mental health of pregnant women or postpartum 
women and their partners.
METHODS: Pregnant women and their partners were prospectively recruited to the 
study before 24 weeks gestation and completed various questionnaires related to 
mental health and general wellbeing at 24 weeks gestation and then again at 
6 weeks postpartum. The Depression, Anxiety and Stress Scale (DASS-21) and the 
Edinburgh Postnatal Depression Scale (EPDS) were used as outcome measures for 
the assessment of mental health in women and DASS-21 was administered to their 
partners. This analysis encompasses 3 time points where families were recruited; 
before the pandemic (Aug 2018-Feb 2020), during lockdown (Mar-Aug 2020) and 
after the first lockdown was over (Sept-Dec 2020).
RESULTS: There was no significant effect of COVID-19 lockdown and post lockdown 
on depression or postnatal depression in women when compared to a pre-COVID-19 
subgroup. The odds of pregnant women or postpartum women experiencing severe 
anxiety was more than halved in women during lockdown relative to women in the 
pre-COVID-19 period (OR = 0.47; 95%CI: 0.27-0.81; P = 0.006). Following lockdown 
severe anxiety was comparable to the pre-COVID-19 women. Lockdown did not have 
any substantial effects on stress scores for pregnant and postpartum women. 
However, a substantial decrease of over 70% in the odds of severe stress was 
observed post-lockdown relative to pre-COVID-19 levels. Partner's depression, 
anxiety and stress did not change significantly with lockdown or post lockdown.
CONCLUSION: A reproductive age population appear to be able to manage the impact 
of lockdown and the pandemic with some benefits related to reduced anxiety.

© 2022. The Author(s).

DOI: 10.1186/s12884-022-04795-9
PMCID: PMC9166205
PMID: 35659202 [Indexed for MEDLINE]

Conflict of interest statement: None.


1943. BMC Public Health. 2022 Jun 3;22(1):1108. doi: 10.1186/s12889-022-13509-x.

Sexual satisfaction and sexual behaviors during the COVID-19 pandemic: results 
from the International Sexual Health And REproductive (I-SHARE) health survey in 
Luxembourg.

Fischer VJ(1), Bravo RG(2), Brunnet AE(3), Michielsen K(4), Tucker JD(5), 
Campbell L(6), Vögele C(2).

Author information:
(1)Research Group Self-Regulation and Health, Institute for Health and 
Behaviour, Department of Behavioural and Cognitive Sciences, University of 
Luxembourg, Esch-sur-Alzette, Luxembourg. viniciusjfischer@gmail.com.
(2)Research Group Self-Regulation and Health, Institute for Health and 
Behaviour, Department of Behavioural and Cognitive Sciences, University of 
Luxembourg, Esch-sur-Alzette, Luxembourg.
(3)Laboratoire Clinique Psychanalyse Développement (CLIPSYD - EA4430), 
University of Paris Nanterre, Paris, France.
(4)International Centre for Reproductive Health, Department of Public Health and 
Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, 
Belgium.
(5)Institute for Global Health and Infectious Diseases, University of North 
Carolina, Chapel Hill, USA.
(6)Centre for Population, Family and Health, University of Antwerp, Antwerp, 
Belgium.

AIM: To identify the impact of COVID-19 measures on sexual behaviors and sexual 
satisfaction in Luxembourg residents.
METHODS: We conducted a cross-sectional online survey of adults (> 18 years of 
age) residing in Luxembourg, while COVID-19 restrictions were in place. The 
survey was available from January 15 to February 12, 2021 in four languages 
(French, German, English and Portuguese). Survey questions focused on 
masturbation, cuddling, condom use, sex frequency, sexting, cybersex, watching 
porn, and sexual satisfaction.
RESULTS: 557 volunteers completed the survey (35.5% men, 64.3% women). Sexual 
satisfaction and sexual problems variables were assessed on 4-point Likert 
scales (0 = not at all/never to 3 = very/often). Sexual problems increased 
during the COVID-19 measures while sexual satisfaction decreased compared to 
before the introduction of COVID-19 restrictions (assessed retrospectively). 
Factors associated with increased odds of sexual satisfaction included having a 
steady relationship before COVID-19 restrictions, engaging in sexting, reporting 
good mental health and not altering alcohol intake.
CONCLUSIONS: The context of the COVID-19 pandemic and the measures implemented 
in Luxembourg affected sexual behaviors and sexual satisfaction. Sexual and 
reproductive health care centers and health professionals in general should take 
these results into consideration when providing care. Recommendations on the 
importance of sexual health for general wellbeing and behaviors associated with 
sexual satisfaction should be offered and possibilities to experience sexuality 
while reducing contamination risks be discussed.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-13509-x
PMCID: PMC9163902
PMID: 35658847 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no competing interests to 
declare.


1944. Aging Ment Health. 2023 Mar;27(3):521-532. doi: 10.1080/13607863.2022.2080179. 
Epub 2022 Jun 6.

Predictors of loneliness during the Covid-19 pandemic in people with dementia 
and their carers in England: findings from the DETERMIND-C19 study.

Perach R(1), Read S(2), Hicks B(3), Harris PR(1), Rusted J(1), Brayne C(4), 
Dangoor M(4), Miles E(1), Dixon J(2), Robinson L(5), Thomas A(5), Banerjee 
S(3)(6); DETERMIND Team.

Author information:
(1)School of Psychology, University of Sussex, Brighton, UK.
(2)Care Policy and Evaluation Centre, London School of Economics and Political 
Science, London, UK.
(3)Brighton and Sussex Medical School, University of Sussex, Brighton, UK.
(4)Department of Public Health and Primary Care, University of Cambridge, 
Cambridge, UK.
(5)Institute for Ageing, Newcastle University, Newcastle, UK.
(6)Faculty of Health, University of Plymouth, Plymouth, UK.

OBJECTIVES: To identify factors that predict the risk of loneliness for people 
with dementia and carers during a pandemic.
METHODS: People with dementia and their carers completed assessments before 
(July 2019-March 2020; 206 dyads) and after (July-October 2020) the first 
Covid-19 'lockdown' in England. At follow-up, the analytic sample comprised 67 
people with dementia and 108 carers. We built a longitudinal path model with 
loneliness as an observed outcome. Carer type and social contacts at both 
measurements were considered. Other social resources (quality of relationship, 
formal day activities), wellbeing (anxiety, psychological wellbeing) and 
cognitive impairment were measured with initial level and change using latent 
growth curves. We adjusted for socio-demographic factors and health at baseline.
RESULTS: In carers, higher levels of loneliness were directly associated with 
non-spouse coresident carer type, level and increase of anxiety in carer, more 
formal day activities, and higher cognitive impairment in the person with 
dementia. In people with dementia, non-spouse coresident carer type, and higher 
initial levels of social resources, wellbeing, and cognitive impairment 
predicted the changes in these factors; this produced indirect effects on social 
contacts and loneliness.
CONCLUSION: Loneliness in the Covid-19 pandemic appears to be shaped by 
different mechanisms for people with dementia and their carers. The results 
suggest that carers of those with dementia may prioritize providing care that 
protects the person with dementia from loneliness at the cost of experiencing 
loneliness themselves. Directions for the promotion of adaptive social care 
during the Covid-19 pandemic and beyond are discussed.

DOI: 10.1080/13607863.2022.2080179
PMID: 35658781 [Indexed for MEDLINE]


1945. Ann Acad Med Singap. 2022 May;51(5):283-291. doi: 
10.47102/annals-acadmedsg.202219.

Prevalence and correlates of psychological distress and coronavirus anxiety 
among hospital essential services workers in Singapore.

Khaing NEE(1), Lim CS, Soon SP, Oh HC.

Author information:
(1)Health Services Research, Changi General Hospital, Singapore.

INTRODUCTION: The COVID-19 pandemic has affected almost all populations, with 
frontline workers experiencing a higher risk of mental health effects compared 
to other groups. Although there are several research studies focusing on the 
mental health effects of the pandemic on healthcare workers, there is little 
research about its impact on workers in outsourced hospital essential services. 
This study aims to examine the prevalence and correlates of psychological 
distress and coronavirus anxiety among staff working in 3 outsourced hospital 
essential services-housekeeping, porter service and maintenance services.
METHODS: A cross-sectional study was conducted among outsourced hospital 
essential services workers in a tertiary hospital. Data on demographics, medical 
history, lifestyle factors, psychosocial factors and mental well-being were 
collected using self-administered questionnaires. Robust logistic regression was 
used to determine risk factors associated with psychological distress and 
dysfunctional anxiety related to COVID-19.
RESULTS: A total of 246 hospital essential services workers participated in the 
study. The prevalence of psychological distress was 24.7%, and dysfunctional 
anxiety related to COVID-19 was 13.4%. Social support and workplace support were 
found to be independently associated with a lower risk of psychological 
distress, and social connectivity was associated with a lower risk of 
dysfunctional anxiety related to COVID-19.
CONCLUSION: These findings highlight the crucial roles of communities and 
workplaces in combating the mental health consequences of the pandemic. Public 
health programmes that aim to tackle the emerging mental health crisis in 
hospital essential services workers should incorporate strategies to address 
psychosocial factors, in addition to traditional self-care approaches.

DOI: 10.47102/annals-acadmedsg.202219
PMID: 35658151 [Indexed for MEDLINE]


1946. J Contemp Dent Pract. 2021 Dec 1;22(12):1426-1433.

Psychological Impact of the COVID-19 Pandemic on Dental Hygiene Students in 
Saudi Arabia: A Nation-wide Study.

Mulla M(1).

Author information:
(1)Department of Oral and Dental Health, College of Applied Health Sciences in 
Arrass, Qassim University, Saudi Arabia, Phone: +966 561691518, e-mail: 
m.mulla@qu.edu.sa.

AIM: Worldwide healthcare professionals are experiencing constant stress during 
their day-to-day work due to coronavirus disease-2019 (COVID-19) pandemic. 
Students' anxiety tendency has also been increased due to the disturbance of 
education. This study aims to evaluate the anxiety and depression levels of 
dental hygiene students in Saudi Arabia during COVID-19 lockdown period.
MATERIALS AND METHODS: A cross-sectional study was conducted among the dental 
hygiene students in Saudi Arabia to assess the psychological impact of the 
COVID-19 outbreak. Questionnaire was distributed to the students, which 
consisted questions regarding demographics, knowledge, and fear related to 
COVID-19 and validated self-reported anxiety screening scale (GAD-7), to assess 
the psychological impact. All the data were then subjected to statistical 
analysis.
RESULTS: Students from King Abdul Aziz University and Prince Sattam University 
showed statistically higher anxiety score when comparing the GAD-7 questions. 
Students whose parents were unemployed during pandemic and the students from 
rural area had statistically greater anxiety level when compared to others. 
Also, anxiety levels were found to be significantly higher among students who 
slightly feared contacting the disease because of their profession.
CONCLUSION: The present results demonstrate that dental hygiene students 
suffered from some form of anxiety ranging from mild anxiety to severe anxiety, 
reporting that they frequently felt nervous and were scared that something 
terrible would happen. Psychological well-being of healthcare professionals is 
necessary for the optimal treatment of patients.
CLINICAL SIGNIFICANCE: Anxiety is considered as an important factor for 
healthcare students that may influence negatively on their personal and academic 
life. Thus appropriate assessment and offering immediate treatment will prove 
beneficial to prevent serious consequences.

PMID: 35656682 [Indexed for MEDLINE]


1947. Front Public Health. 2022 May 17;10:814981. doi: 10.3389/fpubh.2022.814981. 
eCollection 2022.

Prevalence of Anxiety and Depression Among the General Population in Africa 
During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis.

Bello UM(1)(2), Kannan P(3), Chutiyami M(4), Salihu D(5), Cheong AMY(1)(6), 
Miller T(3), Pun JW(3), Muhammad AS(2), Mahmud FA(7), Jalo HA(8), Ali MU(3)(9), 
Kolo MA(10), Sulaiman SK(11), Lawan A(9)(12), Bello IM(13), Gambo AA(14), Winser 
SJ(3).

Author information:
(1)Centre for Eye and Vision Research Limited, Hong Kong, Hong Kong SAR, China.
(2)Department of Physiotherapy, Yobe State University Teaching Hospital, 
Damaturu, Nigeria.
(3)Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 
Hong Kong, Hong Kong SAR, China.
(4)School of Nursing, Institute of Health and Management, Sydney, NSW, 
Australia.
(5)School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong 
SAR, China.
(6)School of Optometry, The Hong Kong Polytechnic University, Hong Kong, Hong 
Kong SAR, China.
(7)Physiotherapy Department, Yobe State Specialist Hospital, Damaturu, Nigeria.
(8)Department of Paediatrics, Yobe State Specialist Hospital, Damaturu, Nigeria.
(9)Department of Rehabilitation Sciences, University of Maiduguri, Maiduguri, 
Nigeria.
(10)Department of Geography, University of Maiduguri, Maiduguri, Nigeria.
(11)Department of Physiotherapy, Bayero University Kano, Kano, Nigeria.
(12)Department of Rehabilitation Science, Western University, London, ON, 
Canada.
(13)Department of Medicine and Surgery, Ahmadu Bello University, Zaria, Nigeria.
(14)Department of Paediatrics, Barau Dikko Teaching Hospital, Kaduna, Nigeria.

BACKGROUND: Medical and socio-economic uncertainties surrounding the COVID-19 
pandemic have had a substantial impact on mental health. This study aimed to 
systematically review the existing literature reporting the prevalence of 
anxiety and depression among the general populace in Africa during the COVID-19 
pandemic and examine associated risk factors.
METHODS: A systematic search of the following databases African Journal Online, 
CINAHL, PubMed, Scopus, and Web of Science was conducted from database inception 
until 30th September 2021. Studies reporting the prevalence of anxiety and/or 
depression among the general populace in African settings were considered for 
inclusion. The methodological quality of included studies was assessed using the 
Agency for Healthcare Research and Quality (AHRQ). Meta-analyses on prevalence 
rates were conducted using Comprehensive Meta-analysis software.
RESULTS: Seventy-eight primary studies (62,380 participants) were identified 
from 2,325 studies via electronic and manual searches. Pooled prevalence rates 
for anxiety (47%, 95% CI: 40-54%, I2 = 99.19%) and depression (48%, 95% CI: 
39-57%, I2 = 99.45%) were reported across Africa during the COVID-19 pandemic. 
Sex (female) and history of existing medical/chronic conditions were identified 
as major risk factors for anxiety and depression.
CONCLUSIONS: The evidence put forth in this synthesis demonstrates the 
substantial impact of the pandemic on the pervasiveness of these psychological 
symptoms among the general population. Governments and stakeholders across 
continental Africa should therefore prioritize the allocation of available 
resources to institute educational programs and other intervention strategies 
for preventing and ameliorating universal distress and promoting psychological 
wellbeing.
SYSTEMATIC REVIEW REGISTRATION: 
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021228023, 
PROSPERO CRD42021228023.

Copyright © 2022 Bello, Kannan, Chutiyami, Salihu, Cheong, Miller, Pun, 
Muhammad, Mahmud, Jalo, Ali, Kolo, Sulaiman, Lawan, Bello, Gambo and Winser.

DOI: 10.3389/fpubh.2022.814981
PMCID: PMC9152218
PMID: 35655463 [Indexed for MEDLINE]

Conflict of interest statement: UB and AC were employed by the Centre for Eye 
and Vision Research (CEVR) Limited. The remaining authors declare that the 
research was conducted in the absence of any commercial or financial 
relationships that could be construed as a potential conflict of interest.


1948. Front Public Health. 2022 May 17;10:871934. doi: 10.3389/fpubh.2022.871934. 
eCollection 2022.

Mental Health Conditions Among E-Learning Students During the COVID-19 Pandemic.

Rutkowska A(1), Cieślik B(2), Tomaszczyk A(3), Szczepańska-Gieracha J(4).

Author information:
(1)Department of Physical Education and Physiotherapy, Opole University of 
Technology, Opole, Poland.
(2)Department of Kinesiology and Health Prevention, Jan Dlugosz University in 
Częstochowa, Częstochowa, Poland.
(3)Descartes' Error Student Research Association, Faculty of Physical Education 
and Physiotherapy, Opole University of Technology, Opole, Poland.
(4)Faculty of Physiotherapy, University School of Physical Education, Wroclaw, 
Poland.

AIM: The COVID-19 pandemic has forced the education system to undergo changes, 
which have also affected universities. E-learning became the main form of 
education, reducing interpersonal contacts, which could affect the mental 
wellbeing of students. The aim of this study was to investigate the prevalence 
of depressive symptoms and the level of perceived stress during e-learning among 
Polish students and to identify the factors for predicting higher levels of 
depression symptoms.
METHODS: The study included 753 participants with a mean age of 22.47 (±4.02) 
years. The Perception of Stress Questionnaire (PSQ) and Beck Depression 
Inventory (BDI-II) were used to measure the severity of stress and level of 
depression. Furthermore, our own survey was used to assess the impact of 
e-learning on various aspects of life. To examine how much stress can explain a 
statistically significant amount of variance in depression, three-step 
hierarchical multiple regression was used. In addition, our own questionnaire 
was used to assess the impact of e-learning on education, social contacts and 
technical abilities.
RESULTS: A total of 58% of the students characterized by an increased level of 
stress. 56% show symptoms of depression and 18% of the participants had suicidal 
thoughts. The most significant predictor of depression is high stress levels and 
factors related to e-learning: isolation from friends and acquaintances, 
negative impact on level of knowledge, reduced motivation to learn, and 
worsening grades. This predictors may explain about 66% of the variance of 
depression.
CONCLUSION: Universities should implement interventions and educational 
programmes, providing ad hoc assistance in the form of individual or group 
meetings with a psychologist (also in a remote form) and organizing workshops 
and webinars on strategies for managing stress.

Copyright © 2022 Rutkowska, Cieślik, Tomaszczyk and Szczepańska-Gieracha.

DOI: 10.3389/fpubh.2022.871934
PMCID: PMC9152265
PMID: 35655450 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1949. Am J Prev Med. 2022 Aug;63(2):273-276. doi: 10.1016/j.amepre.2022.02.010. Epub 
2022 Mar 15.

Community Health Needs Assessment Data and Community Recovery From COVID-19.

Molella RG(1), Murad AL(2), Sherden M(3), Fritz DJ(3), Sadecki EN(4), Briggs 
G(3), Wang Z(5), Murad MH(6).

Author information:
(1)Division of Public Health, Infectious Diseases and Occupational Medicine, 
Mayo Clinic, Rochester, Minnesota.
(2)Stephen and Barbara Slaggie Family Cancer Education Center, Mayo Clinic 
Cancer Center, Rochester, Minnesota.
(3)Olmsted County Public Health Services, Rochester, Minnesota.
(4)Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota.
(5)Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, 
Mayo Clinic, Rochester, Minnesota.
(6)Division of Public Health, Infectious Diseases and Occupational Medicine, 
Mayo Clinic, Rochester, Minnesota. Electronic address: murad.mohammad@mayo.edu.

INTRODUCTION: The COVID-19 pandemic has had a significant impact beyond physical 
morbidity and mortality. A mid-cycle Community Health Needs Assessment survey 
was administered in 1 community to generate data to evaluate change in community 
well-being since the beginning of the pandemic.
METHODS: Surveys were mailed to 2,000 randomly selected residents in Olmsetd 
County, Minnesota. The surveys included the WHO Well-being Index (previously 
included in the 2018 Community Health Needs Assessment) and new subjective 
questions regarding behavior change. Changes in well-being were calculated using 
a propensity-matched cohort, and behavior change was reported as proportions of 
the whole. Data analysis was completed in 2021.
RESULTS: Total survey respondents were 569 people in 2018 and 723 people in 
2021. Well-being scores from the WHO Well-being Index showed a statistically 
significant decrease (score reduction of -8.44) from 2018 to 2021. All the 5 
questions from the WHO Well-being Index also had an individual significant 
decrease; with the question regarding interest in life showing the greatest 
decrease. Individuals reported decreased subjective physical and mental 
well-being and increased substance use (alcohol, marijuana, and tobacco). 
Households also reported decreased household incomes and worse household 
finances since the start of the pandemic.
CONCLUSIONS: Using the Community Health Needs Assessment infrastructure, 1 
community was able to compare prepandemic with postpandemic data, which showed 
decreased well-being and increased substance use and financial stress. Other 
public health planners can similarly conduct interval surveys on the basis of 
their Community Health Needs Assessment questionnaires to tailor ongoing 
Community Health Improvement Plan programming to postpandemic needs and track 
community mental health and well-being recovery.

Copyright © 2022 American Journal of Preventive Medicine. Published by Elsevier 
Inc. All rights reserved.

DOI: 10.1016/j.amepre.2022.02.010
PMCID: PMC8920785
PMID: 35654661 [Indexed for MEDLINE]


1950. Int J Drug Policy. 2022 Aug;106:103752. doi: 10.1016/j.drugpo.2022.103752. Epub 
2022 May 27.

A qualitative study exploring the impact of the COVID-19 pandemic on People Who 
Inject Drugs (PWID) and drug service provision in the UK: PWID and service 
provider perspectives.

May T(1), Dawes J(2), Fancourt D(1), Burton A(3).

Author information:
(1)Research Department of Behavioural Science and Health, Institute of 
Epidemiology & Health Care, University College London, United Kingdom.
(2)UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology and 
Health Care, University College London, United Kingdom.
(3)Research Department of Behavioural Science and Health, Institute of 
Epidemiology & Health Care, University College London, United Kingdom. 
Electronic address: a.burton@ucl.ac.uk.

BACKGROUND: People Who Inject Drugs (PWID) are subject to distinct 
socio-structural inequalities that can expose them to high risks of COVID-19 
transmission and related health and social complications. In response to 
COVID-19 mitigation strategies, these vulnerabilities are being experienced in 
the context of adapted drug treatment service provision, including reduced 
in-person support and increased regulatory flexibility in opioid substitution 
therapy (OST) guidelines. This study aimed to explore the longer-term impact of 
the pandemic on the health and wellbeing of PWID in the UK, including provider 
and client experiences of treatment changes.
METHODS: Interviews were conducted with 19 PWID and 17 drug treatment providers 
between May and September 2021, recruited from drug and homelessness charities 
providing treatment services and healthcare in the UK. Data were analysed using 
reflexive thematic analysis.
RESULTS: Most participants expressed ongoing fears of COVID-19 transmission, 
although socio-structural inequalities limited the contexts in which physical 
distancing could be practised. In addition, virus mitigation strategies altered 
the risk environment for PWID, resulting in ongoing physical (e.g. changing drug 
use patterns, including transitions to crack cocaine, benzodiazepine and 
pregabalin use) and socio-economic harms (e.g. limited opportunities for sex 
work engagement and income generation). Finally, whilst clients reported some 
favourable experiences from service adaptations prompted by COVID-19, including 
increased regulatory flexibility in OST guidelines, there was continued 
scepticism and caution among providers toward sustaining any treatment changes 
beyond the pandemic period.
CONCLUSIONS: Whilst our findings emphasize the importance of accessible harm 
reduction measures attending to changing indices of drug-related harm during 
this period, there is a need for additional structural supports to ensure 
pre-existing disparities and harms impacting PWID are not exacerbated further by 
the conditions of the pandemic. In addition, any sustained policy and service 
delivery adaptations prompted by COVID-19 will require further attention if they 
are to be acceptable to both service users and providers.

Copyright © 2022. Published by Elsevier B.V.

DOI: 10.1016/j.drugpo.2022.103752
PMCID: PMC9135844
PMID: 35653821 [Indexed for MEDLINE]

Conflict of interest statement: Declarations of Interest The authors declare 
that they have no known competing financial interests or personal relationships 
that could have appeared to influence the work reported in this paper.


1951. J Neural Transm (Vienna). 2022 Jun;129(5-6):675-688. doi: 
10.1007/s00702-022-02512-6. Epub 2022 Jun 2.

Impact of the COVID-19 pandemic on mental health and family situation of 
clinically referred children and adolescents in Switzerland: results of a survey 
among mental health care professionals after 1 year of COVID-19.

Werling AM(1), Walitza S(2)(3), Eliez S(3)(4), Drechsler R(2).

Author information:
(1)Department of Child and Adolescent Psychiatry and Psychotherapy, Centre for 
Child and Adolescent Psychiatric Research, Neuropsychology, University Hospital 
of Psychiatry Zurich, University of Zurich, Eisengasse 16, 8008, Zurich, 
Switzerland. anna.werling@pukzh.ch.
(2)Department of Child and Adolescent Psychiatry and Psychotherapy, Centre for 
Child and Adolescent Psychiatric Research, Neuropsychology, University Hospital 
of Psychiatry Zurich, University of Zurich, Eisengasse 16, 8008, Zurich, 
Switzerland.
(3)Swiss Society for Child and Adolescent Psychiatry and Psychotherapy, Bern, 
Switzerland.
(4)Department of Psychiatry, University of Geneva School of Medicine, Geneva, 
Switzerland.

The aim of this study was to assess the impact of the COVID-19 pandemic on 
mental well-being of clinically referred children and adolescents and on their 
families from the perspective of mental health care professionals in Switzerland 
during the first year of the pandemic. Psychiatrists and psychologists for 
children and adolescents participated in an anonymous survey conducted online in 
April/May 2021. The survey was completed by 454 mental health care 
professionals, most of them working in outpatient clinics for child and 
adolescent psychiatry or in independent practices. Most participants indicated 
an important increase of referrals for depression (86.8% of respondents), 
anxiety disorders (81.5%), crisis interventions (76.2%), psychosomatic disorders 
(66.1%), suicidality (63.8%), and behavioral addictions, e.g., excessive gaming 
(64.6%). In contrast, referrals or treatment demands for disorders such as 
autism spectrum disorder or psychosis showed no substantial change or a slight 
decrease, respectively. According to 69% of respondents, patients experienced 
the highest psychological burden in January/February/March 2021. Family problems 
very frequently reported by mental health professionals were parents' worries 
about loneliness/isolation of the child (49%), child's education and academic 
future (33%), increased media use due to missing options of recreational 
activities (37.6%), as well as multiple stresses of mothers (36.3%). To 
conclude, the pandemic has substantially changed the pattern of disorders and 
the number of clinical referrals of children and adolescents with mental health 
problems, which has serious consequences for the treatment supply in 
Switzerland.

© 2022. The Author(s).

DOI: 10.1007/s00702-022-02512-6
PMCID: PMC9160518
PMID: 35652976 [Indexed for MEDLINE]

Conflict of interest statement: S. Walitza has received in the last 5 years 
royalties from Thieme Hogrefe, Kohlhammer, Springer, Beltz, Elsevier. Her work 
was supported in the last 5 years by the Swiss National Science Foundation 
(SNF), diff. EU FP7s, Bfarm Germany, ZInEP, Gertrud Thalmann, Vontobel, 
Unicentia, Erika Schwarz Fonds. Outside professional activities and interests 
are declared under the link of the University of Zurich 
www.uzh.ch/prof/ssl-dir/interessenbindungen/client/web/. RD has received 
royalties from Hogrefe and her work has been supported by the SNF in the last 
5 years. The other authors declare no conflict of interest.


1952. Sociol Health Illn. 2023 Jul;45(6):1187-1204. doi: 10.1111/1467-9566.13483. Epub 
2022 Jun 2.

Affect, dis/ability and the pandemic.

Goodley D(1), Lawthom R(1), Liddiard K(1), Runswick-Cole K(1).

Author information:
(1)iHuman, School of Education, University of Sheffield, Sheffield, UK.

The pandemic has heightened anxieties, impacted mental health and threatened to 
create an overwhelming sense of existential dread. We recognise the material 
ways in which disabled people have been differentially impacted by Covid-19 and 
make a case for understanding the affective dimensions of the pandemic. We 
develop a theoretical approach - cutting across medical sociology and critical 
disability studies - that understands affect as a social, cultural, relational 
and psychopolitical phenomenon. We introduce a public engagement project that 
took place in March and April of 2020 that garnered blogspots from around the 
world to capture the pandemic's impact on the lives of disabled people. Our data 
analysis reveals three key affective themes: fragility, anxiety and affirmation. 
To understand the emotional impacts of Covid-19 upon the lives of disabled 
people we embed critical analyses of affect in the dual processes of disablism 
and ableism: the dis/ability complex. We conclude by considering how we might 
conceive of a post-pandemic recovery that places the health and well-being of 
disabled people at the centre of proceedings.

© 2022 The Authors. Sociology of Health & Illness published by John Wiley & Sons 
Ltd on behalf of Foundation for SHIL (SHIL).

DOI: 10.1111/1467-9566.13483
PMCID: PMC9347725
PMID: 35652519 [Indexed for MEDLINE]


1953. Int J Soc Psychiatry. 2022 Aug;68(5):1063-1070. doi: 10.1177/00207640221099416. 
Epub 2022 Jun 2.

Technostress, anxiety, and depression among university students: A report from 
Paraguay.

Torales J(1)(2), Torres-Romero AD(3), Di Giuseppe MF(3), Rolón-Méndez ER(3), 
Martínez-López PL(3), Heinichen-Mansfeld KV(3), Barrios I(4), O'Higgins M(2), 
Almirón-Santacruz J(2), Melgarejo O(2), Ruiz Díaz N(2), Castaldelli-Maia 
JM(5)(6), Ventriglio A(7).

Author information:
(1)Department of Medical Psychology, School of Medical Sciences, National 
University of Asunción, San Lorenzo, Paraguay.
(2)Department of Psychiatry, School of Medical Sciences, National University of 
Asunción, San Lorenzo, Paraguay.
(3)Neuroscience Research Students Network, School of Medical Sciences, National 
University of Asunción, San Lorenzo, Paraguay.
(4)Department of Statistics (Santa Rosa Campus), School of Medical Sciences, 
National University of Asunción, Paraguay.
(5)Department of Neuroscience, Fundação do ABC, Santo André, Brazil.
(6)Department of Psychiatry, University of São Paulo, Brazil.
(7)Department of Clinical and Experimental Medicine, University of Foggia, 
Italy.

BACKGROUND: Although technologies (including information, e-learning, and 
communication) have been daily employed by University students in the last 
years, the COVID-19 pandemic has led to a considerable increase in their use. 
Technostress is a modern term referring to levels of stress caused by the 
prolonged exposure to technology.
AIM: The aim of this study is to assess the technostress and related anxiety and 
depression among Paraguayan University students, describing their 
sociodemographic characteristics and relevant associations.
METHODS: A cross-sectional and descriptive study has been conducted. 
Participants were recruited through an Internet-based survey. Technostress, 
anxiety, and depression have been assessed with the Technostress Questionnaire 
(TechQ), the Generalized Anxiety Disorder-7 (GAD-7) questionnaire, and the 
Patient Health Questionnaire-2 (PHQ-2), respectively.
RESULTS: A total of 378 participants were included, 74.1% of whom were women. 
According to the TechQ scores, 47.4% of the participants reported a low/moderate 
level of technostress whereas 5.2% showed severe scores. About 58.5% of 
participants reported a GAD-7 score ⩾10, meeting diagnostic criteria for 
generalized anxiety. About 60.3% scored ⩾3 at the PHQ-2 reporting significant 
levels of depression. Technostress has been significantly associated with levels 
of anxiety (p < .001) as well as depression (p < .001).
CONCLUSION: Our results suggest further research regarding the implications of 
technostress on the well-being of University students. Specific measures aimed 
to improve students' coping with the challenges of technology and technostress 
should be promoted.

DOI: 10.1177/00207640221099416
PMID: 35652309 [Indexed for MEDLINE]


1954. Front Public Health. 2022 May 16;10:866992. doi: 10.3389/fpubh.2022.866992. 
eCollection 2022.

Tiny Habits(®) for Gratitude-Implications for Healthcare Education Stakeholders.

Hollingsworth JC(1), Redden DT(1).

Author information:
(1)Edward via College of Osteopathic Medicine-Auburn, Biomedical Affairs and 
Research, Auburn, AL, United States.

The COVID-19 pandemic has led to diminished sleep and increased stress, anxiety, 
and burnout for many health professionals and health professions students. One 
simple approach that may be effective for bolstering personal well-being is 
consciously cultivating gratitude. Gratitude is positively associated with 
physical health, psychological health, hope, sleep, and health behavior 
engagement; and randomized studies indicate that gratitude interventions can 
improve psychological well-being and sleep. The primary aim of this study was to 
assess the impact of practicing Tiny Habits® on self-reported gratitude, as 
measured by the 6-Item Gratitude Questionnaire (GQ-6). In January 2021, 154 
adult participants with GQ-6 <35/42 were randomized to one of 3 groups: Tiny 
Habits for Gratitude (n = 50), Tiny Habits Control (n = 52), and Inactive 
Control (n = 52). Both Tiny Habits groups chose 3 Tiny Habits Recipes to 
practice daily and participated in the free, email-based 5-Day Program with 
automated daily check-in emails and personalized feedback from a Certified Tiny 
Habits Coach. The Recipes for the Tiny Habits for Gratitude group focused on 
cultivating gratitude, while those for the Tiny Habits Control group did not. 
Post-intervention, the mean change in GQ-6 scores in the Tiny Habits for 
Gratitude (Δ = ↑6.9 ± 5.6; n = 37/50, 74%; p< 0.001, Cohen's d = 0.85) and Tiny 
Habits Control (Δ = ↑5.6 ± 4.1; n = 31/52, 60%; p = 0.009, Cohen's d = 0.71) 
groups were greater than that of the Inactive Control group (Δ = ↑2.5 ± 4.4; N = 
42/52, 81%). At 1 month, the mean change in GQ-6 scores in the Tiny Habits for 
Gratitude group (Δ = ↑7.0 ± 5.3; N = 28/50, 56%) was greater than that of the 
Inactive Control group (Δ = ↑2.9 ± 5.4; N = 39/52, 72%; p = 0.002, Cohen's d = 
0.78). These findings suggest that practicing Tiny Habits Recipes and 
participating in the 5-Day Program can significantly increase gratitude in the 
short term and focusing specifically on gratitude during this process can 
sustain the increase in gratitude for up to 1 month. Implementation is quick, 
simple, and free. This has significant implications for healthcare education 
stakeholders.

Copyright © 2022 Hollingsworth and Redden.

DOI: 10.3389/fpubh.2022.866992
PMCID: PMC9149079
PMID: 35651860 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


1955. Stress Health. 2023 Feb;39(1):103-114. doi: 10.1002/smi.3168. Epub 2022 Jun 13.

Caring in a crisis: Understanding the stressors and uplifts for National Health 
Service frontline staff through the lens of clinical psychologists.

Sattar R(1), Heyhoe J(1), O'Hara D(2), Wijeratne D(3), Lawton R(1)(4).

Author information:
(1)Bradford Institute for Health Research, Bradford, West Yorkshire, UK.
(2)Neuropsychology Department, Lincolnshire Partnership NHS Foundation Trust, 
Lincoln, UK.
(3)Leeds Teaching Hospitals NHS Trust, Leeds, UK.
(4)School of Psychology, University of Leeds, Leeds, UK.

The unprecedented public health crisis of the Covid-19 pandemic resulted in a 
significant challenge to the delivery of healthcare that has rarely been 
experienced before. The stress already faced by healthcare staff working in the 
National Health Service (NHS) has been further exacerbated during Covid-19, 
putting them at risk of adverse mental health outcomes. Through the lens of 
clinical psychologists who had provided support to frontline healthcare staff 
during the Covid-19 pandemic, this study aimed to better understand the 
stressors and uplifts healthcare staff experienced during Covid-19, the impact 
of these on the wellbeing of staff and patient care, and to examine the support 
needed to deal with the impact of a crisis. A qualitative study design using a 
combination of diaries followed by semi-structured interviews was utilised. Data 
was analysed using thematic analysis. The following five themes represented the 
stressors and uplifts experienced by NHS frontline healthcare staff during 
Covid-19, the impact on staff wellbeing and patient care: facing change; risks 
of working in the NHS environment; transcending the negatives; challenging 
professional values and haunted by patient deaths. The findings also highlight 
the importance of providing psychological support and suggest the need to 
continue to provide this support service to help NHS staff manage through 
subsequent waves of the pandemic. These findings can contribute towards both the 
management of the current Covid-19 pandemic and other similar crises in the 
future.

© 2022 John Wiley & Sons Ltd.

DOI: 10.1002/smi.3168
PMID: 35650379 [Indexed for MEDLINE]


1956. Ann Am Thorac Soc. 2022 Nov;19(11):1881-1891. doi: 
10.1513/AnnalsATS.202106-651OC.

Relationships among Demographic, Clinical, and Psychological Factors Associated 
with Family Caregiver Readiness to Participate in Intensive Care Unit Care.

Hetland BD(1)(2), McAndrew NS(3)(4), Kupzyk KA(1), Krutsinger DC(5), Turnbull 
AE(6)(7)(8), Pozehl BJ(1), Heusinkvelt JM(9).

Author information:
(1)College of Nursing.
(2)Critical Care Division, Nebraska Medicine, Omaha, Nebraska.
(3)College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin.
(4)Froedtert Hospital, Froedtert & Medical College of Wisconsin, Milwaukee, 
Wisconsin.
(5)Division of Pulmonary, Critical Care, and Sleep Medicine, University of 
Nebraska Medical Center, Omaha, Nebraska.
(6)Outcomes After Critical Illness and Surgery (OACIS) Group.
(7)Division of Pulmonary and Critical Care Medicine, School of Medicine, and.
(8)Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins 
University, Baltimore, Maryland; and.
(9)Direct Primary Care, Priority Care, CHI Health, Lincoln, Nebraska.

Rationale: There has been a paradigm shift to partner with family caregivers by 
actively involving them in the direct care of the patient throughout the 
critical illness trajectory. Before effectively engaging family members in 
patient care, clinicians must assess characteristics and circumstances that may 
affect caregiver readiness to assume a caregiving role in the intensive care 
unit (ICU). Objectives: To determine how demographic, clinical, and 
psychological factors are related to characteristics of family caregiver 
readiness to engage in ICU patient care. Methods: A convenience sample of ICU 
family caregivers of both adult and pediatric patients in the ICU was recruited 
for this cross-sectional study. Participants completed the following measures: 
PROMIS-29 (Patient-Reported Outcomes Measurement and Information System); HADS 
(Hospital Anxiety and Depression Scale); CaSES (Caregiver Self-Efficacy Scale); 
Prep Scale (Preparedness for Caregiving Scale); Patient Activation Measure for 
Caregivers; and FCMFHS (Family Caregiver's Motives for Helping Scale). Data were 
collected via self-report at a single time point while the caregiver was 
visiting the critically ill patient in the ICU. Data analysis consisted of 
descriptive statistics and bivariate correlations. Results: Caregivers (N = 127) 
were primarily White (82.7%), females (77.2%), with a mean age of 51.8 (standard 
deviation [SD], 15.6). Most were either spouses (37.8%) or parents (32.3%) of 
the patient in the ICU. Patients were primarily adult (76.4%) with a mean APACHE 
(Acute Physiology, Age, Chronic Health Evaluation) III of 45.9 (SD, 22.5). There 
were significant (P < 0.05) negative correlations between depression, anxiety, 
and fatigue and all subscales of self-efficacy (resilience r = -0.18 to -0.30; 
self-maintenance r = -0.44 to -0.63; emotional connectivity r = -0.27 to -0.41; 
instrumental giving r = -0.34 to -0.46). Caregiver depression was negatively 
correlated with caregiver activation (r = -0.199) and caregiver preparedness 
(r = -0.300). Social satisfaction was positively correlated (P < 0.05) with 
caregiving preparedness, motivation, and all subscales of self-efficacy 
(preparedness r = 0.19; motivation r = 0.24; resilience r = 0.21; 
self-maintenance r = 0.49; emotional connectivity r = 0.29; instrumental giving 
r = 0.36). Conclusions: We found that caregiver symptoms of depression, anxiety, 
and fatigue are inversely related to caregiver preparation, motivation, and 
self-efficacy. To develop effective interventions for ICU family caregivers, 
further research is needed to understand the relationship between caregiver 
well-being, caregiving readiness, and caregiver involvement in patient care.

DOI: 10.1513/AnnalsATS.202106-651OC
PMID: 35649201 [Indexed for MEDLINE]


1957. Cyberpsychol Behav Soc Netw. 2022 Jul;25(7):409-415. doi: 
10.1089/cyber.2021.0257. Epub 2022 May 31.

A National Study of Zoom Fatigue and Mental Health During the COVID-19 Pandemic: 
Implications for Future Remote Work.

Elbogen EB(1)(2)(3), Lanier M(3), Griffin SC(2)(4), Blakey SM(2)(4), Gluff 
JA(1), Wagner HR(2)(3), Tsai J(1)(5).

Author information:
(1)Department of Veterans Affairs, National Center on Homelessness Among 
Veterans, Washington, District of Columbia, USA.
(2)VISN 6 Mental Illness Research, Education and Clinical Center (MIRECC), 
Durham, North Carolina, USA.
(3)Department of Psychiatry and Behavioral Sciences, Duke University School of 
Medicine, Durham, North Carolina, USA.
(4)Durham VA Health Care System, Durham, North Carolina, USA.
(5)School of Public Health, University of Texas Health Science Center at 
Houston, Houston, Texas, USA.

Overuse of videoconferencing for work may contribute to what has been called 
"Zoom fatigue": feeling anxious, socially isolated, or emotionally exhausted due 
to lack of social connection. Given implications for employee well-being, this 
study investigated Zoom fatigue at work and its potential link to mental health 
symptoms. A national survey of mental health symptoms was conducted in the 
United States during the COVID-19 pandemic in August 2020. Adults (n = 902) 
endorsing a shift at work to videoconferencing completed an online survey; 
survey criteria included an age minimum of 22 years and reported annual gross 
income of <$75,000. Statistical raking was employed to weight the sample using 
U.S. census data on geographic region, age, gender, race, and ethnicity. A 
three-item Zoom Fatigue Scale measuring perceived stress, isolation, and 
depression associated with videoconferencing at work showed good internal 
consistency (α = 0.85). Higher scores on this scale were related to being 
married, nonwhite race, post-high school education, severe mental illness, 
greater loneliness, lower social support, lacking money for food, and more 
weekly videoconference calls. Depressive symptoms demonstrated a significant 
association with Zoom fatigue, even when adjusting for demographic, 
psychosocial, and clinical covariates. The study findings indicated that 
employers and employees should consider a complex array of individual-level and 
environment-level factors when assessing how videoconferencing at work may 
engender stress, social isolation, and emotional exhaustion. This impact could 
adversely impact mental health, work productivity, and quality of life, even 
after the COVID-19 pandemic.

DOI: 10.1089/cyber.2021.0257
PMID: 35648039 [Indexed for MEDLINE]


1958. Games Health J. 2022 Aug;11(4):262-267. doi: 10.1089/g4h.2022.0009. Epub 2022 
May 31.

Virtual Reality-Induced Dissociative Symptoms: A Retrospective Study.

Taveira MC(1), de Sá J(2), da Rosa MG(3).

Author information:
(1)University of Lisbon Medical Faculty, Lisboa, Portugal.
(2)Department of Neurology, Hospital de Santa Maria, Lisboa, Portugal.
(3)Department of Physiology, Centro Cardiovascular da Universidade de Lisboa, 
Lisboa, Portugal.

Objective: The use of virtual reality (VR) has been increasing worldwide, as 
devices are becoming more sophisticated and provide an escape from reality 
during the COVID-19 lockdown. This recent rise in the use of VR leads to new 
side effects being reported, such as dissociative symptoms that may or may not 
constitute a mental health concern. This retrospective study investigated the 
prevalence and intensity of dissociative symptoms in VR users, as well as some 
potential predisposing conditions that may trigger them, and their impact on the 
subjects' wellbeing. Materials and Methods: We conducted a survey (n = 358) that 
was posted on VR Facebook groups. This survey was approved by the University of 
Lisbon Medical Faculty's IRB, and comprised a modified version of the 
Clinician-Administered Dissociative State Scale (CADSS) and questions regarding 
potential risk factors known to induce dissociative disorders or experiences. 
Results: Data analysis revealed that 83.9% participants reported dissociative 
symptoms, with varying intensity according to CADSS (X̄ = 7.62; s = 7.89). 
Significant correlations were found between CADSS score and the time spent 
playing, the use of software applications (apps) that involve virtual hands or 
hand tracking, history of previous dissociative experiences, traumatic childhood 
events, avoidant coping strategies, and psychiatric disorders. Nonetheless, most 
participants categorized the symptoms as nonanxiogenic (85.8%) and minute 
lasting (77.4%). Conclusion: In conclusion, this study revealed that although VR 
can induce dissociative experiences, they seem to be short lasting and 
nonthreatening to the individual's wellbeing and might be predicted or 
attenuated by managing other known risk factors for dissociative phenomena.

DOI: 10.1089/g4h.2022.0009
PMID: 35648035 [Indexed for MEDLINE]


1959. Eur J Psychotraumatol. 2022 May 20;13(1):2065431. doi: 
10.1080/20008198.2022.2065431. eCollection 2022.

You can't do anything about it, but you can make the best of it: a qualitative 
analysis of pandemic-related experiences in six European countries.

Zrnić Novaković I(1)(2), Lueger-Schuster B(1), Verginer L(1), Bakić H(3), 
Ajduković D(2), Borges C(4), Figueiredo-Braga M(4)(5), Javakhishvili JD(6), 
Tsiskarishvili L(7), Dragan M(8), Nagórka N(8), Anastassiou-Hadjicharalambous 
X(9), Lioupi C(9), Lotzin A(10)(11).

Author information:
(1)Department of Clinical and Health Psychology, Faculty of Psychology, 
University of Vienna, Vienna, Austria.
(2)Vienna Doctoral School in Cognition, Behavior and Neuroscience, University of 
Vienna, Vienna, Austria.
(3)Department of Psychology, Faculty of Humanities and Social Sciences, 
University of Zagreb, Zagreb, Croatia.
(4)Trauma Observatory, Centre for Social Studies (CES) of the University of 
Coimbra, Coimbra, Portugal.
(5)Faculty of Medicine, University of Porto, Porto, Portugal.
(6)Institute of Addiction Studies, Ilia State University, Tbilisi, Georgia.
(7)Faculty of Arts and Science, Ilia State University, Tbilisi, Georgia.
(8)Faculty of Psychology, University of Warsaw, Warsaw, Poland.
(9)Psychology Program, School of Ηumanities, Social Sciences and Law, University 
of Nicosia, Nicosia, Cyprus.
(10)Department of Psychiatry and Psychotherapy, University Medical Center 
Hamburg-Eppendorf, Hamburg, Germany.
(11)Department of Psychology, MSH Medical School Hamburg, Hamburg, Germany.

BACKGROUND: The complex system of stressors related to the coronavirus disease 
2019 (COVID-19) pandemic has affected the global population, provoking a broad 
range of psychological reactions. Although numerous studies have investigated 
the mental health impact of COVID-19, qualitative research and cross-country 
comparisons are still rare.
OBJECTIVE: This qualitative study aimed to explore self-perceived challenges and 
opportunities related to COVID-19 across six European countries. The overall 
objective was to provide a differentiated picture of individual subjective 
experiences in the early stages of the pandemic.
METHOD: The present study included 7309 participants from Austria, Croatia, 
Georgia, Greece, Poland, and Portugal. We performed qualitative content analysis 
according to Mayring analyse open-ended questions regarding stressful events, 
positive and negative aspects of the pandemic, and recommendations to cope with 
the pandemic situation. MAXQDA software was used for data management and 
analysis.
RESULTS: Participants' accounts were moderately consistent across the countries. 
The most prominent themes regarding stressful and negative pandemic aspects 
included: Restrictions and changes in daily life, Emotional distress, and Work 
and finances. Answers about positive pandemic consequences were mainly centred 
around the themes Reflection and growth, Opportunity for meaningful/enjoyable 
activities, and Benefits on interpersonal level. Key themes identified from 
participants' recommendations to cope with the pandemic included Beneficial 
behavioural adjustment, Beneficial cognitive-emotional strategies, and Social 
support.
CONCLUSIONS: Participants experienced various challenges, but also shared 
several positive pandemic consequences and recommendations to cope with the 
pandemic. These first-hand data could inform mental health practices to promote 
well-being during COVID-19 and similar global challenges in the participating 
countries and possibly beyond.
HIGHLIGHTS: We examined COVID-19-related experiences in 7309 adults from six 
European countries.Besides challenges, participants identified many positive 
pandemic consequences.Participants' recommendations to cope with COVID-19 
included behavioural and cognitive-emotional strategies.

Publisher: Antecedentes: El complejo sistema de factores estresantes 
relacionados con la pandemia por la COVID-19 ha afectado a la población mundial, 
generando un amplio rango de reacciones psicológicas. A pesar de que múltiples 
estudios han investigado el impacto sobre la salud mental de la COVID-19, las 
investigaciones cualitativas y las comparaciones entre países aún son 
infrecuentes.Objetivo: Este estudio cualitativo buscó explorar los retos y las 
oportunidades autopercibidas asociadas a la COVID-19 en seis países europeos. El 
objetivo general fue el de brindar un panorama diferenciado de experiencias 
individuales subjetivas en las etapas tempranas de la pandemia.Método: Este 
estudio incluyó a N = 7309 participantes de Austria, Croacia, Georgia, Grecia, 
Polonia y Portugal. Se empleó el análisis de contenido de Mayring para analizar 
preguntas abiertas acerca de experiencias estresantes, de experiencias positivas 
y negativas de la pandemia, y recomendaciones para afrontar la situación de la 
pandemia. Se empleó el software MAXQDA para la gestión y el análisis de la 
información.Resultados: Los relatos de los participantes eran moderadamente 
consistentes entre los países. Los temas más prominentes respecto a los aspectos 
estresantes y negativos de la pandemia incluyeron a: restricciones y cambios en 
la vida diaria, angustia emocional, y trabajo y finanzas. Las respuestas sobre 
las consecuencias positivas de la pandemia se centraban principalmente alrededor 
de los temas de reflexión y crecimiento personal, oportunidad para realizar 
actividades significativas / placenteras, y beneficios en a nivel interpersonal. 
Los temas clave identificados a partir de las recomendaciones de los 
participantes para afrontar la pandemia incluyeron adaptaciones conductuales 
beneficiosas, estrategias cognitivo-emocionales beneficiosas, y soporte social. 
Conclusiones: Los participantes experimentaron diversos desafíos, pero también 
compartieron varias consecuencias positivas de la pandemia y recomendaciones 
para afrontarla. Esta información de primera mano podría informar sobre las 
prácticas de salud mental a promover durante la COVID-19 o desafíos globales 
similares en los países participantes y, posiblemente, más allá.

Publisher: 背景：: COVID-19 疫情相关复杂应激源系统影响了全球人口，引发了广泛的心理反应。尽管大量研究调查了 COVID-19 
对心理健康的影响，但定性研究和跨国比较仍然很少见。.
目的：: 本定性研究旨在探索六个欧洲国家 COVID-19 相关的自我认知挑战和机遇。总体目标是为疫情早期阶段的个人主观体验提供不同的描述。.
方法：: 本研究包括来自奥地利、克罗地亚、格鲁吉亚、希腊、波兰和葡萄牙的 N = 7309 名参与者。我们通过 Mayring 
行了定性内容分析，以分析有关紧张事件、疫情积极和消极方面以及应对疫情情况建议的开放式问题。 使用MAXQDA软件进行数据管理和分析。.
结果：: 
参与者的解释在各国之间是适度一致的。关于紧张和疫情消极方面最突出的主题包括：日常生活的限制和变化、情绪困扰以及工作和财务。关于疫情积极后果的回答主要集中在反思和成长、有意义/愉快活动的机会和人际层面的好处等主题上。从参与者应对疫情的建议中确定的关键主题包括有益的行为调整、有益的认知情绪策略和社会支持。.
结论：: 参与者经历了各种挑战，但也分享了一些积极的疫情后果和应对疫情的建议。这些第一手数据可以为心理健康实践提供信息，以促进 COVID-19 
期间的福祉以及参与国甚至更远地区的相似全球挑战。.

© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor &amp; 
Francis Group.

DOI: 10.1080/20008198.2022.2065431
PMCID: PMC9132427
PMID: 35646295 [Indexed for MEDLINE]

Conflict of interest statement: No potential conflict of interest was reported 
by the authors.


1960. Disabil Health J. 2022 Oct;15(4):101337. doi: 10.1016/j.dhjo.2022.101337. Epub 
2022 May 2.

Perceived impacts of COVID-19 on wellbeing among US working-age adults with ADL 
difficulty.

Pendergrast CB(1), Monnat SM(2).

Author information:
(1)Lerner Center for Public Health Promotion, Center for Policy Research, and 
Department of Sociology, Maxwell School of Citizenship and Public Affairs, 
Syracuse University, Syracuse, NY, USA. Electronic address: cpenderg@syr.edu.
(2)Lerner Center for Public Health Promotion, Center for Policy Research, and 
Department of Sociology, Maxwell School of Citizenship and Public Affairs, 
Syracuse University, Syracuse, NY, USA. Electronic address: smmonnat@syr.edu.

BACKGROUND: The COVID-19 pandemic has disproportionately impacted people with 
disabilities. Working-age adults with ADL difficulty may face unique challenges 
and heightened health risks because of the pandemic. It is critical to better 
understand the impacts of COVID-19 on social, financial, physical, and mental 
wellbeing among people with disabilities to inform more inclusive pandemic 
response policies.
OBJECTIVE: This study compares perceived COVID-19 physical and mental health, 
social, and financial impacts for US working-age adults with and without ADL 
difficulty.
METHODS: We analyzed data from a national survey of US working-age adults (aged 
18-64) conducted in February and March 2021 (N = 3697). We used logistic 
regression to compare perceived COVID-19-related impacts on physical and mental 
health, healthcare access, social relationships, and financial wellbeing among 
those with and without ADL difficulty.
RESULTS: Adults with ADL difficulty were more likely to report negative COVID-19 
impacts for many but not all outcomes. Net of covariates, adults with ADL 
difficulty had significantly greater odds of reporting COVID-19 infection 
(OR = 2.1) and hospitalization (OR = 6.7), negative physical health impacts 
(OR = 2.0), and negative impacts on family relationships (OR = 1.6). However, 
they had significantly lower odds of losing a friend or family member to 
COVID-19 (OR = 0.7). There were no significant differences in perceived impacts 
on mental health, ability to see a doctor, relationships with friends, or 
financial wellbeing.
CONCLUSIONS: Working-age adults with ADL difficulty experienced disproportionate 
health and social harm due to the COVID-19 pandemic. To address these 
disparities, public health response efforts and social policies supporting 
pandemic recovery must include disability perspectives.

Copyright © 2022 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.dhjo.2022.101337
PMCID: PMC9060733
PMID: 35643600 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of interest The authors have no 
conflicts of interest to declare.


1961. mSystems. 2022 Jun 28;7(3):e0139921. doi: 10.1128/msystems.01399-21. Epub 2022 
Jun 1.

Sepsis-Induced Gut Dysbiosis Mediates the Susceptibility to Sepsis-Associated 
Encephalopathy in Mice.

Fang H(#)(1)(2)(3), Wang Y(#)(3), Deng J(#)(1)(4), Zhang H(2)(3), Wu Q(3), He 
L(3), Xu J(1)(3), Shao X(3), Ouyang X(3), He Z(3), Zhou Q(3), Wang H(3), Deng 
Y(1)(2), Chen C(1)(2)(3)(5).

Author information:
(1)The Second School of Clinical Medicine, Southern Medical University, 
Guangzhou, China.
(2)Department of Critical Care Medicine, Guangdong Provincial People's Hospital, 
Guangdong Academy of Medical Sciences, Guangzhou, China.
(3)Department of Intensive Care Unit of Cardiac Surgery, Guangdong 
Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong 
Academy of Medical Sciences, Guangzhou, China.
(4)Department of Critical Care Medicine, The Second Hospital of Dalian Medical 
University, Dalian, China.
(5)Clinical Research Center, Maoming People's Hospital, Maoming, Guangdong, 
China.
(#)Contributed equally

Comment in
    mSystems. 2022 Aug 30;7(4):e0053322.

Sepsis-associated encephalopathy (SAE) is common in septic patients and is 
associated with adverse outcomes. The gut microbiota has been recognized as a 
key mediator of neurological disease development. However, the exact role of the 
gut microbiota in regulating SAE remains elusive. Here, we investigated the role 
of the gut microbiota in SAE and its underlying mechanisms. Cecal ligation and 
puncture (CLP) was conducted to induce sepsis in mice. Neurological scores were 
recorded to distinguish SAE-resistant (SER) (score of >6 at 36 h 
postoperatively) from SAE-susceptible (SES) (score of ≤6 at 36 h 
postoperatively) mice. 16S rRNA gene sequencing and metabolomics analyses were 
used to characterize the gut microbiota in the two groups. Fecal microbiota 
transplantation was performed to validate the role of the gut microbiota in SAE 
progression. The gut microbiota was more severely disrupted in SES mice than in 
SER mice after sepsis modeling. Interestingly, mice receiving postoperative 
feces from SES mice exhibited more severe cortical inflammation than mice 
receiving feces from SER mice. Indole-3-propionic acid (IPA), a neuroprotective 
molecule, was more enriched in feces from SER mice than in feces from SES mice. 
IPA alleviated CLP-induced anxiety and spatial memory impairment in septic mice. 
Moreover, IPA markedly inhibited NLRP3 inflammasome activation and 
interleukin-1β (IL-1β) secretion in lipopolysaccharide-stimulated microglia. 
These responses were attenuated after antagonizing the aryl hydrocarbon 
receptor. Our study indicates that the variability in sepsis-induced gut 
dysbiosis mediates the differential susceptibility to SAE in CLP-induced 
experimental sepsis mice, and microbially derived IPA is possibly involved in 
SAE development as a neuroprotective compound. IMPORTANCE The bidirectional 
interactions between the gut microbiota and sepsis-associated encephalopathy 
(SAE) are not well characterized. We found that the gut microbiota was more 
severely disturbed in SAE-susceptible (SES) mice than in SAE-resistant (SER) 
mice after sepsis modeling. Mice gavaged with postoperative feces from SES mice 
exhibited more severe neuroinflammation than mice gavaged with feces from SER 
mice. The gut microbiota from SER mice enriched a neuroprotective metabolite, 
IPA, which appeared to protect mice from SAE. The potential underlying mechanism 
of the protective effect of IPA may be mediated via the inhibition of NLRP3 
inflammasome activation and IL-1β secretion in microglia. These 
anti-inflammatory effects of IPA may be regulated by aryl hydrocarbon receptors. 
These results enhance our understanding of the role of the intestinal microbiota 
in sepsis. In particular, gut microbiota-derived IPA may serve as a potential 
therapeutic agent to prevent neuroinflammation in SAE.

DOI: 10.1128/msystems.01399-21
PMCID: PMC9239149
PMID: 35642838 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1962. BMC Public Health. 2022 May 31;22(1):1087. doi: 10.1186/s12889-022-13481-6.

Prevalence, characteristics, and psychological outcomes of workplace 
cyberbullying during the COVID-19 pandemic in Japan: a cross-sectional online 
survey.

Ikeda T(#)(1), Hori D(#)(2)(3), Sasaki H(1), Komase Y(4)(5), Doki S(6), 
Takahashi T(6), Oi Y(6), Ikeda Y(1), Arai Y(1), Muroi K(1), Ishitsuka M(1), 
Matsuura A(1), Go W(1), Matsuzaki I(6)(7), Sasahara S(6).

Author information:
(1)Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 
Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
(2)Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 
305-8575, Japan. daisuke_hori@md.tsukuba.ac.jp.
(3)International Institute for Integrative Sleep Medicine, University of 
Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan. 
daisuke_hori@md.tsukuba.ac.jp.
(4)Department of Mental Health, Graduate School of Medicine, The University of 
Tokyo, Japan. 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
(5)Japan Society for the Promotion of Science, 5-3-1 Kojimachi, Chiyoda-ku, 
Tokyo, 102-0083, Japan.
(6)Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 
305-8575, Japan.
(7)International Institute for Integrative Sleep Medicine, University of 
Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
(#)Contributed equally

BACKGROUND: The rapid introduction of teleworking due to the coronavirus disease 
2019 pandemic has led to concerns about increases in cyberbullying (CB) 
worldwide. However, little is known about workplace CB in non-Western countries. 
The first objective was to clarify the prevalence and characteristics regarding 
workplace CB victimization in Japan. The second objective was to demonstrate the 
psychological outcomes of CB victimization in combination with traditional 
bullying (TB).
METHODS: We conducted an anonymous, cross-sectional, Internet-based survey 
targeting regular employees in Japan (N = 1200) in January 2021. We investigated 
CB victimization using the Inventory of Cyberbullying Acts at Work and TB 
victimization by using the Short Negative Act Questionnaire. Possible 
explanatory factors for TB/CB victimization were sociodemographic variables, 
personality trait, chronic occupational stress, organizational climate, and 
gratitude at work. We also measured psychological distress, insomnia, and 
loneliness to assess adverse effects of workplace bullying. Two-step cluster 
analysis was used in determining the patterns combined with TB and CB 
victimization. Hierarchical binomial logistic regression analysis was used.
RESULTS: In total, 8.0% of employees reported experiencing CB on a weekly basis. 
CB victimization was associated with younger age, managerial position, higher 
qualitative workload, and active information dissemination via the Internet, and 
frequency of teleworking. Three clusters based on TB and CB victimization 
patterns were identified: those who belong to the first cluster suffered neither 
from TB and CB (81.0%), the second cluster suffered only from TB (14.3%), and 
the third cluster suffered from both TB and CB (4.8%). The third cluster 
exhibited higher odds ratios (ORs) and 95% confidence intervals (CIs) for 
psychological distress (OR = 12.63, 95% CI = 4.20-38.03), insomnia (OR = 6.26, 
95% CI = 2.80-14.01), and loneliness (OR = 3.24, 95% CI = 1.74-6.04) compared to 
the first cluster.
CONCLUSIONS: These findings firstly clarify the prevalence and correlated 
factors of CB victimization among employees in Japan. Further, we showed that 
psychological wellbeing can be impaired by the coexistence of TB and CB. Our 
research could be the first step to develop the effective countermeasures 
against workplace CB.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-13481-6
PMCID: PMC9154040
PMID: 35642023 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1963. BMC Psychol. 2022 May 31;10(1):140. doi: 10.1186/s40359-022-00851-3.

Growing up during a public health crisis: a qualitative study of Born in 
Bradford early adolescents during Covid-19.

Lockyer B(1), Endacott C(2), Dickerson J(2), Sheard L(3).

Author information:
(1)Bradford Institute for Health Research, Bradford Teaching Hospitals NHS 
Foundation Trust, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, 
UK. bridget.lockyer@bthft.nhs.uk.
(2)Bradford Institute for Health Research, Bradford Teaching Hospitals NHS 
Foundation Trust, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, 
UK.
(3)Department of Health Sciences, University of York, Heslington, York, YO10 
5DD, UK.

BACKGROUND: Whilst children and young people have not often been at forefront of 
the immediate Covid-19 pandemic health response there has been concern about the 
indirect consequences of Covid-19 on children's physical and mental health and 
what the effect of the pandemic will be throughout their lifetimes. Early 
adolescence is a time of transition and reorientation. This study considers the 
impact of the first UK Covid-19 lockdown on early adolescents.
METHODS: The study topic was identified through a consultation process which 
aimed to provide appropriate evidence to local decision makers in Bradford, UK 
and plan for future interventions. A group of children and their parents from 
the longitudinal Born in Bradford (BiB) cohort study were randomly selected and 
then purposively sampled by ethnicity, age, sex and deprivation. The BiB cohort 
is made up of 13,776 children and their families and were recruited at Bradford 
Royal Infirmary between 2007 and 2011. 41 interviews (with 20 families: 20 
parents and 21 children) were carried out between August and September 2020. 
Interview data was analysed using reflexive thematic analysis.
RESULTS: The transitional age of the children interviewed had an important 
influence on their experience Covid-19 and the first UK lockdown. Their age 
combined with lockdown and school closures meant that they missed out on key 
learning and social opportunities at a crucial time in their lives. Covid-19 and 
lockdown also disrupted their daily mental wellbeing and led to increased 
anxiety, lethargy and low moods, during a period of personal change and social 
transition.
CONCLUSION: For children at the start of their adolescence undergoing change and 
formation, the experiences and feelings Covid-19 has set in motion will likely 
have an impact on their mental and cognitive functioning as they develop 
further. It is important to acknowledge these early adolescent experiences and 
continue to monitor and provide targeted support to this group of young people.

© 2022. The Author(s).

DOI: 10.1186/s40359-022-00851-3
PMCID: PMC9152307
PMID: 35641988 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1964. BMC Palliat Care. 2022 Jun 1;21(1):91. doi: 10.1186/s12904-022-00979-4.

End of life care in UK care homes during the COVID-19 pandemic: a qualitative 
study.

Hanna K(1), Cannon J(2), Gabbay M(3)(4), Marlow P(4), Mason S(5), Rajagopal 
M(6), Shenton J(7), Tetlow H(8), Giebel C(3)(4).

Author information:
(1)School of Health Sciences, University of Liverpool, Liverpool, L69 3GB, 
England. k.hanna2@liverpool.ac.uk.
(2)Lewy Body Society, Wigan, UK.
(3)Department of Primary Care & Mental Health, University of Liverpool, 
Liverpool, UK.
(4)NIHR ARC NWC, Liverpool, UK.
(5)Institute of Life Course and Medical Sciences, University of Liverpool, 
Liverpool, UK.
(6)Lancashire and South Cumbria NHS Foundation Trust, Preston, UK.
(7)Sefton Advocacy, Sefton, UK.
(8)SURF Liverpool, Liverpool, UK.

PURPOSE: To report the experiences of End of Life (EoL) care in UK care homes 
during the COVID-19 pandemic.
METHODS: UK care home staff and family carers of residents in care home took 
part in remote, semi-structured interviews from October to November 2020, with 
20 participants followed-up in March 2021. Interviews were conducted via 
telephone or online platforms and qualitatively analysed using inductive 
thematic analysis.
RESULTS: Forty-two participants (26 family carers and 16 care home staff) were 
included in a wider qualitative study exploring the impact on dementia care 
homes during the pandemic. Of these, 11 family carers and 9 care home staff 
participated in a follow-up interview. Following descriptive thematic analysis, 
three central themes concerning EoL care during the pandemic specifically, were 
conceptualised and redefined through research team discussions: 1) Wasting or 
losing time; 2) Maintaining control, plans and routine; and 3) Coping with loss 
and lack of support. Lack of suitable, meaningful visits with people with 
dementia in care homes resulted in negative feelings of guilt and abandonment 
with both family carers and care home staff. Where families experienced positive 
EoL visits, these appeared to breach public health restrictions at that time.
CONCLUSION: It is recommended that care homes receive clear guidance from the 
government offering equitable contact with relatives at EoL to all family 
members, to support their grieving and avoid subsequent negative impacts to 
emotional wellbeing.

© 2022. The Author(s).

DOI: 10.1186/s12904-022-00979-4
PMCID: PMC9155982
PMID: 35641946 [Indexed for MEDLINE]

Conflict of interest statement: None.


1965. BMC Pregnancy Childbirth. 2022 May 31;22(1):455. doi: 
10.1186/s12884-022-04789-7.

Receiving screened donor human milk for their infant supports parental 
wellbeing: a mixed-methods study.

Brown A(1)(2), Shenker N(3).

Author information:
(1)School of Health and Social Care, Swansea University, Singleton Park, 
Swansea, UK. a.e.brown@swansea.ac.uk.
(2)Centre for Lactation, Infant Feeding and Translation, Swansea University, 
Swansea, UK. a.e.brown@swansea.ac.uk.
(3)Department of Surgery and Cancer, Imperial College London, London, UK.

BACKGROUND: Access to donor human milk (DHM) has primarily been based on the 
health and development outcomes of premature infants but there has been little 
examination of the broader impact of an infant receiving it upon parental mental 
health. Breastfeeding and mental health are closely tied with women who 
experience breastfeeding difficulties or are unable to meet their own 
breastfeeding goals often experiencing feelings of guilt, sadness and anger, 
alongside an increased risk of postnatal depression. The aim of the current 
study was to explore how experience of receiving DHM for their baby affected the 
wellbeing of parents.
METHODS: UK parents of infants aged 0 - 12 months who had received screened DHM 
from a milk bank (typically on the neonatal unit or in some cases in the 
community) completed an online questionnaire exploring their experiences. The 
questionnaire included Likert scale items examining perceived impact upon infant 
health, own wellbeing and family functioning alongside open-ended questions 
exploring perceptions of how receiving DHM affected wellbeing.
RESULTS: Almost all of the 107 participants (women = 102) agreed that receiving 
DHM had a positive impact upon infant health and development, their own mental 
and physical health, and their family's wellbeing. Parents felt relieved that 
their infant was receiving DHM for health reasons but also due to the experience 
of being listened to, supported and having their infant feeding decisions 
facilitated. Receiving DHM helped mothers to process some of their emotions at 
not being able to breastfeed, in part because knowing their baby was being fed 
gave them the space to focus on recovery and bonding with their baby. Some 
parents did experience challenges, feeling guilty at receiving DHM, insecure 
that another woman was able to feed their baby when they could not, or negative 
reactions from family. Although the impact of receiving DHM upon breastfeeding 
was not measured, some women who were working to build their own milk supply 
noted that it helped motivate them to continue.
CONCLUSIONS: DHM may play an important role not only in protecting infant health 
and development but in supporting the mental health and wellbeing of mothers for 
whom their infant receiving human milk is important.

© 2022. The Author(s).

DOI: 10.1186/s12884-022-04789-7
PMCID: PMC9154035
PMID: 35641919 [Indexed for MEDLINE]

Conflict of interest statement: AB is a trustee for the charity First Steps 
Nutrition Trust. NS is a cofounder and consultant for the Human Milk Foundation, 
a charity that operates the Hearts Milk Bank.


1966. BMC Pregnancy Childbirth. 2022 May 31;22(1):454. doi: 
10.1186/s12884-022-04751-7.

Self-monitoring of blood pressure among women with hypertensive disorders of 
pregnancy: a systematic review.

Yeh PT(1), Rhee DK(1), Kennedy CE(1), Zera CA(2), Lucido B(3), Tunçalp Ö(3), 
Gomez Ponce de Leon R(4), Narasimhan M(5).

Author information:
(1)Department of International Health, Johns Hopkins Bloomberg School of Public 
Health, Baltimore, MD, USA.
(2)Department of Obstetrics and Gynecology, Harvard Medical Faculty Physicians, 
Boston, MA, USA.
(3)Department of Sexual and Reproductive Health and Research, World Health 
Organization, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of 
Research, Development and Research Training in Human Reproduction - HRP, 20 
Avenue Appia, 1211, Geneva 27, Switzerland.
(4)Latin American Center of Perinatology, Women and Reproductive Health 
PAHO/WHO, Montevideo, Uruguay.
(5)Department of Sexual and Reproductive Health and Research, World Health 
Organization, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of 
Research, Development and Research Training in Human Reproduction - HRP, 20 
Avenue Appia, 1211, Geneva 27, Switzerland. narasimhanm@who.int.

BACKGROUND: The World Health Organization (WHO) recommends self-monitoring of 
blood pressure (SMBP) for hypertension management. In addition, during the 
COVID-19 response, WHO guidance also recommends SMBP supported by health workers 
although more evidence is needed on whether SMBP of pregnant individuals with 
hypertension (gestational hypertension, chronic hypertension, or pre-eclampsia) 
may assist in early detection of pre-eclampsia, increase end-user autonomy and 
empowerment, and reduce health system burden. To expand the evidence base for 
WHO guideline on self-care interventions, we conducted a systematic review of 
SMBP during pregnancy on maternal and neonatal outcomes.
METHODS: We searched for publications that compared SMBP with clinic-based 
monitoring during antenatal care. We included studies measuring any of the 
following outcomes: maternal mortality, pre-eclampsia, long-term risk and 
complications, autonomy, HELLP syndrome, C-section, antenatal hospital 
admission, adverse pregnancy outcomes, device-related issues, follow-up care 
with appropriate management, mental health and well-being, social harms, 
stillbirth or perinatal death, birthweight/size for gestational age, and Apgar 
score. After abstract screening and full-text review, we extracted data using 
standardized forms and summarized findings. We also reviewed studies assessing 
values and preferences as well as costs of SMBP.
RESULTS: We identified 6 studies meeting inclusion criteria for the 
effectiveness of SMBP, 6 studies on values and preferences, and 1 study on 
costs. All were from high-income countries. Overall, when comparing SMBP with 
clinic-monitoring, there was no difference in the risks for most of the outcomes 
for which data were available, though there was some evidence of increased risk 
of C-section among pregnant women with chronic hypertension. Most end-users and 
providers supported SMBP, motivated by ease of use, convenience, 
self-empowerment and reduced anxiety. One study found SMBP would lower health 
sector costs.
CONCLUSION: Limited evidence suggests that SMBP during pregnancy is feasible and 
acceptable, and generally associated with maternal and neonatal health outcomes 
similar to clinic-based monitoring. However, more research is needed in 
resource-limited settings.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021233839 .

© 2022. The Author(s).

DOI: 10.1186/s12884-022-04751-7
PMCID: PMC9152837
PMID: 35641913 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


1967. J Am Board Fam Med. 2022 May-Jun;35(3):593-596. doi: 
10.3122/jabfm.2022.03.210461.

A New Pandemic of Loneliness.

Lonergan-Cullum M(1), Hooker SA(2), Levy R(2), Ricco J(2).

Author information:
(1)From University of Minnesota, Department of Family Medicine and Community 
Health, Minneapolis, MN 55455 (ML-C, SAH, RL, JR); HealthPartners Institute, 
Research Division, Minneapolis, MN, 55440 (SAH) loner026@umn.edu.
(2)From University of Minnesota, Department of Family Medicine and Community 
Health, Minneapolis, MN 55455 (ML-C, SAH, RL, JR); HealthPartners Institute, 
Research Division, Minneapolis, MN, 55440 (SAH).

Loneliness is the subjective feeling people experience when they feel less 
socially connected to others than they desire. Beyond the impact to mental 
health and well-being, loneliness is linked to detrimental health outcomes. 
During the COVID-19 pandemic, social distancing and isolation requirements 
likely exacerbated the prevalence of loneliness, which was reported by 1 in 5 
American adults before the pandemic. Whether it be through in-person or virtual 
visits, primary care clinicians have tools and expertise to screen patients for 
loneliness, provide them supportive consultations, and refer persons with 
loneliness to helpful resources. As the societal changes from the pandemic 
continue to evolve, we recommend that primary care providers include loneliness 
screens as part of their standard workflow and consult with patients about 
effective interventions to reduce loneliness.

© Copyright 2022 by the American Board of Family Medicine.

DOI: 10.3122/jabfm.2022.03.210461
PMID: 35641036 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest: None.


1968. Infant Ment Health J. 2022 Jul;43(4):624-637. doi: 10.1002/imhj.21996. Epub 2022 
May 31.

From zero to thrive: A model of cross-system and cross-sector relational health 
to promote early childhood development across the child-serving ecosystem.

Miller AL(1), Stein SF(1)(2), Sokol R(3), Varisco R(1), Trout P(1)(4), Julian 
MM(5), Ribaudo J(2), Kay J(6), Pilkauskas NV(4), Gardner-Neblett N(7), 
Herrenkohl TI(2), Zivin K(1)(5)(8), Muzik M(5)(8), Rosenblum KL(5)(8).

Author information:
(1)School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
(2)School of Social Work, University of Michigan, Ann Arbor, Michigan, USA.
(3)School of Social Work, Wayne State University, Detroit, Michigan, USA.
(4)Ford School of Public Policy, University of Michigan, Ann Arbor, Michigan, 
USA.
(5)Department of Psychiatry, Michigan Medicine, University of Michigan, Ann 
Arbor, Michigan, USA.
(6)University of Michigan Law School, Ann Arbor, Michigan, USA.
(7)Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA.
(8)Department of Obstetrics and Gynecology, Michigan Medicine, University of 
Michigan, Ann Arbor, Michigan, USA.

Early relational health between caregivers and children is foundational for 
child health and well-being. Children and caregivers are also embedded within 
multiple systems and sectors, or a "child-serving ecosystem", that shapes child 
development. Although the COVID-19 pandemic has made this embeddedness 
abundantly clear, systems remain siloed and lack coordination. Fostering 
relational health amongst layers of this ecosystem may be a way to 
systematically support young children and families who are facing adversity. We 
integrate theory, examples, and empirical findings to develop a conceptual model 
informed by infant mental health and public health frameworks that illustrates 
how relational health across the child-serving ecosystem may promote child 
health and well-being at a population level. Our model articulates what 
relational health looks like across levels of this ecosystem from primary 
caregiver-child relationships, to secondary relationships between caregivers and 
child-serving systems, to tertiary relationships among systems that shape child 
outcomes directly and indirectly. We posit that positive relational health 
across levels is critical for promoting child health and well-being broadly. We 
provide examples of evidence-based approaches that address primary, secondary, 
and tertiary relational health, and suggest ways to promote relational health 
through cross-sector training and psychoeducation in the science of early 
development. This model conceptualizes relational health across the 
child-serving ecosystem and can serve as a template for promoting child health 
and well-being in the context of adversity.

Publisher: La salud de la temprana relación entre quienes prestan cuidado y los 
niños es fundamental para la salud y el bienestar del niño. Los niños y quienes 
les cuidan forman parte de múltiples sistemas y sectores, o un “ecosistema de 
servicio al niño,” que moldea el desarrollo del niño. Aunque la pandemia del 
COVID-19 ha demostrado abundante y claramente esta pertenencia, los sistemas 
permanecen aislados y les hace falta coordinación. Fomentar la salud de la 
relación entre las capas del ecosistema pudiera ser una manera de apoyar 
sistemáticamente a los niños pequeños y familias que se enfrentan con 
situaciones adversas. Presentamos un modelo conceptual con base en marcos de 
trabajo de la salud mental infantil y la salud pública que ilustra cómo la salud 
de la relación a lo largo del ecosistema de servicio al niño pudiera promover el 
desarrollo del niño al nivel de grupo de población. Nuestro modelo articula cómo 
aparece la salud de la relación a lo largo de los niveles del ecosistema desde 
las relaciones entre quien presta el cuidado primario y el niño, hasta las 
relaciones secundarias entre quienes prestan el cuidado y loa sistemas de 
servicio al niño, y las relaciones terciarias entre sistemas que amoldan directa 
e indirectamente los resultados en el niño. Una positiva salud de la relación a 
través de todos los niveles es esencial para promover la salud y el bienestar 
del niño de manera amplia. Describimos ejemplos específicos de salud de la 
relación primaria, secundaria y terciaria, y sugerimos maneras de promover la 
salud de la relación a través del entrenamiento intersectorial y la educación 
sicológica dentro de la ciencia del desarrollo temprano. Este modelo 
conceptualiza la salud de la relación a lo largo del ecosistema de servicio al 
niño y puede ser un esquema patrón para promover el desarrollo del niño dentro 
del contexto de situaciones adversas.

Publisher: La Santé Relationnelle Précoce entre les personnes prenant soin des 
enfants et les enfants est fondamentale pour la santé de l'enfant et son 
bien-être. Les enfants et les personnes prenant soin d'eux sont encastrés dans 
de multiples systèmes et des secteurs, ou un « écosystème » servant l'enfant qui 
forme le développement de l'enfant. Bien que la pandémie du Covid19 ait rendu 
cet encastrement très clair, les systèmes demeurent compartimentés et manquent 
de coordination. Cultiver la santé relationnelle au sein des couches de 
l’écosystème pourrait s'avérer être une manière de soutenir des jeunes enfants 
et les familles faisant face aux obstacles. Nous présentons un modèle conceptuel 
informé par les structures de la santé mentale du nourrisson et de la santé 
publique qui illustre la manière dont la santé relationnelle au travers de 
l’écosystème servant les enfants peut promouvoir le développement de l'enfant au 
niveau de la population. Notre modèle articule ce à quoi la santé relationnelle 
ressemble au travers des niveaux de l’écosystème, des relations entre la 
personne principale qui s'occupe de l'enfant et l'enfant aux relations 
secondaires entre les personnes prenant soin de l'enfant et les systèmes servant 
l'enfant, jusqu'aux relations tertiaires entres les systèmes qui donnent forme 
aux résultats directement et indirectement. Une santé relationnelle positive au 
travers de tous les niveaux est critique pour la promotion de la santé de 
l'enfant et de son bien-être en général. Nous décrivons des exemples spécifiques 
de santé relationnelle primaire, secondaire et tertiaire, et suggérons des 
manières de promouvoir la santé relationnelle au travers de la formation entre 
secteurs et de la psychoéducation dans la science du développement précoce. Ce 
modèle conceptualise la santé relationnelle au travers de l’écosystème servant 
l'enfant et peut servir de modèle pour la promotion du développement de l'enfant 
dans le contexte de l'adversité.

Publisher: Von Null zum Erfolg: Ein Modell der system- und sektorübergreifenden 
relationalen Gesundheit zur Förderung der frühkindlichen Entwicklung im gesamten 
Ökosystem der Kinderbetreuung/-erziehung Die frühe relationale Gesundheit 
zwischen Bezugspersonen und Kindern ist von grundlegender Bedeutung für die 
Gesundheit und das Wohlbefinden von Kindern. Kinder und Bezugspersonen sind in 
mehrere Systeme und Sektoren integriert, die die kindliche Entwicklung prägen, 
sozusagen in ein "Ökosystem der Kinderbetreuung/-erziehung". Obwohl die 
COVID-19-Pandemie gezeigt hat, wie wichtig diese Integration ist, sind die 
Systeme nach wie vor isoliert und unkoordiniert. Eine Förderung der relationalen 
Gesundheit über die verschiedenen Ebenen des Ökosystems hinweg könnte ein Weg 
sein, um junge Kinder und Familien, die mit Widrigkeiten konfrontiert sind, 
systematisch zu unterstützen. Wir stellen ein konzeptionelles Modell vor, das 
sich auf das psychische Gesundheitswesen für Kinder und das öffentliche 
Gesundheitswesen stützt. Das Modell veranschaulicht, wie relationale Gesundheit 
im gesamten Ökosystem der Kinderbetreuung/-erziehung die kindliche Entwicklung 
auf Bevölkerungsebene fördern kann. Unser Modell beschreibt, wie relationale 
Gesundheit auf allen Ebenen des Ökosystems aussieht, von der primären Beziehung 
zwischen Bezugsperson und Kind über die sekundären Beziehungen zwischen der 
Bezugsperson und den Kinderbetreuungs /-erziehungssystemen bis hin zu den 
tertiären Beziehungen zwischen den Systemen, die direkte und indirekte Einflüsse 
auf Kinder haben. Positive relationale Gesundheit auf allen Ebenen ist 
entscheidend für die Gesundheitsförderung und das Wohlbefinden von Kindern im 
Allgemeinen. Wir beschreiben spezifische Beispiele für primäre, sekundäre und 
tertiäre relationale Gesundheit. Außerdem schlagen wir Möglichkeiten zur 
Förderung der relationalen Gesundheit durch sektorübergreifende Ausbildung und 
Psychoedukation im wissenschaftlichen Feld der frühkindlichen Entwicklung vor. 
Dieses Modell konzeptualisiert relationale Gesundheit im gesamten Ökosystem der 
Kinderbetreuung/-erziehung und kann als Vorlage für die Förderung kindlicher 
Entwicklung im Kontext von Widrigkeiten dienen.

Publisher: 0からの成功:子ども支援エコシステム全体で幼児期の発達を促進するための、 システム間共通で分野横断的な関係性における健康のモデル 
養育者と子どもの間の早期の関係性における健康は、子どもの健康と幸福の土台となる。子どもと養育者は、子どもの発達を形作る複数のシステムや活動分野、または“子ども支援エコシステム”の中に組み込まれている。COVID-19のパンデミックにより、この組み込み性は明らかになったが、システムは依然として地下に埋め込まれているような状態で 
(サイロ化され) 
、調整が取れていない。エコシステムの層の間で関係性における健康を育むことは、逆境に直面している幼い子どもや家族を体系的に支援する方法かもしれない。私たちは、子ども支援エコシステム全体の関係性における健康が、集団レベルでの子どもの発達をどのように促進するかを提示した乳幼児のメンタルヘルスと公衆衛生の枠組みに基づいた概念モデルを示す。私たちのモデルは、一次的な養育者-子どもの関係性から、養育者と子ども支援システムとの二次的な関係、そして子どもの結果を直接・間接的に形成するシステム間の三次的な関係に至るまで、エコシステムのレベルを超えた関係性における健康がどのようなものかを明確にしている。あらゆるレベルでの肯定的な関係性における健康は子どもの健康と幸福を広く促進するために重要である。一次、二次、三次の関係性における健康の具体的な例を説明し、早期発達の科学における分野横断的なトレーニングと心理教育を通じてそれを促進する方法を提案します。このモデルは、子ども支援エコシステム全体の関係性における健康を概念化したもので、逆境の中で子どもの発達を促進するためのモデルとなり得る。.

Publisher: 看护者和儿童之间的早期关系健康是儿童健康与福祉的基础。儿童和看护者被嵌入到塑造儿童发展的多个系统和部门, 
或“儿童服务生态系统”中。尽管COVID-19大流行使这种嵌入性非常清晰, 但系统间仍然孤立且缺乏协调。促进生态系统各层之间的关系健康, 
可能是系统地支持面临逆境的幼儿和家庭的一种方式。我们提出了一个由婴儿心理健康和公共卫生框架提供信息的概念模型, 
该模型说明了整个“儿童服务生态系统”中的关系健康如何在大众层面促进儿童发展。我们的模型阐明了各生态系统层面上的关系健康状况, 从主要的看护者-儿童关系, 
到看护者和儿童服务系统之间的二级关系, 
再到直接或间接影响儿童发展的各系统之间的三级关系。各个层面上积极的关系健康对于广泛促进儿童健康和福祉至关重要。我们描述了初级、二级和三级关系健康的具体例子, 
并提出了通过早期发展科学中的跨部门培训和心理教育来促进关系健康的方法。该模型将整个“儿童服务生态系统”中的关系健康概念化, 
可以作为在逆境中促进儿童发展的模板。.

Publisher: من الصفر إلى النمو: نموذج للصحة العلائقية عبر الأنظمة وعبر القطاعات 
لتعزيز نمو الطفولة المبكرة عبر النظام البيئي لخدمة الطفل تعد صحة العلاقات 
المبكرة بين مقدمي الرعاية والأطفال أمرًا أساسيًا لصحة الطفل ورفاهيته. ويتعامل 
الأطفال ومقدمي الرعاية في أنظمة وقطاعات متعددة ، أو "نظام بيئي يخدم الأطفال" ، 
والذي يشكل تطور الطفل. على الرغم من أن جائحة كوفيد -19 قد جعل هذا التضمين واضحًا 
تمامًا ، إلا أن هذه الأنظمة مازالت معزولة وتفتقر إلى التنسيق. قد يكون تعزيز 
الصحة العلائقية بين مستويات النظام البيئي وسيلة للدعم المنهجي للأطفال الصغار 
والأسر الذين يواجهون الصعوبات. نقدم نموذجًا مفاهيميًا مستمداً من أطر الصحة 
النفسية والصحة العامة للرضع والذي يوضح كيف أن الصحة العلائقية عبر النظام البيئي 
الذي يخدم الأطفال قد تعزز نمو الطفل على المستوى المجتمعي. يوضح نموذجنا كيف تبدو 
الصحة العلائقية عبر مستويات النظام البيئي من العلاقات الأولية بين مقدم الرعاية 
والطفل ، إلى العلاقات الثانوية بين مقدمي الرعاية وأنظمة خدمة الأطفال ، إلى 
العلاقات من الدرجة الثالثة بين الأنظمة التي تشكل نتائج الأطفال بشكل مباشر وغير 
مباشر. تعد صحة العلاقات الإيجابية على جميع المستويات أمرًا بالغ الأهمية لتعزيز 
صحة الطفل ورفاهيته على نطاق واسع. تصف هذه الدراسة أمثلة محددة للصحة العلائقية 
الأولية والثانوية والدرجة الثالثة ، وتقدم اقتراحات لوسائل لتعزيز الصحة العلائقية 
من خلال التدريب عبر القطاعات والتعليم النفسي في علم النمو المبكر. يصور هذا 
النموذج مفهوم الصحة العلائقية عبر النظام البيئي الذي يخدم الأطفال ويمكن أن يكون 
نموذجًا لتعزيز نمو الطفل في سياق المواقف الصعبة.

© 2022 Michigan Association for Infant Mental Health.

DOI: 10.1002/imhj.21996
PMID: 35638583 [Indexed for MEDLINE]


1969. Sci Rep. 2022 May 30;12(1):8990. doi: 10.1038/s41598-022-12841-x.

Online education and the mental health of faculty during the COVID-19 pandemic 
in Japan.

Kita Y(#)(1)(2)(3), Yasuda S(#)(4), Gherghel C(#)(4).

Author information:
(1)Mori Arinori Institute for Higher Education and Global Mobility, Hitotsubashi 
University, 2-1, Naka, Kunitachi, Tokyo, 186-8601, Japan. yosuke.kita@keio.jp.
(2)Cognitive Brain Research Unit (CBRU), Faculty of Medicine, University of 
Helsinki, Helsinki, Finland. yosuke.kita@keio.jp.
(3)Department of Psychology, Faculty of Letters, Keio University, Tokyo, Japan. 
yosuke.kita@keio.jp.
(4)Mori Arinori Institute for Higher Education and Global Mobility, Hitotsubashi 
University, 2-1, Naka, Kunitachi, Tokyo, 186-8601, Japan.
(#)Contributed equally

While the negative impact of the pandemic on students' mental health has been 
studied around the world, very little is known about the mental health of 
faculty and staff. This research aims to examine mental health among Japanese 
faculty members who taught online courses during the COVID-19 pandemic. We 
recruited 537 university faculty members and assessed their mental health using 
the World Health Organization-Five Well-Being Index (WHO-5), both 
retrospectively (during the academic year before the onset of the pandemic) and 
during the pandemic. We also evaluated workload (number of online lectures 
taught and preparation time per class), difficulty in using information 
technology (IT) for online classes, and satisfaction with the university support 
service for online education. As a result, the WHO-5 score during the COVID-19 
pandemic was significantly lower than before, and 33.5% of the faculty members 
were recognized as being at risk for mental illness during the COVID-19 
pandemic. A binomial logistic regression analysis revealed two significant risk 
factors for mental illness-faculty members were more at risk for mental illness 
when they experienced difficulty in using IT for online classes, and were 
unsatisfied with the administrative support for online education. The 
deterioration of mental health during the COVID-19 was not predicted by 
workload, such as the number of online lectures and preparation time. These 
results suggest the importance of improving workplace support services, 
especially IT support, to prevent mental health deterioration among faculty 
teaching online.

© 2022. The Author(s).

DOI: 10.1038/s41598-022-12841-x
PMCID: PMC9151810
PMID: 35637241 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1970. Clin Psychol Rev. 2022 Jul;95:102173. doi: 10.1016/j.cpr.2022.102173. Epub 2022 
May 24.

Resilience among health care workers while working during a pandemic: A 
systematic review and meta synthesis of qualitative studies.

Curtin M(1), Richards HL(2), Fortune DG(3).

Author information:
(1)Department of Psychology, University of Limerick, Limerick V94 T9P, Ireland.
(2)Department of Psychology, University of Limerick, Limerick V94 T9P, Ireland; 
Department of Clinical Health Psychology, Mercy University Hospital, Cork T12 
WE28, Ireland.
(3)Department of Psychology, University of Limerick, Limerick V94 T9P, Ireland; 
Clinical Psychology, Health Service Executive, CHO3 Mid West, Ireland. 
Electronic address: Donal.fortune@ul.ie.

BACKGROUND: The COVID-19 pandemic has reinforced the need to attend to Health 
Care Workers (HCWs) mental health. What promotes resilience in HCWs during 
pandemics is largely unknown.
AIM: To appraise and synthesize studies investigating resilience among HCWs 
during COVID-19, H1N1, MERS, EBOLA and SARS pandemics.
METHOD: A systematic review of studies from 2002 to 11th March 2022 was 
conducted. PsychInfo, CINAHL, Medline, Embase, Web of Science, Scopus and the 
Cochrane Library databases were searched for qualitative and mixed-methods 
studies investigating the well-being of HCWs working in hospital settings during 
a pandemic. Data was extracted, imported into NVivo and analyzed by means of 
thematic synthesis. Reporting followed PRISMA and ENTREQ guidelines.
RESULTS: One hundred and twenty-one eligible studies (N = 11,907) were 
identified. The results revealed six main themes underpinning HCWs resilience: 
moral purpose and duty, connections, collaboration, organizational culture, 
character and potential for growth.
CONCLUSION: The studies reviewed indicated that HCWs resilience is mainly born 
out of their professional identity, collegial support, effective communication 
from supportive leaders along with flexibility to engage in self-care and 
experiences of growth.

Copyright © 2022. Published by Elsevier Ltd.

DOI: 10.1016/j.cpr.2022.102173
PMCID: PMC9126830
PMID: 35636130 [Indexed for MEDLINE]

Conflict of interest statement: All authors (MC, HLR, DGF) declare that they 
have no conflicts of interest.


1971. J Reprod Infant Psychol. 2024 Mar;42(2):299-314. doi: 
10.1080/02646838.2022.2077921. Epub 2022 May 30.

Mother's mental health and the interaction with her moderate preterm baby in the 
NICU.

Mira A(1)(2), Coo S(2), Bastías R(3).

Author information:
(1)Facultad de Ciencias de la Rehabilitación, Universidad Andrés Bello, 
Santiago, Chile.
(2)Facultad de Psicología, Universidad del Desarrollo (UDD), Santiago, Chile.
(3)Unidad de Neonatología, Hospital Luis Tisné T., Servicio de Salud 
Metropolitana Oriente, Santiago, Chile.

INTRODUCTION: Moderate preterm infants, born between 320/7 and 336/7 weeks, 
represent a significant number of preterm-born infants; however, they remain a 
poorly studied group despite their vulnerability. The objective of this 
correlational study is to describe the impact of having a moderate preterm 
infant hospitalised in the NICU on the mothers' mental health and how this 
relates to the interaction between the dyad.
METHOD: During the hospitalisation period, 85 moderate preterm mother-infant 
dyads participated in this study. The participants provided self-reports of 
depression, parental stress, and skin to skin and breastfeeding practices. Also, 
mother-infant interaction was assessed in the NICU with an observational scale.
RESULTS: Mothers evidenced high levels of stress and depressive symptoms during 
the hospitalization. The stress experienced by these women was significant, 
although weakly, associated with the interaction with their babies; and mothers 
of small for gestational age babies showed difficulties in this area.
CONCLUSIONS: The results of this study could represent a contribution to a 
better understanding of the relation between the characteristics of moderate 
preterm babies, maternal emotional wellbeing, and the quality of mother-infant 
interactions in NICU settings.

DOI: 10.1080/02646838.2022.2077921
PMID: 35635499 [Indexed for MEDLINE]


1972. Florence Nightingale J Nurs. 2022 Feb;30(1):74-82. doi: 10.5152/fnjn.2022.21053.

Experiences and Psychosocial Difficulties of Frontline Health Care Workers 
Struggling With COVID-19 in Turkey: A Qualitative Study.

Uzun Şahin C(1), Aydın M(2), Usta A(3), Sakın M(4).

Author information:
(1)Department of Medical Services and Techniques, Recep Tayyip Erdoğan 
University, Vocational School of Health Services, First and Emergency Program, 
Rize, Turkey.
(2)Department of Mental Health and Nursing, Karadeniz Technical University, 
Faculty of Health Sciences, Trabzon, Turkey.
(3)Surgical Intensive Care Unit, Rize Public Hospital, Rize, Turkey.
(4)Department of Anesthesia and Reanimation, Rize Provincial Health Directorate, 
Rize, Turkey.

AIM: This study was performed to explore the experiences and the psychosocial 
difficulties faced by nurses and physicians involved in the treatment and care 
for COVID-19 adult patients in the intensive care unit.
METHOD: The interpretative phenomenological approach was used, and the data were 
gathered between June and July, 2020 in Rize using face-to-face interviews. The 
sample consisted of 10 nurses and 5 physicians. The thematic analysis was 
utilized to analyze the data. The Consolidated Criteria for Reporting 
Qualitative Research (COREQ) were followed in the study.
RESULTS: The experiences of nurses and physicians were categorized under three 
themes and subcategories. The theme of "Going Through Psychosocial Changes" was 
divided into decreased emotional well-being and experiencing social changes, the 
theme of "Work-Related Challenges" was divided into losing the routines and 
economic concerns, and the theme of "Felt Gains" was divided into realizing 
one's worth and increased motivation.
CONCLUSION: The study revealed that nurses and physicians are supported, 
respected, and described as heroes by Turkish society. However, they are 
psychologically and socially adversely affected, they display negative and 
positive emotions, and experience psychological growth. In addition, nurses 
complain about insufficient and unfair payment. Despite all these challenges, 
nurses and physicians continue to work with increasing emotional resistance. It 
is recommended to be aware of the problems that they experience during and after 
the COVID-19 pandemic, protect their mental health, provide adequate economic 
support, especially for nurses, and take necessary measures by collecting data 
that may be a guide for subsequent outbreaks.

DOI: 10.5152/fnjn.2022.21053
PMCID: PMC8958229
PMID: 35635350

Conflict of interest statement: Conflict of Interest: The authors have no 
conflicts of interest to declare.


1973. Psychol Health Med. 2023 Jul;28(6):1399-1410. doi: 
10.1080/13548506.2022.2079690. Epub 2022 May 29.

Gratitude and kindness at work as predictors of employees' mental health 
outcomes during the COVID-19 pandemic.

Datu JAD(1), Buenconsejo JU(2), Valdez JPM(3), Tang RL(4).

Author information:
(1)Department of Special Education and Counselling, Integrated Centre for 
Wellbeing (i-WELL), the Education University of Hong Kong, Hong Kong.
(2)Department of Special Education and Counselling, the Education University of 
Hong Kong, Hong Kong.
(3)Department with Early Childhood Education, the Education University of Hong 
Kong, Hong Kong.
(4)Office of the Chancellor, de La Salle - College of St. Benilde, Philippines.

This research explored the association of perceptions of gratitude and kindness 
at work with well-being outcomes, such as relatedness needs satisfaction, life 
satisfaction, and COVID-19 anxiety among selected Filipino employees during the 
COVID-19 pandemic. Hierarchical regression analyses demonstrated that kindness 
positively predicted relatedness needs satisfaction even after controlling for 
participants' age, gender, employment status, and length of stay in the 
organization. Gratitude positively predicted life satisfaction. This research 
underscores the mental health payoffs associated with fostering gratitude and 
kindness in organizational contexts during the COVID-19 pandemic.

DOI: 10.1080/13548506.2022.2079690
PMID: 35635265 [Indexed for MEDLINE]


1974. J Alzheimers Dis. 2022;88(2):679-692. doi: 10.3233/JAD-220221.

A Comparison of Well-Being of Carers of People with Dementia and Their Ability 
to Manage Before and During the COVID-19 Pandemic: Findings from the IDEAL 
Study.

Gamble LD(1), Parker S(2), Quinn C(3), Bennett HQ(1), Martyr A(2), Sabatini 
S(2), Pentecost C(2), Collins R(2), Dawson E(2), Hunt A(2), Allan L(2), Burns 
A(4), Litherland R(5), Victor C(6), Matthews FE(1), Clare L(2)(7).

Author information:
(1)Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle 
University, Newcastle, UK.
(2)REACH: The Centre for Research in Ageing and Cognitive Health, University of 
Exeter Medical School, Exeter, UK.
(3)Centre for Applied Dementia Studies, Bradford University, Bradford, UK.
(4)Institute of Brain, Behaviour and Mental Health, University of Manchester, 
Manchester, UK.
(5)Innovations in Dementia CIC, Exeter, UK.
(6)College of Health, Medicine and Life Sciences, Brunel University London, 
London, UK.
(7)NIHR Applied Research Collaboration South-West Peninsula, Plymouth, UK.

BACKGROUND: Social restriction measures imposed to curb the spread of COVID-19 
in the United Kingdom impacted on carers of people with dementia, limiting 
access to support services and increasing perceived burden of caring. Few 
studies have compared data collected both during and before the pandemic to 
examine the effect of these changes.
OBJECTIVE: To explore whether the COVID-19 pandemic affected the well-being of 
carers of people with dementia living in the community, and their ability to 
cope with their caring responsibilities.
METHODS: Analysis was conducted on two groups of carers who were enrolled in the 
IDEAL programme; the 'pre-pandemic group' (n = 312), assessed at two time points 
prior to the pandemic, and the 'pandemic group', assessed prior to and several 
months into the pandemic (n = 156). For the pre-pandemic group, carers were 
matched 2:1 to carers in the pandemic group on certain characteristics. 
Differences in change over time between the two groups on self-reported 
well-being, quality of life, coping, perceived competence, and role captivity, 
were investigated using mixed effect modelling.
RESULTS: Compared to the pre-pandemic group, those in the pandemic group 
appeared to cope better and had more stable self-rated competency and role 
captivity. They did not differ in terms of well-being or quality of life.
CONCLUSIONS: Despite reports of negative impacts on carers early in the 
pandemic, the findings suggest the pandemic had little negative longer-term 
impact on carers of people with dementia, and in fact they appeared to have a 
more positive attitude towards coping several months into the pandemic.

DOI: 10.3233/JAD-220221
PMID: 35634850 [Indexed for MEDLINE]


1975. Work. 2022;72(3):1077-1085. doi: 10.3233/WOR-210517.

Burnout and psychological symptoms in healthcare workers during the COVID-19 
pandemic: Comparisons of different medical professions in a regional hospital in 
Turkey.

Sagaltici E(1), Saydam RB(2), Cetinkaya M(3), Şahin ŞK(4), Küçük SH(5), 
Müslümanoğlu AY(6).

Author information:
(1)Eser Sagaltici, Bagcilar Research and TrainingHospital, Department of 
Psychiatry, University of Health Sciences, Istanbul, Turkey.
(2)Reyhan Bahçivan Saydam, Department of Social Work, Health Science Faculty, 
IstanbulUniversity-Cerrahpaşa, Istanbul, Turkey.
(3)Mustafa Cetinkaya, Department of Psychiatry, Faculty of Medicine, Istanbul 
University, Istanbul, Turkey.
(4)Şengül Kocamer Şahin, Department ofPsychiatry, Faculty of Medicine, Gaziantep 
University, Gaziantep, Turkey.
(5)Suat Hayri Küçük, Departmentof Biochemistry, Bagcilar Research and Training 
Hospital, Universityof Health Sciences, Istanbul, Turkey.
(6)Ahmet YaserMüslümanoğlu, Department of Urology, Bagcilar Researchand Training 
Hospital, University of Health Sciences, Istanbul, Turkey.

BACKGROUND: Early studies have revealed the psychological effects of the 
COVID-19 outbreak on healthcare workers (HCWs). Burnout and psychological 
outcomes of different medical professions during the pandemic have not yet been 
addressed.
OBJECTIVE: The study aimed to investigate the burnout, depression, anxiety, and 
psychological distress levels of HCWs, and to determine the predictive factors 
of burnout in different professions of frontline HCWs during the pandemic.
METHODS: This cross-sectional study included 253 HCWs (79 physicians, 95 nurses, 
and 79 other-HCWs). The Maslach Burnout Inventory, Beck Depression Inventory, 
Beck Anxiety Inventory, and Impact of Event Scale-Revised, and Sociodemographic 
Form were used.
RESULTS: Emotional exhaustion was significantly higher in physicians and nurses 
than in other frontline HCWs. While depersonalization was significantly higher 
in physicians than nurses / other HCWs, levels of avoidance, hyperarousal and 
intrusion were found to be higher in other HCWs / nurses than physicians. 
Depression was the most effective predicting variable for burnout, following 
age, quarantine, supervisor's/team leader's attitude, hyperarousal and 
avoidance.
CONCLUSIONS: It has been observed that depending on the uncertainty and life 
risk of the pandemic in HCWs involved in the treatment of COVID-19, physicians 
who are the decision-making authorities in the treatment process used more 
depersonalization than nurses and other HCWs. Nurses and other-HCWs had 
significantly higher distress symptoms than physicians. Both future research and 
psychosocial services should address those with high depressive symptoms as a 
potentially fragile subgroup for burnout among HCWs, and investigate and develop 
evidence-based interventions that can provide mental well-being, and prevent 
burnout.

DOI: 10.3233/WOR-210517
PMID: 35634831 [Indexed for MEDLINE]


1976. Comput Intell Neurosci. 2022 May 18;2022:4914665. doi: 10.1155/2022/4914665. 
eCollection 2022.

Monitoring the Emotional Response to the COVID-19 Pandemic Using Sentiment 
Analysis: A Case Study in Mexico.

León-Sandoval E(1), Zareei M(1), Barbosa-Santillán LI(1), Falcón Morales LE(1), 
Pareja Lora A(2), Ochoa Ruiz G(1).

Author information:
(1)School of Engineering and Sciences, Monterrey Institute of Technology and 
Higher Education, Monterrey, Mexico.
(2)Universidad de Alcalá, Alcalá, Spain.

The world is facing the COVID-19 pandemic, leading to an unprecedented change in 
the lifestyle routines of millions. Beyond the general physical health, 
financial, and social repercussions of the pandemic, the adopted mitigation 
measures also present significant challenges in the population's mental health 
and health programs. It is complex for public organizations to measure the 
population's mental health in order to incorporate it into their own 
decision-making process. Traditional survey methods are time-consuming, 
expensive, and fail to provide the continuous information needed to respond to 
the rapidly evolving effects of governmental policies on the population's mental 
health. A significant portion of the population has turned to social media to 
express the details of their daily life, rendering this public data a rich field 
for understanding emotional and mental well-being. This study aims to track and 
measure the sentiment changes of the Mexican population in response to the 
COVID-19 pandemic. To this end, we analyzed 760,064,879 public domain tweets 
collected from a public access repository to examine the collective shifts in 
the general mood about the pandemic evolution, news cycles, and governmental 
policies using open sentiment analysis tools. Sentiment analysis polarity 
scores, which oscillate around -0.15, show a weekly seasonality according to 
Twitter's usage and a consistently negative outlook from the population. It also 
remarks on the increased controversy after the governmental decision to 
terminate the lockdown and the celebrated holidays, which encouraged the people 
to incur social gatherings. These findings expose the adverse emotional effects 
of the ongoing pandemic while showing an increase in social media usage rates of 
2.38 times, which users employ as a coping mechanism to mitigate the feelings of 
isolation related to long-term social distancing. The findings have important 
implications in the mental health infrastructure for ongoing mitigation efforts 
and feedback on the perception of policies and other measures. The overall trend 
of the sentiment polarity is 0.0001110643.

Copyright © 2022 Edgar León-Sandoval et al.

DOI: 10.1155/2022/4914665
PMCID: PMC9132622
PMID: 35634092 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that there are no conflicts 
of interest regarding the publication of this paper.


1977. West Afr J Med. 2022 May 27;39(5):548-551.

Depression and Suicidality in a COVID-19 Patient: A Case Report from Calabar, 
Nigeria.

Edet BE(1), Essien EA(1), Ugobo MB(1), Okafor CJ(2), Olose EO(2), Essien VA(1).

Author information:
(1)Department of Clinical Services, Federal Neuropsychiatric Hospital, Calabar, 
Cross River State, Nigeria.
(2)Department of Psychiatry, University of Calabar, Cross River State, Nigeria.

BACKGROUND: The coronavirus pandemic is associated with significant morbidity 
and mortality. While physical recovery has been made a priority, the 
psychological wellbeing of recovered patients is not receiving the attention it 
deserves.
CASE PRESENTATION: We present the case of a 27-year-old male who developed 
severe depression associated with anxiety and suicidal ideations two weeks after 
full recovery from COVID- 19 infection. Significant somatization was also 
present at the onset which he misattributed to a recurrence of the infection. He 
was admitted for in-patient psychiatric care and fully recovered after six weeks 
of medication and psychotherapy.
CONCLUSION: Infection with the virus is a psychologically distressing experience 
that can trigger mental disorders in vulnerable individuals. Our report 
highlights the mental health needs of all COVID-19 patients and the need for 
psychological evaluation in the post-recovery period.

Publisher: CONTEXTE: La pandémie de coronavirus est associée àmorbidité et 
mortalité importantes. Pendant la récupération physiquea été fait une priorité, 
le bien-être psychologique deles patients rétablis ne reçoivent pas l’attention 
qu’ils méritent.
PRÉSENTATION DU CAS: Nous présentons le cas d’un jeune homme de 27 anshomme qui 
a développé une dépression sévère associée à l’anxiétéet les idées suicidaires 
deux semaines après le rétablissement complet de la COVID-19 infection. Une 
somatisation importante était également présente à l’apparition qu’il a 
attribuée à tort à une récurrence de l’infection.Il a été admis pour des soins 
psychiatriques hospitaliers et completsrécupéré après six semaines de 
médicaments et de psychothérapie.
CONCLUSION: L’infection par le virus est une atteinte psychologiqueexpérience 
pénible qui peut déclencher des troubles mentaux dansles personnes vulnérables. 
Notre rapport met en lumière la santé mentaleles besoins de tous les patients 
atteints de la COVID-19 et le besoin deévaluation dans la période 
post-rétablissement.
MOTS-CLÉS: Anxiété, Dépression, Suicidaire, COVID-19, Nigéria.

Copyright © 2022 by West African Journal of Medicine.

PMID: 35633651 [Indexed for MEDLINE]

Conflict of interest statement: The Authors declare that no competing interest 
exists.


1978. Int J Environ Res Public Health. 2022 May 18;19(10):6134. doi: 
10.3390/ijerph19106134.

Health Occupation and Job Satisfaction: The Impact of Psychological Capital in 
the Management of Clinical Psychological Stressors of Healthcare Workers in the 
COVID-19 Era.

Caponnetto P(1)(2), Platania S(1), Maglia M(1)(2), Morando M(1), Gruttadauria 
SV(1), Auditore R(3), Ledda C(4), Rapisarda V(4), Santisi G(1).

Author information:
(1)Section Psychology, Department of Educational Sciences, University of 
Catania, 95124 Catania, Italy.
(2)Center of Excellence for the Acceleration of Harm Reduction (COEHAR), 
University of Catania, 95124 Catania, Italy.
(3)CTA Psychiatric Rehabilitation and Research, 95030 Mascalucia, Italy.
(4)Department of Clinical and Experimental Medicine, Occupational Medicine, 
University of Catania, 95123 Catania, Italy.

The COVID-19 pandemic greatly impacted global health. Frontline healthcare 
workers involved in the response to COVID-19 faced physical and psychological 
challenges that threatened their wellbeing and job satisfaction. The pandemic 
crisis, alongside pre-existing critical issues, exposed healthcare workers to 
constant emotional fatigue, creating an increased workload and vulnerability to 
stress. Maintaining such stress levels increased their levels of anxiety, 
irritability and loneliness. Evidence shows that the Psychological Capital 
(PsyCap) was a strong protective factor against these stressors. The aim of this 
study was to analyze the level of job satisfaction among health workers facing 
the COVID-19 pandemic. The possible antecedent factors to satisfaction and the 
role that PsyCap plays in preserving and fostering higher levels of job 
satisfaction were investigated. A total of 527 healthcare workers from different 
areas of Italy were recruited for the study. The results revealed that 
psychological stress factors have a considerable impact on job satisfaction. All 
four predictors (Stress Vulnerability, Anxiety Symptoms, Loneliness and 
Irritability) had the potential to decrease job satisfaction. Loneliness had a 
more significant effect than other factors assessed in this study. Moreover, the 
results showed how PsyCap could decrease the effects of psychological stressors 
on job satisfaction. Consistent with previous studies, our findings show that 
PsyCap could alleviate negative impacts in work-related circumstances.

DOI: 10.3390/ijerph19106134
PMCID: PMC9140562
PMID: 35627671 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript, or in the decision to 
publish the results.


1979. Int J Environ Res Public Health. 2022 May 16;19(10):6053. doi: 
10.3390/ijerph19106053.

Health-Promoting Quality of Life at Work during the COVID-19 Pandemic: A 
12-Month Longitudinal Study on the Work-Related Sense of Coherence in Acute Care 
Healthcare Professionals.

Berger-Estilita J(1)(2), Abegglen S(3), Hornburg N(3), Greif R(4)(5), Fuchs 
A(4).

Author information:
(1)Institute for Medical Education, University of Bern, 3012 Bern, Switzerland.
(2)CINTESIS-Centre for Health Technology and Services Research, Faculty of 
Medicine, University of Porto, 4200-450 Porto, Portugal.
(3)Department of Health Psychology and Behavioural Medicine, University of Bern, 
3012 Bern, Switzerland.
(4)Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University 
Hospital, University of Bern, 3010 Bern, Switzerland.
(5)School of Medicine, Sigmund Freud University Vienna, 1020 Vienna, Austria.

(1) Background: During a pandemic, the wellbeing of healthcare professionals is 
crucial. We investigated the long-term association of the Work-related Sense of 
Coherence (Work-SoC) and the evolution of psychological health symptoms of acute 
care healthcare professionals during the first year of the COVID-19 pandemic. 
(2) Methods: This longitudinal observational study enrolled 520 multinational 
healthcare professionals, who completed an online survey every three months from 
April 2020 to April 2021. Mixed linear models examined the associations between 
Work-SOC and COVID-19-related anxiety, perceived vulnerability, depressiveness, 
and psychological trauma symptomatology. (3) Results: Healthcare professionals 
with a higher Work-SoC reported lower levels of COVID-19-related anxiety, 
perceived vulnerability, depressiveness, and psychological trauma symptomatology 
in April 2020 than healthcare professionals with an average or lower Work-SoC, 
but the levels increased to higher values in April 2021. Healthcare 
professionals with a lower Work-SoC reported higher levels of depressiveness and 
psychological trauma symptomatology in April 2020 but lower levels in April 
2021. (4) Conclusions: Healthcare professionals with higher levels of 
Work-related Sense of Coherence might be protected against variations in 
psychological symptoms for about three months, but this protection seems to 
decrease as the pandemic continues, resulting in mental health deterioration. In 
contrast, healthcare professionals with a lower Work-SoC might be protected at 
later stages of the pandemic.

DOI: 10.3390/ijerph19106053
PMCID: PMC9140864
PMID: 35627590 [Indexed for MEDLINE]

Conflict of interest statement: The authors report that they have no conflicts 
of interest.


1980. Int J Environ Res Public Health. 2022 May 16;19(10):6028. doi: 
10.3390/ijerph19106028.

Effect of a Park-Based Physical Activity Intervention on Psychological Wellbeing 
at the Time of COVID-19.

Toselli S(1), Bragonzoni L(2), Grigoletto A(1), Masini A(1), Marini S(2), Barone 
G(2), Pinelli E(2), Zinno R(2), Mauro M(2), Pilone PL(3), Arduini S(3), Galli 
S(3), Vitiello M(3), Vicentini B(4), Boldrini G(4), Musti MA(3), Pandolfi P(3), 
Liberti M(3), Astorino G(3), Maietta Latessa P(2), Dallolio L(1).

Author information:
(1)Department of Biomedical and Neuromotor Sciences, University of Bologna, 
40126 Bologna, Italy.
(2)Department of Life Quality Studies, University of Bologna, 47921 Rimini, 
Italy.
(3)Department of Public Health, AUSL di Bologna, 40124 Bologna, Italy.
(4)Culture and City Promotion Department, Municipality of Bologna, 40126 
Bologna, Italy.

Practicing regular physical activity in green spaces has been invocated as a 
promising strategy for improving wellbeing in urban settings. The aim of the 
study was to assess the effect of a structured park-based physical activity 
intervention, the “Moving Parks” project, on citizens’ wellbeing at the time of 
COVID-19. The intervention was carried out in six public parks in Bologna 
(Italy) and administered by qualified instructors (from May 2021 to September 
2021). The Psychological General Well Being Index short form questionnaire was 
administered before and after the three months of outdoor activities. A total of 
328 participants completed the questionnaire at the beginning and at the end of 
the project. In September 2021, all psychosocial domains of the questionnaire 
(anxiety, depressed mood, self-control, positive well-being, vitality energy, 
and vitality-tiredness) significantly improved in the female sample (p value < 
0.01) and only the last two in the male sample (p value < 0.05). The “Moving 
Parks” project seems to be able to improve citizens’ psychological wellbeing, 
particularly in women.

DOI: 10.3390/ijerph19106028
PMCID: PMC9140357
PMID: 35627565 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1981. Int J Environ Res Public Health. 2022 May 15;19(10):5994. doi: 
10.3390/ijerph19105994.

Perfectionism, Resilience and Different Ways of Experiencing Sport during 
COVID-19 Confinement.

González-Hernández J(1), Bianco A(2), Marques da Silva C(3), Gómez-López 
M(4)(5).

Author information:
(1)Department of Personality, Evaluation and Psychological Treatment, University 
of Granada, 18001 Granada, Spain.
(2)Sport and Exercise Sciences Research Unit, Department of Psychology, 
Educational Science and Human Movement, University of Palermo, 90144 Palermo, 
Italy.
(3)Life Quality Research Center (CIEQV), Sport Sciences School of Rio Maior, 
Polytechnic Institute of Santarém, 2000-044 Santarem, Portugal.
(4)Department of Physical Activity and Sport, Faculty of Sport Sciences, 
University of Murcia, 30720 Murcia, Spain.
(5)Campus of International Excellence "Mare Nostrum", University of Murcia, 
30720 Murcia, Spain.

The relationship between sports practice and physical and mental health became 
an important issue during the COVID-19 pandemic, where keeping fit and 
exercising was one of the best and most popular ways to cope with the 
confinement situation. The aim of this study was to determine the relationships 
between perfectionism and resilient resources with psychological well-being, 
differentiating sports category, gender and experience in a sample of athletes 
during confinement in different countries affected by the COVID-19 pandemic. An 
incidental and cross-sectional random sampling method was designed (n = 583). 
The sample was analysed with three different instruments, evaluating 
perfectionism, resilience and psychological well-being patterns and comparing 
three groups with different levels of practice due to confinement (full 
reduction, moderate reduction and only access restrictions). Results show that 
both male and senior athletes were more organized, resistant to changes and 
focused their attention and efforts on their demands and potential. They were 
stimulated by obstacles that required more effort compared to U23, who reported 
higher concerns and lower organisational scores. Athletes who completely 
interrupted their sports dynamics showed higher indicators of perfectionism and 
performed worse in resilience and well-being. Despite this, age and the 
variability of the athletes' experiences proved to be relevant factors in an 
athlete's trajectory, and continued to represent a certain degree of balance in 
the face of COVID-19.

DOI: 10.3390/ijerph19105994
PMCID: PMC9141558
PMID: 35627531 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1982. Int J Environ Res Public Health. 2022 May 13;19(10):5961. doi: 
10.3390/ijerph19105961.

Mental Health and Well-Being Needs among Non-Health Essential Workers during 
Recent Epidemics and Pandemics.

Chowdhury N(1)(2)(3), Kainth A(4), Godlu A(4), Farinas HA(4), Sikdar S(3)(5), 
Turin TC(1)(2).

Author information:
(1)Department of Family Medicine, Cumming School of Medicine, University of 
Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada.
(2)Department of Community Health Sciences, Cumming School of Medicine, 
University of Calgary, Calgary, AB T2N 4N1, Canada.
(3)Alberta International Medical Graduates Association, Calgary, AB T2E 3K8, 
Canada.
(4)Community Scholar and Citizen Researcher, Immigrant and Refugee Health 
Interest Group, Calgary, AB T2N 4N1, Canada.
(5)Department of Microbiology, Immunology and Infectious Disease, Cumming School 
of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada.

Essential workers, those who work in a variety of sectors that are critical to 
sustain the societal infrastructure, were affected both physically and mentally 
by the COVID-19 pandemic. While the most studied group of this population were 
healthcare workers, other essential non-health workers such as those working in 
the law enforcement sector, grocery services, food services, delivery services, 
and other sectors were studied less commonly. We explored both the academic 
(using MEDLINE, PsycInfo, CINAHL, Sociological Abstracts, and Web of Science 
databases) and grey literature (using Google Scholar) to identify studies on the 
mental health effects of the six pandemics in the last 20 years (2000-2020). We 
identified a total of 32 articles; all of them pertained to COVID-19 except for 
one about Ebola. We found there was an increase in depression, anxiety, stress, 
and other mental health issues among non-health essential workers. They were 
more worried about passing the infection on to their loved ones and often did 
not have adequate training, supply of personal protective equipment, and support 
to cope with the effects. Generally, women, people having lower education, and 
younger people were more likely to be affected by a pandemic. Exploring 
occupation-specific coping strategies of those whose mental health was affected 
during a pandemic using more robust methodologies such as longitudinal studies 
and in-depth qualitative exploration would help facilitate appropriate responses 
for their recovery.

DOI: 10.3390/ijerph19105961
PMCID: PMC9141036
PMID: 35627494 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1983. Int J Environ Res Public Health. 2022 May 12;19(10):5908. doi: 
10.3390/ijerph19105908.

At the Peak of the Second Wave of COVID-19, Did Millennials Show Different 
Emotional Responses from Older Adults?

Wagener A(1), Stassart C(1), Etienne AM(1).

Author information:
(1)Research Unit for a Life-Course Perspective on Health and Education (RUCHE), 
Health Psychology, Department of Psychology, Faculty of Psychology and Science 
of Education, University de Liege, Rue de l'Aunaie, 30, 4000 Liege, Belgium.

The COVID-19 pandemic disturbs mental health. Indeed, higher levels of negative 
emotions and anxiety, along with lower levels of positive emotions and 
well-being, have been highlighted. As a result, individuals need to regulate 
these psychological states in a context of uncertainty and daily restrictions 
(e.g., access to leisure activities, social contacts) or modifications of 
livelihood (e.g., working modalities). Overall, psychological reactions to the 
pandemic have been shown to differ based on one's age. The purpose of this 
research is to compare psychological reactions to the pandemic between 
Millennials (born between 1981 and 1996) and Older Adults. The generation's 
prism seems relevant as members of specific generations are shaped (e.g., views 
of the world, the future) by their similar experiences. Ninety-four Millennials 
and 129 Older Adults, recruited in the general population, participated to an 
online survey assessing emotions, emotion regulation strategies, environmental 
satisfaction, and intolerance of uncertainty. Results show that Millennials 
experience higher levels of negative emotions along with higher levels of worry 
and rumination than Older Adults. Millennials also report a higher level of joy. 
Nonetheless, more Older Adults engage themselves in novel activities. Overall, 
findings confirm previous ones and indicate the need to offer effective 
clinicals tool to prevent mental health worsening.

DOI: 10.3390/ijerph19105908
PMCID: PMC9140619
PMID: 35627444 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1984. Int J Environ Res Public Health. 2022 May 12;19(10):5899. doi: 
10.3390/ijerph19105899.

Emotions, Stress and Coping among Healthcare Workers in a Reproductive Medicine 
Unit during the First and Second COVID-19 Lockdowns.

Paterlini M(1), Neri E(2), Nicoli A(3), Genova F(2), Villani MT(3), Santi S(3), 
Agostini F(2).

Author information:
(1)Department of Obstetrics and Pediatrics, AUSL-IRCCS, 42123 Reggio Emilia, 
Italy.
(2)Department of Psychology "Renzo Canestrari", University of Bologna, 40127 
Bologna, Italy.
(3)Center for Reproductive Medicine, Department of Obstetrics and Gynecology, 
AUSL-IRCCS, 42123 Reggio Emilia, Italy.

The impact of the COVID-19 pandemic on global healthcare workers' (HCWs) mental 
health has been well documented in the last two years; however, little is known 
regarding HCWs working in specific healthcare fields. During two subsequent 
periods of national lockdown in Italy (June-July 2020, T1, and November-December 
2020, T2), a total sample of 47 HCWs working in a reproductive medicine hospital 
unit completed an ad hoc questionnaire for assessing emotional reactions to the 
pandemic, stress symptoms, and ways of coping. Moderate-high levels of anger and 
sadness were experienced by 65.9% and 68.1% of the HCWs, respectively, while 
moderate-high levels of anxiety and fear were experienced by 51.1% and 56.8%, 
respectively. Higher stress symptoms experienced by HCWs were hypervigilance, 
avoidance of thoughts and memories, and tiredness/low energy. At T2, levels of 
hypervigilance, irritability, intrusive thoughts, and detachment were higher 
than at T1, while avoidance of external triggers decreased. Moderate-high levels 
of anxiety resulted significantly associated with several symptoms of stress: 
irritability/fearfulness, depression/hopelessness, tiredness/low energy, 
problems with concentration, and intrusive thoughts. Regarding coping 
strategies, HCWs tended to adopt more problem-focused coping (e.g., contributing 
to improving a situation) and this tendency was higher at T2. Overall findings 
suggest a risk for the persistence of stress symptoms and, therefore, a risk for 
a chronic course, which might interfere with the global quality of mental health 
at work and the care provided to patients. Clinical implications highlight the 
relevance of implementing support programs for this category of HCWs focused on 
the elaboration of negative emotions and on fostering adaptive coping 
strategies.

DOI: 10.3390/ijerph19105899
PMCID: PMC9141561
PMID: 35627436 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


1985. Environ Sci Pollut Res Int. 2022 Oct;29(48):73504-73517. doi: 
10.1007/s11356-022-20934-3. Epub 2022 May 27.

Awareness regarding COVID-19 and its effects on mental health among 
pre-professional health sciences students at King Saud bin Abdulaziz University 
for health sciences in Riyadh and Jeddah, Saudi Arabia.

Alghamdy Z(1), Alshahrani A(1), Memon I(2), Khan A(3), Khan MA(1), Alrayani 
Y(4), Alfawzan F(5), Zaidi SF(6)(7).

Author information:
(1)College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, 
Jeddah, Saudi Arabia.
(2)College of Science and Health Professions, King Saud Bin Abdulaziz University 
for Health Sciences, Riyadh, Saudi Arabia.
(3)Riphah Institute of Pharmaceutical Sciences, Riphah International University, 
13KM Raiwind Road, Lahore, Pakistan.
(4)College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, 
Riyadh, Saudi Arabia.
(5)College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, 
Riyadh, Saudi Arabia.
(6)College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, 
Jeddah, Saudi Arabia. sfaisalhz@gmail.com.
(7)Faculty of Eastern Medicine, Hamdard University, Madinat al-Hikmah, Hakim 
Mohammad Said Road, Karachi, 74600, Pakistan. sfaisalhz@gmail.com.

Erratum in
    Environ Sci Pollut Res Int. 2022 Jul 12;:

In light of the outbreak caused by the COVID-19 and its impact on the physical 
and mental wellbeing, we explored the consequences of this pandemic on the 
mental health among pre-professional health sciences students and their 
awareness regarding the virus. A descriptive observational cross-sectional study 
was conducted at King Saud bin Abdulaziz University for Health Sciences 
(KSAU-HS) in Jeddah and Riyadh campuses. Data was collected from 770 
participants using an online questionnaire, and statistical analysis was 
performed using SPSS. The majority of the participants (87.5%) considered 
governmental authorities as their main source of information, and therefore, 
they were up to date on the general information regarding COVID-19. For findings 
on mental health, it was found that 61.9% were exhibiting variant degrees of 
depression, as well as 50% expressing signs of extremely severe anxiety. 
However, 50.9% of the participants expressed no signs of stress during this 
pandemic. An association was found between gender and mental health showing 
females to have higher tendencies to express signs of extremely severe 
depression, anxiety, and stress. An association was also found between parents' 
marital status and anxiety. Analysis revealed that participants with separated 
parents were the least among the participants to show no signs of anxiety, as 
well as reporting the highest numbers in the "extremely severe" anxiety 
category. With the increased awareness and higher than normal levels of the 
investigated mental illnesses, we advise that proper action should be considered 
to address this issue.

© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, 
part of Springer Nature.

DOI: 10.1007/s11356-022-20934-3
PMCID: PMC9139494
PMID: 35624363 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1986. J Sleep Res. 2023 Feb;32(1):e13641. doi: 10.1111/jsr.13641. Epub 2022 May 27.

The predictive power of insomnia symptoms on other aspects of mental health 
during the COVID-19 pandemic: a longitudinal study.

Werner GG(1), Cludius B(1), Sckopke P(2), Stefan A(3), Schönbrodt F(2), 
Zygar-Hoffmann C(2).

Author information:
(1)Department of Psychology, Clinical Psychology and Psychotherapy, LMU Munich, 
Munich, Germany.
(2)Department of Psychology, Psychological Methods and Diagnostics, LMU Munich, 
Munich, Germany.
(3)Faculty of Social and Behavioural Sciences, Programme group Psychological 
Methods, University of Amsterdam, Amsterdam, the Netherlands.

Symptoms of insomnia are an important risk factor for the development of mental 
disorders, especially during stressful life periods such as the coronavirus 
disease 2019 (COVID-19) pandemic. However, up to now, most studies have used 
cross-sectional data, and the prolonged impact of insomnia symptoms during the 
pandemic on later mental health remains unclear. Therefore, we investigated 
insomnia symptoms as a predictor of other aspects of mental health across 
6 months, with altogether seven assessments (every 30 days, t0-t6), in a 
community sample (N = 166-267). Results showed no mean-level increase of 
insomnia symptoms and/or deterioration of mental health between baseline 
assessment (t0) and the 6- month follow-up (t6). As preregistered, higher 
insomnia symptoms (between persons) across all time points predicted reduced 
mental health at the 6-month follow-up. Interestingly, contrary to our 
hypothesis, higher insomnia symptoms at 1 month, within each person (i.e., 
compared to that person's symptoms at other time points), predicted improved 
rather than reduced aspects of mental health 1 month later. Hence, we replicated 
the predictive effect of averagely increased insomnia symptoms on impaired later 
mental health during the COVID-19 pandemic. However, we were surprised that 
increased insomnia symptoms at 1 month predicted aspects of improved mental 
health 1 month later. This unexpected effect might be specific for our study 
population and a consequence of our study design. Overall, increased insomnia 
symptoms may have served as a signal to engage in, and successfully implement, 
targeted countermeasures, which led to better short-term mental health in this 
healthy sample.

© 2022 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd 
on behalf of European Sleep Research Society.

DOI: 10.1111/jsr.13641
PMCID: PMC9347492
PMID: 35623381 [Indexed for MEDLINE]

Conflict of interest statement: None.


1987. Health Place. 2022 Jul;76:102813. doi: 10.1016/j.healthplace.2022.102813. Epub 
2022 May 24.

Mental health and well-being in times of COVID-19: A mixed-methods study of the 
role of neighborhood parks, outdoor spaces, and nature among US older adults.

Bustamante G(1), Guzman V(2), Kobayashi LC(3), Finlay J(4).

Author information:
(1)Program in Health Disparities Research, University of Minnesota, 717 Delaware 
St. SE, Suite 156, Minneapolis, MN, 55414, USA; School of Public Health, 
Universidad San Francisco de Quito, Diego de Robles S/n, Quito, 170901, Ecuador. 
Electronic address: busta027@umn.edu.
(2)Division of Population Health, Royal College of Surgeons in Ireland, Beaux 
Lane House, Mercer St Lower, Dublin 2, D02DH60, Ireland. Electronic address: 
vivekaguzman@rcsi.ie.
(3)Center for Social Epidemiology and Population Health, Department of 
Epidemiology, University of Michigan School of Public Health, 1415 Washington 
Heights, Ann Arbor, MI, 48109, USA. Electronic address: lkob@umich.edu.
(4)Center for Social Epidemiology and Population Health, Department of 
Epidemiology, University of Michigan School of Public Health, 1415 Washington 
Heights, Ann Arbor, MI, 48109, USA; Social Environment and Health Program, 
Institute for Social Research, University of Michigan, 426 Thompson Street, Ann 
Arbor, MI, 48104, USA. Electronic address: jmfinlay@umich.edu.

The role of parks and nature to support well-being during the COVID-19 pandemic 
is uncertain. To examine this topic, we used mixed-methods data collected in 
April-May 2020 from US adults aged ≥55 in the COVID-19 Coping Study. We 
quantitatively evaluated the associations between number of neighborhood parks 
and depression, anxiety, and loneliness; and conducted qualitative thematic 
analysis of participants' outdoor experiences. Among urban residents, depression 
and anxiety were inversely associated with the number of neighborhood parks. 
Thematic analysis identified diverse engagement in greenspaces that boosted 
physical, mental, and social well-being. The therapeutic potential of outdoor 
and greenspaces should be considered for interventions during future epidemics.

Copyright © 2022 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.healthplace.2022.102813
PMCID: PMC9127349
PMID: 35623164 [Indexed for MEDLINE]


1988. BMJ Open. 2022 May 26;12(5):e055678. doi: 10.1136/bmjopen-2021-055678.

Role of COVID-19 pandemic in the academic life and well-being of private sector 
university students: an exploratory qualitative study.

Ali NA(1), Feroz AS(2), Akber N(3), Khoja A(4).

Author information:
(1)School of Nursing & Midwifery, The Aga Khan University, Karachi, Pakistan 
naureenalimeghani@gmail.com.
(2)Department of Community Health Sciences, Aga Khan University, Karachi, 
Pakistan.
(3)Sociology, University of Karachi, Karachi, Pakistan.
(4)Department of Medicine, Aga Khan University, Karachi, Pakistan.

OBJECTIVE: The advent of the COVID-19 pandemic has caused a drastic impact on 
students' life, causing physical and emotional sufferings. Considering the 
relevance of unprecedented conditions, we explored perceptions and attitudes of 
students towards their academic life and well-being amid the COVID-19 pandemic.
SETTING: We conducted an exploratory qualitative study using a purposive 
sampling approach conducted at a single-centre private nursing institution in 
Karachi, Pakistan.
PARTICIPANTS: The current study used in-depth interviews with female university 
students. Study data were analysed manually using the thematic analysis 
approach.
PRIMARY OUTCOME: The primary outcome is to explore perception of students on 
academic life and well-being amidst the COVID-19 pandemic.
RESULTS: A total of 10 in-depth interviews were conducted between August and 
September 2020. Four overarching themes were identified: (1) impact of COVID-19 
on students' well-being; (2) effect of COVID-19 on students' academic life; (3) 
current coping mechanisms adopted by students and (4) recommendations to address 
students' concerns. The pandemic-related stressors served as a major impediment 
on students' motivation, concentration span and socioeconomic conditions which 
negatively influenced their well-being and academic life. However, students have 
adopted diverse coping mechanisms to combat unstable circumstances that include 
connecting with family and relatives, indulging in diverse activities, and 
getting academic support from faculty, senior students, and university 
administration. Students also recommended the need for arranging online mental 
health services, integrating e-learning mediums in existing academia, and 
constant efforts by the government to address electricity and internet 
connectivity issues to promote virtual learning.
CONCLUSION: University students have been struck hard due to rapid 
pandemic-related transitions in their life. The study finding served as the 
potential guide for educational institutions and government officials to employ 
appropriate psychological interventions and provide infrastructure and technical 
facilities to provide support with their academic journey and overcoming the 
ongoing pandemic repercussions.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-055678
PMCID: PMC9136692
PMID: 35618336 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


1989. Br J Soc Psychol. 2023 Jan;62(1):281-301. doi: 10.1111/bjso.12546. Epub 2022 May 
26.

Call me maybe: Risk factors of impaired social contact during the COVID-19 
pandemic and associations with well-being.

Rudert SC(1), Janke S(2).

Author information:
(1)University of Koblenz and Landau, Landau, Germany.
(2)University of Mannheim, Mannheim, Germany.

The COVID-19 pandemic caused major societal changes worldwide, with the most 
notable being lockdowns and restrictions on social contact. We conducted a 
longitudinal study (total n = 1907) in Germany with two time points to (1) 
identify demographic risk factors of impaired social contact during the 
pandemic, as well as investigate potential consequences of (2) impaired social 
contact and (3) different modes of communication on individuals' well-being 
during the first lockdown in spring 2020. Results indicate that particularly 
individuals living alone and being unable to work reported a lower frequency of 
(face-to-face) contact in comparison with participants living with others or 
working. Impaired social contact was indirectly associated with a negative 
development in well-being (life satisfaction, anxiety and depression) over time, 
and this relation was mediated via relatedness. Moreover, the frequency of 
face-to-face and phone communication during lockdown was positively associated 
with relatedness and well-being; however, digital communication was not. The 
findings stress the importance of maintaining social contact in times of social 
distancing and of fostering reconnection between individuals once the pandemic 
is over.

© 2022 The Authors. British Journal of Social Psychology published by John Wiley 
& Sons Ltd on behalf of British Psychological Society.

DOI: 10.1111/bjso.12546
PMCID: PMC9348265
PMID: 35616877 [Indexed for MEDLINE]

Conflict of interest statement: All authors declare no conflict of interest.


1990. Can J Public Health. 2022 Dec;113(6):817-833. doi: 10.17269/s41997-022-00643-7. 
Epub 2022 May 26.

The working conditions for personal support workers in the Greater Toronto Area 
during the COVID-19 pandemic: a mixed-methods study.

Hapsari AP(1), Ho JW(1), Meaney C(2), Avery L(3)(4), Hassen N(5), Jetha A(3)(6), 
Lay AM(7), Rotondi M(8), Zuberi D(9)(10), Pinto A(11)(12)(13)(14).

Author information:
(1)Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge 
Institute, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
(2)Department of Family and Community Medicine, Faculty of Medicine, University 
of Toronto, Toronto, ON, Canada.
(3)Dalla Lana School of Public Health, University of Toronto, Toronto, ON, 
Canada.
(4)Department of Biostatistics, Princess Margaret Hospital, University Health 
Network, Toronto, ON, Canada.
(5)Faculty of Environmental and Urban Change, York University, Toronto, ON, 
Canada.
(6)Institute for Work and Health, Toronto, ON, Canada.
(7)Institute of Population and Public Health, Canadian Institutes of Health 
Research, Toronto, ON, Canada.
(8)School of Kinesiology and Health Science, York University, Toronto, ON, 
Canada.
(9)Munk School of Global Affairs & Public Policy, University of Toronto, 
Toronto, ON, Canada.
(10)Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, 
Canada.
(11)Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge 
Institute, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. 
andrew.pinto@utoronto.ca.
(12)Department of Family and Community Medicine, Faculty of Medicine, University 
of Toronto, Toronto, ON, Canada. andrew.pinto@utoronto.ca.
(13)Dalla Lana School of Public Health, University of Toronto, Toronto, ON, 
Canada. andrew.pinto@utoronto.ca.
(14)Department of Family and Community Medicine, St. Michael's Hospital, 
Toronto, ON, Canada. andrew.pinto@utoronto.ca.

OBJECTIVE: During the height of the COVID-19 pandemic, personal support workers 
(PSWs) were heralded as healthcare 'heroes' as many of them cared for high-risk, 
vulnerable older populations, and worked in long-term care, which experienced a 
high number of COVID-19 outbreaks and deaths. While essential to the healthcare 
workforce, there is little understanding of PSW working conditions during the 
pandemic. The aim of our study was to examine the working conditions (including 
job security, work policies, and personal experiences) for PSWs in the Greater 
Toronto Area during the COVID-19 pandemic from the perspectives of PSWs.
METHODS: This study used a mixed-methods design. From June to December 2020, we 
conducted a survey of 634 PSWs to understand their working conditions during the 
COVID-19 pandemic. Semi-structured interviews with 31 survey respondents were 
conducted from February to May 2021 to understand in greater depth how working 
conditions were impacting the well-being of PSWs.
RESULTS: We found PSWs faced a range of challenges related to COVID-19, 
including anxiety about contracting COVID-19, reduced work hours, taking leaves 
of absences, concerns about job security, and losing childcare. While the 
COVID-19 pandemic highlighted the PSW workforce and their importance to the 
healthcare system (especially in the long-term care system), pre-existing poor 
work conditions of insecure jobs with no paid sick days and benefits exacerbated 
COVID-19-related challenges. Despite these hardships, PSWs were able to rely on 
their mental resilience and passion for their profession to cope with 
challenges.
CONCLUSION: Significant changes need to be made to improve PSW working 
conditions. Better compensation, increased job security, decreased workload 
burden, and mental health supports are needed.

Publisher: RéSUMé: OBJECTIF: Au plus fort de la pandémie de COVID-19, les 
préposés aux bénéficiaires (PAB) étaient salués comme les « héros » des soins de 
santé, car beaucoup s’occupaient de populations vulnérables et âgées à risque 
élevé et travaillaient dans le milieu des soins de longue durée, qui était aux 
prises avec un grand nombre d’éclosions de COVID-19 et de décès. Malgré 
l’importance névralgique des PAB dans la main-d’œuvre des soins de santé, leurs 
conditions de travail durant la pandémie sont peu connues. Nous avons cherché à 
examiner les conditions de travail (sécurité d’emploi, régimes de travail et 
expériences personnelles) des PAB dans la région du Grand Toronto durant la 
pandémie de COVID-19 selon la perspective de ces PAB. MéTHODE: Nous avons 
utilisé un plan d’étude à méthodes mixtes. De juin à décembre 2020, nous avons 
sondé 634 PAB pour connaître leurs conditions de travail durant la pandémie de 
COVID-19. Des entretiens semi-directifs ont été menés auprès de 31 répondants et 
répondantes entre les mois de février et de mai 2021 pour approfondir notre 
compréhension de l’impact des conditions de travail des PAB sur leur bien-être. 
RéSULTATS: Nous avons constaté que les PAB ont connu de nombreuses difficultés 
en lien avec la COVID-19, dont l’anxiété à l’idée de transmettre la COVID-19, 
les heures de travail réduites, la prise de congés, les craintes pour leur 
sécurité d’emploi et la perte de services de garde. Bien que la pandémie de 
COVID-19 ait braqué les projecteurs sur les PAB et leur importance pour le 
système de soins de santé (surtout dans le système de soins de longue durée), 
leurs mauvaises conditions de travail préexistantes – des emplois précaires sans 
congés de maladie payés ni avantages sociaux – ont exacerbé les problèmes posés 
par la COVID-19. Malgré ces épreuves, les PAB ont pu compter sur leur résilience 
mentale et leur passion pour la profession pour faire face aux difficultés. 
CONCLUSION: D’importants changements doivent être apportés pour améliorer les 
conditions de travail des PAB. De meilleurs salaires, une plus grande sécurité 
d’emploi, une charge de travail allégée et des mesures d’appui à la santé 
mentale sont nécessaires.

© 2022. The Author(s) under exclusive license to The Canadian Public Health 
Association.

DOI: 10.17269/s41997-022-00643-7
PMCID: PMC9134716
PMID: 35616873 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1991. Eur Child Adolesc Psychiatry. 2023 Oct;32(10):1873-1883. doi: 
10.1007/s00787-022-01991-y. Epub 2022 May 26.

Internalizing problems before and during the COVID-19 pandemic in independent 
samples of Dutch children and adolescents with and without pre-existing mental 
health problems.

Fischer K(#)(1)(2), Tieskens JM(#)(3), Luijten MAJ(2)(4)(5), Zijlmans J(2)(6), 
van Oers HA(2)(4), de Groot R(2)(7), van der Doelen D(8), van Ewijk H(3), Klip 
H(8), van der Lans RM(3), De Meyer R(9), van der Mheen M(2)(10)(11), van 
Muilekom MM(2)(4), Hyun Ruisch I(12), Teela L(2)(4), van den Berg G(13), 
Bruining H(6), van der Rijken R(9), Buitelaar J(8)(14), Hoekstra PJ(12), 
Lindauer R(10)(11), Oostrom KJ(2)(4), Staal W(8), Vermeiren R(3)(15), Cornet 
R(2)(7), Haverman L(2)(4), Bartels M(1)(2), Polderman 
TJC(#)(16)(17)(18)(19)(20), Popma A(#)(2)(6)(10).

Author information:
(1)Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, 
The Netherlands.
(2)Amsterdam University Medical Centres, Amsterdam Public Health Research 
Institute, Amsterdam, The Netherlands.
(3)LUMC Curium-Child and Adolescent Psychiatry, Leiden University Medical 
Center, Leiden, The Netherlands.
(4)Emma Children's Hospital, Amsterdam University Medical Center, Child and 
Adolescent Psychiatry and Psychosocial Care, Amsterdam Reproduction and 
Development, University of Amsterdam, Amsterdam, The Netherlands.
(5)Amsterdam University Medical Center, Epidemiology and Data Science, Vrije 
Universiteit Amsterdam, Amsterdam, The Netherlands.
(6)Department of Child and Adolescent Psychiatry and Psychosocial Care, 
Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, 
The Netherlands.
(7)Department of Medical Informatics, Amsterdam University Medical Center, 
University of Amsterdam, Amsterdam, The Netherlands.
(8)Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The 
Netherlands.
(9)Praktikon, Nijmegen, The Netherlands.
(10)Levvel, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The 
Netherlands.
(11)Department of Child and Adolescent Psychiatry, Amsterdam University Medical 
Center, University of Amsterdam, Amsterdam, The Netherlands.
(12)Department of Child and Adolescent Psychiatry, University Medical Center 
Groningen, University of Groningen, Groningen, The Netherlands.
(13)Netherlands Youth Institute, Utrecht, The Netherlands.
(14)Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition 
and Behaviour, Radboudumc, Nijmegen, The Netherlands.
(15)Youz, Parnassia Psychiatric Institute, den Hague, The Netherlands.
(16)Amsterdam University Medical Centres, Amsterdam Public Health Research 
Institute, Amsterdam, The Netherlands. tinca.polderman@amsterdamumc.nl.
(17)LUMC Curium-Child and Adolescent Psychiatry, Leiden University Medical 
Center, Leiden, The Netherlands. tinca.polderman@amsterdamumc.nl.
(18)Department of Child and Adolescent Psychiatry and Psychosocial Care, 
Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, 
The Netherlands. tinca.polderman@amsterdamumc.nl.
(19)Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The 
Netherlands. tinca.polderman@amsterdamumc.nl.
(20)Department of Child and Adolescent Psychiatry, University Medical Center 
Groningen, University of Groningen, Groningen, The Netherlands. 
tinca.polderman@amsterdamumc.nl.
(#)Contributed equally

The aim of the study was to assess internalizing problems before and during the 
pandemic with data from Dutch consortium Child and adolescent mental health and 
wellbeing in times of the COVID-19 pandemic, consisting of two Dutch general 
population samples (GS) and two clinical samples (CS) referred to 
youth/psychiatric care. Measures of internalizing problems were obtained from 
ongoing data collections pre-pandemic (NGS = 35,357; NCS = 4487) and twice 
during the pandemic, in Apr-May 2020 (NGS = 3938; clinical: NCS = 1008) and in 
Nov-Dec 2020 (NGS = 1489; NCS = 1536), in children and adolescents (8-18 years) 
with parent (Brief Problem Monitor) and/or child reports (Patient-Reported 
Outcomes Measurement Information System®). Results show that, in the general 
population, internalizing problems were higher during the first peak of the 
pandemic compared to pre-pandemic based on both child and parent reports. Yet, 
over the course of the pandemic, on both child and parent reports, similar or 
lower levels of internalizing problems were observed. Children in the clinical 
population reported more internalizing symptoms over the course of the pandemic 
while parents did not report differences in internalizing symptoms from 
pre-pandemic to the first peak of the pandemic nor over the course of the 
pandemic. Overall, the findings indicate that children and adolescents of both 
the general and clinical population were affected negatively by the pandemic in 
terms of their internalizing problems. Attention is therefore warranted to 
investigate long-term effects and to monitor if internalizing problems return to 
pre-pandemic levels or if they remain elevated post-pandemic.

© 2022. The Author(s).

DOI: 10.1007/s00787-022-01991-y
PMCID: PMC9133820
PMID: 35616715 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest or 
financial ties to disclose.


1992. Anxiety Stress Coping. 2023 Jan;36(1):1-17. doi: 10.1080/10615806.2022.2079637. 
Epub 2022 May 26.

Web-based training for post-secondary student well-being during the pandemic: a 
randomized trial.

Wang Y(1), Farb NAS(1)(2).

Author information:
(1)Department of Psychology, University of Toronto Mississauga, Toronto, Canada.
(2)Department of Psychological Clinical Science, University of Toronto 
Scarborough, Scarborough, Canada.

Background: The COVID-19 pandemic has been a highly stressful period where 
post-secondary education moved to online formats. Coping skills like decentering 
and reappraisal appear to promote stress resilience, but limited research exists 
on cultivating these skills in online learning contexts.Methods: In a three-arm 
randomized trial design, we evaluated three-week, web-based interventions to 
gauge how to best cultivate mindfulness and stress-reappraisal skills and 
whether the proposed interventions led to improved mental health. Undergraduate 
participants (N = 183) were randomly assigned to stress mindset, mindfulness 
meditation, or mindfulness with choice conditions.Results: At the study level 
(baseline vs. post-intervention), decentering improved across all conditions. 
Mindfulness with choice significantly decreased negative affect and rumination 
compared to stress mindset, while stress mindset significantly enhanced stress 
mindset skills compared to both mindfulness groups. At the daily level (three 
sessions per week), stress mindset significantly increased positive affect 
compared to mindfulness meditation.Conclusions: Results suggest that student 
mental health can be remotely supported through brief web-based interventions. 
Mindfulness practices seem to be effective in improving students' negative mood 
and coping strategies, while stress mindset training can help students to adopt 
a stress-is-enhancing mindset. Additional work on refining and better matching 
students to appropriate interventions is needed.

DOI: 10.1080/10615806.2022.2079637
PMID: 35615957 [Indexed for MEDLINE]


1993. Prev Sci. 2022 Oct;23(7):1264-1275. doi: 10.1007/s11121-022-01384-2. Epub 2022 
May 25.

Long-term Effects of Adolescent Substance Use Prevention on Participants, 
Partners, and their Children: Resiliency and Outcomes 15 Years Later During the 
COVID-19 Pandemic.

Feinberg ME(1), Fang S(2), Fosco GM(3), Sloan CJ(3), Mogle J(3), Spoth RL(4).

Author information:
(1)Prevention Research Center, College of Health and Human Development, The 
Pennsylvania State University, State College, USA. Mef11@psu.edu.
(2)Prevention Research Center, College of Health and Human Development, The 
Pennsylvania State University, State College, USA.
(3)Human Development and Family Studies, College of Health and Human 
Development, The Pennsylvania State University, State College, USA.
(4)Partnerships in Prevention Science Institute, Iowa State University, Ames, 
USA.

We examined whether participation in adolescent substance use prevention 
programming can enhance long-term resilience into adulthood such that 
individuals were better able to cope with adversities during the initial months 
of the COVID-19 pandemic, yielding benefits for the individuals, their 
partners/spouses, and children; 197 adults (28-30 years old) who entered the 
PROSPER randomized trial of substance use prevention programming as 6th graders 
and subsequently had become parents-and 128 of their partners-participated in 
two waves of long-term follow-up data collection. Respondents completed 
questionnaires on substance use, adjustment, parenting quality, and children's 
mood and behavior problems 15 years after baseline, and again via an online 
survey in the first three months of the COVID-19 pandemic. Results were mixed, 
with some indications of better adjustment of PROSPER intervention compared to 
control participants during the early phase of the pandemic (less increase in 
alcohol use and less decrease in parenting warmth) and their children (lower 
levels of externalizing and internalizing problems) but several null results as 
well (no differences in other substance use behaviors, other parenting measures, 
or parent depression). Adolescent substance use prevention programs can foster 
long-term individual and interpersonal resilience factors that allow 
participants-as well as their children-to adapt and cope with unforeseen periods 
of acute stress and adversity with less deterioration in health and well-being.

© 2022. Society for Prevention Research.

DOI: 10.1007/s11121-022-01384-2
PMCID: PMC9132568
PMID: 35614368 [Indexed for MEDLINE]

Conflict of interest statement: Not applicable.


1994. Sci Rep. 2022 May 24;12(1):8767. doi: 10.1038/s41598-022-12586-7.

COVID-19 pandemic influence on self-reported health status and 
well-being in a society.

Moniuszko-Malinowska A(#)(1), Czupryna P(#)(2), Dubatówka M(3), Łapińska M(3), 
Kazberuk M(4), Szum-Jakubowska A(3), Sołomacha S(3), Sowa P(3), Kiszkiel Ł(5), 
Szczerbiński Ł(6)(7), Bukłaha A(2), Laskowski PP(#)(5), Kamiński KA(3)(8).

Author information:
(1)Department of Infectious Diseases and Neuroinfections, Medical University of 
Bialystok, Zurawia 14, 15-540, Bialystok, Poland. 
anna.moniuszko-malinowska@umb.edu.pl.
(2)Department of Infectious Diseases and Neuroinfections, Medical University of 
Bialystok, Zurawia 14, 15-540, Bialystok, Poland.
(3)Department of Population Medicine and Lifestyle Diseases Prevention, Medical 
University of Bialystok, 15-269, Bialystok, Poland.
(4)Medical University of Bialystok, Bialystok, Poland.
(5)Society and Cognition Unit, University of Bialystok, 15-403, Bialystok, 
Poland.
(6)Department of Endocrinology, Diabetology and Internal Medicine, Medical 
University of Bialystok, 15-276, Bialystok, Poland.
(7)Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland.
(8)Department of Cardiology, University Hospital of Bialystok, 15-276, 
Bialystok, Podlaskie, Poland.
(#)Contributed equally

Erratum in
    Sci Rep. 2023 Sep 19;13(1):15501.

To assess the frequency of persisting symptoms after SARS-CoV-2 infection and 
assessment of the effects of COVID-19 pandemic on selected parameters of 
self-reported health status and well-being half a year after the disease. The 
study population consisted of 3 groups: post-COVID-19 group I-172 patients; 
group II-172 patients with chronic disease, who have not suffered from COVID-19; 
group III-81 patients from a population study cohort-Bialystok PLUS. A 
standardized interview questionnaire was used to collect data in the three 
groups using the CATI (computer assisted telephone interviewing) technique. 
Interviews were conducted between October 2020 and January 2021, thus during the 
second wave of the pandemic in Poland. The subjective state of health in 
comparison with the state of health before the COVID-19 pandemic deteriorated in 
COVID-19 convalescents. Patients, who suffered from symptomatic COVID-19 were 
more prone to nervousness, anxiousness, tension than patients with 
oligosymptomatic course of the disease. Moreover, anxiety, fear and irritability 
were more frequent in Group I and II in comparison to Group III, whereas Group I 
and II did not differ significantly. The decrease in physical activity observed 
in COVID-19 patients mirrored the changes in general population. The most 
frequent persistent symptoms after COVID-19 are: general malaise, cough, smell 
and taste disorder, dyspnea. COVID-19 convalescents who experienced symptomatic 
disease are more prone to development of nervousness, anxiousness, tension and 
anxiety than patients with oligosymptomatic course of the disease. Females and 
younger patients who suffered from COVID-19 are more prone to development of 
mental distress than healthy population. No significant differences between 
COVID-19 convalescents and healthy population was observed as far as the 
attitude towards physical activity is concerned.

© 2022. The Author(s).

DOI: 10.1038/s41598-022-12586-7
PMCID: PMC9128771
PMID: 35610250 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


1995. Crit Care Med. 2022 Sep 1;50(9):1296-1305. doi: 10.1097/CCM.0000000000005583. 
Epub 2022 May 23.

Daily Written Care Summaries for Families of Critically Ill Patients: A 
Randomized Controlled Trial.

Greenberg JA(1), Basapur S(2), Quinn TV(3), Bulger JL(4), Schwartz NH(5), Oh 
SK(5), Ritz EM(6), Glover CM(7), Shah RC(2)(6).

Author information:
(1)Division of Pulmonary and Critical Care, Department of Internal Medicine, 
Rush University Medical Center, Chicago, IL.
(2)Department of Family Medicine, Rush University Medical Center, Chicago, IL.
(3)Division of Pulmonary and Critical Care, Department of Internal Medicine, 
Loyola University, Chicago, IL.
(4)Rush Medical College, Chicago, IL.
(5)Bioinformatics and Biostatistics Core, Rush University Medical Center, 
Chicago, IL.
(6)Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL.
(7)Department of Psychiatry and Behavioral Sciences, Rush University Medical 
Center, Chicago, IL.

Comment in
    Crit Care Med. 2022 Sep 1;50(9):1394-1396.

OBJECTIVES: To determine the effect of daily written updates on the satisfaction 
and psychologic symptoms of families of ICU patients.
DESIGN: Randomized controlled trial.
SETTING: Single, urban academic medical center.
SUBJECTS: Surrogates of nondecisional, critically ill adults with high risk of 
mortality ( n = 252) enrolled from June 2019 to January 2021.
INTERVENTIONS: Usual communication with the medical team with or without written 
communication detailing the suspected cause and management approach of each ICU 
problem, updated each day.
MEASUREMENTS AND MAIN RESULTS: Participants completed surveys at three time 
points during the ICU stay: enrollment ( n = 252), 1 week ( n = 229), and 2 
weeks ( n = 109) after enrollment. Satisfaction with care was measured using the 
Critical Care Family Needs Inventory (CCFNI). The presence of anxiety, 
depression, and acute stress were assessed using the Hospital Anxiety and 
Depression Scale (HADS) and Impact of Events Scale Revised (IES-R). CCFNI, HADS, 
and IES-R scores were similar among participants assigned to the intervention 
group and control group upon enrollment and during the first week after 
enrollment ( p > 0.05). From enrollment to the second week after enrollment, 
there was an improvement in CCFNI and HADS scores among participants assigned to 
the intervention group versus the control group. At week 2, CCFNI scores were 
significantly lower among participants in the intervention group versus the 
control group, indicating greater satisfaction with care: 15.1 (95% CI, 
14.2-16.0) versus 16.4, (95% CI, 15.5-17.3); p = 0.04. In addition, 2 weeks 
after enrollment, the odds of symptoms of anxiety, depression, and acute stress 
among participants assigned to the intervention versus control group were 0.16 
(95% CI, 0.03-0.82; p = 0.03); 0.15 (95% CI, 0.01-1.87; p = 0.14); and 0.27 (95% 
CI, 0.06-1.27; p = 0.10), respectively.
CONCLUSIONS: Written communication improved satisfaction and the emotional 
well-being of families of critically ill patients, supporting its use as a 
supplement to traditional communication approaches.

Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer 
Health, Inc. All Rights Reserved.

DOI: 10.1097/CCM.0000000000005583
PMID: 35607975 [Indexed for MEDLINE]

Conflict of interest statement: The authors have disclosed that they do not have 
any potential conflicts of interest.


1996. Australas J Ageing. 2022 Sep;41(3):457-465. doi: 10.1111/ajag.13081. Epub 2022 
May 24.

New directions in centre-based aged care in Australia: Responding to changing 
funding models and the COVID-19 pandemic.

Hamilton M(1), Crawford T(2), Thomson C(3), Jeon YH(2), Bassett K(2).

Author information:
(1)Centre of Excellence on Population Ageing Research, University of Sydney, 
Sydney, New South Wales, Australia.
(2)Sydney Nursing School, University of Sydney, Sydney, New South Wales, 
Australia.
(3)Social Policy Research Centre, University of New South Wales, Sydney, New 
South Wales, Australia.

OBJECTIVES: Centre-based aged care services are a key site of early intervention 
and support for people with dementia and their carers. This paper examines the 
impact of new aged care funding structures on centre-based aged care service 
accessibility and delivery. It also examines the challenges and opportunities 
for change facing the sector in the light of the COVID-19 pandemic.
METHODS: Semi-structured interviews were conducted online with 29 managers or 
supervisors of centre-based aged care services in Greater Sydney.
RESULTS: The analysis reinforced the essential role of centre-based aged care 
services in improving the cognitive, physical and psychological health of older 
people with dementia and their carers. However, the changing funding context and 
the COVID-19 pandemic have created challenges in access to centre-based 
services, particularly for the most vulnerable. The challenges created by the 
COVID-19 pandemic also opened opportunities for the introduction of new models 
of service practice to meet the individual needs of older people and their 
carers.
CONCLUSIONS: Greater investment in, and flexibility in the funding for, 
centre-based aged care services is needed to facilitate access for people with 
dementia and their carers and improve their health and well-being.

© 2022 The Authors. Australasian Journal on Ageing published by John Wiley & 
Sons Australia, Ltd on behalf of AJA Inc'.

DOI: 10.1111/ajag.13081
PMCID: PMC9348156
PMID: 35607866 [Indexed for MEDLINE]

Conflict of interest statement: No conflicts of interest declared.


1997. J Neuroinflammation. 2022 May 23;19(1):114. doi: 10.1186/s12974-022-02472-4.

A crosstalk between gut and brain in sepsis-induced cognitive decline.

Giridharan VV(1), Generoso JS(2), Lence L(2), Candiotto G(3), Streck E(3), 
Petronilho F(2), Pillai A(4)(5)(6)(7), Sharshar T(8)(9)(10), Dal-Pizzol F(11), 
Barichello T(12)(13).

Author information:
(1)Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical 
School, The University of Texas Health Science Center at Houston (UTHealth), 
Houston, TX, USA.
(2)Laboratory of Experimental Neurology, Graduate Program in Health Sciences, 
University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil.
(3)Laboratory of Neurometabolic Diseases, Graduate Program in Health Sciences, 
University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil.
(4)Pathophysiology of Neuropsychiatric Disorders Program, Faillace Department of 
Psychiatry and Behavioral Sciences, McGovern Medical School, The University of 
Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.
(5)Neuroscience Graduate Program, The University of Texas MD Anderson Cancer 
Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.
(6)Research and Development, Charlie Norwood VA Medical Center, Augusta, GA, 
USA.
(7)Department of Psychiatry and Health Behavior, Augusta University, Augusta, 
GA, USA.
(8)GHU Paris Psychiatrie et Neuroscience, Neurointensive Care and 
Neuroanesthesia Department, Paris, France.
(9)Université de Paris Cité, Paris, France.
(10)Institute of Psychiatry and Neurosciences of Paris, NSERM UMR 1266, Paris, 
France.
(11)Laboratory of Experimental Pathophysiology, Graduate Program in Health 
Sciences, University of Southern Santa Catarina (UNESC), Criciuma, SC, Brazil.
(12)Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical 
School, The University of Texas Health Science Center at Houston (UTHealth), 
Houston, TX, USA. Tatiana.Barichello@uth.tmc.edu.
(13)Laboratory of Experimental Pathophysiology, Graduate Program in Health 
Sciences, University of Southern Santa Catarina (UNESC), Criciuma, SC, Brazil. 
Tatiana.Barichello@uth.tmc.edu.

BACKGROUND: Sepsis is a potentially fatal disease characterized by acute organ 
failure that affects more than 30 million people worldwide. Inflammation is 
strongly associated with sepsis, and patients can experience impairments in 
memory, concentration, verbal fluency, and executive functioning after being 
discharged from the hospital. We hypothesize that sepsis disrupts the 
microbiota-gut-brain axis homeostasis triggering cognitive impairment. This 
immune activation persists during treatment, causing neurological dysfunction in 
sepsis survivors.
METHODS: To test our hypothesis, adult Wistar rats were subjected to 
cecal-ligation and perforation (CLP) or sham (non-CLP) surgeries. The animals 
were subjected to the [11C]PBR28 positron emission tomography (PET)/computed 
tomography (CT) imaging at 24 h and 10 days after CLP and non-CLP surgeries. At 
24 h and 10 days after surgery, we evaluated the gut microbiome, bacterial 
metabolites, cytokines, microglia, and astrocyte markers. Ten days after sepsis 
induction, the animals were subjected to the novel object recognition (NOR) and 
the Morris water maze (MWM) test to assess their learning and memory.
RESULTS: Compared to the control group, the 24-h and 10-day CLP groups showed 
increased [11C]PBR28 uptake, glial cells count, and cytokine levels in the 
brain. Results show that sepsis modulates the gut villus length and crypt depth, 
alpha and beta microbial diversities, and fecal short-chain fatty acids (SCFAs). 
In addition, sepsis surviving animals showed a significant cognitive decline 
compared with the control group.
CONCLUSIONS: Since several pharmacological studies have failed to prevent 
cognitive impairment in sepsis survivors, a better understanding of the function 
of glial cells and gut microbiota can provide new avenues for treating sepsis 
patients.

© 2022. The Author(s).

DOI: 10.1186/s12974-022-02472-4
PMCID: PMC9125851
PMID: 35606817 [Indexed for MEDLINE]

Conflict of interest statement: AP received preclinical research support from 
ACADIA Pharmaceuticals. All other authors declare that they have no competing 
interests.


1998. BMJ Glob Health. 2022 May;7(5):e008122. doi: 10.1136/bmjgh-2021-008122.

Implications of COVID-19 for safeguarding in international development research: 
learning, action and reflection from a research hub.

Mansaray B(1)(2), Dean L(3), Tubb P(4), Josyula KL(5), Okoth L(6), Chumo I(7), 
Waritu J(8), Klingel A(9), Manzoor F(10), Aktar B(10), Garimella S(11), Murthy 
S(11), Tolhurst R(12), Whittaker L(12), Gray L(13), Forsyth R(13), Elsey H(14), 
Waldman L(15), Theobald S(4).

Author information:
(1)Department of Health Systems Research, COMAHS, Freetown, Western Area, Sierra 
Leone bintumansaray1080@gmail.com.
(2)Pediatrics, King Harman Road Maternal and Child Health Hospital, Freetown, 
Western Area, Sierra Leone.
(3)Department of International Public Health, Liverpool School of Tropical 
Medicine, Liverpool, UK.
(4)International Public Health, Liverpool School of Tropical Medicine, 
Liverpool, UK.
(5)George Institute for Global Health, Sydney, New South Wales, Australia.
(6)LVCT, Nairobi, Kenya.
(7)Research Division, APHRC, Nairobi, Kenya.
(8)Slum Dwellers International, Cape Town, South Africa.
(9)Sierra Leone Urban Research Centre, Freetown, Sierra Leone.
(10)BRAC University James P Grant School of Public Health, Dhaka, Bangladesh.
(11)The George Institute for Global Health, New Delhi, India.
(12)Liverpool School of Tropical Medicine, Liverpool, UK.
(13)University of Glasgow, Glasgow, UK.
(14)Health Sciences, University of York, York, UK.
(15)Institute of Development Studies, Brighton, UK.

COVID-19 brings uncertainties and new precarities for communities and 
researchers, altering and amplifying relational vulnerabilities (vulnerabilities 
which emerge from relationships of unequal power and place those less powerful 
at risk of abuse and violence). Research approaches have changed too, with 
increasing use of remote data collection methods. These multiple changes 
necessitate new or adapted safeguarding responses. This practice piece shares 
practical learnings and resources on safeguarding from the Accountability for 
Informal Urban Equity hub, which uses participatory action research, aiming to 
catalyse change in approaches to enhancing accountability and improving the 
health and well-being of marginalised people living and working in informal 
urban spaces in Bangladesh, India, Kenya and Sierra Leone. We outline three new 
challenges that emerged in the context of the pandemic (1): exacerbated 
relational vulnerabilities and dilemmas for researchers in responding to 
increased reports of different forms of violence coupled with support services 
that were limited prior to the pandemic becoming barely functional or 
non-existent in some research sites, (2) the increased use of virtual and remote 
research methods, with implications for safeguarding and (3) new stress, anxiety 
and vulnerabilities experienced by researchers. We then outline our learning and 
recommended action points for addressing emerging challenges, linking practice 
to the mnemonic 'the four Rs: recognise, respond, report, refer'. COVID-19 has 
intensified safeguarding risks. We stress the importance of communities, 
researchers and co-researchers engaging in dialogue and ongoing discussions of 
power and positionality, which are important to foster co-learning and 
co-production of safeguarding processes.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjgh-2021-008122
PMCID: PMC9125381
PMID: 35606015 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


1999. Aust J Prim Health. 2022 Aug;28(4):271-282. doi: 10.1071/PY22006.

Rapid deployment of support for a mental health crisis: 10 priorities framing 
Australia&#x2019;s COVID-19 pandemic response.

Desborough J(1), Blashki G(2), Hall Dykgraaf S(3), Vine R(4), Roddam M(4), 
Munindradasa A(5), Kidd M(6).

Author information:
(1)Department of Health Services Research and Policy, National Centre for 
Epidemiology and Population Health, College of Health and Medicine, Australian 
National University, 63 Eggleston Road, Acton, ACT 2601, Australia.
(2)Nossal Institute for Global Health and Melbourne Sustainable Society 
Institute, The University of Melbourne, Grattan Street, Parkville, Vic. 3010, 
Australia; and Beyond Blue, 1/360 Burwood Road, Hawthorn, Vic. 3122, Australia.
(3)Rural Clinical School, ANU Medical School, College of Health and Medicine, 
Australian National University, 54 Mills Road, Acton, ACT 2601, Australia.
(4)Health Systems Policy and Primary Care Group, Australian Government 
Department of Health, 23 Furzer Street, Woden, ACT 2615, Australia.
(5)College of Health and Medicine, Australian National University, 54 Mills 
Road, Acton, ACT 2601, Australia.
(6)College of Health and Medicine, Australian National University, 54 Mills 
Road, Acton, ACT 2601, Australia; and Australian Government Department of 
Health, 23 Furzer Street, Woden, ACT 2615, Australia; and Department of Family 
and Community Medicine, University of Toronto, 500 University Avenue, Toronto, 
ON M5G 1V7, Canada; and World Health Organization Collaborating Centre on Family 
Medicine and Primary Care; and Murdoch Children's Research Institute, The Royal 
Children's Hospital Melbourne, Vic., Australia; and Southgate Institute for 
Health, Society and Equity, Flinders University, SA 5042, Australia.

The COVID-19 pandemic has challenged the mental health of communities worldwide, 
with the triple pressures of financial insecurity, lockdowns, and worry about 
the infection. Australia rapidly deployed resources to protect the mental 
wellbeing of the community through supplementing existing services, supporting 
at-risk groups, investing in social supports, embracing technology, and 
supporting the health workforce. This paper describes the Australian 
Government's investment in mental health during the COVID-19 pandemic in 
relation to the 10 priority areas identified in Australia's National Mental 
Health Pandemic Response Plan.

DOI: 10.1071/PY22006
PMID: 35605985 [Indexed for MEDLINE]


2000. PLoS One. 2022 May 23;17(5):e0268642. doi: 10.1371/journal.pone.0268642. 
eCollection 2022.

Symptoms of psychological distress amongst women during the COVID-19 pandemic in 
Saudi Arabia.

Qattan AMN(1)(2).

Author information:
(1)Department of Health Services and Hospital Administration, Faculty of 
Economics and Administration, King Abdulaziz University, Jeddah, Saudi Arabia.
(2)Health Economic Research Group, King Abdulaziz University, Jeddah, Saudi 
Arabia.

BACKGROUND: Since the emergence of the COVID-19 pandemic in early 2020, several 
countries are still struggling to contain its spread. Apart from economic 
challenges, the pandemic has had a negative impact on the mental health and 
psychological well-being of millions of people worldwide. The effects of 
COVID-19 are disproportionate depending on sociodemographic characteristics. The 
aim of this study was to investigate the impact of COVID-19 on psychological 
distress among women in Saudi Arabia.
METHODS: Data were extracted from an online cross-sectional self-reported 
questionnaire conducted to measure symptoms of psychological distress during the 
COVID-19 pandemic in Saudi Arabia from 3 May to 8 May 2020. The study included a 
sample of 1527 women. The questionnaire was based on the COVID-19 Peritraumatic 
Distress Index (CPDI) tool to categorise women who responded to the 
questionnaire as experiencing normal, mild, or severe levels of distress. 
Sociodemographic factors related to different levels of psychological distress 
among women were examined using descriptive analysis and multinomial logistic 
regression models.
RESULTS: Overall, 44% of the respondents indicated symptoms of psychological 
distress due to the COVID-19 pandemic. Approximately 36% of women showed 
symptoms of mild psychological distress, with 8% of women experiencing a severe 
distress level. The results also revealed particularly high levels of 
psychological distress among younger women and female healthcare workers.
CONCLUSION: The COVID-19 pandemic highly contributes to psychological distress 
among women in Saudi Arabia. Therefore, it is essential to establish medium- and 
long-term strategies that target the most vulnerable women affected by the 
COVID-19 pandemic.

DOI: 10.1371/journal.pone.0268642
PMCID: PMC9126401
PMID: 35604900 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2001. Prev Sci. 2022 Aug;23(6):853-864. doi: 10.1007/s11121-022-01382-4. Epub 2022 May 
23.

Mental Health and Well-Being Trends Through the First Year-and-a-Half of the 
COVID-19 Pandemic: Results from a Longitudinal Study of Young Adults in the USA.

Graupensperger S(1), Calhoun BH(2), Fleming C(2), Rhew IC(2), Lee CM(2).

Author information:
(1)Deptartment of Psychiatry and Behavioral Sciences, University of Washington, 
Box 357238, Seattle, WA, 98195, USA. Graups@uw.edu.
(2)Deptartment of Psychiatry and Behavioral Sciences, University of Washington, 
Box 357238, Seattle, WA, 98195, USA.

This study examined longitudinal trajectories of young adults' mental health and 
well-being before and throughout the first year-and-a-half of the COVID-19 
pandemic. Repeated assessments of a young adult community cohort (N = 656; 
Mage = 25.6 years; 59.3% female) were conducted beginning prior to COVID-19 
(January 2020) and extending through August 2021. Multilevel spline growth 
models estimated changes in three segments: (a) from pre-pandemic to April/May 
2020, (b) from April/May 2020 to September 2020, and (c) from September 2020 to 
August 2021. Depression symptoms and loneliness increased significantly in the 
first segment, plateaued slightly, then decreased significantly across the final 
segment. Anxiety symptoms were unchanged across the first two segments, but 
significantly decreased in the final segment. Satisfaction with life decreased 
significantly across the first two segments, and then increased significantly in 
the final segment. Direct comparisons of pre-pandemic scores (January 2020) to 
the last follow-up (July or August 2021) showed a return to pre-pandemic levels 
of depression symptoms, loneliness, and satisfaction with life, as indicated by 
non-significant differences, and significantly lower anxiety symptoms, relative 
to pre-pandemic. Findings support concerns for young adults' mental health and 
well-being in the initial months of the COVID-19 pandemic, but also indicate 
that young adults' emotional well-being, on average, may be returning to 
pre-pandemic levels.

© 2022. Society for Prevention Research.

DOI: 10.1007/s11121-022-01382-4
PMCID: PMC9124628
PMID: 35604479 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


2002. Int J Equity Health. 2022 May 21;21(1):74. doi: 10.1186/s12939-022-01658-9.

Associations of the COVID-19 pandemic with social well-being indicators in 
Mexico.

Vilar-Compte M(1), Hernández-F M(2), Gaitán-Rossi P(2), Pérez V(2), Teruel G(3).

Author information:
(1)Department of Public Health, Montclair State University, 1 Normal Avenue, 
Montclair, NJ, 07043, USA.
(2)Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, 
Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, 
Mexico.
(3)Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, 
Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, 
Mexico. chele.teruel@ibero.mx.

BACKGROUND: Public health measures for COVID-19 containment have implied 
economic and social life disruptions, which have been particularly deleterious 
in low- and middle-income countries (LMIC) due to high rates of informal 
employment, overcrowding, and barriers to accessing health services, amongst 
others social determinants. Mexico, a LMIC, is a country with a high COVID-19 
mortality in which there has been a very limited governmental response to help 
mitigate such COVID-related disruptions. This study analyzes the association of 
the first wave of the COVID-19 crisis in Mexico with four well-being indicators: 
income, employment, anxiety, and food security.
METHODS: It uses pooled cross-sectional data (n = 5453) of five monthly 
nationally representative surveys collected between April and August 2020. 
Probit models are estimated to assess the association of the pandemic with job 
loss and anxiety; a multinomial logistic regression is estimated for food 
security, and an ordinary least squares regression assesses the association 
between the pandemic and changes in household's income.
RESULTS: Females were significantly associated with worse outcomes for the 4 
well-being measures with an average reduction of 2.3% in household income 
compared to pre-COVID-19 levels, an increased probability (6.4 pp) of being in a 
household that had lost jobs, decreased probability of food security (6.9 pp), 
and an increased risk of anxiety symptoms (8.5 pp). In addition, those with 
lower SES and household with children also reported worse outcomes for 
employment, income and food security. The month variable was also statistically 
significant in these models suggesting that as more months of the pandemic 
elapsed the effects persisted.
CONCLUSION: The currents study documents how the COVID-19 pandemic is associated 
with different well-being indicators in a LMIC. It suggests the urgent need to 
take actions to support vulnerable groups, particularly women, households with 
children and those in the lowest SES. If policy actions are not taken, the 
pandemic will increase social and gender disparities, and will jeopardize 
childhood development.

© 2022. The Author(s).

DOI: 10.1186/s12939-022-01658-9
PMCID: PMC9123783
PMID: 35597958 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2003. Spinal Cord. 2022 Nov;60(11):984-989. doi: 10.1038/s41393-022-00812-y. Epub 2022 
May 20.

Living with spinal cord injury during COVID-19: a qualitative study of impacts 
of the pandemic in Nepal.

Bhattarai M(1), Limbu S(2), Sherpa PD(3).

Author information:
(1)College of Nursing, Texas A&M University, College Station, TX, USA. 
mbhattarai@tamu.edu.
(2)Faculty of Nursing, Everest College of Nursing, Kathmandu, Nepal.
(3)Faculty of Nursing, Nepal Institute of Health Sciences, Kathmandu, Nepal.

STUDY DESIGN: A qualitative study using focus group discussion.
OBJECTIVE: To explore the impacts of COVID-19 on multiple aspects of the lives 
of individuals living with spinal cord injury (SCI) in Nepal.
SETTING: Community settings in Nepal.
METHODS: A qualitative phenomenological study was conducted using two virtual 
focus group discussions. Fourteen individuals with SCI residing in different 
parts of Nepal participated. A thematic analysis approach was used to analyze 
and interpret the participants' responses.
RESULTS: The four key themes for the impacts of COVID-19 on individuals with SCI 
were: (1) physical health with subthemes of (a) difficulty due to the presence 
of COVID-19 symptoms and (b) deterioration in secondary conditions; (2) mental 
health with subthemes of (c) constant fear of COVID-19 and (d) psychological 
distress; (3) social life with subthemes of (e) social stigma and (f) social 
isolation, and (4) economic problems with subthemes of (g) financial burden and 
(i) inadequate resources.
CONCLUSIONS: The pandemic has tremendously impacted the physical, mental, 
social, and economic aspects of the lives of individuals with SCI. These, in 
turn, could impede the functioning and well-being of this population. The 
utilization of telehealth to provide education, psychosocial support, social 
awareness programs, and the provision of essential medical supplies appear 
necessary to maintain and improve the well-being of individuals with SCI during 
this pandemic. Future studies using an in-depth interview approach and 
psychosocial interventions are recommended.

© 2022. The Author(s), under exclusive licence to International Spinal Cord 
Society.

DOI: 10.1038/s41393-022-00812-y
PMCID: PMC9122241
PMID: 35595827 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


2004. Vaccine. 2022 Jun 9;40(26):3684-3689. doi: 10.1016/j.vaccine.2022.05.012. Epub 
2022 May 17.

Parental socioeconomic and psychological determinants of the 2009 pandemic 
influenza A(H1N1) vaccine uptake in children.

Salo-Tuominen K(1), Teros-Jaakkola T(2), Toivonen L(2), Ollila H(3), Rautava 
P(4), Aromaa M(5), Lahti E(6), Junttila N(7), Peltola V(8).

Author information:
(1)Department of Paediatrics and Adolescent Medicine, Turku University Hospital 
and University of Turku, Turku, Finland; Turku University of Applied Sciences, 
Turku, Finland.
(2)Department of Paediatrics and Adolescent Medicine, Turku University Hospital 
and University of Turku, Turku, Finland.
(3)Turku Clinical Research Centre, Turku University Hospital, Turku, Finland.
(4)Turku Clinical Research Centre, Turku University Hospital, Turku, Finland; 
Department of Public Health, University of Turku, Turku, Finland.
(5)Department of Public Health, University of Turku, Turku, Finland; Outpatient 
Clinic for Children and Adolescents, City of Turku, Turku, Finland.
(6)Outpatient Clinic for Children and Adolescents, City of Turku, Turku, 
Finland.
(7)Department for Teacher Education, University of Turku, Turku, Finland.
(8)Department of Paediatrics and Adolescent Medicine, Turku University Hospital 
and University of Turku, Turku, Finland. Electronic address: 
ville.peltola@utu.fi.

BACKGROUND: Before COVID-19, the previous pandemic was caused by influenza 
A(H1N1)pdm09 virus in 2009. Identification of factors behind parental decisions 
to have their child vaccinated against pandemic influenza could be helpful in 
planning of other pandemic vaccination programmes. We investigated the 
association of parental socioeconomic and psychosocial factors with uptake of 
the pandemic influenza vaccine in children in 2009-2010.
METHODS: This study was conducted within a prospective birth-cohort study (STEPS 
Study), where children born in 2008-2010 are followed from pregnancy to 
adulthood. Demographic and socioeconomic factors of parents were collected 
through questionnaires and vaccination data from electronic registers. Before 
and after the birth of the child, the mother's and father's individual and 
relational psychosocial well-being, i.e. depressive symptoms, dissatisfaction 
with the relationship, experienced social and emotional loneliness, and maternal 
anxiety during pregnancy, were measured by validated questionnaires (BDI-II, 
RDAS, PRAQ, and UCLA).
RESULTS: Of 1020 children aged 6-20 months at the beginning of pandemic 
influenza vaccinations, 820 (80%) received and 200 (20%) did not receive the 
vaccine against influenza A(H1N1)pdm09. All measures of parents' psychosocial 
well-being were similar between vaccinated and non-vaccinated children. Children 
of younger mothers had a higher risk of not receiving the influenza A(H1N1)pdm09 
vaccine than children of older mothers (OR 2.59, 95% CI 1.52-4.43, for 
mothers < 27.7 years compared to ≥ 33.6 years of age). Children of mothers with 
lower educational level had an increased risk of not receiving the vaccine (OR 
1.46, 95% CI 1.00-2.14).
CONCLUSIONS: Mother's younger age and lower education level were associated with 
an increased risk for the child not to receive the 2009 pandemic influenza 
vaccine, but individual or relational psychosocial well-being of parents was not 
associated with children's vaccination. Our findings suggest that young and 
poorly educated mothers should receive targeted support in order to promote 
children's vaccinations during a pandemic.

Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.vaccine.2022.05.012
PMCID: PMC9112036
PMID: 35595660 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


2005. Rev Esp Geriatr Gerontol. 2022 May-Jun;57(3):161-167. doi: 
10.1016/j.regg.2022.04.005. Epub 2022 May 18.

[Pre-post evaluation of an intergenerational program to improve wellbeing in 
older adults and age stereotypes in primary and secondary students: CRENCO 
project].

[Article in Spanish]

Domènech-Abella J(1), Díaz-Cofine S(2), Rubio-Valera M(3), Aznar-Lou I(3).

Author information:
(1)Unitat de Recerca i Innovació, Parc Sanitari Sant Joan de Déu, Sant Boi de 
Llobregat, Barcelona, España; Instituto de Salud Carlos III, Centro de 
Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, España. 
Electronic address: j.domenech@pssjd.org.
(2)Sant Joan de Déu Fundació de Recerca, Esplugues de Llobregat, Barcelona, 
España.
(3)Unitat de Recerca i Innovació, Parc Sanitari Sant Joan de Déu, Sant Boi de 
Llobregat, Barcelona, España; Instituto de Salud Carlos III, Centro de 
Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 
Madrid, España.

OBJECTIVE: The present study aims to evaluate the effectiveness of the CRENCO 
project which was carried out during the COVID-19 pandemic including 
intergenerational activities shared by students from primary and secondary 
education and users of two centers for older adults and a day hospital in 
Catalonia. The effectiveness was assessed in terms of well-being in older adults 
and on negative stereotypes about the elderly in primary and secondary students.
METHODS: Three interventions were carried out in which 32 older persons (9 users 
of centers for older adults and 23 of a day hospital), 99 primary students and 
56 secondary students participated. Participants answered a questionnaire before 
and after the interventions. Through multilevel linear models for repeated 
measures, changes in feelings of loneliness, social support, anxiety and 
depressive symptoms, self-reported health and health-related quality of life 
were evaluated in older people. In primary and secondary students, changes in 
age stereotypes were evaluated.
RESULTS: Health-related quality of life and self-reported health improved 
statistically after the interventions in older persons. Users of the day 
hospital also reported an improvement in social support. Primary school students 
improved their age stereotypes; no statistically significant changes were 
detected in secondary students.
CONCLUSION: The results of the present study contribute to underlining the 
importance of intergenerational programs such as the one proposed by CRENCO, 
capable of improving well-being and providing a more realistic vision of the 
older adults. Our results suggest that these programs should be implemented 
during childhood in order to prevent the proliferation of ageist stereotypes in 
later life stages.

Copyright © 2022 SEGG. Publicado por Elsevier España, S.L.U. All rights 
reserved.

DOI: 10.1016/j.regg.2022.04.005
PMID: 35595657 [Indexed for MEDLINE]


2006. PLoS One. 2022 May 20;17(5):e0268866. doi: 10.1371/journal.pone.0268866. 
eCollection 2022.

The health impacts of the COVID-19 pandemic on adults who experience 
imprisonment globally: A mixed methods systematic review.

Kim H(1)(2), Hughes E(3), Cavanagh A(1)(3), Norris E(3), Gao A(3), Bondy SJ(4), 
McLeod KE(5), Kanagalingam T(5)(6), Kouyoumdjian FG(5).

Author information:
(1)Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
(2)Faculty of Medicine, The University of British Columbia, Vancouver, British 
Columbia, Canada.
(3)Michael G. DeGroote School of Medicine, McMaster University, Hamilton, 
Ontario, Canada.
(4)Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, 
Canada.
(5)Department of Family Medicine, McMaster University, Hamilton, Ontario, 
Canada.
(6)Schulich School of Medicine and Dentistry, University of Western Ontario, 
London, Ontario, Canada.

BACKGROUND: The prison setting and health status of people who experience 
imprisonment increase the risks of COVID-19 infection and sequelae, and other 
health impacts of the COVID-19 pandemic.
OBJECTIVES: To conduct a mixed methods systematic review on the impacts of the 
COVID-19 pandemic on the health of people who experience imprisonment.
DATA SOURCES: We searched Medline, PsycINFO, Embase, the Cochrane Library, 
Social Sciences Abstracts, CINAHL, Applied Social Sciences Index and Abstracts, 
Sociological Abstracts, Sociology Database, Coronavirus Research Database, ERIC, 
Proquest Dissertations and Theses, Web of Science, and Scopus in October 2021. 
We reviewed reference lists for included studies.
STUDY ELIGIBILITY CRITERIA: Original research conducted in or after December 
2019 on health impacts of the COVID-19 pandemic on adults in prisons or within 
three months of release.
STUDY APPRAISAL AND SYNTHESIS METHODS: We used the Joanna Briggs Institute's 
Critical Appraisal Checklist for Qualitative Research for qualitative studies 
and the Joanna Briggs Institute's Critical Appraisal Checklist for Studies 
Reporting Prevalence Data for quantitative studies. We qualitized quantitative 
data and extracted qualitative data, coded data, and collated similar data into 
categories.
RESULTS: We identified 62 studies. People in prisons had disproportionately high 
rates of COVID-19 infection and COVID-19 mortality. During the pandemic, 
all-cause mortality worsened, access to health care and other services worsened, 
and there were major impacts on mental wellbeing and on relationships with 
family and staff. There was limited evidence regarding key primary and secondary 
prevention strategies.
LIMITATIONS: Our search was limited to databases. As the COVID-19 pandemic is 
ongoing, more evidence will emerge.
CONCLUSIONS: Prisons and people who experience imprisonment should be 
prioritized for COVID-19 response and recovery efforts, and an explicit focus on 
prisons is needed for ongoing public health work including emergency 
preparedness.
PROSPERO REGISTRATION NUMBER: 239324.

DOI: 10.1371/journal.pone.0268866
PMCID: PMC9122186
PMID: 35594288 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2007. Front Public Health. 2022 May 3;10:823303. doi: 10.3389/fpubh.2022.823303. 
eCollection 2022.

Early Adolescents' Experiences During the COVID-19 Pandemic and Changes in Their 
Well-Being.

Gadermann A(1), Thomson K(1), Gill R(1), Schonert-Reichl KA(2), Gagné Petteni 
M(1), Guhn M(1), Warren MT(1), Oberle E(1).

Author information:
(1)Human Early Learning Partnership, School of Population and Public Health, 
University of British Columbia, Vancouver, BC, Canada.
(2)Department of Psychology, University of Illinois Chicago, Chicago, IL, United 
States.

BACKGROUND: Early adolescence is a time of psychological and social change that 
can coincide with declines in mental health and well-being. This study 
investigated the psychological and social impacts of the COVID-19 pandemic from 
the perspective of students who responded to a survey in Grades 7 and 8 (ages 
12-14) in British Columbia (BC), Canada. The objectives of this study were (i) 
to provide an overview on early adolescents' experiences and social-emotional 
well-being during the pandemic; and (ii) to examine whether changes in social 
experiences as well as feeling safe from getting COVID-19 at school were 
associated with changes in well-being outcomes over the course of a year.
METHODS: A sample of n = 1,755 students from a large public school district 
self-reported on their life satisfaction, optimism, and symptoms of sadness 
across two time points: First, in their Grade 7 year (pre-pandemic; January to 
March, 2020) and then 1 year later in their Grade 8 year (during the pandemic; 
January to March, 2021). In Grade 8, students also reported on pandemic-specific 
experiences, including changes in mental health, social relationships, and 
activities, as well as coping strategies and positive changes since the 
pandemic. Data were collected online using the Middle Years Development 
Instrument (MDI), a population-based self-report tool that assesses children's 
social-emotional development and well-being in the context of their home, 
school, and neighborhood. Multivariable linear regression analyses were used to 
examine associations between pandemic-related changes in relationships and 
perceived safety from getting COVID-19 at school with changes in well-being 
outcomes.
RESULTS: Students reported a range of experiences, with a large proportion 
reporting moderate concerns and impacts of the pandemic, including worries about 
their mental health and missing school activities. Students reported 
significantly lower optimism, lower life satisfaction, and higher sadness 
compared to the previous year. Within the sample, improvements in relationships 
with parents and other adults at home was associated with higher well-being 
during the pandemic.
IMPLICATIONS: Results from this study can inform decision making of 
policy-makers, educators, and practitioners working with youth, by providing 
information on students' experiences during the pandemic and identifying factors 
that may be protective for students' mental health during and beyond the 
pandemic.

Copyright © 2022 Gadermann, Thomson, Gill, Schonert-Reichl, Gagné Petteni, Guhn, 
Warren and Oberle.

DOI: 10.3389/fpubh.2022.823303
PMCID: PMC9110968
PMID: 35592082 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2008. Sci Rep. 2022 May 19;12(1):8445. doi: 10.1038/s41598-022-12275-5.

Anxiety among pregnant women during the first wave of the COVID-19 pandemic in 
Poland.

Ilska M(1), Brandt-Salmeri A(2), Kołodziej-Zaleska A(2), Preis H(3), Rehbein 
E(3), Lobel M(3).

Author information:
(1)Institute of Psychology, University of Silesia in Katowice, Grażyńskiego 
Street 53, Katowice, Poland. michalina.ilska@us.edu.pl.
(2)Institute of Psychology, University of Silesia in Katowice, Grażyńskiego 
Street 53, Katowice, Poland.
(3)Department of Psychology, Stony Brook University, Stony Brook, NY, 11794, 
USA.

Although anxiety is common because of the transitional nature of the perinatal 
period, particularly high levels of anxiety have been observed in some studies 
of pregnant women during the pandemic. The purpose of this study was to evaluate 
the severity of anxiety among pregnant women during the first wave of the 
COVID-19 pandemic in Poland, and factors associated with it. Cross-sectional 
study with a total of 1050 pregnant women recruited via social media in Poland 
during the first wave of the COVID-19 pandemic, from March 1 until June 1, 2020. 
The survey included validated psychological measures: the GAD-7 (anxiety), the 
PREPS (pandemic stress), with two subscales: preparedness and infection stress, 
and obstetric, sociodemographic and COVID-19 related variables. T-tests, ANOVAs, 
and hierarchical binary logistic regression for dichotomized GAD-7 scores 
(minimal or mild vs. moderate or severe) were used. Over a third of respondents 
experienced moderate or severe levels of anxiety. Predictors of moderate or 
severe anxiety were non-pandemic related factors like unplanned pregnancy and 
emotional and psychiatric problems, as well as pandemic related pregnancy 
stress. Levels of anxiety among pregnant women during the first wave of the 
COVID-19 pandemic in Poland exceeded pre-pandemic norms. Findings suggest that 
prior psychiatric conditions, unplanned pregnancy, and elevated pandemic-related 
pregnancy stress due to concerns about infection or poor preparation for birth 
contributed to the risk of high anxiety in Polish pregnant women during the 
pandemic onset. Given the harmful effects of antenatal anxiety on the health and 
well-being of mothers and their children, psychotherapeutic interventions, 
efforts to alleviate pregnant women's stress, and training in adaptive ways to 
cope with stress are vital to reduce the prevalence of maternal anxiety and its 
potential consequences during this global crisis.

© 2022. The Author(s).

DOI: 10.1038/s41598-022-12275-5
PMCID: PMC9118185
PMID: 35589774 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


2009. Aust Health Rev. 2022 Oct;46(5):555-558. doi: 10.1071/AH22042.

Perspectives on an exhausted medical radiation practitioner workforce: emotional 
labour and the impact of compassion fatigue.

Ku M(1), Cavanagh J(1), Bartram T(1), Halvorsen B(1).

Author information:
(1)College of Business and Law, School of Management, Royal Melbourne Institute 
of Technology, 124 La Trobe Street, Melbourne, Vic. 3000, Australia.

As the COVID-19 pandemic in Australia reaches its peak, medical radiation 
practitioners (MRPs) are at capacity both physically and emotionally. High 
workloads and stress impact the mental wellbeing of MRPs, with suppression of 
feelings and emotions resulting in experiences of compassion fatigue. From a MRP 
workforce perspective, the long-term cost of the pandemic has yet to be 
realised. MRPs need to be supported to prevent unintended health consequences. 
Robust management interventions will be required to support the MRP workforce to 
manage and hopefully mitigate compassion fatigue transitioning out of the 
pandemic.

DOI: 10.1071/AH22042
PMID: 35589668 [Indexed for MEDLINE]


2010. BMJ Open. 2022 May 19;12(5):e058144. doi: 10.1136/bmjopen-2021-058144.

Well-being app to support young people during the COVID-19 pandemic: randomised 
controlled trial.

Thabrew H(1), Boggiss AL(2), Lim D(2), Schache K(2), Morunga E(2), Cao N(2), 
Cavadino A(3), Serlachius AS(2).

Author information:
(1)Department of Psychological Medicine, The University of Auckland, Auckland, 
New Zealand h.thabrew@auckland.ac.nz.
(2)Department of Psychological Medicine, The University of Auckland, Auckland, 
New Zealand.
(3)Department of Epidemiology and Biostatistics, The University of Auckland, 
Auckland, New Zealand.

OBJECTIVES: To evaluate the efficacy and acceptability of 'Whitu: seven ways in 
seven days', a well-being application (app) for young people.
DESIGN: Prospective randomised controlled trial of Whitu against waitlist 
control, with 45 participants in each arm.
PARTICIPANTS: 90 New Zealand young people aged 16-30 recruited via a social 
media advertising campaign.
SETTING: Participants' homes.
INTERVENTIONS: Developed during the COVID-19 pandemic, and refined from a 
prototype version that was evaluated during a smaller qualitative study, 'Whitu: 
seven ways in seven days' is a well-being app that, as its name suggests, 
contains seven modules to help young people (1) recognise and rate emotions, (2) 
learn relaxation and mindfulness, (3) practice self-compassion and (4) 
gratitude, (5) connect with others, (6) care for their physical health and (7) 
engage in goal-setting. It can be completed within a week or as desired.
MAIN OUTCOME MEASURES: Primary outcomes were changes in well-being on the WHO 
5-item Well-Being Index and Short Warwick-Edinburgh Mental Well-Being Scale. 
Secondary outcomes were changes in depression on the Centre for Epidemiological 
Studies Depression Scale, anxiety on the Generalised Anxiety Disorder 7-item 
Scale, self-compassion on the Self Compassion Scale-Short Form, stress on the 
10-item Perceived Stress Scale, sleep on the single-item Sleep Quality Scale and 
user engagement on the end-user version of the Mobile Application Rating Scale 
and via qualitative feedback during an online survey. Outcomes were evaluated at 
baseline, 4 weeks (primary study endpoint) and 3 months, and analysed using 
linear mixed models with group, time and a group-time interaction.
RESULTS: At 4 weeks, participants in the Whitu group experienced significantly 
higher emotional (Mean difference (md) 13.19 (3.96 to 22.42); p=0.005) and 
mental (md 2.44 (0.27 to 4.61); p=0.027) well-being, self-compassion (md 0.56 
(0.28 to 0.83); p<0.001) and sleep (md 1.13 (0.24 to 2.02); p=0.018), and 
significantly lower stress (md -4.69 (-7.61 to -1.76); p=0.002) and depression 
(md -5.34 (-10.14 to -0.53); p=0.030), compared with the waitlist controls. 
Group differences remained statistically significant at 3 months for all 
outcomes. Symptoms of anxiety were also lower in the intervention group at 4 
weeks (p=0.096), with statistically significant differences at 3 months (md 
-2.31 (-4.54 to -0.08); p=0.042). Usability of Whitu was high (subjective 
ratings of 4.45 (0.72) and 4.38 (0.79) out of 5 at 4 weeks and 3 months, 
respectively) and qualitative feedback indicated individual and cultural 
acceptability of the app.
CONCLUSIONS: Given the evolving psychological burden of the COVID-19 pandemic, 
Whitu could provide a clinically effective and scalable means of improving the 
well-being, mental health and resilience of young people. Replication of current 
findings with younger individuals and in other settings is planned.
TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry 
(ACTRN12620000516987).

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-058144
PMCID: PMC9121135
PMID: 35589362 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2011. Acta Psychol (Amst). 2022 Jul;227:103618. doi: 10.1016/j.actpsy.2022.103618. 
Epub 2022 May 13.

University students' mental well-being during COVID-19 pandemic: The mediating 
role of resilience between meaning in life and mental well-being.

Rasheed N(1), Fatima I(2), Tariq O(3).

Author information:
(1)Institute of Applied Psychology, University of the Punjab, Lahore, Pakistan. 
Electronic address: nisma8419@gmail.com.
(2)Institute of Applied Psychology, University of the Punjab, Lahore, Pakistan. 
Electronic address: iram.appsy@pu.edu.pk.
(3)Institute of Applied Psychology, University of the Punjab, Lahore, Pakistan. 
Electronic address: omama.tariq.appsy@pu.edu.pk.

The current study aims to examine (a) the mental well-being of university 
students, who were taking online classes, and (b) and test whether resilience 
would mediate the relationship between meaning in life and mental well-being. 
The sample of 302 university students (Mage = 20.25 years; 36.1% men, 63.9% 
women) was taken from the universities of Punjab, Pakistan. The participants 
were recruited online and they completed a cross-sectional survey comprising the 
scales of meaning in life, resilience, and mental well-being during COVID-19. 
Findings from the study indicated that participants had a normal to a 
satisfactory level of overall mental wellbeing during COVID-19. Resilience acted 
as a mediator for both the presence of meaning in life, the search for meaning 
in life, and mental well-being. Demographic variables including family size were 
significantly and positively related to resilience while the availability of 
personal room showed a significant positive relationship with mental well-being. 
These findings suggest that meaning in life and resilience supports mental 
well-being during the COVID-19 pandemic and that effective steps should be taken 
to make the lives of university students more meaningful and resilient.

Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.actpsy.2022.103618
PMCID: PMC9098940
PMID: 35588627 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no known 
competing financial interests or personal relationships that could have appeared 
to influence the work reported in this paper.


2012. Arch Gerontol Geriatr. 2022 Sep-Oct;102:104719. doi: 
10.1016/j.archger.2022.104719. Epub 2022 May 10.

Caring in the time of COVID-19, longitudinal trends in well-being and mental 
health in carers in Ireland: Evidence from the Irish Longitudinal Study on 
Ageing (TILDA).

McGarrigle CA(1), Ward M(2), De Looze C(2), O'Halloran A(2), Kenny RA(3).

Author information:
(1)The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, 
Dublin, Ireland. Electronic address: christine.mcgarrigle@tcd.ie.
(2)The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, 
Dublin, Ireland.
(3)The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, 
Dublin, Ireland; Mercer's Institute for Successful Ageing, St James' Hospital, 
Dublin, Ireland.

BACKGROUND: The COVID-19 pandemic in 2020 resulted in the older population being 
asked to remain at home and avoid other people outside their household. This 
could have implications for both receipt and provision of informal caring.
OBJECTIVE: To determine if informal care provision by older carers changed 
during the first wave of the COVID-19 pandemic from pre-pandemic care and if 
this was associated with a change in mental health and well-being of carers.
DESIGN AND SETTING: Longitudinal nationally representative study of community 
dwelling adults from The Irish Longitudinal Study on Ageing (TILDA) (Waves 
3-COVID-Wave 6).
METHODS: We studied a cohort of 3670 adults aged ≥60 in Ireland during the 
COVID-19 pandemic (July-November 2020) and compared with previous data 
collections from the same cohort between 2014-2018. Independent variables were 
caregiving status and caregiving intensity, outcome measures included depressive 
symptoms (CES-D8), Perceived Stress (PSS4) and Quality of life (CASP12). Mixed 
models adjusting for socio-demographics and physical health were estimated.
RESULTS: Caregiving increased from 8.2% (2014) to 15.4% (2020). Depression, and 
stress scores increased while quality of life decreased for all participants. 
Carers reported poorer mental health, and higher caring hours were associated 
with increased depression and stress and decreased quality of life scores on 
average, and increased depression was higher for women.
CONCLUSIONS: Informal caregiving increased during the pandemic and family 
caregivers reported increased adverse mental health and well-being and this 
continued throughout the early months of the pandemic. The disproportionate 
burden of depression was highest in women providing higher caring hours.

Copyright © 2022. Published by Elsevier B.V.

DOI: 10.1016/j.archger.2022.104719
PMCID: PMC9085370
PMID: 35588613 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflict of interest.


2013. PLoS Genet. 2022 May 19;18(5):e1010135. doi: 10.1371/journal.pgen.1010135. 
eCollection 2022 May.

Increased genetic contribution to wellbeing during the COVID-19 pandemic.

Warmerdam CAR(1), Wiersma HH(1), Lanting P(1), Ani A(2); Lifelines Corona 
Research Initiative; Lifelines Cohort Study; Dijkema MXL(1), Snieder H(2), Vonk 
JM(2), Boezen HM(2), Deelen P(1)(3), Franke LH(1)(3).

Author information:
(1)Department of Genetics, University Medical Center Groningen, University of 
Groningen, Groningen, The Netherlands.
(2)Department of Epidemiology, University Medical Center Groningen, University 
of Groningen, Groningen, The Netherlands.
(3)Oncode Institute, Utrecht, The Netherlands.

Physical and mental health are determined by an interplay between nature, for 
example genetics, and nurture, which encompasses experiences and exposures that 
can be short or long-lasting. The COVID-19 pandemic represents a unique 
situation in which whole communities were suddenly and simultaneously exposed to 
both the virus and the societal changes required to combat the virus. We studied 
27,537 population-based biobank participants for whom we have genetic data and 
extensive longitudinal data collected via 19 questionnaires over 10 months, 
starting in March 2020. This allowed us to explore the interaction between 
genetics and the impact of the COVID-19 pandemic on individuals' wellbeing over 
time. We observe that genetics affected many aspects of wellbeing, but also that 
its impact on several phenotypes changed over time. Over the course of the 
pandemic, we observed that the genetic predisposition to life satisfaction had 
an increasing influence on perceived quality of life. We also estimated 
heritability and the proportion of variance explained by shared environment 
using variance components methods based on pedigree information and household 
composition. The results suggest that people's genetic constitution manifested 
more prominently over time, potentially due to social isolation driven by strict 
COVID-19 containment measures. Overall, our findings demonstrate that the 
relative contribution of genetic variation to complex phenotypes is dynamic 
rather than static.

DOI: 10.1371/journal.pgen.1010135
PMCID: PMC9119461
PMID: 35588108 [Indexed for MEDLINE]

Conflict of interest statement: I have read the journal’s policy and the authors 
of this manuscript have the following competing interests: Author H. Marike 
Boezen was unable to confirm their authorship contributions. On their behalf, 
the corresponding author has reported their contributions to the best of their 
knowledge. The authors declare no further competing interests.


2014. PLoS One. 2022 May 19;17(5):e0267583. doi: 10.1371/journal.pone.0267583. 
eCollection 2022.

Coping with COVID-19: Differences in hope, resilience, and mental well-being 
across U.S. racial groups.

Graham C(1)(2), Chun Y(3), Hamilton B(4), Roll S(3)(5), Ross W(6), 
Grinstein-Weiss M(3)(5).

Author information:
(1)Global Economy and Development, The Brookings Institution, Washington, DC, 
United States of America.
(2)University of Maryland, College Park, Maryland, United States of America.
(3)Social Policy Institute, Washington University in St. Louis, St. Louis, 
Missouri, United States of America.
(4)Olin Business School, Washington University in St. Louis, St. Louis, 
Missouri, United States of America.
(5)Brown School of Social Work, Washington University in St. Louis, St. Louis, 
Missouri, United States of America.
(6)Washington University School of Medicine in St. Louis, St. Louis, Missouri, 
United States of America.

OBJECTIVES: To explore if the COVID-19 pandemic revealed differences across 
racial groups in coping, resilience, and optimism, all of which have 
implications for health and mental well-being.
METHODS: We collect data obtained from four rounds of a national sample of 5,000 
US survey respondents in each round from April 2020 to February 2021. Using 
logistic regression and fixed effects models, we estimate the pandemic impacts 
on COVID-19 related concerns, social distancing behaviors, and mental 
health/life satisfaction and optimism for racial/income groups.
RESULTS: Despite extreme income and health disparities before and during the 
COVID-19 outbreak, Blacks and Hispanics remain more resilient and optimistic 
than their White counterparts. Moreover, the greatest difference in resilience, 
optimism and better mental health-is found between poor Blacks and poor Whites, 
a difference that persists through all four rounds.
CONCLUSIONS: These deep differences in resilience have implications for the 
long-term mental health of different population groups in the face of an 
unprecedented pandemic. Better understanding these dynamics may provide lessons 
on how to preserve mental health in the face of public health and other 
large-scale crises.

DOI: 10.1371/journal.pone.0267583
PMCID: PMC9119465
PMID: 35587476 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2015. BMC Pregnancy Childbirth. 2022 May 18;22(1):415. doi: 
10.1186/s12884-022-04729-5.

Implementing "Online Communities" for pregnant women in times of COVID-19 for 
the promotion of maternal well-being and mother-to-infant bonding: a 
pretest-posttest study.

Potharst ES(1)(2), Schaeffer MA(3)(4)(5), Gunning C(6), de Lara MC(7), Boekhorst 
MGBM(8), Hulsbosch LP(8), Pop VJM(8), Duijff SN(6)(9).

Author information:
(1)Research Institute of Child Development and Education, University of 
Amsterdam, Gebouw D, Roeterseilandcomplex, Nieuwe Achtergracht 127, 1018 WS, 
Amsterdam, the Netherlands. epotharst@uvaminds.nl.
(2)UvA Minds, Academic Outpatient (child and adolescent) Treatment Center of the 
University of Amsterdam, Banstraat 29, 1071 JW, Amsterdam, the Netherlands. 
epotharst@uvaminds.nl.
(3)UvA Minds, Academic Outpatient (child and adolescent) Treatment Center of the 
University of Amsterdam, Banstraat 29, 1071 JW, Amsterdam, the Netherlands.
(4)Amsterdam Law and Behaviour Institute (A-LAB), Vrije Universiteit Amsterdam, 
De Boelelaan 1077a, 1081 HV, Amsterdam, the Netherlands.
(5)Netherlands Institute for the Study of Crime and Law Enforcement, De 
Boelelaan 1077, 1081 HV, Amsterdam, the Netherlands.
(6)Infant Mental Health Expertise Centre OuderKindLijn, Javastraat 155, 1095 CC, 
Amsterdam, The Netherlands.
(7)Outpatient Maternal Mental Health Practice Psyche en Zwangerschap, Cornelis 
Anthoniszstraat 28, 1071 VV, Amsterdam, The Netherlands.
(8)Department of Medical and Clinical Psychology, Center of Research On 
Psychological and Somatic Disorders (CoRPS), Tilburg University, Gebouw TIAS, 
Warandelaan 2, 5037 AB, Tilburg, the Netherlands.
(9)Clinical Child, Family and Education Studies, University of Utrecht, 
Heidelberglaan 1, Postbus 80140, 3508 TC, Utrecht, The Netherlands.

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) pandemic elevated the risk 
for mental health problems in pregnant women, thereby increasing the risk for 
long-term negative consequences for mother and child well-being. There was an 
immediate need for easily accessible interventions for pregnant women 
experiencing elevated levels of pandemic related stress.
METHODS: A three-session intervention "Online Communities" (OC) was developed at 
the beginning of the Dutch lockdown, and implemented by a team of midwives and 
psychologists specialized in Infant Mental Health. Pretest (N = 34) and posttest 
(N = 17) measurements of depressive symptoms, worries about COVID-19 and worries 
in general, and mother-to-infant bonding were administered, as well as a 
posttest evaluation.
RESULTS: At pretest, the OC group was compared to two reference groups of 
pregnant women from an ongoing pregnancy cohort study: a COVID-19 (N = 209) and 
pre-COVID-19 reference group (N = 297). OC participants had significantly more 
depressive symptoms than both reference groups, and less positive feelings of 
bonding than the COVID-19 but not the pre-COVID-19 reference group. Compared to 
pretest, significant decreases in depressive symptoms (with significantly less 
participants scoring above cut-off) and worries about COVID-19 (large effect 
sizes) and worries in general (moderate to large effect size) were found at 
posttest for the OC participants. No significant improvement was found in 
bonding. Participants rated the intervention positively.
CONCLUSIONS: The current study provides initial evidence supporting the idea 
that OC is a promising and readily accessible intervention for pregnant women 
experiencing stress due to the COVID-19 pandemic, and possibly also applicable 
to other stressors.
TRIAL REGISTRATION: This intervention was registered in the Netherlands Trial 
Registration (registration number Trial NL8842 , registration date 18/08/2020).

© 2022. The Author(s).

DOI: 10.1186/s12884-022-04729-5
PMCID: PMC9116067
PMID: 35585565 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


2016. Ind Health. 2022 Jul 31;60(4):345-359. doi: 10.2486/indhealth.2022-0081. Epub 
2022 May 19.

Association between home working and mental health by key worker status during 
the Covid-19 pandemic. Evidence from four British longitudinal studies.

Wielgoszewska B(1), Booth C(1), Green MJ(2), Hamilton OK(2), Wels J(3).

Author information:
(1)Centre for Longitudinal Studies (CLS), University College London, United 
Kingdom.
(2)MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, United 
Kingdom.
(3)MRC Unit for Lifelong Health and Ageing, University College London, United 
Kingdom.

Little is known about the relationship between homeworking and mental health 
during the Covid-19 pandemic and how it might differ by keyworker status. To 
understand this relationship, we use longitudinal data collected over three time 
points during the pandemic from three British cohort studies born in 1958 
(National Child Development Study), 1970 (British Cohort Study) and 1989-90 
(Next Step) as well as from a population-based study stratified by four age 
groups (Understanding Society). We estimate the association between life 
satisfaction, anxiety, depression, and psychological distress and homeworking by 
key worker status using mixed effects models with maximum likelihood estimation 
to account for repeated measurements across the pandemic, allowing intercepts to 
vary across individuals after controlling for a set of covariates including 
pre-pandemic home working propensities and loneliness. Results show that key 
workers working from home showed the greatest decline in mental health outcomes 
relative to other groups. Pre-pandemic homeworking did not significantly change 
the nature of such a relationship and loneliness slightly attenuated some of the 
effects. Finally, mental health outcomes varied across age-groups and time 
points. The discussion emphasises the need to pay attention to key workers when 
assessing the relationship between mental health and homeworking.

DOI: 10.2486/indhealth.2022-0081
PMCID: PMC9453552
PMID: 35584949 [Indexed for MEDLINE]


2017. J Dev Behav Pediatr. 2022 Jun-Jul 01;43(5):e288-e295. doi: 
10.1097/DBP.0000000000001085. Epub 2022 May 18.

Remote and Hybrid Schooling During COVID-19: Associations with Child Behavior 
and Sleep.

Levitt KJ(1), Munzer T(1), Torres C(1), Schaller A(1), McCaffery H(2), Radesky 
JS(1).

Author information:
(1)Division of Developmental Behavioral Pediatrics, Department of Pediatrics, 
University of Michigan Medical School, Ann Arbor, MI.
(2)Department of Pediatrics, University of Michigan Medical School, Ann Arbor, 
MI.

OBJECTIVE: The purpose of this study was to assess the prevalence of child 
behavior, academic and sleep concerns, and parent stress and depression symptoms 
during COVID-19; to test associations of parent-child well-being with child 
school format; and to examine effect moderation by child race/ethnicity and 
material hardship.
METHODS: A total of 305 English-speaking parents of elementary school-age 
children completed online surveys regarding demographics, child school format, 
behavior, learning-related experiences, sleep, and parent stress and depression 
symptoms. Multivariable linear and logistic regression analyses examined 
associations of school format with child and parent outcomes.
RESULTS: Children were aged 5.00 to 10.99 years, with 27.8% underrepresented 
minority race/ethnicity. Per parental report, 27.7% attended school in-person, 
12.8% hybrid, and 59.5% remote. In multivariable models, compared with children 
receiving in-person instruction, children receiving remote instruction exhibited 
more hyperactivity (β 0.94 [95% confidence interval, 0.18-1.70]), peer problems 
(β 0.71 [0.17-1.25]), and total behavioral difficulties (β 2.82 [1.11-4.53]); 
were less likely to show academic motivation (odds ratio [OR] 0.47 [0.26-0.85]) 
and social engagement (OR 0.13 [0.06-0.25]); were more likely to show schoolwork 
defiance (OR 2.91 [1.56-5.40]); and had a later sleep midpoint (β 0.37 
[0.18-0.56]) and higher odds of cosleeping (OR 1.89 [1.06-3.37]). Associations 
of remote learning with behavior difficulties were stronger for children without 
material hardships.
CONCLUSION: Children receiving remote and hybrid instruction were reported to 
have more difficulties compared with children receiving in-person instruction. 
Children with material hardships showed more behavior challenges overall but 
less associated with school format. Therefore, planning for a return to 
in-person learning should also include consideration of family supports.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/DBP.0000000000001085
PMCID: PMC10186251
PMID: 35583945 [Indexed for MEDLINE]

Conflict of interest statement: J. S. Radesky is a paid consultant for Melissa 
and Doug Toys, Noggin/CBS/Viacom, and the Worldwide Early Development Movement, 
which are not relevant to the current study. The authors declare no conflict of 
interest.


2018. Nurs Older People. 2022 Aug 2;34(4):20-26. doi: 10.7748/nop.2022.e1400. Epub 
2022 May 18.

Effects of social isolation and restrictions on older people during the COVID-19 
pandemic.

Dunford S(1), Brooke J(2).

Author information:
(1)Faculty of Health, Education and Life Sciences, Birmingham City University, 
Birmingham, England.
(2)Health and Related Research, Faculty of Health, Education and Life Sciences, 
Birmingham City University, Birmingham, England.

BACKGROUND: Older people's health is vulnerable to the effects of long-term 
changes to everyday life and their recovery from ill health can be delayed by 
the deconditioning effects of isolation. Social isolation can increase the 
likelihood of loneliness in older people, which has negative implications for 
their mental and physical health.
AIM: To explore the effects of social isolation and social distancing on older 
people in the Republic of Ireland during and following the government-enforced 
lockdown in the first wave of the coronavirus disease 2019 (COVID-19) pandemic.
METHOD: This study involved a convenience sample of four participants from the 
Republic of Ireland. Semi-structured interviews were conducted and 
audio-recorded with each participant over six sessions, two weeks apart, between 
6 April 2020 and 7 July 2020. Transcripts were analysed using content analysis 
of longitudinal data to identify themes.
FINDINGS: Three themes were identified: the effect on health and mental 
well-being; commitment to restrictions; and concern about the non-adherence of 
others.
CONCLUSION: Participants committed fully to 'cocooning' and other government 
restrictions, sometimes to the detriment of their health. Healthcare 
professionals need to be mindful of potential post-pandemic deconditioning in 
older people resulting from adherence to government restrictions and lingering 
anxieties about returning to normality after prolonged isolation.

©2022 RCN Publishing Company Ltd. All rights reserved. Not to be copied, 
transmitted or recorded in any way, in whole or part, without prior permission 
of the publishers.

DOI: 10.7748/nop.2022.e1400
PMID: 35582820 [Indexed for MEDLINE]

Conflict of interest statement: None declared


2019. Perspect Psychiatr Care. 2022 Oct;58(4):2707-2714. doi: 10.1111/ppc.13111. Epub 
2022 May 17.

Specific coping styles and its relationship with psychological distress, 
anxiety, mental health, and psychological well-being among student nurses during 
the second wave of the COVID-19 pandemic.

Labrague LJ(1).

Author information:
(1)Graduate School, St. Paul University Philippines, Tuguegarao, Philippines.

PURPOSE: To identify specific coping skills that contribute to relieving anxiety 
and stress while supporting student nurses' mental health and psychological 
well-being.
DESIGN AND METHOD: This is a cross-sectional online survey involving 261 
students nurses from private and government-owned nursing schools in the Central 
Philippines.
RESULTS: Resilience was associated with reduced stress and anxiety and better 
mental health and psychological well-being. Mental disengagement was associated 
with lower anxiety and stress levels. Spiritual and not scientific sources of 
support were associated with lower stress and increased psychological well-being 
and mental health.
PRACTICE IMPLICATIONS: Nurse faculty should foster functional coping skills in 
student nurses to enhance their ability to endure negative psychological and 
mental health outcomes related to the pandemic.

© 2022 Wiley Periodicals LLC.

DOI: 10.1111/ppc.13111
PMCID: PMC9348459
PMID: 35582787 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


2020. BMC Psychol. 2022 May 17;10(1):124. doi: 10.1186/s40359-022-00834-4.

Stress management in nurses caring for COVID-19 patients: a qualitative content 
analysis.

Hosseini Moghaddam M(1), Mohebbi Z(1), Tehranineshat B(2).

Author information:
(1)Department of Nursing, School of Nursing and Midwifery, Shiraz University of 
Medical Sciences, Shiraz, Iran.
(2)Community Based Psychiatric Care Research Center, School of Nursing and 
Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran. 
tbanafsheh@yahoo.com.

BACKGROUND: Being in the frontline of the battle against COVID-19, nurses need 
to be capable of stress management to maintain their physical and psychological 
well-being in the face of a variety of stressors. The present study aims to 
explore the challenges, strategies, and outcomes of stress management in nurses 
who face and provide care to COVID-19 patients.
METHODS: The present study is a qualitative descriptive work that was conducted 
in teaching hospitals affiliated with Shiraz University of Medical Sciences, 
Iran, from June 2020 to March 2021. Sixteen nurses who were in practice in units 
assigned to COVID-19 patients were selected via purposeful sampling. Data were 
collected through semi-structured, individual interviews conducted online. The 
collected data were analyzed using MAXQDA 10 according to the conventional 
content analysis method suggested by Graneheim and Lundman.
RESULTS: The data collected in the interviews resulted in 14 subcategories under 
4 main categories: providing care with uncertainty and anxiety, facing 
psychological and mental tension, creating a context for support, and 
experiencing personal-professional growth.
CONCLUSIONS: The nurses caring for COVID-19 patients needed the support of their 
authorities and families to stress management. Providing a supportive 
environment through crisis management training, providing adequate equipment and 
manpower, motivating nurses to achieve psychological growth during the pandemic 
can help them manage stress.

© 2022. The Author(s).

DOI: 10.1186/s40359-022-00834-4
PMCID: PMC9112256
PMID: 35581589 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest for the research, authorship, and/or publication of this article.


2021. Psychiatry Res. 2022 Jul;313:114595. doi: 10.1016/j.psychres.2022.114595. Epub 
2022 May 2.

Psychological impacts of the COVID-19 pandemic on medical students in the United 
States of America.

Zhang Y(1), Geddes J(1), Kanga FH(1), Himelhoch S(2).

Author information:
(1)Department of Psychiatry, University of Kentucky College of Medicine, 
Lexington, KY, USA.
(2)Department of Psychiatry, University of Kentucky College of Medicine, 
Lexington, KY, USA. Electronic address: seth.himelhoch@uky.edu.

This study aimed to assess the early psychological impacts of the COVID-19 
pandemic on United States medical students when compared to graduate students in 
fields unrelated to healthcare using the perceived stress scale (PSS-10) and the 
perceived COVID-19-related risk scale (PCRS). This was a cross-sectional study 
between May and June 2020. We created an anonymous, online questionnaire that 
was administered to medical students nationwide and local graduate students. We 
used Student's t-test, Chi-square test, and regression models. We received 425 
completed responses. Contrary to similar stress levels in graduate students, 
medical students on average experienced significantly more stress after 
coursework suspension than before (20.6 vs 14.7). Female gender and a mental 
illness diagnosis were associated with statistically significantly elevated 
PSS-10 scores before and after suspension in medical students. Medical students 
reported a low PCRS score. Most medical students were confident in their 
department's infection control measures and willing to report to work. Female 
gender and a mental illness diagnosis remain two important risk factors for 
medical students' stress levels during the pandemic. This study highlights the 
need to foster students' public health competency and safely involve students as 
non-frontline workers in public health emergency responses for their mental 
wellbeing.

Copyright © 2022 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.psychres.2022.114595
PMCID: PMC9059342
PMID: 35580431 [Indexed for MEDLINE]

Conflict of interest statement: YZ, JG, FHK and SH report no conflict of 
interest.


2022. J Ment Health. 2023 Dec;32(6):1122-1133. doi: 10.1080/09638237.2022.2069716. 
Epub 2022 May 17.

Effects of COVID-19-related worry and rumination on mental health and loneliness 
during the pandemic: longitudinal analyses of adults in the UK COVID-19 mental 
health & wellbeing study.

O'Connor DB(1), Wilding S(1), Ferguson E(1), Cleare S(2), Wetherall K(2), 
McClelland H(2), Melson AJ(2), Niedzwiedz C(3), O'Carroll RE(4), Platt S(5), 
Scowcroft E(6), Watson B(7), Zortea T(2), Robb KA(3), O'Connor RC(2).

Author information:
(1)School of Psychology, University of Leeds, Leeds, England.
(2)Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, 
University of Glasgow, Glasgow, Scotland.
(3)Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland.
(4)Division of Psychology, University of Stirling, Stirling, Scotland.
(5)Usher Institute, University of Edinburgh, Edinburgh, Scotland.
(6)Samaritans, The Upper Mill, Ewell, Surrey, England.
(7)Scottish Association for Mental Health, Glasgow, Scotland.

BACKGROUND: The lasting effects of the coronavirus disease 2019 pandemic are 
likely to be significant.
AIMS: This study tracked worry and rumination levels during the pandemic and 
investigated whether periods with higher COVID-related worry and rumination were 
associated with more negative mental health and loneliness.
METHODS: A quota survey design and a sampling frame that permitted recruitment 
of a national sample were employed. Findings for waves 1 (March 2020) to 6 
(November 2020) are reported (N = 1943).
RESULTS: Covid-related worry and rumination levels were highest at the beginning 
of the first lockdown, then declined but increased when the UK returned to 
lockdown. Worry levels were higher than rumination levels throughout. High 
levels of COVID-related worry and rumination were associated with a five- and 
ten-fold increase in clinically meaningful rates of depression and anxiety 
(respectively) together with lower well-being and higher loneliness. The effects 
of COVID-related worry on depression and anxiety levels were most marked and 
clinically meaningful in individuals living with a pre-existing mental health 
condition.
CONCLUSIONS: Psychological interventions should include components that 
specifically target COVID-related worry and rumination. Individuals with 
pre-existing mental health conditions should be prioritised as we emerge from 
the current pandemic and in any future public health crises.

DOI: 10.1080/09638237.2022.2069716
PMID: 35579054 [Indexed for MEDLINE]


2023. Trials. 2022 May 16;23(1):406. doi: 10.1186/s13063-022-06391-w.

Study protocol to test the efficacy of self-administration of dexmedetomidine 
sedative therapy on anxiety, delirium, and ventilator days in critically ill 
mechanically ventilated patients: an open-label randomized clinical trial.

Chlan LL(1), Weinert CR(2), Tracy MF(2), Skaar DJ(2), Gajic O(3), Ask J(3), 
Mandrekar J(3).

Author information:
(1)Mayo Clinic, Rochester, MN, USA. chlan.linda@mayo.edu.
(2)University of Minnesota, Minneapolis, MN, USA.
(3)Mayo Clinic, Rochester, MN, USA.

BACKGROUND: Administration of sedative and opioid medications to patients 
receiving mechanical ventilatory support in the intensive care unit is a common 
clinical practice.
METHODS: A two-site randomized open-label clinical trial will test the efficacy 
of self-management of sedative therapy with dexmedetomidine compared to usual 
care on anxiety, delirium, and duration of ventilatory support after 
randomization. Secondary objectives are to compare self-management of sedative 
therapy to usual care on level of alertness, total aggregate sedative and opioid 
medication exposure, and ventilator-free days up to day 28 after study 
enrolment. Exploratory objectives of the study are to compare self-management of 
sedative therapy to usual care on 3- and 6-month post-discharge physical and 
functional status, psychological well-being (depression, symptoms of 
post-traumatic stress disorder), health-related quality of life, and 
recollections of ICU care. ICU patients (n = 190) who are alert enough to follow 
commands to self-manage sedative therapy are randomly assigned to 
self-management of sedative therapy or usual care. Patients remain in the ICU 
sedative medication study phase for up to 7 days as long as mechanically 
ventilated.
DISCUSSION: The care of critically ill mechanically ventilated patients can 
change significantly over the course of a 5-year clinical trial. Changes in 
sedation and pain interventions, oxygenation approaches, and standards related 
to extubation have substantially impacted consistency in the number of eligible 
patients over time. In addition, the COVID-19 pandemic resulted in mandated 
extended pauses in trial enrolment as well as alterations in recruitment methods 
out of concern for study personnel safety and availability of protective 
equipment. Patient triaging among healthcare institutions due to COVID-19 cases 
also has resulted in inconsistent access to the eligible study population. This 
has made it even more imperative for the study team to be flexible and 
innovative to identify and enrol all eligible participants. Patient-controlled 
sedation is a novel approach to the management of patient symptoms that may be 
able to alleviate mechanical ventilation-induced distress without serious side 
effects. Findings from this study will provide insight into the efficacy of this 
approach on short- and long-term outcomes in a subset of mechanically ventilated 
patients.
TRIAL REGISTRATION: ClinicalTrials.gov NCT02819141. Registered on June 29, 2016.

© 2022. The Author(s).

DOI: 10.1186/s13063-022-06391-w
PMCID: PMC9108372
PMID: 35578315 [Indexed for MEDLINE]

Conflict of interest statement: The Mayo Clinic Institutional Review Board 
(IRB-C) approved the study (IRB# 16-000417) with all requirements met for 
research approval (21CFR56.111 and 45CFR46.111). Mayo Clinic is the coordinating 
centre for this two-centre research study and is responsible for the study’s 
conduct, administration, and coordinating activities. The University of 
Minnesota’s principal investigator (CRW) communicates with the University of 
Minnesota IRB #1605M88241. IRBs from both sites approved all protocol documents 
and consent forms. Dissemination of protocol information and modifications are 
communicated through the electronic Mayo Clinic IRB (IRBe) tracking system and 
transmitted to prospective teams. At the University of Minnesota site, 
information and modifications are communicated electronically through the ETHOS 
system. Under the guidance of the Midwest Area Research Consortium for Health 
(MARCH) Data and Safety Monitoring Board (DSMB), a data safety monitoring plan 
is established with oversight on patient safety considerations, study data 
integrity, and efficacy of the clinical trial. Along with patient safety 
recommendations from the DSMB, there is routine medical monitoring by critical 
care physicians independent from research investigators. Patients are closely 
supervised throughout protocol completion. In addition, a blinded adverse event 
attribution adjudication committee was constituted comprising physicians 
independent from the study team. The adjudication committee reviews all adverse 
events (AEs) and serious adverse events (SAEs) to determine the relation of the 
event to the study protocol. A written report is completed and returned to the 
study team PI. All research personnel have undergone human subjects training 
before addition to the IRB protocol, including periodic re-certification for 
faculty and staff involved in human subjects’ research. Conflict of interest is 
assessed before IRB approval. The trained research staff obtain informed consent 
from either the patient or his/her legally authorized representative (LAR). 
Subjects are screened and assessed by the trained research staff for motor 
ability and hand-grip strength via a pen click test simulating the 
patient-controlled sedation button device, alertness, and presence/absence of 
delirium. Pre-screening assessments are reviewed with the attending consultant 
physician and the designated study physician to meet patient safety measures. 
Knowing delirium can be a transient syndrome, patients who are CAM-ICU-positive 
(delirium present), who are alert, following commands, and are willing and able 
to participate are considered for LAR proxy enrolment. Patients provide an 
affirmative head nod “yes” as verbal assent when obtaining LAR consent. All 
subjects for this study are provided with a consent form describing the research 
and providing sufficient information for subjects’ and his/her LAR to make an 
informed decision about their participation in the study. The study staff 
provide ample opportunity for questions. Subjects are reminded that 
participation is entirely voluntary; they are free to change their mind at any 
time without penalty of access to care or benefits. The consenting process and 
signatures by the research staff, subject, and/or his/her LAR are completed 
before study activities begin. Confidentiality is managed according to the 
requirements of the US Health Insurance Portability and Accountability Act of 
1996 (HIPAA). All consent and HIPAA documents containing personally identifiable 
data are secured in a locked file cabinet with access only to the study staff 
with IRB approval, Data and Safety Monitoring Board, study monitors, the FDA, 
and the NIH. These entities have access to these signed documents and data files 
if requested during monitoring visits or audit inspections. The authors declare 
that they have no competing interests.


2024. Evid Based Ment Health. 2022 Dec;25(e1):e34-e40. doi: 
10.1136/ebmental-2021-300416. Epub 2022 May 16.

Guided digital health intervention for depression in Lebanon: randomised trial.

Cuijpers P(1)(2), Heim E(3)(4), Ramia JA(5)(6), Burchert S(7), Carswell K(8), 
Cornelisz I(9), Knaevelsrud C(7), Noun P(4), van Klaveren C(9), Van't Hof E(10), 
Zoghbi E(8), van Ommeren M(8), El Chammay R(6)(11).

Author information:
(1)Department of Clinical, Neuro and Developmental Psychology, Vrije 
Universiteit Amsterdam, Amsterdam, The Netherlands p.cuijpers@vu.nl.
(2)Babeș-Bolyai University, International Institute for Psychotherapy, 
Cluj-Napoca, Romania.
(3)Institute of Psychology, University of Lausanne, Lausanne, Switzerland.
(4)Department of Psychology, University of Zurich, Zurich, Switzerland.
(5)Department of Clinical, Neuro and Developmental Psychology, Vrije 
Universiteit Amsterdam, Amsterdam, The Netherlands.
(6)National Mental Health Programme, Ministry of Public Health of Lebanon, 
Beirut, Lebanon.
(7)Department of Education and Psychology, Freie Universität Berlin, Berlin, 
Germany.
(8)World Health Organization, Geneva, Switzerland.
(9)Department of Educational, Vrije Universiteit Amsterdam, Amsterdam, The 
Netherlands.
(10)Department of Mental Health and Substance Use, World Health Organization, 
Geneva, Switzerland.
(11)Psychiatry Department, Saint Joseph University, Beirut, Lebanon.

BACKGROUND: Most people with mental disorders in communities exposed to 
adversity in low-income and middle-income countries (LMICs) do not receive 
effective care. Digital mental health interventions are scalable when digital 
access is adequate, and can be safely delivered during the COVID-19 pandemic.
OBJECTIVE: To examine the effects of a new WHO-guided digital mental health 
intervention, Step-by-Step, supported by a non-specialist helper in Lebanon, in 
the context of concurring economic, humanitarian and political crises, a large 
industrial disaster and the COVID-19 pandemic.
METHODS: We conducted a single-blind, two-arm pragmatic randomised trial, 
comparing guided Step-by-Step with enhanced care as usual (ECAU) among people 
suffering from depression and impaired functioning. Primary outcomes were 
depression (Patient Health Questionnaire 9 (PHQ-9)) and impaired functioning 
(WHO Disability Assessment Schedule-12 (WHODAS)) at post-treatment.
FINDINGS: 680 people with depression (PHQ-9>10) and impaired functioning 
(WHODAS>16) were randomised to Step-by-Step or ECAU. Intention-to-treat analyses 
showed effects on depression (standardised mean differences, SMD: 0.71; 95% CI: 
0.45 to 0.97), impaired functioning (SMD: 0.43; 95% CI: 0.21 to 0.65), 
post-traumatic stress (SMD: 0.53; 95% CI: 0.27 to 0.79), anxiety (SMD: 0.74; 95% 
CI: 0.49 to 0.99), subjective well-being (SMD: 0.37; 95% CI: 0.12 to 0.62) and 
self-identified personal problems (SMD: 0.56; 95% CI 0.29 to 0.83). Significant 
effects on all outcomes were retained at 3-month follow-up.
CONCLUSIONS: Guided digital mental health interventions can be effective in the 
treatment of depression in communities exposed to adversities in LMICs, although 
some uncertainty remains because of high attrition.
CLINICAL IMPLICATIONS: Guided digital mental health interventions should be 
considered for implementation in LMICs.
TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT03720769.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/ebmental-2021-300416
PMCID: PMC9811068
PMID: 35577536 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2025. J Affect Disord. 2022 Aug 1;310:472-476. doi: 10.1016/j.jad.2022.05.056. Epub 
2022 May 13.

Affective experiences during COVID-19 pandemic lockdown and posttraumatic 
growth: A 1-year longitudinal study in France.

Goutaudier N(1), Martinelli N(2), Chevalère J(2), Dezecache G(2), Belletier 
C(2), Huguet P(2), Droit-Volet S(2), Gil S(3).

Author information:
(1)Université de Poitiers; CNRS (CeRCA UMR7295), France. Electronic address: 
nelly.goutaudier@univ-poitiers.fr.
(2)Université Clermont Auvergne; CNRS, LAPSCO, F-63000 Clermont-Ferrand, France.
(3)Université de Poitiers; CNRS (CeRCA UMR7295), France.

BACKGROUND: The COVID-19 crisis has resulted in major restrictions on daily life 
that are undeniably detrimental to individual wellbeing. Nevertheless, there may 
be positive psychological changes over the longer term, particularly in the form 
of posttraumatic growth (PTG).
METHODS: A total of 1075 individuals representative of the French population 
took part in an online survey during the first lockdown (T1: March to May 2020) 
and 1 year later (T2). Their affective experiences at T1 were analyzed, together 
with the development of PTG at T2.
RESULTS: Three affective profiles were identified at T1: one associated with 
feelings of loneliness and depressive symptoms (Loneliness cluster), one with 
positive feelings (Happiness cluster), and one with rather negative feelings of 
anger and fear, but also a feeling of happiness (Negative-moderate cluster). PTG 
was generally low at T2, with the Negative-moderate cluster achieving the 
highest score.
LIMITATIONS: This study was based on an online survey, and an exploratory 
cluster analysis was conducted. Complementary studies should be conducted to 
determine the predictive value of our findings.
CONCLUSIONS: Within the space of 1 year following the first lockdown due to 
COVID-19, people living in France, especially those who had experienced a 
mixture of feelings during lockdown, appeared to develop some form of PTG. 
Nevertheless, PTG was rather weak overall.

Copyright © 2022 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2022.05.056
PMCID: PMC9101774
PMID: 35577154 [Indexed for MEDLINE]


2026. Compr Psychiatry. 2022 Jul;116:152321. doi: 10.1016/j.comppsych.2022.152321. 
Epub 2022 Apr 30.

Psychological distress among healthcare workers accessing occupational health 
services during the COVID-19 pandemic in Zimbabwe.

Chingono RMS(1), Nzvere FP(2), Marambire ET(3), Makwembere M(4), Mhembere N(4), 
Herbert T(4), Maunganidze AJV(5), Pasi C(6), Chiwanga M(7), Chonzi P(8), Ndhlovu 
CE(9), Mujuru H(10), Rusakaniko S(11), Olaru ID(12), Ferrand RA(12), Simms 
V(13), Kranzer K(14).

Author information:
(1)Biomedical Research and Training Institute, Harare, Zimbabwe; Institute of 
Global Health, University College London, London, UK.
(2)Biomedical Research and Training Institute, Harare, Zimbabwe; Centre for 
Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK.
(3)Biomedical Research and Training Institute, Harare, Zimbabwe.
(4)Counselling Services Unit, Harare, Zimbabwe.
(5)Parirenyatwa Hospital, Harare, Zimbabwe.
(6)Sally Mugabe Central Hospital, Harare, Zimbabwe.
(7)Chitungwiza Hospital, Chitungwiza, Zimbabwe.
(8)Harare City Health, Harare, Zimbabwe.
(9)Internal Medicine Unit, University of Zimbabwe College of Health Sciences, 
Harare, Zimbabwe.
(10)Department of Paediatrics and Child Health, University of Zimbabwe College 
of Health Sciences, Harare, Zimbabwe.
(11)Department of Community Medicine, College of Health Sciences, University of 
Zimbabwe, Harare, Zimbabwe.
(12)Biomedical Research and Training Institute, Harare, Zimbabwe; Clinical 
Research Department, London School of Hygiene & Tropical Medicine, London, UK.
(13)Biomedical Research and Training Institute, Harare, Zimbabwe; International 
Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, 
London, UK. Electronic address: Victoria.simms@lshtm.ac.uk.
(14)Biomedical Research and Training Institute, Harare, Zimbabwe; Clinical 
Research Department, London School of Hygiene & Tropical Medicine, London, UK; 
Division of Infectious Diseases and Tropical Medicine, Medical Center of the 
University of Munich, Munich, Germany.

BACKGROUND: Healthcare workers (HCWs) have experienced anxiety and psychological 
distress during the COVID-19 pandemic. We established and report findings from 
an occupational health programme for HCWs in Zimbabwe that offered screening for 
SARS-CoV-2 with integrated screening for comorbidities including common mental 
disorder (CMD) and referral for counselling.
METHODS: Quantitative outcomes were fearfulness about COVID-19, the Shona 
Symptom Questionnaire (SSQ-14) score (cutpoint 8/14) and the number and 
proportion of HCWs offered referral for counselling, accepting referral and 
counselled. We used chi square tests to identify factors associated with 
fearfulness, and logistic regression was used to model the association of 
fearfulness with wave, adjusting for variables identified using a DAG. 
Qualitative data included 18 in-depth interviews, two workshops conducted with 
HCWs and written feedback from counsellors, analysed concurrently with data 
collection using thematic analysis.
RESULTS: Between 27 July 2020-31 July 2021, spanning three SARS-CoV-2 waves, the 
occupational health programme was accessed by 3577 HCWs from 22 facilities. The 
median age was 37 (IQR 30-43) years, 81.9% were women, 41.7% said they felt 
fearful about COVID-19 and 12.1% had an SSQ-14 score ≥ 8. A total of 501 HCWs 
were offered referral for counselling, 78.4% accepted and 68.9% had ≥1 
counselling session. Adjusting for setting and role, wave 2 was associated with 
increased fearfulness over wave 1 (OR = 1.26, 95% CI 1.00-1.60). Qualitative 
data showed high levels of anxiety, psychosomatic symptoms and burnout related 
to the pandemic. Mental wellbeing was affected by financial insecurity, unmet 
physical health needs and inability to provide quality care within a fragile 
health system.
CONCLUSIONS: HCWs in Zimbabwe experience a high burden of mental health 
symptoms, intensified by the COVID-19 pandemic. Sustainable mental health 
interventions must be multisectoral addressing mental, physical and financial 
wellbeing.

Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.comppsych.2022.152321
PMCID: PMC9055394
PMID: 35576673 [Indexed for MEDLINE]

Conflict of interest statement: No conflict of interest.


2027. Compr Psychiatry. 2022 Jul;116:152324. doi: 10.1016/j.comppsych.2022.152324. 
Epub 2022 May 10.

Lifestyle behaviours and mental health and wellbeing of tertiary students during 
COVID-19 lockdown in Australia: A cross-sectional study.

Dash S(1), Bourke M(2), Parker AG(3), Dadswell K(2), Pascoe MC(4).

Author information:
(1)Institute for Health and Sport (IHES), Victoria University, Melbourne, VIC 
8001, Australia; Food and Mood Centre, IMPACT SRC, Deakin University, Geelong, 
VIC 3127, Australia.
(2)Institute for Health and Sport (IHES), Victoria University, Melbourne, VIC 
8001, Australia.
(3)Institute for Health and Sport (IHES), Victoria University, Melbourne, VIC 
8001, Australia; Centre for Youth Mental Health, University of Melbourne, 
Parkville, VIC 3010, Australia.
(4)Institute for Health and Sport (IHES), Victoria University, Melbourne, VIC 
8001, Australia; Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia. 
Electronic address: michaela.pascoe@vu.edu.au.

BACKGROUND: Australia experienced significant COVID-19 lockdown restrictions 
throughout 2020 that had an impact on mental health and disrupted 
health-promoting lifestyle behaviours. Lockdowns may have exacerbated existing 
mental health concerns among tertiary students, who experience higher levels of 
mental health concerns compared to the wider community. This study aimed to 
investigate the association between modifiable lifestyle factors and wellbeing 
of students at a Melbourne-based tertiary education institution during COVID-19 
lockdown.
METHODS: This quantitative, cross-sectional study was conducted across campuses 
in Melbourne and Sydney. Data was collected via online questionnaire during the 
7th week of a second-wave lockdown. Descriptive statistics were calculated for 
demographic variables (n = 239). Linear regression models were estimated to 
determine multivariate associations between lifestyle variables and 
psychological distress.
RESULTS: Participants were on average 30.98 years old (SD = 9.78), predominantly 
female, domestic students, undergraduate, not the first member of their family 
to attend university and living out of family home. Mindfulness, diet quality, 
sleep quality and moderate-vigorous physical activity (MVPA) were all inversely 
correlated with psychological distress. Unadjusted and adjusted models show that 
mindfulness, sleep quality, and MVPA were all independently inversely related to 
psychological distress. Greater mindfulness, sleep quality and engagement in 
MVPA were associated with lower psychological distress during COVID-19 
lockdowns.
LIMITATIONS: As this study is cross-sectional and we cannot rule out reverse 
causality.
CONCLUSION: This study highlights the potential for lifestyle focused 
mental-health promotion delivered through tertiary education institutions to 
support students in times of crisis as well as more generally.

Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.comppsych.2022.152324
PMCID: PMC9085438
PMID: 35576672 [Indexed for MEDLINE]

Conflict of interest statement: All authors declare that they have no conflicts 
of interest.


2028. Int J Nurs Stud. 2022 Jul;131:104272. doi: 10.1016/j.ijnurstu.2022.104272. Epub 
2022 Apr 27.

Impact of the COVID-19 pandemic on the mental health of hospital staff: An 
umbrella review of 44 meta-analyses.

Dragioti E(1), Tsartsalis D(2), Mentis M(3), Mantzoukas S(4), Gouva M(5).

Author information:
(1)Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring 
Sciences, Linköping University, Linköping, Sweden; Research Laboratory 
Psychology of Patients, Families & Health Professionals, Department of Nursing, 
School of Health Sciences, University of Ioannina, Ioannina, 45500, Greece. 
Electronic address: elena.dragioti@liu.se.
(2)Department of Emergency Medicine, 'Hippokration' Hospital, Athens, Greece. 
Electronic address: dtsartsalis@hippocratio.gr.
(3)Department of Education and Social Work, University of Patras, Greece. 
Electronic address: ementis@upatras.gr.
(4)Research Laboratory Integrated Care, Health & Well-being, Department of 
Nursing, School of Health Sciences, University of Ioannina, Ioannina, 45500, 
Greece. Electronic address: smantzoukas@uoi.gr.
(5)Research Laboratory Psychology of Patients, Families & Health Professionals, 
Department of Nursing, School of Health Sciences, University of Ioannina, 
Ioannina, 45500, Greece. Electronic address: gouva@uoi.gr.

BACKGROUND: Hospital staff is at high risk of developing mental health issues 
during the coronavirus (COVID-19) pandemic. However, the literature lacks an 
overall and inclusive picture of mental health problems with comprehensive 
analysis among hospital staff during the COVID-19 pandemic.
OBJECTIVES: To ascertain the prevalence of anxiety, depression and other mental 
health outcomes as reported in original articles among hospital staff during the 
COVID-19 pandemic.
DESIGN: A PRISMA 2020 and MOOSE 2000 compliant umbrella review of published 
meta-analyses of observational studies evaluating the prevalence of mental 
health problems in hospital staff during the pandemic.
REVIEW METHODS: Systematic searches were conducted in PubMed/Medline, CINAHL, 
EMBASE, and PsycINFO from December 1st, 2019, until August 13th 2021. The random 
effects model was used for the meta-analysis, and the I2 index was employed to 
assess between-study heterogeneity. Publication bias using Egger test and LFK 
index was examined. Data was analyzed using STATA 17.0 software. AMSTAR-2 was 
applied for the quality assessment of systematic reviews, while we used GRADE to 
rate the quality of evidence.
RESULTS: Forty-four meta-analyses from 1298 individual studies were included in 
the final analysis, encompassing the prevalence of 16 mental health symptoms. 
One-third of hospital workers reported anxiety (Prevalence: 29.9%, 95% CI:27.1% 
to 32.7%) and depression (Prevalence: 28.4%, 95% CI:25.5% to 31.3%) 
symptomatology, while about 40% (95% CI: 36.9% to 42.0%) suffered from sleeping 
disorders. Fear-related symptoms, reduced well-being, poor quality of life, and 
acute stress symptoms had the highest prevalence among hospital staff. However, 
the quality of evidence in these areas varied from low to very low. Nurses 
suffered more often from sleep problems and symptoms of anxiety and depression 
than doctors, whereas doctors reported a higher prevalence of acute stress and 
post-traumatic disorders. The burden of anxiety, depression, and sleep disorders 
was higher among female employees than their male counterparts. Remarkably, 
acute stress and insomnia affected more than half of first-line medical staff.
CONCLUSIONS: The prevalence of mental health problems among hospital staff 
during the COVID-19 pandemic is generally high, with anxiety, depression and 
insomnia symptoms representing the most robust evidence based on a large dataset 
of prevalence meta-analyses. However, there is no strong confidence in the body 
of evidence for each outcome assessed.
REGISTRATION: Not registered.
TWEETABLE ABSTRACT: The COVID-19 pandemic is having a major impact on the mental 
health of hospital staff. The need for support must be different for nurses and 
doctors @eldi12345.

Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.ijnurstu.2022.104272
PMCID: PMC9045868
PMID: 35576637 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


2029. J Appl Gerontol. 2022 Aug;41(8):1843-1850. doi: 10.1177/07334648221092029. Epub 
2022 May 16.

COVID-19 Vaccinations and Anxiety in Middle-Aged and Older Jews and Arabs in 
Israel: The Moderating Roles of Ethnicity and Subjective Age.

Bergman YS(1), Palgi Y(2), Ben-David B(3)(4)(5), Bodner E(6)(7).

Author information:
(1)Faculty of Social Work, Ashkelon Academic College, Ashkelon, Israel.
(2)Department of Gerontology, University of Haifa, Haifa, Israel.
(3)Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC) Herzliya, 
Herzliya, Israel.
(4)Toronto Rehabilitation Institute, University Health Networks (UHN), Toronto, 
ON, Canada.
(5)Department of Speech-Language Pathology, University of Toronto, Toronto, ON, 
Canada.
(6)Interdisciplinary Department of Social Sciences, Bar-Ilan University, 
Ramat-Gan, Israel.
(7)Department of Music, Bar-Ilan University, Ramat-Gan, Israel.

Subjective age (i.e., feeling younger/older than one's chronological age) plays 
a significant role in older minority group members' psychological well-being. In 
light of the importance of vaccinations for fighting COVID-19, it is unclear 
whether ethnicity and subjective age moderate the connection between receiving 
COVID-19 vaccinations and anxiety in Israel. Jewish (n = 198) and Arab older 
adults (n = 84) provided information regarding COVID-19 vaccinations, subjective 
age, and anxiety symptoms, as well as additional socio-demographic and 
COVID-19-related health factors (age range= 40-100, M = 62.5, SD = 12.34). 
Results demonstrated that feeling older was associated with increased anxiety (p 
< .001) and that vaccinations were linked to increased anxiety among Jews (p < 
.05). Moreover, the association between COVID-19 vaccinations and anxiety was 
significant only among Jewish participants with an older subjective age (p < 
.05). We stress the importance of examining cultural diversities regarding the 
contribution of subjective age in the context of COVID-19 and psychological 
well-being.

DOI: 10.1177/07334648221092029
PMCID: PMC9111937
PMID: 35575162 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


2030. Front Public Health. 2022 Apr 29;10:791656. doi: 10.3389/fpubh.2022.791656. 
eCollection 2022.

The Role of Urban Environment Design on Health During the COVID-19 Pandemic: A 
Scoping Review.

Faedda S(1), Plaisant A(1), Talu V(1), Tola G(1).

Author information:
(1)Department of Architecture, Design and Planning (DADU), University of 
Sassari, Sassari, Italy.

The COVID-19 pandemic has had a significant impact on the ways and times of 
living and using urban spaces, specifically referring to the dimension of daily 
life. The restrictive measures introduced during the lockdown periods have 
necessarily led to a re-evaluation of proximity scale bringing particularly 
attention to issues relating to public transport and mobility and to the quality 
and distribution of open public spaces. This scoping review explores the 
relationship between the urban environment design and health referring to the 
constraints imposed by the COVID-19 pandemic in the period from 2020 to 2021, 
with two main objectives: (i) to investigate the recurring urban design topics 
and issues related to the spatial and social needs stressed by the emergency; 
(ii) to identify the urban design measures both experienced during the health 
emergency and proposed in view of a post-COVID urban and territorial planning as 
they are considered impactful on health promotion. The search strategy was based 
on a set of keywords searched in two electronic databases which allowed the 
identification of a total of 1,135 contributions. After defining the eligibility 
criteria, we proceeded to the screening process concluded with the inclusion of 
19 studies. The analysis of the contributions led to the systematization of six 
main urban topics-and to the corresponding spatial requirements and project 
proposals-highlighted as relevant and supportive in terms of the promotion of 
inhabitant's public health: (i) transport, mobility and accessibility; (ii) 
green and outdoor spaces; (iii) public and pedestrians' spaces; (iv) care 
services and health network; (v) communications; (vi) public and business 
services. The resulting framework is useful for guiding healthy city planning 
toward public policies, tools, regulations, urban measures, and emergency 
contrast provisions, that contribute to increasing the effectiveness in terms of 
safety and well-being.

Copyright © 2022 Faedda, Plaisant, Talu and Tola.

DOI: 10.3389/fpubh.2022.791656
PMCID: PMC9099229
PMID: 35570975 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2031. Psychol Psychother. 2022 Sep;95(3):820-837. doi: 10.1111/papt.12400. Epub 2022 
May 16.

Using routine outcome measures as clinical process tools: Maximising the 
therapeutic yield in the IAPT programme when working remotely.

Faija CL(1), Bee P(1), Lovell K(1)(2), Lidbetter N(3)(4), Gellatly J(1), Ardern 
K(5), Rushton K(1), Brooks H(1), McMillan D(6), Armitage CJ(7)(8)(9), Woodhouse 
R(6), Barkham M(5).

Author information:
(1)School of Health Sciences, Division of Nursing, Midwifery and Social Work, 
Manchester Academic Health Science Centre, University of Manchester, Manchester, 
UK.
(2)Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
(3)Anxiety UK, Manchester, UK.
(4)The Big Life Group, UK, Manchester, UK.
(5)Clinical and Applied Psychology Unit, Department of Psychology, University of 
Sheffield, Sheffield, UK.
(6)Hull York Medical School and Department of Health Sciences, University of 
York, York, UK.
(7)Manchester University NHS Foundation Trust, Manchester Academic Health 
Science, Manchester, UK.
(8)Centre NIHR Greater Manchester Patient Safety Translational Research Centre, 
Manchester, UK.
(9)Manchester Centre for Health Psychology, University of Manchester, 
Manchester, UK.

OBJECTIVES: The objective of the study was to investigate the administration and 
use of routine outcome monitoring session by session in the context of improving 
guided-self-help interventions when delivered remotely at Step 2 care in the 
English Improving Access to Psychological Therapies (IAPT) services.
DESIGN: Qualitative research using recordings of telephone-treatment sessions.
METHOD: Participants (11 patients and 11 practitioners) were recruited from four 
nationally funded IAPT services and one-third sector organisation commissioned 
to deliver Step 2 IAPT services, in England. Data collection took place prior to 
the COVID-19 pandemic. Transcripts of telephone-treatment sessions were analysed 
using thematic analysis.
RESULTS: Four themes were identified: (1) lack of consistency in the 
administration of outcome measures (e.g. inconsistent wording); (2) outcome 
measures administered as a stand-alone inflexible task (e.g. mechanical 
administration); (3) outcome measures as impersonal numbers (e.g. summarising, 
categorising and comparing total scores); and (4) missed opportunities to use 
outcome measures therapeutically (e.g. lack of therapeutic use of item and total 
scores).
CONCLUSIONS: The administration of outcome measures needs to ensure validity and 
reliability. Therapeutic yield from session-by-session outcome measures could be 
enhanced by focusing on three main areas: (1) adopting a collaborative 
conversational approach, (2) maximising the use of total and items scores and 
(3) integrating outcome measures with in-session treatment decisions. Shifting 
the perception of outcome measures as impersonal numbers to being process 
clinical tools ensures a personalised delivery of psychological interventions 
and has the potential to enhance engagement from practitioners and patients what 
may reduce drop-out rates and improve clinical outcomes.

© 2022 The Authors. Psychology and Psychotherapy: Theory, Research and Practice 
published by John Wiley & Sons Ltd on behalf of The British Psychological 
Society.

DOI: 10.1111/papt.12400
PMCID: PMC9540188
PMID: 35570708 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare they have no competing 
interests.


2032. BMJ Glob Health. 2022 May;7(5):e007866. doi: 10.1136/bmjgh-2021-007866.

Changes in marriage, divorce and births during the COVID-19 pandemic in Japan.

Ghaznavi C(1)(2), Kawashima T(3)(4), Tanoue Y(3)(5), Yoneoka D(3)(6), Makiyama 
K(7), Sakamoto H(8)(9), Ueda P(8)(10), Eguchi A(3)(11), Nomura S(3)(8).

Author information:
(1)Department of Health Policy and Management, Keio University, Tokyo, Japan 
cghaznavi@keio.jp.
(2)Medical Education Program, Washington University School of Medicine in Saint 
Louis, St Louis, Missouri, USA.
(3)Department of Health Policy and Management, Keio University, Tokyo, Japan.
(4)Department of Mathematical and Computing Science, Tokyo Institute of 
Technology, Tokyo, Japan.
(5)Institute for Business and Finance, Waseda University, Tokyo, Japan.
(6)Infectious Disease Surveillance Center, National Institute of Infectious 
Diseases, Tokyo, Japan.
(7)HOXO-M, Tokyo, Japan.
(8)Department of Global Health Policy, The University of Tokyo, Tokyo, Japan.
(9)Department of Hygiene and Public Health, Tokyo Women's Medical University, 
Tokyo, Japan.
(10)Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska 
Institutet, Stockholm, Sweden.
(11)Center for Preventive Medical Sciences, Chiba University, Chiba, Japan.

INTRODUCTION: Marriage, divorce and fertility are declining in Japan. There is 
concern that the COVID-19 pandemic may have accelerated the decrease in 
marriages and births while increasing the number of divorces. Changes in 
partnership behaviours and fertility have significant implications for mental 
health, well-being and population demographics.
METHODS: Japanese vital statistical data were collected for December 2011-May 
2021. We used the Farrington algorithm on the daily numbers of marriages, 
divorces and births (per month) in order to determine whether any given month 
between January 2017 and May 2021 had a significant excess or deficit. Analyses 
were conducted at the national and regional levels.
RESULTS: During the pandemic, significant deficits in the national number of 
marriages were noted in January 2020, April 2020, May 2020, July 2020, September 
2020 and April 2021. Regional marriage patterns reflected national trends. 
Divorces were noted to be in deficit during April 2020, May 2020 and May 2021 at 
the country level. Regional analyses mirrored national divorce trends with the 
exception of Shikoku, which showed no deficits during the pandemic. Significant 
deficits in the number of total births were noted in December 2020, January 2021 
and February 2021. Regionally, birth deficits were concentrated in Chubu, Kansai 
and Kanto. After the start of the pandemic, no significant excesses in 
marriages, divorces or births were noted at the national or regional level.
CONCLUSIONS: Marriages and divorces declined during the pandemic in Japan, 
especially during state of emergency declarations. There were decreased births 
between December 2020 and February 2021, approximately 8-10 months after the 
first state of emergency, suggesting that couples altered their pregnancy 
intention in response to the pandemic. Metropolitan regions were more affected 
by the pandemic than their less metropolitan counterparts.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjgh-2021-007866
PMCID: PMC9108437
PMID: 35569835 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2033. Psychiatr Pol. 2022 Feb 27;56(1):101-114. doi: 10.12740/PP/OnlineFirst/127144. 
Epub 2022 Feb 27.

Depressive disorders among long-term care residents in the face of isolation due 
to COVID-19 pandemic.

[Article in English, Polish]

Górski M(1), Garbicz J(1), Buczkowska M(2), Marsik G(3), Grajek M(4), Całyniuk 
B(5), Polaniak R(5).

Author information:
(1)Śląski Uniwersytet Medyczny w Katowicach, Wydział Nauk o Zdrowiu w Bytomiu, 
Szkoła Doktorska Śląskiego Uniwersytetu Medycznego w Katowicach.
(2)Śląski Uniwersytet Medyczny w Katowicach, Katedra Toksykologii i Uzależnień, 
Wydział Nauk o Zdrowiu w Bytomiu, Zakład Toksykologii i Ochrony Zdrowia w 
Środowisku Pracy.
(3)Śląski Uniwersytet Medyczny w Katowicach, Wydział Nauk o Zdrowiu w 
Katowicach, Szkoła Doktorska Śląskiego Uniwersytetu Medycznego w Katowicach.
(4)Śląski Uniwersytet Medyczny w Katowicach, Wydział Nauk o Zdrowiu w Bytomiu, 
Katedra Polityki Zdrowia Publicznego, Zakład Zdrowia Publicznego.
(5)Śląski Uniwersytet Medyczny w Katowicach, Wydział Nauk o Zdrowiu w Bytomiu, 
Katedra Dietetyki, Zakład Żywienia Człowieka.

OBJECTIVES: The main aim of this study was to assess the effects of social and 
familial isolation due to COVID-19 on the mental well-being of patients staying 
in a residential medical care facility and evaluation of the effectiveness of 
therapeutic measures.
METHODS: The study was conducted among the patients of a residential medical 
care facility (58 patients). A short form of the Geriatric Depression Scale 
(GDS) was used to assess the severity of depressive disorders. The number of 
medical and psychological interventions during the individual months of 
isolation was also compared.
RESULTS: In February 2020, when there was no isolation, 87.9% of the study group 
did not suffer from depression compared to 72.4% during the period of full 
isolation. After introducing controlled methods for contacting loved ones, the 
number of individuals with no depressive symptoms increased again. A mean of 
1.76 medical and 0.23 psychological interventions per one patient were conducted 
during the period of full isolation.
CONCLUSIONS: The number of medical and psychological interventions was higher 
during the period of full isolation compared to months without compulsory 
isolation due to COVID-19. After the introduction of full isolation, the scores 
in the GDS were significantly higher, which means that the residents were at a 
higher risk of depressive disorders than in the months without isolation.

DOI: 10.12740/PP/OnlineFirst/127144
PMID: 35569151 [Indexed for MEDLINE]


2034. J Affect Disord. 2022 Aug 1;310:377-383. doi: 10.1016/j.jad.2022.05.035. Epub 
2022 May 11.

Frailty is associated with poor mental health 1 year after hospitalisation with 
COVID-19.

Braude P(1), McCarthy K(2), Strawbridge R(3), Short R(4), Verduri A(5), 
Vilches-Moraga A(6), Hewitt J(7), Carter B(8).

Author information:
(1)CLARITY (Collaborative Ageing Research) Group, NHS, Bristol, UK. Electronic 
address: philip.braude@nbt.nhs.uk.
(2)CLARITY (Collaborative Ageing Research) Group, NHS, Bristol, UK.
(3)Department of Psychological Medicine, Institute of Psychiatry, Psychology and 
Neuroscience, PO74, King's College London, De Crespigny Park, London SE5 8AZ, 
UK; National Institute for Health Research Maudsley Biomedical Research Centre, 
South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK.
(4)CLARITY (Collaborative Ageing Research) Group, NHS, Bristol, UK; Department 
of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology 
& Neuroscience, King's College London, London, UK.
(5)University of Modena and Reggio Emilia - Hospital Policlinico Modena, Italy.
(6)Salford Royal NHS Trust, Salford, UK.
(7)Cardiff University, Cardiff, Wales, UK.
(8)CLARITY (Collaborative Ageing Research) Group, NHS, Bristol, UK; Department 
of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and 
Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK.

BACKGROUND: Frailty is associated with long-term physical deterioration after 
COVID-19. Mental health recovery has been less well investigated. Early studies 
have shown minimal effect from the virus, although studies have not focused on 
whether people living with frailty may have different psychiatric outcomes. We 
aimed to examine the effect of living with frailty on mental health outcomes one 
year after hospital with COVID-19.
METHODS: We undertook a multicentre cross-sectional study of people admitted 
with COVID-19. We assessed quality of life (ICECAP-O and MRC), psychiatric 
symptoms including: generalised anxiety (GAD-7), depression (Patient Health 
Questionnaire-9), and trauma (Trauma Screening Questionnaire). Frailty was 
measured using the Clinical Frailty Scale (CFS). We used a multivariable 
mixed-effects logistic and linear regression to examine the adjusted odds ratio 
(aOR) and adjusted mean difference (aMD).
RESULTS: From eight hospitals 224 participants consented. Median follow-up time 
from admission 358 days (IQR 153-418), mean age 63.8 (SD = 13.7), 34.8% female 
(n = 78), and 43.7% living with frailty (n = 98 CFS 4-8). People living with 
frailty were significantly more likely to have symptoms of anxiety aOR = 5.72 
(95% CI 1.71-19.13), depression aOR = 2.52 (95% CI 1.59-14.91), post-traumatic 
stress disorder aMD = 1.16 (95% CI 0.47, 1.85), and worse quality of life 
aMD = 1.06 (95% CI 0.76-1.36).
LIMITATIONS: Patient-rated symptoms were captured rather than formal mental 
health diagnoses. CFS has not been validated in under 65-year-olds.
CONCLUSIONS: Living with frailty is associated with significant psychiatric 
morbidity and reduced wellbeing one year after COVID-19 hospital admission. We 
recommend clinical follow-up after COVID-19 for people living with frailty 
should include a psychiatric assessment.

Copyright © 2022. Published by Elsevier B.V.

DOI: 10.1016/j.jad.2022.05.035
PMCID: PMC9091159
PMID: 35568322 [Indexed for MEDLINE]


2035. Chest. 2022 Aug;162(2):331-345. doi: 10.1016/j.chest.2022.05.003. Epub 2022 May 
11.

The Influence of the COVID-19 Pandemic on Intensivists' Well-Being: A 
Qualitative Study.

Vranas KC(1), Golden SE(2), Nugent S(3), Valley TS(4), Schutz A(5), Duggal A(6), 
Seitz KP(7), Chang SY(8), Slatore CG(9), Sullivan DR(10), Hough CL(11), Mathews 
KS(12).

Author information:
(1)Center to Improve Veteran Involvement in Care, VA Portland Health Care 
System, Oregon Health and Science University, Portland, OR; Division of 
Pulmonary and Critical Care, Oregon Health and Science University, Portland, OR; 
Palliative and Advanced Illness Research (PAIR) Center, Department of Medicine, 
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. 
Electronic address: vranas@ohsu.edu.
(2)Center to Improve Veteran Involvement in Care, VA Portland Health Care 
System, Oregon Health and Science University, Portland, OR.
(3)Center to Improve Veteran Involvement in Care, VA Portland Health Care 
System, Oregon Health and Science University, Portland, OR; Department of 
Psychiatry, Oregon Health and Science University, Portland, OR.
(4)Division of Pulmonary and Critical Care Medicine, Department of Internal 
Medicine, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy 
and Innovation, University of Michigan, Ann Arbor, MI; Center for Bioethics and 
Social Sciences in Medicine, University of Michigan, Ann Arbor, MI.
(5)Division of Pulmonary and Critical Care Medicine, Department of Internal 
Medicine, University of Michigan, Ann Arbor, MI.
(6)Department of Critical Care, Respiratory Institute, Cleveland Clinic, 
Cleveland, OH; Cleveland Clinic Lerner College of Medicine of Case Western 
Reserve University, Cleveland, OH.
(7)Division of Pulmonary, Allergy, and Critical Care Medicine, Vanderbilt 
University, Nashville, TN.
(8)Division of Pulmonary and Critical Care Medicine, Department of Medicine, 
David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, Los 
Angeles, CA.
(9)Center to Improve Veteran Involvement in Care, VA Portland Health Care 
System, Oregon Health and Science University, Portland, OR; Division of 
Pulmonary and Critical Care, Oregon Health and Science University, Portland, OR.
(10)Center to Improve Veteran Involvement in Care, VA Portland Health Care 
System, Oregon Health and Science University, Portland, OR; Division of 
Pulmonary and Critical Care, Oregon Health and Science University, Portland, OR; 
Knight Cancer Institute, Oregon Health and Science University, Portland, OR.
(11)Division of Pulmonary and Critical Care, Oregon Health and Science 
University, Portland, OR.
(12)Division of Pulmonary, Critical Care, & Sleep Medicine, Department of 
Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Department of 
Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.

Comment in
    Chest. 2022 Aug;162(2):285-287.

BACKGROUND: The COVID-19 pandemic has strained health care systems and has 
resulted in widespread critical care staffing shortages, negatively impacting 
the quality of care delivered.
RESEARCH QUESTION: How have hospitals' emergency responses to the pandemic 
influenced the well-being of frontline intensivists, and do any potential 
strategies exist to improve their well-being and to help preserve the critical 
care workforce?
STUDY DESIGN AND METHODS: We conducted semistructured interviews of intensivists 
at clusters of tertiary and community hospitals located in six regions across 
the United States between August and November 2020 using the "four S" framework 
of acute surge planning (ie, space, staff, stuff, and system) to organize the 
interview guide. We then used inductive thematic analysis to identify themes 
describing the influence of hospitals' emergency responses on intensivists' 
well-being.
RESULTS: Thirty-three intensivists from seven tertiary and six community 
hospitals participated. Intensivists reported experiencing substantial moral 
distress, particularly because of restricted visitor policies and their 
perceived negative impacts on patients, families, and staff. Intensivists also 
frequently reported burnout symptoms as a result of their experiences with 
patient death, exhaustion over the pandemic's duration, and perceived lack of 
support from colleagues and hospitals. We identified several potentially 
modifiable factors perceived to improve morale, including the proactive 
provision of mental health resources, establishment of formal backup schedules 
for physicians, and clear actions demonstrating that clinicians are valued by 
their institutions.
INTERPRETATION: Restrictive visitation policies contributed to moral distress as 
reported by intensivists, highlighting the need to reconsider the risks and 
benefits of these policies. We also identified several interventions as 
perceived by intensivists that may help to mitigate moral distress and to 
improve burnout as part of efforts to preserve the critical care workforce.

Copyright © 2022 American College of Chest Physicians. Published by Elsevier 
Inc. All rights reserved.

DOI: 10.1016/j.chest.2022.05.003
PMCID: PMC9093195
PMID: 35568205 [Indexed for MEDLINE]


2036. Nutrients. 2022 Apr 20;14(9):1702. doi: 10.3390/nu14091702.

The Concept of Intrauterine Programming and the Development of the Neonatal 
Microbiome in the Prevention of SARS-CoV-2 Infection.

Grot M(1)(2)(3), Krupa-Kotara K(1), Wypych-Ślusarska A(1), Grajek M(2), 
Białek-Dratwa A(3).

Author information:
(1)Department of Epidemiology, Faculty of Health Sciences in Bytom, Medical 
University of Silesia in Katowice, 41-902 Bytom, Poland.
(2)Department of Public Health, Department of Public Health Policy, Faculty of 
Health Sciences in Bytom, Medical University of Silesia in Katowice, 41-902 
Bytom, Poland.
(3)Department of Human Nutrition, Department of Dietetics, Faculty of Health 
Sciences in Bytom, Medical University of Silesia in Katowice, 41-808 Zabrze, 
Poland.

The process of intrauterine programming is related to the quality of the 
microbiome formed in the fetus and the newborn. The implementation of 
probiotics, prebiotics, and psychobiotics shows immunomodulatory potential 
towards the organism, especially the microbiome of the pregnant woman and her 
child. Nutrigenomics, based on the observation of pregnant women and the 
developing fetus, makes it possible to estimate the biological effects of active 
dietary components on gene expression or silencing. Nutritional intervention for 
pregnant women should consider the nutritional status of the patient, biological 
markers, and the potential impact of dietary intervention on fetal physiology. 
The use of a holistic model of nutrition allows for appropriately targeted and 
effective dietary prophylaxis that can impact the physical and mental health of 
both the mother and the newborn. This model targets the regulation of the immune 
response of the pregnant woman and the newborn, considering the clinical state 
of the microbiota and the pathomechanism of the nervous system. Current 
scientific reports indicate the protective properties of immunobiotics 
(probiotics) about the reduction of the frequency of infections and the severity 
of the course of COVID-19 disease. The aim of this study was to test the 
hypothesis that intrauterine programming influences the development of the 
microbiome for the prevention of SARS-CoV-2 infection based on a review of 
research studies.

DOI: 10.3390/nu14091702
PMCID: PMC9104449
PMID: 35565670 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


2037. Int J Environ Res Public Health. 2022 May 2;19(9):5532. doi: 
10.3390/ijerph19095532.

Age-Related Differences in Psychological Distress during the COVID-19 Pandemic.

Rega A(1)(2), Nappo R(2), Simeoli R(1)(2), Cerasuolo M(3)(4)(5).

Author information:
(1)Department of Humanistic Studies, University of Naples Federico II, 80138 
Napoli, Italy.
(2)Neapolisanit s.r.l. Rehabilitation Center, 80044 Ottaviano, Italy.
(3)Associazione Italiana Per L'Assistenza Spastici Onlus Sez Di Cicciano, 80033 
Cicciano, Italy.
(4)Faculty of Medicine, University of Ostrava, 70103 Ostrava, Czech Republic.
(5)Department of Psychology, University of Campania L. Vanvitelli, 81100 
Caserta, Italy.

While the negative impact of COVID-19 total lockdown on mental health in youth 
has been extensively studied, findings collected during subsequent waves of the 
pandemic, in which restrictive rules were more eased, are very sparse. Here, we 
explore perceived psychological distress during the partial lockdown of the 
third wave in Southern Italy in a large sample of students, focusing on age and 
gender differences. Also, we assessed whether attending the type of education 
could have a protective role on students' psychological well-being. An online 
survey was completed by 1064 southern Italian students (age range: 8-19 years; 
males = 368) from March to July 2021. The survey consists of a set of questions 
regarding general sociodemographic information as well as several aspects of 
students' psychological well-being. Psychological distress was higher in high 
school students compared to both elementary and middle ones. In addition, we 
found gender differences, but only in high school students, with females 
reporting higher psychological distress than males. Finally, our mediation 
analysis showed a mediated role of face-to-face schooling in the relationship 
between age and psychological distress. In conclusion, this study highlights 
age-related differences in psychological distress during the pandemic and the 
protective role of school in presence for mental health in Italian students.

DOI: 10.3390/ijerph19095532
PMCID: PMC9101009
PMID: 35564927 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2038. Int J Environ Res Public Health. 2022 Apr 29;19(9):5420. doi: 
10.3390/ijerph19095420.

Perceptions of Risk, Work, and Lifestyle Changes on Mental Health of Healthcare 
Workers Amidst the COVID-19 Pandemic.

Ergai A(1), Spiva L(2), Li L(1), Breshears R(3), Zhan G(4).

Author information:
(1)Department of Industrial and Systems Engineering, Southern Polytechnic 
College of Engineering and Engineering Technology, Kennesaw State University, 
Kennesaw, GA 30144, USA.
(2)Nursing Practice and Operations, Wellstar Health System, Atlanta, GA 30339, 
USA.
(3)Wellstar Psychological Services, Marietta, GA 30060, USA.
(4)Department of Psychological Science, Norman J. Radow College of Humanities 
and Social Sciences, Kennesaw, GA 30144, USA.

The COVID-19 outbreak is significantly affecting the mental health of healthcare 
workers worldwide. This study aims to investigate the mental health outcomes of 
healthcare workers in a health system located in southeastern US during the 
first peak of the pandemic and examine the association of specific factors on 
the mental well-being of healthcare workers. A cross-sectional survey of 388 
healthcare workers was conducted. Data were collected using a 79-item 
questionnaire, which included the Patient Health Questionnaire (PHQ-9) 
instrument, the 7-item Generalized Anxiety Disorder (GAD-7) instrument, and the 
22-item Impact of Event Scale-Revised (IES-R), to assess symptoms of depression, 
anxiety, and general distress, respectively. Data were analyzed using 
descriptive, bivariate, and multivariate statistics. Accordingly, 30.1%, 28.7%, 
and 39.4% of respondents reported depression, anxiety, and distress symptoms, 
respectively. Younger workers and females reported higher mental symptomologies. 
We identified significant, nontraditional factors associated with depression and 
anxiety symptoms among healthcare workers: healthcare procedure change, concern 
of exposing family to COVID-19, number of missed shifts, and access to 
psychological resources/services. These findings emphasize the importance of 
providing the proper training to reduce concerns of exposing family members and 
psychological interventions to promote mental health well-being for healthcare 
workers during the stressful COVID-19 pandemic.

DOI: 10.3390/ijerph19095420
PMCID: PMC9106067
PMID: 35564815 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2039. Int J Environ Res Public Health. 2022 Apr 24;19(9):5174. doi: 
10.3390/ijerph19095174.

Predictors of Healthcare Professionals' Work Difficulty Perception during the 
COVID-19 Pandemic: Study of Work Environment in a Pandemic Hospital.

Emhan A(1), Elkefi S(2), Asan O(2).

Author information:
(1)Collage of Business Administration, University of Central Florida, Orlando, 
FL 32816, USA.
(2)Stevens Institute of Technology, School of Systems and Enterprises, Hoboken, 
NJ 07030, USA.

COVID-19 has dramatically changed the work environment in healthcare, which is 
creating an additional burden for healthcare professionals. In this study, we 
investigate the factors that trigger professionals to have negative perceptions 
of their jobs during the pandemic. A cross-sectional survey is used for this 
study. The respondents are selected based on convenience random sampling. We use 
345 questionaries for the analysis. Respondents are health care professionals 
(nurses, doctors, midwives, technicians, etc.) working in a pandemic hospital in 
Turkey. We run a multivariable logistic regression model to analyze the 
predictors of work difficulty perception. The model is adjusted for the 
respondents’ demographical characteristics and emotional wellbeing. We found 
that depression and burnout are significantly correlated with the perception of 
job difficulty (OR Severe PHQ-9 = 10.8, p = 0.004; OR Severe Burnout = 7.83, p < 
0.001). The professionals who are changed from one department to another are 
also more likely to perceive the job as difficult (OR Department Change = 1.60, 
p = 0.045). However, the professionals that received sufficient applause from 
society are more likely to think that they did not face any difficulties doing 
their job during the pandemic (OR Applause = 0.56, p < 0.016). Anxiety, monetary 
motivation, religious beliefs, and information availability did not contribute 
to the perceived difficulty in their jobs. Thus, efforts need to be made to give 
them more social support and smooth their changes in departments and functions 
to facilitate their jobs.

DOI: 10.3390/ijerph19095174
PMCID: PMC9157311
PMID: 35564568 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2040. Int J Environ Res Public Health. 2022 Apr 22;19(9):5089. doi: 
10.3390/ijerph19095089.

The Impact of COVID-19 on the Mental Well-Being of College Students.

Sauer N(1), Sałek A(1), Szlasa W(2), Ciecieląg T(1), Obara J(1), Gaweł S(1), 
Marciniak D(3), Karłowicz-Bodalska K(3).

Author information:
(1)Faculty of Pharmacy, Wroclaw Medical University, 50-556 Wrocław, Poland.
(2)Faculty of Medicine, Wroclaw Medical University, 50-367 Wrocław, Poland.
(3)Department of Drugs Form Technology, Faculty of Pharmacy, Wroclaw Medical 
University, 50-556 Wrocław, Poland.

The COVID-19 pandemic has caused an overall increase in stress and depression in 
society. The aim of the present research was to evaluate the psychological 
condition of college students during the COVID-19 pandemic and explore factors 
influencing their daily functioning. The study focused on four main aspects such 
as mental well-being, sexuality, concern about financial status, and trust in 
medical authorities. The study was based on a specially designed survey. The 
questionnaire was created using Google Forms and shared on social media sites. A 
total of 630 students participated in the survey, 17 surveys were excluded due 
to incomplete data and 613 surveys (97.30%) were considered for the final 
analysis. During isolation, 68.0% of students experienced fear of missing out 
(FOMO). A total of 73.4% were frustrated due to spending a lot of time in front 
of a computer. A significant decrease in motivation to study was reported by 
78.1% of the respondents. Students showed significantly different attitudes 
towards sexuality. Concern about the financial situation was reported by 48.7% 
of respondents. The state of the Polish economy was of concern to 86.4% of 
respondents. A total of 74.5% of students declared concern about their career 
development. During the pandemic, 59.0% of respondents became concerned about 
their health. The attitude towards vaccination was described as positive by 
82.5% of the respondents. The percentage of respondents experiencing negative 
psychological effects relative to the overall epidemiological situation of 
COVID-19 is troubling. Given the unexpected length and severity of the pandemic, 
we suggest that students' concerns be more thoroughly understood and addressed.

DOI: 10.3390/ijerph19095089
PMCID: PMC9100955
PMID: 35564484 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2041. Int J Environ Res Public Health. 2022 Apr 21;19(9):5073. doi: 
10.3390/ijerph19095073.

Antenatal Classes in the Context of Prenatal Anxiety and Depression during the 
COVID-19 Pandemic.

Ciochoń A(1), Apanasewicz A(2), Danel DP(2), Galbarczyk A(1), Klimek M(1), 
Ziomkiewicz A(3), Marcinkowska UM(1).

Author information:
(1)Department of Environmental Health, Institute of Public Health, Faculty of 
Health Sciences, Jagiellonian University Medical College, 31-066 Kraków, Poland.
(2)Department of Anthropology, Ludwik Hirszfeld Institute of Immunology and 
Experimental Therapy, Polish Academy of Sciences, 53-114 Wrocław, Poland.
(3)Laboratory of Anthropology, Institute of Zoology and Biomedical Research, 
Jagiellonian University, 30-387 Kraków, Poland.

Perinatal maternal anxiety and depression negatively affect intrauterine fetal 
development, birth outcome, breastfeeding initiation, duration, and milk 
composition. Antenatal classes potentially reduce the anxiety of pregnant women 
and may thus contribute to healthy infant development. The study investigates 
the relationship between participation in online or in-person antenatal classes 
and levels of anxiety and depression in Polish women during the COVID-19 
pandemic. The study group included 1774 adult, non-smoking pregnant women. We 
compared the state anxiety (STAI-State) and depression levels (EPDS) in women 
who (i) attended antenatal classes in-person, (ii) attended online classes, and 
(iii) did not attend any of them. The statistical analyses included a GLM model 
and trend analysis, while controlling for maternal trait anxiety, age, pregnancy 
complications, trimester of pregnancy, previous pregnancies, and COVID-19 
infections. We observed statistically significant differences in the level of 
anxiety (and depression). Women who did attend antenatal classes in person had 
the lowest levels of anxiety and depression. Considering the importance of 
maternal mental well-being on fetal development, birth outcome, and 
breastfeeding, in-person participation in antenatal classes should be 
recommended to pregnant women.

DOI: 10.3390/ijerph19095073
PMCID: PMC9101236
PMID: 35564465 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2042. Int J Environ Res Public Health. 2022 Apr 19;19(9):4960. doi: 
10.3390/ijerph19094960.

The COVID-19 Lockdown and Mental Wellbeing of Females in China.

Xia CL(1), Wei AP(2), Huang YT(3).

Author information:
(1)Faculty of Business, City University of Macau, Macau 999078, China.
(2)Department of Business Management, National Taichung University of Science 
and Technology, No. 129, Sec. 3, Sanmin Rd., North Dist., Taichung 404336, 
Taiwan.
(3)Bachelor Program of International Management, National Yunlin University of 
Science and Technology, Yunlin 640301, Taiwan.

Most studies consider that COVID-19 lockdowns lead to mental health problems for 
females, while the effect of role change on female mental health has been 
overlooked. This study aimed to explore multiple facets of the risk of mental 
distress in a sample of Chinese married females aged 21-50 during the COVID-19 
lockdowns. A cross-sectional study was carried out with 613 valid responses from 
married females in the Guangdong province. Our primary tool was a questionnaire 
using a Kessler-10 scale to detect the probability of mental distress based on 
the level of nervousness, tiredness, restlessness, and depression. Eighty-eight 
point three percent of married females possessed a high risk of psychological 
distress because they frequently felt tired out, hopeless, and restless. The 
evidence suggests that the lockdown has caused a conflict in the female role to 
maintain a balance between family and career. Increasing family care 
responsibilities are positively associated with nervousness, tiredness, and 
mental disorder. The heterogeneity of the social role in mental wellbeing is 
explored. Married females whose income was worse off during the lockdown are 
negatively associated with mental wellbeing. Married females who are employed 
are found to be less mentally healthy than the self-employed.

DOI: 10.3390/ijerph19094960
PMCID: PMC9100609
PMID: 35564365 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2043. Int J Environ Res Public Health. 2022 Apr 19;19(9):4951. doi: 
10.3390/ijerph19094951.

Mental Health Outcomes in Australian Healthcare and Aged-Care Workers during the 
Second Year of the COVID-19 Pandemic.

McGuinness SL(1)(2), Johnson J(1)(2), Eades O(1)(2), Cameron PA(1)(2), Forbes 
A(1), Fisher J(1), Grantham K(1), Hodgson C(1)(2), Hunter P(1)(2), Kasza J(1), 
Kelsall HL(1), Kirkman M(1), Russell G(1), Russo PL(3)(4), Sim MR(1), Singh 
KP(5)(6), Skouteris H(1), Smith KL(1)(7), Stuart RL(1)(8), Teede HJ(1)(8), 
Trauer JM(1), Udy A(1)(2), Zoungas S(1)(2), Leder K(1)(9).

Author information:
(1)School of Public Health and Preventive Medicine, Monash University, 
Melbourne, VIC 3800, Australia.
(2)Alfred Health, Melbourne, VIC 3004, Australia.
(3)School of Nursing and Midwifery, Monash University, Melbourne, VIC 3800, 
Australia.
(4)Cabrini Health, Melbourne, VIC 3144, Australia.
(5)Peninsula Health, Melbourne, VIC 3199, Australia.
(6)The Peter Doherty Institute for Infection and Immunity, The University of 
Melbourne, Melbourne, VIC 3000, Australia.
(7)Ambulance Victoria, Melbourne, VIC 3108, Australia.
(8)Monash Health, Melbourne, VIC 3168, Australia.
(9)Royal Melbourne Hospital, Melbourne, VIC 3050, Australia.

OBJECTIVE: the COVID-19 pandemic has incurred psychological risks for healthcare 
workers (HCWs). We established a Victorian HCW cohort (the Coronavirus in 
Victorian Healthcare and Aged-Care Workers (COVIC-HA) cohort study) to examine 
COVID-19 impacts on HCWs and assess organisational responses over time.
METHODS: mixed-methods cohort study, with baseline data collected via an online 
survey (7 May-18 July 2021) across four healthcare settings: ambulance, 
hospitals, primary care, and residential aged-care. Outcomes included 
self-reported symptoms of depression, anxiety, post-traumatic stress (PTS), 
wellbeing, burnout, and resilience, measured using validated tools. Work and 
home-related COVID-19 impacts and perceptions of workplace responses were also 
captured.
RESULTS: among 984 HCWs, symptoms of clinically significant depression, anxiety, 
and PTS were reported by 22.5%, 14.0%, and 20.4%, respectively, highest among 
paramedics and nurses. Emotional exhaustion reflecting moderate-severe burnout 
was reported by 65.1%. Concerns about contracting COVID-19 at work and 
transmitting COVID-19 were common, but 91.2% felt well-informed on workplace 
changes and 78.3% reported that support services were available.
CONCLUSIONS: Australian HCWs employed during 2021 experienced adverse mental 
health outcomes, with prevalence differences observed according to occupation. 
Longitudinal evidence is needed to inform workplace strategies that support the 
physical and mental wellbeing of HCWs at organisational and state policy levels.

DOI: 10.3390/ijerph19094951
PMCID: PMC9103405
PMID: 35564351 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflict of interest to 
declare.


2044. Int J Environ Res Public Health. 2022 Apr 19;19(9):4940. doi: 
10.3390/ijerph19094940.

Sleep Quality, Insomnia, Anxiety, Fatigue, Stress, Memory and Active Coping 
during the COVID-19 Pandemic.

Alqahtani JS(1), AlRabeeah SM(1), Aldhahir AM(2), Siraj R(3), Aldabayan YS(3), 
Alghamdi SM(4)(5), Alqahtani AS(1), Alsaif SS(4)(6), Naser AY(7), Alwafi H(8).

Author information:
(1)Department of Respiratory Care, Prince Sultan Military College of Health 
Sciences, Dammam 34313, Saudi Arabia.
(2)Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan 
University, Jazan 45142, Saudi Arabia.
(3)Department of Respiratory Care, King Faisal University, Al Ahsa 31982, Saudi 
Arabia.
(4)National Heart and Lung Institute, Imperial College London, London SW7 2BX, 
UK.
(5)Respiratory Care Program, Faculty of Applied Medical Sciences, Umm Al-Qura 
University, Makkah 21961, Saudi Arabia.
(6)Rehabilitation Health Sciences Department, College of Applied Medical 
Sciences, King Saud University, Riyadh 11362, Saudi Arabia.
(7)Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty 
of Pharmacy, Isra University, Amman 11622, Jordan.
(8)Faculty of Medicine, Umm Al Qura University, Mecca 21514, Saudi Arabia.

Background: The current study aimed to evaluate the impact of the coronavirus 
(COVID-19) pandemic on sleep quality, insomnia, anxiety, stress, fatigue and 
active coping in the United States. Methods: This was a cross-sectional study 
using a publicly available database taken from the Boston College COVID-19 Sleep 
and Well-Being Dataset. We have selected the most recent data that included 
information about sleep quality and other measures, including insomnia, anxiety, 
stress, fatigue and coping, collected between 22 February−8 March 2021. Results: 
A total of 476 subjects were included in the analysis. The mean (SD) age of the 
study population was 38.8 (17.8) years, and there were more females (85%) than 
males. The population had a mean (SD) score of the Pittsburgh Sleep Quality 
Index (PSQI) of 6 (3.2), with 65% having the prevalence of poor sleep quality 
(defined as PSQ ≥ 5; n = 311). The mean (SD) score for Insomnia Severity Index 
(ISI) was 6.9 (5.2), with 55 subjects (11.5%) having clinical insomnia (defined 
as ISI ≥ 15); of whom 9% had severe clinical insomnia. There were positive 
correlations between PSQI and ISI (r = 0.76, p < 0.001), PROMIS fatigue scale (r 
= 0.53, p < 0.001), Generalized Anxiety Disorder-7 (GAD-7) (r = 0.46, p < 
0.001), and Perceived Stress Scale (PSS) (r = 0.44, p < 0.001). The PSQI was 
inversely correlated with the John Henryism Active Coping Scale (JHACS) and 
memory scale. In the multivariate regression model, JHACS, ISI, fatigue, PSS and 
GAD-7 were significant predictors of PSQI, and these variables accounted for 62% 
of the variance of PSQI, adjusted for age and gender. Conclusion: An important 
contribution to the literature is made by this research, which demonstrates the 
significant prevalence of poor sleep quality and its association with insomnia 
and other mental and physical well-being. It also underlines the need to 
prioritise policy and public health efforts to address sleep issues that have 
substantial health and economic effects for both individuals and the population 
at large.

DOI: 10.3390/ijerph19094940
PMCID: PMC9104759
PMID: 35564337 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2045. Int J Environ Res Public Health. 2022 Apr 19;19(9):4929. doi: 
10.3390/ijerph19094929.

The Developmental Trajectory of a Decade of Research on Mental Health and 
Well-Being amongst Graduate Students: A Bibliometric Analysis.

Okoro C(1), Owojori OM(1), Umeokafor N(2).

Author information:
(1)Finance and Investment Management, College of Business and Economics, 
University of Johannesburg, P.O. Box 526, Auckland Park, Johannesburg 2006, 
South Africa.
(2)School of Civil Engineering and Built Environment, Liverpool John Moores 
University, Byrom Street, Liverpool L3 3AF, UK.

The journey of graduate students through academia can be a difficult road 
plagued with several roadblocks due to several intersectional factors. These 
difficulties often impact the students' mental health with severe consequences 
on their well-being and personal and academic achievements. There is a critical 
need for researchers to conduct studies in response to the positive mental 
well-being for this group of trainees, considering their peculiar role in the 
scholarly environment. This study aimed to explore the scientific research on 
the health and well-being of graduate students; typify the scientific landscape 
and development trajectory, cooperation networks, and fundamental research 
areas; and identify areas of needed research in this field. A bibliometric 
analysis of articles indexed in Scopus and published in the past decade (2012 to 
2021) was undertaken. The results revealed that the research on graduate 
students' mental health and well-being has increased over the years, 
significantly in the past two years, probably owing to the incidence of the 
COVID-19 pandemic and concerns around remote learning. The highest number of 
publications was from the United Kingdom (U.K.) and United States (U.S.), while 
the organizational affiliations were mainly from universities. The most 
prominent source type of publications was journal articles. The result also 
shows a weak collaboration across countries and organizations. The study 
identifies other areas of useful research, collaboration, intervention 
strategies, and policy review.

DOI: 10.3390/ijerph19094929
PMCID: PMC9102193
PMID: 35564324 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2046. Chemosphere. 2022 Sep;302:134907. doi: 10.1016/j.chemosphere.2022.134907. Epub 
2022 May 10.

Long-term monitoring of drug consumption patterns during the COVID-19 pandemic 
in a small-sized community in Brazil through wastewater-based epidemiology.

Hahn RZ(1), Bastiani MF(2), Lizot LLF(2), Schneider A(2), da Silva Moreira 
IC(2), Meireles YF(2), Viana MF(2), do Nascimento CA(3), Linden R(4).

Author information:
(1)Laboratory of Analytical Toxicology, Universidade Feevale, Rua Rubem Berta, 
nº 200, CEP 93525-080, Novo Hamburgo, Brazil. Electronic address: 
betahahn@feevale.br.
(2)Laboratory of Analytical Toxicology, Universidade Feevale, Rua Rubem Berta, 
nº 200, CEP 93525-080, Novo Hamburgo, Brazil.
(3)Department of Production Engineering, Faculdades Integradas de Taquara, Av. 
Oscar Martins Rangel, nº 4500, CEP 95612-150, Taquara, Brazil.
(4)Laboratory of Analytical Toxicology, Universidade Feevale, Rua Rubem Berta, 
nº 200, CEP 93525-080, Novo Hamburgo, Brazil; National Institute of Forensic 
Science and Technology (INCT Forense), Porto Alegre, Brazil. Electronic address: 
rafael.linden@feevale.br.

The abuse of legal and illegal drugs is a global public health problem, also 
affecting the social and economic well-being of the population. Thus, there is a 
significant interest in monitoring drug consumption. Relevant epidemiological 
information on lifestyle habits can be obtained from the chemical analysis of 
urban wastewater. In this work, passive sampling using polar organic chemical 
integrative samplers (POCIS) was used to quantify licit and illicit drugs 
biomarkers in wastewater for the application of wastewater-based epidemiology 
(WBE). In this WBE study, a small urban community of approximately 1179 
inhabitants was monitored from 18 March 2020 to 3 March 2021, covering the 
mobility restriction and flexibilization periods of the COVID-19 pandemic in 
Brazil. Consumption was estimated for amphetamine, caffeine, cocaine, MDMA, 
methamphetamine, nicotine, and THC. The highest estimated consumption among 
illicit drugs was for THC (2369 ± 1037 mg day-1 1000 inh-1) followed by cocaine 
(353 ± 192 mg day-1 1000 inh-1). There was a negative correlation between 
consumption of caffeine, cocaine, MDMA, nicotine, and THC with human mobility, 
expressed by cellular phone mobility reports (P-value = 0.0094, 0.0019, 0.0080, 
0.0009, and 0.0133, respectively). Our study is the first long-term drug 
consumption evaluation during the COVID-19 pandemic, with continuous sampling 
for almost a whole year. The observed reduction in consumption of both licit and 
illicit drugs is probably associated with stay-at-home orders and reduced 
access, which can be due to the closure of commercial facilities during some 
time of the evaluated period, smaller drug supply, and reduced income of the 
population due to the shutdown of companies and unemployment. The assay 
described in this study can be used as a complementary and cost-effective tool 
to the long-term monitoring of drug use biomarkers in wastewater, a relevant 
epidemiological strategy currently limited to short collection times.

Copyright © 2022 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.chemosphere.2022.134907
PMCID: PMC9090174
PMID: 35561781 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no known 
competing financial interests or personal relationships that could have appeared 
to influence the work reported in this paper.


2047. Prim Care Companion CNS Disord. 2022 May 10;24(3):22m03247. doi: 
10.4088/PCC.22m03247.

Markers of Social and Emotional Health in College Students During the COVID-19 
Pandemic.

Sarkar A(1), Jasmine E(1), Thomas SL(1), Andrade C(2)(3).

Author information:
(1)Department of Psychology, Indian Institute of Psychology and Research, 
Bangalore, India.
(2)Department of Clinical Psychopharmacology and Neurotoxicology, National 
Institute of Mental Health and Neurosciences, Bangalore, India.
(3)Corresponding author: Chittaranjan Andrade, MD, Department of Clinical 
Psychopharmacology and Neurotoxicology, National Institute of Mental Health and 
Neurosciences, Bangalore 560 029, India (andradec@gmail.com).

Objective: Research on effects of the coronavirus disease 2019 (COVID-19) 
pandemic on the mental health of youth have mostly focused on the occurrence of 
negative states such as anxiety and depression. The objective of this study was 
to assess the social and emotional health of university students in India, as 
influenced by COVID-19 test results and the experience of isolation or 
quarantine. Methods: A cross-sectional online survey was conducted in India 
during July and early August 2021 among university students aged 20-25 years. 
The Social Emotional Health Survey-Higher Education (SEHS-HE) was used to assess 
4 domains: belief in self, belief in others, emotional competence, and engaged 
living. Results: There were 187 respondents from 78 institutions in 14 of 29 
states of India. The sample was 51% male. The mean SEHS-HE scores were 
approximately 75% of the maximum score in each domain. In multivariable 
regression analysis, sex, residence with family, and a negative COVID-19 report 
had little effect on SEHS-HE domains. COVID-19 positivity was associated with 
significantly lower scores on all domains (P < .01). Isolation/quarantine was 
associated with significantly or near-significantly higher scores on all domains 
(P < .01). In all cases, β coefficients and the proportion of the variance 
explained by the regression were small. Conclusions: Major pandemic-related 
internal and environmental determinants of SEHS-HE remain to be identified. 
Strategies to improve the well-being of college students should be directed 
toward those who have tested positive for the disease. The experience of 
isolation/quarantine is not pathoplastic.

© Copyright 2022 Physicians Postgraduate Press, Inc.

DOI: 10.4088/PCC.22m03247
PMID: 35561324 [Indexed for MEDLINE]


2048. Front Public Health. 2022 Apr 26;10:831087. doi: 10.3389/fpubh.2022.831087. 
eCollection 2022.

Development and Validation of a Questionnaire to Assess Social Participation of 
High Risk-Adults in Germany During the COVID-19 Pandemic.

Schröder D(1), Heesen G(1), Heinemann S(1), Hummers E(1), Jablonka A(2)(3), 
Steffens S(2), Mikuteit M(2), Niewolik J(2), Overbeck TR(4), Kallusky J(4), 
Müller F(1).

Author information:
(1)Department of General Practice, University Medical Center, Göttingen, 
Germany.
(2)Department of Rheumatology and Immunology, Hannover Medical School, Hanover, 
Germany.
(3)German Center for Infection Research (DZIF), Partner Site 
Hannover-Braunschweig, Hanover, Germany.
(4)Department of Hematology and Medical Oncology, University Medical Center 
Göttingen, Göttingen, Germany.

BACKGROUND: Restrictions to contain the COVID-19 pandemic affect the social 
participation of people worldwide. Especially those at high risk for a severe 
disease tend to abstain from social gatherings. While there are a few 
questionnaires to measure social participation in elderly or chronic patients, a 
valid survey instrument that includes pandemic-related social participation is 
needed.
METHODS: We developed a social participation questionnaire that aims to assess 
pandemic-related restrictions in social participation. Items were developed 
using a theory and literature-based approach and then compiled in a discursive 
process involving experts and lay people. This was followed by the validation of 
the questionnaire through a cross-sectional survey on 431 individuals. Items 
with low item-total correlations and low factor loadings using exploratory 
factor analysis [EFA] were excluded. Using EFA on the remaining items, the 
factor structure was retrieved and tested with a confirmatory factor analysis 
[CFA]. Internal consistency was assessed with Chronbachs α.
RESULTS: Initially, 27 items were developed which were used for validation. 13 
items were excluded due to low item-total correlations and factors loadings. EFA 
of the remaining 14 items revealed three factors which were identified as 
domains "active social participation," "wellbeing," and "restrictions". CFA 
showed an acceptable model fit using the three-dimensional structure. Chronbachs 
α of 0.81 and McDonalds Ω of 0.87 indicate good internal consistency. 
Correlation analysis showed an association between the developed questionnaire 
and previously-established participation and mental health scales.
CONCLUSION: This study suggests that our 14 item questionnaire is of high 
reliability and validity and can be used to measure social participation during 
a pandemic.

Copyright © 2022 Schröder, Heesen, Heinemann, Hummers, Jablonka, Steffens, 
Mikuteit, Niewolik, Overbeck, Kallusky and Müller.

DOI: 10.3389/fpubh.2022.831087
PMCID: PMC9086897
PMID: 35558532 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2049. J Pediatr Psychol. 2022 May 13;47(5):595-605. doi: 10.1093/jpepsy/jsab124.

Measurement of Cumulative Preterm Neonatal and Maternal Stressors During 
Neonatal Intensive Care Unit Admission.

Abdelmageed RI(1), Youssef AM(1), El-Farrash RA(1), Mohamed HM(2), Abdelaziz 
AW(1).

Author information:
(1)Pediatrics Department, Faculty of Medicine, Ain Shams University, Egypt.
(2)Egyptian Ministry of Health, Egypt.

OBJECTIVES: By nature, the neonatal intensive care unit (NICU) environment is 
stressful for both infants and mothers. This study aimed to explore and quantify 
the severity of early life stressors in premature infants admitted to the NICU 
and evaluate the effect of cumulative neonatal stressors on maternal mental 
health.
METHODS: This cross-sectional study included 100 preterm infants admitted to the 
NICU for at least 10 days. Daily experiences with painful/stressful procedures 
for 10 days were determined using the Neonatal Infant Stressor Scale. The 
included mothers were assessed for their psychological well-being 1 week after 
NICU admission using the Parental Stressor Scale: NICU and Edinburgh Postnatal 
Depression Scale.
RESULTS: During the first 10 days of NICU admission, preterm infants experienced 
an average of 350.76 ± 84.43 acute procedures and an average of 44.84 ± 11.12 
cumulative hours of chronic events, with the highest scores recorded on first 
3 days of admission. Although intravenous flushing for patency was the most 
frequent acute procedure, blood gas sampling was the most painful. Forty-five 
percent of the mothers showed significant depressive symptoms, with the maternal 
role alteration reported as the most stressful experience, especially for young 
and new mothers (p < .001). The cumulative stressors experienced by infants were 
significantly associated with elevated maternal perception of psychological 
maladjustment (p < .001).
CONCLUSION: This study confirmed that the NICU environment is stressful for both 
infants and mothers, with the total cumulative stressors experienced by preemies 
in the NICU having an negative impact on maternal mental health.

© The Author(s) 2021. Published by Oxford University Press on behalf of the 
Society of Pediatric Psychology. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/jpepsy/jsab124
PMID: 35552433 [Indexed for MEDLINE]


2050. PLoS One. 2022 May 12;17(5):e0268343. doi: 10.1371/journal.pone.0268343. 
eCollection 2022.

Quality of life of veterinary residents in AVMA-Recognized Veterinary Specialty 
Organizations using the WHOQOL-BREF instrument.

Jaworski JL(1), Thompson LA(1), Weng HY(2).

Author information:
(1)Animal Allergy & Dermatology Center of Indiana, Indianapolis, Indiana, United 
States of America.
(2)Department of Comparative Pathobiology, College of Veterinary Medicine, 
Purdue University, West Lafayette, Indiana, United States of America.

OBJECTIVE: To assess whether there is an association between veterinary 
specialty and the quality of life of residents in AVMA-Recognized Veterinary 
Specialty Organizations™ using the WHOQOL-BREF instrument.
METHODS: This cross-sectional study used an online survey and data collection 
service for administration of the survey to veterinary residents during April 
2021 to June 2021. Veterinary residents were contacted through their respective 
AVMA-Recognized Veterinary Specialty Organization™ and through social media. 
Overall quality of life along with the domains of Physical Health, Psychological 
Health, Social Relationships, and Environment were measured using the 
WHOQOL-BREF instrument. Additionally, data on the demographics of participants 
were collected and investigated as potential confounders. Mean standardized 
scores (0 to 100) were compared among the specialties using the general linear 
model.
RESULTS: 792 residents from 21 veterinary specialties were included in the 
analysis. The results showed that overall quality of life and all four domains 
varied significantly among specialties after adjusting for significant 
demographic variables (all Ps < 0.001). The mean standardized overall quality of 
life score was 54.3, ranging from 31.8 in Emergency and Critical Care to 56.3 in 
Laboratory Animal. The mean standardized quality of life scores were lowest for 
Psychological Health (50.3), followed by Social Relationships (55.0), 
Environment (61.4), and Physical Health (62.6). Residents in Emergency and 
Critical Care had the lowest adjusted average scores in all quality of life 
domains. Residents in Internal Medicine, Anesthesia and Analgesia, and Surgeons 
had lower quality of life scores across several domains when compared to other 
specialties.
CLINICAL RELEVANCE: This study provides insight into the mental health and 
general well-being of veterinary residents. The results can assist veterinary 
specialty organizations, universities, and mentors in developing appropriate 
supporting programs for residents. The results can also assist residents in 
recognizing and more efficiently caring for their individual mental health and 
well-being.

DOI: 10.1371/journal.pone.0268343
PMCID: PMC9098004
PMID: 35551334 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2051. J Prim Care Community Health. 2022 Jan-Dec;13:21501319221097075. doi: 
10.1177/21501319221097075.

Predictors of Depression in Nurses During COVID-19 Health Emergency; the 
Mediating Role of Resilience: A Cross-Sectional Study.

Chura S(1), Saintila J(2), Mamani R(1), Ruiz Mamani PG(3), Morales-García WC(1).

Author information:
(1)Universidad Peruana Unión, Lima, Perú.
(2)Universidad Señor de Sipán, Chiclayo, Perú.
(3)Universidad Privada San Juan Bautista, Lima, Perú.

BACKGROUND: Nurses are susceptible to several mental problems, such as fear, 
stress, and depression due to the COVID-19 pandemic, which affects their 
emotional well-being. However, resilience plays an important role in mitigating 
the effects of COVID-19.
OBJECTIVE: This study was to examine the mediating role of resilience in the 
relation between fear, stress, and depression of nurses during COVID-19 health 
emergencies.
METHODS: A cross-sectional-predictive study was carried out. The variables 
analyzed were fear, resilience, stress, and depression. A total of 286 nurses 
from 2 hospitals in the cities of Juliaca and Puno, Peru. Data analyses were 
performed using structural equation modeling (SEM).
RESULTS: Analyses showed that the variables were significantly related 
(P < .01). In addition, a confirmatory analysis of the hypothesized model using 
structural equation modeling shows that fear and stress are predictors of 
depression, and that resilience plays a role in mediating the effect of fear on 
stress (X2 = 534.69, gl = 372, P = .000; TLI = .902, CFI = .910, RMSEA = .039 
[95% CI = 0.032-0.046], and SRMR = .065).
CONCLUSION: Nurses tend to develop fear, stress, and depression. Resilience 
reduces the impact of these psychological variables. Hospital management should 
provide psychological support and training for nurses in coping strategies.

DOI: 10.1177/21501319221097075
PMCID: PMC9109278
PMID: 35549758 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


2052. Australas Psychiatry. 2022 Dec;30(6):732-735. doi: 10.1177/10398562221100090. 
Epub 2022 May 12.

Rapid review and commentary on the clinical implications of the population 
mental health consequences of the COVID-19 pandemic in Australia.

Looi JC(1)(2), Allison S(3)(4), Bastiampillai T(3)(5)(6), Kisely SR(7)(8).

Author information:
(1)Academic Unit of Psychiatry and Addiction Medicine, Canberra Hospital, 
104822The Australian National University Medical School, Canberra, ACT, 
Australia; and.
(2)Consortium of Australian-Academic Psychiatrists for Independent Policy and 
Research Analysis (CAPIPRA), Canberra, ACT, Australia.
(3)Consortium of Australian-Academic Psychiatrists for Independent Policy and 
Research Analysis (CAPIPRA), Canberra, ACT, Australia; and.
(4)College of Medicine and Public Health, 1065Flinders University, Adelaide, SA, 
Australia.
(5)College of Medicine and Public Health, 1065Flinders University, Adelaide, SA, 
Australia; and.
(6)Department of Psychiatry, 2541Monash University, Wellington Road, Clayton, 
VIC, Australia.
(7)Departments of Psychiatry, Community Health and Epidemiology, Dalhousie 
University, Halifax, Nova Scotia, Canada; and.
(8)School of Medicine, Princess Alexandra Hospital, 1974The University of 
Queensland, Ipswich Road, Woolloongabba, Brisbane, QLD, Australia.

OBJECTIVE: To provide a rapid clinical review and commentary for psychiatrists 
on the population mental health consequences of the COVID-19 pandemic in 
Australia, including evidence-based findings and interventions.
CONCLUSIONS: Whilst there was evidence of collective psychological resilience 
during the first 2 years of the COVID-19 pandemic, younger women, carers for 
those with COVID-19, and those with more household chores, childcare needs and 
higher economic strain, were at more risk. Interventions should therefore target 
people with these socio-demographic risk factors, as well as severe COVID-19 
survivors, their relatives and frontline workers. However, the rapid spread of 
the Omicron SARS-CoV-2 variant has the potential for greater impacts on 
population mental health. Innovations in telehealth and online therapy should be 
incorporated into standard care. Ongoing research is needed to assess who 
remains most vulnerable to negative mental health impacts of the current 
pandemic, and especially the longer term outcomes of mental ill health. Further 
research should also investigate evidence-based approaches to resilience and 
well-being. Prospective risk/benefit analyses of infection control measures, 
economic effects and mental health consequences are needed.

DOI: 10.1177/10398562221100090
PMCID: PMC9111908
PMID: 35549517 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship and/or publication of this 
article.


2053. Fam Syst Health. 2022 Sep;40(3):408-412. doi: 10.1037/fsh0000705. Epub 2022 May 
12.

COVID-19 and crisis communication among African American households.

Anakwe A(1), Majee W(2), Ponder M(3), BeLue R(1).

Author information:
(1)College for Public Health and Social Justice, Saint Louis University.
(2)Department of Health Sciences and Public Health, University of Missouri.
(3)Department of Communication, Culture and Media Studies, Howard University.

BACKGROUND: African American (AA) families are disproportionately burdened by 
COVID-19 resulting in morbidity and death. How pandemic risks and impacts are 
communicated to parents and in turn translated to children can have implications 
for familial mental wellbeing. Because culture shapes how information is 
received, processed, and utilized, there is need to understand how AA parents' 
experiences of COVID-19 information sharing and perceived vulnerabilities 
influenced communication with their children.
METHODS: Data was collected through semistructured in-depth telephone interviews 
conducted among 11 African American households with school aged child (5 to 17 
years). Line-byline coding and thematic analysis were used to deduce meaning 
from professionally transcribed data. Preliminary Findings: Four themes on trust 
in information sources, risk perceptions, attitudes to prevention methods, and 
parent-child risk communication emerged. Although participants felt challenged 
by their inherent vulnerabilities and communicating COVID-19 risks at an 
appropriate comprehension level to their children, they leaned into cultural 
safety nets such as "the dinner table" to encourage conversation and foster 
resilience.
IMPLICATIONS: Understanding how African American families with children were 
impacted by COVID-19 and how adequate crisis communication can help mitigate 
adverse health consequences, strengthen recovery, foster resilience, and promote 
family and community healing is important. Clinicians and therapists who work 
with AA families should be sensitive to their social vulnerability and 
culturally responsive to AA family systems when communicating about public 
health emergencies. (PsycInfo Database Record (c) 2022 APA, all rights 
reserved).

DOI: 10.1037/fsh0000705
PMID: 35549489 [Indexed for MEDLINE]


2054. Sci Rep. 2022 May 11;12(1):7771. doi: 10.1038/s41598-022-11924-z.

Curiosity for information predicts wellbeing mediated by loneliness during 
COVID-19 pandemic.

Losecaat Vermeer AB(1)(2), Muth A(3)(4), Terenzi D(3)(4)(5), Park SQ(6)(7)(8).

Author information:
(1)Department of Decision Neuroscience and Nutrition, German Institute of Human 
Nutrition Potsdam-Rehbrücke, Nuthetal, Germany. a.b.losecaatvermeer@gmail.com.
(2)Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität 
Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany. 
a.b.losecaatvermeer@gmail.com.
(3)Department of Decision Neuroscience and Nutrition, German Institute of Human 
Nutrition Potsdam-Rehbrücke, Nuthetal, Germany.
(4)Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität 
Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany.
(5)Deutsches Zentrum Für Diabetes, Neuherberg, Germany.
(6)Department of Decision Neuroscience and Nutrition, German Institute of Human 
Nutrition Potsdam-Rehbrücke, Nuthetal, Germany. soyoung.q.park@gmail.com.
(7)Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität 
Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany. 
soyoung.q.park@gmail.com.
(8)Deutsches Zentrum Für Diabetes, Neuherberg, Germany. 
soyoung.q.park@gmail.com.

The COVID-19 pandemic confronted humans with high uncertainty and lockdowns, 
which severely disrupted people's daily social and health lifestyles, enhanced 
loneliness, and reduced well-being. Curiosity and information-seeking are 
central to behavior, fostering well-being and adaptation in changing 
environments. They may be particularly important to maintain well-being during 
the pandemic. Here, we investigated which motives drive information-seeking, and 
whether and how curiosity and information-seeking related to well-being and mood 
(excitement, anxiety). Additionally, we tested whether daily diet contributed to 
this relationship during lockdown. Participants (N = 183) completed 
questionnaires measuring curiosity, information-seeking, social and mental 
health. Using a smartphone app, participants submitted their daily food intake 
and lifestyle ratings for a week. We found participants had highest motivation 
to seek positive (vs. negative) information, concerning themselves more than 
others. Both trait curiosity and information-seeking predicted higher 
well-being, mediated by loneliness. Trait curiosity also predicted well-being 
and excitement days later. Considering diet, participants with lower trait 
curiosity ate food containing more tyrosine (i.e., dopamine precursor). 
Furthermore, participants consuming food high in sugar reported higher anxiety, 
which was specifically found in participants with relatively low, but not high, 
trait curiosity. Taken together, curiosity and information-seeking may benefit 
well-being and mood in high uncertain and challenging times, by interacting with 
lifestyle measures (loneliness and nutrition).

© 2022. The Author(s).

DOI: 10.1038/s41598-022-11924-z
PMCID: PMC9094121
PMID: 35545697 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


2055. J Appl Gerontol. 2022 Aug;41(8):1812-1820. doi: 10.1177/07334648221095510. Epub 
2022 May 11.

Addressing the Experiences of Family Caregivers of Older Adults During the 
COVID-19 Pandemic in Finland.

Savela RM(1), Välimäki T(1), Nykänen I(2), Koponen S(2), Suominen AL(3)(4), 
Schwab U(2)(5).

Author information:
(1)Department of Nursing Science, University of Eastern Finland, Kuopio, 
Finland.
(2)Institute of Public Health and Clinical Nutrition, University of Eastern 
Finland, Kuopio, Finland.
(3)Institute of Dentistry, School of Medicine, University of Eastern Finland, 
Kuopio, Finland.
(4)Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, 
Kuopio, Finland.
(5)Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio 
University Hospital, Kuopio, Finland.

This cross-sectional study assessed the experiences of family caregivers of 
older adults during the COVID-19 pandemic. Participants were recruited (n = 101) 
between April and December 2019. We applied a mixed-method approach. 
Quantitative data were analyzed using an independent samples t-test and logistic 
regression analysis, and qualitative experiences with modified thematic content 
analysis. The mean age of the family caregivers was 76 years (SD = 7), and 72% 
were females. Experiences of loneliness and worry during the pandemic were 
evaluated by self-assessment. Approximately one-third of the participants 
reported loneliness and worry. These experiences were further associated with 
female sex, increased psychological distress and depressive symptoms, and 
decreased physical condition and social relationships. Family caregivers were 
also worried about the pandemic's impact on health and well-being. Thus, the 
COVID-19 pandemic has added an extra psychosocial load to family caregivers. The 
post-pandemic era requires increased attention to re-evaluating policies and 
services.

DOI: 10.1177/07334648221095510
PMCID: PMC9096174
PMID: 35543183 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of conflicting interests: The 
author(s) declared the following potential conflicts of interest with respect to 
the research, authorship, and/or publication of this article: Tarja Välimäki is 
a board member of Carers Finland.


2056. Asian J Psychiatr. 2022 Oct;76:103155. doi: 10.1016/j.ajp.2022.103155. Epub 2022 
May 6.

Digital determinants of public mental health and wellbeing in Shanghai during 
the 2022 lockdown.

Hall BJ(1), Li G(2), Rafiq MY(3), Lu J(4), Li C(5).

Author information:
(1)Center for Global Health Equity, NYU Shanghai, Shanghai, PR China. Electronic 
address: brianhall@nyu.edu.
(2)Center for Global Health Equity, NYU Shanghai, Shanghai, PR China. Electronic 
address: gl2500@nyu.edu.
(3)Center for Global Health Equity, NYU Shanghai, Shanghai, PR China. Electronic 
address: myr1@nyu.edu.
(4)School of Psychology and Cognitive Science, East China Normal University, PR 
China. Electronic address: jylu@psy.ecnu.edu.cn.
(5)Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health 
Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR 
China; Institute of Psychology and Behavioral Science, Shanghai Jiao Tong 
University, Shanghai 200030, PR China. Electronic address: licb@smhc.org.cn.

DOI: 10.1016/j.ajp.2022.103155
PMID: 35537925 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest The authors declare no 
conflict of interest.


2057. Infant Ment Health J. 2022 May;43(3):361-372. doi: 10.1002/imhj.21980. Epub 2022 
May 10.

Early relational health: Innovations in child health for promotion, screening, 
and research.

Willis DW(1), Eddy JM(2).

Author information:
(1)Center for the Study of Social Policy, Washington, District of Columbia, USA.
(2)Texas Center for Equity Promotion, The University of Texas at Austin, Austin, 
Texas, USA.

Relational experiences during infancy and early childhood are key drivers for 
building health, social emotional development, and learning capacities, each 
vital for wellbeing. The U.S. child health sectors share a commitment to 
universal health promotion, prevention and early intervention, and a growing 
enthusiasm for the research-affirmed primacy of caregiver-child interactions 
during the critical first 1000 days of life. Given our nation's growing 
children's mental health crisis, racial justice awakening and the need to 
reimagine equitable supports for young families post-COVID19, the child health 
sectors seek new tools and clinical approaches that blend science-to-practice 
innovations with co-developed activities that are meaningful to families. This 
special section brings together papers about a journey of co-discovery between 
researchers, clinicians, and parents during the development and refinement of 
new video- and interview-based dyadic relational screening and monitoring tools. 
The collection of papers addresses a range of topics including early relational 
health (ERH), development and validation of the Early Relational Health Screen, 
its application within research and clinical settings, and thoughtful 
discussions from multiple perspectives. Informed by the diversity informed 
tenets, this journey highlights not only science-informed approaches, but also 
co-development with families of equitable approaches to understanding and 
serving children and their caregivers.

Publisher: Las experiencias en las relaciones durante la infancia y la temprana 
niñez son conductores claves para fortalecer la salud, el desarrollo 
socio-emocional y las capacidades de aprendizaje, todas las cuales son vitales 
para el bienestar. Los sectores de salud infantil en los Estados Unidos 
comparten un compromiso para promover globalmente la salud, la prevención y la 
temprana intervención, así como un creciente entusiasmo por la primacía de las 
interacciones entre quien presta el cuidado y el niño, tal como las reafirma la 
investigación, durante los críticos primeros mil días de vida. Dada la creciente 
crisis de salud mental infantil de nuestro país, el despertar de la justicia 
racial y la necesidad de volver a conceptualizar los apoyos equitativos para 
familias jóvenes después del Covid-19, los sectores de salud infantil, buscan 
nuevas herramientas y acercamientos clínicos que mezclan las innovaciones de la 
ciencia a la práctica con actividades desarrolladas en conjunto que resultan 
significativas para las familias. Esta sección especial presenta artículos 
acerca de una trayectoria de descubrimiento en conjunto entre investigadores, 
profesionales clínicos y padres durante el desarrollo y afinamiento de nuevas 
herramientas de detección y supervisión de la relación diádica basadas en videos 
y entrevistas. El grupo de artículos aborda un número de temas que incluyen la 
temprana saludable relación (ERH), el desarrollo y la validez de la Detección de 
la Temprana Saludable Relación, su aplicación dentro de los campos de la 
investigación y clínicos, así como sensatas discusiones a partir de múltiples 
perspectivas. Respaldada por principios basados en la diversidad, esta 
trayectoria subraya no sólo los acercamientos cuya información proviene de la 
ciencia, sino también el desarrollo en conjunto con familias de equitativos 
acercamientos para comprender y servirles a los niños y a quienes los cuidan.

Publisher: Les expériences relationnelles le bas âge et la petite enfance sont 
des facteurs clés pour la construction de la santé, le développement 
socio-émotionnel et les capacités d'apprentissage, qui sont indispensables au 
bien-être. Les secteurs de la santé de l'enfant aux Etats-Unis d'Amérique 
partagent un engagement envers la promotion universelle de la santé, la 
prévention et l'intervention précoce, et un enthousiasme grandissant pour la 
primauté des interactions personne prenant soin de l'enfant-enfant, affirmée par 
les recherches, durant les 100 premiers jours critique de la vie. Au vu de la 
croissance de la crise de santé mentale des enfants dans notre pays, du réveil 
de la justice raciale et du besoin de réimaginer les soutiens équitables pour 
les jeunes familles après le Covid19, les secteurs de la santé mentale de 
l'enfant cherchent de nouveaux outils et des approches cliniques qui mélange des 
innovations science-à-pratique avec des activités élaborées conjointement qui 
sont utiles et ont un sens pour les familles. Cette section spéciale rassemble 
des articles sur un voyage de codécouverte entre des chercheurs, des cliniciens, 
et des parents durant le développement et le perfectionnement d'un nouveau 
dépistage relationnel dyadique à partir d'entretiens et de vidéos, et d'outils 
de suivi. Cette collection d'articles porte sur un éventail de sujets y compris 
la Santé Relationnelle Précoce (SRP), le développement et la validation du 
Dépistage de Santé Relationnelle Précoce, son application dans des contextes de 
recherche et dans des contextes cliniques, et des discussions attentionnées de 
perspectives multiples. Informé par des principes fondés sur la diversité, ce 
voyage met en évidence non seulement des approches scientifiques mais aussi des 
co-développements avec des familles d'approches équitables à la compréhension et 
au service des enfants ainsi que des personnes prenant soin d'eux.

Publisher: Beziehungserfahrungen im Säuglingsalter und in der frühen Kindheit 
sind entscheidend für den Aufbau von Gesundheit, sozial-emotionaler Entwicklung 
und Lernfähigkeiten, welches alles entscheidende Faktoren für das Wohlbefinden 
sind. Die Sektoren des US-Kindergesundheitswesens engagieren sich gemeinsam für 
Gesundheitsförderung, Prävention und Frühintervention. Außerdem gibt es einen 
wachsenden Enthusiasmus für die durch die Forschung bestätigte Vorrangstellung 
der Interaktionen zwischen Bezugspersonen und Kindern in den entscheidenden 
ersten 1000 Lebenstagen. Angesichts des immer kritischer werdenden Zustands der 
psychischen Gesundheit von Kindern in unserem Land, des Erwachens der 
Gerechtigkeit zwischen Ethnien und der Notwendigkeit, Unterstützung für junge 
Familien nach COVID19 neu zu konzipieren, suchen die Sektoren des 
Kindergesundheitswesens nach neuen Instrumenten und klinischen Ansätzen, die 
Innovationen aus der Wissenschaft in die Praxis einfließen lassen und 
Aktivitäten beinhalten, die für die Familien sinnvoll sind. In diesem Sonderteil 
sind Beiträge zusammengestellt, die eine gemeinsame Entdeckungsreise von 
Forschenden, Kliniker:innen und Eltern bei der Entwicklung und Verfeinerung 
neuer video- und interviewbasierter dyadischer Beziehungsscreenings und 
Monitoring-Instrumente darstellen. Die Sammlung von Beiträgen befasst sich mit 
einer Reihe von Themen, darunter frühe relationale Gesundheit (Early Relational 
Health, ERH), die Entwicklung und Validierung des „Early Relational Health 
Screen“, seine Anwendung in der Forschung und im klinischen Umfeld sowie 
durchdachte Diskussionen aus verschiedenen Perspektiven. Auf der Grundlage des 
„Diversity-Informed“-Grundsatzes werden nicht nur wissenschaftlich fundierte 
Ansätze vorgestellt, sondern auch gemeinsam mit Familien erarbeitete, gerechte 
Ansätze zum Verständnis und zur Betreuung von Kindern und ihren Bezugspersonen.

Publisher: 乳幼児期の関係性における健康 (Early Relational Health:ERH) 
促進、スクリーニング、研究のための子どもの健康の革新 
乳児期や幼児期の関係性の経験は、幸福に不可欠な、健康・社会的な情動発達・学習能力の構築のための重要な推進力となる。米国の子どもの健康分野は、普遍的な健康増進、予防、早期介入への公約と、臨界点である人生の最初の1000日間における養育者-子どもの相互交流が研究によって承認された最優先事項であることに対する熱意の高まりを共有している。我が国の子どもの精神保健上の危機が高まり、人種的正義に目覚め、COVID19以降の若い家族に対する公平な支援の再考をより強く求められることから、米国の子どもの健康部門では、科学から実践への革新と家族にとって有意義な共同発達活動を融合した新しい方策と臨床アプローチを求めている。本特集では、ビデオや面接に基づいた新しい親子関係スクリーニングおよびモニタリング方法の開発と改良における、研究者、臨床家、そして親との共同発見の進展に関する論文を集めた。この論文集は、乳幼児期の関係性における健康 
(ERH) 
、ERHスクリーニングの開発と検証、研究および臨床の場への応用、そして多角的な視点からの思慮深い考察を含む幅広いテーマを扱っている。多様性を考慮した考え方により、科学的根拠に基づくアプローチだけでなく、子どもとその養育者を理解し、彼らに役立つように公平なアプローチを家族と共同で開発することに焦点をあてている。.

Publisher: 婴儿期和幼儿期的关系体验是增进健康、发展社交情感和学习能力的关键驱动因素, 
每一种都对幸福感至关重要。美国儿童健康部门共同致力于促进全民健康、预防和早期干预, 并越来越热衷于研究证实, 在生命的最初1000天内, 
看护者与儿童的互动至关重要。鉴于美国日益严重的儿童心理健康危机, 种族正义意识的觉醒, 以及重新构想在COVID19后对年轻家庭提供公平支持的需要, 
儿童健康部门正寻求新的工具和临床方法, 将科学实践创新与共同开发的对家庭有意义的活动结合起来。本节汇集了有关研究人员、临床医生和父母共同发现之旅的论文, 
在这一过程中他们开发并改进了新型的基于视频和访谈的二元关系筛查和监测工具。论文集涉及一系列主题, 包括早期关系健康 (ERH), 
“早期关系健康筛查”的开发和验证, 其在研究和临床机构中的应用, 以及从多个角度进行的深思熟虑的讨论。在倡导多样性原则的基础上, 
这一发现之旅不仅强调科学的方法, 还强调了与家庭共同发展公平的方法来理解和服务儿童及其看护者。.

Publisher: الصحة العلائقية المبكرة: الابتكارات في مجال صحة الطفل من أجل التعزيز 
والفحص والبحث تعد التجارب العلائقية خلال مرحلة الرضاعة والطفولة المبكرة من 
المحركات الرئيسية لبناء الصحة ، والنمو العاطفي الاجتماعي ، وقدرات التعلم ، وكل 
منها أمر حيوي للرفاهية. تشترك قطاعات صحة الطفل في الولايات المتحدة في الالتزام 
بتعزيز الصحة الشاملة والوقاية والتدخل المبكر ، وحماس متزايد للأولوية المؤكدة 
بالبحث في تفاعلات مقدم الرعاية والطفل خلال الأيام الألف الأولى من حياة الطفل. 
نظرًا لتزايد أزمة الصحة النفسية للأطفال في بلادنا ، وصحوة العدالة العرقية ، 
والحاجة إلى إعادة تصور الدعم العادل للأسر الشابة بعد كوفيد 19 ، تسعى قطاعات صحة 
الطفل إلى أدوات وأساليب سريرية جديدة تجمع بين العلم وابتكارات الممارسة من خلال 
أنشطة يتم تطويرها بشكل مشترك مفيد للعائلات. يشمل هذا الفصل الخاص أبحاثاً حول 
رحلة الاكتشاف المشترك بين الباحثين والأطباء وأولياء الأمور أثناء تطوير وصقل 
أدوات فحص ومتابعة العلاقات الثنائية القائمة على الفيديو والمقابلات. تتناول 
الأبحاث مجموعة من الموضوعات بما في ذلك الصحة العلائقية المبكرة(ERH) ، وتطوير فحص 
الصحة العلائقية المبكرة والتحقق من صحتها ، وتطبيقها ضمن الأبحاث والسياقات 
الاكلينيكية ، والمناقشات المدروسة من وجهات نظر متعددة. بناءً على المبادئ 
المستنيرة للتنوع ، تسلط هذه الرحلة الضوء ليس فقط على المناهج المستنيرة بالعلم ، 
ولكن أيضًا على التطوير المشترك مع العائلات لمناهج عادلة لفهم وخدمة الأطفال 
ومقدمي الرعاية لهم.

© 2022 Michigan Association for Infant Mental Health.

DOI: 10.1002/imhj.21980
PMID: 35537061 [Indexed for MEDLINE]


2058. J Hosp Med. 2022 Apr;17(4):259-267. doi: 10.1002/jhm.12812. Epub 2022 Mar 24.

Wellness of hospitalists and hospital medicine advanced practice providers 
during the COVID-19 pandemic, 2020-2021.

Dugani SB(1)(2)(3), Fischer KM(4), Schroeder DR(4), Geyer HL(5), Maniaci MJ(6), 
Croghan IT(2)(3)(7)(8), Kashani D(1), Burton MC(1).

Author information:
(1)Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, 
USA.
(2)Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, 
Minnesota, USA.
(3)Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, 
USA.
(4)Department of Quantitative Health Sciences, Mayo Clinic, Rochester, 
Minnesota, USA.
(5)Division of Hospital Internal Medicine, Mayo Clinic, Scottsdale, Arizona, 
USA.
(6)Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida, 
USA.
(7)Department of Medicine, Division of General Internal Medicine, Mayo Clinic, 
Rochester, Minnesota, USA.
(8)Department of Medicine, Research Hub, Mayo Clinic, Rochester, Minnesota, USA.

BACKGROUND: The early phase of the coronavirus disease 2019 (COVID-19) pandemic 
had a negative impact on the wellness of hospitalists and hospital medicine 
advanced practice providers (APPs). However, the burden of the pandemic has 
evolved and the change in hospitalist and hospital medicine APP wellness is 
unknown.
OBJECTIVE: To evaluate the longitudinal trend in wellness of hospitalists and 
hospital medicine APPs during the COVID-19 pandemic and guide wellness 
interventions.
DESIGN, SETTING AND PARTICIPANTS: Between May 4, 2020, and June 6, 2021, we 
administered three surveys to Internal Medicine hospitalists (physicians) and 
hospital medicine APPs (nurse practitioners and physician assistants) at 16 Mayo 
Clinic hospitals in four U.S. states.
MEASUREMENTS: We evaluated the association of hospitalist and hospital medicine 
APP characteristics with PROMIS® measures of global wellbeing-mental health, 
global wellbeing-social activities and relationships, anxiety, social isolation, 
and emotional support, using logistic and linear regression models.
RESULTS: The response rates were 52.2% (n=154/295; May 2020), 37.1% (n=111/299; 
October 2020) and 35.5% (n=114/321; May 2021). In mixed models that included 
hospitalist and hospital medicine APP characteristics and survey period, APPs, 
compared with physicians, had lower odds of top global wellbeing-social 
activities and relationships (adjusted odds ratio 0.42 [0.22-0.82]; p = .01), 
whereas survey period showed no association. The survey period showed an 
independent association with higher anxiety (May 2020 vs. others) and higher 
social isolation (October 2020 vs. others), whereas profession showed no 
association. Concern about contracting COVID-19 at work was significantly 
associated with lower odds of top global wellbeing-mental health and global 
wellbeing-social activities and relationships, and with higher anxiety and 
social isolation. Hospitalist and hospital medicine APP characteristics showed 
no association with levels of emotional support.
CONCLUSIONS: In this longitudinal assessment of hospitalists and hospital 
medicine APPs, concern about contracting COVID-19 at work remained a determinant 
of wellness. The trend for global wellbeing, anxiety, and social isolation may 
guide wellness interventions.

© 2022 Society of Hospital Medicine.

DOI: 10.1002/jhm.12812
PMCID: PMC9088352
PMID: 35535916 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


2059. BMJ Open. 2022 May 9;12(5):e054506. doi: 10.1136/bmjopen-2021-054506.

How has physical distancing impacted on health and well-being during the 
COVID-19 pandemic? A Scottish longitudinal qualitative study.

Kotzur M(1), O'Connor RC(1), Robb KA(2).

Author information:
(1)Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
(2)Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK 
Katie.Robb@glasgow.ac.uk.

OBJECTIVES: This study provides an in-depth understanding of the impact of 
physical distancing restrictions and other quarantining measures during the 
first 6 months of the COVID-19 pandemic on physical and mental health and 
well-being.
DESIGN: Longitudinal qualitative research using semistructured interviews at two 
time points (21 May to 10 June 2020 when the first restrictions were eased, and 
2 to 26 August 2020 when many restrictions had been eased, but physical 
distancing measures remained) and framework analysis.
SETTING: Interviews by telephone or video call in Scotland.
PARTICIPANTS: Thirty participants: 16 women, 93% reporting white ethnicity, 18+ 
years, 47% from deprived areas, 47% reported mental and/or physical health 
conditions.
RESULTS: Four main themes described the impact of physical distancing 
restrictions on (1) health behaviours; (2) healthcare access; (3) physical 
health; and (4) mental health. Changes in impact over the two time points were 
compared. For example, health behaviours in May/June, such as reduced physical 
activity and increased calorie intake, appeared to improve by August. From 
May/June to August, an increasing number of participants expressed 
dissatisfaction with healthcare they received. Participants with existing 
physical health conditions reported continued negative impact of restrictions on 
their physical health. All participants reported some negative mental health 
impact, mostly anxiety. An increasing number reported mental health improvements 
in August, with those with mental health conditions or under 30 years reporting 
improvement most frequently.
CONCLUSIONS: In line with previous research, our participants felt able to 
return to prepandemic health habits. Our findings corroborate evidence of 
reduced preventive healthcare use and help-seeking behaviours. People with 
existing health conditions appear to be most vulnerable to negative mental and 
physical health impacts of physical distancing. These negative impacts and 
periods of unhealthy behaviours have potential long-term consequences, 
especially among already underserved groups. We recommend public health and 
policy strategies to mitigate long-term impacts of physical distancing.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-054506
PMCID: PMC9086282
PMID: 35534078 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2060. BMJ Open. 2022 May 9;12(5):e051887. doi: 10.1136/bmjopen-2021-051887.

Cohort profile: intimate partner violence and mental health among women from 
refugee background and a comparison group of Australian-born - the WATCH cohort 
study.

Rees S(1), Mohsin M(2)(3), Moussa B(2), Fisher J(4), Steel Z(2), Nadar N(2), 
Hassoun F(2), Khalil B(2), Youssef M(2), Krishna Y(2).

Author information:
(1)Discipline of Psychiatry, School of Clinical Medicine, Faculty of Medicine, 
University of New South Wales, Kensington Campus, Sydney, New South Wales, 
Australia s.j.rees@unsw.edu.au.
(2)Discipline of Psychiatry, School of Clinical Medicine, Faculty of Medicine, 
University of New South Wales, Kensington Campus, Sydney, New South Wales, 
Australia.
(3)Mental Health Research Unit, Liverpool Hospital, Sydney, New South Wales, 
Australia.
(4)Global and Women's Health Unit, Public Health and Preventive Medicine, Monash 
University, Clayton, Victoria, Australia.

PURPOSE: The Women Aware with Their Children study was created because 
prospective data are required to accurately guide prevention programmes for 
intimate partner violence (IPV) and to improve the mental health and 
resettlement trajectories of women from refugee backgrounds in Australia.
PARTICIPANTS: 1335 women (685 consecutively enrolled from refugee backgrounds 
and 650 randomly selected Australian-born) recruited during pregnancy from three 
public antenatal clinics in Sydney and Melbourne, Australia. The mean age was 
29.7 years among women from refugee backgrounds and 29.0 years among women born 
in the host nation. Main measures include IPV, mood, panic, post-traumatic 
stress disorder, disability and living difficulties.
FINDINGS TO DATE: Prevalence of IPV at all three time points is significantly 
higher for refugee-background women. The trend data showed that reported IPV 
rates among Australian-born women increased from 25.8% at time 1 to 30.1% at 
time 3, while for refugee-background women this rate declined from 44.4% at time 
1 to 42.6% at time 3. Prevalence of major depressive disorder (MDD) at all three 
time points is higher for refugee-background women. MDD among Australian-born 
women significantly declined from 14.5% at time 1 to 9.9% at time 3, while for 
refugee-background women it fluctuated from 25.1% at time 1 to 17.3% at time 2 
and to 19.1% at time 3.
FUTURE PLANS: We are currently examining trajectories of IPV and mental disorder 
across four time points. Time 4 occurred during the COVID-19 pandemic, enabling 
a unique opportunity to examine the impacts of the pandemic over time. Time 5 
started in August 2021 and time 6 will begin approximately 12 months later. The 
children at time 5 are in the early school years, providing the capacity to 
examine behaviour, development and well-being of the index child.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-051887
PMCID: PMC9086637
PMID: 35534066 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2061. BMJ Open Qual. 2022 May;11(2):e001643. doi: 10.1136/bmjoq-2021-001643.

Recording and evaluating affect and coping during COVID-19 in healthcare workers 
and outcomes (REACCH-Out): mental health implications for our junior doctor 
cohort.

Akbar S(1), McNally S(2).

Author information:
(1)Burns and Plastic Surgery, Wythenshawe Hospital, Manchester, UK 
sarah.akbar@doctors.org.uk.
(2)Burns and Plastic Surgery, Wythenshawe Hospital, Manchester, UK.

The announcement of the COVID-19 pandemic in March 2020 had a huge impact on 
surgical practice in the UK. Many surgical trainees were redeployed to areas 
within the hospital to provide additional cover during this time. Providing 
adequate well-being and support to trainees is imperative during such times of 
hardship.18 plastic surgery junior doctors were redeployed to either intensive 
care units, emergency departments or medical wards during the period of 
intervention. A 2-3 weekly quantitative survey was completed by trainees which 
aimed to explore rates of anxiety, depression and coping during the first peak 
of the pandemic. A 'COVID-19 Care Package' was provided and regular interactions 
with the parent team was encouraged via the online platform of Zoom to support 
surgical junior doctors.The average anxiety score for trainees exceeded that 
regarded as 'normal' as predicted by the Hospital Anxiety and Depression Scale. 
Core surgical-level trainees were found to show higher scores of anxiety and 
depression throughout the course of project as compared with their senior 
specialty registrar counterparts. 43.8% of junior doctors reported greater 
levels of stress since the announcement of the pandemic. 81% of junior doctors 
stated they would value regular check-ins with work colleagues during difficult 
times.Providing a strong support system for trainees is vital to ensure doctors 
are not overwhelmed during potentially volatile times in their careers. The use 
of psychological monitoring tools to guide the implementation of appropriate 
levels of support for individuals could aid in enhanced junior doctor well-being 
and support. Feedback from surveys during this time of study suggests that 
surgical trainees agree that contact with their parent team and colleagues has a 
positive impact on their well-being and trainees value regular 'check-ins' with 
their colleagues on a monthly basis.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjoq-2021-001643
PMCID: PMC9086280
PMID: 35534040 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2062. J Int Med Res. 2022 May;50(5):3000605221097478. doi: 10.1177/03000605221097478.

Care models for mental health in a population of patients affected by COVID-19.

Maresca G(1), Formica C(1), De Cola MC(1), Lo Buono V(1), Latella D(1), Cimino 
V(1), Carnazza L(1), Giambò FM(1), Parasporo N(1), Bramanti A(2), Corallo F(1).

Author information:
(1)IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy.
(2)Department of Medicine Surgery and Dentistry 'Salerno Medical School', 
University of Salerno, Fisciano, Italy.

OBJECTIVE: Emergency psychological interventions are needed in patients with 
COVID-19. During the pandemic, psychological counseling services have been 
provided using online platforms to address adverse psychological impacts and 
symptoms in patients and the general population. We investigated the effects of 
telepsychotherapy on emotional well-being and psychological distress in patients 
affected by COVID-19.
METHODS: Forty-five Sicilian patients who had contracted COVID-19 joined 
"Telecovid Sicilia" from March to June 2020. Participants completed 
self-assessment questionnaires and psychological testing to measure levels of 
anxiety, presence of depressive symptoms, and altered circadian rhythm with 
consequent sleep disorders and psychological distress. Individual 
telepsychotherapy services were provided for 1 hour, twice a week, for 16 
sessions in total.
RESULTS: We enrolled 45 patients (42.2% women). We found significant changes 
between baseline and the end of follow-up in all outcome measures, especially 
depression (χ2 (1) = 30.1; effect size [ES] = 0.82), anxiety (χ2 (1) = 37.4; 
ES = 0.91), and paranoid ideation (χ2 (1) = 5.6; ES = 0.35). The proportion of 
participants with sleep disorders decreased to 84.1% after intervention (χ2 
(1) = 58.6; ES = 1.14).
CONCLUSION: A telepsychotherapeutic approach showed promising effects on 
psychological symptoms, with significantly reduced patient anxiety and 
depression.

DOI: 10.1177/03000605221097478
PMCID: PMC9092593
PMID: 35531918 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of conflicting interest: The authors 
declare that there is no conflict of interest.


2063. Psychol Rep. 2023 Dec;126(6):2729-2756. doi: 10.1177/00332941221100451. Epub 
2022 May 9.

Social and Psychological Effects of COVID-19 Pandemic on Adolescents' and Young 
Adults' Mental Health: A Cross-Cultural Mediation Study.

Schoeps K(1), Tamarit A(1), De la Barrera U(1), Lacomba-Trejo L(1), 
Montoya-Castilla I(1), Del Rosario C(2), Coello F(3), Herrera S(3), Trujillo 
Á(4), Riveros Munevar F(4), Amador Esparza NA(5).

Author information:
(1)Department of Personality, Psychological Assessment and Treatment, 
Universitat de València, Valencia, Spain.
(2)Fundación Relaciones Inteligentes, Santiago, Chile.
(3)Department of Clinical Psychology, Universidad de Azuay, Cuenca, Ecuador.
(4)Department of Psychology, Universidad de La Sabana, Chía, Colombia.
(5)Department of Social Sciences, Universidad Autónoma de Ciudad Juárez, Ciudad 
Juárez, Mexico.

The ongoing pandemic has dramatically disrupted daily life, increasing the risk 
of developing psychiatric disorders and poor mental wellbeing. The compound 
effects of social, political and psychological stressors have increased 
psychological symptoms among adolescents and young people, with worries about 
COVID-19 playing a central role in the clinical course of their mental health 
problems caused by the pandemic. The aim of this cross-cultural study was to 
examine the social psychological effects of COVID-19 on adolescents' and young 
people's mental health and wellbeing in Ibero-American population. Participants 
involved 6,283 adolescents and young adults from five different Spanish-Speaking 
countries (83.7% female) aged between 12 and 30 years (M = 18.79; SD = 3.48). 
Participants completed the Worries about COVID-19 and its Consequences Scale 
(W-COV), the Satisfaction with Life Scale (SWLS), and the Depression, Anxiety 
and Stress Scale (DASS-21). Descriptive analyses, multivariate ANOVAs and 
Pearson correlations were performed, as well as Structural Equation Modelling 
(SEM) testing a mediational model. The results indicate cross-cultural 
difference in COVID-19 related worries, emotional symptoms and life 
satisfaction. Results from SEM confirmed the overall indirect effects of 
COVID-19 cases, political response and participants' conditions during lockdown 
on depression, anxiety, stress and life satisfaction mediated by COVID-19 
related worries. These findings suggest that the social psychological factors 
underlying psychological symptoms could be partly explained by increased worries 
about COVID-19 and its personal, social, economic and political consequences, 
which may offer guidance to policy makers and health services for safeguarding 
youth mental well-being.

DOI: 10.1177/00332941221100451
PMCID: PMC9098395
PMID: 35531784 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting InterestsThe 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


2064. Acad Emerg Med. 2022 Jul;29(7):851-861. doi: 10.1111/acem.14519. Epub 2022 May 
22.

The perceived work environment and well-being: A survey of emergency health care 
workers during the COVID-19 pandemic.

Blanchard J(1), Li Y(2), Bentley SK(3), Lall MD(4), Messman AM(5), Liu YT(6), 
Diercks DB(7), Merritt-Recchia R(8), Sorge R(9), Warchol JM(10), Greene C(11), 
Griffith J(12), Manfredi RA(1), McCarthy M(13).

Author information:
(1)Department of Emergency Medicine, George Washington University School of 
Medicine and Health Sciences, Washington, District of Columbia, USA.
(2)Department of Health Policy, Milken Institute School of Public Health, George 
Washington University, Washington, District of Columbia, USA.
(3)Departments of Emergency Medicine & Medical Education, Icahn School of 
Medicine at Mount Sinai, New York City Health+Hospitals/Elmhurst, New York, New 
York, USA.
(4)Department of Emergency Medicine, Emory University School of Medicine, 
Atlanta, Georgia, USA.
(5)Department of Emergency Medicine, Wayne State University School of Medicine, 
University Health Center-6G, Detroit, Michigan, USA.
(6)Department of Emergency Medicine, David Geffen School of Medicine at UCLA, 
Harbor-UCLA Medical Center, Torrance, California, USA.
(7)Department of Emergency Medicine, University of Texas, Dallas, Texas, USA.
(8)Department of Emergency Medicine, Alpert Medical School of Brown University, 
Providence, Rhode Island, USA.
(9)Department of Emergency Medicine, Louisiana State University Spirit of 
Charity Emergency Medicine Residency Program, New Orleans, Louisiana, USA.
(10)Department of Emergency Medicine, University of Nebraska Medical Center, 
Omaha, Nebraska, USA.
(11)Department of Emergency Medicine, University of Alabama at Birmingham, 
Birmingham, Alabama, USA.
(12)Department of Psychiatry, George Washington University School of Medicine 
and Health Sciences, Washington, District of Columbia, USA.
(13)Departments of Health Policy and Emergency Medicine, Milken Institute School 
of Public Health, George Washington University, Washington, District of 
Columbia, USA.

BACKGROUND: During the COVID-19 pandemic, health care provider well-being was 
affected by various challenges in the work environment. The purpose of this 
study was to evaluate the relationship between the perceived work environment 
and mental well-being of a sample of emergency physicians (EPs), emergency 
medicine (EM) nurses, and emergency medical services (EMS) providers during the 
pandemic.
METHODS: We surveyed attending EPs, resident EPs, EM nurses, and EMS providers 
from 10 academic sites across the United States. We used latent class analysis 
(LCA) to estimate the effect of the perceived work environment on screening 
positive for depression/anxiety and burnout controlling for respondent 
characteristics. We tested possible predictors in the multivariate regression 
models and included the predictors that were significant in the final model.
RESULTS: Our final sample included 701 emergency health care workers. Almost 23% 
of respondents screened positive for depression/anxiety and 39.7% for burnout. 
Nurses were significantly more likely to screen positive for depression/anxiety 
(adjusted odds ratio [aOR] 2.04, 95% confidence interval [CI] 1.11-3.86) and 
burnout (aOR 2.05, 95% CI 1.22-3.49) compared to attendings. The LCA analysis 
identified four subgroups of our respondents that differed in their responses to 
the work environment questions. These groups were identified as Work Environment 
Risk Group 1, an overall good work environment; Risk Group 2, inadequate 
resources; Risk Group 3, lack of perceived organizational support; and Risk 
Group 4, an overall poor work environment. Participants in the two groups who 
perceived their work conditions as most adverse were significantly more likely 
to screen positive for depression/anxiety (aOR 1.89, 95% CI 1.05-3.42; and 
aOR 2.04, 95% CI 1.14-3.66) compared to participants working in environments 
perceived as less adverse.
CONCLUSIONS: We found a strong association between a perceived adverse working 
environment and poor mental health, particularly when organizational support was 
deemed inadequate. Targeted strategies to promote better perceptions of the 
workplace are needed.

© 2022 Society for Academic Emergency Medicine.

DOI: 10.1111/acem.14519
PMCID: PMC9347760
PMID: 35531649 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interests to 
disclose.


2065. Work. 2022;73(1):3-27. doi: 10.3233/WOR-220062.

COVID-19 pandemic-related anxiety, stress, and depression among teachers: A 
systematic review and meta-analysis.

Ma K(1), Liang L(2), Chutiyami M(2)(3), Nicoll S(4), Khaerudin T(2)(5), Ha 
XV(6)(7).

Author information:
(1)Jiangsu Provincial Key Constructive Laboratory for Big Data of Psychology and 
Cognitive Science, Yancheng Teachers University, Yancheng, Jiangsu, China.
(2)School of Education, Macquarie University, Sydney, Australia.
(3)School of Nursing, Institute of Health & Management, Sydney, Australia.
(4)School of Education, Excelsia College, Sydney, Australia.
(5)Faculty of Education, UIN Syarif Hidayatullah, Jakarta, Indonesia.
(6)Department of Linguistics, Faculty of Medicine, Health and Human Sciences, 
Macquarie University, Sydney, Australia.
(7)Department of Foreign Languages, Ha Tinh University, Ha Tinh, Vietnam.

BACKGROUND: As millions of teachers have been forced to rely upon remote 
teaching due to the closure of schools during the COVID-19 pandemic. It is 
particularly important to understand the extent to which teacher's psychological 
wellbeing has been affected by this global health crisis.
OBJECTIVE: The aim of this comprehensive systematic review and meta-analysis was 
twofold: 1) ascertain the prevalence of stress, anxiety, depression among 
teachers during the COVID-19 outbreak; 2) identify the associated factors of 
these psychological wellbeing domains of the teachers.
METHODS: Academic Search Premier, Eric, PsycInfo, Scopus, and Web of Science 
were searched for articles published from December 2019 and July 2021, using 
search terms including "COVID-19" "anxiety" "depression" "stress", and 
"teachers".
RESULTS: This study included 54 studies synthesising data from 256,896 teachers 
across 22 countries. The meta-analysis showed higher prevalence of stress 
(62.6%, 95% Confidence Interval [CI]: 46.1-76.6), compared to anxiety (36.3%, 
95% CI: 28.5-44.9) and depression (59.9%, 95% CI: 43.4-74.4) among teachers. 
Teachers' experiences of these psychological issues were associated with various 
socio-demographic and institutional factors, including gender, nature of online 
teaching, job satisfaction, teaching experience, and the volume of workload. 
Additionally, several protective factors, such as regular exercises and 
provision of technical support for online teaching, reduced teachers' negative 
psychological experiences.
CONCLUSION: There is a need for authorities to formulate educational policies to 
improve teachers' wellbeing at the time of global crisis. Special attention 
should be paid to assist female teachers in overcoming physical and mental 
stressors.

DOI: 10.3233/WOR-220062
PMID: 35527618 [Indexed for MEDLINE]


2066. Crit Care Nurse. 2022 Aug 1;42(4):20-26. doi: 10.4037/ccn2022769.

Unmasking the Truth of Health Care Workers' Well-being During the COVID-19 
Pandemic.

Bucca A(1), Ullrich L(2), Rahman A(3), Smith C(4), Johnson M(5), Allanson-Dundon 
A(6), Corwin D(7), James JA(8), Marchionni C(9), Bratis L(10), Bendas E(11).

Author information:
(1)Anthony Bucca is a second-year resident in psychiatry, St. Luke's University 
Health Network, Bethlehem, Pennsylvania.
(2)Lauryn Ullrich is an associate in general and acute care surgery, St. Luke's 
University Health Network.
(3)Awan Rahman is a pulmonary critical care fellow, St. Luke's University Health 
Network.
(4)Christopher Smith is an associate, Palliative & Supportive Care, St. Luke's 
University Health Network.
(5)Monica Johnson is the lead social worker, Palliative & Supportive Care, St. 
Luke's University Health Network.
(6)Amie Allanson-Dundon is a licensed psychotherapist practicing in Pennsylvania 
and New Jersey, and the Network Director for Clinical Therapy Services, St. 
Luke's University Health Network.
(7)Douglas Corwin is the Associate Program Director of the Pulmonary & Critical 
Care Medicine Fellowship; an associate, Pulmonary & Critical Care; and the 
Director of Research Informatics, St. Luke's University Health Network.
(8)James A. James III is the Vice Chair of Behavioral Health, core clinical 
faculty for residency, the TMS Medical Director, and an adult psychotherapist, 
St. Luke's University Health Network.
(9)Christine Marchionni is the Program Director for the Psychiatry Residency 
Program, St. Luke's University Health Network.
(10)Livia Bratis is the Section Chief of Pulmonary and Critical Care Medicine, 
St. Luke's University Health Network, and an assistant professor, Temple 
University School of Medicine, Philadelphia, Pennsylvania.
(11)Erin Bendas is the Section Chief of the Palliative & Supportive Care 
Department and the Program Director of the Hospice & Palliative Medicine 
Fellowship, St. Luke's University Health Network.

BACKGROUND: Burnout is a well-documented multifactorial phenomenon that affects 
up to 47% of intensive care unit staff at some point in their career. The 
literature highlights increased rates of anxiety, depression, and posttraumatic 
stress disorder among staff as a result of the COVID-19 pandemic.
LOCAL PROBLEM: Following the second and, at the time of writing, largest surge 
of the COVID-19 pandemic, concern for staff 's mental health prompted a 
hospital-wide study to assess depression, anxiety, posttraumatic stress 
disorder, and alcohol misuse and to determine the use and effectiveness of 
employee resources.
METHODS: Through REDCap, 212 intensive care unit employees were surveyed with 
validated screening tools for depression, anxiety, posttraumatic stress 
disorder, and alcohol misuse. The use and perceived effectiveness of hospital 
initiatives were assessed.
RESULTS: A total of 212 surveys were evaluated. Among respondents, 54% 
experienced mild anxiety, more than 50% screened positive for mild depression, 
and 37% screened positive for posttraumatic stress disorder. Most employees 
(74.5%) were aware of at least 1 resource; 37% knew of the COVID-19 newsletter, 
one of the top resources highlighted in the survey. Perceived effectiveness of 
resources ranged from 0.9% (disaster helpline) to 82.5% (prayers, readings, and 
the on-call chaplain-all "somewhat helpful"). The results correlate with the 
progressive trend of increased mental health concerns among intensive care unit 
employees. Survey results prompted an expansion of hospital resources.
CONCLUSIONS: COVID-19 has brought unique mental health challenges and stressors 
to intensive care unit staff. By adapting and expanding resources, hospitals can 
improve staff resiliency and mitigate some mental health concerns with the aim 
of decreasing the overall psychological impact of the pandemic.

©2022 American Association of Critical-Care Nurses.

DOI: 10.4037/ccn2022769
PMID: 35526846 [Indexed for MEDLINE]


2067. J Clin Psychol Med Settings. 2022 Sep;29(3):509-537. doi: 
10.1007/s10880-022-09880-x. Epub 2022 May 8.

A Systematic Review of the Factors Associated with Post-Traumatic Growth in 
Parents Following Admission of Their Child to the Intensive Care Unit.

O'Toole S(1), Suarez C(2), Adair P(2), McAleese A(3), Willis S(3), McCormack 
D(2).

Author information:
(1)School of Psychology, Queen's University Belfast, David Keir Building, 18-30 
Malone Road, Belfast, BT9 5BN, UK. sotoole05@qub.ac.uk.
(2)School of Psychology, Queen's University Belfast, David Keir Building, 18-30 
Malone Road, Belfast, BT9 5BN, UK.
(3)Clinical Psychology Department, Royal Belfast Hospital for Sick Children, 
Belfast, UK.

This systematic review aims to identify the demographic, clinical and 
psychological factors associated with post-traumatic growth (PTG) in parents 
following their child's admission to the intensive care unit (ICU). Papers 
published up to September 2021 were identified following a search of electronic 
databases (PubMed, Medline, Web of Science, PsycINFO, CINAHL, PTSDpubs and 
EMBASE). Studies were included if they involved a sample of parents whose 
children were previously admitted to ICU and reported correlational data. 1777 
papers were reviewed. Fourteen studies were eligible for inclusion; four were 
deemed to be of good methodological quality, two were poor, and the remaining 
eight studies were fair. Factors associated with PTG were identified. Mothers, 
and parents of older children, experienced greater PTG. Parents who perceived 
their child's illness as more severe had greater PTG. Strong associations were 
uncovered between PTG and post-traumatic stress, psychological well-being and 
coping. PTG is commonly experienced by this population. Psychological factors 
are more commonly associated with PTG in comparison with demographic and 
clinical factors, suggesting that parents' subjective ICU experience may be 
greater associated with PTG than the objective reality.

© 2022. The Author(s).

DOI: 10.1007/s10880-022-09880-x
PMCID: PMC9399044
PMID: 35526209 [Indexed for MEDLINE]

Conflict of interest statement: S. O.’ Toole, C. Suarez, P. Adair, A. McAleese, 
S. Willis, D. McCormack have no known conflict of interest associated with this 
systematic review.


2068. Int J Nurs Stud. 2022 Jul;131:104242. doi: 10.1016/j.ijnurstu.2022.104242. Epub 
2022 Apr 3.

'You can't walk through water without getting wet' UK nurses' distress and 
psychological health needs during the Covid-19 pandemic: A longitudinal 
interview study.

Maben J(1), Conolly A(2), Abrams R(2), Rowland E(3), Harris R(3), Kelly D(4), 
Kent B(5), Couper K(6); Impact of Covid On Nurses (ICON) Survey Research Group.

Author information:
(1)University of Surrey, United Kingdom. Electronic address: 
j.maben@surrey.ac.uk.
(2)University of Surrey, United Kingdom.
(3)King's College London, United Kingdom.
(4)Cardiff University, United Kingdom.
(5)University of Plymouth, United Kingdom.
(6)University of Warwick and University Hospitals Birmingham NHS Foundation 
Trust, United Kingdom.

BACKGROUND: Pre-COVID-19 research highlighted the nursing profession worldwide 
as being at high risk from symptoms of burnout, post-traumatic stress disorder 
(PTSD) and suicide. The World Health Organization declared a pandemic on 11th 
March 2020 due to the sustained risk of further global spread of COVID-19. The 
high healthcare burden associated with COVID-19 has increased nurses' trauma and 
workload, thereby exacerbating pressure on an already strained workforce and 
causing additional psychological distress for staff.
OBJECTIVES: The Impact of COVID-19 on Nurses (ICON) interview study examined the 
impacts of the pandemic on frontline nursing staff's psychosocial and emotional 
wellbeing.
DESIGN: Longitudinal qualitative interview study.
SETTINGS: Nurses who had completed time 1 and 2 of the ICON survey were sampled 
to include a range of UK work settings including acute, primary and community 
care and care homes. Interviewees were purposively sampled for maximum variation 
to cover a broad range of personal and professional factors, and experiences 
during the COVID-19 pandemic, including redeployment.
METHODS: Nurses participated in qualitative in-depth narrative interviews after 
the first wave of COVID-19 in July 2020 (n = 27) and again at the beginning of 
the second wave in December 2020 (n = 25) via video and audio platform software. 
Rigorous qualitative narrative analysis was undertaken both cross-sectionally 
(within wave) and longitudinally (cross wave) to explore issues of consistency 
and change.
RESULTS: The terms moral distress, compassion fatigue, burnout and PTSD describe 
the emotional states reported by the majority of interviewees leading many to 
consider leaving the profession. Causes of this identified included care 
delivery challenges; insufficient staff and training; PPE challenges and 
frustrations. Four themes were identified: (1) 'Deathscapes' and impoverished 
care (2) Systemic challenges and self-preservation (3) Emotional exhaustion and 
(4) (Un)helpful support.
CONCLUSIONS: Nurses have been deeply affected by what they have experienced and 
report being forever altered with the impacts of COVID-19 persisting and deeply 
felt. There is an urgent need to tackle stigma to create a psychologically safe 
working environment and for a national COVID-19 nursing workforce recovery 
strategy to help restore nurse's well-being and demonstrate a valuing of the 
nursing workforce and therefore support retention.

Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.ijnurstu.2022.104242
PMCID: PMC8976696
PMID: 35525086 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


2069. Eur Child Adolesc Psychiatry. 2023 Jun;32(6):1097-1107. doi: 
10.1007/s00787-022-01982-z. Epub 2022 May 7.

The Grow It! app-longitudinal changes in adolescent well-being during the 
COVID-19 pandemic: a proof-of-concept study.

Dietvorst E(1), Legerstee JS(#)(2), Vreeker A(#)(2), Koval S(2), Mens MM(3), 
Keijsers L(#)(4), Hillegers MHJ(#)(2).

Author information:
(1)Department of Child and Adolescents Psychiatry/Psychology Erasmus MC Sophia, 
Children's Hospital, Erasmus University Medical Center, Rotterdam, The 
Netherlands. e.dietvorst@erasmusmc.nl.
(2)Department of Child and Adolescents Psychiatry/Psychology Erasmus MC Sophia, 
Children's Hospital, Erasmus University Medical Center, Rotterdam, The 
Netherlands.
(3)Department of Epidemiology, Harvard T.H. Chan School of Public Health, 
Boston, USA.
(4)Department of Psychology, Education and Child Studies, Erasmus School of 
Social and Behavioural Sciences, Rotterdam, The Netherlands.
(#)Contributed equally

Adolescent mental health and well-being have been adversely impacted by the 
COVID-19 pandemic. In this preregistered longitudinal study, we evaluated 
whether adolescents' well-being improved after playing the multiplayer serious 
game app Grow It! During the first lockdown (May-June 2020), 1282 Dutch 
adolescents played the Grow It! app (age = 16.67, SD = 3.07, 68% girls). During 
the second lockdown (December-May 2020 onwards), an independent cohort of 1871 
adolescents participated (age = 18.66, SD = 3.70, 81% girls). Adolescents 
answered online questionnaires regarding affective and cognitive well-being, 
depressive symptoms, anxiety, and impact of COVID-19 at baseline. Three to six 
weeks later, the baseline questionnaire was repeated and user experience 
questions were asked (N = 462 and N = 733 for the first and second cohort). In 
both cohorts, affective and cognitive well-being increased after playing the 
Grow It! app (t = - 6.806, p < 0.001; t = - 6.77, p < 0.001; t = - 6.12, 
p < 0.001; t = - 5.93, p < 0.001; Cohen's d range 0.20-0.32). At the individual 
level, 41-53% of the adolescents increased in their affective or cognitive 
well-being. Adolescents with higher risk profiles (i.e., more depressive 
symptoms, lower atmosphere at home, and more COVID-19 impact) improved more 
strongly in their well-being. Positive user evaluations and app engagement were 
unrelated to changes in affective and cognitive well-being. This 
proof-of-concept study tentatively suggests that Grow It! supported adolescents 
during the pandemic.

© 2022. The Author(s).

DOI: 10.1007/s00787-022-01982-z
PMCID: PMC9076805
PMID: 35524826 [Indexed for MEDLINE]

Conflict of interest statement: On behalf of all authors, the corresponding 
author states that there is no conflict of interest.


2070. Health Soc Care Community. 2022 Nov;30(6):e4332-e4344. doi: 10.1111/hsc.13826. 
Epub 2022 May 6.

Differential impacts of COVID-19 and associated responses on the health, social 
well-being and food security of users of supportive social and health programs 
during the COVID-19 pandemic: A qualitative study.

Mejia-Lancheros C(1)(2), Alfayumi-Zeadna S(1)(3), Lachaud J(1)(2), O'Campo 
P(1)(4), Gogosis E(1), Da Silva G(1), Stergiopoulos V(5)(6), Hwang SW(1)(7), 
Thulien N(1)(4).

Author information:
(1)MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. 
Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.
(2)Research Group in Nursing Care and Practice, Family Health Nursing and Health 
Measures; Nursing Faculty, Universidad Nacional de Colombia, Bogotá, Colombia.
(3)Center for Women's Health Studies and Promotion, Ben-Gurion University of the 
Negev, Beer-Sheva, Israel.
(4)Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, 
Canada.
(5)Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
(6)Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
(7)Division of General Internal Medicine, Department of Medicine, University of 
Toronto, Toronto, Ontario, Canada.

The effects of the coronavirus disease-2019 (COVID-19) pandemic on the lives of 
underserved populations are underexplored. This study aimed to identify the 
impacts of the COVID-19 pandemic and associated public health responses on the 
health and social well-being, and food security of users of Housing First (HF) 
services in Toronto (Canada) during the first wave of the COVID-19 pandemic. 
This qualitative descriptive study was conducted from July to October 2020 in a 
subsample of 20 adults with a history of homelessness and serious mental 
disorders who were receiving HF services in Toronto. A semi-structured interview 
guide was used to collect narrative data regarding health and social well-being, 
food security and access to health, social and preventive services. A thematic 
analysis framework guided analyses and interpretation of the data. The COVID-19 
pandemic and response measures had a variable impact on the health, social 
well-being and food security of participants. Around 40% of participants were 
minimally impacted by the COVID-19 pandemic. Conversely, among the remaining 
participants (impacted group), some experienced onset of new mental health 
problems (anxiety, stress, paranoia) or exacerbation of pre-existing mental 
disorders (depression, post-traumatic stress disorder and obsessive-compulsive 
disorder). They also struggled with isolation and loneliness and had limited 
leisure activities and access to food goods. The pandemic also contributed to 
disparities in accessing and receiving healthcare services and treatment 
continuity for non-COVID-19 health issues for the negatively impacted 
participants. Overall, most participants were able to adhere to COVID-19 public 
health measures and get reliable information on COVID-19 preventive measures 
facilitated by having access to the phone, internet and media devices and 
services. In conclusion, the COVID-19 pandemic and associated response measures 
impacted the health, social well-being, leisure and food security of people with 
experiences of homelessness and mental disorders who use supportive social and 
housing services in diverse ways.

© 2022 John Wiley & Sons Ltd.

DOI: 10.1111/hsc.13826
PMCID: PMC9347945
PMID: 35524402 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


2071. BMJ Open. 2022 May 6;12(5):e057467. doi: 10.1136/bmjopen-2021-057467.

Social and psychological impact of the COVID-19 pandemic on UK medical and 
nursing students: protocol for a national medical and nursing student survey.

Richardson GE(#)(1), Gillespie CS(#)(2), Mantle O(3), Clynch A(4), Ooi SZY(5), 
Park JJ(6), Bligh ER(7), Kundu S(8), Georgiou I(9), Bandyopadhyay S(10), 
Saunders KE(11)(12); Neurology and Neurosurgery Interest Group (NANSIG); 
SPICE-20 Collaborative.

Collaborators: Gillespie CS, Bligh ER, Bandyopadhyay S, Park JJ, Ooi SZY, 
Richardson GE, Clynch A, Burton O, Shanbhag A, Steinruecke M, Bolton W, Kewlani 
B, Touzet AY, Redpath H, Lee SH, Egiz A, Erhabor J, Mantle O, Adegboyega G, 
Bandyopadhyay S, Bashir MT, Bahu P, Bligh E, Burton O, Cantwell Y, Ciuculete C, 
Clynch A, Davies G, Deepak A, Koning R, Dilip R, Ferreira T, Georgiou I, 
Gnanakumar S, Golash A, Gillespie CS, Ghazi H, Gupta R, Henriques LD, Henshall 
D, Hess T, Hutton D, Isleyen N, Khalil F, Khan M, Kundu S, Lerou E, Lowe C, 
Mantle O, Ooi SZY, Padilla MS, Park JJ, Porter J, Redpath H, Richardson GE, 
Rizaam S, Saunders KEA, Selvakumar J, Sharma I, Schranz A, Wong A, Wilcha R.

Author information:
(1)Institute of Translational Medicine, University of Liverpool School of 
Medicine, Liverpool, UK.
(2)Institute of Systems, Molecular and Integrative Biology, University of 
Liverpool, Liverpool, UK hlcgill2@liv.ac.uk.
(3)Faculty of Life Sciences and Medicine, King's College London, London, UK.
(4)Institute of Systems, Molecular and Integrative Biology, University of 
Liverpool, Liverpool, UK.
(5)Cardiff University School of Medicine, Cardiff, UK.
(6)The University of Edinburgh Medical School, Edinburgh, UK.
(7)School of Medicine, The University of Sheffield, Sheffield, UK.
(8)School of Medicine, University of Liverpool, Liverpool, UK.
(9)School of Medicine, University of Aberdeen, Aberdeen, UK.
(10)Oxford University Medical School, University of Oxford, Oxford, UK.
(11)Department of Psychiatry, University of Oxford, Oxford, UK.
(12)Oxford Health NHS Foundation Trust, Oxford, UK.
(#)Contributed equally

INTRODUCTION: Healthcare students have played a significant role in the National 
Health Service during the COVID-19 pandemic. We captured data on the well-being 
of medical students during the acute phase of the pandemic with the Social and 
Psychological Impact of COVID-19 on medical students: a national survey 
Evaluation (SPICE-19) study. We will evaluate changes in mental health and 
well-being of medical and nursing students 1 year after SPICE-19, in a 
cross-sectional study, to understand the impact of the pandemic, and inform 
well-being policies.
METHODS AND ANALYSIS: This study will be a national, multi-institution, 
cross-discipline study. An online 53-item survey of demographics, mental health 
and well-being will be used to record responses. Students studying for a medical 
or nursing degree at any UK universities will be eligible to participate. The 
survey will be advertised through the Neurology and Neurosurgery Interest Group 
national network. Participation is anonymous and voluntary, with relevant mental 
health resources made available to participants.
ETHICS AND DISSEMINATION: Ethical approval was granted by the University of 
Oxford Central University Research Ethics Committee (R75719/RE001) on 21 May 
2021. Study findings will be presented at national and international meetings, 
and submitted for publication in a peer-reviewed journal.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/bmjopen-2021-057467
PMCID: PMC9082730
PMID: 35523504 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2072. J Community Psychol. 2023 Jul;51(6):2495-2508. doi: 10.1002/jcop.22864. Epub 
2022 May 6.

Utilizing a CBPR approach to assess the impact of COVID-19 on individuals who 
receive publicly funded behavioral health services.

Grant N(1), Byrd R(2), Forlano R(2), Olsen S(2), Youins R(2), Sernyak MJ(3), 
Fulara D(1), Kaufman JS(1).

Author information:
(1)Department of Psychiatry, Division of Prevention and Community Research, Yale 
University School of Medicine, Yale University, New Haven, Connecticut, USA.
(2)The Consultation Center, New Haven, Connecticut, USA.
(3)Department of Psychiatry, Yale University School of Medicine, New Haven, 
Connecticut, USA.

The coronavirus disease pandemic has highlighted significant gaps in community 
mental health services, placing vulnerable individuals at greater risk for 
mental health and substance use difficulties via disrupting their wellness 
journey. Guided by a wellness framework, a needs assessment was conducted among 
adult consumers of behavioral health services to understand their needs during 
the pandemic and to help develop and strengthen service delivery strategies. A 
team of three university researchers and four Consumer Researchers, who receive 
services at a publicly funded community mental health center, engaged in a 
community-based participatory project in which 13 focus groups were conducted 
with 51 consumers. Several themes emerged from a thematic analysis of 
transcripts regarding consumer well-being and healthcare needs, coping 
strategies employed, and the accessibility, benefits, and perception of clinical 
and support services during the pandemic. Results highlighted strengths in 
service delivery and areas in need of enhancement. Findings may inform similar 
community services that seek to enhance delivery of care among vulnerable 
populations.

© 2022 Wiley Periodicals LLC.

DOI: 10.1002/jcop.22864
PMCID: PMC9347813
PMID: 35521662 [Indexed for MEDLINE]


2073. J Sex Med. 2022 Jun;19(6):923-932. doi: 10.1016/j.jsxm.2022.03.607. Epub 2022 
May 2.

Longitudinal Impact of Social Restrictions on Sexual Health in the Italian 
Population.

Vedovo F(1), Capogrosso P(2), Di Blas L(3), Cai T(4), Arcaniolo D(5), Privitera 
S(6), Palumbo F(7), Palmieri A(8), Trombetta C(9).

Author information:
(1)Urology Clinic, Department of Medical, Surgical and Health Science, 
University of Trieste, Trieste, Italy. Electronic address: 
francesca.vedovo@gmail.com.
(2)Department of Urology and Andrology, Ospedale di Circolo and Macchi 
Foundation, Varese, Italy.
(3)Department of Life Sciences, University of Trieste, Italy.
(4)Department of Urology, Santa Chiara Regional Hospital, Trento, Italy.
(5)Unit of Urology, Luigi Vanvitelli University of Campania, Naples, Italy.
(6)A.O.U. Policlinico San Marco, P.O. "G. Rodolico", Catania, Italy.
(7)Department of Urology, Di Venere Hospital, Bari, Italy.
(8)Department of Urology, University of Naples Federico II, Naples, Italy.
(9)Urology Clinic, Department of Medical, Surgical and Health Science, 
University of Trieste, Trieste, Italy.

BACKGROUND: Several trials have reported on the impact of social restrictions 
due to SARS-CoV-2 (COVID-19) pandemic on sexual function and psycho-physical 
well-being. However, data showing modifications of these outcomes over time and 
at the end of lock-down are scant.
AIM: We investigated the longitudinal changes in sexual function during social 
restrictions for COVID-19 pandemic in Italy.
METHODS: A web-based survey was administered to Italian citizens of legal age 
via social networks. The Beck Depression Inventory Primary Care, the General 
Health Survey, Female Sexual Function Index, International Index of Erectile 
Function, UCLA Loneliness Scale-version 3 questionnaires were used to test 
mental, physical and sexual well-being. The questionnaires were administered at 
the beginning of the lockdown (T0), 15 days from the first assessment (T1) and 1 
month after the end of the restrictions in 2020 (T2).
OUTCOMES: Descriptive statistics and multiple regression analysis were applied 
to investigate changes in sexual function over and at the end of social 
restrictions.
RESULTS: Data were available for 2543 people (47.2% of men; 43.4% women; 9.4% 
undefined). Mean age was 48.3 ± 15.1 years for males and 43.9 ± 13.4 for 
females. Overall, 2.6% reported depressive symptoms according to Beck Depression 
Inventory Primary Care, 7.4% reported a high level of UCLA loneliness and 19.4% 
low levels of general mental health. Mild to severe erectile dysfunction was 
reported by 59.1% of men at T0, while 68.4% of women reported sexual 
dysfunction. Sexual function levels remain generally unchanged at further 
follow-up over the social restriction time period (T1), although those who were 
sexually active at baseline showed a decrease in sexual function scores. At T2, 
there was an overall improvement in sexual function scores with a rate of severe 
erectile dysfunction decreasing from 37.1% to 24.1% from T0 to T2 among males 
and a significant decrease of female sexual dysfunction from 68.4% to 51.2%.
CLINICAL IMPLICATIONS: Young individuals and those with good mental and physical 
health were more likely to improve sexual function at the end of social 
restrictions.
STRENGTHS & LIMITATIONS: Valid and reliable questionnaires and longitudinal 
approach design represent strengths; a large but convenient sample and lack of 
pre-pandemic baseline data represent limits.
CONCLUSION: Social restrictions due to COVID-19 pandemic led to an increase in 
sexual dysfunctions in both genders. However, these conditions appeared 
temporary since an overall improvement was observed at the end of lockdown and 
especially in younger individuals with higher psycho-physical well-being. Vedovo 
F, Capogrosso P, Di Blas L, et al. Longitudinal Impact of Social Restrictions on 
Sexual Health in the Italian Population. J Sex Med 2022;19:923-932.

Copyright © 2022 International Society for Sexual Medicine. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jsxm.2022.03.607
PMCID: PMC9060260
PMID: 35513999 [Indexed for MEDLINE]


2074. Occup Med (Lond). 2022 Jul 11;72(5):298-304. doi: 10.1093/occmed/kqac026.

Staff support during COVID-19 within an Acute Hospital Trust.

Blighe S(1), Hotton M(1), Quarmby L(1), Pollard T(1), Neilan N(1), Scholcz A(1), 
Pinckston M(1), Samuel R(1).

Author information:
(1)Oxford Psychological Medicine Centre, John Radcliffe Hospital, Headley Way, 
Headington, Oxford, UK.

BACKGROUND: The COVID-19 pandemic has put immense pressure on the National 
Health Service (NHS) and all healthcare professionals, not only physically but 
also mentally and the need to fully develop and implement a strategy to protect 
the mental health of healthcare professionals has never been more urgent. 
Research has demonstrated that staff can be supported by strengthening teams and 
offering frequent well-being support.
AIMS: To assess the feedback from delivery of a strategy to provide 
psychological well-being support to NHS staff during the COVID-19 pandemic and 
whether this 'Support for Teams' initiative made a positive impact on staff and 
in what way.
METHODS: A mixed methods design was used to gain quantitative and qualitative 
feedback from staff. Feedback was collected from two groups: Well-being Leads 
and clinicians providing support and resources to Well-being Leads. Feedback was 
collected via online forms.
RESULTS: Collectively, feedback responses were received from 70 staff members. 
The majority of staff members felt supported and benefitted from the provisions 
provided.
CONCLUSIONS: This evaluation showed that our healthcare system must continue to 
proactively implement and adapt staff support strategies to protect the mental 
well-being of healthcare professionals, both in the context of future health 
crises and in everyday practice. This study will assist and guide development 
and adaptations to health and psychological well-being support, ahead of future 
pandemics and to provide suitable support beyond the COVID-19 pandemic.

© The Author(s) 2022. Published by Oxford University Press on behalf of the 
Society of Occupational Medicine. All rights reserved. For Permissions, please 
email: journals.permissions@oup.com.

DOI: 10.1093/occmed/kqac026
PMID: 35512422 [Indexed for MEDLINE]


2075. Aust J Rural Health. 2022 Oct;30(5):683-696. doi: 10.1111/ajr.12873. Epub 2022 
May 5.

Differences in psychosocial distress among rural and metropolitan health care 
workers during the COVID-19 pandemic.

Tham R(1)(2)(3), Pascoe A(4), Willis K(5)(6), Kay M(7), Smallwood N(4)(8).

Author information:
(1)Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, 
Melbourne School of Population and Global Health, The University of Melbourne, 
Melbourne, Victoria, Australia.
(2)La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, 
Australia.
(3)Mary MacKillop Institute for Health Research, Australian Catholic University, 
Melbourne, Victoria, Australia.
(4)Department of Allergy, Immunology and Respiratory Medicine, Central Clinical 
School, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia.
(5)College of Health and Biomedicine, Victoria University, Melbourne, Victoria, 
Australia.
(6)Division of Critical Care and Investigative Services, Royal Melbourne 
Hospital, Parkville, Victoria, Australia.
(7)Primary Care Clinical Unit, Royal Brisbane and Women's Hospital, Herston, 
Queensland, Australia.
(8)Department of Respiratory Medicine, The Alfred Hospital, Prahran, Victoria, 
Australia.

OBJECTIVE: The Australian COVID-19 Frontline Healthcare Workers study examined 
the prevalence and severity of mental health symptoms during the second wave of 
the COVID-19 pandemic. This substudy examined the differences in psychological 
well-being between rural and metropolitan health care workers (HCWs).
DESIGN: A nationwide survey conducted between August and October 2020.
SETTING AND PARTICIPANTS: Australian HCWs were recruited through multiple 
strategies.
MAIN OUTCOME MEASURES: Demographics, mental health outcomes (anxiety, 
depression, post-traumatic stress disorder [PTSD] and burnout).
RESULTS: Complete responses were included from 7846 participants, with 1473 
(18.8%) in regional or remote ('rural') areas and 81.2% in metropolitan areas. 
Rural participants were older, more likely to work in allied health, nursing or 
in health administration, and had worked longer in their profession than 
metropolitan participants. Levels of resilience were similar (p = 0.132), but 
there was significantly higher prevalence of pre-COVID-19 pandemic mental 
illness in the rural workforce (p < 0.001). There were high levels of current 
mental health issues: moderate-severe PTSD (rural 38.0%; metropolitan 41.0% 
p = 0.031); high depersonalisation (rural 18.1%; metropolitan 20.7% p = 0.047); 
and high emotional exhaustion (rural 46.5%; metropolitan 43.3% p = 0.002). Among 
rural participants, mental health symptoms were associated with younger age, 
worry about being blamed if they contracted COVID-19, fear of transmitting 
COVID-19 to their family, experiencing worsening relationships and working in 
primary care or allied health.
CONCLUSION: Despite having low COVID-19 case numbers in rural Australian health 
services compared with metropolitan counterparts over the course of 2020, there 
were widespread mental health impacts on the workforce. Rural health services 
need specific and flexible training, education, work policies and practices that 
support psychological well-being now in preparedness for ongoing or future 
crises.

© 2022 The Authors. Australian Journal of Rural Health published by John Wiley & 
Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.

DOI: 10.1111/ajr.12873
PMCID: PMC9347496
PMID: 35511109 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2076. J Ment Health. 2023 Dec;32(6):1080-1085. doi: 10.1080/09638237.2022.2069690. 
Epub 2022 May 5.

Post-COVID-19 distress and unhealthy behavior.

Yang H(1), Ma J(2).

Author information:
(1)Johns Hopkins University, Baltimore, MD, USA.
(2)Peking University, Beijing, China.

BACKGROUND: COVID-19 is one of the most devastating pandemics in history. It is 
important to understand post-COVID-19 mental health issues and unhealthy 
behaviors.
AIMS: Investigate whether and how distress levels and unhealthy behaviors might 
differ across population segments after the end of a nationwide COVID-19 
outbreak.
METHODS: Using random sampling, this large-scale study analyzed post-COVID-19 
distress and unhealthy behaviors of individuals in Wuhan vs. Beijing in China 
(which were differentially impacted by the pandemic).
RESULTS: Higher percentages of individuals residing in Wuhan (vs. Beijing) 
experienced moderate or severe post-COVID-19 distress. Higher percentages of men 
(vs. women) experienced moderate distress. Larger percentages of people with 
(vs. without) children experienced a severe level of distress. Post-COVID-19, 
higher percentages of people decreased (vs. increased) smoking and drinking, but 
the opposite was true for unhealthy snacking. Importantly, higher post-COVID-19 
distress predicted higher consumption in all three unhealthy domains. Men (vs. 
women) were more likely to increase smoking and drinking; younger individuals 
were more likely to increase drinking and unhealthy snacking.
CONCLUSIONS: Some population segments were disproportionately susceptible to 
post-COVID-19 distress and unhealthy behaviors. Post-pandemic policies and 
interventions are needed to help people, especially the most vulnerable, improve 
their mental health and physical well-being.

DOI: 10.1080/09638237.2022.2069690
PMID: 35510749 [Indexed for MEDLINE]


2077. Child Care Health Dev. 2022 Nov;48(6):901-905. doi: 10.1111/cch.13015. Epub 2022 
May 16.

Neurodisability care in the time of COVID-19.

Arichi T(1)(2)(3), Cadwgan J(1)(4)(5), McDonald A(1)(6), Patel A(1), Turner 
S(1), Barkey S(1), Lumsden DE(1)(4), Fairhurst C(1)(4).

Author information:
(1)Children's Neurosciences, Evelina London Children's Hospital, Guy's and St 
Thomas' NHS Foundation Trust, London, UK.
(2)Centre for the Developing Brain, School of Biomedical Engineering and Imaging 
Sciences, King's College London, London, UK.
(3)Department of Bioengineering, Imperial College London, London, UK.
(4)School of Life Sciences, King's College London, London, UK.
(5)Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
(6)Children's Health, Dublin, Ireland.

BACKGROUND: The COVID-19 pandemic resulted in an unprecedented societal and 
healthcare global crisis. Associated changes in regular healthcare provision and 
lifestyle through societal lockdown are likely to have affected clinical 
management and well-being of children/young people with neurodisability, who 
often require complex packages of multidisciplinary care.
METHODS: We surveyed 108 families of children/young people with severe physical 
neurodisability and multiple comorbidities to understand how the pandemic had 
affected acute clinical status, routine healthcare provision, schooling and 
family mental and social well-being.
RESULTS: A significant proportion of families reported missing hospital 
appointments and routine therapy, with subsequent worsening of symptoms and 
function. Families additionally described worsening stress and anxiety during 
the pandemic, regardless of their baseline level of socio-economic deprivation.
CONCLUSION: This highlights the profound effect of the COVID-19 pandemic on 
health and function in young people with severe neurodisabilities and emphasizes 
the clear need to better understand how to support this vulnerable population 
moving forwards.

© 2022 John Wiley & Sons Ltd.

DOI: 10.1111/cch.13015
PMCID: PMC9347684
PMID: 35510689 [Indexed for MEDLINE]


2078. Int J Geriatr Psychiatry. 2022 Jun;37(6):10.1002/gps.5725. doi: 
10.1002/gps.5725.

Staff perceptions of the consequences of COVID-19 on quality of dementia care 
for residents in Ontario long-term care homes.

Kirkham J(1), Shorey CL(2), Iaboni A(3)(4), Quirt H(3), Grigorovich A(5), Astell 
A(3)(4), Lin E(1), Maxwell CJ(2)(6).

Author information:
(1)Department of Psychiatry, Cumming School of Medicine, University of Calgary, 
Calgary, Alberta, Canada.
(2)School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, 
Canada.
(3)KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, 
Ontario, Canada.
(4)Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, 
Toronto, Ontario, Canada.
(5)Recreation and Leisure Studies, Brock University, St Catharines, Ontario, 
Canada.
(6)School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada.

OBJECTIVES: The first wave of the COVID-19 pandemic necessitated extensive 
infection control measures in long-term care (LTC) and had a significant impact 
on staffing and services. Anecdotal reports indicate that this negatively 
affected LTC residents' quality of care and wellbeing, but there is scarce 
evidence on the effects of COVID-19 on quality of dementia care in LTC.
METHODS: From December 2020 to March 2021, we conducted a cross-sectional online 
survey among staff who worked in LTC homes in Ontario, Canada. Survey questions 
examined staffs' perceptions of the impact of COVID-19 on dementia quality of 
care during the initial wave of the COVID-19 pandemic (beginning 1 March 2020).
RESULTS: There were a total of 227 survey respondents; more than half reported 
both worsened overall quality of care (51.3%) and worsening of a majority of 
specific quality of care measures (55.5%). Measures of cognitive functioning, 
mobility and behavioural symptoms were most frequently described as worsened. 
Medical and allied/support staff had the highest odds of reporting overall 
worsened quality of care, while specialized behavioural care staff and those 
with more experience in LTC were less likely to. LTC home factors including 
rural location and smaller size, staffing challenges, higher number of outbreaks 
and less COVID-19 preparedness were associated with increased odds of perceived 
worsening of quality of dementia care outcomes.
CONCLUSIONS: These findings suggest that COVID-19 pandemic restrictions and 
related effects such as inadequate staffing may have contributed to poor quality 
of care and outcomes for those with dementia in LTC.

© 2022 John Wiley & Sons Ltd.

DOI: 10.1002/gps.5725
PMCID: PMC9087411
PMID: 35510483 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no relevant conflicts of 
interest to disclose.


2079. BMC Public Health. 2022 May 4;22(1):889. doi: 10.1186/s12889-022-13305-7.

The COV-ED Survey: exploring the impact of learning and teaching from home on 
parent/carers' and teachers' mental health and wellbeing during COVID-19 
lockdown.

Connor C(1), De Valliere N(2), Warwick J(2), Stewart-Brown S(2), Thompson A(2).

Author information:
(1)Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, England. 
charlotte.connor@warwick.ac.uk.
(2)Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, England.

BACKGROUND: Following the emergence of COVID-19 in the UK, on March 18th 2020 
the majority of schools in England closed and families and teachers were tasked 
with providing educational support for children and adolescents within the home 
environment. Little is known, however, regarding the impact of remote teaching 
and learning on the mental wellbeing of parents/carers and teaching staff.
METHODS: The Coronavirus Education (COV-ED) online survey explored the 
practicalities of learning and teaching from home for 329 parents/carers and 117 
teachers of 11-15 year old adolescents in England, during June/July 2020, and 
the associated impact on their mental wellbeing. Participants were recruited 
through schools and via University of Warwick social media channels. Data was 
analysed using a series of Multiple Linear and Multivariate Regressions.
RESULTS: Despite coping well with the challenges of remote learning, a third of 
teachers reported below average mental wellbeing on the Warwick-Edinburgh Mental 
Wellbeing Scale. Multivariate regression revealed that wellbeing was associated 
with access to resources and confidence to teach from home. Almost half of 
parents/carers surveyed reported below average wellbeing. Multivariate 
regression revealed that poor wellbeing was more common in those who were also 
working from home and who lacked support for their own mental health. Concerns 
about their child's mental health and lack of access to electronic devices and 
workspace were also significantly associated with the mental wellbeing of 
parents/carers.
CONCLUSIONS: Whilst young people's mental health and wellbeing has, and 
continues to be a national priority, the mental health and wellbeing of the 
families and teachers supporting them has not previously been explored. Our 
survey population was of predominantly white British heritage, female and living 
in the West Midlands UK, therefore, findings should be treated with caution. 
Findings provide a snapshot of factors that may be of significance to families 
and schools in supporting the mental wellbeing of those tasked with learning 
from home. They will help i) increase knowledge and awareness with regard to 
future support of families and teachers during similar crises; ii) enable the 
design and development of practical solutions in the delivery of remote teaching 
and learning; and, iii) help address the mental wellbeing needs of those tasked 
with supporting adolescents.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-13305-7
PMCID: PMC9066392
PMID: 35509002 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2080. PLoS One. 2022 May 4;17(5):e0266504. doi: 10.1371/journal.pone.0266504. 
eCollection 2022.

Exploring experiences and impact of the COVID-19 pandemic on young racially 
minoritised people in the United Kingdom: A qualitative study.

Burgess RA(1), Kanu N(1), Matthews T(2), Mukotekwa O(2), Smith-Gul A(2), Yusuf 
I(2), Lamptey I(2), McCauley N(2), Wilson R(2), Pirisola M(2), Gul M(2).

Author information:
(1)Institute for Global Health, University College London, London, United 
Kingdom.
(2)Wandsworth Community Empowerment Network, London, United Kingdom.

Within high-income-countries, the COVID-19 pandemic has disproportionately 
impacted people from racially minoritised backgrounds. There has been 
significant research interrogating the disparate impact of the virus, and 
recently, interest in the long-term implications of the global crisis on young 
people's mental health and wellbeing. However, less work explores the 
experiences of young people from racialised backgrounds as they navigate the 
pandemic, and the specific consequences this has for their mental health. Forty 
young people (age 16-25) from Black, mixed and other minority backgrounds and 
living in London, participated in consecutive focus group discussions over a 
two-month period, to explore the impact of the pandemic on their lives and 
emotional wellbeing. Thematic analysis identified seven thematic categories 
describing the impact of the pandemic, indicating: deepening of existing 
socioeconomic and emotional challenges; efforts to navigate racism and 
difference within the response; and survival strategies drawing on communal and 
individual resources. Young people also articulated visions for a future public 
health response which addressed gaps in current strategies. Findings point to 
the need to contextualize public health responses to the pandemic in line with 
the lived experiences of racialised young people. We specifically note the 
importance of long-term culturally and socio-politically relevant support 
interventions. Implications for policy and practice are discussed.

DOI: 10.1371/journal.pone.0266504
PMCID: PMC9067664
PMID: 35507595 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no competing interests to 
declare.


2081. PLoS One. 2022 May 4;17(5):e0266008. doi: 10.1371/journal.pone.0266008. 
eCollection 2022.

'Unheard,' 'uncared for' and 'unsupported': The mental health impact of Covid 
-19 on healthcare workers in KwaZulu-Natal Province, South Africa.

Dawood B(1), Tomita A(2)(3), Ramlall S(1).

Author information:
(1)Discipline of Psychiatry, School of Clinical Medicine, College of Health 
Sciences, University of KwaZulu-Natal, Durban, South Africa.
(2)KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of 
Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
(3)Centre for Rural Health, School of Nursing and Public Health, College of 
Health Sciences, University of KwaZulu-Natal, Durban, South Africa.

As a direct consequence of the Covid-19 pandemic, due to being exposed to 
chronic and multiple sources of psychological stress, healthcare workers 
constitute a vulnerable population. Despite the potential impact of Covid-19 on 
their psychological and physical health, insufficient attention has been given 
to their mental well-being. The primary objective of this study was to measure 
and understand this psychological impact on public sector doctors and nurses in 
KwaZulu-Natal Province, South Africa. The secondary objective was to ascertain 
their perceptions of psychosocial support, specific to Covid-19, within the 
workplace. This cross-sectional electronic survey was conducted from August to 
October 2020, following the first surge of the pandemic in the country, and 
included 312 participants. Depression, anxiety and stress symptoms were assessed 
with the Depression Anxiety and Stress Scale-21 item and post-traumatic stress 
was measured by the Impact of Events Scale-Revised version. Measures of employer 
support were assessed using an adapted closed-ended questionnaire. The 
participants' mean age was 36.6± 9.3 years with three quarters being male (n = 
234, 75.0%) and predominantly (n = 214, 72.3%) medical doctors. Numbers of 
participants with depression, anxiety and stress were 121 (51.5%), 111 (47.2%) 
and 104 (44.3%) respectively, with 38 (16.2%), 50 (21.3%) and 38 (16.2%) in the 
combined severe/extremely severe range, respectively. On the Impact of Events 
Scale-Revised, 34 (13.7%) participants were in the severe range. Subjectively, 
63.0% felt that their concerns were not 'heard', 75.1% did not feel 'cared for' 
and 81.1% and 74.0% did not feel 'physically' or 'psychologically' supported, 
respectively. High levels of depression, anxiety, stress and traumatic stress, 
combined with poor perceptions of employer support, highlight the need to 
identify and address the psychosocial support needs and expectations of 
healthcare workers for the duration of the pandemic, as well as for the mental 
health sequelae post-pandemic.

DOI: 10.1371/journal.pone.0266008
PMCID: PMC9067674
PMID: 35507540 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2082. Andes Pediatr. 2022 Feb;93(1):10-18. doi: 10.32641/andespediatr.v93i1.4250. Epub 
2022 Apr 14.

[Childhood and COVID-19: The indirect effects of the COVID-19 pandemic on the 
well-being of children and adolescents].

[Article in Spanish]

Díaz Rubio F(1), Donoso Fuentes A(1).

Author information:
(1)Hospital Clínico Metropolitano La Florida, Santiago, Chile.

The impact of the COVID-19 pandemic has been overlooked in children and 
adolescents since many of the negative effects have been the result of 
containment and mitigation measures and will only be quantifiable in the medium 
and long term. Although the global response has been successful in reducing the 
lethality of the disease, the harmful effect on vulnerable populations, such as 
children and adolescents, is enormous and has been classified as catastrophic by 
international organizations. The pandemic has deeply affected the physical and 
mental health of children and adolescents, but also silently its negative 
effects extend across many areas such as schooling, familiar economy, child 
labor and food security. The third year of the pandemic is an opportunity to 
include the multidimen sional well-being of children and adolescents as a 
cornerstone of society's response to a global crisis, whether health, economic 
or political.

DOI: 10.32641/andespediatr.v93i1.4250
PMID: 35506771 [Indexed for MEDLINE]


2083. Am J Audiol. 2022 Jun 2;31(2):392-402. doi: 10.1044/2022_AJA-21-00234. Epub 2022 
May 3.

Adults With Hearing Loss Demonstrate Resilience During COVID-19 Pandemic: 
Applications for Postpandemic Services.

Teece K(1), Oeding K(1), Nelson P(1)(2).

Author information:
(1)Department of Speech-Language-Hearing Sciences, University of Minnesota, 
Minneapolis, Twin Cities.
(2)Center for Applied and Translational Sensory Science, University of 
Minneapolis, Twin Cities.

BACKGROUND: The COVID-19 pandemic has produced unique challenges for persons 
with hearing loss. There is a unique concern that adults with hearing loss may 
be more susceptible to isolation than adults with normal hearing.
PURPOSE: This study explored the impact of the COVID-19 pandemic on the 
well-being of older adults with and without hearing loss.
RESEARCH DESIGN: This was a longitudinal study with pre-COVID-19 and six 
mid-COVID-19 interviews, spanning from March 1, 2020, to October 31, 2020.
STUDY SAMPLE: The study enrolled 12 participants with hearing aids and 12 with 
cochlear implants aged 55-80 years that were compared to 18 age-matched adults 
with hearing within normal limits.
DATA COLLECTION AND ANALYSIS: Surveys were completed to evaluate the impact of 
time alone and loneliness, social contact, depression, and the impact of masks 
on hearing. A mixed-effects statistical model was used to analyze each question.
RESULTS: Participants commonly reported stress and anxiety during monthly video 
calls. Adults with varying degrees of hearing loss reported decreased social 
interaction and increased stress during the pandemic, similar to the rates 
observed by participants with healthy hearing. Face coverings were commonly 
reported to affect the intelligibility of conversational speech. Participants 
with hearing loss found satisfactory methods for maintaining social connection 
during the pandemic that they hope will continue once restrictions ease fully.
CONCLUSIONS: Participants from the hearing loss groups in this study were 
frustrated by challenges posed by facial masks and were resilient in their 
ability to cope with COVID-19 and found the use of technology to be helpful. 
Audiologists are encouraged to use these successful electronic means of 
connecting with their patients even after restrictions are fully lifted.

DOI: 10.1044/2022_AJA-21-00234
PMCID: PMC9524753
PMID: 35503964 [Indexed for MEDLINE]


2084. Asia Pac J Public Health. 2022 Jul;34(5):565-568. doi: 
10.1177/10105395221097743. Epub 2022 May 2.

Decreased Frequency of Small Talk Due to the COVID-19 Pandemic Has Deteriorated 
Mental Health: Findings From Longitudinal Surveys of Middle-Aged and Older 
People in Japan.

Murayama H(1), Sugawara I(2).

Author information:
(1)Research Team for Social Participation and Community Health, Tokyo 
Metropolitan Institute of Gerontology, Tokyo, Japan.
(2)Faculty of Service Management, Bunri University of Hospitality, Saitama, 
Japan.

The coronavirus disease 2019 (COVID-19) has reduced opportunities for small 
talk. As small talk involves socializing, such deprivation can be stressful. 
This study examined the association between the change in the frequency of small 
talk from before to during the pandemic and the mental health of middle-aged and 
older people. We obtained data from web-based longitudinal surveys for members 
of a Japanese social networking service. People who felt their small talk 
frequency decreased during the pandemic compared with the prepandemic period had 
lower psychological well-being and greater loneliness than those who did not. 
Our study quantitatively revealed the importance of small talk during the 
pandemic in maintaining people's mental health.

DOI: 10.1177/10105395221097743
PMID: 35502473 [Indexed for MEDLINE]


2085. Cyberpsychol Behav Soc Netw. 2022 May;25(5):270-277. doi: 
10.1089/cyber.2021.0249. Epub 2022 May 2.

Zoom Fatigue, Psychological Distress, Life Satisfaction, and Academic 
Well-Being.

Deniz ME(1), Satici SA(2), Doenyas C(1), Griffiths MD(3).

Author information:
(1)Department of Psychological Counseling, Yildiz Technical University, 
Istanbul, Turkey.
(2)Department of Psychological Counseling, Artvin Coruh University, Artvin, 
Turkey.
(3)International Gaming Research Unit, Psychology Department, Nottingham Trent 
University, Nottingham, United Kingdom.

Little is known about the psychological consequences of the recently increased 
utilization of videoconferencing, which has enabled life to proceed as close to 
normal as possible during the COVID-19 pandemic. To understand the psychological 
consequences of this recent global lifestyle change in different populations, 
the psychometric validation of the Zoom Exhaustion and Fatigue Scale (ZEFS) and 
the relationship of this construct with academic well-being, mental well-being, 
and life satisfaction are presented. In a sample of 470 Turkish university 
students (57 percent female, Mage = 20.26 ± 2.18, ranging between 18 and 33 
years), first-order and second-order confirmatory factor analyses confirmed the 
construct validity of the scale, and the item response theory results yielded 
appropriate item difficulty and discrimination. ZEFS scores were significantly 
and positively associated with anxiety, depression, and stress, and negatively 
associated with life satisfaction and academic well-being, supporting the 
scale's concurrent validity. Incremental validity was shown with mediational 
models demonstrating significant and separate indirect effects of Zoom 
exhaustion and fatigue on life satisfaction and academic well-being, both 
mediated by psychological distress. The results suggest ZEFS to be a valid and 
reliable tool to evaluate the psychological consequences of videoconferencing, 
which has globally increased during the COVID-19 pandemic, in non-Western 
samples. By showing the relationships of Zoom exhaustion and fatigue with 
psychological distress, life satisfaction, and academic well-being, the present 
study highlights potential avenues to be addressed to protect the mental 
well-being of all individuals who have integrated videoconferencing as part of 
their daily lives.

DOI: 10.1089/cyber.2021.0249
PMID: 35501955 [Indexed for MEDLINE]


2086. BMC Psychol. 2022 May 3;10(1):114. doi: 10.1186/s40359-022-00825-5.

Psychosocial risks factors among victim support workers during the COVID-19 
pandemic: a study with the Copenhagen Psychosocial Questionnaire.

Caridade S(1)(2), Oliveira A(3), Saavedra R(3)(4), Ribeiro R(5)(6), Santos M(3), 
Almeida I(6), Soeiro C(3)(6)(7).

Author information:
(1)Psychology Research Center, School of Psychology, University of Minho, Campus 
de Gualtar, 4710-057, Braga, Portugal. scaridade@psi.uminho.pt.
(2)Interdisciplinary Center for Gender Studies (CIEG) of the Higher Institute of 
Social and Political Sciences of the University of Lisbon (ISCSP-UL), 1300-663, 
Lisboa, Portugal. scaridade@psi.uminho.pt.
(3)Portuguese Association for Victim Support (APAV) - PT, Rua José Estêvão, 135 
A, Piso 1, 1150-201, Lisboa, Portugal.
(4)Interdisciplinary Research Centre on Crime, Justice and Security (CJS) of 
School of Criminology of Faculty of Law of Porto (FDUP-UP), 4050-123, Porto, 
Portugal.
(5)Center for Research in Neuropsychology and Cognitive Behavioral Intervention, 
the Faculty of Psychology and Education Sciences at the University of Coimbra, 
3000-115, Coimbra, Portugal.
(6)Multidisciplinary Research Center of Egas Moniz (CiiEM), Laboratory of 
Psychology (LabPSI), Egas Moniz Higher Institute of Health Science, Campus 
Universitário, Quinta da Granja, Monte de Caparica, 2829-511, Almada, Portugal.
(7)Institute of Judicial Police and Criminal Sciences, Rua Francisco José 
Purificação Chaves, 8, 2670-542, Loures, Portugal.

BACKGROUND: Being a victim support worker (VSW) involves exposure to victims' 
suffering, pain, and traumatic events, which may trigger the risk of VSWs 
developing mental health problems. Psychosocial risks (PSR) and work-related 
stress are considered the most challenging issues in occupational safety and 
health, considering they impact individuals, organizations, and economies.
METHODS: The purpose of the present study was to identify the PSR in a sample of 
196 Portuguese victim support workers (VSW) (Mean age = 36.49; SD = 10.52). A 
questionnaire with socio-demographic characteristics, variables related to VSW's 
job, and the Portuguese medium version of the Copenhagen Psychosocial 
Questionnaire II (COPSOQ II) were used to assess these professionals' perception 
of PSR factors.
RESULTS: The results reveal that although VSW recognizes some psychosocial 
factors favourable to their health and well-being, they also identify some PSR 
that place them at intermediate and severe risk, i.e., emotional and cognitive 
demands, which are the main areas of risk to the VSW. VSW over 38 years old 
scored higher in job insecurity, burnout, and offensive behaviours.
CONCLUSIONS: These findings give important insights into the areas that must be 
enhanced in this context involving VSW. Additionally, the results highlight the 
relevance of encouraging a healthy and supportive work environment, preventing 
and promoting the health and well-being of VSW, particularly when considering 
the coronavirus disease (COVID-19) pandemic.

© 2022. The Author(s).

DOI: 10.1186/s40359-022-00825-5
PMCID: PMC9061027
PMID: 35501849 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2087. BMC Public Health. 2022 May 3;22(1):821. doi: 10.1186/s12889-022-13130-y.

Social alignment matters: Following pandemic guidelines is associated with 
better wellbeing.

Tunçgenç B(1)(2), Newson M(3)(4), Sulik J(5), Zhao Y(6), Dezecache G(7), Deroy 
O(5)(8)(9), Zein ME(10)(11).

Author information:
(1)Department of Psychology, Nottingham Trent University, London, UK. 
bahartuncgenc@gmail.com.
(2)Institute of Cognitive & Evolutionary Anthropology, University of Oxford, 
Oxford, UK. bahartuncgenc@gmail.com.
(3)Institute of Cognitive & Evolutionary Anthropology, University of Oxford, 
Oxford, UK.
(4)School of Anthropology and Conservation, University of Kent, Kent, UK.
(5)Cognition, Values and Behaviour, Ludwig Maximilian University, Munich, 
Germany.
(6)School of Medicine, Indiana University, Bloomington, Indiana, USA.
(7)LAPSCO, Université Clermont Auvergne, CNRS, Clermont-Ferrand, France.
(8)Munich Center for Neuroscience, Ludwig-Maximilian University, Munich, 
Germany.
(9)Institute of Philosophy, School of Advanced Study, University of London, 
London, UK.
(10)Institute of Cognitive Neuroscience, University College London, London, UK.
(11)Adaptive Rationality Center, Max-Planck for Human Development, Berlin, 
Germany.

BACKGROUND: In response to the Covid-19 pandemic, most countries implemented 
physical distancing measures. Many mental health experts warned that through 
increasing social isolation and anxiety, these measures could negatively affect 
psychosocial wellbeing. However, socially aligning with others by adhering to 
these measures may also be beneficial for wellbeing.
METHODS: We examined these two contrasting hypotheses using cross-national 
survey data (N = 6675) collected fortnightly from participants in 115 countries 
over 3 months at the beginning of the pandemic. Participants reported their 
wellbeing, perceptions of how vulnerable they were to Covid-19 (i.e., high risk 
of infection) and how much they, and others in their social circle and country, 
were adhering to the distancing measures.
RESULTS: Linear mixed-effects models showed that being a woman, having lower 
educational attainment, living alone and perceived high vulnerability to 
Covid-19 were risk factors for poorer wellbeing. Being young (18-25) was 
associated with lower wellbeing, but longitudinal analyses showed that young 
people's wellbeing improved over 3 months. In contrast to widespread views that 
physical distancing measures negatively affect wellbeing, results showed that 
following the guidelines was positively associated with wellbeing even for 
people in high-risk groups.
CONCLUSIONS: These findings provide an important counterpart to the idea that 
pandemic containment measures such as physical distancing negatively impacted 
wellbeing unequivocally. Despite the overall burden of the pandemic on 
psychosocial wellbeing, social alignment with others can still contribute to 
positive wellbeing. The pandemic has manifested our propensity to adapt to 
challenges, particularly highlighting how social alignment can forge resilience.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-13130-y
PMCID: PMC9060841
PMID: 35501759 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2088. PLoS One. 2022 May 2;17(5):e0267724. doi: 10.1371/journal.pone.0267724. 
eCollection 2022.

Change in college student health and well-being profiles as a function of the 
COVID-19 pandemic.

Lanza ST(1)(2), Whetzel CA(1), Linden-Carmichael AN(1), Newschaffer CJ(2).

Author information:
(1)The Edna Bennett Pierce Prevention Research Center, College of Health and 
Human Development, The Pennsylvania State University, University Park, PA, 
United States of America.
(2)Department of Biobehavioral Health, College of Health and Human Development, 
The Pennsylvania State University, University Park, PA, United States of 
America.

OBJECTIVE: The COVID-19 pandemic has potential for long-lasting effects on 
college students' well-being. We examine changes from just before to during the 
pandemic in indicators of health and well-being and comprehensive profiles of 
health and well-being, along with links between covariates and profiles during 
the pandemic.
PARTICIPANTS: 1,004 students participated in a longitudinal study that began in 
November 2019.
METHODS: Latent class analysis identified health and well-being profiles at both 
waves; covariates were included in relation to class membership.
RESULTS: Mental health problems increased, whereas substance use, sexual 
behavior, physical inactivity, and food insecurity decreased. Six well-being 
classes were identified at each wave. Baseline class membership, 
sociodemographic characteristics, living situation, ethnicity, coping 
strategies, and belongingness were associated with profile membership at 
follow-up.
CONCLUSIONS: COVID-19 has had significant and differential impacts on today's 
students; their health and well-being should be considered holistically when 
understanding and addressing long-term effects of this pandemic.

DOI: 10.1371/journal.pone.0267724
PMCID: PMC9060353
PMID: 35499988 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2089. J Clin Psychol. 2022 Dec;78(12):2525-2537. doi: 10.1002/jclp.23364. Epub 2022 
May 2.

Gratitude, relatedness needs satisfaction, and negative psychological outcomes 
during the COVID-19 pandemic: A short-term longitudinal study.

Datu JAD(1), Fincham FD(2).

Author information:
(1)Department of Special Education and Counselling, Integrated Centre for 
Well-Being, The Education University of Hong Kong, Hong Kong, SAR China.
(2)FSU Family Institute, Florida State University, Tallahassee, Florida, USA.

OBJECTIVES: Although gratitude relates to coronavirus disease 2019 (COVID-19) 
well-being outcomes in the United States, more evidence is needed to understand 
how this psychological strength reciprocally relates to mental health during 
this pandemic. This study examines the association of gratitude with stress, 
anxiety, and depression among undergraduate students in the United States via a 
longitudinal design.
METHODS: An online survey was administered to 643 undergraduate students in a 
public university located in the southeastern region of the United States. There 
was a 1-month interval between the first and second waves of data collection.
RESULTS: Cross-lagged panel structural equation modeling showed that whereas 
gratitude positively predicted subsequent relatedness needs satisfaction, it 
negatively predicted later stress, anxiety, and depression. Relatedness needs 
satisfaction was reciprocally linked to subsequent gratitude.
CONCLUSION: Results suggest that gratitude might serve as a protective 
psychological resource against the detrimental mental health impacts of the 
COVID-19 pandemic.

© 2022 Wiley Periodicals LLC.

DOI: 10.1002/jclp.23364
PMCID: PMC9348235
PMID: 35491717 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


2090. Behav Res Ther. 2022 Jun;153:104101. doi: 10.1016/j.brat.2022.104101. Epub 2022 
Apr 17.

Exploring the effect of loneliness on fear: Implications for the effect of 
COVID-19-induced social disconnection on anxiety.

Hornstein EA(1), Eisenberger NI(2).

Author information:
(1)Department of Psychology, University of California, Los Angeles 1285 Franz 
Hall, Los Angeles, CA, 90095, USA. Electronic address: ericahornstein@ucla.edu.
(2)Department of Psychology, University of California, Los Angeles 1285 Franz 
Hall, Los Angeles, CA, 90095, USA.

The consequences of the COVID-19 pandemic have resulted in many disruptions to 
daily life, including an abrupt increase in social disconnection. As measures 
were put in place to combat the spread of COVID-19, people across the globe 
began living in states of limited social contact, fostering feelings of social 
isolation and loneliness. Previous literature suggests that these increases in 
social disconnection can have profound effects on both physical and mental 
health, perhaps especially in the case of fear disorders. The combination of 
feeling disconnected from others and the high level of daily threat experienced 
due to COVID-19 created conditions under which dysfunctional and persistent 
fears were especially likely to develop. Building on current understanding of 
the harmful effects of social disconnection on well-being in general as well as 
specific implications for fear, here we present findings from three preliminary 
investigations that are the first to directly examine the effects of loneliness 
on how fears are learned and maintained. The Results of this work show that 
loneliness impairs the process by which fears are extinguished, which is central 
to both the regulation of fear and treatment of fear disorders, and provide 
insight into potential avenues to mitigate such effects.

Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.brat.2022.104101
PMCID: PMC9013316
PMID: 35490455 [Indexed for MEDLINE]

Conflict of interest statement: Drs. Hornstein & Eisenberger have no financial 
disclosures or conflicts of interest to declare.


2091. Women Birth. 2023 Feb;36(1):e57-e64. doi: 10.1016/j.wombi.2022.04.011. Epub 2022 
Apr 19.

Midwives' experiences of providing maternity care to women and families during 
the COVID-19 pandemic in Northern Italy.

Fumagalli S(1), Borrelli S(2), Ornaghi S(3), Vergani P(3), Nespoli A(4).

Author information:
(1)School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy. 
Electronic address: simona.fumagalli@unimib.it.
(2)School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; 
Division of Midwifery, School of Health Sciences, The University of Nottingham, 
Nottingham, United Kingdom.
(3)Department of Obstetrics and Gynecology, MBBM Foundation at San Gerardo 
Hospital, School of Medicine and Surgery, University of Milano-Bicocca, Monza, 
Italy.
(4)School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.

PROBLEM: The COVID-19 pandemic has significantly challenged maternity provision 
internationally. Rapid and radical changes were implemented, with midwives 
facing anxiety and moral distress if not able to provide optimal and 
woman-centred care in line with professional values.
BACKGROUND: Healthcare professionals' stress and burnout are commonly reported 
during other global emergencies, which may eventually contribute to reduced 
quality of care. There is lack of evidence of the challenges faced by midwives 
in Italy during the COVID-19 pandemic.
AIM: To explore midwives' experiences of providing care to women and families 
during the COVID-19 pandemic.
METHODS: Qualitative interpretive phenomenological approach, using 
semi-structured interviews and thematic analysis. The sample included 15 
midwives. Ethical approval was obtained.
FINDINGS: Four themes were identified: 1) adjusting to the ever-evolving 
organisation of care; 2) physical, psychological and relational challenges; 3) 
support network; 4) deferred sense of awareness.
DISCUSSION: Midwives faced professional and personal challenges during the 
pandemic, displaying feelings of fear, anxiety, uncertainty, discomfort, lack of 
support and knowledge with potential long-term effects. Adjusting to the 
continuous, rapid and drastic re-organisation of maternity services was 
particularly challenging. Factors facilitating a safe, supportive and empowering 
workplace included support from colleagues and managers, access to appropriate 
PPE, reliable guidelines, good communication and emotional support. Positive 
aspects of personal and professional development included communication skills, 
establishment of trusting relationships, sense of empowerment and teamwork.
CONCLUSION: In the context of a pandemic, optimisation of midwives' physical, 
emotional and psychological wellbeing should be considered. Timely and 
comprehensive guidelines and appropriate resources should be provided to assist 
midwives in facilitating family-centred respectful maternity care and preserving 
childbirth as a bio-psychosocial event.

Copyright © 2023 Australian College of Midwives. Published by Elsevier Ltd. All 
rights reserved.

DOI: 10.1016/j.wombi.2022.04.011
PMCID: PMC9015962
PMID: 35490090 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest None declared.


2092. Public Health. 2022 May;206:94-101. doi: 10.1016/j.puhe.2021.05.006. Epub 2021 
May 25.

COVID-19 survey burden for health care workers: literature review and audit.

Gnanapragasam SN(1), Hodson A(2), Smith LE(3), Greenberg N(3), Rubin GJ(3), 
Wessely S(3).

Author information:
(1)South London and Maudsley NHS Foundation Trust. Electronic address: 
sam.gnanapragasam@slam.nhs.uk.
(2)Department of War Studies, King's College London, London, UK.
(3)Department of Psychological Medicine, King's College London, London, UK.

OBJECTIVES: Concerns have been raised about the quantity and quality of research 
conducted during the COVID-19 pandemic, particularly related to the mental 
health and wellbeing of health care workers (HCWs). For understanding the 
volume, source, methodological rigour and degree of overlap in COVID-19, studies 
were conducted among HCWs in the United Kingdom (UK).
STUDY DESIGN: Mixed methods approach, literature review and audit.
METHODS: First, a literature review of published research studies and second, an 
audit of studies HCWs have been invited to complete. For the literature review, 
we searched Medline, PsycINFO and Nexis, webpages of three medical organisations 
(Royal Society of Medicine, Royal College of Nursing and British Medical 
Association), and the YouGov website. For the audit, a non-random purposive 
sample of six HCWs from different London NHS Trusts reviewed email, WhatsApp and 
SMS messages they received for study invitations.
RESULTS: The literature review identified 27 studies; the audit identified 70 
study invitations. Studies identified by the literature review were largely of 
poor methodological rigour: only eight studies (30%) provided response rate, one 
study (4%) reported having ethical approval, and one study (4%) reported funding 
details. There was substantial overlap in the topics measured. In the audit, 
volunteers received a median of 12 invitations. The largest number of study 
invitations were for national surveys (n = 23), followed by local surveys 
(n = 16) and research surveys (n = 8).
CONCLUSION: HCWs have been asked to complete numerous surveys that frequently 
have methodological shortcomings and overlapping aims. Many studies do not 
follow scientific good-practice and generate questionable, non-generalisable 
results.

Copyright © 2021 The Royal Society for Public Health. Published by Elsevier Ltd. 
All rights reserved.

DOI: 10.1016/j.puhe.2021.05.006
PMCID: PMC8148427
PMID: 35489796 [Indexed for MEDLINE]


2093. J Affect Disord. 2022 Jul 15;309:274-281. doi: 10.1016/j.jad.2022.04.142. Epub 
2022 Apr 27.

Disruption to well-being activities and depressive symptoms during the COVID-19 
pandemic: The mediational role of social connectedness and rumination.

McMahon G(1), Douglas A(2), Casey K(3), Ahern E(3).

Author information:
(1)Department of Psychology, University of Limerick, Limerick, Ireland. 
Electronic address: grace.mcmahon@ul.ie.
(2)School of Psychology, Coventry University, UK.
(3)Department of Psychology, University of Limerick, Limerick, Ireland.

BACKGROUND: Disruption to everyday routine during the COVID-19 pandemic has 
resulted in considerable implications for global mental health. The inter- and 
intra-personal mechanisms by which disrupted routine can contribute to elevated 
depressive symptoms has not been well-explored. The present study aimed to 
examine how feelings of social (dis)connectedness and rumination, as a 
maladaptive coping strategy, could explain the association between disrupted 
well-being activities and depressive symptoms.
METHODS: Participants (N = 496) ranging in age from 18 to 73 years (M = 28.73, 
SD = 10.93) completed an online survey within the first 3 months of the COVID-19 
pandemic, which included measures of disruption to usual psychological and 
physical well-being activities, social connectedness, rumination, and depressive 
symptoms. Social connectedness and rumination were investigated as serial 
mediators of the association between disrupted well-being activities and 
depression using Hayes' PROCESS macro.
RESULTS: 39.5% of the sample reported clinically significant levels of 
depression. Disruption to well-being activities predicted higher depressive 
symptoms, and this was partially explained by feelings of social 
disconnectedness and subsequent rumination. Rumination, alone, was not a 
significant mediator between disrupted routine and depressive symptoms.
LIMITATIONS: The cross-sectional survey design does not preclude the possibility 
of bidirectional effects.
CONCLUSION: The social distancing public health measures to combat COVID-19 have 
contributed to widespread disrupted routine, and in turn, elevated symptoms of 
depression. Social disconnectedness plays a particularly important role in this 
association. Intervention strategies should consider social factors as a 'social 
cure' for mass, positive mental health promotion during COVID-19.

Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2022.04.142
PMCID: PMC9044653
PMID: 35489558 [Indexed for MEDLINE]


2094. Lancet Respir Med. 2022 Sep;10(9):851-862. doi: 10.1016/S2213-2600(22)00125-4. 
Epub 2022 Apr 27.

An online breathing and wellbeing programme (ENO Breathe) for people with 
persistent symptoms following COVID-19: a parallel-group, single-blind, 
randomised controlled trial.

Philip KEJ(1), Owles H(2), McVey S(3), Pagnuco T(3), Bruce K(3), Brunjes H(3), 
Banya W(4), Mollica J(3), Lound A(5), Zumpe S(3), Abrahams AM(6), Padmanaban 
V(7), Hardy TH(3), Lewis A(8), Lalvani A(2), Elkin S(2), Hopkinson NS(4).

Author information:
(1)National Heart and Lung Institute, Imperial College London, London, UK; 
National Institute for Health Research Imperial Biomedical Research Centre, 
Imperial College London, London, UK. Electronic address: 
k.philip@imperial.ac.uk.
(2)National Heart and Lung Institute, Imperial College London, London, UK; 
Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK.
(3)Learning and Participation, English National Opera, London, UK.
(4)National Heart and Lung Institute, Imperial College London, London, UK; 
National Institute for Health Research Imperial Biomedical Research Centre, 
Imperial College London, London, UK.
(5)Patient Experience Research Centre, Imperial College London, London, UK.
(6)Clinical Health Psychology, Imperial College Healthcare NHS Trust, London, 
UK.
(7)Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK.
(8)Department of Health Sciences, Brunel University London, London, UK.

Comment in
    Lancet Respir Med. 2022 Apr 27;:

BACKGROUND: There are few evidence-based interventions for long COVID; however, 
holistic approaches supporting recovery are advocated. We assessed whether an 
online breathing and wellbeing programme improves health related quality-of-life 
(HRQoL) in people with persisting breathlessness following COVID-19.
METHODS: We conducted a parallel-group, single-blind, randomised controlled 
trial in patients who had been referred from one of 51 UK-based collaborating 
long COVID clinics. Eligible participants were aged 18 years or older; were 
recovering from COVID-19 with ongoing breathlessness, with or without anxiety, 
at least 4 weeks after symptom onset; had internet access with an appropriate 
device; and were deemed clinically suitable for participation by one of the 
collaborating COVID-19 clinics. Following clinical assessment, potential 
participants were given a unique online portal code. Participants were randomly 
assigned (1:1) to either immediate participation in the English National Opera 
(ENO) Breathe programme or to usual care. Randomisation was done by the research 
team using computer-generated block randomisation lists, with block size 10. The 
researcher responsible for randomisation was masked to responses. Participants 
in the ENO Breathe group participated in a 6-week online breathing and wellbeing 
programme, developed for people with long COVID experiencing breathlessness, 
focusing on breathing retraining using singing techniques. Those in the deferred 
group received usual care until they exited the trial. The primary outcome, 
assessed in the intention-to-treat population, was change in HRQoL, assessed 
using the RAND 36-item short form survey instrument mental health composite 
(MHC) and physical health composite (PHC) scores. Secondary outcome measures 
were the chronic obstructive pulmonary disease assessment test score, visual 
analogue scales (VAS) for breathlessness, and scores on the dyspnoea-12, the 
generalised anxiety disorder 7-item scale, and the short form-6D. A thematic 
analysis exploring participant experience was also conducted using qualitative 
data from focus groups, survey responses, and email correspondence. This trial 
is registered with ClinicalTrials.gov, NCT04830033.
FINDINGS: Between April 22 and May 25, 2021, 158 participants were recruited and 
randomly assigned. Of these, eight (5%) individuals were excluded and 150 
participants were allocated to a treatment group (74 in the ENO Breathe group 
and 76 in the usual care group). Compared with usual care, ENO Breathe was 
associated with an improvement in MHC score (regression coefficient 2·42 [95% CI 
0·03 to 4·80]; p=0·047), but not PHC score (0·60 [-1·33 to 2·52]; p=0·54). VAS 
for breathlessness (running) favoured ENO Breathe participation (-10·48 [-17·23 
to -3·73]; p=0·0026). No other statistically significant between-group 
differences in secondary outcomes were observed. One minor self-limiting adverse 
event was reported by a participant in the ENO Breathe group who felt dizzy 
using a computer for extended periods. Thematic analysis of ENO Breathe 
participant experience identified three key themes: (1) improvements in 
symptoms; (2) feeling that the programme was complementary to standard care; and 
(3) the particular suitability of singing and music to address their needs.
INTERPRETATION: Our findings suggest that an online breathing and wellbeing 
programme can improve the mental component of HRQoL and elements of 
breathlessness in people with persisting symptoms after COVID-19. Mind-body and 
music-based approaches, including practical, enjoyable, symptom-management 
techniques might have a role supporting recovery.
FUNDING: Imperial College London.

Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open 
Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All 
rights reserved.

DOI: 10.1016/S2213-2600(22)00125-4
PMCID: PMC9045747
PMID: 35489367 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of interests SM, TP, KB, HB, JM, SZ, 
THH, and ALa work for ENO who developed and deliver ENO Breathe; however, the 
programme is delivered free of charge to participants. All other authors declare 
no competing interests. No authors have been paid to write this article by a 
pharmaceutical company or other agency.


2095. BMJ Open. 2022 Apr 29;12(4):e057106. doi: 10.1136/bmjopen-2021-057106.

Light acupuncture and five-element music therapy for nurses' mental health and 
well-being during and post-COVID-19: protocol for a randomised cross-over 
feasibility study.

Wang CC(1), Lo J(2), Saunders R(3), Adama E(4), Bulsara C(5), Etherton-Beer 
C(6), Yang AWH(7).

Author information:
(1)School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western 
Australia, Australia c.wang@ecu.edu.au.
(2)School of Science, Edith Cowan University, Joondalup, Western Australia, 
Australia.
(3)Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan 
University, Joondalup, Western Australia, Australia.
(4)School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western 
Australia, Australia.
(5)School of Nursing and Midwifery, University of Notre Dame, Fremantle, Western 
Australia, Australia.
(6)Geriatric Medicine, University of Western Australia, Perth, Western 
Australia, Australia.
(7)School of Health and Biomedical Sciences, RMIT University, Melbourne, 
Victoria, Australia.

INTRODUCTION: Australian nurses have experienced higher levels of anxiety during 
the COVID-19 pandemic compared with the prepandemic. This may have affected 
their long-term mental health and intention to stay in the profession resulting 
in a workforce shortage, which further impacts the health of the public. 
Management is urgently required to improve nurses' well-being. However, there is 
limited evidence available. The proposed clinical trial aims to evaluate the 
feasibility and therapeutic effects of using a combination of light acupuncture 
and five-element music therapy to improve nurses' mental health and well-being 
during and post-COVID-19.
METHODS AND ANALYSIS: This randomised, single blinding, two-arm cross-over 
feasibility study involves a 1-week run-in period, 2-week intervention and 
1-week run-in period in between interventions. Thirty-six eligible nurses will 
be recruited from the community and randomised into either a combination of 
light acupuncture treatment and five-element music therapy group or no treatment 
group for 2 weeks. After a 1-week run in period, they will be swapped to the 
different group. The primary outcome of this study is to evaluate the 
feasibility of a combination of light acupuncture treatment and five-element 
music therapy to improve nurses' mental health and well-being. The secondary 
outcomes will include anxiety and depression, work productivity and activity, 
and quality of life assessments. Participants will be asked to complete a set of 
online questionnaires throughout the trial period. All analyses will be 
performed in R Studio V.1.1.463.
ETHICS AND DISSEMINATION: Ethical approval was attained from Edith Cowan 
University's Human Research Ethics Committee (No. 2021-02728-WANG). Research 
findings will be shared with hospitals and in various forms to engage broader 
audiences, including national and international conferences, presentations, 
open-access peer-reviewed journal publications, and local community workshop 
dissemination with healthcare professionals.
TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry: 
ACTRN12621000957897p https://www.anzctr.org.au/ACTRN12621000957897p.aspx.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-057106
PMCID: PMC9058290
PMID: 35487736 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2096. BMJ Open. 2022 Apr 29;12(4):e056736. doi: 10.1136/bmjopen-2021-056736.

Does the trauma associated with out-of-home care transmit across generations? 
Evidence from the 1970 British Cohort Study during a major health pandemic.

Parsons S(1), Schoon I(2).

Author information:
(1)Centre for Longitudinal Studies, Social Research Institute, University 
College London, London, UK sam.parsons@ucl.ac.uk.
(2)Social Research Institute, University College London, London, UK.

OBJECTIVES: Children with experience of out-of-home care (OHC) are at an 
increased risk of adverse outcomes in later life, including poorer levels of 
psycho-social adjustment. Less is known about the intergenerational transmission 
of the trauma associated with OHC and psychosocial outcomes in mid-adulthood, 
particularly during a major health pandemic.
DESIGN: To examine if there is evidence of intergenerational transmission of 
trauma associated with OHC in mid-adulthood, we used data from the 1970 British 
Cohort Study 2020 COVID-19 Survey.
PARTICIPANTS: Cases were defined as cohort members (CMs) who had themselves 
experienced OHC (OHC1) and those whose mother reported to have been in OHC 
(OHC2). Among the 5320 CMs who participated in the second COVID-19 Survey, we 
have OHC information for n=4236. Our analytical samples range from n=2472 to 
3864 depending on outcome: the largest sample comprised 105 (2.5%) CMs with 
direct OHC experience (OHC1), 93 (2.2%) CMs with a mother who had OHC experience 
(OHC2) and 3666 CMs with no OHC experience (OHC0).
OUTCOME MEASURES: Self-reported outcomes at age 50 included indicators of 
depression, health and psychological well-being. Multivariate logistic 
regression models control for socioeconomic childhood background and current 
circumstances.
RESULTS: Compared with the majority OHC0, the OHC1 group report higher levels of 
depression (OR 2.18 (95% CI 1.09 to 4.36) p<.05) and are at a greater risk of 
poor mental (OR 2.23 (95% CI 1.24 to 4.02) p<0.01) and general health (OR 3.32 
(95% CI 1.65 to 6.67) p<0.001) during the pandemic. OHC2 was more than twice as 
likely to report poor mental health prepandemic (OR 2.52 (95% CI 1.37 to 4.64) 
p<0.01), but not during the pandemic.
CONCLUSION: Children of care leaver mothers (OHC2) appear to be better adjusted 
than those who were themselves in care (OHC1), although compared with those 
without care experience (OHC0) both groups had an increased risk of poorer adult 
outcomes. However, the findings point to both continuity and discontinuity of 
disadvantage.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-056736
PMCID: PMC9058807
PMID: 35487711 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2097. Psicothema. 2022 May;34(2):249-258. doi: 10.7334/psicothema2021.467.

Mental Health, Quality of Life and Coping Strategies in Vulnerable Children 
During the COVID-19 Pandemic.

Vallejo-Slocker L(1), Sanz J, García-Vera MP, Fresneda J, Vallejo MA.

Author information:
(1)Aldeas Infantiles SOS España.

BACKGROUND: The coronavirus pandemic has led to a situation without precedent in 
modern history. The aim of this study is to analyse the consequences after one 
year of the pandemic on a group of children and adolescents assessed at the 
beginning of the pandemic in 2020 and to determine the most effective ways of 
psychologically coping with this pandemic.
METHOD: Two different, but equivalent, groups with a total of 604 (study I, 
2020) and 743 (study II, 2021) children and adolescents in residential care, 
foster families, kinship families or family strengthening programs in Spain were 
evaluated using the SDQ (mental health measure), KIDSCREEN-10 index (quality of 
life measure) and Kidcope (coping behaviour measure). An independent sample 
t-test and a decision tree analysis were used.
RESULTS: The mental health of children and adolescents decreased by 9.7%, and 
Self-Perceived quality of life did not change after one year of the COVID-19 
pandemic. Nonactive coping strategies predicted worse mental health and worse 
quality of life. Problem solving served as a protective factor.
CONCLUSION: One year after, the COVID-19 pandemic has an effect on the 
psychological wellbeing of children and adolescents, and the consequences can be 
reduced if proper coping strategies are used.

DOI: 10.7334/psicothema2021.467
PMID: 35485538 [Indexed for MEDLINE]


2098. Sante Publique. 2022 Mar 11;Vol. 33(6):979-989. doi: 10.3917/spub.216.0979.

[COVID-19: Professional practices in closed institutional settings].

[Article in French]

[No authors listed]

INTRODUCTION: While governments have focused efforts on implementing health 
measures such as physical distancing and confinement to protect communities from 
the spread of COVID-19, some researchers focused on the significant impact of 
these measures on mental health and well-being. Persons with mental disorders 
who are both institutionalized and justice-involved in psychiatric and forensic 
hospitals find themselves more vulnerable to these measures and more limited in 
their movements and activities.
AIMS: The purpose of this paper is to examine the changes in practice in 
response to the pandemic and their potential impact on individuals in 
institutional settings.
RESULTS: A rapid review including 69 publications identified nine major themes 
in the literature, which will serve as a framework to analyze the experience of 
one forensic psychiatry institution in Canada. These themes are: 
1) population-specific vulnerability factors; 2) staff management and training; 
3) early discharge, parole, and community integration; 4) management of 
contagion in closed spaces; 5) sanitary measures and personal protective 
equipment; 6) care and service continuity; 7) use of technology to maintain 
social ties and services; 8) legal mechanisms and individual rights; and 
9) post-pandemic realities.
CONCLUSION: Although this is the first pandemic of such international magnitude, 
experts point to an increase in epidemics over the past decade and continued 
growth in the coming decades. It is thus essential to learn from this health 
crisis in order to be prepared and minimize their potential impact on vulnerable 
populations in the future. The reflections presented here could be contrasted 
with the lived-experiences of people in institutions in order to nuance the data 
and propose new strategies.

DOI: 10.3917/spub.216.0979
PMID: 35485029 [Indexed for MEDLINE]


2099. Sante Publique. 2022 Mar 11;Vol. 33(6):905-909. doi: 10.3917/spub.216.0905.

[The impact of COVID-19 on the health of children, a group "protected" 
from infection].

[Article in French]

[No authors listed]

OBJECTIVE: This article underlines that a viral epidemic and strategies to deal 
with it 1) have a major impact on groups that are a priori spared by the disease 
itself, in this case children, and 2) can generate health problems beyond the 
disease and lead to major social, economic and educational difficulties and an 
increase of social inequalities in health.
METHOD: The observations presented are based on the scientific literature 
available in the first half of 2020 and on discussions with actors in the field, 
experts and heads of institutions, conducted by a working group of the Haut 
Conseil de la Santé Publique reflecting on a global and concerted policy for 
children's health.
RESULTS: The health crisis and its management have had an impact on children's 
development and their quality of life. They have been more exposed to sedentary 
lifestyles, screens, accidents, and violence at home. The closure of schools and 
leisure facilities has led to difficulties in school, socialization, 
psychological well-being and mental health. Curative or preventive care has been 
postponed. These effects occurred with significant social and territorial 
inequalities.
CONCLUSION: Any health crisis management requires an assessment of the overall 
impact of the epidemic and the proposed measures on health, economic, social, 
and educational indicators. This crisis shows the need for a coordinated 
children's policy, which is not currently the case in France.

DOI: 10.3917/spub.216.0905
PMID: 35485022 [Indexed for MEDLINE]


2100. Can J Nurs Res. 2023 Mar;55(1):55-67. doi: 10.1177/08445621221097520. Epub 2022 
Apr 28.

The Impact of Canadian Medical Delays and Preventive Measures on Breast Cancer 
Experience: A Silent Battle Masked by the COVID-19 Pandemic.

Fortin J(1)(2), Rivest-Beauregard M(3), Defer C(4), Leblanc M(5), Thamar Louis 
LA(5), Roy CA(6), Lapierre I(7), Brunet A(3), Montreuil M(2)(8), Marin MF(1)(2).

Author information:
(1)Department of Psychology, 14845Université du Québec à Montréal, Montreal, 
Quebec, Canada.
(2)Centre de recherche de l'Institut en santé mentale de Montréal, 
439499CIUSSS-de-l'Est-de-l'Île-de-Montréal, Montreal, Quebec, Canada.
(3)Department of Psychiatry, 5620McGill University, Montreal, Quebec, Canada.
(4)Department of Oncology, Hôpital Maisonneuve-Rosemont 
439499(CIUSSS-de-l'Est-de-l'Île-de-Montréal), Montreal, Quebec, Canada.
(5)Department of psychology, 5622Université de Montréal, Montreal, Quebec, 
Canada.
(6)Department of Psychology, 59310Université du Québec en Outaouais, Montreal, 
Quebec, Canada.
(7)Patient-partner, Montreal, Quebec, Canada.
(8)Department of Nursing, 5620McGill University, Montreal, Quebec, Canada.

BACKGROUND: The COVID-19 pandemic led to the prioritization of breast cancer 
services towards patients who are currently in treatment or diagnosed with 
advanced stages of breast cancer, and the self-assessment of both tumor growth 
and treatment side effects. Alongside the stress associated with cancer itself, 
delays and complications due to COVID-19 may impact patients' mental health.
PURPOSE: To describe the experiences of Canadians living with breast cancer who 
received a diagnosis and/or treatment during the pandemic, and to identify their 
recommendations for improving patients well-being during future pandemics.
METHODS: Semi-structured interviews were conducted with eighteen women living 
with breast cancer who also completed the Distress Thermometer questionnaire. 
The transcripts were analyzed using a descriptive thematic content methodology.
RESULTS: Women who started their breast cancer screening or treatment before the 
pandemic reported fewer delays and less psychological distress than those who 
started during the pandemic. Participants reported feeling dehumanized while 
receiving their medical care, being unable to be accompanied during medical 
visits, and fearing treatment interruption during the pandemic. Patient 
recommendations for improving care and psychological support included the 
presence of family caregivers at consultations to receive the diagnosis and for 
the first treatment session.
CONCLUSION: Study findings provide new insights on how healthcare restrictions 
during the pandemic impacted on patient experiences and their well-being during 
screening and treatment for breast cancer. The need for cancer nursing practices 
and care delivery strategies that promote the delivery of compassionate, 
patient-centred care and the provision of psychological support during future 
pandemics are identified.

DOI: 10.1177/08445621221097520
PMCID: PMC9086203
PMID: 35484788 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


2101. BMC Public Health. 2022 Apr 28;22(1):848. doi: 10.1186/s12889-022-13195-9.

The impact of COVID-19 restrictions on perceived health and wellbeing of adult 
Australian sport and physical activity participants.

Eime R(1)(2), Harvey J(3)(4), Charity M(3), Elliott S(5), Drummond M(5), 
Pankowiak A(4), Westerbeek H(4).

Author information:
(1)School of Science, Psychology and Sport, Federation University, Ballarat, 
Australia. r.eime@federation.edu.au.
(2)Institute for Health and Sport, Victoria University, Footscray, Australia. 
r.eime@federation.edu.au.
(3)School of Science, Psychology and Sport, Federation University, Ballarat, 
Australia.
(4)Institute for Health and Sport, Victoria University, Footscray, Australia.
(5)College of Education, Psychology and Social Work, Flinders University, 
Adelaide, Australia.

Individuals' access to sport and physical activity has been hampered due to 
COVID-19 lockdown restrictions. In Australia participation in community sport 
was cancelled during lockdowns. There is limited research on the impact of sport 
participation restrictions on the health and wellbeing of adults.AimThe aim of 
this study was to investigate the perceived health and wellbeing of a sample of 
predominantly active Australian adults, both during COVID-19 and in comparison 
with one year earlier (pre COVID-19).MethodsA survey was conducted during the 
first COVID-19 restrictions and lockdowns in Australia in May-June 2020. It was 
distributed by national and state sporting organisations and through 
researchers' social media accounts. This particular paper focuses on adults aged 
18-59 years. The survey collected information on participant demographics, the 
sport and physical activity patterns pre- COVID-19, and health and wellbeing 
outcomes during COVID-19 lockdown and compared to one year earlier. The health 
measures were cross-tabulated against the demographic and sport and physical 
activity variables, and group profiles compared with chi-square tests. Scales 
were derived from three wellbeing questions, and group differences were analysed 
by t-tests and F-tests.ResultsThe survey sample included 1279 men and 868 women 
aged 18-59 years. Most (67%) resided in metropolitan cities. The great majority 
(83%) were sport participants. During COVID-19 lockdown men were significantly 
more likely than women to report worse or much worse general (p = 0.014), 
physical (p = 0.015) and mental health (p = 0.038) and lower life satisfaction 
(p = 0.016). The inactive adults were significantly more likely to report poorer 
general health (p = 0.001) and physical health (p = 0.001) compared to active 
adults. The younger age cohort (18-29 years) were significantly more likely to 
report poorer general wellbeing (p < 0.001), and lower life satisfaction 
(p < 0.001) compared to the older age groups.ConclusionIt seems that the absence 
of playing competitive sport and training with friends, teams and within clubs 
has severely impacted males and younger adults in particular. Sports clubs 
provide an important setting for individuals' health and wellbeing which is why 
clubs require the capacity to deliver sport and individuals may need to regain 
the motivation to return.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-13195-9
PMCID: PMC9046706
PMID: 35484616 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2102. J Am Coll Health. 2024 Apr;72(3):805-811. doi: 10.1080/07448481.2022.2057803. 
Epub 2022 Apr 28.

Anticipatory worry and returning to campus during the COVID-19 pandemic.

Pandit N(1), Monda S(1), Campbell K(1).

Author information:
(1)Department of Psychology and Health Sciences, Robert Morris University, Moon 
Township, Pennsylvania, USA.

BACKGROUND: Assessing the psychological needs of students and employees as they 
return to campus is crucial to resuming University life in a safe and secure 
way. The current research aimed to explore how safety concerns, anticipatory 
worry, and mitigation efforts affected the well-being of individuals within a 
campus community.
METHODS: A five-part survey was distributed via student & employee listservs in 
the Fall 2020 at a midsize private university in the Mid-Atlantic Mid-Atlantic 
United States. Participants were surveyed about sources of worry regarding 
Covid-19, levels of anticipatory worry, amenability to various mitigation 
strategies and whether intended implementation of safety mitigation measures 
impacted worry levels.
RESULTS: Data collected from 559 students and employees indicated a relationship 
between source of worry and level of distress, with the greatest source of worry 
being fear of getting sick. Anticipatory worry after thinking about safety 
mechanisms was significantly lower than anticipated worry before thinking about 
safety mechanisms. No differences were found between students and employee 
experiences of worry, and there was no moderating effect of role on the 
difference between anticipated worry after, as compared to before, thinking 
about the mechanisms.
CONCLUSION: Findings highlight how different sources of concern related to 
Covid-19 are associated with varying levels of distress, the significant impact 
that the presence of mitigation strategies can have on reducing overall levels 
of anticipatory worry, and the universality of distress associated with 
Covid-19.

DOI: 10.1080/07448481.2022.2057803
PMID: 35483058 [Indexed for MEDLINE]


2103. PLoS One. 2022 Apr 28;17(4):e0267032. doi: 10.1371/journal.pone.0267032. 
eCollection 2022.

Factors associated with psychological symptoms in hospital workers of a French 
hospital during the COVID-19 pandemic: Lessons from the first wave.

d'Ussel M(1), Fels A(2), Durand X(3), Lemogne C(4), Chatellier G(5), Castreau 
N(6), Adam F(7).

Author information:
(1)Consultation Douleur Chronique, Groupe Hospitalier Paris Saint-Joseph, Paris, 
France.
(2)Centre de Recherche Clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, 
France.
(3)Service de Chirurgie Urologique, Groupe Hospitalier Paris Saint-Joseph, 
Paris, France.
(4)AP-HP, Hôpital Hôtel-Dieu, DMU Psychiatrie et Addictologie, Service de 
Psychiatrie de l'Adulte, INSERM, Institut de Psychiatrie et Neurosciences de 
Paris (IPNP), UMR_S1266, Université de Paris, Paris, France.
(5)Département de Recherche Clinique, Groupe Hospitalier Paris Saint-Joseph, 
Paris, France.
(6)Service de Santé au Travail, Groupe Hospitalier Paris Saint-Joseph, Paris, 
France.
(7)Département d'Anesthésie, Groupe Hospitalier Paris Saint-Joseph, Paris, 
France.

PURPOSE: The COVID-19 pandemic has put hospital workers around the world in an 
unprecedented and difficult situation, possibly leading to emotional 
difficulties and mental health problems. We aimed to analyze psychological 
symptoms of the hospital employees of the Paris Saint-Joseph Hospital Group a 
few months after the 1st wave of the pandemic.
PARTICIPANTS AND METHODS: From July 15 to October 1, 2020, a cross-sectional 
survey was conducted among hospital workers in the two locations of our hospital 
group using the Hospital Anxiety and Depression Scale (HADS) and Post-Traumatic 
Stress Disorder (PTSD) Checklist (PCL) to measure anxiety, depression, and PTSD 
symptoms. Factors independently associated with these symptoms were identified.
RESULTS: In total, 780 participants (47% caregivers, 18% health administrative 
workers, 16% physicians, and 19% other professionals) completed the survey. 
Significant symptoms of anxiety, depression, and PTSD were reported by 41%, 21%, 
and 14% of the participants, respectively. Hierarchical regression analysis 
showed a higher risk of having psychological symptoms among those (1) who were 
infected by SARS-CoV-2 or had colleagues or relatives infected by the virus, (2) 
who retrospectively reported to have had an anxious experience during the first 
wave, and (3) with a previous history of burnout or depression. In contrast, job 
satisfaction appeared to be a protective factor. Overall, hospital workers 
showed the statistically same levels of anxiety, depression, and PTSD symptoms, 
regardless of their profession and whether they had worked in units with 
COVID-19 patients or not.
CONCLUSIONS: Our cross-sectional survey of 780 hospital workers shows that after 
the first wave, hospital employees had a significant burden of mental health 
symptoms. Specific preventive measures to promote mental well-being among 
hospital workers exposed to COVID-19 need to be implemented, first among 
particularly vulnerable staff, and then, for all hospital staff for whom anxiety 
is detected early, and not only those who were directly exposed to infected 
patients.

DOI: 10.1371/journal.pone.0267032
PMCID: PMC9049512
PMID: 35482772 [Indexed for MEDLINE]

Conflict of interest statement: I have read the journal’s policy and the authors 
of this manuscript have the following competing interests: Marguerite d’Ussel 
reports personal fees and non-financial support from Grunenthal, Ethypharm and 
IPRAD in the previous three years, outside the submitted work. Xavier Durand 
reports personal fees and non-financial support from JANSSEN, ASTELLAS, 
RECORDATI and IPSEN in the previous three years, outside the submitted work. 
Cédric Lemogne reports personal fees and non-financial support from 
Janssen-Cilag, Lundbeck, Otsuka Pharmaceutical, and Boehringer Ingelheim in the 
previous three years, outside the submitted work.


2104. Psychol Health Med. 2023 Jan;28(1):211-224. doi: 10.1080/13548506.2022.2067574. 
Epub 2022 Apr 27.

The prevalence and associated factors of depression, anxiety, and PTSD among 
Moroccan medical doctors in the COVID-19 pandemic: a national study.

Ouazzani Housni Touhami Y(1)(2), Maiouak M(3)(4), Ouraghene A(1)(2), Hammani 
Z(5), Abdi CMF(1)(2), Benhammou I(1)(2), Tahiri S(1), Rabhi S(2)(6), Bennani 
B(7), Bout A(1)(2), Aarab C(1)(2), Boujraf S(2), El Fakir S(3)(4), Aalouane 
R(1)(2).

Author information:
(1)Psychiatry Department, Hassan II University Hospital, Fez, Morocco.
(2)Clinical Neurosciences Laboratory, Faculty of Medicine, Pharmacy and Dental 
Medicine of Fez, Sidi Mohamed Ben Abdellah University (USMBA), Fez, Morocco.
(3)Epidemiology Department, Faculty of Medicine, Pharmacy and Dental Medicine of 
Fez, Sidi Mohammed Ben Abdellah University (USMBA), Fez, Morocco.
(4)Laboratory of Epidemiology, Community Health and Clinical Research, Faculty 
of Medicine, Pharmacy and Dental Medicine of Fez, Sidi Mohammed Ben Abdellah 
University (USMBA), Fez, Morocco.
(5)Psychiatry Department, Moulay Ismail Military University Hospital, Meknes, 
Morocco.
(6)Internal Medicine Department, Hassan II University Hospital, Fez, Morocco.
(7)URL-CNRST N15, Laboratory of Human Pathology, Biomedicine and Environmental, 
Faculty of Medicine, Pharmacy and Dental Medicine of Fez, Sidi Mohammed Ben 
Abdellah University (USMBA), Fez, Morocco.

COVID-19 pandemic is facing healthcare professionals with unprecedented 
challenges, which might alter their mental health. We targeted assessing 
depression, generalized anxiety, and post-traumatic stress disorder (PTSD) of 
Moroccan medical doctors during the COVID-19 pandemic; this would allow 
identifying the associated factors. A cross-sectional national study was carried 
out on 1267 exposed and unexposed public health medical doctors to COVID-19 
patients. The study was conducted between May 15 and 15 June 2020. An anonymous 
self-administered questionnaire was completed online voluntarily and randomly. 
We used the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety 
Disorder (GAD-7), and the PTSD Checklist for DSM‑5 (PCL-5) to assess depression, 
generalized anxiety, and PTSD, respectively. The respondents' rate was 63.3%. 
The mean age was 30.97 ± 6.65 years old, and 59.3% (N = 751) were females with a 
sex ratio M/F of 0.68. The sample included 43.0% (N = 545) of COVID-19 frontline 
doctors. Among all participants, 31.5% (N = 400) had depression, 29.2% (N = 370) 
had generalized anxiety, and 21.7% (N = 276) had PTSD. The average scores of the 
PHQ-9, the GAD-7, and the PCL-5 were 7.79 (± 5.54), 6.12 (±5.72), and 18.58 
(±17.62), respectively. The multivariate logistic regression showed that working 
in primary and secondary hospitals, moderate and high-stress perceptions, a 
chronic physical illness, and a family history of psychiatric disorder were 
independently associated factors of depression, generalized anxiety, and PTSD. 
The females expressed significantly more anxiety. Doctors living in a family 
consisting of member with chronic disease showed a significantly higher risk of 
PTSD. The security sense of contamination risk and low threat perception of 
COVID-19 were significantly protective factors of depression, anxiety, and PTSD. 
Moroccan medical doctors are in psychological distress. It is essential to 
preserve medical doctors' mental well-being health for a better fight against 
the COVID-19 pandemic through effective and targeted health policies.

DOI: 10.1080/13548506.2022.2067574
PMID: 35477317 [Indexed for MEDLINE]


2105. J Perinat Neonatal Nurs. 2022 Apr-Jun 01;36(2):186-197. doi: 
10.1097/JPN.0000000000000643.

Perceptions of Parent Stressors in the Neonatal Intensive Care Unit Among the 
General Public and Healthcare Professionals.

Pritchard VE(1), Rizkallah S.

Author information:
(1)Institute of Learning Sciences and Teacher Education, Australian Catholic 
University, and School of Psychology and Counselling, Queensland University of 
Technology, Brisbane, Queensland, Australia (Dr Pritchard); and Department of 
Psychology, Australian Catholic University, Brisbane, Queensland, Australia (Ms 
Rizkallah).

OBJECTIVES: Intervention efforts to improve the psychosocial well-being of 
parents with an infant in the neonatal intensive care unit (NICU) are high 
priority. This study assessed public and healthcare professionals' perceptions 
of prominent NICU stressors to highlight areas where NICU parents are in need of 
further support. Relations with sample characteristics were also examined to 
establish the generalizability of known parent demographic/sociofamilial risk 
factors.
METHODS: A cross-sectional design was used to assess public (n = 96) and staff 
(n = 55) responses on the Parental Stressor Scale: Neonatal Intensive Care Unit 
(PSS:NICU).
RESULTS: The public perceived parental stress as being low to moderate. This was 
significantly lower than the staff estimate and highly comparable with past 
parent reports. Staff communication was perceived as most stressful by the 
public with this influenced by gender and education. Staff with more NICU 
experience were more likely to overestimate parental stress, particularly those 
working at the highest care level.
CONCLUSIONS: Collectively, these findings highlight preconceived anxiety around 
staff communication and behaviors and indicate that education on the potential 
for traumatic unit experiences to influence staff-parent communication may be 
important.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/JPN.0000000000000643
PMID: 35476773 [Indexed for MEDLINE]


2106. Curr Psychiatry Rep. 2022 Jun;24(6):307-324. doi: 10.1007/s11920-022-01338-z. 
Epub 2022 Apr 27.

Substance Use Among Youth During the COVID-19 Pandemic: a Systematic Review.

Layman HM(1), Thorisdottir IE(2)(3), Halldorsdottir T(2), Sigfusdottir 
ID(2)(3)(4), Allegrante JP(4)(5), Kristjansson AL(6)(7)(8).

Author information:
(1)Department of Social and Behavioral Sciences, School of Public Health, West 
Virginia University, Morgantown, WV, USA.
(2)Department of Psychology, Reykjavik University, Reykjavik, Iceland.
(3)Icelandic Centre for Social Research and Analysis, Reykjavik University, 
Reykjavik, Iceland.
(4)Department of Health and Behavior Studies, Teachers College, Columbia 
University, New York, NY, USA.
(5)Department of Sociomedical Sciences, Mailman School of Public Health, 
Columbia University, New York, NY, USA.
(6)Department of Social and Behavioral Sciences, School of Public Health, West 
Virginia University, Morgantown, WV, USA. ALKRISTJANSSON@hsc.wvu.edu.
(7)Department of Psychology, Reykjavik University, Reykjavik, Iceland. 
ALKRISTJANSSON@hsc.wvu.edu.
(8)Icelandic Centre for Social Research and Analysis, Reykjavik University, 
Reykjavik, Iceland. ALKRISTJANSSON@hsc.wvu.edu.

PURPOSE OF REVIEW: To review the literature on the trends in substance use among 
youth during the coronavirus SARS-CoV-2 (COVID-19) pandemic.
RECENT FINDINGS: The pandemic has given rise to concerns about the mental health 
and social well-being of youth, including its potential to increase or 
exacerbate substance use behaviors. This systematic review identified and 
included 49 studies of use across alcohol, cannabis, tobacco, 
e-cigarettes/vaping, and other drugs, and unspecified substances. The majority 
of studies across all categories of youth substance use reported reductions in 
prevalence, except in the case of other drugs and unspecified drug and substance 
use, which included three studies that reported an increase in use and three 
studies that reported decrease in use. Overall, the results of this review 
suggest that the prevalence of youth substance use has largely declined during 
the pandemic. Youth substance use in the post-pandemic years will require 
monitoring and continued surveillance.

© 2022. The Author(s).

DOI: 10.1007/s11920-022-01338-z
PMCID: PMC9043089
PMID: 35476186 [Indexed for MEDLINE]

Conflict of interest statement: Alfgeir Kristjansson, Inga Dora Sigfusdottir, 
and Inga Eva Thorisdottir disclose that they are affiliated with Planet Youth, a 
youth substance use prevention service organization that is distributed globally 
through sale of the Planet Youth Guidance Program, which is based on the 
Icelandic Prevention Model, from which they receive salary or consulting fees; 
all other authors disclose no financial or non-financial interests that are 
directly or indirectly related to the work submitted for publication.


2107. Einstein (Sao Paulo). 2022 Apr 22;20:eAO6707. doi: 
10.31744/einstein_journal/2022AO6707. eCollection 2022.

Depression in healthcare workers from the COVID-19 Care and Isolation Center - 
Villa Panamericana: a single-center prospective study in Peru.

Moya-Salazar J(1), Saciga-Saavedra W(2), Cañari B(2), Contreras-Pulache H(2).

Author information:
(1)Hospital Nacional Docente Madre Niño San Bartolomé, Lima, Peru.
(2)Escuela de Medicina, Universidad Norbert Wiener, Lima, Peru.

OBJECTIVE: Depression is a mental problem that affects the well-being of 
healthcare workers, impacting the quality of care and even leading to commit 
suicide. We aim to the levels of depression in frontline healthcare workers 
during the first severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) 
outbreak in Peru.
METHODS: A prospective cohort study was designed in the coronavirus disease 2019 
(COVID-19) Care and Isolation Center - Villa Panamericana in eastern Lima. Care 
and Isolation Center-Villa Panamericana houses about 150 healthcare workers and 
COVID-19 patients. The Montgomery-Asberg Depression Rating scale was used for 
depression assessment.
RESULTS: A total of 96 participants (30±5.6 years) were analyzed: 15 (15.6%) 
physicians, 39 (40.6%) nurses, 14 (14.6%) medical technologists, and 28 (29.2%) 
nurse technicians. Mild, moderate, and severe depression were present in 35 
(36.5%), 44 (45.8%), and 9 (9.4%) of the cases, respectively. The physicians and 
nurses reported more severe levels of depression: 8 (53.3%) physicians and 18 
(46.2%) nurses presented moderate depression; and 2 (13.3%) physicians and 3 
(7.7%) nurses presented severe depression (p=0.005). This study determined 
greater symptoms of depression according to years of work (p=0.001). Thirty-two 
healthcare workers had COVID-19, 4 (12.5%) physicians, 9 (28.1%) nurses, 7 
(21.9%) medical technologists, and 12 (37.5%) nurse technicians. Twenty-four 
(75%) participants showed symptoms of COVID-19 and developed moderate (12 
[37.5%]) and severe (3 [9.4%]) symptoms of depression (p=0.041).
CONCLUSION: This study clearly demonstrated a high prevalence of depression in 
the Care and Isolation Center-Villa Panamericana frontline healthcare workers 
during the COVID-19 pandemic in Peru.

DOI: 10.31744/einstein_journal/2022AO6707
PMCID: PMC9018059
PMID: 35476087 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest: none.


2108. Epidemiol Psychiatr Sci. 2022 Apr 27;31:e27. doi: 10.1017/S2045796022000051.

Psychological impact of the quarantine during the COVID-19 pandemic on the 
general European adult population: a systematic review of the evidence.

Bonati M(1), Campi R(1), Segre G(1).

Author information:
(1)Laboratory for Mother and Child Health, Department of Public Health, Istituto 
di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy.

AIMS: Due to the coronavirus disease 2019 (COVID-19) different countries 
implemented quarantine measures to limit the spread of the virus. Many studies 
analysed the mental health consequences of restrictive confinement, some of 
which focused their attention on specific populations. The general public's 
mental health also requires significant attention, however. This study aimed to 
evaluate the effects of the COVID-19 quarantine on the general population's 
mental health in different European countries. Risk and protective factors 
associated with the psychological symptoms were analysed.
METHODS: A systematic search was conducted on four electronic databases (PubMed, 
PsycINFO, Scopus and Google Scholar). Studies published up until 20th April 
2021, and following eligibility criteria were selected for this review. One 
thousand three hundred thirty-five (1335) studies were screened, 105 of which 
were included. Via network analysis, the current study investigated the pathways 
that underlie possible risk factors for mental health outcomes.
RESULTS: Anxiety, depression, distress and post-traumatic symptoms are 
frequently experienced during the COVID-19 quarantine and are often associated 
with changes in sleeping and eating habits. Some socio-demographic and 
COVID-19-related variables were found to be risk factors for an individual's 
wellbeing. In particular, being female, young, having a low income, being 
unemployed and having COVID-19-like symptoms or chronic disorders, were found to 
be the most common risk factors for mental health symptoms.
CONCLUSIONS: The COVID-19 pandemic represented an unprecedented threat to mental 
health globally. In order to prevent psychological morbidity and offer support 
tailored to short-, medium- and long-term negative outcomes, it is essential to 
identify the direct and indirect psychosocial effects of the lockdown and 
quarantine measures, especially in certain vulnerable groups. In addition to 
measures to reduce the curve of viral transmission, policy makers should 
urgently take into consideration provisions to alleviate hazards to mental 
health.

DOI: 10.1017/S2045796022000051
PMCID: PMC9069583
PMID: 35475479 [Indexed for MEDLINE]

Conflict of interest statement: All authors declare that they have no competing 
interests.


2109. BMC Med Educ. 2022 Apr 26;22(1):321. doi: 10.1186/s12909-022-03387-7.

Assessment of safety attitudes, professionalism and exploration of medical 
students' experiences.

Keshmiri F(1), Raadabadi M(2).

Author information:
(1)Medical Education Department, Education Development Center, Shahid Sadoughi 
University of Medical Sciences, Yazd, Iran.
(2)Health Policy and Management Research Center, School of Public Health, Shahid 
Sadoughi University of Medical Sciences, Yazd, Iran. mehdiraadabadi@gmail.com.

BACKGROUND: The present study was conducted to examine the interns' perceptions 
of safety attitude and professionalism and to explore their experiences about 
adherence to the principles during the COVID-19 pandemic.
METHOD: The present study was a mixed-method that was performed in two 
quantitative and qualitative stages. The medical interns at X University 
(n = 140) were entered. In the quantitative phase, the assessment of the 
interns' Safety Attitudes and Professionalism was conducted by a survey. In the 
qualitative phase, data were gathered by semi-structured interviews. The 
experiences of participants were analyzed by the inductive content analysis 
approach of Graneheim and Lundman.
RESULTS: Participants' perception scores on safety attitude and professionalism 
were 98.02 (14.78). The results were explained in a theme of "weakness in 
systemic accountability in compliance with professionalism and safety". The 
theme included three categories: 'support system inadequacy', and 'null 
curriculum in safety and professionalism education'.
CONCLUSION: The present results showed participants' perception scores on safety 
attitude and professionalism were below the moderate level. The systemic issues 
were explored as influencing factors in the occurrence of unsafe and 
unprofessional behaviors. They reported the weakness of the support system 
(individual, teamwork, mental health, well-being, management, and culture), and 
the null curriculum in education of professional, and safety principles 
effective on unprofessional and unsafe behaviors. During the COVID-19 pandemic, 
it is recommended to create mechanisms to support the development of 
professionalism of healthcare workers, especially, novice providers and 
students, and pay attention to the safety and professionalism in formal and 
informal educational programs.

© 2022. The Author(s).

DOI: 10.1186/s12909-022-03387-7
PMCID: PMC9040702
PMID: 35473618 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2110. Med Care. 2022 Jul 1;60(7):530-537. doi: 10.1097/MLR.0000000000001726. Epub 2022 
Apr 26.

Family Caregivers of Veterans Experience Clinically Significant Levels of 
Distress Prepandemic and During Pandemic: Implications for Caregiver Support 
Services.

Miller KEM(1)(2), Van Houtven CH(1)(3)(4), Smith VA(1)(3)(5), Lindquist JH(1), 
Gray K(1), Richardson C(6), Shepherd-Banigan M(1)(3).

Author information:
(1)Center of Innovation to Accelerate Discovery and Practice Transformation 
(ADAPT), Durham Veterans Affairs Health Care System, Durham, NC.
(2)Department of Medical Ethics and Health Policy, Perelman School of Medicine, 
University of Pennsylvania, Philadelphia, PA.
(3)Department of Population Health Sciences, Duke University Medical Center.
(4)Duke-Margolis Center for Health Policy.
(5)Division of General Internal Medicine, Department of Medicine, Duke 
University, Durham, NC.
(6)Caregiver Support Program, VA Central Office, Washington, DC.

BACKGROUND: Of the 26.4 million family caregivers in the United States, nearly 
40% report high levels of emotional strain and subjective burden. However, for 
the 5 million caregivers of Veterans, little is known about the experiences of 
caregivers of Veterans during the coronavirus disease 2019 (COVID-19) pandemic.
OBJECTIVE: The aim was to examine pandemic-related changes of caregiver 
well-being outcomes.
RESEARCH DESIGN, SUBJECTS, AND MEASURES: Using a pre/post design and 
longitudinal data of individual caregivers captured pre-COVID-19 and during 
COVID-19, we use multilevel generalized linear mixed models to examine 
pandemic-related changes to caregiver well-being (n=903). The primary outcome 
measures include Zarit Subjective Burden, Center for Epidemiologic Studies Short 
Depression Scale, perceived financial strain, life chaos, and loneliness.
RESULTS: During the pandemic, we observe slight improvements for caregivers 
across well-being measures except for perceived financial strain. Before the 
pandemic, we observed that caregivers screened positive for clinically 
significant caregiver burden and probable depression. While we do not observe 
worsening indicators of caregiver well-being during the COVID-19 pandemic, the 
average predicted values of indicators of caregiver well-being remain clinically 
significant for caregiving subjective burden and depression.
CONCLUSIONS: These findings illuminate pandemic-related impacts of caregivers 
receiving support through the Veterans Affairs (VA) pre-COVID and during the 
COVID-19 pandemic while caring for a population of frail, older care-recipients 
with a high burden of mental illness and other chronic conditions. Considering 
the long-term impacts of the pandemic to increase morbidity and the expected 
increased demand for caregivers in an aging population, these consistently high 
levels of distress despite receiving support highlight the need for 
interventions and policy reform to systematically support caregivers more 
broadly.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/MLR.0000000000001726
PMCID: PMC9187587
PMID: 35471419 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2111. J Clin Rheumatol. 2022 Aug 1;28(5):250-256. doi: 10.1097/RHU.0000000000001846. 
Epub 2022 Apr 22.

Psychological Stress Reported at the Start of the COVID-19 Pandemic and 
Subsequent Stress and Successful Coping in Patients With Rheumatic Diseases: A 
Longitudinal Analysis.

Duculan R, Jannat-Khah D, Wang XA(1), Mancuso CA.

Author information:
(1)Department of Medicine, Weill Cornell Medical College, New York, NY.

OBJECTIVE: In a cohort assembled during the height of mortality-associated 
coronavirus disease 2019 (COVID-19) in New York City, the objectives of this 
qualitative-quantitative mixed-methods study were to assess COVID-related stress 
at enrollment with subsequent stress and clinical and behavioral characteristics 
associated with successful coping during longitudinal follow-up.
METHODS: Patients with rheumatologist-diagnosed rheumatic disease taking 
immunosuppressive medications were interviewed in April 2020 and were asked 
open-ended questions about the impact of COVID-19 on psychological well-being. 
Stress-related responses were grouped into categories. Patients were interviewed 
again in January-March 2021 and asked about interval and current disease status 
and how well they believed they coped. Patients also completed the 29-item 
Patient-Reported Outcomes Measurement Information System (PROMIS-29) measuring 
physical and emotional health during both interviews.
RESULTS: Ninety-six patients had follow-ups; 83% were women, and mean age was 50 
years. Patients who reported stress at enrollment had improved PROMIS-29 scores, 
particularly for the anxiety subscale. At the follow-up, patients reported 
persistent and new stresses as well as numerous self-identified coping 
strategies. Overall coping was rated as very well (30%), well (48%), and 
neutral-fair-poor (22%). Based on ordinal logistic regression, variables 
associated with worse overall coping were worse enrollment-to-follow-up 
PROMIS-29 anxiety (odds ratio [OR], 4.4; confidence interval [CI], 1.1-17.3; p = 
0.03), not reporting excellent/very good disease status at follow-up (OR, 2.7; 
CI, 1.1-6.5; p = 0.03), pandemic-related persistent stress (OR, 5.7; CI, 
1.6-20.1; p = 0.007), and pandemic-related adverse long-lasting effects on 
employment (OR, 6.1; CI, 1.9-20.0; p = 0.003) and health (OR, 3.0; CI, 1.0-9.0; 
p = 0.05).
CONCLUSIONS: Our study reflects the evolving nature of COVID-related 
psychological stress and coping, with most patients reporting they coped well. 
For those not coping well, multidisciplinary health care providers are needed to 
address long-lasting pandemic-associated adverse consequences.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/RHU.0000000000001846
PMCID: PMC9336210
PMID: 35471418 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2112. Contemp Clin Trials. 2022 Jun;117:106768. doi: 10.1016/j.cct.2022.106768. Epub 
2022 Apr 22.

Protecting the mental and physical well-being of frontline health care workers 
during COVID-19: Study protocol of a cluster randomized controlled trial.

Dong L(1), Meredith LS(2), Farmer CM(3), Ahluwalia SC(4), Chen PG(2), Bouskill 
K(2), Han B(5), Qureshi N(2), Dalton S(2), Watson P(6), Schnurr PP(7), Davis 
K(8), Tobin JN(9), Cassells A(10), Gidengil CA(11).

Author information:
(1)RAND Corporation, Santa Monica, CA, USA. Electronic address: ldong@rand.org.
(2)RAND Corporation, Santa Monica, CA, USA.
(3)RAND Corporation, Pittsburgh, PA, USA.
(4)RAND Corporation, Santa Monica, CA, USA; UCLA Fielding School of Public 
Health, Los Angeles, CA, USA.
(5)Department of Research and Evaluation, Kaiser Permanente Southern California, 
Pasadena, CA, USA.
(6)National Center for PTSD, VT, USA.
(7)National Center for PTSD, VT, USA; Geisel School of Medicine at Dartmouth, 
NH, USA.
(8)Vizient, Inc. TX, USA.
(9)Clinical Directors Network (CDN), NY, USA; The Rockefeller University Center 
for Clinical and Translational Science, NY, USA.
(10)Clinical Directors Network (CDN), NY, USA.
(11)RAND Corporation, Boston, MA, USA.

INTRODUCTION: The COVID-19 pandemic has placed health care workers at 
unprecedented risk of stress, burnout, and moral injury. This paper describes 
the design of an ongoing cluster randomized controlled trial to compare the 
effectiveness of Stress First Aid (SFA) to Usual Care (UC) in protecting the 
well-being of frontline health care workers.
METHODS: We plan to recruit a diverse set of hospitals and health centers (eight 
matched pairs of hospitals and six pairs of centers), with a goal of 
approximately 50 HCW per health center and 170 per hospital. Participating sites 
in each pair are randomly assigned to SFA or UC (i.e., whatever psychosocial 
support is currently being received by HCW). Each site identified a leader to 
provide organizational support of the study; SFA sites also identified at least 
one champion to be trained in the intervention. Using a "train the trainer" 
model, champions in turn trained their peers in selected HCW teams or units to 
implement SFA over an eight-week period. We surveyed HCW before and after the 
implementation period. The primary outcomes are posttraumatic stress disorder 
and general psychological distress; secondary outcomes include depression and 
anxiety symptoms, sleep problems, social functioning problems, burnout, moral 
distress, and resilience. In addition, through in-depth qualitative interviews 
with leaders, champions, and HCW, we assessed the implementation of SFA, 
including acceptability, feasibility, and uptake.
DISCUSSION: Results from this study will provide initial evidence for the 
application of SFA to support HCW well-being during a pandemic.
TRIAL REGISTRATION: (Clinicaltrials.govNCT04723576).

Copyright © 2022 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.cct.2022.106768
PMCID: PMC9023359
PMID: 35470104 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no known 
competing financial interests or personal relationships that could have appeared 
to influence the work reported in this paper


2113. BMC Public Health. 2022 Apr 25;22(1):827. doi: 10.1186/s12889-022-13070-7.

The effect of exercise on resilience, its mediators and moderators, in a general 
population during the UK COVID-19 pandemic in 2020: a cross-sectional online 
study.

Lancaster MR(1), Callaghan P(2).

Author information:
(1)Conducted research at London Southbank University, 103 Borough Road, London, 
SE1 0AA, UK. Mollyrose.x.lancaster@gmail.com.
(2)Professor of Mental Health Science and Associate Pro Vice-Chancellor 
Research, London Southbank University, 103 Borough Road, London, SE1 0AA, UK.

BACKGROUND: Resilience is central to positive mental health and well-being 
especially when faced with adverse events. Factors such as exercise, location, 
sleep, mental health, and personality are moderators and mediators of 
resilience. However, the impact of these factors on resilience during severe 
adverse events are unknown. The present study examined how the COVID-19 pandemic 
affected resilience and its moderators and mediators by investigating whether 
there was a difference in resilience and quality of life between people with 
varying levels of exercise, including those who changed their exercise levels 
pre and during a COVID-19-related lockdown, and whether location affected the 
relationship between levels of exercise and resilience and quality of life.
METHODS: Following ethical approval, a cross-sectional online survey capturing 
data on self-reported key moderators and mediators of resilience before and 
during the COVID-19 lockdown imposed on the 23rd March 2020 in the UK was 
distributed via social media and completed over a three week time period during 
July 2020 via a self-selecting sample of the general population (N = 85). The 
key moderators and mediators of resilience the survey assessed were exercise, 
location, life-orientation, mental health, and sleep quality. All data were 
self-reported.
RESULTS: Participants' exercise intensity level increased as resilience 
increased (F(2,82) = 4.22, p = .003: Wilks' lambda = .82, partial n2 = 0.09). 
The relationship between exercise, and resilience and quality of life was 
independent of sleep and mental health status pre-lockdown (p = .013, p = .027 
respectively). In the face of the COVID-19 pandemic, this relationship was 
dependent on mental health but not sleep quality (p = <.001 for resilience 
p = .010 for quality of life). There were no statistically significant 
differences between participants living in urban or rural locations.
CONCLUSION: Exercise is strongly correlated to resilience and during a pandemic 
such as COVID-19 it becomes a mechanism in which to moderate resilience. The 
relationship between exercise and resilience is supported by this study. The 
influence that a pandemic had on mental health is mediated by its effect on 
quality of life.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-13070-7
PMCID: PMC9037056
PMID: 35468747 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2114. Issues Ment Health Nurs. 2022 Sep;43(9):870-877. doi: 
10.1080/01612840.2022.2067275. Epub 2022 Apr 25.

A Dog with an Office: The Process of Embedding a Wellness Dog Intervention in a 
University Setting.

Smith JM(1), Smith J(1), Nowell L(1), Lind C(1), Chalhoub S(2), McMillan C(2), 
Jackson J(1), Dela Cruz A(1).

Author information:
(1)Faculty of Nursing, University of Calgary, Calgary, Canada.
(2)Faculty of Veterinary Medicine, University of Calgary, Calgary, Canada.

Universities are places to promote the wellbeing of people who learn, work, and 
live within them. This article reports on an innovative, holistic, and embedded 
wellness dog program that was developed by the Faculty of Nursing to support the 
wellbeing of students, faculty, and staff. The innovation included a 
collaborative partnership between two faculties (the faculties of Veterinary 
Medicine and Nursing), and the targeted purchase, training, and socialization of 
a wellness dog. Pet wellness programs have the potential to be an important 
mental health intervention on university campuses. While the program was 
postponed due to COVID-19, the purpose of this article is to share processes 
used to create the wellness dog program, with suggestions regarding 
implementation and evaluation.

DOI: 10.1080/01612840.2022.2067275
PMID: 35468302 [Indexed for MEDLINE]


2115. JAMA Pediatr. 2022 Jul 1;176(7):635-636. doi: 10.1001/jamapediatrics.2022.0791.

Data Divide-Disentangling the Role of the COVID-19 Pandemic on Child Mental 
Health and Well-being.

Korczak DJ(1)(2), Madigan S(3)(4), Vaillancourt T(5).

Author information:
(1)Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, 
Canada.
(2)Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, 
Toronto, Ontario, Canada.
(3)Department of Psychology, Faculty of Arts, University of Calgary, Calgary, 
Alberta, Canada.
(4)Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.
(5)Counselling Psychology, Faculty of Education and School of Psychology, 
Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada.

DOI: 10.1001/jamapediatrics.2022.0791
PMID: 35467721 [Indexed for MEDLINE]


2116. J Nurs Adm. 2022 May 1;52(5):280-285. doi: 10.1097/NNA.0000000000001148.

Effects of Classical Music Virtual Reality on Pediatric Healthcare Worker 
Compassion Fatigue.

Hayakawa J(1), Barrows J, See S, Schomberg J.

Author information:
(1)Author Affiliations: Nurse Scientist (Drs Hayakawa and Barrows), Nurse 
Manager of Neuroscience and Multispecialty (Ms See), and Principal 
Biostatistician of Nursing and Trauma Services (Dr Schomberg), Children's 
Hospital of Orange County, California.

OBJECTIVE: The aim of this study was to explore the impact of classical music 
virtual reality (VR) on burnout, secondary traumatic stress, anxiety, and 
capacity for developing caring relationships with patients among healthcare 
workers (HCWs).
BACKGROUND: COVID-19 accentuated the importance of promoting the well-being of 
frontline workers. Efforts to address the mental health needs of HCWs are likely 
to positively impact patient outcomes.
METHODS: Healthcare workers completed 3 sessions of VR. A Wilcoxon rank-sum test 
was used to compare premeasure versus postmeasure on the Professional Quality of 
Life (ProQOL), State Trait Anxiety Inventory, and Caring Ability Inventory. 
Analysis of variance was performed to identify associations between the 
intervention and differences in scores for each ProQOL domain. Bonferroni 
correction adjusted for multiple comparisons. Fisher's t test was used for 
categorical analysis.
RESULTS: Seventy-one HCWs completed the study. There was a significant reduction 
in burnout after the experience, compared with baseline.
CONCLUSIONS: This study provides evidence that classical music VR may reduce 
burnout in HCWs.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/NNA.0000000000001148
PMID: 35467593 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


2117. Int J Ment Health Nurs. 2022 Aug;31(4):985-1001. doi: 10.1111/inm.13009. Epub 
2022 Apr 24.

The effect of the COVID-19 social distancing measures on Turkish women's mental 
well-being and burnout levels: A cross-sectional study.

Tekkas Kerman K(1), Albayrak S(2), Arkan G(3), Ozabrahamyan S(1), Beser A(1).

Author information:
(1)Koç University School of Nursing, Istanbul, Turkey.
(2)Faculty of Health Sciences, Istinye University, Istanbul, Turkey.
(3)Faculty of Health Sciences, Izmir Demokrasi University, Izmir, Turkey.

Lockdown and social distancing measures during the COVID-19 pandemic increase 
women's responsibilities and influence their mental health. This study aimed to 
assess the effect of COVID-19 social distancing measures on mental well-being 
and burnout levels of women using an online cross-sectional survey in Turkey. 
The Warwick-Edinburgh Mental Well-being Scale, The Burnout Measure, and 
Sociodemographic form were used in this study. All analyses were performed on a 
sample of 438 women aged between 18 and 65. The mean score of mental well-being 
was 47.86 (SD = 10.04) and the mean score of burnout was 3.86 (SD = 1.16). Being 
younger than 30 years old (t = 2.14, P = 0.033), having undergraduate education 
or above (F = 5.09, P = 0.007), part-time working (F = 5.39, P = 0.005), 
attending to school (t = 2.68, P = 0.008), having COVID-19 symptoms (t = 6.01, 
P < 0.001), and perceiving spousal emotional support (F = 3.47, P = 0.016) were 
the factors associated with high burnout. Being older than 30 years old 
(z = -3.11, P = 0.002), full time working (H = 11.96, P = 0.003), not attending 
to school (z = -2.09, P = 0.036), perceiving spousal emotional (H = 13.22, 
P = 0.004), or social (H = 13.11, P = 0.004) support were the factors associated 
with higher mental well-being. Age (β = -0.03, P = 0.001), having two or more 
children (β = 0.42, P = 0.015), and perceiving COVID-19 symptoms (β = -0.73, 
P < 0.001) were the predictors of women's burnout. This study shows that mental 
well-being and burnout levels of women in Turkey have been considerably affected 
as a result of social distancing measures taken with the first wave of the 
pandemic. Findings signal the immediate need for targeted mental health nursing 
interventions. Therefore, technology-based mental health support programmes are 
recommended to be designed and utilized by mental health nurses.

© 2022 John Wiley & Sons Australia, Ltd.

DOI: 10.1111/inm.13009
PMCID: PMC9111787
PMID: 35466490 [Indexed for MEDLINE]


2118. Urology. 2022 Aug;166:87-94. doi: 10.1016/j.urology.2022.01.069. Epub 2022 Apr 
22.

A Multinational Study of The Impact of Covid-19 On Urologic Surgery Residency 
and Wellbeing.

Goldman C(1), Pradere B(2), Mete M(3), Talso M(4), Bernardino R(5), Campi R(6), 
Marchalik D(7).

Author information:
(1)Department of Urology, MedStar Georgetown University Hospital, Washington, 
DC.
(2)Department of Urology, Comprehensive Cancer Center, Medical University of 
Vienna, Vienna, Austria.
(3)MedStar Health, Office of Physician Wellbeing, University of Viena, Columbia, 
MD; Department of Behavioral Health Research, MedStar Health Research Institute, 
Washington DC, United States; Department of Psychiatry, Georgetown University 
Medical Center, Washington DC, United States.
(4)Department of Urology, ASST Fatebenefratelli-Sacco, Luigi Sacco University 
Hospital, Milan, Italy.
(5)Urology Department, Central Lisbon University Hospital Centre, Lisbon.
(6)Unit of Urological Robotic Surgery and Renal Transplantation, Careggi 
Hospital, University of Florence, Florence, Italy; Department of Experimental 
and Clinical Medicine, University of Florence, Florence, Italy.
(7)Department of Urology, MedStar Georgetown University Hospital, Washington, 
DC; MedStar Health, Office of Physician Wellbeing, University of Viena, 
Columbia, MD. Electronic address: dan.marchalik@gmail.com.

Comment in
    Urology. 2022 Aug;166:93.

OBJECTIVE: To assess changes to the experiences and wellbeing of urology 
trainees in the United States (US) and European Union (EU) during the COVID-19 
pandemic.
METHODS: A 72-item anonymous online survey was distributed September 2020 to 
urology residents of Italy, France, Portugal, and the US. The survey assessed 
burnout, professional fulfillment, loneliness, depression and anxiety as well as 
38 COVID specific questions.
RESULTS: Two hundred twenty-three urology residents responded to the survey. 
Surgical exposure was the main educational concern for 81% of US and 48% of EU 
residents. E-learning was utilized by 100% of US and 57% of EU residents with 
two-thirds finding it equally or more useful than traditional didactics. No 
significant differences were seen comparing burnout, professional fulfillment, 
depression, anxiety, or loneliness among US or EU residents, 73% of US and 71% 
of EU residents reported good to excellent quality of life during the pandemic. 
In the US and EU, significantly less time was spent in the hospital, clinic, and 
operating room (P <.001) and residents spent more time using telehealth and 
working from home during the pandemic and on research projects, didactic 
lectures, non-medical hobbies and reading. The majority of residents reported 
benefit from more schedule flexibility, improved work life balance, and 
increased time for family, hobbies, education, and research.
CONCLUSION: The COVID-19 pandemic has resulted in significant restructuring of 
residents' educational experience around the globe. Preservation of beneficial 
changes such as reduction of work hours and online learning should be pursued 
within this pandemic and beyond it.

Copyright © 2022 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.urology.2022.01.069
PMCID: PMC9023370
PMID: 35461917 [Indexed for MEDLINE]


2119. Viruses. 2022 Mar 27;14(4):693. doi: 10.3390/v14040693.

Social Support Mediates the Association between Attachment Style and 
Psychological Distress during COVID-19 in Israel.

Adar T(1), Davidof M(1), Elkana O(1).

Author information:
(1)School of Behavioral Science, Tel Aviv- Yaffo Academic College, Tel Aviv-Yafo 
6818211, Israel.

Aim: The aim of this study was to examine the relationships between attachment 
style, social support, and psychological distress (i.e., depression and anxiety) 
during the COVID-19 lockdown of the third wave in Israel. Specifically, we 
examined whether social support mediates the well-documented relationship 
between attachment style and psychological distress. Methods: An online survey 
was administered from 3 January to 6 February, 2021, while a strict lockdown was 
in place. The sample included 288 Israelis ranging between the ages of 18−78, 
recruited by snowball sampling. Psychological distress was evaluated by Patients 
Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder questionnaire 
(GAD-7); attachment style by the Experiences in Close Relationships (ECR-36), 
and social support by the Multi-dimensional Perceived Social Support (MSPSS). A 
mediation model was applied with social support mediating the association 
between attachment style and depression and anxiety. Results: Significant 
correlations were found between attachment style and psychological distress, and 
between social support and psychological distress. Social support partially 
mediated the associations between attachment style and psychological distress 
(Depression: p < 0.001, confidence interval [CI] = 0.4018, 1.7468; Anxiety: p < 
0.001, confidence interval [CI] = 0.0493, 0.9822). These results remained the 
same while controlling for age. Conclusion: Our findings suggest that the secure 
attachment style serves as a protective factor against psychological distress 
and vice versa; insecure attachment style serves as a risk factor for developing 
psychological distress during a peak period of COVID-19. Nevertheless, social 
support played a central role in the association between attachment style and 
psychological distress, thus, individuals with an insecure attachment may thus 
be helped by offering them social support during a crisis, which in turn may 
increase their well-being.

DOI: 10.3390/v14040693
PMCID: PMC9027231
PMID: 35458423 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2120. Int J Environ Res Public Health. 2022 Apr 17;19(8):4879. doi: 
10.3390/ijerph19084879.

Mental Disorder Symptoms and the Relationship with Resilience among Paramedics 
in a Single Canadian Site.

Mausz J(1)(2), Donnelly EA(3), Moll S(4), Harms S(5), McConnell M(6).

Author information:
(1)Peel Regional Paramedic Services, Operations, Fernforest Division, 1600 
Bovaird Drive East, Brampton, ON L6V 4R5, Canada.
(2)Department of Health Research Methods, Evidence, and Impact, McMaster 
University, 1280 Main Street West, HSC-2C1, Hamilton, ON L8S 4K1, Canada.
(3)School of Social Work, The University of Windsor, 167 Ferry Street, Room 167, 
Windsor, ON N9A 0C5, Canada.
(4)School of Rehabilitation Sciences, McMaster University, 1400 Main Street 
West, Institute for Applied Health Sciences (IAHS) Building, Room 403, Hamilton, 
ON L8S 1C7, Canada.
(5)Department of Psychiatry and Behavioural Neurosciences, McMaster University, 
100 West 5th Street, Hamilton, ON L8N 3K7, Canada.
(6)Department of Innovation in Medical Education, Faculty of Medicine, The 
University of Ottawa, 850 Peter Morand Crescent, Room 102, Ottawa, ON K1G 5Z3, 
Canada.

There is growing recognition in research and policy of a mental health crisis 
among Canada's paramedics; however, despite this, epidemiological surveillance 
of the problem is in its infancy. Just weeks before the emergence of the 
COVID-19 pandemic, we surveyed paramedics from a single, large, urban paramedic 
service in Ontario, Canada to assess for symptom clusters consistent with 
post-traumatic stress disorder (PTSD), major depressive disorder, and 
generalized anxiety disorder and to identify potential risk factors for each. In 
total, we received 589 completed surveys (97% completion rate) and found that 
11% screened positive for PTSD, 15% screened positive for major depressive 
disorder, and 15% screened positive for generalized anxiety disorder, with one 
in four active-duty paramedics screening positive for any of the three as 
recently as February 2020. In adjusted analyses, the risk of a positive screen 
varied as a function of employment classification, gender, self-reported 
resilience, and previous experience as a member of the service's peer support 
team. Our findings support the position that paramedics screen positive for 
mental disorders at high rates-a problem likely to have worsened since the onset 
of the COVID-19 pandemic. We echo the calls of researchers and policymakers for 
urgent action to support paramedic mental health in Canada.

DOI: 10.3390/ijerph19084879
PMCID: PMC9030944
PMID: 35457746 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
Canadian Institutes of Health Research (CIHR) had no role in the design, 
execution, interpretation, or writing of the study.


2121. Int J Environ Res Public Health. 2022 Apr 15;19(8):4824. doi: 
10.3390/ijerph19084824.

Xenophobic Bullying and COVID-19: An Exploration Using Big Data and Qualitative 
Analysis.

Dhungana Sainju K(1), Zaidi H(1), Mishra N(2), Kuffour A(1).

Author information:
(1)Faculty of Social Science and Humanities, Ontario Tech University, 2000 
Simcoe St. N., Oshawa, ON L1G 0C5, Canada.
(2)Rotman School of Management, University of Toronto, 105 St. George St., 
Toronto, ON M5S 3E, Canada.

Extant literature suggests that xenophobic bullying is intensified by isolated 
national or global events; however, the analysis of such occurrences is 
methodologically limited to the use of self-reported data. Examining disclosures 
of racist bullying episodes enables us to contextualize various perspectives 
that are shared online and generate insights on how COVID-19 has exacerbated the 
issue. Moreover, understanding the rationale and characteristics present in 
xenophobic bullying may have important implications for our social wellbeing, 
mental health, and inclusiveness as a global community both in the short and 
long term. This study employs a mixed-method approach using Big Data techniques 
as well as qualitative analysis of xenophobic bullying disclosures on Twitter 
following the spread of COVID-19. The data suggests that about half of the 
sample represented xenophobic bullying. The qualitative analysis also found that 
64% of xenophobic bullying-related tweets referred to occasions that perpetuated 
racist stereotypes. Relatedly, the rationale for almost 75% of xenophobic 
bullying incidents was due to being Chinese or Asian. The findings of this 
study, coupled with anti-hate reports from around the world, are used to suggest 
multipronged policy interventions and considerations of how social media sites 
such as Twitter can be used to curb the spread of misinformation and xenophobic 
bullying.

DOI: 10.3390/ijerph19084824
PMCID: PMC9024955
PMID: 35457691 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2122. Int J Environ Res Public Health. 2022 Apr 14;19(8):4787. doi: 
10.3390/ijerph19084787.

Assessment of Subjective Well-Being in a Cohort of University Students and Staff 
Members: Association with Physical Activity and Outdoor Leisure Time during the 
COVID-19 Pandemic.

Quarta S(1), Levante A(2)(3), García-Conesa MT(4), Lecciso F(2)(3), Scoditti 
E(5), Carluccio MA(5), Calabriso N(5), Damiano F(1), Santarpino G(6)(7)(8), 
Verri T(1), Pinto P(9)(10), Siculella L(1), Massaro M(5).

Author information:
(1)Department of Biological and Environmental Sciences and Technologies 
(DISTEBA), University of Salento, 73100 Lecce, Italy.
(2)Department of History, Society, and Human Studies, University of Salento, Via 
di Valesio, 73100 Lecce, Italy.
(3)Laboratory of Applied Psychology, Department of History, Society, and Human 
Studies, University of Salento, 73100 Lecce, Italy.
(4)Research Group on Quality, Safety and Bioactivity of Plant Foods, Centro de 
Edafología y Biología Aplicada 40 del Segura-Consejo Superior de Investigaciones 
Científicas (CEBAS-CSIC), Campus de Espinardo, P.O. Box 164, 30100 Murcia, 
Spain.
(5)Institute of Clinical Physiology (IFC), National Research Council (CNR), 
73100 Lecce, Italy.
(6)Cardiovascular Center, Paracelsus Medical University, 90471 Nuremberg, 
Germany.
(7)GVM Care and Research, Città di Lecce Hospital, 73100 Lecce, Italy.
(8)Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, 
University "Magna Graecia", 88100 Catanzaro, Italy.
(9)Instituto Politécnico de Santarém, Escola Superior Agraria, 2001-904 
Santarem, Portugal.
(10)Life Quality Research Centre (CIEQV), IPSantarém/IPLeiria, 2040-413 Rio 
Maior, Portugal.

Time spent outdoors and physical activity (PA) promote mental health. To confirm 
this relationship in the aftermath of COVID-19 lockdowns, we explored individual 
levels of anxiety, depression, stress and subjective well-being (SWB) in a 
cohort of academic students and staff members and tested their association with 
sport practice, PA at leisure time and time spent outdoors. Our cross-sectional 
study collected data during the COVID-19 outbreak (April−May 2021) on 939 
students and on 238 employees, who completed an online survey on 
sociodemographic and lifestyle features, depression, anxiety, stress, and SWB. 
Results showed that the students exhibited higher levels of anxiety, depression, 
and stress, and lower levels of SWB (p < 0.001 for all domains) compared to the 
staff members. Correlation analysis confirmed that PA and time spent in nature 
were associated to high mental health scores among staff and, more consistently, 
among students. Finally, mediation analyses indicated that the time spent in 
nature, social relationships, and levels of energy play a mediator role in the 
relationship between sport practice and SWB. Our evidence reinforces the 
protective role of time spent in nature in improving mental health, and provides 
support for policymakers to make appropriate choices for a better management of 
COVID-19 pandemic consequences.

DOI: 10.3390/ijerph19084787
PMCID: PMC9025284
PMID: 35457652 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2123. Int J Environ Res Public Health. 2022 Apr 13;19(8):4693. doi: 
10.3390/ijerph19084693.

Pandemic Experience of First Responders: Fear, Frustration, and Stress.

McAlearney AS(1)(2)(3), Gaughan AA(1), MacEwan SR(1)(4), Gregory ME(1)(3), Rush 
LJ(1), Volney J(1), Panchal AR(1)(5).

Author information:
(1)The Center for the Advancement of Team Science, Analytics, and Systems 
Thinking in Health Services and Implementation Science Research (CATALYST), 
College of Medicine, The Ohio State University, Columbus, OH 43210, USA.
(2)Department of Family and Community Medicine, College of Medicine, The Ohio 
State University, Columbus, OH 43210, USA.
(3)Department of Biomedical Informatics, College of Medicine, The Ohio State 
University, Columbus, OH 43210, USA.
(4)Division of General Internal Medicine, College of Medicine, The Ohio State 
University, Columbus, OH 43210, USA.
(5)Department of Emergency Medicine, The Ohio State University Wexner Medical 
Center, Columbus, OH 43210, USA.

Police officers, firefighters, and paramedics are on the front lines of crises 
and emergencies, placing them at high risk of COVID-19 infection. A deeper 
understanding of the challenges facing first responders during the COVID-19 
pandemic is necessary to better support this important workforce. We conducted 
semi-structured interviews with 21 first responders during the COVID-19 
pandemic, asking about the impact of COVID-19. Data collected from our study 
interviews revealed that, despite large numbers of COVID-19 infections among the 
staff of police and fire departments, some-but not all-first responders were 
concerned about COVID-19. A similar divide existed within this group regarding 
whether or not to receive a COVID-19 vaccination. Many first responders reported 
frustration over COVID-19 information because of inconsistencies across sources, 
misinformation on social media, and the impact of politics. In addition, first 
responders described increased stress due to the COVID-19 pandemic caused by 
factors such as the fear of COVID exposure during emergency responses, concerns 
about infecting family members, and frustration surrounding new work policies. 
Our findings provide insight into the impact of COVID-19 on first responders and 
highlight the importance of providing resources for education about COVID-19 
risks and vaccination, as well as for addressing first responders' mental health 
and well-being.

DOI: 10.3390/ijerph19084693
PMCID: PMC9028623
PMID: 35457559 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2124. Int J Environ Res Public Health. 2022 Apr 11;19(8):4590. doi: 
10.3390/ijerph19084590.

Psychological Distress and COVID-19 Related Anxiety among Malaysian Women during 
the COVID-19 Pandemic.

Abdul Latif NI(1), Mohamed Ismail NA(1), Loh SYE(1), Nur Azurah AG(1), Midin 
M(2), Shah SA(3), Kalok A(1).

Author information:
(1)Obstetrics & Gynaecology Department, Faculty of Medicine, Universiti 
Kebangsaan Malaysia Medical Centre, National University of Malaysia, Kuala 
Lumpur 56000, Malaysia.
(2)Psychiatry Department, Faculty of Medicine, Universiti Kebangsaan Malaysia 
Medical Centre, National University of Malaysia, Kuala Lumpur 56000, Malaysia.
(3)Community Health Department, Faculty of Medicine, Universiti Kebangsaan 
Malaysia Medical Centre, National University of Malaysia, Kuala Lumpur 56000, 
Malaysia.

The combination of COVID-19 outbreaks and nationwide lockdown led to an 
increased prevalence of psychological distress among the population, especially 
women, as they have to cope with greater family and work demands. We aimed to 
identify the factors contributing to psychological distress among Malaysian 
women during the COVID-19 pandemic. A cross-sectional study was conducted 
between October 2020 and April 2021, in a teaching hospital in Kuala Lumpur, 
Malaysia. A self-administered questionnaire was distributed among women, which 
consisted of (1) Participant's demographics, (2) COVID-19 knowledge and 
awareness, (3) Depression, Anxiety, Stress Scale-21 (DASS-21), and (4) 
COVID-19-related anxiety. Chi-square test and univariate analysis were performed 
to determine the significant factors associated with psychological distress. The 
mean scores for knowledge, COVID-19 anxiety, and DASS-21 subcomponents were 
compared using the Mann-Whitney U test. A total of three hundred and 
thirty-eight women completed the survey. The majority of respondents 
demonstrated adequate knowledge (95.6%) on COVID-19. The proportion of our women 
who reported symptoms of depression, anxiety, and stress were 17.2%, 25.1%, and 
0.9%, respectively, resulting in a prevalence of psychological distress of 
27.8%. Low education level (p = 0.017), unemployment (p = 0.028), loss of income 
(p = 0.033), and hospital admission for surgical procedures (p = 0.021) were 
significantly associated with a higher psychological burden. A greater level of 
COVID-19 anxiety was found among Malays (p = 0.027), pregnant women (p = 0.013), 
and those who suffered a loss of income (p = 0.038) during this pandemic. The 
COVID-19 pandemic had a negative effect on women's psychological wellbeing, 
especially those from the lower socio-economic background. Therefore, adequate 
information, as well as support, must be provided to the vulnerable groups 
during the ongoing pandemic, to lessen their psychological burden.

DOI: 10.3390/ijerph19084590
PMCID: PMC9024897
PMID: 35457456 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2125. Int J Environ Res Public Health. 2022 Apr 8;19(8):4498. doi: 
10.3390/ijerph19084498.

A Mixed-Methods Formative Evaluation of a Dementia-Friendly Congregation Program 
for Black Churches.

Gore J(1), Toliver J(1), Moore MA(2), Aycock D(3), Epps F(1).

Author information:
(1)Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, 
USA.
(2)School of Medicine, Emory University, Atlanta, GA 30322, USA.
(3)Byrdine F. Lewis College of Nursing and Health Professions, Georgia State 
University, Atlanta, GA 30303, USA.

Black churches have traditionally been a haven for Black American families; 
however, many churches do not currently have programs to support families living 
with dementia. Alter™ was established to assist faith communities in meeting the 
needs of these families and becoming a viable resource to promote their health 
and wellness. Alter™ achieves this aim through a three-pronged approach: (1) 
conducting educational sessions, (2) modifying Black churches to be 
dementia-inclusive spaces, and (3) providing ongoing support. The principal goal 
of Alter™ is to offer guidance to churches in adapting their community to 
reflect a supportive environment for families affected by dementia. Alter™ uses 
a partnership checklist to encourage activities that incorporate dementia 
education opportunities, environmental modifications, and dementia resources and 
support. This paper reports on a formative mixed-methods evaluation of church 
partners enrolled in Alter™. Church partner ambassadors within the faith 
communities participated in the evaluation survey (n = 8) and two focus groups 
(n = 11). Ambassadors are appointed by church leadership to lead the 
implementation of program activities. Data were collected concerning the levels 
of helpfulness, difficulty, usefulness, or utility of checklist activities and 
modifications and the ease of program implementation. The evaluation also 
assessed the COVID-19 pandemic's impact on each church's ability to implement 
activities and modifications. The survey results revealed that most required 
partnership activities and modifications were found to be at least moderately 
helpful. Some of the items (themes) that differed across church partners 
included barriers to implementing activities, the support provided and needed, 
and the use of program funding. This evaluation provides key insights to 
consider in developing and refining community-based, dementia-friendly 
communities (including faith communities). As implementation science expands and 
improves, the need to evaluate the implementation of programs continues to be 
highlighted. Our formative evaluation shed light on key areas in which 
modifications to our original programming would lead to program improvement and 
sustainability. Additionally, implementing the modifications identified in our 
evaluation will facilitate the achievement of the mission of Alter™ to improve 
the well-being of older adults affected by dementia and their families. Other 
programs would reap substantial benefits from engaging in similar formative 
evaluation efforts.

DOI: 10.3390/ijerph19084498
PMCID: PMC9028238
PMID: 35457369 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2126. J Gerontol B Psychol Sci Soc Sci. 2022 Sep 1;77(9):1732-1739. doi: 
10.1093/geronb/gbac063.

Changing Relationships Between Social Contact, Social Support, and Depressive 
Symptoms During the COVID-19 Pandemic.

Ang S(1).

Author information:
(1)School of Social Sciences, Nanyang Technological University, Singapore, 
Singapore.

OBJECTIVES: Given the longstanding consensus that social contact can promote 
older adult well-being, many have focused on how social contact changed during 
the pandemic. Less is known, however, about whether the link between social 
contact and health changed during the pandemic. This study sought to understand 
how associations between social contact, social support, and depressive symptoms 
changed during the coronavirus disease 2019 (COVID-19) pandemic.
METHODS: Data from 2 waves of the Health and Retirement Study were used. 
Respondents reported both virtual and in-person social contact, as well as 
perceived positive and negative social support. Path models were used to 
estimate relationships between social contact, social support, and depressive 
symptoms. Bootstrapping was used to estimate the change in associations between 
2016 and 2020.
RESULTS: Estimates show that associations between positive social support and 
depressive symptoms, as well as between in-person social contact and depressive 
symptoms, attenuated during the pandemic. Virtual social contact played a 
relatively minor role in determining outcomes such as social support and 
depressive symptoms, compared to in-person social contact.
DISCUSSION: Findings suggest that researchers and policymakers should not only 
focus on the changing quantity of social interactions when events such as the 
COVID-19 pandemic happen, but also the changing content and efficacy of the 
social interactions that remain.

© The Author(s) 2022. Published by Oxford University Press on behalf of The 
Gerontological Society of America. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/geronb/gbac063
PMCID: PMC9047190
PMID: 35452515 [Indexed for MEDLINE]


2127. Neuropsychopharmacol Hung. 2022 Mar 1;24(1):42-55.

What you see is what you get? Association of belief in conspiracy theories and 
mental health during COVID-19.

Elek LP(1), Szigeti M(2)(3), Erdelyi-Hamza B(4), Smirnova D(4)(5), Fountoulakis 
KN(6), Gonda X(4)(7).

Author information:
(1)Department of Clinical Psychology, Semmelweis University, Budapest, Hungary.
(2)Imperial Clinical Trials Unit, Imperial College London, London, UK.
(3)Physiological Controls Research Center, Budapest, Hungary.
(4)Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, 
Hungary.
(5)Department of Psychiatry, Narcology, Psychotherapy and Clinical Psychology, 
Samara State Medical University, Samara, Russia.
(6)3rd Department of Psychiatry, AHEPA Hospital, Aristotle University, 
Thessaloniki, Greece.
(7)International Centre for Education and Research in Neuropsychiatry, Samara 
State Medical University, Samara, Russia.

Background: The COVID-19 pandemic brought about great uncertainty and 
significant changes in our people's everyday lives. In times of such crises, it 
is natural to seek explanations to overcome our fears and uncertainties, 
contributing to an increase to believe in conspiracy theories which, by yielding 
explanations, decrease uncertainty and ambiguity and may thus have an effect on 
mental well-being. In spite of this, the majority of research on conspiracy 
theories focused on their social effects with little attention to psychological 
effects. Thus, the aim of our present study was to examine the association 
between belief in conspiracy theories and different aspects of mental health 
during the COVID-19 pandemic in a general population sample. Methods: Our 
analyses included data from the Hungarian leg of the COMET-G (COVID-19 MEntal 
health international for the General population) study. The Hungarian sample 
included participants who completed a detailed questionnaire assessing belief in 
seven conspiracy theory items, as well as STAI-S and CES-D to measure state 
anxiety and depression, respectively, and answered questions related to their 
change in depression, anxiety and suicidal thoughts during the pandemic. 
Association between the individual beliefs as well as a composite Conspiracy 
Theory Belief Score (CTBS) and mental health measures was analysed using linear 
regression models. Results: Overall, belief in conspiracy theories was 
relatively moderate in our sample. Sex and age appeared to have a significant 
effect on the Overall Conspiracy Theory Belief Score (CTBS), with women having a 
higher score and scores increasing with age. Some of the individual beliefs also 
showed associations with age and sex. State anxiety and depression was not 
significantly associated with CTBS, however in case of depression some 
individual items were, and symptom clusters within CES-D also showed a pattern 
of association with some of the individual items. As far as changes in mental 
health during the pandemic is concerned, no association between overall beliefs 
and changes in anxiety or depression was found. However, higher overall belief 
in conspiracy theories was associated with a decrease in suicidal thoughts. 
Discussion: In our study, we explored the association between conspiracy 
theories and mental well-being as well as its changes during the COVID-19 
pandemic. We found a specific pattern of association between belief in distinct 
theories and some aspects of depression, as well as lower increase in suicidal 
ideation in association with increased belief in conspiracy theories. 
Understanding the role of belief in theories can be key to designing mental 
health interventions when reacting to unforeseen events in the future. 
(Neuropsychopharmacol Hung 2022; 24(1): 42-55).

PMID: 35451591 [Indexed for MEDLINE]


2128. S Afr J Surg. 2022 Mar;60(1):40-43.

Surgical training during the COVID-19 pandemic - a single institution's trainee 
survey.

Botha R(1), Cardoso JH(1), Lombard A(1), Vermeulen V(1), Forgan TR(2), Al-Benna 
S(3), Chu KM(4).

Author information:
(1)Faculty of Medicine and Health Sciences, Stellenbosch University, South 
Africa.
(2)Division of Surgery, Faculty of Medicine and Health Sciences, Stellenbosch 
University and Tygerberg Academic Hospital, South Africa.
(3)Division of Plastic and Reconstructive Surgery, Faculty of Medicine and 
Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, South 
Africa.
(4)Centre for Global Surgery, Department of Global Health, Faculty of Medicine 
and Health Sciences, Stellenbosch University, South Africa.

BACKGROUND: Few studies have assessed the impact of COVID-19 on surgical 
training in low- and middle-income countries. The aim of this study was to 
survey the effect of the COVID-19 pandemic on postgraduate surgical training, 
research and registrar wellbeing in South Africa.
METHODS: A cross-sectional study was conducted as an online survey from 5 
October 2020 to 1 December 2020. The study population was registrars from all 
surgical disciplines at the Faculty of Medicine and Health Sciences of 
Stellenbosch University. The survey consisted of 26 multiple-choice and five 
open-ended qualitative questions on the impact of COVID-19 on physical and 
mental wellbeing, skills acquisition and postgraduate research.
RESULTS: Of 98 surgical registrars, 35 (36%) responded. Twenty-three (65.7%) 
reported missed planned surgical rotations, 30 (85.7%) decreased surgical 
training time, and 22 (62.9%) reported a perceived decrease in training quality. 
Simulated skills training was only available to eight (22.9%) participants. 
Twenty-four (68.6%) experienced burnout and/or depression symptoms during the 
pandemic. Twenty-seven (77.1%) reported that postgraduate research was 
unaffected by the pandemic.
CONCLUSION: During the COVID-19 pandemic, surgical trainees at this institution 
reported a decrease in the quality of surgical training and skills acquisition 
and a negative impact on their mental wellbeing.

Copyright© Authors.

PMID: 35451268 [Indexed for MEDLINE]


2129. Can J Psychiatry. 2023 Jul;68(7):499-509. doi: 10.1177/07067437221094549. Epub 
2022 Apr 21.

The Impact of the COVID-19 Pandemic on the Mental Health of First-Year 
Undergraduate Students Studying at a Major Canadian University: A Successive 
Cohort Study.

King N(1), Pickett W(1)(2), Rivera D(3), Byun J(4), Li M(5), Cunningham S(6), 
Duffy A(7)(8).

Author information:
(1)Department of Public Health Sciences, Queen's University, Kingston, ON, 
Canada.
(2)Department of Health Sciences, Brock University, St. Catharines, ON, Canada.
(3)Department of Pharmacology and Toxicology, University of Toronto, ON, Canada.
(4)Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.
(5)Biology Department, Queen's University, Kingston, ON, Canada.
(6)Department of Biomedical and Molecular Sciences, Queen's University, 
Kingston, ON, Canada.
(7)Department of Psychiatry, Division of Student Mental Health, Queen's 
University, Kingston, ON.
(8)Department of Psychiatry, University of Oxford, Oxford, UK.

Comment in
    Can J Psychiatry. 2023 Feb;68(2):130-131.

OBJECTIVE: To examine the impact of the COVID-19 pandemic on first year 
undergraduate student mental health.
METHODS: As part of the Queen's University U-Flourish Student Well-Being and 
Academic Success study, three successive cohorts of students entering 
undergraduate studies in 2018 (pre-pandemic), 2019 (transitional), and 2020 
(during pandemic) completed electronic surveys at entry and completion of first 
year. Validated self-report measures were used to assess mental health status 
including symptom levels of anxiety, depression, and insomnia, self-harm and 
frequency of substance use. Propensity matching and multivariable log-binomial 
regression were used in comparisons of mental health indicators across the 
cohorts.
RESULTS: Clinically significant symptoms of depression, anxiety, insomnia, and 
self-harm were reported more frequently in the 2020-2021 cohort, coincident with 
remote learning and pandemic restrictions. In female students, screen positive 
rates for anxiety and depression, and suicidal ideation increased from about 
one-third to just under one-half in association with the pandemic (χ2, p < .01), 
while increases in mental health concerns were less pronounced among males. 
Among females, increases in clinically significant symptoms over first year 
appeared greatest during the pandemic year, while striking decreases in alcohol 
consumption in both females and males were reported in that same year. Studying 
under pandemic conditions had a negative impact on student well-being, social 
relationships and school connectedness, quality of learning experience, leisure 
activities, and optimism about future prospects.
CONCLUSIONS: Mental health concerns including anxiety, depression and sleep 
problems increased in first year students during the pandemic, especially among 
females, while alcohol use declined. These findings highlight the negative 
mental health impact associated with studying under pandemic restrictions 
involving remote learning and social distancing.

DOI: 10.1177/07067437221094549
PMCID: PMC9096012
PMID: 35450455 [Indexed for MEDLINE]

Conflict of interest statement: The authors declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


2130. Can J Psychiatry. 2022 Aug;67(8):659-660. doi: 10.1177/07067437221094341. Epub 
2022 Apr 21.

COVID-19, Healthcare Workers and Mental Wellbeing: Lessons From One Very Cold 
and Another Very Hot Part of the World.

Arnone D(1)(2), Ramaraj R(1), Stip E(1)(3).

Author information:
(1)Department of Psychiatry and Behavioural Science, College of Medicine and 
Health Sciences, 62776United Arab Emirates University, Al Ain, United Arab 
Emirates.
(2)Centre for Affective Disorders, Department of Psychological Medicine, 
Institute of Psychiatry, Psychology and Neuroscience, King's College London, 
London, UK.
(3)Centre de Recherche Institut Universitaire en Santé 12368Mentale de Montréal, 
Université de Montréal, Montréal, QC, Canada.

Comment on
    Can J Psychiatry. 2021 Sep;66(9):807-814.

DOI: 10.1177/07067437221094341
PMCID: PMC9047658
PMID: 35450434 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
authors declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


2131. BMC Public Health. 2022 Apr 21;22(1):800. doi: 10.1186/s12889-022-13148-2.

Park access and mental health among parents and children during the COVID-19 
pandemic.

Hazlehurst MF(1), Muqueeth S(2), Wolf KL(3), Simmons C(2), Kroshus E(4)(5), 
Tandon PS(6)(7).

Author information:
(1)Department of Epidemiology, University of Washington School of Public Health, 
Seattle, WA, USA.
(2)The Trust for Public Land, Washington DC, USA.
(3)School of Environmental and Forest Sciences, College of the Environment, 
University of Washington, Seattle, WA, USA.
(4)Department of Pediatrics, University of WA, Seattle, WA, USA.
(5)Seattle Children's Research Institute, Seattle, WA, USA.
(6)Department of Pediatrics, University of WA, Seattle, WA, USA. 
pooja.tandon@seattlechildrens.org.
(7)Seattle Children's Research Institute, Seattle, WA, USA. 
pooja.tandon@seattlechildrens.org.

BACKGROUND: Time spent outdoors and in nature has been associated with numerous 
benefits to health and well-being. We examined relationships between park access 
and mental health for children and parents during the COVID-19 pandemic. We also 
explored associations between park access and co-participation of parent and 
child in time outdoors, and child and parent physical activity.
METHODS: We used data from 1,000 respondents to a nationally representative U.S. 
survey of parent-child dyads during October-November 2020. Park access was 
defined as an affirmative response to: "do you have a park that you can safely 
walk to within 10 min of your home?" Child mental health was operationalized as 
the Strengths and Difficulties Questionnaire (SDQ) total difficulties score. The 
Patient Health Questionnaire-4 (PHQ-4) total score assessed parent mental health 
and the International Physical Activity Questionnaire (IPAQ) assessed parent 
physical activity. Child physical activity and co-participation in outdoor 
activity were reported as number of days in the prior week. Linear regression 
was used to examine relationships between park access and health outcomes in 
models adjusted for child and parent characteristics and COVID-19 impact.
RESULTS: Our sample included 500 parents of children ages 6-10 years, and 500 
parent-child dyads of children ages 11-17 years. Park access was associated with 
a lower SDQ total score among children (β: -1.26, 95% CI: -2.25, -0.27) and a 
lower PHQ-4 total score among parents (β: -0.89, 95% CI: -1.39, -0.40). In 
models stratified by child age, these associations were observed for SDQ scores 
among adolescents ages 11-17 and for PHQ-4 scores among parents of children ages 
6-10 years. Park access was also associated with 0.50 more days/week of 
co-participation in outdoor time (95% CI: 0.16, 0.84), and higher levels of 
parent physical activity (β: 1009 MET-min/week, 95% CI: 301, 1717), but not 
child physical activity (β: 0.31 days/week, 95% CI: -0.03, 0.66).
CONCLUSIONS: Park access was associated with better mental health among children 
and parents, and more parent physical activity and parent-child co-participation 
in outdooractivity during the COVID-19 pandemic. Access to nearby parks may be 
an important resource to promote health and well-being, for both individuals and 
families.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-13148-2
PMCID: PMC9022731
PMID: 35449096 [Indexed for MEDLINE]

Conflict of interest statement: S.M. and C.S. both work for the Trust for Public 
Land, an organization focused on protecting land and creating parks for people, 
which could be considered a competing interest given the aims of this paper.


2132. Anxiety Stress Coping. 2022 Sep;35(5):533-546. doi: 
10.1080/10615806.2022.2067983. Epub 2022 Apr 21.

Posttraumatic stress and COVID-19-related stressors: a prospective observational 
study.

Cohen M(1), Yagil D(2).

Author information:
(1)School of Social Work, University of Haifa, Haifa, Israel.
(2)Department of Human Services, University of Haifa, Haifa, Israel.

BACKGROUND: The COVID-19 pandemic may trigger posttraumatic stress symptoms 
(PTSS) due to its threat to health, well-being, and survival.
OBJECTIVES: We sought to assess levels of change in PTSS at three waves during 
the COVID-19 pandemic. Our second objective was to examine the role of four 
objective and subjective predictors salient to COVID-19-loss of resources, sense 
of loneliness, perceived COVID-19 threat, and uncertainty stress-on the 
trajectory of PTSS.
METHODS: The study consisted of three waves, a month apart, between June and 
August 2020, with 903, 718, and 684 participants in each wave, respectively.
RESULTS: At T0, participants had a medium level of PTSS (M = 2.07, SD = 0.89), 
which increased at T1 (M = 2.46, SD = 0.97) and decreased at T2 (M = 2.24, 
SD = 0.93). Linear mixed-effects modeling showed that loss of resources, sense 
of loneliness, perceived COVID-19 threat, and uncertainty stress were 
significant predictors of PTSS over the three time-points. Significant 
interactions between these predictors (except sense of loneliness) and time were 
found: At higher levels of resource loss, uncertainty stress, and COVID-19 
threat, there was a steeper increase in PTSS from baseline to 1 month.
CONCLUSIONS: The four predictors of PTSS should be addressed via strengthening 
resilience of individuals and communities.

DOI: 10.1080/10615806.2022.2067983
PMID: 35446738 [Indexed for MEDLINE]


2133. Sci Rep. 2022 Apr 20;12(1):6483. doi: 10.1038/s41598-022-10361-2.

Mindfulness-based online intervention increases well-being and decreases stress 
after Covid-19 lockdown.

Bossi F(1), Zaninotto F(2)(3), D'Arcangelo S(4), Lattanzi N(5), Malizia AP(2), 
Ricciardi E(2).

Author information:
(1)MoMiLab Research Unit, IMT School for Advanced Studies Lucca, Lucca, Italy. 
francesco.bossi@imtlucca.it.
(2)MoMiLab Research Unit, IMT School for Advanced Studies Lucca, Lucca, Italy.
(3)Department of Psychology, School of Social and Behavioural Sciences, Kingston 
University, London, UK.
(4)Intesa Sanpaolo Innovation Center SpA Neuroscience Lab, Turin, Italy.
(5)Axes Research Unit, IMT School for Advanced Studies Lucca, Lucca, Italy.

Mindfulness interventions were shown to be effective in improving well-being and 
reducing perceived stress in several conditions. These effects were also found 
in online mindfulness-based training, especially in employees in organizational 
environments. The aim of this study was to test the effectiveness of an online 
mindfulness intervention on healthy employees, especially after the first 
Italian Covid-19 lockdown. Participants in the intervention group underwent an 
8-week mindfulness online training program based on the Mindfulness-Based Stress 
Reduction (MBSR) protocol compared to a control (no-intervention) group. All 
participants filled in weekly surveys for the whole intervention duration via 
online questionnaires to measure their habits, mindfulness (FFMQ-15), emotion 
regulation (ERQ), positive and negative affect (PANAS), depression, anxiety and 
stress (DASS-21), resilience (RSA) and insomnia (ISI). 69 participants in the 
intervention group and 63 in the no-treatment control group were considered in 
the longitudinal analyses. We found significant differences between the 
intervention and control groups over time in the measures of mindfulness (in 
particular the nonreactivity subscale), positive affect, depression, and 
insomnia. Moreover, we found that the frequency of practice and ease perceived 
in practicing were positively correlated to several indices of well-being 
(mindfulness, positive affect, cognitive reappraisal) and negatively correlated 
to several indices of stress (negative affect, depression, anxiety, stress, 
insomnia, expressive suppression). These results show the importance and 
effectiveness of online mindfulness training programs to cope with stress among 
employees, especially after the Covid-19 lockdown.

© 2022. The Author(s).

DOI: 10.1038/s41598-022-10361-2
PMCID: PMC9019542
PMID: 35444198 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


2134. Acad Psychiatry. 2022 Dec;46(6):701-709. doi: 10.1007/s40596-022-01633-0. Epub 
2022 Apr 19.

The Impact of COVID-19 on Burnout, Psychological Well-being, and Work 
Satisfaction in Psychiatry Trainees in Ireland.

Mcloughlin C(1), Abdalla A(2), O'Callaghan AK(3), Casey S(4), Barrett E(5).

Author information:
(1)University of Edinburgh/Royal Infirmary Edinburgh, Edinburgh, Scotland.
(2)University of Edinburgh, Edinburgh, Scotland.
(3)Tallaght University Hospital, Dublin 24, Ireland. aoifekocallaghan@gmail.com.
(4)Daughters of Charity Disability Services, Dublin 7, Ireland.
(5)University College Dublin/Children's University Hospital, Dublin 1, Ireland.

OBJECTIVE: Prior to the pandemic, trainee doctors were at higher risk of 
psychological ill health. There is limited evidence measuring the impact of 
COVID-19 on psychiatry trainees. This study evaluates levels of burnout, work 
satisfaction, and psychological well-being in psychiatry junior doctors in 
Ireland and identifies potential contributing factors.
METHODS: The authors carried out a cross-sectional online survey measuring 
demographic and work-related variables. Questions including exposure to COVID-19 
and stress-related factors were included. We evaluated burnout, work 
satisfaction, and psychological well-being using the Abbreviated-Maslach Burnout 
Inventory, Basic Needs Satisfaction at Work Scale, and WHO-5 Well-being Index.
RESULTS: One hundred and five doctors responded (21%). The biggest stressor 
reported was reduced face-to-face contact with family and friends (73%). Forty 
one percent reported weekly supervision changes. Sixty five percent met the 
criteria for burnout, compared with 36.2% in 2018. Significant factors 
associated with burnout included staff shortages, longer hours, and less 
experience. Changes in supervision and working in non-European Working Time 
Directive compliant rotas were associated with lower scores across all 
subdomains of the BNSW Scale. The WHO-5 Well-being Index identified 48% scored 
low in personal well-being, indicating these trainees met the threshold for 
depression. Changes in regular supervision (p=0.010) were a significant 
predictor of low personal well-being.
CONCLUSIONS: High prevalence of burnout and low levels of well-being in this 
vulnerable cohort, particularly those who are inexperienced, have changes in 
supervision, and working longer hours is concerning. This study highlights the 
importance of regular supervision and support for this group.

© 2022. The Author(s).

DOI: 10.1007/s40596-022-01633-0
PMCID: PMC9018053
PMID: 35441349 [Indexed for MEDLINE]

Conflict of interest statement: On behalf of all authors, the corresponding 
author states that there is no conflict of interest.


2135. Int J Audiol. 2023 Jun;62(6):533-540. doi: 10.1080/14992027.2022.2058626. Epub 
2022 Apr 19.

Changes in audiologists' mental wellbeing during the COVID-19 pandemic: the 
supportive role of professional associations, workplaces and hearing device 
manufacturers.

Bennett RJ(1)(2), Cumming-Potvin E(1)(2), Eikelboom RH(1)(2)(3), Manchiah 
V(3)(4)(5)(6)(7), Badcock JC(8), Swanepoel W(1)(2)(3)(4).

Author information:
(1)Ear Science Institute Australia, Subiaco, Western Australia, Australia.
(2)Ear Sciences Centre, Medical School, The University of Western Australia, 
Nedlands, Australia.
(3)Department of Speech-Language Pathology and Audiology, University of 
Pretoria, Gauteng, South Africa.
(4)Virtual Hearing Lab, Collaborative Initiative between Lamar University and 
University of Pretoria.
(5)Department of Otolaryngology-Head and Neck Surgery, University of Colorado 
School of Medicine, Aurora, Colorado, USA.
(6)UCHealth Hearing and Balance, University of Colorado Hospital, Aurora, 
Colorado, USA.
(7)Department of Speech and Hearing, School of Allied Health Sciences, Manipal 
University, Manipal, Karnataka, India.
(8)School of Psychological Science, The University of Western Australia, 
Nedlands, Australia.

Objective: The purpose of this study was to explore whether self-reported mental 
wellbeing (anxiety, depression and loneliness) in audiologists has changed over 
the course of the COVID-19 pandemic and to examine possible factors contributing 
to audiologists' current state of mental wellbeing.Design: Two cross-sectional 
surveys were distributed at two different time points during the COVID-19 
pandemic screening for psychological distress (PHQ-4: anxiety and depression) 
and loneliness (UCLA-3).Study sample: 117 audiologists from around the 
world.Results: Findings demonstrated that over the course of the COVID-19 
pandemic audiologists' levels of depression decreased, levels of anxiety were 
low and stable, whilst levels of loneliness were stable and high. Younger age 
was associated with lower levels of mental well-being. Responses to open text 
questions suggests that audiologists could be supported through development of 
clear and consistent guidelines on COVID-19 workplace restrictions, allowing for 
more workplace flexibility and providing mental health support through employee 
assistance programs.Conclusions: The rates of anxiety, depression and loneliness 
observed highlight the continued need for mental health and workplace 
interventions to support audiologists throughout the COVID-19 pandemic and the 
subsequent recovery period.

DOI: 10.1080/14992027.2022.2058626
PMID: 35439082 [Indexed for MEDLINE]


2136. Vertex. 2022 Mar;XXXIII(155):25-35. doi: 10.53680/vertex.v33i155.133.

[Frequency of anxiety, post-traumatic stress disorder and burnout in health 
personnel in hospitals in Buenos Aires, Argentina, in the context of the 
COVID-19 pandemic].

[Article in Spanish]

Novas SV(1), Nahmod M(2), Nespral M(2), Bori C(2), Zappa LM(2), Korin H(3), Pena 
F(4).

Author information:
(1)Jefa de la Unidad de Salud Mental del Hospital de Niños "Dr. Ricardo 
Gutiérrez", Ciudad Autónoma de Buenos Aires, Argentina.
(2)Unidad de Salud Mental, Hospital de Niños "Dr. Ricardo Gutiérrez", Ciudad 
Autónoma de Buenos Aires, Argentina.
(3)Centro de Salud y Acción Comunitaria N°19, Ciudad Autónoma de Buenos Aires, 
Argentina.
(4)Hospital "J. M. Ramos Mejía" (Instructor de Residentes), Ciudad Autónoma de 
Buenos Aires, Argentina.

INTRODUCTION: The aim of this research is to establish and evaluate the 
frequency of anxiety, burnout and post-traumatic stress disorder in health 
personnel during the COVID-19 pandemic according to the degree of exposure in 
three public healthcare facilities with different levels of complexity in Buenos 
Aires, Argentina.
METHODS: Multicenter, prospective, analytical study. The sample was taken 
through a three-step voluntary and anonymous online form with three invento- 
ries: Gad 7, Maslach Inventory and Davidson Trauma Scale and a self-perceived 
risk questionnaire.
RESULTS: In a total sample of n=1391, a higher prevalence of anxiety symptoms 
(mild: M=41%; moderate to severe: M=27%) and sleep difficulties (M=73%) was 
found, while levels of post-traumatic stress (M=36%) and burnout remained lower 
(M=19%). While the chi-square tests indicated associations between job positions 
with higher exposure and the presence of symptoms, the logistic regression 
models indicated that the professionals in training and those who reported 
higher levels of self-perceived risk showed a greater presence of psychological 
symptoms.
DISCUSSION: The self-perception of risk is an important factor when considering 
the presence of symptoms, regardless of the actual degree of exposure.
CONCLUSIONS: Measures to promote mental well-being in healthcare workers must be 
implemented immediately and sustained over time, especially in young people, 
females and frontline workers.

DOI: 10.53680/vertex.v33i155.133
PMID: 35438683 [Indexed for MEDLINE]


2137. Psychol Health Med. 2023 Jan;28(1):189-199. doi: 10.1080/13548506.2022.2063351. 
Epub 2022 Apr 18.

Influence of mental health on the well-being status among Malaysian adults 
before and during COVID-19 pandemic.

Cheah WL(1), Law LS(1), Samy AL(2), Chua BS(3), Siau CS(4), Fitriana M(5), Bono 
SA(6), S V(7), Low WY(8).

Author information:
(1)Department of Community Medicine and Public Health, Faculty of Medicine and 
Health Sciences, Universiti Malaysia Sarawak, Sarawak, Malaysia.
(2)Institut Tadbiran Awam Negara (INTAN), Kampus Wilayah Timur, Terengganu, 
Malaysi.
(3)Faculty of Psychology and Education, Universiti Malaysia Sabah, Sabah, 
Malaysia.
(4)Centre for Community Health Studies, Faculty of Health Sciences, Universiti 
Kebangsaan Malaysia, Selangor, Malaysia.
(5)Department of Psychology, Faculty of Arts and Science, International 
University of Malaya-Wales, Kuala Lumpur, Malaysia.
(6)School of Social Sciences, Universiti Sains Malaysia, Penang, Malaysia.
(7)School of Education and Social Sciences, Veritas University College, Petaling 
Jaya, Malaysia.
(8)Dean's Office, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 
Malaysia.

The coronavirus disease (COVID-19) pandemic has affected the well-being of 
individuals worldwide. Due to the scarcity of information in the Malaysian 
context, this study aimed at investigating the changes in well-being before and 
during the Movement Control Order (MCO) in Malaysia and its association with 
mental health status. This cross-sectional study was part of a Malaysian 
non-probabilistic online survey on psychosocial well-being in Malaysia, under 
the Personal and Family Coping with COVID-19 Global South Research Consortium. A 
total of 543 respondents (≥18 years old) were recruited using snowball sampling. 
A validated self-administered questionnaire for assessing sociodemographic 
characteristics, well-being, anxiety, boredom, and loneliness was circulated on 
social media platforms (such as Facebook, Twitter, and WhatsApp) and emails. 
Paired samples t-test, chi-square test, and multinomial logistic regression 
analyses were applied during data analysis. Results revealed significant changes 
in the mean scores of well-being, anxiety, boredom, and loneliness before and 
during MCO (p < 0.05). When comparing with no change in the well-being group, 
changes in boredom were less likely to be observed in the decreased well-being 
group (Adj OR = 0.874; p = 0.003) but were more likely to be observed in the 
group with increased well-being (Adj OR = 1.110; p = 0.002). The findings 
indicated that the pandemic did not necessarily create adverse effects. Instead, 
a different perspective is offered, which can be used as a public health 
strategy to help individuals cope with their mental health needs more 
positively.

DOI: 10.1080/13548506.2022.2063351
PMID: 35437088 [Indexed for MEDLINE]


2138. BMC Public Health. 2022 Apr 18;22(1):780. doi: 10.1186/s12889-022-13083-2.

The impact of the COVID-19 lockdown on depression sufferers: a qualitative study 
from the province of Zaragoza, Spain.

Aguilar-Latorre A(1), Oliván-Blázquez B(2)(3), Porroche-Escudero A(4), 
Méndez-López F(1), García-Gallego V(1), Benedé-Azagra B(1)(5), Magallón-Botaya 
R(1)(6)(7).

Author information:
(1)Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.
(2)Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain. 
bolivan@unizar.es.
(3)Department of Psychology and Sociology, University of Zaragoza, Zaragoza, 
Spain. bolivan@unizar.es.
(4)Lancaster Environment Centre, Lancaster University, Lancaster, UK.
(5)Department of Psychology and Sociology, University of Zaragoza, Zaragoza, 
Spain.
(6)Aragonese Healthcare Service (SALUD), Zaragoza, Spain.
(7)Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, 
Zaragoza, Spain.

BACKGROUND AND PURPOSE: The impact of COVID-19 and its control measures have 
exacerbated existing mental health conditions. Although the deleterious effects 
of mental health problems are well known, fewer studies have examined the links 
between the Social Determinants of Health (SDHs) and depression. This study 
provides insights into the relationship between SDHs and depression during the 
first strict lockdown in Spain, which lasted for a period of 7 weeks.
METHODS: Fifty-two structured interviews were conducted with people diagnosed 
with depression during June 2020 in the province of Zaragoza (Spain). Interviews 
were conducted by telephone due to lockdown constraints. Inductive thematic 
content analysis was used to explore, develop, and define emergent categories of 
analysis, which were mapped against the SDH framework.
RESULTS: Listening to people's experiences of living with depression during 
lockdown provided insights into their concerns and coping strategies, which are 
greatly influenced by the conditions in which they live, their job and their 
age. Examples of these factors include access to and quality of physical spaces, 
including housing conditions and public spaces for socialising, social support, 
adverse working conditions which include caring responsibilities, and access to 
digital technologies and healthcare services.
CONCLUSION: SDHs have played a fundamental role in shaping people's health and 
well-being during the COVID-19 pandemic, and this study has shown that they have 
a considerable effect on depression outcomes. Governments should consider 
implementing social welfare programs to tackle both psychosocial problems and 
material need during crisis situations.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-13083-2
PMCID: PMC9015282
PMID: 35436858 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2139. Holist Nurs Pract. 2022 May-Jun 01;36(3):156-165. doi: 
10.1097/HNP.0000000000000511.

The Effect of Mindfulness-Based Breathing and Music Therapy Practice on Nurses' 
Stress, Work-Related Strain, and Psychological Well-being During the COVID-19 
Pandemic: A Randomized Controlled Trial.

Yıldırım D(1), Çiriş Yıldız C.

Author information:
(1)Department of Nursing, Faculty of Health Sciences, İstanbul Aydin University, 
İstanbul, Turkey.

Infectious diseases cause psychological problems for health care workers and 
especially nurses. Nurses who provided coronavirus disease-2019 (COVID-19) 
patients with care experience negative feelings such as stress, work-related 
strain, discomfort, and helplessness related to their high-intensity work. The 
aims of this study are to investigate the effect of the mindfulness-based 
breathing and music therapy practice on stress, work-related strain, and 
psychological well-being levels of nurses who provided COVID-19 patients with 
care. This randomized controlled trial was conducted in a COVID-19 department at 
a university hospital in Turkey. Nurses who care for patients infected with 
COVID-19 were randomly divided into an intervention group (n = 52) and a 
no-treatment control group (n = 52). The intervention group received 
mindfulness-based breathing and music therapy. In data collection, the Personal 
Information Form, State Anxiety Inventory, Work-Related Strain Scale, and 
Psychological Well-Being Scale were used. The data from the study showed that 
mindfulness-based breathing and music therapy decreased stress and work-related 
strain (P < .05) and increased psychological well-being (P < .05). The control 
group showed no statistically significant changes on these measures (P > .05). 
The mindfulness-based breathing and music therapy practice reduced nurses' 
stress and work-related strain and increased psychological well-being during the 
COVID-19 pandemic.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/HNP.0000000000000511
PMCID: PMC8997019
PMID: 35435877 [Indexed for MEDLINE]


2140. J Appl Gerontol. 2022 Jul;41(7):1657-1664. doi: 10.1177/07334648221087120. Epub 
2022 Apr 18.

Leveraging Public-Private Partnerships During COVID-19: Providing Virtual Field 
Opportunities for Student Learners and Addressing Social Isolation in Older 
Adults.

Adepoju OE(1)(2), Jennings S(2)(3), Schrader P(4), Reeve K(4), McManaman-Bridges 
T(4), Gilbert L(1)(2), King B(1)(2), Dobbins J(2)(5), Rollins A(5), Cockerell 
T(5), Woodard L(1)(2), Torres-Hostos L(6).

Author information:
(1)Humana Integrated Health System Sciences Institute, 14743University of 
Houston, Houston, TX, USA.
(2)Department of Health Systems and Population Health Sciences, College of 
Medicine, 14743University of Houston, Houston, TX, USA.
(3)Graduate College of Social Work, 14743University of Houston, Houston, TX, 
USA.
(4)College of Nursing, 14743University of Houston, Houston, TX, USA.
(5)5167Office of Health Affairs and Advocacy, Humana Inc., Louisville, KY, USA.
(6)School of Social Work, 12331University of Texas, Rio Grande Valley, TX, USA.

While preventive and management measures are important to mitigate the spread of 
COVID-19, strategies like social distancing can have devastating effects on 
older adults who are already at risk for social isolation and loneliness. In 
response, two Colleges of Health Professions (Social Work and Nursing) at a 
large public University leveraged a partnership with a national health and 
wellbeing company to address social isolation and loneliness in Houston area 
older adults during the COVID-19 pandemic. This intergenerational linkage 
initiative involved 707 older adults and 177 graduate social work and nursing 
students. This study describes the process of developing a virtual educational 
opportunity for students while also meeting the needs of vulnerable older adults 
in Houston, the third largest, and one of the most diverse cities in the U.S. 
Findings include student/learner outcomes, as well as self-reported improvements 
in loneliness scores, and unhealthy physical and mental health days among 
enrolled older adults.

DOI: 10.1177/07334648221087120
PMCID: PMC9016374
PMID: 35435046 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interest: T. 
Cockerell, J. Dobbins and A. Rollins are employed by Humana Inc. Other authors 
have no conflicts of interest, financial or personal, to declare.


2141. Front Public Health. 2022 Mar 31;10:818777. doi: 10.3389/fpubh.2022.818777. 
eCollection 2022.

The Survey of the Health of Wisconsin (SHOW) Program: An Infrastructure for 
Advancing Population Health.

Malecki KMC(1), Nikodemova M(1), Schultz AA(1), LeCaire TJ(1)(2), Bersch AJ(1), 
Cadmus-Bertram L(1)(3), Engelman CD(1), Hagen E(1), McCulley L(1), Palta M(1), 
Rodriguez A(1), Sethi AK(1), Walsh MC(1), Nieto FJ(1)(2)(4), Peppard PE(1).

Author information:
(1)Department of Population Health Sciences, School of Medicine and Public 
Health, University of Wisconsin, Madison, WI, United States.
(2)School of Medicine and Public Health, Wisconsin Alzheimer's Institute, 
University of Wisconsin, Madison, WI, United States.
(3)Department of Kinesiology, School of Education, University of Wisconsin, 
Madison, WI, United States.
(4)College of Public Health and Human Sciences, Oregon State University, 
Corvallis, OR, United States.

Update of
    medRxiv. 2021 Apr 07;:

INTRODUCTION: The Survey of the Health of Wisconsin (SHOW) was established in 
2008 by the University of Wisconsin (UW) School of Medicine and Public Health 
(SMPH) with the goals of (1) providing a timely and accurate picture of the 
health of the state residents; and (2) serving as an agile resource 
infrastructure for ancillary studies. Today, the SHOW program continues to serve 
as a unique and vital population health research infrastructure for advancing 
public health.
METHODS: SHOW currently includes 5,846 adult and 980 minor participants 
recruited between 2008 and 2019 in four primary waves. WAVE I (2008-2013) 
includes annual statewide representative samples of 3,380 adults ages 21 to 74 
years. WAVE II (2014-2016) is a triannual statewide sample of 1,957 adults (age 
≥18 years) and 645 children (age 0-17). WAVE III (2017) consists of follow-up of 
725 adults from the WAVE I and baseline surveys of 222 children in selected 
households. WAVEs II and III include stool samples collected as part of an 
ancillary study in a subset of 784 individuals. WAVE IV consists of 517 adults 
and 113 children recruited from traditionally under-represented populations in 
biomedical research including African Americans and Hispanics in Milwaukee, 
Wisconsin.
FINDINGS TO DATE: The SHOW resource provides unique spatially granular and 
timely data to examine the intersectionality of multiple social determinants and 
population health. SHOW includes a large biorepository and extensive health data 
collected in a geographically diverse urban and rural population. Over 60 
studies have been published covering a broad range of topics including, urban 
and rural disparities in cardio-metabolic disease and cancer, objective physical 
activity, sleep, green-space and mental health, transcriptomics, the gut 
microbiome, antibiotic resistance, air pollution, concentrated animal feeding 
operations and heavy metal exposures.
DISCUSSION: The SHOW cohort and resource is available for continued follow-up 
and ancillary studies including longitudinal public health monitoring, 
translational biomedical research, environmental health, aging, microbiome and 
COVID-19 research.

Copyright © 2022 Malecki, Nikodemova, Schultz, LeCaire, Bersch, Cadmus-Bertram, 
Engelman, Hagen, McCulley, Palta, Rodriguez, Sethi, Walsh, Nieto and Peppard.

DOI: 10.3389/fpubh.2022.818777
PMCID: PMC9008403
PMID: 35433595 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2142. Eur J Psychotraumatol. 2022 Apr 11;13(1):2057166. doi: 
10.1080/20008198.2022.2057166. eCollection 2022.

Experiences and views of frontline healthcare workers' family members in the UK 
during the COVID-19 pandemic: a qualitative study.

Tekin S(1), Glover N(1), Greene T(2), Lamb D(3), Murphy D(4)(5), Billings J(1).

Author information:
(1)Division of Psychiatry, University College London, London, UK.
(2)Department of Community Mental Health, University of Haifa, Haifa, Israel.
(3)Department of Applied Health Research, University College London, London, UK.
(4)Combat Stress, Tyrwhitt House, Leatherhead, UK.
(5)The King's Centre for Military Health Research, King's College London, 
London, UK.

BACKGROUND: The COVID-19 pandemic has had a well-documented negative impact on 
the mental health and wellbeing of frontline healthcare workers (HCWs). Whilst 
no research has to date been carried out to explore the challenges experienced 
by the families of HCWs, some previous research has been conducted with military 
families, demonstrating that family members of deployed military personnel may 
also be affected seriously and negatively.
OBJECTIVES: This study aimed to explore the experiences, views, and mental 
health impact on frontline HCWs' families during the COVID-19 pandemic in the UK 
and what support the families of frontline HCWs may need.
METHOD: Close family members and friends of HCWs were interviewed. Transcripts 
were analysed in line with the principles of reflexive thematic analysis.
RESULTS: We completed fourteen interviews with three siblings, one mother, one 
friend, and nine spouses of HCWs. Family members were highly motivated to 
support healthcare workers and felt an intense sense of pride in their work. 
However, they also experienced increased domestic responsibilities and emotional 
burden due to anxiety about their loved ones' work. The fact that sacrifices 
made by family members were not noticed by society, the anxiety they felt about 
their family's physical health, the impact of hearing about traumatic 
experiences, and the failure of healthcare organisations to meet the needs of 
the HCWs all negatively affected the family members.
CONCLUSIONS: We have an ethical responsibility to attend to the experiences and 
needs of the families of healthcare professionals. This study emphasises the 
experiences and needs of family members of healthcare professionals, which have 
hitherto been missing from the literature. Further research is needed to hear 
from more parents, siblings and friends, partners in same sex relationships, as 
well as children of HCWs, to explore the variety of family members and 
supporters' experiences more fully.
HIGHLIGHTS: • COVID19 has impacted families of HCWs as well as workers 
themselves. They have experienced more anxiety, increased practical burden, 
significant physical health risks and been exposed vicariously to workers' 
traumatic experiences. We must ensure HCW families are better supported.

Publisher: Antecedentes: La pandemia de COVID-19 ha tenido un impacto negativo 
bien documentado en la salud mental y bienestar de los trabajadores de la salud 
de la primera línea (HCWs por sus siglas en ingles). Mientras que hasta la fecha 
no se han llevado a cabo investigaciones que exploren los desafíos 
experimentados por las familias de los HCWs, algunas investigaciones previas 
fueron realizadas con familias de militares, demostrando que los miembros de la 
familia del personal militar desplegado también pueden ser afectados seria y 
negativamente.Objetivos: Este estudio apuntó a explorar las experiencias, puntos 
de vista, y el impacto en la salud mental de las familias de los HCWs de la 
primera línea durante la pandemia de COVID-19 en el Reino Unido y qué apoyo 
estas familias podrían necesitar.Método: Completamos catorce entrevistas con 
tres hermanos, una madre, un amigo y nueve esposas de HCWs. Los familiares 
estaban altamente motivados en apoyar a los trabajadores de la salud y sintieron 
un intenso sentido de orgullo por su trabajo. Sin embargo, también 
experimentaron un aumento en las responsabilidades domésticas y en la carga 
emocional debido a la ansiedad sobre el trabajo de sus seres queridos. El hecho 
de que el sacrificio hecho por los familiares no fuera notado por la sociedad, 
la ansiedad que sintieron sobre la salud física de su familia, el impacto de 
escuchar sobre experiencias traumáticas y la falla de las organizaciones de 
salud en conocer las necesidades de los HCWs, todo ello afectó negativamente a 
los familiares.Conclusiones: Tenemos una responsabilidad ética de abordar las 
experiencias y necesidades de los familiares de los profesionales de la salud. 
Este estudio enfatiza las experiencias y necesidades de los familiares de los 
profesionales de la salud, que hasta ahora no han aparecido en la literatura. Se 
necesita mayor investigación para escuchar a más padres, hermanos y amigos, 
parejas en relaciones del mismo sexo, así como de hijos de HCWs, para explorar 
de forma más completa la variedad de las experiencias de las familias y personas 
de apoyo.

Publisher: 背景： COVID-19 疫情对一线医护人员 (HCW) 的心理健康和幸福产生了有据可查的负面影响。虽然至今尚未开展任何研究来探讨 HCW 
家庭成员所面临的挑战，先前对军人家庭成员进行的一些研究表明服役军人家庭成员也可能受到严重和负面的影响。目的：本研究旨在探讨英国 COVID-19 
疫情期间一线医护人员家庭成员的经历、观点和心理健康影响，以及一线医护人员家人可能需要的支持。方法：采访了医护人员的亲密家庭成员和朋友。文字稿的分析符合反身主题分析的原则。结果：我们完成了对 
HCW 的三个兄弟姐妹、一位母亲、一位朋友和九位配偶的 14 
次访谈。家庭成员非常积极地支持医护人员，并对他们的工作感到强烈的自豪感。然而，由于对亲人工作的焦虑，他们也经历了更多的家庭责任和情感负担。家庭成员做出的牺牲没有被社会注意到，他们对家人身体健康的焦虑，听到创伤经历的影响，以及医疗机构未能满足医护人员的需求，这些都对家庭成员产生了负面影响。结论：我们有关注医护专业人员家庭成员的经历和需求的伦理责任。本研究强调了至今一直在文献中缺失的医护专业人员家庭成员的经历和需求。需要进一步研究以听取更多父母、兄弟姐妹和朋友、同性关系伴侣以及医护人员子女的意见，以更全面地探讨家庭成员和支持者的各种经历。.

© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & 
Francis Group.

DOI: 10.1080/20008198.2022.2057166
PMCID: PMC9009898
PMID: 35432783 [Indexed for MEDLINE]

Conflict of interest statement: No potential conflict of interest was reported 
by the author(s).


2143. J Soc Psychol. 2023 Nov 2;163(6):806-825. doi: 10.1080/00224545.2022.2061326. 
Epub 2022 Apr 17.

We only know that we don't know: attachment patterns and psychological coping 
during the COVID-19 pandemic - the mediation role of intolerance of uncertainty.

Alfasi Y(1).

Author information:
(1)Hadassah Academic College.

The global outbreak of the COVID-19 pandemic created sudden changes in many 
areas of daily life and increased uncertainty about the future. Two studies 
examined the association between attachment patterns and mental well-being 
during the pandemic, the mediating role of intolerance of uncertainty (IOU), and 
factors related to social relationships and self-perceptions. The results of the 
first study, conducted at the outbreak of the pandemic, indicated that 
individuals with high levels of attachment anxiety experienced more negative 
emotions and fewer positive emotions at that time, and that IOU and perceived 
social support mediated these associations. The results of the second study, 
conducted several months into the pandemic, indicated an association between 
attachment anxiety and avoidance, and perceived stress during the time of the 
pandemic. Results of Study 2 also indicated that IOU mediated the association 
between attachment anxiety and stress, and that sense of coherence (SOC) 
mediated the association between attachment anxiety and avoidance, and stress. 
These findings underscore the adverse psychological effects of uncertain 
situations, especially for individuals with a fragile foundation of 
interpersonal support, thus emphasizing the need for action to reduce 
uncertainty, especially in times of emergency.

DOI: 10.1080/00224545.2022.2061326
PMID: 35430955 [Indexed for MEDLINE]


2144. J Aging Health. 2022 Oct;34(6-8):939-950. doi: 10.1177/08982643221081965. Epub 
2022 Apr 16.

Disparities in Mental Health and Well-Being between Heterosexual and Sexual 
Minority Older Adults during the COVID-19 Pandemic.

Chen JH(1).

Author information:
(1)Department of Sociology & Department of Psychology, 242612National Chengchi 
University, Taipei, Taiwan.

Objectives: This study examines disparities in older adults' mental health and 
well-being during the pandemic by sexual minority status. Methods: This study 
analyzed data on older adults from the Health and Retirement Study's COVID-19 
Module (N = 3142 for heterosexuals and N = 75 for sexual minorities). Weighted 
regressions linked concern about COVID-19, depression, pandemic emotional 
stress, and changes in loneliness, in-person contacts, income, and work to 
sexual minority status, controlling for sociodemographic characteristics. 
Results: Compared to heterosexuals, sexual minority older adults had more 
concern about the pandemic and emotional stress and showed a decrease in 
in-person contact during the pandemic-these differences were not explained by 
sociodemographic characteristics. Sexual minority older adults were also more 
likely to have changes in income and work during the pandemic, but these 
differences were explained by sociodemographic characteristics. Discussion: 
Sexual minority older adults have experienced worse mental health outcomes than 
heterosexuals during the COVID-19 pandemic, which merits intervention.

DOI: 10.1177/08982643221081965
PMCID: PMC9014338
PMID: 35430925 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


2145. Soc Sci Med. 2022 May;301:114889. doi: 10.1016/j.socscimed.2022.114889. Epub 
2022 Mar 18.

Making sense of a pandemic: Mindsets influence emotions, behaviors, health, and 
wellbeing during the COVID-19 pandemic.

Zion SR(1), Louis K(2), Horii R(3), Leibowitz K(2), Heathcote LC(4), Crum AJ(2).

Author information:
(1)Stanford University Department of Psychology, Stanford, CA, USA. Electronic 
address: szion@stanford.edu.
(2)Stanford University Department of Psychology, Stanford, CA, USA.
(3)Stanford University Department of Psychology, Stanford, CA, USA; University 
of Minnesota Department of Psychology, Minneapolis, MN, USA.
(4)Stanford University Department of Anesthesiology, Perioperative & Pain 
Medicine, Stanford, CA, USA; Health Psychology Section, Institute of Psychiatry 
Psychology and Neuroscience, King's College London, England.

RATIONALE: As the SARS-COV-2 virus spread across the world in the early months 
of 2020, people sought to make sense of the complex and rapidly evolving 
situation by adopting mindsets about what the pandemic was and what it meant for 
their lives.
OBJECTIVE: We aimed to measure the mindsets of American adults over the first 
six months of the COVID-19 pandemic to understand their relative stability over 
time and their relationship with emotions, behaviors, experiences, and 
wellbeing.
METHODS: American adults (N = 5,365) were recruited in early March of 2020 to 
participate in a longitudinal survey with follow-up surveys at 6-weeks and 
6-months. Three mindsets that people formed about the COVID-19 pandemic were 
measured: 'the pandemic is a catastrophe', 'the pandemic is manageable' and 'the 
pandemic can be an opportunity'.
RESULTS: In line with our pre-registered hypotheses, these mindsets were 
associated with a unique and largely self-fulfilling pattern of emotions 
(positive, negative), behaviors (healthy, unhealthy, and compliance with CDC 
guidelines), experiences (growth/connection, isolation/meaninglessness) and 
wellbeing (physical health, mental health, quality of life). Moreover, mindsets 
formed in the first week of the pandemic were associated with quality of life 6 
months later, an effect that was mediated by emotions and health behaviors.
CONCLUSION: The mindsets that people adopted about the COVID-19 pandemic - that 
it is 'a catastrophe', 'manageable', or 'an opportunity' may explain some of the 
heterogeneity in the lived experiences of Americans through their 
self-fulfilling impact on peoples' emotions, health behaviors, and wellbeing.

Copyright © 2022 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.socscimed.2022.114889
PMCID: PMC8930786
PMID: 35430098 [Indexed for MEDLINE]


2146. Psychiatry Res. 2022 Jun;312:114541. doi: 10.1016/j.psychres.2022.114541. Epub 
2022 Apr 5.

COVID-19 pandemic-related posttraumatic growth in a small cohort of university 
students: A 1-year longitudinal study.

Van der Hallen R(1), Godor BP(2).

Author information:
(1)Department of Psychology, Education & Child Studies, Erasmus University 
Rotterdam, Rotterdam 3062 PA, The Netherlands. Electronic address: 
vanderhallen@essb.eur.nl.
(2)Department of Psychology, Education & Child Studies, Erasmus University 
Rotterdam, Rotterdam 3062 PA, The Netherlands.

The COVID-19 pandemic has affected all areas of life, with severe potential 
consequences for people's mental health. Posttraumatic growth (PTG), a positive 
psychological change that may develop following a traumatic event, in light of 
the COVID-19 pandemic has only received little attention. The current study 
aimed to investigate (1) the prevalence of PTG within the context of the 
COVID-19 pandemic and (2) which psychological aspects predict COVID-19 
pandemic-related PTG using a 1-year longitudinal design. A sample of 70 
participants completed a survey on COVID-19, posttraumatic stress, emotional 
well-being, coping styles, determinates of resilience, and PTG at both T1, May 
2020, and T2, May 2021. Results reveal moderate levels of PTG for about one in 
five participants at both T1 and T2 (21% and 23%, respectively). Moreover, PTG 
at T1 and T2 were moderate to strongly, positively correlated, r = 0.62. 
Posttraumatic stress and social support were found to positively predict PTG at 
T1, while positive affect and social skills were found to positively predict PTG 
at both T1 and T2, βs = 0.22-.52. Implications of the current findings and 
suggestions for future research are discussed.

Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.psychres.2022.114541
PMCID: PMC8979838
PMID: 35429912 [Indexed for MEDLINE]

Conflict of interest statement: The authors report no conflict of interest. The 
data that support the findings of this study are available from the 
corresponding author upon reasonable request.


2147. Compr Psychiatry. 2022 Jul;116:152313. doi: 10.1016/j.comppsych.2022.152313. 
Epub 2022 Apr 9.

Managing the COVID-19 pandemic in people with mental disorders: An exploratory 
telephone interview study in a psychiatric outpatient department.

Kertzscher L(1), Kohls E(2), Baldofski S(3), Moeller R(4), Schomerus G(5), 
Rummel-Kluge C(6).

Author information:
(1)Leipzig University, Medical Faculty, Department of Psychiatry and 
Psychotherapy, Semmelweisstrasse 10, Haus 13, 04103 Leipzig, Germany. Electronic 
address: Lisa.Kertzscher@medizin.uni-leipzig.de.
(2)Leipzig University, Medical Faculty, Department of Psychiatry and 
Psychotherapy, Semmelweisstrasse 10, Haus 13, 04103 Leipzig, Germany; University 
Leipzig Medical Center, Department of Psychiatry and Psychotherapy, 
Semmelweisstrasse 10, Haus 13, 04103 Leipzig, Germany. Electronic address: 
Elisabeth.Kohls@medizin.uni-leipzig.de.
(3)Leipzig University, Medical Faculty, Department of Psychiatry and 
Psychotherapy, Semmelweisstrasse 10, Haus 13, 04103 Leipzig, Germany. Electronic 
address: Sabrina.Baldofski@medizin.uni-leipzig.de.
(4)Leipzig University, Medical Faculty, Department of Psychiatry and 
Psychotherapy, Semmelweisstrasse 10, Haus 13, 04103 Leipzig, Germany.
(5)Leipzig University, Medical Faculty, Department of Psychiatry and 
Psychotherapy, Semmelweisstrasse 10, Haus 13, 04103 Leipzig, Germany; University 
Leipzig Medical Center, Department of Psychiatry and Psychotherapy, 
Semmelweisstrasse 10, Haus 13, 04103 Leipzig, Germany. Electronic address: 
Georg.Schomerus@medizin.uni-leipzig.de.
(6)Leipzig University, Medical Faculty, Department of Psychiatry and 
Psychotherapy, Semmelweisstrasse 10, Haus 13, 04103 Leipzig, Germany; University 
Leipzig Medical Center, Department of Psychiatry and Psychotherapy, 
Semmelweisstrasse 10, Haus 13, 04103 Leipzig, Germany. Electronic address: 
Christine.Rummel-Kluge@medizin.uni-leipzig.de.

BACKGROUND: The COVID-19 pandemic and associated lockdown measures reduced 
well-being in the general population significantly and led to an increase in 
anxiety and depression symptoms, however, results on the impact on people with 
mental disorders are heterogeneous to date. The aim of this study was to 
investigate the mental health status, social support, perceived stress, and the 
medical care provision of people with mental disorders during the time period 
immediately after the first COVID-19 lockdown in spring 2020 in Germany.
METHODS: Participants were people with mental disorders currently receiving 
treatment in the psychiatric outpatient department of the University Hospital 
Leipzig, Germany. Structured telephone interviews were administered to assess 
depressive symptoms, self-rated medical care provision, attitudes and social and 
emotional aspects of the pandemic (social support, perceived stress, loneliness, 
resilience, and agreeableness).
RESULTS: A total of N = 106 people completed the telephone interview. The most 
frequent clinician-rated diagnoses were attention deficit disorder/attention 
deficit hyperactivity disorder (ADD/ADHD; n = 29, 27.4%) and 
obsessive-compulsive disorder (OCD; n = 24, 22.6%). The mean Patient Health 
Questionnaire-9 sum score was 10.91 (SD = 5.71) and the majority of participants 
(n = 56, 52.8%) reported clinically relevant depressive symptoms. A low 
self-rated medical care provision was significantly associated with higher 
depressive symptom load. In a regression analysis, higher perceived stress 
levels and low medical care provision significantly predicted depressive 
symptoms. Furthermore, 38.1% (n = 40) reported to feel relieved as a result of 
the restrictions and, due to previous experience in dealing with crisis, half of 
the participants (n = 53, 50.5%) stated they were better able to deal with the 
current situation than the general population.
CONCLUSIONS: This study emphasizes the importance of maintenance of medical care 
provision for people with mental disorders, as cancelled or postponed treatment 
appointments and perceived stress were associated with higher depressive 
symptoms. Regular treatment services showed to have a protective effect. In 
addition, a majority of people with mental disorders felt prepared for managing 
the COVID pandemic due to existing crisis management abilities. These resources 
should also be taken into account for further future treatment considerations.
TRIAL REGISTRATION: German Clinical Trials Register (DRKS00022071).

Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.comppsych.2022.152313
PMCID: PMC8993418
PMID: 35429763 [Indexed for MEDLINE]

Conflict of interest statement: None.


2148. Eur J Hosp Pharm. 2023 Dec 27;31(1):57-62. doi: 10.1136/ejhpharm-2021-003164.

A qualitative evaluation of weekly reflective practice sessions for the 
intensive care unit pharmacy team during the COVID-19 pandemic.

Fowlis N(1), Barnett N(2), Banks S(3), Jubraj B(4).

Author information:
(1)Psychology, Royal Holloway University of London, Egham, UK 
naima.fowlis@nhs.net.
(2)Care of Older People, NHS Specialist Pharmacy Service, England and London 
North West Healthcare NHS Trust, Middx, UK.
(3)Northwick Park Hospital, Harrow, London, UK.
(4)UCL School of Pharmacy, University College London, London, UK.

Despite well-being initially being high on the agenda for UK health 
organisations, the COVID-19 pandemic has highlighted significant gaps around 
provision for well-being of pharmacists in the UK. The COVID-19 intensive care 
unit (ICU) environment exposed pharmacists to mental, physical and emotional 
challenges, including high levels of patient mortality.
OBJECTIVES: To provide an account of the experience of pharmacists working 
within an ICU at a large National Health Service hospital who attended 
reflective practice sessions throughout the first wave of the pandemic.
METHOD: A retrospective, cross-sectional design was used to gather information 
from eight participants who had attended nine, 30-minute weekly reflective 
practice sessions. Participants were invited to complete a 10-item online 
self-report questionnaire. The responses from the questionnaire were analysed 
using theoretical thematic analysis.
RESULTS: Seven participants completed the self-report questionnaire. Thematic 
analysis of responses identified four themes: (1) permission: both professional 
and personal 'permission' was necessary for participants to be present for the 
reflective practice sessions and to attend to their own well-being; (2) 
containing safe space: reflective practice sessions offered a consistently 
secure environment from which to explore topics which created challenge, 
personally and/or professionally; (3) connectedness: the impact of these 
sessions on participants' relationships with other attendees, as individuals and 
the group as a whole; and (4) emotional experience: increased awareness of 
developments around their expression, processing and management of emotion as a 
result of attending the sessions.
CONCLUSIONS: This study provides new and important insights into the use of 
reflective practice for pharmacists working in an ICU during the COVID-19 
pandemic. Findings demonstrate heterogeneity in the experience of distress, the 
need to support the pharmacy profession, and the need to provide opportunities 
for staff to connect safely with colleagues during such crises. The impact of 
organisation-led support for the pharmacy profession is discussed as a future 
direction of research.

© European Association of Hospital Pharmacists 2024. No commercial re-use. See 
rights and permissions. Published by BMJ.

DOI: 10.1136/ejhpharm-2021-003164
PMCID: PMC10800256
PMID: 35428696 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2149. J Am Coll Health. 2024 Apr;72(3):897-904. doi: 10.1080/07448481.2022.2060708. 
Epub 2022 Apr 15.

Remote delivery of a Koru Mindfulness intervention for college students during 
the COVID-19 pandemic.

Mirabito G(1), Verhaeghen P(1).

Author information:
(1)Georgia Institute of Technology, Atlanta, Georgia, USA.

OBJECTIVE: To examine whether a remote, online, group-based mindfulness 
intervention results in effects during the COVID-19 pandemic.
PARTICIPANTS: 111 college students: 58 in the intervention group, 53 in a 
waitlist control group.
METHODS: Randomized control trial (RCT) using a 4-week Koru Mindfulness program, 
investigating pre-to-posttest changes in the intervention group compared to 
time-yoked control participants.
RESULTS: Average effect size for all 21 variables measured was 0.48. The 
intervention produced significant benefits for mindfulness, rumination, worry, 
mood, stress, anxiety, three out of six aspects of psychological wellbeing 
(Autonomy, Environmental mastery, Self-acceptance) and physical activity. No 
significant effect was noted for depression (d = 0.33) or sleep (d = -0.13), and 
three aspects of psychological wellbeing (Personal growth, Positive 
relationships, Purpose in life).
CONCLUSIONS: A remote, online, group-based mindfulness program yielded benefits 
on stress, anxiety, and mood in college students, even under the dire 
circumstances of a pandemic.

DOI: 10.1080/07448481.2022.2060708
PMID: 35427456 [Indexed for MEDLINE]


2150. J Am Coll Health. 2024 Apr;72(3):796-804. doi: 10.1080/07448481.2022.2057802. 
Epub 2022 Apr 15.

University student perceptions of health and disease during remote learning in 
the COVID-19 pandemic.

Cass AL(1), Holt EW(1), Murr S(1), Falcone KA(2), Daniel M(2), Gilchrist AE(3).

Author information:
(1)Health Sciences Department, Furman University, Greenville, South Carolina, 
USA.
(2)Furman University, Greenville, South Carolina, USA.
(3)Furman Earle Student Health Center, Prisma Health, Furman University, 
Greenville, South Carolina, USA.

OBJECTIVES: Assess student perceptions of health and disease during remote 
learning in the COVID-19 pandemic.
PARTICIPANTS: Convenience sample of undergraduate students at a liberal arts 
university (n = 67).
METHODS: Survey administered across multiple sections of a required general 
education course in Spring 2020. Measures included Fear of COVID-19 Scale, 
Multidimensional Health Locus of Control, Perceived Health Competence, and 
COVID-19 perceived impact on students' communities and wellbeing.
RESULTS: Students reported relatively low levels of fear about COVID-19, not 
differing by number or severity of known cases or community impact (p = 0.67, 
0.55, 0.11, respectively). Stress and mental health were priority concerns over 
infectious diseases. Students reported negatively affected emotional (70%) and 
interpersonal (67%) wellbeing; unexpectedly, over half of students reported 
positive impacts in ≥ one wellness dimension.
CONCLUSIONS: Student-identified concerns emphasized psychosocial wellbeing, 
suggesting additional need for mental health resources. Low perceived threat of 
infectious diseases may present barriers to COVID-19-related prevention 
behaviors.

DOI: 10.1080/07448481.2022.2057802
PMID: 35427453 [Indexed for MEDLINE]


2151. Arch Prev Riesgos Labor. 2022 Apr 15;25(2):147-161. doi: 
10.12961/aprl.2022.25.02.07.

[Pros and cons of teleworking in relation to the physical and mental health of 
the working general population: a narrative exploratory review].

[Article in Spanish; Abstract available in Spanish from the publisher]

Tomasina F(1), Pisani A(2).

Author information:
(1)Universidad de la República, Facultad de Medicina, Departamento de Salud 
Ocupacional, Montevideo, Uruguay. fernandotomasina@gmail.com.
(2)Universidad de la República, Facultad de Medicina, Departamento de Salud 
Ocupacional, Montevideo, Uruguay.

Teleworking has been growing over the decades, arising many challenges to 
overcome. The COVID-19 pandemic situation accelerated this process. The forms of 
presentation are varied, homework perhaps is the most frequent. The objective of 
this study was to carry out a review on teleworking in the positive and negative 
aspects in relation to the physical and mental health of the teleworker. So, 
from the literature consulted, risk factors for health are identified, most of 
them correspond to damages derived from exposure to psychosocial and ergonomic 
risks. Sleep disturbances, anxiety and distress, and depression stand out as 
damage to mental health. With regard to damage to physical health, 
musculoskeletal disorders, alterations resulting from the decrease in physical 
activity due to sedentary lifestyle and stress, in particular non-communicable 
diseases, and alterations in vision are also identified.  From a preventive 
perspective, actions aimed at policies linked to the organization of teleworking 
should be encouraged. In particular, those related with working and resting 
times, ensuring, among other aspects, the so-called right to disconnection. The 
ergonomic design of the workstation and taking active breaks are an element that 
also contributes to the well-being of the worker. The active participation of 
social actors, workers, employers and the state is strategic for teleworking, 
contributing to decent work and not to its precariousness.

Publisher: El teletrabajo es una realidad compleja que se encuentra en pleno 
desarrollo desde hace varias décadas. La situación de pandemia por la COVID-19 
aceleró dicho proceso. Son variadas las formas de presentación, siendo la del 
trabajo a domicilio quizás de las más frecuentes. El objetivo del presente 
estudio fue realizar una revisión narrativa exploratoria y reflexiva sobre el 
teletrabajo en los aspectos positivos (pros) y negativos (contras) en relación 
con la salud física y mental de la persona teletrabajadora. Así, de la 
literatura consultada se identifican factores de riesgo para la salud de los 
teletrabajadores, mayoritariamente corresponden a daños derivados de la 
exposición a riesgos psicosociales y ergonómicos. Destacan como daños a la salud 
mental las alteraciones del sueño, la ansiedad y la angustia y la depresión. Con 
respecto a los daños a la salud física se identifican trastornos 
músculo-esqueléticos, alteraciones derivadas de la disminución de la actividad 
física por el sedentarismo y el estrés, en particular enfermedades no 
transmisibles, y alteraciones de la visión. Desde la prevención se deberán 
fomentar acciones dirigidas a políticas vinculadas con la organización del 
teletrabajo. En particular se deberá prestar atención a los tiempos de trabajo y 
de descanso, asegurando el denominado derecho a la desconexión. El diseño 
ergonómico del puesto de trabajo y la realización de pausas activas son 
elementos que contribuyen también al bienestar del trabajador. La participación 
activa de los actores sociales, trabajadores, empleadores y Estado, resulta 
estratégica para que el teletrabajo contribuya al trabajo decente y no a su 
precarización.

DOI: 10.12961/aprl.2022.25.02.07
PMID: 35426273 [Indexed for MEDLINE]


2152. Int J Qual Health Care. 2022 Apr 28;34(2):mzac030. doi: 10.1093/intqhc/mzac030.

Rebooting effective clinical supervision practices to support healthcare workers 
through and following the COVID-19 pandemic.

Martin P(1)(2), Kumar S(3), Tian E(3), Argus G(4), Kondalsamy-Chennakesavan 
S(1), Lizarondo L(5), Gurney T(1), Snowdon D(6).

Author information:
(1)Rural Clinical School, Faculty of Medicine, The University of Queensland, 
Toowoomba, QLD 4350, Australia.
(2)Darling Downs Health, Baillie Henderson Hospital, Toowoomba, QLD 4350, 
Australia.
(3)Allied Health and Human Performance, University of South Australia, Adelaide, 
SA 5000, Australia.
(4)Southern Queensland Rural Health, Faculty of Health and Behavioural Sciences, 
The University of Queensland, 152 West St, South Toowoomba, QLD 4350, Australia.
(5)Rural Clinical School, Faculty of Medicine, The University of Adelaide, 
Adelaide, SA 5005, Australia.
(6)JBI, Monash University, Melbourne, VIC 3199, Australia.

Comment in
    Int J Qual Health Care. 2022 Sep 13;34(3):
    Int J Qual Health Care. 2023 Sep 1;35(3):

The importance of clinical supervision, a professional support and clinical 
governance mechanism, to patients, healthcare workers and organizations has been 
well documented. Clinical supervision has been shown to support healthcare 
workers during challenging times, by reducing burnout, enhancing mental health 
and wellbeing at work, and improving job satisfaction. However, clinical 
supervision participation and effectiveness are pre-requisites for realising 
these benefits. During times of stress and increased workloads (e.g. during the 
Coronavirus pandemic), healthcare workers tend to prioritise clinical duties and 
responsibilities over clinical supervision. Effective supervision practices can 
be restored, and healthcare workers can be better supported in their roles 
during and in the post-pandemic period only if healthcare workers, policy 
makers, healthcare organizations, clinical supervision trainers and researchers 
join forces. This paper sheds light on this important topic and offers a number 
of practical recommendations to reboot effective clinical supervision practices 
at the point of care.

© The Author(s) 2022. Published by Oxford University Press on behalf of 
International Society for Quality in Health Care.

DOI: 10.1093/intqhc/mzac030
PMCID: PMC9047206
PMID: 35425977 [Indexed for MEDLINE]


2153. JAAPA. 2022 May 1;35(5):45-53. doi: 10.1097/01.JAA.0000824964.37126.d8.

Psychologic wellness of PA, NP, and physician hospitalists during the COVID-19 
pandemic.

Dugani SB(1), Fischer KM, Geyer HL, Maniaci MJ, Croghan IT, Burton MC.

Author information:
(1)Sagar B. Dugani practices in the Division of Hospital Internal Medicine and 
the Division of Health Care Delivery Research, Kern Center for the Science of 
Health Care Delivery, at the Mayo Clinic in Rochester, Minn. Karen M. Fischer is 
a biostatistician in the Department of Quantitative Health Sciences at the Mayo 
Clinic in Rochester, Minn. Holly L. Geyer practices in the Division of Hospital 
Internal Medicine at the Mayo Clinic in Scottsdale, Ariz. Michael J. Maniaci 
practices in the Division of Hospital Internal Medicine, Mayo Clinic in 
Jacksonville, Fla. Ivana T. Croghan practices in the Department of Medicine, 
Division of General Internal Medicine, the Kern Center for the Science of Health 
Care Delivery, and the Department of Medicine's Clinical Research Office, all at 
the Mayo Clinic in Rochester, Minn. M. Caroline Burton practices in the Division 
of Hospital Internal Medicine at the Mayo Clinic in Rochester, Minn. Dr. Dugani 
discloses that he is supported by the National Institutes of Health/National 
Institute on Minority Health and Health Disparities (NIH K23 MD016230) and the 
Robert and Elizabeth Strickland Career Development Award at the Mayo Clinic in 
Rochester, Minn. This publication was made possible by the Mayo Clinic CTSA 
through grant number UL1TR002377 from the National Center for Advancing 
Translational Sciences (NCATS), a component of the National Institutes of 
Health. The funders had no role in the design and conduct of the study; 
collection, management, analysis, and interpretation of the data; preparation, 
review, or approval of the manuscript; and decision to submit the manuscript for 
publication. The findings do not necessarily represent the views of the funders. 
The authors have disclosed no other potential conflicts of interest, financial 
or otherwise.

OBJECTIVES: Hospitalists, comprising PAs, NPs, and physicians, manage patients 
hospitalized with COVID-19. To guide the development of support programs, this 
study compared the psychologic wellness of hospitalist PAs, NPs, and physicians 
during the COVID-19 pandemic.
METHODS: We surveyed hospitalists in 16 hospitals at Mayo Clinic, from May 4 to 
25, 2020. We used PROMIS surveys for self-reported global well-being (two 
single-item measures), anxiety, social isolation, and emotional support, before 
and during the pandemic. Linear and logistic regression models were adjusted for 
personal and professional factors.
RESULTS: The response rate was 52.2% (N = 154/295). In adjusted linear 
regression models, the change in scores (before minus during pandemic) for 
anxiety, social isolation, and emotional support was similar for PAs and NPs 
compared with physicians. In adjusted logistic regression models, physicians, 
compared with PAs and NPs, had a higher odds of top global well-being for mental 
health (adjusted odds ratio [95% confidence interval]: 2.82 [1.12, 7.13]; P = 
.03) and top global well-being for social activities and relationships (adjusted 
odds ratio 4.08 [1.38, 12.08]; P = .01).
CONCLUSIONS: During the COVID-19 pandemic, global well-being was lower for PAs 
and NPs compared with physician hospitalists. These results can guide support 
programs for hospitalists.

Copyright © 2022 American Academy of Physician Associates.

DOI: 10.1097/01.JAA.0000824964.37126.d8
PMCID: PMC9129920
PMID: 35421872 [Indexed for MEDLINE]

Conflict of interest statement: CONFLICT OF INTEREST The authors report no 
conflicts of interest.


2154. PLoS One. 2022 Apr 14;17(4):e0267042. doi: 10.1371/journal.pone.0267042. 
eCollection 2022.

Psychological health of pregnant and postpartum women before and during the 
COVID-19 Pandemic.

Kuipers YJ(1)(2), Bleijenbergh R(1)(3), Van den Branden L(1)(3), van Gils 
Y(1)(3), Rimaux S(1), Brosens C(1), Claerbout A(1), Mestdagh E(1)(3).

Author information:
(1)Department of Health and Social Care, School of Midwifery, AP University 
College, Antwerp, Belgium.
(2)School of Health and Social Care, Edinburgh Napier University, Edinburgh, 
Scotland.
(3)Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, 
Belgium.

BACKGROUND: The COVID-19 pandemic is likely to influence psychological health of 
pregnant and postpartum women.
METHODS: We conducted a non-concurrent cross-sectional study among 1145 women 
living in the Dutch-speaking part of Belgium, 541 pregnant and 604 postpartum 
women. We measured psychological health with the Whooley questions, Generalized 
Anxiety Disorder 2-item (GAD-2) and the Edinburgh Postnatal Depression Scale 
(EPDS) and compared the scores of pregnant and postpartum women before and 
during the COVID-19 pandemic.
RESULTS: No differences were observed in the Whooley, GAD-2 or EPDS scores among 
pregnant women. The postpartum total GAD-2 scores before vs during the pandemic 
showed significant differences. Controlling for confounders, we observed a small 
main positive effect of having an infant during time of COVID-19 (F(1.13) = 
5.06, p.025, d.27). The effect was significantly larger for women with (a 
history of) perinatal psychological problems (F(1.12) = 51.44, p < .001, d.82). 
Emotional support was significantly related to GAD-2 scores of postpartum women 
during the pandemic (F(1.90) = 35.54, p < .001). Postpartum women reported 
significant higher effects of the pandemic on their behavior compared to 
pregnant women (p.034).
CONCLUSION: The COVID-19 pandemic seems to have a positive effect on postpartum 
women during the first year postpartum, in particular for women with (a history 
of) perinatal psychological problems and for those women who experienced 
emotional support. The findings suggest that less external stimuli caused by 
lockdown restrictions might have a positive effect on postpartum women's 
emotional wellbeing. The sample consisted of white, educated women in a 
relationship and information regarding the extent of exposure to adverse 
COVID-19 consequences was lacking. We relied on self-selection and self-report. 
The postpartum pandemic sample was small.

DOI: 10.1371/journal.pone.0267042
PMCID: PMC9009654
PMID: 35421171 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2155. PLoS One. 2022 Apr 14;17(4):e0264134. doi: 10.1371/journal.pone.0264134. 
eCollection 2022.

Public opinion about the UK government during COVID-19 and implications for 
public health: A topic modeling analysis of open-ended survey response data.

Wright L(1), Burton A(2), McKinlay A(2), Steptoe A(2), Fancourt D(2).

Author information:
(1)Institute of Education, University College London, London, United Kingdom.
(2)Department of Behavioural Science and Health, University College London, 
London, United Kingdom.

BACKGROUND: Confidence in the central UK Government has declined since the 
beginning of the COVID-19 pandemic, and while this may be linked to specific 
government actions to curb the spread of the virus, understanding is still 
incomplete. Examining public opinion is important, as research suggests that low 
confidence in government increases the extent of non-compliance with 
infection-dampening rules (for instance, social distancing); however, the 
detailed reasons for this association are still unclear.
METHODS: To understand public opinion on the central UK government during the 
first phase of the COVID-19 pandemic, we used structural topic modeling, a text 
mining technique, to extract themes from over 4000 free-text survey responses, 
collected between 14 October and 26 November 2020.
RESULTS: We identified eleven topics, among which were topics related to 
perceived government corruption and cronyism, complaints about inconsistency in 
rules and messaging, lack of clear planning, and lack of openness and 
transparency. Participants reported that elements of the government's approach 
had made it difficult to comply with guidelines (e.g., changing rules) or were 
having impacts on mental wellbeing (e.g., inability to plan for the future).
CONCLUSIONS: Results suggested that consistent, transparent communication and 
messaging from the government is critical to improving compliance with measures 
to contain the virus, as well as protecting mental health during health 
emergencies.

DOI: 10.1371/journal.pone.0264134
PMCID: PMC9009625
PMID: 35421112 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2156. Obes Facts. 2022;15(4):570-580. doi: 10.1159/000524352. Epub 2022 Apr 13.

Changes in Alcohol Consumption, Eating Behaviors, and Body Weight during 
Quarantine Measures: Analysis of the CoCo-Fakt Study.

Wessely S(1), Tappiser M(2)(3), Eisenburger N(1), Feddern S(2), Gehlhar A(2), 
Kilimann A(1), Klee L(2), Nießen J(2), Schmidt N(1), Wiesmüller GA(2)(3), Kossow 
A(2)(4), Grüne B(2), Joisten C(1)(2); CoCo-Fakt Group.

Author information:
(1)Department for Physical Activity in Public Health, Institute of Movement and 
Neurosciences, Cologne, Germany.
(2)Cologne Health Department, Infection and Environmental Hygiene, Köln, 
Germany.
(3)Institute for Occupational, Social, and Environmental Medicine, Medical 
Faculty, RWTH Aachen University, Aachen, Germany.
(4)Institute of Hygiene, University Hospital Muenster, Münster, Germany.

INTRODUCTION: Public health measures enacted to reduce COVID-19 transmission 
have affected individuals' lifestyles, mental health, and psychological 
well-being. To date, little is known how stay-at-home orders have influenced the 
eating behaviors, weight development, and alcohol consumption of quarantined 
persons. The CoCo-Fakt cohort study analyzed these parameters and their 
association with psychological distress and coping strategies.
METHODS: An online survey was conducted of all persons who tested positive for 
SARS-CoV-2 (infected persons [IP]) between December 12, 2020, and January 6, 
2021, as well as their close contacts (contact persons [CP]) registered by the 
public health department of Cologne. 8,075 of 33,699 individuals were included 
in the analysis. In addition to demographic data, psychological distress, and 
coping strategies, information on changes in body weight, eating, and drinking 
behaviors was collected.
RESULTS: IP lost 1.2 ± 4.4 kg during the quarantine period, and CP gained 1.6 ± 
4.1 kg. The reasons given by IP for weight change were mainly loss of taste and 
feeling sick, whereas CP were more likely than IP to eat out of boredom. Higher 
psychological burden and lower coping strategies were associated with both 
weight gain and loss. Of the 30.8% of participants who changed their alcohol 
consumption during the quarantine period, CP in particular drank more alcohol 
(IP 15.2%; CP 47.7%). Significantly less alcohol was consumed by individuals 
with higher coping scores.
CONCLUSION: In this short but psychologically stressful period of stay-at-home 
orders, changes in eating and drinking behavior as well as weight development 
are evident, mainly in high-risk contacts. To avoid possible long-term sequelae, 
health authorities should take these findings into account during the quarantine 
period; in particular, general practitioners should consider these findings 
during follow-up.

© 2022 The Author(s). Published by S. Karger AG, Basel.

DOI: 10.1159/000524352
PMCID: PMC9372475
PMID: 35417911 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
declare.


2157. Obes Facts. 2022;15(4):550-559. doi: 10.1159/000524031. Epub 2022 Apr 13.

Supporting Weight Management during COVID-19: A Randomized Controlled Trial of a 
Web-Based, ACT-Based, Guided Self-Help Intervention.

Mueller J(1), Richards R(1), Jones RA(1), Whittle F(1), Woolston J(1), Stubbings 
M(1), Sharp SJ(1), Griffin SJ(1)(2), Bostock J(3), Hughes CA(4)(5), Hill AJ(6), 
Ahern AL(1).

Author information:
(1)MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom.
(2)Primary Care Unit, Department of Public Health and Primary Care, University 
of Cambridge, Cambridge, United Kingdom.
(3)Patient and Public Involvement Representative, Cambridge, United Kingdom.
(4)Fakenham Medical Practice, Fakenham, United Kingdom.
(5)Medical School, University of East Anglia, Norwich, United Kingdom.
(6)Division of Psychological and Social Medicine, School of Medicine, University 
of Leeds, Leeds, United Kingdom.

INTRODUCTION: Adults with overweight and obesity are vulnerable to weight gain 
and mental health deterioration during the COVID-19 pandemic. We developed a 
web-based, guided self-help intervention based on Acceptance and Commitment 
Therapy (ACT) that aims to support adults with overweight and obesity to prevent 
weight gain by helping them to manage their eating behaviours, be more 
physically active, and protect their emotional wellbeing ("SWiM-C"). SWiM-C is a 
guided self-help programme using non-specialist guides to enhance scalability 
and population reach while minimizing cost. This study evaluated the effect of 
SWiM-C on bodyweight, eating behaviour, physical activity, and mental wellbeing 
in adults with overweight and obesity over 4 months during the COVID-19 pandemic 
in the UK.
METHODS: We randomized adults (BMI ≥25 kg/m2) to SWiM-C or to a wait-list 
standard advice group. Participants completed outcome assessments online at 
baseline and 4 months. The primary outcome was self-measured weight; secondary 
outcomes were eating behaviour, physical activity, experiential 
avoidance/psychological flexibility, depression, anxiety, stress, and wellbeing. 
We estimated differences between study groups in change in outcomes from 
baseline to 4 months using linear regression, adjusted for outcome at baseline 
and the randomization stratifiers (BMI, sex). The trial was pre-registered 
(ISRCTN12107048).
RESULTS: 486 participants were assessed for eligibility; 388 participants were 
randomized (196 standard advice, 192 SWiM-C), and 324 were analysed. The 
adjusted difference in weight between SWiM-C and standard advice was -0.60 kg 
(-1.67 to 0.47, p = 0.27). SWiM-C led to improvements in uncontrolled eating 
(-3.61 [-5.94 to -1.28]), cognitive restraint (5.28 [2.81-7.75]), experiential 
avoidance (-3.39 [-5.55 to -1.23]), and wellbeing (0.13 [0.07-0.18]).
CONCLUSIONS: SWiM-C improved several psychological determinants of successful 
weight management and had a protective effect on wellbeing during the pandemic. 
However, differences in weight and some other outcomes were compatible with no 
effect of the intervention, suggesting further refinement of the intervention is 
needed.

© 2022 The Author(s). Published by S. Karger AG, Basel.

DOI: 10.1159/000524031
PMCID: PMC9421710
PMID: 35417910 [Indexed for MEDLINE]

Conflict of interest statement: F.W., J.W., M.S., S.J.S., and J.B. report no 
conflicts of interest. A.J.H. has consulted for Slimming World. C.A.H. reports 
payment or honoraria from Ethicon, Novo Nordisk, and International Medical Press 
for lectures, presentations, speakers' bureaus, manuscript writing, or 
educational events. J.M. and R.R. are Trustees for the Association of the Study 
of Obesity (unpaid roles). A.L.A. and S.J.G. are the chief investigators on two 
publicly funded (MRC, NIHR) trials where the intervention is provided by WW 
(formerly Weight Watchers) at no cost outside the submitted work.


2158. Pediatr Ann. 2022 Apr;51(4):e144-e149. doi: 10.3928/19382359-20220317-02. Epub 
2022 Apr 1.

Adolescents, Suicide, and the COVID-19 Pandemic.

Durante JC, Lau M.

The coronavirus disease 2019 pandemic has vastly disrupted the lives of youth. 
Stressors related to the pandemic and related lockdown measures have increased 
the prevalence of adolescent depression, suicidal ideation, and suicide 
attempts, with their mental and psychosocial development making them highly 
vulnerable to isolating restrictions. Research has demonstrated increased 
loneliness and decreased social support among adolescents during the pandemic. 
Increased social media usage has further affected depression among adolescents. 
Pandemic-related stressors such as fear of illness or life changes have 
negatively affected adolescent mental well-being. Health care use during the 
pandemic has involved disruption in primary care suicide screening, patterns of 
suicide-related presentations in emergency departments, and access to mental 
health services. Health care providers can support adolescent mental health 
through consistent screening, effectively coordinating referral for mental 
health evaluation, and providing family guidance on resiliency, pandemic-related 
mental health risks, and suicide prevention. [Pediatr Ann. 
2022;51(4):e144-e149.].

DOI: 10.3928/19382359-20220317-02
PMID: 35417315 [Indexed for MEDLINE]


2159. Am J Public Health. 2022 May;112(5):786-794. doi: 10.2105/AJPH.2022.306723.

COVID-19 Pandemic Factors and Depressive Symptoms Among Primary Care Workers in 
São Paulo, Brazil, October and November 2020.

Correia da Silva AT(1), Mascayano F(1), Valeri L(1), de Medeiros ME Jr(1), Souza 
MPE(1), Ballester D(1), Cavalcanti MT(1), Martínez-Alés G(1), Moro MF(1), van 
der Ven E(1), Alvarado R(1), Susser E(1).

Author information:
(1)Andréa Tenório Correia da Silva is with the Primary Care Research Center, 
Faculty of Medicine Santa Marcelina, São Paulo, Brazil. Franco Mascayano, 
Gonzalo Martínez-Alés, Maria Francesca Moro, and Ezra Susser are with the 
Department of Epidemiology, Mailman School of Public Health, Columbia 
University, New York, NY. Linda Valeri is with the Department of Biostatistics, 
Mailman School of Public Health, Columbia University. Martim Elviro de Medeiros 
Jr is with the Primary Care Research Center, Faculty of Medicine Santa 
Marcelina, São Paulo, Brazil. Morris Pimenta e Souza is with the Department of 
Public Health, Federal University of São Paulo, São Paulo. Dinarte Ballester is 
with the Hospital Unversitário, Universidade Federal do Rio Grande, Rio Grande 
do Sul, Brazil. Maria Tavares Cavalcanti is with the Department of Psychiatry, 
Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. Els van der Ven is 
with the Department of Clinical, Neuro- & Developmental Psychology, Vrije 
Universiteit, Amsterdam, the Netherlands. Rubén Alvarado is with the School of 
Public Health, Faculty of Medicine, Universidad de Chile, Santiago.

Comment in
    Am J Public Health. 2022 May;112(5):703-705.

Objectives. To investigate associations between COVID-19-related factors and 
depressive symptoms among primary care workers (PCWs) in São Paulo, Brazil, and 
to compare the prevalence of probable depression among PCWs before and during 
the pandemic. Methods. In a random sample of primary care clinics, we examined 6 
pandemic-related factors among 828 PCWs. We used multivariate Poisson regression 
with robust variance to estimate prevalence ratios for probable depression. We 
assessed the prevalence of probable depression in PCWs before and during the 
pandemic in 2 comparable studies. Results. Adjusted prevalence ratios were 
substantial for insufficient personal protective equipment; experiences of 
discrimination, violence, or harassment; and lack of family support. Comparisons 
between PCWs before and during the pandemic showed that the prevalence of 
probable depression among physicians, nurses, and nursing assistants was higher 
during the pandemic and that the prevalence among community health workers was 
higher before the pandemic. Conclusions. Our findings indicate domains that may 
be crucial to mitigating depression among PCWs but that, with the exception of 
personal protective equipment, have not previously been examined in this 
population. It is crucial that governments and communities address 
discriminatory behaviors against PCWs, promote their well-being at work, and 
foster family support. (Am J Public Health. 2022;112(5):786-794. 
https://doi.org/10.2105/AJPH.2022.306723).

DOI: 10.2105/AJPH.2022.306723
PMCID: PMC9010906
PMID: 35417215 [Indexed for MEDLINE]


2160. BMC Pregnancy Childbirth. 2022 Apr 12;22(1):313. doi: 
10.1186/s12884-022-04602-5.

Factors affecting the mental health of pregnant women using UK maternity 
services during the COVID-19 pandemic: a qualitative interview study.

McKinlay AR(1), Fancourt D(2), Burton A(2).

Author information:
(1)Research Department of Behavioural Science and Health, Institute of 
Epidemiology & Health Care, University College London, 1-19 Torrington Place, 
London, WC1E 7HB, UK. a.mckinlay@ucl.ac.uk.
(2)Research Department of Behavioural Science and Health, Institute of 
Epidemiology & Health Care, University College London, 1-19 Torrington Place, 
London, WC1E 7HB, UK.

BACKGROUND: People using maternity services in the United Kingdom (UK) have 
faced significant changes brought on by the COVID-19 pandemic and social 
distancing regulations. We focused on the experiences of pregnant women using UK 
maternity services during the pandemic and the impact of social distancing rules 
on their mental health and wellbeing.
METHODS: We conducted 23 qualitative semi-structured interviews from June 2020 
to August 2021, with women from across the UK who experienced a pregnancy during 
the pandemic. Nineteen participants in the study carried their pregnancy to term 
and four had experienced a miscarriage during the pandemic. Interviews took 
place remotely over video or telephone call, discussing topics such as mental 
health during pregnancy and use of UK maternity services. We used reflexive 
thematic analysis to analyse interview transcripts.
RESULTS: We generated six higher order themes: [1] Some pregnancy discomforts 
alleviated by social distancing measures, [2] The importance of relationships 
that support coping and adjustment, [3] Missed pregnancy and parenthood 
experiences, [4] The mental health consequences of birth partner and visitor 
restrictions, [5] Maternity services under pressure, and [6] Lack of connection 
with staff. Many participants felt a sense of loss over a pregnancy experience 
that differed so remarkably to what they had expected because of the pandemic. 
Supportive relationships were important to help cope with pregnancy and 
pandemic-related changes; but feelings of isolation were compounded for some 
participants because opportunities to build social connections through 
face-to-face parent groups were unavailable. Participants also described feeling 
alone due to restrictions on their partners being present when accessing UK 
maternity services.
CONCLUSIONS: Our findings highlight some of the changes that may have affected 
pregnant women's mental health during the COVID-19 pandemic. Reduced social 
support and being unable to have a partner or support person present during 
maternity service use were the greatest concerns reported by participants in 
this study. Absence of birth partners removed a protective buffer in times of 
uncertainty and distress. This suggests that the availability of a birth partner 
or support person must be prioritised wherever possible in times of pandemics to 
protect the mental health of people experiencing pregnancy and miscarriage.

© 2022. The Author(s).

DOI: 10.1186/s12884-022-04602-5
PMCID: PMC9005019
PMID: 35413807 [Indexed for MEDLINE]

Conflict of interest statement: None declared.


2161. Pain. 2022 Oct 1;163(10):e1095-e1101. doi: 10.1097/j.pain.0000000000002618. Epub 
2022 Mar 14.

The impact of the COVID-19 pandemic on pain and psychological functioning in 
young adults with chronic pain.

Tham SW(1)(2), Murray CB(1)(2), Law EF(1)(2), Slack KE(2), Palermo TM(1)(2)(3).

Author information:
(1)Department of Anesthesiology and Pain Medicine, University of Washington 
School of Medicine, Seattle, WA, United States.
(2)Center for Child Health, Behavior and Development, Seattle Children's 
Research Institute, Seattle, WA, United States.
(3)Department of Pediatrics, University of Washington School of Medicine, 
Seattle, WA, United States.

Data are equivocal on the consequences of COVID-19 pandemic on pain and 
well-being for individuals with chronic pain. Furthermore, little is known 
regarding its impact on the health of young adults with chronic pain. We 
conducted a longitudinal study to compare pain, psychological functioning, and 
substance use before and during the pandemic of 196 young adults with chronic 
pain. Participants aged 18 to 24 years (M = 21.1 years; 79.6% females) reported 
on pain, anxiety, depression, and substance use before (October 2018-August 
2019) and during the pandemic (October 2020-November 2020), in addition to the 
assessment of COVID-19 exposure and its impact. Before the pandemic, young 
adults experienced mild-to-moderate pain intensity (M = 3.75, SD = 2.33) and 
pain interference (M = 3.44, SD = 2.69). Findings were that pain intensity, pain 
interference, and depression symptoms remained stable during the pandemic. In 
contrast, anxiety symptoms increased significantly (M = 8.21, SD = 5.84 vs M = 
8.89, SD = 5.95, P = 0.04). Tobacco, alcohol, and cannabis use were unchanged. 
Mixed linear models revealed that COVID-19 exposure and impact were not 
associated with changes in pain intensity or interference, with female sex 
associated with increased pain intensity (β = 0.86, P = 0.02) and pain 
interference (β = 0.87, P = 0.02). Our findings indicated relative stability of 
pain symptoms experienced by young adults with chronic pain. However, the 
increases in anxiety highlight the need to facilitate treatment access for 
mental health services to mitigate downstream impact.

Copyright © 2022 International Association for the Study of Pain.

DOI: 10.1097/j.pain.0000000000002618
PMCID: PMC9470785
PMID: 35413028 [Indexed for MEDLINE]

Conflict of interest statement: There are no conflicts of interest to report.


2162. Int Rev Psychiatry. 2021 Dec;33(8):711-717. doi: 10.1080/09540261.2021.2013783. 
Epub 2022 Jan 4.

Adapting RISE: meeting the needs of healthcare workers during the COVID-19 
pandemic.

Wu AW(1), Connors CA(2), Norvell M(3).

Author information:
(1)Johns Hopkins School of Medicine, Johns Hopkins University Bloomberg School 
of Public Health, Baltimore, Maryland, USA.
(2)Johns Hopkins Medicine, Armstrong Institute for Patient Safety and Quality, 
Baltimore, Maryland, USA.
(3)Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.

The COVID-19 pandemic has placed extraordinary stresses on healthcare workers. 
Combined with disruptions to daily life outside of work, health care 
professionals experience a high prevalence of anxiety, depression, acute stress 
reaction, burnout, and PTSD. Top leaders at Johns Hopkins Medicine appreciated 
the mission-critical importance of maintaining the well-being and resilience of 
its essential workers. In March 2020 they asked the Johns Hopkins RISE 
(Resilience in Stressful Events) peer support program to help organize support 
for all staff. RISE made several adjustments, including adding virtual 
encounters to the usual in-person support, training additional peer responders, 
and rounding proactively on active units. Communication was broadened to reach 
less visible and lower wage workers. RISE collaborated actively with hospital 
epidemiology and infection control and began reporting regularly at incident 
command centre briefings. RISE also began to coordinate efforts with the other 
helping programs within the institution including the Office of Well-being, 
Employee Assistance, Spiritual Care, and Psychiatry. The number of calls and 
staff supported rose sharply. RISE supported over 4226 workers in the first 
9 months of the pandemic. The adoption of RISE programs was accelerated at 
affiliated hospitals, as well as at other hospitals across the country in 
partnership with the Maryland Patient Safety Center. Experience with large scale 
disasters predicted correctly that worker distress would increase and persist 
beyond the initial wave of the pandemic. With subsequent surges of COVID-19, 
exhaustion and moral distress became nearly universal among workers. It is 
urgent for institutions to provide mechanisms to help their workers cope with 
the ongoing crisis and other crises that will inevitably occur in the future.

DOI: 10.1080/09540261.2021.2013783
PMID: 35412425 [Indexed for MEDLINE]


2163. Nord J Psychiatry. 2023 Jan;77(1):65-72. doi: 10.1080/08039488.2022.2061047. 
Epub 2022 Apr 12.

The effects of mandatory home quarantine on mental health in a community sample 
during the COVID-19 pandemic.

Aaltonen KI(1), Saarni S(1), Holi M(1), Paananen M(2).

Author information:
(1)Department of Psychiatry, University of Helsinki and Helsinki University 
Hospital, Helsinki, Finland.
(2)Kerava Health Care Center, Kerava, Finland.

OBJECTIVE: Major public and scientific interest exists on, whether quarantine as 
a containment measure, could have adverse effects on individual's mental health. 
We investigated psychic well-being and distress, symptoms of depression and 
anxiety among individuals imposed to home quarantine.
METHODS: By total population sampling in a Finnish suburban city, a total of 57 
quarantined cases (participation rate 97%) were identified and followed up for 
two weeks until expiration of the quarantine. A randomized control group 
(n = 53) was formed of people seeking laboratory testing for suspected 
Sars-CoV-2 infection. Primary outcome was the psychic well-being and distress 
experienced during quarantine measured by the Clinical Outcomes in Routine 
Evaluation - Outcome Measure (CORE-OM). The cases were followed up by the 
Clinical Outcomes in Routine Evaluation-10 (CORE-10), Patient Health 
Questionnaire-9 (PHQ-9), and by the Overall Anxiety Severity and Impairment 
Scale (OASIS).
RESULTS: The median CORE-OM score for the cases was 3.53 (95% CI: 2.23-4.66), 
and for the controls 3.24 (1.76-3.82), being mostly in the nonclinical to mild 
range. The difference between the groups was statistically nonsignificant 
(p = .19). Higher levels of psychic distress were explained by previous 
psychiatric disorders and living alone, but not having been quarantined. In 
comparison to controls, the quarantined participants experienced significantly, 
but slightly lower level of life functioning. At the follow-up, the quarantined 
participants rated further low on the CORE-10 (median 2.00; 95% CI: 1.00-3.00), 
the PHQ-9 (1.50; 0.00-3.00), and the OASIS (0.00; 0.00-0.00).
CONCLUSIONS: The distress associated with short-term home quarantine may not be 
to the degree of a mental disorder.

DOI: 10.1080/08039488.2022.2061047
PMID: 35412416 [Indexed for MEDLINE]


2164. J Aging Health. 2022 Aug-Sep;34(4-5):653-665. doi: 10.1177/08982643211052713. 
Epub 2022 Apr 12.

Longitudinal Cohort Study of Depression and Anxiety Among Older Informal 
Caregivers Following the Initial COVID-19 Pandemic Response in Aotearoa New 
Zealand.

Allen J(1), Uekusa S(1), Alpass FM(1).

Author information:
(1)6420Massey University, Palmerston North, New Zealand.

OBJECTIVES: To assess the impact of providing care and conditions of care on 
psychological wellbeing among older informal caregivers following the initial 
period of COVID-19 pandemic restrictions in Aotearoa New Zealand.
METHODS: Data were from population-based cohorts of older adults participating 
in the 2020 Health, Work and Retirement longitudinal survey (n = 3839, 17.4% 
informal caregivers). Changes in symptoms of depression and anxiety over 
2018-2020 surveys associated with sociodemographic factors, caregiving, 
cohabitation with the care recipient, assistance provided with activities of 
daily living, support in providing care, and opportunity cost of care were 
assessed.
RESULTS: Increased depression, but not anxiety, was associated with providing 
informal care. Among caregivers, lower living standards and cohabitation were 
associated with increased depression. Lower living standards, unemployment, and 
lower help from friend/family networks were associated with increased anxiety.
DISCUSSION: Economic hardship and social capital provide targets for supporting 
psychological wellbeing of older caregivers during periods of pandemic 
restrictions.

DOI: 10.1177/08982643211052713
PMCID: PMC9008474
PMID: 35412393 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of conflicting interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


2165. Int J Health Plann Manage. 2022 Jul;37(4):2345-2353. doi: 10.1002/hpm.3476. Epub 
2022 Apr 11.

Job satisfaction, performance appraisal, reinforcement and job tasks in medical 
healthcare professionals during the COVID-19 pandemic outbreak.

Rana W(1), Mukhtar S(2)(3), Mukhtar S(4).

Author information:
(1)Hainan General Hospital, Haikou, China.
(2)University of Management and Technology, Lahore, Pakistan.
(3)Dulwich Center, Adelaide, South Australia, Australia.
(4)University of the Punjab, Lahore, Pakistan.

Medical healthcare profession is under immense stress since the COVID-19 
pandemic outbreak on global scale, and medical healthcare professionals are 
enduring occupational challenges which entail frontline and non-frontline 
duties, appraisal and satisfaction with their job. The present study examined 
perceived job satisfaction as a mediating variable that affects the relationship 
between performance appraisal and reinforcement on performing job tasks among 
medical healthcare professionals during COVID-19. A sample (N = 550) was 
selected from public and private hospitals' medical healthcare professionals 
(n = 300 males, and n = 250 females). The results showed that perceived job 
satisfaction mediates the relationship between performance appraisal and 
reinforcement on job tasks in medical healthcare professionals. This study could 
help stakeholders, medical board regulations, mental health practitioners, 
employers and employees to increment sources which could establish feasible 
healthcare planning and management. The study has significant implications in 
mental healthcare, crisis management, human resource planning, effective 
performance and improvement in well-being of medical workforce's psychological 
health.

© 2022 John Wiley & Sons Ltd.

DOI: 10.1002/hpm.3476
PMCID: PMC9087389
PMID: 35411574 [Indexed for MEDLINE]

Conflict of interest statement: No conflict of interest.


2166. Am J Health Promot. 2022 Sep;36(7):1123-1132. doi: 10.1177/08901171221089627. 
Epub 2022 Apr 11.

Food Insecurity and Mental Well-Being Among Low-Income Families During COVID-19 
Pandemic.

Ling J(1), Duren P(1), Robbins LB(1).

Author information:
(1)3078Michigan State University College of Nursing, East Lansing, MI, USA.

PURPOSE: To examine the interaction effects of adult and child food insecurity 
on parents' and children's mental well-being.
DESIGN: An online survey study was conducted.
SETTING: Two Head Start organizations and the Qualtrics Panel.
SUBJECTS: Four hundred and eight parents under poverty level and having a child 
aged 3-5 years participated.
MEASURES: Food insecurity was assessed by the U.S. Household Food Security 
Survey Module. Parents' stress, anxiety and depression; and children's sadness, 
fear, anger, and positive affect were measured using instruments from 
HealthMeasures.
ANALYSIS: Multivariate general linear models were performed in SPSS.
RESULTS: Mean age was 31 years, 17% Hispanic, 21% Black. About 51% parents and 
37% children were food insecure. After adjusting for demographics and child food 
insecurity, parents with adult food insecurity had higher stress (B = 2.65, p = 
.002), anxiety (B = 3.02, p = .001), and depression (B = 3.66, p = .001); and 
fear in their children (B = 5.03, p = .002) than those without adult food 
insecurity. Similarly, parents reporting child food insecurity had greater 
depression than those having no child food insecurity (B = 4.61, p = .020). 
Black parents had lower stress (B = -1.91, p = .018), anxiety (B = -2.26, p = 
.012), and depression (B = -4.17, p < .001) than their White counterparts.
CONCLUSIONS: The study's results underscore the importance of reducing food 
insecurity in both parents and children as a whole family system to promote 
mental well-being of low-income families.

DOI: 10.1177/08901171221089627
PMCID: PMC9014344
PMID: 35410485 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


2167. Int J Environ Res Public Health. 2022 Apr 5;19(7):4375. doi: 
10.3390/ijerph19074375.

Changes in Perceived Stress and Lifestyle Behaviors in Response to the COVID-19 
Pandemic in The Netherlands: An Online Longitudinal Survey Study.

Slurink IAL(1), Smaardijk VR(1), Kop WJ(1), Kupper N(1), Mols F(1), Schoormans 
D(1), Soedamah-Muthu SS(1)(2).

Author information:
(1)Center of Research on Psychological Disorders and Somatic Diseases (CORPS), 
Department of Medical and Clinical Psychology, Tilburg University, 5000 LE 
Tilburg, The Netherlands.
(2)Institute for Food, Nutrition and Health, University of Reading, Reading RG6 
6AR, UK.

The COVID-19 pandemic has substantial implications for physical and mental 
wellbeing. This study investigated changes, over time, in lifestyle behaviors 
and perceived stress during the initial phase of the pandemic and associations 
with COVID-19 symptoms, in the Dutch general population. An online longitudinal 
survey study was performed with pre-lockdown measurements in February, and 
subsequently in April and June 2020 (n = 259, mean age 59 ± 14 years, 59% 
women). Self-report questionnaires were used to assess weight, diet quality, 
physical activity, alcohol intake, and smoking. Perceived stress was measured 
using the validated perceived stress scale (PSS-10). The presence of COVID-19 
symptoms (yes/no) was defined as fever, or >3 of the following symptoms: 
weakness/tiredness, muscle ache, dry cough, loss of smell/taste, and breathing 
difficulties. Data were analyzed using linear mixed models, adjusted for age, 
sex, educational level, marital status and (change in) employment status. 
Minimal increases over time were observed in alcohol intake (0.6 ± 0.7 to 0.7 ± 
1.1 glasses/day, p = 0.001) and smoking (9.5 ± 8.7 to 10.9 ± 9.4 cigarettes/day 
among 10% smokers, p = 0.03), but other lifestyle behaviors remained stable. In 
April 2020, 15% reported COVID-19-related symptoms, and in June 2020, this was 
10%. The presence of COVID-19 symptoms was associated with increased perceived 
stress (pinteraction = 0.003) and increased alcohol consumption (pinteraction = 
0.03) over time. In conclusion, in this prospective study, COVID-19 symptoms 
were associated with increases in perceived stress and alcohol consumption. 
Future research on biopsychosocial determinants and underlying mechanisms of 
lifestyle changes, as a response to the COVID-19 pandemic, is needed.

DOI: 10.3390/ijerph19074375
PMCID: PMC8998601
PMID: 35410055 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2168. Int J Environ Res Public Health. 2022 Apr 5;19(7):4351. doi: 
10.3390/ijerph19074351.

Sexual Desire and Body Image. Gender Differences and Correlations before and 
during COVID-19 Lockdown.

Cedro C(1), Mento C(1), Piccolo MC(2), Iannuzzo F(1), Rizzo A(3), Muscatello 
MRA(1), Pandolfo G(1).

Author information:
(1)Department of Biomedical, Dental and Morphological and Functional Imaging 
Sciences, University Hospital "G. Martino", 98124 Messina, Italy.
(2)Provincial Health Agency 5, 98123 Messina, Italy.
(3)Psychiatry Unit, University Hospital "G. Martino", 98124 Messina, Italy.

Recent literature has extensively examined sexual behavior during lockdown due 
to COVID-19. However, there are no recent studies that have considered the 
relationship between body image quality, sexual arousability, and sexual 
anxiety. The present study has two main objectives: (1) to examine gender 
differences in bodily and sexual experience; and (2) the comparison of bodily 
and sexual experience, before and during the COVID-19 lockdown. A total of 301 
adult subjects (161 women and 140 men) aged between 16 and 73 years (Mean = 
37.4; S.D. = 10.3) participated in the study. Data on biographical information 
were collected via an online panel. The Body Uneasiness Test (BUT) and the 
Sexual Arousability Inventory (SAI) were used for the assessment. Univariate 
ANOVA showed worse scores for women, compared with men, in terms of body image 
avoidance, depersonalization, overall severity of body image quality, sexual 
arousability, and sexual anxiety dimensions. When compared against time, only 
women showed significant correlations between the function of sexual arousal and 
all parameters concerning body image alteration. Interestingly, these 
correlations were weak and sporadic before lockdown, but strong and numerous 
during lockdown. This finding suggests that the impact of COVID-19 restrictions 
affected the female population more, with a profound repercussion on self-image 
and sexual and mental well-being.

DOI: 10.3390/ijerph19074351
PMCID: PMC8998239
PMID: 35410031 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that there is no financial, 
general, and institutional conflict of interest regarding the publication of 
this article.


2169. Int J Environ Res Public Health. 2022 Apr 5;19(7):4348. doi: 
10.3390/ijerph19074348.

Substance Use among Belgian Higher Education Students before and during the 
First Wave of the COVID-19 Pandemic.

Tholen R(1), Ponnet K(2), Van Hal G(3), De Bruyn S(1), Buffel V(1), Van de Velde 
S(1), Bracke P(4), Wouters E(1).

Author information:
(1)Center for Population, Family and Health, University of Antwerp, 2000 
Antwerp, Belgium.
(2)Department of Communication Studies, imec-mict, Ghent University, 9000 Ghent, 
Belgium.
(3)Department of Family Medicine and Population Health, Social Epidemiology and 
Health Policy, University of Antwerp, 2610 Antwerp, Belgium.
(4)Department of Sociology, Ghent University, 9000 Ghent, Belgium.

The COVID-19 pandemic prompted many countries to issue far-reaching policy 
measures that may have led to increased substance use. Higher education students 
may have been disproportionally affected due to the rearrangement of educational 
life and their susceptibility to psychosocial distress and substance use. The 
current study examined associations between pandemic-related stressors, 
psychosocial distress, and self-reported alcohol, tobacco, and cannabis use 
before and during the first wave of the pandemic. Data were collected in Belgium 
as part of the COVID-19 International Student Well-being Study (C19 ISWS) and 
analyzed using multinomial logistic regression analyses. The sample contained 
18,346 higher education students aged 17 to 24 (75% women). Overall use of 
alcohol, tobacco, and cannabis as well as binge drinking decreased during the 
pandemic, perhaps due to limited social gatherings. Moving back to the parental 
home was associated with decreased substance use, while depressive symptoms were 
associated with increased substance use. Perceived threat and academic stress 
were associated with increased binge drinking among heavy bingers and increased 
tobacco use. Decreases among students who moved back to their parental home may 
be explained by increased informal social control. Increased substance use was 
associated with a number of stressors and psychosocial distress, which suggests 
that some students may have been self-medicating to manage their mental health 
amidst the pandemic. Public health policy concerning substance use may prove to 
be less effective if not tailored to particular subgroups within the student 
population.

DOI: 10.3390/ijerph19074348
PMCID: PMC8998911
PMID: 35410029 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
declare.


2170. Int J Environ Res Public Health. 2022 Apr 2;19(7):4277. doi: 
10.3390/ijerph19074277.

Health Service Accessibility, Mental Health, and Changes in Behavior during the 
COVID-19 Pandemic: A Qualitative Study of Older Adults.

von Humboldt S(1), Low G(2), Leal I(1).

Author information:
(1)William James Center for Research, ISPA-Instituto Universitário, 1149-041 
Lisbon, Portugal.
(2)Faculty of Nursing, University of Alberta, Edmonton, AB T6G 2R3, Canada.

The COVID-19 pandemic has affected the access of older adults to health 
services. The two objectives of this study are understanding the influence of 
the COVID-19 pandemic on older adults' access to health services and exploring 
how health service accessibility during the pandemic influenced older adults' 
mental health and self-reported changes in behavior. This study included 346 
older adults. Content analysis produced five themes: (1) decreased physical 
accessibility to health care providers (78%); (2) increased use of online health 
services and other virtual health care (69%); (3) growth in the online 
prescription of medication (67%); (4) difficulty obtaining information and 
accessing non-communicable disease and mental health indicators (65%); and (5) 
postponement of medical specialist consultations (51%). Regarding mental health, 
three themes emerged: (1) increased symptoms of anxiety, distress, and 
depression (89%); (2) the experience of traumatic situations (61%); and (3) the 
augmented use of alcohol or drugs (56%). Finally, the following changes in 
behavior were indicated: (1) frustrated behavior (92%); (2) emotional explosions 
(79%); and (3) changes in sleeping and eating behaviors (43%). Access to health 
services may have influenced the mental health and behavior of older adults, 
hence interventions in a pandemic must address their interactions with health 
services, their needs, and their well-being.

DOI: 10.3390/ijerph19074277
PMCID: PMC8999009
PMID: 35409957 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
authors alone are responsible for the content and writing of the paper.


2171. Int J Environ Res Public Health. 2022 Mar 30;19(7):4120. doi: 
10.3390/ijerph19074120.

Changes in the Mental Health of Children and Adolescents during the COVID-19 
Lockdown: Associated Factors and Life Conditions.

Bosch R(1)(2)(3), Pagerols M(1), Prat R(1)(4), Español-Martín G(2)(5)(6), Rivas 
C(1), Dolz M(3)(7)(8), Haro JM(3)(9), Ramos-Quiroga JA(2)(3)(5)(6), Ribasés 
M(3)(5)(6)(10), Casas M(1)(2).

Author information:
(1)SJD MIND Schools Program, Hospital Sant Joan de Déu, Institut de Recerca Sant 
Joan de Déu, 08950 Barcelona, Spain.
(2)Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de 
Barcelona, 08193 Bellaterra, Spain.
(3)Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 
Instituto de Salud Carlos III, 28029 Madrid, Spain.
(4)Centre for Health and Social Care Research (CEES), University of Vic-Central 
University of Catalonia (UVic-UCC), 08500 Vic, Spain.
(5)Servei de Psiquiatria, Vall d'Hebron Hospital Universitari, 08035 Barcelona, 
Spain.
(6)Grup de Psiquiatria, Salut Mental i Addiccions, Vall d'Hebron Institut de 
Recerca (VHIR), Vall d'Hebron Hospital Universitari, 08035 Barcelona, Spain.
(7)Child and Adolescent Mental Health Research Group, Institut de Recerca Sant 
Joan de Déu, 08950 Barcelona, Spain.
(8)Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan 
de Déu, 08950 Barcelona, Spain.
(9)Research and Developmental Unit, Parc Sanitari Sant Joan de Déu, 08830 Sant 
Boi de Llobregat, Spain.
(10)Department of Genetics, Microbiology and Statistics, Faculty of Biology, 
Universitat de Barcelona, 08028 Barcelona, Spain.

This study investigated the psychological impact of the coronavirus disease 2019 
(COVID-19) among youth by analyzing their emotional/behavioral problems before 
and during the long-lasting lockdown in Spain. For that purpose, 699 parents 
with children aged 6-17 and 552 adolescents aged 12-17, who completed the parent 
and adolescent version of the Strengths and Difficulties Questionnaire at the 
beginning of 2019, responded to a survey from 26 May to 15 June 2020 that 
assessed psychological well-being and life conditions during quarantine (i.e., 
sociodemographic characteristics, situation before the lockdown, physical 
environment and accompaniment during the lockdown, COVID-related variables). 
According to both parent- and self-reports, children and youth experienced a 
significant worsening in emotional symptoms, conduct problems, 
hyperactivity/inattention, peer problems, and total difficulties subscales. 
Findings also suggested that impairment was mainly associated with variables 
related to the child's situation prior to home quarantine, the quality and 
quantity of the child's social networks during the lockdown, the daily routines 
the child followed, the concerns the child had about health, and the presence of 
economic and learning problems caused by the COVID-19. Thus, the present 
investigation emphasizes the need for carefully monitoring the mental health of 
younger people, provides guidance for the development of interventions that 
mitigate some of the psychological difficulties faced in a situation of 
confinement, and highlights the importance of paying special attention to 
high-risk groups.

DOI: 10.3390/ijerph19074120
PMCID: PMC8998498
PMID: 35409803 [Indexed for MEDLINE]

Conflict of interest statement: J.M.H. has received economic compensation for 
participating in an advisory board organized by Eli Lilly and Co. J.A.R.-Q. has 
served on the speakers’ bureau and acted as consultant for BGaze, Bial, Ferrer, 
Janssen, Laboratorios Rubió, Lundbeck, Medice, Novartis, Ono, Shionogi, Shire, 
Sincrolab, and Takeda. He has received travel awards from Janssen, Medice, 
Shire, and Takeda for participating in psychiatric meetings. The Department of 
Psychiatry chaired by J.A.R.-Q. has received unrestricted educational and 
research support from BGaze, Fundació Barça, Fundació Probitas, Janssen, 
Laboratorios Rubió, Lundbeck, Nesplora, Oryzon, Psious, Roche, Rovi, and Shire 
in the past two years. M.C. has received travel grants and research support from 
Eli Lilly and Co., Janssen, and Shire. He has been on the advisory board and 
served as a consultant for Eli.


2172. Int J Environ Res Public Health. 2022 Mar 29;19(7):4073. doi: 
10.3390/ijerph19074073.

Remote Support of Elderly Women Participating in Mental Health Promotion 
Programme during the COVID-19 Pandemic: A Single-Group Longitudinal 
Intervention.

Juszko K(1), Serweta A(1), Cieślik B(2), Idzikowski W(3), Szczepańska-Gieracha 
J(1), Gajda R(4)(5).

Author information:
(1)Faculty of Physiotherapy, Wroclaw University of Health and Sport Sciences, 
51-612 Wroclaw, Poland.
(2)Faculty of Health Sciences, Jan Dlugosz University, 42-200 Czestochowa, 
Poland.
(3)Faculty of Physical Education and Sport Sciences, Wroclaw University of 
Health and Sport Sciences, 51-612 Wroclaw, Poland.
(4)Gajda-Med District Hospital, 06-100 Pultusk, Poland.
(5)Department of Kinesiology and Health Prevention, Jan Dlugosz University, 
42-200 Czestochowa, Poland.

The aim of the study was to evaluate the longitudinal changes in mental 
well-being during the switch of the intervention from a personal contact to a 
remotely delivered Mental Health Prevention and Promotion Programme in elderly 
women at high risk of developing depression. The study included 70 women aged 
over 60 with a mean age of 72.28 years. In order to determine mental well-being, 
the Geriatric Depression Scale (GDS) was used at four time points: January, 
April, September and December 2020. A self-developed questionnaire was used to 
determine predictors of mental well-being. Two-way ANOVA demonstrated a lack of 
significant differences between the means in the GDS scores at the four data 
collection time points (p = 0.21). Frequent use of green areas reduced the GDS 
score on average by 1.52 points (p = 0.01), while owning a garden by 1.51 points 
(p = 0.04). The illness of a family member increased the GDS score by an average 
of 1.7 points (p = 0.02). No significant mood deterioration was found between 
January 2020 and December 2020 in the studied group of elderly women at a high 
risk of developing depression, which suggests that the remote support provided 
in the mental health promotion programme was effective.

DOI: 10.3390/ijerph19074073
PMCID: PMC8997972
PMID: 35409756 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2173. Int J Environ Res Public Health. 2022 Mar 29;19(7):4062. doi: 
10.3390/ijerph19074062.

Exploring the Potential of a School-Based Online Health and Wellbeing Screening 
Tool: Young People's Perspectives.

Woodrow N(1), Fairbrother H(2), D'Apice K(3), Breheny K(3), Albers P(3), Mills 
C(4), Tebbett S(5), Campbell R(3), De Vocht F(3).

Author information:
(1)School of Health and Related Research (ScHARR), University of Sheffield, 
Regent Court, Sheffield S1 4DA, UK.
(2)Health Sciences School, University of Sheffield, 3a Clarkehouse Road, 
Sheffield S10 2HQ, UK.
(3)Population Health Sciences, Bristol Medical School, University of Bristol, 
Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK.
(4)Public Health, Floor 4, Halford Wing, City Hall, 115 Charles Street, 
Leicester City Council, Leicester LE1 1FZ, UK.
(5)Leicestershire Partnership NHS Trust, Bridge Park Plaza, Bridge Park Road, 
Thurmaston, Leicester LE4 8PQ, UK.

Despite high levels of need, many young people who experience health issues do 
not seek, access or receive support. Between May and November 2021, using 
semi-structured interviews, we explored the perspectives of 51 young people 
(aged 13-14) from two schools who had taken part in a novel online health and 
wellbeing screening programme, the Digital Health Contact (DHC). One school 
delivered the DHC during home-learning due to COVID-19 restrictions, whilst the 
other delivered it in school when restrictions were lifted. The DHC was seen as 
a useful approach for identifying health need and providing support, and had 
high levels of acceptability. Young people appreciated the online format of the 
DHC screening questionnaire and thought this facilitated more honest responses 
than a face-to-face approach might generate. Completion at home, compared to 
school-based completion, was perceived as more private and less time-pressured, 
which young people thought facilitated more honest and detailed responses. Young 
people's understanding of the screening process (including professional service 
involvement and confidentiality) influenced engagement and responses. Overall, 
our findings afford important insights around young people's perspectives of 
participating in screening programmes, and highlight key considerations for the 
development and delivery of health screening approaches in (and out of) school.

DOI: 10.3390/ijerph19074062
PMCID: PMC8998184
PMID: 35409747 [Indexed for MEDLINE]

Conflict of interest statement: N.W., H.F., K.D., K.B., P.A., R.C. and F.D.V. do 
not have any conflict of interest. C.M. is employed at the DHC’s commissioning 
organisation (at Leicester City Council), and S.T. is employed at the DHC’s 
provider organisation (at Leicestershire Partnership NHS Trust). This study, and 
the wider research project evaluating the DHC, has been co-produced with the 
DHC’s commissioners (at Leicester City Council) and providers (at Leicestershire 
Partnership NHS Trust). The commissioner and the provider are committed to 
helping to facilitate a robust evaluation of the DHC in order to inform 
potential changes and wider roll out of the programme. There has been no 
pressure or influence to modify, restate, weaken, omit or frame findings, 
conclusions and recommendations from any team member.


2174. Int J Environ Res Public Health. 2022 Mar 29;19(7):4024. doi: 
10.3390/ijerph19074024.

Impact of COVID-19 on School Populations and Associated Factors: A Systematic 
Review.

Tri Sakti AM(1)(2)(3), Mohd Ajis SZ(2), Azlan AA(1)(2), Kim HJ(4), Wong E(4), 
Mohamad E(1)(2).

Author information:
(1)Centre for Research in Media and Communication, Faculty of Social Sciences 
and Humanities, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia.
(2)UKM x UNICEF Communication for Development Centre in Health, Faculty of 
Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Bangi 43600, 
Malaysia.
(3)Faculty of Communication Science, Mercu Buana University, Jakarta 11650, 
Indonesia.
(4)UNICEF Malaysia Country Office, Putrajaya 62100, Malaysia.

Apart from the severe impact on public health and well-being, the chain effect 
resulting from the COVID-19 health crisis is a profound disruption for various 
other sectors, notably in education. COVID-19 has driven massive transformation 
in many aspects of the educational landscape, particularly as teaching and 
learning shifted online due to school closure. Despite the many impacts of the 
health crises on school populations, a systematic review regarding this 
particular issue has yet to be conducted. This study, therefore, attempts to 
comprehensively review the impact of health crises on school populations 
(student, teacher, parent, and school administration). An extensive literature 
search guided by the Preferred Reporting Items for Systematic Reviews and 
Meta-Analysis (PRISMA) reporting checklist was performed in two selected 
databases, namely Web of Science (WoS) and Scopus to identify how this 
particular topic was previously studied. Exclusion and inclusion criteria were 
set to ensure that only research papers written in English from the year 2000 to 
the present (April 2021) were included. From a total of 457 studies screened, 
only 41 of them were deemed eligible to be included for qualitative synthesis. 
The findings revealed that the COVID-19 pandemic was the only health crisis 
discussed when it comes to investigating the impact of health crises on school 
populations. This study found four notable consequences of health crises on 
school populations, which are impacts on mental health, teaching and learning, 
quality of life, and physical health. Among factors associated with the impact 
of the health crises are; demographic factors, concerns about the pandemic, 
education-related factors, health-related factors, geographic factors, economic 
concerns, teaching challenges, and parenting in the pandemic. This study is 
expected to be a reference for future works in formulating crises mitigation 
strategies to reduce the impact of health crises on schools by exploring the 
contexts of the crises.

DOI: 10.3390/ijerph19074024
PMCID: PMC8997877
PMID: 35409707 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2175. Int J Environ Res Public Health. 2022 Mar 27;19(7):3986. doi: 
10.3390/ijerph19073986.

Impact of COVID-19 Pandemic on Daily Life, Physical Exercise, and General Health 
among Older People with Type 2 Diabetes: A Qualitative Interview Study.

Leite NJC(1)(2), Raimundo AMM(1)(2), Mendes RDC(3)(4)(5), Marmeleira JFF(1)(2).

Author information:
(1)Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, 
Universidade de Évora, 7000-727 Évora, Portugal.
(2)Comprehensive Health Research Centre (CHRC), 7000-727 Évora, Portugal.
(3)EPIUnit-Institute of Public Health, University of Porto, 4050-600 Porto, 
Portugal.
(4)Laboratory for Integrative and Translational Research in Population Health 
(ITR), 4050-600 Porto, Portugal.
(5)Northern Region Health Administration, 4000-447 Porto, Portugal.

The COVID-19 pandemic has resulted in significant alterations to and 
implications for the lives of millions of people, and especially for those with 
pre-existing medical conditions. The aim of this study was to explore the lived 
experience of older people with type 2 diabetes mellitus (T2DM) throughout the 
first 9 months of the pandemic, with emphasis on the habits of physical 
exercise. We conducted a qualitative study using semi-structured interviews. The 
data consist of telephone interviews of seventeen older people with T2DM (10 
women and 7 men, aged 62-76 years). Using thematic analysis, five themes were 
generated: (1) an altered social and relational life; (2) changes in routine and 
attitude regarding physical activity behaviour; (3) home-related activities 
gained relevance; (4) health and well-being impact and management; and (5) 
thoughts about the post-pandemic period. The increase in the number of cases and 
the fear of becoming infected with COVID-19 limited the social (i.e., contact 
with family and/or friends) and functional (i.e., daily routine, the habit of 
exercising) lives of these people, reverberating negatively on their health and 
well-being. Feelings of isolation, loneliness, anxiety were common. The findings 
of this study help to better understand the impact of the pandemic and determine 
areas of need for future interventions. A multidisciplinary approach is 
necessary to provide support for older people with T2DM and tackle the negative 
effect of the pandemic, including the reduction in physical activity.

DOI: 10.3390/ijerph19073986
PMCID: PMC8998106
PMID: 35409672 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2176. Int J Environ Res Public Health. 2022 Mar 27;19(7):3981. doi: 
10.3390/ijerph19073981.

Safety Management and Wellbeing during COVID-19: A Pilot Study in the 
Manufactory Sector.

Guidetti G(1), Cortini M(1), Fantinelli S(2), Di Fiore T(1), Galanti T(1).

Author information:
(1)Department of Psychological, Health and Territorial Sciences, University G. 
d'Annunzio of Chieti-Pescara, 66100 Chieti, Italy.
(2)Department of Humanities, Literature, Cultural Heritage, Education Sciences, 
University of Foggia, 71100 Foggia, Italy.

BACKGROUND: The rapid spread of COVID-19 has generated anxiety and concerns 
among the whole population, by also affecting people's working life quality. 
Although several studies underlined the impact of the COVID-19 pandemic in the 
healthcare sector, very few studies investigated the consequences in the 
occupational sectors with low risk of contagion.
METHOD: 220 full-time in-presence workers of the manufacturing sector agreed to 
participate in a study of cross-sectional design during September and October 
2020. Data were collected by means of a self-reported questionnaire conceived to 
investigate the constructs of the COVID-19 concerns, both the personal 
contribution and the supervisor support to workplace safety, the organizational 
commitment to safety, and finally, the level of workers' exhaustion.
RESULTS: This study highlights that COVID-19 concerns represent a significant 
source of stress since it is significantly associated to higher levels of 
exhaustion among workers. Furthermore, the findings show the relevance of 
resources related to employee's personal contribution to safety management as 
well as the role of climate variables.
CONCLUSIONS: These results promote knowledge on the role of COVID-19 concerns in 
affecting psychological wellbeing at work, as well as the impact of both 
individual and job-related resources that may prevent exhaustion at work. 
Finally, the present findings also have implications for organizations and the 
maintenance of their commitment to safety.

DOI: 10.3390/ijerph19073981
PMCID: PMC8997849
PMID: 35409664 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2177. Int J Environ Res Public Health. 2022 Mar 26;19(7):3959. doi: 
10.3390/ijerph19073959.

Changes in Health-Related Behaviours and Mental Health in a UK Public Sample 
during the First Set of COVID-19 Public Health Restrictions.

Wilson JJ(1)(2), Smith L(3), Yakkundi A(4), Jacob L(5)(6), Martin S(7), Grabovac 
I(8), McDermott DT(9), López-Bueno R(10), Barnett Y(11), Butler LT(12), Schuch 
FB(13), Armstrong NC(14), Tully MA(15).

Author information:
(1)Sport and Exercise Sciences Research Institute, School of Sport, Ulster 
University, Newtownabbey BT37 0QB, UK.
(2)Institute of Mental Health Sciences, School of Health Sciences, Ulster 
University, Newtownabbey BT37 0QB, UK.
(3)The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin 
University, Cambridge CB1 1PT, UK.
(4)Northern Ireland Public Health Research Network, School of Health Sciences, 
Ulster University, Newtownabbey BT37 0QB, UK.
(5)Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, 
78180 Montigny-le-Bretonneux, France.
(6)Parc Sanitari Sant Joan de Deu/CIBERSAM, Universitat de Barcelona, Fundacio 
Sant Joan de Deu, Sant Boi de Llobregat, 08830 Barcelona, Spain.
(7)Centre for Health and Rehabilitation Technologies, Institute of Nursing and 
Health Research, School of Health Sciences, Ulster University, Newtownabbey BT37 
0QB, UK.
(8)Centre for Public Health, Department of Social and Preventive Medicine, 
Medical University of Vienna, 1090 Wien, Austria.
(9)NTU Psychology, School of Social Sciences, Nottingham Trent University, 
Nottingham NG1 4FQ, UK.
(10)Department of Physical Medicine and Nursing, University of Zaragoza, 50009 
Zaragoza, Spain.
(11)School of Life Sciences, Anglia Ruskin University, Cambridge CB1 1PT, UK.
(12)Faculty of Science & Engineering, Anglia Ruskin University, Cambridge CB1 
1PT, UK.
(13)Department of Sports Methods and Techniques, Federal University of Santa 
Maria, Santa Maria 97105-900, Brazil.
(14)Health and Social Care Research & Development Division, Public Health Agency 
(Northern Ireland), Belfast BT2 8BS, UK.
(15)School of Medicine, Ulster University, Londonderry BT48 7JL, UK.

Public health restrictions, in response to the COVID-19 pandemic, have had 
potentially wide-ranging, unintended effects on health-related behaviours such 
as diet and physical activity and also affected mental health due to reduced 
social interactions. This study explored how health-related behaviours and 
mental health were impacted in a sample of the UK public during the first set of 
COVID-19 public health restrictions. Two online surveys were administered in the 
UK, one within the first three months of the restrictions (Timepoints 1 
(T1—involving pre-pandemic recall) and 2/T2) and another ten weeks later 
(Timepoint 3/T3). Moderate−vigorous physical activity (MVPA), outdoor time, 
sitting time, screen time and sexual activity were self-reported. Diet was 
assessed using the Dietary Instrument for Nutrition Education questionnaire. 
Mental health was measured using the short-form Warwick−Edinburgh Mental 
Wellbeing Scale and Becks’ Anxiety and Depression Inventories. Differences 
between timepoints were explored using the Friedman, Wilcoxon signed-rank, 
McNemar and McNemar−Bowker tests. Two hundred and ninety-six adults (74% under 
65 years old; 65% female) provided data across all timepoints. Between T1 and 
T2, MVPA, time outdoors and sexual activity decreased while sitting, and screen 
time increased (p < 0.05). Between T2 and T3, saturated fat intake, MVPA, time 
outdoors, and mental wellbeing increased while sitting, screen time and anxiety 
symptoms decreased (p < 0.05). This study found that depending on the level of 
COVID-19 public health restrictions in place, there appeared to be a varying 
impact on different health-related behaviours and mental health. As countries 
emerge from restrictions, it is prudent to direct necessary resources to address 
these important public health issues.

DOI: 10.3390/ijerph19073959
PMCID: PMC8997575
PMID: 35409642 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2178. Int J Environ Res Public Health. 2022 Mar 26;19(7):3958. doi: 
10.3390/ijerph19073958.

A Study of the Impact of River Improvement and Greening on Public Reassurance 
and the Urban Well-Being Index during the COVID-19 Pandemic.

Lin HH(1)(2), Chen IY(3), Tseng CH(2), Lee YS(4), Lin JC(5).

Author information:
(1)School of Physical Education, Jiaying University, Meizhou 514015, China.
(2)Department of Leisure Industry Management, National Chin-Yi University of 
Technology, Taichung 41170, Taiwan.
(3)Department of Finance, National Changhua University of Education, Changhua 
50074, Taiwan.
(4)General Education Center, National Penghu University of Science and 
Technology, Penghu 880011, Taiwan.
(5)Department of Marine Leisure Management, National Kaohsiung University of 
Science and Technology, Kaohsiung 811213, Taiwan.

This study aims to investigate the effect of river improvement and greening 
projects on people and the urban happiness index. First, the quantitative method 
was adopted, and data collected from 734 questionnaires were analyzed using SPSS 
26.0 software. Then, the qualitative method was used, and semi-structured 
interviews were conducted to collect the opinions of 12 interviewees, including 
scholars, government employees, citizens, and practitioners. Finally, we discuss 
multiple comparison analysis testing. The survey results indicate that river 
improvement and greening projects could be conducted to take advantage of 
diverse ecological environments, urban transportation planning, and geographical 
location. Such projects can help people relieve stress, even during the COVID-19 
pandemic; improve their physical and mental health; and enhance their 
environmental awareness. However, due to poor traffic flow, a low space 
utilization rate, and inflexible management practices, visiting these 
environments has posed a risk of infection. As a result, most respondents 
indicated that the leisure benefits of green fields are limited and not helpful 
for improving their physical and mental health or having fun. Additionally, 
survey responses by people from different backgrounds (p < 0.01) varied. 
Therefore, we believe that by providing a safe living environment, strengthening 
disaster prevention skills and cooperation against epidemics, reducing accident 
risks, improving leisure safety and fluency, and planning diverse leisure 
activities, we can improve people’s perception of environmental experiences, 
promote leisure participation, improve leisure satisfaction, and enhance 
well-being.

DOI: 10.3390/ijerph19073958
PMCID: PMC8997446
PMID: 35409641 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2179. Nutrients. 2022 Apr 2;14(7):1490. doi: 10.3390/nu14071490.

Food Involvement, Food Choices, and Bioactive Compounds Consumption Correlation 
during COVID-19 Pandemic: How Food Engagement Influences Consumers' Food Habits.

Medoro C(1), Cianciabella M(1), Magli M(1), Daniele GM(1), Lippi N(1), Gatti 
E(1), Volpe R(2), Longo V(3), Nazzaro F(4), Mattoni S(5), Tenaglia F(6), 
Predieri S(1).

Author information:
(1)Institute for BioEconomy, National Research Council (CNR), Via Piero Gobetti 
101, 40129 Bologna, Italy.
(2)Health and Safety Unit (SPP), National Research Council (CNR), Piazzale Aldo 
Moro, 7, 00185 Roma, Italy.
(3)Institute of Agricultural Biology and Biotechnology (IBBA), National Research 
Council, 56124 Pisa, Italy.
(4)Institute of Food Sciences, CNR-ISA, Via Roma 64, 83100 Avellino, Italy.
(5)Public Relations Unit, National Research Council (CNR), Piazzale Aldo Moro, 
7, 00185 Roma, Italy.
(6)Department of Biology, Agriculture and Food Sciences-DiSBA, National Research 
Council (CNR), Piazzale Aldo Moro, 7, 00185 Roma, Italy.

The containment measures due to the COVID-19 pandemic affected food-related 
activities, influencing dietary behavior, food habits, and dietary choices. This 
study aimed to compare the relationship between food involvement and dietary 
choices before and during the pandemic, investigating the role played by food in 
dietary habits. Responses given by 2773 Italian consumers to an online survey 
were studied through the Food Involvement Scale (FIS) and correlated to eating 
habits. FIS scores were then used to explain the importance given to food in 
circumstances related to well-being, health, and protection against COVID-19 and 
used to study the relationship between FIS and bioactive compound knowledge, 
use, and efficacy against COVID-19. The consumers more involved in food issues 
recognized the importance of food in circumstances related to well-being, 
health, and protection against COVID-19 and improved their diet during the 
pandemic. Moreover, consumers who gave more importance to food also revealed 
higher attention to the use of healthy substances, such as bioactive compounds, 
considering them effective against COVID-19. These results showed that food 
experiencing and involvement could be important elements to promote healthy 
dietary habits that are essential to maintain physical and mental health during 
emergency periods such as the COVID-19 pandemic.

DOI: 10.3390/nu14071490
PMCID: PMC9003202
PMID: 35406102 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2180. Int J Health Plann Manage. 2022 Jul;37(4):1912-1917. doi: 10.1002/hpm.3472. Epub 
2022 Apr 10.

Risk factors, contemporary challenges and psychological well-being of the 
Rohingya refugees in Bangladesh: Policy implications.

Hossain MA(1)(2), Huda MN(3)(4), Ullah AKMA(5), Renzaho A(6).

Author information:
(1)Department of Sociology, Begum Rokeya University, Rangpur, Bangladesh.
(2)Sydney Medical School, University of Sydney, Sydney, Australia.
(3)School of Liberal Arts and Social Sciences, Independent University, Dhaka, 
Bangladesh.
(4)School of Health Sciences, Western Sydney University, Campbelltown, New South 
Wales, Australia.
(5)Department of Geography, Environment and Development, Faculty of Arts and 
Social Sciences (FASS), Universiti Brunei Darussalam (UBD), Gadong, Brunei 
Darussalam.
(6)Translational Health Research Institute, School of Medicine, Western Sydney 
University, Penrith, New South Wales, Australia.

Over the last few years, the number of Rohingya refugees in Bangladesh has 
increased exponentially. On arrival, they experience poor mental health and 
psychological well-being. This commentary explores the risk factors and 
contemporary challenges that deteriorate Rohingyas' psychological well-being in 
Bangladesh. The onslaught of Covid-19 compounds the pre-existing psychological 
health conditions of the Rohingyas living in cramped and flimsy camps. The 
recent relocation to Bhashan Char may likely trigger tensions and eventually 
exacerbates their existing psychological well-being. The relocation to Bhashan 
Char has presumably happened against their volition. Meanwhile, the Myanmar 
military's coup has added additional fear about their bleak future of a safe and 
dignified return from Bangladesh to Myanmar. All these have contributed to the 
worsening of their existing psychological well-being. In order to subside their 
psychological health challenges, this commentary suggests: (a) the immediate 
execution of 'National Deployment and Vaccination Plan for Covid-19 Vaccines and 
initiation of vaccine rollout among the refugees; and (b) involving Rohingyas in 
economic activities and making them a self-reliant and economically empowered 
community. We suggest that safe and dignified repatriation is the only solution 
to the challenges they have been going through in Bangladesh and to preserve 
their psychological well-being.

© 2022 John Wiley & Sons Ltd.

DOI: 10.1002/hpm.3472
PMID: 35403250 [Indexed for MEDLINE]


2181. Percept Mot Skills. 2022 Jun;129(3):670-695. doi: 10.1177/00315125221087523. 
Epub 2022 Apr 10.

Dispositional Mindfulness May Have Protected Athletes from Psychological 
Distress During COVID-19 in Australia.

O'Connor EJ(1)(2), Crozier AJ(1)(2), Murphy A(3), Immink MA(4)(5).

Author information:
(1)Allied Health and Human Performance, 1067University of South Australia, 
Adelaide, SA, Australia.
(2)Alliance for Research in Exercise, Nutrition and Activity (ARENA), 
1067University of South Australia, Adelaide, SA, Australia.
(3)Sports Science and Sports Medicine Unit, 502515Tennis Australia, Melbourne, 
VIC Australia.
(4)Sport, Health, Activity, Performance and Exercise (SHAPE) Research Centre, 
1065Flinders University, Adelaide, SA, Australia.
(5)College of Nursing and Health Sciences, 1065Flinders University, Adelaide, 
SA, Australia.

Promoting athlete wellbeing has become a priority in elite sport, and the 
COVID-19 pandemic has accentuated the need for a comprehensive understanding of 
risk and protective factors. Existing sport research has not yet considered 
whether specific cognitive factors such as dispositional mindfulness and 
executive function may protect athletes against psychological distress. In a 
sample of high-performance Australian football athletes (n = 27), we 
administered measures of dispositional mindfulness (MAAS), executive function 
(AOSPAN; eStroop), and psychological distress (APSQ) at pre-season, coinciding 
with the initial (2020) COVID-19-related sport shutdown in Australia. Measures 
of executive function and psychological distress were re-administered at the end 
of the COVID-19 affected competitive season in 2020. Athletes reported 
significantly elevated psychological distress relative to previous estimates of 
distress among high-performance athletes established in prior studies. Executive 
functions, including working memory and inhibitory control were not 
significantly associated with psychological distress or dispositional 
mindfulness at either timepoint. However, baseline mindfulness was associated 
with reduced distress at both pre-season (r = -0.48, p = .03) and end of season 
(r = -0.56, p = .004), suggesting that dispositional mindfulness may have 
afforded protective buffering against symptoms of distress. Correlation data 
alone does not establish a directional connection from mindfulness to reduced 
distress, and future research is required to elucidate this association and/or 
establish the mechanism/s by which dispositional mindfulness may protect against 
psychological distress in this population.

DOI: 10.1177/00315125221087523
PMCID: PMC9008473
PMID: 35400226 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


2182. BMC Health Serv Res. 2022 Apr 10;22(1):472. doi: 10.1186/s12913-022-07836-3.

Fighting the waves; Covid-19 family life interference in a neurodevelopmental 
disorder-caregiver population.

Nylén-Eriksen M(1), Lara-Cabrera ML(2)(3)(4), Grov EK(5), Skarsvaag H(6), Lie 
I(7), Dahl-Michelsen T(8), Sæterstrand TM(5), Mandahl A(6)(9), Hafstad H(9), 
Lersveen MB(6)(9), Bjørnnes AK(5).

Author information:
(1)Institute of Nursing and Health Promotion, Oslo Metropolitan University, 
Oslo, Norway. matsnyle@oslomet.no.
(2)Department of Research and Development, Division of Mental Health, St Olav's 
University Hospital, Trondheim, Norway.
(3)Faculty of Medicine and Health Sciences, Department of Mental Health, 
Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
(4)Division of Psychiatry, Tiller Community Mental Health Centre, St. Olav's 
University Hospital, Trondheim, Norway.
(5)Institute of Nursing and Health Promotion, Oslo Metropolitan University, 
Oslo, Norway.
(6)ADHD Norway, Oslo, Norway.
(7)Department of Cardiothoracic Surgery, Division of Cardiovascular and 
Pulmonary Diseases, Center for Patient-Centered Heart and Lung Research, Oslo 
UniversityHospital, Oslo, Norway.
(8)Institute of Physiotherapy, Oslo Metropolitan University, Oslo, Norway.
(9)Vårres Regional User-Led Center Central-Norway, Trondheim, Norway.

INTRODUCTION: The current COVID-19 pandemic interferes with family lives across 
the world, particularly families of children with neurodevelopmental disorders 
(NDDs) are at a greater risk for being negatively impacted by the pandemic. 
Together with representatives from this caregiver population the aim was to 
explore the interference associated with normal family life caused by the 
COVID-19 pandemic.
METHOD: This is a descriptive study using a cross-sectional design. Following a 
strategic network sampling strategy, a user-developed national survey was 
completed by a larger sample (N = 1,186) of parents and informal caregivers of 
children with NDDs. The survey utilized a combination of both closed and 
open-ended questions, and a logistic regression analysis was carried out to 
assess the association between family characteristics, characteristics of the 
child, and COVID-19 related family life interference. Before carrying out the 
regression an inductive content analysis of the open-ended question on `How has 
the isolation affected the family´ was carried out to construct the outcome 
variable.
RESULTS: The initial analysis indicated that the COVID-19 pandemic induced a 
shift in everyday family life and a lack of guidance and support related to 
managing the challenges they were facing. Caregivers who reported that COVID-19 
had significantly interfered with their family life, were more likely to report 
having anxious children, and to have experienced an increased number of 
conflicts at home. The logistic regression showed that both anxious children and 
increased conflicts considerably increased the risk for reporting family life 
interference compared to those that reported no increased conflicts or anxious 
children.
DISCUSSION: Considering how the COVID-19 related increased conflicts at home and 
anxious children threaten the family life of the NDD caregiver population, as an 
external source of family stress, which might lead to negative impact on their 
mental and physical well-being, the need for further research in collaboration 
with user representatives is apparent. Our study suggests that more information 
should be provided to healthcare providers, social professionals, peers, people 
with NDDs, and caregivers of people with NDDs about the potential threats that a 
stressful life event such as the current pandemic can pose to their mental and 
physical health and their family life.

© 2022. The Author(s).

DOI: 10.1186/s12913-022-07836-3
PMCID: PMC8994698
PMID: 35399084 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2183. Eur J Epidemiol. 2022 Mar;37(3):227-234. doi: 10.1007/s10654-022-00861-w. Epub 
2022 Apr 10.

COVID-19 prevalence and mortality in longer-term care facilities.

Levin AT(1)(2)(3), Jylhävä J(4)(5), Religa D(6), Shallcross L(7).

Author information:
(1)Dartmouth College, Hanover, USA. andrew.t.levin@dartmouth.edu.
(2)National Bureau for Economic Research, Cambridge, USA. 
andrew.t.levin@dartmouth.edu.
(3)Center for Economic Policy Research, London, United Kingdom. 
andrew.t.levin@dartmouth.edu.
(4)Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 
Stockholm, Sweden.
(5)Faculty of Social Sciences, Unit of Health Sciences and Gerontology Research 
Center, University of Tampere, Tampere, Finland.
(6)Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 
Stockholm, Sweden.
(7)University College, London, United Kingdom.

This essay considers the factors that have contributed to very high COVID-19 
mortality in longer-term care facilities (LTCFs). We compare the demographic 
characteristics of LTCF residents with those of community-dwelling older adults, 
and then we review the evidence regarding prevalence and infection fatality 
rates (IFRs), including links to frailty and some comorbidities. Finally, we 
discuss policy measures that could foster the physical and mental health and 
well-being of LTCF residents in the present context and in potential future 
pandemics.

© 2022. The Author(s).

DOI: 10.1007/s10654-022-00861-w
PMCID: PMC8994824
PMID: 35397704 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no financial interests nor any 
other conflicts of interest related to this commentary. No funding was received 
for producing this commentary.


2184. Nurs Crit Care. 2023 Nov;28(6):854-862. doi: 10.1111/nicc.12775. Epub 2022 Apr 
9.

Family member's experiences with and evaluation of an ICU Liaison Nurse Service: 
A qualitative study.

Boerenbeker P(1), Brandén AS(1), Chaboyer W(2), Hilli Y(3), Johansson L(1)(4).

Author information:
(1)Sahlgrenska University Hospital, Göteborg, Sweden.
(2)Menzies Health Institute Queensland and the School of Nursing and Midwifery, 
Griffith University, Queensland, Australia.
(3)Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.
(4)Institute of Health and Caring Sciences, The Sahlgrenska Academy, University 
of Gothenburg, Göteborg, Sweden.

BACKGROUND: Family members of critically ill patients often experience anxiety 
when their relatives are transferred from ICU to another level of care. ICU 
liaison nurse (ICULN) visits have been associated with improved support for 
patients, their families and nursing staff but has not been extensively studied 
in the non-English speaking setting. Yet, cross-country variations such as how 
hospital care is delivered and by who means that innovations such as the ICULN 
may not be able to be simply transferred to other contexts and may not have 
similar outcomes.
AIM: The aim of this study was to investigate family member's experiences with 
and evaluation of ICULN support service in one Swedish ICU.
STUDY DESIGN: A qualitative evaluation study was undertaken, recruiting family 
members of former ICU patients. Audio-taped in-depth interviews were conducted. 
Data were analysed by content analysis.
FINDINGS: Fifteen family members were interviewed. Two categories: Minds the gap 
between intensive care and the next care level and providing stability in an 
uncertain situation were identified. The ICULN supported the family members both 
directly, when the ICULNs listened to their questions and met their needs, and 
indirectly, when the ICULNs took responsibility for the patients and their 
physical and psychological conditions and wellbeing.
CONCLUSION: Families valued and were satisfied with the ICULN service but also 
gave suggestions to improve the service in this particular hospital context.
RELEVANCE TO CLINICAL PRACTICE: The study showed that an ICULN support service 
met several needs of family members and therefore was a beneficial way to 
support patients and family members in the transition from the ICU to the ward.

© 2022 British Association of Critical Care Nurses.

DOI: 10.1111/nicc.12775
PMID: 35396916 [Indexed for MEDLINE]


2185. Sci Total Environ. 2022 Aug 10;833:155095. doi: 10.1016/j.scitotenv.2022.155095. 
Epub 2022 Apr 6.

Nature's contributions in coping with a pandemic in the 21st century: A 
narrative review of evidence during COVID-19.

Labib SM(1), Browning MHEM(2), Rigolon A(3), Helbich M(4), James P(5).

Author information:
(1)Department of Human Geography and Spatial Planning, Faculty of Geosciences, 
Utrecht University, 3584 CB Utrecht, The Netherlands. Electronic address: 
s.m.labib@uu.nl.
(2)Department of Parks, Recreation, and Tourism Management, Clemson University, 
Clemson, SC, 29631, USA.
(3)Department of City and Metropolitan Planning, The University of Utah, Salt 
Lake City, UT 84112, USA.
(4)Department of Human Geography and Spatial Planning, Faculty of Geosciences, 
Utrecht University, 3584 CB Utrecht, The Netherlands.
(5)Department of Population Medicine, Harvard Medical School and Harvard Pilgrim 
Health Care Institute, 401 Park Drive, Boston, MA 02215, USA; Department of 
Environmental Health, Harvard T. H. Chan School of Public Health, 655 Huntington 
Avenue, Boston, MA 02115, USA.

While COVID-19 lockdowns have slowed coronavirus transmission, such structural 
measures also have unintended consequences on mental and physical health. 
Growing evidence shows that exposure to the natural environment (e.g., 
blue-green spaces) can improve human health and wellbeing. In this narrative 
review, we synthesized the evidence about nature's contributions to health and 
wellbeing during the first two years of the COVID-19 pandemic. We found that 
during the pandemic, people experienced multiple types of nature, including both 
outdoors and indoors. Frequency of visits to outdoor natural areas (i.e., public 
parks) depended on lockdown severity and socio-cultural contexts. Other forms of 
nature exposure, such as spending time in private gardens and viewing outdoor 
greenery from windows, may have increased. The majority of the evidence suggests 
nature exposure during COVID-19 pandemic was associated with less depression, 
anxiety, stress, and more happiness and life satisfaction. Additionally, nature 
exposure was correlated with less physical inactivity and fewer sleep 
disturbances. Evidence was mixed regarding associations between nature exposure 
and COVID-related health outcomes, while nature visits might be associated with 
greater rates of COVID-19 transmission and mortality when proper social 
distancing measures were not maintained. Findings on whether nature exposure 
during lockdowns helped ameliorate health inequities by impacting the health of 
lower-socioeconomic populations more than their higher-socioeconomic 
counterparts for example were mixed. Based on these findings, we argue that 
nature exposure may have buffered the negative mental and behavioral impacts of 
lockdowns during the COVID-19 pandemic. Recovery and resilience during the 
current crises and future public health crises might be improved with 
nature-based infrastructure, interventions, designs, and governance.

Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.scitotenv.2022.155095
PMCID: PMC8983608
PMID: 35395304 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


2186. Fam Pract. 2022 Nov 22;39(6):1009-1016. doi: 10.1093/fampra/cmac025.

Challenges and experiences of general practitioners during the course of the 
Covid-19 pandemic: a northern Italian observational study-cross-sectional 
analysis and comparison of a two-time survey in primary care.

Mahlknecht A(1), Barbieri V(1), Engl A(1), Piccoliori G(1), Wiedermann CJ(1)(2).

Author information:
(1)Institute of General Practice and Public Health, College of Health Care 
Professions, Bolzano, Italy.
(2)Department of Public Health, Medical Decision Making and HTA, University of 
Health Sciences, Medical Informatics and Technology, Hall, Tyrol, Austria.

BACKGROUND: General practitioners (GPs) have been among the frontline workers 
since the outbreak of the Covid-19 pandemic. Reflecting and analyzing the 
ongoing pandemic response of general practice provides essential information and 
serves as a precondition for outlining future health policy strategies.
OBJECTIVE: To investigate the effects of the pandemic on GPs' daily work and 
well-being and to describe needs for improvement in primary care highlighted by 
the pandemic.
METHODS: A 2-time cross-sectional online survey involving GPs in a northern 
Italian region was conducted in September 2020 and March/April 2021.
RESULTS: Eighty-four GPs (29.6% of invited GPs) participated in the first 
survey, and 41 GPs (14.4%) in the second survey. Most GPs experienced a notable 
workload increase which was tendentially higher during the advanced stages of 
the pandemic. A notable increase between the first and the second survey was 
noted regarding the frequency of Covid-related patient contacts and phone calls. 
Communication with health authorities and hospitals was rated as improvable. 
Psychological distress among GPs tended to increase over time; female GPs were 
more affected in the first survey. Most practices introduced major changes in 
their workflow, mainly appointment-based visits and separating 
Covid-19-suspected patients. Availability of protective equipment considerably 
increased over time. In the second survey, the GPs felt more prepared to 
self-protection and outpatient treatment of Covid-affected patients.
CONCLUSION: The work of GPs has been substantially impacted by the ongoing 
Covid-19 pandemic. Efforts should be undertaken to efficiently strengthen 
primary care which plays an important role in pandemic events.

Plain Language Summary: The Covid-19 pandemic has considerably impacted the way 
of daily working of general practitioners (GPs). Several studies have been 
conducted which reflected the immediate response of general practice to the 
pandemic at its early stages, but studies assessing the ongoing situation are 
missing. This study responded to this need and aimed to illustrate the 
challenges, difficulties, and the personal well-being of GPs during the first 
pandemic wave and during the second/third pandemic wave. The study consisted of 
a 2-time online survey of GPs in a northern Italian province. The 84 GPs 
participating in the first survey and 41 GPs participating in the second survey 
indicated a notable workload increase due to the pandemic. The availability of 
protective equipment and of clinical guidance about how to treat 
Covid-19-affected patients in their homes was poor at the beginning but 
increased considerably over time. Psychological distress was slightly 
increasing. Most GPs modified their workflow and practice organization. Adequate 
support for general practice is required in pandemic events to enable GPs to 
provide safe and high-quality care; needs for improvement especially concern the 
provision of resources and the communication with public health institutions and 
hospitals.

© The Author(s) 2022. Published by Oxford University Press.

DOI: 10.1093/fampra/cmac025
PMCID: PMC9051582
PMID: 35395089 [Indexed for MEDLINE]


2187. J Am Geriatr Soc. 2022 Jun;70(6):1629-1641. doi: 10.1111/jgs.17808. Epub 2022 
Apr 15.

The effect of COVID-19 pandemic-related financial challenges on mental health 
and well-being among US older adults.

Samuel LJ(1), Dwivedi P(1), Hladek M(1), Cudjoe TKM(2), Drazich BF(1), Li Q(1), 
Szanton SL(1)(3).

Author information:
(1)Johns Hopkins University School of Nursing, Baltimore, Maryland, USA.
(2)Department of Medicine, Division of Division of Geriatric Medicine and 
Gerontology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
(3)Department of Health Policy and Management, Johns Hopkins Bloomberg School of 
Public Health, Baltimore, Maryland, USA.

BACKGROUND: Despite profound financial challenges during the COVID-19 pandemic, 
there is a gap in estimating their effects on mental health and well-being among 
older adults.
METHODS: The National Health and Aging Trends Study is an ongoing nationally 
representative cohort study of US older adults. Outcomes included mental health 
related to COVID-19 (scores averaged across eight items ranging from one to 
four), sleep quality during COVID-19, loneliness during COVID-19, having time to 
yourself during COVID-19, and hopefulness during COVID-19. Exposures included 
income decline during COVID-19 and financial difficulty due to COVID-19. 
Propensity score weighting produced covariate balance for demographic, 
socioeconomic, household, health, and well-being characteristics that preceded 
the pandemic to estimate the average treatment effect. Sampling weights 
accounted for study design and non-response.
RESULTS: In weighted and adjusted analyses (n = 3257), both income decline 
during COVID-19 and financial difficulty due to COVID-19 were associated with 
poorer mental health related to COVID-19 (b = -0.159, p < 0.001 and b = -0.381, 
p < 0.001, respectively), poorer quality sleep (OR = 0.63, 95% CI: 0.46, 0.86 
and OR = 0.42, 95% CI: 0.30, 0.58, respectively), more loneliness (OR = 1.53, 
95% CI: 1.16, 2.02 and OR = 2.72, 95% CI: 1.96, 3.77, respectively), and less 
time to yourself (OR = 0.54, 95% CI: 0.40, 0.72 and OR = 0.37, 95% CI: 0.27, 
0.51, respectively) during COVID-19.
CONCLUSIONS: Pandemic-related financial challenges are associated with worse 
mental health and well-being regardless of pre-pandemic characteristics, 
suggesting that they are distinct social determinants of health for older 
adults. Timely intervention is needed to support older adults experiencing 
pandemic-related financial challenges.

© 2022 The Authors. Journal of the American Geriatrics Society published by 
Wiley Periodicals LLC on behalf of The American Geriatrics Society.

DOI: 10.1111/jgs.17808
PMCID: PMC9115091
PMID: 35393645 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
declare.


2188. BMJ Open. 2022 Apr 7;12(4):e059854. doi: 10.1136/bmjopen-2021-059854.

Understanding engagement with Brown Buttabean Motivation, an Auckland 
grassroots, Pacific-led holistic health programme: a qualitative study.

Savila F(1), Leakehe P(1), Bagg W(2), Harwood M(3), Letele D(4), Bamber A(5), 
Swinburn B(6), Goodyear-Smith F(7).

Author information:
(1)Pacific Health, The University of Auckland, Auckland, New Zealand.
(2)School of Medicine, University of Auckland, Auckland, New Zealand.
(3)General Practice & Primary Health Care, University of Auckland, Auckland, New 
Zealand.
(4)BBM Motivation, Auckland, New Zealand.
(5)BBM, Auckland, New Zealand.
(6)Epidemiology & Biostatistics, The University of Auckland, Auckland, New 
Zealand.
(7)General Practice & Primary Health Care, University of Auckland, Auckland, New 
Zealand f.goodyear-smith@auckland.ac.nz.

OBJECTIVES: The aim was to understand how participants engage with Brown 
Buttabean Motivation (BBM) a grassroots, Pacific-led holistic health programme 
and the meaning it has in their lives. The objectives were to explore the impact 
BBM had on all aspects of their health and well-being, what attracted them, why 
they stayed, identify possible enablers and barriers to engagement, and 
understand impact of COVID-19 restrictions.
DESIGN: Qualitative study with thematic analysis of semi-structured interviews 
of BBM participants, followed by theoretical deductive analysis of coded data 
guided by Pacific Fonofale and Māori Te Whare Tapa Whā health models. In this 
meeting-house metaphor, floor is family, roof is culture, house-posts represent 
physical, mental, spiritual and sociodemographic health and well-being, with 
surroundings of environment, time and context.
SETTING: Interviews of BBM members conducted in South Auckland, New Zealand, 
2020.
PARTICIPANTS: 22 interviewees (50% female) aged 24-60 years of mixed Pacific and 
Māori ethnicities with a mixture of regular members, attendees of the programme 
for those morbidly obese and trainers.
RESULTS: Two researchers independently coded data with adjudication and 
kappa=0.61 between coders. Participants identified the interactive holistic 
nature of health and well-being. As well as physical, mental and spiritual 
benefits, BBM helped many reconnect with both their family and their culture.
CONCLUSIONS: BBM's primary aim is weight-loss motivation. Many weight loss 
studies provide programmes to improve physical exercise and nutrition, but 
seldom address sustainability and other core factors such as mental health. 
Programmes are often designed by researchers or authorities. BBM is a 
community-embedded intervention, with no reliance external authorities for its 
ongoing implementation. It addresses many factors impacting participants' lives 
and social determinants of health as well as its core business of exercise and 
diet change. Our results indicate that BBM's holistic approach and 
responsiveness to perceived community needs may contribute to its sustained 
success.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-059854
PMCID: PMC8990259
PMID: 35393331 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: DL is the Founder and AB is 
the Marketing Communications Associate of BBM Motivation, and both are integral 
members of the research team. WB’s wife is a Pilates instructor at BBM. No other 
authors have any conflict of interest to declare.


2189. BMJ Open. 2022 Apr 7;12(4):e057919. doi: 10.1136/bmjopen-2021-057919.

Enabling work participation for people with musculoskeletal conditions: lessons 
from work changes imposed by COVID-19: a mixed-method study.

Morton L(1)(2)(3), Stelfox K(1)(2)(3), Beasley M(1)(2)(3), Jones GT(1)(2)(3), 
Macfarlane GJ(1)(2)(3), Walker-Bone K(4), Hollick RJ(5)(2)(3).

Author information:
(1)Epidemiology Group, University of Aberdeen School of Medicine Medical 
Sciences and Nutrition, Aberdeen, UK.
(2)Medical Research Council Versus Arthritis Centre for Musculoskeletal Health 
and Work, University of Aberdeen School of Medicine Medical Sciences and 
Nutrition, Aberdeen, UK.
(3)Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology 
Group), University of Aberdeen School of Medicine Medical Sciences and 
Nutrition, Aberdeen, UK.
(4)Medical Research Council Versus Arthritis Centre for Musculoskeletal Health 
and Work, University of Southampton, Southampton, UK.
(5)Epidemiology Group, University of Aberdeen School of Medicine Medical 
Sciences and Nutrition, Aberdeen, UK rhollick@abdn.ac.uk.

OBJECTIVES: To understand what we can learn from the impact of the COVID-19 
pandemic and lockdown about what enables work participation for people with 
inflammatory arthritis and chronic pain conditions.
DESIGN: Qualitative interviews embedded within an observational questionnaire 
study of individuals with musculoskeletal (MSK) conditions.
SETTING: UK primary care (general practices), and secondary care-based 
rheumatology services.
PARTICIPANTS: Individuals with axial spondyloarthritis, psoriatic arthritis and 
MSK pain from three established cohorts completed an online/paper-based 
questionnaire (July-December 2020). A subset of respondents were selected for 
semistructured interviews.
PRIMARY AND SECONDARY OUTCOME MEASURES: The survey quantified the effects of 
lockdown on work circumstances. Qualitative interviews explored the impacts of 
these changes and the advantages and disadvantages of changes in work 
circumstances.
RESULTS: 491 people (52% female, median age 49 years) who were employed at the 
time of lockdown responded to the questionnaire. The qualitative analysis 
included 157 free-text comments on work from the questionnaire and data 
collected within 18 interviews.Participants reported impacts on mental and 
physical health, and significant financial anxieties. The impact of work changes 
varied depending on individual and home circumstances. Some felt forced to 
ignore advice to shield and continue working. The flexibility offered by home 
working and changes in commuting enabled greater physical activity for some, 
while others missed the exercise normally undertaken as part of their commute. 
Others reported a constant need to be 'present' online, which heightened anxiety 
and worsened MSK symptoms.
CONCLUSION: Lockdown showed that flexible working arrangements, which consider 
the positive and negative aspects of commuting, posture, movement, and work 
environment matter for work participation, and can have wider benefits in terms 
of health and well-being for those with long-term MSK conditions. Incorporating 
these into new models of work will help make the workplace more equitable and 
inclusive for people with long-term MSK conditions.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/bmjopen-2021-057919
PMCID: PMC8990257
PMID: 35393323 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2190. Patient Educ Couns. 2022 Jul;105(7):2137-2144. doi: 10.1016/j.pec.2022.03.029. 
Epub 2022 Mar 31.

Managing uncertainty and responding to difficult emotions: Cancer patients' 
perspectives on clinician response during the COVID-19 pandemic.

Street RL Jr(1), Treiman K(2), Wu Q(3), Kranzler EC(4), Moultrie R(2), Mack 
N(2), Garcia R(5).

Author information:
(1)Texas A&M University, USA. Electronic address: r-street@tamu.edu.
(2)RTI International, USA.
(3)Cleveland State University, USA.
(4)Cancer Support Community (Formerly), Currently Fors Marsh Group, USA.
(5)Fight Colorectal Cancer, USA.

OBJECTIVE: Patients undergoing cancer treatment during the COVID-19 pandemic 
have experienced stress and uncertainty with respect to disruptions in cancer 
care and COVID-19 related risks. We examined whether clinicians' responsiveness 
to patients' uncertainty and difficult emotions were associated with better 
health and well-being.
METHODS: Patients were recruited from cancer support communities and a market 
research firm. Respondents assessed clinicians communication that addressed 
uncertainty and difficult emotions. Health status measures included mental and 
physical health, coping during the pandemic, and psychological distress.
RESULTS: 317 respondents participated in the study. Patients' perceptions of 
their clinicians responsiveness to patient uncertainty and negative emotions 
were associated with better mental health, physical health, coping, and less 
psychological distress (all p-values <0.001). Respondents with greater 
self-efficacy and social support also reported better health.
CONCLUSION: Even when controlling for patients' personal and health-related 
characteristics, clinicians' communication addressing patients' uncertainty and 
difficult emotions predicted better health, better coping, and less 
psychological distress. Access to social support and self-efficacy also were 
associated with better health status.
PRACTICE IMPLICATIONS: Clinicians' communication focused on helping with 
uncertainty and difficult emotions is important to cancer patients, especially 
during the pandemic. Clinicians should also direct patients to resources for 
social support and patient empowerment.

Copyright © 2022 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.pec.2022.03.029
PMCID: PMC8968177
PMID: 35393231 [Indexed for MEDLINE]

Conflict of interest statement: The authors report no conflicts of interest.


2191. BMC Public Health. 2022 Apr 7;22(1):674. doi: 10.1186/s12889-022-13031-0.

Teleworking from home experiences during the COVID-19 pandemic among public 
health workers (TelEx COVID-19 study).

Chow JSF(1)(2)(3)(4), Palamidas D(5), Marshall S(5), Loomes W(5), Snook S(5), 
Leon R(5)(6).

Author information:
(1)South Western Sydney Local Health District, 52 Scrivener St, Warwick Farm, 
Sydney, NSW, 2170, Australia. Josephine.Chow@health.nsw.gov.au.
(2)The University of Sydney, Sydney, Australia. 
Josephine.Chow@health.nsw.gov.au.
(3)The University of New South Wales, Sydney, Australia. 
Josephine.Chow@health.nsw.gov.au.
(4)Western Sydney University, Sydney, Australia. 
Josephine.Chow@health.nsw.gov.au.
(5)South Western Sydney Local Health District, 52 Scrivener St, Warwick Farm, 
Sydney, NSW, 2170, Australia.
(6)University of Tasmania, Hobart, Australia.

BACKGROUND: When working from home (WFH) became temporarily necessary for staff 
as a result of the COVID-19 pandemic in 2020, it had to be implemented without 
significant organisational experience or understanding of WFH and its 
complexities. This study aims to determine the impacts experienced by staff who 
have undertaken WFH during the COVID-19 pandemic.
METHODS: This was an observational cross-sectional study using survey with a 
purposive sampling strategy for staff from corporate and non-clinical 
departments. These staff undertook WFH during COVID-19 pandemic in 2020. None of 
these staff had any direct operational roles in a hospital facility and clinical 
service. Participants' self-reports of their mood while working in their normal 
workplace and while WFH were collected via the Scale of Positive and Negative 
Experience (SPANE), a validated affect balance questionnaire. The responses from 
the open-ended question were analysed using thematic analysis approach.
RESULTS: A total of 143 participants completed the survey responses. Majority 
(61%) WFH for four or more months as a result of the COVID-19 pandemic. 
Participants rated their skills very highly on the technologies with an average 
rating of 9 (out of 10) for computer skills, smartphones and 
videoconferencing/teleconferencing applications. Participants felt WFH was an 
improvement on normal working, in particular in relation to their ability to 
concentrate and be productive. The "SPANE" relating to affect balance while WFH 
was completed by 124 participants (85.7%), resulting in a mean score of 5.45 
(S.D. 2.98). The SPANE relating to normal working conditions was completed by 
127 participant (88.8%) resulting in a mean score of 2.70 (S.D 3.69). This 
indicated that while participants' positive emotions typically predominated in 
both situations, they felt slightly more positive on average with WFH. Over 90% 
participants reported that they would take the opportunity to WFH again if it 
were offered. Data obtained from the open-ended questions had complimented the 
findings of the structure close-ended questions in the benefits of remote 
working and support for their health and wellbeing. The open-ended questions had 
provided additional information on challenges which the participants encountered 
during the WFH experience and their suggested preference to sustain this 
workplace practice.
CONCLUSIONS: This study highlighted factors that impacted workers' work 
processes, productivity, physical and mental health well-being while WFH and 
provided a foundation for considering how to best support a positive WFH 
experience.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-13031-0
PMCID: PMC8988115
PMID: 35392859 [Indexed for MEDLINE]

Conflict of interest statement: There was no competing interests.


2192. Workplace Health Saf. 2022 Apr;70(4):180-187. doi: 10.1177/21650799211070733. 
Epub 2022 Apr 7.

A Cross-Sectional Study Analyzing Predictors of Perceived Stress Among 
Elementary School Teachers During the COVID-19 Pandemic.

Parthasarathy N(1), Li F(1), Zhang F(1), Chuang RJ(1), Mathur M(1), Pomeroy 
M(2), Noyola J(2), Markham CM(1), Sharma SV(1).

Author information:
(1)The University of Texas Health Science Center at Houston.
(2)Brighter Bites.

INTRODUCTION: Teaching is a stressful occupation due to high-stake job demands 
and limited resources, which were exacerbated during the initial phase of the 
COVID-19 pandemic. Our study assessed the prevalence of perceived stress and 
explored its predictors among elementary school teachers employed at schools 
serving predominantly low-income populations in five cities in the United 
States.
METHOD: Our study analyzed the data among selected schools that were collected 
through the Brighter Bites teacher survey which comprised items measuring 
sociodemographic characteristics, perceived stress, perceived general health, 
food insecurity, and concerns regarding social determinants of health needs. The 
predictors of perceived stress were examined using generalized linear mixed 
models (GLMMs) with schools as the random variable.
FINDINGS: A total of 685 teachers were included in the analysis (84.9% female, 
38.1% Hispanic, 57.6% <5 years of teaching experience). Most (85.4%) of the 
teachers stated they were stressed "sometimes"/"often." Results from adjusted 
GLMM showed that teachers who were food insecure (adjusted odds ratio [AOR]: 
2.33, confidence interval [CI]: [1.63, 3.35]), those who had concerns regarding 
financial stability (2.68 [1.91, 3.75]), food availability (1.69 [1.15, 2.48]), 
food affordability (2.27 [1.57, 3.28]), availability/affordability of housing 
(2.21 [1.33, 3.67]), access to childcare (1.76 [1.06, 2.92]), and access to a 
clinic/doctor (1.60 [1.10, 2.33]) were at significantly greater odds of 
reporting perceived stress.
CONCLUSION/APPLICATION FOR PRACTICE: Our study demonstrates the heightened 
impact of COVID-19 on the mental well-being of teachers across a wide range of 
social needs. Stress management and additional social service programs are 
suggested to support teachers to mitigate pandemic impact.

DOI: 10.1177/21650799211070733
PMID: 35392748 [Indexed for MEDLINE]


2193. Front Public Health. 2022 Mar 22;10:844947. doi: 10.3389/fpubh.2022.844947. 
eCollection 2022.

Mental Health Factors That Guide Individuals to Engage in Overconsumption 
Behavior During the COVID-19 Pandemic: A Cross-Cultural Study Between USA and 
Ecuador.

Franklin V(1), Cintya L(2)(3), Mariel PYM(4), Pablo DJ(5).

Author information:
(1)Department of Marketing, Universidad San Francisco de Quito USFQ, Quito, 
Ecuador.
(2)Departamento de Economía Cuantitativa, Facultad de Ciencias Escuela 
Politécnica Nacional, Quito, Ecuador.
(3)Institut de Recherche en Gestion et Economie Université de Savoie Mont Blanc 
(IREGE/IAE Savoie Mont Blanc), Annecy, France.
(4)Head of Psychology Department, Director of Mental Health Clinic, Universidad 
San Francisco de Quito USFQ, Quito, Ecuador.
(5)Tenured Lecturer IDEA Research Group, Departamento de Economía Cuantitativa 
Escuela Politécnica Nacional, Quito, Ecuador.

BACKGROUND: This study tests a framework that examines the role of several 
mental health factors (mood, wellbeing, health consciousness, and hoarding) on 
individuals' overconsumption behavior under the novel coronavirus context. This 
examination is relevant to public health literature because it increases our 
knowledge on how the context of COVID-19 pandemic affects people's mental health 
and provides answers to why individuals engage in overconsumption behavior. 
Additionally, this research also follows a cross-cultural perspective aiming to 
understand how individuals from different cultural orientations cope with the 
psychological effects of the COVID-19 pandemic.
METHODS: This is a cross-sectional study that compares samples from two 
countries: Ecuador (n = 334) and USA (n = 321). Data was collected via an online 
survey. The timing of data collection was set during the mandatory lockdowns and 
social distance measures taken by both countries to fight against the COVID-19 
virus breakout. Partial least squares structural equation modeling was used to 
test the theorized framework. Multi-group analysis was used to explore cultural 
orientation differences among the relationships included in the model.
RESULTS: The results indicate that individuals' mood state has a positive 
relationship with health consciousness, as people try to regulate their health 
concerns by maintaining positive perceptions of their subjective wellbeing. 
Further, the increased concern individuals express in their health is 
responsible for them to engage in overconsumption behavior. Cultural orientation 
(individualism vs. collectivism) moderates the relationship between mood and 
health consciousness. No moderation effect was found for the relationship 
between health consciousness and overconsumption.
CONCLUSIONS: The COVID-19 pandemic has generated negative effects in 
individuals' mental health. Findings from this study suggest that maintaining a 
positive mood is important for individuals at the time of mandatory lockdowns, 
and this effort is related to a greater concern and awareness of their health. 
Further, health consciousness is responsible to stimulate overconsumption 
behavior. This chain of effects can be explained by individuals' interest in 
their wellbeing. Culture plays a role in these effects. People from 
individualistic countries (USA) compared to people from collectivistic countries 
(Ecuador) demonstrate greater motivation in maintaining their positive mood by 
showing greater health consciousness.

Copyright © 2022 Franklin, Cintya, Mariel and Pablo.

DOI: 10.3389/fpubh.2022.844947
PMCID: PMC8980352
PMID: 35392477 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2194. Ethiop J Health Sci. 2021 Nov;31(6):1125-1132. doi: 10.4314/ejhs.v31i6.7.

Impact on Mental Health of Families during Covid-19: A Cross-Sectional Survey.

Farooqui SI(1), Khan AA(1), Rizvi J(1), Hassan B(1), Adnan QU(1).

Author information:
(1)Ziauddin College of Rehabilitation Sciences, Ziauddin University.

BACKGROUND: The global pandemic of novel coronavirus outbreaks threatens the 
general public and health care workers' physical, social and mental well-being. 
Therefore, the current study is aimed to highlight the status of mental health 
of families suffering from the COVID-19 pandemic.
METHODS: An online cross-sectional survey was conducted on 560 families through 
Google Form distributed via email, Whatsapp groups, Facebook, and LinkedIn from 
November 2020 to January 2021 during the pandemic period in Karachi through the 
snowball sampling technique. The status of COVID-19 patients was assessed 
through demographics information and contextual factors questions whereas impact 
on mental health was assessed through Depression Anxiety Stress Scale (DASS-21).
RESULTS: A total number of 536 participated in the study. The prevalence of 
depression, anxiety and stress was found to be 38.99%, 26.67%, and 15.48% 
respectively included 31% of males and 69% where the highest number of 
respondents belonged to district Central (37.8%). Chi square estimation was 
found to be significant among both the gender and in between all the age group 
ranges from 20 to 60 years. Moreover, significant association among categorical 
division of demography and DASS-21 p<0.05 was observed.
CONCLUSION: The results of our study indicated high rate of depression and 
anxiety in majority of families; in particular females. Consistent with these 
symptoms, significant association was found between gender and age from high to 
low socioeconomic status.

© 2021 Sumaira I.F., et al.

DOI: 10.4314/ejhs.v31i6.7
PMCID: PMC8968383
PMID: 35392342 [Indexed for MEDLINE]


2195. Am J Orthopsychiatry. 2022;92(3):364-370. doi: 10.1037/ort0000618. Epub 2022 Apr 
7.

Centering mental health in society: A human rights approach to well-being for 
all.

Lomax S(1), Cafaro CL(2), Hassen N(3), Whitlow C(4), Magid K(4), Jaffe G(5).

Author information:
(1)Perelman School of Medicine.
(2)College of Science and Health.
(3)Faculty of Environmental and Urban Change.
(4)Health Psychology Program.
(5)Global Alliance for Behavioral Health and Social Justice.

Applying a human rights lens to mental health and well-being will improve the 
systems that govern and operate U.S. society. Achieving this requires learning 
from successful approaches and scaling up the implementation of effective 
strategies that promote equity by actively addressing determinants and barriers 
across systems that impede overall health. As a country, the U.S. has shown 
significant success in innovation but has failed at taking successful programs 
and initiatives to scale. Having endured over a year of loss in education, 
social connection, and routines, the COVID-19 pandemic illuminated America's 
deeply rooted structural inequities that have worsened population mental health 
and well-being. Integrating mental health into institutions and systems, while 
recovering and rebuilding, must be at the forefront to provide a path for 
transformation. Three recommendations are derived from the strategies and 
initiatives described throughout this article that offer tangible steps for 
achieving wellbeing as a human right: 1. Embed mental health within and across 
all systems, and expand its definition across the continuum; 2. Prioritize 
prevention and health promotion through person-centered and community-driven 
strategies; and 3. Expand the diversification and training of the mental health 
workforce across sectors. The inequities addressed in this article are not the 
products of a global pandemic. Instead, they result from historical oppression, 
injustice, and inaction, exacerbated by the current context. Embedding a human 
rights approach to mental health in the United States is fundamental to 
individual and community well-being. (PsycInfo Database Record (c) 2022 APA, all 
rights reserved).

DOI: 10.1037/ort0000618
PMID: 35389744 [Indexed for MEDLINE]


2196. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2022 Feb;34(2):194-197. doi: 
10.3760/cma.j.cn121430-20210525-00779.

[Research progress of sepsis associated encephalopathy influenced by gut 
microbiota via efferocytosis].

[Article in Chinese]

Liao H(1), Li H, Si Y, Bao H.

Author information:
(1)Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical 
University, Nanjing 210006, Jiangsu, China. Corresponding author: Bao Hongguang, 
Email: hongguang_bao@163.com.

Sepsis associated encephalopathy (SAE) is a severe disease secondary to sepsis, 
which is associated with increased mortality and causes long-term cognitive 
deficits in survivors. Recently, an increasing body of evidence has shown that 
gut microbiota is closely related to the central nervous system, and could 
influence brain function via microbiota-gut-brain axis. Therefore, in the 
occurrence and development of SAE, cholinergic anti-inflammatory pathway is one 
of the mechanisms by which gut microbiota could improve cognitive function. 
Efferocytosis, a process of eliminating apoptotic cells in the body, has 
anti-inflammatory effects and provides organ protection in sepsis. On the other 
hand, it could be enhanced by some metabolites of gut microbiota, making it 
another potential mechanism for gut microbiota regulating SAE. This review 
summarizes the mutual regulation of gut microbiota, efferocytosis and SAE, to 
explore potential mechanisms and therapeutic targets of SAE.

DOI: 10.3760/cma.j.cn121430-20210525-00779
PMID: 35387729 [Indexed for MEDLINE]


2197. BMC Geriatr. 2022 Apr 6;22(1):287. doi: 10.1186/s12877-022-02984-x.

Rural-urban differences in food insecurity and associated cognitive impairment 
among older adults: findings from a nationally representative survey.

Srivastava S(1), Muhammad T(2).

Author information:
(1)International Institute for Population Sciences, Mumbai, Maharashtra, 400088, 
India.
(2)International Institute for Population Sciences, Mumbai, Maharashtra, 400088, 
India. muhammad.iips@gmail.com.

INTRODUCTION: Due to rapid urbanization, Covid-19 pandemic and increasing food 
prices, a higher rate of food insecurity has been observed in recent years in 
India. Thus, we aim to study the prevalence of food insecurity among older 
Indian adults and the association of food insecurity as a modifiable risk factor 
with late-life cognitive impairment.
METHOD: Data for this study were obtained from the recent release of the 
Longitudinal Ageing Study in India (2017-18). The total sample size for the 
study was 31,464 older adults aged 60 years and above. Cognitive functioning was 
measured through five broad domains (memory, orientation, arithmetic function, 
executive function, and object naming) adapted from the cognitive module of the 
US Health and Retirement Study (HRS). Descriptive statistics along with 
cross-tabulation were presented in the study. Additionally, multivariable 
logistic regression analysis was used to fulfil the objectives of the study.
RESULTS: It was found that 7.7% of older adults in rural areas reduced their 
size of meals due to unavailability (urban, 3.2%), 41.2% of them did not eat 
enough food of their choice (urban, 38.3%), 6.9% were hungry but did not eat 
food (urban, 2.6%), 5.0% did not eat for whole day (urban, 2.2%), and 6.9% lost 
weight due to lack of food in their household (urban, 2.9%). It was found that 
older adults who did not have enough food of their choice had significantly 
higher odds [AOR: 1.24; CI: 1.14, 1.35] of suffering from cognitive impairment 
in reference to their counterparts. Similarly, the older adults who were hungry 
but did not eat were 30% [AOR: 1.30; CI: 1.02, 1.73] more likely to suffer from 
cognitive impairment in reference to their counterparts. Interaction model 
revealed that older adults who had food insecurity in rural areas had higher 
odds of cognitive impairment than older adults who had food insecurity in urban 
areas.
CONCLUSION: The findings of the study highlight that the food security status in 
older adults may bring about greater challenges due to their limited economic 
resources. Interventions focusing on food security may have unintended positive 
impacts on late-life mental wellbeing as the older age is associated with higher 
cognitive deficits.

© 2022. The Author(s).

DOI: 10.1186/s12877-022-02984-x
PMCID: PMC8985064
PMID: 35387591 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that there is no competing 
interest


2198. Brain Behav. 2022 May;12(5):e2559. doi: 10.1002/brb3.2559. Epub 2022 Apr 6.

The COVID-19 pandemic impact on wellbeing and mental health in people with 
psychotic and bipolar disorders.

Barrett EA(1), Simonsen C(1), Aminoff SR(1)(2), Hegelstad WTV(3)(4), Lagerberg 
TV(5), Melle I(2)(5), Mork E(1), Romm KL(1)(2).

Author information:
(1)Early Intervention in Psychosis Advisory Unit for South East Norway (TIPS 
Sør-Øst), Division of Mental Health and Addiction, Oslo University Hospital, 
Oslo, Norway.
(2)Norwegian Centre for Mental Disorders Research (NORMENT), Institute of 
Clinical Medicine, University of Oslo, Oslo, Norway.
(3)TIPS Centre for Clinical Research in Psychosis, Stavanger University 
Hospital, Stavanger, Norway.
(4)Institute of Social Studies, Faculty of Social Sciences, University of 
Stavanger, Stavanger, Norway.
(5)Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental 
Health and Addiction, Oslo University Hospital, Oslo, Norway.

INTRODUCTION: The COVID-19 pandemic affects people globally, but it may affect 
people with psychotic and bipolar disorders disproportionally. Our aims were to 
investigate the pandemic impact on perceived wellbeing and mental health in this 
population, including which pandemic-related factors have had an impact.
METHODS: People with psychotic and bipolar disorders (N = 520; female = 81%; 
psychotic disorders n = 75/bipolar disorder n = 445) completed an online survey 
about wellbeing and mental health in the early phase of the COVID-19 pandemic 
(June 5-July 5, 2020).
RESULTS: Many participants experienced deteriorated wellbeing and mental health 
after the pandemic outbreak, especially in life satisfaction, meaning in life, 
positive feelings, depression, anxiety, and self-harm/suicidal ideation. 
Experienced recovery from mental health difficulties was significantly lower 
after compared to before the outbreak. Participants with psychotic disorders had 
significantly poorer wellbeing and mental health than participants with bipolar 
disorders, although they experienced significantly more worsening only of 
psychotic symptoms. Nearly half the participants reported coping with the 
situation; however, most factors potentially important to wellbeing and mental 
health changed adversely, including sufficiency and quality of treatment. More 
loneliness, low coping, insufficient mental health treatment during the COVID-19 
pandemic, pandemic worry, more insomnia symptoms, and increased alcohol use 
predicted poor wellbeing and poor mental health.
CONCLUSIONS: During a pandemic, it is particularly important that mental health 
services strive to offer the best possible treatment under the current 
conditions and target loneliness, coping strategies, pandemic worry, insomnia, 
and increased alcohol use to uphold wellbeing and reduce mental health 
difficulties. For some, teletherapy is an agreeable substitute for traditional 
therapy.

© 2022 The Authors. Brain and Behavior published by Wiley Periodicals LLC.

DOI: 10.1002/brb3.2559
PMCID: PMC9110908
PMID: 35385888 [Indexed for MEDLINE]


2199. Expert Rev Respir Med. 2022 May;16(5):595-600. doi: 
10.1080/17476348.2022.2063843. Epub 2022 Apr 18.

COVID-19 patients require multi-disciplinary rehabilitation approaches to 
address persisting symptom profiles and restore pre-COVID quality of life.

Faghy MA(1)(2)(3)(4), Maden-Wilkinson T(2)(4), Arena R(3)(4), Copeland RJ(2)(4), 
Owen R(1), Hodgkins H(5), Willmott A(5).

Author information:
(1)School of Human Sciences, Human Sciences Research Centre, University of 
Derby, Derby, UK.
(2)Research and Innovation for Post Covid-19 Rehabilitation (Ricovr), Advanced 
Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK.
(3)Department of Physical Therapy, College of Applied Sciences, University of 
Illinois at Chicago, Chicago, IL.
(4)Healthy Living for Pandemic Event Protection (Hl - Pivot) Network, Chicago, 
IL.
(5)Cambridge Centre for Sport and Exercise Sciences (Ccses), School of 
Psychology and Sport Science, Anglia Ruskin University, Cambridge, UK.

BACKGROUND: Long-COVID diagnosis is prominent, and our attention must support 
those experiencing debilitating and long-standing symptoms. To establish patient 
pathways, we must consider the societal and economic impacts of sustained 
COVID-19. Accordingly, we sought to determine the pertinent areas impacting 
quality of life (QoL) following a COVID-19 infection.
RESEARCH METHODS: Three hundred and eighty-one participants completed a 
web-based survey (83% female, 17% male) consisting of 70 questions across 7 
sections (demographics, COVID-19 symptoms; QoL; sleep quality; breathlessness; 
physical activity and mental health). Mean age, height, body mass and body mass 
index (BMI) were 42 ± 12 years, 167.6 ± 10.4 cm, 81.2 ± 22.2 kg, and 
29.1 ± 8.4 kg.m2, respectively.
RESULTS: Participant health was reduced because of COVID-19 symptoms ('Good 
health' to 'Poor health' [P < 0.001]). Survey respondents who work reported 
ongoing issues with performing moderate (83%) and vigorous (79%) work-related 
activities.
CONCLUSIONS: COVID-19 patients report reduced capacity to participate in 
activities associated with daily life, including employment activities. Bespoke 
COVID-19 support pathways must consider multi-disciplinary approaches that 
address the holistic needs of patients to restore pre-pandemic quality of life 
and address experienced health and wellbeing challenges.Plain Language Summary: 
The long-term impact of long-COVID has a dramatic impact upon daily activities 
and lifestyle. The development of bespoke support pathways to support patients 
must address the physical and psychological considerations to adequately restore 
pre-COVID quality of life and address broader societal and economic 
implications, especially for those that are of working age.

DOI: 10.1080/17476348.2022.2063843
PMID: 35385677 [Indexed for MEDLINE]


2200. PLoS One. 2022 Apr 6;17(4):e0266612. doi: 10.1371/journal.pone.0266612. 
eCollection 2022.

Psychological distress and well-being among students of health disciplines in 
Geneva, Switzerland: The importance of academic satisfaction in the context of 
academic year-end and COVID-19 stress on their learning experience.

Tran NT(1)(2), Franzen J(3), Jermann F(4), Rudaz S(5), Bondolfi G(4), Ghisletta 
P(6)(7)(8).

Author information:
(1)Faculty of Medicine, University of Geneva, Geneva, Switzerland.
(2)Australian Centre for Public and Population Health Research, Faculty of 
Health, University of Technology Sydney, Sydney, NSW, Australia.
(3)School of Health Sciences, Geneva HES-SO, University of Applied Sciences and 
Arts Western Switzerland, Geneva, Switzerland.
(4)Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland.
(5)School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.
(6)Faculty of Psychology, University of Geneva, Geneva, Switzerland.
(7)Faculty of Psychology, UniDistance Suisse, Brig, Switzerland.
(8)Swiss National Centre of Competence in Research LIVES, University of Geneva, 
Geneva, Switzerland.

INTRODUCTION: University students' psychological health is linked to their 
academic satisfaction. This study aimed to investigate students' psychological 
health and academic satisfaction in the context of COVID-19 and academic 
year-end stress.
MATERIALS AND METHODS: Standardized self-filled scales for anxiety, depression, 
stress, psychological well-being, academic satisfaction (subjective assessment 
of students' quality of life in their educational setting), and an ad-hoc scale 
for stress on the learning experience due to COVID-19 were used in this 
cross-sectional study. Participants were first- to third-year students of eight 
different health-related tracks in Geneva, Switzerland. Descriptive statistics 
and hierarchical regression analyses were applied.
RESULTS: In June 2020, out of 2835 invited students, 433 (15%) completed the 
survey. Academic satisfaction was a stronger mental health predictor than 
COVID-19 stress on the learning experience, which mainly predicted stress and 
anxiety. Lower academic satisfaction scores were significantly associated with 
stress (β = -0.53, p < 0.001), depression (β = -0.26, p < 0.001), anxiety (β = 
-0.20, p < 0.001), while higher scores with psychological well-being (β = 0.48, 
p < 0.001). Identifying as female was strongly associated with anxiety and 
stress but not with depression or psychological well-being. Lower age was 
associated with stress only. The nature of the academic training had a lesser 
impact on mental health and the academic year had no impact.
CONCLUSIONS: Academic satisfaction plays a more substantial role than COVID-19 
stress on the learning experience in predicting students' overall mental health 
status. Training institutions should address the underlying factors that can 
enhance students' academic satisfaction, especially during the COVID-19 period, 
in addition to ensuring that they have a continuous and adequate learning 
experience, as well as access to psychosocial services that help them cope with 
mental distress and enhance their psychological well-being.

DOI: 10.1371/journal.pone.0266612
PMCID: PMC8985938
PMID: 35385555 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2201. J Nurs Educ. 2022 Apr;61(4):217-220. doi: 10.3928/01484834-20220209-07. Epub 
2022 Apr 1.

Innovative Management of Nursing Student COVID-19 Cases and High-Risk Exposures.

Gedney-Lose A, Daack-Hirsch S, Nicholson A.

BACKGROUND: The novel coronavirus disease 2019 (COVID-19) pandemic created 
significant disruption in higher education, especially in health science 
colleges where in-person and hands-on patient-facing learning environments are 
essential. Student monitoring and follow-up was an essential aspect of in-person 
learning for the fall 2020 semester.
METHOD: Senior leaders and faculty in a college of nursing developed and 
implemented an innovative college-based COVID-19 management system to ensure 
real-time response to prolonged pandemic-related student absences.
RESULTS: Decisions made from this management system allowed leaders within the 
college to implement programmatic changes to ensure student and faculty 
well-being. Furthermore, the COVID-19 management system allowed for close 
student follow-up through phone calls with a faculty member to ensure student 
well-being.
CONCLUSION: Monitoring helped ensure appropriate physical and mental health 
services were accessible to students undergoing quarantine or self-isolation 
while also fostering positive student satisfaction throughout their prolonged 
absences. [J Nurs Educ. 2022;61(4):217-220.].

DOI: 10.3928/01484834-20220209-07
PMID: 35384764 [Indexed for MEDLINE]


2202. S Afr Fam Pract (2004). 2022 Mar 29;64(1):e1-e9. doi: 10.4102/safp.v64i1.5428.

Challenges faced by healthcare workers at a central hospital in Zimbabwe after 
contracting COVID-19: An interpretive phenomenological analysis study.

Moyo I(1), Ndou-Mammbona AA, Mavhandu-Mudzusi AH.

Author information:
(1)HIV Services, Population Services International Zimbabwe, Harare, Zimbabwe; 
and, Department Health Sciences, College of Human Sciences, University of South 
Africa, Pretoria. idahbandamoyo@gmail.com.

BACKGROUND: Healthcare workers play a critical role in the delivery of 
healthcare services. Because of the high risk of exposure to healthcare workers, 
the emergence of coronavirus disease 2019 (COVID-19) has had a significant 
impact as they struggled to contain the pandemic. The purpose of this study was 
to explore and describe the challenges they faced after contracting COVID-19.
METHODS: An interpretative phenomenological analysis (IPA) design was employed 
to gain insight into the lived experiences of healthcare workers who contracted 
COVID-19 in the course of their duties. This study involved participants who 
were healthcare workers based at a central hospital in Bulawayo, Zimbabwe. Data 
were collected through in-depth interviews that were audio recorded. A sample 
size of ten was reached based on data saturation.
RESULTS: The study showed that healthcare workers lacked psychosocial support, 
experienced economic challenges as they incurred diagnostic and treatment costs. 
The study also found that the healthcare workers experienced stigma and 
discrimination both at work and in the community. Findings also indicate that 
healthcare workers did not receive institutional support. The study demonstrated 
lack of preparedness at the institution evidenced by inadequate testing for 
COVID-19 and shortage of personal protective equipment.
CONCLUSION: This study's findings will be critical for health authorities, 
programmers and policymakers to facilitate planning and preparedness for 
pandemics. The researchers recommend setting up a differentiated service 
delivery support system for healthcare workers to cater for their mental health 
and well-being and that of their families.

DOI: 10.4102/safp.v64i1.5428
PMCID: PMC8990508
PMID: 35384678 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no financial 
or personal relationships that may have inappropriately influenced them in 
writing this article.


2203. Appl Psychol Health Well Being. 2022 Aug;14(3):937-948. doi: 10.1111/aphw.12359. 
Epub 2022 Apr 5.

The impact of a gratitude intervention on mental well-being during COVID-19: A 
quasi-experimental study of university students.

Geier MT(1), Morris J(1).

Author information:
(1)Wingate University, Wingate, North Carolina, USA.

Previous research suggest that gratitude interventions are effective in 
improving mental well-being, which might be beneficial to university students 
during the COVID-19 pandemic. This quasi-experimental study sought to 
investigate if a gratitude intervention will lead to higher mental well-being of 
university students during the COVID-19 pandemic. Participants (N = 47) mental 
well-being was assessed before and after 10 weekly gratitude reflection journals 
and statistically compared with a control group (N = 40). An analysis of 
covariance (ANCOVA) was used to analyze the data. The treatment group showed 
significantly higher well-being after the gratitude intervention compared with 
the control group (Cohen's d = 0.74). The treatment group significantly 
increased (Cohen's d = 0.35) and the control group significantly decreased 
(Cohen's d = -0.41). Gratitude interventions may be effective in improving the 
mental well-being of university students even during a crisis such as the 
COVID-19 pandemic. Gratitude interventions seem suitable for improving mental 
well-being for temporary mental challenges of university students such as a 
pandemic or other forms of crisis.

© 2022 The Authors. Applied Psychology: Health and Well-Being published by John 
Wiley & Sons Ltd on behalf of International Association of Applied Psychology.

DOI: 10.1111/aphw.12359
PMCID: PMC9111205
PMID: 35384320 [Indexed for MEDLINE]

Conflict of interest statement: There is no conflict of interest.


2204. Qual Manag Health Care. 2022 Jul-Sep 01;31(3):143-148. doi: 
10.1097/QMH.0000000000000337. Epub 2022 Apr 4.

The Effects of Empowerment on Health Care Worker Performance During the COVID-19 
Pandemic in Saudi Arabia.

Alrige M(1), Alshahrani F, Alharbi A, Aljuhani N, Aldini N.

Author information:
(1)Information System Department, Faculty of Computing and Information 
Technology, King Abdulaziz University, Jeddah, Saudi Arabia.

BACKGROUND AND OBJECTIVES: In this study, we assessed the potential impact of 
employee empowerment on health care workers' performance during the novel 
coronavirus SARS-CoV-2 (COVID-19) pandemic. In particular, we aimed to determine 
the empowerment practices that would have the greatest positive effect on 
employee performance. Understanding the relationship between performance and 
empowerment can help health care providers better manage worker stress during 
any global crisis. This understanding is crucial in guiding policies and 
interventions aimed at maintaining health care workers' psychological well-being 
and their overall performance.
METHODS: This cross-sectional study evaluated the relationship between employee 
empowerment and performance, determining the best empowerment practices for 
health care leaders to utilize. Frontline health care workers (n = 100) selected 
using convenience and snowball sampling completed the survey between March 15 
and 31, 2020. This is the period when the pandemic just started to accelerate in 
Saudi Arabia. We conducted Pearson's correlation analysis to assess whether 
there was a relationship between performance and health care workers' 
empowerment practice, and stepwise linear regression analysis to investigate the 
impact each of these empowerment practices on health care workers' performance.
RESULTS: Our results indicate that health care workers' performance can be 
expected to increase the most through 2 empowerment practices: giving employees 
the discretion to change work processes and offering performance-based rewards 
(R2 = 0.301, P < .05).
CONCLUSION: Our findings suggest that health care leaders must invest in these 2 
practices to better equip frontline health care workers. During a global crisis, 
additional discretion granted to employees helps reduce their anxiety and 
burnout and hence empowers them with the flexibility to adapt to unforeseen 
circumstances and improve the quality of their interactions with health service 
recipients.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/QMH.0000000000000337
PMCID: PMC9208740
PMID: 35383712 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


2205. Med Princ Pract. 2022;31(3):224-230. doi: 10.1159/000524436. Epub 2022 Apr 5.

The Impact of the COVID-19 Pandemic on Surgeons' and Surgical Residents' 
Caseload, Surgical Skills, and Mental Health in Kuwait.

Alsafran S(1), Albloushi D(2), Quttaineh D(2), Alfawaz AA(1), Alkhamis A(1), 
Alkhayat A(2), Alsejari M(3), Alsabah S(1).

Author information:
(1)Department of Surgery, Kuwait University, Kuwait City, Kuwait.
(2)Department of Surgery, Mubarak Al Kabeer Hospital, Jabriya, Kuwait.
(3)Department of Sociology and Social Work, College of Science, Kuwait 
University, Kuwait City, Kuwait.

INTRODUCTION: The onset of the COVID-19 pandemic resulted in governments 
implementing new regulations to divert healthcare resources, which in return led 
to the postponement of elective and semi-elective surgical procedures. 
Therefore, many surgeons and as well as surgeons in training reported feeling 
redundant, which eventually resulted in psychological distress. This study aimed 
to assess the sociodemographic differences in the psychological impact resulting 
from the COVID-19 pandemic and outline the effect it had on surgical training.
METHODS: This is a cross-sectional study conducted in Kuwait. Data were 
collected by distributing a questionnaire electronically to surgeons and 
surgeons in training. The survey included questions aimed at assessing both the 
effect of the pandemic on surgical training and the psychological impact it had 
on surgeons, assessing the latter using the Depression, Anxiety and Stress 
Scale-21 screening tool.
RESULTS: The response rate for the study was 52%, with the majority being junior 
male surgeons. A majority of surgeons in training reported postponement of their 
scheduled academic teaching sessions (78.9%) and pre-assigned surgical rotations 
(65.8%). In terms of the psychological impact of the pandemic, a majority of the 
participants reported an element of depression and stress, 61.2% and 55%, 
respectively, while approximately half, 48.1%, had symptoms associated with 
anxiety.
CONCLUSION: The COVID-19 pandemic had a negative association with the 
psychological well-being of a significant proportion of surgeons and associated 
surgical training programs.

© 2022 The Author(s). Published by S. Karger AG, Basel.

DOI: 10.1159/000524436
PMCID: PMC9148889
PMID: 35381595 [Indexed for MEDLINE]

Conflict of interest statement: All the authors declare that there was no 
conflict of interest.


2206. J Am Board Fam Med. 2022 Mar-Apr;35(2):284-294. doi: 
10.3122/jabfm.2022.02.210272.

Hospital-Based Healthcare Worker Perceptions of Personal Risk Related to 
COVID-19: One Year Follow-Up.

Yamane D(1), Zarabian K(1), Devine K(1), Benjenk I(1), Farrar K(1), Park OL(1), 
Kim J(1), Davison D(1), Heinz E(2).

Author information:
(1)From the George Washington University Hospital (JK), Department of 
Anesthesiology and Critical Care (DY, IB, DD, EH), Department of Emergency 
Medicine (DY, OWP); The George Washington University School of Medicine and 
Health Sciences (KZ), School of Engineering and Applies Sciences (KD).
(2)From the George Washington University Hospital (JK), Department of 
Anesthesiology and Critical Care (DY, IB, DD, EH), Department of Emergency 
Medicine (DY, OWP); The George Washington University School of Medicine and 
Health Sciences (KZ), School of Engineering and Applies Sciences (KD). 
eheinz@mfa.gwu.edu.

BACKGROUND: The COVID-19 pandemic has significantly impacted health care workers 
(HCW). Most research focused on the adverse mental health effects during the 
initial surge of cases; and yet little is known about approximately how workers 
are faring 1 year into the pandemic. The objective of this study is to examine 
stress, burnout, and risk perception in an academic medical system, 1 year after 
the start of the pandemic.
METHODS: HCW across care specialties participated in online surveys in Spring 
2020 and Spring 2021. The surveys included questions related to workplace stress 
and risk perception related to COVID-19. Correlates of stress and burnout were 
explored using multivariable linear regression models. Professional Quality of 
Life Scale (PROQOL) questions were added to the second survey.
RESULTS: While HCW reported significantly fewer concerns about the risk of 
COVID-19 transmission to themselves and their families during the 2021 survey 
(compared with 2020), the percentage of workers who reported feeling excess 
stress at work or considered resigning stayed the same. One year into the 
pandemic, 57% of study participants met criteria for moderate or high levels of 
traumatic stress and 75% met criteria for moderate or high levels of burnout. As 
compared with participants who cared for no COVID-19 deaths, participants who 
cared for COVID-19 patients who died had significantly higher traumatic stress 
(1 to 10: Coef. = 2.7, P = .007; >10: Coef. = 6.7, P < .001) and burnout scores 
(1 to 10: Coef. = 2.7, P = .004; >10: Coef. = 2.6, P = .036).
CONCLUSION: While Although perceptions of risk declined over the course of the 
year, levels of stress still remained high despite high vaccination rates. Those 
who witnessed more COVID-19 deaths were more likely to report increased burnout 
and post-traumatic stress. As our nation continues to grapple with the COVID-19 
pandemic and new variants emerge it is imperative to focus on recovery 
strategies for high burnout groups to ensure the wellbeing of our health care 
workforce.

© Copyright 2022 by the American Board of Family Medicine.

DOI: 10.3122/jabfm.2022.02.210272
PMID: 35379716 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest: To the best of our 
knowledge, the named authors have no conflict of interest, financial or 
otherwise.


2207. BMC Psychol. 2022 Apr 4;10(1):88. doi: 10.1186/s40359-022-00793-w.

Development and validation of COVID-19 Impact Scale.

Min H(1), Kim J(2), Moon K(2), Lee S(1), Kim JY(3), Ko YG(4).

Author information:
(1)School of Psychology, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul, 
02841, Republic of Korea.
(2)Office of Digital Information, Korea University, Seoul, Republic of Korea.
(3)Department of Child Studies, Seoul Women's University, Seoul, Republic of 
Korea.
(4)School of Psychology, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul, 
02841, Republic of Korea. elip@korea.ac.kr.

BACKGROUND: As the COVID-19 (Coronavirus disease 2019) pandemic is prolonged, 
psychological responses to the pandemic have changed, and a new scale to reflect 
these changes needs to be developed. In this study, we attempt to develop and 
validate the COVID-19 Impact Scale (CIS) to measure the psychological stress 
responses of the COVID-19 pandemic, including emotional responses and difficulty 
with activities of daily living.
METHODS: We recruited 2152 participants. Participants completed the CIS, the 
Fear of COVID-19 Scale (FCV-19S), and other mental health related measures. The 
factor structure, reliability, and validity of the CIS were analyzed. In 
addition, the validity of the scale was confirmed by its relationships to the 
existing measures assessing fear of COVID-19, depression, anxiety, subjective 
well-being, and suicidal ideation.
RESULTS: Using exploratory factor analysis (N1 = 1076), we derived a one-factor 
structure. In confirmatory factor analysis (N2 = 1076), the one-factor model 
showed good to excellent fitness. The CIS was positively correlated with 
depression, anxiety, suicidal ideation, fear of COVID-19 and negatively 
correlated with subjective well-being. The FCV-19S did not show significant 
correlations with subjective well-being or suicidal ideation, and FCV-19S's 
explanatory powers on depression and anxiety were lower than those of the CIS.
CONCLUSIONS: These results support that the CIS is a valid assessment of 
emotional problems and deterioration of the quality of life caused by the 
COVID-19 pandemic. Finally, the limitations of this study and future research 
directions are discussed.

© 2022. The Author(s).

DOI: 10.1186/s40359-022-00793-w
PMCID: PMC8978488
PMID: 35379349 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no relevant financial or 
non-financial interests to disclose.


2208. Res Aging. 2023 Feb;45(2):133-148. doi: 10.1177/01640275221078959. Epub 2022 Apr 
5.

Political Trust, Mental Health, and the Coronavirus Pandemic: A Cross-National 
Study.

Choi KW(1), Jung JH(2), Kim HH(3).

Author information:
(1)Department of Sociology, 124044University of Chicago, Chicago, IL, USA.
(2)Department of Sociology, Sungkyunkwan University, Seoul, Republic of Korea.
(3)Department of Sociology, 26717Ewha Womans University, Seoul, Republic of 
Korea.

Objectives: We investigate whether older adults who place greater trust in their 
political leadership fare better in terms of mental wellbeing during the 
COVID-19 pandemic. We also test if and how the trust-wellbeing relationship 
varies across individual- and country-level moderators. Methods: Based on 
cross-national data consisting of over 13,000 older adults in 66 countries, we 
estimate a series of multilevel models. Results: Within countries, political 
trust is significantly negatively associated with depressive symptoms. And this 
association is stronger for those who are subjectively less healthy. Between 
countries, the trust-depression link at the individual level is stronger in more 
"fragile" states. These findings are robust to a host of confounders including 
the experienced level of anxiety stemming from COVID-19. Discussion: During the 
novel coronavirus pandemic, political trust provides a significant mental health 
buffer for older adults. This protective role varies partly as a function of 
individual and contextual vulnerability.

DOI: 10.1177/01640275221078959
PMID: 35379034 [Indexed for MEDLINE]


2209. Yale J Biol Med. 2022 Mar 31;95(1):165-170. eCollection 2022 Mar.

In Times of Adversity: A Neuroscience Perspective on Stress, Health, and 
Implications for Society Post-pandemic.

Johnson S(1).

Author information:
(1)University of Toronto, Toronto, Ontario, Canada.

The relationship between chronic stress and chronic disease (including mental 
illness) is well established: HPA-axis hyperactivity leads to hormonal 
dysregulation of primary mediators (eg, glucocorticoids, cytokines, etc.), 
allostatic overload, and neurological degradation, followed by clinical 
manifestations of disease. Amid the largest public health crisis of the century 
lay a myriad of challenges pushing people beyond their limit. From experiencing 
loss of connection or dealing with loss of life to financial shocks of COVID-19 
lockdowns or infection by the SARS-CoV-2 virus, stress is at an all-time high, 
threatening both brain and mental health at scale. Fortunately, there is a way 
forward: the neuroscience of resilience teaches us that it is possible to 
resist, recover, and redirect the brain from trauma to re-establish balance in 
the body and improve well-being. At the same time, health follows a social 
gradient: adverse and protective psychosocial factors are shaped by wider social 
and economic determinants of health. This paper argues the neurobiology of 
stress is not separate from health disparities linked to adverse factors (ie, 
stress) created by complex social and economic contexts. Therefore, the field of 
neuroscience is challenged to inform multi-context and multi-level approaches 
and engage with decision-makers to enact policies and interventions aimed at 
promoting the resilient element in a wider population health context. 
Undoubtedly, achieving such a goal for current and future generations to benefit 
and lead healthier lives requires a heroic effort from all key stakeholders. The 
cost of willful neglect to resolve these issues is too expensive.

Copyright ©2022, Yale Journal of Biology and Medicine.

PMCID: PMC8961708
PMID: 35370488 [Indexed for MEDLINE]


2210. J Sex Med. 2022 Jun;19(6):907-922. doi: 10.1016/j.jsxm.2022.02.025. Epub 2022 
Mar 7.

The Impact of the COVID-19 Pandemic on Sexual Health in Cis Women Living in 
Germany.

Batz F(1), Lermer E(2), Hatzler L(3), Vilsmaier T(1), Schröder L(1), 
Chelariu-Raicu A(1), Behr J(4), Mahner S(1), Buspavanich P(5), Thaler CJ(1).

Author information:
(1)Department of Obstetrics and Gynecology and Center for Gynecological 
Endocrinology and Reproductive Medicine, University Hospital, LMU Munich, 
Germany.
(2)Center for Leadership and People Management, LMU Munich, Germany; Applied 
Business and Media Psychology - Ansbach University of Applied Sciences, Ansbach, 
Germany.
(3)Institute of Sexology and Sexual Medicine, Charité - Universitätsmedizin 
Berlin, Berlin, Germany; Department of Gynecology and Breast Center, Charité - 
Universitätsmedizin Berlin, Berlin, Germany.
(4)Research Department of Experimental and Molecular Psychiatry, Department of 
Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, 
Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, Brandenburg 
Medical School Theodor Fontane, Neuruppin, Germany; Faculty of Health Sciences 
Brandenburg, Joint Faculty of the University of Potsdam, Brandenburg University 
of Technology Cottbus-Senftenberg and Brandenburg Medical School, Potsdam, 
Germany.
(5)Institute of Sexology and Sexual Medicine, Charité - Universitätsmedizin 
Berlin, Berlin, Germany; Department of Psychiatry, Psychotherapy and 
Psychosomatics, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany; 
Faculty of Health Sciences Brandenburg, Joint Faculty of the University of 
Potsdam, Brandenburg University of Technology Cottbus-Senftenberg and 
Brandenburg Medical School, Potsdam, Germany; Department of Psychiatry and 
Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany; Institute 
Gender in Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany. 
Electronic address: pichit.buspavanich@charite.de.

BACKGROUND: Preliminary research shows a substantial impact of the COVID-19 
pandemic on women's sexual health, whereby empirical work on sexual well-being 
of minoritized sexual identities is still rare.
AIM: The objective of this study was to explore sexual health in heterosexual, 
lesbian and bisexual cis women during the first wave of COVID-19 pandemic in 
Germany.
METHODS: An anonymous nationwide online survey was conducted among cis women 
during the first nationwide lockdown in Germany from April 20th to July 20th, 
2020. The questionnaire was distributed via e-mail, online chats and 
social-media platforms.
OUTCOMES: Demographic variables and self-report measures from the Sexual 
Behavior Questionnaire (SBQ-G) "before the pandemic" and "since the pandemic" 
were collected.
RESULTS: A total of 1,368 cis women participants were included: heterosexual 
women (n = 844), lesbian women (n = 293), bisexual women (n = 231). Results 
indicate overall decrease in frequency of sexual contacts and masturbation 
during the COVID-19 pandemic. Regarding differences before and during the 
pandemic lesbian women showed significant changes in sexual arousal whereas 
heterosexual women showed significant changes in all dimensions except 
capability to enjoy sexual intercourse. The data of bisexual women showed 
significant changes in almost all dimensions except for frequency of sexual 
intercourse and sexual arousal. Results of the multiple regression analysis 
revealed that being younger than 36 years-old, and being in a relationship as 
well as being heterosexual (compared with being lesbian) is positively 
associated with general satisfaction with sexual life during the pandemic.
CLINICAL IMPLICATIONS: The findings suggest that during a pandemic sexual and 
mental health care for (cis) women should be provided and address the specific 
needs of sexual minority groups.
STRENGTHS & LIMITATIONS: This is the first study to describe sexual behavior in 
heterosexual, lesbian and bisexual women during the COVID-19 pandemic in 
Germany. Limitations, however, include the fact that the data described were 
obtained at only one time point so there is a possibility of recall bias, and 
that the results cannot be generalized because of the underrepresentation of 
women over age 46.
CONCLUSION: This study examined the impact of the COVID-19 pandemic and 
resulting social constraints on the sexual health of particular groups of 
lesbian and bisexual women, which may improve preparedness for future public 
health and policy crises. Batz F, Lermer E, Hatzler L, et al. The Impact of the 
COVID-19 Pandemic on Sexual Health in Cis Women Living in Germany. J Sex Med 
2022;19:907-922.

Copyright © 2022 International Society for Sexual Medicine. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jsxm.2022.02.025
PMCID: PMC8898699
PMID: 35370105 [Indexed for MEDLINE]


2211. Aging Ment Health. 2023 Mar;27(3):505-511. doi: 10.1080/13607863.2022.2060184. 
Epub 2022 Apr 4.

Rural/urban differences in mental health and social well-being among older US 
adults in the early months of the COVID-19 pandemic.

Henning-Smith C(1), Meltzer G(2), Kobayashi LC(3), Finlay JM(4).

Author information:
(1)Division of Health Policy and Management, University of Minnesota School of 
Public Health, Minneapolis, MN.
(2)Department of Social and Behavioral Sciences, New York University School of 
Global Public Health, New York, NY.
(3)Center for Social Epidemiology and Population Health, Department of 
Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI.
(4)Social Environment and Health Program, Institute for Social Research, 
University of Michigan, Ann Arbor, MI.

OBJECTIVES: This study seeks to identify differences in mental health and social 
well-being during the early months of the COVID-19 pandemic among older adults 
by rural/urban location.
METHODS: We use data from the COVID-19 Coping Study, a nation-wide online study 
of U.S. adults aged 55 and older (n = 6,873) fielded during April-May, 2020. We 
investigated rural/urban differences in mental health (depressive symptoms and 
anxiety symptoms) and social well-being (loneliness and social isolation); 
concern about COVID-19; and types of social participation (e.g. phone/video 
calls, visits). We also used multivariable logistic regression models to assess 
the relationship of rurality with mental health, adjusting for socio-demographic 
correlates, COVID-19 history, and COVID-19 concern.
RESULTS: We found similar prevalence of mental health and social well-being 
outcomes for rural and urban respondents. Rural respondents reported lower 
concern about COVID-19 and more frequent use of social media than urban 
respondents.
CONCLUSION: Mental health and social well-being did not differ by rural/urban 
location in the early months of the COVID-19 pandemic. However, rural residents 
reported less concern about COVID-19 and more use of social media, potentially 
leading to greater risk of illness from the pandemic in later months.

DOI: 10.1080/13607863.2022.2060184
PMID: 35369828 [Indexed for MEDLINE]


2212. BMC Med Educ. 2022 Apr 1;22(1):229. doi: 10.1186/s12909-022-03286-x.

Response of US psychiatric programs to the COVID-19 pandemic and the impact on 
trainees.

Durns T(1), Gethin-Jones T(2), Monson E(2), O'Donohoe J(2).

Author information:
(1)Department of Psychiatry, University of Utah, 501 Chipeta Way, Salt Lake 
City, UT, 84108, USA. tyler.durns@hsc.utah.edu.
(2)Department of Psychiatry, University of Utah, 501 Chipeta Way, Salt Lake 
City, UT, 84108, USA.

BACKGROUND: Medical training program and hospital response to the COVID-19 
pandemic has varied greatly and has impacted trainee well-being. Which factors 
have specifically related to trainee wellness, however, has not yet been 
examined in depth. The aim of the study was to understand trainee perspectives 
on the individual psychiatry trainee programs' hospitals' objective COVID-19 
preparedness management. We also sought and to gauge how program changes, and 
general pandemic-related concerns, have been associated with trainee 
satisfaction and burnout.
METHODS: A cross-sectional survey study of psychiatric trainees was distributed 
electronically throughout the country via various psychiatry residency program 
listservs in April 2020. Statistical analyses were performed utilizing simple 
linear regression.
RESULTS: From 352 respondents (346 complete responses and 6 partial responses), 
the most frequent program changes were "decreased number of rotations requiring 
in-person patient care" and "increased call hours or duties." Of 
pandemic-related concerns surveyed, the two greatest were "spreading COVID-19 to 
family/friends" and "co-residents' burnout and anxiety." A positive relationship 
was found between trainee satisfaction with perceived COVID-19 departmental 
response and comfort level of residents/fellows in expressing concerns with 
attending clinicians and department leadership.
CONCLUSIONS: Since the start of the COVID-19 pandemic, trainees have experienced 
a variety of changes to trainee program policies and guidelines. Overall, poor 
communication and trainee dissatisfaction with departmental response correlated 
with concern of infection and anxiety/burnout. Insights garnered from this study 
could provide scaffolding for the best practices to reduce trainee physician 
anxiety/burnout for the current and future pandemics of this variety and 
magnitude.

© 2022. The Author(s).

DOI: 10.1186/s12909-022-03286-x
PMCID: PMC8972686
PMID: 35365125 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2213. Int Ophthalmol. 2022 Aug;42(8):2493-2499. doi: 10.1007/s10792-022-02296-4. Epub 
2022 Apr 1.

Drop in well-being of ARMD patients under treatment with anti-VEGF injections 
during the COVID-19 pandemic.

Mylona I(1), Papadopoulou K(2), Roumelis S(3), Floros GD(4).

Author information:
(1)Department of Ophthalmology, General Hospital of Katerini, Katerini, Greece. 
milona_ioanna@windowslive.com.
(2)Department of Ophthalmology, 'Hippokration' General Hospital of Thessaloniki, 
Thessaloniki, Greece.
(3)Department of Ophthalmology, General Hospital of Serres, Serres, Greece.
(4)2nd Department of Psychiatry, Aristotle University of Thessaloniki, 
Thessaloniki, Greece.

PURPOSE: Patients with age-related macular degeneration (ARMD) are required to 
follow a treatment protocol that requires regular follow-ups. The COVID-19 
pandemic has created an additional burden for patients with ARMD under treatment 
with anti-vascular endothelial growth factor (anti-VEGF) injections, since 
patients face a congestion of the health system and closing of the outpatient 
services. This study examines the impact of the uncertainty regarding patients' 
treatment on their sense of well-being.
METHODS: This is a longitudinal cohort study of eighty patients who were 
followed during the year following the outbreak of the COVID pandemic. Patients 
reported their sense of well-being with the WHO-5 questionnaire and their 
perception and fears for the impact of the pandemic on their ongoing ARMD 
treatment.
RESULTS: There was a significant drop in mental well-being during the pandemic 
that paralleled the self-reported impact of the pandemic on ARMD treatment. 
Patients who reported a higher impact of COVID-19 on their treatment had 
experienced a higher drop in mental wellbeing compared to those who hadn't, with 
female gender being an additional risk factor. Objective measurements of visual 
acuity did not factor in the drop of sense of well-being.
CONCLUSIONS: The high initial level of uncertainty regarding ARMD patients' 
long-term course was further exacerbated when exposed to additional 
uncertainties during the pandemic regarding their standard of care. Planning 
ahead for continuation of services and close contact with patients during 
similar health emergencies is of paramount importance.

© 2022. The Author(s), under exclusive licence to Springer Nature B.V.

DOI: 10.1007/s10792-022-02296-4
PMCID: PMC8972774
PMID: 35362811 [Indexed for MEDLINE]

Conflict of interest statement: No potential conflicts of interest were 
disclosed by the authors.


2214. Rheumatol Int. 2022 May;42(5):783-790. doi: 10.1007/s00296-022-05111-6. Epub 
2022 Mar 31.

Isolation in patients with inflammatory rheumatic diseases during COVID-19 
pandemic compared to healthy individuals: a questionnaire survey.

Eriksen TE(#)(1)(2), Dinesen WKH(#)(1)(2), Uhrenholt L(1)(2), Dreyer L(1)(2), 
Duch K(1)(3), Kristensen S(4)(5).

Author information:
(1)Department of Rheumatology, Aalborg University Hospital, Reberbansgade 15, 
9000, Aalborg, Denmark.
(2)Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
(3)Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, 
Denmark.
(4)Department of Rheumatology, Aalborg University Hospital, Reberbansgade 15, 
9000, Aalborg, Denmark. sakr@rn.dk.
(5)Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. 
sakr@rn.dk.
(#)Contributed equally

As a result of the pandemic, many patients with an inflammatory rheumatic 
disease (IRD) have isolated themselves. The lack of disease management together 
with fear of infection could lead to changes in physical- and mental health. The 
aim of this study was to evaluate the social- and health behaviour in patients 
with an IRD compared with the behaviour of healthy individuals during the 
COVID-19 pandemic. The study was a questionnaire survey answered by patients 
with an IRD and healthy individuals (HI). The questionnaire contained seven 
sections with questions regarding COVID-19 and quality of life including SF-36, 
EQ-5D-5L, and visual analogue scale (VAS) pain, fatigue and global health. Of 
1663 invited participants, 661 patients with IRD and 266 HI were included in the 
analyses. Patients with an IRD felt more isolated during the COVID-19 pandemic 
compared with HI (IRD: 9.5% (61/644), HI: 3.1% (8/259), p-value = 0.001). More 
HI (5.4%) had been infected with COVID-19 than patients with an IRD (1.7%). 
Among patients with an IRD those with worse self-reported disease activity 
outcomes (VAS pain, fatigue and global health, all p-value < 0.001), worse 
social functioning and emotional well-being were more isolated than individuals 
with low disease activity. Patients with an IRD feel more isolated during the 
COVID-19 pandemic compared to HI. Isolation seems to be most pronounced in 
patients with worse disease related patient-reported outcomes and lower quality 
of life.

© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, 
part of Springer Nature.

DOI: 10.1007/s00296-022-05111-6
PMCID: PMC8970065
PMID: 35359192 [Indexed for MEDLINE]

Conflict of interest statement: LD: Grants (BMS), Speakers bureau (Galderma, Eli 
Lilly, Janssen). TEE, WKHD, LU, KD, and SK: None declared.


2215. MMWR Suppl. 2022 Apr 1;71(3):16-21. doi: 10.15585/mmwr.su7103a3.

Mental Health, Suicidality, and Connectedness Among High School Students During 
the COVID-19 Pandemic - Adolescent Behaviors and Experiences Survey, United 
States, January-June 2021.

Jones SE, Ethier KA, Hertz M, DeGue S, Le VD, Thornton J, Lim C, Dittus PJ, Geda 
S.

Disruptions and consequences related to the COVID-19 pandemic, including school 
closures, social isolation, family economic hardship, family loss or illness, 
and reduced access to health care, raise concerns about their effects on the 
mental health and well-being of youths. This report uses data from the 2021 
Adolescent Behaviors and Experiences Survey, an online survey of a 
probability-based, nationally representative sample of U.S. public- and 
private-school students in grades 9-12 (N = 7,705), to assess U.S. high school 
students' mental health and suicidality during the COVID-19 pandemic. The study 
also examines whether mental health and suicidality are associated with feeling 
close to persons at school and being virtually connected to others during the 
pandemic. Overall, 37.1% of students experienced poor mental health during the 
pandemic, and 31.1% experienced poor mental health during the preceding 30 days. 
In addition, during the 12 months before the survey, 44.2% experienced 
persistent feelings of sadness or hopelessness, 19.9% had seriously considered 
attempting suicide, and 9.0% had attempted suicide. Compared with those who did 
not feel close to persons at school, students who felt close to persons at 
school had a significantly lower prevalence of poor mental health during the 
pandemic (28.4% versus 45.2%) and during the past 30 days (23.5% versus 37.8%), 
persistent feelings of sadness or hopelessness (35.4% versus 52.9%), having 
seriously considered attempting suicide (14.0% versus 25.6%), and having 
attempted suicide (5.8% versus 11.9%). The same pattern was observed among 
students who were virtually connected to others during the pandemic (i.e., with 
family, friends, or other groups by using a computer, telephone, or other 
device) versus those who were not. Comprehensive strategies that improve 
feelings of connectedness with others in the family, in the community, and at 
school might foster improved mental health among youths during and after the 
COVID-19 pandemic.

DOI: 10.15585/mmwr.su7103a3
PMCID: PMC8979602
PMID: 35358165 [Indexed for MEDLINE]

Conflict of interest statement: All authors have completed and submitted the 
International Committee of Medical Journal Editors form for disclosure of 
potential conflicts of interest. No potential conflicts of interest were 
disclosed.


2216. MMWR Suppl. 2022 Apr 1;71(3):22-27. doi: 10.15585/mmwr.su7103a4.

Perceived Racism and Demographic, Mental Health, and Behavioral Characteristics 
Among High School Students During the COVID-19 Pandemic - Adolescent Behaviors 
and Experiences Survey, United States, January-June 2021.

Mpofu JJ, Cooper AC, Ashley C, Geda S, Harding RL, Johns MM, Spinks-Franklin A, 
Njai R, Moyse D, Underwood JM.

Perceived racism in school (i.e., a student's report of being treated badly or 
unfairly because of their race or ethnicity) is an important yet understudied 
determinant of adolescent health and well-being. Knowing how perceived racism 
influences adolescent health can help reduce health inequities. CDC's 2021 
Adolescent Behaviors and Experiences Survey (ABES), an online survey of a 
probability-based, nationally representative sample of U.S. public- and 
private-school students in grades 9-12 (N = 7,705), was conducted during 
January-June 2021 to assess student behaviors during the COVID-19 pandemic. CDC 
analyzed data from ABES to measure perceived racism and the extent to which 
perceptions of racism are associated with demographic, mental health, and 
behavioral characteristics. Mental health and behavioral characteristics 
analyzed included mental health status; virtual connection with others outside 
of school; serious difficulty concentrating, remembering, or making decisions; 
and feeling close to persons at school. Demographic characteristics analyzed 
included sex, race and ethnicity, and grade. Prevalence of perceived racism and 
associations between perceived racism and demographic, mental health, and 
behavioral characteristics are reported overall and stratified by race and 
ethnicity. Approximately one third (35.6%) of U.S. high school students reported 
perceived racism. Perceived racism was highest among Asian (63.9%), Black 
(55.2%), and multiracial students (54.5%). Students who reported perceived 
racism had higher prevalences of poor mental health (38.1%); difficulty 
concentrating, remembering, or making decisions (44.1%); and not feeling close 
to persons at school (40.7%). Perceived racism was higher among those students 
who reported poor mental health than those who did not report poor mental health 
during the pandemic among Asian (67.9% versus 40.5%), Black (62.1% versus 
38.5%), Hispanic (45.7% and 22.9%), and White students (24.5% versus 12.7%). A 
better understanding of how negative health outcomes are associated with student 
experiences of racism can guide training for staff and students to promote 
cultural awareness and antiracist and inclusivity interventions, which are 
critical for promoting safe school environments for all students.

DOI: 10.15585/mmwr.su7103a4
PMCID: PMC8979604
PMID: 35358163 [Indexed for MEDLINE]

Conflict of interest statement: All authors have completed and submitted the 
International Committee of Medical Journal Editors form for disclosure of 
potential conflicts of interest. No potential conflicts of interest were 
disclosed.


2217. J Perinat Med. 2022 Apr 1;50(5):539-548. doi: 10.1515/jpm-2021-0368. Print 2022 
Jun 27.

Giving birth alone due to COVID-19-related hospital restrictions compared to 
accompanied birth: psychological distress in women with caesarean section or 
vaginal birth - a cross-sectional study.

Oddo-Sommerfeld S(1), Schermelleh-Engel K(2), Konopka M(1), La Rosa VL(3), 
Louwen F(1), Sommerlad S(1).

Author information:
(1)Division of Obstetrics and Fetomaternal Medicine, University Hospital of 
Frankfurt, Frankfurt, Germany.
(2)Institute of Psychology, University of Frankfurt, Frankfurt, Germany.
(3)Department of Educational Sciences, University of Catania Catania, Italy.

OBJECTIVES: We examined the mental health of mothers after unaccompanied birth 
(unaccompanied group, UG) due to COVID-19-related visiting bans and compared the 
data with a control group with accompanied birth (AG). Additionally, a 
distinction was made between caesarean section (CS) and vaginal birth (VB), as 
existing research indicates a higher risk for mental distress after CS.
METHODS: The cross-sectional study included 27 mothers in the UG and 27 matched 
controls (AG). Anxiety, depression, postpartum traumatic stress symptoms (PTSS), 
and psychological well-being were assessed. Additionally, emotions and attitudes 
related to the restrictions were measured by self-developed items.
RESULTS: Psychological distress was high especially in the UG (anxiety: 23%, 
PTSS: 34.6%, low well-being: 42.3%, depression: 11.5%). Mothers in the AG had 
lower psychological distress than those in the UG, but still had enhanced rates 
of PTSS (11.1%) and diminished well-being (22.2%). In both groups, women with CS 
reported higher anxiety and trauma scores and lower well-being than women with 
VB. Unaccompanied mothers with CS perceived visitation restrictions as less 
appropriate and felt more helpless, angry, worried, and frustrated about the 
partner's absence than women with VB.
CONCLUSIONS: The partner's absence during, but also after childbirth has a major 
impact on psychological outcomes. Particularly, higher rates of anxiety and PTSS 
can lead to negative consequences for mothers and their children. Therefore, it 
is strongly recommended to relax visitation bans and avoid unaccompanied births. 
Psychological treatment in obstetric units is more urgently needed than ever, 
especially for women with a caesarean section.

© 2022 Walter de Gruyter GmbH, Berlin/Boston.

DOI: 10.1515/jpm-2021-0368
PMID: 35357796 [Indexed for MEDLINE]


2218. Int J Public Health. 2022 Mar 14;67:1604608. doi: 10.3389/ijph.2022.1604608. 
eCollection 2022.

A Longitudinal Study on Maternal Depressive Symptoms During the COVID-19 
Pandemic: The Role of Strict Lockdown Measures and Social Support.

Fernandes J(1), Tavares I(1), Bem-Haja P(2), Barros T(3), Carrito ML(1).

Author information:
(1)Faculty of Psychology and Education Sciences, University of Porto, Porto, 
Portugal.
(2)Department of Education and Psychology, University of Aveiro, Aveiro, 
Portugal.
(3)Centro Materno-Infantil do Norte, Porto, Portugal.

Objectives: This study examined the trajectory of perinatal depressive symptoms 
in Portuguese women during the COVID-19 pandemic and the role of individual, 
relational, and contextual risk and protective factors. Methods: This 3-wave 
longitudinal study followed 290 pregnant women from the third trimester of 
pregnancy until 6-months postpartum. Women self-reported on depressive symptoms, 
psychological (anxiety, perceived stress, mindfulness), relational (perceived 
social support, dyadic adjustment, sexual wellbeing), and contextual (lockdown 
status) factors. Results: Women who were under strict lockdown presented 
significantly higher scores of depressive symptoms at baseline (by 1.38 EPDS 
points) than women who were not under strict lockdown measures. Mixed Growth 
Models showed that trajectories of depressive symptoms were explained by 
differences in women's baseline depression. Differences in women's depressive 
symptoms at baseline were mainly explained by higher anxiety and lower social 
support (22% and 24% for women under lockdown; 39% and 6% for women not on 
lockdown, respectively). Conclusion: Preventative interventions targeted at 
pregnant women should aim to reduce anxiety and enhance women's social support 
to prevent depression in pregnancy and postpartum during the COVID-19 pandemic.

Copyright © 2022 Fernandes, Tavares, Bem-Haja, Barros and Carrito.

DOI: 10.3389/ijph.2022.1604608
PMCID: PMC8959081
PMID: 35356264 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2219. Nurs Open. 2022 Jul;9(4):2003-2012. doi: 10.1002/nop2.1207. Epub 2022 Mar 30.

Psychological impact of the COVID-19 pandemic on nursing students in the first 
wave: A cross-sectional survey.

Roldán-Merino J(1)(2)(3), Hurtado-Pardos B(1)(2)(4), Molina-Raya L(1)(2), Bande 
D(5), Casas I(6)(7), Farrés-Tarafa M(1)(2)(8)(9).

Author information:
(1)Campus Docent, Sant Joan de Déu - Fundació Privada, School of Nursing, 
University of Barcelona, Barcelona, Spain.
(2)Research Group GIES (Grupo de investigación en Enfermería, Educación y 
Sociedad), Barcelona, Spain.
(3)Research Group GEIMAC (Consolidated Group 2017-1681): Group of Studies of 
Invarianza of the Instruments of Measurement and Analysis of Change in the 
Social and Health Areas, Barcelona, Spain.
(4)Member Research Group GRIN (Grupo consolidado de recerca Infermeria, 
SRG:664), Barcelona, Spain.
(5)Servicio Anestesiología, Reanimación y Tratamiento del dolor. Parc de Salut 
Mar, Barcelona, Spain.
(6)Universitat Autònoma de Barcelona, Barcelona, Spain.
(7)Hospital Germans Tris i Pujol, Badalona, Spain.
(8)Member Research Group GRISIMula (Grupo emergente 2017 SGR 531; Grupo en 
Recerca Enfermera en Simulación), Barcelona, Spain.
(9)Secretaria Research Group GRISCA (Grupo en Recerca Enfermera en Simulación en 
Cataluña y Andorra), Barcelona, Spain.

AIM: The aim of the study was to evaluate the psychological impact on nursing 
students at the end of period of confinement during the first wave of the 
COVID-19 outbreak in Spain.
DESIGN: A cross-sectional study reported in line with the STROBE guidelines.
METHODS: Nursing students were invited to complete an online questionnaire at 
the end of the 2019-2020 academic year using convenience sampling. The 
questionnaire collected data on sociodemographic factors, work, and life 
experiences in relation to COVID-19, habits and lifestyle using the World Health 
Organization Five Well-Being Index (WHO-5) and the Generalized Anxiety 
disorder-7 scale. Variables related to anxiety were analysed using multiple 
lineal regression analysis, RESULTS: The prevalence of low psychological 
well-being in the 203 students was 44.3% and of anxiety 55.7%. In the 
multivariate analysis the variables associated with anxiety were having worked 
in the pandemic, having had symptoms of COVID-19 and having been afraid of 
getting infected.
CONCLUSIONS: The levels of anxiety due to the COVID-19 pandemic in nursing 
students have been high, and levels of psychological well-being have been low. 
The fact of having worked during the pandemic, having had symptoms compatible 
with COVID-19 or being afraid of getting infected are associated with the 
highest scores for anxiety.
RELEVANCE TO CLINICAL PRACTICE: This study gives more evidence on the 
psychological impact on nursing students during the first wave of the pandemic 
in Spain. This can be used to design anxiety management programmes for inclusion 
into teaching syllabuses. It also gives arguments for the setting up of 
psychological and emotional support services for these students and other 
healthcare professionals working during the pandemic.

© 2022 The Authors. Nursing Open published by John Wiley & Sons Ltd.

DOI: 10.1002/nop2.1207
PMCID: PMC9190679
PMID: 35355432 [Indexed for MEDLINE]

Conflict of interest statement: The authors report no current or potential 
conflicts of interest. The article is original, and it is not submitted anywhere 
other than your journal. We would of course be ready to give further information 
about the data and methods you so desire.


2220. J Sport Exerc Psychol. 2022 Mar 30;44(3):189-197. doi: 10.1123/jsep.2021-0253. 
Print 2022 Jun 1.

Relationships Between Physical Activity, Boredom Proneness, and Subjective 
Well-Being Among U.K. Adults During the COVID-19 Pandemic.

McCurdy A(1), Stearns JA(2), Rhodes RE(3), Hopkins D(4), Mummery K(1), Spence 
JC(1).

Author information:
(1)Faculty of Kinesiology, Sport, and Recreation, University of Alberta, 
Edmonton, AB,Canada.
(2)Division of Preventive Medicine, Faculty of Medicine and Dentistry, 
University of Alberta, Edmonton, AB,Canada.
(3)School of Exercise Science, Physical & Health Education, University of 
Victoria, Victoria, BC,Canada.
(4)School of Geography and the Environment, University of Oxford, Oxford,United 
Kingdom.

This investigation sought to examine physical activity (PA) as a potential 
determinant of chronic boredom and associated well-being within the context of 
COVID-related restrictions. A representative sample of U.K. adults (N = 1,521) 
completed a survey on June 1, 2020. Bivariate analyses demonstrated that 
individuals who met guidelines and maintained or increased PA scored higher on 
life satisfaction, worthwhileness, and happiness and lower on anxiety 
(i.e., indicators of well-being) and boredom proneness (d = 0.13-0.43). Boredom 
proneness was correlated with all indicators of well-being (r = .38-.54). A 
series of regression models revealed that PA predicted lower boredom proneness 
and better life satisfaction, worthwhileness, and happiness. Boredom proneness 
accounted for the covariance between PA and well-being. Prospective research is 
needed to confirm causality of the observed relationships.

DOI: 10.1123/jsep.2021-0253
PMID: 35354669 [Indexed for MEDLINE]


2221. BMJ Open. 2022 Mar 30;12(3):e055430. doi: 10.1136/bmjopen-2021-055430.

Psychosocial impact of the COVID-19 pandemic and shielding in adults and 
children with early-onset neuromuscular and neurological disorders and their 
families: a mixed-methods study.

Spurr L(1), Tan HL(2), Wakeman R(2), Chatwin M(3), Hughes Z(4), Simonds A(3).

Author information:
(1)Academic and Clinical Department of Sleep and Ventilation, Royal Brompton 
Hospital, London, UK l.spurr@nhs.net.
(2)Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, 
London, UK.
(3)Academic and Clinical Department of Sleep and Ventilation, Royal Brompton 
Hospital, London, UK.
(4)Myotubular Trust, London, UK.

AIM: To describe and evaluate the psychosocial impact of the COVID-19 pandemic 
and measures to reduce the risk of transmission on patients with early-onset 
neuromuscular and neurological disorders (NMDs) and their families.
DESIGN: A mixed-methods study in which data were collected between 17 September 
2020 and 31 December 2020 using a semi-structured telephone questionnaire 
developed specifically to meet research aims, and were analysed using 
quantitative methods and qualitative inductive thematic analysis.
PARTICIPANTS: Forty questionnaires were completed by patients with NMDs (eg, 
muscular dystrophies, spinal muscular atrophy) or their parent. 70% (n=28) of 
patients were male, aged 2-48 years. 90% (n=36) were wheelchair users; 72.5% 
(n=29) required long-term non-invasive or tracheostomy ventilation.
RESULTS: Strict adherence to risk mitigation strategies, for example, shielding, 
were reported at the start of the pandemic. Over half continued some or all 
measures after official limitations were relaxed. 67.5% (n=27) reported changes 
to personal care assistance arrangements including temporary cessation of 
outside carers. Three themes were identified: (1) Concern regarding the health 
impact of COVID-19; (2) Perceptions of strategies to prevent SARS-CoV-2 
transmission; (3) Psychological impact of the COVID-19 pandemic. The level and 
pervasiveness of frequently reported negative psychological effects, for 
example, anxiety and fear fluctuated, and were related to the perceived risk of 
COVID-19, concern about attending hospital, and perceived lack of access to 
intensive care management if severe COVID-19 infection occurred. Support, 
particularly from family and healthcare services, were considered to have 
positive psychosocial effects.
CONCLUSIONS: Measures to reduce transmission of COVID-19 have greatly affected 
patients with NMDs and their families. For most, negative psychosocial impacts 
have and will continue to improve, but this may depend on the incidence of 
further pandemic waves. Consistent, up-to-date and accessible information on 
clinical outcomes and risk mitigation must be provided to support patients' 
physical and mental well-being.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-055430
PMCID: PMC8968110
PMID: 35354630 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: All authors have completed 
the Unified Competing Interest form (available on request from the corresponding 
author) and declare: no support from any organisation for the submitted work; MC 
reports personal fees from Honorarium paid for lecture at virtual ERS 2020 from 
ResMed, grants from Support from Breas Medical to attend the ERS 2019, outside 
the submitted work; and MC also works part-time for Breas Medical. Breas Medical 
had no part in the development or writing of this manuscript and all time spent 
on this project was outside of her employment hours for Breas Medical. No other 
authors have any financial or other relationships or activities that could 
appear to have influenced the submitted work.


2222. J Community Psychol. 2023 Jul;51(6):2408-2429. doi: 10.1002/jcop.22829. Epub 
2022 Mar 30.

Weathering the storm alone or together: Examining the impact of COVID-19 on sole 
and partnered working mothers.

Dionisi AM(1), Smith CJ(1), Dupré KE(2).

Author information:
(1)Sprott School of Business, Carleton University, Ottawa, Canada.
(2)Department of Psychology, Carleton University, Ottawa, Canada.

Sole employed mothers and their families face numerous challenges. Yet, the 
unprecedented circumstances of the COVID-19 pandemic may be adding additional 
risk to the already precarious day-to-day reality of this population. Thus, we 
examine the implications of this crisis for the mental health and job-related 
well-being of both sole and partnered working mothers. Participants were 206 
mothers who continued to work during the pandemic. A moderated mediation model 
was analyzed. Work-family conflict (WFC) during the pandemic differentially 
related to mothers' parenting stress, based on romantic partnership status; when 
mothers were sole parents, the relationship between WFC and parenting stress was 
exacerbated. Moreover, this stress mediated the relationship between WFC and 
both poor mental health and decreased work engagement for sole employed mothers. 
Findings broaden our understanding of the implications of the COVID-19 pandemic 
for sole and partnered employed mothers, and how this crisis may be increasing 
disparities between working sole-parent and dual-partner families.

© 2022 Wiley Periodicals LLC.

DOI: 10.1002/jcop.22829
PMCID: PMC9088265
PMID: 35353912 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interests.


2223. J Adolesc. 2022 Feb;94(2):191-205. doi: 10.1002/jad.12017. Epub 2022 Feb 14.

Adolescents' longitudinal trajectories of mental health and loneliness: The 
impact of COVID-19 school closures.

Houghton S(1), Kyron M(1)(2), Hunter SC(1)(3), Lawrence D(1), Hattie J(4), 
Carroll A(5), Zadow C(1).

Author information:
(1)Graduate School of Education, The University of Western Australia, Crawley, 
Western Australia, Australia.
(2)School of Psychological Sciences, The University of Western Australia, 
Crawley, Western Australia, Australia.
(3)Department of Psychology, Glasgow Caledonian University, Glasgow, UK.
(4)Graduate School of Education, The University of Melbourne, Melbourne, 
Victoria, Australia.
(5)Faculty of Humanities and Social Sciences, School of Education, The 
University of Queensland, Brisbane, Queensland, Australia.

INTRODUCTION: Longitudinal research examining the impact of coronavirus disease 
2019 (COVID-19) school closures on the mental health of adolescents is scarce. 
Prolonged periods of physical and social isolation because of such restrictions 
may have impacted heavily on adolescents' mental health and loneliness.
METHODS: The current study addresses a major gap by examining the impact of 
school closures on the mental health and loneliness of 785, 10- to 17-year-old 
Western Australian adolescents (mean age = 14.1, SD = 1.31), who were surveyed 
across four time points: twice before COVID-19, once as schools closed, and once 
post reopening of schools. Pre- and post-COVID-19 changes in mental health and 
loneliness were compared using linear mixed models. Random intercept 
cross-lagged panel models (RI-CLPMs) assessed temporal associations between 
loneliness, depression symptoms, and positive mental wellbeing.
RESULTS: Compared with pre-COVID-19 symptom levels, there were significant 
increases in depression symptoms, internalizing and externalizing symptoms, and 
a significant decrease in positive mental wellbeing at different points over 
time. Symptom change over time differed according to gender and pre-COVID-19 
symptom severity. Significant increases in positive attitudes towards being 
alone and feelings of isolation occurred at different points over time. Gender 
differences were evident. RI-CLPMs highlighted the predictive significance of 
friendship quality and having a negative attitude towards being alone over time 
in relation to depression symptoms. A positive or negative attitude towards 
being alone was predictive of positive mental wellbeing over time.
CONCLUSION: Findings provide evidence that COVID-19-related school closures 
adversely affected adolescents' mental health and feelings of loneliness.

© 2022 The Authors. Journal of Adolescence published by Wiley Periodicals LLC on 
behalf of Foundation for Professionals in Services to Adolescents.

DOI: 10.1002/jad.12017
PMCID: PMC9087620
PMID: 35353417 [Indexed for MEDLINE]

Conflict of interest statement: The authors declared that there are no 
conflict of interests.


2224. J Adolesc. 2022 Feb;94(2):176-190. doi: 10.1002/jad.12016. Epub 2022 Feb 9.

Strength-based parenting and stress-related growth in adolescents: Exploring the 
role of positive reappraisal, school belonging, and emotional processing during 
the pandemic.

Allen KA(1)(2), Waters L(2), Arslan G(2)(3)(4), Prentice M(1).

Author information:
(1)School of Educational Psychology and Counselling, Faculty of Education, 
Monash University, Victoria, Clayton, Australia.
(2)Centre for Wellbeing Science, Melbourne Graduate School of Education, 
University of Melbourne, Melbourne, Victoria, Australia.
(3)Department of Psychological Counseling, Burdur Mehmet Akif Ersoy University, 
Burdur, Turkey.
(4)International Network on Personal Meaning, Ontario, Toronto, Canada.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has changed the way families 
live, interact, and connect with others, resulting in higher levels of stress 
for many teenagers who struggle with the ongoing uncertainty and disrupted 
school and family life. The current study examined the psychosocial factors that 
influence the capacity of adolescents to grow through the stress of the COVID-19 
pandemic.
METHODS: The sample included 404 secondary school students ranging in age from 
11 to 18 (M = 14.75, SD = 1.59; 50.2% female, 46.8% male, and 3% non-/other 
gendered or declined to answer) from an independent high school in Australia. 
Data were collected from a battery of questionnaires that assessed 
strength-based parenting (SBP) and the effect of three psychosocial factors 
(positive reappraisal, emotional processing, and school belonging) on 
stress-related growth.
RESULTS: Structural equation modeling showed that (SBP) was significantly 
associated with stress-related growth (SRG). Positive reappraisal and emotional 
processing were also positively and significantly associated with SRG and 
mediated the effect of SBP on SRG. Moreover, school belonging was positively 
linked to positive coping, emotional processing, and SRG, as well as mediating 
the association of SBP with positive reappraisal, emotional processing, and SRG 
in adolescents during the pandemic.
CONCLUSIONS: The results show that teenagers can experience SRG during the 
COVID-19 pandemic, and adolescents adapting by engaging in constructive coping 
responses such as positive reappraisal and emotional processing is positively 
related to SRG.

© 2022 Authors. Journal of Adolescence published by Wiley Periodicals LLC on 
behalf of Foundation for Professionals in Services to Adolescents.

DOI: 10.1002/jad.12016
PMCID: PMC9087671
PMID: 35353416 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that there are no conflict 
of interests.


2225. J Am Med Dir Assoc. 2022 Jul;23(7):1166-1170. doi: 10.1016/j.jamda.2022.02.016. 
Epub 2022 Mar 26.

A Randomized Controlled Trial of a Digital Adaptation of the WHELD 
Person-Centered Nursing Home Training Program.

McDermid J(1), Da Silva MV(1), Williams G(2), Khan Z(2), Corbett A(3), Ballard 
C(4).

Author information:
(1)The University of Exeter College of Medicine and Health, St Luke's Campus, 
Exeter, United Kingdom; Institute of Psychiatry, Psychology & Neuroscience, De 
Crespigny Park, King's College London, London, United Kingdom.
(2)Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, King's 
College London, London, United Kingdom.
(3)The University of Exeter College of Medicine and Health, St Luke's Campus, 
Exeter, United Kingdom.
(4)The University of Exeter College of Medicine and Health, St Luke's Campus, 
Exeter, United Kingdom. Electronic address: c.ballard@exeter.ac.uk.

OBJECTIVE: Digital approaches to delivering person-centered care training to 
nursing home staff have the potential to enable widespread affordable 
implementation, but there is very limited evidence and no randomized controlled 
trials (RCTs) evaluating digital training in the nursing home setting. The 
objective was to evaluate a digital person-centered care training intervention 
in a robust RCT.
DESIGN: We conducted a 2-month cluster RCT in 16 nursing homes in the United 
Kingdom, randomized equally to receive a digitally adapted version of the WHELD 
person-centered care home training program with virtual coaching compared to the 
digital training program alone.
SETTING AND PARTICIPANTS: The study was conducted in UK nursing homes. There 
were 175 participants (45 nursing home staff and 130 residents with dementia).
METHODS: The key outcomes were the well-being and quality of life (QoL) of 
residents with dementia and the attitudes and knowledge of nursing home staff.
RESULTS: There were significant benefits in well-being (t = 2.76, P = .007) and 
engagement in positive activities (t = 2.34, P = .02) for residents with 
dementia and in attitudes (t = 3.49, P = .001), including hope (t = 2.62, P = 
.013) and personhood (t = 2.26, P = .029), for staff in the group receiving 
digital eWHELD with virtual coaching compared to the group receiving digital 
learning alone. There was no improvement in staff knowledge about dementia.
CONCLUSION AND IMPLICATIONS: The study provides encouraging initial clinical 
trial evidence that a digital version of the WHELD program supported by virtual 
coaching confers significant benefits for care staff and residents with 
dementia. Evidence-based digital interventions with remote coaching may also 
have particular utility in supporting institutional recovery of nursing homes 
from the COVID-19 pandemic.

Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jamda.2022.02.016
PMID: 35351443 [Indexed for MEDLINE]


2226. BMC Public Health. 2022 Mar 29;22(1):608. doi: 10.1186/s12889-022-12642-x.

The UK stand together trial: protocol for a multicentre cluster randomised 
controlled trial to evaluate the effectiveness and cost-effectiveness of KiVa to 
reduce bullying in primary schools.

Clarkson S(#)(1), Bowes L(#)(2), Coulman E(3), Broome MR(4)(5), Cannings-John 
R(3), Charles JM(1), Edwards RT(1), Ford T(6), Hastings RP(7)(8), Hayes R(9), 
Patterson P(10), Segrott J(3), Townson J(3), Watkins R(1)(11), Badger J(12)(7), 
Hutchings J(1); Stand Together Team.

Collaborators: Fong M, Gains H, Gosalia H, Jones A, Longdon B, Lugg-Widger F, 
Mitchell SB, Murray C, Rose N, Whiteley H, Taiyari K, Varley M, Williams ME.

Author information:
(1)Bangor University, Bangor, Gwynedd, LL57 2DG, UK.
(2)Department of Experimental Psychology, Oxford University, Oxford, OX2 6GG, 
England. lucy.bowes@psy.ox.ac.uk.
(3)Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath 
Park, Cardiff, CF14 4YS, UK.
(4)Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, 
B15 2TT, England.
(5)Birmingham Women's and Children's NHS Foundation Trust, Steelhouse Lane, 
Birmingham, B4 6NH, England.
(6)Department of Psychiatry, Hershel Smith Building, Cambridge Biomedical 
Campus, Robinson Way, Cambridge, CB2 0SZ, England.
(7)Centre for Educational Development, Appraisal and Research, University of 
Warwick, Coventry, CV4 8UW, England.
(8)Centre for Developmental Psychiatry and Psychology, School of Clinical 
Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia.
(9)College of Life and Environmental Sciences, Psychology, University of Exeter, 
Exeter, EX1 2LU, England.
(10)Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
(11)Regional School Effectiveness and Improvement Service for North Wales (GwE), 
Bae Colwyn, UK.
(12)Department of Experimental Psychology, Oxford University, Oxford, OX2 6GG, 
England.
(#)Contributed equally

BACKGROUND: Reducing bullying is a public health priority. KiVa, a school-based 
anti-bullying programme, is effective in reducing bullying in Finland and 
requires rigorous testing in other countries, including the UK. This trial aims 
to test the effectiveness and cost-effectiveness of KiVa in reducing child 
reported bullying in UK schools compared to usual practice. The trial is 
currently on-going. Recruitment commenced in October 2019, however due to 
COVID-19 pandemic and resulting school closures was re-started in October 2020.
METHODS: Design: Two-arm pragmatic multicentre cluster randomised controlled 
trial with an embedded process and cost-effectiveness evaluation.
PARTICIPANTS: 116 primary schools from four areas; North Wales, West Midlands, 
South East and South West England. Outcomes will be assessed at student level 
(ages 7-11 years; n = approximately 13,000 students).
INTERVENTION: KiVa is a whole school programme with universal actions that 
places a strong emphasis on changing bystander behaviour alongside indicated 
actions that provide consistent strategies for dealing with incidents of 
bullying. KiVa will be implemented over one academic year.
COMPARATOR: Usual practice.
PRIMARY OUTCOME: Student-level bullying-victimisation assessed through 
self-report using the extensively used and validated Olweus Bully/Victim 
questionnaire at baseline and 12-month follow-up.
SECONDARY OUTCOMES: student-level bullying-perpetration; student mental health 
and emotional well-being; student level of, and roles in, bullying; school 
related well-being; school attendance and academic attainment; and teachers' 
self-efficacy in dealing with bullying, mental well-being, and burnout.
SAMPLE SIZE: 116 schools (58 per arm) with an assumed ICC of 0.02 will provide 
90% power to identify a relative reduction of 22% with a 5% significance level.
RANDOMISATION: recruited schools will be randomised on 1:1 basis stratified by 
Key-Stage 2 size and free school meal status. Process evaluation: assess 
implementation fidelity, identify influences on KiVa implementation, and examine 
intervention mechanisms. Economic evaluation: Self-reported victimisation, Child 
Health Utility 9D, Client Service Receipt Inventory, frequency of services used, 
and intervention costs. The health economic analysis will be conducted from a 
schools and societal perspective.
DISCUSSION: This two-arm pragmatic multicentre cluster randomised controlled 
trial will evaluate the KiVa anti-bullying intervention to generate evidence of 
the effectiveness, cost-effectiveness and scalability of the programme in the 
UK. Our integrated process evaluation will assess implementation fidelity, 
identify influences on KiVa implementation across England and Wales and examine 
intervention mechanisms. The integrated health economic analysis will be 
conducted from a schools and societal perspective. Our trial will also provide 
evidence regarding the programme impact on inequalities by testing whether KiVa 
is effective across the socio-economic gradient.
TRIAL REGISTRATION: Trials ISRCTN 12300853 Date assigned 11/02/2020.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-12642-x
PMCID: PMC8961482
PMID: 35351054 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that as part of the initial 
introduction of KiVa to the UK, JH and SC were licensed as KiVa trainers and 
received some funding for the training activity that has helped in the initial 
recruitment of schools and dissemination of KiVa in the UK. However, there is 
now a licensed training agency, the Children’s Early Intervention Trust 
(registered charity number 1120056) that oversees a trainer team and neither JH 
or SC would be involved in training schools recruited to this trial.


2227. BMC Pregnancy Childbirth. 2022 Mar 28;22(1):260. doi: 
10.1186/s12884-022-04553-x.

Self-reported mental health status of pregnant women in Sweden during the 
COVID-19 pandemic: a cross-sectional survey.

Ho-Fung C(1)(2), Andersson E(3), Hsuan-Ying H(2), Acharya G(4)(5)(6), Schwank 
S(7)(8)(9).

Author information:
(1)Department of Psychology, The University of Hong Kong, Hong Kong, China.
(2)Department of Anthropology, The Chinese University of Hong Kong, Hong Kong, 
China.
(3)Department of Women's and Children's Health, Division of Reproductive Health, 
Karolinska Institutet, Stockholm, Sweden.
(4)Division of Obstetrics and Gynecology, Department of Clinical Science 
Intervention and Technology (CLINTEC), Karolinska Institutet and Center for 
Fetal Medicine, Stockholm, Sweden.
(5)Department of Obstetrics and Gynecology, Karolinska University Hospital, 
Stockholm, Sweden.
(6)Women's Health and Perinatology Research Group, Department of Clinical 
Medicine, UiT-The Arctic University of Norway, Tromsø, Norway.
(7)Women's Health and Perinatology Research Group, Department of Clinical 
Medicine, UiT-The Arctic University of Norway, Tromsø, Norway. 
simone.schwank@ki.se.
(8)Division of Obstetrics and Gynecology, Department of Clinical Science 
Intervention and Technology (CLINTEC), Karolinska Institutet, K56 Huddinge, 141 
86, Stockholm, Sweden. simone.schwank@ki.se.
(9)Collage for Physicians and Surgeons, Center for Psychoanalytic Training and 
Research, Columbia University, New York, USA. simone.schwank@ki.se.

BACKGROUND: The COVID-19 pandemic has contributed to unprecedented worries and 
challenges for pregnant women due to social restrictions and changes in 
maternity care provision. We aimed to investigate the mental health impact of 
COVID-19 pandemic on pregnant women in Sweden and explore factors associated 
with poor perinatal mental health in this specific context.
METHOD: This was a nation-wide cross-sectional survey of pregnant women living 
in Sweden. Validated questionnaires were distributed through non-profit 
organizations´ websites and social media channels from May 2020 to February 
2021. Perinatal depression, anxiety, and acute stress reaction were assessed 
using the Edinburgh Postnatal Depression Scale (EPDS), Generalized Anxiety 
Disorder-7 (GAD-7) and Impact Event Scale (Revised) (IES-R), respectively. 
Sociodemographic characteristics and self-perceived mental well-being were also 
obtained. Factors associated with mental health outcomes were analyzed using 
multivariate logistic regression model.
RESULTS: Among a total of 470 participants, 43.2% (n = 203) reported depression 
(EPDS ≥13), 25.7% (n = 121) moderate to severe anxiety (GAD-7 score ≥ 10), and 
23.7% (n = 110) moderate to severe acute stress reaction (IES-R ≥ 33). 27.4% 
participants (n = 129) expressed concerns regarding their mental well-being 
during the pandemic. Pregnant mothers who had sick family members reported 
poorer mental health outcomes than those who did not (median [Interquartile 
range (IQR)] EPDS scores: 14.0 [8.75-18.0] vs 11.0 [6.25-15.0], p < .001; median 
(IQR) GAD7 scores: 7.0 [4.0-12.25] vs 6.0 [3.0-9.0], p = .003); median (IQR) 
IES-R scores: 20.0 [9.0-38.0] vs 15.0 [7.0-30.0], p = .048). Logistic regression 
analyses revealed that risk factors for poor mental health outcomes were having 
a sick family member with any illness, unemployment, and experiencing a 
substantially stressful life event. Having a higher educational level and a 
younger age during the pandemic were protective.
CONCLUSION: Depression and anxiety were highly prevalent among pregnant women in 
Sweden during the COVID-19 pandemic, indicating a need for professional mental 
health support for this vulnerable group of population. Unemployment was an 
associated risk factor whereas younger age and higher educational level were 
protective suggesting an important role of socio-economic factors in modulating 
the impact of COVID-19 pandemic on perinatal mental health.

© 2022. The Author(s).

DOI: 10.1186/s12884-022-04553-x
PMCID: PMC8960205
PMID: 35351030 [Indexed for MEDLINE]

Conflict of interest statement: Authors have no competing interest to declare in 
relation to this article.


2228. J Relig Health. 2022 Jun;61(3):2168-2197. doi: 10.1007/s10943-022-01549-x. Epub 
2022 Mar 29.

The Role of Spirituality and Religiosity in Healthcare During the COVID-19 
Pandemic: An Integrative Review of the Scientific Literature.

de Diego-Cordero R(1), Ávila-Mantilla A(2), Vega-Escaño J(3), Lucchetti G(4), 
Badanta B(5).

Author information:
(1)Research Group PAIDI-CTS 969 Innovation in HealthCare and Social Determinants 
of Health, Department of Nursing, Faculty of Nursing, Physiotherapy and 
Podiatry, University of Seville, 41009, Seville, Spain.
(2)Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, 
University of Seville, 41009, Seville, Spain.
(3)Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, 
University of Seville, c/Avenzoar, 6, 41009, Seville, Spain. jvega5@us.es.
(4)School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil.
(5)Research Group PAIDI-CTS 1050 Complex Care, Chronicity and Health Outcomes, 
Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, 
University of Seville, 41009, Seville, Spain.

The pandemic caused by the new coronavirus SARS-CoV-2 has been affecting 
populations globally since the end of 2019. Previous studies have indicated that 
spirituality in these times of crisis serves as a source of hope and well-being 
that helps people get through the day. This study investigated the role of 
spirituality and religiosity in healthcare during the COVID-19 pandemic. An 
integrative review of the scientific literature available on PubMed, Scopus, and 
Web of Science databases and a review of the gray literature in the Information 
System on Gray Literature in Europe (OpenGrey) were carried out. From a total of 
1,338 articles searched; 25 articles were included in this review (22 
quantitative observational, 2 qualitative and one randomized controlled trial). 
Our findings revealed the importance of including spirituality in clinical 
practice for both health professionals and patients. On the one hand, 
spirituality can be considered a good coping strategy used by healthcare 
professionals to promote mental health and well-being during the COVID-19 
pandemic and resulting in greater patient satisfaction with the care given. On 
the other hand, addressing spiritual needs of individuals leads to a reduction 
in stress, anxiety, depression, and an increase in resilience and hope among 
patients.

© 2022. The Author(s).

DOI: 10.1007/s10943-022-01549-x
PMCID: PMC8960681
PMID: 35348988 [Indexed for MEDLINE]

Conflict of interest statement: No conflict of interest has been declared by the 
authors.


2229. Zhejiang Da Xue Xue Bao Yi Xue Ban. 2021 Dec 25;50(6):741-747. doi: 
10.3724/zdxbyxb-2021-0296.

Association between napping status and depressive symptoms in urban residents 
during the COVID-19 epidemic.

[Article in English]

Lin W(1), Bai G(2), He W(1), Yang F(1), Li W(1), Min Y(3), Lu Y(4), Hsing A(3), 
Zhu S(1).

Author information:
(1)1. School of Public Health, Zhejiang University, Hangzhou 310058, China.
(2)2. Children's Hospital, Zhejiang University School of Medicine, National 
Clinical Research Center for Child Health, National Children's Regional Medical 
Center, Hangzhou 310052, China.
(3)3. Department of Epidemiology and Population Health, Stanford University 
School of Medicine, Stanford 94305, USA.
(4)4. Department of Biomedical Data Science, Stanford University School of 
Medicine, Stanford 94305, USA.

: To explore the association between napping status and depressive symptoms in 
urban residents during the coronavirus disease 2019 (COVID-19) epidemic. : The 
survey was embedded in the Wellness Living Laboratory-China (WELL China) cohort 
study. Health and lifestyle information during the COVID-19 epidemic were 
obtained via the telephone interview from April 8, 2020 to May 29, 2020. A total 
of 3075 residents aged 18 to from Gongshu district of Hangzhou city with 
complete data were included in the analyses. The World Health Organization-Five 
Well-being Index (WHO-5) was used to measure depressive symptoms. Multiple 
logistic regression model was used to assess the association between napping 
status and depressive symptoms in the participants. : The prevalence of 
depressive symptoms was 20.6% in the participants during the epidemic. Daytime 
napping behavior, especially napping time ≤30 min, was associated with a lower 
risk of prevalent depressive symptoms (=0.61, 95%: 0.47-0.79, <0.01) and 
incident depressive symptoms in the population (=0.66, 95%: 0.50-0.88, <0.01). 
Among those with depressive symptoms at baseline, napping time ≤ was beneficial 
for the outcome of depressive symptoms (=0.42, 95%: 0.21-0.82, <0.05). : One in 
five urban residents have depressive symptoms during the COVID-19 epidemic, and 
a short nap during the day may be a protective factor against depressive 
symptoms.

OBJECTIVE: : To explore the association between napping status and depressive 
symptoms in urban residents during the coronavirus disease 2019 (COVID-19) 
epidemic.
METHODS: : The survey was embedded in the Wellness Living Laboratory-China (WELL 
China) cohort study. Health and lifestyle information during the COVID-19 
epidemic were obtained via the telephone interview from April 8, 2020 to May 29, 
2020. A total of 3075 residents aged 18 to 80 years from Gongshu district of 
Hangzhou city with complete data were included in the analyses. The World Health 
Organization-Five Well-being Index (WHO-5) was used to measure depressive 
symptoms. Multiple logistic regression model was used to assess the association 
between napping status and depressive symptoms in the participants.
RESULTS: : The prevalence of depressive symptoms was 20.6% in the participants 
during the COVID-19 epidemic. Daytime napping behavior, especially napping time 
≤30 min, was associated with a lower risk of prevalent depressive symptoms ( 
OR=0.61, 95% CI: 0.47–0.79, P<0.01) and incident depressive symptoms in the 
population ( OR=0.66, 95% CI: 0.50–0.88, P<0.01). Among those with depressive 
symptoms at baseline, napping time ≤ 30 min was beneficial for the outcome of 
depressive symptoms ( OR=0.42, 95% CI: 0.21–0.82, P<0.05).
CONCLUSION: : One in five urban residents have depressive symptoms during the 
COVID-19 epidemic, and a short nap during the day may be a protective factor 
against depressive symptoms.

DOI: 10.3724/zdxbyxb-2021-0296
PMCID: PMC8931595
PMID: 35347909 [Indexed for MEDLINE]

Conflict of interest statement: 所有作者均声明不存在利益冲突


2230. Inquiry. 2022 Jan-Dec;59:469580221081445. doi: 10.1177/00469580221081445.

Changes in Healthcare Provision During Covid-19 and Their Impact on Children 
With Chronic Illness: A Scoping Review.

Lignou S(1), Greenwood J(2), Sheehan M(3), Wolfe I(4).

Author information:
(1)Nuffield Department of Population Health, Ethox Centre and Wellcome Centre 
for Ethics and Humanities, 6396University of Oxford, Oxford, UK.
(2)Kings Health Partners, 4616King's College London, London, UK.
(3)Nuffield Department of Population Health, Ethox Centre, 6396University of 
Oxford, Oxford, UK.
(4)4616King's College London, London UK.

This paper provides an overview of the evidence around how the health systems 
and policy response to the Covid-19 pandemic affected children with long-term 
conditions in the UK. We conducted a scoping review guided by the PRISMA-ScR 
Checklist. The PubMed and PsycINFO databases (2019-August 2021) were searched 
and screened for papers (of any design) by 2 reviewers independently. The 
electronic database search was supplemented by manual searching. A total of 32 
papers were identified, including studies on UK paediatric populations, studies 
on chronic illness in the UK, and international studies on chronic illness and 
children (including data from the UK). Most studies focussed on epilepsy, 
cancer, diabetes or asthma. Three categories of impact were identified: (a) 
impact of policy response on the delivery of and access to child healthcare (b) 
impact of innovative practice on children's physical and mental health (c) 
impact of service restrictions on children's physical health. Our results showed 
that policy response to the pandemic significantly affected healthcare provision 
for children with chronic illness in the UK. However, the specific assessment of 
the impact of service restrictions and innovative practice on children's health 
and wellbeing is limited. Future research is required to fill knowledge gaps on 
changes in access to effective diagnostic and treatment investigations and their 
impact on a range of paediatric patients during the pandemic.

DOI: 10.1177/00469580221081445
PMCID: PMC8969043
PMID: 35345920 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


2231. Soc Sci Med. 2022 May;301:114884. doi: 10.1016/j.socscimed.2022.114884. Epub 
2022 Mar 11.

Personality, gender, and age resilience to the mental health effects of 
COVID-19.

Staneva A(1), Carmignani F(2), Rohde N(2).

Author information:
(1)Griffith University, Griffith Business School, Australia. Electronic address: 
a.staneva@griffith.edu.au.
(2)Griffith University, Griffith Business School, Australia.

RATIONALE: Understanding the impact of COVID-19 on different population cohorts 
and which personality traits affected individual's coping responses can help 
identify strategies to promote self-directed behaviours, thereby enhancing and 
maintaining individual's mental well-being.
OBJECTIVE: Using longitudinal data for the UK, we examine the impact of the 
COVID-19 pandemic on individuals' mental well-being, focusing on age, gender, 
and personality traits as possible modifiers.
METHODS: We explore the longitudinal nature of the data using individual fixed 
effects models, which implicitly control for unobserved time-invariant 
individual-level characteristics. Our sample is an unbalanced panel consisting 
of 373,555 person-years observations, observed from 2009 until June 2020.
RESULTS: The negative impacts of the first months of the pandemic period are 
found to be larger for young adults (aged 16-25 years) and vary by personality 
traits. The increase in psychological distress symptoms is more pronounced for 
individuals who score higher in neuroticism, extroversion, and openness to 
experience. Indeed, for introverted young people, recent events may have 
actually brought a sense of calm. Other findings indicate that worsening in the 
psychological distress level occurs alongside with increased feelings of 
loneliness.
CONCLUSIONS: Our findings support the theoretical knowledge that different 
people have different psychological and behaviour responses and personality 
concepts can be used when studying individual's adaptive behaviour in critical 
situations such as COVID-19. Our results indicate the necessity of public health 
programmes to assist distressed young individuals.

Copyright © 2022 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.socscimed.2022.114884
PMCID: PMC8915456
PMID: 35344776 [Indexed for MEDLINE]


2232. J Pediatr Endocrinol Metab. 2022 Mar 28;35(5):627-630. doi: 
10.1515/jpem-2022-0002. Print 2022 May 25.

Increased anxiety symptoms in pediatric type 1 diabetes during the acute phase 
of COVID-19 lockdown.

Wade C(1), Burton ET(2)(3), Akinseye L(3), Nelson G(3)(4), Smith-Young J(4), Kim 
A(3)(4).

Author information:
(1)College of Medicine, University of Tennessee Health Science Center, Memphis, 
TN, USA.
(2)Children's Foundation Research Institute, Le Bonheur Children's Hospital, 
Memphis, TN, USA.
(3)Department of Pediatrics, University of Tennessee Health Science Center, 
Memphis, TN, USA.
(4)Division of Pediatric Endocrinology, Le Bonheur Children's Hospital, Memphis, 
TN, USA.

Comment in
    J Pediatr Endocrinol Metab. 2022 May 17;35(6):819.

OBJECTIVES: The prevalence of mental health issues has increased at an alarming 
rate during the COVID-19 pandemic. Furthermore, an exacerbated psychosocial 
burden in populations with chronic disease is observed. This cross-sectional 
study evaluated the psychosocial factors of pediatric type 1 diabetes (T1D) 
during the COVID-19 pandemic.
METHODS: During April 2020, 15 min phone interviews were performed for pediatric 
T1D group (n=100) and healthy comparison group (n=93) to assess psychosocial 
functioning during the acute lockdown phase of the pandemic. The patient health 
questionnaire-4 was utilized to assess anxiety and depressive symptoms. An 
additional questionnaire to assess specific concerns related to T1D and COVID-19 
was administered to the T1D group to explore potential causes for increased 
psychosocial burden.
RESULTS: T1D was associated with a five-times higher risk of anxiety symptoms. 
Increased anxiety symptoms in T1D group appear to be, at least in part, due to 
fear of higher risk of severe COVID-19 infection and uncertainty regarding 
access to diabetes supplies.
CONCLUSIONS: This study provides a snapshot of mental well-being in a diverse 
population of patients with T1D in the acute phase of a crisis and underscores 
the need for timely, accurate medical information and distribution of medical 
resources for pediatric T1D population.

© 2022 Walter de Gruyter GmbH, Berlin/Boston.

DOI: 10.1515/jpem-2022-0002
PMID: 35344643 [Indexed for MEDLINE]


2233. Environ Health Prev Med. 2022;27:14. doi: 10.1265/ehpm.22-00008.

Predictors of happiness during the COVID-19 pandemic in mothers of infants 
and/or preschoolers: a pre-COVID-19 comparative study in Japan.

Kimura M(1), Ide K(2), Kimura K(3), Ojima T(4).

Author information:
(1)Department of Preventive Medicine, St. Marianna University School of 
Medicine.
(2)Department of Social Preventive Medical Sciences, Center for Preventive 
Medical Sciences, Chiba University.
(3)Graduate School of Applied Life Science, Nippon Veterinary and Life Science 
University.
(4)Hamamatsu University School of Medicine, Community Health & Preventive 
Medicine.

BACKGROUND: Happiness may help to prevent negative physiological outcomes in 
response to life events; however, factors contributing to happiness during the 
COVID-19 pandemic have not been longitudinally investigated. This study explored 
the predictors of happiness in mothers of young children in Japan using 
comparable data that were obtained before and during the COVID-19 pandemic.
METHODS: We conducted the baseline survey in February 2020, and 4 months later, 
we also conducted the follow-up survey. Throughout all 47 prefectures in Japan, 
4,700 (100 respondents/prefecture) mothers of infants and/or preschoolers (0-6 
years) participated in the baseline online survey; 2,489 of these also 
participated in the follow-up survey.
RESULTS: We performed hierarchical multiple regression analysis and our final 
model indicated that maternal happiness during COVID-19 pandemic was positively 
related to employment status (homemaker, β = 0.052, p = 0.014), levels of 
available social support (average, β = 0.052, p = 0.012, high, β = 0.055, p = 
0.010) and happiness score before the pandemic (β = 0.467, p < 0.001), and 
satisfaction toward the measures against the COVID-19 at partners' workplace 
(average, β = 0.129, p < 0.001; high, β = 0.279, p < 0.001), preventive behavior 
against COVID-19 (average, β = 0.055, p = 0.002; high, β = 0.045, p = 0.015) and 
positive attitudes/thinking (β = 0.087, p < 0.001) during the pandemic. In 
contrast, poor mental health (K6 ≥5, β = -0.042, p = 0.011) before the pandemic 
and negative changes during the pandemic (≥3, β = -0.085, p < 0.001) were 
negatively related to maternal happiness during the pandemic. Our final model 
explained 44.9% of the variance in mothers' happiness during the COVID-19 
pandemic.
CONCLUSIONS: Satisfaction toward the measures against the COVID-19 at partners' 
workplace, preventive behavior, and positive attitudes/thinking were especially 
important for maternal happiness during the COVID-19 pandemic. Future study is 
needed to consider measures against infectious diseases in the workplace that 
are desirable for the well-being of parents with young children, taking into 
account the gender perspective.

DOI: 10.1265/ehpm.22-00008
PMCID: PMC9251627
PMID: 35342123 [Indexed for MEDLINE]

Conflict of interest statement: The authors declared that they have no competing 
interest.


2234. Stress Health. 2022 Dec;38(5):950-960. doi: 10.1002/smi.3147. Epub 2022 Apr 2.

The psychological response and perception of stress during the COVID-19 pandemic 
in Slovenia: Three-wave repeated cross-sectional study.

Kozina A(1), Peras I(1), Veldin M(1), Pivec T(1).

Author information:
(1)Educational Research Institute, Ljubljana, Slovenia.

In addition to COVID-19 being a health threat, its longevity and restrictions 
act as significant stressors and risk for mental health. In the current study, 
we take a look at how psychological response, both its positive aspects, for 
example, mental well-being and life satisfaction, and its negative aspects, for 
example, anxiety and COVID-19 anxiety, have changed as the pandemic has 
continued (first three waves in Slovenia). Additionally, we are interested in 
whether the psychological response is associated with the perception of stress 
level in waves 2 and 3 as less, equally or more stressful when compared to the 
stress level in wave 1 and what shapes these perceptions. An online 
questionnaire battery (COVID-19 stress level comparison, Warwick-Edinburgh 
Mental Well-being Scale; LAOM Anxiety Scale; Global Life Satisfaction scale; 
COVID-19 anxiety), with ANOVA and qualitative analysis of the open-ended 
question on reasons for perceiving wave 2 and wave 3 as more stressful when 
compared to wave 1, was used on a Slovene convenience adult sample (wave 1: 
N = 364, 83.5% female; wave 2: N = 987, 85.5% female; wave 3: N = 467, 78.5% 
female). The findings show (a) a significant increase in COVID-19 anxiety from 
wave 1 to wave 3, with a peak in wave 2, and a significant decrease in mental 
well-being from wave 1 to wave 3; (b) the level of anxiety, mental well-being, 
and life satisfaction differs significantly between individuals who perceive 
wave 2 and 3 as more stressful compared to individuals who perceive wave 2 and 
wave 3 as equally or less stressful when compared to wave 1; (c) reasons for 
perceiving the succeeding waves of the pandemic as more stressful compared to 
wave 1 are diverse, with some being reported in both succeeding waves (e.g., 
negative emotional response to the pandemic, negative perceptions of measures). 
The findings highlight the important role of stress analysis in identifying the 
support mechanisms for dealing with the challenges of the COVID-19 pandemic.

© 2022 John Wiley & Sons Ltd.

DOI: 10.1002/smi.3147
PMCID: PMC9111042
PMID: 35338675 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that they have no 
conflict of interest.


2235. Am J Med Genet A. 2022 Jul;188(7):1997-2004. doi: 10.1002/ajmg.a.62736. Epub 
2022 Mar 26.

Impact of the COVID-19 pandemic on medical genetics and genomics training: 
Perspective from clinical trainees.

Chenbhanich J(1), Slavotinek A(1), Tam A(1).

Author information:
(1)Division of Medical Genetics, Department of Pediatrics, University of 
California San Francisco, San Francisco, California, USA.

We sought to understand how the coronavirus disease 2019 (COVID-19) pandemic has 
affected the well-being, clinical training, and medical education for clinical 
trainees in medical genetics and genomics residency and fellowship programs. All 
clinical genetics trainees in the Accreditation Council for Graduate Medical 
Education (ACGME)-accredited training programs were invited to complete a 
survey. 31 out of 174 trainees completed the survey. With regards to well-being, 
18 trainees reported increased anxiety, 10 had increased depression, 3 increased 
financial strain, 13 worsening work-life balance, and 13 worsening physical 
health. There was increased telehealth utilization in both outpatient (3% before 
the pandemic vs. 67% during the pandemic) and inpatient clinical encounters (0% 
vs. 29%). The most commonly reported challenges in telehealth use were 
inadequate physical examination and technical problems during visits. Twenty 
trainees believed that the pandemic has negatively impacted overall clinical 
training while none reported a positive impact. We concluded that the COVID-19 
pandemic has negatively impacted most clinical genetics trainees in 
ACGME-accredited training programs. Telehealth has been increasingly used with 
some challenges. Further studies are needed on how to optimally integrate what 
we have learned into the training of medical genetics and genomics in the 
post-pandemic era.

© 2022 Wiley Periodicals LLC.

DOI: 10.1002/ajmg.a.62736
PMCID: PMC9082060
PMID: 35338572 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


2236. BMC Pregnancy Childbirth. 2022 Mar 25;22(1):251. doi: 
10.1186/s12884-022-04587-1.

The 'new normal' includes online prenatal exercise: exploring pregnant women's 
experiences during the pandemic and the role of virtual group fitness on 
maternal mental health.

Silva-Jose C(1), Nagpal TS(2), Coterón J(3), Barakat R(1), Mottola MF(4)(5)(6).

Author information:
(1)AFIPE Research Group, Universidad Politécnica de Madrid, Madrid, Spain.
(2)Kinesiology, Faculty of Applied Health Sciences, Brock University St. 
Catharines, St. Catharines, Canada.
(3)AFIPE Research Group, Universidad Politécnica de Madrid, Madrid, Spain. 
j.coteron@upm.es.
(4)School of Kinesiology, Faculty of Health Sciences, University of Western 
Ontario, London, Canada.
(5)Children's Health Research Institute, University of Western Ontario, London, 
Canada.
(6)Department of Anatomy & Cell Biology, Schulich School of Medicine & 
Dentistry, University of Western Ontario, London, Canada.

BACKGROUND: Prenatal anxiety and depressive symptoms have significantly 
increased since the onset of the coronavirus (COVID-19) pandemic In addition, 
home confinement regulations have caused a drastic increase in time spent 
sedentary. Online group fitness classes may be an effective strategy that can 
increase maternal physical activity levels and improve mental health outcomes by 
providing an opportunity for social connectedness. The present study explores 
the experiences of pregnant women who participated in an online group exercise 
program during the pandemic and identifies relationships with maternal mental 
health and well-being. In addition, we present person-informed recommendations 
on how to improve the delivery of future online prenatal exercise programs.
METHODS: Semi-structured interviews were conducted with pregnant women 
(8-39 weeks of pregnancy) who participated in an online group exercise program, 
from March to October 2020 in Spain. A phenomenological approach was taken, and 
open-ended questions were asked to understand women's experiences throughout the 
pandemic and the role the online exercise classes may have had on their physical 
activity levels, mental health, and other health behaviours such as diet. A 
thematic analysis was performed to evaluate data. In addition, women completed 
the State-Trait Anxiety Inventory and these data supplemented qualitative 
findings.
RESULTS: Twenty-four women were interviewed, and the anxiety scores were on 
average 32.23 ± 9.31, ranging from low to moderate levels. Thematic analysis 
revealed that women felt safe exercising from home, an increased availability of 
time to schedule a structured exercise class, and consequently an improvement in 
their adherence to the program and other behaviours (i.e., healthier diet). 
Women emphasized feeling connected to other pregnant women when they exercised 
online together, and overall, this had a positive effect on their mental 
well-being. Women suggested that future online exercise programs should include 
flexible options, detailed instructions and facilitation by a qualified exercise 
professional.
CONCLUSION: Pregnant women are receptive to online group exercise classes and 
expressed that they are an accessible option to accommodating physical activity 
during the pandemic. In addition, the online group environment provides an 
important sense of connectivity among pregnant women exercising together and 
this may mitigate the detrimental effect of COVID-19 on maternal mental health.

© 2022. The Author(s).

DOI: 10.1186/s12884-022-04587-1
PMCID: PMC8953965
PMID: 35337280 [Indexed for MEDLINE]

Conflict of interest statement: No declared.


2237. Soc Sci Med. 2022 May;301:114890. doi: 10.1016/j.socscimed.2022.114890. Epub 
2022 Mar 12.

How American college students understand social resilience and navigate towards 
the future during covid and the movement for racial justice.

Sanchez M(1), Lamont M(2), Zilberstein S(2).

Author information:
(1)Harvard University Department of Sociology, Cambridge, MA, 02139, USA. 
Electronic address: mjsanchez@g.harvard.edu.
(2)Harvard University Department of Sociology, Cambridge, MA, 02139, USA.

The COVID-19 pandemic and crisis around racial injustice have generated 
compounded macro-level stressors for American society that negatively impact 
mental health and wellbeing. We contribute to understanding the impact of these 
crises by examining the process of developing social resilience, which we 
conceptualize as a temporally-embedded process of sense-making through which 
actors activate a sense of dignity, agency, and hope in the face of challenges 
to sustain wellbeing based on available resources. We interviewed 80 college 
students (aged 18-23) living in the American Northeast and Midwest before 
(September 2019-February 2020) and during (June-July 2020) the pandemic to 
analyze how they make sense of crises, respond to challenges, and project 
themselves into the future. We compare "privileged" upper-middle class youth who 
have families with more resources to buffer themselves against growing 
uncertainty, with "less privileged" youth from lower-middle and working class 
families. Efforts to achieve a sense of dignity, agency, and hope amidst 
widespread uncertainty illuminate opportunities and constraints in the process 
of building social resilience, which take different temporal forms across the 
two class groups given their experiences and resources.

Copyright © 2022 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.socscimed.2022.114890
PMCID: PMC8916841
PMID: 35334261 [Indexed for MEDLINE]


2238. Dementia (London). 2022 May;21(4):1363-1380. doi: 10.1177/14713012221079477. 
Epub 2022 Mar 25.

The use of digital technologies by people with mild-to-moderate dementia during 
the COVID-19 pandemic: A positive technology perspective.

Talbot CV(1), Briggs P(2).

Author information:
(1)Department of Psychology, 276175Bournemouth University, Poole, UK.
(2)Department of Psychology, 5995Northumbria University, Newcastle upon Tyne, 
UK.

A growing body of research has shown that people with dementia are using digital 
technologies to enhance lived experience. The COVID-19 pandemic has brought new 
digital opportunities and challenges and so provides a unique opportunity to 
understand how people with dementia have adapted to this new digital landscape. 
Semi-structured interviews were conducted with 19 people with dementia and 
analysed thematically. We generated five themes, showing how participants used 
digital means to combat the stresses of the pandemic by facilitating social 
connection, self-actualisation, enhanced well-being and by assisting with 
activities of daily life. These technologies helped to reduce isolation, provide 
access to support groups, create opportunities for cognitive stimulation and 
self-development, and engendered a sense of identity at a time of perceived 
loss. Despite these benefits, participants also reported challenges regarding 
cognitive fatigue and usability issues. We recommend that training on how to use 
digital technologies is co-produced with people with dementia and designers 
engage with the voices of people with dementia throughout the design process. In 
turn, this could promote the social connectedness, well-being and self-worth of 
people with dementia.

DOI: 10.1177/14713012221079477
PMCID: PMC8960751
PMID: 35333111 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of conflicting interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


2239. Acad Emerg Med. 2022 Aug;29(8):974-986. doi: 10.1111/acem.14490. Epub 2022 May 
22.

In their own words: Experiences of emergency health care workers during the 
COVID-19 pandemic.

Blanchard J(1), Messman AM(2), Bentley SK(3), Lall MD(4), Liu YT(5), Merritt 
R(6), Sorge R(7), Warchol JM(8), Greene C(9), Diercks DB(10), Griffith J(1), 
Manfredi RA(1), McCarthy M(11).

Author information:
(1)George Washington University School of Medicine and Health Sciences, 
Washington, District of Columbia, USA.
(2)Wayne State University School of Medicine, Detroit, Michigan, USA.
(3)Icahn SOM at Mount Sinai, New York City Health + Hospitals/Elmhurst, New 
York, New York, USA.
(4)Emory University School of Medicine, Atlanta, Georgia, USA.
(5)David Geffen School of Medicine at UCLA, Harbor-UCLA Medical Center, 
Torrance, California, USA.
(6)Alpert Medical School of Brown University, Providence, Rhode Island, USA.
(7)Louisiana State University Spirit of Charity Emergency Medicine Residency 
Program, New Orleans, Louisiana, USA.
(8)University of Nebraska Medical Center, Omaha, Nebraska, USA.
(9)University of Alabama at Birmingham, Birmingham, Alabama, USA.
(10)University of Texas, Dallas, Texas, USA.
(11)George Washington University, Milken Institute of Public Health, Washington, 
District of Columbia, USA.

BACKGROUND: During the COVID-19 pandemic, a substantial number of emergency 
health care workers (HCWs) have screened positive for anxiety, depression, risk 
of posttraumatic stress disorder, and burnout. The purpose of this qualitative 
study was to describe the impact of COVID-19 on emergency care providers' health 
and well-being using personal perspectives. We conducted in-depth interviews 
with emergency physicians, emergency medicine nurses, and emergency medical 
services providers at 10 collaborating sites across the United States between 
September 21, 2020, and October 26, 2020.
METHODS: We developed a conceptual framework that described the relationship 
between the work environment and employee health. We used qualitative content 
analysis to evaluate our interview transcripts classified the domains, themes, 
and subthemes that emerged from the transcribed interviews.
RESULTS: We interviewed 32 emergency HCWs. They described difficult working 
conditions, such as constrained physical space, inadequate personnel protective 
equipment, and care protocols that kept changing. Organizational leadership was 
largely viewed as unprepared, distant, and unsupportive of employees. Providers 
expressed high moral distress caused by ethically challenging situations, such 
as the perception of not being able to provide the normal standard of care and 
emotional support to patients and their families at all times, being responsible 
for too many sick patients, relying on inexperienced staff to treat infected 
patients, and caring for patients that put their own health and the health of 
their families at risk. Moral distress was commonly experienced by emergency 
HCWs, exacerbated by an unsupportive organizational environment.
CONCLUSIONS: Future preparedness efforts should include mechanisms to support 
frontline HCWs when faced with ethical challenges in addition to an adverse 
working environment caused by a pandemic such as COVID-19.

© 2022 Society for Academic Emergency Medicine.

DOI: 10.1111/acem.14490
PMCID: PMC9111302
PMID: 35332615 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interests to 
disclose.


2240. Clin Nutr ESPEN. 2022 Apr;48:329-335. doi: 10.1016/j.clnesp.2022.01.024. Epub 
2022 Jan 31.

COVID-19 confinement impact on weight gain and physical activity in the older 
adult population: Data from the LOST in Lombardia study.

Stival C(1), Lugo A(1), Bosetti C(2), Amerio A(3), Serafini G(3), Cavalieri 
d'Oro L(4), Odone A(5), Stuckler D(6), Iacoviello L(7), Bonaccio M(8), van den 
Brandt PA(9), Zucchi A(10), Gallus S(11).

Author information:
(1)Department of Environmental Health Sciences, Istituto di Ricerche 
Farmacologiche Mario Negri IRCCS, Milan, Italy.
(2)Department of Oncology, Istituto Di Ricerche Farmacologiche Mario Negri 
IRCCS, Milan, Italy.
(3)Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal 
and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, 
Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
(4)ATS della Brianza, Monza, Italy.
(5)School of Medicine, University Vita-Salute San Raffaele, Milan, Italy; 
Department of Public Health, Experimental and Forensic Medicine, University of 
Pavia, Pavia, Italy.
(6)Department of Social Sciences and Politics, Bocconi University, Milan, Italy.
(7)School of Medicine, University of Insubria, Varese, Italy; IRCCS Neuromed, 
Pozzilli, Italy.
(8)IRCCS Neuromed, Pozzilli, Italy.
(9)Maastricht University Medical Centre, GROW- School for Oncology and 
Developmental Biology, Department of Epidemiology, Maastricht, the Netherlands; 
Maastricht University Medical Centre, CAPHRI- School for Public Health and 
Primary Care, Department of Epidemiology, Maastricht, the Netherlands.
(10)ATS di Bergamo, Bergamo, Italy.
(11)Department of Environmental Health Sciences, Istituto di Ricerche 
Farmacologiche Mario Negri IRCCS, Milan, Italy. Electronic address: 
silvano.gallus@marionegri.it.

BACKGROUND & AIMS: COVID-19 containment measures significantly impacted 
lifestyle of the general population, including physical activity. Although the 
older adults are particularly susceptible to the potential consequences of 
sedentary lifestyle and inactivity, few studies investigated pandemic effects in 
this segment of the population. We aimed to evaluate COVID-19 pandemic effects 
on weight gain and physical activity in the Italian older adults, and assess the 
impact of possible changes in physical activity on mental health wellbeing.
METHODS: In November 2020, a cross-sectional survey was conducted on a 
representative sample of 4400 older adults (aged 65 or more) from the Lombardy 
region, Northern Italy. Changes in body mass index (BMI) and physical activity 
were assessed, compared to the previous year. Using unconditional multiple 
logistic models, we estimated the odds ratios (OR) and the corresponding 95% 
confidence intervals (CI) of a decrease in physical activity during COVID-19 
pandemic and we evaluated if decreased physical activity was a determinant of a 
worsening in psychological wellbeing.
RESULTS: Neither weight gain nor increase in obesity prevalence occurred during 
the pandemic. Mean time spent in physical activity significantly decreased, with 
43.8% of participants reporting a decrease of 1 h/week or more during COVID-19 
pandemic. A decreased physical activity was determinant of a worsening of 
selected mental health outcomes, such as: sleep quality (OR = 2.45; 95% CI: 
1.91-3.15) and quantity (OR = 1.54; 95% CI: 1.18-2.02), anxiety (OR = 1.31; 95% 
CI: 1.14-1.52) and depressive symptoms (OR = 1.61; 95% CI: 1.38-1.88).
CONCLUSION: During the COVID-19 pandemic, while no major changes in BMI were 
observed, physical activity significantly declined in the older adults. In this 
population, the lack of physical activity might have contributed to the observed 
worsening in mental health. During emergency periods, encouraging physical 
activity might be effective also to preserve psychological wellbeing.

Copyright © 2022. Published by Elsevier Ltd.

DOI: 10.1016/j.clnesp.2022.01.024
PMCID: PMC8802547
PMID: 35331509 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest None.


2241. Int J Circumpolar Health. 2022 Dec;81(1):2043577. doi: 
10.1080/22423982.2022.2043577.

How did Nunavummiut youth cope during the COVID-19 pandemic? A qualitative 
exploration of the resilience of Inuit youth leaders involved in the I-SPARX 
project.

Thomas A(1), Bohr Y(1), Hankey J(1), Oskalns M(1), Barnhardt J(1), Singoorie 
C(2).

Author information:
(1)Department of Psychology, York University, Toronto, Ontario, Canada.
(2)Nunabox, Iqaluit, Nunavut.

This study investigated how COVID-19 has affected the wellness of a group of 
Inuit youth leaders in Nunavut in the context of their involvement with an 
ongoing mental health research initiative, the Making I-SPARX Fly in Nunavut 
[I-SPARX] project. The study had three goals: (1) to understand how the pandemic 
has affected I-SPARX leaders' perceived involvement in the I-SPARX Project; (2) 
to build knowledge around how the pandemic has impacted the daily life and 
wellbeing of youth in Nunavummiut communities; and (3) to acquire a culturally 
specific understanding of their coping mechanisms and resilience strategies 
through the lens of Inuit Qaujimajatuqangit (IQ). Nine Inuit youth were 
interviewed virtually about their participation in I-SPARX, their life during 
the pandemic, and their coping strategies. Their comments were analysed using 
inductive thematic analysis. Pandemic challenges, the utility of I-SPARX 
teachings and participation, and culturally and community-embedded pathways to 
resilience were discussed.The implications of COVID-19 on Inuit youth in remote 
communities are not fully understood. The current study illuminates their 
experiences of the pandemic to inform future research on ways in which Inuit 
youth might be supported in situations, such as a global pandemic, that restrict 
their traditional resilience-enhancing activities and create social isolation.

DOI: 10.1080/22423982.2022.2043577
PMCID: PMC8959525
PMID: 35331088 [Indexed for MEDLINE]

Conflict of interest statement: No potential conflict of interest was reported 
by the author(s).


2242. Int J Environ Res Public Health. 2022 Mar 21;19(6):3745. doi: 
10.3390/ijerph19063745.

The Effect of the COVID-19 Pandemic on Pediatric Physician Wellness: A 
Cross-Sectional Study.

Belfer J(1), Feld L(1), Jan S(1)(2)(3), Fishbein J(2), Young JQ(4)(5), Barone 
S(1).

Author information:
(1)Pediatrics, Steven and Alexandra Cohen Children's Medical Center, New Hyde 
Park, New York, NY 11040, USA.
(2)The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, 
New York, NY 11030, USA.
(3)Medicine & Pediatrics, Donald and Barbara Zucker School of Medicine at 
Hofstra/Northwell, Hempstead, New York, NY 11549, USA.
(4)Psychiatry, Donald and Barbara Zucker School of Medicine at 
Hofstra/Northwell, Hempstead, New York, NY 11549, USA.
(5)Zucker Hillside Hospital at Northwell Health, Glen Oaks, New York, NY 11004, 
USA.

The COVID-19 pandemic has provided challenges to all healthcare workers. While 
the brunt of treating COVID-19 patients fell upon adult providers, pediatricians 
also experienced significant stressors and disruptions. Academic pediatricians 
and trainees (fellows and residents) were redeployed to manage adult patients in 
hospitalist and intensive care settings and/or had major changes to their 
clinical schedules. In this study, we aimed to describe levels of self-reported 
depression, anxiety, and burnout in pediatric physicians following the initial 
wave of the pandemic at the largest integrated health system in New York State. 
A cross-sectional study was conducted among pediatric physicians who cared for 
patients during the COVID-19 pandemic within the Northwell Health System as part 
of the Northwell Wellbeing Registry, a longitudinal registry assessing the 
psychological impact of COVID-19 on healthcare providers. A total of 99 
pediatric physician respondents were included in this study; 72% of whom were 
attendings, 28% of whom were trainees. Compared to attendings, trainees reported 
significantly higher proportions of burnout-emotional exhaustion (p = 0.0007) 
and burnout-depersonalization (p = 0.0011) on the Abbreviated Maslach Burnout 
Inventory. There was not a similar trend in probable depression or probable 
anxiety using the Patient Health Questionnaire. In a multivariable logistic 
regression model, being a trainee was significantly associated with increased 
odds of burnout-emotional exhaustion (OR 5.94, 95% Confidence Interval: 
1.85-19.02). These findings suggest that fellows and residents were a vulnerable 
population during the COVID-19 pandemic. Training programs should pay special 
attention to their trainees during times of crisis, and future studies can help 
to identify protective factors to reduce the risk of burnout during these times.

DOI: 10.3390/ijerph19063745
PMCID: PMC8952305
PMID: 35329432 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2243. Int J Environ Res Public Health. 2022 Mar 15;19(6):3494. doi: 
10.3390/ijerph19063494.

COVID-19 Pandemic in Portugal: Psychosocial and Health-Related Factors 
Associated with Psychological Discomfort.

Pais-Ribeiro J(1)(2), Ferreira-Valente A(2)(3), Jarego M(2), Sánchez-Rodríguez 
E(4)(5), Miró J(4)(5).

Author information:
(1)Faculty of Psychology and Education Sciences, University of Porto, 4200-135 
Porto, Portugal.
(2)William James Center for Research, ISPA-University Institute, 1100-304 
Lisbon, Portugal.
(3)Department of Rehabilitation Medicine, University of Washington, Seattle, WA 
98104, USA.
(4)Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, 
Research Center for Behavior Assessment (CRAMC), Department of Psychology, 43007 
Tarragona, Spain.
(5)Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 
43003 Catalonia, Spain.

The COVID-19 pandemic is a stressful long-lasting event with an increasingly 
negative impact upon individuals. This study aimed at assessing the magnitude of 
depression, anxiety, and stress among adults living in Portugal during the first 
mandatory lockdown of 2020, and the psychosocial and health-related factors 
associated with these symptoms. A sample of 484 adults (73% women) with an 
average age of 40 years old (Standard Deviation, SD = 14.03) responded to an 
online survey. The survey included measures of depression, anxiety, stress, 
social support, COVID-19 interference in daily life, attitudes towards COVID-19, 
and health perception. The impact of the lockdown on psychological well-being 
was large, with up to 36% of the participants showing signs of at least mild 
psychological discomfort (i.e., depression, anxiety, and stress). Social 
support, COVID-19 interference on daily life, health perception, and age, 
explained all the dependent variables. Education level, income, attitudes 
towards COVID-19, and gender explained some of the dependent variables. These 
results suggest that the COVID-19 pandemic has a serious impact on the 
psychological health of Portuguese adults. The role of the procedures to control 
the pandemic on the mental health of Portuguese adults should not be 
underestimated.

DOI: 10.3390/ijerph19063494
PMCID: PMC8948976
PMID: 35329180 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2244. Int J Environ Res Public Health. 2022 Mar 13;19(6):3391. doi: 
10.3390/ijerph19063391.

Young Adult Carers during the Pandemic: The Effects of Parental Illness and 
Other Ill Family Members on COVID-19-Related and General Mental Health Outcomes.

Landi G(1)(2), Pakenham KI(3), Grandi S(1)(2), Tossani E(1)(2).

Author information:
(1)Department of Psychology "Renzo Canestrari", University of Bologna, 40127 
Bologna, Italy.
(2)Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, 
University of Bologna, 47521 Cesena, Italy.
(3)School of Psychology, The University of Queensland, Brisbane, QLD 4072, 
Australia.

The mental health impacts of the COVID-19 pandemic on young adult carers have 
been neglected. This study aimed to identify COVID-19 related risk factors for 
young adult carers and to investigate their mental health relative to non-carer 
peers. Of the 1823 Italians aged 18-29 who completed an online survey, 1458 
reported no ill family member (non-carers). Young adult carers included 268 with 
an ill parent, and 97 with an ill non-parent family member. Two mental health 
outcome categories were measured: COVID-19-related (risky health behaviors, 
loneliness, home violence, fear of COVID-19) and general (anxiety, depression, 
wellbeing). Six COVID-19 related risk factors were significantly correlated with 
poorer mental health in young adult carers. These factors constituted a COVID-19 
Context Index. Compared to non-carers, young adult carers reported poorer mental 
health across all outcomes, as expected. The prediction that young adult carers 
caring for an ill parent would report poorer mental health than those caring for 
ill non-parent family members was evident only for the COVID-19-related mental 
health outcomes. The elevated rates of clinically significant distress and 
pandemic-related mental health problems among young adult carers highlight this 
group as a priority for mental health promotion interventions and 
whole-of-family support across multiple sectors.

DOI: 10.3390/ijerph19063391
PMCID: PMC8950288
PMID: 35329079 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2245. Int J Environ Res Public Health. 2022 Mar 12;19(6):3360. doi: 
10.3390/ijerph19063360.

The Predictors of Psychological Well-Being in Lithuanian Adolescents after the 
Second Prolonged Lockdown Due to COVID-19 Pandemic.

Jusienė R(1), Breidokienė R(1), Sabaliauskas S(2), Mieziene B(2), Emeljanovas 
A(2).

Author information:
(1)Faculty of Philosophy, Institute of Psychology, Vilnius University, LT-01513 
Vilnius, Lithuania.
(2)Faculty of Medicine, Institute of Health Sciences, Vilnius University, 
LT-03101 Vilnius, Lithuania.

Recent research highlights the impact of prolonged pandemics and lockdown on the 
mental health of youngsters. The second wave of COVID-19 brought an increase in 
mental health problems among young people. Therefore, this study aims to analyze 
the main factors arising from intra-individual, inter-individual, and 
environmental contexts that predict good psychological well-being in a group of 
adolescents after a second prolonged period of social restrictions and distance 
education. The study included 1483 school students from 11 to 19 years old. The 
survey assessed self-reported students' psychological well-being (WHO-5 index), 
physical activity, sedentary behavior, school social capital, communication with 
peers and relationships with parents, existing emotional and behavioral 
problems. The results indicated that 58% of adolescents were of good 
psychological well-being in spring 2021, after half a year in lockdown. Almost 
19% of adolescents had depression risk. The study revealed that during a period 
of prolonged isolation, male gender, better relationships between young people 
and their parents, the absence of serious emotional and behavioral problems, 
less sedentary behavior, and higher school social capital were found to be 
significant factors predicting adolescents' psychological well-being. Lower 
physical activity is an important contributor to students' poor well-being. 
Finally, the lack of face-to-face communication with peers was revealed as a 
specific factor in predicting adolescents with depression risk.

DOI: 10.3390/ijerph19063360
PMCID: PMC8949903
PMID: 35329053 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2246. Int J Environ Res Public Health. 2022 Mar 10;19(6):3259. doi: 
10.3390/ijerph19063259.

COVID-19 Pandemic Impacts on Children with Developmental Disabilities: Service 
Disruption, Transition to Telehealth, and Child Wellbeing.

Zhang S(1), Hao Y(2), Feng Y(3), Lee NY(1).

Author information:
(1)Department of Social Work, University of Mississippi, Oxford, MS 38677, USA.
(2)Department of Communication Sciences and Disorders, University of 
Mississippi, Oxford, MS 38677, USA.
(3)Social Sciences, Health and Education Library, University of Illinois at 
Urbana-Champaign, Urbana, IL 61801, USA.

The COVID-19 pandemic has resulted in substantial service disruption and 
transition from in-person services to telehealth for children with developmental 
disabilities. However, there is limited knowledge about the specific dimensions 
and consequences of the disruption and transition. This study aims to examine 
the extent of service disruption and transition, the experiences of client 
children and their caregivers with telehealth vis-à-vis in-person services, and 
the impacts of the disruption and transition on child wellbeing. The 
cross-sectional study collected data from parents of children with developmental 
disabilities using an online survey. McNemar's tests were used to compare 
service changes before and after the pandemic outbreak, and multivariate 
analyses were used to examine how service changes were associated with child 
wellbeing. Results show that more than two-thirds of the children experienced 
reduction in service amount, and one-third lost services for more than two 
months in about five months into the pandemic. While telehealth had comparable 
features relative to in-person services, it had lower ratings with respect to 
diagnostic accuracy, treatment effectiveness, and rapport building. Service 
disruption/transition and social isolation were associated with behavioral and 
emotional deterioration in children. However, child and family stress may have 
confounded these adverse effects. We concluded that the magnitude of service 
disruption and transition was large in the first half year after the pandemic 
outbreak, and the amount and duration of service loss varied substantially 
across clients. Diagnostic accuracy, treatment efficacy, and rapport building 
were areas in which parents had major concerns toward telehealth relative to 
in-person services. However, such drawbacks may partially be due to the limited 
logistics in telehealth implementation during the pandemic. Service disruption 
and transition seemed to contribute to family stress, which played a direct role 
in eroding child wellbeing. Implications of these findings for future research 
and practices are discussed.

DOI: 10.3390/ijerph19063259
PMCID: PMC8951004
PMID: 35328947 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2247. Int J Environ Res Public Health. 2022 Mar 9;19(6):3236. doi: 
10.3390/ijerph19063236.

The Well-Being of the German Adult Population Measured with the WHO-5 over 
Different Phases of the COVID-19 Pandemic: An Analysis within the COVID-19 
Snapshot Monitoring Study (COSMO).

Tsai FY(1)(2), Schillok H(1)(2), Coenen M(1)(2), Merkel C(3), Jung-Sievers 
C(1)(2), On Behalf Of The Cosmo Study Group.

Author information:
(1)Chair of Public Health and Health Services Research, Institute for Medical 
Information Processing, Biometry, and Epidemiology-IBE, 
Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany.
(2)Pettenkofer School of Public Health, Elisabeth-Winterhalter-Weg 6, 81377 
Munich, Germany.
(3)Federal Centre for Health Education (BZgA), Maar-Weg 149-161, 50825 Cologne, 
Germany.

The aim of this study is to evaluate factors associated with the subjective 
well-being (SWB) and suspected depression measured with WHO-5 among German 
adults during different phases of the COVID-19 pandemic. Survey data were 
analyzed from the COVID-19 Snapshot Monitoring (COSMO) study, which collected 
data from 972, 1013, and 973 participants in time point 1 (19-20 May 2020), time 
point 2 (15-16 September 2020), and time point 3 (21-22 December 2020), 
respectively. Descriptive analyses and logistic regression analyses to identify 
the factors associated with suspected depression (WHO-5 ≤ 50) were conducted. 
Data showed that the mean WHO-5 scores in three time points were 56.17, 57.27, 
and 53.93, respectively. The risk of suspected depression was increased by about 
1.5 times for females, 2.5-3 times among 18-24 year-olds compared to ages above 
65 years, 1.5 times for singles, 2 times for those with chronic illnesses, and 
2-3 times for people living in poverty. The main study findings show that German 
adult SWB is lower than pre-pandemic reference values. Special focus should be 
placed on vulnerable groups, such as females, younger persons, and people living 
in poverty who are most prone to a reduction in SWB and therefore suspected 
depression.

DOI: 10.3390/ijerph19063236
PMCID: PMC8955618
PMID: 35328923 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2248. Int J Environ Res Public Health. 2022 Mar 9;19(6):3219. doi: 
10.3390/ijerph19063219.

A Scoping Review of the Health Impact of the COVID-19 Pandemic on Persons 
Experiencing Homelessness in North America and Europe.

Corey J(1), Lyons J(1), O'Carroll A(2), Stafford R(3), Ivers JH(1).

Author information:
(1)Department of Public Health & Primary Care, School of Medicine, Trinity 
College Dublin, D24H74 Dublin, Ireland.
(2)North Dublin City GP Training Scheme, D07H984 Dublin, Ireland.
(3)HSE Community Healthcare Organisation Dublin North City & County, D09C8P5 
Dublin, Ireland.

Persons experiencing homelessness (PEH) are at heightened risk for infection, 
morbidity, and mortality from COVID-19. However, health consequences of the 
pandemic extend far beyond those directly caused by the virus. This scoping 
review aimed to explore the impacts of the COVID-19 pandemic on the health and 
well-being of PEH in North America and Europe. A systematic search of academic 
and grey literature was conducted in September 2021. To be included, studies had 
to include primary data related to the impact of the pandemic on health or 
well-being of PEH and be written in English. All potentially relevant references 
were independently screened by two reviewers, and minor conflicts were settled 
with input of a third reviewer. A total of 96 articles met criteria for 
inclusion. Data extraction was completed for all included studies, and findings 
synthesised and presented thematically. Numerous health impacts of the pandemic 
on PEH were identified, including SARS-CoV-2 infection, morbidity, mortality, 
and hospitalisation, fear of infection, access to housing, hygiene, PPE, food, 
as well as mental health, substance use, other health-related outcomes and 
treatment services. Gaps in the literature relating to persons using alcohol, 
access to mental health support, and violence were also identified. Implications 
for future research are discussed.

DOI: 10.3390/ijerph19063219
PMCID: PMC8954292
PMID: 35328907 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. 
While two authors work for the funding agency (A.O. and R.S.), the funders had 
no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript; or in the decision to 
publish the results.


2249. Int J Environ Res Public Health. 2022 Mar 8;19(6):3166. doi: 
10.3390/ijerph19063166.

A Longitudinal Study on Mental Well-Being, Perceived Stress Level and 
Job-Related Meaningfulness of Austrian Telephone Emergency Service Counselors 
during the COVID-19 Pandemic.

Humer E(1), Pieh C(1), Kisler IM(2), Schimböck W(2), Schadenhofer P(2)(3).

Author information:
(1)Department for Psychotherapy and Biopsychosocial Health, University for 
Continuing Education Krems, 3500 Krems, Austria.
(2)ABILE-Viktor Frankl Education Austria, 3390 Melk, Austria.
(3)Telephone Emergency Service-Lower Austria (TelefonSeelsorge NÖ), Diocese St. 
Pölten, 3100 St. Pölten, Austria.

Telephone emergency service (TES) consultants have been challenged even more 
since the beginning of the pandemic. How the COVID-19 situation and the 
associated increasing demand for TES services affect the well-being and stress 
of TES counselors has not been assessed so far. This longitudinal study examined 
mental well-being (WHO-5), perceived stress level (PSS-10), and experienced 
job-related meaningfulness (CERES) of TES counselors at two measurement points 
during the pandemic. From December 2020 to January 2021 (t1), N = 374 counselors 
were recruited within the Austrian nationwide organization “TelefonSeelsorge”. 
From those, N = 108 also participated one year later at t2. Neither well-being 
nor perceived stress differed significantly between t1 and t2. There was a 
decrease in job-related meaningfulness (from 5.46 at t1 to 5.34 at t2; p < 
0.001). The consultants identified loneliness and mental health as the most 
common problems of helpline callers at both measurement points. The results 
confirm a stable level of stress and well-being during the pandemic in TES 
consultants. However, they also show a slight decrease in perceived job-related 
meaningfulness. Well-being of counselors should be watched closely, as they are 
an important part of the psychosocial healthcare system.

DOI: 10.3390/ijerph19063166
PMCID: PMC8954390
PMID: 35328853 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2250. J Public Health (Oxf). 2023 Jun 14;45(2):499-504. doi: 10.1093/pubmed/fdac034.

Conversations that warm the heart: positive and negative links to the mental 
health challenges of the Covid-19 pandemic.

Peterson CC(1).

Author information:
(1)School of Psychology, University of Queensland, Brisbane, Queensland 4072, 
Australia.

BACKGROUND: Public-health precautions to curb Covid-19 (e.g. lockdowns) threaten 
mental health and emotional wellbeing, especially for today's youngest adults. 
Their overuse of solitary, screen-mediated social media, plus underdeveloped 
in-person conversation skills, heighten their vulnerability to mental health 
problems such as loneliness, anxiety and depression.
METHODS: To explore interconnections among variables such as social media use, 
empathic skills for in-person conversation and strategies for coping with 
Covid-19 anxiety, Australian 18- to 26-year-olds took several novel in-depth 
questionnaire measures that were purpose-built for the present research.
RESULTS: Main findings were threefold: (i) Individuals who most frequently and 
wholeheartedly enjoyed live in-person conversations with friends suffered the 
most Covid-19 anxiety, worry and stress during periods of pandemic restriction. 
(ii) Empathic conversational skills were highest among those who conversed 
in-person (by phone or face-to-face) most often and were lowest for those who 
rarely did so and/or had little skill with in-person conversation. (iii) Those 
who gained the greatest relief from anxiety (e.g. about Covid-19) through 
solitary use of screen-based social media and games had the fewest empathic 
conversational skills.
CONCLUSIONS: Implications of these findings for suggesting possible future 
interventions to help young people cope with public health measures such as 
lockdowns and to foster community health and wellbeing are discussed.

© The Author(s) 2022. Published by Oxford University Press on behalf of Faculty 
of Public Health. All rights reserved. For permissions, please e-mail: 
journals.permissions@oup.com.

DOI: 10.1093/pubmed/fdac034
PMID: 35325232 [Indexed for MEDLINE]


2251. PLoS One. 2022 Mar 24;17(3):e0263856. doi: 10.1371/journal.pone.0263856. 
eCollection 2022.

Behavioural Activation for Social IsoLation (BASIL+) trial (Behavioural 
activation to mitigate depression and loneliness among older people with 
long-term conditions): Protocol for a fully-powered pragmatic randomised 
controlled trial.

Burke L(1), Littlewood E(1), Gascoyne S(1), McMillan D(1)(2), Chew-Graham CA(3), 
Bailey D(1), Sloan C(1), Fairhurst C(1), Baird K(1), Hewitt C(1), Henry A(1)(4), 
Ryde E(1)(4), Shearsmith L(5), Coventry P(1), Crosland S(1), Newbronner E(1), 
Traviss-Turner G(5), Woodhouse R(1), Clegg A(5), Gentry T(6), Hill A(5), Lovell 
K(7), Dexter Smith S(4), Webster J(8), Ekers D(1)(4), Gilbody S(1)(2).

Author information:
(1)Department of Health Sciences, University of York, York, United Kingdom.
(2)Hull York Medical School, University of York, York, United Kingdom.
(3)School of Medicine, Keele University, Staffordshire, United Kingdom.
(4)Tees, Esk and Wear Valleys NHS FT, Research & Development, Flatts Lane 
Centre, Middlesbrough, United Kingdom.
(5)Leeds Institute of Health Sciences, University of Leeds, Leeds, United 
Kingdom.
(6)Age UK, Tavis House, 1-6 Tavistock Square, London United Kingdom.
(7)Division of Nursing, Midwifery & Social Work, University of Manchester, 
Manchester, United Kingdom.
(8)Patient and Public Representative, United Kingdom.

INTRODUCTION: Depression is a leading mental health problem worldwide. People 
with long-term conditions are at increased risk of experiencing depression. The 
COVID-19 pandemic led to strict social restrictions being imposed across the UK 
population. Social isolation can have negative consequences on the physical and 
mental wellbeing of older adults. In the Behavioural Activation in Social 
IsoLation (BASIL+) trial we will test whether a brief psychological intervention 
(based on Behavioural Activation), delivered remotely, can mitigate depression 
and loneliness in older adults with long-term conditions during isolation.
METHODS: We will conduct a two-arm, parallel-group, randomised controlled trial 
across several research sites, to evaluate the clinical and cost-effectiveness 
of the BASIL+ intervention. Participants will be recruited via participating 
general practices across England and Wales. Participants must be aged ≥65 with 
two or more long-term conditions, or a condition that may indicate they are 
within a 'clinically extremely vulnerable' group in relation to COVID-19, and 
have scored ≥5 on the Patient Health Questionnaire (PHQ9), to be eligible for 
inclusion. Randomisation will be 1:1, stratified by research site. Intervention 
participants will receive up to eight intervention sessions delivered remotely 
by trained BASIL+ Support Workers and supported by a self-help booklet. Control 
participants will receive usual care, with additional signposting to reputable 
sources of self-help and information, including advice on keeping mentally and 
physically well. A qualitative process evaluation will also be undertaken to 
explore the acceptability of the BASIL+ intervention, as well as barriers and 
enablers to integrating the intervention into participants' existing health and 
care support, and the impact of the intervention on participants' mood and 
general wellbeing in the context of the COVID-19 restrictions. Semi-structured 
interviews will be conducted with intervention participants, participant's 
caregivers/supportive others and BASIL+ Support Workers. Outcome data will be 
collected at one, three, and 12 months post-randomisation. Clinical and 
cost-effectiveness will be evaluated. The primary outcome is depressive symptoms 
at the three-month follow up, measured by the PHQ9. Secondary outcomes include 
loneliness, social isolation, anxiety, quality of life, and a bespoke health 
services use questionnaire.
DISCUSSION: This study is the first large-scale trial evaluating a brief 
Behavioural Activation intervention in this population, and builds upon the 
results of a successful external pilot trial.
TRIAL REGISTRATION: ClinicalTrials.Gov identifier ISRCTN63034289, registered on 
5th February 2021.

DOI: 10.1371/journal.pone.0263856
PMCID: PMC8947398
PMID: 35324908 [Indexed for MEDLINE]

Conflict of interest statement: We have read the journal’s policy and the 
authors of this manuscript have the following competing interests. DE and CCG 
are current committee members for the NICE Depression Guideline (update) 
Development Group, and SG was a member between 2015-18. SG, PC and DMcM are 
supported by the NIHR Yorkshire and Humberside Applied Research Collaboration 
(ARC) and DE is supported by the North East and North Cumbria ARCs.


2252. Int J Occup Saf Ergon. 2023 Mar;29(1):407-423. doi: 
10.1080/10803548.2022.2057011. Epub 2022 Apr 26.

The mediator role of well-being in the effect of COVID-19 anxiety on 
occupational commitment: research in the aviation sector.

Yüksek H(1), Çelik M(1), Keser A(2).

Author information:
(1)Department of Business Administration, Hasan Kalyoncu University, Turkey.
(2)Department of Political Science and International Relations, Hasan Kalyoncu 
University, Turkey.

The coronavirus (COVID-19) pandemic, which emerged in China in December 2019, 
has severely affected many industries across the world and created substantial 
psychological, social and economic impact on individuals. With the coronavirus 
outbreak labelled as a pandemic by the World Health Organization, the first 
measures have been taken for the aviation industry. The crisis environment 
created by the pandemic had a negative impact on aviation personnel. The main 
purpose of this research is to investigate the mediator role of employee 
well-being in the effect of COVID-19 anxiety on occupational commitment. The 
data were collected through a survey of cabin and cockpit staff (n = 3862). 
After the analyses, it was found that the effect of COVID-19 anxiety on 
well-being, and occupational affective and normative commitment was significant. 
Moreover, it is among the findings that well-being has a partial mediator role 
in the effect of COVID-19 anxiety on occupational affective and normative 
commitment.

DOI: 10.1080/10803548.2022.2057011
PMID: 35322753 [Indexed for MEDLINE]


2253. Qual Life Res. 2022 Aug;31(8):2295-2305. doi: 10.1007/s11136-022-03113-2. Epub 
2022 Mar 24.

Flattening the quality of life curve? A prospective person-centred study from 
Norway amid COVID-19.

Nes RB(1)(2), Yu B(3)(4), Hansen T(3)(4), Vedaa Ø(5)(6)(7)(8), Røysamb E(4)(9), 
Nilsen TS(3).

Author information:
(1)Department of Mental Health and Suicide, The Norwegian Institute of Public 
Health, Oslo, Norway. raba@fhi.no.
(2)Promenta Research Centre, Department of Psychology, University of Oslo, Oslo, 
Norway. raba@fhi.no.
(3)Department of Mental Health and Suicide, The Norwegian Institute of Public 
Health, Oslo, Norway.
(4)Promenta Research Centre, Department of Psychology, University of Oslo, Oslo, 
Norway.
(5)Department of Health Promotion, Norwegian Institute of Public Health, Bergen, 
Norway.
(6)Department of Mental Health, Norwegian University of Science and Technology, 
Trondheim, Norway.
(7)Voss District Psychiatric Hospital, NKS Bjørkeli, Voss, Norway.
(8)Department of Research and Development, St. Olavs University Hospital, 
Trondheim, Norway.
(9)Department of Child Health and Development, The Norwegian Institute of Public 
Health, Oslo, Norway.

PURPOSE: We examined multidimensional, heterogeneous reactions to the COVID-19 
pandemic and associated measures to provide further insights into the 
developmental processes of risk and adaptation.
METHOD: We used three-wave questionnaire data from 8156 individuals 
participating in the Norwegian County Public Health Survey assessed 1-5 months 
before and three (June 2020) and nine (December 2020) months after the outbreak. 
Latent profile and latent transition analyses were used to identify latent 
quality of life (QoL) classes and multiform changes, their probabilities, and 
predictors.
RESULTS: We identified five distinct QoL classes of varying proportions, namely 
Flourishing (i.e. 24-40%), Content (31-46%), Content-Symptomatic (8-10%), 
Languishing (14-20%), and Troubled (2-5%). Despite higher levels of negative 
affect and lower levels of life satisfaction and positive emotions, most 
individuals remained in their pre-pandemic QoL profiles. Yet, changes occurred 
for a meaningful proportion, with transition to a less favourable class more 
common than to a favourable. Between time 1 and 3, the flourishing and troubled 
groups decreased by 40% and 60%, while the content and languishing groups 
increased by 48% and 43%, respectively. Favourable pre-pandemic relational 
(marital status, support, interpersonal trust, and belonging), health, and 
economy-related status predicted significantly lower odds of belonging to the 
high-risk groups both pre-pandemic and during the pandemic.
CONCLUSIONS: Overall, this study shows lower levels of QoL amid the COVID-19 
pandemic, but substantial stability in the QoL distribution, and an overall 
levelling of the QoL distribution. Our findings also underscore the importance 
of financial, health-related, and social capital to QoL.

© 2022. The Author(s).

DOI: 10.1007/s11136-022-03113-2
PMCID: PMC8942803
PMID: 35322305 [Indexed for MEDLINE]

Conflict of interest statement: A competing interests declaration is mandatory 
for publication in this journal. Please confirm that this declaration is 
accurate, or provide an alternative.


2254. Psychiatry Res. 2022 May;311:114501. doi: 10.1016/j.psychres.2022.114501. Epub 
2022 Mar 7.

Mental health of healthcare workers of Latin American countries: a review of 
studies published during the first year of COVID-19 pandemic.

Rosales Vaca KM(1), Cruz Barrientos OI(1), Girón López S(1), Noriega S(1), More 
Árias A(1), Guariente SMM(2), Zazula R(3).

Author information:
(1)School of Medicine, Federal University of Latin American Integration, Foz do 
Iguacu, Brazil.
(2)Londrina State University, Londrina, Brazil.
(3)School of Medicine, Federal University of Latin American Integration, Foz do 
Iguacu, Brazil. Electronic address: robsonzazula@gmail.com.

OBJECTIVE: Identify and review articles that evaluated mental health of HCW of 
Latin American countries (except Brazil), published during the first year of 
COVID-19 pandemic.
METHOD: We systematically searched EMBASE, PsycINFO, Scopus, PUBMED/ Medline, 
Web of Science, PePSIC, and Scielo for articles published during the first year 
of the COVID-19 pandemic. Two independent researchers reviewed titles and 
abstracts and then, for eligible studies, extracted data from full texts. 
Outcomes included mental health variables, country where the study was 
conducted, period of data collection, healthcare professional categories, study 
design, mental health measurements and main outcomes. The quality and risk 
assessment was also performed.
RESULTS: Out of 248 records identified, 24 initially were assessed for 
eligibility. From those, 17 studies matched eligibility criteria and were 
included in the review. Higher scores of anxiety were reported in different 
studies, as well as an increased level of depression among HCW. Being a female, 
younger age, and closer distance of the epicenter of the outbreak increased the 
likelihood to develop mental health disorder. Concerns and fear related to 
COVID-19 have a greater impact on stress, anxiety, and depression symptoms.
CONCLUSION: Our findings highlight that COVID-19 pandemic had been worse for HCW 
from Latin America, showing the harmful effects of burnout on their health. 
Greater psychological distress, as well as anxiety and depression had been 
experienced by HCW from Latin America in their fight against COVID-19, 
demonstrating the importance of psychological well-being policies for them 
during and post- the pandemic.

Copyright © 2022 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.psychres.2022.114501
PMCID: PMC8900936
PMID: 35320759 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no known 
competing financial interests or personal relationships that could have appeared 
to influence the work reported in this paper.


2255. Healthc Policy. 2022 Feb;17(3):49-64. doi: 10.12927/hcpol.2022.26728.

Effects of the COVID-19 Pandemic on Healthcare Providers: Policy Implications 
for Pandemic Recovery.

Limoges J(1), Mclean J(2), Anzola D(3), Kolla NJ(4).

Author information:
(1)Associate Professor, Athabasca University, Athabasca, AB; Faculty, Georgian 
College, Barrie, ON.
(2)Research Manager, Royal Victoria Regional Health Centre, Barrie, ON.
(3)Research Associate, Department of Research and Innovation, Georgian College, 
Barrie, ON.
(4)Research Chair in Forensic Mental Health Science, Waypoint Centre for Mental 
Health Care, Penetanguishene, ON; Clinician Scientist, Centre for Addiction and 
Mental Health, Toronto, ON.

BACKGROUND: Notably higher rates of mental health issues have been reported 
among healthcare providers (HCPs) during the COVID-19 pandemic. Concerns over 
the impact of policy decisions on the well-being of HCPs is growing, yet it 
remains underexplored in the literature.
METHOD: HCPs from a 301-bed mental health hospital and a 408-bed acute care 
community hospital, both located in central Ontario, participated in interviews 
(N = 30) and answered open-ended questionnaires (N = 88) to provide their 
experiences with the COVID-19 pandemic.
RESULTS: Using interpretive description methods, we found that public health 
policies and other strategies intended to mitigate COVID-19 transmission 
variably impacted HCP well-being and professional practice.
DISCUSSION: Pandemic-related policies contributed to HCP stress by changing the 
healthcare environment and clinical practice. Understanding HCP experiences is 
key for leaders, policy makers and health system planners to deal with the 
current state, recovery and preparation for future pandemics. Direct input into 
policy development, implementation and evaluation from HCPs may support their 
well-being.

CONTEXTE: Des taux nettement plus élevés de problèmes de santé mentale ont été 
signalés chez les fournisseurs de soins de santé pendant la pandémie de la 
COVID-19. Les inquiétudes concernant l'impact des décisions politiques sur le 
bien-être des professionnels de la santé augmentent, mais elles restent 
sous-étudiées dans la littérature.
MÉTHODE: Les fournisseurs de soins de santé d'un hôpital de santé mentale de 301 
lits et d'un hôpital communautaire de soins de courte durée de 408 lits, tous 
deux situés dans le centre de l'Ontario, ont participé à des entrevues (N = 30) 
et ont répondu à des questionnaires ouverts (N = 88) pour faire part de leur 
expérience dans le contexte de la pandémie de la COVID-19.
RÉSULTATS: À l'aide de méthodes de description interprétative, nous avons 
observé que les politiques de santé publique et d'autres stratégies visant à 
atténuer la transmission de la COVID-19 avaient un impact variable sur le 
bien-être et la pratique professionnelle des fournisseurs de soins de santé.
DISCUSSION: Les politiques liées à la pandémie ont contribué au stress des 
fournisseurs de services de santé en modifiant l'environnement des soins et la 
pratique clinique. Comprendre l'expérience des fournisseurs de soins est 
essentiel aux dirigeants, aux décideurs et aux planificateurs du système de 
santé pour faire face à l'état actuel, au rétablissement et à la préparation à 
d'éventuelles pandémies. La contribution directe des fournisseurs de soins à 
l'élaboration, à la mise en œuvre et à l'évaluation des politiques peut 
contribuer à leur bien-être.

Copyright © 2022 Longwoods Publishing.

DOI: 10.12927/hcpol.2022.26728
PMCID: PMC8935928
PMID: 35319444 [Indexed for MEDLINE]


2256. Recenti Prog Med. 2022 Mar;113(3):172-176. doi: 10.1701/3761.37482.

[Mental health and pandemic in children and adolescents: what is likely to label 
as "long-covid".].

[Article in Italian]

Cozzi G(1), Iacono A(2), Troisi A(2), Marchetti F(2).

Author information:
(1)IRCCS Materno-Infantile "Burlo Garofolo", Trieste.
(2)UOC di Pediatria e Neonatologia, Ospedale di Ravenna, AUSL della Romagna.

Long-covid is a typical condition of adults with a history of probable or 
confirmed SARS-CoV-2 infection in the previous 3 months and with symptoms 
lasting over 2 months not explained by an alternative diagnosis. In pediatric 
age the lack of significative differences comparing the reported symptoms 
between seropositive and seronegative suggests that long-covid might be less 
common than previously thought, emphasizing the impact of pandemic-associated 
symptoms regarding the well-being and mental health of young adolescents. Many 
children-adolescents, who have had SARS-CoV-2 infection or not, have a health 
request to which we must respond with a professional approach aimed at a complex 
functional rehabilitation. The risk is that the "long-covid" becomes a 
"long-inattention" on relevant mental health problems.

DOI: 10.1701/3761.37482
PMID: 35315447 [Indexed for MEDLINE]


2257. Clin Psychol Psychother. 2022 Sep;29(5):1707-1716. doi: 10.1002/cpp.2736. Epub 
2022 Apr 11.

Path analysis from COVID-19 perceptions to psychological health: The roles of 
critical distance and mastery.

Faustino B(1)(2), Vasco AB(1), Farinha-Fernandes A(1), Delgado J(1), Guerreiro 
JC(1), Matos M(3).

Author information:
(1)Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal.
(2)HEI-Lab, Lusófona University, Lisbon, Portugal.
(3)Instituto Universitário de Lisboa (ISCTE-IUL), CIS-ISCTE, Lisbon, Portugal.

OBJECTIVE: The Coronavirus disease 2019 (COVID-19) pandemic was previously 
associated with psychopathological symptoms. However, the psychological 
mechanisms underlying these associations are largely unexplored. Previous 
studies suggested associations between metacognitive abilities (e.g., mastery) 
and symptomatology, which may have impacts on COVID-19 perceptions. This study 
aims to explore, using path analysis, the mediational role of Critical Distance 
(differentiation and decentration abilities) and Mastery on the relationships 
between COVID-19 perceptions and psychological well-being and distress.
METHODS: In a cross-sectional design, 227 participants (M = 34.21, SD = 10.9) 
filled self-report questionnaires.
RESULTS: Metacognitive abilities were negatively correlated with 
psychopathological symptoms. Both Critical Distance and Mastery mediated the 
path from COVID-19 perceived severity and anxiety to psychological distress and 
well-being. Critical Distance seems to augment Mastery which tends to increase 
psychological well-being and limited psychological distress.
CONCLUSIONS: Metacognition seems to play a mediational role on the relationship 
between COVID-19 perceptions and mental health. Clinical psychologists and 
psychotherapists may enhance psychological interventions regarding COVID-19 
psychopathological symptomatology by working on metacognitive Critical Distance 
and Mastery abilities.

© 2022 John Wiley & Sons, Ltd.

DOI: 10.1002/cpp.2736
PMCID: PMC9087008
PMID: 35315180 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest


2258. J Rural Health. 2022 Sep;38(4):795-804. doi: 10.1111/jrh.12659. Epub 2022 Mar 
21.

Anxiety, depression, stress, burnout, and professional quality of life among the 
hospital workforce during a global health pandemic.

Kelly D(1), Schroeder S(2)(3), Leighton K(2)(3).

Author information:
(1)McKenzie County Healthcare Systems, Inc., Watford City, North Dakota, USA.
(2)School of Medicine & Health Sciences, University of North Dakota, Grand 
Forks, North Dakota, USA.
(3)Mountain Plains Mental Health Technology Transfer Center.

PURPOSE: Working in a hospital setting during a global health pandemic can lead 
to increased levels of anxiety, stress, burnout, and depression. Anecdotal 
evidence exists, but there is little research utilizing clinically validated 
tools to measure hospital staff psychological distress.
METHODS: In Summer 2021, 771 hospital staff in North Dakota responded to an 
electronic survey collecting demographic data and employing validated behavioral 
health screening tools to assess anxiety, depression, emotional distress, and 
work-related quality of life.
FINDINGS: Compassion satisfaction was significantly higher for those who worked 
in rural areas than urban [t(769) = -1.99, P = .0467]. The burnout rating was 
significantly higher for those who worked in urban areas than rural [t(769) = 
2.23, P = .0261)]. There was no significant geographic variation in stress, 
anxiety, or depression. Anxiety, depression, burnout, and stress were all 
significantly higher for those who worked directly with COVID-19 patients than 
those who did not, regardless of hospital location.
CONCLUSIONS: Hospital staff caring for COVID-19 patients experienced equitable 
(and high) levels of depression and anxiety. However, data indicate that rural 
providers experienced greater protective factors, resulting in lower rates of 
burnout and higher compassion satisfaction. Rural communities, hospitals, and 
health systems may have characteristics that could be duplicated in urban areas 
to support hospital staff well-being. Support and promotion of mental wellness 
must also come from the hospital system, and health care and policy leaders. If 
we do not care for our hospital staff, there will not be hospital staff left to 
care for the community.

© 2022 The Authors. The Journal of Rural Health published by Wiley Periodicals 
LLC on behalf of National Rural Health Association.

DOI: 10.1111/jrh.12659
PMCID: PMC9790729
PMID: 35315126 [Indexed for MEDLINE]

Conflict of interest statement: The 3 authors have no personal or financial 
disclosures to report.


2259. Br J Gen Pract. 2022 Apr 28;72(718):e325-e333. doi: 10.3399/BJGP.2021.0680. 
Print 2022 May.

GP wellbeing during the COVID-19 pandemic: a systematic review.

Jefferson L(1), Golder S(1), Heathcote C(1), Avila AC(1), Dale V(1), Essex H(1), 
van der Feltz Cornelis C(1), McHugh E(1), Moe-Byrne T(1), Bloor K(1).

Author information:
(1)Department of Health Sciences, University of York, York.

BACKGROUND: Doctors' organisations in the UK have reported worrying levels of 
work-related stress and burnout in the GP workforce for some time, and the 
COVID-19 pandemic has presented clear new challenges.
AIM: To synthesise international evidence exploring the impact of COVID-19 on 
primary care doctors' mental health and wellbeing, and identify risk factors 
associated with their psychological wellbeing during this time.
DESIGN AND SETTING: Mixed-methods systematic review.
METHOD: Six bibliographic databases, Google Scholar, and MedRxiv were searched 
on 19 November 2020 and 3 June 2021 to identify studies of GP psychological 
wellbeing during the pandemic. Reference checking was also conducted. Two 
reviewers selected studies, extracted data, and assessed the quality of studies 
using standardised tools. Heterogeneity in outcomes, setting, and design 
prohibited statistical pooling; studies were combined using a convergent 
integrated thematic synthesis.
RESULTS: Thirty-one studies were included. Multiple sources of stress were 
identified including changed working practices; risk, exposure, and inadequate 
personal protective equipment (PPE); information overload; pandemic 
preparedness; and cohesion across sectors. Studies demonstrated an impact on 
psychological wellbeing, with some GPs experiencing stress, burnout, anxiety, 
depression, fear of COVID-19, lower job satisfaction, and physical symptoms. 
Studies reported gender and age differences: women GPs had poorer psychological 
outcomes across all domains, and older GPs reported greater stress and burnout. 
Use of outcome measures and reporting practice varied greatly.
CONCLUSION: This review of international evidence demonstrates that the COVID-19 
pandemic has adversely affected GPs' wellbeing around the world. Further 
research could explore gender and age differences, identifying interventions 
targeted to these groups.

© The Authors.

DOI: 10.3399/BJGP.2021.0680
PMCID: PMC8966782
PMID: 35314428 [Indexed for MEDLINE]


2260. BMC Psychol. 2022 Mar 21;10(1):76. doi: 10.1186/s40359-022-00729-4.

UK children's sleep and anxiety during the COVID-19 pandemic.

Knowland VCP(1)(2), van Rijn E(3), Gaskell MG(3), Henderson L(3).

Author information:
(1)Department of Psychology, University of York, York, YO10 5DD, UK. 
vic.knowland@newcastle.ac.uk.
(2)Speech and Language Sciences, Newcastle University, Newcastle upon Tyne, NE1 
7RU, UK. vic.knowland@newcastle.ac.uk.
(3)Department of Psychology, University of York, York, YO10 5DD, UK.

BACKGROUND: Sleep and mental wellbeing are intimately linked. This relationship 
is particularly important to understand as it emerges over childhood. Here we 
take the opportunity that the COVID-19 pandemic, and resulting lockdown in the 
UK, presented to study sleep-related behaviour and anxiety in school-aged 
children.
METHODS: Parents and children were asked to complete questionnaires towards the 
start of the UK lockdown in April-to-May of 2020, then again in August of that 
year (when many restrictions had been lifted). We explored children's emotional 
responses to the pandemic and sleep patterns at both time points, from the 
perspectives of parents and children themselves.
RESULTS: Children's bedtime anxiety increased at the start of the lockdown as 
compared to a typical week; however, by August, bedtime anxiety had ameliorated 
along with children's COVID-19 related anxiety. Bedtime anxiety predicted how 
long it took children to fall asleep at night at both the start and the end of 
the lockdown. Bedtime and wake-up time shifted at the start of lockdown, but 
interestingly total sleep time was resilient (likely owing to an absence of 
early school start times) and was not predicted by child anxiety.
CONCLUSIONS: These findings further support calls for sleep quality (in 
particular, time taken to fall asleep) to be taken as a key indicator of mental 
health in children, particularly under usual circumstances when schools are open 
and sleep duration may be less resilient.

© 2022. The Author(s).

DOI: 10.1186/s40359-022-00729-4
PMCID: PMC8936042
PMID: 35313993 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2261. Psychiatr Hung. 2022;37(1):64-75.

[Recommendation for a programme transforming and improving mental health 
services - starting the debate].

[Article in Hungarian]

Kapócs G(1), Bacsák D.

Author information:
(1)E-mail: gabor.kapocs@gmail.com.

Today mental health services face various challenges for which they are barely 
or not at all prepared under current structural, functional and financial 
circumstances, while the mental effects of the COVID-19 pandemic are yet to be 
fully recognized. In Hungary, health and social services provide mental health 
services collectively, although simul taneously: in many cases, vertical and 
horizontal cooperation tends to be incidental or completely lacking among 
treatment types and stages, causing perplexing patient journeys, significant 
regional disparities, and deficiencies in the necessary multidisciplinary 
approach. In our thesis, first we start from the definition of health by WHO, 
which brings well-being to the forefront, then we attempt to present a 
comprehensive assessment of the current situation of the Hungarian social and 
health care system regarding mental health, introducing international and 
domestic statistics along with foreign national public policy programmes. 
Finally, with particular attention to the recommendations of various 
professional programmes, we present a proposal for the reform and development of 
integrated social and health care systems. Along with delivering a keynote 
address, we hope to attract the critical attention of a wide range of mental 
health professionals with our proposed programme.

PMID: 35311699 [Indexed for MEDLINE]


2262. Aging Ment Health. 2023 Mar;27(3):496-504. doi: 10.1080/13607863.2022.2053836. 
Epub 2022 Mar 21.

Tai chi or health education for older adults with hypertension: effects on 
mental health and psychological resilience to COVID-19.

Kohn JN(1)(2), Lobo JD(1), Troyer EA(1), Wilson KL(3), Ang G(1), Walker AL(3), 
Pruitt C(3), Pung MA(3), Redwine LS(4)(5), Hong S(1)(3).

Author information:
(1)Department of Psychiatry, University of California San Diego, La Jolla, CA, 
USA.
(2)Sam and Rose Stein Institute for Research on Aging, University of California 
San Diego, La Jolla, CA, USA.
(3)Herbert Wertheim School of Public Health, University of California San Diego, 
La Jolla, CA, USA.
(4)College of Behavioral and Community Sciences, University of South Florida, 
Tampa, FL, USA.
(5)Department of Public Health Sciences, University of Miami, Miller School of 
Medicine, Miami, FL, USA.

OBJECTIVE: To compare the effectiveness of 12 weeks of community-based, 
in-person, group Tai Chi (TC) and Health Education (HAP-E) in improving health 
and wellbeing in older adults with hypertension and in promoting psychological 
resilience during COVID-19.
METHODS: A 12-week randomized controlled trial (RCT) in San Diego County, USA. 
Self-reported depressive symptoms, anxiety, sleep disturbances, gratitude, 
resilience, mental and physical health were assessed in-person pre- and 
post-intervention, and by long-term follow-up surveys during COVID-19. Linear 
mixed-effects models were used to assess study arm differences over time and 
logistic regression to identify predictors of positive intervention response.
RESULTS: Of 182 randomized participants (72.6 ± 7.9 yrs; 72% female), 131 
completed the intervention. Modest improvements in health and wellbeing occurred 
post-intervention in both arms (Cohen's d: TC = 0.38, 95% CI: 0.25-0.51; 
HAP-E = 0.24, 0.11-0.37), though positive intervention responses were more than 
twice as likely in TC (OR = 2.29, 1.07-4.57). Younger age, higher anxiety, and 
poorer mental health at baseline predicted greater odds of response. Small 
declines in health and wellbeing were reported at the first COVID-19 follow-up, 
with smaller declines in the TC arm (Cohen's d: TC = -0.15, -0.31-0.00; HAP-E = 
-0.34, -0.49 to -0.19). Health and wellbeing stabilized at the second COVID-19 
follow-up. Most participants (>70%) reported that the interventions benefitted 
their health and wellbeing during COVID-19.
CONCLUSION: TC and HAP-E improved health and wellbeing, though TC conferred 
greater odds of an improved mental health response. Declines in health and 
wellbeing were observed at pandemic follow-up, with smaller declines in the TC 
arm, suggesting increased resilience.

DOI: 10.1080/13607863.2022.2053836
PMCID: PMC9489818
PMID: 35311437 [Indexed for MEDLINE]

Conflict of interest statement: Disclosure Statement: The Authors have declared 
that there are no conflicts of interest in relation to the subject of this 
study.


2263. Int J Soc Psychiatry. 2023 Mar;69(2):277-285. doi: 10.1177/00207640221081800. 
Epub 2022 Mar 19.

How did the Covid-19 pandemic affect individuals with schizophrenia from Turkey?

Karanci AN(1), Ikizer G(1), Aldemir İD(1), Bilgehan A(1), Karagöz C(1).

Author information:
(1)Department of Psychology, TOBB University of Economics and Technology, 
Ankara, Turkey.

BACKGROUND: Serious mental illness, including schizophrenia, have been shown to 
be associated with psychosocial vulnerabilities in the face of adverse events. 
While individuals with schizophrenia might undergo many psychosocial 
difficulties during the COVID-19 pandemic, they might also not be affected, or 
report increased subjective well-being. This suggests that it is important to 
understand diverse impacts and further understand the unique experiences.
METHODS: To capture how the pandemic affected them and how they handled the 
challenges if there were any in the initial and more recent phases of the 
pandemic, 18 individuals with schizophrenia living in Turkey were interviewed.
RESULTS: Thematic analysis of interviews resulted in four superordinate themes 
for both time points. Three themes related to the impact of the pandemic (i.e. 
burdens of COVID-19, positive impacts of COVID-19, no impact of COVID-19) 
indicated that they shared a number of challenges with the general population. 
Themes about the positive impacts and no impact also replicated the previous 
findings in this clinical population. One last theme named as facilitators of 
coping implied that the participants tried to deal with the burdens by using 
available resources, adapt to the changes in their daily living, and benefit 
from social interaction and support.
CONCLUSIONS: To conclude, people with schizophrenia seem to be coping with 
challenges posed by the pandemic with diverse strategies and they seem to even 
experience psychological growth alongside with negative impacts. The 
individualized needs and potential for growth have pivotal implications for the 
management of the illness during the pandemic.

DOI: 10.1177/00207640221081800
PMCID: PMC10076154
PMID: 35311388 [Indexed for MEDLINE]


2264. Fam Syst Health. 2022 Mar;40(1):79-86. doi: 10.1037/fsh0000638.

Parenting during the COVID-19 pandemic: The sociodemographic and mental health 
factors associated with maternal caregiver strain.

Radomski A(1), Cloutier P(2), Polihronis C(1), Gardner W(2), Pajer K(2), 
Sheridan N(2), Sundar P(1), Cappelli M(1).

Author information:
(1)Ontario Centre of Excellence for Child and Youth Mental Health.
(2)Children's Hospital of Eastern Ontario Research Institute.

INTRODUCTION: The COVID-19 pandemic has introduced new stressors for parents 
("caregivers") that may affect their own and their child's mental health (MH). 
We explored self-reported levels of caregiver strain (parents' perceived ability 
to meet parenting demands), and the MH and sociodemographic factors of 
caregivers to identify predictors of strain that can be used to guide MH service 
delivery for families.
METHODS: We administered a web-based survey to Ontario caregivers with a child 
between 4 and 25 years old, between April and June 2020. We analyzed information 
from 570 maternal caregivers on their sociodemographics, youngest (or only) 
child's MH, their own MH, and the degree of caregiver strain experienced since 
the pandemic. We used linear regressions (unadjusted and adjusted models) to 
explore the relationship between caregiver strain and sociodemographics, child 
MH and caregiver MH.
RESULTS: Over 75% of participants reported "moderate-to-high" caregiver strain. 
More than 25% of caregivers rated their MH as "poor" and 20% reported 
moderate-to-severe anxiety. Forty-five percent of the variance in caregiver 
strain was accounted for by child age, caregiver anxiety, and multiple child and 
caregiver MH variables. Younger child age and higher caregiver anxiety were the 
greatest predictors of caregiver strain.
CONCLUSION: We found a relationship between child age, child and caregiver MH 
variables, and caregiver strain. Given the interrelatedness of these factors, 
supporting caregivers' MH and lessening their role strain becomes critical for 
family well-being. Evidence-based individual, family, and public health 
strategies are needed to alleviate pandemic-related strain. (PsycInfo Database 
Record (c) 2022 APA, all rights reserved).

DOI: 10.1037/fsh0000638
PMID: 35311325 [Indexed for MEDLINE]


2265. Health Soc Care Community. 2022 Sep;30(5):1713-1725. doi: 10.1111/hsc.13777. 
Epub 2022 Mar 21.

Maximising the health impacts of free advice services in the UK: A mixed methods 
systematic review.

Young D(1), Bates G(2).

Author information:
(1)Sustainable Housing and Urban Studies Unit (SHUSU), University of Salford, 
Salford, UK.
(2)Institute for Policy Research, University of Bath, Bath, UK.

After a decade of austerity spending cuts and welfare reform, the COVID-19 
pandemic has posed further challenges to the finances, health and wellbeing of 
working-age, low-income people. While advice services have been widely seen (and 
funded) as an income maximisation intervention, their health and well-being 
impact is less clear. Previous systematic reviews investigating the link between 
advice services and health outcomes have found a weak evidence base and cover 
the period up until 2010. This mixed methods review examined up to date evidence 
to help understand the health impacts of free and independent welfare rights 
advice services. We included evaluations of free to access advice services on 
social welfare issues for members of the public that included health outcomes. 
Through comprehensive searches of two bibliographic databases and websites of 
relevant organisations we identified 15 articles based on a mixture of study 
designs. The advice interventions evaluated were based in a range of settings 
and only limited information was available on the delivery and nature of advice 
offered. We undertook a convergent synthesis to analyse data on the 
effectiveness of advice services on health outcomes and to explain variation in 
these outcomes. Our synthesis suggested that improvements in mental health and 
well-being measures are commonly attributed to advice service interventions. 
However, there is little insight to explain these impacts or to inform the 
delivery of services that maximise health benefits. Co-locating services in 
health settings appears promising and embracing models of delivery that promote 
collaboration between organisations tackling the social determinants of health 
may help to address the inherent complexities in the delivery of advice services 
and client needs. We make recommendations to improve routine monitoring and 
reporting by advice services, and methods of evaluation that will better account 
for complexity and context.

© 2022 The Authors. Health and Social Care in the Community published by John 
Wiley & Sons Ltd.

DOI: 10.1111/hsc.13777
PMCID: PMC9545623
PMID: 35307896 [Indexed for MEDLINE]

Conflict of interest statement: Neither author declares any conflict of 
interest.


2266. Int J Health Plann Manage. 2022 Jul;37(4):2183-2197. doi: 10.1002/hpm.3460. Epub 
2022 Mar 20.

Factors associated with burnout among medical laboratory professionals in 
Ontario, Canada: An exploratory study during the second wave of the COVID-19 
pandemic.

Nowrouzi-Kia B(1)(2)(3), Dong J(4), Gohar B(3)(5), Hoad M(6).

Author information:
(1)Department of Occupational Science and Occupational Therapy, Temerty Faculty 
of Medicine, University of Toronto, Toronto, Ontario, Canada.
(2)Krembil Research Institute-University Health Network, Toronto, Ontario, 
Canada.
(3)Centre for Research in Occupational Safety and Health, Laurentian University, 
Sudbury, Ontario, Canada.
(4)Shanghai Jiao Tong University, Shanghai, China.
(5)Department of Population Medicine, The University of Guelph, Guelph, Ontario, 
Canada.
(6)Medical Laboratory Professionals Association of Ontario, Hamilton, Ontario, 
Canada.

OBJECTIVE: The objective of this study was to examine factors associated with 
burnout among medical laboratory technologists (MLT) in Ontario, Canada during 
the second wave of coronavirus disease 2019 pandemic.
METHODS: We employed a cross-sectional design and used a self-reported 
questionnaire designed for MLT in Ontario, Canada.
RESULTS: There were 441 (47.5% response rate) MLT who were included in the 
analytic sample. Most of the respondents were women, with a mean age of 43.1 and 
a standard deviation of 11.7. The prevalence of experiencing burnout was 72.3% 
for MLT. In the adjusted demographic model, those ≥50 (OR = 0.36, 95% CI: 
0.22-0.59) were 0.36 or about one third as likely to experience burnout as those 
under 50. Similarly, those who held a university degree were less likely to 
experience burnout compared with high school degree (OR = 0.35, 95% CI: 
0.15-0.79). In the adjusted occupational model, high quantitative demands 
(OR = 2.15, 95% CI: 1.21-3.88), high work pace (OR = 2.21, 95% CI: 1.25-3.98), 
high job insecurity (OR = 2.56, 95% CI: 1.39-4.82), high work life conflict 
(OR = 5.08, 95% CI: 2.75-9.64) and high job satisfaction (OR = 0.43, 95% CI: 
0.20-0.88), high self-rated health (OR = 0.32, 95% CI: 0.17-0.56) were 
significant.
CONCLUSION: This study provides preliminary evidence regarding the factors 
associated with burnout in MLT. Additional research is needed to understand 
their relationship with workers health and well-being and in the delivery of 
health services.

© 2022 The Authors. The International Journal of Health Planning and Management 
published by John Wiley & Sons Ltd.

DOI: 10.1002/hpm.3460
PMCID: PMC9541906
PMID: 35306693 [Indexed for MEDLINE]


2267. Int J Obes (Lond). 2022 Jul;46(7):1280-1287. doi: 10.1038/s41366-022-01100-8. 
Epub 2022 Mar 19.

Determinants of weight, psychological status, food contemplation and lifestyle 
changes in patients with obesity during the COVID-19 lockdown: a nationwide 
survey using multiple correspondence analysis.

Caretto A(1), Pintus S(2), Petroni ML(3), Osella AR(4), Bonfiglio C(4), Morabito 
S(5), Zuliani P(6), Sturda A(7), Castronuovo M(8), Lagattolla V(7), Maghetti 
A(3), Lapini E(9), Bianco AM(10), Cisternino M(11), Cerutti N(12), Mulas CA(13), 
Hassan O(14), Cardamone N(15), Parillo M(16), Sonni L(17); ADI (Italian Dietetic 
and Clinical Nutrition Association) Foundation.

Collaborators: Urso E, Bianco C, Scotto Di Carlo M, Fantola G, Vincis M, Pironi 
L, Barbanti F, Musio A, Ravaioli F, Minciullo F, Balzano R, Cozzolino AR, 
Castanò I, Cusano P, Di Giacomo C, Mollica MP, Coppola M, Della Rosa D, Vignola 
G, Bolesina L, Zaccheroni V, Pullara R, Caprino G, Tubili C, Baccari B, 
Monacelli G, Paolini B, Martinelli B, Carella M, Di Gregorio C, Cella D, Facci 
W, Lista M, Giungato S, Fazzolari L, Altomare M, Lo Prinzi L, Grandone I, Vigna 
L, Di Berardino P, Messeri L.

Author information:
(1)Endocrinology, Metabolic diseases and Clinical Nutrition, Ospedale Perrino, 
Brindisi, Italy. carettoa2019@gmail.com.
(2)Bariatric Surgery Center, ARNAS Brotzu, Cagliari, Italy.
(3)Metabolism and Clinical Nutrition Unit, IRCCS Policlinico S. Orsola, Alma 
Mater University of Bologna, Bologna, Italy.
(4)Epidemiology and Statistics, IRCCS Saverio De Bellis, Castellana Grotte, BA, 
Italy.
(5)Obesity Day Center, Messina, Italy.
(6)Obesity Day Center, Sorrento, NA, Italy.
(7)Endocrinology, Metabolic diseases and Clinical Nutrition, Ospedale Perrino, 
Brindisi, Italy.
(8)Information technology consultant, Brindisi, Italy.
(9)Obesity Rehab Unit, Ospedali Privati Forli, Forlì, Italy.
(10)U.O.C. Igiene degli Alimenti e della Nutrizione ASP, Potenza, Italy.
(11)Clinical Nutrition, IRCCS "S. De Bellis", Castellana Grotte, BA, Italy.
(12)UOSD Medicina Generale a Indirizzo Dietologico ASST, Pavia, Italy.
(13)Clinical Dietary Service "Holy Spirit" Hospital Casale Monferrato ASLAL, 
Alessandria, Italy.
(14)UOSD Diabetology, San Camillo Hospital -, Roma, Italy.
(15)A.S.P., Catanzaro, Italy.
(16)Azienda ospedaliera S. Anna S. Sebastiano, Caserta, Italy.
(17)SIAN ASL RM2, Roma, Italy.

INTRODUCTION: The corona virus disease 2019 (COVID-19) pandemic forced most of 
the Italian population into lockdown from 11 March to 18 May 2020. A nationwide 
survey of Italian Clinical Nutrition and Dietetic Services (Obesity Centers or 
OCs) was carried out to assess the impact of lockdown restrictions on the 
physical and mental wellbeing of patients with obesity (PWO) who had follow-up 
appointments postponed due to lockdown restrictions and to compare determinants 
of weight gain before and after the pandemic.
METHODS: We designed a structured 77-item questionnaire covering employment 
status, diet, physical activity and psychological aspects, that was disseminated 
through follow-up calls and online between 2 May and 25 June 2020. Data were 
analyzed by multiple correspondence analysis (MCA) and multiple linear 
regression.
RESULTS: A total of 1,232 PWO from 26 OCs completed the questionnaires (72% 
female, mean age 50.2 ± 14.2 years; mean BMI 34.7 ± 7.6 kg/m2; 41% obesity class 
II to III). During the lockdown, 48.8% gained, 27.1% lost, while the remainder 
(24.1%) maintained their weight. The mean weight change was +2.3 ± 4.8 kg (in 
weight gainers: +4.0 ± 2.4 kg; +4.2% ± 5.4%). Approximately 37% of participants 
experienced increased emotional difficulties, mostly fear and dissatisfaction. 
Sixty-one percent reduced their physical activity (PA) and 55% experienced a 
change in sleep quality/quantity. The lack of online contact (37.5%) with the OC 
during lockdown strongly correlated with weight gain (p < 0.001). Using MCA, two 
main clusters were identified: those with unchanged or even improved lifestyles 
during lockdown (Cluster 1) and those with worse lifestyles during the same time 
(Cluster 2). The latter includes unemployed people experiencing depression, 
boredom, dissatisfaction and increased food contemplation and weight gain. 
Within Cluster 2, homemakers reported gaining weight and experiencing anger due 
to home confinement.
CONCLUSIONS: Among Italian PWO, work status, emotional dysregulation, and lack 
of online communication with OCs were determinants of weight gain during the 
lockdown period.

© 2022. The Author(s).

DOI: 10.1038/s41366-022-01100-8
PMCID: PMC8933751
PMID: 35306529 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


2268. Occup Med (Lond). 2022 Apr 19;72(3):215-224. doi: 10.1093/occmed/kqac003.

Hospital clinicians' psychosocial well-being during the COVID-19 pandemic: 
longitudinal study.

Wynter K(1)(2), Holton S(1)(2), Trueman M(3), Bruce S(4), Sweeney S(3), Crowe 
S(3), Dabscheck A(5), Eleftheriou P(5), Booth S(6), Hitch D(6), Said 
CM(6)(7)(8), Haines KJ(6), Rasmussen B(1)(2)(9)(10).

Author information:
(1)School of Nursing and Midwifery, Faculty of Health, Deakin University, 
Geelong, 3220, Australia.
(2)The Centre for Quality and Patient Safety Research in the Institute of Health 
Transformation, Deakin University, Western Health Partnership, St Albans, 3021, 
Australia.
(3)Nursing and Midwifery, Western Health, St Albans, 3021, Australia.
(4)People, Culture and Communications, Western Health, Footscray, 3021, 
Australia.
(5)Medical Services, Western Health, St Albans, 3021, Australia.
(6)Allied Health, Western Health, St Albans, 3021, Australia.
(7)Physiotherapy, Melbourne School of Health Sciences, The University of 
Melbourne, Parkville, 3010, Australia.
(8)Australian Institute of Musculoskeletal Sciences, St Albans, 3021, Australia.
(9)Faculty of Health Sciences, University of Southern Denmark and Steno Diabetes 
Center, Odense, 5230, Denmark.
(10)Faculty of Health and Medical Sciences, University of Copenhagen, 
Copenhagen, 1165, Denmark.

BACKGROUND: Hospital clinicians report poor psychosocial well-being during the 
COVID-19 pandemic. Few studies have reported data at more than one time point.
AIMS: To compare psychosocial well-being among hospital clinicians at two 
different time points during the COVID-19 pandemic in 2020.
METHODS: Participants included doctors, nurses, midwives and allied health 
clinicians at a multi-site, public health service in Melbourne, Australia. Data 
were collected via two cross-sectional, online surveys: May to June (wave 1; n = 
638) and October to December 2020 (wave 2; n = 358). The Depression, Anxiety and 
Stress Scale (DASS-21) assessed psychological well-being in the past week. 
Investigator-devised questions assessed COVID-19 concerns and perceived work 
impacts. General linear models were used to assess impact of wave on 
psychological distress.
RESULTS: There were no significant demographic differences between the two 
groups. Both positive (e.g. learning experience) and negative (e.g. risk of 
getting COVID-19) impacts were reported. In both waves, staff were most 
concerned about health risks to family members. Wave 2 respondents were 
significantly more likely than wave 1 respondents to indicate concerns about 
colleagues having COVID-19, increased workloads, leave cancellation and 
increased conflict at work (all P < 0.001). Adjusting for sex, age, self-rated 
health and discipline group, depression, anxiety and stress scores were 
significantly higher for respondents in the second than the first wave (all P < 
0.001).
CONCLUSIONS: Psychological well-being of hospital clinicians was significantly 
worse during the second wave of the COVID-19 pandemic than the first. Sustained 
occupational and psychosocial support is recommended even when immediate 
COVID-19 concerns and impacts resolve.

© The Author(s) 2022. Published by Oxford University Press on behalf of the 
Society of Occupational Medicine. All rights reserved. For Permissions, please 
email: journals.permissions@oup.com.

DOI: 10.1093/occmed/kqac003
PMCID: PMC9189476
PMID: 35304607 [Indexed for MEDLINE]


2269. Arch Pediatr. 2022 May;29(4):281-286. doi: 10.1016/j.arcped.2022.02.002. Epub 
2022 Feb 28.

A qualitative study of adolescents and young adults' experience and perceived 
needs during the first wave of the COVID-19 pandemic.

Morsa M(1), Sassine S(2), Yang XY(2), Gong RN(2), Amir-Yazdani P(3), Sonia 
TA(4), Gibson M(5), Drouin O(6), Chadi N(7), Jantchou P(8).

Author information:
(1)Université de Montréal, Montréal, Québec, Canada; Sorbonne Paris North 
University, Laboratory of Education and Health Practices (UR 3412), Paris, 
France.
(2)Université de Montréal, Montréal, Québec, Canada; CHU Sainte-Justine Research 
Center, Montréal, Quebec, Canada.
(3)CHU Sainte-Justine Research Center, Montréal, Quebec, Canada; Université 
Laval, Québec, Québec, Canada.
(4)CHU Sainte-Justine Research Center, Montréal, Quebec, Canada.
(5)McGill University, Montréal, Québec, Canada.
(6)Université de Montréal, Montréal, Québec, Canada; CHU Sainte-Justine Research 
Center, Montréal, Quebec, Canada; Division of General Pediatrics, Department of 
Pediatrics, CHU Sainte-Justine, Canada; Department of Social and Preventive 
Medicine, School of Public Health, Université de Montréal, Canada.
(7)Université de Montréal, Montréal, Québec, Canada; CHU Sainte-Justine Research 
Center, Montréal, Quebec, Canada; Division of Adolescent Medicine, Department of 
Pediatrics, CHU Sainte-Justine University Hospital, Canada.
(8)Université de Montréal, Montréal, Québec, Canada; CHU Sainte-Justine Research 
Center, Montréal, Quebec, Canada; Division of Gastroenterology, Department of 
Pediatrics, CHU Sainte-Justine University Hospital, Canada. Electronic address: 
prevost.jantchou@umontreal.ca.

AIMS: COVID-19 has led to unprecedented public health measures such as school 
and university closures across the world. While initial surveys show an increase 
in anxiety, we have little information on the subjective experience of 
adolescents and young adults (AYAs). The aims of this study were to understand 
the lived experience and needs of AYAs related to home confinement and 
preventive measures due to COVID-19.
DEMOGRAPHICS AND SETTINGS: A total of 25 AYAs (13-24 years old) with diverse 
gender, age, or health conditions, living in Québec (Canada), were interviewed 
in May 2020, during the COVID-19 home confinement period.
METHODOLOGY: Four virtual focus groups were held via a virtual 
video-conferencing platform (Zoom©). Thematic analysis was conducted.
RESULTS: Thematic analysis revealed five main themes: (1) challenges and 
opportunities related to the experience of home confinement; (2) variable risk 
perception of COVID-19 infection; (3) development of coping strategies to 
maintain well-being; (4) need for information and accompaniment; (5) 
apprehensions related to perceptions of the future.
CONCLUSION: AYAs did not feel considered in public health decisions, fostering 
an increase in anxiety, especially in more vulnerable AYAs living with chronic 
diseases.

Copyright © 2022 French Society of Pediatrics. Published by Elsevier Masson SAS. 
All rights reserved.

DOI: 10.1016/j.arcped.2022.02.002
PMCID: PMC8882423
PMID: 35304032 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest None.


2270. J Ment Health Policy Econ. 2022 Mar 1;25(1):21-34.

Mask Mandate's Effect on Job Loss Expectation and Mental Health in the United 
States during the COVID-19 Pandemic.

Mandal B(1).

Author information:
(1)School of Economic Sciences, Washington State University, PO Box 646210, 
Hulbert 111E, Pullman, WA 99164, USA, bmandal@wsu.edu.

BACKGROUND: Uncertainty around economic recovery from a pandemic, in addition to 
restrictions on mobility and socializing, can be isolating and stressful. While 
preventive measures, such as mask mandates, are expected to mitigate spread of 
the disease and lower concerns of future job loss, state- and local-level 
mandates could signal that infection rates are worse in the mandated areas and 
decrease consumer confidence and mobility. Thus, the association between mask 
mandates and psychological well-being is unclear.
AIMS OF THE STUDY: Twenty-five states in the United States implemented statewide 
mask mandates early in the pandemic. This study seeks to examine the effect of 
mask mandates on self-reported job loss expectation and mental health.
METHODS: This study analyzes U.S. Census Bureau's Household Pulse Survey data, 
collected between April 23rd and July 21st, 2020. Using a panel subset of the 
data, fixed effects models are estimated to understand statewide mask mandate's 
effect on psychological well-being over a twelve-week period while controlling 
for individual-level unobserved heterogeneity. All data are then 
state-aggregated, and fixed effects models are estimated to examine average 
differences in job loss expectation and mental health between mandate and 
non-mandate states.
RESULTS: In the individual-level panel data, job loss expectation was lower by 
1.1 percentage point by the second week of a statewide mask mandate and by 1.6 
percentage point by the third week, compared to average job loss expectation in 
states without a mask mandate and to the mandate states before the policy 
implementation. Average job loss expectation was 6.5 percentage point lower by 
the twelfth week in the five states that were the first to implement statewide 
mask mandates. Mental health status improved steadily from the fourth week on in 
states with a mask mandate. Analysis of state-aggregated data indicates 
considerable variability and lack of uniformity in mask mandates' impact on job 
loss expectation and mental health status.
DISCUSSION: Local-level mandates, such as those at the county-level, could not 
be identified in these data. The impact of a mask mandate could be 
underestimated when only state-level mandates are considered, and local 
regulations are excluded. This is a limitation of this study.
IMPLICATIONS FOR HEALTH CARE PROVISION: The staggered state-by-state approach to 
implementing mask mandates and the considerable variability in enforcement of 
mask rules has possibly contributed to lack of uniformity and consistency in how 
mask mandates impact subjective psychological well-being.
IMPLICATIONS FOR HEALTH POLICIES: The lack of statistically significant impact 
of statewide mask mandates on the two outcome variables in the state-aggregated 
data, and on long-run job loss expectation in the individual-level panel data, 
could be indicative of the complexities of effective science communication 
regarding behavioral recommendations to promote overall well-being.
IMPLICATIONS FOR FURTHER RESEARCH: Multiple variants of SARS-CoV-2, the virus 
that causes COVID-19, has emerged around the world. Further research could more 
clearly assess the degree to which communicating public health implications of 
these variants has evolved, and whether it has elicited behavior change and 
affected psychological well-being.

PMID: 35302051 [Indexed for MEDLINE]


2271. Pediatrics. 2022 Apr 1;149(4):e2021054754. doi: 10.1542/peds.2021-054754.

Youth Well-being During the COVID-19 Pandemic.

Blackwell CK(1), Mansolf M(1), Sherlock P(1), Ganiban J(2), Hofheimer JA(3), 
Barone CJ(4), Bekelman TA(5), Blair C(6), Cella D(1), Collazo S(7), Croen LA(8), 
Deoni S(9), Elliott AJ(10), Ferrara A(8), Fry RC(3), Gershon R(1), Herbstman 
JB(11), Karagas MR(12), LeWinn KZ(13), Margolis A(11), Miller RL(7), O'Shea 
TM(3), Porucznik CA(14), Wright RJ(7).

Author information:
(1)Department of Medical Social Sciences, Feinberg School of Medicine, 
Northwestern University, Chicago, Illinois.
(2)Department of Psychology & Brain Sciences, Columbian School of Arts and 
Sciences, George Washington University, Washington, DC.
(3)University of North Carolina, Chapel Hill, North Carolina.
(4)Department of Pediatrics, Henry Ford Health System, Detroit, Michigan; School 
of Medicine, Wayne State University, Detroit, Michigan.
(5)University of Colorado Anschutz Medical Campus, Aurora, Colorado.
(6)New York University Langone Health, New York, New York.
(7)Icahn School of Medicine at Mount Sinai, New York, New York.
(8)Kaiser Permanente North California, Oakland, California.
(9)Rhode Island Hospital, Brown University, Providence, Rhode Island.
(10)Avera Research Institute & Department of Pediatrics, University of South 
Dakota School of Medicine, Sioux Falls, South Dakota.
(11)Columbia University, New York, New York.
(12)Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.
(13)University of California, San Francisco, California.
(14)University of Utah, Salt Lake City, Utah.

OBJECTIVES: The family stress model proposes economic hardship results in 
caregiver distress and relational problems, which negatively impact youth 
outcomes. We extend this model to evaluate the impact of coronavirus disease 
2019 pandemic-related family hardships on caregiver and youth stress, and, in 
turn, youth's psychological well-being. We also investigate how social supports 
moderate this relationship.
METHODS: We used 2 samples of cross-sectional survey data collected between May 
2020 and May 2021: children aged 2 to 12 years (n = 977) and adolescents aged 11 
to 17 years (n = 669). Variables included pandemic-related family hardships, 
stress, social support, and youth life satisfaction. Data were analyzed using 
structural equation modeling.
RESULTS: Experiencing more pandemic-related family hardships was associated with 
increased caregiver and youth stress (b = 0.04 to 0.21, SE = 0.01-0.02) and, in 
turn, decreased youth life satisfaction (b = -0.36 to -0.38, SE = 0.04-0.07). 
Social connectedness (b^ = 0.11-0.17, SE = 0.04) and family engagement (b^ = 
0.12-0.18, SE = 0.05-0.06) had direct positive associations with life 
satisfaction; for children aged 2 to 12 years, greater family engagement was 
associated with decreased effect of child stress on life satisfaction (b^ = 
0.15, SE = 0.05). For adolescents, females had higher levels of stress compared 
with males (b^ = 0.40, SE = 0.6), and having anxiety and/or depression was 
associated with decreased life satisfaction (b^ = -0.24, SE = 0.11).
CONCLUSIONS: Caregivers and youth who experienced more coronavirus disease 2019 
pandemic hardships had higher levels of stress, particularly adolescent females. 
Although stress negatively impacted life satisfaction across all ages, family 
engagement was a protective factor for children aged 2 to 12 years, whereas 
having anxiety and/or depression was a risk factor for adolescents. For all 
youth, however, being more socially connected and engaged with family promoted 
life satisfaction.

Copyright © 2022 by the American Academy of Pediatrics.

DOI: 10.1542/peds.2021-054754
PMCID: PMC9169239
PMID: 35301542 [Indexed for MEDLINE]

Conflict of interest statement: CONFLICT OF INTEREST DISCLOSURES: The authors 
have indicated they have no potential conflicts of interest to disclose.


2272. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2022 Feb;44(1):30-39. doi: 
10.3881/j.issn.1000-503X.14144.

[Mental Health Status and Its Influencing Factors among College Students during 
the Epidemic of Coronavirus Disease 2019:A Multi-center Cross-sectional Study].

[Article in Chinese]

Wang H(1), Si MY(1), Su XY(1), Huang YM(1), Xiao WJ(1), Wang WJ(2), Gu XF(3), Ma 
L(4), Li J(5), Zhang SK(6), Ren ZF(7), Qiao YL(1).

Author information:
(1)Department of Epidemiology and Biostatistics,School of Population Medicine 
and Public Health, CAMS and PUMC,Beijing 100730,China.
(2)Department of Environmental Health,School of Public Health,Jining Medical 
University,Jining,Shandong 272067,China.
(3)Student Affairs Office,Affiliated Tumor Hospital of Xinjiang Medical 
University,Urumqi 830011,China.
(4)Department of Epidemiology,School of Public Health,Dalian Medical 
University,Dalian,Liaoning 116044,China.
(5)Department of Epidemiology and Biostatistics,West China School of Public 
Health,Sichuan University,Chengdu 610041,China.
(6)Henan Office for Cancer Control and Research,Affiliated Cancer Hospital of 
Zhengzhou University,Zhengzhou 450008,China.
(7)Department of Epidemiology and Biostatistics,School of Public Health,Sun 
Yat-sen University,Guangzhou 510080,China.

Objective To measure the prevalence of mental health symptoms and identify the 
associated factors among college students at the beginning of coronavirus 
disease 2019(COVID-19)outbreak in China. Methods We carried out a multi-center 
cross-sectional study via snowball sampling and convenience sampling of the 
college students in different areas of China.The rates of self-reported 
depression,anxiety,and stress and post-traumatic stress disorder(PTSD)were 
assessed via the 21-item Depression-Anxiety-Stress Scale(DASS-21)and the 6-item 
Impact of Event Scale-Revised(IES-6),respectively.Covariates included 
sociodemographic characteristics,health-related data,and information of the 
social environment.Data pertaining to mental health service seeking were also 
collected.Multivariate Logistic regression analyses were performed to identify 
the risk factors. Results A total of 3641 valid questionnaires were collected 
from college students.At the beginning of the COVID-19 
outbreak,535(14.69%)students had negative emotions,among which 
402(11.04%),381(10.49%),and 171(4.90%)students had the symptoms of 
depression,anxiety,and stress,respectively.Meanwhile,1245(34.19%)college 
students had PTSD.Among the risk factors identified,male gender was associated 
with a lower likelihood of reporting depression symptoms(AOR=0.755,P=0.037],and 
medical students were at higher risk of depression and stress symptoms than 
liberal arts students(AOR=1.497,P=0.003;AOR=1.494,P=0.045).Family support was 
associated with lower risks of negative emotions and PTSD in college 
students(AOR=0.918,P<0.001;AOR=0.913,P<0.001;AOR=0.899,P<0.001;AOR=0.971,P=0.021). 
Conclusions College students were more sensitive to public health 
emergencies,and the incidence of negative emotions and PTSD was significantly 
higher than that before the outbreak of COVID-19.More attention should be paid 
to female college students who were more likely to develop negative emotions.We 
should strengthen positive and proper propaganda via mass media and help college 
students understand the situation and impact of COVID-19.Furthermore,we should 
enhance family support for college students.The government and relevant agencies 
need to provide appropriate mental health services to the students under similar 
circumstances to avoid the deterioration of their mental well-being.

DOI: 10.3881/j.issn.1000-503X.14144
PMID: 35300762 [Indexed for MEDLINE]


2273. Pilot Feasibility Stud. 2022 Mar 17;8(1):63. doi: 10.1186/s40814-022-01014-2.

Study protocol for the online adaptation and evaluation of the 'Reboot' 
(Recovery-boosting) coaching programme, to prepare critical care nurses for, and 
aid recovery after, stressful clinical events.

Vogt KS(1)(2), Grange A(3), Johnson J(3)(4)(5), Marran J(3), Budworth L(3), 
Coleman R(3), Simms-Ellis R(3)(4).

Author information:
(1)Bradford Institute for Health Research, Bradford Royal Infirmary, Temple Bank 
House, Duckworth Lane, Bradford, BD9 6RJ, UK. Kathy.vogt@bthft.nhs.uk.
(2)Department of Psychology, University of Leeds, Leeds, LS2 9JT, UK. 
Kathy.vogt@bthft.nhs.uk.
(3)Bradford Institute for Health Research, Bradford Royal Infirmary, Temple Bank 
House, Duckworth Lane, Bradford, BD9 6RJ, UK.
(4)Department of Psychology, University of Leeds, Leeds, LS2 9JT, UK.
(5)School of Public Health and Community Medicine, University of New South 
Wales, Sydney, 2052, Australia.

BACKGROUND: Critical care nurses (CCNs) are routinely exposed to highly 
stressful events, exacerbated during the COVID-19 pandemic. Supporting 
resilience and wellbeing of CCNs is therefore crucial to prevent burnout. One 
approach for delivering this support is by preparing critical care nurses for 
situations they may encounter, drawing on evidence-based techniques to 
strengthen relevant psychological coping strategies. As such, the current study 
seeks to tailor a Resilience-boosting psychological coaching programme [Reboot] 
for CCNs, based on cognitive behavioural therapy (CBT) principles and the 
Bi-Dimensional Resilience Framework (BDF), and (1) to assess the feasibility of 
delivering Reboot via online, remote delivery to CCNs, and (2) to provide a 
preliminary assessment of whether Reboot could increase resilience and 
confidence in coping with adverse events.
METHODS: Eighty CCNs (n=80) will be recruited to the 8-week Reboot programme, 
comprised of two group workshops and two individual coaching calls. The study 
uses a single-arm before-after feasibility study design and will be evaluated 
with a mixed-methods approach, using online questionnaires (all participants) 
and telephone interviews (25% of participants). Primary outcomes will be 
confidence in coping with adverse events (the Confidence scale) and resilience 
(the Brief Resilience Scale) measured at four time points.
DISCUSSION: Results will determine whether it is feasible to deliver and 
evaluate a remote version of the Reboot coaching programme to CCNs, and will 
indicate whether participating in the programme is associated with increases in 
confidence in coping with adverse events, resilience and wellbeing (as indicated 
by levels of depression).

© 2022. The Author(s).

DOI: 10.1186/s40814-022-01014-2
PMCID: PMC8927745
PMID: 35300720

Conflict of interest statement: All authors declare that they have no competing 
interests.


2274. BMC Public Health. 2022 Mar 17;22(1):523. doi: 10.1186/s12889-022-12892-9.

Young parents' experiences of pregnancy and parenting during the COVID-19 
pandemic: a qualitative study in the United Kingdom.

Moltrecht B(1)(2)(3), Dalton LJ(1), Hanna JR(1)(4), Law C(5), Rapa E(6).

Author information:
(1)Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, 
OX3 7JX, UK.
(2)Evidence-Base Practice Unit, University College London, London, N1 9JH, UK.
(3)Centre for Longitudinal Studies, University College London, London, WC1H 0NU, 
UK.
(4)School of Nursing and Midwifery, Queen's University Belfast, Belfast, BT9 
7BL, UK.
(5)Centre for Early Child Development, Blackpool Better Start (NSPCC), 
Blackpool, UK.
(6)Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, 
OX3 7JX, UK. Elizabeth.rapa@psych.ox.ac.uk.

Young parents (aged 16-24 years) in the perinatal period are at an increased 
risk of poor mental health especially during the COVID-19 pandemic, due to 
multiple risk factors including social and economic instability. COVID-19 
related restrictions had profound implications for the delivery of perinatal 
care services and other support structures for young parents. Investigating 
young parents' experiences during the pandemic, including their perceived 
challenges and needs, is important to inform good practice and provide 
appropriate support for young parents.Qualitative interviews were conducted with 
young parents (n = 21) during the COVID-19 pandemic in the United Kingdom from 
February - May 2021. Data were analysed using thematic analysis.Three key themes 
were identified to describe parents' experiences during the COVID-19 pandemic. 
Parents reported specific COVID-19 related anxieties and stressors, including 
worries around contracting the virus and increased feelings of distress due to 
uncertainty created by the implications of the pandemic. Parents described 
feeling alone both at home and during antenatal appointments and highlighted the 
absence of social support as a major area of concern. Parents also felt their 
perinatal care had been disrupted by the pandemic and experienced difficulties 
accessing care online or over the phone.This study highlights the potential 
impact of the COVID-19 pandemic on young parents, including their mental 
wellbeing and the perinatal support they were able to access. Insights from this 
study can inform the support and services offered to families going forward. 
Specifically, the findings emphasise the importance of (a) supporting both 
parents during perinatal appointments, (b) providing parents with mental health 
support early on and (c) finding ways to facilitate communication pathways 
between professionals and parents.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-12892-9
PMCID: PMC8927525
PMID: 35300654 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2275. Sultan Qaboos Univ Med J. 2022 Feb;22(1):82-90. doi: 10.18295/squmj.4.2021.067. 
Epub 2022 Feb 28.

Psychosocial Impact of COVID-19 on Healthcare Workers: A cross-sectional survey 
from Pakistan.

Ali SM(1), Nausheen S(2).

Author information:
(1)Department of Surgery, Hamad General Hospital, Doha, Qatar.
(2)Department of Obstetrics & Gynecology, Aga Khan University Hospital, Karachi, 
Pakistan.

OBJECTIVES: This study aimed to assess the anxiety and depression symptoms in 
healthcare professionals in Pakistan as a result of the coronavirus pandemic.
METHODS: This cross-sectional study was conducted from May to June 2020 and 
included six different hospitals in Pakistan. An English-language demographics 
questionnaire, a validated COVID-19 fear scale, depression scale PHQ-9 and 
anxiety scale GAD-7 were sent to doctors, nurses and paramedical staff via 
WhatsApp. Data were analysed using descriptive statistics, Chi-square test and 
Student's t-test.
RESULTS: A total of 400 participants were included in this study (response rate: 
80.0%); 263 (65.8%) were doctors and 137 (34.3%) were nurses and paramedical 
staff. Of the participants, 57.0% were less than 40 years old and 18.3% were 
aged above 50. Most of the participants (n = 262; 65.5 %) experienced moderate 
levels of fear and 16.5% (n = 66) experienced a high level of fear. Moreover, 
19.5% feared death and 56.5% reported social media to be responsible for 
increasing their fears. On the depression PHQ-9 and anxiety GAD-7 scales, 21.8% 
(n = 87) reported moderate to severe depression and anxiety symptoms. A 
significant relationship was demonstrated between the depression level and age, 
education and profession (P <0.001 each). Similarly, anxiety and depression 
scores were strongly related to the availability of personal protective 
equipment (P <0.001).
CONCLUSION: It was found that 21.8% of healthcare professionals are suffering 
from moderate to severe depression symptoms, 15.5% had moderate to severe 
anxiety, whereas 65.5% had moderate symptoms of fear. The predictors are age, 
education level and co-morbidities. These moderate to high levels of fear and 
anxiety and depression raise concerns about the psychological well-being of 
healthcare staff and should be addressed through different programmes.

© Copyright 2022, Sultan Qaboos University Medical Journal, All Rights Reserved.

DOI: 10.18295/squmj.4.2021.067
PMCID: PMC8904111
PMID: 35299803 [Indexed for MEDLINE]

Conflict of interest statement: CONFLICT OF INTEREST The authors declare no 
conflicts of interest.


2276. BMC Public Health. 2022 Mar 16;22(1):517. doi: 10.1186/s12889-022-12941-3.

The effects of living and learning conditions on the health-related quality of 
life of children and adolescents during the COVID-19 lockdown in the French 
Grand Est region.

Bourion-Bédès S(1)(2), Rousseau H(3), Batt M(4), Tarquinio P(5), Lebreuilly 
R(4), Sorsana C(4), Legrand K(6)(7), Tarquinio C(6), Baumann C(6)(3).

Author information:
(1)Centre Hospitalier de Versailles, Service Universitaire de Psychiatrie de 
l'Enfant et de l'Adolescent, 78157, Versailles-Le Chesnay, France. 
sbourionbedes@ch-versailles.fr.
(2)UR 4360 APEMAC (Health Adjustment, Measurement and Assessment, 
Interdisciplinary Approaches), University of Lorraine, Nancy, France. 
sbourionbedes@ch-versailles.fr.
(3)Methodology, Data Management and Statistics Unit, University Hospital of 
Nancy, 54000, Nancy, France.
(4)InterPsy, GRC Team, University of Lorraine, 54000, Nancy, France.
(5)Pierre Janet Center, 57000, Metz, France.
(6)UR 4360 APEMAC (Health Adjustment, Measurement and Assessment, 
Interdisciplinary Approaches), University of Lorraine, Nancy, France.
(7)Clinical Investigation Center, INSERM, University Hospital of Nancy, 54000, 
Nancy, France.

INTRODUCTION: COVID-19 lockdown measures resulted in children and adolescents 
staying and learning at home. This study investigated health-related quality of 
life (HRQoL) and its associated factors among youth during the first lockdown.
METHODS: A cross-sectional study was conducted among 8- to 18-year-olds from the 
French Grand Est region. Sociodemographic data and information on living and 
learning conditions were collected using an online survey. HRQoL was assessed 
using the KIDSCREEN-27. Multiple regression analysis was performed to explore 
factors related to low HRQoL in each dimension.
RESULTS: In total, 471 children from 341 households were included. Difficulties 
isolating at home were associated with low HRQoL in the psychological well-being 
(OR = 2.2, 95% CI: 1.2-4.0) and parent relations and autonomy (OR = 2.1, 95% CI: 
1.2-3.8) dimensions. Conflicts with dwelling occupants were related to increased 
ORs in the psychological well-being (OR = 2.9, 95% CI: 1.9-4.6), parent 
relations and autonomy (OR = 2.2, 95% CI: 1.4-3.4) and school environment 
(OR = 2.4, 95% CI: 1.5-3.7) dimensions. Living in an apartment (OR = 1.8, 95% 
CI: 1.1-3.1), never leaving home (OR = 2.6, 95% CI: 1.2-5.9), having indoor 
noise at home (OR = 2.3, 95% CI: 1.2-4.6), and having a parent with high anxiety 
(OR = 1.8, 95% CI: 1.1-3.1) were associated with low HRQoL in the social support 
and peers dimension. Children working less than 1 h/day on schoolwork had an 
increased OR of 3.5 (95% CI: 1.4-9.0) in the school environment dimension.
CONCLUSION: Living and learning conditions were associated with low HRQoL among 
children and adolescents during the COVID-19 lockdown. Prevention and 
intervention programs are needed to support youth by facilitating their 
interactions and improving their coping and to prepare for future waves.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-12941-3
PMCID: PMC8926099
PMID: 35296280 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
disclose.


2277. PLoS One. 2022 Mar 16;17(3):e0264655. doi: 10.1371/journal.pone.0264655. 
eCollection 2022.

Mental health of individuals infected with SARS-CoV-2 during mandated isolation 
and compliance with recommendations-A population-based cohort study.

Domenghino A(1)(2), Aschmann HE(1)(3), Ballouz T(1), Menges D(1), Strebel D(1), 
Derfler S(1), Fehr JS(1), Puhan MA(1).

Author information:
(1)Epidemiology, Biostatistics and Prevention Institute (EBPI), University of 
Zurich (UZH), Zurich, Switzerland.
(2)Department of Visceral and Transplantation Surgery, University Hospital 
Zurich, University of Zurich (UZH), Zurich, Switzerland.
(3)Department of Epidemiology and Biostatistics, University of California San 
Francisco (UCSF), San Francisco, California, United States of America.

BACKGROUND: Isolation is an indispensable measure to contain the SARS-CoV-2 
virus, but it may have a negative impact on mental health and overall wellbeing. 
Evidence on the isolation experience, facilitating and complicating factors is 
needed to mitigate negative effects.
METHODS AND FINDINGS: This observational, population-based cohort study enrolled 
1547 adults from the general population with SARS-CoV-2 infection reported to 
authorities between 27 February 2020 and 19 January 2021 in Zurich, Switzerland. 
We assessed the proportion of individuals reporting symptoms of depression and 
anxiety before, during and after isolation (by DASS-21), and queried worries, 
positive experiences, and difficulties. We analyzed the association of these 
outcomes with socio-demographics using ordinal regression. Additionally, we 
report free-text statements by participants to capture most important aspects of 
isolation. The proportion of participants affected by depression or anxiety 
increased during isolation from 10·0% to 17·1% and 9·1% to 17·6%, respectively. 
Ordinal regression showed that taking care of children increased the difficulty 
of isolation (OR 2·10, CI 1·43-3·08) and risk of non-compliance (OR 1·63, CI 
1·05-2·53), especially in younger participants. A facilitating factor that 
individuals commonly expressed was receiving more support during isolation.
CONCLUSION: Isolation due to SARS-CoV-2 presents a mental burden, especially for 
younger individuals and those taking care of children. Public health authorities 
need to train personnel and draw from community-based resources to provide 
targeted support, information, and guidance to individuals during isolation. 
Such efforts could alleviate the negative impact isolation has on the mental and 
physical health of individuals and ensure compliance of the population with 
recommendations.

DOI: 10.1371/journal.pone.0264655
PMCID: PMC8926272
PMID: 35294465 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2278. Aging (Albany NY). 2022 Mar 16;14(6):2462-2474. doi: 10.18632/aging.203956. Epub 
2022 Mar 16.

Association between social isolation and reduced mental well-being in Swedish 
older adults during the first wave of the COVID-19 pandemic: the role of 
cardiometabolic diseases.

Dove A(1), Guo J(1), Calderón-Larrañaga A(1), Vetrano DL(1), Fratiglioni 
L(1)(2), Xu W(1).

Author information:
(1)Aging Research Center, Department of Neurobiology, Care Sciences and Society, 
Karolinska Institutet, Stockholm, Sweden.
(2)Stockholm Gerontology Research Center, Stockholm, Sweden.

Social isolation has been recommended as a strategy for reducing COVID-19 risk, 
but it may have unintended consequences for mental well-being. We explored the 
relationship between social isolation and symptoms of depression and anxiety in 
older adults during the first wave of the COVID-19 pandemic and assessed the 
role of cardiometabolic diseases (CMDs) in this association. Between May and 
September 2020, 1,190 older adults from the Swedish National Study on Aging and 
Care in Kungsholmen were surveyed about their behaviors and health consequences 
during the first wave of the COVID-19 pandemic. In total, 913 (76.7%) 
participants reported socially isolating at home to avoid infection during this 
period. Social isolation was associated with a greater likelihood of reduced 
mental well-being (i.e., feelings of depression or anxiety) (OR: 1.74, 95% CI: 
1.15-2.65). In joint exposure analysis, there was a significant likelihood of 
reduced mental well-being only among people who were socially isolating and had 
CMDs (OR: 2.13, 95% CI: 1.22-3.71) (reference: not isolating, CMD-free). In 
conclusion, social isolation as a COVID-19 prevention strategy was related to 
reduced mental well-being in an urban sample of Swedish older adults, especially 
among individuals with CMDs.

DOI: 10.18632/aging.203956
PMCID: PMC9004574
PMID: 35294400 [Indexed for MEDLINE]

Conflict of interest statement: CONFLICTS OF INTEREST: The authors have no 
conflicts of interest to report.


2279. J Psychosom Obstet Gynaecol. 2022 Dec;43(4):447-452. doi: 
10.1080/0167482X.2022.2050210. Epub 2022 Mar 16.

Validation of the COVID-19 Fear Scale modified for application during the 
perinatal period.

Soto Briseño AI(1), Gomez-Diaz RA(1), Saldaña Espinoza RC(1), Lavielle P(1), 
Valdez González AL(1), Wacher NH(1).

Author information:
(1)Unidad De Investigación en Epidemiología Clínica UMAE HE CMN SXXI, Mexico 
City, Mexico.

PURPOSE: The COVID-19 Fear Scale (FCV-19S) allows screening in general 
population; however, there is no specific instrument in our population for 
screening in the perinatal period that considers fear related with COVID-19 and 
offspring well-being. We aimed to validate the FCV-19S modified for application 
during the perinatal period.
MATERIALS AND METHODS: Analytical, cross-sectional design. After signing 
consent, women 18-45 years were included. Internal consistency was calculated 
with Cronbach's alpha, external validity using the Hospital Anxiety and 
Depression Scale (HADS), factorial analysis and intraclass correlation 
coefficient for re-test.
RESULTS: The sample included 178 women, mean age 31.04 ± 5.9. We obtained 
internal consistency with Cronbach's alpha = 0.873 (95%CI, 0.842-0.899). 
Spearman's Rho coefficient was 0.207 (p= .013). All the elements were 
statistically significant for the polychoric correlation (p<.001). Reliability 
test-retest with intraclass correlation was 0.873.
CONCLUSIONS: The version of FCV-19S modified with eight items is a valid 
measurement instrument for application during the perinatal period, showing 
adequate internal consistency and external validity with HADS as measure of 
concurrence to identify anxiety related with COVID-19 during the perinatal 
period.

DOI: 10.1080/0167482X.2022.2050210
PMID: 35294335 [Indexed for MEDLINE]


2280. J Pain Symptom Manage. 2022 Jul;64(1):49-57. doi: 
10.1016/j.jpainsymman.2022.03.003. Epub 2022 Mar 12.

Mindful Self-Care, Self-Compassion, and Resilience Among Palliative Care 
Providers During the COVID-19 Pandemic.

Garcia ACM(1), Ferreira ACG(2), Silva LSR(2), da Conceição VM(3), Nogueira 
DA(4), Mills J(5).

Author information:
(1)School of Nursing, Federal University of Alfenas, Alfenas, Brazil. Electronic 
address: ana.mesquita@unifal-mg.edu.br.
(2)School of Nursing, Federal University of Alfenas, Alfenas, Brazil.
(3)Nursing Department, Federal University of Fronteira Sul, Brazil.
(4)Institute of Exact Sciences, Federal University of Alfenas, Alfenas, Brazil.
(5)School of Nursing, Midwifery and Paramedicine, University of the Sunshine 
Coast, Sippy Downs, Australia.

CONTEXT: Given the adverse impact of COVID-19 on the wellbeing of palliative 
care providers, there is a growing need to better understand protective 
variables, such as self-care, mindfulness and self-compassion, as they relate to 
resilience.
OBJECTIVE: To investigate mindful self-care, self-compassion, and resilience as 
reported by palliative care providers during the COVID-19 pandemic.
METHODS: Descriptive, cross-sectional survey. An electronic questionnaire 
captured data from validated instruments measuring each study variable, as well 
as participant demographics and perceived impacts of COVID-19 on professional 
quality of life.
RESULTS: Positive, statistically significant correlations were found between 
mindful self-care, self-compassion, and resilience. These variables were also 
associated with greater satisfaction with professional life and perceived 
lessened impairment in physical and/or mental health due to a decrease in 
self-care activities stemming from altered routines during COVID-19. Those with 
higher resilience had worked in palliative care longer and also reported higher 
levels of self-compassion and mindful self-care, explaining 50% of variance. 
Self-compassion, satisfaction with professional life, and changes in self-care 
routine due to professional activities in the pandemic explained 44.3% of 
variance in mindful self-care. Self-compassion, female gender, and working as a 
frontline responder to the COVID-19 pandemic accounted for 35% variance in 
resilience levels.
CONCLUSIONS: Results from this study extend the currently limited knowledge of 
self-care, mindfulness and self-compassion, as protective variables related to 
resilience in palliative care providers during the COVID-19 pandemic. Further 
longitudinal studies into causal effects on health and wellbeing over time are 
needed.

Copyright © 2022 American Academy of Hospice and Palliative Medicine. Published 
by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jpainsymman.2022.03.003
PMCID: PMC8917778
PMID: 35292366 [Indexed for MEDLINE]


2281. BMC Psychiatry. 2022 Mar 15;22(1):184. doi: 10.1186/s12888-022-03826-1.

Emotional distress in COVID-19 patients in Maldives.

Dey RK(1), Mansoor S(2), Hilmy AI(3), Moosa S(4), Rahman SA(3), Latheef R(3), 
Rasheed N(3), Hassan FG(3), Zaadhee A(5), Ibrahim A(6), Usman SK(7).

Author information:
(1)Department of Internal Medicine, Indira Gandhi Memorial Hospital, PO:20402, 
Malé, Maldives. dr_rajibdey@yahoo.co.uk.
(2)Center for Mental Health, Indira Gandhi Memorial Hospital, PO:20402, Malé, 
Maldives.
(3)Department of Internal Medicine, Indira Gandhi Memorial Hospital, PO:20402, 
Malé, Maldives.
(4)Maldives National University, Malé, Maldives.
(5)Department of Surgery, Indira Gandhi Memorial Hospital, PO:20402, Malé, 
Maldives.
(6)National Cardiac Center, Indira Gandhi Memorial Hospital, PO:20402, Malé, 
Maldives.
(7)Ministry of Health, PO: 20379, Malé, Maldives.

BACKGROUND AND OBJECTIVES: Researchers are exploring the epidemiology, clinical 
characteristics, treatment, vaccination and the challenges faced by healthcare 
authorities. However less focus is being paid towards the impact of COVID-19 on 
mental health of the patients. This study is a cross-sectional study, measuring 
the prevalence of emotional distress among patients with COVID-19 in the 
Maldivian population.
METHODS: This study was conducted in Maldivian nations above 18 of age with 
COVID-19 who were admitted in isolation facilities. Patients who were on 
treatment for any other chronic medical conditions, severe and critical COVID-19 
disease were excluded. This study was conducted over a period of 2 months by 
administering a local translated version of DASS21 questionnaire.
RESULTS: The total of 195 patients were included in this study. The mean age of 
the patients was 40 (CI at 95% 38-42) years. The respondents were 48.7% men and 
51.3% women. Overall, 9% of patients with COVID-19 had depression while 23% of 
patients had anxiety and 12% of the patients had stress. There was a 
statistically significant relationship between gender and depression, anxiety 
and stress (p < 0.01). Symptomatic cases had a significantly higher level of 
stress than asymptomatic patients (p < 0.05), but no significant association was 
observed with symptomatic status and anxiety or depression.
CONCLUSION: The management of patients with COVID-19 should be 
multi-disciplinary with special focus on the mental wellbeing of our patients. 
We should aim to establish proper communication with the patients in order to 
identify emotional distress and provide appropriate mental health care.

© 2022. The Author(s).

DOI: 10.1186/s12888-022-03826-1
PMCID: PMC8922980
PMID: 35291963 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2282. BMC Public Health. 2022 Mar 15;22(1):507. doi: 10.1186/s12889-022-12857-y.

A comparative study on mental health and adaptability between older and younger 
adults during the COVID-19 circuit breaker in Singapore.

Yu CC(1), Tou NX(2), Low JA(2)(3).

Author information:
(1)Geriatric Education and Research Institute, Yishun Central 2, Singapore, 
768024, Singapore. yu.chou.chuen@geri.com.sg.
(2)Geriatric Education and Research Institute, Yishun Central 2, Singapore, 
768024, Singapore.
(3)Khoo Teck Phuat Hospital, Singapore, Singapore.

BACKGROUND: While older age is associated with better emotional well-being, it 
is unclear whether such age advantages remain during a pandemic. This study 
examined differences in mental health, adaptive behaviours, social support, 
perceived stress, digital media usage, and perceived change in circumstances 
between younger and older adults during the circuit breaker period (partial 
lockdown) in Singapore.
METHODS: A door-to-door survey was administered to a nationally representative 
sample of 602 younger (n = 302) and older (n = 300) adults aged 21-89 years from 
Singapore from 17 October to 27 November 2020. All participants self-reported 
their depression, anxiety, stress, adaptive behaviours, social support, 
perceived stress, change in circumstances, and digital media usage during the 
partial lockdown period.
RESULTS: Older adults were found to report significantly lower levels of 
depression, anxiety, and stress as compared to younger adults. Although older 
adults were less able to perform essential activities during the lockdown, they 
were more adaptable psycho-socially. Logistic regression analyses revealed that 
for older age group, adaptability and health status significantly predicted 
better mental health. Older adults had higher odds of low depression scores 
[odds ratio (OR) 1.81, 95% confidence intervals (CI) 1.07-3.08], anxiety scores 
(OR 1.80, 95% CI 1.05-3.08), and stress scores (OR 3.05, 95% CI 1.72-5.41). In 
addition, adaptability was found to moderate the relationship between age and 
mental health with detrimental effects of low adaptability stronger for younger 
adults than older adults.
CONCLUSIONS: During the lockdown period, older adults in Singapore had better 
mental health, perceived less stress-related concerns and were more adaptable 
psycho-socially as compared to younger adults. This study's findings extend 
current evidence that age-related advantages in emotional well-being persisted 
in the wake of the COVID-19 pandemic.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-12857-y
PMCID: PMC8922982
PMID: 35291961 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2283. J Psychiatr Res. 2022 May;149:233-242. doi: 10.1016/j.jpsychires.2022.03.001. 
Epub 2022 Mar 8.

The impact of the initial and second national COVID-19 lockdowns on mental 
health in young people with and without pre-existing depressive symptoms.

Joensen A(1), Danielsen S(2), Andersen PK(3), Groot J(4), Strandberg-Larsen 
K(5).

Author information:
(1)Section of Epidemiology, Faculty of Health and Medical Sciences, University 
of Copenhagen, Postal address: Øster Farimagsgade 5, bd. 24, PO Box 2099, DK - 
1014, Copenhagen K, Denmark. Electronic address: anjo@sund.ku.dk.
(2)Section of Epidemiology, Faculty of Health and Medical Sciences, University 
of Copenhagen, Postal address: Øster Farimagsgade 5, bd. 24, PO Box 2099, DK - 
1014, Copenhagen K, Denmark. Electronic address: stda@sund.ku.dk.
(3)Section of Biostatistics, University of Copenhagen, Postal address: Øster 
Farimagsgade 5, bd. 5, PO Box 2099, DK - 1014, Copenhagen K, Denmark. Electronic 
address: pka@biostat.ku.dk.
(4)Section of Epidemiology, Faculty of Health and Medical Sciences, University 
of Copenhagen, Postal address: Øster Farimagsgade 5, bd. 24, PO Box 2099, DK - 
1014, Copenhagen K, Denmark. Electronic address: jgro@sund.ku.dk.
(5)Section of Epidemiology, Faculty of Health and Medical Sciences, University 
of Copenhagen, Postal address: Øster Farimagsgade 5, bd. 24, PO Box 2099, DK - 
1014, Copenhagen K, Denmark. Electronic address: ksla@sund.ku.dk.

BACKGROUND: The evidence on mental health during COVID-19 evolved fast, but 
still little is known about the long-lasting impact of the sequential lockdowns. 
We examine changes in young people's mental health from before to during the 
initial and second more prolonged lockdown, and whether women and those with 
pre-existing depressive symptoms were disproportionally impacted.
METHODS: Participants reported on mental health indicators in an ongoing 18-year 
data collection in the Danish National Birth Cohort and in a COVID-19 survey, 
including 8 data points: 7 in the initial lockdown, and 1 year post. Changes in 
quality of life (QoL), mental well-being, and loneliness were estimated with 
random effect linear regressions on longitudinal data (N = 32,985), and linear 
regressions on repeated cross-sections (N = 28,579).
FINDINGS: Interim deterioration in mental well-being and loneliness was observed 
during the initial lockdown, and only in those without pre-existing depressive 
symptoms. During the second lockdown, a modest deterioration was again observed 
for mental well-being and loneliness. QoL likewise only declined among those 
without pre-existing symptoms, where women showed a greater decline than men. 
QoL did not normalise during the initial lockdown and remained at lower levels 
during the second lockdown. These findings were not replicated in the repeated 
cross-sections.
INTERPRETATION: Except for an interim decrease in mental health, and only in 
those without pre-existing depressive symptoms, this study's findings do not 
suggest a substantial detrimental impact of the lockdowns.

Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.jpsychires.2022.03.001
PMCID: PMC8902858
PMID: 35290818 [Indexed for MEDLINE]

Conflict of interest statement: All authors declare no competing interests.


2284. Eur J Public Health. 2022 Jun 1;32(3):481-487. doi: 10.1093/eurpub/ckac026.

Depressive symptoms in higher education students during the COVID-19 pandemic: 
the role of containment measures.

Buffel V(1), Van de Velde S(1), Akvardar Y(2), Bask M(3), Brault MC(4), Busse 
H(5), Chatzittofis A(6), Ladner J(7), Rabiee-Khan F(8), Stathopoulou T(9), 
Tavolacci MP(10), van der Heijde C(11), Pischke CR(12), Matos Fialho PM(12), 
Wouters E(1).

Author information:
(1)Centre for Population, Family and Health, Social Sciences, University of 
Antwerp, Antwerp, Belgium.
(2)Department of Psychiatry, School of Medicine, Marmara University, İstanbul, 
Turkey.
(3)Department of Sociology, Uppsala University, Uppsala, Sweden.
(4)Department of Humanities and Social Sciences, Université du Québec à 
Chicoutimi (UQAC), Chicoutimi, QC, Canada.
(5)Department of Prevention and Evaluation, Leibniz Institute for Prevention 
Research and Epidemiology-BIPS, Bremen, Germany.
(6)Medical School, University of Cyprus, Nicosia, Cyprus.
(7)Epidemiology and Health Promotion Department, Rouen University Hospital, 
Rouen, France.
(8)Faculty of Health, Education & Life Sciences, Birmingham City University, 
Birmingham, UK.
(9)National Centre for Social Research, Institute of Social Research, Athens, 
Greece.
(10)CIC 1404 and INSERM 1073, Rouen University Hospital and Rouen Normandy 
University, Rouen, France.
(11)Student Health Service, University of Amsterdam, Amsterdam, The Netherlands.
(12)Institute of Medical Sociology, Centre for Health and Society, Medical 
Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany.

BACKGROUND: Students are a vulnerable group for the indirect impact of the 
COVID-19 pandemic, particularly their mental health. This paper examined the 
cross-national variation in students' depressive symptoms and whether this can 
be related to the various protective measures implemented in response to the 
initial stage of the COVID-19 outbreak.
METHODS: Student data stem from the COVID-19 International Student Well-being 
Study, covering 26 countries during the first wave of the COVID-19 pandemic. 
Country-level data on government responses to the COVID-19 pandemic were 
retrieved from the Oxford COVID-19 Tracker. Multilevel analyses were performed 
to estimate the impact of the containment and economic support measures on 
students' depressive symptoms (n = 78 312).
RESULTS: School and workplace closures, and stay-at-home restrictions were 
positively related to students' depressive symptoms during the COVID-19 
pandemic, while none of the economic support measures significantly related to 
depressive symptoms. Countries' scores on the index of these containment 
measures explained 1.5% of the cross-national variation in students' depressive 
symptoms (5.3%). This containment index's effect was stable, even when 
controlling for the economic support index, students' characteristics, and 
countries' epidemiological context and economic conditions.
CONCLUSIONS: Our findings raise concerns about the potential adverse effects of 
existing containment measures (especially the closure of schools and workplaces 
and stay-at-home restrictions) on students' mental health.

© The Author(s) 2022. Published by Oxford University Press on behalf of the 
European Public Health Association.

DOI: 10.1093/eurpub/ckac026
PMCID: PMC8992322
PMID: 35289850 [Indexed for MEDLINE]


2285. J Adolesc Health. 2022 Jun;70(6):877-884. doi: 10.1016/j.jadohealth.2022.01.228. 
Epub 2022 Feb 4.

Adolescent Carers' Psychological Symptoms and Mental Well-being During the 
COVID-19 Pandemic: Longitudinal Study Using Data From the UK Millennium Cohort 
Study.

Nakanishi M(1), Richards M(2), Stanyon D(3), Yamasaki S(3), Endo K(3), Sakai 
M(4), Yoshii H(4), Nishida A(3).

Author information:
(1)Department of Psychiatric Nursing, Tohoku University Graduate School of 
Medicine, Sendai-shi, Miyagi, Japan; Research Center for Social Science & 
Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, 
Japan. Electronic address: mnakanishi-tky@umin.ac.jp.
(2)MRC Unit for Lifelong Health and Ageing at UCL, University College London, 
London, United Kingdom.
(3)Research Center for Social Science & Medicine, Tokyo Metropolitan Institute 
of Medical Science, Setagaya-ku, Tokyo, Japan.
(4)Department of Psychiatric Nursing, Tohoku University Graduate School of 
Medicine, Sendai-shi, Miyagi, Japan.

PURPOSE: During the COVID-19 pandemic, adolescent carers in the UK may have 
experienced psychological distress owing to increased caring burden and loss of 
a break from their caring role. This study investigated longitudinal association 
between adolescents' caring status and mental health outcomes from 2018/2019 to 
February-March 2021.
METHODS: The participants (n = 3,927) answered mental health questions in both 
the Millennium Cohort Study sweep 7 survey (age 17 years in 2018/2019) and at 
least one of three waves of the COVID-19 survey from May 2020 to February-March 
2021. Caring status at the age of 17 years was assessed using a single question 
regarding whether the participant regularly looked after anyone who needed care, 
without being paid. Outcome measures were psychological symptoms, measured using 
the Kessler Distress Scale, and mental well-being, measured using the 
Warwick-Edinburgh Mental Well-being Scale.
RESULTS: Compared with 3,616 noncarers, 311 (7.9%) adolescent carers reported 
significantly higher Kessler Distress Scale and lower Warwick-Edinburgh Mental 
Well-being Scale scores during the pandemic. These associations were largely 
explained by psychosocial risk factors. Worse outcomes were associated with poor 
sleep quality, attempted suicide at baseline, low social support, and a strong 
feeling of loneliness during the pandemic. These factors were significantly more 
likely to be observed among adolescent carers than noncarers.
DISCUSSION: UK adolescent carers exhibited worsened mental health outcomes one 
year after the first national lockdown. This increased distress may be 
attributable to psychosocial risk factors during the pre-COVID-19 and current 
COVID-19 periods, and they require psychosocial support.

Copyright © 2022 Society for Adolescent Health and Medicine. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jadohealth.2022.01.228
PMCID: PMC8813552
PMID: 35288005 [Indexed for MEDLINE]


2286. BMC Psychol. 2022 Mar 14;10(1):62. doi: 10.1186/s40359-022-00767-y.

Attachment style and mental health during the later stages of COVID-19 pandemic: 
the mediation role of loneliness and COVID-19 anxiety.

Vismara L(1), Lucarelli L(1), Sechi C(2).

Author information:
(1)Department of Pedagogy, Psychology and Philosophy, University of Cagliari, 
Cagliari, Italy.
(2)Department of Pedagogy, Psychology and Philosophy, University of Cagliari, 
Cagliari, Italy. cristina.sechi@unica.it.

BACKGROUND: An insecure attachment style is an important risk factor for 
psychological problems. The aim of this study was to use Bartholomew and 
Horowitz's model (Bartholomew and Horowitz in J Pers Soc Psychol 61(2): 226, 
2019) to test a sample of Italian individuals to determine the mediation role of 
loneliness and COVID-19-related anxiety symptoms in the relationship between 
attachment styles and mental health issues in the context of the pandemic.
METHOD: A cross-sectional research study was conducted using a sample of 330 
Italian participants (82.1% women; mean age = 34.3 years; SD = 13.16) who 
completed online self-reported measures of attachment styles (RQ), loneliness 
(RULS), COVID-19-related anxiety symptoms (C-19ASS) and mental health problems 
(GHQ-12). Serial mediation analyses were performed, and bootstrap tests were 
included.
RESULTS: Our results supported the hypothesized model with respect to each 
attachment style (p < 0.001). In particular, insecure attachment styles predict 
mental health problems both directly and indirectly, through loneliness and 
COVID-19-related anxiety symptoms. In addition, loneliness directly influences 
mental health problems and also mediates the relationship between insecure 
attachment styles and COVID-19-related anxiety symptoms which, in turn, 
positively predict mental health problems.
CONCLUSIONS: Our findings reinforce the importance of attachment in people's 
processes of adapting to experiences during the coronavirus pandemic. The study 
makes an important contribution to developing effective prevention and 
intervention strategies to support people's wellbeing in the context of the 
pandemic.

© 2022. The Author(s).

DOI: 10.1186/s40359-022-00767-y
PMCID: PMC8919140
PMID: 35287741 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no affiliation with any 
organization, with a direct or indirect financial interest in the subject matter 
discussed in the manuscript.


2287. BMC Psychiatry. 2022 Mar 14;22(1):179. doi: 10.1186/s12888-022-03812-7.

How did the first COVID-19 lockdown affect persons with concurrent mental health 
and substance use disorders in Norway? A qualitative study.

Leonhardt M(1)(2), Brodahl M(3), Cogan N(4), Lien L(3)(5).

Author information:
(1)Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental 
Health Disorders, Innlandet Hospital Trust, Post Box 104, 2381, Brumunddal, 
Norway. marja.leonhardt@sykehuset-innlandet.no.
(2)Faculty of Health Studies, VID Specialized University, Oslo, Norway. 
marja.leonhardt@sykehuset-innlandet.no.
(3)Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental 
Health Disorders, Innlandet Hospital Trust, Post Box 104, 2381, Brumunddal, 
Norway.
(4)School of Psychological Sciences & Health, University of Strathclyde, 40 
George Street, G1 1QE, Glasgow, UK.
(5)Department of Health and Social Science, Inland Norway University of Applied 
Science, Elverum, Norway.

BACKGROUND: The outbreak of COVID-19 with its severe social restrictions touched 
the daily life of most people. While everyday social life becomes difficult for 
citizens with economic and cultural capital, it becomes even worse for 
vulnerable groups such as persons with mental health and substance use 
disorders, who are particularly vulnerable to social exclusion. The aim of this 
study is to investigate how the first COVID-19 lockdown affected the everyday 
life and health of persons with co-occurring mental health and substance use 
disorders.
METHODS: This qualitative study reports data from 17 individual interviews and 
one focus group of five participants, all with a self-reported mental health and 
substance use disorder. Interviews were conducted based on a semi-structured 
interview guide in September and October 2020 in a medium-sized local authority 
in Norway. Data were analysed using thematic analysis. A reference group of 
people with varied knowledge and experiences of the phenomenon were involved in 
study design, recruitment, data generation and analysis.
RESULTS: The analysis identified four interrelated main themes, describing how 
the first lockdown affected the everyday life and health of persons suffering 
from a mental health and substance use disorder: (1) The COVID-19 outbreak as a 
perceived challenge, (2) A decline in mental health and well-being, (3) 
Increased substance use challenges, and (4) Diverse experiences with health and 
social services. The results show that people with a co-occurring disorder have 
challenges with digital tools and/or do not have the appropriate equipment. 
Further, participants were not concerned about becoming infected themselves, but 
infecting others.
CONCLUSIONS: Persons with a mental health and substance use disorder face major 
challenges during the COVID-19 pandemic. There is a need to maintain continuous 
low-threshold services especially directed towards persons with co-occurring 
disorders during the pandemic. Furthermore, it is important to improve the 
digital skills of every service user or offer alternatives to digital 
consultations and meetings.

© 2022. The Author(s).

DOI: 10.1186/s12888-022-03812-7
PMCID: PMC8919911
PMID: 35287637 [Indexed for MEDLINE]

Conflict of interest statement: ML, MB and NC declare that they have no 
competing interests. LL has a temporary part-time engagement as an external 
consultant for the Norwegian Directorate of Health.


2288. BMC Public Health. 2022 Mar 15;22(1):500. doi: 10.1186/s12889-022-12873-y.

The impact of COVID-19 on access to harm reduction, substance use treatment and 
recovery services in Scotland: a qualitative study.

Schofield J(1), Dumbrell J(2), Matheson C(3), Parkes T(1), Bancroft A(4).

Author information:
(1)Salvation Army Centre for Addiction Services and Research, Faculty of Social 
Sciences, Colin Bell Building, University of Stirling, Stirling, FK9 4LA, 
Scotland.
(2)Salvation Army Centre for Addiction Services and Research, Faculty of Social 
Sciences, Colin Bell Building, University of Stirling, Stirling, FK9 4LA, 
Scotland. j.l.dumbrell@stir.ac.uk.
(3)Faculty of Social Sciences, Colin Bell Building, University of Stirling, 
Stirling, FK9 4LA, Scotland.
(4)School of Social and Political Science, Chrystal Macmillan Building, 15a 
George Square, Edinburgh, EH8 9LD, Scotland.

INTRODUCTION: People who use drugs (PWUD) are considered vulnerable to COVID-19 
exposure and the sequelae of infection due to their social circumstances, health 
conditions, drug purchasing, and substance use. They can depend on access to 
services that provide harm reduction, substance use treatment, recovery and 
support, and general healthcare. Social distancing measures and service 
restrictions posed significant challenges to the health and wellbeing of PWUD.
METHODS: Ethical approvals were secured. PWUD were recruited from voluntary 
sector homeless and housing, harm reduction, and recovery organisations across 
central Scotland. Data was collected via semi-structured interviews and analysed 
using the Framework Method.
RESULTS: Twenty nine PWUD participated and reported mixed experiences of the 
impacts of COVID-19 lockdown. Several benefitted from policy and practice 
developments designed to sustain or increase access to harm reduction services. 
Some PWUD reported improved access to substitute prescribing and/or appreciated 
being trusted to manage multiple take-home doses. Others noted the loss of 
regular in-person contact with treatment providers and dispensers. Access to 
recovery support was challenging for many, especially those unable to access or 
uncomfortable with online provision who experienced greater isolation. Lack of 
access to general healthcare services was common, and especially problematic for 
PWUD with chronic physical and mental health conditions.
CONCLUSIONS: This qualitative research describes the impacts of COVID-19 social 
and service restrictions on PWUD in Scotland. These impacts were anticipated by 
policy makers and service providers. Effective and acceptable developments were 
shown to maintain and even increase service provision for PWUD. Developments 
were geographically dependent and significant challenges remained for many 
people. The learning generated can inform responses to increase service access 
and uptake in post-pandemic times.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-12873-y
PMCID: PMC8920805
PMID: 35287630 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2289. Psychother Psychosom Med Psychol. 2022 Oct;72(9-10):445-451. doi: 
10.1055/a-1778-5316. Epub 2022 Mar 14.

[Parental Stress: Psychometric Evaluation of the German Version of the Parental 
Stress Scale in the General Population].

[Article in German; Abstract available in German from the publisher]

Kölch M(1), Lübke L(2), Müller S(3)(4), Reis O(1), Brähler E(5)(6), Lincke L(1), 
Spitzer C(2).

Author information:
(1)Klinik für Psychiatrie, Neurologie, Psychosomatik und Psychotherapie im 
Kindes- und Jugendalter, Universitätsmedizin Rostock, Rostock, Germany.
(2)Klinik und Poliklinik für Psychosomatik und Psychotherapeutische Medizin, 
Universitätsmedizin Rostock, Rostock, Germany.
(3)Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin 
Rostock, Rostock, Germany.
(4)Institut für Psychologie, Universität Kassel, Kassel, Germany.
(5)Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, 
Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany.
(6)Integriertes Forschungs- und Behandlungszentrum Adipositas-Erkrankungen, 
Forschungsstelle Verhaltensmedizin, Klinik für Psychosomatische Medizin und 
Psychotherapie, Universitätsklinikum Leipzig, Leipzig, Germany.

Parental stress has negative impact on parents and their children. Parental 
stress may be of special interest for family and child well-being due to 
Covid-19 pandemic. A reliable and valid assessment of parental stress would be 
beneficial both in research and clinical practice. The Parental Stress Scale 
(PSS) is internationally well established as an economic and psychometric valid 
assessment. It consists of 18 items. The study evaluated the factor structure of 
the German version of the PSS in a general population (n=386 parents with 
children<16 years) for the first time. The sample was part of a representative 
sample (n=2519). The confirmatory factor analysis did not confirm 
internationally previously reported models. Eliminating one item, the 
explorative factor analysis suggested a two factor structure with the dimensions 
"lack of confident" and "worries and strain". Both subscales showed a good 
internal consistence (McDonalds ω≥0,87). We observed correlations of the PSS-17 
items with family dysfunction and elevated scores for depressive or anxiety 
symptoms, but not with sociodemographic factors. One conclusion is that the 
multidimensional construct of parental stress maybe is not comprehensively 
represented by the PSS. For the use in clinical practice and research this has 
to be taken into account. Albeit, the German version of the PSS is an economic, 
reliable and valid assessment.

Publisher: Stress aufgrund von Elternschaft wirkt sich nicht nur negativ auf die 
Betroffenen selbst, sondern v. a. auch nachteilig auf die psychische und 
körperliche Gesundheit ihrer Kinder aus, was reziprok die Belastung im Sinne 
eines Teufelskreises erhöht. Elterlicher Stress scheint ein negativer Faktor für 
die psychische Gesundheit auch im Rahmen der Covid-19 Pandemie zu sein. Daher 
kommt einer reliablen und validen Erfassung der elterlichen Stressbelastung 
sowohl wissenschaftlich als auch klinisch-praktisch eine hohe Bedeutung zu. Die 
18 Items umfassende Parental Stress Scale (PSS) ist aufgrund ihrer 
Anwendungsökonomie und soliden psychometrischen Kennwerte international gut 
etabliert. In dieser Studie wurde die deutsche Version der PSS erstmals an 
Eltern (n=386) von Kindern unter 16 Jahren aus einer repräsentativen 
Allgemeinbevölkerungsstichprobe (n=2519) mit einem Fokus auf der 
Faktorenstruktur teststatistisch evaluiert. Mittels konfirmatorischer 
Faktorenanalyse konnten die in der internationalen Literatur berichteten Modelle 
nicht bestätigt werden. Eine explorative Faktorenanalyse legte unter Ausschluss 
eines Items eine zweifaktorielle Lösung mit den Dimensionen ‚Mangel an 
Zufriedenheit‘ sowie ‚Sorgen und Belastungen‘ nahe. Beide Subskalen zeigten eine 
gute interne Konsistenz mit Werten für McDonalds ω≥0,87. Entgegen den Annahmen 
fanden sich keine relevanten Zusammenhänge zwischen der um ein Item gekürzten 
Gesamtskala (PSS-17) einschließlich der Subskalen und soziodemographischen 
Merkmalen, jedoch hypothesenkonforme Assoziationen mit familiärer Dysfunktion 
sowie aktueller Depressivität und Ängstlichkeit. Obwohl mit der deutschen 
Version der PSS Stressbelastung durch Elternschaft anwendungsökonomisch, 
ausreichend reliabel und valide erfasst werden kann, legen die Befunde zur 
faktoriellen Validität nahe, dass das Verfahren der Multidimensionalität des 
zugrundeliegenden Konstrukts nur bedingt gerecht wird. Dieser Aspekt ist bei der 
klinischen und wissenschaftlichen Anwendung einschränkend zu berücksichtigen.

Thieme. All rights reserved.

DOI: 10.1055/a-1778-5316
PMID: 35287236 [Indexed for MEDLINE]

Conflict of interest statement: Die Autorinnen/Autoren geben an, dass kein 
Interessenkonflikt besteht.


2290. Stress Health. 2022 Dec;38(5):891-901. doi: 10.1002/smi.3142. Epub 2022 Mar 20.

Self-compassion and savouring buffer the impact of the first year of the 
COVID-19 on PhD students' mental health.

Paucsik M(1), Leys C(2), Marais G(3), Baeyens C(1), Shankland R(4)(5).

Author information:
(1)Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, LIP/PC2S, Grenoble, France.
(2)Univ. Libre de Bruxelles, Brussels, Belgium.
(3)Univ. Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive, 
Villeurbanne, France.
(4)Grenoble Ecole de Management, Grenoble, France.
(5)Univ. Lumière Lyon 2, Laboratory DIPHE (Development, Individual, Processes, 
Handicap, Education), Bron, France.

Doctoral students face many challenges that were reinforced by COVID-19-related 
lockdowns. We assessed this impact over 1 year on doctoral students' depression, 
anxiety, stress, well-being, and doctoral engagement. We also investigated the 
potential protective role of self-compassion and savouring on mental health, 
well-being, and doctoral engagement. A total of 134 PhD students from several 
French universities responded to the three-time points of this longitudinal 
study. The results showed a significant increase in depression, anxiety and 
stress and a significant decrease in well-being and doctoral engagement during 
the first year of the pandemic. Self-compassion and savouring predicted lower 
levels of depression, anxiety, and stress, and higher levels of well-being over 
time. Savouring alone predicted higher doctoral engagement over time. This study 
reveals the significant impact of the pandemic year on the mental health of 
doctoral students, and the relevance of self-compassion and savouring as 
psychological resources to cope with adversity.

© 2022 John Wiley & Sons Ltd.

DOI: 10.1002/smi.3142
PMCID: PMC9111133
PMID: 35286765 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no financial or 
non‐financial interests to disclose.


2291. J Sex Res. 2023 Jan;60(1):1-12. doi: 10.1080/00224499.2022.2035663. Epub 2022 
Mar 14.

Initial Impacts of COVID-19 on Sex Life and Relationship Quality in Steady 
Relationships in Britain: Findings from a Large, Quasi-representative Survey 
(Natsal-COVID).

Mitchell KR(1), Shimonovich M(1), Bosó Pérez R(1), Dema E(2), Clifton S(2)(3), 
Riddell J(1), Copas AJ(2), Tanton C(4), Macdowall W(4), Bonell C(4), Sonnenberg 
P(2), Mercer CH(2), Field N(2).

Author information:
(1)MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
(2)Institute for Global Health, University College London.
(3)NatCen Social Research.
(4)Faculty of Public Health and Policy, London School of Hygiene and Tropical 
Medicine.

Intimate relationships are ubiquitous and exert a strong influence on health. 
Widespread disruption to them may impact wellbeing at a population level. We 
investigated the extent to which the first COVID-19 lockdown (March 2020) 
affected steady relationships in Britain. In total, 6,654 participants aged 
18-59 years completed a web-panel survey (July-August 2020). 
Quasi-representativeness was achieved via quota sampling and weighting. We 
explored changes in sex life and relationship quality among participants in 
steady relationships (n = 4,271) by age, gender, and cohabitation status, and 
examined factors associated with deterioration to a lower-quality relationship. 
A total of 64.2% of participants were in a steady relationship (of whom 88.9% 
were cohabiting). A total of 22.1% perceived no change in their sex-life 
quality, and 59.5% no change in their relationship quality. Among those 
perceiving change, sex-life quality was more commonly reported to decrease and 
relationship quality to improve. There was significant variation by age; less 
often by gender or cohabitation. Overall, 10.6% reported sexual difficulties 
that started/worsened during lockdown. In total, 6.9% reported deterioration to 
a "lower quality" relationship, more commonly those: aged 18-24 and aged 35-44; 
not living with partner (women only); and reporting depression/anxiety and 
decrease in sex-life quality. In conclusion, intimate relationship quality is 
yet another way in which COVID-19 has led to divergence in experience.

DOI: 10.1080/00224499.2022.2035663
PMID: 35286182 [Indexed for MEDLINE]


2292. JAMA Pediatr. 2022 Jul 1;176(7):e220056. doi: 10.1001/jamapediatrics.2022.0056. 
Epub 2022 Jul 5.

Five-Year Trends in US Children's Health and Well-being, 2016-2020.

Lebrun-Harris LA(1), Ghandour RM(1), Kogan MD(1), Warren MD(1).

Author information:
(1)US Department of Health and Human Services, Health Resources and Services 
Administration, Maternal and Child Health Bureau.

Erratum in
    JAMA Pediatr. 2022 Apr 4;:null.
    JAMA Pediatr. 2023 Mar 1;177(3):323.

Comment in
    JAMA Pediatr. 2022 Jul 1;176(7):e220063.

IMPORTANCE: Ensuring the well-being of the 73 million children in the United 
States is critical for improving the nation's health and influencing children's 
long-term outcomes as they grow into adults.
OBJECTIVE: To examine recent trends in children's health-related measures, 
including significant changes between 2019 and 2020 that might be attributed to 
the COVID-19 pandemic.
DESIGN, SETTING, AND PARTICIPANTS: Annual data were examined from the National 
Survey of Children's Health (2016-2020), a population-based, nationally 
representative survey of randomly selected children. Participants were children 
from birth to age 17 years living in noninstitution settings in all 50 states 
and the District of Columbia whose parent or caregiver responded to an 
address-based survey by mail or web. Weighted prevalence estimates account for 
probability of selection and nonresponse. Adjusted logistic regression models 
tested for significant trends over time.
MAIN OUTCOMES AND MEASURES: Diverse measures pertaining to children's current 
health conditions, positive health behaviors, health care access and 
utilization, and family well-being and stressors.
RESULTS: A total of 174 551 children were included (annual range = 21 599 to 
50 212). Between 2016 and 2020, there were increases in anxiety (7.1% [95% CI, 
6.6-7.6] to 9.2% [95% CI, 8.6-9.8]; +29%; trend P < .001) and depression (3.1% 
[95% CI, 2.9-3.5] to 4.0% [95% CI, 3.6-4.5]; +27%; trend P < .001). There were 
also decreases in daily physical activity (24.2% [95% CI, 23.1-25.3] to 19.8% 
[95% CI, 18.9-20.8]; -18%; trend P < .001), parent or caregiver mental health 
(69.8% [95% CI, 68.9-70.8] to 66.3% [95% CI, 65.3-67.3]; -5%; trend P < .001), 
and coping with parenting demands (67.2% [95% CI, 66.3-68.1] to 59.9% [95% CI, 
58.8-60.9]; -11%; trend P < .001). In addition, from 2019 to 2020, there were 
increases in behavior or conduct problems (6.7% [95% CI, 6.1-7.4] to 8.1% [95% 
CI, 7.5-8.8]; +21%; P = .001) and child care disruptions affecting parental 
employment (9.4% [95% CI, 8.0-10.9] to 12.6% [95% CI, 11.2-14.1]; +34%; trend 
P = .001) as well as decreases in preventive medical visits (81.0% [95% CI, 
79.7-82.3] to 74.1% [95% CI, 72.9-75.3]; -9%; trend P < .001).
CONCLUSIONS AND RELEVANCE: Recent trends point to several areas of concern that 
can inform future research, clinical care, policy decision making, and 
programmatic investments to improve the health and well-being of children and 
their families. More analyses are needed to elucidate varying patterns within 
subpopulations of interest.

DOI: 10.1001/jamapediatrics.2022.0056
PMCID: PMC8922203
PMID: 35285883 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest Disclosures: None reported.


2293. Postgrad Med. 2022 May;134(4):349-358. doi: 10.1080/00325481.2022.2052467. Epub 
2022 Mar 30.

The impact of physical activity on well-being, lifestyle and health promotion in 
an era of COVID-19 and SARS-CoV-2 variant.

So B(1), Kwon KH(2).

Author information:
(1)Division of Beauty Arts Care, Department of Practical Arts, Graduate School 
of Culture and Arts, Dongguk University, Seoul, Republic of Korea.
(2)College of General Education, Kookmin University, Seoul, Republic of Korea.

We must recognize the limitations of the current situation and vaccines where 
SARS-CoV-2 variants continue to transform and spread and need to build 
strategies to maintain and promote health in adherence to the suggested 
recommended action of the WHO. The purpose of this review is to examine the 
literature and latest research on the effects of physical activity (PA) on 
health in preparation for the SARS-CoV-2 strain and future infectious diseases 
era. In addition, it provides some general guidelines for actionable PA. We 
performed a literature search using Scopus, Riss, MEDLINE, and Google Scholar, 
this review method was a narrative literature review of the available literature 
and latest literature regarding health and PA-related factors during the 
COVID-19 pandemic. As a result, PA suggests opportunities to not only maintain 
and promote health by strengthening the immune system in an era where the 
COVID-19 variant is a crisis but also implement opportunities for well-being 
(WB), healthy lifestyles, and long-term health improvement. In particular, 
maintaining a regular PA routine outdoors or at home could be an important means 
to lower infection rates and maintain health during the potential impact of the 
current COVID-19 crisis and future pandemics (i.e. dramatic moments). The 
clinical relevance of the present review is crucial to understanding the impact 
of PA on WB, lifestyle, physical and mental health, maintaining regular PA, and 
important preventive factor to better prepare for the era of COVID-19 variants 
and similar pandemics in the future as it is emphasized as a prevention strategy 
and key strategy for continuous health promotion.

DOI: 10.1080/00325481.2022.2052467
PMID: 35285767 [Indexed for MEDLINE]


2294. Int J Public Health. 2022 Feb 25;67:1604418. doi: 10.3389/ijph.2022.1604418. 
eCollection 2022.

Self-Esteem, Happiness, and Flourishing in Times of COVID-19: A Study During the 
Lockdown Period in Ecuador.

Paz C(1), Hermosa-Bosano C(1), Hidalgo-Andrade P(1), García-Manglano J(2), 
Sábada Chalezquer C(3), López-Madrigal C(4), Serrano C(5).

Author information:
(1)School of Psychology and Education, Universidad de Las Américas, Quito, 
Ecuador.
(2)Institute for Culture and Society, University of Navarra, Pamplona, Spain.
(3)School of Communication, University of Navarra, Pamplona, Spain.
(4)School of Education and Psychology, University of Navarra, Pamplona, Spain.
(5)Department of Sociology, Università Cattolica di Milano, Milano, Italy.

Objective: Several studies have investigated the negative toll the pandemic has 
had on people's mental health. However, there is limited research on the 
pandemic's effect on positive mental health variables. This article reports on 
the levels of self-esteem and well-being (flourishing and happiness) in a sample 
of adults living in Ecuador and their relationships with the characteristics of 
their personal situation and the effects of the COVID-19 pandemic had on their 
personal lives. Methods: A total of 766 adults completed an anonymous online 
survey between March and August 2020. Results: Participants reported average 
scores in the flourishing scale, the majority considered themselves to be happy 
or very happy people, and more than half presented high levels of self-esteem. 
Age, education, socioeconomic status, time spent using mobile phones and on 
hobbies, among others, explained self-esteem, happiness, and flourishing. 
Conclusion: The relationships between sociodemographic and situational variables 
of confinement during the pandemic are discussed, as well as the possible 
predictors of happiness, flourishing, and self-esteem.

Copyright © 2022 Paz, Hermosa-Bosano, Hidalgo-Andrade, García-Manglano, Sábada 
Chalezquer, López-Madrigal and Serrano.

DOI: 10.3389/ijph.2022.1604418
PMCID: PMC8916225
PMID: 35283717 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2295. Int J Neurosci. 2023 Dec;133(10):1071-1089. doi: 10.1080/00207454.2022.2045290. 
Epub 2022 Mar 14.

A reappraisal on amyloid cascade hypothesis: the role of chronic infection in 
Alzheimer's disease.

Phuna ZX(1), Madhavan P(1).

Author information:
(1)School of Medicine, Faculty of Health and Medical Sciences, Taylor's 
University, Selangor, Malaysia.

Alzheimer disease (AD) is a progressive neurological disorder that accounted for 
the most common cause of dementia in the elderly population. Lately, 'infection 
hypothesis' has been proposed where the infection of microbes can lead to the 
pathogenesis of AD. Among different types of microbes, human immunodeficiency 
virus-1 (HIV-1), herpes simplex virus-1 (HSV-1), Chlamydia pneumonia, 
Spirochetes and Candida albicans are frequently detected in the brain of AD 
patients. Amyloid-beta protein has demonstrated to exhibit antimicrobial 
properties upon encountering these pathogens. It can bind to microglial cells 
and astrocytes to activate immune response and neuroinflammation. Nevertheless, 
HIV-1 and HSV-1 can develop into latency whereas Chlamydia pneumonia, 
Spirochetes and Candida albicans can cause chronic infections. At this stage, 
the DNA of microbes remains undetectable yet active. This can act as the 
prolonged pathogenic stimulus that over-triggers the expression of Aβ-related 
genes, which subsequently lead to overproduction and deposition of Aβ plaque. 
This review will highlight the pathogenesis of each of the stated microbial 
infection, their association in AD pathogenesis as well as the effect of chronic 
infection in AD progression. Potential therapies for AD by modulating the 
microbiome have also been suggested. This review will aid in understanding the 
infectious manifestations of AD.

DOI: 10.1080/00207454.2022.2045290
PMID: 35282779 [Indexed for MEDLINE]


2296. Glob Public Health. 2022 May;17(5):652-661. doi: 10.1080/17441692.2022.2049844. 
Epub 2022 Mar 13.

COVID-19, violence, and mental health among Indigenous gay and bisexual men in 
Guatemala: An urgent call from key stakeholders.

Davis DA(1), Orellana ER(2), Estrada-Villalta S(3), Brouwer KC(1).

Author information:
(1)Herbert Wertheim School of Public Health and Human Longevity Science, 
University of California, San Diego, CA, USA.
(2)School of Social Work, University of Washington, Seattle, WA, USA.
(3)Department of Psychology, Universidad del Valle de Guatemala, Guatemala City, 
Guatemala.

We explored how the COVID-19 pandemic has affected the health and wellbeing of 
Indigenous gay and bisexual men (GBM) in Guatemala, a group that experiences 
intersectional stigma and structural barriers to health. Between February and 
May 2021, we conducted in-depth qualitative interviews via Zoom with key 
stakeholders (n = 11) working with Indigenous GBM throughout Guatemala. We coded 
thematically and conducted narrative analysis to identify the most salient 
themes. Participants described that prior to the COVID-19 pandemic, many 
Indigenous GBM migrated to urban centres to avoid stigma and violence from 
families and rural communities. After the onset of COVID-19, many Indigenous GBM 
lost their jobs and were forced to move back in with families. For Indigenous 
GBM who returned, participants described a perceived increase in the severity of 
physical and psychological violence. Participants attributed this increase in 
severity to retribution from families and communities for having left. Most 
Indigenous GBM-serving organisations reported a drastic increase in demand for 
mental health services. Organisations serving Indigenous GBM have an urgent need 
to scale up their mental health services and find innovative ways to provide 
these services remotely during the pandemic and beyond. Technology-based mental 
health interventions that require little 'live' interaction may be appropriate.

DOI: 10.1080/17441692.2022.2049844
PMCID: PMC9118334
PMID: 35282763 [Indexed for MEDLINE]


2297. Int J Ment Health Nurs. 2022 Jun;31(3):687-696. doi: 10.1111/inm.12989. Epub 
2022 Mar 13.

Protocol for a mixed methods process evaluation of the Promoting Resilience in 
Nurses (PRiN) trial.

Bui MV(1)(2), McInnes E(1)(3), Ennis G(2), Foster K(1)(2).

Author information:
(1)School of Nursing, Midwifery and Paramedicine, Australian Catholic 
University, Fitzroy, Victoria, Australia.
(2)NorthWestern Mental Health, Melbourne Health, Parkville, Victoria, Australia.
(3)Nursing Research Institute - St Vincent's Health Network Sydney, St Vincent's 
Hospital Melbourne and Australian Catholic University, Parkville, Victoria, 
Australia.

Mental health nurses are exposed frequently to occupational stress and can 
experience a range of negative impacts on their well-being and intention to stay 
in the nursing workforce. Promoting Resilience in Nurses (PRiN) is a 
strength-based resilience education programme that incorporates evidence-based 
cognitive behavioural and interpersonal approaches with post-traumatic growth 
theory. A partially clustered randomized controlled trial at a large public 
mental health service will be used to examine the effects of PRiN on mental 
health nurses' coping self-efficacy, resilience, well-being, mental health, 
emotional regulation, post-traumatic growth, workplace belonging, and turnover 
intention as compared to controls. Process evaluations are increasingly used to 
help understand and interpret trial results for complex interventions. This 
paper describes the protocol for an embedded mixed methods process evaluation 
that aims to evaluate the PRiN programme implementation and identify factors 
that may explain variation in participant outcomes in the trial. Data collection 
includes a programme participant satisfaction survey; a follow-up 
semi-structured interview with selected programme participants; a unit/team 
manager survey on barriers and facilitators to staff recruitment and programme 
participation; and a fidelity checklist completed by programme facilitators. 
Normalisation Process Theory will be used to inform data analysis and 
integration. The findings will provide insights into factors that affect 
programme implementation, particularly in the context of the COVID-19 pandemic 
and may help explain differences in participant outcomes. Findings will also 
inform post-trial programme sustainability as well as potential future upscale 
and adaptation for implementation across healthcare settings.

© 2022 The Authors. International Journal of Mental Health Nursing published by 
John Wiley & Sons Australia, Ltd.

DOI: 10.1111/inm.12989
PMCID: PMC9314145
PMID: 35279934 [Indexed for MEDLINE]


2298. Psychiatry Res. 2022 May;311:114495. doi: 10.1016/j.psychres.2022.114495. Epub 
2022 Mar 6.

Pandemic-related experiences, mental health symptoms, substance use, and 
relationship conflict among older adolescents and young adults from Manitoba, 
Canada.

Salmon S(1), Taillieu TL(1), Fortier J(1), Stewart-Tufescu A(2), Afifi TO(3).

Author information:
(1)Department of Community Health Sciences, University of Manitoba, S113-750 
Bannatyne Avenue, Winnipeg, Manitoba R3E 0W5, Canada.
(2)Faculty of Social Work, University of Manitoba, Winnipeg, Manitoba, Canada.
(3)Department of Community Health Sciences, University of Manitoba, S113-750 
Bannatyne Avenue, Winnipeg, Manitoba R3E 0W5, Canada; Department of Psychiatry, 
University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address: 
tracie.afifi@umanitoba.ca.

There is growing awareness of the negative impact of the COVID-19 pandemic on 
young people. The purpose of this study was to examine older adolescents' and 
young adults' pandemic-related experiences, including financial difficulties, 
emotional support, social connections, mental health symptoms, substance use, 
and relationship conflict. Data from the Well-being and Experiences Study (The 
WE Study) were gathered from November to December 2020 in Manitoba, Canada, 
among a community sample (n = 664; ages 16-21 years). Over half of the sample 
self-reported increased stress/anxiety (57.6%) and depression (54.2%) attributed 
to the pandemic. Increased alcohol consumption was reported by 18.2% of 
alcohol-users. Among cannabis-users, 35.1% reported increased use. Conflict with 
parents, siblings, and an intimate partner increased for 19.9%, 15.2%, and 24.0% 
of respondents, respectively. Females reported greater financial burden, mental 
health burden, and conflict with parents than males. Young adults reported 
greater financial and mental health burden than older adolescents. Higher 
household income was protective of some experiences. The current study adds to 
growing evidence that young people were adversely impacted by the COVID-19 
pandemic. Increased access to virtual support resources is needed and should 
continue following the pandemic. Evidence-based interventions may need to be 
tailored to females and young adults.

Copyright © 2022. Published by Elsevier B.V.

DOI: 10.1016/j.psychres.2022.114495
PMCID: PMC8898590
PMID: 35279437 [Indexed for MEDLINE]

Conflict of interest statement: No authors have any conflicts of interest to 
report.


2299. BMC Public Health. 2022 Mar 12;22(1):491. doi: 10.1186/s12889-022-12911-9.

The association of resilience with depression, anxiety, stress and physical 
activity during the COVID-19 pandemic.

To QG(1)(2), Vandelanotte C(3), Cope K(4), Khalesi S(3)(4), Williams SL(3)(4), 
Alley SJ(3)(4), Thwaite TL(3)(4), Fenning AS(4), Stanton R(3)(4).

Author information:
(1)Appleton Institute, Central Queensland University, Rockhampton, 4701, 
Australia. q.to@cqu.edu.au.
(2)School of Health, Medical and Applied Sciences, Central Queensland 
University, Rockhampton, 4701, Australia. q.to@cqu.edu.au.
(3)Appleton Institute, Central Queensland University, Rockhampton, 4701, 
Australia.
(4)School of Health, Medical and Applied Sciences, Central Queensland 
University, Rockhampton, 4701, Australia.

BACKGROUND: COVID-19 has resulted in substantial global upheaval. Resilience is 
important in protecting wellbeing, however few studies have investigated changes 
in resilience over time, and associations between resilience with depression, 
anxiety, stress, and physical activity during the COVID-19 pandemic.
METHODS: Online surveys were conducted to collect both longitudinal and 
cross-sectional data at three time points during 2020. Australian adults aged 
18 years and over were invited to complete the online surveys. Measures include 
the six-item Brief Resilience Scale, the 21-item Depression, Anxiety and Stress 
Scale, and the Active Australia Survey which have eight items identifying the 
duration and frequency of walking, and moderate and vigorous physical activities 
(MVPA), over the past 7 days. General linear mixed models and general linear 
models were used in the analysis.
RESULTS: In the longitudinal sample, adjusted differences (aDif) in resilience 
scores did not significantly change over time (time 2 vs. time 1 [aDif = - 0.02, 
95% CI = - 0.08, 0.03], and time 3 vs. time 1 [aDif = < 0.01, 95% CI = - 0.07, 
0.06]). On average, those engaging in at least 150 min of MVPA per week 
(aDif = 0.10, 95% CI = 0.04, 0.16), and having depression (aDif = 0.40, 95% 
CI = 0.33), anxiety (aDif = 0.34, 95% CI = 0.26, 0.41), and stress scores 
(aDif = 0.30, 95% CI = 0.23, 0.37) within the normal range had significantly 
higher resilience scores. The association between resilience and physical 
activity was independent of depression, anxiety, and stress levels. All results 
were similar for the cross-sectional sample.
CONCLUSIONS: Resilience scores did not change significantly during the COVID-19 
pandemic. However, there were significant associations between resilience with 
physical activity and psychological distress. This research helps inform future 
interventions to enhance or nurture resilience, particularly targeted at people 
identified as at risk of psychological distress.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-12911-9
PMCID: PMC8917786
PMID: 35279118 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2300. Prim Care Companion CNS Disord. 2022 Mar 8;24(2):21m03166. doi: 
10.4088/PCC.21m03166.

Occupational Risk Factors and Mental Health Among Frontline Health Care Workers 
in a Large US Metropolitan Area During the COVID-19 Pandemic.

Cahill AG(1)(2), Olshavsky ME(3), Newport DJ(1)(4), Benzer J(4), Chambers KM(5), 
Custer J(6), Rathouz PJ(6), Nutt S(1), Jwaied S(7), Leslie R(3), Matsui EC(6).

Author information:
(1)Department of Women's Health, University of Texas at Austin, Dell Medical 
School, Austin, Texas.
(2)Corresponding author: Alison G. Cahill, MD, MSCI, Department of Women's 
Health, University of Texas at Austin, Dell Medical School, 1601 Trinity St, 
Austin, TX 78712 (alison.cahill@austin.utexas.edu).
(3)Ascension, St Louis, Missouri.
(4)Department of Psychiatry and Behavioral Sciences, University of Texas at 
Austin, Dell Medical School, Austin, Texas dDepartment of Surgery and 
Perioperative Care, University of Texas at Austin, Dell Medical School, Austin, 
Texas eDepartment of Population Health, University of Texas at Austin, Dell 
Medical School, Austin, Texas fUniversity of Texas at Austin, Austin, Texas 
*Corresponding author: Alison G. Cahill, MD, MSCI, Department of Women's Health, 
University of Texas at Austin, Dell Medical School, 1601 Trinity St, Austin, TX 
78712 (alison.cahill@austin.utexas.edu).
(5)Department of Surgery and Perioperative Care, University of Texas at Austin, 
Dell Medical School, Austin, Texas eDepartment of Population Health, University 
of Texas at Austin, Dell Medical School, Austin, Texas fUniversity of Texas at 
Austin, Austin, Texas *Corresponding author: Alison G. Cahill, MD, MSCI, 
Department of Women's Health, University of Texas at Austin, Dell Medical 
School, 1601 Trinity St, Austin, TX 78712 (alison.cahill@austin.utexas.edu).
(6)Department of Population Health, University of Texas at Austin, Dell Medical 
School, Austin, Texas.
(7)University of Texas at Austin, Austin, Texas.

Objective: To assess depression, anxiety, and burnout among health care workers 
using well-established validated scales and to examine associations of these 
mental health outcomes with personal protective equipment (PPE) and high-risk 
patient contact. Methods: This prospective survey was conducted between August 
and October 2020 among 970 essential health care workers from 2 health systems 
in central Texas. The survey captured basic demographic, occupational, and 
baseline health information including history of mental health disorders. 
Depression, anxiety, and burnout were assessed with the 8-item Patient Health 
Questionnaire, 7-item Generalized Anxiety Disorder Scale, and 23-item Burnout 
Assessment Tool. Questions about clinical contact with patients with suspected 
or known COVID-19 were also incorporated. Results: Approximately 24% of 
respondents had moderate or severe anxiety, 14% had moderate or severe 
depression, and 7% were at high risk for burnout. Statistically significant 
associations were found between perceived PPE adequacy and the 3 mental health 
outcomes, while accounting for age, gender, and education. Hours of contact with 
COVID-19 patients during aerosolizing procedures was positively correlated with 
measures of anxiety, burnout, and depression after adjustment for age, gender, 
and occupational role. Perception of PPE adequacy was inversely correlated with 
measures of depression, anxiety, and burnout among essential members of 2 health 
care systems, whose roles precluded working remotely during the pandemic. 
Conclusion: This study highlights the correlations of perceptions of PPE 
adequacy and contact hours with COVID-19 patients undergoing aerosolizing 
procedures and employee mental well-being. Future work confirming the findings 
can help identify ways that systems can support their employees through 
similarly stressful and demanding events.

© Copyright 2022 Physicians Postgraduate Press, Inc.

DOI: 10.4088/PCC.21m03166
PMID: 35276759 [Indexed for MEDLINE]


2301. Compr Psychiatry. 2022 May;115:152300. doi: 10.1016/j.comppsych.2022.152300. 
Epub 2022 Feb 26.

An intervention package for supporting the mental well-being of community health 
workers in low, and middle-income countries during the COVID-19 pandemic.

Yakubu K(1), Musoke D(2), Chikaphupha K(3), Chase-Vilchez A(4), Maulik PK(5), 
Joshi R(6).

Author information:
(1)The George Institute for Global Health, Faculty of Medicine, University of 
New South Wales, Sydney, Australia. Electronic address: 
kyakubu@georgeinstitute.org.au.
(2)Department of Disease Control and Environmental Health, School of Public 
Health, College of Health Sciences, Makerere University, Kampala, Uganda.
(3)Research for Equity and Community Health (REACH) Trust, Lilongwe, Malawi.
(4)Global Alliance for Chronic Diseases, London, United Kingdom.
(5)The George Institute for Global Health, Faculty of Medicine, University of 
New South Wales, Sydney, Australia; The George Institute for Global Health, New 
Delhi, India; Prasanna School of Public Health, Manipal University, Manipal, 
India.
(6)The George Institute for Global Health, Faculty of Medicine, University of 
New South Wales, Sydney, Australia; The George Institute for Global Health, New 
Delhi, India; School of Population Health, Faculty of Medicine, University of 
New South Wales, Sydney, Australia.

BACKGROUND: As the COVID-19 pandemic continues, there is an increasing reliance 
on community health workers (CHWs) to achieve its control especially in low, and 
middle-income countries (LMICs). An increase in the demand for their services 
and the challenges they already face make them prone to mental health illness. 
Therefore, there is a need to further support the mental health and well-being 
of CHWs during the COVID-19 pandemic.
METHODS: We organised a workshop on Zoom to deliberate on relevant components of 
an intervention package for supporting the mental health of CHWs in LMICs during 
the COVID-19 pandemic. We used a thematic analysis approach to summarise 
deliberations from this workshop.
OUTCOMES: Participants identified the need for a hub for coordinating CHW 
activities, a care coordination team to manage their health, training programs 
aimed at improving their work performance and taking control of their health, a 
communication system that keeps them in touch with colleagues, family, and the 
communities they serve. They cautioned against confidentiality breaches while 
handling personal health information and favoured tailoring interventions to the 
unique needs of CHWs. Participants also advised on the need to ensure job 
security for CHWs and draw on available resources in the community. To measure 
the impact of such an intervention package, participants encouraged the use of 
mixed methods and a co-designed approach.
INTERPRETATION: As CHWs contribute to the pandemic response in LMICs, their 
mental health and well-being need to be protected. Such protection can be 
provided by using an intervention package that harnesses inputs from members of 
the broader health system, their families, and communities.

Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.comppsych.2022.152300
PMCID: PMC8881902
PMID: 35276492 [Indexed for MEDLINE]

Conflict of interest statement: We have no conflict of interest to declare. The 
views expressed in this article do not represent the position of our affiliated 
organisations.


2302. Aging Ment Health. 2023 Mar;27(3):489-495. doi: 10.1080/13607863.2022.2048357. 
Epub 2022 Mar 11.

Benefit-finding buffers the effects of home confinement and centralized 
quarantine (HCCQ) on late midlife and older adults' mental health during the 
COVID-19 pandemic.

Zhang F(1), Cheng ST(2)(3).

Author information:
(1)Department of Public Health and Preventive Medicine, School of Medicine, 
Jinan University, Guangzhou, China.
(2)Department of Health and Physical Education, The Education University of Hong 
Kong, Hong Kong.
(3)Department of Clinical Psychology, Norwich Medical School, University of East 
Anglia, Norwich, United Kingdom.

Objective: Older adults' well-being may suffer due to prolonged social isolation 
leading to loneliness and increased stress during the COVID-19 pandemic. The 
current study aimed to address the role of benefit-finding, defined as the 
capacity to derive meaning and positive aspects from stressful situations, in 
late midlife and older adults' adaptation to the effects of home confinement and 
centralized quarantine (HCCQ).Methods: 421 participants aged 50 or above in 
mainland of China participated in an online survey to study the effects of HCCQ 
on loneliness, stress, anxiety, depression and life satisfaction, as well as the 
moderating role of benefit-finding.Results: Correlational analysis showed that a 
history of HCCQ was basically unrelated to any outcome. However, the effect 
actually varied by levels of benefit-finding. Among late midlife and older 
people with lower benefit-finding, those who had experienced HCCQ reported more 
loneliness, perceived stress, as well as more anxiety and depressive symptoms; 
no such relationships were found when benefit-finding was moderate or 
high.Conclusion: The findings extended our understanding of the role of 
benefit-finding in buffering the negative impact of adversity. By mitigating the 
effects of prolonged social isolation, benefit-finding served as a protective 
factor in late midlife and older people's adaptation to the sequelae of this 
pandemic.

DOI: 10.1080/13607863.2022.2048357
PMID: 35274581 [Indexed for MEDLINE]


2303. J Child Health Care. 2023 Sep;27(3):488-508. doi: 10.1177/13674935211059980. 
Epub 2022 Mar 10.

The indirect health impacts of the COVID-19 pandemic on children and 
adolescents: A review.

Oostrom TG(1), Cullen P(2)(3)(4), Peters SA(1)(3)(5).

Author information:
(1)Julius Center for Health Sciences and Primary Care, University Medical Center 
Utrecht, Utrecht University, Utrecht, The Netherlands.
(2)School of Population Health, UNSW Sydney, Sydney, NSW, Australia.
(3)The George Institute for Global Health, UNSW Sydney, Sydney, NSW, Australia.
(4)Ngarruwan Ngadju: First Peoples Health and Wellbeing Research Centre, 
University of Wollongong, Sydney, NSW, Australia.
(5)The George Institute for Global Health, Imperial College London, London, UK.

It is pertinent to examine potentially detrimental impacts of the coronavirus 
disease 2019 (COVID-19) pandemic on young people. We conducted a review to 
assess the health impacts of the COVID-19 pandemic on children and adolescents. 
Databases of MEDLINE, Embase and the Cochrane Library were searched in June 
2020, using keywords for 'children', 'adolescents' and 'COVID-19'. English 
papers discussing young people in context to the COVID-19 pandemic were 
included. Quality of selected studies was evaluated and scored. Of the 2013 
identified articles, 22 met the inclusion criteria, including 11 cohort studies, 
ten cross-sectional studies and one report. Five main issues emerged: Increased 
mental health conditions, declines in presentations to paediatric emergency 
departments, declines in vaccination rates, changes in lifestyle behaviour 
(mainly decreased physical activity for specific groups of children), and 
changes in paediatric domestic violence and online child sexual abuse. There are 
early indications that the COVID-19 pandemic is impacting the health of young 
people, and this is amplified for those with existing health conditions and 
vulnerabilities. Despite this, there is limited insight into the protective 
factors for young people's health and wellbeing, as well as how the impacts of 
the pandemic can be mitigated in both the short and long term.

DOI: 10.1177/13674935211059980
PMCID: PMC8919137
PMID: 35272523 [Indexed for MEDLINE]

Conflict of interest statement: The authors declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


2304. Ann Palliat Med. 2022 Jun;11(6):1865-1875. doi: 10.21037/apm-21-3416. Epub 2022 
Mar 7.

Association among sleep, depression, and health-related quality of life in 
patients with non-dialysis chronic kidney disease during the coronavirus disease 
2019 pandemic.

Chen Y(1), Li M(2), Zhou L(1), Chen C(1), Li N(1), Meng J(1), Wei G(1), Zhang 
H(1), Feng L(1), Li H(1), Sun J(1), Liu H(1).

Author information:
(1)Department of Nephrology, Tangdu Hospital, Air Force Medical University 
(Fourth Military Medical University), Xi'an, China.
(2)Department of Pathology, School of Basic Medical Sciences, Southern Medical 
University, Guangzhou, China.

BACKGROUND: Sleep disturbance is well documented as a crucial element that 
impairs health. Depression and health-related quality of life (HRQOL), which on 
behalf of a patient's overall perception of emotional, physical and social 
well-being, are increasingly emphasized self-reported health outcomes especially 
during the coronavirus disease 2019 (COVID-19) pandemic. Among dialysis 
patients, sleep disturbance is associated with depression and poorer HRQOL. The 
study was designed to depict the prevalence of sleep disturbance, and to explore 
the association among sleep, depression, and HRQOL in patients with non-dialysis 
chronic kidney disease (CKD) during the COVID-19 pandemic.
METHODS: A total of 172 non-dialysis CKD patients enrolled in this 
cross-sectional study, with sociodemographic and clinical data recorded. Sleep, 
HRQOL, and depression were evaluated via the Pittsburgh Sleep Quality Index 
(PSQI), the Kidney Disease Quality of Life 36-Item Short-Form Survey (KDQOL-36), 
and the 9-item Patient Health Questionnaire (PHQ-9), respectively.
RESULTS: A total of 100 (58%) met the criteria for poor sleep. Good sleepers had 
strikingly disparate HRQOL and depression scores compared to poor sleepers. 
Sleep disorders were significantly associated with decreased HRQOL and increased 
depression in regression models adjusted or unadjusted for sociodemographic and 
clinical characteristics. Mediation analysis indicated depression was a 
significant mediator explaining 51% of the relationship between sleep status 
with physical component summary (PCS) and played a fully mediating role in the 
association between sleep and mental component summary (MCS).
CONCLUSIONS: Our study suggested the high incidence of sleep disorders in 
patients with non-dialysis CKD during the COVID-19 pandemic, as well as the 
tight associations among sleep, depression, and HRQOL. Considering the negative 
influences of sleep and depression on HRQOL, appropriate screening and treatment 
for these treatable health-related domains are necessary for patients with 
non-dialysis CKD.

DOI: 10.21037/apm-21-3416
PMID: 35272471 [Indexed for MEDLINE]


2305. Psychol Rep. 2023 Aug;126(4):1661-1683. doi: 10.1177/00332941211066259. Epub 
2022 Mar 10.

Impact of COVID-19 Pandemic on Mental Health and Quality of Life. An Exploratory 
Study During the First Outbreak in Italy.

Cavazzoni F(1), Pancake R(1), Veronese G(1)(2).

Author information:
(1)University of Milano-Bicocca, Milan, Italy.
(2)Stellenbosch University, South Africa.

The coronavirus pandemic has been sweeping the world for more than a year. As 
physical health begins to stabilize in the western world, an increasing concern 
is related to the impact of the virus and its containment measures on people's 
mental health. This work aimed to explore the effect of demographic factors 
(age, gender, level of education, and socioeconomic status) and variables such 
as fear of COVID-19 and social support in predicting the quality of life and 
mental health of adults during the first wave of the pandemic in Italy. Through 
an online survey with 1087 Italian adults (M = 39.7, SD = 16.39; 74.4% women), 
gender and socioeconomic status emerged as crucial factors in determining 
differences regarding people's responses and reactions to the pandemic. In 
addition, the results highlighted the importance of perceived social support and 
a moderate fear of COVID-19 in predicting people's quality of life and mental 
health. The study suggests important guidelines for the development of 
interventions to support the population's well-being and mental health.

DOI: 10.1177/00332941211066259
PMCID: PMC8914301
PMID: 35271789 [Indexed for MEDLINE]

Conflict of interest statement: All authors have authorized the submission of 
their manuscript and approved any statements or declarations.


2306. Int J Environ Res Public Health. 2022 Mar 6;19(5):3109. doi: 
10.3390/ijerph19053109.

The Biggest Challenges Resulting from the COVID-19 Pandemic on Gender-Related 
Work from Home in Biomedical Fields-World-Wide Qualitative Survey Analysis.

Bezak E(1), Carson-Chahhoud KV(1)(2)(3), Marcu LG(1)(4), Stoeva M(5), Lhotska 
L(6), Barabino GA(7), Ibrahim F(8), Kaldoudi E(9), Lim S(10), Marques da Silva 
AM(11), Tan PH(12), Tsapaki V(13), Frize M(14).

Author information:
(1)Cancer Research Institute, University of South Australia, Adelaide, SA 5001, 
Australia.
(2)Australian Centre for Precision Health, University of South Australia, 
Adelaide, SA 5001, Australia.
(3)School of Medicine, University of Adelaide, Adelaide, SA 5001, Australia.
(4)Faculty of Informatics and Science, University of Oradea, 1 Universitatii 
Str., 410087 Oradea, Romania.
(5)Department of Diagnostic Imaging, Medical University of Plovdiv, 4002 
Plovdiv, Bulgaria.
(6)Faculty of Biomedical Engineering, Czech Technical University in Prague, 160 
00 Prague 6, Czech Republic.
(7)Olin College of Engineering, Needham, MA 02492, USA.
(8)Department of Biomedical Engineering, Centre for Innovation in Medical 
Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur 50603, 
Malaysia.
(9)School of Medicine, Democritus University of Thrace, 69100 Alexandroupoli, 
Greece.
(10)School of Chemical and Biomedical Engineering, Nanyang Technological 
University, Singapore 637457, Singapore.
(11)School of Technology, Pontifical Catholic University of Rio Grande do Sul, 
PUCRS, Porto Alegre 90619-900, Brazil.
(12)School of Engineering, Ngee Ann Polytechnic, Singapore 599489, Singapore.
(13)Medical Physics Department, Konstantopoulio General Hospitals, Nea Ionia, 
14233 Athens, Greece.
(14)Department of Systems and Computer Engineering, Carleton University, Ottawa, 
ON K1S 5B6, Canada.

(1) Background: This paper aims to present and discuss the most significant 
challenges encountered by STEM professionals associated with remote working 
during the COVID-19 lockdowns. (2) Methods: We performed a qualitative analysis 
of 921 responses from professionals from 76 countries to the open-ended 
question: "What has been most challenging during the lockdown for you, and/or 
your family?" (3) Findings: Participants reported challenges within the 
immediate family to include responsibilities for school, childcare, and 
children's wellbeing; and the loss of social interactions with family and 
friends. Participants reported increased domestic duties, blurred lines between 
home and work, and long workdays. Finding adequate workspace was a problem, and 
adaptations were necessary, especially when adults shared the same setting for 
working and childcare. Connectivity issues and concentration difficulties 
emerged. While some participants reported employers' expectations did not 
change, others revealed concerns about efficiency. Mental health issues were 
expressed as anxiety and depression symptoms, exhaustion and burnout, and no 
outlets for stress. Fear of becoming infected with COVID-19 and uncertainties 
about the future also emerged. Pressure points related to gender, relationship 
status, and ethnicities were also evaluated. Public policies differed 
substantially across countries, raising concerns about the adherence to 
unnecessary restrictions, and similarly, restrictions being not tight enough. 
Beyond challenges, some benefits emerged, such as increased productivity and 
less time spent getting ready for work and commuting. Confinement resulted in 
more quality time and stronger relationships with family. (4) Interpretation: 
Viewpoints on positive and negative aspects of remote working differed by 
gender. Females were more affected professionally, socially, and personally than 
males. Mental stress and the feeling of inadequate work efficiency in women were 
caused by employers' expectations and lack of flexibility. Working from home 
turned out to be challenging, primarily due to a lack of preparedness, limited 
access to a dedicated home-office, and lack of previous experience in 
multi-layer/multi-scale environments.

DOI: 10.3390/ijerph19053109
PMCID: PMC8910706
PMID: 35270801 [Indexed for MEDLINE]

Conflict of interest statement: The Authors declare no conflict of interest.


2307. Int J Environ Res Public Health. 2022 Mar 5;19(5):3079. doi: 
10.3390/ijerph19053079.

The Workplace and Psychosocial Experiences of Australian Senior Doctors during 
the COVID-19 Pandemic: A Qualitative Study.

Tran J(1), Willis K(2)(3), Kay M(4), Hutt K(5), Smallwood N(6)(7).

Author information:
(1)The Melbourne Medical School, The University of Melbourne, Parkville, VIC 
3010, Australia.
(2)Public Health, College of Health and Biomedicine, Victoria University, 
Footscray Park, Melbourne, VIC 3011, Australia.
(3)Division of Critical Care and Investigative Services, Royal Melbourne 
Hospital, Grattan Street, Parkville, VIC 3050, Australia.
(4)General Practice Clinical Unit, Level 8 Health Sciences Building, Royal 
Brisbane and Women's Hospital, Herston, QLD 4029, Australia.
(5)Doctors' Health Advisory Service, Suite 207, 69 Christie Street, St Leonards, 
NSW 2065, Australia.
(6)Department of Respiratory Medicine, The Alfred Hospital, Prahan, VIC 3004, 
Australia.
(7)Department of Allergy, Immunology and Respiratory Medicine, Central Clinical 
School, The Alfred Hospital, Monash University, Melbourne, VIC 3004, Australia.

The coronavirus disease 2019 (COVID-19) pandemic has had significant mental 
health impacts among healthcare workers (HCWs), related to resource scarcity, 
risky work environments, and poor supports. Understanding the unique challenges 
experienced by senior doctors and identifying strategies for support will assist 
doctors facing such crises into the future. A cross-sectional, national, online 
survey was conducted during the second wave of the Australian COVID-19 pandemic. 
Inductive content analysis was used to examine data reporting workplace and 
psychosocial impacts of the pandemic. Of 9518 responses, 1083 senior doctors 
responded to one or more free-text questions. Of the senior doctors, 752 were 
women and 973 resided in Victoria. Four themes were identified: (1) work-life 
challenges; (2) poor workplace safety, support, and culture; (3) poor political 
leadership, planning and support; and (4) media and community responses. Key 
issues impacting mental health included supporting staff wellbeing, moral injury 
related to poorer quality patient care, feeling unheard and undervalued within 
the workplace, and pandemic ill-preparedness. Senior doctors desired better 
crisis preparedness, HCW representation, greater leadership, and accessible, 
authentic psychological wellbeing support services from workplace organisations 
and government. The pandemic has had significant impacts on senior doctors. The 
sustainability of the healthcare system requires interventions designed to 
protect workforce wellbeing.

DOI: 10.3390/ijerph19053079
PMCID: PMC8910257
PMID: 35270770 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2308. Int J Environ Res Public Health. 2022 Mar 3;19(5):2979. doi: 
10.3390/ijerph19052979.

Impacts of Emergency Remote Teaching on College Students Amid COVID-19 in the 
UAE.

El-Sakran A(1), Salman R(1), Alzaatreh A(1).

Author information:
(1)Department of Mathematics and Statistics, American University of Sharjah, 
Sharjah P.O. Box 26666, United Arab Emirates.

With the aim of appraising the impact of Emergency Remote Teaching (ERT) amidst 
the COVID-19 pandemic on college students, an online survey was conducted in 
December 2020 on a total of 588 undergraduate students at the American 
University of Sharjah in the United Arab Emirates. The purpose of the study was 
to probe into the perceptions of college students regarding their learning 
process and its influence on their mental health with the abrupt transition from 
face-to-face classes to ERT in the Spring 2020 semester. A comprehensive 
analysis was performed using structural equation modeling and other statistical 
techniques to reveal crucial results associated with the factors that have an 
effect on the students' psychological distress, such as quality of courses, 
academic performance, and readiness for future work or studies. Findings suggest 
that the students' perceived quality of courses under ERT has a significant 
impact on their academic performance and readiness for future work or studies. 
Moreover, they indicate that these factors serve as a vital mediating role in 
provoking psychological distress among the students. The study also shows that 
gender, previous history of anxiety/distress, education being at risk due to 
financial issues caused by COVID-19, and year of study significantly affect the 
students' distress levels. In order to ensure and prioritize the well-being of 
college students during these turbulent times, new strategies are urgently 
needed to develop and enhance resilient ERT environments in higher education. 
The study concludes with limitations and suggestions for further research.

DOI: 10.3390/ijerph19052979
PMCID: PMC8910722
PMID: 35270670 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2309. Int J Environ Res Public Health. 2022 Mar 3;19(5):2953. doi: 
10.3390/ijerph19052953.

The Impact of the COVID-19 Outbreak on Mental Wellbeing in Children with a 
Chronic Condition Compared to Healthy Peers.

Hoefnagels JW(1), Schoen AB(1), van der Laan SEI(1), Rodijk LH(1), van der Ent 
CK(2), van de Putte EM(1), Dalmeijer GW(3), Nijhof SL(1).

Author information:
(1)Department of Paediatrics, Wilhelmina Children's Hospital, University Medical 
Center Utrecht, Utrecht University, 3584 EA Utrecht, The Netherlands.
(2)Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, 
University Medical Center Utrecht, Utrecht University, 3584 EA Utrecht, The 
Netherlands.
(3)Julius Center for Health Sciences and Primary Care, 3508 GA Utrecht, The 
Netherlands.

The aim of this study was to assess the impact of the COVID-19 pandemic on the 
mental wellbeing of children 8-18 years old with chronic conditions, by 
comparing pandemic data with pre-pandemic data and with healthy peers. Data were 
obtained from two ongoing longitudinal cohorts: the PROactive cohort study 
following children with a chronic condition, and the WHISTLER population cohort. 
Mental wellbeing was assessed by three indicators: life satisfaction, 
internalising symptoms, and psychosomatic health. The stringency of the 
COVID-19-related lockdown was considered a moderating factor. Data on chronic 
patients were recorded before (n = 934, 65% girls) and during (n = 503, 61% 
girls) the pandemic, and compared to healthy peers during the pandemic (n = 166, 
61% girls). Children with a chronic condition reported lower life satisfaction, 
but no clinically relevant changes in internalising symptoms or psychosomatic 
health, during the pandemic compared to before. In comparison to healthy peers, 
children with a chronic condition experienced decreased life satisfaction and 
psychosomatic health, but internalising symptoms did not differ between groups 
during the COVID-19 pandemic. The lockdown stringency was negatively associated 
with all indicators of mental wellbeing-worse life satisfaction, more 
internalising symptoms, and more psychosomatic symptoms.

DOI: 10.3390/ijerph19052953
PMCID: PMC8910023
PMID: 35270646 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2310. Int J Environ Res Public Health. 2022 Mar 2;19(5):2924. doi: 
10.3390/ijerph19052924.

A Phenomenological Study of Nurses' Experience in Caring for COVID-19 Patients.

Jang HY(1), Yang JE(2), Shin YS(1).

Author information:
(1)School of Nursing, Research Institute of Nursing Science, Hanyang University, 
Seoul 04763, Korea.
(2)Department of Nursing, Jesus University, Jeonju-si 54989, Korea.

This study aimed to understand and describe the experiences of nurses who cared 
for patients with COVID-19. A descriptive phenomenological approach was used to 
collect data from individual in-depth interviews with 14 nurses, from 20 October 
2020 to 15 January 2021. Data were analyzed using the phenomenological method of 
Colaizzi. Five theme clusters emerged from the analysis: (1) nurses struggling 
under the weight of dealing with infectious disease, (2) challenges added to 
difficult caring, (3) double suffering from patient care, (4) support for 
caring, and (5) expectations for post-COVID-19 life. The findings of this study 
are useful primary data for developing appropriate measures for health 
professionals' wellbeing during outbreaks of infectious diseases. Specifically, 
as nurses in this study struggled with mental as well as physical difficulties, 
it is suggested that future studies develop and apply mental health recovery 
programs for them. To be prepared for future infectious diseases and contribute 
to patient care, policymakers should improve the work environment, through 
various means, such as nurses' practice environment management and incentives.

DOI: 10.3390/ijerph19052924
PMCID: PMC8910268
PMID: 35270615 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2311. Int J Environ Res Public Health. 2022 Mar 1;19(5):2874. doi: 
10.3390/ijerph19052874.

Sleep Quality and Its Associations with Physical and Mental Health-Related 
Quality of Life among University Students: A Cross-Sectional Study.

Carpi M(1), Cianfarani C(2), Vestri A(2).

Author information:
(1)Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy.
(2)Department of Public Health and Infectious Diseases, Sapienza University of 
Rome, 00185 Rome, Italy.

The association between sleep problems and quality of life has been well 
documented and the COVID-19 pandemic seemingly had an impact on both sleep 
quality and health-related quality of life (HRQoL). However, recent evidence 
about this relationship among university students is limited. The aims of this 
study are to investigate the prevalence of poor sleep quality and insomnia and 
to explore the associations between these outcomes, perceived stress, and HRQoL 
among Italian university students. An anonymous questionnaire comprising the 
Pittsburgh Sleep Quality Index, the Insomnia Severity Index, the Short Form-12 
health survey, and the Perceived Stress Scale was administered to a convenience 
sample of 1279 students (1119 females and 160 males, mean age: 23.4 ± 2.5 years) 
attending one of the largest Italian universities. A total of 65% of the 
participants showed poor sleep quality, whereas 55% reported insomnia symptoms. 
Students reporting poor sleep quality and insomnia obtained higher perceived 
stress scores and lower physical and mental HRQoL scores. Controlling for 
health-related variables and perceived stress, hierarchical regression analyses 
showed that sleep quality components added a significant contribution to the 
prediction of both physical (ΔR2 = 0.1) and mental (ΔR2 = 0.02) HRQoL. As a 
whole, these findings confirm the relevance of sleep for university students' 
well-being and might inform the development of health promotion interventions 
for this population.

DOI: 10.3390/ijerph19052874
PMCID: PMC8910365
PMID: 35270566 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2312. Int J Environ Res Public Health. 2022 Feb 26;19(5):2723. doi: 
10.3390/ijerph19052723.

Promoting Mental Health and Wellbeing in Multicultural Australia: A 
Collaborative Regional Approach.

Blignault I(1), Saab H(2)(3), Woodland L(4)(5), Giourgas K(2), Baddah H(2).

Author information:
(1)Translational Health Research Institute, Western Sydney University, Penrith 
2751, Australia.
(2)South Eastern Sydney Local Health District, Multicultural Health Service, 
Darlinghurst 2010, Australia.
(3)St George Community Mental Health, Kogarah 2172, Australia.
(4)South Eastern Sydney Local Health District, Population and Community Health, 
Darlinghurst 2010, Australia.
(5)Centre for Primary Health Care and Equity, UNSW Sydney, Sydney 2052, 
Australia.

Migrant communities are often under-served by mental health services. Lack of 
community engagement results in missed opportunities for mental health promotion 
and early intervention, delayed care, and high rates of untreated psychological 
distress. Bilingual clinicians and others who work with these communities lack 
linguistically and culturally appropriate resources. This article reports on the 
implementation and evaluation of a community-based group mindfulness program 
delivered to Arabic and Bangla-speaking communities in Sydney, Australia, 
including modifications made to the content and format in response to the 
COVID-19 pandemic. The program was positioned within a stepped-care model for 
primary mental health care and adopted a collaborative regional approach. In 
addition to improved mental health outcomes for face-to-face and online program 
participants, we have documented numerous referrals to specialist services and 
extensive diffusion of mindfulness skills, mostly to family members, within each 
community. Community partnerships were critical to community engagement. 
Training workshops to build the skills of the bilingual health and community 
workforce increased the program's reach. In immigrant nations such as Australia, 
mainstream mental health promotion must be complemented by activities that 
target specific population groups. Scaled up, and with appropriate adaptation, 
the group mindfulness program offers a low-intensity in-language intervention 
for under-served communities.

DOI: 10.3390/ijerph19052723
PMCID: PMC8910043
PMID: 35270415 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript, or in the decision to 
publish the results.


2313. Int J Environ Res Public Health. 2022 Feb 25;19(5):2698. doi: 
10.3390/ijerph19052698.

Emotional Situation of Children and Adolescents during the COVID-19 Pandemic in 
Germany: Results from the COVID-19 Snapshot Monitoring Study (COSMO).

Rathgeb C(1)(2), Schillok H(1)(2), Voss S(1)(2), Coenen M(1)(2), Schulte-Körne 
G(3), Merkel C(4), Eitze S(5), Jung-Sievers C(1)(2), On Behalf Of The Cosmo 
Study Team.

Author information:
(1)Institute for Medical Information Processing, Biometry, and Epidemiology-IBE, 
Chair of Public Health and Health Services Research, LMU Munich, 
Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany.
(2)Pettenkofer School of Public Health, Elisabeth-Winterhalter-Weg 6, 81377 
Munich, Germany.
(3)Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und 
Psychotherapie, Klinikum der Universität München, 80336 Munich, Germany.
(4)Federal Centre for Health Education (BZgA), Maarweg 149-161, 50825 Cologne, 
Germany.
(5)COSMO-Study Group, Faculty of Philosophy, University of Erfurt, 99089 Erfurt, 
Germany.

The COVID-19 pandemic led to numerous restrictions in daily life that had a 
significant impact on the well-being and mental health of the population. Among 
others, children and adolescents were particularly affected, being a vulnerable 
group at risk. The aim of this study was to assess the emotional situation of 
children and adolescents during different phases of the pandemic and to identify 
modifying factors. Data from the serial cross-sectional COVID-19 Snapshot 
Monitoring (COSMO) survey in Germany were used for this study. The survey waves 
12 (19th/20th May 2020) and 21 (15th/16th September 2020) were investigated as 
examples of two different pandemic phases. The psychosocial and emotional 
situation and well-being of children were measured with the emotional subscale 
of the Strengths and Difficulties Questionnaire (SDQ) assessed by parents. 
Descriptive analyses and logistic regressions were calculated. In total, a third 
of the participating parents in wave 12 and in wave 21 reported having children 
and adolescents with emotional symptoms. Especially children with younger 
parents seemed to be more affected by emotional symptoms. Sociodemographic 
aspects, such as household language, showed a significant association with 
reported emotional symptoms in children (Wave 12: OR = 2.22; 95% CI: 1.20-4.09). 
Reported prevalences of emotional symptoms in children did not differ between 
the pandemic phases. In conclusion, the pandemic had negative influences on the 
emotional symptoms of children and adolescents in COVID-19 pandemic waves in 
2020, indicating a forecasted reoccurrence and need for preventive measures for 
upcoming waves and other pandemics in the future.

DOI: 10.3390/ijerph19052698
PMCID: PMC8910582
PMID: 35270389 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2314. Int J Environ Res Public Health. 2022 Feb 24;19(5):2657. doi: 
10.3390/ijerph19052657.

Signifying the Relationship between Fear of COVID-19, Psychological Concerns, 
Financial Concerns and Healthcare Employees Job Performance: A Mediated Model.

Sarfraz M(1), Ji X(1), Asghar M(2), Ivascu L(3), Ozturk I(4).

Author information:
(1)College of International Students, Wuxi University, Wuxi 214105, China.
(2)School of Economics and Management, Yanshan University, Qinhuangdao 066104, 
China.
(3)Department of Management, Faculty of Management in Production and 
Transportation, Politehnica University of Timisoara, 300191 Timisoara, Romania.
(4)Higher Vocational School, Cag University, Mersin 33800, Turkey.

The coronavirus pandemic (COVID-19) has undoubtedly created immense health 
problems in the global healthcare sector. Apart from its impact on physical 
health, it has devastatingly affected the psychological well-being of 
individuals. Based on Affective Events Theory (AET), the current study aims to 
contemplate the relationship between Fear of COVID-19 (CVF), psychological 
concerns (PC), and financial concerns (FC) while considering the impact on the 
healthcare employees' job performance (JP). Moreover, this study investigates 
the mediating role of job anxiety (ANX), stress (ST), and depression (DEP). The 
data were collected through an online structured questionnaire (Google Forms) 
from 489 employees working in the healthcare centers of Pakistan. The structured 
equation modeling (partial least square) approach is adopted for data analysis. 
The study results showed that Fear of COVID-19, psychological and financial 
concerns positively and significantly affect healthcare workers' job 
performance. Depression, anxiety, and stress mediated the relationship between 
Fear of COVID-19, psychological concerns, financial concerns, and job 
performance. The study theoretically and practically contributes to the existing 
literature on psychological and mental health by providing a better 
understanding of the individual variables that affect employees' job 
performance.

DOI: 10.3390/ijerph19052657
PMCID: PMC8909897
PMID: 35270350 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2315. Int J Environ Res Public Health. 2022 Feb 24;19(5):2645. doi: 
10.3390/ijerph19052645.

Preschool Teachers' Psychological Distress and Work Engagement during COVID-19 
Outbreak: The Protective Role of Mindfulness and Emotion Regulation.

Keleynikov M(1), Benatov J(1)(2), Berger R(3)(4).

Author information:
(1)Department of Special Education, Faculty of Education, University of Haifa, 
Haifa 3498838, Israel.
(2)Department of Psychology, College of Management and Academic Studies, Haifa 
3498838, Israel.
(3)Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv 6997801, 
Israel.
(4)The Center for Compassionate Mindful Education, Tel Aviv 6997801, Israel.

COVID-19 has dramatically affected the mental health and work environment of the 
educational sector. Our primary aim was to investigate preschool teachers' 
psychological distress and work engagement during the COVID-19 outbreak, while 
examining the possible protective role of participating in a mindfulness-based 
intervention geared to foster compassion (Call2Care-Israel for Teachers; C2C-IT) 
and emotion regulation. The prevalence of emotional distress, work engagement, 
and COVID-19 concerns were evaluated in 165 preschool teachers in the early 
stages of the COVID-19 outbreak in Israel through questionnaires. The findings 
showed that preschool teachers experienced increased emotional distress. 
Teachers who had participated in the C2C-IT intervention six months before the 
pandemic outbreak (N = 41) reported lower emotional distress, higher use of 
adaptive emotion regulation strategies, and higher work engagement, compared to 
their counterparts that had not participated in the intervention (N = 124). 
Emotion regulation strategies mediated the link between participating in CTC-IT 
intervention and emotional distress and work engagement. Teaching is a highly 
demanding occupation, especially during a pandemic, thus making it important to 
invest resources in empowering this population. The findings here suggest that 
the implementation of a mindfulness-based intervention during the school year 
can enhance teachers' well-being, even during stressful events such as the 
COVID-19 pandemic.

DOI: 10.3390/ijerph19052645
PMCID: PMC8909723
PMID: 35270334 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2316. Int J Environ Res Public Health. 2022 Feb 24;19(5):2602. doi: 
10.3390/ijerph19052602.

Telework and Mental Health during COVID-19.

Mendonça I(1), Coelho F(1), Ferrajão P(2), Abreu AM(1)(3).

Author information:
(1)Institute of Health Sciences, Universidade Católica Portuguesa, 1649-023 
Lisbon, Portugal.
(2)Faculty of Social Sciences and Technology, Universidade Europeia, 1500-210 
Lisbon, Portugal.
(3)Center for Interdisciplinary Research in Health, Universidade Católica 
Portuguesa, 1649-023 Lisbon, Portugal.

COVID-19 has come to change societal organization. Due to lockdowns, work 
typologies have been rethought and telework has gained strength. However, the 
impact of the constant use of information and communication technologies on the 
mental health of workers needs to be considered. We aimed to investigate the 
impact of different work conditions on mental health, to which end we 
disseminated an online questionnaire during lockdowns to assess imagined 
surveillance, mobile maintenance expectation, communication overload, feelings 
of entrapment, depression, anxiety, stress, and flourishing in four groups 
(employed in telework, employed on-site, employed in layoff, and unemployed). We 
computed mean comparisons and serial mediations. We show that depression and 
anxiety were more prevalent in women; parents flourished more than people 
without children; and people with a higher level of education feel more 
entrapment. Crucially, we show that telework was associated with imagined 
surveillance and communication overload, which mediated the association with 
mobile maintenance expectations and entrapment (which was exacerbated by 
parenthood), impacting mental health and the quality of life. However, this was 
also partially observed in the remaining work conditions. Finally, flourishing 
worked as a protector against mental health issues in all work conditions. We 
discuss this given the massification of digital migration.

DOI: 10.3390/ijerph19052602
PMCID: PMC8909524
PMID: 35270294 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2317. Int J Environ Res Public Health. 2022 Feb 22;19(5):2536. doi: 
10.3390/ijerph19052536.

Adolescer in Time of COVID-19's Pandemic: Rationale and Construction Process of 
a Digital Intervention to Promote Adolescents' Positive Development.

Freire T(1), Santana G(1), Vieira A(1), Barbosa B(1).

Author information:
(1)School of Psychology, University of Minho, 4710-057 Braga, Portugal.

The coronavirus pandemic has severely impacted children's and adolescents' lives 
due to policies and regulations implemented to slow the virus from spreading, 
which led to a loss of routine, structure, academic support, and social 
contacts. Literature also reports a lack of outdoor activity, inappropriate 
diet, and disruption of sleeping habits as affecting children's and adolescents' 
lifestyles and well-being. Remarkably, these consequent psychological, 
behavioral, and emotional changes can compromise their self-esteem, sense of 
self-efficacy, and self-concept, affecting their immune systems. These 
maladaptive coping strategies and associated effects may emerge as a failure to 
access some of the sources of support that might help them cope. Facing this 
crisis, we aimed at promoting well-being, growth, and the positive development 
of Portuguese adolescents through an intervention focused on positive coping 
strategies. We developed "Adolescer in time of COVID-19-A good practices Guide 
for adolescents in social distancing" as a digital document to be quickly 
disseminated online, answering the emergent needs of Portuguese youth between 13 
and 18 years old during the COVID-19 pandemic. In this article, we present the 
rationale and process of construction of this intervention while living within a 
quarantine period, considering the restrictive measures adopted at the time.

DOI: 10.3390/ijerph19052536
PMCID: PMC8909284
PMID: 35270229 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2318. Minerva Med. 2023 Apr;114(2):169-177. doi: 10.23736/S0026-4806.22.07847-8. Epub 
2022 Mar 10.

Post-traumatic stress disorder, depression and anxiety symptoms in COVID-19 
outpatients with different levels of respiratory and ventilatory support in the 
acute phase undergoing three months follow-up.

Ferraris M(1), Maffoni M(2), DE Marzo V(3), Pierobon A(4), Sommaruga M(5), 
Barbara C(1), Porcile A(1), Russo C(1), Ghio L(6), Clavario P(1), Porto I(3).

Author information:
(1)Cardiac Rehabilitation Center of Genoa, Azienda Sanitaria Locale ASL 3 
Genovese, Genoa, Italy.
(2)Unit of Psychology, Istituti Clinici Scientifici Maugeri IRCCS, Montescano 
Institute, Montescano, Pavia, Italy - marina.maffoni@icsmaugeri.it.
(3)Unit of Cardiology, DICATOV-Cardiothoracic and Vascular Department, IRCCS San 
Martino Hospital, Genoa, Italy.
(4)Unit of Psychology, Istituti Clinici Scientifici Maugeri IRCCS, Montescano 
Institute, Montescano, Pavia, Italy.
(5)Unit of Psychology, Istituti Clinici Scientifici Maugeri IRCCS, Camaldoli 
Institute, Milan, Italy.
(6)Mental Health Department, ASL 3 Genovese, Genoa, Italy.

BACKGROUND: The well-known COVID-19 pandemic totally transformed people's lives, 
paving the way to various psychopathological symptoms. In particular, patients 
may experience a short- and long-term decreasing in their wellbeing. In this 
vein, the aim of this paper was to assess the COVID-19 patients' 
psychopathological profile (post-traumatic stress disorder, distress, anxiety 
and depression symptoms), detecting possible differences linked to the 
ventilatory treatments.
METHODS: Outpatients who recovered from COVID-19 were asked to provide 
socio-demographic and clinical information, and to complete a brief 
psychological screening evaluation (Impact of Event Scale-Revised [IES-R], 
Depression Anxiety Stress Scale [DASS-21]).
RESULTS: Overall, after informed consent, 163 Italian patients took part in this 
research. Of them, 31.9% did not undergo any ventilatory therapy, 27.6% 
undertook oxygen therapy, 28.2% underwent noninvasive mechanical ventilation, 
and 12.3% received invasive mechanical ventilation. Although no statistically 
significant differences were revealed among patients stratified by spontaneous 
breathing or ventilatory therapies, they reported statistically significant more 
depression (4.5+5.2 vs. 3.5+3.2; P=0.017) and anxiety (4.3+4.5 vs. 2.4+2.6; 
P<0.00001) symptoms than normative groups. Moreover, patients experiencing 
COVID-19 disease as a trauma, complained statistically significant higher levels 
of depression, anxiety and stress symptoms than who did not describe a 
clinically relevant traumatic experience (P<0.001).
CONCLUSIONS: Thus, this study suggests to healthcare professionals to consider 
COVID-19 experience as a potential real trauma for patients, and underlines the 
necessity to define patients' psychopathological profile in order to propose 
tailored and effective preventive and supportive psychological interventions.

DOI: 10.23736/S0026-4806.22.07847-8
PMID: 35266658 [Indexed for MEDLINE]


2319. Health Soc Care Community. 2022 Nov;30(6):2240-2249. doi: 10.1111/hsc.13772. 
Epub 2022 Mar 9.

Living through lockdown: A qualitative exploration of individuals' experiences 
in the UK.

Taylor C(1), Lafarge C(1), Cahill S(1), Milani R(1), Görzig A(1)(2).

Author information:
(1)University of West London, London, UK.
(2)Psychology and Counselling, School of Human Sciences, University of 
Greenwich, Royal Naval College, Greenwich, London, UK.

In response to the COVID-19 outbreak, the British government introduced a 
lockdown resulting in country wide restrictions on movement and socialisation. 
This research sought to explore individuals' experience of the first lockdown in 
the UK. A qualitative online survey was conducted between April and June 2020. 
Using a convenience sample, 29 individuals participated in the study. Data were 
analysed using thematic analysis. Four themes were identified: 'health and 
well-being', 'social connectedness and belonging', 'employment and finances' and 
'personal and collective values'. Participants' experiences involved both 
challenges and opportunities. Participants reported challenges to their physical 
health, mental health, sense of connection to others as well as their employment 
and finances. However, they also viewed the lockdown as an opportunity to 
reassess their goals and values, and define a 'new normal' for society. Lockdown 
restrictions threatened individuals' well-being on many aspects of their lives. 
As anxiety, loneliness and a compromised grieving process may lead to severe 
mental health issues, early interventions are needed to prevent these and 
promote well-being. Interventions may include traditional therapies (e.g. 
Acceptance and Commitment Therapy), or focus specifically on developing social 
networks and social support (e.g. mutual help groups). These interventions may 
also be conducive to the experience of growth reported by some participants.

© 2022 The Authors. Health and Social Care in the Community published by John 
Wiley & Sons Ltd.

DOI: 10.1111/hsc.13772
PMCID: PMC9111840
PMID: 35266223 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflict of interest to 
disclose.


2320. Health Promot Chronic Dis Prev Can. 2022 Mar;42(3):113-121. doi: 
10.24095/hpcdp.42.3.05.

Well-being of Canadian Armed Forces members during the COVID-19 pandemic: the 
influence of positive health behaviours.

Sudom KA(1), Lee JEC(1).

Author information:
(1)Director General Military Personnel Research and Analysis, Department of 
National Defence, Ottawa, Ontario, Canada.

INTRODUCTION: The COVID-19 pandemic has been linked to increased depression, 
anxiety and other adverse mental health outcomes. Understanding the behaviours 
that positively influence health is important for the development of strategies 
to maintain andimprove well-being during the pandemic.
METHODS: This study focussed on Canadian Armed Forces Regular Force members (N = 
13 668) who participated in the COVID-19 Defence Team Survey, administered 
between April and May 2020. The use of positive health behaviours and the extent 
to which such behaviours were associated with anxiety, depression and 
self-reported change in health and stress levels compared to before the pandemic 
were examined.
RESULTS: Depression and anxiety were experienced by 14% and 15% of the sample, 
respectively, while 36% reported that their mental health had gotten worse since 
the pandemic started, and close to half reported worse physical health and 
stress levels. The most common behaviours respondents reported engaging in to 
maintain or improve their health were exercising outdoors, healthy eating and 
connecting with loved ones. Although most behaviours were associated with better 
health outcomes, meditation and connecting with loved ones showed associations 
with worse health.
CONCLUSION: Engaging in behaviours such as exercise and healthy eating was 
generally associated with better health outcomes. Unexpected relationships of 
meditation and connecting with loved ones are discussed in terms of their use in 
stressful times among those with mental health issues, past research on coping 
strategies and impacts of the pandemic and physical distancing on social 
connections. The findings may have implications for strategies to promote 
healthy behaviours during the remainder of the pandemic and similar crises in 
the future.

Publisher: INTRODUCTION: La pandémie de COVID-19 a été associée à une 
augmentation de la dépression, de l’anxiété et de diverses autres répercussions 
négatives en santé mentale. Il est important de comprendre les comportements qui 
ont une influence positive sur la santé afin d’élaborer des stratégies de 
maintien et d’amélioration du bien-être pendant la pandémie.
MÉTHODOLOGIE: Cette étude a porté sur les membres de la Force régulière des 
Forces armées canadiennes (N = 13 668) qui ont participé à l’Enquête de l’Équipe 
de la Défense sur la COVID-19, mené en avril et mai 2020. Nous avons analysé le 
recours à des comportements propices à la santé et la mesure dans laquelle ces 
comportements ont été associés à l’anxiété, à la dépression et à des changements 
autodéclarés de l’état de santé et du stress par rapport à la période précédant 
la pandémie.
RÉSULTATS: La dépression et l’anxiété ont été ressenties par respectivement 14 % 
et 15 % des répondants, 36 % des personnes interrogées ont déclaré que leur 
santé mentale s’était altérée depuis le début de la pandémie et près de la 
moitié ont fait état d’une dégradation de leur santé physique et de niveaux de 
stress plus élevés. Les comportements les plus courants mentionnés par les 
répondants pour maintenir ou améliorer leur santé étaient faire de l’exercice 
physique en plein air, manger sainement et maintenir la connexion avec ses 
proches. Bien que la plupart des comportements aient été associés à de meilleurs 
résultats en matière de santé, la méditation et la connexion avec ses proches 
ont été corrélé à une moins bonne santé.
CONCLUSION: L’adoption de comportements comme l’exercice physique et une 
alimentation saine a généralement conduit à de meilleurs résultats pour la 
santé. Les liens inattendus en ce qui concerne la méditation et la connexion 
avec ses proches ont pu être recadrés en lien avec leur utilisation en période 
de stress chez les personnes aux prises avec des problèmes de santé mentale, en 
lien également avec des recherches antérieures sur les stratégies d’adaptation 
et enfin en lien avec les répercussions de la pandémie et de l’éloignement 
physique sur les liens sociaux. Ces conclusions pourraient avoir des 
répercussions sur le choix des stratégies de promotion de comportements sains 
pendant la pandémie et lors d’autres crises similaires.

Plain Language Summary: This study examined health behaviours and indicators 
among Canadian military personnel early in the COVID-19 pandemic. The most 
common behaviours used to improve or maintain health were exercising, healthy 
eating and getting enough sleep. Many of these behaviours were associated with 
more favourable mental and physical health and lower stress levels. Results 
provide valuable information on the prevalence of healthpromoting behaviours and 
their associations with indicators of well-being. The findings point to key 
areas that could be targeted in future health promotion programs and 
interventions to preserve or improve health and to maintain operational 
readiness among military personnel.

Plain Language Summary: Cette étude a porté sur les comportements et les 
indicateurs en matière de santé chez le personnel militaire canadien au début de 
la pandémie de COVID-19. Les comportements les plus couramment adoptés pour 
améliorer ou maintenir son état de santé ont été l’activité physique, une 
alimentation saine et un sommeil suffisant. Bon nombre de ces comportements ont 
été associés à une meilleure santé mentale et physique et à des niveaux de 
stress inférieurs. Ces résultats fournissent de précieux renseignements sur la 
prévalence des comportements favorisant la santé et sur leurs liens avec les 
indicateurs du bien-être. Nos conclusions font ressortir les principaux domaines 
à cibler potentiellement dans les futurs programmes de promotion de la santé et 
les interventions connexes afin de préserver ou d’améliorer la santé et de 
maintenir l’état de préparation opérationnelle du personnel militaire.

DOI: 10.24095/hpcdp.42.3.05
PMCID: PMC9022951
PMID: 35262313 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
declare.


2321. Health Promot Chronic Dis Prev Can. 2022 Mar;42(3):104-112. doi: 
10.24095/hpcdp.42.3.04.

Trials and tribulations among members of Canada's Defence Team early in the 
pandemic: key insights from the COVID-19 Defence Team Survey.

Lee JEC(1), Goldenberg I(1), Blais AR(2), Comeau C(1), Daugherty C(1), Guérin 
E(1), Frank C(1), LeBlanc MM(1), Peach J(1), Pearce K(1), Sudom KA(1), Wang 
Z(1).

Author information:
(1)Department of National Defence, Ottawa, Ontario, Canada.
(2)Statistics Canada, Ottawa, Ontario, Canada.

INTRODUCTION: Due to the unprecedented impact of COVID-19, there is a need for 
research assessing pandemic-related challenges and stressors. The current study 
aimed to assess key concerns and general well-being among members of Canada's 
Defence Team, including Canadian Armed Forces personnel and members of the 
Department of National Defence (DND) Public Service.
METHODS: The COVID-19 Defence Team Survey was administered electronically to 
Defence Team staff in April and May of 2020 and was completed by 13 688 Regular 
Force, 5985 Reserve Force and 7487 civilian DND Public Service personnel. Along 
with demographic information, the survey included assessments of work 
arrangement, pandemic-related concerns, general well-being and social and 
organizational support. Weighted data (to ensure representation) were used in 
all analyses.
RESULTS: The majority of respondents were working from home, with a small 
minority unable to work due to restrictions. Though many concerns were endorsed 
by a substantial proportion of respondents, the most prevalent concerns were 
related to the health and well-being of loved ones. The majority of respondents 
reported their partner, family, supervisors, friends, colleagues and children 
provided general support. Half of the civilian defence staff and one-third of 
military respondents reported a decline in mental health. Women, younger 
respondents, those with dependents and, in some cases, those who were single 
without children were at risk of lower well-being.
CONCLUSION: The pandemic has negatively impacted a substantial portion of the 
Defence Team. When responding to future crises, it is recommended that leaders 
of organizations provide additional supports to higher-risk groups and to 
supervisors who are ideally positioned to support employees during challenging 
times.

Publisher: INTRODUCTION: En raison des répercussions sans précédent de la 
COVID-19, il est nécessaire de réaliser des études visant à évaluer les défis et 
les facteurs de stress liés à la pandémie. Cette étude avait pour but d’évaluer 
les principales préoccupations et le bien-être général des membres de l’Équipe 
de la Défense du Canada, que ce soit le personnel militaire des Forces armées 
canadiennes ou les employés de la fonction publique du ministère de la Défense 
nationale (MDN).
MÉTHODOLOGIE: Le sondage de l’Équipe de la Défense sur la COVID-19 a été soumis 
par voie électronique au personnel de l’Équipe de la Défense en avril et mai 
2020, et 13 688 membres de la Force régulière, 5 985 membres de la Force de 
réserve et 7 487 employés civils de la fonction publique du MDN y ont répondu. 
Outre le recueil de données sociodémographiques, le sondage visait à évaluer les 
modalités de travail, les préoccupations liées à la pandémie, le bien-être 
général et le soutien social et organisationnel. Des données pondérées ont été 
utilisées dans toutes les analyses (pour garantir une juste représentation des 
différents groupes).
RÉSULTATS: La majorité des répondants travaillaient depuis leur domicile et une 
petite minorité n’était pas en mesure de travailler en raison des restrictions. 
Les principales préoccupations parmi les nombreuses préoccupations communes à 
une proportion importante de répondants étaient liées à la santé et au bien-être 
de leurs proches. La majorité des répondants ont déclaré avoir reçu d’une 
manière générale un soutien de la part de leur conjoint(e), de leur famille, de 
leurs superviseurs, de leurs amis, de leurs collègues et de leurs enfants. La 
moitié du personnel civil du ministère de la Défense nationale et un tiers du 
personnel militaire ont fait état d’une détérioration de leur santé mentale. Les 
femmes, les répondants plus jeunes, les répondants ayant des personnes à charge 
et, dans certains cas, les célibataires sans enfants risquaient davantage un 
faible degré de bien-être.
CONCLUSION: La pandémie a eu des effets négatifs sur une grande partie du 
personnel de l’Équipe de la Défense. Lors de futures crises, les dirigeants 
d’organismes devraient fournir un soutien accru aux groupes les plus exposés et 
aux superviseurs, qui sont très bien placés pour soutenir les employés en 
période difficile.

Plain Language Summary: Top concerns reported by all groups centred on the 
health and well-being of loved ones, with civilian Defence Team personnel 
reporting higher levels of concern compared to Regular and Reserve Force 
personnel. Over 75% of all participants agreed that their spouse/partner 
provided them with significant support. Family members, supervisors and friends 
were also commonly perceived as providing significant support (57%–66%). A 
decline in mental health was reported by almost half of civilian Defence Team 
personnel and approximately one-third of military personnel. Women, younger 
respondents and those with dependents appear to be at risk for lower levels of 
wellbeing during the pandemic.

Plain Language Summary: Les principales préoccupations signalées par tous les 
groupes concernaient la santé et le bien-être de leurs proches, le personnel 
civil de l’Équipe de la Défense faisant état de niveaux d’inquiétude plus élevés 
que ceux des membres de la Force régulière et de la Force de réserve. Plus de 75 
% des participants ont déclaré avoir reçu un soutien important de la part de 
leur conjoint(e). Les membres de la famille, les superviseurs et les amis ont 
également été perçus comme apportant un soutien important (57 % à 66 %). Une 
détérioration de la santé mentale a été signalée par près de la moitié du 
personnel civil de l’Équipe de la Défense et environ un tiers du personnel 
militaire. Les femmes, les jeunes répondants et les répondants ayant des 
personnes à charge semblent avoir des degrés de bien‑être plus faibles que les 
autres groupes durant cette pandémie.

DOI: 10.24095/hpcdp.42.3.04
PMCID: PMC9022953
PMID: 35262312 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
declare.


2322. J Am Acad Orthop Surg Glob Res Rev. 2022 Mar 7;6(3):e21.00227. doi: 
10.5435/JAAOSGlobal-D-21-00227.

Promoting Wellness in Orthopaedic Surgery Residency.

Federico V(1), Higgins J, Nolte M, Kogan M.

Author information:
(1)From the Rush University Medical Center, Chicago, IL.

The challenges associated with surgical residency have been well documented and 
described. Despite implementation of work-hour restrictions, residency remains a 
balancing act between patient care, surgical and clinical education, medical 
record documentation, and research endeavors. The added challenge of balancing 
these duties with life outside of the hospital further complicates the 
situation. Multiple studies have documented the stress associated with residency 
training, highlighting the prevalence of emotional exhaustion, detachment from 
people both in and out of the hospital, and a concerning rate of clinical 
depression among residents. Moreover, this emotional exhaustion has been shown 
to directly correlate with residents' clinical performance and abilities to 
carry out academic duties. More recently, feelings of isolation and detachment 
have been exacerbated by the necessity of COVID-19 precautions and change in 
clinical duties. The Accreditation for Graduate Medical Education (ACGM) now 
requires all residencies to include programming that focuses on resident 
well-being. Programs have implemented various strategies in an effort to help 
their trainees cope with the stress associated with residency and beyond. 
Despite the variety in approaches of programs, these initiatives have the 
similar objective of teaching resilience and the ability to navigate stressors 
in a healthy and effective manner. The programming can also serve to promote 
resident interaction and develop camaraderie in an effort to minimize feelings 
of emotional exhaustion and isolation. In this article, we discuss the 
importance of sustained physician wellness and describe approaches from various 
professions that can be implemented into the wellness curriculum for residency 
programs across the country. By promoting a culture of wellness and 
incorporating effective wellness programming, our aim is that residents will be 
able to succeed not only in their training but also in their personal lives and 
professional endeavors after graduation.

Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf 
of the American Academy of Orthopaedic Surgeons.

DOI: 10.5435/JAAOSGlobal-D-21-00227
PMCID: PMC8906460
PMID: 35258490 [Indexed for MEDLINE]

Conflict of interest statement: None of the following authors or any immediate 
family member has received anything of value from or has stock or stock options 
held in a commercial company or institution related directly or indirectly to 
the subject of this article: Dr. Federico, Dr. Higgins, Dr. Nolte, and Dr. 
Kogan.


2323. Soc Cogn Affect Neurosci. 2022 Oct 3;17(10):877-889. doi: 10.1093/scan/nsac018.

Prefrontal cortical thickness, emotion regulation strategy use and COVID-19 
mental health.

Dimanova P(1)(2), Borbás R(1)(3), Schnider CB(1), Fehlbaum LV(1)(3), Raschle 
NM(1)(2)(3).

Author information:
(1)Jacobs Center for Productive Youth Development at the University of Zurich, 
Zurich 8057, Switzerland.
(2)Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich 8057, 
Switzerland.
(3)University Psychiatric Clinic and University of Basel, Basel 4002, 
Switzerland.

Coronavirus disease 2019 (COVID-19) and associated restrictions have been linked 
to negative mental health outcomes across the globe. Cognitive emotion 
regulation strategies, neurally supported by prefrontal and limbic regions, 
constitute means to mitigate negative affects resulting from adverse life 
experiences. Variations in cognitive emotion regulation strategy use, anxiety, 
and depression were assessed in 43 adults (31♀/12♂, age = 35.14 ± 9.20 years) 
during the first months following COVID-19 onset and at the end of 2020 (seven 
assessments). Direct and indirect effects of emotion regulatory brain structures 
assessed prior to the pandemic and emotion regulation strategy use during the 
pandemic were assessed in relation to mental well-being. Varying levels of 
anxiety and depression were observed. While adaptive emotion regulation 
strategies were most frequently employed, maladaptive strategies explained the 
highest variation in anxiety and depression scores. The effectiveness of 
specific emotion regulation strategies varied. Momentary emotion regulation 
strategy use mediated the association between cortical thickness in right 
lateral prefrontal cortex assessed prior to the pandemic and mental health 
during the pandemic. Early mental health measures impacted later mental 
well-being. Maladaptive strategies have a negative effect on mental health 
during prolonged stress as induced by pandemics, providing possible targets for 
intervention.

© The Author(s) 2022. Published by Oxford University Press.

DOI: 10.1093/scan/nsac018
PMCID: PMC8992300
PMID: 35257168 [Indexed for MEDLINE]


2324. J Am Coll Health. 2024 Feb-Mar;72(2):398-407. doi: 
10.1080/07448481.2022.2037614. Epub 2022 Mar 7.

Psychological predictors of physical activity intensity among college students.

Marenus MW(1), Friedman K(1), Sanowski J(1), Murray A(1), Ottensoser H(1), 
Cahuas A(2), Kumaravel V(1), Chen W(1).

Author information:
(1)School of Kinesiology, University of Michigan, Ann Arbor, MI, USA.
(2)Department of Psychology, University of Michigan, Ann Arbor, MI, USA.

Objective: The purpose of this study was to investigate the association of 
mental health, subjective well-being, and the impact of COVID-19 on quality of 
life with PA intensity among college students. Participants: The sample included 
1262 college students from a large Midwestern research university (mean age = 
21.5 ± 3.6 years). Methods: Participants voluntarily and anonymously completed 
the Qualtrics questionnaires which included the Patient Health Questionnaire 
-Anxiety and Depression Scale, the Satisfaction with Life Scale, the Impact of 
COVID-19 on Quality of Life (QoL) Scale, and the International Physical Activity 
Questionnaire. Results: Multiple linear regression models indicated that 
COVID-19 QoL and life satisfaction were significant predictors of the total, 
vigorous, and moderate PA (p's < .05). Life satisfaction was also a significant 
predictor of walking. Conclusion: Higher level satisfaction and lower impact of 
COVID-19 on quality of life were related to higher total, vigorous, and moderate 
PA levels.

DOI: 10.1080/07448481.2022.2037614
PMID: 35254959 [Indexed for MEDLINE]


2325. mBio. 2022 Apr 26;13(2):e0380121. doi: 10.1128/mbio.03801-21. Epub 2022 Mar 7.

Nutritional Modulation of Gut Microbiota Alleviates Severe Gastrointestinal 
Symptoms in a Patient with Post-Acute COVID-19 Syndrome.

Wang Y(1), Wu G(1)(2), Zhao L(1)(2), Wang W(3).

Author information:
(1)Department of Biochemistry and Microbiology, School of Environmental and 
Biological Sciences, Rutgers, The State University of New Jerseygrid.430387.b, 
New Brunswick, New Jersey, USA.
(2)Center for Microbiome, Nutrition, and Health, New Jersey Institute for Food, 
Nutrition, and Health, Rutgers, The State University of New Jerseygrid.430387.b, 
New Brunswick, New Jersey, USA.
(3)Division of Gastroenterology and Hepatology, Department of Medicine, Rutgers 
New Jersey Medical School, Newark, New Jersey, USA.

With the increase in total coronavirus disease 2019 (COVID-19) infection cases, 
post-acute COVID-19 syndrome, defined as experiencing ongoing health problems 4 
or more weeks after the first severe acute respiratory syndrome coronavirus 2 
(SARS-CoV-2) infection, has become a new arising public health concern. As part 
of post-acute COVID-19 syndrome, gastrointestinal symptoms might be associated 
with dysbiosis of the gut microbiota, which has the potential to become a target 
for intervention. In this study, a patient with post-acute COVID-19 syndrome 
with long-lasting severe gastrointestinal symptoms was provided 2-month expanded 
access to a high-fiber formula with investigational new drug (IND) status 
developed to alleviate COVID-19-related symptoms by modulating the gut 
microbiota. Symptoms including severe "loss of appetite," palpitation, and 
anxiety were significantly alleviated by the end of the intervention. The 
medication dosage for controlling nausea decreased during the intervention. The 
serum lipid profile, insulin level, and leptin level were improved compared to 
the baseline values. Significant structural changes of the patient's gut 
microbiota and reduced microbial fermentation activity in the small intestine 
were found during the intervention. Eighteen amplicon sequence variants (ASVs) 
of the V4 region of the 16S rRNA gene significantly responded to this 
nutritional intervention. Six out of the 18 ASVs were also found to be 
negatively correlated with symptom severity/medication dosage. Five of the six 
ASVs (ASV0AKS_Oscillibacter, ASV009F_Anaerofustis, ASV02YT_Blautia, 
ASV07LA_Blautia, and ASV0AM6_Eubacterium hallii) were potential short-chain 
fatty acid (SCFA)-producing bacteria, which might be associated with the 
alleviation of symptoms. Our study indicates the feasibility of alleviating 
gastrointestinal symptoms in patients with post-acute COVID-19 syndrome by way 
of nutritional modulation of their gut microbiota. IMPORTANCE It has become 
evident that the care of patients with COVID-19 does not end at the time of 
negative SARS-CoV-2 detection, as the number of patients with post-acute 
COVID-19 syndrome increases with an ever-increasing total infected patient 
population. This case report shows the possibility of alleviating the 
gastrointestinal symptoms of post-acute COVID-19 syndrome via 
microbiota-targeted nutritional intervention. As a promising strategy, it might 
not only improve the quality of life of patients but also reduce the burden to 
the public health system when the end of the COVID-19 pandemic is not in sight.

DOI: 10.1128/mbio.03801-21
PMCID: PMC9040862
PMID: 35254129 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare a conflict of interest. 
Liping Zhao is a co-founder of Notitia Biotechnologies.


2326. Work. 2022;71(3):515-526. doi: 10.3233/WOR-211030.

How does fear of COVID-19 affect the mental well-being of waiters in Turkey.

Üngüren E(1), Ceyhan S(2), Türker N(3).

Author information:
(1)Department of Business Administration, Faculty of Economics, Administrative 
and Social Sciences, Alanya Alaaddin Keykubat University, Alanya, Turkey.
(2)Department of Business, Faculty of Economics and Administrative Sciences, 
Burdur Mehmet Akif Ersoy University, Burdur, Turkey.
(3)Department of Business Administration, Institute of Graduate Studies, Alanya 
Alaaddin Keykubat University, Alanya, Turkey.

BACKGROUND: Empirical findings are needed to determine how the fear of COVID-19 
might change in the context of different individuals.
OBJECTIVE: This study aims to determine the moderating role of fatalism and 
psychological resilience on the effect of fear of COVID-19 on general mental 
health.
METHODS: This study makes use of qualitative research methods that involved 
collecting data from 355 full-time waiters via questionnaires on online 
platforms.
RESULT: The collected data suggests that the fear of COVID-19 has a significant 
negative impact on mental well-being. Morever, the data gathered for this study 
also indicates that the fear of COVID-19 infection differs significantly 
according to the fatalistic belief and psychological resilience levels of the 
waiters.
CONCLUSIONS: Findings of this study indicate that the psychological effects of 
infectious diseases on individuals are not universal, but rather depend on the 
personal characteristics of individuals. It is hoped that the results of this 
study will contribute to the reduction of negative effects associated with the 
general anxiety of pandemic that individuals experience.

DOI: 10.3233/WOR-211030
PMID: 35253713 [Indexed for MEDLINE]


2327. Child Adolesc Ment Health. 2022 May;27(2):138-145. doi: 10.1111/camh.12550. Epub 
2022 Mar 6.

COVID-related distress, mental health, and substance use in adolescents and 
young adults.

Villanti AC(1), LePine SE(1), Peasley-Miklus C(1), West JC(1)(2), Roemhildt 
M(3), Williams R(4), Copeland WE(1).

Author information:
(1)Department of Psychiatry, University of Vermont, Burlington, VT, USA.
(2)Department of Psychological Science, University of Vermont, Burlington, VT, 
USA.
(3)Health Surveillance, Vermont Department of Health, Burlington, VT, USA.
(4)Health Promotion and Disease Prevention, Vermont Department of Health, 
Burlington, VT, USA.

BACKGROUND: This study examined the impact of COVID-related disruptions on 
mental health and substance use in young people residing in a state with an 
initially lower COVID burden and earlier reopening of in-person learning than 
other states.
METHODS: Data come from Waves 3 (Fall 2019) and 4 (Fall 2020) of the Policy and 
Communication Evaluation (PACE) Vermont, an online cohort study of adolescents 
(ages 12-17) and young adults (ages 18-25). Participants in Wave 4 (212 
adolescents; 662 young adults) completed items on COVID-related stressors, the 
impact of the pandemic on their substance use, brief mental health scales, and 
past 30-day substance use. Analyses examined correlational and longitudinal 
relationships between COVID-related stressors, mental health symptoms, and 
substance use.
RESULTS: More than 60% of participants noted negative effects of the pandemic on 
their physical, emotional, and social well-being, with greater impacts of 
COVID-related stressors in young adults than adolescents. There were significant 
increases in depressive (OR 1.31, 95% CI 1.03, 1.66) and anxiety symptoms (OR 
1.34; 95% CI 1.10, 1.64) in young adults between Fall 2019 and Fall 2020. Higher 
overall COVID Impact scores were associated with higher odds of depressive and 
anxiety symptoms, as well as past 30-day electronic vapor product use, in 
adjusted cross-sectional and longitudinal models.
CONCLUSIONS: Robust associations between COVID-related distress, mental health, 
and substance use outcomes in young people signal the opportunity to increase 
evidence-based interventions while adding novel approaches to minimize 
longer-term harms of the pandemic on mental health in adolescents and young 
adults.

© 2022 Association for Child and Adolescent Mental Health.

DOI: 10.1111/camh.12550
PMCID: PMC9018497
PMID: 35253363 [Indexed for MEDLINE]


2328. Front Psychol. 2022 Feb 17;12:820074. doi: 10.3389/fpsyg.2021.820074. 
eCollection 2021.

Psychological Support in a COVID-19 Hospital: A Community Case Study.

Rizzi D(1)(2), Asperges E(3), Rovati A(1)(2), Bigoni F(1)(2), Pistillo E(1), 
Corsico A(4), Mojoli F(5), Perlini S(2), Bruno R(3).

Author information:
(1)Fondazione Soleterre Strategie di Pace ONLUS, Milan, Italy.
(2)Unit of Emergency Medicine, Department of Internal Medicine, IRCCS 
Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy.
(3)Unit of Infectious Disease, IRCCS Policlinico San Matteo Foundation, 
University of Pavia, Pavia, Italy.
(4)Unit of Respiratory Diseases, Department of Medical Sciences and Infective 
Diseases, IRCCS Policlinico San Matteo Foundation, University of Pavia, Milan, 
Italy.
(5)Unit of Anaesthesia and Intensive Care, Department of Clinical-Surgical, 
Diagnostic, and Pediatric Sciences, IRCCS Policlinico San Matteo Foundation, 
University of Pavia, Pavia, Italy.

Burnout is a well-documented entity in Care Workers population, affecting up to 
50% of physicians, just as it is equally well established that managing an 
infectious disease outbreaks, such as confirmed in the COVID-19 pandemic, 
increases Post-Traumatic Stress Disorder (PTSD) and the psychological burden. 
Mental health support, in the form of formal or remote sessions, has been shown 
to be helpful to health care staff, despite the organizational difficulties in 
an emergency. During the first emergence of COVID-19 in Italy, the Scientific 
Institute for Research, Hospitalization and Health Care Istituto di Ricovero e 
Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo Foundation (Pavia, 
Lombardy), the Italian hospital that treated "patient 1," has activated an 
agreement with the Soleterre Foundation, an international Non-Governmental 
Organization (NGO) that manages health emergency projects, to provide 
psychological support. A task force of psychologists was created with the aim of 
designing and administering a Therapeutic Mental Health Assessment for COVID-19 
Care Workers (TMHA COVID-19 CWs) to evaluate and support health care workers' 
mental health. The assessment battery was developed to evaluate symptoms and 
behaviors associated with trauma and the corresponding maladaptive behaviors 
(the National Stressful Events Survey for PTSD-Short Scale "NSESSS" and the 
Diagnostic and Statistical Manual of Mental Disorders "DSM-5" Self-Rated Level 1 
transversal Symptom Measure-Adult). Once the TMHA COVID-19 CWs had been 
developed, the team of psychologists regularly visited healthcare staff in the 
ward to administer it. One hundred seven care workers (44 males, mean age 40 ± 
15) across Intensive Care Units (ICUs), the emergency room and medical ward were 
administered the TMHA COVID-19 CWs. PTSD symptoms were reported as severe by 13% 
of the population. Depressive symptoms as severe for 7% and Anxiety symptoms as 
severe for 14%. Severe psychotic symptoms were experienced by 2% and severe 
suicidal thoughts by 1% of the population. The possibility of acting upon the 
results of the TMHA COVID-19 CWs allowed an early intervention through 
individual session beyond the cut-off level (moderate and severe symptoms) for 
PTSD in NSESSS. In fact, 280 individual support sessions were offered. 
Therefore, we considered our project a protective and support factor for 
healthcare workers' mental well-being and we recommend implementing a mental 
health screening program in ward involved in COVID-19 patients' care.

Copyright © 2022 Rizzi, Asperges, Rovati, Bigoni, Pistillo, Corsico, Mojoli, 
Perlini and Bruno.

DOI: 10.3389/fpsyg.2021.820074
PMCID: PMC8893142
PMID: 35250697

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2329. AIDS Behav. 2022 Sep;26(9):2920-2930. doi: 10.1007/s10461-022-03638-0. Epub 2022 
Mar 6.

Psychological and Emotional Impact of COVID-19 Pandemic on People Living with 
Chronic Disease: HIV and Cancer.

Focà E(#)(1), Fornari C(#)(2), Arsuffi S(2), Vetrano MC(2), Calza S(3), Renzetti 
S(3), Copeta S(4), Berruti A(4), Castelli F(2), Compostella S(#)(5), 
Quiros-Roldan E(#)(2).

Author information:
(1)Unit of Infectious and Tropical Diseases, Department of Clinical and 
Experimental Sciences, University of Brescia and ASST Spedali Civili Hospital, 
Brescia, Italy. emanuele.foca@unibs.it.
(2)Unit of Infectious and Tropical Diseases, Department of Clinical and 
Experimental Sciences, University of Brescia and ASST Spedali Civili Hospital, 
Brescia, Italy.
(3)Unit of Biostatistics and Bioinformatics, Department of Molecular and 
Translational Medicine, University of Brescia, Brescia, Italy.
(4)Department of Medical and Surgical Specialties, Radiological Sciences, and 
Public Health, Medical Oncology, University of Brescia at ASST Spedali Civili, 
Brescia, Italy.
(5)Unit of Infectious Diseases of ASST Spedali Civili Hospital, Brescia, Italy.
(#)Contributed equally

People living with chronic disease (PLWCD) are the frailest category, both for 
the risk of severe COVID-19 illness and for the impact on the care continuum. 
Aim of this study was to analyze coping strategies and resilience in people 
living with HIV (PLWH) compared to people living with oncological diseases 
(PLWOD) during COVID-19 pandemic. We administrated an anonymous questionnaire, 
which explored the emotional experience, the demographic factors linked to a 
COVID-19-related stress syndrome, the patient's perception about the adequacy of 
clinical undertaking from the hospital and the resilience. We analyzed 324 
questionnaires. There were no significant differences in prevalence of 
psychological distress among the whole cohort; however, PLWOD were calmer, less 
troubled, and more serene than PLWH. Moreover, PLWH smoked more, ate more, and 
gained more weight than PLWOD. Most patients didn't feel lonely and continued to 
take pleasure from their activities. No differences in resilience were found 
between the groups. In the whole cohort lower levels of resilience were found in 
patients that were unemployed, with history of psychological disorders and in 
those who experienced more feelings of anger, anxiety and concern. In our study, 
patients seemed to preserve their well-being, and to activate adaptive coping 
during the pandemic.

© 2022. The Author(s).

DOI: 10.1007/s10461-022-03638-0
PMCID: PMC8898333
PMID: 35249178 [Indexed for MEDLINE]

Conflict of interest statement: EF received speakers’ honoraria, research grants 
and advisory board fees from Viiv Healthcare, Janssen-Cilag, Gilead Sciences and 
Merck Sharp & Dohme. The remaining authors declare that they have no competing 
interests.


2330. BMC Med Educ. 2022 Mar 5;22(1):149. doi: 10.1186/s12909-022-03197-x.

Medical student's perception of the COVID-19 pandemic effect on their education 
and well-being: a cross-sectional survey in the United States.

Chakladar J(#)(1)(2), Diomino A(#)(3), Li WT(#)(1)(2), Tsai JC(1)(2), Krishnan 
AR(4), Zou AE(5), Kharidia K(6), Baig FA(7), Householder S(8), Kuo SZ(9), 
Chandrasekar S(10), Chang EY(11)(12), Ongkeko WM(13)(14).

Author information:
(1)Division of Otolaryngology-Head and Neck Surgery, Department Surgery, 
University of California, La Jolla, San Diego, California, USA.
(2)Research Service, VA San Diego Healthcare System, San Diego, CA, 92161, USA.
(3)UC San Diego School of Medicine, University of California, San Diego, CA, 
92093, USA.
(4)Stanford University School of Medicine, Stanford, CA, 94305, USA.
(5)Harvard Medical School, Harvard University, Boston, MA, 02115, USA.
(6)Keck School of Medicine, University of Southern California, Los Angeles, CA, 
90089, USA.
(7)University of Missouri-Kansas City School of Medicine, Kansas City, MO, 
64110, USA.
(8)Vagelos College of Physicians and Surgeons, Columbia University, New York, 
NY, 10032, USA.
(9)Department of Internal Medicine, Vagelos College of Physicians and Surgeons, 
Columbia University, New York, NY, 10032, USA.
(10)Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, 
USA.
(11)Department of Radiology, University of California, San Diego, CA, 92093, 
USA.
(12)Radiology Service, VA San Diego Healthcare System, San Diego, CA, 92161, 
USA.
(13)Division of Otolaryngology-Head and Neck Surgery, Department Surgery, 
University of California, La Jolla, San Diego, California, USA. 
rongkeko@health.ucsd.edu.
(14)Research Service, VA San Diego Healthcare System, San Diego, CA, 92161, USA. 
rongkeko@health.ucsd.edu.
(#)Contributed equally

BACKGROUND: The effects of drastic curricular changes necessitated by the 
COVID-19 pandemic on medical students' education and wellbeing have remained 
largely unstudied. Out study aimed to characterize how medical students were 
affected by the pandemic, specifically how limitations introduced by the 
pandemic may have affected the quality, delivery, and experience of medical 
education.
METHODS: Three hundred students from 5 U.S. allopathic medical schools were 
surveyed to determine students' perceptions about their quality of medical 
education, professional development, and mental health during the COVID-19 
pandemic (October 2020-December 2020).
RESULTS: A large majority of students report that while lecture-based learning 
has not been significantly affected by the pandemic, small-group and clinical 
learning have greatly declined in quality. Students also reported higher levels 
of depression, anxiety, and uncertainty with regards to their futures as 
physicians.
CONCLUSIONS: The COVID-19 pandemic has greatly affected the medical student 
education and wellbeing. Although medical schools have implemented measures to 
continue to train medical students as effectively as they can, further 
strategies must be devised to ensure the well-being of students in the present 
and for future national emergencies.

© 2022. The Author(s).

DOI: 10.1186/s12909-022-03197-x
PMCID: PMC8897763
PMID: 35248030 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


2331. BMC Public Health. 2022 Mar 4;22(1):435. doi: 10.1186/s12889-021-12468-z.

Working mothers during COVID-19: a cross-sectional study on mental health status 
and associations with the receipt of employment benefits.

Kirwin MA(1), Ettinger AK(2).

Author information:
(1)Milken Institute School of Public Health, The George Washington University, 
950 NH Avenue NW, Washington, DC, 20052, USA. melissakirwin@gwu.edu.
(2)Department of Psychology, University of Pittsburgh, 210 South Bouquet Street, 
Pittsburgh, PA, 15213, USA.

BACKGROUND: Beyond the sweeping physiological effects of COVID-19 infections in 
2020 and 2021, the psychosocial impacts of lockdowns, social distancing, and the 
associated disruptions to daily life have brought on a simultaneous mental 
health crisis, particularly among many working mothers who are 
disproportionately balancing childcare, virtual schooling, and employment 
vulnerability. The aim of this study was to measure the mental health status of 
working mothers in the United States and associations with the provision of 
family-friendly employment benefits one year into the pandemic.
METHODS: Cross-sectional data were collected from a sample of working mothers in 
the U.S. using an online survey of mental health status and the receipt of 
employer-provided family-friendly benefits. Mental health was measured with the 
Kessler 6 (K-6) and the Short Warwick-Edinburgh Mental Wellbeing Scale 
(SWEMWBS). Perceived helpfulness of benefits was assessed through self-reported 
Likert-scale scores of 0 (not at all helpful) to 4 (extremely helpful) to 
determine mean helpfulness scores for benefit types. Multivariable logistic 
regression analyses were conducted to determine associations between receipt of 
employment benefits and serious mental illness (SMI).
RESULTS: A total of 728 participants met the study criteria, 83.7% were 
non-Hispanic/Latino white and 61.1% were 35-44 years of age. Among study 
participants, 54.3% (n = 395) and 21.8% (n = 159) reported psychological 
distress levels associated with moderate mental illness (MMI) and serious mental 
illness (SMI), respectively. Not receiving benefits was associated with a 50% 
increase in odds of SMI (aOR = 1.50, 95% CI [1.03-2.20], p = 0.036). Benefits 
perceived to be the most helpful for participants were flexible hours/schedule 
(3.5; SD ± 0.9), flexible work location (3.3; SD ± 1.1), and supplemental paid 
time off (3.1; SD ± 1.1), with mean scores above very helpful.
CONCLUSION: Results suggest employment benefits may help support the mental 
health of working mothers and provide a call to action to employers and policy 
stakeholders to develop solutions addressing gaps in workplace benefits and 
mental health support for working parents, with sustainable reform in mind to 
mitigate employment benefit inequities exposed by the pandemic.

© 2022. The Author(s).

DOI: 10.1186/s12889-021-12468-z
PMCID: PMC8895361
PMID: 35246093 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2332. Am J Mens Health. 2022 Mar-Apr;16(2):15579883221082428. doi: 
10.1177/15579883221082428.

Exploring the Impact of the COVID-19 Pandemic on Male Mental Health Emergencies 
Attended by Ambulances During the First National "Lockdown" in the East Midlands 
of the United Kingdom.

Moore HE(1), Siriwardena AN(2), Gussy M(3), Hill B(4), Tanser F(3), Spaight 
R(5).

Author information:
(1)DIRE Research Group, Department of Geography, University of Lincoln, Lincoln, 
UK.
(2)Community and Health Research Unit, School of Health and Social Care, 
University of Lincoln, Lincoln, UK†.
(3)Lincoln Institute of Rural Health, University of Lincoln, Lincoln, UK.
(4)Water WISER CDT, University of Loughborough, Loughborough, UK.
(5)East Midlands Ambulance Service NHS Trust, Nottingham, UK.

The novel coronavirus disease 2019 (COVID-19) pandemic and associated mitigation 
strategies such as "lockdown" are having widespread adverse psychological 
effects, including increased levels of anxiety and depression. Most research 
using self-reported data highlights the pandemic's impact on the psychological 
well-being of females, whereas data for mental health emergency presentations 
may reflect the impact on male mental health more accurately. We analyzed 
records of male mental health emergencies occurring in the East Midlands of the 
United Kingdom during the first national "lockdown." We computed two binary 
logistic regression models to (a) compare male mental health emergencies 
occurring during "lockdown," 2020 (5,779) with those occurring in the same 
period in 2019 (N = 4,744) and (b) compare male (N = 5,779) and female (N = 
7,695) mental health emergencies occurring during "lockdown." Comparisons 
considered the characteristics of mental health emergencies recorded by 
ambulance clinicians (Primary Impressions), and the socioeconomic 
characteristics of communities where emergencies use the Index of Multiple 
Deprivation. We found that during "lockdown," male emergencies were more likely 
to involve acute anxiety (odds ratio [OR]: 1.42) and less likely to involve 
intentional drug overdose (OR: 0.86) or attempted suicide (OR: 0.71) compared 
with 2019. Compared with females, male emergencies were more likely to involve 
acute behavioral disturbance (OR: 1.99) and less likely to involve anxiety (OR: 
0.67), attempted suicide (OR: 0.83), or intentional drug overdose (OR: 0.76). 
Compared with 2019, and compared with females, males experiencing mental health 
emergencies during "lockdown" were more likely to present in areas of high 
deprivation. Understanding the presentation of male mental health emergencies 
could inform improved patient care pathways.

DOI: 10.1177/15579883221082428
PMCID: PMC8902032
PMID: 35246002 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


2333. Medicine (Baltimore). 2022 Mar 4;101(9):e28976. doi: 
10.1097/MD.0000000000028976.

Investigation and influencing factors about well-being level of elderly chronic 
patients during COVID-19 postpandemic period in Beijing.

Wu C(1), Liu YX(1), Liu TJ(1), Yan XL(1), Zhao YX(1), Zeng H(2), Zhou T(1), Rao 
P(1), Sun LY(3), Jiao Y(1), Xi JN(1).

Author information:
(1)Beijing Rehabilitation Hospital of Capital Medical University, Beijing, 
China.
(2)Beijing Municipal Health Commission, Beijing, China.
(3)Peking University Third Hospital.

The Corona Virus Disease 2019 (COVID-19) pandemic has huge impacts on the world, 
including human health and economic decline. The COVID-19 has severe 
infectivity, especially the elderly with chronic diseases will cause various 
complications after infection and accelerate the disease process. In addition, 
COVID-19 will also affect their mental health. Therefore, the mental health of 
elderly patients with chronic diseases cannot be ignored. The aim of this study 
was to investigate the well-being level of elderly people with chronic disease 
during COVID-19 postpandemic period in Beijing and analysis related influencing 
factors, so as to provide a basis for improving the well-being level of elderly 
chronic patients during the postpandemic period.Elderly patients with chronic 
diseases who met the inclusion criteria in 5 different administrative regions in 
Beijing were selected to carry out a questionnaire survey. The contents of the 
questionnaire included general data, the Memorial University of Newfoundland 
Happiness scale and the awareness situation of the COVID-19 pandemic. A total of 
500 questionnaires were distributed by WeChat and 486 valid questionnaires were 
collected. The t test and one-way analysis of variance were used to compare 
Memorial University of Newfoundland Happiness scores between 2 or more groups, 
multiple linear regression analysis was used to conduct multiple factor analysis 
to explore the related factors about well-being level of elderly chronic 
patients.A total of 109 cases (22.43%) were evaluated high well-being level, 319 
cases (65.64%) were evaluated moderate well-being level and 58 cases (11.93%) 
were evaluated low well-being according to the Memorial University of 
Newfoundland Happiness (MUNSH) scores rating. The multiple linear regression 
indicated that the education level, number of chronic diseases, medical 
expenses, frequency of children's visits, taking care of grandchildren or not, 
and group activity frequency significantly affected the well-being of patients 
with chronic diseases during COVID-19 postpandemic period in Beijing 
(P < .05).Most elderly patients with chronic diseases had moderate or above 
sense of well-being during postpandemic period, but we should still pay 
attention to the mental health of those elderly chronic patients with low 
education level, much comorbidity, more medical expenses, less visits by 
children, not take care of grandchildren and never participate in group 
activities.

Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

DOI: 10.1097/MD.0000000000028976
PMCID: PMC8896424
PMID: 35244066 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
disclose.


2334. Am J Geriatr Psychiatry. 2022 Oct;30(10):1135-1150. doi: 
10.1016/j.jagp.2022.01.013. Epub 2022 Feb 3.

The Role of Telemedicine in the Management of the Behavioral and Psychological 
Symptoms of Dementia: A Systematic Review.

Nkodo JA(1), Gana W(2), Debacq C(2), Aidoud A(2), Poupin P(2), Camus V(3), 
Fougère B(4).

Author information:
(1)Division of Geriatric Medicine (JAN, WG, CD, AA, PP, BF), CHRU de Tours, 
Tours, France; Service de Psychiatrie Universitaire (JAN, VC), CHRU Tours, 
Tours, France. Electronic address: j.nkodo@chu-tours.fr.
(2)Division of Geriatric Medicine (JAN, WG, CD, AA, PP, BF), CHRU de Tours, 
Tours, France.
(3)Service de Psychiatrie Universitaire (JAN, VC), CHRU Tours, Tours, France; 
UMR INSERM U1253 & Université de Tours (VC), Tours, France.
(4)Division of Geriatric Medicine (JAN, WG, CD, AA, PP, BF), CHRU de Tours, 
Tours, France; Education, Ethics, Health (EA 7505) (BF), Tours University, 
Tours, France.

The first-line management of behavioral and psychological symptoms of dementia 
(BPSD) is based on nonpharmacologic interventions such as the provision of 
guidance and medical support to caregivers. However, accessibility to 
specialized care and medical resources is often scarce. The ongoing COVID-19 
pandemic has compromised the delivery of outpatient care (notably in order to 
minimize the risk of disease transmission), thus making it essential to provide 
other means of accessing care for these patient populations. The use of 
telemedicine (TM) may be a means of increasing access to specialist care for 
patients with disabilities and poor access to health services, such as those 
with BPSD. The aim of this study is to provide a review of the literature on the 
use of TM for treatment and follow-up of patients with BPSD and their 
caregivers. We searched the PUBMED, EMBASE and CINAHL for articles published 
between January 1st, 2000, and December 31st, 2020, on the applicability of TM 
support for people with BPSD and their caregivers. We included open-label 
studies, qualitative studies, and randomized controlled trials . We did not 
include studies on the use of TM during the COVID-19 pandemic. A total of 22 
publications were included and reviewed. TM was found to 1) be acceptable and 
feasible for both patients and caregivers, 2) decrease the frequency and 
intensity of BPSD, and 3) improve the caregiver's perceived wellbeing and mental 
health. Videoconferencing was effective for patient-centered interventions in 
nursing homes. Telephone-based interventions were more relevant when they were 
targeted at caregivers. The published studies are lacking in scope and 
high-quality studies are now needed to confirm these findings and assess TM's 
cost-effectiveness and ability to improve the management of patients with BPSD. 
In view of the ongoing COVID-19 pandemic, remote solutions for assessing and 
monitoring individuals with BPSD are urgently needed - particularly those living 
in rural areas and so-called "medical deserts."

Copyright © 2022 American Association for Geriatric Psychiatry. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jagp.2022.01.013
PMID: 35241355 [Indexed for MEDLINE]


2335. BMC Psychol. 2022 Mar 3;10(1):49. doi: 10.1186/s40359-022-00759-y.

Mental health and self-determination profiles of the diverse population of 
medical students in Malaysia during the COVID-19 pandemic.

Cockburn JG(1), Tan CY(2)(3), Poh DCSC(2)(4), Tan DJ(2)(3), Foong CC(1), Hong 
WH(5).

Author information:
(1)Medical Education and Research Development Unit, Faculty of Medicine, 
Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
(2)Society of Malaysia Medical Association Medical Students, Malaysia Medical 
Association, 53000, Kuala Lumpur, Malaysia.
(3)Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
(4)Newcastle University Medicine Malaysia, 79200, Nusajaya, Johor, Malaysia.
(5)Medical Education and Research Development Unit, Faculty of Medicine, 
Universiti Malaya, 50603, Kuala Lumpur, Malaysia. weihan@um.edu.my.

INTRODUCTION: Medical schools throughout the world were forced to modify their 
programming during the COVID-19 pandemic. In Malaysia, virtual learning plans 
were implemented for non-clinical programming, while clinical posting 
modifications were designed to meet local SOPs. The prolonged enforcement of 
these modifications to undergraduate medical education will have affected 
student experiences, including well-being. Since these feelings can relate to 
perceived relatedness, autonomy, and competence, it is important to identify any 
potential factors that may lead to reduced intrinsic motivation in students. It 
is also important to consider how demographic features may contribute to student 
perspectives, which can be studied using the unique diversity represented by 
Malaysian students.
METHODS: A quantitative survey was distributed to Malaysian medical students to 
assess their overall wellbeing, autonomy in educational decision making, student 
experiences, and position on changes to graduation timing. Intrinsic components 
were identified using Principal Component Analysis and were aligned with the 
three needs for self-determination, namely relatedness, autonomy, and 
competence. Finally, trends in responses for participants from various 
sub-populations were assessed using ANOVA testing.
RESULTS: Responses were collected from 442 students representing 23 accredited 
Malaysian medical schools. Upon validation and reliability testing, eight 
components were identified with themes relating to: mental health, social 
concerns, communication, timing of modifications, depth of learning, and 
student-centred learning. Of these, gender was related to mental health, 
student-centred learning, and delayed graduation, while stage was related to 
student-centred learning and delayed graduation in addition to concerns about 
depth of learning and timing of modifications. Interestingly, ethnicity was 
related to differences in opinions about delayed graduation and income was 
related to social concerns.
CONCLUSION: The results of this study indicate that, while students were 
satisfied in general with the content and delivery of their programmes given the 
circumstances, there is evidence to suggest negative effects on emotional 
wellbeing and expression of student voice, due to the modifications that were 
made. Additionally, these feelings related to the three motivational needs, 
suggesting that students were experiencing a dampened motivational profile 
during the pandemic. Further, motivational profiles were distinct between 
student sub-groups, providing insight for developing appropriate and inclusive 
accommodations moving forward.

© 2022. The Author(s).

DOI: 10.1186/s40359-022-00759-y
PMCID: PMC8892400
PMID: 35241163 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2336. Child Psychiatry Hum Dev. 2023 Oct;54(5):1287-1296. doi: 
10.1007/s10578-022-01337-4. Epub 2022 Mar 3.

COVID-19 Related Stressors, Parent-Child Relationship, and Alcohol Use and 
Mental Health Profiles Among White and Hispanic/Latinx First-Year College 
Students.

Su J(1), Conroy I(2), Trevino A(2), Zheng Y(3), Kuo SI(4).

Author information:
(1)Department of Psychology, Arizona State University, P.O. Box 871104, Tempe, 
AZ, 85287, USA. jinnisu1@asu.edu.
(2)Department of Psychology, Arizona State University, P.O. Box 871104, Tempe, 
AZ, 85287, USA.
(3)Department of Psychology, University of Alberta, Edmonton, Canada.
(4)Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers 
University, Piscataway, NJ, USA.

Transitioning to college during the novel coronavirus disease 2019 (COVID-19) 
pandemic may increase risk for alcohol use and mental health problems. We 
examined how COVID-19 related stressors and parent-child relationships are 
independently and interactively associated with alcohol use and mental health 
profiles in a sample of first-year college students (N = 425, 34.8% 
Hispanic/Latinx; 74.9% female) who completed an online survey in October 2020. 
Latent profile analysis identified four profiles: well-adjusted (53.2%), mental 
health problems only (21.6%), alcohol use only (17.4%), and comorbid (7.8%). 
COVID-19 related stressful events increased risk of being in the alcohol use 
only and comorbid profiles, whereas COVID-19 related worries increased risk of 
being in the mental health problems only profile. Parent-child relationship 
quality lowered risk of being in the mental health problems only and the 
comorbid profiles. In addition, parent-child relationship quality moderated the 
role of COVID-19 related worries such that COVID-19 related worries were 
associated with lower odds of being in the comorbid profile when parent-child 
relationship quality was high but not when parent-child relationship quality was 
low. Strengthening parent-child relationship quality appears important for 
promoting college students' well-being.

© 2022. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s10578-022-01337-4
PMCID: PMC8891429
PMID: 35239056 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


2337. J Sleep Res. 2022 Oct;31(5):e13569. doi: 10.1111/jsr.13569. Epub 2022 Mar 2.

Perceived risk of COVID-19 exposure and poor COVID-19 prognosis impair sleep: 
The mediating and moderating roles of COVID-19-related anxiety and knowledge.

Zerbini G(1), Taflinger S(2), Reicherts P(1), Kunz M(1), Sattler S(2)(3)(4).

Author information:
(1)Department of Medical Psychology and Sociology, Medical Faculty, University 
of Augsburg, Augsburg, Germany.
(2)Institute of Sociology and Social Psychology, University of Cologne, Cologne, 
Germany.
(3)Faculty of Sociology, Bielefeld University, Bielefeld, Germany.
(4)Pragmatic Health Ethics Research Unit, Institut de Recherches Cliniques de 
Montréal, Montréal, Germany.

The ongoing COVID-19 pandemic has been linked to increased levels of stress, 
depression, and anxiety in many people around the world. Therefore, identifying 
individuals at risk of psychosocial burden during this unprecedented crisis is 
essential for developing prevention measures and treatment options for mental 
health issues. To this aim, we investigated two risk groups: individuals at 
higher risk of exposure to the virus and individuals at higher risk of poor 
prognosis if they contract the virus. We conducted a survey (N = 4167) with a 
representative sample of the German population and assessed perceived risk of 
COVID-19 exposure and poor prognosis if infected, COVID-19-related anxiety, 
problems with sleep and daytime functioning, as well as self-reported knowledge 
about the disease. Results showed that perceived risk group membership was 
linked to increased problems with sleep and daytime functioning via elevated 
levels of COVID-19-related anxiety. This mediated effect was further moderated 
by self-reported COVID-19 knowledge, but only for individuals who rated 
themselves at higher risk of COVID-19 exposure. Thus, knowledge buffered the 
negative effect of exposure risk on anxiety and ultimately on sleep in this risk 
group. Reaching individuals at increased risk of exposure with clear information 
about the disease, how to prevent infection, and treatment options could be an 
effective strategy to contain anxiety levels and promote good sleep, which is 
important for general well-being.

© 2022 The Authors. Journal of Sleep Research published by John Wiley &amp; Sons 
Ltd on behalf of European Sleep Research Society.

DOI: 10.1111/jsr.13569
PMCID: PMC9115167
PMID: 35238104 [Indexed for MEDLINE]

Conflict of interest statement: The Authors declare that there is no conflict of 
interest.


2338. BMC Psychol. 2022 Mar 2;10(1):47. doi: 10.1186/s40359-022-00758-z.

Mental health, learning behaviour and perceived fatigue among university 
students during the COVID-19 outbreak: a cross-sectional multicentric study in 
the UAE.

Mosleh SM(1)(2), Shudifat RM(3)(4), Dalky HF(3)(5), Almalik MM(3)(4), Alnajar 
MK(3).

Author information:
(1)Faculty of Health Science, Higher Colleges of Technology, PO Box 1626, 
Fujairah, UAE. smosleh@hct.ac.ae.
(2)Faculty of Nursing, Mutah University, Karak, Jordan. smosleh@hct.ac.ae.
(3)Faculty of Health Science, Higher Colleges of Technology, Sharjah, UAE.
(4)Faculty of Nursing, Mutah University, Karak, Jordan.
(5)Faculty of Nursing, Jordan University of Science and Technology, Irbid, 
Jordan.

BACKGROUND: The rapid shift to online education due to COVID-19 quarantine 
challenged students' ability to accept pure online learning without negative 
consequences for their physical, emotional and mental health. Some educational 
institutions introduced new strategies to reduce the psychosocial burden 
associated with online learning during home confinement. Thus, the primary aims 
were to determine the consequences of COVID-19 for the psychological well-being 
and fatigue levels of higher education students and to explore the effects of a 
new academic assessment approach in reducing home confinement stress.
METHOD: A cross-sectional online survey was conducted among students, from 30 
August to 30 September 2020, of 7 disciplines in all 16 higher colleges of 
technology in the United Arab Emirates (UAE). The Mental Well-being and Learning 
Behaviours Scale and the modified Copenhagen Burnout Inventory were used to 
evaluate students' psychological well-being and fatigue levels. A Welch t-test 
and Welch ANOVA were performed to determine the differences in perceived 
psychological well-being associated with students' characteristics. Second, 
Kruskal_Wallis and Mann_Whitney were performed to determine the differences in 
fatigue level based on students' characteristics.
RESULTS: One thousand four hundred students participated. The majority were 
female (78.5%) and aged from 21-25 years (58.1%). Around 14% of respondents were 
married with children. Nearly 40% were satisfied with the new assessment 
approach introduced during the COVID pandemic and 45.5% perceived it as having 
reduced their home confinement stress. The mean psychological distress score of 
3.00 (SD ± 0.71) indicates a moderate impact of COVID-19 on psychological 
well-being. Students' psychological distress was positively correlated with 
fatigue level (0.256, p < 0.001) and negatively correlated with the perceived 
impact of the new assessment approach on student lifestyle (- 0.133, p < 0.001), 
physical health (- 0.149, p < 0.001) and coping with stress (- 0.125, 
p < 0.001). Male students experienced significantly lower fatigue and better 
psychological well-being than female students.
CONCLUSION: The study reveals that new assessment approaches which emerged 
during home confinement reduced students' perception of stress and of impaired 
lifestyle. However, students still had a considerable burden of psychological 
distress, requiring further preventive measures to maintain their psychological 
well-being during future outbreak events. Educational institutions should 
consider additional strategies to improve students' preparedness for online 
teaching, which could help maintain their psychological well-being.

© 2022. The Author(s).

DOI: 10.1186/s40359-022-00758-z
PMCID: PMC8890023
PMID: 35236395 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


2339. BMC Health Serv Res. 2022 Mar 2;22(1):284. doi: 10.1186/s12913-022-07608-z.

Burnout and well-being of healthcare workers in the post-pandemic period of 
COVID-19: a perspective from the job demands-resources model.

Zhou T(1), Xu C(2), Wang C(2), Sha S(3), Wang Z(3), Zhou Y(4), Zhang X(3), Hu 
D(1), Liu Y(3), Tian T(3), Liang S(3), Zhou L(3), Wang Q(5).

Author information:
(1)Department of Medical Psychology, School of Health Humanities, Peking 
University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China.
(2)Beijing Hospitals Authority, No.70 Zaolinqian Road, Xicheng District, 
Beijing, 100053, China.
(3)Beijing Anding Hospital of Capital Medical University, No.5 Ankang Hutong, 
Deshengmenwai Street, Xicheng District, Beijing, 100088, China.
(4)New York Psychoanalytic Society & Insititute, New York, USA.
(5)Beijing Anding Hospital of Capital Medical University, No.5 Ankang Hutong, 
Deshengmenwai Street, Xicheng District, Beijing, 100088, China. 
qianwanganding@163.com.

BACKGROUND: The present study aimed 1) to examine the effects of 
epidemic-related job stressors, perceived social support and organizational 
support on the burnout and well-being of Chinese healthcare workers in the 
period of COVID-19 regular epidemic prevention and control and 2) to investigate 
the moderating effects of social support and organizational support on the 
relationship between job stressors and burnout and well-being within the 
theoretical framework of the Job Demands-Resources (JD-R) model.
METHODS: A sample of healthcare workers (N = 3477) from 22 hospitals in Beijing, 
China participated in the cross-sectional investigation in October 2020 and 
reported epidemic-related job stressors, perceived social support, 
organizational support, burnout, anxiety and depression symptoms.
RESULTS: 1) Medical doctors, females, people aged from 30 to 50, and those who 
worked in the second line during the pandemic reported higher scores of 
psychological symptoms and burnout in the period of regular epidemic prevention 
and control; 2) Epidemic-related job stressors positively predicted burnout, 
anxiety, and depression among healthcare workers; 3) Perceived social support 
and organizational support were negatively related to reported burnout, anxiety 
and depression symptoms; 4) Social support reduced the adverse effects of 
epidemic-related job stressors on anxiety and depression but enhanced the 
association between stressors and burnout; 5) Organizational support mitigated 
the adverse effects of epidemic-related job stressors on depression.
CONCLUSION: The results shed light on preventing burnout and enhancing the 
psychological well-being of healthcare workers under epidemic prevention and 
control measures by reducing epidemic-related job stressors and strengthening 
personal and organizational support systems.

© 2022. The Author(s).

DOI: 10.1186/s12913-022-07608-z
PMCID: PMC8888816
PMID: 35236354 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests” in this section.


2340. Midwifery. 2022 May;108:103290. doi: 10.1016/j.midw.2022.103290. Epub 2022 Feb 
21.

COVID-19-related stress in postpartum women from Argentina during the second 
wave in 2021: Identification of impairing and protective factors.

Miranda AR(1), Cortez MV(1), Scotta AV(1), Soria EA(2).

Author information:
(1)Facultad de Ciencias Médicas, Escuela de Fonoaudiología, Universidad Nacional 
de Córdoba, Ciudad Universitaria, Bv. de la Reforma, Córdoba 5014, Argentina; 
Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET, INICSA, 
Ciudad Universitaria, Bv. de la Reforma, Córdoba 5014, Argentina.
(2)Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET, INICSA, 
Ciudad Universitaria, Bv. de la Reforma, Córdoba 5014, Argentina; Facultad de 
Ciencias Médicas, Cátedra de Biología Celular, Histología y Embriología, 
Instituto de Biología Celular, Universidad Nacional de Córdoba, Ciudad 
Universitaria, Bv. de la Reforma, Córdoba 5014, Argentina. Electronic address: 
easoria@fcm.unc.edu.ar.

OBJECTIVE: Postpartum women are a vulnerable population to pandemic stressors 
that challenge their psychological well-being. Thus, reliable and valid 
instruments are necessary to measure pandemic-related stress and to identify 
risk and protective factors. This work aimed to assess psychometric properties 
of the COVID-19 Pandemic-Related Stress Scale (PSS-10-C) and associations of 
maternal pandemic stress with demographic, reproductive and pandemic factors of 
Argentinian postpartum women during the second COVID-19 wave.
DESIGN: An online cross-sectional survey was conducted from April to June 2021.
SETTING: Online recruitment of postpartum women was carried out during the 
second wave of COVID-19 in Argentina. This study was conducted in accordance 
with the Declaration of Helsinki and had the corresponding ethical approval.
PARTICIPANTS: This study was performed on 300 women, aged 18-49 years, up to 12 
months postpartum in Argentina.
MEASUREMENTS AND FINDINGS: Stress was assessed with PSS-10-C, with a 
sociodemographic questionnaire being used to collect demographic, reproductive 
and pandemic variables. Statistical analysis included psychometric procedures, 
structural equation modeling, and multiple regressions. PSS-10-C was a reliable 
and structurally valid instrument with two subscales, with entire scale, Stress 
and Coping subscales scoring 17.31 (6.52), 9.70 (4.61) and 7.61 (2.77), 
respectively. History of mood disorders, pregnancy loss, and unhealthy child 
during the pandemic predisposed to increased stress (β > 0.10, p < 0.05), 
whereas having work and practicing breastfeeding promoted coping to face it 
(β < -0.13, p < 0.05). This situation was impaired by mood changes, loss of 
happiness, economic changes, fear of contracting COVID-19 -own or by a loved 
one- (β > 0.11, p < 0.05).
KEY CONCLUSIONS: The study highlighted the vulnerability of postpartum women's 
mental health in the pandemic context, with PSS-10-C being a useful instrument 
for clinicians and researchers to assess perceived stress. Targeting 
interventions toward women at higher risk can be highly beneficial for maternal 
and child health.

Copyright © 2022. Published by Elsevier Ltd.

DOI: 10.1016/j.midw.2022.103290
PMCID: PMC8860463
PMID: 35235890 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships. That could have appeared to influence the work reported in this 
paper.


2341. Nutr Health. 2022 Dec;28(4):711-719. doi: 10.1177/02601060221082362. Epub 2022 
Mar 2.

Associations among Self-Reported Mental Health, Physical Activity, and Diet 
during the COVID-19 Pandemic.

Andersen JA(1), Rowland B(2), Gloster E(2), Willis DE(1), Hernandez N(3), Felix 
HC(4), Long CR(1), McElfish PA(1).

Author information:
(1)College of Medicine, 37323University of Arkansas for Medical Sciences 
Northwest, Fayetteville, AR.
(2)Office of Community Health and Research, 12215University of Arkansas for 
Medical Sciences Northwest, Fayetteville, AR.
(3)Department of Sociology, 14719University of Nebraska-Lincoln, Lincoln, NE.
(4)Fay W. Boozman College of Public Health, 12215University of Arkansas for 
Medical Sciences, Little Rock, AR.

Background: Understanding the relationship between physical activity, diet, and 
mental health during the COVID-19 pandemic may help inform resources encouraging 
healthy lifestyle choices during the time of an increased threat to health and 
wellbeing. Aim: Our objective was to examine how self-rated mental health was 
associated with engagement in physical activity and consumption of fruits and 
vegetables during the COVID-19 pandemic. Methods: The study utilized 
cross-sectional survey data from adults (≥18 years of age) living, working, 
and/or receiving healthcare in Arkansas (n  =  754). Multivariable regression 
models were used to examine the associations between self-rated mental health 
and the number of days respondents engaged in 30 min of physical activity and 
the number of days respondents consumed five or more servings of fruits and 
vegetables. Results: Respondents who reported somewhat poor/poor mental health 
reported engaging in at least 30 min of physical activity fewer days per week 
(β  =  -.77, p  =  .018) compared with those reporting excellent mental health, 
after controlling for sociodemographic factors and self-rated health. The 
significant association observed in the first two models between mental health 
and number of days consuming five or more servings of fruits and vegetables 
became non-significant after inclusion of self-rated health. Conclusion: The 
relationship between mental health and physical activity and diet reaffirms a 
need for healthcare providers to promote the importance of maintaining both a 
healthy physical activity level and a nutrient-rich diet in the face of 
challenging circumstances, such as a global pandemic.

DOI: 10.1177/02601060221082362
PMCID: PMC8891903
PMID: 35234099 [Indexed for MEDLINE]


2342. Dementia (London). 2022 May;21(4):1233-1249. doi: 10.1177/14713012211072929. 
Epub 2022 Mar 2.

Dementia and dignity of identity: A qualitative evidence synthesis.

Cruise CE(1), Lashewicz BM(1).

Author information:
(1)Department of Community Health Sciences, Cumming School of Medicine, 
70401University of Calgary, Calgary, AB, Canada.

In the late stages of dementia, individuals rely on others for their wellbeing 
and this creates an ethical imperative for responsive dementia care. Through a 
qualitative evidence synthesis of literature on what constitutes responsive 
dementia care, we identified dignity of identity as a central theme. Dignity of 
identity is the status each of us holds in relation to others and reflects our 
past experiences and our aspirations for the future. We did a qualitative 
evidence synthesis of 10 qualitative studies conducted with a total of 149 
research participants, 95 of whom had dementia, and 54 of whom were paid and 
family member caregivers to people with dementia. Using "new materialism 
disability studies" as our theoretical framework, we illustrate how 
environments, both material and discursive, shape the abilities of people with 
dementia in residential care settings (RSCs) to live well and we use our 
findings to point to ways forward in dignity of identity-enhancing dementia care 
practice. Echoing the literature, we observe that people with dementia have the 
virtual capacity to live with dignity of identity and illustrate how material 
conditions and discourse influence the transition of dignity of identity in 
people with dementia from a virtual capacity to an actual capacity and how 
demonstrated capacity in turn influences material conditions and discourse 
surrounding care for people with dementia in RSCs. We call for a greater 
acknowledgement within literature on dignity and dementia of structural barriers 
to dignity of identity-enhancing care. The COVID-19 pandemic has shown us the 
fatal consequences of insufficient material conditions in RCSs and we hope that 
on a societal level there is improvement to both the material conditions in RCSs 
as well as an improvement in discourse about those who live and work in RCSs.

DOI: 10.1177/14713012211072929
PMCID: PMC9109213
PMID: 35232314 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of conflicting interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


2343. Swiss Med Wkly. 2022 Feb 23;152:Swiss Med Wkly. 2022;152:w30142. doi: 
10.4414/smw.2022.w30142. eCollection 2022 Feb 14.

The mental distress of our youth in the context of the COVID-19 pandemic.

Berger G(1), Häberling I(1), Lustenberger A(1), Probst F(1), Franscini M(1), 
Pauli D(1), Walitza S(1)(2)(3).

Author information:
(1)Department of Child and Adolescent Psychiatry and Psychotherapy, University 
Hospital of Psychiatry Zurich, University of Zurich, Switzerland.
(2)Neuroscience Centre Zurich, University of Zurich and ETH Zurich, Switzerland.
(3)Zurich Centre for Integrative Human Physiology, University of Zurich, 
Switzerland.

BACKGROUND: Epidemiological evidence from population-based surveys suggest that 
the psychological well-being of adolescents has been severely affected by the 
COVID-19 pandemic itself, as well as by the safety measures implemented. The 
rationale of the study was to investigate the influence of the pandemic on 
psychiatric emergency service use, psychiatric admissions rates, emotional 
well-being, suicidality and self-harm behaviour in help-seeking children and 
adolescents.
METHODS: Retrospective cohort study of electronic patient records before and 
during the COVID-19 pandemic from the emergency out-patient facility of the 
department of child and adolescent psychiatry and psychotherapy of the 
Psychiatric University Hospital Zürich. The frequency of all emergency service 
contacts from 1 January 2019 to 31 June 2021 were described and the frequency of 
records compared in half-year intervals. Emotional well-being, behavioural 
problems, suicidality and self-harm were estimated based on the mental state 
examination notes of electronic patient records from the 1 March to the 30 April 
for the years 2019, 2020 and 2021.
RESULTS: After an initial decline in emergency contacts at the beginning of the 
first lockdown, the use of the centralised emergency service increased during 
the subsequent months and has since stabilised at a significantly higher level 
than before the pandemic. Comparison of emergency contacts in the first half of 
2019 with the first half of 2021 shows that the number of emergency phone 
contacts nearly doubled, emergency outpatient assessments increased by 40%, 
emergency bridging interventions increased by 230%, and inpatient admissions of 
minors to adult psychiatric inpatient units more than doubled because of lack of 
service capacity in child and adolescent psychiatry. The proportion of 
adolescents who reported suicidal ideation increased significantly by 15%, from 
69% to 84%, and the proportion of adolescents who reported self-harm behaviour 
increased by 17%, from 31% to 48%.
CONCLUSION: We found a significant increase in psychiatric service use, as well 
as in reported serious mental health symptoms such as suicidality and self-harm 
behaviour in help-seeking children and adolescents in the course of the 
pandemic. The child and adolescent psychiatric healthcare system is overburdened 
and down-referral of adolescents in need of ongoing therapy is becoming 
increasingly difficult. We recommend prioritising preventive and therapeutic 
measures to support the mental health of our children and adolescents alongside 
the somatic management of the COVID-19 pandemic.

DOI: 10.4414/smw.2022.w30142
PMID: 35230030 [Indexed for MEDLINE]


2344. Aust J Rural Health. 2022 Jun;30(3):363-372. doi: 10.1111/ajr.12845. Epub 2022 
Mar 1.

Police, permits and politics: Navigating life on Australia's state borders 
during the COVID-19 pandemic.

McCann L(1), Thompson SC(1), Rolf F(2), Podubinski T(3).

Author information:
(1)Western Australian Centre for Rural Health, University of Western Australia, 
Geraldton, Western Australia, Australia.
(2)Southern Queensland Rural Health, University of Queensland, Charleville, 
Queensland, Australia.
(3)Department of Rural Health, University of Melbourne, Melbourne, Victoria, 
Australia.

OBJECTIVE: To explore the ways in which the Coronavirus disease-19 (COVID-19) 
pandemic has affected Australians who live and travel in cross-border regions in 
the course of their daily lives.
DESIGN: Semi-structured interviews were undertaken with participants by 
telephone. The analysis utilised qualitative exploratory methods and provided 
rich data through immersive and reflexive analysis.
SETTING: Interviews of people across Australia.
PARTICIPANTS: Of 90 people interviewed in relation to their experiences of the 
COVID-19 pandemic, 13 described challenges related to border crossing that 
impacted their usual work and personal life.
MAIN OUTCOME MEASURE: Description of challenges faced by Australians living 
close to state borders due to internal border closures in the early period of 
COVID-19 (2020).
RESULTS: Policy changes surrounding border closures negatively impacted people's 
wellbeing in Australia with three key interconnected themes identified for 
Australians living in cross-border regions. First, border closures presented 
participants of these communities with physical barriers which reduced access to 
healthcare and employment. Second, participants reported how restrictions on 
travel to neighboring states and territories impacted their mental wellbeing. 
Finally, many Australians in cross-border regions faced financial struggles 
exacerbated by border closures.
CONCLUSION: Normally, interstate borders are largely invisible with formalities 
relevant to few circumstances. Since the emergence of the COVID-19 pandemic, 
Australians who used to regularly cross these borders in the course of their 
daily activities were no longer able or willing to do so due to the uncertain 
circumstances surrounding border policy. This study elaborates on the impact of 
these closures on people's physical, financial, and emotional state.

© 2022 The Authors. Australian Journal of Rural Health published by John Wiley & 
Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.

DOI: 10.1111/ajr.12845
PMCID: PMC9111201
PMID: 35229397 [Indexed for MEDLINE]

Conflict of interest statement: The authors are not aware of any conflict of 
interest.


2345. PLoS One. 2022 Feb 28;17(2):e0264023. doi: 10.1371/journal.pone.0264023. 
eCollection 2022.

COVID-19 mitigation measures in primary schools and association with infection 
and school staff wellbeing: An observational survey linked with routine data in 
Wales, UK.

Marchant E(1)(2), Griffiths L(1), Crick T(3), Fry R(1)(2), Hollinghurst J(1), 
James M(1)(2), Cowley L(2)(4), Abbasizanjani H(1), Torabi F(1), Thompson DA(1), 
Kennedy J(1)(2), Akbari A(1), Gravenor MB(1), Lyons RA(1), Brophy S(1)(2).

Author information:
(1)Population Data Science, Medical School, Swansea University, Swansea, United 
Kingdom.
(2)National Centre for Population Health and Wellbeing Research, Swansea 
University, Swansea, United Kingdom.
(3)School of Education, Swansea University, Swansea, United Kingdom.
(4)Research and Evaluation Division, Public Health Knowledge and Research 
Directorate, Public Health Wales, Cardiff, United Kingdom.

INTRODUCTION: School-based COVID-19 mitigation strategies have greatly impacted 
the primary school day (children aged 3-11) including: wearing face coverings, 
two metre distancing, no mixing of children, and no breakfast clubs or 
extra-curricular activities. This study examines these mitigation measures and 
association with COVID-19 infection, respiratory infection, and school staff 
wellbeing between October to December 2020 in Wales, UK.
METHODS: A school staff survey captured self-reported COVID-19 mitigation 
measures in the school, participant anxiety and depression, and open-text 
responses regarding experiences of teaching and implementing measures. These 
survey responses were linked to national-scale COVID-19 test results data to 
examine association of measures in the school and the likelihood of a positive 
(staff or pupil) COVID-19 case in the school (clustered by school, adjusted for 
school size and free school meals using logistic regression). Linkage was 
conducted through the SAIL (Secure Anonymised Information Linkage) Databank.
RESULTS: Responses were obtained from 353 participants from 59 primary schools 
within 15 of 22 local authorities. Having more direct non-household contacts was 
associated with a higher likelihood of COVID-19 positive case in the school (1-5 
contacts compared to none, OR 2.89 (1.01, 8.31)) and a trend to more 
self-reported cold symptoms. Staff face covering was not associated with a lower 
odds of school COVID-19 cases (mask vs. no covering OR 2.82 (1.11, 7.14)) and 
was associated with higher self-reported cold symptoms. School staff reported 
the impacts of wearing face coverings on teaching, including having to stand 
closer to pupils and raise their voices to be heard. 67.1% were not able to 
implement two metre social distancing from pupils. We did not find evidence that 
maintaining a two metre distance was associated with lower rates of COVID-19 in 
the school.
CONCLUSIONS: Implementing, adhering to and evaluating COVID-19 mitigation 
guidelines is challenging in primary school settings. Our findings suggest that 
reducing non-household direct contacts lowers infection rates. There was no 
evidence that face coverings, two metre social distancing or stopping children 
mixing was associated with lower odds of COVID-19 or cold infection rates in the 
school. Primary school staff found teaching challenging during COVID-19 
restrictions, especially for younger learners and those with additional learning 
needs.

DOI: 10.1371/journal.pone.0264023
PMCID: PMC8884508
PMID: 35226680 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare there are no competing 
interests.


2346. Int J Med Educ. 2022 Feb 26;13:35-46. doi: 10.5116/ijme.6209.10d6.

Medical education and mental health during COVID-19: a survey across 9 
countries.

Michaeli D(1), Keough G(2), Perez-Dominguez F(3), Polanco-Ilabaca F(3), 
Pinto-Toledo F(3), Michaeli J(4), Albers S(5), Achiardi J(6), Santana V(7), 
Urnelli C(8), Sawaguchi Y(9), Rodríguez P(10), Maldonado M(11), Raffeeq Z(12), 
de Araujo Madeiros O(13), Michaeli T(14).

Author information:
(1)Department of Personalized Oncology, University Hospital Mannheim, Heidelberg 
University, Mannheim, Germany.
(2)Department of Health Policy, London School of Economics and Political 
Sciences, London, United Kingdom.
(3)Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, 
Santiago, Chile.
(4)Department of Obstetrics and Gynecology, Asklepios-Clinic Hamburg-Altona, 
Asklepios Hospital Group, Hamburg, Germany.
(5)Department of Orthopedic Surgery, ATOS Klinik Fleetinsel Hamburg, Hamburg, 
Germany.
(6)Facultad de Medicina y Ciencias de la Salud, Universidad Militar Nueva 
Granada, Bogotá, Colombia.
(7)Escuela Luis Razetti, Universidad Central de Venezuela, Caracas, Venezuela.
(8)Facoltà di Medicina e Chirurgia, Università degli Studi del Piemonte 
Orientale, Novara, Italy.
(9)Faculty of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
(10)Facultad de Medicina, Universidad Panamericana, Ciudad de México, Mexico.
(11)Facultad de Medicina, Universidad de Sevilla, Sevilla, Spain.
(12)Humanitas University - Hunimed, Milan, Italy.
(13)Faculdade de Ciências Médicas Santa Casa de São Paulo, São Paulo, Brazil.
(14)Fifth Department of Medicine, University Hospital Mannheim, Heidelberg 
University, Mannheim, Germany.

OBJECTIVES: To investigate students' experience with medical education alongside 
their mental and physical health since the onset of the COVID-19 pandemic across 
nine countries.
METHODS: A cross-sectional online survey was distributed by local collaborators 
to 2,280 medical students across 148 medical schools in Brazil, Chile, Colombia, 
Germany, Italy, Japan, Mexico, Spain, and Venezuela using non-probability 
convenience sampling from June 22 to July 24, 2020. Students answered questions 
regarding teaching, internet use, COVID-19, physical and mental well-being. A 
multivariate logistic regression examined factors associated with depressed 
mood, insomnia, and headache.
RESULTS: Academic teaching shifted to a virtual (67%, n=1,534) or hybrid 
environment (23%, n=531), whilst bedside teaching was suspended or cancelled 
(93%, n=2,120). Across all countries students were equally satisfied with the 
teaching modality, quantity, quality, and the evaluation system of in-person, 
hybrid, and online curricula. Negative changes in mental (40% (n=912) insomnia, 
57% (n=1,300) emotional irritability, 47% (n=1,072) emotional instability, 41% 
(n=935) anhedonia, 40% (n=912) depressed mood) and physical (36% (n=821) 
headache, 57% (n=1,299) ocular tiredness, 49% (n=1,117) backache) health 
symptoms were frequently observed. Positive associations between the number of 
daily screen hours and depressed mood (adjusted odds ratio (AOR)=1.09, 95%CI: 
1.05-1.12, p<.001), insomnia (AOR=1.08, 95%CI: 1.05-1.11, p<.001), and headache 
(AOR=1.11, 95%CI: 1.07-1.14, p<.001) were identified.
CONCLUSIONS: Students' experience with digital and hybrid medical curricula was 
diverse during the pandemic. Education modality, quantity, and quality were 
positively evaluated. However, students' mental and physical health worsened. 
Besides bedside teaching, faculties ought to digitalize and strengthen social 
communities and extend support services for students.

DOI: 10.5116/ijme.6209.10d6
PMCID: PMC9017502
PMID: 35226614 [Indexed for MEDLINE]


2347. J Women Aging. 2023 Jan-Feb;35(1):38-48. doi: 10.1080/08952841.2022.2041154. 
Epub 2022 Feb 28.

The intersection of race and financial strain: The pain of social disconnection 
among women in the United States.

Bhatta TR(1), Lekhak N(2), Goler TD(3), Kahana E(4), Rathi S(5).

Author information:
(1)Department of Sociology, University of Nevada, Las Vegas, Nevada, USA.
(2)School of Nursing, University of Nevada, Las Vegas, Nevada, USA.
(3)Department of Sociology, Norfolk State University, Norfolk, Virginia, USA.
(4)Department of Sociology, Case Western Reserve University, Cleveland, Ohio, 
USA.
(5)School of Public Health, University of Nevada, Las Vegas, Nevada, USA.

Objectives: Considerable attention has been directed at increased social 
isolation and loneliness during the COVID-19 pandemic and their impact on 
later-life psychological well-being. There is a dearth of research on the effect 
of financial strain and associated psychosocial mechanisms on loneliness among 
women across racial groups. It is unclear how racial status and financial strain 
intersect to impact later-life loneliness amid immense uncertainty, social 
isolation, and anxiety induced by the pandemic.Methods: Based on our nationwide 
Web-based survey (n = 1,301), we used ordinary least square regression to 
examine the effects of financial strain on loneliness among Black and White 
women and assessed the role of emotional support in contributing to such 
effects.Results: We found that Black women face significantly more financial 
strain than White women but also receive more emotional support and experience 
less loneliness. Findings show that women experiencing financial strain report 
increased loneliness, but the negative effects of financial strain are 
significantly greater for Black women than for White women. Our mediation 
analysis revealed that emotional support made a significant contribution to the 
effects of financial strain on loneliness in White women but not in Black 
women.Discussion: Despite shared vulnerability and social isolation across the 
general population, our findings suggest that negative effects of financial 
strain on loneliness among women continue to differ across race, even amid the 
pandemic. Our findings demonstrate how emotional support explains the 
relationship between financial strain and later-life loneliness in a racially 
distinct manner.

DOI: 10.1080/08952841.2022.2041154
PMID: 35226586 [Indexed for MEDLINE]


2348. Psychiatr Q. 2022 Jun;93(2):613-625. doi: 10.1007/s11126-022-09974-7. Epub 2022 
Feb 28.

Opportunities to expand access to mental health services: A case for the role of 
online peer support communities.

Merchant R(1), Goldin A(2), Manjanatha D(3), Harter C(2), Chandler J(2), Lipp 
A(4), Nguyen T(5), Naslund JA(6).

Author information:
(1)Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA. 
rutvij.merchant@icahn.mssm.edu.
(2)Inspire, Arlington, VA, 22201, USA.
(3)Harvard TH Chan School of Public Health, Harvard University, Boston, MA, 
02115, USA.
(4)Center for Applied Research Solutions Inc, Santa Rosa, CA, 95404-410, USA.
(5)Mental Health America, Alexandria, VA, 22314, USA.
(6)Department of Global Health and Social Medicine, Harvard Medical School, 
Boston, MA, 02115, USA.

This study investigated whether with disruptions in care due to the COVID-19 
pandemic, persons who self-identified as living with a mental health condition 
increased their usage of an online peer support community. We also explored 
whether study participants who self-reported usage of online peer support 
communities were interested in using these communities to connect with 
evidence-based interventions and mental health services. This study employed a 
cross-sectional online survey design. The survey was disseminated by the Inspire 
online peer support community and Mental Health America through various social 
media channels. Descriptive and inferential analyses were conducted to summarize 
participant demographics, investigate patterns of use of online peer support 
communities, and interest in accessing additional programs through these 
platforms. There were 369 survey respondents, with a mean age of 49 (SD = 15.6), 
of which 77% were female. Most respondents self-reported having depression 
(34%), post-traumatic stress disorder (25%), and anxiety-related conditions 
(20%). The number of respondents who reported accessing online peer support 
platforms multiple times a day appeared to double after March 2020. We also 
found an overall positive association between frequency of community use and 
self-reported benefit to mental health. Approximately 81% of respondents 
expressed interest in accessing mental health services via an online peer 
support community. Persons who self-report living with mental health conditions 
and who engage in online peer support communities expressed interest in 
accessing evidence-based interventions via these online platforms. Participants 
were most interested in services related to enhancing coping mechanisms and 
skills, enabling overall wellbeing, and accessing therapy.

© 2022. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s11126-022-09974-7
PMCID: PMC8883016
PMID: 35226251 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


2349. J Fam Psychol. 2022 Aug;36(5):653-660. doi: 10.1037/fam0000981. Epub 2022 Feb 
28.

How social support and parent-child relationship quality relate to LGBTQ+ 
college students' well-being during COVID-19.

Zhang Y(1), Farina RE(1), Lawrence SE(1), Walters TL(1), Clark AN(1), 
Hanna-Walker V(1), Lefkowitz ES(1).

Author information:
(1)Department of Human Development and Family Sciences, University of 
Connecticut.

The coronavirus disease (COVID-19) pandemic has negatively impacted the 
well-being of many college students, particularly lesbian, gay, bisexual, 
transgender, queer, and questioning (LGBTQ +) students who are already at a 
disproportionate risk for negative mental health and well-being outcomes. To 
identify potential risk and protective factors we examined LGBTQ + college 
students' disclosure of sexual orientation, gender identity, or both (SOGI) to 
mothers and fathers, living arrangements (whether or not students lived with 
mothers and fathers), social support from family and friends, and parent-child 
relationship quality and their association with stress, depressive symptoms, 
anxiety symptoms, and problem drinking during the pandemic. LGBTQ + college 
students (N = 366; Mage = 20.4) completed an online survey. Students who 
reported more social support from family and friends and better quality 
relationships with mothers or fathers had better well-being and were less likely 
to perceive a substantial decrease in their well-being due to the pandemic. In 
contrast, SOGI disclosure and whether or not students lived with mothers or 
fathers were generally unrelated to well-being. Findings suggest that 
universities should consider offering mental health resources for students 
living on- and off-campus, and that clinical professionals should consider 
strategies to help these young adults identify and maintain support systems and 
highlight the value of positive parent-child relationships. (PsycInfo Database 
Record (c) 2022 APA, all rights reserved).

DOI: 10.1037/fam0000981
PMID: 35225639 [Indexed for MEDLINE]


2350. Front Public Health. 2022 Feb 9;9:788598. doi: 10.3389/fpubh.2021.788598. 
eCollection 2021.

The COVID-19 Pandemic and Cancer Patients in Germany: Impact on Treatment, 
Follow-Up Care and Psychological Burden.

Eckford RD(1), Gaisser A(2), Arndt V(3)(4), Baumann M(5), Kludt E(2), Mehlis 
K(6), Ubels J(1)(7), Winkler EC(6), Weg-Remers S(2), Schlander M(1)(7)(8).

Author information:
(1)Division of Health Economics, German Cancer Research Center (DKFZ), 
Heidelberg, Germany.
(2)German Cancer Information Service, German Cancer Research Center (DKFZ), 
Heidelberg, Germany.
(3)Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging 
Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
(4)Epidemiological Cancer Registry Baden-Württemberg, German Cancer Research 
Center (DKFZ), Heidelberg, Germany.
(5)German Cancer Research Center (DKFZ), Heidelberg, Germany.
(6)Department of Medical Oncology, Section of Translational Medical Ethics, 
National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, 
Germany.
(7)Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
(8)Alfred Weber Institute, Faculty of Economics and Social Sciences, University 
of Heidelberg, Heidelberg, Germany.

In response to the ongoing coronavirus disease 2019 (COVID-19) pandemic, 
governments imposed various measures to decrease the rate of disease spread, and 
health care policy makers prioritized resource allocation to accommodate 
COVID-19 patients. We conducted a cross-sectional online survey in Germany (July 
2020-June 2021) to assess the frequency of changes to cancer care among cancer 
patients and to explore the psychological impact of the pandemic writ large. 
Cancer patients who contacted the Cancer Information Service 
(Krebsinformationsdienst, KID) of the German Cancer Research Center (Deutsches 
Krebsforschungszentrum, DKFZ) via email were invited to complete an online 
questionnaire, capturing demographics, cancer specifics (e.g., type, disease 
phase, primary place of treatment, etc.), and any changes to their medical, 
follow-up, psycho-oncological or nursing care. General level of psychological 
distress was measured using the Hospital Anxiety and Depression Scale (HADS) 
along with face-validated items regarding worries and social isolation specific 
to the pandemic. In total, 13% of 621 patients reported a change to their 
treatment or care plan. Of those patients with changes, the majority of changes 
were made to follow-up care after treatment (56%), to monitoring during 
treatment (29%) and to psychological counseling (20%). Of the overall sample, 
more than half of patients (55%) reported symptoms of anxiety and 39% reported 
symptoms of depression. Patients with a change in cancer care were more likely 
to report symptoms of depression than those with no change (AOR: 2.18; 95% CI: 
1.26-3.76). Concern about the pandemic affecting the quality of health care was 
a predictor of both anxiety (AOR: 2.76; 95% CI: 1.75-4.35) and depression (AOR: 
2.15; 95% CI: 1.43-3.23). Results showed that the majority of cancer patients in 
our study did not experience a change in their cancer care. However, the level 
of anxiety and psycho-social burden of cancer patients during the pandemic was 
high throughout the study period. Our findings underscore the need for health 
care services and policy makers to assess and to attend cancer patients' medical 
needs, with added emphasis on patients' psychological and social well-being. 
This applies particularly in situations where the healthcare system is strained 
and prioritization is necessary.

Copyright © 2022 Eckford, Gaisser, Arndt, Baumann, Kludt, Mehlis, Ubels, 
Winkler, Weg-Remers and Schlander.

DOI: 10.3389/fpubh.2021.788598
PMCID: PMC8865576
PMID: 35223757 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2351. J Immigr Minor Health. 2022 Dec;24(6):1435-1445. doi: 
10.1007/s10903-022-01347-3. Epub 2022 Feb 27.

Psychological Wellbeing and Associated Factors Among Ethnic Minorities During 
the COVID-19 Pandemic.

Wong CL(1), Leung AWY(2), Chan DNS(1), Chow KM(1), Chan CWH(1), Ng MSN(1), So 
WKW(1).

Author information:
(1)The Nethersole School of Nursing, Faculty of Medicine, The Chinese University 
of Hong Kong, Hong Kong SAR, China.
(2)The Nethersole School of Nursing, Faculty of Medicine, The Chinese University 
of Hong Kong, Hong Kong SAR, China. alicewyleung@cuhk.edu.hk.

This study assessed the psychological wellbeing and its associated factors 
amongst ethnic minorities during the coronavirus disease 2019 (COVID-19) 
pandemic. A total of 310 Hong Kong South Asians aged 41.3 (SD 13.7) years 
completed an anonymous online survey between July 2020 and February 2021. The 
results showed an overall moderate level of stress and high levels of 
depression, anxiety and post-traumatic stress disorder (PTSD) symptoms amongst 
South Asian minorities. Multivariable regression analyses suggested that being 
single/divorced, following Hinduism or other non-Muslim religions, having lower 
perceived knowledge of COVID-19 and having worried about losing job were 
significant predictors of higher levels of depression, anxiety and/or stress; 
additionally, being male, having a low monthly household income, having worried 
about losing job and healthcare collapse were significant predictors of a higher 
level of PTSD symptoms. The findings suggest an urgent need to alleviate the 
psychological impacts of the COVID-19 pandemic on ethnic minorities, 
specifically for those most vulnerable to these impacts.

© 2022. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s10903-022-01347-3
PMCID: PMC8882315
PMID: 35220516 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


2352. J Am Med Dir Assoc. 2022 Mar;23(3):405-413.e3. doi: 10.1016/j.jamda.2022.01.059.

The Effect of COVID-19 Endemicity on the Mental Health of Health Workers.

Abhiram K(1), Tan BYQ(2), Tan M(3), Tan L(4), Sia CH(5), Chua YX(6), Lim LJH(7), 
Suppiah CM(8), Sim K(9), Chan YH(10), Ooi SBS(11).

Author information:
(1)Department of Obstetrics and Gynaecology, National University Hospital, 
Singapore.
(2)Yong Loo Lin School of Medicine, National University of Singapore, Singapore; 
Division of Neurology, Department of Medicine, National University Hospital, 
Singapore. Electronic address: benjamin_yq_tan@nuhs.edu.sg.
(3)Department of Geriatric Medicine, Ng Teng Fong General Hospital, Singapore.
(4)Division of Healthy Ageing, Alexandra Hospital, Singapore.
(5)Yong Loo Lin School of Medicine, National University of Singapore, Singapore; 
Department of Cardiology, National University Heart Centre, Singapore.
(6)Pioneer Polyclinic, National University Polyclinics, National University 
Health System, Singapore.
(7)Psychiatry Residency Programme, National Healthcare Group, Singapore.
(8)National University Health System, Singapore.
(9)Yong Loo Lin School of Medicine, National University of Singapore, Singapore; 
West Region, Institute of Mental Health, Singapore.
(10)Biostatistics Unit, Yong Loo Lin School of Medicine, National University of 
Singapore, Singapore.
(11)Yong Loo Lin School of Medicine, National University of Singapore, 
Singapore; Emergency Medicine Department, National University Hospital, 
Singapore.

OBJECTIVES: A major surge in COVID-19 cases despite Singapore's high vaccination 
has strained the health care system in October 2021. Our aim was to assess and 
compare Healthcare Worker (HCW) mental well-being in 2021 against a previously 
published cohort in 2020.
DESIGN: Cross-sectional survey study.
SETTING AND PARTICIPANTS: HCWs from 4 public hospitals and a primary health care 
system over a 4-week duration in 2021 coinciding with a major surge compared 
with a similar period in 2020.
METHODS: A survey comprising of the Oldenburg Burnout Inventory (OLBI), Hospital 
Anxiety and Depression Scale (HADS), and Safety Attitudes Questionnaire (SAQ) 
was distributed via email. Primary endpoints were the proportion meeting OLBI 
thresholds for both disengagement and exhaustion and being at risk for both 
Anxiety and Depression using HADS. Multivariate analysis identified significant 
predictors among demographic, workplace, and SAQ data. Subgroup analysis of 
overseas HCWs was performed.
RESULTS: We surveyed 1475 HCWs. Significantly more HCWs met primary outcomes 
using OLBI and HADS than in 2020 (84.1% and 39.6% vs 68.2% and 23.3%, 
respectively; P < .001). Burnout levels were uniformly high. A HADS score ≥8 in 
either subscale was significantly associated with meeting burnout thresholds (P 
< .001). Overseas HCWs (P = .002), South Asian ethnicity (P = .004), 
preuniversity educational qualifications (P = .026), and longer shift workhours 
of 8 to <12 (P = .015) and ≥12 (P = .001) were significantly associated with 
meeting HADS thresholds. Among overseas HCWs (n=407), seeing family more than a 
year ago was significantly associated with worse OLBI disengagement scores and a 
greater proportion meeting HADS thresholds vs seeing them within a year or being 
local HCWs (47.2% vs 37.2% and 35.6%, respectively; P = .001).
CONCLUSIONS AND IMPLICATIONS: HCW mental health has objectively worsened between 
2020 and 2021 in the pandemic's second year. Avoiding prolonged shifts, adopting 
preventive mental health strategies, improving patient safety, and attention to 
HCWs of minority ethnicity, from overseas, and with preuniversity education may 
help.

Copyright © 2022 AMDA – The Society for Post-Acute and Long-Term Care Medicine. 
Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jamda.2022.01.059
PMCID: PMC8863564
PMID: 35219506 [Indexed for MEDLINE]


2353. Psychiatr Clin North Am. 2022 Mar;45(1):191-210. doi: 10.1016/j.psc.2021.11.012. 
Epub 2021 Nov 12.

Preparing for the Next Pandemic to Protect Public Mental Health: What Have We 
Learned from COVID-19?

Morganstein JC(1).

Author information:
(1)Center for the Study of Traumatic Stress, Department of Psychiatry, School of 
Medicine, Uniformed Services University, 6720B Rockledge Drive, Suite 550, 
Bethesda, MD 20817, USA. Electronic address: Joshua.morganstein@usuhs.edu.

The COVID-19 pandemic exerted an extraordinary impact on public mental health to 
an extent not yet fully understood. Risk perception shaped psychological and 
behavioral responses, including experiences of distress, psychiatric disorders, 
and engagement in pandemic-related health behaviors. COVID-19 created unique 
aspects of evolving risk with various communities disproportionately impacted. 
The unique nature and duration of the pandemic required public-private 
partnerships that leveraged and adapted promising practices to promote essential 
elements that foster well-being after disasters. Early findings are reviewed, 
and further research will inform on best practices for protecting public mental 
health during future pandemics.

Published by Elsevier Inc.

DOI: 10.1016/j.psc.2021.11.012
PMCID: PMC8585601
PMID: 35219438 [Indexed for MEDLINE]


2354. Psychiatr Clin North Am. 2022 Mar;45(1):109-121. doi: 10.1016/j.psc.2021.11.007. 
Epub 2021 Nov 12.

Impact of COVID-19 on Mental Health Care Practitioners.

Yellowlees P(1).

Author information:
(1)Department of Psychiatry and Behavioral Sciences, University of California 
Davis, 2230 Stockton Boulevard, Sacramento, CA 95817, USA. Electronic address: 
pmyellowlees@ucdavis.edu.

Many mental health practitioners, including psychiatrists, have suffered 
multiple social and mental health impacts from COVID-19. A range of actions are 
described that health care organizations and individuals can take to mitigate 
these impacts. There will likely be substantial positive short- and long-term 
outcomes for psychiatrists individually and as a profession post-COVID-19. These 
include improved professional well-being and more efficient practice modalities 
through the development of hybrid care clinical approaches integrating 
technologies into practice, and a greater focus on providing better care for 
diverse racial and ethnic communities.

Copyright © 2022 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.psc.2021.11.007
PMCID: PMC8585595
PMID: 35219432 [Indexed for MEDLINE]


2355. Complement Ther Clin Pract. 2022 May;47:101566. doi: 10.1016/j.ctcp.2022.101566. 
Epub 2022 Feb 23.

Effect of the Mindfulness-Based Stress Reduction program on stress, anxiety, and 
childbirth fear in pregnant women diagnosed with COVID-19.

Güney E(1), Cengizhan SÖ(2), Karataş Okyay E(3), Bal Z(4), Uçar T(5).

Author information:
(1)Department of Midwifery, Faculty of Health Sciences, İnönü University, 
Malatya, Turkey. Electronic address: esra.guney@inonu.edu.tr.
(2)Department of Midwifery, Faculty of Health Sciences, Gaziantep Islam Science 
and University, Gaziantep, Turkey. Electronic address: 
sidika_cengizhan@hotmail.com.
(3)Department of Midwifery, Faculty of Health Sciences, Kahramanmaraş Sütçü İmam 
University, Kahramanmaraş, Turkey. Electronic address: eokyay@ksu.edu.tr.
(4)Department of Midwifery, Faculty of Health Sciences, İnönü University, 
Malatya, Turkey. Electronic address: zeynepp_ball@hotmail.com.
(5)Department of Midwifery, Faculty of Health Sciences, İnönü University, 
Malatya, Turkey. Electronic address: tuba.ucar@inonu.edu.tr.

OBJECTIVE: This study aims to examine the effectiveness of a live online 
Mindfulness-Based Stress Reduction (MBSR) program in preventing distress, 
anxiety and childbirth fear in pregnant women diagnosed with COVID-19.
MATERIAL AND METHODS: Designed as a randomized-controlled trial, this study was 
performed with the participation of pregnant women who were diagnosed with 
COVID-19. The sample comprised 84 pregnant women, including 42 in the 
experimental group and 42 in the control group. The online MBSR program composed 
of eight sessions and lasting four weeks was provided to the pregnant women in 
the experimental group, whereas such an initiative was not provided to the 
control group. The data were collected via the Revised Prenatal Distress 
Questionnaire (NuPDQ), the Beck Anxiety Inventory (BAI), and the Childbirth 
Attitudes Questionnaire (CAQ).
RESULTS: After the MBSR program, the mean NuPDQ, BAI and CAQ scores of the 
pregnant women in the experimental group were significantly lower than the mean 
scores of those in the control group (p < 0.001).
CONCLUSION: The online MBSR program may be utilized to reduce the distress, 
anxiety and childbirth fear levels of pregnant women diagnosed with COVID-19. By 
using the MBSR program, health professionals might improve the psychological 
well-being of pregnant women diagnosed with COVID-19.

Copyright © 2022 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.ctcp.2022.101566
PMCID: PMC8863420
PMID: 35219222 [Indexed for MEDLINE]

Conflict of interest statement: All authors declare no conflict of interest. No 
ﬁnancial support was received for this study. No other 
relationships/conditions/circumstances are present.


2356. Acta Psychol (Amst). 2022 May;225:103538. doi: 10.1016/j.actpsy.2022.103538. 
Epub 2022 Feb 21.

Psychological well-being, risk factors, and coping strategies with social 
isolation and new challenges in times of adversity caused by the COVID-19 
pandemic.

Zsido AN(1), Arato N(2), Inhof O(2), Matuz-Budai T(2), Stecina DT(2), Labadi 
B(2).

Author information:
(1)Institute of Psychology, University of Pécs, Hungary. Electronic address: 
zsido.andras@pte.hu.
(2)Institute of Psychology, University of Pécs, Hungary.

OBJECTIVE: COVID-19 triggers anxiety and fear due to several reasons, and thus, 
dealing with it requires prolonged coping mechanisms. When the number of 
infections soared, to slow the spread, many governments decided to close 
universities and dormitories and move teaching to online platforms. The majority 
of the university students decided to move back home to their parents changing 
their social lives. Here, we aimed to point to risk, as well as protective 
factors, and understand the influence of these factors on both physical and 
psychological indicators of well-being. Further, to discover how university 
students cope with maintaining their social lives during the COVID-19 pandemic.
METHOD: We collected online survey data from multiple university sources. 
Participants (N = 605) completed measures of emotion regulation strategies, 
knowledge on the disease, contamination fear, perceived social support, worrying 
and intolerance of uncertainty, quality of sleep, well-being, emotional 
stability, anxiety, and depression.
RESULTS: Our results showed that the most prominent risk and protective factors 
that were most strongly associated with the indicators of well-being were 
rumination, catastrophizing, positive refocusing, and social support from 
family; respectively.
CONCLUSION: These results have implications for professionals working with and 
helping (e.g., as counselors) people during the challenges of an emergency.

Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.actpsy.2022.103538
PMCID: PMC8858700
PMID: 35219042 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest. The authors report no conflict 
of interest.


2357. Health Promot Int. 2023 Jun 1;38(3):daac012. doi: 10.1093/heapro/daac012.

Change in health, wellbeing and physical activity levels during the COVID-19 
pandemic: a longitudinal cohort of parkrun participants in the United Kingdom.

Quirk H(1), Haake S(2), Goyder E(1), Bullas A(2), Graney M(3), Wellington C(3).

Author information:
(1)School of Health and Related Research, The University of Sheffield, 30 Regent 
Street, Sheffield S1 4DA, UK.
(2)The Advanced Wellbeing Research Centre, Sheffield Hallam University, Olympic 
Legacy Park, 2 Old Hall Road, Sheffield, S9 3TU, UK.
(3)Parkrun UK, Unit 3 Lower Deck, Phoenix Wharf, Twickenham, TW1 3DY, UK.

Lockdown restrictions imposed across the UK in response to the coronavirus 
disease 2019 (COVID-19) pandemic had a profound impact on many people's health 
and wellbeing. People were encouraged to be active, but population surveys 
suggest some groups found this easier than others. We explored the changes in 
health, wellbeing and physical activity levels among a sample in the UK who 
experienced the sudden loss of a weekly community-based physical activity 
opportunity, parkrun. A sample of UK parkrun participants responded to two 
surveys: pre-COVID-19 in January/February 2019 and during the COVID-19 pandemic 
in September 2020. Outcomes were happiness, life satisfaction, connections with 
others, physical health, mental health and physical activity. The sample was 
stratified by gender, age, deprivation status, physical activity and number of 
parkruns completed. Demographics were reported using descriptive statistics; 
distributions between sub-groups were compared using Chi-square tests while 
differences in outcomes were determined using the Mann-Whitney U test. Open text 
responses were also analysed. Happiness, life satisfaction, connections with 
others, physical health and mental health of 450 parkrun participants were 
negatively impacted for all sub-groups, although the impact was not experienced 
equally. Physical activity fell by 6% while happiness and life satisfaction fell 
by 12%. People experienced the worst negative impact on their connections with 
others. The COVID-19 pandemic negatively impacted the wellbeing of a greater 
proportion of females, younger adults, inactive people, those from higher 
deprivation areas, and those who had completed fewer parkruns. There is evidence 
that the wellbeing of those who were more active, and those more involved in a 
community-based physical activity initiative pre-pandemic, was less negatively 
affected during the COVID-19 lockdown.

© The Author(s) 2022. Published by Oxford University Press. All rights reserved. 
For permissions, please email: journals.permissions@oup.com.

DOI: 10.1093/heapro/daac012
PMCID: PMC8903462
PMID: 35218652 [Indexed for MEDLINE]


2358. BMC Health Serv Res. 2022 Feb 25;22(1):258. doi: 10.1186/s12913-022-07616-z.

Social prescribing during the COVID-19 pandemic: a qualitative study of service 
providers' and clients' experiences.

Morris SL(1), Gibson K(2), Wildman JM(2), Griffith B(2), Moffatt S(2), Pollard 
TM(3).

Author information:
(1)Department of Anthropology, Durham University, Dawson Building, South Road, 
Durham, DH1 3LE, UK. stephanie.l.morris@durham.ac.uk.
(2)Population Health Sciences Institute, Faculty of Medical Sciences, Ridley 1, 
Newcastle University, Newcastle Upon Tyne, NE1 7RU, UK.
(3)Department of Anthropology, Durham University, Dawson Building, South Road, 
Durham, DH1 3LE, UK.

BACKGROUND: COVID-19 public health restrictions, such as social distancing and 
self-isolation, have been particularly challenging for vulnerable people with 
health conditions and/or complex social needs. Link worker social prescribing is 
widespread in the UK and elsewhere and is regarded as having the potential to 
provide support to vulnerable people during the pandemic. This qualitative study 
explores accounts of how an existing social prescribing service adapted to meet 
clients' needs in the first wave of the pandemic, and of how clients experienced 
these changes.
METHODS: Data were collected in a deprived urban area of North East England via 
remote interviews with clients (n = 44), link workers (n = 5) and service 
provider managerial staff (n = 8) from May-September 2020. Thematic data 
analysis was conducted.
RESULTS: The research found that service providers quickly adapted to remote 
intervention delivery aiming to serve existing clients and other vulnerable 
groups. Service providers experienced improved access to some existing clients 
via telephone in the first months of remote delivery and in some cases were able 
to engage clients who had previously not attended appointments at GP surgeries. 
However, link workers also experienced challenges in building rapport with 
clients, engaging clients with the aims of the intervention and providing a 
service to digitally excluded people. Limited link worker capacity meant clients 
experienced variable contact with link workers with only some experiencing 
consistent support that was highly valued for helping to manage their conditions 
and mental wellbeing. Limited access to linked services also adversely affected 
clients. Clients living in less affluent circumstances and/or with worse health 
were more likely to experience negative impacts on their long-term condition. 
Some found their health and progress with social prescribing was 'on hold' or 
'going backwards', which sometimes negatively affected their health.
CONCLUSIONS: Social prescribing offered valued support to some during the 
pandemic, but remote support sometimes had limited impact for clients and 
findings highlight the vulnerability of social prescribing's success when linked 
services are disrupted. Findings also show the need for more to be done in the 
upscaling of social prescribing to provide support to digitally excluded 
populations.

© 2022. The Author(s).

DOI: 10.1186/s12913-022-07616-z
PMCID: PMC8873347
PMID: 35216608 [Indexed for MEDLINE]

Conflict of interest statement: None of the authors have any conflicts of 
interest to declare.


2359. J Holist Nurs. 2023 Mar;41(1):40-59. doi: 10.1177/08980101221079472. Epub 2022 
Feb 25.

Mindfulness-Based Stress Reduction for Nurses: An Integrative Review.

Wexler TM(1), Schellinger J(1).

Author information:
(1)Emory & Henry College, USA.

Introduction: The impact of occupational stress on the mental health and 
well-being of nurses is a growing concern, magnified by the COVID-19 pandemic. 
Such compromised health is considered an occupational and patient safety risk. 
Our aim is to critically examine, analyze, and synthesize the evidence regarding 
MBSR on the perceived stress levels of nurses including overall mental health 
and well-being. Methods: An integrative review was conducted. Databases included 
were PubMed, Embase, PsychINFO, CINAHL, and the Cochrane Library. Inclusion 
criteria were English only, MBSR, and practicing nurses. Results: We identified 
833 articles during database searching. After removal of duplicates and two 
rounds of screening, 15 articles were included in the final analysis. Several 
themes were derived with 60% of the studies showing a significant effect of MBSR 
on decreasing stress. Other significant themes were the decrease in burnout and 
increase in mindfulness. Conclusions: MBSR may be an effective holistic method 
of improving mental health for nurses during the COVID-19 pandemic. In both the 
abbreviated and full, 8-week versions of MBSR, the findings indicate the 
intervention can reduce depression, anxiety, and stress. Future recommendations 
include larger sample sizes and measurements other than self-reports to promote 
generalizability.

DOI: 10.1177/08980101221079472
PMID: 35213264 [Indexed for MEDLINE]


2360. JNMA J Nepal Med Assoc. 2022 Feb 15;60(246):132-136. doi: 10.31729/jnma.6553.

Anxiety among the General Population of Himalayan District during the COVID-19 
Pandemic: A Descriptive Cross-sectional Study.

Pandit S(1), Thapa N(2), Sharma A(2), Pokhrel B(2), Bham G(2), Acharya N(3).

Author information:
(1)Rapti Academy of Health Sciences, Ghorahi, Dang, Nepal.
(2)Karnali Academy of Health Sciences, Jumla, Nepal.
(3)Transcultural Psychosocial Organization, Baluwatar, Kathmandu, Nepal.

INTRODUCTION: COVID-19 pandemic and subsequent measures taken by the government 
to control the situation have imposed adverse impacts on the mental health and 
wellbeing of the general population. We conducted a study to determine the 
prevalence of anxiety among general population of a Himalayan district during 
the COVID-19 pandemic.
METHODS: A descriptive cross-sectional study was conducted in rural communities 
of the Himalayan district during the early stage of the pandemic using the 
Hospital Anxiety and Depression Scale. Data was collected for a period of one 
month from 13th April 2020 to 13th May 2020. Ethical approval was sought from 
the Institutional Review Committee of Karnali Academy of Health Sciences 
(Reference number: 2076/2077/07). All the participants of age 18 or above were 
included in the study excluding those with known mental illness. Convenience 
sampling method was used. A total of 427 participants were included in the 
study. Data were analyzed using the Statistical Package for the Social Sciences 
version 20. Point estimate at 95% confidence interval was calculated along with 
frequency and proportion for binary data.
RESULTS: The prevalence rate of anxiety was 196 (45.9%) (41.15-50.64 at 95% 
Confidence Interval). Anxiety was more prevalent among farmers, illiterate, 
widowed, and old aged.
CONCLUSIONS: The study indicates a higher prevalence of anxiety amidst the 
COVID-19 pandemic compared to reported studies and highlights the need for a 
strategic intervention to promote awareness and wellbeing at mental health 
level.

DOI: 10.31729/jnma.6553
PMCID: PMC9200010
PMID: 35210646 [Indexed for MEDLINE]

Conflict of interest statement: None.


2361. BMC Health Serv Res. 2022 Feb 24;22(1):253. doi: 10.1186/s12913-022-07645-8.

Understanding post-conflict mental health needs and co-producing a 
community-based mental health intervention for older adults in Colombia: a 
research protocol.

Giebel C(1)(2), Zuluaga MI(3), Saldarriaga G(3), White R(4), Reilly S(5)(6), 
Montoya E(3), Allen D(7), Liu G(7), Castaño-Pineda Y(3), Gabbay M(4)(7).

Author information:
(1)Department of Primary Care & Mental Health, University of Liverpool, 
Liverpool, UK. Clarissa.giebel@liverpool.ac.uk.
(2)NIHR ARC NWC, Liverpool, UK. Clarissa.giebel@liverpool.ac.uk.
(3)Public Health Faculty, Universidad de Antioquia, Medellín, Colombia.
(4)Department of Primary Care & Mental Health, University of Liverpool, 
Liverpool, UK.
(5)Centre for Applied Dementia Studies, Faculty of Health Studies, University of 
Bradford, Bradford, UK.
(6)NIHR Applied Research Collaboration Yorkshire & Humber, Leeds, UK.
(7)NIHR ARC NWC, Liverpool, UK.

BACKGROUND: Older adults in Colombia have seen a number of stressful life events 
- including the Colombian armed conflict, forced misplacement and recently 
COVID-19. These events likely have had and are having a substantial impact on 
people's mental health and well-being, whilst mental health care provision in 
Colombia is not sufficient and often access is limited and unaffordable. 
Therefore, the aim of this study is to understand the impact of stressful life 
events on the mental health of older adults living in Colombia, and co-produce, 
pilot, and evaluate a community-based mental health intervention in Turbo.
METHODS: This 3-year international mixed-methods study comprises of three 
phases: Phase I will explore the impact of stressful life events on the mental 
health of older adults living in Colombia, and their mental health needs, via 
quantitative needs assessments and qualitative interviews and focus groups; 
Phase II will involve synthesising the findings from Phase I as well as 
conducting a systematic review and qualitative interviews with experts into 
implementing mental health interventions in LMICs to co-produce a 
community-based mental health intervention with older adults and local community 
group leaders and care providers; Phase III will involve the piloting and 
evaluation of the mental health intervention via quantitative and qualitative 
assessments. Co-production and public involvement underpin each element of this 
project.
DISCUSSION: Appropriate mental health care is as important as physical health 
care, but this study also looks at how we might integrate these findings into 
community-level public health initiatives for application both within Colombia 
and more widely in both LMICs and more developed countries. This study protocol 
will act as a guide for the development and adaptation of psychosocial mental 
health interventions in different cultures and contexts.

© 2022. The Author(s).

DOI: 10.1186/s12913-022-07645-8
PMCID: PMC8867455
PMID: 35209878 [Indexed for MEDLINE]

Conflict of interest statement: This study has been externally funded, and 
therefore peer reviewed, by the ESRC and the Newton Fund. The first author (CG) 
is Guest Editor of the submitted special issue of the journal, entitled ‘Health 
services and systems in fragile and conflict-affected regions’. Dr Giebel had no 
role in the handling or review of this manuscript.


2362. Int J Environ Res Public Health. 2022 Feb 17;19(4):2269. doi: 
10.3390/ijerph19042269.

COVID-19 Pandemic Lockdown and Wellbeing: Experiences from Aotearoa New Zealand 
in 2020.

Officer TN(1), Imlach F(1), McKinlay E(2), Kennedy J(2), Pledger M(1), Russell 
L(1), Churchward M(1), Cumming J(1), McBride-Henry K(3).

Author information:
(1)Te Hikuwai Rangahau Hauora|Health Services Research Centre, Te Herenga 
Waka-Victoria University of Wellington, Wellington 6140, New Zealand.
(2)Department of Primary Health Care and General Practice, University of Otago 
(Wellington), Wellington 6021, New Zealand.
(3)School of Nursing, Midwifery and Health Practice, Te Herenga Waka-Victoria 
University of Wellington, Wellington 6140, New Zealand.

In 2020, in the first COVID-19 pandemic lockdown, Aotearoa New Zealand 
consistently maintained stringent public health measures including stay-at-home 
lockdowns and distancing responses. Considering the widespread disruption to 
social functioning caused by the pandemic, this paper aimed to explore 
environmental and social factors that influenced the wellbeing of individuals 
during the first lockdown in Aotearoa New Zealand. Our mixed-methods study 
involved a survey (n = 1010) and semi-structured interviews of a subset of 
surveyed individuals undertaken at the tail end of the first 2020 lockdown. 
Survey participants were recruited through social media-driven snowball 
sampling, less than 50% were aged under 45 years and 85% identified as female. 
Of those interviewed, 63% identified as female. Qualitative interview findings 
and open-ended survey results were analysed thematically. Participants described 
a variety of factors influencing wellbeing, largely related to the community and 
household; physical, behavioural, and lifestyle factors; access to health 
services; and social and economic foundations. While much of the focus of 
COVID-19 recovery was on reversing the economic and physical toll of the 
pandemic, our findings emphasise the need to empower individuals, families, and 
communities to mitigate the pandemic's negative implications on wellbeing.

DOI: 10.3390/ijerph19042269
PMCID: PMC8871666
PMID: 35206457 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript, or in the decision to 
publish the results.


2363. Int J Environ Res Public Health. 2022 Feb 16;19(4):2229. doi: 
10.3390/ijerph19042229.

Burnout Syndrome in a Military Tertiary Hospital Staff during the COVID-19 
Contingency.

Martínez-Cuazitl A(1)(2), Martínez-Salazar IN(1), Maza-De La Torre G(3), 
García-Dávila JA(4), Montelongo-Mercado EA(5), García-Ruíz A(6), 
Noyola-Villalobos HF(7), García-Araiza MG(8), Hernández-Díaz S(9), 
Villegas-Tapia DL(10), Cerda-Reyes E(11), Chávez-Velasco AS(1), García-Hernández 
JS(1).

Author information:
(1)Research Department, Military Central Hospital (Ministry of National Defense 
of Mexico-SEDENA), Mexico City 11200, Mexico.
(2)Military School of Medicine (Ministry of National Defense of Mexico-SEDENA), 
Mexico City 11200, Mexico.
(3)General Direction of Health (Ministry of National Defense of Mexico-SEDENA), 
Mexico City 11200, Mexico.
(4)General Direction, Military Central Hospital (Ministry of National Defense of 
Mexico-SEDENA), Mexico City 11200, Mexico.
(5)General Deputy Direction, Military Central Hospital (Ministry of National 
Defense of Mexico-SEDENA), Mexico City 11200, Mexico.
(6)Technic Deputy Direction, Military Central Hospital (Ministry of National 
Defense of Mexico-SEDENA), Mexico City 11200, Mexico.
(7)Medical Deputy Direction, Military Central Hospital (Ministry of National 
Defense of Mexico-SEDENA), Mexico City 11200, Mexico.
(8)Teaching and Research Area, Military Central Hospital l (Ministry of National 
Defense of Mexico-SEDENA), Mexico City 11200, Mexico.
(9)Medical Area, Military Central Hospital (Ministry of National Defense of 
Mexico-SEDENA), Mexico City 11200, Mexico.
(10)Psychology Subsection, Military Central Hospital (Ministry of National 
Defense of Mexico-SEDENA), Mexico City 11200, Mexico.
(11)Academic Coordination Department, Military Central Hospital (Ministry of 
National Defense of Mexico-SEDENA), Mexico City 11200, Mexico.

(1) Background: Burnout syndrome (BOS) is defined as a psychological state of 
physical and mental fatigue associated with work. The COVID-19 pandemic greatly 
impacted the physical and mental wellbeing of health professionals. The 
objective of this work was to determine the impact on personnel, monitoring the 
frequency of BOS throughout the pandemic. (2) Methods: The Maslach Burnout 
Inventory (MBI) was self-applied in four periods of the pandemic according to 
sociodemographic and employment characteristics. In this study, all hospital 
personnel were included; the association of BOS with sex, age, type of 
participant (civilian or military), military rank and profession was analyzed. 
(3) Results: The frequency of BOS was 2.4% (start of the pandemic), 7.9% (peak 
of the first wave), 3.7% (end of the first wave) and 3.6% (peak of the third 
wave). Emotional exhaustion (EE) was the most affected factor, and the groups 
most affected were men under 30 years of age, civilians, chiefs and doctors, 
especially undergraduate medical doctors and specialty resident doctors, and 
nursing personnel were less affected. (4) Conclusions: The low BOS levels show 
that the containment measures and military training implemented by the hospital 
authorities were effective, although the chief personnel were more affected in 
the first wave. It is probable that this combination allowed the containment of 
BOS, which was not observed in civilians.

DOI: 10.3390/ijerph19042229
PMCID: PMC8872413
PMID: 35206414 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2364. Int J Environ Res Public Health. 2022 Feb 16;19(4):2219. doi: 
10.3390/ijerph19042219.

Prevalence and Risk Factors Associated with Postpartum Depression during the 
COVID-19 Pandemic: A Literature Review and Meta-Analysis.

Chen Q(1), Li W(1), Xiong J(1), Zheng X(1).

Author information:
(1)Health Science Centre, Shenzhen University, Shenzhen 518060, China.

BACKGROUND: Owing to the high prevalence and detrimental consequences, 
postpartum depression (PPD) has been identified as one of the severe global 
public health issues in the last decade. Prior research found that during 
disasters or events, the prevalence rates of mental disorders among postpartum 
women are significantly high. However, the effect of the coronavirus disease 
2019 (COVID-19) pandemic on PPD and its risk factors remained unclear for 
postpartum women. Therefore, the present systematic review and meta-analysis 
aimed to estimate the influence of the COVID-19 pandemic on the prevalence of 
PPD and to summarize risk factors for PPD during the COVID-19 pandemic.
METHODS: Three electronic databases of MEDLINE, EMBASE, and Cochrane library 
databases were systematically searched for articles from their commencements 
until 1 November 2021. Quality assessment of included studies, random-effects 
meta-analysis, and sensitivity analysis were performed.
RESULTS: A total of eight studies with 6480 postpartum women during the COVID-19 
pandemic were included, and most studies were conducted in developed countries. 
The pooled prevalence of PPD was 34% (95% CI: 21-46%) during the COVID-19 
pandemic, much higher than the incident of previous research during the 
non-pandemic period. Risk factors for PPD during the COVID-19 pandemic were 
defined as socio-demographic and clinical characteristics, stress and anxiety, 
lack of various supports, and the COVID-19 related factors.
CONCLUSION: The research findings indicated that the COVID-19 pandemic could 
make detrimental effects on maternal mental wellbeing among women after 
childbirth. Investigating the prevalence and risk factors of PPD among 
postpartum women could shed some light on their mental and emotional states; so 
that support measures and tailored interventions from health professionals and 
policymakers could be offered to improve the maternal and infant outcomes, 
especially during the COVID-19 pandemic. Much more research on maternal 
psychological wellbeing during the COVID-19 pandemic was strongly recommended to 
undertake in the middle and low-income countries.

DOI: 10.3390/ijerph19042219
PMCID: PMC8872263
PMID: 35206407 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2365. Int J Environ Res Public Health. 2022 Feb 16;19(4):2215. doi: 
10.3390/ijerph19042215.

Association between Pet Ownership and Mental Health and Well-Being of Canadians 
Assessed in a Cross-Sectional Study during the COVID-19 Pandemic.

Denis-Robichaud J(1), Aenishaenslin C(2)(3)(4), Richard L(3)(5), Desmarchelier 
M(6), Carabin H(2)(3)(4)(7).

Author information:
(1)Independent Researcher, Amqui, QC G5J 2N5, Canada.
(2)Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire, 
Université de Montréal, Saint-Hyacinthe, QC J2S 2M2, Canada.
(3)Centre de Recherche en Santé Publique (CReSP), Montreal, QC H3N 1X9, Canada.
(4)Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique 
(GREZOSP), Saint-Hyacinthe, QC J2S 2M1, Canada.
(5)Faculté des Sciences Infirmières, Université de Montréal, Montreal, QC H3T 
1J4, Canada.
(6)Département de Sciences Cliniques, Faculté de Médecine Vétérinaire, 
Université de Montréal, Saint-Hyacinthe, QC J2S 2M2, Canada.
(7)Département de Médecine Sociale et Préventive, École de Santé Publique, 
Université de Montréal, Montreal, QC H3N 1X9, Canada.

The objective of this cross-sectional study was to assess the association 
between pet ownership and quality of life (QoL), loneliness, anxiety, stress, 
overall health, and mental health of Canadians during the COVID-19 pandemic 
using a One Health perspective. An online bilingual survey was completed by 1500 
Canadians in April-May 2021. Socio-demographics, health, QoL, stress and 
anxiety, loneliness, social support, pet ownership, and attitude towards pets 
data were collected. Crude and adjusted associations between pet ownership and 
mental health and well-being indicators were estimated. The 1500 participants 
were from all provinces and territories, half were women; half of the 
participants were pet owners by design. The crude association estimates showed 
that pet owners had poorer QoL, overall health, and mental health than non-pet 
owners, and were lonelier, more stressed, and more anxious than non-pet owners. 
Adjusted estimates showed that these associations disappeared with the inclusion 
of the confounders (socio-economic, demographic, health, and pet-related 
variables). Our results suggest that there was no association between pet 
ownership and the mental health and well-being indicators measured in the 
present study.

DOI: 10.3390/ijerph19042215
PMCID: PMC8924879
PMID: 35206405 [Indexed for MEDLINE]

Conflict of interest statement: The funders had no role in the design of the 
study; in the collection, analyses, or interpretation of data; in the writing of 
the manuscript, or in the decision to publish the results. The author J.D.R. was 
hired as an independent researcher for her contribution to the study and 
manuscript. She declares no conflict of interest.


2366. Int J Environ Res Public Health. 2022 Feb 13;19(4):2107. doi: 
10.3390/ijerph19042107.

Association between the Physical Activity Behavioral Profile and Sedentary Time 
with Subjective Well-Being and Mental Health in Chilean University Students 
during the COVID-19 Pandemic.

Reyes-Molina D(1), Alonso-Cabrera J(2), Nazar G(3), Parra-Rizo MA(4)(5), 
Zapata-Lamana R(6), Sanhueza-Campos C(6), Cigarroa I(7).

Author information:
(1)Facultad de Ciencias Sociales, Universidad de Concepción, Concepción 4030000, 
Chile.
(2)Departamento de Matemáticas y Estadística, Universidad del Norte, 
Barranquilla 081008, Colombia.
(3)Departamento de Psicología y Centro de Vida Saludable, Universidad de 
Concepción, Concepción 4030000, Chile.
(4)Departamento de Psicología de la Salud, Universidad Miguel Hernández, 03202 
Alicante, Spain.
(5)Facultad de Psicología, Universidad Internacional de Valencia, 46002 
Valencia, Spain.
(6)Escuela de Educación, Universidad de Concepción, Los Ángeles 4440000, Chile.
(7)Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Los 
Ángeles 4440000, Chile.

OBJECTIVE: To analyze the association between the behavioral profile of physical 
activity and sedentary time with subjective well-being and mental health in 
university students during the COVID-19 pandemic in Chile.
METHODS: Cross-sectional study in a voluntary sample of 469 university students 
(22.4 ± 0.19 years; 66% women). According to students' self-reports of physical 
activity and sedentary time, four behavioral profiles were created to 
investigate their association with subjective well-being and mental health using 
one-factor ANOVA that was adjusted to a multifactorial model.
RESULTS: The physically inactive and sedentary behavior profile presents the 
lowest levels of subjective well-being (p < 0.001), positive affective 
experiences (p < 0.001) and general mental health (p = 0.001). When adjusting 
for confounding variables, it was observed that the physically active and 
non-sedentary profile was associated with better general mental health (p < 
0.01) in contrast to those who are physically active and sedentary.
CONCLUSIONS: Chilean university students with a physically inactive and 
sedentary profile during the pandemic presented worse well-being and mental 
health, with a sedentary lifestyle being one of the variables that most affects 
the mental health of these students. Therefore, measures should be implemented 
to encourage this population to maintain adequate levels of physical activity 
and reduce sedentary times.

DOI: 10.3390/ijerph19042107
PMCID: PMC8872099
PMID: 35206294 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2367. Death Stud. 2023;47(2):172-182. doi: 10.1080/07481187.2022.2039812. Epub 2022 
Feb 24.

Slovak Adaptation of the Coronavirus Anxiety Scale.

Pekárová V(1), Rajčániová E(1), Tomšik R(1).

Author information:
(1)Research Institute for Child Psychology and Pathopsychology, Bratislava, 
Slovakia.

This study examined the psychometric properties of the Slovak version of the 
Coronavirus Anxiety Scale (CAS-SK) in a sample of adult Slovaks (N = 743). The 
data were collected online during the second wave of the COVID-19 pandemic in 
Slovakia. Along with the Coronavirus Anxiety Scale, the Perceived Stress Scale, 
and the Well-Being Index were administered to the respondents. The results of 
the Confirmatory Factor Analysis show a stable uni-dimensional structure of the 
CAS-SK, good reliability, and adequate convergent validity. The Item Response 
Theory findings suggest that all items have good discrimination parameters, all 
thresholds increased monotonically across the rating scale, and that the CAS-SK 
is more informative in individuals with a high level of coronavirus anxiety. 
These results suggest that the CAS-SK is a valid and reliable tool for measuring 
coronavirus anxiety.

DOI: 10.1080/07481187.2022.2039812
PMID: 35201952 [Indexed for MEDLINE]


2368. JCO Oncol Pract. 2022 Jun;18(6):e948-e957. doi: 10.1200/OP.21.00514. Epub 2022 
Feb 24.

Resilience in the Face of Pandemic: The Impact of COVID-19 on the Psychologic 
Morbidity and Health-Related Quality of Life Among Women With Ovarian Cancer.

Javellana M(1), Hlubocky FJ(1)(2), Somasegar S(1), Sorkin M(1), Kurnit KC(1), 
Jani I(1), Stock E(1), Mills K(1), Lengyel E(1), Lee NK(1).

Author information:
(1)The University of Chicago Medicine, Department of Gynecology/ Obstetrics, 
Section of Gynecologic Oncology, Chicago, IL.
(2)Department of Medicine, Section of Hematology/Oncology, MacLean Center for 
Clinical Medical Ethics, Cancer Research Center, Supportive Oncology Program, 
Chicago, IL.

PURPOSE: The COVID-19 pandemic has created new challenges for ovarian cancer 
survivors. This study aims to evaluate the psychologic morbidity and alterations 
in medical care caused by the pandemic.
METHODS: Advanced-stage ovarian cancer survivors at our institution were 
contacted for participation in a cross-sectional telephone-based quantitative 
survey study assessing pandemic-related psychologic morbidity. Psychologic 
domains using validated measures were explored: health-related quality of life 
(HRQOL; functional assessment of cancer therapy [FACT-G7]), anxiety (generalized 
anxiety disorder-7 [GAD7]), depression (Patient Health Questionnarie-2 [PHQ2]), 
global health Patient-Reported Outcomes Measurement Information System - Global 
Physical Health/Global Mental Health (PROMIS-GMH/GPH), resilience (brief 
resilience scale), and loneliness (English Longitudinal Study on Aging). Novel 
COVID-19 pandemic questions were drawn from a larger survey developed in our 
department.
RESULTS: Fifty-nine percent (61 of 104) of contacted patients completed the 
survey. One quarter of respondents had high resilience, with only 10% reporting 
low resilience. Only one patient screened positive for depression, and two for 
anxiety. Increased loneliness was reported by 43% of respondents. Patients' 
overall HRQOL was good (median = 21; range = 6-28). Few patients experienced 
treatment delays, with only four experiencing chemotherapy interruption and two 
reporting surgical delays. Multiple regression analyses revealed that high 
FACT-G7 HRQOL was predicted by age > 65 years, high self-reported mental health, 
high resilience, and being off chemotherapy. Lower COVID-19 concern was 
predicted by recurrent cancer and high resilience.
CONCLUSION: Despite the far-reaching impact of the COVID-19 pandemic, ovarian 
cancer survivors' HRQOL has been maintained. Older age, high resilience, high 
mental health, and being off chemotherapy predicted better HRQOL. Ovarian cancer 
survivors remain resilient in the face of the pandemic, and the support of 
clinicians to preserve this invaluable personal resource is critical for 
well-being.

DOI: 10.1200/OP.21.00514
PMID: 35201895 [Indexed for MEDLINE]

Conflict of interest statement: Fay J. HlubockyThis author is an Associate 
Editor for JCO Oncology Practice. Journal policy recused the author from having 
any role in the peer review of this manuscript. Katherine C. KurnitConsulting or 
Advisory Role: Leap TherapeuticsTravel, Accommodations, Expenses: Clovis 
Oncology Kathryn MillsConsulting or Advisory Role: Stryker Ernst LengyelStock 
and Other Ownership Interests: ExelixisResearch Funding: AbbVie, ArsenalBioNo 
other potential conflicts of interest were reported.


2369. Psychol Serv. 2023;20(Suppl 2):11-19. doi: 10.1037/ser0000625. Epub 2022 Feb 24.

Provider perspectives on telemental health implementation: Lessons learned 
during the COVID-19 pandemic and paths forward.

Lipschitz JM(1), Connolly SL(2), Van Boxtel R(1), Potter JR(1), Nixon N(3), 
Bidargaddi N(4).

Author information:
(1)Department of Psychiatry, Brigham and Women's Hospital.
(2)Department of Psychiatry, Harvard Medical School.
(3)Division of Psychiatry and Applied Psychology, School of Medicine, University 
of Nottingham.
(4)Flinders Health & Medical Research Institute, Flinders University.

After years of slow and fragmented implementation of telemental health (TMH), 
the coronavirus disease (COVID-19) pandemic necessitated widespread adoption. 
With the initial state of public health emergency behind us, we are at a 
decision point on whether to continue with TMH or return to a largely in-person 
care model. In this qualitative study, we investigated clinicians' perspectives 
on advantages and disadvantages of TMH in outpatient mental healthcare as well 
as considerations for future implementation. We conducted 29 semistructured 
interviews with outpatient mental health providers. Data were analyzed using 
rapid qualitative analysis methodology. Advantages included increased 
utilization of services, improved therapeutic processes, and improved provider 
wellbeing. Providers, however, also noted that TMH has some disadvantages in 
terms of therapeutic processes and provider wellbeing, and they reported 
technology issues as an additional disadvantage. Overall providers reported they 
can provide high quality care via TMH, but indicated some patient populations 
and appointment types are a better fit for in-person services. Most providers 
preferred a hybrid model of care moving forward with reimbursement discrepancies 
and out-of-state licensure restrictions as barriers. They indicated that, as TMH 
becomes a mainstay in psychiatric care, training and professional guidelines 
will be important. Continued implementation of TMH alongside in-person care is 
likely to offer improved access and enhanced service quality when applied to the 
right patient populations and appointment types. Effective implementation may 
require policy and systems level support on equitable reimbursement rates, 
out-of-state licensure restrictions and professional guidelines for delivering 
TMH. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

DOI: 10.1037/ser0000625
PMCID: PMC9399300
PMID: 35201809 [Indexed for MEDLINE]


2370. Health Promot Pract. 2022 Nov;23(6):907-911. doi: 10.1177/15248399211072535. 
Epub 2022 Feb 24.

You've Got a Friend in Me: Fostering Social Connection Among College Students 
Through Peer-Led Physical Activity.

Kirby JB(1), Babkes Stellino M(2), Lewis C(1), Humphrey K(1), Gordon K(1), 
Lindsay KG(1).

Author information:
(1)University of Colorado Colorado Springs, Colorado Springs, CO, USA.
(2)University of Northern Colorado, Greeley, CO, USA.

Social connection and physical activity (PA) are essential health behaviors 
necessary for young adults to thrive. The majority of college students in the 
United States are not meeting PA recommendations and simultaneously report 
concerning rates of loneliness, depression, anxiety, and fatigue; all factors 
that contribute to poor psychological well-being and reduce students' abilities 
to sustain academic success. These mental and physical health indicators have 
only worsened due to the stress, isolation, and uncertainty experienced during 
the COVID-19 pandemic. Fitness Buddies (FB) is a free peer-led PA program 
designed to combat loneliness, stress, anxiety, depression, and low PA, by 
providing students the opportunity to connect with one another through PA. FB 
participants are matched with a peer leader for weekly PA sessions based on 
activity interests and schedules. The FB program model shifts the focus of 
traditional PA programs, from prescribing and monitoring PA duration, intensity 
and modalities, to supporting psychological well-being through satisfaction of 
the three basic psychological needs of competence, autonomy, and relatedness 
within peer PA-based relationships. In the first pilot phase of implementation, 
students reported improved situational affect, to include reduced stress and 
anxiety, following participation in the FB program for one academic semester. 
Participants also reported the development of quality peer relationships and a 
sense of belonging to the campus community, both of which had previously been 
lacking. The FB program model is an innovative and cost-efficient strategy to 
supporting college students' psychological well-being and long-term success.

DOI: 10.1177/15248399211072535
PMID: 35199587 [Indexed for MEDLINE]


2371. BMC Oral Health. 2022 Feb 23;22(1):46. doi: 10.1186/s12903-022-02081-w.

Impact of COVID-19 on Malaysian dental students' physical, mental, financial and 
academic concerns.

Lestari W(1), Yazid NH(2), Azhar ZN(2), Ismail A(1), Sukotjo C(3).

Author information:
(1)Fundamental Dental and Medical Sciences Department, Kulliyyah of Dentistry, 
International Islamic University Malaysia, Kuantan, Malaysia.
(2)Kulliyyah of Dentistry, International Islamic University Malaysia, Kuantan, 
Malaysia.
(3)Department of Restorative Dentistry, University of Illinois at Chicago, 
Chicago, USA. csukotjo@uic.edu.

BACKGROUND: The coronavirus disease 2019 (COVID-19) caused by a novel 
coronavirus (SARS-CoV-2) has gained worldwide attention and proved to hold an 
impact to humankind in all aspects of life. Dental students' performances may 
indirectly be affected following the preventive measures in containing the 
disease. This study aims to evaluate the impact of COVID-19 pandemic on 
physical, mental, financial health and academic concern among dental students in 
Malaysia.
METHODS: The current research implemented a cross sectional study among dental 
students in Malaysia. Assessment of the impact of COVID-19 on dental education 
was done by the distribution of a set of online survey consisting of 28 
questions to dental students (n = 353) from public and private universities in 
Malaysia. The questionnaires include sociodemographic backgrounds and assessment 
on the mental health, financial health, physical health and academic concern. 
Kruskal Wallis test and Mann-Whitney U test were used to analyse the impact of 
COVID-19 to these 4 domains according to sociodemographic background.
RESULTS: A total number of 353 respondents was recorded and 76.2% comprised of 
female. 59.7% were clinical students and 40.3% were preclinical students. Most 
of students were concerned about their own emotional health, financial concern, 
physical wellbeing, in which Year 3 students were found to be more concerned 
about their mental and financial health concern.
CONCLUSIONS: COVID-19 pandemic had indeed significantly affected Malaysian 
dental students mainly due to fear of the quality of online learning and the 
amount of clinical skills acquired. Therefore, it is important to identify 
dental stressors and lessen the impact of COVID-19 to dental students.

© 2022. The Author(s).

DOI: 10.1186/s12903-022-02081-w
PMCID: PMC8865728
PMID: 35197029 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2372. PLoS One. 2022 Feb 23;17(2):e0264280. doi: 10.1371/journal.pone.0264280. 
eCollection 2022.

The where and when of COVID-19: Using ecological and Twitter-based assessments 
to examine impacts in a temporal and community context.

Pasquini G(1), Ferguson G(1), Bouklas I(1), Vu H(2), Zamani M(2), Zhaoyang R(3), 
Harrington KD(3), Roque NA(4), Mogle J(5), Schwartz HA(2), Scott SB(1).

Author information:
(1)Department of Psychology, Stony Brook University, Stony Brook, New York, 
United States of America.
(2)Department of Computer Science, Stony Brook University, Stony Brook, New 
York, United States of America.
(3)Center for Healthy Aging, Pennsylvania State University, University Park, 
Pennsylvania, United States of America.
(4)Department of Psychology, University of Central Florida, Orlando, Florida, 
United States of America.
(5)Edna Bennett Pierce Prevention Research Center, College of Health and Human 
Development, Pennsylvania State University, University Park, Pennsylvania, 
United States of America.

In March 2020, residents of the Bronx, New York experienced one of the first 
significant community COVID-19 outbreaks in the United States. Focusing on 
intensive longitudinal data from 78 Bronx-based older adults, we used a 
multi-method approach to (1) examine 2019 to early pandemic (February-June 2020) 
changes in momentary psychological well-being of Einstein Aging Study (EAS) 
participants and (2) to contextualize these changes with community distress 
scores collected from public Twitter posts posted in Bronx County. We found 
increases in mean loneliness from 2019 to 2020; and participants that were 
higher in neuroticism had greater increases in thought unpleasantness and 
feeling depressed. Twitter-based Bronx community scores of anxiety, 
depressivity, and negatively-valenced affect showed elevated levels in 2020 
weeks relative to 2019. Integration of EAS participant data and community data 
showed week-to-week fluctuations across 2019 and 2020. Results highlight how 
community-level data can characterize a rapidly changing environment to 
supplement individual-level data at no additional burden to individual 
participants.

DOI: 10.1371/journal.pone.0264280
PMCID: PMC8865674
PMID: 35196353 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2373. J Reprod Infant Psychol. 2023 Nov;41(5):488-502. doi: 
10.1080/02646838.2022.2042799. Epub 2022 Feb 23.

The role of perceived social support on pregnant women's mental health during 
the COVID-19 pandemic.

Corno G(1), Villani D(2), de Montigny F(3), Pierce T(4), Bouchard S(1), Molgora 
S(2).

Author information:
(1)Department of Psychoeducation and Psychology, Université du Québec en 
Outaouais, Gatineau, QC, Canada.
(2)Department of Psychology, Catholic University of the Sacred Heart, Milan, 
Italy.
(3)Department of Nursey Sciences, Université du Québec en Outaouais, Gatineau, 
QC, Canada.
(4)School of Psychology, Université Laval, Laval, QC, Canada.

PURPOSE: The present study aimed at investigating which sources of social 
support best account for pregnant women's levels of psychological distress and 
mental well-being during the COVID-19 pandemic.
METHODS: 274 Italian and Canadian expectant mothers completed an online-based 
survey including measures of perceived social support (from family, significant 
other and friends), state anxiety, depressive symptoms, and satisfaction with 
life. Correlation analyses and amultivariate analysis of covariance were 
performed to explore how social support from different sources was related to 
depressive symptoms, state anxiety and satisfaction with life.
RESULTS: Different sources of social support contributed to explaining women's 
psychological distress and mental well-being. Social support both from family 
and friends was significantly related to women's state anxiety and depressive 
symptoms. Social support from friends was specifically related to women's 
satisfaction with life.
CONCLUSION: Our findings endorse the crucial role of perceived social support as 
a protective factor for pregnant women's mental health. In the context of the 
COVID-19 pandemic, our results suggest that support from family seems important 
in preventing psychological distress, whereas support from friends is also 
associated with mental well-being. These results may help designing future 
interventions aimed at improving women's perinatal mental health in 
life-threatening conditions.

DOI: 10.1080/02646838.2022.2042799
PMID: 35196188 [Indexed for MEDLINE]


2374. Clin Obes. 2022 Jun;12(3):e12512. doi: 10.1111/cob.12512. Epub 2022 Feb 22.

A qualitative exploration of weight management during COVID-19.

Thomson M(1), Martin A(1), Long E(1), Logue J(2), Simpson SA(1).

Author information:
(1)MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 
Glasgow, UK.
(2)Lancaster Medical School, University of Lancaster, Lancaster, UK.

COVID-19 has been associated with worse outcomes in people living with obesity 
and has altered how people can engage with weight management. However, the 
impact of risk perceptions and changes to daily life on weight loss has not been 
explored. This study aimed to examine how COVID-19 and perception of risk 
interacted with weight loss attempts in adults participating in a behavioural 
weight management programme. Forty-eight participants completed a 
semi-structured interview exploring the impact of COVID-19 on their weight 
management experience. Interviews were completed via telephone and analysed 
using a thematic approach. Reaction to perceived risk varied, but most 
participants reported the knowledge of increased risk promoted anxiety and 
avoidance behaviours. Despite this, many reported it as a motivating factor for 
weight loss. Restrictions both helped (e.g., reduced temptation) and hindered 
their weight loss (e.g., less support). However, there was consensus that the 
changes to everyday life meant participants had more time to engage with and 
take control of their weight loss. To the authors' knowledge, this is the first 
study to explore the impact of COVID-19 on participation in a weight management 
programme started during the pandemic in the United Kingdom. Restrictions had 
varying impacts on participant's weight loss. How risk is perceived and reported 
to participants is an important factor influencing engagement with weight 
management. The framing of health information needs to be considered carefully 
to encourage engagement with weight management to mitigate risk. Additionally, 
the impact of restrictions and personal well-being are key considerations for 
weight management programmes.

© 2022 The Authors. Clinical Obesity published by John Wiley & Sons Ltd on 
behalf of World Obesity Federation.

DOI: 10.1111/cob.12512
PMCID: PMC9286397
PMID: 35194943 [Indexed for MEDLINE]

Conflict of interest statement: JL received personal fees from Novo Nordisk. No 
other competing interests.


2375. Psychooncology. 2022 Jul;31(7):1178-1185. doi: 10.1002/pon.5907. Epub 2022 Mar 
3.

Coronaphobia: A barrier to ongoing cancer treatment?

Sönmez Ö(1)(2), Tezcanli E(2), Taşçı EŞ(1), Kazancı HB(2), Altınok A(2), Toklucu 
E(3), Taşçı Y(4), Aydoğdu Ç(5), Aydın AB(3), Yüce S(5), Oyan B(1).

Author information:
(1)Department of Medical Oncology, School of Medicine, Acibadem University, 
Istanbul, Turkey.
(2)Department of General Senology, School of Medicine, Acibadem University, 
Research Institute of Senology, Istanbul, Turkey.
(3)Acibadem Maslak Hospital, Istanbul, Turkey.
(4)Department of Public Health, Istanbul University, Institute of Health 
Sciences, Istanbul, Turkey.
(5)Acibadem Altunizade Hospital, Istanbul, Turkey.

INTRODUCTION: Increased stress levels caused by the pandemic might cause delays 
in cancer treatment. We conducted a survey among cancer patients undergoing 
treatment to evaluate their psychological wellbeing and treatment adherence 
during Coronavirus disease 19 (COVID-19) pandemic.
MATERIAL AND METHODS: Patients receiving active chemotherapy at a private 
oncology center between January and May 2021 were included. Healthy volunteers 
were employees of a district health directorate with no history of cancer or 
chronic disease. Treatment adherence was described as compliant if the 
prescribed treatment was received within a week and the information was gained 
from patient charts. Hospital anxiety and depression scale (HADS) and COVID-19 
phobia scale (CP19-S) were administered to participants.
RESULTS: 402 participants were included; 193 (48%) were cancer patients. The 
mean age of the participants was 44 years old and 68% of the participants were 
female. All participants' CP19-S mean score was 47.9. Patient group had 
significantly lower CP19-S (p = 0.006). Chronic disease and history of a 
shocking event were the factors associated with CP19-S. All participants 
reporting hospital anxiety were found to have significantly higher COVID-19 
phobia levels (p < 0.05). Patients' mean HADS-anxiety score was significantly 
higher (7.3 vs. 6.5, p = 0.027). COVID-19 phobia was an independent factor 
increasing the level of anxiety and depression in both groups. Adherence to 
treatment was 100%.
CONCLUSION: The pandemic increased levels of anxiety, however, cancer treatment 
continued to be a priority in patients' lives. Strategies should be developed to 
support oncology patients cope with the pandemic and increase their courage to 
avoid treatment delays.

© 2022 John Wiley & Sons Ltd.

DOI: 10.1002/pon.5907
PMCID: PMC9088561
PMID: 35194885 [Indexed for MEDLINE]

Conflict of interest statement: N/A.


2376. J Child Psychol Psychiatry. 2022 Nov;63(11):1332-1343. doi: 10.1111/jcpp.13579. 
Epub 2022 Feb 22.

Longitudinal trajectories of mental health and loneliness for Australian 
adolescents with-or-without neurodevelopmental disorders: the impact of COVID-19 
school lockdowns.

Houghton S(1), Kyron M(1)(2)(3), Lawrence D(1), Hunter SC(1)(4), Hattie J(5), 
Carroll A(6), Zadow C(1), Chen W(1)(7)(8)(9).

Author information:
(1)Graduate School of Education, The University of Western Australia, Perth, WA, 
Australia.
(2)School of Psychological Sciences, The University of Western Australia, Perth, 
WA, Australia.
(3)Centre for Social Impact, The University of Western Australia, Perth, WA, 
Australia.
(4)Department of Psychology, Glasgow Caledonian University, Glasgow, UK.
(5)Graduate School of Education, The University of Melbourne, Melbourne, Vic., 
Australia.
(6)School of Education, Faculty of Humanities and Social Sciences, The 
University of Queensland, Brisbane, Qld, Australia.
(7)Mental Health Service, Fiona Stanley Hospital, Perth, WA, Australia.
(8)Curtin Medical School, Curtin University, Perth, WA, Australia.
(9)School of Medicine, University of Notre Dame Australia, Fremantle, WA, 
Australia.

Comment in
    J Child Psychol Psychiatry. 2022 Nov;63(11):1344-1346.

BACKGROUND: The impact of COVID-19 (SARS-CoV-2) pandemic school lockdowns on the 
mental health problems and feelings of loneliness of adolescents with 
neurodevelopmental disorders (NDDs) is hypothesized to be greater than that of 
their non-NDD peers. This two and a half year longitudinal study compared 
changes in the mental health and loneliness of Western Australian adolescents 
pre-COVID-19 (November 2018 and April 2019), immediately prior to COVID-19 
school lockdowns (March 2020), and post schools reopening (July/August 2020).
METHODS: An age-and-gender matched sample of 476 adolescents with-or-without 
NDDs completed online assessments for mental health and loneliness.
RESULTS: Adolescents with NDDs reported elevated levels of adverse mental health 
across all four waves of data collection. These young people experienced little 
change in mental health problems and feelings of loneliness over time, and any 
increase during school lockdowns returned to, or fell below pre-COVID-19 levels 
once schools reopened. In comparison, adolescents without NDDs experienced 
significant increases from a low baseline in depression symptoms, externalizing 
symptoms, feelings of isolation, and having a positive attitude to being alone, 
and evidenced a significant decline in positive mental wellbeing. Quality of 
friendships were unaffected by COVID-19 school lockdowns for all adolescents 
regardless of NDD status. Of the adolescents with NDDs, those with 
Attention-Deficit/Hyperactivity Disorder reported a significant increase in 
positive mental wellbeing following school lockdowns.
CONCLUSIONS: Adolescents with NDDs emerged relatively unscathed from COVID-19 
school lockdowns and the short term impacts associated with these were not 
maintained over time. These findings should be considered in the context of this 
study's geographical location and the unpredictability of school lockdowns. 
Learning to live with school lockdowns into the future may be a critical element 
for further investigation in the context of interventions.

© 2022 The Authors. Journal of Child Psychology and Psychiatry published by John 
Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental 
Health.

DOI: 10.1111/jcpp.13579
PMCID: PMC9790479
PMID: 35194802 [Indexed for MEDLINE]


2377. Global Health. 2022 Feb 22;18(1):24. doi: 10.1186/s12992-022-00818-4.

Implementation of initiatives designed to improve healthcare worker health and 
wellbeing during the COVID-19 pandemic: comparative case studies from 13 
healthcare provider organisations globally.

O'Brien N(1), Flott K(2), Bray O(2), Shaw A(2), Durkin M(2).

Author information:
(1)Institute of Global Health Innovation, Imperial College London, London, 
United Kingdom. n.obrien@imperial.ac.uk.
(2)Institute of Global Health Innovation, Imperial College London, London, 
United Kingdom.

BACKGROUND: Healthcare workers are at a disproportionate risk of contracting 
COVID-19. The physical and mental repercussions of such risk have an impact on 
the wellbeing of healthcare workers around the world. Healthcare workers are the 
foundation of all well-functioning health systems capable of responding to the 
ongoing pandemic; initiatives to address and reduce such risk are critical. 
Since the onset of the pandemic healthcare organizations have embarked on the 
implementation of a range of initiatives designed to improve healthcare worker 
health and wellbeing.
METHODS: Through a qualitative collective case study approach where participants 
responded to a longform survey, the facilitators, and barriers to implementing 
such initiatives were explored, offering global insights into the challenges 
faced at the organizational level. 13 healthcare organizations were surveyed 
across 13 countries. Of these 13 participants, 5 subsequently provided missing 
information through longform interviews or written clarifications.
RESULTS: 13 case studies were received from healthcare provider organizations. 
Mental health initiatives were the most commonly described health and wellbeing 
initiatives among respondents. Physical health and health and safety focused 
initiatives, such as the adaption of workspaces, were also described. Strong 
institutional level direction, including engaged leadership, and the input, 
feedback, and engagement of frontline staff were the two main facilitators in 
implementing initiatives. The most common barrier was HCWs' fear of contracting 
COVID-19 / fear of passing COVID-19 to family members. In organizations who 
discussed infection prevention and control initiatives, inadequate personal 
protective equipment and supply chain disruption were highlighted by 
respondents.
CONCLUSIONS: Common themes emerge globally in exploring the enablers and 
barriers to implementing initiatives to improve healthcare workers health and 
wellbeing through the COVID-19 pandemic. Consideration of the themes outlined in 
the paper by healthcare organizations could help influence the design and 
deployment of future initiatives ahead of implementation.

© 2022. The Author(s).

DOI: 10.1186/s12992-022-00818-4
PMCID: PMC8862403
PMID: 35193629 [Indexed for MEDLINE]

Conflict of interest statement: We have no competing interests to declare.


2378. Scand J Public Health. 2022 Aug;50(6):765-771. doi: 10.1177/14034948221075433. 
Epub 2022 Feb 22.

Subjective mental well-being among higher education students in Finland during 
the first wave of COVID-19.

Sarasjärvi KK(1)(2), Vuolanto PH(3), Solin PCM(2), Appelqvist-Schmidlechner 
KL(2), Tamminen NM(2), Elovainio M(4), Therman S(2).

Author information:
(1)Faculty of Medicine, Doctoral Programme in Population Health, University of 
Helsinki, Helsinki, Finland.
(2)Finnish Institute for Health and Welfare, Mental Health Team, Helsinki, 
Finland.
(3)Faculty of Social Sciences, Research Centre for Knowledge, Science, 
Technology and Innovation Studies (TaSTI), University of Tampere, Tampere, 
Finland.
(4)Faculty of Medicine, Department of Psychology and Logopedics, University of 
Helsinki, Helsinki, Finland.

AIMS: Increased mental health problems during the COVID-19 pandemic have become 
a major concern among young adults. Our aim was to understand which 
COVID-19-related questions predicted mental well-being during the outbreak.
METHODS: Two cross-sectional datasets were used. The primary dataset was 
collected in May 2020 (n = 1001), during the initial COVID-19 outbreak, and the 
secondary in April 2019 (n = 10866), before the pandemic. Mental well-being was 
assessed with the Short Warwick-Edinburgh Mental Well-Being Scale. Relationships 
between mental well-being and COVID-19-related questions were investigated with 
lasso regression. As an exploratory analysis, two-way ANOVAs were used to 
compare mental well-being before and during the outbreak.
RESULTS: Higher levels of mental well-being were associated with lower levels of 
academic stress and COVID-19-related worry, along with a higher satisfaction 
with the procedures and information provided by the higher education 
institutions and the government. COVID-19-related symptoms and infections did 
not have an impact on students' mental well-being during the outbreak. Small to 
moderate effect sizes across the time points were detected, indicating an 
overall decrease in mental well-being across age and gender during the outbreak.
CONCLUSIONS: COVID-19 had an impact on higher education students' mental 
well-being. Higher education institutes may play a crucial role in protecting 
their students' well-being during uncertain times.

DOI: 10.1177/14034948221075433
PMCID: PMC9361411
PMID: 35191341 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
authors declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


2379. BMJ Open. 2022 Feb 21;12(2):e049627. doi: 10.1136/bmjopen-2021-049627.

Psychological distress of frontline healthcare workers in the intensive care 
unit during the early stage of the COVID-19 pandemic: a qualitative study from 
China.

Yin Z(1), Zhang W(1), Jia X(1), Wang X(1), Hao J(1), Yang Y(1), Zhang X(1), Du 
S(1), Yue X(2).

Author information:
(1)Department of Pharmacy, The First Affiliated Hospital of Zhengzhou 
University, Zhengzhou, Henan, China.
(2)Blood Purification Center, The First Affiliated Hospital of Zhengzhou 
University, Zhengzhou, Henan, China Yuexiaohong2009@126.com.

OBJECTIVE: The rapid spread of COVID-19 has overwhelmed healthcare systems 
across the world. During the early stage of the pandemic, frontline healthcare 
workers (FHWs) caring for patients at intensive care units (ICUs) faced extreme 
pressure and challenges. This qualitative study aimed to describe the different 
phases of psychological distress of FHWs during the early stage of the COVID-19 
pandemic.
DESIGN: Qualitative study.
SETTING: The First Affiliated Hospital of Zhengzhou University, a designated 
hospital for patients with COVID-19 in central China.
PARTICIPANTS: Eight physicians and six nurses working in the ICU who provided 
direct patient care for COVID-19 patients.
METHODS: A descriptive phenomenological study using thematic analysis was 
applied. Semi-structured one-on-one interviews over telephone or Wechat (a 
social platform in China) rather than face-to-face interviews were conducted due 
to quarantine. Interviews were audio-recorded and transcribed verbatim and then 
were analysed thematically.
FINDINGS: A total of 14 interviews were conducted, and each interview lasted 
20-60 min. Five thematic categories were identified, and the participants' 
psychological experiences were classified into five stages (1) the mobilisation 
period: a sense of responsibility with worries; (2) the preparation period: 
worries, fears and doubts about the epidemic; (3) the transitional period: 
complex and diverse psychological feelings; (4) the adaptation period: 
self-adjustment and help from external support and (5) the reflection period: a 
reflection on life and nature.
CONCLUSION: The study showed that the COVID-19 pandemic had significant 
psychological impacts on FHWs. Self-regulation and external support help FHWs to 
overcome challenges to a certain extent. More attention should be paid to the 
psychological wellbeing of ICU FHWs in COVID-19-designated hospitals.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-049627
PMCID: PMC8861884
PMID: 35190413 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2380. J Arthroplasty. 2022 Jul;37(7S):S449-S456. doi: 10.1016/j.arth.2021.11.020. Epub 
2022 Feb 18.

The Psychological Impact of COVID-19 on Arthroplasty Surgeons.

Suraci A(1), Wood G(1), Tanzer M(2); Canadian Arthroplasty Society 
Investigators.

Collaborators: Keegan A, Burnett S, Leighton J, Zukor D, Wadey V, Johnston K, 
Desy N, Kim P, Howard J, Lanting B, Rosen L, MacDonald S, Schemitsch E, Antoniou 
J.

Author information:
(1)Queen's University, Kingston, Ontario, Canada.
(2)McGill University Hospital Centre, Montreal, Quebec, Canada.

BACKGROUND: After the COVID-19 pandemic declaration in March 2020, all the 
elective total joint replacement surgeries in Canada were abruptly canceled for 
an indefinite period of time. The principal objective of this study was to 
determine the prevalence of psychological morbidity experienced by arthroplasty 
surgeons during the peak of the first wave of the COVID-19 pandemic. Secondary 
objectives included characterizing influential variables affecting the surgeon's 
well-being and suggesting directives for improvement.
METHODS: This study surveyed Canadian Arthroplasty Society (CAS) members 
regarding their psychological well-being using the validated General Health 
Questionnaire (GHQ-12), the Center for Epidemiological Studies Depression 
(CES-D) scale, and the Personal Wellbeing Index-Adult (PWI-A). As well, the 
survey included questions regarding concerns about COVID-19, precautionary 
measures, personal well-being, and sociodemographic characteristics.
RESULTS: A total of 80 surgeons (52% of those surveyed) completed the 
questionnaire, representing all 10 provinces in Canada. The prevalence of 
emotional distress and depression were 38% and 29%, respectively. Psychological 
morbidity most commonly resulted from concerns of loss of income/operating time, 
experiences of emotional conflict, and generalized safety worries. The surgeons 
commonly (93%) demonstrated insight in recognizing the impact of COVID-19 on 
their emotional health.
CONCLUSION: Canadian arthroplasty surgeons demonstrated emotional resilience and 
insight during COVID-19. Continual communication, as well as remuneration action 
plans, could improve the mental well-being of at-risk individuals.

Crown Copyright © 2022. Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.arth.2021.11.020
PMCID: PMC8855243
PMID: 35190242 [Indexed for MEDLINE]


2381. Psychol Med. 2023 Jul;53(9):3887-3896. doi: 10.1017/S0033291722000551. Epub 2022 
Feb 22.

Associations of online religious participation during COVID-19 lockdown with 
subsequent health and well-being among UK adults.

Shiba K(1)(2), Cowden RG(2), Gonzalez N(3), Ransome Y(4), Nakagomi A(5), Chen 
Y(2), Lee MT(2), VanderWeele TJ(1)(2)(6), Fancourt D(7).

Author information:
(1)Department of Epidemiology, Harvard T.H. Chan School of Public Health, 
Boston, MA, USA.
(2)Human Flourishing Program, Institute for Quantitative Social Science, Harvard 
University, Cambridge, MA, USA.
(3)Independent Researcher, Madrid, Spain.
(4)Department of Social and Behavioral Sciences, Yale University School of 
Public Health, New Haven, CT, USA.
(5)Department of Social Preventive Medical Sciences, Center for Preventive 
Medical Sciences, Chiba University, Chiba, Japan.
(6)Department of Biostatistics, Harvard T.H. Chan School of Public Health, 
Boston, MA, USA.
(7)Department of Behavioural Science and Health, University College London, 
London, UK.

BACKGROUND: In-person religious service attendance has been linked to favorable 
health and well-being outcomes. However, little research has examined whether 
online religious participation improves these outcomes, especially when 
in-person attendance is suspended.
METHODS: Using longitudinal data of 8951 UK adults, this study prospectively 
examined the association between frequency of online religious participation 
during the stringent lockdown in the UK (23 March -13 May 2020) and 21 
indicators of psychological well-being, social well-being, pro-social/altruistic 
behaviors, psychological distress, and health behaviors. All analyses adjusted 
for baseline socio-demographic characteristics, pre-pandemic in-person religious 
service attendance, and prior values of the outcome variables whenever data were 
available. Bonferroni correction was used to correct for multiple testing.
RESULTS: Individuals with online religious participation of ≥1/week (v. those 
with no participation at all) during the lockdown had a lower prevalence of 
thoughts of self-harm in week 20 (odds ratio 0.24; 95% CI 0.09-0.62). Online 
religious participation of <1/week (v. no participation) was associated with 
higher life satisfaction (standardized β = 0.25; 0.11-0.39) and happiness 
(standardized β = 0.25; 0.08-0.42). However, there was little evidence for the 
associations between online religious participation and all other outcomes (e.g. 
depressive symptoms and anxiety).
CONCLUSIONS: There was evidence that online religious participation during the 
lockdown was associated with some subsequent health and well-being outcomes. 
Future studies should examine mechanisms underlying the inconsistent results for 
online v. in-person religious service attendance and also use data from 
non-pandemic situations.

DOI: 10.1017/S0033291722000551
PMCID: PMC10317791
PMID: 35189993 [Indexed for MEDLINE]

Conflict of interest statement: None.


2382. Intern Med J. 2022 May;52(5):745-754. doi: 10.1111/imj.15720. Epub 2022 Apr 6.

The workplace and psychosocial experiences of Australian junior doctors during 
the COVID-19 pandemic.

Hunter R(1), Willis K(2)(3), Smallwood N(4)(5).

Author information:
(1)Department of Medicine, St Vincent's Hospital Melbourne, Melbourne, Victoria, 
Australia.
(2)Public Health, College of Health and Biomedicine, Victoria University, 
Melbourne, Victoria, Australia.
(3)Division of Critical Care and Investigative Services, Royal Melbourne 
Hospital, Melbourne, Victoria, Australia.
(4)Department of Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria.
(5)Department of Allergy, Immunology and Respiratory Medicine, Central Clinical 
School, The Alfred Hospital, Monash University, Melbourne, Victoria.

BACKGROUND: Junior doctors experience high levels of psychological distress and 
emotional exhaustion. The current Coronavirus disease 2019 (COVID-19) pandemic 
has resulted in significant changes to healthcare globally, with quantitative 
studies demonstrating increased fatigue, depression and burnout in junior 
doctors. However, there has been limited qualitative research to examine junior 
doctors' experiences, challenges and beliefs regarding management of future 
crises.
AIMS: To investigate the workplace and psychosocial experiences of Australian 
junior doctors working during the second wave of the COVID-19 pandemic.
METHODS: Australian healthcare workers were invited to participate in a 
nationwide, voluntary, anonymous, single time point, online survey between 27 
August and 23 October 2020. A qualitative descriptive study of responses to four 
free-text questions from 621 junior doctors was undertaken, with responses 
analysed using inductive content analysis.
RESULTS: Participants were predominantly female (73.2%), aged 31-40 years 
(48.0%) and most frequently reported working in medical specialties (48.4%), 
emergency medicine (21.7%) or intensive care medicine (11.4%). Most (51.9%) 
participants had 0-5 years of clinical experience since medical graduation. 
Junior doctors described experiences related to four key themes: a hierarchical, 
difficult workplace culture; challenging working conditions; disrupted training 
and career trajectories; and broader psychosocial impacts. The COVID-19 pandemic 
exacerbated longstanding, workplace issues and stressors for junior doctors and 
highlighted the threat that crises pose to medical workforce retention. There is 
an urgent need for authentic, positive workplace cultural interventions to 
engage, validate and empower junior doctors.
CONCLUSIONS: Challenging workplace cultures and conditions, which have worsened 
during the COVID-19 pandemic, are associated with poor psychological well-being 
in junior doctors. There exists a need for long-term, widespread improvements in 
workplace culture and working conditions to ensure junior doctors' well-being, 
facilitate workforce retention and enhance the safety and quality of patient 
care in Australia.

© 2022 The Authors. Internal Medicine Journal published by John Wiley & Sons 
Australia, Ltd on behalf of Royal Australasian College of Physicians.

DOI: 10.1111/imj.15720
PMCID: PMC9111491
PMID: 35189019 [Indexed for MEDLINE]


2383. Front Public Health. 2022 Feb 1;9:793868. doi: 10.3389/fpubh.2021.793868. 
eCollection 2021.

Digital Media Use and Adolescents' Mental Health During the Covid-19 Pandemic: A 
Systematic Review and Meta-Analysis.

Marciano L(1)(2), Ostroumova M(1), Schulz PJ(1), Camerini AL(1)(2).

Author information:
(1)Faculty of Communication, Culture and Society, USI Università della Svizzera 
italiana, Lugano, Switzerland.
(2)Institute of Public Health, USI Università della Svizzera italiana, Lugano, 
Switzerland.

The Covid-19 physical distancing measures had a detrimental effect on 
adolescents' mental health. Adolescents worldwide alleviated the negative 
experiences of social distancing by spending more time on digital devices. 
Through a systematic literature search in eight academic databases (including 
Eric, Proquest Sociology, Communication & Mass Media Complete, Psychology and 
Behavioral Sciences Collection, PsycINFO, CINAHL, Pubmed, and Web of Science), 
the present systematic review and meta-analysis first summarized the existing 
evidence from 30 studies, published up to September 2021, on the link between 
mental health and digital media use in adolescents during Covid-19. Digital 
media use measures included social media, screen time, and digital media 
addiction. Mental health measures were grouped into conceptually similar 
dimensions, such as well-being, ill-being, social well-being, lifestyle habits, 
and Covid-19-related stress. Results showed that, although most studies reported 
a positive association between ill-being and social media use (r = 0.171, p = 
0.011) and ill-being and media addiction (r = 0.434, p = 0.024), not all types 
of digital media use had adverse consequences on adolescents' mental health. In 
particular, one-to-one communication, self-disclosure in the context of mutual 
online friendship, as well as positive and funny online experiences mitigated 
feelings of loneliness and stress. Hence, these positive aspects of online 
activities should be promoted. At the same time, awareness of the detrimental 
effects of addictive digital media use should be raised: That would include 
making adolescents more aware of adverse mechanisms such as social comparison, 
fear of missing out, and exposure to negative contents, which were more likely 
to happen during social isolation and confinement due to the pandemic.

Copyright © 2022 Marciano, Ostroumova, Schulz and Camerini.

DOI: 10.3389/fpubh.2021.793868
PMCID: PMC8848548
PMID: 35186872 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2384. Front Public Health. 2022 Feb 2;9:772805. doi: 10.3389/fpubh.2021.772805. 
eCollection 2021.

Transition and Sustainability of an Online Care Model for People With 
Parkinson's Disease in Response to the COVID-19 Pandemic.

Ketigian L(1), Piniella N(1), McGivney K(1), Lui S(2), Dukat A(1), Jung MK(1), 
Gallagher R(2), Leder A(1).

Author information:
(1)Department of Osteopathic Medicine, New York Institute of Technology College 
of Osteopathic Medicine, Old Westbury, NY, United States.
(2)Department of Physical Therapy, New York Institute of Technology School of 
Health Professions, Old Westbury, NY, United States.

INTRODUCTION: CoronaVirus Disease-2019 (COVID-19) led to social distancing and 
the need for alternative care models. Telehealth programs for people with 
Parkinson's (PWP) disease may ensure continuity of care. The goal of this 
observational survey study was to determine the practicability, satisfaction, 
and barriers to online programs, their relationship to perceived symptoms, mood, 
and quality of life, and program sustainability beyond the immediate pandemic.
METHODS: In-person Parkinson's programs at New York Institute of Technology 
College of Osteopathic Medicine transitioned online at the start of the pandemic 
to include Rock Steady Boxing, Support Groups, and Rock Steady Buddies. A custom 
online survey sent to 150 participants investigated PD history, symptomatology, 
level of exercise before and during the pandemic, depression (PHQ-9), quality of 
life (PDQ-39), and practicability and perceived satisfaction related to these 
online programs. Descriptive statistics were reported.
RESULTS: Of 69 respondents [mean age of 70.2y (SD 8.4 yrs)], >75% were satisfied 
with the transition to online programs. Consistent attendance and minimal 
barriers to programs indicated practicability, with increased adherence to 
exercise. Of 66 completed PHQ-9s, 22.7% had scores ≥9 (moderate to severe 
depression); of 61 completed PDQ-39s, scores averaged 21.4; better quality of 
life than national averages for PWP. Self-perceived physical and mental 
wellbeing were positively affected.
CONCLUSIONS: Results suggest the transition to online programs met the needs of 
the Parkinson's community in a practicable and sustainable manner during the 
pandemic. With COVID-19 still prevalent, the current model of blending 
synchronous online and in-person classes provides a more flexible, sustainable 
format compared to in-person alone. Institutions may consider including online 
components to existing programs to promote continuity of care for aging 
populations as part of best practices.

Copyright © 2022 Ketigian, Piniella, McGivney, Lui, Dukat, Jung, Gallagher and 
Leder.

DOI: 10.3389/fpubh.2021.772805
PMCID: PMC8847449
PMID: 35186865 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2385. BMC Infect Dis. 2022 Feb 20;22(1):161. doi: 10.1186/s12879-022-07155-2.

How have governments supported citizens stranded abroad due to COVID-19 travel 
restrictions? A comparative analysis of the financial and health support in 
eleven countries.

McDermid P(1), Craig A(1), Sheel M(2), Seale H(3).

Author information:
(1)School of Population Health, Faculty of Medicine, University of New South 
Wales, Level 2, Samuels Building, Sydney, NSW, 2052, Australia.
(2)Sydney School of Public Health, Faculty of Health and Medicine, the 
University of Sydney, Sydney, NSW, Australia.
(3)School of Population Health, Faculty of Medicine, University of New South 
Wales, Level 2, Samuels Building, Sydney, NSW, 2052, Australia. 
h.seale@unsw.edu.au.

BACKGROUND: In response to the continuing threat of importing novel coronavirus 
disease (COVID-19), many countries have implemented some form of border 
restriction. A repercussion of these restrictions has been that some travellers 
have found themselves stranded abroad unable to return to their country of 
residence, and in need for government support. Our analysis explores the 
COVID-19-related information and support options provided by 11 countries to 
their citizens stranded overseas due to travel restrictions. We also examined 
the quality (i.e., readability, accessibility, and useability) of the 
information that was available from selected governments' web-based resources.
METHODS: Between June 18 to June 30, 2021, COVID-19-related webpages from 11 
countries (Australia, New Zealand, Fiji, Canada, United States of America (USA), 
United Kingdom (UK), France, Spain, Japan, Singapore, and Thailand) were 
reviewed and content relating to information and support for citizens stuck 
overseas analysed. Government assistance-related data from each webpage was 
extracted and coded for the following themes: travel arrangements, health and 
wellbeing, finance and accommodation, information needs, and sources. 
Readability was examined using the Simplified Measure of Gobbledygook (SMOG) and 
the Flesch Kincaid readability tests; content 'accessibility' was measured using 
the Web Content Accessibility Guidelines (WCAG) Version 2.1; and content 
'usability' assessed using the usability heuristics for website design tool.
RESULTS: Ninety-eight webpages from 34 websites were evaluated. No country 
assessed covered all themes analysed. Most provided information and some level 
of support regarding repatriation options; border control and re-entry measures; 
medical assistance; and traveller registration. Only three countries provided 
information or support for emergency housing while abroad, and six provided some 
form of mental health support for their citizens. Our analysis of the quality of 
COVID-19-related information available on a subset of four countries' websites 
found poor readability and multiple accessibility and usability issues.
CONCLUSION: This study uniquely analyses government support for citizens stuck 
abroad during the COVID-19 pandemic. With large variance in the information and 
services available across the countries analysed, our results highlight gaps, 
inconsistencies, and potential inequities in support available, and raise issues 
pertinent to the quality, accessibility, and usability of information. This 
study will assist policymakers plan and communicate comprehensive support 
packages for citizens stuck abroad due to the COVID-19 situation and design 
future efforts to prepare for global public health emergencies.

© 2022. The Author(s).

DOI: 10.1186/s12879-022-07155-2
PMCID: PMC8858437
PMID: 35184735 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2386. Enferm Clin (Engl Ed). 2022 Jun;32 Suppl 1:S5-S13. doi: 
10.1016/j.enfcle.2021.10.003. Epub 2022 Feb 8.

Factors associated with prenatal stress and anxiety in pregnant women during 
COVID-19 in Spain.

Awad-Sirhan N(1), Simó-Teufel S(2), Molina-Muñoz Y(3), Cajiao-Nieto J(4), 
Izquierdo-Puchol MT(5).

Author information:
(1)Facultad de Psicología, Universidad de Valencia, Valencia, Spain; Facultad de 
Psicología, Universidad del Desarrollo, Santiago, Chile. Electronic address: 
nawadsirhan@gmail.com.
(2)Facultad de Psicología, Universidad de Valencia, Valencia, Spain.
(3)Facultad de Psicología, Universidad Adolfo Ibáñez, Santiago, Chile.
(4)Grupo Interdisciplinario de Investigación en Salud, Fundación Universitaria 
CAFAM, Bogotá, Colombia.
(5)Hospital Vithas Valencia 9 de Octubre, Valencia, Spain.

AIM OF THE STUDY: To describe prenatal stress and state anxiety levels in 
pregnant women living in Spain during the lockdown of the first wave of COVID-19 
and its relation with obstetric factors, perception of health care, and concerns 
about the socio-sanitary situation.
METHODS: The present study is an observational, correlational, and 
cross-sectional quantitative study. The participants in the study were pregnant 
women recruited through non-probabilistic convenience and snowball sampling 
during the lockdown. A web link was provided to an online questionnaire designed 
for this research, which collected socio-demographic and obstetric variables, 
perceptions of health care received during the pandemic and preoccupations 
associated with COVID-19. It also included the Prenatal Stress Questionnaire 
(PDQ) and the State Anxiety Inventory (STAI-S).
RESULTS: Based on the responses of 695 pregnant women, the results showed a mean 
of 16.98 (SD = 25.20) of prenatal stress and elevated levels of anxiety 
(M = 25.20/SD = 11.07) in the first wave of the pandemic. Risk factors for 
prenatal stress and anxiety were the level of preoccupation associated with 
COVID-19 and previous mental health issues. A specific risk factor for anxiety 
was having more than one child and a protective factor were perceiving 
accessibility and availability of health care, with clear and consistent 
pregnancy care and follow-up protocols.
CONCLUSIONS: The lockdown period for COVID-19 was a stressful experience for 
pregnant women, highlighting the need to address their psychological well-being 
through clear and coherent protocols in terms of maternal-foetal health control 
and follow-up.

OBJETIVO: Describir los niveles de estrés prenatal y ansiedad estado en mujeres 
gestantes residentes en España durante el confinamiento generado por la primera 
ola de COVID-19, y su asociación con los factores obstétricos, percepción de la 
atención sanitaria y preocupación provocada por la situación sociosanitaria.
MÉTODO: Estudio cuantitativo, observacional, correlacional y de corte 
transversal. La población de estudio fueron mujeres gestantes confinadas, 
reclutadas a través de muestreo no probabilístico por conveniencia y de bola de 
nieve. Se difundió un enlace web de acceso a un cuestionario online diseñado 
para la investigación, que recogía variables sociodemográficas, obstétricas, 
sobre la percepción de la atención sanitaria recibida durante la pandemia y 
preocupaciones asociadas al COVID-19. Se incluyó también el Cuestionario de 
Preocupaciones Prenatales (PDQ) y el Inventario de Ansiedad Estado (STAI-S).
RESULTADOS: Basados en las respuestas de 695 mujeres gestantes, los resultados 
indican que durante la primera ola de la pandemia se observó un nivel medio de 
estrés prenatal de 16,98 (DS = 25,20) y un nivel elevado de ansiedad 
(M = 25,20/DS = 11,07). Factores de riesgo determinante del estrés prenatal y 
ansiedad fueron el nivel de preocupación asociada al COVID-19 y tener 
antecedentes de salud mental. Un factor de riesgo específico para la ansiedad 
fue tener más de un hijo/a y un factor protector fue percibir accesibilidad y 
disponibilidad de la atención sanitaria.
CONCLUSIONES: El periodo de confinamiento por COVID-19 significó un estrés 
adicional para las mujeres gestantes, poniendo en evidencia la necesidad de 
atender el bienestar psicológico de dicha población a través de protocolos 
claros y coherentes en cuanto a control y seguimiento de la salud materno-fetal.

Copyright © 2021 Elsevier España, S.L.U. All rights reserved.

DOI: 10.1016/j.enfcle.2021.10.003
PMCID: PMC8824223
PMID: 35183488 [Indexed for MEDLINE]


2387. BMC Med Educ. 2022 Feb 19;22(1):108. doi: 10.1186/s12909-022-03174-4.

The impact of COVID-19 on the well-being, education and clinical practice of 
general practice trainees and trainers: a national cross-sectional study.

Coenen L(1), Poel LV(2), Schoenmakers B(3), Van Renterghem A(4), Gielis G(5), 
Remmen R(6), Michels NR(6).

Author information:
(1)Department of Family Medicine and chronic care, Vrije Universiteit Brussels, 
Laarbeeklaan 103, 1090, Brussels, Belgium. lotta_coenen@live.be.
(2)Faculty of Medicine, KU Leuven, ON II Herestraat 49 - box 400, 3000, Leuven, 
Belgium.
(3)Department of Public Health and Primary care, KU Leuven, Kapucijnenvoer 7 
blok h - box 7001, 3000, Leuven, Belgium.
(4)Department of Public Health and Primary care, Ghent University, Ghent, 
Belgium.
(5)Interuniversity Centre for the Education of General Practitioners, 
Kapucijnenvoer 33 - Blok H - bus 7001, 3000, Leuven, Belgium.
(6)Centre for General Practice, Department of Family Medicine and Population 
health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, 
Belgium.

BACKGROUND: COVID-19 has changed General Practice (GP) education as well as GP 
clinical activities. These changes have had an impact on the well-being of 
medical trainees and the role of GP plays in the society. We have therefore 
aimed to investigate the impact that COVID-19 has had on GP trainees and 
trainers in four domains: education, workload, practice organization and the 
role of GP in society.
DESIGN: a cross-sectional study design was used.
METHODS: The Interuniversity Centre for the Education of General Practitioners 
sent an online survey with close-ended and open-ended questions to all GP 
trainees and trainers in Flanders, active in the period March - September 2020. 
Descriptive statistics were performed to analyze the quantitative data and 
thematic analysis for the qualitative data.
RESULTS: 216 (response 25%) GP trainees and 311 (response 26%) trainers 
participated. GP trainees (63%, N = 136) and trainers (76%, N = 236) reported 
new learning opportunities since the COVID-19 pandemic. The introduction of 
telehealth consulting and changing guidelines required new communication and 
organizational skills. Most of the GP trainees (75%, n = 162) and trainers (71%, 
n = 221) experienced more stress at work and an overload of administrative work. 
The unfamiliarity with a new infectious disease and the fact that COVID-19 care 
compromised general GP clinical activities, created insecurity among GP trainers 
and trainees. Moreover, GP trainees felt that general GP activities were 
insufficiently covered during the COVID-19 pandemic for their training in GP. GP 
trainers and trainees experienced mutual support, and secondary support came 
from other direct colleagues. Measures such as reducing the writing of medical 
certificates and financial support for administrative and (para) medical support 
can help to reprioritize the core of GP care. COVID-19 has enhanced the use of 
digital learning over peer-to-peer learning and lectures. However, GP trainees 
and trainers preferred blended learning educational activities.
CONCLUSIONS: COVID-19 has created learning opportunities such as telehealth 
consulting and a flexible organization structure. To ensure quality GP education 
during the pandemic and beyond, regular GP care should remain the core activity 
of GP trainees and trainers and a balance between all different learning methods 
should be found.

© 2022. The Author(s).

DOI: 10.1186/s12909-022-03174-4
PMCID: PMC8857395
PMID: 35183171 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2388. Eur Rev Med Pharmacol Sci. 2022 Feb;26(3):1049-1055. doi: 
10.26355/eurrev_202202_28015.

Impact of COVID-19 pandemic on psychological wellbeing of Oncology clinicians in 
the Middle East and North Africa (MENA) region.

Azam F(1), Latif MF, Bashir S, Tirmazi SH, Bukhari N, Al-Selwi W, AlShamsi HO, 
Ibnshamsah F, Zekri J.

Author information:
(1)King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia. 
drfaisalazam@hotmail.co.uk.

OBJECTIVE: The reorganization of cancer services and the increased work burden 
on health care providers during the COVID-19 pandemic are likely to be 
associated with significant negative psychological impact. The aim of this study 
is to evaluate the impact of COVID-19 pandemic on the psychological well-being 
of oncology clinicians in the Middle East and North Africa (MENA) region.
MATERIALS AND METHODS: We randomly invited 1500 oncology clinicians including 
medical oncologists, clinical oncologists, radiation oncologists and surgical 
oncologists from 17 countries in the MENA region to complete a web-based survey 
to determine the level of psychological stress during the COVID-19 pandemic from 
October 2020 to January 2021. The questionnaire was based on the Perceived 
Stress Scale (PSS), Generalized Anxiety Disorders Scale (GAD-7) and WHO 
Well-being Index (WHO-5). The data was analyzed using SPSS version 21 and the 
difference between groups was measured by t-test and ANOVA.
RESULTS: Overall, 520 (35%) clinicians including 368 (71%) males and 152 (29%) 
females participated in the survey with 247 (47%) participants between the ages 
of 36 to 45 years. Average score of 29.6 for males and 30.2 on PSS-10, 
indicative of high-perceived stress in both the genders. Compared to males, 
females had significantly higher anxiety levels on GAD-7 scale (p=.04), but this 
difference in stress level and well-being was not observed on PSS-10 (p=.134) 
and WHO -5 well-being index (p=.709). Clinicians of age 25-35 years had 
significantly higher anxiety levels on GAD-7 scale (p=.004) and higher stress on 
PSS (p=.000) as compared to other age groups. Age over 55 years was associated 
with lower levels of anxiety and stress on GAD-7 and PSS. Oncology clinicians 
working in public sector experienced significantly lower stress as compared to 
private sector on PSS scale (p=.041).
CONCLUSIONS: Anxiety and stress levels among oncology clinicians have 
significantly increased in COVID-19 pandemic in the MENA region. Females and 
young clinicians had higher anxiety and stress, while oncology clinicians over 
the age of 55 years and working in the public sector reported less stress and 
anxiety. The general wellbeing of clinicians was well preserved even in a highly 
stressful and anxious situation.

DOI: 10.26355/eurrev_202202_28015
PMID: 35179772 [Indexed for MEDLINE]


2389. J Sports Med Phys Fitness. 2022 Nov;62(11):1541-1551. doi: 
10.23736/S0022-4707.22.13341-4. Epub 2022 Feb 18.

Perceived usefulness of yoga to maintain well-being and in relation to COVID-19 
cases among Hungarian yoga practitioners.

Tornóczky GJ(1), Rózsa S(2)(3), Nagy H(4), Bánhidi M(5).

Author information:
(1)Department of Sports, Education and Social Sciences, University of Physical 
Education, Budapest, Hungary - gustav.tornoczky@gmail.com.
(2)Department of Personality and Health Psychology, Faculty of Humanities and 
Social Sciences, Károli Gáspár University, Budapest, Hungary.
(3)Department of Psychiatry, Washington University School of Medicine, St. 
Louis, MO, USA.
(4)Department of Personality and Health Psychology, Faculty of Pedagogy and 
Psychology, Eötvös Loránd University, Budapest, Hungary.
(5)Department of Sports Science, Health and Sport Science Faculty, Széchenyi 
University, Győr, Hungary.

BACKGROUND: The present COVID-19 epidemic has had a considerable impact on the 
mental health of individuals worldwide. Research projects suggests potential 
benefits of yoga practice for prevention, or as medical supplementation in 
relation to the present pandemic. This study investigated the association 
between yoga and health status, and how the frequency of yoga practice affected 
the mental well-being (MWB) of the respondents.
METHODS: Hungarian yoga practitioners (N.=379) aged 20 to 75 years (93.4% 
female) were asked about their personal health, perceived usefulness of yoga 
practice for COVID-19 cases and their MWB. Data were collected between April 17 
and May 17, 2021. The measurement tool used was an online questionnaire 
including sociodemographic data, characteristics of yoga practice, COVID-19 and 
health related questions, and WHO Well-being Index (WBI-5). Associations were 
examined through ANOVA and χ2 tests.
RESULTS: There was a significant difference among the yoga practice groups by 
weekly frequency (once a week, 2-3 times a week, 4-5 times a week, daily) on the 
total mean score of well-being (WBI-5), F (3, 373) =12.97, P<0.001, 
η<inf>p</inf>2=0.094. The daily practice of yoga showed the highest MWB.
CONCLUSIONS: According to our findings, it can be stated that regular yoga 
practice is associated with higher level of MWB which can be successful in 
dealing with COVID-19 issues such as stress and depression.

DOI: 10.23736/S0022-4707.22.13341-4
PMID: 35179328 [Indexed for MEDLINE]


2390. J Nurs Adm. 2022 Mar 1;52(3):177-184. doi: 10.1097/NNA.0000000000001126.

Clinical Leader Series: A Virtual Mental Well-being Initiative for Nurse Leaders 
During the COVID-19 Pandemic and Beyond.

Sawyer AT(1), Harris S, Green JF, Du Y, Richard T, Robinson PS, Celano P, Kelly 
K, Bailey AK.

Author information:
(1)Author Affiliations: Research Scientists (Dr Sawyer, Ms Harris, Dr Green, and 
Ms Bailey), Statistician (Ms Du), Program Manager (Ms Richard), Scientific 
Director of Nursing, Population Health, and Academic Research (Dr Robinson), 
AdventHealth Research Institute, Orlando; Associate Chief Clinical Officer, 
Chief Nurse Executive, Senior Vice President (Ms Celano), Nursing Vice President 
(Ms Kelly), AdventHealth, Altamonte Springs, Florida.

OBJECTIVE: A virtual mental well-being initiative was developed for nurse 
leaders to provide education about mental health and to teach self-care skills.
BACKGROUND: Because of substantial demand placed on nurse leaders during the 
COVID-19 pandemic, organizations must address stress and burnout by providing a 
continuum of care to include education, support, and intervention.
METHODS: All levels of nurse leaders at a multicampus healthcare system were 
invited to attend. Data were collected on coping, empowerment, burnout, and 
quality of life. Participant responses to discussion prompts were compiled and 
reviewed.
RESULTS: Although the independent parallel comparison did not show significant 
improvements, scores on the coping, empowerment, burnout, and quality-of-life 
measures were maintained. Discussion prompts yielded valuable insights into 
nurse leader experiences and session effectiveness.
CONCLUSIONS: This type of education, as well as psychological support, will 
continue to be needed after the pandemic due to burnout, moral injury, and 
primary or secondary trauma. Findings are applicable to future crisis 
situations.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/NNA.0000000000001126
PMID: 35179144 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


2391. Breast. 2022 Apr;62:123-134. doi: 10.1016/j.breast.2022.02.007. Epub 2022 Feb 
10.

On top of that all, now Covid-19, too. A scoping review of specificities and 
correlates of fear of cancer recurrence in breast cancer patients during 
COVID-19.

Kállay É(1), Medrea F(1), Dégi CL(2).

Author information:
(1)Psychology and Educational Sciences, Babes Bolyai University, Cluj Napoca, 
Romania.
(2)Sociology and Social Work, Babes Bolyai University, Cluj Napoca, Romania. 
Electronic address: csabadegi@gmail.com.

Fear of cancer recurrence (FCR) is a normal response in cancer survivors and one 
of the most prevalent reactions reported by up to 87% of them. However, elevated 
levels of FCR impair well-being, quality of life and professional functioning, 
and lead to anxiety, depression or PTSD. COVID-19 pandemic can exacerbate FCR 
symptoms, given the restricting access to follow-up investigations and 
treatment, the isolation restrictions imposed and the possibility of the medical 
system becoming overworked. This scoping review's objective was to synthesize 
the literature investigating the factors associated with higher levels of FCR in 
cancer survivors during the COVID-19 pandemic. The focus was on FCR in breast 
cancer patients, including most of the studies (5 out of 9) on this topic. 
However, given the novelty of the subject, the increased interest in it, and the 
fact that there are few studies in this field, the review included 4 other 
studies with mixed samples of patients with breast cancer and other oncological 
pathologies. Following rigorous methodological criteria, 9 studies with 
quantitative or mixed methodology were included (N = 4831 patients). The results 
indicate that high levels of FCR are associated with distress and concerns 
regarding the pandemic impact, with most common concerns of patients being 
changes in treatment plan (delays and interruptions), dysfunctional 
communication with medical staff or difficult access to food or medicine. The 
most common correlates of FCR during the pandemic are marital status, 
childlessness, low financial status, level of education, type of cancer 
diagnosis, generalized anxiety and depression.

Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.breast.2022.02.007
PMCID: PMC8828428
PMID: 35176683 [Indexed for MEDLINE]


2392. Br J Clin Psychol. 2022 Sep;61(3):816-835. doi: 10.1111/bjc.12362. Epub 2022 Feb 
16.

Unrealistic pessimism and obsessive-compulsive symptoms during the COVID-19 
pandemic: Two longitudinal studies.

Jelinek L(1), Röhrig G(1), Moritz S(1), Göritz AS(2), Voderholzer U(3)(4)(5), 
Riesel A(6), Yassari AH(1), Miegel F(1).

Author information:
(1)Department of Psychiatry and Psychotherapy, University Medical Center 
Hamburg-Eppendorf, Germany.
(2)Occupational and Consumer Psychology, University of Freiburg, Germany.
(3)Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, 
Germany.
(4)Schoen Clinic Roseneck, Prien am Chiemsee, Germany.
(5)Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, 
Germany.
(6)Department of Clinical Psychology and Psychotherapy, University of Hamburg, 
Germany.

OBJECTIVE: Unrealistic pessimism (UP) is an aspect of overestimation of threat 
(OET) that has been associated with obsessive-compulsive disorder/symptoms 
(OCD/OCS). During the COVID-19 pandemic, UP may have played an important role in 
the course of OCD. To investigate the relationship, we conducted two 
longitudinal studies assuming that higher UP predicts an increase in OCS.
METHOD: In Study 1, we investigated UP in the general population (N = 1,184) at 
the start of the pandemic asking about overall vulnerability to infection with 
SARS-CoV-2 and UP regarding infection and outcome of severe illness. Further, 
OCS status (OCS+/-) was assessed at the start of the pandemic and 3 months 
later. In Study 2, we investigated UP in individuals with OCD (N = 268) 
regarding the likelihood of getting infected, recovering, or dying from an 
infection with SARS-CoV-2 at the start of the pandemic and re-assessed OCS 
3 months later.
RESULTS: In Study 1, UP was higher in the OCS+ compared to the OCS- group, and 
estimates of a higher overall vulnerability for an infection predicted a 
decrease in OCS over time. UP regarding severe illness predicted an increase in 
symptoms over time. In Study 2, UP was found for a recovery and death after an 
infection with SARS-CoV-2, but not for infection itself.
CONCLUSIONS: Exaggeration of one's personal vulnerability rather than OET per se 
seems pivotal in OCD, with UP being associated with OCD/OCS+ as well as a more 
negative course of symptomatology over the pandemic in a nonclinical sample.
PRACTITIONER POINTS: Unrealistic optimism, a bias common in healthy individuals, 
is thought to be a coping mechanism promoting well-being in the face of danger 
or uncertainty. The current study extends findings that its inversion, 
unrealistic pessimism, may play an important role in obsessive-compulsive 
disorder and may also be involved in the development of the disorder. This study 
highlights the importance that prevention programs during a pandemic should 
include targeting unrealistic pessimism.

© 2022 The Authors. British Journal of Clinical Psychology published by John 
Wiley & Sons Ltd on behalf of British Psychological Society.

DOI: 10.1111/bjc.12362
PMCID: PMC9111568
PMID: 35174521 [Indexed for MEDLINE]

Conflict of interest statement: All authors declare no conflict of interest.


2393. Eur Child Adolesc Psychiatry. 2023 Jun;32(6):1119-1130. doi: 
10.1007/s00787-021-01933-0. Epub 2022 Feb 17.

Online peer support training to promote adolescents' emotional support skills, 
mental health and agency during COVID-19: Randomised controlled trial and 
qualitative evaluation.

Pavarini G(1), Reardon T(2), Hollowell A(3), Bennett V(4), Lawrance E(5); Peer 
Support Young People’s Advisory Group; Pinfold V(3), Singh I(4).

Collaborators: Brooks-Hall E, Foster-Estwick A, Juma DO, Lewis P, Power L, 
Rogers M.

Author information:
(1)Department of Psychiatry and Wellcome Centre for Ethics and Humanities, 
University of Oxford, Oxford, UK. gabriela.pavarini@ethox.ox.ac.uk.
(2)Department of Experimental Psychology and Department of Psychiatry, 
University of Oxford, Oxford, UK.
(3)The McPin Foundation, London, UK.
(4)Department of Psychiatry and Wellcome Centre for Ethics and Humanities, 
University of Oxford, Oxford, UK.
(5)Imperial College London and Mental Health Innovations, London, UK.

Adolescents often look to their peers for emotional support, so it is critical 
that they are prepared to take on a supportive role, especially during a health 
crisis. Using a randomised controlled trial (ISRCTN99248812, 28/05/2020), we 
tested the short-term efficacy of an online training programme to equip young 
people with skills to support to their peers' mental wellbeing during the 
COVID-19 pandemic. In June 2020, one-hundred UK adolescents (aged 16-18) 
recruited through social media were randomly allocated (1:1) to immediate 5-day 
peer support training or a wait-list, via an independently generated allocation 
sequence. Primary outcomes were indicators of ability to help others 
(motivation, perceived skills, frequency of help provided, compassion to others 
and connectedness to peers). Secondary outcomes included emotional symptoms, 
mental wellbeing, and indicators of agency (civic engagement and self-efficacy). 
We also collected qualitative reports of participants' experience. Assessments 
were completed at baseline and 1 week post randomisation (primary endpoint), and 
up to 4 weeks post randomisation (training group only). The training increased 
support-giving skills, frequency of providing support, compassion and peer 
connectedness (medium-large-effect sizes), but not motivation to provide 
support, 1 week post randomisation, compared to controls. Gains in the training 
group were maintained 4 weeks post randomisation. Training also improved 
adolescents' mental health and agency, and qualitative reports revealed further 
positive outcomes including increased self-care and empowerment. Leveraging 
digital platforms that are familiar to young people, peer support training has 
the potential to enable adolescents to support their own and their peers' mental 
wellbeing during a health crisis.

© 2022. The Author(s).

DOI: 10.1007/s00787-021-01933-0
PMCID: PMC8853257
PMID: 35174419 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no relevant financial or 
non-financial interests to disclose.


2394. Eur Child Adolesc Psychiatry. 2023 Jun;32(6):1131-1146. doi: 
10.1007/s00787-021-01934-z. Epub 2022 Feb 17.

Happier during lockdown: a descriptive analysis of self-reported wellbeing in 
17,000 UK school students during Covid-19 lockdown.

Soneson E(1), Puntis S(2), Chapman N(3), Mansfield KL(2), Jones PB(#)(4), Fazel 
M(#)(2).

Author information:
(1)Department of Psychiatry, University of Cambridge, Douglas House, 18b 
Trumpington Road, Cambridge, CB2 8AH, UK. es703@medschl.cam.ac.uk.
(2)Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, 
OX3 7JX, UK.
(3)Fresh+ Group, Fresh CAMHS Liverpool, Catkin Building, Alder Hey Children's 
NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, UK.
(4)Department of Psychiatry, University of Cambridge, Douglas House, 18b 
Trumpington Road, Cambridge, CB2 8AH, UK.
(#)Contributed equally

Relatively little research has focused on children and young people (CYP) whose 
mental health and wellbeing improved during Covid-19 lockdown measures. We aimed 
to (1) determine the proportion of CYP who self-reported improvement in their 
mental wellbeing during the first Covid-19 lockdown and (2) describe the 
characteristics of this group in relation to their peers. We conducted a 
descriptive analysis of data from the 2020 OxWell Student Survey, a self-report, 
cross-sectional survey of English CYP. A total of 16,940 CYP primarily aged 
8-18 years reported on change in mental wellbeing during lockdown. We 
characterised these CYP in terms of school, home, relational, and lifestyle 
factors as well as feelings about returning to school. One-third (33%) of CYP 
reported improved mental wellbeing during the first UK national lockdown. 
Compared with peers who reported no change or deterioration, a higher proportion 
of CYP with improved mental wellbeing reported improved relationships with 
friends and family, less loneliness and exclusion, reduced bullying, better 
management of school tasks, and more sleep and exercise during lockdown. In 
conclusion, a sizeable minority of CYP reported improved mental wellbeing during 
lockdown. Determining the reasons why these CYP felt they fared better during 
lockdown and considering how these beneficial experiences can be maintained 
beyond the pandemic might provide insights into how to promote the future mental 
health and wellbeing of school-aged CYP. All those working with CYP now have an 
opportunity to consider whether a systemic shift is needed in order to 
understand and realise any learnings from experiences during the pandemic.

© 2022. The Author(s).

DOI: 10.1007/s00787-021-01934-z
PMCID: PMC8853175
PMID: 35174418 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
declare that are relevant to the content of this article.


2395. Front Public Health. 2022 Jan 31;10:785383. doi: 10.3389/fpubh.2022.785383. 
eCollection 2022.

Impact of the COVID-19 Lockdown on Quality of Life in Pregnant Women.

Ma J(1), Wang A(1), Zhou H(2)(3).

Author information:
(1)Department of Nutrition, Baoji Maternal and Child Health Hospital, Baoji, 
China.
(2)Clinical Medical College, Yangzhou University, Yangzhou, China.
(3)Department of Clinical Nutrition, Northern Jiangsu People's Hospital, 
Yangzhou, China.

BACKGROUND: The COVID-19 pandemic has been associated with significant impacts 
on mental health and well-being of populations worldwide. However, little is 
known about its significant impact on psychological aspects of vulnerable 
population groups such as pregnant women. Therefore, the aim of the study was to 
determine the psychological impact of the COVID-19 pandemic among pregnant women 
in mainland China.
METHODS: A cross-sectional survey was performed between July and August 2020 
using a modified validated 40-item questionnaire which consisted of 
sociodemographics, attitude, lifestyle changes and the Impact of Event Scale 
(IES) toward COVID-19 using snowball and convenience samplings.
RESULTS: A total of 1,078 participants were included in the study. The mean age 
of participants was 29.4 ± 4.0 years. Overall, the mean IES of participants was 
30.6 ± 12.8 (i.e., moderate-to-severe stressful impact) amidst the COVID-19 
pandemic, with 63.9% of participants had an IES score ≥26. Despite increased 
family and social support, more than half of participants also reported 
increased feeling of being horrified, apprehensive and helpless.
CONCLUSIONS: The COVID-19 pandemic has several psychological impacts on pregnant 
women. Therefore, based on these valuable data of pregnant women collected, we 
recommend that a thoughtful planning and time preparation by the government 
would definitely help to reduce the negative impacts caused by the COVID-19 
pandemic and restore the quality of life among pregnant women. Further research 
is needed to identify vulnerable groups including pregnant women to better adapt 
and inform mental health interventions and policies by health authorities.

Copyright © 2022 Ma, Wang and Zhou.

DOI: 10.3389/fpubh.2022.785383
PMCID: PMC8841653
PMID: 35174122 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2396. PLoS One. 2022 Feb 16;17(2):e0263570. doi: 10.1371/journal.pone.0263570. 
eCollection 2022.

Subjective well-being during the 2020-21 global coronavirus pandemic: Evidence 
from high frequency time series data.

Foa RS(1), Fabian M(2), Gilbert S(1).

Author information:
(1)Department of Political Science and International Studies, Bennett Institute 
for Public Policy, University of Cambridge, Cambridge, United Kingdom.
(2)Institute for Social Change, University of Tasmania, Hobart, Australia.

We investigate how subjective well-being varied over the course of the global 
COVID-19 pandemic, with a special attention to periods of lockdown. We use 
weekly data from YouGov's Great Britain Mood Tracker Poll, and daily reports 
from Google Trends, that cover the entire period from six months before until 
eighteen months after the global spread of COVID-19. Descriptive trends and 
time-series models suggest that negative mood associated with the imposition of 
lockdowns returned to baseline within 1-3 weeks of lockdown implementation, 
whereas pandemic intensity, measured by the rate of fatalities from COVID-19 
infection, was persistently associated with depressed affect. The results 
support the hypothesis that country-specific pandemic severity was the major 
contributor to increases in negative affect observed during the COVID-19 
pandemic, and that lockdowns likely ameliorated rather than exacerbated this 
effect.

DOI: 10.1371/journal.pone.0263570
PMCID: PMC8849501
PMID: 35171919 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2397. PLoS One. 2022 Feb 16;17(2):e0263514. doi: 10.1371/journal.pone.0263514. 
eCollection 2022.

Evaluation of a credit-bearing online administered happiness course on 
undergraduates' mental well-being during the COVID-19 pandemic.

Hobbs C(1), Jelbert S(1), Santos LR(2), Hood B(1).

Author information:
(1)School of Psychological Science, University of Bristol, Bristol, United 
Kingdom.
(2)Department of Psychology, Yale University, New Haven, Connecticut, United 
States of America.

Psychoeducational courses focused on positive psychology interventions have been 
shown to benefit student well-being. However, since the onset of the COVID-19 
pandemic and accompanying social restrictions, many educators have had to 
deliver their courses online. Given that online teaching presents a very 
different university experience for students, do psychoeducational courses 
provide similar well-being benefits in an online format? In this pre-registered 
study (https://osf.io/3f89m), we demonstrate that despite the challenges of 
remote learning, first year university students (N = 166) taking an online 
"Science of Happiness" course during the first term experienced positive 
benefits to mental well-being in comparison to a wait-list control group (N = 
198) registered to take the course in the second term. Specifically, university 
students currently taking the course maintained their mental well-being over the 
semester relative to the wait-list control who showed a significant decline in 
well-being and increase in anxiety during the same period. Our findings suggest 
that the online-administered "Science of Happiness" course delivered during the 
COVID-19 pandemic was associated with a protective effect on mental well-being. 
We also observed that engagement with the course was high, though there was no 
evidence that this factor mediated the positive effects we observed. However, we 
did find evidence that prior interest in increasing well-being influenced the 
effects of the course; participants with lower well-being interest showed less 
of a benefit. Our results suggest that online psychoeducational courses might 
provide a relatively cheap, flexible, and efficient means of providing support 
as part of an integrated approach to student mental well-being.

DOI: 10.1371/journal.pone.0263514
PMCID: PMC8849469
PMID: 35171917 [Indexed for MEDLINE]

Conflict of interest statement: The course being evaluated was taught by two of 
the authors (Bruce Hood and Sarah Jelbert), and is based on a similar course 
developed, and previously taught, by another author (Laurie R. Santos). This 
does not alter our adherence to PLOS ONE policies on sharing data and materials. 
Catherine Hobbs has no competing interests.


2398. Br J Sports Med. 2022 Jun;56(12):667-675. doi: 10.1136/bjsports-2021-104994. 
Epub 2022 Feb 15.

Train at home, but not alone: a randomised controlled multicentre trial 
assessing the effects of live-streamed tele-exercise during COVID-19-related 
lockdowns.

Wilke J(1), Mohr L(2), Yuki G(3), Bhundoo AK(4), Jiménez-Pavón D(5)(6), Laiño 
F(7), Murphy N(8), Novak B(9), Nuccio S(10), Ortega-Gómez S(5)(6), Pillay JD(4), 
Richter F(11), Rum L(10), Sanchez-Ramírez C(12), Url D(9), Vogt L(2), Hespanhol 
L(3)(13).

Author information:
(1)Institute of Occupational, Social and Environmental Medicine, Goethe 
University Frankfurt, Frankfurt am Main, Germany wilke@sport.uni-frankfurt.de.
(2)Department of Sports Medicine and Exercise Physiology, Goethe University, 
Frankfurt am Main, Germany.
(3)Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de Sao 
Paulo, Sao Paulo, Brazil.
(4)Department of Basic Medical Sciences, Durban University of Technology, 
Durban, South Africa.
(5)MOVE-IT Research Group, Department of Physical Education, Faculty of 
Education Sciences and Biomedical Research Innovation Institute of Cádiz, 
University of Cádiz, CIBERFES, Cádiz, Spain, Cadiz, Spain.
(6)ImFine Research Group, Department of Health and Human Performance, 
Universidad Politécnica de Madrid; Exercise is Medicine, Madrid, Spain.
(7)Fundación Instituto Superior de Ciencias de la Salud, Buenos Aires, 
Argentina.
(8)Department of Sport and Exercise Science, Waterford Institute of Technology, 
Waterford, Ireland.
(9)Institute of Human Movement Science, Sport and Health, 
Karl-Franzens-Universitat Graz, Graz, Austria.
(10)Department of Movement, Human and Health Sciences, University of Rome "Foro 
Italico", Rome, Italy.
(11)Department of Sports Medicine and Exercise Physiology, Goethe University 
Frankfurt, Frankfurt am Main, Germany.
(12)Sciences of Physical Activity, Sports and Health School, Universidad de 
Santiago de Chile, Santiago de Chile, Chile.
(13)Department of Public and Occupational Health and the Amsterdam Public Health 
research institute, VU University Medical Center Amsterdam, Amsterdam, The 
Netherlands.

OBJECTIVE: Public life restrictions associated with the COVID-19 pandemic caused 
reductions in physical activity (PA) and decreases in mental and somatic health. 
Considering the interplay between these factors, we investigated the effects of 
digital home exercise (DHE) during government-enforced lockdowns.
METHODS: A multicentre randomised controlled trial was performed allocating 
healthy individuals from nine countries (N=763; 523 female) to a DHE or an 
inactive control group. During the 4-week main intervention, DHE members engaged 
in live-streamed multicomponent home exercise. Subsequently, both groups had 
access to prerecorded workouts for an additional 4 weeks. Outcomes, assessed 
weekly, included PA level (Nordic Physical Activity Questionnaire-Short), 
anxiety (Generalized Anxiety Disorder Scale-7), mental well-being (WHO-5 
Questionnaire), sleep quality (Medical Outcome Study Sleep Scale), 
pain/disability (Chronic Pain Grade Scale) and exercise motivation 
(Self-Concordance Scale). Mixed models were used for analysis.
RESULTS: Live-streamed DHE consistently increased moderate PA (eg, week 1: 1.65 
times more minutes per week, 95% CI 1.40 to 1.94) and vigorous PA (eg, week 1: 
1.31 times more minutes per week, 95% CI 1.08 to 1.61), although the effects 
decreased over time. In addition, exercise motivation, sleep quality and anxiety 
were slightly improved for DHE in the 4-week live streaming period. The same 
applied to mental well-being (mean difference at week 4: +0.99, 95% CI 0.13 to 
1.86), but an inverted trend was observed after live streaming was substituted 
by prerecorded exercise.
CONCLUSIONS: Live-streamed DHE represents an efficacious method to enhance PA 
and selected markers of health during pandemic-related public life restrictions. 
However, research on implementation is warranted to reduce dropout rates.
TRIAL REGISTRATION NUMBER: DRKS00021273.

© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and 
permissions. Published by BMJ.

DOI: 10.1136/bjsports-2021-104994
PMID: 35168957 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2399. Int Nurs Rev. 2022 Dec;69(4):529-537. doi: 10.1111/inr.12750. Epub 2022 Feb 15.

Burnout and psychological distress among Pakistani nurses providing care to 
COVID-19 patients: A cross-sectional study.

Andlib S(1), Inayat S(2), Azhar K(3), Aziz F(4).

Author information:
(1)Benazir Bhutto Hospital, Rawalpindi, Pakistan.
(2)Isra College of Nursing, Isra University, Islamabad, Pakistan.
(3)Rawal Surgical Hospital, Wah Cantt, Pakistan.
(4)Interdisciplinary Metabolic Medicine Trials Unit, Department of Endocrinology 
and Diabetology, Medical University of Graz, Graz, Austria.

AIM: The aim of this study is to assess the burden of burnout and psychological 
distress and its association among Pakistani nurses providing care to patients 
with COVID-19.
BACKGROUND: Nurses may experience an elevated risk of burnout and psychological 
distress during epidemics.
METHODS: A cross-sectional study was conducted using a convenience sample of 288 
nurses. Maslach Burnout Inventory was administered to measure burnout and its 
domains of emotional exhaustion, depersonalization, and personal accomplishment. 
Screening Tool for Psychological Distress was administered to measure 
depression, anxiety, stress, anger, and low social support.
RESULTS: Burnout was present in 48.6% of nurses, severe emotional exhaustion in 
37.2%, severe depersonalization in 36.8%, and low personal accomplishment in 
46.9% of nurses. Psychological distress was present in 45% of nurses. Burnout 
and psychological distress were significantly higher in nurses who: were working 
in public hospitals, did not receive training for COVID-19 prevention, and were 
dealing with increased patient load. Burnout and its domains were significantly 
associated with depression, anxiety, stress, anger, and low social support.
CONCLUSION: Nurses are experiencing high levels of burnout and psychological 
distress during the COVID-19 pandemic with a significant moderate-to-strong 
association between these conditions. These findings accentuate the need for 
institution-based interventions to mitigate burnout and preserve the mental 
health of nurses.
IMPLICATIONS FOR NURSING AND HEALTH POLICY: Hospitals must screen nurses 
frequently for the presence of significant burnout and psychological distress 
and offer supportive interventions to protect their mental health and 
well-being.

© 2022 International Council of Nurses.

DOI: 10.1111/inr.12750
PMCID: PMC9111774
PMID: 35167710 [Indexed for MEDLINE]

Conflict of interest statement: All authors declare no competing interests 
related to this study.


2400. East Mediterr Health J. 2022 Jan 31;28(1):14-22. doi: 10.26719/emhj.22.006.

Sleep disturbances following recovery from COVID-19: a comparative 
cross-sectional study in Egypt.

Abdelghani M(1), Alsadik M(2), Abdelmoaty A(3), Atwa S(1), Said A(4), Hassan 
M(1).

Author information:
(1)Department of Psychiatry, College of Medicine, Zagazig University, Zagazig, 
Egypt.
(2)Department of Chest Diseases, College of Medicine, Zagazig University, 
Zagazig, Egypt.
(3)Department of Tropical Medicine, College of Medicine, Zagazig University, 
Zagazig, Egypt.
(4)Department of Anaesthesia and Surgical Intensive Care, College of Medicine, 
Zagazig University, Zagazig, Egypt.

BACKGROUND: Sequelae from COVID-19 are increasingly being reported, but sleep 
disturbances after recovery from the disease have had little attention.
AIMS: This study aimed to identify and compare sleep disturbances and associated 
correlates among adults who have recovered from COVID-19 with those who have 
never been infected with the disease.
METHODS: The sample included 85 adults who have recovered from COVID-19 and 85 
adults who have never been infected (matched on age, sex, education and 
socioeconomic level). Individuals were recruited from Zagazig University 
Hospitals, Egypt from 1 September to 29 November 2020. Participants were 
interviewed using a sociodemographic and clinical checklist, the Pittsburgh 
Sleep Quality Index and the Hospital Anxiety Depression Scale.
RESULTS: Most (77%) of the recovered cases had experienced sleep disturbances, 
compared with 46% of controls. Individuals who had recovered from COVID-19 were 
more likely to have poor subjective sleep quality (odds ratio (OR) 1.5, 95% 
confidence interval (CI): 1.1-2.1), prolonged sleep latency (OR 1.8, 95% CI: 
1.3-2.6), shorter sleep duration (OR 1.6, 95% CI: 1.1-2.2), reduced sleep 
efficiency (OR 3.8, 95% CI: 2.0-7.1), frequent daytime dysfunction (OR 1.9, 95% 
CI: 1.2-3.1) and poor global Pittsburgh Sleep Quality Index score (OR 3.0, 95% 
CI: 1.5-6.0). Depressive (P = 0.002) and anxiety (P = 0.003) symptoms were 
associated with a poor global Pittsburgh Sleep Quality Index score among 
recovered female participants (P = 0,034) who had low-to-medium education level 
(P = 0.004).
CONCLUSIONS: Further studies (e.g. population-based longitudinal studies) are 
needed on sleep disturbances as a potential sequelae of COVID-19, because it can 
impair mental and physical well-being.

Publisher: اضطرابات النوم عقب التعافي من مرض كوفيد-19 : دراسة مقطعية مقارنة في 
مصر. محمد عبد الغني، مها الصادق، أحمد عبد المعطي، سمر عطوة، أميرة سعيد، ميرفت 
حسن.
الخلفية: يتزايد الإبلاغ عن مضاعفات مرض فيروس كورونا 2019 (كوفيد-19)، ولكن لم 
تحظَ اضطرابات النوم التالية للإصابة بمرض كوفيد-19 بالاهتمام الكافي.
الأهداف: هدفت هذه الدراسة إلى تحديد اضطرابات النوم والمعاملات المرتبطة بها 
ومقارنتها بين البالغين الذين تعافوا من مرض كوفيد-19 والبالغين الذين لم يصابوا 
به.
طرق البحث: شملت العينة 85 مشاركًا متعافيًا من مرض كوفيد-19، و85 بالغًا لم يصابوا 
به (متماثلين من حيث العمر والجنس والمستوى التعليمي والاجتماعي الاقتصادي). وتمت 
الاستعانة بأفراد من مستشفيات جامعة الزقازيق، مصر، في الفترة من 1 سبتمبر/أيلول 
إلى 29 نوفمبر/تشرين الثاني 2020. وأُجريت مقابلات مع المشاركين باستخدام قائمة 
مرجعية اجتماعية سكانية وسريرية، ومؤشر بيتسبرج لجودة النوم، ومقياس القلق 
والاكتئاب في المستشفيات.
النتائج: عانت معظم الحالات المتعافية من مرض كوفيد-19 (77٪) من اضطرابات النوم، 
مقارنة بنسبة 46٪ من الشواهد. كما أن الأفراد الذين تعافوا من مرض كوفيد-19 كانوا 
أكثر عرضة لضعف الجودة الذاتية للنوم (نسبة الأرجحية 1.5، فاصل الثقة 95٪: 1.1-2.1) 
، وطول مدة النوم (نسبة الأرجحية 1.8، فاصل الثقة 95٪: 1.3-2.6)، ومدة النوم 
القصيرة (نسبة الأرجحية: 1.6، فاصل الثقة 95٪: 1.1-2.2)، وانخفاض كفاءة النوم (نسبة 
الأرجحية: 3.8، فاصل الثقة 95٪: 2.0-7.1)، والخلل الوظيفي المتكرر أثناء النهار 
(نسبة الأرجحية: 1.9، فاصل ثقة 95٪: 1.2-3.1)، وتدني الدرجة الخاصة بمؤشر بتسبرج 
العالمي لجودة النوم (نسبة الأرجحية: 3.0، فاصل ثقة 95٪: 1.5-6.0). ومن بين 
المشاركين المتعافين من مرض كوفيد-19، كان جنس الإناث (الاحتمالية = 0.034)، 
والتعليم المنخفض إلى المتوسط (الاحتمالية = 0.004)، وأعراض الاكتئاب (الاحتمالية = 
0.002) والقلق (الاحتمالية = 0.003) مرتبطة بتدني الدرجة الخاصة بمؤشر بتسبرج 
العالمي لجودة النوم.
الاستنتاجات: يلزم إجراء مزيد من الدراسات (مثل الدراسات الطولية القائمة على 
السكان) بشأن اضطرابات النوم، باعتبارها أحد المضاعفات المحتملة لمرض كوفيد-19 التي 
يمكن أن تضعف السلامة النفسية والبدنية.

Publisher: Troubles du sommeil après la guérison de la COVID-19 : étude 
transversale comparative en Égypte.
CONTEXTE: Les séquelles post-COVID-19 sont de plus en plus souvent signalées, 
mais les troubles du sommeil après la guérison de la maladie ont suscité peu 
d'attention.
OBJECTIFS: La présente étude visait à identifier et à comparer les troubles du 
sommeil et les corrélats associés chez les adultes qui avaient guéri de la 
COVID-19 et chez ceux qui n'avaient pas contracté la maladie.
MÉTHODES: Les échantillons comprenaient 85 adultes guéris de la COVID-19 et 85 
autres qui n'ont jamais été infectés de COVID-19 (appariés en fonction de l'âge, 
du sexe, du niveau d'éducation et du niveau socio-économique). Des personnes ont 
été recrutées dans les hôpitaux universitaires de Zagazig (Égypte) du 1er 
septembre au 29 novembre 2020. Les participants ont été interrogés à l'aide 
d'une liste de contrôle socio-démographique et clinique, de l'index de qualité 
du sommeil de Pittsburgh et de l'échelle d'anxiété et de dépression de 
l'hôpital.
RÉSULTATS: La plupart (77 %) des cas de COVID-19 guéris avaient présenté des 
troubles du sommeil, contre 46 % des témoins. Les personnes qui s'étaient 
rétablies de la COVID-19 étaient plus susceptibles d'avoir une mauvaise qualité 
subjective du sommeil (odds ratio (OR) 1,5, intervalle de confiance (IC) à 95 % 
: 1,1-2,1), une latence prolongée du sommeil (OR 1,8, IC à 95 % : 1,3-2,6), une 
durée de sommeil plus courte (OR : 1,6, IC à 95 % : 1,1-2,2), une efficacité 
courte du sommeil (OR 3,8, IC à 95 % : 2,0-7 , 1), des dysfonctionnements 
fréquents pendant la journée (OR 1,9, IC à 95 % : 1,2-3,1) et un score global 
médiocre de l'index de qualité du sommeil de Pittsburgh (OR 3,0, IC à 95 % : 
1,5-6,0). Chez les participantes guéries (p = 0,034) qui avaient un niveau 
d'éducation compris entre faible et modéré (p = 0,004), les symptômes dépressifs 
(p = 0,002) et liés à l'anxiété (p = 0,003) étaient associés à un score global 
médiocre de l'index de qualité du sommeil de Pittsburgh.
CONCLUSION: D'autres études (par exemple, des études longitudinales en 
population) sont nécessaires sur les troubles du sommeil en tant que séquelles 
potentielles de la COVID-19 qui peuvent nuire au bien-être mental et physique.

Copyright © World Health Organization (WHO) 2022. Open Access. Some rights 
reserved. This work is available under the CC BY-NC-SA 3.0 IGO license 
(https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

DOI: 10.26719/emhj.22.006
PMID: 35165874 [Indexed for MEDLINE]


2401. J Addict Med. 2022 Nov-Dec 01;16(6):645-652. doi: 10.1097/ADM.0000000000000981.

Shifting Medication Treatment Practices in the COVID-19 Pandemic: A Statewide 
Survey of Pennsylvania Opioid Treatment Programs.

Krawczyk N(1), Maniates H, Hulsey E, Smith JS, DiDomenico E, Stuart EA, Saloner 
B, Bandara S.

Author information:
(1)From the Center for Opioid Epidemiology and Policy, Department of Population 
Health, NYU Grossman School of Medicine, New York, NY (NK); Department of Health 
Policy and Management, Johns Hopkins Bloomberg School of Public Health, 
Baltimore, MD (HM, BS); Department of Mental Health, Johns Hopkins Bloomberg 
School of Public Health, Baltimore, MD (EAS; SB); Vital Strategies, New York, NY 
(EH); and Pennsylvania Department of Drug and Alcohol Programs, Harrisburg, PA 
(JSS, ED).

OBJECTIVES: We sought to understand how opioid treatment programs (OTPs) adapted 
OTP operations to the COVID-19 pandemic and new federal regulations around 
methadone and buprenorphine.
METHODS: In fall 2020, we conducted an online survey of all 103 OTPs licensed by 
the Pennsylvania Department of Drug and Alcohol Programs, including clinical 
directors. Survey domains included changes to methadone take-home and telehealth 
practices; overdose and diversion prevention tactics; perceptions regarding how 
such changes influence patient well-being; and financial/operational concerns 
related to the new policies and practices. We calculated descriptive statistics 
and conducted Chi-square test to test for differences between not-for-profit 
versus for-profit and large versus small OTPs.
RESULTS: Forty-seven percent (46%) OTPs responded to the survey. 10% and 25%, 
respectively, endorsed offering telephone and video-based telemedicine 
buprenorphine induction. Sixty-six percent endorsed extending take-home supplies 
of methadone, but most indicated that these extensions applied to a minority of 
their patients. Most respondents agreed that provision of buprenorphine via 
telehealth and extended take-home methadone reduced patient burden in accessing 
medications and prevented exposure to COVID-19, while not significantly 
increasing risk of overdose. We did not find major differences in COVID-19 
practice modifications by nonprofit status or size of OTP.
CONCLUSIONS: In Pennsylvania, the COVID-19 pandemic led to rapid changes in 
provision of opioid treatment services. Findings on relatively low uptake of 
longer methadone take-home regimens and virtual buprenorphine initiation despite 
general support for these practices imply a need to further develop guidelines 
for best clinical practices and understand/address barriers to their 
implementation.

Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on 
behalf of the American Society of Addiction Medicine.

DOI: 10.1097/ADM.0000000000000981
PMCID: PMC9653109
PMID: 35165225 [Indexed for MEDLINE]

Conflict of interest statement: The authors report no conflicts of interest.


2402. Int J Environ Res Public Health. 2022 Feb 4;19(3):1792. doi: 
10.3390/ijerph19031792.

Physical Activity, Mental Health and Wellbeing of Adults within and during the 
Easing of COVID-19 Restrictions, in the United Kingdom and New Zealand.

Faulkner J(1), O'Brien WJ(2), Stuart B(3), Stoner L(4), Batten J(1), Wadsworth 
D(5)(6), Askew CD(6)(7), Badenhorst CE(2), Byrd E(8), Draper N(9), Elliot C(10), 
Fryer S(11), Hamlin MJ(10), Jakeman JR(8), Mackintosh KA(12), McNarry MA(12), 
Mitchelmore A(8), Ryan-Stewart H(1), Saynor Z(13), Schaumberg MA(6)(7)(14), 
Spiegelhalter E(1), Stone K(11), Lambrick D(15).

Author information:
(1)School of Sport, Health and Community, University of Winchester, Winchester 
SO22 4NR, UK.
(2)School of Sport, Exercise and Nutrition, Massey University, Auckland 0745, 
New Zealand.
(3)Southampton Clinical Trials Unit, Faculty of Medicine, University of 
Southampton, Southampton SO17 1BJ, UK.
(4)Department of Exercise and Sport Science, University of North Carolina, 
Chapel Hill, NC 27514, USA.
(5)School of Nursing, Midwifery and Paramedicine, University of the Sunshine 
Coast, Queensland 4558, Australia.
(6)Sunshine Coast Health Institute, Sunshine Coast Hospital and Health Service, 
Queensland 4575, Australia.
(7)School of Health and Behavioural Sciences, University of the Sunshine Coast, 
Queensland 4558, Australia.
(8)Department of Sport, Health Sciences and Social Work, Oxford Brookes 
University, Oxford OX3 0BP, UK.
(9)Faculty of Health, University of Canterbury, Christchurch 4800, New Zealand.
(10)Department of Tourism, Sport and Society, Lincoln University, Lincoln 7647, 
New Zealand.
(11)School of Sport and Exercise, University of Gloucestershire, Gloucester GL2 
9HW, UK.
(12)Applied Sports, Technology, Exercise and Medicine Research Centre, Swansea 
University, Swansea SA1 8EN, UK.
(13)Physical Activity, Health and Rehabilitation Thematic Research Group, School 
of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth PO1 
2UP, UK.
(14)School of Human Movement and Nutrition Sciences, The University of 
Queensland, Queensland 4067, Australia.
(15)School of Health Sciences, University of Southampton, Southampton SO17 1BJ, 
UK.

Physical activity (PA) participation was substantially reduced at the start of 
the COVID-19 pandemic. The purpose of this study was to assess the association 
between PA, mental health, and wellbeing during and following the easing of 
COVID-19 restrictions in the United Kingdom (UK) and New Zealand (NZ). In this 
study, 3363 adults completed online surveys within 2-6 weeks of initial COVID-19 
restrictions (April/May 2020) and once restrictions to human movement had been 
eased. Outcome measures included the International Physical Activity 
Questionnaire Short-Form, Depression Anxiety and Stress Scale-9 (mental health) 
and World Health Organisation-5 Wellbeing Index. There were no differences in 
PA, mental health or wellbeing between timepoints (p > 0.05). Individuals 
engaging in moderate or high volume of PA had significantly better mental health 
(-1.1 and -1.7 units, respectively) and wellbeing (11.4 and 18.6 units, 
respectively) than individuals who engaged in low PA (p < 0.001). Mental health 
was better once COVID-19 restrictions were eased (p < 0.001). NZ had better 
mental health and wellbeing than the UK (p < 0.001). Participation in 
moderate-to-high volumes of PA was associated with better mental health and 
wellbeing, both during and following periods of COVID-19 containment, compared 
to participation in low volumes of PA. Where applicable, during the current or 
future pandemic(s), moderate-to-high volumes of PA should be encouraged.

DOI: 10.3390/ijerph19031792
PMCID: PMC8835233
PMID: 35162815 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2403. Int J Environ Res Public Health. 2022 Feb 4;19(3):1777. doi: 
10.3390/ijerph19031777.

Supporting Perinatal Mental Health and Wellbeing during COVID-19.

Bridle L(1), Walton L(2), van der Vord T(3), Adebayo O(4), Hall S(5), Finlayson 
E(1), Easter A(6), Silverio SA(6).

Author information:
(1)Women's Services, St. Thomas' Hospital, Guy's and St. Thomas' NHS Foundation 
Trust, London SE1 7EH, UK.
(2)Women's and Children's Division, Princess Royal University Hospital, King's 
College Hospital NHS Foundation Trust, London BR6 8ND, UK.
(3)Women's Health Services, Chelsea and Westminster Hospital, Chelsea and 
Westminster NHS Foundation Trust, London SW10 9NH, UK.
(4)Maternity Services, Watford General Hospital, West Hertfordshire Hospitals 
NHS Trust, Watford WD18 0HB, UK.
(5)Maternity Services, University Hospital Lewisham, Lewisham and Greenwich NHS 
Trust, London SE13 6LH, UK.
(6)Department of Women & Children's Health, School of Life Course & Population 
Sciences, King's College London, London WC2R 2LS, UK.

Mental health is especially important as women transition into parenthood. The 
COVID-19 pandemic has necessitated the rapid reconfiguration of maternity 
services, including perinatal mental healthcare, as offered by Specialist 
Perinatal Mental Health Midwives, in NHS Trusts in the United Kingdom. This 
article represents work undertaken in rapid response to the COVID-19 pandemic 
and aims to document the findings from March 2020 up until May 2021 in 
literature published on perinatal mental health through the pandemic, as well as 
to engage in a knowledge mapping exercise across five NHS Trusts in London. In 
this research, we utilised a critical review methodology which purposefully 
selects and synthesises materials after extensive literature searching to 
provide a broad and informed narrative around an issue. For our knowledge 
mapping exercise, we utilised an inclusive stance to gather, pool, and 
synthesise data from five NHS Trusts regarding the provisions and 
reconfigurations of their perinatal mental health services, creating a 
comparable and translatable snapshot in time. Our rapid, critical review 
highlighted two themes: 'Increased Perinatal Distress' and 'Inaccessible 
Services and Support'. Our knowledge mapping exercise produced four themes: 
'Retention of Existing Service Provision'; 'Additional Services Provided'; 
'Reconfiguration of Service Provision'; 'Additional Provision to Support Staff 
Wellbeing'. We conclude by offering best practice guidance in order to provide 
shared learning to aid the transition through para-pandemic circumstances to 
service delivery in a post-pandemic 'new normal'.

DOI: 10.3390/ijerph19031777
PMCID: PMC8835495
PMID: 35162798 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2404. Int J Environ Res Public Health. 2022 Jan 31;19(3):1659. doi: 
10.3390/ijerph19031659.

Fear of Infection and Depressive Symptoms among German University Students 
during the COVID-19 Pandemic: Results of COVID-19 International Student 
Well-Being Study.

Spatafora F(1), Matos Fialho PM(1), Busse H(2), Helmer SM(3), Zeeb H(2)(4), 
Stock C(3)(5), Wendt C(6), Pischke CR(1).

Author information:
(1)Institute of Medical Sociology, Centre for Health and Society, Medical 
Faculty, Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany.
(2)Department Prevention and Evaluation, Leibniz-Institute for Prevention 
Research and Epidemiology-BIPS, 28359 Bremen, Germany.
(3)Institute of Health and Nursing Science, Charité-Universitätsmedizin Berlin, 
Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 
10117 Berlin, Germany.
(4)Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany.
(5)Unit of Health Promotion Research, University of Southern Denmark, 6705 
Esbjerg, Denmark.
(6)Sociology of Health and Health Care Systems, University Siegen, 57076 Siegen, 
Germany.

The COVID-19 pandemic has a significant psychological impact at the population 
level and fear of infection is one of the stressors involved. The study aimed to 
examine fear of infection and associations with university students' depressive 
symptoms, substance use, and social contacts during the COVID-19 outbreak in 
Germany in May 2020. A cross-sectional online survey was conducted at four 
German universities (n = 5.021, 69% female, mean age: 24 years) as part of the 
COVID-19 International Student Well-being Study. Fear of infection was assessed 
using self-generated items, depressive symptoms were assessed using the Center 
of Epidemiologic Studies Scale (CES-D-8). Associations between fear of infection 
and depressive symptoms were analyzed with linear regressions, controlling for 
sociodemographic variables. A total of 34% of the participants reported feeling 
worried about getting infected themselves, 75% were worried about someone from 
their personal network getting infected, and 78% feared that individuals close 
to them would get severely ill after infection. Sixteen percent of the variance 
of depressive symptoms could be explained by fear of infection (p ≤ 0.001). 
Students' fear of infection should be considered in student communication and 
counseling to prevent worsening of mental health in this population.

DOI: 10.3390/ijerph19031659
PMCID: PMC8834840
PMID: 35162681 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2405. Int J Environ Res Public Health. 2022 Jan 27;19(3):1435. doi: 
10.3390/ijerph19031435.

Assessment of Psychosocial Functioning of Polish Nurses during COVID-19 
Pandemic.

Rachubińska K(1), Cybulska AM(1), Sołek-Pastuszka J(2), Panczyk M(3), 
Stanisławska M(1), Ustianowski P(1), Grochans E(1).

Author information:
(1)Department of Nursing, Pomeranian Medical University in Szczecin, 71-210 
Szczecin, Poland.
(2)Department of Anaesthesiology and Intensive Therapy in Szczecin, Pomeranian 
Medical University, 71-242 Szczecin, Poland.
(3)Department of Education and Research in Health Sciences, Faculty of Health 
Science, Medical University of Warsaw, 00-581 Warsaw, Poland.

(1) The COVID-19 pandemic has significantly affected the psychological 
well-being of people around the world. The aim of this study was to assess the 
levels of psychological distress of nurses (anxiety, depression, stress, 
insomnia) in relation to sociodemographic variables and psychosocial variables: 
self-assessment of health, quarantine, psychological support, presence of 
chronic diseases and the Impact of Events Scale (IES-R). (2) A total of 207 
nurses working with COVID-19 patients at the Independent Public Clinical 
Hospital No. 1 of the Pomeranian Medical University in Szczecin participated in 
the study. The study was conducted with the diagnostic survey method, using the 
Athens Insomnia Scale, the Generalized Anxiety Disorder questionnaire, the 
Impact of Event Scale-Revised, the Patient Health Questionnaire-9, The Perceived 
Stress Scale and a questionnaire of our authorship. (3) Among the respondents, 
40.58% suffered sleep disturbance, 36.71% had mild anxiety, 71.95% had high 
stress according to the PSS-10 and 31.88% had depression according to the PHQ-9. 
The study observed that the chances of insomnia decreased with the age of the 
respondents. Moreover, the form of employment of nurses significantly affected 
the levels of depression, anxiety and stress. (4) Education, gender and age were 
variables that significantly affected the severity of anxiety, depression and 
insomnia in the surveyed nurses working with patients with COVID-19.

DOI: 10.3390/ijerph19031435
PMCID: PMC8835236
PMID: 35162456 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2406. Int J Environ Res Public Health. 2022 Jan 23;19(3):1261. doi: 
10.3390/ijerph19031261.

PaLS Study: Tobacco, Alcohol and Drugs Usage among Polish University Students in 
the Context of Stress Caused by the COVID-19 Pandemic.

Jodczyk AM(1), Kasiak PS(1), Adamczyk N(1)(2), Gębarowska J(1)(2), Sikora Z(1), 
Gruba G(1), Mamcarz A(2)(3), Śliż D(1)(2)(3)(4).

Author information:
(1)Students' Scientific Group of Lifestyle Medicine, 3rd Department of Internal 
Medicine and Cardiology, Medical University of Warsaw, 04-749 Warsaw, Poland.
(2)Polish Society of Lifestyle Medicine, 00-388 Warsaw, Poland.
(3)3rd Department of Internal Medicine and Cardiology, Medical University of 
Warsaw, 04-749 Warsaw, Poland.
(4)School of Public Health, Postgraduate Medical Education Center, 01-813 
Warsaw, Poland.

The COVID-19 pandemic and imposed restrictions were strong stress factors for 
young people, especially students. Increased alcohol consumption, smoking 
cigarettes, usage of heated tobacco products, and other stimulants are common 
methods of coping with anxiety. However, they can have serious negative health 
effects. A survey consisting of 12 questions related to mental health and 
psychoactive substance taking habits was distributed among Polish students 
between 22 February 2021 and 3 April 2021. A total of 1323 participants met all 
inclusion criteria (nfemales = 1021, nmales = 297, nother gender = 5). The mean 
age was 22 years old (±4.17); 47.62% were medical university students. A total 
of 71.92% reported negative impact, 8.25% did not notice changes, and 12.58% 
declared a positive pandemic impact on their mental health. A total of 12.58% 
declared an increase, 70.22% did not see any differences, and 17.20% reported a 
decrease in their psychoactive substance usage tendency due to the pandemic. 
Worse perceived psychologic well-being was correlated with a higher tendency to 
use tobacco (p < 0.001) and alcohol (p < 0.001), and not with marijuana and 
products containing tetrahydrocannabinol (p = 0.136), and hard drugs (p = 
0.799). The majority of participants declared a negative pandemic impact on 
mental health and did not report significant changes in psychoactive substance 
taking habits. Medical personnel should be aware of the current situation and 
apply for proper prevention and treatment programs.

DOI: 10.3390/ijerph19031261
PMCID: PMC8835269
PMID: 35162281 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2407. Int J Environ Res Public Health. 2022 Jan 21;19(3):1170. doi: 
10.3390/ijerph19031170.

Women's Lived Experiences with Temporary Assistance for Needy Families (TANF): 
How TANF Can Better Support Women's Wellbeing and Reduce Intimate Partner 
Violence.

Spencer RA(1), Lemon ED(2), Komro KA(2), Livingston MD(2), Woods-Jaeger B(2).

Author information:
(1)Hubert Department of Global Health, Rollins School of Public Health, Emory 
University, Atlanta, GA 30329, USA.
(2)Department of Behavioral, Social, & Health Education Sciences, Rollins School 
of Public Health, Emory University, Atlanta, GA 30329, USA.

Women experiencing poverty are more likely to face intimate partner violence 
(IPV), poor health, and stigma. IPV survivors are overrepresented among those 
who receive Temporary Assistance for Needy Families (TANF), a conditional cash 
program serving families experiencing poverty. More generous TANF policies may 
be protective against IPV, but a greater insight into TANF's effect could be 
gleaned through a contemporaneous study that examines intersecting determinants 
of wellbeing and engages community interpretation of findings. Using an adapted 
Family Stress Model framework and analyzing data through an intersectional and 
community-based lens, we explore the impact of TANF on women's wellbeing through 
in-depth, semi-structured interviews during the COVID-19 pandemic with 13 women 
who had TANF experience in three U.S. states. Data were analyzed using thematic 
analysis in MAXQDA and researchers facilitated three member-checking events to 
enhance validity of result interpretation. Four themes emerged: (1) Low cash and 
conditional benefits provided limited short-term "relief" but contributed to 
poverty and hard choices; (2) TANF benefit levels and conditions increased 
women's dependence on others, straining relationships; (3) Women undertook 
extraordinary measures to access TANF, largely to fulfill their roles as 
mothers; and (4) TANF stigma creates psychological stress, differentially 
experienced by African Americans. Increasing TANF cash benefits and other cash 
transfers for those experiencing poverty, adopting solely state funded TANF 
programs, increasing funding for TANF administration, addressing TANF stigma and 
racialized narratives, and allowing optional child support participation or a 
larger "pass-through" of child support are important steps toward making TANF 
more protective against IPV.

DOI: 10.3390/ijerph19031170
PMCID: PMC8834626
PMID: 35162193 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript, or in the decision to 
publish the results.


2408. Int J Environ Res Public Health. 2022 Jan 20;19(3):1132. doi: 
10.3390/ijerph19031132.

Mental Health and Wellbeing in Young People in the UK during Lockdown 
(COVID-19).

Owens M(1), Townsend E(2), Hall E(1), Bhatia T(1), Fitzgibbon R(1), Miller-Lakin 
F(1).

Author information:
(1)Department of Psychology, University of Exeter, Exeter EX4 4QG, UK.
(2)Self-Harm Research Group, School of Psychology, University of Nottingham, 
Nottingham NG7 2RD, UK.

This study aimed to assess the levels of mental wellbeing and potential for 
clinical need in a sample of UK university students aged 18-25 during the 
COVID-19 pandemic. We also tested the dose-response relationship between the 
severity of lockdown restrictions and mental wellbeing. We carried out a 
prospective shortitudinal study (one month between baseline and follow up) 
during the pandemic to do this and included 389 young people. We measured a 
range of facets of mental wellbeing, including depression, depressogenic 
cognition (rumination), wellbeing, stress and sleep disturbance. Our primary 
outcome was 'probable depression' as indexed by a score of ≥10 on the patient 
health questionnaire (PHQ-8). The prevalence of probable depression was 
significantly higher than pre-pandemic levels (55%) and did not decrease 
significantly over time (52%). Higher levels of lockdown severity were 
prospectively associated with higher levels of depressive symptoms. Nearly all 
students had at least one mental wellbeing concern at either time point (97%). 
The evidence suggests that lockdown has caused a wellbeing crisis in young 
people. The associated long-term mental, social, educational, personal and 
societal costs are as yet unknown but should be tracked using further 
longitudinal studies.

DOI: 10.3390/ijerph19031132
PMCID: PMC8834421
PMID: 35162165 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2409. Int J Environ Res Public Health. 2022 Jan 20;19(3):1123. doi: 
10.3390/ijerph19031123.

Hope and Fear of Threats as Predictors of Coping with Two Major Adversities, the 
COVID-19 Pandemic and an Armed Conflict.

Marciano H(1)(2), Eshel Y(1)(3), Kimhi S(1), Adini B(4).

Author information:
(1)Stress and Resilience Research Center, Tel-Hai College, Tel Hai 1220800, 
Israel.
(2)The Institute of Information Processing and Decision Making (IIPDM), 
University of Haifa, Haifa 3498838, Israel.
(3)Department of Psychology, University of Haifa, Haifa 3498838, Israel.
(4)Department of Emergency and Disaster Management, School of Public Health, 
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel.

Coping with adversities has been explained by two major theories: the fear 
appeal theory and the hope theory. The predictability of hope with that of fear 
of threats as variables explaining coping with two major adversities, the 
COVID-19 pandemic and an armed conflict, was compared. Participants were 
approached via an internet panel company in two different times: (1) January 
2021 (N = 699; age range: 18-82; 330 women), during the third wave of the 
COVID-19 pandemic in Israel and (2) May 2021 (N = 647; age range: 19-83; 297 
women), during an armed conflict between Israel and Hamas. Participants 
self-reported on hope, four perceived threats (health, economics, security, and 
political), well-being, individual resilience, societal resilience, and distress 
symptoms (anxiety and depression symptoms) were collected. Hope was found as a 
more consistent and stronger predictor of the following expressions of coping: 
well-being, individual and societal resilience, depression, and anxiety. It can 
be concluded that hope is a better and more consistent predictor of coping, as 
well as coping suppressing expressions, compared with fear of threats, in the 
face of the current adversities. The innovative nature of these findings, the 
importance of hope as a coping supporter, and the need for replicating these 
innovative results are discussed and elaborated.

DOI: 10.3390/ijerph19031123
PMCID: PMC8834741
PMID: 35162144 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2410. Int J Environ Res Public Health. 2022 Jan 19;19(3):1081. doi: 
10.3390/ijerph19031081.

Leisure Engagement during COVID-19 and Its Association with Mental Health and 
Wellbeing in U.S. Adults.

Shen X(1), MacDonald M(2), Logan SW(2), Parkinson C(1), Gorrell L(1), Hatfield 
BE(2).

Author information:
(1)Department of Forest Ecosystems and Society, College of Forestry, Oregon 
State University, Corvallis, OR 97331, USA.
(2)College of Public Health and Human Sciences, Oregon State University, 
Corvallis, OR 97331, USA.

Leisure engagement has risen as a salient societal issue during the COVID-19 
pandemic, not only because it provides a pathway for people to continue meeting 
their physical, cognitive, and social-emotional needs, but also due to the 
phenomenal juxtaposition of general increases in leisure time and unparalleled 
constraints. This study reports the results of the first investigation of U.S. 
adults' overall leisure engagement and its association with mental health amidst 
the major disruptions and sustained stress of the COVID-19 pandemic. Qualitative 
and quantitative data were collected through an online survey in February 2021 
through Prolific from a sample representative of the U.S. adult population in 
age, gender, and race (n = 503) and analyzed using a mixed-method approach. A 
total of 104 unique leisure activities in 19 categories and 3 domains were 
identified through iterative thematic coding. Participants reported general 
increases in home-based traditional leisure and digital/online activities and 
decreases in physical and nature-based activities. Multiple regression analyses 
controlling for socio-demographic and context-specific covariates revealed 
distinct associations between changes in leisure engagement and different 
aspects of mental health (perceived stress, depressive symptoms, and mental 
wellbeing), supporting leisure's dual role in facilitating stress alleviation 
and wellbeing enhancement during taxing events, such as COVID-19.

DOI: 10.3390/ijerph19031081
PMCID: PMC8834183
PMID: 35162106 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript, or in the decision to 
publish the results.


2411. Int J Environ Res Public Health. 2022 Jan 19;19(3):1077. doi: 
10.3390/ijerph19031077.

The Mental Health and Social Media Use of Young Australians during the COVID-19 
Pandemic.

Bailey E(1)(2), Boland A(3), Bell I(1)(2), Nicholas J(1)(2), La Sala L(1)(2), 
Robinson J(1)(2).

Author information:
(1)Orygen, Parkville, VIC 3052, Australia.
(2)Centre for Youth Mental Health, University of Melbourne, Parkville, VIC 3010, 
Australia.
(3)Department of Family Medicine & Community Health, University of Massachusetts 
Medical School, Worcester, MA 01655, USA.

Young people may be particularly vulnerable to the mental health impacts of the 
COVID-19 pandemic and may also be more likely to use social media at this time. 
This study aimed to explore young people's mental health and social media use 
during the COVID-19 pandemic and examined their use of social media to seek and 
provide support for suicidal thoughts and self-harm during this period. Young 
people aged 16-25 (n = 371, M = 21.1) from the general population in Australia 
completed an anonymous, cross-sectional online survey advertised on social media 
from June to October 2020. Participants reported high levels of psychological 
distress, with over 40% reporting severe levels of anxiety and depression, and 
those with a mental health diagnosis were more likely to perceive the pandemic 
to have had a negative impact on their mental health. Gender-diverse 
participants appeared the most negatively impacted. Social media use was high, 
with 96% reporting use at least once a day, and two-thirds reporting an increase 
in social media use since the start of the pandemic. One-third had used social 
media to seek support for suicidal thoughts or self-harm, and half had used it 
to support another person. This study adds to a growing literature suggesting 
social media can provide an opportunity to support young people experiencing 
psychological distress and suicide risk. Uniquely, this study points to the 
utility of using social media for this purpose during high-risk periods such as 
pandemics, where access to face-to-face support may be limited. To promote the 
quality and safety of support provided on social media, resources for 
help-seekers and help-givers should be developed and disseminated. Social media 
companies must consider the vulnerability of some users during pandemics and do 
what they can to promote wellbeing and safety.

DOI: 10.3390/ijerph19031077
PMCID: PMC8834625
PMID: 35162101 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2412. J Affect Disord. 2022 Apr 15;303:187-195. doi: 10.1016/j.jad.2022.02.024. Epub 
2022 Feb 12.

Stressful events induce long-term gut microbiota dysbiosis and associated 
post-traumatic stress symptoms in healthcare workers fighting against COVID-19.

Gao F(1), Guo R(2), Ma Q(1), Li Y(3), Wang W(1), Fan Y(3), Ju Y(2), Zhao B(3), 
Gao Y(3), Qian L(3), Yang Z(3), He X(3), Jin X(3), Liu Y(3), Peng Y(3), Chen 
C(3), Chen Y(3), Gao C(3), Zhu F(4), Ma X(5).

Author information:
(1)Department of Psychiatry, The First Affiliated Hospital of Xi'an Jiaotong 
University, 277 Yanta West Road, Xi'an 710061, China; Center for Brain Science, 
The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, 
Xi'an 710061, China; Clinical Research Center for Psychiatric Medicine of 
Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 
277 Yanta West Road, Xi'an 710061, China.
(2)BGI-Shenzhen, Shenzhen 518083, China.
(3)Department of Psychiatry, The First Affiliated Hospital of Xi'an Jiaotong 
University, 277 Yanta West Road, Xi'an 710061, China.
(4)Department of Psychiatry, The First Affiliated Hospital of Xi'an Jiaotong 
University, 277 Yanta West Road, Xi'an 710061, China; Center for Brain Science, 
The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, 
Xi'an 710061, China; Clinical Research Center for Psychiatric Medicine of 
Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 
277 Yanta West Road, Xi'an 710061, China; Center for Translational Medicine, The 
First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, 
Xi'an 710061, China. Electronic address: zhufeng1982@xjtu.edu.cn.
(5)Department of Psychiatry, The First Affiliated Hospital of Xi'an Jiaotong 
University, 277 Yanta West Road, Xi'an 710061, China; Center for Brain Science, 
The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, 
Xi'an 710061, China; Clinical Research Center for Psychiatric Medicine of 
Shaanxi Province, The First Affiliated Hospital of Xi'an Jiaotong University, 
277 Yanta West Road, Xi'an 710061, China. Electronic address: 
maxiancang@163.com.

OBJECTIVE: The microbiota-gut-brain axis is a key pathway perturbed by prolonged 
stressors to produce brain and behavioral disorders. Frontline healthcare 
workers (FHWs) fighting against COVID-19 typically experience stressful event 
sequences and manifest some mental symptoms; however, the role of gut microbiota 
in such stress-induced mental problems remains unclear. We investigated the 
association between the psychological stress of FHW and gut microbiota.
METHODS: We used full-length 16S rRNA gene sequencing to characterize the 
longitudinal changes in gut microbiota and investigated the impact of microbial 
changes on FHWs' mental status.
RESULTS: Stressful events induced significant depression, anxiety, and stress in 
FHWs and disrupted the gut microbiome; gut dysbiosis persisted for at least half 
a year. Different microbes followed discrete trajectories during the half-year 
of follow-up. Microbes associated with mental health were mainly 
Faecalibacterium spp. and [Eubacterium] eligens group spp. with 
anti-inflammatory effects. Of note, the prediction model indicated that low 
abundance of [Eubacterium] hallii group uncultured bacterium and high abundance 
of Bacteroides eggerthii at Day 0 (immediately after the two-month frontline 
work) were significant determinants of the reappearance of post-traumatic stress 
symptoms in FHWs.
LIMITATIONS: The lack of metabolomic evidence and animal experiments result in 
the unclear mechanism of gut dysbiosis-related stress symptoms.
CONCLUSION: The stressful event sequences of fighting against COVID-19 induce 
characteristic longitudinal changes in gut microbiota, which underlies dynamic 
mental state changes.

Copyright © 2022. Published by Elsevier B.V.

DOI: 10.1016/j.jad.2022.02.024
PMCID: PMC8837476
PMID: 35157946 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2413. J Am Coll Health. 2024 Feb-Mar;72(2):414-422. doi: 
10.1080/07448481.2022.2037616. Epub 2022 Feb 14.

Student mental health during the COVID-19 pandemic: Are international students 
more affected?

Kivelä L(1), Mouthaan J(1), van der Does W(1)(2), Antypa N(1).

Author information:
(1)Department of Clinical Psychology, Institute of Psychology, Leiden 
University, Leiden, The Netherlands.
(2)Department of Psychiatry, Leiden University Medical Center, Leiden, The 
Netherlands.

Background: The psychological well-being of students may be especially affected 
by the COVID-19 pandemic; international students can lack local support systems 
and represent a higher risk subgroup. Methods: Self-reported depressive 
symptoms, suicidal ideation, anxiety, post-traumatic stress disorder (PTSD), 
insomnia, alcohol use, academic stress, and loneliness were examined in two 
cohorts of university students (March 2020 n = 207, March 2021 n = 142). We 
investigated differences i) between 2020 and 2021, ii) between domestic and 
international students, and ii) whether differences between the two cohorts were 
moderated by student status. Results: More depressive symptoms, academic stress, 
and loneliness were reported in 2021. International students reported more 
depressive symptoms, suicidal ideation, anxiety, PTSD, academic stress, and 
loneliness. The main effect of cohort was not moderated by student status. 
Conclusions: International students had worse mental health outcomes overall, 
but were not affected more by the COVID-19 pandemic than domestic students.

DOI: 10.1080/07448481.2022.2037616
PMID: 35157564 [Indexed for MEDLINE]


2414. Front Public Health. 2022 Jan 27;9:789912. doi: 10.3389/fpubh.2021.789912. 
eCollection 2021.

Pandemic-Related Challenges and Organizational Support Among Personnel in 
Canada's Defense Establishment.

Goldenberg I(1), Denomme WJ(1), Lee JEC(1).

Author information:
(1)Department of National Defence, Director General Military Personnel Research 
and Analysis, Ottawa, ON, Canada.

In the final week of March 2020, 2.8 million Canadians were away from their 
usual places of work and engaging in remote and/or telework to mitigate the 
spread of COVID-19 (Statistics Canada, 2020). The Government of Canada's 
Department of National Defence (DND) and the Canadian Armed Forces (CAF) were no 
exception, with most members from the regular force (Reg F), the primary reserve 
force (P Res), and the DND public service (DND PS) working from home. The 
COVID-19 Defence Team Survey was administered from April 29th, 2020, and May 
22nd, 2020, to gain insight into work, health, and family-related challenges 
since the onset of the pandemic and change in work arrangements. Responses from 
five open-ended questions were qualitatively analyzed to determine general 
themes of concern regarding work, personal, and family related challenges, 
stress-management and coping strategies, and recommendations for improving the 
work situation and personal well-being. Given the different roles and conditions 
of employment, responses of the different groups or "components" of respondents 
(Reg F, P Res, DND PS) were compared to identify common and unique challenges to 
inform targeted organizational responses. A total of 26,207 members (Reg F = 
13,668, 52.2%; P Res = 5,052, 19.3%; DND PS = 7,487, 28.6%) responded to the 
survey's five open-ended questions, which yielded a total of 75,000 open-ended 
responses. When asked about work-related challenges, respondents' most common 
challenges included dissatisfaction with technology/software, work arrangements, 
ergonomics, work-life balance, communication within the organization, and the 
uncertainties regarding career development. In terms of personal and/or 
family-related challenges, the most common challenges included social isolation, 
the impact of the pandemic on mental health, school closures and homeschooling, 
caring for vulnerable family members, and childcare concerns. The most common 
stress-management and coping strategies included exercise, spending time 
outdoors, communicating or spending time with family members, household 
chores/projects, mind-body wellness exercises, and playing games. The most 
common recommendations made by respondents to improve their work- or 
personal-related situations included improving technological capabilities, 
streamlining communication, providing hardware and software necessary to ensure 
comfortable ergonomics, the provision of flexibility in terms of telework 
schedules, return-to-work decisions, and the expansion of benefits and access to 
childcare services. In terms of differences among the components, DND PS 
personnel were most likely to report dissatisfaction with technological changes 
and ergonomics, and to recommend improving these technological limitations to 
maximize productivity. Reg F members, on the other hand, were most likely to 
recommend increased support and access to childcare, and both Reg F and P Res 
members were more likely to mention that increased benefits and entitlements in 
response to the COVID-19 pandemic would be ameliorative. The results of this 
study highlight several important facts about the impact of the COVID-19 
pandemic on personnel working in large, diverse organizations. For example, 
advancements in organizational technological capabilities were highlighted 
herein, and these are likely to grow to maintain productivity should remote work 
come to be used more extensively in the long-term. This study also highlighted 
the importance of flexibility and accommodation in relation to individual needs 
- a trend that was already underway but has taken on greater relevance and 
urgency in light of the pandemic. This is clearly essential to the 
organization's role in supporting the well-being of personnel and their 
families. Clear and streamlined communication regarding organizational changes 
and support services is also essential to minimize uncertainty and to provide 
useful supports for coping with this and other stressful situations.

Copyright © 2022 Goldenberg, Denomme and Lee.

DOI: 10.3389/fpubh.2021.789912
PMCID: PMC8829139
PMID: 35155349 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2415. J Intensive Care Soc. 2021 Nov;22(4):312-318. doi: 10.1177/1751143720965109. 
Epub 2020 Oct 14.

Psychological impact of caring for critically ill patients during the Covid-19 
pandemic and recommendations for staff support.

Bates A(1), Ottaway J(1), Moyses H(1), Perrrow M(1), Rushbrook S(2), Cusack 
R(1).

Author information:
(1)University Hospital Southampton NHS Foundation Trust, Southampton, UK.
(2)Dorset HealthCare, NHS Foundation Trust Poole, Poole, UK.

BACKGROUND: Reports of significant psychological stress among frontline 
healthcare workers are emerging from the Covid-19 outbreak in China. 
Concerningly, these match findings from previous infective outbreaks, which 
resulted in long-term psychological pathology.
METHODS: During the Covid-19 pandemic, a multi-disciplinary cohort of Intensive 
Care staff completed an online survey of psychological well-being and rated the 
perceived usefulness of supportive interventions.
RESULTS: Sixty per cent of invited staff responded. Seventy-seven per cent 
reported normal/high level of resilience. Thirty-two staff (35%) reported 
anxiety of a level at which formal psychological assessment is recommended. 
Sixteen (14%) staff members reported symptomology suggestive of post-traumatic 
stress disorder (PTSD). Multiple regression analysis revealed a significant 
relationship between job-related well-being, anxiety (p = 0.003) and PTSD 
(p = 0.005). Nurses were seven times more likely than doctors to score higher 
anxiety (OR = 6.8; p = 0.01). Preferred supportive interventions were adequate 
personal protective equipment, rest facilities and regular breaks. In the 
subgroup with high anxiety, psychological support was perceived as significantly 
more useful, with significant reductions reported for rest facilities and PPE.
DISCUSSION: We report concerning levels of anxiety and post-traumatic stress 
symptomology among intensive care staff during the Covid-19 crisis, 
significantly impacting job-related well-being. Nurses are disproportionately 
affected. Overall, physiologically protective supportive interventions were 
preferred by staff; however, staff with established anxiety desire professional 
psychological help. Our findings match reports from SARS 2003 and China 2019. To 
mitigate long-term psychological consequences of caring for patients during a 
pandemic, easily deliverable protective strategies should be instigated, 
supported by formal and longer-term psychological support. Particular attention 
should be paid to developing strategies which support nursing staff.

© The Intensive Care Society 2020.

DOI: 10.1177/1751143720965109
PMCID: PMC8829768
PMID: 35154369

Conflict of interest statement: Declaration of conflicting interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


2416. Br J Nurs. 2022 Feb 10;31(3):148-154. doi: 10.12968/bjon.2022.31.3.148.

Evaluating a psychological support service focused on the needs of critical care 
and theatres staff in the first wave of COVID-19.

Herron K(1), Lonergan G(2), Travis S(3), Rowan P(4), Hutton J(5), Kelly L(6), 
Jordan D(7), Beattie J(8), Hampshire P(9), McCarthy J(10), Ryan S(11), Tsang 
HK(12).

Author information:
(1)Clinical Psychologist, Pain Medicine Department, Liverpool University 
Hospitals NHS Foundation Trust, and The Walton Centre, NHS Foundation Trust, 
Liverpool.
(2)Specialist Pain Nurse, Pain Medicine Department, Liverpool University 
Hospitals NHS Foundation Trust.
(3)Matron, Theatres and Anaesthetics, Liverpool University Hospitals NHS 
Foundation Trust.
(4)Matron, Intensive Care Unit, Liverpool University Hospitals NHS Foundation 
Trust.
(5)Consultant Clinical Psychologist, Clinical Health Psychology, Liverpool 
University Hospitals NHS Foundation Trust.
(6)Honorary Assistant Psychologist, Pain Medicine Department, Liverpool 
University Hospitals NHS Foundation Trust.
(7)Trainee Clinical Psychologist, Pain Medicine Department, Liverpool University 
Hospitals NHS Foundation Trust.
(8)Consultant in Anaesthesia, Theatres and Anaesthetics, Liverpool University 
Hospitals NHS Foundation Trust.
(9)Consultant in Intensive Care Medicine, Critical Care, Liverpool University 
Hospitals NHS Foundation Trust.
(10)Specialist Nurse, Critical Care, Liverpool University Hospitals NHS 
Foundation Trust.
(11)Divisional Nursing Director, Theatres and Anaesthetics, Liverpool University 
Hospitals NHS Foundation Trust.
(12)Consultant in Pain Medicine and Anaesthesia, Pain Medicine Department, 
Liverpool University Hospitals NHS Foundation Trust.

BACKGROUND: In response to COVID-19, the authors used clinical psychology 
resources from their hospital's Pain Medicine Department to provide direct 
support to critical areas.
AIMS: The degree to which the service met the needs of staff and managers 
between March and August 2020 was evaluated.
METHODS: A total of 51 staff were referred. Most were nurses (43%), followed by 
theatre practitioners (36%), healthcare assistants (9%), consultants (8%), 
administrative (2%) and support staff (2%). Working status, reason for referral 
and presenting difficulties at first appointment and outcome were recorded. 
Staff were sent an anonymous survey following intervention.
FINDINGS: Staff reported high rates of burnout, anxiety and low mood, with 22% 
experiencing exacerbation of pre-existing mental health problems. All staff 
reported benefit from the intervention and managers provided positive feedback.
CONCLUSION: Establishing a supportive service that included psychology benefited 
both staff and managers at the peak of the pandemic. Recommendations are 
provided.

DOI: 10.12968/bjon.2022.31.3.148
PMID: 35152743 [Indexed for MEDLINE]


2417. BMC Public Health. 2022 Feb 12;22(1):292. doi: 10.1186/s12889-022-12733-9.

Work fatigue among Lebanese physicians and students during the COVID-19 
pandemic: validation of the 3D-Work Fatigue Inventory (3D-WFI) and correlates.

Sfeir E(1), Rabil JM(1), Obeid S(2), Hallit S(#)(3)(4), Khalife MF(#)(1)(5).

Author information:
(1)School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, 
P.O. Box 446, Jounieh, Lebanon.
(2)Social and Education Sciences Department, School of Arts and Sciences, 
Lebanese American University, Jbeil, Lebanon.
(3)School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, 
P.O. Box 446, Jounieh, Lebanon. souheilhallit@hotmail.com.
(4)Research Department, Psychiatric Hospital of the Cross, Jal-Eddib, Lebanon. 
souheilhallit@hotmail.com.
(5)Department of Pediatrics, Notre Dame des Secours University Hospital Center, 
Street 93, Byblos, Postal Code 3, Lebanon.
(#)Contributed equally

BACKGROUND: Work fatigue is a work-related condition that affects physicians' 
health, work attitude safety and performance. Work fatigue affects not only 
medical workers but can also leave a negative impact on patients. With the 
burden of the COVID-19 pandemic as well as the economic crisis Lebanese doctors 
have been facing in the last 2 years, the aim of our study was to validate the 
3D-Work Fatigue Inventory (3D-WFI) among Lebanese physicians and assess the rate 
and correlates of work fatigue (physical, mental and emotional).
METHODS: A cross-sectional study was undertaken through an anonymous 
self-administered questionnaire between October 2020 and January 2021. The SPSS 
AMOS software v.24 was used to conduct confirmatory factor analysis (CFA). To 
validate the 3D-WFI, multiple indices of goodness-of-fit were described: the 
Relative Chi-square (χ2/df) (cut-off values:< 2-5), the Root Mean Square Error 
of Approximation (RMSEA) (close and acceptable fit are considered for values 
< 0.05 and < 0.11 respectively), the Tucker Lewis Index (TLI) and the 
Comparative Fit Index (CFI) (acceptable values are ≥0.90).
RESULTS: A total of 401 responses was collected; 66.1, 64.8 and 65.1% 
respondents had an intermediate to high level of emotional, mental and physical 
work fatigue respectively. The fit indices obtained in the CFA of the 3D-WFI 
items fitted well: CFI =0.98, TLI =0.98, RMSEA = 0.05; 95% CI 0.046-0.063; 
pclose = 0.20) and χ2(136) = 295.76. The correlation coefficients between the 
three factors (Factor 1 = Physical work fatigue, Factor 2 = Mental work fatigue, 
Factor 3 = Emotional work fatigue) were adequate as well: Factor 1-Factor 2 
(r = 0.70), Factor 1-Factor 3 (r = 0.52) and Factor 2-Factor 3 (r = 0.65). In 
addition, feeling pressured by long working hours during the pandemic, having 
more hours of night duty per month, more stressful events in life, and higher 
depression were significantly associated with more physical and mental work 
fatigue. Higher depression and having more stressful events in life were 
significantly associated with more emotional work fatigue.
CONCLUSION: Work fatigue in Lebanese physicians seems to be associated with 
higher level of everyday stress, high work load and depression. Hospitals and 
local health authorities can use these results for early interventions that aim 
to reduce work fatigue and ensure the wellbeing of Lebanese physicians.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-12733-9
PMCID: PMC8841075
PMID: 35151284 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
report.


2418. J Infect. 2022 Apr;84(4):566-572. doi: 10.1016/j.jinf.2022.02.003. Epub 2022 Feb 
10.

Determinants of persistence of symptoms and impact on physical and mental 
wellbeing in Long COVID: A prospective cohort study.

Righi E(1), Mirandola M(2), Mazzaferri F(2), Dossi G(2), Razzaboni E(2), 
Zaffagnini A(2), Ivaldi F(2), Visentin A(2), Lambertenghi L(2), Arena C(3), 
Micheletto C(3), Gibellini D(4), Tacconelli E(2).

Author information:
(1)Diagnostics and Public Health Department, Infectious Diseases Division, 
University of Verona, P.le L.A. Scuro 10, Verona 37134, Italy. Electronic 
address: elda.righi@univr.it.
(2)Diagnostics and Public Health Department, Infectious Diseases Division, 
University of Verona, P.le L.A. Scuro 10, Verona 37134, Italy.
(3)Respiratory Unit, Verona University Hospital, Verona, Italy.
(4)Diagnostics and Public Health Department, Microbiology Unit, University of 
Verona, Verona, Italy.

Comment in
    J Infect. 2022 Dec;85(6):702-769.
    J Infect. 2023 Feb;86(2):154-225.
    J Infect. 2023 Apr;86(4):e97-e99.

BACKGROUND: Residual symptoms can be detected for several months after COVID-19. 
To better understand the predictors and impact of symptom persistence we 
analyzed a prospective cohort of COVID-19 patients.
METHODS: Patients were followed for 9 months after COVID-19 onset. Duration and 
predictors of persistence of symptoms, physical health and psychological 
distress were assessed.
RESULTS: 465 patients (54% males, 51% hospitalized) were included; 37% presented 
with at least 4 symptoms and 42% complained of symptom lasting more than 28 
days. At month 9, 20% of patients were still symptomatic, showing mainly fatigue 
(11%) and breathlessness (8%). Hospitalization and ICU stay vs. non-hospitalized 
status increased the median duration of fatigue of 8 weeks. Age > 50 years (OR 
2.50), ICU stay (OR 2.35), and presentation with 4 or more symptoms (OR 2.04) 
were independent predictors of persistence of symptoms at month 9. A total of 
18% of patients did not return to optimal pre-COVID physical health, while 19% 
showed psychological distress at month 9. Hospital admission (OR 2.28) and 
persistence of symptoms at day 28 (OR 2.21) and month 9 (OR 5.16) were 
independent predictors of suboptimal physical health, while female gender (OR 
5.27) and persistence of symptoms at day 28 (OR 2.42) and month 9 (OR 2.48) were 
risk factors for psychological distress.
CONCLUSIONS: Patients with advanced age, ICU stay and multiple symptoms at onset 
were more likely to suffer from long-term symptoms, which had a negative impact 
on both physical and mental wellbeing. This study contributes to identify the 
target populations and Long COVID consequences for planning long-term recovery 
interventions.

Copyright © 2022. Published by Elsevier Ltd.

DOI: 10.1016/j.jinf.2022.02.003
PMCID: PMC8828388
PMID: 35150765 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
have no competing interests


2419. Psychiatr Danub. 2021 Dec;33(Suppl 13):420-423.

Screen Time beyond Gaming and Social Media: Excessive and Problematic Use of 
Over the Top (OTT) Platforms among College Students during COVID-19 Pandemic.

Kattula D(1), Singh Balhara YP, Chukkali S, Singh S, Bhargava R, Ganesh R.

Author information:
(1)National Drug Dependence Treatment Center (NDDTC), Department of Psychiatry, 
All India Institute of Medical Sciences (AIIMS), New Delhi, India.

There is a gap in existing literature regarding Over the Top (OTT) platform use 
contributing to the excessive and problematic screen time. We aimed to assess 
OTT platform use among college students and its associations with increased 
screen time, mental well-being, COVID-19 related anxiety and personality traits. 
A total of 1039 students from a college in India were invited to participate in 
this web-based survey. A majority of participants used OTT platforms regularly. 
Subscription to paid OTT platforms, poor mental well-being were associated with 
problematic OTT use; whereas personality trait of conscientiousness seemed to 
offer protection against problematic OTT use.

PMID: 35150519 [Indexed for MEDLINE]


2420. Psychiatr Danub. 2021 Dec;33(Suppl 13):372-378.

Stress Reactions and Coping Strategy among Healthcare Professionals during 
COVID-19 Outbreak.

Bany Hamdan A(1), Alharbi L, Alghamdi S, Wani T, Alqahtani A, Alharbi M.

Author information:
(1)Clinical Care Excellence, King Fahad Medical City, P.O. Box 59046 Riyadh 
11525, Saudi Arabia, ahamdan@kfmc.med.sa.

BACKGROUND: Psychological impacts among healthcare professionals have increased 
significantly due to the increasing number of COVID-19 cases. This study aimed 
to identify stress and coping strategies among healthcare professionals in Saudi 
Arabia during the COVID-19 outbreak.
SUBJECTS AND METHODS: A cross-sectional study online survey was conducted for 
health care professionals during a peak of COVID-19 from March to June 2020 at 
different healthcare institutions at KSA (n=342).
RESULTS: Sixty-five percent of responders often and always feel fears about 
infection and subsequent effects on themselves, the patient, and the family. 57% 
of them stated that they felt sometimes depressed mode and 47% anxiety during 
the outbreak. Eighty-four percent of the respondent always focusing on 
prevention as the first biosecurity measures such as hand-washing habits and 
using hand sanitizer, and 38.3% of them make sometimes relax and rest. While 
half of the responses (50%) sometimes had physical exercise. Also, thirty-eight 
percent joined sometimes community and/or group online chat groups, and 56.1% 
always keep contact with family and friends through social messaging or phone 
calls.
CONCLUSION: Understanding this topic is important for healthcare organizations, 
effective strategies, and programs is needed to provide holistic staff care and 
wellbeing during outbreaks that focus on the value of mental and emotional 
support.

PMID: 35150511 [Indexed for MEDLINE]


2421. Sci Rep. 2022 Feb 10;12(1):2246. doi: 10.1038/s41598-022-06166-y.

Comparison of mental health outcomes in seropositive and seronegative 
adolescents during the COVID19 pandemic.

Blankenburg J(1), Wekenborg MK(2), Reichert J(1), Kirsten C(1), Kahre E(1), Haag 
L(1), Schumm L(1), Czyborra P(1), Berner R(1), Armann JP(3).

Author information:
(1)Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav 
Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, 
Germany.
(2)Biological Psychology, Institute of Psychology, Technische Universität 
Dresden, Zellescher Weg 19, 01069, Dresden, Germany.
(3)Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav 
Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, 
Germany. jakob.armann@uniklinikum-dresden.de.

Post-COVID19 complications such as pediatric inflammatory multisystem syndrome 
(PIMS) and Long-COVID19 move increasingly into focus, potentially causing more 
harm in young adolescents than the acute infection. To better understand the 
symptoms of long-term mental health outcomes in adolescents and distinguish 
infection-associated symptoms from pandemic-associated symptoms, we conducted a 
12 question Long-COVID19 survey. Using this survey, we compared the responses on 
neurocognitive, general pain and mood symptoms from seropositive and 
seronegative adolescents in a cross-sectional study design. Since May 2020, 
students grade 8-12 in fourteen secondary schools in Eastern Saxony were 
enrolled in the SchoolCovid19 study. Serostatus was assessed regularly in all 
participants. In March/April 2021, 1560 students with a median age of 15 years 
participated at the regular study visit after re-opening of the schools in 
mid-March and responded to our Long-COVID19 survey as part of this visit. 1365 
(88%) students were seronegative, 188 (12%) were seropositive. Each symptom 
asked in the Long-COVID19 survey was present in at least 35% of the students 
within the last seven days before the survey. With the exception of seropositive 
students being less sad, there was no significant difference comparing the 
reported symptoms between seropositive students and seronegative students. The 
lack of differences comparing the reported symptoms between seropositive and 
seronegative students suggests that Long-COVID19 might be less common than 
previously thought and emphasizes on the impact of pandemic-associated symptoms 
regarding the well-being and mental health of young adolescents.Clinical Trial 
Registration: SchoolCoviDD19: Prospektive Erfassung der SARS-CoV-2 
Seropositivität bei Schulkindern nach Ende der unterrichtsfreien Zeit aufgrund 
der Corona-Schutz-Verordnung (COVID-19), DRKS00022455, 
https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022455.

© 2022. The Author(s).

DOI: 10.1038/s41598-022-06166-y
PMCID: PMC8831534
PMID: 35145161 [Indexed for MEDLINE]

Conflict of interest statement: Reinhard Berner and Jakob P. Armann report 
grants from the Federal State of Saxony during the conduct of the study. The 
other authors declare no competing interests.


2422. BMJ Open. 2022 Feb 10;12(2):e053563. doi: 10.1136/bmjopen-2021-053563.

What factors have influenced quality of life in people with dementia and their 
family carers during the COVID-19 pandemic: a qualitative study.

Daley S(1), Akarsu N(2), Armsby E(2), Farina N(3), Feeney Y(3), Fine B(2), 
Hughes L(3), Pooley J(2), Tabet N(3), Towson G(2), Banerjee S(3)(4).

Author information:
(1)Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK 
s.daley@bsms.ac.uk.
(2)Sussex Partnership NHS Foundation Trust, Worthing, UK.
(3)Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, 
UK.
(4)Faculty of Health, University of Plymouth, Plymouth, UK.

OBJECTIVES: The COVID-19 pandemic has led to significant disruption to health 
and social care services. For people with dementia and their family carers this 
is problematic, as a group who rely on timely and responsive services to live 
well with the condition. This study has sought to understand how COVID-19 has 
affected the quality of life of people diagnosed with dementia and their family 
carers.
DESIGN: Our mixed-methods study was nested in a larger cohort study of an 
education programme, Time for Dementia.
SETTING: The study took place in the South-East of England.
PARTICIPANTS: Existing study participants, family carers were approached about 
the COVID-19 nested study. A purposeful sample of participants were invited to 
take part in in-depth qualitative interview. The sample included family carers 
in a range of different caring situations.
MEASUREMENT: Interviews were undertaken remotely by telephone. Interviews sought 
to understand quality of life before the pandemic, impact of the restrictions on 
both the person with dementia and family carer, role of services and other 
agencies as well as supportive factors. Data were analysed using thematic 
analysis.
RESULTS: 16 family carers were interviewed. Seven themes were identified from 
our analysis: (1) decreased social interaction; (2) reduced support; (3) 
deteriorating cognitive and physical health for the person with dementia; (4) 
decreased carer well-being; (5) difficulties understanding COVID-19 
restrictions; (6) limited impact for some and (7) trust and relationship with 
care home. There was little change between themes during the first and second 
wave of national lockdowns.
CONCLUSIONS: Our study provides an understanding the short-term impact of 
COVID-19 on the quality of life of people with dementia and their family carers. 
Our findings suggest that recovery between the first and second wave of the 
restrictions did not automatically take place.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/bmjopen-2021-053563
PMCID: PMC8845096
PMID: 35144951 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2423. Afr J Prim Health Care Fam Med. 2022 Jan 12;14(1):e1-e10. doi: 
10.4102/phcfm.v14i1.3034.

Maternity healthcare providers' self-perceptions of well-being during COVID-19: 
A survey in Tshwane Health District, South Africa.

Oosthuizen S(1), Bergh AM, Silver A, Malatji R, Mfolo V, Botha T.

Author information:
(1)Department of Family Medicine, Faculty of Health Sciences, University of 
Pretoria, Pretoria, South Africa; and, Research Centre for Maternal, Fetal, 
Newborns and Child Health Care Strategies, Faculty of Health Sciences, 
University of Pretoria, Pretoria, South Africa; and, South African Medical 
Research Council, Research Unit for Maternal and Infant Health Care Strategies, 
Faculty of Health Sciences, University of Pretoria, Pretoria. 
sarie.silberbauer@gmail.com.

BACKGROUND: Mental health manifestations such as depression and anxiety 
disorders became more marked during the coronavirus disease 2019 (COVID-19) 
pandemic as frontline healthcare workers struggled to maintain high-quality 
intrapartum care and essential health services.
AIM: This study aimed to identify maternity healthcare providers' 
self-perceptions of changes in their feelings of mental well-being.
SETTING: Ten midwife obstetric units and the labour wards of four district 
hospitals in Tshwane Health District, South Africa.
METHODS: We conducted an anonymous, cross-sectional survey amongst a convenience 
sample of 114 maternity healthcare workers to gauge the changes in healthcare 
workers' experience and perceptions of well-being during the COVID-19 pandemic. 
Four items measured the perceived changes on a scale of 0-10 for the periods 
before and during COVID-19, respectively, namely feelings of fear or anxiety, 
stress, depression and anger.
RESULTS: The majority of participants were professional nurses (37%) and 
advanced midwives (47%). They reported a significant change in well-being from 
before the pandemic to during the pandemic with regard to all four items (p 
0.0001). The biggest 'before-during' difference was in perceptions of fear or 
anxiety and the smallest difference was in perceptions of anger. A framework was 
constructed from the open-ended responses to explain healthcare workers' 
understanding and perceptions of increased negative feelings regarding their 
mental well-being.
CONCLUSION: The observed trends in the changes in healthcare workers' 
self-perceptions of their mental well-being highlight the need for further 
planning to build resilient frontline healthcare workers and provide them with 
ongoing mental health support and improved communication pathways.

DOI: 10.4102/phcfm.v14i1.3034
PMCID: PMC8831906
PMID: 35144457 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no financial 
or personal relationships that may have inappropriately influenced them in 
writing this article.


2424. Afr J Prim Health Care Fam Med. 2022 Jan 31;14(1):e1-e6. doi: 
10.4102/phcfm.v14i1.2896.

Satisfaction with life and psychological distress during the COVID-19 pandemic: 
An Egyptian online cross-sectional study.

El-Monshed AH(1), Loutfy A, Saad MT, Ali AS, El-Gilany AH, Soliman Mohamed A, 
Salah M, Zoromba M.

Author information:
(1)Department of Psychiatric and Mental Health Nursing, Faculty of Nursing, 
Mansoura University, Mansoura. ahmed_elmonshed@mans.edu.eg.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a novel sickness that emerged 
worldwide as an unprecedented crisis and led to major effects on the daily life 
of the general public as well as negative impacts on their mental well-being.
AIM: This study aimed to assess satisfaction with life and psychological 
distress during the COVID-19 pandemic in Egypt.
SETTING: An online study was conducted in Egypt.
METHODS: A cross-sectional online survey was fulfilled by 1056 Egyptian adults 
from 06 to 13 June 2020. Psychological distress and satisfaction with life were 
measured by Arabic validated versions of the Kessler Psychological Distress 
Scale (K10) and the Satisfaction with Life Scale (SWLS).
RESULTS: About half of the surveyed respondents (51%) were satisfied with their 
life, whilst 57.4% experienced severe psychological distress. The independent 
predictors of satisfaction with life are being married, satisfactory income, low 
distress, moderate distress and high distress (adjusted odds ratio [AOR] = 1.2, 
3.0, 2.5, 6.9, 5.2 and 2.1, respectively). Being a female, having secondary 
education, secondary education, unsatisfactory income and presence of mental 
illness are the independent predictors of mental distress (AOR = 2.3, 3.9, 1.9, 
1.9, 1.6 and 4.0, respectively).
CONCLUSION: The study provides evidence about the high prevalence of 
psychological distress during the peak period of Egypt's COVID-19 pandemic. The 
study results highlight the enhancement of development interventions to promote 
psychological well-being and feeling of satisfaction with life during the 
pandemic.

DOI: 10.4102/phcfm.v14i1.2896
PMCID: PMC8831996
PMID: 35144450 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no financial 
or personal relationships that may have inappropriately influenced them in 
writing this article.


2425. J Occup Health Psychol. 2022 Feb;27(1):1-2. doi: 10.1037/ocp0000319.

Professor Sharon Clarke (Editor, Journal of Occupational Health Psychology).

Clarke S(1).

Author information:
(1)Alliance Manchester Business School, University of Manchester.

In this brief article, the editor of the Journal of Occupational Health 
Psychology notes that there has been a rapid increase in the visibility of 
occupational health psychology over the last 25 years, which has seen growing 
impact and importance of OHP topics. In this time, the nature of work has 
changed considerably due to significant societal and technological 
transformations and particularly over the last 2 years as the result of the 
coronavirus disease (COVID-19) global pandemic, which has impacted all of our 
lives, including our mental health, well-being, and safety in the context of 
work. The author welcomes the incoming editorial team, thanks members of the 
outgoing editorial team, and thanks the editorial board for their support as she 
starts her editorial tenure in 2022. (PsycInfo Database Record (c) 2022 APA, all 
rights reserved).

DOI: 10.1037/ocp0000319
PMID: 35143245 [Indexed for MEDLINE]


2426. Curr Opin Clin Nutr Metab Care. 2022 May 1;25(3):188-194. doi: 
10.1097/MCO.0000000000000821. Epub 2022 Feb 9.

Breastfeeding in a COVID-19 world.

Sakalidis VS(1), Perrella SL(1)(2), Prosser SA(1)(2), Geddes DT(1)(3).

Author information:
(1)School of Molecular Sciences, University of Western Australia, Perth, WA, 
Australia.
(2)One For Women, Mt Lawley, WA, Australia.
(3)Telethon Kids Institute, Perth, WA, Australia.

PURPOSE OF REVIEW: The coronavirus disease 2019 (COVID-19) pandemic has changed 
the birthing and postnatal experience of women. This review highlights how 
policy changes have affected pregnant and breastfeeding women, the evidence for 
continued breastfeeding and severe acute respiratory syndrome coronavirus 2 
(SARS-CoV-2) vaccines, and how the pandemic's unexpected consequences have 
affected these women's wellbeing. Additionally, we postulate the future of 
lactation and perinatal support as the pandemic continues.
RECENT FINDINGS: Women who have given birth during the pandemic have had 
restricted access to postnatal care. Although pregnant and breastfeeding women 
who contract SARS-CoV-2 are more vulnerable to poor health outcomes than their 
nonpregnant counterparts, they are also at higher risk of mental health 
difficulties, with limited access to support. Continued breastfeeding may be 
protective to the infant, offering passive immunity against SARS-CoV-2, and 
vaccination against COVID-19 is safe and effective for pregnant and lactating 
women. Innovative and adaptable lactation care, including holistic perinatal, 
mental health, and social support services, both digital and in-person, will 
help mothers continue breastfeeding during future outbreaks.
SUMMARY: Continued breastfeeding and vaccination may confer protection to the 
infant against SARS-CoV-2 infection. New mothers should not be isolated in 
future pandemics. Prioritizing lactation and perinatal care, including in-person 
services, remains paramount to optimizing breastfeeding during COVID-19.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/MCO.0000000000000821
PMID: 35142722 [Indexed for MEDLINE]


2427. Eur J Psychotraumatol. 2021 Apr 30;12(1):1904700. doi: 
10.1080/20008198.2021.1904700. eCollection 2021.

Understanding the lived experiences of healthcare professionals during the 
COVID-19 pandemic: an interpretative phenomenological analysis.

McGlinchey E(1), Hitch C(1), Butter S(1), McCaughey L(1), Berry E(2), Armour 
C(1)(2).

Author information:
(1)Stress Trauma and Related Conditions (STARC) Research Lab, School of 
Psychology, Queen's University Belfast, Belfast, Northern Ireland, UK.
(2)Centre for Improving Health Related Quality of Life (CIHRQoL), School of 
Psychology, Queen's University Belfast, Belfast, Northern Ireland, UK.

Background: Little research has examined the impact of working within the 
context of COVID-19 on UK healthcare professionals (HCPs) mental health and 
well-being, despite previous pandemic findings indicating that HCPs are 
particularly vulnerable to suffering PTSD and other mental health difficulties 
due to the nature of healthcare work. Specifically, it appears that no research 
has employed qualitative methodologies to explore the effects of working amidst 
COVID-19 on mental health for HCPs in the UK. Objective: To qualitatively 
examining the lived experiences of HCPs in Northern Ireland, working during the 
early stages of the pandemic and lockdown period (14.04.20 and 29.04.20). 
Method: Interpretative phenomenological analysis (IPA) was used to explore the 
experiences of healthcare professionals, who were working during the COVID-19 
outbreak. Ten HCPs were recruited via a social media campaign and snowball 
sampling. All interviews were conducted via telephone and transcribed verbatim. 
Results: Three superordinate themes with subordinate themes were elicited 
through the analysis. Theme one centred on specific challenges of HCPs working 
during the pandemic, such as redeployment, isolation from loved ones, infection 
concerns, lack of PPE and impact on patient interpersonal care. Theme two 
offered insights into the mental health and wellbeing of HCPs, while many 
experienced feelings of fear, sadness and hypervigilance, all also demonstrated 
a marked resilience. Finally, many felt undervalued and misunderstood, and 
wished to press upon the general public seriousness of the disease. Conclusion: 
To the authors' knowledge this is the first study to explore in depth, the 
unique experiences of frontline HCPs in Northern Ireland, offering a detailed 
account of the challenges confronted in these unprecedented circumstances and 
highlighting support needs within this cohort.

Publisher: Antecedentes: Pocas investigaciones han examinado el impacto de 
trabajar en el contexto COVID-19 en la salud mental y bienestar de los 
profesionales de salud del Reino Unido (HCPs por sus siglas en inglés), a pesar 
que los hallazgos de pandemias previas señalan que los HCPs son particularmente 
vulnerables a sufrir TEPT y otras dificultades de salud mental debido a la 
naturaleza del trabajo sanitario. Específicamente, pareciera que ninguna 
investigación ha utilizado metodologías cualitativas para explorar los efectos 
de trabajar en medio de COVID-19 en la salud mental de los HCPs en el Reino 
Unido.Objetivo: Examinar cualitativamente las experiencias vividas de los HCPs 
en Irlanda del Norte, trabajando durante las primeras etapas de la pandemia y el 
periodo de confinamiento (14.04.20 y 29.04.20).Método: Se utilizó un Análisis 
fenomenológico interpretativo (IPA por sus siglas en inglés) para explorar las 
experiencias de los profesionales de la salud, que estuvieron trabajando durante 
el brote de COVID-19. Fueron reclutados diez HCPs a través de una campaña por 
medios sociales y un muestreo de bola de nieve. Todas las entrevistas se 
realizaron por teléfono y se transcribieron literalmente.Resultados: A través 
del análisis se obtuvieron tres temas superiores con temas subordinados. El tema 
uno se centró en los desafíos específicos de los HCPs que trabajaban durante la 
pandemia, como el redespliegue, estar aislados de los seres queridos, 
preocupaciones de infectarse, falta de EPP y el impacto en la atención 
interpersonal del paciente. El tema dos ofreció concientización sobre la salud 
mental y bienestar de los HCPs, aunque muchos experimentaron sentimientos de 
miedo, tristeza e hipervigilancia, todos también demostraron una marcada 
resiliencia. Finalmente, muchos se sintieron subvalorados y poco comprendidos y 
desearon presionar al público en general sobre la gravedad de la 
enfermedad.Conclusión: Según el conocimiento de los autores, este es el primer 
estudio que explora en profundidad, las experiencias únicas de los HCPS de 
primera línea en Irlanda del Norte, ofreciendo un recuento detallado de los 
desafíos enfrentados en estas circunstancias sin precedentes y destaca las 
necesidades de apoyo dentro de esta cohorte.

Publisher: 背景: 尽管先前疫情研究表明, 英国医护专业人员 (HCP) 因医护工作性质格外易感PTSD和其他精神疾病困扰, 
很少有研究考查在COVID-19背景下工作对HCP心理健康的影响。具体而言, 
似乎没有研究采用定性方法来探究英国HCP在COPID-19中工作对其心理健康的影响。目的: 定性考查在疫情和封锁期间 (14.04.20和29.04.20) 
早期工作的北爱尔兰HCP的亲身经历。方法: 使用解释性现象学分析 (IPA) 
来探讨COVID-19爆发期间工作的医护人员的经历。通过社交媒体活动和滚雪球采样招募了十组HCP。所有访谈均通过电话进行, 并逐字记录。结果: 
通过分析得出了三个有子主题的上级主题。主题一集中在疫情期间HCP工作的特定挑战, 例如人员调动, 与亲人隔离, 感染问题, 
缺乏PPE以及对患者人际关怀的影响。主题二提供了对HCP心理健康和幸福的见解, 尽管经历了许多恐惧, 悲伤和高警觉的感觉, 大家都表现出明显的心理韧性。最后, 
许多人感到被低估和被误解了, 并希望向公众强调这种疾病的严重性。结论: 据作者所知, 这是首篇深入探究北爱尔兰前线HCP独特经历的研究, 
详细介绍了此群体在这些前所未有情况下面临的挑战, 并强调了支持他们的需求。.

© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & 
Francis Group.

DOI: 10.1080/20008198.2021.1904700
PMCID: PMC8820784
PMID: 35140877 [Indexed for MEDLINE]

Conflict of interest statement: No potential conflict of interest was reported 
by the author(s).


2428. BMJ Open. 2022 Feb 9;12(2):e057492. doi: 10.1136/bmjopen-2021-057492.

Changes in mental health problems and suicidal behaviour in students and their 
associations with COVID-19-related restrictions in Norway: a national repeated 
cross-sectional analysis.

Sivertsen B(1)(2)(3), Knapstad M(4), Petrie K(5), O'Connor R(6), Lønning 
KJ(7)(8), Hysing M(9).

Author information:
(1)Department of Health Promotion, Norwegian Institute of Public Health, Bergen, 
Norway borge.sivertsen@fhi.no.
(2)Department of Mental Health, Norwegian University of Science and Technology, 
Trondheim, Norway.
(3)Department of Research & Innovation, Helse Fonna HF, Haugesund, Norway.
(4)Department of Health Promotion, Norwegian Institute of Public Health, Bergen, 
Norway.
(5)Department of Psychological Medicine, University of Auckland, Auckland, New 
Zealand.
(6)Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, 
University of Glasgow, Glasgow, UK.
(7)The Student Welfare Organization in Oslo and Akershus (SiO), Oslo, Norway.
(8)The Norwegian Medical Association, Oslo, Norway.
(9)Department of Psychosocial Science, University of Bergen, Bergen, Norway.

OBJECTIVE: The COVID-19 pandemic has had a devastating impact on higher 
education, with the closure of student campuses. The aim of this study was to 
examine changes and prevalence of mental health problems, suicidal ideation and 
suicidal behaviour, and their associations with COVID-19-related restrictions.
DESIGN, SETTING AND PARTICIPANTS: As part of the SHoT-study in Norway, 62 498 
students completed an online questionnaire (65.6% women; response rate of 34.4%) 
in March 2021. Data were compared with previous waves, conducted in 2018, 2014 
and 2010.
PRIMARY AND SECONDARY OUTCOME MEASURES: Mental health problems were assessed 
using the Hopkins Symptoms Checklist. Suicidal ideation, suicide attempts and 
non-suicidal self-harm (NSSH) were assessed with three items drawn from the 
Adult Psychiatric Morbidity Survey, and thoughts of NSSH were assessed with one 
item from the Child and Adolescent Self-Harm in Europe study.
RESULTS: There was a significant increase in mental health problems from 2010 to 
2021, and especially from 2018 (men: 27%/women: 45%) to 2021 (men: 41%/women: 
62%, p <0.001). A similar pattern was also observed for suicidal thoughts. 
Unlike previous waves, there were large geographical differences in mental 
health problems in 2021, which mapped onto the different levels of COVID-19 
cases and regional COVID-19-related restrictions. There was a significant 
negative dose-response association between days spent physically on campus and 
both mental health problems and indicators of suicide risk. We found the fewer 
days spent on campus in the last 2 weeks, the higher levels of mental health 
problems during the same time period. There was also an association between days 
on campus and a higher prevalence of suicidal thoughts, NSSH and suicide 
attempts in the last year.
CONCLUSION: This study demonstrates a sharp increase and disturbing levels of 
mental health problems and suicide risk among students during the COVID-19 
pandemic. Although causal conclusions cannot be drawn, the associations between 
closure of campuses and mental problems emphasise the importance of having 
access to campuses for student well-being.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-057492
PMCID: PMC8829843
PMID: 35140162 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2429. BMJ Open. 2022 Feb 9;12(2):e053676. doi: 10.1136/bmjopen-2021-053676.

'You're just there, alone in your room with your thoughts': a qualitative study 
about the psychosocial impact of the COVID-19 pandemic among young people living 
in the UK.

McKinlay AR(1), May T(2), Dawes J(3), Fancourt D(2), Burton A(2).

Author information:
(1)Department of Behavioural Science and Health, Department of Epidemiology and 
Health Care, University College London, London, UK a.mckinlay@ucl.ac.uk.
(2)Department of Behavioural Science and Health, Department of Epidemiology and 
Health Care, University College London, London, UK.
(3)UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology and 
Health Care, University College London, London, UK.

OBJECTIVES: Adolescents and young adults have been greatly affected by 
quarantine measures during the COVID-19 pandemic, but little is understood about 
how restrictions have affected their well-being, mental health, and social life. 
We therefore aimed to learn more about how UK quarantine measures affected the 
social lives, mental health and well-being of adolescents and young adults.
DESIGN: Qualitative interview study. The data were analysed using reflexive 
thematic analysis, with particular attention paid to contextual factors (such as 
age, gender, ethnicity and health status) when analysing each individual 
transcript.
SETTING: Data collection took place remotely across the UK via audio or video 
call, between June 2020 and January 2021.
PARTICIPANTS: We conducted semi-structured interviews with 37 participants (aged 
13-24 years) to elicit their views.
RESULTS: Authors generated four themes during the qualitative analysis: (a) 
concerns about disruption to education, (b) missing social contact during 
lockdown, (c) changes to social relationships and (d) improved well-being during 
lockdown. Many participants said they struggled with a decline in mental health 
during the pandemic, lack of support and concern about socialising after the 
pandemic. However, some participants described experiences and changes brought 
on by the pandemic as helpful, including an increased awareness of mental health 
and feeling more at ease when talking about it, as well as stronger relationship 
ties with family members.
CONCLUSIONS: Findings suggest that young people may have felt more comfortable 
when talking about their mental health compared with prepandemic, in part 
facilitated by initiatives through schools, universities and employers. However, 
many were worried about how the pandemic has affected their education and social 
connections, and support for young people should be tailored accordingly around 
some of these concerns.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/bmjopen-2021-053676
PMCID: PMC8829834
PMID: 35140155 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2430. Singapore Med J. 2023 Nov;64(11):667-676. doi: 10.11622/smedj.2022014.

Safety attitudes, burnout and well-being among healthcare workers during the 
COVID-19 pandemic: an Indo-Pacific regional cross-sectional study.

Kanneganti A(1), Tan BYQ(2), Nik Ab Rahman NH(3), Leow AS(2), Denning M(4), Goh 
ET(4), Hao Lim LJ(5), Sia CH(6), Chua YX(7), Kinross J(4), Tan M(8), Tan LF(9), 
Wan YM(10), Sharma A(11), Danuaji R(12), Komal Kumar RN(13), Sheng CK(14), Kheng 
CP(15), Abdul Karim SS(16), Abdul Ghani MN(17), Mahmud S(18), Chan YH(19), 
Sharma VK(2), Sim K(20), Suat Ooi SB(21).

Author information:
(1)Department of Obstetrics and Gynaecology, National University Hospital, 
Singapore.
(2)Department of Medicine, Yong Loo Lin School of Medicine, National University 
of Singapore, Singapore.
(3)Department of Emergency & Trauma, Hospital Universiti Sains Malaysia; 
Department of Emergency Medicine, School of Medical Sciences, Universiti Sains 
Malaysia, Kota Bharu, Malaysia.
(4)Department of Surgery and Cancer, Imperial College London, UK.
(5)Early Psychosis Intervention Program, Institute of Mental Health, Singapore.
(6)Department of Medicine, Yong Loo Lin School of Medicine, National University 
of Singapore; Department of Cardiology, National University Heart Centre 
Singapore, Singapore.
(7)National University Polyclinics - Pioneer, National University Health System, 
Singapore.
(8)Department of Geriatric Medicine, Ng Teng Fong General Hospital, Singapore.
(9)Division of Healthy Ageing, Alexandra Hospital, Singapore.
(10)Department of Psychiatry, Ng Teng Fong General Hospital, Singapore.
(11)Department of Neurology, Zydus Hospitals and BJ Medical College, Ahmedabad, 
Gujarat, India.
(12)Department of Neurology, Dr Moewardi Hospital, Kota Surakarta, Jawa Tengah, 
Indonesia.
(13)Cerebrovascular Unit, Yashoda Institute of Neuroscience, Secunderabad, 
Telangana, India.
(14)Department of Surgery, Faculty of Medicine & Health Sciences, Universiti 
Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
(15)Emergency and Trauma Department, Sabah Women and Children's Hospital, Kota 
Kinabalu, Sabah, Malaysia.
(16)Emergency and Trauma Department, Hospital Sungai Buloh, Sungai Buloh, 
Selangor, Malaysia.
(17)Emergency and Trauma Department, Hospital Raja Perempuan Zainab (II), Bandar 
Kota Bharu, Kelantan, Malaysia.
(18)Emergency and Trauma Department, Hospital Tuanku Jaafar, Seremban, Negeri 
Sembilan, Malaysia.
(19)Biostatistics Unit, Yong Loo Lin School of Medicine, National University of 
Singapore, Singapore.
(20)West Region, Institute of Mental Health; Department of Psychological 
Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 
Singapore.
(21)Emergency Medicine Department, National University Hospital; Department of 
Surgery, Yong Loo Lin School of Medicine, National University Singapore, 
Singapore.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has had an 
unprecedented impact in Asia and has placed significant burden on already 
stretched healthcare systems. We examined the impact of COVID-19 on the safety 
attitudes among healthcare workers (HCWs), as well as their associated 
demographic and occupational factors, and measures of burnout, depression and 
anxiety.
METHODS: A cross-sectional survey study utilising snowball sampling was 
performed involving doctors, nurses and allied health professions from 23 
hospitals in Singapore, Malaysia, India and Indonesia between 29 May 2020 and 13 
July 2020. This survey collated demographic data and workplace conditions and 
included three validated questionnaires: the Safety Attitudes Questionnaire 
(SAQ), Oldenburg Burnout Inventory and Hospital Anxiety and Depression Scale. We 
performed multivariate mixed-model regression to assess independent associations 
with the SAQ total percentage agree rate (PAR).
RESULTS: We obtained 3,163 responses. The SAQ total PARs were found to be 35.7%, 
15.0%, 51.0% and 3.3% among the respondents from Singapore, Malaysia, India and 
Indonesia, respectively. Burnout scores were highest among respondents from 
Indonesia and lowest among respondents from India (70.9%-85.4% vs. 56.3%-63.6%, 
respectively). Multivariate analyses revealed that meeting burnout and 
depression thresholds and shifts lasting ≥12 h were significantly associated 
with lower SAQ total PAR.
CONCLUSION: Addressing the factors contributing to high burnout and depression 
and placing strict limits on work hours per shift may contribute significantly 
towards improving safety culture among HCWs and should remain priorities during 
the pandemic.

DOI: 10.11622/smedj.2022014
PMCID: PMC10754367
PMID: 35139631 [Indexed for MEDLINE]

Conflict of interest statement: None


2431. J Med Internet Res. 2022 Apr 13;24(4):e26438. doi: 10.2196/26438.

Single-Session, Internet-Based Cognitive Behavioral Therapy to Improve Parenting 
Skills to Help Children Cope With Anxiety During the COVID-19 Pandemic: 
Feasibility Study.

Korpilahti-Leino T(#)(1)(2), Luntamo T(#)(1)(2)(3), Ristkari T(1)(2), 
Hinkka-Yli-Salomäki S(1)(2), Pulkki-Råback L(1)(2), Waris O(1)(2), Matinolli 
HM(1)(2), Sinokki A(1)(2), Mori Y(1)(2), Fukaya M(4), Yamada Y(5), Sourander 
A(1)(2)(3).

Author information:
(1)Research Centre for Child Psychiatry, Department of Clinical Medicine, 
Faculty of Medicine, University of Turku, Turku, Finland.
(2)INVEST Child Psychiatry, INVEST Research Flagship Center, Department of 
Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland.
(3)Department of Child Psychiatry, Turku University Hospital, Turku, Finland.
(4)Department of Psychology and Human Developmental Sciences, Graduate School of 
Education and Human Development, Nagoya University, Nagoya, Japan.
(5)Section of Medical Care and Consultation, Nagoya City Central Care Center for 
Disabled Children, Nagoya, Japan.
(#)Contributed equally

BACKGROUND: The COVID-19 pandemic has had a major impact on families' daily 
routines and psychosocial well-being, and technology has played a key role in 
providing socially distanced health care services.
OBJECTIVE: The first objective of this paper was to describe the content and 
delivery of a single-session, internet-based cognitive behavioral therapy (iCBT) 
intervention, which has been developed to help parents cope with children's 
anxiety and manage daily situations with their children. The second objective 
was to report user adherence and satisfaction among the first participants who 
completed the intervention.
METHODS: The Let's Cope Together intervention has been developed by our research 
group. It combines evidence-based CBT elements, such as psychoeducation and 
skills to manage anxiety, with parent training programs that strengthen how 
parents interact with their child and handle daily situations. A pre-post design 
was used to examine user satisfaction and the skills the parents learned. 
Participants were recruited using advertisements, media activity, day care 
centers, and schools and asked about background characteristics, emotional 
symptoms, and parenting practices before they underwent the iCBT. After they 
completed the 7 themes, they were asked what new parenting skills they had 
learned from the iCBT and how satisfied they were with the program.
RESULTS: Of the 602 participants who filled in the baseline survey, 196 (32.6%) 
completed the program's 7 themes, and 189 (31.4%) completed the postintervention 
survey. Most (138/189, 73.0%) of the participants who completed the 
postintervention survey were satisfied with the program and had learned skills 
that eased both their anxiety (141/189, 74.6%) and their children's anxiety 
(157/189, 83.1%). The majority (157/189, 83.1%) reported that they learned how 
to organize their daily routines better, and just over one-half (100/189, 53.0%) 
reported that the program improved how they planned each day with their 
children.
CONCLUSIONS: The single-session iCBT helped parents to face the psychological 
demands of the COVID-19 pandemic. Future studies should determine how the 
participation rate and adherence can be optimized in digital, universal 
interventions. This will help to determine what kinds of programs should be 
developed, including their content and delivery.

©Tarja Korpilahti-Leino, Terhi Luntamo, Terja Ristkari, Susanna 
Hinkka-Yli-Salomäki, Laura Pulkki-Råback, Otto Waris, Hanna-Maria Matinolli, 
Atte Sinokki, Yuko Mori, Mami Fukaya, Yuko Yamada, Andre Sourander. Originally 
published in the Journal of Medical Internet Research (https://www.jmir.org), 
13.04.2022.

DOI: 10.2196/26438
PMCID: PMC9009379
PMID: 35138265 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: AS is the founder and 
director of Digifamilies, which provides evidence-based treatments to Finnish 
public health services.


2432. Ethn Health. 2023 Feb;28(2):257-280. doi: 10.1080/13557858.2022.2035692. Epub 
2022 Feb 9.

Impact of COVID-19 pandemic on the psychological well-being of migrants and 
refugees settled in Spain.

Garrido R(1), Paloma V(1), Benítez I(2), Skovdal M(3), Verelst A(4), Derluyn 
I(4).

Author information:
(1)Department of Social Psychology, Universidad de Sevilla, Sevilla, Spain.
(2)Department of Methodology of Behavioral Sciences, Universidad de Granada, 
Granda, Spain.
(3)Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
(4)Department of Social Work and Social Pedagogy, Ghent University, Gent, 
Belgium.

OBJECTIVES: The COVID-19 pandemic has exacerbated health inequalities worldwide, 
having a disproportionately harsh impact on unprivileged populations such as 
migrants and refugees. These populations are often more exposed to the virus, 
but less protected, while at the same time being at higher risk of suffering 
from poor living and working conditions, limited access to healthcare, and 
discrimination by the host society, all of which is challenging to their mental 
health. Empirical evidence on how the COVID-19 pandemic is affecting migrants 
and refugees is required to design effective actions aimed at ensuring health 
equity. Therefore, this paper aims to analyse how the pandemic has impacted the 
psychological well-being of migrants and refugees living in Spain.
DESIGN: This study was carried out within the framework of the ApartTogether 
study sponsored by the World Health Organization. Data collection was carried 
out during March-November 2020, through an online survey completed by 241 
participants (age: M = 37 years; 129 women).
RESULTS: The results indicate that 78.7% of participants had suffered a decrease 
in their psychological well-being since the onset of the COVID-19 pandemic, with 
number of difficulties and worries experienced being the best individual 
predictors of this outcome. Enjoying social connections and perceiving positive 
treatment from the host society were positively associated with psychological 
well-being at a relational and community level, respectively.
CONCLUSION: Based on these findings, we outline priority areas of psychosocial 
interventions aimed at guaranteeing the mental health of migrants and refugees 
in the face of the pandemic in Spain.

DOI: 10.1080/13557858.2022.2035692
PMID: 35138212 [Indexed for MEDLINE]


2433. J Public Health (Oxf). 2023 Mar 14;45(1):e57-e64. doi: 10.1093/pubmed/fdac008.

Impact of COVID-19 pandemic outbreak on mental health of the hospital front-line 
healthcare workers in Chile: a difference-in-differences approach.

Olivares-Tirado P(1)(2), Zanga-Pizarro R(1)(3).

Author information:
(1)Research and Development Department, Superintendency of Health of Chile, 
Santiago, Chile.
(2)Health Service Development Research Center. University of Tsukuba, 7921501 
Tsukuba, Japan.
(3)School of Public Health, Faculty of Medicine, University of Chile, 7921501 
Santiago, Chile.

BACKGROUND: Most of the evidence about impact of COVID-19 pandemic on the mental 
health of healthcare workers (HCWs) comes from symptom questionnaires. It is 
important to evaluate main mental health diagnoses in hospital front-line HCW's 
during the early acute phase of the COVID-19 pandemic in Chile.
METHODS: An individual-level cross-sectional study using administrative data was 
conducted. A Difference-in-Difference (DiD) approach was used to estimate the 
impact of the COVID-19 pandemic on sick leave rates of depression, anxiety and 
acute stress reaction among hospital front-line HCW's in comparison with other 
private insured workers.
RESULTS: DiD estimates showed a significant reduction of depression (17%), 
anxiety (8%) and acute stress reaction (8%) sick leave rate, in the front-line 
HCWs during the COVID-19 pandemic. Reduction of the three mental disorders sick 
leave rates was higher in men than women. Except for depression, front-line 
HCW's from the Santiago region's sick leave rates of anxiety and acute stress 
reaction decreased more than other regions'.
CONCLUSION: Opposite to our hypothesis the results suggests a remarkable 
resilience level and compromise of front-line HCW's. To address threats to the 
mental health of HCW's is key to promotes programs for their psychological 
well-being and safety.

© The Author(s) 2022. Published by Oxford University Press on behalf of Faculty 
of Public Health. All rights reserved. For permissions, please e-mail: 
journals.permissions@oup.com.

DOI: 10.1093/pubmed/fdac008
PMCID: PMC8903375
PMID: 35137226 [Indexed for MEDLINE]


2434. Global Health. 2022 Feb 8;18(1):12. doi: 10.1186/s12992-022-00807-7.

A cross-sectional investigation of the mental health and wellbeing among 
individuals who have been negatively impacted by the COVID-19 international 
border closure in Australia.

Ali K(1)(2), Iasiello M(3)(4), van Agteren J(5)(3), Mavrangelos T(5), Kyrios 
M(5)(6), Fassnacht DB(5)(6).

Author information:
(1)College of Education, Psychology and Social Work, Flinders University, Sturt 
Road, Bedford Park, South Australia, 5042, Australia. 
kathina.ali@flinders.edu.au.
(2)Órama Institute for Mental Health & Wellbeing, Flinders University, Sturt 
Road, Bedford Park, South Australia, 5042, Australia. 
kathina.ali@flinders.edu.au.
(3)Wellbeing and Resilience Centre, Lifelong Health Theme, South Australian 
Health and Medical Research Institute, North Terrace, Adelaide, South Australia, 
5000, Australia.
(4)College of Nursing and Health Science, Flinders University, Sturt Road, 
Bedford Park, South Australia, 5042, Australia.
(5)College of Education, Psychology and Social Work, Flinders University, Sturt 
Road, Bedford Park, South Australia, 5042, Australia.
(6)Órama Institute for Mental Health & Wellbeing, Flinders University, Sturt 
Road, Bedford Park, South Australia, 5042, Australia.

BACKGROUND: The COVID-19 pandemic resulted in the Australian government 
implementing strict international border closures. However, research has not yet 
investigated the mental health status of individuals impacted negatively by 
these international border closures.
METHODS: The present study was a cross-sectional online survey of 3968 adults 
who reported being negatively affected by the border closure during June and 
July 2021. Psychological distress was measured with the Kessler Psychological 
Distress Scale (K10), stress with the Perceived Stress Scale (PSS) and wellbeing 
with the Mental Health Continuum Short Form (MHC-SF).
RESULTS: In total, 3968 participants reported being negatively affected by the 
current restrictions (63.4% in Australia, 36.6% overseas). The vast majority of 
respondents (83.6%) reported high or very high levels of psychological distress 
(mean K10 score > 22), and 74.8% reported poor mental wellbeing, with similar 
risk profiles for participants in Australia or overseas. The most common 
scenarios of affected individuals included 1) wanting to enter Australia 
(30.8%), 2) wanting to leave Australia (29.6%) and 3) wanting someone to enter 
Australia (25.6%). Reasons included wanting to be with partners, family and 
friends (81.1%), for employment/economic reasons (4.9%), study (4.1%), personal 
safety/health (2.6%) or holiday (1.4%). While psychological distress was 
extremely high across all groups, separated partners and those with interrupted 
study experienced the highest distress (mean K10 = 35.7, n = 155).
CONCLUSION: The data suggests a highly elevated mental health risk profile among 
individuals who report being negatively affected by current Australian 
international border closures. The results provide valuable data to inform 
future policy decisions and have clear implications regarding effective service 
provision for this vulnerable group.

© 2022. The Author(s).

DOI: 10.1186/s12992-022-00807-7
PMCID: PMC8822815
PMID: 35135575 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2435. Infect Disord Drug Targets. 2022;22(1):e100821195494. doi: 
10.2174/1871526521666210810124359.

SARS-CoV-2 Transmission Among Healthcare Workers in Iran: An Urgent Need for 
Early Identification and Management.

Abdolsalehi MR(1), Mahmoudi S(2), Badv RS(3), Pourakbari B(2), Mirnia K(3), 
Mahmoudieh Y(4), Mamishi S(1)(2).

Author information:
(1)Department of Infectious Diseases, Pediatrics Center of Excellence, 
Children\'s Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
(2)Pediatric Infectious Disease Research Center, Tehran University of Medical 
Sciences, Tehran, Iran.
(3)Pediatrics Center of Excellence, Children's Medical Center, Tehran University 
of Medical Sciences, Tehran, Iran.
(4)Department of Molecular and Cell Biology, University of California, Berkeley, 
CA-94720, USA.

INTRODUCTION: With the increasing rate of COVID-19, particularly in developing 
countries such as Iran, a high number of frontline service providers, including 
doctors and nurses, have died, making frontline healthcare workers (HCWs) more 
vulnerable to psychological disorders and fear and anxiety of secondary 
transmission to others, especially their family members. In this study, we aimed 
to report the incidence of COVID-19 infection among HCWs in an Iranian referral 
pediatrics hospital between April 2020 and July 2020.
MATERIALS AND METHODS: In this retrospective cross-sectional study, HCWs and 
hospital staff working at Children's Medical Center, Tehran, Iran, with positive 
SARS-CoV-2 real-time polymerase chain reaction (RT-PCR) test results were 
evaluated between April 2020 and July 2020.
RESULTS: Sixty-one out of the 1085 personnel (5.6%) including 14 pediatricians 
(23%), 24 nurses (39%), 9 paramedics (15%), and 14 HCWs without direct patient 
contact (23%) had a nasopharyngeal specimen positive SARS-CoV-2 RT-PCR test. The 
mean age was 39.8±10.6 years. Eleven cases (18%) had underlying diseases such as 
hypertension and asthma. The most common symptoms were fatigue (67%, n=41), dry 
cough (61%, n=37), fever (52%, n=32), headache (46%, n=28), dyspnea (43%, n=24), 
anosmia (28%, n=17), chills (26%, n=16), sore throat (26%, n=16), 
gastrointestinal symptoms (23%, n=14), and productive cough (3%, n=2). Eleven 
cases (18%) showed lung involvement in their chest X-rays and/or CT scans. 
Eighteen cases (29.5%) had lymphopenia, and 20 individuals (33%) had a high 
level of C-reactive protein.
CONCLUSION: In conclusion, in the early phase of the COVID-19 outbreak, a 
substantial proportion of HCWs with fever, respiratory, and other prevalent 
symptoms including fatigue and headache were infected with SARS-CoV-2. 
Therefore, implementation of infection prevention measures, isolation of 
confirmed HCWs, disinfection of the environment, and regular COVID-19 prevention 
training for HCWs are strongly recommended for the wellbeing of health workers 
and minimizing the spread of infection.

Copyright© Bentham Science Publishers; For any queries, please email at 
epub@benthamscience.net.

DOI: 10.2174/1871526521666210810124359
PMID: 35135466 [Indexed for MEDLINE]


2436. J R Soc Med. 2022 Jun;115(6):220-230. doi: 10.1177/01410768221077366. Epub 2022 
Feb 8.

Experiences of staff providing specialist palliative care during COVID-19: a 
multiple qualitative case study.

Bradshaw A(1), Dunleavy L(2), Garner I(2), Preston N(2), Bajwah S(1), Cripps 
R(1), Fraser LK(3), Maddocks M(1), Hocaoglu M(1), Murtagh FE(4), Oluyase AO(1), 
Sleeman KE(1), Higginson IJ(1), Walshe C(2).

Author information:
(1)Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, 
King's College London, SE5 9PJ, UK.
(2)International Observatory on End of Life Care, Lancaster University, LA1 4AT, 
UK.
(3)Martin House Research Centre, Department of Health Sciences, University of 
York, YO10 5DD, UK.
(4)Wolfson Palliative Care Research Centre, Hull York Medical School, University 
of Hull, HU6 7RX, UK.

OBJECTIVE: To explore the experiences of, and impact on, staff working in 
palliative care during the COVID-19 pandemic.
DESIGN: Qualitative multiple case study using semi-structured interviews between 
November 2020 and April 2021 as part of the CovPall study. Data were analysed 
using thematic framework analysis.
SETTING: Organisations providing specialist palliative services in any setting.
PARTICIPANTS: Staff working in specialist palliative care, purposefully sampled 
by the criteria of role, care setting and COVID-19 experience.
MAIN OUTCOME MEASURES: Experiences of working in palliative care during the 
COVID-19 pandemic.
RESULTS: Five cases and 24 participants were recruited (n = 12 nurses, 4 
clinical managers, 4 doctors, 2 senior managers, 1 healthcare assistant, 1 
allied healthcare professional). Central themes demonstrate how infection 
control constraints prohibited and diluted participants' ability to provide care 
that reflected their core values, resulting in experiences of moral distress. 
Despite organisational, team and individual support strategies, continually 
managing these constraints led to a 'crescendo effect' in which the impacts of 
moral distress accumulated over time, sometimes leading to burnout. Solidarity 
with colleagues and making a valued contribution provided 'moral comfort' for 
some.
CONCLUSIONS: This study provides a unique insight into why and how healthcare 
staff have experienced moral distress during the pandemic, and how organisations 
have responded. Despite their experience of dealing with death and dying, the 
mental health and well-being of palliative care staff was affected by the 
pandemic. Organisational, structural and policy changes are urgently required to 
mitigate and manage these impacts.

DOI: 10.1177/01410768221077366
PMCID: PMC9158238
PMID: 35133216 [Indexed for MEDLINE]


2437. Early Interv Psychiatry. 2022 Nov;16(11):1259-1266. doi: 10.1111/eip.13280. Epub 
2022 Feb 7.

Delivery of an online psychosocial recovery program during COVID-19: A survey of 
young people attending a youth mental health service.

Somaiya J(1)(2), Thompson A(1)(2)(3), O'Donoghue B(1)(2), Brown E(1)(2)(4).

Author information:
(1)Orygen, Melbourne, Victoria, Australia.
(2)Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, 
Australia.
(3)Warwick Medical School, University of Warwick, UK.
(4)College of Nursing and Midwifery, Charles Darwin University, Darwin, 
Australia.

AIMS: The COVID-19 pandemic forced the rapid move of mental health services to 
being delivered online. This included the delivery of a psychosocial recovery 
program (PRP) delivered in youth mental health services in Melbourne, Australia 
which consists of groups that address functional recovery. At the time, there 
was limited evidence about how this switch in service provision would be 
received by service users or what impact the pandemic was having on their mental 
health.
METHODS: Young people engaged with the PRP between March and May 2020 were sent 
a link to complete an online survey that was co-developed by young people and 
clinicians. Attendance data at groups were extracted as a proximal measure of 
feasibility and acceptability.
RESULTS: A total of 44 young people undertook the survey with the domains of 
wellbeing most impacted by lockdown being work/study, motivation and social 
connection. Groups provided online were generally well attended during lockdown, 
particularly those that had a focus on therapeutic content. Young people 
indicated little preference for continuing to attend groups run purely online 
when restrictions eased, with many expressing a preference for these to be 
offered face-to-face or in a combined format.
CONCLUSIONS: These findings suggest that implementation of online psychosocial 
groups during periods of lockdown is both feasible and acceptable. Whilst young 
people found accessing groups online to be of benefit at the time, they felt 
that continued substitution of face-to-face groups would not necessarily be 
preferable and clinical services should consider these preferences in their 
long-term service delivery.

© 2022 The Authors. Early Intervention in Psychiatry published by John Wiley & 
Sons Australia, Ltd.

DOI: 10.1111/eip.13280
PMCID: PMC9111580
PMID: 35132766 [Indexed for MEDLINE]


2438. Fam Process. 2022 Dec;61(4):1730-1748. doi: 10.1111/famp.12760. Epub 2022 Feb 7.

Dyadic associations between COVID-19-related stress and mental well-being among 
parents and children in Hong Kong: An actor-partner interdependence model 
approach.

Chan RCH(1).

Author information:
(1)Department of Special Education and Counselling, The Education University of 
Hong Kong, Tai Po, Hong Kong.

The spread of COVID-19 and its subsequent social distancing policies have 
profoundly impacted the lives of parents and children. Prolonged exposure to 
parenting-related responsibilities and heightened levels of family conflict 
under stay-at-home orders coupled with reduced access to support systems and 
resources have rendered parents and children more prone to stress and mental 
health difficulties. Drawing on a transactional model of parent-child 
interactions, the present study applied an actor-partner interdependence model 
approach to examine the transactional relationship between COVID-19-related 
stress and mental well-being among parents and children. Data from 109 Chinese 
parent-child dyads in Hong Kong were included in the study. Parents and their 8- 
to 10-year-old children completed a questionnaire on COVID-19-related stress, 
parent-child relationships, and mental well-being. The results showed that 53.2% 
and 30.3% of the parents and children, respectively, showed poor mental 
well-being, indicating possible emotional problems. Both actor and partner 
effects of parent COVID-19-related stress were found. Parent COVID-19-related 
stress was indirectly related to lower levels of parent and child mental 
well-being, through the mediation of parent-child conflict. To facilitate 
psychological adjustment following the COVID-19 outbreak, effective family-based 
mental health and parenting interventions are needed to promote family cohesion 
and alleviate stress-induced psychological symptoms. Even in the time of social 
distancing, telepsychotherapy and other online non-psychotherapeutic 
interventions can serve as a valid alternative for parents and children who 
experience excessive distress. Implications for psychological services, 
family-friendly policies, and social protection measures are also discussed.

Publisher: 
COVID-19的传播及其随后的保持社交距离政策深刻影响了父母和子女的生活。长时间里都得承担家长有关的责任，在居家令下家庭冲突的加剧，再加上获得支持系统和资源的机会减少，这使得父母和子女更容易承受压力和出现精神健康问题。基于亲子互动的交互作用模型，本研究运用行动者与伙伴相互依存模型方法，研究了父母和子女所感受到与COVID-19相关压力和精神健康之间的相互影响的关系。研究采用了109对在中国香港的父母和子女的数据。父母和他们8-10岁的孩子完成了一份关于COVID-19相关压力、亲子关系和精神健康的问卷。结果显示，53.2%的家长和30.3%的孩子的精神健康状况较差，可能存在情绪问题。研究发现父母所感受到与COVID-19相关压力的行动者效应，也发现了伙伴效应。父母的COVID-19相关压力通过亲子冲突的影响，与父母和子女精神健康水平的降低有间接相关。为促进COVID-19疫情后的心理调整，需要采取有效的家庭精神健康和亲职教养的干预措施，以促进家庭凝聚力，缓解压力引发的心理症状。即使在保持社交距离的时候，远程心理治疗以及其他的在线非心理治疗干预，对于经历过度困扰的父母和子女来说，也可以作为一种有效的选择。本研究还对心理服务、家庭友好政策和社会保护措施的影响进行了讨论。.

© 2022 Family Process Institute.

DOI: 10.1111/famp.12760
PMCID: PMC9111617
PMID: 35132637 [Indexed for MEDLINE]

Conflict of interest statement: The author declares that he has no conflict of 
interest.


2439. Sci Rep. 2022 Feb 7;12(1):2021. doi: 10.1038/s41598-022-06016-x.

Cancer as a risk factor for distress and its interactions with sociodemographic 
variables in the context of the first wave of the COVID-19 pandemic in Germany.

Ernst M(1), Beutel ME(2), Brähler E(2)(3).

Author information:
(1)Department of Psychosomatic Medicine and Psychotherapy, University Medical 
Center of the Johannes-Gutenberg-University Mainz, Mainz, Germany. 
Mareike.Ernst@unimedizin-mainz.de.
(2)Department of Psychosomatic Medicine and Psychotherapy, University Medical 
Center of the Johannes-Gutenberg-University Mainz, Mainz, Germany.
(3)Integrated Research and Treatment Center Adiposity Diseases, Behavioral 
Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, 
University of Leipzig Medical Center, Leipzig, Germany.

The COVID-19 pandemic poses a psychological challenge, especially for 
individuals with chronic illnesses. The aim of this study was to investigate 
associations of cancer with distress, including its interplay with further risk 
and protective factors. We conducted a representative survey of the German 
population (N = 2503, including N = 144 with a cancer diagnosis) during the 
first wave of the pandemic. In multiple linear and logistic regression analyses, 
we tested associations of cancer with depression and anxiety symptoms and 
suicidal ideation. We also investigated moderating effects of age, gender, 
income, living situation, marital status, and loneliness. Individuals with 
cancer were more likely to report anxiety symptoms (φ = .061), suicidal ideation 
(φ = .050), and loneliness (φ = .044) than other participants. In regression 
analyses that controlled for sociodemographic differences, cancer was still 
associated with anxiety symptoms. We also observed interaction effects, 
indicating that this relation was especially strong in men with cancer and that 
cancer survivors with a low income were particularly likely to report anxiety 
symptoms. The findings demonstrate that cancer survivors are a vulnerable group 
and that factors of different life domains interact in shaping well-being in the 
population, necessitating comprehensive risk assessment and support offers 
during the pandemic and beyond.

© 2022. The Author(s).

DOI: 10.1038/s41598-022-06016-x
PMCID: PMC8821553
PMID: 35132127 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


2440. Clin Med Res. 2022 Mar;20(1):34-39. doi: 10.3121/cmr.2022.1704. Epub 2022 Feb 7.

Reasons for Suicide Attempts in South India during the COVID-19 Pandemic.

Prabhakar K(1), Aswathanarayana A(1), Kumar Reddy KH(2).

Author information:
(1)Department of General Medicine, Sri Devaraj URS Academy of Higher Education 
and Research, Karnataka, India.
(2)Department of General Medicine, Sri Devaraj URS Academy of Higher Education 
and Research, Karnataka, India hemanthreddy56789@gmail.com.

Objective: By increasing the risk of isolation, fear, stigma, abuse, and 
economic fallout, COVID-19 has led to an increase in the risk of psychiatric 
disorders, chronic trauma, and stress. These factors eventually increase 
suicidality and suicidal behavior. This study intends to evaluate the reasons 
for suicide attempts due to the COVID-19 pandemic in the south Indian 
population.Design: Cross-sectional studySetting: The study was conducted in R. 
L. Jalappa Hospital and Research Centre, Kolar.Participants: This study was 
conducted on 91 patients admitted to the general medicine department for a 
suicide attempt because of the COVID 19 pandemic.Methods: A single examiner 
conducted a structured interview with a pretested questionnaire with each 
participant. Participants were asked to indicate the primary reason or 
motivation for their suicide attempt. Patients answered a set of questions 
regarding personal and family concerns (marginalization, fear and uncertainty, 
domestic abuse, loneliness, grief over loss of loved one) and work-related 
concerns (economic fallout, high-risk environment, shortage of personnel and 
personal protective equipment [PPE]). We employed mean and standard deviation to 
descriptively analyze quantitative variables. Categorical variables were 
expressed in terms of frequency and proportion. For non-normally-distributed 
quantitative parameters, medians and interquartile range (IQR) were compared 
across study groups using the Kruskal-Wallis test (> 2 groups). Data was 
analyzed using coGuide software, V.1.03.Results: The mean age of participants 
was 29.47±11.06 years, the majority (43.63%) of which were aged between 21 to 40 
years of age. The majority (72.53%) of participants reported personal and family 
concerns as reasons/motivation for suicide, whereas only 17.58% reported 
work-related concerns. There was a statistically significant difference across 
reason or motivation for suicide with age (in years) and gender (P value < 
0.001).Conclusion: The study concluded that more than half of the patients 
indicated personal and family concerns as the major reason for suicide attempts 
during the pandemic. It is vital to emphasize the mental health well-being of 
the population and take proactive steps to minimize its detrimental effects 
during the COVID-19 pandemic.

© 2022 Marshfield Clinic Health System.

DOI: 10.3121/cmr.2022.1704
PMCID: PMC9390856
PMID: 35131843 [Indexed for MEDLINE]


2441. BMJ Open. 2022 Feb 7;12(2):e056628. doi: 10.1136/bmjopen-2021-056628.

Qualitative analysis of the impact of the SARS-CoV-2 pandemic response on 
paediatric health services in North of Scotland and North of England.

Gadsby EW(1)(2), Christie-de Jong F(3), Bhopal S(4)(5), Corlett H(6), Turner 
S(7)(8).

Author information:
(1)Centre for Health Services Studies, University of Kent, Canterbury, UK 
E.Gadsby@kent.ac.uk.
(2)Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK.
(3)Faculty of Health Sciences and Wellbeing, University of Sunderland, 
Sunderland, UK.
(4)Population Health Sciences Institute, Newcastle University, Newcastle upon 
Tyne, UK.
(5)Great North Children's Hospital, Newcastle upon Tyne, UK.
(6)Child Health and Wellbeing Network, North East and North Cumbria Integrated 
Care System, Middlesbrough, UK.
(7)Department of Child Health, University of Aberdeen, Aberdeen, UK.
(8)Women and Children Division, NHS Grampian, Aberdeen, UK.

OBJECTIVE: To capture the extent and impact of changes in the delivery of child 
health services in the UK, resulting from the SARS-CoV-2 pandemic response, from 
the perspectives of a range of child healthcare providers.
SETTING: National Health Service commissioned/delivered healthcare services in 
two regional settings in the UK: North of Scotland (NOS) and North East and 
North Cumbria (NENC) in England.
PARTICIPANTS: Purposive sample of 39 child healthcare professionals including 
paediatricians, community/specialist nurses, allied health professionals and 
mental health professionals, from across the two regions (22 in NOS, 17 in 
NENC).
METHODS: Semistructured qualitative interviews conducted via telephone between 
June and October 2020, fully transcribed and analysed in NVivo V.11 using 
thematic analysis.
RESULTS: Extensive changes across a range of paediatric services were rapidly 
implemented to support the pandemic response and ongoing healthcare delivery. 
New ways of working emerged, principally to control the spread of the virus. 
Keeping users and their families out of hospital was an urgent driver for 
change. The changes had considerable impact on the health and well-being of 
staff with many experiencing radical changes to their working conditions and 
roles. However, there were some positive changes noted: some practitioners felt 
empowered and listened to by decision makers; some of the usual bureaucratic 
barriers to change were lifted; staff saw improved collaboration and joint 
working across the system; and some new ways of working were seen to be more 
efficient. Interviewees perceived the implications for children and their 
families to be profound, particularly with regard to self-care, relationships 
with practitioners and timely access to services.
CONCLUSIONS: Despite the challenges experienced by staff, the pandemic provided 
an opportunity for positive, lasting change. It is vital to capitalise on this 
opportunity to benefit patient outcomes and to 'build back' services in a more 
sustainable way.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-056628
PMCID: PMC8822532
PMID: 35131833 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2442. PLoS One. 2022 Feb 7;17(2):e0245182. doi: 10.1371/journal.pone.0245182. 
eCollection 2022.

The experience of European hospital-based health care workers on following 
infection prevention and control procedures and their wellbeing during the first 
wave of the COVID-19 pandemic.

van Hout D(1), Hutchinson P(2), Wanat M(3), Pilbeam C(3), Goossens H(4), 
Anthierens S(5), Tonkin-Crine S(3)(6), Gobat N(3).

Author information:
(1)Julius Center for Health Sciences and Primary Care, University Medical Center 
Utrecht, University Utrecht, Utrecht, The Netherlands.
(2)Department of Global Community Health and Behavioral Sciences, School of 
Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United 
States of America.
(3)Nuffield Department of Primary Care Health Sciences, University of Oxford, 
Oxford, United Kingdom.
(4)Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, 
University of Antwerp, Antwerp, Belgium.
(5)Department of Family Medicine and Population Health (FAMPOP), University of 
Antwerp, Antwerp, Belgium.
(6)National Institute for Health Research Health Protection Research Unit in 
Healthcare Associated Infections and Antimicrobial Resistance, University of 
Oxford, Oxford, United Kingdom.

BACKGROUND: Working under pandemic conditions exposes health care workers (HCWs) 
to infection risk and psychological strain. A better understanding of HCWs' 
experiences of following local infection prevention and control (IPC) procedures 
during COVID-19 is urgently needed to inform strategies for protecting the 
psychical and psychological health of HCWs. The objective of this study was 
therefore to capture the perceptions of hospital HCWs on local IPC procedures 
and the impact on their emotional wellbeing during the first wave of the 
COVID-19 pandemic in Europe.
METHODS: Participants were recruited in two sampling rounds of an international 
cross-sectional survey. Sampling took place between 31 March and 17 April 2020 
via existing research networks and between 14 May and 31 August 2020 via online 
convenience sampling. Main outcome measures were behavioural determinants of 
HCWs' adherence to IPC guidelines and the WHO-5 Well-Being Index, a validated 
scale of 0-100 reflecting emotional wellbeing. The WHO-5 was interpreted as a 
score below or above 50 points, a cut-off score used in previous literature to 
screen for depression.
RESULTS: 2289 HCWs from 40 countries in Europe participated. Mean age was 42 
(±11) years, 66% were female, 47% and 39% were medical doctors and nurses, 
respectively. 74% (n = 1699) of HCWs were directly treating patients with 
COVID-19, of which 32% (n = 527) reported they were fearful of caring for these 
patients. HCWs reported high levels of concern about COVID-19 infection risk to 
themselves (71%) and their family (82%) as a result of their job. 40% of HCWs 
considered that getting infected with COVID-19 was not within their control. 
This feeling was more common among junior than senior HCWs (46% versus 38%, P 
value < .01). Sufficient COVID-19-specific IPC training, confidence in PPE use 
and institutional trust were positively associated with the feeling that 
becoming infected with COVID-19 was within their control. Female HCWs were more 
likely than males to report a WHO-5 score below 50 points (aOR 1.5 (95% 
confidence interval (CI) 1.2-1.8).
CONCLUSIONS: In Europe, the COVID-19 pandemic has had a differential impact on 
those providing direct COVID-19 patient care, junior staff and women. Health 
facilities must be aware of these differential impacts, build trust and provide 
tailored support for this vital workforce during the current COVID-19 pandemic.

DOI: 10.1371/journal.pone.0245182
PMCID: PMC8820620
PMID: 35130294 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2443. Psychol Trauma. 2022 Nov;14(8):1347-1355. doi: 10.1037/tra0001198. Epub 2022 Feb 
7.

Understanding the experiences of people with posttraumatic stress disorder 
(PTSD) during the COVID-19 pandemic: A qualitative study.

Buttanshaw LE(1), Purnell LR(1), El-Leithy SM(1), Pain AS(1).

Author information:
(1)Traumatic Stress Service, South West London and St George's Mental Health NHS 
Trust.

OBJECTIVE: There has been great concern about the psychological implications of 
the coronavirus disease 2019 (COVID-19) pandemic on wellbeing and mental health 
worldwide. Previous pandemics have been associated with an increased risk of 
posttraumatic stress disorder (PTSD); however, the experience of a pandemic for 
those with preexisting diagnoses of PTSD has not previously been researched. We 
aimed to understand the experience of the COVID-19 pandemic for people with a 
diagnosis of PTSD before the pandemic.
METHOD: Ten people, who were under the care of a specialist outpatient clinic 
for adults with PTSD during the COVID-19 pandemic, took part in semistructured 
interviews. Thematic analysis was used to analyze the interview transcripts.
RESULTS: Themes were identified relating to changes in how a sense of threat was 
experienced during the pandemic, with both factors increasing and decreasing 
threat recognized; challenges related to trying to cope with the pandemic; and 
resources that helped with coping.
CONCLUSIONS: Recommendations for clinicians working with people with PTSD during 
a pandemic are made. These include assessing for changes in the person's sense 
of threat and changes in triggers; supporting adaptation of prepandemic ways of 
coping and engagement with personal and professional support networks; and being 
alert to a possible increase or change in safety-seeking behaviors and 
addressing in the treatment. (PsycInfo Database Record (c) 2022 APA, all rights 
reserved).

DOI: 10.1037/tra0001198
PMID: 35130022 [Indexed for MEDLINE]


2444. J Obstet Gynaecol Res. 2022 Apr;48(4):1026-1032. doi: 10.1111/jog.15164. Epub 
2022 Feb 7.

Did the COVID-19 pandemic affect mental health, training progression, and 
fertility planning of obstetrics and gynecology trainees? A survey of London 
trainees.

Gunasekera A(1), Berg L(1), Sekar H(2), Patra-Das S(3), Clarke S(4), Yoong W(1).

Author information:
(1)Department of Obstetrics and Gynaecology, North Middlesex University 
Hospital, London, UK.
(2)Department of Obstetrics and Gynaecology, Barnet General Hospital, Barnet, 
UK.
(3)Department of Obstetrics and Gynaecology, Homerton University Hospital, 
London, UK.
(4)Department of Obstetrics and Gynaecology, Guys and St Thomas NHS Foundation 
Trust, London, UK.

PURPOSE OF STUDY: To assess impact of COVID-19 pandemic on mental wellbeing, 
workload, training progression, and fertility planning among London Obstetrics 
and Gynecology trainees.
DESIGN: An anonymous survey comprising 41 peer-validated questions was sent to 
London trainees. Anxiety and depression were screened using Generalized Anxiety 
Disorder Questionnaire 7 (GAD 7) and Patient Health Questionnaire-9 (PHQ-9).
RESULTS: One hundred and seventy-seven trainees completed the questionnaire, of 
whom 54% were aged 25-34 years, 43% were senior trainees (ST6-7), and 51% 
classified themselves as Black, Asian, and Minority Asian (BAME). Although the 
percentage of respondents with "moderate"/"severe" GAD 7 and PHQ-9 scores was 
two to three times that of UK population estimates, median GAD 7 and PHQ-9 
scores were 7 and 6 ("mild"). Sixteen percent deferred their fertility plans and 
26% of ST6-7 trainees changed their Advanced Training Skills Modules. Other 
issues raised ranged from lack of assistance with electronic portfolio, 
postponement of examinations, poor senior input for mental health, lack of 
debriefing for redeployed trainees and requests for deferment of annual reviews.
CONCLUSIONS: The pandemic has incurred an impact on mental health, training 
progression, and fertility planning of London trainees. With recommencement of 
nonemergency consultations and elective gynecology theater, alongside Royal 
College of Obstetricians and Gynecologists' Recovery Blueprint to optimize 
learning opportunities, there is optimism that these challenges can be overcome. 
Trainers and trainees need to safeguard training opportunities and consider 
innovative forms of future learning, while anticipating potential effects of 
subsequent waves.

© 2022 Japan Society of Obstetrics and Gynecology.

DOI: 10.1111/jog.15164
PMCID: PMC9115236
PMID: 35128763 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no known 
competing financial or personal relationships that could have appeared to 
influence the work reported in this paper.


2445. J Psychiatr Res. 2022 Mar;147:313-323. doi: 10.1016/j.jpsychires.2022.01.004. 
Epub 2022 Jan 5.

Media use and emotional distress under COVID-19 lockdown in a clinical sample 
referred for internalizing disorders: A Swiss adolescents' perspective.

Werling AM(1), Walitza S(2), Gerstenberg M(3), Grünblatt E(2), Drechsler R(3).

Author information:
(1)Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric 
University Hospital Zurich, University of Zurich, Switzerland. Electronic 
address: anna.werling@pukzh.ch.
(2)Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric 
University Hospital Zurich, University of Zurich, Switzerland; Zurich Center for 
Integrative Human Physiology, University of Zurich, Switzerland; Neuroscience 
Center Zurich, University of Zurich and ETH Zurich, Switzerland.
(3)Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric 
University Hospital Zurich, University of Zurich, Switzerland.

The COVID-19 outbreak has profoundly affected adolescents' life. Adolescents 
with pre-existing psychiatric disorders have been at particular risk of 
increased mental health problems and problematic media use. 178 patients, aged 
12-18 years, referred before the COVID-19 outbreak to child and adolescent 
psychiatry, participated in an anonymous online survey on the impact of the 
lockdown on media use and mental well-being. The survey was conducted 
approximately one month after the first easing of restrictions following a 
six-week lockdown in Switzerland. Based on self-report, half of the patients had 
been diagnosed with internalizing disorders (ID; depression or anxiety disorder) 
and the other half with other disorders (non-ID, e.g. ADHD, autistic spectrum 
disorder). Patients with ID reported higher emotional distress during the 
lockdown, and a larger number of patients with ID indicated a deterioration of 
pre-existing symptoms compared to non-ID patients. Although more patients with 
ID than with non-ID indicated spending a large amount of time on social media, 
social media time per day in hours was not significantly higher in ID. Patients 
with ID indicated a higher impact of media use on well-being and mood in 
everyday life during the lockdown. Social media time was higher in worsened than 
in improved non-ID patients, while the opposite was found in ID patients, 
indicating a possible protective effect of media use at least for some ID 
patients. The results confirm positive as well as negative associations between 
mental health, emotional well-being and media use for adolescents with ID during 
the lockdown.

Copyright © 2022. Published by Elsevier Ltd.

DOI: 10.1016/j.jpsychires.2022.01.004
PMCID: PMC8811353
PMID: 35124401 [Indexed for MEDLINE]

Conflict of interest statement: SW has received in the last 5 years royalties 
from Thieme Hogrefe, Kohlhammer, Springer, Beltz. Her work was supported in the 
last 5 years by the Swiss National Science Foundation (SNF), diff. EU FP7s, 
Bfarm Germany, ZInEP, Hartmann Müller Stiftung, Olga Mayenfisch, Gertrud 
Thalmann, Vontobel, Unicentia, Erika Schwarz Fonds. Outside professional 
activities and interests are declared under the link of the University of Zurich 
www.uzh.ch/prof/ssl-dir/interessenbindungen/client/web/. RD has received 
royalties from Hogrefe and her work has been supported by the SNF in the last 5 
years. The other authors declare no conflict of interest.


2446. Am J Surg. 2022 Jul;224(1 Pt B):358-362. doi: 10.1016/j.amjsurg.2022.01.022. 
Epub 2022 Jan 22.

Resilience matters: Student perceptions of the impact of COVID-19 on medical 
education.

Haskett LA(1), Doster DL(2), Athanasiadis DI(2), Anton NE(2), Huffman EK(2), 
Wallach P(3), Walvoord E(4), Stefanidis D(2), Mitchell SA(5), Lee NK(6).

Author information:
(1)Indiana University School of Medicine, Department of Surgery, USA. Electronic 
address: haskettl@iu.edu.
(2)Indiana University School of Medicine, Department of Surgery, USA.
(3)Indiana University School of Medicine, Department of Internal Medicine, USA.
(4)Indiana University School of Medicine, Department of Pediatrics, USA.
(5)Indiana University School of Medicine, Department of Anesthesia, USA.
(6)Indiana University School of Medicine, Department of Surgery, USA. Electronic 
address: leenk@iu.edu.

INTRODUCTION: We assessed students' perception of the impact of the pandemic on 
their well-being, education, academic achievement, and whether grit and 
resilience alter students' ability to mitigate the stress associated with 
disruptions in education. We hypothesized that students would report a negative 
impact, and those with higher grit and resilience scores would be less impacted.
METHODS: A multidisciplinary team of educators created and distributed a survey 
to medical students. Survey results were analyzed using descriptive statistics, 
ANOVA, and multivariate linear regressions. A p-value <.05 was considered 
statistically significant.
RESULTS: A total of 195 students were included in the study. Approximately 92% 
reported that clinical education was negatively affected, including participants 
with higher grit scores. Students with higher resilience scores were more 
optimistic about clinical education. Those with higher resilience scores were 
less likely to report anxiety, insomnia, and tiredness.
CONCLUSION: More resilient students were able to manage the stress associated 
with the disruption in their education. Resiliency training should be 
year-specific, and integrated into the UME curriculum due to the different 
demands each year presents.

Copyright © 2022 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.amjsurg.2022.01.022
PMCID: PMC8782734
PMID: 35123769 [Indexed for MEDLINE]


2447. Diabetes Res Clin Pract. 2022 Mar;185:109210. doi: 
10.1016/j.diabres.2022.109210. Epub 2022 Feb 2.

Prevalence and correlates of diabetes distress and depressive symptoms among 
individuals with type-2 diabetes mellitus during Ramadan fasting: A 
cross-sectional study in Bangladesh amid the COVID-19.

Sultana MS(1), Islam MS(2), Sayeed A(3), Potenza MN(4), Sikder MT(5), Rahman 
MA(6), Koly KN(7).

Author information:
(1)Department of Public Health and Informatics, Jahangirnagar University, Savar, 
Dhaka, Bangladesh. Electronic address: sadiasuhi.ju@gmail.com.
(2)Department of Public Health and Informatics, Jahangirnagar University, Savar, 
Dhaka, Bangladesh; Center for Advanced Research Excellence in Public Health, 
Dhaka, Bangladesh.
(3)Department of Post-Harvest Technology and Marketing, Patuakhali Science and 
Technology University, Patuakhali 8602, Bangladesh.
(4)Department of Psychiatry and Child Study Center, Yale School of Medicine, New 
Haven, CT, United States; Connecticut Mental Health Center, New Haven, CT, 
United States; Connecticut Council on Problem Gambling, Wethersfield, CT, United 
States; Department of Neuroscience and Wu Tsai Institute, Yale University, New 
Haven, CT, United States.
(5)Department of Public Health and Informatics, Jahangirnagar University, Savar, 
Dhaka, Bangladesh.
(6)School of Health, Federation University Australia, Berwick, Victoria, 
Australia; Australian Institute for Primary Care and Ageing, La Trobe 
University, Melbourne, Victoria, Australia; Department of Non-Communicable 
Diseases, Bangladesh University of Health Sciences, Dhaka, Bangladesh; Faculty 
of Public Health, Universitas Airlangga, Surabaya, Indonesia.
(7)Health Systems and Population Studies Division, International Centre for 
Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

AIMS: Psychological concerns relating to "diabetes distress" (DD) and depressive 
symptoms (DS) in individuals with type-2 diabetes mellitus (T2DM) may negatively 
impact adherence to medical treatments and overall mental health. Thus, this 
study was undertaken to investigate DS and DD in relation to fasting during the 
month of Ramadan.
METHODS: A cross-sectional survey was conducted among 735 patients with T2DM in 
2021. DD and DS were measured by the Problem Areas in Diabetes scale and Patient 
Health Questionnaire-9, respectively. Logistic regression and correlation 
analyses were executed.
RESULTS: More than one-third of the participants (41.2%) had DD and DS (36.9%). 
DS was significantly higher in participants who did not fast (p = 0.027). 
Participants who had higher dietary diversity were less likely to have DD 
(p = 0.004) and DS (p = 0.001). Females (AOR = 1.89, 95% CI: 1.25-2.85) and 
those who lived alone (AOR = 1.89, 95% CI: 1.25-2.85) were more likely to have 
DS. Participants with diabetes-related complications were more likely to 
experience DS (AOR = 2.17; 95% CI: 1.5-3.13) and DD (AOR = 3.46; 95% CI: 
2.42-4.95). DD was also associated with being younger (p = 0.003), having 
hypertension (p = 0.030), having heart disease (p = 0.012), and taking insulin 
(p = 0.010).
CONCLUSIONS: Individuals with T2DM who were not fasting experienced more mental 
health concerns. Psychosocial support and other interventions from health 
professionals should be examined and empirical interventions should be 
implemented to promote the mental health and well-being of individuals with 
T2DM.

Copyright © 2022 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.diabres.2022.109210
PMID: 35122903 [Indexed for MEDLINE]


2448. Sci Rep. 2022 Feb 4;12(1):1939. doi: 10.1038/s41598-022-04909-5.

Impact of housing conditions on changes in youth's mental health following the 
initial national COVID-19 lockdown: a cohort study.

Groot J(1), Keller A(2), Joensen A(2), Nguyen TL(2), Nybo Andersen AM(2), 
Strandberg-Larsen K(2).

Author information:
(1)Section of Epidemiology, Faculty of Health and Medical Sciences, University 
of Copenhagen. Postal Address, Øster Farimagsgade 5, bd. 24, PO Box 2099, 1014, 
Copenhagen K, Denmark. jgro@sund.ku.dk.
(2)Section of Epidemiology, Faculty of Health and Medical Sciences, University 
of Copenhagen. Postal Address, Øster Farimagsgade 5, bd. 24, PO Box 2099, 1014, 
Copenhagen K, Denmark.

We aimed to investigate if declines in youth's mental health during lockdown 
were dependent on housing condition among 7445 youth (median age ~ 20 years) 
from the Danish National Birth Cohort (DNBC), with data collected at 18 years of 
age and again three weeks into the first national lockdown (April 2020). We 
examined associations between housing conditions (access to outdoor spaces, 
urbanicity, household density, and household composition) and changes in mental 
health (mental well-being, Quality of Life (QoL) and loneliness). We report 
results from multivariate linear and logistic regression models. Youth without 
access to outdoor spaces experienced greater declines in mental well-being (vs. 
garden; mean difference: - 0·75 (95% CI - 1·14, - 0·36)), and correspondingly 
greater odds of onset of low mental well-being (vs. garden; OR: 1·72 (95% CI 
1·20, 2·48)). Youth in higher density households vs. below median or living 
alone vs. with parents only also had greater odds of onset of low mental 
well-being (OR: 1·26 (95% CI 1·08, 1·46) and OR: 1·62 (95% CI 1·17, 2·23), 
respectively). Living in denser households (vs. below median; OR: 1·18 (95% CI 
1·06, 1·33), as well as living alone (vs. with parents; OR: 1·38 (95% CI 1·04, 
1·82) was associated with onset of low QoL. Living alone more than doubled odds 
of onset of loneliness compared to living with parents, OR: 2·12 (95% CI 1·59, 
2·82). Youth living alone, in denser households, and without direct access to 
outdoor spaces may be especially vulnerable to mental health declines.

© 2022. The Author(s).

DOI: 10.1038/s41598-022-04909-5
PMCID: PMC8816918
PMID: 35121742 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


2449. BMJ Open. 2022 Feb 4;12(2):e051700. doi: 10.1136/bmjopen-2021-051700.

Experiences and well-being of healthcare professionals working in the field of 
ultrasound in obstetrics and gynaecology as the SARS-CoV-2 pandemic were 
evolving: a cross-sectional survey study.

Bourne T(1)(2), Kyriacou C(3), Shah H(3), Ceusters J(4), Preisler J(5)(6), 
Metzger U(7), Landolfo C(8), Lees C(9), Timmerman D(2)(10).

Author information:
(1)Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and 
Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, 
London, UK t.bourne@imperial.ac.uk.
(2)Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
(3)Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and 
Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, 
London, UK.
(4)Department of Oncology, Laboratory of Tumour Immunology and Immunotherapy, KU 
Leuven, Leuven, Belgium.
(5)Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago 
de Chile, Chile.
(6)Facultad de Medicina, Clínica Alemana, Hospital Clínico de la Universidad de 
Chile José Joaquín Aguirre, Santiago, Chile.
(7)Département d'échographie en Gynécologie et Obstétrique, Centre d'Échographie 
de l'Odéon, Paris, France.
(8)Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità 
Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, 
Italy.
(9)Centre for Fetal Care, Department of Obstetrics and Gynaecology, Queen 
Charlotte's and Chelsea Hospital, Imperial College London, London, UK.
(10)Department of Obstetrics and Gynaecology, KU Leuven University Hospitals 
Leuven, Leuven, Belgium.

OBJECTIVE: Assess experience of healthcare professionals (HCPs) working with 
ultrasound in obstetrics and gynaecology during the evolving SARS-CoV-2 
pandemic, given the new and unprecedented challenges involving viral exposure, 
personal protective equipment (PPE) and well-being.
DESIGN: Prospective cross-sectional survey study.
SETTING: Online international survey. Single-best, open box and Hospital Anxiety 
and Depression Scale (HADS) questions.
PARTICIPANTS: The survey was sent to 35 509 HCPs in 124 countries and was open 
from 7 to 21 May 2020. 2237/3237 (69.1%) HCPs from 115 countries who consented 
to participate completed the survey. 1058 (47.3%) completed the HADS.
PRIMARY OUTCOME MEASURES: Overall prevalence of SARS-CoV-2, depression and 
anxiety among HCPs in relation to country and PPE availability.
ANALYSES: Univariate analyses were used to investigate associations without 
generating erroneous causal conclusions.
RESULTS: Confirmed/suspected SARS-CoV-2 prevalence was 13.0%. PPE provision 
concerns were raised by 74.1% of participants; highest among trainees/resident 
physicians (83.9%) and among HCPs in Spain (89.7%). Most participants worked in 
self-perceived high-risk areas with SARS-CoV-2 (67.5%-87.0%), with 
proportionately more trainees interacting with suspected/confirmed infected 
patients (57.1% vs 24.2%-40.6%) and sonographers seeing more patients who did 
not wear a mask (33.3% vs 13.9%-7.9%). The most frequent PPE combination used 
was gloves and a surgical mask (22.3%). UK and US respondents reported spending 
less time self-isolating (8.8 days) and lower satisfaction with their national 
pandemic response (37.0%-43.0%). 19.8% and 8.8% of respondents met the criteria 
for moderate to severe anxiety and depression, respectively.
CONCLUSIONS: Reported prevalence of SARS-CoV-2 in HCPs is consistent with 
literature findings. Most respondents used gloves and a surgical mask, with a 
greater SARS-CoV-2 prevalence compared with those using 'full' PPE. HCPs with 
the least agency (trainees and sonographers) were not only more likely to see 
high-risk patients but also less likely to be protected. A fifth of respondents 
reported moderate to severe anxiety.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/bmjopen-2021-051700
PMCID: PMC8819548
PMID: 35121598 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2450. Intensive Crit Care Nurs. 2022 Jun;70:103206. doi: 10.1016/j.iccn.2022.103206. 
Epub 2022 Jan 21.

Moral distress, emotional impact and coping in intensive care unit staff during 
the outbreak of COVID-19.

Romero-García M(1), Delgado-Hito P(1), Gálvez-Herrer M(2), Ángel-Sesmero JA(3), 
Velasco-Sanz TR(4), Benito-Aracil L(5), Heras-La Calle G(6).

Author information:
(1)School of Nursing, University of Barcelona (Barcelona), Spain; Fundamental 
Care and Medical-Surgical Nursing Department, Spain; IDIBELL, Institute of 
Biomedical Research, Spain; International Research Project for the Humanization 
of Health Care, Proyecto HU-CI, Spain.
(2)International Research Project for the Humanization of Health Care, Proyecto 
HU-CI, Spain; Stress and Health Research Team, Autonomous University of Madrid 
(Madrid), Spain.
(3)International Research Project for the Humanization of Health Care, Proyecto 
HU-CI, Spain; Infanta Leonor University Hospital (Madrid), Spain.
(4)International Research Project for the Humanization of Health Care, Proyecto 
HU-CI, Spain; Clínico San Carlos University Hospital (Madrid), Spain; Faculty of 
Nursing, Physiotherapy and Podiatry Complutense University (Madrid) Spain.
(5)School of Nursing, University of Barcelona (Barcelona), Spain; Fundamental 
Care and Medical-Surgical Nursing Department, Spain; IDIBELL, Institute of 
Biomedical Research, Spain. Electronic address: lbenito@ub.edu.
(6)Hospital Comarcal Santa Ana, Motril (Granada), Spain; International Research 
Project for the Humanization of Health Care, Proyecto HU-CI, Spain; Universidad 
Francisco de Vitoria, Madrid, Spain.

Comment in
    Intensive Crit Care Nurs. 2022 Dec;73:103301.

BACKGROUND: From the beginning, the COVID-19 pandemic increased ICU workloads 
and created exceptionally difficult ethical dilemmas. ICU staff around the world 
have been subject to high levels of moral stress, potentially leading to mental 
health problems. There is only limited evidence on moral distress levels and 
coping styles among Spanish ICU staff, and how they influenced health 
professionals' mental health during the pandemic.
OBJECTIVES: To assess moral distress, related mental health problems (anxiety 
and depression), and coping styles among ICU staff during the first wave of the 
COVID-19 pandemic in Spain.
DESIGN: Cross-sectional.
SETTINGS AND PARTICIPANTS: The study setting consisted of intensive care unit 
and areas converted into intensive care units in public and private hospitals. A 
total of 434 permanent and temporary intensive care staff (reassigned due to the 
pandemic from other departments to units) answered an online questionnaire 
between March and June 2020.
METHODS: Sociodemographic and job variables, moral distress, anxiety, 
depression, and coping mechanisms were anonymously evaluated through a 
self-reported questionnaire. Descriptive and correlation analyses were conducted 
and multivariate linear regression models were developed to explore the 
predictive ability of moral distress and coping on anxiety and depression.
RESULTS: Moral distress during the pandemic is determined by situations related 
to the patient and family, the intensive care unit, and resource management of 
the organisations themselves. intensive care unit staff already reached moderate 
levels of moral distress, anxiety, and depression during the first wave of the 
pandemic. Temporary staff (redeployed from other units) obtained higher scores 
in these variables (p = 0.04, p = 0.038, and p = 0.009, respectively) than 
permanent staff, as well as in greater intention to leave their current position 
(p = 0.03). This intention was also stronger in health staff working in areas 
converted into intensive care units (45.2%) than in normal intensive care units 
(40.2%) (p = 0.02). Moral distress, coupled with primarily avoidance-oriented 
coping styles, explains 37% (AdR2) of the variance in anxiety and 38% (AdR2) of 
the variance in depression.
CONCLUSIONS: Our study reveals that the emotional well-being of intensive care 
unit staff was already at risk during the first wave of the pandemic. The moral 
distress they experienced was related to anxiety and depression issues, as well 
as the desire to leave the profession, and should be addressed, not only in 
permanent staff, but also in temporary staff, redeployed to these units as 
reinforcement workers.

Copyright © 2022 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.iccn.2022.103206
PMCID: PMC8776502
PMID: 35120794 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no known 
competing financial interests or personal relationships that could have appeared 
to influence the work reported in this paper.


2451. J Occup Environ Med. 2022 Feb 1;64(2):151-157. doi: 
10.1097/JOM.0000000000002380.

The Impact of Physicians' COVID-19 Pandemic Occupational Experiences on Mental 
Health.

Schwartz RM(1), McCann-Pineo M, Bellehsen M, Singh V, Malhotra P, Rasul R, 
Corley SS, Jan S, Parashar N, George S, Yacht AC, Young JQ.

Author information:
(1)The Feinstein Institutes for Medical Research, Northwell Health, Great Neck, 
New York (Dr Schwartz, Dr McCann-Pineo, Rasul, Corley, Dr Jan); Department of 
Occupational Medicine Epidemiology and Prevention, Donald and Barbara Zucker 
School of Medicine at Hofstra/Northwell, Hempstead, New York (Dr Schwartz, Dr 
McCann-Pineo, Rasul, Corley); Center Traumatic Stress, Resilience and Recovery 
at Northwell Health, Great Neck, New York (Dr Schwartz, Dr McCann-Pineo, Dr 
Bellehsen, Rasul, Corley); Unified Behavioral Health Center for Military 
Veterans and their Families, Northwell Health, Great Neck, New York (Dr 
Bellehsen); Division of Infectious Disease, Donald and Barbara Zucker School of 
Medicine at Hofstra/Northwell, Hempstead, New York (Dr Singh, Dr Malhotra); 
Division of Pediatrics and Medicine, Donald and Barbara Zucker School of 
Medicine at Hofstra/Northwell, Hempstead, New York (Dr Jan); Division of 
Pediatrics, Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, 
New York (Dr Jan); Department of Psychiatry and Resident Mental Health Program, 
Lenox Hill Hospital, New York, New York (Dr Parashar); Department of Psychiatry, 
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, 
New York (Dr Parashar, Dr Young); Division of Hospital Medicine, Donald and 
Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Dr 
George); Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 
Hempstead, New York (Dr Yacht); Department of Psychiatry, Zucker Hillside 
Hospital at Northwell Health, Glen Oaks, New York (Dr Young).

OBJECTIVE: To examine the association between a number of negative COVID-19 
occupational experiences and probable anxiety, depression, and PTSD among 
physicians.
METHODS: Cross-sectional examination of longitudinal registry data consisting of 
physician personal and occupational well-being. Multivariable logistic 
regressions were performed to determine the association between negative 
COVID-19 experiences and outcomes.
RESULTS: Of the 620 eligible physicians, approximately half were female (49%), 
and 71% white with a mean age of 46.51 (SD = 13.28). A one-point increase in 
negative experience score was associated with a 23% increase in probable anxiety 
(OR = 1.23, 95% CI: 1.14-1.34), a 23% increase in probable depression 
(OR = 1.23, 95% CI: 1.13-1.33), and a 41% increase in probable PTSD (OR = 1.41, 
95% CI: 1.30-1.52).
CONCLUSIONS: Negative pandemic experiences were strongly associated with adverse 
mental health outcomes while greater resilience was protective.

Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on 
behalf of the American College of Occupational and Environmental Medicine.

DOI: 10.1097/JOM.0000000000002380
PMCID: PMC8808755
PMID: 35119424 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest: None declared. The authors 
report no conflicts of interest.


2452. Front Public Health. 2022 Jan 18;9:752004. doi: 10.3389/fpubh.2021.752004. 
eCollection 2021.

Social Media Use and Its Associations With Mental Health 9 Months After the 
COVID-19 Outbreak: A Cross-National Study.

Thygesen H(1)(2), Bonsaksen T(2)(3), Schoultz M(4), Ruffolo M(5), Leung J(6), 
Price D(5), Geirdal AØ(7).

Author information:
(1)Department of Occupational Therapy, Faculty of Health Sciences, Prosthetics 
and Orthotics, Oslo Metropolitan University, Oslo, Norway.
(2)VID Specialized University, Faculty of Health Studies, Department of Health, 
Oslo, Norway.
(3)Department of Health and Nursing Sciences, Faculty of Social and Health 
Sciences, Inland Norway University of Applied Sciences, Elverum, Norway.
(4)Faculty of Health and Life Sciences, Northumbria University, Newcastle upon 
Tyne, United Kingdom.
(5)School of Social Work, University of Michigan, Ann Arbor, MI, United States.
(6)Faculty of Health and Behavioural Science, The University of Queensland, 
Brisbane, QLD, Australia.
(7)Department of Social Work, Faculty of Social Sciences, Oslo Metropolitan 
University, Oslo, Norway.

BACKGROUND: The covid-19 pandemic has impacted the health and well-being of 
millions across the globe. Strict social distancing policies and periodic 
lockdowns has led to an increased reliance on alternative online means of 
communication, including social media.
OBJECTIVES: to examine (i) social media use and mental health in the general 
population 9 months after the COVID-19 pandemic outbreak and (ii) mental health 
in relation to motives for and extent of social media use, while adjusting for 
sociodemographic variables.
METHODS: A cross-national online survey was conducted in Norway, UK, USA and 
Australia. Participants (n = 3,474) reported extent of and motives for social 
media use and completed the 12-item General Health Questionnaire. The data were 
analyzed by chi-square tests, one-way analyses of variance, and multiple linear 
regression analysis.
RESULTS: Poorer mental health was associated with using social media to decrease 
loneliness and for entertainment motives, while better mental health was 
associated with using social media for personal contact and maintaining 
relationships. Overall increased daily time on social media was associated with 
poorer mental health. The social media use variables were responsible for a 
substantial proportion of the outcome variance explained. These findings were 
consistent across the four countries, with only minor variations.
CONCLUSIONS: Motives for using, and time spent using, social media were 
associated with the participants' mental health. Guidance and recommendations 
for social media usage to the general public for prevention and intervention for 
behavioral health may be beneficial.

Copyright © 2022 Thygesen, Bonsaksen, Schoultz, Ruffolo, Leung, Price and 
Geirdal.

DOI: 10.3389/fpubh.2021.752004
PMCID: PMC8804162
PMID: 35118039 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2453. Trials. 2022 Feb 3;23(1):110. doi: 10.1186/s13063-022-06034-0.

Protocol for a cluster randomized control trial of the impact of the Breaking 
the Man Code workshops on adolescent boys' intentions to seek help.

King K(1), Schlichthorst M(2), Chondros P(3), Rice S(4)(5), Clark A(6), Le 
LK(7), Mihalopoulos C(7), Pirkis J(2).

Author information:
(1)Turner Institute for Brain and Mental Health, Monash University, Melbourne, 
Australia. kylie.king@monash.edu.
(2)Centre for Mental Health, Melbourne School of Population and Global Health, 
The University of Melbourne, Melbourne, Australia.
(3)Department of General Practice, Melbourne Medical School, The University of 
Melbourne, Melbourne, Australia.
(4)Orygen, Parkville, Melbourne, Australia.
(5)Centre for Youth Mental Health, The University of Melbourne, Melbourne, 
Australia.
(6)Turner Institute for Brain and Mental Health, Monash University, Melbourne, 
Australia.
(7)Deakin Health Economics, Institute for Health Transformation, School of 
Health and Social Development, Deakin University, Melbourne, Australia.

BACKGROUND: Males in Australia and many other countries account for 
three-quarters of all deaths by suicide. School-based programs to support young 
men's wellbeing have become increasingly common in recent years and show much 
promise to tackle the issue of male suicide by fostering protective factors and 
mitigating harmful factors. However, only a few of these programs have been 
evaluated. This trial seeks to address the lack of knowledge about the potential 
for school-based gender-transformative programs to have a positive impact on 
boys. Breaking the Man Code workshops, delivered by Tomorrow Man in Australia, 
challenge and transform harmful masculinities with young men with a view to 
ultimately reducing their suicide risk. The trial aims to examine whether 
adolescent boys who participate in the Breaking the Man Code workshop 
demonstrate an increase in their likelihood of seeking help for personal or 
emotional problems compared to boys waiting to take part in the workshop.
METHODS: A stratified cluster randomized controlled superiority trial with two 
parallel groups will be conducted. Schools will be randomly allocated 1:1, 
stratified by location of the schools (rural or urban), state (Victoria, NSW, or 
WA), and mode of workshop delivery (face-to-face or online), to the intervention 
group and waitlist control group.
DISCUSSION: The Breaking the Man Code workshops show great promise as a 
school-based prevention intervention. The trial will fill a gap in knowledge 
that is critically needed to inform future interventions with boys and men. Some 
methodological challenges have been identified related to the COVID-19 pandemic 
in Australia, such as delays in ethics approvals and the need for Tomorrow Man 
to introduce an online delivery option for the workshop. The trial protocol has 
been designed to mitigate these challenges. The findings from the trial will be 
used to improve the workshops and will assist others who are designing and 
implementing suicide prevention interventions for boys and men.
TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ( 
ACTRN12620001134910 ). Registered on 30 October 2020.

© 2022. The Author(s).

DOI: 10.1186/s13063-022-06034-0
PMCID: PMC8811738
PMID: 35115023 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2454. J Intern Med. 2022 Jun;291(6):837-848. doi: 10.1111/joim.13461. Epub 2022 Feb 
16.

The first wave of COVID-19 and concurrent social restrictions were not 
associated with a negative impact on mental health and psychiatric well-being.

Love TJ(1)(2), Wessman I(3), Gislason GK(1), Rognvaldsson S(1)(2), 
Thorsteinsdottir S(1), Sigurdardottir GA(1), Thordardottir AR(1), Eythorsson 
E(2), Asgeirsdottir TL(4), Aspelund T(5), Bjornsson AS(3), Kristinsson SY(1)(2).

Author information:
(1)Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
(2)Department of Medicine, Landspitali University Hospital, Reykjavik, Iceland.
(3)Faculty of Psychology, University of Iceland, Reykjavik, Iceland.
(4)Faculty of Economics, University of Iceland, Reykjavik, Iceland.
(5)Centre for Public Health Sciences, University of Iceland, Reykjavik, Iceland.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic and efforts to 
contain it have substantially affected the daily lives of most of the world's 
population.
OBJECTIVE: We describe the impact of the first COVID-19 wave and associated 
social restrictions on the mental health of a large adult population.
METHODS: We performed a cohort study nested in a prospective randomized clinical 
trial, comparing responses during the first COVID-19 wave to previous responses. 
We calculated the odds ratio (OR) of the population moving up one severity 
category on validated instruments used to measure stress (PSS-10), anxiety 
(GAD-7), depression (PHQ-9), and Satisfaction With Life Scale (SWLS). Responses 
were linked to inpatient and outpatient ICD-10 codes from registries. Models 
were adjusted for age, sex, comorbidities, and pre-existing diagnoses of mental 
illness.
RESULTS: Of 63,848 invited participants, 42,253 (66%) responded. The median age 
was 60 (inter-quartile range 53-68) and 19,032 (45%) were male. Responses during 
the first wave of COVID-19 did not suggest increased stress (OR 0.97; 95% 
confidence interval [CI], 0.93-1.01; p = 0.28) or anxiety (OR 1.01; 95% CI, 0.96 
to 1.05; p = 0.61), but were associated with decreased depression (OR 0.89; 95% 
CI, 0.85-0.93, p < 0.0001) and increased satisfaction with life (OR 1.12; 95% 
CI, 1.08-1.16, p < 0.0001). A secondary analysis of repeated measures data 
showed similar results.
CONCLUSIONS: Social restrictions were sufficient to contain the pandemic but did 
not negatively impact validated measures of mental illness or psychiatric 
well-being. However, responses to individual questions showed signs of fear and 
stress. This may represent a normal, rather than pathological, population 
response to a stressful situation.

© 2022 The Association for the Publication of the Journal of Internal Medicine.

DOI: 10.1111/joim.13461
PMID: 35112416 [Indexed for MEDLINE]


2455. Front Public Health. 2022 Jan 17;9:809357. doi: 10.3389/fpubh.2021.809357. 
eCollection 2021.

Impact of Military Service in Vietnam on Coping and Health Behaviors of Aging 
Veterans During the COVID-19 Pandemic.

Stellman JM(1), Stellman SD(2), Spiro A 3rd(3), Pless Kaiser A(4), Smith BN(5).

Author information:
(1)Department of Health Policy and Management, Mailman School of Public Health, 
Columbia University, New York, NY, United States.
(2)Department of Epidemiology, Mailman School of Public Health, Columbia 
University, New York, NY, United States.
(3)Massachusetts Veterans Epidemiology Research and Information Center 
(MAVERIC), VA Boston Healthcare System and Departments of Epidemiology and 
Psychiatry, Boston University Schools of Public Health and Medicine, Boston, MA, 
United States.
(4)National Center for PTSD Behavioral Science Division at VA Boston Healthcare 
System and Department of Psychiatry, Boston University School of Medicine, 
Boston, MA, United States.
(5)National Center for PTSD Women's Health Sciences Division, VA Boston 
Healthcare System and Department of Psychiatry, Boston University School of 
Medicine, Boston, MA, United States.

Many Vietnam War veterans who experienced military trauma still exhibit PTSD 
symptomatology. Little is known about how new stressful situations, like the 
COVID-19 pandemic, affect previously traumatized people or whether they will 
react differently to them. We explore whether military combat experiences in 
Vietnam affect veterans' perceived abilities to cope with COVID-19 and whether 
current PTSD symptoms and later-adulthood reengagement with trauma memories are 
related to coping. We examine the extent that current PTSD symptoms and trauma 
reengagement relate to preventive practices. Participants were part of a 
randomly sampled cohort of American Legionnaires who responded to two previous 
surveys (1984, 1998), were born 1945-1953 and deployed to Vietnam 1963-1973, 
thus representing an aging veteran population. A survey supplement assessed 
coping with the pandemic and adherence to public health guidelines. The response 
rate was 74% (N = 507); 422 (61.6%) completed the COVID-19 supplement. Military 
experiences were found to affect coping with 41.4% reporting they affected 
ability to cope with COVID-19. Medium- and high-combat veterans were more likely 
to report that military experience affected coping than low-combat (OR 2.4, 95% 
CI 1.51-3.96; 2.6, 95% CI 1.41-4.61, respectively). Those with high PTSD scores 
had 7.7-fold (95% CI 4.3-13.17) increased likelihood of reporting that their 
coping was affected, compared to low-PTSD scorers. Few adopted social distancing 
(4%), staying at home (17%), or ceasing usual activities (32%); high-combat 
veterans were least likely to stay home. Veterans who practiced handwashing, 
sanitizer use, mask-wearing, and surface disinfection had significantly higher 
PTSD scores than those who did not. Veterans with higher scores on the LOSS-SF 
scale associated more reengagement with trauma memories and were more likely to 
engage in personal preventive strategies. Analysis of open-ended responses 
supported these findings. We conclude that fifty years after returning from 
Vietnam, PTSD scores were high for high-combat veterans, suggestive of PTSD 
diagnosis. Military experiences affected coping with COVID both positively and 
negatively, and may have helped instill useful personal health behaviors. 
Veterans, especially those with PTSD symptomatology, may have special needs 
during stressful times, like the COVID-19 pandemic, affecting compliance with 
recommended practices, as well as their overall health and well-being.

Copyright © 2022 Stellman, Stellman, Spiro, Pless Kaiser and Smith.

DOI: 10.3389/fpubh.2021.809357
PMCID: PMC8802994
PMID: 35111722 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2456. Indian J Crit Care Med. 2022 Jan;26(1):100-107. doi: 
10.5005/jp-journals-10071-24081.

Mental Health Indices of Intensive Care Unit and Emergency Room Frontliners 
during the Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic in India.

Vadi S(1), Shah S(2), Bajpe S(1), George N(1), Santhosh A(1), Sanwalka N(3), 
Ramakrishnan A(4).

Author information:
(1)Department of Intensive Care Medicine, Kokilaben Dhirubhai Ambani Hospital 
and Medical Research Institute, Mumbai, Maharashtra, India.
(2)Accident and Emergency Department, Kokilaben Dhirubhai Ambani Hospital and 
Medical Research Institute, Mumbai, Maharashtra, India.
(3)Department of Nutrition and Biostatistics, NutriCanvas, Mumbai, Maharashtra, 
India.
(4)Department of Psychiatry, Kokilaben Dhirubhai Ambani Hospital and Medical 
Research Institute, Mumbai, Maharashtra, India.

BACKGROUND: The contagious coronavirus disease-2019 (COVID-19) pandemic has had 
a significant psychological impact on healthcare workers. Intensive care unit 
(ICU) and emergency room (ER) providers have functioned in an environment of 
fear for their health as well as their family well-being.
AIM AND OBJECTIVE: The aim and objective of the article was to study mental 
health disorders (anxiety, depression, stress, post-traumatic stress disorder 
(PTSD), and sleep quality) in frontliners and to identify factors affecting 
mental health indices.
MATERIALS AND METHODS: A survey of 153 doctors and nurses working in ICU and ER 
was conducted from December 2020 to January 2021 using questionnaire with 
clinically validated scales: Acute Stress Disorder Scale, Perceived Stress 
Scale, Beck's Depression Inventory (BDI), Zung Self-rating Anxiety Scale (SAS), 
Global Pittsburgh Sleep Quality Index (PSQI), Multidimensional Scale of 
Perceived Social Support (MSPS), and New General Self-efficacy (NGSE) Scale. 
Analysis was performed to identify of gender, age, place of work, self-efficacy, 
and social support using logistic regression.
RESULTS: Of the 153 participants, 21.6% had PTSD, 88.6% had moderate to high 
stress, 16.3% had anxiety, and 59.5% had poor sleep. Of these, the majority were 
females and those aged ≤30 years. Males had lesser depression, anxiety, and poor 
sleep compared to females (p <0.05). Participants working in ER reported higher 
stress as compared to those working in ICU (p <0.05). PTSD, perceived stress, 
depression, anxiety, and poor sleep were higher in participants with 
low-to-moderate perceived self-efficacy as compared to participants with high 
self-efficacy (p <0.05).
CONCLUSION: This study reveals significant psychological distress among ER and 
ICU frontliners during severe acute respiratory syndrome coronavirus 2 
(SARS-CoV-2) pandemic, a typical high-acuity environment during the nonpandemic 
times.
HOW TO CITE THIS ARTICLE: Vadi S, Shah S, Bajpe S, George N, Santhosh A, 
Sanwalka N, et al. Mental Health Indices of Intensive Care Unit and Emergency 
Room Frontliners during the Severe Acute Respiratory Syndrome Coronavirus 2 
Pandemic in India. Indian J Crit Care Med 2022;26(1):100-107.

Copyright © 2022; The Author(s).

DOI: 10.5005/jp-journals-10071-24081
PMCID: PMC8783251
PMID: 35110852

Conflict of interest statement: Source of support: Nil Conflict of interest: 
None


2457. J Matern Fetal Neonatal Med. 2022 Dec;35(25):9383-9390. doi: 
10.1080/14767058.2022.2035713. Epub 2022 Feb 2.

Impact of in utero opioid exposure on newborn outcomes: beyond neonatal opioid 
withdrawal syndrome.

Bailey BA(1), Shah DS(2), Boynewicz KL(3), Justice NA(2), Wood DL(2).

Author information:
(1)College of Medicine, Central Michigan University, Mt Pleasant, MI, USA.
(2)Department of Pediatrics, Quillen College of Medicine, East Tennessee State 
University, Johnson City, TN, USA.
(3)Department of Physical Therapy, College of Clinical & Rehabilitation Health 
Science, East Tennessee State University, Johnson City, TN, USA.

BACKGROUND AND OBJECTIVES: Research on in utero opioid exposure impacts has 
focused on Neonatal Opioid Withdrawal Syndrome (NOWS). However, possible impacts 
on fetal growth and newborn wellbeing have emerged, with inconsistencies likely 
driven by methodological issues. Our goal was to compare birth outcomes between 
newborns with prenatal opioid exposure and a matched control group.
METHODS: Participants were identified via manual review of electronic medical 
records of all deliveries over five years within a regional health system (6 
delivery hospitals across 2 states). From over 18,000 births, 300 with prenatal 
opioid exposure and 300 control newborns matched on exposure, medical, and 
background factors were included. Additional factors were statistically 
controlled. Outcomes included pregnancy/delivery complications, newborn size, 
and newborn health complications.
RESULTS: Compared to biochemically verified controls, exposed newborns had 
higher rates of fetal growth restriction, weighed less, had decreased length and 
head circumference, and had higher rates of respiratory distress, sepsis, and 
jaundice. No significant differences in gestational length, Apgar scores, or 
neonatal hypoglycemia were found. Adjusted regression analyses revealed that 
compared to controls, those exposed had an average 150 g decrease in birth 
weight, a two-fold increased risk for IUGR (OR = 2.09), a nearly three-fold (OR 
= 2.80) increased risk for jaundice, a more than seven-fold (OR = 7.40) 
increased risk for respiratory distress, and a thirty-fold (OR = 30.47) 
increased risk for sepsis.
CONCLUSIONS: Results suggest significant pregnancy and newborn outcomes beyond 
NOWS following pregnancy opioid use, informing clinical screening and treatment 
decisions to enhance health and wellbeing in pregnancy, during the neonatal 
period, and beyond.

DOI: 10.1080/14767058.2022.2035713
PMID: 35109759 [Indexed for MEDLINE]


2458. PLoS One. 2022 Feb 2;17(2):e0261773. doi: 10.1371/journal.pone.0261773. 
eCollection 2022.

Compounding inequalities: Adolescent psychosocial wellbeing and resilience among 
refugee and host communities in Jordan during the COVID-19 pandemic.

Jones N(1), Baird S(2), Abu Hamad B(3), Bhutta ZA(4)(5), Oakley E(2), Shah M(6), 
Sajdi J(7), Yount KM(8).

Author information:
(1)Gender and Adolescence: Global Evidence (GAGE), ODI, London, United Kingdom.
(2)Department of Global Health, George Washington University, Washington, DC., 
United States of America.
(3)Department of Public Health, Al Quds University, Gaza, State of Palestine.
(4)Department of Nutritional Sciences, Hospital for Sick Children, Toronto, 
Canada.
(5)Aga Khan University, Karachi, Pakistan.
(6)Luskin School of Public Affairs, University of California, Los Angeles, CA, 
United States of America.
(7)Information and Research Center, King Hussein Foundation, Amman, Jordan.
(8)Department of Global Health, Emory University, Atlanta, GA, United States of 
America.

PURPOSE: The COVID-19 pandemic and associated risk-mitigation strategies have 
altered the social contexts in which adolescents in low- and middle-income 
countries live. Little is known, however, about the impacts of the pandemic on 
displaced populations, and how those impacts differ by gender and life stage. We 
investigate the extent to which the pandemic has compounded pre-existing social 
inequalities among adolescents in Jordan, and the role support structures play 
in promoting resilience.
METHODS: Our analysis leverages longitudinal quantitative survey data and 
in-depth qualitative interviews, collected before and after the onset of 
COVID-19, with over 3,000 Syrian refugees, stateless Palestinians and vulnerable 
Jordanians, living in camps, host communities and informal tented settlements. 
We utilize mixed-methods analysis combining multivariate regression with 
deductive qualitative tools to evaluate pandemic impacts and associated policy 
responses on adolescent wellbeing and mental health, at three and nine months 
after the pandemic onset. We also explore the role of support systems at 
individual, household, community, and policy levels.
FINDINGS: We find the pandemic has resulted in severe economic and service 
disruptions with far-reaching and heterogenous effects on adolescent wellbeing. 
Nine months into the pandemic, 19.3% of adolescents in the sample presented with 
symptoms of moderate-to severe depression, with small signs of improvement (3.2 
percentage points [pp], p<0.001). Two thirds of adolescents reported household 
stress had increased during the pandemic, especially for Syrian adolescents in 
host communities (10.7pp higher than any other group, p<0.001). Social 
connectedness was particularly low for girls, who were 13.4 percentage points 
(p<0.001) more likely than boys to have had no interaction with friends in the 
past 7 days. Adolescent programming shows signs of being protective, 
particularly for girls, who were 8.8 percentage points (p<0.01) more likely to 
have a trusted friend than their peers who were not participating in 
programming.
CONCLUSIONS: Pre-existing social inequalities among refugee adolescents affected 
by forced displacement have been compounded during the COVID-19 pandemic, with 
related disruptions to services and social networks. To achieve Sustainable 
Development Goal targets to support healthy and empowered development in 
adolescence and early adulthood requires interventions that target the urgent 
needs of the most vulnerable adolescents while addressing population-level root 
causes and determinants of psychosocial wellbeing and resilience for all 
adolescent girls and boys.

DOI: 10.1371/journal.pone.0261773
PMCID: PMC8809558
PMID: 35108293 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2459. Child Care Health Dev. 2022 Nov;48(6):1001-1007. doi: 10.1111/cch.12980. Epub 
2022 Feb 10.

The impact of the COVID-19 pandemic on young children and their caregivers.

Costa P(1), Cruz AC(1), Alves A(2), Rodrigues MC(3), Ferguson R(4).

Author information:
(1)Department of Pediatric Nursing, School of Nursing, Federal University of São 
Paulo, São Paulo, Brazil.
(2)School of Nursing, Federal University of São Paulo, São Paulo, Brazil.
(3)Delivery Associates, São Paulo, Brazil.
(4)Harvard Kennedy School, Harvard University, Cambridge, Massachusetts, United 
States.

BACKGROUND: The COVID-19 pandemic has adversely impacted child development and 
the well-being of caregivers, and such evidence ought to be used to inform 
public policy decisions. This study investigated the impact of COVID-19 on 
children's behaviours and their caregivers' needs.
METHODS: A cross-sectional study was conducted with 153 caregivers of children 
(from 0 to 5 years old) from three public daycare centres in Brazil. The 
Nurturing Care Framework of the World Health Organization was used to guide the 
assessment of caregivers' needs. Online data collection using a questionnaire 
was conducted from June to July 2020.
RESULTS: The COVID-19 pandemic increased stressors such as low family income, 
unemployment, sadness, depression and anxiety of caregivers. Their most commonly 
reported needs were related to offering age-appropriate playful activities 
(49.7%), organizing the care routine of children at home (41.8%) and educating 
children when they do something wrong (39.9%). Additionally, the results showed 
that misbehaviour, aggressiveness and agitation occurred more frequently among 
preschoolers than infants or toddlers (p ≤ 0.05).
CONCLUSION: During the COVID-19 pandemic, public policies should provide mental 
health support to caregivers, as well as information about security, safety and 
early learning opportunities for childcare at home.

© 2022 John Wiley & Sons Ltd.

DOI: 10.1111/cch.12980
PMID: 35106795 [Indexed for MEDLINE]


2460. BMJ Open. 2022 Jan 31;12(1):e055515. doi: 10.1136/bmjopen-2021-055515.

Specchio-COVID19 cohort study: a longitudinal follow-up of SARS-CoV-2 serosurvey 
participants in the canton of Geneva, Switzerland.

Baysson H(1)(2), Pennachio F(3), Wisniak A(3)(2), Zabella ME(3), Pullen N(3), 
Collombet P(3)(2), Lorthe E(3), Joost S(4), Balavoine JF(5), Bachmann D(6), 
Azman A(7)(8), Pittet D(9), Chappuis F(10), Kherad O(11), Kaiser L(5)(12)(13), 
Guessous I(#)(2)(14), Stringhini S(#)(3)(2)(15); Specchio-COVID19 study group.

Collaborators: Azman AS, Ba F, Ba O, Bachmann D, Balavoine JF, Balavoine M, 
Baysson H, Beigbeder L, Berthelot J, Bleich P, Rumley GB, Chappuis F, Collombet 
P, Courvoisier D, Cudet A, Vargas CM, D'Ippolito P, Dubos R, Dumont R, Eckerle 
I, Merjani NE, Flahault A, Francioli N, Frangville M, Guessous I, Harnal S, 
Hurst S, Kaiser L, Kherad O, Lamour J, Lescuyer P, L'Huissier F, Lombard FB, 
Loizeau AJ, Lorthe E, Martinez C, Ménard L, Menon L, Metral-Boffod L, Meyer B, 
Moulin A, Nehme M, Noël N, Pennacchio F, Perez-Saez J, Piumatti G, Pittet D, 
Portier J, Posfay-Barbe KM, Poulain G, Pugin C, Pullen N, Randrianandrasana ZF, 
Richard A, Richard V, Rinaldi F, Rizzo J, Samir K, Semaani C, Stringhini S, 
Testini S, Trono D, Violot G, Vuilleumier N, Wisniak A, Yerly S, Zaballa ME.

Author information:
(1)Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva 
University Hospitals, Geneva, Switzerland helene.baysson@unige.ch.
(2)Department of Health and Community Medicine, Faculty of Medicine, University 
of Geneva, Geneva, Switzerland.
(3)Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva 
University Hospitals, Geneva, Switzerland.
(4)Laboratory of Geographic Information Systems (LASIG), School of Architecture, 
Civil and Environmental engineering (ENAC), Ecole Polytechnique Fédérale de 
Lausanne (EPFL), Lausanne, Switzerland.
(5)Department of Medicine, Faculty of Medicine, University of Geneva, Geneva, 
Switzerland.
(6)Hirslanden Clinique des Grangettes and Hislanden Clinique La Colline, Geneva, 
Switzerland.
(7)Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 
Baltimore, MD, USA.
(8)Institute of Global Health, Faculty of Medicine, University of Geneva, 
Geneva, Switzerland.
(9)Infection Control Program and World Health Organization Collaborating Center 
on Patient Safety, Geneva University Hospitals and Faculty of Medecine, 
University of Geneva, Geneva, Switzerland.
(10)Department of Primary Care Medicine, Geneva University Hospitals, Geneva, 
Geneva, Switzerland.
(11)Division of Internal Medicine, Hôpital de la Tour and Faculty of Medicine, 
University of Geneva, Geneva, Switzerland.
(12)Geneva Center of Emerging Viral Diseases and Laboratory of Virology, Geneva 
University Hospitals, Geneva, Switzerland.
(13)Division of Laboratory Medicine, Geneva University Hospitals, Geneva, 
Switzerland.
(14)Division of Primary Care Medicine, Geneva University Hospitals, Geneva, 
Switzerland.
(15)University Center for General Medicine and Public Health, University of 
Lausanne, Lausanne, Switzerland.
(#)Contributed equally

INTRODUCTION: The COVID-19 pandemic has affected billions of people around the 
world both directly through the infection itself and indirectly through its 
economic, social and sanitary impact. Collecting data over time is essential for 
the understanding of the disease spread, the incidence of COVID-19-like 
symptoms, the level and dynamics of immunity, as well as the long-term impact of 
the pandemic. The objective of the study was to set up a longitudinal follow-up 
of adult participants of serosurveys carried out in the canton of Geneva, 
Switzerland, during the COVID-19 pandemic. This follow-up aims at monitoring 
COVID-19 related symptoms and SARS-CoV-2 seroconversion, as well as the overall 
impact of the pandemic on several dimensions of health and on socioeconomic 
factors over a period of at least 2 years.
METHODS AND ANALYSIS: Serosurvey participants were invited to create an account 
on the dedicated digital platform Specchio-COVID19 
(https://www.specchio-covid19.ch/). On registration, an initial questionnaire 
assessed sociodemographic and lifestyle characteristics (including housing 
conditions, physical activity, diet, alcohol and tobacco consumption), 
anthropometry, general health and experience related to COVID-19 (symptoms, 
COVID-19 test results, quarantines, hospitalisations). Weekly, participants were 
invited to fill in a short questionnaire with updates on self-reported 
COVID-19-compatible symptoms, SARS-CoV-2 infection testing and vaccination. A 
more detailed questionnaire about mental health, well-being, risk perception and 
changes in working conditions was proposed monthly. Supplementary questionnaires 
were proposed at regular intervals to assess more in depth the impact of the 
pandemic on physical and mental health, vaccination adherence, healthcare 
consumption and changes in health behaviours. At baseline, serology testing 
allowed to assess the spread of SARS-CoV-2 infection among the general 
population and subgroups of workers. Additionally, seropositive participants and 
a sample of randomly selected participants were invited for serologic testing at 
regular intervals in order to monitor both the seropersistance of 
anti-SARS-CoV-2 antibodies and the seroprevalence of anti-SARS-CoV-2 antibodies 
in the population of the canton of Geneva.
ETHICS AND DISSEMINATION: The study was approved by the Cantonal Research Ethics 
Commission of Geneva, Switzerland (CCER Project ID 2020-00881). Results will be 
disseminated in a variety of ways, via the Specchio-COVID-19 platform, social 
media posts, press releases and through regular scientific dissemination methods 
(open-access articles, conferences).

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-055515
PMCID: PMC8804307
PMID: 35105645 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2461. BMJ Open. 2022 Feb 1;12(2):e056368. doi: 10.1136/bmjopen-2021-056368.

Loneliness and mental well-being in the Polish population during the COVID-19 
pandemic: a cross-sectional study.

Kobos E(1)(2), Knoff B(2), Dziedzic B(2), Maciąg R(2), Idzik A(2).

Author information:
(1)Department of Development of Nursing, Social and Medical Sciences, Faculty of 
Health Sciences, Medical University of Warsaw, Warsaw, Poland ekobos@wum.edu.pl.
(2)Medical University of Warsaw, Warsaw, Poland.

OBJECTIVE: There is a growing concern that the restrictions imposed due to the 
COVID-19 pandemic could lead to increased loneliness and mental disorders, which 
are considered a major public health problem. The aim of the study was to assess 
loneliness, anxiety, depression and irritability in the Polish population during 
the COVID-19 pandemic.
DESIGN: A cross-sectional study. The study participants completed an online 
questionnaire using the computer-assisted web interview technique. Data were 
collected using Revised UCLA Loneliness Scale and Hospital Anxiety and 
Depression Scale.
SETTING: Poland.
PARTICIPANTS: This study was conducted between 6 October and 12 October 2020, in 
a representative sample of 890 Polish residents.
PRIMARY OUTCOME MEASURES: Self-reported loneliness; sociodemographic and 
COVID-19 pandemic factors associated with loneliness, anxiety, depression and 
irritability.
RESULTS: The analyses showed a moderately high degree of loneliness in 22%, 
symptoms of anxiety in 27%, depression in 14% and irritability in 33% of the 
respondents. The increasing severity of anxiety, depression and irritation in 
the study group was accompanied by higher loneliness. Generally, younger people, 
both tested positive for SARS-CoV-2 and those who experienced home quarantine, 
scored higher in both scales.
CONCLUSIONS: It is necessary to identify those most vulnerable to loneliness, 
anxiety and depression during a crisis to assess health needs and proactively 
allocate resources during and after the pandemic. Loneliness, anxiety, 
depression and irritability are important factors to consider in a population of 
younger, disadvantaged people, who tested positive for SARS-CoV-2, people who 
were quarantined at home, and people who believe that their physical and mental 
health is worse than in the pre-pandemic period. It is important to cater for 
the mental health of individuals during the COVID-19 pandemic and to promote 
psychological interventions to improve mental well-being in potentially 
vulnerable social groups.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-056368
PMCID: PMC8808318
PMID: 35105595 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2462. BMC Pregnancy Childbirth. 2022 Feb 1;22(1):92. doi: 10.1186/s12884-021-04374-4.

Mental well-being during stages of COVID-19 lockdown among pregnant women and 
new mothers.

Overbeck G(1), Rasmussen IS(2), Siersma V(2), Kragstrup J(2), Ertmann RK(2), 
Wilson P(2)(3).

Author information:
(1)The Research Unit for General Practice and Section of General Practice, 
Department of Public Health, University of Copenhagen, Copenhagen, Denmark. 
grio@sund.ku.dk.
(2)The Research Unit for General Practice and Section of General Practice, 
Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
(3)Centre for Rural Health, Institute of Applied Health Sciences, University of 
Aberdeen, Aberdeen, Scotland.

BACKGROUND: Pregnancy and early motherhood are sensitive times where epidemic 
disease outbreaks can affect mental health negatively. Countries and health care 
systems handled the pandemic and lockdowns differently and knowledge about how 
the COVID-19 pandemic affected the mental well-being of pregnant women and new 
mothers is limited and points in different directions.
AIM: To investigate symptoms of anxiety and depression in a population of 
pregnant women and new mothers in various stages of infection pressure and 
lockdown during the first 15 months of the COVID-19 pandemic in Denmark.
METHODS: The study population was nested an inception cohort of women recruited 
in their first trimester of pregnancy. Data about mental health of the woman 
were obtained in relation to pregnancy and child development (first trimester, 
8 weeks postpartum and 5 months postpartum), and data were analysed 
cross-sectionally according to calendar time (periods defined by infection rate 
and lock-down during the COVID-19 pandemic).
RESULTS: No differences in reported levels of depressive symptoms between the 
six examined time periods of the pandemic were observed. Specifically, symptoms 
remained unchanged after the first lock-down. No major changes in anxiety 
symptoms were observed in relation to increased infection pressure or lockdowns, 
but a small increase was observed during the second lockdown in women 8 weeks 
postpartum.
CONCLUSION: No clear change in mood among pregnant women was seen between during 
the stages of COVID-19 pandemic in Denmark.

© 2022. The Author(s).

DOI: 10.1186/s12884-021-04374-4
PMCID: PMC8804668
PMID: 35105334 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2463. Epilepsy Behav. 2022 Mar;128:108536. doi: 10.1016/j.yebeh.2021.108536. Epub 2022 
Jan 1.

Impact of the COVID-19 pandemic on persons with epilepsy in Uganda: A 
descriptive cross-sectional study.

Gumisiriza N(1), Kamoen O(2), Boven A(3), Dusabimana A(3), Nono D(4), Musisi 
S(5), Colebunders R(6).

Author information:
(1)Department of Mental Health, Kabale University School of Medicine, Kabale, 
Uganda.
(2)Department of Neurology, Heilig Hart Ziekenhuis, Lier, Belgium.
(3)Global Health Institute, University of Antwerp, Antwerp, Belgium.
(4)AfriChild Centre for the Study of the African Child, Makerere University, 
Kampala, Uganda.
(5)Department of Psychiatry, Makerere University College of Health Sciences, 
Kampala, Uganda.
(6)Global Health Institute, University of Antwerp, Antwerp, Belgium. Electronic 
address: robert.colebunders@uantwerpen.be.

OBJECTIVE: To evaluate the impact of the coronavirus disease 2019 (COVID-19) 
pandemic on the disease course, lives, and psychosocial wellbeing of persons 
with epilepsy (PWE) in Uganda.
METHODS: From April 2021 till May 2021, we carried out a descriptive 
cross-sectional study at four hospitals located in four regions of Uganda. PWE 
presenting at the study sites were offered a structured questionnaire in the 
local language. We used the PHQ-9 questionnaire to screen for depression and the 
GAD-7 to screen for anxiety. Univariate and multivariable logistic regression 
was used to investigate factors associated with anxiety and depression.
RESULTS: A total of 370 responses were collected. The median age of the 
respondents was 20.5 years (IQR 15-29), and 51.9% were males. During the 
lockdown period, the seizure frequency increased in 87 (23.5%) PWE. Various 
forms of physical and psychological violence were inflicted upon 106 (28.6%) 
PWE. Fifty-eight (15.7%) screened positive for anxiety and 65 (17.6%) positive 
for depression. Both increased seizure frequency and experienced violence were 
associated with experiencing depression and anxiety.
CONCLUSION: The COVID-19 pandemic and lockdown impacted seizure frequency and 
the psychosocial wellbeing of PWE in Uganda. Increased seizure frequency was 
associated with higher rates of anxiety and depression. This underlines the 
importance of continued follow-up of PWE and a low threshold to screen for 
depression, anxiety, and domestic violence.

Copyright © 2021 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.yebeh.2021.108536
PMCID: PMC8720867
PMID: 35104731 [Indexed for MEDLINE]


2464. J Youth Adolesc. 2022 Mar;51(3):585-597. doi: 10.1007/s10964-022-01573-w. Epub 
2022 Feb 1.

Young Adult Adaptability to the Social Challenges of the COVID-19 Pandemic: The 
Protective Role of Friendships.

Juvonen J(1), Lessard LM(2), Kline NG(3), Graham S(3).

Author information:
(1)University of California, Los Angeles, Los Angeles, CA, USA. 
Juvonen@psych.ucla.edu.
(2)University of Connecticut, Storrs, CT, USA.
(3)University of California, Los Angeles, Los Angeles, CA, USA.

The continuing COVID-19 pandemic enables assessment of the adaptability of young 
adults to non-normative stressors threatening their social-emotional wellbeing. 
Focusing specifically on a developmentally critical social challenge of 
restricted in-person contact, the goal of the current study was to examine the 
role of friendships in alleviating social-emotional problems. Data were 
collected via online surveys from an ethnically diverse sample (n = 1557) of 20 
to 24-year-olds (62% cisgender female, 31% male, 7% gender diverse or gender 
questioning) in spring of 2021. Longitudinal data from an earlier time point 
involving an age-normative social challenge (transition out of high school) were 
used as a comparison. The comparisons between the transition from high school 
and the pandemic showed that whereas social anxiety and depressive symptoms 
increased, loneliness decreased. Participants also reported having slightly more 
friends and rated the overall quality of their friendships as somewhat higher. 
Regression analyses revealed that a greater number of friends over time and 
greater satisfaction with friend electronic communication during the pandemic 
were most robustly related to lower social and generalized anxiety as well as 
depressive symptoms, over and above earlier social-emotional wellbeing and a 
number of relevant correlates. Loneliness was protected by higher quality of 
friendships, greater contact with friends, as well as more frequent and 
satisfying electronic communication with friends. The results suggest that 
although young adults are facing emotional challenges during the continued 
pandemic, they are also able to adapt by keeping in touch with friends to 
decrease subjective sense of isolation. The findings have novel intervention 
implications to reduce loneliness.

© 2022. The Author(s).

DOI: 10.1007/s10964-022-01573-w
PMCID: PMC8805132
PMID: 35103932 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


2465. Appl Psychol Health Well Being. 2022 Aug;14(3):734-756. doi: 10.1111/aphw.12344. 
Epub 2022 Jan 31.

Longitudinal effects of COVID-19-related stressors on young adults' mental 
health and wellbeing.

Graupensperger S(1), Calhoun BH(1), Patrick ME(2), Lee CM(1).

Author information:
(1)Department of Psychiatry and Behavioral Sciences, University of Washington, 
Seattle, Washington, USA.
(2)Institute for Social Research, University of Michigan, Ann Arbor, Michigan, 
USA.

The COVID-19 pandemic has presented young adults with novel challenges and 
disruptions to several life domains. The current study examined how 
COVID-19-related stressors (i.e., job-related, financial-related, 
social/relational, and illness-related stressors) relate to young adults' 
symptoms of depression and anxiety, and satisfaction with life (in the US). In 
Aim 1, we examined associations between COVID-19-related stressors and indices 
of mental health and well-being in the initial phase of the pandemic (April/May 
2020) while accounting for participants' pre-pandemic levels of these outcomes 
in January of 2020 (N = 519; Mage  = 25.4; 62.8% women). Social/relational 
stressors were most strongly associated with increased symptoms of 
anxiety/depression, and financial stressors were most strongly associated with 
decreased satisfaction with life. Extending this research longitudinally (Aim 
2), we sampled young adults bi-monthly across a year-long period (September 2020 
to August 2021). Multilevel models revealed within-person associations between 
each stressor domain and mental health/well-being; young adults reported more 
symptoms of depression/anxiety and lower satisfaction with life in months that 
stressors were relatively more salient. Interactions between stressors and time 
revealed associations were generally stronger in earlier months and decreased 
linearly across the pandemic. Taken together, longitudinal evidence indicates 
that COVID-19-related stressors, especially social/relational stressors, have 
direct and time-varying associations with mental health and well-being.

© 2022 The International Association of Applied Psychology.

DOI: 10.1111/aphw.12344
PMCID: PMC9746887
PMID: 35102692 [Indexed for MEDLINE]

Conflict of interest statement: CONFLICT OF INTEREST The authors have no 
conflict of interest to disclose.


2466. Curr Psychiatry Rep. 2022 Jan;24(1):37-46. doi: 10.1007/s11920-022-01313-8. Epub 
2022 Feb 1.

Emotional and Behavioral Impact of the COVID-19 Epidemic in Adolescents.

Bera L(1), Souchon M(1), Ladsous A(1), Colin V(1), Lopez-Castroman J(2)(3)(4).

Author information:
(1)Département de psychiatrie, CHU Nîmes, Nîmes, France.
(2)Département de psychiatrie, CHU Nîmes, Nîmes, France. 
jorge.lopezcastroman@chu-nimes.fr.
(3)IGF, CNRS-INSERM, Montpellier, France. jorge.lopezcastroman@chu-nimes.fr.
(4)University of Montpellier, Montpellier, France. 
jorge.lopezcastroman@chu-nimes.fr.

PURPOSE OF REVIEW: This review of the literature aims to explore the impact of 
the COVID-19 pandemic and the lockdown on teenagers' mental health. We 
distinguish two groups: adolescents who had already been diagnosed with a mental 
disorder and the general population of adolescents.
RECENT FINDINGS: An increase in the number of mental health-related difficulties 
in adolescents has already been reported in previous health crises. Accordingly, 
the perceived well-being of teenagers declined during the COVID-19 pandemic. 
Adolescents with mental disorders were significantly more affected by the 
lockdown than those in the general population. The effect of the COVID-19 crisis 
on the mental health of adolescents has been heterogeneous. The first pandemic 
wave was essentially associated with an increase of internalizing symptoms in 
adolescents, particularly anxiety, depression and eating disorders. The impact 
on externalizing symptoms was less clear, and seem to concern mostly adolescents 
with pre-existing behavioral disorders. During the second and later waves of the 
pandemic, an upsurge of suicidal ideation and attempts among adolescents have 
been reported in many countries.

© 2022. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s11920-022-01313-8
PMCID: PMC8803571
PMID: 35102536 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no relevant financial or 
non-financial interests to disclose.


2467. BMC Public Health. 2022 Feb 1;22(1):209. doi: 10.1186/s12889-022-12590-6.

The association between physical activity and mental health during the first 
year of the COVID-19 pandemic: a systematic review.

Marconcin P(1)(2), Werneck AO(3), Peralta M(4)(5), Ihle A(6)(7)(8), Gouveia 
ÉR(9)(10), Ferrari G(11), Sarmento H(12), Marques A(4)(3).

Author information:
(1)KinesioLab, Research Unit in Human Movement Analysis, Insituto Piaget, 
Almada, Portugal. priscilamarconcin@fmh.ulisboa.pt.
(2)CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, 
Portugal. priscilamarconcin@fmh.ulisboa.pt.
(3)Center for Epidemiological Research in Nutrition and Health, Department of 
Nutrition, School of Public Health, São Paulo, Brazil.
(4)CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, 
Portugal.
(5)ISAMB, Universidade de Lisboa, Lisbon, Portugal.
(6)Center for the Interdisciplinary Study of Gerontology and Vulnerability, 
University of Geneva, Geneva, Switzerland.
(7)Swiss National Centre of Competence in Research LIVES - Overcoming 
vulnerability: Life course perspectives, Lausanne and Geneva, Switzerland.
(8)Department of Psychology, University of Geneva, Geneva, Switzerland.
(9)Universidade da Madeira, Funchal, Portugal.
(10)Interactive Technologies Institute, LARSyS, Funchal, Portugal.
(11)Laboratorio de Rendimiento Humano, Grupo de Estudio en Educación, Actividad 
Física y Salud (GEEAFyS), Universidad Católica del Maule, Talca, Chile.
(12)University of Coimbra, Research Unit for Sport and Physical Activity 
(CIDAF). Faculty of Sport Sciences and Physical Education, Coimbra, Portugal.

INTRODUCTION: The Coronavirus disease-19 (COVID-19) pandemic affected countries 
worldwide and has changed peoples' lives. A reduction in physical activity and 
increased mental health problems were observed, mainly in the first year of the 
COVID-19 pandemic. Thus, this systematic review aims to examine the association 
between physical activity and mental health during the first year of the 
COVID-19 pandemic.
METHODS: In July 2021, a search was applied to PubMed, Scopus, and Web of 
Science. Eligibility criteria included cross-sectional, prospective, and 
longitudinal study designs and studies published in English; outcomes included 
physical activity and mental health (e.g., depressive symptoms, anxiety, 
positive and negative effects, well-being).
RESULTS: Thirty-one studies were included in this review. Overall, the studies 
suggested that higher physical activity is associated with higher well-being, 
quality of life as well as lower depressive symptoms, anxiety, and stress, 
independently of age. There was no consensus for the optimal physical activity 
level for mitigating negative mental symptoms, neither for the frequency nor for 
the type of physical activity. Women were more vulnerable to mental health 
changes and men were more susceptive to physical activity changes.
CONCLUSION: Physical activity has been a good and effective choice to mitigate 
the negative effects of the COVID-19 pandemic on mental health during the first 
year of the COVID-19 pandemic. Public health policies should alert for 
possibilities to increase physical activity during the stay-at-home order in 
many countries worldwide.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-12590-6
PMCID: PMC8803575
PMID: 35101022 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2468. J Fam Psychol. 2022 Apr;36(3):325-336. doi: 10.1037/fam0000948. Epub 2022 Jan 
31.

Parent work-life conflict and adolescent adjustment during COVID-19: Mental 
health and parenting as mediators.

Wang C(1), Cheong Y(2), Zhu Q(1), Havewala M(1), Ye Y(3).

Author information:
(1)Department of Counseling, Higher Education, and Special Education, University 
of Maryland, College Park.
(2)Asian American Studies Program, University of Maryland, College Park.
(3)Department of Student Services, TsingHua University High School.

Coronavirus disease (COVID-19) pandemic is an unprecedented challenging time for 
parents and adolescents. The present study examines the role of parent work-life 
conflict on adolescent adjustment (i.e., academic engagement and mental health) 
and family processes (i.e., parental mental health and parenting) as potential 
mediators for this association. A total of 692 middle school students (53.2% 
boys; Mage = 13.54 years, SDage = 0.58) and their parents (29.6% fathers and 
70.4% mothers; Mage = 44.75 years, SDage = 4.14 years) completed an online 
survey in May 2020 in Beijing, China. Results indicated that many parents 
(24.6%) experienced work-life conflicts amid the COVID-19 pandemic. Findings 
also showed that parent work-life conflict was negatively associated with youth 
academic engagement and mental health indirectly through parental mental health 
difficulties and parenting behavior (parental control, autonomy granting, and 
parental involvement). In addition, parental mental health difficulties had 
direct and indirect effects on youth adjustment via parenting behaviors, such 
that parental involvement and autonomy granting predicted greater academic 
engagement and covitality (co-occurrence of positive traits and positive mental 
health), whereas the parental control predicted youth mental health 
difficulties. Our findings extend prior research by examining the pathways 
linking parental work-life conflict to youth adjustment during COVID-19. 
Findings are discussed in terms of how to better support families and promote 
better youth academic engagement and well-being during COVID-19. (PsycInfo 
Database Record (c) 2022 APA, all rights reserved).

DOI: 10.1037/fam0000948
PMID: 35099233 [Indexed for MEDLINE]


2469. Am J Orthopsychiatry. 2022;92(3):291-301. doi: 10.1037/ort0000606. Epub 2022 Jan 
31.

Subjective well-being, sense of coherence, and posttraumatic growth mediate the 
association between COVID-19 stress, trauma, and burnout among Palestinian 
health-care providers.

Veronese G(1), Mahamid FA(2), Bdier D(1).

Author information:
(1)Department of Human Sciences and Education "R. Massa", University of 
Milano-Bicocca.
(2)Department of Human Sciences, An-Najah National University.

The present work sought to examine the relationship between stress of 
coronavirus disease (COVID-19) disease, psychological trauma, and burnout, and 
whether subjective well-being (SWB), sense of coherence (SOC), and posttraumatic 
growth (PTG) mediated the relationship between the three constructs in a group 
of professional healthcare workers engaged on the frontline during the outbreak 
in Palestine. Results indicated that SWB, SOC, and PTG mediated the association 
between the stress of COVID, symptoms of trauma, and burnout. The psychological 
burdens of the ongoing military occupation have been exacerbated by the COVID 
outbreak, exposing health workers to additional stressors during their work and 
everyday life. However, a SOC associated with SWB and PTG might be a protective 
factor for trauma during the pandemic. Implications for health-care providers 
empowerment are discussed. (PsycInfo Database Record (c) 2022 APA, all rights 
reserved).

DOI: 10.1037/ort0000606
PMID: 35099199 [Indexed for MEDLINE]


2470. Arch Psychiatr Nurs. 2022 Feb;36:41-47. doi: 10.1016/j.apnu.2021.11.002. Epub 
2021 Nov 23.

Stress and depressive symptoms among Italian mental health nurses during the 
COVID-19 pandemic, a cross-sectional study.

Napoli G(1).

Author information:
(1)Dipartimento di Salute Mentale, Azienda Sanitaria Universitaria Friuli 
Centrale (ASUFC), Udine, Italy. Electronic address: 
giovanni.napoli@asufc.sanita.fvg.it.

This study used the cross-sectional web survey methodology to assess how the 
COVID-19 pandemic affected Italian psychiatric nurses in terms of stress levels 
and depressive symptoms. A total of 266 nurses belonging to the Italian Mental 
Health Departments were interviewed and they were subjected to two validated 
scales respectively PSS-10 (for the evaluation of stress) and PHQ-9 (for the 
evaluation of depressive symptoms). Statistical analysis showed moderate stress 
levels and a prevalence of sub-threshold (borderline) depressive symptoms among 
responding nurses. Logistic regression analysis reported that frontline nurses 
on COVID-19 positive patients are at greater risk of reporting higher levels of 
stress and major depressive symptoms, as are female nurses and juvenile nurses. 
age. Monitoring and managing the psychological well-being of nursing staff are 
to be considered among the priorities of mental health service managers and are 
part of a process that aims to increase individual and organizational well-being 
but above all to improve the outcomes resulting from assistance.

Copyright © 2021 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.apnu.2021.11.002
PMCID: PMC8616576
PMID: 35094824 [Indexed for MEDLINE]

Conflict of interest statement: None declared.


2471. Int J Nurs Stud. 2022 Mar;127:104155. doi: 10.1016/j.ijnurstu.2021.104155. Epub 
2021 Dec 15.

The impact of COVID-19 on the wellbeing of the UK nursing and midwifery 
workforce during the first pandemic wave: A longitudinal survey study.

Couper K(1), Murrells T(2), Sanders J(3), Anderson JE(4), Blake H(5), Kelly 
D(6), Kent B(7), Maben J(8), Rafferty AM(9), Taylor RM(10), Harris R(11).

Author information:
(1)Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, 
UK; Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, 
Birmingham Heartlands Hospital, Bordesley Green, Birmingham, B9 5SS, UK. 
Electronic address: k.couper@warwick.ac.uk.
(2)Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's 
College London, 57 Waterloo Road, London, SE1 8WA, UK. Electronic address: 
trevor.murrells@kcl.ac.uk.
(3)St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, 
EC1A 7BE, UK; William Harvey Research Institute, Queen Mary University of 
London, Charterhouse Square, London, EC1M 6BQ UK. Electronic address: 
j.sanders@qmul.ac.uk.
(4)School of Health Sciences, City University of London, Northampton Square, 
London, EC1V 0HB, UK. Electronic address: janet.anderson@city.ac.uk.
(5)School of Health Sciences, University of Nottingham, Queen's Medical Centre, 
Derby Road, Nottingham, NG7 2HA, UK; NIHR Nottingham Biomedical Research Centre, 
Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, UK. Electronic address: 
Holly.Blake@nottingham.ac.uk.
(6)School of Healthcare Sciences, Cardiff University, Eastgate House, Cardiff, 
CF24 0AB, UK. Electronic address: KellyDM@cardiff.ac.uk.
(7)Faculty of Health, University of Plymouth, Rolle Building, Drake Circus, 
Plymouth, PL4 8AA, UK. Electronic address: bridie.kent@plymouth.ac.uk.
(8)School of Health Sciences, University of Surrey, 30 Priestley Rd, Guildford, 
GU2 7YH UK. Electronic address: j.maben@surrey.ac.uk.
(9)Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's 
College London, 57 Waterloo Road, London, SE1 8WA, UK. Electronic address: 
anne_marie.rafferty@kcl.ac.uk.
(10)Centre for Nurse, Midwife and AHP Led Research, University College London 
NHS Foundation Trust, 2nd Floor North, 250 Euston Rd, London NW1 2PG, UK; EGA 
Institute for Women's Health, Faculty of Population Health Sciences, University 
College London, Medical School Building, 74 Huntley Street, London, WC1E 6AU, 
UK. Electronic address: rtaylor13@nhs.net.
(11)Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's 
College London, 57 Waterloo Road, London, SE1 8WA, UK. Electronic address: 
ruth.harris@kcl.ac.uk.

BACKGROUND: The specific challenges experienced by the nursing and midwifery 
workforce in previous pandemics have exacerbated pre-existing professional and 
personal challenges, and triggered new issues. We aimed to determine the 
psychological impact of the COVID-19 pandemic on the UK nursing and midwifery 
workforce and identify potential factors associated with signs of post-traumatic 
stress disorder.
METHODS: A United Kingdom national online survey was conducted at three 
time-points during the first wave of the COVID-19 pandemic between April and 
August 2020 (T1 and T2 during initial wave; T3 at three-months following the 
first wave). All members of the UK registered and unregistered nursing and 
midwifery workforce were eligible to participate. The survey was promoted via 
social media and through organisational email and newsletters. The primary 
outcome was an Impact of Events Scale-Revised score indicative of a 
post-traumatic stress disorder diagnosis (defined using the cut-off score ≥33). 
Multivariable logistic regression modelling was used to assess the association 
between explanatory variables and post-traumatic stress disorder.
RESULTS: We received 7840 eligible responses (T1- 2040; T2- 3638; T3- 2162). 
Overall, 91.6% participants were female, 77.2% were adult registered nurses, and 
28.7% were redeployed during the pandemic. An Impact of Events Scale-Revised 
score ≥33 (probable post-traumatic stress disorder) was observed in 44.6%, 
37.1%, and 29.3% participants at T1, T2, and T3 respectively. At all three 
time-points, both personal and workplace factors were associated with probable 
post-traumatic stress disorder, although some specific associations changed over 
the course of the pandemic. Increased age was associated with reduced probable 
post-traumatic stress disorder at T1 and T2 (e.g. 41-50 years at T1 odds ratio 
(OR) 0.60, 95% confidence interval (CI) 0.42-0.86), but not at T3. Similarly, 
redeployment with inadequate/ no training was associated with increased probable 
post-traumatic stress disorder at T1 and T2, but not at T3 (T1 OR 1.37, 95% CI 
1.06-1.77; T3 OR 1.17, 95% CI 0.89-1.55). A lack of confidence in infection 
prevention and control training was associated with increased probable 
post-traumatic stress disorder at all three time-points (e.g. T1 OR 1.48, 95% CI 
1.11-1.97).
CONCLUSION: A negative psychological impact was evident 3-months following the 
first wave of the pandemic. Both personal and workplace are associated with 
adverse psychological effects linked to the COVID-19 pandemic. These findings 
will inform how healthcare organisations should respond to staff wellbeing needs 
both during the current pandemic, and in planning for future pandemics.

Copyright © 2021. Published by Elsevier Ltd.

DOI: 10.1016/j.ijnurstu.2021.104155
PMCID: PMC8673915
PMID: 35093740 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest None.


2472. Sleep Med. 2022 Feb;90:44-52. doi: 10.1016/j.sleep.2021.12.018. Epub 2022 Jan 
10.

Insomnia and nightmare profiles during the COVID-19 pandemic in Portugal: 
characterization and associated factors.

Goncalves M(1), Henriques A(2), Costa AR(1), Correia D(1), Severo M(1), Lucas 
R(3), Barros H(3); Task Force COVID-19 ISPUP – INESC TEC.

Collaborators: Santos AC, Ribeiro AI, Rocha A, Lopes C, Correia D, Ramos E, 
Gonçalves G, Barros H, Araújo J, Talih M, Tavares M, Severo M, Lunet N, Meireles 
P, Duarte R, Lucas R, Camacho R, Fraga S, Correia S, Silva S, Leão T.

Author information:
(1)EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, 
nº 135, 4050-600 Porto, Portugal; Laboratório para a Investigação Integrativa e 
Translacional em Saúde Populacional (ITR), Porto, Portugal.
(2)EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, 
nº 135, 4050-600 Porto, Portugal; Laboratório para a Investigação Integrativa e 
Translacional em Saúde Populacional (ITR), Porto, Portugal. Electronic address: 
ana.henriques@ispup.up.pt.
(3)EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, 
nº 135, 4050-600 Porto, Portugal; Laboratório para a Investigação Integrativa e 
Translacional em Saúde Populacional (ITR), Porto, Portugal; Departamento de 
Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, 
Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.

OBJECTIVE/BACKGROUND: To describe and characterize insomnia symptoms and 
nightmare profiles in Portugal during the first six weeks of a national lockdown 
due to COVID-19.
PATIENTS/METHODS: An open cohort study was conducted to collect information of 
the general population during the first wave of SARS-CoV-2/COVID-19 pandemic in 
Portugal. We analyzed data from 5011 participants (≥16 years) who answered a 
weekly questionnaire about their well-being. Two questions about the frequency 
of insomnia and nightmares about COVID-19 were consecutively applied during six 
weeks (March-May 2020). Latent class analysis was conducted and different 
insomnia and nightmare profiles were identified. Associations between individual 
characteristics and both profiles were estimated using odds ratios (ORs) and 95% 
confidence intervals (CI).
RESULTS: Five insomnia (No insomnia, Stable-mild, Decreasing-moderate, 
Stable-severe, Increasing-severe) and three nightmares profiles (Stable-mild, 
Stable-moderate, Stable-severe) were identified. Being female, younger, 
perceiving their income as insufficient and feelings of fear towards COVID-19 
were associated with higher odds of insomnia (Women: OR = 6.98 95%CI: 
4.18-11.64; ≥60 years: OR = 0.30 95%CI: 0.18-0.53; Insufficient income: adjusted 
OR (aOR) = 8.413 95%CI: 3.93-16.84; Often presenting fear of being infected with 
SARS-CoV-2 infection: aOR = 9.13 95%CI: 6.36-13.11), and nightmares (Women: 
OR = 2.60 95%CI: 1.74-3.86; ≥60 years: OR = 0.45 95%CI: 0.28-0.74; Insufficient 
income: aOR = 2.60 95%CI: 1.20-5.20; Often/almost always presenting fear of 
being infected with SARS-CoV-2 infection: aOR = 6.62 95%CI: 5.01-8.74). Having a 
diagnosis of SARS-CoV-2 virus infection was associated with worse patterns of 
nightmares about the pandemic.
CONCLUSIONS: Social and psychological individual factors are important 
characteristics to consider in the development of therapeutic strategies to 
support people with sleep problems during the COVID-19 pandemic.

Copyright © 2022 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.sleep.2021.12.018
PMCID: PMC8744402
PMID: 35093683 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest. The ICMJE Uniform Disclosure Form for Potential Conflicts of 
Interest associated with this article can be viewed by clicking on the following 
link: https://doi.org/10.1016/j.sleep.2021.12.018.


2473. BMC Public Health. 2022 Jan 29;22(1):199. doi: 10.1186/s12889-022-12630-1.

Enforced home-working under lockdown and its impact on employee wellbeing: a 
cross-sectional study.

Platts K(1), Breckon J(2), Marshall E(3).

Author information:
(1)Advanced Wellbeing Research Centre, Sheffield Hallam University, Olympic 
Legacy Park, Sheffield, S9 3TU, UK. Katharine.Platts@shu.ac.uk.
(2)Academy of Sport & Physical Activity, Sheffield Hallam University, Collegiate 
Campus, Sheffield, S10 2BP, UK.
(3)Department of Engineering and Maths, Sheffield Hallam University, City 
Campus, Sheffield, S1 1WB, UK.

BACKGROUND: The Covid-19 pandemic precipitated a shift in the working practices 
of millions of people. Nearly half the British workforce (47%) reported to be 
working at home under lockdown in April 2020. This study investigated the impact 
of enforced home-working under lockdown on employee wellbeing via markers of 
stress, burnout, depressive symptoms, and sleep. Moderating effects of factors 
including age, gender, number of dependants, mental health status and work 
status were examined alongside work-related factors including work-life conflict 
and leadership quality.
METHOD: Cross-sectional data were collected over a 12-week period from May to 
August 2020 using an online survey. Job-related and wellbeing factors were 
measured using items from the COPSOQIII. Stress, burnout, somatic stress, 
cognitive stress, and sleep trouble were tested together using MANOVA and 
MANCOVA to identify mediating effects. T-tests and one-way ANOVA identified 
differences in overall stress. Regression trees identified groups with highest 
and lowest levels of stress and depressive symptoms.
RESULTS: 81% of respondents were working at home either full or part-time 
(n = 623, 62% female). Detrimental health impacts of home-working during 
lockdown were most acutely experienced by those with existing mental health 
conditions regardless of age, gender, or work status, and were exacerbated by 
working regular overtime. In those without mental health conditions, predictors 
of stress and depressive symptoms were being female, under 45 years, 
home-working part-time and two dependants, though men reported greater levels of 
work-life conflict. Place and pattern of work had a greater impact on women. 
Lower leadership quality was a significant predictor of stress and burnout for 
both men and women, and, for employees aged > 45 years, had significant impact 
on level of depressive symptoms experienced.
CONCLUSIONS: Experience of home-working under lockdown varies amongst groups. 
Knowledge of these differences provide employers with tools to better manage 
employee wellbeing during periods of crisis. While personal factors are not 
controllable, the quality of leadership provided to employees, and the 'place 
and pattern' of work, can be actively managed to positive effect. Innovative 
flexible working practices will help to build greater workforce resilience.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-12630-1
PMCID: PMC8800406
PMID: 35093054 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2474. BMC Pregnancy Childbirth. 2022 Jan 29;22(1):84. doi: 10.1186/s12884-022-04424-5.

The experience of women with recent gestational diabetes during the COVID-19 
lockdown: a qualitative study from Denmark.

Jensen NH(1), Nielsen KK(2), Dahl-Petersen IK(2), Maindal HT(3)(2).

Author information:
(1)Department of Public Health, Aarhus University, Aarhus, Denmark. 
naje@ph.au.dk.
(2)Health Promotion Research, Steno Diabetes Centre Copenhagen, Herlev, Denmark.
(3)Department of Public Health, Aarhus University, Aarhus, Denmark.

BACKGROUND: Following COVID-19 and the lockdowns, maternity care and support for 
women after delivery have been temporary restructured. Studies show that 
COVID-19 adversely impacts pregnant and peripartum women in the general 
population, but experiences among women in the first year after delivery/in the 
wider postpartum period remain unexplored. Moreover, experiences among women 
with recent gestational diabetes mellitus (GDM) are lacking; though it is a 
group with a potential high need for support after delivery. The aim of our 
study was to investigate (i) how women with recent GDM experienced COVID-19 and 
the first lockdown in Denmark, and (ii) the women's risk perception and health 
literacy in terms of interaction with the healthcare system in relation to 
COVID-19.
METHODS: We performed a qualitative study among 11 women with recent GDM 
(infants aged 2-11 months old). Semi-structured interviews were conducted in 
April-May 2020 by telephone or Skype for Business, when Denmark was under 
lockdown. We analysed data using a thematic qualitative content analysis.
RESULTS: Three themes emerged: i) Everyday life and family well-being, ii) 
Worries about COVID-19 and iii) Health literacy: Health information and access 
to healthcare. The women were generally not worried about their own or their 
infant's risk of COVID-19. The lockdown had a negative impact on everyday life 
e.g. routines, loneliness, breastfeeding uncertainties and worries for the 
infant's social well-being; but better family dynamics were also described. It 
was challenging to maintain healthy behaviours and thus the women described 
worries for the risk of type 2 diabetes and GDM in subsequent pregnancies. The 
women missed peer support and face-to-face visits from health visitors and found 
it difficult to navigate the restructured care with online/telephone set-ups.
CONCLUSIONS: COVID-19 and the lockdown affected everyday life among women with 
recent GDM both positively and negatively. Our findings suggest a need for care 
that are responsive to psychological and social aspects of health throughout the 
COVID-19 pandemic and support to limit worries about adaptation to motherhood 
and the infant's social well-being. Communication focusing on the importance and 
relevance of contacting healthcare providers should also be strengthened.

© 2022. The Author(s).

DOI: 10.1186/s12884-022-04424-5
PMCID: PMC8800544
PMID: 35093021 [Indexed for MEDLINE]

Conflict of interest statement: HTM, IDP and KKN are employed at Steno Diabetes 
Center Copenhagen, which is a regional public hospital and research institution. 
It is partly funded by a grant from Novo Nordisk Foundation. The funder had no 
role in any part of this article. NHJ report no competing interest.


2475. J Psychiatr Res. 2022 Apr;148:21-26. doi: 10.1016/j.jpsychires.2022.01.029. Epub 
2022 Jan 18.

Individual obsessive-compulsive traits are associated with poorer adjustment to 
the easing of COVID-19 restrictions.

Fineberg NA(1), Pellegrini L(2), Burkauskas J(3), Clarke A(4), Laws KR(4).

Author information:
(1)School of Life and Medical Sciences, University of Hertfordshire, Hatfield, 
United Kingdom; Hertfordshire Partnership University NHS Foundation Trust, 
Welwyn Garden City, United Kingdom; University of Cambridge School of Clinical 
Medicine, Cambridge, United Kingdom.
(2)School of Life and Medical Sciences, University of Hertfordshire, Hatfield, 
United Kingdom; Hertfordshire Partnership University NHS Foundation Trust, 
Welwyn Garden City, United Kingdom; Department of Biomedical and Neuromotor 
Sciences, University of Bologna, Italy. Electronic address: 
luca.pellegrini@nhs.net.
(3)Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian 
University of Health Sciences, Palanga, Lithuania.
(4)School of Life and Medical Sciences, University of Hertfordshire, Hatfield, 
United Kingdom.

BACKGROUND: As COVID-19 restrictions ease, the public are expected to relinquish 
previously enforced safety behaviors and resume a more normal lifestyle. Despite 
these aims, our recent survey of 438 adults from the general population, during 
a temporary release of lockdown in the United Kingdom (July-November 2020), 
showed that 25% of the public find re-adjustment problematic. This was 
especially the case in those with a history of mental disorder and 
obsessive-compulsive (OC) traits and symptoms, including rigidity as measured by 
a neurocognitive test of attentional flexibility. To aid in identifying those 
most at risk, we performed a secondary analysis on the data to determine which 
specific OC traits were related to specific aspects of behavioral adjustment.
METHODS: Correlational and multiple regression analyses were performed to 
determine associations between the eight individual personality traits 
constituting DSM-5 Obsessive-Compulsive Personality Disorder (OCPD), as measured 
by the self-rated Compulsive Personality Assessment Scale (CPAS) and a range of 
self-rated Post-Pandemic Adjustment Questionnaire items.
RESULTS: Three items on the Post-Pandemic Adjustment Questionnaire correlated 
with individual CPAS items: 'General difficulties adjusting' correlated with 
perfectionism, preoccupation with details, over-conscientiousness and need for 
control; 'social avoidance' correlated with perfectionism and preoccupation with 
details; and 'disinfecting behaviors' correlated with preoccupation with details 
and miserliness (Pearson's r - all p < .001). Intriguingly, none of the 
adjustment items correlated significantly with self-rated rigidity.
CONCLUSIONS: Several OCPD traits predict post-pandemic adjustment difficulties, 
but perfectionism and preoccupation-with-details showed the most robust 
correlations. These traits constitute a platform for the development of new 
screening and interventional strategies aimed at restoring public mental health 
and wellbeing. Cognitive rigidity may be more reliably evaluated using an 
objective form of assessment.

Copyright © 2022. Published by Elsevier Ltd.

DOI: 10.1016/j.jpsychires.2022.01.029
PMCID: PMC8764617
PMID: 35091357 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no known 
competing financial interests or personal relationships that could have appeared 
to influence the work reported in this paper.


2476. J Adolesc Health. 2022 Mar;70(3):387-395. doi: 10.1016/j.jadohealth.2021.11.023. 
Epub 2022 Jan 26.

The Pandemic's Toll on Young Adolescents: Prevention and Intervention Targets to 
Preserve Their Mental Health.

Kiss O(1), Alzueta E(1), Yuksel D(1), Pohl KM(2), de Zambotti M(1), 
Műller-Oehring EM(2), Prouty D(1), Durley I(1), Pelham WE 3rd(3), McCabe CJ(3), 
Gonzalez MR(3), Brown SA(3), Wade NE(3), Marshall AT(4), Sowell ER(4), Breslin 
FJ(5), Lisdahl KM(6), Dick AS(7), Sheth CS(8), McCandliss BD(9), Guillaume M(9), 
Van Rinsveld AM(9), Dowling GJ(10), Tapert SF(3), Baker FC(11).

Author information:
(1)Center for Health Sciences, SRI International, Menlo Park, California.
(2)Center for Health Sciences, SRI International, Menlo Park, California; 
Department of Psychiatry and Behavioral Sciences, Stanford University School of 
Medicine, Stanford, California.
(3)Department of Psychiatry, University of California, San Diego, La Jolla, 
California.
(4)Children's Hospital Los Angeles, Los Angeles, California.
(5)Laureate Institute for Brain Research, Tulsa, Oklahoma.
(6)Department of Psychology, University of Wisconsin at Milwaukee, Milwaukee, 
Wisconsin.
(7)Department of Psychology, Florida International University, Miami, Florida.
(8)Department of Psychiatry, University of Utah, Salt Lake City, Utah.
(9)Graduate School of Education, Stanford University, Stanford, California.
(10)National Institute on Drug Abuse, Rockville, Maryland.
(11)Center for Health Sciences, SRI International, Menlo Park, California. 
Electronic address: fiona.baker@sri.com.

PURPOSE: Adolescence is characterized by dramatic physical, social, and 
emotional changes, making teens particularly vulnerable to the mental health 
effects of the COVID-19 pandemic. This longitudinal study identifies young 
adolescents who are most vulnerable to the psychological toll of the pandemic 
and provides insights to inform strategies to help adolescents cope better in 
times of crisis.
METHODS: A data-driven approach was applied to a longitudinal, demographically 
diverse cohort of more than 3,000 young adolescents (11-14 years) participating 
in the ongoing Adolescent Brain Cognitive Development Study in the United 
States, including multiple prepandemic visits and three assessments during the 
COVID-19 pandemic (May-August 2020). We fitted machine learning models and 
provided a comprehensive list of predictors of psychological distress in 
individuals.
RESULTS: Positive affect, stress, anxiety, and depressive symptoms were 
accurately detected with our classifiers. Female sex and prepandemic 
internalizing symptoms and sleep problems were strong predictors of 
psychological distress. Parent- and youth-reported pandemic-related psychosocial 
factors, including poorer quality and functioning of family relationships, more 
screen time, and witnessing discrimination in relation to the pandemic further 
predicted youth distress. However, better social support, regular physical 
activities, coping strategies, and healthy behaviors predicted better emotional 
well-being.
DISCUSSION: Findings highlight the importance of social connectedness and 
healthy behaviors, such as sleep and physical activity, as buffering factors 
against the deleterious effects of the pandemic on adolescents' mental health. 
They also point to the need for greater attention toward coping strategies that 
help the most vulnerable adolescents, particularly girls and those with 
prepandemic psychological problems.

Copyright © 2021. Published by Elsevier Inc.

DOI: 10.1016/j.jadohealth.2021.11.023
PMCID: PMC8789404
PMID: 35090817 [Indexed for MEDLINE]


2477. BMC Public Health. 2022 Jan 28;22(1):194. doi: 10.1186/s12889-022-12551-z.

The Infant Health Study - Promoting mental health and healthy weight through 
sensitive parenting to infants with cognitive, emotional, and regulatory 
vulnerabilities: protocol for a stepped-wedge cluster-randomized trial and a 
process evaluation within municipality settings.

Skovgaard AM(1), Bakermans-Kranenburg M(2), Pontoppidan M(3), Tjørnhøj-Thomsen 
T(4), Madsen KR(4), Voss I(4), Wehner SK(4), Pedersen TP(4), Finseth L(4), 
Taylor RS(5)(6), Tolstrup JS(4), Ammitzbøll J(4).

Author information:
(1)National Institute of Public Health, NIPH, University of Southern Denmark, 
Copenhagen, Denmark. amsk@sdu.dk.
(2)Clinical Child and Family Studies, Vrije Universiteit, Amsterdam, The 
Netherlands.
(3)The Danish Center for Social Science Research, VIVE, Copenhagen, Denmark.
(4)National Institute of Public Health, NIPH, University of Southern Denmark, 
Copenhagen, Denmark.
(5)MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for 
Biostatistics, Institute of Health and Well Being, University of Glasgow, 
Glasgow, UK.
(6)University of Exeter, Exeter, United Kingdom.

Erratum in
    BMC Public Health. 2022 Feb 21;22(1):365.

BACKGROUND: Child mental health problems are a major public health concern 
associated with poor mental and physical health later in development. The study 
evaluates a new community-based intervention to promote sensitive parenting and 
reduce enduring mental health problems and unhealthy weight among vulnerable 
infants aged 9-24 months.
METHODS: We use a step-wedge cluster randomized controlled trial design 
conducted within a home visiting program offered by community health nurses to 
infant families in Denmark. Sixteen municipalities are randomly allocated to 
implement the intervention starting at three successive time points from May 1, 
2022 to January 1, 2023. A total of 900-1000 families will be included. A 
standardized program, Psykisk Udvikling og Funktion (PUF), is used to identify 
infants with major problems of eating, sleep, emotional or behavioral regulation 
or developmental problems. The intervention builds on the Video-Feedback 
Intervention to Promote Positive Parenting (VIPP) program, adapted to the 
PUF-context and named the VIPP-PUF. Children will be followed up at ages 18 and 
24 months. Primary outcome measure is the Strengths and Difficulties 
Questionnaire (SDQ) at child age 24 months. The other outcome measures include 
body mass index z-scores, the Ages and Stages Questionnaire Social-Emotional 
(ASQ:SE2); the Child Behavior Checklist (CBCL 1½ -5); Eating behavior 
Questionnaires; the Being a Mother-questionnaire (BaM13); the Parental Stress 
Scale (PSS); and the WHO-5 well-being index (WHO-5). Data on child and family 
factors are obtained from National registries and the Child Health Database. 
Quantitative measures are applied to examine the effectiveness of the VIPP-PUF 
intervention and the implementation process. Qualitative measures include 
interviews with CHNs, parents and municipality stakeholders to explore factors 
that may influence the adherence and effectiveness of the intervention.
DISCUSSION: The study examines a service-setting based intervention building on 
the promotion of sensitive parenting to vulnerable infants. We use a mixed 
methods approach to evaluate the intervention, taking into account the 
influences of COVID-19 pandemic running since March 2020. Overall, the study has 
potential to add to the knowledge on the possibilities of prevention within the 
municipality child health care to reduce the risk of mental health problems and 
unhealthy weight in early childhood.
TRIAL REGISTRATION: www.ClinicalTrials.gov ; ID NCT04601779 ; Protocol ID 
95-110-21307. Registered 25 June 2021.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-12551-z
PMCID: PMC8796192
PMID: 35090411 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2478. Can J Public Health. 2022 Feb;113(1):23-35. doi: 10.17269/s41997-021-00584-7. 
Epub 2022 Jan 28.

Understanding and attenuating pandemic-related disruptions: a plan to reduce 
inequalities in child development.

Côté SM(1)(2), Geoffroy MC(3)(4), Haeck C(5), Ouellet-Morin I(6), Larose S(7), 
Chadi N(8)(9), Zinszer K(10), Gauvin L(10)(11), Mâsse B(10)(8).

Author information:
(1)School of Public Health, Université de Montréal, Montréal, Québec, Canada. 
sylvana.cote.1@umontreal.ca.
(2)CHU Sainte-Justine, Montréal, Québec, Canada. sylvana.cote.1@umontreal.ca.
(3)Department of Educational and Counselling Psychology, McGill University, 
Montréal, Québec, Canada.
(4)Douglas Hospital Research Centre, Montréal, Québec, Canada.
(5)Department of Economics, University of Québec in Montréal, Montréal, Québec, 
Canada.
(6)School of Criminology, University of Montreal, Montréal, Québec, Canada.
(7)Département d'études sur l'enseignement et l'apprentissage, Université Laval, 
Québec, Québec, Canada.
(8)CHU Sainte-Justine, Montréal, Québec, Canada.
(9)Department of Pediatrics, University of Montreal, Montréal, Québec, Canada.
(10)School of Public Health, Université de Montréal, Montréal, Québec, Canada.
(11)Centre de recherche du centre hospitalier de l'Université de Montréal, 
Montréal, Québec, Canada.

The Secretary General of the United Nations described the impact of 
COVID-19-related school closures as a "generational catastrophe." What will be 
the legacy of the 2020-2021 pandemic-related disruptions in 5, 10, 20 years from 
now, as regards education and well-being of children and youth? Addressing the 
disproportionate impact on those growing up in socio-economically disadvantaged 
areas or on those with pre-existing learning challenges is key to sustainable 
recovery. This commentary builds on the four literature reviews presented in 
this Special Section on a Pandemic Recovery Plan for Children and proposes 
strategies to understand and attenuate the impact of pandemic-related lockdown 
measures. Importantly, we need a monitoring strategy to assess indicators of 
child development in three areas of functioning: education and learning, health, 
and well-being (or mental health). Surveillance needs to begin in the critical 
prenatal period (with prenatal care to expectant parents), and extend to the end 
of formal high school/college education. Based on child development indicators, 
a stepped strategy for intervention, ranging from all-encompassing 
population-based health and education promotion initiatives to targeted 
prevention programs and targeted remedial/therapeutic interventions, can be 
offered. As proposed in the UN plan for recovery, ensuring healthy present and 
future generations involves a concerted and intensive intersectoral effort from 
the education, health, psychosocial services, and scientific communities.

Publisher: RéSUMé: Selon les Nations Unis, les perturbations scolaires associées 
à la pandémie de COVID-19 pourraient mener à une « catastrophe générationnelle » 
en gaspillant un potentiel humain incalculable, sapant des décennies de progrès 
et exacerbant des inégalités bien ancrées. Le déploiement du vaccin chez les 
moins de 12 ans n’a pas débuté avant la rentrée scolaire 2021, ce qui laisse 
présager de nombreuses perturbations pour cette 3e année scolaire pandémique. 
Quel sera le legs des perturbations entrainées par la pandémie de COVID-19 en 
matière d’éducation et de bien-être dans 5, 10, ou 20 ans? Une relance durable 
dépendra des mesures prises pour prévenir l’impact négatif disproportionné sur 
les enfants/adolescents de milieux socioéconomiques défavorisés et ceux qui ont 
des défis d’apprentissage préexistants. Ce commentaire propose des stratégies 
pour comprendre et atténuer l’impact des perturbations pandémiques en se fondant 
sur les quatre articles de la présente « Section spéciale sur un plan de relance 
pour les enfants suite à la pandémie ». Trois lignes d’action prioritaires 
émergent à la lumière des connaissances scientifiques actuelles. Premièrement, 
le contexte pandémique met en évidence la nécessité d’accéder à données 
intersectorielles (éducation, santé, services psychosociaux) permettant de 
distinguer les conséquences à court et à long terme. Deuxièmement, il faut être 
prêt à déployer une stratégie interventionnelle par étape, avec des 
interventions universelles en promotion, jusqu’aux interventions plus ciblées et 
intensives. Troisièmement, il faudra mettre en place des programmes particuliers 
pour les enfants/adolescents de milieux défavorisés et pour ceux qui présentent 
des facteurs de risque personnels (défis de santé mentale, retards 
d’apprentissage). À titre d’exemple, le tutorat scolaire devrait être facilement 
accessible dans tous les milieux défavorisés. Tel que proposé dans le plan de 
relance de l’ONU, un effort concerté, intensif et intersectoriel de la part des 
sciences de l’éducation, de la santé, et des services psychosociaux sera 
nécessaire pour assurer la santé et l’éducation des générations présentes et 
futures.

© 2021. The Author(s).

DOI: 10.17269/s41997-021-00584-7
PMCID: PMC8796600
PMID: 35089591 [Indexed for MEDLINE]


2479. Eur J Psychotraumatol. 2022 Jan 24;13(1):2012374. doi: 
10.1080/20008198.2021.2012374. eCollection 2022.

Well-being of Canadian Veterans during the COVID-19 pandemic: cross-sectional 
results from the COVID-19 Veteran well-being study.

Richardson JD(1)(2)(3)(4), St Cyr K(1)(2)(5), Forchuk C(1), Liu JJW(1)(2), 
Plouffe RA(1)(2), Le T(1), Gargala D(1), Deda E(4), Soares V(1), Hosseiny 
F(6)(7), Smith P(6)(7), Dupuis G(6)(7), Roth M(4)(8), Bridgen A(1)(2), 
Marlborough M(2)(4), Jetly R(7), Heber A(9)(10), Lanius R(2)(4), Nazarov 
A(1)(2)(3).

Author information:
(1)The MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, 
London, Ontario, Canada.
(2)Department of Psychiatry, Western University, London, Ontario, Canada.
(3)Department of Psychiatry and Behavioral Neurosciences, McMaster University, 
Hamilton, Ontario, Canada.
(4)St. Joseph's OSI Clinic, Parkwood Institute, St. Joseph's Health Care, 
London, Ontario, Canada.
(5)Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, 
Canada.
(6)Centre of Excellence for PTSD, Ottawa, Ontario, Canada.
(7)The Royal's Institute for Mental Health Research, Ottawa, Ontario, Canada.
(8)School of Graduate Studies, Ryerson University, Toronto, Ontario, Canada.
(9)Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada.
(10)Veterans Affairs Canada, Ottawa, Ontario, Canada.

BACKGROUND: The impacts of the COVID-19 pandemic have disproportionally affected 
different population groups. Veterans are more likely to have pre-existing 
mental health conditions compared to the general Canadian population, experience 
compounded stressors resulting from disruptions to familial, social, and 
occupational domains, and were faced with changes in health-care delivery (e.g. 
telehealth). The objectives of this study are to assess (a) the mental health 
impact of COVID-19 and related life changes on the well-being of Veterans and 
(b) perceptions of and satisfaction with changes in health-care treatments and 
delivery during the pandemic.
METHODS: A total of 1136 Canadian Veterans participated in an online survey. 
Participants completed questions pertaining to their mental health and 
well-being, lifestyle changes, and concerns relating to the COVID-19 pandemic, 
as well as experiences and satisfaction with health-care treatments during the 
pandemic.
RESULTS: Results showed that 55.9% of respondents reported worse mental health 
functioning compared to before the pandemic. The frequency of probable 
posttraumatic stress disorder, major depressive disorder, generalized anxiety 
disorder, alcohol use disorder, and suicidal ideation were 34.2%, 35.3%, 26.8%, 
13.0%, and 22.0%, respectively. Between 38.6% and 53.1% of respondents 
attributed their symptoms as either directly related to or exacerbated by the 
pandemic. Approximately 18% of respondents reported using telehealth for mental 
health services during the pandemic, and among those, 72.8% indicated a choice 
to use telehealth even after the pandemic.
CONCLUSIONS: This study found that Veterans experienced worsening mental health 
as a result of the COVID-19 pandemic. The use of telehealth services was widely 
endorsed by mental health treatment-seeking Veterans who transitioned to virtual 
care during the pandemic. Our findings have important clinical and 
programmeadministrator implications, emphasizing the need to reach out to 
support veterans, especially those with pre-existing mental health conditions 
and to enhance and maintain virtual care even post-pandemic.

Publisher: Antecedentes: Los impactos de la pandemia del COVID-19 han afectado 
de manera desproporcionada a diferentes grupos de la población. Los veteranos 
tienen más probabilidades de tener afecciones de salud mental preexistentes en 
comparación con la población canadiense en general, experimentar factores 
estresantes agravados como resultado de las interrupciones en los dominios 
familiares, sociales, y ocupacionales, y se enfrentan a cambios en la prestación 
de la atención médica (por ejemplo, telesalud). Los objetivos de este estudio 
son evaluar (a) el impacto en la salud mental del COVID-19 y los cambios de vida 
relacionados en el bienestar de los Veteranos y (b) las percepciones y la 
satisfacción con los cambios en los tratamientos y la entrega de la atención 
médica durante la pandemia.Métodos: Un total de 1136 veteranos canadienses 
participaron en una encuesta en línea. Los participantes completaron preguntas 
relacionadas con su salud mental y bienestar, cambios en el estilo de vida, e 
inquietudes relacionadas con la pandemia del COVID-19, así como experiencias y 
satisfacción con los tratamientos de atención médica durante la 
pandemia.Resultados: Los resultados mostraron que el 55,9% de los encuestados 
informaron un peor funcionamiento de la salud mental en comparación con antes de 
la pandemia. La frecuencia de probable trastorno de estrés postraumático, 
trastorno depresivo mayor, trastorno de ansiedad generalizada, trastorno por 
consumo de alcohol, e ideación suicida fue del 34,2%, 35,3%, 26,8%, 13,0% y 
22,0%, respectivamente. Entre el 38,6% y el 53,1% de los encuestados atribuyeron 
sus síntomas como directamente relacionados con la pandemia o agravados por 
ella. Aproximadamente el 18% de los encuestados informó haber utilizado la 
telesalud para los servicios de salud mental durante la pandemia, y entre ellos, 
el 72,8% indicó que había optado por utilizar la telesalud incluso después de la 
pandemia.Conclusiones: Este estudio encontró que los Veteranos experimentaron un 
empeoramiento de la salud mental como resultado de la pandemia del COVID-19. El 
uso de los servicios de telesalud fue ampliamente respaldado por los Veteranos 
en busca de tratamiento de salud mental que hicieron la transición a la atención 
virtual durante la pandemia. Nuestros hallazgos tienen importantes implicaciones 
clínicas y para los administradores de programas, enfatizando la necesidad de 
ayudar a los veteranos, especialmente a aquellos con condiciones de salud mental 
preexistentes, y de mejorar y mantener la atención virtual incluso después de 
una pandemia.

Publisher: 背景: COVID-19 疫情的影响不成比例地影响了不同的人群。与加拿大普通民众相比, 退伍军人更有可能有预先存在的心理健康状况, 
经历因家庭, 社会和职业领域中断而导致的复合应激源, 并面临医护服务的变化 (例如远程医疗) 。本研究旨在评估 (a) COVID-19 
和相关生活变化对退伍军人幸福感的心理健康影响, 以及 (b) 对疫情期间医护治疗和交付变化的看法和满意度。方法: 共有 1136 
名加拿大退伍军人参加了一项在线调查。参与者完成了与其心理健康和幸福感, 生活方式改变, COVID-19 
疫情相关的担忧以及疫情期间对医护治疗的体验和满意度的问题。结果: 结果显示, 55.9% 的受访者表示心理健康功能比疫情前更差。可能的创伤后应激障碍, 
重性抑郁障碍, 广泛性焦虑障碍, 酒精使用障碍和自杀意念的频率分别为 34.2%, 35.3%, 26.8%, 13.0% 和 22.0%。 38.6% 至 
53.1% 的受访者将其症状归因于与疫情直接相关或被疫情加剧。大约 18% 的受访者报告了在疫情期间使用远程医疗来获取心理健康服务, 其中 72.8% 
表示即使在疫情之后也选择使用远程医疗。结论: 本研究发现, 由于 COVID-19 疫情, 
退伍军人的心理健康状况恶化。远程医疗服务的使用得到了在疫情期间过渡到虚拟护理的寻求心理健康治疗退伍军人的广泛认可。我们的研究结果具有重要的临床和计划管理意义, 
强调需要伸出援手支持退伍军人, 尤其是那些有先存心理健康问题的退伍军人, 即使在疫情之后也加强和维持虚拟护理。.

© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & 
Francis Group.

DOI: 10.1080/20008198.2021.2012374
PMCID: PMC8788339
PMID: 35087643 [Indexed for MEDLINE]

Conflict of interest statement: No potential conflict of interest was reported 
by the author(s).


2480. J Subst Abuse Treat. 2022 Jul;138:108720. doi: 10.1016/j.jsat.2022.108720. Epub 
2022 Jan 22.

The impact of COVID-19 on health care professionals who are exposed to 
drug-related deaths while supporting clients experiencing addiction.

O'Callaghan D(1), Lambert S(2).

Author information:
(1)School of Applied Psychology, University College Cork, North Mall, Cork 
Enterprise Centre, Cork, Ireland. Electronic address: daniel.ocallaghan@ucc.ie.
(2)School of Applied Psychology, University College Cork, North Mall, Cork 
Enterprise Centre, Cork, Ireland. Electronic address: sharon.lambert@ucc.ie.

INTRODUCTION: This paper explores the impact of the COVID-19 pandemic on health 
care professionals who support clients experiencing addiction. During the 
pandemic, addiction support became more challenging, as existing health care 
models had changed or been completely abolished. Clients continued to engage 
with social, justice, and health services in limited capacities, connecting with 
general practitioners, key workers, homelessness support workers, and other 
service providers. This marginalized population was among the most high-risk 
groups for adverse health outcomes during the pandemic and understanding the 
associated implications for practitioner well-being is crucial.
METHODS: Fifteen health care professionals who work with active addiction in 
homelessness, public health, addiction, emergency medicine, and other areas 
participated in individual semi-structured interviews. Data analyses utilized 
reflexive thematic analysis.
RESULTS: Four core themes emerged from the analysis: (i) Shift in Priority, (ii) 
Being Left Behind, (iii) Managing a Death, and (iv) Anxious Environment. Within 
each core theme, associated subthemes provide further context. The COVID-19 
pandemic had a significant impact on the well-being of clinicians who work with 
people who use drugs, fostering a more anxious environment and compounding what 
can already be a high-stress occupation. Participants exhibited high levels of 
concern for the well-being of clients, and uncertainty permeated throughout 
conversations. Furthermore, staff expressed concern for their own well-being in 
the long term due to the inability to process adverse events, such as a service 
user's death, due to the chaotic nature of the pandemic.
CONCLUSIONS: This paper highlights some areas of concern to address for future 
service delivery and presents opportunities to future-proof services as the 
world moves toward hybrid models of working. The inflexibility of service 
provision during the pandemic and the digital divide due to public health 
measures pushed marginalized groups further into the margins, with significant 
implications for practitioner occupational well-being due to feelings of 
anxiety, powerlessness, and concern for mortality of clients. This study 
collects a broad scope of experiences across disciplines in health care and 
demonstrates how professionals navigated unprecedented circumstances.

Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jsat.2022.108720
PMCID: PMC8782730
PMID: 35086760 [Indexed for MEDLINE]

Conflict of interest statement: With respect to the named paper submitted to 
Journal of Substance Abuse Treatment, the authors wish to confirm that the 
publication has been approved by all co-authors, there are no conflicts of 
interest to report, and this paper is not under consideration for publication 
elsewhere. The study was approved by the University ethics committee and ethical 
guidelines were adhered to. The work is original, and no copyright has been 
breached by the inclusion of any content drawn from another source.


2481. Arch Sex Behav. 2022 Jan;51(1):247-271. doi: 10.1007/s10508-021-02208-0. Epub 
2022 Jan 27.

Love in the Time of COVID-19: A Multi-Wave Study Examining the Salience of 
Sexual and Relationship Health During the COVID-19 Pandemic.

Pollard AE(1), Rogge RD(2).

Author information:
(1)Department of Psychology, University of Rochester, 462 Meliora Hall; RC Box 
270266, Rochester, NY, 14627-0266, USA.
(2)Department of Psychology, University of Rochester, 462 Meliora Hall; RC Box 
270266, Rochester, NY, 14627-0266, USA. ronald.rogge@rochester.edu.

The current study used Family Systems Theory as a framework to clarify the 
impact of the COVID-19 pandemic on sexual, romantic, and individual functioning. 
Specifically, sexual and romantic functioning were modeled as key mechanisms 
linking COVID-19 related stressors (as predictors) to aspects of individual 
functioning over time (as outcomes). A sample of 1,241 sexually active adults in 
relationships (47% married/engaged) was recruited from March 5 to May 5, 2020: 
82% White, 66% women, M = 34 years old, 58% heterosexual. All participants 
completed a baseline survey and 642 participants completed at least one of the 
six, monthly, follow-up surveys. Multilevel SEM models evaluated the model both 
at the level of stable between-person differences (i.e., level 2) and at the 
level of within-person change across time (i.e., level 1). The findings 
suggested that COVID-19 related stress was predictive of lower sexual, romantic, 
and individual functioning in both levels of the model. Significant indirect 
paths supported the proposed mediation at the level of within-person change 
across time: elevations in COVID-19 stress within specific months predicted 
corresponding drops in sexual functioning, which in turn predicted corresponding 
drops in romantic functioning, which in turn predicted corresponding drops in 
individual well-being (highlighting points of intervention). In contrast, at the 
level of between-person differences, stable levels of sexual and relationship 
satisfaction across the 6 months of the study were not associated with stable 
levels of COVID-19 stressors (representing sources of resilience that promoted 
well-being) and stable levels of stress from social isolation predicted stably 
higher amounts of communicating affection to one's loved ones (suggesting a need 
for affiliation in the face of chronic stress) whereas stable difficulties with 
orgasms were linked to stable irritability toward partners and depressive 
symptoms. Multigroup analyses suggested that the findings generalized across 
gender, age, race/ethnicity, sexual orientation, relationship stage, and 
cohabitation groups. Spillover effects within a Family Systems Theory framework 
clarify how upheaval of the COVID-19 pandemic could have impacted sexual, 
romantic, and individual functioning in a process-oriented framework, 
highlighting sources of resilience (sexual satisfaction, communicating 
affection) and risk (orgasm difficulties).

© 2021. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s10508-021-02208-0
PMCID: PMC8791703
PMID: 35083594 [Indexed for MEDLINE]

Conflict of interest statement: Neither author has any financial conflicts of 
interest to report for this project or this manuscript.


2482. PLoS One. 2022 Jan 26;17(1):e0260465. doi: 10.1371/journal.pone.0260465. 
eCollection 2022.

Effects of physical activity and exercise on well-being in the context of the 
Covid-19 pandemic.

de Abreu JM(1), de Souza RA(1), Viana-Meireles LG(1), Landeira-Fernandez J(2), 
Filgueiras A(3).

Author information:
(1)Instituto de Educação Física e Esportes, Universidade Federal do Ceara, 
Fortaleza, Brazil.
(2)Departamento de Psicologia, Pontifícia Universidade Católica do Rio de 
Janeiro, Rio de Janeiro, Brazil.
(3)Departamento de Cognição e Desenvolvimento, Universidade do Estado do Rio de 
Janeiro, Rio de Janeiro, Brazil.

Coronavirus disease 2019 (COVID-19) was discovered in China and characterized by 
the World Health Organization as a pandemic in March 2020. Many countries 
worldwide implemented stringent social isolation as a strategy to contain virus 
transmission. However, the same physical distancing that protects against the 
spread of COVID-19 may negatively impact mental health and well-being of the 
population. The present study sought to shed light on this phenomenon by 
assessing the relationship between physical activity and subjective well-being 
(SWB) among individuals who were subjected to social isolation during the 
COVID-19 pandemic. Data were collected in Brazil between March 31 and April 2, 
2020. All of the volunteers agreed to participate by digitally checking the 
option of agreement after reading consent terms. The inclusion criteria were 
participants who had been in social isolation for at least 1 week and agreed to 
the consent terms. Three instruments were applied. A questionnaire was 
constructed for this study that assessed the participants' exercise routines. 
The Psychosocial Aspects, Well-being, and Exercise in Confinement (PAWEC) scale 
was created by researchers of this study that assessed the relationship between 
well-being and physical activity during social isolation. The Brazilian 
Portuguese-adapted version of the Positive and Negative Affect Schedule (PANAS) 
was also used. A total of 592 participants (371 female, 220 male, 1 
transgender), 14-74 years old (M = 32.39 years, SD = 10.5 years), reported being 
in social isolation for an average of 14.4 days (SD = 3.3 days). Well-being that 
was related to the practice of physical activity during quarantine was linked to 
an established routine of physical activity before the social isolation period. 
Participants who already practiced physical exercises previously and reported 
continuing the practice during the quarantine period had higher positive affect 
scores. Participants who engaged in physical activity without direct guidance 
only during the quarantine period had higher negative affect scores. 
Participants who already practiced physical activity felt more motivated to 
continue practicing physical activity during the social isolation period, 
resulting in positive affect, unlike participants who began exercising only 
during quarantine. Our results suggest that negative affect can occur among 
individuals who only just begin exercising during social isolation, indicating 
that physical activity should be habitual and not only occur during periods of 
social isolation. Engaging in exercise only during social isolation may 
contribute to an increase in malaise.

DOI: 10.1371/journal.pone.0260465
PMCID: PMC8791524
PMID: 35081122 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2483. J Urban Health. 2022 Feb;99(1):146-163. doi: 10.1007/s11524-021-00603-5. Epub 
2022 Jan 25.

Characterization of Healthy Housing in Africa: Method, Profiles, and 
Determinants.

Iddi S(1), Muindi K(2), Gitau H(3), Mberu B(3).

Author information:
(1)Department of Statistics and Actuarial Science, University of Ghana, Accra, 
Legon, Ghana. siddi@ug.edu.gh.
(2)Urbanization and Wellbeing Unit, African Population and Health Research 
Center, Nairobi, Kenya. kmuindi@aphrc.org.
(3)Urbanization and Wellbeing Unit, African Population and Health Research 
Center, Nairobi, Kenya.

Housing is a key social determinant of health with implications for both 
physical and mental health. The measurement of healthy housing and studies 
characterizing the same in sub-Saharan Africa (SSA) are uncommon. This study 
described a methodological approach employed in the assessment and 
characterization of healthy housing in SSA using the Demographic and Health 
Survey (DHS) data for 15 countries and explored healthy housing determinants 
using a multiple survey-weighted logistic regression analysis. For all 
countries, we demonstrated that the healthy housing index developed using factor 
analysis reasonably satisfies both reliability and validity tests and can 
therefore be used to describe the distribution of healthy housing across 
different groups and in understanding the linkage with individual health 
outcomes. We infer from the results that unhealthy housing remains quite high in 
most SSA countries. Having a male head of the household was associated with 
decreased odds of healthy housing in Burkina Faso (OR = 0.80, CI = 0.68-0.95), 
Cameroon (OR = 0.65, CI = 0.57, 0.76), Malawi (OR = 0.70, CI = 0.64-0.78), and 
Senegal (OR = 0.62, CI = 0.51-0.74). Further, increasing household size was 
associated with reducing odds of healthy housing in Kenya (OR = 0.53, 
CI = 0.44-0.65), Namibia (OR = 0.34, CI = 0.24-0.48), Nigeria (OR = 0.57, 
CI = 0.46-0.71), and Uganda (OR = 0.79, CI = 0.67-0.94). Across all countries, 
household wealth was a strong determinant of healthy housing, with middle and 
rich households having higher odds of residing in healthy homes compared to poor 
households. Odds ratios ranged from 3.63 (CI = 2.96-4.44) for households in the 
middle wealth group in the DRC to 2812.2 (CI = 1634.8-4837.7) in Namibia's 
wealthiest households. For other factors, the analysis also showed variation 
across countries. Our findings provide timely insights for the implementation of 
housing policies across SSA countries, drawing attention to aspects of housing 
that would promote occupant health and wellbeing. Beyond the contribution to the 
measurement of healthy housing in SSA, our paper highlights key policy and 
program issues that need further interrogation in the search for pathways to 
addressing the healthy housing deficit across most SSA countries. This has 
become critical amid the COVID-19 pandemic, where access to healthy housing is 
pivotal in its control.

© 2022. The New York Academy of Medicine.

DOI: 10.1007/s11524-021-00603-5
PMCID: PMC8788402
PMID: 35079945 [Indexed for MEDLINE]


2484. J Med Syst. 2022 Jan 26;46(3):14. doi: 10.1007/s10916-022-01799-y.

Online Mindfulness Experience for Emotional Support to Healthcare staff in times 
of Covid-19.

Castillo-Sánchez G(1), Sacristán-Martín O(2), Hernández MA(3), Muñoz I(4), de la 
Torre I(5), Franco-Martín M(4)(3).

Author information:
(1)Department of Signal Theory and Communications, and Telematics Engineering, 
Universidad de Valladolid, Valladolid, Spain. 
gemaanabel.castillo@alumnos.uva.es.
(2)RedIAPP (Primary Care Prevention and Health Promotion Research Network), 
Valladolid, Spain.
(3)Zamora Healthcare Complex, Zamora, Spain.
(4)Río Hortega University Hospital, Valladolid, Spain.
(5)Department of Signal Theory and Communications, and Telematics Engineering, 
Universidad de Valladolid, Valladolid, Spain.

During the first confinement in Spain, between the months of March to June 2020, 
Information and Communication Technologies strategies were implemented in order 
to support health workers in the Wellbeing of Mental Health. Faced with so much 
uncertainty about the pandemic, an Online Mindfulness course. The objective of 
the course was to support healthcare professionals in Castilla y León in 
managing stress, anxiety and other emotional disturbances generated by coping 
with a situation as uncertain and unexpected as a pandemic, in order to manage 
emotions and thoughts that can lead to suicidal ideation. The motivations for 
the demand, reasons or motivations in which the health professionals of Castilla 
y León decided to participate in the mindfulness course in the first wave of 
Covid-19 in Spain are described. The descriptive and inferential statistical 
analysis of the customer satisfaction survey applied at the end of the 
mindfulness course, to the health professionals who participated in a 
satisfaction survey (CSQ-8: Client Satisfaction Questionnaire). Professional 
were asked to complete a survey based on (CSQ-8: Client Satisfaction 
Questionnaire) whose Cronbach's alpha = 0.917 is why the instrument used with 
N = 130 participants has high reliability. The 66% answered with a highly 
satisfied that they would return to the mindfulness online course. The 93% of 
the people who answered the satisfaction survey were women, of which they are 
professionals in the nursing area, with a participation of around 62%. In 
relation to the online system used in the Mindfulness intervention, 74% 
expressed that they fully agreed that it has been easy to use the online system 
for the mindfulness intervention. Health Professionals responded with 58% high 
satisfaction and 36% satisfaction, making a total of 94% on the help received in 
the online mindfulness courses to solve their problems. There is no difference 
between the age groups of the professionals who have preferred the Mindfulness 
online course (p = 0.672).

© 2022. The Author(s).

DOI: 10.1007/s10916-022-01799-y
PMCID: PMC8789545
PMID: 35079899 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


2485. BMJ Mil Health. 2023 Nov 22;169(6):529-534. doi: 
10.1136/bmjmilitary-2021-002046.

Longitudinal survey of UK veterans with pre-existing mental health difficulties: 
mental health during the COVID-19 pandemic.

Murphy D(1)(2), Hendrikx LJ(3), Williamson C(3)(2), Baumann J(3).

Author information:
(1)Department of Research, Combat Stress, Leatherhead, UK 
dominic.murphy@combatstress.org.uk.
(2)King's Centre for Military Health Research, King's College London, London, 
UK.
(3)Department of Research, Combat Stress, Leatherhead, UK.

INTRODUCTION: At the start of the COVID-19 pandemic, individuals with 
pre-existing mental health difficulties were thought to be vulnerable to mental 
health deterioration due to the emerging threat and the actions taken to control 
infection rates. Yet, there remained a paucity of research investigating changes 
in veteran well-being, a population facing higher rates of mental health 
difficulties compared with the general public. This longitudinal study aimed to 
investigate the mental health and well-being of UK veterans with pre-existing 
mental health difficulties at two time points during the COVID-19 pandemic.
METHODS: UK treatment-seeking veterans (N=121) completed an online survey 
administered towards the end of the first UK lockdown in June 2020 and 1 year 
later. Data were gathered on sociodemographic characteristics as well as 
psychometric measures of post-traumatic stress disorder (PTSD), common mental 
disorders (CMDs), anger difficulties and alcohol misuse.
RESULTS: The proportion of veterans meeting criteria of PTSD, anger and alcohol 
misuse remained similar across the two time points, while significantly fewer 
veterans met criteria for CMDs 1 year later. A notable proportion of the sample 
reported challenges in attending mental and physical health appointments, which 
was positively associated with not working and negatively associated with more 
COVID-19-related stressors.
CONCLUSIONS: These findings suggest that, to date, veterans with pre-existing 
mental health difficulties appear to demonstrate resilience as the COVID-19 
pandemic progressed. However, as the pandemic continued, veterans faced 
significantly more COVID-19-related stressors, less social support, as well as 
difficulties attending health appointments.

© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and 
permissions. Published by BMJ.

DOI: 10.1136/bmjmilitary-2021-002046
PMID: 35078940 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2486. BMJ Open. 2022 Jan 25;12(1):e056288. doi: 10.1136/bmjopen-2021-056288.

The role of risk perception and affective response in the COVID-19 preventive 
behaviours of young adults: a mixed methods study of university students in the 
Netherlands.

Kollmann J(1)(2), Kocken PL(3), Syurina EV(4), Hilverda F(5).

Author information:
(1)Erasmus School of Social and Behavioural Sciences, Erasmus University 
Rotterdam, Rotterdam, The Netherlands kollmann@essb.eur.nl 
hilverda@eshpm.eur.nl.
(2)Department of Socio-Medical Sciences, Erasmus School of Health Policy & 
Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
(3)Erasmus School of Social and Behavioural Sciences, Erasmus University 
Rotterdam, Rotterdam, The Netherlands.
(4)Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, 
Amsterdam, The Netherlands.
(5)Department of Socio-Medical Sciences, Erasmus School of Health Policy & 
Management, Erasmus University Rotterdam, Rotterdam, The Netherlands 
kollmann@essb.eur.nl hilverda@eshpm.eur.nl.

OBJECTIVES: Due to an increased infection rate among young adults, they need to 
adhere to the preventive guidelines to stop the spread of COVID-19 and protect 
vulnerable others. The purpose of this mixed methods study was to explore the 
role of risk perception and affective response in the preventive behaviours of 
young adults during the COVID-19 outbreak.
SETTING: This study followed a convergent mixed methods design, in which a 
quantitative online survey (n=1081) and 10 qualitative in-depth semistructured 
video interviews were conducted separately in the Netherlands during 
April-August 2020.
PARTICIPANTS: 1081 participants filled in the online survey, and 10 participants 
participated in the interviews. Eligibility criteria included being a university 
student.
PRIMARY AND SECONDARY OUTCOME MEASURES: Data on risk perception, affective 
response, that is, worry, and adherence to preventive guidelines were combined 
and analysed during this study. There were no secondary outcome measures.
RESULTS: The results showed that young adults perceived their risk as low. Their 
affective response for their own well-being was also low; however, their 
affective response was high with regards to vulnerable others in their 
surroundings. Due to their high impersonal risk perception (ie, perceived risk 
to others) and high affective response, young adults adhered to most preventive 
guidelines relatively frequently. However, young adults sometimes neglected 
social distancing due to the negative effects on mental health and the 
uncertainty of the duration of the situation.
CONCLUSIONS: In conclusion, high impersonal risk perception and high affective 
response regarding others are key motivators in young adults' preventive 
behaviour. To maximise adherence to the preventive guidelines, risk 
communication should put emphasis on the benefits to vulnerable others' health 
when young adults adhere to the preventive guidelines.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-056288
PMCID: PMC8795930
PMID: 35078850 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2487. J Ayub Med Coll Abbottabad. 2021 Oct-Dec;33(Suppl 1)(4):S778-S787.

Impact Of The COVID-19 Pandemic On Quality Of Life Of Health Care Workers In 
Pakistan.

Noor-ul-Huda(1); Arshad S(1), Lodhi FS(2), Rabbani U(3), Anis S(1), Misbah 
MB(4).

Author information:
(1)Ayub Medical College, Abbottabad, Pakistan.
(2)Department of Epidemiology and Biostatistics, School of Public Health, Tehran 
University of Medical Sciences, Tehran, Iran.
(3)Family Medicine Academy, Qassim Health Cluster, Kingdom of Saudi Arabia.
(4)Benazir Bhutto Teaching Hospital, Abbottabad, Pakistan.

BACKGROUND: Health care workers (HCWs) working on frontlines in COVID-19 
pandemic are highly vulnerable to deteriorating physical and mental health. The 
quality of life of health care workers plays an important role in their skilful 
delivery of work. Our study assesses their quality of life (QOL) during COVID-19 
pandemic so that appropriate measures can be taken to improve their well-being.
METHODS: This was an online crosssectional survey among healthcare workers of 
COVID-19 designated government hospitals in districts Abbottabad, Manshera and 
Haripur, Khyber Pakhtunkhwa, Pakistan from 23rdJune till 25thJuly, 2020. QOL was 
assessed using validated WHO QOL BREF. Univariate and multivariate linear 
regression were used to assess the factors associated with QOL among HCWs.
RESULTS: A total of 362 HCWs participated in the study. The mean scores of 
physical, psychological, social relationships, environmental domains were 60.7 
(±17.40), 59.70 (±17.30), 67.90 (±17.90), and 58.20 (±18.40) respectively. 
Hospital where the respondents were working was the consistent predictor of QOL 
scores in all four domains with generally lower scores associated with other 
hospitals compared to Ayub Medical Hospital. Years of experience were positively 
associated with psychological, social relationship and environmental domains. 
Designation was associated with social relationship domain only. The scores were 
lower for trainee medical officers (adjusted β - 11.5) and higher for house 
officer (adjusted β 10.0) and nurses and technicians (adjusted β 7.0) compared 
to heads of departments and specialists.
CONCLUSION: Quality of life of health care workers has been affected negatively 
in hospitals of Abbottabad, Pakistan during COVID-19. This calls for hospital 
administrations, policymakers and the government to take necessary actions to 
protect the wellbeing of the backbone of the healthcare system.

PMID: 35077626 [Indexed for MEDLINE]


2488. Sci Med Footb. 2021 Nov;5(sup1):70-75. doi: 10.1080/24733938.2021.1962540. Epub 
2021 Aug 24.

Mental health and well-being during COVID-19 lockdown: A survey case report of 
high-level male and female players of an Italian Serie A football club.

Ivarsson A(1)(2), McCall A(3), Mutch S(3), Giuliani A(4), Bassetto R(4), 
Fanchini M(4)(5).

Author information:
(1)Center for Research on Welfare, Health and Sport, Halmstad University, 
Halmstad, Sweden.
(2)Department of Sport Science and Physical Education, University of Agder, 
Kristiansand, Norway.
(3)Department of School of Applied Sciences, School of Applied Sciences, 
Edinburgh Napier University, Edinburgh, UK.
(4)Performance Department, AS Roma Football Club, Roma, Italy.
(5)University of Verona, Department of Neurosciences, Biomedicine and Movement 
Sciences, Verona, Italy.

OBJECTIVES: To describe high-level footballers' levels and changes in mental 
health and well-being throughout a 8-week period of lockdown and restricted 
training during the COVID-19 pandemic.
METHOD: One-hundred and one players belonging to four teams (women's and men's, 
first and U19 teams) of the same Italian Serie A club participated in the study. 
Data were collected through an online questionnaire, and administered at 2, 3, 
5, 7 and 9 weeks after the start of the lockdown . Well-being, positive and 
negative affects measurements were examined.
RESULTS: Across the five measures, 36% of players reported clinical levels in 
depressive symptoms (scores ≤50) on at least one occasion. Thirteen percent of 
the players reported clinical levels on > 50% of the occasions. There was a 
decrease in depressive symptoms and negative affects over the period. No change 
was found in positive affects.
CONCLUSIONS: High number of players reportedclinical levels of depressive 
symptoms compared to what was found previously in high-level athletes. The 
number decrease during the 8-week period. A similar trend was found for negative 
affects.Despite a higher prevalence in depressive symptoms earlier during 
lockdown, this improved as players progressed towards fewer restrictions.

DOI: 10.1080/24733938.2021.1962540
PMID: 35077318 [Indexed for MEDLINE]


2489. Sci Med Footb. 2021 Nov;5(sup1):62-69. doi: 10.1080/24733938.2021.1959047. Epub 
2021 Jul 31.

Resilience as a protective factor for well-being and emotional stability in 
elite-level football players during the first wave of the COVID-19 pandemic.

Madsen EE(1)(2)(3), Krustrup P(2)(4), Larsen CH(1), Elbe AM(3), Wikman JM(5), 
Ivarsson A(5), Lautenbach F(3)(6).

Author information:
(1)Department of Sports Science and Clinical Biomechanics, University of 
Southern Denmark, Odense, Denmark.
(2)Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor 
Therapy, University College Copenhagen, Denmark.
(3)Leipzig University, Faculty of Sport Science, Institute of Sport Psychology 
and Physical Education, Germany.
(4)Danish Institute for Advanced Study (DIAS), University of Southern Denmark, 
Odense, Denmark.
(5)School of Health and Welfare, Halmstad University, Halmstad, Sweden.
(6)Humboldt-Universität Zu Berlin, Institute of Sport Science, Sport Psychology, 
Germany.

Background: In Denmark, the first COVID-19 pandemic lockdown resulted in a 
compact season finisher for elite footballers, potentially impacting their 
mental health.Purpose: This study aimed to investigate the protective role of 
resilience and the impeding role of trait anxiety on elite footballers' level 
and variability of well-being and emotional stability.Material and Methods: One 
hundred and twenty-five male elite-level players (Mage = 25.04 ± 4.82) completed 
baseline measures on trait anxiety and resilience. Additionally, well-being and 
positive and negative affect were assessed before games (n = 24) over 62 days. 
Separate two-level regression analysis using Bayesian statistics was conducted 
to test potential relationships. Results: Results show a credible positive 
relationship between the average level of well-being and within-person 
variability over time as well as the average level in positive affect. This 
indicates that resilience might be a protector for mental health. In addition, 
higher levels of trait anxiety (i.e., subscale concentration disruption) were 
associated with higher levels of negative affect and higher variability over 
time. This indicates that trait anxiety might facilitate negative affect. No 
other credible relationships were found. Conclusion: High resilience and low 
trait anxiety are identified as relevant factors for mental health within elite 
footballers during COVID-19. Implications for practice are discussed.

DOI: 10.1080/24733938.2021.1959047
PMID: 35077313 [Indexed for MEDLINE]


2490. BMJ Open. 2022 Jan 24;12(1):e050187. doi: 10.1136/bmjopen-2021-050187.

Impact of the COVID-19 pandemic on the experience and mental health of 
university students studying in Canada and the UK: a cross-sectional study.

Appleby JA(1), King N(2), Saunders KE(3)(4), Bast A(1), Rivera D(5), Byun J(6), 
Cunningham S(7), Khera C(3), Duffy AC(8)(9).

Author information:
(1)Oxford Medical School, University of Oxford Medical Sciences Division, 
Oxford, UK.
(2)Department of Public Health Sciences, Queen's University, Kingston, Ontario, 
Canada.
(3)Department of Psychiatry, University of Oxford, Oxford, UK.
(4)Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.
(5)Department of Pharmacology and Toxicology, University of Toronto, Toronto, 
Ontario, Canada.
(6)Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada.
(7)Department of Psychology, Queen's University, Kingston, Ontario, Canada.
(8)Department of Psychiatry, University of Oxford, Oxford, UK 
anne.duffy@queensu.ca.
(9)Department of Psychiatry, Queen's University, Kingston, Ontario, Canada.

OBJECTIVES: To explore the impact of the COVID-19 pandemic on the experiences 
and mental health of university students.
DESIGN: A cross-sectional study consisting of an electronic survey about 
students' experiences and concerns during the pandemic and the associated 
impact. In addition to the quantitative analysis, free-text responses were 
extracted and analysed using a framework technique.
SETTING: Queen's University in Canada and the University of Oxford in the UK.
PARTICIPANTS: Undergraduate students at Queen's University and first-year 
undergraduate students at the University of Oxford were invited to complete the 
COVID-19 supplement survey. This study included data from 3013 Queen's students 
as the primary focus and 339 Oxford students as a secondary comparison.
RESULTS: Females at Queen's reported greater adherence to government 
recommendations to prevent the spread of COVID-19 (91.3% vs 86.7%, χ2 p<0.01) 
and were more likely to self-isolate (63.9% vs 57.0%, χ2 p<0.01) than males. A 
similar trend was seen among Oxford students. Students' concerns were wide 
ranging including those related to their learning experience, finances and 
future academic and career prospects. 78.9% of Queen's students and 50.4% of 
first-year Oxford students reported worries about the long-term impact on their 
academic and job prospects. A sizeable proportion of students also reported that 
the pandemic negatively impacted their plans to continue at university (29.4% of 
Queen's, 14.2% of Oxford) and disrupted activities important to their mental 
well-being. Key themes identified in the qualitative component included the 
negative impacts of social isolation, challenging academic changes and 
disruption to support services and means of coping.
CONCLUSIONS: Overall, findings underscore the importance of addressing areas of 
student concern and the aspects of student life negatively impacted by the 
pandemic in order to maintain student well-being and support a successful 
university experience.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-050187
PMCID: PMC8787844
PMID: 35074809 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: KES is supported by the 
National Institute for Health Research Oxford Health Biomedical Research Centre 
(grant BRC-1215–20005).


2491. Ital J Pediatr. 2022 Jan 24;48(1):13. doi: 10.1186/s13052-022-01202-z.

Impact of psychological distress and psychophysical wellbeing on posttraumatic 
symptoms in parents of preterm infants after NICU discharge.

Salomè S(1), Mansi G(2), Lambiase CV(2), Barone M(2), Piro V(2), Pesce M(3), 
Sarnelli G(3), Raimondi F(2), Capasso L(2).

Author information:
(1)Division of Neonatology and Neonatal Intensive Care Unit, Department of 
Translational Medical Sciences, University of Naples Federico II, Via Sergio 
Pansini 5, 80131, Naples, Italy. serena.salome@unina.it.
(2)Division of Neonatology and Neonatal Intensive Care Unit, Department of 
Translational Medical Sciences, University of Naples Federico II, Via Sergio 
Pansini 5, 80131, Naples, Italy.
(3)Division of Gastroenterology, Department of Clinical Medicine and Surgery, 
University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.

BACKGORUND: Parents after Neonatal Intensive Care Unit (NICU) hospitalization of 
preterm infant may develop psychopathological symptoms. The aim of the study was 
to determine how parental stress and psychophysical wellbeing affect 
posttraumatic symptoms (PTTS) in parents during the first year after NICU 
discharge. Moreover, this study aimed to explore any gender-specific difference 
in psychological distress among mothers and fathers.
METHODS: Prospective study design from September 2018 to September 2019. 20 
pairs of parents of preterm infants admitted to a tertiary-level NICU were 
enrolled. Primary outcome was evaluation of PTTS in parents of preterm infants 
at one year after NICU discharge through Impact of Event Scale- Revised. 
Secondary outcomes were: impact of parental stress, psychophysical wellbeing, 
anxiety and depression respectively through Parental Stressor Scale: NICU, Short 
Form Health Survey-36(SF-36), Self-rating Anxiety Scale and Self-rating 
Depression Scale.
RESULTS: Mothers experienced higher rates of PTTS than fathers across the first 
year after NICU discharge (55% vs 20%). Maternal avoidance symptoms were 
associated with perception of their own infant look. Emotional aspects linked to 
maternal role predicted 36,8% of their hyperarousal symptoms. Maternal PTTS 
severity was predicted by their social functioning. Paternal mental health was 
associated both with maternal and paternal intrusive symptoms.. Maternal stress 
was associated with paternal avoidance symptoms. Paternal mental health 
predicted their hyperarousal symptoms (40%) and PTSD severity (52%).
CONCLUSIONS: Parents who experienced NICU hospitalization of their own infant 
are at heightened risk to develop psychopathological symptoms. According to our 
initial hypothesis, investigating parental psychophysical wellbeing, through 
SF-36, originally provides a valuable support to detect parents at higher risk 
to develop posttraumatic outcomes across the first year after NICU discharge. In 
addition, paternal depression deserves to be taken into account since 
hospitalization as it could impact paternal PTSD development. Finally, these 
findings provide an initial evidence of gender-related patterns in PTSD 
development and psychological distress among mothers and fathers across the 
first year of their infant.

© 2022. The Author(s).

DOI: 10.1186/s13052-022-01202-z
PMCID: PMC8785440
PMID: 35073953 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2492. PLoS One. 2022 Jan 24;17(1):e0261652. doi: 10.1371/journal.pone.0261652. 
eCollection 2022.

Polish medical students facing the pandemic-Assessment of resilience, well-being 
and burnout in the COVID-19 era.

Forycka J(1), Pawłowicz-Szlarska E(1), Burczyńska A(1), Cegielska N(1), 
Harendarz K(1), Nowicki M(1).

Author information:
(1)Department of Nephrology, Hypertension and Kidney Transplantation, Medical 
University of Lodz, Lodz, Poland.

INTRODUCTION: Recent reports indicate that COVID-19 pandemic has significant 
influence on medical professionals' mental health. Strict limitations in 
clinical practice and social interactions within academic community, which had 
to be introduced, could lead to significant psychological distress in medical 
students. The aim of the study was to assess resilience, well-being and burnout 
among Polish medical students in the COVID-19 era.
METHODS: The online survey consisting of validated questionnaires assessing 
resilience (Resilience Scale 14; RS-14), well-being (Medical Student Well-Being 
Index) and burnout (Maslach Burnout Inventory) as well as self-created survey 
concerning mental health problems, use of stimulants, SARS-CoV-2 infection, work 
in COVID-19 units, medical education and social attitude towards health care 
professionals in the pandemic era was distributed via Facebook and other online 
students' platforms. 1858 MSs from all polish medical schools agreed to fill in 
the survey.
RESULTS: 'Very low', 'low' and 'on the low end' levels of resilience were found 
in 26%, 19.1% and 26.9% of the study group, respectively. Students with higher 
resilience level presented better attitude towards online and hybrid classes. 
16.8% of respondents stated that they worked, currently work or plan to work 
voluntarily at the pandemic frontline. In terms of burnout, these respondents 
presented lower exhaustion (p = 0.003) and cynicism (p = 0.02), and higher 
academic efficacy (p = 0.002). That group also showed greater resilience (p = 
0.046). The SARS-CoV-2 infection among respondents, their relatives and friends 
did not influence the results. 39.1% of respondents declared the need of the 
psychological or psychiatric consultation in relation to pandemic challenges. 
231 (26.4%) participants previously diagnosed with mental health disorders 
noticed worsening of their symptoms. Increased intake of alcohol, cigarettes or 
other stimulants was noticed by 340 (28.6%) respondents. 80.2% of respondents 
thought that social aversion and mistrust towards doctors increased during the 
pandemic and part of them claimed it affected their enthusiasm toward medical 
career.
CONCLUSIONS: The majority of medical students presented low levels of resilience 
and high burnout at the time of pandemic. Providing necessary support especially 
in terms of mental health and building up the resilience of this vulnerable 
group seems crucial to minimize harm of current pandemic and similar future 
challenges.

DOI: 10.1371/journal.pone.0261652
PMCID: PMC8786167
PMID: 35073318 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2493. J Fam Psychol. 2022 Apr;36(3):337-345. doi: 10.1037/fam0000951. Epub 2022 Jan 
24.

Weathering the economic storm together: Family identification predicts future 
well-being during COVID-19 via enhanced financial resilience.

Stevenson C(1), Wakefield JRH(1), Bowe M(1), Kellezi B(1), Jones B(1), McNamara 
N(1).

Author information:
(1)Department of Psychology.

The economic crisis precipitated by the coronavirus disease (COVID-19) pandemic 
has placed considerable financial pressures on households across the world. 
These are compounded by the enforced isolation accompanying pandemic 
restrictions, during which individuals can struggle to access external 
assistance and often need to rely heavily on the social, emotional, and 
financial support of other family members. Previous research indicates that 
family financial stress has negative consequences for the mental health and 
well-being of members, but that heightened family identification can provide 
individuals with a stronger sense of collective financial resilience. In the 
present study, an online longitudinal survey of U.K. residents (N = 172) shows 
that, in summer 2020, the positive relationship between individuals' family 
identification and their well-being 1 month later was mediated by levels of 
perceived family financial efficacy and financial stress. These findings build 
upon existing evidence of the pivotal role of the family in financial well-being 
and suggest that supporting family units to cope with shared financial 
challenges may have psychological benefits over and above supporting individual 
family members. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

DOI: 10.1037/fam0000951
PMID: 35073125 [Indexed for MEDLINE]


2494. Ginekol Pol. 2022;93(2):142-150. doi: 10.5603/GP.a2021.0179. Epub 2022 Jan 24.

Expectations of pregnant women for antenatal care services and factors affecting 
anxiety severity during the COVID-19 pandemic.

Kumru P(1), Merih YD(2), Özdemir M(3), Akalin M(4), Cogendez E(4).

Author information:
(1)University of Health Sciences , Zeynep Kamil Women and Children's Disease 
Training and Research Hospital, Istanbul, Turkey. pkumru@gmail.com.
(2)University of Health Sciences Hamidiye Nursing Faculty / Turkey Institutes of 
Health Presidency, Istanbul, Turkey.
(3)Osmaniye Community Health Center, Osmaniye, Turkey.
(4)University of Health Sciences , Zeynep Kamil Women and Children's Disease 
Training and Research Hospital, Istanbul, Turkey.

OBJECTIVES: We aimed to evaluate the difficulties pregnant women encountered 
while receiving health care, their demands for antenatal care, and their mental 
state during the COVID-19 pandemic.
MATERIAL AND METHODS: A total of 447 pregnant women were included in this 
cross-sectional study. The data were collected through a face-to-face 
questionnaire, which assessed participants' demographic, individual, and 
obstetric characteristics, their opinions regarding the COVID-19 pandemic, 
expectations from their antenatal care services, and their Beck Anxiety 
Inventory (BAI) scores.
RESULTS: During the COVID-19 pandemic, it was determined that 17.2% of the 
pregnant women participating in our study could not go to antenatal follow-ups 
and almost half (45.9%) demanded that their follow-ups be reduced due to the 
risk of coronavirus transmission. The BAI scores were found to be significantly 
higher in participants with low-income levels, chronic diseases, those in the 
third trimester, those with high-risk pregnancy either previous or current, and 
those who got pregnant unintentionally. Young age, unintentional conception, 
advanced pregnancy week, previous high-risk pregnancy, and failure to receive 
regular antenatal care were independent variables that predicted moderate-severe 
anxiety in logistic regression analysis.
CONCLUSIONS: In order to minimize the adverse effects of the COVID-19 pandemic 
on the mental health of pregnant women, it is important to develop support 
programs that contribute to the well-being of the mother and fetus by 
recognizing the pregnant women at risk in the antenatal period.

DOI: 10.5603/GP.a2021.0179
PMID: 35072249 [Indexed for MEDLINE]


2495. Ginekol Pol. 2022;93(10):842-846. doi: 10.5603/GP.a2021.0198. Epub 2022 Jan 24.

Pregnancy and childbirth during the coronavirus pandemic. The cross-sectional 
study of 1321 participants in Poland.

Jurgiel J(1), Graniak A(2), Jozwik K(2), Pomorski M(2).

Author information:
(1)2nd Department and Clinic of Gynaecology, Obstetrics and Neonatology, Wroclaw 
Medical University, Wroclaw, Poland. janjurgiel@gmail.com.
(2)2nd Department and Clinic of Gynaecology, Obstetrics and Neonatology, Wroclaw 
Medical University, Wroclaw, Poland.

OBJECTIVES: The impact of infection with novel coronavirus - SARS-CoV-2 - on 
women's and fetus' was unclear; therefore, it was the reason for many worries. 
We wanted to understand and describe the worries of pregnant women, assess 
mental well-being, and analyse the problems affecting prenatal care and hospital 
stay in this unprecedented time.
MATERIAL AND METHODS: We designed an original 23-question survey aimed at women 
who were pregnant during the pandemic or who gave birth at that time. The survey 
included demographic data, questions about prenatal care, mental status and 
worries, and hospitalisation.
RESULTS: Our study included 1321 women: 1010 (76.5%) during pregnancy and 311 
(23.5%) after the delivery in the studied time. For 1168 (88,4%) respondents, 
the pandemic had a negative impact on their mood. The three main concerns were: 
the need for isolation from the child (n = 498, 37.7%), the childbirth without a 
partner/trusted companion (n = 417, 31.6%) and the risk of infection of the 
child in hospital (n = 381, 28.8%).
CONCLUSIONS: The novel coronavirus pandemic affects the mental health of 
pregnant women. Pregnant patients should be considered a group of particular 
concerns. Patients consider remote obstetrical consultations as an insufficient 
approach. The reason for the highest worries of pregnant patients is a lack of 
companionship during labour. There was no difference between the rate of 
childbirth via caesarean sections over vaginal delivery during the "first wave" 
of the pandemic.

DOI: 10.5603/GP.a2021.0198
PMID: 35072248 [Indexed for MEDLINE]


2496. Front Pediatr. 2022 Jan 6;9:684576. doi: 10.3389/fped.2021.684576. eCollection 
2021.

Neonates in the Intensive Care Unit: Maternal Health-Related Quality of Life and 
Depression After Term and Preterm Births.

Mautner E(1), Stern C(1), Avian A(2), Deutsch M(1), Schöll W(1), Greimel E(1).

Author information:
(1)Department of Obstetrics and Gynecology, Medical University of Graz, Graz, 
Austria.
(2)Institute for Medical Informatics, Statistics and Documentation, Medical 
University of Graz, Graz, Austria.

Background/Objective: To examine maternal physical and mental health-related 
quality of life (HRQoL) and depression after early and late preterm and term 
births in the early postpartum period. Method: In a prospective pilot study, 
three groups of women whose newborns had to be treated in the neonatal ward 
during the immediate postpartum period were established and compared with each 
other: 20 women with extremely to very preterm birth, 20 with moderate to late 
preterm birth and 20 women with term birth. All participants completed the Short 
Form-12 Health Survey (SF-12) to measure HRQoL, and the Edinburgh Postnatal 
Depression Scale (EPDS) to detect depressive symptoms combined with 
independently developed questions to evaluate anxiety and psychological 
distress. Results: Maternal psychological HRQoL was significantly worse in the 
very preterm birth group compared to moderate to late preterm birth (p < 0.001) 
and full-term birth groups (p = 0.004). There were no differences between the 
birth groups in depressive symptoms (p = 0.083), anxiety (p = 0.238), perceived 
stress (p = 0.340) and the general psychological distress values (p = 0.755). In 
the EPDS, the depression screening instrument 30 to 65% were beyond the 
cut-off-value to detect major depression. Conclusions: During the early 
postpartum period, an extensive medical care focussing on acute stress, HRQoL 
parameters and depression may be a good step to improving maternal well-being.

Copyright © 2022 Mautner, Stern, Avian, Deutsch, Schöll and Greimel.

DOI: 10.3389/fped.2021.684576
PMCID: PMC8770971
PMID: 35071122

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2497. Am J Prev Med. 2022 Mar;62(3):326-332. doi: 10.1016/j.amepre.2021.08.032. Epub 
2021 Nov 1.

Association of Poor Mental-Health Days With COVID-19 Infection Rates in the U.S.

Ransome Y(1), Luan H(2), Song I(2), Fiellin DA(3), Galea S(4).

Author information:
(1)Department of Social and Behavioral Sciences, Yale School of Public Health, 
New Haven, Connecticut. Electronic address: yusuf.ransome@yale.edu.
(2)Department of Geography, University of Oregon, Eugene, Oregon.
(3)Department of Internal Medicine, Yale School of Medicine, New Haven, 
Connecticut.
(4)Dean's Office, Boston University School of Public Health, Boston, 
Massachusetts.

INTRODUCTION: Limited evidence exists about the association between prior 
prevalence of poor mental health at the area level and subsequent rates of 
COVID-19 infections. This association was tested using area-level nationwide 
population data in the U.S.
METHODS: A nationwide study including 2,839 U.S. counties was conducted. Poor 
mental health was the age-adjusted average number of days within the past 30 
days that adults reported poor mental health, including depression, stress, and 
problems with emotions, from the Behavioral Risk Factor Surveillance System. 
COVID-19 infection rates were cumulative confirmed cases between January 22 and 
October 7, 2020 per 100,000 people in the general population. Bayesian spatial 
mixed-effects regression estimated the relationship between COVID-19 infection 
and poor mental-health days at the county level in 2019 and change in poor 
mental health between 2010 and 2019, adjusted for several covariates.
RESULTS: Poor mental-health days in 2019 were positively associated with higher 
COVID-19 infection rates (RRR=1.059, 95% credible interval=1.003, 1.117). Change 
in mental health was not significantly associated with COVID-19.
CONCLUSIONS: Prior rates of poor mental health in a county were associated with 
a higher burden of COVID-19 infection. Interventions that improve well-being and 
strengthen mental-health systems at the community and other geographic levels 
are needed to address post-COVID-19 mental health problems.

Copyright © 2021 American Journal of Preventive Medicine. Published by Elsevier 
Inc. All rights reserved.

DOI: 10.1016/j.amepre.2021.08.032
PMCID: PMC8557977
PMID: 35067362 [Indexed for MEDLINE]


2498. Med J Aust. 2022 Apr 18;216(7):364-372. doi: 10.5694/mja2.51368. Epub 2022 Jan 
23.

Potential indirect impacts of the COVID-19 pandemic on children: a narrative 
review using a community child health lens.

Goldfeld S(1)(2), O'Connor E(1), Sung V(1)(2), Roberts G(1)(2), Wake M(1)(2), 
West S(1), Hiscock H(1)(2).

Author information:
(1)Centre for Community Child Health, Murdoch Children's Research Institute, The 
Royal Children's Hospital Melbourne, Melbourne, VIC.
(2)University of Melbourne, Melbourne, VIC.

▪In this narrative review, we summarise the vast and burgeoning research on the 
potential and established indirect impacts on children of the COVID-19 pandemic. 
We used a community child health lens to organise our findings and to consider 
how Australia might best respond to the needs of children (aged 0-12 years). ▪We 
synthesised the literature on previous pandemics, epidemics and natural 
disasters, and the current COVID-19 pandemic. We found clear evidence of adverse 
impacts of the COVID-19 pandemic on children that either repeated or extended 
the findings from previous pandemics. ▪We identified 11 impact areas, under 
three broad categories: child-level factors (poorer mental health, poorer child 
health and development, poorer academic achievement); family-level factors that 
affect children (poorer parent mental health, reduced family income and job 
losses, increased household stress, increased abuse and neglect, poorer maternal 
and newborn health); and service-level factors that affect children (school 
closures, reduced access to health care, increased use of technology for 
learning, connection and health care). ▪There is increasing global concern about 
the likely disproportionate impact of the current pandemic on children 
experiencing adversity, widening existing disparities in child health and 
developmental outcomes. ▪We suggest five potential strategy areas that could 
begin to address these inequities: addressing financial instability through 
parent financial supplements; expanding the role of schools to address learning 
gaps and wellbeing; rethinking health care delivery to address reduced access; 
focusing on prevention and early intervention for mental health; and using 
digital solutions to address inequitable service delivery.

© 2022 AMPCo Pty Ltd.

DOI: 10.5694/mja2.51368
PMID: 35066868 [Indexed for MEDLINE]


2499. Lancet Psychiatry. 2022 Feb;9(2):169-182. doi: 10.1016/S2215-0366(21)00199-1.

Public mental health: required actions to address implementation failure in the 
context of COVID-19.

Campion J(1), Javed A(2), Lund C(3), Sartorius N(4), Saxena S(5), Marmot M(6), 
Allan J(7), Udomratn P(8).

Author information:
(1)South London and Maudsley NHS Foundation Trust, London, UK; Public Mental 
Health Implementation Centre, Royal College of Psychiatrists, London, UK. 
Electronic address: jonathan.campion@slam.nhs.uk.
(2)Department of Mental Health and Wellbeing, Warwick Medical School, University 
of Warwick, Coventry, UK.
(3)King's Global Health Institute, Centre for Global Mental Health, Health 
Service and Population Research Department, Institute of Psychiatry, Psychology 
and Neuroscience, King's College, London, UK; Alan J Flisher Centre for Public 
Mental Health, Department of Psychiatry and Mental Health, University of Cape 
Town, Cape Town, South Africa.
(4)Association for the Improvement of Mental Health Programmes, Geneva, 
Switzerland.
(5)Department of Global Health and Population at the Harvard TH Chan School of 
Public Health, Harvard University, Boston, MA, USA.
(6)Institute of Health Equity, Department of Epidemiology and Public Health, 
UCL, London, UK.
(7)Office of the President, Royal Australian and New Zealand College of 
Psychiatrists, Melbourne, VIC, Australia; Mental Health, Alcohol and Other Drugs 
Branch, Clinical Excellence Queensland, Queensland Health, Brisbane, QLD, 
Australia; Mayne Academy of Psychiatry, University of Queensland Medical School, 
University of Queensland, Brisbane, QLD, Australia.
(8)Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 
Thailand.

Comment in
    Lancet Psychiatry. 2022 Apr;9(4):e17.

Mental disorders account for at least 18% of global disease burden, and the 
associated annual global costs are projected to be US$6 trillion by 2030. 
Evidence-based, cost-effective public mental health (PMH) interventions exist to 
prevent mental disorders from arising, prevent associated impacts of mental 
disorders (including through treatment), and promote mental wellbeing and 
resilience. However, only a small proportion of people with mental disorders 
receive minimally adequate treatment. Compared with treatment, there is even 
less coverage of interventions to prevent the associated impacts of mental 
disorders, prevent mental disorders from arising, or promote mental wellbeing 
and resilience. This implementation failure breaches the right to health, has 
increased during the COVID-19 pandemic, and results in preventable suffering, 
broad impacts, and associated economic costs. In this Health Policy paper, we 
outline specific actions to improve the coverage of PMH interventions, including 
PMH needs assessments, collaborative advocacy and leadership, PMH practice to 
inform policy and implementation, training and improvement of population 
literacy, settings-based and integrated approaches, use of digital technology, 
maximising existing resources, focus on high-return interventions, human rights 
approaches, legislation, and implementation research. Increased interest in PMH 
in populations and governments since the onset of the COVID-19 pandemic supports 
these actions. Improved implementation of PMH interventions can result in broad 
health, social, and economic impacts, even in the short-term, which support the 
achievement of a range of policy objectives, sustainable economic development, 
and recovery.

Copyright © 2022 Elsevier Ltd. All rights reserved.

DOI: 10.1016/S2215-0366(21)00199-1
PMCID: PMC8776278
PMID: 35065723 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of interests AJ, MM, PU, CL, SS, JC, 
and JA are members of the Public Mental Health Working Group for the World 
Psychiatric Association's 2020–2023 Action Plan. JC has contributed to national 
policy in England, has done mental health needs assessments for local 
authorities in England (for which his employer received payment); is strategic 
and clinical director of the Royal College of Psychiatrist's Public Mental 
Health Implementation Centre; and is a public mental health advisor to WHO 
Europe. CL has received research funding from the UK Department for 
International Development, UK National Institute for Health Research, US 
National Institute of Mental Health, UK Economic and Social Research Council, 
European Commission, the Wellcome Trust, and Prudential Africa. NS has received 
honoraria for lectures from the Lundbeck company and from several universities. 
JA has contributed to national and state policy and service development in his 
role as a senior public servant.


2500. Hum Resour Health. 2022 Jan 22;20(1):11. doi: 10.1186/s12960-022-00705-4.

Perceived risk and distress related to COVID-19 in healthcare versus 
non-healthcare workers of Pakistan: a cross-sectional study.

Abid A(#)(1), Shahzad H(#)(1), Khan HA(2), Piryani S(2), Khan AR(3), Rabbani 
F(4)(5).

Author information:
(1)Medical College, Aga Khan University, Karachi, Pakistan.
(2)Department of Community Health Sciences, Aga Khan University, Karachi, 
Pakistan.
(3)Office of Research & Graduate Studies, Aga Khan University, Karachi, 
Pakistan.
(4)Department of Community Health Sciences, Aga Khan University, Karachi, 
Pakistan. fauziah.rabbani@aku.edu.
(5)Office of Research & Graduate Studies, Aga Khan University, Karachi, 
Pakistan. fauziah.rabbani@aku.edu.
(#)Contributed equally

BACKGROUND: Healthcare workers (HCWs) have found themselves and their families 
more susceptible to contracting COVID-19. This puts them at a higher risk of 
psychological distress, which may compromise patient care. In this study, we aim 
to explore the risk perceptions and psychological distress between HCWs and 
non-healthcare workers (NHCWs) in Pakistan.
METHODS: A cross-sectional study was conducted using an online self-administered 
questionnaire. Psychological distress was assessed through The Hospital Anxiety 
and Depression Scale (HADS). Comparisons were made between HCWs (front/backend, 
students/graduates) and NHCWs related to risk perceptions and stress levels 
related to COVID-19. Following tests for normality (Shapiro-Wilk test), 
variables that fulfilled the normality assumption were compared using the 
independent samples t-test, while for other variables Mann-Whitney U-test was 
employed. Pearson Chi-square test was used to compare categorical data. Multiple 
logistic regression techniques examined the association of participant age, 
gender, household income, and the presence of COVID-19 symptoms with depression 
and anxiety levels.
RESULTS: Data from 1406 respondents (507 HCWs and 899 NHCWs) were analyzed. No 
significant difference was observed between HCWs and NHCWs' perception of 
susceptibility and severity towards COVID-19. While healthcare graduates 
perceived themselves (80% graduates vs 66% students, p-value 0.011) and their 
family (82% graduates vs 67% students, p-value 0.008) to be more susceptible to 
COVID-19, they were less likely to experience depression than students. 
Frontline HCWs involved in direct patient care perceived themselves (83% 
frontline vs. 70% backend, p-value 0.003) and their family (84% frontline vs. 
72% backend, p-value 0.006) as more susceptible to COVID-19 than backend 
healthcare professionals. Over half of the respondents were anxious (54% HCWs 
and 55% NHCWs). Female gender, younger age, lower income, and having COVID-19 
related symptoms had a significant effect on the anxiety levels of both HCWs and 
NHCWs.
CONCLUSION: Frontline HCWs, young people, women, and individuals with lower 
income were at a higher risk of psychological distress due to the pandemic. 
Government policies should thus be directed at ensuring the mental well-being of 
frontline HCWs and improving their satisfaction to strengthen the health care 
delivery system. The findings suggest the need to provide mental health support 
for health workers.

© 2022. The Author(s).

DOI: 10.1186/s12960-022-00705-4
PMCID: PMC8783178
PMID: 35065653 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2501. Appl Psychol Health Well Being. 2022 Nov;14(4):1408-1428. doi: 
10.1111/aphw.12341. Epub 2022 Jan 22.

Online Isha Upa Yoga for student mental health and well-being during COVID-19: A 
randomized control trial.

Chang TFH(1), Ley BL(2), Ramburn TT(3), Srinivasan S(4), Hariri S(5), Purandare 
P(6), Subramaniam B(7).

Author information:
(1)School of Management and Labor Relations, Rutgers University, Piscataway, New 
Jersey, USA.
(2)Departments of Women & Gender Studies and Communication, University of 
Delaware, Newark, Delaware, USA.
(3)Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada.
(4)Bioengineering Research Consultant, San Francisco, California, USA.
(5)Sadhguru Center for a Conscious Planet, Beth Israel Deaconess Medical Center, 
Harvard Medical University, Boston, Massachusetts, USA.
(6)Amalgamated Life Insurance Company, White Plains, New York, USA.
(7)Sadhguru Center for a Conscious Planet, Beth Israel Deaconess Medical Center, 
Harvard Medical School, Boston, Massachusetts, USA.

College students experienced increased stress and anxiety during the COVID-19 
pandemic. This study evaluated the effect of brief online Isha Upa Yoga modules 
on undergraduates' mental health and well-being. Randomized control trial (RCT) 
with waitlist control crossover (N = 679). The intervention group was instructed 
to learn and practice the modules daily for 12 weeks. At the end of the 4-week 
RCT, the control group was instructed to learn and practice the modules for the 
remaining 8 weeks. Primary outcomes included stress and well-being. Secondary 
outcomes included anxiety, depression, resilience, positive affect and negative 
affect. Linear mixed-effects models were used for analyses. Isha Upa Yoga 
significantly reduced stress (Group [intervention, control] × Time [baseline, 
Week 4] interaction, p = .009, d = .27) and increased well-being (Group × Time 
interaction p = .002, d = .32). By the study's end, the intervention and control 
groups experienced significant improvements in well-being (p < .001, p < .001), 
stress (p < .001, p < .001), anxiety (p < .001, p < .001), depression (p < .001, 
p = .004), positive affect (p = .04, p < .001), and negative affect (p < .001, 
p < .001). Online Isha Upa Yoga shows promise for mitigating the pandemic's 
negative impact on undergraduates' mental health and improving their well-being.

© 2022 The International Association of Applied Psychology.

DOI: 10.1111/aphw.12341
PMID: 35064741 [Indexed for MEDLINE]


2502. Eur J Clin Microbiol Infect Dis. 2022 Apr;41(4):581-588. doi: 
10.1007/s10096-022-04402-x. Epub 2022 Jan 22.

Capnocytophaga zoonotic infections: a 10-year retrospective study (the French 
CANCAN study).

Beauruelle C(1), Plouzeau C(2), Grillon A(3), Isnard C(4), Corvec S(5), Degand 
N(6), Jacquier H(7), Amara M(8), Mizrahi A(9), Diedrich T(10), Piau C(11), 
Farfour E(12), Bonzon L(13), Le Brun C(14), Walewski V(15), Bille E(16), Dortet 
L(17), Guillard T(18), Soismier N(19), Le Guen R(20), Morand P(21), de Ponfilly 
GP(7), Le Monnier A(9), Héry-Arnaud G(22)(23).

Author information:
(1)Université de Brest, Inserm, UMR 1078, Unité de Bactériologie, CHRU de Brest, 
29200, Brest, France.
(2)Service de Bactériologie Et d'Hygiène Hospitalière, Unité de Microbiologie 
Moléculaire Et Séquençage, CHU de Poitiers, 86000, Poitiers, France.
(3)EA7290, Plateau Technique de Microbiologie, Laboratoire de Bactériologie, 
Université de Strasbourg, CHU de Strasbourg, 67000, Strasbourg, France.
(4)Normandie Univ, UNICAEN/UNIROUEN, EA2656 GRAM2.0, CHU de Caen Normandie, 
Service Microbiologie, 14000, Caen, France.
(5)Service de Bactériologie-Hygiène Hospitalière, CHU de Nantes, 44049, Nantes 
Cedex 1, France.
(6)Laboratoire de Bactériologie, Hôpital L'archet 2, CHU de Nice, 06202, Nice, 
France.
(7)Service de Microbiologie, Hôpitaux Universitaires Saint-Louis 
Lariboisière-Fernand Widal, Paris, France.
(8)Service de Biologie, Unité de Microbiologie, CH Versailles-Site André Mignot, 
Le Chesnay, France.
(9)Institut Micalis, UMR1319, Université Paris-Saclay, INRAe, AgroParisTech, 
Bactéries Pathogènes et Santé, Chatenay-Malabry, Service de Microbiologie 
clinique, GH Paris Saint-Joseph, 75014, Paris, France.
(10)Pôle Biologie-Hygiène, 59304, Valenciennes, CH, France.
(11)Service de Bactériologie-Hygiène Hospitalière, CHU de Rennes, 35033, Rennes, 
France.
(12)Service de Biologie Clinique, Hôpital Foch, 92150, Suresnes, France.
(13)Université de Montpellier, UMR MIVEGEC IRD-CNRS-Laboratoire de 
Bactériologie, CHU de Montpellier, Montpellier, France.
(14)Service de Bactériologie-Virologie-Hygiène, Hôpital Bretonneau, CHRU de 
Tours, 37000, Tours, France.
(15)Laboratoire de Microbiologie, Hôpital Avicenne, 93000, Bobigny, France.
(16)Laboratoire de Microbiologie, Hôpital Necker-Enfants Malades, 75015, Paris, 
France.
(17)Service de Bactériologie-Hygiène, CHU de Bicêtre, 94270, Le Kremlin-Bicêtre, 
France.
(18)Université de Reims-Champagne-Ardenne, Inserm UMR-S, 1250 P3Cell, SFR 
CAP-Santé, Laboratoire de Bactériologie-Virologie-Hygiène 
Hospitalière-Parasitologie-Mycologie, Hôpital Robert Debré, CHU Reims, 51000, 
Reims, France.
(19)Laboratoire de Microbiologie, CHIC, 94000, Créteil, France.
(20)Unité de Bactériologie, Groupe Hospitalier Henri Mondor, 94010, Créteil, 
France.
(21)Université de Paris, Faculté de Médecine, Service de Bactériologie, Groupe 
Hospitalier Cochin,, 75014, Paris, France.
(22)Université de Brest, Inserm, UMR 1078, Unité de Bactériologie, CHRU de 
Brest, 29200, Brest, France. hery@univ-brest.fr.
(23)Laboratoire de Bactériologie-Virologie, Unité INSERM UMR1078 "Genetics, 
Genomics and Biotechnology", Axe Microbiota, UFR de Médecine Et Des Sciences de 
La Santé, 22 avenue Camille Desmoulins, 29238, Brest, France. 
hery@univ-brest.fr.

Zoonotic species of Capnocytophaga genus belong to the oral microbiota of dogs 
and cats. They may be responsible for serious human infections, mainly after 
animal bites, with a high mortality rate. In France, only few cases have been 
reported and no multicenter study has been conducted. Our aim was to describe 
the French epidemiology of Capnocytophaga zoonosis. We conducted a multicenter 
(21 centers) retrospective non-interventional, observational study in France 
describing the epidemiology of Capnocytophaga zoonosis (C. canimorsus, C. 
cynodegmi, C. canis) over 10 years with regard to clinical and bacteriological 
data. From 2009 to 2018, 44 cases of Capnocytophaga zoonotic infections were 
described (C. canimorsus, n = 41; C. cynodegmi, n = 3). We observed an increase 
(2.5 times) in the number of cases over the study period (from the first to the 
last 5 years of the study). The most frequent clinical presentations were sepsis 
(n = 37), skin and soft tissue infections (n = 12), meningitis (n = 8), 
osteoarticular infections (n = 6), and endocarditis (n = 2). About one-third of 
patients with sepsis went into septic shock. Mortality rate was 11%. Mortality 
and meningitis rates were significantly higher for alcoholic patients (p = 0.044 
and p = 0.006, respectively). Other comorbidities included smoking, splenectomy, 
diabetes mellitus, and immunosuppressive therapy are associated to zoonotic 
Capnocytophaga infection. Eighty-two percent of cases involved contact with 
dogs, mostly included bites (63%). Despite all isolates were susceptible to the 
amoxicillin-clavulanic acid combination, three of them were resistant to 
amoxicillin.

© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, 
part of Springer Nature.

DOI: 10.1007/s10096-022-04402-x
PMID: 35064380 [Indexed for MEDLINE]


2503. Eur Heart J Cardiovasc Imaging. 2022 Mar 22;23(4):441-446. doi: 
10.1093/ehjci/jeac002.

EACVI survey on burnout amongst cardiac imaging specialists during the 2019 
coronavirus disease pandemic.

Joshi SS(1), Stankovic I(2), Demirkiran A(3), Haugaa K(4)(5), Maurovich-Horvat 
P(6), Popescu BA(7), Cosyns B(8), Edvardsen T(4)(5), Petersen SE(9)(10), 
Carvalho RF(11)(12), Cameli M(13), Dweck MR(1).

Author information:
(1)BHF Centre for Cardiovascular Science, Chancellor's Building, University of 
Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
(2)Faculty of Medicine, Department of Cardiology, Clinical Hospital Centre 
Zemun, University of Belgrade, Vukova 9, 11080 Belgrade, Serbia.
(3)Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, 
Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
(4)ProCardio Center for Innovation, Department of Cardiology, Oslo University 
Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway.
(5)Institute for Clinical Medicine, University of Oslo, Postboks 1171, Blindern, 
0318 Oslo, Norway.
(6)Department of radiology, MTA-SE Cardiovascular Imaging Research Group, 
Department of Radiology, Medical Imaging Centre, Semmelweis University, 
Budapest, Hungary.
(7)Department of Cardiology, University of Medicine and Pharmacy "Carol Davila" 
- Euroecolab, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. 
Iliescu", Sos. Fundeni 258, Sector 2, 022328, Bucharest, Romania.
(8)Department of Cardiology, Centrum voor Hart en Vattziekten, Universitair 
Ziekenhuis Brussel, Vrij Universiteit van Brussel, Brussels, Belgium.
(9)Department of Cardiology, William Harvey Research Institute, NIHR Barts 
Biomedical Research Centre, Queen Mary University of London, Charterhouse 
Square, London EC1M 6BQ, UK.
(10)Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 
Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK.
(11)Department of Physiology and Cardiothoracic Surgery, Centro Hospitalar Vila 
Noba Gaia/Espinho, Gaia, Portugal.
(12)Department of Physiology and Cardiothoracic Surgery, Cardiovascular Research 
and Investigation Unit, Faculty of Medicine University of Porto, Porto, 
Portugal.
(13)U.O. Cardiologia Universitaria, Universita degli Studi, Siena, Italy.

AIMS: The European Association of Cardiovascular Imaging Scientific Initiatives 
Committee conducted a global survey to evaluate the impact of the 2019 
coronavirus disease (COVID-19) pandemic on the mental well-being of cardiac 
imaging specialists.
METHODS AND RESULTS: In a prospective international survey performed between 23 
July 2021 and 31 August 2021, we assessed the mental well-being of cardiac 
imaging specialists ∼18 months into the COVID-19 pandemic. 
One-hundred-and-twenty-five cardiac imaging specialists from 34 countries 
responded to the survey. More than half described feeling anxious during the 
pandemic, 34% felt melancholic, 27% felt fearful, and 23% respondents felt 
lonely. A quarter of respondents had increased their alcohol intake and more 
than half reported difficulties in sleeping. Two-thirds of respondents described 
worsening features of burnout during the past 18 months, 44% considered quitting 
their job. One in twenty respondents had experienced suicidal ideation during 
the pandemic. Despite these important issues, the majority of participants (57%) 
reported having no access to any formal mental health support at work.
CONCLUSION: The survey has highlighted important issues regarding the mental 
well-being of cardiac imaging specialists during the COVID-19 pandemic. This is 
a major issue in our sub-specialty, which requires urgent action and 
prioritization so that we can improve the mental health of cardiovascular 
imaging specialists.

Published on behalf of the European Society of Cardiology. All rights reserved. 
© The Author(s) 2022. For permissions, please email: 
journals.permissions@oup.com.

DOI: 10.1093/ehjci/jeac002
PMCID: PMC8807202
PMID: 35061874 [Indexed for MEDLINE]


2504. PLoS One. 2022 Jan 21;17(1):e0262421. doi: 10.1371/journal.pone.0262421. 
eCollection 2022.

The impact of COVID-19 non-pharmaceutical interventions on the lived experiences 
of people living in Thailand, Malaysia, Italy and the United Kingdom: A 
cross-country qualitative study.

Schneiders ML(1)(2)(3), Naemiratch B(1), Cheah PK(4), Cuman G(5), Poomchaichote 
T(1)(6), Ruangkajorn S(1), Stoppa S(7), Osterrieder A(1)(2), Cheah PK(8), 
Ongkili D(9), Pan-Ngum W(1)(10), Mackworth-Young CRS(11), Cheah PY(1)(2)(3)(6).

Author information:
(1)Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, 
Mahidol University, Bangkok, Thailand.
(2)Nuffield Department of Medicine, Centre for Tropical Medicine & Global 
Health, University of Oxford, Oxford, United Kingdom.
(3)Nuffield Department of Population Health, Ethox Centre, Big Data Institute, 
University of Oxford, Oxford, United Kingdom.
(4)Faculty of Arts & Social Science, Universiti Tunku Abdul Rahman, Kampar, 
Malaysia.
(5)Paediatric Ethics Committee; Research Ethics Committee, University Hospital 
of Padua, Padua, Italy.
(6)The SoNAR-Global Network, Mahidol University, Bangkok, Thailand.
(7)Luoghi di Prevenzione, Reggio Emilia, Italy.
(8)Emergency and Trauma Department, Sabah Women and Children's Hospital, 
Ministry of Health Malaysia, Kota Kinabalu, Malaysia.
(9)Emergency and Trauma Department, Queen Elizabeth Hospital, Ministry of Health 
Malaysia, Kota Kinabalu, Malaysia.
(10)Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol 
University, Bangkok, Thailand.
(11)Department of Global Health and Development, London School of Hygiene and 
Tropical Medicine, London, United Kingdom.

This qualitative study explores the impact of non-pharmaceutical interventions 
(NPIs), including social distancing, travel restrictions and quarantine, on 
lived experiences during the first wave of the COVID-19 pandemic in Thailand 
(TH), Malaysia (MY), Italy (IT) and the United Kingdom (UK). A total of 86 
interviews (TH: n = 28; MY: n = 18; IT: n = 20; UK: n = 20) were conducted with 
members of the public, including healthcare workers (n = 13). Participants 
across countries held strong views on government imposed NPIs, with many feeling 
measures lacked clarity. Most participants reported primarily negative impacts 
of NPIs on their lives, including through separation, isolation and grief over 
missed milestones; work-related challenges and income loss; and poor mental 
health and wellbeing. Nonetheless, many also experienced inadvertent positive 
consequences, including more time at home to focus on what they most valued in 
life; a greater sense of connectedness; and benefits to working life. Commonly 
employed coping strategies focused on financial coping (e.g. reducing spending); 
psycho-emotional coping (e.g. engaging in spiritual practices); social coping 
and connectedness (e.g., maintaining relationships remotely); reducing and 
mitigating risks (e.g., changing food shopping routines); and limiting exposure 
to the news (e.g., checking news only occasionally). Importantly, the extent to 
which participants' lived experiences were positive or negative, and their 
ability to cope was underpinned by individual, social and economic factors, with 
the analysis indicating some salient differences across countries and 
participants. In order to mitigate negative and unequal impacts of NPIs, 
COVID-19 policies will benefit from paying closer attention to the social, 
cultural and psychological-not just biological-vulnerabilities to, and 
consequences of public health measures.

DOI: 10.1371/journal.pone.0262421
PMCID: PMC8782407
PMID: 35061789 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2505. Front Public Health. 2022 Jan 4;9:792533. doi: 10.3389/fpubh.2021.792533. 
eCollection 2021.

Psychological Distress During COVID-19 Curfews and Social Distancing in Saudi 
Arabia: A Cross-Sectional Study.

Alghamdi BS(1)(2), Alatawi Y(3), Alshehri FS(4), Tayeb HO(5), AboTaleb H(1), 
Binsalman A(2).

Author information:
(1)Department of Physiology, Faculty of Medicine, King Abdulaziz University, 
Jeddah, Saudi Arabia.
(2)Pre-Clinical Research Unit, King Fahad Medical Research Center, King 
Abdulaziz University, Jeddah, Saudi Arabia.
(3)Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, 
Tabuk, Saudi Arabia.
(4)Department of Pharmacology and Toxicology, College of Pharmacy, Umm Al-Qura 
University, Makkah, Saudi Arabia.
(5)Division of Neurology, Department of Internal Medicine, Faculty of Medicine, 
King Abdulaziz University, Jeddah, Saudi Arabia.

Background: Coronavirus disease 2019 (COVID-19) has spread to over 150 countries 
worldwide. Since the first case of COVID-19 was confirmed in Saudi Arabia, cases 
have continued to escalate exponentially. The COVID-19 outbreak has had a 
negative effect on mental health and well-being. The study aimed to investigate 
the effects of the strict national regulations associated with the COVID-19 
pandemic on mental health. Methods: This was a cross-sectional study of a 
convenience sample of Saudi residents. Saudi residents aged 18 years or older 
were invited to complete an online questionnaire after one month of a nationwide 
24-h curfew between May 6, 2020 and May 13, 2020. We measured psychological 
distress using the Depression, Anxiety, and Stress Scale-21 (DASS-21). We ran 
binary logistic regression analyses to detect variables that significantly 
predicted DASS-21 scores. Results: A sample of 2252 participants was recruited 
from the general population of Saudi Arabia. The DASS-21 score means and 
standard deviations for depression and anxiety for the whole sample (10.73 ± 
10.29 and 6.98 ± 8.30, respectively) were in the range of mild depression and 
anxiety. In contrast, the mean DASS-21 stress score was within the normal range 
(11.97 ± 10.80). The mean stress score for healthcare workers was within the 
normal range (13.70 ± 10.68) but was significantly higher than the mean score 
for the public (11.56 ± 10.89; P = 0.0006). Several variables (e.g., age, 
gender, and history of contact with confirmed COVID-19 cases) were significantly 
associated with higher DASS-21 scores. Conclusions: The COVID-19 pandemic has 
created a psychological burden. Therefore, there is an urgent need to implement 
emergency public health interventions that ameliorate the risk perception of 
COVID-19 through the dissemination of adequate and targeted health information 
that could be a successful measure to mitigate the psychological impact of the 
Covid-19 pandemic.

Copyright © 2022 Alghamdi, Alatawi, Alshehri, Tayeb, AboTaleb and Binsalman.

DOI: 10.3389/fpubh.2021.792533
PMCID: PMC8764301
PMID: 35059380 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2506. Front Public Health. 2022 Jan 4;9:758874. doi: 10.3389/fpubh.2021.758874. 
eCollection 2021.

Anxiety and Depression Prevalence and Risk Factors Among Patients With 
Cardiovascular Diseases in Post-COVID-19 China.

Wu M(1)(2), Shen L(3), Wang Q(4), Liu L(5), Lu S(6), Jin J(4), Dai Z(4), Shu 
Z(7).

Author information:
(1)Department of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang 
University, School of Medicine, Hangzhou, China.
(2)Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, 
Hangzhou, China.
(3)College of Medicine, Affiliated Huzhou Hospital, Zhejiang University, Huzhou, 
China.
(4)Department of Cardiology and Atrial Fibrillation Center, The First Affiliated 
Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
(5)Library, The First Affiliated Hospital, School of Medicine, Zhejiang 
University, Hangzhou, China.
(6)Department of Colorectal Surgery, The First Affiliated Hospital, Zhejiang 
University, School of Medicine, Hangzhou, China.
(7)Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The 
First Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, 
China.

Objective: Data are limited on the psychological disorders of patients with 
cardiovascular disease during the post-COVID-19 period, although mental health 
status is associated with morbidity and mortality. We aimed to investigate the 
prevalence of anxiety and depression and risk factors among patients with 
cardiovascular disease in the post-pandemic period. Method: A cross-sectional 
survey was conducted through opportunistic and snowball sampling in southeast 
China from 10 October to 24 November. Anxiety and depression were assessed on 
the hospital anxiety and depression scale (HADS). Results: A total of 435 
patients with hypertension (48.05%), atrial fibrillation (17.24%), coronary 
artery disease (14.48%), heart failure (9.89%) and other heart diseases (10.34%) 
completed the survey. Interestingly, most patients reported monthly income 
comparable to (90.11%) or even greater than (8.51%) pre-pandemic income. The 
occurrence of anxiety and depression was 11.72 and 9.20%, respectively. Marital 
status and treatment interruption during the pandemic were independent risk 
factors for both anxiety and depression. Moreover, current monthly income and 
access to telemedicine during the pandemic were independent risk factors for 
anxiety. Conclusion: Patients with cardiovascular disease may experience anxiety 
and depression not only because of disease complications but also because of the 
effects of the pandemic. In facing the global challenge posed by the 
coronavirus, efforts should be made to improve patients' psychological 
well-being in the management of populations with cardiovascular disease.

Copyright © 2022 Wu, Shen, Wang, Liu, Lu, Jin, Dai and Shu.

DOI: 10.3389/fpubh.2021.758874
PMCID: PMC8763782
PMID: 35059375 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2507. Nat Hum Behav. 2022 Feb;6(2):217-228. doi: 10.1038/s41562-021-01255-w. Epub 2022 
Jan 20.

Adolescents' psychosocial well-being one year after the outbreak of the COVID-19 
pandemic in Norway.

von Soest T(#)(1)(2), Kozák M(#)(3), Rodríguez-Cano R(3), Fluit S(3), 
Cortés-García L(3), Ulset VS(3), Haghish EF(3), Bakken A(4).

Author information:
(1)PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, 
Norway. t.v.soest@psykologi.uio.no.
(2)Norwegian Social Research (NOVA), Oslo Metropolitan University, Oslo, Norway. 
t.v.soest@psykologi.uio.no.
(3)PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, 
Norway.
(4)Norwegian Social Research (NOVA), Oslo Metropolitan University, Oslo, Norway.
(#)Contributed equally

The COVID-19 pandemic has dramatically restricted adolescents' lives. We used 
nationwide Norwegian survey data from 2014-2021 (N = 227,258; ages 13-18) to 
examine psychosocial outcomes in adolescents before and during the pandemic. 
Multilevel models revealed higher depressive symptoms and less optimistic future 
life expectations during the pandemic, even when accounting for the measures' 
time trends. Moreover, alcohol and cannabis use decreased, and screen time 
increased. However, the effect sizes of all observed changes during the pandemic 
were small. Overall, conduct problems and satisfaction with social relationships 
remained stable. Girls, younger adolescents and adolescents from low 
socio-economic backgrounds showed more adverse changes during the pandemic. 
Estimated changes in psychosocial outcomes varied little with municipality 
infection rates and restrictions. These findings can inform means and 
interventions to reduce negative psychological outcomes associated with the 
pandemic and identify groups that need particular attention during and after the 
pandemic.

© 2022. The Author(s), under exclusive licence to Springer Nature Limited.

DOI: 10.1038/s41562-021-01255-w
PMID: 35058644 [Indexed for MEDLINE]


2508. Psychol Health Med. 2023 Jun;28(5):1380-1386. doi: 
10.1080/13548506.2022.2029504. Epub 2022 Jan 20.

Associations of consequences of coronavirus pandemic with anxiety, depression 
and loneliness: moderating effects of internal resources.

Stefaniak I(1), Janicki A(2), Świtaj P(1), Szykuła-Piec B(3), Grabowska-Lepczak 
I(3).

Author information:
(1)Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, 
Poland.
(2)Warsaw University of Technology, Warsaw, Poland.
(3)Main School of Fire Service, Warsaw, Poland.

The influence of personal internal resources (IRs) on coping with traumatic 
events is constantly researched. This study aimed to determine how the 
SARS-CoV-2 pandemic affected anxiety, depression, and loneliness in two groups 
at different levels of exposure (low and high) to the infection. We analysed the 
impact of IRs in the form of the level of hope and self-efficacy on mental 
reactions (anxiety and depression) and social well-being (loneliness). The study 
was conducted as an internet survey. Descriptive statistics, correlation 
analysis, and difference tests were used for preliminary analyses. Structural 
equation models (SEM) were used for multivariate data analysis. The SEM model 
revealed that people working in a profession with a higher risk of infection 
coped better in the pandemic. We observed a higher level of IRs in the higher 
exposure group, and the consequences were less pronounced. We concluded by 
stating that the level of hope and sense of self-efficacy could moderate the 
response in a pandemic situation and constitute protective factors against 
psychopathological symptoms.

DOI: 10.1080/13548506.2022.2029504
PMID: 35057673 [Indexed for MEDLINE]


2509. Int J Environ Res Public Health. 2022 Jan 17;19(2):1004. doi: 
10.3390/ijerph19021004.

Mental Health Symptoms and Workplace Challenges among Australian Paramedics 
during the COVID-19 Pandemic.

Petrie K(1), Smallwood N(2), Pascoe A(2), Willis K(3).

Author information:
(1)Black Dog Institute, School of Psychiatry, University of New South Wales, 
Sydney 2000, Australia.
(2)Department of Allergy, Immunology and Respiratory Medicine, The Alfred 
Hospital, Monash University, Melbourne 3004, Australia.
(3)Public Health, College of Health and Biomedicine, and Institute for Health 
and Sport, Victoria University, Melbourne 3011, Australia.

BACKGROUND: Paramedics are vital to the health system response to the COVID-19 
pandemic; however, the pressures on this workforce have been intense and 
challenging. This study reports on mental health symptoms and the working 
environment among Australian paramedics during the COVID-19 pandemic and 
explores their experiences of work and wellbeing during this time.
METHODS: An anonymous, online survey of frontline healthcare workers examined 
work environment, psychological wellbeing, and contained four open-ended 
qualitative items. Using a mixed method approach, quantitative data were 
analysed descriptively and qualitative data were analysed using content 
analysis.
RESULTS: This paper reports findings from 95 paramedics who provided complete 
quantitative data and 85 paramedics who provided free-text responses to at least 
one qualitative item. Objectively measured mental health symptoms were common 
among paramedics, and almost two thirds of paramedics self-reported experiencing 
burnout. Qualitative analysis highlighted key issues of safety and risk in the 
workplace, uncertainty and upheaval at work and at home, and lack of crisis 
preparedness. Qualitative analysis revealed four themes; 'the pervasiveness of 
COVID-19 disruptions across all life domains'; 'the challenges of widespread 
disruption at work'; 'risk, uncertainty and feeling unsafe at work', and 'the 
challenges of pandemic (un)preparedness across the health system'.
CONCLUSIONS: The COVID-19 pandemic resulted in considerable occupational 
disruption for paramedics and was associated with significant negative impacts 
on mental health. Findings emphasise the need for more adaptive working 
conditions, mental health support for paramedics, and enhanced crisis 
preparedness across the health system for future crises.

DOI: 10.3390/ijerph19021004
PMCID: PMC8775775
PMID: 35055836 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript; or in the decision to 
publish the results.


2510. Int J Environ Res Public Health. 2022 Jan 17;19(2):1011. doi: 
10.3390/ijerph19021011.

How Does the Involuntary Choice of Self-Employment Affect Subjective Well-Being 
in Small-Sized Business Workers? A Cross-Sectional Study from the Fifth Korean 
Working Conditions Survey.

Park S(1), Park C(2)(3), Sung JH(4).

Author information:
(1)Department of Occupational and Environmental Medicine, Gyeongsang National 
University Changwon Hospital, College of Medicine, Gyeongsang National 
University, Jinju 52727, Korea.
(2)Department of Occupational and Environmental Medicine, Yeungnam University 
Hospital, Daegu 42415, Korea.
(3)Department of Preventive Medicine and Public Health, College of Medicine, 
Yeungnam University, Daegu 42415, Korea.
(4)Department of Occupational and Environmental Medicine, Institute of Health 
Sciences, Gyeongsang National University Changwon Hospital, College of Medicine, 
Gyeongsang National University, Jinju 52727, Korea.

In South Korea, self-employed workers comprise 24.6% of the working 
population-among which 99.7% were found to operate with less than 50 employees. 
However, few studies have investigated the effects of an involuntary choice of 
self-employment. In this study, based on the fifth Korean Working Conditions 
Survey, the factors affecting subjective well-being and mental health in small 
business owners with less than 50 employees among service/sales workers, who 
account for more than half of the self-employed population in Korea, were 
analyzed by the World Health Organization-Five Well-Being Index, using the 
Student's t-test, ANOVA and logistic regression analysis. Results showed that 
the well-being level for those who opted for self-employment involuntarily was 
lower than those who chose it voluntarily. Then, participants were separated 
into two groups according to sex; the degree corresponding to the poor 
well-being score group was compared, and that of the group who chose 
self-employment because they could not find any other work was significantly 
higher than that of the group who chose it voluntarily, in both men and women, 
and this was similar even after correcting for covariance. As the number of 
people being forced to choose self-employment is expected to further increase 
after the outbreak of COVID-19, future studies should be conducted to improve 
subjective well-being of such workers.

DOI: 10.3390/ijerph19021011
PMCID: PMC8775374
PMID: 35055828 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2511. Int J Environ Res Public Health. 2022 Jan 15;19(2):945. doi: 
10.3390/ijerph19020945.

Developing a Scale of Care Work-Related Quality of Life (CWRQoL) for Long-Term 
Care Workers in England.

Hussein S(1), Towers AM(2), Palmer S(3), Brookes N(2), Silarova B(3), Mäkelä 
P(1).

Author information:
(1)Department of Health Services Research and Policy, Faculty of Public Health 
and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
(2)Centre for Health Services Studies (CHSS), University of Kent, Canterbury CT2 
7NF, UK.
(3)Personal Social Services Research Unit (PSSRU), University of Kent, 
Canterbury CT2 7NF, UK.

BACKGROUND: Long-term care (LTC) workers are subjected to structural and 
inherent difficult conditions that are likely to impact their quality of life at 
work; however, no agreed scale measures it. This study aims to develop a scale 
to measure the work-related quality of life among LTC workers in England 
(CWRQoL). The study establishes the domains/sub-domains of CWRQoL, investigates 
the tool's utility and collates information on existing supporting strategies 
for CWRQoL.
METHODS: We adopt a mixed-methods approach employing inductive/deductive 
processes at three stages: (1) a scoping review of the literature; (2) 
interviews and focus groups with frontline LTC workers, managers and LTC 
stakeholders; and (3) a content validity consensus survey.
RESULTS: CWRQoL is composed of seven domains (and 23 sub-domains). Additional 
domains to those in the literature include financial wellbeing, sufficient time 
for building relations, managing grief and emotions associated with client death 
and end of life care. Stakeholders identified several benefits and challenges 
related to the CWRQoL tool's utility. COVID-19 significantly impacted LTC 
workers' mental wellbeing and spillover between work and home.
CONCLUSIONS: The study highlighted the complex nature of CWRQoL and provided a 
solid ground for developing and validating a CWRQoL scale.

DOI: 10.3390/ijerph19020945
PMCID: PMC8775923
PMID: 35055767 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2512. Int J Environ Res Public Health. 2022 Jan 14;19(2):912. doi: 
10.3390/ijerph19020912.

The Association between COVID-19-Related Wellbeing with Materialism and 
Perceived Threat.

Teng F(1), Shi J(2), Wang X(3), Chen Z(2).

Author information:
(1)Faculty of Psychology, South China Normal University, Guangzhou 510631, 
China.
(2)Department of Psychology, The University of Hong Kong, Hong Kong, China.
(3)Department of Social and Behavioural Science, City University of Hong Kong, 
Hong Kong, China.

The ongoing coronavirus disease (COVID-19) pandemic has had a profound impact on 
people's wellbeing. Here, we proposed that an individual characteristic might be 
associated with wellbeing; that is, materialism. Specifically, we conducted 
three studies (total N = 3219) to examine whether people with high levels of 
materialism would experience poorer wellbeing (i.e., anxiety and depression, in 
the current case). The results showed that materialism was positively associated 
with depression (Studies 1A, 1B and 2) and anxiety (Study 2). Moreover, such a 
relationship was mediated by people's perceived threat of COVID-19 (Study 2). 
These findings were observed in both Chinese and American people. The findings 
are discussed in terms of their theoretical and practical contributions.

DOI: 10.3390/ijerph19020912
PMCID: PMC8775696
PMID: 35055735 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2513. Int J Environ Res Public Health. 2022 Jan 14;19(2):904. doi: 
10.3390/ijerph19020904.

Sleep Deprivation, Immune Suppression and SARS-CoV-2 Infection.

Ragnoli B(1), Pochetti P(1), Pignatti P(2), Barbieri M(1), Mondini L(1), Ruggero 
L(1), Trotta L(1), Montuschi P(3)(4), Malerba M(1)(5).

Author information:
(1)Respiratory Unit, S. Andrea Hospital, 13100 Vercelli, Italy.
(2)Allergy and Immunology Unit, Istituti Clinici Scientifici Maugeri IRCCS 
Pavia, 27100 Pavia, Italy.
(3)Pharmacology Department, Faculty of Medicine, Catholic University of the 
Sacred Heart, 20123 Milan, Italy.
(4)Faculty of Medicine, National Hearth and Lung Institute, Imperial College of 
Science Technology and Medicine, Airways Disease Section, London SW7 2BX, UK.
(5)Department of Traslational Medicine, University of Eastern Piedmont, 28100 
Novara, Italy.

Sleep health and its adaptation to individual and environmental factors are 
crucial to promote physical and mental well-being across animal species. In 
recent years, increasing evidence has been reported regarding the relationship 
between sleep and the immune system and how sleep disturbances may perturb the 
delicate balance with severe repercussions on health outcomes. For instance, 
experimental sleep deprivation studies in vivo have reported several major 
detrimental effects on immune health, including induced failure of host defense 
in rats and increased risk for metabolic syndrome (MetS) and immune suppression 
in humans. In addition, two novel risk factors for dysregulated metabolic 
physiology have recently been identified: sleep disruption and circadian 
misalignment. In light of these recent findings about the interplay between 
sleep and the immune system, in this review, we focus on the relationship 
between sleep deprivation and immunity against viruses, with a special interest 
in SARS-CoV-2 infection.

DOI: 10.3390/ijerph19020904
PMCID: PMC8775678
PMID: 35055726 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2514. Int J Environ Res Public Health. 2022 Jan 12;19(2):819. doi: 
10.3390/ijerph19020819.

A Randomized Clinical Trial to Assess the Efficacy of Online-Treatment with 
Trial-Based Cognitive Therapy, Mindfulness-Based Health Promotion and Positive 
Psychotherapy for Post-Traumatic Stress Disorder during the COVID-19 Pandemic: A 
Study Protocol.

Duran ÉP(1), Hemanny C(1), Vieira R(1), Nascimento O(2), Machado L(3), de 
Oliveira IR(1), Demarzo M(2).

Author information:
(1)Postgraduate Program of Interactive Processes of Organs and Systems, Health 
Sciences Institute, Department of Neuroscience and Mental Health, Federal 
University of Bahia, Salvador 40110-060, Brazil.
(2)Mente Aberta-Brazilian Center for Mindfulness and Health Promotion, 
Department of Preventive Medicine, Universidade Federal de São Paulo (UNIFESP), 
Sao Paulo 04753-060, Brazil.
(3)Postgraduate Program in Neuropsychiatry and Behavioral Sciences, Center for 
Medical Sciences, Department of Neuropsychiatry, Federal University of 
Pernambuco (POSNEURO-CCM-UFPE), Recife 50070-460, Brazil.

BACKGROUND: Research suggests the use of different forms of therapy as a way of 
decreasing dropout rates in the treatment of post-traumatic stress disorder 
(PTSD). The psychotherapies to be assessed in this study are trial-based 
cognitive therapy (TBCT), mindfulness-based health promotion (MBHP) and positive 
psychotherapy (PPT).
OBJECTIVES: (1) to assess the online efficacy of TBCT compared to MBHP and PPT 
to reduce the symptoms of PTSD in the context of the Coronavirus Disease 2019 
(COVID-19) pandemic; (2) to compare the efficacy of these psychotherapies in 
improving anxiety, depression, guilt and in promoting well-being; and (3) to 
describe how professionals perceive online treatment.
METHODS: A randomized, multicenter, single-blind clinical trial will be 
conducted, with three separate arms. An estimated sample of 135 patients will 
receive either TBCT, MBHP or PPT and will be treated through online, individual, 
weekly visits, totaling 14 sessions. The primary outcome will be CAPS-5 and 
secondary outcomes will be HADS and WHO-5. The variables used to mediate these 
outcomes will be the Trauma-Related Guilt Inventory (TRGI), Negative Core 
Beliefs Inventory (NCBI) and the California Psychotherapy Alliance Scale 
(CALPAS-P).
EXPECTED RESULTS: PTSD symptoms are expected to be reduced after TBCT, MBHP and 
PPT. No statistical difference is expected to be found among the three.
DISCUSSION: The present study will evaluate and contribute towards the 
development of new psychotherapeutic options for patients with PTSD. The results 
of this study will allow the dissemination of new effective and adaptable 
interventions for patients with PTSD.

DOI: 10.3390/ijerph19020819
PMCID: PMC8775699
PMID: 35055641 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research will be 
conducted in the absence of any commercial or financial relationships that can 
be construed as a potential conflict of interest.


2515. Int J Environ Res Public Health. 2022 Jan 11;19(2):763. doi: 
10.3390/ijerph19020763.

Occupational Stressors and Access to COVID-19 Resources among Commuting and 
Residential Hispanic/Latino Farmworkers in a US-Mexico Border Region.

Keeney AJ(1), Quandt A(2), Villaseñor MD(1), Flores D(3), Flores L Jr(3).

Author information:
(1)School of Social Work, San Diego State University, San Diego, CA 92182, USA.
(2)Department of Geography, San Diego State University, San Diego, CA 92182, 
USA.
(3)Imperial Valley Equity & Justice Coalition, Calexico, CA 92231, USA.

Hispanic/Latino and migrant workers experience high degrees of occupational 
stress, constitute most of California's agricultural workforce, and were among 
the most impacted populations by the COVID-19 pandemic. However, relatively 
little is known about the occupational stress experienced by farmworkers who 
commute daily between the US and Mexico. Occupational stress is considered an 
imbalance between the demands at work and the capabilities to respond in the 
context of the workforce. The goal of this study is to determine the type and 
severity of stressors in daytime and resident farmworkers and how COVID-19 
vaccination status contributes to these stressors. Interviews containing the 
Migrant Farmworker Stress Inventory (MSWSI) were administered to a sample of 199 
Hispanic/Latino farmworkers in Imperial County, a multi-billion-dollar 
agriculture sector in the US. Principal factor analysis differentiated latent 
factors in the MFSWI. Simple linear regression models and correlations 
identified associations between MFWSI scores and sample characteristics. The 
MFWSI reduced to five stressor domains: Health and Well-Being Vulnerabilities, 
Inadequate Standards of Living/Unknown Conditions of Living, Working Conditions, 
Working Environment, and Language Barriers. Approximately 40 percent of the 
respondents reported significant stress levels, with foreign-born (p = 0.014) 
and older respondents (p = 0.0415) being more likely to experience elevated 
stress regardless of their nighttime residence. We found that Spanish-language 
COVID-19 outreach might have been particularly effective for workers who 
reported high stress from English-language communication (p = 0.001). Moreover, 
our findings point to the importance of worker and human rights to mitigate the 
high-stress foreign-born workers who live in Mexico and the US experience.

DOI: 10.3390/ijerph19020763
PMCID: PMC8775392
PMID: 35055585 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2516. Psychother Psychosom. 2022;91(6):398-410. doi: 10.1159/000521302. Epub 2022 Jan 
20.

Effectiveness of an Internet-Based Self-Help Intervention versus Public Mental 
Health Advice to Reduce Worry during the COVID-19 Pandemic: A Pragmatic, 
Parallel-Group, Randomized Controlled Trial.

Heckendorf H(1), Lehr D(1), Boß L(1).

Author information:
(1)Department of Health Psychology and Applied Biological Psychology, Institute 
of Psychology, Leuphana University of Lüneburg, Lüneburg, Germany.

INTRODUCTION: The mental health burden for the general population due to the 
COVID-19 pandemic has been highlighted. Evidence on effective, easily accessible 
public health interventions to reduce worry, a major transdiagnostic risk-factor 
for, e.g., anxiety and depression, is scarce.
OBJECTIVE: In a pragmatic randomized controlled trial, we aimed to assess 
whether an internet cognitive-behavioral self-help intervention could reduce 
worry more than public mental health advice in the general population.
METHODS: Eligible internet users above the age of 18 were recruited from the 
German general population and randomly assigned, to either get.calm-move.on 
(GCMO), a 10-day unguided, internet-based self-help intervention, or mental 
health advice waiting group (MHA-W, receiving officially endorsed mental health 
recommendations). The primary outcome was level of worry, using the Penn State 
Worry Questionnaire (PSWQ), 2 weeks after randomization. Baseline assessment and 
2-month and 6-month follow-ups were conducted. The trial was registered at the 
German Clinical Trials Registry (DRKS00021153).
RESULTS: Between April 7, 2020 and December 11, 2020, we randomly assigned 351 
individuals to receive either GCMO (n = 175) or MHA-W (n = 176). Participants 
receiving GCMO (PSWQ = 46.6; change -10.3) reported significantly less worrying 
at post-intervention (F1,219 = 12.9; p < 0.001; d = 0.38) than MHA-W controls 
(PSWQ = 51.6; change -5.1). Improvements were also seen on most secondary 
outcomes, including symptoms of anxiety and depression, general well-being, 
resiliency, and emotion regulation skills. Improvements made from baseline were 
stable until the 6-month follow-up.
CONCLUSIONS: This internet-based self-help intervention providing 
cognitive-behavioral techniques to cope with the threatening pandemic situation 
is effective in reducing worry in the general population and should complement 
existing and potentially effective mental health recommendations.

© 2022 The Author(s). Published by S. Karger AG, Basel.

DOI: 10.1159/000521302
PMID: 35051939 [Indexed for MEDLINE]


2517. Adapt Phys Activ Q. 2022 Jan 20;39(3):285-302. doi: 10.1123/apaq.2021-0137. 
Print 2022 Jul 1.

COVID-19 Pandemic and Individuals With Intellectual Disability: Special Olympics 
as an Example of Organizational Responses and Challenges.

Temple VA.

The COVID-19 pandemic is a worldwide crisis. It has been, and is, an extreme 
challenge for our health care and prevention systems, and for society as a 
whole. Among many facets of life, physical activity and sport has been heavily 
impacted. The aim of this viewpoint article is to highlight the effect of the 
COVID-19 pandemic on individuals with an intellectual disability, with a 
particular focus on physical activity and Special Olympics. Specific objectives 
are (a) to share what the literature reveals about the impact of COVID-19 on the 
health and well-being of individuals with an intellectual disability, (b) to 
examine what is known about the impact of the pandemic on physical activity of 
individuals with an intellectual disability, (c) to describe Special Olympics 
program responses during the pandemic, and (d) to recommend areas for future 
research.

DOI: 10.1123/apaq.2021-0137
PMID: 35051902 [Indexed for MEDLINE]


2518. Eur Rev Med Pharmacol Sci. 2022 Jan;26(1):291-297. doi: 
10.26355/eurrev_202201_27780.

COVID-19 pandemic, substance use disorders and body image issues, a worrisome 
correlation.

Zaami S(1), Sirignano A, García-Algar Ó, Marinelli E.

Author information:
(1)Department of Anatomical, Histological, Forensic, and Orthopedic Sciences, 
Sapienza University of Rome, Rome, Italy. enrico.marinelli@uniroma1.it.

Comment in
    Eur Rev Med Pharmacol Sci. 2022 Mar;26(6):1787-1788.

The SARS-CoV-2 pandemic has profoundly affected the social fabric and the 
economic and health care viability and functioning of most countries. Aside from 
its deeply destructive impact on health care systems and national economies, the 
pandemic has jeopardized people's emotional and psychological well-being as 
well. The authors aimed to shed a light on how the pandemic has been affecting 
patients with addiction issues and body dysmorphic disorder (BDD), which is 
characterized by negative thoughts about appearance and body misperceptions. 
People with body dysmorphic disorder are in fact at increased risk of developing 
substance use disorders, and such a destructive association has only been made 
more severe by pandemic-related restrictions, emotional distress and anxiety, as 
well as longer exposure to social media and online interactions. This is a major 
cause for concern, because substance use worsens symptoms of BDD and contributes 
to unfavorable treatment outcomes.

DOI: 10.26355/eurrev_202201_27780
PMID: 35049007 [Indexed for MEDLINE]


2519. Br J Psychiatry. 2021 Oct;219(4):551-556. doi: 10.1192/bjp.2021.44.

Time use and mental health in UK adults during an 11-week COVID-19 lockdown: a 
panel analysis.

Bu F(1), Steptoe A(1), Mak HW(1), Fancourt D(1).

Author information:
(1)Department of Behavioural Science and Health, Institute of Epidemiology & 
Health Care, University College London, UK.

BACKGROUND: There is currently major concern about the impact of the global 
COVID-19 outbreak on mental health. But it remains unclear how individual 
behaviours could exacerbate or protect against adverse changes in mental health.
AIMS: To examine the associations between specific activities (or time use) and 
mental health and well-being among people during the COVID-19 pandemic.
METHOD: Data were from the UCL COVID-19 Social Study, a panel study collecting 
data weekly during the COVID-19 pandemic. The analytical sample consisted of 55 
204 adults living in the UK who were followed up for the 11-week strict lockdown 
period from 21 March to 31 May 2020. Data were analysed using fixed-effects and 
Arellano-Bond models.
RESULTS: Changes in time spent on a range of activities were associated with 
changes in mental health and well-being. After controlling for bidirectionality, 
behaviours involving outdoor activities such as gardening and exercising 
predicted subsequent improvements in mental health and well-being, whereas 
increased time spent following news about COVID-19 predicted declines in mental 
health and well-being.
CONCLUSIONS: These results are relevant to the formulation of guidance for 
people obliged to spend extended periods in isolation during health emergencies 
and may help the public to maintain well-being during future lockdowns and 
pandemics.

DOI: 10.1192/bjp.2021.44
PMCID: PMC8481937
PMID: 35048881 [Indexed for MEDLINE]

Conflict of interest statement: None.


2520. Respirology. 2022 Jun;27(6):411-426. doi: 10.1111/resp.14208. Epub 2022 Jan 19.

COVID-19 infection and the broader impacts of the pandemic on healthcare 
workers.

Smallwood N(1)(2), Harrex W(3), Rees M(4)(5), Willis K(6)(7), Bennett CM(8).

Author information:
(1)Department of Respiratory Medicine, The Alfred Hospital, Prahran, Victoria, 
Australia.
(2)Department of Allergy, Immunology and Respiratory Medicine, Central Clinical 
School, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia.
(3)Consultant Occupational & Environmental Physician, Woden, Australian Capital 
Territory, Australia.
(4)Department of Respiratory and Sleep Disorders Medicine, The Royal Melbourne 
Hospital, Parkville, Victoria, Australia.
(5)Department of Medicine, RMH, Faculty of Medicine, Dentistry and Health, The 
University of Melbourne, Melbourne, Victoria, Australia.
(6)Public Health, College of Health and Biomedicine, Victoria University, 
Melbourne, Victoria, Australia.
(7)Division of Critical Care and Investigative Services, Royal Melbourne 
Hospital, Parkville, Victoria, Australia.
(8)Institute for Health Transformation, Deakin University, Burwood, Victoria, 
Australia.

Comment in
    Respirology. 2022 Jun;27(6):469-471.
    Respirology. 2022 Jun;27(6):472-473.

The severe acute respiratory syndrome coronavirus (SARS-CoV-2) disease or 
COVID-19 pandemic is associated with more than 230 million cases and has 
challenged healthcare systems globally. Many healthcare workers (HCWs) have 
acquired the infection, often through their workplace, with a significant number 
dying. The epidemiology of COVID-19 infection in HCWs continues to be explored, 
with manifold exposure risks identified, leading to COVID-19 being recognised as 
an occupational disease for HCWs. The physical illness due to COVID-19 in HCWs 
is similar to the general population, with some HCWs experiencing a long-term 
illness, which may impact their ability to return to work. HCWs have also been 
affected by the immense workplace and psychosocial disruption caused by the 
pandemic. The impacts on the psychological well-being of HCWs globally have been 
profound, with high prevalence estimates for mental health symptoms, including 
emotional exhaustion. Globally, governments, healthcare organisations and 
employers have key responsibilities, including: to be better prepared for crises 
with comprehensive disaster response management plans, and to protect and 
preserve the health workforce from the physical and psychological impacts of the 
pandemic. While prioritising HCWs in vaccine rollouts globally has been 
critical, managing exposures and outbreaks occurring in healthcare settings 
remains challenging and continues to lead to substantial disruption to the 
health workforce. Safeguarding healthcare workforces during crises is critical 
as we move forward on the new path of 'COVID normal'.

© 2022 Asian Pacific Society of Respirology.

DOI: 10.1111/resp.14208
PMID: 35048469 [Indexed for MEDLINE]


2521. J Agric Food Chem. 2022 Feb 2;70(4):944-956. doi: 10.1021/acs.jafc.1c06151. Epub 
2022 Jan 18.

Ancestral Food Sources Rich in Polyphenols, Their Metabolism, and the Potential 
Influence of Gut Microbiota in the Management of Depression and Anxiety.

Álvarez SA(1), Rocha-Guzmán NE(1), González-Laredo RF(1), Gallegos-Infante 
JA(1), Moreno-Jiménez MR(1), Bravo-Muñoz M(2).

Author information:
(1)Research Group on Functional Foods and Nutraceuticals, TecNM/Instituto 
Tecnológico de Durango, Felipe Pescador 1830 Ote., 34080 Durango, Durango, 
México.
(2)Instituo Nacional de Neurociencias y Salud Mental, INNSAM, 21831 Chiapas, 
México.

The relationship between a population's diet and the risk of suffering from 
mental disorders has gained importance in recent years, becoming exacerbated due 
to the COVID-19 lockdown. This review concentrates relevant literature from 
Scopus, PubMed, and Google Scholar analyzed with the aim of rescuing knowledge 
that promotes mental health. In this context, it is important to highlight those 
flowers, seeds, herbaceous plants, fungi, leaves, and tree barks, among other 
ancestral matrices, that have been historically part of the eating habits of 
human beings and have also been a consequence of the adaptation of collectors, 
consuming the ethnoflora present in different ecosystems. Likewise, it is 
important to note that this knowledge has been progressively lost in the new 
generations. Therefore, this review concentrates an important number of matrices 
used particularly for food and medicinal purposes, recognized for their 
anxiolytic and antidepressant effects, establishing the importance of metabolism 
and biotransformation mainly of bioactive compounds such as polyphenols by the 
action of the gut microbiota.

DOI: 10.1021/acs.jafc.1c06151
PMID: 35041424 [Indexed for MEDLINE]


2522. JAMA Pediatr. 2022 Apr 1;176(4):400-409. doi: 10.1001/jamapediatrics.2021.5840.

School Closures During Social Lockdown and Mental Health, Health Behaviors, and 
Well-being Among Children and Adolescents During the First COVID-19 Wave: A 
Systematic Review.

Viner R(1), Russell S(1), Saulle R(2), Croker H(1), Stansfield C(3), Packer 
J(1), Nicholls D(4), Goddings AL(1), Bonell C(5), Hudson L(1), Hope S(1), Ward 
J(1), Schwalbe N(6), Morgan A(7), Minozzi S(2).

Author information:
(1)UCL Great Ormond St Institute of Child Health, London, United Kingdom.
(2)Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
(3)UCL Institute of Education, London, United Kingdom.
(4)Division of Psychiatry, Department of Brain Sciences, Imperial College 
London, London, United Kingdom.
(5)London School of Hygiene and Tropical Medicine, London, United Kingdom.
(6)Heilbrunn Department of Population and Family Health, Mailman School of 
Public Health, Columbia University, New York, New York.
(7)Yunus Centre for Social Business and Health, Glasgow Caledonian University, 
London, United Kingdom.

Comment in
    JAMA Pediatr. 2022 Apr 1;176(4):347-348.

IMPORTANCE: School closures as part of broader social lockdown measures during 
the COVID-19 pandemic may be associated with the health and well-being of 
children and adolescents.
OBJECTIVE: To review published reports on the association of school closures 
during broader social lockdown with mental health, health behaviors, and 
well-being in children and adolescents aged 0 to 19 years, excluding 
associations with transmission of infection.
EVIDENCE REVIEW: Eleven databases were searched from inception to September 
2020, and machine learning was applied for screening articles. A total of 16 817 
records were screened, 151 were reviewed in full text, and 36 studies were 
included. Quality assessment was tailored to study type. A narrative synthesis 
of results was undertaken because data did not allow meta-analysis.
FINDINGS: A total of 36 studies from 11 countries were identified, involving a 
total of 79 781 children and adolescents and 18 028 parents, which occurred 
during the first wave of the COVID-19 pandemic (February to July 2020). All 
evaluated school closure as part of broader social lockdown during the first 
COVID-19 wave, and the duration of school closure ranged from 1 week to 3 
months. Of those, 9 (25%) were longitudinal pre-post studies, 5 (14%) were 
cohort, 21 (58%) were cross-sectional, and 1 (3%) was a modeling study. Thirteen 
studies (36%) were high quality, 17 (47%) were medium quality, and 6 (17%) were 
low quality. Twenty-three studies (64%) were published, 8 (22%) were online 
reports, and 5 (14%) were preprints. Twenty-five studies (69%) concerning mental 
health identified associations across emotional, behavioral, and 
restlessness/inattention problems; 18% to 60% of children and adolescents scored 
above risk thresholds for distress, particularly anxiety and depressive 
symptoms, and 2 studies reported no significant association with suicide. Three 
studies reported that child protection referrals were lower than expected number 
of referrals originating in schools. Three studies suggested higher screen time 
usage, 2 studies reported greater social media use, and 6 studies reported lower 
physical activity. Studies on sleep (10 studies) and diet (5 studies) provided 
inconclusive evidence on harms.
CONCLUSIONS AND RELEVANCE: In this narrative synthesis of reports from the first 
wave of the COVID-19 pandemic, studies of short-term school closures as part of 
social lockdown measures reported adverse mental health symptoms and health 
behaviors among children and adolescents. Associations between school closure 
and health outcomes and behaviors could not be separated from broader lockdown 
measures.

DOI: 10.1001/jamapediatrics.2021.5840
PMID: 35040870 [Indexed for MEDLINE]


2523. BMC Public Health. 2022 Jan 17;22(1):119. doi: 10.1186/s12889-022-12532-2.

Psychosocial impacts of home-schooling on parents and caregivers during the 
COVID-19 pandemic.

Calear AL(1), McCallum S(2), Morse AR(2), Banfield M(2), Gulliver A(2), Cherbuin 
N(3), Farrer LM(2), Murray K(4), Rodney Harris RM(5)(6), Batterham PJ(2).

Author information:
(1)Centre for Mental Health Research, Research School of Population Health, The 
Australian National University, 63 Eggleston Road, ACT 2601, Acton, Australia. 
Alison.Calear@anu.edu.au.
(2)Centre for Mental Health Research, Research School of Population Health, The 
Australian National University, 63 Eggleston Road, ACT 2601, Acton, Australia.
(3)Centre for Research on Ageing, Health and Wellbeing, Research School of 
Population Health, The Australian National University, Acton, Australia.
(4)Research School of Psychology, The Australian National University, Acton, 
Australia.
(5)National Centre for Epidemiology and Population Health, Research School of 
Population Health, The Australian National University, Acton, Australia.
(6)Fenner School of Environment and Society, The Australian National University, 
Acton, Australia.

BACKGROUND: The COVID-19 pandemic has been highly disruptive, with the closure 
of schools causing sudden shifts for students, educators and parents/caregivers 
to remote learning from home (home-schooling). Limited research has focused on 
home-schooling during the COVID-19 pandemic, with most research to date being 
descriptive in nature. The aim of the current study was to comprehensively 
quantify the psychosocial impacts of home-schooling on parents and other 
caregivers, and identify factors associated with better outcomes.
METHODS: A nationally representative sample of 1,296 Australian adults was 
recruited at the beginning of Australian COVID-19 restrictions in late-March 
2020, and followed up every two weeks. Data for the current study were drawn 
from waves two and three. Surveys assessed psychosocial outcomes of 
psychological distress, work and social impairment, and wellbeing, as well as a 
range of home-schooling factors.
RESULTS: Parents and caregivers who were home-schooling during the COVID-19 
pandemic experienced significantly higher levels of psychological distress and 
work/social impairment compared to those who were not home-schooling or had no 
school-aged children. A current mental health diagnosis or lower levels of 
perceived support from their child's school negatively affected levels of 
psychological distress, work and social impairment, and wellbeing in parents and 
caregivers involved in home-schooling.
CONCLUSIONS: The mental health impacts of home-schooling were high and may rise 
as periods of home-schooling increase in frequency and duration. Recognising and 
acknowledging the challenges of home-schooling is important, and should be 
included in psychosocial assessments of wellbeing during periods of school 
closure. Emotional and instrumental support is needed for those involved in 
home-schooling, as perceived levels of support is associated with improved 
outcomes. Proactive planning by schools to support parents may promote better 
outcomes and improved home-schooling experiences for students.

© 2022. The Author(s).

DOI: 10.1186/s12889-022-12532-2
PMCID: PMC8763398
PMID: 35039044 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2524. Health Soc Care Community. 2022 Sep;30(5):e2793-e2804. doi: 10.1111/hsc.13723. 
Epub 2022 Jan 17.

The effects of COVID-19 on the mental health and job stress of frontline 
homelessness services workers in Texas (U.S.).

Aykanian A(1).

Author information:
(1)School of Social Work, The University of Texas at Arlington, Arlington, 
Texas, USA.

As the COVID-19 pandemic persists in the U.S. and elsewhere, there is a growing 
need to understand the impacts of the pandemic on essential and frontline 
workers. Given the dearth of research on the experiences of homelessness 
services workers during the COVID-19 pandemic, this study aimed to understand 
the impact of COVID-related stressors in the workplace on the wellbeing of the 
homelessness services workers in the state of Texas (U.S.). Using a 
cross-sectional survey design, the analysis focusses on examining the 
relationship between COVID stressors with mental health symptoms and job stress 
indictors. Data were collected from a sample of 132 frontline homelessness 
services workers across the state during April, May and June of 2021. Primary 
outcomes of interest were measured with the Depression, Anxiety and Stress Scale 
(DASS-42) and the Professional Quality of Life Scale (ProQOL). Multiple linear 
regression models were specified to explore associations between the outcomes of 
interest and predictor variables (i.e. demographics, work experiences and 
COVID-19 stressors). Results showed that perceiving a decline in job 
satisfaction because of the COVID-19 pandemic was associated with higher stress 
(β = ++0.18), 95% CI [.13, 6.68], higher burnout (β = 0.32), 95% CI [2.54, 7.30] 
and lower compassion satisfaction (β = 0.42), 95% CI [-8.14, -3.69]. 
Additionally, being worried about contracting COVID-19 at work was associated 
with an increase in burnout (β = 0.19), 95% CI [.40, 4.79]. Also notable is that 
older age and Black/African American race were associated with lower stress, 
lower burnout and higher compassion satisfaction. Implications for supporting 
the homelessness sector through high-quality supervision, useful training, 
adequate benefits and routine check-ins are discussed.

© 2022 John Wiley & Sons Ltd.

DOI: 10.1111/hsc.13723
PMID: 35037348 [Indexed for MEDLINE]


2525. Appl Nurs Res. 2022 Feb;63:151517. doi: 10.1016/j.apnr.2021.151517. Epub 2021 
Oct 27.

Psychological responses of hospital-based nurses working during the COVID-19 
pandemic in the United States: A cross-sectional study.

Mensinger JL(1), Brom H(2), Havens DS(3), Costello A(4), D'Annunzio C(5), 
Durning JD(6), Bradley PK(7), Copel L(8), Maldonado L(9), Smeltzer S(10), Yost 
J(11), Kaufmann P(12).

Author information:
(1)M. Louise Fitzpatrick College of Nursing, United States of America. 
Electronic address: janell.mensinger@villanova.edu.
(2)M. Louise Fitzpatrick College of Nursing, United States of America. 
Electronic address: Heather.brom@villanova.edu.
(3)M. Louise Fitzpatrick College of Nursing, United States of America. 
Electronic address: donna.havens@villanova.edu.
(4)M. Louise Fitzpatrick College of Nursing, United States of America; 
Department of Applied Mathematics and Statistics, College of Liberal Arts and 
Sciences, United States of America. Electronic address: acostel5@villanova.edu.
(5)M. Louise Fitzpatrick College of Nursing, United States of America. 
Electronic address: cdannun1@villanova.edu.
(6)M. Louise Fitzpatrick College of Nursing, United States of America; 
Massachusetts General Hospital Institute of Health Professions, United States of 
America. Electronic address: jdurnin1@villanova.edu.
(7)M. Louise Fitzpatrick College of Nursing, United States of America. 
Electronic address: patricia.bradley@villanova.edu.
(8)M. Louise Fitzpatrick College of Nursing, United States of America. 
Electronic address: linda.copel@villanova.edu.
(9)M. Louise Fitzpatrick College of Nursing, United States of America. 
Electronic address: linda.maldonado@villanova.edu.
(10)M. Louise Fitzpatrick College of Nursing, United States of America. 
Electronic address: suzanne.smeltzer@villanova.edu.
(11)M. Louise Fitzpatrick College of Nursing, United States of America. 
Electronic address: jennifer.yost@villanova.edu.
(12)M. Louise Fitzpatrick College of Nursing, United States of America. 
Electronic address: peter.kaufmann@villanova.edu.

Studies show decreased well-being during the COVID-19 pandemic, especially for 
healthcare providers from Asia. Less is known about the psychological responses 
of working during the pandemic on hospital-based registered nurses (RNs) in the 
United States (US). Therefore, the purpose of this paper is to report the 
well-being of U.S.-based hospital RNs working during the initial acute phase of 
COVID-19 and compare it with well-being among healthcare workers described in 
two global meta-analyses. We conducted a cross-sectional survey in May-June 2020 
(N = 467). Well-being was measured using the following tools: Generalized 
Anxiety Disorder-7, Patient Health Questionnaire-2 for depressive symptoms, 
Impact of Events Scale-Revised for traumatic stress, and the Insomnia Severity 
Index. Compared with global rates from two meta-analyses, US-based RNs reported 
significantly more traumatic stress (54.6% vs. 11.4% and 21.5%; p < .001) and 
depressive symptoms (54.6% vs. 31.8% and 21.7%; p < .001). Rates of insomnia 
were also higher in U.S.-based RNs than in the meta-analysis that reported 
insomnia (32.4% vs 27.8%; p < .033). Rates of anxiety symptoms among US-based 
RNs did not differ from that reported in one meta-analysis (37.3% vs. 34.4%), 
while it was significantly higher in the other (37.3% vs. 22.1%; p < .001). 
Hospital-based RNs from the US exhibited over twice the rates of trauma and 
nearly double the rates of depressive symptoms than shown in reports from 
hospital workers globally during the acute phase of the COVID-19 pandemic. The 
lasting effects of this distress are unknown and warrant ongoing evaluation and 
solutions to better support emotional well-being and prevent burnout in the 
workplace.

Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.apnr.2021.151517
PMCID: PMC8549528
PMID: 35034708 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no known 
competing financial interests or personal relationships that could have appeared 
to influence the work reported in this paper.


2526. BMC Geriatr. 2022 Jan 16;22(1):56. doi: 10.1186/s12877-022-02752-x.

Caregivers of people with dementia and mental health during COVID-19: findings 
from a cross-sectional study.

Messina A(1), Lattanzi M(2), Albanese E(2), Fiordelli M(2).

Author information:
(1)Institute of Public Health, Faculty of Biomedical Sciences, Università della 
Svizzera Italiana, Lugano, Switzerland. anna.messina@usi.ch.
(2)Institute of Public Health, Faculty of Biomedical Sciences, Università della 
Svizzera Italiana, Lugano, Switzerland.

BACKGROUND: There is sparse evidence on the impact on vulnerable populations of 
the COVID-19 pandemic. The aim of our study was to explore burden and mental 
wellbeing (including depressive, anxiety, and stress symptoms) in caregivers of 
people with dementia during the first wave of the pandemic in Italy and southern 
Switzerland, two bordering regions severely hit by the COVID-19 pandemic.
METHODS: We conducted an online cross-sectional survey with family carers of 
people with dementia between May and June 2020. We registered socio-demographic 
characteristics, and information about the relationship with the care recipient, 
dementia subtype, care inputs from others, and the need of care of the person 
with dementia. We measured caregiver burden with the Zarit Burden Interview 
(ZBI), psychological distress with the Depression, Anxiety and Stress Scale 
(DASS-21), and perceived isolation with the 3-item UCLA Loneliness Scale 
(UCLALS3).
RESULTS: Caregivers (N =571) reported moderate to severe care-related burden 
(mean=54.30; SD=18.33), moderate anxiety symptoms (mean=10.04; SD=6.93), mild 
depressive symptoms (mean=11.79; SD=6.12) and mild stress (mean=12.95; SD=5.53), 
and 72.3% of participants reported to feel lonely. All scores were significantly 
more severe in Swiss compared to Italian caregivers (all p values<0.001).
CONCLUSIONS: We found that caregivers' burden, anxiety symptoms, depression and 
perceived loneliness were marked during the first wave of the COVID-19 pandemic, 
in two severely hit bordering countries. Regional differences in the impact of 
the epidemic on caregivers could be due to contextual, societal, and cultural 
circumstances. As the pandemic endures, support to caregivers of people with 
dementia should be proportionate and tailored to needs and adapted to contextual 
factors.

© 2022. The Author(s).

DOI: 10.1186/s12877-022-02752-x
PMCID: PMC8761089
PMID: 35034607 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2527. Radiol Med. 2022 Feb;127(2):220-224. doi: 10.1007/s11547-021-01440-x. Epub 2022 
Jan 16.

Impact on mental health of the COVID-19 pandemic in a radiation oncology 
department.

Caliandro M(1), Fabiana G(1), Surgo A(2), Carbonara R(1), Ciliberti MP(1), 
Bonaparte I(1), Caputo S(3), Fiorentino A(1).

Author information:
(1)Radiation Oncology Department, General Regional Hospital F. Miulli, Strada 
Provinciale 127, 70020, Acquaviva delle fonti (BA), Italy.
(2)Radiation Oncology Department, General Regional Hospital F. Miulli, Strada 
Provinciale 127, 70020, Acquaviva delle fonti (BA), Italy. 
surgo.alessia@gmail.com.
(3)General Regional Hospital F. Miulli, Acquaviva delle fonti (BA), Italy.

AIM: To evaluate the emotional state and organizational well-being of healthcare 
workers in radiation oncology departments, during the COVID pandemic.
METHODS: A survey was carried out with three questionnaires: Impact of Event 
Scale-Revised (IES-R); Italian ANAC questionnaire; and Maslach Burnout Inventory 
(MBI). Comparisons between groups were done by Student's t test.
RESULTS: Seventy-eight questionnaires for 26 workers were analyzed. Thirty-three 
percent of the sample obtained an IES-R high score, such as post-traumatic 
syndrome. In terms of organizational well-being, younger age and lower working 
seniority were statistically significant for higher score of ANAC items 
(p < 0.5). Regarding MBI, 0, 27 and 50% high scores of emotional exhaustion, 
depersonalization and personal accomplishment were reported, respectively. Low 
working seniority and male sex were correlated with high score of personal 
accomplishment (p:0.05; p:0.03).
CONCLUSION: Intervention to promote mental health well-being should be 
implemented in radiation oncology department.

© 2022. Italian Society of Medical Radiology.

DOI: 10.1007/s11547-021-01440-x
PMCID: PMC8761247
PMID: 35034319 [Indexed for MEDLINE]

Conflict of interest statement: The authors declared no conflicts of interest.


2528. Acad Radiol. 2022 Apr;29(4):576-583. doi: 10.1016/j.acra.2021.11.015. Epub 2021 
Nov 24.

The Impact of the COVID-19 Pandemic on Radiology Resident Education: Where Do We 
Go From Here?

Patil NS(1), Gunter D(2), Larocque N(3).

Author information:
(1)Michael G Degroote School of Medicine, McMaster University, Hamilton, ON, 
Canada. Electronic address: patiln@mcmaster.ca.
(2)University College Cork School of Medicine, Cork, Ireland.
(3)Department of Diagnostic Imaging, Hamilton General Hospital, Hamilton Health 
Sciences, McMaster University, Hamilton, ON, Canada.

The Coronavirus Disease of 2019 (COVID-19) pandemic caused a dramatic shift in 
radiology resident education. Primarily, physical distancing prompted a general 
transition to virtual learning. Common changes made by radiology residency 
programs included virtual rounds and readouts, the use of simulation technology, 
and case-based learning which utilized pedagogical approaches such as the 
flipped classroom for teaching residents. Virtual learning appears to be a 
suitable alternative to traditional, in-person learning, and may have a place 
post-pandemic as part of a blended curriculum with in-person and virtual 
components. The extent of disruption to radiology resident education varied 
based on the local impact of COVID-19 and the prevalence of redeployment, as did 
residents' mental health and wellbeing. Accessibility of mental health resources 
for residents was highlighted as an issue that programs need to address during 
these difficult times. Moreover, the pandemic resulted in unavoidable reductions 
in procedural exposure which programs mitigated through the use of simulation 
technologies and virtual learning resources. Professional development activities 
such as mentorship and career planning were also dramatically impacted by the 
pandemic and remains a challenge that programs need to consider moving forward 
post-pandemic. The purpose of this review is to outline the changes made to 
radiology resident education as a result of the COVID-19 pandemic and suggest 
what changes may be worthwhile to continue.

Copyright © 2021 The Association of University Radiologists. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.acra.2021.11.015
PMCID: PMC8610839
PMID: 35033451 [Indexed for MEDLINE]


2529. Child Abuse Negl. 2022 Aug;130(Pt 1):105457. doi: 10.1016/j.chiabu.2021.105457. 
Epub 2022 Jan 10.

Mental health & maltreatment risk of children with special educational needs 
during COVID-19.

Tso WWY(1), Chan KL(2), Lee TMC(3), Rao N(4), Lee SL(5), Jiang F(6), Chan 
SHS(5), Wong WHS(5), Wong RS(5), Tung KTS(5), Yam JC(7), Liu APY(5), Chua GT(5), 
Rosa Duque JS(5), Lam ALN(5), Yip KM(5), Leung LK(5), Wang Y(5), Sun J(8), Wang 
G(6), Chan GCF(5), Wong ICK(9), Ip P(10).

Author information:
(1)Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, 
The University of Hong Kong, Pokfulam, Hong Kong; State Key Laboratory of Brain 
and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong.
(2)Department of Applied Social Sciences, The Hong Kong Polytechnic University, 
Hong Kong. Electronic address: koling.chan@polyu.edu.hk.
(3)State Key Laboratory of Brain and Cognitive Sciences, The University of Hong 
Kong, Pokfulam, Hong Kong; Laboratory of Neuropsychology, The University of Hong 
Kong, Pokfulam, Hong Kong.
(4)Faculty of Education, The University of Hong Kong, Pokfulam, Hong Kong.
(5)Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, 
The University of Hong Kong, Pokfulam, Hong Kong.
(6)Department of Developmental and Behavioral Pediatrics, Pediatric 
Translational Medicine Institute, National Children's Medical Center-Shanghai 
Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 
Shanghai, China.
(7)Department of Ophthalmology and Visual Sciences, The Chinese University of 
Hong Kong, Hong Kong.
(8)Department of Early Childhood Education, The Education University of Hong 
Kong, Hong Kong.
(9)Centre for Safe Medication Practice and Research, Department of Pharmacology 
and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, 
Hong Kong; Research Department of Practice and Policy, University College London 
School of Pharmacy, London, United Kingdom.
(10)Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, 
The University of Hong Kong, Pokfulam, Hong Kong. Electronic address: 
patricip@hku.hk.

BACKGROUND: Children with special educational needs (SEN) are more vulnerable 
during the COVID-19 pandemic with risk of poor mental wellbeing and child 
maltreatment.
OBJECTIVE: To examine the impact of COVID-19 on the mental health of children 
with SEN and their maltreatment risk.
PARTICIPANTS AND SETTING: 417 children with SEN studying at special schools and 
25,427 children with typical development (TD) studying at mainstream schools 
completed an online survey in April 2020 in Hong Kong during school closures due 
to COVID-19.
METHOD: Emotional/behavioural difficulties, quality of life and parental stress 
of children with SEN were compared with typically developed children using mixed 
effect model. Linear regression analyses were performed to explore factors 
associated with child emotional/behavioural difficulties and parental stress 
during the pandemic. Chi-square test was performed to detect the differences in 
maltreatment risk before and during COVID-19.
RESULTS: Children with SEN had significantly poorer overall quality of life 
(68.05 vs 80.65, p < 0.01). 23.5% of children had at least one episode of severe 
physical assault and 1.9% experienced very severe physical assault during 
COVID-19. Rates of physical assault increased significantly (59.8% vs. 71.2% 
p < 0.001) while children with mental disorders had increased risk of severe 
physical assault comparing to those without mental disorders (RR = 1.58, 
ꭓ2 = 5.19 p = 0.023).
CONCLUSION: Children with SEN had poorer mental health than typically developed 
children during the COVID-19 pandemic. Maltreatment risk for children with SEN 
is higher in comparison to pre-COVID-19 era. Surveillance of child maltreatment, 
continuity of medical and rehabilitation care to support children with SEN are 
essential during a disease pandemic.

Copyright © 2021. Published by Elsevier Ltd.

DOI: 10.1016/j.chiabu.2021.105457
PMCID: PMC8743505
PMID: 35033372 [Indexed for MEDLINE]

Conflict of interest statement: None.


2530. J Gerontol B Psychol Sci Soc Sci. 2022 May 20;77(Suppl_1):S86-S97. doi: 
10.1093/geronb/gbac002.

The Changing Tides of Caregiving During the COVID-19 Pandemic: How Decreasing 
and Increasing Care Provision Relates to Caregiver Well-Being.

Leggett A(1), Koo HJ(1), Park B(2), Choi H(2).

Author information:
(1)Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.
(2)Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, 
USA.

OBJECTIVES: Pandemic-specific changes to the caregiving context (e.g., attempts 
to reduce exposure, physical distancing requirements) may lead to changes in 
care provision. This study uses the 2020 National Health and Aging Trends Study 
Family Members and Friends coronavirus disease 2019 (COVID-19) questionnaire to 
explore changes in the amount of care provision during COVID-19 and associations 
with stress process outcomes of caregiving.
METHODS: The sample includes 1,020 caregivers who provided care for an older 
adult during COVID-19. Caregivers indicated whether their hours of care 
decreased, stayed stable, or increased during the pandemic. We describe reasons 
for change in care and compare changes in care by demographic and care-related 
characteristics using chi-squares and analyses of variance, and relate changes 
in care with stress process outcomes (e.g., overload, COVID-related anxiety) 
using multivariable linear regression.
RESULTS: Caregivers were 60.7 years old on average, 69.3% were female, and 18.6% 
were non-White. While most caregivers reported no change, 30.5% reported an 
increase and 11.5% reported a decrease in the amount of pandemic care provided. 
Relative to maintaining stable care provision, an increase was associated 
broadly with worse mental health and care-related stress, whereas a decrease was 
associated with greater emotional difficulty related to care and lower levels of 
positive affectivity.
DISCUSSION: Those who changed their care provision during the pandemic 
predominantly did so to protect their care recipient from COVID-19 exposure. 
Increasing one's care provision was strongly associated with worse mental health 
and well-being. Supports for caregivers who take on additional care tasks during 
the pandemic could have great public health benefit.

© The Author(s) 2022. Published by Oxford University Press on behalf of The 
Gerontological Society of America. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/geronb/gbac002
PMCID: PMC9122649
PMID: 35032387 [Indexed for MEDLINE]


2531. Community Ment Health J. 2022 Oct;58(7):1297-1309. doi: 
10.1007/s10597-021-00932-4. Epub 2022 Jan 15.

The Impact of the COVID-19 Pandemic on Those Supported in the Community with 
Long-Term Mental Health Problems: A Qualitative Analysis of Power, Threat, 
Meaning and Survival.

Leeming D(1), Lucock M(2), Shibazaki K(2), Pilkington N(2), Scott B(2).

Author information:
(1)School of Human and Health Sciences, University of Huddersfield, Queensgate, 
Huddersfield, HD1 3DH, UK. d.leeming@hud.ac.uk.
(2)School of Human and Health Sciences, University of Huddersfield, Queensgate, 
Huddersfield, HD1 3DH, UK.

Research suggests that the COVID-19 pandemic has had a significant impact on 
those already living with mental health problems, though there is also evidence 
of resilience. However, to date there has been limited in-depth qualitative 
investigation. We interviewed 15 people living with long-term mental health 
problems who, before the pandemic, were being supported by third sector 
organisations, to explore how they experienced lockdowns and accessing services 
remotely. Template analysis was informed by the Power Threat Meaning Framework 
and suggested that participants experienced significant threats to their mental 
wellbeing and recovery which were exacerbated by current or previous 
powerlessness and inequality. Although participants described positive coping 
strategies, several described a return of unhelpful behaviours that had 
contributed to the original difficulties. The findings illustrate the wider 
contributions of social and economic context to mental health problems and the 
importance of ensuring that people do not feel abandoned and are proactively 
supported.

© 2022. The Author(s).

DOI: 10.1007/s10597-021-00932-4
PMCID: PMC8760583
PMID: 35032283 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
declare that are relevant to the content of this article.


2532. Am J Crit Care. 2022 Mar 1;31(2):104-110. doi: 10.4037/ajcc2022633.

Effects of Safety Zone Implementation on Perceptions of Safety and Well-being 
When Caring for COVID-19 Patients.

Skinner C(1), Ablir L(2), Bloom T(3), Fujimoto S(4), Rozenfeld Y(5), Leung P(6).

Author information:
(1)Claudia Skinner is director of clinical excellence, St Jude Medical Center, 
Fullerton, California.
(2)Lilian Ablir is an infection prevention RN specialist, St Jude Medical 
Center.
(3)Todd Bloom is an infection preventionist specialist, St Jude Medical Center.
(4)Stacie Fujimoto is an infection prevention RN specialist, St Jude Medical 
Center.
(5)Yelena Rozenfeld is director of advanced analytics and data science, St Jude 
Medical Center.
(6)Peggy Leung is an infection prevention RN specialist, St Jude Medical Center.

BACKGROUND: In March 2020, the caseload of patients positive for COVID-19 in 
hospitals began increasing rapidly, creating fear and anxiety among health care 
workers and concern about supplies of personal protective equipment.
OBJECTIVES: To determine if implementing safety zones improves the perceptions 
of safety, well-being, workflow, and teamwork among hospital staff caring for 
patients during a pandemic.
METHODS: A safety zone process was implemented to designate levels of 
contamination risk and appropriate activities for certain areas. Zones were 
designated as hot (highest risk), warm (moderate risk), or cold (lowest risk). 
Caregivers working in the safety zones were invited to complete a survey 
regarding their perceptions of safety, caregiver well-being, workflow, and 
teamwork. Each question was asked twice to obtain caregiver opinions for the 
periods before and after implementation of the zones.
RESULTS: Significant improvements were seen in perceptions of caregiver safety 
(P < .001) and collaboration within a multidisciplinary staff (P < .001). 
Significant reductions in perceived staff fatigue (P = .03), perceived cross 
contamination (P < .001), anxiety (P < .001), and fear of exposure (P < .001) 
were also seen. Teamwork (P = .23) and workflow (P = .69) were not significantly 
affected.
CONCLUSIONS: Safety zone implementation improved caregivers' perceptions of 
their safety, their well-being, and collaboration within the multidisciplinary 
staff but did not improve their perceptions of teamwork or workflow.

©2022 American Association of Critical-Care Nurses.

DOI: 10.4037/ajcc2022633
PMID: 35028660 [Indexed for MEDLINE]


2533. Nurs Res. 2022 Jul-Aug 01;71(4):257-265. doi: 10.1097/NNR.0000000000000576. Epub 
2022 Jan 13.

Lifestyle Behaviors and Parents' Mental Well-Being Among Low-Income Families 
During COVID-19 Pandemic.

Robbins LB, Ling J.

BACKGROUND: The coronavirus 2019 (COVID-19) pandemic has negatively altered many 
families' lifestyles and the mental well-being of parents, especially those who 
have a low income and young children. To improve low-income parents' mental 
well-being, especially during a pandemic, understanding parents' and children's 
lifestyle behaviors and the relationship between their lifestyle behaviors and 
parents' mental well-being is essential.
OBJECTIVE: This cross-sectional study examined relationships between lifestyle 
behaviors (sleep, physical activity, screen time, and eating behavior of parents 
and children) and low-income parents' well-being (stress, anxiety, and 
depression) during COVID-19.
METHODS: Parents were recruited from two Michigan Head Start organizations as 
well as across the United States; 408 parents completed an online survey. 
Demographic characteristics were assessed, along with parents' sleep, physical 
activity, screen time, and dietary intake; stress, anxiety, and depression were 
also examined. Children's sleep time, physical activity, screen time, and 
fruit/vegetable intake were assessed. Descriptive statistics, correlations, and 
the multivariate general linear model procedure were used.
RESULTS: Approximately 69.4% of parents reported moderate stress levels, and 
17.2% reported high levels. Most parents had sleep disturbances, attained 
minimal physical activity, and consumed <5 fruits/vegetables per day; average 
screen time was >2 hours per day. Only 41% of preschoolers were active 7 days a 
week and slept ≥10 hours per day. Two thirds had >2 hours per day of screen 
time, and less than one fifth consumed ≥5 fruits/vegetables per day. After 
adjusting for parents' demographics and children's lifestyle behaviors, parents' 
sleep disturbance was positively correlated with their levels of stress, 
anxiety, and depression. After controlling for parents' demographics and 
lifestyle behaviors, child sleep time was negatively associated with parents' 
stress levels. Family demographics and parents' and children's lifestyle 
behaviors explained 33.4%, 29.8%, and 28.1% of the variances in parents' stress, 
anxiety, and depression, respectively.
DISCUSSION: Most parents and preschoolers were not meeting many lifestyle 
behavior recommendations, indicating a need for interventions. Improving 
parents' sleep quality and reducing bedtime challenges involving their 
preschoolers may be necessary for enhancing parental mental well-being.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/NNR.0000000000000576
PMCID: PMC9232248
PMID: 35026803 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
report.


2534. J Am Coll Health. 2024 Jan;72(1):1-3. doi: 10.1080/07448481.2022.2026362. Epub 
2022 Jan 13.

Reflections from the peer-supported writing and wellbeing program, Write Smarter 
Feel Better.

Fox-Harding C(1)(2), Carew M(3), Harrington K(4).

Author information:
(1)School of Medical and Health Sciences, Edith Cowan University, Perth, 
Australia.
(2)Exercise Medicine Research Institute, Edith Cowan University, Perth, 
Australia.
(3)The Florey Institute of Neuroscience and Mental Health, Parkville, Australia.
(4)Center for Healthy Aging, The Pennsylvania State University, University Park, 
PA, USA.

PURPOSE: This paper aims to provide an overview of a peer-supported writing and 
wellbeing pilot program for higher degree by research (HDR) students in 
Australia. It proposes a six-month program is a beneficial service to HDR 
students that improves not only their productivity and writing confidence but 
assists with their perceived mental wellbeing as well.
DESIGN/METHODOLOGY/APPROACH: This paper offers a perspective of the piloted 
writing and wellbeing program for HDR students during the recovery period during 
the COVID-19 global pandemic. It includes generalized reflections of 
participation, content, and structure alongside future directions and further 
implementation.
FINDINGS: This research includes generalized, anonymous data regarding the 
success of the writing and wellbeing pilot program for HDR students and 
components to improve upon. It suggests that the overwhelming response from 
participants was positive, especially during various COVID-19 related lockdowns 
and travel restriction measures.
RESEARCH LIMITATIONS/IMPLICATIONS: As this paper involves a small cohort of 
preliminary impressions from the pilot study, results will lack 
generalizability. Therefore, it is acknowledged that further research will ensue 
to examine the program further.
PRACTICAL IMPLICATIONS: The success, measured by adherence and wellbeing 
improvements, of the Write Smarter: Feel Better program can influence the way in 
which universities address and protect mental wellbeing of their HDR students.
ORIGINALITY/VALUE: This paper fulfills an identified and growing need for mental 
wellbeing to be strengthened among HDR students.

DOI: 10.1080/07448481.2022.2026362
PMCID: PMC9306019
PMID: 35025721 [Indexed for MEDLINE]

Conflict of interest statement: Declarations of Interest None


2535. Wiad Lek. 2021;74(11 cz 1):2723-2727.

COVID-19 PANDEMIC LIFESTYLE: STUDENTS MENTAL HEALTH CHALLENGES.

Boiko II(1), Herus OI(1), Klymanska LD(1), Savka VY(1), Klos LY(1), Shkoliar 
MV(1), Vitale V(2).

Author information:
(1)LVIV POLYTECHNIC NATIONAL UNIVERSITY, LVIV, UKRAINE.
(2)ROMA TRE UNIVERSITY, ROME, ITALY.

OBJECTIVE: The aim: To determine how quarantine restrictions affect the 
lifestyle of Ukrainian students, and their mental health.
PATIENTS AND METHODS: Materials and methods: 37 student essays were submitted to 
the university contest held at Lviv Polytechnic University in May-June 2020. 
They were analyzed with the help of qualitative thematic analysis and standard 
qualitative analysis method. Essays are focused on a list of issues important 
for assessing the social well-being of students during quarantine. Each fragment 
of essay's answer was coded into the data matrix system according to either 
multiple or single themes, built in the statements. The thematic analysis 
identified several categories that determine students' attitude to the pandemic 
situation and its consequences for them.
RESULTS: Results: It is determined that students' lifestyle, including study and 
leisure, has changed significantly, which has affected their mental health. 
Learning online provoked a number of emotional disorders. At the same time, the 
desire for communication in person and self-improvement increased. «Quarantine 
lessons» were divided into categories: challenges, threats and opportunities. 
Threats and challenges were considered at the global level, while opportunities 
affected rather the personal level.
CONCLUSION: Conclusions: Mental health of students disorders: anxiety, 
restlessness, fear, self-doubt, feelings of loneliness, panic, sleep 
disturbances, and increased fatigue indicate the negative effects of the 
pandemic. At the same time, recording such facts as the feeling of satisfaction 
from communication with loved ones, the ability to help them, the desire for 
self-improvement, etc. allows to say about the positive effects.

PMID: 35023482 [Indexed for MEDLINE]


2536. Vox Sang. 2022 May;117(5):685-692. doi: 10.1111/vox.13236. Epub 2022 Jan 12.

Psychological impact of the COVID-19 pandemic on young professionals in blood 
banks and transfusion services: A global cross-sectional survey.

Al-Riyami AZ(1), Masser B(2), Herczenik E(3), Arora S(4), Boateng LA(5), Dinardo 
CL(6), Hutchinson T(7), Ji Y(8), Langi Sasongko S(9), Tung JP(10), Panchatcharam 
SM(11); ISBT Young Professional Council.

Author information:
(1)Department of Haematology, Sultan Qaboos University Hospital, Muscat, Oman.
(2)Australian Red Cross Lifeblood Chair in Donor Research, School of Psychology, 
The University of Queensland, St Lucia, Queenland, Australia.
(3)ISBT Central Office, Amsterdam, The Netherlands.
(4)Department of Transfusion Medicine, Super Speciality Paediatric Hospital and 
Post Graduate Teaching Institute, Noida, India.
(5)Department of Medical Diagnostics, Kwame Nkrumah University of Science and 
Technology, Kumasi, Ghana.
(6)Immunohaematology Division, Fundação Pró-Sangue, São Paulo, Brazil.
(7)Freenome, South San Francisco, California, USA.
(8)Institute of Clinical Blood Transfusion, Guangzhou Blood Centre, Guangzhou, 
China.
(9)Department of Donor Medicine Research, Sanquin Research, Amsterdam, the 
Netherlands.
(10)Research and Development, Australian Red Cross Lifeblood, Brisbane, 
Queensland, Australia.
(11)Research & Studies Section, Medical Simulation and Innovation Centre, Oman 
Medical Speciality Board, Muscat, Oman.

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic brought about changes to daily 
life as measures to contain the spread of the virus increased across the world. 
The aim of this survey was to assess the psychological impact of the pandemic on 
young professionals (YPs) in transfusion medicine.
MATERIALS AND METHODS: A cross-sectional web-based survey was distributed 
electronically to ISBT members inviting YPs (≤40 years) to participate. 
Statistical analysis was performed using SPSS software.
RESULTS: Two hundred and fifty-nine YPs completed the survey, including 107 
clinicians/physicians and/or nurses. Almost half of the YPs (52.5%) indicated 
increased stress levels and 15.4% indicated symptoms of depression. YPs 
highlighted the loss of social engagement (59.1%) and increased pressure from 
information seen on media (35.5%) as factors negatively impacting their 
psychological wellbeing. Further, 20.8% expressed increased economic stress 
resulting from concerns about job security. Almost half of the YPs indicated 
that their organization provided moderate/occasional holistic support to them 
and their families. Sixty percent and 74.4% of YPs reported increased workload 
and staff absence due to COVID-19 infection, respectively. Only half of 
clinicians/physicians and/or nurses indicated that they often had sufficient 
personal protective equipment. The majority of these (76.6%) had 
family/household members living with them, and 61% indicated that they were 
significantly worried about infecting them because of the nature of their work.
CONCLUSION: COVID-19 had a major impact on the well-being of YPs working in 
transfusion medicine. Measures are required to ensure that YPs are protected and 
mentally supported while undertaking their duties in current and future 
pandemics.

© 2022 International Society of Blood Transfusion.

DOI: 10.1111/vox.13236
PMID: 35023178 [Indexed for MEDLINE]


2537. Spinal Cord Ser Cases. 2022 Jan 12;8(1):2. doi: 10.1038/s41394-021-00470-x.

Perception of the COVID-19 pandemic among people with spinal cord injury: an 
Italian survey.

Righi G(1), Baroni E(2), Righi L(3), Belloni L(2), Del Popolo G(4).

Author information:
(1)Spinal Unit, Careggi University Hospital, Florence, Italy. 
righiga@aou-careggi.toscana.it.
(2)Regional Center for Critical Relationships, Careggi University Hospital, 
Florence, Italy.
(3)Clinical Trial Center, Careggi University Hospital, Florence, Italy.
(4)Spinal Unit, Careggi University Hospital, Florence, Italy.

STUDY DESIGN: An observational study based on an online survey to explore if the 
participant had experienced (1) cancellation or delay of scheduled health 
services (2) reduction of assistance provided by a caregiver (3) barriers to 
social participation and recreational activities. Three validated questionnaires 
to investigate well-being and symptoms of anxiety and depression were also 
administered.
OBJECTIVES: Our main aim was to quantify the obstacles experienced by adults 
living with SCI in Italy during COVID-19 pandemic, to explore the presence of 
depression and anxiety symptoms and to quantify subjective well-being.
SETTING: Outpatient clinic of a Spinal Unit in Italy.
METHODS: Online survey via direct contact and by e-mail lists.
RESULTS: In total, 101 individuals completed the survey. Of, 82.2% participants 
reported a history of deferment or cancellation of non-COVID-19 health services. 
The majority (56.4%) revealed that, at least seldom, they have chosen to reduce 
their usual everyday activities and more than one third (37.6%) affirmed that 
they had been forced to renounce to one or more of their occupations. 
Discontinuation of assistance by caregivers was uncommon. The median score of 
questionnaires measuring depression and anxiety symptoms do not differ 
significatively when compared with prior studies. The variable that explored the 
limitations experienced in everyday activities showed a significant correlation 
with the results of the questionnaires measuring well-being and symptoms of 
anxiety.
CONCLUSIONS: We believe that our results could contribute to the discussion 
ongoing inside our community on how to answer to the new challenges of this 
pandemic period and of the post-pandemic future.

© 2022. The Author(s), under exclusive licence to International Spinal Cord 
Society.

DOI: 10.1038/s41394-021-00470-x
PMCID: PMC8753331
PMID: 35022388 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


2538. PLoS One. 2022 Jan 12;17(1):e0262562. doi: 10.1371/journal.pone.0262562. 
eCollection 2022.

The mental health of university students during the COVID-19 pandemic: An online 
survey in the UK.

Chen T(1), Lucock M(2).

Author information:
(1)Department of Computer Science, School of Computing and Engineering, 
University of Huddersfield, Huddersfield, West Yorkshire, United Kingdom.
(2)Centre for Applied Research in Health, School of Human and Health Sciences, 
University of Huddersfield, Huddersfield, West Yorkshire, United Kingdom.

Higher education students' mental health has been a growing concern in recent 
years even before the COVID-19 pandemic. The stresses and restrictions 
associated with the pandemic have put university students at greater risk of 
developing mental health issues, which may significantly impair their academic 
success, social interactions and their future career and personal opportunities. 
This paper aimed to understand the mental health status of University students 
at an early stage in the pandemic and to investigate factors associated with 
higher levels of distress. An online survey including demographics, 
lifestyle/living situations, brief mental well-being history, questions relating 
to COVID-19 and standardised measures of depression, anxiety, resilience and 
quality of life was completed by 1173 students at one University in the North of 
England. We found high levels of anxiety and depression, with more than 50% 
experiencing levels above the clinical cut offs, and females scoring 
significantly higher than males. The survey also suggested relatively low levels 
of resilience which we attribute to restrictions and isolation which reduced the 
opportunities to engage in helpful coping strategies and activities rather than 
enduring personality characteristics. Higher levels of distress were associated 
with lower levels of exercising, higher levels of tobacco use, and a number of 
life events associated with the pandemic and lockdown, such as cancelled events, 
worsening in personal relationships and financial concerns. We discuss the 
importance of longer-term monitoring and mental health support for university 
students.

DOI: 10.1371/journal.pone.0262562
PMCID: PMC8754313
PMID: 35020758 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2539. J Adv Nurs. 2022 Mar;78(3):e52-e61. doi: 10.1111/jan.15134. Epub 2022 Jan 12.

A call for nurses and interdisciplinary collaborators to urgently respond to the 
health and well-being needs of refugees across the world.

Wilson RL(1)(2), Atem JM(1), Gumuskaya O(1), Lavadas M(3), Šošić B(4), Urek 
M(5).

Author information:
(1)School of Nursing and Midwifery, University of Newcastle, Callaghan, New 
South Wales, Australia.
(2)College of Health, Massey University, Palmerston North, New Zealand.
(3)Society and Workplace Diversity Research Group, Bergen University, Bergen, 
Norway.
(4)Board for Psychiatric and Neurological Research, Department of Medical 
Sciences, Academy of Sciences and Arts of Bosnia and Herzegovina, Sarajevo, 
Bosnia and Herzegovina.
(5)Faculty of Social Work, University of Ljubljana, Ljubljana, Slovenia.

The COVID-19 pandemic is compounding the distress of millions of refugees (made 
up of displaced persons, forced migrants, refugees and asylum seekers) 
throughout the world. This discursive paper pitches a challenge for the global 
nursing profession, within the multidisciplinary context, to consider its 
collective agency in responding to the health and well-being needs of a priority 
portion of the global population. Nursing leaders are encouraged to renew their 
commitment to the International Council of Nurses' Code of Ethics and consider 
the role of their profession in assisting global refugees, because the extent of 
present need has become an escalating major global humanitarian crisis. The 
nursing profession comprises half the world's healthcare workforce. The World 
Health Organization considers that nurses play a fundamental role in ensuring 
access to universal healthcare as a basic human right, addressing the global 
need for health promotion care, disease prevention and primary and community 
healthcare (International Council of Nurses, The ICN code of ethics for nurses; 
2012). It is a human right to seek asylum from persecution, and in doing so, 
people should not be subjected to cruel, inhumane or degrading treatment or 
circumstances. Nurses are increasingly interested in fostering a healthy and 
adaptive environment in which people can thrive, despite personal, political, 
emotional, physical or social adversity. Nursing care is indispensable for the 
easement of human distress and for the promotion of comfort and coping. Nurses 
have an essential role in advocating for policies that will enhance immigrants' 
access to health/mental health services and address barriers irrespective of 
migrant/refugee/asylum seeker status. These are challenging times as the world 
responds to the pandemic crisis, and nurses are called to rise to global and 
local leadership roles and join with other health and social care colleagues in 
addressing the universal human health, social and political crisis of our time. 
The global nursing collective must come to terms with the need to initiate 
additional compelling ways to improve and integrate health and social care 
processes so that nursing care, mental health and social care augment a holistic 
achievement of appropriate care for refugees.

© 2022 John Wiley & Sons Ltd.

DOI: 10.1111/jan.15134
PMID: 35020230 [Indexed for MEDLINE]


2540. J Obstet Gynaecol. 2022 Jul;42(5):1455-1460. doi: 10.1080/01443615.2021.2002286. 
Epub 2022 Jan 12.

The effect of the measures taken during the coronavirus pandemic on specialty 
trainees in obstetrics and gynaecology in the United Kingdom: an online 
questionnaire survey in one region.

Elghobashy M(1), Stout A(2), Hatti A(3), Smotra G(4), El-Ghobashy A(2).

Author information:
(1)College of Medical and Dental Sciences, University of Birmingham Medical 
School, Birmingham, UK.
(2)Department of Gynaecological Oncology, The Royal Wolverhampton NHS Trust, 
Wolverhampton, UK.
(3)Department of Obstetrics and Gynaecology, Walsall Manor Hospital, Walsall, 
UK.
(4)Department of Obstetrics and Gynaecology, The Shrewsbury and Telford Hospital 
NHS Trust, Shrewsbury, UK.

The coronavirus pandemic (COVID-19) has had unprecedented effects on healthcare 
delivery. A 34-question online survey was sent to obstetrics and gynaecology 
trainees within the West Midlands to assess the impact of the pandemic on 
training, working practices and well-being. 101 responses were received from 
obstetrics and gynaecology trainees. Trainees reported a significant reduction 
in both elective and emergency surgeries as well as outpatient clinics. Over one 
third of respondents felt additional training time may be required following 
reduction of clinical opportunities. 44% of trainees felt their workload 
increased significantly. 55% of trainees felt the pandemic had a significant 
negative impact on their physical and mental well-being. Obstetrics and 
gynaecology trainees in the West Midlands have adapted to the challenges of the 
COVID-19 pandemic despite significant impact on their training, working 
practices and wellbeing. It is important to tailor training to improve trainees' 
education and combat lost training time during the pandemic. This should be 
considered for long-term shaping of the obstetrics and gynaecology training 
pathway.IMPACT STATEMENTWhat is already known on this subject? Little research 
is available about the impact of the COVID-19 pandemic on obstetrics and 
gynaecology trainees. This is the first study of its kind to assess the effect 
of the pandemic on obstetrics ang gynaecology trainees in the United 
Kingdom.What do the results of this study add? The results of this study have 
shown that obstetrics and gynaecology training has been heavily affected during 
the COVID-19 pandemic. There have been significant impacts on their training, 
working patterns and physical and mental wellbeing.What are the implications of 
these findings for clinical practice and/or further research? These findings can 
be used to mould the obstetrics and gynaecology training pathway based on the 
feedback given by the trainees during the pandemic. The survey questions can 
also be utilised as a framework for similar research projects across the United 
Kingdom Deaneries, among other specialties and around the world.

DOI: 10.1080/01443615.2021.2002286
PMID: 35019818 [Indexed for MEDLINE]


2541. Laryngorhinootologie. 2022 Oct;101(10):797-804. doi: 10.1055/a-1727-6012. Epub 
2022 Jan 11.

[Vocal tract discomfort and wellbeing of caregivers for the elderly during the 
pandemic].

[Article in German; Abstract available in German from the publisher]

Schuster M(1)(2), Deitmerg U(3), Gantner S(1).

Author information:
(1)Klinik für Hals-Nasen-Ohrenheilkunde, Kopf-Hals-Chirurgie, 
Ludwig-Maximilians-Universität München, München, Germany.
(2)Praxis für Hals-Nasen-Ohrenheilkunde, Phoniatrie und Pädaudiologie, 
Nuremberg, Germany.
(3)NürnbergStift, Stadt Nürnberg, Nürnberg, Germany.

BACKGROUND: During the SARS-CoV2-pandemic, people working in healthcare such as 
caregives for the elderly face additional burden, e.g. by the use of face masks.
METHODS: In a prospective study, the emotional and physical wellbeing as well as 
the vocal tract discomfort of caregivers of two municipal homes for the elderly 
were assessed by questionnaires, the Mini-SCL and the Vocal Tract Discomfort 
Scale (VTDS), and one on personal data (sex, age, lung disease, previous 
SARS-CoV2-infection) and on voice symptoms.
RESULTS: 67% of the questionnaires were answered by 56 women and 11 men aged 
45.2 ± 11.5. In the Mini-SCL, increased scores were found in depression in 
23.8%, anxiety in 49.3%, somatization in 55.2% and in the global score in 44.7%. 
52% showed increased scores in the VTDS. Significant correlations were found in 
between the subscales of the Mini-SCL and the VTDS as well as to dysphonia 
symptoms.
DISCUSSION: Psychological problems, somatization and vocal tract discomfort is 
more frequently reported by caregivers for the elderly than in the normal 
population. The VTDS, voice symptoms and the Mini-SCL scales are significantly 
related. Training on vocal hygiene should be included in workplace health 
promotion during the pandemic.

Publisher: Die SARS-CoV-2-Pandemie bedeutet für Berufstätige im Gesundheitswesen 
eine besondere Belastung in mehreren Bereichen, u.a. durch das Tragen einer 
Mund-Nasen-Bedeckung und damit veränderter Kommunikation. In einer prospektiven 
Studie wurde die Belastung des Vokaltrakts und das psychisch-körperliche 
Wohlbefinden hier am Beispiel von Tätigen in der Altenpflege mittels Fragebogen 
erfasst.
METHODEN: In 2 Altenpflegeeinrichtungen wurden die standardisierten Fragebogen 
Symptom-Checkliste 90 in der Kurzversion (Mini-SCL) und die Vocal Tract 
Discomfort Scale (VTDS) in deutscher Übersetzung eingesetzt, kombiniert mit 
Fragen zu Alter, Komorbidität, Stimme und bereits erfolgter 
SARS-CoV-2-Infektion.
ERGEBNIS: Bei einer Rückmeldung von 67 von 100 ausgeteilten Fragebogen zeigten 
sich bei den teilnehmenden Mitarbeitern (56 Frauen und 11 Männer, 45,2 ± 11,5 
Jahre alt) erhöhte Werte für beide Fragebogen. Im Mini-SCL wiesen in der Skala 
Depressivität 23,8% erhöhte Werte auf, in der Skala Ängstlichkeit 49,3%, in der 
Skala Somatisierung 55,2% und in der Gesamtskala 44,7%. Bei 52% der Teilnehmer 
ergaben sich erhöhte Werte im VTDS. Zwischen dem VTDS und den Einzelskalen des 
Mini-SCL sowie zu Stimmbeschwerden bestand jeweils ein signifikanter 
Zusammenhang.
DISKUSSION: In der Altenpflege Tätige leiden während der Pandemie vermehrt unter 
psychischen und physischen Beschwerden. Es bestehen Zusammenhänge zwischen 
Missempfindungen im Vokaltrakt und Stimmsymptomen sowie dem emotionalen und 
körperlichen Wohlbefinden. Stimmhygienische Schulungen können bei den aktuell 
erhöhten kommunikativen Anforderungen hilfreich sein.

Thieme. All rights reserved.

DOI: 10.1055/a-1727-6012
PMID: 35016249 [Indexed for MEDLINE]

Conflict of interest statement: Die Autorinnen/Autoren geben an, dass kein 
Interessenkonflikt besteht.


2542. Mult Scler Relat Disord. 2022 Feb;58:103482. doi: 10.1016/j.msard.2021.103482. 
Epub 2022 Jan 4.

Worsening physical functioning in patients with neuroinflammatory disease during 
the COVID-19 pandemic.

Levit E(1), Cohen I(1), Dahl M(2), Edwards K(3), Weinstock-Guttman B(4), 
Ishikawa T(5), Kavak K(4), Leavitt V(6), Nelson K(6), Onomichi K(6), Bar-Or 
A(7), Perrone C(7), Riley C(6), Venkatesh S(2), De Jager PL(6), Xia Z(2), 
Longbrake EE(8); Multiple Sclerosis Resilience to COVID-19 (MSReCOV) 
Collaborative.

Author information:
(1)Department of Neurology, Yale University, New Haven, CT, United States.
(2)Department of Neurology, University of Pittsburgh, Pittsburgh PA, United 
States.
(3)MS Center of Northeastern NY, Latham NY, United States.
(4)Jacobs MS Center at the University of Buffalo, Buffalo NY, United States.
(5)School of Public Health, Yale University, New Haven CT, United States.
(6)Columbia Multiple Sclerosis Center, Center for Translational & Computational 
Neuroimmunology, Department of Neurology, New York NY, United States.
(7)Center for Neuroinflammation and Experimental Therapeutics and Division of MS 
and Related Disorders, University of Pennsylvania, Philadelphia, PA, United 
States.
(8)Department of Neurology, Yale University, New Haven, CT, United States. 
Electronic address: erin.longbrake@yale.edu.

OBJECTIVE: To quantify changes in psychological wellbeing and physical function 
as reported by people with neurological inflammatory disease (PwNID) during the 
COVID-19 pandemic.
METHODS: 1134 PwNID and 868 control participants were recruited through five 
major academic medical centers in the Northeast/Mid-Atlantic U.S. beginning in 
April 2020. Participants completed serial surveys throughout the COVID-19 
pandemic that aimed to quantify mood symptoms and physical function, analyzed 
cross-sectionally with a smaller cohort analyzed longitudinally.
RESULTS: Throughout the pandemic, depression scores were not significantly 
different between PwNID and controls, although a higher proportion of PwNID 
reported clinically significant depression at study entry. Depression scores did 
not worsen over time for either group. Loneliness was the strongest predictor of 
worse depression, along with older age, male gender in both PwNID and controls, 
as well as lack of disease modifying therapy use, and disease duration in PwNID 
only. In contrast, physical disability worsened significantly over time for both 
PwNID and controls. Age, DMT status and comorbid health conditions emerged as 
significant predictors of physical function.
CONCLUSIONS: Depressive symptoms remained consistent for both PwNID and controls 
throughout the COVID-19 pandemic, but physical function worsened significantly 
over time for both groups. This is particularly impactful for PwNID, who have 
higher baseline levels of physical disability, and underscores the importance of 
reinstituting services and interventions that facilitate exercise and 
reconditioning for this population.

Copyright © 2022 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.msard.2021.103482
PMCID: PMC8742609
PMID: 35016114 [Indexed for MEDLINE]


2543. Health Soc Care Community. 2022 Sep;30(5):e2590-e2603. doi: 10.1111/hsc.13703. 
Epub 2022 Jan 11.

Falls in people post-Guillain-Barré syndrome in the United Kingdom: A national 
cross-sectional survey of community based adults.

Davidson I(1), Parker ZJ(2).

Author information:
(1)Department of Health Professionals, Manchester Metropolitan University, 
Manchester, UK.
(2)Department of Psychology, Staffordshire University, Stoke-on-Trent, UK.

Guillain-Barré syndrome (GBS) has several enduring effects that can lead to 
further harm and/or lower quality of life. These effects include falling and 
body pain, neither of which have been fully explored. This study aims to examine 
the risk factors associated with falling and potential causes of body pain in a 
post-GBS population. A cross-sectional survey of 216 participants was conducted 
using an electronic questionnaire that included. Self-report measures for: 
overall health, balance, anxiety and depression levels, body pain and 
demographics related to GBS experience and falls. A large proportion of 
individuals post-GBS experience ongoing problems beyond those expected with 
ageing. Comparative tests indicated that people reporting falls in the previous 
12 months had: poorer levels of mobility, poorer F-scores, higher levels of body 
pain, poorer balance, poorer anxiety and depression scores and higher levels of 
fatigue. Gender did not appear to contribute to falls. Injuries following falls 
were associated with a lack of physiotherapy postdischarge and time since GBS. 
In a regression analysis of the identified and expected key variables, age and 
body pain statistically predicted falls. In over a quarter of cases reported 
here, respondents did not receive community physiotherapy following hospital 
discharge. In the midst and aftermath of COVID-19, provision of rehabilitation 
needs to be recalibrated, not just for COVID patients, but the wider community 
with ongoing needs. Issues around well-being and quality of life in the post-GBS 
community also need further consideration.

© 2022 The Authors. Health and Social Care in the Community published by John 
Wiley & Sons Ltd.

DOI: 10.1111/hsc.13703
PMCID: PMC9546005
PMID: 35015326 [Indexed for MEDLINE]

Conflict of interest statement: None.


2544. Nutrients. 2021 Dec 30;14(1):161. doi: 10.3390/nu14010161.

Food Security, Financial Resources, and Mental Health: Evidence during the 
COVID-19 Pandemic.

Yenerall J(1), Jensen K(1).

Author information:
(1)Department of Agricultural and Resource Economics, University of Tennessee, 
302 Morgan Hall, 2621 Morgan Circle, Knoxville, TN 37996, USA.

COVID-19 has negatively impacted many households' financial well-being, food 
security, and mental health status. This paper investigates the role financial 
resources play in understanding the relationship between food security and 
mental health among U.S. households using data from a survey in June 2020. 
Results show job loss and savings draw down to pay for household bills had a 
significant relationship with both lower food security and greater numbers of 
poor mental health days during the pandemic.

DOI: 10.3390/nu14010161
PMCID: PMC8746951
PMID: 35011036 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript, or in the decision to 
publish the results.


2545. Int J Environ Res Public Health. 2022 Jan 5;19(1):568. doi: 
10.3390/ijerph19010568.

Qualitative Investigation into the Mental Health of Healthcare Workers in Japan 
during the COVID-19 Pandemic.

Kotera Y(1), Ozaki A(2)(3), Miyatake H(4), Tsunetoshi C(5), Nishikawa Y(6), 
Kosaka M(4), Tanimoto T(3).

Author information:
(1)School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK.
(2)Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki 
972-8322, Japan.
(3)Medical Governance Research Institute, Tokyo 108-0074, Japan.
(4)Orange Home-Care Clinic, Fukui 910-0018, Japan.
(5)Department of Community Health Nursing, University of Fukui, Fukui 910-1104, 
Japan.
(6)Department of Health Informatics, Kyoto University School of Public Health, 
Kyoto 606-8501, Japan.

The COVID-19 pandemic has negatively impacted the mental health of healthcare 
workers in many countries including Japan. While many survey-based findings have 
reported the serious state of their wellbeing among healthcare workers, the 
first-hand experience of the mental health and coping in this population remains 
to be evaluated. Accordingly, this study aimed to appraise them using 
constructionist thematic analysis on semi-structured interviews attended by a 
purposive and snowball sample of 24 healthcare workers in Japan conducted in 
December 2020-January 2021. Four themes were identified: (1) increased stress 
and loneliness, (2) reduced coping strategies, (3) communication and 
acknowledgement as a mental health resource, and (4) understanding of self-care. 
Participants noted that the characteristics of Japanese work culture such as 
long hours, collectivism and hatarakigai (i.e., meaning in work) to explain 
these themes. These findings suggest that robust support at an organizational 
and individual level, capturing intrinsic values, are particularly important for 
this key workforce to cope with increased stress and loneliness, leading to 
better patient care.

DOI: 10.3390/ijerph19010568
PMCID: PMC8744919
PMID: 35010828 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2546. Int J Environ Res Public Health. 2022 Jan 4;19(1):519. doi: 
10.3390/ijerph19010519.

The Impact of Social Distancing Due to the COVID-19 Pandemic on People with 
Dementia, Family Carers and Healthcare Professionals: A Qualitative Study.

Smaling HJA(1), Tilburgs B(2), Achterberg WP(1), Visser M(1).

Author information:
(1)Department of Public Health and Primary Care, Leiden University Medical 
Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
(2)Department of Intensive Care Medicine, Radboud University Medical Center, 
Radboud Institute for Health Science, P.O. Box 9101, 6500 HB Nijmegen, The 
Netherlands.

Social distancing measures imposed because of the COVID-19 pandemic presented 
challenges to the health and wellbeing of people with dementia, family carers, 
and healthcare professionals. This study investigated the impact of these 
measures on all involved in the care for people with dementia. For this 
qualitative study, 20 family carers and 20 healthcare professionals from home 
care and long-term care (LTC) participated in a semi-structured interview. 
Interviews were analysed using an inductive thematic analysis approach. For 
people with dementia, the social distancing measures resulted in a deterioration 
of physical health. The impact on their emotional state and behaviour depended 
on the stage of dementia. Family carers experienced difficulty coping with 
visiting restrictions, anxiety regarding safety, and changes in carer burden. 
Healthcare professionals had an increased workload, and felt guilty about 
adhering to restrictive measures. Differences between home care and LTC were 
reported (i.e., societal initiatives focussed on LTC, scarcity of activities for 
community-dwelling people with dementia, use of personal protective equipment 
more intrusive for home care). The social distancing measures had a negative 
impact on persons with dementia, their family carers, and healthcare 
professionals. More attention is needed for community-dwelling people with 
dementia and family carers in times of social isolation.

DOI: 10.3390/ijerph19010519
PMCID: PMC8744737
PMID: 35010779 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2547. Int J Environ Res Public Health. 2021 Dec 31;19(1):421. doi: 
10.3390/ijerph19010421.

Mental Health Problems among COVID-19 Frontline Healthcare Workers and the Other 
Country-Level Epidemics: The Case of Mexico.

Robles R(1), Morales-Chainé S(2), Bosch A(2), Astudillo-García C(3), Feria M(1), 
Infante S(1), Alcocer-Castillejos N(4), Ascencio L(5), Real-Ramírez J(6), Díaz 
D(1), Gómez-Estrada HF(7), Becerra C(1), Escamilla R(1), López-Montoya A(2), 
Beristain-Aguirre A(2), Vega H(1), Álvarez-Icaza D(2), Rodríguez E(8), Durand 
S(1), Fresán A(1), Medina-Mora ME(1)(2), Fernández-Cáceres C(7), Madrigal de 
León EÁ(1).

Author information:
(1)Ramón de la Fuente Muñiz National Institute of Psychiatry, Ciudad de México 
14370, Mexico.
(2)Faculty of Psychology and General Directorate of Academic Personnel Affairs, 
National Autonomous University of Mexico, Ciudad de México 04510, Mexico.
(3)Psychiatric Care Services, Ministry of Health, Ciudad de México 11470, 
Mexico.
(4)Salvador Zubirán National Institute of Medical Sciences and Nutrition, Ciudad 
de México 14080, Mexico.
(5)Palliative Care Service, National Cancer Institute, Ciudad de México 14080, 
Mexico.
(6)Population Health Research Center, National Institute of Public Health, 
Ciudad de México 14080, Mexico.
(7)Centros de Integración Juvenil, Ciudad de México 03600, Mexico.
(8)Infectious Disease Research Center, National Institute of Respiratory 
Diseases, Ciudad de México 14080, Mexico.

COVID-19 frontline healthcare workers (FHCW) are struggling to cope with 
challenges that threaten their wellbeing. We examine the frequency and 
predictors of the most frequent mental health problems (MHP) among FHCW during 
the first COVID-19 peak in Mexico, one of the most severely affected countries 
in terms of FHCW's COVID-19 mortality. A cross-sectional survey was conducted 
between May 8 and August 18, 2020. A total of 47.5% of the sample (n = 2218) 
were FHCW. The most frequent MHP were insomnia, depression, posttraumatic stress 
symptoms, and health anxiety/somatization (whole sample: 45.7, 37.4, 33.9, and 
21.3%; FHCW: 52.4, 43.4, 40.3 and 26.1, respectively). As compared to during the 
initial COVID-19 phase, depression and health anxiety/somatization symptoms as 
well as experiences of grieving due to COVID-19, personal COVID-19 status, and 
having relatives and close friends with COVID-19 were more frequent during the 
COVID-19 peak. Obesity, domestic violence, personal COVID-19 status, and 
grieving because of COVID-19 were included in regression models for main FHCW's 
MHP during the COVID-19 peak. In conclusion, measures to decrease other 
country-level epidemics contributing to the likelihood of COVID-19 complications 
(obesity) and MHP (domestic violence) as well as FHCW´s probability of COVID-19 
infection could safeguard not only their physical but also mental health.

DOI: 10.3390/ijerph19010421
PMCID: PMC8744587
PMID: 35010679 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2548. Int J Environ Res Public Health. 2021 Dec 30;19(1):402. doi: 
10.3390/ijerph19010402.

Regression Analysis of Perceived Stress among Elite Athletes from Changes in 
Diet, Routine and Well-Being: Effects of the COVID-19 Lockdown and "Bubble" 
Training Camps.

Washif JA(1), Ammar A(2)(3)(4), Trabelsi K(5)(6), Chamari K(7), Chong CSM(1), 
Mohd Kassim SFA(1), Lew PCF(1), Farooq A(7), Pyne DB(8), James C(1).

Author information:
(1)Sports Performance Division, Institut Sukan Negara Malaysia (National Sports 
Institute of Malaysia), National Sports Complex, Kuala Lumpur 57000, Malaysia.
(2)Department of Training and Movement Science, Institute of Sport Science, 
Johannes Gutenberg-University Mainz, 55099 Mainz, Germany.
(3)Institute of Sport Science, Otto-von-Guericke University, 39106 Magdeburg, 
Germany.
(4)Interdisciplinary Laboratory in Neurosciences, Physiology and Psychology: 
Physical Activity, Health and Learning (LINP2), UPL, Paris Nanterre University, 
92000 Nanterre, France.
(5)High Institute of Sport and Physical Education, University of Sfax, Sfax 
3000, Tunisia.
(6)Research Laboratory: Education, Motricity, Sport and Health, EM2S, LR19JS01, 
University of Sfax, Sfax 3000, Tunisia.
(7)Aspetar, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of 
Excellence, Doha 29222, Qatar.
(8)Research Institute for Sport and Exercise, University of Canberra, Canberra 
2617, Australia.

The COVID-19 pandemic has affected the lifestyles and training of elite athletes 
around the world. The detrimental effects of lockdown periods may vary among 
individuals, as well as among sports and sexes. This study investigated the 
changes in dietary habits, and the predictors of perceived stress during 
lockdown and a "bubble" training camp. This cross-sectional, online survey 
involved 76 elite and world-class athletes from six able-bodied sports and nine 
parasports, all of whom were involved in a 30-day "bubble" training camp. 
Questions were asked on socio-demographics, training routines and wellbeing, 
perceived stress, and dietary habits, pertaining to "normal" training 
(prelockdown), lockdown training, and "bubble" camp training periods. Changes in 
perceived stress were trivial to small during lockdown compared to "normal" 
training, and trivial to moderate during a "bubble" camp, compared to lockdown. 
Para-athletes, males, older athletes, less experienced athletes, married 
individuals, and specific ethnicities appeared to be more detrimentally affected 
(increased perceived stress) by lockdown. These negative experiences, however, 
were largely reversed during "bubble" camps. During lockdown, more athletes 
reported increased evening snack consumption (+8%), later meal-times (+6%), 
decreased fluid intake (-6%), and no breakfast (+7%). These changes were 
reversed during "bubble" camps (12-18% improvements). Sport classification 
accounted for 16% of the increased perceived stress (p = 0.001) during lockdown. 
Overall, socio-demographic factors, improvements in training routines, 
well-being, and dietary habits explained 28% of the decreased perceived stress 
during a "bubble" camp. In conclusion, better dietary habits, training routines 
and well-being have implications for reduced perceived stress. During lockdown, 
"bubble" camps may be beneficial, but this observation may be a case-by-case 
consideration, and short split "bubble" periods are recommended.

DOI: 10.3390/ijerph19010402
PMCID: PMC8744934
PMID: 35010662 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2549. Int J Environ Res Public Health. 2021 Dec 29;19(1):337. doi: 
10.3390/ijerph19010337.

Mental Health and Psychological Impact during COVID-19 Pandemic: An Online 
Survey of Portuguese Higher Education Students.

Laranjeira C(1)(2)(3), Dixe MA(1)(2), Valentim O(1)(4), Charepe Z(5)(6), Querido 
A(1)(2)(4).

Author information:
(1)School of Health Sciences, Campus 2, Polytechnic of Leiria, Morro do Lena, 
Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal.
(2)Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo 
André-66-68, Campus 5, Polytechnic of Leiria, 2410-541 Leiria, Portugal.
(3)Research in Education and Community Intervention (RECI I&D), Piaget 
Institute, 3515-776 Viseu, Portugal.
(4)Center for Research in Health and Information Systems (CINTESIS), NursID, 
University of Porto, 4200-450 Porto, Portugal.
(5)Institute of Health Sciences (ICS), Universidade Católica Portuguesa, Palma 
de Cima, 1649-023 Lisboa, Portugal.
(6)Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica 
Portuguesa, 1649-023 Lisboa, Portugal.

The COVID-19 pandemic has had significant psychological impact on vulnerable 
groups, particularly students. The present study aims to investigate the mental 
and psychological impact of the COVID-19 pandemic and associated factors in a 
sample of Portuguese higher education students. An online cross-sectional study 
was conducted among 1522 higher education students selected by convenience 
sampling. The survey assessed mental health symptoms as well as sociodemographic 
variables, health-related perceptions, and psychological factors. Results were 
fitted to binary and multivariable logistic regression models. The overall 
prevalences of stress, anxiety, and depression were 35.7%, 36.2%, and 28.5%, 
respectively. Poor mental health outcomes were related with being female, having 
no children, living with someone with chronic disease, facing hopelessness, and 
lacking resilient coping. Future studies focusing on better ways to promote 
mental health and wellbeing among students are warranted. It is necessary to 
gather more evidence on the post-pandemic mental health using robust study 
designs and standardized assessment tools.

DOI: 10.3390/ijerph19010337
PMCID: PMC8751187
PMID: 35010604 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study, in the collection, analyses, or 
interpretation of data, in the writing of the manuscript, or in the decision to 
publish the results.


2550. Int J Environ Res Public Health. 2021 Dec 26;19(1):238. doi: 
10.3390/ijerph19010238.

Subjective Well-Being among Parents of Children with Special Educational Needs 
in Hong Kong: Impacts of Stigmatized Identity and Discrimination under Social 
Unrest and COVID-19.

Ye FT(1), Sin KF(1), Gao X(2).

Author information:
(1)Centre for Special Educational Needs and Inclusive Education, The Education 
University of Hong Kong, Hong Kong SAR, China.
(2)Centre for Educational and Developmental Sciences, The Education University 
of Hong Kong, Hong Kong SAR, China.

The COVID-19 pandemic and social unrest have posed a unique set of challenges to 
Hong Kong. During these two social events, parents of children with special 
educational needs (SEN) who were already experiencing caregiving pressure, 
likely coped with additional stressors; they were at a higher risk of mental 
health problems. A pre-registered, cross-sectional survey study was carried out 
among 234 Hong Kong parents of children with SEN, investigating the associations 
of stigmatized identity, perceived discrimination, and subjective well-being 
under the impact of these social events. Utilizing the Bayesian modelling, we 
found that highly self-stigmatized parents not only perceived more daily-life 
discriminating behaviors against them, but also reported having higher distress, 
more negative emotions, and lower life satisfaction. A higher perceived impact 
of social events and more discrimination were also associated with lower 
well-being. Additionally, stigmatized identity, perceived discrimination, and 
perceived impact of social events demonstrated unique associations with 
well-being variables, indicating they were substantial stressors. The study 
called out for public attention to the mental health conditions among parents of 
children with SEN and other disadvantaged groups in society.

DOI: 10.3390/ijerph19010238
PMCID: PMC8745026
PMID: 35010498 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2551. Int J Environ Res Public Health. 2021 Dec 26;19(1):232. doi: 
10.3390/ijerph19010232.

An Investigation into Art Therapy Aided Health and Well-Being Research: A 
75-Year Bibliometric Analysis.

Liu Z(1), Yang Z(1), Xiao C(1), Zhang K(1), Osmani M(2).

Author information:
(1)School of Design, South China University of Technology, Guangzhou 510006, 
China.
(2)School of Architecture, Building and Civil Engineering, Loughborough 
University, Loughborough LE11 3TU, UK.

Considering the physical, and psychological impacts and challenges brought about 
the coronavirus disease 2019 (COVID-19), art therapy (AT) provides opportunities 
to promote human health and well-being. There are few systematic analysis 
studies in the fields of AT, which can provide content and direction for the 
potential value and impact of AT. Therefore, this paper aims to critically 
analyze the published work in the field of AT from the perspective of promoting 
health and well-being, and provides insights into current research status, 
hotspots, limitations, and future development trends of AT. This paper adopts a 
mixed method of quantitative and qualitative analysis including bibliometric 
analysis and keyword co-occurrence analysis. The results indicate that: (1) the 
current studies on AT are mostly related to research and therapeutic methods, 
types of AT, research populations and diseases, and evaluation of therapeutic 
effect of AT. The research method of AT mainly adopts qualitative research, 
among which creative arts therapy and group AT are common types of AT, and its 
main research populations are children, veterans, and adolescents. AT-aided 
diseases are trauma, depression, psychosis, dementia, and cancer. In addition, 
the therapeutic methods are mainly related to psychotherapy, drama, music, and 
dance/movement. Further, computer systems are an important evaluation tool in 
the research of AT; (2) the future development trend of AT-aided health and 
well-being based on research hotspots, could be focused on children, 
schizophrenia, well-being, mental health, palliative care, veterans, and the 
elderly within the context of addressing COVID-19 challenges; and (3) future 
AT-aided health and well-being could pay more attention to innovate and 
integrate the therapeutic methods of behavior, movement, and technology, such as 
virtual reality and remote supervision.

DOI: 10.3390/ijerph19010232
PMCID: PMC8744960
PMID: 35010491 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that there is no conflict of 
interest.


2552. Int J Environ Res Public Health. 2021 Dec 24;19(1):188. doi: 
10.3390/ijerph19010188.

Kidney Care during COVID-19 in the UK: Perspectives of Healthcare Professionals 
on Impacts on Care Quality and Staff Well-Being.

Kanavaki AM(1), Lightfoot CJ(1), Palmer J(1), Wilkinson TJ(1), Smith AC(1), 
Jones CR(2).

Author information:
(1)Leicester Kidney Lifestyle Team, Department of Health Sciences, University 
Hospitals of Leicester NHS Trust, University of Leicester, Leicester LE17RH, UK.
(2)Department of Neuroscience, Psychology and Behaviour, University of 
Leicester, Leicester LE17RH, UK.

In light of the rapid changes in healthcare delivery due to COVID-19, this study 
explored kidney healthcare professionals' (HCPs) perspectives on the impact of 
these changes on care quality and staff well-being. Fifty-nine HCPs from eight 
NHS Trusts across England completed an online survey and eight took part in 
complementary semi-structured interviews between August 2020 and January 2021. 
Free-text survey responses and interviews were analysed using inductive thematic 
analysis. Themes described the rapid adaptations, concerns about care quality, 
benefits from innovations, high work pressure, anxiety and mental exhaustion in 
staff and the team as a well-being resource. Long-term retention and integration 
of changes and innovations can improve healthcare access and efficiency, but 
specification of conditions for its use is warranted. The impact of prolonged 
stress on renal HCPs also needs to be accounted for in quality planning. Results 
are further interpreted into a theoretical socio-technical framework.

DOI: 10.3390/ijerph19010188
PMCID: PMC8750502
PMID: 35010447 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2553. Wien Med Wochenschr. 2022 Jun;172(9-10):227-232. doi: 
10.1007/s10354-021-00901-2. Epub 2022 Jan 10.

Successful application of pulsed electromagnetic fields in a patient with 
post-COVID-19 fatigue: a case report.

Wagner B(1), Steiner M(1), Markovic L(1), Crevenna R(2).

Author information:
(1)Department of Physical Medicine, Rehabilitation and Occupational Medicine, 
Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
(2)Department of Physical Medicine, Rehabilitation and Occupational Medicine, 
Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. 
richard.crevenna@meduniwien.ac.at.

BACKGROUND: Post-COVID-19 fatigue is a frequent symptom in COVID-19 survivors, 
which substantially limits patients to achieve full recovery and potentially 
restrains return to work. The previous literature has not yet reported the use 
of pulsed electromagnetic fields in this indication.
METHODS: Over the course of 5 weeks, 10 sessions of pulsed electromagnetic field 
treatment with a high magnetic flux density were applied to a patient suffering 
from post-COVID-19 fatigue syndrome. Fatigue, work ability, quality of life as 
well as anxiety, depression, stress level, and resilience were evaluated using 
validated patient-reported outcome measures.
RESULTS: Fatigue, work ability, quality of life, and psychological well-being 
improved clearly over the course of the treatment and showed stable results 
6 weeks later.
CONCLUSION: The use of pulsed electromagnetic field therapy with a device that 
allows sufficient penetration of the body tissue might be a promising physical 
modality to manage post-COVID-19 fatigue syndrome, which could reduce clinical 
and economic health consequences. Clinical sham-controlled studies are needed to 
evaluate the effect of pulsed electromagnetic fields in this indication.

Publisher: ZUSAMMENFASSUNG: GRUNDLAGEN: Das Post-COVID-19-Erschöpfungssyndrom 
ist ein häufiges Syndrom nach COVID-19, das die vollständige Genesung und 
möglicherweise auch die Rückkehr in den Arbeitsprozess erheblich einschränkt. In 
der bisherigen wissenschaftlichen Literatur wurde noch nicht über den Einsatz 
gepulster Magnetfelder bei dieser Indikation berichtet.
METHODIK: Eine Patientin, die an einem Post-COVID-19 Erschöpfungssyndrom litt, 
wurde über einen Zeitraum von 5 Wochen mit 10 Einheiten gepulster 
Magnetfeldtherapie von hoher magnetischer Flussdichte behandelt. Müdigkeit, 
Arbeitsfähigkeit, Lebensqualität, Ängstlichkeit, Depression, Stressniveau und 
Resilienz wurden mittels validierter Fragebögen erfasst.
ERGEBNISSE: Die Müdigkeit, Arbeitsfähigkeit, Lebensqualität und das psychische 
Wohlbefinden besserten sich im Verlauf der Behandlung deutlich und zeigten auch 
6 Wochen später stabile Ergebnisse.
SCHLUSSFOLGERUNGEN: Die Anwendung der gepulsten Magnetfeldtherapie mit einem 
Gerät, das eine ausreichende Eindringtiefe in das Körpergewebe ermöglicht, 
könnte eine vielversprechende physikalische Methode zur Behandlung des 
Erschöpfungssyndroms nach COVID-19 sein, um die gesundheitlichen und 
wirtschaftlichen Folgen der Erkrankung zu reduzieren. Klinische 
placebokontrollierte Studien sind notwendig, um die Wirkung gepulster 
Magnetfeldtherapie in dieser Indikation zu erforschen.

© 2021. The Author(s).

DOI: 10.1007/s10354-021-00901-2
PMCID: PMC8743351
PMID: 35006516 [Indexed for MEDLINE]

Conflict of interest statement: B. Wagner, M. Steiner, L. Markovic, and 
R. Crevenna declare that they have no competing interests.


2554. Front Public Health. 2021 Dec 22;9:802180. doi: 10.3389/fpubh.2021.802180. 
eCollection 2021.

Adherence and Psychosocial Well-Being During Pandemic-Associated Pre-deployment 
Quarantine.

Bühler A(1), Willmund GD(1).

Author information:
(1)German Center for Military Mental Health, Military Hospital Berlin, Berlin, 
Germany.

Background: With the purpose of preventing SARS-Cov-2 traveling with the troops, 
pre-deployment and post-deployment quarantine are mandatory for the German 
military. This study investigates which factors could be addressed in order to 
facilitate adherence and mental health during isolation. Method: Six hundred 
three soldiers completed questionnaires at the beginning and at the end of 
pre-deployment quarantine: Mini-SCL (BSI), Perceived Social Support (FSozU-K22), 
Unit Cohesion, Military Quarantine Adherence Questionnaire (MQAQ), and 
quarantine-associated factors including informedness about Covid-19, perceived 
individual risk, benefit of quarantine, clarity of quarantine protocol, need of 
intimacy, social norms, stigma, practicality of the quarantine, financial 
disadvantages, boredom, and health promoting leadership. Results: Using stepwise 
regression analyses, up to 57% of the quarantine adherence was explained by 
social norms, boredom, perceived benefit/effectiveness of the quarantine, clear 
communication of the quarantine protocol and perceived risk of an infection, 
with social norms explaining 43%. In respect to mental health (Mini-SCL) at the 
beginning of quarantine, only 15% is explained by being in a partnership, 
(un)fulfilled need for bonding/intimacy, perceived unit cohesion, and perceived 
social support. Up to 20 % of the variance in mental health at the end of 
quarantine is explained by accumulated days of isolation before pre-deployment 
quarantine, age, clear communication of the quarantine protocol, perceived 
social support, fulfilled need for bonding/intimacy and perceived stigma. Mental 
health and quarantine adherence did correlate significantly, but to a slight 
extent. No differences between the beginning and the end of pre-deployment 
quarantine were found for the overall group in respect to mental health, 
quarantine adherence, perceived social support and perceived unit cohesion, 
while their trajectories differed for different subgroups including age, gender, 
rank, and accumulated days of quarantine: With increasing accumulated days of 
isolation prior to pre-deployment quarantine, mental health declined over the 
course of quarantine, though to a small degree. Conclusion: Findings suggest 
that addressing the norms of fellow soldiers and dependents alike could 
contribute to quarantine adherence in pre-deployment quarantine. Ongoing 
research should examine long-term effects on mental health, including these of 
accumulated days of quarantine, also taking into account post-deployment 
quarantine.

Copyright © 2021 Bühler and Willmund.

DOI: 10.3389/fpubh.2021.802180
PMCID: PMC8727777
PMID: 35004600 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2555. Med Care Res Rev. 2022 Oct;79(5):663-675. doi: 10.1177/10775587211062405. Epub 
2022 Jan 10.

Caregiving in a Pandemic: COVID-19 and the Well-Being of Family Caregivers 55+ 
in the United States.

Truskinovsky Y(1), Finlay JM(2), Kobayashi LC(3).

Author information:
(1)Wayne State University, Detroit, MI, USA.
(2)University of Michigan, Ann Arbor, USA.
(3)University of Michigan School of Public Health, Ann Arbor, USA.

Little is known about the effects of Coronavirus disease 2019 (COVID-19) on 
older family caregivers. Using data from a national sample of 2,485 U.S. adults 
aged ≥55, we aimed to describe the magnitude of disruptions to family care 
arrangements during the initial wave of the COVID-19 pandemic, and the 
associations between these disruptions and the mental health outcomes 
(depression, anxiety, loneliness, and self-rated health) and employment outcomes 
(job loss or furlough, hours or wages reduced, transition to work-from-home) of 
family caregivers. We found that COVID-19 disrupted over half of family 
caregiving arrangements, and that care disruptions were associated with 
increased depression, anxiety, and loneliness among caregivers, compared with 
both noncaregivers and caregivers who did not experience disruptions. Family 
caregivers who experienced pandemic-related employment disruptions were 
providing more care than caregivers who did not experience disruptions. These 
findings highlight the impact of the pandemic on an essential and vulnerable 
health care workforce.

DOI: 10.1177/10775587211062405
PMID: 35001714 [Indexed for MEDLINE]


2556. Eur Child Adolesc Psychiatry. 2023 Jul;32(7):1189-1199. doi: 
10.1007/s00787-021-01925-0. Epub 2022 Jan 10.

Maternal mood moderates the trajectory of emotional and behavioural problems 
from pre- to during the COVID-19 lockdown in preschool children.

Frigerio A(1), Nettuno F(2), Nazzari S(2).

Author information:
(1)Child Psychopathology Unit, Scientific Institute Eugenio Medea, Via Don Luigi 
Monza, 20, 23842, Bosisio Parini, LC, Italy. 
alessandra.frigerio@lanostrafamiglia.it.
(2)Child Psychopathology Unit, Scientific Institute Eugenio Medea, Via Don Luigi 
Monza, 20, 23842, Bosisio Parini, LC, Italy.

The COVID-19 outbreak and subsequent lockdown have dramatically impacted 
families' life, raising serious concerns about children's emotional wellbeing. 
However, few studies have investigated whether the impact of the COVID-19 
lockdown on psychological adjustment in youngest can be moderated by maternal 
mood and, to our knowledge, none of them has adopted a longitudinal design. The 
main aim of the current study was to explore if the intensity and directionality 
of maternal mood symptoms moderated the trajectory of emotional and behavioural 
problems in Italian pre-schoolers from pre- to during the lockdown adopting a 
longitudinal design. To assess maternal anxiety and depression symptoms, the 
EPDS and the STAI-Y were filled in by 94 and 88 women before the lockdown, when 
their children were 1 (Wave P1) and 3 years old (Wave P2), respectively, and by 
74 women during the lockdown, when their children were 4 years old (Wave L). 
Mothers also filled in the CBCL/1 ½-5 to assess their children's emotional and 
behavioural problems at each assessment wave. As a whole, children's emotional 
and behavioural problems significantly increased from pre- to during the 
lockdown. Furthermore, maternal mood moderated this trajectory. In particular, 
greater maternal mood symptoms were significantly associated with a greater 
increase in emotional reactive, anxious-depressed, withdrawn and aggressive 
symptoms during the lockdown. These results contribute to shed light on the role 
played by maternal emotional wellbeing in buffering the impact of the COVID-19 
lockdown on children's behavioural development. Albeit preliminary, the current 
findings highlight the need to provide timely psychological interventions to 
distressed mothers to help their children to better cope with the effects of the 
pandemic.

© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

DOI: 10.1007/s00787-021-01925-0
PMCID: PMC8743103
PMID: 35001205 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflict of interest to 
declare.


2557. Behav Med. 2023 Apr-Jun;49(2):195-203. doi: 10.1080/08964289.2021.2015278. Epub 
2022 Jan 10.

Mental Health and Alcohol Use during and before the Early Phases of the COVID-19 
Pandemic.

Sumetsky N(1)(2), Frankeberger J(1)(2), Coulter RWS(1)(2)(3), Burke JG(1)(2), 
Friedman MR(3)(4), Mair C(1)(2).

Author information:
(1)Department of Behavioral and Community Health Sciences, University of 
Pittsburgh Graduate School of Public Health.
(2)Center for Social Dynamics and Community Health, University of Pittsburgh 
Graduate School of Public Health.
(3)Center for LGBT Health Research, University of Pittsburgh Graduate School of 
Public Health.
(4)Department of Infectious Diseases and Microbiology, University of Pittsburgh 
Graduate School of Public Health.

The early phases of the coronavirus 19 disease (COVID-19) pandemic were 
associated with changes in psychological well-being and alcohol use. However, it 
is unclear whether these changes are artifacts of psychological well-being and 
alcohol use prior to the pandemic across different sociodemographic groups. We 
received surveys from 247 adult residents of Allegheny County, Pennsylvania 
(United States), with an oversampling of sexual- and gender-minority 
individuals. Responses included measures of psychological well-being, substance 
use, and sociodemographic characteristics. Unadjusted mean depression scores, 
anxiety scores, and number of drinking days increased for all age and income 
groups during COVID-19, while average number of drinks per drinking day and days 
intoxicated differentially increased or decreased by age and income groups. 
Using Bayesian seemingly unrelated regression, we assessed depression and 
anxiety symptoms and alcohol use during the early stages of the pandemic and one 
month before COVID-19 was first identified in Allegheny County concurrently. 
Those in the youngest (18-24) group drank on more days during (but not before) 
the pandemic than those in the 25-44 age group. Compared to cisgender women, 
gender-minority adults had higher depression scores during the early stages of 
the pandemic. Employed adults had lower anxiety scores during (but not before) 
the pandemic than adults who were unemployed. Those with past-year annual 
incomes above $80,000 had fewer drinks on average drinking occasions than those 
in the $40,000 or below group before (but not during) the pandemic. Patterns of 
psychological distress and alcohol use associated with the COVID-19 pandemic 
differ by subgroup compared to patterns prior to the pandemic. Interventions 
addressing worsening mental health outcomes and shifting alcohol use patterns 
must be sensitive to the needs of vulnerable groups, such as younger adults and 
those experiencing poverty or unemployment.

DOI: 10.1080/08964289.2021.2015278
PMCID: PMC9289939
PMID: 35000570 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None to declare


2558. Mymensingh Med J. 2022 Jan;31(1):237-241.

Quality of Life of Bangladeshi Doctors in the COVID-19 era: Are We Taking Good 
Care of Our Carers?

Saiyara MN(1), Islam MF, Porag MR, Islam MM, Bodruddoza K, Hossain S, Ferdaus 
JA.

Author information:
(1)Dr Ms Noshin Saiyara, Registrar, General Surgery, Leicester General Hospital, 
NHS, UK; E-mail: noshinsahmed@gmail.com.

The Coronavirus pandemic has been affecting our healthcare professionals 
physically as well as psychologically since March 2020. Whilst various measures 
have been taken to protect their physical health, their mental wellbeing has not 
been brought into attention. We aimed to assess the well-being of Bangladeshi 
doctors and identify the high-risk group using a core-10 validated form. We 
performed an observational cross-sectional survey among Bangladeshi healthcare 
professionals. One hundred one (101) doctors filled out the core-10 form. We 
collected data over a 1-month-period during the first peak of COVID-19. 
According to our data, majority of the participants (49%) felt anxious or 
nervous at some point. Thirty one percent (31%) felt hopeless, unhappy even 
panic attacks but most significant finding was that 21% participants had at 
least once thought about ending their lives. This is a matter of concern and the 
workplaces should identify the vulnerable professionals so that they can be 
supported better mentally and socially. More than half of the participants (55%) 
were found to have moderate to severe depression in the first peak of COVID 19 
pandemic. This is not over yet; more waves are coming. Therefore, it is really 
important that we address this issue before it is too late and ensure regular 
counselling, better childcare for working parents, safety measures to protect 
their families and financial security. Otherwise, we might exhaust our carers to 
a level where even they cannot help us survive this global challenge.

PMID: 34999709 [Indexed for MEDLINE]


2559. BMJ Open. 2022 Jan 7;12(1):e055696. doi: 10.1136/bmjopen-2021-055696.

Predicting transitions between longitudinal classes of post-traumatic stress 
disorder, adjustment disorder and well-being during the COVID-19 pandemic: 
protocol of a latent transition model in a general Dutch sample.

Lenferink L(1)(2), Mouthaan J(3), Fritz AM(3), Soydas S(4)(5), Eidhof M(6)(7), 
van Hoof MJ(8)(9), Groen S(10), Mooren T(4)(5).

Author information:
(1)Psychology, Health, and Technology, University of Twente, Enschede, The 
Netherlands l.i.m.lenferink@rug.nl.
(2)Clinical Psychology and Experimental Psychopathology, Rijksuniversiteit 
Groningen, Groningen, The Netherlands.
(3)Department of Clinical Psychology, Leiden University, Leiden, The 
Netherlands.
(4)Department of Clinical Psychology, Utrecht University, Utrecht, The 
Netherlands.
(5)ARQ National Psychotrauma Centre, Diemen, The Netherlands.
(6)Behavioural Science Institute, Radboud Universiteit, Nijmegen, The 
Netherlands.
(7)Reinier van Arkel Psychotraumacenter South Netherlands, Den Bosch, The 
Netherlands.
(8)Department of Child and Adolescent Psychiatry, Amsterdam UMC, locatie 
Meibergdreef, Amsterdam, The Netherlands.
(9)Child and Adolescent Psychiatry, Curium-LUMC, Leiden, The Netherlands.
(10)GGZ Drenthe Mental Health Care, De Evenaar Centrum Transculturele 
Psychiatrie, Beilen, The Netherlands.

BACKGROUND: A growing body of literature shows profound effects of the COVID-19 
pandemic on mental health, among which increased rates of post-traumatic stress 
disorder (PTSD) and adjustment disorder (AD). However, current research efforts 
have largely been unilateral, focusing on psychopathology and not including 
well-being, and are dominated by examining average psychopathology levels or on 
disorder absence/presence, thereby ignoring individual differences in mental 
health. Knowledge on individual differences, as depicted by latent subgroups, in 
the full spectrum of mental health may provide valuable insights in how 
individuals transition between health states and factors that predict 
transitioning from resilient to symptomatic classes. Our aim is to (1) identify 
longitudinal classes (ie, subgroups of individuals) based on indicators of PTSD, 
AD and well-being in response to the pandemic and (2) examine predictors of 
transitioning between these subgroups.
METHODS AND ANALYSIS: We will conduct a three-wave longitudinal online survey 
study of n≥2000 adults from the general Dutch population. The first measurement 
occasion takes place 6 months after the start of the pandemic, followed by two 
follow-up measurements with 6 months of intervals. Latent transition analysis 
will be used for data analysis.
ETHICS AND DISSEMINATION: Ethical approval has been obtained from four Dutch 
universities. Longitudinal study designs are vital to monitor mental health (and 
predictors thereof) in the pandemic to develop preventive and curative mental 
health interventions. This study is carried out by researchers who are board 
members of the Dutch Society for Traumatic Stress Studies and is part of a 
pan-European study (initiated by the European Society for Traumatic Stress 
Studies) examining the impact of the pandemic in 11 countries. Results will be 
published in peer-reviewed journals and disseminated at conferences, via 
newsletters, and media appearance among (psychotrauma) professionals and the 
general public.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-055696
PMCID: PMC8743835
PMID: 34996798 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2560. J Psychiatr Res. 2022 Feb;146:179-185. doi: 10.1016/j.jpsychires.2021.12.040. 
Epub 2021 Dec 27.

Does perceived post-traumatic growth predict better psychological adjustment 
during the COVID-19 pandemic? Results from a national longitudinal survey in the 
USA.

Park CL(1), Wilt JA(2), Russell BS(3), Fendrich MR(4).

Author information:
(1)Department of Psychological Sciences, University of Connecticut, Storrs, CT, 
USA. Electronic address: crystal.park@uconn.edu.
(2)Department of Psychological Sciences, University of Connecticut, Storrs, CT, 
USA; Department of Psychology, Case Western Reserve University, Cleveland, OH, 
USA.
(3)Department of Human Development and Family Sciences, University of 
Connecticut, Storrs, CT, USA.
(4)School of Social Work, University of Connecticut, Hartford, CT, USA.

Perceiving that one has grown in positive ways following highly stressful 
experiences (perceived posttraumatic growth; PPTG) is common and sometimes--but 
not always--related to psychological wellbeing. However, PPTG is typically 
studied cross-sectionally and well after the stressful experience has passed; 
how PPTG might relate to wellbeing over time in an unprecedented, ongoing 
worldwide disaster such as the COVID-19 pandemic remains unknown. Thus, the 
current study sought to answer whether, in the midst of the pandemic, PPTG 
relates to subsequent wellbeing, broadly defined. Participants were N = 1544 
MTurk workers who completed a five-wave (T1-T5) six-month longitudinal study. 
Current analyses focused on T2-T5 (ns = 860-712). At each time point, 
participants completed self-report measures of PPTG and wellbeing (depression, 
anxiety, stress, positive states of mind, alcohol use, posttraumatic stress). In 
cross-lagged panel models, PPTG was largely unrelated to subsequent wellbeing. 
Somewhat more evidence was found that increasing distress led to increases in 
PPTG, suggesting perceptions of growth may serve as a coping mechanism. PPTG 
does not appear to benefit adjustment to the COVID-19 pandemic and may simply 
reflect efforts to manage distress.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.jpsychires.2021.12.040
PMCID: PMC8719907
PMID: 34995993 [Indexed for MEDLINE]

Conflict of interest statement: The authors report no conflicts of interest with 
the content of the manuscript. The content of this manuscript does not 
necessarily reflect the views of the funding agencies and reflects the views of 
the authors.


2561. Rheumatology (Oxford). 2022 Aug 30;61(9):3723-3736. doi: 
10.1093/rheumatology/keab937.

Will 'the feeling of abandonment' remain? Persisting impacts of the COVID-19 
pandemic on rheumatology patients and clinicians.

Sloan M(1), Harwood R(2), Gordon C(3), Bosley M(2), Lever E(4), Modi R(1), Blane 
M(2), Brimicombe J(1), Barrere C(2), Holloway L(2), Sutton S(1), D'Cruz D(5).

Author information:
(1)Department of Public Health and Primary Care, School of Clinical Medicine.
(2)Patient and Public Involvement in Rheumatology Research Group, Institute of 
Public Health, University of Cambridge, Cambridge.
(3)Rheumatology Research Group, Institute of inflammation and ageing, College of 
Medical and Dental Science, University of Birmingham, Birmingham.
(4)Rheumatology Department, West Middlesex Hospital.
(5)The Louise Coote Lupus Unit, Guy's and St Thomas', NHS Foundation Trust, 
London, UK.

Comment in
    doi: 10.1093/rheumatology/keac193.

OBJECTIVE: To better understand rheumatology patient and clinician 
pandemic-related experiences, medical relationships and behaviours in order to 
help identify the persisting impacts of the COVID-19 pandemic and inform efforts 
to ameliorate the negative impacts and build upon the positive ones.
METHODS: Rheumatology patients and clinicians completed surveys (patients 
n = 1543, clinicians n = 111) and interviews (patients n = 41, clinicians 
n = 32) between April 2021 and August 2021. A cohort (n = 139) of systemic 
autoimmune rheumatic disease patients was also followed up from March 2020 to 
April 2021. Analyses used sequential mixed methods. Pre-specified outcome 
measures included the Warwick-Edinburgh Mental wellbeing score (WEMWBS), 
satisfaction with care and healthcare behaviours.
RESULTS: We identified multiple ongoing pandemic-induced/increased barriers to 
receiving care. The percentage of patients agreeing they were medically 
supported reduced from 74.4% pre-pandemic to 39.7% during-pandemic. Ratings for 
medical support, medical security and trust were significantly (P <0.001) 
positively correlated with patient WEMWBS and healthcare behaviours, and 
decreased during the pandemic. Healthcare-seeking was reduced, potentially 
long-term, including from patients feeling 'abandoned' by clinicians, and a 
'burden' from government messaging to protect the NHS. Blame and distrust were 
frequent, particularly between primary and secondary care, and towards the UK 
government, who <10% of clinicians felt had supported clinicians during the 
pandemic. Clinicians' efforts were reported to be impeded by inefficient 
administration systems and chronic understaffing, suggestive of the pandemic 
having exposed and exacerbated existing healthcare system weaknesses.
CONCLUSION: Without concerted action-such as rebuilding trust, improved 
administrative systems and more support for clinicians-barriers to care and 
negative impacts of the pandemic on trust, medical relationships, medical 
security and patient help-seeking may persist in the longer term.
TRIAL REGISTRATION: This study is part of a pre-registered longitudinal 
multi-stage trial, the LISTEN study (ISRCTN-14966097), with later COVID-related 
additions registered in March 2021, including a pre-registered statistical 
analysis plan.

© The Author(s) 2022. Published by Oxford University Press on behalf of the 
British Society for Rheumatology.

DOI: 10.1093/rheumatology/keab937
PMCID: PMC8755362
PMID: 34995345 [Indexed for MEDLINE]


2562. Matern Child Health J. 2022 Jan;26(1):102-109. doi: 10.1007/s10995-021-03344-8. 
Epub 2022 Jan 7.

"Mourning the Experience of What Should Have Been": Experiences of Peripartum 
Women During the COVID-19 Pandemic.

Shuman CJ(1), Morgan ME(2), Chiangong J(2), Pareddy N(2), Veliz P(2), Peahl 
AF(3), Dalton VK(3).

Author information:
(1)Department of Systems, Populations, and Leadership, University of Michigan 
School of Nursing, 400 N. Ingalls, Ste. 4162, Ann Arbor, MI, 48109-5842, USA. 
clayshu@med.umich.edu.
(2)Department of Systems, Populations, and Leadership, University of Michigan 
School of Nursing, 400 N. Ingalls, Ste. 4162, Ann Arbor, MI, 48109-5842, USA.
(3)Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, 
USA.

OBJECTIVES: The ongoing COVID-19 pandemic may significantly affect the 
peripartum experience; however, little is known about the perceptions of women 
who gave birth during the COVID-19 pandemic. Thus, the purpose of our study was 
to describe the peripartum experiences of women who gave birth during the 
COVID-19 pandemic in the United States.
METHODS: Using a cross-sectional design, we collected survey data from a 
convenience sample of postpartum women recruited through social media. 
Participants were 18 years of age or older, lived in the United States, gave 
birth after February 1, 2020, and could read English. This study was part of the 
COVID-19 Maternal Attachment, Mood, Ability, and Support study, which was a 
larger study that collected survey data describing maternal mental health and 
breastfeeding during the COVID-19 pandemic. This paper presents findings from 
the two free-text items describing peripartum experiences. Using the constant 
comparative method, responses were thematically analyzed to identify and collate 
major and minor themes.
RESULTS: 371 participants responded to at least one free-text item. Five major 
themes emerged: (1) Heightened emotional distress; (2) Adverse breastfeeding 
experiences; (3) Unanticipated hospital policy changes shifted birthing plans; 
(4) Expectation vs. reality: "mourning what the experience should have been;" 
and (5) Surprising benefits of the COVID-19 pandemic to the delivery and 
postpartum experience.
CONCLUSIONS FOR PRACTICE: Peripartum women are vulnerable to heightened stress 
induced by COVID-19 pandemic sequalae. During public health crises, peripartum 
women may need additional resources and support to improve their mental health, 
wellbeing, and breastfeeding experiences.

© 2021. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s10995-021-03344-8
PMCID: PMC8739000
PMID: 34993749 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


2563. Eur J Psychotraumatol. 2021 Feb 2;12(1):1871555. doi: 
10.1080/20008198.2020.1871555. eCollection 2021.

A symptom-based definition of resilience in times of pandemics: patterns of 
psychological responses over time and their predictors.

Valiente C(1), Vázquez C(1), Contreras A(1), Peinado V(1), Trucharte A(1).

Author information:
(1)Department of Clinical Psychology, Complutense University of Madrid, Madrid, 
Spain.

Background: It has been suggested that resilience is best conceptualized as 
healthy and stable functioning in the face of a potentially traumatic event. 
However, most research on this field has focused on self-reported resilience, 
and other patterns of response when facing adversity, in cross-sectional 
designs. Objective: Alternatively, we aimed to study changing patterns of 
psychological responses to the COVID-19 pandemic in the general population, 
based on patterns of symptoms, and factors contributing to those patterns. 
Method: A national representative sample of Spain (N = 1,628) responded to an 
internet-based survey at two assessment points, separated by 1 month (April and 
May 2020), during the official national confinement stage. Based upon whether 
participants exhibited absence/presence of distress (i.e., significant 
trauma-related, depression, or anxiety symptoms) at one or two of the assessment 
times, patterns of psychological responses were defined by categorizing 
individuals into one of the four categories: Resilience, Delayed distress, 
Recovered, and Sustained distress. Results: Analyses of the levels of 
disturbance associated with the symptoms provided support to that four-fold 
distinction of patterns of responses. Furthermore, resilience responses were the 
most common psychological response to the pandemic. Multinomial regression 
analyses revealed that the main variables increasing the probability of 
resilience to COVID-19 were being male, older, having no history of mental 
health difficulties, higher levels of psychological well-being and high 
identification with all humanity. Also, having low scores in several variables 
(i.e., anxiety and economic threat due to COVID-19, substance use during the 
confinement, intolerance to uncertainty, death anxiety, loneliness, and 
suspiciousness) was a significant predictor of a resilient response to COVID-19. 
Conclusion: Our findings are consistent with previous literature that 
conceptualizes resilience as a dynamic process. The clinical implications of 
significant predictors of the resilience and the rest of psychological patterns 
of response are discussed.

Publisher: Antecedentes: Se ha sugerido que la mejor manera de conceptualizar la 
resiliencia es como un funcionamiento saludable y estable ante un evento 
potencialmente traumático. Sin embargo, la mayor parte de las investigaciones 
sobre la resiliencia y otras pautas de respuesta ante la adversidad se han 
centrado en el uso de cuestionarios de autoinforme de resiliencia en diseños 
transversales.Objetivo: Alternativamente, nuestro objetivo fue estudiar los 
cambios en los patrones de las respuestas psicológicas a la pandemia de COVID-19 
en la población general y analizar de manera empírica las características que 
contribuyen a la respuesta resiliente.Métodos: Se utilizó una muestra nacional 
representativa española (N=1.628), que respondió a una encuesta realizada a 
través de Internet, en dos momentos de evaluación, separados por un mes, durante 
la etapa de confinamiento asociada a la pandemia (Abril y Mayo 2020). Se 
definieron los patrones de respuesta psicológica en función de la 
ausencia/presencia de malestar (v.g., síntomas significativos de estrés 
post-traumático, depresión y Ansiedad) en los dos momentos de evaluación, 
clasificando a los individuos en: resiliencia, malestar tardío, recuperación y 
malestar sostenido.Resultados: Análisis de los niveles de interferencia apoyaron 
estos cuatro de patrones dinámicos de respuesta psicológica. Además, la 
respuesta de resiliencia fue la más común frente a la pandemia. Un análisis de 
regresión multinomial indicó que los predictores de una mayor probabilidad de 
resiliencia fueron ser hombre, tener más edad, no tener antecedentes de salud 
mental, y altos niveles de identificación con la humanidad y de bienestar 
psicológico. Además, bajos niveles en otras variables (ansiedad y amenaza 
económica debida a la pandemia, consumo de sustancias durante el confinamiento, 
intolerancia a la incertidumbre, ansiedad ante la muerte, soledad, y 
desconfianza) fueron también predictores significativos de una respuesta de 
resiliencia psicológica al COVID-19.Conclusión: Nuestros hallazgos están en 
línea con la literatura previa que identifica la resiliencia como un patrón de 
respuesta común y un proceso dinámico. Se discuten las implicaciones clínicas de 
los predictores significativos de los cuatro diferentes patrones de respuesta.

Publisher: 背景: 在缺乏对心理韧性通用定义的情况下, 有人建议最好将其概念化为面对潜在创伤事件保持健康和稳定的功能。但是, 
大多数对于面对逆境时心理韧性和其他反应模式的研究都集中在横截面设计中对心理韧性的自我评估。目的 :反之, 
我们旨在根据症状模式研究普通人群对COVID-19疫情心理反应的变化模式及其促成因素。方法: 在官方国家禁闭阶段, 一个全国代表性样本 (N = 1,628) 
在两个相隔一个月的评估点 (2020年4月和2020年5月) 对网络调查做出了回应。根据参与者在一次或两次评估表现出/不存在困扰 (即明显的创伤相关, 
抑郁或焦虑症状), 通过将个体分为以下四类之一来定义心理反应的模式:心理韧性, 延迟困扰, 康复和持续困扰。结果: 
对症状相关困扰水平的分析为四种反应模式的区分提供了支持。此外, 心理韧性反应是应对疫情最常见的心理反应。多项回归分析表明, 
增加对COVID-19心理韧性的主要变量是男性, 年龄较大, 没有精神健康困难史, 心理健康水平较高以及对全人类的认同感。同样, 在几个变量中具有较低的水平 
(即由COVID-19引起的焦虑和经济威胁, 分娩期间的药物使用, 对不确定性的不容忍, 死亡焦虑, 孤独和可疑性) 都是对COVID- 
19心理韧性反应的预测因子。结论: 我们的发现与先前将创伤事件后心理韧性确定为一种常见的反应模式, 
并将其概念化为一种动态过程的文献一致。讨论了心理韧性和其他心理反应模式显著预测指标的临床意义。.

© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & 
Francis Group.

DOI: 10.1080/20008198.2020.1871555
PMCID: PMC8725762
PMID: 34992748 [Indexed for MEDLINE]

Conflict of interest statement: No potential conflict of interest.


2564. PLoS One. 2022 Jan 6;17(1):e0261509. doi: 10.1371/journal.pone.0261509. 
eCollection 2022.

The impact of COVID-19 on fertility behaviour and intentions in a middle income 
country.

Emery T(1), Koops JC(2).

Author information:
(1)Department of Public Administration, Erasmus University Rotterdam, Rotterdam, 
Netherlands.
(2)Netherlands Interdisciplinary Demographic Institute (NIDI)-KNAW, University 
of Groningen, Groningen, Netherlands.

The COVID Pandemic may affect fertility behaviour and intentions in many ways. 
Restrictions on service provision reduce access to family planning services and 
increase fertility in the short term. By contrast, the economic uncertainty 
brought about by the pandemic and its impact on mental health and well-being may 
reduce fertility. These various pathways have been explored in the context of 
high income countries such as the United States and Western Europe, but little 
is known about middle income countries. In this paper we asses the impact of the 
COVID pandemic on fertility intentions and behaviour in the Republic of Moldova, 
a middle income country in Eastern Europe, using the Generations and Gender 
Survey. This survey was conducted partially before and partially after the onset 
of the pandemic in 2020, allowing for detailed comparisons of individual 
circumstances. The results indicate that the pandemic reduced the used of 
intrauterine devices, and increased the use of male condoms, but with no overall 
decrease in contraceptive use. Conversely individuals interviewed after the 
onset of the pandemic were 34.5% less likely to be trying to conceive, although 
medium term fertility intentions were unchanged. Indicators therefore suggest 
that in the medium term fertility intentions may not be affected by the pandemic 
but restricted access to contraception requiring medical consultation and a 
decrease in short-term fertility intentions could disrupt short term family 
planning.

DOI: 10.1371/journal.pone.0261509
PMCID: PMC8735619
PMID: 34990459 [Indexed for MEDLINE]

Conflict of interest statement: No authors have competing interests.


2565. JCO Oncol Pract. 2022 Apr;18(4):e586-e599. doi: 10.1200/OP.21.00630. Epub 2022 
Jan 6.

Impact of COVID-19 on Hematology-Oncology Trainees: A Quantitative and 
Qualitative Assessment.

Durani U(1), Major A(2), Velazquez AI(3)(4), May J(5), Nelson M(6), Zheng 
Z(7)(8), Hall AG(9), Alam ST(10), Reynolds R(11), Thompson JC(11), Kumbamu 
A(12), Das DG(5), Murphy MC(13), Henry E(14)(15), Lee AI(16), Marshall 
AL(17)(18), Wun T(19), Weeks LD(20).

Author information:
(1)Department of Hematology and HCT, City of Hope, Duarte, CA.
(2)Section of Hematology-Oncology, Department of Medicine, The University of 
Chicago, Chicago, IL.
(3)Division of Hematology-Oncology, Department of Medicine, University of 
California San Francisco, San Francisco, CA.
(4)National Clinician Scholars Program, Philip R. Lee Institute for Health 
Policy Studies, University of California San Francisco, San Francisco, CA.
(5)Division of Hematology and Oncology, Department of Medicine, University of 
Alabama at Birmingham Medical Center, Birmingham, AL.
(6)Division of Hematology and Oncology, Department of Medicine, University of 
Tennessee Health Science Center, Memphis, TN.
(7)Division of Endocrinology, Department of Medicine, Medical College of 
Wisconsin, Milwaukee, WI.
(8)Blood Research Institute, Versiti Blood Center of Wisconsin, Milwaukee, WI.
(9)Division of Hematology and Oncology, Department of Pediatrics, Seattle 
Children's Hospital, University of Washington, Seattle, WA.
(10)Division of Hematology and Oncology, Baylor College of Medicine, Houston, 
TX.
(11)American Society of Hematology, Washington, DC.
(12)Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, 
MN.
(13)Division of Hematology and Oncology, University of Florida, Gainesville, FL.
(14)Department of Medical Education, Loyola University Medical Center, Maywood, 
IL.
(15)Division of Hematology and Oncology, Loyola University Medical Center, 
Maywood, IL.
(16)Section of Hematology, Department of Internal Medicine, Yale University 
School of Medicine and Yale Cancer Center, New Haven, CT.
(17)Division of Hematology, Mayo Clinic, Rochester, MN.
(18)Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
(19)Division of Hematology and Oncology, University of California Davis School 
of Medicine, Sacramento, CA.
(20)Division of Hematologic Malignancies, Department of Medical Oncology, Dana 
Farber Cancer Institute, Harvard Medical School, Boston, MA.

PURPOSE: Graduate medical and research training has drastically changed during 
the COVID-19 pandemic, with widespread implementation of virtual learning, 
redeployment from core rotations to the care of patients with COVID-19, and 
significant emotional and physical stressors. The specific experience of 
hematology-oncology (HO) fellows during the COVID-19 pandemic is not known.
METHODS: We conducted a mixed-methods study using a survey of Likert-style and 
open-ended questions to assess the training experience and well-being of HO 
fellows, including both clinical and postdoctoral trainee members of the 
American Society of Hematology and ASCO.
RESULTS: A total of 2,306 surveys were distributed by e-mail; 548 (23.8%) 
fellows completed the survey. Nearly 40% of fellows felt that they had not 
received adequate mental health support during the pandemic, and 22% reported 
new symptoms of burnout. Pre-existing burnout before the pandemic, 
COVID-19-related clinical work, and working in a primary research or nonclinical 
setting were associated with increased burnout on multivariable logistic 
regression. Qualitative thematic analysis of open-ended responses revealed 
significant concerns about employment after training completion, perceived 
variable quality of virtual education and board preparation, loss of clinical 
opportunities to prepare for independent clinical practice, inadequate grant 
funding opportunities in part because of shifting research priorities, variable 
productivity, and mental health or stress during the pandemic.
CONCLUSION: HO fellows have been profoundly affected by the pandemic, and our 
data illustrate multiple avenues for fellowship programs and national 
organizations to support both clinical and postdoctoral trainees.

DOI: 10.1200/OP.21.00630
PMCID: PMC9014488
PMID: 34990292 [Indexed for MEDLINE]

Conflict of interest statement: Ana I. VelazquezEmployment: J&J Innovations 
(I)Stock and Other Ownership Interests: Portola Pharmaceuticals, Corbus 
Pharmaceuticals, Midatech Pharma Sara Taveras AlamHonoraria: Integrity CEOpen 
Payments Link: https://openpaymentsdata.cms.gov/physician/1369581 Devika G. 
DasThis author is a member of the JCO Oncology Practice Editorial Board. Journal 
policy recused the author from having any role in the peer review of this 
manuscript. Martina C. MurphyHonoraria: North American Thrombosis 
ForumConsulting or Advisory Role: Pfizer Elizabeth HenryEmployment: 
theMednetConsulting or Advisory Role: Seattle Genetics/AstellasResearch Funding: 
Seattle Genetics/Astellas (Inst), Bristol Myers Squibb (Inst), Nektar 
(Inst)Other Relationship: theMednet Ariela L. MarshallStock and Other Ownership 
Interests: Teladoc Ted WunHonoraria: Pfizer, JanssenConsulting or Advisory Role: 
Janssen, PfizerResearch Funding: Janssen (Inst), Pfizer (Inst)No other potential 
conflicts of interest were reported.


2566. Clin Psychol Psychother. 2022 Jul;29(4):1297-1308. doi: 10.1002/cpp.2706. Epub 
2022 Jan 17.

Early maladaptive schemas and COVID-19 anxiety: The mediational role of 
mistrustfulness and vulnerability to harm and illness.

Faustino B(1), Vasco AB(1), Delgado J(1), Farinha-Fernandes A(1), Guerreiro 
JC(1).

Author information:
(1)Faculdade de Psicologia da, Universidade de Lisboa, Lisboa, Portugal.

BACKGROUND: Early maladaptive schemas (EMS), as lifelong psychological 
structures, tend to be associated with psychopathological symptomatology. 
Previous research has suggested that schemas act as psychological 
vulnerabilities to stressful life situations, such as the present worldwide 
COVID-19 pandemic. In this context, anxiety and psychological distress have been 
documented as two of the main psychological symptoms associated with the 
COVID-19 pandemic. However, the associations between specific EMS and COVID-19 
anxiety remain unexplored. Therefore, this study aims to explore the 
relationships between EMS, COVID-19 anxiety as well as other mental health 
variables such as psychological well-being, distress and life satisfaction.
METHODS: In a cross-sectional design, 249 individuals (M = 34.2, SD = 12.0) 
completed several self-report measures.
RESULTS: EMS from different schematic domains were positively associated with 
COVID-19 anxiety and psychological distress and negatively associated with 
psychological well-being and life satisfaction. An EMS hierarchical regression 
model predicted COVID-19 anxiety. Mistrustfulness and vulnerability to harm and 
illness mediated the relationships between COVID-19 anxiety, psychological 
distress and life satisfaction.
CONCLUSIONS: According to these results, mistrustfulness and vulnerability to 
harm and illness can act as underlying variables for the decrease in mental 
health associated with the COVID-19 pandemic.

© 2022 John Wiley & Sons, Ltd.

DOI: 10.1002/cpp.2706
PMCID: PMC9015275
PMID: 34989057 [Indexed for MEDLINE]

Conflict of interest statement: The authors state that there is no conflict of 
interest.


2567. J Public Health Policy. 2022 Mar;43(1):140-148. doi: 10.1057/s41271-021-00335-5. 
Epub 2022 Jan 4.

We must practice what we preach: a framework to promote well-being and 
sustainable performance in the public health workforce in the United States.

Jackson Preston P(1).

Author information:
(1)Department of Public Health, California State University, Fullerton, 800 N. 
State College Blvd, KHS-121, Fullerton, CA, 92834, USA. 
Pjacksonpreston@fullerton.edu.

The COVID-19 pandemic, along with efforts to address systemic racism and social 
injustice, has required the public health workforce to mobilize an unprecedented 
and extensive frontline response while simultaneously delivering core services 
and addressing natural disasters and other emergent threats. Research conducted 
among health care professionals during the COVID-19 pandemic indicates an 
increase in anxiety, depression, and burnout, but mental health effects of the 
pandemic on the public health workforce are less well understood. Left 
unaddressed, secondary traumatic stress resulting from exposure to the trauma of 
those we serve, as well as burnout stemming from work-related factors, may 
hinder our ability to fulfill our mission to serve the population at large. This 
Viewpoint provides a framework for shifting our culture to prioritize the 
well-being and sustainable performance of the public health workforce to foster 
resilience and mitigate stressors.

© 2022. The Author(s), under exclusive licence to Springer Nature Limited.

DOI: 10.1057/s41271-021-00335-5
PMCID: PMC8724584
PMID: 34983961 [Indexed for MEDLINE]


2568. Health Aff (Millwood). 2022 Jan;41(1):105-111. doi: 10.1377/hlthaff.2021.01239.

Informal Caregivers Provide Considerable Front-Line Support In Residential Care 
Facilities And Nursing Homes.

Coe NB(1), Werner RM(2).

Author information:
(1)Norma B. Coe (nbcoe@pennmedicine.upenn.edu), University of Pennsylvania, 
Philadelphia, Pennsylvania.
(2)Rachel M. Werner, University of Pennsylvania and Corporal Michael J. Crescenz 
Veterans Affairs Medical Center, Philadelphia, Pennsylvania.

Informal care, or care provided by family and friends, is the most common form 
of care received by community-dwelling older adults with functional limitations. 
However, less is known about informal care provision within residential care 
settings including residential care facilities (for example, assisted living) 
and nursing homes. Using data from the Health and Retirement Study (2016) and 
the National Health and Aging Trends Study (2015), we found that informal care 
was common among older adults with functional limitations, whether they lived in 
the community, a residential care facility, or a nursing home. The hours of 
informal care provided were also nontrivial across all settings. This evidence 
suggests that informal caregiving and some of the associated burdens do not end 
when a person transitions from the community to residential care or a nursing 
home setting. It also points to the large role that families play in the care 
and well-being of these residents, which is especially important considering the 
recent visitor bans during the COVID-19 epidemic. Family members are an 
invisible workforce in nursing homes and residential care facilities, providing 
considerable front-line work for their loved ones. Providers and policy makers 
could improve the lives of both the residents and their caregivers by 
acknowledging, incorporating, and supporting this workforce.

DOI: 10.1377/hlthaff.2021.01239
PMCID: PMC8996285
PMID: 34982633 [Indexed for MEDLINE]


2569. Eur Rev Med Pharmacol Sci. 2021 Dec;25(24):7964-7970. doi: 
10.26355/eurrev_202112_27646.

Developing mental health nursing strategies for the inbound quarantined 
population in China during the COVID-19 global pandemic.

Zhao P(1), Ma XL.

Author information:
(1)First Affiliated Hospital of Kunming Medical University, Wu Hua District, 
Kunming City, Yunnan Province, China. maxiaoling01145@hotmail.com.

OBJECTIVE: The aim of the study was to develop mental health nursing strategies 
for the inbound quarantined population based on the results of a survey study 
and frontline nursing experiences.
SUBJECTS AND METHODS: A mixed research method was selected, we collected data by 
questionnaires from 128 quarantined people, and by semi-structured interviews 
from 5 registered nurses. Generalized anxiety disorder-7 (GAD-7), the patient 
health questionnaire-9 (PHQ-9), the Pittsburgh Sleep Quality Index (PSQI), 
Social Support Rating Scale (SSRS) were used in the quantitative research to 
identify the prevalence of psychological issues and risk factors. 
Semi-structured interviews were conducted in the qualitative study to conclude 
nursing experiences from RNs.
RESULTS: The overall prevalence of anxiety, depression, and insomnia were 34%, 
41%, and 18% respectively. Binary logistic regression analysis showed that 
social support, urban residence, and chronic disease were associated with mental 
health problems in certain aspects. Three themes were emerged from the analysis 
of RNs interviews: personality, chronic diseases, and social support.
CONCLUSIONS: The prevalence of mental health issues in the inbound quarantined 
population was the same as the general population in the initial stage of 
COVID-19 outbreak, and significantly lower than people who lived in high-risk 
areas. Living in urban areas, with chronic diseases, and obtaining less social 
support are the risk factors. Finally, four nursing strategies were proposed by 
the research team for mental health well-being.

DOI: 10.26355/eurrev_202112_27646
PMID: 34982459 [Indexed for MEDLINE]


2570. Eur Rev Med Pharmacol Sci. 2021 Dec;25(24):7847-7857. doi: 
10.26355/eurrev_202112_27632.

How physical activity behavior affected well-being, anxiety and sleep quality 
during COVID-19 restrictions in Iran.

Akbari HA(1), Pourabbas M, Yoosefi M, Briki W, Attaran S, Mansoor H, Moalla W, 
Damak M, Dergaa I, Teixeira AL, Nauman J, Behm DG, Bragazzi NL, Ben Saad H, 
Lavie CJ, Ghram A.

Author information:
(1)Department of Exercise Physiology, Faculty of Physical Education and Sport 
Sciences, University of Tehran, Tehran, Iran. robertobragazzi@gmail.com.

OBJECTIVE: The Islamic Republic of Iran has displayed one of the highest rates 
of COVID-19 infection in the world and the highest rate of mortality in the 
Middle East. Iran has used a stringent package of preventive health measures to 
mitigate the spread of infection, which however has negatively affected 
individuals' physical and psychological health. This study aimed at examining 
whether physical-activity (PA) behavior, anxiety, well-being, and sleep-quality 
changed in response to the COVID-19-related public health restrictions enforced 
in Iran.
PATIENTS AND METHODS: An online questionnaire was disseminated to adults 
residing in Iran from November 17, 2020, to February 13, 2021 (~88 days), during 
Iran's strictest public health restrictions. Main outcome measures included 
Godin-Shephard Leisure-Time Exercise Questionnaire, General Anxiety Disorder-7, 
Mental Health Continuum-Short Form, and Pittsburgh Sleep Quality Index.
RESULTS: A total of 3,323 adults (mean age 30±11 years, 54.3% female) 
participated in the survey. Firstly, the restrictions generally reduced PA 
behavior: (a) among inactive participants (IPs), 60.6% became less active vs. 
5.1% who became more active; and (b) among active participants (APs), 49.9% 
became less active vs. 22.8% who became more active. Secondly, PA behavior was 
associated with higher well-being and sleep quality during the restrictions: (a) 
APs reported higher (or lower) levels of well-being and sleep quality (or 
anxiety) than did IPs; and (b) among IPs as well as among APs, the more active 
the participants, the greater (or lower) the levels of well-being and sleep 
quality (or anxiety).
CONCLUSIONS: This study showed the beneficial role of PA behavior for 
well-being, anxiety, and sleep quality during the COVID-19 restrictions, whereas 
such restrictions appeared to decrease PA participation. Active lifestyle should 
be then encouraged during the COVID-19 outbreak while taking precautions.

DOI: 10.26355/eurrev_202112_27632
PMID: 34982447 [Indexed for MEDLINE]


2571. Ann Behav Med. 2022 May 18;56(5):484-497. doi: 10.1093/abm/kaab106.

Psychological Predictors of Self-reported COVID-19 Outcomes: Results From a 
Prospective Cohort Study.

Ayling K(1), Jia R(1), Coupland C(1), Chalder T(2), Massey A(1), Broadbent E(3), 
Vedhara K(1).

Author information:
(1)Centre for Academic Primary Care, University of Nottingham, University Park, 
Nottingham, UK.
(2)Department of Psychological Medicine, Institute of Psychiatry, Psychology & 
Neuroscience, King's College London, London, UK.
(3)Department of Psychological Medicine, University of Auckland, Auckland, New 
Zealand.

BACKGROUND: Previous research has shown that psychological factors, such as 
stress and social support, are associated with greater susceptibility to viral 
respiratory illnesses and more severe symptoms. During the COVID-19 pandemic 
there has been a well-documented deterioration in psychological well-being and 
increased social isolation. This raises questions as to whether those 
experiencing psychological adversity during the pandemic are more at risk of 
contracting and/or experiencing COVID-19 symptoms.
PURPOSE: To examine the relationship between psychological factors and the risk 
of COVID-19 self-reported infection and the symptomatic experience of SARS-CoV-2 
(indicated by the number and severity of symptoms).
METHODS: As part of a longitudinal prospective observational cohort study, 1,087 
adults completed validated measures of psychological well-being during April 
2020 and self-reported incidence of COVID-19 infection and symptom experience 
across the pandemic through to December 2020. Regression models were used to 
explore these relationships controlling for demographic and occupational 
factors.
RESULTS: Greater psychological distress during the early phase of the pandemic 
was significantly associated with subsequent self-reported SARS-CoV-2 infection 
as well as the experience of a greater number and more severe symptoms.
CONCLUSIONS: COVID-19 infection and symptoms may be more common among those 
experiencing elevated psychological distress. Further research to elucidate the 
mechanisms underlying these associations is needed.

© The Author(s) 2022. Published by Oxford University Press on behalf of the 
Society of Behavioral Medicine.

DOI: 10.1093/abm/kaab106
PMCID: PMC8755370
PMID: 34979556 [Indexed for MEDLINE]


2572. J Affect Disord. 2022 Mar 1;300:289-295. doi: 10.1016/j.jad.2021.12.114. Epub 
2022 Jan 1.

The effects of perceived psychological, educational, and financial impact of 
COVID-19 pandemic on Greek university students' satisfaction with life through 
Mental Health.

Kokkinos CM(1), Tsouloupas CN(2), Voulgaridou I(3).

Author information:
(1)Department of Primary Education, School of Education Sciences, Democritus 
University of Thrace, Greece. Electronic address: kkokkino@eled.duth.gr.
(2)Department of Life and Health Science, School of Sciences and Engineering, 
University of Nicosia, Cyprus.
(3)Department of Primary Education, School of Education Sciences, Democritus 
University of Thrace, Greece; Department of Education Sciences in Early 
Childhood, School of Education Sciences, Democritus University of Thrace, 
Greece; School of Humanities, Hellenic Open University, Greece.

BACKGROUND: The purpose of this study was to provide an operating mechanism for 
understanding the effects of COVID-19's on satisfaction with life, subject to 
students' general mental health METHODS: A sample of 1653 Greek speaking 
university students (72.4% females, 65.3% undergraduate, M age=26.1) completed 
an online survey including measures for perceived psychological, academic, and 
financial impact of the COVID-19 pandemic, general mental health and 
satisfaction with life.
RESULTS: A mediation model was tested to illuminate these relationships by 
considering students' general mental health as a mediator. Findings demonstrated 
that there were significant direct effects of perceived COVID-19 impact on 
participants' financial status on satisfaction with life and indirect effects of 
perceived COVID-19 impact on participants' financial status and academic 
performance respectively on satisfaction with life through general mental 
health.
LIMITATIONS: The study's cross-sectional design, self-report data and snowball 
sampling.
CONCLUSIONS: The findings add to our understanding of the relationship between 
perceived COVID-19 impact and life satisfaction among university students, and 
they shed light on the critical role of general mental health in mediating the 
relationship. Targeting the factors that influence general mental health can 
help to mitigate potential problems while also finding ways to improve mental 
health and well-being.

Copyright © 2021. Published by Elsevier B.V.

DOI: 10.1016/j.jad.2021.12.114
PMCID: PMC8733280
PMID: 34979179 [Indexed for MEDLINE]

Conflict of interest statement: All the authors declare that there is no 
conflict of interest.


2573. JMIR Mhealth Uhealth. 2022 Jul 1;10(7):e30976. doi: 10.2196/30976.

The Efficacy of "Foundations," a Digital Mental Health App to Improve Mental 
Well-being During COVID-19: Proof-of-Principle Randomized Controlled Trial.

Catuara-Solarz S(1), Skorulski B(1), Estella-Aguerri I(1), Avella-Garcia CB(1), 
Shepherd S(1), Stott E(1), Hemmings NR(1), Ruiz de Villa A(1), Schulze L(1), Dix 
S(1).

Author information:
(1)Koa Health, Barcelona, Spain.

BACKGROUND: Against a long-term trend of increasing demand, the COVID-19 
pandemic has led to a global rise in common mental disorders. Now more than 
ever, there is an urgent need for scalable, evidence-based interventions to 
support mental well-being.
OBJECTIVE: The aim of this proof-of-principle study was to evaluate the efficacy 
of a mobile-based app in adults with self-reported symptoms of anxiety and 
stress in a randomized control trial that took place during the first wave of 
the COVID-19 pandemic in the United Kingdom.
METHODS: Adults with mild to severe anxiety and moderate to high levels of 
perceived stress were randomized to either the intervention or control arm. 
Participants in the intervention arm were given access to the Foundations app 
for the duration of the 4-week study. All participants were required to 
self-report a range of validated measures of mental well-being (10-item 
Connor-Davidson Resilience scale [CD-RISC-10], 7-item Generalized Anxiety 
Disorder scale [GAD-7], Office of National Statistics Four Subjective Well-being 
Questions [ONS-4], World Health Organization-5 Well-Being Index [WHO-5]) and 
sleep (Minimal Insomnia Scale [MISS]) at baseline and at weeks 2 and 4. The 
self-reported measures of perceived stress (10-item Perceived Stress Score 
[PSS-10]) were obtained weekly.
RESULTS: A total of 136 participants completed the study and were included in 
the final analysis. The intervention group (n=62) showed significant 
improvements compared to the control group (n=74) on measures of anxiety, with a 
mean GAD-7 score change from baseline of -1.35 (SD 4.43) and -0.23 (SD 3.24), 
respectively (t134=1.71, P=.04); resilience, with a mean change in CD-RISC score 
of 1.79 (SD 4.08) and -0.31 (SD 3.16), respectively (t134=-3.37, P<.001); sleep, 
with a mean MISS score change of -1.16 (SD 2.67) and -0.26 (SD 2.29), 
respectively (t134=2.13, P=.01); and mental well-being, with a mean WHO-5 score 
change of 1.53 (SD 5.30) and -0.23 (SD 4.20), respectively (t134=-2.16, P=.02), 
within 2 weeks of using Foundations, with further improvements emerging at week 
4. Perceived stress was also reduced within the intervention group, although the 
difference did not reach statistical significance relative to the control group, 
with a PSS score change from baseline to week 2 of -2.94 (SD 6.84) and -2.05 (SD 
5.34), respectively (t134= 0.84, P=.20).
CONCLUSIONS: This study provides a proof of principle that the digital mental 
health app Foundations can improve measures of mental well-being, anxiety, 
resilience, and sleep within 2 weeks of use, with greater effects after 4 weeks. 
Foundations therefore offers potential as a scalable, cost-effective, and 
accessible solution to enhance mental well-being, even during times of crisis 
such as the COVID-19 pandemic.
TRIAL REGISTRATION: OSF Registries osf.io/f6djb; https://osf.io/vm3xq.

©Silvina Catuara-Solarz, Bartlomiej Skorulski, Iñaki Estella-Aguerri, Claudia 
Bibiana Avella-Garcia, Sarah Shepherd, Emily Stott, Nicola R Hemmings, Aleix 
Ruiz de Villa, Laura Schulze, Sophie Dix. Originally published in JMIR mHealth 
and uHealth (https://mhealth.jmir.org), 01.07.2022.

DOI: 10.2196/30976
PMCID: PMC9255362
PMID: 34978535 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: All authors, excluding 
NRH and LS, were employees of Telefónica Innovación Alpha at the time of the 
study. The app and the authors have now transferred from Telefonica Innovation 
Alpha to Koa Health.


2574. AIDS Behav. 2022 Jun;26(6):1905-1922. doi: 10.1007/s10461-021-03541-0. Epub 2022 
Jan 3.

Stay-at-Home: The Impact of the COVID-19 Lockdown on Household Functioning and 
ART Adherence for People Living with HIV in Three Sub-districts of Cape Town, 
South Africa.

Campbell LS(1), Masquillier C(2), Knight L(3)(4), Delport A(4), Sematlane 
N(2)(4), Dube LT(4), Wouters E(2)(5).

Author information:
(1)Centre for Population, Family and Health, University of Antwerp, Prinsstraat 
13, 2000, Antwerpen, Belgium. linda.campbell@uantwerpen.be.
(2)Centre for Population, Family and Health, University of Antwerp, Prinsstraat 
13, 2000, Antwerpen, Belgium.
(3)Division of Social and Behavioural Sciences, School of Public Health and 
Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, 
South Africa.
(4)School of Public Health, Community and Health Sciences, University of the 
Western Cape, Cape Town, South Africa.
(5)Centre for Health Systems Research & Development, University of the Free 
State, Bloemfontein, South Africa.

In March 2020, the South African government imposed a lockdown to control 
COVID-19 transmission. Lockdown may affect people living with HIV's (PLWH) 
antiretroviral therapy (ART) adherence. Data from a cluster randomised control 
trial was collected from 152 PLWH in Cape Town sub-districts from October 
2019-March 2020 when the lockdown halted collection. Subsequently, 83 PLWH were 
followed-up in June-July 2020. Random effects models were used to analyse: (1) 
changes between baseline and follow-up and (2) correlates of adherence during 
lockdown. At follow-up, there was an increase in the odds of being below the 
poverty line and the odds of experiencing violence decreased. Measures for 
well-being, household functioning, stigma and HIV competency improved. Violence, 
depression, food insecurity, and stigma were associated with poorer ART 
adherence; higher well-being scores were associated with better adherence. 
During lockdown, governments need to ensure financial support, access to 
(mental) health services, and services for those experiencing violence.Clinical 
Trial Number: Pan African Clinical Trial Registry, PACTR201906476052236. 
Registered on 24 June 2019.

Publisher: En marzo de 2020, el gobierno sudafricano impuso un confinamiento 
generalizado para controlar la transmisión del COVID-19. Estas medidas pueden 
afectar la adherencia a la terapia antirretroviral de las personas con VIH. A 
partir de un ensayo aleatorio grupal se recopilan datos de 152 personas con VIH 
en los sub-distritos de Ciudad del Cabo entre octubre de 2019 y marzo de 2020 
cuando el confinamiento detuvo la recopilación. Posteriormente, se realizó un 
seguimiento de 83 pacientes entre junio y julio de 2020. Se utilizaron modelos 
de efectos aleatorios para analizar: 1) los cambios en las variables entre la 
línea de base y de seguimiento; 2) covariables de adhesión al tratamiento. En el 
seguimiento se observa que aumentaron las probabilidades de estar por debajo del 
umbral de pobreza y disminuyeron las probabilidades de sufrir violencia. Las 
medidas de bienestar, funcionamiento del hogar, estigma e idoneidad en materia 
de VIH mejoraron entre la línea base y el seguimiento. Por otro lado, la 
violencia, la depresión, la inseguridad alimentaria y el estigma se asocian a 
una menor adherencia al tratamiento antirretroviral, mientras la mejora del 
bienestar se asocia a una mayor adherencia al tratamiento. De tal manera, se 
observa que durante situaciones de emergencia que requieran de confinamientos es 
recomendable que los gobiernos garanticen apoyo financiero, atención a la salud 
física y mental de manera continua, así como servicios especializados hacia 
quienes sufren violencia.

© 2021. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s10461-021-03541-0
PMCID: PMC8720535
PMID: 34977957 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


2575. J Acquir Immune Defic Syndr. 2022 Apr 15;89(5):481-488. doi: 
10.1097/QAI.0000000000002901.

Structural and Psychosocial Impacts of the COVID-19 Pandemic on HIV Care and 
Treatment Outcomes Among Female Sex Workers in the Dominican Republic.

Wang Y(1), Karver TS(1), Barrington C(2), Donastorg Y(3), Perez M(3), Gomez 
H(3), Davis W(1), Galai N(4)(5), Kerrigan D(1).

Author information:
(1)Department of Prevention and Community Health, Milken Institute School of 
Public Health, George Washington University, Washington, DC.
(2)Department of Health Behavior, Gillings Global School of Public Health, 
University of North Carolina, Chapel Hill, NC.
(3)HIV Vaccine Trials Research Unit, Instituto Dermatologico y Cirugia de la 
Piel, Santo Domingo, Dominican Republic.
(4)Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins 
University, Baltimore, MD; and.
(5)Department of Statistics, University of Haifa, Haifa, Israel.

BACKGROUND: The COVID-19 pandemic and its associated socioeconomic disruptions 
have disproportionally affected marginalized populations, including people 
living with HIV. Little is known about how the pandemic has affected populations 
experiencing multiple forms of stigma, discrimination, and violence, such as 
female sex workers (FSW) living with HIV.
METHODS: We conducted a cross-sectional survey between August and December 2020 
among 187 FSW living with HIV in the Dominican Republic to examine the impact of 
COVID-19. Using multivariable logistic regression, we examined associations 
between COVID-19-related financial concerns, mental health, substance use, and 
partner abuse on engagement in HIV care and antiretroviral therapy adherence. We 
conducted mediation analysis to assess whether mental health challenges mediated 
the impact of partner abuse or substance use on HIV outcomes.
RESULTS: Most participants reported no income (72%) or a substantial decline in 
income (25%) since the COVID-19 pandemic. Approximately one-third of the 
participants (34%) reported COVID-19 had an impact on their HIV care and 
treatment. Greater COVID-19 financial concerns (adjusted odds ratio [aOR] = 
1.14, 95% CI: 1.02 to 1.27), mental health challenges (aOR = 1.38, 95% CI: 1.06 
to 1.79), and partner emotional abuse (aOR = 2.62, 95% CI: 1.01 to 6.79) were 
associated with higher odds of negatively affected HIV care, respectively. The 
relationship between increased emotional partner abuse and negatively affected 
HIV care was mediated by greater COVID-19-related mental health challenges.
CONCLUSIONS: FSW living with HIV in the Dominican Republic have been 
significantly affected by the COVID-19 pandemic. Targeted interventions that 
address structural (financial security and partner abuse) and psychosocial 
(mental health) factors are needed to sustain HIV outcomes and well-being.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/QAI.0000000000002901
PMCID: PMC9058160
PMID: 34974474 [Indexed for MEDLINE]

Conflict of interest statement: D.K. received an R01 grant from the NIH as a PI 
(R01MH110158). Y.W. received a pilot award (PI: Y.W.) from the District of 
Columbia Center for AIDS Research, an NIH-funded program (P30AI117970), which is 
supported by the following NIH cofunding and participating institutes and 
centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, NIDDK, NIMHD, NIDCR, NINR, 
FIC, and OAR. The authors have no conflicts of interest to disclose. The content 
is solely the responsibility of the authors and does not necessarily represent 
the official views of the NIH.


2576. Semin Nephrol. 2021 Nov;41(6):580-591. doi: 10.1016/j.semnephrol.2021.10.010.

The Role of Kidney Supportive Care and Active Medical Management Without 
Dialysis in Supporting Well-Being in Kidney Care.

Lupu D(1), Moss AH(2).

Author information:
(1)Center for Aging, Health and Humanities, George Washington University, 
Washington, DC. Electronic address: dlupu@gwu.edu.
(2)Center for Health Ethics and Law, West Virginia University School of 
Medicine, Morgantown, WV.

People living with kidney failure often experience a higher symptom burden 
(including anxiety and depression) and lower quality of life than patients with 
other serious chronic diseases. The end of life for these patients is 
characterized by high intensity of treatment (such as intensive care unit stays) 
and lack of support for family. Kidney supportive care, which emphasizes quality 
of life, person-centered care, and holistic care for the person and their 
family, is an approach that improves well-being by aligning care with the 
patient's preferences and goals. Kidney supportive care encompasses identifying 
seriously ill patients, eliciting patient values and goals through shared 
decision making and advance care planning, assessing and managing symptoms, 
communicating prognosis, offering active medical management without dialysis, 
and planning and managing care transitions, especially at the end of life. 
Models, strategies, and tools for incorporating kidney supportive care and 
active medical management without dialysis into existing workflows are 
available. However, barriers to implementation in the United States include 
clinician knowledge gaps, current workflows, and financial incentives, which 
make it difficult to break from the de facto default practice of starting 
dialysis for patients with kidney failure regardless of age, frailty, or 
debilitating condition. Policy changes are needed to fully implement kidney 
supportive care in the United States.

Copyright © 2021 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.semnephrol.2021.10.010
PMID: 34973702 [Indexed for MEDLINE]


2577. Infant Ment Health J. 2022 Jan;43(1):55-68. doi: 10.1002/imhj.21956. Epub 2022 
Jan 1.

Taking care of the caregivers: The moderating role of reflective supervision in 
the relationship between COVID-19 stress and the mental and professional 
well-being of the IECMH workforce.

Morelen D(1), Najm J(1), Wolff M(1), Daniel K(1).

Author information:
(1)Department of Psychology, East Tennessee State University, Johnson City, 
Tennessee, USA.

The present study examined the relationships between COVID-related stress, 
mental health and professional burnout in the infant and early child mental 
health (IECMH) workforce and examined reflective supervision and consultation 
(RSC) as a potential protective factor in the context of COVID-related stress. 
Participants included 123 adults (n = 121 female, modal age range 30-39 years) 
in the TN IECMH workforce (mean years of experience = 13.6 years) surveyed in 
June/July 2020. Sector representation was quite varied (home visiting, 
childcare, child welfare, early intervention). Results indicated the majority 
(63%) of the sample was caring for someone else (e.g., child or elderly person) 
while working at home, 46% of the sample had depression symptoms (18% in the 
moderate-severe range), and 75% of the sample had anxiety symptoms (33% in the 
moderate-severe range). Higher COVID stress was associated with higher 
internalizing symptoms and burnout levels and this relationship was mediated by 
self-care behaviors such that the more COVID stress one reported, the fewer 
self-care behaviors they engaged in, and the higher the risk for internalizing 
and burnout. Finally, the pathway from COVID stress to self-care behaviors was 
moderated by RSC. IECMH professionals who received less than 1 year (or no 
experience) of RSC showed a significant decrease in self-care behaviors during 
times of low, average and high levels of COVID stress compared to those who 
received 1 year or more of RSC. Implications for both policy and practice will 
be discussed.

Publisher: El presente estudio examinó las relaciones entre el estrés causado 
por el COVID, la salud mental y el cansancio profesional en la fuerza laboral de 
IECMH y examinó la supervisión y consulta con reflexión (RSC) como un potencial 
factor de protección en el contexto del estrés relacionado con COVID. Los 
participantes fueron 123 adultos (edad modal entre 30-39 años) de la fuerza 
laboral de IECMH en TN (años promedio de experiencia = 13.6 años). La 
representación de sector fue muy variada (visitas a casa, bienestar infantil, 
intervención temprana). Los resultados indicaron que el 63% del grupo muestra 
tenía bajo su cuidado a alguien más mientras trabajaba en casa, el 46% del grupo 
muestra presentaba síntomas de depresión y el 75% del grupo muestra tenía 
síntomas de ansiedad. El más alta estrés por COVID se asoció con más altos 
síntomas de internalización y niveles de cansancio y esta relación fue mediada 
por conductas de autocuidado de manera que mientras más estrés por COVID se 
reportaba, ellos participaban en menos conductas de autocuidado y era más alto 
el riesgo de internalización y cansancio. Finalmente, el paso del estrés por 
COVID a las conductas de autocuidado fue moderado por RSC. Los profesionales de 
IECMH que recibieron menos de 1 año (o ninguna experiencia) de RSC mostraron una 
significativa baja en conductas de autocuidado durante momentos de bajos, 
promedio y altos niveles de estrés por COVID, comparados con aquellos que 
recibieron 1 año o más de RSC. Se discuten las implicaciones tanto para 
políticas como para la práctica.

Publisher: Cette étude a examiné les relations entre le stress lié au COVID, la 
santé mentale et le burnout professionnel chez les effectifs de IECMH et examiné 
la supervision et la consultation de réflexion (RSC en anglais) en tant que 
facteur de protection potentiel dans le contexte du stress lié au COVID. Les 
participants ont inclus 123 adultes (tranche d’âge modale 30-39 ans) dans les 
effectifs TN IECHM (moyenne d'années d'expérience - 13,6 années). La 
représentation par secteur était assez variée (visites à domicile, bien-être de 
l'enfant, intervention précoce). Les résultats indiquent que 63% de 
l’échantillon prenait soin de quelqu'un d'autre tout en travaillant à la maison, 
46% de l’échantillon présentaient des symptômes de dépression et 75% de 
l’échantillon avaient des symptômes d'anxiété. Un stress COVID plus élevé était 
lié avec des symptômes d'internalisation plus élevés et des niveaux de burnout 
plus élevés et cette relation était mitigée par des comportements d'auto-soin, à 
tel point que plus quelqu'un faisait état de stress de COVID, le moins cette 
même personne s'engageait en comportement d'auto-soin, et les plus élevé 
s'avérait le risque d'internalisation et de burnout. Enfin, la trajectoire du 
stress COVID aux comportements d'auto-soin était modérée par la RSC. Les 
professionnels IECMH ayant reçu moins d'une année (ou pas d'expérience) de la 
RSC ont présenté une baisse importante dans les comportements d'auto-soin durant 
les moments de niveaux de stress COVID bas, moyens et élevés, comparés à ceux 
ayant reçu une année ou plus de RSC. Les implications pour les politiques et les 
pratiques seront discutées.

Publisher: Fürsorge für Pflegekräfte: Die moderierende Rolle reflektierter 
Supervision im Zusammenhang von COVID-19-Stress und dem psychischen und 
beruflichen Wohlbefinden von IECMH-Mitarbeitenden Die vorliegende Studie 
untersuchte die Beziehungen zwischen COVID-bedingtem Stress, psychischer 
Gesundheit und beruflichem Burnout bei IECMH-Mitarbeitenden. Außerdem wurde 
reflektierte Supervision und Beratung (reflective supervision and consultation; 
RSC) als potenzieller Schutzfaktor im Zusammenhang mit COVID-bedingtem Stress 
untersucht. Zu den Teilnehmenden gehörten 123 Erwachsene (modale Alterspanne 
30-39 Jahre), die in der TN IECMH tätig sind (durchschnittliche Berufserfahrung 
= 13,6 Jahre). Unterschiedliche Sektoren waren vertreten (Hausbesuche, Kinder- 
und Jugendhilfe, Frühförderung). Die Ergebnisse zeigten, dass 63 % der 
Stichprobe sich neben der Arbeit noch zuhause um jemanden kümmerten, 46 % der 
Stichprobe hatten Depressionssymptome und 75 % der Stichprobe hatten 
Angstsymptome. Höherer COVID-Stress war mit höheren Internalisierungssymptomen 
und Burnout-Levels assoziiert. Diese Beziehung wurde durch 
Selbstfürsorgeverhalten mediiert, d. h. je mehr COVID-Stress berichtet wurde, 
desto weniger Selbstfürsorgeverhalten wurde praktiziert und desto höher war das 
Risiko für Internalisierung und Burnout. Der Zusammenhang zwischen COVID-Stress 
und Selbstfürsorgeverhalten wurde durch RSC moderiert. IECMH-Mitarbeitende, die 
weniger als ein Jahr (oder gar keine Erfahrung) mit RSC hatten, zeigten eine 
signifikante Abnahme des Selbstfürsorgeverhaltens in Zeiten von niedrigem, 
mittlerem und hohem COVID-Stress im Vergleich zu denjenigen, die ein Jahr oder 
mehr RSC hatten. Implikationen für Politik und Praxis werden diskutiert.

Publisher: 
援助職者をケアすること:乳幼児精神保健従事者におけるCOVID-19によるストレスと精神面および専門性の健全との関係を緩和する内省的スーパービジョンの役割 
本研究では、乳幼児精神保健 (IECMH) 
従事者におけるCOVID関連のストレスとメンタルヘルス、燃え尽き症候群の間の関係性を調査し、COVID関連のストレスという文脈における潜在的保護因子としての内省的スーパービジョンおよびコンサルテーション 
(RSC) を検討した。参加者はテネシー州IECMH従事者 (経験年数平均13.6年) の中の123名 (主に30歳から39歳) 
である。活動部門はかなり多様な形態である (家庭訪問、児童福祉、早期介入) 
。結果から、被験者の63％は自宅で仕事をしながら誰かほかの人世話をし、46％は抑うつ症状があり、75％には不安症状がみられた。COVIDのストレスが高くなるほど内在化症状と燃え尽き症候群の度合いが高くなるが、この関係はセルフケア行動によって媒介されていた。それはCOVIDのストレスが高いほど、セルフケア行動が少なくなり、内在化と燃え尽き症候群のリスクが高くなるということである。最後に、COVIDのストレスからセルフケア行動への経路は、RSCにより緩和された。RSCを受けて1年未満 
(あるいは未経験) 
のIECMH専門家は1年以上RSCを受けて来た専門家と比べて、COVIDのストレスが低い、平均的、高いレベルのそれぞれの期間にセルフケア行動の有意な減少が見られた。政策と実践の両方の意味を検討する。>キーワード:乳幼児精神保健、燃え尽き症候群、セルフケア、内省的スーパービ.

Publisher: 本研究调查了IECMH工作人员中与COVID相关的压力、心理健康和职业倦怠之间的关系, 并考察了反思性监督和咨询 (RSC) 
作为COVID相关压力背景下的潜在保护因素。参与者包括田纳西州IECMH工作人员中的123名成年人 (年龄范围众数是30-39岁, 平均工作年限是13.6年) 
。部门代表性差异很大 (家访、儿童福利、早期干预) 。结果表明, 63%的样本在家工作时也需照顾他人, 46%的样本有抑郁症状, 
75%的样本有焦虑症状。较高的COVID压力与较高的内化症状和倦怠水平相关, 这种关系是由自我护理行为介导的, 也即报告的COVID压力越大, 
他们从事的自我护理行为就越少, 内化和倦怠的风险就越高。最后, 
RSC调节了从COVID压力到自我护理行为的途径。与接受1年或更长时间RSC的IECMH专业人员相比, 接受RSC少于1年 (或没有经验) 
的IECMH专业人员在低、平均和高水平的COVID压力下的自我护理行为显著减少。本研究还将讨论上述研究结果对政策和实践的影响。.

Publisher: العناية بمقدمي الرعاية: الدور الوسيط للإشراف التأملي في العلاقة بين 
الإجهاد العصبي لكوفيد-19 والرفاهية النفسية والمهنية للقوى العاملة في مجال الصحة 
النفسية للرضع والطفولة المبكرة (IECMH) تناولت الدراسة الحالية العلاقات بين 
الإجهاد المرتبط بكوفيد والصحة النفسية والإنهاك المهني عند القوى العاملة في مجال 
الصحة النفسية للرضع والأطفال. كما تناولت الإشراف والتشاور التأملي (RSC) كعامل 
وقائي محتمل في سياق الإجهاد المرتبط بكوفيد. تضمن المشاركون 123 شخصًا بالغًا 
(30-39 عامًا) من القوة العاملة في مجال الصحة النفسية للأطفال في تينيسي (متوسط 
سنوات الخبرة = 13.6 عامًا). وكانت القطاعات ممثلة بشكل متنوع (زيارة المنزل ، 
ورعاية الطفل ، والتدخل المبكر). أشارت النتائج إلى أن 63٪ من العينة كانوا يعتنون 
بشخص آخر أثناء العمل في المنزل ، و 46٪ من العينة يعانون من أعراض الاكتئاب ، و 
75٪ من العينة يعانون من أعراض القلق. ارتبط ارتفاع ضغط كوفيد بارتفاع الأعراض 
الداخلية ومستويات الإرهاق ، وتوسطت هذه العلاقة سلوكيات الرعاية الذاتية بحيث أنه 
كلما زاد ضغط كوفيد الذي أبلغ عنه الشخص ، كلما قل عدد سلوكيات الرعاية الذاتية 
التي ينخرطون فيها ، وزادت مخاطر الاستيعاب والإرهاق. . أخيرًا ، المسار من إجهاد 
كوفيد إلى سلوكيات الرعاية الذاتية تم توسطه من خلال الإشراف والتشاور التأملي 
(RSC). وأظهر المهنيون في مجال الصحة النفسية للأطفال الذين تلقوا أقل من سنة واحدة 
(أو لا خبرة) في (RSC) انخفاضًا ملحوظًا في سلوكيات الرعاية الذاتية خلال أوقات 
المستويات المنخفضة والمتوسطة والعالية من إجهاد كوفيد مقارنةً بأولئك الذين تلقوا 
سنة واحدة أو أكثر من RSC. وتناقش الدراسة تطبيقات النتائج على السياسات والممارسات 
في مجال الصحة النفسية للأطفال والرضع.

© 2021 Michigan Association for Infant Mental Health.

DOI: 10.1002/imhj.21956
PMCID: PMC9015542
PMID: 34973059 [Indexed for MEDLINE]


2578. BMJ Open. 2021 Dec 31;11(12):e053396. doi: 10.1136/bmjopen-2021-053396.

'We weren't checked in on, nobody spoke to us': an exploratory qualitative 
analysis of two focus groups on the concerns of ethnic minority NHS staff during 
COVID-19.

Jesuthasan J(1), Powell RA(2), Burmester V(1), Nicholls D(3).

Author information:
(1)Department of Brain Sciences, Imperial College London Faculty of Medicine, 
London, UK.
(2)Department of Primary Care and Public Health, Imperial College London School 
of Public Health, London, UK.
(3)Department of Brain Sciences, Imperial College London Faculty of Medicine, 
London, UK d.nicholls@imperial.ac.uk.

OBJECTIVE: To gain exploratory insights into the multifaceted, lived experience 
impact of COVID-19 on a small sample of ethnic minority healthcare staff to 
cocreate a module of questions for follow-up online surveys on the well-being of 
healthcare staff during the pandemic.
DESIGN: A cross-sectional design using two online focus groups among ethnic 
minority healthcare workers who worked in care or supportive roles in a 
hospital, community health or primary care setting for at least 12 months.
PARTICIPANTS: Thirteen healthcare workers (11 female) aged 26-62 years from 
diverse ethnic minority backgrounds, 11 working in clinical roles.
RESULTS: Five primary thematic domains emerged: (1) viral vulnerability, 
centring around perceived individual risk and vulnerability perceptions; (2) 
risk assessment, comprising pressures to comply, perception of a tick-box 
exercise and issues with risk and resource stratification; (3) interpersonal 
relations in the workplace, highlighting deficient consultation of ethnic 
minority staff, cultural insensitivity, need for support and collegiate 
judgement; (4) lived experience of racial inequality, consisting of job 
insecurity and the exacerbation of systemic racism and its emotional burden; (5) 
community attitudes, including public prejudice and judgement, and patient 
appreciation.
CONCLUSIONS: Our novel study has shown ethnic minority National Health Service 
(NHS) staff have experienced COVID-19 in a complex, multidimensional manner. 
Future research with a larger sample should further examine the complexity of 
these experiences and should enumerate the extent to which these varied thematic 
experiences are shared among ethnic minority NHS workers so that more empathetic 
and supportive management and related occupational practices can be instituted.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/bmjopen-2021-053396
PMCID: PMC8720640
PMID: 34972767 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2579. Child Abuse Negl. 2022 Aug;130(Pt 1):105450. doi: 10.1016/j.chiabu.2021.105450. 
Epub 2021 Dec 23.

COVID-19 distress, negative parenting, and child behavioral problems: The 
moderating role of parent adverse childhood experiences.

Hails KA(1), Petts RA(2), Hostutler CA(3), Simoni M(4), Greene R(5), Snider 
TC(6), Riley AR(7).

Author information:
(1)Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, 
OR 97239, United States of America; University of Oregon Prevention Science 
Institute, 1600 Millrace Dr., Eugene, OR 97403, United States of America. 
Electronic address: khails@uoregon.edu.
(2)Fairleigh Dickinson University, 1000 River Rd., Teaneck, NJ 07666, United 
States of America. Electronic address: r.santer@fdu.edu.
(3)Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, 
United States of America. Electronic address: 
cody.hostutler@nationwidechildrens.org.
(4)Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, 
OR 97239, United States of America. Electronic address: simonim@ohsu.edu.
(5)Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, 
OR 97239, United States of America. Electronic address: greenrac@ohsu.edu.
(6)Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, 
United States of America. Electronic address: 
tyanna.snider@nationwidechildrens.org.
(7)Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, 
OR 97239, United States of America. Electronic address: rileyand@ohsu.edu.

BACKGROUND: Heightened familial stress and distress during the COVID-19 pandemic 
may lead to increased negative parenting practices, particularly for parents 
with substantial adverse childhood experiences (ACES).
OBJECTIVE: To determine whether families' COVID-19-related distress is 
associated with young children's emotional/behavioral functioning via negative 
parenting, and whether these relationships vary based on parents' ACEs.
PARTICIPANTS AND SETTING: Participants were 267 parents of children ages 
1.5-5 years recruited from five primary care sites across the United States.
METHODS: Participants completed internet questionnaires including measures of 
demographics, parent ACES, negative parenting, parent mental health, and 
COVID-19 distress. We used regression analyses to test a moderated mediation 
model in which the relationship between COVID-19 distress and child 
emotional/behavioral problems is mediated by negative parenting, and both the 
direct and indirect effects of COVID-19 distress on child emotional/behavioral 
problems is moderated by parents' ACEs.
RESULTS: Negative parenting significantly mediated the relationship between 
COVID-19 distress and child emotional/behavioral problems (indirect effect 
β = 0.07). Parents' ACEs moderated the associations between COVID-19 distress 
and both negative parenting and child emotional/behavioral problems, such that 
each relationship was stronger in the context of higher parental ACEs. The model 
accounted for 42% of the variance in child emotional/behavioral problems.
CONCLUSIONS: Findings have implications for managing risk and promoting 
well-being in young children during periods of significant stress and routine 
disruption. This study advances understanding of factors influencing negative 
outcomes in children during the pandemic's acute phase and may have implications 
for the development of targeted interventions to improve families' adjustment in 
the future.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.chiabu.2021.105450
PMCID: PMC8710429
PMID: 34969517 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


2580. Prim Care Companion CNS Disord. 2021 Dec 30;24(1):21m02991. doi: 
10.4088/PCC.21m02991.

Subjective Well-being Among Migrant Workers Residing in a Shelter Home During 
Lockdown: A Pilot Survey From North India.

Singh GP(1)(2), Arun P(1).

Author information:
(1)Department of Psychiatry, Government Medical College and Hospital, 
Chandigarh, India.
(2)Corresponding author: Gurvinder Pal Singh, MD, Department of Psychiatry, 
Government Medical College and Hospital, Chandigarh, India 160030 
(gpsluthra@gmail.com).

Objective: To explore the impact of lockdown due to coronavirus disease 2019 
(COVID-19) on the subjective well-being of migrant workers staying in a shelter 
home in India. Methods: A total of 54 residents of the shelter home participated 
in this exploratory survey study. Baseline assessments included sociodemographic 
profile, the Subjective Well-Being Inventory (SUBI), and the Perceived Stress 
Scale. The participants were reassessed with the SUBI after 2 weeks of staying 
in the shelter home. The survey was administered April 11 to May 10, 2020. 
Results: The mean ± SD age of the participants was 23.54 ± 11.68 years, and the 
majority were men and in the age group 21-30 years (45%). At baseline 
assessments, the mean ± SD stress level score was 17.39±4.62. The mean ± SD SUBI 
score was 81.44 ± 4.62 at baseline and increased to 100.65±5.95 after 2 weeks of 
staying in the shelter home. Conclusions: The survey findings demonstrate that 
the levels of subjective well-being among participants improved after their 
physical and mental health needs were met during their stay in the shelter home. 
The findings could help policy planners and senior public health administrators 
minimize gaps to better understand the multiple issues related to the subjective 
well-being of this population.

© Copyright 2021 Physicians Postgraduate Press, Inc.

DOI: 10.4088/PCC.21m02991
PMID: 34969183 [Indexed for MEDLINE]


2581. Psychol Serv. 2023 Aug;20(3):657-667. doi: 10.1037/ser0000601. Epub 2021 Dec 30.

Development and cross-sectional evaluation of a text message protocol to support 
mental health well-being.

Whealin JM(1), Saleem JJ(2), Vetter B(3), Roth J(4), Herout J(5).

Author information:
(1)Department of Veterans Affairs, Clinical Informatics Service, VA Pacific 
Islands Health Care System.
(2)Department of Industrial Engineering, J.B. Speed School of Engineering, 
University of Louisville.
(3)Department of Veterans Affairs, Office of Connected Care, St. Cloud VA Health 
Care System.
(4)Department of Veterans Affairs, Outpatient Mental Health Service, St. Cloud 
VA Health Care System.
(5)Department of Veterans Affairs, Office of Connected Care.

Coping with stressors related to the coronavirus disease (COVID) pandemic has 
caused major mental health challenges. Text message interventions are identified 
as helpful for promoting health behavior self-management. Drawing from 
cognitive-behavioral theory (CBT), U.S. Veterans Health Administration staff 
developed a 20-week automated text messaging protocol called "Coping During 
COVID" to support veterans' self-care during the pandemic. This project 
evaluated attitudes about and perceived helpfulness of the protocol among 651 
veterans. A cross-sectional evaluation quantitatively assessed COVID-related 
stressors as well as reported use, acceptability, attitudes, and perceived 
helpfulness of the protocol via a self-administered online questionnaire. 
Open-ended questions assessed perceived helpfulness/unhelpfulness of the 
protocol. Of the 651 veterans (22% of those enrolled in the protocol) who 
responded to the survey, 73.1% were male and 88.5% were 50 years or over. Ninety 
percent found the protocol messages helpful and about half endorsed various 
additional benefits, including feeling better, being more educated about coping 
behaviors, and being better able to focus on positive thoughts. Qualitative 
feedback was overwhelmingly positive. For example, veterans stated that the 
protocol "was like having a personal coach giving hints and tips to cope with 
the boredom every day," that it "gave me reminders of skills I was not using. It 
helped me focus on the positives," and brought relief from "many hopeless and 
sad thoughts … the messages from Annie have been a Godsend to me." Overall 
results suggested that the Coping During COVID text messaging protocol 
successfully supported the majority of respondents' self-care efforts during the 
COVID pandemic. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

DOI: 10.1037/ser0000601
PMID: 34968123 [Indexed for MEDLINE]


2582. Psychol Aging. 2022 Mar;37(2):175-189. doi: 10.1037/pag0000664. Epub 2021 Dec 
30.

Well-being trajectories of middle-aged and older adults and the corona pandemic: 
No "COVID-19 effect" on life satisfaction, but increase in depressive symptoms.

Wettstein M(1), Nowossadeck S(1), Vogel C(1).

Author information:
(1)German Centre of Gerontology.

The coronavirus disease (COVID-19) pandemic has led to profound changes in 
individuals' lives and might have meaningful implications for well-being. We 
investigated if and how two major indicators of well-being (life satisfaction 
and depressive symptoms) changed in Germany from a prepandemic measurement 
occasion (2017) to June/July 2020, the time of the fading first wave of 
COVID-19. This change was compared with prepandemic change between 2014 and 
2017. We also analyzed whether change in well-being varied according to age, 
self-rated health, corona-specific attitudes, and subjective standard of living. 
Ten thousand seven-hundred and ninety three individuals had taken part in at 
least one of the measurement occasions between 2014 and 2020 (mean age in 2014: 
64.30 years; SD = 11.58 years). Based on latent change score models controlling 
for baseline well-being and sociodemographic indicators, we found, across both 
time intervals (2014-2017, 2017-2020) and independent of individuals' age, a 
small mean-level increase in life satisfaction. In contrast, depressive symptoms 
increased from 2017 to 2020, particularly among older participants, whereas they 
remained, on average, stable between 2014 and 2017. Individuals with a poorer 
self-rated health, who felt more threatened by the pandemic and whose subjective 
standard of living was lower revealed a decrease in life satisfaction and a 
steeper increase in depressive symptoms between 2017 and 2020. Our findings thus 
suggest that whereas life satisfaction remained quite stable, the pandemic was, 
already 3-4 months after its onset in Germany, accompanied by an increase in 
depressive symptoms, particularly among adults who were older, felt less healthy 
and were more concerned about COVID-19. (PsycInfo Database Record (c) 2022 APA, 
all rights reserved).

DOI: 10.1037/pag0000664
PMID: 34968101 [Indexed for MEDLINE]


2583. J Intensive Care Med. 2022 Sep;37(9):1206-1214. doi: 10.1177/08850666211070740. 
Epub 2021 Dec 30.

The Continuing Effect of COVID-19 Pandemic on Physical Well-Being and Mental 
Health of ICU Healthcare Workers in Turkey: A Single-Centre Cross-Sectional 
Later-Phase Study.

Duru H(1).

Author information:
(1)Rize State Hospital, Rize, Turkey.

BACKGROUND: This study aimed to evaluate the effect of COVID-19 pandemic on 
physical well-being and mental health of ICU healthcare workers (HCWs).
METHODS: A total of 51 ICU HCWs working at a tertiary care hospital were 
included in this cross-sectional study conducted before (January 2019-January 
2020) and during (January 2021-April 2021) COVID-19 pandemic. Data on 
sociodemographic and work-related characteristics, COVID 19 history and current 
mental health issues via Hospital Anxiety-Depression Scale (HADS), Pittsburgh 
Sleep Quality Index (PSQI), Eating Attitudes Test (EAT-40), Suicidal Ideation 
Scale (SIS) and Maslach Burnout Inventory (MBI) were recorded.
RESULTS: Overall, 62.7% of participants were nurses, heavy workload (working 
≥200 h/month) was reported by 76.5% of participants and previous history of 
COVID-19 was confirmed by 62.7%. Current mental health issues involved poor 
sleep quality in majority (96.1%) of participants, anxiety (51.0%), depression 
(51.0%) in at least half of them and a moderate degree of emotional exhaustion 
Heavy workload was associated with more remarkable decrease in sleep duration 
(median change: -0.5 vs. -1.0 h/day, P = .020), Vit B12 (median change: 
60[-48-293] vs. -65[-371-262] pg/mL, P < .001) and Vit D (median change: 
-1.6[-13.1-20] vs. -9.7[-39.7-21.8] ng/mL, P = .004) during pandemic, while 
working hours per month were also significantly higher in those with versus 
without anxiety (264[150-390] vs. 240[150-264] h, P = .003) and with versus 
without depression (264[150-390] vs. 240[150-264] h, P = .037).
CONCLUSION: Our findings indicate high prevalence of mental health issues 
including anxiety and depression as well as poor sleep quality and emotional 
burnout among ICU HCWs, particularly those with heavy workload.

DOI: 10.1177/08850666211070740
PMCID: PMC9393404
PMID: 34967250 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


2584. Aging Ment Health. 2022 Oct;26(10):2080-2089. doi: 
10.1080/13607863.2021.2013433. Epub 2021 Dec 30.

The experiences of care home staff during the COVID-19 pandemic: A systematic 
review.

Gray KL(1), Birtles H(2), Reichelt K(2), James IA(2).

Author information:
(1)Cumbria Northumberland Tyne and Wear NHS Foundation Trust, North East and 
North Cumbria staff wellbeing hub, Akenside Psychology Offices, Campus for 
ageing and vitality, Newcastle upon Tyne, United Kingdom of Great Britain and 
Northern Ireland.
(2)Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Older adult 
psychology services, United Kingdom of Great Britain and Northern Ireland.

Objectives: To examine experiences of care home staff to better understand how 
to support them during the ongoing pandemic and in the future.Method: A 
systematic review examining experiences of care staff over the last year (March 
2020-2021).Results: Fourteen papers related to experiences of staff and one was 
an intervention study. Quantitatively there was evidence of anxiety, PTSD and 
depression amongst the staff. Qualitatively, seven themes were identified: Poor 
working conditions; Lack of skills and knowledge; Psychological/Mental health 
concerns; Feeling undervalued and abandoned; Fears of contagion; Support and the 
positive impacts of COVID. The intervention study recommended employing 
needs-based approaches, including educational and wellbeing 
components.Conclusion: Recommendations are made in terms of how to work with 
staff, both practically and clinically. There are also suggestions about how to 
deal with similar situations if they were to reoccur. It is evident that lessons 
need to be learned because errors were made. Indeed, from a UK perspective, 
discharging thousands back to care homes, without testing, cost lives. This may 
have been done to protect the NHS, but it unwittingly 'lockdown' the virus 
within the care sector.

DOI: 10.1080/13607863.2021.2013433
PMID: 34967232 [Indexed for MEDLINE]


2585. J Nurs Manag. 2022 Apr;30(3):604-611. doi: 10.1111/jonm.13540. Epub 2022 Jan 7.

Nurses' spiritual well-being and the COVID-19 pandemic: A thematic approach.

Alquwez N(1), Cruz JP(1)(2), Balay-Odao EM(1).

Author information:
(1)Department of Nursing, College of Applied Medical Sciences, Shaqra 
University, Dawadmi, Saudi Arabia.
(2)Department of Medicine, School of Medicine, Nazarbayev University, 
Nur-Sultan, Kazakhstan.

AIMS: This study explores nurses' perceived spiritual well-being in the 
workplace during the COVID-19 pandemic.
BACKGROUND: Nurses have been working heavy shifts under challenging workplace 
conditions during the COVID-19 pandemic, leading to anxiety and psychological 
stress. These various challenges at work place their spiritual well-being at 
risk.
METHODS: An unstructured individual online interview was conducted to collect 
data from 18 nurses from April to August 2021. Data were analysed using the 
thematic approach.
RESULTS: This study highlighted the four themes of spiritual well-being of 
nurses, namely, "Trust in God," "spiritual encouragement," "spiritual attributes 
in the workplace," and "spiritual growth."
CONCLUSIONS: The study concludes that spirituality is critical in helping nurses 
overcome the myriad of adversities they face as they assume their important 
roles during the ongoing pandemic.
IMPLICATION FOR NURSING MANAGEMENT: The study emphasizes that nurses' spiritual 
aspect during crises is equally important with the other aspects of a nurse's 
life. Moreover, policies and interventions in hospitals must be implemented to 
ensure excellent levels of spiritual well-being among nurses.

© 2021 John Wiley & Sons Ltd.

DOI: 10.1111/jonm.13540
PMID: 34965000 [Indexed for MEDLINE]


2586. Psychol Rep. 2023 Apr;126(2):674-687. doi: 10.1177/00332941211061692. Epub 2021 
Dec 29.

Well-Being and the Pandemic: Trust in People Matters More Than Trust in 
Institutions.

Jovanović V(1), Sarracino F(2), Lazić M(1), Gavrilov-Jerković V(1).

Author information:
(1)Department of Psychology, Faculty of Philosophy, 229705University of Novi 
Sad, Novi Sad, Serbia.
(2)9296STATEC Research - National Institute of Statistics and Economic Studies, 
Luxembourg, Luxembourg.

Trust is an important correlate of well-being, and it plays an important 
moderating role against adversity. But does this conclusion also hold during 
pandemics? We address this question by investigating the role of interpersonal 
and institutional trust for well-being, as measured by five proxies, during the 
COVID-19 pandemic in Serbia. We also examined age and gender differences in the 
relationship between trust and well-being, and tested the protective role of 
trust among individuals whose well-being might be at risk during the pandemic. 
The sample included a total of 5776 Serbian adults (Mage = 37.00 years, 75% 
female). The results showed that interpersonal trust has a small but significant 
relationship with well-being, whereas institutional trust has negligible 
effects. We also found some evidence for the protective role of general 
interpersonal trust on well-being among individuals with poorer self-rated 
health and in a poorer financial situation. Our findings confirm the role of 
interpersonal trust for well-being in times of crisis, and support previous 
evidence indicating that promoting interpersonal trust should be a core goal of 
public policy.

DOI: 10.1177/00332941211061692
PMID: 34964386 [Indexed for MEDLINE]


2587. J Sleep Res. 2022 Aug;31(4):e13542. doi: 10.1111/jsr.13542. Epub 2021 Dec 28.

Disturbances in sleep, circadian rhythms and daytime functioning in relation to 
coronavirus infection and Long-COVID - A multinational ICOSS study.

Merikanto I(1)(2)(3), Dauvilliers Y(4), Chung F(5), Holzinger B(6)(7), De 
Gennaro L(8), Wing YK(9), Korman M(10), Partinen M(11)(12); 2nd ICOSS members.

Collaborators: Benedict C, Bjelajac A, Bjorvatn B, Yin Chan N, Hrubos-Strøm H, 
Inoue Y, Kirov R, Landtblom AM, Léger D, Matsui K, Morin CM, Mota-Rolim S, 
Nadorff MR, Penzel T, Plazzi G, Reis C, Yordanova J, Kortesoja L, Merikanto, De 
Santis A, Bolstad C, Nadorff, de Macêdo TF, Cunha AS, Mota-Rolim, Nierwetberg F, 
Agami D, Schwartsberg E, Korman, Koumanova S, Lyamova L, Yordanova, 
Kristoffersson A, Berntsson S, Liu Y, Ferreira D, Avdagic SC, Delale EA, Macan 
J, Ross B, Vidovic D, Lyamova VK.

Author information:
(1)SleepWell Research Program, Faculty of Medicine, University of Helsinki, 
Helsinki, Finland.
(2)Department of Public Health and Welfare, Finnish Institute for Health and 
Welfare, Helsinki, Finland.
(3)Orton Orthopaedics Hospital, Helsinki, Finland.
(4)Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, 
CHU Montpellier, INM, Univ Montpellier, INSERM, Montpellier, France.
(5)Department of Anesthesiology and Pain Medicine, University Health Network, 
University of Toronto, Toronto, Canada.
(6)Institute for Consciousness and Dream Research, Vienna, Austria.
(7)ZK-Schlafcoaching, Medical University Vienna, Wien, Austria.
(8)IRCCS Fondazione Santa Lucia, Rome, Italy.
(9)Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty 
of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
(10)Department of Occupational Therapy, Faculty of Health Sciences, Ariel 
University, Ariel, Israel.
(11)Helsinki Sleep Clinic, Terveystalo Healthcare, Helsinki, Finland.
(12)Department of Neurosciences, Clinicum, University of Helsinki, Helsinki, 
Finland.

This protocol paper describes the second survey produced by the International 
Covid Sleep Study (ICOSS) group with the aim to examine the associations between 
SARS-CoV-2 infection and sleep, sleepiness, and circadian problems as potential 
predisposing factors for more severe COVID-19 disease profile and for 
development of Long-COVID in the general population. The survey consists of 47 
questions on sleep, daytime sleepiness, circadian rhythm, health, mental 
wellbeing, life habits, and socioeconomic situation before and during the 
pandemic, and conditional questions to those reporting having had coronavirus 
infection, being vaccinated, or suffering from particular sleep symptoms or 
sleep disorders. Surveys will be administered online between May and November 
2021 in Austria, Brazil, Bulgaria, Canada, China, Croatia, Finland, France, 
Germany, Israel, Italy, Japan, Norway, Portugal, Sweden and USA. Data collected 
by the survey will give valuable information on the open questions regarding 
COVID-19 disease risk factors, symptomatology and evolution of Long-COVID, and 
on other long-term consequences related to the pandemic.

© 2021 European Sleep Research Society.

DOI: 10.1111/jsr.13542
PMID: 34964184 [Indexed for MEDLINE]


2588. Turk Psikiyatri Derg. 2021;32(4):275-282. doi: 10.5080/u26021.

Role of the Telemental Health Services During the COVID-19 Pandemic: A 
Systematic Review.

[Article in English, Turkish]

Ali NA, Khoja A, Kazim F.

OBJECTIVE: The COVID-19 pandemic has directed the use of telemedicine and 
digital mental health services to meet the needs of people in order to maintain 
physical distancing by preventing person to person contact. The aim of this 
review is to highlight the role of telemental health services during the 
COVID-19 pandemic.
METHOD: An electronic search was carried out between January 01, 2020 and 
October 31, 2020 to explore the utilization of telehealth services for mental 
health problems among adults during the COVID-19 pandemic. The primary source of 
literature was the structured search of major electronic databases from the 
MEDLINE (PubMed), CINAHL Plus, Science Direct and the Web of Science. We 
included nine published studies meeting the the eligibility criteria.
RESULTS: The role of telehealth identified in this review mainly focused on the 
applicability of this modality for assessing and managing various mental health 
problems in these unprecedented times. It also pointed out that the provision of 
telemental health support reduced the burden of mental health diseases and 
promoted the wellbeing of the individual. Further, it was witnessed that 
patients preferred remote consultation as compared to face-to-face visits in 
order to avoid contracting the virus and found online mental health 
interventions and psychological counseling very helpful to cope up with the 
current crisis.
CONCLUSION: The current COVID-19 lockdown has changed the management of the 
mental health problems of patients. The use of this innovative modality prevents 
transmission of infection and provides timely treatment to the community members 
most in need.

DOI: 10.5080/u26021
PMID: 34964102 [Indexed for MEDLINE]


2589. Health Promot Pract. 2023 Jan;24(1):26-30. doi: 10.1177/15248399211065407. Epub 
2021 Dec 29.

Creating Comics to Address Well-Being and Resilience During the COVID-19 
Pandemic.

West K(1), Jackson KR(1), Spears TL(1), Callender B(1).

Author information:
(1)The University of Chicago, Chicago, IL, USA.

In this descriptive case series, we detail the theoretical basis, methodology, 
and impact of a small-scale pilot implementation of graphic medicine workshops 
as an innovative approach to well-being and resilience in the age of COVID-19 
and increasing awareness of racial injustice. The data provided in this article 
are anecdotal and based on participation in the workshops. Images created during 
the workshops are also shared as examples of the types of reflection that 
graphic medicine can enable. The workshops themselves were designed 
collaboratively and are based on the theoretical principles of graphic medicine, 
narrative medicine, and racial and social justice. They were conducted as part 
of a larger wellness initiative and were offered to health care-focused faculty 
at our academic medical institution. Our findings suggest that this was a 
beneficial activity which helped participants to reflect and reconsider their 
experiences with the COVID-19 pandemic and surging awareness of racial 
injustice. Reflections also showed that drawings were correlated with ProQOL 
scores and may, in larger numbers, also help to mitigate or bring attention to 
issues of burnout in frontline providers. Drawings shared show the tremendous 
impact of COVID-19 and the simultaneous chaos and emptiness of practicing during 
dual pandemics. Our workshops engaged about 20 frontline health care providers 
and other health care faculty and highlight the utility of graphic medicine as a 
tool for building resilience and encouraging self-reflection. Further study is 
necessary, as is more rigorous analysis of the relationship between the graphics 
created and the ability to recognize and mitigate burnout.

DOI: 10.1177/15248399211065407
PMCID: PMC9805918
PMID: 34963374 [Indexed for MEDLINE]


2590. PLoS One. 2021 Dec 28;16(12):e0261818. doi: 10.1371/journal.pone.0261818. 
eCollection 2021.

International professional practices in mental health, organization of 
psychiatric care, and COVID-19: A survey protocol.

Fond-Harmant L(1), Kane H(2), Gourret Baumgart J(2), Rusch E(2), Breton H(2), 
El-Hage W(3), Deloyer J(4), Lebas MC(5), Marazziti D(6), Thome J(7), Denis F(2).

Author information:
(1)Agence de Coopération Scientifique Europe-Afrique-Luxembourg and LEPS, 
Laboratoire Education et Pratiques en Santé, Université Sorbonne Paris Nord, 
Paris, France.
(2)Faculté de Médecine, EA 75-05 Education, Ethique, Santé, Université 
François-Rabelais, Tours, France.
(3)CIC 1415, INSERM, Centre d'Investigation Clinique, CHRU de Tours, Tours, 
France.
(4)Centre Neuro Psychiatrique St. Martin, Dave Namur, Belgium.
(5)Département des Sciences de la Santé Publique et de la Motricité, Haute Ecole 
de la Province de Namur, Namur, Belgium.
(6)Department of Experimental and Clinical Medicine, Section of Psychiatry, 
University of Pisa, Unicamillus University of Rome and Brain Research 
Foundation, Lucca, Italy.
(7)Department of Psychiatry, University of Rostock, Rostock, Germany.

OBJECTIVE: Our project aims to provide: an overview of the impact of the 
COVID-19 pandemic on the field of mental health professionals in 23 countries;a 
model of recommendations for good practice and proposals for methods and digital 
tools to improve the well-being at work of mental health professionals and the 
quality of services offered during crisis and post-crisis periods;an in-depth 
ethics review of the assessment of the use of numerical tools for psychiatry 
professionals and patient support, including teleconsulting.
METHODS: This is a large international survey conducted among 2,000 mental 
health professionals in 23 countries over a 12-month period. This survey will be 
based on 30 individual interviews and 20 focus group sessions, and a digital 
questionnaire will be sent online to 2,000 professionals based on the criteria 
of gender, age, professional experience, psychiatric specialty, context of work 
in psychiatry, and geographical location. Regarding the development of 
telepsychiatry during the COVID-19 pandemic, a pilot study on the use of digital 
tools will be carried out on 100 clients of psychiatry professionals in France 
and Belgium.
DISCUSSION-CONCLUSION: This study will contribute to the co-construction of an 
international organization and monitoring system that takes into account 
psychiatric health professionals as major resources to fight against the 
COVID-19 pandemic and to develop efficient processes for preparing and 
anticipating crises by reducing psychosocial risks as much as possible. This 
project also aims to design tools for remote medicine and to develop the use of 
numerical tools for monitoring and supporting professionals and helping 
professionals to build the conditions for satisfactory operational work during 
crises and post-crisis situations, using adapted organizational methods. Our 
ongoing research should support professionals in the search for existing 
concrete solutions to cope with emergency work situations while maintaining an 
optimal quality of life.

DOI: 10.1371/journal.pone.0261818
PMCID: PMC8714114
PMID: 34962945 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2591. Infant Ment Health J. 2022 Jan;43(1):36-54. doi: 10.1002/imhj.21959. Epub 2021 
Dec 28.

When the Bough Breaks: A systematic review and meta-analysis of mental health 
symptoms in mothers of young children during the COVID-19 pandemic.

Racine N(1)(2), Eirich R(1)(2), Cooke J(1)(2), Zhu J(1)(2), Pador P(1), 
Dunnewold N(3), Madigan S(1)(2).

Author information:
(1)Department of Psychology, University of Calgary, Calgary, Alberta, Canada.
(2)Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.
(3)Health Sciences Library, Libraries and Cultural Resources, University of 
Calgary, Calgary, Alberta, Canada.

Parents have experienced considerable challenges and stress during the COVID-19 
pandemic, which may impact their well-being. This meta-analysis sought to 
identify: (1) the prevalence of depression and anxiety in parents of young 
children (<age 5) during the COVID-19 pandemic, and (2) sociodemographic (e.g., 
parent age, being racially minoritized) and methodological moderators (e.g., 
study quality) that explain heterogeneity among studies. A systematic search was 
conducted across four databases from January 1, 2020 to March 3, 2021. A total 
of 18 non-overlapping studies (8981 participants), all focused on maternal 
mental health, met inclusion criteria. Random-effect meta-analyses were 
conducted. Pooled prevalence estimates for clinically significant depression and 
anxiety symptoms for mothers of young children during the COVID-19 pandemic were 
26.9% (95% CI: 21.3-33.4) and 41.9% (95% CI: 26.7-58.8), respectively. 
Prevalence of clinically elevated depression and anxiety symptoms were higher in 
Europe and North America and among older mothers. Clinically elevated depressive 
symptoms were lower in studies with a higher percentage of individuals who were 
racially minoritized. In comparison, clinically elevated anxiety symptoms were 
higher among studies of low study quality and in samples with highly educated 
mothers. Policies and resources targeting improvements in maternal mental health 
are essential.

Publisher: Los padres han experimentado retos considerables y estrés durante la 
pandemia del COVID-19, lo cual puede tener un impacto en su bienestar. Este 
metaanálisis busca identificar: 1) la prevalencia de la depresión y ansiedad en 
los padres de niños pequeños (<edad 5) durante la pandemia del COVID-19, y 2) 
moderadores sociodemográficos (v.g. edad de los padres, el ser racialmente 
considerado parte de un grupo minoritario) y metodológicos (v.g. calidad del 
estudio) que explican la heterogeneidad entre los estudios. Se llevó a cabo una 
investigación sistemática a lo largo de cuatro bases de datos a partir de11° de 
enero de 2020 al 3 de marzo de 2021. Un total de 18 estudios no duplicados 
(8,981 participantes), todos con enfoque en la salud mental materna, cumplieron 
con los criterios para ser incluidos. Se llevaron a cabo metaanálisis de efectos 
al azar. Los estimados de la prevalencia combinada para los síntomas de 
depresión y ansiedad clínicamente significativos para madres de niños pequeños 
durante la pandemia del COVID-19 fueron de 26.9% (95% CI: 21.3-33.4) y 41.9% 
(95% CI: 26.7-58.8) respectivamente. La prevalencia de síntomas de depresión y 
ansiedad clínicamente elevados fue más alta en Europa y América del Norte y 
entre madres más viejas. Los síntomas depresivos clínicamente elevados fueron 
más bajos en estudios con un más alto porcentaje de individuos que eran 
considerados como parte de un grupo racialmente minoritario. En comparación, los 
síntomas de ansiedad clínicamente elevados fueron más altos en los estudios que 
presentaban una baja calidad de estudio y en muestras con madres altamente 
educadas. Las políticas y recursos que buscan el mejoramiento en la salud mental 
materna son esenciales.

Publisher: Les parents ont fait l'expérience de défis considérables et d'un 
stress considérable durant la pandémie du COVID-19, ce qui peut impacter leur 
bien-être. Cette méta-analyse s'est donné pour but d'identifier: 1) la 
prévalence de la dépression et de l'anxiété chez les parents de jeunes enfants 
(<âge 5) durant la pandémie du COVID-18, et 2) les facteurs de modération 
sociodémographique (par exemple, l’âge du parent, le fait d’être d'une minorité 
raciale) et méthodologique (par exemple, la qualité de l’étude) qui expliquent 
l'hétérogénéité dans les étudies. Une recherche systématique a été faite au 
travers de quatre banques de données du premier janvier 2020 au 3 mars 2021. Un 
total de 18 études ne se recoupant pas (8981 participants), toutes focalisées 
sur la santé mentale maternelle, ont rempli les critères d'inclusion. Des 
méta-analyses à effet aléatoire approprié ont été faites. Les estimations de 
prévalences regroupées pour une dépression cliniquement importante et des 
symptômes d'anxiété pour les mères de jeunes enfants durant la pandémie de 
COVID-19 étaient respectivement de 26,9% (95% CI: 21,3-33,4) et de 41,9% (95% 
CI: 26,7-58,8). La prévalence d'une dépression cliniquement élevée et de 
symptômes d'anxiété était plus élevée en Europe et en Amérique du Nord et chez 
les mères plus âgées. Les symptômes dépressifs cliniquement élevés étaient plus 
bas dans les études avec un pourcentage plus élevé d'individus de minorités 
raciales. Par comparaison les symptômes d'anxiété cliniquement élevés étaient 
plus haut dans les études de moindre qualité d’étude et dans les échantillons 
avec des mères très éduquées. Les politiques et les ressources visant des 
améliorations dans la santé mentale maternelle sont essentielles.

Publisher: “When the Bough Breaks“: Ein systematisches Review und eine 
Meta-Analyse psychischer Symptomatiken bei Müttern von Kleinkindern während der 
COVID-19-Pandemie Eltern waren während der COVID-19-Pandemie erheblichen 
Herausforderungen und Stress ausgesetzt, was ihr Wohlbefinden beeinträchtigt 
haben könnte. Zum einen untersucht die vorliegende Metaanalyse die Prävalenz von 
Depressionen und Angst bei Eltern von Kleinkindern (< 5 Jahre) während der 
COVID-19-Pandemie. Zum anderen wurde nach soziodemografischen Moderatoren (z. B. 
Alter der Eltern, ethnische Zugehörigkeit) sowie methodischen Moderatoren (z. B. 
Studienqualität) gesucht, die die Heterogenität zwischen Studien erklären. Für 
den Zeitraum vom 1. Januar 2020 bis zum 3. März 2021 wurde eine systematische 
Suche in vier Datenbanken durchgeführt. Insgesamt 18 sich nicht überschneidende 
Studien (mit 8.981 Teilnehmer:innen), alle mit einem Fokus auf die Gesundheit 
von Müttern, erfüllten die Einschlusskriterien. Eine Random-Effects Metaanalyse 
wurde durchgeführt. Die gepoolten Prävalenzschätzungen für klinisch signifikante 
Depressions- und Angstsymptome bei Müttern von Kleinkindern während der 
COVID-19-Pandemie lagen bei 26,9 % (95 % CI: 21,3-33,4) bzw. 41,9 % (95 % CI: 
26,7-58,8). Die Prävalenz klinisch erhöhter Depressions- und Angstsymptome war 
in Europa und Nordamerika sowie bei älteren Müttern höher. Klinisch erhöhte 
Depressionssymptome waren in Studien mit einem höheren Anteil an Personen, die 
einer ethnischen Minderheit angehörten, geringer. Im Vergleich dazu waren 
klinisch erhöhte Angstsymptome in Studien mit geringer Studienqualität und in 
Stichproben mit hoch gebildeten Müttern häufiger. Politische Maßnahmen und 
Ressourcen, die die psychische Gesundheit von Müttern fördern, sind 
unerlässlich.

Publisher: 枝が折れるとき:COVID-19パンデミック中の幼児の母親のメンタルヘルス症状に関する系統的レビューとメタ分析 
親達はCOVID-19パンデミックの間に大きな挑戦とストレスを経験しており、それは彼らの幸福に影響を与える可能性がある。本メタ分析は、1) 
COVID-19パンデミック中の幼児 (5歳以下) の親の抑うつと不安の有病率、および、2) 社会人口統計学的 (例、親の年齢、人種的社会的少数派) 
および、研究間の異質性を説明する方法論的モデレーター (例、研究の質) 
を特定しようと試みるものである。2020年1月1日から2021年3月3日までの4つのデータベースで、体系的な検索が行われた。どれも母親のメンタルヘルスに焦点を当てた、重複のない計18の研究 
(参加者8,981人) 
が選択基準を満たした。変量効果メタ分析が実施された。COVID-19パンデミック中の幼児の母親の臨床的に有意な抑うつと不安症状のプールされた有病率の推定値は、それぞれ26.9% 
(95% CI:21.3-33.4) と41.9% (95%　CI:26.7-58.8) 
だった。臨床的に抑うつと不安症状の悪化の有病率は、ヨーロッパと北アメリカ、そして年配の母親の間で高かった。人種的に社会的少数派の割合の高い研究では、臨床的に抑うつ症状悪化の割合は低かった。比較すると、臨床的に不安症状の悪化は、研究の質が低い研究や高学歴の母親のサンプルでより高かった。母親のメンタルヘルスの改善を目標とする政策と社会資源が不可欠だ。.

Publisher: 父母在COVID-19大流行期间经历了相当大的挑战和压力, 这可能会影响他们的健康。这项荟萃分析旨在确定: 1) 
在COVID-19大流行期间, 幼儿 (<5岁) 父母的抑郁和焦虑患病率;2) 解释研究异质性的社会人口统计学 (例如, 父母年龄, 被种族歧视) 
和方法的调节因素 (例如, 研究质量) 。从2020年1月1日到2021年3月3日, 对四个数据库进行了系统搜索。共有18项非重叠研究 (8981名参与者) 
符合纳入标准, 所有研究均关注于产妇心理健康。对数据进行了随机效应荟萃分析。在 COVID-19 大流行期间, 
幼儿母亲的临床显著抑郁和焦虑症状的合并患病率估计值分别为26.9% (95% CI: 21.3-33.4) 和41.9% (95% CI: 
26.7-58.8)。在欧洲、北美以及年长的母亲中, 临床上抑郁和焦虑症状升高的患病率较高。在被种族歧视个体比例较高的研究中, 
其临床上抑郁症状升高的患病率较低。相比之下, 在研究质量较低的研究中以及受过高等教育的母亲样本中, 
临床上焦虑症状升高的患病率更高。旨在改善产妇心理健康的政策和资源至关重要。.

Publisher: عندما ينكسر الغصن: مراجعة منهجية وتحليل تلوي لأعراض الصحة النفسية لدى 
أمهات الأطفال الصغار أثناء جائحة كوفيد-19 واجه الآباء تحديات وضغوط كبيرة خلال 
جائحة كوفيد-19، والتي قد تؤثر على رفاههم. سعى هذا التحليل التلوي إلى تحديد: 1) 
انتشار الاكتئاب والقلق لدى آباء الأطفال الصغار (أقل من 5 سنوات) أثناء وباء 
كوفيد-19 ، و 2) العوامل الديموغرافية الوسيطة (على سبيل المثال ، عمر الوالدين ، 
كونهم أقلية) والجوانب المنهجية (على سبيل المثال ، جودة الدراسة) التي تفسر عدم 
التجانس بين الدراسات. تم إجراء بحث منهجي عبر أربع قواعد بيانات من 1 يناير 2020 
إلى 3 مارس 2021. اشتمل البحث على 18 دراسة غير متداخلة (8981 مشاركًا) ، ركزت 
جميعها على الصحة النفسية للأمهات ، واستوفت معايير التضمين. أجريت التحليلات 
التلوية ذات التأثير العشوائي. وكانت تقديرات الانتشار المجمعة لأعراض الاكتئاب 
والقلق عند أمهات الأطفال الصغار خلال جائحة كورونا حوالي ٪26.9 و 41.9٪ على 
التوالي. وكان انتشار أعراض الاكتئاب والقلق المرتفعة أعلى في أوروبا وأمريكا 
الشمالية وبين الأمهات الأكبر سنًا. بينما كانت هذه الأعراض أقل في الدراسات التي 
أجريت على نسبة أعلى من الأفراد من مجموعة الأقليات العنصرية. بالمقارنة ، كانت 
أعراض القلق المرتفعة سريريًا أعلى بين الدراسات ذات الجودة المنخفضة وفي العينات 
ذات الأمهات المتعلمات تعليماً عالياً. وبذلك تعتبر السياسات والموارد التي تستهدف 
تحسين الصحة النفسية للأم ضرورية.

© 2021 Michigan Association for Infant Mental Health.

DOI: 10.1002/imhj.21959
PMCID: PMC9015533
PMID: 34962649 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflict of interest to 
declare.


2592. JAMA Intern Med. 2022 Feb 1;182(2):172-177. doi: 
10.1001/jamainternmed.2021.7387.

Effectiveness of an Analytics-Based Intervention for Reducing Sleep Interruption 
in Hospitalized Patients: A Randomized Clinical Trial.

Najafi N(1), Robinson A(2), Pletcher MJ(1), Patel S(1).

Author information:
(1)Department of Medicine, University of California, San Francisco.
(2)University of California, San Francisco Medical Center, San Francisco.

Comment in
    JAMA Intern Med. 2022 Feb 1;182(2):178.

IMPORTANCE: Sleep has major consequences for physical and emotional well-being. 
Hospitalized patients experience frequent iatrogenic sleep interruptions and 
there is evidence that such interruptions can be safely reduced.
OBJECTIVE: To determine whether a clinical decision support tool, powered by 
real-time patient data and a trained prediction algorithm, can help physicians 
identify clinically stable patients and safely discontinue their overnight vital 
sign checks.
DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial, with inpatient 
encounters randomized 1:1 to intervention vs usual care, was conducted from 
March 11 to November 24, 2019. Participants included physicians serving on the 
primary team of 1699 patients on the general medical service (not in the 
intensive care unit) of a tertiary care academic medical center.
INTERVENTIONS: A clinical decision support notification informed the physician 
if the patient had a high likelihood of nighttime vital signs within the 
reference ranges based on a logistic regression model that used real-time 
patient data as input. The notification provided the physician an opportunity to 
discontinue measure of nighttime vital signs, dismiss the notification for 1 
hour, or dismiss the notification for that day.
MAIN OUTCOMES AND MEASURES: The primary outcome was delirium, as determined by 
bedside nurse assessment of Nursing Delirium Screening Scale scores, a 
standardized delirium screening tool (delirium diagnosed with score ≥2). 
Secondary outcomes included mean nighttime vital sign checks. Potential harms 
included intensive care unit transfers and code blue alarms. All analyses were 
conducted on the basis of intention-to-treat.
RESULTS: A total of 1930 inpatient encounters in 1699 patients (intervention 
encounters: 566 of 966 [59%] men; mean [SD] age, 53 [15] years) were randomized. 
In the intervention vs control arm, there was a significant decrease in the mean 
(SD) number of nighttime vital sign checks (0.97 [0.95] vs 1.41 [0.86]; 
P < .001) with no increase in intensive care unit transfers (49 [5%] vs 47 [5%]; 
P = .92) or code blue alarms (2 [0.2%] vs 9 [0.9%]; P = .07). The incidence of 
delirium was not significantly reduced (108 [11%] vs 123 [13%]; P = .32).
CONCLUSIONS AND RELEVANCE: While this randomized clinical trial found no 
difference between groups in the primary outcome, delirium incidence, the 
secondary findings indicate that a real-time prediction algorithm embedded 
within a clinical decision support tool in the electronic health record can help 
physicians identify clinically stable patients who can forgo routine vital sign 
checks, safely giving them greater opportunity to sleep. Other aspects of 
hospital care that depend on clinical stability, such as level of care or 
cardiac monitoring, may be amenable to a similar intervention.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04046458.

DOI: 10.1001/jamainternmed.2021.7387
PMCID: PMC8715385
PMID: 34962506 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest Disclosures: None reported.


2593. Soc Sci Med. 2022 Jan;293:114674. doi: 10.1016/j.socscimed.2021.114674. Epub 
2021 Dec 21.

Loneliness and psychological distress before and during the COVID-19 pandemic: 
Relationships with social media identity bubbles.

Latikka R(1), Koivula A(2), Oksa R(3), Savela N(4), Oksanen A(5).

Author information:
(1)Faculty of Social Sciences, Tampere University, Kalevantie 4, 33100, Tampere, 
Finland. Electronic address: rita.latikka@tuni.fi.
(2)Faculty of Social Sciences, University of Turku, Assistentinkatu 7, 20500, 
Turku, Finland. Electronic address: akjeko@utu.fi.
(3)Faculty of Social Sciences, Tampere University, Kalevantie 4, 33100, Tampere, 
Finland. Electronic address: reetta.oksa@tuni.fi.
(4)Faculty of Social Sciences, Tampere University, Kalevantie 4, 33100, Tampere, 
Finland. Electronic address: nina.savela@tuni.fi.
(5)Faculty of Social Sciences, Tampere University, Kalevantie 4, 33100, Tampere, 
Finland. Electronic address: atte.oksanen@tuni.fi.

Impacts of the COVID-19 pandemic on well-being and mental health are a concern 
worldwide. This article is based on two longitudinal studies that investigated 
the role of social media use in loneliness and psychological distress before and 
during the COVID-19 pandemic. Study 1 utilized nationally representative 3-point 
longitudinal data (n = 735) collected in 2017-2020 on the Finnish population. 
Study 2 utilized 5-point longitudinal data (n = 840) collected in 2019-2021 
representing the Finnish working population. We analyzed the data using 
multilevel mixed-effects regression analysis. A longitudinal analysis of Study 1 
showed that perceived loneliness did not increase among the Finnish population 
during the COVID-19 pandemic. Stronger involvement in social media identity 
bubbles predicted lower loneliness during the pandemic. Study 2 results showed 
that since the outbreak of the pandemic, psychological distress has increased 
among lonely individuals but not among the general working population. 
Involvement in social media identity bubbles predicted generally lower 
psychological distress during the COVID-19 pandemic, but it did not buffer 
against higher psychological distress among lonely individuals. The findings 
suggest that perceived loneliness is a risk factor for prolonged negative mental 
health effects of the pandemic. Social media identity bubbles can offer 
meaningful social resources during times of social distancing but cannot protect 
against higher psychological distress among those who perceive themselves as 
often lonely.

Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.socscimed.2021.114674
PMCID: PMC8688936
PMID: 34959045 [Indexed for MEDLINE]

Conflict of interest statement: None.


2594. J Pediatr Psychol. 2022 Feb 14;47(2):158-170. doi: 10.1093/jpepsy/jsab135.

The COVID-19 Pandemic Impact on Households of Young Children With Special 
Healthcare Needs.

Liu S(1), Lombardi J(2), Fisher PA(1).

Author information:
(1)Center for Translational Neuroscience, Department of Psychology, University 
of Oregon, USA.
(2)Early Opportunities, LLC, USA.

OBJECTIVE: This study examined how the COVID-19 pandemic differently affected 
households of children with versus without special healthcare needs. We compared 
caregivers' and children's emotional well-being (Aim 1), the utilization of 
preventive healthcare services for young children (Aim 2), and the promotive 
effects of social support on well-being outcomes (Aim 3) during the pandemic 
between the two groups.
METHODS: Data were drawn from an ongoing, large, longitudinal, and national 
survey that assessed the pandemic impact on households of young children (0-5). 
Analyses for Aims 1 and 2 were based on 10,572 households, among which 10.96% 
had children with special healthcare needs. Analyses for Aim 3 were based on a 
subsample of 821 families, among which 12.54% had children with special 
healthcare needs.
RESULTS: Caregivers of children with special healthcare needs exhibited more 
emotional distress and reported higher levels of household children's behavioral 
problems during the pandemic. The percentages of missed preventive healthcare 
visits and vaccinations were also higher in families of children with special 
healthcare needs due to structural barriers. Lastly, emotional social support 
was indirectly related to children's decreased behavioral problems through 
caregivers' reduced emotional distress, only among households of children 
without special healthcare needs. In other words, social support alone was not 
sufficient in promoting caregivers' and children's better well-being outcomes 
among households of children with special healthcare needs.
CONCLUSIONS: The pandemic has caused extensive burdens on families of children 
with special healthcare needs. Actions from policymakers and early intervention 
service providers are urgently needed to mitigate these impacts.

© The Author(s) 2021. Published by Oxford University Press on behalf of the 
Society of Pediatric Psychology. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/jpepsy/jsab135
PMCID: PMC8755305
PMID: 34957525 [Indexed for MEDLINE]


2595. Front Public Health. 2021 Dec 9;9:782846. doi: 10.3389/fpubh.2021.782846. 
eCollection 2021.

Occupational Stress and Mental Health Among Healthcare Workers Serving Socially 
Vulnerable Populations During the COVID-19 Pandemic.

Salgado de Snyder VN(1)(2), Villatoro AP(3), McDaniel MD(2), Ocegueda AS(2), 
Garcia D(4), Parra-Medina D(2).

Author information:
(1)National Institute of Public Health, Center for Health Systems Research, 
Cuernavaca, Mexico.
(2)Latino Research Institute, College of Liberal Arts, The University of Texas 
at Austin, Austin, TX, United States.
(3)Santa Clara University, Program of Public Health, Santa Clara, CA, United 
States.
(4)Migrant Clinicians Network, Austin, TX, United States.

The purpose of this study was to analyze occupational and personal stressors, 
mental health indicators, perceived discrimination and help-seeking behaviors 
among healthcare workers and providers (HCWPs) serving socially vulnerable 
groups such as immigrants, refugees, farmworkers, homeless individuals, people 
living in poverty, and other disadvantaged populations in the United States 
(U.S.) during the COVID-19 pandemic. Using a cross-sectional descriptive 
approach, we gathered information between July and September 2020, from a sample 
of 407 affiliates of two national organizations of clinic-based HCWPs who worked 
at federally funded and community safety-net clinics. Informed consent was 
obtained from all participants who completed a self-administered online survey 
available in English and Spanish. Our results indicated that the HCWPs serving 
vulnerable groups in the midst of the pandemic experienced high levels of 
occupational and personal stressors as well as anxiety and depressive 
symptomology. Major occupational stressors were excessive workload, long 
working-hours, and institutional barriers to refer and follow-up on their 
clients' access to needed social services. High-rated personal stressors 
included sleep disorders, lack of and child-care, partner's loosing job, and 
other family related situations. Our findings suggest that HCWPs working with 
vulnerable populations need specialized interventions that bolster their mental 
health and well-being as the pandemic continues to unfold. We recommend 
implementing initiatives that encourage HCWPs' to be actively involved in clinic 
decisions regarding employee safety and protection as well as in management 
decisions to improve work place infrastructure and capacity to respond to the 
social needs of their clients. Lessons learned from the pandemic are useful 
tools in designing protocols for addressing the mental-health needs of HCWPs in 
health-care organizations that attend to socially underprivileged populations.

Copyright © 2021 Salgado de Snyder, Villatoro, McDaniel, Ocegueda, Garcia and 
Parra-Medina.

DOI: 10.3389/fpubh.2021.782846
PMCID: PMC8695753
PMID: 34957034 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2596. Front Public Health. 2021 Dec 10;9:767004. doi: 10.3389/fpubh.2021.767004. 
eCollection 2021.

Mental Disorders and Emotional Competence Among Chinese Adolescents Before and 
During COVID-19 Pandemic: A Longitudinal Mediation Model.

Shi W(1), Yuan GF(2), Hall BJ(3)(4), Liu X(5), Su Y(6), Zhao L(7)(8), Jia 
P(1)(9)(10).

Author information:
(1)Institute for Disaster Management and Reconstruction (IDMR), Sichuan 
University, Chengdu, China.
(2)Department of Psychology, Faculty of Social Sciences, University of Macau, 
Macau SAR, China.
(3)Global and Community Mental Health Research Group, New York University, 
Shanghai, China.
(4)Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of 
Public Health, Baltimore, MD, United States.
(5)Office of Humanities and Social Sciences Administration, Sichuan University, 
Chengdu, China.
(6)Department of Sociology, Dickinson College, Carlisle, PA, United States.
(7)Department of Health Policy and Management, West China School of Public 
Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
(8)Health Emergency Management Research Center. China-PUMC C.C. Chen Institute 
of Health, Sichuan University, Chengdu, China.
(9)School of Resources and Environmental Science, Wuhan University, Wuhan, 
China.
(10)International Institute of Spatial Lifecourse Epidemiology (ISLE), Wuhan 
University, Wuhan, China.

Background: The outbreak of the COVID-19 pandemic has had a profound influence 
on the mental health and well-being of individuals across the globe. Emotional 
competence, defined as one's ability to recognize, understand, and manage their 
emotions, has been found linked with mental health problems (e.g., depression 
and anxiety) in previous studies. However, there is limited knowledge about the 
direction of the association between these factors among populations exposed to 
COVID-19. This study examined the possible mediation relationships between 
depression, anxiety, emotional competence, and COVID-19 exposure among Chinese 
adolescents. Methods: Responses from 7,958 Chinese adolescents who had 
previously taken part in a two-wave study before (December 23, 2019-January 13, 
2020) and during COVID-19 (June 16, 2020-July 8, 2020) were analyzed (51.67% 
males, mean age = 11.74, SD = 2.15). Structural equation modeling with three 
covariates (i.e., age, gender, and ethnicity) was used to test the longitudinal 
mediation relationships between COVID-19 exposure and depression, anxiety via 
emotional competence. Results: Results indicated that the prevalence of 
depression (38.67 to 36.74%) and anxiety (13.02 to 12.77%) decreased from Time 1 
to Time 2. The T2 emotional competence significantly mediated the relationship 
between T2 COVID-19 exposure and T2 anxiety (indirect effect [95% CI] = 0.011 
[0.004-0.019], p < 0.05). T2 emotional competence also significantly mediated 
the relationship between T2 COVID-19 exposure and T2 depression (indirect effect 
[95% CI] = 0.013 [0.005-0.022], p < 0.05). The results indicated that T2 
emotional competence had a significant and negative influence on T2 anxiety (β = 
-0.266, SE = 0.005, p < 0.001), and T2 depression (β = -0.326, SE = 0.029, p < 
0.001). Conclusions: This longitudinal research study demonstrated the crucial 
role of emotional competence in influencing the severity of long-term mental 
health problems, and suggested that emotional competence interventions can be 
conducted to improve mental well-being among Chinese adolescents exposed to 
COVID-19.

Copyright © 2021 Shi, Yuan, Hall, Liu, Su, Zhao and Jia.

DOI: 10.3389/fpubh.2021.767004
PMCID: PMC8702639
PMID: 34957019 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2597. Int J Public Health. 2021 Dec 9;66:1604220. doi: 10.3389/ijph.2021.1604220. 
eCollection 2021.

Gender Inequality and Mental Health During the COVID-19 Pandemic.

Borrescio-Higa F(1), Valenzuela P(2).

Author information:
(1)Business School, Universidad Adolfo Ibañez, Santiago, Chile.
(2)Faculty of Engineering and Applied Sciences, Universidad de los Andes, 
Santiago, Chile.

Objective: We explore gender differences in mental health deterioration and 
psychological well-being due to the COVID-19 pandemic, as well as the mechanisms 
through which these differences may operate. Methods: Using data from the Life 
during Pandemic survey in Chile, which covers 2,545 adult respondents, we 
estimate econometric models to explore gender differences in psychological 
well-being and mental health as well as economic fragility and household 
workload during the COVID-19 pandemic. Results: We find women are more likely to 
report overall bad mental health and deterioration of well-being. They are also 
more likely to have a new diagnosis of a mental health problem, to be pursuing 
treatment and taking prescription medication. Moreover, women report an increase 
in household chores and in childcare, and are more likely to have lost their 
employment or experienced a loss of income due to the pandemic. Conclusion: Our 
results offer a general picture of gender differences in the psychological 
impact of COVID-19. We argue that policies that mitigate economic stress and 
address the needs of women specifically may ease mental health deterioration due 
to the pandemic.

Copyright © 2021 Borrescio-Higa and Valenzuela.

DOI: 10.3389/ijph.2021.1604220
PMCID: PMC8698135
PMID: 34955701 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2598. Int J Drug Policy. 2022 Mar;101:103563. doi: 10.1016/j.drugpo.2021.103563. Epub 
2021 Dec 8.

Impacts of changes in alcohol consumption patterns during the first 2020 
COVID-19 restrictions for people with and without mental health and 
neurodevelopmental conditions: A cross sectional study in 13 countries.

Davies EL(1), Puljevic C(2), Gilchrist G(3), Potts L(3), Zhuparris A(4), Maier 
LJ(5), Barratt MJ(6), Winstock AR(7), Ferris JA(8).

Author information:
(1)Centre for Psychological Research, Oxford Brookes University, UK. Electronic 
address: edavies@brookes.ac.uk.
(2)Centre for Health Services Research, The University of Queensland, Australia; 
School of Public Health, The University of Queensland, Australia.
(3)King's College London, UK.
(4)Global Drug Survey, UK.
(5)Department of Clinical Pharmacy, University of California, San Francisco, 
USA.
(6)Social and Global Studies Centre and Digital Ethnography Research Centre, 
RMIT University, Melbourne, Vic, Australia; National Drug and Alcohol Research 
Centre, UNSW Sydney, NSW, Australia.
(7)Global Drug Survey, UK; University College London, UK.
(8)Centre for Health Services Research, The University of Queensland, Australia.

BACKGROUND: The initial period of COVID-19-related restrictions affected 
substance use in some population groups. We explored how changes in alcohol use 
at the beginning of the pandemic impacted the health and wellbeing of people 
with and without mental health and neurodevelopmental conditions (MHDCs).
METHODS: Data came from the Global Drug Survey Special Edition on COVID-19 
conducted in May-June 2020. Measured were; changes in drinking compared to 
February 2020 (pre-COVID-19 restrictions), reasons for changes, and impact on 
physical health, mental health, relationships, finances, work/study, and 
enjoyment. This study included 38,141 respondents (median age = 32 IQR 25-45; 
51.9% cis man; 47.8% cis woman; 1.2% trans/non-binary; 30.2% with MHDCs e.g. 
depression 20.0%, anxiety 16.3%, ADHD 3.8%, PTSD 3.3%).
RESULTS: A third (35.3%) of respondents with MHDCs and 17.8% without MHDCs 
indicated that increased drinking affected their mental health negatively 
(p<.001); 44.2% of respondents with MHDCS compared to 32.6% without MHDCs said 
it affected their physical health negatively (p<.001). Reduced drinking was 
associated with better mental health among a fifth (21.1%) of respondents with 
MHDCS and 14.4% without MHDCs (p<.001). Age, relationship status, living 
arrangements, employment, coping and distress were significant predictors of 
increases in drinking.
CONCLUSION: Among people with MHDCS, reduced alcohol consumption was associated 
with better mental health, while the negative effects of increased drinking were 
more pronounced when compared to people without MHDCS. When supporting people in 
reducing alcohol consumption during uncertain times, people with MHDCS may need 
additional support, alongside those experiencing greater levels of distress.

Copyright © 2021 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.drugpo.2021.103563
PMCID: PMC8692164
PMID: 34952280 [Indexed for MEDLINE]

Conflict of interest statement: Declarations of Interest None.


2599. J Affect Disord. 2022 Feb 15;299:525-527. doi: 10.1016/j.jad.2021.12.078. Epub 
2021 Dec 22.

Love in the time of COVID-19: The negative effects of the pandemic on 
psychological well-being and dyadic adjustment.

Romeo A(1), Castelli L(1), Benfante A(1), Tella MD(2).

Author information:
(1)Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, 
Italy.
(2)Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, 
Italy. Electronic address: marialaura.ditella@unito.it.

DOI: 10.1016/j.jad.2021.12.078
PMCID: PMC8758137
PMID: 34952110 [Indexed for MEDLINE]


2600. BMJ Open. 2021 Dec 23;11(12):e057021. doi: 10.1136/bmjopen-2021-057021.

Stressors, self-reported overall health, potential protective factors and the 
workplace well-being of nurses during the COVID-19 pandemic in Switzerland: a 
longitudinal mixed-methods study protocol.

Ortoleva Bucher C(1), Delmas P(2), Oulevey Bachmann A(2), Gilles I(3).

Author information:
(1)La Source School of Nursing, HES-SO, University of Applied Sciences and Arts 
Western Switzerland, Lausanne, Switzerland c.ortolevabucher@ecolelasource.ch.
(2)La Source School of Nursing, HES-SO, University of Applied Sciences and Arts 
Western Switzerland, Lausanne, Switzerland.
(3)Epidemiology and Health Systems, Center for Primary Care and Public Health, 
Lausanne, Switzerland.

INTRODUCTION: The COVID-19 pandemic was making a huge impact on Europe's 
healthcare systems in the spring of 2020, and most predictive models concurred 
that pandemic waves were in the offing. Most studies adopted a pathogenic 
approach to the subject; few used a salutogenic approach. These showed, however, 
that nurses can retain their health despite a pandemic by mobilising generalised 
resistance resources. Our study aims to understand how nurses working in 
Switzerland's hospitals protected their health and workplace well-being during 
the COVID-19 pandemic by investigating the moderating effects of the health 
resources they mobilised against the stressors inherent to the situation. The 
study aims to explore and describe the stressors and the resources nurses used 
to remain healthy during the COVID-19 pandemic.
METHOD AND ANALYSIS: We will use a concurrent mixed-methods panel design with 
qualitative analyses ancillary to quantitative analyses. Quantitative data will 
be collected using electronic questionnaires at four time points over 2 years. 
Qualitative data will be collected using focus groups. Nurses from Switzerland's 
two main linguistic regions who had direct, indirect or no contact with patients 
with COVID-19 will be invited to participate. The a priori sample size will be 
at least 3631 participants at T0 and 1852 at T4. Longitudinal structural 
equation modelling and knowledge mapping will be used to analyse quantitative 
and qualitative data, respectively. The results derived from the two data types 
will then be compared and discussed using a side-by-side approach to determine 
whether they agree or disagree and how they complement each other to achieve our 
aims.
ETHICS AND DISSEMINATION: Nurses will receive an electronic informed consent 
form. The data collected will be stored on a secure server at the authors' 
institution. This research project was approved by the Human Research Ethics 
Committee of the Canton of Vaud (2020-02845).

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/bmjopen-2021-057021
PMCID: PMC8704022
PMID: 34949633 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2601. J Affect Disord. 2022 Feb 15;299:393-407. doi: 10.1016/j.jad.2021.07.048. Epub 
2021 Jul 19.

The collaborative outcomes study on health and functioning during infection 
times in adults (COH-FIT-Adults): Design and methods of an international online 
survey targeting physical and mental health effects of the COVID-19 pandemic.

Solmi M(1), Estradé A(2), Thompson T(3), Agorastos A(4), Radua J(5), Cortese 
S(6), Dragioti E(7), Leisch F(8), Vancampfort D(9), Thygesen LC(10), Aschauer 
H(11), Schloegelhofer M(12), Akimova E(13), Schneeberger A(14), Huber CG(15), 
Hasler G(16), Conus P(17), Cuénod KQD(18), von Känel R(19), Arrondo G(20), 
Fusar-Poli P(21), Gorwood P(22), Llorca PM(23), Krebs MO(24), Scanferla E(25), 
Kishimoto T(26), Rabbani G(27), Skonieczna-Żydecka K(28), Brambilla P(29), 
Favaro A(30), Takamiya A(31), Zoccante L(32), Colizzi M(33), Bourgin J(34), 
Kamiński K(35), Moghadasin M(36), Seedat S(37), Matthews E(38), Wells J(39), 
Vassilopoulou E(40), Gadelha A(41), Su KP(42), Kwon JS(43), Kim M(44), Lee 
TY(45), Papsuev O(46), Manková D(47), Boscutti A(48), Gerunda C(49), Saccon 
D(50), Righi E(51), Monaco F(52), Croatto G(53), Cereda G(54), Demurtas J(55), 
Brondino N(56), Veronese N(57), Enrico P(58), Politi P(59), Ciappolino V(60), 
Pfennig A(61), Bechdolf A(62), Meyer-Lindenberg A(63), Kahl KG(64), Domschke 
K(65), Bauer M(66), Koutsouleris N(67), Winter S(68), Borgwardt S(69), Bitter 
I(70), Balazs J(71), Czobor P(72), Unoka Z(73), Mavridis D(74), Tsamakis K(75), 
Bozikas VP(76), Tunvirachaisakul C(77), Maes M(78), Rungnirundorn T(79), 
Supasitthumrong T(80), Haque A(81), Brunoni AR(82), Costardi CG(83), Schuch 
FB(84), Polanczyk G(85), Luiz JM(86), Fonseca L(87), Aparicio LV(88), Valvassori 
SS(89), Nordentoft M(90), Vendsborg P(91), Hoffmann SH(92), Sehli J(93), 
Sartorius N(94), Heuss S(95), Guinart D(96), Hamilton J(97), Kane J(98), Rubio 
J(99), Sand M(100), Koyanagi A(101), Solanes A(102), Andreu-Bernabeu A(103), 
Cáceres ASJ(104), Arango C(105), Díaz-Caneja CM(106), Hidalgo-Mazzei D(107), 
Vieta E(108), Gonzalez-Peñas J(109), Fortea L(110), Parellada M(111), Fullana 
MA(112), Verdolini N(113), Fárková E(114), Janků K(115), Millan M(116), Honciuc 
M(117), Moniuszko-Malinowska A(118), Łoniewski I(119), Samochowiec J(120), 
Kiszkiel Ł(121), Marlicz M(122), Sowa P(123), Marlicz W(124), Spies G(125), 
Stubbs B(126), Firth J(127), Sullivan S(128), Darcin AE(129), Aksu H(130), 
Dilbaz N(131), Noyan O(132), Kitazawa M(133), Kurokawa S(134), Tazawa Y(135), 
Anselmi A(136), Cracco C(137), Machado AI(138), Estrade N(139), De Leo D(140), 
Curtis J(141), Berk M(142), Ward P(143), Teasdale S(144), Rosenbaum S(145), Marx 
W(146), Horodnic AV(147), Oprea L(148), Alexinschi O(149), Ifteni P(150), 
Turliuc S(151), Ciuhodaru T(152), Bolos A(153), Matei V(154), Nieman DH(155), 
Sommer I(156), van Os J(157), van Amelsvoort T(158), Sun CF(159), Guu TW(160), 
Jiao C(161), Zhang J(162), Fan J(163), Zou L(164), Yu X(165), Chi X(166), de 
Timary P(167), van Winke R(168), Ng B(169), Pena E(170), Arellano R(171), Roman 
R(172), Sanchez T(173), Movina L(174), Morgado P(175), Brissos S(176), Aizberg 
O(177), Mosina A(178), Krinitski D(179), Mugisha J(180), Sadeghi-Bahmani D(181), 
Sadeghi M(182), Hadi S(183), Brand S(184), Errazuriz A(185), Crossley N(186), 
Ristic DI(187), López-Jaramillo C(188), Efthymiou D(189), Kuttichira P(190), 
Kallivayalil RA(191), Javed A(192), Afridi MI(193), James B(194), Seb-Akahomen 
OJ(195), Fiedorowicz J(196), Carvalho AF(197), Daskalakis J(198), Yatham 
LN(199), Yang L(200), Okasha T(201), Dahdouh A(202), Gerdle B(203), Tiihonen 
J(204), Shin JI(205), Lee J(206), Mhalla A(207), Gaha L(208), Brahim T(209), 
Altynbekov K(210), Negay N(211), Nurmagambetova S(212), Jamei YA(213), Weiser 
M(214), Correll CU(215).

Author information:
(1)University of Ottawa, Department of Psychiatry, Ontario, Canada; The Ottawa 
Hospital, Department of Mental Health, Ontario, Canada; University of Ottawa, 
Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, Ottawa 
Ontario; Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, 
Department of Psychosis Studies, Institute of Psychiatry, Psychology& 
Neuroscience, King's College London, London, United Kingdom; Centre for 
Innovation in Mental Health-Developmental Lab, School of Psychology, University 
of Southampton, and NHS Trust, Southampton, United Kingdom. Electronic address: 
marco.solmi83@gmail.com.
(2)Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department 
of Psychosis Studies, Institute of Psychiatry, Psychology& Neuroscience, King's 
College London, London, United Kingdom; Universidad Católica, Department of 
Psychology, Montevideo, Uruguay. Electronic address: 
andres.estrade_vaz@kcl.ac.uk.
(3)University of Greenwich, School of Human Sciences, London, United Kingdom. 
Electronic address: T.Thompson@greenwich.ac.uk.
(4)Aristotle University of Thessaloniki, II. Dept. of Psychiatry, Division of 
Neurosciences, Medical School, Faculty of Health Sciences, Greece. Electronic 
address: aagorast@auth.gr.
(5)Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department 
of Psychosis Studies, Institute of Psychiatry, Psychology& Neuroscience, King's 
College London, London, United Kingdom; Institut d'Investigacions Biomèdiques 
August Pi i Sunyer (IDIBAPS), Imaging of Mood- and Anxiety-Related Disorders 
(IMARD), CIBERSAM, Barcelona, Spain; Karolinska Institutet, Centre for 
Psychiatric Research and Education, Department of Clinical Neuroscience, 
Stockholm, Sweden. Electronic address: radua@clinic.cat.
(6)University of Southampton, Centre for Innovation in Mental Health, 
Southampton, United Kingdom. Electronic address: samuele.cortese@soton.ac.uk.
(7)Linköping University, Pain and Rehabilitation Centre and Department of 
Health, Medicine and Caring Sciences, Linköping, Sweden; University of Ioannina, 
Research Laboratory Psychology of Patients, Families & Health Professionals, 
Department of Nursing, School of Health Sciences, Ioannina, Greece. Electronic 
address: elena.dragioti@liu.se.
(8)University of Natural Resources and Life Sciences, Wien, Austria. Electronic 
address: Friedrich.Leisch@boku.ac.at.
(9)Katholieke Universiteit Leuven (KU Leuven), Department of Rehabilitation 
Sciences, Leuven, Belgium. Electronic address: davy.vancampfort@kuleuven.be.
(10)National Institute of Public Health, University of Southern Denmark, 
Denmark. Electronic address: lct@sdu.dk.
(11)BioPsyC - Biopsychosocial Corporation, Non-profit association for Research 
Funding Ltd., Vienna, Austria. Electronic address: harald.aschauer@biopsyc.at.
(12)BioPsyC - Biopsychosocial Corporation, Non-profit association for Research 
Funding Ltd., Vienna, Austria. Electronic address: 
monika.schloegelhofer@biopsyc.at.
(13)BioPsyC - Biopsychosocial Corporation, Non-profit association for Research 
Funding Ltd., Vienna, Austria. Electronic address: elena.akimova@biopsyc.at.
(14)Psychiatric Services Grisons, Department of Adult Psychiatry, Switzerland. 
Electronic address: andres.schneeberger@pdgr.ch.
(15)University of Basel, Universitäre Psychiatrische Kliniken Basel (UPK), 
Basel, Switzerland. Electronic address: christian.huber@unibas.ch.
(16)University of Fribourg, Fribourg Network of Mental Health (RFSM), Fribourg, 
Switzerland. Electronic address: gregor.hasler@unifr.ch.
(17)University of Lausanne, Department of Psychiatry, Lausanne, Switzerland. 
Electronic address: philippe.conus@chuv.ch.
(18)University of Lausanne, Department of Psychiatry, Lausanne, Switzerland. 
Electronic address: Kim.Do@chuv.ch.
(19)University Hospital Zurich, Department of Consultation-Liaison Psychiatry 
and Psychosomatic Medicine, Switzerland. Electronic address: 
roland.vonkaenel@usz.ch.
(20)University of Southampton, Centre for Innovation in Mental Health, 
Southampton, United Kingdom; University of Navarra, Mind-Brain Group, Institute 
for Culture and Society (ICS), Pamplona, Spain. Electronic address: 
garrondo@unav.es.
(21)Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department 
of Psychosis Studies, Institute of Psychiatry, Psychology& Neuroscience, King's 
College London, London, United Kingdom; OASIS service, South London and Maudsley 
NHS Foundation Trust, London, United Kingdom; University of Pavia, Department of 
Brain and Behavioral Sciences, Pavia, Italy. Electronic address: 
paolo.fusar-poli@unipv.it.
(22)Université de Paris, CMME, GHU Paris Psychiatrie et Neurosciences, Paris, 
France; Institute de Psychiatrie et Neuroscience de Paris, INSERM U1266, 
F-75014, Paris, France. Electronic address: p.gorwood@ghu-paris.fr.
(23)Université Clermont Auvergne, CHU Clermont-Ferrand, Service de Psychiatrie 
B, Clermont-Ferrand, France. Electronic address: 
pmllorca@chu-clermontferrand.fr.
(24)Institute de Psychiatrie et Neuroscience de Paris, INSERM U1266, F-75014, 
Paris, France; Université de Paris, PEPIT, GHU Paris Psychiatrie et 
Neuroscience, Paris, France. Electronic address: MO.KREBS@ghu-paris.fr.
(25)Université de Paris, CMME, GHU Paris Psychiatrie et Neurosciences, Paris, 
France. Electronic address: e.scanferla@ghu-paris.fr.
(26)Keio University School of Medicine, Department of Neuropsychiatry, Tokyo, 
Japan. Electronic address: tkishimoto@keio.jp.
(27)The National Foundation of Mental Health of Bangladesh, Bangladesh. 
Electronic address: rabbanigolam33@gmail.com.
(28)Pomeranian Medical University in Szczecin, Department of Biochemical 
Sciences, Szczecin, Poland. Electronic address: karzyd@pum.edu.pl.
(29)University of Milan, Department of Pathophysiology and Transplantation, 
Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 
Department of Neurosciences and Mental Health, Milan, Italy. Electronic address: 
paolo.brambilla1@unimi.it.
(30)University of Padua, Neurosciences Department, Padua, Italy. Electronic 
address: angela.favaro@unipd.it.
(31)Keio University School of Medicine, Department of Neuropsychiatry, Tokyo, 
Japan. Electronic address: akihiro.takamiya@keio.jp.
(32)Integrated University Hospital of Verona, Child and Adolescent 
Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Verona, Italy. 
Electronic address: leonardo.zoccante@aovr.veneto.it.
(33)University of Verona, Section of Psychiatry, Department of Neurosciences, 
Biomedicine and Movement Sciences, Verona, Italy. Electronic address: 
marco.colizzi@univr.it.
(34)Service de Psychiatrie de l'enfant et de l'adolescent, GHNE, 91440 Bures Sur 
Yvette, France. Electronic address: j.bourgin@gh-nord-essonne.fr.
(35)Medical University of Białystok, Department of Population Medicine and 
Lifestyle Diseases Prevention, Bialystok, Poland. Electronic address: 
fizklin@gmail.com.
(36)Kharazmi University, Department of Clinical Psychology, Faculty of 
Psychology and Education, Tehran, Iran. Electronic address: 
mmoghadasin@yahoo.com.
(37)Stellenbosch University, Department of Psychiatry, Faculty of Medicine and 
Health Sciences, South Africa. Electronic address: sseedat@sun.ac.za.
(38)Waterford Institute of Technology, School of Health Sciences, Waterford, 
Ireland. Electronic address: ematthews@wit.ie.
(39)Waterford Institute of Technology, School of Health Sciences, Waterford, 
Ireland. Electronic address: jswells@wit.ie.
(40)University of Nicosia, Department of Life and Health Sciences, Nicosia, 
Cyprus. Electronic address: vassilopoulouemilia@gmail.com.
(41)Universidade Federal de São Paulo, Department of Psychiatry, São Paulo, 
Brazil. Electronic address: aryararipe@gmail.com.
(42)An-Nan Hospital, China Medical University, Department of Psychiatry, Tainan, 
Taiwan; Maastricht University, Department of Psychiatry and Neuropsychology, 
Maastricht, The Netherlands. Electronic address: cobolsu@gmail.com.
(43)Seoul National University College of Medicine, Department of Psychiatry, 
Seoul, Republic of Korea. Electronic address: kwonjs@snu.ac.kr.
(44)Seoul National University Hospital, Department of Neuropsychiatry, Seoul, 
Republic of Korea. Electronic address: verte82@snu.ac.kr.
(45)Pusan National University Yangsan Hospital, Department of Psychiatry, 
Yangsan, Republic of Korea. Electronic address: leetaey@gmail.com.
(46)Moscow Research Institute of Psychiatry, Moscow, Russia. Electronic address: 
oleg.papsouev@gmail.com.
(47)National Institute of Mental Health, Klecany, Czech Republic. Electronic 
address: denisa.mankova@nudz.cz.
(48)University of Milan, Department of Pathophysiology and Transplantation, 
Milan, Italy. Electronic address: a.boscutti@gmail.com.
(49)University of Padua, Neurosciences Department, Padua, Italy. Electronic 
address: cristiano.gerunda@unipd.it.
(50)AULSS4 Veneto Orientale, Addictions Department, Italy. Electronic address: 
diego.saccon@aulss4.veneto.it.
(51)University of Modena and Reggio Emilia, Department of Biomedical, Metabolic 
and Neural Sciences, Modena, Italy. Electronic address: elena.righi@unimore.it.
(52)ASL Salerno, Department of Mental Health, Salerno, Italy. Electronic 
address: fmonaco1980@gmail.com.
(53)University of Padova, Padova, Italy. Electronic address: 
giovannicroatto8@gmail.com.
(54)University of Milan, Department of Pathophysiology and Transplantation, 
Milan, Italy. Electronic address: guido.cereda@unimi.it.
(55)University of Modena and Reggio Emilia, Clinical and Experimental Medicine 
PhD Program, Modena, Italy. Electronic address: eritrox7@gmail.com.
(56)University of Pavia, Department of Brain and Behavioral Sciences, Pavia, 
Italy. Electronic address: natascia.brondino@unipv.it.
(57)University of Palermo, Department of Internal Medicine, Geriatrics Section, 
Palermo, Italy. Electronic address: nicola.veronese@unipa.it.
(58)University of Milan, Department of Pathophysiology and Transplantation, 
Milan, Italy. Electronic address: paolo.enrico@unimi.it.
(59)University of Pavia, Department of Brain and Behavioral Sciences, Pavia, 
Italy. Electronic address: pierluigi.politi@unipv.it.
(60)Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of 
Neurosciences and Mental Health, Milan, Italy. Electronic address: 
valentina.ciappolino@policlinico.mi.it.
(61)Technische Universität Dresden, University Hospital Carl Gustav Carus, 
Department of Psychiatry and Psychotherapy, Dresden, Germany. Electronic 
address: Andrea.Pfennig@uniklinikum-dresden.de.
(62)University of Cologne, Cologne, Germany. Electronic address: 
andreas.bechdolf@uk-koeln.de.
(63)Heidelberg University, Central Institute of Mental Health, Medical Faculty 
Mannheim, Germany. Electronic address: Andreas.Meyer-Lindenberg@zi-mannheim.de.
(64)Hannover Medical School, Department of Psychiatry, Social Psychiatry and 
Psychotherapy, Germany. Electronic address: kahl.kai@mh-hannover.de.
(65)University of Freiburg, Department of Psychiatry and Psychotherapy, Medical 
Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany. 
Electronic address: katharina.domschke@uniklinik-freiburg.de.
(66)Technische Universität Dresden, University Hospital Carl Gustav Carus, 
Department of Psychiatry and Psychotherapy, Dresden, Germany. Electronic 
address: Michael.Bauer@uniklinikum-dresden.de.
(67)Ludwig-Maximilians-University of Munich, Munich, Germany. Electronic 
address: Nikolaos.Koutsouleris@med.uni-muenchen.de.
(68)Charité Universitätsmedizin Berlin, Department of Child and Adolescent 
Psychiatry, Berlin, Germany. Electronic address: sibylle.winter@charite.de.
(69)University of Lübeck, Lübeck, Germany. Electronic address: 
s.borgwardt@unibas.ch.
(70)Semmelweis University, Department of Psychiatry and Psychotherapy, Budapest, 
Hungary. Electronic address: bitter.istvan@med.semmelweis-univ.hu.
(71)Eotvos Lorand University, Institute of Psychology, Budapest, Hungary; 
Bjørknes University College, Oslo, Norway. Electronic address: 
balazs.judit@ppk.elte.hu.
(72)Semmelweis University, Department of Psychiatry and Psychotherapy, Budapest, 
Hungary. Electronic address: czobor.pal@med.semmelweis-univ.hu.
(73)Semmelweis University, Department of Psychiatry and Psychotherapy, Budapest, 
Hungary. Electronic address: unoka.zsolt@med.semmelweis-univ.hu.
(74)University of Ioannina, Department of Primary Education, Ioannina, Greece. 
Electronic address: dmavridi@uoi.gr.
(75)King's College London, Institute of Psychiatry, Psychology and Neuroscience, 
London, United Kingdom. Electronic address: ktsamakis@gmail.com.
(76)Aristotle University of Thessaloniki, II. Dept. of Psychiatry, Division of 
Neurosciences, Medical School, Faculty of Health Sciences, Greece. Electronic 
address: mpozikas@auth.gr.
(77)Chulalongkorn University, Department of Psychiatry, Thailand. Electronic 
address: chavit.T@chula.ac.th.
(78)Chulalongkorn University, Department of Psychiatry, Thailand. Electronic 
address: dr.michaelmaes@hotmail.com.
(79)Chulalongkorn University, Department of Psychiatry, Thailand. Electronic 
address: drteerayuth@gmail.com.
(80)Chulalongkorn University, Department of Psychiatry, Thailand. Electronic 
address: thitiporn.s@chula.ac.th.
(81)The National Foundation of Mental Health of Bangladesh, Bangladesh. 
Electronic address: arifulhaque.ukzn@gmail.com.
(82)Faculdade de Medicina da Universidade de São Paulo, Departments of Internal 
Medicine and Psychiatry, São Paulo, Brazil. Electronic address: brunoni@usp.br.
(83)Universidade Federal de São Paulo, Department of Psychiatry, São Paulo, 
Brazil. Electronic address: gustavocostardi@hotmail.com.
(84)Universidade Federal de Santa Maria, Department of Sports Methods and 
Techniques, Santa Maria, RS, Brazil. Electronic address: felipe.schuch@ufsm.br.
(85)Faculdade de Medicina da Universidade de São Paulo, Departments of Internal 
Medicine and Psychiatry, São Paulo, Brazil. Electronic address: 
polanczyk.guilherme@gmail.com.
(86)Universidade do Extremo Sul Catarinense, Translational Psychiatry 
Laboratory, Graduate Program in Health Sciences, Criciúma, SC, Brazil. 
Electronic address: jhoanne_luiz@hotmail.com.
(87)Universidade Federal de São Paulo, Department of Psychiatry, São Paulo, 
Brazil. Electronic address: laismfonseca@gmail.com.
(88)Faculdade de Medicina da Universidade de São Paulo, Departments of Internal 
Medicine and Psychiatry, São Paulo, Brazil. Electronic address: 
luanavma@hotmail.com.
(89)Universidade do Extremo Sul Catarinense, Translational Psychiatry 
Laboratory, Graduate Program in Health Sciences, Criciúma, SC, Brazil. 
Electronic address: samiravalvassori@unesc.net.
(90)University of Copenhagen, Copenhagen, Denmark. Electronic address: 
mn@dadlnet.dk.
(91)Psykiatrifonden, Copenhagen, Denmark. Electronic address: 
pv@psykiatrifonden.dk.
(92)National Institute of Public Health, University of Southern Denmark, 
Denmark. Electronic address: sohh@sdu.dk.
(93)University of Fribourg, Fribourg Network of Mental Health (RFSM), Fribourg, 
Switzerland. Electronic address: jihed.sehli@gmail.com.
(94)Association for the Improvement of Mental Health Programmes (AMH), 
Switzerland. Electronic address: sartorius@normansartorius.com.
(95)FHNW University of Applied Sciences and Arts Northwestern Switzerland, 
Switzerland. Electronic address: sabina.heuss@fhnw.ch.
(96)The Zucker Hillside Hospital, Northwell Health, New York, USA; Donald and 
Barbara Zucker School of Medicine at Hofstra/Northwell, New York, USA; 
Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de 
Salud Mental (CIBERSAM), Institut de Neuropsiquiatria i Addiccions (INAD), 
Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), 
Departament de Psiquiatria, Barcelona, Spain. Electronic address: 
DGuinart@northwell.edu.
(97)University of Texas Health Science Center Houston, McGovern Medical School, 
Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, USA. 
Electronic address: Jane.E.Hamilton@uth.tmc.edu.
(98)The Zucker Hillside Hospital, Northwell Health, New York, USA; Feinstein 
Institutes for Medical Research, New York, USA. Electronic address: 
JKane2@northwell.edu.
(99)The Zucker Hillside Hospital, Northwell Health, New York, USA; Feinstein 
Institutes for Medical Research, New York, USA. Electronic address: 
JRubio13@northwell.edu.
(100)Boehringer-Ingelheim, USA. Electronic address: 
michael.sand@boehringer-ingelheim.com.
(101)Parc Sanitari Sant Joan de Deu, Research and Development Unit, CIBERSAM, 
ICREA, Barcelona, Spain. Electronic address: a.koyanagi@pssjd.org.
(102)Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Imaging 
of Mood- and Anxiety-Related Disorders (IMARD), CIBERSAM, Barcelona, Spain. 
Electronic address: al.solanes@gmail.com.
(103)Hospital General Universitario Gregorio Marañón, Department of Child and 
Adolescent Psychiatry, Institute of Psychiatry and Mental Health (IPS MARAÑÓN), 
IiSGM, CIBERSAM, Madrid, Spain. Electronic address: a.andreu.bernabeu@gmail.com.
(104)Hospital General Universitario Gregorio Marañón, Department of Child and 
Adolescent Psychiatry, Institute of Psychiatry and Mental Health (IPS MARAÑÓN), 
IiSGM, CIBERSAM, Madrid, Spain. Electronic address: antonia.sanjose@iisgm.com.
(105)Hospital General Universitario Gregorio Marañón, Department of Child and 
Adolescent Psychiatry, Institute of Psychiatry and Mental Health (IPS MARAÑÓN), 
IiSGM, CIBERSAM, Madrid, Spain. Electronic address: carango@hggm.es.
(106)Hospital General Universitario Gregorio Marañón, Department of Child and 
Adolescent Psychiatry, Institute of Psychiatry and Mental Health (IPS MARAÑÓN), 
IiSGM, CIBERSAM, Madrid, Spain. Electronic address: 
covadonga.martinez@iisgm.com.
(107)University of Barcelona, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, 
Spain. Electronic address: dahidalg@clinic.cat.
(108)University of Barcelona, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, 
Spain. Electronic address: evieta@clinic.cat.
(109)Hospital General Universitario Gregorio Marañón, Department of Child and 
Adolescent Psychiatry, Institute of Psychiatry and Mental Health (IPS MARAÑÓN), 
IiSGM, CIBERSAM, Madrid, Spain. Electronic address: javipenhas@gmail.com.
(110)Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Imaging 
of Mood- and Anxiety-Related Disorders (IMARD), CIBERSAM, Barcelona, Spain. 
Electronic address: lydiafor94@gmail.com.
(111)Hospital General Universitario Gregorio Marañón, Department of Child and 
Adolescent Psychiatry, Institute of Psychiatry and Mental Health (IPS MARAÑÓN), 
IiSGM, CIBERSAM, Madrid, Spain. Electronic address: parelladahggm@gmail.com.
(112)Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Imaging 
of Mood- and Anxiety-Related Disorders (IMARD), CIBERSAM, Barcelona, Spain. 
Electronic address: mafullana@clinic.cat.
(113)University of Barcelona, Hospital Clínic, Bipolar and Depressive Disorders 
Unit, Institute of Neuroscience, IDIBAPS, CIBERSAM, Barcelona, Spain. Electronic 
address: norma.verdolini@gmail.com.
(114)National Institute of Mental Health, Klecany, Czech Republic. Electronic 
address: eva.farkova@nudz.cz.
(115)National Institute of Mental Health, Klecany, Czech Republic. Electronic 
address: karolina.janku@nudz.cz.
(116)Institute de Recherché de Servier (IDRS), France. Electronic address: 
mark.millan@servier.com.
(117)Université Clermont Auvergne, CHU Clermont-Ferrand, Service de Psychiatrie 
B, Clermont-Ferrand, France. Electronic address: 
rmhonciuc@chu-clermontferrand.fr.
(118)Medical University of Białystok, Department of Infectious Diseases and 
Neuroinfections, Poland. Electronic address: annamoniuszko@op.pl.
(119)Pomeranian Medical University in Szczecin, Department of Biochemical 
Sciences, Szczecin, Poland; Sanprobi Sp. z o.o. Sp. k, Poland. Electronic 
address: sanprobi@sanprobi.pl.
(120)Pomeranian Medical University in Szczecin, Department of Psychiatry, 
Szczecin, Poland. Electronic address: samoj@pum.edu.pl.
(121)University of Białystok, Institute of Sociology, Society and Cognition 
Unit, Białystok, Poland. Electronic address: lukaszkiszkiel@gmail.com.
(122)Pomeranian Medical University in Szczecin, Department of Biochemical 
Sciences, Szczecin, Poland. Electronic address: mariamarlicz@gmail.com.
(123)Medical University of Białystok, Department of Population Medicine and 
Lifestyle Diseases Prevention, Bialystok, Poland. Electronic address: 
mailtosowa@gmail.com.
(124)Pomeranian Medical University in Szczecin, Department of Gastroenterology, 
Szczecin, Poland; The Centre for Digestive Diseases Endoklinika, Szczecin, 
Poland. Electronic address: marlicz@hotmail.com.
(125)Stellenbosch University, Department of Psychiatry, Faculty of Medicine and 
Health Sciences, South Africa. Electronic address: ggiocos@sun.ac.za.
(126)King's College London, London, United Kingdom. Electronic address: 
brendon.stubbs@kcl.ac.uk.
(127)University of Manchester, Division of Psychology and Mental Health, 
Manchester, United Kingdom. Electronic address: joseph.firth@manchester.ac.uk.
(128)University of Bristol, Bristol, United Kingdom. Electronic address: 
Sarah.Sullivan@bristol.ac.uk.
(129)Istanbul Basaksehir Cam ve Sakura City Hospital, Department of Psychiatry, 
Istanbul, Turkey. Electronic address: aslienez@gmail.com.
(130)Adnan Menderes University Department of Child and Adolescent Psychiatry, 
Aydın, Turkey. Electronic address: aksubhatice@yahoo.com.
(131)Uskudar University, Department of Psychiatry and Psychology, Istanbul, 
Turkey. Electronic address: nesrin.dilbaz@gmail.com.
(132)Uskudar University, Department of Psychiatry and Psychology, Istanbul, 
Turkey. Electronic address: conurnoyan@gmail.com.
(133)Keio University School of Medicine, Department of Neuropsychiatry, Tokyo, 
Japan. Electronic address: m-kitazawa@keio.jp.
(134)Keio University School of Medicine, Department of Neuropsychiatry, Tokyo, 
Japan. Electronic address: shunya5@keio.jp.
(135)Keio University School of Medicine, Department of Neuropsychiatry, Tokyo, 
Japan. Electronic address: tazawa@a5.keio.jp.
(136)Universidad Católica, Department of Psychology, Montevideo, Uruguay. 
Electronic address: alejandro.anselmi@ucu.edu.uy.
(137)Universidad Católica, Department of Psychology, Montevideo, Uruguay. 
Electronic address: ccracco@ucu.edu.uy.
(138)Universidad Católica, Department of Psychology, Montevideo, Uruguay. 
Electronic address: amachado@ucu.edu.uy.
(139)Universidad Católica, Department of Psychology, Montevideo, Uruguay. 
Electronic address: natalia.estrade@ucu.edu.uy.
(140)Griffith University, South East Queensland, Australia. Electronic address: 
D.DeLeo@griffith.edu.au.
(141)Mindgardens Neuroscience Network, Sydney, Australia. Electronic address: 
j.curtis@unsw.edu.au.
(142)Deakin University School of Medicine, Victoria, Australia. Electronic 
address: michael.berk@deakin.edu.au.
(143)UNSW Sydney, School of Psychiatry, Sydney, Australia. Electronic address: 
p.ward@unsw.edu.au.
(144)Deakin University School of Medicine, Victoria, Australia. Electronic 
address: s.teasdale@unsw.edu.au.
(145)UNSW Sydney, School of Psychiatry, Sydney, Australia. Electronic address: 
s.rosenbaum@unsw.edu.au.
(146)Deakin University School of Medicine, Victoria, Australia. Electronic 
address: wolf.marx@deakin.edu.au.
(147)University of Medicine and Pharmacy Grigore T. Popa, Faculty of Medicine, 
Iasi, Romania. Electronic address: adrian-vasile-horodnic@umfiasi.ro.
(148)University of Medicine and Pharmacy Grigore T. Popa, Faculty of Medicine, 
Iasi, Romania. Electronic address: liviu.oprea@umfiasi.ro.
(149)Institute of Psychiatry "Socola", Iasi, Romania. Electronic address: 
alexinschi@yahoo.com.
(150)Transilvania University of Brasov, Faculty of Medicine, Brasov, Romania. 
Electronic address: petru_ifteni@yahoo.com.
(151)University of Medicine and Pharmacy Grigore T. Popa, Faculty of Medicine, 
Iasi, Romania. Electronic address: serban_turliuc@yahoo.com.
(152)Emergency Hospital "Nicolae Oblu", Iasi, Romania. Electronic address: 
tudorciuhodaru@yahoo.co.uk.
(153)University of Medicine and Pharmacy Grigore T. Popa, Faculty of Medicine, 
Iasi, Romania. Electronic address: alex_andra_bolos@yahoo.com.
(154)Psychiatry Department, University of Medicine and Pharmacy "Carol Davila" 
Bucharest, "Prof. Dr. Alexandru Obregia" Psychiatric Hospital, Bucharest, 
Romania. Electronic address: valipmatei@yahoo.com.
(155)Academisch Medisch Centrum Universiteit van Amsterdam, Amsterdam, The 
Netherlands. Electronic address: d.h.nieman@amc.uva.nl.
(156)University Medical Center Groningen, University of Groningen, Cognitive 
Neurosciences, Department of Biomedical Sciences of Cells & Systems, Groningen, 
The Netherlands; University Medical Center Groningen, University of Groningen, 
Department of Psychiatry, Groningen, The Netherlands. Electronic address: 
i.e.c.sommer@umcg.nl.
(157)Utrecht University Medical Centre, Department of Psychiatry, Utrecht, The 
Netherlands. Electronic address: j.j.vanos-2@umcutrecht.nl.
(158)Maastricht University, Department of Psychiatry and Neuropsychology, 
Maastricht, The Netherlands. Electronic address: 
t.vanamelsvoort@maastrichtuniversity.nl.
(159)China Medical University Hospital, Mind-Body Interface Research Center, 
Taichung, Taiwan; Department of Psychiatry and Behavioral Medicine, Carilion 
Clinic Virginia Tech Carilion School of Medicine, Roanoke, VA, USA. Electronic 
address: chingfangsun@gmail.com.
(160)China Medical University Beigang Hospital, Division of Psychiatry, 
Department of Internal Medicine, Taiwan. Electronic address: da20vid@gmail.com.
(161)Shenzhen University, School of Psychology, Shenzhen, China. Electronic 
address: jiaocan@szu.edu.cn.
(162)Shenzhen University, School of Psychology, Shenzhen, China. Electronic 
address: jenny121@126.com.
(163)Shenzhen University, School of Psychology, Shenzhen, China. Electronic 
address: FanJL@szu.edu.cn.
(164)Shenzhen University, School of Psychology, Shenzhen, China. Electronic 
address: liyezou123@gmail.com.
(165)Peking University Institute of Mental Health, Department of Public Mental 
Health, Pekin, China. Electronic address: yuxin@bjmu.edu.cn.
(166)Shenzhen University, School of Psychology, Shenzhen, China. Electronic 
address: xinlichi@126.com.
(167)UCLouvain, Institute of Neuroscience and Cliniques Universitaires 
Saint-Luc, Department of Adult Psychiatry, Brussels, Belgium. Electronic 
address: Philippe.detimary@uclouvain.be.
(168)Katholieke Universiteit Leuven (KU Leuven), Department of Neurosciences, 
Leuven, Belgium. Electronic address: ruud.vanwinkel@kuleuven.be.
(169)Asociación Psiquiátrica Mexicana, Mexico. Electronic address: 
bng@sunvalleyb.com.
(170)Asociación Psiquiátrica Mexicana, Mexico. Electronic address: 
epena@cisne.mx.
(171)Asociación Psiquiátrica Mexicana, Mexico. Electronic address: 
jramonarellanoc@hotmail.com.
(172)Asociación Psiquiátrica Mexicana, Mexico. Electronic address: 
raquelrr@hotmail.com.
(173)Asociación Psiquiátrica Mexicana, Mexico. Electronic address: 
marsan2@prodigy.net.mx.
(174)Moscow Research Institute of Psychiatry, Moscow, Russia. Electronic 
address: movina_larisa@bk.ru.
(175)University of Minho, Life and Health Sciences Research Institute (ICVS), 
School of Medicine, Braga, Portugal; ICVS/3B's - PT Government Associate 
Laboratory, Braga Guimarães, Portugal. Electronic address: 
pedromorgado@med.uminho.pt.
(176)Lisbon's Psychiatric Hospital Centre, Department of Psychiatry, Portugal. 
Electronic address: brissos.sofia@gmail.com.
(177)Belarusian Medical Academy of Postgraduate Education, Belarus. Electronic 
address: oleg.aizberg@gmail.com.
(178)Clienia AG, Wetzikon Psychiatric Centre, Switzerland. Electronic address: 
annamosina.md@gmail.com.
(179)Integrated Psychiatry Winterthur (IPW), Switzerland. Electronic address: 
damir.krinitski@gmail.com.
(180)Kyambogo University, Department of Sociology and Social Administration, 
Kampala, Uganda. Electronic address: Jmmugi77@hotmail.com.
(181)Stanford University, Department of Psychology, California, USA; 
Universitäre Psychiatrische Kliniken Basel (UPK), Center of Affective, Stress 
and Sleep Disorders (ZASS), Basel, Switzerland. Electronic address: 
Bahmanid@stanford.edu.
(182)Kermanshah University of Medical Sciences, Medical Biology Research Center, 
Kermanshah, Iran. Electronic address: sadeghi_mbrc@yahoo.com.
(183)Kharazmi University, Tehran, Iran. Electronic address: 
hadi.samira@yahoo.com.
(184)Universitäre Psychiatrische Kliniken Basel (UPK), Center of Affective, 
Stress and Sleep Disorders (ZASS), Basel, Switzerland; University of Basel, 
Department of Sport, Exercise, and Health, Division of Sport Science and 
Psychosocial Health, Basel, Switzerland; Kermanshah University of Medical 
Sciences, Substance Abuse Prevention Research Center, Kermanshah, Iran; 
Kermanshah University of Medical Sciences, Sleep Disorders Research Center, 
Kermanshah, Iran; Tehran University of Medical Sciences, School of Medicine, 
Tehran, Iran. Electronic address: serge.brand@upk.ch.
(185)Pontificia Universidad Católica de Chile, Department of Psychiatry, School 
of Medicine, Santiago, Chile. Electronic address: anerrazuriz@uc.cl.
(186)Pontificia Universidad Católica de Chile, Department of Psychiatry, School 
of Medicine, Santiago, Chile. Electronic address: ncrossley@uc.cl.
(187)University of Kragujevac, Department of Psychiatry, Faculty of Medical 
Sciences, Kragujevac, Serbia. Electronic address: draganaristic4@gmail.com.
(188)University of Antioquia, Department of Psychiatry, Medellín, Colombia. 
Electronic address: carlos.lopez20@udea.edu.co.
(189)University of Nicosia, Department of Life and Health Sciences, Nicosia, 
Cyprus. Electronic address: dimitrisefthy@gmail.com.
(190)Jubilee Mission Medical College & Research Institute, Thrissur, India. 
Electronic address: drpraveenlalkuttichira@gmail.com.
(191)Pushpagiri Institute of Medical Sciences, Deptartment of Psychiatry, 
Thiruvalla, Kerala, India. Electronic address: roykalli@gmail.com.
(192)Chairman, Pakistan Psychiatric Research Centre-Fountain House, Lahore, 
Pakistan. Electronic address: afzalj@gmail.com.
(193)Dean, Faculty of Psychiatry, College of Physicians and Surgeons, Pakistan; 
Dean, Jinnah Postgraduate Medical Centre, Karachi, Pakistan; Dean, Faculty of 
Medicine, Jinnah Sindh Medical University, Karachi, Pakistan. Electronic 
address: driqbalafridi@yahoo.com.
(194)Federal Neuropsychiatric Hospital, Department of Clinical Services, 
Benin-City, Nigeria. Electronic address: bawojames@yahoo.com.
(195)Irrua Specialist Teaching Hospital, Department of Psychiatry, Edo State, 
Nigeria. Electronic address: sebakahomen@gmail.com.
(196)University of Ottawa, Department of Psychiatry, Ontario, Canada. Electronic 
address: jfiedorowicz@toh.ca.
(197)Centre for Addiction and Mental Health (CAMH), Canada. Electronic address: 
Andre.Carvalho@camh.ca.
(198)University of Toronto, Toronto, Canada. Electronic address: 
Jeff.Daskalakis@camh.ca.
(199)University of British Columbia, Vancouver, Canada. Electronic address: 
l.yatham@ubc.ca.
(200)University of Calgary, Alberta Health Services, Calgary, Canada. Electronic 
address: lin.yang@ahs.ca.
(201)Okasha Institute of Psychiatry, Faculty of Medicine, Ain Shams University, 
Cairo, Egyp. Electronic address: tarek.okasha@gmail.com.
(202)Oran 1 University, Department of Psychiatry-Addictology, Oran, Algeria. 
Electronic address: aichadahdouh@gmail.com.
(203)Linköping University, Pain and Rehabilitation Centre and Department of 
Health, Medicine and Caring Sciences, Linköping, Sweden. Electronic address: 
bjorn.gerdle@liu.se.
(204)Karolinska Institutet, Centre for Psychiatric Research and Education, 
Department of Clinical Neuroscience, Stockholm, Sweden. Electronic address: 
jari.tiihonen@ki.se.
(205)Yonsei University College of Medicine, Department of Pediatrics, Seoul, 
South Korea. Electronic address: SHINJI@yuhs.ac.
(206)Yonsei University Wonju College of Medicine, Department of Psychiatry, 
Wonju, South Korea. Electronic address: jinh.lee95@yonsei.ac.kr.
(207)University of Monastir, Research Unit "Vulnerability to Mental Disorders" 
LR05ES10, Monastir, Tunisia. Electronic address: ahmed.mhalla@yahoo.fr.
(208)University of Monastir, Research Unit "Vulnerability to Mental Disorders" 
LR05ES10, Monastir, Tunisia. Electronic address: gaha.lotfi@yahoo.fr.
(209)University of Monastir, University Hospital of Monastir, Department of 
Psychiatry, Monastir, Tunisia. Electronic address: takoua.brahim@yahoo.com.
(210)Republican Scientific and Practical Center of Mental Health, Kazakhstan. 
Electronic address: altyn@mail.ru.
(211)Republican Scientific and Practical Center of Mental Health, Kazakhstan. 
Electronic address: nick_negaj@mail.ru.
(212)Republican Scientific and Practical Center of Mental Health, Kazakhstan. 
Electronic address: saya_n@yahoo.com.
(213)Gaza Community Mental Health Programme, Palestine. Electronic address: 
yasser@gcmhp.net.
(214)Sheba Medical Center, Israel. Electronic address: mweiser@netvision.net.il.
(215)Charité Universitätsmedizin Berlin, Department of Child and Adolescent 
Psychiatry, Berlin, Germany; The Zucker Hillside Hospital, Northwell Health, New 
York, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 
New York, USA. Electronic address: CCorrell@northwell.edu.

BACKGROUND: . High-quality comprehensive data on short-/long-term 
physical/mental health effects of the COVID-19 pandemic are needed.
METHODS: . The Collaborative Outcomes study on Health and Functioning during 
Infection Times (COH-FIT) is an international, multi-language (n=30) project 
involving >230 investigators from 49 countries/territories/regions, endorsed by 
national/international professional associations. COH-FIT is a multi-wave, 
on-line anonymous, cross-sectional survey [wave 1: 04/2020 until the end of the 
pandemic, 12 months waves 2/3 starting 6/24 months threreafter] for adults, 
adolescents (14-17), and children (6-13), utilizing non-probability/snowball and 
representative sampling. COH-FIT aims to identify non-modifiable/modifiable risk 
factors/treatment targets to inform prevention/intervention programs to improve 
social/health outcomes in the general population/vulnerable subgrous 
during/after COVID-19. In adults, co-primary outcomes are change from 
pre-COVID-19 to intra-COVID-19 in well-being (WHO-5) and a composite 
psychopathology P-Score. Key secondary outcomes are a P-extended score, global 
mental and physical health. Secondary outcomes include health-service 
utilization/functioning, treatment adherence, functioning, 
symptoms/behaviors/emotions, substance use, violence, among others.
RESULTS: . Starting 04/26/2020, up to 14/07/2021 >151,000 people from 155 
countries/territories/regions and six continents have participated. 
Representative samples of ≥1,000 adults have been collected in 15 countries. 
Overall, 43.0% had prior physical disorders, 16.3% had prior mental disorders, 
26.5% were health care workers, 8.2% were aged ≥65 years, 19.3% were exposed to 
someone infected with COVID-19, 76.1% had been in quarantine, and 2.1% had been 
COVID 19-positive.
LIMITATIONS: . Cross-sectional survey, preponderance of non-representative 
participants.
CONCLUSIONS: . Results from COH-FIT will comprehensively quantify the impact of 
COVID-19, seeking to identify high-risk groups in need for acute and long-term 
intervention, and inform evidence-based health policies/strategies during 
this/future pandemics.

Copyright © 2021. Published by Elsevier B.V.

DOI: 10.1016/j.jad.2021.07.048
PMCID: PMC8288233
PMID: 34949568 [Indexed for MEDLINE]

Conflict of interest statement: All conflict of interest statements of all 
authors are detailed in Supplementary Table 6.


2602. Int J Environ Res Public Health. 2021 Dec 18;18(24):13340. doi: 
10.3390/ijerph182413340.

Positive Psychology in Times of Pandemic-Time Perspective as a Moderator of the 
Relationship between Resilience and Meaning in Life.

Lasota A(1), Mróz J(2).

Author information:
(1)Institute of Psychology, Pedagogical University of Krakow, 30-084 Krakow, 
Poland.
(2)Department of Psychology, Jan Kochanowski University, 25-029 Kielce, Poland.

Resilience and meaning in life are significant indicators of psychological 
well-being and health, which are particularly important in the context of the 
COVID-19 pandemic. Therefore, they have been explored by a growing number of 
scientists. There has been a research gap, however, that fails to show that time 
perspectives also have a significant impact on the perception and building of 
different life aspects. The current study investigated the associations between 
resilience, time perspectives and meaning in life and examined the moderating 
role of time perspective in the relationship between resilience and meaning in 
life.
METHODS: Participants of this cross-sectional study were 363 adults aged 18-70. 
Resilience Measurement Scale (SPP-25), the Zimbardo Time Perspective Inventory 
(ZTPI), and the Purpose in Life Questionnaire (PIL) were used.
RESULTS: The findings confirmed a positive relationship between resilience, 
meaning in life, and positive time perspectives (Present Hedonistic and Future) 
and a negative link with Past Negative and Present Fatalistic perspectives. The 
linear regression analyses showed that Past Negative and Past Positive 
perspectives significantly moderated the relationship between resilience and 
meaning in life. The moderating effect was also confirmed in the case of past 
time perspectives only.
CONCLUSIONS: The findings indicate the relevance of positive resources, such as 
resilience and positive perception of the past, in keeping the meaning in life. 
Understanding the effect of psychological strengths in the context of the 
pandemic time can be a key to providing intervention and therapeutic services 
fostering mental health and well-being.

DOI: 10.3390/ijerph182413340
PMCID: PMC8707410
PMID: 34948949 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2603. Int J Environ Res Public Health. 2021 Dec 14;18(24):13191. doi: 
10.3390/ijerph182413191.

Assessing the Acceptability of a Co-Produced Long COVID Intervention in an 
Underserved Community in the UK.

Fowler-Davis S(1), Young R(1), Maden-Wilkinson T(1), Hameed W(2), Dracas E(3), 
Hurrell E(4), Bahl R(5), Kilcourse E(5), Robinson R(5), Copeland R(1).

Author information:
(1)Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield S9 
3TU, UK.
(2)Community Wellbeing Service (Specific Identity Withheld).
(3)Sheffield Health and Social Care NHS Foundation Trust, Sheffield Teaching 
Hospitals NHS Foundation Trust, Sheffield S5 7AU, UK.
(4)Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation 
Trust, Sheffield, S10 2JF, UK.
(5)Faculty of Sport and Exercise Medicine, Virtual Institution, Edinburgh EH8 
9DR, UK.

BACKGROUND: The COVID-19 pandemic has disproportionately affected people from 
more deprived communities. The experience of Long COVID is similarly distributed 
but very few investigations have concentrated on the needs of this population. 
The aim of this project was to co-produce an acceptable intervention for people 
with Long COVID living in communities recognised as more deprived.
METHODS: The intervention was based on a multi-disciplinary team using 
approaches from sport and exercise medicine and functional rehabilitation. The 
co-production process was undertaken with a stakeholder advisory group and 
patient public involvement representation. This study identified participants by 
postcode and the indices of multiple deprivation (IMD); recruitment and 
engagement were supported by an existing health and wellbeing service. A virtual 
'clinic' was offered with a team of professional practitioners who met 
participants three times each; to directly consider their needs and offer 
structured advice. The acceptability of the intervention was based on the 
individual's participation and their completion of the intervention.
RESULTS: Ten participants were recruited with eight completing the intervention. 
The partnership with an existing community health and wellbeing service was 
deemed to be an important way of reaching participants. Two men and six women 
ages ranging from 38 to 73 were involved and their needs were commonly 
associated with fatigue, anxiety and depression with overall de-conditioning. 
None reported serious hardship associated with the pandemic although most were 
in self-employment/part-time employment or were not working due to retirement or 
ill-health. Two older participants lived alone, and others were single parents 
and had considerable challenges associated with managing a household alongside 
their Long COVID difficulties.
CONCLUSIONS: This paper presents the needs and perspectives of eight individuals 
involved in the process and discusses the needs and preferences of the group in 
relation to their support for self- managed recovery from Long COVID.

DOI: 10.3390/ijerph182413191
PMCID: PMC8701839
PMID: 34948798 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2604. Int J Environ Res Public Health. 2021 Dec 14;18(24):13189. doi: 
10.3390/ijerph182413189.

The Relationships among Anxiety, Subjective Well-Being, Media Consumption, and 
Safety-Seeking Behaviors during the COVID-19 Epidemic.

Luo YF(1)(2), Shen HY(1), Yang SC(1), Chen LC(1)(3).

Author information:
(1)The Intelligent Electronic Commerce Research Center, Institute of Education, 
National Sun Yat-sen University, Kaohsiung 80424, Taiwan.
(2)Center for Teaching and Learning Development, National Kaohsiung University 
of Science and Technology, Kaohsiung 805301, Taiwan.
(3)Department of Foreign Languages, R.O.C. Military Academy, Kaohsiung 83059, 
Taiwan.

The COVID-19 epidemic has been confirmed as the largest scale outbreak of 
atypical pneumonia since the outbreak of severe acute respiratory syndrome 
(SARS) in 2003 and it has become a public health emergency of international 
concern. It exacerbated public confusion and anxiety, and the impact of COVID-19 
on people needs to be better understood. Indeed, prior studies that conducted 
meta-analysis of longitudinal cohort research compared mental health before 
versus during the COVID-19 pandemic and proved that public health polices (e.g., 
city lockdowns, quarantines, avoiding gatherings, etc.) and COVID-19-related 
information that circulates on new media platforms directly affected citizen's 
mental health and well-being. Hence, this research aims to explore Taiwanese 
people's health status, anxiety, media sources for obtaining COVID-19 
information, subjective well-being, and safety-seeking behavior during the 
COVID-19 epidemic and how they are associated. Online surveys were conducted 
through new media platforms, and 342 responses were included in the analysis. 
The research results indicate that the participants experienced different 
aspects of COVID-19 anxiety, including COVID-19 worry and perceived COVID-19 
risk. Among the given media sources, the more participants searched for COVID-19 
information on new media, the greater they worried about COVID-19. Furthermore, 
COVID-19 worry was positively related to safety-seeking behavior, while 
perceived COVID-19 risk was negatively related to subjective well-being. This 
paper concludes by offering some suggestions for future studies and pointing out 
limitations of the present study.

DOI: 10.3390/ijerph182413189
PMCID: PMC8700923
PMID: 34948796 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


2605. Int J Environ Res Public Health. 2021 Dec 14;18(24):13171. doi: 
10.3390/ijerph182413171.

Exploring the Protective Function of Positivity and Regulatory Emotional 
Self-Efficacy in Time of Pandemic COVID-19.

Thartori E(1), Pastorelli C(1), Cirimele F(1), Remondi C(1), Gerbino M(1), 
Basili E(1), Favini A(1), Lunetti C(1), Fiasconaro I(1), Caprara GV(1).

Author information:
(1)Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy.

Despite several empirical studies on the 2019 coronavirus disease (COVID-19) 
pandemic that have highlighted its detrimental effect on individuals' mental 
health, the identification of psychological factors that may moderate its impact 
on individuals' behavior and well-being remains partly unexplored. The present 
study was conceived to examine the mediation role of regulatory emotional 
self-efficacy in the relationship between positivity and anxiety, depression, 
and perceived self-efficacy in complying with the containment measures to 
contrast the COVID-19 spread. Furthermore, the moderation role of age was 
tested. A sample of 1258 participants (64.2% women; Mage = 42.09, SD = 13.62) 
enrolled from the Italian general population answered an online survey aimed at 
investigating the role of individual differences in facing the COVID-19 
pandemic. We opted for a snowball recruiting procedure to find participants. The 
online survey was disseminated through email invitation and using social media 
platforms (i.e., Facebook, Instagram). A multi-group path analysis model was 
performed using Mplus 8.4 to explore the hypothesized relations among variables. 
The following criteria were employed to evaluate the goodness of fit: χ2 
likelihood ratio statistic, CFI and TLI > 0.95, RMSEA < 0.06 and SRMR < 0.08. 
The findings corroborated the protective role of both positivity and regulatory 
emotional self-efficacy in reducing individuals' anxiety and depressive 
symptoms, as well as in fostering individuals' capabilities in complying with 
the containment measures imposed by the government to reduce the risk of illness 
and to contain the spread of the virus COVID-19. Specifically, regulatory 
emotional self-efficacy beliefs partially mediated the relations between 
positivity and anxiety and depressive symptoms and fully mediated the effect of 
positivity on perceived self-efficacy beliefs in complying with the containment 
measures. These paths were equal across ages. The results of the present study 
appear relevant to implementing psychological interventions aimed to reduce the 
deleterious effects of the COVID-19 pandemic on mental health through the 
promotion of individuals' optimistic orientation and emotion regulation.

DOI: 10.3390/ijerph182413171
PMCID: PMC8702160
PMID: 34948780 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2606. Int J Environ Res Public Health. 2021 Dec 12;18(24):13111. doi: 
10.3390/ijerph182413111.

Fear of Coronavirus, Stress and Fear of Childbirth in Polish Pregnant Women 
during the COVID-19 Pandemic.

Dymecka J(1), Gerymski R(1), Iszczuk A(2), Bidzan M(3).

Author information:
(1)Department of Health Psychology and Quality of Life, Institute of Psychology, 
Opole University, 45-040 Opole, Poland.
(2)Faculty of Health Sciences, Opole University, 45-040 Opole, Poland.
(3)Department of Clinical and Health Psychology, Institute of Psychology, 
University of Gdansk, 80-309 Gdansk, Poland.

The COVID-19 pandemic is the largest pandemic of an aggressive coronavirus in 
the human population in the 21st century. The pandemic may have a negative 
emotional impact on pregnant women, causing fear and stress. Negative feelings 
during pregnancy later affect fear of childbirth. Our study aimed to determine 
the relationship between fear of COVID-19, stress and fear of childbirth. We 
assume that fear of COVID-19 will be a mediator of the relationship between 
perceived stress and fear of childbirth. A total of 262 Polish pregnant women 
participated in this study. Perceived Stress Scale (PSS-10), Fear of COVID-19 
Scale (FOC-6) and Labour Anxiety Questionnaire (KLP II) were used in the study. 
There was a statistically significant, moderate, and positive relationship 
between perceived stress, fear of COVID-19, and fear of childbirth. Fear of 
COVID-19 was a statistically significant mediator in the relationship between 
perceived stress and fear of childbirth. The COVID-19 epidemic may have a 
negative emotional impact on pregnant women, causing fear, stress and increased 
fear of childbirth. Childbirth during the COVID-19 pandemic is perceived by 
women as a threat to their well-being and health. Therefore, it is especially 
important to support a woman in the perinatal period and to enable her to give 
birth to a child.

DOI: 10.3390/ijerph182413111
PMCID: PMC8700819
PMID: 34948718 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2607. Int J Environ Res Public Health. 2021 Dec 8;18(24):12935. doi: 
10.3390/ijerph182412935.

New Insights on the Mediating Role of Emotional Intelligence and Social Support 
on University Students' Mental Health during COVID-19 Pandemic: Gender Matters.

Barros C(1), Sacau-Fontenla A(1).

Author information:
(1)Faculty of Human and Social Sciences, University Fernando Pessoa, 4249-004 
Porto, Portugal.

Due to the demanding changes caused in the population by the COVID-19 pandemic, 
including a persisting experience of fear and social isolation, multiple studies 
have focused on the protective role of several psychological characteristics on 
mental health. Emotional intelligence and social support are commonly linked to 
mental health and well-being. The present study aims to analyze the mediator 
role of emotional intelligence and social support on university students' mental 
health, taking into consideration the role of gender differences. An online 
questionnaire was administered to a sample of 923 university students during the 
COVID-19 lockdown in Portugal. Significant gender differences were found on 
mental health symptoms, emotional intelligence, and social support. A double 
mediation model was computed to verify if gender influences on mental health 
were mediated by emotional intelligence and social support. The results show 
indirect effects of gender on mental health. However, as both mediators mediate 
in the opposite direction, the total indirect effects become null. Thus, a 
strong direct effect of gender on mental health remains. The results of the 
present study have theoretical implications on protective factors of mental 
health by gender and practical implications for psychological intervention in 
university counselling services.

DOI: 10.3390/ijerph182412935
PMCID: PMC8701843
PMID: 34948544 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2608. PLoS One. 2021 Dec 23;16(12):e0261761. doi: 10.1371/journal.pone.0261761. 
eCollection 2021.

Working from home and productivity under the COVID-19 pandemic: Using survey 
data of four manufacturing firms.

Kitagawa R(1), Kuroda S(2), Okudaira H(3), Owan H(4).

Author information:
(1)Graduate School of Economics, Waseda University, Tokyo, Japan.
(2)Faculty of Education and Integrated Arts and Sciences, Waseda University; The 
Research Institute of Economy, Trade and Industry, Tokyo, Japan.
(3)Business School, Doshisha University, Kyoto, Japan.
(4)Faculty of Political Science and Economics, Waseda University; The Research 
Institute of Economy, Trade and Industry, Tokyo, Japan.

The coronavirus disease 2019 (COVID-19) pandemic has impacted the world economy 
in various ways. In particular, the drastic shift to telework has dramatically 
changed how people work. Whether the new style of working from home (WFH) will 
remain in our society highly depends on its effects on workers' productivity. 
However, to the best of our knowledge, the effects of WFH on productivity are 
still unclear. By leveraging unique surveys conducted at four manufacturing 
firms in Japan, we assess within-company productivity differences between those 
who work from home and those who do not, along with identifying possible factors 
of productivity changes due to WFH. Our main findings are as follows. First, 
after ruling out the time-invariant component of individual productivity and 
separate trends specific to employee attributes, we find that workers who worked 
from home experienced productivity declines more than those who did not. Second, 
our analysis shows that poor WFH setups and communication difficulties are the 
major reasons for productivity losses. Third, we find that the mental health of 
workers who work from home is better than that of workers who are unable to work 
from home. Our result suggests that if appropriate investments in upgrading WFH 
setups and facilitating communication can be made, WFH may improve productivity 
by improving employees' health and well-being.

DOI: 10.1371/journal.pone.0261761
PMCID: PMC8700052
PMID: 34941956 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2609. Ann R Coll Surg Engl. 2023 Jan;105(1):43-51. doi: 10.1308/rcsann.2021.0272. Epub 
2021 Dec 23.

Junior doctors' wellbeing at peak and post-peak pandemic: a repeated 
cross-sectional study.

Doulias T(1), Thrikandiyur AA(1), Titus N(1), Soundararasha K(1), Coxon A(1), 
Amarantidis E(2), Arulampalam T(1)(3).

Author information:
(1)East Sussex and North Essex NHS Foundation Trust, UK.
(2)Aristotle University of Thessaloniki, Greece.
(3)Anglia Ruskin University School of Medicine, UK.

INTRODUCTION: The impact of the COVID-19 pandemic on healthcare professionals 
has been significant. The aim of this study was to explore the mental state and 
wellbeing of UK junior doctors at different phases of the initial outbreak.
METHODS: This is a cross-sectional study of UK-based junior doctors' perceptions 
of threat and support during and after the first wave of the COVID-19 pandemic. 
Levels of anxiety, depression, post-traumatic stress disorder symptoms and use 
of coping mechanisms were explored through a Google questionnaire.
RESULTS: 196 participants were included in this study (93 in period A and 103 in 
period B). Junior doctors reported feeling increased risk (p=0.001) and 
increased fear of contracting the virus (p<0.001) during period A. Increased 
levels of severe anxiety (Generalized Anxiety Disorder-7 score >15) along with 
increased cases level of depression (Patient Health Questionnaire-9 score >10) 
were reported for both periods. Junior doctors described suffering more 
frequently with flashbacks (p=0.006) and nightmares (p=0.024) in comparison with 
senior colleagues during period A. During period A, 21.4% of participants felt 
isolated at work (p<0.001), whereas 13% reported being easily annoyed on a daily 
basis, 11.7% reported very low morale (p<0.001) and 66% were not aware of any 
psychological support being available. The use of exercise, peer support and 
mindfulness apps increased during period B (p=0.023).
CONCLUSIONS: Healthcare systems need to urgently establish robust psychological 
support mechanisms and infrastructure to protect junior doctors and provide 
institutional resilience against the adverse consequences of the long physical 
and mental battle with COVID-19.

DOI: 10.1308/rcsann.2021.0272
PMCID: PMC9773290
PMID: 34941458 [Indexed for MEDLINE]


2610. Fam Syst Health. 2022 Mar;40(1):46-59. doi: 10.1037/fsh0000657. Epub 2021 Dec 
23.

Associations of household structure and presence of children in the household 
with mental distress during the early stages of the U.S. COVID-19 pandemic.

Smail EJ(1), Riehm KE(1), Veldhuis CB(2), Johnson RM(1), Holingue C(1), Stuart 
EA(1), Kalb LG(1), Thrul J(1).

Author information:
(1)Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins 
University.
(2)School of Nursing, Columbia University.

PURPOSE: The objectives of the current study were to (1) assess associations 
between household structure (i.e., living with spouse compared to living alone, 
with children, or with a spouse and children), presence of children, and mental 
distress in April 2020 and change in mental distress (between April and August 
2020); and (2) determine whether these associations are moderated by income or 
sex.
PARTICIPANTS: A total of 2,214 adults aged 25-55 from the April and August 2020 
waves of the Understanding America study were included in the analytic sample.
STUDY METHOD: Multivariable, survey-weighted linear regression models were used 
to examine associations between explanatory variables (i.e., household structure 
and number of children) and outcome variables (mental distress in April and 
change in mental distress), measured via the Patient Health Questionnaire 
(PHQ)-4.
RESULTS: In adjusted models, each additional child under the age of 12 was 
associated with lower mental distress in April 2020 (β = -.30, p = .002). Having 
children aged 13 to 18 and household structure were not significantly associated 
with mental distress. In interaction models, living with children only was 
associated with decreased mental distress among individuals reporting low income 
(interaction β = -1.28, p = .016) but not high income. Similarly, living with 
children only was associated with decreased mental distress in females 
(interaction β = -1.09, p = .025) but not males.
CONCLUSION: This study supports prior literature that demonstrates the positive 
association of child rearing with psychological well-being and suggests that 
these benefits may be present even under stay-at-home orders in the early stages 
of the U.S. COVID-19 pandemic. (PsycInfo Database Record (c) 2022 APA, all 
rights reserved).

DOI: 10.1037/fsh0000657
PMCID: PMC8940685
PMID: 34941298 [Indexed for MEDLINE]

Conflict of interest statement: All authors have no potential conflicts of 
interest to disclose. The project described in this article relies on data from 
survey (s) administered by the Understanding America Study, which is maintained 
by the Center for Economic and Social Research (CESR) at the University of 
Southern California. The content of this article is solely the responsibility of 
the authors and does not necessarily represent the official views of USC or UAS. 
For any questions or more information about the UAS, contact Tania Gutsche, 
Project and Panel Manager, Center for Economic and Social Research, University 
of Southern California, at tgutsche@usc.edu.


2611. Autism Res. 2022 Mar;15(3):413-420. doi: 10.1002/aur.2662. Epub 2021 Dec 23.

Experiences of student and trainee autism researchers during the COVID-19 
pandemic.

Kaku SM(1), McVey AJ(2)(3), Gerber AH(4), Pretzsch CM(5), Jones DR(6), 
Kodakkadan FM(7), Lei J(8), Singer L(9), Chitehwe L(10), Poulsen RE(11), Coffman 
M(12).

Author information:
(1)Center for Advanced Research and Excellence in Autism and Developmental 
Disorders (CAREADD), St. John's Medical College Hospital, Bangalore, India.
(2)Department of Psychology, University of British Columbia, Vancouver, Canada.
(3)Department of Psychiatry and Behavioral Sciences, University of Washington, 
Seattle, Washington, USA.
(4)Department of Psychology, Stony Brook University, Stony Brook, New York, USA.
(5)Department of Forensic and Neurodevelopmental Sciences, Institute of 
Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
(6)Department of Psychology, The University of Texas at Dallas, Richardson, 
Texas, USA.
(7)Department of Psychology, Anglia Ruskin University, Cambridge, UK.
(8)Department of Psychology, Institute of Psychiatry Psychology & Neuroscience, 
King's College London, London, UK.
(9)Department of Cognitive Science, Yale University, New Haven, Connecticut, 
USA.
(10)Department of Psychiatry, Nelson R Mandela School of Medicine, University of 
KwaZulu Natal, Durban, South Africa.
(11)The Queensland Brain Institute, University of Queensland, Brisbane, 
Australia.
(12)Department of Psychiatry and Behavioral Sciences, Duke Center for Autism and 
Brain Development, Duke University, Durham, North Carolina, USA.

Circumstances surrounding the COVID-19 pandemic have resulted in significant 
personal and professional adjustments. Students and trainees, including those in 
autism research, face unique challenges to accomplishing their training and 
career goals during this unprecedented time. In this commentary, we, as members 
of the International Society for Autism Research Student and Trainee Committee, 
describe our personal experiences, which may or may not align with those of 
other students and trainees. Our experiences have varied both in terms of the 
ease (or lack thereof) with which we adapted and the degree to which we were 
supported in the transition to online research and clinical practice. We faced 
and continue to adjust to uncertainties about future training and academic 
positions, for which opportunities have been in decline and have subsequently 
negatively impacted our mental health. Students and trainees' prospects have 
been particularly impacted compared to more established researchers and faculty. 
In addition to the challenges we have faced, however, there have also been 
unexpected benefits in our training during the pandemic, which we describe here. 
We have learned new coping strategies which, we believe, have served us well. 
The overarching goal of this commentary is to describe these experiences and 
strategies in the hope that they will benefit the autism research community 
moving forward. Here, we provide a set of recommendations for faculty, 
especially mentors, to support students and trainees as well as strategies for 
students and trainees to bolster their self-advocacy, both of which we see as 
crucial for our future careers. LAY SUMMARY: The COVID-19 pandemic has affected 
students and trainees, including those in autism research, in different ways. 
Here, we describe our personal experiences. These experiences include 
challenges. For example, it has been difficult to move from in-person to online 
work. It has also been difficult to keep up with work and training goals. 
Moreover, working from home has made it hard to connect with our supervisors and 
mentors. As a result, many of us have felt unsure about how to make the best 
career choices. Working in clinical services and getting to know and support our 
patients online has also been challenging. Overall, the pandemic has made us 
feel more isolated and some of us have struggled to cope with that. On the other 
hand, our experiences have also included benefits. For example, by working 
online, we have been able to join meetings all over the world. Also, the 
pandemic has pushed us to learn new skills. Those include technical skills but 
also skills for well-being. Next, we describe our experiences of returning to 
work. Finally, we give recommendations for trainees and supervisors on how to 
support each other and to build a strong community.

© 2021 International Society for Autism Research and Wiley Periodicals LLC.

DOI: 10.1002/aur.2662
PMID: 34939747 [Indexed for MEDLINE]


2612. Aust N Z J Public Health. 2022 Apr;46(2):170-176. doi: 10.1111/1753-6405.13199. 
Epub 2021 Dec 23.

Self-reported wellbeing and health-related quality of life of Aboriginal and 
Torres Strait Islander people pre and post the first wave of the COVID-19 2020 
pandemic.

Gall A(1), Diaz A(1)(2), Garvey G(2)(3), Anderson K(1)(2), Lindsay D(1)(2), 
Howard K(3)(4).

Author information:
(1)Wellbeing and Preventable Chronic Disease Division, Menzies School of Health 
Research, Charles Darwin University, Casuarina, Northern Territory.
(2)School of Public Health, University of Queensland, Brisbane, Queensland.
(3)School of Public Health, Faculty of Medicine & Health, University of Sydney, 
New South Wales.
(4)Menzies Centre for Health Policy and Economics, Faculty of Medicine and 
Health, University of Sydney, New South Wales.

OBJECTIVE: Quantify change in wellbeing and health-related quality-of-life 
(HRQoL) in Aboriginal and Torres Strait Islander adults pre and post Australia's 
initial COVID-19 lockdown.
METHODS: Aboriginal and Torres Strait Islander adults completed an online survey 
at Time 1 (October-November 2019; before the initial Australian COVID-19 
outbreak) and Time 2 (August-September 2020; after the first Australian 
lockdown). We assessed wellbeing using a visual analogue scale (VAS) and HRQoL 
using the Assessment of Quality of Life (AQoL-4D) instrument. Participants who 
completed both surveys (n=42) were included to quantify change in outcomes over 
time and by comorbidity and demographic factors.
RESULTS: Mean reduction in wellbeing over time was 6.4 points (95%CI -14.2 to 
1.4) and was associated with age (18-54yo), financial instability and mental 
health comorbidity. Mean reduction in HRQoL over time was 0.06 (95%CI -0.12 to 
0.01) and was associated with financial instability, high physical comorbidity 
level and mental health comorbidity.
CONCLUSIONS: Aboriginal and Torres Strait Islanders aged 18-54yo, who were 
financially unstable or had elevated comorbidity during COVID lockdowns 
experienced greater reductions in wellbeing and HRQoL.
IMPLICATIONS FOR PUBLIC HEALTH: As the COVID-19 pandemic continues in Australia, 
both urgent and forward planning is needed, especially for the priority groups 
identified.

© 2021 The Authors.

DOI: 10.1111/1753-6405.13199
PMCID: PMC9968567
PMID: 34939687 [Indexed for MEDLINE]


2613. J Prim Care Community Health. 2021 Jan-Dec;12:21501319211067674. doi: 
10.1177/21501319211067674.

Post-Covid-19 Syndrome: Improvements in Health-Related Quality of Life Following 
Psychology-Led Interdisciplinary Virtual Rehabilitation.

Harenwall S(1), Heywood-Everett S(1), Henderson R(2), Godsell S(1), Jordan S(1), 
Moore A(1), Philpot U(1)(3), Shepherd K(1)(4), Smith J(1), Bland AR(2).

Author information:
(1)Bradford District Care NHS Foundation Trust, Bradford, UK.
(2)Manchester Metropolitan University, Manchester, UK.
(3)Leeds Beckett University, Leeds, UK.
(4)University of Bradford, Bradford, UK.

Coronavirus disease 2019 (COVID-19) is increasingly recognized as having 
significant long-term impact on physical and mental health. The Primary Care 
Wellbeing Service (PCWBS) in Bradford District Care NHS Foundation Trust (BDCFT) 
is a psychology-led specialist interdisciplinary team of health professionals 
specializing in persistent physical symptoms (PPS) and Chronic Fatigue Syndrome 
(CFS)/Myalgic Encephalomyelitis (ME) with an emphasis on holistic integrated 
care. The PCWBS quickly recognized the risk of the long-term effects of 
COVID-19, particularly for social, health and care staff, and developed a 7-week 
virtual rehabilitation course which was piloted in October 2020. The "Recovering 
from COVID" course takes a whole system, biopsychosocial approach to 
understanding COVID-19 and post-viral fatigue (PVF) and is delivered by an 
interdisciplinary team consisting of a clinical psychologist, physiotherapist, 
occupational therapist, dietitian, speech and language therapist, assistant 
psychologist, and a personal support navigator with support from a team 
administrator. The course focuses on understanding PVF, sleep optimization, 
nutrition, swallowing, activity management, energy conservation, stress 
management, breathing optimization, managing setbacks, and signposting to 
appropriate resources and services. Since the pilot, PCWBS has delivered 7 
courses to support over 200 people suffering from post-COVID-19 syndrome. One 
hundred and forty-nine individuals that enrolled on the "Recovering from COVID" 
course completed the EQ-5D-5L to assess Health-related quality of life (HRQoL) 
across 5 dimensions, including problems with mobility, self-care, usual 
activities, pain/discomfort, and anxiety/depression. Subsequently, 76 
individuals completed these measures at the end of the rehabilitation course 
showing that patient ratings were significantly improved. In response to the 
NIHR recommendation for rapid evaluation of different service models for 
supporting people with post-COVID-19 syndrome, this data offers hope that 
rehabilitation is effective in reversing some of the problems faced by people 
living with the long-term effects of COVID-19.

DOI: 10.1177/21501319211067674
PMCID: PMC8721676
PMID: 34939506 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


2614. Appl Psychol Health Well Being. 2022 Nov;14(4):1228-1254. doi: 
10.1111/aphw.12332. Epub 2021 Dec 22.

Effectiveness of an online positive psychology intervention among Tunisian 
healthcare students on mental health and study engagement during the Covid-19 
pandemic.

Krifa I(1)(2), Hallez Q(3), van Zyl LE(4)(5)(6)(7), Braham A(1)(8), Sahli J(9), 
Ben Nasr S(1)(8), Shankland R(3).

Author information:
(1)Mental illness Epidemiology Research Laboratory, University of Sousse, 
Sousse, Tunisia.
(2)Higher School of Sciences and Techniques of Health of Sousse, Department of 
Psychiatry LR12ES04, Farhat Hached University Hospital, Sousse, Tunisia.
(3)Laboratory DIPHE, Department of Psychology, Education and Vulnerabilities, 
Université Lumière Lyon 2, Lyon, France.
(4)Department of Industrial Engineering and Innovation Sciences, University of 
Eindhoven, Eindhoven, Netherlands.
(5)Optentia Research Unit, North-West University, South Africa.
(6)Department of Human Resource Management, University of Twente, the 
Netherlands.
(7)Department of Social Psychology, Goethe University, Frankfurt am Main, 
Germany.
(8)Faculty of Medicine of Sousse, Department of Psychiatry LR12ES04, Farhat 
Hached University Hospital, Sousse, Tunisia.
(9)Laboratory of Research Quality of Care and Management of Maternal Health 
Services, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia.

Publisher: Research indicates that university students present higher levels of 
psychological distress compared with non-student age-matched youth. These levels 
are higher among healthcare students, and even higher during the Covid-19 
pandemic. Therefore, cost-effective large-scale interventions are needed in 
order to prevent further development of psychological distress during this 
period, and more generally. The aim of the current study was to assess the 
effectiveness of an 8-week Internet-based positive psychology intervention for 
healthcare students in Tunisia. A two-armed randomized controlled trial was 
conducted among a sample of 366 health care students (183 in the experimental 
group and 183 in the control group), with a majority of women (94%). The average 
age was 20.74 years (±1.64). The participants completed the following online 
questionnaires at three time-points (before the program, immediately after, and 
three months later): stress, anxiety, depression, emotional regulation, 
optimism, hope, study engagement, and well-being. Repeated-measures ANOVAs 
revealed significant positive effects of the intervention on all the measured 
variables for the experimental group. The results showed a significant 
improvement immediately after the intervention compared to the control group, 
which was maintained three months later. This program may thus be considered as 
a promising means of improving students' mental health and study engagement.

DOI: 10.1111/aphw.12332
PMID: 34939332 [Indexed for MEDLINE]


2615. Health Expect. 2022 Apr;25(2):532-540. doi: 10.1111/hex.13416. Epub 2021 Dec 22.

'A lot of small things make a difference'. Mental health and strategies of 
coping during the COVID-19 pandemic.

Halliday EC(1), Holt V(1), Khan K(1), Ward F(1), Wheeler P(1), Sadler G(1).

Author information:
(1)Division of Health Research, Faculty of Health & Medicine, Lancaster 
University, Lancaster, UK.

INTRODUCTION: The social and economic consequences of COVID-19 have the 
potential to affect individuals and populations through different pathways 
(e.g., bereavement, loss of social interaction).
OBJECTIVE: This study adopted a solicited diary method to understand how mental 
health was affected during England's first lockdown. We also considered the 
experiences of diary keeping during a pandemic from the perspective of public 
participants.
METHODS: Fifteen adults older than 18 years of age were recruited from northwest 
England. Diarists completed semistructured online diaries for 8 weeks, which was 
combined with weekly calls. A focus group captured participants' experiences of 
diary keeping.
FINDINGS: Four key factors influenced mental health, which fluctuated over time 
and in relation to diarists' situations. These concerned navigating virus risk, 
loss of social connections and control and constrictions of the domestic space. 
Diarists also enacted a range of strategies to cope with the pandemic. This 
included support from social networks, engagement with natural environments, 
establishing normality, finding meaning and taking affirmative action.
CONCLUSION: Use of diary methods provided insights into the lived experiences of 
the early months of a global pandemic. As well as contributing evidence on its 
mental health effects, diarists' accounts illuminated considerable 
resourcefulness and strategies of coping with positive effects for well-being. 
While diary keeping can also have therapeutic benefits during adversity, ethical 
and practical issues need to be considered, which include the emotional nature 
of diary keeping.
PUBLIC CONTRIBUTION: Members of the public were involved in interpretation of 
data as well as critiquing the overall diary method used in the study.

© 2021 The Authors. Health Expectations published by John Wiley & Sons Ltd.

DOI: 10.1111/hex.13416
PMCID: PMC8957741
PMID: 34939261 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that there are no conflict 
of interests.


2616. JCO Oncol Pract. 2022 May;18(5):e669-e676. doi: 10.1200/OP.21.00585. Epub 2021 
Dec 22.

The Hardest Weeks of My Life: A Qualitative Study of Experiences, Practice 
Changes, and Emotional Burden of New York City Oncology Physicians During the 
COVID-19 Surge in 2020.

Lynch KA(1), Green A(2)(3), Saltz L(2)(3), Epstein AS(2)(3), Romano DR(2), Vera 
J(1), Nelson JE(2)(3).

Author information:
(1)Department of Psychiatry and Behavioral Science, Memorial Sloan Kettering 
Cancer Center, New York, NY.
(2)Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
(3)Weill Cornell Medical College, New York, NY.

PURPOSE: The COVID-19 pandemic surge in New York City in Spring 2020 resulted in 
an unprecedented constraint on health care resources. This study aimed to 
explore the experiences of doctors providing care to oncology patients during 
this time.
METHODS: Hospitalists and medical oncologists from two large inpatient services 
at a dedicated cancer center participated in virtual in-depth interviews 
exploring how the pandemic affected their practice and to what extent it may 
have affected decisions for urgent evaluation or hospital admission, 
interventions, or goals-of-care discussions. Interviews also explored how the 
pandemic affected each individual physician's psychologic well-being. 
Transcripts were analyzed by three independent coders in Atlas.ti v. 7.5, using 
a thematic analysis approach.
RESULTS: Eighteen physicians were interviewed (n = 6 GI medical oncologists, n = 
6 gynecologic medical oncologists, and n = 6 hospitalists). Analysis identified 
five major themes related to fear and distress: (1) perceived patient fears of 
the hospital during COVID-19, leading to avoidance and delay of acute care needs 
before admission, (2) physicians' fear and distress delivering oncology care 
during COVID-19, (3) physician distress resulting from ambiguity in decision 
making, (4) distress and anxiety balancing the need for patient contact with the 
need to minimize infection risk, and (5) distress regarding impact of 
uncertainty and acuity of COVID-19 on goals-of-care discussions.
CONCLUSION: Insight into the experiences of physicians providing cancer care 
during a COVID-19 surge underscores the need for strategies mitigate short-term 
distress and long-term psychologic impacts. Findings can also inform 
practitioner training and preparedness for future pandemics in the oncology 
setting.

DOI: 10.1200/OP.21.00585
PMCID: PMC9797244
PMID: 34936377 [Indexed for MEDLINE]

Conflict of interest statement: Angela GreenHonoraria: Clinical Congress 
ConsultantsResearch Funding: Mereo BioPharma (Inst) Leonard SaltzResearch 
Funding: Taiho Pharmaceutical Andrew S. EpsteinOther Relationship: UpToDateNo 
other potential conflicts of interest were reported.


2617. JAMA Psychiatry. 2022 Feb 1;79(2):151-159. doi: 
10.1001/jamapsychiatry.2021.3749.

Immediate and Longer-Term Changes in the Mental Health and Well-being of Older 
Adults in England During the COVID-19 Pandemic.

Zaninotto P(1), Iob E(2), Demakakos P(1), Steptoe A(2).

Author information:
(1)Department of Epidemiology and Public Health, University College London, 
London, United Kingdom.
(2)Department of Behavioural Science and Health, University College London, 
London, United Kingdom.

IMPORTANCE: Despite the emphasis placed on the psychological impact of the 
COVID-19 pandemic, evidence from representative studies of older adults 
including pre-COVID-19 data and repeated assessments during the pandemic is 
scarce.
OBJECTIVE: To examine changes in mental health and well-being before and during 
the initial and later phases of the COVID-19 pandemic and test whether patterns 
varied with sociodemographic characteristics in a representative sample of older 
adults living in England.
DESIGN, SETTING, AND PARTICIPANTS: This longitudinal cohort study analyzed data 
from 5146 older adults participating in the English Longitudinal Study of Ageing 
who provided data before the COVID-19 pandemic (2018 and 2019) and at 2 
occasions in 2020 (June or July as well as November or December).
EXPOSURES: The COVID-19 pandemic and sociodemographic characteristics, including 
sex, age, partnership status, and socioeconomic position.
MAIN OUTCOMES AND MEASURES: Changes in depression (8-item Centre for 
Epidemiological Studies Depression scale), anxiety (7-item Generalized Anxiety 
Disorder scale), quality of life (12-item Control, Autonomy, Self-realization, 
and Pleasure scale), and loneliness (3-item Revised University of California, 
Los Angeles, loneliness scale) were tested before and during the COVID-19 
pandemic using fixed-effects regression models.
RESULTS: Of 5146 included participants, 2723 (52.9%) were women, 4773 (92.8%) 
were White, and the mean (SD) age was 67.7 (10.6) years. The prevalence of 
clinically significant depressive symptoms increased from 12.5% (95% CI, 
11.5-13.4) before the COVID-19 pandemic to 22.6% (95% CI, 21.6-23.6) in June and 
July 2020, with a further rise to 28.5% (95% CI, 27.6-29.5) in November and 
December 2020. This was accompanied by increased loneliness and deterioration in 
quality of life. The prevalence of anxiety rose from 9.4% (95% CI, 8.8-9.9) to 
10.9% (95% CI, 10.3-11.5) from June and July 2020 to November and December 2020. 
Women and nonpartnered people experienced worse changes in mental health. 
Participants with less wealth had the lowest levels of mental health before and 
during the COVID-19 pandemic. Higher socioeconomic groups had better mental 
health overall but responded to the COVID-19 pandemic with more negative 
changes.
CONCLUSIONS AND RELEVANCE: In this longitudinal cohort study of older adults 
living in England, mental health and well-being continued to worsen as the 
COVID-19 pandemic progressed, and socioeconomic inequalities persisted. Women 
and nonpartnered people experienced greater deterioration in mental health.

DOI: 10.1001/jamapsychiatry.2021.3749
PMCID: PMC8696687
PMID: 34935862 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest Disclosures: None reported.


2618. Health Promot Pract. 2023 Jan;24(1):9-11. doi: 10.1177/15248399211064638. Epub 
2021 Dec 22.

Creating Community During COVID-19: A Virtual Art Gallery to Address Social 
Isolation During a Pandemic.

Baumann SE(1), Burke JG(1).

Author information:
(1)University of Pittsburgh, Pittsburgh, PA, USA.

The COVID-19 pandemic, a public health crisis, significantly impacted millions 
of people around the world. "Creating Community During COVID-19" is a 
community-engaged virtual art gallery that explores resilience, social cohesion, 
and creativity during the onset of the pandemic in the United States. It aimed 
to address social isolation and encourage inclusion at a large public university 
in the early days of the pandemic. The community was invited to submit artworks 
that reflected how they are staying connected during the pandemic. The artworks 
were then qualitatively analyzed and highlighted three key themes: (1) 
reflecting (turning inward), (2) advocating (turning outward), and (3) engaging 
(coming together). This arts-based project demonstrates promise as a creative 
approach for promoting social cohesion and positive health and well-being, 
especially in times of uncertainty.

DOI: 10.1177/15248399211064638
PMCID: PMC9805919
PMID: 34935542 [Indexed for MEDLINE]


2619. Trends Psychiatry Psychother. 2023;45:e20210367. doi: 
10.47626/2237-6089-2021-0367. Epub 2021 Dec 21.

A Study on the Health and Wellness of Undergraduate Students (SABES-Grad): 
methodological aspects of a nationwide multicenter and multilevel study 
overlapping with the Covid-19 pandemic.

Demenech LM(1), Neiva-Silva L(1), Brignol SMS(2), Marcon SR(3), Lemos SM(4), 
Tassitano RM(5), Dumith SC(6).

Author information:
(1)Centro de Estudos sobre Risco e Saúde, Universidade Federal do Rio Grande 
(FURG), Rio Grande, RS, Brazil. Programa de Pós-Graduação em Ciências da Saúde, 
FURG, Rio Grande, RS, Brazil.
(2)Instituto de Saúde Coletiva, Universidade Federal Fluminense (UFF), Niterói, 
RJ, Brazil.
(3)Programa de Pós-Graduação em Enfermagem, Universidade Federal de Mato Grosso 
(UFMT), Cuiabá, MT, Brazil.
(4)Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas 
(UEA), Manaus, AM, Brazil.
(5)Departamento de Educação Física, Universidade Federal Rural de Pernambuco 
(UFRPE), Recife, PE, Brazil.
(6)Programa de Pós-Graduação em Ciências da Saúde, FURG, Rio Grande, RS, Brazil.

INTRODUCTION: The academic environment can negatively impact the mental health 
of undergraduate students, particularly in the context of the coronavirus 
disease 2019 (Covid-19) pandemic. This study aimed to describe the 
methodological and operational aspects of a study of the health and well-being 
of undergraduate students: the Study on the Health and Wellness of Undergraduate 
Students (SABES-Grad) project.
METHOD: This was a nationwide cross-sectional study divided across two data 
collection strategies: a single-center, on-site data collection carried out in 
2019 at the Universidade Federal do Rio Grande (FURG) and a multicenter, 
multilevel, online data collection carried out in 2020/2021 at FURG, the 
Universidade Federal Fluminense (UFF), the Universidade Federal do Mato Grosso 
(UFMT), the Universidade do Estado do Amazonas (UEA), and the Universidade 
Federal Rural de Pernambuco (UFRPE). The main outcomes of interest were 
depressive symptoms, generalized anxiety, and suicide risk.
RESULTS: A total of 996 students participated in the 2019 data collection (63.8% 
female; median age of 22 years; response rate of 85.2%) and 5,720 students 
participated in the 2020/2021 collection (66.7% female; median age of 22 years; 
response rate of 84.3%). Significant variations in socioeconomic and demographic 
profiles were observed between the different universities. Approximately 
one-third of the sample had been tested for Covid-19 in 2020/2021, 7.8% of whom 
had tested positive.
CONCLUSION: The SABES-Grad project was the result of collaborative work between 
several actors from public universities in Brazil. Several aspects of the 
preparation and execution of this research are discussed in terms of its 
originality and relevance. Barriers and limitations and strategies adopted to 
overcome them are also presented.

DOI: 10.47626/2237-6089-2021-0367
PMCID: PMC10164404
PMID: 34932897 [Indexed for MEDLINE]

Conflict of interest statement: No conflicts of interest declared concerning the 
publication of this article.


2620. Infant Ment Health J. 2022 Jan;43(1):8-23. doi: 10.1002/imhj.21955. Epub 2021 
Dec 21.

The impact of COVID-19 on experiences of pregnancy and/or early parenting in 
Chile.

Olhaberry M(1), Sieverson C(1), Franco P(1), Romero M(1), Tagle T(1), Iribarren 
D(1), Honorato C(1), Muzard A(1).

Author information:
(1)Pontificia Universidad Católica de Chile, Av Vicuña Mackenna, Macul, 
Santiago, Chile.

The unprecedented COVID-19 pandemic has impacted families' mental health around 
the globe. In June 2020, 1163 parents of high (43%), middle (47%), and low 
socioeconomic status (SES) (10%) participated in an online survey developed to 
explore how daily life changes and restrictions that came with COVID-19 affected 
the experiences of pregnancy and/or parenting children under the age of 5 in 
Chile. The survey's design had an exploratory and descriptive scope, with a mix 
of qualitative and quantitative questions. With the aim of exploring differences 
before and after COVID-19, two time periods were established, and the 47-item 
questionnaire covered participants' sociodemographic information, support 
networks, health concerns, mood changes, self-regulation, adult and children's 
perceived well-being, parental competencies and parents' perceptions of the 
unborn baby and/or their children's needs. The results relative to retrospective 
reporting of pre-pandemic levels, showed an increase in children's crying and 
tantrums as well as in parental irritability and sadness. Additionally, 
decreases in the ability to calm down and sleep quality in both parents and 
children were identified. Finally, at a qualitative level, COVID-19 stands out 
both as an opportunity to get to know their children better and as a stressor 
related to parental burn-out and discomfort.

Publisher: La sin precedentes pandemia del COVID-19 ha tenido un impacto en la 
salud mental de las familias alrededor del mundo. En junio de 2020, 1,163 
progenitores de condiciones socioeconómicas (SES) altas (43%), medias (47%) y 
bajas (10%) participaron en una encuesta por computadora desarrollada para 
explorar cómo los cambios en la vida diaria y las restricciones que surgieron 
con el COVID-19 afectaron las experiencias de embarazo y/o crianza de niños bajo 
la edad de 5 años en Chile. El diseño de la encuesta tenía un alcance 
exploratorio y descriptivo, con una mezcla de preguntas cualitativas y 
cuantitativas. Con el propósito de explorar las diferencias antes y después del 
COVID-19, se establecieron dos períodos de tiempo, y el cuestionario de 47 
puntos cubría la información sociodemográfica de los participantes, las redes de 
apoyo, las preocupaciones relacionadas con la salud, los cambios en el estado de 
ánimo, la autorregulación, la percepción del bienestar de adultos y niños, las 
competencias de los padres y las percepciones de los padres acerca del bebé no 
nacido y/o las necesidades de sus niños. Los resultados relativos al reporte 
retrospectivo de niveles previos a la pandemia mostraron un incremento en el 
llanto y las rabietas de los niños como también en la irritabilidad y estado de 
tristeza de los padres. Adicionalmente, se identificó una disminución en la 
habilidad de calmar y la calidad del sueño tanto en padres como en niños. 
Finalmente, al nivel cualitativo, el COVID-19 se presenta tanto como una 
oportunidad de llegar a conocer mejor a sus niños y como un factor de estrés 
relacionado con la fatiga y la incomodidad de los padres.

Publisher: La pandémie sans précédent du COVID-19 a impacté la santé mentale des 
familles dans le monde entier. En juin 2020 1163 parents issus d'un milieu 
socioéconomique élevé (43%), moyen (47%) et peu élevé (10%) ont participé à un 
questionnaire en ligne afin d'explorer comment les changements de la vie de tous 
les jours et les restrictions qui ont accompagné le COVID-19 ont affecté les 
expériences de grossesse et/ou le parentage d'enfants sous l’âge de 5 ans au 
Chili. La conception de l'enquête avait une portée exploratoire et descriptive, 
avec un mélange de questions qualitatives et quantitatives. Avec le but 
d'explorer les différences entre l'avant et l'après COVID-19, deux périodes de 
temps ont été établies, et le questionnaire de 47 éléments a couvert les 
renseignements sociodémographiques des participants, leurs réseaux de soutien, 
leurs inquiétudes relatives à la santé, les changements d'humeurs, 
l'auto-régulation, le bien-être perçu des adultes et des enfants, les 
compétences parentales et les perceptions des parents du bébé à naître et/ou des 
besoins de leurs enfants. Les résultats relatifs aux états de fait rétrospectifs 
de niveaux pré pandémiques ont montré une augmentation des pleurs des enfants et 
des crises des enfants ainsi qu'une augmentation de l'irritabilité et de la 
tristesse parentale. De plus des baisses dans la capacité à se calmer t dans la 
qualité de sommeil des deux parents et des enfants ont été identifiées. 
Finalement, au niveau qualitatif, le COVID-19 se distingue à la fois en tant 
qu'une chance de mieux connaître leurs enfants et en tant que facteur de stress 
lié au burn-out et au malaise parental.

Publisher: Der Einfluss von COVID-19 auf Erfahrungen in der Schwangerschaft 
und/oder dem frühen Elterndasein in Chile Die beispiellose COVID-19-Pandemie hat 
die psychische Gesundheit von Familien auf der ganzen Welt beeinträchtigt. Im 
Juni 2020 nahmen 1163 Eltern mit hohem (43 %), mittlerem (47 %) und niedrigem 
(10 %) sozioökonomischem Status an einer Online-Umfrage teil, die untersuchen 
sollte, wie sich die durch COVID-19 verursachten Veränderungen und 
Einschränkungen des täglichen Lebens auf Erfahrungen in der Schwangerschaft 
und/oder in der Erziehung von Kindern unter 5 Jahren in Chile auswirken. Das 
Design der Umfrage war explorativ und deskriptiv, mit einer Mischung aus 
qualitativen und quantitativen Fragen. Mit dem Ziel, Unterschiede vor und nach 
COVID-19 zu erforschen, wurden zwei Zeitpunkte festgelegt. Der Fragebogen 
enthielt 47 Items und erfasste soziodemografische Informationen, 
Unterstützungsnetzwerke, gesundheitliche Bedenken, Stimmungsschwankungen, 
Selbstregulation, das wahrgenommene Wohlbefinden der Erwachsenen sowie der 
Kinder, Elternkompetenz und die elterliche Wahrnehmung bzgl. des ungeborene 
Babys und/oder der Bedürfnisse ihrer Kinder. Die Ergebnisse zeigten im Vergleich 
zu den retrospektiven Berichten über den Stand vor der Pandemie eine Zunahme an 
kindlichem Schreien und Wutanfällen sowie an elterlicher Reizbarkeit und 
Traurigkeit. Darüber hinaus wurde eine Abnahme von Selbstberuhigungsfähigkeiten 
und Schlafqualität sowohl bei den Eltern als auch bei den Kindern festgestellt. 
Auf qualitativer Ebene stellte sich heraus, dass COVID-19 sowohl eine Chance 
darstellt, die Kinder besser kennen zu lernen, als auch ein Stressfaktor, der 
mit elterlichem Burn-out und Unbehagen zusammenhängt.

Publisher: チリにおける妊娠や子育て初期の体験に与えるCOVID-19の影響 
未曾有のCOVID-19パンデミックは、世界中の家族のメンタルヘルスに影響を与えている。2020年6月、COVID-19に伴う日常生活の変化や制限が、チリでの妊娠や5歳未満の子どもの養育体験にどのような影響を与えたかを探るために開発されたオンライン調査に、社会経済的な地位 
(SES) が高い (43％) 、中程度 (47％) 、低い (10％) 
1,163人の親が参加した。本調査では、定性・定量的質問を織り交ぜ、探索的かつ記述的な調査を行った。COVID-19の前後での違いを調査する目的で、2つの期間を設定し、47項目のアンケートには、参加者の社会人口統計学的情報、支援ネットワーク、健康上の懸念、気分の変化、自己制御、大人と子どもの幸福感、親の能力、胎児や我が子のニーズに対する親の認識などを含めた。パンデミック前の後方視的な報告と比較した結果、子どもの泣き声や癇癪、親のイライラや悲しみが増加していた。さらに、親子ともに、落ち着く能力や睡眠の質の低下が確認された。最後に、質的なレベルでは、COVID-19は、子どもをよりよく知る機会として、また、親の燃え尽きや不快感に関連するストレス要因として際立っている。.

Publisher: 史无前例的COVID-19大流行影响了全球家庭的心理健康。2020年6月, 智利的1163名高 (43%)、中 (47%) 和低 
(10%) 社会经济地位 (SES) 的父母参与了一项在线调查, 
旨在探讨COVID-19带来的日常生活变化和限制如何影响他们怀孕以及养育5岁以下儿童的经历。这项调查的设计具有探索性和描述性的研究范畴, 
混合了定性和定量问题。为了探索COVID-19前后的差异, 确立了两个时间段开展调查, 
47个问题的调查问卷涵盖了参与者的社会人口信息、关系网、健康问题、情绪变化、自我调节、成人和儿童的幸福感、育儿能力以及父母对未出生婴儿或其子女需求的感受。结果显示, 
与大流行前回顾性报告的水平相比, 儿童的哭闹和发脾气以及父母的烦躁和悲伤有所增加。此外, 还发现父母和孩子的镇静能力和睡眠质量都有所下降。最后, 在定性层面上, 
COVID-19既是更好地了解孩子的机会, 也是与父母倦怠和不适相关的压力源。.

Publisher: تأثير19 -COVID على تجارب الحمل والتربية الوالدية المبكرة في تشيلي 
الملخص أثرت جائحة كوفيد-19 الغير المسبوقة على الصحة النفسية للعائلات في جميع 
أنحاء العالم. في يونيو 2020 ، شارك 1،163 من الآباء والأمهات من ذوي الوضع 
الاجتماعي والاقتصادي المرتفع (43٪) والمتوسط (47٪) والمنخفض (10%) في استطلاع عبر 
الإنترنت تم تطويره لاستكشاف كيف أثرت تغيرات الحياة اليومية والقيود المصاحبة 
لكوفيد-19 على تجارب الحمل والتربية الوالدية للأطفال دون سن الخامسة في تشيلي. كان 
لتصميم الاستبيان نطاقًا استكشافيًا ووصفيًا ، مع مزيج من الأسئلة النوعية والكمية. 
ومن أجل استكشاف الاختلافات قبل وبعد كوفيد-19 ، تم تحديد فترتين زمنيتين ، وغطى 
الاستبيان المكون من 47 عنصرًا المعلومات الاجتماعية الديموغرافية للمشاركين ، 
وشبكات الدعم ، والمخاوف الصحية ، وتغيرات الحالة المزاجية ، والتنظيم الذاتي ، 
ورفاهية الأطفال والبالغين وكفاءات الوالدين وتصورات الوالدين للجنين و احتياجات 
أطفالهم.أظهرت النتائج المتعلقة بالإبلاغ بأثر رجعي لمستويات ما قبل الجائحة زيادة 
في بكاء الأطفال ونوبات الغضب وكذلك في انزعاج الوالدين وحزنهم. بالإضافة إلى ذلك ، 
تم رصد انخفاض في القدرة على استعادة الهدوء وجودة النوم لدى كل من الوالدين 
والأطفال. أخيرًا ، على المستوى الكيفي ، ظهر كوفيد-19 كفرصة لتعرف الآباء على 
أطفالهم بشكل أفضل وكعنصر ضغط مرتبط بإرهاق الوالدين وعدم ارتياحهم.

© 2021 Michigan Association for Infant Mental Health.

DOI: 10.1002/imhj.21955
PMID: 34932824 [Indexed for MEDLINE]


2621. BMC Med Educ. 2021 Dec 20;21(1):624. doi: 10.1186/s12909-021-03068-x.

Remote versus on-site proctored exam: comparing student results in a 
cross-sectional study.

Andreou V(1), Peters S(2)(3)(4), Eggermont J(5), Wens J(6), Schoenmakers B(2).

Author information:
(1)Department of Public Health and Primacy Care, KU Leuven, Academic Center for 
General Practice, Kapucijnenvoer 7 -Box 7001, 3000, Leuven, Belgium. 
vasiliki.andreou@kuleuven.be.
(2)Department of Public Health and Primacy Care, KU Leuven, Academic Center for 
General Practice, Kapucijnenvoer 7 -Box 7001, 3000, Leuven, Belgium.
(3)Evidence Based Practice, EBMPracticeNet, 3000, Leuven, Belgium.
(4)School of Health Sciences, Faculty of Medicine, Dentistry and Health 
Sciences, University of Melbourne, Melbourne, 3800, Australia.
(5)Department of Cellular and Molecular Medicine, KU Leuven, 3000, Leuven, 
Belgium.
(6)Center for General Practice/Family Medicine, Department of Primary and 
Interdisciplinary Care, University of Antwerp, 2610, Wilrijk, Belgium.

BACKGROUND: The COVID-19 pandemic has profoundly affected assessment practices 
in medical education necessitating distancing from the traditional classroom. 
However, safeguarding academic integrity is of particular importance for 
high-stakes medical exams. We utilised remote proctoring to administer safely 
and reliably a proficiency-test for admission to the Advanced Master of General 
Practice (AMGP). We compared exam results of the remote proctored exam group to 
those of the on-site proctored exam group.
METHODS: A cross-sectional design was adopted with candidates applying for 
admission to the AMGP. We developed and applied a proctoring software operating 
on three levels to register suspicious events: recording actions, analysing 
behaviour, and live supervision. We performed a Mann-Whitney U test to compare 
exam results from the remote proctored to the on-site proctored group. To get 
more insight into candidates' perceptions about proctoring, a post-test 
questionnaire was administered. An exploratory factor analysis was performed to 
explore quantitative data, while qualitative data were thematically analysed.
RESULTS: In total, 472 (79%) candidates took the proficiency-test using the 
proctoring software, while 121 (20%) were on-site with live supervision. The 
results indicated that the proctoring type does not influence exam results. Out 
of 472 candidates, 304 filled in the post-test questionnaire. Two factors were 
extracted from the analysis and identified as candidates' appreciation of 
proctoring and as emotional distress because of proctoring. Four themes were 
identified in the thematic analysis providing more insight on candidates' 
emotional well-being.
CONCLUSIONS: A comparison of exam results revealed that remote proctoring could 
be a viable solution for administering high-stakes medical exams. With regards 
to candidates' educational experience, remote proctoring was met with mixed 
feelings. Potential privacy issues and increased test anxiety should be taken 
into consideration when choosing a proctoring protocol. Future research should 
explore generalizability of these results utilising other proctoring systems in 
medical education and in other educational settings.

© 2021. The Author(s).

DOI: 10.1186/s12909-021-03068-x
PMCID: PMC8686350
PMID: 34930231 [Indexed for MEDLINE]

Conflict of interest statement: None.


2622. BMC Public Health. 2021 Dec 20;21(1):2307. doi: 10.1186/s12889-021-12359-3.

Acute respiratory infection symptoms and COVID-19 testing behaviour: results 
based on South Australian health surveys.

Joshi S(1), D'Onise K(2), Nolan R(2), Davis S(3), Glass K(4), Lokuge K(3).

Author information:
(1)Epidemiology Branch, Prevention and Population Health, Wellbeing SA, 
Government of South Australia, Level 9, The Conservatory, Rundle Mall, PO BOX 
388, Adelaide, SA, 5000, Australia. suresh.joshi@sa.gov.au.
(2)Epidemiology Branch, Prevention and Population Health, Wellbeing SA, 
Government of South Australia, Level 9, The Conservatory, Rundle Mall, PO BOX 
388, Adelaide, SA, 5000, Australia.
(3)Humanitarian Health Research Initiative, Research School of Population 
Health, Australian National University, 62A Mills Road, Canberra, ACT 2601, 
Australia.
(4)National Centre for Epidemiology and Population Health, Australian National 
University, 62A Mills Road, ACT 2601, Canberra, Australia.

BACKGROUND: Effective syndromic surveillance alongside COVID-19 testing 
behaviours in the population including in higher risk and hard to reach 
subgroups is vital to detect re-emergence of COVID-19 transmission in the 
community. The aim of this paper was to identify the prevalence of acute 
respiratory infection symptoms and coronavirus testing behaviour among South 
Australians using data from a population based survey.
METHODS: We used cross-sectional data from the 2020 state-wide population level 
health survey on 6857 respondents aged 18 years and above. Descriptive 
statistics were used to explore the risk factors and multivariable logistic 
regression models were used to assess the factors associated with the acute 
respiratory infection symptoms and coronavirus testing behaviour after adjusting 
for gender, age, household size, household income, Aboriginal and/or Torres 
Strait Islander status, SEIFA, Country of birth, number of chronic diseases, 
wellbeing, psychological distress, and mental health.
RESULTS: We found that 19.3% of respondents reported having symptoms of acute 
respiratory infection and the most commonly reported symptoms were a runny nose 
(11.2%), coughing (9.9%) and sore throat (6.2%). Fever and cough were reported 
by 0.8% of participants. Of the symptomatic respondents, 32.6% reported seeking 
health advice from a nurse, doctor or healthcare provider. Around 18% (n = 130) 
of symptomatic respondents had sought testing and a further 4.3% (n = 31) 
reported they intended to get tested. The regression results suggest that older 
age, larger household size, a higher number of chronic disease, mental health 
condition, poor wellbeing, and psychological distress were associated with 
higher odds of ARI symptoms. Higher household income was associated with lower 
odds of being tested or intending to be tested for coronavirus after adjusting 
for other explanatory variables.
CONCLUSIONS: There were relatively high rates of self-reported acute respiratory 
infection during a period of very low COVID-19 prevalence and low rate of 
coronavirus testing among symptomatic respondents. Ongoing monitoring of testing 
uptake, including in higher-risk groups, and possible interventions to improve 
testing uptake is key to early detection of disease.

© 2021. The Author(s).

DOI: 10.1186/s12889-021-12359-3
PMCID: PMC8685806
PMID: 34930193 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


2623. J Clin Neurosci. 2022 Jan;95:27-30. doi: 10.1016/j.jocn.2021.11.026. Epub 2021 
Nov 29.

A paradoxical psychological impact of COVID-19 among a sample of Italian adults 
with High Functioning Autism Spectrum Disorder.

Nisticò V(1), Gambini O(2), Pizzi L(3), Faggioli R(4), Priori A(5), Demartini 
B(6).

Author information:
(1)Dipartimento di Scienze della Salute, Università degli Studi di Milano, 
Milano, Italy; "Aldo Ravelli" Research Center for Neurotechnology and 
Experimental Brain Therapeutics, Università degli Studi di Milano, Milano, 
Italy.
(2)Dipartimento di Scienze della Salute, Università degli Studi di Milano, 
Milano, Italy; "Aldo Ravelli" Research Center for Neurotechnology and 
Experimental Brain Therapeutics, Università degli Studi di Milano, Milano, 
Italy; Unità di Psichiatria II, Presidio San Paolo, ASST Santi Paolo e Carlo, 
Milano, Italy.
(3)Dipartimento di Scienze della Salute, Università degli Studi di Milano, 
Milano, Italy.
(4)Unità di Psichiatria II, Presidio San Paolo, ASST Santi Paolo e Carlo, 
Milano, Italy.
(5)Dipartimento di Scienze della Salute, Università degli Studi di Milano, 
Milano, Italy; "Aldo Ravelli" Research Center for Neurotechnology and 
Experimental Brain Therapeutics, Università degli Studi di Milano, Milano, 
Italy; III Clinica Neurologica, Presidio San Paolo, ASST Santi Paolo e Carlo, 
Milano, Italy.
(6)Dipartimento di Scienze della Salute, Università degli Studi di Milano, 
Milano, Italy; "Aldo Ravelli" Research Center for Neurotechnology and 
Experimental Brain Therapeutics, Università degli Studi di Milano, Milano, 
Italy; Unità di Psichiatria II, Presidio San Paolo, ASST Santi Paolo e Carlo, 
Milano, Italy. Electronic address: benedetta.demartini@unimi.it.

BACKGROUND: Since February 2020, many governments of the world ordered strict 
social distancing rules to try to contain the COVID-19 pandemic, with a reported 
consequent increase in levels of stress, anxiety and depression in the general 
population. Aim of this study was to assess the prevalence of the aforementioned 
psychiatric symptoms across a sample of individuals with High Functioning Autism 
Spectrum Disorders (HF-ASDs) with respect to a group of neurotypical adults 
(NA), during the first two months of COVID-19 pandemic in Italy.
METHOD: 45 adults with HF-ASDs and 45NA completed a structured online 
questionnaire, including; the Depression, Anxiety and Stress Scale - 21 items 
(DASS-21); the Impact of Event Scale-Revised (IES-R); the Perceived Stress Scale 
(PSS). We also explored some specific aspects of participants' psychological 
well-being through an ad-hoc questionnaire.
RESULTS: Subjects with HF-ASDs scored significantly higher than NA at the 
DASS-21, the IES-R Total Score and the PSS; NA reported a higher perceived 
change of their lifestyle during the lockdown than individuals with HF-ASDs, and 
subjects with HF-ASDs reported to feel more comfortable and less tired during 
the lockdown period, in relation to the social distancing measures adopted by 
Italian authorities.
CONCLUSIONS: Adults with HF-ASDs presented higher rates of depression, anxiety, 
stress and PTSD-related symptoms than NA during the first two months of COVID-19 
pandemic. However, they also reported to feel subjectively more comfortable and 
less tired during the lockdown than before, in relation to the social distancing 
measures.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.jocn.2021.11.026
PMCID: PMC8627848
PMID: 34929647 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


2624. J Am Med Dir Assoc. 2022 Mar;23(3):428-433.e1. doi: 10.1016/j.jamda.2021.11.026. 
Epub 2021 Dec 17.

Caring for a Relative With Dementia in Long-Term Care During COVID-19.

Mitchell LL(1), Albers EA(2), Birkeland RW(2), Peterson CM(2), Stabler H(2), 
Horn B(2), Cha J(2), Drake A(3), Gaugler JE(2).

Author information:
(1)Department of Psychology & Neuroscience, Emmanuel College, Boston, MA, USA. 
Electronic address: mitchelll@emmanuel.edu.
(2)School of Public Health, University of Minnesota, Minneapolis, MN, USA.
(3)Department of Psychology & Neuroscience, Emmanuel College, Boston, MA, USA.

OBJECTIVES: The COVID-19 pandemic created unique stressors for caregivers of 
persons with dementia living in long-term care (LTC) facilities. The purpose of 
this qualitative study was to identify the challenges associated with caring for 
a relative with dementia in LTC during the pandemic, as well as resources, 
strategies, and practices caregivers found helpful in coping with COVID-19.
DESIGN: This study was conducted within the context of an ongoing randomized 
controlled trial of a psychosocial intervention to support caregivers. 
Open-ended survey responses (n = 125) and semistructured interviews with a 
subset of the sample (n = 20) collected between June 2020 and June 2021 explored 
caregivers' experiences during COVID-19.
SETTING AND PARTICIPANTS: Participants included 125 family caregivers of persons 
with dementia living in residential LTC.
METHODS: Thematic analysis was used to identify themes capturing caregivers' 
experiences.
RESULTS: In addition to concerns about COVID-19 infection, participants reported 
key challenges such as the difficulty of maintaining contact with relatives 
because of visiting restrictions, lack of information about relatives' health 
and well-being, worries about overburdened LTC staff, impossibility of returning 
relatives home from the LTC facility, and fears about relatives dying alone. 
Participants also identified resources, strategies, and practices that they 
perceived as helpful, including effective infection prevention within the LTC 
facility, good communication with LTC staff, and creative strategies for 
connecting with their relatives.
CONCLUSIONS AND IMPLICATIONS: This qualitative analysis informs recommendations 
for practice within LTC facilities, as well as supports that may help caregivers 
manage stressful situations in the context of COVID-19. Vaccination and testing 
protocols should be implemented to maximize family caregivers' opportunities for 
in-person contact with relatives in LTC, as alternative visiting modalities were 
often unsatisfactory or unfeasible. Informing caregivers regularly about 
individual residents' needs and status is crucial. Supports for bereaved 
caregivers should address complicated grief and feelings of loss.

Copyright © 2021 AMDA – The Society for Post-Acute and Long-Term Care Medicine. 
Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jamda.2021.11.026
PMCID: PMC8677585
PMID: 34929196 [Indexed for MEDLINE]


2625. Psychiatr Danub. 2021 Winter;33(4):639-645. doi: 10.24869/psyd.2021.639.

The Sense of Coherence and Subjective Well-Being as Resources of Resilience in 
the Time of Stressful Situations: COVID-19 Outbreak and Earthquakes.

Matić I(1), Takšić I, Božičević M.

Author information:
(1)Erasmus Department, School of Nursing Mlinarska, Zagreb, Croatia.

BACKGROUND: The coronavirus outbreak was labeled a global pandemic by the WHO in 
March 2020. Simultaneously, an earthquake of 5.5 hit Croatia's capital Zagreb. 
The present study investigated the association between the sense of coherence, 
subjective well-being, and emotional distress (depression, anxiety, and stress) 
that people went through while facing an acute stress situation of COVID-19 
outbreak and the earthquakes.
SUBJECTS AND METHODS: This cross-sectional study included 1152 subjects. 
Orientation to Life Questionnaires (OLQ-13), Personal Wellbeing Index (PWI) and 
DASS-21 scale were used in an anonymous online survey which was conducted on 22 
March 2020 (the twelfth day of the COVID-19 outbreak in Croatia and the day of 
the earthquakes in the Capital). The results of the questionnaires were 
determined by the correlation analysis. Hierarchical multiple regression was 
used to evaluate the association between the subjective well-being and the sense 
of coherence on the emotional distress.
RESULTS: The sense of coherence correlated positively with subjective well-being 
(p<0.01) and negatively with all distress domains (p<0.01) as well as subjective 
well-being (p<0.01). Mild emotional distress was detected. Subjects who 
experienced the earthquakes showed a significantly higher degree of anxiety 
(p=0.005) and stress (p=0.003), with significantly decreased the two personal 
well-being domains: standard of living (p=0.023) and personal safety (p=0.026). 
Sense of coherence made a major contribution in explaining emotional distress 
(p<0.001).
CONCLUSION: The results support the importance of improving coping efficiency of 
the sense of coherence with respect to obtaining an appropriate level of 
well-being and reducing emotional distress in acute stressful situations.

DOI: 10.24869/psyd.2021.639
PMID: 34928923 [Indexed for MEDLINE]


2626. Psychiatr Danub. 2021 Winter;33(4):626-633. doi: 10.24869/psyd.2021.626.

Intervention Effect of Time Management Training on Nurses' Mental Health during 
the COVID-19 Epidemic.

Sun L(1).

Author information:
(1)School of Economics & Management, Tongji University; Shangha, China, 
SUN15021652598@126.com.

BACKGROUND: The sudden outbreak of COVID-19 has put nurses into a severe test, 
both physiologically and psychologically. While being required to provide 
patients with high-quality medical services, nurses also bear the 
responsibilities and pressures from work, face trauma, disease and even death 
events, and are thereby more inclined to negative psychological feelings, 
decline in mental health, and reduction in the quality of their clinical nursing 
services. Under the background of the COVID-19 epidemic, it is urgent to carry 
out related intervention in nurses' psychological crisis.
SUBJECTS AND METHODS: The mental health of 400 nurses from three tertiary 
hospitals in Shanghai, China was assessed from September to December 2020. Then, 
time management training was conducted for 66 nurses who were voluntarily 
enrolled in the study. They were divided into the intervention group (35 
participants) and the control group (31 participants).
RESULTS: After the 16-week intervention, (1) there is a significant decrease in 
the total SCL-90 score of the intervention group and significant decreases in 
the scores in the 9 dimensions of the scale, suggesting significant improvement 
in the mental health level; (2) there is a significant increase in the score of 
the intervention group in subjective well-being, while there is no significant 
increase in the control group; (3) There is a significant decrease in the score 
of the intervention group in work stress reaction, but there is no significant 
decrease in the control group, and there is a significant increase in the 
physiological reaction of the control group in the measurement after 8 weeks.
CONCLUSIONS: It is critical to pay attention to and solve the low mental health 
level of nurses during the COVID-19 epidemic; Time management training can 
effectively improve the mental health level of nurses, and it is an effective 
intervention model to promote nurses' mental health and relieve their work 
stress.

DOI: 10.24869/psyd.2021.626
PMID: 34928921 [Indexed for MEDLINE]


2627. Psychol Trauma. 2022 Nov;14(8):1365-1373. doi: 10.1037/tra0001188. Epub 2021 Dec 
20.

The mental health effects of the COVID-19 pandemic on children and adolescents: 
Risk and protective factors.

Shoshani A(1), Kor A(1).

Author information:
(1)Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC) Herzliya.

OBJECTIVE: The restrictions to contain the coronavirus disease 2019 (COVID-19) 
pandemic have led to considerable social isolation, posing significant threats 
to mental health worldwide. The preventive lockdowns may be especially difficult 
for children and adolescents, who rely extensively on their daily routines and 
peer connections for stability and optimal development. However, there is a 
dearth of longitudinal research examining the mental health and daily life 
impact of the pandemic among children and adolescents. This study addresses this 
gap by examining the influence of the COVID-19 pandemic on children and 
adolescents' mental health and well-being, and potential risk and protective 
moderators of mental health change.
METHOD: In the present study, 1,537 Israeli children and adolescents (Mage = 
13.97; 52% girls) completed a battery of questionnaires in September 2019; 
before the COVID-19 outbreak and immediately after an 8-week lockdown period 
when schools reopened in May 2020.
RESULTS: A repeated measures multivariant analysis of variance (MANOVA) revealed 
significantly greater anxiety, depression, and panic symptoms, increases in 
video game, Internet and TV screen time use, and decreases in positive emotions, 
life satisfaction, social media use, and peer support during the pandemic. 
Participants with higher baseline mental health symptoms showed greater symptoms 
after the lockdown period. Perceived social support and consistent daily 
routines were found to act as significant protective factors against 
symptomatology.
CONCLUSIONS: The results highlight the significant mental health consequences of 
the pandemic on children and adolescents, and substantiate the significant 
parents' and peers' roles in children's and adolescents' coping during this 
global pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

DOI: 10.1037/tra0001188
PMID: 34928689 [Indexed for MEDLINE]


2628. Ann Surg Oncol. 2022 Mar;29(3):1649-1657. doi: 10.1245/s10434-021-11209-1. Epub 
2021 Dec 20.

Patient Perceptions of Changes in Breast Cancer Care and Well-Being During 
COVID-19: A Mixed Methods Study.

Ludwigson A(1), Huynh V(2), Myers S(3), Hampanda K(4), Christian N(2), Ahrendt 
G(2), Romandetti K(2), Tevis S(5).

Author information:
(1)University of Colorado School of Medicine, Aurora, CO, USA.
(2)Department of Surgery, University of Colorado, Aurora, CO, USA.
(3)Department of Surgery, University of Pittsburg, Pittsburg, PA, USA.
(4)Department of Obstetrics and Gynecology, University of Colorado, Aurora, CO, 
USA.
(5)Department of Surgery, University of Colorado, Aurora, CO, USA. 
sarah.tevis@cuanschutz.edu.

Comment in
    Ann Surg Oncol. 2022 Mar;29(3):1502-1503.

BACKGROUND: Widespread healthcare restructuring due to the COVID-19 pandemic led 
to modifications in the timing and delivery of care for breast cancer patients. 
Our study explores patient concerns relating to COVID-19, breast cancer, and 
changes to breast cancer care.
PATIENTS AND METHODS: Breast cancer patients who presented for surgical 
consultation at an academic, multidisciplinary clinic completed the 
electronically distributed validated COVID-19 Impact and Healthcare Related 
Quality of Life questionnaire between August 2020 and February 2021. This 
questionnaire uses Likert score responses to assess COVID-specific concerns 
within domains, including distress and financial hardship. Scale scores were 
determined by averaging items within each domain, and scores > 2 indicated 
greater disruption. Semistructured interviews were conducted with patients who 
indicated interest in participating in the questionnaire.
RESULTS: Of 381 patients recruited, 133 patients completed the questionnaire and 
20 patients completed interviews. Sixty-three percent of survey participants 
reported attending a telemedicine appointment for their cancer care, and the 
majority (67%) were satisfied with their experience. Half of the participants 
(50%) reported fear about how the COVID-19 pandemic will impact their cancer 
care or recovery, and 66% reported anxiety about contracting COVID-19. 
Twenty-two percent of participants reported decreased income due to COVID-19. 
Patient interviews revealed tangible changes to care and provided in-depth 
information on the advantages and disadvantages of telehealth.
CONCLUSIONS: Breast cancer patients report anxiety about COVID-19 infection and 
potential care modifications. Our study identifies impacts on patients' care and 
quality of life. Further investigation will inform interventions to improve 
psychosocial outcomes for patients and the telehealth experience.

© 2021. Society of Surgical Oncology.

DOI: 10.1245/s10434-021-11209-1
PMCID: PMC8685309
PMID: 34928479 [Indexed for MEDLINE]


2629. Fam Process. 2022 Mar;61(1):76-90. doi: 10.1111/famp.12730. Epub 2021 Dec 19.

Building long-term family resilience through universal prevention: 10-year 
parent and child outcomes during the COVID-19 pandemic.

Feinberg ME(1), Gedaly L(1), Mogle J(1), Hostetler ML(1), Cifelli JA(1), 
Tornello SL(2), Lee JK(3), Jones DE(1).

Author information:
(1)Prevention Research Center, Human Development and Family Studies, College of 
Health and Human Development, The Pennsylvania State University.
(2)Human Development and Family Studies, College of Health and Human 
Development, The Pennsylvania State University.
(3)Institute for Poverty Alleviation and International Development, Yonsei 
University.

As the COVID-19 pandemic has been highly stressful for parents and children, it 
is clear that strategies that promote long-term family resilience are needed to 
protect families in future crises. One such strategy, the Family Foundations 
program, is focused on promoting supportive coparenting at the transition to 
parenthood. In a randomized trial, we tested the long-term intervention effects 
of Family Foundations on parent, child, and family well-being one to two months 
after the imposition of a national shelter-in-place public health intervention 
in 2020. We used regression models to test intervention impact on outcomes 
reported on by parents in a standard questionnaire format and a series of 8 days 
of daily reports. We also tested moderation of intervention impact by parent 
depression and coparenting relationship quality. Relative to control families, 
intervention families demonstrated significantly lower levels of individual and 
family problems (general parent hostility, harsh and aggressive parenting, 
coparenting conflict, sibling relationship conflict, and children's negative 
mood and behavior problems), and higher levels of positive family relationship 
quality (positive parenting, couple relationship quality, sibling relations, and 
family cohesion). For some outcomes, including coparenting conflict, harsh 
parenting, and child behavior problems, intervention effects were larger for 
more vulnerable families-that is, families with higher pre-pandemic levels of 
parent depression or lower levels of coparenting relationship quality. We 
conclude that targeted family prevention programming is able to promote healthy 
parent and child functioning during unforeseen future periods of acute stress. 
The long-term benefits of a universal approach to family support at the 
transition to parenthood indicate the need for greater investment in the 
dissemination of effective approaches.

Publisher: Dado que la pandemia de COVID-19 ha sido muy estresante para padres e 
hijos, está claro que se necesitan estrategias que promuevan la resiliencia 
familiar a largo plazo para proteger a las familias en crisis futuras. Una de 
esas estrategias, el programa Family Foundations, se centra en promover la 
crianza compartida de apoyo en la transición a la paternidad. En un ensayo 
aleatorizado, probamos los efectos de la intervención a largo plazo de Family 
Foundations en el bienestar de los padres, el niño y la familia uno o dos meses 
después de la imposición de una intervención nacional de salud pública de 
refugio en el lugar en 2020. Usamos modelos de regresión para evaluar el impacto 
de la intervención en los resultados informados por los padres en un formato de 
cuestionario estándar y una serie de 8 días de informes diarios. También 
probamos la moderación del impacto de la intervención por la depresión de los 
padres y la calidad de la relación de coparentalidad. En relación con las 
familias de control, las familias de intervención demostraron niveles 
significativamente más bajos de problemas individuales y familiares (hostilidad 
general de los padres, crianza dura y agresiva, conflicto de crianza conjunta, 
conflicto de relaciones entre hermanos y problemas de comportamiento y estado de 
ánimo negativos de los niños) y niveles más altos de calidad de relación 
familiar positiva (crianza positiva, calidad de la relación de pareja, 
relaciones entre hermanos y cohesión familiar). Para algunos resultados, 
incluido el conflicto de crianza compartida, la crianza severa y los problemas 
de comportamiento infantil, los efectos de la intervención fueron mayores para 
las familias más vulnerables, es decir, familias con niveles más altos de 
depresión de los padres prepandémicos o niveles más bajos de calidad de la 
relación de crianza compartida. Concluimos que los programas de prevención 
familiar específicos pueden promover el funcionamiento saludable de padres e 
hijos durante períodos futuros imprevistos de estrés agudo. Los beneficios a 
largo plazo de un enfoque universal del apoyo familiar en la transición a la 
paternidad indican la necesidad de una mayor inversión en la difusión de 
enfoques eficaces.

Publisher: 新冠大流行病给父母和儿童带来了巨大的压力。增强家庭未来的抗逆力将帮助家庭更好地应对未来 
的危机。一种提高家庭抗逆力的方式是通过“家庭建设”项目。“家庭建设”项目着重于在向父母身份 过渡的阶段促进支持型父母共同养育。在一项随机对照试验中, 
我们测试了“家庭建设”项目在2020 年美国全国性的公共卫生干预措施居家隔离实施的一到两个月后对父母、儿童和家庭健康的长期干 
预效果。通过使用回归模型和父母提供的8天的问卷调查数据, 我们测试了“家庭建设”项目的长期干 
预效果。我们还测试了父母抑郁程度和共育关系质量对干预效果的调节作用。相对于对照组家庭, 干预组家庭的个人和家庭问题 
(父母的敌意、严厉和攻击性的养育方式、共同养育的冲突、兄弟姐 妹之间的冲突、以及儿童的负面情绪和行为问题) 水平明显较低, 而积极的家庭关系质量 (积极的 
养育方式、夫妻关系、兄弟姐妹关系、以及家庭凝聚力) 水平较高。对于一些结果变量, 包括共同 养育的冲突、严厉的养育方式和儿童行为问题, 
干预效果对于更脆弱的家庭- 即大流行前父母抑郁 2 程度水平较高或共同养育关系质量水平较低的家庭--更大。我们的结论是, 有针对性的家庭预防项 
目能够在未来不可预见的急性压力时期促进父母和儿童的健康。 在向父母身份过渡的阶段提供普遍 性干预的家庭支持所带来的长期好处表明, 
我们应该为推广此类有效方法投入更多。.

© 2021 Family Process Institute.

DOI: 10.1111/famp.12730
PMID: 34927239 [Indexed for MEDLINE]


2630. Front Public Health. 2021 Dec 2;9:720180. doi: 10.3389/fpubh.2021.720180. 
eCollection 2021.

Alzheimer's Association Project VITAL: A Florida Statewide Initiative Using 
Technology to Impact Social Isolation and Well-Being.

Prophater LE(1), Fazio S(1), Nguyen LT(2), Hueluer G(3), Peterson LJ(3), Sherwin 
K(1), Shatzer J(1), Branham M(1), Kavalec A(2), O'Hern K(2), Stoglin K(2), Tate 
R(3), Hyer K(3).

Author information:
(1)Alzheimer's Association, Chicago, IL, United States.
(2)iN2L, Greenwood Village, CO, United States.
(3)School of Aging Studies, University of South Florida, Tampa, FL, United 
States.

Lack of social engagement and the resulting social isolation can have negative 
impacts on health and well-being, especially in senior care communities and for 
those living with dementia. Project VITAL leverages technology and community 
resources to create a network for connection, engagement, education, and support 
of individuals with dementia and their caregivers, and explores the impact of 
these interventions in reducing feelings of social isolation and increasing mood 
among residents during the COVID-19 pandemic. Through two phases, 600 
personalized Wi-Fi-enabled iN2L tablets were distributed to 300 senior care 
communities (55% assisted living communities, 37% skilled nursing communities, 
6% memory care communities, and 2% adult family-care homes) to connect and 
engage residents and their families. Different phases also included Project 
ECHO, a video-based learning platform, Alzheimer's Association virtual and 
online education and support for family caregivers, evidence-based online 
professional dementia care staff training and certification, and Virtual Forums 
designed to explore ways to build sustainable, scalable models to ensure access 
to support and decrease social isolation in the future. Tablet usage was 
collected over an 11-month period and an interim survey was designed to assess 
the effectiveness of the tablets, in preventing social isolation and increasing 
mood among residents during the COVID-19 pandemic. A total of 105 care community 
staff (whose community used the tablets) completed the survey and overall, these 
staff showed a high level of agreement to statements indicating that residents 
struggled with loneliness and mood, and that the tablet was useful in improving 
loneliness and mood in residents and allowing them to stay in touch with family 
and friends. Additional positive results were seen through a variety of other 
responses around the tablets and Project ECHO. Overall, the tablets were shown 
to be an effective way to engage residents and connect them with friends and 
family, as well as being a useful tool for staff members. A third phase is 
currently underway in the homes of people with dementia and their family 
caregivers, which includes tablets and direct access to Alzheimer's Association 
virtual and online education and support programs.

Copyright © 2021 Prophater, Fazio, Nguyen, Hueluer, Peterson, Sherwin, Shatzer, 
Branham, Kavalec, O'Hern, Stoglin, Tate and Hyer.

DOI: 10.3389/fpubh.2021.720180
PMCID: PMC8674735
PMID: 34926365 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2631. J Pediatr Nurs. 2022 Jul-Aug;65:e11-e12. doi: 10.1016/j.pedn.2021.12.005. Epub 
2021 Dec 17.

Cemetery, tombstones, tears and hidden silences: Suicide in children and 
adolescents.

da Silva UP(1), Reis AOA(2), Pereira YTG(3), Vieira NB(3), Neto MLR(3), Lima 
NNR(4).

Author information:
(1)Doctoral Program in Nuerosciences and Human Development, Logos University 
International, UNILOGOS, Miami, FL - EUA, United States of America; Graduate 
Program in Neuropsychiatry, Universidade Federal de Pernambuco - UFPE, Recife, 
Pernambuco, Brazil.
(2)Department of Maternal and Child Health, Faculty of Public Health, University 
of São Paulo - USP, São Paulo, Brazil.
(3)Mais Médicos Program - Federal Government of Brazil, Ministry of Health, 
Iguatú, Ceará, Brazil.
(4)School of Medicine, Federal University of Cariri - UFCA, Barbaçha, Ceará, 
Brazil. Electronic address: nararolim@yahoo.com.br.

Recent studies have reported a deterioration in children's mental health since 
the onset of the COVID-19 pandemic, with an increase in anxiety and mood 
disorders leading to significant suicidal ideation and suicide rates. Suicide is 
complex, and individual tragedies and circumstances can diverge. Evidence 
suggests that the mental health and well-being of some children and youth were 
substantially affected because of and during the pandemic. Those with 
pre-existing mental health problems that experienced the most negative impacts 
compared to pre-pandemic data.

Copyright © 2021 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.pedn.2021.12.005
PMCID: PMC9759679
PMID: 34924258 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that the research was conducted in the absence of any commercial or 
financial relationships that could be construed as a potential conflict of 
interest.


2632. Psychiatry Res. 2022 Jan;307:114337. doi: 10.1016/j.psychres.2021.114337. Epub 
2021 Dec 11.

Relation of perceived discrimination with depression, insomnia and 
post-traumatic stress in COVID-19 survivors.

Campo-Arias A(1), Pedrozo-Pupo JC(2), Caballero-Domínguez CC(3).

Author information:
(1)MD, MSc, associate professor, Universidad del Magdalena, Santa Marta, 
Colombia. Electronic address: acampoa@unimagdalena.edu.co.
(2)MD, FCCP, MSc, assistant professor, Universidad del Magdalena, Santa Marta, 
Colombia. Electronic address: jpedrozo@unimagdalena.edu.co.
(3)Psicóloga, PhD, titular professor, Universidad del Magdalena, Santa Marta, 
Colombia. Electronic address: ccaballero@unimagdalena.edu.co.

The study's objective was to study the association of perceived discrimination 
with depression, insomnia and post-traumatic stress in people recovered from 
coronavirus disease (COVID-19) in Santa Marta, Colombia. COVID-19 survivors were 
invited to participate. The authors measured perceived discrimination related to 
COVID-19 (COVID-19 Perceived Stigma Scale), depression (PHQ-9), insomnia (Athens 
Insomnia Scale), and post-traumatic stress (Brief Davidson Trauma Scale). Three 
hundred thirty COVID-19 survivors participated in the research; the participants 
were between 18 and 89 years; 61.52% were females. 32.12% of the participants 
reported high perceived discrimination; 49.70%, depression; 60.61%, insomnia; 
and 13.33% post-traumatic stress. After adjusting for age, gender, and income, 
depression, insomnia, and post-traumatic stress were associated significantly 
with discrimination perceived by COVID-19. Perceived discrimination is a social 
stressor that affects the psychological well-being of people recovered from 
COVID-19. In the follow-up of this group of patients, it is important to 
consider the impact of perceived discrimination on psychological well-being.

Copyright © 2021 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.psychres.2021.114337
PMCID: PMC8665839
PMID: 34922241 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
declare.


2633. Nurse Educ Pract. 2022 Jan;58:103275. doi: 10.1016/j.nepr.2021.103275. Epub 2021 
Dec 10.

The impact of covid-19 on psychosocial well-being and learning for australian 
nursing and midwifery undergraduate students: a cross-sectional survey.

Rasmussen B(1), Hutchinson A(2), Lowe G(3), Wynter K(4), Redley B(5), Holton 
S(6), Manias E(7), Phillips N(8), McDonall J(9), McTier L(10), Kerr D(11).

Author information:
(1)School of Nursing and Midwifery; Centre for Quality and Patient Safety 
Research in the Institute for Health Transformation, Deakin University, 1 
Gheringhap St, Geelong, VIC 3220, Australia; The Centre for Quality and Patient 
Safety Research in the Institute of Health Transformation -Western Health 
Partnership, Western Health, Furlong Road, St Albans VIC 3021 Australia; Faculty 
of Health and Medical Sciences, University of Copenhagen Blegdamsvej 3B, 2200 
Copenhagen, Denmark; Faculty of Health Sciences, University of Southern Denmark 
and Steno Diabetes Center, Campusvej 55, Odense M, DK-5230, Denmark. Electronic 
address: Bodil.rasmussen@deakin.edu.au.
(2)School of Nursing and Midwifery; Centre for Quality and Patient Safety 
Research in the Institute for Health Transformation, Deakin University, 1 
Gheringhap St, Geelong, VIC 3220, Australia; The Centre for Quality and Patient 
Safety Research in the Institute of Health Transformation -Monash Health 
Partnership, Monash Health, 246 Clayton Road, Clayton, VIC 3168, Australia. 
Electronic address: Alison.hutchinson@deakin.edu.au.
(3)School of Nursing and Midwifery; Centre for Quality and Patient Safety 
Research in the Institute for Health Transformation, Deakin University, 1 
Gheringhap St, Geelong, VIC 3220, Australia. Electronic address: 
g.lowe@deakin.edu.au.
(4)School of Nursing and Midwifery; Centre for Quality and Patient Safety 
Research in the Institute for Health Transformation, Deakin University, 1 
Gheringhap St, Geelong, VIC 3220, Australia; The Centre for Quality and Patient 
Safety Research in the Institute of Health Transformation -Western Health 
Partnership, Western Health, Furlong Road, St Albans VIC 3021 Australia. 
Electronic address: k.wynter@deakin.edu.au.
(5)School of Nursing and Midwifery; Centre for Quality and Patient Safety 
Research in the Institute for Health Transformation, Deakin University, 1 
Gheringhap St, Geelong, VIC 3220, Australia; The Centre for Quality and Patient 
Safety Research in the Institute of Health Transformation -Monash Health 
Partnership, Monash Health, 246 Clayton Road, Clayton, VIC 3168, Australia. 
Electronic address: Bernice.redley@deakin.edu.au.
(6)School of Nursing and Midwifery; Centre for Quality and Patient Safety 
Research in the Institute for Health Transformation, Deakin University, 1 
Gheringhap St, Geelong, VIC 3220, Australia; The Centre for Quality and Patient 
Safety Research in the Institute of Health Transformation -Western Health 
Partnership, Western Health, Furlong Road, St Albans VIC 3021 Australia. 
Electronic address: s.holton@deakin.edu.au.
(7)School of Nursing and Midwifery; Centre for Quality and Patient Safety 
Research in the Institute for Health Transformation, Deakin University, 1 
Gheringhap St, Geelong, VIC 3220, Australia. Electronic address: 
emanias@deakin.edu.au.
(8)School of Nursing and Midwifery; Centre for Quality and Patient Safety 
Research in the Institute for Health Transformation, Deakin University, 1 
Gheringhap St, Geelong, VIC 3220, Australia. Electronic address: 
Nikki.phillips@deakin.edu.au.
(9)School of Nursing and Midwifery; Centre for Quality and Patient Safety 
Research in the Institute for Health Transformation, Deakin University, 1 
Gheringhap St, Geelong, VIC 3220, Australia. Electronic address: 
Jo.mcdonall@deakin.edu.au.
(10)School of Nursing and Midwifery; Centre for Quality and Patient Safety 
Research in the Institute for Health Transformation, Deakin University, 1 
Gheringhap St, Geelong, VIC 3220, Australia. Electronic address: 
Lauren.mctier@deakin.edu.au.
(11)School of Nursing and Midwifery; Centre for Quality and Patient Safety 
Research in the Institute for Health Transformation, Deakin University, 1 
Gheringhap St, Geelong, VIC 3220, Australia. Electronic address: 
d.kerr@deakin.edu.au.

AIM: To explore the impact of COVID-19 on psychosocial well-being and learning 
for nursing and midwifery undergraduate students in an Australian university.
BACKGROUND: The World Health Organization has reported a substantial 
psychological impact of COVID-19 on healthcare professionals to date. Evidence 
is lacking, however, regarding university nursing and midwifery students of the 
pandemic and its impact on their educational preparation and/or clinical 
placement during the COVID-19 pandemic.
DESIGN: Cross-sectional survey of nursing and midwifery undergraduate students 
enrolled in the Bachelor of Nursing suite of courses from the study institution 
in August- September 2020.
METHODS: A cross-sectional self-administered anonymous online survey was 
distributed to current nursing and midwifery undergraduate students. The survey 
included three open-ended questions; responses were thematically analysed.
RESULTS: Of 2907 students invited, 637 (22%) responded with 288 of the 
respondents (45%) providing a response to at least one of the three open-ended 
questions. Three major themes associated with the impact of the pandemic on 
psychosocial well-being and learning were identified: psychosocial impact of the 
pandemic, adjustment to new modes of teaching and learning, and concerns about 
course progression and career. These themes were underpinned by lack of 
motivation to study, feeling isolated, and experiencing stress and anxiety that 
impacted on students' well-being and their ability to learn and study.
CONCLUSIONS: Students were appreciative of different and flexible teaching modes 
that allowed them to balance their study, family, and employment 
responsibilities. Support from academic staff and clinical facilitators/mentors 
combined with clear and timely communication of risk management related to 
personal protective equipment (PPE) in a healthcare facility, were reported to 
reduce students' stress and anxiety. Ways to support and maintain motivation 
among undergraduate nursing and midwifery students are needed.

Crown Copyright © 2021. Published by Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.nepr.2021.103275
PMCID: PMC8662551
PMID: 34922092 [Indexed for MEDLINE]

Conflict of interest statement: There are no conflicts of interest for any 
authors.


2634. Health Soc Care Community. 2022 Sep;30(5):e2419-e2432. doi: 10.1111/hsc.13683. 
Epub 2021 Dec 17.

The hidden minority: Discrimination and mental health among international 
students in the US during the COVID-19 pandemic.

Maleku A(1), Kim YK(2), Kirsch J(1), Um MY(3), Haran H(1), Yu M(4), Moon SS(5).

Author information:
(1)College of Social Work, The Ohio State University, Columbus, OH, USA.
(2)School of Social Work, Louisiana State University, Baton Rouge, LA, USA.
(3)School of Social Work, Watts College of Public Service and Community 
Solutions, Arizona State University, Tempe, AZ, USA.
(4)School of Social Work, Department of Public Health, University of Missouri, 
Columbia, MO, USA.
(5)School of Social Work, Baylor University, Waco, TX, USA.

International students in the US occupy a precarious position at the 
intersection of immigration policy and global education mobility, one made more 
challenging by the disparate impact of COVID-19 on college students' mental 
health. Few studies, however, have explored the pandemic's effects on mental 
well-being among the international student population in the US. Our study aims 
to provide initial empirical evidence on the mental health status of these 
students, with a specific focus on discrimination, loneliness, anxiety, and 
depression. We propose a mediation framework and estimate the mediating effects 
of loneliness and anxiety in the relationships between discrimination and 
depression in a sample of US-based international students (N = 103). We 
collected cross-sectional data from July to August 2020, using a 50-item online 
survey instrument with three open-ended questions. Mediation analyses using 
PROCESS Macro were used to analyse quantitative data and thematic analysis was 
used to analyse qualitative data. Findings showed that higher levels of 
discrimination were significantly associated with higher levels of loneliness. 
Higher levels of loneliness were significantly associated with higher levels of 
anxiety, which in turn led to high levels of depressive symptoms. Our study 
contributes to understanding the needs and capacities of international students 
in the wake of COVID-19 and simultaneously provides pragmatic program and policy 
implications for inclusive higher education environments and the overall health 
and well-being of this crucial US student population.

© 2021 John Wiley & Sons Ltd.

DOI: 10.1111/hsc.13683
PMID: 34921449 [Indexed for MEDLINE]


2635. Nurs Open. 2022 Mar;9(2):1181-1189. doi: 10.1002/nop2.1159. Epub 2021 Dec 16.

Role of resilience in healthcare workers' distress and somatization during the 
COVID-19 pandemic: A cross-sectional study across Flanders, Belgium.

Franck E(1)(2), Goossens E(1)(3)(4), Haegdorens F(1), Geuens N(1)(2), Portzky 
M(5), Tytens T(1), Dilles T(1), Beeckman K(1)(6), Timmermans O(1)(7), Slootmans 
S(1), Van Rompaey B(1), Van Bogaert P(1).

Author information:
(1)Faculty of Medicine and Health Sciences, Centre for Research and Innovation 
in Care (CRIC), University of Antwerp, Wilrijk, Belgium.
(2)Nursing and Midwifery, Karel de Grote University College Antwerp, Antwerpen, 
Belgium.
(3)Department of Public Health and Primary Care, University of Leuven - KU 
Leuven, Leuven, Belgium.
(4)Department of Patient Care, Antwerp University Hospital - UZA, Antwerp, 
Belgium.
(5)Psychiatric Centre Ghent-Sleidinge, Gent, Belgium.
(6)Nursing and Midwifery Research Group, Vrije Universiteit Brussel, Brussel, 
Belgium.
(7)HZ University of Applied Sciences, Research Group Healthy Region, Vlissingen, 
The Netherlands.

AIM: To evaluate the impact and the possible role of psychological resilience in 
the COVID-19 pandemic outbreak on healthcare workers' mental and physical 
well-being in Belgium.
DESIGN: This cross-sectional, survey-based study enrolled 1376 healthcare 
workers across Belgium from 17 April 2020 to 24 April 2020.
METHODS: The study sample consisted of direct care workers (nurses and doctors), 
supporting staff and management staff members. The main outcomes are resilience, 
distress and somatization.
RESULTS: Higher educational level was associated with lower symptoms of distress 
and somatization. Physicians exhibited the lowest risk of experiencing 
heightened levels of distress and somatization. Controlling for confounding 
factors, higher levels of resilience were associated with a 12% reduced chance 
of increased distress levels and 5% lower chance of increased somatization 
levels. Our results suggest the potentially buffering role of mental resilience 
on those working on the frontline during the COVID-19 pandemic outbreak.

© 2021 The Authors. Nursing Open published by John Wiley & Sons Ltd.

DOI: 10.1002/nop2.1159
PMCID: PMC8859066
PMID: 34918478 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2636. J Gen Intern Med. 2022 Feb;37(2):397-408. doi: 10.1007/s11606-021-07252-z. Epub 
2021 Dec 16.

The Impact of the COVID-19 Pandemic on Mental Health, Occupational Functioning, 
and Professional Retention Among Health Care Workers and First Responders.

Hendrickson RC(1)(2), Slevin RA(3), Hoerster KD(4)(5)(6), Chang BP(7), Sano 
E(7), McCall CA(4)(5)(8), Monty GR(6), Thomas RG(9), Raskind MA(3)(4).

Author information:
(1)VISN 20 Northwest Mental Illness Research, Education, and Clinical Center 
(MIRECC), VA Puget Sound Health Care System, Seattle, WA, USA. 
Rebecca.Hendrickson@va.gov.
(2)Department of Psychiatry and Behavioral Sciences, University of Washington 
School of Medicine, Seattle, WA, USA. Rebecca.Hendrickson@va.gov.
(3)VISN 20 Northwest Mental Illness Research, Education, and Clinical Center 
(MIRECC), VA Puget Sound Health Care System, Seattle, WA, USA.
(4)Department of Psychiatry and Behavioral Sciences, University of Washington 
School of Medicine, Seattle, WA, USA.
(5)Mental Health Service, VA Puget Sound Healthcare System, Seattle, WA, USA.
(6)Health Services Research and Development, VA Puget Sound Healthcare System, 
Seattle, WA, USA.
(7)Department of Emergency Medicine, Columbia University Irving Medical Center, 
New York, NY, USA.
(8)VA Puget Sound Healthcare System, Seattle, WA, USA.
(9)Department of Biostatistics, University of California, La Jola, CA, USA.

BACKGROUND: The COVID-19 pandemic has greatly affected front-line health care 
workers (HCW) and first responders (FR). The specific components of COVID-19 
related occupational stressors (CROS) associated with psychiatric symptoms and 
reduced occupational functioning or retention remain poorly understood.
OBJECTIVES: Examine the relationships between total and factored CROS, 
psychiatric symptoms, and occupational outcomes.
DESIGN: Observational, self-report, single time-point online assessment.
PARTICIPANTS: A total of 510 US HCW (N = 301) and FR (N = 200) with occupational 
duties affected by the COVID-19 pandemic.
MAIN OUTCOMES AND MEASURES: CROS were assessed using a custom 17-item 
questionnaire. Post-traumatic stress disorder (PTSD), depression, insomnia, and 
generalized anxiety symptoms were assessed using the PTSD Checklist-5 (PCL5), 
Patient Health Questionnaire-9 (PHQ9), Insomnia Severity Index (ISI), and 
General Anxiety Disorder-7 (GAD7). Respondents' likelihood of leaving current 
field and occupational functioning were assessed with 2-item PROMIS subscales. 
Relationships were modeled using multivariable regression. Open-ended responses 
were coded using rapid template analysis.
RESULTS: CROS total scores correlated significantly with all four psychiatric 
symptom domains (R's = .42-.53), likelihood of leaving one's current occupation 
(R = .18), and trouble doing usual work (R = .28), all p's < .001. Half of HCW 
indicated a decreased likelihood of staying in their current occupation as a 
result of the pandemic. CROS were fit to a 3-factor model consisting of risk, 
demoralization, and volume factors. All CROS factors were associated with 
psychiatric symptom burden, but demoralization was most prominently associated 
with psychiatric symptoms and negative occupational outcomes. Among psychiatric 
symptoms, PTSD symptoms were most strongly associated with negative occupational 
outcomes. Open-ended statements emphasized lack of protection and support, 
increased occupational demands, and emotional impact of work duties.
CONCLUSIONS AND RELEVANCE: These results demonstrate potentially treatable 
psychiatric symptoms in HCW and FR experiencing CROS, impacting both wellbeing 
and the health care system. Mitigating CROS, particularly by addressing factors 
driving demoralization, may improve HCW and FR mental health, occupational 
functioning, and retention.

© 2021. This is a U.S. government work and not under copyright protection in the 
U.S.; foreign copyright protection may apply.

DOI: 10.1007/s11606-021-07252-z
PMCID: PMC8675543
PMID: 34918181 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they do not have a 
conflict of interest.


2637. Encephale. 2022 Dec;48(6):647-652. doi: 10.1016/j.encep.2021.06.021. Epub 2021 
Oct 5.

[CONFAMI study: Effects of home confinement during the COVID-19 epidemic on the 
lives of children and their families].

[Article in French]

Zebdi R(1), Plateau E(2), Delalandre A(2), Vanwalleghem S(3), Chahed M(4), 
Hentati Y(5), Chaudoye G(6), Moreau E(7), Lignier B(8).

Author information:
(1)UR CLIPSYD, laboratoire EvaCliPsy, université Paris Nanterre, 200, avenue de 
la République, 92001 Nanterre cedex, France. Electronic address: 
rzebdi@parisnanterre.fr.
(2)Hôpital Raymond Poincaré, 104, boulevard Raymond-Poincaré, 92380 Garches, 
France.
(3)UR CLIPSYD, laboratoire EvaCliPsy, université Paris Nanterre, 200, avenue de 
la République, 92001 Nanterre cedex, France.
(4)Université Tunis El Manar, Département de Psychologie, Institut Supérieur des 
Sciences Humaines de Tunis, 26, Avenue Darghouth Pacha, 1007 Tunis, Tunisie.
(5)Université de Jendouba, Institut Supérieur des Études Appliquées et Humanité, 
Cité Eddir, 7100 Le Kef, Tunisie.
(6)UR CLIPSYD, laboratoire A2P, université Paris Nanterre, 200, avenue de la 
République, 92001 Nanterre cedex, France.
(7)Espace Jeunes Adultes, 29, rue du faubourg Saint-Antoine, 75011 Paris, 
France.
(8)Laboratoire de psychologie : dynamiques relationnelles et processus 
identitaires (Psy-DREPI, EA 7458), université de Bourgogne Franche-Comté, 
Esplanade Erasme, BP 27877, 21078 Dijon cedex, France; CSAPA La Santoline, 
SEDAP, Société d'Entraide et d'Action Psychologique, Dijon, France.

OBJECTIVES: The aim of this study is to understand the changes within families 
during confinement motivated by the COVID-19 pandemic and to explore the 
psycho-emotional experiences of children and their parents in this new 
situation. Confinement necessarily induced significant changes in daily family 
routines, particularly for work, education, leisure and social activities. In 
the more vulnerable pediatric population, several authors have warned of the 
need to consider the impact of lockdown measures during COVID-19 on the 
psychological impact and well-being.
METHOD: This is an anonymous online survey with methodology combining 
quantitative and qualitative analyses. The questions targeted several themes 
such as life context, emotional experience and the impact on daily habits in 
children and adolescents, as perceived by parents. Participants are adults and 
parents of at least one child. They were recruited through social media and 
email.
RESULTS: A total of 439 parents responded to the questionnaire. The families 
generally stayed in their usual place of residence and managed to adapt well. On 
average, the children's level of worry (as estimated by parents) was lower than 
the level of worry parents attributed to themselves. For the majority, the 
parents did not observe any change, the psychological state of the children and 
adolescents was generally stable, but for those who experienced more negative 
emotions than usual, it was an increase in boredom, irritability and anger. A 
decrease in the quality of sleep was also observed by a third of the 
respondents. On the other hand, an increase in autonomy was noted. Regarding the 
quality of family cohabitation, an important result showed that confinement had 
improved family relationships for 41% parents but at the expense of usual social 
ties inducing a feeling of deprivation. Indeed, the participants evoke a lack of 
"social link" and "social contact with friends". Lack became synonymous with 
absence, a feeling of loneliness and separation.
CONCLUSION: Our results confirm European and international data collected in 
children in countries where strict lockdown measures have been applied. Despite 
the negative emotions felt in some children, confinement has helped develop new 
resources in most families. Families seem to have been successful in maintaining 
a stable and secure routine which has certainly been a protective factor against 
anxiety. Some reported factors, such as bonding, could be protective factors and 
constitute good leads in interventions to be offered to children and their 
families.

OBJECTIFS: L’objectif est de comprendre les changements au sein des familles 
durant le confinement motivé par la pandémie de la COVID-19 et explorer le vécu 
psychoaffectif des enfants et de leurs parents face à cette situation.
MÉTHODE: Il s’agit d’une enquête en ligne anonyme avec méthodologie associant 
des analyses quantitatives et qualitatives. Les questions ciblaient plusieurs 
thèmes tels que le contexte de vie, le vécu émotionnel et les répercussions sur 
les habitudes quotidiennes chez les enfants et adolescents, tels que perçus par 
les parents.
RÉSULTATS: Au total, 439 parents ont répondu au questionnaire. Les familles sont 
globalement restées dans leur lieu de vie habituel et ont réussi à bien 
s’adapter. En moyenne, le niveau d’inquiétude des enfants (estimé par les 
parents) était moins élevé que celui que les parents s’attribuent. L’état 
psychologique des enfants et adolescents était globalement stable mais pour ceux 
qui ont vécu davantage d’émotions négatives que d’habitude, il s’agissait d’une 
augmentation de l’ennui, de l’irritabilité et de la colère. Une baisse de la 
qualité de sommeil a aussi été constatée par un tiers des répondants. En 
revanche, une progression de l’autonomie a été soulignée. Les parents ont aussi 
rapporté une amélioration des relations familiales, mais aux dépens des liens 
sociaux habituels induisant un sentiment de privation.
CONCLUSION: Malgré des émotions négatives ressenties chez certains enfants, le 
confinement a permis de développer de nouvelles ressources dans la plupart des 
familles. Certains facteurs rapportés, tels que le renforcement des liens, 
pourraient être des facteurs protecteurs et constituent de bonnes pistes dans 
les interventions à proposer aux enfants et leur famille.

Copyright © 2021 L'Encéphale, Paris. Published by Elsevier Masson SAS. All 
rights reserved.

DOI: 10.1016/j.encep.2021.06.021
PMCID: PMC8491935
PMID: 34916077 [Indexed for MEDLINE]


2638. Twin Res Hum Genet. 2021 Dec;24(6):365-370. doi: 10.1017/thg.2021.49. Epub 2021 
Dec 17.

The Australian Twins Economic Preferences Survey.

Kettlewell N(1), Tymula A(2).

Author information:
(1)Economics Discipline Group, University of Technology Sydney, New South Wales, 
Australia.
(2)School of Economics, University of Sydney, Sydney, New South Wales, 
Australia.

This article describes the Australian Twins Economic Preferences Survey (ATEPS). 
The data set comprises a wide variety of preference and behavioral measures 
(risk aversion, impatience, ambiguity aversion, trust, confidence) elicited 
using incentivized decision tasks. One-thousand one-hundred twenty Australian 
adult twins (560 pairs) completed the survey, making it one of the largest data 
sets containing incentivized preference measures of twins. As the survey was 
conducted during the COVID-19 pandemic, we also collected information on 
experiences related to the pandemic, along with a variety of questions on 
political attitudes and mental wellbeing. We hope that ATEPS can make a valuable 
contribution to social science and genetics research.

DOI: 10.1017/thg.2021.49
PMID: 34915959 [Indexed for MEDLINE]


2639. Aging Ment Health. 2022 Oct;26(10):2071-2079. doi: 
10.1080/13607863.2021.2010183. Epub 2021 Dec 16.

With age comes well-being: older age associated with lower stress, negative 
affect, and depression throughout the COVID-19 pandemic.

Fields EC(1)(2)(3), Kensinger EA(1), Garcia SM(1), Ford JH(1), Cunningham 
TJ(1)(4)(5).

Author information:
(1)Department of Psychology and Neuroscience, Boston College, Chestnut Hill, MA, 
USA.
(2)Department of Psychology, Brandeis University, Waltham, MA, USA.
(3)Department of Psychology, Westminster College, New Wilmington, PA, USA.
(4)Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
(5)Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, 
USA.

Objectives: Despite initial concerns about older adult's emotional well-being 
during the COVID-19 pandemic, reports from the first months of the pandemic 
suggested that older adults were faring better than younger adults, reporting 
lower stress, negative affect, depression, and anxiety. In this study, we 
examined whether this pattern would persist as the pandemic progressed.Method: A 
convenience sample of 1,171 community-dwelling adults in the United States, ages 
18-90, filled out surveys on various metrics of emotional well-being starting in 
March 2020 and at various time points through April 2021. We created time bins 
to account for the occurrence of significant national events, allowing us to 
determine how age would relate to affective outcomes when additional 
national-level emotional events were overlaid upon the stress of the 
pandemic.Results: Older age was associated with lower stress, negative affect, 
and depressive symptomatology, and with higher positive affect, and this effect 
was consistent across time points measured from March, 2020 through April, 2021. 
Age was less associated with measures of worry and social isolation, but older 
adults were more worried about their personal health throughout the 
pandemic.Conclusion: These results are consistent with literature suggesting 
that older age is associated with increased resilience in the face of stressful 
life experiences and show that this pattern may extend to resilience in the face 
of a prolonged real-world stressor.Supplemental data for this article can be 
accessed online at https://doi.org/10.1080/13607863.2021.2010183 .

DOI: 10.1080/13607863.2021.2010183
PMCID: PMC9200900
PMID: 34915781 [Indexed for MEDLINE]

Conflict of interest statement: Disclosure statement The authors declare no 
conflicts of interest.


2640. J Pediatr Psychol. 2022 Apr 8;47(4):420-431. doi: 10.1093/jpepsy/jsab129.

Mental Health Outcomes Among Parents of Children With a Chronic Disease During 
the COVID-19 Pandemic: The Role of Parental Burn-Out.

Wauters A(1), Vervoort T(1), Dhondt K(2), Soenens B(3), Vansteenkiste M(3), 
Morbée S(3), Waterschoot J(3), Haerynck F(4), Vandekerckhove K(4), Verhelst 
H(4), Van Aken S(4), Raes A(4), Schelstraete P(4), Walle JV(5), Van Hoecke E(6).

Author information:
(1)Department of Experimental-Clinical and Health Psychology, Ghent University, 
Ghent, Belgium.
(2)Department of Child & Adolescent Psychiatry, Ghent University Hospital, 
Ghent, Belgium.
(3)Department of Developmental, Personality, and Social Psychology, Ghent 
University, Ghent, Belgium.
(4)Department of Pediatrics, Ghent University Hospital, Ghent, Belgium.
(5)Utoped, ERKnet, Ghent University Hospital, Ghent, Belgium.
(6)Pediatric Psychology, Department of Pediatrics, Ghent University Hospital, 
Ghent, Belgium.

OBJECTIVE: The COVID-19 pandemic and associated quarantine measures highly 
impacted parental psychological well-being. Parents of children with chronic 
diseases might be specifically vulnerable as they already face multiple 
challenges to provide adequate care for their child. The research questions of 
the current study were twofold: (a) to examine whether parents of children with 
a chronic disease experienced more anxiety and depression compared to parents of 
healthy children and (b) to examine a series of risk factors for worsened 
well-being (i.e., depression, anxiety, and sleep problems), such as 
sociodemographic variables, COVID-19-specific variables (i.e., financial 
worries, living space, and perceived quality of health care), and parental 
psychological experiences (i.e., parental burn-out and less positive parenting 
experiences).
METHODS: Parents of children with a chronic disease (i.e., the clinical sample; 
N = 599 and 507 for Research Questions 1 and 2, respectively) and parents of 
healthy children (i.e., the reference sample: N = 417) filled out an online 
survey.
RESULTS: Findings demonstrated that the parents in the clinical sample reported 
higher levels of anxiety than parents in the reference sample. Analyses within 
the clinical sample indicated that COVID-19-specific stressors and parental 
psychological experiences were associated with higher levels of anxiety, 
depression, and sleep problems. Mediation analyses furthermore indicated that 
the association of COVID-19-specific stressors with all outcome measures was 
mediated by parental burn-out.
CONCLUSIONS: Parents of children with a chronic disease constitute a vulnerable 
group for worse well-being during the current pandemic. Findings suggest 
interventions directly targeting parental burn-out are warranted.

© The Author(s) 2021. Published by Oxford University Press on behalf of the 
Society of Pediatric Psychology. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/jpepsy/jsab129
PMCID: PMC8754736
PMID: 34915562 [Indexed for MEDLINE]


2641. J Gerontol A Biol Sci Med Sci. 2022 Dec 6;77(Suppl 1):S31-S41. doi: 
10.1093/gerona/glab371.

Associations Between Changes in Loneliness and Social Connections, and Mental 
Health During the COVID-19 Pandemic: The Women's Health Initiative.

Goveas JS(1), Ray RM(2), Woods NF(3), Manson JE(4), Kroenke CH(5), Michael 
YL(6), Shadyab AH(7), Meliker JR(8), Chen JC(9), Johnson L(2), Mouton C(10), 
Saquib N(11), Weitlauf J(12)(13), Wactawski-Wende J(14), Naughton M(15), 
Shumaker S(16), Anderson GL(2).

Author information:
(1)Department of Psychiatry and Behavioral Medicine, Medical College of 
Wisconsin, Milwaukee, Wisconsin, USA.
(2)Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
(3)University of Washington School of Nursing, Seattle, Washington, USA.
(4)Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 
Boston, Massachusetts, USA.
(5)Division of Research, Kaiser Permanente Northern California, Oakland, 
California, USA.
(6)Department of Epidemiology and Biostatistics, Dornsife School of Public 
Health, Drexel University, Philadelphia, Pennsylvania, USA.
(7)Herbert Wertheim School of Public Health and Human Longevity Science, 
University of California, San Diego, La Jolla, California, USA.
(8)Program in Public Health, Department of Family, Population and Preventive 
Medicine, Stony Brook University, Stony Brook, New York, USA.
(9)Departments of Preventive Medicine and Neurology, University of Southern 
California Keck School of Medicine, Los Angeles, California, USA.
(10)Office of the Provost, University of Texas Medical Branch, Galveston, Texas, 
USA.
(11)College of Medicine, Sulaiman AlRajhi University, Al Bukayriyah, Saudi 
Arabia.
(12)Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.
(13)Department of Psychiatry and Behavioral Sciences, Stanford University, 
Stanford, California, USA.
(14)Department of Epidemiology and Environmental Health, School of Public Health 
and Health Professions, University at Buffalo (SUNY), Buffalo, New York, USA.
(15)Ohio State University College of Medicine, Columbus, Ohio, USA.
(16)Department of Social Sciences and Health Policy, Wake Forest School of 
Medicine, Winston-Salem, North Carolina, USA.

BACKGROUND: Older women have faced significant disruptions in social connections 
during the coronavirus disease 2019 pandemic. Whether loneliness increased or 
whether a change in loneliness from pre- to intrapandemic period was associated 
with mental health during the pandemic is unknown.
METHODS: Older women (n = 27 479; mean age 83.2 [SD: 5.4] years) completed 
surveys in mid-2020, including questions about loneliness, living arrangements, 
changes in social connections, and mental health. Loneliness was also previously 
assessed in 2014-2016. We examined whether loneliness changed from the pre- to 
intrapandemic period and explored factors associated with this change. In 
multivariable models, we investigated the association of changes in loneliness 
and social connections with mental health.
RESULTS: Loneliness increased from pre- to intrapandemic levels. Factors 
associated with worsening loneliness included older age, experiencing stressful 
life events, bereavement, histories of vascular disease and depression, and 
social connection disruptions. Factors associated with a decrease in loneliness 
included identifying as Black, engaging in more frequent physical activity, 
being optimistic, and having a higher purpose in life. A 3-point increase in 
loneliness scores was associated with higher perceived stress, higher 
depressive, and higher anxiety symptoms. Social connection disruptions showed 
modest or no associations with mental health.
CONCLUSIONS: Loneliness increased during the pandemic in older women and was 
associated with higher stress, depressive, and anxiety symptoms. Our findings 
point to opportunities for interventions targeting lifestyle behaviors, 
well-being, disrupted social connections, and paying closer attention to those 
with specific medical and mental health histories that may reduce loneliness and 
improve mental health.

© The Author(s) 2021. Published by Oxford University Press on behalf of The 
Gerontological Society of America. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/gerona/glab371
PMCID: PMC8754805
PMID: 34915558 [Indexed for MEDLINE]


2642. Sci Total Environ. 2022 Mar 10;811:152332. doi: 10.1016/j.scitotenv.2021.152332. 
Epub 2021 Dec 13.

COVID-19 and the compact city: Implications for well-being and sustainable urban 
planning.

Mouratidis K(1).

Author information:
(1)Department of Urban and Regional Planning, Norwegian University of Life 
Sciences, Ås, Norway. Electronic address: konstantinos.mouratidis@nmbu.no.

This paper provides new evidence on the role of city planning, urban form, and 
built environment characteristics in health and well-being during the 
coronavirus disease (COVID-19) pandemic. Based on survey and geographic 
information systems (GIS) data from Oslo and Viken in Norway, the paper 
investigates changes in health and well-being due to COVID-19 and how the 
compact city and its characteristics relate to these changes. Findings indicate 
that self-reported measures of health and well-being worsened due to COVID-19. 
The most substantial changes were reported for life satisfaction, anxiety, and 
satisfaction with leisure, personal relationships, and vacations. General 
health, happiness, and satisfaction with income also declined during COVID-19 in 
comparison with pre-COVID-19 times. Overall, residents of compact neighborhoods 
reported lower well-being during COVID-19 compared to residents of lower-density 
neighborhoods. Important compact city characteristics - higher neighborhood 
density, reliance on public transport, smaller dwellings, and less green space - 
were negatively associated with well-being and health outcomes during COVID-19. 
In contrast, another compact city attribute, the presence of numerous local 
facilities, was positively linked to well-being and health during COVID-19. 
Based on these findings, the paper presents possible implications for 
sustainable urban planning and compact cities.

Copyright © 2021 The Author. Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.scitotenv.2021.152332
PMCID: PMC8666382
PMID: 34914991 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The author 
declares that he has no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


2643. PLoS One. 2021 Dec 16;16(12):e0261328. doi: 10.1371/journal.pone.0261328. 
eCollection 2021.

A data-driven approach for examining the demand for relaxation games on Steam 
during the COVID-19 pandemic.

Croissant M(1), Frister M(1).

Author information:
(1)Department of Computer Science, University of York, York, North Yorkshire, 
United Kingdom.

The COVID-19 pandemic has been a major source of stress for a majority of people 
that might have negative long-term effects on mental health and well-being. In 
recent years, video games and their potential positive effects on stress relief 
have been researched and "relaxation" has been an important keyword in marketing 
a certain kind of video game. In a quasi-experimental design, this study 
investigated the increase of average daily player peak (ADPPs) for the COVID 
period compared to the pre-COVID period and if this increase was significantly 
larger for relaxing games in contrast to non-relaxing games. Results showed a 
medium-sized increase of ADPPs over all types of games but no difference between 
relaxing games and non-relaxing games. These results are discussed in regards to 
their potential of presenting gaps between the current theoretical models of the 
influence of video games on mental health and actual observed player behaviour.

DOI: 10.1371/journal.pone.0261328
PMCID: PMC8675663
PMID: 34914782 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2644. J Appl Res Intellect Disabil. 2022 Mar;35(2):587-595. doi: 10.1111/jar.12971. 
Epub 2021 Dec 16.

What are the experiences of clinical psychologists working with people with 
intellectual disabilities during the COVID-19 pandemic?

Chemerynska N(1)(2), Marczak M(1), Kucharska J(1).

Author information:
(1)Department of Psychology and Behavioural Sciences, Coventry University, 
Coventry, UK.
(2)Department of Psychology, University of Warwick, Coventry, UK.

BACKGROUND: People with intellectual disabilities are a particularly vulnerable 
group, at an increased risk of mortality from COVID-19 and of poor mental 
health. Psychologists providing mental health support to people with 
intellectual disabilities report poorer mental wellbeing and higher occupational 
stress. Moreover, they raise concerns about the ability of people with 
intellectual disabilities to engage with digital technologies for mental health 
support in the context of reduced face-to-face psychological provision.
AIMS: The study aimed to understand psychologists' experiences of working with 
people with intellectual disabilities during the pandemic.
MATERIALS & METHODS: Semi-structured interviews were conducted with 11 
psychologists from community intellectual disabilities services. Data were 
analysed using interpretative phenomenological analysis.
RESULTS: Two superordinate themes emerged. Survive or Thrive highlighted the 
challenges and successes clinical psychologists experienced while working during 
the pandemic. 'Left to Their Own Devices' described psychologists' experiences 
of their clients as forgotten within society.
CONCLUSION: The current study demonstrates psychologists' ability to adapt to 
extremely challenging circumstances, exposes the vulnerabilities of people with 
intellectual disabilities and highlights the gaps in service provision.

© 2021 John Wiley & Sons Ltd.

DOI: 10.1111/jar.12971
PMID: 34913546 [Indexed for MEDLINE]


2645. BMJ Open. 2021 Dec 15;11(12):e048469. doi: 10.1136/bmjopen-2020-048469.

Relationship between self-care activities, stress and well-being during COVID-19 
lockdown: a cross-cultural mediation model.

Luis E(1)(2), Bermejo-Martins E(3)(4), Martinez M(1)(2), Sarrionandia A(5), 
Cortes C(6), Oliveros EY(7), Garces MS(8), Oron JV(9), Fernández-Berrocal P(10).

Author information:
(1)School of Education and Psychology, University of Navarra, Pamplona, Spain.
(2)IdiSNA, Navarre Institute of Health Research, Pamplona, Spain.
(3)IdiSNA, Navarre Institute of Health Research, Pamplona, Spain 
ebermejo@unav.es.
(4)Faculty of Nursing, Department of Community Nursing and Midwifery, University 
of Navarra, Pamplona, Spain.
(5)Faculty of Psychology, University of the Basque Country, Donostia, Spain.
(6)Faculty of Psychology, Universidad del Desarrollo, Santiago de Chile, Chile.
(7)School of Psychology, University of San Buenaventura, Bogotá, Colombia.
(8)Neuroscience Institute, Universidad San Francisco de Quito, Quito, Ecuador.
(9)UpToYou Fundation, Pamplona, Spain.
(10)Faculty of Psychology, University of Malaga, Malaga, Spain.

OBJECTIVES: To examine the mediation role of self-care between stress and 
psychological well-being in the general population of four countries and to 
assess the impact of sociodemographic variables on this relationship.
DESIGN: Cross-sectional, online survey.
PARTICIPANTS: A stratified sample of confined general population (N=1082) from 
four Ibero-American countries-Chile (n=261), Colombia (n=268), Ecuador (n=282) 
and Spain (n=271)-balanced by age and gender.
PRIMARY OUTCOMES MEASURES: Sociodemographic information (age, gender, country, 
education and income level), information related to COVID-19 lockdown (number of 
days in quarantine, number of people with whom the individuals live, 
absence/presence of adults and minors in charge and attitude towards the search 
of information related to COVID-19), Perceived Stress Scale-10, Ryff's 
Psychological Well-Being Scale-29 and Self-Care Activities Screening Scale-14.
RESULTS: Self-care partially mediates the relationship between stress and 
well-being during COVID-19 confinement in the general population in the total 
sample (F (3,1078)=370.01, p<0.001, R2=0.507) and in each country. On the other 
hand, among the evaluated sociodemographic variables, only age affects this 
relationship.
CONCLUSION: The results have broad implications for public health, highlighting 
the importance of promoting people's active role in their own care and health 
behaviour to improve psychological well-being if stress management and social 
determinants of health are jointly addressed first. The present study provides 
the first transnational evidence from the earlier stages of the COVID-19 
lockdown, showing that the higher perception of stress, the less self-care 
activities are adopted, and in turn the lower the beneficial effects on 
well-being.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2020-048469
PMCID: PMC8678542
PMID: 34911708 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2646. BMC Psychol. 2021 Dec 15;9(1):194. doi: 10.1186/s40359-021-00701-8.

Impact of the COVID-19 pandemic on the mental health and wellbeing of parents 
with young children: a qualitative interview study.

Dawes J(1), May T(2), McKinlay A(2), Fancourt D(2), Burton A(3).

Author information:
(1)UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology and 
Health Care, University College London, London, UK.
(2)Department of Behavioural Science and Health, Institute of Epidemiology and 
Health Care, University College London, London, UK.
(3)Department of Behavioural Science and Health, Institute of Epidemiology and 
Health Care, University College London, London, UK. a.burton@ucl.ac.uk.

BACKGROUND: Parents have faced unique challenges during the coronavirus disease 
2019 (COVID-19) pandemic, including mobility constraints, isolation measures, 
working from home, and the closure of schools and childcare facilities. There is 
presently a lack of in-depth qualitative research exploring how these changes 
have affected parents' mental health and wellbeing.
METHODS: Semi-structured qualitative interviews with 29 parents of young 
children. Interviews were analysed using reflexive thematic analysis.
RESULTS: We identified five superordinate themes affecting participant mental 
health and wellbeing: (1) navigation of multiple responsibilities and change 
inside the home; (2) disruption to home life; (3) changes to usual support 
networks; (4) changes in personal relationships; and (5) use of coping 
strategies. Participants described stress and exhaustion from navigating 
multiple pressures and conflicting responsibilities with home, schooling, and 
work, without their usual support networks and in the context of disrupted 
routines. Family roles and relationships were sometimes tested, however, many 
parents identified coping strategies that protected their wellbeing including 
access to outdoor space, spending time away from family, and avoiding conflict 
and pandemic-related media coverage.
CONCLUSIONS: Employers must be cognisant of the challenges that the pandemic has 
placed on parents, particularly women and lone parents. Flexible working 
arrangements and support might therefore relieve stress and increase 
productivity. Coping strategies identified by parents in this study could be 
harnessed and encouraged by employers and policymakers to promote positive 
wellbeing during times of stress throughout the pandemic and beyond.

© 2021. The Author(s).

DOI: 10.1186/s40359-021-00701-8
PMCID: PMC8672159
PMID: 34911570 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declare no competing interests 
with respect to the research, authorship and/or publication of this article.


2647. Int J Drug Policy. 2022 Mar;101:103554. doi: 10.1016/j.drugpo.2021.103554. Epub 
2021 Dec 1.

The COVID-19 pandemic and the health of people who use illicit opioids in New 
York City, the first 12 months.

Bennett AS(1), Townsend T(2), Elliott L(3).

Author information:
(1)Department of Social and Behavioral Sciences, School of Global Public Health, 
New York University, United States; Center for Drug Use and HIV Research 
(CDUHR), School of Global Public Health, New York University, 708 Broadway, 6th 
Floor, New York, NY 10012, United States. Electronic address: asb19@nyu.edu.
(2)Center for Drug Use and HIV Research (CDUHR), School of Global Public Health, 
New York University, 708 Broadway, 6th Floor, New York, NY 10012, United States; 
Center for Opioid Epidemiology and Policy, Department of Population Health, New 
York University Grossman School of Medicine, United States; Behavioral Science 
Training Program, NYU Rory College of Nursing, United States.
(3)Department of Social and Behavioral Sciences, School of Global Public Health, 
New York University, United States; Center for Drug Use and HIV Research 
(CDUHR), School of Global Public Health, New York University, 708 Broadway, 6th 
Floor, New York, NY 10012, United States.

BACKGROUND: Concurrent opioid-related overdose and COVID-19 crises in the U.S. 
have imposed unprecedented challenges on people who use illicit opioids.
METHODS: Using the experiences of 324 people who use illicit opioids between 
April 2020 and March 2021, we examined four domains of health and well-being 
potentially impacted by COVID-19: drug risks and responses, healthcare and 
related services, material hardship, and mental health. Data were drawn from 
participants' completed monthly survey assessments which were grouped into four 
periods of interest for the unfolding pandemic: April-June 2020, July-October 
2020, November-January 2021, and February-March 2021.
RESULTS: A majority of measures in our four domains showed early COVID-19 
related impacts, which quickly diminished as people and agencies responded to 
the pandemic. Difficulty obtaining food was the most frequently reported 
material hardship and appeared worst in April-June 2020. Over half of the 
population reported depression in April-June 2020, but this declined over the 
study period. Some participants reported changes to the heroin supply, including 
higher prices, lower quality, difficulty finding the drug, and fentanyl 
contamination. There was no discernable temporal shift in the frequency of use 
of each substance or the frequency of withdrawal symptoms. Over the study 
period, the mean number of overdoses per month decreased while the percent of 
opioid use events at which both a witness and naloxone were present (i.e., 
protected events) increased. Most participants receiving MOUD experienced an 
increase in take-home doses.
CONCLUSIONS: Findings speak to the resilience of people who use drugs as a 
population with disproportionate experience of trauma and crisis and also to the 
rapid response of NYC health agencies and service providers working with this 
population. Despite evident signs of adaptability and resilience, the COVID-19 
pandemic has highlighted some of the unique vulnerabilities of people who use 
illicit opioids and the need for greater rates of "protected" opioid use and 
greater availability of wrap-around services to efficiently address the safety, 
food security, mental health, and treatment needs of the population.

Copyright © 2021. Published by Elsevier B.V.

DOI: 10.1016/j.drugpo.2021.103554
PMCID: PMC8632599
PMID: 34911010 [Indexed for MEDLINE]

Conflict of interest statement: Declarations of Interest None of the authors has 
any conflict of interest to declare. The opinions of the authors do not 
necessarily reflect those of National Institutes of Health, National Institute 
on Drug Abuse, or New York University.


2648. PLoS One. 2021 Dec 15;16(12):e0261384. doi: 10.1371/journal.pone.0261384. 
eCollection 2021.

The role of social connection on the experience of COVID-19 related 
post-traumatic growth and stress.

Matos M(1), McEwan K(2), Kanovský M(3), Halamová J(4), Steindl SR(5), Ferreira 
N(6), Linharelhos M(1), Rijo D(1), Asano K(7), Vilas SP(8), Márquez MG(8), 
Gregório S(1)(8), Brito-Pons G(9), Lucena-Santos P(1), Oliveira MDS(10), Souza 
EL(11), Llobenes L(12), Gumiy N(12), Costa MI(12), Habib N(13), Hakem R(13), 
Khrad H(13), Alzahrani A(13), Cheli S(14), Petrocchi N(15), Tholouli E(16), 
Issari P(16), Simos G(17), Lunding-Gregersen V(18), Elklit A(19), Kolts R(20), 
Kelly AC(21), Bortolon C(22)(23), Delamillieure P(24)(25), Paucsik M(22), Wahl 
JE(26)(27), Zieba M(27), Zatorski M(27), Komendziński T(28)(29), Zhang S(30), 
Basran J(2), Kagialis A(6), Kirby J(5), Gilbert P(2).

Author information:
(1)University of Coimbra, Center for Research in Neuropsychology and Cognitive 
Behavioral Intervention (CINEICC), Coimbra, Portugal.
(2)Centre for Compassion Research and Training, College of Health, Psychology 
and Social Care, University of Derby, Derby, United Kingdom.
(3)Faculty of Social and Economic Sciences, Institute of Social Anthropology, 
Comenius University, Bratislava, Slovakia.
(4)Faculty of Social and Economic Sciences, Institute of Applied Psychology, 
Comenius University, Bratislava, Slovakia.
(5)Compassionate Mind Research Group, School of Psychology, The University of 
Queensland, Brisbane, Australia.
(6)Department of Social Sciences, University of Nicosia, Nicosia, Cyprus.
(7)Department of Psychological Counseling, Faculty of Psychology, Mejiro 
University, Tokyo, Japan.
(8)Department of Psychology, Faculty of Biomedical and Health Sciences, 
Behavior, Emotions, and Health Research Group, Universidad Europea de Madrid, 
Madrid, Spain.
(9)Escuela de Psicología, Pontificia Universidad Católica de Chile, Santiago, 
Chile.
(10)Evaluation and Treatment in Cognitive and Behavioral 
Psychotherapies-Research Group (GAAPCC), Pontifical Catholic University of Rio 
Grande do Sul, Porto Alegre, Brazil.
(11)Conectta: Mindfulness & Compassion, São Paulo, Brazil.
(12)Motivación Compasiva, Buenos Aires, Argentina.
(13)Neuroscience Department, Section of Psychiatry and Psychology, King Faisal 
Specialist Hospital and Research Centre (KFSH&RC), Jeddah, Saudi Arabia.
(14)School of Human Health Sciences, University of Florence, Florence, Italy.
(15)Department of Economics and Social Sciences, John Cabot University, Rome, 
Italy.
(16)Center for Qualitative Research in Psychology and Psychosocial Well-being, 
National and Kapodistrian University of Athens, Athens, Greece.
(17)Department of Educational and Social Policy, University of Macedonia, 
Thessaloniki, Greece.
(18)Mindwork Psycological Center, Copenhagen, Denmark.
(19)Department of Psychology, University of Southern Denmark, Odense, Denmark.
(20)Department of Psychology, Eastern Washington University, Cheney, WA, United 
States of America.
(21)Department of Psychology, University of Waterloo, Waterloo, Canada.
(22)Laboratoire Inter-universitaire de Psychologie: Personnalité, Cognition et 
Changement Social, Grenoble Alpes University, Grenoble, France.
(23)Centre Hospitalier Alpes Isère, C3R - Réhabilitation psychosociale et 
remédiation cognitive, Grenoble, France.
(24)CHU de Caen, Service de Psychiatrie Adulte, Caen, France.
(25)UNICAEN, ISTS, GIP Cyceron, University of Normandy, Caen, France.
(26)The Mind Institute Poland, Warsaw, Poland.
(27)SWPS University of Social Sciences and Humanities, Warsaw & Poznań, Poland.
(28)Department of Cognitive Science, Nicolaus Copernicus University, Torún, 
Poland.
(29)Neurocognitive Laboratory, Centre for Modern Interdisciplinary Technologies, 
Nicolaus Copernicus University, Torún, Poland.
(30)School of Human Sciences, University of Derby, Derby, United Kingdom.

BACKGROUND: Historically social connection has been an important way through 
which humans have coped with large-scale threatening events. In the context of 
the COVID-19 pandemic, lockdowns have deprived people of major sources of social 
support and coping, with others representing threats. Hence, a major stressor 
during the pandemic has been a sense of social disconnection and loneliness. 
This study explores how people's experience of compassion and feeling socially 
safe and connected, in contrast to feeling socially disconnected, lonely and 
fearful of compassion, effects the impact of perceived threat of COVID-19 on 
post-traumatic growth and post-traumatic stress.
METHODS: Adult participants from the general population (N = 4057) across 21 
countries worldwide, completed self-report measures of social connection 
(compassion for self, from others, for others; social safeness), social 
disconnection (fears of compassion for self, from others, for others; 
loneliness), perceived threat of COVID-19, post-traumatic growth and traumatic 
stress.
RESULTS: Perceived threat of COVID-19 predicted increased post-traumatic growth 
and traumatic stress. Social connection (compassion and social safeness) 
predicted higher post-traumatic growth and traumatic stress, whereas social 
disconnection (fears of compassion and loneliness) predicted increased traumatic 
symptoms only. Social connection heightened the impact of perceived threat of 
COVID-19 on post-traumatic growth, while social disconnection weakened this 
impact. Social disconnection magnified the impact of the perceived threat of 
COVID-19 on traumatic stress. These effects were consistent across all 
countries.
CONCLUSIONS: Social connection is key to how people adapt and cope with the 
worldwide COVID-19 crisis and may facilitate post-traumatic growth in the 
context of the threat experienced during the pandemic. In contrast, social 
disconnection increases vulnerability to develop post-traumatic stress in this 
threatening context. Public health and Government organizations could implement 
interventions to foster compassion and feelings of social safeness and reduce 
experiences of social disconnection, thus promoting growth, resilience and 
mental wellbeing during and following the pandemic.

DOI: 10.1371/journal.pone.0261384
PMCID: PMC8673633
PMID: 34910779 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2649. PLoS One. 2021 Dec 15;16(12):e0260640. doi: 10.1371/journal.pone.0260640. 
eCollection 2021.

Factors influencing wellbeing in young people during COVID-19: A survey with 
6291 young people in Wales.

James M(1), Jones H(1), Baig A(1), Marchant E(1), Waites T(2), Todd C(3), Hughes 
K(4), Brophy S(1).

Author information:
(1)Swansea University Medical School, Swansea University, Swansea, Wales, United 
Kingdom.
(2)Children in Wales, Cardiff, Wales, United Kingdom.
(3)Public Health Wales, Keir Hardie University Health Park, Merthyr Tydfil, 
Wales, United Kingdom.
(4)College of Human Sciences, Bangor University, Bangor, Wales, United Kingdom.

COVID-19 infection and the resultant restrictions has impacted all aspects of 
life across the world. This study explores factors that promote or support 
wellbeing for young people during the pandemic, how they differ by age, using a 
self-reported online survey with those aged 8-25 in Wales between September 2020 
and February 2021. Open-ended responses were analysed via thematic analysis to 
provide further context. A total of 6,291 responses were obtained from 81 
education settings across Wales (including primary and secondary schools as well 
as sixth form, colleges and universities). Wellbeing was highest in primary 
school children and boys and lowest in those who were at secondary school 
children, who were girls and, those who preferred not to give a gender. Among 
primary school children, higher wellbeing was seen for those who played with 
lots of others (rather than alone), were of Asian ethnicity (OR 2.17, 95% CI: 
1.26 to 4.3), had a safe play area (OR: 2.4, 95% CI: 1.67 to 2.56) and had more 
sleep. To support their wellbeing young people reported they would like to be 
able to play with their friends more. Among secondary school children those who 
were of mixed ethnicity reported lower wellbeing (OR: 5.14, 95% CI: 1.68 to 
15.79). To support their wellbeing they reported they would like more support 
with mental health (due to anxiety and pressure to achieve when learning 
online). This study found self-reported wellbeing differed by gender, ethnicity 
and deprivation and found younger children report the need for play and to see 
friends to support wellbeing but older children/young people wanted more support 
with anxiety and educational pressures.

DOI: 10.1371/journal.pone.0260640
PMCID: PMC8673639
PMID: 34910753 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2650. Lancet Public Health. 2022 Jan;7(1):e86-e92. doi: 10.1016/S2468-2667(21)00235-8. 
Epub 2021 Dec 11.

Safeguarding people living in vulnerable conditions in the COVID-19 era through 
universal health coverage and social protection.

Barron GC(1), Laryea-Adjei G(2), Vike-Freiberga V(3), Abubakar I(4), Dakkak 
H(5), Devakumar D(4), Johnsson A(6), Karabey S(7), Labonté R(8), Legido-Quigley 
H(9), Lloyd-Sherlock P(10), Olufadewa II(11), Ray HC(12), Redlener I(13), 
Redlener K(14), Serageldin I(15), Lima NT(16), Viana V(17), Zappone K(18), Huynh 
UK(19), Schlosberg N(19), Sun H(19), Karadag O(20); Lancet Commission on 
COVID-19: Task Force on Humanitarian Relief, Social Protection and Vulnerable 
Groups.

Author information:
(1)Parliament at the Mexican Congress, Mexico City, Mexico.
(2)UNICEF, Kathmandu, Nepal.
(3)Riga, Latvia.
(4)Institute for Global Health, UCL, London, UK.
(5)Policy and Liaison Unit/Humanitarian Office, UNFPA, New York, NY, USA.
(6)Malmo, Sweden.
(7)Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
(8)School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, 
Canada.
(9)Saw Swee Hock School of Public Health, National University of Singapore, 
Singapore.
(10)School of International Development, University of East Anglia, Norwich, UK.
(11)Slum and Rural Health Initiative, Ibadan, Nigeria.
(12)The National Center For Faith Based Initiative, Palm Beach, FL, USA.
(13)Pandemic Resource and Response Initiative, New York, NY, USA.
(14)Children's Health Fund, New York, NY, USA.
(15)Bibliotheca Alexandrina, Alexandria, Egypt.
(16)Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.
(17)Foundation for Amazon Sustainability (FAS), Manaus, Brazil.
(18)New York, NY, USA.
(19)UNICEF, New York, NY, USA.
(20)Center for Sustainable Development, Earth Institute, Columbia University, 
New York, NY, USA. Electronic address: ok2267@columbia.edu.

The COVID-19 pandemic is unprecedented. The pandemic not only induced a public 
health crisis, but has led to severe economic, social, and educational crises. 
Across economies and societies, the distributional consequences of the pandemic 
have been uneven. Among groups living in vulnerable conditions, the pandemic 
substantially magnified the inequality gaps, with possible negative implications 
for these individuals' long-term physical, socioeconomic, and mental wellbeing. 
This Viewpoint proposes priority, programmatic, and policy recommendations that 
governments, resource partners, and relevant stakeholders should consider in 
formulating medium-term to long-term strategies for preventing the spread of 
COVID-19, addressing the virus's impacts, and decreasing health inequalities. 
The world is at a never more crucial moment, requiring collaboration and 
cooperation from all sectors to mitigate the inequality gaps and improve 
people's health and wellbeing with universal health coverage and social 
protection, in addition to implementation of the health in all policies 
approach.

Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open 
Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. 
All rights reserved.

DOI: 10.1016/S2468-2667(21)00235-8
PMCID: PMC8665842
PMID: 34906331 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of interests We declare no competing 
interests.


2651. PLoS One. 2021 Dec 14;16(12):e0261346. doi: 10.1371/journal.pone.0261346. 
eCollection 2021.

Health and well-being of university students before and during COVID-19 
pandemic: A gender comparison.

Gestsdottir S(1), Gisladottir T(1), Stefansdottir R(1), Johannsson E(1)(2), 
Jakobsdottir G(1), Rognvaldsdottir V(1).

Author information:
(1)Center of Sport and Health Sciences, School of Education, University of 
Iceland, Reykjavik, Iceland.
(2)Department of Sport, Food and Natural Sciences, Western Norway University of 
Applied Sciences, Bergen, Norway.

OBJECTIVE: COVID-19 has affected people's health in various ways. University 
students are a particularly sensitive group for mental and physical health 
issues. The aim of this study was to assess and compare the mental and physical 
health of male and female first-year university students during and before 
COVID-19.
METHOD: Total of 115 first-year university students (54% male) answered 
questions about mental and physical health. The students were asked to estimate 
their physical activity, sedentary behavior, loneliness, stress, and sleep 
quality during COVID-19 opposed to before the pandemic.
RESULT: Males had fewer symptoms of anxiety and depression, and their 
self-esteem was higher than females (p<0.05). Over 50% of both genders estimated 
their mental health to be worse than before COVID-19. Larger proportion of males 
(69%) compared to females (38%) estimated that their physical health had 
worsened than before the pandemic. Larger proportion of females (38%) than males 
(14%) experience increased loneliness and stress (68% vs. 48%). Over 70% of both 
genders estimated increased sedentary behavior than before the pandemic, and 
larger proportion of males (76%), compared to females (56%), estimated that they 
were less physically active than before COVID-19. About 50% of participants 
estimated their sleep quality was worse than before COVID-19.
CONCLUSION: University students estimated their mental and physical health to 
have deteriorated during the pandemic. Therefore, it is important that the 
school and healthcare systems assist students in unwinding these negative health 
and lifestyle changes that have accompanied the pandemic.

DOI: 10.1371/journal.pone.0261346
PMCID: PMC8670668
PMID: 34905564 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2652. Hastings Cent Rep. 2021 Nov;51(6):11-12. doi: 10.1002/hast.1303.

Considering People with Dementia and Their Caregivers in Covid-19 Lockdowns.

Viaña JN.

Recent outbreaks in Australia and the detection of more virulent SARS-CoV-2 
strains suggest that Covid-19 is not yet over. In July 2021, three states in 
Australia were in lockdown as a result of community transmission of the Delta 
variant. Despite being effective at mitigating outbreaks, lockdowns could have 
adverse effects on the elderly and people with dementia. This commentary reviews 
general lockdown and aged-care lockdown policies in Victoria, New South Wales, 
and South Australia and highlights how these could affect the well-being of 
people with dementia and their caregivers. Drawing from literature on Covid-19 
and dementia, this commentary provides pragmatic recommendations on how to 
consider the well-being of people with dementia and their care providers in 
Covid-19 management policies.

© 2021 The Hastings Center.

DOI: 10.1002/hast.1303
PMID: 34904736 [Indexed for MEDLINE]


2653. Psychol Psychother. 2022 Jun;95(2):383-401. doi: 10.1111/papt.12374. Epub 2021 
Dec 13.

How young people experienced COVID-19 disease containment measures in the 
Western Cape, South Africa: A qualitative study including the perspectives of 
young people, their parents, teachers and school counsellors.

Coetzee BJ(1), Gericke H(1), Human S(1), Stallard P(2), Loades M(3).

Author information:
(1)Department of Psychology, Stellenbosch University, Stellenbosch, South 
Africa.
(2)Department for Health, University of Bath, Bath, UK.
(3)Department of Psychology, University of Bath, Bath, UK.

BACKGROUND: Little is known about the potential impact of COVID-19 disease 
containment measures on children's mental health and well-being, particularly in 
low- and middle-income countries. We sought to explore this amongst young 
adolescents in South Africa and from the perspectives of multiple key 
stakeholders.
METHODS: We conducted 25 individual semi-structured telephonic interviews with 
children (n = 7, aged 12-13 years), teachers (n = 8), parents/caregivers (n = 7) 
and school counsellors (n = 3) from two public primary schools in the Western 
Cape, South Africa. Interviews were conducted between July and September 2020 
and transcribed verbatim. The data were analysed inductively using thematic 
analysis procures.
RESULTS: We generated three overarching themes: "locked down at home", "social 
disconnection" and "back to school." Children had varying reactions to COVID-19 
and lockdown including excitement, frustration, anxiety, boredom and loneliness. 
Parents were anxious about teaching, and technology did not consistently provide 
the necessary support. Children felt disconnected from their peers at home, and 
at school, reconnecting with friends was obstructed by disease containment 
measures. All participants were concerned about children completing the academic 
year successfully and worried excessively about the implications of this year on 
their future.
CONCLUSION: Young people and their immediate networks, in a low- and 
middle-income context, described a variety of negative impacts of disease 
containment measures emotionally, although there was a wide variety of 
experiences. Children, parents, teachers and counsellors all wanted resources 
and support and were concerned about the longer-term impacts of disease 
containment measures.

© 2021 The Authors. Psychology and Psychotherapy: Theory, Research and Practice 
published by John Wiley & Sons Ltd on behalf of The British Psychological 
Society.

DOI: 10.1111/papt.12374
PMCID: PMC9300161
PMID: 34904360 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) have declared that they have no 
competing or potential conflicts of interest.


2654. BMJ Open. 2021 Dec 13;11(12):e050672. doi: 10.1136/bmjopen-2021-050672.

Sleep and daytime problems during the COVID-19 pandemic and effects of 
coronavirus infection, confinement and financial suffering: a multinational 
survey using a harmonised questionnaire.

Partinen M(1)(2), Holzinger B(3), Morin CM(4), Espie C(5), Chung F(6), Penzel 
T(7), Benedict C(8), Bolstad CJ(9), Cedernaes J(10)(11), Chan RNY(12), 
Dauvilliers Y(13), De Gennaro L(14)(15), Han F(16), Inoue Y(17)(18), Matsui 
K(19)(20), Leger D(21)(22), Cunha AS(23), Merikanto I(24), Mota-Rolim S(25)(26), 
Nadorff M(9), Plazzi G(27)(28), Schneider J(5), Sieminski M(29), Wing YK(12), 
Bjorvatn B(30)(31).

Author information:
(1)Department of Clinical Neurosciences, University of Helsinki Clinicum Unit, 
Helsinki, Finland markku.partinen@helsinki.fi.
(2)Helsinki Sleep Clinic, Terveystalo Healthcare Services, Helsinki, Finland.
(3)Institute for Dream and Consciousness Research, Medical University of Vienna, 
Wien, Austria.
(4)Centre d'étude des troubles du sommeil, Centre de recherche CERVO/Brain 
Research Center, Université Laval École de psychologie, Quebec, Quebec, Canada.
(5)Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical 
Neurosciences, University of Oxford, Oxford, UK.
(6)Department of Anesthesiology and Pain Medicine, University Health Network, 
Toronto, Ontario, Canada.
(7)Sleep Medicine Center, Charite University Hospital Berlin, Berlin, Germany.
(8)Department of Neuroscience, Sleep Science (BMC), Uppsala University, Uppsala, 
Sweden.
(9)Department of Psychology, Mississippi State University, Mississippi State, 
Mississippi, USA.
(10)Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
(11)Department of Medicine, Division of Endocrinology, Metabolism, and Molecular 
Medicine, Northwestern University Feinberg School of Medicine, Chicago, 
Illinois, USA.
(12)Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, The 
Chinese University of Hong Kong, Hong Kong, Hong Kong.
(13)National Reference Center for Narcolepsy, Sleep and Wake Unit, Department of 
Neurology, Gui-de-Chauliac Hospital, University Hospital Centre Montpellier, 
Montpellier, France.
(14)Department of Psychology, Sapienza University of Rome, Roma, Lazio, Italy.
(15)IRCCS Fondazione Santa Lucia, Roma, Italy.
(16)Department of Pulmonary Medicine, Peking University People's Hospital, 
Beijing, China.
(17)Department of Somnology, Tokyo Medical University, Shinjuku-ku, Japan.
(18)Neuropsychiatric Research Institute, Japan Somnology Center, Tokyo, Japan.
(19)Department of Clinical Laboratory and Department of Sleep-Wake Disorders, 
National Center of Neurology and Psychiatry National Institute of Mental Health, 
Kodaira, Japan.
(20)Department of Psychiatry, Tokyo Women's Medical University, Shinjuku-ku, 
Japan.
(21)Sleep and Vigilance Center, Hopital Hotel-Dieu de Paris, Paris, France.
(22)VIFASOM (EA 7331 Vigilance Fatigue Sommeil et Santé Publique), Universite de 
Paris, Paris, France.
(23)Production Engineering Department, Federal University of Rio Grande do 
Norte, Natal, Brazil.
(24)Research Programs Unit, Faculty of Medicine, University of Helsinki, 
Helsinki, Finland.
(25)Brain Institute, Onofre Lopes University Hospital, Petropolis, Brazil.
(26)Physiology and Behavior Department, Federal University of Rio Grande do 
Norte, Natal, Brazil.
(27)IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy.
(28)Department of Biomedical, Metabolic and Neural Sciences, University of 
Modena and Reggio Emilia, Modena, Italy.
(29)Department of Emergency Medicine, Medical University of Gdansk, Gdansk, 
Poland.
(30)Department of Global Public Health and Primary Care, University of Bergen, 
Bergen, Norway.
(31)Norwegian Competence Center for Sleep Disorders, Haukeland University 
Hospital, Bergen, Norway.

OBJECTIVES: Sleep is important for human health and well-being. No previous 
study has assessed whether the COVID-19 pandemic impacts sleep and daytime 
function across the globe.
METHODS: This large-scale international survey used a harmonised questionnaire. 
Fourteen countries participated during the period of May-August 2020. Sleep and 
daytime problems (poor sleep quality, sleep onset and maintenance problems, 
nightmares, hypnotic use, fatigue and excessive sleepiness) occurring 'before' 
and 'during' the pandemic were investigated. In total, 25 484 people 
participated and 22 151 (86.9%) responded to the key parameters and were 
included. Effects of COVID-19, confinement and financial suffering were 
considered. In the fully adjusted logistic regression models, results (weighted 
and stratified by country) were adjusted for gender, age, marital status, 
educational level, ethnicity, presence of sleep problems before COVID-19 and 
severity of the COVID-19 pandemic in each country at the time of the survey.
RESULTS: The responders were mostly women (64%) with a mean age 41.8 (SD 15.9) 
years (median 39, range 18-95). Altogether, 3.0% reported having had COVID-19; 
42.2% reported having been in confinement; and 55.9% had suffered financially. 
All sleep and daytime problems worsened during the pandemic by about 10% or 
more. Also, some participants reported improvements in sleep and daytime 
function. For example, sleep quality worsened in about 20% of subjects and 
improved in about 5%. COVID-19 was particularly associated with poor sleep 
quality, early morning awakening and daytime sleepiness. Confinement was 
associated with poor sleep quality, problems falling asleep and decreased use of 
hypnotics. Financial suffering was associated with all sleep and daytime 
problems, including nightmares and fatigue, even in the fully adjusted logistic 
regression models.
CONCLUSIONS: Sleep problems, fatigue and excessive sleepiness increased 
significantly worldwide during the first phase of the COVID-19 pandemic. 
Problems were associated with confinement and especially with financial 
suffering.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-050672
PMCID: PMC8671846
PMID: 34903540 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: FC reports grants from 
Ontario Ministry of Health Innovation Grant and University Health Network 
Foundation, and personal fees from Masimo Inc and Takeda Pharma, outside the 
submitted work. In addition, University Health Network has a patent STOP-Bang 
questionnaire pending. YI reports personal fees and other from Astellas Pharma, 
personal fees from Eisai, other from Idorsia Pharmaceuticals Japan, grants from 
Koike Medical, personal fees from Otsuka Pharmaceutical and grants from Philips 
Japan outside the submitted work; DL reports grants from grants from Philips 
(Netherlands), Vanda (USA), Sanofi, Vitalaire International, Merck, and Janssen, 
Jazz and TYTHM outside the submitted work; KM reports personal fees from Eisai, 
Meiji Seika Pharma, Mochida, MSD, Otsuka Pharmaceutical and Yoshitomi 
Pharmaceutical, outside the submitted work; MP reports personal fees and other 
from Bioprojet, other from Jazz Pharmaceuticals, personal fees from UCB-Pharma, 
GSK, Takeda and Orion, personal fees and other from MSD and Umecrine, outside 
the submitted work. MP reports personal fees and other from Bioprojet, other 
from Jazz Pharmaceuticals, personal fees from UCB-Pharma, GSK, Takeda and Orion, 
personal fees and other from MSD and Umecrine, outside the submitted work; TP 
reports personal fees from Jazz Pharmaceuticals, personal fees from Bayer 
Healthcare, Neuwirth and Löwenstein Medical, outside the submitted work, and 
Shareholder of The Siestagroup GmbH, Advanced Sleep Research GmbH, Nukute; GP 
reports personal fees from UCB-Pharma, Jazz pharmaceuticals, Bioprojet,Idorsia, 
Takeda, outside the submitted work; Y-KW reports grants from Research Grant 
Council General Research Fund, grants from Health and Medical Research Fund, 
personal fees from Eisai Inc, personal fees from Eisai Co., Ltd, other from 
Lundbeck HK Limited, outside the submitted work.


2655. BMC Pregnancy Childbirth. 2021 Dec 13;21(1):828. doi: 
10.1186/s12884-021-04300-8.

Associations between postpartum depression and assistance with household tasks 
and childcare during the COVID-19 pandemic: evidence from American mothers.

Gildner TE(1), Uwizeye G(2)(3), Milner RL(2), Alston GC(2), Thayer ZM(2)(4).

Author information:
(1)Department of Anthropology, Washington University in St. Louis, St. Louis, 
MO, USA. gildner@wustl.edu.
(2)Department of Anthropology, Dartmouth College, Hanover, NH, USA.
(3)Society of Fellows, Dartmouth College, Hanover, NH, USA.
(4)Ecology, Evolution, Environment & Society Program, Dartmouth College, 
Hanover, NH, USA.

BACKGROUND: The early postpartum period is recognized cross-culturally as being 
important for recovery, with new parents receiving increased levels of community 
support. However, COVID-19-related lockdown measures may have disrupted these 
support systems, with possible implications for mental health. Here, we use a 
cross-sectional analysis among individuals who gave birth at different stages of 
the pandemic to test (i) if instrumental support access in the form of help with 
household tasks, newborn care, and care for older children has varied temporally 
across the pandemic, and (ii) whether access to these forms of instrumental 
support is associated with lower postpartum depression scores.
METHODS: This study used data from the COVID-19 And Reproductive Effects (CARE) 
study, an online survey of pregnant persons in the United States. Participants 
completed postnatal surveys between April 30 - November 18, 2020 (n = 971). 
Logistic regression analysis tested whether birth timing during the pandemic was 
associated with odds of reported sustained instrumental support. Linear 
regression analyses assessed whether instrumental support was associated with 
lower depression scores as measured via the Edinburgh Postnatal Depression 
survey.
RESULTS: Participants who gave birth later in the pandemic were more likely to 
report that the pandemic had not affected the help they received with household 
work and newborn care (p < 0.001), while access to childcare for older children 
appeared to vary non-linearly throughout the pandemic. Additionally, respondents 
who reported that the pandemic had not impacted their childcare access or help 
received around the house displayed significantly lower depression scores 
compared to participants who reported pandemic-related disruptions to these 
support types (p < 0.05).
CONCLUSIONS: The maintenance of postpartum instrumental support during the 
pandemic appears to be associated with better maternal mental health. Healthcare 
providers should therefore consider disrupted support systems as a risk factor 
for postpartum depression and ask patients how the pandemic has affected support 
access. Policymakers seeking to improve parental wellbeing should design 
strategies that reduce disease transmission, while facilitating safe 
interactions within immediate social networks (e.g., through investment in 
COVID-19 testing and contact tracing). Cumulatively, postpartum instrumental 
support represents a potential tool to protect against depression, both during 
and after the COVID-19 pandemic.

© 2021. The Author(s).

DOI: 10.1186/s12884-021-04300-8
PMCID: PMC8666834
PMID: 34903201 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2656. Int J Soc Psychiatry. 2022 Dec;68(8):1748-1755. doi: 10.1177/00207640211057729. 
Epub 2021 Dec 14.

Emotional support received moderates academic stress and mental well-being in a 
sample of Afghan university students amid COVID-19.

Green ZA(1)(2), Faizi F(2), Jalal R(2), Zadran Z(3).

Author information:
(1)Faculty of Business Administration, Preston University, Islamabad, Pakistan.
(2)Contemporary Research Initiative, Preston University, Islamabad, Pakistan.
(3)Faculty of Economics, Kabul University, Kart-e-Char, Kabul, Afghanistan.

BACKGROUND: Academic stress experienced during the COVID-19 pandemic has 
triggered high levels of anxiety and depression and other severe mental health 
issues among university students around the globe. In Afghanistan, there is a 
paucity of research on the academic and mental health issues of Afghan 
university students and none pertaining to their academic stress and mental 
well-being amid the pandemic.
AIM: This research examines the potential stress-buffering role of emotional 
support received between academic stress and mental well-being in a sample of 
Afghan university students during the COVID-19 outbreak.
METHOD: The study sample comprised 508 Afghan university students. An online 
survey was developed for data collection. Model 1 of the PROCESS macro was used 
to conduct the moderation analysis.
RESULTS: These indicate that moderate and high levels of emotional support 
received may protect against the negative effects of higher levels of academic 
stress on mental well-being.
CONCLUSION: This research makes an important contribution to the literature on 
social support. It may be inferred from the results that Afghan university 
students who experience academic stress, but have strong emotional support are 
able to attain greater mental well-being during the COVID-19 outbreak as 
compared to those with weak emotional support. Results may encourage mental 
health practitioners, university counselors, education administrators, and 
faculty to jointly formulate strategies for offering emotional support to Afghan 
university students.

DOI: 10.1177/00207640211057729
PMID: 34903066 [Indexed for MEDLINE]


2657. Br J Educ Psychol. 2022 Sep;92(3):843-860. doi: 10.1111/bjep.12475. Epub 2021 
Dec 13.

Secondary school students' perception of the online teaching experience during 
COVID-19: The impact on mental wellbeing and specific learning difficulties.

Walters T(1), Simkiss NJ(2), Snowden RJ(3), Gray NS(2)(4).

Author information:
(1)Howell's School, Cardiff, UK.
(2)Department of Psychology, Swansea University, UK.
(3)School of Psychology, Cardiff University, UK.
(4)Caswell Clinic, Swansea Bay University Health Board, Bridgend, UK.

BACKGROUND: Student engagement and concentration is critical for successful 
learning. Due to the COVID-19 pandemic, there has been a dramatic increase in 
the use of online learning which may affect engagement and concentration, 
particularly for those students with specific learning difficulties.
AIMS: Students would show lower scores on all the measures of student experience 
when judging these during online learning versus learning within the classroom. 
This negative impact of online learning on concentration, engagement, perceived 
learning, and self-worth compared to classroom education would be more 
significant for those with specific learning difficulties. The drop in student 
experience scores due to online learning would be associated with poorer mental 
well-being.
SAMPLE: Four hundred seven pupils aged 11-18 years at a secondary education 
school in Wales.
METHODS: A retrospective online survey comparing pupils' normal classroom 
experience to learning online during the first national lockdown in the United 
Kingdom (March-July 2020).
RESULTS: Pupils' learning experiences (concentration, engagement, ability to 
learn, and self-worth from learning) were significantly lower for online 
learning compared to the classroom learning. These differences were more marked 
in students with specific learning difficulties. Perceived ability to learn and 
engage during classroom and online learning were also associated with mental 
well-being.
CONCLUSIONS: The move to online learning appears to have affected students' 
ability to concentrate and engage in their schoolwork and appears to have 
reduced their ability to learn and get self-worth from their work. These 
decreases are associated with a decrease in mental well-being. The effects 
appear to be exacerbated in some students with specific learning difficulties.

© 2021 The Authors. British Journal of Educational Psychology published by John 
Wiley & Sons Ltd on behalf of British Psychological Society.

DOI: 10.1111/bjep.12475
PMCID: PMC9542811
PMID: 34902881 [Indexed for MEDLINE]

Conflict of interest statement: All authors declare no conflict of interest


2658. Public Health Nurs. 2022 May;39(3):562-571. doi: 10.1111/phn.13035. Epub 2021 
Dec 13.

COVID-19 related fear and depression of pregnant women and new mothers.

Fan HSL(1), Choi EPH(1), Ko RWT(1), Kwok JYY(1), Wong JYH(1), Fong DYT(1), Shek 
NWM(2), Ngan HYS(3), Li J(4), Huang YY(4), Ouyang YQ(4), Lok KYW(1).

Author information:
(1)School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong 
Kong, Hong Kong.
(2)Department of Obstetrics and Gynaecology, Queen Mary Hospital, Hong Kong.
(3)Department of Obstetrics and Gynecology, Li Ka Shing Faculty of Medicine, 
University of Hong Kong, Hong Kong.
(4)Department of Nursing, School of Health Sciences, Wuhan University, Wuhan, 
China.

OBJECTIVE: To explore factors associated with depression and COVID-19 related 
fear among pregnant women and new mothers.
DESIGN: A cross-sectional survey was conducted in China from July 2020 to July 
2021.
SAMPLE: A total of 3027 pregnant and new mothers were recruited.
MEASUREMENT: Sociodemographic characteristics and the perceptions of the 
COVID-19 pandemic were collected. The Patient Health Questionnaire-9 (PHQ-9) and 
the Fear Scale was used to assess the depressive and fear level towards the 
COVID-19 pandemic, respectively.
RESULTS: Approximately 17.2% of the participants had depression (PHQ-9 ≥10). In 
Hong Kong, participants who perceived that they have increased knowledge to 
prevent infection were less likely to have depression (adjusted odds ratio 
[aOR] = 0.83; 95% confidence interval [CI] = 0.74-0.94). There was no 
association between perceived severity if infected and severity of spread and 
the depression level in our sample. An inverse relationship was found between 
the COVID-19 related fear level and perceived knowledge to prevent 
infection (Beta-coefficient [β] = -0.20; 95% CI = -0.38 to -0.02).
CONCLUSION: Public health nurses need to promote accurate and up to date 
COVID-19 related information at clinical and community settings and implement 
effective screening for depression and fear symptoms to identify these high-risk 
groups to improve women's psychological well-being.

© 2021 Wiley Periodicals LLC.

DOI: 10.1111/phn.13035
PMID: 34902184 [Indexed for MEDLINE]


2659. Front Public Health. 2021 Nov 25;9:746052. doi: 10.3389/fpubh.2021.746052. 
eCollection 2021.

How Did the COVID-19 Lockdown Affect Children and Adolescent's Well-Being: 
Spanish Parents, Children, and Adolescents Respond.

Ajanovic S(1), Garrido-Aguirre J(2)(3)(4), Baro B(1), Balanza N(1), Varo 
R(1)(5), Millat-Martínez P(1), Arias S(1), Fonollosa J(2)(3)(6), Perera-Lluna 
A(2)(3)(7), Jordan I(2)(8)(9), Muñoz-Almagro C(2)(9)(10)(11), Bonet-Carne 
E(3)(12)(13), Crosas-Soler A(2), Via E(2)(14), Nafria B(2), García-García 
JJ(2)(9)(15), Bassat Q(1)(5)(9)(15)(16).

Author information:
(1)ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
(2)Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, 
Spain.
(3)Universitat Politècnica de Catalunya, BarcelonaTech, Barcelona, Spain.
(4)B2SLab, Departament d'Enginyeria de Sistemes, Automàtica i Informàtica 
Industrial, Universitat Politècnica de Catalunya, Barcelona, Spain.
(5)Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.
(6)Networking Biomedical Research Centre in the Subject Area of Bioengineering, 
Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain.
(7)Institut de Recerca Sant Joan de Déu, Barcelona, Spain.
(8)Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of 
Barcelona, Barcelona, Spain.
(9)Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, 
Madrid, Spain.
(10)Department of Medicine, Universitat Internacional de Catalunya, Barcelona, 
Spain.
(11)Molecular Microbiology Department, Hospital Sant Joan de Deu, Esplugues, 
Barcelona, Spain.
(12)BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant 
Joan de Déu), University of Barcelona, Barcelona, Spain.
(13)Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
(14)Child and Adolescent Psychiatry and Psychology Department, Hospital Sant 
Joan de Déu, Barcelona, Spain.
(15)Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, 
Barcelona, Spain.
(16)ICREA, Catalan Institution for Research and Advanced Studies, Barcelona, 
Spain.

Background: During the COVID-19 pandemic, lockdown strategies have been widely 
used to contain SARS-CoV-2 virus spread. Children and adolescents are especially 
vulnerable to suffering psychological effects as result of such measures. In 
Spain, children were enforced to a strict home lockdown for 42 days during the 
first wave. Here, we studied the effects of lockdown in children and adolescents 
through an online questionnaire. Methods: A cross-sectional study was conducted 
in Spain using an open online survey from July (after the lockdown resulting 
from the first pandemic wave) to November 2020 (second wave). We included 
families with children under 16 years-old living in Spain. Parents answered a 
survey regarding the lockdown effects on their children and were instructed to 
invite their children from 7 to 16 years-old (mandatory scholar age in Spain) to 
respond a specific set of questions. Answers were collected through an 
application programming interface system, and data analysis was performed using 
R. Results: We included 1,957 families who completed the questionnaires, 
covering a total of 3,347 children. The specific children's questionnaire was 
completed by 167 kids (7-11 years-old), and 100 adolescents (12-16 years-old). 
Children, in general, showed high resilience and capability to adapt to new 
situations. Sleeping problems were reported in more than half of the children 
(54%) and adolescents (59%), and these were strongly associated with less time 
doing sports and spending more than 5 h per day using electronic devices. 
Parents perceived their children to gain weight (41%), be more irritable and 
anxious (63%) and sadder (46%). Parents and children differed significantly when 
evaluating children's sleeping disturbances. Conclusions: Enforced lockdown 
measures and isolation can have a negative impact on children and adolescent's 
mental health and well-being. In future waves of the current pandemic, or in the 
light of potential epidemics of new emerging infections, lockdown measures 
targeting children, and adolescents should be reconsidered taking into account 
their infectiousness potential and their age-specific needs, especially to 
facilitate physical activity and to limit time spent on electronic devices.

Copyright © 2021 Ajanovic, Garrido-Aguirre, Baro, Balanza, Varo, 
Millat-Martínez, Arias, Fonollosa, Perera-Lluna, Jordan, Muñoz-Almagro, 
Bonet-Carne, Crosas-Soler, Via, Nafria, García-García and Bassat.

DOI: 10.3389/fpubh.2021.746052
PMCID: PMC8655116
PMID: 34900898 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2660. Leadersh Health Serv (Bradf Engl). 2021 Dec 15;ahead-of-print(ahead-of-print). 
doi: 10.1108/LHS-05-2021-0042.

Leading through the first wave of COVID: a Canadian action research study.

Hartney E(1), Melis E(2), Taylor D(3), Dickson G(4), Tholl B(2), Grimes K(2), 
Chan MK(5), Van Aerde J(6), Horsley T(7).

Author information:
(1)Royal Roads University, Victoria, Canada and Canadian Health Leadership 
Network, Ottawa, Canada.
(2)Canadian Health Leadership Network, Ottawa, Canada.
(3)Interior Health Authority, Kelowna, Canada and Canadian Health Leadership 
Network, Ottawa, Canada.
(4)Professor Emeritus, Royal Roads University, Victoria, Canada and Canadian 
Health Leadership Network, Ottawa, Canada.
(5)Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, 
Canada and Canadian Health Leadership Network, Ottawa, Canada.
(6)Department of Pediatrics, Faculty of Medicine and Dentistry, University of 
Alberta, Edmonton, Canada and Canadian Health Leadership Network, Ottawa, 
Canada.
(7)Royal College of Physicians and Surgeons of Canada, Ottawa, Canada and 
Canadian Health Leadership Network, Ottawa, Canada.

PURPOSE: This first phase of a three-phase action research project aims to 
define leadership practices that should be used during and after the pandemic to 
re-imagine and rebuild the health and social care system. Specifically, the 
objectives were to determine what effective leadership practices Canadian health 
leaders have used through the first wave of the COVID-19 pandemic, to explore 
how these differ from pre-crisis practices; and to identify what leadership 
practices might be leveraged to create the desired health and care systems of 
the future.
DESIGN/METHODOLOGY/APPROACH: The authors used an action research methodology. In 
the first phase, reported here, the authors conducted one-on-one, virtual 
interviews with 18 health leaders from across Canada and across leadership 
roles. Data were analyzed using grounded theory methodology.
FINDINGS: Five key practices emerged from the data, within the core dimension of 
disrupting entrenched structures and leadership practices. These were, namely, 
responding to more complex emotions in self and others. Future practice 
identified to create more psychologically supportive workplaces. Agile and 
adaptive leadership. Future practice should allow leaders to move systemic 
change forward more quickly. Integrating diverse perspectives, within and across 
organizations, leveling hierarchies through bringing together a variety of 
perspectives in the decision-making process and engaging people more broadly in 
the co-creation of strategies. Applying existing leadership capabilities and 
experience. Future practice should develop and expand mentorship to support 
early career leadership. Communication was increased to build credibility and 
trust in response to changing and often contradictory emerging evidence and 
messaging. Future practice should increase communication.
RESEARCH LIMITATIONS/IMPLICATIONS: The project was limited to health leaders in 
Canada and did not represent all provinces/territories. Participants were 
recruited through the leadership networks, while diverse, were not 
demographically representative. All interviews were conducted in English; in the 
second phase of the study, the authors will recruit a larger and more diverse 
sample and conduct interviews in both English and French. As the interviews took 
place during the early stages of the pandemic, it may be that health leaders' 
views of what may be required to re-define future health systems may change as 
the crisis shifts over time.
PRACTICAL IMPLICATIONS: The sponsoring organization of this research - the 
Canadian Health Leadership Network and each of its individual member partners - 
will mobilize knowledge from this research, and subsequent phases, to inform 
processes for leadership development and, succession planning across, the 
Canadian health system, particularly those attributes unique to a context of 
crisis management but also necessary in post-crisis recovery.
SOCIAL IMPLICATIONS: This research has shown that there is an immediate need to 
develop innovative and influential leadership action - commensurate with its 
findings - to supporting the evolution of the Canadian health system, the 
emotional well-being of the health-care workforce, the mental health of the 
population and challenges inherent in structural inequities across health and 
health care that discriminate against certain populations.
ORIGINALITY/VALUE: An interdisciplinary group of health researchers and 
decision-makers from across Canada who came together rapidly to examine 
leadership practices during COVID-19's first wave using action research study 
design.

© Emerald Publishing Limited.

DOI: 10.1108/LHS-05-2021-0042
PMID: 34898142 [Indexed for MEDLINE]


2661. J Rural Health. 2022 Sep;38(4):773-787. doi: 10.1111/jrh.12638. Epub 2021 Dec 
13.

Mental health at the COVID-19 frontline: An assessment of distress, fear, and 
coping among staff and attendees at screening clinics of rural/regional settings 
of Victoria, Australia.

Rahman MA(1)(2)(3), Ford D(4), Sousa G(5)(6), Hedley L(4), Greenstock L(7), 
Cross WM(1), Brumby S(2)(4).

Author information:
(1)School of Health, Federation University Australia, Berwick, Victoria, 
Australia.
(2)National Centre for Farmer Health, Deakin University, Hamilton, Victoria, 
Australia.
(3)Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia.
(4)Western District Health Service (WDHS), Hamilton, Victoria, Australia.
(5)South West Healthcare (SWH), Warrnambool, Victoria, Australia.
(6)Hawaii Emergency Physicians Associated, Honolulu, Hawaii, USA.
(7)Western Alliance, Warrnambool, Victoria, Australia.

PURPOSE: Research examining psychological well-being associated with COVID-19 in 
rural/regional Australia is limited. This study aimed to assess the extent of 
psychological distress, fear of COVID-19, and coping strategies among the 
attendees in COVID-19 screening clinics at 2 rural Victorian settings.
METHODS: A cross-sectional study was conducted during July 2020 to February 2021 
inclusive. Participants were invited to fill in an online questionnaire. Kessler 
Psychological Distress Scale (K-10), Fear of COVID-19 Scale, and Brief Resilient 
Coping Scale were used to assess psychological distress, fear of COVID-19, and 
coping, respectively.
FINDINGS: Among 702 total participants, 69% were females and mean age (±SD) was 
49 (±15.8) years. One in 5 participants (156, 22%) experienced high to very high 
psychological distress, 1 in 10 (72, 10%) experienced high fear, and more than 
half (397, 57%) had medium to high resilient coping. Participants with mental 
health issues had higher distress (AOR 10.4, 95% CI: 6.25-17.2) and fear (2.56, 
1.41-4.66). Higher distress was also associated with having comorbidities, 
increased smoking (5.71, 1.04-31.4), and alcohol drinking (2.03, 1.21-3.40). 
Higher fear was associated with negative financial impact, drinking alcohol 
(2.15, 1.06-4.37), and increased alcohol drinking. Medium to high resilient 
coping was associated with being ≥60 years old (1.84, 1.04-3.24) and completing 
Bachelor and above levels of education.
CONCLUSION: People who had pre-existing mental health issues, comorbidities, 
smoked, and consumed alcohol were identified as high-risk groups for poorer 
psychological well-being in rural/regional Victoria. Specific interventions to 
support the mental well-being of these vulnerable populations, along with 
engaging health care providers, should be considered.

© 2021 The Authors. The Journal of Rural Health published by Wiley Periodicals 
LLC on behalf of National Rural Health Association.

DOI: 10.1111/jrh.12638
PMID: 34897806 [Indexed for MEDLINE]


2662. J Adv Nurs. 2022 Jun;78(6):1676-1687. doi: 10.1111/jan.15128. Epub 2021 Dec 13.

Symptoms of depression in parents after discharge from NICU associated with 
family-centred care.

Axelin A(1)(2), Feeley N(3)(4), Campbell-Yeo M(5), Silnes Tandberg B(6), Szczapa 
T(7), Wielenga J(8), Weis J(9), Pavicic Bosnjak A(10)(11), Jonsdottir RB(12), 
George K(13), Blomqvist YT(14)(15), Bohlin K(16)(17), Lehtonen L(18)(19); 
Separation, Closeness Experiences in Neonatal Environment (SCENE) research 
group.

Author information:
(1)Department of Nursing Science, University of Turku, Turku, Finland.
(2)Department of Women's and Children's Health, University of Uppsala, Uppsala, 
Sweden.
(3)Ingram School of Nursing, McGill University, Montréal, Canada.
(4)Centre for Nursing Research, Lady Davis Institute, Jewish General Hospital, 
Montréal, Canada.
(5)School of Nursing, Faculty of Health and Departments of Pediatrics, 
Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.
(6)Department of Pediatric and Adolescent Medicine, Drammen Hospital, Vestre 
Viken Hospital Trust, Drammen, Norway.
(7)Department of Neonatology, Neonatal Biophysical Monitoring and 
Cardiopulmonary Therapies Research Unit, Poznan University of Medical Sciences, 
Poznan, Poland.
(8)IC Neonatology, Emma Children's Hospital, Amsterdam University Medical 
Center, Amsterdam, The Netherlands.
(9)Department of Neonatology, Copenhagen University Hospital, Copenhagen, 
Denmark.
(10)Department of Obstetrics and Gynecology, Clinical Hospital Sveti Duh Zagreb, 
Zagreb, Croatia.
(11)Division on Breastfeeding Support, Human Milk Bank, Croatian Tissue and Cell 
Bank, Department for Transfusion Medicine and Transplantation Biology, 
University Hospital Centre Zagreb, Zagreb, Croatia.
(12)Faculty of Nursing, School of Health Sciences, University of Iceland, 
Reykjavik, Iceland.
(13)School of Nursing, Midwifery and Paramedicine, University of the Sunshine 
Coast, Sippy Downs, Qld, Australia.
(14)Neonatal Intensive Care Unit, University Children's Hospital, Uppsala, 
Sweden.
(15)Department of Women's and Children's Health, Uppsala University, Uppsala, 
Sweden.
(16)Department of Neonatology, Karolinska University Hospital, Stockholm, 
Sweden.
(17)Department of Clinical Science, Intervention and Technology, Karolinska 
Institutet, Stockholm, Sweden.
(18)Department of Pediatrics and Adolescent Medicine, Turku University Hospital, 
Turku, Finland.
(19)Department of Clinical Medicine, University of Turku, Turku, Finland.

AIMS: The aim of this study was to examine the potential association of 
family-centred care as perceived by parents during a NICU stay with parents' 
depressive symptoms at discharge and at 4 months corrected for infant age.
DESIGN: A longitudinal, multicentre cohort study was conducted from 2018 to 2020 
in 23 NICUs across 15 countries.
METHODS: Parents (n = 635 mothers, n = 466, fathers) of infants (n = 739) born 
before 35 weeks of gestation and admitted to the participating NICUs were 
enrolled to the study during the first weeks of their infants' hospitalizations. 
They responded to Digi-FCC daily text messages inquiring about their perception 
of family-centred care provided by NICU staff. In addition, they completed a 
questionnaire assessing their overall perception of family-centred care at 
discharge. Parents' depressive symptoms were measured by the Edinburgh Postnatal 
Depression Scale at discharge and again after discharge when their infants were 
at 4 months corrected for age.
RESULTS: The mothers' and the fathers' perceptions of family-centred care were 
associated with their depressive symptoms at discharge and at 4 months corrected 
age, controlling for gestational age, multiple birth, parent education and 
relationship status. Parents' participation in infant care, care-related 
decisions and emotional support provided to parents by staff explained the 
variation in the parents' perceptions of family-centred care. The factors 
facilitating the implementation of family-centred care included unlimited access 
to the unit for the parents and for their significant others, as well as 
amenities for parents.
CONCLUSIONS: Our study shows that family-centred NICU care associates with 
parents' depressive symptoms after a NICU stay.
IMPACT: Depression is common in parents of preterm infants. The provision of 
family-centred care may protect the mental well-being of parents of preterm 
infants.

© 2021 The Authors. Journal of Advanced Nursing published by John Wiley & Sons 
Ltd.

DOI: 10.1111/jan.15128
PMCID: PMC9299776
PMID: 34897769 [Indexed for MEDLINE]

Conflict of interest statement: No conflict of interest has been declared by the 
authors.


2663. J Community Psychol. 2022 Jul;50(5):2243-2259. doi: 10.1002/jcop.22772. Epub 
2021 Dec 12.

Psychological well-being and family distress of Italian caregivers during the 
COVID-19 outbreak.

Fusar-Poli L(1), Surace T(1), Meo V(1), Patania F(1), Avanzato C(1), Pulvirenti 
A(2), Aguglia E(1), Signorelli MS(1).

Author information:
(1)Department of Clinical and Experimental Medicine, Psychiatry Unit, University 
of Catania, Catania, Italy.
(2)Department of Clinical and Experimental Medicine, Unit of Bioinformatics and 
Computer Science, University of Catania, Catania, Italy.

The present study aimed to investigate the personal well-being and family 
distress of Italian caregivers during the lockdown. Five hundred 
sixty-five family caregivers and 638 age- and sex-matched noncaregivers 
completed a web-based survey. The following scales were administered to all 
participants: General Health Questionnaire-12 items (GHQ-12), Insomnia Severity 
Index (ISI), Brief Resilient Coping Scale (BRCS), and Family Distress Index 
(FDI). Caregivers were also asked to provide information about their family 
members with disabilities. Individual and family distress, as well as insomnia, 
were significantly higher in caregivers than controls. Contrariwise, caregivers 
reported lower resilience levels. Multiple linear regression showed that 
distress was higher in caregivers living in Central and Southern Italy. 
Individual well-being was negatively predicted by low independence measured by 
the activities of daily living (ADL). Family distress was higher in households 
of psychiatric patients. Finally, low resilience levels appeared as the 
strongest predictors of both individual and family distress. The lockdown caused 
severe distress among caregivers and families of people with disabilities. 
Support networks for people with disabilities and their families are fundamental 
to prevent severe consequences from a psychological, social, and economical 
point of view.

© 2021 Wiley Periodicals LLC.

DOI: 10.1002/jcop.22772
PMID: 34897728 [Indexed for MEDLINE]


2664. Dev Psychopathol. 2023 Aug;35(3):1203-1218. doi: 10.1017/S0954579421001139. Epub 
2021 Dec 13.

Pre-pandemic psychological and behavioral predictors of responses to the 
COVID-19 pandemic in nine countries.

Lansford JE(1), Skinner AT(1), Godwin J(1), Chang L(2), Deater-Deckard K(3), Di 
Giunta L(4), Dodge KA(1), Gurdal S(5), Liu Q(6), Long Q(7), Oburu P(8), 
Pastorelli C(4), Sorbring E(5), Steinberg L(9), Tapanya S(10), Uribe Tirado 
LM(11), Yotanyamaneewong S(10), Alampay LP(12), Al-Hassan SM(13), Bacchini 
D(14), Bornstein MH(15).

Author information:
(1)Duke University, Durham, NC, USA.
(2)University of Macau, Macau, China.
(3)University of Massachusetts, Amherst, MA, USA.
(4)Università di Roma "La Sapienza,"Rome, Italy.
(5)University West, Trollhättan, Sweden.
(6)Chongqing Medical University, Chongqing, China.
(7)Duke Kunshan University, Kunshan, China.
(8)Maseno University, Maseno, Kenya.
(9)Temple University, Philadelphia, PA, USA, and King Abdulaziz University, 
Jeddah, Saudi Arabia.
(10)Chiang Mai University, Chiang Mai, Thailand.
(11)Universidad de San Buenaventura, Medellín, Colombia.
(12)Ateneo de Manila University, Quezon City, Philippines.
(13)Hashemite University, Zarqa, Jordan.
(14)University of Naples "Federico II," Naples, Italy.
(15)Eunice Kennedy ShriverNational Institute of Child Health and Human 
Development, Bethesda, MD, USA, UNICEF, New York, USA, and Institute for Fiscal 
Studies, London, UK.

Prior to the COVID-19 pandemic, adolescents (N = 1,330; Mages = 15 and 16; 50% 
female), mothers, and fathers from nine countries (China, Colombia, Italy, 
Jordan, Kenya, Philippines, Sweden, Thailand, United States) reported on 
adolescents' internalizing and externalizing problems, adolescents completed a 
lab-based task to assess tendency for risk-taking, and adolescents reported on 
their well-being. During the pandemic, participants (Mage = 20) reported on 
changes in their internalizing, externalizing, and substance use compared to 
before the pandemic. Across countries, adolescents' internalizing problems 
pre-pandemic predicted increased internalizing during the pandemic, and poorer 
well-being pre-pandemic predicted increased externalizing and substance use 
during the pandemic. Other relations varied across countries, and some were 
moderated by confidence in the government's handling of the pandemic, gender, 
and parents' education.

DOI: 10.1017/S0954579421001139
PMCID: PMC9189256
PMID: 34895387 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None


2665. BMC Public Health. 2021 Dec 11;21(1):2257. doi: 10.1186/s12889-021-12277-4.

Psychological experience of patients with confirmed COVID-19 at the initial 
stage of pandemic in Wuhan, China: a qualitative study.

Li T(#)(1)(2), Hu Y(#)(1), Xia L(3), Wen L(4), Ren W(1), Xia W(5), Wang J(1)(2), 
Cai W(1)(2), Chen L(6).

Author information:
(1)Department of Nursing, Shenzhen Hospital, Southern Medical University, Number 
1333, Xinhu Road, Baoán District, Shenzhen, 518101, China.
(2)School of Nursing, Southern Medical University, Guangzhou, 510515, China.
(3)Department of Traumatology, Tongji Hospital affiliated to Tongji Medical 
College, Huazhong University of Science and Technology, Wuhan, 430030, China.
(4)Department of Hepatobiliary, Pancreatic and Splenic Surgery, Suzhou Ninth 
People's Hospital, Suzhou, 215299, China.
(5)School of Nursing, The University of Hong Kong, Hong Kong, 999077, SAR, 
China.
(6)Department of Nursing, Shenzhen Hospital, Southern Medical University, Number 
1333, Xinhu Road, Baoán District, Shenzhen, 518101, China. 
dangdang601@smu.edu.cn.
(#)Contributed equally

BACKGROUND: Coronavirus disease 2019 (COVID-19) quickly developed into a global 
pandemic and affected patients' mental health. However, little is known about 
psychological experience of patients with COVID-19. The aim was to elucidate the 
psychological experience of patients with confirmed COVID-19 in Wuhan, at the 
initial stage of the pandemic.
METHODS: This study was conducted using a phenomenological approach in a 
qualitative study. Thirteen patients with confirmed COVID-19 from a 
COVID-19-designated hospital in Wuhan, were recruited between March 15th and 
April 20th, 2020 via purposive sampling. Semi-structured in-depth interviews 
were conducted face-to-face. The interview data were analyzed using inductive 
thematic analysis.
RESULTS: The psychological experience of patients was summarized into three 
themes: mental distress related to COVID-19, expectations of life scenarios 
after discharge, and making sense of the experience. These themes were 
classified into 10 sub-themes. Patients experienced confusion, uncertainty, 
worry, guilt and concern. Both positive and negative expectations of life 
scenarios after discharge were reported, manifested as expectations about making 
up for lost time with family, anxiety about social discrimination and feelings 
of helplessness about poor financial security. Moreover, patients perceived 
strength of abundant social support and awareness of social responsibility from 
their unique experience to cope with their condition.
CONCLUSIONS: This study demonstrated that patients with confirmed COVID-19 in 
Wuhan underwent complex psychological experience, both positive and negative at 
the initial stage of the pandemic. These findings will contribute to the 
delivery of effective mental health care to safeguard patients' wellbeing.

© 2021. The Author(s).

DOI: 10.1186/s12889-021-12277-4
PMCID: PMC8665711
PMID: 34895189 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2666. Scand J Gastroenterol. 2022 Apr;57(4):406-414. doi: 
10.1080/00365521.2021.2013527. Epub 2021 Dec 11.

Assessing the repercussions of COVID-19 pandemic on symptoms, disease 
management, and emotional well-being in patients with inflammatory bowel 
disease: a multi-site survey study.

El-Dallal M(1)(2), Saroufim A(2), Systrom H(3), Ballou S(2), Farhoud A(4), Pasam 
RT(4), Gadupudi SS(5), Osman K(4), Chaudrey K(5), Cheifetz A(2), Feuerstein 
JD(2).

Author information:
(1)Division of Hospital Medicine, Cambridge Health Alliance, Harvard Medical 
School, Cambridge, MA, USA.
(2)Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard 
Medical School, Boston, MA, USA.
(3)Department of Medicine, Beth Israel Deaconess Medical Center, Boston and 
Harvard Medical School, MA, USA.
(4)Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA, 
USA.
(5)Division of Gastroenterology, Lahey Hospital and Medical Center, Burlington, 
MA, USA.

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic has created numerous 
challenges in provision of safe and effective care for patients with 
Inflammatory Bowel Disease (IBD). In this study, we surveyed patients with IBD 
to highlight the impact of the pandemic on their IBD symptoms, management, and 
well-being.
METHODS: A multi-site survey was administered to patients with IBD. We evaluated 
patient's symptoms, medications changes, seeking medical attention, eating 
behaviors, sleep patterns, stress, self-reported anxiety and depression. The 
survey also measured emotional impact of the pandemic using the validated 
Pandemic Emotional Impact Scale (PEIS) and resilience using the Brief Resilience 
Scale (BRS). Logistic, ordinal, and linear regression models were utilized to 
perform sensitivity analyses.
RESULTS: The response rate to the survey was 61%. Of 391 surveyed patients, 
21.1% reported worsened gastrointestinal symptoms, 17.5% reported changing 
biologic medication infusion schedule, 18.7% reported changing medication 
regimen, 43.6% attended at least one telemedicine visit with their 
gastroenterologist, 16.5% reported a less healthy diet, 40.5% reported worsening 
sleep, 63.7% reported more stress, and 65.3% reported feeling more vulnerable 
than before the pandemic. Women and participants with self-reported anxiety and 
depression were more likely to have worse symptoms, psychological well-being and 
daily functioning. Increased PEIS scores and decreased BRS scores were 
associated with worse outcomes.
CONCLUSIONS: COVID-19 pandemic has impacted symptoms, disease management and 
well-being for patient with IBD, more prominently in patients who suffer from 
anxiety and depression. Utilizing PEIS and BRS scores as screening tools could 
help better tailor outreach and follow-up to support these patients.

DOI: 10.1080/00365521.2021.2013527
PMID: 34894999 [Indexed for MEDLINE]


2667. J Nurs Manag. 2022 Mar;30(2):393-402. doi: 10.1111/jonm.13534. Epub 2022 Jan 2.

Mental health, safety and support during COVID-19: A cross-sectional study of 
primary health care nurses.

Halcomb E(1)(2), Fernandez R(1)(3), Mursa R(1)(2), Stephen C(1)(2), Calma 
K(1)(2), Ashley C(1), McInnes S(1), Desborough J(4), James S(1)(5), Williams 
A(6).

Author information:
(1)School of Nursing, Faculty of Science, Medicine and Health, University of 
Wollongong, Wollongong, New South Wales, Australia.
(2)Illawarra Health and Medical Institute, Wollongong, New South Wales, 
Australia.
(3)Centre for Research in Nursing and Health, St George Hospital, Kogarah, New 
South Wales, Australia.
(4)Research School of Population Health, College of Health and Medicine, 
Australian National University, Canberra, Australian Capital Territory, 
Australia.
(5)Department of General Practice, School of Public Health and Preventative 
Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, 
Notting Hill, Victoria, Australia.
(6)School of Nursing and Midwifery, Health Sciences and Physiotherapy, 
University of Notre Dame Australia, Sydney, New South Wales, Australia.

AIM: The aim of this study is to explore primary health care nurses' mental 
health, concerns and perceived safety and supports during COVID-19.
BACKGROUND: Respiratory pandemics have negative impacts on nurses' wellbeing. 
While literature is replete with hospital nurses' experiences, there is less 
exploration of COVID-19 impacts on primary health care nurses. Given the 
importance of primary health care nurses in the health system, understanding 
their experiences is vital.
METHODS: Three hundred and fifty nine primary health care nurses responded to an 
online cross-sectional survey. The Depression Anxiety Stress Scales (DASS-21) 
was used to measure emotional state. Data were analysed using descriptive and 
inferential statistics.
RESULTS: DASS-21 scores indicated that 39.6% of participants were experiencing 
symptoms of depression, anxiety or stress. Of those, 41.8% were experiencing 
symptoms on one scale, 26.9% were experiencing symptoms on two scales and 31.2% 
were experiencing symptoms across all three scales. Most participants identified 
that their feelings were related to COVID-19.
CONCLUSIONS: COVID-19 is having a significant impact on primary health care 
nurses' mental health. Nurse managers need to develop strategies to effectively 
address nurses' concerns and effectively support them to sustain the workforce 
during and after the pandemic.
IMPLICATIONS FOR NURSING MANAGEMENT: Findings from this study can inform the 
design of effective nurse support programmes to reduce mental health impacts and 
promote staff wellbeing during the pandemic.

© 2021 John Wiley & Sons Ltd.

DOI: 10.1111/jonm.13534
PMID: 34890472 [Indexed for MEDLINE]


2668. Annu Int Conf IEEE Eng Med Biol Soc. 2021 Nov;2021:2326-2329. doi: 
10.1109/EMBC46164.2021.9630833.

COVID-19: Affect recognition through voice analysis during the winter lockdown 
in Scotland.

de la Fuente Garcia S, Haider F, Luz S.

The COVID-19 pandemic has led to unprecedented restrictions in people's 
lifestyle which have affected their psychological wellbeing. In this context, 
this paper investigates the use of social signal processing techniques for 
remote assessment of emotions. It presents a machine learning method for affect 
recognition applied to recordings taken during the COVID-19 winter lockdown in 
Scotland (UK). This method is exclusively based on acoustic features extracted 
from voice recordings collected through home and mobile devices (i.e. phones, 
tablets), thus providing insight into the feasibility of monitoring people's 
psychological wellbeing remotely, automatically and at scale. The proposed model 
is able to predict affect with a concordance correlation coefficient of 0.4230 
(using Random Forest) and 0.3354 (using Decision Trees) for arousal and valence 
respectively.Clinical relevance- In 2018/2019, 12% and 14% of Scottish adults 
reported depression and anxiety symptoms. Remote emotion recognition through 
home devices would support the detection of these difficulties, which are often 
underdiagnosed and, if untreated, may lead to temporal or chronic disability.

DOI: 10.1109/EMBC46164.2021.9630833
PMID: 34890322 [Indexed for MEDLINE]


2669. Pediatr Blood Cancer. 2022 Mar;69(3):e29497. doi: 10.1002/pbc.29497. Epub 2021 
Dec 10.

Provider and staff crisis well-being associated with trust in leadership and 
baseline burnout.

Moerdler S(1)(2), Steinberg DM(3)(4), Jin Z(5), Cole PD(1)(2), Kesselheim J(6), 
Levy AS(7), Roth M(8), Rosenthal SL(4)(9).

Author information:
(1)Pediatric Hematology Oncology, Rutgers Cancer Institute of New Jersey, New 
Brunswick, New Jersey, USA.
(2)Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New 
Brunswick, New Jersey, USA.
(3)Department of Pediatrics, Division of Hematology, Oncology and Stem Cell 
Transplantation, Columbia University Irving Medical Center, New York City, New 
York, USA.
(4)Department of Psychiatry, Division of Child & Adolescent Psychiatry, Columbia 
University Irving Medical Center, New York City, New York, USA.
(5)Department of Biostatistics, Mailman School of Public Health, Columbia 
University, New York City, New York, USA.
(6)Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard 
Medical School, Boston, Massachusetts, USA.
(7)Division of Pediatric Hematology, Oncology and Cellular Therapy, Children's 
Hospital at Montefiore, Brons, New York City, New York, USA.
(8)Division of Pediatrics, University of Texas MD Anderson Cancer Center, 
Houston, Texas, USA.
(9)Department of Pediatrics, Columbia University Irving Medical Center, New York 
City, New York, USA.

BACKGROUND: The impact of the coronavirus 2019 (COVID-19) pandemic on the 
emotional health of health care workers continues to be an area of active 
research. However, few studies have focused on those working in pediatrics and 
its subspecialties, as well as ancillary and non-patient-facing staff. The 
purpose of this study was to determine the prevalence and associated predictors 
of burnout and emotional well-being of providers and staff.
METHODS: An anonymous electronic survey was developed evaluating demographics, 
pandemic experiences, possible predictor variables, and three main outcomes of 
burnout, psychological distress, and perceived stress. Pediatric hematology 
oncology (PHO) chiefs and program directors across the country were invited to 
participate and disseminate the survey to their programs.
RESULTS: A total of 682/1950 (35% of invited) individuals responded to all 
predictor and outcome variables. Over half reported high levels of burnout and 
some reported moderate/high levels of distress. Prepandemic burnout and 
decreased trust in leadership were associated with all three outcomes. 
Additional predictors included having a child ≤18 years at home, hospital role, 
and worrying about patient care or relationship with their patients. The 
majority (n = 444/682, 65.5%) reported that their institution had made 
COVID-19-related mental health resources available. However, only 6.5% 
(n = 44/682) reported utilizing these resources.
CONCLUSIONS: While the majority of PHO providers and staff were resilient during 
the early stages of the COVID-19 pandemic, many reported high levels of burnout, 
yet few are utilizing institutional resources. This study has highlighted 
several actionable areas to help identify and address factors that are wearing 
down the emotional well-being of providers and staff.

© 2021 Wiley Periodicals LLC.

DOI: 10.1002/pbc.29497
PMID: 34890105 [Indexed for MEDLINE]


2670. Glob Health Action. 2021 Dec 6;14(1):1997410. doi: 
10.1080/16549716.2021.1997410.

Protecting vulnerable communities and health professionals from COVID-19 
associated mental health distress: a comprehensive approach led by a 
public-civil partnership in rural Chiapas, Mexico.

Ortega AC(1), Valtierra E(1), Rodríguez-Cuevas FG(1)(2), Aranda Z(3), Preciado 
G(1), Mohar S(4).

Author information:
(1)Mental Health Program, Partners In Health Mexico/Compañeros En Salud, Ángel 
Albino Corzo, México.
(2)Department of Global Health and Development, London School of Hygiene and 
Tropical Medicine, London, UK.
(3)Research and Impact Program, Partners in Health Mexico/Compañeros En Salud, 
Ángel Albino Corzo, México.
(4)Hospital Básico Comunitario de Ángel Albino Corzo, Chiapas Ministry of 
Health, Ángel Albino Corzo, México.

BACKGROUND: The COVID-19 pandemic has stricken mental health worldwide. 
Marginalized populations in low- and middle-income countries have been the most 
affected, as they were already experiencing barriers to accessing mental health 
care prior to the pandemic and are unequally exposed to the stressors associated 
with the health emergency, such as economic ravages or increased risk of 
complicated disease outcomes.
OBJECTIVE: The aim of this paper is to describe a comprehensive initiative 
resulting from a public-civil partnership to address the increased burden of 
mental health illness associated with the COVID-19 pandemic in rural Chiapas, 
Mexico.
METHODS: To address the emerging health needs of the general population and 
health professionals resulting from the pandemic, Compañeros En Salud (CES), a 
non-profit civil society organization based in Chiapas, implemented a 
comprehensive strategy to compensate for the shortage of mental health services 
in the region in collaboration with the Chiapas Ministry of Health. The strategy 
included three components: capacity building in mental health care delivery, 
psychosocial support to the general population, and provision of mental health 
care to CES collaborating staff. In this capacity building article, implementers 
from CES and the government share descriptive information on the specific 
interventions carried out and their beneficiaries, as well as a critical 
discussion of the strategy followed.
RESULTS: Through this strategy, we have been successful in filling the gaps in 
the public health system to ensure that CES-served populations and 
CES-collaborating health professionals have access to mental health care. 
However, further studies to quantify the impact of this intervention in 
alleviating the burden of mental health illnesses associated with the pandemic 
are needed.
CONCLUSIONS: The current situation represents an opportunity to reimagine global 
mental health. Only through the promotion of community-based initiatives and the 
development of integrated approaches will we ensure the well-being of 
marginalized populations.

DOI: 10.1080/16549716.2021.1997410
PMCID: PMC8667903
PMID: 34889715 [Indexed for MEDLINE]

Conflict of interest statement: No potential conflict of interest was reported 
by the author(s).


2671. Psychol Rep. 2023 Apr;126(2):557-600. doi: 10.1177/00332941211048734. Epub 2021 
Dec 10.

The Utility of Meditation and Mindfulness-Based Interventions in the Time of 
COVID-19: A Theoretical Proposition and Systematic Review of the Relevant 
Prison, Quarantine and Lockdown Literature.

Bursky M(1)(2), Kosuri M(1)(2)(3), Walsh Carson K(1)(2), Babad S(1)(2), 
Iskhakova A(2), Nikulina V(1)(2).

Author information:
(1)Psychology Department, The Graduate Center, City University of New York, New 
York, NY, USA.
(2)Psychology Department, Queens College, City University of New York, Queens, 
NY, USA.
(3)Psychology Department, John Jay College of Criminal Justice, City University 
of New York, New York, NY, USA.

As of July 20, 2021, Covid-19 has killed 4,086,000 people, infected at least 
190,169,833 others, and devastated the world's economy. To slow the spread of 
the virus, numerous governments instituted "lockdown" policies and quarantines, 
limiting social interactions to the immediate household. The experience of 
isolation and uncertainty have contributed to increased fear, anxiety, and 
loneliness; with limited options of research-supported interventions. Although 
different in nature, the experiences of quarantine and lockdown have been 
likened to incarceration. Past research has found meditation and 
mindfulness-based interventions (MBIs) to be effective psychological treatments 
for prisoners and may therefore translate well into effective methods for the 
maintenance of psychological well-being for individuals quarantined during the 
pandemic. More recently, research investigating the effects of meditation and 
MBIs during the pandemic have demonstrated preliminary evidence for beneficial 
psychological improvements. In accordance with the Preferred Reporting Items for 
Systematic Reviews and Meta-analyses (PRISMA), the current narrative review 
paper: 1) examines the parallels and differences between the experience of 
quarantine and imprisonment, 2) investigates the mechanisms through which 
meditation and mindfulness enact their effects, and 3) systematically reviews 
literature on the benefits of various types of meditation and MBIs for inmates 
and individuals in lockdown or quarantine. With this knowledge, the public can 
garner applicable insight into the potential use of meditation and MBIs for 
individuals forced to cope with pandemic lockdowns and quarantines. Two hundred 
and twenty one (221) articles were identified through Pubmed and Google Scholar, 
and 24 articles were ultimately included in the manuscript.

DOI: 10.1177/00332941211048734
PMCID: PMC10037136
PMID: 34889700 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


2672. Br J Nurs. 2021 Dec 9;30(22):1303-1307. doi: 10.12968/bjon.2021.30.22.1303.

The psychological effects of working in the NHS during a pandemic on final-year 
students: part 1.

Kane C(1), Rintakorpi E(2), Wareing M(3), Hewson D(4).

Author information:
(1)Principal Lecturer/Portfolio Lead for Nursing, School of Nursing and Health 
Education, Faculty of Health and Social Sciences, University of Bedfordshire, 
Luton.
(2)Consultant Nurse, Acute and Emergency Care, Buckinghamshire Healthcare NHS 
Trust.
(3)Director of Practice Learning, School of Nursing and Health Education, 
Faculty of Health & Social Sciences, University of Bedfordshire, Luton.
(4)Professor of Health and Ageing Institute for Health Research, University of 
Bedfordshire, Luton.

Resilience in nursing and midwifery involves being able to manage ethically 
adverse situations without suffering moral distress and is key to mental 
wellbeing, staff retention and patient safety. The aim of this research was to 
ask what the psychological effects were for nursing and midwifery students who 
had been deployed to work in the NHS during the COVID-19 pandemic. This study 
looked at the incidence of burnout in a small cohort of nursing and midwifery 
students who were employed as band 4 aspirant nurses and midwives in acute NHS 
trusts in the south of England. The findings suggested that student midwives 
reported higher levels of emotional exhaustion and depersonalisation than 
student nurses but overall, both cohorts of students reported moderate levels of 
burnout. Part 2 will present the lived experience of deployment as described by 
students.

DOI: 10.12968/bjon.2021.30.22.1303
PMID: 34889683 [Indexed for MEDLINE]


2673. J Holist Nurs. 2022 Dec;40(4):397-409. doi: 10.1177/08980101211064605. Epub 2021 
Dec 10.

The Impact of Robotic Companion Pets on Depression and Loneliness for Older 
Adults with Dementia During the COVID-19 Pandemic.

Fogelson DM(1), Rutledge C(1), Zimbro KS(1).

Author information:
(1)49374Old Dominion University, 520792Virginia Beach Higher Education Center, 
University Drive.

Purpose: Differences in depression and loneliness, during the COVID-19 pandemic, 
for older adults with mild to moderate dementia living in residential care after 
interacting with a robotic companion dog or cat were explored. Experiences of 
family members and professional caregivers were also examined. Design: This 
study used a mixed research design with pre- and post-questionnaires on 
depression and loneliness. Method: Quantitative data exploring the impact of 
companion pets on depression and loneliness were collected from participants 
pre-intervention and at 3- and 6-week intervals. Qualitative data were collected 
during the 6-week study period, permitting researchers to explore the impact of 
robotic companion pets on participants, family members, and professional 
caregivers. Findings: Results indicated depression (χ2F(2)  =  21.29, p < 0.001) 
and loneliness (χ2F(2)  =  21.11, p < 0.001) improved. Moreover, participants 
were engaged with their companion pet, providing meaningful, activity and 
positive experiences. Conclusions: Robotic companion pet therapy, a holistic, 
nonpharmacologic animal-assisted therapy (AAT), changed the AAT landscape at the 
study site and provided an alternative option to live pet therapy during 
COVID-19. Participant interactions with their robotic companion pets enhanced 
their well-being and quality of life, especially during stringent COVID-19 
restrictions and social isolation.

DOI: 10.1177/08980101211064605
PMCID: PMC9629053
PMID: 34889146 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


2674. Pediatr Ann. 2021 Dec;50(12):e494-e497. doi: 10.3928/19382359-20211117-01. Epub 
2021 Dec 1.

Making a Difference With Mental Health During Adolescence in a Global Pandemic.

Plax K.

Comment in
    Pediatr Ann. 2021 Dec;50(12):e486-e487.

Anxiety and depression are common in adolescence and have increased during the 
coronavirus disease 2019 pandemic. The isolation from shutdowns and loss of 
school, loved ones, and typical activities left many children and youth with 
increased mental health needs. Standardized mental health screening, diagnosis, 
and treatment with close follow-up care can be done within the framework of the 
medical home, which is accessible to patients and caregivers. Best practices and 
a decision tree, a decision support tool, are offered to help meet the growing 
need. Even with current longer wait times for therapists and psychiatry provider 
shortages, teenagers and families can be helped in meaningful ways to achieve 
remission, recovery, and well-being. [Pediatr Ann. 2021;50(12):e494-e497.].

DOI: 10.3928/19382359-20211117-01
PMID: 34889137 [Indexed for MEDLINE]


2675. Int J Nurs Educ Scholarsh. 2021 Dec 10;18(1). doi: 10.1515/ijnes-2021-0060.

Depression, anxiety and stress among Australian nursing and midwifery 
undergraduate students during the COVID-19 pandemic: a cross-sectional study.

Wynter K(1)(2), Redley B(1)(3), Holton S(1)(2), Manias E(1), McDonall J(1), 
McTier L(1), Hutchinson AM(1)(3), Kerr D(1), Lowe G(1), Phillips NNM(1), 
Rasmussen B(1)(2)(4)(5).

Author information:
(1)School of Nursing and Midwifery, The Centre for Quality and Patient Safety 
Research in the Institute for Health Transformation, Deakin University, Geelong, 
VIC, Australia.
(2)The Centre for Quality and Patient Safety Research - Western Health 
Partnership, St Albans, VIC, Australia.
(3)The Centre for Quality and Patient Safety Research - Monash Health 
Partnership, Monash Health, VIC, Australia.
(4)Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 
Denmark.
(5)Steno Diabetes Center, Faculty of Health Sciences, University of Southern 
Denmark, Odense, Denmark.

OBJECTIVES: To assess depression, anxiety and stress among undergraduate nursing 
and midwifery students during the COVID-19 pandemic, and identify 
socio-demographic and educational characteristics associated with higher 
depression, anxiety and stress scores.
METHODS: Cross-sectional study during August-September 2020, using an anonymous, 
online, self-administered survey. E-mail invitations with a survey link were 
sent to 2,907 students enrolled in the Bachelor of Nursing suite of courses, 
offered across four campuses of a single university in Victoria, Australia. 
Depression, anxiety and stress were assessed using the DASS-21. Data on 
socio-demographic and educational characteristics, self-rated physical health 
and exposure to COVID-19 were also collected. DASS-21 subscale scores were 
compared with existing data for various pre-pandemic and COVID-19 samples. 
Multiple regression was used to investigate factors associated with higher 
scores on depression, anxiety and stress subscales.
RESULTS: The response rate was 22% (n=638). Mean scores on all DASS-21 subscales 
were significantly higher (p<0.001) than means from all comparative sample data. 
The proportions of students reporting moderate to severe symptoms of depression, 
anxiety and stress were 48.5%, 37.2% and 40.2% respectively. Being a woman, 
being younger, having completed more years of study and having poorer self-rated 
general health were all significantly associated (p<0.05) with higher scores on 
at least one DASS-21 subscale.
CONCLUSIONS: Almost half of participants reported at least moderate symptoms of 
depression; more than a third reported at least moderate symptoms of anxiety or 
stress. Poor psychological wellbeing can impact students' successful completion 
of their studies and therefore, has implications for nursing and midwifery 
workforce recruitment and retention. During and after pandemics, universities 
should consider screening undergraduate students not only for anxiety and 
stress, but also for depression. Clear, low-cost referral pathways should be 
available, should screening indicate that further diagnosis or treatment is 
required.

© 2021 Walter de Gruyter GmbH, Berlin/Boston.

DOI: 10.1515/ijnes-2021-0060
PMID: 34889085 [Indexed for MEDLINE]


2676. J Appl Res Intellect Disabil. 2022 Mar;35(2):577-586. doi: 10.1111/jar.12969. 
Epub 2021 Dec 9.

Impact of COVID-19 on the burden of care of families of people with intellectual 
and developmental disabilities.

Navas P(1), Verdugo MÁ(1), Martínez S(1), Amor AM(1), Crespo M(1), Deliu MM(1).

Author information:
(1)Institute on Community Integration (INICO), University of Salamanca, 
Salamanca, Spain.

AIM: This study analysed the impact that COVID-19 and the response measures 
implemented by the Spanish Government have had on families of individuals with 
intellectual and developmental disabilities.
METHOD: Data on 323 family members (M = 52.3 years old; SD = 10.5) were 
collected through an online survey, which was focused on analysing difficulties 
experienced and service provision during lockdown.
RESULTS: Many families (66.3%) have seen their level of stress increased during 
lockdown because of, among other reasons, a greater burden of care. Difficulties 
were associated with the closure and changes in disability-related services. 
Families of people with extensive support needs have generally experienced 
greater difficulties.
CONCLUSION: Support services should have been considered essential services 
during lockdown. The failure to receive support has resulted in excessive burden 
on families, who had to assume a multitude of roles to support their family 
member with intellectual and developmental disability.

© 2021 The Authors. Journal of Applied Research in Intellectual Disabilities 
published by John Wiley & Sons Ltd.

DOI: 10.1111/jar.12969
PMID: 34888996 [Indexed for MEDLINE]


2677. Health Soc Care Community. 2022 Sep;30(5):e2374-e2384. doi: 10.1111/hsc.13676. 
Epub 2021 Dec 9.

Loneliness and mental health at the early stages of the Covid-19 pandemic in 
England.

Allen R(1), Prescott J(1), McHugh S(1), Carson J(1).

Author information:
(1)University of Bolton, Bolton, UK.

The current researchers carried out a large online survey on 18 March 2020 and 
unintentionally provided a 'snap shot' of how the British population was 
responding in the early stages of the Covid-19 pandemic. This paper aims to 
investigate the relationship between loneliness and mental health at the early 
stages of the global crisis. This cross-sectional study was carried out using 
Prolific, an online participant recruitment platform that allowed 1608 responses 
in just 2 hr. Participants completed measures of Personal Well-being, 
Psychological Distress, Flourishing and Loneliness. Numerous associations 
between loneliness and mental health were found. A multiple regression found 
that 43% of the variance in loneliness can be accounted for by age, 
psychological distress and flourishing. Responses were also categorised into 
three groups: the non-lonely (n = 311), averagely lonely (n = 1054) and the 
severely lonely (n = 243), with analysis indicating that poorer well-being was 
associated with increased loneliness. Due to the cross sectional nature of this 
research, determining the direction of causality is not possible. It remains 
uncertain whether increased loneliness negatively impacted on mental health, 
whether poor mental health lead to increased loneliness, or both in fact. 
Current findings suggest that severely lonely individuals may be particularly 
vulnerable to psychological distress and that individuals with poor mental 
health may be especially prone to loneliness. Individuals experiencing 
loneliness and/or poor mental health will almost certainly need additional 
support during and beyond the pandemic.

© 2021 John Wiley & Sons Ltd.

DOI: 10.1111/hsc.13676
PMID: 34888972 [Indexed for MEDLINE]


2678. Int J Environ Res Public Health. 2021 Dec 5;18(23):12812. doi: 
10.3390/ijerph182312812.

Leisure Time Use and Adolescent Mental Well-Being: Insights from the COVID-19 
Czech Spring Lockdown.

Cosma A(1), Pavelka J(2), Badura P(2).

Author information:
(1)Sts Cyril and Methodius Faculty of Theology, Olomouc University Social Health 
Institute, Palacký University Olomouc, 779 00 Olomouc, Czech Republic.
(2)Department of Recreation and Leisure Studies, Faculty of Physical Culture, 
Palacký University Olomouc, 771 11 Olomouc, Czech Republic.

BACKGROUND: As leisure-one of the crucial life domains-was completely disrupted 
by the COVID-19 pandemic, our study aimed to investigate how adolescents spent 
their leisure time during the Spring 2020 lockdown. Secondly, we aimed to 
investigate the associations between the perceived changes in leisure time use, 
the leisure activities adolescents engaged in, and the associations with 
well-being during the Spring 2020 lockdown in Czechia.
METHODS: Data from 3438 participants were included in this study (54.2% girls; 
mean age = 13.45, SD = 1.62). First, the initial number of items measuring 
leisure, electronic media use, and sports was reduced through Principal 
Component Analysis (PCA). Multivariate linear regression models tested the 
associations between leisure domains and mental well-being Results: The amount 
of leisure time, together with socially active leisure and sports and physical 
activity, formed the strongest positive predictors of mental well-being, whereas 
idle activities and time spent on electronic media acted as negative predictors. 
The amount of time spent doing schoolwork was unrelated to mental well-being.
CONCLUSIONS: Overall, our results support the idea that leisure as a promoting 
factor for well-being is not just a matter of its amount but rather of 
engagement in meaningful and fulfilling activities.

DOI: 10.3390/ijerph182312812
PMCID: PMC8657078
PMID: 34886538 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study, in the collection, analyses, or 
interpretation of the data, in the writing of the manuscript, or in the decision 
to publish the results.


2679. Int J Environ Res Public Health. 2021 Dec 4;18(23):12795. doi: 
10.3390/ijerph182312795.

Does the Progression of the COVID-19 Pandemic Have an Influence on the Mental 
Health and Well-Being of Young People? A Cross-Sectional Multicenter Study.

Özlü-Erkilic Z(1)(2), Kothgassner OD(3), Wenzel T(4)(5), Goreis A(6)(7), Chen 
A(5), Ceri V(8), Fakhr Mousawi A(2), Akkaya-Kalayci T(1)(2).

Author information:
(1)Outpatient Clinic of Transcultural Psychiatry and Migration Induced Disorders 
in Childhood and Adolescence, Department of Child and Adolescent Psychiatry, 
Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
(2)Postgraduate University Program Transcultural Medicine and Diversity Care, 
Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria.
(3)Department of Child and Adolescent Psychiatry, Medical University of Vienna, 
Währinger Gürtel 18-20, 1090 Vienna, Austria.
(4)Department of Psychiatry and Psychotherapy, Medical University of Vienna, 
Währinger Gürtel 18-20, 1090 Vienna, Austria.
(5)Scientific Section on Psychological Aspects of Torture and Persecution, World 
Psychiatric Association (WPA), 1226 Thônex, Switzerland.
(6)Department of Clinical and Health Psychology, Faculty of Psychology, 
University of Vienna, 1010 Vienna, Austria.
(7)Outpatient Unit for Research, Teaching and Practice, Faculty of Psychology, 
University of Vienna, 1010 Vienna, Austria.
(8)Department of Child Development, Faculty of Health Sciences, Batman 
University, Merkez Kampüsü, Batman 72060, Turkey.

The COVID-19 pandemic has been shown to have impaired the mental health and 
well-being of young people. This study, for the first time, explores these 
aspects in young people with and without a migratory background during the 
extended course of the pandemic and restrictive measures, comparing two 
countries with a high COVID-19 prevalence: Austria and Turkey.
METHODS: The authors used the "Psychological General Well-being" index as part 
of an anonymous online survey with 3665 participants (ages 15-25), recruited 
from both countries during the first and the second waves of the pandemic, 
collecting data on individual experiences and problems encountered during the 
pandemic.
RESULTS: Mental health (b = 0.06, p < 0.023) and general psychological 
well-being worsened with the progression of the pandemic. Participants with 
financial problems had the most severe negative effect on mental health (b = 
0.12, p < 0.001). Furthermore, females living in Turkey, both natives (b = 
-0.21, p < 0.001) and migrants (b = 0.25, p < 0.001), reported a more 
deteriorated mental health status over time.
CONCLUSIONS: The extended pandemic duration and resultant "lockdown" 
restrictions have negatively affected the mental health of young people to 
varying degrees, depending on country of residence and migration background. A 
strong "recovery plan" that considers group-specific needs and vulnerabilities 
is urgently needed.

DOI: 10.3390/ijerph182312795
PMCID: PMC8657101
PMID: 34886520 [Indexed for MEDLINE]

Conflict of interest statement: All authors declare no competing interest. 
Thomas Wenzel declared no conflict of interest. I had been invited to comment on 
the original proposal by the donor, but see no conflict of interest, as I 
received no funding or any remuneration myself. I only participated as an 
independent advisor and in writing the final paper based on a request to the WPA 
section. I do not work in the same department as the other authors.


2680. Int J Environ Res Public Health. 2021 Dec 3;18(23):12743. doi: 
10.3390/ijerph182312743.

Come for Information, Stay for Support: Harnessing the Power of Online Health 
Communities for Social Connectedness during the COVID-19 Pandemic.

Green BM(1), Hribar CA(2), Hayes S(1), Bhowmick A(1)(3), Herbert LB(1).

Author information:
(1)Health Union, LLC, Philadelphia, PA 19107, USA.
(2)School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, 
NC 27599, USA.
(3)Department of Health Behavior, Gillings School of Global Public Health, 
University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.

The COVID-19 pandemic created a globally shared stressor that saw a rise in the 
emphasis on mental and emotional wellbeing. However, historically, these topics 
were not openly discussed, leaving those struggling without professional 
support. One powerful tool to bridge the gap and facilitate connectedness during 
times of isolation is online health communities (OHCs). This study surveyed 
Health Union OHC members during the pandemic to determine the degree of COVID-19 
concern, social isolation, and mental health distress they are facing, as well 
as to assess where they are receiving information about COVID-19 and what 
sources of support they desire. The survey was completed in six independent 
waves between March 2020 and April 2021, and garnered 10,177 total responses. In 
the United States, OHCs were utilized significantly more during peak lockdown 
times, and the desire for emotional and/or mental health support increased over 
time. Open-ended responses demonstrated a strong desire for connection and 
validation, which are quintessential characteristics of OHCs. Through active 
moderation utilizing trained moderators, OHCs can provide a powerful, 
intermediate and safe space where conversations about mental and emotional 
wellbeing can be normalized and those in need are encouraged to seek additional 
assistance from healthcare professionals if warranted.

DOI: 10.3390/ijerph182312743
PMCID: PMC8656945
PMID: 34886468 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest with 
the reported research results.


2681. Int J Environ Res Public Health. 2021 Nov 30;18(23):12641. doi: 
10.3390/ijerph182312641.

What about the Consequences of the Use of Distance Learning during the COVID-19 
Pandemic? A Survey on the Psychological Effects in Both Children and Parents.

Maggio MG(1), Stagnitti MC(2), Calatozzo P(2), Cannavò A(3), Bruschetta D(3), 
Foti Cuzzola M(2), Manuli A(3), Pioggia G(4), Calabrò RS(5).

Author information:
(1)Department of Biomedical and Biotechnological Science, The University of 
Catania, 95123 Catania, Italy.
(2)Studio di Psicoterapia Relazionale e Riabilitazione Cognitiva, 98124 Messina, 
Italy.
(3)AOU Policlinico "G. Martino", 98125 Messina, Italy.
(4)Institute for Biomedical Research and Innovation, National Research Council 
of Italy (IRIB-CNR), 98164 Messina, Italy.
(5)IRCCS Centro Neurolesi "Bonino Pulejo", 98121 Messina, Italy.

BACKGROUND: The COVID-19 pandemic implicated many social restrictions, including 
the use of distance learning (DL). Indeed, parents were obligated to support 
their children in online lessons and schoolwork. The aim of this study was to 
investigate the psycho-emotional impact of the COVID-19 pandemic on parents and 
children submitted to DL.
METHODS: One hundred and ninety-two participants (96 parents and 96 children) 
were enrolled in this study. Parents and children completed an online 
questionnaire, structured in four sections.
RESULTS: The results showed that parents had higher levels of stress and 
anxiety. In particular, the stress for DL was positively correlated with 
depression and anxiety. Parents' jobs were negatively correlated with their 
levels of anxiety and stress. On the other hand, children reported higher levels 
of depressive symptoms and event-related anxiety, which increased as children 
got older. The stress and the anxiety in parents were positively correlated with 
the mood depression and anxiety of their children.
CONCLUSIONS: The COVID-19 pandemic had a negative impact on the psychological 
well-being of children and parents who used DL. Although DL could be an 
alternative teaching method during pandemics, face-to-face teaching is 
fundamental and irreplaceable as it encourages dialogue, involvement, and human 
contact.

DOI: 10.3390/ijerph182312641
PMCID: PMC8656827
PMID: 34886366 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2682. Int J Environ Res Public Health. 2021 Nov 30;18(23):12622. doi: 
10.3390/ijerph182312622.

Psychosocial and Biological Outcomes of Immersive, Mindfulness-Based Treks in 
Nature for Groups of Young Adults and Caregivers Affected by Cancer: Results 
from a Single Arm Program Evaluation from 2016-2021.

Victorson D(1)(2)(3), Doninger G(1), Victorson S(1), Victorson G(1), Hall L(4), 
Maletich C(1), Corr BR(1)(5), Scortino K(1), Burns Z(6), Allen L(1), Rosa I(1), 
Quirk K(1)(7), Adegbemi A(1), Strokoff J(1), Zuidema K(1)(8), Sajdak K(1), 
Mckibben T(4), Roberts A(4), McDade TW(9), Boes A(1), McAlinden K(1), Arredondo 
K(1), Sauer C(1)(2), Smith K(1)(3), Salsman JM(1)(10).

Author information:
(1)True North Treks, Evanston, IL 60201, USA.
(2)Department of Medical Social Sciences, Northwestern University Feinberg 
School of Medicine, Chicago, IL 60611, USA.
(3)Robert H. Lurie Comprehensive Cancer Center of Northwestern University, 
Chicago, IL 60611, USA.
(4)Breakwater Expeditions, Sandpoint, ID 83864, USA.
(5)Anschutz Medical Campus, University of Colorado Comprehensive Cancer Center, 
Aurora, CO 80045, USA.
(6)Encompass Learning, Duluth, MN 55804, USA.
(7)Department of Human Development and Family Studies, College of Health and 
Human Sciences, Colorado State University, Fort Collins, CO 80523, USA.
(8)Upper Penninsula Forestry Innovatoin Center, College of Agriculture and 
Natural Resources, Michigan State University, East Lansing, MI 48824, USA.
(9)Deparment of Anthropology and Institute for Policy Research, Weinberg College 
of Arts and Sciences, Northwestern University, Evanston, IL 60208, USA.
(10)Wake Forest School of Medicine and Wake Forest Baptist Comprehensive Cancer 
Center, Winston-Salem, NC 27157, USA.

The COVID-19 pandemic has left many individuals suffering from "connection 
deficit disorder" given changes to the way we work, go to school, socialize, and 
engage in daily activities. Young adults affected by cancer between the ages of 
18-39 have known this connection deficit long before the pandemic. Being 
diagnosed and treated for cancer during this time can significantly disrupt 
engagement in important educational, career, social, and reproductive pursuits, 
and contribute to increased stress, anxiety, depression, and other negative 
outcomes. Experiencing meaningful connection-with nature, with peers who 
understand, and with oneself, may help assuage this adverse effect of 
disconnect. A single arm within-subjects program evaluation was conducted to 
examine outcomes following participation in immersive, multi-night, 
mindfulness-based treks in nature in a sample of young adults (n = 157) and 
caregivers (n = 50) affected by cancer from 2016-2021. Pre to post-trek changes 
included significant (p < 0.001) self-reported improvements in feeling connected 
to nature (d = 0.93-0.95), peers (d = 1.1-1.3), and oneself (d = 0.57-1.5); 
significant (p < 0.001) improvements on PROMIS Anxiety (d = 0.62-0.78), 
Depression (d = 0.87-0.89), and Sleep Disturbance (d = 0.37-0.48) short forms; 
and significant (p < 0.05) changes in pro-inflammatory biomarkers (d = 
0.55-0.82). Connection-promoting experiences like this have the potential to 
improve health and wellbeing in this population and serve as a model for others.

DOI: 10.3390/ijerph182312622
PMCID: PMC8657001
PMID: 34886348 [Indexed for MEDLINE]

Conflict of interest statement: The authors David Victoron, Gretchen Doninger, 
Scott Victorson, and Gwen Victorson are co-founders of True North Treks. David 
Victorson and Gretchen Doninger have been volunteer directors since its 
incorporation and have never received financial remuneration for their 
activities. Scott Victorson and Gwen Victorson have both received payment for 
employment-related activities during their tenure, however neither works for 
True North Treks at present. Co-authors Lars Hall, Carly Maletich, Kelle Sadjak, 
Zachary Burns, Lori Allen, Ian Rosa, Kelley Quirk, Johanna Strokoff, Kile 
Zuidema, Kathy Scortino, Thomas Mckibben, Angie Roberts, Amanda Boes, and 
Christina Sauer have all received previous financial remuneration for employment 
or independent contractor-related activities related to the delivery of 
programming or services at True North Treks. Co-authors Brad Corr, Adekunle 
Adegbemi, Katie McAlinden, Karen Arredondo, Kristin Smith, and John Salsman are 
current volunteer board members of True North Treks and have never received 
financial remuneration for their services. Co-author Thomas McDade has no 
conflict to declare.


2683. Adicciones. 2023 Jul 1;35(2):143-150. doi: 10.20882/adicciones.1643.

Self-reported increase in alcohol and drugs intake as a coping strategy in 
hospital workers during COVID-19 outbreak: A cross-sectional study.

[Article in English, Spanish; Abstract available in Spanish from the publisher]

Madoz-Gúrpide A(1), Leira-Sanmartín M, Ibañez-Cuadrado Á, Ochoa-Mangado E.

Author information:
(1)Hospital Universitario Ramón y Cajal Instituto Ramón y Cajal de Investigación 
Sanitaria Universidad de Alcalá. amagur@yahoo.com.

Situations of psychological stress, such as the current COVID-19 pandemic, could 
lead to an increase in the consumption of alcohol and other drugs of abuse as an 
inadequate coping strategy in health workers. This study aimed to investigate 
the intake of alcohol and drugs of abuse in hospital workers during the first 
wave of COVID-19. A further focus was to define the worker profile most 
vulnerable to this behavior through a logistic regression analysis. A 
cross-sectional study in a tertiary hospital in Madrid, Spain, during the first 
wave of COVID-19 was designed. Information was collected from a sample (n = 657) 
of healthcare workers (n = 536) and non-healthcare workers (n = 121). An online 
survey (including questions about basic health habits, working environment 
conditions, sociodemographic data, and the 12-item version of the General Health 
Questionnaire as a measure of psychological well-being) was conducted. Increased 
consumption of alcohol and/or drugs of abuse during the analyzed period of the 
pandemic was reported by 17.1% of workers. The following variables were 
associated with a higher probability of increased consumption of alcohol and/or 
drugs of abuse: male gender (p = .044), living alone or without dependents (p = 
.005), staff physician or resident (p = .010), having worked on the COVID 
frontline (p = .058), poor nutritional habits (p = .004) and self-prescription 
of psychotropic drugs to manage anxiety and insomnia (p = .003). A significant 
percentage of hospital workers increased their consumption of alcohol and drugs 
of abuse during the first wave of the COVID-19 pandemic. A professional risk 
profile can be defined for this practice.

Publisher: Las situaciones de estrés psicológico, como la actual pandemia 
COVID-19, pueden implicar un aumento del consumo de alcohol y otras drogas de 
abuso como estrategia inadecuada de afrontamiento en profesionales sanitarios. 
Esta investigación tiene como objetivo estudiar el incremento de la ingesta de 
alcohol y drogas de abuso en los trabajadores hospitalarios. Persigue también, 
mediante un análisis de regresión logística, definir qué perfil de trabajador es 
el más vulnerable a este comportamiento. Para ello se realizó un estudio 
transversal en un hospital terciario en Madrid, España, durante la primera 
oleada de COVID-19. Participaron en el estudio un total de 657 trabajadores del 
hospital, 536 de ellos sanitarios y 121 no sanitarios. La recogida de datos se 
realizó a través de una encuesta en línea que incluía preguntas sobre hábitos 
básicos de salud, condiciones del entorno laboral, datos sociodemográficos, así 
como la versión de 12 ítems del Cuestionario de Salud General. El 17,1% declaró 
haber aumentado su consumo de alcohol y/o drogas de abuso durante el período 
analizado. Se asoció a una mayor probabilidad de dicho incremento: sexo 
masculino (p = ,044), vivir sin personas dependientes a cargo (p = ,005), ser 
médico adjunto o residente (p = ,010), haber trabajado en primera línea de COVID 
(p = ,058), presentar malos hábitos nutricionales (p = ,004) y realizar 
autoprescripción de fármacos psicotrópicos para controlar la ansiedad y el 
insomnio (p = ,003). Un porcentaje significativo de los trabajadores 
hospitalarios ha aumentado su consumo de alcohol y drogas de abuso durante la 
primera oleada de la pandemia COVID-19, existiendo un perfil de mayor riesgo 
para esta práctica.

DOI: 10.20882/adicciones.1643
PMID: 34882239 [Indexed for MEDLINE]


2684. J Am Geriatr Soc. 2022 Mar;70(3):669-676. doi: 10.1111/jgs.17607. Epub 2021 Dec 
13.

Can changes in social contact (frequency and mode) mitigate low mood before and 
during the COVID-19 pandemic? The I-CONECT project.

Wu CY(1)(2), Mattek N(1)(2), Wild K(1)(2), Miller LM(2)(3), Kaye JA(1)(2), 
Silbert LC(1)(2)(4), Dodge HH(1)(2).

Author information:
(1)Department of Neurology, Oregon Health & Science University (OHSU), Portland, 
Oregon, USA.
(2)Oregon Center for Aging & Technology (ORCATECH), Oregon Health & Science 
University (OHSU), Portland, Oregon, USA.
(3)School of Nursing, Oregon Health & Science University (OHSU), Portland, 
Oregon, USA.
(4)Department of Neurology, Veterans Affairs Portland Health Care System, 
Portland, Oregon, USA.

BACKGROUND/OBJECTIVES: The coronavirus disease 2019 (COVID-19) global outbreak 
allowed a natural experiment to observe how older adults changed social patterns 
and how it affected their emotional well-being. We studied the frequency and 
modes of social contact and their effects on older adults' mood before and 
during the COVID-19 pandemic.
DESIGN: Phone-based surveys were administered weekly before and during the 
COVID-19 pandemic.
SETTING: Participants were recruited from Portland, Oregon, and Detroit, 
Michigan.
PARTICIPANTS: Older adults ≥75 years old (n = 155, age = 81.0 ± 4.5, 72.3% 
women) were included in a randomized controlled trial, the Internet-Based 
Conversational Engagement Clinical Trial (I-CONECT).
MEASUREMENTS: Low mood was self-reported as feeling downhearted or blue for 
three or more days in the past week. Social contact was self-reported by the 
amount of time spent in interactions, with whom (family, friends, others), and 
via which modes (in-person, phone/video call, text/email/letter).
RESULTS: A total of 5525 weeks of data were derived from 155 participants. 
Before the COVID-19 pandemic, average social interaction time spent in-person, 
on phone/video call, and via text/email/letter was 406, 141, and 68 min/week, 
respectively. During the COVID-19 pandemic, time spent in-person was reduced by 
135 min/week, while time spent via phone/video call and writing increased by 33 
and 26 mins/week, respectively. In-person family contact was associated with 
less low mood regardless of the pandemic (odds ratio = 0.92, p < 0.05). There 
was a COVID-19 × text/email/letter with friends interaction (odds ratio = 0.77, 
p = 0.03), suggesting that during the COVID-19 pandemic, an increase of 1 h of 
writing with friends per week was associated with a 23% decrease in the 
likelihood of experiencing low mood.
CONCLUSION: The lost in-person time relating to COVID-19 restrictions tended to 
be partially compensated for with increased calls and writing time, although 
overall social interaction time decreased. During the COVID-19 pandemic, at 
least two types of social interactions (writing to friends and in-person family 
time) showed promise for mitigating low mood for older adults with limited 
social resources.

© 2021 The American Geriatrics Society.

DOI: 10.1111/jgs.17607
PMCID: PMC8904274
PMID: 34881436 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest: HHD serves as a consultant 
for Biogen. Other authors have no conflicts.


2685. Clin Endocrinol (Oxf). 2022 Jun;96(6):869-877. doi: 10.1111/cen.14649. Epub 2021 
Dec 8.

A survey on the psychological impact and access to health care of thyroid 
patients during the first SARS-COV-2 lockdown.

Pavlatou MG(1), Žarković M(2)(3), Hegedüs L(4), Priestley J(5), McMullan C(5), 
Perros P(6).

Author information:
(1)Department of Endocrinology, Diabetes and Metabolism, Athens Medical Center, 
Athens, Greece.
(2)Faculty of Medicine, University of Belgrade, Dr Subotića 8, Belgrade, Serbia.
(3)Department of Endocrinology, University of Belgrade, Belgrade, Serbia.
(4)Department of Endocrinology and Metabolism, Odense University Hospital, 
Odense, Denmark.
(5)British Thyroid Foundation, Harrogate, UK.
(6)Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, 
UK.

OBJECTIVE: Information on the impact of SARS-COV-2 on the daily life of thyroid 
patients during lockdown is sparse. The main objective was explorative, focusing 
on how SARS-COV-2 affected thyroid patients.
DESIGN: Cross-sectional, questionnaire-based, using an online platform.
PATIENTS: Patients >18 years with a history of thyroid disease.
MEASUREMENTS: Demographic data, psychological impact of SARS-COV-2, medical care 
during the pandemic.
RESULTS: Valid responses were received from 609 responders. The median age was 
50 years, 94% were female and 98.5% were UK residents. The commonest diagnosis 
was primary hypothyroidism (52.2%). Negative psychological effects following the 
lockdown were reported by 45.6%-58.7%. Cancellations of appointments with 
thyroid specialists were reported by 43.8%, although cancellations of thyroid 
investigations and treatments were relatively infrequent (12.9%-14.1%). Overall 
satisfaction rates for thyroid services were low (satisfaction score 40.1-42.8 
out of 100), but nearly 80% were satisfied with remote consultations. Responder 
ratings of online information sources about SARS-COV-2 and thyroid diseases were 
lowest for government sites. Unmet needs during lockdown were: more remote 
access to thyroid specialists, more online information in 'plain English', and 
psychological support. In multivariate analyses, younger age, female gender, 
history of depression, hyperthyroidism, not having contracted SARS-COV-2 and 
multiple comorbidities were risk factors for a negative psychological impact of 
lockdown.
CONCLUSIONS: This survey identified a significant negative impact of SARS-COV-2 
and lockdown on psychological wellbeing, particularly in some groups of patients 
defined by demographic factors, history of hyperthyroidism and comorbidities. 
Low satisfaction with healthcare services among thyroid patients was noted, but 
remote consultations were rated favourably.

© 2021 John Wiley & Sons Ltd.

DOI: 10.1111/cen.14649
PMID: 34881433 [Indexed for MEDLINE]


2686. BMJ Open. 2021 Dec 8;11(12):e054010. doi: 10.1136/bmjopen-2021-054010.

Exploring healthcare providers' perceptions of mental health amid COVID-19 
pandemic in obstetrics and gynaecology department of a tertiary care public 
sector hospital of Karachi, Pakistan: an exploratory qualitative study protocol.

Yasmin H(1), Sadia A(2), Qamar A(1), Shahil Feroz A(3)(4).

Author information:
(1)Obstetrics and Gynaecology, Jinnah Postgraduate Medical Center, Karachi, 
Pakistan.
(2)Community Health Sciences, Aga Khan University, Karachi, Pakistan.
(3)Community Health Sciences, Aga Khan University, Karachi, Pakistan 
anam.shahil@mail.utoronto.ca.
(4)Dalla Lana School of Public Health, Institute of Health Policy, Management 
and Evaluation, University of Toronto, Toronto, Ontario, Canada.

INTRODUCTION: In the wake of the unprecedented public health challenge of the 
COVID-19 pandemic, it is highly significant to recognise the mental health 
impact of this mounting threat on healthcare providers (HCPs) working in the 
obstetrics and gynaecology department. Experience from epidemics and emerging 
literature around COVID-19 show that the unparalleled amount of stress that HCPs 
are dealing with is linked with the increased burden of mental health 
conditions. We aim to conduct an exploratory qualitative descriptive study to 
assess HCPs' perceptions of mental health amid the COVID-19 pandemic in the 
obstetrics and gynaecology department of a public sector tertiary care hospital 
of Karachi, Pakistan.
METHODS AND ANALYSIS: This study will use a qualitative descriptive approach 
where approximately 20-25 HCPs from the obstetrics and gynaecology department 
will be recruited using a purposive sampling approach. Data will be collected 
through semistructured interviews and it will be analysed thematically using 
NVivo V.12 Plus software.
ETHICS AND DISSEMINATION: Ethical approval for this study has been obtained from 
the Institutional Review Board Committee of Jinnah Postgraduate Medical Center 
hospital. The study results will be disseminated to the scientific community and 
the HCPs participating in the study. The findings will help us to explore the 
doctor's perceptions of mental health during the current pandemic of COVID-19 
and its impact on their daily lives and mental well-being.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-054010
PMCID: PMC8655342
PMID: 34880024 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2687. BMC Public Health. 2021 Dec 8;21(1):2232. doi: 10.1186/s12889-021-12316-0.

Contested solidarity and vulnerability in social media-based public responses to 
COVID-19 policies of mobility restrictions in Singapore: a qualitative analysis 
of temporal evolution.

Ligo VAC(#)(1), Chang CM(1), Yi H(#)(2).

Author information:
(1)Saw Swee Hock School of Public Health, National University of Singapore and 
National University Health System, Singapore, Singapore.
(2)Saw Swee Hock School of Public Health, National University of Singapore and 
National University Health System, Singapore, Singapore. ephyh@nus.edu.sg.
(#)Contributed equally

BACKGROUND: Mobility restriction is the most effective measure to control the 
spread of infectious disease at its early stage, especially if a cure and 
vaccine are not available. When control of the coronavirus disease 2019 
(COVID-19) required strong precautionary measures, lockdowns were necessarily 
implemented in countries around the globe. Public health risk communication 
about the justification and scope of a lockdown was challenging as it involved a 
conflict between solidarity and individual liberty and a trade-off between 
various values across groups with different socioeconomic statuses. In the 
study, we examined public responses to the government-announced "circuit 
breaker" (a local term for lockdown) at four-time points in Singapore: (1) 
entry, (2) extension, (3) exit of lockdown 'phase 1' and (4) entry of lockdown 
'phase 2'.
METHODS: We randomly collected 100 comments from the relevant articles on new 
organisations' Facebook and Instagram pages and conducted preliminary coding. 
Later, additional random 20 comments were collected to check the data 
saturation. Content analysis was focused on identifying themes that emerged from 
the responses across the four-time points.
RESULTS: At the entry, public support for the lockdown was prevalent; yet most 
responses were abstract with uncertainty. At six weeks of lockdown, initial 
public responses with uncertainty turned into salient narratives of their lived 
experiences and hardship with lockdown and unmasking of societal weaknesses 
caused by COVID-19. At the entry to phase 2, responses were centred on 
social-economic impact, disparity, and lockdown burnout with the contested 
notion of continuing solidarity. A temporal pattern was seen in the 
rationalisation of the lockdown experience from trust, anxiety, attribution of 
pandemic and lockdown, blaming of non-compliant behaviours, and confusion.
CONCLUSIONS: The findings indicated a temporal evolution of public responses 
from solidarity, attribution of the sustained pandemic, increasing ambiguity 
towards strong precautionary measures, concerns about economic hardship and 
mental well-being to worsened social vulnerability, where the government's 
restrictive policies were questioned with anxiety and confusion. Public health 
risk communication in response to COVID-19 should be transparent and address 
health equity and social justice to enhance individual and collective 
responsibility in protecting the public from the pandemic.

© 2021. The Author(s).

DOI: 10.1186/s12889-021-12316-0
PMCID: PMC8652376
PMID: 34879835 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2688. Public Health. 2022 Jan;202:35-42. doi: 10.1016/j.puhe.2021.10.007. Epub 2021 
Oct 20.

Perceived changes in lifestyle behaviours and in mental health and wellbeing of 
elementary school children during the first COVID-19 lockdown in Canada.

Maximova K(1), Khan MKA(2), Dabravolskaj J(3), Maunula L(3), Ohinmaa A(3), 
Veugelers PJ(4).

Author information:
(1)MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. 
Michael's Hospital, 209 Victoria St, M5B 1T8, Toronto, Ontario, Canada; Dalla 
Lana School of Public Health, University of Toronto, 155 College St Room 500, 
M5T 3M7, Toronto, Ontario, Canada; School of Public Health, University of 
Alberta, 3-50E University Terrace, 8303 112 Street NW, T6G 1K4, Edmonton, 
Alberta, Canada.
(2)Dalla Lana School of Public Health, University of Toronto, 155 College St 
Room 500, M5T 3M7, Toronto, Ontario, Canada.
(3)School of Public Health, University of Alberta, 3-50E University Terrace, 
8303 112 Street NW, T6G 1K4, Edmonton, Alberta, Canada.
(4)School of Public Health, University of Alberta, 3-50E University Terrace, 
8303 112 Street NW, T6G 1K4, Edmonton, Alberta, Canada. Electronic address: 
paul.veugelers@ualberta.ca.

OBJECTIVES: The closure of schools to prevent the spread of COVID-19 prompted 
concerns of deteriorating lifestyle behaviours, mental health, and wellbeing of 
children, particularly those in socioeconomically disadvantaged settings. We 
assessed changes in lifestyle behaviours (physical activity, screen time, eating 
habits and bed/wake-up times), mental health and wellbeing during the first 
lockdown in Spring 2020 as perceived by school children from disadvantaged 
settings, and examined determinants of these changes.
STUDY DESIGN: Cross-sectional study.
METHODS: We surveyed 1095 grade 4 to 6 students (age 9-12 years) from 20 schools 
in socioeconomically disadvantaged communities in northern Canada. Students 
reported on changes in lifestyle behaviours, mental health and wellbeing during 
the lockdown. Determinants of these perceived changes were examined in 
multivariable regression models.
RESULTS: A majority of students reported declines in physical activity, having 
late bed/wake-up times, and modest improvements in mental health and wellbeing. 
Many students reported increases rather than decreases in screen time and 
snacking. Positive attitudes toward being active, eating healthy, going to sleep 
on time and being healthy were strongly associated with maintaining healthy 
lifestyle behaviours during the lockdown. Positive attitudes toward active and 
healthy living and healthy lifestyle behaviours were associated with maintaining 
positive mental health and wellbeing during the lockdown.
CONCLUSIONS: The considerable changes in lifestyle behaviors, superimposed on 
the pre-existing burden of unhealthy lifestyle behaviours, put this generation 
of children at increased risk for future chronic disease. Findings call for 
effective health promotion of active and healthy lifestyles to benefit both 
physical and mental health.

Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.puhe.2021.10.007
PMCID: PMC8645293
PMID: 34879321 [Indexed for MEDLINE]


2689. Drug Alcohol Rev. 2022 Sep;41(6):1293-1303. doi: 10.1111/dar.13415. Epub 2021 
Dec 7.

'Super googs on a Zoom, are you kidding me?': The pleasures and constraints of 
digitally-mediated alcohol and other drug consumption.

Duncan T(1)(2)(3), Dwyer R(1), Savic M(2)(3), Pennay A(1), MacLean S(4).

Author information:
(1)Centre for Alcohol Policy Research, La Trobe University, Melbourne, 
Australia.
(2)Monash Addiction Research Centre, Eastern Health Clinical School, Monash 
University, Melbourne, Australia.
(3)Turning Point, Eastern Health, Melbourne, Australia.
(4)School of Allied Health, Human Services and Sport, La Trobe University, 
Melbourne, Australia.

INTRODUCTION: The COVID-19 pandemic and associated social restrictions have 
profoundly shaped the routines, practices and space-times of alcohol and other 
drug (AOD) consumption. As a part of these transformations, video conferencing 
services (e.g. Zoom, Whereby) have emerged as popular mediums for socialising 
and AOD consumption. In this article, we adopt a more-than-human theoretical 
framework to explore how these online contexts re-shape experiences of AOD 
consumption.
METHODS: Data were gathered using a case-study approach, guided by principles of 
digital ethnography. We 'staged' the online gatherings of three established 
friendship clusters of adults in Melbourne, Australia, and drew on a discussion 
guide to elicit accounts of past online AOD encounters during the COVID-19 
pandemic. Our thematic analysis was sensitised to the dynamic composition of 
these encounters and the kinds of relations, practices and affects they enabled 
and constrained.
RESULTS: Composed via video conferencing services, AOD consumption afforded 
distinct pleasures, including enhanced sociality, excitement and momentary 
reprieves from isolation. Importantly, these effects were not uniform or stable. 
Participants also navigated various constraints of online AOD consumption while 
establishing for themselves what substances and associated practices 'fit' 
within these novel encounters.
DISCUSSION AND CONCLUSIONS: Our study conveys the importance of 
digitally-mediated AOD consumption as a site of socialising and pleasure. In so 
doing, it demonstrates the ways in which AOD consumption was drawn on in the 
everyday negotiation of health and wellbeing under lockdown conditions. We call 
for research and policy approaches that are sensitive to the affirmative 
potentials of digitally=mediated AOD encounters.

© 2021 Australasian Professional Society on Alcohol and other Drugs.

DOI: 10.1111/dar.13415
PMID: 34875140 [Indexed for MEDLINE]


2690. J Pediatr Psychol. 2022 Feb 14;47(2):135-147. doi: 10.1093/jpepsy/jsab120.

Exploring American Parents' Lived Experiences During the COVID-19 Pandemic: 
Ramifications for Well-Being.

Kaugars AS(1), Holly LE(1), Tait M(1), Oswald D(1).

Author information:
(1)Marquette University, Milwaukee, WI, USA.

OBJECTIVE: The objective of this study was to document the direct impact of the 
COVID-19 pandemic on parents and families in the United States.
METHODS: Parents' experiences during the pandemic were examined using an online 
survey (N = 564) collected during May and June 2020.
RESULTS: Parents reported experiencing a high frequency of COVID-19-related 
events (e.g., job loss and health concerns) and impact on their lives. Parents' 
experiences with COVID-19, as well as self-reported perceived increase in home 
labor, experiences with assisting children with remote schooling, and work-life 
conflict were all significantly associated with higher levels of parental role 
overload. COVID-19-related events and impact, as well as parental role overload, 
significantly predicted parents' anxiety and depression, even after controlling 
for demographic factors.
CONCLUSIONS: The findings suggest the importance of providing support for 
parents and families through direct services and public policy changes.

© The Author(s) 2021. Published by Oxford University Press on behalf of the 
Society of Pediatric Psychology. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/jpepsy/jsab120
PMCID: PMC8689727
PMID: 34875088 [Indexed for MEDLINE]


2691. Asian J Psychiatr. 2022 Jan;67:102957. doi: 10.1016/j.ajp.2021.102957. Epub 2021 
Nov 30.

The impact of school closure on children's well-being during the COVID-19 
pandemic.

Ortega Pacheco YJ(1), Barrero Toncel VI(2).

Author information:
(1)Social Psychology of Health, Aix-Marseille University, Marseille, France. 
Electronic address: yesid.1594@gmail.com.
(2)Education and Social Development, University of Manizales, Manizales, 
Colombia.

DOI: 10.1016/j.ajp.2021.102957
PMCID: PMC8641925
PMID: 34871968 [Indexed for MEDLINE]

Conflict of interest statement: The authors report no financial or other 
relationship relevant to the subject of this article.


2692. Med Pr. 2021 Dec 22;72(6):645-652. doi: 10.13075/mp.5893.01181. Epub 2021 Dec 6.

Job insecurity and emotional disturbance of Polish employees during pandemic 
COVID-19.

Chirkowska-Smolak T(1), Chumak M(1).

Author information:
(1)Adam Mickiewicz University, Poznań, Poland (Faculty of Psychology and 
Cognitive Science).

BACKGROUND: The pandemic, as an event that is new and dangerous to the health 
and life of the population, has put employees at risk of losing their job and 
experiencing deteriorating working and employment conditions. In this situation, 
authors were particularly concerned with the extent to which job insecurity 
(both quantitative and qualitative) contributed to the deterioration of workers' 
well-being.
MATERIAL AND METHODS: The study was carried out on 382 Polish employees in April 
and May 2020. The following research tools were used: the Job Insecurity in 
Pandemic Scale by Chirkowska-Smolak and Czumak and the Depression, Anxiety, 
Stress Scale (DASS-21) by Levibond and Levibond.
RESULTS: The quantitative and qualitative job insecurity were significant 
predictors of depression and stress, but they did not explain anxiety symptoms. 
The scope of the explained variance of these negative emotional states by 
concerns related to work and employment was not large (from 11% to 17.6%). The 
moderating role of perceived employability was confirmed only in the case of the 
relationship between qualitative job insecurity and depression, as well as 
quantitative job insecurity and stress. However, the increase in the explained 
variance was very small.
CONCLUSIONS: Uncertainty related to the maintenance of employment and concerns 
about the deterioration of working conditions due to the COVID-19 pandemic had 
an impact on emotional disturbances of employees, but they only explained some 
of the variance of depression and stress and did not affect the perceived level 
of anxiety. The smaller role of economic stress in the emergence of negative 
emotional states could be associated with the occurrence of much more serious 
threats to the health and life of the population in this period. The very low 
level of unemployment in Poland, which remained at a similar level throughout 
the pandemic despite the catastrophic forecasts of economists, could also have 
played an important role. Med Pr. 2021;72(6):645-52.

This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL 
license.

DOI: 10.13075/mp.5893.01181
PMID: 34870642 [Indexed for MEDLINE]


2693. J Neurosurg Anesthesiol. 2022 Jan 1;34(1):122-126. doi: 
10.1097/ANA.0000000000000806.

COVID-19 Impact on Resident Mental Health and Well-Being.

Jaconia GD(1), Lynch LR(1), Miller LK(1), Hines RL(2), Pinyavat T(1).

Author information:
(1)Department of Anesthesiology, Columbia University, New York, NY.
(2)Department of Anesthesiology, Yale University, New Haven, CT.

Columbia University's Papper Symposium, a virtual event held on March 20, 2021, 
was dedicated to the coronavirus disease-2019 (COVID-19) pandemic. This article 
summarizes a lecture by Dr. Roberta Hines, Nicholas M. Greene Professor of 
Anesthesiology and Department Chair and Chief of Anesthesiology at Yale-New 
Haven Hospital titled "The impact of COVID-19 on trainees: lessons learned and 
unanticipated opportunities," in addition draws from experiences at Columbia 
University Irving Medical Center and a focused review of the literature on the 
toll of the pandemic on trainee well-being and mental health. Early research has 
demonstrated that rates of burnout and acute stress were higher among health 
care providers who cared for COVID-19 patients than those who did not and that 
COVID-19 frontline health care providers are at high risk for common 
psychological disorders, including depression, anxiety, and post-traumatic 
stress disorder. Trainees working on the frontlines may be at particularly high 
risk for these mental health disorders and are less likely to access resources 
available to them. Program directors and hospital graduate medical education 
leaders should be aware of the threats to physiological and psychological safety 
and take action to prevent further detrimental effects. The rates of burnout and 
mental health disorders among trainees are expected to rise as a result of the 
pandemic, making screening programs and increased access to mental health 
treatment an essential feature of all residency and fellowship programs.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/ANA.0000000000000806
PMID: 34870634 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
disclose.


2694. J Nurs Educ. 2021 Dec;60(12):674-679. doi: 10.3928/01484834-20211004-02. Epub 
2021 Dec 1.

Students, Stress, and the Pandemic: An Occupational Health Perspective for 
Nursing Education.

Hughes MJ.

BACKGROUND: Nursing students have high risk factors for stress, and the 
coronavirus disease 2019 pandemic underscored weaknesses in mitigating nursing 
student stress and supporting well-being. Occupational health uses proven 
frameworks and perspectives for understanding and mitigating health risks, and 
promoting worker wellness. Nurse educators can draw from this knowledge to 
implement system-level changes in support of a safe and healthy learning 
environment.
METHOD: This article describes the use of an occupational health strategy to 
create healthier educational environments.
RESULTS: Applying occupational health concepts to nursing education supports 
honest appraisal of mental health dangers to students, offers keys to managing 
student health risks, and provides effective approaches for communicating risks 
with mitigation tactics.
CONCLUSION: An occupational health and safety perspective creates a lens through 
which nursing stress resulting from the pandemic can be viewed and managed 
creatively using a holistic approach to mitigate harm from stress in the nursing 
educational setting. [J Nurs Educ. 2021;60(12):674-679.].

DOI: 10.3928/01484834-20211004-02
PMID: 34870498 [Indexed for MEDLINE]


2695. Psychodyn Psychiatry. 2021 Winter;49(4):543-561. doi: 
10.1521/pdps.2021.49.4.543.

Burnout and Moral Injury Among Consultation-Liaison Psychiatry Trainees.

Sales PMG(1), Arshed A(2), Cosmo C(3), Li P(4), Garrett M(5), Cohen MA(6).

Author information:
(1)An Assistant Professor of Psychiatry at the University of Alabama, 
Birmingham.
(2)A Clinical Assistant Professor of Psychiatry at the NYU Grossman School of 
Medicine, New York.
(3)A Psychiatry Resident at the Department of Psychiatry and Human Behavior, 
Alpert Medical School of Brown University, and VA RR&D Center for 
Neurorestoration and Neurotechnology, Providence VA, Providence, Rhode Island.
(4)A medical student at The Warren Alpert Medical School of Brown University, 
Providence, Rhode Island.
(5)A Clinical Professor of Psychiatry at SUNY Downstate, New York.
(6)A Clinical Professor of Psychiatry at the Icahn School of Medicine at Mount 
Sinai, New York.

Burnout and moral injury within medicine have steadily increased over the last 
decades, especially among those providing care during the COVID-19 pandemic. The 
term burnout has been used to describe clinician distress and a syndrome of 
emotional exhaustion, a diminished sense of personal accomplishment, and 
depersonalization. Burnout has a significant impact on both job performance and 
patient care. Moral injury occurs when external circumstances interact with a 
person's cherished beliefs and standards. When the tension between them cannot 
be reconciled, the felt integrity of the individual is disrupted and the person 
experiences distress. The consultative aspect in consultation-liaison psychiatry 
(CLP) presents challenges that may predispose the young clinician to burnout and 
moral injury, especially during fellowship training. CLP psychiatrists also have 
a liaison role that could catalyze systemlevel change to enhance the mental 
well-being of their colleagues. This article reviews clinically relevant 
psychodynamic aspects of burnout and moral injury during CLP training. In 
addition, the authors propose strategies to enhance career growth and prevent 
and address moral injury during training to generate fulfilling professional 
development.

DOI: 10.1521/pdps.2021.49.4.543
PMCID: PMC9233943
PMID: 34870461 [Indexed for MEDLINE]


2696. Front Public Health. 2021 Nov 19;9:775374. doi: 10.3389/fpubh.2021.775374. 
eCollection 2021.

Sleep Quality and Mental Health of Medical Students in Greece During the 
COVID-19 Pandemic.

Eleftheriou A(1), Rokou A(1), Arvaniti A(2), Nena E(3), Steiropoulos P(4).

Author information:
(1)Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
(2)Department of Psychiatry, Medical School, Democritus University of Thrace, 
Alexandroupolis, Greece.
(3)Laboratory of Social Medicine, Medical School, Democritus University of 
Thrace, Alexandroupolis, Greece.
(4)Department of Pulmonology, Medical School, Democritus University of Thrace, 
Alexandroupolis, Greece.

Background-Aim: Medical students have been greatly affected by the COVID-19 
pandemic due to their educational program, which comprises theoretical knowledge 
and also clinical duties, making them vulnerable to viral exposures and possibly 
affecting their everyday life. The aim of this study was to explore changes in 
sleep and mental health parameters among medical students in Greece during the 
second year of the pandemic. Methods: This cross-sectional study comprised 
students of all medical schools in Greece (n = 7), using an anonymous online 
survey. Participants completed the following questionnaires: Pittsburgh Sleep 
Quality Index (PSQI), Athens Insomnia Scale (AIS), Fatigue Severity Scale (FSS), 
General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9). 
Statistical analysis was conducted with the use of SPSS v.26 (IBM SPSS, Armonk 
NY, USA). Results: Out of the 562 received responses, 559 met the inclusion 
criteria. The largest proportion of the respondents came from 4th-year (27.8%) 
and the majority of the sample were females (69.8%). Only 5.9% of the 
participants reported having been infected by SARS-COV-2. Most of the 
respondents experienced insomnia (65.9%, mean AIS score: 7.59 ± 4.24), poor 
sleep quality (52.4%, mean PSQI score: 6.6 ± 3.25) and increased fatigue (48.5%, 
mean 35.82 ± 11.74). Moderate to severe symptoms of anxiety (mean 9.04 ± 5.66) 
and depression (mean 9.36 ± 6.15) were noted. Suicidal ideation was found in 
16.7% of the sample, while use of sleeping pills in the previous month was 
reported by 8.8% (n = 47). Further analysis revealed independent associations 
between sleep and mental health parameters. Higher AIS score was associated with 
greater FSS score; higher PSQI scores with higher GAD-7 and PHQ-9 scores. 
Additionally, female students were found to be significantly more affected than 
males by the COVID-19 pandemic, displaying higher levels of insomnia, sleep 
disturbances, anxiety and depression. In addition, those with a history of 
COVID-19 infection or in close proximity with a positive case reported 
significantly more significant post-traumatic symptoms in IES-COVID-19 
questionnaire. Conclusions: In the aftermath of the COVID-19 pandemic, 
prevalence of sleep and mental health disorders among Greek medical students is 
significant, highlighting the need for better surveillance of students' 
wellbeing and subsequent counseling, with special focus on female students and 
other affected groups.

Copyright © 2021 Eleftheriou, Rokou, Arvaniti, Nena and Steiropoulos.

DOI: 10.3389/fpubh.2021.775374
PMCID: PMC8639533
PMID: 34869189 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2697. Arch Psychiatr Nurs. 2021 Dec;35(6):653-657. doi: 10.1016/j.apnu.2021.08.002. 
Epub 2021 Aug 10.

"I'm losing everything all over again": Responses from youth experiencing 
homelessness during the COVID-19 pandemic.

Rew L(1), Yeargain O(2), Peretz C(3), Croce E(2).

Author information:
(1)The University of Texas at Austin School of Nursing, Austin, TX, United 
States of America. Electronic address: ellerew@mail.utexas.edu.
(2)The University of Texas at Austin School of Nursing, Austin, TX, United 
States of America.
(3)The University of Texas at Austin Hicks School of Social Work, Austin, TX, 
United States of America.

PURPOSE: Already at high-risk for adverse consequences associated with daily 
living, youth experiencing homelessness face additional barriers to health and 
well-being during the COVID-19 pandemic. The purpose of this study was to 
identify the self-reported experiences and healthcare needs of youth 
experiencing homelessness as services in the community began to shut down at the 
beginning of the pandemic.
METHOD: From May through November 2020, qualitative data were obtained by 
telephone or Facebook messenger from 20 youth (M = 22.4, SD = 2.64 years) who 
had been enrolled in a longitudinal intervention study.
RESULTS: Content analysis of qualitative data yielded 5 categories and 1 overall 
theme. Categories were resource availability, financial instability, mental 
health, relationship conflict, and maladaptive coping. The overall theme was 
multiple losses. Youths lost jobs, means of financial support for self and 
family, access to social and healthcare services, meaningful and important 
relationships, and skills and controls over high-risk behaviors such as 
substance abuse.
CONCLUSIONS: Having similar experiences such as social isolation as those of 
high school students during the pandemic, the youths in this sample experienced 
multiple and simultaneous losses, needing time to grieve, and leaving them once 
more at high-risk for adverse outcomes.

Copyright © 2021 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.apnu.2021.08.002
PMCID: PMC8551686
PMID: 34861960 [Indexed for MEDLINE]


2698. Am J Mens Health. 2021 Nov-Dec;15(6):15579883211062681. doi: 
10.1177/15579883211062681.

Health and Access to Gender-Affirming Care During COVID-19: Experiences of 
transmasculine individuals and men assigned female sex at birth.

D'Angelo AB(1)(2), Argenio K(1), Westmoreland DA(1)(2), Appenroth MN(3), Grov 
C(1)(2).

Author information:
(1)The City University of New York Graduate School of Public Health and Health 
Policy, New York, NY, USA.
(2)The City University of New York Institute for Implementation Science in 
Population Health, New York, NY, USA.
(3)Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, 
Germany.

Since the onset of the COVID-19 pandemic, global research has suggested that the 
pandemic has negatively affected lesbian, gay, bisexual, transgender, and queer 
or questioning (LGBTQ) populations, including by limiting health care access. 
There is little research on the impact of COVID-19 among transmasculine persons 
and men assigned female sex at birth (AFAB) in the United States, who face 
unique health care challenges outside of the pandemic context. Between May and 
June of 2020, 20 transmasculine individuals and AFAB men who have sex with men 
participated in semi-structured interviews about their experiences during the 
early months of the COVID-19 pandemic. Participants were asked how the pandemic 
affected their access to health care, overall health, and well-being. Interviews 
were analyzed using an inductive, thematic approach. Participants reported 
reduced access to in-person health care, which in some cases meant overdue 
hormone-related bloodwork and unmet health care needs. Most participants 
reported that they were able to maintain their testosterone regimen, although 
some were concerned about future access, citing anxiety about potential 
shortages. Three participants reported canceled or deferred gender-affirming 
procedures, which they were uncertain would be rescheduled soon. Participants 
generally reported that the expansion of telehealth improved access to care, 
particularly for gender-affirming psychotherapy that was otherwise inaccessible 
or inconvenient prior to the pandemic. Other salient themes include the 
pandemic's impact on health behaviors and daily routines. Although the COVID-19 
pandemic created new challenges for maintaining health, it also expanded access 
to gender-affirming health care, largely through the expansion of telehealth. 
Our findings provide new insights for supporting the health of transmasculine 
individuals and AFAB men.

DOI: 10.1177/15579883211062681
PMCID: PMC8646200
PMID: 34861796 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


2699. J Infect Public Health. 2022 Jan;15(1):21-28. doi: 10.1016/j.jiph.2021.11.016. 
Epub 2021 Nov 18.

Long term predictors of breathlessness, exercise intolerance, chronic fatigue 
and well-being in hospitalized patients with COVID-19: A cohort study with 4 
months median follow-up.

Tleyjeh IM(1), Saddik B(2), Ramakrishnan RK(2), AlSwaidan N(3), AlAnazi A(3), 
Alhazmi D(3), Aloufi A(4), AlSumait F(3), Berbari EF(5), Halwani R(6).

Author information:
(1)Infectious Diseases Section, Department of Medical Specialties, King Fahad 
Medical City, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, 
Riyadh, Saudi Arabia; Division of Infectious Diseases, Mayo Clinic College of 
Medicine and Science, Rochester, MN, USA; Division of Epidemiology, Mayo Clinic 
College of Medicine and Science, Rochester, MN, USA. Electronic address: 
Tleyjeh.Imad@mayo.edu.
(2)Sharjah Institute for Medical Research, University of Sharjah, Sharjah, 
United Arab Emirates; College of Medicine, University of Sharjah, Sharjah, 
United Arab Emirates.
(3)Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi 
Arabia.
(4)Infectious Diseases Section, Department of Medical Specialties, King Fahad 
Medical City, Riyadh, Saudi Arabia.
(5)Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, 
Rochester, MN, USA.
(6)Sharjah Institute for Medical Research, University of Sharjah, Sharjah, 
United Arab Emirates; College of Medicine, University of Sharjah, Sharjah, 
United Arab Emirates; Prince Abdullah Ben Khaled Celiac Disease Chair, 
Department of Pediatrics, Faculty of Medicine, King Saud University, Riyadh, 
Saudi Arabia.

BACKGROUND: Post-acute COVID-19 syndrome (PACS) is an emerging healthcare 
burden. We therefore aimed to determine predictors of different functional 
outcomes after hospital discharge in patients with COVID-19.
METHODS: An ambidirectional cohort study was conducted between May and July 
2020, in which PCR-confirmed COVID-19 patients underwent a standardized 
telephone assessment between 6 weeks and 6 months post discharge. We excluded 
patients who died, had a mental illness or failed to respond to two follow-up 
phone calls. The medical research council (MRC) dyspnea scale, metabolic 
equivalent of task (MET) score for exercise tolerance, chronic fatigability 
syndrome (CFS) scale and World Health Organization-five well-being index (WHO-5) 
for mental health were used to evaluate symptoms at follow-up.
RESULTS: 375 patients were contacted and 153 failed to respond. The median 
timing for the follow-up assessment was 122 days (IQR, 109-158). On multivariate 
analyses, female gender, pre-existing lung disease, headache at presentation, 
intensive care unit (ICU) admission, critical COVID-19 and post-discharge ER 
visit were predictors of higher MRC scores at follow-up. Female gender, older 
age >67 years, arterial hypertension and emergency room (ER) visit were 
associated with lower MET exercise tolerance scores. Female gender, pre-existing 
lung disease, and ER visit were associated with higher risk of CFS. Age, 
dyslipidemia, hypertension, pre-existing lung disease and duration of symptoms 
were negatively associated with WHO-5 score.
CONCLUSIONS: Several risk factors were associated with an increased risk of 
PACS. Hospitalized patients with COVID-19 who are at risk for PACS may benefit 
from a targeted pre-emptive follow-up and rehabilitation programs.

Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.jiph.2021.11.016
PMCID: PMC8600938
PMID: 34861604 [Indexed for MEDLINE]


2700. Eur Rev Med Pharmacol Sci. 2021 Nov;25(22):6941-6958. doi: 
10.26355/eurrev_202111_27243.

COVID-19 pandemic related excessive electronic media exposure and mental health 
in Saudi Arabia.

Alnohair S(1), Syed NK, Ahmed HG, Sharaf F, Alshehri F, Haque S, Griffiths MD.

Author information:
(1)Department of Family and Community Medicine, College of Medicine, Qassim 
University, Buraydah, Saudi Arabia. shafiul.haque@hotmail.com.

OBJECTIVE: Due to the continued spread of COVID-19 and the emergence of novel 
mutated viral variants, families all over the world are experiencing 
wide-ranging stressors that threaten not only their financial well-being but 
also their physical and mental health. The present study assessed the 
association between excessive electronic media exposure of pandemic-related news 
and mental health of the residents of Ha'il Province, Saudi Arabia. The present 
study also assessed the prevalence of perceived stress, fear of COVID-19, 
anxiety, depression, and loneliness due to COVID-19-related restrictions in the 
same population.
MATERIALS AND METHODS: A total of 490 residents of Ha'il Province participated 
in a cross-sectional online survey during a two-month period (March to April 
2021). A validated 38-item self-report survey was used to collect the data.
RESULTS: Significant associations were reported between excessive electronic 
media exposure and the prevalence of perceived stress (χ2=140.56; p<.001), 
generalized anxiety (χ2=74.55; p<.001), depression (χ2=71.58; p<.001), 
COVID-19-related fear (χ2=24.54; p<.001), and loneliness (χ2=11.46; p<.001). It 
was also found that participants without depressive symptoms were 0.28 times 
less likely to have been exposed to excessive electronic media exposure (AOR: 
0.28; C.I. 0.16-0.48; p<.001). Similarly, participants with no stress/mild 
stress were 0.32 times less likely to have been exposed to excessive electronic 
media exposure (AOR: 0.32; C.I. 0.19-0.52; p<.001).
CONCLUSIONS: The findings of the present study suggest an urgent need for 
educational resilience programs (online and in-person) for susceptible 
individuals (females, unemployed, urban residents, etc.). Such programs would 
help them to develop skills to cope with the psychological impact of the 
COVID-19 pandemic.

DOI: 10.26355/eurrev_202111_27243
PMID: 34859856 [Indexed for MEDLINE]


2701. Front Public Health. 2021 Nov 11;9:701920. doi: 10.3389/fpubh.2021.701920. 
eCollection 2021.

Psychological Distress Among Healthcare Professionals During the Early Stages of 
the COVID-19 Outbreak in Low Resource Settings: A Cross-Sectional Study in 
Bangladesh.

Hossain MR(1), Patwary MM(2)(3), Sultana R(2), Browning MHEM(4).

Author information:
(1)Institute of Disaster Management, Khulna University of Engineering & 
Technology, Khulna, Bangladesh.
(2)Environmental Science Discipline, Life Science School, Khulna University, 
Khulna, Bangladesh.
(3)Environment and Sustainability Research Initiative, Khulna, Bangladesh.
(4)Department of Parks, Recreation and Tourism Management, Clemson University, 
Clemson, SC, United States.

The COVID-19 pandemic has been very destructive to and compromised the 
functioning of all nations' public health systems. In the absence of a vaccine, 
healthcare workers have been employed to relentlessly fight against COVID-19. 
The psychological status of healthcare workers during the pandemic in countries 
with limited resources, notably Bangladesh, remains unclear. The present study 
aimed to investigate the psychological states of frontline and non-frontline 
Bangladeshi healthcare workers during the early stages of the COVID-19 outbreak. 
An online cross-sectional study was conducted from May 5 to 31, 2020 with 203 
respondents. Psychological states were measured with a self-reported numerical 
scale of fear, the Generalized Anxiety Disorder (GAD-7) scale, and the Patient 
Health Questionnaire (PHQ-9). The prevalence rates of fear, anxiety, and 
depression were 60.6, 71.9, and 55.2%, respectively. Compared to non-frontline 
workers, frontline workers reported higher rates of anxiety (79.0 vs. 67.2%) and 
depression (65.4 vs. 48.4%). Multivariate logistic regression models showed that 
working in a public institution, being employed for <5 years, and being 
over-worked were risk factors for developing psychological distress. Our 
findings emphasize the need for timely psychological interventions to support 
the mental well-being of healthcare professionals in Bangladesh.

Copyright © 2021 Hossain, Patwary, Sultana and Browning.

DOI: 10.3389/fpubh.2021.701920
PMCID: PMC8632035
PMID: 34858914 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2702. Sci Rep. 2021 Dec 2;11(1):23349. doi: 10.1038/s41598-021-02702-4.

Lifestyle and mental health 1 year into COVID-19.

Barbieri PN(1), Giuntella O(#)(2)(3), Saccardo S(#)(4), Sadoff S(#)(5).

Author information:
(1)Centre for Health Economics, University of Gothenburg, Gothneburg, Sweden. 
paolo.barbieri@economics.gu.se.
(2)Department of Economics, University of Pittsburgh, Pittsburgh, USA.
(3)Institute of Labor Economics - IZA, Bonn, Germany.
(4)Department of Social and Decision Sciences, Carnegie Mellon University, 
Pittsburgh, USA.
(5)University of California San Diego, San Diego, USA.
(#)Contributed equally

Erratum in
    Sci Rep. 2021 Dec 8;11(1):23969.

In previous work, Giuntella et al. (Proc Natl Acad Sci 118:e2016632118, 2021), 
we documented large disruptions to physical activity, sleep, time use and mental 
health among young adults at the onset of the COVID-19 pandemic in Spring 2020. 
This study explores the trends 1 year into COVID-19, as vaccines began to roll 
out, COVID-19 deaths declined, and social distancing measures eased in the 
United States. We combine biometric and survey data from multiple cohorts of 
college students spanning Spring 2019 through Spring 2021 (N = 1179). Our 
results show persistent impacts of the pandemic on physical activity and mental 
health. One year into the pandemic, daily steps averaged about 6300 per day 
compared to about 9800 per day prior to the pandemic, a 35% decline. Almost half 
of participants were at risk of clinical depression compared to a little over 
one-third prior to the pandemic, a 36% increase. The impacts on screen time, 
social interactions and sleep duration at the onset of COVID-19 largely 
dissipated over the course of the pandemic, though screen time remained 
significantly higher than pre-pandemic levels. In contrast to the sharp changes 
in lifestyle and mental health documented as the pandemic emerged in March 2020, 
we do not find evidence of behavioral changes or improvements in mental 
well-being over the course of Spring 2021 as the pandemic eased.

© 2021. The Author(s).

DOI: 10.1038/s41598-021-02702-4
PMCID: PMC8640003
PMID: 34857806 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


2703. Am J Pharm Educ. 2022 Nov;86(9):ajpe8847. doi: 10.5688/ajpe8847. Epub 2021 Dec 
2.

The Role of Educators in Supporting the Mental Well-being of Postgraduate 
Pharmacist Distance Learners.

Hassam Z(1), Gulzar N(2), Latif A(3).

Author information:
(1)De Montfort University, School of Pharmacy, Faculty of Health and Life 
Sciences, Leicester, England zeenat.hassam@hee.nhs.uk.
(2)De Montfort University, School of Pharmacy, Faculty of Health and Life 
Sciences, Leicester, England.
(3)University of Nottingham, School of Health Sciences, Faculty of Medicine and 
Health Sciences, Nottingham, England.

Frontline health care professionals have experienced rapid changes to workloads 
and work-related pressures during the COVID-19 pandemic, resulting in anxiety, 
depression, and mental health stressors. For working professionals engaged in 
postgraduate pharmacy distance learning, access to educators was seen as a means 
to relay some of these stories and offload the stress caused by these 
unprecedented circumstances. The postgraduate pharmacy education team at De 
Montfort University felt a moral responsibility to provide extra support and 
extended their roles toward offering greater well-being support. In this 
commentary, we detail the emergence of this new role and offer insights into how 
this was fashioned and its significance for catering to the mental health needs 
of pharmacists. This role has largely gone undetected, and research is needed to 
investigate the acceptability and feasibility of such a model and its 
plausibility and sustainability in the long-term.

© 2022 American Association of Colleges of Pharmacy.

DOI: 10.5688/ajpe8847
PMCID: PMC10159394
PMID: 34857532 [Indexed for MEDLINE]


2704. J Psychiatr Res. 2022 Feb;146:228-233. doi: 10.1016/j.jpsychires.2021.11.011. 
Epub 2021 Nov 7.

Promoting resilience in healthcare workers during the COVID-19 pandemic with a 
brief online intervention.

DeTore NR(1), Sylvia L(2), Park ER(3), Burke A(2), Levison JH(4), Shannon A(5), 
Choi KW(2), Jain FA(2), Coman DC(2), Herman J(2), Perlis R(2), Fava M(2), Holt 
DJ(2).

Author information:
(1)Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; 
Harvard Medical School, Boston, MA, USA. Electronic address: 
ndetore@mgh.harvard.edu.
(2)Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; 
Harvard Medical School, Boston, MA, USA.
(3)Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; 
Harvard Medical School, Boston, MA, USA; Department of Medicine, Massachusetts 
General Hospital, Boston, MA, USA.
(4)Harvard Medical School, Boston, MA, USA; Department of Medicine, 
Massachusetts General Hospital, Boston, MA, USA.
(5)Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.

INTRODUCTION: The psychological wellbeing of healthcare workers has been 
impacted by the high levels of stress many have experienced during the 
Coronavirus Disease 2019 (COVID-19) pandemic. This study aimed to examine the 
feasibility and acceptability of a brief online course focused on introducing 
evidence-based skills that could increase resilience and decreases emotional 
distress in healthcare workers during the pandemic.
MATERIALS AND METHODS: Employees of a large healthcare system completed a mental 
health survey at baseline, and then one month and two months after some 
employees participated in an online resilience-enhancement course consisting of 
three 12-19 min videos focused on mindfulness, mentalization, and 
self-compassion.
RESULTS: A total of 554 participants completed the baseline survey, endorsing 
moderate to high levels of emotional distress. Of those who completed all three 
assessments and participated in the course (n = 38), significant improvements in 
resilience and reductions in emotional distress were found one and two months 
later, in comparison to those who did not participate in the course (n = 110).
DISCUSSION: These findings suggest that a brief, online intervention can improve 
the mental health of healthcare workers during a crisis such as the COVID-19 
pandemic.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.jpsychires.2021.11.011
PMCID: PMC8572311
PMID: 34857369 [Indexed for MEDLINE]

Conflict of interest statement: Dr. Perlis has received consulting fees from 
Burrage Capital, RID Ventures, Genomind, and Takeda, and he holds equity in 
Outermost Therapeutics and Psy Therapeutics; these activities are unrelated to 
the present work. Dr. Sylvia has served as a consultant for United Biosource 
Corporation, Clintara, Bracket, and Clinical Trials Network and Institute. She 
receives royalties from New Harbinger and has received grant/research support 
from NIMH, PCORI, AFSP, and Takeda. Dr. Fava's lifetime financial disclosures 
are listed here. All other authors have no disclosures to report.


2705. Int J Nurs Stud. 2022 Feb;126:104136. doi: 10.1016/j.ijnurstu.2021.104136. Epub 
2021 Nov 12.

Global prevalence and associated risk factors of posttraumatic stress disorder 
during COVID-19 pandemic: A meta-analysis.

Yunitri N(1), Chu H(2), Kang XL(3), Jen HJ(4), Pien LC(5), Tsai HT(6), Kamil 
AR(7), Chou KR(8).

Author information:
(1)School of Nursing, College of Nursing, Taipei Medical University, Taipei, 
Taiwan; Mental Health and Psychiatric Nursing Department, Faculty of Nursing, 
Universitas Muhammadiyah Jakarta, Indonesia.
(2)Institute of Aerospace and Undersea Medicine, School of Medicine, National 
Defense Medical Center, Taipei, Taiwan; Department of Neurology, Tri-Service 
General Hospital, National Defense Medical Center, Taipei, Taiwan.
(3)School of Nursing, College of Nursing, Taipei Medical University, Taipei, 
Taiwan; School of Nursing, University of Pennsylvania, Philadelphia, USA.
(4)School of Nursing, College of Nursing, Taipei Medical University, Taipei, 
Taiwan; Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New 
Taipei, Taiwan.
(5)Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical 
University, Taipei, Taiwan; Psychiatric Research Center, Wan Fang Hospital, 
Taipei Medical University, Taipei, Taiwan.
(6)School of Nursing, College of Nursing, Taipei Medical University, Taipei, 
Taiwan; Post-Baccalaureate Program in Nursing, College of Nursing, Taipei 
Medical University, Taipei, Taiwan.
(7)Medical Surgical Nursing Department, Faculty of Nursing, Universitas 
Muhammadiyah Jakarta, Indonesia.
(8)School of Nursing, College of Nursing, Taipei Medical University, Taipei, 
Taiwan; Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New 
Taipei, Taiwan; Center for Nursing and Healthcare Research in Clinical Practice 
Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; 
Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan. 
Electronic address: kueiru@tmu.edu.tw.

BACKGROUND: The COVID-19 pandemic has negatively impacted the psychological 
well-being of individuals and society. Previous studies conducted on coronavirus 
outbreaks including Severe Acute Respiratory Syndrome and Middle East 
Respiratory Syndrome pandemic found that posttraumatic stress disorder (PTSD), 
depression, and anxiety were the most common mental health problems and 
long-term consequences of these outbreaks. Currently, comprehensive and 
integrated information on the global prevalence of PTSD due to the COVID-19 
pandemic is lacking.
OBJECTIVE: In the present meta-analysis, we examined the global prevalence and 
associated risk factors of PTSD in patients/survivors of COVID-19, health 
professionals, and the population at large.
DESIGN: Meta-analysis.
DATA SOURCE: Cochrane, CINAHL, Embase, MEDLINE, PubMed, Scopus, Web of Science, 
and manual search up to June 2021.
METHODS: We included studies evaluating the prevalence of PTSD during the 
COVID-19 pandemic in either patients/survivors, health professionals, and the 
population at large. The data were analyzed using logit transformation with the 
random-effects model. Risk of bias assessment was conducted using Hoy and 
colleagues.
RESULTS: A total of 63 studies (n = 124,952) from 24 different countries were 
involved. The overall pooled estimate of PTSD prevalence was 17.52% (95% CI 
13.89 to 21.86), with no evidence of publication bias (t=-0.22, p-value=0.83). 
This study found a high prevalence of PTSD among patients with COVID-19 (15.45%; 
95% CI 10.59 to 21.99), health professionals (17.23%; 95% CI 11.78 to 24.50), 
and the population at large (17.34%; 95% CI 12.21 to 24.03). Subgroup analyses 
showed that those working in COVID-19 units (30.98%; 95% CI, 16.85 to 49.86), 
nurses (28.22%; 95% CI, 15.83 to 45.10), those living in European countries 
(25.05%; 95% CI 19.14 to 32.06), and studies that used Clinician-Administered 
PTSD Scale for DSM-5 (30.18%, 95% CI 25.78 to 34.98) demonstrated to have the 
highest PTSD prevalence compared to other subgroups. Meta-regression analyses 
revealed that the elderly (above age 65) had lower PTSD prevalence (-1.75, 95% 
CI -3.16 to -0.34) than the adult population.
CONCLUSION AND IMPLICATIONS: Substantial PTSD prevalence was found in patients 
with COVID-19, health professionals, and the population at large. Moderator 
analysis revealed that age, unit of work, health profession, continent, and 
assessment tools as significant moderators. Mental health services are needed 
for everyone, especially adults under the age of 65, those who work in COVID-19 
units, nurses, and people in the European continent.
REGISTRATION: The study protocol was registered with the International database 
of prospective registered systematic reviews (PROSPERO): CRD42020218762. 
Tweetable abstract: The pooled PTSD prevalence during COVID-19 pandemic for 
patients with COVID-19, health professionals, and the population at large was 
17.52%.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.ijnurstu.2021.104136
PMCID: PMC8585564
PMID: 34856503 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest No conflict 
interest to be declared.


2706. PLoS One. 2021 Dec 2;16(12):e0259546. doi: 10.1371/journal.pone.0259546. 
eCollection 2021.

Education for non-citizen children in Malaysia during the COVID-19 pandemic: A 
qualitative study.

Loganathan T(1), Chan ZX(1), Hassan F(1), Kunpeuk W(2), Suphanchaimat R(2)(3), 
Yi H(4), Majid HA(5)(6).

Author information:
(1)Centre for Epidemiology and Evidence-Based Practice, Department of Social and 
Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia.
(2)International Health Policy Program, Ministry of Public Health, Nonthaburi, 
Thailand.
(3)Division of Epidemiology, Department of Disease Control, Ministry of Public 
Health, Nonthaburi, Thailand.
(4)Saw Swee Hock School of Public Health, National University of Singapore and 
National University Health System, Singapore, Singapore.
(5)Centre for Population Health, Department of Social and Preventive Medicine, 
University of Malaya, Kuala Lumpur, Malaysia.
(6)Department of Nutrition, Faculty of Public Health, Universitas Airlangga, 
Surabaya, Indonesia.

The COVID-19 pandemic disrupted schooling for children worldwide. Most 
vulnerable are non-citizen children without access to public education. This 
study aims to explore challenges faced in achieving education access for 
children of refugee and asylum-seekers, migrant workers, stateless and 
undocumented persons in Malaysia during the pandemic. In-depth interviews of 33 
stakeholders were conducted from June 2020 to March 2021. Data were thematically 
analysed. Our findings suggest that lockdowns disproportionately impacted 
non-citizen households as employment, food and housing insecurity were 
compounded by xenophobia, exacerbating pre-existing inequities. School closures 
disrupted school meals and deprived children of social interaction needed for 
mental wellbeing. Many non-citizen children were unable to participate in online 
learning due to the scarcity of digital devices, and poor internet connectivity, 
parental support, and home learning environments. Teachers were forced to adapt 
to online learning and adopt alternative arrangements to ensure continuity of 
learning and prevent school dropouts. The lack of government oversight over 
learning centres meant that measures taken were not uniform. The COVID-19 
pandemic presents an opportunity for the design of more inclusive national 
educational policies, by recognising and supporting informal learning centres, 
to ensure that no child is left behind.

DOI: 10.1371/journal.pone.0259546
PMCID: PMC8638886
PMID: 34855770 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2707. Australas J Ageing. 2022 Jun;41(2):293-300. doi: 10.1111/ajag.13025. Epub 2021 
Dec 2.

Impact of the first wave of COVID-19 on the health and psychosocial well-being 
of Māori, Pacific Peoples and New Zealand Europeans living in aged residential 
care.

Cheung G(1), Bala S(2), Lyndon M(3), Ma'u E(1), Rivera Rodriguez C(4), Waters 
DL(2)(5), Jamieson H(6), Nada-Raja S(7), Chan AHY(8), Beyene K(8), Meehan B(9), 
Walker X(2).

Author information:
(1)Department of Psychological Medicine, School of Medicine, The University of 
Auckland, Auckland, New Zealand.
(2)Department of Medicine, Otago Medical School, University of Otago, Dunedin, 
New Zealand.
(3)The Centre for Medical and Health Sciences Education, School of Medicine, The 
University of Auckland, Auckland, New Zealand.
(4)Department of Statistics, The University of Auckland, Auckland, New Zealand.
(5)School of Physiotherapy, University of Otago, Dunedin, New Zealand.
(6)Department of Medicine, University of Otago, Christchurch, New Zealand.
(7)Va'a o Tautai - Centre for Pacific Health, University of Otago, Dunedin, New 
Zealand.
(8)School of Pharmacy, Faculty of Medical and Health Sciences, The University of 
Auckland, Auckland, New Zealand.
(9)interRAI Services, Technical Advisory Services (TAS), Wellington, New 
Zealand.

OBJECTIVE: To investigate the impact of New Zealand's (NZ) first wave of 
COVID-19, which included a nationwide lockdown, on the health and psychosocial 
well-being of Māori, Pacific Peoples and NZ Europeans in aged residential care 
(ARC).
METHODS: interRAI assessments of Māori, Pacific Peoples and NZ Europeans (aged 
60 years and older) completed between 21/3/2020 and 8/6/2020 were compared with 
assessments of the same ethnicities during the same period in the previous year 
(21/3/2019 to 8/6/2019). Physical, cognitive, psychosocial and service 
utilisation indicators were included in the bivariate analyses.
RESULTS: A total of 538 Māori, 276 Pacific Peoples and 11,322 NZ Europeans had 
an interRAI assessment during the first wave of COVID-19, while there were 
549 Māori, 248 Pacific Peoples and 12,367 NZ Europeans in the comparative 
period. Fewer Māori reported feeling lonely (7.8% vs. 4.5%, p = 0.021), but more 
NZ Europeans reported severe depressive symptoms (6.9% vs. 6.3%, p = 0.028) 
during COVID-19. Lower rates of hospitalisation were observed in Māori (7.4% vs. 
10.9%, p = 0.046) and NZ Europeans (8.1% vs. 9.4%, p < 0.001) during COVID-19.
CONCLUSIONS: We found a lower rate of loneliness in Māori but a higher rate of 
depression in NZ European ARC populations during the first wave of COVID-19. 
Further research, including qualitative studies with ARC staff, residents and 
families, and different ethnic communities, is needed to explain these ethnic 
group differences. Longer-term effects from the COVID-19 pandemic on ARC 
populations should also be investigated.

© 2021 AJA Inc.

DOI: 10.1111/ajag.13025
PMID: 34855238 [Indexed for MEDLINE]


2708. Australas Psychiatry. 2022 Apr;30(2):235-238. doi: 10.1177/10398562211057078. 
Epub 2021 Dec 2.

The impact of COVID-19 lockdown on the well-being of clients of a specialist 
personality disorder service.

Heidari P(1), Broadbear JH(1), Cheney L(2), Dharwadkar NP(3), Rao S(1).

Author information:
(1)Spectrum Service for Personality Disorder, Richmond, VIC, Australia; Faculty 
of Medicine, Nursing and Health Sciences, 2541Monash University, Clayton, VIC, 
Australia.
(2)Spectrum Service for Personality Disorder, Richmond, VIC, Australia.
(3)Faculty of Medicine, Nursing and Health Sciences, 2541Monash University, 
Clayton, VIC, Australia.

OBJECTIVE: The aim of this study was to investigate the well-being of people 
with severe borderline personality disorder (BPD) during the first wave of 
COVID-19 social restrictions.
METHOD: Clients of an outpatient specialist personality disorder clinic (n = 77) 
were invited to the study. An online survey was conducted including a range of 
open-ended questions exploring well-being and the Coronavirus Anxiety Scale 
(CAS) which assesses 'coronaphobia'. Qualitative data were analysed using 
inductive content analysis with NVivo software. CAS data were analysed 
descriptively using SPSS version 25.
RESULTS: Thirty-six surveys were completed (48% response rate). Many 
participants experienced significant challenges to their overall well-being 
during lockdown although some reported improvements in psychosocial functioning. 
Three participants (8.3%) experienced clinically significant 'coronaphobia'.
CONCLUSION: The self-reported physical and mental health of participants with 
BPD demonstrated resilience, suggesting that the capacity to maintain treatment 
via telehealth helped to mitigate many of the adverse aspects of social 
restrictions. This study was conducted during the first wave of social 
restrictions; subsequent studies will reveal longer-term effects of extended 
community lockdowns.

DOI: 10.1177/10398562211057078
PMCID: PMC8990572
PMID: 34854337 [Indexed for MEDLINE]

Conflict of interest statement: Disclosure: The author(s) declared no potential 
conflicts of interest with respect to the research, authorship, and/or 
publication of this article.


2709. South Med J. 2021 Dec;114(12):807-811. doi: 10.14423/SMJ.0000000000001330.

A Virtual Wellness and Learning Communities Program for Medical Students during 
the COVID-19 Pandemic.

Ahlers CG(1), Lawson V(1), Lee J(1), March C(1), Schultz J(1), Anderson K(1), 
Neeley M(1), Fleming AE(1), Drolet BC(1).

Author information:
(1)From the Departments of Pediatrics and Plastic Surgery, Vanderbilt University 
Medical Center, and the Vanderbilt University School of Medicine, Nashville, 
Tennessee.

OBJECTIVES: Numerous studies have demonstrated the high risk for burnout and 
mental illness in medical students. Because of the coronavirus disease 2019 
(COVID-19) pandemic, our medical school transitioned to an all-virtual learning 
environment from March to June 2020, which raised concerns among student leaders 
and administrators, as reduced interpersonal attachments have known associations 
with decreased mental health. In an effort to facilitate student well-being 
during the pandemic, the Virtual Wellness and Learning Communities (VWLC) 
program was established. VWLC consisted of hour-long events that offered 
students the opportunity to engage with their peers online.
METHODS: More than 20 events and workshops were conducted from March to June 
2020, including trivia nights, song and guitar performances, sketching, video 
editing tutorials, chess lessons, yoga, and personal investing tips. An 
institutional review board-approved survey to assess the efficacy of the VWLC 
program was sent to medical student participants and nonparticipants.
RESULTS: The overall response rate of this study was 43% (53/123). The response 
rate for students who attended a VWLC event was 51% (33/65), and the response 
rate for students who did not attend a VWLC event was 34% (20/58). Of all of the 
respondents, 85% (45/53) reported a decreased sense of connectivity with peers 
because of the pandemic, and 40% (21/53) reported a decrease in their sense of 
wellness. After attending a VWLC event, 79% (26/33) reported an increased sense 
of peer connectivity, 61% (20/33) reported improved wellness, and 55% (18/33) 
believed that these events should continue postpandemic to supplement in-person 
programming. Those who did not attend a virtual event stated that the main 
barriers to attending were unfamiliarity with attendees and screen fatigue.
CONCLUSIONS: The COVID-19 pandemic has worsened medical student well-being and 
sense of community. VWLC programming may be an effective strategy for promoting 
medical student wellness and community while social distancing during the 
COVID-19 pandemic. To our knowledge, this is the first virtual wellness program 
for promotion of medical student mental health during the COVID-19 pandemic to 
be described in the literature.

DOI: 10.14423/SMJ.0000000000001330
PMCID: PMC8607913
PMID: 34853859 [Indexed for MEDLINE]

Conflict of interest statement: The authors did not report any financial 
relationships or conflicts of interest.


2710. Br J Clin Psychol. 2022 Jun;61(2):385-404. doi: 10.1111/bjc.12351. Epub 2021 Nov 
30.

A longitudinal investigation of COVID-19 pandemic experiences and mental health 
among university students.

Stamatis CA(1)(2)(3), Broos HC(1), Hudiburgh SE(1), Dale SK(1), Timpano KR(1).

Author information:
(1)Department of Psychology, University of Miami, Coral Gables, Florida, USA.
(2)NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, New 
York, USA.
(3)Center for Behavioral Intervention Technologies, Northwestern University 
Feinberg School of Medicine, Chicago, Illinois, USA.

OBJECTIVES: Previous studies have established a link between the COVID-19 
pandemic and poor mental health. They further suggest that young adults may be 
especially vulnerable to worsened mental health during the pandemic, but few 
studies have investigated which specific aspects of the COVID-19 experience 
affect psychological well-being over time. To better understand concrete 
predictors of poor mental health outcomes in this population, we identified 
several pandemic-related experiences and evaluated their effects on mental 
health symptoms (depression, anxiety, stress, alcohol, and substance use) in a 
sample of U.S. college students (N = 176).
METHODS: Both mental health symptoms and pandemic-related experiences were 
evaluated at the start of quarantine (March/April 2020, Time 1) and the end of 
the Spring 2020 semester (May 2020, Time 2). Given the limited literature on 
specific predictors of mental health during a pandemic, we used elastic net 
regression, a novel analytic method that helps with variable selection when 
theoretical background is limited, to narrow our field of possible predictors.
RESULTS: While mental health symptoms were elevated at both timepoints, there 
were no clinically significant changes from Time 1 to Time 2 and few differences 
between sociodemographic groups. Both disruption due to the pandemic (β = .25, 
p = .021) and limited confidence in the federal government's response (β = -.14, 
p = .038) were significant predictors of depression symptoms at the end of the 
semester, even when controlling for baseline depression. Further, predictions 
that the pandemic would continue to impact daily life further into the future 
were linked with pandemic stress response symptoms (β = .15, p = .032) at Time 
2, beyond the effects of baseline symptoms. Alcohol (β = -.22, p = .024) and 
substance use (β = -.26, p = .01) were associated with reduced adherence to 
COVID-19 guidelines.
CONCLUSIONS: Our findings indicate that specific aspects of the pandemic 
experience may be influencing internalizing symptoms and alcohol/substance use 
in college students, pointing to potential avenues for targeted support and 
intervention.
PRACTITIONER POINTS: A range of factors may influence university student mental 
health during the COVID-19 pandemic. Students who expect the pandemic will 
continue to impact daily life further into the future maybe more likely to 
report stress symptoms. Disruption due to the pandemic and limited confidence in 
the federal government's response may be associated with depression symptoms. 
Alcohol and substance use are associated with lower COVID-19 guideline adherence 
in university students.

© 2021 The British Psychological Society.

DOI: 10.1111/bjc.12351
PMID: 34850405 [Indexed for MEDLINE]


2711. Clin Infect Dis. 2022 Aug 24;75(1):e191-e200. doi: 10.1093/cid/ciab991.

Acute and Persistent Symptoms in Children With Polymerase Chain Reaction 
(PCR)-Confirmed Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) 
Infection Compared With Test-Negative Children in England: Active, Prospective, 
National Surveillance.

Zavala M(1), Ireland G(1), Amin-Chowdhury Z(1), Ramsay ME(1), Ladhani SN(1)(2).

Author information:
(1)Public Health England, London, United Kingdom.
(2)Paediatric Infectious Diseases Research Group, St. George's University of 
London, London, United Kingdom.

BACKGROUND: Most children recover quickly after coronavirus disease 2019 
(COVID-19), but some may have ongoing symptoms. Follow-up studies have been 
limited by small sample sizes and lack of appropriate controls.
METHODS: We used national testing data to identify children aged 2-16 years with 
a SARS-CoV-2 PCR test during 1-7 January 2021 and randomly selected 1500 
PCR-positive cases and 1500 matched PCR-negative controls. Parents were asked to 
complete a questionnaire about the acute illness and prespecified neurological, 
dermatological, sensory, respiratory, cardiovascular, gastrointestinal, mental 
health (including emotional and behavioral well-being), and other symptoms 
experienced ≥5 times at 1 month after the PCR test.
RESULTS: Overall, 35.0% (859/2456) completed the questionnaire, including 38.0% 
(472/1242) of cases and 32% (387/1214) of controls, of whom 68% (320/472) and 
40% (154/387) were symptomatic, respectively. The most prevalent acute symptoms 
were cough (249/859, 29.0%), fever (236/859, 27.5%), headache (236/859, 27.4%), 
and fatigue (231/859, 26.9%). One month later, 21/320 (6.7%) of symptomatic 
cases and 6/154 (4.2%) of symptomatic controls (P = .24) experienced ongoing 
symptoms. Of the 65 ongoing symptoms solicited, 3 clusters were significantly 
(P < .05) more common, albeit at low prevalence, among symptomatic cases (3-7%) 
than symptomatic controls (0-3%): neurological, sensory, and emotional and 
behavioral well-being. Mental health symptoms were reported by all groups but 
more frequently among symptomatic cases than symptomatic controls or 
asymptomatic children.
CONCLUSIONS: Children with symptomatic COVID-19 had a slightly higher prevalence 
of ongoing symptoms than symptomatic controls, and not as high as previously 
reported. Healthcare resources should be prioritized to support the mental 
health of children.

© Crown copyright 2021.

DOI: 10.1093/cid/ciab991
PMCID: PMC8767867
PMID: 34849658 [Indexed for MEDLINE]


2712. Sci Rep. 2021 Nov 30;11(1):23161. doi: 10.1038/s41598-021-02342-8.

Socioeconomic inequality in mental well-being associated with COVID-19 
containment measures in a low-incidence Asian globalized city.

Chung RY(#)(1)(2)(3)(4), Chung GK(#)(5), Chan SM(5)(6), Chan YH(5), Wong 
H(5)(7), Yeoh EK(5)(8), Allen J(9), Woo J(5)(10), Marmot M(5)(9).

Author information:
(1)CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong 
Kong SAR, China. rychung@cuhk.edu.hk.
(2)The Jockey Club School of Public Health and Primary Care, The Chinese 
University of Hong Kong, Hong Kong SAR, China. rychung@cuhk.edu.hk.
(3)CUHK Institute of Ageing, The Chinese University of Hong Kong, Hong Kong SAR, 
China. rychung@cuhk.edu.hk.
(4)4/F, School of Public Health and Primary Care, Prince of Wales Hospital, 
Shatin, NT, Hong Kong SAR, China. rychung@cuhk.edu.hk.
(5)CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong 
Kong SAR, China.
(6)CityU Department of Social and Behavioural Sciences, The City University of 
Hong Kong, Hong Kong SAR, China.
(7)Department of Social Work, The Chinese University of Hong Kong, Hong Kong 
SAR, China.
(8)The Jockey Club School of Public Health and Primary Care, The Chinese 
University of Hong Kong, Hong Kong SAR, China.
(9)Department of Epidemiology and Public Health, UCL Institute of Health Equity, 
UCL Research, London, UK.
(10)CUHK Institute of Ageing, The Chinese University of Hong Kong, Hong Kong 
SAR, China.
(#)Contributed equally

The COVID-19 pandemic exposes and amplifies pre-existing inequalities even in 
places with relatively well-controlled outbreaks such as Hong Kong. This study 
aimed to explore whether the socioeconomically disadvantaged fare worse via 
various types of worry in terms of their mental health and well-being. Between 
September and October 2020, 1067 adults in Hong Kong were recruited via a 
cross-sectional population-wide telephone survey. The inter-relationship between 
deprivation, types of worry, mental health disorders, and subjective well-being 
was assessed using structural equation modelling. Results showed significant 
total effects of deprivation on worries about being infected (p = 0.002), 
economic activities and livelihood (p < 0.001), and personal savings 
(p < 0.001), as well as mental health disorders (p < 0.001) and subjective 
well-being (p < 0.001). Specifically, worry about economic activities and 
livelihood partly mediated the total effect of deprivation on mental health 
disorders (p = 0.004), whereas worry about personal savings and worry about 
economic activities and livelihood partially mediated the total effect of 
deprivation on subjective well-being (p = 0.007 and 0.002, respectively). 
Socioeconomic inequality, particularly in mental health and well-being, could be 
exacerbated via people's economic concerns during the pandemic, which was 
largely induced by the COVID-19 containment measures rather than the pandemic 
per se given the relatively low COVID-19 incidence in Hong Kong.

© 2021. The Author(s).

DOI: 10.1038/s41598-021-02342-8
PMCID: PMC8633192
PMID: 34848754 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


2713. BMJ Open. 2021 Nov 30;11(11):e051895. doi: 10.1136/bmjopen-2021-051895.

Psychological impact of repeated epidemic exposure on healthcare workers: 
findings from an online survey of a healthcare workforce exposed to both SARS 
(severe acute respiratory syndrome) and COVID-19.

Chan LG(1), Tan PLL(2), Sim K(3), Tan MY(4), Goh KH(5), Su PQ(6), Tan AKH(7), 
Lee ES(8), Tan SY(8), Lim WP(9), Aw CH(10), Goh YZ(11), Sadarangani S(12)(13), 
Chow A(14)(15).

Author information:
(1)Psychiatry, Tan Tock Seng Hospital, Singapore lai_gwen_chan@ttsh.com.sg.
(2)Psychiatry, Tan Tock Seng Hospital, Singapore.
(3)Adult Psychiatry, Institute of Mental Health, Singapore.
(4)General Psychiatry, Institute of Mental Health, Singapore.
(5)Psychological Medicine, Khoo Teck Puat Hospital, Singapore.
(6)National Skin Centre, Singapore.
(7)Anaesthesia, Ng Teng Fong General Hospital, Singapore.
(8)Clinical Research Unit, National Healthcare Group Polyclinics, Singapore.
(9)Medical Psychiatry, Woodlands Health Campus, Singapore.
(10)Palliative Medicine, Woodlands Health Campus, Singapore.
(11)Dover Park Hospice, Singapore.
(12)National Centre for Infectious Diseases, Singapore.
(13)Infectious Diseases, Tan Tock Seng Hospital, Singapore.
(14)Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore.
(15)Lee Kong Chian School of Medicine, Nanyang Technological University, 
Singapore.

OBJECTIVE: To measure the psychological well-being of healthcare workers (HCWs) 
during this COVID-19 pandemic and examine the experiences of the subgroup of 
participants who were also HCWs during the 2003 SARS epidemic.
DESIGN: Anonymous online survey adapted from a similar study conducted during 
the SARS epidemic, disseminated from July 2020 to August 2020.
SETTING: Nine healthcare institutions across Singapore ranging from primary 
care, community care, tertiary care and specialised referral centres.
PARTICIPANTS: Employees working in the participating healthcare institutions.
RESULTS: Of 3828 survey returns, 3616 had at least one completed item on the 
questionnaire. Majority were female (74.7%), nurses (51.7%), foreign-born 
(53.2%) and not working in the tertiary care setting (52.1%). The median score 
on the Impact of Events Scale (IES) was 15 (IQR 23) and 28.2% of the sample 
scored in the moderate/severe range. 22.7% of the participants were also HCWs 
during SARS and more than half of them felt safer and better equipped in the 
current pandemic. 25.2% of SARS HCWs and 25.9% of non-SARS HCWs had 
moderate/severe IES scores (p=0.904). After adjusting for age, marital status, 
parity and length of work experience, racial minority groups and living apart 
from family were independent predictors of high IES regardless of prior SARS 
epidemic experience. Daily exposure to confirmed or suspect COVID-19 cases 
increased the odds of high IES for non-SARS HCWs only.
CONCLUSIONS AND RELEVANCE: Overall, while 28% of HCWs in our study suffered from 
significant trauma-related psychological symptoms regardless of prior experience 
with the SARS epidemic, those with prior experience reported feeling safer and 
better equipped, finding the workload easier to manage, as well as having more 
confidence in their healthcare leaders. We recommend for more trauma-informed 
support strategies for our HCWs especially those from racial minority groups, 
who are foreign-born and isolated from their families.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-051895
PMCID: PMC8635888
PMID: 34848518 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2714. BMC Psychol. 2021 Nov 30;9(1):187. doi: 10.1186/s40359-021-00688-2.

Prevalence of depression, anxiety and stress during the COVID-19 pandemic: a 
cross-sectional study among Palestinian students (10-18 years).

Radwan E(1)(2), Radwan A(3), Radwan W(4), Pandey D(5).

Author information:
(1)Department of Biology, Faculty of Science, Islamic University of Gaza, Gaza 
Strip, Palestine. ernp2030@gmail.com.
(2)Directorate of Education-East Gaza, Ministry of Education and Higher 
Education, Gaza Strip, Palestine. ernp2030@gmail.com.
(3)Faculty of Education, Islamic University of Gaza, Gaza Strip, Palestine.
(4)Faculty of Education, Ummah Open University, Gaza Strip, Palestine.
(5)Department of Technical Education, Dr. A.P.J. Abdul, Kalam Technical 
University Uttar Pradesh, Lucknow, India.

BACKGROUND: The COVID-19 pandemic considers a threat to students' well-being and 
mental health. The current descriptive cross-sectional study aims to identify 
psychological distress among school students during the lockdown period.
METHODS: This study was carried out in a sample of 420 primary and secondary 
school students from June 10 to July 13, 2020, in the Gaza Strip in Palestine. 
Data was collected using an online questionnaire that included informed consent, 
socio-demographic questions, and a psychometric scale (DASS-21).
RESULTS: The results revealed that most students experienced moderate to severe 
levels of anxiety (89.1%) and depression (72.1%), whereas less than half of them 
(35.7%) experienced moderate to severe stress. Stress, anxiety and depression 
scores were significantly different across gender, age groups, family size, and 
family's economic status. The results showed that gender (β = -0.174, 
p < 0.001), age (β = -0.155, p = 0.001) and economic level of family 
(β = -0.147, p = 0.002) were negative predictors correlated with stress. Family 
size (β = 0.156, p = 0.001) played a positive role in stress. It was found that 
gender (β = -0.105, p = 0.031), age (β = -0.135, p = 0.006) and economic level 
of family (β = -0.136, p = 0.005) were negative predictors correlated with 
anxiety, whereas family size (β = 0.139, p = 0.004) played a positive role in 
anxiety. For depression, gender (β = -0.162, p = 0.001), age (β = -0.160, 
p = 0.001) and economic level of family (β = -0.131, p = 0.007) were negative 
predictors correlated with depression, whereas family size (β = -0.133, 
p = 0.006) was found to be a positive predictor. Concerns about the influence of 
COVID-19 on economic, education, and daily life were positively correlated to 
the levels of depression, anxiety and stress, whereas the availability of social 
support was negatively correlated.
CONCLUSION: The development of a health protocol for influenced students is 
urgently needed to maintain them remain resilient during dangerous times.

© 2021. The Author(s).

DOI: 10.1186/s40359-021-00688-2
PMCID: PMC8630193
PMID: 34847961 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


2715. Curr Drug Saf. 2022;17(4):382-386. doi: 10.2174/1574886316666211130142624.

Clozapine and COVID-19: A Case Report and Clinical Considerations.

Lahiff D(1), Chatham P(2), Sullivan G(1)(2), Fusick AJ(1)(2).

Author information:
(1)Department of Psychiatry and Behavioral Neurosciences, University of South 
Florida Morsani College of Medicine, Tampa, Florida, USA.
(2)Mental Health and Behavioral Sciences Service, James A. Haley Veterans 
Hospital, Tampa, Florida, USA.

BACKGROUND: The emergence of coronavirus SARS-CoV-2, and the subsequent global 
epidemic of COVID-19, brought with it innumerable new clinical experiences 
across all medical specialties, and psychiatry is no exception. Individuals with 
serious mental illness, in particular schizophrenia and related disorders, may 
be especially susceptible to coronavirus infection given the overlapping risk 
factors of vulnerable sociodemographic status, increased challenges with 
quarantining requirements, and limited compliance with "respiratory etiquette." 
The case presented here describes a patient with schizophrenia who was being 
managed on clozapine and who developed symptomatic COVID-19 infection. Special 
care was taken to ensure that potential interactions between clozapine and the 
associated COVID-19 treatments were safe for the patient's mental and physical 
wellbeing.
CASE PRESENTATION: A 71-year-old schizophrenic Caucasian male is being managed 
with clozapine. While hospitalized, the patient was screened positive for 
COVID-19 and was admitted to the ICU due to his declining respiratory status. He 
was treated with both remdesivir and prednisone. He was able to fully recover 
from his COVID-19 infection.
CONCLUSION: The authors review the clinical characteristics of the case, 
highlighting both the overlapping synergistic effects and antagonistic 
influences of clozapine therapy in combination with COVID-19 and its associated 
treatments. A review of the literature offers an opportunity to examine various 
frameworks for individualized clinical decision-making while making the case for 
greater epidemiologic research into the optimal management of individuals with a 
psychotic disorder who are diagnosed with COVID-19 infection.

Copyright© Bentham Science Publishers; For any queries, please email at 
epub@benthamscience.net.

DOI: 10.2174/1574886316666211130142624
PMID: 34847849 [Indexed for MEDLINE]


2716. Rheumatol Int. 2022 Feb;42(2):241-250. doi: 10.1007/s00296-021-05054-4. Epub 
2021 Nov 30.

Participation in physical activity decreased more in people with rheumatoid 
arthritis than the general population during the COVID-19 lockdown: a 
cross-sectional study.

Balchin C(1), Tan AL(2)(3), Wilson OJ(1), McKenna J(1), Stavropoulos-Kalinoglou 
A(4).

Author information:
(1)Leeds Beckett University, Carnegie School of Sport, Leeds, UK.
(2)University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal 
Medicine, Chapel Allerton Hospital, Leeds, UK.
(3)Leeds Teaching Hospitals NHS Trust, NIHR Leeds Biomedical Research Centre, 
Leeds, UK.
(4)Leeds Beckett University, Carnegie School of Sport, Leeds, UK. 
A.Stavropoulos@leedsbeckett.ac.uk.

The COVID-19 pandemic and social distancing restrictions have significantly 
reduced population-wide physical activity (PA) levels. However, the impact of 
the pandemic and relevant restrictions on PA participation, and any potential 
barriers to it, in people with rheumatoid arthritis (RA) are not clear. 
Furthermore, we are unsure if any such PA changes have affected their body 
weight, mental wellbeing, and/or quality of life (QoL). Thus, the aim of this 
study was to examine the impact of the lockdown on PA participation in people 
with RA, versus people without RA. Participants (n = 128; RA = 27, non-RA = 101) 
completed a self-administered online survey, which included questions on PA, 
body weight, mental wellbeing and QoL. PA participation during lockdown was 
significantly lower among RA versus non-RA participants (p < 0.001). 
Additionally, a similar profile of results was found where more RA participants 
vs non-RA participants reported reduced habitual PA (59% vs 33%) and increased 
body weight (59% vs 35%). Mental wellbeing scores were similarly low in both 
groups during lockdown (RA: 20.8 ± 4.2; non-RA: 22.2 ± 3.4, p = 0.080). Matched 
group comparisons identified similar trends to full sample analyses. In the 
first months of the lockdown, more people with RA reported decreased PA 
participation and increased body weight than their non-RA counterparts. Access 
to exercise equipment and facilities appears to be the main cause for these 
results. Looking beyond COVID-19, specific PA promotion for people with RA will 
be required to prevent a pandemic of inactivity.

© 2021. The Author(s).

DOI: 10.1007/s00296-021-05054-4
PMCID: PMC8631264
PMID: 34846554 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


2717. Arch Sex Behav. 2022 Jan;51(1):343-354. doi: 10.1007/s10508-021-02121-6. Epub 
2021 Nov 29.

Sex in the Era of COVID-19 in a U.S. National Cohort of Cisgender Men, 
Transgender Women, and Transgender Men Who Have Sex with Men: April-May 2020.

Grov C(1)(2), Zohra F(3), Westmoreland DA(4)(3), Mirzayi C(4)(3), D'Angelo 
A(4)(3), Stief M(3), Kulkarni S(3), Nash D(4)(3), Carrico AW(5).

Author information:
(1)CUNY Graduate School of Public Health and Health Policy, 7th Floor Mailroom, 
55 W. 125th St., New York, NY, 10027, USA. cgrov@sph.cuny.edu.
(2)CUNY Institute for Implementation Science in Population Health, New York, 
USA. cgrov@sph.cuny.edu.
(3)CUNY Institute for Implementation Science in Population Health, New York, 
USA.
(4)CUNY Graduate School of Public Health and Health Policy, 7th Floor Mailroom, 
55 W. 125th St., New York, NY, 10027, USA.
(5)University of Miami, Miami, USA.

Since the emergence of the COVID-19 pandemic, there has been an increasing body 
of research focused on the effects that measures like stay-at-home orders and 
social distancing are having on other aspects of health, including mental health 
and sexual health. Currently, there are limited extant data on the effects of 
the pandemic on sexual and gender minorities. Between April 15, 2020, and May 
15, 2020, we invited participants in an ongoing U.S. national cohort study 
(Together 5000) to complete a cross-sectional online survey about the pandemic, 
and its effects on mental and sexual health and well-being (n = 3991). Nearly 
all (97.7%) were living in an area where they were told they should only leave 
their homes for essentials. Most (70.1%) reported reducing their number of sex 
partners as a result of the pandemic. Among the 789 participants prescribed HIV 
pre-exposure prophylaxis (PrEP), 29.9% said they stopped taking their PrEP 
entirely, and 14.2% started selectively skipping doses. For those who had been 
taking PrEP, discontinuing PrEP was associated with having no new sex partners 
(β = 0.90, 95% CI 0.40-1.40). Among the 152 HIV-positive participants, 30.9% 
said they were unable to maintain an HIV-related medical appointment because of 
the pandemic and 13.8% said they had been unable to retrieve HIV medications. 
Additionally, 35.3% of participants were experiencing moderate to severe anxiety 
because of the pandemic and 36.7% reported symptoms of depression. In a 
multivariable logistic regression, reporting a new sex partner in the prior 
30 days was significantly associated with being aged 30 or older (vs. not, 
AOR = 1.21), being Black (AOR = 1.79) or Latinx (AOR = 1.40, vs. white), and 
being unsure if they had been in close contact with someone diagnosed with 
COVID-19 (AOR = 1.32, vs. no contact). It was unassociated with COVID-19-induced 
anxiety, depression, or knowing someone hospitalized with COVID-19. The pandemic 
has caused disruptions in sexual behavior (partner reduction) as well as 
difficulties navigating PrEP and HIV care continua. Findings will guide more 
comprehensive public health responses to optimize HIV prevention and treatment 
in the era of COVID-19.

© 2021. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s10508-021-02121-6
PMCID: PMC8628839
PMID: 34845579 [Indexed for MEDLINE]

Conflict of interest statement: The author declared that there is no conflict of 
interest.


2718. MCN Am J Matern Child Nurs. 2022 Mar-Apr 01;47(2):77-84. doi: 
10.1097/NMC.0000000000000802.

Postpartum Depressive Symptoms and Experiences During COVID-19.

Goyal D, Beck CT, Webb R, Ayers S.

PURPOSE: To identify postpartum depression risk and describe experiences of 
women in the first 6 weeks after giving birth during the COVID-19 pandemic.
STUDY DESIGN AND METHODS: Using a convergent mixed-methods approach, we 
recruited a convenience sample of women living in the United States who gave 
birth March 1, 2020 or later from social media Web sites. Participants completed 
the Postpartum Depression Screening Scale-Short Form and provided written 
answers to open-ended questions regarding their experiences at home with their 
new infant.
RESULTS: Our 262 participants were on average 32.6 years of age, the majority 
were White (82%), married or partnered (91.9%), and college educated (87.4%). 
Mean postpartum depression score was 17.7 (SD = 5.9) with 75% scoring ≥14, 
indicating significant postpartum depressive symptoms. Qualitative content 
analysis revealed five themes: Isolation and seclusion continue; Fear, anxiety, 
and stress filled the days; Grieving the loss of normal: It's just so sad; 
Complicated by postpartum depression: A dark time; and There is a silver lining. 
Quantitative and qualitative findings provided a holistic view of women's 
depressive symptoms and experiences at home with their infants during the 
COVID-19 pandemic.
CLINICAL IMPLICATIONS: Although policies that reduce risk of COVID-19 exposure 
and infection for patients and the health care team must continue to be 
implemented, the adverse effects of depressive symptoms on maternal-infant 
wellbeing within the context of increased isolation due to the pandemic need to 
be kept at the forefront. Nurses need to be aware of the consequences of women 
sheltering in place and social distancing on maternal-infant outcomes, 
particularly on depression and likelihood of breastfeeding.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/NMC.0000000000000802
PMCID: PMC8865026
PMID: 34845175 [Indexed for MEDLINE]


2719. MCN Am J Matern Child Nurs. 2022 Mar-Apr 01;47(2):71-76. doi: 
10.1097/NMC.0000000000000796.

Perinatal Experiences of Asian American Women During COVID-19.

Goyal D, Han M, Feldman-Schwartz T, Le HN.

PURPOSE: To explore the wellbeing, pregnancy, childbirth, and postpartum 
experiences of Asian American women who gave birth during the COVID-19 pandemic.
STUDY DESIGN: Qualitative exploratory design.
METHODS: Using convenience and snowball sampling, we recruited Asian American 
women who gave birth during the COVID-19 pandemic via social media. Participants 
completed sociodemographic and depressive symptom questionnaires and took part 
in a virtual semistructured interview where they were asked to describe their 
pregnancy, birth, and postpartum experiences in the midst of the COVID-19 
pandemic. Qualitative content analysis methods were used to identify themes from 
participant narratives.
RESULTS: Thirty-eight Asian American women representing several racial ethnic 
subgroups (Asian Indian, Chinese, Filipino, Hmong, Laotian, Vietnamese) 
participated in our study. Participants were on average 34 (SD = 3.5) years of 
age; the majority were married and lived in California. At the time of data 
collection, participants were 3.7 (SD = 2.07) months postpartum and 5.3 to 10.5 
months into the COVID-19 pandemic. Qualitative content analysis revealed two 
main themes: 1) unexpected perinatal journey, and 2) the emotional and 
psychological consequences of COVID-19.
CLINICAL IMPLICATIONS: Our findings are not unique to Asian American women, but 
they offer insight for nurses taking care of all childbearing women. Nurses can 
provide individually tailored anticipatory guidance to help women navigate 
perinatal changes and manage expectations during future public health crises. 
Nurses can also encourage and help perinatal women identify ways to increase 
their own social support networks during the pregnancy and postpartum period.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/NMC.0000000000000796
PMCID: PMC8865031
PMID: 34845174 [Indexed for MEDLINE]


2720. Emotion. 2021 Dec;21(8):1671-1690. doi: 10.1037/emo0001046. Epub 2021 Nov 29.

Emotion regulation and psychological and physical health during a nationwide 
COVID-19 lockdown.

Low RST(1), Overall NC(2), Chang VT(2), Henderson AME(2), Sibley CG(2).

Author information:
(1)School of Social Sciences and Public Policy, Auckland University of 
Technology.
(2)School of Psychology, University of Auckland.

The current research tests the links between emotion regulation and 
psychological and physical health during the COVID-19 pandemic. In Study 1, 
parents (N = 365) who had reported on their psychological and physical health 
prior to the pandemic completed the same health assessments along with their use 
of emotion regulation strategies when confined in the home with their 
school-aged children during a nationwide lockdown. In Study 2, individuals (N = 
1,607) from a nationally representative panel study completed similar measures 
of psychological and physical health and use of emotion regulation strategies 
one-year prior to the lockdown and then again during the lockdown. Accounting 
for prepandemic psychological health, greater rumination and emotional 
suppression were independently associated with poorer psychological health 
(greater depressive symptoms and psychological distress, lower emotional and 
personal well-being), even when controlling for the emotional challenges of the 
pandemic (emotion control difficulties, perceived support; Studies 1 and 2) and 
a range of demographic covariates (Study 2). Greater rumination was also 
associated with greater fatigue in both studies, but greater rumination and 
emotional suppression were only independently associated with poorer perceptions 
of physical health in Study 2. The results for cognitive reappraisal were mixed; 
positive associations with personal well-being and general health only emerged 
in Study 2. The results provide evidence that key models in affective science 
help explain differences in psychological and physical health within the throes 
of a real-world demanding context and thus offer targets to help facilitate 
health and resilience during the pandemic (and other crises). (PsycInfo Database 
Record (c) 2022 APA, all rights reserved).

DOI: 10.1037/emo0001046
PMID: 34843308 [Indexed for MEDLINE]


2721. Community Dent Health. 2021 Nov 29;38(4):226-229. doi: 10.1922/CDH_00328Agius04.

Dental Public Health in Action: Experiences and Responses of Oral Health Care 
Professionals during the First Wave of the COVID-19 Pandemic in Malta.

Agius AM(1), Sammut EJ(1), Vento Zahra E(1), Gatt G(2), Vassallo PJ(1), Cortes 
AR(3), Attard NJ(1).

Author information:
(1)Department of Oral Rehabilitation and Community Care, University of Malta, 
Malta.
(2)Child Dental Health and Orthodontics, Faculty of Dental Surgery, University 
of Malta, Malta.
(3)Department of Dental Surgery, University of Malta, Malta.

Initial impetus for action: Maltese Oral Health Care Professionals (OHCP) 
experienced changes to clinical practice and redeployment during the COVID-19 
pandemic. In the early stages, there were few data on the resultant changes to 
the provision of dental services or their impact on the wellbeing of dental 
professionals. Solutions Suggested: Two questionnaires were designed to explore 
different domains in OHCP working on the frontline of the COVID-19 pandemic as 
well as in other areas/sectors. The findings were intended to inform guidance 
documents and to better support the profession. Findings: Anxiety-provoking 
factors, challenges, and areas of concern of OHCP were identified and practical 
recommendations to support transitioning to the 'new normal' were presented. 
OHCP expressed anxiety about contracting COVID-19 from their workplace and 
passing infection to other family members, friends, or patients. As a result, 
OHCP expressed the need for better protective clothing, workplace ventilation, 
and air filtration systems. Future implications: Provision of adequate PPE for 
OHCP was a priority. New guidelines for dental practice were informed by the 
experiences of the particpating OHCP. University modules to enhance the 
resilience of OHCP were among the recommendations to support practitioners.

Copyright© 2021 Dennis Barber Ltd.

DOI: 10.1922/CDH_00328Agius04
PMID: 34842369 [Indexed for MEDLINE]


2722. Cleft Palate Craniofac J. 2023 Jan;60(1):82-92. doi: 10.1177/10556656211055006. 
Epub 2021 Nov 29.

Isolation, Uncertainty and Treatment Delays: Parents' Experiences of Having a 
Baby with Cleft Lip/Palate During the Covid-19 Pandemic.

Costa B(1), McWilliams D(1), Blighe S(2), Hudson N(3), Hotton M(2), Swan MC(4), 
Stock NM(5).

Author information:
(1)Centre for Appearance Research, 1981University of the West of England, 
Bristol, UK.
(2)Spires Cleft Centre, Level 2 Children's Hospital, 11269John Radcliffe 
Hospital, Oxford, UK.
(3)Spires Cleft Centre, Salisbury District Hospital, Salisbury, UK.
(4)Spires Cleft Centre, Children's Hospital, 11269John Radcliffe Hospital, 
Oxford, UK.
(5)Centre for Appearance Research, Bristol, UK.

OBJECTIVES: Previous literature finds that having a child with a cleft lip 
and/or palate (CL/P) may pose social and emotional challenges for parents. For 
parents of children born during the Covid-19 pandemic, such challenges may be 
heightened. Further, novel demands brought about by the pandemic could have 
caused additional hardships. The aim of this study was to describe the impact of 
the pandemic on new parents through qualitative exploration of their 
experiences.
DESIGN: Semi-structured interviews were conducted with 14 parents of children 
born in the United Kingdom with CL/P between January and June 2020, around the 
start of the pandemic. Data were analysed using inductive thematic analysis.
RESULTS: Three themes, with sub-themes, were identified. The first theme, 
"Changes to Healthcare: The Impact of Restrictions and Reduced Contact", 
discussed the impact of the pandemic on perinatal care, the care received from 
the specialist CL/P teams, and parents' experiences of virtual consultations. 
The second theme, "Family Functioning During the Pandemic", covered parental 
anxiety, fathers' experiences, and social support. The third theme, "Surgical 
Prioritisation: Delays and Uncertainty", addressed changes to surgical 
protocols, coping with uncertainty, complications associated with delayed 
surgery, and how parents created positive meaning from this period.
CONCLUSIONS: A range of increased and additional psychosocial impacts for 
parents were identified, along with several coping strategies, utilization of 
social support, and the positive aspects of their experiences. As the pandemic 
continues, close monitoring of families affected by CL/P remains imperative, 
particularly for those at risk of emotional distress.

DOI: 10.1177/10556656211055006
PMCID: PMC9218610
PMID: 34841909 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


2723. Epidemiol Prev. 2021 Sep-Oct;45(5):411-415. doi: 10.19191/EP21.5.P411.107.

[Disability in children and adolescents: a reflection of the Italian GBD 
initiative].

[Article in Italian]

Chiandetti A(1), Armocida B(2), Ronfani L(3), Monasta L(3).

Author information:
(1)Dipartimento universitario clinico di scienze mediche, chirurgiche e della 
salute, Università degli Studi di Trieste.
(2)IRCCS materno infantile "Burlo Garofolo", Trieste; 
benedetta.armocida@burlo.trieste.it.
(3)IRCCS materno infantile "Burlo Garofolo", Trieste.

Childhood and adolescence are vulnerable and crucial phases for determining 
health in adulthood. Despite the enormous progress achieved in child and 
adolescent's health and well-being globally, the disability burden has remained 
almost unchanged. In 2019, in Italy and globally, low back pain, headache 
disorders, depression, and anxiety were among the first causes of disability. 
Through the analysis of the estimates of the Global Burden of Disease Study 
2019, we propose a reflection on the state of health of the Italian paediatric 
and adolescent population in terms of disability, suggesting recommendations on 
preventive actions, and public health interventions. The aim is the improvement 
of their health, considering how the current COVID-19 pandemic is impacting on 
their quality of life.

DOI: 10.19191/EP21.5.P411.107
PMID: 34841843 [Indexed for MEDLINE]


2724. J Nurs Manag. 2022 Mar;30(2):359-366. doi: 10.1111/jonm.13526. Epub 2021 Dec 12.

Stress, psychological distress and support in a health care organization during 
Covid-19: A cross-sectional study.

Ollis L(1)(2), Shanahan P.

Author information:
(1)Your Healthcare CIC, Surbiton, UK.
(2)University of Surrey, Guildford, UK.

AIM: The main aim of this study was to understand what health and wellbeing 
initiatives are helpful for health care workers' stress and psychological 
distress during the Covid-19 pandemic.
BACKGROUND: Health care workers are at increased risk of poor mental health 
during health emergencies; understanding support required for health care 
workers is of paramount importance.
METHODS: Participants were health care workers at a health and social care 
organization (N = 159). The study included an online questionnaire including an 
evaluation of health and wellbeing initiatives and measures of perceived stress 
and psychological distress.
RESULTS: The highest rated resources were counselling, personal protective 
equipment (PPE) and Covid-19 testing. Those who accessed yoga reported 
significantly less stress and psychological distress than those who did not 
access yoga.
CONCLUSIONS: Health care workers with higher stress and psychological distress 
felt less supported by their organization, less listened to and less involved in 
organizational decisions.
IMPLICATIONS FOR NURSING MANAGEMENT: Practical implications are discussed such 
as forward planning for health emergencies (e.g., PPE supply), accessible 
Covid-19 testing as well as budgeting for counselling services and exercise 
classes. In addition, targeted support for those diagnosed with Covid-19 is 
recommended, alongside involvement of staff members in organizational decisions.

© 2021 John Wiley & Sons Ltd.

DOI: 10.1111/jonm.13526
PMID: 34837274 [Indexed for MEDLINE]


2725. BMJ Open. 2021 Nov 26;11(11):e044836. doi: 10.1136/bmjopen-2020-044836.

Identifying research priorities in newborn medicine: a Delphi study of parents' 
views.

Eeles AL(1)(2)(3)(4), Burnett AC(5)(2)(6)(7), Cheong JL(5)(8)(9), Aldis A(10), 
Pallot L(10), Polonidis T(10), Rust K(10), Hunt RW(5)(4)(6)(7), Delany 
C(11)(12), Spittle AJ(5)(3)(9); Centre of Research Excellence in Newborn 
Medicine.

Collaborators: Allen R, McIntyre S, Cheong JL, Doyle LW, Davis PG, Anderson PJ, 
Spittle AJ, Hunt RW, Thompson DK, Lee KJ, Manley BJ, Owen LS, Goldfeld S, 
Roberts G, Jacobs SE, Burnett AC, Dawson JA, Boland RA, Dalziel KM, Treyvaud K, 
Thio M, Aldis A.

Author information:
(1)Clinical Sciences Theme, Murdoch Childrens Research Institute, Parkville, 
Victoria, Australia abbey.eeles@mcri.edu.au.
(2)Newborn Research, The Royal Women's Hospital, Parkville, Victoria, Australia.
(3)Department of Physiotherapy, University of Melbourne, Parkville, Victoria, 
Australia.
(4)Department of Paediatrics, Monash University, Clayton, Victoria, Australia.
(5)Clinical Sciences Theme, Murdoch Childrens Research Institute, Parkville, 
Victoria, Australia.
(6)Department of Neonatal Medicine, The Royal Children's Hospital, Parkville, 
Victoria, Australia.
(7)Department of Paediatrics, University of Melbourne, Parkville, Victoria, 
Australia.
(8)Neonatal Services, Royal Women's Hospital, Parkville, Victoria, Australia.
(9)Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, 
Australia.
(10)Consumer Advisory Group, Murdoch Childrens Research Institute Centre of 
Research Excellence in Newborn Medicine, Parkville, Victoria, Australia.
(11)Children's Bioethics Centre, The Royal Children's Hospital Melbourne, 
Parkville, Victoria, Australia.
(12)Department of Medical Education, University of Melbourne, Parkville, 
Victoria, Australia.

OBJECTIVE: Neonatal conditions can have lifelong implications for the health and 
well-being of children and families. Traditionally, parents and patients have 
not been included in shaping the agenda for research and yet they are profoundly 
affected by the neonatal experience and its consequences. This study aimed to 
identify consensus research priorities among parents/patients of newborn 
medicine in Australia and New Zealand.
DESIGN: Parents/patients with experience of neonatal care in Australia and New 
Zealand completed an online Delphi study to identify research priorities across 
four epochs (neonatal admission, early childhood, childhood/adolescence and 
adulthood). Parents/patients first generated key challenges in each of these 
epochs. Through inductive thematic analysis, recurring topics were identified 
and research questions generated. Parents/patients rated these questions in 
terms of priorities and a list of questions consistently rated as high priority 
was identified.
PARTICIPANTS: 393 individuals participated, 388 parents whose children had 
received neonatal care and 5 adults who had received neonatal care themselves.
RESULTS: Many research questions were identified as high-priority across the 
lifespan. These included how to best support parental mental health, 
relationships between parents and neonatal clinical staff (including involvement 
in care and communication), bonding and the parent-child relationship, improving 
neonatal medical care and addressing long-term impacts on child health and 
neurodevelopment.
CONCLUSIONS: Parents with experience of newborn medicine have strong, clear and 
recurring research priorities spanning neonatal care practices, psychological 
and other impacts on families, and impacts on child development. These findings 
should guide neonatal research efforts. In addition to generating new knowledge, 
improved translation of existing evidence to parents is also needed.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2020-044836
PMCID: PMC8628322
PMID: 34836894 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2726. NASN Sch Nurse. 2022 Jan;37(1):42-47. doi: 10.1177/1942602X211048481. Epub 2021 
Nov 26.

The Role of School Connectedness in Supporting the Health and Well-Being of 
Youth: Recommendations for School Nurses.

McCabe EM(1), Davis C(2), Mandy L(2), Wong C(3).

Author information:
(1)Assistant Professor, Hunter College, Hunter College School of Nursing, New 
York, NY.
(2)Bates College, Lewiston, ME.
(3)Hunter College School of Nursing, New York, NY.

The importance of students feeling connected in school cannot be overstated, as 
this perception is crucial to support their health and well-being. A lack of 
school connectedness can lead to adverse physical and mental health outcomes, 
including bully victimization. Numerous factors, including individual, social, 
and environmental, influence students' perceived sense of school connectedness. 
School nurses are well positioned to establish and maintain school connectedness 
due to their knowledge, accessibility to students, and familiarity with the 
school environment. This article details the importance of school connectedness 
and describes the associations between school connectedness, bullying, and 
mental health. In addition, we offer recommendations geared toward school nurses 
regarding strengthening school connectedness and promoting a culture of care and 
inclusivity within school environments, especially salient in the context of the 
COVID-19 pandemic.

DOI: 10.1177/1942602X211048481
PMID: 34836466 [Indexed for MEDLINE]


2727. Medicina (Kaunas). 2021 Nov 21;57(11):1278. doi: 10.3390/medicina57111278.

Meta-Analysis of Prevalence of Depression in Dental Students during COVID-19 
Pandemic.

Santabárbara J(1)(2)(3), Ozamiz-Etxebarria N(4), Idoiaga N(4), Olaya B(2)(5), 
Bueno-Novitol J(6).

Author information:
(1)Department of Microbiology, Pediatrics, Radiology and Public Health, 
University of Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Spain.
(2)Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry 
of Science and Innovation, 28029 Madrid, Spain.
(3)Aragonese Institute of Health Sciences (IIS Aragón), 50009 Zaragoza, Spain.
(4)Department of Developmental and Educational Psychology, University of the 
Basque Country UPV/EHU, 48940 Leioa, Spain.
(5)Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, 
Universitat de Barcelona, 08830 Barcelona, Spain.
(6)Psychiatry Service, Hospital Universitario Miguel Servet, 50009 Zaragoza, 
Spain.

Background and Objectives: The COVID-19 pandemic has a negative impact on the 
mental health of the population in general, and in college students in 
particular. Dental students have seen their teaching altered and their clinical 
practice reduced. This study was aimed at conducting a systematic review and 
meta-analysis of studies reporting levels of depression among dental students 
during the COVID-19 and estimating the pooled prevalence of depression. 
Materials and Methods: Medline via PubMed and other databases were searched for 
studies on the prevalence of depression in dental undergraduates, published from 
1 December 2019 to 1 September 2021. The pooled proportions of depression were 
calculated with random effects models. Results: We identified 13 studies from 9 
countries. The pooled prevalence of depression in dental students was 37% (95% 
CI: 26-49%) with no variation due to gender, response rate or methodological 
quality. We only found a significantly higher prevalence of depression in 
studies from Asia compared to Europe and America. Conclusions: Our results 
suggest that dental students are suffering from higher levels of depression 
compared with the general population or other college students during the 
COVID-19 pandemic, with differences across regions. Measures to improve mental 
health and wellbeing of dental students during the pandemic are needed.

DOI: 10.3390/medicina57111278
PMCID: PMC8619286
PMID: 34833496 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2728. Int J Environ Res Public Health. 2021 Nov 22;18(22):12264. doi: 
10.3390/ijerph182212264.

Mental Well-Being during COVID-19: A Cross-Sectional Study of Fly-In Fly-Out 
Workers in the Mining Industry in Australia.

Asare BY(1)(2), Thomas E(1), Affandi JS(1), Schammer M(3), Brown P(3), Pilbeam 
M(3), Harris C(3), Ellison C(3), Kwasnicka D(4)(5), Powell D(2)(6), Reid CM(1), 
Robinson S(1).

Author information:
(1)Curtin School of Population Health, Curtin University, Kent Street, Bentley 
6102, Australia.
(2)Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 
2ZD, UK.
(3)Mineral Resources Limited, Applecross 6153, Australia.
(4)Faculty of Psychology, SWPS University of Social Sciences and Humanities, 
Aleksandra Ostrowskiego, 53-238 Wroclaw, Poland.
(5)NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, 
Melbourne School of Population and Global Health, University of Melbourne, 
Melbourne 3000, Australia.
(6)Rowett Institute, University of Aberdeen, Aberdeen AB25 2ZD, UK.

Coronavirus disease 2019 (COVID-19) has devastated the world, and its mental 
health impact has been recognized in the general population. However, little is 
known about the mental health impact of COVID-19 on fly-in fly-out (FIFO) 
workers, who are flown to temporarily stay and work in remote areas, during this 
pandemic. This study examined the mental well-being of FIFO workers in the 
mining industry during COVID-19 restrictions in Western Australia. An online 
survey was conducted between May to November 2020 among (N = 842) FIFO workers 
who underwent COVID-19 screening at a large mining company in Western Australia. 
The mental well-being score among workers was higher than population norms. 
One-way ANOVA with Bonferroni post-hoc tests showed significant differences in 
mental well-being by age, being placed under travel quarantine, undertaking 
self-isolation, impact of social distance guidelines, and experience of COVID-19 
related symptoms. Multiple linear regression analysis showed workers who were 
younger, placed under travel quarantine and experienced two or more COVID-19 
related symptoms were more likely to have worse mental well-being. Acknowledging 
the negative emotions and distress experiences among the vulnerable groups could 
help in providing suitable support to help lessen these negative experiences in 
FIFO workers.

DOI: 10.3390/ijerph182212264
PMCID: PMC8620700
PMID: 34832023 [Indexed for MEDLINE]

Conflict of interest statement: B.Y.-A.A., E.T., J.S.A., D.K., D.P., C.M.R. and 
S.R. declare no conflicts of interest. M.S., P.B., M.P., C.E. and C.H. are 
employees of and receive salaries from the Mineral Resources Limited 
(Australia).


2729. Int J Environ Res Public Health. 2021 Nov 16;18(22):12036. doi: 
10.3390/ijerph182212036.

Physical Activity, Mental Health and Wellbeing during the First COVID-19 
Containment in New Zealand: A Cross-Sectional Study.

O'Brien WJ(1), Badenhorst CE(1), Draper N(2), Basu A(2), Elliot CA(3), Hamlin 
MJ(3), Batten J(4), Lambrick D(5), Faulkner J(4).

Author information:
(1)School of Sport, Exercise and Nutrition, Massey University, Auckland 0632, 
New Zealand.
(2)School of Health Sciences, University of Canterbury, Christchurch 8140, New 
Zealand.
(3)Department of Tourism, Sport, and Society, Lincoln University, Lincoln 7647, 
New Zealand.
(4)School of Sport, Health and Community, University of Winchester, Hampshire 
SO22 4NR, UK.
(5)School of Health Sciences, University of Southampton, Southampton SO17 1BJ, 
UK.

Strategies implemented worldwide to contain COVID-19 outbreaks varied in 
severity across different countries, and established a new normal for work and 
school life (i.e., from home) for many people, reducing opportunities for 
physical activity. Positive relationships of physical activity with both mental 
and physical health are well recognised, and therefore the aim was to ascertain 
how New Zealand's lockdown restrictions impacted physical activity, mental 
health and wellbeing. Participants (n = 4007; mean ± SD: age 46.5 ± 14.7 years, 
72% female, 80.7% New Zealand European) completed (10-26 April 2020) an online 
amalgamated survey (Qualtrics): International Physical Activity Questionnaire: 
Short Form; Depression, Anxiety and Stress Scale-9; World Health 
Organisation-Five Well-Being Index; Stages of Change Scale. Positive 
dose-response relationships between physical activity levels and wellbeing 
scores were demonstrated for estimates that were unadjusted (moderate activity 
OR 3.79, CI 2.88-4.92; high activity OR 8.04, CI 6.07-10.7) and adjusted 
(confounding variables: age, gender, socioeconomic status, time sitting and 
co-morbidities) (moderate activity 1.57, CI 1.11-2.52; high activity 2.85, CI 
1.97-4.14). The study results support previous research demonstrating beneficial 
effects of regular physical activity on mental health and wellbeing. Governments 
may use these results to promote meeting physical activity guidelines in order 
to protect mental health and wellbeing during the ongoing COVID-19 restrictions 
and future pandemics.

DOI: 10.3390/ijerph182212036
PMCID: PMC8620825
PMID: 34831789 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2730. Int J Environ Res Public Health. 2021 Nov 12;18(22):11908. doi: 
10.3390/ijerph182211908.

The Role of Animal Ownership for People with Severe Mental Illness during the 
COVID-19 Pandemic: A Mixed-Method Study Investigating Links with Health and 
Loneliness.

Shoesmith E(1), Spanakis P(1), Peckham E(1), Heron P(1), Johnston G(2), Walker 
L(1), Crosland S(1), Ratschen E(1).

Author information:
(1)Department of Health Sciences, University of York, York YO10 5DD, UK.
(2)Independent Researcher, Clackmannan FK10 4EF, UK.

Research has reported the benefits of companion animals for people with severe 
mental illness (SMI). However, this evidence base is fragmented and unclear. The 
COVID-19 pandemic presents an opportunity to explore the role of companion 
animals in the context of social distancing and isolation measures for people 
with SMI. Therefore, we aimed to investigate the links between mental and 
physical health and animal ownership in people with SMI and to explore animal 
owners' perceptions related to human-animal interactions during the pandemic 
restrictions. A survey was conducted with a previously assembled cohort of 
individuals with SMI in the UK. The survey included previously validated and new 
bespoke items measuring demographics, and outcomes related to mental and 
physical health, and human-animal interactions. The survey also included a 
question inviting free-text responses, allowing participants to describe any 
experiences of their human-animal relationships during the pandemic. Of 315 
participants who consented to participate, 249 (79%) completed the survey. Of 
these, 115 (46.2%) had at least one companion animal. Regression analyses 
indicated that animal ownership was not significantly associated with well-being 
and loneliness. However, animal ownership was associated with a self-reported 
decline in mental health (b = 0.640, 95% CI [0.102-1.231], p = 0.025), but no 
self-reported change in physical health. Thematic analysis identified two main 
themes relating to the positive and negative impact of animal ownership during 
pandemic restrictions. Animal ownership appeared to be linked to self-reported 
mental health decline in people with SMI during the second wave of the pandemic 
in the UK. However, the thematic analysis also highlighted the perceived benefit 
of animal ownership during this time. Further targeted investigation of the role 
of human-animal relationships and the perceived human-animal bond for human 
health is warranted.

DOI: 10.3390/ijerph182211908
PMCID: PMC8624942
PMID: 34831665 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2731. Int J Environ Res Public Health. 2021 Nov 11;18(22):11832. doi: 
10.3390/ijerph182211832.

Older People's Lived Perspectives of Social Isolation during the First Wave of 
the COVID-19 Pandemic in Italy.

Cipolletta S(1), Gris F(1).

Author information:
(1)Department of General Psychology, University of Padua, 35131 Padua, Italy.

The aim of the present study is to understand the experiences of isolation and 
strategies used to cope with it among older people living at home during the 
first wave of the COVID-19 pandemic. More specifically, the roles of media and 
online technologies were also explored. Semistructured interviews were conducted 
via telephone between March and April 2020 with 30 people aged 72-94 years old 
living in Northern Italy. The thematic analysis identified six thematic areas: 
changes in daily life, emotions, social networks, exploited resources and 
strategies, use of media, and view of the future. Older people faced the 
emergency in heterogeneous ways; some were able to take advantage of their own 
residual resources and of social support, whereas in other cases, isolation 
exacerbated existing weaknesses. Technology and media were useful for reducing 
loneliness and fostering social contacts, but people with age-related 
impairments or low digital literacy presented many difficulties in approaching 
new technologies. Moreover, the overabundance of information could also increase 
anxiety and feelings of threat. Given the impact of social isolation on older 
people's well-being, it is critical to identify and strengthen personal 
resources and social support strategies that may help older people cope with the 
restrictions imposed by the COVID-19 pandemic.

DOI: 10.3390/ijerph182211832
PMCID: PMC8618043
PMID: 34831586 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


2732. Int J Environ Res Public Health. 2021 Nov 11;18(22):11807. doi: 
10.3390/ijerph182211807.

Universal Screening in Positive School Mental Health Using the ASEBA Methodology 
for Teachers: A Pilot Epidemiological Study.

Cortés-Ramos A(1), Landa-Blanco M(2).

Author information:
(1)Department of Developmental Psychology and Education, Faculty of Psychology 
and Speech Therapy, University of Malaga, 29010 Malaga, Spain.
(2)Degree in Clinical Psychology, School of Psychological Sciences, National 
Autonomous University of Honduras, Tegucigalpa 11101, Honduras.

School-based detection and intervention are critical components in ensuring 
positive mental health in children, with teachers playing an essential role in 
assessing students' well-being. The current research aims to be a pilot 
epidemiological study on positive school mental health in Malaga, Spain, using 
the Achenbach System of Empirically Based Assessment (ASEBA). Data were 
collected in the COVID-19 pre-pandemic setting, using the Caregiver-Teacher 
Report Form (C-TRF) and the Teacher Report Form (TRF) in a sample of 420 
children, who were between 5 and 8 years old at the time of the data collection. 
In 5-year-old children, the DSM-oriented scale with the highest clinical 
prevalence corresponds to attention deficit and hyperactivity problems (1.13%). 
In this same sub-sample, clinical levels of externalizing problems (4.52%) were 
non-significantly more common than internalizing conditions (1.69%). As for 
children between 6 and 8 years old, the DSM-oriented scale with the highest 
prevalence of clinical scores corresponds to anxiety problems (4.12%) and 
conduct problems (2.88%). Clinical levels of externalizing problems (9.47%) were 
non-significantly more prevalent than internalizing problems (6.58%). The 
results present 95% confidence intervals prevalence data in the general 
population and sex-differentiated descriptive statistics. The results are 
discussed according to their implication for school mental health.

DOI: 10.3390/ijerph182211807
PMCID: PMC8617970
PMID: 34831563 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2733. Int J Soc Psychiatry. 2022 Dec;68(8):1756-1763. doi: 10.1177/00207640211057794. 
Epub 2021 Nov 25.

Understanding health anxiety in the COVID-19 pandemic.

Heinen A(1), Varghese S(1), Krayem A(1), Molodynski A(1).

Author information:
(1)Oxford Health NHS Foundation Trust, UK.

BACKGROUND: The COVID-19 pandemic continues to be one of the greatest public 
health challenges faced by the UK. Reported rates of psychiatric difficulties 
have increased and the mechanisms by which the pandemic has affected mental 
health requires investigation.
AIMS: The aim of the study was to understand the psychological impact of the 
COVID-19 pandemic on health anxiety in the general population, with a focus on 
Oxford Health NHS Foundation Trust, which provides specialist mental health care 
within Oxfordshire and Buckinghamshire.
METHODS: We invited participants aged 18+ across Oxfordshire and Buckinghamshire 
to complete an online questionnaire consisting of standardised questionnaires 
measuring psychological wellbeing, non-standardised questions to provide 
demographic information, and information about social circumstances and 
behaviour during the COVID-19 pandemic. Participants were then invited via email 
to complete a 3-month follow-up questionnaire.
RESULTS: About 324 participants completed the baseline survey while 199 
completed the follow-up. Our analysis demonstrated that higher scores on a 
health anxiety inventory were related to reports of depression, anxiety, 
loneliness, poor quality of life and obsessive-compulsive symptoms and panic. We 
also identified several predictors of health anxiety such as being female, 
having a pre-existing physical or mental health condition, and poor tolerance of 
uncertainty. Lifestyle and demographic factors such as changes in financial 
situation, changes in employment status, having a close relative or friend with 
COVID-19, being able to do grocery shopping, being a key worker, and ethnicity 
were not found to predict health anxiety.
CONCLUSIONS: Awareness of the impact of health anxiety on people needs to be 
consistently high among healthcare professionals, especially in the continuing 
fallout from the COVID-19 pandemic. The relationship between health anxiety and 
fatigue, sleep quality, gender and co-morbid mental and physical health 
difficulties needs to be investigated further to determine areas of 
intervention.

DOI: 10.1177/00207640211057794
PMID: 34823387 [Indexed for MEDLINE]


2734. PLoS One. 2021 Nov 24;16(11):e0259013. doi: 10.1371/journal.pone.0259013. 
eCollection 2021.

COVID-19 pandemic and health worker stress: The mediating effect of emotional 
regulation.

García-Batista ZE(1), Guerra-Peña K(1), Nouri Kandany V(2), Marte MI(3), Garrido 
LE(1), Cantisano-Guzmán LM(1), Moretti L(4), Medrano LA(4).

Author information:
(1)Pontificia Universidad Católica Madre y Maestra (PUCMM), Santiago de los 
Caballeros, Dominican Republic.
(2)Unidad de Investigación de la Escuela de Medicina, Universidad Autónoma de 
Santo Domingo (UASD), Santiago de los Caballeros, Dominican Republic.
(3)Escuela de Medicina, Universidad Tecnológica de Santiago (UTESA), Santiago de 
los Caballeros, Dominican Republic.
(4)Universidad Siglo 21, Córdoba, Argentina.

BACKGROUND/INTRODUCTION: Psychological and physical well-being of health 
personnel has been significantly affected by COVID-19. Work overload and 
continuous exposure to positive COVID-19 cases have caused them fatigue, stress, 
anxiety, insomnia and other detriments. This research aims: 1) to analyze 
whether the use of cognitive reevaluation and emotional suppression strategies 
decreases and increases, respectively, stress levels of health personnel; 2) to 
quantify the impact of contact with patients with COVID-19 on stress levels of 
medical staff.
METHOD: Emotion regulation strategies (cognitive reevaluation and emotional 
expression) and stress levels were evaluated in 155 Dominican physicians who 
were treating people infected with COVID-19 at the moment of the study (67.9% 
women and 32.1% men; mean age = 34.89; SD = 9.26). In addition, a questionnaire 
created by the researchers quantified the impact that contact with those 
infected had on their stress levels.
RESULTS: Contact with patients with COVID-19 predicts increased use of emotion 
suppression strategies, although is not associated with the use of cognitive 
reevaluation. These findings lead to an even greater increase in stress on 
health care providers.
CONCLUSIONS: Contextual contingencies demand immediate responses and may not 
allow health personnel to use cognitive re-evaluation strategies, leaning more 
towards emotion suppression. However, findings regarding high levels of stress 
require the implementation of intervention programs focused on the promotion of 
more functional emotion regulation strategies. Such programs may reduce current 
stress and prevent post-traumatic symptoms.

DOI: 10.1371/journal.pone.0259013
PMCID: PMC8612545
PMID: 34818330 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2735. JAMA Netw Open. 2021 Nov 1;4(11):e2136150. doi: 
10.1001/jamanetworkopen.2021.36150.

Morally Injurious Experiences and Emotions of Health Care Professionals During 
the COVID-19 Pandemic Before Vaccine Availability.

Song YK(1), Mantri S(2)(3), Lawson JM(3)(4), Berger EJ(5), Koenig HG(1)(6).

Author information:
(1)Department of Psychiatry and Behavioral Sciences, Duke University Medical 
Center, Durham, North Carolina.
(2)Department of Neurology, Duke University Medical Center, Durham, North 
Carolina.
(3)Trent Center for Bioethics, Humanities, and History of Medicine, Duke 
University, Durham, North Carolina.
(4)Department of Pediatrics, Duke University Medical Center, Durham, North 
Carolina.
(5)Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, 
New York.
(6)Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.

IMPORTANCE: Moral injury in health care professionals (HPs) has worsened over 
the course of the COVID-19 pandemic. The trauma and burnout associated with 
moral injury has profound implications for the mental health of HPs.
OBJECTIVE: To explore the potential factors associated with moral injury for HPs 
who were involved in patient care during the COVID-19 pandemic in 2020, prior to 
the availability of vaccines.
DESIGN, SETTING, AND PARTICIPANTS: In this qualitative study, HPs were actively 
recruited to participate in a survey via snowball sampling via email and social 
media in 2 phases of 5 weeks each: April 24 to May 30, 2020 (phase 1), and 
October 24 to November 30, 2020 (phase 2). Overall, 1831 respondents answered 
demographic questions and assessments for moral injury, intrinsic religiosity, 
and burnout. Of those, 1344 responded to the open-ended questions. Responses to 
open-ended questions were coded iteratively and thematically analyzed within the 
framework of moral injury.
EXPOSURES: Working in a patient care setting during the COVID-19 pandemic prior 
to the availability of vaccines.
MAIN OUTCOMES AND MEASURES: Inductive thematic analysis of open-response survey 
answers identified dominant emotions and common stressors associated with moral 
injury.
RESULTS: There were 335 individuals (109 [32.6%] aged 35-44 years; 288 [86.0%] 
women; 294 [87.8%] White) in phase 1 and 1009 individuals (384 [38.1%] aged 
35-44 years; 913 [90.5%] women; 945 [93.7%] White) in phase 2. In phase 1, the 
respondents were predominantly nurses (100 [29.9%]), physicians (78 [23.3%]), 
advanced practice practitioners (APPs) (70 [20.9%]), and chaplains (55 [16.4%]). 
In phase 2, the respondents were predominantly nurses (589 [58.4%]), physicians 
(114 [11.3%]), and APPs (104 [10.3%]). HPs faced numerous stressors, such as 
fear of contagion, stigmatization, short-staffing, and inadequate personal 
protective equipment. The emotions experienced were (1) fear in phase 1, then 
fatigue in phase 2; (2) isolation and alienation; and (3) betrayal.
CONCLUSIONS AND RELEVANCE: These findings suggest that HPs experienced moral 
injury during the COVID-19 pandemic. Moral injury was not only experienced after 
a single moral dilemma but also from working in morally injurious environments. 
These experiences can serve as potential starting points for organizations to 
engender and enhance organizational and individual recovery, team building, and 
trust. System-level solutions that address shortages in staffing and personal 
protective equipment are needed to promote HP well-being.

DOI: 10.1001/jamanetworkopen.2021.36150
PMCID: PMC8613593
PMID: 34817579 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest Disclosures: Ms Berger 
reported receiving personal fees from Kansas City University outside the 
submitted work and being a speaker-consultant, an advanced practice board 
certified chaplain, and a narrative medicine specialist whose work is directed 
to spiritual health (meaning, purpose, and connectedness), clinician well-being, 
and the connection to patient care, which is inherently related to the areas of 
moral injury and burnout in healthcare. No other disclosures were reported.


2736. Acad Med. 2022 Mar 1;97(3S):S55-S60. doi: 10.1097/ACM.0000000000004536.

Ethical Dilemmas, Moral Distress, and the Risk of Moral Injury: Experiences of 
Residents and Fellows During the COVID-19 Pandemic in the United States.

Farrell CM(1), Hayward BJ(2).

Author information:
(1)C.M. Farrell is a clinical fellow, Division of Pulmonary and Critical Care 
Medicine and Division of Medical Ethics, Weill Cornell Medicine, New York, New 
York.
(2)B.J. Hayward is assistant professor of clinical medicine, Division of 
Pulmonary and Critical Care Medicine and Division of Geriatrics and Palliative 
Medicine, Weill Cornell Medicine, New York, New York.

The ongoing COVID-19 pandemic has brought numerous ethical dilemmas to the 
forefront of clinical care, including for resident and fellow physician 
trainees. In this paper, the authors draw on their own experiences providing 
frontline COVID-19 clinical care in New York City in their respective roles as 
an internal medicine resident and later a pulmonary and critical care fellow, 
and as an associate program director for a pulmonary and critical care 
fellowship, along with published literature on trainees' experiences in the 
pandemic, to describe common ethical dilemmas confronted by residents and 
fellows during the pandemic. These dilemmas are related to personal health risk, 
resource allocation, health care inequities, and media relations. The authors 
use a framework of microethics to underscore how these dilemmas are highly 
contextualized within trainees' institutions, their specific roles, and the 
patient populations to which they provide care. They argue that frequent ethical 
dilemmas, compounded by the intense physical and emotional stress of medical 
training and the pandemic itself, increase the potential for trainees to 
experience moral distress. Recurrent moral distress may, in turn, put trainees 
at risk for moral injury with consequences for their mental health and overall 
well-being. It is imperative to gain a clear understanding of this issue, not 
only for those trainees who have experienced or are at risk for experiencing 
personal consequences but also because it may help identify ways to better 
support the well-being of providers and the care of patients going forward.

Copyright © 2021 by the Association of American Medical Colleges.

DOI: 10.1097/ACM.0000000000004536
PMCID: PMC8855775
PMID: 34817403 [Indexed for MEDLINE]


2737. Ulster Med J. 2021 Sep;90(3):151-156. Epub 2021 Nov 11.

SUPPORT FOR GENERAL PRACTITONERS DURING COVID-19.

Davies M(1), Carr D(2), Dugan J(3), Hart N(4), Kirkpatrick R(5), Loughrey C(6), 
Loughrey P(7), O'Neill G(8).

Author information:
(1)Consultant Clinical Psychologist, Belfast Health and Social Care Trust.
(2)General Practitioner, Clinical Teaching Fellow Queen's University Belfast, 
Clinical Lead North Belfast GP Subdeanery Pilot.
(3)General Practitioner, Co-chair West Belfast GP Federation, Honorary Lecturer 
in Clinical Medicine Queen's University Belfast.
(4)Academic General Practitioner and Associate Director for General Practice & 
Primary Care, Centre for Medical Education, Queen's University Belfast.
(5)Trainee Clinical Psychologist, Queen's University Belfast.
(6)Director of General Practitioner Education & Training, Eastern Support Unit.
(7)General Practitioner, Chair North Belfast GP Federation.
(8)General Practitioner, Co-chair West Belfast GP Federation.

BACKGROUND: Evidence of initiatives to support General Practitioners (GPs) 
during the Covid-19 pandemic is scant.
AIM: To understand the impact of a novel method of providing support in the 
early stages of the pandemic.
DESIGN AND SETTING: A mixed-methods study of GPs working in a socially deprived 
area of Belfast.
METHOD: A survey was distributed to GPs who had attended a series of educational 
meetings at the beginning of the COVID-19 pandemic. The survey incorporated the 
Warwick Edinburgh Mental Wellbeing Scale and questions about the virtual 
meetings. Follow-up interviews were undertaken with five GPs to further explore 
their lived experiences and their perceptions of the virtual support forum.
RESULTS: The Covid-19 pandemic resulted in a measurable diminution of emotional 
well-being in GPs in North and West Belfast. Attendees rated a series of virtual 
meetings highly and described the following themes (and subthemes): a sudden 
traumatic change (emotional response, fight or flight, painful reminders of the 
status of general practice in the NHS); a coming together (stepping up to take 
responsibility, sharing of information, feeling of affirmation); reflections on 
what worked (calming facilitation, careful selection of speakers, creating the 
right atmosphere, ownership and autonomy) and building future direction 
(defining future direction, capitalising on lesson learned).
CONCLUSION: The virtual meetings harnessed the instinct to come together 
witnessed at the beginning of the pandemic, and as well as sharing valuable 
information, also provided emotional support along with a sense of comradeship, 
ownership and autonomy.
HOW THIS FITS IN: GPs did not feel included or supported at the outset of the 
pandemic. Coming together with fellow professionals was a welcome source of 
support. Professional support can be delivered using a virtual platform. 
Continued professional development is more acceptable than explicit emotional 
support, but when done well can bolster resilience and emotional well-being.

Copyright © 2021 Ulster Medical Society.

PMCID: PMC8581688
PMID: 34815593 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared no competing 
interests.


2738. J Investig Med. 2022 Feb;70(2):428-435. doi: 10.1136/jim-2021-001942. Epub 2021 
Nov 23.

Relationship between stress and alexithymia, emotional processing and 
negative/positive affect in medical staff working amid the COVID-19 pandemic.

Warchoł-Biedermann K(1), Bugajski P(2)(3), Budzicz Ł(4), Ziarko M(5), Jasielska 
A(6), Samborski W(7), Daroszewski P(8), Greberski K(2)(9), Bączyk G(10), Karoń 
J(3), Mojs E(11).

Author information:
(1)Department of Clinical Psychology, Poznan University of Medical Sciences, 
Poznan, Poland k.warchol@pro.onet.pl.
(2)Department of Cardiovascular Disease Prevention, Poznan University of Medical 
Sciences, Poznan, Poland.
(3)Department of General and Colorectal Surgery, Józef Strus Hospital, Poznan, 
Poland.
(4)Department of Psychology, University of Zielona Gora, Zielona Gora, Poland.
(5)Institute of Psychology, Uniwersytet im Adama Mickiewicza w Poznaniu, Poznan, 
Poland.
(6)Faculty of Psychology and Cognitive Sciences (FPCS AMU), Adam Mickiewicz 
University, Poznan, Poland.
(7)Department of Rheumatology and Rehabilitation, Poznan University of Medical 
Sciences, Poznan, Poland.
(8)Department of Organization and Management in Health Care, Poznan University 
of Medical Sciences, Poznan, Poland.
(9)Department of Cardiac Surgery, Józef Strus Hospital, Poznan, Poland.
(10)Department of Practice Nursing, Poznan University of Medical Sciences, 
Poznan, Poland.
(11)Department of Clinical Psychology, Poznan University of Medical Sciences, 
Poznan, Poland.

The psychological burden of the COVID-19 pandemic may have a lasting effect on 
emotional well-being of healthcare workers. Medical personnel working at the 
time of the pandemic may experience elevated occupational stress due to the 
uncontrollability of the virus, high perceived risk of infection, poor 
understanding of the novel virus transmission routes and unavailability of 
effective antiviral agents. This study used path analysis to analyze the 
relationship between stress and alexithymia, emotional processing and 
negative/positive affect in healthcare workers. The sample included 167 nurses, 
65 physicians and 53 paramedics. Sixty-two (21.75 %) respondents worked in 
COVID-19-designated hospitals. Respondents were administered the Toronto 
Alexithymia Scale-20, Cohen's Perceived Stress Scale, Emotional Processing 
Scale, and the Positive and Negative Affect Schedule. The model showed excellent 
fit indices (χ2 (2)=2.642, p=0.267; CFI=0.999, RMSEA=0.034, SRMR=0.015). 
Multiple group path analysis demonstrated physicians differed from nurses and 
paramedics at the model level (X2diff (7)=14.155, p<0.05 and X2diff (7)=18.642, 
p<0.01, respectively). The relationship between alexithymia and emotional 
processing was stronger in nurses than in physicians (difference in beta=0.27; 
p<0.05). Individual path χ2 tests also revealed significantly different paths 
across these groups. The results of the study may be used to develop 
evidence-based intervention programs promoting healthcare workers' mental health 
and well-being.

© American Federation for Medical Research 2022. No commercial re-use. See 
rights and permissions. Published by BMJ.

DOI: 10.1136/jim-2021-001942
PMID: 34815298 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2739. Appl Nurs Res. 2021 Dec;62:151502. doi: 10.1016/j.apnr.2021.151502. Epub 2021 
Sep 25.

Factors associated with nurses emotional distress during the COVID-19 pandemic.

Da Rosa P(1), Brown R(2), Pravecek B(2), Carotta C(3), Garcia AS(3), Carson 
P(2), Callies D(2), Vukovich M(4).

Author information:
(1)Office of Nursing Research, College of Nursing, South Dakota State 
University, USA. Electronic address: Patricia.darosa@sdstate.edu.
(2)College of Nursing, South Dakota State University, USA.
(3)Department of Counseling and Human Development, South Dakota State 
University, USA.
(4)Education & Human Sciences, South Dakota State University, USA.

BACKGROUND: Nurses are among the frontline healthcare workers directly impacted 
by the burden of the coronavirus disease of 2019 (COVID-19) pandemic. This study 
aimed to examine the prevalence of emotional distress and the associated factors 
among nurses practicing in South Dakota during the COVID-19 pandemic.
METHODS: An online survey was conducted among practicing, licensed nurses in 
South Dakota during the pandemic (July 2020 - August 2020). Emotional distress 
was measured using the Depression, Anxiety, and Stress Scale (DASS-21). Logistic 
regression models were performed to examine the association of emotional 
distress and the three DASS-21 subscales with: sociodemographic and work 
environment factors (e.g., work setting, job satisfaction, number of COVID-19 
cases seen at the facility, preparedness, concerns with worsening pre-exiting 
mental health conditions due to the pandemic, and contracting the illness).
RESULTS: Among 1505 participants, overall emotional distress was reported by 
22.2%, while anxiety, depression and stress were 15.8%, 14.5% and 11.9%, 
respectively. Factors associated with moderate to severe emotional distress, 
depression, anxiety, and stress were as follows: concerns for worsening of 
pre-existing mental health conditions, job dissatisfaction, encountering higher 
number of COVID-19 cases at one's work facility, feeling unprepared for the 
pandemic, and concern for contracting the illness (all p < 0.05).
CONCLUSIONS: Our study suggests a high prevalence of emotional distress among 
nurses and highlights the factors associated with emotional distress during the 
COVID-19 pandemic. Promoting appropriate support is imperative to reduce nurses' 
emotional distress and promote psychological well-being during the COVID-19 
world health crisis and in future pandemics.

Copyright © 2021 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.apnr.2021.151502
PMCID: PMC8463109
PMID: 34814998 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no known 
competing financial interests or personal relationships that could have appeared 
to influence the work reported in this paper.


2740. Acta Neuropsychiatr. 2022 Apr;34(2):93-98. doi: 10.1017/neu.2021.37. Epub 2021 
Nov 24.

Mental well-being, health, and locus of control in Danish adults before and 
during COVID-19.

Würtzen H(1), Clausen LH(1), Andersen PB(2), Santini ZI(3), Erkmen J(4), 
Pedersen HF(5).

Author information:
(1)Multidisciplinary Pain Centre, Department of Anaesthesia, Pain and 
Respiratory Support, Neuroscience Centre, Rigshospitalet - Copenhagen University 
Hospital, Copenhagen, Denmark.
(2)Department of Cross-Cultural and Regional Studies, University of Copenhagen, 
Copenhagen, Denmark.
(3)National Institute for Public Health, University of Southern Denmark, 
Copenhagen, Denmark.
(4)Applied Research of Education and Social Science, UCL University College, 
Odense, Denmark.
(5)Research Clinic for Functional Disorders and Psychosomatics, Aarhus 
University Hospital, Aarhus, Denmark.

AIM: The aim of this study was to investigate the possible impact of the 
Covid-19 pandemic on general health, mental well-being, and experiences of 
control compared to pre-pandemic populations. Our hypotheses were that we would 
observe a significantly lower level of psychological well-being and general 
health in the 2020 sample compared to the pre-pandemic samples, and that we 
would observe younger age groups to be the most affected.
METHOD: Two representative Danish populations (2016, n = 1656) and (2017, n = 
3366) were compared to a representative Danish population (2020, n = 1538) 
sampled during the first lockdown in May 2020. Two-tailed tests of proportions 
were used to investigate possible differences between samples in proportions 
reporting poorer mental well-being measured by 5-item World Health Organization 
Well-Being Index, general health, and internal locus of control.
RESULTS: Younger men (aged 18-24) and younger women (aged 18-44) as well as 
elderly women (aged 65-74) reported lower mental well-being during the early 
phase of the pandemic compared to the population from 2016. Both women and men 
in 2020 reported significantly lower levels of internal locus of control 
compared to the 2017 sample. This was especially true for younger men and women. 
There were no statistically significant differences in general health between 
populations.
DISCUSSION: This study partly supports the hypothesis that the Covid-19 pandemic 
affected mental well-being negatively among younger persons. However, 
longitudinal studies are needed to investigate possible long-term effects of the 
pandemic on mental health and well-being. Further, qualitative studies are 
needed to investigate the in-depth consequences of Covid-19.

DOI: 10.1017/neu.2021.37
PMID: 34814958 [Indexed for MEDLINE]


2741. Pediatrics. 2021 Dec 1;148(6):e2021050300. doi: 10.1542/peds.2021-050300.

Perinatal Mental Health Task Force: Integrating Care Across a Pediatric Hospital 
Setting.

Jarvis L(1)(2), Long M(1)(2), Theodorou P(1), Barclay Hoffman S(1), Soghier 
L(1)(2), Beers L(1)(2).

Author information:
(1)Children's National Hospital, Washington, District of Columbia.
(2)Department of Pediatrics, The George Washington University School of Medicine 
and Health Sciences, Washington, District of Columbia.

Perinatal mood and anxiety disorders (PMADs) are the most common complication of 
childbirth, with suicide a leading cause of postpartum deaths. PMADs are 
associated with poor maternal, infant, and family outcomes. Identification and 
early intervention are imperative for successful treatment. This case study 
describes the implementation and outcomes of a multidisciplinary Perinatal 
Mental Health Task Force ("Task Force") at one urban academic children's 
hospital that was created to promote systems change and health care policy 
solutions for improved identification and treatment of PMADs. Using the social 
ecological model as a framework, the Task Force addressed care at the 
individual, interpersonal, organizational, community, and policy levels. The 
Task Force applied lessons learned from division-specific screening initiatives 
to create best practices and make hospital-wide recommendations. This 
foundational work enabled us to build community bridges and break down internal 
barriers to shift our pediatric hospital toward prioritizing perinatal mental 
health. As a result, screening expanded to multiple hospital locations and 
became a hospital corporate goal, the Perinatal Mental Health Screening Tool Kit 
was created and disseminated within the community, Task Force members testified 
in governmental hearings and joined national organizations to inform policy, and 
Task Force and community collaborations resulted in significant grant funding. 
Lessons learned have been disseminated nationally. Moving forward, we aim to 
expand our program and partnerships to ensure that caregivers of infants receive 
appropriate mental health support to strengthen family well-being. The Task 
Force can serve as a model for advocates looking to expand and integrate PMAD 
care.

Copyright © 2021 by the American Academy of Pediatrics.

DOI: 10.1542/peds.2021-050300
PMID: 34814188 [Indexed for MEDLINE]

Conflict of interest statement: POTENTIAL CONFLICT OF INTEREST: The authors have 
indicated they have no potential conflicts of interest to disclose.


2742. PLoS One. 2021 Nov 23;16(11):e0260261. doi: 10.1371/journal.pone.0260261. 
eCollection 2021.

Comprehensive occupational health services for healthcare workers in Zimbabwe 
during the SARS-CoV-2 pandemic.

Kavenga F(1), Rickman HM(2), Chingono R(1), Taruvinga T(1)(3), Marembo T(4), 
Manasa J(4), Marambire E(1), McHugh G(1), Gregson CL(5), Bandason T(1), Redzo 
N(1), Maunganidze A(6), Magure T(7), Ndhlovu C(8), Mujuru H(9), Rusakaniko 
S(10), Manangazira P(11), Ferrand RA(1)(2), Kranzer K(1)(2)(11)(12).

Author information:
(1)Biomedical Research and Training Institute, Harare, Zimbabwe.
(2)Clinical Research Department, London School of Hygiene & Tropical Medicine, 
London, United Kingdom.
(3)Department of Global Health and Development, London School of Hygiene & 
Tropical Medicine, London, United Kingdom.
(4)African Institute of Biomedical Science and Technologies Laboratory, Harare, 
Zimbabwe.
(5)Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical 
School, University of Bristol, Bristol, United Kingdom.
(6)Department of Surgery, College of Health Sciences, University of Zimbabwe, 
Harare, Zimbabwe.
(7)Department of Obstetrics and Gynaecology, College of Health Science, 
University of Zimbabwe, Harare, Zimbabwe.
(8)Department of Medicine, University of Zimbabwe College of Health Sciences, 
Harare, Zimbabwe.
(9)Department of Paediatrics and Child Health, University of Zimbabwe College of 
Health Sciences, Harare, Zimbabwe.
(10)Department of Community Medicine, College of Health Sciences, University of 
Zimbabwe, Harare, Zimbabwe.
(11)Department of Epidemiology and Disease Control, Ministry of Health and Child 
Care, Harare, Zimbabwe.
(12)Department of Infectious Diseases & Tropical Medicine, Ludwig Maximilian 
University of Munich, Munich, Germany.

BACKGROUND: Healthcare workers are disproportionately affected by COVID-19. In 
low- and middle- income countries, they may be particularly impacted by 
underfunded health systems, lack of personal protective equipment, challenging 
working conditions and barriers in accessing personal healthcare.
METHODS: In this cross-sectional study, occupational health screening was 
implemented at the largest public sector medical centre in Harare, Zimbabwe, 
during the "first wave" of the country's COVID-19 epidemic. Clients were 
voluntarily screened for symptoms of COVID-19, and if present, offered a 
SARS-CoV-2 nucleic acid detection assay. In addition, measurement of height, 
weight, blood pressure and HbA1c, HIV and TB testing, and mental health 
screening using the Shona Symptom Questionnaire (SSQ-14) were offered. An 
interviewer-administered questionnaire ascertained client knowledge and 
experiences related to COVID-19.
RESULTS: Between 27th July and 30th October 2020, 951 healthcare workers 
accessed the service; 210 (22%) were tested for SARS-CoV-2, of whom 12 (5.7%) 
tested positive. Clients reported high levels of concern about COVID-19 which 
declined with time, and faced barriers including lack of resources for infection 
prevention and control. There was a high prevalence of largely undiagnosed 
non-communicable disease: 61% were overweight or obese, 34% had a blood pressure 
of 140/90mmHg or above, 10% had an HbA1c diagnostic of diabetes, and 7% had an 
SSQ-14 score consistent with a common mental disorder. Overall 8% were 
HIV-positive, with 97% previously diagnosed and on treatment.
CONCLUSIONS: Cases of SARS-CoV-2 in healthcare workers mirrored the national 
epidemic curve. Implementation of comprehensive occupational health services 
during a pandemic was feasible, and uptake was high. Other comorbidities were 
highly prevalent, which may be risk factors for severe COVID-19 but are also 
important independent causes of morbidity and mortality. Healthcare workers are 
critical to combatting COVID-19; it is essential to support their physical and 
psychological wellbeing during the pandemic and beyond.

DOI: 10.1371/journal.pone.0260261
PMCID: PMC8610265
PMID: 34813627 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2743. Postgrad Med J. 2022 Dec;98(1166):930-935. doi: 
10.1136/postgradmedj-2021-140719. Epub 2021 Nov 22.

What gets resident physicians stressed and how would they prefer to be 
supported? A best-worst scaling study.

Wu A(1)(2), Parris RS(3)(4), Scarella TM(5)(2), Tibbles CD(3)(6), Torous 
J(5)(2), Hill KP(5)(2).

Author information:
(1)Psychiatry, Harvard Medical School, Boston, Massachusetts, USA 
anwu@partners.org.
(2)Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
(3)Office of Graduate Medical Education, Beth Israel Deaconess Medical Center, 
Boston, Massachusetts, USA.
(4)Medicine, Harvard Medical School, Boston, Massachusetts, USA.
(5)Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
(6)Emergency Medicine, Harvard Medical School, Boston, MA, USA.

INTRODUCTION: Physician burnout has severe consequences on clinician well-being. 
Residents face numerous work-stressors that can contribute to burnout; however, 
given specialty variation in work-stress, it is difficult to identify systemic 
stressors and implement effective burnout interventions on an institutional 
level. Assessing resident preferences by specialty for common wellness 
interventions could also contribute to improved efficacy.
METHODS: This cross-sectional study used best-worst scaling (BWS), a type of 
discrete choice modelling, to explore how 267 residents across nine specialties 
(anaesthesiology, emergency medicine, internal medicine, neurology, obstetrics 
and gynaecology, pathology, psychiatry, radiology and surgery) prioritised 16 
work-stressors and 4 wellness interventions at a large academic medical centre 
during the COVID-19 pandemic (December 2020).
RESULTS: Top-ranked stressors were work-life integration and electronic health 
record documentation. Therapy (63%, selected as 'would realistically consider 
intervention') and coaching (58%) were the most preferred wellness supports in 
comparison to group-based peer support (20%) and individual peer support (22%). 
Pathology, psychiatry and OBGYN specialties were most willing to consider all 
intervention options, with emergency medicine and internal medicine specialties 
least willing to consider intervention options.
CONCLUSION: BWS can identify relative differences in surveyed stressors, 
allowing for the generation of specialty-specific stressor rankings and 
preferences for specific wellness interventions that can be used to drive 
institution-wide changes to improve clinician wellness. BWS surveys are a 
potential methodology for clinician wellness programmes to gather specific 
information on preferences to determine best practices for resident wellness.

© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and 
permissions. Published by BMJ.

DOI: 10.1136/postgradmedj-2021-140719
PMID: 34810273 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2744. Fam Syst Health. 2021 Sep;39(3):518-525. doi: 10.1037/fsh0000646.

Prevention of psychological trauma among health care providers during the 
COVID-19 pandemic.

Mullin DJ(1), Pearson S(1), Eisdorfer E(1), Mullarkey J(1), Dykhouse E(1).

Author information:
(1)Department of Family Medicine and Community Health, University of 
Massachusetts Medical School.

The COVID-19 pandemic presented unique biological, psychological, and social 
threats to health care providers. The failure of local macrosystems placed 
providers at elevated risk of psychological and physical harm. To reduce the 
immediate risk of trauma to our local physician workforce, our team initiated a 
program of proactive psychological first aid in which physicians were regularly 
contacted by behavioral health colleagues to assess safety conditions and 
physician's well-being. When threats to the physician's safety were identified, 
these concerns were escalated to leadership and addressed when possible. When 
threats to well-being were identified, behavioral health team members provided 
supportive listening, and, if indicated, provided referral information for 
appropriate treatment resources. This paper reviews the rationale for this 
program, addresses ethical concerns, and proposes future directions for 
responding to threats to safety during events such as the COVID-19 pandemic. 
(PsycInfo Database Record (c) 2021 APA, all rights reserved).

DOI: 10.1037/fsh0000646
PMID: 34807648 [Indexed for MEDLINE]


2745. Fam Syst Health. 2021 Sep;39(3):454-466. doi: 10.1037/fsh0000633.

Family well-being and individual mental health in the early stages of COVID-19.

Crandall A(1), Daines C(1), Barnes MD(1), Hanson CL(1), Cottam M(1).

Author information:
(1)Department of Public Health.

BACKGROUND: The objective of the study was to examine the association of 
COVID-19 with family well-being and adult mental health 1 month into the 
COVID-19 pandemic in the United States. Prior pandemics have had long-term 
effects on mental health. COVID-19 and its related stressors, such as loss of 
work and social distancing requirements, may have a profound impact on 
short-term and long-term mental health. Family stress theory indicates that 
subjective family meaning making and family resources affect how stressors lead 
to outcomes.
METHOD: Participants, adults ages 18 years and older (N = 416), completed a 
cross-sectional online survey measuring depressive and anxiety symptoms, family 
health, subjective family meaning making, and loss of work resulting from 
COVID-19. Data were analyzed using a structural equation modeling framework.
RESULTS: Results indicated that subjective negative family meaning and effects 
were associated with more depression and anxiety. Higher family health resources 
were associated with less depression and anxiety. Family health resources 
mediated the relationships between COVID-19 loss of work with depression and 
anxiety.
CONCLUSION: COVID-19 associated stressors 1 month into the pandemic had modest 
effects on family meaning making and family health resources. Individuals from 
families whose health resources were negatively impacted by COVID-19 reported 
more anxiety and depressive symptoms. Health care and public health systems 
should consider family health resources to help reduce the negative effects of 
COVID-19 on mental health. Longitudinal research is needed to examine the 
accumulation of stressors over time and the directionality of relationships. 
(PsycInfo Database Record (c) 2021 APA, all rights reserved).

DOI: 10.1037/fsh0000633
PMID: 34807645 [Indexed for MEDLINE]


2746. J Epidemiol Glob Health. 2021 Dec;11(4):377-388. doi: 
10.1007/s44197-021-00014-4. Epub 2021 Nov 22.

Psychological Impact of COVID-19 Pandemic on Healthcare Workers in Riyadh, Saudi 
Arabia: Perceived Stress Scale Measures.

Alwaqdani N(1), Amer HA(2)(3), Alwaqdani R(4), AlMansour F(5), Alzoman HA(2), 
Saadallah A(6), Alsuwaidan S(7), Soule BM(8), Memish ZA(9)(10)(11).

Author information:
(1)Riyadh Dental Center, King Saud Medical City, Riyadh, Saudi Arabia.
(2)Prevention and Control of Infection Administration, King Saud Medical City, 
Riyadh, Saudi Arabia.
(3)Community Medicine Research Department, National Research Center, Cairo, 
Egypt.
(4)Dental Private Clinics, King Saud Medical City, Riyadh, Saudi Arabia.
(5)Eradah Medical Complex, Riyadh, Saudi Arabia.
(6)King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
(7)Research and Innovation Center, King Saud Medical City, Ministry of Health, 
Riyadh, Saudi Arabia.
(8)Joint Commission Resources/Joint Commission International, Six Sigma Yellow 
Belt, Chicago, USA.
(9)Research and Innovation Center, King Saud Medical City, Ministry of Health, 
Riyadh, Saudi Arabia. zmemish@yahoo.com.
(10)College of Medicine, Al-Faisal University, Riyadh, Saudi Arabia. 
zmemish@yahoo.com.
(11)Hubert Department of Global Health, Rollins School of Public Health, Emory 
University, Atlanta, GA, 30322, USA. zmemish@yahoo.com.

BACKGROUND: The COVID-19 pandemic has been stressful and of considerable concern 
among health care workers (HCWs). Being particularly at increased risk for 
exposure, HCWs worry about becoming infected as well as infecting co-workers, 
patients and family members. Such distress and panic may have destructive 
effects on individuals and may last long after the pandemic situation leading to 
depression or post-traumatic stress disorder. Therefore, the aim of the current 
study is to measure and investigate the prevalence of the factors affecting 
psychological stress during the COVID-19 pandemic among HCWs.
METHODS: A self-administered online survey-including perceived stress scale 
(PSS) questions-was disseminated among HCWs in Riyadh, Saudi Arabia (SA) 
between1st June and 30th July 2020.
RESULTS: A total of 469 HCWs responded to the survey for a high response rate 
(93.8%). The PSS revealed that 15.8% of the respondents were suffering from high 
stress levels, 77.2% were suffering from moderate stress levels and 7% with low 
stress levels. Females and junior frontline staff reported more severe stress 
levels. Participation on the pandemic team shows significant impact on stress 
levels.
CONCLUSION: COVID-19 pandemic has increased stress levels among HCWs and affects 
their psychological wellbeing. Designing programs promoting HCWs mental health 
are crucial and emotional and psychological support strategies should be part of 
every public health crisis management plan.

© 2021. The Author(s).

DOI: 10.1007/s44197-021-00014-4
PMCID: PMC8607404
PMID: 34807430 [Indexed for MEDLINE]

Conflict of interest statement: Given his role as Editor in Chief, Ziad Memish 
had no involvement in the peer-review of this article and has no access to 
information regarding its peer-review. Full responsibility for the editorial 
process for this article was delegated to Shahul Ebrahim. Authors declare they 
have no conflict of interest.


2747. J Child Psychol Psychiatry. 2021 Dec;62(12):1375-1378. doi: 10.1111/jcpp.13537.

Editorial: Do lockdowns scar? Three putative mechanisms through which COVID-19 
mitigation policies could cause long-term harm to young people's mental health.

Sonuga-Barke E(1)(2), Fearon P(3).

Author information:
(1)School of Psychiatry, Institute of Psychology, Psychiatry and Neuroscience, 
King's College London, London, UK.
(2)Department of Child & Adolescent Psychiatry, University of Aarhus, Aarhus, 
Denmark.
(3)Research Department of Clinical, Educational and Health Psychology, 
University College London, London, UK.

The use of lockdown to slow the spread of COVID-19 has been unprecedented in its 
scale, scope and duration despite early predictions that such a measure would 
have a negative impact on the mental health and well-being of many young people 
and their families. From a developmental psychopathology perspective both direct 
and indirect effects of lockdown-related harms to young people's mental health 
were predictable: Direct effects, for instance, being due to the negative 
psychological impact of social isolation and confinement on children; Indirect 
effects being exerted via negative impacts on family and parent mental health 
and wellbeing. That these effects would vary from person-to-person was also 
predicted from this perspective; with vulnerable individuals with pre-existing 
conditions and those living in high-risk settings being at particular risk. The 
presumption has been that such negative effects, if they do occur, would be time 
limited and that everything would return to normal once lockdowns ended. But 
this is not necessarily the case. In this editorial we ask whether lockdowns 
could have long-term effects on young people's mental health and then briefly 
outline three putative mechanisms through which such long-term effects might 
occur.

© 2021 Association for Child and Adolescent Mental Health.

DOI: 10.1111/jcpp.13537
PMCID: PMC9011706
PMID: 34806768 [Indexed for MEDLINE]


2748. Med J Malaysia. 2021 Nov;76(6):876-880.

Impact of virtual brief wellness based psychosocial intervention on mental 
wellbeing of stable hospitalised COVID-19 patients - A pilot study.

Thong KS(1), Seed HF(2).

Author information:
(1)Universiti Tunku Abdul Rahman, Faculty of Medicine and Health Sciences, 
Selangor, Malaysia.
(2)Universiti Tunku Abdul Rahman, Faculty of Medicine and Health Sciences, 
Selangor, Malaysia. seed_tabo@yahoo.com.

INTRODUCTION: The Optimal Health Program (OHP) is a collaborative 
self-management program that promotes clients to be actively involved in their 
own healthcare and overall wellbeing. Program Kesihatan Optimum (SANUBARI) is a 
Malay version of the OHP after a translational process and cultural adaptation 
by psychiatrists, clinical psychologist and family medicine specialists in 2017. 
The program is of a low intensity, patient-centred program, advocating 
self-health management to improve health literacy by enhancing self-efficacy, 
building strengths and values, and initiating change and planning, ultimately 
enhancing wellbeing of people. The programme can be used as a form of early 
psychosocial intervention during the current pandemic in maintaining the general 
mental wellbeing of COVID-19 patients.
METHODS: This is an open labelled interventional study of a virtual brief 
psychosocial intervention, called SANUBARI. The program was conducted among 
COVID-19 patients hospitalized in the COVID-19 wards of two centres from May 
2020 until August 2020. Inclusion criteria include patients aged eighteen years 
and above, diagnosed with COVID-19, medically stable, speaking and reading 
Bahasa Melayu or English. All study subjects attended two sessions on OHP via 
telecommunication method and answered questionnaires (General Self-Efficacy 
(GSE) Scale, Patient Health Questionnaire and Generalized Anxiety Disorder 
Questionnaire) via computer-assisted self-interview. Data collection was done 
before the start of the intervention, at the end of the intervention and a month 
post-intervention.
RESULTS: A total of 37 patients were recruited and more than half of the 
subjects were males (62.2%), single (75.5%) and from the Malay ethnicity 
(78.4%). Seventy-three per cent of subjects had received tertiary education, and 
most of them were students reflecting a higher unemployment status (73%). Most 
subjects have no comorbid chronic medical illness (89.2%), and none has a 
comorbid psychiatric illness. Comparison of the GSE score across 3-time points 
(preintervention, immediate post-intervention and a month postintervention) 
showed statistically significant improvement in the mean total GSE score 
immediate and a month postintervention as compared to the pre-intervention; from 
mean total GSE score of 29.78 pre-intervention to 34.73 (mean difference 4.946, 
95% Confidence Interval 95%CI: 3.361, 6.531) immediate post-intervention and 
33.08 (mean difference 3.297, 95%CI: 1.211, 5.348) a month post intervention. 
There was no significant association between the socio-demographic or clinical 
data, depressive and anxiety symptoms, and changes in GSE scores over three time 
points.
CONCLUSION: COVID-19 patients improved their self-efficacy levels after the 
virtual brief OHP intervention, and it maintained a month post-intervention, 
protecting them from psychological stress and ultimately enhances wellbeing 
during this coronavirus pandemic.

PMID: 34806676 [Indexed for MEDLINE]


2749. Health Soc Care Community. 2022 Sep;30(5):e2169-e2178. doi: 10.1111/hsc.13655. 
Epub 2021 Nov 21.

Socioeconomic challenges during the COVID-19 pandemic for Veterans with 
psychosis or recent homelessness.

McCleery A(1)(2)(3), Wynn JK(2)(3), Novacek D(2)(3), Reavis EA(2)(3), Tsai 
J(4)(5)(6), Green MF(2)(3).

Author information:
(1)Department of Psychological and Brain Sciences, University of Iowa, Iowa 
City, Iowa, USA.
(2)Center on Enhancement of Community Integration for Homeless Veterans, 
Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, 
USA.
(3)Semel Institute for Neuroscience and Human Behavior, University of 
California, Los Angeles, Los Angeles, California, USA.
(4)VA National Center on Homelessness Among Veterans, Washington, District of 
Columbia, USA.
(5)School of Public Health, University of Texas Health Science Center at 
Houston, Houston, Texas, USA.
(6)Department of Psychiatry, Yale University School of Medicine, New Haven, 
Connecticut, USA.

The COVID-19 pandemic and social distancing have directly impacted the 
socioeconomic well-being of most Americans. Veterans with psychosis (PSY) and 
Veterans who were recently housed (RHV) through a supportive housing programme 
may be especially vulnerable to experiencing negative socioeconomic effects of 
the pandemic. In this study, we investigated socioeconomic experiences and 
challenges during the pandemic in these two putatively vulnerable Veteran groups 
and in Veterans with no history of PSY or homeless (i.e., control Veterans, 
CTL). A total of 231 Veterans (81 PSY, 76 RHV, 64 CTL) participated in the 
baseline assessment, and 203 in the follow-up assessment (74 PSY, 63 RHV, 66 
CTL). At both assessment points we obtained socioeconomic information, including 
personal finances, financial concerns, housing concerns, experience of material 
hardships, and employment status. All groups of Veterans reported socioeconomic 
challenges during the pandemic, but the pattern of effects differed across 
groups. Although RHV was in a similar position to the PSY group with respect to 
personal finances, they reported lower levels of financial well-being and were 
more prone to experiencing material hardships compared to the other two groups. 
CTL was most vulnerable to experiencing negative financial shocks. Contrary to 
expectations, PSY did not experience disproportionate material hardships 
compared to CTL. Veterans face significant socioeconomic challenges during the 
COVID-19 pandemic. However, RHV disproportionately experienced certain concerns 
and hardships, and these are a target for intervention by clinicians and service 
providers. PSY generally fared better than anticipated, possibly reflecting 
longstanding engagement with VA services that could serve to buffer the 
socioeconomic impact of the pandemic.

© 2021 John Wiley & Sons Ltd.

DOI: 10.1111/hsc.13655
PMCID: PMC9011530
PMID: 34806259 [Indexed for MEDLINE]


2750. Probiotics Antimicrob Proteins. 2022 Jun;14(3):426-448. doi: 
10.1007/s12602-021-09875-4. Epub 2021 Nov 22.

Precision Postbiotics and Mental Health: the Management of Post-COVID-19 
Complications.

Pandey M(1), Bhati A(1), Priya K(1), Sharma KK(2), Singhal B(3).

Author information:
(1)School of Biotechnology, Gautam Buddha University, Greater Noida, Uttar 
Pradesh, 201312, India.
(2)Department of Microbiology, Maharshi Dayanand University, Rohtak, Haryana, 
124001, India.
(3)School of Biotechnology, Gautam Buddha University, Greater Noida, Uttar 
Pradesh, 201312, India. barkha@gbu.ac.in.

The health catastrophe originated by COVID-19 pandemic construed profound impact 
on a global scale. However, a plethora of research studies corroborated 
convincing evidence conferring severity of infection of SARS-CoV-2 with the 
aberrant gut microbiome that strongly speculated its importance for development 
of novel therapeutic modalities. The intense exploration of probiotics has been 
envisaged to promote the healthy growth of the host, and restore intestinal 
microecological balance through various metabolic and physiological processes. 
The demystifying effect of probiotics cannot be defied, but there exists a 
strong skepticism related to their safety and efficacy. Therefore, molecular 
signature of probiotics termed as "postbiotics" are of paramount importance and 
there is continuous surge of utilizing postbiotics for enhancing health 
benefits, but little is explicit about their antiviral effects. Therefore, it is 
worth considering their prospective role in post-COVID regime that pave the way 
for exploring the pastoral vistas of postbiotics. Based on previous research 
investigations, the present article advocates prospective role of postbiotics in 
alleviating the health burden of viral infections, especially SARS-CoV-2. The 
article also posits current challenges and proposes a futuristic model 
describing the concept of "precision postbiotics" for effective therapeutic and 
preventive interventions that can be used for management of this deadly disease.

© 2021. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s12602-021-09875-4
PMCID: PMC8606251
PMID: 34806151 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


2751. Environ Sci Pollut Res Int. 2022 Apr;29(16):23374-23382. doi: 
10.1007/s11356-021-17580-6. Epub 2021 Nov 22.

Social media and spreading panic among adults during the COVID-19 pandemic, 
Egypt.

Shehata WM(1), Abdeldaim DE(2).

Author information:
(1)Public Health and Community Medicine Department, Faculty of Medicine, Tanta 
University, Tanta, Egypt.
(2)Public Health and Community Medicine Department, Faculty of Medicine, Tanta 
University, Tanta, Egypt. Doaam3y@gmail.com.

The COVID-19 pandemic became a challenge to human well-being. The rapid spread 
of the coronavirus diseases with quarantine measures make people use social 
media platforms more than before. The bad use of social media platforms affects 
the mental health of users leading to spread of panic among persons. This study 
aimed to determine the impact of social media on spreading panic about COVID-19 
among adults in Egypt. This was a cross-sectional study that enrolled 2032 
participants through online snowball sampling approach conducted during May 2021 
to collect data from adults in Egypt. A self-administered questionnaire was 
used. It consists of three sections as follows: demographic characteristics, the 
social media platforms employed during the pandemic, the impact of social media 
on study participants. Nearly half of both sexes believed that spreading news 
about COVID-19 on social media platforms has a major role in spreading fear 
among people. More than half of the study participants reported that the level 
of Egyptian pages on social media covering COVID-19 was not good. A total of 46% 
females and 30.1% of males; those with primary, preparatory, higher, and 
postgraduate education; and 46.7% of medical and 32.1% of nonmedical were 
psychologically affected. The impact of social media on spreading panic among 
Egyptians varies according to gender, level of education, and occupation. 
Therefore, social media played an important role in spreading panic during the 
COVID-19 pandemic.

© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, 
part of Springer Nature.

DOI: 10.1007/s11356-021-17580-6
PMCID: PMC8606231
PMID: 34806145 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


2752. Child Abuse Negl. 2022 Aug;130(Pt 1):105393. doi: 10.1016/j.chiabu.2021.105393. 
Epub 2021 Nov 6.

Parenting practices, stressors and parental concerns during COVID-19 in 
Pakistan.

Zafar N(1), Naeem M(2), Zehra A(3), Muhammad T(4), Sarfraz M(5), Hamid H(6), 
Enam K(7), Moaz M(8), Shah B(9), Ishaque S(7), Muhammad N(6).

Author information:
(1)PAHCHAAN (Protection and Help of Children Against Abuse and Neglect), Canal 
Park, Gulberg II, Lahore, Pakistan; Child Rights Department, The University of 
Lahore. Main Campus, 1-KM Defence Road, Near Bhuptian Chowk, Off Raiwind Road, 
Lahore, Pakistan; Globark Institute of Development and Training (GIDAT), 
Pakistan. Electronic address: naeem.pahchaan@gmail.com.
(2)PAHCHAAN (Protection and Help of Children Against Abuse and Neglect), Canal 
Park, Gulberg II, Lahore, Pakistan; Child Rights Department, The University of 
Lahore. Main Campus, 1-KM Defence Road, Near Bhuptian Chowk, Off Raiwind Road, 
Lahore, Pakistan; Globark Institute of Development and Training (GIDAT), 
Pakistan.
(3)PAHCHAAN (Protection and Help of Children Against Abuse and Neglect), Canal 
Park, Gulberg II, Lahore, Pakistan; Child Rights Department, The University of 
Lahore. Main Campus, 1-KM Defence Road, Near Bhuptian Chowk, Off Raiwind Road, 
Lahore, Pakistan.
(4)CRG-PPA (Child Rights Group PPA), Pakistan; Globark Institute of Development 
and Training (GIDAT), Pakistan.
(5)Shalamar Medical and Dental College Lahore, Pakistan.
(6)King Edward Medical University, Pakistan.
(7)Agha Khan University, Pakistan.
(8)PAHCHAAN (Protection and Help of Children Against Abuse and Neglect), Canal 
Park, Gulberg II, Lahore, Pakistan; CRG-PPA (Child Rights Group PPA), Pakistan.
(9)Molvi Ji Hospital Peshawar, Pakistan.

BACKGROUND: COVID-19 is a global crisis that has added fear, uncertainty, and 
stress to parents. Parents are going through several challenges related to 
school closure, financial insecurity and working remotely. These stressors are 
affecting the mental health of parents.
OBJECTIVES: This study aimed to observe major stressors along with the impact of 
COVID-19 on parental concerns and practices during lockdown.
PARTICIPANTS: Sample (N = 923) was selected through purposive sampling from 
parents attending Out Patients Departments of hospitals in three provincial 
capital cities of Pakistan having a high burden of COVID-19, i.e. Lahore, 
Karachi and Peshawar. Parents having at least one child younger than 18 years 
were included in the study.
METHODS: A quantitative design was used using a COVID-19 Parenting Response 
Scale (α = 0.74). It was used as a self-administered tool for parents who knew 
how to read and write Urdu/English language, however it was conducted as a 
structured interview for those who could not read/write. Data was analyzed by 
applying descriptive statistics (frequency, mean, percentage), independent 
sample t-test and Pearson Product Moment Correlation.
RESULTS: Findings of the current study showed several stressful factors for 
parents during COVID-19 pandemic, mainly financial burden, children's education, 
uncertainty of the situation, and many others. The study also suggests an 
association of parental concerns during COVID-19 with parenting practices.
CONCLUSION: COVID-19 pandemic presents a global crisis not only of the health of 
the people but also on family relations and mental well-being. Findings of this 
research indicate the need for targeted and accessible interventions for mental 
health of parents especially during these challenging circumstances so that they 
can cope with the challenges in an effective way and be able to take care of 
their children better.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.chiabu.2021.105393
PMCID: PMC8576182
PMID: 34802747 [Indexed for MEDLINE]

Conflict of interest statement: No potential source of conflict of interest of 
any author.


2753. Life Sci. 2022 Jan 1;288:120153. doi: 10.1016/j.lfs.2021.120153. Epub 2021 Nov 
18.

Induction of distinct neuroinflammatory markers and gut dysbiosis by 
differential pyridostigmine bromide dosing in a chronic mouse model of GWI 
showing persistent exercise fatigue and cognitive impairment.

Kozlova EV(1), Carabelli B(2), Bishay AE(2), Liu R(3), Denys ME(2), Macbeth 
JC(4), Piamthai V(5), Crawford MS(6), McCole DF(6), Zur Nieden NI(2), Hsiao 
A(5), Curras-Collazo MC(7).

Author information:
(1)Department of Molecular, Cell and Systems Biology, University of California, 
Riverside, CA, USA; Neuroscience Graduate Program, University of California, 
Riverside, CA, USA.
(2)Department of Molecular, Cell and Systems Biology, University of California, 
Riverside, CA, USA.
(3)Department of Microbiology and Plant Pathology, University of California, 
Riverside, CA, USA; Graduate Program in Genetics, Genomics, and Bioinformatics, 
University of California, Riverside, CA, USA.
(4)Department of Microbiology and Plant Pathology, University of California, 
Riverside, CA, USA; Division of Biomedical Sciences, School of Medicine, 
University of California, Riverside, CA, USA.
(5)Department of Microbiology and Plant Pathology, University of California, 
Riverside, CA, USA.
(6)Division of Biomedical Sciences, School of Medicine, University of 
California, Riverside, CA, USA.
(7)Department of Molecular, Cell and Systems Biology, University of California, 
Riverside, CA, USA. Electronic address: mcur@ucr.edu.

AIMS: To characterize neuroinflammatory and gut dysbiosis signatures that 
accompany exaggerated exercise fatigue and cognitive/mood deficits in a mouse 
model of Gulf War Illness (GWI).
METHODS: Adult male C57Bl/6N mice were exposed for 28 d (5 d/wk) to 
pyridostigmine bromide (P.O.) at 6.5 mg/kg/d, b.i.d. (GW1) or 8.7 mg/kg/d, q.d. 
(GW2); topical permethrin (1.3 mg/kg), topical N,N-diethyl-meta-toluamide (33%) 
and restraint stress (5 min). Animals were phenotypically evaluated as described 
in an accompanying article [124] and sacrificed at 6.6 months post-treatment 
(PT) to allow measurement of brain neuroinflammation/neuropathic pain gene 
expression, hippocampal glial fibrillary acidic protein, brain Interleukin-6, 
gut dysbiosis and serum endotoxin.
KEY FINDINGS: Compared to GW1, GW2 showed a more intense neuroinflammatory 
transcriptional signature relative to sham stress controls. Interleukin-6 was 
elevated in GW2 and astrogliosis in hippocampal CA1 was seen in both GW groups. 
Beta-diversity PCoA using weighted Unifrac revealed that gut microbial 
communities changed after exposure to GW2 at PT188. Both GW1 and GW2 displayed 
systemic endotoxemia, suggesting a gut-brain mechanism underlies the 
neuropathological signatures. Using germ-free mice, probiotic supplementation 
with Lactobacillus reuteri produced less gut permeability than microbiota 
transplantation using GW2 feces.
SIGNIFICANCE: Our findings demonstrate that GW agents dose-dependently induce 
differential neuropathology and gut dysbiosis associated with cognitive, 
exercise fatigue and mood GWI phenotypes. Establishment of a comprehensive 
animal model that recapitulates multiple GWI symptom domains and 
neuroinflammation has significant implications for uncovering pathophysiology, 
improving diagnosis and treatment for GWI.

Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.lfs.2021.120153
PMCID: PMC9048156
PMID: 34801513 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest No competing 
interests to declare.


2754. Encephale. 2022 Oct;48(5):510-516. doi: 10.1016/j.encep.2021.08.007. Epub 2021 
Oct 7.

Medical students and the response to COVID-19: Educational preparedness and 
psychological impact of their involvement in communicating with patients' 
relatives.

Tebeka S(1), Huillard O(2), Pignon B(3), Nguyen YL(4), Dubertret C(1), Mallet 
J(5).

Author information:
(1)AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU ESPRIT, service de 
Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, Inserm U1266, 178, 
rue des Renouillers, 92700 Colombes, France; UFR de Médecine Paris Nord, 
Université de Paris, 16, rue Henri Huchard, 75018 Paris, France.
(2)Department of Medical Oncology, Hopital Cochin, APHP Centre-Université de 
Paris, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France.
(3)AP-HP, DMU IMPACT, Département Médico-Universitaires de psychiatrie et 
d'addictologie des Hôpitaux universitaires Henri-Mondor, 94000 Créteil, France; 
Inserm, U955, Laboratoire Neuro-Psychiatrie translationnelle, Institut Mondor de 
Recherche Biomédicale, 94000 Créteil, France; UPEC, Université Paris Est 
Créteil, Faculté de médecine, 94000 Créteil, France.
(4)AP-HP, Groupe Hospitalo-Universitaire AP-HP Centre, DMU ARME, département 
d'anesthésie et réanimation. Hôpital Cochin, Faculté de médecine, Université de 
Paris, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France.
(5)AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU ESPRIT, service de 
Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, Inserm U1266, 178, 
rue des Renouillers, 92700 Colombes, France; UFR de Médecine Paris Nord, 
Université de Paris, 16, rue Henri Huchard, 75018 Paris, France. Electronic 
address: jasmina.mallet@aphp.fr.

OBJECTIVES: The COVID-19 pandemic has challenged without precedent both 
healthcare and educational systems worldwide. How medical students could and 
should be engaged in the response remains unclear. Medical students were asked 
to help with communicating with patients' relatives in our institution. Authors 
aimed: to (i) present the rapid implementation and assessment of a 
teaching/e-teaching lesson in the COVID-19 era; (ii) report an early evaluation 
of preparedness, mental health and well-being of students involved.
METHODS: The lesson was elaborated at lockdown in France. The clinical guidance 
consisted of a voluntary lesson entitled: "How to communicate with relatives of 
hospitalized COVID-19 patients?". Students received an anonymous online 
questionnaire after two weeks.
RESULTS: Sixty-six medical students were trained (32% face-to-face). The 
response rate was 64%. Most students informed relatives about the routine care 
of the patient (95%). Concerning the lesson, students assured to have had one 
(95%), considered it relevant (86%), and had used the educational content (81%). 
33% were charged with unexpected missions (only 36% felt prepared). Most of them 
did not report any psychological impact, but some reported anxiety or sleep 
disorders with no difference between face-to-face/distance training.
CONCLUSIONS: This pandemic may last. Communication ability is a key competence 
in medical curriculum and is more than ever essential. Distance learning 
technologies may provide a useful and accepted tool for medical students. We 
report on a rapid feedback on what can be expected or not from students in terms 
of mission and short-term psychological consequences.

OBJECTIFS: La pandémie de COVID-19 a posé des défis sans précédent aux systèmes 
de santé et d’éducation du monde entier. La manière dont les étudiants en 
médecine pourraient et devraient participer à la réponse à cette crise reste 
incertaine. Pendant la première vague épidémique, les étudiants en médecine de 
notre hôpital ont été invités à aider à communiquer avec les proches des 
patients hospitalisés en unités COVID, dans le contexte de l’interdiction des 
visites. Les auteurs souhaitent: (i) présenter la mise en œuvre et l’évaluation 
rapides d’un enseignement/e-enseignement facilitant les capacités de 
communication avec les familles, à l’ère du COVID-19; (ii) fournir les résultats 
d’une évaluation précoce du sentiment de préparation de ces étudiants à ce type 
de mission, de leur santé mentale et leur bien-être des élèves concernés.
MÉTHODE: Le cours a été élaboré lors du premier confinement en France, à 
destination des étudiants volontaires pour la mission d’information aux familles 
(par téléphone uniquement). L’enseignement était proposé en distanciel ou en 
présentiel, et s’intitulait: «Comment communiquer avec les proches des patients 
hospitalisés COVID-19?». Les étudiants ont reçu un questionnaire en ligne 
anonyme deux semaines après le début de leur mission, évaluant leur sentiment de 
préparation pour cette mission, leur santé mentale et leur bien-être.
RÉSULTATS: Soixante-six étudiants en médecine ont été formés (32% en 
présentiel). Le taux de réponse était de 64%. La plupart des étudiants ont 
informé leurs proches des soins de routine du patient (95%). Concernant 
l’évaluation de l’enseignement, les élèves ont été rassurés d’avoir bénéficié de 
ce cours (95%), l’ont jugé pertinent (86%) et ont utilisé son contenu 
pédagogique (81%). 33% ont été chargés de missions imprévues (seulement 36% se 
sont sentis préparés), dont des annonces d’aggravation clinique. La plupart 
d’entre eux n’ont signalé aucun impact psychologique, mais certains ont signalé 
des troubles anxieux ou du sommeil sans différence entre la formation en 
présentiel/à distance.
CONCLUSIONS: Cette pandémie peut durer encore plusieurs mois. Les compétences 
communicationnelles sont à acquérir dans le cursus médical et plus que 
nécessaires dans ce contexte. Les technologies d’apprentissage à distance 
peuvent fournir un outil utile et accepté pour les étudiants en médecine. Nous 
rapportons un retour rapide sur ce que l’on peut attendre ou non des étudiants 
en termes de mission et de conséquences psychologiques à court terme.

Copyright © 2021 L'Encéphale, Paris. Published by Elsevier Masson SAS. All 
rights reserved.

DOI: 10.1016/j.encep.2021.08.007
PMCID: PMC8494989
PMID: 34801232 [Indexed for MEDLINE]


2755. BMC Geriatr. 2021 Nov 19;21(1):650. doi: 10.1186/s12877-021-02593-0.

Impact of the COVID-19 pandemic on symptoms of anxiety and depression and 
health-related quality of life in older patients with chronic kidney disease.

Voorend CGN(1), van Oevelen M(2), Nieberg M(2), Meuleman Y(3), Franssen CFM(4), 
Joosten H(5), Berkhout-Byrne NC(2), Abrahams AC(6), Mooijaart SP(7), Bos 
WJW(2)(8), van Buren M(2)(9); POLDER investigators.

Collaborators: van Alphen A, Berkhout-Byrne N, van Breda GF, van Buren M, Boom 
H, Bos WJ, Diepenbroek A, Emmelot-Vonk M, Franssen C, Gaillard CAJM, 
Groeneweg-Peeters N, Hoekstra B, Hommes N, Hoornaar F, Joosten H, Lagro J, 
Litjens E, Molenaar F, Mooijaart SP, Neradova A, Peters M, Veldman W, Voorend C, 
Westerbos L, Westerman-van der Wijden C, Wierdsma J.

Author information:
(1)Department of Internal Medicine, Leiden University Medical Center, Leiden, 
The Netherlands. c.g.n.voorend@lumc.nl.
(2)Department of Internal Medicine, Leiden University Medical Center, Leiden, 
The Netherlands.
(3)Department of Clinical Epidemiology, Leiden University Medical Center, 
Leiden, The Netherlands.
(4)Department of Nephrology, University Medical Center Groningen, University of 
Groningen, Groningen, The Netherlands.
(5)Department of Internal Medicine, Division of General Internal Medicine, 
Section Geriatric Medicine, Maastricht University Medical Center+, Maastricht, 
The Netherlands.
(6)Department of Nephrology and Hypertension, University Medical Center Utrecht, 
Utrecht, The Netherlands.
(7)Department of Gerontology and Geriatrics, Leiden University Medical Center, 
Leiden, The Netherlands.
(8)Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The 
Netherlands.
(9)Department of Internal Medicine, Haga Teaching Hospital, The Hague, The 
Netherlands.

BACKGROUND: Older patients with advanced chronic kidney disease are at increased 
risk for a severe course of the coronavirus disease-2019 (COVID-19) and 
vulnerable to mental health problems. We aimed to investigate prevalence and 
associated patient (demographic and clinical) characteristics of mental 
wellbeing (health-related quality of life [HRQoL] and symptoms of depression and 
anxiety) before and during the COVID-19 pandemic in older patients with advanced 
chronic kidney disease.
METHODS: An ongoing Dutch multicentre prospective cohort study enrols patients 
of ≥70 years with an eGFR < 20 mL/min/1.73m2 from October 2018 onward. With 
additional questionnaires during the pandemic (May-June 2020), disease-related 
concerns about COVID-19 and general anxiety symptoms were assessed 
cross-sectionally, and depressive symptoms, HRQoL, and emotional symptoms 
longitudinally.
RESULTS: The 82 included patients had a median age of 77.5 years (interquartile 
range 73.9-82.1), 77% were male and none had tested positive for COVID-19. 
Cross-sectionally, 67% of the patients reported to be more anxious about 
COVID-19 because of their kidney disease, and 43% of the patients stated that 
their quality of life was reduced due to the COVID-19 pandemic. Compared to 
pre-COVID-19, the presence of depressive symptoms had increased (11 to 22%; 
p = .022) and physical HRQoL declined (M = 40.4, SD = 10.1 to M = 36.1, 
SD = 10.4; p < .001), particularly in males. Mental HRQoL (M = 50.3, SD = 9.6 to 
M = 50.4, SD = 9.9; p = .913) and emotional symptoms remained similar.
CONCLUSIONS: Older patients with advanced chronic kidney disease suffered from 
disease-related anxiety about COVID-19, increased depressive symptoms and 
reduced physical HRQoL during the COVID-19 pandemic. The impact of the pandemic 
on this vulnerable patient group extends beyond increased mortality risk, and 
awareness of mental wellbeing is important.
TRIAL REGISTRATION: The study is registered at the Netherlands Trial Register 
(NTR), trial number NL7104. Date of registration: 06-06-2018.

© 2021. The Author(s).

DOI: 10.1186/s12877-021-02593-0
PMCID: PMC8602979
PMID: 34798817 [Indexed for MEDLINE]

Conflict of interest statement: WB reports grants from Zilveren Kruis Insurance, 
outside the submitted work. All other authors declare that they have no 
competing interests.


2756. Pan Afr Med J. 2021 Sep 15;40:39. doi: 10.11604/pamj.2021.40.39.25357. 
eCollection 2021.

Knowledge of the coronavirus disease 2019 (COVID-19) and sleep problems among a 
selected sample of psychiatric hospital staff in Nigeria: a cross-sectional 
study.

Oderinde KO(1), Akanni OO(2), Olashore A(3).

Author information:
(1)Department of Mental Health, University of Benin Teaching Hospital, Benin 
City, Nigeria.
(2)Forensic Unit, Federal Neuro-Psychiatric Hospital, Benin City, Nigeria.
(3)Department of Psychiatry, University of Botswana, Gaborone, Botswana.

INTRODUCTION: as the coronavirus disease 2019 (COVID-19) spreads, sleep problems 
are expected to increase among healthcare workers. Therefore, we aimed to assess 
the knowledge of COVID-19, sleep problem and identify sociodemographic factors 
associated with sleep problems among healthcare workers in a Nigerian 
neuropsychiatric hospital.
METHODS: a cross-sectional study was conducted among 200 healthcare workers in a 
neuropsychiatric hospital using self-administered questionnaires to assess 
knowledge of COVID-19, sleep problem, social support, and sociodemographic 
factors that affect sleep. Chi-square test and Spearman's correlation were 
applied to assess the association between sociodemographic factors and sleep 
problems.
RESULTS: about 23.9% of the healthcare workers reported having a sleep problem. 
However, there was no association of sleep problems with any sociodemographic 
factors except age (r=0.26) and social support (r=-0.18).
CONCLUSION: the study offered insight into the occurrence of sleep problems 
among healthcare workers and suggested a guide for planning interventions 
targeted at improving the psychological well-being of healthcare workers in the 
face of current global pandemics.

Copyright: Kehinde Oyeyemi Oderinde et al.

DOI: 10.11604/pamj.2021.40.39.25357
PMCID: PMC8571927
PMID: 34795820 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


2757. BMJ Open. 2021 Nov 18;11(11):e052259. doi: 10.1136/bmjopen-2021-052259.

Supporting population mental health and wellness during the COVID-19 pandemic in 
Canada: protocol for a sequential mixed-method study.

Risling T(1), Carlberg C(1), Kassam I(2), Moss T(1), Janssen P(3), Iduye S(1), 
Strudwick G(4)(5).

Author information:
(1)College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, 
Canada.
(2)Campbell Family Mental Health Research Institute, Centre for Addiction and 
Mental Health, Toronto, Ontario, Canada.
(3)School of Population and Public Health, University of British Columbia, 
Vancouver, British Columbia, Canada.
(4)Campbell Family Mental Health Research Institute, Centre for Addiction and 
Mental Health, Toronto, Ontario, Canada gillian.strudwick@camh.ca.
(5)Institute of Health Policy, Management and Evaluation, University of Toronto, 
Toronto, Ontario, Canada.

INTRODUCTION: The global COVID-19 pandemic has reported to have a negative 
impact on the mental health and well-being of individuals around the world. 
Mental health system infrastructure, primarily developed to support individuals 
through in-person care, struggled to meet rising demand for services even prior 
to COVID-19. With public health guidelines requiring the use of physical 
distancing during the pandemic, digital mental health supports may be one way to 
address the needs of the population. Despite this, barriers exist in promoting 
and supporting access to existing and emerging digital resources. Text messaging 
may address some of these barriers, extending the potential reach of these 
digital interventions across divides that may separate some vulnerable or 
disadvantaged groups from essential mental health supports. Building on an 
existing knowledge synthesis project identifying key digital resources for 
improved mental health, this research will establish low-tech connections to 
assess need and better match access to services for those who need it most. The 
aim of this study is to codesign a customised two-way texting service to explore 
need and better align access to mental health supports for Canadians located in 
Saskatchewan during the COVID-19 pandemic.
METHODS AND ANALYSIS: This study will be completed in Saskatchewan, Canada. For 
this project, the RE-AIM (reach, effectiveness, adoption, implementation, 
maintenance) framework will be used to support three phases of a sequential 
mixed-method study. An advisory committee of Saskatchewan residents will guide 
this work with the study team. A 10-week service will be launched to connect 
individuals with appropriately suited digital mental health interventions 
through the use of text messaging. In phase 1, implementation and prototyping 
will be conducted with collaborative codesign for key elements related to 
features of an enrolment survey and initial messaging content. Phase 2 will 
focus on advancing the effectiveness of the service using quantitative user 
data. In phase 3, an embedding approach will be used to integrate both 
qualitative and quantitative data collected to understand the overall 
acceptability, satisfaction and perceived benefit of the text messaging service. 
Thematic analysis and descriptive statistics will be used as analytic methods.
ETHICS AND DISSEMINATION: This study has received approval from the Research 
Ethics Board at the University of Saskatchewan. A knowledge dissemination plan 
has been developed that includes traditional academic approaches such as 
conference presentations, and academic publications, as well as mainstream 
approaches such as social media, radio and dissemination through the advisory 
committee.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-052259
PMCID: PMC8602926
PMID: 34794993 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2758. Int J Soc Psychiatry. 2022 Sep;68(6):1283-1288. doi: 10.1177/00207640211057724. 
Epub 2021 Nov 18.

Wellbeing and mental health amongst medical students in Canada.

Wilkes TC(1), Lewis T(2), Paget M(3), Holm J(3), Brager N(1), Bulloch A(4), 
Macmaster F(1), Molodynski A(5), Bhugra D(6).

Author information:
(1)Department of Psychiatry, Cumming School of Medicine, University of Calgary, 
Calgary, AB, Canada.
(2)Tees Esk and Wear Valleys NHS Foundation Trust, Darlington, UK.
(3)Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
(4)The Mathison Centre for Health Research and Education, Calgary, AB, Canada.
(5)Oxford Health NHS Foundation Trust, Oxford, UK.
(6)Kings College, London, UK.

RESEARCH: There is abundant data revealing that there is significant rate of 
rates of Psychiatric morbidity, psychological stress, and burnout in the medical 
student population. A core study group in the UK collaborated with 12 countries 
around the world to review medical student wellness. In this context we surveyed 
101 medical students at the Cummings medical school, Calgary, Canada during the 
height of the COVID pandemic regarding their wellbeing and mental health.
RESULTS/MAIN FINDINGS: Prior to medical school 27% reported a diagnosis with a 
mental disorder. Whilst at medical school 21% reported a mental health 
condition, most commonly an anxiety disorder and or depressive disorder. The 
most commonly reported source of stress was study at 81%, the second being 
relationships at 62%, money stress was a significant source of stress for 35%, 
and finally 10% reported accommodation or housing as stressful. Interestingly 
only 14% tested CAGE positive but 20% of students reported having taken a 
non-prescription substance to feel better or regulate their mood. Seventy-five 
percent of medical students met specific case criteria for exhaustion on the 
Oldenburg Burnout inventory 74% met criteria for the GHQ questionnaire.
CONCLUSIONS: These findings confirm that medical students are facing significant 
stressors during their training. These stressors include, in order of frequency, 
study, relational, financial, and accommodation issues. Nonprescription 
Substance use was a common finding as well as exhaustion and psychiatric 
morbidity. Future interventions pursued will have to address cultural issues as 
well as the organizational and individual determinates of stress.

DOI: 10.1177/00207640211057724
PMCID: PMC9465500
PMID: 34791951 [Indexed for MEDLINE]


2759. BMC Health Serv Res. 2021 Nov 17;21(1):1240. doi: 10.1186/s12913-021-07243-0.

"Watch Me Grow- Electronic (WMG-E)" surveillance approach to identify and 
address child development, parental mental health, and psychosocial needs: study 
protocol.

Eapen V(1)(2), Woolfenden S(3), Schmied V(4), Jalaludin B(5)(6), Lawson K(7), 
Liaw ST(8)(9), Lingam R(8), Page A(10), Cibralic S(6), Winata T(5), Mendoza Diaz 
A(11), Lam-Cassettari C(11), Burley J(8), Boydell K(12), Lin P(11)(5), Masi 
A(11), Katz I(13), Dadich A(7), Preddy J(14), Bruce J(14), Raman S(5), Kohlhoff 
J(11)(15), Descallar J(6), Karlov L(5), Kaplun C(6)(16), Arora A(17)(18), Di 
Mento B(11), Smead M(14), Doyle K(10), Grace R(16), McClean T(19), Blight V(5), 
Wood A(15), Raine KH(15).

Author information:
(1)School of Psychiatry, Faculty of Medicine, University of New South Wales, 
Sydney, Australia. v.eapen@unsw.edu.au.
(2)South Western Sydney Local Health District, Liverpool, Australia. 
v.eapen@unsw.edu.au.
(3)Sydney Children's Hospital Randwick, Randwick, Australia.
(4)School of Nursing and Midwifery, Western Sydney University, Sydney, 
Australia.
(5)South Western Sydney Local Health District, Liverpool, Australia.
(6)Ingham Institute for Applied Medical Research, Liverpool, Australia.
(7)School of Business, Western Sydney University, Sydney, Australia.
(8)Population Child Health Research Group, School of Women's and Children's 
Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.
(9)WHO Collaborating Centre for eHealth, University of New South Wales, Sydney, 
Australia.
(10)School of Medicine, Western Sydney University, Campbelltown, Australia.
(11)School of Psychiatry, Faculty of Medicine, University of New South Wales, 
Sydney, Australia.
(12)Black Dog Institute, Sydney, Australia.
(13)Social Policy Research Centre, Faculty of Arts, Design, & Architecture, 
University of New South Wales, Sydney, Australia.
(14)Murrumbidgee Local Health District, Wagga Wagga, Australia.
(15)Karitane, Carramar, Australia.
(16)TeEACH -Transforming early Education and Child Health Research Centre, 
Western Sydney University, Sydney, Australia.
(17)School of Health Sciences, Western Sydney University, Sydney, Australia.
(18)Sydney Local Health District, Camperdown, Australia.
(19)Uniting, Sydney, Australia.

BACKGROUND: The COVID-19 pandemic and the associated economic recession has 
increased parental psychosocial stress and mental health challenges. This has 
adversely impacted child development and wellbeing, particularly for children 
from priority populations (culturally and linguistically diverse (CALD) and 
rural/regional communities) who are at an already increased risk of health 
inequality. The increased mental health and psychosocial needs were compounded 
by the closure of in-person preventive and health promotion programs resulting 
in health organisations embracing technology and online services. Watch Me Grow- 
Electronic (WMG-E) - developmental surveillance platform- exemplifies one such 
service. WMG-E was developed to monitor child development and guide parents 
towards more detailed assessments when risk is identified. This Randomised 
Controlled Trial (RCT) aims to expand WMG-E as a digital navigation tool by also 
incorporating parents' mental health and psychosocial needs. Children and 
families needing additional assessments and supports will be electronically 
directed to relevant resources in the 'care-as-usual' group. In contrast, the 
intervention group will receive continuity of care, with additional in-person 
assessment and 'warm hand over' by a 'service navigator' to ensure their needs 
are met.
METHODS: Using an RCT we will determine: (1) parental engagement with 
developmental surveillance; (2) access to services for those with mental health 
and social care needs; and (3) uptake of service recommendations. Three hundred 
parents/carers of children aged 6 months to 3 years (recruited from a culturally 
diverse, or rural/regional site) will be randomly allocated to the 
'care-as-usual' or 'intervention' group. A mixed methods implementation 
evaluation will be completed, with semi-structured interviews to ascertain the 
acceptability, feasibility and impact of the WMG-E platform and service 
navigator.
CONCLUSIONS: Using WMG-E is expected to: normalise and de-stigmatise mental 
health and psychosocial screening; increase parental engagement and service use; 
and result in the early identification and management of child developmental 
needs, parental mental health, and family psychosocial needs. If effective, 
digital solutions such as WMG-E to engage and empower parents alongside a 
service navigator for vulnerable families needing additional support, will have 
significant practice and policy implications in the pandemic/post pandemic 
period.
TRIAL REGISTRATION: The trial (Protocol No. 1.0, Version 3.1) was registered 
with ANZCTR (registration number: ACTRN12621000766819 ) on July 21st, 2021 and 
reporting of the trial results will be according to recommendations in the 
CONSORT Statement.

© 2021. The Author(s).

DOI: 10.1186/s12913-021-07243-0
PMCID: PMC8596348
PMID: 34789234 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2760. BMC Med Educ. 2021 Nov 16;21(1):580. doi: 10.1186/s12909-021-03019-6.

Impact of COVID-19 on post graduate medical education and training.

Enujioke SC(1), McBrayer K(2), Soe KC(3)(4), Imburgia TM(2)(5), Robbins C(2).

Author information:
(1)Division of Adolescent Medicine, Department of Pediatrics, Indiana University 
School of Medicine, 410 West 10th Street. Suite 1001, Indianapolis, IN, 46202, 
USA. senujioke@hotmail.com.
(2)Division of Adolescent Medicine, Department of Pediatrics, Indiana University 
School of Medicine, 410 West 10th Street. Suite 1001, Indianapolis, IN, 46202, 
USA.
(3)Department of Pediatrics, Indiana University School of Medicine, 
Indianapolis, IN, USA.
(4)Department of Psychiatry, Indiana University School of Medicine, 
Indianapolis, IN, USA.
(5)Indiana University School of Social Work, Indianapolis, IN, USA.

PURPOSE: The novel Coronavirus Disease 19 (COVID-19) has had a significant 
impact worldwide that led to changes in healthcare. The purpose of this study 
was to evaluate the effect of the COVID-19 pandemic on trainee's mental health 
and educational preparedness.
METHODS: Trainees at the Indiana University School of Medicine were surveyed 
regarding the impact of the COVID-19 pandemic on their training. Using a Likert 
scale, participants were asked questions pertaining to educational preparedness, 
mental health, and clinical work during the pandemic. Data was analyzed using 
SPSS version 27. The study was approved as exempt by the Institutional review 
Board (IRB).
RESULTS: 324 of the 1204 trainees responded to the survey. The respondents were 
76% white with an equal distribution of males and females. A majority of the 
respondents were first year residents with an equal distribution of second, 
third, and fourth year residents. Twenty-three percent of respondents were in a 
procedural residency or fellowship program. Better perceived educational 
preparedness was associated with an improved home-work balance during COVID-19 
(β = 0.506, p < 0.0001) and having a department that advocated/supported focus 
on mental health during COVID-19 (β = 0.177, p < 0.0001). Worse perceived 
educational preparedness was associated with being in procedural vs. 
non-procedural dominant training program (β = - 0.122, p = 0.01).
CONCLUSION: COVID-19 has had a significant impact on the training experience of 
residents and fellows. Departmental support increased mental well-being and 
perceived education preparedness in trainees. Trainees that felt they had a 
better home-work life balance had better educational preparedness compared to 
their peers. Also, trainees in procedural programs had less educational 
preparedness compared to their peers in non-procedural programs. This study 
highlights the importance for programs to find avenues to increase educational 
preparedness in their trainees while being attuned to the mental health of their 
trainees.

© 2021. The Author(s).

DOI: 10.1186/s12909-021-03019-6
PMCID: PMC8595953
PMID: 34789217 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare they have no competing 
interest.


2761. J Am Coll Health. 2023 Dec;71(9):2775-2785. doi: 10.1080/07448481.2021.1996372. 
Epub 2021 Nov 17.

Comparing mental health and well-being of US undergraduate and graduate students 
during the early stages of the COVID-19 pandemic.

Dial LA(1)(2), DeNardo FA(3), Fevrier B(4), Morgan AL(5), Du C(6), Tucker RM(6), 
Hsiao PY(7), Ludy MJ(4).

Author information:
(1)Department of Psychology, Bowling Green State University, Bowling Green, 
Ohio, USA.
(2)Department of Psychology, California State University, Fresno, California, 
USA.
(3)Division of Health and Wellness, Bowling Green State University, Bowling 
Green, Ohio, USA.
(4)Department of Public and Allied Health, Bowling Green State University, 
Bowling Green, Ohio, USA.
(5)School of Human Movement, Sport, and Leisure Studies, Bowling Green State 
University, Bowling Green, Ohio, USA.
(6)Department of Food Science and Human Nutrition, Michigan State University, 
East Lansing, Michigan, USA.
(7)Department of Food and Nutrition, Indiana University of Pennsylvania, 
Indiana, Pennsylvania, USA.

Objective: This study explored how COVID-related mental health and well-being 
varied between undergraduate and graduate students. Relationships with physical 
health behaviors were also examined. Participants: Undergraduate (n = 897) and 
graduate (n = 314) students were recruited from three US universities between 
mid-April and late-May 2020. Methods: Participants in this cross-sectional 
survey self-reported perceived stress, financial stress, resilience, repetitive 
negative thinking, mood, anxiety, diet, sleep, and physical activity using 
validated instruments. Results: Undergraduate students reported more perceived 
stress, more repetitive negative thinking, less positive mood, and less support 
from professors than graduate students. Perceived stress, repetitive negative 
thinking, negative mood, and anxiety increased among all students (p < .05 for 
all). Correlations between mental health outcomes and physical health behaviors 
were weak to moderate (r = .08 to .49). Conclusions: College students, 
particularly undergraduates, perceived negative mental health impacts during 
COVID. Creative approaches for meeting student needs are necessary.

DOI: 10.1080/07448481.2021.1996372
PMID: 34788587 [Indexed for MEDLINE]


2762. Turk J Gastroenterol. 2021 Oct;32(10):879-887. doi: 10.5152/tjg.2021.201110.

Impact of COVID-19 Pandemic on Gastroenterology Fellowship Training in Turkey: A 
Prospective Nationwide Survey Study.

Demirtaş CÖ(1), Vahabov C(2), Mustafayev F(2), Sahin T(2), Parlak E(2).

Author information:
(1)Department of Gastroenteroloy, School of Medicine, Marmara University, 
Istanbul, Turkey;Department of Gastroenterology, School of Medicine, Hacettepe 
University, Ankara, Turkey.
(2)Department of Gastroenterology, School of Medicine, Hacettepe University, 
Ankara, Turkey.

BACKGROUND: The Coronavirus-2019 disease (COVID-19) pandemic has markedly 
restricted endoscopic and clinical activities in gastroenterology (GI), with a 
negative impact on trainee education. We aimed to inve stigate how and to what 
extent has GI trainees in Turkey are affected by the current pandemic in terms 
of general, psychological, and educational status.
METHODS: We conducted a web-based survey sent electronically to 103 official GI 
trainees in Turkey from 37 centers. The 32-item survey included questions to 
capture demographic (5-questions), endoscopic (7-questions), personal protective 
equipment (PPE) (3-questions), psychological and general well-being 
(11-questions), and educational (6-questions) data.
RESULTS: Ninety-six (93.2%) trainees completed the survey, of which 56.3% (n = 
54) reported a decrease in independently performed endoscopic procedures. Due to 
pandemic, 91.7% of standard diagnostic endoscopic procedures, 57.2% of standard 
therapeutic procedures, and 67.7% of advanced endoscopic procedures were 
decreased. Out of 96 respondents, we detected signs of anxiety in 88.5%, 
exposure concern in 92.7%, concerns for prolongation of training period in 49%, 
loss of concentration and interest in 47.9%, and burnout syndrome in 63.5%. 
Female gender (odds-ratio: 3.856, 95% confidence interval: 1.221-12.174, P = 
.021) was the only independently associated factor with pandemic-related 
anxiety.
CONCLUSIONS: COVID-19 pandemic has led to high amounts of anxiety and 
non-negligible rates of burnout syndrome among GI trainees, with a significant 
reduction in endoscopic activities. More effort and novel strategies are 
required to deliver sufficient competence and general-psychological well-being 
to GI trainees.

DOI: 10.5152/tjg.2021.201110
PMCID: PMC8975368
PMID: 34787093 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest: The authors have no 
conflict of interest to declare.


2763. CMAJ Open. 2021 Nov 16;9(4):E1013-E1020. doi: 10.9778/cmajo.20210042. Print 2021 
Oct-Dec.

The mental well-being and coping strategies of Canadian adolescents during the 
COVID-19 pandemic: a qualitative, cross-sectional study.

Ferguson KN(1), Coen SE(1), Tobin D(1), Martin G(1), Seabrook JA(1), Gilliland 
JA(2).

Author information:
(1)Human Environments Analysis Laboratory (Ferguson, Coen, Tobin, Martin, 
Seabrook, Gilliland), and Department of Geography and Environment (Ferguson, 
Tobin, Gilliland), Western University; Children's Health Research Institute 
(Ferguson, Martin, Seabrook, Gilliland), Lawson Health Research Institute, 
London, Ont.; School of Geography (Coen), University of Nottingham, Nottingham, 
UK; Faculty of Health Disciplines (Martin), Athabasca University, Athabasca, 
Alta.; School of Food and Nutritional Sciences (Seabrook), Brescia University 
College at Western University, London, Ont.
(2)Human Environments Analysis Laboratory (Ferguson, Coen, Tobin, Martin, 
Seabrook, Gilliland), and Department of Geography and Environment (Ferguson, 
Tobin, Gilliland), Western University; Children's Health Research Institute 
(Ferguson, Martin, Seabrook, Gilliland), Lawson Health Research Institute, 
London, Ont.; School of Geography (Coen), University of Nottingham, Nottingham, 
UK; Faculty of Health Disciplines (Martin), Athabasca University, Athabasca, 
Alta.; School of Food and Nutritional Sciences (Seabrook), Brescia University 
College at Western University, London, Ont. jgillila@uwo.ca.

BACKGROUND: Qualitative research is lacking on the mental well-being of 
adolescents during the COVID-19 pandemic. The aim of this study was to explore 
the feelings and emotions adolescents experienced during the first wave of the 
COVID-19 pandemic and the coping strategies they identified and employed to 
manage those emotions.
METHODS: Participants living in Canada aged 13-19 years were recruited through 
social media platforms and youth-serving organizations. Qualitative data were 
gathered from 2 open-ended questions included in a youth-informed 
cross-sectional online survey: "What feelings and emotions have you experienced 
around the pandemic?" and "What coping strategies have you used during the 
pandemic?" We collected data from June 2020 to September 2020. A summative 
content analysis was undertaken to analyze survey responses inductively.
RESULTS: A total of 1164 open-ended responses from Canadian adolescents (n = 
851; mean age 15.6, standard deviation 1.7, yr) were analyzed. We identified 3 
major themes within the category of feelings and emotions associated with the 
pandemic: sociospatial and temporal disconnections, emotional toll of the 
pandemic and positives amid the pandemic. Within the category of coping 
strategies used during the pandemic, 2 major themes were identified: connecting 
online and outdoors, and leisure and health-promoting activities.
INTERPRETATION: Although the emotional toll of the first wave of the COVID-19 
pandemic is evident, participants in our study adopted various positive coping 
strategies to mitigate their distress, including physical activity, safe peer 
interactions and hobbies. The results have important implications for public 
health policy and practice during pandemic times, emphasizing the importance of 
accessible mental health resources for those experiencing psychological 
distress.

© 2021 CMA Joule Inc. or its licensors.

DOI: 10.9778/cmajo.20210042
PMCID: PMC8598240
PMID: 34785531 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: Kendra Nelson Ferguson and 
Gina Martin received postdoctoral trainee support from the Children’s Health 
Foundation through the Children’s Health Research Institute. No other competing 
interests were declared.


2764. BMC Public Health. 2021 Nov 16;21(1):2102. doi: 10.1186/s12889-021-11770-0.

'Dove Confident Me Indonesia: Single Session': study protocol for a randomised 
controlled trial to evaluate a school-based body image intervention among 
Indonesian adolescents.

Craddock N(1), Garbett KM(2), Haywood S(2), Nasution K(3), White P(2), Saraswati 
LA(4), Rizkiah C(5), Medise BE(3), Diedrichs PC(2).

Author information:
(1)Centre for Appearance Research, University of the West of England, 
Coldharbour Lane, Bristol, BS16 1QY, UK. Nadia.Craddock@uwe.ac.uk.
(2)Centre for Appearance Research, University of the West of England, 
Coldharbour Lane, Bristol, BS16 1QY, UK.
(3)Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
(4)University of Hawai'i at Mānoa, Honolulu, USA.
(5)Lazuardi Al Falah Depok Junior High School Indonesia, Kota Depok, Indonesia.

BACKGROUND: Due to the prevalence and associated adverse health consequences of 
negative body image among adolescents globally, there is a need to develop 
acceptable, effective, and scalable interventions. School-based body image 
interventions delivered by trained teachers show promise in reducing negative 
body image in adolescents. However, there is currently a lack of evidenced-based 
body image interventions for use in low- and middle-income countries (LMICs). 
This paper outlines a protocol for the development and evaluation of Dove 
Confident Me Indonesia: Single Session, a single-session, teacher-led body image 
intervention for Indonesian adolescents.
METHOD: The effectiveness of the intervention will be evaluated using a cluster 
randomised controlled trial design. Due to the COVID-19 pandemic, the trial will 
be conducted online. Trained teachers or school guidance counsellors will 
deliver the intervention. Self-report questionnaires will be collected at three 
time points: baseline, post-intervention, and two-month follow-up. The primary 
outcome is body esteem. Secondary outcomes are internalisation of appearance 
ideals, mood, engagement in life activities, tendency to engage in appearance 
comparisons, and skin shade satisfaction. A minimum of 1000 participants will 
provide 95% power to detect small-to-medium intervention effects. To account for 
attrition and potential internet issues, the sample will comprise of 2000 
Indonesian adolescents in grades 7-9, attending state junior high schools in 
Surabaya, East Java. Quantitative and qualitative data on acceptability of the 
intervention will also be collected from teachers and students. Additionally, 
fidelity of lesson implementation will be assessed. This project received 
ethical approval from the Universitas Indonesia and the University of the West 
of England. The intervention will be disseminated in junior high schools 
throughout Indonesia via UNICEF's Life Skills Education (LSE) programme, which 
will be freely available for teachers to download.
DISCUSSION: This paper presents Dove Confident Me Indonesia: Single Session, a 
culturally adapted school-based intervention designed to improve Indonesian 
adolescents' body image. It details the plan for evaluation, highlighting the 
strengths and limitations of the proposed study design. It will be informative 
for others aiming to adapt evidence-based school curricula to promote well-being 
among adolescents in LMICs.
TRIAL REGISTRATION: NCT04665557 . Registered 11th December 2020.

© 2021. The Author(s).

DOI: 10.1186/s12889-021-11770-0
PMCID: PMC8593637
PMID: 34784916 [Indexed for MEDLINE]

Conflict of interest statement: PCD is an independent consultant to the Dove 
Self-Esteem Project global education initiative. PCD and SH were on the Dove 
Self-Esteem Project Global Advisory Board in 2013–2016. The authors declare no 
other conflicts of interest in relation to this work.


2765. BMC Geriatr. 2021 Nov 15;21(1):643. doi: 10.1186/s12877-021-02436-y.

Digital personal assistants are smart ways for assistive technology to aid the 
health and wellbeing of patients and carers.

Balasubramanian GV(1), Beaney P(2), Chambers R(3).

Author information:
(1)Centre for Biomechanics and Rehabilitation Technologies, Faculty of Health, 
Staffordshire University, Stoke-on-Trent, UK. 
Gayathri.balasubramanian@research.staffs.ac.uk.
(2)Keele University Medical School, Keele, Newcastle-under-Lyme, UK.
(3)Digital Workstream, Staffordshire and Stoke-on-Trent Sustainability and 
Transformation Partnership (STP), Staffordshire, UK.

BACKGROUND: Digital health solutions such as assistive technologies create 
significant opportunities to optimise the effectiveness of both health and 
social care delivery. Assistive technologies include 'low-tech' items, such as 
memory aids and digital calendars or 'high-tech' items, like health tracking 
devices and wearables. Depending on the type of assistive devices, they can be 
used to improve quality of life, effect lifestyle improvements and increase 
levels of independence. Acceptance of technology among patients and carers 
depends on various factors such as perceived skills and competencies in using 
the device, expectations, trust and reliability. This service evaluation 
explored the impact of a pilot service redesign focused on improving health and 
wellbeing by the use of a voice-activated device 'smart speaker', Alexa Echo 
Show 8.
METHODS: A service evaluation/market research was conducted for a pilot service 
redesign programme. Data were collected via a survey in person or telephone and 
from two focus groups of patients (n = 44) and informal carers (n = 7). The age 
of the study participants ranged from 50 to 90 years. Also, the participants 
belonged to two types of cohort: one specifically focused on diabetes and the 
other on a range of long-term health conditions such as multiple sclerosis, 
dementia, depression and others.
RESULTS: The device had a positive impact on the health and social well-being of 
the users; many direct and indirect benefits were identified. Both patients and 
carers had positive attitudes towards using the device. Self-reported benefits 
included: reminders for medications and appointments improved adherence and 
disease control; increased independence and productivity; and for those living 
alone, the device helped combat their loneliness and low mood.
CONCLUSION: The findings from the study help to realise the potential of 
assistive technology for empowering supporting health/social care. Especially, 
the season of COVID-19 pandemic has highlighted the need for remote management 
of health, the use of assistive technology could have a pivotal role to play 
with the sustainability of health/social care provision by promoting shared care 
between the care provider and service user. Further evaluation can explore the 
key drivers and barriers for implementing assistive technologies, especially in 
people who are ageing and with long-term health conditions.

© 2021. The Author(s).

DOI: 10.1186/s12877-021-02436-y
PMCID: PMC8591585
PMID: 34781881 [Indexed for MEDLINE]

Conflict of interest statement: GB is a research student at Staffordshire 
University; RC is employed by Stoke-on-Trent Clinical Commissioning Group; PB 
has no declarations of interest.


2766. PLoS One. 2021 Nov 15;16(11):e0260055. doi: 10.1371/journal.pone.0260055. 
eCollection 2021.

A qualitative assessment of factors affecting nursing home caregiving staff 
experiences during the COVID-19 pandemic.

Snyder RL(1), Anderson LE(1), White KA(1), Tavitian S(1), Fike LV(1), Jones 
HN(1), Jacobs-Slifka KM(1), Stone ND(1), Sinkowitz-Cochran RL(1).

Author information:
(1)Division of Healthcare Quality Promotion, Centers for Disease Control and 
Prevention, Atlanta, Georgia, United States of America.

BACKGROUND: A large portion of COVID-19 cases and deaths in the United States 
have occurred in nursing homes; however, current literature including the 
frontline perspective of staff working in nursing homes is limited. The 
objective of this qualitative assessment was to better understand what 
individual and facility level factors may have contributed to the impact of 
COVID-19 on Certified Nursing Assistants (CNAs) and Environmental Services (EVS) 
staff working in nursing homes.
METHODS: Based on a simple random sample from the National Healthcare Safety 
Network (NHSN), 7,520 facilities were emailed invitations requesting one CNA 
and/or one EVS staff member for participation in a voluntary focus group over 
Zoom. Facility characteristics were obtained via NHSN and publicly available 
sources; participant demographics were collected via SurveyMonkey during 
registration and polling during focus groups. Qualitative information was coded 
using NVIVO and Excel.
RESULTS: Throughout April 2021, 23 focus groups including 110 participants from 
84 facilities were conducted homogenous by participant role. Staffing problems 
were a recurring theme reported. Participants often cited the toll the pandemic 
took on their emotional well-being, describing increased stress, 
responsibilities, and time needed to complete their jobs. The lack of consistent 
and systematic guidance resulting in frequently changing infection prevention 
protocols was also reported across focus groups.
CONCLUSIONS: Addressing concerns of low wages and lack of financial incentives 
may have the potential to attract and retain employees to help alleviate nursing 
home staff shortages. Additionally, access to mental health resources could help 
nursing home staff cope with the emotional burden of the COVID-19 pandemic. 
These frontline staff members provided invaluable insight and should be included 
in improvement efforts to support nursing homes recovering from the impact of 
COVID-19 as well as future pandemic planning.

DOI: 10.1371/journal.pone.0260055
PMCID: PMC8592470
PMID: 34780563 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2767. J Spinal Cord Med. 2021;44(sup1):S256-S265. doi: 10.1080/10790268.2021.1970885.

Feasibility of a virtual service delivery model to support physical activity 
engagement during the COVID-19 pandemic for those with spinal cord injury.

Mehta S(1)(2), Ahrens J(1), Abu-Jurji Z(1), Marrocco SL(1), Upper R(1), Loh 
E(1)(2), Cornell S(1)(3), Wolfe DL(1)(2).

Author information:
(1)Parkwood Institute Research, Lawson Health Research Institute, London ON, 
Canada.
(2)Department of Physical Medicine and Rehabilitation, Western University, 
London ON, Canada.
(3)Parkwood Institute, St. Joseph's Health Care London, London ON, Canada.

BACKGROUND: The current pandemic has reduced access to safe, monitored physical 
activity (PA) programs for persons with spinal cord injury (SCI). The use of 
telerehabilitation has the potential for continuing activity engagement without 
risking virus exposure. The present study evaluates the feasibility and efficacy 
of an online group-based PA program for persons with SCI.
METHODS: This preliminary pre-post study delivered an online group-based PA 
program to persons with SCI. The program consisted of 1-hour sessions twice 
weekly for six weeks. Online PA satisfaction questionnaires were assessed at 
post-treatment. Psychosocial subscales from the NeuroQOL-SF were assessed.
RESULTS: Participants were adult females between 3 and 32 years post-injury, 1 
tetraplegic and 3 paraplegics (n = 4). All participants were highly satisfied 
with the online instruction, overall content, and videoconferencing platform. 
Participants stated that the online program was beneficial for their overall 
physical and psychosocial wellbeing. The program resulted in improvement in 
anxiety and satisfaction with social roles and activities.
CONCLUSION: The current pilot study demonstrates the acceptability and limited 
efficacy of an online PA program for those with SCI. The program resulted in 
improved overall perceived wellbeing and satisfaction with social roles and 
activities. These results have important implications for the clinical 
implementation of online PA programs in a hospital and community setting.

DOI: 10.1080/10790268.2021.1970885
PMCID: PMC8604449
PMID: 34779728 [Indexed for MEDLINE]


2768. Adv Health Care Manag. 2021 Dec 6;20. doi: 10.1108/S1474-823120210000020010.

Even Superheroes Need Rest: A Guide to Facilitating Recovery from Work for 
Health-care Workers during COVID-19 and beyond.

Fleuren BPI, Stephenson AL, Sullivan EE, Raj M, Tietschert MV, Sriharan A, Lai 
AY, DePuccio MJ, Thomas SC, McAlearney AS.

The COVID-19 pandemic burdens health-care workers (HCWs) worldwide. Amid 
high-stress conditions and unprecedented needs for crisis management, 
organizations face the grand challenge of supporting the mental health and 
well-being of their HCWs. The current literature on mental health and well-being 
primarily focuses on improving personal resilience among HCWs. However, this 
puts the responsibility for coping with COVID-19-related stress almost fully on 
the individual. This chapter discusses an important alternative framing of this 
issue - how health-care organizations (HCOs) can facilitate recovery from work 
processes (i.e., returning to a baseline level by engaging in nonwork activities 
after work) for their workers. Based on a narrative review of the occupational 
health psychology literature, we provide practical strategies for supporting the 
four key recovery experiences of detachment, control, mastery, and relaxation, 
as well as present general recommendations about how to promote recovery. These 
strategies can help HCOs facing the grand challenge of sustaining worker 
well-being and functioning during the COVID-19 pandemic, as well as during 
future pandemics and for workers facing high work pressure in general.

Copyright © 2022 Jennifer L. Hefner and Ingrid M. Nembhard. Published under 
exclusive licence by Emerald Publishing Limited.

DOI: 10.1108/S1474-823120210000020010
PMID: 34779188 [Indexed for MEDLINE]


2769. Front Public Health. 2021 Oct 29;9:750529. doi: 10.3389/fpubh.2021.750529. 
eCollection 2021.

Burnout Among Healthcare Workers in the COVID 19 Era: A Review of the Existing 
Literature.

Leo CG(1), Sabina S(1), Tumolo MR(2), Bodini A(3), Ponzini G(2), Sabato E(2)(4), 
Mincarone P(2).

Author information:
(1)Institute of Clinical Physiology, National Research Council, Lecce, Italy.
(2)Institute for Research on Population and Social Policies, National Research 
Council, Brindisi, Italy.
(3)Institute for Applied Mathematics and Information Technologies "E. Magenes," 
National Research Council, Milan, Italy.
(4)Respiratory Diseases Unit, "A. Perrino" P.O., Brindisi, Italy.

In the current period of global public health crisis due to the COVID-19, 
healthcare workers are more exposed to physical and mental exhaustion - burnout 
- for the torment of difficult decisions, the pain of losing patients and 
colleagues, and the risk of infection, for themselves and their families. The 
very high number of cases and deaths, and the probable future "waves" raise 
awareness of these challenging working conditions and the need to address 
burnout by identifying possible solutions. Measures have been suggested to 
prevent or reduce burnout at individual level (physical activity, balanced diet, 
good sleep hygiene, family support, meaningful relationships, reflective 
practices and small group discussions), organizational level (blame-free 
environments for sharing experiences and advices, broad involvement in 
management decisions, multi-disciplinary psychosocial support teams, safe areas 
to withdraw quickly from stressful situations, adequate time planning, social 
support), and cultural level (involvement of healthcare workers in the 
development, implementation, testing, and evaluation of measures against 
burnout). Although some progress has been made in removing the barrier to 
psychological support to cope with work-related stress, a cultural change is 
still needed for the stigma associated with mental illness. The key 
recommendation is to address the challenges that the emergency poses and to 
aggregate health, well-being and behavioral science expertise through long term 
researches with rigorous planning and reporting to drive the necessary cultural 
change and the improvement of public health systems.

Copyright © 2021 Leo, Sabina, Tumolo, Bodini, Ponzini, Sabato and Mincarone.

DOI: 10.3389/fpubh.2021.750529
PMCID: PMC8585922
PMID: 34778184 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2770. Eur J Psychotraumatol. 2021 Nov 10;12(1):1984667. doi: 
10.1080/20008198.2021.1984667. eCollection 2021.

Impacts of morally distressing experiences on the mental health of Canadian 
health care workers during the COVID-19 pandemic.

Plouffe RA(1)(2), Nazarov A(1)(2)(3), Forchuk CA(1), Gargala D(1), Deda E(4), Le 
T(1), Bourret-Gheysen J(1), Jackson B(1), Soares V(1), Hosseiny F(5)(6), Smith 
P(5)(6), Roth M(2)(4)(7), MacDougall AG(2)(8)(9), Marlborough M(2)(4), Jetly 
R(6), Heber A(10)(11), Albuquerque J(12), Lanius R(2)(13), Balderson K(2)(4), 
Dupuis G(5)(6), Mehta V(2)(9), Richardson JD(1)(2)(3)(4).

Author information:
(1)The MacDonald Franklin Operational Stress Injury Research Centre, Lawson 
Health Research Institute, London, Ontario, Canada.
(2)Department of Psychiatry, Schulich School of Medicine & Dentistry, Western 
University, London, Ontario, Canada.
(3)Department of Psychiatry and Behavioral Neurosciences, McMaster University, 
Hamilton, Ontario, Canada.
(4)St. Joseph's Operational Stress Injury Clinic, Parkwood Institute, St. 
Joseph's Health Care London, London, Ontario, Canada.
(5)Centre of Excellence on Post-Traumatic Stress Disorder (PTSD), Ottawa, 
Ontario, Canada.
(6)Institute of Mental Health Research at The Royal, University of Ottawa, 
Ottawa, Ontario, Canada.
(7)Yeates School of Graduate Studies, Ryerson University, Toronto, Ontario, 
Canada.
(8)Department of Epidemiology & Biostatistics, Schulich School of Medicine & 
Dentistry, Western University, London, Ontario, Canada.
(9)St. Joseph's Health Care London and Parkwood Institute, Lawson Health 
Research Institute, London, Ontario, Canada.
(10)Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada.
(11)Veterans Affairs Canada, Ottawa, Ontario, Canada.
(12)Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
(13)Department of Neuroscience, Schulich School of Medicine & Dentistry, Western 
University, London, Ontario, Canada.

BACKGROUND: Research is urgently needed to understand health care workers' 
(HCWs') experiences of moral-ethical dilemmas encountered throughout the 
COVID-19 pandemic, and their associations with organizational perceptions and 
personal well-being. This research is important to prevent long-term moral and 
psychological distress and to ensure that workers can optimally provide health 
services.
OBJECTIVE: Evaluate associations between workplace experiences during COVID-19, 
moral distress, and the psychological well-being of Canadian HCWs.
METHOD: A total of 1362 French- and English-speaking Canadian HCWs employed 
during the COVID-19 pandemic were recruited to participate in an online survey. 
Participants completed measures reflecting moral distress, perceptions of 
organizational response to the pandemic, burnout, and symptoms of psychological 
disorders, including depression, anxiety, and posttraumatic stress disorder 
(PTSD).
RESULTS: Structural equation modelling showed that when organizational 
predictors were considered together, resource adequacy, positive work life 
impact, and ethical work environment negatively predicted severity of moral 
distress, whereas COVID-19 risk perception positively predicted severity of 
moral distress. Moral distress also significantly and positively predicted 
symptoms of depression, anxiety, PTSD, and burnout.
CONCLUSIONS: Our findings highlight an urgent need for HCW organizations to 
implement strategies designed to prevent long-term moral and psychological 
distress within the workplace. Ensuring availability of adequate resources, 
reducing HCW risk of contracting COVID-19, providing organizational support 
regarding individual priorities, and upholding ethical considerations are 
crucial to reducing severity of moral distress in HCWs.

Publisher: Antecedentes: Se necesita con urgencia investigaciones para 
comprender las experiencias de los dilemas éticos y morales que los trabajadores 
de la salud encontraron durante la pandemia de la COVID-19 y su asociación con 
las percepciones de la organización y el bienestar personal. Esta investigación 
es importante para prevenir la angustia moral y psicológica a largo plazo y para 
asegurar que los trabajadores de la salud puedan proveer de manera óptima los 
servicios de salud.Objetivo: Evaluar la asociación entre las experiencias en el 
lugar de trabajo durante la COVID-19, la angustia moral y el bienestar 
psicológico de los trabajadores de salud canadienses.Métodos: Se reclutó a un 
total de 1362 trabajadores de salud canadienses, que hablaban francés e inglés y 
que fueron contratados durante la pandemia de la COVID-19, para participar en un 
cuestionario en línea. Los participantes completaron mediciones que reflejaban 
la angustia moral, la percepción de la respuesta de la organización a la 
pandemia, el burnout y los síntomas de trastornos psicológicos, que incluían a 
la depresión, a la ansiedad y al trastorno de estrés postraumático 
(TEPT).Resultados: El modelo de ecuaciones estructurales mostró que cuando los 
predictores de la organización se consideraban en conjunto – los recursos 
adecuados, el impacto positivo en la vida laboral y un ambiente de trabajo ético 
–, predijeron negativamente la gravedad de la angustia moral, mientras que la 
percepción del riesgo de contraer la COVID-19 predijo positivamente la gravedad 
de la angustia moral. La angustia moral también predijo de manera significativa 
y positiva los síntomas de la depresión, la ansiedad, el TEPT y el 
burnout.Conclusiones: Nuestros hallazgos resaltan la urgente necesidad de que 
las organizaciones de trabajadores de salud implementen estrategias diseñadas 
para prevenir la angustia moral y psicológica a largo plazo en el lugar de 
trabajo. El asegurar la disponibilidad de los recursos adecuados, el reducir el 
riesgo de que los trabajadores de salud contraigan la COVID-19, el proveer un 
soporte organizacional adecuado según las prioridades individuales y el respetar 
las consideraciones éticas son fundamentales para reducir la gravedad de la 
angustia moral en los trabajadores de salud.

Publisher: 背景:亟需研究以了解卫生保健工作者 (HCW) 在整个 COVID-19 疫情期间遇到的道德伦理困境的经历, 
及其与组织观念和个人幸福感的关联。本研究对于预防长期道德和心理困扰并确保工作人员能够最好地提供健康服务非常重要。目的:评估加拿大医护人员的 COVID-19 
期间工作场所经历, 道德困扰和心理健康之间的关联。方法:共招募了 1362 名在 COVID-19 疫情期间受雇的讲法语和英语的加拿大 HCW 
参与在线调查。参与者完成了反映道德困扰, 组织对疫情, 倦怠和心理障碍症状 (包括抑郁, 焦虑和创伤后应激障碍 (PTSD)) 
的看法的测量。结果:结构方程模型表明, 当同时考虑组织预测因素时, 资源充足性, 积极的工作生活影响和道德工作环境负向预测道德困扰的严重程度, 而 
COVID-19 风险感知正向预测道德困扰的严重程度。道德困扰也显著且正向预测了抑郁, 焦虑, PTSD和倦怠的症状。结论:我们的结果强调了 HCW 
组织迫切需要实施旨在预防工作场所内长期道德和心理困扰的策略。确保可获取足够资源, 降低HCW接触 COVID-19 的风险, 
提供个体优先性相关的组织支持以及坚持伦理考虑对于降低医护人员道德困境的严重程度至关重要.

© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & 
Francis Group.

DOI: 10.1080/20008198.2021.1984667
PMCID: PMC8583841
PMID: 34777712 [Indexed for MEDLINE]

Conflict of interest statement: No potential conflict of interest was reported 
by the author(s).


2771. Child Care Health Dev. 2022 Nov;48(6):924-934. doi: 10.1111/cch.12925. Epub 2021 
Dec 16.

Care in COVID: A qualitative analysis of the impact of COVID-19 on the health 
and care of children and young people with severe physical neurodisability and 
their families.

Cadwgan J(1)(2)(3), Goodwin J(3), Arichi T(1)(4)(5), Patel A(1), Turner S(1), 
Barkey S(1), McDonald A(1), Lumsden DE(1)(2), Fairhurst C(1)(2).

Author information:
(1)Children's Neurosciences, Evelina London Children's Hospital, Guy's and St 
Thomas' NHS Foundation Trust, London, UK.
(2)School of Life Sciences, King's College London, London, UK.
(3)Population Health Sciences Institute, Newcastle University, Newcastle upon 
Tyne, UK.
(4)Centre for the Developing Brain, School of Biomedical Engineering and Imaging 
Sciences, King's College London, London, UK.
(5)Department of Bioengineering, Imperial College London, London, UK.

AIM: To evaluate clinicians' perspectives on the impact of 'lockdown' during the 
COVID-19 pandemic for children and young people with severe physical 
neurodisability and their families.
METHOD: Framework analysis of comments from families during a recent service 
review was used to code the themes discussed according to the World Health 
Organization International Classification of Functioning, Disability and Health 
(ICF) and interpreted into emergent themes to summarize the impact of lockdown 
(Stage 1). They were presented to a clinician focus group for discussion 
(consultants and physiotherapists working in a specialist motor disorders 
service, [Stage 2]).
RESULTS: Three overarching themes 'Uncertainty and Anxiety', 'Exacerbation of 
Existing Inequalities' and 'Care Provision: Reaction, Adaptation, and 
Innovation' summed up the impact of the COVID-19 pandemic on health and 
well-being in children and young people with neurodisability and their families. 
All themes were influenced by time.
INTERPRETATION: This study reflects clinician's perceptions of family 
experiences of the pandemic and lockdown. Significant impact is apparent in the 
entire U.K. population, but the complexity of care needs for children with 
physical neurodisability exacerbates this. Lobbying for government policy is 
vital to ensure that all children, and in particular those with significant 
health and social care needs, are protected and continue to access services. 
During the restoration and recovery phase of the pandemic, there is a need for 
service reconfiguration that utilizes what we have learned and is adaptive to 
individual family circumstances.

© 2021 John Wiley & Sons Ltd.

DOI: 10.1111/cch.12925
PMCID: PMC8652970
PMID: 34773287 [Indexed for MEDLINE]


2772. BMJ Open. 2021 Nov 12;11(11):e050945. doi: 10.1136/bmjopen-2021-050945.

'Stressed, uncomfortable, vulnerable, neglected': a qualitative study of the 
psychological and social impact of the COVID-19 pandemic on UK frontline 
keyworkers.

May T(1), Aughterson H(2), Fancourt D(2), Burton A(2).

Author information:
(1)Research Department of Behavioural Science and Health, Institute of 
Epidemiology and Health Care, University College London, London, UK 
t.may@ucl.ac.uk.
(2)Research Department of Behavioural Science and Health, Institute of 
Epidemiology and Health Care, University College London, London, UK.

OBJECTIVES: Non-healthcare keyworkers face distinct occupational vulnerabilities 
that have received little consideration within broader debates about 'essential' 
work and psychological distress during the COVID-19 pandemic. The aim of this 
study was therefore to explore the impact of the pandemic on the working lives 
and mental health and well-being of non-healthcare keyworkers in the UK.
DESIGN: In-depth, qualitative interviews, analysed using a reflexive thematic 
analysis.
SETTING: Telephone or video call interviews, conducted in the UK between 
September 2020 and January 2021.
PARTICIPANTS: 23 participants aged 26-61 (mean age=47.2) years employed in a 
range of non-healthcare keyworker occupations, including transport, retail, 
education, postal services, the police and fire services, waste collection, 
finance and religious services.
RESULTS: Keyworkers experienced adverse psychological effects during the 
COVID-19 pandemic, including fears of COVID-19 exposure, contagion and 
subsequent transmission to others, especially their families. These concerns 
were often experienced in the context of multiple exposure risks, including 
insufficient personal protective equipment and a lack of workplace mitigation 
practices. Keyworkers also described multiple work-related challenges, including 
increased workload, a lack of public and organisational recognition and feelings 
of disempowerment.
CONCLUSIONS: In efforts to reduce psychosocial concerns among non-healthcare 
keyworkers, there is a need for appropriate support during the COVID-19 pandemic 
and in preparation for other infections (eg, seasonal influenza) in the future. 
This includes the provision of psychological and workplace measures attending to 
the intersections of personal vulnerability and work conditions that cause 
unique risks and challenges among those in frontline keyworker occupations.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/bmjopen-2021-050945
PMCID: PMC8593269
PMID: 34772752 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2773. Int J Environ Res Public Health. 2021 Nov 3;18(21):11567. doi: 
10.3390/ijerph182111567.

The Impact of the COVID-19 Pandemic on Ophthalmology Residents: A Narrative 
Review.

Dub N(1), Konopińska J(1), Obuchowska I(1), Lisowski Ł(1), Dmuchowska DA(1), 
Rękas M(2).

Author information:
(1)Department of Ophthalmology, Medical University of Bialystok, 15-276 
Bialystok, Poland.
(2)Department of Ophthalmology, Military Institute of Medicine, 04-141 Warsaw, 
Poland.

The ongoing outbreak of the coronavirus disease 2019 (COVID-19) pandemic has 
drastically affected medical societies. We aim to provide an overview and 
summarize the information published so far concerning the impact of the COVID-19 
pandemic on ophthalmology residency programs and the mental wellbeing of 
trainees, and to establish factors to help maintain successful residency 
training to ensure high-quality, specialist ophthalmic training. A literature 
search was conducted in October 2021 of the PubMed database for articles 
assessing the impact of the COVID-19 pandemic on the mental health of 
ophthalmology trainees and on ophthalmology residency programs. Cross-sectional 
survey studies, editorials, articles in scientific journals, letters to editors, 
and commentaries were considered; finally, 19 studies were included after 
excluding abstract-only publications and conference posters. The studies' 
demographic details, participant characteristics, interventions, outcomes, and 
limitations were extracted. Our summarized information showed the alarmingly 
significant impact of the COVID-19 pandemic on ophthalmology trainees' mental 
health and the associated considerable changes in ophthalmic training programs. 
Thus, in future, virtual training and surgical simulators should be permanently 
introduced, in addition to traditional teaching, to complete successful 
ophthalmology residency programs. Additionally, we emphasize the need for a 
widely facilitated and encouraged access to psychological support programs for 
healthcare workers, including ophthalmologists.

DOI: 10.3390/ijerph182111567
PMCID: PMC8583285
PMID: 34770081 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2774. Int J Environ Res Public Health. 2021 Oct 30;18(21):11436. doi: 
10.3390/ijerph182111436.

Behavioral Correlates of COVID-19 Worry: Stigma, Knowledge, and News Source.

Meltzer GY(1), Chang VW(1)(2), Lieff SA(1), Grivel MM(1), Yang LH(1)(3)(4), Des 
Jarlais DC(3).

Author information:
(1)Department of Social and Behavioral Sciences, School of Global Public Health, 
New York University, New York, NY 10003, USA.
(2)Department of Population Health, Grossman School of Medicine, New York 
University, New York, NY 10003, USA.
(3)Department of Epidemiology, School of Global Public Health, New York 
University, New York, NY 10003, USA.
(4)Department of Epidemiology, Mailman School of Public Health, Columbia 
University, New York, NY 10032, USA.

Non-adherence to COVID-19 guidelines may be attributable to low levels of worry. 
This study assessed whether endorsing COVID-19-stigmatizing restrictions, 
COVID-19 knowledge, and preferred news source were associated with being 'very 
worried' versus 'not at all' or 'somewhat' worried about contracting COVID-19. 
Survey data were collected in July-August 2020 from N = 547 New York State (NYS) 
and N = 504 national Amazon MTurk workers. Respondents who endorsed COVID-19 
stigmatizing restrictions (NYS OR 1.96; 95% CI 1.31, 2.92; national OR 1.80; 95% 
CI 1.06, 3.08) and consumed commercial news (NYS OR 1.89; 95% CI 1.21, 2.96; 
national OR 1.93; 95% CI 1.24, 3.00) were more likely to be very worried. 
National respondents who consumed The New York Times (OR 1.52; 95% CI 1.00, 
2.29) were more likely to be very worried, while those with little knowledge (OR 
0.24; 95% CI 0.13, 0.43) were less likely to be very worried. NYS (OR 2.66; 95% 
CI 1.77, 4.00) and national (OR 3.17; 95% CI 1.95, 5.16) respondents with 
probable depression were also more likely to be very worried. These 
characteristics can help identify those requiring intervention to maximize 
perceived threat to COVID-19 and encourage uptake of protective behaviors while 
protecting psychological wellbeing.

DOI: 10.3390/ijerph182111436
PMCID: PMC8583421
PMID: 34769952 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2775. Int J Environ Res Public Health. 2021 Oct 30;18(21):11429. doi: 
10.3390/ijerph182111429.

Italian Children's Well-Being after Lockdown: Predictors of Psychopathological 
Symptoms in Times of COVID-19.

Caputi M(1), Forresi B(2), Giani L(2), Michelini G(2), Scaini S(2).

Author information:
(1)Department of Life Sciences, University of Trieste, Via E. Weiss 21, 34128 
Trieste, Italy.
(2)Child and Youth Lab, Sigmund Freud University of Milan, Via Ripa di Porta 
Ticinese 77, 20143 Milan, Italy.

The first Italian lockdown imposed to fight the spread of COVID-19 caused 
important disruptions in families' everyday lives. The main aim of this research 
was to investigate the predictors of psychopathology in children aged 5-10 
years, immediately after the national 2-month lockdown. A total of 158 Italian 
parents (148 mothers, 10 fathers, mean age = 41 years) were recruited and asked 
to complete an online research concerning their 158 children (76 boys, mean age 
= 7.4 years). Parents completed questionnaires on parent-child conflict, 
resilience, temperament, behavior, and previous adverse childhood experiences. 
Hierarchical regressions showed that children's psychopathology was predicted by 
low child resilience, high novelty seeking and harm avoidance, adverse 
experiences, and high flooding levels. Moreover, girls exposed to adverse 
experiences appeared more vulnerable to psychopathology. The recruitment of a 
convenience sample, the small sample size, and the cross-sectional design of our 
study limit the generalizability and interpretation of the present findings. 
Nonetheless, this research extends our knowledge of children's functioning in 
such an exceptional period. Shedding light on predictors of children's 
psychopathology following prolonged quarantine can indeed guide effective 
psychological interventions now and in future similar situations.

DOI: 10.3390/ijerph182111429
PMCID: PMC8583178
PMID: 34769947 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2776. Int J Environ Res Public Health. 2021 Oct 29;18(21):11410. doi: 
10.3390/ijerph182111410.

Occupational Health of Frontline Healthcare Workers in the United Arab Emirates 
during the COVID-19 Pandemic: A Snapshot of Summer 2020.

Ajab S(1), Ádam B(1), Al Hammadi M(2), Al Bastaki N(3), Al Junaibi M(4), Al 
Zubaidi A(4), Hegazi M(5), Grivna M(1)(6), Kady S(4), Koornneef E(1)(4), Neves 
R(7), Uva AS(8), Sheek-Hussein M(1), Loney T(9), Serranheira F(8), Paulo 
MS(1)(10).

Author information:
(1)Institute of Public Health, College of Medicine and Health Sciences, United 
Arab Emirates University, Al Ain P.O. Box 17666, United Arab Emirates.
(2)Tawam Hospital, Al Ain P.O. Box 17666, United Arab Emirates.
(3)Department of Medical Education and Research, Dubai Health Authority, Dubai 
P.O. Box 4545, United Arab Emirates.
(4)Ministry of Presidential Affairs, Abu Dhabi P.O. Box 280, United Arab 
Emirates.
(5)Department of Family Medicine, Mediclinic City Hospital, Dubai P.O. Box 
505004, United Arab Emirates.
(6)Department of Public Health and Preventive Medicine, Second Faculty of 
Medicine, Charles University, 150 06 Prague, Czech Republic.
(7)Health Science Faculty, Higher College of Technology Abu Dhabi, Abu Dhabi 
P.O. Box 25026, United Arab Emirates.
(8)CHRC, Comprehensive Health Research Center, Escola Nacional de Saúde Pública, 
Universidade NOVA de Lisboa, 1600-560 Lisbon, Portugal.
(9)College of Medicine, Mohammed Bin Rashid University of Medicine and Health 
Sciences, Dubai P.O. Box 505055, United Arab Emirates.
(10)CHRC, Comprehensive Health Research Center, Nova Medical School, 
Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal.

The study aim was to understand the availability of personal protective 
equipment (PPE) and the levels of anxiety, depression, and burnout of healthcare 
workers (HCWs) in the United Arab Emirates (UAE). This study was an 
online-based, cross-sectional survey during July and August 2020. Participants 
were eligible from the entire country, and 1290 agreed to participate. The 
majority of HCWs were females aged 30-39 years old, working as nurses, and 80% 
considered PPE to be available. Twelve percent of respondents tested positive 
for SARS-CoV-2. Half of HCWs considered themselves physically tired (52.2%), 
reported musculoskeletal pain or discomfort (54.2%), and perceived 
moderate-to-high levels of burnout on at least one of three burnout domains 
(52.8%). A quarter of HCWs reported anxiety (26.3%) or depression (28.1%). HCWs 
reporting not having musculoskeletal pain, having performed physical activity, 
and higher scores of available PPE reported lower scores of anxiety, depression, 
and burnout. UAE HCWs experienced more access to PPE and less anxiety, 
depression, and burnout compared with HCWs in other countries. Study findings 
can be used by healthcare organizations and policymakers to ensure adequate 
measures are implemented to maximize the health and wellbeing of HCWs during the 
current COVID-19 and future pandemics.

DOI: 10.3390/ijerph182111410
PMCID: PMC8583571
PMID: 34769927 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2777. Int J Environ Res Public Health. 2021 Oct 29;18(21):11406. doi: 
10.3390/ijerph182111406.

Silver Linings Reported by Australians Experiencing Public Health Restrictions 
during the First Phase of the COVID-19 Pandemic: A Qualitative Report.

Campbell N(1), Thompson SC(2), Tynan A(3)(4), Townsin L(5), Booker LA(6), Argus 
G(4)(7).

Author information:
(1)Rural and Remote Health College of Medicine and Public Health, Flinders 
University, Darwin 0815, Australia.
(2)Western Australian Centre for Rural Health, University of Western Australia, 
Geraldton 6530, Australia.
(3)Research Support Team, Darling Downs Health, Toowoomba 4350, Australia.
(4)Southern Queensland Rural Health, The University of Queensland, Toowoomba 
4350, Australia.
(5)Research Office, Torrens University Australia, Adelaide 5000, Australia.
(6)La Trobe Rural Health School, University Department of Rural Health, La Trobe 
University, Bendigo 3551, Australia.
(7)School of Psychology and Counselling, University of Southern Queensland, 
Toowoomba 4350, Australia.

This national study investigated the positives reported by residents 
experiencing the large-scale public health measures instituted in Australia to 
manage the first wave of the COVID-19 pandemic in 2020. Most Australians had not 
previously experienced the traditional public health measures used (social 
distancing, hand hygiene and restriction of movement) and which could 
potentially impact negatively on mental well-being. The research design included 
qualitative semi-structured phone interviews where participants described their 
early pandemic experiences. Data analysis used a rapid identification of themes 
technique, well-suited to large-scale qualitative research. The ninety 
participants (mean age 48 years; 70 women) were distributed nationally. Analysis 
revealed five themes linked with mental well-being and the concept of silver 
linings: safety and security, gratitude and appreciation, social cohesion and 
connections, and opportunities to reset priorities and resilience. Participants 
demonstrated support for the public health measures and evidence of individual 
and community resilience. They were cognisant of positives despite personal 
curtailment and negative impacts of public health directives. Stories of hope, 
strength, and acceptance, innovative connections with others and focusing on 
priorities and opportunities within the hardship were important strategies that 
others could use in managing adversity.

DOI: 10.3390/ijerph182111406
PMCID: PMC8582702
PMID: 34769921 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript, or in the decision to 
publish the results.


2778. Int J Environ Res Public Health. 2021 Oct 21;18(21):11066. doi: 
10.3390/ijerph182111066.

Distress Levels of Parents of Children with Neurodevelopmental Disorders during 
the COVID-19 Pandemic: A Comparison between Italy and Australia.

Burnett D(1), Masi A(2), Mendoza Diaz A(2)(3), Rizzo R(4), Lin PI(2)(5), Eapen 
V(2)(3).

Author information:
(1)Department of Women's and Children's Health, Uppsala University, 752 36 
Uppsala, Sweden.
(2)School of Psychiatry, University of New South Wales, Kensington 2052, 
Australia.
(3)Academic Unit of Child Psychiatry, South Western Sydney Local Health District 
& Ingham Institute, Sydney 2170, Australia.
(4)Department of Clinical and Experimental Medicine, University of Catania, 
95124 Catania, Italy.
(5)Mental Health Research Unit, South Western Sydney Local Health District, 
Liverpool 2170, Australia.

Parents of children with a neurodevelopmental disorder (NDD) report higher 
levels of distress compared to those of typically developing children. Distress 
levels may be heightened by the restrictions associated with the COVID-19 
pandemic. However, it is unclear whether distress levels of parents varied by 
the diagnosis of neurodevelopmental disorder in children during the COVID-19 
pandemic. This study aims to investigate whether parental distress was 
influenced by the type of NDD. Participants were from Australia (N = 196) and 
Italy (N = 200); the parents of children aged 3-18 were invited to complete an 
online self-reported survey which included the 6-item Kessler Psychological 
Distress Scale (K6) to determine parental distress. The results show that 
intellectual or learning disorder (ILD) is a major contributor to parental 
distress compared to other NDDs in both Australia and Italy. Moreover, the 
worsening of symptomatic changes in children with NDDs was significantly 
associated with parental distress. The differences between the two countries in 
terms of the pandemic impact, however, were not statistically significant. The 
results suggest that intervention strategies need to be tailored for individual 
clinical information and factor in the society's stringency level of 
anti-contagion policies to improve parental wellbeing.

DOI: 10.3390/ijerph182111066
PMCID: PMC8583226
PMID: 34769585 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2779. JAMA Netw Open. 2021 Nov 1;4(11):e2134315. doi: 
10.1001/jamanetworkopen.2021.34315.

Experiences of Work-Family Conflict and Mental Health Symptoms by Gender Among 
Physician Parents During the COVID-19 Pandemic.

Frank E(1), Zhao Z(1), Fang Y(1), Rotenstein LS(2)(3), Sen S(1)(4), Guille C(5).

Author information:
(1)Michigan Neuroscience Institute, University of Michigan, Ann Arbor.
(2)Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
(3)Harvard Medical School, Boston, Massachusetts.
(4)Department of Psychiatry, University of Michigan Medical School, Ann Arbor.
(5)Department of Psychiatry and Behavioral Sciences, Medical University of South 
Carolina, Charleston.

IMPORTANCE: The COVID-19 pandemic has placed increased strain on health care 
workers and disrupted childcare and schooling arrangements in unprecedented 
ways. As substantial gender inequalities existed in medicine before the 
pandemic, physician mothers may be at particular risk for adverse professional 
and psychological consequences.
OBJECTIVE: To assess gender differences in work-family factors and mental health 
among physician parents during the COVID-19 pandemic.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study included 276 US 
physicians enrolled in the Intern Health Study since their first year of 
residency training. Physicians who had participated in the primary study as 
interns during the 2007 to 2008 and 2008 to 2009 academic years and opted into a 
secondary longitudinal follow-up study were invited to complete an online survey 
in August 2018 and August 2020.
EXPOSURES: Work-family experience included 3 single-item questions and the Work 
and Family Conflict Scale, and mental health symptoms included the Patient 
Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 scale.
MAIN OUTCOMES AND MEASURES: The primary outcomes were work-to-family and 
family-to-work conflict and depressive symptoms and anxiety symptoms during 
August 2020. Depressive symptoms between 2018 (before the COVID-19 pandemic) and 
2020 (during the COVID-19 pandemic) were compared by gender.
RESULTS: Among 215 physician parents who completed the August 2020 survey, 114 
(53.0%) were female and the weighted mean (SD) age was 40.1 (3.57) years. Among 
physician parents, women were more likely to be responsible for childcare or 
schooling (24.6% [95% CI, 19.0%-30.2%] vs 0.8% [95% CI, 0.01%-2.1%]; P < .001) 
and household tasks (31.4% [95% CI, 25.4%-37.4%] vs 7.2% [95% CI, 3.5%-10.9%]; 
P < .001) during the pandemic compared with men. Women were also more likely 
than men to work primarily from home (40.9% [95% CI, 35.1%-46.8%] vs 22.0% [95% 
CI, 17.2%-26.8%]; P < .001) and reduce their work hours (19.4% [95% CI, 
14.7%-24.1%] vs 9.4% [95% CI, 6.0%-12.8%]; P = .007). Women experienced greater 
work-to-family conflict (β = 2.79; 95% CI, 1.00 to 4.59; P = .03), 
family-to-work conflict (β = 3.09; 95% CI, 1.18-4.99; P = .02), and depressive 
(β = 1.76; 95% CI, 0.56-2.95; P = .046) and anxiety (β = 2.87; 95% CI, 
1.49-4.26; P < .001) symptoms compared with men. We observed a difference 
between women and men in depressive symptoms during the COVID-19 pandemic (mean 
[SD] PHQ-9 score: 5.05 [6.64] vs 3.52 [5.75]; P = .009) that was not present 
before the pandemic (mean [SD] PHQ-9 score: 3.69 [5.26] vs 3.60 [6.30]; 
P = .86).
CONCLUSIONS AND RELEVANCE: This study found significant gender disparities in 
work and family experiences and mental health symptoms among physician parents 
during the COVID-19 pandemic, which may translate to increased risk for suicide, 
medical errors, and lower quality of patient care for physician mothers. 
Institutional and public policy solutions are needed to mitigate the potential 
adverse consequences for women's careers and well-being.

DOI: 10.1001/jamanetworkopen.2021.34315
PMCID: PMC8590168
PMID: 34767022 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest Disclosures: None reported.


2780. PLoS One. 2021 Nov 11;16(11):e0259376. doi: 10.1371/journal.pone.0259376. 
eCollection 2021.

Exploring the awareness, attitudes, and actions (AAA) of UK adults at high risk 
of severe illness from COVID-19.

Flint SW(1)(2), Brown A(3)(4), Sanders G(5), Tahrani AA(6)(7)(8).

Author information:
(1)School of Psychology, University of Leeds, Leeds, United Kingdom.
(2)Scaled Insights, Nexus, University of Leeds, Leeds, United Kingdom.
(3)Centre for Obesity Research, University College London, London, United 
Kingdom.
(4)National Institute of Health Research, University College London, London, 
United Kingdom.
(5)School of Sport, Leeds Beckett University, Leeds, United Kingdom.
(6)Institute of Metabolism and Systems Research, University of Birmingham, 
Birmingham, United Kingdom.
(7)Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS 
Foundation Trust, Birmingham, United Kingdom.
(8)Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health 
Partners, Birmingham, United Kingdom.

BACKGROUND: People at high risk of severe illness from COVID-19 have experienced 
greater restrictions during the pandemic, yet there is a paucity of research 
exploring their lived experience.
OBJECTIVES: This study explored the impact of COVID-19 on people identified as 
at high risk of severe illness by UK Government, and in particular, the impact 
of the first lockdown on access to healthcare, medications and use of 
technological platforms.
METHODS: 1038 UK adults who identified as at high risk of severe illness from 
COVID-19 in line with UK Government guidance or self-identified with acute or 
other chronic health conditions, completed the Awareness, Attitudes and Actions 
survey which explored the impact of COVID-19 on access to healthcare, management 
of long-term health condition, mental health, and health behaviours.
RESULTS: Most participants reported feelings of vulnerability, anxiety and 
isolation, noticed that other people changed their behaviour towards them 
including a feeling of being stigmatised by people not categorised as high risk. 
Participants described the largely negative impact that the COVID-19 lockdown 
had on to health-related behaviours and access to healthcare, which had resulted 
in large declines in mental health and wellbeing. Participants also indicated 
disappointment at the UK Governments response and handling of the COVID-19 
lockdown.
IMPLICATIONS: This study provides novel evidence of the lived experience of the 
first COVID-19 lockdown for people identified as at high risk of severe illness. 
In the context of behavioural health interventions, the ubiquity of digital 
technologies and their adoption into day-to-day life translates into greater 
potential reach than traditional interventions, and consequently, greater 
potential for positive public health impact. Findings should be considered by 
policymakers and healthcare professionals to support people now and as we 
transition through the recovery phase with a particular emphasis on supporting 
mental health and changes to the management of long-term health conditions.

DOI: 10.1371/journal.pone.0259376
PMCID: PMC8584659
PMID: 34762659 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2781. J Stud Alcohol Drugs. 2021 Nov;82(6):776-781. doi: 10.15288/jsad.2021.82.776.

Associations Between Substance Use Problems and Stress During COVID-19.

Vogel EA(1), Chieng A(1), Robinson A(2), Pajarito S(2), Prochaska JJ(1).

Author information:
(1)Stanford Prevention Research Center, Department of Medicine, School of 
Medicine, Stanford University, Stanford, California.
(2)Woebot Health, San Francisco, California.

OBJECTIVE: The COVID-19 pandemic has produced major life disruptions and 
increased stress. We explored associations between pandemic-related stress and 
substance use problems.
METHOD: Adults (N = 180; 65% female) with problematic substance use (CAGE-AID > 
1) were recruited online June-August 2020. Measures included the 15-item Short 
Inventory of Problems-Alcohol and Drugs (SIP-AD), Generalized Anxiety Disorder-7 
(GAD-7) seven-item anxiety measure, Patient Health Questionnaire-8 (PHQ-8) 
eight-item depression measure, a three-item measure of pandemic life 
disruptions, a six-item measure of pandemic-related mental health effects, and a 
five-item measure of pandemic-related personal growth. Participants reported 
whether they frequented bars and attended large gatherings. Participants with 
children (<18 years of age) in the home completed a four-item measure of 
pandemic-related worry about children's well-being. Pandemic-related measures 
with significant bivariate associations with SIP-AD, GAD, and PHQ scores were 
tested in multivariable linear regression, adjusting for sex, age, and 
race/ethnicity.
RESULTS: Participants who struggled with responsibilities at home, had greater 
mental health impacts, had greater personal growth, and frequented bars or large 
gatherings had higher SIPAD scores (all ps < .05). Participants who struggled 
with responsibilities at home, had difficulty getting necessities, had greater 
mental health impacts, and worried more about their children had higher GAD-7 
and PHQ-8 scores (all ps < .05). Participants who lost a job or income during 
the pandemic had higher PHQ-8 scores (p = .015). In multivariable analyses, 
greater mental health impacts were associated with higher SIP-AD, PHQ-8, and 
GAD-7 scores (all ps < .05).
CONCLUSIONS: Experiencing worsened mental health symptoms during COVID-19 was 
associated with more substance use problems and symptoms of depression and 
anxiety. Pandemic disruptions may exacerbate preexisting substance use problems.

DOI: 10.15288/jsad.2021.82.776
PMCID: PMC8819622
PMID: 34762037 [Indexed for MEDLINE]

Conflict of interest statement: Athena Robinson, Ph.D., and Sarah Pajarito, 
M.A., are Woebot Health employees.


2782. Am J Med. 2022 Feb;135(2):254-257. doi: 10.1016/j.amjmed.2021.10.010. Epub 2021 
Oct 29.

Association of Social Gaming with Well-Being (Escape COVID-19): A Sentiment 
Analysis.

Krittanawong C(1), Virk HUH(2), Katz CL(3), Kaplin S(4), Wang Z(5), 
Gonzalez-Heydrich J(6), Storch EA(7), Lavie CJ(8).

Author information:
(1)The Michael E. DeBakey VA Medical Center, Baylor College of Medicine, 
Houston, Tex. Electronic address: Chayakrit.Krittanawong@bcm.edu.
(2)Section of Cardiology, University Hospitals, Case Western Reserve University, 
Cleveland, Ohio.
(3)Departments of Medical Education, Psychiatry, and Health System Design & 
Global Health, Icahn School of Medicine at Mount Sinai, New York, NY.
(4)Department of Cardiovascular Medicine, NYU Langone-Long Island, Mineola, NY.
(5)Mayo Clinic Evidence-Based Practice Center, Rochester, Minn; Robert D. and 
Patricia E. Kern Center for the Science of Health Care Delivery, and Division of 
Health Care Policy and Research, Department of Health Sciences Research, Mayo 
Clinic, Rochester, Minn.
(6)Department of Psychiatry, Boston Children's Hospital, Boston, Mass; 
Department of Psychiatry, Harvard Medical School, Boston, Mass.
(7)Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of 
Medicine; Houston, Tex.
(8)John Ochsner Heart and Vascular Institute, Ochsner Clinical School, 
University of Queensland School of Medicine, New Orleans, La.

BACKGROUND: During the 2020-2021 coronavirus disease 2019 (COVID-19) lockdown, 
social activities were limited by the government-recommended social distancing 
guidelines, leading to an abundance of mental health issues.
METHODS: We hypothesized that Twitter sentiment analysis may shed some light 
on Animal Crossing: New Horizons and its impact on mental health during the 
COVID-19 pandemic.
RESULTS: We found that social gaming and social media may be used as tools to 
cope with stress during the COVID-19 pandemic.
CONCLUSIONS: Further research, including randomized study designs and 
prospective measurements of mental health outcomes related to social gaming 
behavior are required.

Copyright © 2021 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.amjmed.2021.10.010
PMCID: PMC8553656
PMID: 34756871 [Indexed for MEDLINE]


2783. Women Birth. 2022 Sep;35(5):511-520. doi: 10.1016/j.wombi.2021.10.002. Epub 2021 
Oct 11.

Postpartum women's experiences of social and healthcare professional support 
during the COVID-19 pandemic: A recurrent cross-sectional thematic analysis.

Jackson L(1), De Pascalis L(2), Harrold JA(3), Fallon V(4), Silverio SA(5).

Author information:
(1)Department of Psychology, Institute of Population Health, University of 
Liverpool, United Kingdom. Electronic address: Leanne.Jackson@liverpool.ac.uk.
(2)Department of Psychology, Institute of Population Health, University of 
Liverpool, United Kingdom. Electronic address: 
https://www.twitter.com/leodepascalis.
(3)Department of Psychology, Institute of Population Health, University of 
Liverpool, United Kingdom. Electronic address: 
https://www.twitter.com/joaharrold.
(4)Department of Psychology, Institute of Population Health, University of 
Liverpool, United Kingdom. Electronic address: 
https://www.twitter.com/drfallonzi.
(5)Department of Women & Children's Health, School of Life Course Sciences, 
King's College London, United Kingdom. Electronic address: 
https://www.twitter.com/Silverio_SA_.

PROBLEM: Disrupted access to social and healthcare professional support during 
the COVID-19 pandemic have had an adverse effect on maternal mental health.
BACKGROUND: Motherhood is a key life transition which increases vulnerability to 
experience negative affect.
AIM: Explore UK women's postnatal experiences of social and healthcare 
professional support during the COVID-19 pandemic.
METHODS: Semi-structured interviews were conducted with 12 women, approximately 
30 days after initial social distancing guidelines were imposed (T1), and a 
separate 12 women were interviewed approximately 30 days after the initial 
easing of social distancing restrictions (T2). Recurrent cross-sectional 
thematic analysis was conducted in NVivo 12.
FINDINGS: T1 themes were, 'Motherhood has been an isolating experience' 
(exacerbated loneliness due to diminished support accessibility) and 'Everything 
is under lock and key' (confusion, alienation, and anxiety regarding disrupted 
face-to-face healthcare checks). T2 themes were, 'Disrupted healthcare 
professional support' (feeling burdensome, abandoned, and frustrated by virtual 
healthcare) and 'Easing restrictions are bittersweet' (conflict between enhanced 
emotional wellbeing, and sadness regarding lost postnatal time).
DISCUSSION: Respondents at both timepoints were adversely affected by restricted 
access to informal (family and friends) and formal (healthcare professional) 
support, which were not sufficiently bridged virtually. Additionally, the 
prospect of attending face-to-face appointments was anxiety-provoking and 
perceived as being contradictory to social distancing guidance. Prohibition of 
family from maternity wards was also salient and distressing for T2, but not T1 
respondents.
CONCLUSION: Healthcare professionals should encourage maternal help-seeking and 
provide timely access to mental health services. Improving access to informal 
and formal face-to-face support are essential in protecting maternal and infant 
wellbeing.

Copyright © 2021 Australian College of Midwives. Published by Elsevier Ltd. All 
rights reserved.

DOI: 10.1016/j.wombi.2021.10.002
PMCID: PMC8553649
PMID: 34756734 [Indexed for MEDLINE]

Conflict of interest statement: Sergio A. Silverio (King’s College London) is 
supported by the National Institute for Health Research Applied Research 
Collaboration South London [NIHR ARC South London] at King’s College Hospital 
NHS Foundation Trust and an NIHR Senior Investigator Award [NIHR200306]. The 
views expressed are those of the authors and not necessarily those of the NIHR 
or the Department of Health and Social Care.


2784. Perspect Psychol Sci. 2022 May;17(3):662-679. doi: 10.1177/17456916211014189. 
Epub 2021 Nov 10.

Reexamining Social Media and Socioemotional Well-Being Among Adolescents Through 
the Lens of the COVID-19 Pandemic: A Theoretical Review and Directions for 
Future Research.

Hamilton JL(1), Nesi J(2)(3), Choukas-Bradley S(4).

Author information:
(1)Department of Psychology, Rutgers University.
(2)Department of Psychiatry and Human Behavior, Brown University.
(3)Bradley Hasbro Research Center, Rhode Island Hospital, Providence, Rhode 
Island.
(4)Department of Psychological and Brain Sciences, University of Delaware.

Social media has rapidly transformed the ways in which adolescents socialize and 
interact with the world, which has contributed to ongoing public debate about 
whether social media is helping or harming adolescents. The COVID-19 pandemic 
has magnified both the challenges and opportunities of adolescents' social-media 
use, which necessitates revisiting the conversation around teens and social 
media. In this article, we discuss key aspects of adolescent social-media use 
and socioemotional well-being and outline how these issues may be amplified in 
the context of the COVID-19 pandemic. We use this as a springboard to outline 
key future research directions for the field, with the goal of moving away from 
reductionist approaches and toward a more nuanced perspective to understand the 
who, what, and when of social-media use and its impact on adolescent well-being. 
We conclude with a commentary on how psychological science can inform the 
translation of research to provide evidence-based recommendations for adolescent 
social-media use.

DOI: 10.1177/17456916211014189
PMCID: PMC9081105
PMID: 34756118 [Indexed for MEDLINE]


2785. Nephrol Nurs J. 2021 Sep-Oct;48(5):447-461.

Mental Health and Health-Related Quality of Life Among Nephrology Nurses: A 
Survey-Based Cross-Sectional Study.

Montoya V(1)(2), Donnini K(3), Gauthier-Loiselle M(4), Sanon M(5), Cloutier 
M(6), Maitland J(7), Guérin A(8), Dutka P(9)(10)(11), Pryor L(12)(13)(14), 
Thomas-Hawkins C(15)(16), Voegel A(7), Hoffmann M(17), Savin S(18), Kurzman 
A(19), Kear T(20)(21)(22)(23).

Author information:
(1)Assistant Professor, Nursing Practice Department, College of Nursing, 
University of Central Florida, Orlando, FL.
(2)Chair of ANNA's Research Committee (2020-2021), and a member of ANNA's 
Sunshine State Chapter.
(3)Director of Patient Advocacy and Stakeholder Management, Otsuka America 
Pharmaceutical Inc., Princeton, NJ.
(4)Manager, Analysis Group, Inc., Montreal, Quebec, Canada.
(5)Was the Director of Health Economics and Outcomes Research, Otsuka 
Pharmaceutical Development and Commercialization, Inc., Princeton, NJ, when this 
study was completed.
(6)Vice President, Analysis Group, Inc., Montreal, Quebec, Canada.
(7)Senior Research Professional, Analysis Group, Inc., Montreal, Quebec, Canada.
(8)Managing Principal, Analysis Group, Inc., Montreal, Quebec, Canada.
(9)Director, Education and Research, Nephrology Network, NYU Langone Hospital - 
Long Island, Long Island, NY.
(10)member of the Nephrology Nursing Journal Editorial Board.
(11)member of ANNA's Long Island Chapter.
(12)Renal Clinic Nurse, Atlanta VAMC, Decatur, GA.
(13)Past President of the American Nephrology Nurses Association.
(14)member of ANNA's Dogwood Chapter.
(15)Associate Dean and Associate Professor, Rutgers University School of 
Nursing, Newark, NJ.
(16)member of ANNA's Garden State Chapter.
(17)Managing Director, High Lantern Group, Philadelphia, PA.
(18)Director, High Lantern Group, Philadelphia, PA.
(19)Associate, High Lantern Group, Philadelphia, PA.
(20)Executive Director, American Nephrology Nurses Association, Pitman, NJ.
(21)Associate Adjunct Professor, M. Louise Fitzpatrick College of Nursing, 
Villanova University, Villanova, PA.
(22)Past President of ANNA.
(23)member of ANNA's Keystone Chapter.

Nephrology nurses face health and wellness challenges due to significant 
work-related stressors. This survey, conducted online between July 24 and August 
17, 2020, assessed the psychological well-being of nephrology nurses in the 
United States during the COVID-19 pandemic (n = 393). Respondents reported 
feeling burned out from work (62%), symptoms of anxiety (47% with Generalized 
Anxiety Disorder-7 [GAD-7] scores ≥ 5), and major depressive episodes (16% with 
Patient Health Questionnaire-2 [PHQ-2] scores ≥ 3). Fifty-six percent (56%) of 
survey respondents reported caring for COVID-19 patients, and 62% were somewhat 
or very worried about COVID-19. Factors, including high workload, age, race, and 
the COVID-19 pandemic, may partially explain the high proportion of nephrology 
nurses who reported symptoms of burnout, anxiety, and depression.

Copyright© by the American Nephrology Nurses Association.

PMID: 34756000 [Indexed for MEDLINE]


2786. Prim Health Care Res Dev. 2021 Nov 10;22:e67. doi: 10.1017/S146342362100013X.

Understanding the impact of COVID-19 pandemic on health-related quality of life 
amongst Iranian patients with beta thalassemia major: a grounded theory.

Arian M(1), Vaismoradi M(2), Badiee Z(3), Soleimani M(4).

Author information:
(1)Student Research Committee, Faculty of Nursing and Midwifery, Semnan 
University of Medical Sciences, Semnan, Iran.
(2)Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.
(3)Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical 
Sciences, Mashhad, Iran.
(4)Nursing Care Research Center, Faculty of Nursing and Midwifery, Semnan 
University of Medical Sciences, Semnan, Iran.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic and the resulting 
measures can impact daily life and healthcare management amongst patients with 
beta thalassemia major.
METHODS: The Corbin and Strauss method of grounded theory was used to explore 
the impact of the COVID-19 pandemic on health-related quality of life (HRQoL) 
amongst Iranian patients with beta thalassemia major. Semi-structured interviews 
with 16 patients with thalassemia major in the eastern of Iran were performed. 
Data collection was conducted from 19 September through 18 November 2020. 
Collected data were recorded, transcribed, and coded to develop themes and 
subthemes. Paradigm components were sought to find out what happened to these 
patients and explore the process and events.
RESULTS: Insights from these interviews led to five major themes: 'changing 
physical health', 'emotional and psychological reactions', 'changing the nature 
of relationships and the scope of social support', 'metamorphosis of ongoing 
healthcare, and 'functionality and adaptation to new realities.' The emerging 
core concept was labelled: 'maintaining well-being balance.' The COVID-19 
pandemic disturbed the balance of life and health of the patients. Multiple 
strategies to maintain balance and reduce the negative effects of the COVID-19 
pandemic on HRQoL were used by the patients, the healthcare team, and support 
systems.
CONCLUSIONS: Due to the fear of COVID-19, the patients with beta thalassemia 
were less likely to contact healthcare professionals. They considered postponing 
blood transfusion and abandoned evaluating disease complications. Reduced access 
to the healthcare system and shifting resources from existing programmes to 
COVID-19 by the healthcare system were incompatible policies. These policies and 
strategies had strong and negative effects on the physical domain of HRQoL. The 
patients experienced a deterioration of emotional functioning. They reported a 
strong reduction in social functioning and felt lonely. Online interventions 
supporting mental health and social interactions and telemedicine can help 
during the times of social distancing and lockdowns.

DOI: 10.1017/S146342362100013X
PMCID: PMC8581459
PMID: 34753533 [Indexed for MEDLINE]


2787. BMC Pregnancy Childbirth. 2021 Nov 8;21(1):755. doi: 10.1186/s12884-021-04234-1.

Exploring factors associated with pregnant women's experiences of material 
hardship during COVID-19: a cross-sectional Qualtrics survey in the United 
States.

Johnson L(1).

Author information:
(1)School of Social Work, Temple University, Ritter Annex Room 543, 1301 Cecil 
B. Moore Avenue, Philadelphia, PA, 19122, USA. l.johnson@temple.edu.

BACKGROUND: The COVID-19 pandemic has exacerbated the financial insecurity of 
women and their families globally. Some studies have explored the impact of 
financial strain among pregnant women, in particular, during the pandemic. 
However, less is known about the factors associated with pregnant women's 
experiences of material hardship.
METHODS: This cross-sectional study used a non-probability sample to examine the 
factors associated with pregnant women's experiences of material hardship during 
the COVID-19 pandemic. In January 2021, 183 pregnant women living in the United 
States participated in an online Qualtrics panel survey. In addition to 
socio-demographic characteristics, individuals were asked about their finances 
and predictors of financial well-being, mental health symptoms, and intimate 
partner violence (IPV) experiences. Chi-square analysis and one-way ANOVA were 
used to examine whether women's experiences with material hardship and 
associated factors differed by income level (i.e., less than $20,000; $20,000 to 
$60,000; more than $60,000). Ordinary least squares regression was used to 
calculate unadjusted and adjusted estimates.
RESULTS: Study findings showed that the majority of women in the sample 
experienced at least one form of material hardship in the past year. Individuals 
with an annual household income less than $20,000 reported the highest average 
number of material hardships experienced (M = 3.7, SD = 2.8). Compared to women 
with household incomes less than $20,000, women with incomes of more than 
$60,000 reported significantly fewer material hardships, less financial strain, 
and higher levels of financial support, economic self-efficacy, and 
economic-self-sufficiency. Women with incomes of $60,000 or more also reported 
significantly lower levels of psychological abuse, and a smaller percentage met 
the cut-off for anxiety. Economic self-sufficiency, financial strain, 
posttraumatic stress disorder, and economic abuse were all significantly 
associated with material hardship.
CONCLUSIONS: A contribution of this study is that it highlights the significant, 
positive association between economic abuse, a unique form of IPV, and material 
hardship among pregnant women during the pandemic. These findings suggest the 
need for policy and practice interventions that help to ameliorate the financial 
insecurity experienced by some pregnant women, as well as respond to associated 
bidirectional vulnerabilities (e.g., mental health symptoms, experiences of 
IPV).

© 2021. The Author(s).

DOI: 10.1186/s12884-021-04234-1
PMCID: PMC8573078
PMID: 34749686 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2788. LGBT Health. 2022 Jan;9(1):34-42. doi: 10.1089/lgbt.2021.0238. Epub 2021 Nov 5.

Impact of the COVID-19 Pandemic on Perceptions of Health and Well-Being Among 
Sexual and Gender Minority Adolescents and Emerging Adults.

Mitchell KJ(1), Ybarra ML(2), Banyard V(3), Goodman KL(4), Jones LM(1).

Author information:
(1)Crimes Against Children Research Center, University of New Hampshire, Durham, 
New Hampshire, USA.
(2)Center for Innovative Public Health Research, San Clemente, California, USA.
(3)School of Social Work, Rutgers University, New Brunswick, New Jersey, USA.
(4)Rape, Abuse & Incest National Network, Washington, District of Columbia, USA.

Purpose: The study purpose was to examine how the COVID-19 pandemic may be 
differentially impacting the well-being of sexual and gender minority (SGM) 
youth compared with their non-SGM counterparts. Specifically, we looked at 
perceptions of mental and physical health impact and relevant aspects of coping 
with the pandemic such as engagement in prosocial activities that might 
ultimately promote resilience. Methods: Survey data were collected between 
November 27, 2020, and December 11, 2020, from 990 adolescents and emerging 
adults aged 13-23 years. Participants were recruited through advertisements on 
Facebook and Instagram with an effort to overrecruit SGM youth. Questions asked 
youth about their perception of the impact of the COVID-19 pandemic on their 
physical and mental health, the types of prosocial activities engaged in during 
the pandemic, and how they felt they were doing now versus before the pandemic. 
Results: SGM youth reported a significantly greater impact from the pandemic 
than non-SGM youth. Both SGM youth and cisgender heterosexual females reported 
greater impact on their mental health compared with cisgender heterosexual 
males, with cisgender sexual minority females and gender minority youth 
reporting the highest mental health impact. Gender minority youth also reported 
feeling less connected to their families and less safe at home as a result of 
the pandemic. Conclusion: Health professionals, educators, and advocates need to 
help assess SGM youth for negative impact from the pandemic and help them 
connect with other youth and support resources online as they move forward. 
Youth may also benefit from programs connecting them to volunteer work and 
neighbors.

DOI: 10.1089/lgbt.2021.0238
PMCID: PMC8783628
PMID: 34747660 [Indexed for MEDLINE]

Conflict of interest statement: No competing financial interests exist.


2789. J Pers Disord. 2022 Jun;36(3):277-295. doi: 10.1521/pedi_2021_35_539. Epub 2021 
Nov 8.

Telehealth Treatment of Patients With Borderline Personality Disorder in a 
Partial Hospital Setting During the COVID-19 Pandemic: Comparative Safety, 
Patient Satisfaction, and Effectiveness of In-Person Treatment.

Zimmerman M(1), Ward M(1), D'Avanzato C(1), Tirpak JW(1).

Author information:
(1)Department of Psychiatry and Human Behavior, Brown Medical School, and the 
Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island.

There are no studies of the safety and effectiveness of telehealth psychiatric 
treatment of partial hospital level of care, in general, and for borderline 
personality disorder (BPD) in particular. In the present report from the Rhode 
Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, 
the authors compared the effectiveness of their partial hospital treatment 
program in treating patients with BPD. For both the in-person and telehealth 
partial hospital level of care, patients with BPD were highly satisfied with 
treatment and reported a significant reduction in symptoms from admission to 
discharge. Both groups reported a significant improvement in functioning, coping 
ability, positive mental health, and general well-being. A large effect size of 
treatment was found in both treatment groups. No patients attempted suicide. 
Telehealth partial hospital treatment was as effective as in-person treatment in 
terms of patient satisfaction, symptom reduction, and improved functioning and 
well-being for patients with BPD.

DOI: 10.1521/pedi_2021_35_539
PMID: 34747648 [Indexed for MEDLINE]


2790. Front Public Health. 2021 Oct 21;9:737223. doi: 10.3389/fpubh.2021.737223. 
eCollection 2021.

Resilience and Higher Education Support as Protective Factors for Student 
Academic Stress and Depression During Covid-19 in the Netherlands.

Versteeg M(1), Kappe R(1).

Author information:
(1)Department of Student Success, InHolland University of Applied Sciences, 
Haarlem, Netherlands.

Background: The corona pandemic has forced higher education (HE) institutes to 
transition to online learning, with subsequent implications for student 
wellbeing. Aims: This study explored influences on student wellbeing throughout 
the first wave of the corona crisis in the Netherlands by testing serial 
mediation models of the relationships between perceived academic stress, 
depression, resilience, and HE support. Methods: The Covid-19 International 
Student Wellbeing Study (C19 ISWS) was used, with a total sample of 2,480 higher 
education students studying at InHolland Universities of Applied Sciences in the 
Netherlands. Student subgroups were created, so that students with low and high 
perceived academic stress could be assessed, in addition to depressed and 
non-depressed students. Predictive model fit was tested using Macro PROCESS. 
Results: A significant serial mediation model for the total student sample was 
revealed, including protective mediating effects of resilience and HE support on 
the positive direct effect of perceived academic stress on depression. At 
subgroup level, significant (partial) predictive effects of resilience on 
depression scores were noted. A partial serial effect between resilience and HE 
support was found for students with low perceived stress levels, whereas a 
parallel partial mediation model was present among highly academically stressed 
students. Regarding non-depressed students, a full parallel mediation model was 
found, whereas the model for depressed students inadequately explained the data. 
Conclusions: Overall, resilience and HE support mediate the predictive effect of 
academic stress on depressive symptoms among students. In addition, substantial 
differences in model fit arise when inspecting the students on a subgroup level. 
These findings contribute to the gap in knowledge regarding student wellbeing 
during the Covid-19 pandemic in the Netherlands, in addition to providing novel 
insights on student subgroup dynamics. While Covid-19 restrictions continue to 
demand online learning, student wellbeing may be enhanced overall by targeting 
resilience and increasing awareness and availability of HE support services. The 
current study also highlights the need for differential approaches when 
examining wellbeing for specific student groups.

Copyright © 2021 Versteeg and Kappe.

DOI: 10.3389/fpubh.2021.737223
PMCID: PMC8566549
PMID: 34746083 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2791. Front Public Health. 2021 Oct 22;9:692884. doi: 10.3389/fpubh.2021.692884. 
eCollection 2021.

Sexual Minority Orientation Is Associated With Greater Psychological Impact Due 
to the COVID-19 Crisis-Evidence From a Longitudinal Cohort Study of Young Swiss 
Men.

Marmet S(1), Wicki M(1), Gmel G(1)(2)(3)(4), Gachoud C(1), Bertholet N(1), 
Studer J(1).

Author information:
(1)Addiction Medicine, Lausanne University Hospital and University of Lausanne, 
Lausanne, Switzerland.
(2)Addiction Switzerland, Lausanne, Switzerland.
(3)Centre for Addiction and Mental Health, Toronto, ON, Canada.
(4)Faculty of Health and Social Sciences, University of the West of England, 
Bristol, United Kingdom.

Background: The COVID-19 pandemic and its countermeasures may have had a 
significant impact on the psychological well-being of specific population 
subgroups. The present study investigated whether sexual minority men (defined 
here as attracted partly or exclusively to men) from an ongoing cohort study of 
young Swiss men experienced different psychological impacts, levels of substance 
use and addictive behaviors, and to which degree pre-existing vulnerabilities 
and participants experiences during the crisis might explain these differences. 
Methods: An ongoing cohort sample based on the general population of young Swiss 
men (mean age = 29.07 years; SD = 1.27) was assessed before and during the 
COVID-19 crisis for depression, stress, sleep quality, substance use and 
addictive behaviors. Additionally, during the crisis, we assessed its impact in 
form of fear, isolation and traumatic experiences. Potential associations 
between these outcomes and sexual orientation (sexual minority vs. heterosexual) 
were tested using linear regression models. It was additionally estimated to 
which degree these associations were attenuated if adjusted for differences in 
mental health, personality and socioeconomic status before the crisis, as well 
as the experience of the COVID-19 crisis (infection with the virus and changes 
to work situation). Results: Compared to heterosexual men, sexual minority men 
showed higher levels of psychological trauma (b = 0.37 [0.25, 0.49]), fear (b = 
0.18 [0.06, 0.30]) and isolation (b = 0.32 [0.20, 0.44]) due to the COVID-19 
pandemic as well as higher levels of depression (b = 0.31 [0.20, 0.41]) and 
lower sleep quality (b = -0.13 [-0.24, -0.02]) during the crisis. These 
differences were to a large degree explained by higher pre-crisis levels of 
mental health problems and the personality dimension of neuroticism-anxiety. 
Sexual minority men showed higher overall levels of substance use and addictive 
behaviors, but these differences were already present before the crisis. 
Conclusion: The COVID-19 crisis may have worsened pre-existing vulnerabilities 
in sexual minority men, leading to its greater psychological impact on them than 
on heterosexual men. Reducing minority stress due to sexual orientation may help 
not only to improve mental health among important proportions of the population 
but also to reduce their vulnerability to crises. Services offering 
psychological support to sexual minorities may need to be reinforced during 
crises.

Copyright © 2021 Marmet, Wicki, Gmel, Gachoud, Bertholet and Studer.

DOI: 10.3389/fpubh.2021.692884
PMCID: PMC8570433
PMID: 34746075 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2792. Psychol Med. 2023 Apr;53(6):2476-2484. doi: 10.1017/S0033291721004372. Epub 2021 
Nov 8.

The effects of the pandemic on mental health in persons with and without a 
psychiatric history.

Murphy E(1), Svob C(1)(2), Van Dijk M(1)(2), Gameroff MJ(1)(2), Skipper J(2), 
Abraham E(1)(2), Yangchen T(1), Posner J(1)(2), Shankman SA(3), Wickramaratne 
PJ(1)(2), Weissman MM(1)(2)(4), Talati A(1)(2).

Author information:
(1)Department of Psychiatry, Vagelos College of Physicians and Surgeons, 
Columbia University, New York, NY, USA.
(2)Division of Translational Epidemiology, New York State Psychiatric Institute, 
New York, NY, USA.
(3)Departments of Psychiatry and Psychology, Northwestern University, Chicago, 
IL, USA.
(4)Department of Epidemiology, Mailman School of Public Health, Columbia 
University, New York, NY, USA.

BACKGROUND: Prospective studies are needed to assess the influence of 
pre-pandemic risk factors on mental health outcomes following the COVID-19 
pandemic. From direct interviews prior to (T1), and then in the same individuals 
after the pandemic onset (T2), we assessed the influence of personal psychiatric 
history on changes in symptoms and wellbeing.
METHODS: Two hundred and four (19-69 years/117 female) individuals from a 
multigenerational family study were followed clinically up to T1. Psychiatric 
symptom changes (T1-to-T2), their association with lifetime psychiatric history 
(no, only-past, and recent psychiatric history), and pandemic-specific worries 
were investigated.
RESULTS: At T2 relative to T1, participants with recent psychopathology (in the 
last 2 years) had significantly fewer depressive (mean, M = 41.7 v. 47.6) and 
traumatic symptoms (M = 6.6 v. 8.1, p < 0.001), while those with no and 
only-past psychiatric history had decreased wellbeing (M = 22.6 v. 25.0, p < 
0.01). Three pandemic-related worry factors were identified: Illness/death, 
Financial, and Social isolation. Individuals with recent psychiatric history had 
greater Illness/death and Financial worries than the no/only-past groups, but 
these worries were unrelated to depression at T2. Among individuals with 
no/only-past history, Illness/death worries predicted increased T2 depression [B 
= 0.6(0.3), p < 0.05].
CONCLUSIONS: As recent psychiatric history was not associated with increased 
depression or anxiety during the pandemic, new groups of previously unaffected 
persons might contribute to the increased pandemic-related depression and 
anxiety rates reported. These individuals likely represent incident cases that 
are first detected in primary care and other non-specialty clinical settings. 
Such settings may be useful for monitoring future illness among newly at-risk 
individuals.

DOI: 10.1017/S0033291721004372
PMCID: PMC8632413
PMID: 34743762 [Indexed for MEDLINE]

Conflict of interest statement: In the last 3 years, Dr Weissman has received 
funding from NIMH, John J Templeton Foundation and Brain and Behavior (NARSAD) 
and has received royalties from Oxford University Press, Perseus Books Group, 
American Psychiatric Association Publishing, and Multi-Health Systems. Dr Posner 
has received funding from Takeda (formerly Shire) and Aevi Genomics. None of 
these present any conflict with the present work, and no other authors report 
any disclosures.


2793. Obes Facts. 2022;15(2):186-196. doi: 10.1159/000520718. Epub 2021 Nov 5.

Impact of the COVID-19 Pandemic and Related Lockdown Measures on Lifestyle 
Behaviors and Well-Being in Children and Adolescents with Severe Obesity.

Welling MS(1)(2), Abawi O(3)(4), van den Eynde E(1)(2), van Rossum EFC(1)(5), 
Halberstadt J(6), Brandsma AE(7), Kleinendorst L(1)(8), van den Akker ELT(1)(2), 
van der Voorn B(1)(2)(5).

Author information:
(1)Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, 
Rotterdam, The Netherlands.
(2)Division of Endocrinology, Department of Pediatrics, Erasmus MC-Sophia 
Children's Hospital, University Medical Center Rotterdam, Rotterdam, The 
Netherlands.
(3)Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, 
Rotterdam, The Netherlands, o.abawi@erasmusmc.nl.
(4)Division of Endocrinology, Department of Pediatrics, Erasmus MC-Sophia 
Children's Hospital, University Medical Center Rotterdam, Rotterdam, The 
Netherlands, o.abawi@erasmusmc.nl.
(5)Division of Endocrinology, Department of Internal Medicine, Erasmus MC, 
University Medical Center Rotterdam, Rotterdam, The Netherlands.
(6)Department of Health Sciences, Amsterdam Public Health Research Institute, 
Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
(7)Division of Endocrinology, Department of Pediatrics, Obesity Center CGG, 
Maasstad Ziekenhuis, Rotterdam, The Netherlands.
(8)Department of Clinical Genetics, Amsterdam UMC location AMC, University of 
Amsterdam, Amsterdam, The Netherlands.

Erratum in
    Obes Facts. 2022;15(2):302.

INTRODUCTION: COVID-19 lockdown measures have large impact on lifestyle 
behaviors and well-being of children. The aim of this mixed-methods study was to 
investigate the impact of COVID-19 lockdown measures on eating styles and 
behaviors, physical activity (PA), screen time, and health-related quality of 
life (HRQoL) in children (0-18 years) with severe obesity.
METHODS: During the first COVID-19 wave (April 2020), validated questionnaires 
were completed and semi-structured telephone interviews were conducted with 
parents of children with severe obesity (adult body mass index [BMI]-equivalent 
≥35 kg/m2) and/or with the children themselves. Changes in pre-pandemic versus 
lockdown scores of the Dutch Eating Behavior Questionnaire Children, Pediatric 
Quality of Life Inventory, and Dutch PA Questionnaire were assessed. Qualitative 
analyses were performed according to the Grounded Theory.
RESULTS: Ninety families were approached of which 83 families were included. 
Characteristics of the included children were: mean age 11.2 ± 4.6 years, 52% 
female, mean BMI SD-score +3.8 ± 1.0. Emotional, restrained, and external eating 
styles, HRQoL, and (noneducational) screen time did not change on group level 
(all p > 0.05). However, weekly PA decreased (mean difference -1.9 h/week, p = 
0.02) mostly in adolescents. In the majority of children, mean weekly PA 
decreased to ≤2 h/week. Children with high emotional or external eating scores 
during lockdown or pre-existent psychosocial problems had the lowest HRQoL (p < 
0.01). Qualitative analyses revealed an increased demand for food in a 
significant proportion of children (n = 21), mostly in children <10 years 
(19/21). This was often attributed to loss of daily structure and perceived 
stress. Families who reported no changes (n = 15) or improved eating behaviors 
(n = 11) attributed this to already existing strict eating schemes that they 
kept adhering to during lockdown.
CONCLUSION: This study shows differing responses to COVID-19 lockdown measures 
in children with severe obesity. On group level, PA significantly decreased and 
in substantial minorities eating styles and HRQoL deteriorated. Children with 
pre-existent psychosocial problems or pre-pandemic high external or emotional 
eating scores were most at risk. These children and their families should be 
targeted by health care professionals to minimize negative physical and mental 
health consequences.

© 2021 The Author(s) Published by S. Karger AG, Basel.

DOI: 10.1159/000520718
PMCID: PMC8805051
PMID: 34743080 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
declare.


2794. BMC Med Educ. 2021 Nov 6;21(1):563. doi: 10.1186/s12909-021-02990-4.

Digital mental health literacy -program for the first-year medical students' 
wellbeing: a one group quasi-experimental study.

Kurki M(1)(2)(3), Gilbert S(4)(5), Mishina K(4)(5)(6), Lempinen L(4)(5), Luntamo 
T(4)(5)(7), Hinkka-Yli-Salomäki S(4)(5), Sinokki A(4)(5), Upadhyaya S(4)(5), Wei 
Y(8), Sourander A(4)(5)(7).

Author information:
(1)Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3, 
FI-20014, Turku, Finland. mhkurk@utu.fi.
(2)Finland INVEST Research Flagship, University of Turku, FI-20014, Turku, 
Finland. mhkurk@utu.fi.
(3)ITLA Children's Foundation, Porkkalankatu 24, 00180, Helsinki, Finland. 
mhkurk@utu.fi.
(4)Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3, 
FI-20014, Turku, Finland.
(5)Finland INVEST Research Flagship, University of Turku, FI-20014, Turku, 
Finland.
(6)Department of Nursing Science, University of Turku, Joukahaisenkatu 3-5, 
FI-20014, Turku, Finland.
(7)Turku University Hospital, PO Box 52, 20521, Turku, Finland.
(8)Department of Psychiatry, Faculty of Medicine and Dentistry, University of 
Alberta, 1E1 Walter Mackenzie Health Sciences Centre (WMC), 8440 112 St NW, 
Edmonton, AB, T6G 2B7, Canada.

Erratum in
    BMC Med Educ. 2021 Dec 6;21(1):602.

BACKGROUND: Medical students are prone to mental disorders, such as depression 
and anxiety, and their psychological burden is mainly related to their highly 
demanding studies. Interventions are needed to improve medical students' mental 
health literacy (MHL) and wellbeing. This study assessed the digital 
Transitions, a MHL program for medical students that covered blended life skills 
and mindfulness activities.
METHODOLOGY: This was a one group, quasi-experimental pretest-posttest study. 
The study population was 374 first-year students who started attending the 
medical faculty at the University of Turku, Finland, in 2018-2019. Transitions 
was provided as an elective course and 220 students chose to attend and 182 
agreed to participate in our research. Transitions included two 60-minute 
lectures, four weeks apart, with online self-learning material in between. The 
content focused on life and academic skills, stress management, positive mental 
health, mental health problems and disorders. It included mindfulness 
audiotapes. Mental health knowledge, stigma and help-seeking questionnaires were 
used to measure MHL. The Perceived Stress Scale and General Health Questionnaire 
measured the students' stress and health, respectively. A single group design, 
with repeated measurements of analysis of variance, was used to analyze the 
differences in the mean outcome scores for the 158 students who completed all 
three stages: the pre-test (before the first lecture), the post-test (after the 
second lecture) and the two-month follow-up evaluation.
RESULTS: The students' mean scores for mental health knowledge improved (-1.6, 
95% Cl -1.9 to -1.3, P<.001) and their emotional symptoms were alleviated 
immediately after the program (0.5, 95% Cl 0.0 to 1.1, P=.040). The changes were 
maintained at the two-month follow up (-1.7, 95% Cl -2.0 to -1.4, P<.001 and 
1.0, 95% Cl 0.2 to 1.8, P=.019, respectively). The students' stress levels 
reduced (P=.022) and their attitudes towards help-seeking improved after the 
program (P<.001), but these changes were not maintained at the two-month follow 
up. The stigma of mental illness did not change during the study (P=.13).
CONCLUSIONS: The digital Transitions program was easily integrated into the 
university curriculum and it improved the students' mental health literacy and 
wellbeing. The program may respond to the increasing global need for universal 
digital services, especially during the lockdowns due to the COVID-19 pandemic.
TRIAL REGISTRATION: The trial was registered at the ISRCTN registry (26 May 
2021), registration number 10.1186/ ISRCTN10565335 ).

© 2021. The Author(s).

DOI: 10.1186/s12909-021-02990-4
PMCID: PMC8571980
PMID: 34742258 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2795. Asian J Psychiatr. 2021 Dec;66:102897. doi: 10.1016/j.ajp.2021.102897. Epub 2021 
Oct 28.

Assessment of mental health issues among geriatric population during COVID19 
pandemic, Indian perspective.

Kumar V(1), Klanidhi KBK(2), Chakrawarty A(3), Singh J(4), Priti(5), Chatterjee 
P(6), Dey AB(7).

Author information:
(1)Department of Geriatric Medicine, All India Institute of Medical Sciences 
(AIIMS), New Delhi, India. Electronic address: vjg737@gmail.com.
(2)Department of Geriatric Medicine, All India Institute of Medical Sciences 
(AIIMS), New Delhi, India. Electronic address: kbandhu1@gmail.com.
(3)Department of Geriatric Medicine, All India Institute of Medical Sciences 
(AIIMS), New Delhi, India. Electronic address: pat_avinash@rediffmail.com.
(4)Department of Psychiatry & NDDTC, AIIMS, New Delhi. Electronic address: 
drjawaharaiims@gmail.com.
(5)Department of Geriatric Medicine, All India Institute of Medical Sciences 
(AIIMS), New Delhi, India. Electronic address: pritir0311@gmail.com.
(6)Department of Geriatric Medicine, All India Institute of Medical Sciences 
(AIIMS), New Delhi, India. Electronic address: drprasun.geriatrics@gmail.com.
(7)Department of Geriatric Medicine, All India Institute of Medical Sciences 
(AIIMS), New Delhi, India. Electronic address: abdey@hotmail.com.

OBJECTIVES: Study was aimed to assess magnitude of mental health problems among 
geriatric population during COVID19 pandemic.
METHODOLOGY: Study was a cross-sectional observational study, total of 106 
participants (Age ≥60 years) of either gender included in study. Mental health 
variables depressive and anxiety were assessed using GDS and HAM-A.
RESULTS: On GDS, 20(18.87%) patients had depressive symptoms and on HAM-A, 
24(22.6%) patients were having anxiety symptoms.
CONCLUSION: Study highlight that Geriatric population have significant mental 
health issues during COVID19 pandemic, it should not be overlooked. It's 
necessary to provide elderly psychological intervention measures to improve 
their wellbeing.

Copyright © 2021 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.ajp.2021.102897
PMCID: PMC8552627
PMID: 34740131 [Indexed for MEDLINE]


2796. Gerontologist. 2022 Sep 7;62(8):1173-1184. doi: 10.1093/geront/gnab162.

Couples' Experiences Managing Young-Onset Dementia Early in the COVID-19 
Pandemic.

Bannon SM(1), Wang KE(1), Grunberg VA(1), Dickerson BC(2), Vranceanu AM(1).

Author information:
(1)Integrated Brain Health Clinical and Research Program, Department of 
Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, 
Massachusetts, USA.
(2)Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General 
Hospital, Harvard Medical School, Boston, Massachusetts, USA.

BACKGROUND AND OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic 
created unexpected stressors for society and could disproportionately affect 
more vulnerable groups. One such group is couples facing young-onset dementias 
(YOD), who experience pandemic-induced stressors alongside ongoing YOD-related 
stressors (e.g., progressive symptoms, increased caregiving needs). Using a 
qualitative design, our objective was to characterize the experiences of couples 
living with YOD early in the COVID-19 pandemic and the impact on couples' 
'relationships' and well-being.
RESEARCH DESIGN AND METHODS: Couples (N = 23) of persons with YOD and their 
spousal caregivers participated in a 1 hour live video, joint interview during 
the early COVID-19 pandemic. We used a hybrid inductive-deductive coding 
approach to thematic analysis to extract findings within 2 a priori domains: (a) 
psychosocial stressors experienced during the early pandemic and (2) the impact 
of early pandemic stressors on couples' relationships and well-being.
RESULTS: Thematic analyses revealed 6 main themes: (a) increased caregiving 
responsibilities, (b) increased uncertainty, (c) increased social isolation and 
disruptions in social support and medical care, (d) loss of meaningful 
activities and routines, (e) changes to the couple's relationship, and (f) 
heightened emotional distress.
DISCUSSION AND IMPLICATIONS: The COVID-19 pandemic exacerbated relationship 
strain and distress among couples managing YOD. This population may face 
negative outcomes due to the dual impact of YOD- and pandemic-related stressors. 
It is imperative to provide timely resources and psychosocial support to couples 
facing YOD to mitigate the negative impact of such stressors on individual 
health and well-being and the couples' relationship together.

Published by Oxford University Press on behalf of The Gerontological Society of 
America 2021.

DOI: 10.1093/geront/gnab162
PMCID: PMC9451019
PMID: 34739072 [Indexed for MEDLINE]


2797. J Fam Psychol. 2022 Apr;36(3):346-357. doi: 10.1037/fam0000928. Epub 2021 Nov 4.

Strengths of the heart: Stressors, gratitude, and mental health in single 
mothers during the COVID-19 pandemic.

Taylor ZE(1), Bailey K(1), Herrera F(1), Nair N(1), Adams A(2).

Author information:
(1)Department of Human Development and Family Studies, Purdue University.
(2)Department of Public Health, Purdue University.

The Coronavirus disease (COVID-19) pandemic has created significant economic, 
social, and mental health challenges for many parents. However, single mothers 
(who are typically both primary caregivers and wage earners for their families) 
may be especially vulnerable to stress and mental health problems during this 
crisis. Gratitude is strongly linked to positive emotions as well as mental 
health and has been shown to be amendable in interventions but has rarely been 
assessed in regard to parent well-being. In the present study, we assessed the 
longitudinal relations between life stressors and gratitude on single mothers' 
mental health (N = 200) prior to, and during, the pandemic using quantitative 
and qualitative data. We found that stressors contributed to poor mental health 
both concurrently and across time. However, T1 gratitude was associated with 
lower internalizing problems at T2 (controlling for prior internalizing 
problems). Qualitative interviews revealed both challenges and strengths of 
single mothers during the COVID-19 pandemic. Our findings suggest that fostering 
gratitude in single mothers could have benefits for their mental health and 
well-being. Future research should test this in an intervention and further 
elucidate strength-based resources that single mothers utilize to assist them 
during challenging times, reduce stressors, and improve their mental health. 
(PsycInfo Database Record (c) 2022 APA, all rights reserved).

DOI: 10.1037/fam0000928
PMID: 34735179 [Indexed for MEDLINE]


2798. BMC Womens Health. 2021 Nov 3;21(1):387. doi: 10.1186/s12905-021-01533-9.

Psychological well-being and death anxiety among breast cancer survivors during 
the Covid-19 pandemic: the mediating role of self-compassion.

Yousefi Afrashteh M(1), Masoumi S(2).

Author information:
(1)Department of Psychology, Faculty of Humanities, University of Zanjan, 
Zanjan, Iran. yousefi@znu.ac.ir.
(2)Department of Psychology, Faculty of Humanities, University of Zanjan, 
Zanjan, Iran.

BACKGROUND: Despite the abundance of clinical data available for Coronavirus 
Disease 2019 (COVID-19), little research on the psychological well-being of 
breast cancer survivors has been published. We investigate the extent to which 
self-compassion accounted for the association between psychological well-being 
(depression, anxiety) and death anxiety in breast cancer survivors.
METHODS: A cross-sectional study design was applied. Participants were recruited 
from three departments of oncology in Zanjan, Iran. Data were collected from 210 
breast cancer patients. Participants completed self-report measures. Pearson 
correlation coefficient was used to assess the relationship among the study 
variables. Bootstrapping analyses were used to test the significance of indirect 
effects.
RESULTS: Correlational analyses revealed that depression and anxiety were 
significantly and positively related to death anxiety (r = 0.77, p < 0.01; 
r = 0.85, p < 0.01, respectively) and negatively to self-compassion (r = - 0.48, 
p < 0.01; r = - 0.53, p < 0.01, respectively). Bootstrapping analyses revealed 
significant indirect effects of depression (β = 0.065, SE = 0.35, p < 0.03, 95% 
CI [LL = - 0.0083, UL: - 0.1654]) and anxiety (β = 0.089, SE = 0.09, p < 0.04, 
95% CI [LL = - 0.0247, UL: - 0.1987]) on death anxiety through self-compassion.
CONCLUSIONS: Findings from this study indicate that self-compassion may be 
considered as one treatment strategy to improve psychological well-being of 
cancer patients in the new context of the COVID-19 pandemic.

© 2021. The Author(s).

DOI: 10.1186/s12905-021-01533-9
PMCID: PMC8564789
PMID: 34732193 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2799. Sleep Med. 2021 Dec;88:46-57. doi: 10.1016/j.sleep.2021.10.006. Epub 2021 Oct 
16.

Pre-sleep arousal and sleep quality during the COVID-19 lockdown in Italy.

Gorgoni M(1), Scarpelli S(1), Mangiaruga A(2), Alfonsi V(3), Bonsignore MR(4), 
Fanfulla F(5), Ferini-Strambi L(6), Nobili L(7), Plazzi G(8), De Gennaro L(9); 
Board of the Italian Association of Sleep Medicine (AIMS).

Collaborators: Arnaldi D, Bonanni E, Bonetti GA, Castronovo C, Maestri M, 
Garbarino S, Guarnieri B, Manni R, Palagini L, Puligheddu M, Ferri R, Silvani A, 
Vicini C.

Author information:
(1)Department of Psychology, Sapienza University of Rome, Rome, Italy.
(2)Department of Medical and Surgical Sciences, University of Bologna, Bologna, 
Italy.
(3)IRCCS Fondazione Santa Lucia, Rome, Italy.
(4)PROMISE Department, University of Palermo, and IRIB-CNR, Palermo, Italy.
(5)Sleep Medicine Unit, Clinical and Scientific Maugeri Institutes, Scientific 
Institute of Pavia IRCCS Pavia, Italy.
(6)Sleep Disorders Center, Vita-Salute San Raffaele University, Milan, Italy.
(7)Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy; 
Department of Medical and Surgical Neuroscience and Rehabilitation (DINOGMI), 
University of Genoa, Genoa, Italy.
(8)Department of Biomedical and Neuromotor Sciences (DIBINEM), University of 
Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, 
Bologna, Italy.
(9)Department of Psychology, Sapienza University of Rome, Rome, Italy; IRCCS 
Fondazione Santa Lucia, Rome, Italy. Electronic address: 
luigi.degennaro@uniroma1.it.

OBJECTIVE: The COVID-19 pandemic has strongly affected daily habits and 
psychological wellbeing, and many studies point to large modifications in 
several sleep and sleep-related domains. Nevertheless, pre-sleep arousal during 
the pandemic has been substantially overlooked. Since hyperarousal represents 
one of the main factors for the development and the perpetuation of chronic 
insomnia disorder, the assessment of variables associated with high levels of 
pre-sleep arousal during the pandemic is clinically relevant. The study aimed to 
assess the prevalence and predictors of perceived sleep quality and pre-sleep 
arousal in an Italian sample during the COVID-19 lockdown.
METHODS: We used an online survey to collect self-reported sociodemographic, 
environmental, clinical, sleep, and sleep-related data. Our final sample 
included 761 participants.
RESULTS: Beyond a high frequency of poor sleep quality, depressive and stress 
symptoms, our results show that almost half of the sample suffered from 
clinically relevant levels of at least one component (ie, cognitive, somatic) of 
pre-sleep arousal. Subjects with greater pre-sleep arousal exhibited poorer 
sleep quality. Also, sleep quality was strongly associated with somatic and 
cognitive pre-sleep arousal. Regarding the predictors of sleep and sleep-related 
measures, depressive and event-related stress symptoms were the main factors 
associated with both poor sleep quality and pre-sleep arousal components. 
Moreover, specific sociodemographic and environmental variables were uniquely 
related to sleep quality, cognitive or somatic pre-sleep arousal.
CONCLUSIONS: These findings suggest that the assessment of specific 
sleep-related factors (ie, pre-sleep arousal), together with more global 
measures of sleep quality, may be crucial to depict the complex impact of the 
pandemic on sleep, and to help prevent and counteract the spread of insomnia 
symptoms.

Copyright © 2021 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.sleep.2021.10.006
PMCID: PMC8577578
PMID: 34731828 [Indexed for MEDLINE]

Conflict of interest statement: None of the authors have potential conflicts of 
interest to be disclosed. The ICMJE Uniform Disclosure Form for Potential 
Conflicts of Interest associated with this article can be viewed by clicking on 
the following link: https://doi.org/10.1016/j.sleep.2021.10.006.


2800. PLoS One. 2021 Nov 3;16(11):e0251683. doi: 10.1371/journal.pone.0251683. 
eCollection 2021.

Psychological distress during the COVID-19 epidemic in Chile: The role of 
economic uncertainty.

Duarte F(1)(2), Jiménez-Molina Á(2)(3)(4)(5).

Author information:
(1)Department of Economics, Facultad de Economía y Negocios, Universidad de 
Chile, Santiago, Chile.
(2)Millennium Nucleus in Social Development (DESOC), Santiago, Chile.
(3)Millennium Nucleus to Improve the Mental Health of Adolescents and Youths 
(Imhay), Santiago, Chile.
(4)Millennium Institute for Research in Depression and Personality (MIDAP), 
Santiago, Chile.
(5)Facultad de Psicología, Universidad Diego Portales, Santiago, Chile.

Previous research has shown that the COVID-19 outbreak, social distancing, and 
lockdown can affect people's psychological well-being. The aims of this study 
were (1) to estimate the extent to which perceptions and expectations regarding 
the social, economic, and domestic effects of the COVID-19 outbreak are 
associated with psychological distress and (2) to identify some demographic, 
psychosocial, and economic factors associated with increased vulnerability to 
psychological distress during the COVID-19 outbreak in Chile. 1078 people 
participated in a telephone survey between May 30 and June 10, 2020. The sample 
is representative of the Chilean adult population. Psychological distress was 
assessed through a questionnaire of anxious and depressive symptoms (Patient 
Health Questionnaire-4). We analyzed the data set using ordinary least-squares 
regression models, first estimating models for the entire sample, and then 
stratifying the sample into different groups to explore differences by gender 
and age. 19.2% of participants displayed significant psychological distress 
(PHQ-4 ≥ 6), with moderate to severe anxiety-depression symptoms being more 
prevalent in women than in men (23.9% vs 14.1%, χ2 16.78, p<0.001). The results 
of this study suggest that being a woman, feeling lonely and isolated, living in 
the areas hit hardest by the pandemic and lockdown, expecting a lack of income 
due to having to stop working as a consequence of the pandemic, and having a 
history of diagnosed mental disorders are significantly associated with 
psychological distress (p<0.05). The results of this study highlight the need to 
implement psychosocial programs to guard people's psychological well-being and 
social policies to address economic uncertainty during the current COVID-19 
outbreak in Chile.

DOI: 10.1371/journal.pone.0251683
PMCID: PMC8565721
PMID: 34731175 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2801. Early Interv Psychiatry. 2022 Sep;16(9):935-957. doi: 10.1111/eip.13230. Epub 
2021 Nov 2.

Supporting family and friends of young people with mental health issues using 
online technology: A rapid scoping literature review.

Migliorini C(1)(2), Lam DS(3), Harvey C(1)(2).

Author information:
(1)Psychosocial Research Centre, NorthWestern Mental Health Service, Coburg, 
Victoria, Australia.
(2)Department of Psychiatry, The University of Melbourne, Parkville, Victoria, 
Australia.
(3)Forensicare: Victorian Institute of Forensic Mental Health, Victoria, 
Australia.

AIM: Family and friends are often the first and/or only support options used by 
young people (12-25 years) struggling with mental health issues. The overarching 
aim of this literature review is to map current practice in online interventions 
specifically targeting family and friends of young people with mental health 
issues, especially relevant in light of the current worldwide COVID-19 pandemic.
METHODS: A rapid scoping literature review was conducted searching health and 
psychology databases for online interventions targeting family and friends 
supporting a young person (12-25 years) struggling with a mental health issue. 
The search strategy was comprehensive and expert librarian endorsed. The final 
synthesis comprised 13 articles.
RESULTS: Identified articles were few, reporting a disparate range of research 
aims, intervention content and delivery modes. Studies addressing caregivers of 
adolescents with a mental health diagnosis were small-scale, although suggested 
virtual modalities are positively received and viable alternatives to other 
delivery methods with potential for equivalent outcomes. Five randomized control 
trials involving caregivers of 'at-risk' adolescents reported improved parental 
knowledge, but mixed effects on family functioning.
CONCLUSIONS: Preliminary evidence suggests flexible online options including 
professional and peer support, to respond to carers' busy lives are needed to 
maximize benefits. Content that is sufficiently individualized and targeted to 
address the diverse needs of parents, as well as other caregivers, is also 
required. Well-being and self-care, in addition to parenting skills should be 
given more consideration in online interventions. Examination of the value of 
support from peers is also warranted.

© 2021 John Wiley & Sons Australia, Ltd.

DOI: 10.1111/eip.13230
PMID: 34729912 [Indexed for MEDLINE]


2802. J Affect Disord. 2022 Feb 1;298(Pt A):209-216. doi: 10.1016/j.jad.2021.10.128. 
Epub 2021 Oct 30.

The interplay between acute post-traumatic stress, depressive and anxiety 
symptoms on healthcare workers functioning during the COVID-19 emergency: A 
multicenter study comparing regions with increasing pandemic incidence.

Carmassi C(1), Dell'Oste V(2), Bui E(3), Foghi C(1), Bertelloni CA(1), Atti 
AR(4), Buselli R(5), Di Paolo M(6), Goracci A(7), Malacarne P(8), Nanni MG(9), 
Gesi C(10), Cerveri G(11), Dell'Osso L(1).

Author information:
(1)Department of Clinical and Experimental Medicine, University of Pisa, Pisa, 
Italy.
(2)Department of Clinical and Experimental Medicine, University of Pisa, Pisa, 
Italy; Department of Biotechnology, Chemistry and Pharmacy, University of Siena, 
Siena, Italy. Electronic address: valerio.delloste@gmail.com.
(3)Department of Psychiatry, Caen University and Caen University Hospital, Caen, 
France.
(4)Department of Biomedical and Neuromotor Sciences, University of Bologna, 
Bologna, Italy.
(5)Occupational Health Department, Azienda Ospedaliero-Universitaria Pisana, 
Pisa, Italy.
(6)Department of Surgical, Medical and Molecular Pathology and Critical Care 
Medicine, University of Pisa, Pisa, Italy.
(7)Department of Molecular and Developmental medicine, University of Siena, 
Siena, Italy.
(8)Anaesthesia and Intensive Care Unit, Azienda Ospedaliero-Universitaria 
Pisana, Pisa, Italy.
(9)Department of Neurosciences and Rehabilitation, University of Ferrara, 
Ferrara, Italy.
(10)Department of Mental Health and Addiction, ASST Fatebenefratelli-Sacco, 
Milan, Italy.
(11)Department of Mental Health and Addiction, ASST Lodi, Lodi, Italy.

BACKGROUND: Healthcare workers (HCWs) deployed to the frontline during the 
COVID-19 pandemic are at risk for developing mental disorders, with a possible 
impact on their wellbeing and functioning. The present study aimed at 
investigating post-traumatic stress symptoms (PTSS), anxiety and depressive 
symptoms and their relationships with impairment in the functioning impairment 
among frontline HCWs from three Italian regions differently exposed to the first 
wave of the COVID-19 emergency: Tuscany (low), Emilia-Romagna (medium) and 
Lombardy (high).
METHODS: 514 frontline HCWs were consecutively enrolled in hospital units 
devoted to the treatment of COVID-19 patients. They completed the IES-R, PHQ-9 
and GAD-7 to assess PTSS, depressive and anxiety symptoms respectively, and the 
WSAS to investigate functioning impairment.
RESULTS: A total of 23.5% of HCWs reported severe PTSS, 22.4% moderate-severe 
anxiety symptoms, 19.3% moderate-severe depressive symptoms and 22.8% impairment 
in global functioning. HCWs from the higher-exposure regions reported 
significantly higher scores in all instruments than those from lower-exposure 
regions. In a multiple linear regression model, PTSS, depressive and anxiety 
symptoms presented a significant positive association with the functioning 
impairment. Both PTSS and depression resulted to be independently related to 
functioning impairment.
LIMITATIONS: The cross-sectional design and the use of self-report instruments.
CONCLUSIONS: Depressive and PTSS appear to be the greatest contributors to 
functioning impairment in HCWs exposed to a massive stressful sanitary event as 
the COVID-19 pandemic. A more accurate assessment of work-related mental health 
outcomes in such population could help planning effective prevention strategies 
and therapeutic interventions.

Copyright © 2021 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2021.10.128
PMCID: PMC8556686
PMID: 34728285 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2803. Encephale. 2022 Oct;48(5):496-503. doi: 10.1016/j.encep.2021.06.016. Epub 2021 
Sep 23.

Anxiety and sleep quality in a sample of Lebanese healthcare workers during the 
COVID-19 outbreak.

Zarzour M(1), Hachem C(2), Kerbage H(2), Richa S(2), Choueifaty DE(3), Saliba 
G(4), Haddad E(4), Melki E(5), Sleilaty G(6), Saliby R(7), Sabbagh C(5), 
Choucair J(4).

Author information:
(1)Department of Psychiatry, Hôtel-Dieu de France Hospital, Alfred Naccache, 
Beirut, 166830, Lebanon; Saint Joseph University, Faculty of Medicine, Damas Rd, 
Beirut, 1104 2020, Lebanon. Electronic address: myzarzour@gmail.com.
(2)Department of Psychiatry, Hôtel-Dieu de France Hospital, Alfred Naccache, 
Beirut, 166830, Lebanon; Saint Joseph University, Faculty of Medicine, Damas Rd, 
Beirut, 1104 2020, Lebanon.
(3)Department of Psychiatry, Hôtel-Dieu de France Hospital, Alfred Naccache, 
Beirut, 166830, Lebanon; Saint Joseph University, Faculty of Nursing, Damas Rd, 
Beirut, 1104 2020, Lebanon.
(4)Department of Infectious Disease, Hôtel-Dieu de France, Alfred Naccache, 
Beirut, 166830, Lebanon; Saint Joseph University, Faculty of Medicine, Damas Rd, 
Beirut, 1104 2020, Lebanon.
(5)Emergency Department, Hôtel-Dieu de France, Alfred Naccache, Beirut, 166830, 
Lebanon; Saint Joseph University, Faculty of Medicine, Damas Rd, Beirut, 1104 
2020, Lebanon.
(6)Clinical Research Centre, Hôtel-Dieu de France, Alfred Naccache, Beirut, 1104 
2020, Lebanon; Saint Joseph University, Faculty of Medicine, Damas Rd, Beirut, 
1104 2020, Lebanon.
(7)Saint Joseph University, Faculty of Medicine, Damas Rd, Beirut, 1104 2020, 
Lebanon.

A cross-sectional, survey based study was conducted in order to assess mental 
health outcomes among healthcare workers in a private university hospital 
involved in the COVID-19 response in Lebanon. The main objective was to quantify 
symptoms of anxiety and sleep quality using self-rating scales (the State-Trait 
Anxiety Inventory (STAI) and Pittsburgh Sleep Quality Index (PSQI) 
respectively), while identifying factors that might affect those symptoms. A 
total of 628 healthcare workers completed the survey; 409 (66.2%) were younger 
than 40 years, and 441 (71.4%) were women. Of all participants, 503 (81.4%) were 
nurses, 52 (8.4%) were physicians and 63 (10.2%) were residents. Registered 
nurses, residents, women, and younger participants presented higher scores on 
both scales than other categories of participants. Among factors related with 
COVID-19, those associated with higher scores were having relatives affected by 
the virus (22.2%), being excessively exposed to media (12.9%), and increasing 
the consumption of substances/alcohol (31.2%) during this period. Factors 
associated with higher risk of anxiety symptoms after multivariable logistic 
regression analysis were: female sex, young age, poor sleep quality, and living 
with elderly. Our findings contribute to the understanding of the psychological 
wellbeing of health care workers involved in the acute COVID-19 outbreak in 
Lebanon.

Une étude transversale, a été menée afin d’évaluer l’impact de la pandémie du 
coronavirus sur le niveau d’anxiété et la qualité du sommeil du personnel 
hospitalier d’un hôpital universitaire privé impliqué dans la réponse contre la 
pandémie au Liban, tout en identifiant les facteurs qui pourraient affecter ces 
symptômes. L’évaluation s’est effectuée à l’aide de questionnaires 
auto-administrés; un auto-questionnaire qui inclut les données 
sociodémographiques, la nature du travail exercé à l’hôpital, des questions sur 
les facteurs affectant le niveau de stress, et des questions sur la consommation 
de substances. Des échelles d’auto-évaluation ont été utilisées ; l’Inventaire 
d’anxiété d’État-Trait (STAI) pour le dépistage des symptômes anxieux, et 
l’indice de qualité du sommeil de Pittsburgh (PSQI) pour mesurer la qualité du 
sommeil. Un total de 628 personnels de santé a répondu au questionnaire. Parmi 
tous les participants, 503 (81,4 %) étaient des infirmiers/infirmières, 52 
(8,4 %) des médecins et 63 (10,2 %) des internes. En ce qui concerne les 
caractéristiques des participants: 409 (66,2 %) avaient moins de 40 ans, 441 
(71,4 %) étaient des femmes, 309 (55 %) étaient mariés, 333 (53,9 %) avaient un 
seul enfant, 428 (69,3 %) avaient un niveau universitaire, et 591 (95,6 %) ne 
présentaient pas une histoire psychiatrique. Les moyennes obtenues aux deux 
échelles étaient de 44,5 au STAI, et de 6,0 au PSQI. Parmi le total des 
participants, 61,5 % auront un score au STAI supérieur à 40, indiquant des 
symptômes anxieux modérés à sévères, et 48,4 % auront un score au PSQI supérieur 
à 5, indiquant une mauvaise qualité de sommeil. Les infirmiers/infirmières 
diplômés, les internes, les femmes et les participants plus jeunes présentent 
des scores significativement plus élevés au niveau des deux échelles que les 
autres catégories de participants. Les participants sans enfants, ceux ayant un 
niveau académique universitaire, et ceux ayant des antécédents psychiatriques 
présentent des scores significativement plus élevés uniquement en ce qui 
concerne la PSQI. Une proportion de 31,2 % de nos participants aura augmenté 
leur consommation d’alcool ou de substances (tabac, caféine, tranquillisants, 
cannabis ou autres). Parmi les facteurs liés à la COVID-19, le fait d’avoir des 
proches touchés par le virus (22,2 %), d’être excessivement exposé aux médias 
(12,9 %) et d’avoir augmenté la consommation de substances/alcool pendant la 
période de la pandémie (31,2 %) a été associé à des scores significativement 
plus élevés au niveau des deux échelles d’évaluation. Parmi les sources de 
stress liées à la pandémie rapportées, nous trouvons la peur d’être infecté ou 
d’infecter les autres dans 61,7 %, la peur que quelqu’un de leurs proches soit 
infecté des 45,6 %, la peur d’avoir un accès limité aux équipements médicaux 
dans 17 %, et la perte financière dans 16,3 %. Une analyse de régression 
logistique multivariée a permis d’identifier les facteurs suivants comme étant 
associés à un risque plus élevé de symptômes anxieux: sexe féminin, jeune âge, 
mauvaise qualité de sommeil et le fait de vivre avec des personnes âgées. La 
prévalence de symptômes anxieux et de troubles du sommeil dans notre étude 
s’avère supérieure à celles retrouvées dans la littérature, d’où la possibilité 
que nos résultats soient influencés de même par d’autres facteurs comme la crise 
socioéconomique que le Liban traverse. Par ailleurs, l’étude actuelle a été 
faite pendant une période où la pandémie était toujours considérée comme 
« contenue », ce qui peut expliquer l’absence de différence entre les soignants 
exposés directement (travaillant avec des personnes atteintes du virus) et ceux 
exposés indirectement. Nos résultats contribuent à la meilleure compréhension de 
l’état psychologique des professionnels de santé impliqués dans la réponse aiguë 
à la pandémie du coronavirus au Liban. Des études prospectives sont nécessaires 
afin d’évaluer le possible impact psychologique à long terme dans cette 
population.

Copyright © 2021 L'Encéphale, Paris. Published by Elsevier Masson SAS. All 
rights reserved.

DOI: 10.1016/j.encep.2021.06.016
PMCID: PMC8457956
PMID: 34728067 [Indexed for MEDLINE]


2804. Prim Health Care Res Dev. 2021 Nov 3;22:e64. doi: 10.1017/S1463423621000207.

Coping with COVID-19 pandemic: reflections of older couples living alone in 
urban Odisha, India.

Mahapatra P(1), Sahoo KC(2), Desaraju S(2), Pati S(2).

Author information:
(1)Department of Psychiatry, Kalinga Institute of Medical Sciences, Bhubaneswar, 
Odisha, India.
(2)Regional Medical Research Centre, Indian Council of Medical Research, 
Bhubaneswar, Odisha, India.

AIM: We explored the 'coping reflections' of elderly couples living alone 
(without any other family members) during the COVID-19 pandemic in urban Odisha, 
India.
BACKGROUND: Evidence worldwide suggests that older people are at increased risk 
from COVID-19 adverse outcomes and experience greater stress. In our previous 
community-based study urban dwelling, particularly elderly participants, and 
living alone reported higher pandemic-associated health care challenges than 
their rural and residing-with-family counterparts. We intended to explore how 
the elderly couples living alone coped through this challenging yet stressful 
situation during the COVID-19 pandemic and what were their key strategies 
adopted toward this.
METHODS: We conducted telephonic in-depth interviews (IDIs) with 11 urban 
elderly couples living alone in Bhubaneswar city of Odisha, India using a 
semi-structured interview guide. All IDIs were digitally recorded, transcribed 
into the original language, and translated to English. We used a thematic 
approach for analysis.
FINDINGS: Four themes emerged: (1) Risk appraisal and feeling vulnerable; (2) 
Safeguarding against COVID-19; (3) Managing routine health care and emergency; 
and (4) Pursuing mental and psychological well-being. Although fear, anxiety, 
and loneliness were continuing stressors, many of them learnt to adapt and 
emerge resilient with the evolving situation. Various elements at the 
individual, family, community, and organizational levels were conducive to 
better coping. The companionship and complementary support of spouse, 
self-health literacy, and digital efficacy, virtual connectedness with family 
and friends, availability of community pharmacy and diagnostic services in the 
vicinity, support of neighbors, reengaging with creative leisure time activity, 
and assurance of a responsive administration at the time of emergency helped 
them to cruise through the pandemic. Furthermore, watching the re-telecast of 
prime time serials made these elderly fondly remember their own youth time 
memories. Self-health monitoring, indoor physical exercise, spiritual practices, 
continuation of previous prescription, telephonic advice of physicians were 
add-on strategies that facilitated their physical and psychological well-being 
during the pandemic.

DOI: 10.1017/S1463423621000207
PMCID: PMC8569829
PMID: 34728006 [Indexed for MEDLINE]


2805. Prim Dent J. 2021 Sep;10(3):63-68. doi: 10.1177/20501684211029425.

Dental Emergencies: Perceived impact of the COVID-19 pandemic on the mental 
health and wellbeing of dental teams in the UK.

Ellwood F(1).

Author information:
(1)Mental Health First Aider, Trustee Dentaid Charity, Southampton, UK.

The burden of the COVID-19 pandemic has and continues to stretch the healthcare 
systems and the workforce alike, both nationally and internationally. This is 
equally true of the dental care systems and the dental workforce which had to 
respond and act promptly.This paper examines the perceived impact of the 
COVID-19 pandemic on the mental health and wellbeing of dental teams in the UK 
and provides insight into not only this impact, but the early signs of mental 
ill health commonly triggered by life events, anxiety and fear, and often 
exacerbated by stresses. A sample of an established body of literature and 
recognised sources are considered. Finally, extracts of common threads from 
meaningful conversations will be alluded to, shining a light on the current 
state of the mental health and wellbeing of many in dentistry and the need for 
intervention and longer-term plans. We are often reminded that this period in 
time is a marathon not a sprint, the same could perhaps be said about a national 
response to mental health and wellbeing, as it will take time, but the time to 
begin is now.

DOI: 10.1177/20501684211029425
PMID: 34727774 [Indexed for MEDLINE]


2806. PLoS One. 2021 Nov 2;16(11):e0259213. doi: 10.1371/journal.pone.0259213. 
eCollection 2021.

Anxiety and depression among medical doctors in Catalonia, Italy, and the UK 
during the COVID-19 pandemic.

Quintana-Domeque C(1)(2)(3)(4), Lee I(5), Zhang A(6), Proto E(4)(6)(7)(8), 
Battisti M(4)(6)(8)(9), Ho A(10).

Author information:
(1)Department of Economics, Business School, University of Exeter, Exeter, 
United Kingdom.
(2)GLO, Essen, Germany.
(3)Department of Economics, HCEO, University of Chicago, Chicago, IL, United 
States of America.
(4)IZA, Bonn, Germany.
(5)Faculty of Economics, University of Cambridge, Cambridge, United Kingdom.
(6)Department of Economics, Adam Smith Business School, University of Glasgow, 
Glasgow, United Kingdom.
(7)CEPR, London, United Kingdom.
(8)CESifo, Munich, Germany.
(9)CReAM, London, United Kingdom.
(10)MRC-University of Glasgow Centre for Virus Research, Glasgow, United 
Kingdom.

Healthcare workers have had the longest and most direct exposure to COVID-19 and 
consequently may suffer from poor mental health. We conducted one of the first 
repeated multi-country analysis of the mental wellbeing of medical doctors (n = 
5,275) at two timepoints during the COVID-19 pandemic (June 2020 and 
November/December 2020) to understand the prevalence of anxiety and depression, 
as well as associated risk factors. Rates of anxiety and depression were highest 
in Italy (24.6% and 20.1%, June 2020), second highest in Catalonia (15.9% and 
17.4%, June 2020), and lowest in the UK (11.7% and 13.7%, June 2020). Across all 
countries, higher risk of anxiety and depression symptoms were found among 
women, individuals below 60 years old, those feeling vulnerable/exposed at work, 
and those reporting normal/below-normal health. We did not find systematic 
differences in mental health measures between the two rounds of data collection, 
hence we cannot discard that the mental health repercussions of the pandemic are 
persistent.

DOI: 10.1371/journal.pone.0259213
PMCID: PMC8562811
PMID: 34727110 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2807. Work. 2021;70(3):687-694. doi: 10.3233/WOR-210450.

The vital role of physiotherapy during COVID-19: A systematic review.

Antony Leo Asser P(1), Soundararajan K(1).

Author information:
(1)Faculty of Physiotherapy, Sri Ramachandra Institute of Higher Education and 
Research (Deemed to be University), Chennai, India.

BACKGROUND: The current COVID-19 pandemic has changed the entire world 
population's physical and mental wellbeing irrespective of the person being 
infected or not. Flourishing numbers of new research recommends physiotherapy 
for the management of COVID-19 patients. However, there are cavities in the 
study in the recommendation of physiotherapy specific to the current pandemic.
OBJECTIVE: This review aimed to synthesize physiotherapy-related articles to 
COVID-19 and summarize their efficacious highlights.
METHODS: For the literature search PubMed, PEDro, DOAJ and The Cochrane Database 
of Systematic Reviews were used. The keywords included "Physiotherapy", 
"COVID-19", and "Coronavirus". The Boolean search was applied as required. 
Selection criteria included studies that included physiotherapy intervention as 
a tool for recovery of COVID-19. Exclusion criteria included animal studies, 
non-COVID-19 studies and physiotherapy as an adjunct treatment. The study 
evaluated evidence of all full-text articles in English from December 2019 to 
August 2020.
RESULTS: Of the retrieved 577 articles, 390 articles were excluded at the title 
and abstract screening. 167 articles underwent full-text screening and further 
narrowed to 11 studies matching the expected criteria. 156 studies were excluded 
for various reasons.
CONCLUSION: The current study findings support that physiotherapy interventions 
facilitate recovery in COVID-19 patients and act as a protective barrier. 
Further results include a reduced length of stay in intensive care and reduced 
treatment cost since this outbreak has brought a significant economic burden to 
many countries.

DOI: 10.3233/WOR-210450
PMID: 34719461 [Indexed for MEDLINE]


2808. Work. 2021;70(3):733-749. doi: 10.3233/WOR-210191.

A comparison of coupled microeconomic and mental health devastating alterations 
between low-income and affluent countries afflicted with COVID-19.

Chu X(1).

Author information:
(1)Department of Economics, The University of Sheffield, Sheffield, UK E-mail: 
achuxinxin@163.com.

BACKGROUND: The exponential increase in the rate of individuals' affliction by 
SARS-CoV-2 (COVID-19) has put extreme strains on health care systems worldwide 
and has sparked fears of an impending economic recession and mental turmoil.
OBJECTIVE: The review discusses the impact of COVID-19 on medical crises in two 
sections, focusing on the evidence presented from both neuropathological and 
epidemiological perspectives. First, this paper outlines how countries have 
implemented containment and appraises its effect on the microeconomy. Second, it 
highlights how government support for the economic crisis caused by COVID-19 
depends on the size of a country's economy. Third, it attempts to explain how 
COVID-19 has affected business by explicitly evaluating each industry divided 
into primary, secondary, and tertiary sectors. Finally, we assert an extended 
discussion on the challenges and post-pandemic outlook.
METHODS: Peer-reviewed studies from inception until 2021 were searched in the 
Google scholar, PubMed, and Scopus databases.
RESULTS: Through the imposition of restrictions and lockdown measures to contain 
the COVID-19 pandemic spread, besides arising a broad array of mental health 
concerns, a drastic drop in liquidity and significant spillover effect across 
almost all the global economic system has ensued.
CONCLUSION: The COVID-19 implication on socioeconomic issues and mental 
wellbeing, as the most devastating sequelae of the current pandemic, is of great 
importance to curb the infection and deprive post-pandemic sequelae, demanding 
prompt actions.

DOI: 10.3233/WOR-210191
PMID: 34719457 [Indexed for MEDLINE]


2809. Work. 2021;70(3):763-775. doi: 10.3233/WOR-205311.

Employee well-being in the COVID-19 pandemic: The moderating role of teleworking 
during the first lockdown in the province of Quebec, Canada.

Parent-Lamarche A(1), Boulet M(2).

Author information:
(1)Department of Human Resources Management, Université du Québec à 
Trois-Rivières, Trois-Rivières, Quebec, Canada.
(2)École Nationale d'Administration Publique, Quebec, Quebec, Canada.

BACKGROUND: The COVID-19 pandemic has had a profound effect on all aspects of 
society, including mental health. Many employees have had to pivot suddenly to 
teleworking to prevent the virus from spreading. While teleworking may have some 
negative consequences, it may also represent a human resources practice that may 
improve employee well-being.
OBJECTIVE: The study main objective was to determine if teleworking played a 
moderating role in the relation between potential stressors and employee 
well-being during the first months of the COVID-19 pandemic when working from 
home. This was based on the theory of conservation of resources.
METHODS: Multivariate regression analyses were conducted with Stata 13 software 
to determine the contribution of potential stressors on employee well-being, as 
well as the moderating role of teleworking on a sample of 480 Canadian 
employees. Data were collected once for white and blue collar from both public 
(67.08%) and private (32.92%) business sectors.
RESULTS: Results indicated that work-life imbalances, workload, and marital 
tension were associated with lower levels of well-being. On the other hand, 
teleworking and household income were associated with higher levels of 
well-being. Teleworking also moderated the differences in well-being between the 
public and private sectors. Teleworking in the public sector seems to increase 
employee well-being. Conversely, working on-site in the public sector seems to 
decrease well-being.
CONCLUSIONS: Employers need to proactively address work-life imbalances, 
workloads, and teleworking to maintain employee well-being. Specific 
recommendations are offered to ensure that teleworking remains positive for 
employee well-being both during a pandemic and afterward.

DOI: 10.3233/WOR-205311
PMID: 34719454 [Indexed for MEDLINE]


2810. BMC Med Educ. 2021 Oct 30;21(1):554. doi: 10.1186/s12909-021-02962-8.

Challenges of students and residents of human medicine in the first four months 
of the fight against the Covid-19 pandemic - Implications for future waves and 
scenarios.

Wohlfarth B(1), Gloor B(2), Hautz WE(3).

Author information:
(1)Department of Visceral Surgery and Medicine, lnselspital, Bern University 
Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland. 
benny.wohlfarth@insel.ch.
(2)Department of Visceral Surgery and Medicine, lnselspital, Bern University 
Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland.
(3)Department of Emergency Medicine, lnselspital, Bern University Hospital, 
University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland.

INTRODUCTION: In the fight against the Covid-19 pandemic, medical students and 
residents are expected to adapt and contribute in a healthcare environment 
characterized by ever-changing measures and policies. The aim of this narrative 
review is to provide a summary of the literature that addresses the challenges 
of students and residents of human medicine in the first 4 months of the fight 
against the Covid-19 pandemic in order to identify gaps and find implications 
for improvement within the current situation and for potential future scenarios.
METHODS: We performed a systematic literature search and content analysis (CA) 
of articles available in English language that address the challenges of 
students and residents of human medicine in the first 4 months of the fight 
against the Covid-19 pandemic.
RESULTS: We retrieved 82 articles from a wide range of journals, professional 
backgrounds and countries. CA identified five recurring subgroup topics: 
"faculty preparation", «uncertainties and mental health», «clinical knowledge», 
«rights and obligations» and «(self-) support and supply». Within these 
subgroups the main concerns of (re-)deployment, interruption of training and 
career, safety issues, transmission of disease, and restricted social 
interaction were identified as potential stressors that hold a risk for fatigue, 
loss of morale and burnout.
DISCUSSION: Students and residents are willing and able to participate in the 
fight against Covid-19 when provided with appropriate deployment, legal 
guidance, safety measures, clinical knowledge, thorough supervision, social 
integration and mental health support. Preceding interviews to decide on 
reasonable voluntary deployment, the use of new technology and frequent feedback 
communication with faculties, educators and policymakers can further help with a 
successful and sustainable integration of students and residents in the fight 
against the pandemic.
CONCLUSION: It is critical that faculties, educators and policymakers have a 
thorough understanding of the needs and concerns of medical trainees during 
pandemic times. Leaders should facilitate close communication with students and 
residents, value their intrinsic creativeness and regularly evaluate their needs 
in regards to deployment, knowledge aspects, safety measures, legal concerns and 
overall well-being.

© 2021. The Author(s).

DOI: 10.1186/s12909-021-02962-8
PMCID: PMC8556795
PMID: 34717600 [Indexed for MEDLINE]

Conflict of interest statement: None


2811. J Affect Disord. 2022 Jan 15;297:486-494. doi: 10.1016/j.jad.2021.10.091. Epub 
2021 Oct 29.

The association between insecurity and subjective well-being among youth during 
the COVID-19 outbreak: A moderated mediation model.

Wen F(1), Ye H(1), Zuo B(2), Han S(1), Zhu J(1), Ke W(1), He Y(1).

Author information:
(1)Psychology Department, Central China Normal University, Wuhan, China.
(2)Psychology Department, Central China Normal University, Wuhan, China. 
Electronic address: zuobin@ccnu.edu.cn.

BACKGROUND: Sudden and unpredictable changes caused by the COVID-19 pandemic 
have profoundly threatened the psychological well-being and increased insecurity 
among adolescents worldwide. At a critical developmental stage, the well-being 
of the youth is more vulnerable to adverse environments. This study constructed 
a moderated mediation model to explore the buffering factors between insecurity 
and subjective well-being of the youth during the pandemic.
METHODS: During the COVID-19 outbreak in June 2020, data of 5,503 Chinese youth 
(15-29 years old) were collected via an online questionnaire. Subjective 
well-being, insecurity, self-control, and hope were measured, and the moderated 
mediation model was analyzed.
RESULTS: Findings from this study showed that with the mediating effect of 
self-control, insecurity negatively predicted subjective well-being, and hope 
moderated the association between insecurity and self-control. Specifically, the 
link between insecurity and self-control was stronger when hope was low but 
weaker when hope was high.
LIMITATIONS: Since this study was mainly conducted in China, and considering the 
continuous change of the pandemic on a global scale, it is of great significance 
to conduct cross-cultural and cross-time studies in the future.
CONCLUSIONS: The results demonstrate that self-control and hope play important 
roles in buffering the negative effects of insecurity on the subjective 
well-being of adolescents and young adults. The findings provide implications 
for reducing the negative impact of insecurity from a positive psychology 
perspective and for youth mental health interventions during public health 
crises.

Copyright © 2021 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2021.10.091
PMCID: PMC8612099
PMID: 34715194 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2812. J Affect Disord. 2022 Feb 1;298(Pt A):329-336. doi: 10.1016/j.jad.2021.10.116. 
Epub 2021 Oct 27.

Stress, coping and silver linings: How depressed perinatal women experienced the 
COVID-19 pandemic.

Anderson MR(1), Salisbury AL(2), Uebelacker LA(3), Abrantes AM(3), Battle CL(4).

Author information:
(1)Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine 
of Brown University, Providence, RI, USA; Women and Infants' Hospital of Rhode 
Island, Providence, RI, USA. Electronic address: micheline_anderson@brown.edu.
(2)Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine 
of Brown University, Providence, RI, USA; Women and Infants' Hospital of Rhode 
Island, Providence, RI, USA; School of Nursing, Virginia Commonwealth 
University, Richmond, VA, USA.
(3)Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine 
of Brown University, Providence, RI, USA; Butler Hospital, Providence, RI, USA.
(4)Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine 
of Brown University, Providence, RI, USA; Women and Infants' Hospital of Rhode 
Island, Providence, RI, USA; Butler Hospital, Providence, RI, USA.

BACKGROUND: Research on perinatal mental health during the COVID-19 pandemic has 
largely focused on data from community samples. This study sought to understand 
the experiences of pregnant and postpartum women with histories of clinically 
elevated symptoms of depression.
METHODS: Participants included 60 perinatal women who participated in wellness 
intervention trials for women with antenatal depression. We used a mixed methods 
approach, assessing depression, anxiety, stressors and coping behaviors, along 
with narrative responses to questions regarding COVID-specific effects on mental 
health.
RESULTS: Over three-fourths of the sample indicated a worsening of mental health 
during the pandemic, with 31.7% of women endorsing clinically elevated 
depression symptoms and 36.7% screening positive for anxiety. Women reported 
negative impacts on their emotional wellbeing, especially a resurgence of mental 
health symptoms. Participants also articulated positive experiences during the 
pandemic, including an appreciation for increased time with family, especially 
infants. Women detailed numerous, mostly adaptive, coping strategies they had 
used to mitigate stress; self-isolation and spending time outdoors were 
associated with having depression above or below the clinical cut off, 
respectively.
LIMITATIONS: The study had a small sample, and the generalizability of findings 
may be limited, given that participants were clinical trial completers.
CONCLUSIONS: Although the pandemic upended many aspects of life for perinatal 
women and raised mental health concerns, many also reported adaptive means of 
coping and positive experiences or 'silver linings' related to pandemic 
restrictions. Some coping strategies that were utilized, including 
wellness-based behaviors, may have helped to mitigate the impact of COVID-19 
related stress.

Copyright © 2021 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2021.10.116
PMCID: PMC8548890
PMID: 34715180 [Indexed for MEDLINE]

Conflict of interest statement: Dr. Uebelacker's spouse is employed by Abbvie 
Pharmaceuticals. Other authors have no potential conflicts of interest 
associated with this publication. There has been no significant financial 
support for this work that could have influenced its outcome.


2813. J Affect Disord. 2022 Feb 1;298(Pt A):119-125. doi: 10.1016/j.jad.2021.10.102. 
Epub 2021 Oct 29.

COVID-19 and delayed antenatal care impaired pregnant women's quality of life 
and psychological well-being: What supports should be provided? Evidence from 
Vietnam.

Nguyen LH(1), Nguyen LD(2), Ninh LT(3), Nguyen HTT(4), Nguyen AD(4), Dam VAT(5), 
Nguyen TT(6), Do HP(7), Vu TMT(8), Tran BX(9), Latkin CA(10), Ho CSH(11), Ho 
RCM(12).

Author information:
(1)VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, 
Vietnam. Electronic address: longnh.ump@vnu.edu.vn.
(2)Department of Anaesthesiology, Hanoi Medical University, Hanoi, Vietnam.
(3)Social Affair Department, Ca Mau Obstetrics & Pediatrics Hospital, Ca Mau, 
Vietnam.
(4)Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam.
(5)Institute for Global Health Innovations, Duy Tan University, Da Nang, 
Vietnam; Faculty of Medicine, Duy Tan University, Da Nang, Vietnam. Electronic 
address: damtanhvu@duytan.edu.vn.
(6)Institute for Global Health Innovations, Duy Tan University, Da Nang, 
Vietnam; Faculty of Medicine, Duy Tan University, Da Nang, Vietnam. Electronic 
address: nguyenthitham11@duytan.edu.vn.
(7)Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, 
Ho Chi Minh City, Vietnam.
(8)Institute of Health Economics and Technology, Hanoi, Vietnam.
(9)Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 
United States; Institute for Preventive Medicine and Public Health, Hanoi 
Medical University, Hanoi, Vietnam.
(10)Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 
United States. Electronic address: carl.latkin@jhu.edu.
(11)Department of Psychological Medicine, Yong Loo Lin School of Medicine, 
National University of Singapore, Singapore, Singapore; Department of 
Psychological Medicine, National University Health System, Singapore, Singapore.
(12)Department of Psychological Medicine, Yong Loo Lin School of Medicine, 
National University of Singapore, Singapore, Singapore; Institute for Health 
Innovation and Technology (iHealthtech), National University of Singapore, 
Singapore, Singapore. Electronic address: pcmrhcm@nus.edu.sg.

BACKGROUND: This study explored the associations between different structural 
and functional supports with the quality of life (QOL) and mental well-being of 
pregnant women whose antenatal care was delayed due to the COVID-19 pandemic in 
Vietnam.
METHODS: A multi-center cross-sectional study was performed on 868 pregnant 
women. The pregnant women's quality of life questionnaire (QOL-GRAV), the 
Edinburgh Postnatal Depression Scale (EPDS), and the Perinatal Infant Care 
Social Support (PICSS) instruments were employed. The satisfaction with care 
from different sources was measured. Multivariate Tobit Regression models were 
used.
RESULTS: Seventy pregnant women (8.1%) reported that their antenatal care was 
influenced by the COVID-19. In this group, a higher level of satisfaction with 
the care of parents-in-law and a higher score of emotional support were 
associated with a better "Physical and Emotional changes" domain, while a higher 
level of appraisal support was related to poorer "Physical and Emotional 
changes" domain. A higher level of satisfaction with relatives' care and a 
higher score of emotional support were correlated with a better "Life 
Satisfaction" domain. EPDS score was negatively correlated with satisfaction 
with parents-in-law care and appraisal support.
CONCLUSIONS: Our study highlighted that intervention programs to improve the QOL 
and psychological well-being of pregnant women in epidemics such as COVID-19 or 
other diseases in the future should involve other family members such as 
parents-in-law and relatives as sources of support.
LIMITATIONS: The cross-sectional design was unable to draw causal relationships. 
Recall bias might occur. The convenient sampling method might limit the 
generalizability of findings.

Copyright © 2021. Published by Elsevier B.V.

DOI: 10.1016/j.jad.2021.10.102
PMCID: PMC8573380
PMID: 34715160 [Indexed for MEDLINE]


2814. West J Nurs Res. 2022 Mar;44(3):269-278. doi: 10.1177/01939459211055773. Epub 
2021 Oct 29.

Experiences of Family Caregivers of People with Dementia during the COVID-19 
Pandemic.

Harris ML(1), Titler MG(2).

Author information:
(1)Duke University, Durham, NC, USA.
(2)University of Michigan, Ann Arbor, MI, USA.

Although behavioral and psychological symptoms are burdensome for people with 
dementia and their caregivers, perceptions of family caregivers regarding 
management of these symptoms are unclear. This study explored the experiences of 
family caregivers regarding behavioral and psychological symptoms experienced by 
relatives with dementia, management of these symptoms, and changes in their 
experiences during the COVID-19 pandemic. A qualitative, exploratory approach 
using constant comparative methods was used; 21 family caregivers were 
interviewed virtually. The following 10 major themes emerged: (1) Emotional and 
psychological experiences of caregiver, (2) emotional, psychological, and 
behavioral responses of person with dementia, (3) cognition of person with 
dementia, (4) loss, (5) concerns for the future, (6) reliance, (7) learning to 
caregive, (8) rewarding aspects of caregiving, (9) caregiver perspectives, and 
(10) care strategies. Caregivers described many challenges to care before and 
during the pandemic. Acceptable and effective care strategies are needed to 
promote the well-being of families living with dementia.

DOI: 10.1177/01939459211055773
PMCID: PMC9362861
PMID: 34713757 [Indexed for MEDLINE]


2815. J Int AIDS Soc. 2021 Oct;24 Suppl 6(Suppl 6):e25800. doi: 10.1002/jia2.25800.

HIV service delivery in the time of COVID-19: focus group discussions with key 
populations in India.

Pollard R(1), Gopinath U(2), Reddy YA(1), Kumar BR(2), Mugundu P(1), Vasudevan 
CK(2), Srikrishnan AK(2), Singh A(1), McFall AM(3), Mayer KH(4)(5), Mehta SH(3), 
Solomon SS(1).

Author information:
(1)Division of Infectious Diseases, The Johns Hopkins University School of 
Medicine, Baltimore, Maryland, USA.
(2)YR Gaitonde Center for AIDS Research and Education, Chennai, India.
(3)Department of Epidemiology, The Johns Hopkins Bloomberg School of Public 
Health, Baltimore, Maryland, USA.
(4)Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical 
School, Boston, Massachusetts, USA.
(5)Fenway Health, The Fenway Institute, Boston, Massachusetts, USA.

INTRODUCTION: There are limited data on the impact of COVID-19-associated 
disruptions and novel HIV service delivery strategies among key populations 
(KPs) in low- and middle-income countries. In March 2020, in response to 
COVID-19, the Government of India revised HIV service delivery policies to 
include community antiretroviral therapy (ART) distribution and multi-month 
dispensing (MMD) of ART for all people living with HIV (PLHIV).
METHODS: To assess the acceptability of these adaptations and impact of the 
pandemic among KPs, we conducted focus groups in November-December 2020 with 
purposively sampled men who have sex with men (MSM), female sex workers (FSWs) 
and transgender women (TGW) in Telangana and Maharashtra. Seven discussions were 
conducted. Topics included HIV service access, risk behaviours, economic 
security and feedback to ensure service continuity. Inductive coding identified 
themes across topics.
RESULTS: Forty-four individuals aged 20-49 years participated in discussions (13 
MSM; 16 FSW; and 15 TGW). Twenty-four participants self-identified as living 
with HIV. People not living with HIV reported challenges in accessing HIV 
antibody testing at hospitals due to travel restrictions and fear of contracting 
COVID-19. Participants accessed HIV antibody testing using transportation 
arranged by community-based organizations after lockdowns eased. PLHIV reported 
uninterrupted ART refills and generally consistent adherence; however, there 
were experiences of delayed CD4 and HIV RNA testing. Participants shared 
appreciation for MMD as it saved time, money, and reduced exposure to COVID-19. 
Participants expressed gratitude for home deliveries which enabled ART access, 
yet shared concerns about home-based services causing confidentiality breaches 
with family/neighbours. Participants voiced preferences for community-based 
service provision due to proximity, convenient hours, and welcoming environments 
compared to public hospitals. Other requests included support for income, 
employment, nutrient-rich food and more accessible mental health, HIV, and other 
health services.
CONCLUSIONS: COVID-19 restrictions had a greater impact on access to HIV 
antibody, CD4, and RNA testing services compared to ART access. High acceptance 
of MMD and community-based services support the continued role of differentiated 
service delivery models to improve KP access to HIV antibody, CD4, RNA testing 
services, convenient ART retrieval, and integrated services beyond HIV, which 
may be critical for survival and wellbeing.

© 2021 The Authors. Journal of the International AIDS Society published by John 
Wiley & Sons Ltd on behalf of the International AIDS Society.

DOI: 10.1002/jia2.25800
PMCID: PMC8554214
PMID: 34713583 [Indexed for MEDLINE]

Conflict of interest statement: SSS received consulting fees and research grants 
and products for his institution from Gilead Sciences and research grant and 
product from Abbott Laboratories outside of the submitted work. SSS and SHM 
received consulting fees from Gilead Sciences outside of the submitted work. KHM 
has received research grants outside of the submitted work for his institution 
from Gilead, Merck and Janssen, and has served on scientific advisory boards for 
Gilead, Merck and ViiV focused on HIV prevention. AUTHORS' CONTRIBUTIONS: AMM, 
SHM, SSS and RP designed the study, developed the data collection tools, and 
trained field teams. YAR, BRK, PM, CKV, AKS and AS led and supervised data 
collection. UG and RP conducted data analysis, and RP drafted the manuscript 
with key inputs from KHM and SSS. All authors read and approved the final 
manuscript.


2816. Epidemiol Prev. 2021;45(6):552-558. doi: 10.19191/EP21.6.094.

Prevalence of post-traumatic stress disorder (PTSD) symptoms in a sample of 
Italian citizens during the first COVID-19 pandemic wave: a cross-sectional 
survey.

[Article in English]

Rousset S(1), Favaro E(2), Giordano L(3), Piccinelli C(3), Senore C(3), Ferrante 
G(3).

Author information:
(1)SSD epidemiologia e screening, CPO-AOU Città della salute e della scienza di 
Torino (Italy); stefano.rousset@unito.it.
(2)Servizio sovrazonale di epidemiologia, ASL TO3, Regione Piemonte, Grugliasco 
(Italy).
(3)SSD epidemiologia e screening, CPO-AOU Città della salute e della scienza di 
Torino (Italy).

OBJECTIVES: to assess the prevalence of post-traumatic stress disorder (PTSD) 
symptoms in a sample of Italian citizens during the first COVID-19 pandemic wave 
and its association with sociodemographic characteristics, housing conditions, 
and lifestyles modifications.
DESIGN: cross-sectional survey.
SETTING AND PARTICIPANTS: between 21st April and 7th June 2020, a 
self-administered online questionnaire aiming at investigating mental well-being 
and lifestyle habits during the lockdown period was disseminated online. 
Respondents were recruited through a snowball sampling.
MAIN OUTCOME MEASURES: PTSD symptoms were assessed using a validated screening 
tool, the SPAN (Startle, Physiological arousal, Anger, Numbness) questionnaire.
RESULTS: the study population is composed of 6,687 participants, of whom 71.5% 
were females. The mean age of the sample was 48.7 years. Globally, 43.8% of the 
participants reported symptoms of PTSD, especially females. PTSD prevalence 
showed a decreasing trend across age groups. The likelihood of PTSD symptoms was 
higher among those who increased alcohol consumption, decreased physical 
activity, and experienced restless sleep.
CONCLUSIONS: a high prevalence of PTSD symptoms emerged from this survey, 
especially among women and younger subjects. Preventive strategies should be 
implemented to protect the mental health of the most vulnerable citizens in a 
period of emergency.

DOI: 10.19191/EP21.6.094
PMID: 34711043 [Indexed for MEDLINE]


2817. BMC Psychiatry. 2021 Oct 27;21(1):530. doi: 10.1186/s12888-021-03546-y.

The impacts of coping style and perceived social support on the mental health of 
undergraduate students during the early phases of the COVID-19 pandemic in 
China: a multicenter survey.

Huang Y(1), Su X(2), Si M(1), Xiao W(1), Wang H(1), Wang W(3), Gu X(4), Ma L(5), 
Li J(6), Zhang S(7), Ren Z(8), Qiao Y(9).

Author information:
(1)School of Population Medicine and Public Health, Chinese Academy of Medical 
Sciences and Peking Union Medical College, Beijing, China.
(2)School of Population Medicine and Public Health, Chinese Academy of Medical 
Sciences and Peking Union Medical College, Beijing, China. 
suxiaoyou@hotmail.com.
(3)School of Nursing, Jining Medical University, Jining, Shandong, China.
(4)Affiliated Tumor Hospital, Xinjiang Medical University, Urumqi, China.
(5)Public Health School, Dalian Medical University, Dalian, China.
(6)West China School of Public Health, Sichuan University/West China Forth 
Hospital, Sichuan University, Chengdu, China.
(7)Henan Cancer Hospital, Affiliate Cancer Hospital of Zhengzhou University, 
Zhengzhou, China.
(8)School of Public Health, Sun Yat-sen University, Guangzhou, China.
(9)Department of Cancer Epidemiology, National Cancer Center/National Clinical 
Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences 
and Peking Union Medical College, 17 South Panjiayuan, Chaoyang District, 
Beijing, China.

BACKGROUND: An increasing number of undergraduate students in China have been 
reported to have psychological problems. In response to the COVID-19 pandemic, a 
series of preventive and control measures were implemented, which undoubtedly 
worsened their psychological health. Coping style and social support were 
probably important factors that affected the psychological well-being of 
undergraduate students during the pandemic. This study aimed to explore the 
effects of coping style and perceived social support on the psychological 
well-being of college students and relevant risk factors.
METHODS: This cross-sectional study was performed in February and March of 2020 
by distributing an online questionnaire among undergraduate students from seven 
geographical regions across China. The questionnaire included sociodemographic 
information; the 21-item Depression, Anxiety and Stress Scale (DASS-21); the 
Perceived Social Support Scale (PSSS); and the Simplified Coping Style 
Questionnaire (SCSQ). For the analyses, t-tests, one-way analysis of variance 
(ANOVA), the Kruskal-Wallis test and multiple linear regression were utilized. 
The level of significance was set at P < 0.05.
RESULTS: Among 3113 college students, the rates of anxiety, depression and 
stress symptoms were 13.3, 15.4 and 6.8%, respectively. Increased rates of 
current smoking and drinking (5.5 and 25.2%, respectively) among undergraduates 
were identified. The results indicated that the PSSS subscales and SCSQ 
subscales were significantly associated with DASS-21 scores (P < 0.001). 
Multiple linear regression analysis showed that active coping style and family 
support were protective factors while passive coping style could aggravate 
psychological problems among participants (P < 0.001).
CONCLUSIONS: A remarkable number of college students adopted passive coping 
strategies to cope with negative feelings, such as smoking and drinking, which 
were detrimental to their mental health. In contrast, active coping strategies 
helped improve their psychological well-being. Moreover, family support was 
particularly important for maintaining their mental health and ameliorating 
mental health challenges in this major health crisis. Consequently, suitable 
psychointervention, routine screening for risk behaviors, and provision of 
further social support are needed for undergraduate students in the COVID-19 
pandemic or other emergency public health events.

© 2021. The Author(s).

DOI: 10.1186/s12888-021-03546-y
PMCID: PMC8549419
PMID: 34706690 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2818. J Affect Disord. 2021 Dec 1;295:1012-1023. doi: 10.1016/j.jad.2021.08.031. Epub 
2021 Sep 1.

Feelings of fear, sadness, and loneliness during the COVID-19 pandemic: Findings 
from two studies in the UK.

Ypsilanti A(1), Mullings E(2), Hawkins O(2), Lazuras L(2).

Author information:
(1)Centre for Behavioural Science and Applied Psychology, Department of 
Psychology, Sociology & Politics, Sheffield Hallam University, UK. Electronic 
address: A.Ypsilanti@shu.ac.uk.
(2)Centre for Behavioural Science and Applied Psychology, Department of 
Psychology, Sociology & Politics, Sheffield Hallam University, UK.

During the COVID-19 pandemic, exposure to COVID-related stimuli, has been 
enormous. Exposure to threat-related stimuli, can have a significant impact on 
people's wellbeing particularly in relation to COVID-related anxiety. The 
present research comprises two empirical studies. In Study 1, a newly developed 
Emotional Stroop Task (EST) and an Image Rating Task (IRT) were used to assess, 
automatic and non-automatic affective responses to COVID-related words and 
images during the first wave of the pandemic in the UK general population. In 
Study 2, the same tasks were used to evaluate the affective responses of 
University students during the second wave of the pandemic. Additionally, 
loneliness and pro-social behaviours were explored in relation COVID-related 
anxiety in the same population. Overall, the results showed that automatic 
affective responses as measured by interference effects on the EST, remained 
unaffected during the pandemic. However, non-automatic affective responses to 
COVID-related images measured by the IRT, indicated that participants rated 
these images as more fearful sadder and higher in anger, compared to non-COVID 
negative images matched for arousal and negativity and this was more evident in 
people with high COVID-anxiety. Trait anxiety was related to higher levels of 
loneliness, more prosocial behaviour and higher intentions to help others, while 
COVID-related anxiety mediated these effects, suggesting that for high levels of 
trait anxiety, participants were more likely to have helped someone in need 
during the pandemic when their COVID-anxiety levels were low.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.jad.2021.08.031
PMCID: PMC8407941
PMID: 34706409 [Indexed for MEDLINE]

Conflict of interest statement: The authors do not have any conflict of interest 
to declare.


2819. J Gerontol Nurs. 2021 Nov;47(11):11-14. doi: 10.3928/00989134-20211012-02. Epub 
2021 Nov 1.

"A World Upside Down": Experiences of Informal Caregivers During the COVID-19 
Pandemic.

McLennon SM, Lekhak N.

The caregiving process may result in negative outcomes for caregivers. The 
coronavirus disease 2019 pandemic has contributed additional challenges for 
family caregivers of older adults with chronic illnesses. Little is known about 
the additional impact of the pandemic on caregivers. The purpose of the current 
study was to understand the effects of the pandemic on the caregiving 
experience. A qualitative descriptive content analysis was conducted on nine 
blogs of caregivers of older adults. Blogs were identified using purposive 
sampling. Bloggers were American, middle-aged, and caring for an older adult 
with dementia. Caregivers reported "a world upside down" and change that 
contributed to uncertainty; the need for support; and how isolation, depressive 
symptoms, and threat contributed to negative psychological well-being. Managing 
and struggling in response to caregiving challenges and wishing for resolution 
were also reported. Blogs of caregivers of older adults with chronic illness 
yielded important information that may be useful to clinicians. [Journal of 
Gerontological Nursing, 47(11), 11-14.].

DOI: 10.3928/00989134-20211012-02
PMID: 34704870 [Indexed for MEDLINE]


2820. Policy Polit Nurs Pract. 2022 Feb;23(1):48-55. doi: 10.1177/15271544211054435. 
Epub 2021 Oct 27.

I Am a Nurse, Not a Martyr: Qualitative Investigation of Nurses' Experiences 
During Onset of the Coronavirus Pandemic.

Jun J(1), Rosemberg MS(2).

Author information:
(1)Center for Healthy Aging, Self-Management and Complex Care, 2647The Ohio 
State University, College of Nursing, Columbus, OH, USA.
(2)Department of Systems, Populations and Leadership, 1259University of 
Michigan, School of Nursing, Ann Arbor, MI, USA.

Nurses have always played an essential role during epidemics, risking their 
lives caring for sick and dying patients. However, the unprecedented nature of 
the novel coronavirus disease 2019 (COVID-19) has left organizations and 
healthcare professionals ill-prepared and under-equipped to manage the severity, 
manifestations, and acute and long-term implications. While COVID-19 has 
presented profound physical and mental health implications for nurses, we know 
little about nurses' professional experiences within their organizational 
context. Thus, this qualitative descriptive study fills that gap through 
in-depth exploration of nurses' shared professional experiences working in 
hospitals during the first surge of COVID-19 in the United States. Twenty-two 
nurses were interviewed via telephone during April and May 2020. Through 
thematic analysis four main themes emerged: (1) fear, (2) collective resilience 
through shared trauma, (3) uncharted territory, and (4) perceived disposability. 
Nurses felt ill-praepared for the rapid changes wrought by COVID-19; yet they 
also felt proud with a renewed sense of meaning in their work. While unit 
colleagues were a great source of strength, nurses still reported 
disappointment, even feeling abandoned by their organizations. Our study 
indicates that nurses relied on one another to cope and find meaning. These 
findings are invaluable for policy development and the establishment of 
preventive and early intervention strategies. Done right, such efforts could 
better support nurses by encouraging team building, protection, and rewards to 
maintain nurses' wellbeing during such outbreaks and in their aftermath. 
Organizations also ought to make nurses' health and wellbeing a priority by 
streamlining communication, transparency, and leadership visibility.

DOI: 10.1177/15271544211054435
PMCID: PMC9425780
PMID: 34704859 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


2821. J Relig Health. 2022 Feb;61(1):798-810. doi: 10.1007/s10943-021-01448-7. Epub 
2021 Oct 26.

The Relationship between the Fear of Covid-19, Depression, and Spiritual 
Well-Being in Pregnant Women.

Durmuş M(1), Öztürk Z(2), Şener N(3), Eren SY(4).

Author information:
(1)Department of Gerontology, Faculty of Health Sciences, Mus Alparslan 
University, 49100, Muş, Turkey. saremeryem01@gmail.com.
(2)Department of Psychiatric Nursing, Faculty of Nursing, Ataturk University, 
25240, Erzurum, Turkey.
(3)Department of Nursing, Faculty of Health Sciences, Fırat University, 23000, 
Elazığ, Turkey.
(4)Department of Midwifery, Faculty of Health Sciences, Mus Alparslan 
University, 49100, Muş, Turkey.

The purpose of this study was to explore the relationship between pregnant 
women's fear of coronavirus (COVID-19), depression, and spiritual well-being. 
This cross-sectional research was carried out with 336 pregnant women living in 
a city in the Eastern Anatolia region of Turkey between the 1st of March and 
30th of March 2021. For data collection, the scales of the Fear of COVID-19, the 
Beck Depression Inventory, and the Spiritual Well-being were administered to the 
participants. The pregnant women's fear of COVID-19 was found to be at a 
moderate level, their depression was at a mild level, and their spiritual 
well-being was above the moderate level. It was found that there was a 
significant negative correlation between the spiritual well-being levels of 
pregnant women and their fear of COVID-19 and depression. Moreover, it was also 
found that there was a significant positive correlation between pregnant women's 
levels of fear of COVID-19 and depression (p < 0.001). It is recommended that 
relevant spiritual care practices can be disseminated and implemented 
effectively to reduce pregnant women's fear and depression during the pandemic. 
In addition, when providing care to pregnant women, health professionals can 
adopt a holistic approach to increase pregnant women's spiritual well-being.

© 2021. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s10943-021-01448-7
PMCID: PMC8547724
PMID: 34704161 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


2822. Am J Crit Care. 2022 Mar 1;31(2):96-103. doi: 10.4037/ajcc2022312.

Critical Care Nurses' Experiences During the COVID-19 Pandemic: A US National 
Survey.

Guttormson JL(1), Calkins K(2), McAndrew N(3), Fitzgerald J(4), Losurdo H(5), 
Loonsfoot D(6).

Author information:
(1)Jill L. Guttormson is an associate professor, Marquette University College of 
Nursing, Milwaukee, Wisconsin.
(2)Kelly Calkins is an assistant professor, Marquette University College of 
Nursing.
(3)Natalie McAndrew is an assistant professor, University of Wisconsin-Milwaukee 
College of Nursing.
(4)Jacklynn Fitzgerald is an assistant professor, Marquette University 
Department of Psychology.
(5)Holly Losurdo is a PhD candidate, Marquette University College of Nursing.
(6)Danielle Loonsfoot was a student at Marquette University College of Nursing 
when the study was done; she is now a staff nurse at Froedtert Hospital, 
Milwaukee, Wisconsin.

BACKGROUND: Given critical care nurses' high prepandemic levels of moral 
distress and burnout, the COVID-19 pandemic will most likely have a tremendous 
influence on intensive care unit (ICU) nurses' mental health and continuation in 
the ICU workforce.
OBJECTIVE: To describe the experiences of ICU nurses during the COVID-19 
pandemic in the United States.
METHODS: Nurses who worked in ICUs in the United States during the COVID-19 
pandemic were recruited to complete a survey from October 2020 through early 
January 2021 through social media and the American Association of Critical-Care 
Nurses. Three open-ended questions focused on the experiences of ICU nurses 
during the pandemic.
RESULTS: Of 498 nurses who completed the survey, 285 answered the open-ended 
questions. Nurses reported stress related to a lack of evidence-based treatment, 
poor patient prognosis, and lack of family presence in the ICU. Nurses perceived 
inadequate leadership support and inequity within the health care team. Lack of 
consistent community support to slow the spread of COVID-19 or recognition that 
COVID-19 was real increased nurses' feelings of isolation. Nurses reported 
physical and emotional symptoms including exhaustion, anxiety, sleeplessness, 
and moral distress. Fear of contracting COVID-19 or of infecting family and 
friends was also prevalent.
CONCLUSIONS: Intensive care unit nurses in the United States experienced 
unprecedented and immense burden during the COVID-19 pandemic. Understanding 
these experiences provides insights into areas that must be addressed to build 
and sustain an ICU nurse workforce. Studies are needed to further describe 
nurses' experiences during the COVID-19 pandemic and identify effective 
resources that support ICU nurse well-being.

©2022 American Association of Critical-Care Nurses.

DOI: 10.4037/ajcc2022312
PMID: 34704108 [Indexed for MEDLINE]


2823. BMC Public Health. 2021 Oct 26;21(1):1947. doi: 10.1186/s12889-021-11971-7.

Life in a time of COVID: a mixed method study of the changes in lifestyle, 
mental and psychosocial health during and after lockdown in Western Australians.

Bhoyroo R(1)(2)(3)(4), Chivers P(5)(6), Millar L(5)(7), Bulsara C(5), Piggott 
B(8), Lambert M(8)(9), Codde J(5)(10).

Author information:
(1)Institute for Health Research, The University of Notre Dame Australia, 19 
Mouat Street, PO Box 1225, Fremantle, Western Australia, 6959, Australia. 
ranila.bhoyroo@nd.edu.au.
(2)School of Population Health, Curtin University, Perth, Australia. 
ranila.bhoyroo@nd.edu.au.
(3)School of Health Sciences, The University of Notre Dame Australia, Perth, 
Australia. ranila.bhoyroo@nd.edu.au.
(4)Disciplines of Psychology and Exercise Science, Murdoch University, Perth, 
Australia. ranila.bhoyroo@nd.edu.au.
(5)Institute for Health Research, The University of Notre Dame Australia, 19 
Mouat Street, PO Box 1225, Fremantle, Western Australia, 6959, Australia.
(6)School of Medical and Health Sciences, Edith Cowan University, Perth, 
Australia.
(7)School of Population Health, Curtin University, Perth, Australia.
(8)School of Health Sciences, The University of Notre Dame Australia, Perth, 
Australia.
(9)Injury Matters, Perth, Australia.
(10)Division of Obstetrics & Gynaecology, The University of Western Australia, 
Perth, Australia.

BACKGROUND: Since the beginning of the COVID-19 pandemic, the Western Australian 
government imposed multiple restrictions that impacted daily life activities and 
the social life. The aim of this study was to examine the effects of COVID-19 
lockdown on the community's physical, mental and psychosocial health.
METHODS: Approximately 2 months after a three-month lockdown, a cross-sectional 
study was opened to Western Australian adults for an 8-week period (25th August 
- 21 October 2020). Participants competed a 25-min questionnaire adapted from 
the Western Australia Health and Wellbeing Surveillance system. Participants 
provided information on their socio-demographic status, lifestyle behaviours, 
mental health, and psychosocial health during and post-lockdown. Open-ended 
questions explored key issues in greater detail. Changes between the lockdown 
and post-lockdown period were assessed using Wilcoxon signed rank test and 
One-Sample Kolmogorov-Smirnov Normal tests as appropriate. Sex differences were 
examined using the Mann-Whitney U test. A content analysis approach examined 
responses to the open-ended questions with frequencies and variations in 
responses determined using Chi-Square tests.
RESULTS: A total of 547 complete responses were obtained. Compared to 
post-lockdown period, lockdown was associated with a significantly lower levels 
of physical activity, poorer mental well-being and sense of control over one's 
life, and a higher level of loneliness. Similarly, during lockdown, there was a 
significantly higher consumption of junk food, soft drinks and alcoholic drinks 
but no change in fruit and vegetable intake. Participants recalled health 
campaigns on hand washing and social distancing and there was a retrospective 
view that more timely and informative campaigns on physical activity, nutrition 
and mental well-being should have been available during lockdown.
CONCLUSIONS: While advice on infection control measures were appropriately 
provided, there is a need for concurrent health promotional information to help 
combat the changes in physical, mental and psychosocial well-being observed 
during quarantine to prevent negative health consequences in the community even 
if there are minimal effects of the pandemic itself.

© 2021. The Author(s).

DOI: 10.1186/s12889-021-11971-7
PMCID: PMC8547299
PMID: 34702238 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2824. BMC Med Educ. 2021 Oct 27;21(1):542. doi: 10.1186/s12909-021-02968-2.

Academic experiences, physical and mental health impact of COVID-19 pandemic on 
students and lecturers in health care education.

Idris F(1), Zulkipli IN(2), Abdul-Mumin KH(2), Ahmad SR(2), Mitha S(2), Rahman 
HA(2), Rajabalaya R(2), David SR(2), Naing L(2).

Author information:
(1)PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Jalan 
Tungku Link, Gadong, BE1410, Brunei Darussalam. fazean.idris@ubd.edu.bn.
(2)PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Jalan 
Tungku Link, Gadong, BE1410, Brunei Darussalam.

BACKGROUND: In keeping with nation-wide efforts to contain the spread of 
COVID-19, Universiti Brunei Darussalam (UBD) transformed fully its pedagogical 
delivery to online mode, where we investigated teaching and learning 
experiences, physical and mental health of undergraduate students and lecturers 
during the COVID-19 pandemic.
METHODS: We conducted a cross-sectional study on undergraduate students and 
lecturers in a health science faculty using a self-developed pretested 
questionnaire through anonymous online data collection method.
RESULTS: Fifty-six lecturers (100% response rate) and 279 students (93.3% 
response rate) participated. The positive experiences reported by students 
include becoming independent (72.8%) and adapting to online learning (67.4%), 
while lecturers learned new teaching techniques (50.0%) and became more 
innovative (50.0%) by learning new tools (48.2%). However, studying at home 
caused students to feel more distracted (72.0%) with a feeling of uncertainty 
towards examinations (66.7%), while lecturers felt that students' laboratory 
skills were compromised (44.6%). Even though online delivery of assessments 
enabled lecturers to explore all options (50.0%), they found it difficult to 
maintain appropriate questions (41.1%) and fair assessments (37.5%). Majority of 
students missed eating out (68.8%) and felt a lack of participation in 
extracurricular activities (64.9%), while lecturers reported more time for 
exercise (51.8%), despite having more screen time (50.0%) and computer-related 
physical stress (44.6%). In terms of mental health, increased stress in students 
was reported (64.9%), though they had more time for self-reflection (54.8%). 
Although lecturers reported a closer relationship with family (44.6%), they also 
felt more stressed due to deadlines, unexpected disruptions and higher workloads 
(44.6%) as well as concerns related to work, family and self (39.3%).
CONCLUSION: In this abrupt shift to online teaching, students and lecturers in 
our study identified both positive and negative experiences including the impact 
on their physical and mental health. Our findings are important to provide the 
evidence for online pedagogical benefits and can serve to promote the 
enhancement and adaptation of digital technology in education. Our findings also 
aim to promote the importance of addressing physical and mental health issues of 
the university community's well-being through provision of emotional and mental 
health support and appropriate programs.

© 2021. The Author(s).

DOI: 10.1186/s12909-021-02968-2
PMCID: PMC8548144
PMID: 34702230 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


2825. Biol Psychol. 2022 Jan;167:108212. doi: 10.1016/j.biopsycho.2021.108212. Epub 
2021 Oct 23.

Emotion regulation and diurnal cortisol: A longitudinal study of early 
adolescents.

Rnic K(1), Jopling E(2), Tracy A(2), LeMoult J(2).

Author information:
(1)Department of Psychology, The University of British Columbia, Canada. 
Electronic address: krnic@psych.ubc.ca.
(2)Department of Psychology, The University of British Columbia, Canada.

Aberrant patterns of diurnal cortisol, a marker of stress reactivity, predict 
adverse physical and mental health among adolescents. However, the mechanisms 
underlying aberrant diurnal cortisol production are poorly understood. Thus, the 
objective of this study was to investigate, for the first time, whether the core 
emotion regulation (ER) strategies of rumination (brooding, reflection), 
reappraisal, and suppression were prospectively associated with individual 
differences in diurnal cortisol during the COVID-19 pandemic, a period of 
significant stress. A community sample of 48 early adolescents (Mage = 13.45; 
60% males) was recruited from British Columbia, Canada. Participants completed 
ER measures before the pandemic, and diurnal cortisol was assessed by collecting 
eight saliva samples over two days during the first COVID-19-related lockdown in 
the region. As expected, brooding predicted elevated waking cortisol and a 
blunted cortisol awakening response (CAR), whereas reflection predicted lower 
waking cortisol and suppression predicted a steeper CAR. Unexpectedly, 
reappraisal was not associated with diurnal cortisol production. Results 
indicate that ER strategies may represent a mechanism underlying individual 
differences in biological markers of wellbeing during stress.

Copyright © 2021 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.biopsycho.2021.108212
PMID: 34699918 [Indexed for MEDLINE]


2826. Nurs Leadersh (Tor Ont). 2021 Sep;34(3):40-50. doi: 10.12927/cjnl.2021.26594.

Coastal Mental Health and Substance Use Services' COVID-19 Response: A Quality 
Improvement Initiative.

Devane C(1), Saulnier L(2), Latham L(3).

Author information:
(1)Clinical Planner, Vancouver Coastal Health, Greta and Robert H. N. Ho 
Psychiatry and Education Centre, Vancouver, BC.
(2)Clinical Research Coordinator, Department of Anesthesia, BC Women's Hospital 
& Health Centre, Vancouver, BC.
(3)Manager, Vancouver Coastal Health, Older Adult Community Mental Health Team, 
Vancouver, BC.

Health organizations play a pivotal role during pandemic preparedness, response 
and recovery. During the first wave of the COVID-19 pandemic, Vancouver Coastal 
Health, BC, adapted their delivery of mental health and substance use services. 
Healthcare providers were required to be flexible while continuing to provide 
patient care. To understand how healthcare providers in the mental health and 
substance use field experienced the COVID-19 response at their workplace, a 
quality improvement initiative was designed. This initiative aimed to evaluate 
their perceptions using an online survey tool that explored their insights 
related to communication, redeployment and safety and well-being. The survey 
results aligned with the ADKAR (awareness, desire, knowledge, ability and 
reinforcement) model of change management, which informed our recommendations to 
healthcare leaders to support ongoing pandemic response procedures.

Copyright © 2021 Longwoods Publishing.

DOI: 10.12927/cjnl.2021.26594
PMID: 34698013 [Indexed for MEDLINE]


2827. Handb Exp Pharmacol. 2022;274:181-201. doi: 10.1007/164_2021_558.

Obesity and Obstructive Sleep Apnea.

Bonsignore MR(1)(2).

Author information:
(1)Sleep Disordered Breathing and Chronic Respiratory Failure Clinic, PROMISE 
Department, University of Palermo, Palermo, Italy. 
mariarosaria.bonsignore@unipa.it.
(2)Institute for Biomedical Research and Innovation (IRIB), National Research 
Council (CNR), Palermo, Italy. mariarosaria.bonsignore@unipa.it.

Obstructive sleep apnea (OSA) is characterized by upper airway collapse during 
sleep. Chronic intermittent hypoxia, sleep fragmentation, and inflammatory 
activation are the main pathophysiological mechanisms of OSA. OSA is highly 
prevalent in obese patients and may contribute to cardiometabolic risk by 
exerting detrimental effects on adipose tissue metabolism and potentiating the 
adipose tissue dysfunction typically found in obesity. This chapter will provide 
an update on: (a) the epidemiological studies linking obesity and OSA; (b) the 
studies exploring the effects of intermittent hypoxia and sleep fragmentation on 
the adipose tissue; (c) the effects of OSA treatment with continuous positive 
airway pressure (CPAP) on metabolic derangements; and (d) current research on 
new anti-diabetic drugs that could be useful in the treatment of obese OSA 
patients.

© 2021. The Author(s), under exclusive license to Springer Nature Switzerland 
AG.

DOI: 10.1007/164_2021_558
PMID: 34697666 [Indexed for MEDLINE]


2828. Enferm Clin. 2022 May;32:S5-S13. doi: 10.1016/j.enfcli.2021.10.006. Epub 2021 
Oct 21.

[Factors associated with prenatal stress and anxiety in pregnant women during 
COVID-19 in Spain].

[Article in Spanish]

Awad-Sirhan N(1)(2), Simó-Teufel S(1), Molina-Muñoz Y(3), Cajiao-Nieto J(4), 
Izquierdo-Puchol MT(5).

Author information:
(1)Facultad de Psicología, Universidad de Valencia, Valencia, España.
(2)Facultad de Psicología, Universidad del Desarrollo, Santiago, Chile.
(3)Facultad de Psicología, Universidad Adolfo Ibáñez, Santiago, Chile.
(4)Grupo Interdisciplinario de Investigación en Salud, Fundación Universitaria 
CAFAM, Bogotá, Colombia.
(5)Hospital Vithas Valencia 9 de Octubre, Valencia, España.

AIM OF THE STUDY: To describe prenatal stress and state anxiety levels in 
pregnant women living in Spain during the lockdown of the first wave of COVID-19 
and its relation with obstetric factors, perception of health care, and concerns 
about the socio-sanitary situation.
METHODS: The present study is an observational, correlational, and 
cross-sectional quantitative study. The participants in the study were pregnant 
women recruited through non-probabilistic convenience and snowball sampling 
during the lockdown. A web link was provided to an online questionnaire designed 
for this research, which collected socio-demographic and obstetric variables, 
perceptions of health care received during the pandemic and preoccupations 
associated with COVID-19. It also included the Prenatal Stress Questionnaire 
(PDQ) and the State Anxiety Inventory (STAI-S).
RESULTS: Based on the responses of 695 pregnant women, the results showed a mean 
of 16.98 (SD = 25.20) of prenatal stress and elevated levels of anxiety 
(M = 25.20/SD = 11.07) in the first wave of the pandemic. Risk factors for 
prenatal stress and anxiety were the level of preoccupation associated with 
COVID-19 and previous mental health issues. A specific risk factor for anxiety 
was having more than one child and a protective factor were perceiving 
accessibility and availability of health care, with clear and consistent 
pregnancy care and follow-up protocols.
CONCLUSIONS: The lockdown period for COVID-19 was a stressful experience for 
pregnant women, highlighting the need to address their psychological well-being 
through clear and coherent protocols in terms of maternal-foetal health control 
and follow-up.

OBJETIVO: Describir los niveles de estrés prenatal y ansiedad estado en mujeres 
gestantes residentes en España durante el confinamiento generado por la primera 
ola de COVID-19, y su asociación con los factores obstétricos, percepción de la 
atención sanitaria y preocupación provocada por la situación sociosanitaria.
MÉTODO: Estudio cuantitativo, observacional, correlacional y de corte 
transversal. La población de estudio fueron mujeres gestantes confinadas, 
reclutadas a través de muestreo no probabilístico por conveniencia y de bola de 
nieve. Se difundió un enlace web de acceso a un cuestionario online diseñado 
para la investigación, que recogía variables sociodemográficas, obstétricas, 
sobre la percepción de la atención sanitaria recibida durante la pandemia y 
preocupaciones asociadas al COVID-19. Se incluyó también el Cuestionario de 
Preocupaciones Prenatales (PDQ) y el Inventario de Ansiedad Estado (STAI-S).
RESULTADOS: Basados en las respuestas de 695 mujeres gestantes, los resultados 
indican que durante la primera ola de la pandemia se observó un nivel medio de 
estrés prenatal de 16,98 (DS = 25,20) y un nivel elevado de ansiedad 
(M = 25,20/DS = 11,07). Factores de riesgo determinante del estrés prenatal y 
ansiedad fueron el nivel de preocupación asociada al COVID-19 y tener 
antecedentes de salud mental. Un factor de riesgo específico para la ansiedad 
fue tener más de un hijo/a y un factor protector fue percibir accesibilidad y 
disponibilidad de la atención sanitaria.
CONCLUSIONES: El periodo de confinamiento por COVID-19 significó un estrés 
adicional para las mujeres gestantes, poniendo en evidencia la necesidad de 
atender el bienestar psicológico de dicha población a través de protocolos 
claros y coherentes en cuanto a control y seguimiento de la salud materno-fetal.

© 2021 Elsevier España, S.L.U. All rights reserved.

DOI: 10.1016/j.enfcli.2021.10.006
PMCID: PMC8529258
PMID: 34697530 [Indexed for MEDLINE]


2829. Public Health Rep. 2022 Jan-Feb;137(1):149-162. doi: 10.1177/00333549211054083. 
Epub 2021 Oct 25.

Experiences of Safety-Net Practice Clinicians Participating in the National 
Health Service Corps During the COVID-19 Pandemic.

Pathman DE(1), Sonis J(1)(2), Harrison JN(3), Sewell RG(4), Fannell J(5), 
Overbeck M(6), Konrad TR(1)(7).

Author information:
(1)Department of Family Medicine, Cecil G. Sheps Center for Health Services 
Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
(2)Department of Social Medicine, University of North Carolina at Chapel Hill, 
Chapel Hill, NC, USA.
(3)New Mexico Health Resources, Inc, Albuquerque, NM, USA.
(4)Office of Healthcare Access, Section on Rural and Community Health Systems, 
Division of Public Health, Alaska Department of Health and Social Services, 
Anchorage, AK, USA.
(5)Provider Retention and Information System Management Collaborative, National 
Rural Recruitment and Retention Network (3RNET), Jefferson City, MO, USA.
(6)Oregon Primary Care Office, Oregon Health Authority, Portland, OR, USA.
(7)Health Workforce Analytics, Chapel Hill, NC, USA.

OBJECTIVES: The impact of the COVID-19 pandemic has been particularly harsh for 
low-income and racial and ethnic minority communities. It is not known how the 
pandemic has affected clinicians who provide care to these communities through 
safety-net practices, including clinicians participating in the National Health 
Service Corps (NHSC).
METHODS: In late 2020, we surveyed clinicians who were serving in the NHSC as of 
July 1, 2020, in 20 states. Clinicians reported on work and job changes and 
their current well-being, among other measures. Analyses adjusted for 
differences in subgroup response rates and clustering of clinicians within 
practices.
RESULTS: Of 4263 surveyed clinicians, 1890 (44.3%) responded. Work for most NHSC 
clinicians was affected by the pandemic, including 64.5% whose office visit 
numbers fell by half and 62.5% for whom most visits occurred virtually. Fewer 
experienced changes in their jobs; for example, only 14.9% had been furloughed. 
Three-quarters (76.6%) of these NHSC clinicians scored in at-risk levels for 
their well-being. Compared with primary care and behavioral health clinicians, 
dental clinicians much more often had been furloughed and had their practices 
close temporarily.
CONCLUSIONS: The pandemic has disrupted the work, jobs, and mental health of 
NHSC clinicians in ways similar to its reported effects on outpatient clinicians 
generally. Because clinicians' mental health worsens after a pandemic, which 
leads to patient disengagement and job turnover, national programs and policies 
should help safety-net practices build cultures that support and give greater 
priority to clinicians' work, job, and mental health needs now and before the 
next pandemic.

DOI: 10.1177/00333549211054083
PMCID: PMC8721684
PMID: 34694922 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
authors declared the following potential conflicts of interest with respect to 
the research, authorship, and/or publication of this article: R.G.S., M.O., and 
J.N.H. work in public agencies that operate or are affiliated with joint 
National Health Service Corps state loan repayment programs that are included in 
this study.


2830. Appl Psychol Health Well Being. 2022 May;14(2):434-452. doi: 10.1111/aphw.12312. 
Epub 2021 Oct 24.

Actor-partner association of work-family conflict and parental depressive 
symptoms during COVID-19 in China: Does coparenting matter?

Zou S(1), Wu X(2), Ren Y(2), Wang X(2).

Author information:
(1)Center for Mind & Brain Science, Cognition and Human Behavior Key Laboratory 
of Human Province, Department of Psychology, Hunan Normal University, Changsha, 
China.
(2)Beijing Key Laboratory of Applied Experimental Psychology, National 
Demonstration Center for Experimental Psychology Education (Beijing Normal 
University), Faculty of Psychology, Beijing Normal University, Beijing, China.

Parental depressive symptoms and their related factors have not been widely 
examined during the COVID-19 pandemic. Therefore, the current study examined the 
actor and partner associations of work-family conflict and parental depressive 
symptoms. Considering the new demands and challenges for families during the 
COVID-19 pandemic, we further explored the moderation effect of coparenting. A 
cross-sectional online survey with 985 paired fathers and mothers was conducted 
in Mainland China. In 11.6% of families, only mothers reported moderate to 
severe depressive symptoms; in 10.6% families, only fathers reported moderate to 
severe depressive symptoms; in 9.5% families, the mother and father reported 
mild to moderate depressive symptoms. Results of the actor-partner 
interdependence model showed that parental family-to-work conflict was 
negatively associated with their own depressive symptoms. The negative actor 
association of maternal family-to-work conflict and depressive symptoms was 
moderated by undermining coparenting. The partner effects of maternal 
family-to-work and work-to-family conflicts on paternal depressive symptoms were 
moderated by undermining coparenting. Moreover, supportive coparenting moderated 
the actor association of work-to-family conflict and the depressive symptoms of 
fathers. Results highlight the importance of family-to-work conflict and family 
function for parental depressive symptoms. These findings can help promote 
parental well-being during the COVID-19 pandemic.

© 2021 The International Association of Applied Psychology.

DOI: 10.1111/aphw.12312
PMCID: PMC8653357
PMID: 34693632 [Indexed for MEDLINE]


2831. Oral Surg Oral Med Oral Pathol Oral Radiol. 2022 Jan;133(1):34-41. doi: 
10.1016/j.oooo.2021.09.011. Epub 2021 Sep 27.

Effect of COVID-19 on training and mental health of oral medicine residents in 
North America.

Sandhu S(1), Sankar V(2), Sroussi HY(3), Villa A(4).

Author information:
(1)Oral Medicine Resident PGY-3, Division of Oral Medicine and Dentistry, 
Brigham and Women's Hospital, Department of Oral Medicine, Harvard School of 
Dental Medicine, Boston, MA, USA. Electronic address: shaiba_sandhu89@yahoo.com.
(2)Associate Professor, Division of Oral Medicine, Tufts University School of 
Dental Medicine, Boston, MA, USA.
(3)Associate Professor, Department of Oral Medicine, Harvard School of Dental 
Medicine, Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, 
Boston, MA, USA.
(4)Associate Professor, Department of Orofacial Sciences, University of 
California San Francisco School of Dentistry, San Francisco, CA, USA.

OBJECTIVE: The objective of this study was to assess resident and faculty 
perception of the effect of the coronavirus disease 2019 pandemic on the 
training experience, education, and psychological well-being of oral medicine 
(OM) residents.
STUDY DESIGN: An anonymous 16-item online questionnaire was e-mailed to faculty 
and residents of all Commission on Dental Accreditation-accredited OM residency 
programs in North America. Survey questions asked about the pandemic's effect on 
resident educational, clinical, and research activities and the well-being of 
the residents. Survey data were collected using Qualtrics XM.
RESULTS: Forty participants (52.5% residents and 47.5% faculty members) 
responded to the survey. Regarding the effect on clinical activities, 67.5% 
reported 50% or less reduction in patient volume seen by residents at its worst 
during the pandemic. With respect to educational activities, most reported a 
complete switch of didactic training (85.3%), academic examinations (60%), and 
off-site resident rotations (45%) to a virtual platform. Research activities 
were affected the most; 55% reported complete cessation for some time. 
Thirty-three percent perceived a negative effect, 18% perceived no effect, 11% 
perceived a positive effect, and 38% were unsure regarding the effect of 
coronavirus disease 2019 on resident morale. Despite the interruptions in the 
clinical, research, and educational activities, 62.5% expected on-time resident 
graduation.
CONCLUSION: Despite constraints due to the pandemic, OM residency programs 
successfully continued clinical activities, didactic training, and research 
productivity through virtual means and a hybrid delivery care model while 
supporting their residents' morale.

Copyright © 2021 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.oooo.2021.09.011
PMCID: PMC8502457
PMID: 34688590 [Indexed for MEDLINE]


2832. Int J Behav Med. 2022 Aug;29(4):506-516. doi: 10.1007/s12529-021-10036-8. Epub 
2021 Oct 22.

Predictors of Psychological Distress and Resilience in the Post-COVID-19 Era.

Lin T(1), Yi Z(2), Zhang S(3), Veldhuis CB(4).

Author information:
(1)Department of Psychology, Ohio University, 22 Richland Ave, Athens, OH, 
45701, USA.
(2)Department of Disability and Human Development, College of Applied Health 
Science, University of Illinois Chicago, 1640 W Roosevelt Rd, Chicago, IL, 
60608, USA.
(3)The College of Economics and Management, Beijing University of Chemical 
Technology, 15 North 3rd Ring Road E., Chaoyang District, Beijing, People's 
Republic of China, 100029. zhangsixuess@163.com.
(4)School of Nursing, Columbia University, 630 West 168th St., New York, NY, 
10032, USA.

BACKGROUND: The COVID-19 global pandemic has had profound effects on mental 
health and wellbeing. The present study examined trends in distress and recovery 
in the aftermath of COVID-19 in China. Predictors that might increase risks or 
provide protections again distress were explored.
METHOD: Participants were recruited using social media during the COVID-19 
pandemic to complete a baseline and 6-week follow-up survey (N = 241). The 
change patterns of PTSD symptoms from baseline to follow-up were characterized 
using latent class growth analysis (LCGA). A repeated-measures ANOVA was 
conducted to explore the differences in the depressive symptoms across 
trajectory groups. Multinominal logistic regression was performed to investigate 
potential predictors of the outcome trajectories.
RESULTS: Four longitudinal outcome trajectories were identified: chronic (PTSD 
symptoms remained high; 14.9%), resilient (symptoms remained low; 43.2%), 
recovered (symptoms decreased from symptomatic levels to asymptomatic; 19.5%), 
and delayed (symptoms increased from asymptomatic levels to symptomatic; 22.4%). 
Hopelessness and maladaptive coping strategies were unique predictors of 
distress and resilience as well as longer-term trajectories.
CONCLUSION: Individuals evidenced four outcome trajectories of distress in the 
aftermath of COVID-19 in China. Despite the uncertainty and high levels of 
stress related to the pandemic, the majority of the sample demonstrated 
resilience and recovery. It is essential to identify individuals at risk for 
chronic and delayed distress in order to build resilience.

© 2021. International Society of Behavioral Medicine.

DOI: 10.1007/s12529-021-10036-8
PMCID: PMC8533665
PMID: 34686965 [Indexed for MEDLINE]


2833. Int J Environ Res Public Health. 2021 Oct 19;18(20):10979. doi: 
10.3390/ijerph182010979.

How Does Food Addiction Relate to Obesity? Patterns of Psychological Distress, 
Eating Behaviors and Physical Activity in a Sample of Lebanese Adults: The MATEO 
Study.

Brytek-Matera A(1), Obeid S(2), Akel M(3), Hallit S(4)(5).

Author information:
(1)Institute of Psychology, University of Wroclaw, 50-527 Wroclaw, Poland.
(2)Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), 
Jounieh, Lebanon.
(3)School of Pharmacy, Lebanese International University, Beirut, Lebanon.
(4)Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik 
(USEK), Jounieh, Lebanon.
(5)Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.

Food addiction is currently not an official diagnosis (as a standalone disorder 
substance-related and addictive disorder) in the Diagnostic and Statistical 
Manual of Mental Disorders, 5th Edition (DSM-5). To best of our knowledge, there 
is no previous research on differences between addictive-like eating behavior 
regarding its associations with psychological distress, eating behaviors and 
physical activity among individuals with obesity. The objective of the present 
study was to distinguish psychological and behavioral patterns of individuals 
with obesity concerning food addiction using a cluster analysis. We determined 
the profiles of the participants in terms of psychological distress, eating 
behaviors and physical activity and evaluated their association with food 
addiction. A cross-sectional study was conducted between September and November 
2020, during the lockdown period imposed by the government for the COVID-19 
pandemic. A sample of 507 individuals with obesity aged between 18 and 65 years 
participated in the present study by filling in the online questionnaire, 
including the validated Arabic version of the modified version of the Yale Food 
Addiction Scale, the Arabic version of the Depression, Anxiety and Stress Scale, 
the Three-Factor Eating Questionnaire, and the short version of the 
International Physical Activity Questionnaire. A cluster analysis was performed 
using the K-mean method to identify and group participants according to their 
patterns/profiles. A stepwise linear regression was conducted, taking the food 
addiction score as the dependent variable. Higher levels of uncontrolled eating, 
emotional eating and stress were significantly associated with higher food 
addiction score. Belonging to cluster 2 (psychological well-being and cognitive 
restraint) (B = 14.49) or cluster 3 (moderate psychological distress and 
cognitive restraint) (B = 6.67) compared to cluster 1 (psychological well-being, 
appropriate physical activity levels and eating behaviors) was significantly 
associated with higher food addiction score. The present research revealed that 
food addiction is significantly associated with higher psychological distress 
and maladaptive eating behaviors. Higher levels of uncontrolled eating, 
emotional eating and stress as well as belonging to clusters 2 and 3 were found 
to be predictors of food addiction in individuals with obesity in the present 
study. This knowledge could be useful in regard to psychological treatment of 
obesity and addictive-like eating behavior.

DOI: 10.3390/ijerph182010979
PMCID: PMC8535988
PMID: 34682724 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2834. Int J Environ Res Public Health. 2021 Oct 16;18(20):10891. doi: 
10.3390/ijerph182010891.

The Interplay between Housing Environmental Attributes and Design Exposures and 
Psychoneuroimmunology Profile-An Exploratory Review and Analysis Paper in the 
Cancer Survivors' Mental Health Morbidity Context.

Hernandez-Garcia E(1), Chrysikou E(1)(2), Kalea AZ(3)(4).

Author information:
(1)The Bartlett Real Estate Institute, The Bartlett School of Sustainable 
Construction, University College London, London WC1E 6BT, UK.
(2)Clinic of Social and Family Medicine, Department of Social Medicine, 
University of Crete, 700 13 Heraklion, Greece.
(3)Division of Medicine, University College London, London WC1E 6JF, UK.
(4)Institute of Cardiovascular Science, University College London, London WC1E 
6HX, UK.

Adult cancer survivors have an increased prevalence of mental health 
comorbidities and other adverse late-effects interdependent with mental illness 
outcomes compared with the general population. Coronavirus Disease 2019 
(COVID-19) heralds an era of renewed call for actions to identify sustainable 
modalities to facilitate the constructs of cancer survivorship care and health 
care delivery through physiological supportive domestic spaces. Building on the 
concept of therapeutic architecture, psychoneuroimmunology (PNI) indicators-with 
the central role in low-grade systemic inflammation-are associated with major 
psychiatric disorders and late effects of post-cancer treatment. Immune 
disturbances might mediate the effects of environmental determinants on 
behaviour and mental disorders. Whilst attention is paid to the non-objective 
measurements for examining the home environmental domains and mental health 
outcomes, little is gathered about the multidimensional effects on physiological 
responses. This exploratory review presents a first analysis of how addressing 
the PNI outcomes serves as a catalyst for therapeutic housing research. We argue 
the crucial component of housing in supporting the sustainable primary care and 
public health-based cancer survivorship care model, particularly in the 
psychopathology context. Ultimately, we illustrate a series of interventions 
aiming at how housing environmental attributes can trigger PNI profile changes 
and discuss the potential implications in the non-pharmacological treatment of 
cancer survivors and patients with mental morbidities.

DOI: 10.3390/ijerph182010891
PMCID: PMC8536084
PMID: 34682637 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2835. Int J Environ Res Public Health. 2021 Oct 15;18(20):10868. doi: 
10.3390/ijerph182010868.

The Relationships between Character Strengths and Subjective Wellbeing: Evidence 
from Greece under Lockdown during COVID-19 Pandemic.

Vasileiou D(1), Moraitou D(1)(2), Papaliagkas V(3), Pezirkianidis C(4), Stalikas 
A(4), Papantoniou G(2)(5)(6), Sofologi M(5)(6).

Author information:
(1)Laboratory of Psychology, Section of Experimental and Cognitive Psychology, 
Faculty of Philosophy, School of Psychology, Aristotle University of 
Thessaloniki, 54124 Thessaloniki, Greece.
(2)Laboratory of Neurodegenerative Diseases, Center for Interdisciplinary 
Research and Innovation (CIRI-AUTH), Aristotle University of Thessaloniki, 57001 
Thessaloniki, Greece.
(3)Department of Biomedical Sciences, Alexander Campus, International Hellenic 
University, P.O. Box 141, 57400 Thessaloniki, Greece.
(4)Lab of Positive Psychology, Department of Psychology, Panteion University of 
Social and Political Sciences, 17671 Athens, Greece.
(5)Laboratory of Psychology, Department of Early Childhood Education, School of 
Education, University of Ioannina, 45110 Ioannina, Greece.
(6)Institute of Humanities and Social Sciences, University Research Centre of 
Ioannina (URCI), 45100 Ioannina, Greece.

COVID-19 was first identified in December 2019. As long as this type of 
coronavirus was new, the main way for governments to avoid the spread of the 
infection was enforced quarantine. Besides public health protection, quarantine 
can have a psychological impact on the residents, with main symptoms being 
angst, anxiety, depressive, and PTSD symptoms. As it has been found that 
character strengths can promote subjective wellbeing, the purpose of the study 
was to examine this relationship under the new situation of quarantine in the 
Greek population in adults who were in quarantine for at least two weeks. The 
total sample consisted of 354 participants who were aged 18-72-years-old. A 
total of 263 participants were women (74.3%), 91 were men (25.7%), and 94.6% of 
them were highly educated. The sample was a convenience sample. The tools used 
were PANAS, PERMA and finally VIA-114GR. The data analysis was completed using 
SPSS software version 26.0 (IBM Corp. Released 2019. IBM SPSS Statistics for 
Windows, Version 26.0. Armonk, NY, USA: IBM Corp) and EQS 6.1 (Multivariate 
Software Inc.: Encino, CA, USA, 2006). The results showed that love, curiosity, 
persistence, hope, and zest are strongly associated with subjective wellbeing, 
even in conditions such as quarantine, and can support specific aspects of it.

DOI: 10.3390/ijerph182010868
PMCID: PMC8535913
PMID: 34682609 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2836. Int J Environ Res Public Health. 2021 Oct 14;18(20):10786. doi: 
10.3390/ijerph182010786.

Exploring Perceived Importance of a Novel Emergency Food Program during COVID-19 
and Program Recipient Characteristics.

Barr ML(1), OoNorasak K(1), Hughes K(2), Batey L(1), Jackson K(1), Marshall 
H(3), Stephenson T(1).

Author information:
(1)Department of Dietetics and Human Nutrition, University of Kentucky, 
Lexington, KY 40506, USA.
(2)FoodChain Nourish Lexington, Lexington, KY 40508, USA.
(3)Department of Internal Medicine and Pediatrics, University of Kentucky, 
Lexington, KY 40506, USA.

Following rising unemployment rates and consequent loss of income due to 
COVID-19, many people have been seeking meal assistance. This study examines the 
impact of a community-based free meal distribution program during the pandemic 
in Kentucky, reviewing characteristics of recipients of the program. 
Demographics, health behaviors, food insecure classification, and rating of 
importance of the meal program were collected. Qualitative feedback on the 
impact of the program was collected via open response. Of the 92 participants 
using the meal service, the cohort was female, Black, 43 years of age (43.5 ± 
15.0 years), with a household income under 30,000 USD before COVID, decreased 
income since COVID, and were food insecure. Recipients rated the importance of 
the service as 8.7 ± 1.8 (of 10), and those with children indicated the 
importance as 4.2 ± 1.1 (of 5). Qualitative data on program importance 
highlighted four response categories including "changed habits", "mental 
wellbeing", "provided resources", and "other". In response to the COVID-19 
pandemic, many individuals have struggled. Meal assistance programs are a 
fundamental asset in the community that have seen marketed demand since 
COVID-19. Collaboration with, and evaluation of, meal assistance programs can be 
valuable for continued programmatic funding support.

DOI: 10.3390/ijerph182010786
PMCID: PMC8535328
PMID: 34682533 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript, or in the decision to 
publish the results.


2837. Int J Environ Res Public Health. 2021 Oct 13;18(20):10759. doi: 
10.3390/ijerph182010759.

COVID-19 Pandemic and Personality: Agreeable People Are More Stressed by the 
Feeling of Missing.

Getzmann S(1), Digutsch J(1), Kleinsorge T(1).

Author information:
(1)Leibniz Research Centre for Working Environment and Human Factors, Technical 
University of Dortmund (IfADo), Ardeystrasse 67, D-44139 Dortmund, Germany.

The COVID-19 pandemic and the measures taken to contain it have substantial 
consequences for many people, resulting in negative effects on individual 
well-being and mental health. In the current study, we examined whether 
individual changes in perceived stress relative to pre-pandemic levels depended 
on differences in behavior, appraisal, and experience of pandemic-related 
constraints. In addition, we tested whether this potential relationship was 
moderated by personality traits. We conducted an online survey during the end of 
the first lockdown in Germany in spring 2020, and assessed pandemic-related 
individual consequences as well as perceived stress. These data were related to 
the big five personality traits and to ratings of perceived stress obtained from 
the same participants in a study conducted before the outbreak of the pandemic, 
using the same standardized stress questionnaires. There was no overall 
increase, but a large interindividual variety in perceived stress relative to 
pre-pandemic levels. Increased stress was associated especially with strong 
feelings of missing. This relationship was moderated by agreeableness, with more 
agreeable people showing a higher association of the feeling of missing and the 
increase of perceived stress. In addition, openness and conscientiousness were 
positively correlated with an increase in stress. The results highlight the 
importance of considering personality and individual appraisals when examining 
the consequences of the COVID-19 pandemic on perceived stress and well-being.

DOI: 10.3390/ijerph182010759
PMCID: PMC8535900
PMID: 34682500 [Indexed for MEDLINE]

Conflict of interest statement: All authors disclose no actual or potential 
conflicts of interest including any financial, personal, or other relationships 
with other people or organizations that could inappropriately influence (bias) 
their work.


2838. Int J Environ Res Public Health. 2021 Oct 12;18(20):10698. doi: 
10.3390/ijerph182010698.

Loneliness and Depression among Women in Poland during the COVID-19 Pandemic.

Idzik A(1), Leńczuk-Gruba A(1), Kobos E(1), Pietrzak M(1), Dziedzic B(1).

Author information:
(1)Department of Development of Nursing, Social and Medical Sciences, Medical 
University of Warsaw ul., Żwirki i Wigury 61, 02-091 Warsaw, Poland.

BACKGROUND: The COVID-19 pandemic has forced many changes in the functioning of 
people all over the world in a short period of time. According to a WHO report 
(2020), it is women who are at a particular risk of the negative effects of the 
pandemic, especially in terms of mental health.
AIM OF STUDY: The aim of the study was to assess the prevalence of anxiety, 
depression, irritability, and loneliness among adult women during the COVID-19 
pandemic.
MATERIALS AND METHODS: The study was conducted on a representative sample of 
women in Poland (n = 452). The data were collected using the HADS-M scale and 
the R-UCLA scale.
RESULTS: A low level of loneliness was found in 37.3% of the women, moderate in 
38.9%, moderately high in 22.3% and very high in 1.3% of women. Self-rating of 
physical and mental health was significantly positively correlated with anxiety, 
depression, and irritability in HADS-M, and loneliness in R-UCLA. As the 
severity of loneliness increased, so did Hospital Anxiety and Depression Scale 
scores on all subscales (p < 0.001).
CONCLUSIONS: The study group presented with mental well-being disorders in the 
form of anxiety and depression. Two in three women experienced loneliness.

DOI: 10.3390/ijerph182010698
PMCID: PMC8535819
PMID: 34682443 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2839. Int J Environ Res Public Health. 2021 Oct 12;18(20):10676. doi: 
10.3390/ijerph182010676.

Are Sleep Problems Related to Psychological Distress in Healthy Aging during the 
COVID-19 Pandemic? A Review.

Cipriani GE(1), Bartoli M(1), Amanzio M(1).

Author information:
(1)Department of Psychology, University of Turin, 10124 Turin, Italy.

The SARS-CoV-2 pandemic, characterized by home confinement and other restrictive 
measures to reduce the spread of the infection, led to significant changes in 
people's habits and lifestyle. One of the most common problems is the worsening 
of sleep quality or quantity, which could have negative effects on psychological 
wellbeing, particularly in older adults. The purposes of the present literature 
review considering healthy aging subjects are (a) to examine the existing 
research on sleep alterations during the current pandemic and (b) to highlight 
possible relationships between sleep problems and psychological distress. A 
systematic search strategy was implemented according to PRISMA guidelines in the 
international literature online databases, up to 1 July 2021. After 
identification and screening phases, 11 articles were included in this review. 
The studies found possible associations between sleep problems and mood 
changes-particularly in terms of depression and anxiety. In addition, altered 
sleep patterns seemed to be related to changes in individual aspects, lifestyle, 
and attitudes adopted by older adults during the COVID-19 lockdown. Thus, the 
pandemic could affect the sleep and psychological wellbeing of the older 
population, even in healthy aging.

DOI: 10.3390/ijerph182010676
PMCID: PMC8536178
PMID: 34682423 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2840. Int J Environ Res Public Health. 2021 Oct 12;18(20):10675. doi: 
10.3390/ijerph182010675.

Impacts of the COVID-19 Pandemic and Self-Isolation on Students and Staff in 
Higher Education: A Qualitative Study.

Knight H(1), Carlisle S(1), O'Connor M(2), Briggs L(2), Fothergill L(2), 
Al-Oraibi A(2), Yildirim M(2), Morling JR(1)(3), Corner J(4), Ball J(5)(6), 
Denning C(1)(5), Vedhara K(1), Blake H(2)(3).

Author information:
(1)School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK.
(2)School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK.
(3)NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals 
NHS Trust and the University of Nottingham, Nottingham NG7 2UH, UK.
(4)University Executive Board, University of Nottingham, Nottingham NG7 2RD, UK.
(5)Biodiscovery Institute, University of Nottingham, Nottingham NG7 2RD, UK.
(6)School of Life Sciences, University of Nottingham, Nottingham NG7 2UH, UK.

This qualitative study explored the impact of COVID-19 self-isolation and social 
restriction measures on university students, through the perspectives of both 
students and the staff supporting them. The study comprised 11 focus groups 
(students) and 26 individual interviews (staff) at a higher education 
institution in England during a period of national lockdown (January-March 
2021). Participants were university students (n = 52) with self-isolation 
experiences and university staff (n = 26) with student-facing support roles. 
Focus group and interview data were combined and analysed using an inductive 
thematic approach. Four themes emerged: 'Adaptation during the pandemic', 
'Practical, environmental, and emotional challenges of self-isolating', 'Social 
factors and their impact on COVID-19 testing and self-isolation adherence', and 
'Supporting self-isolation'. Students and staff struggled with the imposed 
restrictions and shift to online education. Students found it difficult to adapt 
to new expectations for university life and reported missing out on professional 
and social experiences. Students and staff noted concerns about the impact of 
online teaching on educational outcomes. Students endorsed varied emotional 
responses to self-isolation; some felt unaffected whilst others experienced 
lowered mood and loneliness. Students were motivated by pro-social attitudes; 
campaigns targeting these factors may encourage continued engagement in 
protective behaviours. Staff struggled to manage their increased workloads 
delivering support for self-isolating students. Universities must consider the 
support needs of students during self-isolation and prepare for the long-term 
impacts of the pandemic on student wellbeing and educational attainment. Greater 
support should be provided for staff during transitional periods, with ongoing 
monitoring of workforce stress levels warranted.

DOI: 10.3390/ijerph182010675
PMCID: PMC8535702
PMID: 34682418 [Indexed for MEDLINE]

Conflict of interest statement: All authors were employees of University of 
Nottingham (UoN), the institution at which data were collected. JC sits on the 
Executive Board for UoN. JB and CD were involved in the delivery of the 
university’s asymptomatic testing service but were not involved in data 
collection or analysis for this research. No other conflicts of interest were 
declared.


2841. Int J Environ Res Public Health. 2021 Oct 11;18(20):10647. doi: 
10.3390/ijerph182010647.

Psychological Impacts of COVID-19 on Healthcare Trainees and Perceptions towards 
a Digital Wellbeing Support Package.

Blake H(1)(2), Mahmood I(3), Dushi G(3), Yildirim M(1), Gay E(3).

Author information:
(1)School of Health Sciences, University of Nottingham, Nottingham NH7 2HA, UK.
(2)NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH, UK.
(3)School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK.

We explore the impact of COVID-19 on the psychological wellbeing of healthcare 
trainees, and the perceived value of a digital support package to mitigate the 
psychological impacts of the pandemic (PoWerS Study). This mixed-methods study 
includes (i) exposure to a digital support package; (ii) participant survey to 
assess wellbeing, perceptions of work and intervention fidelity; (iii) 
semi-structured qualitative interviews. Interviews were digitally recorded and 
transcribed, data were handled and analysed using principles of thematic 
framework analysis. Participants are 42 health and medical trainees (9M, 33F) 
from 13 higher education institutions in the UK, studying during the COVID-19 
pandemic. Survey findings showed high satisfaction with healthcare training 
(92.8%), but low wellbeing (61.9%), moderate to high perceived stressfulness of 
training (83.3%), and high presenteeism (50%). Qualitative interviews generated 
3 over-arching themes, and 11 sub-themes. The pandemic has impacted negatively 
on emotional wellbeing of trainees, yet mental health is not well promoted in 
some disciplines, and provision of pastoral support is variable. Disruption to 
academic studies and placements has reduced perceived preparedness for future 
clinical practice. Regular check-ins, and wellbeing interventions will be 
essential to support the next generation health and care workforce, both in 
higher education and clinical settings. The digital support package was 
perceived to be accessible, comprehensive, and relevant to healthcare trainees, 
with high intervention fidelity. It is a useful tool to augment longer-term 
provision of psychological support for healthcare trainees, during and after the 
COVID-19 pandemic.

DOI: 10.3390/ijerph182010647
PMCID: PMC8535361
PMID: 34682396 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2842. J Health Psychol. 2022 Sep;27(11):2529-2538. doi: 10.1177/13591053211049942. 
Epub 2021 Oct 22.

Uncertain crisis time affects psychosocial dimensions in beta-thalassemia 
patients during Covid-19 pandemic: A cross-sectional study.

Cerami C(1)(2), Santi GC(1), Sammartano I(3), Borsellino Z(3), Cuccia L(3), 
Battista Ruffo G(3), Crespi C(2)(4).

Author information:
(1)Scuola Universitaria di Studi Superiori IUSS, Pavia, Italy.
(2)Cognitive Computational Neuroscience Research Unit, IRCCS Mondino Foundation, 
Pavia, Italy.
(3)U.O. Ematologia con Talassemia A.R.N.A.S. Civico Di Cristina Palermo, Italy.
(4)Department of Brain and Behavioral Sciences, University of Pavia, Pavia, 
Italy.

Psychosocial variables are key factors influencing the delicate equilibrium of 
chronic patients during crisis time. In this study, we explored distress, 
anxiety, depression, loneliness, coping strategies, and changes in life habits 
in 43 beta-thalassemia patients and 86 controls during Covid-19 pandemic. 
Patients showed higher anxiety levels and a predominant transcendent coping 
profile compared to controls. Patients significantly differed from controls in 
outdoor habits. Social isolation and habits changes in uncertain life-threaten 
situations as Covid-19 pandemic are particularly detrimental in fragile 
beta-thalassemia patients. Structured support interventions are needed to 
promote well-being in the Covid-19 era.

DOI: 10.1177/13591053211049942
PMID: 34674572 [Indexed for MEDLINE]


2843. Indian Heart J. 2021 Nov-Dec;73(6):674-681. doi: 10.1016/j.ihj.2021.10.002. Epub 
2021 Oct 18.

COVID 19-related burnout among healthcare workers in India and ECG based 
predictive machine learning model: Insights from the BRUCEE- Li study.

Gupta MD(1), Jha MK(2), Bansal A(3), Yadav R(4), Ramakrishanan S(4), Girish 
MP(3), Sarkar PG(5), Qamar A(6), Kumar S(7), Kumar S(8), Jain A(9), Saijpaul 
R(10), Gupta V(11), Kansal D(11), Garg S(7), Arora S(12), Biswas PS(3), Yusuf 
J(3), Malhotra RK(4), Batra V(3), Kathuria S(3), Mehta V(3), Safal(3), Shetty 
MK(10), Mukhopadhyay S(3), Tyagi S(3), Gupta A(11); BRUCEE Li Investigators.

Author information:
(1)GB Pant Institute of Post Graduate Education and Research, New Delhi, India. 
Electronic address: drmohitgupta@yahoo.com.
(2)Center for Depression Research and Clinical Care, University of Texas 
Southwestern Medical Center, Dallas, TX, USA.
(3)GB Pant Institute of Post Graduate Education and Research, New Delhi, India.
(4)All India Institute of Medical Sciences, New Delhi, India.
(5)Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
(6)Section of Interventional Cardiology and Vascular Medicine, NorthShore 
University Health System, University of Chicago Pritzker School of Medicine, 
Evanston, IL, USA.
(7)Lok Nayak Hospital, New Delhi, India.
(8)Bokaro General Hospital, Bokaro Steel City, Jharkhand, India.
(9)Rajiv Gandhi Super Specialty Hospital, Tahirpur, Delhi, India.
(10)Maulana Azad Medical College, New Delhi, India.
(11)Indraprastha Institute of Information Technology, Delhi, India.
(12)Division of Cardiology, University of North Carolina, Chapel Hill, NC, USA.

OBJECTIVES: COVID-19 pandemic has led to unprecedented increase in rates of 
stress and burn out among healthcare workers (HCWs). Heart rate variability 
(HRV) has been shown to be reflective of stress and burnout. The present study 
evaluated the prevalence of burnout and attempted to develop a HRV based 
predictive machine learning (ML) model to detect burnout among HCWs during 
COVID-19 pandemic.
METHODS: Mini-Z 1.0 survey was collected from 1615 HCWs, of whom 664, 512 and 
439 were frontline, second-line and non-COVID HCWs respectively. Burnout was 
defined as score ≥3 on Mini-Z-burnout-item. A 12-lead digitized ECG recording 
was performed and ECG features of HRV were obtained using feature extraction. A 
ML model comprising demographic and HRV features was developed to detect 
burnout.
RESULTS: Burnout rates were higher among second-line workers 20.5% than 
frontline 14.9% and non-COVID 13.2% workers. In multivariable analyses, features 
associated with higher likelihood of burnout were feeling stressed (OR = 6.02), 
feeling dissatisfied with current job (OR = 5.15), working in a chaotic, hectic 
environment (OR = 2.09) and feeling that COVID has significantly impacted the 
mental wellbeing (OR = 6.02). HCWs with burnout had a significantly lower HRV 
parameters like root mean square of successive RR intervals differences (RMSSD) 
[p < 0.0001] and standard deviation of the time interval between successive RR 
intervals (SDNN) [p < 0.001]) as compared to normal subjects. Extra tree 
classifier was the best performing ML model (sensitivity: 84%) CONCLUSION: In 
this study of HCWs from India, burnout prevalence was lower than reports from 
developed nations, and was higher among second-line versus frontline workers. 
Incorporation of HRV based ML model predicted burnout among HCWs with a good 
accuracy.

Copyright © 2021 Cardiological Society of India. Published by Elsevier B.V. All 
rights reserved.

DOI: 10.1016/j.ihj.2021.10.002
PMCID: PMC8522680
PMID: 34673026 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest Dr. Jha has 
received contract research grants from Acadia Pharmaceuticals and Janssen 
Research & Development, educational grant to serve as Section Editor of the 
Psychiatry & Behavioral Health Learning Network, consultant fees from Eleusis 
Therapeutics US, Inc, and honoraria for CME presentations from North American 
Center for Continuing Medical Education and Global Medical Education. Dr Qamar 
is supported by institutional grant support from the North Shore Auxiliary 
research scholar fund and has received funding from Daiichi-Sankyo, American 
Heart Association and fees for educational activities from the American College 
of Cardiology, Society for Vascular Medicine, Society for Cardiovascular 
Angiography and Interventions, Janssen and Janssen, Pfizer, Medscape, and 
Clinical Exercise Physiology Association. The remaining authors have no 
disclosures to report.


2844. Health Educ Behav. 2021 Dec;48(6):733-738. doi: 10.1177/10901981211050638. Epub 
2021 Oct 21.

Coping With COVID-19: The Impact of the Pandemic on Latina Immigrant Women's 
Mental Health and Well-being.

Ornelas IJ(1), Tornberg-Belanger S(1), Balkus JE(1), Bravo P(1), Perez Solorio 
SA(1), Perez GE(1), Tran AN(2).

Author information:
(1)University of Washington, Seattle, WA, USA.
(2)Duke University, Durham, NC, USA.

INTRODUCTION: We sought to describe how Latina immigrants living in King County 
coped with the pandemic, including their attitudes and behaviors related to 
COVID-19, and the impact of the pandemic on their mental health and wellbeing.
METHOD: We conducted surveys by phone with adult Spanish-speaking Latina 
immigrants (n = 137) in the summer of 2020.
RESULTS: Very few women had been infected with COVID-19, and 23% reported having 
been tested. Most frequent reasons for not being tested were not knowing where 
to go (14%), concerns over the cost (15%), and not wanting to know if they were 
infected (12%). Most participants had concerns about paying for housing (76%) 
and food (73%). Depression and anxiety symptoms were in the moderate range. 
Almost all participants were practicing recommended preventive behaviors.
CONCLUSION: Although few participants had COVID-19 infection, the pandemic had 
significant impacts on their mental health and ability to meet basic needs.

DOI: 10.1177/10901981211050638
PMCID: PMC9241170
PMID: 34672827 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


2845. Psychiatr Danub. 2021 Sep;33(Suppl 10):120-125.

Psychological Effects of "Double Crisis" (COVID-19 Pandemic and Earthquakes) on 
Croatian Medical Students.

Romic I(1), Silovski H, Mance M, Pavlek G, Petrovic I, Figl J, Grbavac D, Moric 
T, Romic R, Bakula B, Vulic A.

Author information:
(1)Department of Surgery, University Hospital Centre Zagreb, Kispaticeva 12, 
10000 Zagreb, Croatia, i.romic@gmail.com.

INTRODUCTION: In 2020. the COVID-19 pandemic presented an additional source of 
stress and anxiety not just to the general population but also to medical 
students who are, even under normal circumstances, constantly under pressure due 
to demanding student duties. In addition, they experienced a series of 
devastating earthquakes in and around the Zagreb region which altogether could 
have had compromised their psychological well-being. The aim of this review was 
to evaluate the psychological effects of these two natural disasters on the 
mental health of Croatian medical students.
RESULTS: According to standardized questionnaires for depression and anxiety 
evaluation, 75.3% of students were anxious and 65.2% were depressive during the 
"double crisis". No significant difference of these two outcomes was observed 
regarding genders, but it was found that first year students had a significantly 
higher anxiety score than older ones.
CONCLUSION: In such stressful situations, we should emphasize the importance of 
mental health not just of healthcare workers, but also of medical students in 
order to prevent serious psychological consequences and to alleviate the 
negative effects on students' motivation and their educational process.

PMID: 34672284 [Indexed for MEDLINE]


2846. Pflege. 2022 Apr;35(2):104-113. doi: 10.1024/1012-5302/a000846. Epub 2021 Oct 
21.

[The situation of nurses in hospitals during the second wave of the COVID-19 
pandemic: an online survey].

[Article in German; Abstract available in German from the publisher]

Mai T(1), Todisco L(1), Schilder M(2), Franke V(1), Ristau J(3).

Author information:
(1)Stabsstelle Pflegeentwicklung, Universitätsklinikum Frankfurt.
(2)Professur für Pflegewissenschaft, Evangelische Hochschule Darmstadt.
(3)Lübeck.

The situation of nurses in hospitals during the second wave of the COVID-19 
pandemic: an online survey Abstract. Background: The COVID-19 pandemic has an 
impact on stress and wellbeing of nurses. Anxiety of infection, lack of 
protective equipment and insufficient expertise in care of these patients were 
described as reasons of burnout. Aim: The influence of work-related sense of 
coherence as well as perceived organizational support on the burnout level and 
the intention to leave the job will be explored. Method: In December 2020 and 
January 2021, staff of 81 hospitals in Hessia, Germany were invited to 
participate in an online survey using the BAT (Burnout-Assessment-Tool), 
work-SoC (work-related - Sence of Coherence), the POS-s (perceived 
organizational Support - short version) and items based on a literature review. 
Results: Of 595 nurses, 47.6% showed a moderate or high burnout level, 20.7% 
want to leave the job after the pandemic. The higher the work-SoC (β = -0.467; p 
< 0.001) and the higher the POS-s (β = -0.178; p < 0.001), the lower the burnout 
level. Trainings in the organization were mentioned by 24.7% of the nurses as a 
positive factor. They missed support in mindfulness and resilience training, in 
child care and health-related topics. 55.1% did not agree that the employer does 
everything to support them. Conclusions: Regardless of the pandemic, salutogenic 
leadership is required, which deals with "moral injuries" of employees as a 
result of implicit rationing and foster health-related support.

Publisher: Zusammenfassung. Hintergrund: Die COVID-19-Pandemie hat Auswirkungen 
auf Stress und Wohlbefinden von Pflegenden. Angst vor Infektionen, fehlende 
Schutzausrüstung und mangelnde Expertise in der Pflege dieser Patient_innen 
wurden als Gründe für Burnout beschrieben. xFragestellung: Untersucht wird der 
Einfluss des arbeitsbezogenen Kohärenzgefühls sowie der wahrgenommenen 
organisationalen Unterstützung auf das Burnoutlevel und die Absicht, den 
Arbeitsplatz zu wechseln. Methode: Im Dezember 2020 und Januar 2021 wurden 
Beschäftigte von 81 Krankenhäusern in Hessen, Deutschland online befragt. Der 
Fragebogen umfasste die Instrumente BAT (Burnout-Assessment-Tool), Work-SoC 
(arbeitsbezogenes Kohärenzgefühl), POS-s (wahrgenommene organisatorische 
Unterstützung – Kurzfassung) sowie literaturbasierte Items. Ergebnisse: Von 595 
Pflegenden wiesen 47,6% ein moderates oder hohes Burnoutlevel auf; 20,7% wollen 
den Arbeitsplatz nach der Pandemie wechseln. Je höher der Work-SoC (β = –0,467; 
p < 0,001) und je höher der POS-s (β = –0,178; p < 0,001), desto niedriger ist 
das Burnoutlevel. Schulungsangebote wurden von 24,7% der Pflegenden als 
positiver Faktor genannt. Sie vermissten Achtsamkeits- und Resilienztraining, 
Angebote zur Kinderbetreuung und zu gesundheitsbezogenen Themen. 55,1% stimmten 
nicht zu, dass der Arbeitgeber alles unternimmt sie zu unterstützen. 
Schlussfolgerungen: Unabhängig von der Pandemie ist eine salutogene Führung 
erforderlich, die sich „moralischen Verletzungen“ der Beschäftigten durch 
implizite Rationierung annimmt und die gesundheitsbezogene Unterstützung 
fördert.

DOI: 10.1024/1012-5302/a000846
PMID: 34672205 [Indexed for MEDLINE]


2847. Aust J Rural Health. 2021 Oct;29(5):811-812. doi: 10.1111/ajr.12809.

COVID-19 and mental health and well-being in rural Australia.

Fitzmaurice C(1).

Author information:
(1)National Rural Health Alliance, Canberra, ACT, Australia.

DOI: 10.1111/ajr.12809
PMCID: PMC8652968
PMID: 34672055 [Indexed for MEDLINE]


2848. BMC Geriatr. 2021 Oct 20;21(1):583. doi: 10.1186/s12877-021-02551-w.

The COVID-19 pandemic as experienced by the spouses of home-dwelling people with 
dementia - a qualitative study.

Rokstad AMM(1)(2), Røsvik J(3)(4), Fossberg M(3), Eriksen S(3)(5).

Author information:
(1)Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital 
Trust, Tønsberg, Norway. anne.marie.rokstad@aldringoghelse.no.
(2)Molde University college, Faculty of Health Sciences and Social Care, Molde, 
Norway. anne.marie.rokstad@aldringoghelse.no.
(3)Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital 
Trust, Tønsberg, Norway.
(4)Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
(5)Lovisenberg Diaconal University College, Oslo, Norway.

BACKGROUND: Worldwide, restrictive measures have been taken to manage the spread 
of the COVID-19 pandemic. Social distancing and self-isolation have considerably 
affected the lives of people with dementia and their informal caregivers. The 
purpose of the study was to explore the consequences of the COVID-19 pandemic as 
experienced by the spouses of home-dwelling people with dementia in Norway.
METHODS: The study had a qualitative descriptive design using individual 
telephone interviews for data collection. A total sample of 17 spouses of people 
with dementia were included, 14 women and three men ages 52 to 82 years. A 
qualitative content analysis following six steps inspired by Graneheim and 
Lundman was used to identify the categories presented.
RESULTS: The participants emphasized four main perspectives: 1) Radical changes 
in available services, 2) Restrictions changed everyday life, 3) Impacts on 
health and well-being, and 4) Actions that made life easier. The participants 
also described how positive activities and easily accessible services helped 
them in this situation.
CONCLUSIONS: The governmental restrictions of the COVID-19 pandemic resulted in 
radical changes in available services with severe consequences for the lives and 
well-being of home-dwelling people with dementia and their spouses. Examples of 
coping strategies and possible psychosocial interventions compatible with virus 
precautions were identified. The potential of such interventions should be 
further explored to meet the needs of vulnerable groups in situations like a 
pandemic.

© 2021. The Author(s).

DOI: 10.1186/s12877-021-02551-w
PMCID: PMC8527970
PMID: 34670496 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2849. PLoS One. 2021 Oct 20;16(10):e0258027. doi: 10.1371/journal.pone.0258027. 
eCollection 2021.

Music and mood regulation during the early stages of the COVID-19 pandemic.

Hennessy S(1), Sachs M(2), Kaplan J(1), Habibi A(1).

Author information:
(1)Brain and Creativity Institute, University of Southern California, Los 
Angeles, California, United States of America.
(2)Center for Science and Society, Columbia University, New York, New York, 
United States of America.

Music listening can be an effective strategy for regulating affect, leading to 
positive well-being. However, it is unclear how differences in disposition and 
personality can impact music's affective benefits in response to acute and major 
real-world stressful events. The COVID-19 pandemic provides a unique opportunity 
to study how music is used to cope with stress, loss, and unease across the 
world. During the first month of the spread of the COVID pandemic, we used an 
online survey to test if people from four different countries used music to 
manage their emotions during quarantine and if the functions of music depended 
on empathy, anxiety, depression, or country of residence. We found a positive 
relationship between the use of music listening for affect regulation and 
current well-being, particularly for participants from India. While people with 
stronger symptoms of depression and anxiety used music differently, the end 
result was still a positive change in affect. Our findings highlight the 
universality of music's affective potency and its ability to help people manage 
an unprecedented life stressor.

DOI: 10.1371/journal.pone.0258027
PMCID: PMC8528311
PMID: 34669731 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2850. Int J Gynaecol Obstet. 2021 Oct;155 Suppl 1(Suppl 1):94-101. doi: 
10.1002/ijgo.13868.

COVID-19 and the impact on gynecologic cancer care.

Manchanda R(1)(2)(3), Oxley S(1), Ghaem-Maghami S(4), Sundar S(5).

Author information:
(1)Wolfson Institute of Preventive Medicine, Cancer Research UK Barts Centre, 
Queen Mary University of London, London, UK.
(2)Department of Gynecological Oncology, St Bartholomew's Hospital, Barts Health 
NHS Trust, London, UK.
(3)Faculty of Public Health and Policy, Department of Health Services Research, 
London School of Hygiene and Tropical Medicine, London, UK.
(4)Faculty of Medicine, Department of Surgery and Cancer, Imperial College 
London, London, UK.
(5)Institute of Cancer and Genomic Sciences, University of Birmingham, 
Birmingham, UK.

The COVID-19 pandemic resulted in significant reconfiguration of gynecologic 
cancer services and care pathways across the globe, with a transformation of 
working practices. Services had to adapt to protect their vulnerable patients 
from infection, whilst providing care despite reduced resources/capacity and 
staffing. The international gynecologic cancer community introduced modified 
clinical care guidelines. Remote working, reduced hospital visiting, routine 
COVID-testing, and use of COVID-free surgical areas/hubs enabled the ongoing and 
safe delivery of complex cancer care, with priority levels for cancer treatments 
established to guide decision-making by multidisciplinary tumor boards. Some 2.3 
million cancer surgeries were delayed or cancelled during the first peak, with 
many patients reporting significant anxiety/concern for cancer progression and 
COVID infection. Although COVID trials were prioritized, recruitment to other 
cancer trials/research activity was significantly reduced. The impact of 
resultant protocol deviations on outcomes remains to be established. During the 
recovery healthcare services must maintain capacity and flexibility to manage 
future surges of infection, address the large backlog of patients with altered 
or delayed treatments, along with salvaging screening and prevention services. 
Training needs/mental well-being of trainees need addressing and staff burnout 
prevented. Future research needs to fully evaluate the impact of COVID-19 on 
long-term patient outcomes.

International Journal of Gynecology & Obstetrics© 2021 The Authors. 
International Journal of Gynecology & Obstetrics published by John Wiley & Sons 
Ltd on behalf of International Federation of Gynecology and Obstetrics.

DOI: 10.1002/ijgo.13868
PMCID: PMC9087539
PMID: 34669200 [Indexed for MEDLINE]

Conflict of interest statement: Relating to the submitted work, RM reports grant 
funding received from BGCS to support work into COVID‐19 outcomes on gynecologic 
oncology. Outside of the submitted work, RM reports grant funding received from 
the Eve Appeal, Barts Charity, CRUK, and Rosetrees Trust and speaker/lecture 
fees from AstraZeneca and GSK. Outside of the submitted work, SG‐M is an officer 
and trustee for the BGCS and member of the RCOG Academic and eLearning Editorial 
Boards and CPD Committee. Relating to the submitted work, SS received funding 
from the BGCS for COVIDSurg‐Gynaecological cancer via the University of 
Birmingham. SO declares no conflicts of interest.


2851. Appl Psychol Health Well Being. 2022 May;14(2):347-361. doi: 10.1111/aphw.12306. 
Epub 2021 Oct 20.

The effects of gratitude and kindness on life satisfaction, positive emotions, 
negative emotions, and COVID-19 anxiety: An online pilot experimental study.

Datu JAD(1), Valdez JPM(2), McInerney DM(3), Cayubit RF(4).

Author information:
(1)Department of Special Education and Counselling, Integrated Centre for 
Wellbeing (i-WELL), The Education University of Hong Kong, Hong Kong.
(2)Department of Early Childhood Education, The Education University of Hong 
Kong, Hong Kong.
(3)Department of Special Education and Counselling, The Education University of 
Hong Kong, Hong Kong.
(4)Department of Psychology, University of Sto. Tomas, Manila, The Philippines.

The continuous surge in the number of confirmed diagnoses and fatalities 
associated with the coronavirus disease 2019 (COVID-19) has caused debilitating 
economic, educational, social, and psychological issues. However, little is 
known about how psychological interventions may boost well-being outcomes amid 
the pandemic. This research addresses this gap by examining the effects of 
gratitude and kindness interventions on life satisfaction, positive emotions, 
negative emotions, and COVID-19 anxiety via an online pilot experimental study. 
A 3-week online pilot experiment was implemented among 107 Filipino 
undergraduate students (M = 20.27; SD = 1.10). These participants were randomly 
assigned to kindness (n = 37), gratitude (n = 32), and control (n = 38) 
conditions. The results showed that there were significant differences on 
positive emotions when controlling for the baseline well-being, gratitude, and 
kindness scores across all conditions (i.e., gratitude, kindness, and control). 
Participants assigned in the gratitude and kindness conditions had significantly 
higher scores on positive emotions than those in the control condition. The 
findings point to the emotional benefits associated with promoting gratitude and 
kindness during the COVID-19 pandemic. This research contributes to scarce 
literature on the applicability of well-being interventions in non-Western 
cultural contexts.

© 2021 The International Association of Applied Psychology.

DOI: 10.1111/aphw.12306
PMCID: PMC8652666
PMID: 34668323 [Indexed for MEDLINE]


2852. Health Soc Care Community. 2022 Sep;30(5):e1805-e1814. doi: 10.1111/hsc.13609. 
Epub 2021 Oct 19.

Provision of services to persons experiencing homelessness during the COVID-19 
pandemic: A qualitative study on the perspectives of homelessness service 
providers.

Kaur S(1), Jagpal P(1), Paudyal V(1).

Author information:
(1)School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, 
Birmingham, UK.

This study aimed to explore the perspectives of homelessness service providers 
on the impact of the COVID-19 pandemic on service provision, barriers 
encountered and learning for the future. Semi-structured online interviews were 
conducted with homelessness service providers (n = 15) identified through the 
network of homelessness services operating within the United Kingdom. Data were 
transcribed verbatim and analysed thematically using framework technique. Six 
key themes were identified including the impact of the pandemic on health and 
well-being of persons experiencing homelessness (PEH); the changing needs of 
service users during the pandemic; impact of emergency provision of housing 
support on services offered; service adaptations; sustainability of services and 
learnings from the pandemic. Participants described that being able to offer 
accommodation through government schemes provided protection to PEH through 
'wrap-around support'. The pandemic was deemed to have precipitated change and 
developed resilience in some services. However, lack of resources, donations and 
sponsors during the pandemic constrained the services forcing many to close or 
offer reduced services. Reduced face-to-face contact with PEH and lack of 
ability to offer skills sessions led to the exacerbation of mental health 
concerns amongst clients. The pandemic was also identified to have encouraged 
positive relationship building between clients and service providers, better 
communications between service providers and effective housing of PEH. There is 
a need to address the barriers, sustain the positive learnings and enable 
organisations and PEH to adapt to the transition when transient and emergency 
support from the government and local councils ends.

© 2021 John Wiley & Sons Ltd.

DOI: 10.1111/hsc.13609
PMCID: PMC8653035
PMID: 34668258 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2853. J Pediatr Psychol. 2022 Feb 3;47(1):37-48. doi: 10.1093/jpepsy/jsab107.

Storm Clouds and Silver Linings: Day-to-Day Life in COVID-19 Lockdown and 
Emotional Health in Adolescent Girls.

Silk JS(1), Scott LN(2), Hutchinson EA(1), Lu C(1), Sequeira SL(1), McKone 
KMP(1), Do QB(1), Ladouceur CD(2).

Author information:
(1)Department of Psychology, University of Pittsburgh, USA.
(2)Department of Psychiatry, University of Pittsburgh, USA.

OBJECTIVE: We examined risk and protective factors for emotional health problems 
in adolescent girls during the COVID-19 pandemic. We investigated pre- to 
early-pandemic changes in symptoms of anxiety and depression, documented daily 
activities and perceived positive and negative impacts of the pandemic, and 
linked perceived positive and negative impacts of the pandemic to real-time 
changes in emotional health.
METHODS: The study was a 10-day daily diary study with 93 U.S. adolescent girls 
(aged 12-17; 68% White non-Hispanic) at temperamental risk for anxiety and 
depression, conducted in April/May 2020 when all participants were under 
state-issued stay-at-home orders. Girls provided daily reports of positive and 
negative affect, depressive and anxious symptoms, activities, and positive and 
negative impacts resulting from the pandemic.
RESULTS: Girls reported engaging in many activities that may contribute to 
well-being. Mixed effects analyses revealed positive impacts associated with 
improved same-day emotional health such as more time for family and relaxation 
and reduced pressure from school/activities. Negative impacts associated with 
poorer same-day emotional health included problems with online schooling, lack 
of space/privacy, lack of a regular schedule, and family conflict.
CONCLUSION: Findings highlight the importance of providing in-person or quality 
online schooling, resources and space for learning, promoting daily routines, 
and spending time with teens while reducing family conflict. The pandemic also 
appears to have offered many girls a respite from the chronic stress of modern 
teen life, with time to relax and engage in creative and healthy pursuits 
showing benefits for daily emotional health, which should be considered 
following the return to normal life.

© The Author(s) 2021. Published by Oxford University Press on behalf of the 
Society of Pediatric Psychology.

DOI: 10.1093/jpepsy/jsab107
PMCID: PMC8574543
PMID: 34664665 [Indexed for MEDLINE]


2854. Palliat Med. 2022 Jan;36(1):152-160. doi: 10.1177/02692163211049497. Epub 2021 
Oct 19.

'It feels it's wasting whatever time I've got left': A qualitative study of 
living with treatable but not curable cancer during the COVID-19 pandemic.

Radcliffe E(1), Khan A(2), Wright D(1), Berman R(2), Demain S(1), Foster C(1), 
Restorick-Banks S(3), Richardson A(1), Wagland R(1), Calman L(1).

Author information:
(1)University of Southampton, Southampton, UK.
(2)The Christie NHS Foundation Trust, Manchester, UK.
(3)Patient Representative, Southampton, UK.

BACKGROUND: People living with cancer that is treatable but not curable have 
complex needs, often managing health at home, supported by those close to them. 
Challenges are likely to be exacerbated during the COVID-19 pandemic and the 
risk-reducing measures introduced in response. The impact of COVID-19 on those 
living with incurable, life-threatening conditions is little understood.
AIM: To investigate the experiences and identify the impact of the COVID-19 
pandemic for people living with treatable not curable cancer and their informal 
carers.
DESIGN: Qualitative semi-structured phone interviews were conducted with 21 
patients living with cancer that is treatable but not curable and 14 carers.
SETTING/ PARTICIPANTS: Participants were part of a larger longitudinal 
qualitative study (ENABLE) on supported self-management for people living with 
cancer that is treatable but not curable.
RESULTS: The COVID-19 pandemic magnified uncertainty and anxiety and led to loss 
of opportunities to do things important to patients in the limited time they 
have left to live. Lack of face-to-face contact with loved ones had a 
significant impact on patients' and carers' emotional wellbeing. Carers 
experienced increased responsibilities but less access to formal and informal 
support and respite. While changes to treatment led to some concern about 
longer-term impact on health, most patients felt well-supported by healthcare 
teams.
CONCLUSION: The study provides rich insights into the nature of challenges, 
uncertainty and lost opportunities resulting from the COVID-19 pandemic for 
patients and carers living with cancer that is treatable but not curable, which 
has wider resonance for people living with other life-limiting conditions.

DOI: 10.1177/02692163211049497
PMCID: PMC8796164
PMID: 34664537 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of conflicting interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


2855. J Med Case Rep. 2021 Oct 18;15(1):523. doi: 10.1186/s13256-021-03104-w.

Neuropsychological and psychological dysfunctions associated with coronavirus 
disease 2019: a case report.

Damianova M(1)(2)(3).

Author information:
(1)Neurosurgery Clinic, University Multiprofile Hospital for Active Treatment 
"Saint Ivan Rilski", 15 Akademik Ivan Geshov Blvd., Sofia, Bulgaria. 
damianova.mk@gmail.com.
(2)School of Human and Community Development (Department of Psychology), 
University of the Witwatersrand, Johannesburg, South Africa. 
damianova.mk@gmail.com.
(3)School of Clinical Medicine, University of the Witwatersrand, Johannesburg, 
South Africa. damianova.mk@gmail.com.

BACKGROUND: Patient's account of personal experiences of having lived through 
coronavirus disease 2019 is important for understanding the magnitude of the 
debilitating impact of the infection. There is increasing recognition that the 
infection impedes multiple functional domains, but to date the evidence remains 
scarce. Moreover, to the author's knowledge, there are no documented cases 
reporting on research data derived from self-reflective first-person experience.
CASE PRESENTATION: The patient was a 59-year-old female psychologist of White 
self-ascribed ethnicity who had coronavirus disease 2019. She had no history of 
medical, neurological, or psychiatric conditions and works in a neurosurgery 
clinic at a large hospital as a psychologist, specializing in neuropsychology. 
Using the introspective method, she captured the occurrence of 
neuropsychological and psychological dysfunctions she experienced in the acute 
stage of the illness, which took place in December 2020 and lasted for 17 days. 
Treatment of coronavirus disease 2019 was conducted in the home environment 
under medical supervision and followed a standardized protocol adopted at the 
time in the country.
CONCLUSIONS: The data derived from the first-person experience indicated that 
among the most salient cognitive functions impacted by the disease were: 
executive control, working memory, attention, concentration, and processing 
speed. Furthermore, emotional instability; mood swings; racing, repetitive, or 
intrusive thoughts; uncontrolled associations; dizziness; fatigue; disbalance; 
and sleep disturbances featured consistently throughout the illness. The overall 
profile of these dysfunctions suggests disruption in the overall operation of 
the brain and particularly in the functioning of the frontal lobes. Although 
less tangible than the physical symptoms, the neuropsychological and 
psychological dysfunctions associated with coronavirus disease 2019 form a 
distinct cluster that has a highly debilitating impact on a person's well-being.

© 2021. The Author(s).

DOI: 10.1186/s13256-021-03104-w
PMCID: PMC8521245
PMID: 34663466 [Indexed for MEDLINE]

Conflict of interest statement: The author declares no competing interests.


2856. Transl Behav Med. 2022 Feb 16;12(2):273-283. doi: 10.1093/tbm/ibab133.

Trends in mental health symptoms, service use, and unmet need for services among 
US adults through the first 8 months of the COVID-19 pandemic.

Coley RL(1), Baum CF(2).

Author information:
(1)Department of Counseling, Developmental, and Educational Psychology, Boston 
College, Chestnut Hill, MA, USA.
(2)Department of Economics and School of Social Work, Boston College, Chestnut 
Hill, MA, USA.

Comment in
    Transl Behav Med. 2022 Jul 18;12(7):781.

Corrected and republished from
    Transl Behav Med. 2021 Oct 23;11(10):1947-1956.

The COVID-19 pandemic has led to rising morbidity, mortality, and social and 
economic disruption, likely impairing mental health. The purpose of this study 
was to track trends in mental health symptoms, use of services, and unmet need 
for services among US adults, and to delineate variation across demographic 
strata. Data were drawn from the 2020 US Household Pulse Survey from repeated 
cross-sectional online surveys collected between April 23 and November 23, 2020 
from 1,302,455 US adults, weighted to represent the US population. Survey 
respondents self-reported their symptoms of anxiety and depression, use of 
medication and counseling services, and unmet need for services. Reports of 
probable anxiety and depression rose significantly through the study period, to 
prevalence rates of 37% and 29%, respectively, by November, 2020, rates more 
than four times higher than early 2019 US norms. Use of prescription medication, 
counseling services, and unmet need for mental health services also rose 
significantly. Prevalence rates of probable mental health disorders were highest 
among young, less educated, single parent, female, Black and multi-racial 
respondents, with some vacillation in such disparities over cohorts. Young, 
female, and moderately educated respondents also reported higher unmet needs for 
services. Disparities in estimates of mental health disorders and mental health 
treatment indicate a striking disequilibrium between the potential need for and 
the use of mental health services during the COVID-19 pandemic. Rising mental 
health challenges are being borne largely by young, less advantaged people of 
color and women, with the potential for expanded interruptions to optimal 
functioning and societal recovery from COVID-19.

Plain Language Summary: The myriad stressors imposed by the COVID-19 pandemic 
have impaired mental health and wellbeing. Although evidence from early in the 
pandemic revealed elevated rates of mental health conditions, research has not 
documented whether psychological disorders have continued to rise as the 
pandemic has persisted. In this research, we assess data from over 1.3 million 
US adults who participated in cross-sectional surveys between April and 
November, 2020 to track trends in mental health disorder symptoms and services. 
Our results show that reports of anxiety and depression rose significantly from 
April to November, 2020 to rates more than four-times higher than in 2019. We 
also found evidence of growing unmet need for mental health services. Rising 
mental health challenges are being borne largely by young, less advantaged 
people of color and women. Growing disparities in mental health disorders and 
treatment raise concerns for psychological, social, and economic recovery from 
COVID-19.

© Society of Behavioral Medicine 2021. All rights reserved. For permissions, 
please e-mail: journals.permissions@oup.com.

DOI: 10.1093/tbm/ibab133
PMID: 34662427 [Indexed for MEDLINE]


2857. Hawaii J Health Soc Welf. 2021 Sep;80(9 Suppl 1):5-11.

Impact of COVID-19 on Hawai'i Community Agencies, Service Organizations, and the 
Individuals They Serve: A Snapshot from a Spring 2020 HI-EMA Survey.

Sentell T(1), Choi SY(2), Maldonado FA(3), Oyama K(4), Talana AL(1), Unciano 
S(1), Arndt RG(3), Buenconsejo-Lum LE(2), Burrage RL(3), Qureshi K(4).

Author information:
(1)Office of Public Health Studies, Thompson School of Social Work and Public 
Health, University of Hawai'i at Mānoa, Honolulu, HI (TS, ALT, SU).
(2)John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, 
HI (SYC, LEB).
(3)Department of Social Work, Thompson School of Social Work and Public Health, 
University of Hawai'i at Mānoa, Honolulu, HI (FAM, RGA, RLB).
(4)School of Nursing and Dental Hygiene at University of Hawai'i at Mānoa, 
Honolulu, HI (KO, KQ).

Health and social service organizations across Hawai'i were surveyed between 
April 29 and May 11, 2020 by the Community Care Outreach Unit of the Hawai'i 
Emergency Management Agency. This article contextualizes and describes some of 
the major findings of that survey that reveal the impact of coronavirus disease 
2019 (COVID-19) on Hawai'i community agencies, service organizations, and the 
individuals they serve. Major issues for individuals served by the responding 
organizations included securing basic needs such as food and housing as well as 
access to health services, mental health needs, and COVID-19 concerns (such as 
inadequate personal protective equipment, cleaning supplies, quarantine, and 
testing issues). Respondents reported that job loss and the resulting financial 
problems were a root cause of personal strain among clients served. 
Community-level stress was related to the distressed economy and store closures. 
Fulfilling immediate and future needs of health and social service agencies and 
the individuals they serve, as articulated in this report, could dampen the 
effect of COVID-19, promote population wellbeing, and support community 
resilience.

©Copyright 2021 by University Health Partners of Hawai‘i (UHP Hawai‘i).

PMCID: PMC8504321
PMID: 34661123 [Indexed for MEDLINE]


2858. Front Public Health. 2021 Sep 29;9:590335. doi: 10.3389/fpubh.2021.590335. 
eCollection 2021.

Public Policy Responses to Address the Mental Health Consequences of the 
COVID-19 Pandemic: Evidence From Chile.

Irarrazaval M(1)(2), Norambuena P(1)(3), Montenegro C(2)(4), Toro-Devia O(3), 
Vargas B(1), Caqueo-Urízar A(5).

Author information:
(1)Department of Mental Health, Ministry of Health, Santiago, Chile.
(2)Millenium Institute for Research in Depression and Personality, Santiago, 
Chile.
(3)School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, 
Chile.
(4)Wellcome Centre for Cultures and Environments of Health, University of 
Exeter, Exeter, United Kingdom.
(5)Instituto de Alta Investigación, Universidad de Tarapacá, Arica, Chile.

Objectives: This paper reviews the mental health policies that have been 
implemented in Chile in response to the COVID-19 pandemic and the international 
context of countries' responses. Even before the start of the pandemic, there 
were significant barriers to access mental health services in Chile, coupled 
with a scenario of nationwide social unrest and protests that questioned the 
legitimacy of public institutions; now the rapidly worsening outbreaks of 
COVID-19 are exacerbating the pre-existing mental health crisis. Methods: We 
conducted a bibliometric and content analysis of the Chilean mental health 
public policies implemented during the COVID-19 pandemic and then compared these 
policies with international experiences and emerging scientific evidence on the 
mental health impact of pandemics. Results: Our analysis of the policies 
identifies five crucial points of action developed in Chile: (i) an established 
framework to address mental health in emergency and disaster situations; (ii) a 
timely COVID-19 Mental Health Action Plan; (iii) inclusion of mental health in 
the public health agenda; (iv) development of a presidential strategy during the 
pandemic for comprehensive mental health and well-being; and (v) emerging 
research assessing the mental health implications of COVID-19. Conclusions: In 
Chile, the public policy responses to address the mental health consequences of 
the COVID-19 pandemic has been characterized by the coordinated implementation 
of mental health plans, ranging from a health sectoral initiative to 
inter-agency and intersectoral efforts. However, it is imperative that increased 
funding is allocated to mental health, and efforts should be made to promote the 
participation of people with lived experiences and communities in the design and 
implementation of the proposed actions. This aspect could be of key importance 
to social peace and community recovery after the pandemic.

Copyright © 2021 Irarrazaval, Norambuena, Montenegro, Toro-Devia, Vargas and 
Caqueo-Urízar.

DOI: 10.3389/fpubh.2021.590335
PMCID: PMC8511669
PMID: 34660500 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2859. Front Pediatr. 2021 Sep 30;9:737089. doi: 10.3389/fped.2021.737089. eCollection 
2021.

Parental Stress, Depression, and Participation in Care Before and During the 
COVID-19 Pandemic: A Prospective Observational Study in an Italian Neonatal 
Intensive Care Unit.

Bua J(1), Mariani I(2), Girardelli M(3), Tomadin M(1), Tripani A(1), Travan 
L(1), Lazzerini M(2).

Author information:
(1)Neonatal Intensive Care Unit, Institute for Maternal and Child Health IRCCS 
"Burlo Garofolo", Trieste, Italy.
(2)WHO Collaborating Centre for Maternal and Child Health, Institute for 
Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy.
(3)Department of Pediatrics, Institute for Maternal and Child Health IRCCS 
"Burlo Garofolo", Trieste, Italy.

Background: Recent studies reported, during the COVID-19 pandemic, increased 
mental distress among the general population and among women around the 
childbirth period. COVID-19 pandemic may undermine the vulnerable well-being of 
parents in Neonatal Intensive Care Units (NICUs). Objective: Our study aimed to 
explore whether parental stress, depression, and participation in care in an 
Italian NICU changed significantly over three periods: pre-pandemic (T0), low 
(T1), and high COVID-19 incidence (T2). Methods: Enrolled parents were assessed 
with the Parental Stressor Scale in the NICU (PSS:NICU), Edinburgh Postnatal 
Depression Scale (EPDS), and Index of Parental Participation (IPP). Stress was 
the study primary outcome. A sample of 108 parents, 34 for each time period, was 
estimated to be adequate to detect a difference in PSS:NICU stress occurrence 
level score (SOL) of 1.25 points between time periods. To estimate score 
differences among the three study periods a non-parametric analysis was 
performed. Correlation among scores was assessed with Spearman rank coefficient. 
Results: Overall, 152 parents were included in the study (62 in T0, 56 in T1, 
and 34 in T2). No significant differences in the median PSS:NICU, EPDS, and IPP 
scores were observed over the three periods, except for a slight increase in the 
PSS:NICU parental role sub-score in T2 (T0 3.3 [2.3-4.1] vs. T2 3.9 [3.1-4.3]; p 
= 0.038). In particular, the question regarding the separation from the infant 
resulted the most stressful aspect during T2 (T0 4.0 [4.0-5.0] vs. T2 5.0 
[4.0-5.0], p = 0.008). The correlation between participation and stress scores 
(r = 0.19-022), and between participation and depression scores (r = 0.27) were 
weak, while among depression and stress, a moderate positive correlation was 
found (r = 0.45-0.48). Conclusions: This study suggests that parental stress and 
depression may be contained during the COVID-19 pandemic, while participation 
may be ensured.

Copyright © 2021 Bua, Mariani, Girardelli, Tomadin, Tripani, Travan and 
Lazzerini.

DOI: 10.3389/fped.2021.737089
PMCID: PMC8515023
PMID: 34660492

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2860. J Psychiatr Res. 2021 Nov;143:409-415. doi: 10.1016/j.jpsychires.2021.10.001. 
Epub 2021 Oct 11.

The impact of emotion regulation and mental health difficulties on health 
behaviours during COVID19.

Cardi V(1), Albano G(2), Gentili C(3), Sudulich L(4).

Author information:
(1)Department of General Psychology, University of Padova, Padova, Italy; 
Department of Psychological Medicine, Institute of Psychiatry, Psychology and 
Neuroscience, King's College London, London, UK. Electronic address: 
valentina.cardi@unipd.it.
(2)Department of Psychology, Educational Science and Human Movement, University 
of Palermo, Palermo, Italy.
(3)Department of General Psychology, University of Padova, Padova, Italy.
(4)Department of Government, University of Essex, UK.

The COVID-19 outbreak is having a profound impact on individuals' psychological 
and physical wellbeing. The aim of this study was to assess the extent of this 
impact and its mechanisms on a sample of adults living in Italy during the first 
lockdown (April-May 2020). Two hundred ninety-two individuals (67.1% females) 
were recruited from the community through social media. They completed baseline 
online questionnaires to collect demographic information, data on past and 
present general health and health behaviours, and to assess emotion regulation 
strategies. Participants completed a brief survey to assess mood and health 
behaviours three times a week, for three weeks. Individuals with lifetime 
psychiatric disorders (about 50%) reported greater negative mood and use of 
unhealthy behaviours over time, compared to those with no psychiatric 
vulnerability. The use of cognitive reappraisal to regulate emotions was 
associated with greater resilience (i.e., feelings of hope and resourcefulness, 
and ability to seek social support and enjoyable activities). Cognitive 
reappraisal is a skill that can be trained and could be utilised to buffer the 
effect of general stress (i.e. stress caused by the pandemic) on individuals' 
wellbeing.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.jpsychires.2021.10.001
PMCID: PMC8514266
PMID: 34655950 [Indexed for MEDLINE]


2861. J Trauma Stress. 2022 Feb;35(1):330-337. doi: 10.1002/jts.22742. Epub 2021 Oct 
16.

The impact of the COVID-19 pandemic on treatment-seeking veterans in the United 
Kingdom with preexisting mental health difficulties: A longitudinal study.

Hendrikx LJ(1), Williamson C(1)(2), Baumann J(1), Murphy D(1)(2).

Author information:
(1)Combat Stress, Research Department, Tyrwhitt House, Leatherhead, Surrey, UK.
(2)King's Centre for Military Health Research, King's College London, London, 
UK.

Individuals with preexisting psychological difficulties are at risk of further 
deterioration of their mental well-being during the COVID-19 pandemic. This 
longitudinal study, conducted during the period between two national lockdowns, 
aimed to investigate the impact of the COVID-19 pandemic on veterans in the 
United Kingdom with preexisting mental health difficulties. Treatment-seeking 
veterans with preexisting mental health difficulties (N = 95) were surveyed in 
two waves. Wave 1 was conducted at the end of the first lockdown (June 2020-July 
2020), and Wave 2 took place during the second lockdown (November 2020). 
Participants completed measures to assess symptoms of posttraumatic stress 
disorder (PTSD); common mental health difficulties (CMDs), including anxiety and 
depression; anger; and alcohol use. Initial analyses revealed no significant 
changes in symptoms of PTSD, CMDs, anger, or alcohol use between the lockdowns, 
ps = .247-.986. However, veterans who experienced more COVID-19-related 
stressors were more likely to experience increases in PTSD, odds ratio 
(OR) = 6.30, p = .002, and CMD symptoms, OR = 4.32, p = .025. Participants with 
lower levels of social support during the second lockdown were more likely to 
experience increased anger difficulties, OR = 0.91, p = .025. The findings 
suggest that although mental health among veterans in the United Kingdom may 
have remained relatively stable between the two lockdowns, those who reported 
more COVID-related stressors and lower levels of social support may have been 
particularly vulnerable to symptom exacerbation. Such findings hold important 
implications for tailoring support for veterans during the COVID-19 pandemic.

Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic 
Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Traditional Chinese 
一項縱向研究探索新冠肺炎爆發對有精神健康障礙的英國退伍軍人尋求治療的影響 摘要 在新冠肺炎爆發期間, 
已有心理困難的個人存在心理健康進一步惡化的風險。這項縱向研究是在兩次國家封鎖期間進行的, 
目的是調查新冠肺炎爆發對英國已有心理健康問題的退伍軍人的影響。分兩波對有精神健康問題的尋求治療的退伍軍人 (N = 95) 
進行了調查。第一波調查是在第一次封鎖結束時進行的 (2020年6月至2020年7月) , 第二波調查是在第二次封鎖期間進行的 (2020年11月) 
。參與者完成了評估創傷後壓力症 (PTSD) 症狀的措施;常見的心理健康困難 (CMD) , 包括焦慮及抑鬱;憤怒;及酒精使用。初步分析顯示, 在封鎖期間, 
創傷後壓力症的症狀、CMDs、憤怒或酒精使用沒有明顯變化, ps = .247‐.986。然而, 
經歷了更多與新冠肺炎有關的壓力源的退伍軍人更有可能經歷創傷後壓力症的增加, 機率比 (OR) = 6.30, p = 0.002, 及CMD症狀, OR = 
4.32, p = 0.025。在第二次封鎖期間, 社會支持水平較低的參與者更有可能經歷憤怒困難的增加, OR = 0.91, p = .025。研究結果表明, 
雖然英國退伍軍人的心理健康在兩次封鎖期間可能保持相對穩定, 
但那些報告了更多與COVID有關的壓力源及較低水平的社會支持的人可能特別容易出現症狀惡化。這些發現對於在新冠肺炎爆發期間為退伍軍人提供支持具有重要意義。 
Simplified Chinese 一项纵向研究探索新冠肺炎爆发对有精神健康障碍的英国退伍军人寻求治疗的影响 摘要 在新冠肺炎爆发期间, 
已有心理困难的个人存在心理健康进一步恶化的风险。这项纵向研究是在两次国家封锁期间进行的, 
目的是调查新冠肺炎爆发对英国已有心理健康问题的退伍军人的影响。分两波对有精神健康问题的寻求治疗的退伍军人 (N = 95) 
进行了调查。第一波调查是在第一次封锁结束时进行的 (2020年6月至2020年7月) , 第二波调查是在第二次封锁期间进行的 (2020年11月) 
。参与者完成了评估创伤后压力症 (PTSD) 症状的措施;常见的心理健康困难 (CMD) , 包括焦虑及抑郁;愤怒;及酒精使用。初步分析显示, 在封锁期间, 
创伤后压力症的症状、CMDs、愤怒或酒精使用没有明显变化, ps = .247‐.986。然而, 
经历了更多与新冠肺炎有关的压力源的退伍军人更有可能经历创伤后压力症的增加, 机率比 (OR) = 6.30, p = 0.002, 及CMD症状, OR = 
4.32, p = 0.025。在第二次封锁期间, 社会支持水平较低的参与者更有可能经历愤怒困难的增加, OR = 0.91, p = .025。研究结果表明, 
虽然英国退伍军人的心理健康在两次封锁期间可能保持相对稳定, 
但那些报告了更多与COVID有关的压力源及较低水平的社会支持的人可能特别容易出现症状恶化。这些发现对于在新冠肺炎爆发期间为退伍军人提供支持具有重要意义。

© 2021 International Society for Traumatic Stress Studies.

DOI: 10.1002/jts.22742
PMCID: PMC8662124
PMID: 34655485 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
declare.


2862. J Prim Prev. 2021 Dec;42(6):641-648. doi: 10.1007/s10935-021-00649-w. Epub 2021 
Oct 15.

School Connectedness Still Matters: The Association of School Connectedness and 
Mental Health During Remote Learning Due to COVID-19.

Perkins KN(1), Carey K(1), Lincoln E(1), Shih A(1), Donalds R(1), Kessel 
Schneider S(2), Holt MK(1), Green JG(3).

Author information:
(1)Wheelock College of Education and Human Development, Boston University, 2 
Silber Way, Boston, MA, 02215, USA.
(2)Education Development Center, Waltham, MA, USA.
(3)Wheelock College of Education and Human Development, Boston University, 2 
Silber Way, Boston, MA, 02215, USA. jggreen@bu.edu.

School connectedness is consistently associated with adolescent mental health 
and well-being. We investigated whether student perceptions of school 
connectedness were associated with anxiety and depressive symptoms, even during 
remote learning due to COVID-19. In June of 2020, after 13 weeks of remote 
learning, 320 middle and high school students in one Massachusetts school 
district completed an online survey that included questions about their 
perceptions of school connectedness, social connectedness, and symptoms of 
anxiety and depression. Students were approximately evenly distributed across 
grades, with 37% in middle school (grades 6-8) and 63% in high school (grades 
9-12). School connectedness had a significant negative association with symptoms 
of anxiety and depression. This association persisted in models controlling for 
demographic factors and social connectedness. Findings indicate that school 
connectedness is associated with student mental health, even in the context of 
remote learning due to COVID-19. Schools engaged in remote learning should 
consider how to foster school connectedness as a means of supporting youth 
mental health, particularly given expected increases in the mental health needs 
of adolescents.

© 2021. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s10935-021-00649-w
PMCID: PMC8519330
PMID: 34654995 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare they have no conflict of 
interest.


2863. Aust Crit Care. 2022 Jan;35(1):34-39. doi: 10.1016/j.aucc.2021.08.006. Epub 2021 
Sep 14.

Risk perception and emotional wellbeing in healthcare workers involved in rapid 
response calls during the COVID-19 pandemic: A substudy of a cross-sectional 
survey.

Subramaniam A(1), Tiruvoipati R(2), Zuberav A(3), Wengritzky R(4), Bowden C(4), 
Wang WC(5), Wadhwa V(4).

Author information:
(1)Frankston Hospital, Peninsula Health, Australia; Peninsula Clinical School, 
Monash University, Australia; School of Public Health and Preventive Medicine, 
Monash UNiversity, Australia; The Bays Hospital, Mornington, Australia. 
Electronic address: ashwin.subramaniam@monash.edu.
(2)Frankston Hospital, Peninsula Health, Australia; Peninsula Clinical School, 
Monash University, Australia; Peninsula Private Hospital, Australia. Electronic 
address: travindranath@hotmail.com.
(3)Frankston Hospital, Peninsula Health, Australia.
(4)Peninsula Health, Australia.
(5)Cabrini Health, Monash University, Australia.

BACKGROUND: Coronavirus disease-2019 (COVID-19) has effected major changes to 
healthcare delivery within acute care settings. Rapid response calls (RRCs) in 
healthcare organisations have been effective at identifying and urgently 
managing acute clinical deterioration. Code-95 RRC were introduced to prewarn 
healthcare workers (HCWs) attending to patients suspected or confirmed with 
COVID-19 infection.
AIMS: The primary aim of the study was to identify the personal impact of the 
COVID-19 pandemic on HCWs involved in attending Code-95 RRC. We sought to 
evaluate their perception of risks and effects on wellbeing and identify 
potential opportunities for improvement at organisational levels.
METHODS: We undertook a detailed survey on HCWs attending Code-95 RRCs, 
including questions that sought to understand the impact of the pandemic as well 
as their perception of infection risk and emotional wellbeing. This was a 
substudy of the prospective cross-sectional single-centre survey of HCWs that 
was conducted over a 3-week period at Frankston Hospital, Victoria, Australia. 
We adopted a quantitative content analysis approach for free-text responses in 
this secondary analysis.
RESULTS: Four hundred two free-text comments were received from 297 respondents 
and were analysed. More than two-thirds (68%, 223/297) were female. Of all 
comments, 39% (155/402) were related to organisational issues including 
communication, confusion due to constantly changing infection control policies, 
and insufficient training. Thirty-three percent of comments (133/402) raised 
issues regarding the adequacy of personal protective equipment. Anxiety was 
reported in 25% of comments (101/402) with concerns predominantly relating to 
emotional stress and fatigue, risks of virus exposure and transmitting the 
infection to others, and COVID-19 precautions impairing care delivery.
CONCLUSION(S): Our study raises important issues that have relevance for all 
healthcare organisations in the management of patients with COVID-19. These 
include the importance of improving communication, especially when infection 
control policies are revised, optimising training, maintaining adequate personal 
protective equipment, and HCW support. Early recognition and management of these 
issues are crucial to maintain optimal healthcare delivery.

Copyright © 2021 Australian College of Critical Care Nurses Ltd. Published by 
Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.aucc.2021.08.006
PMCID: PMC8437811
PMID: 34654611 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest All authors declare no 
support from any organisation for the submitted work and no competing interests 
with regards to the submitted work.


2864. Maturitas. 2021 Nov;153:19-25. doi: 10.1016/j.maturitas.2021.07.012. Epub 2021 
Aug 6.

The impact of physical activity on psychological well-being in women aged 45-55 
years during the Covid pandemic: A mixed-methods investigation.

Lum KJ(1), Simpson EEA(2).

Author information:
(1)School of Psychology, Ulster University, Northern Ireland, UK. Electronic 
address: lum-k@ulster.ac.uk.
(2)Psychology Research Institute, Ulster University, Coleraine, Cromore Road, 
Co. Londonderry, Northern Ireland, BT52 1SA, UK. Electronic address: 
eea.simpson@ulster.ac.uk.

Evidence suggests that being physically active may improve quality of life 
through the menopausal transition. This study is one of the first to investigate 
how meeting the UK Physical Activity Guidelines (PAG) impacted quality of life, 
stress, coping and menopausal symptoms in UK midlife women, aged 45-55 years, 
during the unfolding Covid pandemic (Phase 1 quantitative, n=164). The study 
also explored their motivation to undertake regular physical activity during 
Covid lockdown (Phase 2 qualitative, n=4). An explanatory sequential 
mixed-methods design was used to collate quantitative (survey) and qualitative 
(focus group) data. Participants who met PAG experienced fewer depressive 
symptoms and less perceived stress, and had better physical and mental health 
and quality of life than women who did not. This was supported by focus group 
discussions reporting lack of facilities, time constraints, reduced social 
support and existing health complaints as barriers to physical activity. Factors 
motivating women to exercise during Covid lockdown were benefits for physical 
and mental health, and support from friends (Qualitative). Women are 
postmenopausal for one-third of their lives, and health interventions need to 
promote positive healthy ageing around menopause. Menopausal changes could be 
used by clinicians as cues to action to promote female health and well-being. 
Clinicians should be promoting the health benefits of exercise and making women 
aware of the importance of aiming to meet the PAG for optimal health benefits. 
Women should be encouraged to increase their levels of physical activity by 
making plans and setting goals and gaining support by exercising with friends or 
family, as a way to better control menopausal symptoms.

Copyright © 2021 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.maturitas.2021.07.012
PMID: 34654524 [Indexed for MEDLINE]


2865. BMC Psychiatry. 2021 Oct 15;21(1):509. doi: 10.1186/s12888-021-03505-7.

Emotional distress in the early stages of the COVID-19 related lockdowns 
depending on the severity of the pandemic and emergency measures: a comparative 
online-survey in Germany, Austria and Italy.

Eichenberg C(1), Grossfurthner M(2), Kietaibl S(3), Riboli G(2)(4), Borlimi 
R(4), Holocher-Benetka S(2).

Author information:
(1)Institute of Psychosomatics, Faculty of Medicine, Sigmund Freud University, 
Vienna, Austria. c.eichenberg@sfu.ac.at.
(2)Faculty of Psychology, Sigmund Freud University, Vienna, Austria.
(3)Faculty of Medicine, Sigmund Freud University, Vienna, Austria: Evangelical 
Hospital Vienna, Vienna, Austria.
(4)Faculty of Psychology, Sigmund Freud University, Milan, Italy.

BACKGROUND: The first wave of the COVID-19-pandemic hit different countries with 
varying degrees of severity, so that differences in the type and level of 
emergency measures were also necessary. It can be assumed that the psychological 
burden was higher in countries subjected to a more severe course of the pandemic 
(Italy) than in countries subjected to a less severe one (Germany, Austria).
OBJECTIVE: To investigate and contrast the wellbeing of the population in Italy, 
Austria, and Germany in the early phase of the first lockdown.
METHOD: Online survey on N = 4289 individuals. The questionnaire comprised a 
self-administered section, exploring the dimensions: perceived severity of 
COVID-19, perceived risk of disease, concerns related to COVID-19, emergency 
measure acceptance and emotional distress due to emergency measures; and 
standardized scales to record emotional state and coping: Stress-Coping-Style 
Questionnaire, Positive and Negative Affect Schedule, 
State-Trait-Anxiety-Inventory.
RESULTS: The three countries displayed significant differences in all 
investigated dimensions (p < .001). Italian participants assessed the COVID-19 
virus as much more dangerous (p < .001), but despite the prevalence of the 
virus, the subjective risk of disease was perceived to be lower in Italy 
(p < .001). This could be a positive effect of the restrictive curfews set by 
the government in Italy. The emergency measures were generally perceived to be 
very effective in all three countries, but due to the duration and the severity 
of the measures, the fear and stress-reaction were the strongest among Italian 
participants (p < .001).
CONCLUSION: The stricter measures in Italy prevented an application of many 
positive stress processing strategies, which, in turn, fostered the perpetuation 
of stresses and fear.

© 2021. The Author(s).

DOI: 10.1186/s12888-021-03505-7
PMCID: PMC8518266
PMID: 34654389 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2866. Nurse Educ Pract. 2021 Nov;57:103228. doi: 10.1016/j.nepr.2021.103228. Epub 2021 
Oct 7.

Prevalence of mental health problems and sleep disturbances in nursing students 
during the COVID-19 pandemic: A systematic review and meta-analysis.

Mulyadi M(1), Tonapa SI(2), Luneto S(3), Lin WT(4), Lee BO(5).

Author information:
(1)College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan; School 
of Nursing, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia. 
Electronic address: mulyadi@unsrat.ac.id.
(2)College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan; School 
of Nursing, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia. 
Electronic address: santo.imanuel@unsrat.ac.id.
(3)RSUP Prof. Dr. R.D. Kandou, Manado, Indonesia; Muhammadiyah School of Health 
Science, Manado, Indonesia. Electronic address: suwandi.er@gmail.com.
(4)College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan. 
Electronic address: weitingl@kmu.edu.tw.
(5)College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan. 
Electronic address: biholee@kmu.edu.tw.

Comment in
    Evid Based Nurs. 2022 Jan;25(1):8-9.

AIM: To identify the prevalence of mental health problems and sleep disturbances 
among nursing students during the COVID-19 pandemic.
BACKGROUND: As a future professional workforce, nursing students are expected to 
play a role in controlling the COVID-19 pandemic; however, physical and mental 
health problems may hinder their willingness to stay in the nursing profession. 
Evidence of the prevalence of the health problems among nursing students related 
to COVID-19 may allow educators to manage their students' health problems and 
make them feel more positive about their future careers.
DESIGN: Systematic review and meta-analysis. This study was prospectively 
registered with PROSPERO.
DATA SOURCES: Databases, including CINAHL, Embase, PubMed and Web of Science, 
were searched for all related journal articles, from database inception to June 
29, 2021, published between 2020 and 2021.
METHODS: This review was conducted following Preferred Reporting Items for 
Systematic Reviews and Meta-Analyses (PRISMA) guidelines using a PICOS search 
strategy. A DerSimonian-Laird random-effects model was used to estimate the 
prevalence and potential heterogeneity among the selected studies using the 
Cochran Q statistic and I-square test. Publication bias was assessed using the 
Egger intercept test.
RESULTS: Seventeen studies were included in the meta-analysis, representing 
13,247 nursing students. During the COVID-19 pandemic, the prevalence of four 
health problems and sleep disturbances were identified. The health problem with 
the highest prevalence in nursing students was depression (52%). Other 
COVID-19-related health problems were fear (41%), anxiety (32%) and stress (30%) 
and sleep disturbances (27%).
CONCLUSIONS: The findings from this study showed that strategies are necessary 
to manage nursing students' teaching and learning during the COVID-19 pandemic 
or similar future situations. Our results suggest that preparing modified 
distance learning might reduce the prevalence of health problems related to the 
educational process. In addition, providing regular mental health assessments or 
online mental health services to students may improve their mental health and 
increase their well-being. Nursing education policies regarding clinical 
practice remain to be formulated to ensure the achievement of competencies to 
support future careers while considering the mental readiness and safety of 
students.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.nepr.2021.103228
PMCID: PMC8496961
PMID: 34653783 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no known 
competing financial interests or personal relationships that could have appeared 
to influence the work reported in this paper.


2867. PLoS One. 2021 Oct 15;16(10):e0258778. doi: 10.1371/journal.pone.0258778. 
eCollection 2021.

Self-reported impact of the COVID-19 pandemic, affective responding, and 
subjective well-being: A Swedish survey.

Gröndal M(1), Ask K(1), Luke TJ(1), Winblad S(1).

Author information:
(1)Department of Psychology, University of Gothenburg, Gothenburg, Sweden.

A rapid stream of research confirms that the COVID-19 pandemic is a global 
threat to mental health and psychological well-being. It is therefore important 
to identify both hazardous and protective individual factors during the 
pandemic. The current research explored the relationships between self-reported 
affective responding, perceived personal consequences of the COVID-19 pandemic, 
and subjective well-being. An online survey (N = 471) conducted in Sweden 
between June and September, 2020, showed that higher levels of irritability, 
impulsivity, and the tendency to experience and express anger were generally 
associated with more severe personal consequences of the pandemic, particularly 
in areas related to family life, work/study, and finances. While more severe 
impacts of the pandemic in these areas of life were directly associated with 
lower subjective well-being, emotion regulation through cognitive reappraisal 
appeared to moderate the extent to which consequences of the pandemic in other 
areas of life (i.e., social, free-time and physical activities) translated into 
decreased well-being. This suggests that cognitive reappraisal may serve to 
protect against some of the debilitating effects of the COVID-19 pandemic on 
mental health. Overall, the results indicate that the perceived consequences of 
the pandemic are multifaceted and that future research should examine these 
consequences using a multidimensional approach.

DOI: 10.1371/journal.pone.0258778
PMCID: PMC8519461
PMID: 34653222 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2868. PLoS One. 2021 Oct 14;16(10):e0257983. doi: 10.1371/journal.pone.0257983. 
eCollection 2021.

Psychological distress among healthcare providers during COVID-19 in Asia: 
Systematic review and meta-analysis.

Ching SM(1)(2)(3)(4), Ng KY(1), Lee KW(5)(6), Yee A(7), Lim PY(8), Ranita H(9), 
Devaraj NK(1)(2), Ooi PB(3), Cheong AT(1).

Author information:
(1)Department of Family Medicine, Faculty of Medicine and Health Sciences, 
Universiti Putra Malaysia, Serdang Selangor, Malaysia.
(2)Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, 
Selangor, Malaysia.
(3)Department of Medical Sciences, School of Medical and Life Sciences, Sunway 
University, Bandar Sunway, Selangor, Malaysia.
(4)Centre for Research, Bharath Institute of Higher Education and Research, 
Selaiyur, Chennai, Tamil Nadu, India.
(5)Department of Pre-Clinical Sciences, Faculty of Medicine and Health Sciences, 
Universiti Tunku Abdul Rahman, Kajang, Malaysia.
(6)Centre for Research on Communicable Diseases, Universiti Tunku Abdul Rahman, 
Kajang, Malaysia.
(7)Department of Psychological Medicine, Faculty of Medicine, University Malaya, 
Kuala Lumpur, Malaysia.
(8)Department of Community Health, Faculty of Medicine and Health Sciences, 
Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
(9)Universiti Malaya Library, Universiti Malaya, Kuala Lumpur, Malaysia.

INTRODUCTION: COVID-19 pandemic is having a devastating effect on the mental 
health and wellbeing of healthcare providers (HCPs) globally. This review is 
aimed at determining the prevalence of depression, anxiety, stress, fear, 
burnout and resilience and its associated factors among HCPs in Asia during the 
COVID-19 pandemic.
MATERIAL AND METHODS: We performed literature search using 4 databases from 
Medline, Cinahl, PubMed and Scopus from inception up to March 15, 2021 and 
selected relevant cross-sectional studies. Publication bias was assessed using 
funnel plot. Random effects model was used to estimate the pooled prevalence 
while risk factors were reported in odds ratio (OR) with 95% CI.
RESULTS: We included 148 studies with 159,194 HCPs and the pooled prevalence for 
depression was 37.5% (95%CI: 33.8-41.3), anxiety 39.7(95%CI: 34.3-45.1), stress 
36.4% (95%CI: 23.2-49.7), fear 71.3% (95%CI: 54.6-88.0), burnout 68.3% (95%CI: 
54.0-82.5), and low resilience was 16.1% (95%CI: 12.8-19.4), respectively. The 
heterogeneity was high (I2>99.4%). Meta-analysis reported that both females (OR 
= 1.48; 95% CI = 1.30-1.68) and nurses (OR = 1.21; 95%CI = 1.02-1.45) were at 
increased risk of having depression and anxiety [(Female: OR = 1.66; 95% CI = 
1.49-1.85), (Nurse: OR = 1.36; 95%CI = 1.16-1.58)]. Females were at increased 
risk of getting stress (OR = 1.59; 95%CI = 1.28-1.97).
CONCLUSION: In conclusion, one third of HCPs suffered from depression, anxiety 
and stress and more than two third of HCPs suffered from fear and burnout during 
the COVID-19 pandemic in Asia.

DOI: 10.1371/journal.pone.0257983
PMCID: PMC8516240
PMID: 34648526 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2869. J Racial Ethn Health Disparities. 2022 Dec;9(6):2077-2089. doi: 
10.1007/s40615-021-01146-w. Epub 2021 Oct 14.

2020 Syndemic: Convergence of COVID-19, Gender-Based Violence, and Racism 
Pandemics.

Khanlou N(1), Vazquez LM(2), Pashang S(3), Connolly JA(2), Ahmad F(2), Ssawe 
A(4).

Author information:
(1)Faculty of Health, York University, 4700 Keele Street, ON, M3J 1P3, Toronto, 
Canada. nkhanlou@yorku.ca.
(2)Faculty of Health, York University, 4700 Keele Street, ON, M3J 1P3, Toronto, 
Canada.
(3)Faculty of Social and Community Services, Humber Institute of Technology and 
Advanced Learning, ON, Toronto, Canada.
(4)Newcomers, Families and Clinical Programs and Services, South Riverdale 
Community Health Centre, ON, Toronto, Canada.

OBJECTIVE: To conduct a rapid knowledge synthesis of literature on the social 
determinants of mental health of racialized women exposed to gender-based 
violence (GBV) during the COVID-19 pandemic.
METHODS: We adapted the Cochrane Rapid Reviews method and were guided by an 
equity lens in conducting rapid reviews on public health issues. Four electronic 
databases (Cochrane CENTRAL, Medline, ProQuest, and EBSCO), electronic news 
media, Google Scholar, and policy documents were searched for literature between 
January 2019 and October 2020 with no limitations for location. Fifty-five 
articles qualified for the review.
RESULTS: Health emergencies heighten gender inequalities in relation to income, 
employment, job security, and working conditions. Household stress and 
pandemic-related restrictions (social distancing, closure of services) increase 
women's vulnerability to violence. Systemic racism and discrimination intensify 
health disparities.
CONCLUSION: Racialized women are experiencing a 2020 Syndemic: a convergence of 
COVID-19, GBV, and racism pandemics, placing their wellbeing at a 
disproportionate risk. GBV is a public health issue and gender-responsive 
COVID-19 programming is essential. Anti-racist and equity-promoting policies to 
GBV service provision and disaggregated data collection are required.

© 2021. The Author(s).

DOI: 10.1007/s40615-021-01146-w
PMCID: PMC8515913
PMID: 34648144 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


2870. Pediatr Res. 2022 Mar;91(4):853-861. doi: 10.1038/s41390-021-01751-9. Epub 2021 
Oct 14.

Psychological risks to mother-infant bonding during the COVID-19 pandemic.

Liu CH(1)(2)(3), Hyun S(4)(5), Mittal L(6)(5), Erdei C(4)(5).

Author information:
(1)Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 
Boston, MA, USA. chliu@bwh.harvard.edu.
(2)Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA. 
chliu@bwh.harvard.edu.
(3)Harvard Medical School, Boston, MA, USA. chliu@bwh.harvard.edu.
(4)Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 
Boston, MA, USA.
(5)Harvard Medical School, Boston, MA, USA.
(6)Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA.

Comment in
    Pediatr Res. 2022 Mar;91(4):725-726.

BACKGROUND: The purpose of this study was to examine the association between 
mental health symptoms, along with psychological experiences and coronavirus 
disease 2019 (COVID-19) related concerns, and self-reported maternal-infant 
bonding experiences of postpartum women.
METHODS: Using data collected from May 19 to August 17, 2020, this 
cross-sectional online study assessed 429 women to better understand the impact 
of the COVID-19 pandemic on women during the postpartum period. Enrolled 
respondents were asked to participate in a 30-45-min online survey about 
COVID-19-related experiences, pregnancy, stress, and well-being.
RESULTS: Postpartum women's depressive symptoms were related to lower quality 
maternal-infant bonding, but the anxiety symptoms were not associated with 
bonding. Maternal self-efficacy, but not social support, was associated with 
mothers' higher quality of maternal-infant bonding. COVID-19-related grief was 
significantly associated with lower quality bonding. On the other hand, 
COVID-19-related health worries were associated with higher quality of 
maternal-infant bonding.
CONCLUSIONS: We describe potential psychological risk factors to maternal-infant 
bonding among postpartum women during the pandemic period. To best support the 
medical and psychological well-being of the mothers and infants, enhanced 
interdisciplinary partnerships among perinatal healthcare professionals involved 
in primary and/or specialty care is needed.
IMPACT: Unique COVID-19-related health and grief concerns exist, with 
implications for maternal-infant bonding. Depression but not anxiety is 
associated with lower maternal-infant bonding. Caregiving confidence, but not 
social support, is associated with higher maternal-infant bonding. It is 
critical to screen for postpartum depression and COVID-19-related grief during 
maternal follow-up and pediatric visits. Study findings inform and prioritize 
pediatric interventions toward enhancing maternal-infant bonding during the 
COVID-19 era.

© 2021. The Author(s), under exclusive licence to the International Pediatric 
Research Foundation, Inc.

DOI: 10.1038/s41390-021-01751-9
PMCID: PMC9008072
PMID: 34645943 [Indexed for MEDLINE]

Conflict of interest statement: Disclosure statement: Authors have no financial 
ties to products in the study or potential/perceived conflicts of interest.


2871. BMC Health Serv Res. 2021 Oct 13;21(1):1089. doi: 10.1186/s12913-021-07103-x.

'Fix the issues at the coalface and mental wellbeing will be improved': a 
framework analysis of frontline NHS staff experiences and use of health and 
wellbeing resources in a Scottish health board area during the COVID-19 
pandemic.

Clarissa C(1), Quinn S(1), Stenhouse R(2).

Author information:
(1)Nursing Studies, School of Health in Social Science, University of Edinburgh, 
Elsie Inglis Quad, Teviot Place, EH8 9AG, Edinburgh, United Kingdom.
(2)Nursing Studies, School of Health in Social Science, University of Edinburgh, 
Elsie Inglis Quad, Teviot Place, EH8 9AG, Edinburgh, United Kingdom. 
Rosie.Stenhouse@ed.ac.uk.

BACKGROUND: Frontline healthcare staff working in pandemics have been reported 
to experience mental health issues during the early and post-peak stages. To 
alleviate these problems, healthcare organisations have been providing support 
for their staff, including organisational, cognitive behavioural and physical 
and mental relaxation interventions. This paper reports the findings of a study 
commissioned by a Scottish NHS health board area during the initial outbreak of 
COVID-19. The study aimed to understand the experience of NHS staff relating to 
the provision of wellbeing interventions between March and August 2020.
METHODS: Data were gathered from free-text comments of eight surveys completed 
by a wide range of staff across sites within one NHS health board in Scotland. 
We conducted a framework analysis of the data.
RESULTS: Our findings show that despite the provision of relaxational and 
cognitive behavioural interventions to support staff wellbeing during the early 
months of the COVID-19 pandemic, there were barriers to access, including heavy 
workload, understaffing, inconvenient locations and the stigma of being judged. 
Organisational factors were the most frequently reported support need amongst 
frontline staff across sites.
CONCLUSIONS: While relaxational and cognitive behavioural interventions were 
well received by staff, barriers to accessing them still existed. Staff support 
in the context of organisational factors, such as engagement with managers was 
deemed as the most important for staff wellbeing. Managers play a key role in 
everyday organisational processes and therefore are in the right position to 
meet increasing frontline staff demands due to the pandemic and removing 
barriers to accessing wellbeing support. Healthcare managers should be aware of 
organisational factors that might increase job demands and protect 
organisational resources that can promote wellbeing for frontline staff.

© 2021. The Author(s).

DOI: 10.1186/s12913-021-07103-x
PMCID: PMC8513559
PMID: 34645439 [Indexed for MEDLINE]

Conflict of interest statement: No potential conflict of interest was reported 
by the authors.


2872. BMC Oral Health. 2021 Oct 13;21(1):520. doi: 10.1186/s12903-021-01871-y.

Associations between psychological wellbeing, depression, general anxiety, 
perceived social support, tooth brushing frequency and oral ulcers among adults 
resident in Nigeria during the first wave of the COVID-19 pandemic.

Folayan MO(1), Ibigbami OI(2), Oloniniyi IO(2), Oginni O(2), Aloba O(2).

Author information:
(1)Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, 
Nigeria. toyinukpong@yahoo.co.uk.
(2)Department of Mental Health, Obafemi Awolowo University, Ile-Ife, Nigeria.

INTRODUCTION: The aims of this study were to determine the associations between 
psychological wellbeing, and the frequency of tooth brushing and presence of 
oral ulcers during the COVID-19 pandemic; and to identify the mediating roles of 
psychological distress (general anxiety and depression) and perceived social 
support in the paths of observed associations.
METHODS: This cross-sectional study recruited 996 adults in Nigeria between June 
and August 2020. Data collected through an online survey included outcome 
variables (decreased frequency of tooth brushing and presence of oral ulcers), 
explanatory variable (psychological wellbeing), mediators (general anxiety 
symptoms, depression symptoms and perceived social support) and confounders 
(age, sex at birth, educational and employment status). Multivariate logistic 
regression was used to determine the risk indicators for the outcome variables. 
A path analysis was conducted to identify the indirect effect of mediators on 
the association between the outcome and explanatory variables.
RESULTS: Of the 966 respondents, 96 (9.9%) reported decreased tooth-brushing 
frequency and 129 (13.4%) had oral ulcers during the pandemic. The odds of 
decreased tooth-brushing during the pandemic decreased as the psychological 
wellbeing increased (AOR: 0.87; 95% CI: 0.83-0.91; p < 0.001) and as generalized 
anxiety symptoms increased (AOR: 0.92; 95% CI: 0.86-0.98; p = 0.009). The odds 
of having an oral ulcer was higher as the generalized anxiety symptoms increased 
(AOR: 1.15; 95% CI: 01.08-1.21; p < 0.001). Only generalized anxiety (indirect 
effect: 0.02; 95% CI: 0.01-0.04; P = 0.014) significantly mediated the 
relationship between wellbeing and tooth-brushing accounting for approximately 
12% of the total effect of wellbeing on decreased toothbrushing. Generalized 
anxiety (indirect effect 0.05; 95% CI: - 0.07-0.03; P < 0.001) also 
significantly mediated the relationship between wellbeing and presence of oral 
ulcer accounting for 70% of the total effect of wellbeing on presence of oral 
ulcer. Depressive symptoms and perceived social support did not significantly 
mediate the associations between psychological wellbeing, decreased frequency of 
tooth brushing and the presence of oral ulcers.
CONCLUSION: Patients who come into the dental clinic with poor oral hygiene or 
oral ulcers during the COVID-19 pandemic may benefit from screening for 
generalized anxiety and psychological wellbeing to identify those who will 
benefit from interventions for mental health challenges.

© 2021. The Author(s).

DOI: 10.1186/s12903-021-01871-y
PMCID: PMC8510883
PMID: 34645423 [Indexed for MEDLINE]

Conflict of interest statement: Morenike Oluwatoyin Folayan is a senior 
editorial consultant with BMC Oral Health. All other authors declare no conflict 
of interest.


2873. Epidemiol Health. 2021;43:e2021078. doi: 10.4178/epih.e2021078. Epub 2021 Oct 6.

Maternal mental health in Africa during the COVID-19 pandemic: a neglected 
global health issue.

Ajayi KV(1)(2)(3), Wachira E(4), Bolarinwa OA(5)(6), Suleman BD(1).

Author information:
(1)Education, Direction, Empowerment, and Nurturing (EDEN) Foundation, Abuja, 
Nigeria.
(2)Department of Health and Kinesiology, Texas A&M University, College Station, 
TX, USA.
(3)Laboratory of Community Systems and Sciences, Texas A&M University, College 
Station, TX, USA.
(4)Department of Health and Human Performance, Texas A&M University, Commerce, 
TX, USA.
(5)Department of Public Health Medicine, School of Nursing and Public Health, 
University of KwaZulu-Natal, Durban, South Africa.
(6)Obaxlove Consult, Lagos, Nigeria.

The coronavirus disease 2019 (COVID-19) pandemic has profoundly impacted mental 
health and well-being around the globe. Public health measures to control the 
virus's rapid spread, such as physical distancing, social isolation, lockdown, 
restricted movements, and quarantine, caused fear and panic in the general 
population. Although pandemic-related stressors have been reported, changes that 
occur during the perinatal period compounded by those made to obstetric care 
guidelines may put pregnant and postpartum mothers at an increased risk of poor 
mental health. While an abundance of research has examined the impact of the 
pandemic on maternal mental health in developed nations such as Europe and 
America, very few studies have done so in the African continent. Considering 
that Africa has prominently weak health systems, poor mental health policies and 
infrastructure, high poverty rates, and unreliable maternal care, the pandemic 
is expected to have dire consequences on maternal mental health in the region. 
As such, multipronged mental health interventions and strategies that consider 
the heterogeneity within and between African regions must be developed. Doing so 
will close existing and widening global health disparities to achieve the United 
Nations Sustainable Development Goals by 2030.

DOI: 10.4178/epih.e2021078
PMCID: PMC8854782
PMID: 34645206 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
declare for this study.


2874. PLoS One. 2021 Oct 13;16(10):e0258493. doi: 10.1371/journal.pone.0258493. 
eCollection 2021.

Depression, anxiety and stress symptoms in Brazilian university students during 
the COVID-19 pandemic: Predictors and association with life satisfaction, 
psychological well-being and coping strategies.

Lopes AR(1), Nihei OK(1).

Author information:
(1)Education, Languages and Health Center, Western Parana State University 
(UNIOESTE), Foz do Iguaçu, Parana, Brazil.

BACKGROUND: The COVID-19 pandemic raises concerns about the mental health of the 
world population. Protection measures to prevention the disease impacted 
education and undergraduate students were exposed to additional stressors.
OBJECTIVES: Analyze depression, anxiety and stress symptoms in undergraduates, 
their respective predictors and the association with satisfaction with life, 
psychological well-being and coping strategies.
METHODS: An online cross-sectional study was conducted from September 14 to 
October 19, 2020, involving undergraduate students enrolled in 33 courses from 5 
public university campuses in the state of Parana, Brazil, using: questionnaire 
with sociodemographic, academic, health and pandemic effects variables; 
Depression, Anxiety and Stress Scale-21 (DASS-21); Satisfaction with Life Scale 
(SWLS); Psychological Well-Being (PWB); BriefCOPE. The convenience sample was 
composed of 1,224 participants, with 18 years old or older, that completed all 
research instruments. Spearman correlation and logistic analysis (univariate and 
multivariate) were applied to the collected data.
RESULTS: Most of the undergraduates presented symptoms of depression (60.5%), 
anxiety (52.5%) and stress (57.5%). Depression, anxiety and stress presented 
significant correlations in common: negative with satisfaction with life, all 
dimensions of psychological well-being, and 3 adaptive copings (active coping, 
planning, positive reframing); positive with 5 maladaptive copings (behavioral 
disengagement, denial, self-blame, self-distraction, substance use). In 
addition, there were 7 common predictors for symptoms of depression, anxiety and 
stress: female; age 18-24 years old; having a chronic disease; lower scores in 2 
dimensions of psychological well-being (positive relations with others, 
self-acceptance); higher scores in 2 maladaptive copings (self-blame, substance 
use).
CONCLUSIONS: The data indicate a high prevalence of symptoms of depression, 
anxiety and stress, and suggest that higher scores of satisfaction with life, 
psychological well-being dimensions and adaptive copings may present protective 
effects in undergraduates during a pandemic crisis.

DOI: 10.1371/journal.pone.0258493
PMCID: PMC8513908
PMID: 34644347 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2875. Issues Ment Health Nurs. 2022 Apr;43(4):300-307. doi: 
10.1080/01612840.2021.1978598. Epub 2021 Oct 13.

Psychological Impact of the COVID-19 Pandemic on Mental Health Nurses.

King M(1), Farrington A(1), Donohue G(2), McCann E(2).

Author information:
(1)Nurse Education Centre, St. Patrick's Mental Health Services, Dublin, 
Ireland.
(2)Trinity Centre for Practice and Healthcare Innovation, School of Nursing and 
Midwifery, Trinity College, University of Dublin, Dublin, Ireland.

The aim of this research was to assess the psychological effects of the novel 
coronavirus disease (COVID-19) on mental health nurses. An internet-based 
questionnaire that included the Impact of Event Scale-Revised (IES-R) and the 
Zung Self Rating Anxiety Score (SAS) was used to assess the impact of the 
pandemic on the wellbeing of mental health nurses in an Irish mental health 
service. Among the nurses surveyed (n = 161), 12% of the participants had an 
overall IES-R score from 24 to 32 indicating that posttraumatic stress disorder 
(PTSD) was a clinical concern, while 38% had an overall IES-R score >32 
indicating that PTSD was a probable diagnosis. The mean SAS score that had been 
converted to anxiety index scores was 40.78 (SD = 9.25). The results showed that 
30% of mental health nurses experienced anxiety levels from moderate to extreme. 
Overall findings confirm that mental health nurses are experiencing 
psychological distress as a result of working during the COVID-19 pandemic. 
Nurses who were <30 years of age or who were in their current roles for less 
than a year or were ward-based and worked full-time, were most likely to be 
affected. Working during COVID-19 has not been routine work practice and for a 
cohort of workers who are already under pressure, the sacrifice in terms of 
general well-being has been immense. The offer of individualized psychological 
support for mental health nurses working during the pandemic should be both 
practical in nature and flexible enough to meet individual needs.

DOI: 10.1080/01612840.2021.1978598
PMID: 34644213 [Indexed for MEDLINE]


2876. Curr Psychiatry Rep. 2021 Oct 13;23(12):80. doi: 10.1007/s11920-021-01295-z.

Children and Adolescents with Disabilities and Exposure to Disasters, Terrorism, 
and the COVID-19 Pandemic: a Scoping Review.

Mann M(1), McMillan JE(2), Silver EJ(2), Stein REK(2).

Author information:
(1)Department of Pediatrics, Albert Einstein College of Medicine/Children's 
Hospital at Montefiore, Bronx, NY, USA. mmann@montefiore.org.
(2)Department of Pediatrics, Albert Einstein College of Medicine/Children's 
Hospital at Montefiore, Bronx, NY, USA.

PURPOSE OF REVIEW: This paper reviews the empirical literature on exposures to 
disaster or terrorism and their impacts on the health and well-being of children 
with disabilities and their families since the last published update in 2017. We 
also review the literature on studies examining the mental health and 
functioning of children with disabilities during the COVID-19 pandemic.
RECENT FINDINGS: Few studies have examined the effects of disaster or terrorism 
on children with disabilities. Research shows that children with disabilities 
and their families have higher levels of disaster exposure, lower levels of 
disaster preparedness, and less recovery support due to longstanding 
discriminatory practices. Similarly, many reports of the COVID-19 pandemic have 
documented its negative and disproportionate impacts on children with 
disabilities and their families. In the setting of climate change, environmental 
disasters are expected to increase in frequency and severity. Future studies 
identifying mitigating factors to disasters, including COVID-19; increasing 
preparedness on an individual, community, and global level; and evaluating 
post-disaster trauma-informed treatment practices are imperative to support the 
health and well-being of children with disabilities and their families.

© 2021. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s11920-021-01295-z
PMCID: PMC8511280
PMID: 34643813 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


2877. Eur Arch Psychiatry Clin Neurosci. 2022 Feb;272(1):53-66. doi: 
10.1007/s00406-021-01340-1. Epub 2021 Oct 13.

The impact of COVID-19-related distress on levels of depression, anxiety and 
quality of life in psychogeriatric patients.

Miklitz C(#)(1)(2), Westerteicher C(#)(3)(4), Lippold S(3)(4), Ochs L(3)(4), 
Schneider A(3)(4), Fliessbach K(3)(4).

Author information:
(1)Department of Neurodegenerative Diseases and Geriatric Psychiatry, University 
of Bonn, Bonn, Germany. Carolin.Miklitz@ukbonn.de.
(2)German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany. 
Carolin.Miklitz@ukbonn.de.
(3)Department of Neurodegenerative Diseases and Geriatric Psychiatry, University 
of Bonn, Bonn, Germany.
(4)German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.
(#)Contributed equally

Within the elderly population, psychogeriatric patients may be particularly 
susceptible to negative mental health effects of the coronavirus crisis. 
Detailed information about the psychosocial well-being of psychogeriatric 
patients during the pandemic is still sparse. Here we examined which aspects of 
subjective experience of the COVID-19 pandemic especially affect levels of 
depression, anxiety and quality of life in psychogeriatric patients with and 
without cognitive impairment. A cross-sectional paper survey was conducted 
during the first German lockdown among patients with a diagnosed psychiatric 
disorder (≥ 60 years) or a diagnosed neurodegenerative disease (regardless of 
their age) from the department for neurodegenerative diseases and geriatric 
psychiatry at the University of Bonn. The WHO-5-, GAD-7- and WHOQOL-old score 
were used to determine levels of depression, anxiety and quality of life. The 
second part obtained information about the subjective experience of the COVID-19 
pandemic. Statistical analysis included among others principal component 
analysis and multiple linear regression analysis. COVID-19-related, immediate 
distress was a strong predictor of elevated symptoms of depression, anxiety and 
a reduced quality of life. COVID-19-related concerns regarding health and 
financial security, however, were not significantly associated with negative 
mental health outcomes. The overall prevalence of symptoms of depression (50.8% 
[95% CI 43.8-57.6%]) and anxiety (32.7% [95% CI 26.4-39.2%]) among 
psychogeriatric patients was high. Our findings indicate that psychogeriatric 
patients are not significantly affected by COVID-19-related concerns but are 
primarily suffering from emotional consequences resulting from changed living 
conditions due to the pandemic.

© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

DOI: 10.1007/s00406-021-01340-1
PMCID: PMC8511612
PMID: 34643799 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


2878. J Med Internet Res. 2021 Oct 13;23(10):e27507. doi: 10.2196/27507.

Building the Digital Mental Health Ecosystem: Opportunities and Challenges for 
Mobile Health Innovators.

Spadaro B(#)(1), Martin-Key NA(#)(1), Bahn S(1)(2).

Author information:
(1)Cambridge Centre for Neuropsychiatric Research, Department of Chemical 
Engineering and Biotechnology, University of Cambridge, Cambridge, United 
Kingdom.
(2)Psyomics Ltd, Cambridge, United Kingdom.
(#)Contributed equally

Digital mental health technologies such as mobile health (mHealth) tools can 
offer innovative ways to help develop and facilitate mental health care 
provision, with the COVID-19 pandemic acting as a pivot point for digital health 
implementation. This viewpoint offers an overview of the opportunities and 
challenges mHealth innovators must navigate to create an integrated digital 
ecosystem for mental health care moving forward. Opportunities exist for 
innovators to develop tools that can collect a vast range of active and passive 
patient and transdiagnostic symptom data. Moving away from a symptom-count 
approach to a transdiagnostic view of psychopathology has the potential to 
facilitate early and accurate diagnosis, and can further enable personalized 
treatment strategies. However, the uptake of these technologies critically 
depends on the perceived relevance and engagement of end users. To this end, 
behavior theories and codesigning approaches offer opportunities to identify 
behavioral drivers and address barriers to uptake, while ensuring that products 
meet users' needs and preferences. The agenda for innovators should also include 
building strong evidence-based cases for digital mental health, moving away from 
a one-size-fits-all well-being approach to embrace the development of 
comprehensive digital diagnostics and validated digital tools. In particular, 
innovators have the opportunity to make their clinical evaluations more 
insightful by assessing effectiveness and feasibility in the intended context of 
use. Finally, innovators should adhere to standardized evaluation frameworks 
introduced by regulators and health care providers, as this can facilitate 
transparency and guide health care professionals toward clinically safe and 
effective technologies. By laying these foundations, digital services can become 
integrated into clinical practice, thus facilitating deeper technology-enabled 
changes.

©Benedetta Spadaro, Nayra A Martin-Key, Sabine Bahn. Originally published in the 
Journal of Medical Internet Research (https://www.jmir.org), 13.10.2021.

DOI: 10.2196/27507
PMCID: PMC8552100
PMID: 34643537 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: SB is a director of 
Psynova Neurotech Ltd and Psyomics Ltd. SB and NAMK have financial interests in 
Psyomics Ltd. BS reports no conflicts of interest.


2879. J Paediatr Child Health. 2022 Jan;58(1):39-45. doi: 10.1111/jpc.15791. Epub 2021 
Oct 13.

COVID-19 in children: I. Epidemiology, prevention and indirect impacts.

Howard-Jones AR(1)(2), Bowen AC(3)(4), Danchin M(5)(6)(7), Koirala A(1)(8)(9), 
Sharma K(1)(8), Yeoh DK(3)(10), Burgner DP(5)(6)(11), Crawford NW(5)(6)(7), 
Goeman E(12), Gray PE(13)(14), Hsu P(1)(15), Kuek S(16), McMullan BJ(13)(14), 
Tosif S(5)(6)(7), Wurzel D(6)(16)(17), Britton PN(1)(18).

Author information:
(1)Sydney Medical School, University of Sydney, Sydney, New South Wales, 
Australia.
(2)NSW Health Pathology-Nepean, Nepean Hospital, Sydney, New South Wales, 
Australia.
(3)Department of Infectious Diseases, Perth Children's Hospital, Perth, Western 
Australia, Australia.
(4)Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids 
Institute, University of Western Australia, Perth, Western Australia, Australia.
(5)Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, 
Australia.
(6)Infection and Immunity Theme, Murdoch Children's Research Institute, 
Melbourne, Victoria, Australia.
(7)Department of General Medicine, Royal Children's Hospital, Melbourne, 
Victoria, Australia.
(8)National Centre for Immunisation Research and Surveillance, The Children's 
Hospital at Westmead, Sydney, New South Wales, Australia.
(9)Department of Infectious Diseases, Nepean Hospital, Penrith, New South Wales, 
Australia.
(10)Sir Peter MacCallum Department of Oncology, The University of Melbourne, 
Melbourne, Victoria, Australia.
(11)Infectious Diseases Unit, Department of General Medicine, Royal Children's 
Hospital, Melbourne, Victoria, Australia.
(12)Department of Infectious Diseases and Microbiology, Royal Prince Alfred 
Hospital, Sydney, New South Wales, Australia.
(13)Department of Immunology and Infectious Diseases, Sydney Children's 
Hospital, Sydney, New South Wales, Australia.
(14)School of Women's and Children's Health, University of New South Wales, 
Sydney, New South Wales, Australia.
(15)Department of Immunology, The Children's Hospital at Westmead, Sydney, New 
South Wales, Australia.
(16)Department of Respiratory and Sleep Medicine, The Royal Children's Hospital, 
Melbourne, Victoria, Australia.
(17)School of Population and Global Health, The University of Melbourne, 
Melbourne, Victoria, Australia.
(18)Department of Infectious Diseases and Microbiology, The Children's Hospital 
at Westmead, Sydney, New South Wales, Australia.

Children globally have been profoundly impacted by the coronavirus disease 2019 
(COVID-19) pandemic. This review explores the direct and indirect public health 
impacts of COVID-19 on children. We discuss in detail the transmission dynamics, 
vaccination strategies and, importantly, the 'shadow pandemic', encompassing 
underappreciated indirect impacts of the pandemic on children. The indirect 
effects of COVID-19 will have a long-term impact beyond the immediate pandemic 
period. These include the mental health and wellbeing risks, disruption to 
family income and attendant stressors including increased family violence, 
delayed medical attention and the critical issue of prolonged loss of 
face-to-face learning in a normal school environment. Amplification of existing 
inequities and creation of new disadvantage are likely additional sequelae, with 
children from vulnerable families disproportionately affected. We emphasise the 
responsibility of paediatricians to advocate on behalf of this vulnerable group 
to ensure the longer-term effects of COVID-19 public health responses on the 
health and wellbeing of children are fully considered.

© 2021 Paediatrics and Child Health Division (The Royal Australasian College of 
Physicians).

DOI: 10.1111/jpc.15791
PMCID: PMC8662210
PMID: 34643307 [Indexed for MEDLINE]


2880. J Public Health (Oxf). 2021 Dec 8;43(Suppl 3):iii34-iii42. doi: 
10.1093/pubmed/fdab321.

Mental health impacts of COVID-19 on healthcare workers in the Eastern 
Mediterranean Region: a multi-country study.

Ghaleb Y(1), Lami F(2), Al Nsour M(3), Rashak HA(4), Samy S(5), Khader YS(6), Al 
Serouri A(1), BahaaEldin H(5), Afifi S(5), Elfadul M(7), Ikram A(8), Akhtar 
H(9), Hussein AM(10), Barkia A(11), Hakim H(12), Taha HA(13), Hijjo Y(14), Kamal 
E(5), Ahmed AY(15), Rahman F(16), Islam KM(17), Hussein MH(4), Ramzi SR(18).

Author information:
(1)Ministry of Public Health and Population, Yemen Field Epidemiology Training 
Program, Sana'a, Yemen.
(2)Department of Community and Family Medicine, University of Baghdad, Baghdad, 
Iraq.
(3)Global Health Development (GHD), The Eastern Mediterranean Public Health 
Network (EMPHNET), Amman, Jordan.
(4)Directorate of Public Health, Ministry of Health, Baghdad, Iraq.
(5)Ministry of Health and Population, Cairo, Egypt.
(6)Professor of Epidemiology, Medical Education and Biostatistics, Department of 
Public Health, Jordan University of Science & Technology, Irbid 22110, Jordan.
(7)Public Health Institute, Federal Ministry of Health, Department of Research, 
Khartoum, Sudan.
(8)National Institute of Health, Islamabad, Pakistan.
(9)Yusra Institute of Pharmaceutical Sciences, Yusra Medical and Dental Collage, 
Islamabad, Pakistan.
(10)Somali International University, Somal.
(11)Epidemic Diseases Service, Ministry of Health, Rabat, Morocco.
(12)Department of Community Medicine, Al-Majmaah University, AL-Majmaah, Kingdom 
of Saudi Arabia.
(13)Health Protection and Promotion, Global Health Development (GHD), Eastern 
Mediterranean Public Health Network, Amman, Jordan.
(14)Clinical Pharmacy, Public and Tropical Health Programs, University of 
Medical Sciences & Technology, Khartoum, Sudan.
(15)Demartino Hospital, Somalia.
(16)Medical Unit 1 Benazir Bhutto Hospital, Rawalpindi Medical University, 
Rawalpindi, Pakistan.
(17)Afghanistan Field Epidemiology Training Program, Global Health Development 
(GHD), Afghanistan.
(18)Al-Rusafa Health Directorate, Public Health Department, Ministry of Health, 
Baghdad, Iraq.

BACKGROUND: Healthcare workers (HCWs) fighting against the COVID-19 pandemic are 
under incredible pressure, which puts them at risk of developing mental health 
problems. This study aimed to determine the prevalence of depression, anxiety, 
and stress among HCWs responding to COVID-19 and its associated factors.
METHODS: A multi-country cross-sectional study was conducted during July-August 
2020 among HCWs responding to COVID-19 in nine Eastern Mediterranean Region 
(EMR) countries. Data were collected using an online questionnaire administered 
using KoBo Toolbox. Mental problems were assessed using the Depression, Anxiety, 
and Stress Scale (DASS-21).
RESULTS: A total of 1448 HCWs from nine EMR countries participated in this 
study. About 51.2% were male and 52.7% aged ≤ 30 years. Of all HCWs, 57.5% had 
depression, 42.0% had stress, and 59.1% had anxiety. Considering the severity, 
19.2%, 16.1%, 26.6% of patients had severe to extremely severe depression, 
stress, and anxiety, respectively. Depression, stress, anxiety, and distress 
scores were significantly associated with participants' residency, having 
children, preexisting psychiatric illness, and being isolated for COVID-19. 
Furthermore, females, those working in a teaching hospital, and specialists had 
significantly higher depression and stress scores. Married status, current 
smoking, diabetes mellitus, having a friend who died with COVID-19, and high 
COVID-19 worry scores were significantly associated with higher distress scores.
CONCLUSIONS: Mental problems were prevalent among HCWs responding to COVID-19 in 
EMR. Therefore, special interventions to promote mental well-being among HCWs 
responding to COVID-19 need to be immediately implemented.

© The Author(s) 2021. Published by Oxford University Press on behalf of Faculty 
of Public Health. All rights reserved. For permissions, please e-mail: 
journals.permissions@oup.com.

DOI: 10.1093/pubmed/fdab321
PMCID: PMC8524602
PMID: 34642765 [Indexed for MEDLINE]


2881. Scand J Public Health. 2022 Aug;50(6):703-710. doi: 10.1177/14034948211048746. 
Epub 2021 Oct 12.

The COVIDPregDK Study: A national survey on pregnancy during the early COVID-19 
pandemic in Denmark.

Stokholm L(1)(2), Schrøder K(3)(4)(5), Nøhr EA(3)(4), Rubin KH(1)(2), Jørgensen 
JS(3)(4), Petersen LK(1)(2), Bliddal M(1)(2).

Author information:
(1)Open Patient data Explorative Network, Odense University Hospital, Denmark.
(2)Research unit OPEN, Department of Clinical Research, University of Sourthern 
Denmark, Denmark.
(3)Research Unit of Gynecology and Obstetrics, Odense University Hospital, 
Denmark.
(4)Department of Clinical Research, University of Southern Denmark, Denmark.
(5)Research Unit of User Perspectives, Department of Public Health, University 
of Southern Denmark, Denmark.

AIM: We aimed to describe the aim, data collection and content from a survey 
completed among pregnant women during the first peak of the COVID-19 pandemic in 
Denmark.
METHODS: The declaration of the COVID-19 pandemic in early 2020 challenged 
pregnant women's mental well-being due to a concern for their unborn child and 
their need for healthcare services through pregnancy and birth. To explore how 
the COVID-19 pandemic and the intensified measures such as the lockdown of 
Denmark impacted pregnant women's well-being and mental health, we conducted a 
questionnaire survey in the spring of 2020 when the COVID-19 pandemic was at its 
first peak, and the consequences for pregnant women and the unborn child were 
very uncertain. All women residing in Denmark and registered with an ongoing 
pregnancy on 24 April 2020 were invited to participate. The questionnaire 
included background information, variables on COVID-19 symptoms and validated 
batteries of questions on loneliness, anxiety, stress, quality of life, 
meditation and prayers. Additional questions were included to examine concerns 
related to pregnancy and childbirth during the pandemic.
COHORT CHARACTERISTICS: Almost 18,000 women answered the questionnaire, which 
represents 60% of all invited women who experienced a national lockdown for the 
first time. Their median age was 30 years, and they were more likely to be 
multiparous.
CONCLUSIONS: Data from the COVIDPregDK Study will enable us to gain valuable 
knowledge on how the pandemic, the intensified measures from the health 
authorities and the national lockdown affected pregnant women's mental health 
and their concerns during the COVID-19 pandemic.

DOI: 10.1177/14034948211048746
PMID: 34641709 [Indexed for MEDLINE]


2882. Int J Environ Res Public Health. 2021 Oct 6;18(19):10489. doi: 
10.3390/ijerph181910489.

Perceived Consequences of Extended Social Isolation on Mental Well-Being: 
Narratives from Indonesian University Students during the COVID-19 Pandemic.

Rahiem MDH(1), Krauss SE(2)(3), Ersing R(4).

Author information:
(1)Faculty of Education, UIN Syarif Hidayatullah, Jakarta 15412, Indonesia.
(2)Institute for Social Science Studies (IPSAS), Universiti Putra Malaysia, 
Selangor 43400, Malaysia.
(3)Faculty of Educational Studies, Universiti Putra Malaysia, Selangor 43400, 
Malaysia.
(4)School of Public Affairs, University of South Florida, Tempa, FL 33620, USA.

Despite several recent studies reporting on young people's well-being during 
COVID-19, few large-scale qualitative studies have been carried out that capture 
the experiences of young people from low- and middle-income countries (LMICs) 
undergoing extended social restrictions. The challenges faced by young people 
from LMICs during COVID-19 are likely to be amplified by their countries' large 
populations, resource constraints, lack of access to health care, living 
conditions, socio-spatial contexts, and the pandemic's ramifications for 
communities. This study explored how youths perceived their well-being after 
being isolated for one-and-a-half years during the COVID-19 pandemic. 
Qualitative narrative research was employed as a method of inquiry. One-hundred 
and sixty-six university students in Jakarta, Indonesia, between the ages of 17 
and 22 wrote reflective online essays on the consequences of extended pandemic 
isolation on their mental health. This data collection strategy offered an 
in-depth understanding of the phenomenon through the narratives of those who 
experienced it. Seven themes expressing the youths' perceived well-being were 
identified through inductive reflective thematic analysis: (1) the anguish of 
loneliness and estrangement; (2) a state of "brokenness" resulting from 
emotional agony and distress; (3) frustration, confusion, and anger; (4) the 
experience of conflicting emotions; (5) uncertainty about both the present and 
future; (6) a sense of purpose and fulfillment; and (7) turning to faith. The 
findings provide important insights into Indonesian youths' well-being following 
extended social restrictions following the outbreak. Their collective 
experiences can be used to inform policy and practice regarding the nature of 
support mechanisms required both during and following the pandemic, and in the 
future if such a situation were to occur again.

DOI: 10.3390/ijerph181910489
PMCID: PMC8508155
PMID: 34639788 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript, or in the decision to 
publish the results.


2883. Int J Environ Res Public Health. 2021 Sep 28;18(19):10207. doi: 
10.3390/ijerph181910207.

Kidcope and the COVID-19 Pandemic: Understanding High School Students' Coping 
and Emotional Well-Being.

Hsieh WJ(1), Powell T(1), Tan K(1), Chen JH(2).

Author information:
(1)School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL 
61801, USA.
(2)Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA.

The COVID-19 pandemic has resulted in social isolation, grief, and loss among 
many adolescents. As the pandemic continues to impact individuals and 
communities across the globe, it is critical to address the psychological 
well-being of youths. More studies are needed to understand the effective ways 
adolescents cope with pandemic-related psychological distress. In this study, 
146 students from 1 high school in a U.S. midwestern state completed an adapted 
version of Kidcope, a widely used coping instrument in disaster research, and 
measures were taken on generalized distress and COVID-19-related worries. 
Findings indicated that most students experienced COVID-19-related fears and 
general emotional distress. Additionally, we found that disengagement coping 
strategies were associated with lower general distress (p ≤ 0.05) and COVID-19 
worries (p ≤ 0.10). Active coping was not associated with general distress and 
COVID-19 worries. Overall, our findings highlight the need to develop tailored 
interventions targeting youth coping strategies to reduce and prevent emotional 
distress and amplify healthy coping skills as the pandemic persists.

DOI: 10.3390/ijerph181910207
PMCID: PMC8508328
PMID: 34639505 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2884. Int J Environ Res Public Health. 2021 Sep 28;18(19):10184. doi: 
10.3390/ijerph181910184.

Abuse, Mental State, and Health Factors Pre and during the COVID-19 Pandemic: A 
Comparison among Clinically Referred Adolescents in Ontario, Canada.

Stewart SL(1), Toohey A(1), Celebre A(1), Poss JW(2).

Author information:
(1)Faculty of Education, Western University, London, ON N6G 1G7, Canada.
(2)Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON N2L 
3G5, Canada.

Throughout the COVID-19 pandemic, population surveys revealed increased levels 
of anxiety and depression, while findings from large-scale population data 
analyses have revealed mixed findings with respect to the mental health 
consequences for children and youth. The purpose of this study was to examine 
the impact of the COVID-19 pandemic on the well-being and health-compromising 
behaviors of adolescents (12-18 years) previously referred for mental health 
services. Data were collected (pre-pandemic n = 3712; pandemic n = 3197) from 
mental health agencies across Ontario, Canada using the interRAI Child and Youth 
Mental Health assessment. Our findings revealed no increased incidence of 
witnessing domestic violence nor experiencing physical, sexual, or emotional 
abuse. Further, there were no increases in the risk of self-harm and suicide, 
anxiety, or depression among our sample of clinically referred youth. Finally, 
results demonstrated no increase in problematic videogaming/internet use, 
disordered eating, or alcohol intoxication, and a decrease in cannabis use. Our 
findings add to the growing body of knowledge as to the impact of the COVID-19 
pandemic on children and youth. Further, findings underscore the importance of 
understanding the nuanced impact of the pandemic on various subgroups of 
children, youth, and families and highlight the need for continued monitoring of 
outcomes for these children and youth.

DOI: 10.3390/ijerph181910184
PMCID: PMC8507612
PMID: 34639487 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare they have no conflict of 
interest.


2885. Int J Environ Res Public Health. 2021 Sep 25;18(19):10092. doi: 
10.3390/ijerph181910092.

Mental Health during COVID-19 Pandemic among Caregivers of Young Children in 
Kenya's Urban Informal Settlements. A Cross-Sectional Telephone Survey.

Angwenyi V(1), Kabue M(1), Chongwo E(1), Mabrouk A(1), Too EK(1), Odhiambo R(1), 
Nasambu C(2), Marangu J(1), Ssewanyana D(1)(3), Njoroge E(1), Ombech E(1), 
Mokaya MM(1), Obulemire EK(1), Khamis A(1)(4), Abubakar A(1)(2).

Author information:
(1)Institute for Human Development, Aga Khan University, Nairobi P.O. Box 
30270-00100, Kenya.
(2)Neurosciences Group, KEMRI/Wellcome Trust Research Programme, Centre for 
Geographic Medicine Research (Coast), Kenya Medical Research Institute, Kilifi 
P.O. Box 230-80108, Kenya.
(3)Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, 
Toronto, ON M5T 3L9, Canada.
(4)Institute of Education, University College London, 20 Bedford Way, London 
WC1H 0AL, UK.

The emergence of COVID-19 has profoundly affected mental health, especially 
among highly vulnerable populations. This study describes mental health issues 
among caregivers of young children and pregnant women in three urban informal 
settlements in Kenya during the first pandemic year, and factors associated with 
poor mental health. A cross-sectional telephone survey was administered to 845 
participants. Survey instruments included the Patient Health Questionnaire-9, 
General Anxiety Disorder-7 scale, COVID-19 Anxiety Scale, and questions on the 
perceived COVID-19 effects on caregiver wellbeing and livelihood. Data were 
analyzed using descriptive statistics, and univariate and multivariate analysis. 
Caregivers perceived COVID-19 as a threatening condition (94.54%), affecting 
employment and income activities (>80%). Caregivers experienced discrimination 
(15.27%) and violence (12.6%) during the pandemic. Levels of depression (34%), 
general anxiety (20%), and COVID-19 related anxiety (14%) were highly prevalent. 
There were significant associations between mental health outcomes and economic 
and socio-demographic factors, violence and discrimination experiences, 
residency, and perceptions of COVID-19 as a threatening condition. Caregivers 
high burden of mental health problems highlights the urgent need to provide 
accessible mental health support. Innovative and multi-sectoral approaches will 
be required to maximize reach to underserved communities in informal settlements 
and tackle the root causes of mental health problems in this population.

DOI: 10.3390/ijerph181910092
PMCID: PMC8508326
PMID: 34639394 [Indexed for MEDLINE]

Conflict of interest statement: All authors declare no competing interests.


2886. Int J Environ Res Public Health. 2021 Sep 25;18(19):10079. doi: 
10.3390/ijerph181910079.

Teens' Social Media Engagement during the COVID-19 Pandemic: A Time Series 
Examination of Posting and Emotion on Reddit.

Zhang S(1), Liu M(2), Li Y(3), Chung JE(4).

Author information:
(1)Department of Social Work, University of Mississippi, Oxford, MS 38677, USA.
(2)School of Social Work, Howard University, Washington, DC 20059, USA.
(3)Thomas Jefferson High School for Science and Technology, Alexandria, VA 
22312, USA.
(4)Cathy Hughes School of Communications, Howard University, Washington, DC 
20059, USA.

Research has rarely examined how the COVID-19 pandemic may affect teens' social 
media engagement and psychological wellbeing, and even less research has 
compared the difference between teens with and without mental health concerns. 
We collected and analyzed weekly data from January to December 2020 from teens 
in four Reddit communities (subreddits), including teens in r/Teenagers and 
teens who participated in three mental health subreddits (r/Depression, 
r/Anxiety, and r/SuicideWatch). The results showed that teens' weekly subreddit 
participation, posting/commenting frequency, and emotion expression were related 
to significant pandemic events. Teen Redditors on r/Teenagers had a higher 
posting/commenting frequency but lower negative emotion than teen Redditors on 
the three mental health subreddits. When comparing posts/comments on 
r/Teenagers, teens who ever visited one of the three mental health subreddits 
posted/commented twice as frequently as teens who did not, but their emotion 
expression was similar. The results from the Interrupted Time Series Analysis 
(ITSA) indicated that both teens with and without mental health concerns 
reversed the trend in posting frequency and negative emotion from declining to 
increasing right after the pandemic outbreak, and teens with mental health 
concerns had a more rapidly increasing trend in posting/commenting. The findings 
suggest that teens' social media engagement and emotion expression reflect the 
pandemic evolution. Teens with mental health concerns are more likely to reveal 
their emotions on specialized mental health subreddits rather than on the 
general r/Teenagers subreddit. In addition, the findings indicated that teens 
with mental health concerns had a strong social interaction desire that various 
barriers in the real world may inhibit. The findings call for more attention to 
understand the pandemic's influence on teens by monitoring and analyzing social 
media data and offering adequate support to teens regarding their mental health 
wellbeing.

DOI: 10.3390/ijerph181910079
PMCID: PMC8507823
PMID: 34639381 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2887. Sleep. 2022 Jan 11;45(1):zsab250. doi: 10.1093/sleep/zsab250.

Reopening after lockdown: the influence of working-from-home and digital device 
use on sleep, physical activity, and wellbeing following COVID-19 lockdown and 
reopening.

Massar SAA(1), Ng ASC(1), Soon CS(1), Ong JL(1), Chua XY(1), Chee NIYN(1), Lee 
TS(2), Chee MWL(1).

Author information:
(1)Sleep and Cognition Laboratory, Centre for Sleep and Cognition, Yong Loo Lin 
School of Medicine, National University of Singapore, Singapore.
(2)Laboratory of Neurobehavioral Genomics, Neuroscience and Behavioral Disorders 
Programme, Duke-NUS Medical School, Singapore.

STUDY OBJECTIVES: COVID-19 lockdowns drastically affected sleep, physical 
activity, and wellbeing. We studied how these behaviors evolved during reopening 
the possible contributions of continued working from home and smartphone usage.
METHODS: Participants (N = 198) were studied through the lockdown and subsequent 
reopening period, using a wearable sleep/activity tracker, smartphone-delivered 
ecological momentary assessment (EMA), and passive smartphone usage tracking. 
Work/study location was obtained through daily EMA ascertainment.
RESULTS: Upon reopening, earlier, shorter sleep and increased physical activity 
were observed, alongside increased self-rated stress and poorer evening mood 
ratings. These reopening changes were affected by post-lockdown work 
arrangements and patterns of smartphone usage. Individuals who returned to work 
or school in-person tended toward larger shifts to earlier sleep and wake 
timings. Returning to in-person work/school also correlated with more physical 
activity. Contrary to expectation, there was no decrease in objectively measured 
smartphone usage after reopening. A cluster analysis showed that persons with 
relatively heavier smartphone use prior to bedtime had later sleep timings and 
lower physical activity.
CONCLUSIONS: These observations indicate that the reopening after lockdown was 
accompanied by earlier sleep timing, increased physical activity, and altered 
mental wellbeing. Moreover, these changes were affected by work/study 
arrangements and smartphone usage patterns.

© Sleep Research Society 2021. Published by Oxford University Press on behalf of 
the Sleep Research Society.

DOI: 10.1093/sleep/zsab250
PMCID: PMC8549292
PMID: 34636396 [Indexed for MEDLINE]


2888. Int J Ment Health Nurs. 2022 Feb;31(1):91-103. doi: 10.1111/inm.12938. Epub 2021 
Oct 11.

The impact of COVID-19 pandemic-related stress experienced by Australian nurses.

Aggar C(1)(2), Samios C(1), Penman O(1), Whiteing N(1), Massey D(1), Rafferty 
R(2), Bowen K(2), Stephens A(2).

Author information:
(1)School of Health & Human Sciences, Southern Cross University, Bilinga, 
Queensland, Australia.
(2)Northern New South, Wales Local Health District, Ballina, New South Wales, 
Australia.

Globally, the impact of COVID-19 on healthcare workers' mental health has been a 
major focus of recent research. However, Australian research involving nurses, 
particularly across the acute care sector, is limited. This cross-sectional 
research aimed to explore the impact of pandemic-related stress on psychological 
adjustment outcomes and potential protective factors for nurses (n = 767) 
working in the Australian acute care sector during the COVID-19 pandemic. Nurses 
completed an online questionnaire with psychometrically validated measures of 
pandemic-related stress, psychological adjustment outcomes (depression, anxiety, 
and subjective well-being), and protective factors (posttraumatic growth and 
self-compassion). Descriptive analyses revealed that pandemic-related stress was 
reported by 17.7% of the participants. Psychological adjustment outcome scores 
above normal for depression (27.5%) and anxiety (22.0%) were found, and 36.4% of 
the participants reported poor subjective well-being. Regression analyses 
suggest that pandemic-related stress predicted greater depression (B = 0.32, 
SE = 0.02, 95% confidence interval [0.28, 0.35]) and anxiety (B = 0.26, 
SE = 0.01, 95% confidence interval [0.24, 0.29]) and less subjective well-being 
(B = -0.14, SE = 0.01, 95% confidence interval [-0.16, -0.12]). Self-compassion 
weakened the relationship between pandemic-related stress and greater 
depression, however, exacerbated the relationship between pandemic-related 
stress and less subjective well-being. Posttraumatic growth reduced the negative 
relationship between pandemic-related stress and psychological adjustment 
outcomes. These findings will inform strategies to facilitate psychological 
resources that support nurses' psychological adjustment, enabling better 
pandemic preparedness at both an individual and organizational level.

© 2021 John Wiley & Sons Australia, Ltd.

DOI: 10.1111/inm.12938
PMCID: PMC8653281
PMID: 34636134 [Indexed for MEDLINE]


2889. J Psychiatr Res. 2021 Dec;144:151-157. doi: 10.1016/j.jpsychires.2021.09.035. 
Epub 2021 Sep 23.

Decreasing mental well-being during the COVID-19 pandemic: A longitudinal study 
among Danes before and during the pandemic.

Thygesen LC(1), Møller SP(2), Ersbøll AK(2), Santini ZI(2), Nielsen MBD(2), 
Grønbæk MK(2), Ekholm O(2).

Author information:
(1)National Institute of Public Health, University of Southern Denmark, 
Studiestræde 6, DK-1455, Copenhagen, Denmark. Electronic address: lct@sdu.dk.
(2)National Institute of Public Health, University of Southern Denmark, 
Studiestræde 6, DK-1455, Copenhagen, Denmark.

The COVID-19 pandemic has had a huge impact on people's lives and may influence 
mental health in the general population. In a unique representative Danish 
longitudinal study, we examined mental well-being measured just before and 
during the COVID-19 pandemic. The Danish Health and Wellbeing Survey is the 
Danish contribution to the European Health Interview Survey. In this study, we 
included the wave from autumn 2019, which we re-invited in the autumn 2020. The 
study population consisted of 4,234 persons. The main outcome was mental 
well-being measured by the Short Warwick-Edinburgh Mental Well-Being Scale 
(SWEMWBS). Linear and logistic regression models were conducted to evaluate 
change in SWEMWBS between 2019 and 2020. The SWEMWBS distribution was similar in 
2019 and 2020, although the distribution moved to lower scores in 2020 compared 
to 2019. Mean SWEMWBS decreased significantly from 25.5 in 2019 to 24.6 in 2020 
corresponding to a mean change of -1.0 (95%CI, -1.1. to -0.8). The proportion 
with low SWEMWBS increased from 16.5% in 2019 to 20.1% in 2020 (p < 0.001). The 
mean change was similar for men and women and for different age groups. The most 
negative development was observed among persons without depression or 
long-standing illnesses at baseline and among persons with higher educational 
level. Among persons with depression SWEMWBS increased. As expected, mental 
well-being significantly decreased in the adult Danish population during the 
COVID-19 pandemic. However, somewhat more unexpectedly, the decrease was most 
pronounced among persons without depression or long-standing illnesses and among 
higher educated groups.

Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.jpsychires.2021.09.035
PMCID: PMC8460161
PMID: 34634602 [Indexed for MEDLINE]

Conflict of interest statement: All authors have no conflicts of interest to 
declare that are relevant to the content of this article.


2890. Lancet. 2021 Nov 6;398(10312):1700-1712. doi: 10.1016/S0140-6736(21)02143-7. 
Epub 2021 Oct 8.

Global prevalence and burden of depressive and anxiety disorders in 204 
countries and territories in 2020 due to the COVID-19 pandemic.

COVID-19 Mental Disorders Collaborators.

Collaborators: Santomauro DF, Mantilla Herrera AM, Shadid J, Zheng P, Ashbaugh 
C, Pigott DM, Abbafati C, Adolph C, Amlag JO, Aravkin AY, Bang-Jensen BL, 
Bertolacci GJ, Bloom SS, Castellano R, Castro E, Chakrabarti S, Chattopadhyay J, 
Cogen RM, Collins JK, Dai X, Dangel WJ, Dapper C, Deen A, Erickson M, Ewald SB, 
Flaxman AD, Frostad JJ, Fullman N, Giles JR, Giref AZ, Guo G, He J, Helak M, 
Hulland EN, Idrisov B, Lindstrom A, Linebarger E, Lotufo PA, Lozano R, Magistro 
B, Malta DC, Månsson JC, Marinho F, Mokdad AH, Monasta L, Naik P, Nomura S, 
O'Halloran JK, Ostroff SM, Pasovic M, Penberthy L, Reiner RC Jr, Reinke G, 
Ribeiro ALP, Sholokhov A, Sorensen RJD, Varavikova E, Vo AT, Walcott R, Watson 
S, Wiysonge CS, Zigler B, Hay SI, Vos T, Murray CJL, Whiteford HA, Ferrari AJ.

Comment in
    Lancet. 2021 Nov 6;398(10312):1665-1666.
    Lancet. 2022 Feb 5;399(10324):518-519.
    Lancet. 2022 Feb 5;399(10324):518.

BACKGROUND: Before 2020, mental disorders were leading causes of the global 
health-related burden, with depressive and anxiety disorders being leading 
contributors to this burden. The emergence of the COVID-19 pandemic has created 
an environment where many determinants of poor mental health are exacerbated. 
The need for up-to-date information on the mental health impacts of COVID-19 in 
a way that informs health system responses is imperative. In this study, we 
aimed to quantify the impact of the COVID-19 pandemic on the prevalence and 
burden of major depressive disorder and anxiety disorders globally in 2020.
METHODS: We conducted a systematic review of data reporting the prevalence of 
major depressive disorder and anxiety disorders during the COVID-19 pandemic and 
published between Jan 1, 2020, and Jan 29, 2021. We searched PubMed, Google 
Scholar, preprint servers, grey literature sources, and consulted experts. 
Eligible studies reported prevalence of depressive or anxiety disorders that 
were representative of the general population during the COVID-19 pandemic and 
had a pre-pandemic baseline. We used the assembled data in a meta-regression to 
estimate change in the prevalence of major depressive disorder and anxiety 
disorders between pre-pandemic and mid-pandemic (using periods as defined by 
each study) via COVID-19 impact indicators (human mobility, daily SARS-CoV-2 
infection rate, and daily excess mortality rate). We then used this model to 
estimate the change from pre-pandemic prevalence (estimated using Disease 
Modelling Meta-Regression version 2.1 [known as DisMod-MR 2.1]) by age, sex, and 
location. We used final prevalence estimates and disability weights to estimate 
years lived with disability and disability-adjusted life-years (DALYs) for major 
depressive disorder and anxiety disorders.
FINDINGS: We identified 5683 unique data sources, of which 48 met inclusion 
criteria (46 studies met criteria for major depressive disorder and 27 for 
anxiety disorders). Two COVID-19 impact indicators, specifically daily 
SARS-CoV-2 infection rates and reductions in human mobility, were associated 
with increased prevalence of major depressive disorder (regression coefficient 
[B] 0·9 [95% uncertainty interval 0·1 to 1·8; p=0·029] for human mobility, 18·1 
[7·9 to 28·3; p=0·0005] for daily SARS-CoV-2 infection) and anxiety disorders 
(0·9 [0·1 to 1·7; p=0·022] and 13·8 [10·7 to 17·0; p<0·0001]. Females were 
affected more by the pandemic than males (B 0·1 [0·1 to 0·2; p=0·0001] for major 
depressive disorder, 0·1 [0·1 to 0·2; p=0·0001] for anxiety disorders) and 
younger age groups were more affected than older age groups (-0·007 [-0·009 to 
-0·006; p=0·0001] for major depressive disorder, -0·003 [-0·005 to -0·002; 
p=0·0001] for anxiety disorders). We estimated that the locations hit hardest by 
the pandemic in 2020, as measured with decreased human mobility and daily 
SARS-CoV-2 infection rate, had the greatest increases in prevalence of major 
depressive disorder and anxiety disorders. We estimated an additional 53·2 
million (44·8 to 62·9) cases of major depressive disorder globally (an increase 
of 27·6% [25·1 to 30·3]) due to the COVID-19 pandemic, such that the total 
prevalence was 3152·9 cases (2722·5 to 3654·5) per 100 000 population. We also 
estimated an additional 76·2 million (64·3 to 90·6) cases of anxiety disorders 
globally (an increase of 25·6% [23·2 to 28·0]), such that the total prevalence 
was 4802·4 cases (4108·2 to 5588·6) per 100 000 population. Altogether, major 
depressive disorder caused 49·4 million (33·6 to 68·7) DALYs and anxiety 
disorders caused 44·5 million (30·2 to 62·5) DALYs globally in 2020.
INTERPRETATION: This pandemic has created an increased urgency to strengthen 
mental health systems in most countries. Mitigation strategies could incorporate 
ways to promote mental wellbeing and target determinants of poor mental health 
and interventions to treat those with a mental disorder. Taking no action to 
address the burden of major depressive disorder and anxiety disorders should not 
be an option.
FUNDING: Queensland Health, National Health and Medical Research Council, and 
the Bill and Melinda Gates Foundation.

Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open 
Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All 
rights reserved.

DOI: 10.1016/S0140-6736(21)02143-7
PMCID: PMC8500697
PMID: 34634250 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of interests C Adolph reports 
support from the Benifcus Foundation. A Flaxman holds stock in Agathos, and 
consults and advises Janssen, SwissRe, Sanofi, and Merck for Mothers on 
simulation modeling, outside of the submitted work. S Nomura reports support 
from the Ministry of Education, Culture, Sports, Science and Technology of 
Japan. All other authors declare no competing interests.


2891. Eat Disord. 2022 Nov-Dec;30(6):602-617. doi: 10.1080/10640266.2021.1985286. Epub 
2021 Oct 11.

Longitudinal experiences and impact of the COVID-19 pandemic among people with 
past or current eating disorders in Sweden.

Birgegård A(1), Abbaspour A(1), Borg S(1), Clinton D(1), Mantilla EF(1), Savva 
A(1), Termorshuizen JD(1), Bulik CM(1)(2)(3).

Author information:
(1)Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 
Stockholm, Sweden.
(2)Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel 
Hill, NC, USA.
(3)Department of Nutrition, University of North Carolina at Chapel Hill, Chapel 
Hill, NC, USA.

The study aimed to document the impact of the COVID-19 pandemic on the health 
and well-being of individuals with past and current eating disorders (ED) in 
Sweden. We re-contacted participants with a known lifetime history of ED from 
two previous Swedish studies. Participants completed an online survey about 
health and functioning at baseline early in the pandemic (Wave 1 ca May/June 
2020; N= 982) and six months later (Wave 2 Dec/Jan 2020/21; N= 646). Three 
important patterns emerged: 1) higher current ED symptoms were associated with 
greater anxiety, worry, and pandemic-related ED symptom increase; 2) patterns 
were fairly stable across time, although a concerning percentage (23%) who were 
symptom-free at Wave 1 reported the re-emergence of symptoms at Wave 2; and 3) 
only a minority of participants (<50%) with a current ED were in treatment, and 
of those in treatment, many reported fewer treatment sessions and decreased 
quality of care. The COVID-19 pandemic appears to pose serious health challenges 
for individuals with an ED, whether currently symptomatic or in remission. We 
encourage health service providers and patient advocates to be alert to the 
needs of individuals with ED and to take active measures to ensure access to 
appropriate evidence-based care both during and following the pandemic.

DOI: 10.1080/10640266.2021.1985286
PMID: 34634228 [Indexed for MEDLINE]


2892. HIV Med. 2022 Mar;23(3):227-236. doi: 10.1111/hiv.13190. Epub 2021 Oct 11.

A qualitative study of the impact of coronavirus disease (COVID-19) on 
psychological and financial wellbeing and engagement in care among men who have 
sex with men living with HIV in Thailand.

Nitpolprasert C(1), Anand T(1), Phanuphak N(2), Reiss P(3), Ananworanich J(3), 
Peay HL(4).

Author information:
(1)Adam's Love Global Foundation for MSM and Transgender Health (ALGO), Bangkok, 
Thailand.
(2)Institute of HIV Research and Innovation (IHRI), Bangkok, Thailand.
(3)Department of Global Health, Amsterdam University Medical Centers, University 
of Amsterdam, and Amsterdam Institute for Global Health and Development, 
Amsterdam, The Netherlands.
(4)Center for Newborn Screening, Ethics, and Disability Studies, RTI 
International, Research Triangle Park, NC, USA.

OBJECTIVES: The coronavirus disease (COVID-19) pandemic is an unprecedented 
event with massive global health and socio-economic impacts on vulnerable 
populations, especially people living with HIV. The epidemic has severely 
affected Thailand's economy and potentially impacted the financial and 
psychological wellbeing of Thai HIV-positive men who have sex with men (MSM).
METHODS: Between 15 June and 10 December 2020, we conducted qualitative 
interviews with 26 MSM living with HIV in Thailand who participate in an Adam's 
Love We Care Study. We intentionally recruited individuals who may have 
experienced a greater impact of COVID-19. Interviews explored worry, stigma and 
stress surrounding COVID-19, and multiple domains of potential COVID-19 impact: 
financial/employment, HIV service delivery and antiretroviral (ART) adherence 
during the first 10 months of the COVID-19 pandemic.
RESULTS: Participants perceived themselves as immunocompromised and susceptible, 
and feared contracting COVID-19. Participants worried that contracting COVID-19 
would lead to HIV status disclosure and stigmatization. Participants had 
considerable worry about job loss as a result of the economic downturn, and some 
shared challenges associated with relocation and re-engaging with HIV care. 
Financial stress and lack of basic necessities caused by job losses were 
commonly reported. Participants reported optimal ART adherence as a consequence 
of local HIV service delivery responses, convenient ART refills and Adam's Love 
online support interventions.
CONCLUSIONS: Our study highlights that the COVID-19 pandemic produced high 
levels of anxiety and concerns about additional stigma among MSM living with 
HIV. It had a significant negative effect on the daily lives of our 
participants. These findings indicate a need for the provision of confidential 
COVID-19 diagnosis and care, relief programmes, vaccination roll-out equity, and 
addressing employment needs of vulnerable populations.

© 2021 British HIV Association.

DOI: 10.1111/hiv.13190
PMCID: PMC8653254
PMID: 34634181 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
declare.


2893. Eur J Gen Pract. 2021 Dec;27(1):277-285. doi: 10.1080/13814788.2021.1982889.

To prevent being stressed-out: Allostatic overload and resilience of general 
practitioners in the era of COVID-19. A cross-sectional observational study.

Békési D(1), Teker I(2), Torzsa P(3), Kalabay L(3), Rózsa S(4)(5), Eőry A(3).

Author information:
(1)Rácz Károly Clinical Medicine PhD School, Semmelweis University, Budapest, 
Hungary.
(2)Semmelweis University, Budapest, Hungary.
(3)Department of Family Medicine, Semmelweis University, Budapest, Hungary.
(4)Washington University, St. Louis, USA.
(5)Károli Gáspár University of the Reformed Church, Budapest, Hungary.

BACKGROUND: Responsibility of general practitioners (GPs) in delivering safe and 
effective care is always high but during the COVID-19 pandemic they face even 
growing pressure that might result in unbearable stress load (allostatic 
overload, AO) leading to disease.
OBJECTIVES: We aimed to measure AO of Hungarian GPs during the COVID-19 pandemic 
and explore their recreational resources to identify potential protective 
factors against stress load.
METHODS: In a mixed-method design, Fava's clinimetric approach to AO was applied 
alongside the Psychosocial Index (PSI); Kellner's symptom questionnaire (SQ) to 
measure depression, anxiety, hostility and somatisation and the Public Health 
Surveillance Well-being Scale (PHS-WB) to determine mental, social, and physical 
well-being. Recreational resources were mapped. Besides Chi-square and 
Kruskal-Wallis tests, regression analysis was applied to identify explanatory 
variables of AO.
RESULTS: Data of 228 GPs (68% females) were analysed. Work-related changes 
caused the biggest challenges leading to AO in 60% of the sample. While female 
sex (OR: 1.99; CI: 1.06; 3.74, p = 0.032) and other life stresses (OR: 1.4; CI: 
1.2; 1.6, p < 0.001) associated with increased odds of AO, each additional day 
with 30 min for recreation purposes associated with 20% decreased odds (OR: 
0.838; CI: 0.72; 0.97, p = 0.020). 3-4 days a week when time was ensured for 
recreation associated with elevated mental and physical well-being, while 
5-7 days associated with lower depressive and anxiety symptoms, somatisation, 
and hostility.
CONCLUSION: Under changing circumstances, resilience improvement through 
increasing time spent on recreation should be emphasised to prevent GPs from the 
adverse health consequences of stress load.

DOI: 10.1080/13814788.2021.1982889
PMCID: PMC8510612
PMID: 34633272 [Indexed for MEDLINE]

Conflict of interest statement: The authors report no conflicts of interest. The 
authors alone are responsible for the content and writing of the paper.


2894. Int J Clin Pract. 2021 Dec;75(12):e14973. doi: 10.1111/ijcp.14973. Epub 2021 Oct 
21.

Comparison of emotional approaches of medical doctors against COVID-19 pandemic: 
Eastern and Western Mediterranean countries.

Ozen G(1), Zanfardino A(2), Ozen G(3), Acan B(4), Piscopo A(2), Casaburo F(2), 
Gicchino F(2), Confetto S(2), Troncone A(2), Iafusco D(2).

Author information:
(1)Department of Pediatrics, University of Health Science, Kecioren Training and 
Research Hospital, Ankara, Turkey.
(2)Regional Centre for Pediatric Diabetes, Department of Pediatrics, University 
of Campania "Luigi Vanvitelli", Naples, Italy.
(3)Department of Emergency Medicine, Ataturk Chest Diseases and Thoracic Surgery 
Training and Research Hospital, Ankara, Turkey.
(4)Department of Emergency Medicine, Hacettepe University, Ankara, Turkey.

BACKGROUND: Pandemics are states of disease that occur worldwide and sharply 
increase in populations. It causes life events which trigger anxiety, 
depression, anger, sleep deprivation, emotional distress and stress. World 
Health Organization (WHO) declared coronavirus disease 2019 (COVID-19) a 
pandemic on March 11, pointing to the over 118,000 cases in over 110 countries. 
Many healthcare workers became ill during the pandemic and some among them died. 
In this study, we aimed to evaluate and compare level of stress against COVID-19 
pandemic among doctors from Turkey and Italy.
METHODS: This research is a cross-sectional study in which Perceived Stress 
Scale (PSS-10) and Secondary Traumatic Stress Scale (STSS) are administered 
online via social networks. All data collection tools were delivered to 
individuals between 1 and 15 June 2020 and filled in online with Google Forms 
application. In total, 618 individuals were included in this study and all of 
them were medical doctors.
RESULTS: Higher PS and STS levels were found related to female gender, being 
married, working in pandemic hospital and older ages. Stress levels were found 
statistically higher in Turkish doctors when compared to Italian doctors for 
both stress scales (Turkish/Italian PSS:20.18 ± 7.90/ 19.35 ± 6.71, STSS: 
44.19 ± 13.29/ 38.83 ± 13.74).
CONCLUSION: The number of doctors per 1000 of population is lower and per capita 
visits to a physician are higher in Turkey when compared to Italy. Besides 
pandemic, these heavier working conditions, increased weekly working hours can 
cause stress for Turkish doctors. Reporting information such this study is 
important and international collaborations are essential to plan future 
prevention strategies. We need to strengthen international ties and build more 
international collaborations rather than staying within our national silos. 
Additionally, interventions to promote mental well-being in health care 
professionals exposed to COVID-19 need to be immediately implemented.

© 2021 John Wiley & Sons Ltd.

DOI: 10.1111/ijcp.14973
PMCID: PMC8646585
PMID: 34626512 [Indexed for MEDLINE]


2895. Autism Res. 2022 Jan;15(1):93-102. doi: 10.1002/aur.2621. Epub 2021 Oct 9.

Job loss predicts worsening depressive symptoms for young adults with autism: A 
COVID-19 natural experiment.

Taylor JL(1), Adams RE(2), Pezzimenti F(1), Zheng S(3), Bishop SL(3).

Author information:
(1)Department of Pediatrics, Vanderbilt University Medical Center, Nashville, 
Tennessee, USA.
(2)Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 
Cincinnati, Ohio, USA.
(3)Department of Psychiatry and Behavioral Sciences and Weill Institute for 
Neurosciences, University of California, San Francisco, San Francisco, 
California, USA.

Adults with autism spectrum disorder (ASD) experience high rates of both 
unemployment and depression. Though job loss predicts increased risk of 
depression in the general population, studies have yet to directly examine this 
relationship among individuals with ASD. With the backdrop of rising 
unemployment due to COVID-19, we used a longitudinal design to examine whether 
employment changes predicted increasing depressive symptoms among young adults 
with ASD. Online surveys were collected from young adults with ASD at two times: 
just before widespread social distancing measures were adopted in the United 
States, and again 10 weeks later. Both time points included measurement of 
depressive symptoms (Beck Depression Inventory-2). At Time 2, COVID-related 
employment changes and the perceived impact of those changes on well-being were 
collected. Of the young adults who were employed at Time 1 (n = 144), over 
one-third (37.5%) reported employment changes during the first 2 months of 
COVID-19. Most of this change was job loss or reductions in hours or pay ("job 
loss/reduction"). Controlling for Time 1 depressive symptoms, young adults who 
experienced job loss/reduction had significantly higher depressive symptoms at 
Time 2 than those without an employment change. Individuals' perceived impact of 
employment change also predicted depressive symptoms. These findings suggest 
that losing a job or experiencing reductions in hours or pay leads to worsening 
depressive symptoms among adults with ASD. Better supporting autistic adults in 
the workplace may not only decrease the likelihood of job loss, but also combat 
the exceedingly high rates of depression in this group. LAY SUMMARY: Though 
unemployment has been linked to mental health problems in the general 
population, this relationship is seldom considered among adults with autism. In 
this study, we found that adults on the autism spectrum who lost their jobs or 
experienced reductions in pay or hours during the first 2 months of COVID-19 had 
worsening depression compared to adults who did not have job changes. Our 
findings suggest that increasing access to employment may help alleviate poor 
mental health among autistic adults.

© 2021 International Society for Autism Research and Wiley Periodicals LLC.

DOI: 10.1002/aur.2621
PMCID: PMC8646555
PMID: 34626164 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no potential conflict of 
interest.


2896. J Adv Nurs. 2022 Mar;78(3):609-644. doi: 10.1111/jan.15063. Epub 2021 Oct 9.

Psychological impacts and online interventions of social isolation amongst older 
adults during COVID-19 pandemic: A scoping review.

Rodrigues NG(1), Han CQY(1), Su Y(2), Klainin-Yobas P(1), Wu XV(1).

Author information:
(1)Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, 
National University of Singapore, Singapore, Singapore.
(2)Faculty of Health Sciences, Hokkaido University, Sapporo, Japan.

AIM: To summarise the psychological impacts of social isolation amongst older 
adults during COVID-19 and review the benefits and limitations of online 
interventions used to combat social isolation.
DESIGN: A scoping review was performed.
DATA SOURCES: A systematic search was performed from October 2020 to January 
2021 in seven electronic databases: China National Knowledge Infrastructure 
(CNKI), PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature 
(CINAHL), PsycINFO, Cochrane Library and Web of Science. A hand search of the 
reference lists of included papers and WHO publications was performed. Grey 
literature search was carried out from Scopus, ProQuest Dissertation and Google 
Scholar.
REVIEW METHODS: Studies were screened, appraised and extracted independently by 
two reviewers. Thematic analysis was used to synthesise data, which were 
presented in a descriptive manner and organised into categories and themes.
RESULTS: Totally, 33 studies were included. Four themes and eight sub-themes 
emerged: (1) negative impacts and experiences of older adults during social 
isolation, (2) adopting coping behaviours in the midst of COVID-19, (3) online 
interventions to combat the consequences of social isolation, (4) barriers to 
online intervention.
CONCLUSION: The COVID-19 pandemic has taken an emotional toll on older adults' 
psychological wellbeing and has highlighted the untapped strengths of older 
adults facing isolation. Online interventions, which could be a new normal in 
the COVID era, were beneficial in combating social isolation. Strategies by 
various stakeholders were recommended to tackle the barriers of online 
interventions.
IMPACT: With the COVID-19 pandemic still in progress, this review provides 
insights on the psychological impacts of social isolation amongst older adults. 
Nurses in the community and long-term care facilities could adopt strategies and 
online intervention to better support the older adults, contribute to a stronger 
COVID-19 response and support system, and an overall better road to recovery 
from this crisis.

© 2021 John Wiley & Sons Ltd.

DOI: 10.1111/jan.15063
PMCID: PMC8661520
PMID: 34625997 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


2897. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2021 
Nov;64(11):1452-1462. doi: 10.1007/s00103-021-03432-8. Epub 2021 Oct 7.

[Transgender health and healthcare during the COVID‑19 pandemic: 
a cross-sectional online survey in German-speaking countries].

[Article in German; Abstract available in German from the publisher]

Szücs D(1), Köhler A(1), Holthaus MM(1), Güldenring A(2)(3), Balk L(4), Motmans 
J(5), Nieder TO(6).

Author information:
(1)Institut für Sexualforschung, Sexualmedizin und Forensische Psychiatrie, 
Interdisziplinäres Transgender Versorgungscentrum Hamburg, Universitätsklinikum 
Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
(2)Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Westküstenklinikum 
Heide, Heide, Deutschland.
(3)BVT* e. V. (Bundesverband Trans* e. V.), Schiffbauerdamm 8, 10117, Berlin, 
Deutschland.
(4)dgti e. V. (Deutsche Gesellschaft für Transidentität und Intersexualität 
e. V.), Braunschweig, Deutschland.
(5)Transgender Infopunt, Ghent University Hospital, Gent, Belgien.
(6)Institut für Sexualforschung, Sexualmedizin und Forensische Psychiatrie, 
Interdisziplinäres Transgender Versorgungscentrum Hamburg, Universitätsklinikum 
Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland. 
t.nieder@uke.de.

BACKGROUND AND OBJECTIVE: Since spring of 2020, the COVID‑19 pandemic has 
disrupted our day-to-day lives and led to negative consequences in various areas 
of life, including mental and physical wellbeing. In this article, we take 
a closer look at the situation of trans people, who - due to experiences with 
discrimination and marginalization as well as their specific health-related 
interests - could be characterized by a particular vulnerability.
METHODS: Using an online cross-sectional survey, which we designed 
collaboratively with experts from the trans community, we investigated the 
mental and physical health of trans people from German-speaking countries and 
their access to trans-related healthcare during the COVID‑19 pandemic in the 
period from 1 May 2020 to 31 January 2021.
RESULTS: Since the beginning of the COVID‑19 pandemic, trans people have 
experienced barriers in access to gender-affirming treatments, mental health 
services, and COVID‑19-related medical care. At the same time, trans people 
reported being affected by chronic diseases disproportionately more often than 
the general population, including those leading to a higher risk for poorer 
outcomes of a COVID‑19 infection. Moreover, the participants reported being 
exposed to many risk factors associated with higher mental distress (e.g., 
having a chronic illness, belonging to a minority based on a non-heterosexual 
orientation, or having a low income).
DISCUSSION: The results of this survey indicate that prior vulnerabilities with 
regards to health problems and the restricted access to an informed and 
qualified transgender healthcare were exacerbated by the COVID‑19 pandemic.

Publisher: ZUSAMMENFASSUNG: EINLEITUNG UND ZIEL: Seit dem Frühjahr 2020 hat die 
COVID‑19-Pandemie nahezu alle Bereiche des gesellschaftlichen Lebens erheblich 
eingeschränkt, was bei vielen Menschen sowohl zu psychischen als auch zu 
körperlichen Belastungen geführt hat. In diesem Artikel nehmen wir die Situation 
von trans Personen in den Blick, die infolge ihrer gesellschaftlichen 
Diskriminierung und Marginalisierung sowie spezifischer, gesundheitsbezogener 
Anliegen durch eine besondere Vulnerabilität gekennzeichnet sein können.
METHODEN: Unter Beachtung partizipativer Elemente haben wir mit einer 
Online-Querschnitterhebung im Zeitraum vom 01.05.2020 bis zum 31.01.2021 die 
psychische und physische Gesundheit von trans Personen im deutschsprachigen Raum 
sowie deren Zugang zur Trans-Gesundheitsversorgung während der COVID‑19-Pandemie 
untersucht.
ERGEBNISSE: Trans Personen erleben seit Beginn der COVID‑19-Pandemie vermehrt 
Barrieren sowohl bei geschlechtsangleichenden Behandlungen und psychosozialen 
Unterstützungsangeboten als auch im Bereich der COVID‑19-bezogenen medizinischen 
Versorgung. Im Vergleich zur Gesamtbevölkerung berichten sie übermäßig häufig 
von somatischen Erkrankungen, auch von solchen, die ein erhöhtes Risiko für 
schwere Verläufe einer COVID‑19-Infektion darstellen. Außerdem berichten die 
Teilnehmenden verschiedene Faktoren, die ein Risiko für eine erhöhte psychische 
Belastung darstellen können (z. B. Zugehörigkeit zu einer Minderheit aufgrund 
nicht-heterosexueller Orientierung, niedriges Einkommen).
DISKUSSION: Die Ergebnisse unserer Untersuchung weisen darauf hin, dass 
bisherige Vulnerabilitäten für gesundheitliche Probleme und der eingeschränkte 
Zugang zu einer qualifiziert informierten Trans-Gesundheitsversorgung durch die 
Folgen der COVID‑19-Pandemie verschärft wurden.

© 2021. The Author(s).

DOI: 10.1007/s00103-021-03432-8
PMCID: PMC8496616
PMID: 34622306 [Indexed for MEDLINE]


2898. J Med Life. 2021 Jul-Aug;14(4):523-530. doi: 10.25122/jml-2020-0165.

The impact of the SARS-CoV-2 pandemic on the mental health of hemodialysis 
patients in Lebanon.

Beaini C(1)(2), Aoun M(1)(3), El Hajj C(2), Sleilaty G(4)(5), Haber N(6), 
Maalouf G(6), Abi Rached E(7).

Author information:
(1)Department of Nephrology, Faculty of Medicine, Saint-Joseph University, 
Beirut, Lebanon.
(2)Department of Nephrology, Bellevue Medical Center, Mansourieh, Lebanon.
(3)Department of Nephrology, Saint-George Hospital, Ajaltoun, Lebanon.
(4)Department of Biostatistics, Faculty of Medicine, Saint-Joseph University, 
Beirut, Lebanon.
(5)Department of Cardiovascular Surgery, Hôtel-Dieu de France Hospital, Beirut, 
Lebanon.
(6)Administrative Department, Bellevue Medical Center, Mansourieh, Lebanon.
(7)Department of Psychology, Bellevue Medical Center, Mansourieh, Lebanon.

Hemodialysis is a necessary treatment for end-stage kidney disease patients. It 
imposes undergoing three sessions of dialysis per week in a specialized center. 
Amid the SARS-CoV-2 pandemic, precautionary measures were mandatory in all 
dialysis facilities and may have negatively impacted patients' well-being. This 
study aimed to uncover the scale of this effect. We performed a cross-sectional 
study of all patients undergoing chronic hemodialysis in two dialysis units (one 
urban and another rural). Patients with Alzheimer's disease were excluded. 
Patients filled a questionnaire including information on socio-demographics, 
factors related to the dialysis facility, and the impact of the COVID-19 
epidemic on their mental health. A total of 72 patients responded. Their median 
age was 70 (60.79) years. Of them, 68% were males, 71% were married, and 10% 
were living alone. Following the pandemic, 35% felt more anxious, with a higher 
incidence of anxiety in the rural unit (p=0.021). Half of them felt very limited 
in their relationships, and 29% were isolated from their families. In total, 98% 
of patients were satisfied with the staff support. The imposed preventive 
measures were perceived as very strict in 27% of the surveyed patients. The 
majority of the urban group were bothered for not eating during the session, and 
they felt significantly more stress than the rural group (p=0.001). The 
SARS-CoV-2 pandemic increased anxiety among hemodialysis patients from a rural 
setting. Stress was more prevalent in the urban group and most probably related 
to limitations in eating during sessions. The majority were satisfied with staff 
support.

©2021 JOURNAL of MEDICINE and LIFE.

DOI: 10.25122/jml-2020-0165
PMCID: PMC8485366
PMID: 34621377 [Indexed for MEDLINE]


2899. J Clin Pathol. 2023 Apr;76(4):234-238. doi: 10.1136/jclinpath-2021-207725. Epub 
2021 Oct 7.

Impact of COVID-19 on the practice of breast pathologists: a survey of breast 
pathologists in the UK and Ireland.

Elghobashy M(1), Wahab L(2), Gunavardhan A(3), O'Sullivan E(4), Provenzano E(5), 
Deb R(6), Pritchard S(7), Di Palma S(8), Ellis IO(9), Boyd C(10), Pinder SE(11), 
Shaaban AM(12)(13); UK National Coordinating Group for Breast Pathology and the 
Association of Breast Pathology.

Author information:
(1)University of Birmingham, College of Medical and Dental Sciences, Birmingham, 
UK mirna1elghobashy@gmail.com.
(2)Histopathology, West Hertfordshire Hospitals NHS Trust, Watford, UK.
(3)Histopathology, Betsi Cadwaladr University Health Board, Bangor, UK.
(4)Public Health England, London, UK.
(5)Pathology Department, Addenbrooke's Hospital, Cambridge, UK.
(6)Cellular Pathology, University Hospitals of Derby and Burton NHS Foundation 
Trust, Derby, UK.
(7)Histopathology, Wythenshawe Hospital, Manchester, UK.
(8)Histology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK.
(9)Molecular Medical Sciences, University of Nottingham, Nottingham, UK.
(10)Histopathology, Belfast Health and Social Care Trust, Belfast, UK.
(11)Academic Oncology/Breast Pathology, King's College London, London, UK.
(12)Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
(13)Cellular Pathology, Queen Elizabeth Hospital, Birmingham, UK.

AIMS: There is little information on the impact of COVID-19 on breast 
pathologists. This survey assessed the effect of the COVID-19 pandemic on UK and 
Ireland-based breast pathologists to optimise working environments and ensure 
preparedness for potential future pandemics.
METHODS: A 35-question survey during the first wave of COVID-19 infections in 
the UK including questions on workload, working practices, professional 
development, training, health and safety and well-being was distributed to 
consultant breast pathologists and responses collected anonymously.
RESULTS: There were 135 responses from breast pathologists based in the UK and 
Ireland. Most participants (75.6%) stated that their workload had decreased and 
their productivity dropped. 86/135 (63.7%) were given the option of working from 
home and 36% of those who did reported improved efficiency. Multidisciplinary 
team meetings largely moved to virtual platforms (77.8%) with fewer members 
present (41.5%). Online education, including webinars and courses, was utilised 
by 92.6%. 16.3% of pathologists reported shortages of masks, visors or gowns as 
the the most common health and safety concern. COVID-19 had a significant 
negative impact on the physical and mental health of 33.3% of respondents. A 
small number of pathologists (10.4%) were redeployed and/or retrained.
CONCLUSION: The UK and Ireland breast pathologists adapted to the rapid change 
and maintained service delivery despite the significant impact of the pandemic 
on their working practices and mental health. It is important to apply flexible 
working patterns and environments that improve productivity and well-being. The 
changes suggested should be considered for long-term shaping of breast pathology 
services.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/jclinpath-2021-207725
PMCID: PMC8507406
PMID: 34620607 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2900. BMC Public Health. 2021 Oct 7;21(1):1801. doi: 10.1186/s12889-021-11751-3.

The impact of the COVID-19 pandemic on mental health and well-being of people 
living with a long-term physical health condition: a qualitative study.

Fisher A(#)(1), Roberts A(#)(2), McKinlay AR(2), Fancourt D(2), Burton A(2).

Author information:
(1)Department of Behavioural Science and Health, University College London, 1-19 
Torrington Place, London, WC1E 7HB, UK. abigail.fisher@ucl.ac.uk.
(2)Department of Behavioural Science and Health, University College London, 1-19 
Torrington Place, London, WC1E 7HB, UK.
(#)Contributed equally

BACKGROUND: The COVID-19 pandemic and associated restrictions caused major 
global disruption. Individuals with long-term physical health conditions (LTCs) 
are at higher risk of severe illness and often subject to the strictest pandemic 
guidance, so may be disproportionally affected. The aim of this study was to 
qualitatively explore how living with a LTC during the COVID-19 pandemic 
affected people's mental health and wellbeing.
METHODS: Participants were people living with LTCs who participated in 
telephone/video call interviews based on a semi-structured topic guide. Key 
themes and subthemes were determined using deductive and inductive thematic 
analysis.
RESULTS: The sample included 32 participants with LTCs (most commonly cancer, 
respiratory conditions or cardiovascular diseases), mean age 57 (SD 13) years, 
66% female and 72% white British. There were four overarching themes specific to 
living with a LTC. These were 1) high levels of fear and anxiety related to 
perceived consequences of catching COVID-19, 2) impact of shielding/isolation on 
mental health and wellbeing, 3) experience of healthcare during the pandemic and 
4) anxiety created by uncertainty about the future. Fourteen subthemes were 
identified, including concerns about accessing essential supplies and the 
importance of social support. Individuals who lived alone and were advised to 
shield could be profoundly negatively affected.
CONCLUSIONS: This study found that there were a number of aspects of living with 
a LTC during the pandemic that had a significant impact on mental health and 
well-being. There should be focus on how best to provide practical and social 
support to people with LTCs during a pandemic, particularly if they have to 
shield or isolate.

© 2021. The Author(s).

DOI: 10.1186/s12889-021-11751-3
PMCID: PMC8496145
PMID: 34620136 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests


2901. Eat Behav. 2021 Dec;43:101573. doi: 10.1016/j.eatbeh.2021.101573. Epub 2021 Oct 
1.

Higher admission and rapid readmission rates among medically hospitalized youth 
with anorexia nervosa/atypical anorexia nervosa during COVID-19.

Matthews A(1), Kramer RA(2), Peterson CM(2), Mitan L(3).

Author information:
(1)Cincinnati Children's Hospital Medical Center, Division of Behavioral 
Medicine and Clinical Psychology, 3333 Burnet Avenue, MLC 3015, Cincinnati, OH 
45229, USA; Department of Pediatrics, University of Cincinnati College of 
Medicine, Cincinnati, OH, USA. Electronic address: abigail.matthews@cchmc.org.
(2)Cincinnati Children's Hospital Medical Center, Division of Behavioral 
Medicine and Clinical Psychology, 3333 Burnet Avenue, MLC 3015, Cincinnati, OH 
45229, USA; Department of Pediatrics, University of Cincinnati College of 
Medicine, Cincinnati, OH, USA.
(3)Department of Pediatrics, University of Cincinnati College of Medicine, 
Cincinnati, OH, USA; Cincinnati Children's Hospital Medical Center, Division of 
Adolescent Medicine, 3333 Burnet Avenue, MLC 4000, 45229 Cincinnati, OH, USA.

The COVID-19 pandemic has had sweeping and deleterious effects on the well-being 
of individuals worldwide. Eating disorders (EDs) are no exception, with 
incidence and prevalence of EDs rising since COVID-19 onset. The current study 
examined inpatient census and readmission rates among youth (aged 8-18) 
hospitalized for medical complications of anorexia nervosa (AN) or atypical 
anorexia nervosa (AAN) throughout distinct periods of the COVID-19 pandemic, 
including pre-COVID-19 (n = 136), COVID-19 lockdown (n = 3), and post COVID-19 
lockdown (n = 24). Data from the COVID-19 lockdown period was excluded from 
analyses due to low sample size. Youth hospitalized during post COVID-19 
lockdown were over 8-times more likely to be readmitted within 30-days of 
discharge compared to patients hospitalized before the pandemic (p = .002). 
Further, the inpatient census of youth with AN/AAN was significantly higher 
during post COVID-19 lockdown compared to pre-COVID-19 (p = .04). One-third of 
patients hospitalized since the pandemic identified COVID-19 consequences as a 
primary correlate of their ED. Our findings, although not causal, suggest an 
association between COVID-19 and AN/AAN development and exacerbation in youth, 
thus prompting more medical admissions and rapid readmissions among this 
demographic. This study has important implications for understanding how AN/AAN 
onset and exacerbation in youth has been affected by the COVID-19 pandemic and 
can inform new efforts to support individuals navigating treatment during a 
global crisis.

Copyright © 2021. Published by Elsevier Ltd.

DOI: 10.1016/j.eatbeh.2021.101573
PMCID: PMC8490008
PMID: 34619464 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no known 
competing financial interests or personal relationships that could have appeared 
to influence the work reported in this paper.


2902. Nephrology (Carlton). 2022 Feb;27(2):190-194. doi: 10.1111/nep.13978. Epub 2021 
Oct 6.

Anxiety and psychosocial impact during coronavirus disease 2019 in home dialysis 
patients.

Davis MJ(1), Alqarni KA(1), McGrath-Chong ME(1), Bargman JM(1), Chan CT(1).

Author information:
(1)Division of Nephrology, University Health Network Toronto General Hospital, 
Toronto, Ontario, Canada.

The severe acute respiratory syndrome coronavirus (SARS-Cov-2) resulting in the 
coronavirus disease 2019 (COVID-19) is documented to have a negative 
psychosocial impact on patients. Home dialysis patients may be at risk of 
additional isolating factors affecting their mental health. The aim of this 
study is to describe levels of anxiety and quality of life during the COVID-19 
pandemic among home dialysis patients. This is a single-centre survey of home 
dialysis patients in Toronto, Ontario. Surveys were sent to 98 home 
haemodialysis and 43 peritoneal dialysis patients. Validated instruments 
(Haemodialysis and Peritoneal Dialysis Treatment Satisfaction Questionnaire, 
Generalized Anxiety Disorder 7 Item [GAD7] Scale, Patient Health Questionnaire 
[PHQ-9], Illness Intrusiveness Ratings Scale, Family APGAR Questionnaire and The 
Self Perceived Burden Scale) assessing well-being were used. Forty of the 141 
patients surveyed, participated in September 2020. The mean age was 
53.1 ± 12.1 years, with 60% male, and 85% home haemodialysis, 80% of patients 
rated their satisfaction with dialysis at 8/10 or greater, 82% of respondents 
reported either "not at all" or "for several days" indicating frequency of 
anxiety and depressive symptoms, 79% said their illness minimally or moderately 
impacted their life, 76% of respondents were almost always satisfied with 
interactions with family members, 91% were never or sometimes worried about 
caregiver burden. Among our respondents, there was no indication of a negative 
psychosocial impact from the pandemic, despite the increased social isolation. 
Our data further supports the use of home dialysis as the optimal form of 
dialysis.

© 2021 Asian Pacific Society of Nephrology.

DOI: 10.1111/nep.13978
PMCID: PMC8646267
PMID: 34617354 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


2903. BMC Psychiatry. 2021 Oct 6;21(1):489. doi: 10.1186/s12888-021-03506-6.

Resilience, coping, and distress among healthcare service personnel during the 
COVID-19 pandemic.

Elliott TR(1), Perrin PB(2), Bell AS(3), Powers MB(4), Warren AM(5).

Author information:
(1)Department of Educational Psychology, Texas A&M University, College Station, 
TX, 77843-4225, USA. telliott@tamu.edu.
(2)Department of Psychology, Virginia Commonwealth University, Richmond, 
Virginia, USA.
(3)Department of Educational Psychology, Texas A&M University, College Station, 
TX, 77843-4225, USA.
(4)Baylor University Medical Center, Dallas, TX, USA.
(5)Baylor Scott & White Research Institute, Baylor University Medical Center, 
Dallas, TX, USA.

BACKGROUND: The COVID-19 pandemic has a detrimental effect on the health and 
well-being of health care workers (HCWs). The extent to which HCWs may differ in 
their experience of depression and anxiety is unclear, and longitudinal studies 
are lacking. The present study examined theorized differences in distress 
between resilient and non-resilient HCWs over time, as reported in a national 
online survey. We also examined possible differences in distress as a function 
of sex and doctoral-level status.
METHODS: A national sample responded to an online survey data that included the 
study measures. Of the HCWs who responded, 666 had useable data at the two time 
points. A longitudinal structural equation model tested an a priori model that 
specified the relationship of a resilient personality prototype to self-reported 
resilience, coping, depression and anxiety at both measurement occasions. 
Additional invariance models examined possible differences by sex and 
doctoral-level status.
RESULTS: The final model explained 46.4% of the variance in psychological 
distress at Time 1 and 69.1% at Time 2. A non-resilient personality prototype 
predicted greater depression and anxiety. A resilient personality prototype was 
predictive of and operated through self-reported resilience and less disengaged 
coping to effect lower distress. No effects were found for active coping, 
however. The final model was generally invariant by sex and HCWs status. 
Additional analyses revealed that non-doctoral level HCWs had significantly 
higher depression and anxiety than doctoral-level HCWs on both occasions.
CONCLUSIONS: HCWs differ in their susceptibility to distress imposed by 
COVID-19. Those who are particularly vulnerable may have characteristics that 
contribute to a lower sense of confidence and efficacy in stressful situations, 
and more likely to rely on ineffective, disengaged coping behaviors that can 
exacerbate stress levels. Individual interventions and institutional policies 
may be implemented to support HCWs at risk.

© 2021. The Author(s).

DOI: 10.1186/s12888-021-03506-6
PMCID: PMC8493044
PMID: 34615501 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2904. PLoS One. 2021 Oct 6;16(10):e0257381. doi: 10.1371/journal.pone.0257381. 
eCollection 2021.

COVID-19 pandemic preparedness period through healthcare workers' eyes: A 
qualitative study from a Romanian healthcare facility.

Stoichitoiu LE(1)(2), Baicus C(1)(2).

Author information:
(1)University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.
(2)Department of Internal Medicine, Colentina Hospital, Bucharest, Romania.

INTRODUCTION: Healthcare providers represent a limited resource, and their 
mental health is crucial for patient care and for ensuring containment of the 
pandemics. We aimed to explore how healthcare workers experienced the 
preparedness period of COVID-19 pandemic, in order to ascertain the perceived 
weaknesses and strengths.
METHODS: Interviews were conducted with 17 participants encompassing senior 
physicians, residents, and nurses. They were audio-recorded, and the 
transcription was verbatim. We used thematic analysis.
RESULTS: We identified four themes, with subsequent subthemes: dealing with the 
unknown, human versus doctors, sense of helplessness, and a bridge to heaven, 
which explore how healthcare workers experienced the lack of knowledge, their 
feeling of losing control, and how they managed their internal fights. The 
disappointment provoked by the authorities and their colleagues was further 
evaluated. We identified factors involved in their well-being.
CONCLUSIONS: COVID-19 pandemic represented and will still pose a challenge for 
healthcare workers (HCWs) from all over the world. They felt unprepared for such 
a crisis. Further measures should be implemented in every hospital to maintain 
HCWs awareness and to prevent physical imbalance. Appropriate standards of care 
should be further stated by the authorities so that the healthcare providers may 
find easier a balance between their safety and their patients' needs. Conducting 
qualitative research involving HCWs during pandemic times may help in informing 
more significant policy decisions.

DOI: 10.1371/journal.pone.0257381
PMCID: PMC8494332
PMID: 34613987 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2905. Curr Psychiatry Rep. 2021 Oct 6;23(11):70. doi: 10.1007/s11920-021-01288-y.

The Impact of Social Media on College Mental Health During the COVID-19 
Pandemic: a Multinational Review of the Existing Literature.

Haddad JM(1)(2), Macenski C(3)(4), Mosier-Mills A(4), Hibara A(5), Kester K(4), 
Schneider M(4)(6), Conrad RC(3)(4), Liu CH(3)(4)(7).

Author information:
(1)Department of Psychiatry, Brigham and Women's Hospital, 75 Francis St., 221 
Longwood Avenue, Boston, MA, 02115, USA. jhaddad@bwh.harvard.edu.
(2)Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA. 
jhaddad@bwh.harvard.edu.
(3)Department of Psychiatry, Brigham and Women's Hospital, 75 Francis St., 221 
Longwood Avenue, Boston, MA, 02115, USA.
(4)Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
(5)Harvard College, 86 Brattle Street, Cambridge, MA, 02138, USA.
(6)Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
(7)Department of Newborn Medicine, Brigham and Women's Hospital, 75 Francis St., 
221 Longwood Avenue, Boston, MA, 02115, USA.

PURPOSE OF REVIEW: During the COVID-19 pandemic, both social media use and rates 
of anxiety and depression among college students have increased significantly. 
This begs the question, what is the relationship between social media use and 
college student mental health during the COVID-19 pandemic?
RECENT FINDINGS: Prior studies have found mixed results regarding the 
relationship between social media use and college student mental health. This 
relationship has become increasingly complex during the COVID-19 pandemic. We 
found that excessive or problematic social media use during the COVID-19 
pandemic was correlated with worse mental health outcomes that could be 
mitigated by dialectical thinking, optimism, mindfulness, and cognitive 
reappraisal. The COVID-19 pandemic acts as a moderator by strengthening the 
relationship between social media use and mental health. Future studies should 
consider the impact of social media on college student mental health and 
concentrate on intervention initiatives to ensure the psychological well-being 
of college students during a global pandemic outbreak.

© 2021. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s11920-021-01288-y
PMCID: PMC8493361
PMID: 34613542 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


2906. Support Care Cancer. 2022 Feb;30(2):1863-1872. doi: 10.1007/s00520-021-06611-0. 
Epub 2021 Oct 6.

The effect of anxiety and spiritual well-being on the care burden of caregivers 
of cancer patients during the COVID-19 pandemic.

Akkuş Y(1), Karacan Y(2), Ünlü K(3), Deniz M(4), Parlak A(5).

Author information:
(1)Nursing Department, Health Science Faculty, Kafkas University, 36100, Kars, 
Turkey. yelizakkus@gmail.com.
(2)Health Science Faculty, Nursing Department, Medical Nursing, Uludağ 
University, Bursa, Turkey.
(3)Pathology Department, Celal Bayar University, Manisa, Turkey.
(4)Nursing Department, Health Science Faculty, Kafkas University, 36100, Kars, 
Turkey.
(5)Atatürk Vocational Health School, Kafkas University, 36100, Kars, Turkey.

OBJECTIVES: The COVID-19 pandemic has adversely affected the caregivers of 
people with all chronic diseases, including people with cancer (PWC). This study 
was conducted to determine the impact of anxiety and spiritual well-being on the 
care burden of caregivers of PWC during the COVID-19 pandemic.
DESIGN: This cross-sectional descriptive study included 250 caregivers of 
hematology and oncology patients registered with a cancer support association. 
All participants completed the following self-report questionnaires: the 
Spiritual Well-Being Scale (SWBS), Generalized Anxiety Disorder 7-item scale 
(GAD-7), and the Zarit Caregiver Burden Interview (ZBI).
RESULTS: Most (82.4%) of the caregivers expressed fear that their patient may 
contract COVID-19, and 42.0% stated that they had difficulty getting to the 
hospital. The caregivers' mean ZBI score was 21.06 ± 14.64, their mean GAD-7 
score was 14.51 ± 6.02, and their mean SWBS score was 111.50 ± 16.84. According 
to the results of regression analysis, SWBS and GAD-7 scores had a significant 
effect on the ZBI score (p < 0.05).
CONCLUSION: In this study, anxiety explained most of the care burden during 
COVID-19. Therefore, during the COVID-19 pandemic, it may be beneficial to 
implement practices to promote spirituality and reduce anxiety in caregivers of 
PWC.

© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, 
part of Springer Nature.

DOI: 10.1007/s00520-021-06611-0
PMCID: PMC8493049
PMID: 34613473 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


2907. BMC Health Serv Res. 2021 Oct 5;21(1):1055. doi: 10.1186/s12913-021-07076-x.

"It changed everything": The safe Home care qualitative study of the COVID-19 
pandemic's impact on home care aides, clients, and managers.

Markkanen P(1), Brouillette N(2), Quinn M(2), Galligan C(2), Sama S(2), Lindberg 
J(2), Karlsson N(2)(3).

Author information:
(1)Department of Public Health, Zuckerberg College of Health Sciences, 
University of Massachusetts Lowell (UMASS Lowell), Lowell, MA, USA. 
Pia_Markkanen@uml.edu.
(2)Department of Public Health, Zuckerberg College of Health Sciences, 
University of Massachusetts Lowell (UMASS Lowell), Lowell, MA, USA.
(3)Department of Health and Human Services, New Hampshire (NH) Environmental 
Public Health Tracking Program, Division of Public Health Services, NH, Concord, 
NH, USA.

BACKGROUND: Home care (HC) services are crucial to the health and social 
wellbeing of older adults, people with disabilities, and the chronically ill. 
Although the HC sector is growing rapidly in the USA, there is high job turnover 
among the HC aide workforce. HC provides an important alternative to 
facility-based care, yet it has often been overlooked within the larger health 
care system: most recently, in COVID-19 pandemic planning. The objective of the 
study was to characterize qualitatively the impact of the COVID-19 pandemic on 
three key HC stakeholders: clients, aides, and agency managers.
METHODS: The study included 37 phone interviews conducted during April - 
November 2020: HC clients (n = 9), aides (n = 16), and agency managers (n = 12). 
All interviews were audio recorded and transcribed verbatim. Qualitative 
analysis of the transcripts followed the grounded theory approach. The interview 
transcriptions were coded line-by-line into hierarchical themes with NVivo 12 
software which allowed weighting of themes based on the number of interviews 
where they were coded.
RESULTS: Fear of infection and transmission among HC clients and aides were 
strong themes. Infection prevention and control became the top priority guiding 
day-to-day business operations at agencies; sourcing adequate personal 
protective equipment for staff was the most urgent task. HC aides expressed 
concerns for their clients who showed signs of depression, due to increased 
isolation during the pandemic. The disappearance of comforting touch - resulting 
from physical distancing practices - altered the expression of compassion in the 
HC aide-client care relationship.
CONCLUSIONS: The findings suggest that the pandemic has further increased 
psychosocial job demands of HC aides. Increased isolation of clients may be 
contributing to a wider public health problem of elder loneliness and 
depression. To support the HC stakeholders during the on-going COVID-19 
pandemic, for future pandemic planning or other health emergencies, it is 
important to improve HC aide job retention. This action could also ease the 
serious care services shortage among the growing population of older adults.

© 2021. The Author(s).

DOI: 10.1186/s12913-021-07076-x
PMCID: PMC8491760
PMID: 34610836 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2908. Radiography (Lond). 2022 May;28(2):553-559. doi: 10.1016/j.radi.2021.09.009. 
Epub 2021 Sep 29.

COVID-19: A literature review of the impact on diagnostic radiography students.

Astirbadi D(1), Lockwood P(2).

Author information:
(1)Imaging Department, Medway Maritime Hospital, Medway NHS Foundation Trust, 
Gillingham, Kent, United Kingdom.
(2)School of Allied Health Professions, Faculty of Medicine, Health and Social 
Care, Canterbury Christ Church University, Kent, United Kingdom. Electronic 
address: paul.lockwood@canterbury.ac.uk.

INTRODUCTION: COVID-19 is a highly contagious viral disease declared a global 
pandemic in March 2020. Throughout the pandemic, radiography students have been 
working in hospitals on the frontline. The review aimed to search for evidence 
of the impact COVID-19 has had on diagnostic radiography students and consider 
whether additional support and learning needs to be implemented.
METHODS: A literature search strategy applied keywords, BOOLEAN search 
operators, and eligibility criteria on PubMed, Medline, and Google Scholar 
databases. Cormack's (2000) critique framework was chosen to methodologically 
appraise the mixed-method studies to evaluate the quality, validity and rigour.
RESULTS: The search decisions were displayed in a PRISMA flowchart to evidence 
the process to identify the found articles comprised of two surveys, two 
semi-structured interviews and one case study. The findings identified common 
and reoccurring themes of personal protective equipment, mental wellbeing, 
accommodation and travel, assessments and learning, and transitioning to 
registration.
CONCLUSION: The literature suggests that students felt positive impacts of the 
pandemic, such as being prepared for registration. However, negative effects 
included the fear of contracting the virus, anxieties of working with ill 
patients, impracticalities of accommodation and travel during clinical 
placement, and the adaption to online learning.
IMPLICATIONS FOR PRACTICE: Clinical staff and universities need to work together 
to ensure students are mentally and physically supported during the pandemic. 
Regular meetings and agreed channels of communication with students will allow 
any issues to be brought to attention and addressed. In addition, employers 
should recognise that newly qualified radiographers will need extra support.

Copyright © 2021 The College of Radiographers. Published by Elsevier Ltd. All 
rights reserved.

DOI: 10.1016/j.radi.2021.09.009
PMCID: PMC8479461
PMID: 34607744 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest statement None.


2909. J Affect Disord. 2022 Feb 15;299:367-376. doi: 10.1016/j.jad.2021.09.090. Epub 
2021 Oct 2.

Physical and mental health impact of COVID-19 on children, adolescents, and 
their families: The Collaborative Outcomes study on Health and Functioning 
during Infection Times - Children and Adolescents (COH-FIT-C&A).

Solmi M(1), Estradé A(2), Thompson T(3), Agorastos A(4), Radua J(5), Cortese 
S(6), Dragioti E(7), Leisch F(8), Vancampfort D(9), Thygesen LC(10), Aschauer 
H(11), Schloegelhofer M(12), Akimova E(13), Schneeberger A(14), Huber CG(15), 
Hasler G(16), Conus P(17), Cuénod KQD(18), von Känel R(19), Arrondo G(20), 
Fusar-Poli P(21), Gorwood P(22), Llorca PM(23), Krebs MO(24), Scanferla E(25), 
Kishimoto T(26), Rabbani G(27), Skonieczna-Żydecka K(28), Brambilla P(29), 
Favaro A(30), Takamiya A(31), Zoccante L(32), Colizzi M(33), Bourgin J(34), 
Kamiński K(35), Moghadasin M(36), Seedat S(37), Matthews E(38), Wells J(39), 
Vassilopoulou E(40), Gadelha A(41), Su KP(42), Kwon JS(43), Kim M(44), Lee 
TY(45), Papsuev O(46), Manková D(47), Boscutti A(48), Gerunda C(49), Saccon 
D(50), Righi E(51), Monaco F(52), Croatto G(53), Cereda G(54), Demurtas J(55), 
Brondino N(56), Veronese N(57), Enrico P(58), Politi P(59), Ciappolino V(60), 
Pfennig A(61), Bechdolf A(62), Meyer-Lindenberg A(63), Kahl KG(64), Domschke 
K(65), Bauer M(66), Koutsouleris N(67), Winter S(68), Borgwardt S(69), Bitter 
I(70), Balazs J(71), Czobor P(72), Unoka Z(73), Mavridis D(74), Tsamakis K(75), 
Bozikas VP(76), Tunvirachaisakul C(77), Maes M(78), Rungnirundorn T(79), 
Supasitthumrong T(80), Haque A(81), Brunoni AR(82), Costardi CG(83), Schuch 
FB(84), Polanczyk G(85), Luiz JM(86), Fonseca L(87), Aparicio LV(88), Valvassori 
SS(89), Nordentoft M(90), Vendsborg P(91), Hoffmann SH(92), Sehli J(93), 
Sartorius N(94), Heuss S(95), Guinart D(96), Hamilton J(97), Kane J(98), Rubio 
J(99), Sand M(100), Koyanagi A(101), Solanes A(102), Andreu-Bernabeu A(103), 
Cáceres ASJ(104), Arango C(105), Díaz-Caneja CM(106), Hidalgo-Mazzei D(107), 
Vieta E(108), Gonzalez-Peñas J(109), Fortea L(110), Parellada M(111), Fullana 
MA(112), Verdolini N(113), Fárková E(114), Janků K(115), Millan M(116), Honciuc 
M(117), Moniuszko-Malinowska A(118), Łoniewski I(119), Samochowiec J(120), 
Kiszkiel Ł(121), Marlicz M(122), Sowa P(123), Marlicz W(124), Spies G(125), 
Stubbs B(126), Firth J(127), Sullivan S(128), Darcin AE(129), Aksu H(130), 
Dilbaz N(131), Noyan O(132), Kitazawa M(133), Kurokawa S(134), Tazawa Y(135), 
Anselmi A(136), Cracco C(137), Machado AI(138), Estrade N(139), De Leo D(140), 
Curtis J(141), Berk M(142), Ward P(143), Teasdale S(144), Rosenbaum S(145), Marx 
W(146), Horodnic AV(147), Oprea L(148), Alexinschi O(149), Ifteni P(150), 
Turliuc S(151), Ciuhodaru T(152), Bolos A(153), Matei V(154), Nieman DH(155), 
Sommer I(156), van Os J(157), van Amelsvoort T(158), Sun CF(159), Guu TW(160), 
Jiao C(161), Zhang J(162), Fan J(163), Zou L(164), Yu X(165), Chi X(166), de 
Timary P(167), van Winke R(168), Ng B(169), Pena E(170), Arellano R(171), Roman 
R(172), Sanchez T(173), Movina L(174), Morgado P(175), Brissos S(176), Aizberg 
O(177), Mosina A(178), Krinitski D(179), Mugisha J(180), Sadeghi-Bahmani D(181), 
Sadeghi M(182), Hadi S(183), Brand S(184), Errazuriz A(185), Crossley N(186), 
Ristic DI(187), López-Jaramillo C(188), Efthymiou D(189), Kuttichira P(190), 
Kallivayalil RA(191), Javed A(192), Afridi MI(193), James B(194), Seb-Akahomen 
OJ(195), Fiedorowicz J(196), Carvalho AF(197), Daskalakis J(198), Yatham 
LN(199), Yang L(200), Okasha T(201), Dahdouh A(202), Gerdle B(203), Tiihonen 
J(204), Shin JI(205), Lee J(206), Mhalla A(207), Gaha L(208), Brahim T(209), 
Altynbekov K(210), Negay N(211), Nurmagambetova S(212), Jamei YA(213), Weiser 
M(214), Correll CU(215).

Author information:
(1)University of Ottawa, Department of Psychiatry, Ontario, Canada; The Ottawa 
Hospital, Department of Mental Health, Ontario, Canada; University of Ottawa, 
Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, Ottawa 
Ontario; Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, 
Department of Psychosis Studies, Institute of Psychiatry, Psychology& 
Neuroscience, King's College London, London, United Kingdom; Centre for 
Innovation in Mental Health-Developmental Lab, School of Psychology, University 
of Southampton, and NHS Trust, Southampton, United Kingdom. Electronic address: 
marco.solmi83@gmail.com.
(2)Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department 
of Psychosis Studies, Institute of Psychiatry, Psychology& Neuroscience, King's 
College London, London, United Kingdom; Universidad Católica, Department of 
Psychology, Montevideo, Uruguay. Electronic address: 
andres.estrade_vaz@kcl.ac.uk.
(3)University of Greenwich, School of Human Sciences, London, United Kingdom. 
Electronic address: T.Thompson@greenwich.ac.uk.
(4)Aristotle University of Thessaloniki, II. Dept. of Psychiatry, Division of 
Neurosciences, Medical School, Faculty of Health Sciences, Greece. Electronic 
address: aagorast@auth.gr.
(5)Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department 
of Psychosis Studies, Institute of Psychiatry, Psychology& Neuroscience, King's 
College London, London, United Kingdom; Institut d'Investigacions Biomèdiques 
August Pi i Sunyer (IDIBAPS), Imaging of Mood- and Anxiety-Related Disorders 
(IMARD), CIBERSAM, Barcelona, Spain; Karolinska Institutet, Centre for 
Psychiatric Research and Education, Department of Clinical Neuroscience, 
Stockholm, Sweden. Electronic address: radua@clinic.cat.
(6)University of Southampton, Centre for Innovation in Mental Health, 
Southampton, United Kingdom. Electronic address: samuele.cortese@soton.ac.uk.
(7)Linköping University, Pain and Rehabilitation Centre and Department of 
Health, Medicine and Caring Sciences, Linköping, Sweden; University of Ioannina, 
Research Laboratory Psychology of Patients, Families & Health Professionals, 
Department of Nursing, School of Health Sciences, Ioannina, Greece. Electronic 
address: elena.dragioti@liu.se.
(8)University of Natural Resources and Life Sciences, Wien, Austria. Electronic 
address: Friedrich.Leisch@boku.ac.at.
(9)Katholieke Universiteit Leuven (KU Leuven), Department of Rehabilitation 
Sciences, Leuven, Belgium. Electronic address: davy.vancampfort@kuleuven.be.
(10)National Institute of Public Health, University of Southern Denmark, 
Denmark. Electronic address: lct@sdu.dk.
(11)BioPsyC - Biopsychosocial Corporation, Non-profit association for Research 
Funding Ltd., Vienna, Austria. Electronic address: harald.aschauer@biopsyc.at.
(12)BioPsyC - Biopsychosocial Corporation, Non-profit association for Research 
Funding Ltd., Vienna, Austria. Electronic address: 
monika.schloegelhofer@biopsyc.at.
(13)BioPsyC - Biopsychosocial Corporation, Non-profit association for Research 
Funding Ltd., Vienna, Austria. Electronic address: elena.akimova@biopsyc.at.
(14)Psychiatric Services Grisons, Department of Adult Psychiatry, Switzerland. 
Electronic address: andres.schneeberger@pdgr.ch.
(15)University of Basel, Universitäre Psychiatrische Kliniken Basel (UPK), 
Basel, Switzerland. Electronic address: christian.huber@unibas.ch.
(16)University of Fribourg, Fribourg Network of Mental Health (RFSM), Fribourg, 
Switzerland. Electronic address: gregor.hasler@unifr.ch.
(17)University of Lausanne, Department of Psychiatry, Lausanne, Switzerland. 
Electronic address: philippe.conus@chuv.ch.
(18)University of Lausanne, Department of Psychiatry, Lausanne, Switzerland. 
Electronic address: Kim.Do@chuv.ch.
(19)University Hospital Zurich, Department of Consultation-Liaison Psychiatry 
and Psychosomatic Medicine, Switzerland. Electronic address: 
roland.vonkaenel@usz.ch.
(20)University of Southampton, Centre for Innovation in Mental Health, 
Southampton, United Kingdom; University of Navarra, Mind-Brain Group, Institute 
for Culture and Society (ICS), Pamplona, Spain. Electronic address: 
garrondo@unav.es.
(21)Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department 
of Psychosis Studies, Institute of Psychiatry, Psychology& Neuroscience, King's 
College London, London, United Kingdom; OASIS service, South London and Maudsley 
NHS Foundation Trust, London, United Kingdom; University of Pavia, Department of 
Brain and Behavioral Sciences, Pavia, Italy. Electronic address: 
paolo.fusar-poli@unipv.it.
(22)Université de Paris, CMME, GHU Paris Psychiatrie et Neurosciences, Paris, 
France; Institute de Psychiatrie et Neuroscience de Paris, INSERM U1266, 
F-75014, Paris, France. Electronic address: p.gorwood@ghu-paris.fr.
(23)Université Clermont Auvergne, CHU Clermont-Ferrand, Service de Psychiatrie 
B, Clermont-Ferrand, France. Electronic address: 
pmllorca@chu-clermontferrand.fr.
(24)Institute de Psychiatrie et Neuroscience de Paris, INSERM U1266, F-75014, 
Paris, France; Université de Paris, PEPIT, GHU Paris Psychiatrie et 
Neuroscience, Paris, France. Electronic address: MO.KREBS@ghu-paris.fr.
(25)Université de Paris, CMME, GHU Paris Psychiatrie et Neurosciences, Paris, 
France. Electronic address: e.scanferla@ghu-paris.fr.
(26)Keio University School of Medicine, Department of Neuropsychiatry, Tokyo, 
Japan. Electronic address: tkishimoto@keio.jp.
(27)The National Foundation of Mental Health of Bangladesh, Bangladesh. 
Electronic address: rabbanigolam33@gmail.com.
(28)Pomeranian Medical University in Szczecin, Department of Biochemical 
Sciences, Szczecin, Poland. Electronic address: karzyd@pum.edu.pl.
(29)University of Milan, Department of Pathophysiology and Transplantation, 
Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 
Department of Neurosciences and Mental Health, Milan, Italy. Electronic address: 
paolo.brambilla1@unimi.it.
(30)University of Padua, Neurosciences Department, Padua, Italy. Electronic 
address: angela.favaro@unipd.it.
(31)Keio University School of Medicine, Department of Neuropsychiatry, Tokyo, 
Japan. Electronic address: akihiro.takamiya@keio.jp.
(32)Integrated University Hospital of Verona, Child and Adolescent 
Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Verona, Italy. 
Electronic address: leonardo.zoccante@aovr.veneto.it.
(33)University of Verona, Section of Psychiatry, Department of Neurosciences, 
Biomedicine and Movement Sciences, Verona, Italy. Electronic address: 
marco.colizzi@univr.it.
(34)Service de Psychiatrie de l'enfant et de l'adolescent, GHNE, 91440 Bures Sur 
Yvette, France. Electronic address: j.bourgin@gh-nord-essonne.fr.
(35)Medical University of Białystok, Department of Population Medicine and 
Lifestyle Diseases Prevention, Bialystok, Poland. Electronic address: 
fizklin@gmail.com.
(36)Kharazmi University, Department of Clinical Psychology, Faculty of 
Psychology and Education, Tehran, Iran. Electronic address: 
mmoghadasin@yahoo.com.
(37)Stellenbosch University, Department of Psychiatry, Faculty of Medicine and 
Health Sciences, South Africa. Electronic address: sseedat@sun.ac.za.
(38)Waterford Institute of Technology, School of Health Sciences, Waterford, 
Ireland. Electronic address: ematthews@wit.ie.
(39)Waterford Institute of Technology, School of Health Sciences, Waterford, 
Ireland. Electronic address: jswells@wit.ie.
(40)University of Nicosia, Department of Life and Health Sciences, Nicosia, 
Cyprus. Electronic address: vassilopoulouemilia@gmail.com.
(41)Universidade Federal de São Paulo, Department of Psychiatry, São Paulo, 
Brazil. Electronic address: aryararipe@gmail.com.
(42)An-Nan Hospital, China Medical University, Department of Psychiatry, Tainan, 
Taiwan; Maastricht University, Department of Psychiatry and Neuropsychology, 
Maastricht, The Netherlands. Electronic address: cobolsu@gmail.com.
(43)Seoul National University College of Medicine, Department of Psychiatry, 
Seoul, Republic of Korea. Electronic address: kwonjs@snu.ac.kr.
(44)Seoul National University Hospital, Department of Neuropsychiatry, Seoul, 
Republic of Korea. Electronic address: verte82@snu.ac.kr.
(45)Pusan National University Yangsan Hospital, Department of Psychiatry, 
Yangsan, Republic of Korea. Electronic address: leetaey@gmail.com.
(46)Moscow Research Institute of Psychiatry, Moscow, Russia. Electronic address: 
oleg.papsouev@gmail.com.
(47)National Institute of Mental Health, Klecany, Czech Republic. Electronic 
address: denisa.mankova@nudz.cz.
(48)University of Milan, Department of Pathophysiology and Transplantation, 
Milan, Italy. Electronic address: a.boscutti@gmail.com.
(49)University of Padua, Neurosciences Department, Padua, Italy. Electronic 
address: cristiano.gerunda@unipd.it.
(50)AULSS4 Veneto Orientale, Addictions Department, Italy. Electronic address: 
diego.saccon@aulss4.veneto.it.
(51)University of Modena and Reggio Emilia, Department of Biomedical, Metabolic 
and Neural Sciences, Modena, Italy. Electronic address: elena.righi@unimore.it.
(52)ASL Salerno, Department of Mental Health, Salerno, Italy. Electronic 
address: fmonaco1980@gmail.com.
(53)University of Padova, Padova, Italy. Electronic address: 
giovannicroatto8@gmail.com.
(54)University of Milan, Department of Pathophysiology and Transplantation, 
Milan, Italy. Electronic address: guido.cereda@unimi.it.
(55)University of Modena and Reggio Emilia, Clinical and Experimental Medicine 
PhD Program, Modena, Italy. Electronic address: eritrox7@gmail.com.
(56)University of Pavia, Department of Brain and Behavioral Sciences, Pavia, 
Italy. Electronic address: natascia.brondino@unipv.it.
(57)University of Palermo, Department of Internal Medicine, Geriatrics Section, 
Palermo, Italy. Electronic address: nicola.veronese@unipa.it.
(58)University of Milan, Department of Pathophysiology and Transplantation, 
Milan, Italy. Electronic address: paolo.enrico@unimi.it.
(59)University of Pavia, Department of Brain and Behavioral Sciences, Pavia, 
Italy. Electronic address: pierluigi.politi@unipv.it.
(60)Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of 
Neurosciences and Mental Health, Milan, Italy. Electronic address: 
valentina.ciappolino@policlinico.mi.it.
(61)Technische Universität Dresden, University Hospital Carl Gustav Carus, 
Department of Psychiatry and Psychotherapy, Dresden, Germany. Electronic 
address: Andrea.Pfennig@uniklinikum-dresden.de.
(62)University of Cologne, Cologne, Germany. Electronic address: 
andreas.bechdolf@uk-koeln.de.
(63)Heidelberg University, Central Institute of Mental Health, Medical Faculty 
Mannheim, Germany. Electronic address: Andreas.Meyer-Lindenberg@zi-mannheim.de.
(64)Hannover Medical School, Department of Psychiatry, Social Psychiatry and 
Psychotherapy, Germany. Electronic address: kahl.kai@mh-hannover.de.
(65)University of Freiburg, Department of Psychiatry and Psychotherapy, Medical 
Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany. 
Electronic address: katharina.domschke@uniklinik-freiburg.de.
(66)Technische Universität Dresden, University Hospital Carl Gustav Carus, 
Department of Psychiatry and Psychotherapy, Dresden, Germany. Electronic 
address: Michael.Bauer@uniklinikum-dresden.de.
(67)Ludwig-Maximilians-University of Munich, Munich, Germany. Electronic 
address: Nikolaos.Koutsouleris@med.uni-muenchen.de.
(68)Charité Universitätsmedizin Berlin, Department of Child and Adolescent 
Psychiatry, Berlin, Germany. Electronic address: sibylle.winter@charite.de.
(69)University of Lübeck, Lübeck, Germany. Electronic address: 
s.borgwardt@unibas.ch.
(70)Semmelweis University, Department of Psychiatry and Psychotherapy, Budapest, 
Hungary. Electronic address: bitter.istvan@med.semmelweis-univ.hu.
(71)Eotvos Lorand University, Institute of Psychology, Budapest, Hungary; 
Bjørknes University College, Oslo, Norway. Electronic address: 
balazs.judit@ppk.elte.hu.
(72)Semmelweis University, Department of Psychiatry and Psychotherapy, Budapest, 
Hungary. Electronic address: czobor.pal@med.semmelweis-univ.hu.
(73)Semmelweis University, Department of Psychiatry and Psychotherapy, Budapest, 
Hungary. Electronic address: unoka.zsolt@med.semmelweis-univ.hu.
(74)University of Ioannina, Department of Primary Education, Ioannina, Greece. 
Electronic address: dmavridi@uoi.gr.
(75)King's College London, Institute of Psychiatry, Psychology and Neuroscience, 
London, United Kingdom. Electronic address: ktsamakis@gmail.com.
(76)Aristotle University of Thessaloniki, II. Dept. of Psychiatry, Division of 
Neurosciences, Medical School, Faculty of Health Sciences, Greece. Electronic 
address: mpozikas@auth.gr.
(77)Chulalongkorn University, Department of Psychiatry, Thailand. Electronic 
address: chavit.T@chula.ac.th.
(78)Chulalongkorn University, Department of Psychiatry, Thailand. Electronic 
address: dr.michaelmaes@hotmail.com.
(79)Chulalongkorn University, Department of Psychiatry, Thailand. Electronic 
address: drteerayuth@gmail.com.
(80)Chulalongkorn University, Department of Psychiatry, Thailand. Electronic 
address: thitiporn.s@chula.ac.th.
(81)The National Foundation of Mental Health of Bangladesh, Bangladesh. 
Electronic address: arifulhaque.ukzn@gmail.com.
(82)Faculdade de Medicina da Universidade de São Paulo, Departments of Internal 
Medicine and Psychiatry, São Paulo, Brazil. Electronic address: brunoni@usp.br.
(83)Universidade Federal de São Paulo, Department of Psychiatry, São Paulo, 
Brazil. Electronic address: gustavocostardi@hotmail.com.
(84)Universidade Federal de Santa Maria, Department of Sports Methods and 
Techniques, Santa Maria, RS, Brazil. Electronic address: felipe.schuch@ufsm.br.
(85)Faculdade de Medicina da Universidade de São Paulo, Departments of Internal 
Medicine and Psychiatry, São Paulo, Brazil. Electronic address: 
polanczyk.guilherme@gmail.com.
(86)Universidade do Extremo Sul Catarinense, Translational Psychiatry 
Laboratory, Graduate Program in Health Sciences, Criciúma, SC, Brazil. 
Electronic address: jhoanne_luiz@hotmail.com.
(87)Universidade Federal de São Paulo, Department of Psychiatry, São Paulo, 
Brazil. Electronic address: laismfonseca@gmail.com.
(88)Faculdade de Medicina da Universidade de São Paulo, Departments of Internal 
Medicine and Psychiatry, São Paulo, Brazil. Electronic address: 
luanavma@hotmail.com.
(89)Universidade do Extremo Sul Catarinense, Translational Psychiatry 
Laboratory, Graduate Program in Health Sciences, Criciúma, SC, Brazil. 
Electronic address: samiravalvassori@unesc.net.
(90)University of Copenhagen, Copenhagen, Denmark. Electronic address: 
mn@dadlnet.dk.
(91)Psykiatrifonden, Copenhagen, Denmark. Electronic address: 
pv@psykiatrifonden.dk.
(92)National Institute of Public Health, University of Southern Denmark, 
Denmark. Electronic address: sohh@sdu.dk.
(93)University of Fribourg, Fribourg Network of Mental Health (RFSM), Fribourg, 
Switzerland. Electronic address: jihed.sehli@gmail.com.
(94)Association for the Improvement of Mental Health Programmes (AMH), 
Switzerland. Electronic address: sartorius@normansartorius.com.
(95)FHNW University of Applied Sciences and Arts Northwestern Switzerland, 
Switzerland. Electronic address: sabina.heuss@fhnw.ch.
(96)The Zucker Hillside Hospital, Northwell Health, New York, USA; Donald and 
Barbara Zucker School of Medicine at Hofstra/Northwell, New York, USA; 
Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de 
Salud Mental (CIBERSAM), Institut de Neuropsiquiatria i Addiccions (INAD), 
Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), 
Departament de Psiquiatria, Barcelona, Spain. Electronic address: 
DGuinart@northwell.edu.
(97)University of Texas Health Science Center Houston, McGovern Medical School, 
Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, USA. 
Electronic address: Jane.E.Hamilton@uth.tmc.edu.
(98)The Zucker Hillside Hospital, Northwell Health, New York, USA; Feinstein 
Institutes for Medical Research, New York, USA. Electronic address: 
JKane2@northwell.edu.
(99)The Zucker Hillside Hospital, Northwell Health, New York, USA; Feinstein 
Institutes for Medical Research, New York, USA. Electronic address: 
JRubio13@northwell.edu.
(100)Boehringer-Ingelheim, USA. Electronic address: 
michael.sand@boehringer-ingelheim.com.
(101)Parc Sanitari Sant Joan de Deu, Research and Development Unit, CIBERSAM, 
ICREA, Barcelona, Spain. Electronic address: a.koyanagi@pssjd.org.
(102)Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Imaging 
of Mood- and Anxiety-Related Disorders (IMARD), CIBERSAM, Barcelona, Spain. 
Electronic address: al.solanes@gmail.com.
(103)Hospital General Universitario Gregorio Marañón, Department of Child and 
Adolescent Psychiatry, Institute of Psychiatry and Mental Health (IPS MARAÑÓN), 
IiSGM, CIBERSAM, Madrid, Spain. Electronic address: a.andreu.bernabeu@gmail.com.
(104)Hospital General Universitario Gregorio Marañón, Department of Child and 
Adolescent Psychiatry, Institute of Psychiatry and Mental Health (IPS MARAÑÓN), 
IiSGM, CIBERSAM, Madrid, Spain. Electronic address: antonia.sanjose@iisgm.com.
(105)Hospital General Universitario Gregorio Marañón, Department of Child and 
Adolescent Psychiatry, Institute of Psychiatry and Mental Health (IPS MARAÑÓN), 
IiSGM, CIBERSAM, Madrid, Spain. Electronic address: carango@hggm.es.
(106)Hospital General Universitario Gregorio Marañón, Department of Child and 
Adolescent Psychiatry, Institute of Psychiatry and Mental Health (IPS MARAÑÓN), 
IiSGM, CIBERSAM, Madrid, Spain. Electronic address: 
covadonga.martinez@iisgm.com.
(107)University of Barcelona, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, 
Spain. Electronic address: dahidalg@clinic.cat.
(108)University of Barcelona, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, 
Spain. Electronic address: evieta@clinic.cat.
(109)Hospital General Universitario Gregorio Marañón, Department of Child and 
Adolescent Psychiatry, Institute of Psychiatry and Mental Health (IPS MARAÑÓN), 
IiSGM, CIBERSAM, Madrid, Spain. Electronic address: javipenhas@gmail.com.
(110)Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Imaging 
of Mood- and Anxiety-Related Disorders (IMARD), CIBERSAM, Barcelona, Spain. 
Electronic address: lydiafor94@gmail.com.
(111)Hospital General Universitario Gregorio Marañón, Department of Child and 
Adolescent Psychiatry, Institute of Psychiatry and Mental Health (IPS MARAÑÓN), 
IiSGM, CIBERSAM, Madrid, Spain. Electronic address: parelladahggm@gmail.com.
(112)Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Imaging 
of Mood- and Anxiety-Related Disorders (IMARD), CIBERSAM, Barcelona, Spain. 
Electronic address: mafullana@clinic.cat.
(113)University of Barcelona, Hospital Clínic, Bipolar and Depressive Disorders 
Unit, Institute of Neuroscience, IDIBAPS, CIBERSAM, Barcelona, Spain. Electronic 
address: norma.verdolini@gmail.com.
(114)National Institute of Mental Health, Klecany, Czech Republic. Electronic 
address: eva.farkova@nudz.cz.
(115)National Institute of Mental Health, Klecany, Czech Republic. Electronic 
address: karolina.janku@nudz.cz.
(116)Institute de Recherché de Servier (IDRS), France. Electronic address: 
mark.millan@servier.com.
(117)Université Clermont Auvergne, CHU Clermont-Ferrand, Service de Psychiatrie 
B, Clermont-Ferrand, France. Electronic address: 
rmhonciuc@chu-clermontferrand.fr.
(118)Medical University of Białystok, Department of Infectious Diseases and 
Neuroinfections, Poland. Electronic address: annamoniuszko@op.pl.
(119)Pomeranian Medical University in Szczecin, Department of Biochemical 
Sciences, Szczecin, Poland; Sanprobi Sp. z o.o. Sp. k, Poland. Electronic 
address: sanprobi@sanprobi.pl.
(120)Pomeranian Medical University in Szczecin, Department of Psychiatry, 
Szczecin, Poland. Electronic address: samoj@pum.edu.pl.
(121)University of Białystok, Institute of Sociology, Society and Cognition 
Unit, Białystok, Poland. Electronic address: lukaszkiszkiel@gmail.com.
(122)Pomeranian Medical University in Szczecin, Department of Biochemical 
Sciences, Szczecin, Poland. Electronic address: mariamarlicz@gmail.com.
(123)Medical University of Białystok, Department of Population Medicine and 
Lifestyle Diseases Prevention, Bialystok, Poland. Electronic address: 
mailtosowa@gmail.com.
(124)Pomeranian Medical University in Szczecin, Department of Gastroenterology, 
Szczecin, Poland; The Centre for Digestive Diseases Endoklinika, Szczecin, 
Poland. Electronic address: marlicz@hotmail.com.
(125)Stellenbosch University, Department of Psychiatry, Faculty of Medicine and 
Health Sciences, South Africa. Electronic address: ggiocos@sun.ac.za.
(126)King's College London, London, United Kingdom. Electronic address: 
brendon.stubbs@kcl.ac.uk.
(127)University of Manchester, Division of Psychology and Mental Health, 
Manchester, United Kingdom. Electronic address: joseph.firth@manchester.ac.uk.
(128)University of Bristol, Bristol, United Kingdom. Electronic address: 
Sarah.Sullivan@bristol.ac.uk.
(129)Istanbul Basaksehir Cam ve Sakura City Hospital, Department of Psychiatry, 
Istanbul, Turkey. Electronic address: aslienez@gmail.com.
(130)Adnan Menderes University Department of Child and Adolescent Psychiatry, 
Aydın, Turkey. Electronic address: aksubhatice@yahoo.com.
(131)Uskudar University, Department of Psychiatry and Psychology, Istanbul, 
Turkey. Electronic address: nesrin.dilbaz@gmail.com.
(132)Uskudar University, Department of Psychiatry and Psychology, Istanbul, 
Turkey. Electronic address: conurnoyan@gmail.com.
(133)Keio University School of Medicine, Department of Neuropsychiatry, Tokyo, 
Japan. Electronic address: m-kitazawa@keio.jp.
(134)Keio University School of Medicine, Department of Neuropsychiatry, Tokyo, 
Japan. Electronic address: shunya5@keio.jp.
(135)Keio University School of Medicine, Department of Neuropsychiatry, Tokyo, 
Japan. Electronic address: tazawa@a5.keio.jp.
(136)Universidad Católica, Department of Psychology, Montevideo, Uruguay. 
Electronic address: alejandro.anselmi@ucu.edu.uy.
(137)Universidad Católica, Department of Psychology, Montevideo, Uruguay. 
Electronic address: ccracco@ucu.edu.uy.
(138)Universidad Católica, Department of Psychology, Montevideo, Uruguay. 
Electronic address: amachado@ucu.edu.uy.
(139)Universidad Católica, Department of Psychology, Montevideo, Uruguay. 
Electronic address: natalia.estrade@ucu.edu.uy.
(140)Griffith University, South East Queensland, Australia. Electronic address: 
D.DeLeo@griffith.edu.au.
(141)Mindgardens Neuroscience Network, Sydney, Australia. Electronic address: 
j.curtis@unsw.edu.au.
(142)Deakin University School of Medicine, Victoria, Australia. Electronic 
address: michael.berk@deakin.edu.au.
(143)UNSW Sydney, School of Psychiatry, Sydney, Australia. Electronic address: 
p.ward@unsw.edu.au.
(144)Deakin University School of Medicine, Victoria, Australia. Electronic 
address: s.teasdale@unsw.edu.au.
(145)UNSW Sydney, School of Psychiatry, Sydney, Australia. Electronic address: 
s.rosenbaum@unsw.edu.au.
(146)Deakin University School of Medicine, Victoria, Australia. Electronic 
address: wolf.marx@deakin.edu.au.
(147)University of Medicine and Pharmacy Grigore T. Popa, Faculty of Medicine, 
Iasi, Romania. Electronic address: adrian-vasile-horodnic@umfiasi.ro.
(148)University of Medicine and Pharmacy Grigore T. Popa, Faculty of Medicine, 
Iasi, Romania. Electronic address: liviu.oprea@umfiasi.ro.
(149)Institute of Psychiatry "Socola", Iasi, Romania. Electronic address: 
alexinschi@yahoo.com.
(150)Transilvania University of Brasov, Faculty of Medicine, Brasov, Romania. 
Electronic address: petru_ifteni@yahoo.com.
(151)University of Medicine and Pharmacy Grigore T. Popa, Faculty of Medicine, 
Iasi, Romania. Electronic address: serban_turliuc@yahoo.com.
(152)Emergency Hospital "Nicolae Oblu", Iasi, Romania. Electronic address: 
tudorciuhodaru@yahoo.co.uk.
(153)University of Medicine and Pharmacy Grigore T. Popa, Faculty of Medicine, 
Iasi, Romania. Electronic address: alex_andra_bolos@yahoo.com.
(154)Psychiatry Department, University of Medicine and Pharmacy "Carol Davila" 
Bucharest, "Prof. Dr. Alexandru Obregia" Psychiatric Hospital, Bucharest, 
Romania. Electronic address: valipmatei@yahoo.com.
(155)Academisch Medisch Centrum Universiteit van Amsterdam, Amsterdam, The 
Netherlands. Electronic address: d.h.nieman@amc.uva.nl.
(156)University Medical Center Groningen, University of Groningen, Cognitive 
Neurosciences, Department of Biomedical Sciences of Cells & Systems, Groningen, 
The Netherlands; University Medical Center Groningen, University of Groningen, 
Department of Psychiatry, Groningen, The Netherlands. Electronic address: 
i.e.c.sommer@umcg.nl.
(157)Utrecht University Medical Centre, Department of Psychiatry, Utrecht, The 
Netherlands. Electronic address: j.j.vanos-2@umcutrecht.nl.
(158)Maastricht University, Department of Psychiatry and Neuropsychology, 
Maastricht, The Netherlands. Electronic address: 
t.vanamelsvoort@maastrichtuniversity.nl.
(159)China Medical University Hospital, Mind-Body Interface Research Center, 
Taichung, Taiwan; Department of Psychiatry and Behavioral Medicine, Carilion 
Clinic Virginia Tech Carilion School of Medicine, Roanoke, VA, USA. Electronic 
address: chingfangsun@gmail.com.
(160)China Medical University Beigang Hospital, Division of Psychiatry, 
Department of Internal Medicine, Taiwan. Electronic address: da20vid@gmail.com.
(161)Shenzhen University, School of Psychology, Shenzhen, China. Electronic 
address: jiaocan@szu.edu.cn.
(162)Shenzhen University, School of Psychology, Shenzhen, China. Electronic 
address: jenny121@126.com.
(163)Shenzhen University, School of Psychology, Shenzhen, China. Electronic 
address: FanJL@szu.edu.cn.
(164)Shenzhen University, School of Psychology, Shenzhen, China. Electronic 
address: liyezou123@gmail.com.
(165)Peking University Institute of Mental Health, Department of Public Mental 
Health, Pekin, China. Electronic address: yuxin@bjmu.edu.cn.
(166)Shenzhen University, School of Psychology, Shenzhen, China. Electronic 
address: xinlichi@126.com.
(167)UCLouvain, Institute of Neuroscience and Cliniques Universitaires 
Saint-Luc, Department of Adult Psychiatry, Brussels, Belgium. Electronic 
address: Philippe.detimary@uclouvain.be.
(168)Katholieke Universiteit Leuven (KU Leuven), Department of Neurosciences, 
Leuven, Belgium. Electronic address: ruud.vanwinkel@kuleuven.be.
(169)Asociación Psiquiátrica Mexicana, Mexico. Electronic address: 
bng@sunvalleyb.com.
(170)Asociación Psiquiátrica Mexicana, Mexico. Electronic address: 
epena@cisne.mx.
(171)Asociación Psiquiátrica Mexicana, Mexico. Electronic address: 
jramonarellanoc@hotmail.com.
(172)Asociación Psiquiátrica Mexicana, Mexico. Electronic address: 
raquelrr@hotmail.com.
(173)Asociación Psiquiátrica Mexicana, Mexico. Electronic address: 
marsan2@prodigy.net.mx.
(174)Moscow Research Institute of Psychiatry, Moscow, Russia. Electronic 
address: movina_larisa@bk.ru.
(175)University of Minho, Life and Health Sciences Research Institute (ICVS), 
School of Medicine, Braga, Portugal; ICVS/3B's - PT Government Associate 
Laboratory, Braga Guimarães, Portugal. Electronic address: 
pedromorgado@med.uminho.pt.
(176)Lisbon's Psychiatric Hospital Centre, Department of Psychiatry, Portugal. 
Electronic address: brissos.sofia@gmail.com.
(177)Belarusian Medical Academy of Postgraduate Education, Belarus. Electronic 
address: oleg.aizberg@gmail.com.
(178)Clienia AG, Wetzikon Psychiatric Centre, Switzerland. Electronic address: 
annamosina.md@gmail.com.
(179)Integrated Psychiatry Winterthur (IPW), Switzerland. Electronic address: 
damir.krinitski@gmail.com.
(180)Kyambogo University, Department of Sociology and Social Administration, 
Kampala, Uganda. Electronic address: Jmmugi77@hotmail.com.
(181)Stanford University, Department of Psychology, California, USA; 
Universitäre Psychiatrische Kliniken Basel (UPK), Center of Affective, Stress 
and Sleep Disorders (ZASS), Basel, Switzerland. Electronic address: 
Bahmanid@stanford.edu.
(182)Kermanshah University of Medical Sciences, Medical Biology Research Center, 
Kermanshah, Iran. Electronic address: sadeghi_mbrc@yahoo.com.
(183)Kharazmi University, Tehran, Iran. Electronic address: 
hadi.samira@yahoo.com.
(184)Universitäre Psychiatrische Kliniken Basel (UPK), Center of Affective, 
Stress and Sleep Disorders (ZASS), Basel, Switzerland; University of Basel, 
Department of Sport, Exercise, and Health, Division of Sport Science and 
Psychosocial Health, Basel, Switzerland; Kermanshah University of Medical 
Sciences, Substance Abuse Prevention Research Center, Kermanshah, Iran; 
Kermanshah University of Medical Sciences, Sleep Disorders Research Center, 
Kermanshah, Iran; Tehran University of Medical Sciences, School of Medicine, 
Tehran, Iran. Electronic address: serge.brand@upk.ch.
(185)Pontificia Universidad Católica de Chile, Department of Psychiatry, School 
of Medicine, Santiago, Chile. Electronic address: anerrazuriz@uc.cl.
(186)Pontificia Universidad Católica de Chile, Department of Psychiatry, School 
of Medicine, Santiago, Chile. Electronic address: ncrossley@uc.cl.
(187)University of Kragujevac, Department of Psychiatry, Faculty of Medical 
Sciences, Kragujevac, Serbia. Electronic address: draganaristic4@gmail.com.
(188)University of Antioquia, Department of Psychiatry, Medellín, Colombia. 
Electronic address: carlos.lopez20@udea.edu.co.
(189)University of Nicosia, Department of Life and Health Sciences, Nicosia, 
Cyprus. Electronic address: dimitrisefthy@gmail.com.
(190)Jubilee Mission Medical College & Research Institute, Thrissur, India. 
Electronic address: drpraveenlalkuttichira@gmail.com.
(191)Pushpagiri Institute of Medical Sciences, Deptartment of Psychiatry, 
Thiruvalla, Kerala, India. Electronic address: roykalli@gmail.com.
(192)Chairman, Pakistan Psychiatric Research Centre-Fountain House, Lahore, 
Pakistan. Electronic address: afzalj@gmail.com.
(193)Dean, Faculty of Psychiatry, College of Physicians and Surgeons, Pakistan; 
Dean, Jinnah Postgraduate Medical Centre, Karachi, Pakistan; Dean, Faculty of 
Medicine, Jinnah Sindh Medical University, Karachi, Pakistan. Electronic 
address: driqbalafridi@yahoo.com.
(194)Federal Neuropsychiatric Hospital, Department of Clinical Services, 
Benin-City, Nigeria. Electronic address: bawojames@yahoo.com.
(195)Irrua Specialist Teaching Hospital, Department of Psychiatry, Edo State, 
Nigeria. Electronic address: sebakahomen@gmail.com.
(196)University of Ottawa, Department of Psychiatry, Ontario, Canada. Electronic 
address: jfiedorowicz@toh.ca.
(197)Centre for Addiction and Mental Health (CAMH), Canada. Electronic address: 
Andre.Carvalho@camh.ca.
(198)University of Toronto, Toronto, Canada. Electronic address: 
Jeff.Daskalakis@camh.ca.
(199)University of British Columbia, Vancouver, Canada. Electronic address: 
l.yatham@ubc.ca.
(200)University of Calgary, Alberta Health Services, Calgary, Canada. Electronic 
address: lin.yang@ahs.ca.
(201)Okasha Institute of Psychiatry, Faculty of Medicine, Ain Shams University, 
Cairo, Egyp. Electronic address: tarek.okasha@gmail.com.
(202)Oran 1 University, Department of Psychiatry-Addictology, Oran, Algeria. 
Electronic address: aichadahdouh@gmail.com.
(203)Linköping University, Pain and Rehabilitation Centre and Department of 
Health, Medicine and Caring Sciences, Linköping, Sweden. Electronic address: 
bjorn.gerdle@liu.se.
(204)Karolinska Institutet, Centre for Psychiatric Research and Education, 
Department of Clinical Neuroscience, Stockholm, Sweden. Electronic address: 
jari.tiihonen@ki.se.
(205)Yonsei University College of Medicine, Department of Pediatrics, Seoul, 
South Korea. Electronic address: SHINJI@yuhs.ac.
(206)Yonsei University Wonju College of Medicine, Department of Psychiatry, 
Wonju, South Korea. Electronic address: jinh.lee95@yonsei.ac.kr.
(207)University of Monastir, Research Unit "Vulnerability to Mental Disorders" 
LR05ES10, Monastir, Tunisia. Electronic address: ahmed.mhalla@yahoo.fr.
(208)University of Monastir, Research Unit "Vulnerability to Mental Disorders" 
LR05ES10, Monastir, Tunisia. Electronic address: gaha.lotfi@yahoo.fr.
(209)University of Monastir, University Hospital of Monastir, Department of 
Psychiatry, Monastir, Tunisia. Electronic address: takoua.brahim@yahoo.com.
(210)Republican Scientific and Practical Center of Mental Health, Kazakhstan. 
Electronic address: altyn@mail.ru.
(211)Republican Scientific and Practical Center of Mental Health, Kazakhstan. 
Electronic address: nick_negaj@mail.ru.
(212)Republican Scientific and Practical Center of Mental Health, Kazakhstan. 
Electronic address: saya_n@yahoo.com.
(213)Gaza Community Mental Health Programme, Palestine. Electronic address: 
yasser@gcmhp.net.
(214)Sheba Medical Center, Israel. Electronic address: mweiser@netvision.net.il.
(215)Charité Universitätsmedizin Berlin, Department of Child and Adolescent 
Psychiatry, Berlin, Germany; The Zucker Hillside Hospital, Northwell Health, New 
York, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 
New York, USA. Electronic address: CCorrell@northwell.edu.

BACKGROUND: The COVID-19 pandemic has altered daily routines and family 
functioning, led to closing schools, and dramatically limited social 
interactions worldwide. Measuring its impact on mental health of vulnerable 
children and adolescents is crucial.
METHODS: The Collaborative Outcomes study on Health and Functioning during 
Infection Times (COH-FIT - www.coh-fit.com) is an on-line anonymous survey, 
available in 30 languages, involving >230 investigators from 49 countries 
supported by national/international professional associations. COH-FIT has thee 
waves (until the pandemic is declared over by the WHO, and 6-18 months plus 
24-36 months after its end). In addition to adults, COH-FIT also includes 
adolescents (age 14-17 years), and children (age 6-13 years), recruited via 
non-probability/snowball and representative sampling and assessed via 
self-rating and parental rating. Non-modifiable/modifiable risk 
factors/treatment targets to inform prevention/intervention programs to promote 
health and prevent mental and physical illness in children and adolescents will 
be generated by COH-FIT. Co-primary outcomes are changes in well-being (WHO-5) 
and a composite psychopathology P-Score. Multiple behavioral, family, coping 
strategy and service utilization factors are also assessed, including 
functioning and quality of life.
RESULTS: Up to June 2021, over 13,000 children and adolescents from 59 countries 
have participated in the COH-FIT project, with representative samples from 
eleven countries.
LIMITATIONS: Cross-sectional and anonymous design.
CONCLUSIONS: Evidence generated by COH-FIT will provide an international 
estimate of the COVID-19 effect on children's, adolescents' and families', 
mental and physical health, well-being, functioning and quality of life, 
informing the formulation of present and future evidence-based interventions and 
policies to minimize adverse effects of the present and future pandemics on 
youth.

Copyright © 2021 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2021.09.090
PMCID: PMC8486586
PMID: 34606810 [Indexed for MEDLINE]

Conflict of interest statement: All conflict of interest statements of 
all authors are detailed below in supplementary Table 1.


2910. Psychiatr Q. 2022 Mar;93(1):227-247. doi: 10.1007/s11126-021-09952-5. Epub 2021 
Oct 4.

COVID-19 Pandemic Support Programs for Healthcare Workers and Implications for 
Occupational Mental Health: A Narrative Review.

David E(1), DePierro JM(2), Marin DB(2), Sharma V(2), Charney DS(2), Katz CL(2).

Author information:
(1)Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, 
NY, USA. eden.david@icahn.mssm.edu.
(2)Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, 
NY, USA.

This narrative review aims to summarize initiatives developed during the 
COVID-19 pandemic to support healthcare workers' emotional well-being within the 
context of a pre-existing framework of occupational mental health guidelines. 
This occupational mental health framework integrates principles from multiple 
disciplines to optimize prevention and management of mental health issues among 
employees. We conducted an online search on Medline/PubMed, Cochrane Library, 
and Embase for studies that reported on design or execution of medical 
institution-based interventions, aiming to support healthcare worker mental 
health during the COVID-19 pandemic. Inclusion criteria was intentionally broad 
in order to incorporate as many types of interventions at varying stages of 
development or evaluation. We included 31 studies in our review that reported on 
newly designed psychological support interventions for healthcare workers (HCW) 
during the COVID-19 pandemic. We found that most programs commonly supported HCW 
mental health through offering one or more of the following initiatives: 
expanded basic need resources/services, additional workplace training programs 
that bolstered professional preparedness while also indirectly boosting HCW 
emotional health, and/or expanded psychological support programs, such as peer 
support programs, psychoeducational or counseling services. Most programs, 
however, did not consider methods to ensure program longevity or sustainability. 
The COVID-19 pandemic has underscored the acuity of HCW mental health issues and 
is likely to leave long lasting mental health strains among HCW. This pandemic 
is a critical point in time to catalyze much needed progress in reducing stigma 
and expanding HCW mental health care access.

© 2021. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s11126-021-09952-5
PMCID: PMC8488324
PMID: 34606067 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare the following financial 
interests/personal relationships which may be considered as potential competing 
interests. Dr. Dennis Charney is named co-inventor on an issued patent in the 
United States, and several issued patents outside the U.S. filed by the Icahn 
School of Medicine at Mount Sinai (ISMMS), for the use of ketamine as a therapy 
for PTSD. This intellectual property has not been licensed. In addition, Dr. 
Charney is named co-inventor on several issued U.S. patents, and several pending 
U.S. patent applications, filed by ISMMS for the use of ketamine as a therapy 
for treatment-resistant depression and suicidal ideation. ISMMS has entered into 
a licensing agreement with Janssen Pharmaceuticals, Inc. and it has and will 
receive payments from Janssen under the license agreement related to these 
patents. As a co-inventor, Dr. Charney is entitled to a portion of the payments 
received by the ISMMS. Since SPRAVATO (esketamine) has received regulatory 
approval for TRD, ISMMS and Dr. Charney as its employee and a co-inventor, will 
be entitled to additional payments, under the license agreement. Dr. Charney is 
named co-inventor on a patent application filed by the ISMMS for the use of 
intranasally administered neuropeptide Y for the treatment of mood and anxiety 
disorders. This intellectual property has not been licensed. Dr. Charney is a 
named co-inventor on several patents filed by ISMMS for a cognitive training 
intervention to treat depression and related psychiatric disorders. ISMMS has 
entered into a licensing agreement with Click Therapeutics, Inc., and has and 
will receive payments related to the use of this cognitive training intervention 
for the treatment of psychiatric disorders. In accordance with the ISMMS Faculty 
Handbook, Dr. Charney has received a portion of these payments and is entitled 
to a portion of any additional payments that the medical school might receive 
from this license with Click Therapeutics. Dr. Craig L. Katz is a paid 
consultant with Advanced Recovery Systems and the RANE Crisis Network. Eden 
David and Drs. Jonathan DePierro, Deborah B. Marin, and Vanshdeep Sharma report 
no financial relationships with commercial interests.


2911. Int J Pharm Pract. 2021 Dec 4;29(6):556-565. doi: 10.1093/ijpp/riab062.

Impact of the coronavirus pandemic (COVID-19) on the professional practice and 
personal well-being of community pharmacy teams in the UK.

Bhamra SK(1), Parmar J(1), Heinrich M(2).

Author information:
(1)Medway School of Pharmacy, University of Kent, Chatham, Kent, UK.
(2)UCL School of Pharmacy, London, UK.

OBJECTIVES: Community pharmacy teams (CPTs) were at the frontline of dealing 
with patients throughout the COVID-19 pandemic. This study aimed to explore the 
impact on professional practice and personal well-being of CPTs, in the UK.
METHODS: A 25-item survey was designed including a range of open and closed 
questions. The survey was piloted before being published online via SurveyMonkey 
and distributed using social media platforms. A combination of opportunity and 
snowball sampling was employed to recruit participants who worked in community 
pharmacy (CP) during the pandemic.
RESULTS: In total 758 participants (75% completion rate) including pharmacists, 
owners, managers, technicians, dispensers, healthcare assistants and 
pre-registration pharmacists took part. Increased workloads and working hours 
coupled with staff shortages compromised professional practice (n = 257, 35%). 
Some of the key challenges of working in CP during the pandemic included: a fear 
of contracting and passing the virus to others (n = 578, 78%), patients 
stockpiling medicines (n = 530, 71%) and doctors' surgeries being closed (n = 
517, 70%) The impact on emotional well-being (n = 433, 76%) included stress, 
anxiety, depression and loneliness; physically (n = 322, 56%) it affected sleep, 
pain and weight. The effects of the pandemic left 45% (n = 258/569) of 
participants reconsidering their future in CP as they felt demotivated, 
unsupported and undervalued.
CONCLUSION: Despite the enhanced pressures and lack of initial recognition CPTs 
played a vital role in caring for the population during the pandemic. Resources 
to better support pharmacy teams in the future not only rely on more funding for 
better provisions but also investing in CPTs' well-being.

© The Author(s) 2021. Published by Oxford University Press on behalf of the 
Royal Pharmaceutical Society.

DOI: 10.1093/ijpp/riab062
PMCID: PMC8500076
PMID: 34605895 [Indexed for MEDLINE]


2912. Nurs Forum. 2022 Jan;57(1):87-93. doi: 10.1111/nuf.12660. Epub 2021 Oct 2.

Improvement in the psychological health of nurses working during the COVID-19 
pandemic.

Slykerman RF(1), Li E(2), Booth RJ(3).

Author information:
(1)Department of Psychological Medicine, University of Auckland, Auckland, New 
Zealand.
(2)A Better Start-National Science Challenge University of Auckland, New 
Zealand.
(3)Department of Molecular Medicine and Pathology, University of Auckland, New 
Zealand.

BACKGROUND: Nurses are a critical component of any healthcare system. The novel 
coronavirus pandemic has resulted in an increased workload for nurses and 
heightened stress.
AIMS: To assess the psychological health over time of nurses working during the 
COVID-19 pandemic and to examine the factors associated with stress, anxiety, 
and psychological wellbeing.
METHODS: Nurses enrolled in the study between 2 July and 26 August 2020 
andcompleted questionnaires about stress, anxiety, and psychological wellbeing 
at baseline and at a second time point T2 12 weeks later. A paired sample t-test 
was used to examine whether changes in stress, anxiety, and psychological 
wellbeing were significantly different between baseline and T2. Linear 
regression models examined factors associated with psychological health 
outcomes.
RESULTS: Of the 600 nurses initially enrolled, 484 (80.7%) completed 
psychological health measures at T2. Stress, anxiety, and poor psychological 
wellbeing scores were high at baseline. Unexpectedly, stress and psychological 
wellbeing significantly improved between baseline and T2, while anxiety levels 
increased. Younger nurses had higher baseline stress and anxiety scores.
CONCLUSIONS: This study demonstrates the potential beneficial effect of 
effective public health management of the COVID-19 pandemic on nurses' stress 
and psychological wellbeing and highlights the importance of longitudinal 
research to understand psychological health in nurses.

© 2021 Wiley Periodicals LLC.

DOI: 10.1111/nuf.12660
PMCID: PMC8661679
PMID: 34601731 [Indexed for MEDLINE]


2913. Asian J Psychiatr. 2021 Dec;66:102858. doi: 10.1016/j.ajp.2021.102858. Epub 2021 
Sep 11.

Suicide prevention in the context of COVID-19: An Indian perspective.

Suchandra HH(1), Bhaskaran AS(1), Manjunatha N(1), Kumar CN(1), Bada Math S(1), 
Reddi VSK(2).

Author information:
(1)Department of Psychiatry, National Institute of Mental Health and Neuro 
Sciences, Bangalore, Karnataka, India.
(2)Department of Psychiatry, National Institute of Mental Health and Neuro 
Sciences, Bangalore, Karnataka, India. Electronic address: 
senthilreddi@gmail.com.

The ongoing COVID-19 pandemic has impacted the health and wellbeing of 
communities worldwide. Measures to limit transmission, have enhanced 
vulnerability of individuals to well identified risk factors associated with 
mental illness and suicide. These include a sense of loneliness, anxiety, 
depression, insomnia, PTSD, harmful alcohol and drug use. Given that the 
potential for increased rates of suicide persist, the suicide prevention agenda 
remains urgent and essential. The same is one of the cornerstones of resilience 
in a society that is facing an array of challenges due to the pandemic. In this 
article, we recommend few possible strategies for attenuating suicide risk 
amidst the COVID-19 pandemic with particular relevance to the Indian context.

Copyright © 2021 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.ajp.2021.102858
PMCID: PMC8434885
PMID: 34601291 [Indexed for MEDLINE]


2914. Aust Crit Care. 2022 Jan;35(1):40-45. doi: 10.1016/j.aucc.2021.08.007. Epub 2021 
Sep 1.

Critical care health professionals' self-reported needs for wellbeing during the 
COVID-19 pandemic: A thematic analysis of survey responses.

Elliott R(1), Crowe L(2), Abbenbroek B(3), Grattan S(4), Hammond NE(5).

Author information:
(1)Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, 
Pacific Highway, St Leonards NSW 2065 Australia. Electronic address: 
Rosalind.Elliott@health.nsw.gov.au.
(2)School of Medicine, Brisbane, The University of Queensland, 20 Weightman 
Street, Herston QLD 4006 Australia; Queensland Children's Hospital, 501 Stanley 
Street, South Brisbane, QLD 4101 Australia. Electronic address: 
Liz.Crowe@health.qld.gov.au.
(3)Critical Care Division, The George Institute for Global Health and University 
of NSW, Level 5, 1 King Street, Newtown NSW 2042 Australia. Electronic address: 
babbenbroek@georgeinstitute.org.au.
(4)Critical Care Division, The George Institute for Global Health and University 
of NSW, Level 5, 1 King Street, Newtown NSW 2042 Australia. Electronic address: 
sgrattan@georgeinstitute.org.au.
(5)Critical Care Division, The George Institute for Global Health and University 
of NSW, Level 5, 1 King Street, Newtown NSW 2042 Australia; Malcolm Fisher 
Department of Intensive Care, Royal North Shore Hospital, Pacific Highway, St 
Leonards NSW 2065 Australia. Electronic address: 
nhammond@georgeinstitute.org.au.

BACKGROUND: Critical care healthcare professionals are a key part of any 
pandemic response and are at an increased risk for physical and psychological 
harm, yet their self-reported suggestions to ameliorate the negative effects of 
pandemics on their wellbeing have rarely been sought.
OBJECTIVES: The objective of this study was to explore and interpret themes of 
critical care healthcare professionals' responses to the question 'What do you 
think could assist your wellbeing during the COVID-19 crisis?'
METHODS: A descriptive study using an online survey, performed in April 2020, 
investigating pandemic preparedness and psychological burden during the early 
stages of the COVID-19 pandemic among critical care professionals was carried 
out. Informal snowball sampling was used. Thematic analysis of qualitative data 
from an open-ended survey item was informed by Braun and Clark.
FINDINGS: Eighty percent (2387/3770) of respondents completed the open-ended 
survey. Three themes were generated from the synthesis: adequate resourcing for 
the role; consistent, clear information, and prioritised communications; and the 
need for genuine kindness and provision of support for healthcare professional 
wellbeing.
CONCLUSIONS: There is merit for considering the perceptions, concerns, and 
suggestions of critical care clinicians during a pandemic. Suggestions included 
simple measures to maintain physical and mental health, clear messaging, 
consistent information, trust in health and political leaders, supportive 
working environments, specific training, and allowances for personal 
circumstances. This information is important for health and political leaders 
and policy makers to implement strategies to reduce the burden associated with 
delivering care in the context of a pandemic.

Copyright © 2021 Australian College of Critical Care Nurses Ltd. All rights 
reserved.

DOI: 10.1016/j.aucc.2021.08.007
PMCID: PMC8418353
PMID: 34598873 [Indexed for MEDLINE]


2915. Global Health. 2021 Oct 1;17(1):117. doi: 10.1186/s12992-021-00768-3.

COVID-19: Factors associated with psychological distress, fear, and coping 
strategies among community members across 17 countries.

Rahman MA(1)(2)(3), Islam SMS(4), Tungpunkom P(5), Sultana F(6), Alif SM(7), 
Banik B(8), Salehin M(8), Joseph B(8), Lam L(8), Watts MC(8), Khan SJ(9), Ghozy 
S(10), Chair SY(11), Chien WT(11), Schönfeldt-Lecuona C(12), El-Khazragy N(13), 
Mahmud I(14), Al Mawali AH(15), Al Maskari TS(16), Alharbi RJ(17), Hamza A(18), 
Keblawi MA(18), Hammoud M(19), Elaidy AM(20), Susanto AD(21), Bahar Moni AS(22), 
AlQurashi AA(23), Ali A(24), Wazib A(25), Sanluang CS(5), Elsori DH(26), Yasmin 
F(27), Taufik FF(21), Al Kloub M(28), Ruiz MG(16), Elsayed M(29), Eltewacy 
NK(30), Al Laham N(31), Oli N(32), Abdelnaby R(33), Dweik R(26), Thongyu R(34), 
Almustanyir S(35), Rahman S(25), Nitayawan S(5), Al-Madhoun S(31), Inthong S(5), 
Alharbi TA(36), Bahar T(37), Ginting TT(38), Cross WM(8).

Author information:
(1)School of Health, Federation University Australia, Berwick, Victoria, 
Australia. ma.rahman@federation.edu.au.
(2)Australia Institute for Primary Care and Ageing (AIPCA), La Trobe University, 
Melbourne, Victoria, Australia. ma.rahman@federation.edu.au.
(3)Department of Noncommunicable Diseases, Bangladesh University of Health 
Sciences (BUHS), Dhaka, Bangladesh. ma.rahman@federation.edu.au.
(4)Deakin University, Burwood, Victoria, Australia.
(5)Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.
(6)Telstra Health, Melbourne, Victoria, Australia.
(7)Monash University, Clayton, Victoria, Australia.
(8)School of Health, Federation University Australia, Berwick, Victoria, 
Australia.
(9)The University of Melbourne, Melbourne, Victoria, Australia.
(10)Neurovascular Research Lab, Radiology Department, Mayo Clinic, Rochester, 
MN, USA.
(11)The Nethersole School of Nursing, The Chinese University of Hong Kong, 
Shatin, New Territories, Hong Kong.
(12)Psychiatric University Clinic Ulm, Ulm, Germany.
(13)Faculty of Medicine, Ain Shams University, Cairo, Egypt.
(14)Department of Public Health, College of Public Health and Health 
Informatics, Qassim University, Al Bukairiyah, Kingdom of Saudi Arabia.
(15)Ministry of Health, Muscat, Sultanate of Oman.
(16)Oman College of Health Sciences-South Sharquiya, Sur, Sultanate of Oman.
(17)Department of Emergency Medical Service, Jazan University, Jazan, Kingdom of 
Saudi Arabia.
(18)Faculty of Medicine, University of Aleppo, Aleppo, Syria.
(19)Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.
(20)Faculty of Medicine for Girls, Al-azhar University, Cairo, Egypt.
(21)Department of Pulmonology and Respiratory Medicine, Universitas Indonesia, 
Jakarta, Indonesia.
(22)Advanced Medical and Dental Institute, Universiti Sains Malaysia, Penang, 
Malaysia.
(23)King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.
(24)Brega General Hospital, Brega, Libya.
(25)Enam Medical College & Hospital, Dhaka, Bangladesh.
(26)Abu Dhabi University, Abu Dhabi, United Arab Emirates.
(27)Lahore Garrison University, Lahore, Pakistan.
(28)The Hashemite University, Zarqa, Jordan.
(29)Department of Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany.
(30)Faculty of Pharmacy, Beni-Suef University, Minia, Egypt.
(31)Al Azhar University-Gaza, Gaza strip, Palestine.
(32)Kathmandu Medical College, Kathmandu, Nepal.
(33)Department of Neurology, RWTH Aachen University, Aachen, Germany.
(34)Rangsit University, Pathum Thani, Thailand.
(35)Ministry of Health, Riyadh, Kingdom of Saudi Arabia.
(36)King Saud University Medical City, King Saud University, Riyadh, Kingdom of 
Saudi Arabia.
(37)National Institute of Cancer Research and Hospital, Dhaka, Bangladesh.
(38)Psychiatric Medical Staff Group, Persahabatan General Hospital, Jakarta, 
Indonesia.

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

© 2021. The Author(s).

DOI: 10.1186/s12992-021-00768-3
PMCID: PMC8485312
PMID: 34598720 [Indexed for MEDLINE]

Conflict of interest statement: The authors confirm that there are no known 
conflicts of interest associated with this publication.


2916. Appetite. 2022 Jan 1;168:105720. doi: 10.1016/j.appet.2021.105720. Epub 2021 Sep 
29.

Exploring impact on eating behaviour, exercise and well-being during COVID-19 
restrictions in the Netherlands.

Dijksterhuis GB(1), van Bergen G(2), de Wijk RA(3), Zandstra EH(4), Kaneko D(5), 
Vingerhoeds M(6).

Author information:
(1)Wageningen Food & Biobased Research, Wageningen University & Research, PO Box 
17, NL 6700 AA, Wageningen, the Netherlands. Electronic address: 
garmt.dijksterhuis@wur.nl.
(2)Wageningen Food & Biobased Research, Wageningen University & Research, PO Box 
17, NL 6700 AA, Wageningen, the Netherlands. Electronic address: 
geertje.vanbergen@wur.nl.
(3)Wageningen Food & Biobased Research, Wageningen University & Research, PO Box 
17, NL 6700 AA, Wageningen, the Netherlands. Electronic address: 
rene.dewijk@wur.nl.
(4)Human Nutrition & Health, Wageningen University & Research, Stippeneng 4, 
6708 WE, Wageningen, the Netherlands; Unilever Foods Innovation Centre 
Wageningen, Bronland 14, 6708 WH, Wageningen, the Netherlands. Electronic 
address: liesbeth.zandstra@wur.nl.
(5)Kikkoman Europe R&D Laboratory B.V., Nieuwe Kanaal 7G, 6709 PA, Wageningen, 
the Netherlands. Electronic address: d.kaneko@kikkoman.nl.
(6)Wageningen Food & Biobased Research, Wageningen University & Research, PO Box 
17, NL 6700 AA, Wageningen, the Netherlands. Electronic address: 
monique.vingerhoeds@wur.nl.

Many studies address the effect of the COVID-19 restrictions on food consumption 
and health, focusing on one or two measurements. Whether or not any effects are 
permanent or change over a longer period of restrictions has not been assessed 
in such studies. This study presented a survey containing questions on food 
consumption, exercise and self-assessed physical and mental health, repeatedly 
for six times over a 20-week period (July to November 2020) to a representative 
sample of 258 Dutch consumers. The majority of consumers reported no change in 
food consumption compared to before the COVID-19 restrictions, two smaller 
groups report a change to a more, or a less, healthy choice. This trend appears 
stable over the course of the measurements. The 'healthy changers' seem to 
couple a healthy and more diverse diet to healthy exercise habits, in contrast 
to the 'unhealthy changers'. No change was observed in self-assessed physical 
health over the measurements. Overall a decline in time spent exercising showed, 
as well as a decline in self-assessed mental health. Clearly a lockdown 
situation affects food choice, exercise habits and (self-assessed) mental 
health. The fact that habits are able to suddenly change, for better or for 
worse, and that a decrease in mental health was reported, suggests that such 
insights need to be further explored to help individual consumers retain a 
healthy diet and lifestyle, and governments devise effective public health 
recommendations.

Copyright © 2021. Published by Elsevier Ltd.

DOI: 10.1016/j.appet.2021.105720
PMCID: PMC8479541
PMID: 34597741 [Indexed for MEDLINE]


2917. Swiss Med Wkly. 2021 Sep 30;151:w30028. doi: 10.4414/smw.2021.w30028. 
eCollection 2021 Sep 27.

The psychological impact of the COVID-19 crisis on young Swiss men participating 
in a cohort study.

Marmet S(1), Wicki M(1), Gmel G(1)(2)(3)(4), Gachoud C(1), Daeppen JB(1), 
Bertholet N(1), Studer J(1).

Author information:
(1)Addiction Medicine, Lausanne University Hospital and University of Lausanne, 
Switzerland.
(2)Addiction Switzerland, Lausanne, Switzerland.
(3)Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
(4)University of the West of England, Frenchay Campus, Bristol, United Kingdom.

AIMS: The COVID-19 pandemic caused many disturbances to daily life worldwide and 
may also have significantly affected people's psychological well-being. The 
present study aimed to describe the psychological impact of the crisis on our 
sample of young Swiss men and to examine differences due to their linguistic 
region, experiencing COVID-19 symptoms and living arrangements.
METHODS: Based on an ongoing cohort study, we assessed a general-population 
sample of young Swiss men (n = 2345; average 29 years old) shortly before (from 
April 2019) and early on during the COVID-19 crisis (between 13 May and 8 June 
2020). This was a unique opportunity to estimate the crisis' psychological 
impact in the form of depression, perceived stress and sleep quality (assessed 
before and during COVID-19), and any crisis-induced fears, isolation or 
psychological trauma. Associations of psychological impact with living 
arrangements, experiencing COVID-19 symptoms and linguistic region 
(German-speaking vs French-speaking) were investigated using linear regression 
models.
FINDINGS: By the time participants responded to our questionnaire, less than 1% 
had been tested positive for COVID-19, 2.6% had been tested negative and 14.7% 
had had some COVID-19 symptoms but had not been tested. About 8.2% of the sample 
reported at least some symptoms of psychological trauma (≥24 points on the 
Impact of Event Scale). On average, participants reported higher levels of fear 
for others (43.6% at least moderate) and economic fear (12.7% at least moderate) 
than fear for themselves (5.8% at least moderate). Those living alone and those 
who reported having COVID-19 symptoms themselves, or knowing someone with 
symptoms, reported higher overall psychological impact in the form of 
depression, perceived stress, sleep quality, psychological trauma, fear and 
isolation. Associations with linguistic region varied by outcome, with higher 
levels of depression and fear in French-speaking regions and higher levels of 
perceived stress and isolation in German-speaking regions.
INTERPRETATION: The crisis had a considerable impact on the psychological 
well-being of our sample of young Swiss men, and some groups were more affected 
than others: those living alone and those who had shown COVID-19 symptoms 
themselves or had known someone with symptoms may have felt a greater 
psychological impact from the crisis. Supporting those at a higher risk of 
psychological consequences in such crises, whether through structural measures 
or via individual support, should be an important aspect of crisis management 
and could help reduce the overall impact of the current pandemic on 
Switzerland's population.

DOI: 10.4414/smw.2021.w30028
PMID: 34596372 [Indexed for MEDLINE]


2918. J Dev Behav Pediatr. 2022 Apr 1;43(3):168-175. doi: 
10.1097/DBP.0000000000001010. Epub 2021 Sep 29.

Changes in Children's Behavioral Health and Family Well-Being During the 
COVID-19 Pandemic.

Hanno EC(1), Cuartas J, Miratrix LW, Jones SM, Lesaux NK.

Author information:
(1)Harvard Graduate School of Education, Harvard University, Cambridge, MA.

OBJECTIVE: The coronavirus disease 2019 pandemic and associated public health 
measures have influenced all aspects of life for children and families. In this 
study, we examine changes in children's behavioral health and families' 
well-being at the start of the pandemic.
METHOD: We used longitudinal data on 2880 children from 1 US state collected 
over 3 waves to compare family and child well-being before and after a 
state-wide stay-at-home advisory set in March 2020. We descriptively examined 
levels and changes in 4 child behavioral health outcomes (externalizing, 
internalizing, adaptive, and dysregulated behaviors) and 4 family well-being 
outcomes (parental mental health, parental stress, parent-child relationship 
conflict, and household chaos) across the preshutdown and postshutdown periods. 
Fixed effects regression models were used to predict within-child and 
within-family differences in preshutdown and postshutdown outcomes.
RESULTS: Fixed effects analyses showed children's externalizing (0.09 points; 
95% confidence interval [CI] 0.05-0.13), internalizing (0.04 points; 95% CI, 
0.01-0.08), and dysregulated (0.11 points; 95% CI, 0.06-0.16) behaviors 
increased after the shutdown, whereas children's adaptive behaviors declined 
(-0.10 points; 95% CI, -0.15 to -0.05). Parental mental health issues (0.22 
points; 95% CI, 0.17-0.27), parental stress (0.08 points; 95% CI, 0.03-0.12), 
parent-child relationship conflict (0.10 points; 95% CI, 0.04-0.16), and 
household chaos (0.10 points; 95% CI, 0.05-0.14) all increased relative to 
preshutdown levels.
CONCLUSION: Many children experienced declines in behavioral health and many 
families experienced declines in well-being in the early months of the public 
health crisis, suggesting the need for family-focused and child-focused policies 
to mitigate these changes.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/DBP.0000000000001010
PMID: 34596101 [Indexed for MEDLINE]

Conflict of interest statement: Disclosure: The authors declare no conflict of 
interest.


2919. Health Promot Int. 2022 Apr 29;37(2):daab144. doi: 10.1093/heapro/daab144.

Pandemic-related racial discrimination and its health impact among 
non-Indigenous racially minoritized peoples in high-income contexts: a 
systematic review.

Yashadhana A(1)(2)(3)(4), Derbas A(1)(5), Biles J(1), Grant J(1).

Author information:
(1)School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt 
University, Bathurst, Australia.
(2)Centre for Health Equity Training Research & Evaluation (CHETRE), University 
of New South Wales, Sydney, Australia.
(3)Ingham Institute for Applied Medical Research, Sydney, Australia.
(4)School of Social Sciences, University of New South Wales, Sydney, Australia.
(5)School of Social Sciences, Western Sydney University, Sydney, Australia.

This study aims to review articles reporting the perspectives and experiences of 
pandemic-related discrimination among racially minoritized peoples in 
high-income contexts. We searched online databases (Medline, EMBASE, PsycINFO, 
Web of Science, and ProQuest) for peer-reviewed articles published between 
January 2002 and October 2020. Eligible studies reported either quantitative or 
qualitative accounts of pandemic-related discrimination from the perspectives of 
racially minoritized peoples in high-income contexts. Two authors screened 30% 
of titles/abstracts, and all full-text articles. Each article included for 
extraction underwent a quality assessment by two reviewers. Data were extracted 
and categorized thematically using NVivo 12, followed by a secondary analysis 
informed by critical race theory. Of the 1289 articles screened, 16 articles 
from five countries met the inclusion criteria. Racial discrimination is 
heightened during pandemic periods, due to the social association of specific 
racial groups with pandemic diseases including COVID-19, SARS (Asian), H1N1 
(Hispanic) and Ebola (African). Fear based responses to racially minoritized 
peoples during pandemic periods included verbal/physical abuse, 
hypersurveillance, and avoidance, often occurring in public spaces. 
Pandemic-related racism had subsequent impacts on mental health and health care 
accessibility. Various coping strategies, including community support, 
avoidance, and problem solving, were documented in response to racial 
discrimination. Racialized discrimination and violence is a serious threat to 
the health and wellbeing of racially minoritized peoples, particularly due to 
its increase during pandemic periods. Racism must be recognized as a public 
health issue, and efforts to address its increased impact in pandemic contexts 
should be made, including ensuring that adequate representation of racially 
minoritized groups is present in policy, planning, and implementation.

© The Author(s) 2021. Published by Oxford University Press. All rights reserved. 
For permissions, please email: journals.permissions@oup.com.

DOI: 10.1093/heapro/daab144
PMCID: PMC8500046
PMID: 34595531 [Indexed for MEDLINE]


2920. Front Public Health. 2021 Sep 14;9:717747. doi: 10.3389/fpubh.2021.717747. 
eCollection 2021.

Impact of COVID-19 Pandemic Lockdown on Mental Well-Being of Norwegian 
Adolescents During the First Wave-Socioeconomic Position and Gender Differences.

Myhr A(1), Naper LR(1), Samarawickrema I(2), Vesterbekkmo RK(3).

Author information:
(1)SINTEF Digital, Steinkjer, Norway.
(2)Faculty of Health, University of Canberra, Canberra, ACT, Australia.
(3)Regional Drug and Alcohol Competence Centre, St. Olavs University Hospital, 
Trondheim, Norway.

Background: The lockdowns associated with the COVID-19 pandemic has been called 
a crisis in mental health, and adolescents may have been among the most 
affected. Comparing the first period of societal lockdown in spring 2020 to 
periods going back to 2014 using a rich cross-sectional dataset based on 
repeated surveys, we explore the potential changes in self-reported mental 
well-being across sociodemographic groups among Norway's adolescents. Methods: 
Norway closed schools and implemented strict restrictions in March 2020; an 
electronic questionnaire survey was distributed to lower secondary school 
students in Trøndelag county (N = 2,443) in May 2020. Results were compared with 
similar surveys conducted annually in the same county dating back to 2014. 
Logistic regression models were applied to investigate potential changes in 
depressive symptoms, loneliness, and quality of life and life satisfaction, and 
to detect possible differences in the impact of lockdown between the genders and 
socioeconomic groups. Results: The prevalence of boys and girls reporting high 
quality of life (43-34%; 23-16%) and life satisfaction (91-80%; 82-69%) 
decreased significantly compared to the pre-pandemic. For girls only, lockdown 
was associated with higher odds for reporting high depressive symptoms. As 
expected, the least privileged socioeconomic groups showed the greatest 
psychological distress. However, our trend analyses provided no evidence that 
the socioeconomic inequalities in psychological distress (according to 
prevalence of high depressive symptoms or loneliness) changed substantial in any 
direction during the first wave of the pandemic [between the pre-pandemic and 
inter-pandemic periods]. Conclusion: Adolescents are vulnerable, and 
interventions should provide them with mental health support during crises such 
as societal lockdown. In particular, the social and health policy, public 
health, and further research should target these least privileged groups.

Copyright © 2021 Myhr, Naper, Samarawickrema and Vesterbekkmo.

DOI: 10.3389/fpubh.2021.717747
PMCID: PMC8476849
PMID: 34595148 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2921. Contemp Nurse. 2021 Apr-Jun;57(3-4):213-223. doi: 10.1080/10376178.2021.1987941. 
Epub 2021 Oct 18.

Generational differences in psychological wellbeing and preventative behaviours 
among nursing students during COVID-19: a cross-sectional study.

Middleton R(1)(2), Fernandez R(1)(2)(3), Moxham L(1)(2)(4), Tapsell A(5), 
Halcomb E(1)(2), Lord H(3), Alomari A(6), Hunt L(6).

Author information:
(1)School of Nursing, University of Wollongong, Wollongong, Australia.
(2)Illawarra Health and Medical Research Institute (IHMRI), University of 
Wollongong, Wollongong, Australia.
(3)St George Hospital, Sydney, Australia.
(4)Global Challenges Program, Research and Innovation Division, University of 
Wollongong, Wollongong, Australia.
(5)Public Health Unit, Illawarra Shoalhaven Local Health District, Australia.
(6)School of Nursing and Midwifery, Western Sydney University, Liverpool, 
Australia.

BACKGROUND: Many nursing programmes have had to swiftly move online in response 
to COVID-19. Nursing students are often a heterogenous group that traverses 
generational boundaries. Exploring generational differences may assist in 
developing support systems for specific groups. This study sought to examine 
psychological wellbeing and preventative behaviours among nursing students from 
the iGeneration in comparison to older generations.
METHOD: A prospective cross-sectional study was undertaken using a convenience 
sample of pre-registration nursing students studying at two Australian 
Universities, one regional and one metropolitan. About 631 pre-registration 
nursing students completed an online survey.
RESULTS: An independent samples t-test revealed that students from the 
iGeneration possess higher anxiety compared to nursing students from older 
generations (p = .000). Compared to iGeneration participants, older generation 
participants had significantly higher scores for knowledge of COVID-19 
(p = .015). iGeneration participants utilised social media to source information 
about COVID-19 far more than older generations (p = .008). iGeneration 
participants were significantly more concerned than older generations about the 
impact of COVID-19 on completing their clinical placement (p = .014). Older 
generations tended to have higher academic preventative behaviours, with 
significant mean scores for not attending university if they or others they knew 
had symptoms of COVID-19.
CONCLUSION: Given the differences between generation groups with regard to 
psychological wellbeing, knowledge about COVID-19, and concerns about studying 
in an altered study environment, strategies should be targeted to generational 
groups. Anxiety negatively impacts the quality of life, educational performance 
and clinical practice and is experienced more frequently in the iGeneration. 
Therefore it is crucial for nursing educators to reflect on how they engage this 
generation in the online space to provide support, stability and a sense of 
connection. This will contribute towards ensuring a well-prepared future nursing 
workforce who may encounter other pandemics and isolating events.
IMPACT STATEMENT: Compared with other generations, iGeneration students have a 
greater likelihood to experience mental health issues, isolation and insecurity. 
Nursing leaders and educators must be sensitive to such intergenerational 
differences, to ensure they are developing a skilled and productive workforce.

DOI: 10.1080/10376178.2021.1987941
PMID: 34591737 [Indexed for MEDLINE]


2922. Autism Res. 2021 Dec;14(12):2477-2494. doi: 10.1002/aur.2616. Epub 2021 Sep 30.

The impact of COVID-19 on the mental health and wellbeing of caregivers of 
autistic children and youth: A scoping review.

Lee V(1), Albaum C(2), Tablon Modica P(2), Ahmad F(3), Gorter JW(4), Khanlou 
N(5), McMorris C(6), Lai J(7)(8), Harrison C(9), Hedley T(9), Johnston P(9), 
Putterman C(9), Spoelstra M(10), Weiss JA(2).

Author information:
(1)Department of Psychology, Carleton University, Ottawa, Canada.
(2)Department of Psychology, York University, Toronto, Canada.
(3)School of Health Policy and Management, York University, Toronto, Canada.
(4)Department of Paediatrics, McMaster University, Hamilton, Canada.
(5)School of Nursing, York University, Toronto, Canada.
(6)Werklund School of Education, University of Calgary, Calgary, Canada.
(7)Canadian Autism Spectrum Disorder Alliance, Canada.
(8)Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
(9)Canada.
(10)Autism Ontario, Toronto, Canada.

Caregivers and families of autistic people have experienced stress and increase 
in demands due to the COVID-19 pandemic that may have long-term negative 
consequences for both their own and their children's mental health. A scoping 
review was conducted to identify pandemic related demands experienced by 
caregivers and families of autistic children and youth. The review also 
consolidated information on coping strategies and parenting-related guidelines 
that have emerged to help parents meet these demands. Search strategies were 
approved by a research librarian and were conducted in peer-reviewed and gray 
literature databases between May 2020 and February 2021. Additional resources 
were solicited through author networks and social media. All articles were 
published between December 2019 and February 2021. Article summaries were 
charted, and a thematic analysis was conducted with confirmation of findings 
with our knowledge users. Twenty-three published articles and 14 pieces of gray 
literature were included in the review. The majority of articles characterized 
and highlighted the increase in demands on caregivers of autistic children and 
youth during the pandemic globally. Both quantitative and qualitative studies 
suggest that parents have experienced an increase in stress and mental 
health-related symptoms during lockdown measures. Findings suggest that families 
are employing coping strategies, but there no evidence-based supports were 
identified. The review highlighted the potential long-term impact of prolonged 
exposure to increasing demands on the mental health and wellbeing of caregivers 
and families of autistic people, and pointed to a need for the rapid development 
and evaluation of flexible and timely support programs. LAY SUMMARY: Caregivers 
and families of autistic children and youth have faced increased demands due to 
pandemic-related lockdown measures. We reviewed the literature to outline 
sources of stress, links to their influence on caregiver mental health, and if 
support programs have emerged to help them. Our findings suggest a number of 
demands have increased caregivers' risk to mental health challenges, and their 
potential impact on family wellbeing. Ongoing development of evidence-based 
supports of all families of autistic children and youth are needed.

© 2021 The Authors. Autism Research published by International Society for 
Autism Research and Wiley Periodicals LLC.

DOI: 10.1002/aur.2616
PMCID: PMC8646541
PMID: 34591373 [Indexed for MEDLINE]


2923. BMJ Open. 2021 Sep 28;11(9):e049704. doi: 10.1136/bmjopen-2021-049704.

Virtual reality for relatives of ICU patients to improve psychological sequelae: 
study protocol for a multicentre, randomised controlled trial.

Vlake JH(1)(2), van Bommel J(2), Wils EJ(1), Korevaar T(3), Hellemons ME(4), 
Klijn E(2), Schut AF(5), Labout JA(6), Van Bavel MP(2), van Mol MM(2), Gommers 
D(2), van Genderen ME(7).

Author information:
(1)Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.
(2)Department of Intensive Care, Erasmus Medical Centre, Rotterdam, The 
Netherlands.
(3)Department of Internal Medicine, Academic Centre for Thyroid Diseases, 
Erasmus Medical Centre, Rotterdam, The Netherlands.
(4)Pulmonology, Erasmus Medical Centre, Rotterdam, The Netherlands.
(5)Intensive Care, Ikazia Hospital, Rotterdam, The Netherlands.
(6)Intensive Care, Maasstad Hospital, Rotterdam, The Netherlands.
(7)Department of Intensive Care, Erasmus Medical Centre, Rotterdam, The 
Netherlands m.vangenderen@erasmusmc.nl.

INTRODUCTION: Intensive care unit (ICU) admission of a relative might lead to 
psychological distress and complicated grief (post-intensive care 
syndrome-family; PICS-F). Evidence suggests that increased distress during ICU 
stay increases risk of PICS-F, resulting in difficulty returning to their normal 
lives after the ICU experience. Effective interventions to improve PICS-F are 
currently lacking. In the present trial, we hypothesised that information 
provision using ICU-specific Virtual Reality for Family members/relatives 
(ICU-VR-F) may improve understanding of the ICU and subsequently improve 
psychological well-being and quality of life in relatives of patients admitted 
to the ICU.
METHODS AND ANALYSIS: This multicentre, clustered randomised controlled trial 
will be conducted from January to December 2021 in the mixed medical-surgical 
ICUs of four hospitals in Rotterdam, the Netherlands. We aim to include adult 
relatives of 160 ICU patients with an expected ICU length of stay over 72 hours. 
Participants will be randomised clustered per patient in a 1:1 ratio to either 
the intervention or control group. Participants allocated to the intervention 
group will receive ICU-VR-F, an information video that can be watched in VR, 
while the control group will receive usual care. Initiation of ICU-VR-F will be 
during their hospital visit unless participants cannot visit the hospital due to 
COVID-19 regulations, then VR can be watched digitally at home. The primary 
objective is to study the effect of ICU-VR-F on psychological well-being and 
quality of life up to 6 months after the patients' ICU discharge. The secondary 
outcome is the degree of understanding of ICU treatment and ICU modalities.
ETHICS AND DISSEMINATION: The Medical Ethics Committee of the Erasmus Medical 
Centre, Rotterdam, the Netherlands, approved the study and local approval was 
obtained from each participating centre (NL73670.078.20). Our findings will be 
disseminated by presentation of the results at (inter)national conferences and 
publication in scientific, peer-reviewed journals.
TRIAL REGISTRATION NUMBER: Netherlands Trial Register (TrialRegister.nl, 
NL9220).

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-049704
PMCID: PMC8479939
PMID: 34588250 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


2924. AANA J. 2021 Oct;89(5):413-418.

Pandemic, Economic Uncertainty, and Protests: What Will Happen to Student 
Registered Nurse Anesthetists--Resiliency or Burnout?

Horvath C(1), Grass N(2).

Author information:
(1)is an assistant professor and program director of the Doctor of Nursing 
Practice Nurse Anesthesiology Track at the Johns Hopkins School of Nursing, 
Baltimore, Maryland. Email: chorvat1@jhmi.edu.
(2)is an assistant professor at the Georgetown University Doctor of Nurse 
Anesthesia Practice program, Washington, DC. Email: ndg26@georgetown.edu.

Nurse anesthesiology education is inherently stressful, and student registered 
nurse anesthetists (SRNAs) must demonstrate a high level of resilience for 
successful completion. Because of the coronavirus disease 2019 (COVID-19) 
pandemic, social unrest from racial protests, and uncertain economic conditions, 
SRNAs are facing unprecedented levels of stress. Additionally, traditional 
clinical and didactic training has been drastically interrupted, leading to 
feelings of anxiety and uneasiness. Much research has demonstrated that high 
levels of stress and anxiety can lead to burnout and mental health concerns, 
including fatigue, depression, substance abuse, and suicidal ideation. To 
prevent burnout, promote resilience, and decrease the risk of severe mental 
health conditions, nurse anesthesiology educational programs must explore ways 
to promote students' well-being, through oﬀered wellness interventions and 
resources.

Copyright © by the American Association of Nurse Anesthetists.

PMID: 34586995 [Indexed for MEDLINE]

Conflict of interest statement: Name: Catherine Horvath, DNP, CRNA Contribution: 
This author made significant contributions to the conception, synthesis, 
writing, and final editing and approval of the manuscript to justify inclusion 
as an author. Disclosures: None. Name: Nicole Grass, DNP, CRNA Contribution: 
This author made significant contributions to the conception, synthesis, 
writing, and final editing and approval of the manuscript to justify inclusion 
as an author. Disclosures: None. The authors did not discuss off-label use 
within the article. Disclosure statements are available for viewing upon 
request.


2925. Aust J Rural Health. 2021 Oct;29(5):753-767. doi: 10.1111/ajr.12804. Epub 2021 
Sep 29.

Mental health and well-being impacts of COVID-19 on rural paramedics, police, 
community nurses and child protection workers.

Roberts R(1), Wong A(1), Jenkins S(2), Neher A(1), Sutton C(1), O'Meara P(3), 
Frost M(1), Bamberry L(4), Dwivedi A(4).

Author information:
(1)Charles Sturt University, Bathurst, NSW, Australia.
(2)Charles Sturt University, Wagga, NSW, Australia.
(3)Monash University, Frankston, Vic., Australia.
(4)Charles Sturt University, Albury, NSW, Australia.

OBJECTIVE: To investigate the impact of COVID-19 on the mental health and 
well-being of rural paramedics, police, community nursing and child protection 
staff.
METHOD: An online survey was distributed to investigate the sources of stress 
and support across individual, task and organisational domains.
SETTING AND PARTICIPANTS: The survey was completed by 1542 paramedics, police, 
community nurses and child protection workers from all states and territories of 
Australia. This study describes the data for the 632 rural participants.
MAIN OUTCOME MEASURES: The main measures of well-being were the Public Health 
Questionnaire (PHQ9), the Generalised Anxiety Disorder (GAD7), the Maslach 
Burnout Inventory (MBI), workplace engagement, intention to quit and 
COVID-19-related stress.
RESULTS: The mean depression and anxiety scores were 8.2 (PHQ9) and 6.8 (GAD7). 
This is 2-3 times that found in the general community. Over half (56.1%) of 
respondents showed high emotional exhaustion (burnout). The emotional 
exhaustion, depersonalisation and personal accomplishment mean scores were 28.5, 
9.3 and 34.2, respectively. The strongest associations with burnout and 
psychological distress were workload, provision of practical support, training 
and organisational communication. A significant proportion of respondents were 
seriously considering quitting (27.4%) or looking for a new job with a different 
employer (28.5%) in the next 12 months.
CONCLUSIONS: COVID-19 has increased the workload and stress on rural front-line 
community staff. The major sources of stress were related to organisations' 
responses to COVID-19 and not COVID-19 per se. The data suggest the most 
effective mental health interventions are practical and preventive, such as 
firstly ensuring fair and reasonable workloads.

© 2021 National Rural Health Alliance Ltd.

DOI: 10.1111/ajr.12804
PMCID: PMC8653026
PMID: 34586704 [Indexed for MEDLINE]

Conflict of interest statement: This work has not been previously published. The 
authors declare no conflict of interest.


2926. BMC Med. 2021 Sep 29;19(1):254. doi: 10.1186/s12916-021-02133-y.

SOCRATES-CoMix: a platform for timely and open-source contact mixing data during 
and in between COVID-19 surges and interventions in over 20 European countries.

Verelst F(1), Hermans L(2), Vercruysse S(3), Gimma A(4), Coletti P(3), Backer 
JA(5), Wong KLM(4), Wambua J(3), van Zandvoort K(4), Willem L(1), Bogaardt L(5), 
Faes C(3), Jarvis CI(4), Wallinga J(5)(6), Edmunds WJ(4), Beutels P(1)(7), Hens 
N(1)(3).

Author information:
(1)Centre for Health Economics Research and Modelling Infectious Diseases, 
Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, 
Belgium.
(2)Data Science Institute and I-BioStat, Hasselt University, Hasselt, Belgium. 
lisa.hermans@uhasselt.be.
(3)Data Science Institute and I-BioStat, Hasselt University, Hasselt, Belgium.
(4)London School of Hygiene and Tropical Medicine, London, UK.
(5)Centre for Infectious Disease Control, National Institute for Public Health 
and the Environment, Bilthoven, The Netherlands.
(6)Dept Biomedical Data Sciences, Leiden University Medical Center, Leiden, The 
Netherlands.
(7)School of Public Health and Community Medicine, The University of New South 
Wales, Sydney, Australia.

BACKGROUND: SARS-CoV-2 dynamics are driven by human behaviour. Social contact 
data are of utmost importance in the context of transmission models of 
close-contact infections.
METHODS: Using online representative panels of adults reporting on their own 
behaviour as well as parents reporting on the behaviour of one of their 
children, we collect contact mixing (CoMix) behaviour in various phases of the 
COVID-19 pandemic in over 20 European countries. We provide these timely, 
repeated observations using an online platform: SOCRATES-CoMix. In addition to 
providing cleaned datasets to researchers, the platform allows users to extract 
contact matrices that can be stratified by age, type of day, intensity of the 
contact and gender. These observations provide insights on the relative impact 
of recommended or imposed social distance measures on contacts and can inform 
mathematical models on epidemic spread.
CONCLUSION: These data provide essential information for policymakers to balance 
non-pharmaceutical interventions, economic activity, mental health and 
wellbeing, during vaccine rollout.

© 2021. The Author(s).

DOI: 10.1186/s12916-021-02133-y
PMCID: PMC8478607
PMID: 34583683 [Indexed for MEDLINE]

Conflict of interest statement: Not applicable.


2927. J Womens Health (Larchmt). 2022 Jan;31(1):84-90. doi: 10.1089/jwh.2021.0158. 
Epub 2021 Sep 28.

Impact of Stress on Menstrual Cyclicity During the Coronavirus Disease 2019 
Pandemic: A Survey Study.

Ozimek N(1), Velez K(1), Anvari H(1), Butler L(1), Goldman KN(1)(2), Woitowich 
NC(3).

Author information:
(1)Department of Obstetrics and Gynecology and Feinberg School of Medicine, 
Northwestern University, Chicago, Illinois, USA.
(2)Department of Medical Social Sciences, Feinberg School of Medicine, 
Northwestern University, Chicago, Illinois, USA.
(3)Division of Reproductive Endocrinology and Infertility, Department of 
Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 
Chicago, Illinois, USA.

Comment in
    J Womens Health (Larchmt). 2022 Feb;31(2):299-300.

Background: The coronavirus disease 2019 (COVID-19) pandemic has introduced 
acute and persistent psychosocial stressors for many individuals, with emerging 
gender differences that suggest women may be at greater risk for poorer mental 
health outcomes. This may have unintended consequences for women's overall 
health and well-being, including disruptions to reproductive function as 
elevated stress is often associated with menstrual cycle irregularities. The 
objective of this study was to determine if and how the COVID-19 pandemic and 
its related stressors have impacted women's menstrual cyclicity. Materials and 
Methods: An online survey instrument designed to capture self-reported 
information on menstrual cycle changes and perceived stress levels was 
distributed between July and August 2020. A total of 210 women between the ages 
of 18-45 years met stringent inclusion and exclusion criteria and completed the 
survey. Results: Of the 210 respondents, more than half (54%) reported changes 
in their menstrual cycles. These included changes in menstrual cycle length 
(50%), the duration of menses (34%), and changes in premenstrual symptoms (50%). 
Respondents with high perceived stress scale (PSS) scores during Covid were more 
likely to experience a longer duration of menses (p < 0.001) and heavier 
bleeding during menses (p = 0.028) compared with those with moderate Covid PSS 
scores. Conclusions: By uncovering a trend in increased menstrual cycle 
irregularities during the early months of the COVID-19 pandemic, this study 
contributes to our understanding of the implications that the pandemic may have 
on women's reproductive health.

DOI: 10.1089/jwh.2021.0158
PMID: 34582731 [Indexed for MEDLINE]


2928. Acta Anaesthesiol Scand. 2022 Jan;66(1):94-102. doi: 10.1111/aas.13988. Epub 
2021 Oct 3.

Caregiver burden and emotional wellbeing in informal caregivers to ICU 
survivors-A prospective cohort study.

Milton A(1)(2), Schandl A(3), Larsson IM(4), Wallin E(4), Savilampi J(5), 
Meijers K(6), Joelsson-Alm E(6), Bottai M(7), Sackey P(1).

Author information:
(1)Department of Physiology and Pharmacology, Karolinska Institutet, Solna, 
Sweden.
(2)Department of Perioperative Medicine and Intensive care, Karolinska 
University Hospital, Stockholm, Sweden.
(3)Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, 
Sweden.
(4)Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
(5)Department of Anaesthesiology and Intensive care, Örebro University Hospital, 
Örebro, Sweden.
(6)Department of Anaesthesiology and Intensive care, Södersjukhuset, Stockholm, 
Sweden.
(7)Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden.

BACKGROUND: Informal caregivers to intensive care unit (ICU) survivors may 
develop post-intensive care syndrome family (PICS-F), including depression, 
anxiety and post-traumatic stress (PTS). Our primary aim was to investigate 
associations between caregiver burden in informal caregivers cohabiting with ICU 
survivors and patients' physical and psychological outcomes.
METHODS: A prospective, multicentre cohort study in four ICUs in Sweden. Adults 
cohabiting with ICU patients included in a previous study were eligible for 
inclusion. Three months post-ICU, informal caregivers received questionnaires 
assessing caregiver burden, health-related quality of life (HRQL) and symptoms 
of depression, anxiety and PTS. In parallel, patients reported their three-month 
physical and psychological status via validated questionnaires. The primary 
outcome of this study was to compare caregiver burden in informal caregivers to 
patients with and without adverse physical and psychological outcomes 3 months 
post-ICU. Secondary outcomes were correlations between caregiver burden and 
informal caregivers' mental HRQL.
RESULTS: Among 62 included informal caregivers, 55 (89%) responded to the 
follow-up questionnaires. Caregiver burden was higher among informal caregivers 
to patients with an adverse outcome, compared to informal caregivers to patients 
without an adverse outcome, caregiver burden scale score mean (±standard 
deviation) 52 (11) and 41 (13) respectively (p = 0.003). There was strong 
negative correlation between caregiver burden and informal caregivers' mental 
HRQL (rs -0.74, p < 0.001).
CONCLUSION: Informal caregivers to ICU survivors with adverse physical or 
psychological outcome experience a higher caregiver burden. A higher caregiver 
burden correlates with worse caregiver mental HRQL. ICU follow-up programs 
should consider screening and follow-up of informal caregivers for mental health 
problems.

© 2021 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley 
& Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.

DOI: 10.1111/aas.13988
PMID: 34582048 [Indexed for MEDLINE]


2929. Tuberk Toraks. 2021 Sep;69(3):387-391. doi: 10.5578/tt.20219711.

[COVID-19 pandemic and sleep disorders: COVID-somnia].

[Article in Turkish]

İnönü Köseoğlu H(1).

Author information:
(1)Department of Chest Diseases, Tokat Gaziosmanpasa University Faculty of 
Medicine, Tokat, Turkey.

As a pandemic sweeping over the world, COVID-19 has led to significant changes 
in daily routines and lifestyle. People closed to their homes to reduce their 
contact with each other and socialization took place with telecommunication 
facilities. Moreover, factors like an extended period of isolation, fear of 
infection, uncertainty, disappointment, insufficient supplies, and economic 
damage also negatively impacted individuals' psychological wellbeing. 
Psychosocial stressors affected the pattern of sleep and caused worsening of 
sleep quality in individuals. As a result of all this, sleep disorders have 
emerged. Sleep disturbances during pandemic have been referred as COVID-somnia. 
In this review, the relationship of COVID-19 infection and sleep, and sleep 
disorders during COVID-19 pandemic are presented in the light of the literature.

DOI: 10.5578/tt.20219711
PMID: 34581160 [Indexed for MEDLINE]


2930. Qual Life Res. 2022 May;31(5):1401-1414. doi: 10.1007/s11136-021-02998-9. Epub 
2021 Sep 28.

Factors associated with impaired quality of life three months after being 
diagnosed with COVID-19.

Rass V(1), Ianosi BA(2), Zamarian L(2), Beer R(2), Sahanic S(3), Lindner A(2), 
Kofler M(2), Schiefecker AJ(2), Mahlknecht P(2), Heim B(2), Limmert V(2), 
Sonnweber T(3), Pizzini A(3), Tymoszuk P(3), Scherfler C(2), Djamshidian A(2), 
Kiechl S(2), Tancevski I(3), Seppi K(2), Pfausler B(2), Loeffler-Ragg J(3), 
Helbok R(2).

Author information:
(1)Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 
6020, Innsbruck, Austria. verena.rass@tirol-kliniken.at.
(2)Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 
6020, Innsbruck, Austria.
(3)Department of Internal Medicine II, Medical University of Innsbruck, 
Anichstrasse 35, 6020, Innsbruck, Austria.

PURPOSE: To assess patient characteristics associated with health-related 
quality of life (HR-QoL) and its mental and physical subcategories 3 months 
after diagnosis with COVID-19.
METHODS: In this prospective multicentre cohort study, HR-QoL was assessed in 90 
patients using the SF-36 questionnaire (36-item Short Form Health Survey), which 
consists of 8 health domains that can be divided into a mental and physical 
health component. Mental health symptoms including anxiety, depression, and 
post-traumatic stress disorders were evaluated using the Hospital Anxiety and 
Depression Scale (HADS) and Post-traumatic Stress Disorder Checklist-5 (PCL-5) 3 
months after COVID-19. Using descriptive statistics and multivariable regression 
analysis, we identified factors associated with impaired HR-QoL 3 months after 
COVID-19 diagnosis.
RESULTS: Patients were 55 years of age (IQR, 49-63; 39% women) and were 
classified as severe (23%), moderate (57%), or mild (20%) according to acute 
disease severity. HR-QoL was impaired in 28/90 patients (31%). Younger age [per 
year, adjOR (95%CI) 0.94 (0.88-1.00), p = 0.049], longer hospitalization [per 
day, adjOR (95%CI) 1.07 (1.01-1.13), p = 0.015], impaired sleep [adjOR (95%CI) 
5.54 (1.2-25.61), p = 0.028], and anxiety [adjOR (95%CI) 15.67 (3.03-80.99), 
p = 0.001) were independently associated with impaired HR-QoL. Twenty-nine 
percent (n = 26) scored below the normal range on the mental health component of 
the SF-36 and independent associations emerged for anxiety, depression, and 
self-reported numbness. Impairments in the physical health component of the 
SF-36 were reported by 12 (13%) patients and linked to hypogeusia and fatigue.
CONCLUSION: Every third patient reported a reduction in HR-QoL 3 months after 
COVID-19 diagnosis and impairments were more prominent in mental than physical 
well-being.

© 2021. The Author(s).

DOI: 10.1007/s11136-021-02998-9
PMCID: PMC8476326
PMID: 34580823 [Indexed for MEDLINE]

Conflict of interest statement: KS reports grants from FWF Austrian Science 
Fund, grants from Michael J. Fox Foundation, grants from International Parkinson 
and Movement Disorder Society, personal fees from Teva, personal fees from UCB, 
personal fees from Lundbeck, personal fees from AOP Orphan Pharmaceuticals AG, 
personal fees from Abbvie, personal fees from Roche, and personal fees from 
Grünenthal; all outside the submitted work. PM reports grants from TWF (Tyrolean 
Science Fund), grants from Medtronic, personal fees from Boston Scientific, all 
outside the submitted work. The other authors have nothing to disclose. All 
other authors declare no competing interests.


2931. Int J Environ Res Public Health. 2021 Sep 21;18(18):9929. doi: 
10.3390/ijerph18189929.

Anxiety, Depression and Risk of Post-Traumatic Stress Disorder in Health 
Workers: The Relationship with Burnout during COVID-19 Pandemic in Italy.

Ghio L(1), Patti S(1), Piccinini G(1), Modafferi C(2), Lusetti E(1), Mazzella 
M(3), Del Sette M(4)(5).

Author information:
(1)Psychiatry Branch, Galliera Hospital, Mura delle Cappuccine, 14, 16128 Genoa, 
Italy.
(2)V.I.E. Development, Innovation, Empowerment srl Spinoff, University of Genoa, 
Via Eugenia Ravasco 12, 16128 Genoa, Italy.
(3)Maternal and Infant Department, Galliera Hospital, Mura delle Cappuccine, 14, 
16128 Genoa, Italy.
(4)Neurology Unit, Galliera Hospital, Mura delle Cappuccine, 14, 16128 Genoa, 
Italy.
(5)San Martino Polyclinic Hospital IRCCS, Largo R. Benzi, 10, 16132 Genoa, 
Italy.

During the COVID-19 pandemic, healthcare workers (HW) have faced an extremely 
difficult work environment, with an increased workload and traumatic events. Our 
study aimed to investigate the impact of COVID-19 pandemic on HW's mental 
wellbeing. We analyzed the correlations between levels of burnout and other 
mental health disorders and we searched for the presence of specific risk 
factors of post-traumatic symptomatology related to the pandemic. A structured 
an on-line questionnaire and validated instruments were completed by a sample of 
HW from some hospitals in Genoa, Italy. Anxious, depressive, post-traumatic and 
other psychological symptoms were assessed and risk factors, related to the 
pandemic, were considered. Then, we investigated the correlation between levels 
of burnout and the risk of developing psychopathology. A total of 731 HW were 
screened, and we found increased levels of anxiety (61%), depression (62%), PTSD 
(34%) and high levels of burnout; especially emotional exhaustion (37%). A 
statistically significant association between burnout and insomnia, depression, 
anxiety, and post-traumatic symptoms was demonstrated. This study indicates that 
during the COVID-19 pandemic, HW showed high levels of psychological distress 
and that burnout is an important predictor of sufferance. These findings support 
the idea to provide psychological and psychiatric support for HW.

DOI: 10.3390/ijerph18189929
PMCID: PMC8469269
PMID: 34574851 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2932. Int J Environ Res Public Health. 2021 Sep 19;18(18):9880. doi: 
10.3390/ijerph18189880.

The COVID-19 Pandemic: A Longitudinal Study on the Emotional-Behavioral Sequelae 
for Children and Adolescents with Neuropsychiatric Disorders and Their Families.

Raffagnato A(1), Iannattone S(1), Tascini B(1), Venchiarutti M(1), Broggio A(1), 
Zanato S(1), Traverso A(1), Mascoli C(1), Manganiello A(1), Miscioscia M(1)(2), 
Gatta M(1).

Author information:
(1)Department of Women's and Children's Health, Padua University Hospital, 35128 
Padua, Italy.
(2)Department of Developmental Psychology and Socialization, University of 
Padua, 35131 Padua, Italy.

This study aimed to investigate the immediate and short-term impact of the 
pandemic on the psychological well-being of Italian children and adolescents 
with psychiatric disorders and their families. Overall, 56 patients aged 6-18 (M 
= 13.4 years, SD = 2.77) and their parents were evaluated during the COVID-19 
lockdown (T0) and after 4 months (T1). An ad hoc data sheet, Youth Self-Report 
11-18 (YSR), Child Behavior Checklist 6-18 (CBCL), and Depression Anxiety Stress 
Scale-21 (DASS-21) were administered. Patients, mainly suffering from 
internalizing disorders, overall demonstrated a good adaptation to the pandemic 
context. Moreover, patients with behavioral disorders showed a greater 
psychological discomfort at both T0 and T1 compared to patients with 
internalizing disorders. Over time, patients presented an improvement on the 
emotional side, as proven by a significant decrease in internalizing and 
post-traumatic stress problems. Finally, no significant differences were found 
in the emotional-behavioral profile of patients according to the means of 
conducting neuropsychiatric interventions during the lockdown (i.e., in 
person/remotely/interrupted), thus allowing us to exclude important negative 
effects caused by the transition to remote therapy. Concerning parents, an 
inverse relationship emerged between the DASS-21 scores and the level of 
resilience, which therefore represents a protective factor against psychological 
maladjustment. Over time, an improvement in the psychological well-being of 
parents was observed, as shown by a significant decrease in mothers' anxiety and 
fathers' stress.

DOI: 10.3390/ijerph18189880
PMCID: PMC8471939
PMID: 34574803 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2933. Int J Environ Res Public Health. 2021 Sep 16;18(18):9762. doi: 
10.3390/ijerph18189762.

The Mediating Role of Resilience in the Relationship between Perceived Stress 
and Mental Health.

Lara-Cabrera ML(1)(2)(3), Betancort M(4), Muñoz-Rubilar CA(5), Rodríguez Novo 
N(6)(7), De Las Cuevas C(8)(9).

Author information:
(1)Department of Research and Development, Division of Mental Health, St Olav's 
University Hospital, 7006 Trondheim, Norway.
(2)Department of Mental Health, Faculty of Medicine and Health Sciences, 
Norwegian University of Science and Technology (NTNU), 7091 Trondheim, Norway.
(3)Nidelv Division of Psychiatry, Community Mental Health Centre, St. Olav's 
University Hospital, 7006 Trondheim, Norway.
(4)Department of Clinical Psychology, Psychobiology and Methodology, Universidad 
de La Laguna, 38200 San Cristóbal de La Laguna, Spain.
(5)Faculty of Health Sciences, Nursing School, Universidad Central de Chile, 
Santiago 8370178, Chile.
(6)Department of Nursing, Universidad de La Laguna, 38200 San Cristóbal de La 
Laguna, Spain.
(7)Colegio Oficial de Enfermeros de Santa Cruz de Tenerife, 38201 San Cristóbal 
de La Laguna, Spain.
(8)Department of Internal Medicine, Dermatology and Psychiatry, Universidad de 
La Laguna, 38200 San Cristóbal de La Laguna, Spain.
(9)Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, 
38200 San Cristóbal de La Laguna, Spain.

The COVID-19 pandemic has created great uncertainty around the world, and due to 
the pandemic, nurses have been exposed to an increase in highly stressful 
clinical situations. This study examines the relationships between perceived 
stress and emotional disorders among nurses who have provided direct patient 
care during the COVID-19 pandemic and explores the mediating role of resilience 
in these relationships. In an online cross-sectional design, we asked Spanish 
nurses (N = 214) to complete self-reported scales, and we performed correlation 
and mediation analyses between perceived stress (Perceived Stress Scale, PSS-4), 
resilience (Wagnild Resilience Scale, RS-14), wellbeing (World Health 
Organization Wellbeing Index, five items, WHO-5), anxiety (PHQ-2) and depression 
(GAD-2). The nurses self-reported moderate levels of perceived stress, 
considerable psychological distress and high resilience. We found resilience to 
be significantly negatively correlated with the reported levels of perceived 
stress, anxiety and depression (p < 0.001). The mediating analysis revealed that 
resilience played a protective role in the direct relationships of stress with 
depression, anxiety, and psychological distress. To conclude, our findings 
supported the hypothesis that resilience mediated the relationship between 
stress and mental health.

DOI: 10.3390/ijerph18189762
PMCID: PMC8465177
PMID: 34574684 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript, or in the decision to 
publish the results.


2934. Int J Environ Res Public Health. 2021 Sep 13;18(18):9621. doi: 
10.3390/ijerph18189621.

Burnout and the Psychological Impact among Physiatrists in Saudi Arabia during 
COVID-19.

Alwashmi AH(1), Alkhamees AA(2).

Author information:
(1)Department of Orthopedic Surgery, College of Medicine, Qassim University, 
Buraydah 52571, Saudi Arabia.
(2)Department of Medicine, Unaizah College of Medicine and Medical Sciences, 
Qassim University, Buraydah 52571, Saudi Arabia.

BACKGROUND: Burnout is an emerging critical issue facing specialists and 
trainees in all disciplines and not particularly studied among physiatry 
specialists and trainees in Saudi Arabia during the COVID-19 pandemic.
OBJECTIVE: To assess physiatrist burnout, depression, anxiety, and stress during 
the current COVID-19 pandemic crisis in Saudi Arabia.
DESIGN: Cross-sectional study.
SETTING: By distributing an electronic survey, the researcher assessed burnout 
using the Maslach Burnout Inventory (MBI) Human Services Survey (HSS) in the 
midst of the curfew that Saudi authorities imposed.
PARTICIPANTS: One hundred one participating trainees, specialists, and 
consultants.
RESULTS: Of the 101 study participants, the majority (73.3%) were between the 
ages of 24 and 34 years old, with the rest distributed within the age group 
ranging from 35 to 65 years old. Junior residents represented 34.7%, senior 
residents 22.8%, physiatrist specialists 26.7%, and consultants 15.8%. The 
sample included 55.4% males and 44.6% females; 64.4% of the participants were 
married, 29.7% were still single, and 5.9% were divorced. Among the total group 
participating, 25.7% were handling COVID-19 patients. In the total participant 
sample, 80.2% reported experiencing burnout, 10.9% experienced stress, and 22.8% 
and 6.9% experienced anxiety and depression, respectively.
CONCLUSION: Burnout in Saudi Arabia exists among more than two-thirds of 
practicing physiatrists in Physical Medicine & Rehabilitation (PM&R), and that 
did not appear to have a statistically significant influence on stress, anxiety, 
or depression (p > 0.05). The current COVID-19 global pandemic might escalate 
burnout and influence mental health outcomes. The healthcare authority and 
administration should take the lead in identifying the challenges, overcoming 
the obstacles, and optimizing clinician well-being, delivering up-to-date 
solutions, and promptly checking their effectiveness.

DOI: 10.3390/ijerph18189621
PMCID: PMC8472589
PMID: 34574546 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2935. Int J Environ Res Public Health. 2021 Sep 12;18(18):9605. doi: 
10.3390/ijerph18189605.

The Influence of Technology on Mental Well-Being of STEM Teachers at University 
Level: COVID-19 as a Stressor.

Navarro-Espinosa JA(1), Vaquero-Abellán M(2)(3), Perea-Moreno AJ(4), 
Pedrós-Pérez G(4), Aparicio-Martínez P(2)(3), Martínez-Jiménez MP(4)(5).

Author information:
(1)Unidad de Seguimiento a Graduados, Banca Laboral y Prácticas Pre 
Profesionales, Universidad de ECOTEC, Guayaquil 090501, Ecuador.
(2)GC12 Clinical and Epidemiological Research in Primary Care, Instituto 
Maimónides, Campus de Menéndez Pidal, Universidad de Córdoba, 14071 Córdoba, 
Spain.
(3)Departamento de Enfermería, Fisioterapia y Farmacología, Campus de Menéndez 
Pidal, Universidad de Córdoba, 14071 Córdoba, Spain.
(4)Departamento de Física Aplicada, Radiología y Medicina Física, Edificio 
Albert Einstein, Campus de Rabanales, Universidad de Córdoba, 14071 Córdoba, 
Spain.
(5)Responsable Grupo Investigación PAIDI de la Junta de Andalucía TEP149, 
Modelos de Simulación en Energías, Transporte, Física, Ingeniería y Riesgos 
Laborales, Edificio Albert Einstein, Campus de Rabanales, Universidad de 
Córdoba, 14071 Córdoba, Spain.

Stress can result in psychopathologies, such as anxiety or depression, when this 
risk factor continues in time. One major stressor was the COVID-19 pandemic, 
which triggered considerable emotional distress and mental health issues among 
different workers, including teachers, with another stressor: technology and 
online education. A mixed-method approach is presented in this research, 
combining a cross-sectional study of university teachers from Ecuador and Spain 
with a medium of twenty years of working experience (N = 55) and a bibliometric 
analysis carried out in three databases (161 documents). The levels of anxiety 
and depression, and therefore the risk of developing them as mental disorders, 
were high. The lack of training (p < 0.01), time (p < 0.05), or research 
regarding the use of technology in education (p < 0.01) and stress caused by 
COVID-19 (p < 0.001) were linked to frequency. The most relevant observational 
study obtained through the bibliometric analysis (138 citations and over 65% of 
methodological quality) indicated that previous training and behavioral factors 
are key in the stress related to technology. The combination of the results 
indicated that mental health in STEM teachers at university is related to 
diverse factors, from training to the family and working balance.

DOI: 10.3390/ijerph18189605
PMCID: PMC8472288
PMID: 34574529 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2936. Int J Environ Res Public Health. 2021 Sep 11;18(18):9581. doi: 
10.3390/ijerph18189581.

PaLS Study of Sleep Deprivation and Mental Health Consequences of the COVID-19 
Pandemic among University Students: A Cross-Sectional Survey.

Gruba G(1), Kasiak PS(1), Gębarowska J(1)(2), Adamczyk N(1)(2), Sikora Z(1), 
Jodczyk AM(1), Mamcarz A(2)(3), Śliż D(1)(2)(3)(4).

Author information:
(1)Students' Scientific Group of Lifestyle Medicine, 3rd Department of Internal 
Medicine and Cardiology, Medical University of Warsaw, 04-749 Warsaw, Poland.
(2)Polish Society of Lifestyle Medicine, 00-388 Warsaw, Poland.
(3)3rd Department of Internal Medicine and Cardiology, Medical University of 
Warsaw, 04-749 Warsaw, Poland.
(4)School of Public Health, Postgraduate Medical Education Center, 01-813 
Warsaw, Poland.

The COVID-19 pandemic has changed the way many people live. To assess its impact 
on sleep quality and quantity, blue light exposure, and the mental health of 
Polish university students, a cross-sectional survey was conducted. Almost half 
of the participants were medical students (47.62%; n = 630). The majority of 
students were suffering from insomnia (58.13%, n = 769). Almost every third 
student was sleeping less than 7 h a day (30.39%, n = 402). Our study showed 
that a short sleep duration correlates with poorer mental health outcomes. 
Respondents who declared sadness and depression were more likely to suffer from 
insomnia (OR = 5.6997, 95% CI: 4.3641-7.4441). Difficulty with tasks was also 
more likely to co-occur with insomnia (OR = 5.4723, 95% CI: 4.3007 to 6.9630). 
The results of this study showed that the COVID-19 pandemic contributed to the 
deterioration of sleep quality and quantity as well as the psychological 
well-being of Polish students. It is important to take steps to promote proper 
sleeping habits to alleviate the risk of mental health disorders in this group 
of people.

DOI: 10.3390/ijerph18189581
PMCID: PMC8464860
PMID: 34574505 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2937. Int J Environ Res Public Health. 2021 Sep 11;18(18):9571. doi: 
10.3390/ijerph18189571.

Lifestyle Changes among Polish University Students during the COVID-19 Pandemic.

Fila-Witecka K(1), Senczyszyn A(1), Kołodziejczyk A(1), Ciułkowicz M(1), 
Maciaszek J(1), Misiak B(1), Szcześniak D(1), Rymaszewska J(1).

Author information:
(1)Department and Clinic of Psychiatry, Wrocław Medical University, 50-367 
Wrocław, Poland.

Students worldwide have been impacted by nationwide safety closures due to the 
COVID-19 pandemic, creating an environment with loss of interaction with 
colleagues, social isolation, boredom, and economic uncertainty. Since 
university students were considered uniquely vulnerable to mental health 
problems even before the pandemic, this study aimed to investigate lifestyle and 
behavioral changes experienced by this population due to the epidemiological 
situation and their effect on their mental health. Data were collected via an 
online survey conducted among university students across Poland. The survey 
addressed recent lifestyle changes that were a result of the pandemic as well as 
psychological distress, symptoms of insomnia and symptoms of post-traumatic 
stress. The results indicate that protective factors include maintaining a daily 
routine, staying physically active, following a usual eating pattern and taking 
care of sleep hygiene. Changes in behavior contributing to poorer mental health 
included giving up a daily routine, neglecting meals, tidiness, hygiene as well 
as social relationships, changes in food intake, sleeping schedule, a decrease 
in physical activity and the onset of sexual dysfunctions. A history of 
psychiatric treatment and an increase in self-harm as well as an increase in 
alcohol and tobacco consumption were also found to be associated with 
psychological distress. Experienced lifestyle and behavioral changes and their 
impact on mental health were apparent throughout the obtained data, highlighting 
the need for psychological support in the studied population. Based on the 
results we were able to establish a list of protective and risk factors 
influencing the everyday life and psychological wellbeing of students amidst the 
COVID-19 pandemic, which could also be translated into life skills.

DOI: 10.3390/ijerph18189571
PMCID: PMC8469884
PMID: 34574496 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2938. Int J Environ Res Public Health. 2021 Sep 9;18(18):9501. doi: 
10.3390/ijerph18189501.

Associations of the Initial COVID-19 Lockdown on Self-Reported Happiness and 
Worry about Developing Loneliness: A Cross-Sectional Analysis of Rural, 
Regional, and Urban Australian Communities.

Isaac V(1), Cheng T(2), Townsin L(3)(4), Assareh H(5), Li A(2)(6), McLachlan 
CS(2).

Author information:
(1)Flinders Rural Health South Australia, Flinders University, Renmark, SA 5341, 
Australia.
(2)Centre for Healthy Futures, Torrens University Australia, Pyrmont, NSW 2009, 
Australia.
(3)Research Office, Torrens University Australia, Adelaide, SA 5000, Australia.
(4)School of Health, Federation University Australia, Berwick, VIC 3806, 
Australia.
(5)Evidence Generation and Dissemination, Agency for Clinical Innovation, St 
Leonards, NSW 2065, Australia.
(6)Department of Pharmacy & Biomedical Sciences, La Trobe University, Bendigo, 
VIC 3550, Australia.

Australia adopted hard lockdown measures to eliminate community transmission of 
COVID-19. Lockdown imposes periods of social isolation that contributes to 
increased levels of stress, anxiety, depression, loneliness, and worry. We 
examined whether lockdowns have similar psychosocial associations across rural 
and urban areas and whether associations existed between happiness and worry of 
loneliness in the initial wave of the COVID-19 pandemic in Australia. Data were 
collected using the "COVID-19 Living Survey" between 13 and 20 May 2020 by 
BehaviourWorks Australia at the Monash Sustainable Development Institute. The 
mean self-reported feeling of happiness and anxiousness (N = 1593), on a 
10-point Likert scale with 0 being least happy or highly anxious, was 6.5 (SD = 
2.4) and 3.9 (2.9), respectively. Factors associated with happiness were older 
age and having a postgraduate education. Participants worried about becoming 
lonely also exhibited reduced happiness (estimate = -1.58, 95%CI = -1.84--1.32) 
and higher anxiousness (2.22, 1.93-2.51) scores, and these conditions remained 
associated after adjusting for demographics. Interestingly, worry about 
loneliness was greater in rural areas than in urban communities. The negative 
impact of the COVID-19 lockdown on rural youth and those less-educated was 
evident. Participants in rural Australia who were worried about becoming lonely 
were reportedly less happy than participants in major cities. This dataset 
provides a better understanding of factors that influence psychological 
well-being and quality of life in the Australian population and helps to 
determine whether happiness may be an associative factor that could mitigate 
self-feelings of anxiety and worry about loneliness.

DOI: 10.3390/ijerph18189501
PMCID: PMC8467504
PMID: 34574425 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2939. Int J Environ Res Public Health. 2021 Sep 8;18(18):9453. doi: 
10.3390/ijerph18189453.

Resilience, Coping Strategies and Posttraumatic Growth in the Workplace 
Following COVID-19: A Narrative Review on the Positive Aspects of Trauma.

Finstad GL(1)(2), Giorgi G(3), Lulli LG(4), Pandolfi C(2), Foti G(2), León-Perez 
JM(5), Cantero-Sánchez FJ(5), Mucci N(1).

Author information:
(1)Department of Experimental and Clinical Medicine, University of Florence, 
50139 Florence, Italy.
(2)Business @ Health Laboratory, European University of Rome, 00163 Rome, Italy.
(3)Department of Human Sciences, European University of Rome, 00163 Rome, Italy.
(4)School of Occupational Medicine, University of Florence, 50134 Florence, 
Italy.
(5)Department of Social Psychology, Universidad de Sevilla, 41004 Sevilla, 
Spain.

The COVID-19 pandemic represents a traumatic event that has profoundly changed 
working conditions with detrimental consequences for workers' health, in 
particular for the healthcare population directly involved in addressing the 
emergency. Nevertheless, previous research has demonstrated that traumatic 
experiences can also lead to positive reactions, stimulating resilience and 
feelings of growth. The aim of this narrative review is to investigate the 
positive aspects associated with the COVID-19 pandemic and the possible health 
prevention and promotion strategies by analyzing the available scientific 
evidence. In particular, we focus on the constructs of resilience, coping 
strategies and posttraumatic growth (PTG). A literature search was performed on 
the PubMed, EMBASE, Scopus, Web of Science, Google Scholar and Psycinfo 
databases. Forty-six articles were included in the literature synthesis. 
Psychological resilience is a fundamental variable for reducing and preventing 
the negative psychological effects of the pandemic and is associated with lower 
levels of depression, anxiety and burnout. At the individual and organizational 
level, resilience plays a crucial role in enhancing wellbeing in healthcare and 
non-healthcare workers. Connected to resilience, adaptive coping strategies are 
essential for managing the emergency and work-related stress. Several positive 
factors influencing resilience have been highlighted in the development of PTG. 
At the same time, high levels of resilience and positive coping strategies can 
enhance personal growth. Considering the possible long-term coexistence and 
consequences of COVID-19, organizational interventions should aim to improve 
workers' adaptive coping skills, resilience and PTG in order to promote 
wellbeing.

DOI: 10.3390/ijerph18189453
PMCID: PMC8468098
PMID: 34574378 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2940. Int J Environ Res Public Health. 2021 Sep 7;18(18):9430. doi: 
10.3390/ijerph18189430.

Physical Activity, Physical Well-Being, and Psychological Well-Being: 
Associations with Life Satisfaction during the COVID-19 Pandemic among Early 
Childhood Educators.

Randall K(1), Ford TG(2), Kwon KA(3), Sisson SS(4), Bice MR(5), Dinkel D(6), 
Tsotsoros J(1).

Author information:
(1)Department of Rehabilitation Sciences, College of Allied Health, University 
of Oklahoma Schusterman Center, 4502 East 41st Street, Tulsa, OK 74135, USA.
(2)Department of Educational Leadership and Policy Studies, Jeanine Rainbolt 
College of Education, University of Oklahoma Schusterman Center, 4502 East 41st 
Street, Tulsa, OK 74135, USA.
(3)Department of Instructional Leadership and Academic Curriculum, Jeanine 
Rainbolt College of Education, University of Oklahoma, 820 Van Vleet Oval, 
Norman, OK 73019, USA.
(4)Department of Nutritional Sciences, College of Allied Health, University of 
Oklahoma Health Sciences Center, 1200 North Stonewall Avenue, Oklahoma City, OK 
73104, USA.
(5)Department of Kinesiology and Sport Sciences, University of Nebraska at 
Kearney, 2504 9th Ave, Kearney, NE 68849, USA.
(6)School of Health and Kinesiology, College of Education, Health, and Human 
Sciences, University of Nebraska at Omaha, H & K Building, 6001 Dodge Street, 
Omaha, NE 68182, USA.

Seeking personal well-being and life satisfaction during a global pandemic can 
be daunting, such is the case for early care and education teachers who were 
considered non-health care essential workers during the COVID-19 pandemic. The 
potential changes in their physical activity, along with their overall physical 
and psychological well-being, may have ultimately influenced their life 
satisfaction. These changes included the potential for increased sedentary 
behaviors. Despite the high health risks associated with these factors during 
the pandemic, the role of physical activity in early care and education 
teachers' well-being and life satisfaction remains largely unknown. The purpose 
of this study is to examine the associations of physical activity and sedentary 
behaviors with teacher well-being and life satisfaction during the COVID-19 
pandemic. In doing so, we explored two competing models of the relationship 
between the teachers' physical activity, well-being, and life satisfaction, one 
with physical activity as a mediator and the other with teachers' well-being as 
a mediator. An online survey, that collected information on physical, 
psychological, and professional well-being, job demands, and life satisfaction, 
was completed by 1434 US ECE teachers in 46 states. To test our hypothesized 
models, we conducted confirmatory factor analyses, followed by structural 
equation modeling. Of the respondents, 77% were overweight or obese and only 39% 
met the recommended 150 min of moderate physical activity per week. They had a 
mean life satisfaction score that qualifies as slight satisfaction, they 
experience moderate stress, and, collectively, are approaching the threshold for 
depression yet still reflect moderate-to-high work commitment. The empirical 
test of our competing mediation models found the model where teacher well-being 
mediated the association between physical activity, sedentary behavior, and life 
satisfaction was the superior model. The relationships between physical 
activity, sedentary behavior, and overall well-being suggest that these 
modifiable risk factors can be addressed such that early care and education 
teachers can improve their overall physical and psychological well-being, along 
with their life satisfaction.

DOI: 10.3390/ijerph18189430
PMCID: PMC8465281
PMID: 34574354 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2941. Children (Basel). 2021 Aug 30;8(9):755. doi: 10.3390/children8090755.

Psychological Wellbeing of Parents with Infants Admitted to the Neonatal 
Intensive Care Unit during SARS-CoV-2 Pandemic.

Polloni L(1), Cavallin F(2), Lolli E(3), Schiavo R(1), Bua M(1), Volpe B(1), 
Meneghelli M(3), Baraldi E(3), Trevisanuto D(3).

Author information:
(1)Psychology Unit, University Hospital of Padua, 35128 Padua, Italy.
(2)Independent Statistician, 36020 Solagna, Italy.
(3)Neonatal Intensive Care Unit, Department of Women's and Children's Health, 
University Hospital of Padua, Via Giustiniani, 3, 35128 Padua, Italy.

The current SARS-CoV-2 disease (COVID-19) pandemic is a sudden major stressor 
superimposed on pre-existing high distress in parents of infants admitted to the 
neonatal intensive care unit (NICU). This study aimed to investigate the 
psychological wellbeing of NICU parents during the COVID-19 pandemic. Forty-four 
parents of 25 inpatients of the Padua University Hospital NICU were included 
from June 2020 to February 2021. At 7-14 days postpartum parents completed the 
Edinburgh Postnatal Depression Scale (EPDS), State-Trait Anxiety Inventory 
(STAI), Parental Stressor Scale: NICU (PSS:NICU) and an ad-hoc questionnaire 
measuring parental COVID-19 related stress. About one third of parents reported 
extreme/high stress and a relevant negative impact on parenthood experience. 
Less time (82%) and less physical contact (73%) with infants due to COVID-19 
preventive measures were the most frequent negative factors. Higher COVID-19 
related parental stress was positively associated with anxiety, depression, NICU 
parental stress, stress related to NICU environment, and parental role 
alterations. Depression symptoms, stress related to infant condition and 
parental role alterations were higher in mothers. The pandemic affected parental 
emotional and relational wellbeing directly through additional stress due to 
COVID-19 concerns and indirectly through the impact of restrictions on the 
experience of becoming parents.

DOI: 10.3390/children8090755
PMCID: PMC8471119
PMID: 34572187

Conflict of interest statement: The authors have no competing interests relevant 
to this article to disclose.


2942. Public Health. 2021 Oct;199:77-86. doi: 10.1016/j.puhe.2021.08.014. Epub 2021 
Sep 1.

Social and psychological impact of the COVID-19 pandemic on people with 
Parkinson's disease: a scoping review.

Brooks SK(1), Weston D(2), Greenberg N(3).

Author information:
(1)Department of Psychological Medicine, King's College London, Weston Education 
Centre, London, SE5 9RJ, UK. Electronic address: samantha.k.brooks@kcl.ac.uk.
(2)Behavioural Science Team, Emergency Response Department Science & Technology, 
Public Health England, Porton Down, Salisbury, SP4 0JG, UK. Electronic address: 
dale.weston@phe.gov.uk.
(3)Department of Psychological Medicine, King's College London, Weston Education 
Centre, London, SE5 9RJ, UK. Electronic address: neil.greenberg@kcl.ac.uk.

OBJECTIVES: The COVID-19 pandemic caused countries across the globe to impose 
restrictions to slow the spread of the virus, with people instructed to stay at 
home and reduce contact with others. This reduction in social contact has the 
potential to negatively impact mental health and well-being. The restrictions 
are particularly concerning for people with existing chronic illnesses such as 
Parkinson's disease, who may be especially affected by concerns about the 
pandemic and associated reduction of social contact. The aim of this review was 
to synthesise published literature on the impact of the COVID-19 pandemic on the 
social and psychological well-being of people with Parkinson's disease.
STUDY DESIGN: The design of this study is a scoping review.
METHODS: We searched five electronic databases for English language articles 
containing primary data on this topic.
RESULTS: Thirty-one relevant studies were found and included in the review. Six 
main themes were identified: impact of the pandemic on physical and mental 
health; COVID-19 concerns; access to health care; impact on daily and social 
activities; impact on physical activity and impact on caregivers. Levels of 
perceived risk of COVID-19 differed across studies, but most participants had 
adopted preventive measures such as staying at home and reducing social 
contacts. Participants in many studies reported a discontinuation of regular 
healthcare appointments and physiotherapy, as well as concerns about being able 
to obtain medication. Loss of daily activities and social support was noted by 
many participants. There was mixed evidence on the impact of the pandemic on 
physical exercise, with some studies finding no change in physical activity and 
others reporting a reduction; generally, participants with reduced physical 
activity had poorer mental health and greater worsening of symptoms. Caregivers 
of people with Parkinson's disease were more likely to be negatively affected by 
the pandemic if they cared for people with complex needs such as additional 
mental health problems.
CONCLUSIONS: The COVID-19 pandemic has had negative effects on the physical and 
mental health of people with Parkinson's disease, perhaps due to disruption of 
healthcare services, loss of usual activities and supports and reduction in 
physical activity. We make recommendations for policy, practice and future 
research.

Copyright © 2021 The Royal Society for Public Health. Published by Elsevier Ltd. 
All rights reserved.

DOI: 10.1016/j.puhe.2021.08.014
PMCID: PMC8407946
PMID: 34571441 [Indexed for MEDLINE]


2943. J Nerv Ment Dis. 2022 Feb 1;210(2):83-90. doi: 10.1097/NMD.0000000000001437.

Personality Traits, Media Exposure, and Deterioration of Psychological Wellbeing 
in Japan During the COVID-19 Pandemic.

Yamauchi T(1), Suka M, Yanagisawa H.

Author information:
(1)Department of Public Health and Environmental Medicine, The Jikei University 
School of Medicine, Tokyo, Japan.

This study examined the associations among personality traits, media exposure 
regarding COVID-19, and deterioration of mental wellbeing among the public in 
Japan. We conducted a cross-sectional Web-based questionnaire survey among 8000 
Japanese men and women aged 25 to 64 years. Approximately half of participants 
reported deterioration of mental wellbeing. Nearly 20% of participants reported 
"constant/excessive" exposure to media information regarding COVID-19. As 
compared with those with low "extraversion" and "less frequent" exposure to 
media information about COVID-19, those with high "extraversion" and "more 
frequent" media exposure reported significantly less deterioration of mental 
wellbeing. In addition, as compared with those with low "neuroticism" and media 
exposure, those with high "neuroticism" and "constant/excessive" exposure to 
COVID-19-related information significantly more frequently reported 
deterioration of mental wellbeing. Under the ongoing pandemic of COVID-19, 
measures for the promotion and maintenance of mental wellbeing should be 
implemented considering the interaction between personality traits and media 
exposure.

Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.

DOI: 10.1097/NMD.0000000000001437
PMID: 34570060 [Indexed for MEDLINE]


2944. Front Public Health. 2021 Sep 9;9:738304. doi: 10.3389/fpubh.2021.738304. 
eCollection 2021.

The Long-Term Impact of the COVID-19 Pandemic on Loneliness in People Living 
With Disability and Visual Impairment.

Heinze N(1)(2), Hussain SF(1)(2), Castle CL(1)(2), Godier-McBard LR(3), 
Kempapidis T(1)(2), Gomes RSM(1)(2)(4).

Author information:
(1)Research and Innovation, Blind Veterans UK, London, United Kingdom.
(2)BRAVO VICTOR, Research, London, United Kingdom.
(3)Veterans and Families Institute for Military Social Research, Anglia Ruskin 
University, Chelmsford, United Kingdom.
(4)Northern Hub for Veterans and Military Families Research, Department of 
Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria 
University, Newcastle upon Tyne, United Kingdom.

Background: There has been growing concern about the impact of restrictions put 
in place to contain the coronavirus pandemic on loneliness, particularly in 
individuals with disabilities. This study explored the longitudinal impact of 
the pandemic on loneliness in these individuals, with a focus on those living 
with visual impairment (VI). Methods: An online survey was conducted in 
April-2020 and repeated in March 2021 to explore current life circumstances, 
health-related behaviours, sleep (Pittsburgh Sleep Quality Index) and social 
well-being, including state anxiety (State-Trait Anxiety Index) and loneliness 
(UCLA Loneliness scale). A convenience sample of 602 participants completed the 
first survey. Participants who agreed to be re-contacted were invited to take 
part in the follow-up survey. Results: Data is presented for the 160 
participants who completed both timepoints. At both timepoints, median 
loneliness was significantly higher in participants with disabilities and those 
with VI than in participants with no disabilities. While there was no 
significant change in loneliness in any of the three subgroups, participants 
with VI experienced the largest increase in median loneliness. Loneliness was 
associated with having a mental health condition and higher levels of state 
anxiety at both timepoints. Conclusions: Individuals with disabilities such as 
VI experienced consistently higher levels of loneliness than those with no 
disabilities throughout the pandemic. While loneliness remained relatively 
stable in individuals with no disabilities, it increased, albeit to a 
non-significant level, in those with disabilities and particularly those with 
VI. Interventions designed to alleviate loneliness may benefit from addressing 
state anxiety.

Copyright © 2021 Heinze, Hussain, Castle, Godier-McBard, Kempapidis and Gomes.

DOI: 10.3389/fpubh.2021.738304
PMCID: PMC8458570
PMID: 34568266 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2945. J Adolesc Health. 2021 Dec;69(6):917-924. doi: 10.1016/j.jadohealth.2021.07.039. 
Epub 2021 Aug 4.

An Impact Analysis of the Early Months of the COVID-19 Pandemic on Mental Health 
in a Prospective Cohort of Canadian Adolescents.

Bélanger RE(1), Patte KA(2), Leatherdale ST(3), Gansaonré RJ(4), Haddad S(5).

Author information:
(1)Projet COMPASS-Québec, VITAM - Centre de recherche en santé durable de 
l'Université Laval, Quebec City, Quebec, Canada; Department of Pediatrics, 
Faculty of Medicine - Université Laval, Ferdinand Vandry Pavillon, Quebec City, 
Quebec, Canada.
(2)Department of Health Sciences, Brock University, Niagara Region, St. 
Catharines, Ontario, Canada; School of Public Health Sciences, University of 
Waterloo, Waterloo, Ontario, Canada. Electronic address: kpatte@brocku.ca.
(3)School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, 
Canada.
(4)Projet COMPASS-Québec, VITAM - Centre de recherche en santé durable de 
l'Université Laval, Quebec City, Quebec, Canada.
(5)Projet COMPASS-Québec, VITAM - Centre de recherche en santé durable de 
l'Université Laval, Quebec City, Quebec, Canada; Department of Social and 
Preventive Medicine, Faculty of Medicine - Université Laval, Ferdinand Vandry 
Pavillon, Quebec City, Quebec, Canada.

PURPOSE: The impact of the COVID-19 pandemic on adolescent mental health is a 
global concern; however, most research is cross-sectional or started after the 
pandemic response began and thus unable to evaluate within-individual change. 
The purpose of this prospective study was to evaluate the effect of the initial 
COVID-19 response on adolescent mental health and ill-health as a natural 
experiment.
METHODS: We used 3-year linked data from the COMPASS study, including 7,653 
Canadian (Quebec, Ontario) adolescents from which 2,099 completed surveys in all 
three waves (pre-COVID-19 [2018 and 2019] and online [May-July 2020], 2-3 months 
into the pandemic). A structural equation modeling approach to fixed effects and 
a difference-in-differences design were used to estimate pre-COVID-19-to-early 
lockdown change in mental health (psychosocial well-being [flourishing-reverse 
scored]) and ill-health (depression and anxiety symptoms), compared with 
2018-to-2019 change. Models were adjusted for self-selection, age of entry into 
the cohort, and sociodemographics.
RESULTS: Depression, anxiety, and reverse-flourishing scores increased across 
all waves; however, the mental health changes from the pre-COVID-19 wave (2019) 
to 2020 were not greater relative to the changes seen across the 2018-to-2019 
waves.
CONCLUSIONS: Our results do not support a detrimental effect of the initial 
stages of the COVID-19 lockdown measures on adolescent mental health. The 
deterioration in mental health in the early COVID-19 response was less than the 
decline found over a prepandemic period. Further prospective research is needed 
to explore the impact of the prolonged pandemic and related measures on 
adolescents and inequitable effects in population subgroups.

Copyright © 2021 Society for Adolescent Health and Medicine. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jadohealth.2021.07.039
PMCID: PMC8457891
PMID: 34565667 [Indexed for MEDLINE]


2946. Psychopathology. 2021;54(6):291-297. doi: 10.1159/000519366. Epub 2021 Sep 24.

Well-Being and Mental Health of Students during the COVID-19 Pandemic.

Holm-Hadulla RM(1)(2), Klimov M(1), Juche T(3), Möltner A(4), Herpertz SC(1).

Author information:
(1)Department of General Psychiatry, Centre for Psychosocial Medicine at 
Heidelberg University Hospital, Heidelberg, Germany.
(2)Department of Psychiatry and Mental Health, Universidad de Chile, Santiago, 
Chile.
(3)Psychological Institute of Heidelberg University, Heidelberg, Germany.
(4)Dean's Office of the Medical Faculty of Heidelberg University, Heidelberg, 
Germany.

BACKGROUND: During the COVID-19 pandemic, a decrease in well-being and an 
increase in mental health problems were registered in medical and 
psychotherapeutic practices, counseling centers, and clinics. According to 
previous studies, younger people and women seemed to be particularly affected. 
The aim of this study was to describe mental health problems of students and to 
draw consequences for the further handling of pandemics and other crises.
METHOD: Students at the University of Heidelberg, a typical German "full 
university," were surveyed online using internationally comparable screening 
instruments like the Well-Being Index (WHO-5) and the Patient Health 
Questionnaire (PHQ). In addition, the students had the opportunity to describe 
in a narrative form their well-being and to make suggestions how to improve 
their situation.
RESULTS: Out of a population of 27,162 students who were contacted by email, 
2,137 students completed the questionnaire. The salient finding is that 
according to the WHO-5 Well-Being Index, 72.2% of the respondents feel seriously 
impaired in their well-being. This corresponds to the finding that 75.8% of the 
respondents in the PHQ-D show indications of at least one syndrome diagnosis. 
Depression was found in 41.8% of the respondents in the PHQ-D. Indications of 
moderate to severe and severe depressive syndromes were present in 31.8%. Signs 
of somatoform syndromes are found in 25.4% and of anxiety syndromes in 20.0%. 
1,089 students gave narrative reports on how they were feeling and made 
suggestions for improvement. About 75% reported severely reduced well-being. 
Their main complaints were loneliness and depression and lack of recognition for 
their specific academic and life situation during the pandemic. By far, the 
largest proportion of students supposed that their mental health issues were 
caused and/or intensified by the pandemic-related social contact restrictions. 
The vast majority of them made reasonable suggestions for controlled relaxation 
of contact restrictions.
CONCLUSIONS: Students suffer severely from the pandemic-related social 
restriction. In respect to future pandemic outbreaks or other crises leading to 
social isolation, the dramatic consequences of social lockdowns should be taken 
into account. Under pandemic conditions, we especially should support persons 
lacking social networks.

© 2021 S. Karger AG, Basel.

DOI: 10.1159/000519366
PMCID: PMC8678268
PMID: 34564075 [Indexed for MEDLINE]

Conflict of interest statement: There are no conflicts of interest on the part 
of any author of the study.


2947. J Adolesc. 2021 Oct;92:189-193. doi: 10.1016/j.adolescence.2021.09.006. Epub 
2021 Sep 21.

Psychological well-being of ruminative adolescents during the transition to 
COVID-19 school closures: An EMA study.

Swords CM(1), Lecarie EK(2), Doane LD(2), Hilt LM(3).

Author information:
(1)Department of Psychology, Lawrence University, USA.
(2)Department of Psychology, Arizona State University, USA.
(3)Department of Psychology, Lawrence University, USA. Electronic address: 
lori.m.hilt@lawrence.edu.

INTRODUCTION: Adolescents with moderate-to-severe levels of trait rumination are 
at heightened risk for psychopathology and may be particularly vulnerable to 
disruptions caused by the onset of the COVID-19 pandemic. As most past research 
documenting the impact of COVID-19 on adolescent well-being has been 
cross-sectional, it is unclear exactly how ruminative adolescents responded to 
the onset of the pandemic as it unfolded.
METHODS: We used ecological momentary assessment (EMA) to explore changes in 
rumination among adolescents during the initial transition to distance learning 
in the United States. A subsample of 22 ruminative youth (Mage = 13.58; 
SD = 0.96; 54.5% male; 86.4% White) from a larger study provided EMA data 
throughout January-April 2020 (M responses per participant = 105.09, 
SD = 65.59). Following school closures, we hypothesized that adolescents would 
report greater rumination (i.e., focusing on emotions and problems) and 
depressive symptom level would moderate this effect.
RESULTS: Surprisingly, rumination decreased, and this effect was moderated by 
depressive symptom level for emotion-focused rumination, i.e., those with 
average and below-average depressive symptoms experienced decreases in 
rumination.
CONCLUSIONS: These results suggest that the first wave of stay-at-home orders 
and the transition to distance learning were not immediately distressing to 
vulnerable adolescents. However, more research is needed to determine whether 
the results from recent research are generalizable to other adolescents and to 
examine the long-term impact of the pandemic on adolescent well-being.

Copyright © 2021 The Foundation for Professionals in Services for Adolescents. 
Published by Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.adolescence.2021.09.006
PMCID: PMC8459107
PMID: 34563838 [Indexed for MEDLINE]

Conflict of interest statement: We have no conflicts of interest to disclose.


2948. Crit Care. 2021 Sep 25;25(1):347. doi: 10.1186/s13054-021-03763-7.

Restricted visitation policies in acute care settings during the COVID-19 
pandemic: a scoping review.

Moss SJ(1), Krewulak KD(1), Stelfox HT(1), Ahmed SB(2), Anglin MC(1), Bagshaw 
SM(3), Burns KEA(4), Cook DJ(5), Doig CJ(1), Fox-Robichaud A(5), Fowler R(6), 
Hernández L(1), Kho ME(7), Kredentser M(8), Makuk K(1), Murthy S(9), Niven 
DJ(1), Olafson K(10), Parhar KKS(1), Patten SB(11), Rewa OG(12), Rochwerg B(5), 
Sept B(1), Soo A(13), Spence K(1), Spence S(14), Straus S(6), West A(15), 
Parsons Leigh J(16), Fiest KM(17).

Author information:
(1)Department of Critical Care Medicine, Cumming School of Medicine, University 
of Calgary, Calgary, AB, Canada.
(2)Department of Medicine, Cumming School of Medicine, University of Calgary, 
Calgary, AB, Canada.
(3)Department of Critical Care Medicine, Faculty of Medicine and Dentistry, 
University of Alberta, and Alberta Health Services, Edmonton, Canada.
(4)Interdepartmental Division of Critical Care, University of Toronto, Toronto, 
ON, Canada.
(5)Department of Medicine, McMaster University, Hamilton, ON, Canada.
(6)Department of Medicine, University of Toronto, Toronto, ON, Canada.
(7)School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
(8)Department of Clinical Health Psychology, University of Manitoba, Manitoba, 
Canada.
(9)Department of Pediatrics, University of British Columbia, British Columbia, 
Canada.
(10)Department of Medicine, University of Manitoba, Manitoba, Canada.
(11)Department of Psychiatry, Cumming School of Medicine, Cuthbertson and 
Fischer Chair in Pediatric Mental Health, University of Calgary, Calgary, AB, 
Canada.
(12)Department of Critical Care Medicine, University of Alberta, Edmonton, AB, 
Canada.
(13)Department of Critical Care Medicine, Cumming School of Medicine, University 
of Calgary and Alberta Health Services, Calgary, AB, Canada.
(14)Chinook Regional Hospital, Lethbridge County, Alberta, Canada.
(15)Canadian Society of Respiratory Therapists, Saint John, NB, Canada.
(16)School of Health Administration, Faculty of Health, Dalhousie University, 
Halifax, NS, Canada.
(17)Department of Critical Care Medicine, Cumming School of Medicine, University 
of Calgary, Calgary, AB, Canada. kmfiest@ucalgary.ca.

BACKGROUND: Restricted visitation policies in acute care settings because of the 
COVID-19 pandemic have negative consequences. The objective of this scoping 
review is to identify impacts of restricted visitation policies in acute care 
settings, and describe perspectives and mitigation approaches among patients, 
families, and healthcare professionals.
METHODS: We searched Medline, Embase, PsycINFO, Healthstar, CINAHL, Cochrane 
Central Register of Controlled Trials on January 01/2021, unrestricted, for 
published primary research records reporting any study design. We included 
secondary (e.g., reviews) and non-research records (e.g., commentaries), and 
performed manual searches in web-based resources. We excluded records that did 
not report primary data. Two reviewers independently abstracted data in 
duplicate.
RESULTS: Of 7810 citations, we included 155 records. Sixty-six records (43%) 
were primary research; 29 (44%) case reports or case series, and 26 (39%) cohort 
studies; 21 (14%) were literature reviews and 8 (5%) were expert 
recommendations; 54 (35%) were commentary, editorial, or opinion pieces. 
Restricted visitation policies impacted coping and daily function (n = 31, 20%) 
and mental health outcomes (n = 29, 19%) of patients, families, and healthcare 
professionals. Participants described a need for coping and support (n = 107, 
69%), connection and communication (n = 107, 69%), and awareness of state of 
well-being (n = 101, 65%). Eighty-seven approaches to mitigate impact of 
restricted visitation were identified, targeting families (n = 61, 70%), 
patients (n = 51, 59%), and healthcare professionals (n = 40, 46%).
CONCLUSIONS: Patients, families, and healthcare professionals were impacted by 
restricted visitation polices in acute care settings during COVID-19. The 
consequences of this approach on patients and families are understudied and 
warrant evaluation of approaches to mitigate their impact. Future pandemic 
policy development should include the perspectives of patients, families, and 
healthcare professionals.
TRIAL REGISTRATION: The review was registered on PROSPERO (CRD42020221662) and a 
protocol peer-reviewed prior to data extraction.

© 2021. The Author(s).

DOI: 10.1186/s13054-021-03763-7
PMCID: PMC8465762
PMID: 34563234 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2949. BMC Psychiatry. 2021 Sep 24;21(1):465. doi: 10.1186/s12888-021-03469-8.

Psychiatric emergency admissions during and after COVID-19 lockdown: short-term 
impact and long-term implications on mental health.

Ambrosetti J(1), Macheret L(2), Folliet A(2), Wullschleger A(3), Amerio A(4)(5), 
Aguglia A(4)(5), Serafini G(4)(5), Prada P(6)(7), Kaiser S(3)(6), Bondolfi 
G(6)(7), Sarasin F(6)(8), Costanza A(6).

Author information:
(1)Department of Psychiatry and Department of Emergency, Emergency Psychiatric 
Unit (UAUP), Geneva University Hospitals (HUG), 1211, Geneva, Switzerland. 
julia.ambrosetti@hcuge.ch.
(2)Department of Psychiatry and Department of Emergency, Emergency Psychiatric 
Unit (UAUP), Geneva University Hospitals (HUG), 1211, Geneva, Switzerland.
(3)Adult Psychiatry Division, Department of Psychiatry, University Hospital of 
Geneva (HUG), Geneva, Switzerland.
(4)Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal 
and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16132, 
Genoa, Italy.
(5)IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy.
(6)Faculty of Medicine, University of Geneva (UNIGE), 1206, Geneva, Switzerland.
(7)Department of Psychiatry, Service of Liaison Psychiatry and Crisis 
Intervention (SPLIC), Geneva University Hospitals (HUG), 1211, Geneva, 
Switzerland.
(8)Department of Emergency, Emergency Medicine Unit, Geneva University Hospitals 
(HUG), 1211, Geneva, Switzerland.

BACKGROUND: The 'lockdown' measures, adopted to restrict population movements in 
order to help curb the novel coronavirus disease 2019 (COVID-19) pandemic, 
contributed to a global mental health crisis. Although several studies have 
extensively examined the impact of lockdown measures on the psychological 
well-being of the general population, little is known about long-term 
implications. This study aimed to identify changes in psychiatric emergency 
department (ED) admissions between two 8-week periods: during and immediately 
after lifting the lockdown.
METHODS: Socio-demographic and clinical information on 1477 psychiatric ED 
consultations at the University Hospital of Geneva (HUG) were retrospectively 
analyzed.
RESULTS: When grouped according to admission dates, contrary to what we 
expected, the post-lockdown group presented with more severe clinical conditions 
(as measured using an urgency degree index) compared to their lockdown 
counterparts. Notably, after the lockdown had been lifted we observed a 
statistically significant increase in suicidal behavior and psychomotor 
agitation and a decrease in behavior disorder diagnoses. Furthermore, more 
migrants arrived at the HUG ED after the lockdown measures had been lifted. 
Logistic regression analysis identified diagnoses of suicidal behavior, 
behavioral disorders, psychomotor agitation, migrant status, involuntary 
admission, and private resident discharge as predictors of post-lockdown 
admissions.
CONCLUSIONS: Collectively, these findings can have implications concerning the 
prioritization of mental health care facilities and access for patients at risk 
of psychopathological decompensation in time of confinement policies, but above 
all, provide a foundation for future studies focusing on the long-term impact of 
the pandemic and its associated sanitary measures on mental health.
TRIAL REGISTRATION: Research Ethics Committee of Geneva, Registration number 
2020-01510, approval date: 29 June 2020.

© 2021. The Author(s).

DOI: 10.1186/s12888-021-03469-8
PMCID: PMC8464091
PMID: 34560856 [Indexed for MEDLINE]

Conflict of interest statement: None of the authors have any financial 
disclosure or conflict of interest.


2950. Psychiatr Danub. 2021 Sep;33(Suppl 9):114-118.

The Effect of the Pandemic on the Care of Patients with Mental Disorders: 
Measure of "Compassion Fatigue" and "Burn-Out" in the Operator.

Minò MV(1), Vacca A, Colizzi I, Solomita B, Franza F, Tavormina G.

Author information:
(1)Psychiatric Rehabilitation Center "Don Tonino Bello"- Assoc. M.I.T.A.G. - 
Onlus, Via Venezia, 1, 72019 San Vito dei Normanni, Brindisi, Italy, 
marenza.m@virgilio.it.

BACKGROUND: The Covid-19 Pandemic has had a significant impact on psychophysical 
well-being and the ability to work productively in contexts concerning people's 
physical and mental care. The helping professions involved have seen an increase 
in stress levels, a sense of helplessness, fear, pain and social isolation. They 
are anchored to the hope of being able to return to their normality.
METHOD: In this study, 87 mental health operators were evaluated, divided into 
nurses, psychiatric rehabilitation technicians, educators, social workers, 
psychologists and doctors, working in two psychiatric care rehabilitation 
communities in Puglia and Campania in southern Italy.
RESULTS: The results obtained with the administration of the scales ProQOL, BHS, 
Save-9, BDI-II, BEES reported a remarkable impact in nursing and medical 
professions due to the pandemic. A 11%. burn-out was reported by nurses.
CONCLUSIONS: The collected data are comparable to the previous work (Franza et 
al. 2015, 2020); however, there is no evidence of a high level of burnout in the 
helping professions involved in this study.

PMID: 34559789 [Indexed for MEDLINE]


2951. J Relig Health. 2021 Dec;60(6):4564-4578. doi: 10.1007/s10943-021-01434-z. Epub 
2021 Sep 24.

Negotiating Safety and Wellbeing: The Collaboration Between Faith-Based 
Communities and Public Health During the COVID-19 Pandemic.

El-Majzoub S(1), Narasiah L(2), Adrien A(3), Kaiser D(4), Rousseau C(5).

Author information:
(1)Department of Psychiatry, McGill University, Montreal, QC, Canada. 
Salam.el-majzoub@mail.mcgill.ca.
(2)Faculty of Medicine, McGill University, Montreal, QC, Canada.
(3)Department of Epidemiology, Biostatics and Occupational Health, McGill 
University, Montreal, QC, Canada.
(4)Public Health School- Department of Social and Preventative Medicine, 
Université de Montréal, Montreal, QC, Canada.
(5)Division of Social and Cultural Psychiatry, McGill University, Montreal, QC, 
Canada.

The COVID-19 pandemic led to lockdown measures where congregational faith-based 
activities were prohibited. With time, the collateral impacts of confinement 
emerged as priorities, and impositions had to be balanced with the collaboration 
of the population. In this process, faith-based organizations played a key role 
in encouraging their congregations to adhere to lockdown measures while 
fostering their mental wellbeing and resilience. This paper describes the 
process of establishing a collaborative negotiation among the Montreal Regional 
Public Health Unit, the police, and the Muslim and Jewish communities, examining 
the role of mediation in this context. Despite some obstacles, such as 
communication difficulties and decision-making limitations, the collaborative 
approach seems to buffer the escalation of intercommunity tension and to promote 
communities' commitment to physical distancing measures and should be considered 
in times of pandemic for a more inclusive public health approach.

© 2021. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s10943-021-01434-z
PMCID: PMC8475844
PMID: 34559364 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
declare that are relevant to the content of this article.


2952. Spinal Cord. 2021 Dec;59(12):1261-1267. doi: 10.1038/s41393-021-00708-3. Epub 
2021 Sep 23.

Resilience and mental health in individuals with spinal cord injury during the 
COVID-19 pandemic.

Mikolajczyk B(1), Draganich C(2), Philippus A(3), Goldstein R(1), Erin 
Andrews(4)(5), Pilarski C(6), Wudlick R(1), Morse LR(1), Monden KR(7).

Author information:
(1)Department of Rehabilitation Medicine, University of Minnesota Medical 
School, Minneapolis, MN, USA.
(2)Department of Physical Medicine and Rehabilitation, University of Colorado 
School of Medicine, Aurora, CO, USA.
(3)Research Department, Craig Hospital, Englewood, CO, USA.
(4)VA Texas Valley Coastal Bend Health Care System, Harlingen, TX, USA.
(5)The University of Texas at Austin Dell Medical School, Austin, TX, USA.
(6)Department of Physical Medicine and Rehabilitation, Division of 
Rehabilitation Psychology/Neuropsychology, University of Michigan, Ann Arbor, 
MI, USA.
(7)Department of Rehabilitation Medicine, University of Minnesota Medical 
School, Minneapolis, MN, USA. kmonden@umn.edu.

STUDY DESIGN: Cross-sectional, observational study.
OBJECTIVES: To understand how resilience, access to personal care attendants 
(PCAs) and medical supplies, and concerns about medical rationing, finances, and 
social isolation are related to overall and mental health in individuals with 
spinal cord injury (SCI) in the context of the COVID-19 pandemic.
SETTING: Community dwelling adults (N = 187) with SCI.
METHODS: Data were collected online between May 1, 2020 and August 31, 2020. 
Outcomes were overall and mental health, depression and anxiety symptoms, and 
quality of life (QoL). Predictors were resilience, access to PCAs and medical 
supplies, and concerns about medical rationing, finances, and social isolation.
RESULTS: Incomplete injury, concern about medical rationing, medical supply 
disruption, and social isolation predicted a greater perceived impact of the 
pandemic on overall heath. Younger age, decreased resilience, and concern about 
medical rationing and social isolation predicted greater perceived impact of the 
pandemic on mental health. Decreased resilience and concern about medical 
rationing and finances predicted increased anxiety symptoms. Incomplete injury, 
believing that medical rationing was occurring, decreased resilience, and 
concern about finances and social isolation predicted increased depressive 
symptoms. Decreased resilience and concern about finances, medical rationing, 
and social isolation predicted lower QoL.
CONCLUSIONS: The negative effects of the pandemic on the overall and mental 
health of individuals with SCI may be ameliorated by resilience. In future 
crises, it may be beneficial to screen individuals for resilience so that those 
with decreased resilience are offered the appropriate resources to enhance 
resilience and improve overall wellbeing.

© 2021. The Author(s), under exclusive licence to International Spinal Cord 
Society.

DOI: 10.1038/s41393-021-00708-3
PMCID: PMC8459146
PMID: 34556819 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


2953. BMC Pregnancy Childbirth. 2021 Sep 23;21(1):648. doi: 
10.1186/s12884-021-04097-6.

Intergenerational effects of violence on women's perinatal wellbeing and infant 
health outcomes: evidence from a birth cohort study in Central Vietnam.

Do HP(1)(2), Baker PRA(3), Van Vo T(4)(5), Murray A(6), Murray L(7), Valdebenito 
S(8), Eisner M(8), Tran BX(9)(10), Dunne MP(4)(11).

Author information:
(1)Queensland University of Technology (QUT), Faculty of Health, School of 
Public Health and Social Work, Brisbane, Australia. phuchuyen@gmail.com.
(2)Institute of Health Economics and Technology, Hanoi, Vietnam. 
phuchuyen@gmail.com.
(3)Queensland University of Technology (QUT), Faculty of Health, School of 
Public Health and Social Work, Brisbane, Australia.
(4)Institute for Community Health Research, Hue University of Medicine and 
Pharmacy, Hue University, Hue, Vietnam.
(5)Faculty of Public Health, Hue University of Medicine and Pharmacy, Hue 
University, Hue, Vietnam.
(6)Department of Psychology, University of Edinburgh, Edinburgh, UK.
(7)College of Health Sciences, Massey University, Wellington, New Zealand.
(8)Institute of Criminology, University of Cambridge, Cambridge, UK.
(9)Institute for Preventive Medicine and Public Health, Hanoi Medical 
University, Hanoi, Vietnam.
(10)Department of Health, Behavior and Society, Johns Hopkins Bloomberg School 
of Public Health, Baltimore, USA.
(11)Australian Centre for Health Law Research, Queensland University of 
Technology (QUT), Brisbane, Australia.

BACKGROUND: Girls exposed to violence have a high risk of being victimized as 
adults and are more likely than non-abused women to have children who are 
treated violently. This intergenerational transmission may be especially serious 
when women suffer violence during pregnancy and early motherhood, as it impairs 
maternal wellbeing and infant health and development. This study examined the 
intergenerational effects of being exposed to childhood maltreatment (CM) and 
prenatal intimate partner violence (p-IPV) on perinatal mental distress and 
birth outcomes in central Vietnam.
METHODS: A birth cohort study in Hue City, Vietnam was conducted with 150 women 
in the third trimester of pregnancy (Wave 1) and 3 months after childbirth (Wave 
2). Using multivariable logistic regression models, augmented 
inverse-probability-weighted estimators and structural equation modelling (SEM), 
we analyzed a theoretical model by evaluating adjusted risk differences and 
pathways between CM, p-IPV and subsequent perinatal adversity and indicators of 
infant health problems.
RESULTS: One in two pregnant women experienced at least one form of CM (55.03%) 
and one in ten pregnant women experienced both CM and p-IPV (10.67%). Mothers 
who experienced p-IPV or witnessed IPV as a child were approximately twice as 
likely to experience poor mental health during pregnancy [ARR 1.94, 95% CI 
(1.20-3.15)]. Infants had a two-fold higher risk of adverse birth outcomes (low 
birth weight, preterm birth, admission to neonatal intensive care) [ARR 2.45 95% 
CI (1.42, 4.25)] if their mothers experienced any form of p-IPV, with greater 
risk if their mothers were exposed to both CM and p-IPV [ARR 3.45 95% CI (1.40, 
8.53)]. Notably, significant pathways to p-IPV were found via adverse childhood 
experience (ACE) events (β = 0.13), neighborhood disorder (β = 0.14) and partner 
support (β = - 1.3).
CONCLUSION: These results emphasize the detrimental and prolonged nature of the 
effect of violence during childhood and pregnancy. Exposure to childhood 
maltreatment and violence during pregnancy increases the risk of maternal mental 
health difficulties and adverse birth outcomes. Antenatal care systems need to 
be responsive to women's previous experiences of violence and maternal mental 
health. The significant protective role of partner support and social support 
should also be considered when designing tailored interventions to address 
violence during pregnancy.

© 2021. The Author(s).

DOI: 10.1186/s12884-021-04097-6
PMCID: PMC8461881
PMID: 34556095 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2954. PLoS One. 2021 Sep 23;16(9):e0257252. doi: 10.1371/journal.pone.0257252. 
eCollection 2021.

Teachers' mental health during the first two waves of the COVID-19 pandemic in 
Poland.

Jakubowski TD(1), Sitko-Dominik MM(1).

Author information:
(1)Institute of Psychology, Faculty of Social Sciences, University of Silesia in 
Katowice, Katowice, Poland.

BACKGROUND: Teaching work is stressful, moreover during the pandemic teachers' 
stress might have been intensified by distance education as well as by limited 
access to social support, which functions as a buffer in experiencing stress. 
The aim of the research was to investigate the relation between distance 
education and teachers' well-being, and their close relations and other social 
relations during the first two waves of the COVID-19 pandemic.
METHODS: The research was conducted in two stages on 285 Polish primary and 
secondary school teachers who were recruited by means of the chain referral 
method. The following measures were used: The Depression Anxiety & Stress 
Scales-21, Berlin Social Support Scales, The Relationship Satisfaction Scale and 
The Injustice Experience Questionnaire.
RESULTS: The teachers experienced at least mild levels of stress, anxiety and 
depression, both during the first as well as the second waves of the COVID-19 
pandemic in Poland. It has been confirmed that there is a negative relation 
between relationship quality change and social relations quality change, and 
stress, anxiety and depression. The variables taken into consideration in the 
research have provided the explanation for the variation of stress-from 6% in 
the first stage of the research to 47% in the second stage; for the variation of 
anxiety-from 21% to 31%; and for the variation of depression-from 12% to 46%, 
respectively.
CONCLUSIONS: The research results show that due to distance work the distinction 
between professional work and family life might have been blurred, and as a 
consequence teachers' well-being could have been worsened. The isolation put on 
to stop the spreading of the virus might have contributed to changes in social 
relations, in close relations in particular, and at the same time negatively 
influenced teachers' abilities to effectively cope with the crisis situations.

DOI: 10.1371/journal.pone.0257252
PMCID: PMC8460021
PMID: 34555049 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


2955. Brain Behav. 2021 Nov;11(11):e2326. doi: 10.1002/brb3.2326. Epub 2021 Sep 23.

Effects of the COVID-19 pandemic in a preexisting longitudinal study of patients 
with recently diagnosed bipolar disorder: Indications for increases in manic 
symptoms.

Koenders M(1)(2), Mesbah R(1)(3), Spijker A(1)(4), Boere E(1)(3), de Leeuw 
M(1)(5), van Hemert B(1), Giltay E(1).

Author information:
(1)Department of Psychiatry, Leiden University Medical Centre, Leiden, The 
Netherlands.
(2)Faculty of Social Sciences, Institute of Psychology, Leiden University, 
Leiden, The Netherlands.
(3)Department of Mood Disorders, Mental Health Care PsyQ Kralingen, Rotterdam, 
The Netherlands.
(4)Parnassia Groep, Den Haag, The Netherlands.
(5)Mental Health Care Rivierduinen, Bipolar Disorder Outpatient Clinic, Leiden, 
The Netherlands.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic interfered in the 
daily lives of people and is assumed to adversely affect mental health. However, 
the effects on mood (in)stability of bipolar disorder (BD) patients and the 
comparison to pre-COVID-19 symptom severity levels are unknown.
METHOD: Between April and September, 2020, symptoms and well-being were assessed 
in the Bipolar Netherlands Cohort (BINCO) study of recently diagnosed patients 
with BD I and II. The questionnaire contained questions regarding manic and 
depressive symptoms (YMRS and ASRM, QIDS), worry (PSWQ), stress (PSS), 
loneliness, sleep, fear for COVID-19, positive coping, and substance use. As 
manic, depressive and stress symptoms levels were assessed pre-COVID-19, their 
trajectories during the lockdown restrictions were estimated using mixed models.
RESULTS: Of the 70 invited BD patients, 36 (51%) responded at least once (mean 
age of 36.7 years, 54% female, and 31% BD type 1) to the COVID-19 assessments. 
There was a significant increase (X2 = 17.06; p = .004) in (hypo)manic symptoms 
from baseline during the first COVID-19 wave, with a decrease thereafter. Fear 
of COVID-19 (X2 = 18.01; p = .003) and positive coping (X2  = 12.44; p = .03) 
were the highest at the start of the pandemic and decreased thereafter. Other 
scales including depression and stress symptoms did not vary significantly over 
time.
CONCLUSION: We found a meaningful increase in manic symptomatology from 
pre-COVID-19 into the initial phases of the pandemic in BD patients. These 
symptoms decreased along with fear of COVID-19 and positive coping during the 
following months when lockdown measures were eased.

© 2021 The Authors. Brain and Behavior published by Wiley Periodicals LLC.

DOI: 10.1002/brb3.2326
PMCID: PMC8613426
PMID: 34554650 [Indexed for MEDLINE]

Conflict of interest statement: All authors declare no conflict of interest.


2956. J Public Health (Oxf). 2021 Sep 22;43(3):e539-e540. doi: 10.1093/pubmed/fdab126.

COVID-19 impact on learners: challenges and responses.

Del Castillo FA(1)(2).

Author information:
(1)Theology and Religious Education Department, De La Salle University, Manila 
1004, Philippines.
(2)Graduate School of Religion and Religious Education, Fordham University, NY 
10458, United States.

The effects of coronavirus disease 2019 pandemic among the learners are shown in 
the rising cases of mental health issues. Young people are forced to stay at 
home and limit their physical and social interaction with peers. This paper 
contributes to address the well-being of the young learners.

© The Author(s) 2021. Published by Oxford University Press on behalf of Faculty 
of Public Health. All rights reserved. For permissions, please e-mail: 
journals.permissions@oup.com.

DOI: 10.1093/pubmed/fdab126
PMCID: PMC8499727
PMID: 34553230 [Indexed for MEDLINE]


2957. BMC Health Serv Res. 2021 Sep 22;21(1):1002. doi: 10.1186/s12913-021-07013-y.

Detrimental changes to the health and well-being of healthcare workers in an 
Australian COVID-19 hospital.

Stubbs JM(1), Achat HM(2), Schindeler S(2).

Author information:
(1)Epidemiology and Health Analytics, Western Sydney Local Health District, 
Locked Bag 7118, Parramatta BC, NSW, 2124, Australia. 
joanne.stubbs@health.nsw.gov.au.
(2)Epidemiology and Health Analytics, Western Sydney Local Health District, 
Locked Bag 7118, Parramatta BC, NSW, 2124, Australia.

BACKGROUND: Most studies examining the psychological impact of COVID-19 on 
healthcare workers (HCWs) have assessed well-being during the initial stages or 
the peak of the first wave of the pandemic. We aimed to measure the impact of 
COVID-19 and potential changes over time in its impact, on the health and 
well-being of HCWs in an Australian COVID-19 hospital.
METHODS: An online questionnaire assessed current and retrospective physical and 
mental health; psychological distress (Kessler Psychological Distress Scale); 
lifestyle behaviours; and demographics, providing measures of health and 
wellbeing at three phases of the pandemic. Targeted staff were invited to 
participate via email and in-person. Additional promotional activities were 
directed to all staff. Changes in general health, mental health and 
psychological distress were examined using McNemar's Chi-square. Associations 
between other categorical variables were tested using Chi-Square or 
non-parametric equivalents as appropriate. Logistic regression explored risk 
factors for current distress.
RESULTS: Four hundred thirty-three eligible HCWs answered all (74 %) or part of 
the questionnaire. Current self-rated health and mental health were 
significantly better than during the height of the pandemic, but had not 
returned to pre-pandemic levels. Psychological distress was significantly more 
common during the height of the pandemic (34.2 %) than currently (22.4 %), and 
during the height of the pandemic distress was significantly more common among 
younger than older HCWs. Females were significantly more likely to be distressed 
that males currently, but not during the height of the pandemic. High distress 
during the height of the pandemic was more likely to be maintained by HCWs who 
were less physically active than usual during the height of the pandemic 
(OR = 5.5); had low self-rated mental health before the pandemic (OR = 4.8); and 
who had 10 or more years of professional experience (OR = 3.9).
CONCLUSIONS: The adverse effects of the pandemic on HCWs have lessened with the 
easing of pandemic demands, but health and well-being have not reverted to 
pre-pandemic levels. This indicates continued exposure to elevated levels of 
stress and/or a sustained effect of earlier exposure. Initiatives that provide 
ongoing support beyond the pandemic are needed to ensure that HCWs remain 
physically and mentally healthy and are able to continue their invaluable work.

© 2021. The Author(s).

DOI: 10.1186/s12913-021-07013-y
PMCID: PMC8456684
PMID: 34551775 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare they have no competing 
interests.


2958. Nurs Adm Q. 2022 Jan-Mar 01;46(1):5-18. doi: 10.1097/NAQ.0000000000000499.

Associations Among Nurses' Mental/Physical Health, Lifestyle Behaviors, Shift 
Length, and Workplace Wellness Support During COVID-19: Important Implications 
for Health Care Systems.

Melnyk BM(1), Hsieh AP, Tan A, Teall AM, Weberg D, Jun J, Gawlik K, Hoying J.

Author information:
(1)Helene Fuld Health Trust National Institute for Evidence-based Practice in 
Nursing and Healthcare (Dr Melnyk) and Center of Research and Health Analytics 
(Dr Tan), College of Nursing (Ms Hsieh and Drs Teall, Jun, Gawlik, and Hoying), 
The Ohio State University (Dr Weberg), Columbus; and Trusted Health Inc, San 
Francisco, California (Dr Weberg).

Work cultures supportive of wellness and shorter shift length have been 
associated with better mental/physical health outcomes in nurses, but how the 
coronavirus disease-19 (COVID-19) pandemic impacted such outcomes is not known. 
This study's aims were to (1) describe the mental/physical health, well-being, 
and healthy lifestyle behaviors of nurses during the pandemic; (2) explore the 
pandemic's impact on their health and healthy lifestyle behaviors; and (3) 
determine the associations of perceived workplace wellness support and shift 
length with nurses' health, well-being, and healthy lifestyle behaviors. A 
cross-sectional descriptive design was used with 264 nurses associated with 
Trusted Health. Nurses completed a survey containing valid and reliable scales 
measuring depression, anxiety, burnout and quality of life, perceived wellness 
culture, and healthy lifestyle behaviors. Results indicated that more than 50% 
of nurses had worsening mental/physical health relating to the pandemic. 
Compared with nurses whose workplaces provided little/no wellness support, 
nurses with workplaces that supported their wellness were 3 to 9 times as likely 
to have better mental/physical health, no/little stress, no burnout, and high 
quality of life. Nurses who worked longer shifts had poorer health outcomes. 
These findings indicate that workplace wellness support and shorter shifts 
positively impacted nurse mental/physical health and professional quality of 
life amidst the pandemic.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/NAQ.0000000000000499
PMCID: PMC8647526
PMID: 34551423 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


2959. Neuron. 2021 Oct 20;109(20):3206-3210. doi: 10.1016/j.neuron.2021.08.021. Epub 
2021 Sep 21.

Supporting mental health and productivity within labs.

Duffy MA(1), Tronson NC(2), Eisenberg D(3).

Author information:
(1)Department of Ecology and Evolutionary Biology, University of Michigan, Ann 
Arbor, MI 48109, USA. Electronic address: duffymeg@umich.edu.
(2)Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA.
(3)Department of Health Policy and Management, Fielding School of Public Health, 
UCLA, Los Angeles, CA 90095, USA.

Laboratories are the central workplace for academic scientists and can play a 
key role in supporting psychological safety, mental health, and well-being. We 
provide strategies to build inclusive structures within laboratories and support 
mental health for all members.

Copyright © 2021 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.neuron.2021.08.021
PMID: 34551313 [Indexed for MEDLINE]


2960. Telemed J E Health. 2022 May;28(5):706-711. doi: 10.1089/tmj.2021.0262. Epub 
2021 Sep 22.

Satisfaction of the Use of Telehealth and Access to Care for Veterans During the 
COVID-19 Pandemic.

Kintzle S(1), Rivas WA(1), Castro CA(1).

Author information:
(1)Suzanne Dworak-Peck School of Social Work, University of Southern California, 
Los Angeles, California, USA.

Background:While many health care providers have shifted toward telehealth 
services in response to the COVID-19 pandemic, little is known about the 
perception and acceptance of such services, particularly among vulnerable 
populations. Veterans, who are at increased risk of physical and mental health 
needs, may benefit from the use and availability of telehealth 
services.Materials and Methods:Cross sectional survey data related to telehealth 
use, satisfaction, and access were collected through an online survey. 
Participants from previous research studies and veterans receiving care at a 
national veteran behavioral health organization were invited to 
participate.Results:A total of 404 veterans participated. Before the pandemic, 
many veterans had never used telehealth for physical (72%) or mental (76%) 
health care. Since the start of the pandemic, 62% of participants reported they 
received some care through telehealth services. Most participants found 
telehealth valuable and helpful (82%), indicated the technology was well 
explained (77%), and felt that issues were resolved quickly and easily (67%). 
Access to care was limited among participants who utilize massage therapy (64%), 
dental care (53%), routine checkups (50%), acupuncture (50%), and physical 
therapy (48%).Discussion:These findings showed an increase in the use of 
telehealth services and overwhelming satisfaction among veterans. Despite this, 
some veterans indicated barriers to receiving physical and mental health 
care.Conclusions:This provides an opportunity to expand the use of telehealth 
services to meet the health care needs of veterans. Barriers to care should be 
addressed to minimize the impact on the well-being of veterans.

DOI: 10.1089/tmj.2021.0262
PMID: 34551276 [Indexed for MEDLINE]


2961. J Nurs Adm. 2021 Oct 1;51(10):526-531. doi: 10.1097/NNA.0000000000001058.

The Impact of Volunteering at a Family Camp for Children and Adolescents With 
Cancer: The Experience of Pediatric Intensive Care Nurses.

Butterworth L(1), Nasr A, Pyke-Grimm KA, Swisher D, Johnson K.

Author information:
(1)Author Affiliations: CEO (Ms Butterworth), AIM Youth Mental Health, Carmel, 
California and Founder, Jacob's Heart Children's Cancer Support Services, 
Watsonville, California; and Director of Nursing Research (Dr Nasr), Stanford 
Children's Health, Stanford School of Medicine; and Nurse Scientist and 
Postdoctoral Fellow in Palliative Care (Dr Pyke-Grimm), Stanford Children's 
Health; and PICU Nurse (Ms Swisher), Stanford Children's Health, Palo Alto, 
California; and SVP Patient Care Services and Chief Nursing Executive (Dr 
Johnson), Queens Health System, Honolulu, Hawaii.

OBJECTIVE: This study explored the experience of pediatric ICU (PICU) nurses who 
volunteered at a camp for families of children and adolescents with cancer.
BACKGROUND: PICU nurses are at risk of developing symptoms of posttraumatic 
stress disorder, compassion fatigue, depression, and burnout due to exposure(s) 
to traumatic events. Spending time with patients, families, and nurse colleagues 
at camp may reduce the effects of this exposure.
METHODS: A qualitative descriptive study was conducted using content analysis. 
Fifteen nurse participants completed a precamp questionnaire and semistructured 
focus groups immediately following camp. Individual interviews were conducted 6 
months after camp.
RESULTS: Three categories emerged: 1) personal factors, changes in the nurses 
themselves; 2) patient and family factors, changes in how nurses perceived 
patients and families; and 3) work-related factors, relationships with 
colleagues.
CONCLUSIONS: Supporting PICU nurses to participate with patients, families, and 
colleagues outside of the hospital may reduce burnout and support nurses' 
well-being.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/NNA.0000000000001058
PMID: 34550106 [Indexed for MEDLINE]

Conflict of interest statement: Jacob's Heart Children's Cancer Support Services 
is the sponsor of the camp for families with cancer. L.B. is the founder of 
Jacob’s Heart. The other authors declare no conflicts of interest.


2962. Pediatrics. 2021 Oct;148(4):e2021050414. doi: 10.1542/peds.2021-050414. Epub 
2021 Sep 21.

Neonatal Stress, Health, and Development in Preterms: A Systematic Review.

van Dokkum NH(1)(2), de Kroon MLA(2), Reijneveld SA(2), Bos AF(3).

Author information:
(1)Division of Neonatology, Department of Pediatrics, Beatrix Children's 
Hospital n.h.van.dokkum@umcg.nl.
(2)Department of Health Sciences, University Medical Center Groningen and 
University of Groningen, Groningen, Netherlands.
(3)Division of Neonatology, Department of Pediatrics, Beatrix Children's 
Hospital.

CONTEXT: An overview of the full range of neonatal stressors and the associated 
clinical, laboratory, and imaging outcomes regarding infants' health and 
development may contribute to the improvement of neonatal care.
OBJECTIVE: To systematically review existing literature on the associations 
between all kinds of neonatal stressors and the health and development of 
preterm infants.
DATA SOURCES: Data sources included Embase, Medline, PsycINFO, the Cumulative 
Index to Nursing and Allied Health Literature, and reference lists.
STUDY SELECTION: Studies were eligible if they included a measure of neonatal 
stress during the NICU stay, reported clinical, laboratory, and/or imaging 
outcomes regarding health and/or development on discharge from the NICU or 
thereafter, included preterm infants, and were written in English or Dutch.
DATA EXTRACTION: Two reviewers independently screened the sources and extracted 
data on health and development. Study quality was assessed by using the 
Newcastle-Ottawa Quality Assessment Scale.
RESULTS: We identified 20 articles that reported on neonatal stress associated 
negatively with clinical outcomes, including cognitive, motor, and emotional 
development, and laboratory and imaging outcomes, including epigenetic 
alterations, hypothalamic-pituitary-adrenal axis functioning, and structural 
brain development. We found no evidence regarding associations with growth, 
cardiovascular health, parent-infant interaction, the neonatal immune system, 
and the neonatal microbiome.
LIMITATIONS: The studies were all observational and used different definitions 
of neonatal stress.
CONCLUSIONS: Neonatal stress has a profound impact on the health and development 
of preterm infants, and physicians involved in their treatment and follow-up 
should be aware of this fact.

Copyright © 2021 by the American Academy of Pediatrics.

DOI: 10.1542/peds.2021-050414
PMID: 34548378 [Indexed for MEDLINE]

Conflict of interest statement: POTENTIAL CONFLICT OF INTEREST: The authors have 
indicated they have no potential conflicts of interest to disclose.


2963. BMC Health Serv Res. 2021 Sep 21;21(1):996. doi: 10.1186/s12913-021-07019-6.

Challenges faced during the COVID-19 pandemic by family carers of people living 
with dementia towards the end of life.

Aker N(1), West E(2), Davies N(1)(2), Moore KJ(2)(3), Sampson EL(2)(4), Nair 
P(1), Kupeli N(5).

Author information:
(1)Centre for Ageing Population Studies, Research Department of Primary Care and 
Population Health, University College London, London, UK.
(2)Marie Curie Palliative Care Research Department, Division of Psychiatry, 
University College London, 6th Floor, Maple House, 149 Tottenham Court Road, 
London, W1T 7NF, UK.
(3)National Ageing Research Institute, Parkville, Victoria, Australia.
(4)Barnet, Enfield and Haringey Mental Health Liaison Service, North Middlesex 
University Hospital NHS Trust, London, UK.
(5)Marie Curie Palliative Care Research Department, Division of Psychiatry, 
University College London, 6th Floor, Maple House, 149 Tottenham Court Road, 
London, W1T 7NF, UK. n.kupeli@ucl.ac.uk.

BACKGROUND: People living with dementia account for a large proportion of deaths 
due to COVID-19. Family carers are faced with making significant and emotive 
decisions during the pandemic, including decisions about end of life. We aimed 
to explore the challenges faced by family carers of people living with dementia 
during the first wave of the COVID-19 pandemic in England, as reported by 
charity telephone support line staff, who were able to objectively discuss a 
range of different experiences of many different carers who call the helpline. 
In particular, we focussed on key concerns and areas of decision making at the 
end of life.
METHODS: We conducted a qualitative study using semi-structured interviews with 
eight telephone support line staff from two UK based charities who support 
carers of people living with dementia and those at the end of life. Interviews 
were conducted in the first wave of the pandemic in England in May-June 2020.
RESULTS: An overarching theme of uncertainty and reactivity during a crisis was 
identified, and within this, five main themes were identified: concerns about 
care transitions, uncertainty in engaging support and help, pandemic-motivated 
care planning, maintaining the wellbeing of the person living with dementia, and 
trust, loss of agency and confusion.
CONCLUSIONS: Family carers may be reluctant to seek support because of fear of 
what may happen to their relative, which may include hospitalisation and 
becoming ill with COVID-19, care home placement, or not being able to be with a 
relative at the end of life. In some cases, a lack of trust has developed, and 
instead carers are seeking support from alternative services they trust such as 
nationally known charities.This study was used to inform the development of a 
decision aid to support family carers making decisions about care for their 
relative with dementia during the pandemic, who the lack the capacity to make 
their own decisions.

© 2021. The Author(s).

DOI: 10.1186/s12913-021-07019-6
PMCID: PMC8454696
PMID: 34548067 [Indexed for MEDLINE]

Conflict of interest statement: There are no conflicts of interest to declare.


2964. Swiss Med Wkly. 2021 Sep 17;151:w30009. doi: 10.4414/smw.2021.w30009. 
eCollection 2021 Sep 13.

Impact of the COVID-19 pandemic on Swiss pregnant and breastfeeding women - a 
cross-sectional study covering the first pandemic wave.

Lambelet V(1), Ceulemans M(2)(3), Nordeng H(4), Favre G(1), Horsch A(1)(4), 
Stojanov M(1), Winterfeld U(5), Baud D(1), Panchaud A(6)(7), Pomar L(1)(8).

Author information:
(1)Department Woman-Mother-Child, Lausanne University Hospital, Switzerland.
(2)Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 
Belgium.
(3)Teratology Information Service, Pharmacovigilance Centre Lareb, 's 
Hertogenbosch, the Netherlands.
(4)Institute of Higher Education and Research in Healthcare, Faculty of Biology 
and Medicine, University of Lausanne, Switzerland
(5)Swiss Teratogen Information Service, Service de Pharmacologie Clinique, 
Lausanne University Hospital and University of Lausanne, Switzerland.
(6)Institute of Primary Health Care (BIHAM), University of Bern, Bern, 
Switzerland
(7)Service of Pharmacy, Lausanne University Hospital and University of Lausanne, 
Switzerland.
(8)School of Health Sciences (HESAV), University of Applied Sciences and Arts 
Western Switzerland, Lausanne, Switzerland

Information on the impact of the COVID-19 pandemic on pregnancy and 
breastfeeding experiences, as well as on perinatal mental health in Switzerland 
is limited. In Switzerland, there are few national studies and little 
information. Using an anonymous online survey accessible after the first wave of 
the outbreak in Switzerland, we have investigated how this pandemic affected 
pregnant and breastfeeding women. Among women who completed the survey, 69.0% 
(1050/1518) indicated the first wave of the pandemic affected their personal 
habits, 61.0% (689/1131) were affected in their work and 40.0% (632/1573) 
reported impaired relations with healthcare services (different denominators 
correspond to the number of participants who answered the question). 36.8% 
(110/299) of women reported an impact of the pandemic on their current pregnancy 
experience or breastfeeding experience (8.2%, 46/555). Overall, 11.6% (170/1467) 
of participants who completed the validated screening tests for mental health 
symptoms (Edinburgh Postnatal Depression Scale, Generalized Anxiety Disorder 7, 
Perceived Stress Scale) presented a score compatible with symptoms of major 
depression, severe anxiety or high perceived stress, which is higher than in the 
pre-pandemic period according to literature. Risk factors independently 
associated with impaired mental health were being hospitalized, having symptoms 
of COVID-19, living with a person with COVID-19 symptoms, having comorbidities, 
having experienced reduced healthcare services, having restricted usual 
activities and being a housewife. Protective factors independently associated 
were a high level of education and living with a partner. Our findings suggest 
that the COVID-19 pandemic might have significantly affected the well-being and 
mental health of pregnant and breastfeeding women, directly in the case of 
exposure, and indirectly as a result of the potential modifications in their 
life habits and in healthcare facilities.

DOI: 10.4414/smw.2021.w30009
PMID: 34546015 [Indexed for MEDLINE]


2965. J Gerontol Soc Work. 2022 Jul;65(5):512-528. doi: 10.1080/01634372.2021.1983684. 
Epub 2021 Sep 21.

Grandparents' Mental Health and Lived Experiences while Raising Their 
Grandchildren at the Forefront of COVID-19 in Saudi Arabia.

Zakari NMA(1), Hamadi HY(2), Bailey CE(2), Jibreel EAM(1).

Author information:
(1)College of Applied Sciences, Al Maarefa University, Riyadh, Saudi Arabia.
(2)Department of Health Administration, University of North Florida, 
Jacksonville, Florida, USA.

Understanding grandparents' lived experiences and healthy aging is essential to 
designing efficient, effective, and safe services to support a family structure 
in which grandparents care for their grandchildren. However, no study to date 
has explored this concept in an Arab and Muslim country during a pandemic. The 
purpose of this study was to examine grandparents' experiences raising their 
grandchildren to provide recommendations for needed mental health interventions 
during and after COVID-19. We used a phenomenological approach to gain a 
detailed and in-depth understanding of the lived experiences of 15 grandparents 
caring for their grandchildren. This study shows the need for support service 
interventions (support groups, health professional support, and respite care) 
for grandparents in Saudi Arabia, especially during global crises like COVID-19, 
that enhance social distance and social isolation. Raising grandchildren affects 
the physical, mental, and social wellbeing of the grandparents.

DOI: 10.1080/01634372.2021.1983684
PMID: 34545773 [Indexed for MEDLINE]


2966. Autism Res. 2021 Dec;14(12):2663-2676. doi: 10.1002/aur.2614. Epub 2021 Sep 21.

The association between COVID-19, personal wellbeing, depression, and suicide 
risk factors in Australian autistic adults.

Hedley D(1), Hayward SM(2)(3), Denney K(1), Uljarević M(4), Bury S(1), Sahin 
E(1), Brown CM(5), Clapperton A(6), Dissanayake C(1), Robinson J(7)(8), Trollor 
J(9), Stokes MA(5).

Author information:
(1)Olga Tennison Autism Research Centre, School of Psychology and Public Health, 
La Trobe University, Melbourne, Victoria, Australia.
(2)School of Health and Social Development, Deakin University, Melbourne, 
Victoria, Australia.
(3)School of Social and Political Sciences, University of Melbourne, Melbourne, 
Victoria, Australia.
(4)School of Psychological Sciences, University of Melbourne, Melbourne, 
Victoria, Australia.
(5)School of Psychology, Deakin University, Melbourne, Victoria, Australia.
(6)Melbourne School of Population and Global Health, University of Melbourne, 
Melbourne, Victoria, Australia.
(7)Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, 
Victoria, Australia.
(8)Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, 
Australia.
(9)Department of Developmental Disability Neuropsychiatry, University of New 
South Wales, Sydney, New South Wales, Australia.

The COVID-19 pandemic has had a significant impact on the mental health and 
wellbeing of the world's population, with particularly negative effects on 
vulnerable populations, including autistic people. Although some consensus 
regarding specific impact on aspects of wellbeing and mental health in autism is 
starting to emerge, it is unclear whether the pandemic has increased suicide 
risk. The goals of this study were to examine (a) potential associations between 
COVID-19 impact and depression, personal wellbeing, and suicide risk factors in 
Australian autistic adults and (b) age and gender effects. The COVID-19 Impact 
Scale (CIS), Personal Wellbeing Index, Patient Health Questionnaire, and the 
Suicide Behavior Questionnaire, Revised (SBQ-R), were administered to 111 
autistic adults aged 20 to 71 years during the second wave of the COVID-19 
pandemic in Australia. COVID-19 impact showed small associations with poorer 
personal wellbeing (r = -0.224, p = 0.023, [-0.409, -0.016]) and higher 
depressive symptoms (r = 0.268, p = 0.006, [0.056, 0.445]) and was not 
associated with the SBQ-R suicide risk score (r = 0.081, p = 0.418, [-0.118, 
0.264). No significant effects were identified for age. Although model results 
were similar for women and men, the strength of the associations between 
personal wellbeing and depression (z = -2.16, p = 0.015), and depression and 
SBQ-R suicide risk (z = 1.961, p = 0.025), were stronger in women than in men. 
Qualitative analysis of an open response question from the CIS suggested that 
the pandemic had both positive and negative impacts on participants. The 
COVID-19 pandemic has had a large impact on the mental health and wellbeing of 
the world's population, particularly vulnerable populations such as autistic 
people. It is not known if these impacts on mental health and wellbeing have 
increased suicide risk. Our findings suggest that the impact of the COVID-19 
pandemic may be associated with poorer wellbeing and higher depression, but is 
not associated with suicide risk. Overall, autistic people reported both 
positive and negative impacts of the pandemic on their lives.

© 2021 The Authors. Autism Research published by International Society for 
Autism Research and Wiley Periodicals LLC.

DOI: 10.1002/aur.2614
PMCID: PMC8646719
PMID: 34545706 [Indexed for MEDLINE]

Conflict of interest statement: Darren Hedley is supported by a Suicide 
Prevention Australia National Suicide Prevention Research fellowship. Mirko 
Uljarević is supported by a Discovery Early Career Researcher Award from the 
Australian Research Council (DE180100632). Jo Robinson is supported by a 
National Health and Medical Research Council (NHMRC) Career Development 
Fellowship (APP1142348) and a University of Melbourne Dame Kate Campbell 
Fellowship. The authors declare no actual or potential conflict of interest.


2967. Eur J Dent Educ. 2022 Aug;26(3):459-467. doi: 10.1111/eje.12721. Epub 2021 Sep 
23.

How are you coping with the COVID-19 pandemic? Survey of undergraduate dental 
students' well-being during an unexpected global event.

Poma M(1), Al Amri F(1), Tawse-Smith A(1), Ma S(1).

Author information:
(1)Faculty of Dentistry, University of Otago, Dunedin, New Zealand.

BACKGROUND: COVID-19 pandemic has led to major life changes including suspension 
of dental education programmes worldwide. The impact of this unexpected 
disruption in clinical teaching needs to be assessed.
AIM: The aim of this study was to evaluate the impact of the COVID-19 
restriction measures on the undergraduate dental students' perception regarding 
their physical, mental and social well-being as well as financial stress and 
anxiety for their future careers.
MATERIALS AND METHODS: An electronic questionnaire (Qualtrics, Provo, Utah, USA) 
with main themes (general well-being, academic stressors, financial implications 
and dental career concerns) related to the COVID-19 lockdown was sent to the 
undergraduate dental students at the University Of Otago, New Zealand. 
Participants were asked to rank their answers according to a 5-level Likert 
scale (strongly disagreed-strongly agreed). Other questions included 
demographic, fee-paying status and living situation.
RESULTS: There were 301 out of 376 students who responded to the survey. 
Generally, the students perceived that the COVID-19 restrictions affected their 
behavioural and social well-being (3.20 ± 0.75) and less impact on their 
physical (2.75 ± 0.82) and psychological (2.79 ± 0.62) well-being. Students were 
significantly worried about their academic work and future careers 
(3.41 ± 1.20), but less concerned with their financial situation (2.74 ± 1.14).
CONCLUSIONS: The study provides valuable information on the impact of COVID-19 
pandemic on undergraduate dental students, and areas that the University should 
consider when providing support to the affected students. It is important that 
the University is proactive and prepared to deal with future pandemics 
effectively and efficiently.

© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

DOI: 10.1111/eje.12721
PMCID: PMC8652817
PMID: 34543521 [Indexed for MEDLINE]

Conflict of interest statement: The authors confirm that there is no conflict of 
interest in preparing this manuscript.


2968. Health Expect. 2022 Feb;25(1):149-162. doi: 10.1111/hex.13359. Epub 2021 Sep 20.

An outbreak of appreciation: A discursive analysis of tweets of gratitude 
expressed to the National Health Service at the outset of the COVID-19 pandemic.

Day G(1)(2), Robert G(1), Leedham-Green K(2), Rafferty AM(1).

Author information:
(1)Division of Methodologies Research, Florence Nightingale Faculty of Nursing, 
Midwifery and Palliative Care, King's College London, London, UK.
(2)Medical Education Research Unit, School of Medicine, Imperial College London, 
London, UK.

BACKGROUND: The early stages of the coronavirus disease 2019 pandemic prompted 
unprecedented displays of gratitude to healthcare workers. In the United 
Kingdom, gratitude was a hotly debated topic in public discourse, catalysing 
compelling displays of civic togetherness but also attracting criticism for 
being an unhelpful distraction that authorized unrealistic expectations of 
healthcare workers. Expressions of thanks tend to be neglected as drivers of 
transformation, and yet, they are important indicators of qualities to which 
people attach significance.
OBJECTIVE: This study aimed to use discursive analysis to explore how the 
National Health Service (NHS) was constructed in attention-attracting tweets 
that expressed and/or discussed gratitude to the NHS.
METHODS: Having determined that Twitter was the most active site for traffic 
relating to gratitude and the NHS, we established a corpus of 834 most-liked 
tweets, purposively sampled from Twitter searches on a day-by-day basis over the 
period of the first lockdown in the United Kingdom (22 March-28 May 2020). We 
developed a typology for tweets engaging with gratitude as well as analysing 
what the NHS was thanked for.
RESULTS: Our analysis, informed by a discursive psychology approach, found that 
the meanings attributed to gratitude were highly mobile and there were distinct 
patterns of activity. The NHS was predominantly-and sometimes 
idealistically-thanked for working, effort, saving and caring. Displays of 
gratitude were seen as incommensurable with failures of responsibility. The 
clap-for-carers campaign was a potent driver of affect, especially in the early 
parts of the lockdown.
CONCLUSIONS: The social value of gratitude is implicated in the re-evaluation of 
the risks and rewards of healthcare and social care work in the wake of the 
pandemic. We caution against cynicism about gratitude overshadowing the 
well-being effects that expressing and receiving gratitude can engender, 
particularly given concerns over the detrimental effects of the pandemic on 
mental health.
PUBLIC CONTRIBUTION: This study involves the analysis of data provided by the 
public and published on social media.

© 2021 The Authors. Health Expectations published by John Wiley & Sons Ltd.

DOI: 10.1111/hex.13359
PMCID: PMC8652934
PMID: 34543519 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


2969. Eye Contact Lens. 2021 Oct 1;47(10):559-564. doi: 10.1097/ICL.0000000000000834.

Evaluating Well-being of Individuals With Chronic Visual Conditions Requiring 
Regular Eyecare During COVID-19 Lockdown: A Cross-Sectional Study.

Almhdawi KA(1), Alsalem MF, Obeidat D, Al-Khateeb LT, Al Aqarbah MN, Alshiyab 
WM, Arabiat AA, Bazel MA, Al-Share Z.

Author information:
(1)Department of Rehabilitation Sciences (K.A.A., D.O.), Faculty of Applied 
Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan; 
Department of Ophthalmology (M.F.A., L.T.A.-K., M.N.A.A.). Royal Medical 
Services, Amman, Jordan; Department of Ophthalmology (W.M.A., Z.A.-S.), Ministry 
of Health, Amman, Jordan; Department of Family Medicine (A.A.A.), The Jordanian 
Ministry of Health, Amman, Jordan; and Department of Ophthalmology (M.A.B.), 
King Fahad Medical City, Riyadh, Saudi Arabia.

OBJECTIVES: To assess health-related quality of life (HRQoL) and its predictors 
among individuals with chronic vision conditions during COVID-19 lockdown.
METHODS: A cross-sectional, survey-based study targeted Jordanian adults with a 
variety of chronic vision conditions requiring regular ophthalmic follow-up. 
Outcome measures included HRQoL measured by the 12-item Short-Form Health Survey 
(SF-12), mental health symptoms measured by the Depression Anxiety Stress Scale, 
and vision ability measured by the National Eye Institute Visual Functioning 
Questionnaire (VFQ-25) General Vision and Role Limitation subscales. Data were 
analyzed descriptively and using a multiple variable linear regression model to 
identify HRQoL predictors.
RESULTS: A total of 203 participants with a mean age of 52.09 (±15.41) years 
participated, and SF-12 mean scores were 58.15 for the physical component and 
57.48 for the mental component. The level of HRQoL was significantly associated 
with VFQ-25 Role Limitation subscale, diabetes, the need of ophthalmic 
follow-up, and stress. The regression model explained 47.1% of the variance in 
HRQoL (r2=0.471, F=35.57, P<0.001).
CONCLUSIONS: Jordanian individuals with chronic vision conditions demonstrated 
low levels of HRQoL during COVID-19 lockdown. Participants also showed high 
levels of mental health symptoms and reported low accessibility to ophthalmic 
care. Access to nonurgent ophthalmic care in individuals with chronic vision 
diseases should be carefully planned in future pandemics.

Copyright © 2021 Contact Lens Association of Ophthalmologists.

DOI: 10.1097/ICL.0000000000000834
PMID: 34542424 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no funding or conflicts of 
interest to disclose.


2970. Pediatr Ann. 2021 Sep;50(9):e366-e370. doi: 10.3928/19382359-20210818-01. Epub 
2021 Sep 1.

COVID-19 and Transgender and Gender Expansive Children and Youth.

Ehrensaft D.

The coronavirus disease 2019 pandemic has put strains on transgender and gender 
expansive (TGE) children and youth, with increased rates of anxiety and 
depression, lower access to medical and mental health services, and greater 
exposure to unaccepting home environments. At the same time, for some of these 
young people, particularly those with supportive living situations, sheltering 
in place and online schooling has afforded them the opportunity to freely 
explore and consolidate their gender, protected from the strains of socially 
induced anxieties, and anticipated or experienced negative, hostile messages 
from their surrounding environment (ie, school or public meeting places). 
Culling from emerging data on the psychosocial effects of the pandemic on TGE 
children and youth, an argument is made for an understanding of these young 
people's experiences as both stress-inducing and resilience-building, each 
existing in dialectic tension with the other. Providers are called on to hold 
both in mind to fortify the biopsychosocial well-being of transgender and gender 
expansive children and youth. [Pediatr Ann. 2021;50(9):e366-e370.].

DOI: 10.3928/19382359-20210818-01
PMID: 34542341 [Indexed for MEDLINE]


2971. Int J Public Health. 2021 Sep 1;66:1604219. doi: 10.3389/ijph.2021.1604219. 
eCollection 2021.

Mental Health and Wellbeing of 9-12-year-old Children in Northern Canada Before 
the COVID-19 Pandemic and After the First Lockdown.

Dabravolskaj J(1), Khan MKA(2), Veugelers PJ(1), Maximova K(3)(2).

Author information:
(1)School of Public Health, University of Alberta, Edmonton, AB, Canada.
(2)Dalla Lana School of Public Health, University of Toronto, Toronto, ON, 
Canada.
(3)MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. 
Michael's Hospital, Toronto, ON, Canada.

Objectives: Children's mental health and wellbeing declined during the first 
COVID-19 lockdown (Spring 2020), particularly among those from disadvantaged 
settings. We compared mental health and wellbeing of school-aged children 
observed pre-pandemic in 2018 and after the first lockdown was lifted and 
schools reopened in Fall 2020. Methods: In 2018, we surveyed 476 grade 4-6 
students (9-12 years old) from 11 schools in socioeconomically disadvantaged 
communities in Northern Canada that participate in a school-based health 
promotion program targeting healthy lifestyle behaviours and mental wellbeing. 
In November-December 2020, we surveyed 467 grade 4-6 students in the same 
schools. The 12 questions in the mental health and wellbeing domain were grouped 
based on correlation and examined using multivariable logistic regression. 
Results: There were no notable changes pre-pandemic vs. post-lockdown in 
responses to each of the 12 questions or any of the sub-groupings. Conclusion: 
Supporting schools to implement health promotion programs may help mitigate the 
impact of the pandemic on children's mental health and wellbeing. The findings 
align with recent calls for schools to remain open as long as possible during 
the pandemic response.

Copyright © 2021 Dabravolskaj, Khan, Veugelers and Maximova.

DOI: 10.3389/ijph.2021.1604219
PMCID: PMC8441596
PMID: 34539323 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


2972. Ger Med Sci. 2021 Sep 1;19:Doc11. doi: 10.3205/000298. eCollection 2021.

Impaired psychological well-being of healthcare workers in a German department 
of anesthesiology is independent of immediate SARS-CoV-2 exposure - a 
longitudinal observational study.

Schmid B(1), Schulz SM(2), Schuler M(3), Göpfert D(1), Hein G(4), Heuschmann 
P(3)(5), Wurmb T(1), Pauli P(2), Meybohm P(1), Rittner HL(1).

Author information:
(1)Department of Anesthesiology, Würzburg University Hospital, Würzburg, 
Germany.
(2)Department of Psychology I - Biological Psychology, Clinical Psychology and 
Psychotherapy, Julius Maximilians University, Würzburg, Germany.
(3)Institute for Clinical Epidemiology and Biometry, Julius Maximilians 
University, Würzburg, Germany.
(4)Department of Psychiatry, Würzburg University Hospital, Würzburg, Germany.
(5)Clinical Trial Centre, Würzburg University Hospital, Würzburg, Germany.

Background: The study aimed to assess the mental well-being of healthcare 
professionals at a German department of anesthesiology and critical care with a 
specialized ICU for treatment of COVID-19 patients during the first two peaks of 
the 2020 pandemic, and identifying risk and protective factors. Methods: A 
single-center longitudinal, online-based survey was conducted in healthcare 
workers from a department of anesthesiology and critical care in Bavaria, the 
most affected federal state in Germany at the time of assessment. Validated 
scores for depression, anxiety, somatic disorders, burnout, resilience, and 
self-management were used and complemented by questions about perceived 
COVID-19-related stressors. In parallel, patient characteristics in the ICU were 
collected. Results: 24 and 23 critically ill COVID-19 patients were treated 
during both observation periods in April/May and November/December 2020, 
respectively. 87.5% and 78.2% of patients had moderate to severe acute 
respiratory distress syndrome. From March 6, 2020 onwards, the hospital had 
switched to a command and control-based hospital incident command system (HICS) 
and increased work forces. Point prevalence of depression-like symptoms (13.6% 
and 12.8%) and burnout (21.6% and 17.4%) in the department's healthcare 
professionals was high. Exposure to SARS-CoV-2 did not increase psychological 
burden. Consequences of the lockdown were rated as highly distressing by a 
majority of all ICU personnel. High self-reported trait resilience was 
protective against signs of depression, generalized anxiety, and burnout. 
Conclusions: During the pandemic, healthcare professionals have been suffering 
from increased psychological distress compared to reference data for both the 
general population and ICU personnel. General effects of the lockdown appear 
more relevant than actual COVID-19 patient contact. High trait resilience has a 
protective effect, yet vulnerable individuals may require specific support. 
Prevention against potential after effects of the lockdown, and in particular 
measures allowing to avoid another lockdown, appear warranted.

Publisher: Hintergrund: Die Studie hatte zum Ziel, die psychische Gesundheit der 
anästhesiologischen Mitarbeiterinnen und Mitarbeiter einer Universitätsklinik 
mit einer auf COVID-19 spezialisierten Intensivstation während der ersten beiden 
Wellen der Pandemie im Frühjahr und Herbst 2020 zu untersuchen und sowohl 
Risikofaktoren als auch protektive Faktoren zu identifizieren.Methoden: Es wurde 
eine monozentrische, Web-basierte Umfrage unter medizinischen Angestellten der 
Klinik für Anästhesiologie, Universitätsklinikum Würzburg, durchgeführt. Hierzu 
wurden validierte Tests zu den Domänen Depressivität, Ängstlichkeit, somatoforme 
Störungen, Burnout, Resilienz und Selbstmanagement verwendet und des Weiteren 
offene Fragen zu subjektiv belastenden, COVID-19-assoziierten Faktoren gestellt. 
Zusätzlich wurden Charakteristika der in den Umfragezeiträumen behandelten 
Patientinnen und Patienten sowie Informationen zum Krankenhausmanagement während 
der Pandemie erfasst.Ergebnisse: In den beiden Erhebungszeiträumen wurden 24 
bzw. 23 kritisch kranke COVID-19-Patientinnen und -Patienten behandelt. 87.5% 
bzw. 78.2% der Patientinnen und Patienten litten an einer moderaten bis schweren 
Form des adulten akuten Lungenversagens. Ab dem 6. März 2020 implementierte die 
Klinik eine streng hierarchische Notfall-Einsatzleitung, um tagesaktuell auf die 
Dynamik der Pandemie reagieren zu können, und die personellen Ressourcen wurden 
erhöht. Punktprävalenzen von Depressivität (13,6% und 12.8%) und Burnout (21,3% 
und 17.4%) bei den Studienteilnehmerinnen und -teilnehmern waren hoch. Die 
unmittelbare psychische Belastung war unabhängig von einer Exposition gegenüber 
SARS-CoV-2. Die Auswirkungen der Ausgangsbeschränkungen wurden von einer 
Mehrheit der Untersuchten als stark beeinträchtigend beschrieben. Hohe Resilienz 
schien protektiv zu wirken gegen Anzeichen von Depressivität, generalisierter 
Angst und Burnout.Schlussfolgerungen: Im Verlauf der ersten Monate der Pandemie 
litt das medizinische Personal unter erhöhter psychischer Belastung verglichen 
mit früheren Vergleichsdaten sowohl der Allgemeinbevölkerung als auch von 
Personal auf Intensivstationen. Die allgemeinen Auswirkungen der 
Ausgangsbeschränkungen schienen hierbei einen größeren Einfluss gehabt zu haben 
als der tatsächliche Kontakt mit COVID-19-Patientinnen und -Patienten. 
Ausgeprägte Resilienz hatte einen positiven Effekt. Allerdings könnten anfällige 
Mitarbeiterinnen und Mitarbeiter unter Umständen gezielte Unterstützung 
benötigen. Zudem sind vorbeugende Maßnahmen gegen mögliche Nachwirkungen der 
Pandemie-Beschränkungen sowie alle Maßnahmen, die geeignet erscheinen, einen 
weiteren Lockdown zu verhindern, sinnvoll.

Copyright © 2021 Schmid et al.

DOI: 10.3205/000298
PMCID: PMC8422798
PMID: 34539301 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2973. Eur Neuropsychopharmacol. 2022 Jan;54:65-66. doi: 
10.1016/j.euroneuro.2021.08.266. Epub 2021 Sep 3.

Well-being, resilience and post-traumatic growth in the era of Covid-19 
pandemic.

Gonda X(1), Tarazi FI(2).

Author information:
(1)Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, 
Hungary; NAP-2-SE New Antidepressant Target Research Group, Semmelweis 
University, Budapest, Hungary. Electronic address: 
gonda.xenia@med.semmelweis-univ.hu.
(2)Department of Psychiatry and Neuroscience Program, Harvard Medical School and 
McLean Hospital, Boston, MA, United States.

DOI: 10.1016/j.euroneuro.2021.08.266
PMCID: PMC8413303
PMID: 34538545 [Indexed for MEDLINE]


2974. Intensive Crit Care Nurs. 2022 Feb;68:103130. doi: 10.1016/j.iccn.2021.103130. 
Epub 2021 Aug 11.

Healthcare professionals' experiences during the initial stage of the COVID-19 
pandemic in the intensive care unit: A qualitative study.

Mortensen CB(1), Zachodnik J(2), Caspersen SF(2), Geisler A(2).

Author information:
(1)Department of Anaesthesiology and Intensive Care Medicine, Centre for 
Anaesthesiological Research, Zealand University Hospital, Koege, Denmark; 
Department of Health Sciences, Faculty of Medicine, Lund University, Sweden. 
Electronic address: cbem@regionsjaelland.dk.
(2)Department of Anaesthesiology and Intensive Care Medicine, Centre for 
Anaesthesiological Research, Zealand University Hospital, Koege, Denmark.

BACKGROUND: The COVID-19 pandemic called for rapidly considerable changes in the 
healthcare system. Healthcare professionals from different departments within 
the hospital settings were enrolled in the emergency preparedness. This study, 
therefore, aimed to explore the healthcare professionals' experiences attending 
the ICU-preparedness and caring for patients with COVID-19 during the initial 
stage of the pandemic.
METHODS: A descriptive explorative qualitative study was conducted by 
interviewing healthcare professionals during spring 2020, exploring their 
experiences as part of the ICU-preparedness team and caring for patients with 
COVID-19 in the ICU. Healthcare professionals from different departments were 
recruited by purposive sampling. The interviews were transcribed verbatim and 
analysed using content analysis.
FINDINGS: Sixteen nurses and four physicians from a university hospital in 
Denmark participated. The analysis revealed three main themes and eight 
sub-themes. The main themes were (1) Professionalism in work-life (adaption, the 
patient's welfare, insecurity, and security), (2) Community Spirit 
(responsibility and contribution), and (3) Institutional organisation (the role 
of management, loss of freedom, and information).
INTERPRETATION: Despite work specialities and professions, the participants 
reported a uniformity of similar experiences of uncertainties, but also a sense 
of community arose during the first phase of COVID-19.
RECOMMENDATIONS: To ensure resilience and mental health, and well-being for the 
healthcare professionals, comprehensive support should be provided. Guidelines 
for interventions and training are necessary to promote preparedness and reduce 
psychological stress.

Copyright © 2021. Published by Elsevier Ltd.

DOI: 10.1016/j.iccn.2021.103130
PMCID: PMC8354791
PMID: 34538544 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no known 
competing financial interests or personal relationships that could have appeared 
to influence the work reported in this paper.


2975. J Emerg Med. 2021 Dec;61(6):782-788. doi: 10.1016/j.jemermed.2021.07.066. Epub 
2021 Sep 16.

Addressing Moral Injury in Emergency Medicine.

Giwa A(1), Crutchfield D(2), Fletcher D(3), Gemmill J(4), Kindrat J(5), Smith 
A(6), Bayless P(7).

Author information:
(1)Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 
New York, New York.
(2)Maricopa County Correctional Health Services, Phoenix, Arizona.
(3)Overton Brooks VA Medical Center, Shreveport, Louisiana.
(4)Department of Emergency Medicine, Methodist Hospital, San Antonio, Texas.
(5)Department of Clinical Emergency Medicine, Indiana University Health/Indiana 
University School of Medicine, Hendricks Regional Health, Danville, Indiana.
(6)Intermountain Park City Hospital, Park City, Utah.
(7)Creighton University School of Medicine, Valleywise Health Medical Center, 
Phoenix, Arizona.

BACKGROUND: Moral injury, which is described as the psychological distress that 
results from actions, or lack of them, that go against one's beliefs or values, 
has become front and center among issues facing the practice of emergency 
medicine. Although it predates the COVID-19 outbreak, the pandemic has played a 
significant role in the increased rate of burnout, and even suicide, among 
emergency physicians.
CASE REPORTS: This paper includes several clinical vignettes to highlight 
incidents that may occur in the emergency department (ED) when physicians 
experience violations of their moral codes, leading to distress and moral 
injury. These scenarios explore the conflicts posed between competing bioethical 
principles such as beneficence, nonmaleficence, end-of-life decision-making, 
medical futility, respect for self-determination (autonomy), resource scarcity 
and triage, duty to care, and physician impairment.
DISCUSSION: There are significant similarities between moral injury and 
post-traumatic stress disorder (PTSD), with some authors describing moral injury 
as a subset of PTSD. We explore these commonalities to provide coping mechanisms 
and mitigation strategies for those suffering from moral injury.
CONCLUSION: Physicians experiencing moral injury may benefit from the many 
available evidence-based treatments for PTSD to identify and manage moral injury 
and to support patient care and personal well-being.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.jemermed.2021.07.066
PMID: 34538517 [Indexed for MEDLINE]


2976. Soc Sci Med. 2021 Oct;287:114397. doi: 10.1016/j.socscimed.2021.114397. Epub 
2021 Sep 13.

The impact of providing end-of-life care during a pandemic on the mental health 
and wellbeing of health and social care staff: Systematic review and 
meta-synthesis.

Porter B(1), Zile A(2), Peryer G(3), Farquhar M(4), Sanderson K(5).

Author information:
(1)School of Health Sciences, University of East Anglia, Norwich Research Park, 
NR4 7TJ, United Kingdom. Electronic address: bryony.porter@uea.ac.uk.
(2)School of Health Sciences, University of East Anglia, Norwich Research Park, 
NR4 7TJ, United Kingdom. Electronic address: A.Zile@uea.ac.uk.
(3)School of Health Sciences, University of East Anglia, Norwich Research Park, 
NR4 7TJ, United Kingdom. Electronic address: g.peryer@uea.ac.uk.
(4)School of Health Sciences, University of East Anglia, Norwich Research Park, 
NR4 7TJ, United Kingdom. Electronic address: m.farquhar@uea.ac.uk.
(5)School of Health Sciences, University of East Anglia, Norwich Research Park, 
NR4 7TJ, United Kingdom. Electronic address: kristy.sanderson@uea.ac.uk.

BACKGROUND: Disease outbreaks and disasters can result in excess deaths and 
severe disruption of usual end-of-life care processes. We aimed to: i) 
synthesise evidence describing the experiences of health and social care staff 
providing end-of-life care during a disease outbreak or humanitarian disaster, 
ii) understand the impact on their mental health and wellbeing and, iii) 
identify means of support.
METHODS: A systematic review with meta-synthesis was conducted including studies 
of health and social care staff providing end-of-life care during disease 
outbreaks (Ebola, COVID-19, SARs, MERs) or humanitarian disasters (2001-2020). 
MEDLINE (Ovid), Embase, PsycInfo, Web of Science, and grey literature databases 
were searched systematically, with forward and backward citation searching of 
included studies. Any research study designs, in any care settings, were 
included. Study quality was assessed using an appraisal tool relevant to each 
study design. Qualitative meta-synthesis was used to analyse the findings, which 
were then reported narratively. PROSPERO registration: CRD42020181444.
RESULTS: Nineteen studies were included, including 10 Ebola studies and two 
COVID-19 studies. The analysis generated two superordinate themes: individual 
experience and organisational responsibilities. Individual experience comprised 
four themes: dignity in death, positive experiences, negative experience and 
support for staff. Organisational responsibilities comprised four themes: 
preparation, adaption, resources, and Personal Protective Equipment (PPE).
DISCUSSION: No studies quantitively measured the impact of providing end-of-life 
care on staff mental health and wellbeing, however qualitative studies described 
experiences in varied settings. Serious disease outbreaks and disasters can 
expose care staff to abnormally high levels of mortality and suffering. Health 
and social care systems need to proactively prepare for future events and enable 
peer support mechanisms that may help mitigate experiences of psychological 
distress in humanitarian crises.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.socscimed.2021.114397
PMCID: PMC8445829
PMID: 34537656 [Indexed for MEDLINE]

Conflict of interest statement: None.


2977. Lancet Psychiatry. 2021 Oct;8(10):929-936. doi: 10.1016/S2215-0366(21)00206-6.

COVID-19 and UK family carers: policy implications.

Onwumere J(1), Creswell C(2), Livingston G(3), Shiers D(4), Tchanturia K(5), 
Charman T(6), Russell A(7), Treasure J(5), Di Forti M(8), Wildman E(6), Minnis 
H(9), Young A(5), Davis A(10), Kuipers E(11).

Author information:
(1)Department of Psychology, Institute of Psychiatry, Psychology and 
Neuroscience, King's College London, London, UK; South London and Maudsley NHS 
Foundation Trust, Bethlem Royal Hospital, Beckenham, UK. Electronic address: 
juliana.1.onwumere@kcl.ac.uk.
(2)Department of Experimental Psychology, and Department of Psychiatry, 
University of Oxford, Oxford, UK.
(3)Division of Psychiatry, University College London, London, UK.
(4)Psychosis Research Unit, Greater Manchester Mental Health Trust, Manchester, 
UK; Division of Psychology and Mental Health, University of Manchester, 
Manchester, UK; Primary Care and Health Sciences, Keele University, Keele, UK.
(5)Department of Psychological Medicine, Institute of Psychiatry, Psychology and 
Neuroscience, King's College London, London, UK.
(6)Department of Psychology, Institute of Psychiatry, Psychology and 
Neuroscience, King's College London, London, UK.
(7)Department of Psychology, Centre of Applied Autism Research, University of 
Bath, Bath, UK.
(8)Department of Social, Genetic and Developmental Psychiatry, Institute of 
Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
(9)University of Glasgow, Institute of Health and Wellbeing, Glasgow, UK.
(10)South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, 
Beckenham, UK.
(11)Department of Psychology, Institute of Psychiatry, Psychology and 
Neuroscience, King's College London, London, UK; South London and Maudsley NHS 
Foundation Trust, Bethlem Royal Hospital, Beckenham, UK.

Informal (unpaid) carers are an integral part of all societies and the health 
and social care systems in the UK depend on them. Despite the valuable 
contributions and key worker status of informal carers, their lived experiences, 
wellbeing, and needs have been neglected during the COVID-19 pandemic. In this 
Health Policy, we bring together a broad range of clinicians, researchers, and 
people with lived experience as informal carers to share their thoughts on the 
impact of the COVID-19 pandemic on UK carers, many of whom have felt abandoned 
as services closed. We focus on the carers of children and young people and 
adults and older adults with mental health diagnoses, and carers of people with 
intellectual disability or neurodevelopmental conditions across different care 
settings over the lifespan. We provide policy recommendations with the aim of 
improving outcomes for all carers.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/S2215-0366(21)00206-6
PMCID: PMC8445736
PMID: 34537103 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of interests We declare no competing 
interests.


2978. Z Rheumatol. 2023 May;82(4):331-341. doi: 10.1007/s00393-021-01081-5. Epub 2021 
Sep 17.

Work situation of rheumatologists and residents in times of COVID-19 : Findings 
from a survey in Germany.

Kuhlmann E(1), Bruns L(2), Hoeper K(2)(3), Richter M(2)(3), Witte T(2), Ernst 
D(2), Jablonka A(2).

Author information:
(1)Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, 
OE 6830, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. 
kuhlmann.ellen@mh-hannover.de.
(2)Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, 
OE 6830, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
(3)Regionales Kooperatives Rheumazentrum Niedersachsen e. V., Hannover , 
Germany.

BACKGROUND AND OBJECTIVE: The work situation is an important dimension of 
professional life and wellbeing, and a policy lever to strengthen recruitment 
and retention. This study aims to explore the work situation of physicians and 
residents in internal medical rheumatology, considering the impact of the 
coronavirus pandemic COVID-19.
METHODS: A questionnaire-based online survey was conducted in early 2021 at the 
Hannover Medical School, supported by the German Society of Rheumatology. Target 
groups were all rheumatology physicians and residents in Germany. The main areas 
of investigation included work hours, task delegation, and collaboration; 
workload and mental health issues; discrimination and sexual harassment 
experiences; and the impact of COVID-19. Descriptive statistical analysis was 
performed for the standardized items and qualitative content analysis for the 
free-text information.
RESULTS: The respondents (n = 101) expressed positive attitudes towards 
cooperation and task delegation to medical assistants, especially those 
specialized in rheumatology, while attitudes towards cooperation with GPs 
pointed to blockades. There was a strong mismatch between actual and desired 
work hours both in the group of women and in the group of men. 81% rated their 
workload as high or very high; every sixth rheumatologist has suffered from 
stress or burnout syndromes at least once in the past. Experiences of gender 
discrimination and sexual harassment/violence were frequently reported, mostly 
by women. COVID-19 was an amplifier of stress, with major stressors being 
digitalization and increased demand for communication and patient education.
CONCLUSION: There is an urgent need to improve the work situation of 
rheumatologists and reduce stress and mental health risks.

Publisher: ZUSAMMENFASSUNG: HINTERGRUND UND FRAGESTELLUNG: Die Arbeitssituation 
ist ein wichtiger Aspekt im Berufsleben und für das Wohlergehen und ein 
politischer Hebel, um den Verbleib im Beruf sowie die Fachkräfterekrutierung zu 
verbessern. Ziel dieser Studie war es, die Arbeitsbedingungen internistischer 
Rheumatolog*innen und Weiterbildungsassistent*innen unter Berücksichtigung der 
Auswirkungen der Coronavirus-Pandemie COVID-19 zu untersuchen.
METHODE: Eine fragebogenbasierte Online-Erhebung wurde Anfang 2021 an der 
Medizinischen Hochschule Hannover durchgeführt, unterstützt von der Deutschen 
Gesellschaft für Rheumatologie. Zielgruppe waren alle Rheumatolog*innen und 
Weiterbildungsassistent*innen in Deutschland. Thema waren Arbeitszeiten, 
Kooperation und Delegation, Arbeitsbelastungen und Burnout-Syndrome, 
Diskriminierung und sexuelle Belästigung sowie Auswirkungen von COVID-19. 
Standardisierte Items wurden deskriptiv und Freitextinformationen mittels 
qualitativer Inhaltsanalyse ausgewertet.
ERGEBNISSE: In der Untersuchungsgruppe (n = 101) zeigten sich positive 
Einstellungen zu Kooperation und Aufgabendelegation an medizinische 
Fachangestellte, v. a. Rheumatologische Fachassistenz, während die Einstellungen 
zur Kooperation mit Hausärzt*innen Blockaden sichtbar machten. Die tatsächliche 
Arbeitszeit unterschied sich sowohl in der Gruppe der Frauen als auch der Männer 
sehr deutlich von der Wunscharbeitszeit. Ihre Arbeitsbelastung bewerteten 81 % 
als hoch oder sehr hoch; jede*r 6. Befragte war mindestens einmal in der 
Vergangenheit von Stress und Burnout betroffen. Diskriminierungserfahrungen und 
sexuelle Belästigungen waren weitverbreitet und betrafen Frauen stärker als 
Männer. COVID-19 erwies sich als Stressverstärker; Digitalisierung, erhöhter 
Bedarf an Kommunikation und Patientenaufklärung waren wesentliche 
Stressfaktoren.
SCHLUSSFOLGERUNGEN: Die Arbeitssituation von Rheumatolog*innen sollte dringend 
verbessert werden, um Stress und Gesundheitsrisiken zu verringern.

© 2021. The Author(s).

DOI: 10.1007/s00393-021-01081-5
PMCID: PMC8448391
PMID: 34535820 [Indexed for MEDLINE]

Conflict of interest statement: E. Kuhlmann, L. Bruns, K. Hoeper, M. Richter, 
T. Witte, D. Ernst, and A. Jablonka declare that they have no competing 
interests.


2979. Nord J Psychiatry. 2022 Jul;76(5):338-347. doi: 10.1080/08039488.2021.1970222. 
Epub 2021 Sep 17.

Mental health of patients with mental illness during the COVID-19 pandemic 
lockdown: a questionnaire-based survey weighted for attrition.

Kølbæk P(1)(2)(3), Jefsen OH(1)(2)(3), Speed M(1)(3), Østergaard SD(1)(3).

Author information:
(1)Department of Affective Disorders, Aarhus University Hospital - Psychiatry, 
Aarhus, Denmark.
(2)Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Aarhus, 
Denmark.
(3)Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.

BACKGROUND: Individuals with pre-existing mental illness may be particularly 
vulnerable to the negative impact that the coronavirus disease 2019 (COVID-19) 
pandemic seems to have on mental health. Accordingly, the objective of the 
present study was to assess whether patients with mental illness experienced 
deterioration in mental health during the COVID-19 lockdown of Denmark in the 
Spring of 2020.
METHODS: We conducted a cross-sectional, questionnaire-based survey coupled with 
sociodemographic and clinical data from the medical records of all invitees. The 
latter enabled analysis of attrition and weighting of results. The online 
questionnaire included the 18-item Brief Symptom Inventory (BSI-18), the 
five-item World Health Organization Well-Being Index (WHO-5), and 14 questions 
evaluating worsening or improvement in symptoms during lockdown using the 
pre-pandemic period as reference.
RESULTS: A total of 992 randomly drawn patients with mental illness from the 
psychiatric services of the Central Denmark Region responded to the 
questionnaire (response rate = 21.6%). The weighted mean WHO-5 and BSI-18 scores 
were 38 and 28, respectively. A total of 52% of the respondents reported that 
their mental health had deteriorated during the lockdown, while 33% reported no 
change, and 16% reported improvement. The most commonly reported reasons for 
deterioration were loneliness, disruption of routines, concerns regarding the 
coronavirus, less contact with family/friends, boredom, and reduced access to 
psychiatric care.
CONCLUSION: More than half of the patients reported worsening of their mental 
health during the pandemic lockdown. There should be an increased emphasis on 
ensuring both social and clinical support for individuals with mental illness 
during pandemics.

DOI: 10.1080/08039488.2021.1970222
PMID: 34533424 [Indexed for MEDLINE]


2980. Environ Sci Pollut Res Int. 2022 Feb;29(8):11142-11159. doi: 
10.1007/s11356-021-16002-x. Epub 2021 Sep 16.

Studying the psychology of coping negative emotions during COVID-19: a 
quantitative analysis from India.

Pandey V(1), Talan A(2), Mahendru M(3)(4), Shahzad U(5).

Author information:
(1)Department of Commerce, Ramjas College, University of Delhi, University 
Enclave, Delhi, 110007, India.
(2)Department of Commerce, College of Vocational Studies, University of Delhi, 
Triveni, Sheikh Sarai-II, New Delhi, 110017, India.
(3)State Bank Institute of Leadership, Kolkata, India. mandip129@gmail.com.
(4)State Bank Institute of Credit and Risk Management, Gurugram, India. 
mandip129@gmail.com.
(5)School of Statistics and Applied Mathematics, Anhui University of Finance and 
Economics, Bengbu, 233030, People's Republic of China. Shehzad-umer@hotmail.com.

The outbreak of the COVID-19 virus adversely affected the material and mental 
well-being of the infected individuals and their families. The poor health 
system combined with lack of fear of infection has created significant negative 
health effects for people. The present research consider the notable models of 
coping with negative emotions, including '3Cs' and 'direct action and palliation 
approach'. With the observation method's help, a detailed perspective was found 
on people's coping processes, categorized as psychological, control, coherence, 
and connectedness coping. The present study considers the notable models of 
dealing with negative feelings, including '3Cs' and 'direct intervention and 
palliation strategy'. With the observation method's support, a detailed 
viewpoint was found on people's coping mechanisms, categorized as neurological, 
regulation, coherence, and connectedness coping. Using the ANOVA and t-tests, a 
significant augmentation in people's negative emotions was found since the 
beginning of the pandemic. Using GMM regression technique, 'avoidance', 
'proactive preparedness', 'emotional resilience', 'entertainment', and 
'spiritualism' were highly significant techniques in curbing the negative 
emotions during the COVID-19 pandemic. Meanwhile, the LOGIT regression found 
cumulative negative emotions and emotions about negative career outlooks to be 
the most significant to bring negative emotions to normalcy. The study suggests 
that policymakers design a national-level strategy to strengthen the mental 
health systems to boost mental well-being.

© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, 
part of Springer Nature.

DOI: 10.1007/s11356-021-16002-x
PMCID: PMC8445258
PMID: 34532794 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


2981. J Adolesc Health. 2021 Nov;69(5):705-712. doi: 10.1016/j.jadohealth.2021.07.016. 
Epub 2021 Sep 14.

COVID-19 Employment Status, Dyadic Family Relationships, and Child Psychological 
Well-Being.

Wang MT(1), Henry DA(2), Del Toro J(3), Scanlon CL(3), Schall JD(3).

Author information:
(1)Learning Research & Development Center, Department of Psychology, School of 
Education, University of Pittsburgh, Pittsburgh, Pennsylvania. Electronic 
address: mtwang@pitt.edu.
(2)Department of Counseling, Developmental & Educational Psychology, Boston 
College, Chestnut Hill, Massachusetts.
(3)Learning Research & Development Center, Department of Psychology, School of 
Education, University of Pittsburgh, Pittsburgh, Pennsylvania.

PURPOSE: COVID-19 has led to soaring unemployment rates and the widespread 
adoption of working-from-home (WFH) arrangements that have disrupted family 
relationships and adolescent psychological well-being. This longitudinal study 
investigated how parental employment status (i.e., job loss and WFH) influenced 
adolescents' daily affect indirectly through family functioning (i.e., 
parent-adolescent conflict and parental warmth) and whether these links varied 
by family's socioeconomic status.
METHODS: Daily-diary approaches were used to collect dyadic parent-adolescent 
data from a nationwide American sample (6,524 daily assessments from 447 
parent-adolescent dyads; 45% black, 36% white, 10% Latinx, 7% Asian American, 2% 
Native American) over the course of 15 consecutive days at the onset of the 
COVID-19 pandemic.
RESULTS: Parents who experienced job loss demonstrated increases in parent-child 
conflict, which in turn predicted decreases in child positive affect and 
increases in child negative affect. Furthermore, parents' WFH status predicted 
increases in parental warmth, which in turn predicted increases in child 
positive affect and decreases in child negative affect. Parents of low-income 
families were more likely to experience job loss (24% vs. 13%) and less likely 
to WFH (44% vs. 73%) than middle-high income parents.
CONCLUSIONS: Adolescents from families facing economic hardship and employment 
shifts during COVID-19 experienced changes in parent-child relational dynamics 
that influenced their emotional well-being. Recognizing these shifts in family 
ecology is critical to health providers' ability to screen for mental health, 
assess existing family supports, and provide timely, targeted information about 
stress management and contending with family conflict.

Copyright © 2021 Society for Adolescent Health and Medicine. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jadohealth.2021.07.016
PMCID: PMC8437706
PMID: 34531094 [Indexed for MEDLINE]


2982. BMC Pregnancy Childbirth. 2021 Sep 17;21(1):625. doi: 
10.1186/s12884-021-04071-2.

Postpartum women's psychological experiences during the COVID-19 pandemic: a 
modified recurrent cross-sectional thematic analysis.

Jackson L(1), De Pascalis L(2), Harrold JA(2), Fallon V(#)(2), Silverio 
SA(#)(3).

Author information:
(1)Department of Psychology, Institute of Population Health, Faculty of Health 
and Life Sciences, University of Liverpool, Eleanor Rathbone Building, Bedford 
Street South, Liverpool, Merseyside, L69 7ZA, UK. 
Leanne.Jackson@liverpool.ac.uk.
(2)Department of Psychology, Institute of Population Health, Faculty of Health 
and Life Sciences, University of Liverpool, Eleanor Rathbone Building, Bedford 
Street South, Liverpool, Merseyside, L69 7ZA, UK.
(3)Department of Women & Children's Health, School of Life Course Sciences, 
Faculty of Life Sciences & Medicine, King's College London, London, UK.
(#)Contributed equally

BACKGROUND: COVID-19 has placed additional stressors on mothers during an 
already vulnerable lifecourse transition. Initial social distancing restrictions 
(Timepoint 1; T1) and initial changes to those social distancing restrictions 
(Timepoint 2; T2) have disrupted postpartum access to practical and emotional 
support. This qualitative study explores the postpartum psychological 
experiences of UK women during different phases of the COVID-19 pandemic and 
associated 'lockdowns'.
METHODS: Semi-structured interviews were conducted with 12 women, approximately 
30 days after initial social distancing guidelines were imposed in the UK (22 
April 2020). A separate 12 women were interviewed approximately 30 days after 
the initial easing of social distancing restrictions (10 June 2020). Data were 
transcribed verbatim, uploaded into NVivo for management and analysis, which 
followed a recurrent cross-sectional approach to thematic analysis.
RESULTS: Two main themes were identified for T1: 'Motherhood is Much Like 
Lockdown' and 'A Self-Contained Family Unit'. Each main T1 theme contained two 
sub-themes. Two main themes were also identified for T2: 'Incongruously Held 
Views of COVID-19' and 'Mothering Amidst the Pandemic'. Each main T2 theme 
contained three sub-themes. Comparisons between data gathered at each timepoint 
identified increased emotional distress over time. Current findings call for the 
improvement of postpartum care by improving accessibility to social support, and 
prioritising the re-opening of schools, and face-to-face healthcare appointments 
and visitation.
CONCLUSION: Social distancing restrictions associated with COVID-19 have had a 
cumulative, negative effect on postpartum mental health. Recommendations such 
as: Allowing mothers to 'bubble' with a primary support provider even at their 
healthcare appointments; allowing one support partner to attend all necessary 
healthcare appointments; and providing tailored informational resources, may 
help to support postpartum emotional wellbeing during this, and similar health 
crises in the future.

© 2021. The Author(s).

DOI: 10.1186/s12884-021-04071-2
PMCID: PMC8445650
PMID: 34530772 [Indexed for MEDLINE]

Conflict of interest statement: No conflicts of interest or competing interests 
have been declared by any author.


2983. AIDS Care. 2022 Jul;34(7):821-827. doi: 10.1080/09540121.2021.1975628. Epub 2021 
Sep 16.

"I have the strength to get through this using my past experiences with HIV": 
findings from a mixed-method survey of health outcomes, service accessibility, 
and psychosocial wellbeing among people living with HIV during the Covid-19 
pandemic.

Pantelic M(1)(2), Martin K(1)(3), Fitzpatrick C(3), Nixon E(1), Tweed M(4), 
Spice W(5), Jones M(6), Darking M(7), Whetham J(3), Vera JH(1)(3).

Author information:
(1)Department of Global Health and Infection, Brighton and Sussex Medical 
School, University of Sussex, Brighton, UK.
(2)Department of Social Policy and Intervention, University of Oxford, Oxford, 
UK.
(3)University Hospitals Sussex NHS Foundation Trust, Brighton, UK.
(4)Terrence Higgins Trust, London, UK.
(5)University Hospitals Sussex NHS Foundation Trust, Western Sussex University 
Hospitals, Crawley, UK.
(6)East Sussex Healthcare NHS Trust, Eastbourne, UK.
(7)School of Applied Social Science, University of Brighton, Brighton, UK.

We examined the impact of Covid-19 restrictions on the wellbeing and access to 
care among people living with HIV (PLWH) in the UK. A cross-sectional anonymous 
online survey was circulated to PLWH attending care at three HIV services in 
Sussex. The questionnaire covered key themes: socio-demographic characteristics; 
changes in physical and mental health; accessibility of essential health 
services and information; and socio-economic concerns. Free-text qualitative 
responses were examined through framework analysis. Quantitative data from 653 
respondents were available, with a subset of 385 free-text qualitative 
responses. In terms of mental health, 501 (77.6%) respondents reported feeling 
more anxious; 464 (71.8%) reported feeling more depressed than usual; and 128 
(19.8%) reported having suicidal thoughts since the start of the pandemic. 
Respondents worried about running out of HIV medicine (n = 264, 40.7%); 
accessing HIV services (n = 246, 38.0%) as well as other health services 
(n = 408, 63.0%). Widespread resilience was also noted: 537 (83.3%) of 
respondents felt that living with HIV had equipped them with the strength to 
adapt to the Covid-19 pandemic. Findings highlight important gaps between the 
multifaceted needs of PLWH. Multisectoral collaborations and investments are 
needed to adequately support PLWH and to build resilience to future shocks 
within HIV services.

DOI: 10.1080/09540121.2021.1975628
PMID: 34530649 [Indexed for MEDLINE]


2984. BMC Psychol. 2021 Sep 15;9(1):142. doi: 10.1186/s40359-021-00649-9.

Predictors of academic performance during the covid-19 outbreak: impact of 
distance education on mental health, social cognition and memory abilities in an 
Italian university student sample.

Giusti L(1)(2), Mammarella S(1)(2), Salza A(1)(2), Del Vecchio S(1)(2), Ussorio 
D(1)(2), Casacchia M(1)(2), Roncone R(3)(4).

Author information:
(1)Department of Clinical Medicine, Public Health, Life and Environmental 
Science, University of L'Aquila, L'Aquila, Italy.
(2)Counselling and Consultation Service for Students (SACS), University of 
L'Aquila, L'Aquila, Italy.
(3)Department of Clinical Medicine, Public Health, Life and Environmental 
Science, University of L'Aquila, L'Aquila, Italy. rita.roncone@univaq.it.
(4)Counselling and Consultation Service for Students (SACS), University of 
L'Aquila, L'Aquila, Italy. rita.roncone@univaq.it.

BACKGROUND: This study aimed to investigate the impact of distance education 
(DE) on mental health, social cognition, and memory abilities in a sample of 
university students during the national COVID-19 lockdown in Italy and to 
identify the predictors of academic performance.
METHODS: Two hundred and three students (76.4% women, mean age 24.3, SD ± 4.9) 
responded to an anonymous online cross-sectional survey between July 15 and 
September 30, 2020, on DE experience and cognitive and social-cognitive 
variables. A short version of the Beck Depression Inventory-II, ten images from 
the Eyes Task, and five memory vignette stimuli were included in the survey. 
Descriptive, one-way ANOVA, correlation, and logistic regression analyses were 
conducted.
RESULTS: Half of the student sample reported significant impairment in 
concentration and learning abilities during DE. Regarding psychological health, 
19.7%, 27.1%, and 23.6% of the sample reported mild, moderate, and severe 
depressive symptoms, respectively. Correlation analyses showed a statistically 
significant negative association between depression and the overall subjective 
evaluation of DE (r =  - 0.359; p < 0.000). Changes in one's study context and 
habits, i.e., studying alone at one's parents' home instead of studying with 
colleagues or alone in a university "social place" (e.g., the university 
library), seemed to increase the likelihood of poor academic performance by 
almost 3 times (O.R. 3.918; p = 0.032). This predictor was no longer 
statistically significant in the subsequent step when the individual impairment 
predictors were entered. Learning concentration impairment during DE (O.R. 
8.350; p = 0.014), anxiety about COVID-19 contagion for oneself or others (O.R. 
3.363; p = 0.022), female gender (O.R. 3.141; p = 0.045), and depressive 
symptomatology (O.R. 1.093; p = 0.047) were ultimately determined to be the 
strongest predictors of poor academic performance, whereas the appreciation of 
DE represented a protective variable (O.R. 0.610; p < 0.000).
CONCLUSIONS: The study showed a negative impact of DE on the mental health of 
students presenting depressive symptoms and impairment in concentration and 
learning, the latter identified as the strongest predictors of poor academic 
performances. The study confirms the emerging need to monitor the impact of DE, 
which occurred during the 2019/2020 academic year and will continue in the 
coming months, to refine educational offerings and meet students' psychological 
needs by implementing psychological interventions based on the modifiable 
variables that seem to compromise students' psychological well-being and 
academic outcomes.

© 2021. The Author(s).

DOI: 10.1186/s40359-021-00649-9
PMCID: PMC8441245
PMID: 34526153 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


2985. BMC Public Health. 2021 Sep 15;21(1):1679. doi: 10.1186/s12889-021-11732-6.

Ontario adults' health behaviors, mental health, and overall well-being during 
the COVID-19 pandemic.

Shillington KJ(1), Vanderloo LM(2), Burke SM(1)(3), Ng V(4)(5)(6), Tucker 
P(1)(2), Irwin JD(7)(8).

Author information:
(1)Health and Rehabilitation Sciences Program, Faculty of Health Sciences, 
University of Western Ontario, London, Ontario, Canada.
(2)School of Occupational Therapy, Faculty of Health Sciences, University of 
Western Ontario, London, Ontario, Canada.
(3)School of Health Studies, Faculty of Health Sciences, University of Western 
Ontario, London, Ontario, Canada.
(4)Schulich School of Medicine and Dentistry, University of Western Ontario, 
London, Ontario, Canada.
(5)Department of Family and Community Medicine, University of Toronto, Toronto, 
Ontario, Canada.
(6)Division of Professional and Practice Support, College of Family Physicians 
of Canada, Mississauga, Ontario, Canada.
(7)Health and Rehabilitation Sciences Program, Faculty of Health Sciences, 
University of Western Ontario, London, Ontario, Canada. jenirwin@uwo.ca.
(8)School of Health Studies, Faculty of Health Sciences, University of Western 
Ontario, London, Ontario, Canada. jenirwin@uwo.ca.

BACKGROUND: Public health measures such as physical distancing and 
work-from-home initiatives have been implemented to slow the spread of COVID-19. 
These measures may also be associated with unhealthy lifestyle behaviors, which 
could be particularly problematic for those already at highest risk for losing 
years of healthy life due to chronic disease (i.e., 30-59-year-olds). The 
purpose of this paper is two-fold: (1) to provide an overview of Ontario adults' 
health behaviors (i.e., physical activity, sedentary behaviors, and dietary 
intake), mental health, and well-being during the first few months of the 
COVID-19 pandemic (April-July 2020); and (2) to explore the difference between 
physical activity and various health behaviors (i.e., well-being, mental health, 
and dietary intake).
METHODS: As a part of a larger, longitudinal study, participants completed an 
online survey that included demographic information, the Global Physical 
Activity Questionnaire, Starting the Conversation, the Mental Health Inventory, 
and the Personal Wellbeing Index-Adult. Data analyses involved computing 
measures of central tendency and dispersion for demographic characteristics and 
tools followed by descriptive statistics. Separate independent t-tests were 
conducted to investigate the difference between physical activity status and 
well-being, mental health, and dietary intake.
RESULTS: A total of 2157 Ontarians completed an online survey. Descriptive 
statistics indicated that respondents met physical activity and sedentary 
behavior guidelines, reported double the amount of recommended recreational 
screen time, practiced moderately healthy dietary behaviors, experienced mental 
health problems, and scored below "normal" in some well-being domains.
CONCLUSION: As the end of the COVID-19 pandemic is currently unknown, its 
associated restrictions and society changes may influence adults' behaviors in 
both the short- and longer-term. As such, our findings might provide immediate 
insight into the development of timely and evidence-informed health promotion 
and disease prevention strategies for Canadians, which could support adults' 
health behaviors, mental health, and well-being during the COVID-19 pandemic and 
other, future pandemics.

© 2021. The Author(s).

DOI: 10.1186/s12889-021-11732-6
PMCID: PMC8441954
PMID: 34526005 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2986. Public Health Rep. 2022 Jan-Feb;137(1):120-127. doi: 10.1177/00333549211045817. 
Epub 2021 Sep 15.

Essential but Ill-Prepared: How the COVID-19 Pandemic Affects the Mental Health 
of the Grocery Store Workforce.

Mayer B(1), Arora M(2), Helm S(3), Barnett M(3).

Author information:
(1)School of Sociology, College of Social and Behavioral Sciences, University of 
Arizona, Tucson, AZ, USA.
(2)Community, Environment, and Policy, Mel & Enid Zuckerman College of Public 
Health, University of Arizona, Tucson, AZ, USA.
(3)Norton School of Family and Consumer Sciences, College of Agriculture and 
Life Sciences, University of Arizona, Tucson, AZ, USA.

OBJECTIVES: Frontline essential workers face elevated risks of exposure to 
COVID-19 because of the interactive nature of their jobs, which require high 
levels of interaction with the general public and coworkers. The impact of these 
elevated risks on the mental health of essential workers, especially outside the 
health care sector, is not well studied. To address this knowledge gap, we 
examined correlations between perceptions of workplace risks and mental health 
distress among grocery store workers in Arizona.
METHODS: We collected the first statewide sample of essential workers outside 
the health care sector focused on mental health and well-being. A total of 3344 
grocery store workers in Arizona completed an online survey in July 2020. We 
used multiple regression models to identify demographic and work-based 
correlates of mental health distress.
RESULTS: Levels of mental health distress among respondents were high: 557 of 
3169 (17.6%) reported severe levels and 482 of 3168 (15.2%) reported moderate 
levels. Perceptions of workplace safety were strongly correlated with 
significantly reduced levels of mental health distress (ß = -1.44; SE = 0.20) 
and reduced perceived stress (ß = -0.97; SE = 0.16). Financially disadvantaged 
workers and employees aged <55 reported high levels of mental health distress. 
Perceptions of safety and protection in the workplace were significantly 
correlated with availability of safety trainings, social distancing, and 
policies governing customer behaviors.
CONCLUSIONS: Lacking sufficient workplace protections, grocery store employees 
in Arizona experienced high levels of mental health distress during the COVID-19 
pandemic. Providing clear federal and state policies to employers to guide 
implementation of workplace protections may help reduce sources of mental health 
distress.

DOI: 10.1177/00333549211045817
PMCID: PMC8721764
PMID: 34524904 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
authors declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


2987. Sci Rep. 2021 Sep 14;11(1):18273. doi: 10.1038/s41598-021-97421-1.

Having more virtual interaction partners during COVID-19 physical distancing 
measures may benefit mental health.

Sahi RS(#)(1), Schwyck ME(#)(2), Parkinson C(2)(3), Eisenberger NI(2).

Author information:
(1)Department of Psychology, University of California Los Angeles, Los Angeles, 
CA, 90095, USA. rsahi1@ucla.edu.
(2)Department of Psychology, University of California Los Angeles, Los Angeles, 
CA, 90095, USA.
(3)Brain Research Institute, University of California Los Angeles, Los Angeles, 
CA, 90095, USA.
(#)Contributed equally

Social interactions play an extremely important role in maintaining health and 
well-being. The COVID-19 pandemic and associated physical distancing measures, 
however, restricted the number of people one could physically interact with on a 
regular basis. A large percentage of social interactions moved online, resulting 
in reports of "Zoom fatigue," or exhaustion from virtual interactions. These 
reports focused on how online communication differs from in-person 
communication, but it is possible that when in-person interactions are 
restricted, virtual interactions may benefit mental health overall. In a survey 
conducted near the beginning of the COVID-19 pandemic (N2020 = 230), we found 
that having a greater number of virtual interaction partners was associated with 
better mental health. This relationship was statistically mediated by decreased 
loneliness and increased perceptions of social support. We replicated these 
findings during the pandemic 1 year later (N2021 = 256) and found that these 
effects held even after controlling for the amount of time people spent 
interacting online. Convergent with previous literature on social interactions, 
these findings suggest that virtual interactions may benefit overall mental 
health, particularly during physical distancing and other circumstances where 
opportunities to interact in-person with different people are limited.Open 
Science Framework repository: https://osf.io/6jsr2/ .

© 2021. The Author(s).

DOI: 10.1038/s41598-021-97421-1
PMCID: PMC8440653
PMID: 34521876 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


2988. J Adolesc Health. 2021 Nov;69(5):721-728. doi: 10.1016/j.jadohealth.2021.07.027. 
Epub 2021 Sep 11.

Chronic Pain in Schoolchildren and its Association With Psychological Wellbeing 
Before and During the COVID-19 Pandemic.

Rau LM(1), Grothus S(2), Sommer A(2), Grochowska K(2), Claus BB(3), Zernikow 
B(4), Wager J(4).

Author information:
(1)German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, 
Germany; Department of Children's Pain Therapy and Paediatric Palliative Care, 
Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, 
Germany. Electronic address: L.Rau@Deutsches-Kinderschmerzzentrum.de.
(2)German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, 
Germany; Department of Children's Pain Therapy and Paediatric Palliative Care, 
Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, 
Germany.
(3)German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, 
Germany; PedScience Research Institute, Datteln, Germany.
(4)German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, 
Germany; Department of Children's Pain Therapy and Paediatric Palliative Care, 
Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, 
Germany; PedScience Research Institute, Datteln, Germany.

PURPOSE: The current longitudinal observational study aimed to explore how 
chronic pain among schoolchildren changed before and during the COVID-19 
pandemic, and how changes in chronic pain were related to changes in 
psychological wellbeing and COVID-19-related experiences.
METHODS: Data were collected from N = 777 German schoolchildren (aged 
9-17 years) at two assessments before and one assessment during the COVID-19 
pandemic lockdown. Participants self-reported chronic pain experience, anxiety, 
depression, and quality of life across all assessments; and COVID-19-related 
experiences at the last assessment. Trajectories of anxiety, depression, and 
quality of life as well as COVID-19-related experiences were analyzed separately 
for groups of stable chronic pain trajectories compared to chronic pain 
trajectories that changed during the pandemic.
RESULTS: Chronic pain prevalence was lowest at the assessment during the 
COVID-19 pandemic (22.8% vs. 29.2% and 29.9% before the pandemic). However, 4.6% 
experienced new chronic pain onset during the COVID-19 pandemic. This was 
preceded by heightened depression and anxiety, as well as lowered quality of 
life scores. These students were also more likely to describe time with their 
family during the COVID-19 pandemic as tense compared to students who did not 
develop chronic pain. During the COVID-19 pandemic boys were more likely to 
recover from ongoing chronic pain than girls.
CONCLUSIONS: Overall, during the COVID-19 pandemic the prevalence of chronic 
pain decreased. However, stressful situations and pre-existing vulnerabilities 
in psychological wellbeing can facilitate the development of chronic pain during 
the pandemic.

Copyright © 2021 Society for Adolescent Health and Medicine. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jadohealth.2021.07.027
PMCID: PMC8492937
PMID: 34521577 [Indexed for MEDLINE]


2989. BMC Pediatr. 2021 Sep 14;21(1):404. doi: 10.1186/s12887-021-02869-9.

A prospective investigation of developmental trajectories of psychosocial 
adjustment in adolescents facing a chronic condition - study protocol of an 
observational, multi-center study.

Warschburger P(1), Petersen AC(2), von Rezori RE(2), Buchallik F(2), Baumeister 
H(3), Holl RW(4), Minden K(5)(6), Müller-Stierlin AS(7), Reinauer C(8), Staab 
D(9); COACH consortium.

Author information:
(1)Department of Psychology, Counseling Psychology, University of Potsdam, 
Karl-Liebknecht-Str. 24-25, 14476, Potsdam, Germany. warschb@uni-potsdam.de.
(2)Department of Psychology, Counseling Psychology, University of Potsdam, 
Karl-Liebknecht-Str. 24-25, 14476, Potsdam, Germany.
(3)Department of Clinical Psychology and Psychotherapy, Faculty of Engineering, 
Computer Science and Psychology, Institute of Psychology and Education, Ulm 
University, Ulm, Germany.
(4)Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, 
Germany.
(5)Charité University Medicine Berlin, Berlin, Germany.
(6)German Rheumatism Research Centre, Berlin, Germany.
(7)Department of Psychiatry and Psychotherapy II, BKH Günzburg, Ulm University, 
Günzburg, Germany.
(8)Department of General Pediatrics, Neonatology and Pediatric Cardiology, 
University Hospital Düsseldorf, Düsseldorf, Germany.
(9)Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, 
Charité University Medicine Berlin, Berlin, Germany.

BACKGROUND: Relatively little is known about protective factors and the 
emergence and maintenance of positive outcomes in the field of adolescents with 
chronic conditions. Therefore, the primary aim of the study is to acquire a 
deeper understanding of the dynamic process of resilience factors, coping 
strategies and psychosocial adjustment of adolescents living with chronic 
conditions.
METHODS/DESIGN: We plan to consecutively recruit N = 450 adolescents 
(12-21 years) from three German patient registries for chronic conditions (type 
1 diabetes, cystic fibrosis, or juvenile idiopathic arthritis). Based on 
screening for anxiety and depression, adolescents are assigned to two parallel 
groups - "inconspicuous" (PHQ-9 and GAD-7 < 7) vs. "conspicuous" (PHQ-9 or 
GAD-7 ≥ 7) - participating in a prospective online survey at baseline and 
12-month follow-up. At two time points (T1, T2), we assess (1) intra- and 
interpersonal resiliency factors, (2) coping strategies, and (3) health-related 
quality of life, well-being, satisfaction with life, anxiety and depression. 
Using a cross-lagged panel design, we will examine the bidirectional 
longitudinal relations between resiliency factors and coping strategies, 
psychological adaptation, and psychosocial adjustment. To monitor Covid-19 
pandemic effects, participants are also invited to take part in an intermediate 
online survey.
DISCUSSION: The study will provide a deeper understanding of adaptive, 
potentially modifiable processes and will therefore help to develop novel, 
tailored interventions supporting a positive adaptation in youths with a chronic 
condition. These strategies should not only support those at risk but also 
promote the maintenance of a successful adaptation.
TRIAL REGISTRATION: German Clinical Trials Register (DRKS), no. DRKS00025125 . 
Registered on May 17, 2021.

© 2021. The Author(s).

DOI: 10.1186/s12887-021-02869-9
PMCID: PMC8438102
PMID: 34521358 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


2990. Ir Med J. 2021 Aug 19;114(7):410.

Perspectives of Interstitial Lung Disease Patients and Carers During COVID-19.

Cassidy N(1), Sheahan D(2), Fox L(1)(3), Brown L(1)(4), Galvin L(1), Cassidy 
E(1), Sheridan M(1), O'Dowd G(1), O'Reilly KMA(1)(3).

Author information:
(1)The Irish Lung Fibrosis Association, Dublin, Ireland.
(2)Invisio Ltd., Blessington, Co. Wicklow, Ireland.
(3)Mater Misericordiae University Hospital, Dublin, Ireland.
(4)St. Vincent's University Hospital, Dublin, Ireland.

Aim To gain an understanding of the impact of COVID-19 on the daily life, 
healthcare needs, mental wellbeing and outlook of patients with Interstitial 
Lung Disease (ILD) and their caregivers. Methods ILD patients and caregivers 
were invited to participate in a quantitative survey. Respondents could 
self-select to then participate in in-depth structured telephone interviews. 
Survey data was compared to Department of Health COVID-19 public opinion tracker 
findings for the comparable time period. Results There were 170 survey respones 
(111 patients and 59 caregivers) and 14 in-depth interview participants. 32% 
(n=36) of patients and 42% (n=25) of caregivers expressed extreme worry 
regarding COVID-19 on a 1-10 scale. 83% (n=92) of patients expressed concern 
about safe hospital access, 33% (n=37) had received a telephone consultation 
with their clinician, 43% (n=48) reported test delays, 47% (n=52) were 
exercising less, 23% (n=26) reported worse sleep and 15% (n=17) reported being 
financially worse off. Carers reported that sleep was worse for 58% (n=34), 42% 
(n=25) reported being worse off financially, and 40% (n=24) reported a worse 
diet. Worry (66%, n=39), stress (51%, n=30), anxiety (49%, n=29) were commonly 
reported by carers. Discussion ILD patients and caregivers reported higher 
levels of worry regarding COVID-19 compared to the general public. Alternative 
pathways for quality ILD patient care and interventions to reduce the burden of 
care on ILD caregivers are required.

PMID: 34520645 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
declare.


2991. Drug Alcohol Rev. 2022 Jul;41(5):1009-1019. doi: 10.1111/dar.13382. Epub 2021 
Sep 14.

Opioid agonist treatment and patient outcomes during the COVID-19 pandemic in 
south east Sydney, Australia.

Lintzeris N(1)(2)(3), Deacon RM(1)(2)(3), Hayes V(2)(3)(4), Cowan T(2)(3), Mills 
L(1)(2)(3), Parvaresh L(2)(3)(5), Harvey Dodds L(2)(3)(4), Jansen L(2)(3), 
Dojcinovic R(2)(3), Leung MC(2)(3), Demirkol A(2)(3)(4)(6), Finch T(2)(3), 
Mammen K(2)(3).

Author information:
(1)Sydney School of Medicine (Central Clinical School), Faculty of Medicine and 
Health, The University of Sydney, Sydney, Australia.
(2)Drug and Alcohol Services, South Eastern Sydney Local Health District, 
Sydney, Australia.
(3)NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, 
Australia.
(4)School of Public Health and Community Medicine, UNSW Sydney, Sydney, 
Australia.
(5)School of Public Health, Faculty of Medicine and Health, The University of 
Sydney, Sydney, Australia.
(6)Pain Management Centre, Prince of Wales Hospital and Community Health 
Services, Sydney, Australia.

INTRODUCTION: In early 2020, many services modified their delivery of opioid 
treatment in response to the COVID-19 pandemic, to limit viral spread and 
maintain treatment continuity. We describe the changes to treatment and 
preliminary analysis of the association with patients' substance use and 
well-being.
METHODS: A pre-post comparison of treatment conditions and patient self-reported 
outcomes using data extracted from electronic medical records in the 5 months 
before (December 2019-April 2020) and after (May 2020-September 2020) changes 
were implemented in three public treatment services in South Eastern Sydney 
Local Health District.
RESULTS: Data are available for 429/460 (93%) patients. Few (21, 5%) dropped out 
of treatment. In the 'post' period there was significantly more use of depot 
buprenorphine (12-24%), access to any take-away doses (TAD; 24-69%), access to 
≥6 TAD per week (7-31%), pharmacy dosing (24-52%) and telehealth services. There 
were significant reductions in average opioid and benzodiazepine use, increases 
in cannabis use, with limited group changes in social conditions, or quality of 
life, psychological and physical health. At an individual level, 22% of patients 
reported increases in their use of either alcohol, opioids, benzodiazepines or 
stimulants of ≥4 days in the past 4 weeks. Regression analysis indicates 
increases in substance use were associated with higher levels of supervised 
dosing.
DISCUSSION AND CONCLUSIONS: These preliminary findings suggest that the modified 
model of care continued to provide safe and effective treatment, during the 
pandemic. Notably, there was no association between more TAD and significant 
increases in substance use. Limitations are discussed and further evaluation is 
needed.

© 2021 Australasian Professional Society on Alcohol and other Drugs.

DOI: 10.1111/dar.13382
PMCID: PMC8652992
PMID: 34520592 [Indexed for MEDLINE]

Conflict of interest statement: NL has received research funding from Camurus 
for unrelated research. VH has received money from Camurus and Viiv for 
providing education and training sessions. TC has received money from Camurus 
for providing education sessions.


2992. Am J Clin Oncol. 2021 Nov 1;44(11):580-587. doi: 10.1097/COC.0000000000000865.

The Impact of COVID-19 on Patients With Cancer: A National Study of Patient 
Experiences.

Rodriguez GM(1), Ferguson JM(2)(3), Kurian A(1)(2), Bondy M(2), Patel MI(1)(3).

Author information:
(1)Division of Oncology, Department of Medicine.
(2)Center for Population Health Sciences, Stanford University, Stanford.
(3)Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic abruptly disrupted 
cancer care. The impact of these disruptions on patient experiences remain 
relatively understudied. The objective of this study was to assess patients' 
perspectives regarding the impact of COVID-19 on their experiences, including 
their cancer care, emotional and mental health, and social determinants of 
health, and to evaluate whether these outcomes differed by cancer stage.
MATERIALS AND METHODS: We conducted a survey among adults with cancer across the 
United States from April 1, 2020 to August 26, 2020 using virtual snowball 
sampling strategy in collaboration with professional organizations, cancer care 
providers, and patient advocacy groups. We analyzed data using descriptive 
statistics, χ2 and t tests.
RESULTS: Three hundred twelve people with cancer participated and represented 38 
states. The majority were non-Hispanic White (n=183; 58.7%) and female (n=177; 
56.7%) with median age of 57 years. Ninety-one percent spoke English at home, 
70.1% had health insurance, and 67% had access to home internet. Breast cancer 
was the most common diagnosis (n=67; 21.5%). Most had Stage 4 disease (n=80; 
25.6%). Forty-six percent (n=145) experienced a change in their care due to 
COVID-19. Sixty percent (n=187) reported feeling very or extremely concerned 
that the pandemic would affect their cancer and disproportionately experienced 
among those with advanced cancer stages compared with earlier stages (P<0.001). 
Fifty-two percent (n=162) reported impact of COVID-19 on 1 or more aspects of 
social determinants of health with disproportionate impact among those with 
advanced cancer stages compared with earlier stages.
CONCLUSIONS: COVID-19 impacted the care and well-being of patients with cancer 
and this impact was more pronounced among people with advanced cancer stages. 
Future work should consider tailored interventions to mitigate the impact of 
COVID-19 on patients with cancer.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/COC.0000000000000865
PMCID: PMC8541895
PMID: 34519677 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


2993. J Dev Behav Pediatr. 2021 Sep 1;42(7):532-539. doi: 
10.1097/DBP.0000000000000935.

Child Psychological Functioning During the COVID-19 Lockdown: An Ecological, 
Family-Centered Approach.

Dubois-Comtois K(1)(2), Suffren S(1)(2)(3), St-Laurent D(1)(3), Milot T(3)(4), 
Lemelin JP(3)(5).

Author information:
(1)Département de Psychologie, Université du Québec à Trois-Rivières, 
Trois-Rivières, QC, Canada.
(2)Centre de Recherche, Centre Intégré Universitaire de Santé et de Services 
Sociaux du Nord-de-I'lle-de-Montréal (CIUSSS-NIM), Montreal, QC, Canada.
(3)Centre de Recherche Universitaire sur les Jeunes et les Familles (CRUJeF), 
Québec, QC, Canada.
(4)Département de Psychoéducation, Université du Québec à Trois-Rivières, 
Trois-Rivières, QC, Canada.
(5)Département de Psychoéducation, Université de Sherbrooke, Sherbrooke, QC, 
Canada.

OBJECTIVE: To evaluate how sociodemographic characteristics and various aspects 
of parent well-being, family functioning, parent-child relationship, and child 
characteristics are related to psychological functioning in children aged 9 to 
12 years during the COVID-19 lockdown.
METHOD: Participants included 144 children aged 9 to 12 years and their parents 
who lived in the province of Quebec, Canada, during the COVID-19 mandatory 
lockdown. Parents and children were administered a phone-based survey in which 
various child, parent, parent-child, and family characteristics were assessed.
RESULTS: Results showed that higher internalizing problems in children were 
related to greater depressive symptoms in parents, lower attachment security to 
parents, and greater aversion to aloneness in children. Results on externalizing 
behavior problems showed that more problems were associated with more family 
dysfunction and chaos and lower attachment security to parents. Finally, results 
on children's anxiety toward COVID-19 showed that more anxiety was associated 
with greater parental anxiety toward COVID-19 and more child aversion to 
aloneness.
CONCLUSION: Our findings showed that even during an unusual and stressful 
context such as a pandemic, proximal variables such as the attachment 
relationship that have been known to be closely associated with adaptation are 
significantly related to child psychological functioning. Such observations are 
important because they highlight factors that may accentuate child vulnerability 
in times of a pandemic and shed light on potential intervention targets.

Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.

DOI: 10.1097/DBP.0000000000000935
PMCID: PMC8432605
PMID: 34518496 [Indexed for MEDLINE]

Conflict of interest statement: Disclosure: The authors declare no conflict of 
interest.


2994. Neonatal Netw. 2021 Aug 1;40(5):332-334. doi: 10.1891/11-T-709.

The Application of Trauma-Informed Care to Substance Use Disorder.

Maguire DJ, Cirrito BL, Solomon J.

Trauma-informed care (TIC) has been described to apply to several groups of 
traumatized patient/families in the NICU. Trauma is multidimensional, including 
physical and psychological injuries with long-term effects on well-being and 
function. A newborn experiences the best outcomes when the mother also 
experiences the best outcomes. Thus, the TIC approach is applicable to the care 
of the infant with neonatal abstinence syndrome (NAS) and mother. Organizational 
adoption of this model is likely to provide a supportive and therapeutic 
environment for the infant with NAS and family.

© Copyright 2021 Springer Publishing Company, LLC.

DOI: 10.1891/11-T-709
PMID: 34518385 [Indexed for MEDLINE]


2995. Dementia (London). 2022 Feb;21(2):410-425. doi: 10.1177/14713012211042187. Epub 
2021 Sep 14.

Exploring resilience and well-being of family caregivers of people with dementia 
exposed to mandatory social isolation by COVID-19.

Sánchez-Teruel D(1), Robles-Bello MA(2), Sarhani-Robles M(3), Sarhani-Robles 
A(4).

Author information:
(1)Psychology Department, 16735University of Cordoba, Cordoba, Spain.
(2)Psychology Department, 16747University of Jaen, Jaen, Spain.
(3)16741Faculty of Medicine of the Autonomous University of Barcelona, 
Barcelona, Spain.
(4)Faculty of Medicine of the 16747University of Granada, Granada, Spain.

BACKGROUND: The COVID-19 pandemic has raised questions about the resilience of 
health care systems worldwide. In this regard, one group of people whose 
physical and mental health has been affected has been family caregivers of 
people with dementia.
OBJECTIVE: This study aims to identify the variables that predict a high degree 
of well-being in family caregivers of people with dementia during this period of 
mandatory lockdown.
METHODS: A total of 310 respondents participated in an online survey (266 women 
and 44 men) from various regions in Spain, aged between 20 and 73 years old (M = 
46.45; SD = 15.97), and all were family members.
RESULTS: The results showed that there were notable differences in all the 
protective variables, together with a significant strong positive relationship 
between well-being and resilience (r = 0.92; p < 0.01) and with coping 
strategies (r = 0.85; p < 0.01), and there were also some significant negative 
relationships between well-being and difficulties in emotional regulation (ρ = 
-.78; p < 0.01). The most predictive variables of a higher level of well-being 
included the type of dementia (β = 1.19; CI (95%) = 1.01-1.29; p< 0.01), living 
in a large house (β = 0.97; CI (95%) =. 23-0.98; p < 0.01), social support as a 
coping strategy (β = 1.27; CI (95%) = 1.21-1.29; p < 0.01) and mainly resilience 
(β = 1.34; CI (95%) = 1.30-1.37; p < 0.01).
DISCUSSION: We discuss the importance of promoting higher levels of resilience 
through the development of protective psychosocial variables in caregivers of 
people with dementia exposed to situations of mandatory social isolation as a 
modulator of the psychosocial well-being of these family caregivers.

DOI: 10.1177/14713012211042187
PMCID: PMC8818476
PMID: 34517732 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of conflicting interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


2996. JMIR Public Health Surveill. 2021 Sep 28;7(9):e29413. doi: 10.2196/29413.

Tracking Self-reported Symptoms and Medical Conditions on Social Media During 
the COVID-19 Pandemic: Infodemiological Study.

Ding Q(1)(2), Massey D(1), Huang C(1), Grady CB(3), Lu Y(1)(4), Cohen A(5), 
Matzner P(5), Mahajan S(1)(4), Caraballo C(1)(4), Kumar N(6)(7), Xue Y(8), 
Dreyer R(9), Roy B(3)(10), Krumholz HM(1)(4)(11).

Author information:
(1)Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New 
Haven, CT, United States.
(2)College of Health and Human Sciences, Purdue University, West Lafayette, IN, 
United States.
(3)Department of Chronic Disease Epidemiology, Yale School of Public Health, New 
Haven, CT, United States.
(4)Section of Cardiovascular Medicine, Department of Internal Medicine, Yale 
School of Medicine, New Haven, CT, United States.
(5)Skai, Tel-Aviv, Israel.
(6)Department of Sociology, Yale University, New Haven, CT, United States.
(7)Institute for Network Science, Yale University, New Haven, CT, United States.
(8)Foundation for a Smoke-Free World, New York, NY, United States.
(9)Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, 
United States.
(10)Department of Medicine, Yale School of Medicine, New Haven, CT, United 
States.
(11)Department of Health Policy and Management, Yale School of Public Health, 
New Haven, CT, United States.

BACKGROUND: Harnessing health-related data posted on social media in real time 
can offer insights into how the pandemic impacts the mental health and general 
well-being of individuals and populations over time.
OBJECTIVE: This study aimed to obtain information on symptoms and medical 
conditions self-reported by non-Twitter social media users during the COVID-19 
pandemic, to determine how discussion of these symptoms and medical conditions 
changed over time, and to identify correlations between frequency of the top 5 
commonly mentioned symptoms post and daily COVID-19 statistics (new cases, new 
deaths, new active cases, and new recovered cases) in the United States.
METHODS: We used natural language processing (NLP) algorithms to identify 
symptom- and medical condition-related topics being discussed on social media 
between June 14 and December 13, 2020. The sample posts were geotagged by 
NetBase, a third-party data provider. We calculated the positive predictive 
value and sensitivity to validate the classification of posts. We also assessed 
the frequency of health-related discussions on social media over time during the 
study period, and used Pearson correlation coefficients to identify 
statistically significant correlations between the frequency of the 5 most 
commonly mentioned symptoms and fluctuation of daily US COVID-19 statistics.
RESULTS: Within a total of 9,807,813 posts (nearly 70% were sourced from the 
United States), we identified a discussion of 120 symptom-related topics and 
1542 medical condition-related topics. Our classification of the health-related 
posts had a positive predictive value of over 80% and an average classification 
rate of 92% sensitivity. The 5 most commonly mentioned symptoms on social media 
during the study period were anxiety (in 201,303 posts or 12.2% of the total 
posts mentioning symptoms), generalized pain (189,673, 11.5%), weight loss 
(95,793, 5.8%), fatigue (91,252, 5.5%), and coughing (86,235, 5.2%). The 5 most 
discussed medical conditions were COVID-19 (in 5,420,276 posts or 66.4% of the 
total posts mentioning medical conditions), unspecified infectious disease 
(469,356, 5.8%), influenza (270,166, 3.3%), unspecified disorders of the central 
nervous system (253,407, 3.1%), and depression (151,752, 1.9%). Changes in posts 
in the frequency of anxiety, generalized pain, and weight loss were significant 
but negatively correlated with daily new COVID-19 cases in the United States 
(r=-0.49, r=-0.46, and r=-0.39, respectively; P<.05). Posts on the frequency of 
anxiety, generalized pain, weight loss, fatigue, and the changes in fatigue 
positively and significantly correlated with daily changes in both new deaths 
and new active cases in the United States (r ranged=0.39-0.48; P<.05).
CONCLUSIONS: COVID-19 and symptoms of anxiety were the 2 most commonly discussed 
health-related topics on social media from June 14 to December 13, 2020. 
Real-time monitoring of social media posts on symptoms and medical conditions 
may help assess the population's mental health status and enhance public health 
surveillance for infectious disease.

©Qinglan Ding, Daisy Massey, Chenxi Huang, Connor B Grady, Yuan Lu, Alina Cohen, 
Pini Matzner, Shiwani Mahajan, César Caraballo, Navin Kumar, Yuchen Xue, Rachel 
Dreyer, Brita Roy, Harlan M Krumholz. Originally published in JMIR Public Health 
and Surveillance (https://publichealth.jmir.org), 28.09.2021.

DOI: 10.2196/29413
PMCID: PMC8480398
PMID: 34517338 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: YL is supported by the 
National Heart, Lung, and Blood Institute (K12HL138037) and the Yale Center for 
Implementation Science. RD is supported by an American Heart Association 
Transformational Project Award (#19TPA34830013) and a Canadian Institutes of 
Health Research Project Grant (RN356054–401229). In the past 3 years, HMK 
received expenses and personal fees from UnitedHealth, IBM Watson Health, 
Element Science, Aetna, Facebook, the Siegfried and Jensen Law Firm, Arnold and 
Porter Law Firm, Martin/Baughman Law Firm, F-Prime, and the National Center for 
Cardiovascular Diseases in Beijing. He is an owner of Refactor Health and 
HugoHealth, and had grants and contracts from the Centers for Medicare & 
Medicaid Services, Medtronic, the US Food and Drug Administration, Johnson & 
Johnson, and the Shenzhen Center for Health Information. The remaining authors 
have no disclosures to report.


2997. Psychiatr Rehabil J. 2021 Sep;44(3):201-203. doi: 10.1037/prj0000500.

Introduction to the special section: A call to action to address psychiatric 
rehabilitation workers' well-being.

Rollins AL(1), Morse G(2), Monroe-DeVita M(3).

Author information:
(1)VA HSR&D Center for Health Information and Communication.
(2)Places for People.
(3)School of Medicine.

The well-being of the psychiatric rehabilitation workforce is a growing concern, 
particularly as a result of the stresses of the COVID-19 pandemic on demand for 
mental health services. Research focusing on this aspect of psychiatric 
rehabilitation services remains limited but is important in supporting a 
resilient mental health workforce. This special section presents four papers 
that focus on aspects of worker well-being and burnout, including drivers of 
well-being and other outcomes, as well as exploring potential action steps and 
contexts that organizations could consider in their efforts to bolster 
well-being. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

DOI: 10.1037/prj0000500
PMID: 34516153 [Indexed for MEDLINE]


2998. J Clin Nurs. 2022 Aug;31(15-16):2189-2197. doi: 10.1111/jocn.16034. Epub 2021 
Sep 12.

Nurses' perceptions of social rejection, resilience and well-being during 
COVID-19: A national comparative study.

Benbenishty J(1), Ashkenazy S(2), Levdov Avital I(3), Jakobson L(4), Kolpak 
O(4), DeKeyser Ganz F(5).

Author information:
(1)Hadassah Hebrew University Medical Center, Kiryat Hadassah, Jerusalem, 
Israel.
(2)Hadassah Medical Center, Kiryat Hadassah, Jerusalem, Israel.
(3)Israel Poison Information Center, Rambam Health Care Campus, Haifa, Israel.
(4)Galilee Medical Center, Nahariya, Israel.
(5)Jerusalem College of Technology, Jerusalem, Israel.

AIMS AND OBJECTIVES: To determine the level of social rejection and well-being 
of nurses, whether resilience is a mediator between them and to compare nurses 
who worked versus did not work on COVID-19 wards.
BACKGROUND: During the COVID-19 pandemic health care workers reported 
psychological distress and social rejection.
METHODS: An online survey was sent to nursing social media groups in Israel. 
Respondents completed a Demographic, Social Rejection, Resilience and General 
Well-being questionnaire.
RESULTS: Two hundred and forty-seven nurses responded. The majority were female 
with a mean age of 43.6 years Approximately one-third were worried about 
infecting their family members and many agreed that their family fears that the 
nurse will infect them. Nurses reported their partner, family members, 
neighbours and the public physically distanced themselves from them. 
Approximately one quarter reported feeling lonely. Statistically significant 
differences were found between those who worked versus not work on a COVID-19 
unit on general well-being, and social rejection. No differences were found in 
resilience scores.
CONCLUSIONS: Social rejection was felt by many nurses as shown by an inverse 
relationship between the closeness of the relationship and the sense of social 
rejection and a high level of loneliness and depression. A higher level of 
social rejection and lower well-being were found among nurses working on 
COVID-19 wards as opposed to those who did not. General well-being was found to 
be exceptionally low during COVID-19. Resilience did not mediate the 
relationship between social rejection and general well-being.
RELEVANCE TO CLINICAL PRACTICE: Perceived social rejection might be associated 
with decreased well-being. The level of resilience is related to the level of 
well-being among nurses in general. Nurses not working in COVID-19 wards have 
higher levels of well-being and less social rejection compared with nurses 
working in these wards.

© 2021 John Wiley & Sons Ltd.

DOI: 10.1111/jocn.16034
PMCID: PMC8661763
PMID: 34514674 [Indexed for MEDLINE]

Conflict of interest statement: None.


2999. J Relig Health. 2021 Dec;60(6):4579-4599. doi: 10.1007/s10943-021-01422-3. Epub 
2021 Sep 12.

Coping with Anxiety During the COVID-19 Pandemic: A Case Study of Academics in 
the Muslim World.

Achour M(1), Souici D(2), Bensaid B(3), Binti Ahmad Zaki N(4), Alnahari AAA(4).

Author information:
(1)Laboratory of Economic Studies On Industrial Zones in Light of the New Role 
of the University, Department of Management, Faculty of Economics, Business and 
Management Sciences, University of Mohamed, El Bachir El-Ibrahimi, Bordj-Bou 
Arreridj, El Anceur, Algeria. achour.meguellati@univ-bba.dz.
(2)Department of Psychology, Educational Sciences and Orthophony, Faculty of 
Human and Social Sciences, University of Batna 1, Batna, Algeria.
(3)Istanbul Sabahattin Zaim University, Istanbul, Turkey.
(4)Fiqh and Usul Department, Academy of Islamic Studies, University of Malaya, 
50603, Kuala Lumpur, Malaysia.

The COVID-19 pandemic has been a global phenomenon defined by uncertainty, fear 
and grief which has resulted in record high levels of stress and anxiety in the 
first half of 2020. It also led to an increased interest in the study of the 
role of belief, religion, and spirituality as responses to coping with and 
responding to the pandemic throughout different societal domains. This study 
explores the impact of anxiety and stress caused by the pandemic on Muslim 
academics' subjective well-being. It also explores correlations between coping 
and spirituality by assessing Muslim academics' coping strategies in overcoming 
stress and anxiety. To this end, this study sampled 480 Muslim academics ages 
25-60 years residing in Muslim countries. The findings show a negative yet 
significant correlation between anxiety and well-being while also showing a 
positive and significant correlation between coping strategies and subjective 
well-being. The research also points to the role of coping strategies in 
reducing anxiety and stress, the resulting improvements in well-being for Muslim 
academics, and the mediating effect of coping strategies between anxiety, 
stress, and well-being for Muslim academics.

© 2021. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s10943-021-01422-3
PMCID: PMC8435299
PMID: 34514548 [Indexed for MEDLINE]

Conflict of interest statement: The authors reported no potential conflict of 
interest.


3000. BMC Health Serv Res. 2021 Sep 11;21(1):953. doi: 10.1186/s12913-021-06947-7.

Changes in pediatric hospital care during the COVID-19 pandemic: a national 
qualitative study.

Penwill NY(1), Roessler De Angulo N(2), Pathak PR(2), Ja C(3), Elster MJ(2), 
Hochreiter D(4), Newton JM(5), Wilson KM(6), Kaiser SV(2)(7).

Author information:
(1)Department of Pediatrics, University of California, San Francisco, 550 16th 
Street, San Francisco, CA, 94158, USA. Nicole.Penwill@ucsf.edu.
(2)Department of Pediatrics, University of California, San Francisco, 550 16th 
Street, San Francisco, CA, 94158, USA.
(3)University of California, Davis, 1 Shields Ave, Davis, CA, 95616, USA.
(4)Lawrence and Memorial Hospital, 365 Montauk Ave, New London, CT, 06320, USA.
(5)Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, 
USA.
(6)The Kravis Children's Hospital at the Icahn School of Medicine at Mount 
Sinai, One Gustave L. Levy Place, Box 1198, New York, NY, 10029, USA.
(7)Philip R. Lee Institute for Health Policy Studies, 3333 California St, San 
Francisco, CA, 94118, USA.

BACKGROUND: The COVID-19 pandemic has necessitated rapid changes in healthcare 
delivery in the United States, including changes in the care of hospitalized 
children. The objectives of this study were to identify major changes in 
healthcare delivery for hospitalized children during the COVID-19 pandemic, 
identify lessons learned from these changes, and compare and contrast the 
experiences of children's and community hospitals.
METHODS: We purposefully sampled participants from both community and children's 
hospitals serving pediatric patients in the six U.S. states with the highest 
COVID-19 hospitalization rates at the onset of the pandemic. We recruited 2-3 
participants from each hospital (mix of administrators, front-line physicians, 
nurses, and parents/caregivers) for semi-structured interviews. We analyzed 
interview data using constant comparative methods to identify major themes.
RESULTS: We interviewed 30 participants from 12 hospitals. Participants 
described how leaders rapidly developed new hospital policies (e.g., directing 
use of personal protective equipment) and how this was facilitated by reviewing 
internal and external data frequently and engaging all relevant stakeholders. 
Hospital leaders optimized communication through regular, transparent, 
multi-modal, and bi-directional communication. Clinicians increased use of 
videoconference and telehealth to facilitate physical distancing, but these 
technologies may have disadvantaged non-English speakers. Due to declining 
volumes of hospitalized children and surges of adult patients, clinicians newly 
provided care for hospitalized adults. This was facilitated by developing care 
teams supported by adult hospitalists, multidisciplinary support via 
videoconference, and educational resources. Participants described how the 
pandemic negatively impacted clinicians' mental health, and they stressed the 
importance of mental health resources and wellness activities/spaces.
CONCLUSIONS: We identified several major changes in inpatient pediatric care 
delivery during the COVID-19 pandemic, including the adoption of new hospital 
policies, video communication, staffing models, education strategies, and staff 
mental health supports. We outline important lessons learned, including 
strategies for successfully developing new policies, effectively communicating 
with staff, and supporting clinicians' expanding scope of practice. Potentially 
important focus areas in pandemic recovery include assessing and supporting 
clinicians' mental health and well-being, re-evaluating trainees' 
skills/competencies, and adapting educational strategies as needed. These 
findings can help guide hospital leaders in supporting pandemic recovery and 
addressing future crises.

© 2021. The Author(s).

DOI: 10.1186/s12913-021-06947-7
PMCID: PMC8435183
PMID: 34511079 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3001. JMIR Public Health Surveill. 2021 Sep 24;7(9):e31278. doi: 10.2196/31278.

The Influence of Social Distancing Behaviors and Psychosocial Factors on 
Physical Activity During the COVID-19 Pandemic: Cross-sectional Survey Study.

Cross TJ(1)(2), Isautier JMJ(1)(2), Morris SJ(1), Johnson BD(2), Wheatley-Guy 
CM(3), Taylor BJ(4).

Author information:
(1)Sydney School of Health Sciences, Faculty of Medicine and Health, The 
University of Sydney, Camperdown, Australia.
(2)Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United 
States.
(3)Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, United 
States.
(4)Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL, United 
States.

BACKGROUND: The COVID-19 pandemic has arguably facilitated a shift toward 
increased sedentariness and reduced physical activity. Moreover, there is 
mounting evidence that mental health has also declined during the pandemic. 
However, it remains unknown to what extent social distancing (SD) behaviors and 
mental health have affected the physical activity levels of the general 
population.
OBJECTIVE: The purpose of this study was to determine the influence of SD 
behaviors and prevailing mental health on the odds of being physically active 
during the early COVID-19 pandemic response.
METHODS: A total of 4819 adults (2474/4819, 51.3%, female) from the US 
population with a median age of 46 (IQR 35-59) completed an online survey during 
the early pandemic response (April-June 2020). The survey included questions on 
adherence to 11 SD behaviors, and validated questionnaires which assessed 
self-reported physical activity, depression, anxiety, and mental well-being. 
Respondents were categorized into 2 physical activity groups: inactive (0-599 
metabolic equivalent of task [MET]-minutes/week) and active (≥600 
MET-minutes/week). A logistic generalized additive model (GAM) was used to 
determine which SD factors and mental health outcomes were associated with 
physical activity level.
RESULTS: The GAM analysis revealed that wearing a facemask in public (odds ratio 
[OR] 1.46, 95% CI 1.14-1.79; P=.003), limiting the use of public transport (OR 
1.47, 95% CI 1.19-1.83; P=.001), and restricting travel outside the house (OR 
1.56, 95% CI 1.19-2.05; P=.002) were SD behaviors associated with higher odds of 
being more physically active. Conversely, avoiding physical activity outside the 
house was associated with higher odds of being inactive (OR 0.52, 95% CI 
0.46-0.63; P<.001). Leaving the house more frequently, and a higher mental 
well-being were associated with increasing odds of being physically active 
(P<.001). Engaging with a moderate number of SD behaviors (3-7 total) was 
positively associated with physical activity, whereas a very high SD vigilance 
(ie, engaging with ≥10 total behaviors) decreased the odds of being active 
during the early pandemic response.
CONCLUSIONS: Based on the findings of our study, we suggest that future public 
health messaging of SD guidelines should include (1) a clear portrayal of the 
benefits of regular exercise on mental health; and (2) a specific focus on how 
to be physically active outdoors in a COVID-safe manner.

©Troy J Cross, Jennifer M J Isautier, Sarah J Morris, Bruce D Johnson, Courtney 
M Wheatley-Guy, Bryan J Taylor. Originally published in JMIR Public Health and 
Surveillance (https://publichealth.jmir.org), 24.09.2021.

DOI: 10.2196/31278
PMCID: PMC8477911
PMID: 34509976 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


3002. Soc Sci Med. 2021 Oct;287:114371. doi: 10.1016/j.socscimed.2021.114371. Epub 
2021 Sep 4.

Student returnees from China's COVID-19 epicenter: Spatio-temporal movement and 
impact of tracing.

Fei D(1), Liao C(2), Yang H(3).

Author information:
(1)School of Sustainability, Arizona State University, 800 S Cady Mall, Tempe, 
AZ, 85281, USA. Electronic address: dfei4@asu.edu.
(2)School of Sustainability, Arizona State University, 800 S Cady Mall, Tempe, 
AZ, 85281, USA. Electronic address: cliao29@asu.edu.
(3)Department of Public Administration, Huazhong Agricultural University, China. 
Electronic address: yanghuan@mail.hzau.edu.cn.

At the initial stage of COVID-19 outbreak, tracing returnees from Wuhan - the 
epicenter of the disease - is a major strategy in each province of China to 
contain its spread. However, scholars are yet to assess the impact of tracing on 
individuals. Drawing upon a large-scale survey with students from four major 
universities in Wuhan, we investigate individual experiences with tracing 
activities at government and community levels and the impacts on students' 
socio-psychological wellbeing. Findings indicate that tracing is likely to 
increase the risks of privacy infringement, verbal slur, and warning at 
residence; and students experience moderate-to-high levels of anxiety and fear. 
Improved public health measures are therefore necessary to balance the twin 
goals of containing disease and alleviating unintended consequences of tracing.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.socscimed.2021.114371
PMCID: PMC8418049
PMID: 34509030 [Indexed for MEDLINE]


3003. Sleep Med. 2021 Nov;87:38-45. doi: 10.1016/j.sleep.2021.07.035. Epub 2021 Aug 4.

Insomnia, anxiety, and depression during the COVID-19 pandemic: an international 
collaborative study.

Morin CM(1), Bjorvatn B(2), Chung F(3), Holzinger B(4), Partinen M(5), Penzel 
T(6), Ivers H(7), Wing YK(8), Chan NY(8), Merikanto I(9), Mota-Rolim S(10), 
Macêdo T(11), De Gennaro L(12), Léger D(13), Dauvilliers Y(14), Plazzi G(15), 
Nadorff MR(16), Bolstad CJ(16), Sieminski M(17), Benedict C(18), Cedernaes 
J(19), Inoue Y(20), Han F(21), Espie CA(22).

Author information:
(1)École de Psychologie, Centre d'étude des Troubles du Sommeil, Centre de 
Recherche CERVO/Brain Research Center, Université Laval, Québec, Canada. 
Electronic address: cmorin@psy.ulaval.ca.
(2)Department of Global Public Health and Primary Care, University of Bergen, 
Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, 
Bergen, Norway.
(3)Department of Anesthesiology and Pain Medicine, University Health Network, 
University of Toronto, Toronto, Canada.
(4)Institute for Dream and Consciousness Research, Medical University of Vienna, 
Austria.
(5)Helsinki Sleep Clinic, Vitalmed Research Center, Terveystalo, Department of 
Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland.
(6)Sleep Medicine Center, Charité Universitätsmedizin Berlin, Berlin, Germany.
(7)École de Psychologie, Centre d'étude des Troubles du Sommeil, Centre de 
Recherche CERVO/Brain Research Center, Université Laval, Québec, Canada.
(8)Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty 
of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
(9)SleepWell Research Program, Faculty of Medicine, University of Helsinki, 
Helsinki, Finland; Department of Public Health Solutions, Finnish Institute for 
Health and Welfare, Helsinki, Finland.
(10)Brain Institute, Physiology and Behavior Department, Onofre Lopes University 
Hospital - Federal University of Rio Grande do Norte, Natal, Brazil.
(11)Department of Psychology, Federal University of Rio Grande do Norte, Natal, 
Brazil.
(12)Department of Psychology, Sapienza University of Rome, Rome, Italy; IRCCS 
Fondazione Santa Lucia, Rome, Italy.
(13)Université de Paris, APHP, VIFASOM, Hôtel-Dieu, Centre du Sommeil et de la 
Vigilance, Paris, France.
(14)Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac 
Hospital, CHU Montpellier, INM, Univ Montpellier, INSERM, Montpellier, France.
(15)IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; 
Department of Biomedical, Metabolic and Neural Sciences, University of Modena 
and Reggio-Emilia, Modena, Italy.
(16)Mississippi State University, Starkville, MS, USA and Department of 
Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, 
USA.
(17)Department of Emergency Medicine, Medical University of Gdansk, Gdansk, 
Poland.
(18)Department of Neuroscience (Sleep Science Lab), BMC, Uppsala University, 
Uppsala, Sweden.
(19)Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
(20)Tokyo Medical University, Tokyo, Japan.
(21)Department of Respiratory Medicine, Peking University People's Hospital, 
China.
(22)Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical 
Neurosciences, University of Oxford, Oxford, UK.

IMPORTANCE AND STUDY OBJECTIVE: The COVID-19 pandemic has produced unprecedented 
changes in social, work, and leisure activities, which all have had major impact 
on sleep and psychological well-being. This study documented the prevalence of 
clinical cases of insomnia, anxiety, and depression and selected risk factors 
(COVID-19, confinement, financial burden, social isolation) during the first 
wave of the pandemic in 13 countries throughout the world.
DESIGN AND PARTICIPANTS: International, multi-center, harmonized survey of 
22 330 adults (mean age = 41.9 years old, range 18-95; 65.6% women) from the 
general population in 13 countries and four continents. Participants were 
invited to complete a standardized web-based survey about sleep and 
psychological symptoms during the first wave of the COVID-19 pandemic from May 
to August 2020.
RESULTS: Clinical insomnia symptoms were reported by 36.7% (95% CI, 36.0-37.4) 
of respondents and 17.4% (95% CI, 16.9-17.9) met criteria for a probable 
insomnia disorder. There were 25.6% (95% CI, 25.0-26.2) with probable anxiety 
and 23.1% (95% CI, 22.5-23.6) with probable depression. Rates of insomnia 
symptoms (>40%) and insomnia disorder (>25%) were significantly higher in women, 
younger age groups, and in residents of Brazil, Canada, Norway, Poland, USA, and 
United Kingdom compared to residents from Asian countries (China and Japan, 8% 
for disorder and 22%-25% for symptoms) (all Ps < 0.01). Proportions of insomnia 
cases were significantly higher among participants who completed the survey 
earlier in the first wave of the pandemic relative to those who completed it 
later. Risks of insomnia were higher among participants who reported having had 
COVID-19, who reported greater financial burden, were in confinement for a 
period of four to five weeks, and living alone or with more than five people in 
same household. These associations remained significant after controlling for 
age, sex, and psychological symptoms.
CONCLUSION AND RELEVANCE: Insomnia, anxiety, and depression were very prevalent 
during the first wave of the COVID-19 pandemic. Public health prevention 
programs are needed to prevent chronicity and reduce long-term adverse outcomes 
associated with chronic insomnia and mental health problems.

Copyright © 2021 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.sleep.2021.07.035
PMCID: PMC8425785
PMID: 34508986 [Indexed for MEDLINE]

Conflict of interest statement: The ICMJE Uniform Disclosure Form for Potential 
Conflicts of Interest associated with this article can be viewed by clicking on 
the following link: https://doi.org/10.1016/j.sleep.2021.07.035.


3004. JNMA J Nepal Med Assoc. 2021 Jul 1;59(238):580-584. doi: 10.31729/jnma.6747.

Depression, Anxiety and Stress among Nepali Health Care Workers during the 
Coronavirus Disease 2019 Pandemic: A Cross-sectional Survey.

Sharma I(1), Misra A(2), Kumar Shrestha B(3), Kumar Koirala A(4), Banjade A(5), 
Banjade P(6).

Author information:
(1)Division of Nephrology, University at Buffalo, New York, United States of 
America.
(2)Black Country Healthcare NHS Foundation Trust, West Midlands, United Kingdom.
(3)Department of Physiology, Nepalese Army Institute of Health Sciences, 
Kathmandu, Nepal.
(4)School of Health and Allied Sciences, Pokhara University, Nepal.
(5)Patan Academy of Health Sciences, Oxford University Clinical Research Unit, 
Nepal.
(6)Emergency Medical Services, Ministry of Health, Male, Maldives.

INTRODUCTION: Studies among health care workers from different part of world 
during the coronavirus disease 19 pandemic have reported substantial impact on 
their physical, mental and emotional well-being. This study measured the impact 
of coronavirus disease 2019 on the mental health of Nepali healthcare workers in 
different parts of the world during the pandemic.
METHODS: This cross-sectional survey was carried out from December 25, 2020 to 
Jan 25, 2021. Ethical approval was taken from the Institutional Review Committee 
(reference number: 372). Online questionnaire including demographic profiles and 
Depression, Anxiety, and Stress Scales-21 instrument were sent to Nepali 
healthcare workers around the world through social media apps using convenience 
sampling. Data were entered into Microsoft Excel for Mac version 16.49 and 
analysed.
RESULTS: Among 208 who participated in the study, 62 (30%) participants were 
positive for anxiety, 47 (22.5%) for depression and 25 (12%) for stress. Higher 
prevalence of depression 18 (30%) and stress 10 (17%) was found in nurses 
compared to paramedics, among whom depression was seen in 5 (20%) and stress in 
4 (16%). Among doctors, depression was found in 24 (19%) and stress in 11 (9%).
CONCLUSIONS: This study demonstrated that a high proportion of healthcare 
workers were suffering from depression, anxiety and stress. Our findings are 
similar to the data from other national and international studies.

DOI: 10.31729/jnma.6747
PMCID: PMC8369558
PMID: 34508398 [Indexed for MEDLINE]

Conflict of interest statement: None.


3005. Clin Med (Lond). 2021 Sep;21(5):e522-e525. doi: 10.7861/clinmed.2021-0244.

Foundation doctors' perspectives on the impact of the COVID-19 pandemic and 
lessons for the future.

Kotta PA(1), Elango M(2), Matcha N(1), Chow KY(1).

Author information:
(1)St Thomas' Hospital, London, UK.
(2)Imperial College London, London, UK.

The foundation programme is a 2-year training programme for newly qualified 
doctors and aims to bridge the gap between medical school and specialty 
training. The pandemic led to some major disruptions to foundation training. As 
foundation trainees, we encountered new challenges: there were reduced learning 
opportunities and our future paths became uncertain with changes to specialty 
training applications and membership exams. However, it is said that every 
crisis creates new opportunities and is a test of our resilience and 
innovativeness. There was the adoption of novel teaching methods, new research 
opportunities, increased importance given to teamwork and support for our 
wellbeing and mental health. We learnt lessons from this crisis that we should 
take forward to improve foundation training for the future.

© Royal College of Physicians 2021. All rights reserved.

DOI: 10.7861/clinmed.2021-0244
PMCID: PMC8439498
PMID: 34507937 [Indexed for MEDLINE]


3006. BMC Fam Pract. 2021 Sep 10;22(1):181. doi: 10.1186/s12875-021-01532-7.

The effect of COVID-19 on mental well-being in Switzerland: a cross-sectional 
survey of the adult Swiss general population.

Diaz Hernandez L(1), Giezendanner S(2), Fischer R(2), Zeller A(2).

Author information:
(1)Centre for Primary Health Care, University of Basel, Kantonsspital Baselland, 
Rheinstrasse 26, 4410, Liestal, Switzerland. laura.diazhernandez@unibas.ch.
(2)Centre for Primary Health Care, University of Basel, Kantonsspital Baselland, 
Rheinstrasse 26, 4410, Liestal, Switzerland.

BACKGROUND: In addition to the threat of the COVID-19 pandemic to physical 
health, mental health is challenged by the emotional response to the situation 
and the official measures taken to stop the pandemic. This study aimed to assess 
the prevalence of impaired mental well-being due to COVID-19 and explore 
associated factors.
METHODS: The study was an observational, population-based, nationwide, 
cross-sectional online survey of a representative sample of the general Swiss 
population performed between March and April 2020. Participants reported on 
mental well-being, self-isolation/quarantine, their risk for developing severe 
COVID-19, and their work situation. Multivariable logistic regression analyses 
assessed risk factors for impaired mental well-being due to the pandemic.
RESULTS: Data from 1022 individuals were analysed. The median age was 44 years 
(range 18 to 78) and 49% were women. A third of respondents reported that the 
COVID-19 pandemic impaired their mental well-being and almost half reported 
specific mental health concerns. Impaired mental well-being was associated with 
having health problems (OR = 1.88, 95% CI: 1.29-2.74, vs no problems), being or 
living with someone at risk for severe COVID-19 (OR = 1.38, 95% CI: 1-1.9,), 
smoking (OR = 1.8, 95% CI: 1.24-2.61), living in urban residential environments 
(OR = 1.62, 95% CI: 1.13-2.32, vs rural), not being able to work due to closed 
workplace (OR = 1.66, 95% CI: 1.04-2.67), aged between 18 and 29 years old 
(OR = 1.99, 95% CI: 1.32-3.01, vs 45 to 59 years old), and living in a single 
household (living with someone, OR = 0.65, 95% CI: 0.44-0.97,vs single 
household). Overall, the most significant covariates of impaired mental 
well-being were specific mental health concerns: feeling depressed (OR = 7.21, 
95% CI: 4.5-11.55), feeling less pleasure in doing things than before 
(OR = 6.28, 95% CI: 4.1-9.62), feeling anxious (OR = 6.13, 95% CI: 3.91-9.59) 
and feeling lonely (OR = 4.08, 95% CI: 2.53-6.58).
CONCLUSION: Impaired mental well-being can carry long-term consequences. We 
encourage policymakers to implement strategies to promote mental health during 
this pandemic situation. Special attention should be addressed to the youngest, 
those at risk for severe COVID-19 and those with government-imposed work 
restrictions.

© 2021. The Author(s).

DOI: 10.1186/s12875-021-01532-7
PMCID: PMC8432273
PMID: 34507540 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


3007. Prim Care Companion CNS Disord. 2021 Sep 9;23(5):21m03003. doi: 
10.4088/PCC.21m03003.

COVID-19 Infection in an Inpatient Psychiatric Hospital Setting: Demographics, 
Outcomes, and Impact on Well-being.

Levitt G(1)(2)(3)(4)(5)(6).

Author information:
(1)Department of Psychiatry, District Medical Group, Phoenix, Arizona.
(2)Creighton University Medical School, Omaha, Nebraska.
(3)University of Arizona Medical School-Phoenix, Phoenix, Arizona.
(4)Mayo Hospital Medical School, Scottsdale, Arizona.
(5)Midwestern University Medical School, Glendale, Arizona.
(6)Corresponding author: Gwen Levitt, DO, DFAPA, Valleywise Health Systems, 
Behavioral Health Annex, 2619 East Peirce St, Phoenix, AZ 85008 
(Gwen_Levitt@dmgaz.org).

Objective: The mental health community expected that seriously mentally ill 
(SMI) patients would be especially vulnerable to coronavirus disease 2019 
(COVID-19) infection due to a higher medical comorbidity rate than the general 
population and disparities in access to medical care. Concern was voiced as to 
the impact on the psychiatric stability of this population due to anxiety about 
the pandemic, recommended isolation, and limited in-person interactions with 
treatment providers and support systems. The objective of this study was to 
evaluate the impact of COVID-19 on a cohort of involuntarily hospitalized SMI 
patients. Methods: The electronic medical records from March 28 through December 
31, 2020 of all COVID-positive psychiatric inpatients were retrospectively 
reviewed. No outpatients or readmissions were included in the sample. Results: 
During the study period 238, COVID-positive inpatients were identified out of 
approximately 12,859 discreet admissions. The sample consisted of 158 men (66%) 
and 80 women (34%). The mean age of positive patients was 41 years. Eight 
patients (3%) required medical hospitalizations related to COVID-19, with 1 
death. Ninety-seven patients (41%) had at least 1 or more of the known medical 
comorbidities related to increased risk for COVID-19 infection. Seclusion, 
restraints, and administration of as-needed medications (PRN) for anxiety or 
psychotic agitation occurred less frequently in the COVID-positive patients 
compared to those without infection. Conclusions: Medical hospitalizations were 
infrequent in the study sample. Medical comorbidities were much higher in this 
group relative to statewide data. Seclusion, restraint, and PRN administration 
were lower in the COVID-positive cohort compared to COVID-negative inpatients. 
Overall, the sample group did not experience significant negative outcomes as 
might have been expected for this population.

© Copyright 2021 Physicians Postgraduate Press, Inc.

DOI: 10.4088/PCC.21m03003
PMID: 34507388 [Indexed for MEDLINE]


3008. J Affect Disord. 2021 Dec 1;295:405-409. doi: 10.1016/j.jad.2021.08.059. Epub 
2021 Aug 29.

Role of access to personal protective equipment, treatment prioritization 
decisions, and changes in job functions on health workers' mental health 
outcomes during the initial outbreak of the COVID-19 pandemic.

Mediavilla R(1), Fernández-Jiménez E(2), Martínez-Alés G(3), Moreno-Küstner 
B(4), Martínez-Morata I(5), Jaramillo F(6), Morán-Sánchez I(7), Minué S(8), 
Torres-Cantero A(9), Alvarado R(10), Ayuso-Mateos JL(11), Mascayano F(12), 
Susser E(12), Bravo-Ortiz MF(13); COVID-19 Health Care Workers (C19-HCW) Working 
Group.

Author information:
(1)Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, 
Spain; Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.
(2)Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain; 
Department of Psychiatry, Clinical Psychology and Mental Health, La Paz 
University Hospital, Madrid, Spain.
(3)Department of Psychiatry, Clinical Psychology and Mental Health, La Paz 
University Hospital, Madrid, Spain; Department of Epidemiology, Columbia 
University Mailman School of Public Health, New York, NY, United States; 
Institute of Health Carlos III, Centro de Investigación Biomédica en Red de 
Salud Mental (CIBERSAM), Spain. Electronic address: gm2794@cumc.columbia.edu.
(4)Department of Personality, Assessment and Psychological Treatment, University 
of Malaga, Malaga, Spain; Andalusian Group of Psychosocial Research (GAP), 
Andalusia, Spain; Biomedical Research Institute of Malaga (IBIMA), Malaga, 
Spain.
(5)Department of Environmental Health Sciences, Columbia University Mailman 
School of Public Health, New York, NY, United States; Institute for Biomedical 
Research of Murcia (IMIB-Arrixaca), Murcia, Spain.
(6)Andalusian School of Public Health, Andalusia, Spain; Program of Mental 
Health, Universidad de Chile, Santiago de Chile, Chile.
(7)Institute for Biomedical Research of Murcia (IMIB-Arrixaca), Murcia, Spain; 
Cartagena Mental Health Centre, Health Service of Murcia, Murcia, Spain.
(8)Andalusian School of Public Health, Andalusia, Spain.
(9)Institute for Biomedical Research of Murcia (IMIB-Arrixaca), Murcia, Spain; 
Department of Preventive Medicine, Virgen de la Arrixaca Hospital, Murcia, 
Spain.
(10)Program of Mental Health, Universidad de Chile, Santiago de Chile, Chile.
(11)Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, 
Spain; Institute of Health Carlos III, Centro de Investigación Biomédica en Red 
de Salud Mental (CIBERSAM), Spain; Department of Psychiatry, La Princesa 
University Hospital, Instituto de Investigación Sanitaria Princesa 
(IIS-Princesa), Madrid, Spain.
(12)Department of Epidemiology, Columbia University Mailman School of Public 
Health, New York, NY, United States; New York State Psychiatric Institute, New 
York, NY, United States.
(13)Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, 
Spain; Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain; 
Department of Psychiatry, Clinical Psychology and Mental Health, La Paz 
University Hospital, Madrid, Spain; Institute of Health Carlos III, Centro de 
Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain.

BACKGROUND: During the initial COVID-19 outbreak, organizational changes were 
required to ensure adequate staffing in healthcare facilities. The extent to 
which organizational changes impacted the mental wellbeing of healthcare workers 
(HCWs) remains unexplored. Here we analyzed the association between three 
work-related stressors (reported access to protective equipment, change in job 
functions, and patient prioritization decision-making) and mental health 
outcomes (depression symptoms, psychological distress, suicidal thoughts, and 
fear of infection) in a large sample of Spanish HCWs during the initial COVID-19 
outbreak.
METHODS: We conducted a cross-sectional study including HCWs from three regions 
of Spain between April 24th and June 22nd, 2020. An online survey measured 
sociodemographic characteristics, work-related stressors, fear of infection, and 
mental health outcomes (depression [PHQ-9], psychological distress [GHQ-12], 
death wishes [C-SSRS]). We conducted mixed-effects regression models to adjust 
all associations for relevant individual- and region-level sources of 
confounding.
RESULTS: We recruited 2,370 HCWs. Twenty-seven percent screened positive for 
depression and 74% for psychological distress. Seven percent reported death 
wishes. Respondents were more afraid of infecting their loved ones than of 
getting infected themselves. All work-related stressors were associated with 
depression symptoms and psychological distress in adjusted models.
LIMITATIONS: Non-probabilistic sampling, potential reverse causation.
CONCLUSIONS: Modifiable work-related stressors are associated with worse mental 
health among HCWs. Our results suggest that workplace prevention strategies for 
HCWs should provide sufficient protective equipment, minimize changes in job 
functions, favor the implementation of criteria for patient triage and on-call 
bioethics committees, and facilitate access to stepped-care, evidence-based 
mental health treatment.

Copyright © 2021 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2021.08.059
PMCID: PMC8403068
PMID: 34507219 [Indexed for MEDLINE]

Conflict of interest statement: None


3009. PLoS One. 2021 Sep 10;16(9):e0257304. doi: 10.1371/journal.pone.0257304. 
eCollection 2021.

Psychological distress, fear and coping among Malaysians during the COVID-19 
pandemic.

Bahar Moni AS(1), Abdullah S(2), Bin Abdullah MFIL(1), Kabir MS(3), Alif SM(4), 
Sultana F(5)(6), Salehin M(7), Islam SMS(8), Cross W(7), Rahman 
MA(7)(9)(10)(11).

Author information:
(1)Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, 
Kepala Batas, Penang, Malaysia.
(2)Faculty of Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia, Kuala 
Lumpur, Malaysia.
(3)Faculty of Medicine, Quest International University, Ipoh, Perak, Malaysia.
(4)School of Public Health and Preventive Medicine, Monash University, 
Melbourne, Victoria, Australia.
(5)Telstra Health, Melbourne, Victoria, Australia.
(6)Melbourne School of Population and Global Health, University of Melbourne, 
Carlton, Victoria, Australia.
(7)School of Health, Federation University Australia, Berwick, Victoria, 
Australia.
(8)Institute for Physical Activity and Nutrition, Deakin University, Burwood, 
Victoria, Australia.
(9)Australian Institute for Primary Care and Ageing, La Trobe University, 
Melbourne, Victoria, Australia.
(10)Department of Noncommunicable Diseases, Bangladesh University of Health 
Sciences (BUHS), Dhaka, Bangladesh.
(11)Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia.

INTRODUCTION: The COVID-19 pandemic has enormously affected the psychological 
well-being, social and working life of millions of people across the world. This 
study aimed to investigate the psychological distress, fear and coping 
strategies as a result of the COVID-19 pandemic and its associated factors among 
Malaysian residents.
METHODS: Participants were invited to an online cross-sectional survey from 
Aug-Sep 2020. The study assessed psychological distress using the Kessler 
Psychological Distress Scale, level of fear using the Fear of COVID-19 Scale, 
and coping strategies using the Brief Resilient Coping Scale. Univariate and 
multivariate logistic regression analyses were conducted to adjust for potential 
confounders.
RESULTS: The mean age (±SD) of the participants (N = 720) was 31.7 (±11.5) 
years, and most of them were females (67.1%). Half of the participants had an 
income source, while 216 (30%) identified themselves as frontline health or 
essential service workers. People whose financial situation was impacted due to 
COVID-19 (AOR 2.16, 95% CIs 1.54-3.03), people who drank alcohol in the last 
four weeks (3.43, 1.45-8.10), people who were a patient (2.02, 1.39-2.93), and 
had higher levels of fear of COVID-19 (2.55, 1.70-3.80) were more likely to have 
higher levels of psychological distress. Participants who self-isolated due to 
exposure to COVID-19 (3.12, 1.04-9.32) and who had moderate to very high levels 
of psychological distress (2.56, 1.71-3.83) had higher levels of fear. 
Participants who provided care to a family member/patient with a suspected case 
of COVID-19 were more likely to be moderately to highly resilient compared to 
those who did not.
CONCLUSION: Vulnerable groups of individuals such as patients and those impacted 
financially during COVID-19 should be supported for their mental wellbeing. 
Behavioural interventions should be targeted to reduce the impact of alcohol 
drinking during such crisis period.

DOI: 10.1371/journal.pone.0257304
PMCID: PMC8432783
PMID: 34506576 [Indexed for MEDLINE]

Conflict of interest statement: The authors have read the journal’s policy and 
have the following competing interests: RS is a staff member of Telstra Health 
(https://www.telstrahealth.com/). There are no patents, products in development 
or marketed products associated with this research to declare. This does not 
alter our adherence to PLOS ONE policies on sharing data and materials.


3010. JNMA J Nepal Med Assoc. 2021 Mar 31;59(235):231-233. doi: 10.31729/jnma.5703.

Anxiety during COVID -19 among School Going Adolescents of Six Private Schools 
in Kathmandu Valley: A Descriptive Cross-sectional Study.

Bhatta A(1), Kafley RK(1), Yadav A(1), Phuyal R(1), Chikanbanjar VK(1).

Author information:
(1)Department of Pediatrics, Kathmandu Medical College Teaching Hopsital, 
Sinamangal, Kathmandu, Nepal.

INTRODUCTION: Psychological health problems are common in adolescent and young 
adults. The psychological well-being is greatly influenced by stressful 
environment and the coping mechanism of an individual. The 2019 Coronavirus 
disease has caused unprecedented morbidity and mortality worldwide owing to its 
high infectivity and mortality. In addition to these physical manifestations, 
psychological impact has also been substantial. This study is a descriptive 
cross-sectional study done to find out the prevalence of anxiety disorder and 
its severity during the COVID-19 pandemic in school going adolescents of 
Kathmandu valley.
METHODS: A descriptive cross-sectional study was carried out among adolescents 
from August 15 to September 30, 2020. Two private schools from each district in 
the Kathmandu valley i.e. Kathmandu, Lalitpur and Bhaktapur were included in the 
study using convenient sampling. Ethical clearance was obtained from 
Institutional Review Committee (reference no: 1208202007). All data were 
inserted on Microsoft Excel 2016 and analysed using Statistical Package for the 
Social Sciences version 20. Point estimate at 95% Confidence Interval was 
calculated along with frequency and proportion for binary data.
RESULTS: Among 358 students, 165 (46.1%) at 95% Confidence Interval (40.8-51.2) 
were found to have anxiety. Out of these patients, 115 (69.7%) had mild, 39 
(23.6%) had moderate and 11 (6.7%) had severe anxiety. The mean age was 
16.17±1.57 years.
CONCLUSIONS: This study shows that a remarkably higher number of children had 
symptoms of anxiety disorder. Majority of the children with anxiety had mild 
form. The study further highlights the need of emotional support to adolescent 
children during the current ongoing pandemic.

DOI: 10.31729/jnma.5703
PMCID: PMC8369537
PMID: 34506446 [Indexed for MEDLINE]

Conflict of interest statement: None.


3011. JNMA J Nepal Med Assoc. 2020 Nov 22;58(231):957-959. doi: 10.31729/jnma.5319.

Parenting during the COVID-19 Pandemic.

Karki U(1), Dhonju G(1), Raj Kunwar A(1).

Author information:
(1)Child and Adolescent Psychiatrist, Child and Adolescent Psychiatry Unit, 
Kanti Children's Hospital, Kathmandu, Nepal.

Parenting is both an art and science of nurturing a child that comes very 
naturally to some. In today's world, the fundamentals of parenting are getting 
challenged but it has been even more magnified during the coronavirus 2019 
(COVID-19) pandemic. The mental health of children is bound to be affected by 
the stress related to COVID-19 owing to loss of usual routine, unpredictability, 
uncertainty. Various other social, economic, and environmental factors also 
threaten their mental well-being. Parents are the child's first and 
longest-lasting context for development Positive parenting that involves 
sensitivity, responsivity, caring, communicating, and empowering would ensure 
positive developmental outcomes in children and adolescents. Positive parenting 
and self-care of parents would serve as a promotive and preventative 
intervention for child and adolescent mental health, especially during this 
crisis.

DOI: 10.31729/jnma.5319
PMCID: PMC7775027
PMID: 34506413 [Indexed for MEDLINE]

Conflict of interest statement: None.


3012. JNMA J Nepal Med Assoc. 2020 Dec 31;58(232):1103-1106. doi: 10.31729/jnma.5738.

Conducting Qualitative Interviews using Virtual Communication Tools amid 
COVID-19 Pandemic: A Learning Opportunity for Future Research.

Sah LK(1), Singh DR(2), Sah RK(1).

Author information:
(1)Faculty of Medicine Health and Social Care, Canterbury Christ Church 
University, Kent, United Kingdom.
(2)Department of Public Health, Asian College for Advance Studies, Purbanchal 
University, Satdobato, Lalitpur, Nepal.

The COVID-19 pandemic has threatened the health and wellbeing of the global 
citizens which has led to a significant change in attitude, lifestyle, and 
behavior of people from diverse professions, including academics and 
researchers. Doctoral students and funded researchers with the time limit to 
their research project have experienced stress and anxiety due to the struggle 
of negotiating and managing the timeline to complete the fieldwork for their 
research. In the current circumstances, an increasing number of researchers are 
looking for alternative methods to conduct the fieldwork and complete the data 
collection. In this context, the aim of this viewpoint is to provide reflections 
on the challenges and opportunities experienced by the authors while conducting 
qualitative research fieldwork during the COVID-19 pandemic.

DOI: 10.31729/jnma.5738
PMCID: PMC8028517
PMID: 34506374 [Indexed for MEDLINE]

Conflict of interest statement: None.


3013. JCO Oncol Pract. 2022 Jan;18(1):e60-e71. doi: 10.1200/OP.21.00170. Epub 2021 Sep 
10.

Prevalence and Workplace Drivers of Burnout in Cancer Care Physicians in 
Ontario, Canada.

Singh S(1)(2), Farrelly A(1), Chan C(1), Nicholls B(1), Nazeri-Rad N(1), 
Bellicoso D(3), Eisen A(1)(2), Falkson CB(4), Fox C(1), Holloway C(2), Kennedy 
E(1)(5), McLeod R(1), Rothenberger D(6), Trudeau M(2), Shanafelt T(7), Bauman 
G(8).

Author information:
(1)Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.
(2)Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
(3)St Michael's Hospital, Toronto, Ontario, Canada.
(4)Queens University, Kingston, Ontario, Canada.
(5)University of Toronto, Toronto, Ontario, Canada.
(6)University of Minnesota, Minneapolis, MN.
(7)Department of Medicine & WellMD Center, Stanford University, Palo Alto, CA.
(8)Western University, London Regional Cancer Program, London, Ontario, Canada.

PURPOSE: Provider well-being has become the fourth pillar of the quadruple aim 
for providing quality care. Exacerbated by the global COVID-19 pandemic, 
provider well-being has become a critical issue for health care systems 
worldwide. We describe the prevalence and key system-level drivers of burnout in 
oncologists in Ontario, Canada.
METHODS: This is a cross-sectional survey study conducted in November-December 
2019 of practicing cancer care physicians (surgical, medical, radiation, 
gynecologic oncology, and hematology) in Ontario, Canada. Ontario is Canada's 
largest province (with a population of 14.5 million), and has a single-payer 
publicly funded cancer system. The primary outcome was burnout experience 
assessed through the Maslach Burnout Inventory.
RESULTS: A total of 418 physicians completed the questionnaire (response rate 
was 44% among confirmed oncologists). Seventy-three percent (n = 264 of 362) of 
oncologists had symptoms of burnout (high emotional exhaustion and/or 
depersonalization scores). Significant drivers of burnout identified in 
multivariable regression modeling included working in a hectic or chaotic 
atmosphere (odds ratio [OR] = 15.5; 95% CI, 3.4 to 71.5; P < .001), feeling 
unappreciated on the job (OR = 7.9; 95% CI, 2.9 to 21.3; P < .001), reporting 
poor or marginal control over workload (OR = 7.9; 95% CI, 2.9 to 21.3; P < 
.001), and not being comfortable talking to peers about workplace stress (OR = 
3.0; 95% CI, 1.1 to 7.9; P < .001). Older age (≥ 56 years) was associated with 
lower odds of burnout (OR = 0.16; 95% CI, 0.1 to 0.4; P < .001).
CONCLUSION: Nearly three quarters of participants met predefined standardized 
criteria for burnout. This number is striking, given the known impact of burnout 
on provider mental health, patient safety, and quality of care, and suggests 
Oncologists in Ontario may be a vulnerable group that warrants attention. Health 
care changes being driven by the COVID-19 pandemic provide an opportunity to 
rebuild new systems that address drivers of burnout. Creating richer 
peer-to-peer and leadership engagement opportunities among early- to mid-career 
individuals may be a worthwhile organizational strategy.

DOI: 10.1200/OP.21.00170
PMID: 34506217 [Indexed for MEDLINE]

Conflict of interest statement: Simron SinghEmployment: Sanofi (I), AstraZeneca 
(I)Honoraria: Novartis, IpsenResearch Funding: Novartis Brett 
NichollsEmployment: McKesson Canada Andrea EisenOther Relationship: Cancer Care 
Ontario Conrad B. FalksonStock and Other Ownership Interests: AllScripts Maureen 
TrudeauStock and Other Ownership Interests: RNA DiagnosticsResearch Funding: 
Roche Canada, Novartis, Pfizer, Eisai, AstraZeneca, Astellas Pharma, Genomic 
Health Tait ShanafeltHonoraria: Multiple Healthcare OrganizationsResearch 
Funding: Pharmacyclics, GlaxoSmithKline, Genentech, Celgene, Hospira, Cephalon, 
Polyphenon E InternationalPatents, Royalties, Other Intellectual Property: Dr 
Shanafelt is coinventor of the Well-being Index Instruments (Physician 
Well-being Index; Nurse Well-being Index; Medical Student Well-being Index; 
Well-being Index) and the Mayo Clinic Participatory Management Leadership Index. 
Mayo Clinic holds the copyright to these instruments and has licensed them for 
use outside Mayo Clinic. Mayo Clinic pays Dr Shanafelt receives a portion of any 
royalties it receivesOther Relationship: Medical CentersOpen Payments Link: 
https://openpaymentsdata.cms.gov/physician/429217 Glenn BaumanHonoraria: 
BayerResearch Funding: SiemensNo other potential conflicts of interest were 
reported.


3014. Exp Ther Med. 2021 Oct;22(4):1162. doi: 10.3892/etm.2021.10596. Epub 2021 Aug 
11.

COVID-19 and post-traumatic stress disorder: The perfect 'storm' for mental 
health (Review).

Giannopoulou I(1), Galinaki S(1), Kollintza E(1), Adamaki M(2), Kympouropoulos 
S(1), Alevyzakis E(1), Tsamakis K(1), Tsangaris I(3), Spandidos DA(4), Siafakas 
N(5), Zoumpourlis V(2), Rizos E(1).

Author information:
(1)Second Department of Psychiatry, National and Kapodistrian University of 
Athens, Attikon University General Hospital, Athens 12462, Greece.
(2)Biomedical Applications Unit, Institute of Chemical Biology, National 
Hellenic Research Foundation (NHRF), Athens 11635, Greece.
(3)Second Department of Critical Care Medicine, Attikon University Hospital, 
Athens 12462, Greece.
(4)Laboratory of Clinical Virology, School of Medicine, University of Crete, 
Heraklion 71003, Greece.
(5)Clinical Microbiology Laboratory, School of Medicine, National and 
Kapodistrian University of Athens, Attikon University General Hospital, Athens 
12462, Greece.

Since its outbreak, in December, 2019, in the Chinese city of Wuhan, coronavirus 
disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 
2 (SARS-CoV-2) has evolved into an ongoing global pandemic. Due to the novel 
antigenic properties of this virus, the world population could not develop 
immunity effectively and this led to the subsequent spread of COVID-19. This 
caused an unprecedented emergency situation with significant negative effects on 
health and well-being both on an individual and societal level. Apart from 
health, economic and social consequences, the impact of this pandemic on mental 
health is increasingly being reported in the scientific literature. The present 
review aimed to provide a comprehensive discussion of the possible neurological 
and neuropsychiatric manifestations of SARS-CoV-2, together with the related 
underlying molecular pathways. In addition, the present review focused on 
populations which are at a higher risk of developing psychiatric disturbances 
due to the COVID-19 pandemic and discussed possible routes of clinical 
management and therapeutics to minimize the burden associated with psychiatric 
disorders. Moreover, research findings exploring the prevalence of 
COVID-19-related post-traumatic stress disorder (PTSD) symptoms across 
vulnerable groups, including children, adolescents and COVID-19 survivors are 
presented, with particular emphasis on those with severe disease who required 
hospitalization and/or intensive care unit admission. Based on the available 
literature, the identification of potential determinants associated with PTSD 
across the different populations is underlined. Lessons learnt from the 
pandemics across the globe together with the ongoing research on COVID-19 and 
its impact on mental health, highlight the utmost importance for evidence-based, 
proactive and targeted interventions in high-risk groups aiming to mitigate the 
risks and manage vulnerabilities.

Copyright: © Giannopoulou et al.

DOI: 10.3892/etm.2021.10596
PMCID: PMC8392877
PMID: 34504607

Conflict of interest statement: DAS is the Editor-in-Chief for the journal, but 
had no personal involvement in the reviewing process, or any influence in terms 
of adjudicating on the final decision, for this article. The other authors 
declare that they have no competing interests.


3015. JNMA J Nepal Med Assoc. 2020 Oct 15;58(230):744-750. doi: 10.31729/jnma.5498.

Mental Wellbeing during the Lockdown Period following the COVID-19 Pandemic in 
Nepal: A Descriptive Cross-sectional Study.

Shrestha C(1), Ghimire C(1), Acharya S(2), Kc P(1), Singh S(3), Sharma P(4).

Author information:
(1)Patan Academy of Health Sciences-School of Medicine, Lalitpur, Nepal.
(2)New York Medical College/Metropolitan Hospital Center, New York, USA.
(3)Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, 
India.
(4)Department of Psychiatry, Patan Academy of Health Sciences-School of 
Medicine, Lalitpur, Nepal.

INTRODUCTION: COVID-19 pandemic has profoundly affected all aspects of society, 
including mental and physical health. Often missed is the fact that the pandemic 
is occurring against the backdrop of a very high prevalence of mental health 
issues. Protecting the mental health of people and healthcare workers is 
important for long-term positive health outcomes and proper control of the 
outbreak.
METHODS: This is a descriptive cross-sectional, questionnaire-based, online 
survey by convenience sampling. Ethical approval was obtained from the 
institutional review committee of Nepal Health Research Council (reference no. 
2467). Open access, pre-validated questionnaires were used. Participants with 
significantly poor Mental wellbeing were identified using the WHO well-being 
index threshold score. Descriptive statistical analysis was carried out.
RESULTS: Five hundred and fifty-six participants were included in the analysis. 
Forty percent of the participants reported a WHO well-being index score of below 
13, indicative of poor mental wellbeing and a need for further assessment for 
depression. Poor Mental wellbeing was more prevalent among participants less 
than 30 years of age, female gender, never married, diagnosed mental disorder, 
living alone and those using informal sources for COVID-19 related information. 
More participants with lower sleep quality score and higher perceived stress 
score reported poor Mental wellbeing.
CONCLUSIONS: Combating this challenge requires integration across disciplines. 
One potential part of the solution is psychological intervention teams. An 
emerging positive connotation to the pandemic is that it needs to be harnessed 
as a tool for improving health facilities, community participation, and fighting 
misinformation.

DOI: 10.31729/jnma.5498
PMCID: PMC7654491
PMID: 34504359 [Indexed for MEDLINE]

Conflict of interest statement: None.


3016. JNMA J Nepal Med Assoc. 2020 Oct 15;58(230):751-757. doi: 10.31729/jnma.5499.

Interpersonal Violence during the COVID-19 Lockdown Period in Nepal: A 
Descriptive Cross-sectional Study.

Ghimire C(1), Acharya S(2), Shrestha C(1), Kc P(1), Singh S(3), Sharma P(4).

Author information:
(1)Patan Academy of Health Sciences-School of Medicine, Lalitpur, Nepal.
(2)New York Medical College/Metropolitan Hospital Center, New York, USA.
(3)Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, 
India.
(4)Department of Psychiatry, Patan Academy of Health Sciences-School of 
Medicine, Lalitpur, Nepal.

INTRODUCTION: The government issued a country-wide lockdown in Nepal as a 
measure to curb the spread of COVID-19 pandemic. This has resulted in various 
difficult experiences which includes financial loss, separation from loved ones, 
grief, uncertainty over disease status and loss of freedom. During these 
stressful situations, interpersonal violence is likely to be aggravated. To 
avoid the occurrence of adverse events such as impulsive acts, homicide, or 
suicide, it is important to identify high-risk individuals.
METHODS: This is a descriptive cross-sectional, questionnaire-based, online 
survey by convenience sampling. The prevalence of different types of 
interpersonal violence with socio-demographic factors, substance use, and 
overall mental wellbeing was assessed by using descriptive statistical tests.
RESULTS: Out of total 556 participants included in the analysis, 50.9% (283) 
were male and 48.7% (271) were female. There were 100 (18.0%) participants who 
reported being a victim of interpersonal violence and 101 (18.2%) participants 
who reported being a perpetrator during the lockdown. The victims of violence 
were more likely to be living with their spouse alone. The victims and 
perpetrators were also more likely to have increased alcohol and tobacco use. 
More number of victims and perpetrators had lower mental wellbeing scores on the 
WHO wellbeing index.
CONCLUSIONS: There was prevalence of interpersonal violence during the COVID-19 
lockdown. In addition to the fear regarding pandemic, victims have to face 
domestic violence placing them at a double injustice. Identification of 
vulnerable groups and proper management of survivors must be prioritized given 
the unanimous consensus on the rise of interpersonal violence during periods of 
heightened stress.

DOI: 10.31729/jnma.5499
PMCID: PMC7654498
PMID: 34504358 [Indexed for MEDLINE]

Conflict of interest statement: None.


3017. Nurs Outlook. 2022 Jan-Feb;70(1):81-88. doi: 10.1016/j.outlook.2021.07.009. Epub 
2021 Aug 6.

Addressing mental and emotional health concerns experienced by nurses during the 
COVID-19 pandemic.

Dohrn J(1), Ferng YH(2), Shah R(2), Diehl E(2), Frazier L(2).

Author information:
(1)Columbia University School of Nursing, New York, NY. Electronic address: 
jed19@cumc.columbia.edu.
(2)Columbia University School of Nursing, New York, NY.

BACKGROUND: Nurses are the majority of the world's health work force and the 
frontline responders during pandemics. The mental/emotional toll can be profound 
if it is not identified and treated.
PURPOSE: In March 2020, with New York City as the epicenter of the COVID-19 
pandemic in the United States, Columbia University School of Nursing organized 
support circles for faculty and students providing clinical care as a healing 
method to address trauma.
METHODS: Columbia University School of Nursing adapted guidelines and conducted 
Circles of Care to share, listen, and acknowledge the new challenges for nurses 
via Zoom. Analysis of these sessions produced major themes of concern for 
nurses.
FINDINGS: Between March 31 and May 31, 2020, we facilitated 77 sessions with 636 
attendees. Eight major themes emerged: coping mechanisms, patients suffering and 
dying, feelings of helplessness, frustration with COVID-19 response, silver 
lining, disconnection from the world, the thread that holds nurses together, and 
exhaustion.
DISCUSSION: This report offers insight into the mental/emotional outcomes of 
being on the frontlines. Addressing these issues is essential for the well-being 
of nurses and all health care providers for an effective pandemic response.

Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.outlook.2021.07.009
PMCID: PMC8809193
PMID: 34503838 [Indexed for MEDLINE]


3018. Int J Environ Res Public Health. 2021 Sep 6;18(17):9423. doi: 
10.3390/ijerph18179423.

Impact of the SARS-CoV-2 Coronavirus Pandemic on Physical Activity, Mental 
Health and Quality of Life in Professional Athletes-A Systematic Review.

Jurecka A(1), Skucińska P(2), Gądek A(1).

Author information:
(1)Department of Orthopedics and Physiotherapy, Faculty of Health Sciences, 
Jagiellonian University Medical College, 30-688 Krakow, Poland.
(2)Students' Scientific Society, Faculty of Health Sciences, Jagiellonian 
University Medical College, 31-007 Krakow, Poland.

Due to the rapid rate of spread of the SARS-CoV-2 coronavirus, a number of 
restrictions have been introduced into public spaces, including those related to 
the operation of sports facilities, compounding the difficulty for athletes to 
conduct appropriate forms of training. The aim of this study was to review 
current scientific reports assessing the impact of the pandemic on the physical 
activity, mental state, and quality of life of professional athletes. Popular 
scientific databases-PubMed, Scopus, and Embase-were systematically searched 
from the beginning of the pandemic until 12 July 2021. According to the adopted 
criteria, 14 articles were included in the review. Ten of the qualified studies 
determined the impact of the pandemic on the physical activity of athletes. The 
authors of 11 papers assessed the mental state and quality of life of athletes 
during the pandemic. The studies showed negative effects of the pandemic: a 
decrease in overall physical fitness and number of days and hours of training, 
as well as an increase in the occurrence of negative emotions (stress, fatigue, 
and depression) and a decrease in sleep quality. Changes in physical activity 
had an impact on overall well-being ratings, which depended on the sex of the 
subjects. Women were more likely to experience negative emotions compared to 
men. The mental state of the athletes affected the quality of sleep. This review 
summarises the negative effects of the SARS-CoV-2 coronavirus pandemic on the 
physical and mental health of professional athletes.

DOI: 10.3390/ijerph18179423
PMCID: PMC8431129
PMID: 34502010 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3019. Int J Environ Res Public Health. 2021 Sep 4;18(17):9344. doi: 
10.3390/ijerph18179344.

The Impact of the COVID-19 Pandemic on Students' Mental Health and Sleep in 
Saudi Arabia.

Alyoubi A(1), Halstead EJ(1), Zambelli Z(1), Dimitriou D(1)(2).

Author information:
(1)Sleep Education and Research Laboratory (SERL), Department of Psychology and 
Human Development, University College London-Institute of Education, 25 Woburn 
Square, London WC1H 0AA, UK.
(2)The National Institute for Stress, Anxiety, Depression and Behavioural Change 
(NISAD), 252 21 Helsingborg, Sweden.

BACKGROUND: Mental health problems are prevalent among university students in 
Saudi Arabia. This study aimed to investigate the impact of the COVID-19 
pandemic on university students' mental health and sleep in Saudi Arabia.
METHOD: A total of 582 undergraduate students from Saudi Arabia aged between 18 
and 45 years old (M = 20.91, SD = 3.17) completed a cross-sectional online 
questionnaire measuring depression, anxiety, stress, resilience, and insomnia 
during the COVID-19 pandemic (2020). Analysis included an independent samples 
t-test, one-way ANOVA, and Hierarchical regression analysis.
RESULTS: Undergraduate students reported high levels of depression, anxiety, and 
perceived stress and low levels of resilience (p < 0.001) during the pandemic. 
In addition, students reported experiencing insomnia. A hierarchical regression 
analysis indicated that lower resilience, high levels of insomnia, having a 
pre-existing mental health condition, and learning difficulties (such as 
dyslexia, dyspraxia, or dyscalculia) were significantly associated with high 
levels of depression and stress. In addition, lower resilience, a high level of 
insomnia, and pre-existing mental health conditions were significantly 
associated with high levels of anxiety. Finally, a lower level of psychological 
resilience and a high level of insomnia were significantly associated with 
increased levels of depression, anxiety and stress within university students.
CONCLUSION: This study has provided evidence that a lower level of psychological 
resilience and insomnia were associated with mental health problems among 
undergraduate students in Saudi Arabia, thus enhancing psychological resilience 
and interventions to support sleep and mental health are vital to support 
student well-being outcomes throughout the pandemic.

DOI: 10.3390/ijerph18179344
PMCID: PMC8430501
PMID: 34501935 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript; or in the decision to 
publish the results.


3020. Int J Environ Res Public Health. 2021 Aug 31;18(17):9168. doi: 
10.3390/ijerph18179168.

Associations between Physical Activity, Sitting Time, and Time Spent Outdoors 
with Mental Health during the First COVID-19 Lock Down in Austria.

Haider S(1), Smith L(2), Markovic L(1)(3), Schuch FB(4), Sadarangani KP(5)(6), 
Lopez Sanchez GF(7), Lopez-Bueno R(8), Gil-Salmerón A(9), Rieder A(1), Tully 
MA(10), Tschiderer L(11), Seekircher L(11), Willeit P(11)(12), Grabovac I(1).

Author information:
(1)Department of Social and Preventive Medicine, Centre for Public Health, 
Medical University of Vienna, 1090 Vienna, Austria.
(2)Centre for Health, Performance and Wellbeing, Anglia Ruskin University, 
Cambridge CB1 1PT, UK.
(3)Department of Physical Medicine, Rehabilitation and Occupational Medicine, 
Medical University of Vienna, 1090 Vienna, Austria.
(4)Department of Sports Methods and Techniques, Federal University of Santa 
Maria, Santa Maria 97105-900, Brazil.
(5)Escuela de Kinesiología, Facultad de Salud y Odontología, Universidad Diego 
Portales, Santiago 8370179, Chile.
(6)Department of Kinesiology, Universidad Autónoma de Chile, Santiago 7500912, 
Chile.
(7)Vision and Eye Research Institute, School of Medicine, Faculty of Health, 
Education, Medicine and Social Care, Anglia Ruskin University, Cambridge CB1 
1PT, UK.
(8)Department of Physical Medicine and Nursing, University of Zaragoza, 50009 
Zaragoza, Spain.
(9)International Foundation for Integrated Care, Oxford OX2 6UD, UK.
(10)Institute of Mental Health Sciences, School of Health Sciences, Ulster 
University, Newtownabbey BT37 0QB, UK.
(11)Clinical Epidemiology Team, Department of Neurology, Medical University of 
Innsbruck, 6020 Innsbruck, Austria.
(12)Department of Public Health and Primary Care, University of Cambridge, 
Cambridge CB1 8RN, UK.

Measures implemented to reduce the spread of SARS-CoV-2 have resulted in a 
decrease in physical activity (PA) while sedentary behaviour increased. The aim 
of the present study was to explore associations between PA and mental health in 
Austria during COVID-19 social restrictions. In this web-based cross-sectional 
study (April-May 2020) moderate-to-vigorous physical activity (MVPA), sitting 
time, and time spent outdoors were self-reported before and during 
self-isolation. Mental well-being was assessed with the Warwick-Edinburgh Mental 
Well-being Scale, and the Beck depression and anxiety inventories. The majority 
of the participants (n = 652) were female (72.4%), with a mean age of 36.0 years 
and a standard deviation (SD) of 14.4. Moreover, 76.5% took part in ≥30 min/day 
of MVPA, 53.5% sat ≥10 h/day, and 66.1% spent ≥60 min/day outdoors during 
self-isolation. Thirty-eight point five percent reported high mental well-being, 
40.5% reported depressive symptoms, and 33.9% anxiety symptoms. Participating in 
higher levels of MVPA was associated with higher mental well-being (odds ratio = 
OR: 3.92; 95% confidence interval = 95%CI: 1.51-10.15), less depressive symptoms 
(OR: 0.44; 95%CI: 0.29-0.66) and anxiety symptoms (OR = 0.62; 95%CI: 0.41-0.94), 
and less loneliness (OR: 0.46; 95%CI: 0.31-0.69). Participants sitting <10 h/day 
had higher odds of mental well-being (OR: 3.58; 95%CI: 1.13-11.35). Comparable 
results were found for spending ≥60 min/day outdoors. Maintaining one's MVPA 
levels was associated with higher mental well-being (OR = 8.61, 95%CI: 
2.68-27.62). In conclusion, results show a positive association between PA, time 
spent outdoors and mental well-being during COVID-19 social restrictions. 
Interventions aiming to increase PA might mitigate negative effects of such 
restrictions.

DOI: 10.3390/ijerph18179168
PMCID: PMC8431505
PMID: 34501758 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3021. Int J Environ Res Public Health. 2021 Aug 29;18(17):9119. doi: 
10.3390/ijerph18179119.

Comparison of Experiences in Two Birth Cohorts Comprising Young Families with 
Children under Four Years during the Initial COVID-19 Lockdown in Australia and 
the UK: A Qualitative Study.

Gibson LY(1)(2)(3)(4), Lockyer B(5), Dickerson J(5), Endacott C(5), Bridges 
S(5), McEachan RRC(5), Pickett KE(6), Whalan S(1), Bear NL(7)(8), Silva 
DT(1)(2)(3)(4)(8)(9), Prescott SL(1)(2)(3)(4)(8)(9)(10)(11)(12), Davis 
JA(1)(2)(3)(8).

Author information:
(1)Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA 6009, Australia.
(2)School of Medicine, The University of Western Australia, Perth, WA 6009, 
Australia.
(3)VIVO Planetary Health, Worldwide Universities Network (WUNWest), New York, NY 
10704, USA.
(4)School of Medicine & Health Sciences, Edith Cowan University, Perth, WA 6027, 
Australia.
(5)Bradford Institute for Health Research, Bradford Teaching Hospitals NHS 
Foundation Trust, Bradford BD9 6RJ, UK.
(6)Department of Health Sciences, University of York, York YO10 5DD, UK.
(7)Institute for Health Research, Notre Dame University, Fremantle, WA 6160, 
Australia.
(8)School of Public Health, Curtin University, Bentley, WA 6102, Australia.
(9)Joondalup Health Campus, Joondalup, WA 6027, Australia.
(10)Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA 6009, Australia.
(11)NOVA Institute for Health of People, Places and Planet, Baltimore, MD 21231, 
USA.
(12)Department of Family and Community Medicine, University of Maryland School 
of Medicine, Baltimore, MD 21201, USA.

This study aims to understand the experience and impact of the initial COVID-19 
lockdown in young families with children aged below 4 years. Free text questions 
were administered to participants in the ORIGINS (Australia) and Born in 
Bradford (UK) cohort studies to collect qualitative information on worries, 
concerns and enjoyable experiences during the pandemic. A total of 903 (400 for 
ORIGINS and 503 for BiB) participants completed the two surveys during April 
2020. Despite varying in geography, levels of socio-economic disadvantage and 
their situational context during the pandemic, respondents from both cohorts 
reported similar worries and challenges during the lockdown period, including: 
employment/finances, health anxiety, mental health and social isolation, caring 
for children and child development. Families across the globe experienced both 
positive and negative immediate impacts of COVID-19. Population-based data can 
be used to inform the development of support services, public health campaigns 
and universal interventions to assist families in future health crises.

DOI: 10.3390/ijerph18179119
PMCID: PMC8431681
PMID: 34501709 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript, or in the decision to 
publish the results.


3022. Int J Environ Res Public Health. 2021 Aug 28;18(17):9079. doi: 
10.3390/ijerph18179079.

"We Thought We Were Prepared, but We Were Not": Experiences from the Management 
of the Psychosocial Support Response during the COVID-19 Pandemic in Sweden. A 
Mixed-Methods Study.

Hugelius K(1), Johansson S(2), Sjölin H(1).

Author information:
(1)Faculty of Medicine and Health, Örebro University, 702 81 Örebro, Sweden.
(2)Creative Mammals, 413 27 Gothenburg, Sweden.

This study aimed to describe experiences of managing mental health and 
psychosocial activities during the first six months of the COVID-19 pandemic in 
Sweden. A national survey was answered by a non-probability sample of 340 
involved in the psychosocial response. The psychosocial response operations met 
several challenges, mainly related to the diverse actors involved, lack of 
competence, and lack of preparations. Less than 20% of the participants had 
received specific training in the provision of psychosocial support during major 
incidents. The interventions used varied, and no large-scale interventions were 
used. The psychosocial response organizations were overwhelmed by the needs of 
health care staff and failed to meet the needs of patients and family members. 
An efficient and durable psychosocial response in a long-term crisis requires to 
be structured, planned and well-integrated into the overall pandemic response. 
All personnel involved need adequate and specific competence in evidence-based 
individual and large-scale interventions to provide psychosocial support in 
significant incidents. By increasing general awareness of mental wellbeing and 
psychosocial support amongst health professionals and their first-line managers, 
a more resilient health care system, both in everyday life and during major 
incidents and disasters, could be facilitated.

DOI: 10.3390/ijerph18179079
PMCID: PMC8431117
PMID: 34501668 [Indexed for MEDLINE]

Conflict of interest statement: One author (S.J.) works for a private company 
that provides training and consultancy for psychosocial support in disasters and 
has worked for some of the Swedish actors involved in the pandemic response. The 
remaining authors (K.H. and H.S.) have no conflict of interest to declare.


3023. Int J Environ Res Public Health. 2021 Aug 26;18(17):9002. doi: 
10.3390/ijerph18179002.

The Experiences of Nurses and Physicians Caring for COVID-19 Patients: Findings 
from an Exploratory Phenomenological Study in a High Case-Load Country.

Khatatbeh M(1), Alhalaiqa F(2), Khasawneh A(3), Al-Tammemi AB(4)(5), Khatatbeh 
H(6), Alhassoun S(3), Al Omari O(7).

Author information:
(1)Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk 
University, Irbid 21163, Jordan.
(2)Faculty of Nursing, Philadelphia University, Amman 19392, Jordan.
(3)Department of Neurosciences, Jordan University of Science and Technology, 
King Abdullah University Hospital, Irbid 22110, Jordan.
(4)Department of Family and Occupational Medicine, Faculty of Medicine, 
University of Debrecen, 4032 Debrecen, Hungary.
(5)Doctoral School of Health Sciences, University of Debrecen, 4032 Debrecen, 
Hungary.
(6)Doctoral School of Health Sciences, Faculty of Health Sciences, University of 
Pécs, 7621 Pécs, Hungary.
(7)College of Nursing, Sultan Qaboos University, Al-Khoudh, Muscat 123, Oman.

Various changes have affected health services delivery in response to the 
repercussions of the COVID-19 pandemic, and this may exhibit unprecedented 
effects on healthcare workers (HCWs). This study aimed to explore the lived 
experience of physicians and nurses caring for patients with COVID-19 in Jordan. 
An interpretative phenomenology approach was used, and sampling was purposively 
performed. Data were collected through semi-structured interviews using an 
online meeting platform (Zoom®). Interviews were audio-recorded, transcribed 
verbatim, and analyzed. The data were obtained from 26 physicians and nurses 
caring for patients with COVID-19. The mean age of the participants was 29.41 
years (SD = 2.72). Six main themes and 17 subthemes were identified: (i) 
emotional reactions; (ii) preparation; (iii) source of support; (iv) extreme 
workload; (v) occupational challenges, and (vi) work-related concerns. The 
results showed that nurses and physicians caring for COVID-19 patients in Jordan 
were experiencing mental and emotional distress and were practicing under 
inadequate work conditions. This distress could be multifactorial with personal, 
organizational, or cultural origins. Our findings may guide policymakers to 
consider the potential factors that significantly affect working environment in 
healthcare settings, the physical and mental wellbeing of HCWs, and the required 
professional training that can help in enhancing resilience and coping 
strategies amidst crises.

DOI: 10.3390/ijerph18179002
PMCID: PMC8431539
PMID: 34501587 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3024. Int J Environ Res Public Health. 2021 Aug 25;18(17):8933. doi: 
10.3390/ijerph18178933.

Mental Health of Apprentices during the COVID-19 Pandemic in Austria and the 
Effect of Gender, Migration Background, and Work Situation.

Dale R(1), O'Rourke T(1), Humer E(1), Jesser A(1), Plener PL(2)(3), Pieh C(1).

Author information:
(1)Department for Psychotherapy and Biopsychosocial Health, Danube University 
Krems, 3500 Krems, Austria.
(2)Department of Child and Adolescence Psychiatry, Medical University of Vienna, 
1090 Vienna, Austria.
(3)Department of Child and Adolescent Psychiatry and Psychotherapy, University 
of Ulm, 89075 Ulm, Germany.

This study assessed the mental health of apprentices during the COVID-19 
pandemic in Austria and the effect of gender, migration background, work 
situation, and work sector. An online survey via REDCap was performed with a 
sample of 1442 apprentices (female: 53.5%, male: 45.4%, diverse: 1.1%, migration 
background: 28.4%) from 29 March to 18 May 2021. Indicators of mental health 
were depression (PHQ-9), anxiety (GAD-7), well-being (WHO-5), disordered eating 
(EAT-8), and insomnia (ISI-7). There was a high prevalence of clinically 
relevant depression (cut-offs ≥11 for adolescents, ≥10 for adults: 48.3%), 
anxiety (cut-offs ≥11 for adolescents, ≥10 for adults: 35.4%), insomnia (cut-off 
≥15: 27%), and disordered eating (cut-offs ≥2 for men, ≥3 for women: 50.6%). 
Linear models revealed that apprentices with female and diverse gender, 
migration background, and unemployed status showed the poorest scores on all 
mental health measures (all p-values < 0.05) except disordered eating. These 
findings emphasize the need for intersectional strategies to reduce and prevent 
adverse mental health consequences of the COVID-19 pandemic for apprentices.

DOI: 10.3390/ijerph18178933
PMCID: PMC8430826
PMID: 34501523 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3025. Int J Environ Res Public Health. 2021 Aug 25;18(17):8924. doi: 
10.3390/ijerph18178924.

Sextech Use as a Potential Mental Health Reprieve: The Role of Anxiety, 
Depression, and Loneliness in Seeking Sex Online.

Marcotte AS(1), Kaufman EM(1)(2), Campbell JT(1), Reynolds TA(1)(3), Garcia 
JR(1)(4), Gesselman AN(1).

Author information:
(1)The Kinsey Institute, Indiana University, Bloomington, IN 47405, USA.
(2)Luddy School of Informatics, Computing, and Engineering, Indiana University, 
Bloomington, IN 47405, USA.
(3)Department of Psychology, University of New Mexico, Albuquerque, NM 87131, 
USA.
(4)Department of Gender Studies, Indiana University, Bloomington, IN 47405, USA.

Depression, anxiety, and loneliness have long been recognized as global mental 
health concerns. To temporarily relieve psychological distress, self-soothing 
behavior is common, including engagement in sexual behaviors that are linked to 
positive mental well-being. Considering the COVID-19 pandemic further 
exacerbated many mental health ailments alongside physical distancing 
regulations, we specifically examined online sexual behavior via the use of 
emergent digital sexual technologies, or sextech. In a 2019 study of 8004 
American adults, we assessed whether people experiencing higher anxiety, 
depression, and/or loneliness were more likely to engage in sextech use. 
Furthermore, we examined whether anxiety or depression mediated the association 
between loneliness and sextech use, as loneliness is one contributor to anxiety 
and depression. People with higher anxiety and depression were more likely to 
engage in sextech. However, those who were more lonely were less likely to 
engage with sextech, suggesting the aforementioned patterns were not due to lack 
of social connection. Our findings suggest people with mental health struggles 
may be drawn to interactive, digital forms of sexual behavior as a means of 
alleviating symptoms through distraction or self-soothing. This insight offers 
an important pathway for expanding the scope of mental health interventions, 
particularly as technology becomes increasingly prevalent and accessible in 
everyday life.

DOI: 10.3390/ijerph18178924
PMCID: PMC8430900
PMID: 34501522 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3026. BMC Public Health. 2021 Sep 8;21(1):1641. doi: 10.1186/s12889-021-11666-z.

Preventing within household transmission of Covid-19: is the provision of 
accommodation to support self-isolation feasible and acceptable?

Denford S(1)(2), Morton K(3), Horwood J(4), de Garang R(5), Yardley L(4)(6)(3).

Author information:
(1)Population Health Sciences, Bristol Medical School, University of Bristol, 
Bristol, UK. Sarah.denford@bristol.ac.uk.
(2)School of Psychological Science, University of Bristol, Bristol, UK. 
Sarah.denford@bristol.ac.uk.
(3)Academic Unit of Psychology, University of Southampton, Southampton, UK.
(4)Population Health Sciences, Bristol Medical School, University of Bristol, 
Bristol, UK.
(5)Public contributor and BME Engagement Worker for the Voice & Influence 
Partnership at The Care Forum, Bristol, UK.
(6)School of Psychological Science, University of Bristol, Bristol, UK.

BACKGROUND: Within-household transmission of Covid-19 is responsible for a 
significant number of infections. Efforts to protect at risk communities are 
needed. This study explored the acceptability of offering accommodation to 
support self-isolation among at risk populations, to prevent transmission of 
Covid-19 within vulnerable households.
METHODS: Mixed methods design structured in two phases. Phase 1: Survey of 545 
individuals who had provided consent to be contacted about ongoing research 
projects into infection control. Phase 2: Semi-structured interviews with 19 
participants from ethnic minority and low income communities.
RESULTS: Many survey and interview participants viewed the provision of 
accommodation as important and necessary in certain contexts. Of the 110 survey 
respondents, 85 (77%) said that they were not able to isolate at home. Among 
this group, 24 (28%) said they would accept accommodation and 23 (27%) said that 
they would probably accept. Of those unable to isolate at home, and at high risk 
if they caught the virus (N = 36) or living with someone at high risk (N 18), 19 
(35%) said that they would accept, and 12 (22%) said they would probably accept 
accommodation. Factors influencing uptake of accommodation included perceived 1) 
household vulnerability 2) virus exposure and 3) lack of isolation at home 
options. Barriers to accepting the accommodation offer included 1) able to 
isolate at home 2) wanting to be with family 3) caring responsibilities 4) 
mental wellbeing concerns 5) concerns about moving when ill and 6) infection 
control concerns. Participants raised issues that should be addressed before 
accommodation is offered, including questions regarding who should use temporary 
accommodation and when, and how infection control in temporary accommodation 
would be managed.
CONCLUSION: The provision of accommodation to prevent within household 
transmission of Covid-19 is viewed as acceptable, feasible and necessary by some 
people who are concerned about infection transmission in the home and are unable 
to self-isolate or socially distance at home. Different households will have 
different requirements, e.g., those with caring responsibilities, and to 
overcome these challenges additional support may be needed for the provision of 
accommodation to be feasible to those who could benefit most.

© 2021. The Author(s).

DOI: 10.1186/s12889-021-11666-z
PMCID: PMC8424161
PMID: 34496809 [Indexed for MEDLINE]

Conflict of interest statement: None declared.


3027. J Hum Lact. 2021 Nov;37(4):649-662. doi: 10.1177/08903344211026565. Epub 2021 
Sep 9.

Breastfeeding Experiences During the COVID-19 Lockdown in the United Kingdom: An 
Exploratory Study Into Maternal Opinions and Emotional States.

Costantini C(1), Joyce A(1), Britez Y(1).

Author information:
(1)11624 School of Psychotherapy and Psychology, Regent's University London, UK.

BACKGROUND: The COVID-19 pandemic has hugely impacted upon people's 
psychological and physical wellbeing; however, the effects of the COVID-19 
lockdown on mothers of young children, with particular regard to breastfeeding, 
are unknown.
RESEARCH AIMS: To explore: (1) Sources of advice and support available to 
breastfeeding mothers during and prior to the COVID-19 lockdown; (2) Mothers' 
opinions on statements and recommendations made by the World Health Organization 
on the importance of breastfeeding and breastfeeding during the COVID-19 
pandemic; (3) Maternal emotional states (i.e., anxiety and depression symptoms) 
experienced by breastfeeding mothers during the COVID-19 lockdown; and (4) 
influence of breastfeeding duration and number of children on breastfeeding 
opinions and emotional states.
METHODS: Mothers of children aged 0-36 months (N = 4018) took part in an online 
survey. The survey included demographic questions, as well as the Generalised 
Anxiety Disorder Questionnaire and the Patient Health Questionnaire. Mothers 
were further probed on opinions regarding breastfeeding practices during the 
COVID-19 pandemic.
RESULTS: Participants strongly agreed with the importance of breastfeeding, even 
if a mother showed symptoms of COVID-19. Differences in opinions on 
breastfeeding practices (e.g., the use of donor human milk and relactation), 
were found between participants in relation to breastfeeding duration and number 
of children. Participants with more than one child showed higher negative 
emotional states, namely anxiety symptoms. Except for Internet usage, 
participants indicated a decline in all sources of advice and support for 
breastfeeding during the COVID-19 lockdown.
CONCLUSIONS: Health bodies and professionals should consider maternal viewpoints 
and opinions regarding breastfeeding during the COVID-19 pandemic. Interventions 
are urgently needed in order to support breastfeeding mothers and prevent the 
development of mental health issues.

DOI: 10.1177/08903344211026565
PMCID: PMC8641027
PMID: 34496657 [Indexed for MEDLINE]

Conflict of interest statement: Disclosures and conflicts of interest: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


3028. BMJ Open. 2021 Sep 6;11(9):e054377. doi: 10.1136/bmjopen-2021-054377.

Qualitative study of UK health professionals' experiences of working at the 
point of care during the COVID-19 pandemic.

Baldwin S(1)(2), George J(3).

Author information:
(1)Warwick Clinical Trials Unit, University of Warwick, Coventry, UK 
sharin.baldwin@nhs.net.
(2)Learning and Organisation Development, London North West University 
Healthcare NHS Trust, Harrow, UK.
(3)College of Nursing, Midwifery and Healthcare, University of West London, 
Ealing, UK.

OBJECTIVES: To develop an understanding of health professionals' experiences of 
working at the point of care during the COVID-19 pandemic, the impact on their 
health and well-being and their support needs.
DESIGN: A qualitative study using semistructured interviews. Data were analysed 
using framework analysis.
SETTING: One large National Health Service integrated care trust.
PARTICIPANTS: A purposive sample of 19 qualified health professionals (doctors, 
nurses or allied health professionals), working with patients with COVID-19 
admitted to the hospitals between March and May 2020 were eligible to take part.
RESULTS: Eight major categories were identified: (1) Working in a 'war zone', 
(2) 'Going into a war zone without a weapon', (3) 'Patients come first', (4) 
Impact of COVID-19, (5) Leadership and management, (6) Support systems, (7) 
Health professionals' support needs, and (8) Camaraderie and pride. Health 
professionals reported increased levels of stress, anxiety and a lack of sleep. 
They prioritised their patients' needs over their own and felt a professional 
obligation to be at work. A key finding was the reported camaraderie among the 
health professionals where they felt that they were 'fighting this war 
together'.
CONCLUSIONS: This study provides a valuable insight into the experiences of some 
of the frontline health professionals working in a large London-based hospital 
trust during the first COVID-19 peak. Findings from this study could be used to 
inform how managers, leaders and organisations can better support their health 
professional staff during the current pandemic and beyond.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-054377
PMCID: PMC8423514
PMID: 34489298 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3029. BMC Health Serv Res. 2021 Sep 6;21(1):923. doi: 10.1186/s12913-021-06917-z.

Experiences of frontline healthcare workers and their views about support during 
COVID-19 and previous pandemics: a systematic review and qualitative 
meta-synthesis.

Billings J(1), Ching BCF(2), Gkofa V(2), Greene T(2)(3), Bloomfield 
M(2)(4)(5)(6).

Author information:
(1)Division of Psychiatry, University College London, 6th Floor, Maple House, 
149 Tottenham Court Road, London, W1T 7NF, UK. j.billings@ucl.ac.uk.
(2)Division of Psychiatry, University College London, 6th Floor, Maple House, 
149 Tottenham Court Road, London, W1T 7NF, UK.
(3)Department of Community Mental Health, University of Haifa, Haifa, Israel.
(4)Traumatic Stress Clinic, Camden & Islington NHS Foundation Trust, London, UK.
(5)National Institute for Health Research University College London Hospitals 
Biomedical Research Centre, London, UK.
(6)University College London Hospitals NHS Foundation Trust, London, UK.

BACKGROUND: Healthcare workers across the world have risen to the demands of 
treating COVID-19 patients, potentially at significant cost to their own health 
and wellbeing. There has been increasing recognition of the potential mental 
health impact of COVID-19 on frontline workers and calls to provide psychosocial 
support for them. However, little attention has so far been paid to 
understanding the impact of working on a pandemic from healthcare workers' own 
perspectives or what their views are about support.
METHODS: We searched key healthcare databases (Medline, PsychINFO and PubMed) 
from inception to September 28, 2020. We also reviewed relevant grey literature, 
screened pre-print servers and hand searched reference lists of key texts for 
all published accounts of healthcare workers' experiences of working on the 
frontline and views about support during COVID-19 and previous 
pandemics/epidemics. We conducted a meta-synthesis of all qualitative results to 
synthesise findings and develop an overarching set of themes and sub-themes 
which captured the experiences and views of frontline healthcare workers across 
the studies.
RESULTS: This review identified 46 qualitative studies which explored healthcare 
workers' experiences and views from pandemics or epidemics including and prior 
to COVID-19. Meta-synthesis derived eight key themes which largely transcended 
temporal and geographical boundaries. Participants across all the studies were 
deeply concerned about their own and/or others' physical safety. This was 
greatest in the early phases of pandemics and exacerbated by inadequate Personal 
Protective Equipment (PPE), insufficient resources, and inconsistent 
information. Workers struggled with high workloads and long shifts and desired 
adequate rest and recovery. Many experienced stigma. Healthcare workers' 
relationships with families, colleagues, organisations, media and the wider 
public were complicated and could be experienced concomitantly as sources of 
support but also sources of stress.
CONCLUSIONS: The experiences of healthcare workers during the COVID-19 pandemic 
are not unprecedented; the themes that arose from previous pandemics and 
epidemics were remarkably resonant with what we are hearing about the impact of 
COVID-19 globally today. We have an opportunity to learn from the lessons of 
previous crises, mitigate the negative mental health impact of COVID-19 and 
support the longer-term wellbeing of the healthcare workforce worldwide.

© 2021. The Author(s).

DOI: 10.1186/s12913-021-06917-z
PMCID: PMC8419805
PMID: 34488733 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3030. J Affect Disord. 2021 Dec 1;295:316-322. doi: 10.1016/j.jad.2021.08.029. Epub 
2021 Aug 24.

Groups 4 Health protects against unanticipated threats to mental health: 
Evaluating two interventions during COVID-19 lockdown among young people with a 
history of depression and loneliness.

Cruwys T(1), Haslam C(2), Rathbone JA(2), Williams E(2), Haslam SA(2).

Author information:
(1)Research School of Psychology, The Australian National University, Australia. 
Electronic address: tegan.cruwys@anu.edu.au.
(2)School of Psychology, The University of Queensland, Australia.

BACKGROUND: Decades of research indicate that when social connectedness is 
threatened, mental health is at risk. However, extant interventions to tackle 
loneliness have had only modest success, and none have been trialled under 
conditions of such threat.
METHOD: 174 young people with depression and loneliness were randomised to one 
of two evidence-based treatments: cognitive behaviour therapy (CBT) or Groups 4 
Health (G4H), an intervention designed to increase social group belonging. 
Depression, loneliness, and well-being outcomes were evaluated at one-year 
follow-up; COVID-19 lockdown restrictions were imposed partway through follow-up 
assessments. This provided a quasi-experimental test of the utility of each 
intervention in the presence (lockdown group) and absence (control group) of a 
threat to social connectedness.
RESULTS: At one-year follow-up, participants in lockdown reported significantly 
poorer wellbeing than controls who completed follow-up before lockdown, 
t(152)=2.41, p=.017. Although both CBT and G4H led to symptom improvement, the 
benefits of G4H were more robust following an unanticipated threat to social 
connectedness for depression (χ2(16)=31.35, p=.001), loneliness (χ2(8)=21.622, 
p=.006), and wellbeing (χ2(8)=22.938, p=.003).
LIMITATIONS: Because the COVID-19 lockdown was unanticipated, this analysis 
represents an opportunistic use of available data. As a result, we could not 
measure the specific impact of restrictions on participants, such as reduced 
income, degree of isolation, or health-related anxieties.
CONCLUSIONS: G4H delivered one year prior to COVID-19 lockdown offered greater 
protection than CBT against relapse of loneliness and depression symptoms. 
Implications are discussed with a focus on how these benefits might be extended 
to other life stressors and transitions.

Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2021.08.029
PMCID: PMC8413117
PMID: 34488085 [Indexed for MEDLINE]

Conflict of interest statement: The authors TC, CH and AH are the developers of 
the GROUPS 4 HEALTH program, and The University of Queensland holds its 
associated Intellectual Property. These authors have an academic, rather than 
commercial, interest in the program, with training offered at cost and 
additional funds directed to ongoing program development and evaluation.


3031. Work. 2021;70(1):3-10. doi: 10.3233/WOR-205309.

Healthcare students' mental and physical well-being during the COVID-19 lockdown 
and distance learning.

Almhdawi KA(1), Alazrai A(2), Obeidat D(2), Altarifi AA(3), Oteir AO(4), 
Aljammal AH(5), Arabiat AA(6), Alrabbaie H(2), Jaber H(2), Almousa KM(7).

Author information:
(1)Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, 
Jordan University of Science and Technology, Jordan.
(2)Rehabilitation Sciences, Department of Rehabilitation Sciences, Faculty of 
Applied Medical Sciences, Jordan University of Science and Technology, Jordan.
(3)Department of Pharmacology, Faculty of Medicine, Jordan University of Science 
and Technology, Jordan.
(4)Department of Allied Medical Sciences-Paramedics, Faculty of Applied Medical 
Sciences, Jordan University of Science and Technology, Jordan.
(5)Department of Computer Science and Applications, Faculty of Prince Al-Hussein 
Bin Abdallah II for Information Technology, The Hashemite University, Jordan.
(6)Department of Family Medicine, The Jordanian Ministry of Health, Jordan.
(7)Ministry of Health, Jordan.

BACKGROUND: The sudden shift into distance learning during the coronavirus 
(COVID-19) lockdown might have impacted university students' well-being.
OBJECTIVE: This study aimed to investigate undergraduate healthcare university 
students' health-related quality of life (HRQoL) and its predictors during 
COVID-19.
METHODS: A cross-sectional study used an online self-administered questionnaire. 
The study targeted undergraduate medical, dental, pharmacy, and nursing students 
at Jordanian universities. Data collected included demographics,12-item Short 
Form health survey (SF-12), students' evaluation of distance learning, Neck 
Disability Index (NDI), Depression Anxiety Stress Scale (DASS21), and the 
International Physical Activity Questionnaire (IPAQ). Descriptive analyses were 
conducted to summarize primary outcome measures data. Predictors of HRQoL were 
determined using a multiple variable regression analysis.
RESULTS: In total, 485 university students successfully completed this study 
with a mean age of 20.6 (±2.0). Participants' HRQoL level measured by SF-12 mean 
scores were 66.5 (±20.2) for physical health component and 44.8 (±21.2) for 
mental health component. The regression model explained 65.5% of the variation 
(r2 = 0.655, F = 127.8, P < 0.001) in participants' HRQoL. Factors significantly 
associated with HRQoL included depression, neck disability index score, stress, 
health self-evaluation, average of satisfaction with distance learning, IPAQ 
score, and weekly studying hours.
CONCLUSIONS: This study showed that healthcare students had a relatively low 
level of HRQoL during COVID-19 pandemic in Jordan. Academic and non-academic 
factors associated with HRQoL were identified and should be considered by 
healthcare educational institutions for better academic planning in future 
similar pandemics.

DOI: 10.3233/WOR-205309
PMID: 34487002 [Indexed for MEDLINE]


3032. J Women Aging. 2022 Jul-Aug;34(4):501-522. doi: 10.1080/08952841.2021.1965456. 
Epub 2021 Sep 6.

Physical and mental well-being, risk and protective factors among older lesbians 
/gay women in the United Kingdom during the initial COVID-19 2020 lockdown.

Westwood S(1), Hafford-Letchfield T(2), Toze M(3).

Author information:
(1)York Law School, University of York, York, UK.
(2)University of Strathclyde, Glasgow, Scotland, UK.
(3)University of Lincoln, England, UK.

This article reports on a subset of findings from a recent UK survey of the 
impact of COVID-19 on older LGBT+ people in the UK. It considers the responses 
of 149 lesbian/gay women (137 cisgender, 12 trans) to questions relating to 
physical and mental health and wellbeing. Findings indicate that those women - 
in couples and singles - who were happy with their living circumstances 
pre-COVID showed stoicism, adaptability, and determined positivity in response 
to the pandemic and associated lockdown. Some even reported an improved quality 
of life, better personal relationships and increased neighborly support. By 
contrast, those women who were very unhappy with their circumstances prior to 
COVID-19 - generally women who lived alone and experienced a mismatch between 
their actual and desired social network - either remained unhappy or became more 
unhappy, due to its impact on fragile support systems. For trans women, formal 
support from trans/LGBT+ specific networks - online during COVID lockdown - were 
central to their wellbeing. Having access to, and being able to use, online 
technologies were essential to good mental health during lockdown. These 
findings reaffirm the diversity among older lesbians/gay women as well as 
highlighting how COVID-19 has acted as a magnifier to their preexisting 
circumstances. The narratives of those doing well - generally better-networked, 
intentionally positive and engaged in practices which promote their well-being - 
may offer insights for supporting those who find their lives more challenging, 
both during a public health crisis and more generally.

DOI: 10.1080/08952841.2021.1965456
PMID: 34486952 [Indexed for MEDLINE]


3033. Aging Ment Health. 2022 Oct;26(10):2039-2047. doi: 
10.1080/13607863.2021.1972281. Epub 2021 Sep 6.

Mediation effect of coping strategies on general psychological health among 
middle-aged and older adults during the COVID-19 pandemic.

Malek Rivan NF(1), Shahar S(2), Singh DKA(3), Ibrahim N(4), Mat Ludin AF(5), 
Yahya HM(1), Mohamed Sakian NI(6), Mahadzir H(7), Subramaniam P(4), Kamaruddin 
MZA(8).

Author information:
(1)Nutritional Sciences Programme and Centre for Healthy Ageing and Wellness 
(H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala 
Lumpur, Malaysia.
(2)Dietetics Programme and Centre for Healthy Ageing and Wellness (H-CARE), 
Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, 
Malaysia.
(3)Physiotherapy Programme and Centre for Healthy Ageing and Wellness (H-CARE), 
Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
(4)Clinical Psychology Programme and Centre for Healthy Ageing and Wellness 
(H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala 
Lumpur, Malaysia.
(5)Biomedical Science Programme and Centre for Healthy Ageing and Wellness 
(H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala 
Lumpur, Malaysia.
(6)Occupational Therapy Programme, Centre for Healthy Ageing and Wellness 
(H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala 
Lumpur, Malaysia.
(7)Internal Medicine and Geriatric Department, Pusat Perubatan Universiti 
Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
(8)Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, 
Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.

OBJECTIVE: In this study, we aim to assess general psychological health, 
associated factors, and the potential of coping strategies as a mediator for 
middle-aged and older Malaysian adults during the COVID-19 pandemic.
METHODS: A total of 535 individuals aged 52 years and above from the previous 
cohort and interventional studies in Peninsular Malaysia were contacted during 
the Movement Control Order (MCO) issued during the COVID-19 pandemic. Telephonic 
interviews were conducted to obtain participant information concerning 
socio-demography, physical activity, subjective well-being (SWB) as assessed 
using flourishing scale, coping strategies, and general psychological health 
(GHQ-12). Simple linear regression (SLR) and multiple linear regression (MLR) 
analyses were performed to identify the factors associated with GHQ-12. The 
associated factors were further analysed using mediation analysis to determine 
the potential of coping strategies as a mediator.
RESULTS: It was observed that participants had a low mean GHQ-12 score 
(M = 0.80, SD = 2.19), indicating good psychological health. Living arrangement, 
physical activity, and flourishing scale were associated with psychological 
health (R2 = 0.412, p < 0.05) in MLR. Positive reinterpretation, emotional 
support, instrumental support, humour, denial, and self-blame appear to 
partially mediate the relationship between socio-demography, physical activity, 
flourishing scale and GHQ-12, with lower coefficient values.
CONCLUSION: Middle-aged and older adults in Malaysia had good psychological 
health during the COVID-19 pandemic, especially when living with family, 
physically active, and having good subjective well-being. These findings provide 
the initial evidence to help promote the ageing population's general well-being 
and mental health and enable them to cope with change during the COVID-19 
pandemic.

DOI: 10.1080/13607863.2021.1972281
PMID: 34486885 [Indexed for MEDLINE]


3034. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2021 Jul;29(4):844-847. doi: 
10.32687/0869-866X-2021-29-4-844-847.

[The mental reactions of psychiatrists and narcologists against the background 
of COVID-19 pandemic].

[Article in Russian]

Novikov VV(1), Novikova AM(2), Petrov DS(2), Volodin BY(3), Filimonov AP(3).

Author information:
(1)The Federal State Budget Educational Institution of Higher Education "The 
Academician I. P. Pavlov Ryazan State Medical University" of Minzdrav of Russia, 
390026 Ryazan, Russia, novlad2006@ya.ru.
(2)The State Budget Institution of the Ryazan Oblast "The Oblast Clinical 
Narcological Dispensary", 390046 Ryazan, Russia.
(3)The Federal State Budget Educational Institution of Higher Education "The 
Academician I. P. Pavlov Ryazan State Medical University" of Minzdrav of Russia, 
390026 Ryazan, Russia.

The article considers various mental reactions of psychiatrists and narcologists 
against the background of the SARS-CoV-2 pandemic, based on a brief scientific 
analysis of publications and experimental psychological research methods. The 
purpose of study was to identify impact of the COVID-19 pandemic on mental 
health of psychiatrists and psychiatrists-narcologists. The results of survey of 
psychiatrists and narcologists are presented. The study was carried out using 
such test techniques as life quality scale SF-36 (Health Status Survey), Lazarus 
questionnaire "Coping Behaviors" adjusted to conditions of Russia and Hamilton 
scales to assess depression and anxiety (HDRS, HARS). The results.The low level 
of psychological well-being, moderate degree of preference for all coping 
strategies were established. The anxiety was determine in 34.8% of respondents 
and depression in 8.7%. It was established that actually, the impact of the 
COVID-19 pandemic on medical workers is conditioned by complex of mental 
reactions (from anosognosia to expressed anxiety and depressive disorders) and 
is accompanied by increasing general anxiety.

DOI: 10.32687/0869-866X-2021-29-4-844-847
PMID: 34486846 [Indexed for MEDLINE]


3035. Nurs Stand. 2021 Nov 3;36(11):45-50. doi: 10.7748/ns.2021.e11678. Epub 2021 Sep 
6.

Individual and organisational strategies to develop resilience in the nursing 
workforce.

Cajanding RJ(1).

Author information:
(1)Adult Critical Care Unit, St Bartholomew's Hospital, Barts Health NHS Trust, 
London, England.

Nurses are likely to encounter a wide range of distressing, challenging and 
sometimes traumatic situations. However, the coronavirus disease 2019 (COVID-19) 
pandemic has created unprecedented levels of stress, risk, uncertainty and 
anxiety for nurses. Nurses have been working in highly challenging conditions, 
particularly on the front line of patient care, which has had adverse effects on 
their mental health and well-being. The challenges generated by the COVID-19 
pandemic have called into question the notion of nursing being an innately 
resilient profession. Consequently, the pandemic has reinforced the need for 
individuals, teams and healthcare organisations to foster resilience in nurses. 
This article discusses the theoretical underpinnings of resilience, explains 
what resilience in nurses means, and describes the adverse effects of the 
pandemic on nurses' mental health and resilience. The article also explores how 
nurses' resilience can be developed and enhanced from an individual and 
organisational perspective.

© 2021 RCN Publishing Company Ltd. All rights reserved. Not to be copied, 
transmitted or recorded in any way, in whole or part, without prior permission 
of the publishers.

DOI: 10.7748/ns.2021.e11678
PMID: 34486360 [Indexed for MEDLINE]

Conflict of interest statement: None declared


3036. Front Public Health. 2021 Aug 13;9:640205. doi: 10.3389/fpubh.2021.640205. 
eCollection 2021.

An Italy-China Collaboration for Promoting Public Mental Health Recommendations 
During the COVID-19 Pandemic.

Scattoni ML(1), Starace F(2)(3), de Girolamo G(4), Xia J(5).

Author information:
(1)Istituto Superiore di Sanità, Research Coordination and Support Service, 
Rome, Italy.
(2)AUSL Modena, Department of Mental Health and Drug Abuse, Modena, Italy.
(3)Italian Society of Epidemiological Psychiatry (SIEP), Modena, Italy.
(4)Saint John of God Clinical Research Center, Psychiatric Epidemiology and 
Evaluation Unit, Brescia, Italy.
(5)University of Nottingham Ningbo, Nottingham Ningbo GRADE Centre, Nottingham, 
China.

The rapid evolution of severe acute respiratory syndrome coronavirus 2 
(SARS-CoV-2) emergency involved Italy as the first European country. Meanwhile, 
China was the only other country to experience the emergency scenario, 
implementing public health recommendations and raising concerns about the mental 
health of the population. The Italian National Institute of Health [Istituto 
Superiore di Sanità (ISS)] reviewed relevant scientific literature in mental 
health to evaluate the best clinical practices and established the collaboration 
with the WHO, World Psychiatry Association, and China to support the public 
health system in a phase of acute emergency. This process permitted the 
definition of organizational and practical-operational Italian guidelines for 
the protection of the well-being of healthcare workers. These guidelines have 
been extensively disseminated within the Italian territory for maximum 
stakeholder utilization.

Copyright © 2021 Scattoni, Starace, de Girolamo and Xia.

DOI: 10.3389/fpubh.2021.640205
PMCID: PMC8414581
PMID: 34485211 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


3037. Am J Phys Med Rehabil. 2021 Nov 1;100(11):1033. doi: 
10.1097/PHM.0000000000001865.

Letter to the Editor on "Disrupted Access to Therapies and Impact on Well-being 
During the COVID-19 Pandemic for Children With Motor Impairment and Their 
Caregivers".

Beardsley J, Houtrow A, Verduzco-Gutierrez M.

Comment on
    Am J Phys Med Rehabil. 2021 Sep 1;100(9):821-830.

DOI: 10.1097/PHM.0000000000001865
PMID: 34483261 [Indexed for MEDLINE]


3038. Econ Hum Biol. 2021 Dec;43:101056. doi: 10.1016/j.ehb.2021.101056. Epub 2021 Aug 
20.

Shelter-in-place orders, loneliness, and collaborative behavior.

Babin JJ(1), Foray M(2), Hussey A(3).

Author information:
(1)College of Business and Technology, Western Illinois University, USA. 
Electronic address: jj-babin@wiu.edu.
(2)College of Business and Technology, Western Illinois University, USA. 
Electronic address: mp-foray@wiu.edu.
(3)Fogelman College of Business and Economics, University of Memphis, USA. 
Electronic address: ajhussey@memphis.edu.

The outbreak of COVID-19 resulted in numerous jurisdictions instituting 
"shelter-in-place'' orders (SPOs). While designed to restrict or impede normal 
levels of social proximity, SPOs altered the way or degree to which workers 
interact with each other and have likely imposed a toll on employee well-being. 
The authors exploit the temporal and geographic variation in U.S. SPOs to 
investigate their effect on loneliness among online workers. Variation in 
loneliness is then linked to worker behavior in a simple two-person, 
collaborative task (a framed stag hunt). The analysis reveals a strong positive 
relationship between SPOs and loneliness on average, peaking during the wave 
associated with the most prolonged duration of isolation. SPOs 
disproportionately impacted workers in occupations not substantially involving 
teamwork or collaboration. As reported loneliness increases, the probability of 
an individual collaborating in a simple interactive workplace scenario decreases 
significantly. In the final survey wave, SPOs are scarcer, loneliness subsides, 
and cooperative behavior increases dramatically.

Copyright © 2021 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.ehb.2021.101056
PMCID: PMC8515353
PMID: 34482119 [Indexed for MEDLINE]


3039. Lancet. 2021 Sep 4;398(10303):920-930. doi: 10.1016/S0140-6736(21)01596-8.

Mental illness and suicide among physicians.

Harvey SB(1), Epstein RM(2), Glozier N(3), Petrie K(4), Strudwick J(5), Gayed 
A(5), Dean K(6), Henderson M(7).

Author information:
(1)Black Dog Institute, Faculty of Medicine, University of New South Wales, 
Randwick, NSW, Australia. Electronic address: s.harvey@unsw.edu.au.
(2)Center for Communication and Disparities Research, Department of Family 
Medicine, University of Rochester School of Medicine and Dentistry, Rochester, 
NY, USA.
(3)Sydney School of Medicine (Central Clinical School), Faculty of Medicine and 
Health, University of Sydney, Sydney, NSW, Australia.
(4)Black Dog Institute, Faculty of Medicine, University of New South Wales, 
Randwick, NSW, Australia; School of Psychiatry, UNSW Medicine, University of New 
South Wales, Kensington, NSW, Australia.
(5)Black Dog Institute, Faculty of Medicine, University of New South Wales, 
Randwick, NSW, Australia.
(6)School of Psychiatry, UNSW Medicine, University of New South Wales, 
Kensington, NSW, Australia; Justice Health and Forensic Mental Health Network, 
Matraville, NSW, Australia.
(7)Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.

Comment in
    Lancet. 2021 Sep 4;398(10303):817.

The COVID-19 pandemic has heightened interest in how physician mental health can 
be protected and optimised, but uncertainty and misinformation remain about some 
key issues. In this Review, we discuss the current literature, which shows that 
despite what might be inferred during training, physicians are not immune to 
mental illness, with between a quarter and a third reporting increased symptoms 
of mental ill health. Physicians, particularly female physicians, are at an 
increased risk of suicide. An emerging consensus exists that some aspects of 
physician training, working conditions, and organisational support are 
unacceptable. Changes in medical training and health systems, and the additional 
strain of working through a pandemic, might have amplified these problems. A new 
evidence-informed framework for how individual and organisational interventions 
can be used in an integrated manner in medical schools, in health-care settings, 
and by professional colleagues is proposed. New initiatives are required at each 
of these levels, with an urgent need for organisational-level interventions, to 
better protect the mental health and wellbeing of physicians.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/S0140-6736(21)01596-8
PMCID: PMC9618683
PMID: 34481571 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of interests SBH and KP reports 
grant income from iCare Foundation and NSW Health. MH was a consultant 
psychiatrist at the Practitioner Health Programme between 2010 and 2015. All 
other authors declare no competing interests.


3040. Pediatr Int. 2022 Jan;64(1):e14981. doi: 10.1111/ped.14981.

Children's daily lives and well-being: Findings from the CORONA-CODOMO survey 
1st wave.

Hangai M(1)(2), Piedvache A(1), Sawada N(1)(3), Okubo Y(1)(4), Sampei M(1)(5), 
Yamaoka Y(5), Tanaka K(6), Hosozawa M(7), Morisaki N(1), Igarashi T(8).

Author information:
(1)Department of Social Medicine, National Center for Child Health and 
Development, Setagaya-ku, Japan.
(2)Department of Pediatrics, The University of Tokyo, Bunkyo-ku, Japan.
(3)School of Public Health, The University of Tokyo, Bunkyo-ku, Japan.
(4)Department of Epidemiology, UCLA Fielding School of Public Health, Los 
Angeles, CA, USA.
(5)Department of Global Health Promotion, Tokyo Medical and Dental University, 
Bunkyo-ku, Japan.
(6)Department of Psychosocial Medicine, National Center for Child Health and 
Development, Setagaya-ku, Japan.
(7)Institute for Global Health Policy Research, Bureau of International Health 
Cooperation, National Center for Global Health and Medicine, Shinjuku-ku, Japan.
(8)National Center for Child Health and Development, Setagaya-ku, Japan.

BACKGROUND: The coronavirus disease 2019 pandemic has changed people's lives 
dramatically. Few data on the acute effects of the pandemic on children's daily 
lives and well-being have been published to date. This study aimed to capture 
its effects on Japanese children during the first peak of the outbreak.
METHODS: We conducted a web-based, anonymous cross-sectional survey targeting 
Japanese children aged 7-17 years and parents/guardians of children aged 
0-17 years. Eligible individuals were invited to participate in the survey from 
April 30 to May 31, 2020. This self-report questionnaire examined daily life and 
behaviors, psychological symptoms, well-being, quality of life, and positive 
parenting or abusive behaviors at the very beginning of the outbreak.
RESULTS: A total of 2,591 children and 6,116 parents/guardians participated in 
our survey. Sixty-two percent of children reported screen time exceeding 2 h. 
Twenty percent of children reported abusive behaviors by family members. Nine in 
ten parents/guardians of school-aged children reported that their child had at 
least one acute stress symptom in the past month. Average mental health subscale 
scores from KINDLR questionnaire on quality of life were lower than the national 
average for all grades. Nearly half of parents/guardians refrained from seeking 
medical care for the child's symptoms.
CONCLUSIONS: The COVID-19 pandemic had serious acute impacts on Japanese 
children's daily lives, well-being, family relationships, and health-care 
utilization, including some impacts that are potentially long-lasting; thus, 
proactive interventions and services are needed, as well as longitudinal 
surveys.

© 2021 Japan Pediatric Society.

DOI: 10.1111/ped.14981
PMCID: PMC8662137
PMID: 34480819 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3041. Pain Med. 2022 Feb 1;23(2):280-287. doi: 10.1093/pm/pnab262.

The Relationship Between Pain and Psychological Distress During the COVID-19 
Pandemic: Is Social Technology Use Protective?

Yang Y(1), Grol-Prokopczyk H(2), Reid MC(1), Pillemer K(1)(3).

Author information:
(1)Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New 
York, New York.
(2)Department of Sociology, University at Buffalo, State University of New York, 
Buffalo, New York.
(3)Department of Human Development, Cornell University, Ithaca, New York, USA.

OBJECTIVES: The COVID-19 pandemic and resulting shelter-in-place orders have 
profoundly changed the everyday social environment. This study examines the 
relationship between pain and psychological distress (depression, anxiety, and 
loneliness) among U.S. adults ages 54 and older during the pandemic. We also 
test whether use of technology for social purposes moderates the association 
between pain severity and psychological distress.
METHODS: Using cross-sectional data on 1,014 adults ages 54 and older (pain 
free, n = 637; mild pain, n = 106; moderate pain, n = 227; and severe pain, 
n = 64) from the 2020 Health and Retirement Study COVID-19 Project (Early, 
Version 1.0), we conducted regression analyses to test the association between 
pain severity and psychological outcomes and to assess social technology use 
frequency as a moderator.
RESULTS: Compared with their pain-free peers, participants with mild-to-moderate 
pain reported more depressive symptoms and greater loneliness; those with severe 
pain reported higher levels of depression, anxiety, and loneliness. Social 
technology use was associated with lower levels of depression and loneliness. 
However, interaction analyses show that social technology use predicted an 
increase in depression for individuals with pain but a decrease in depression 
among pain-free individuals. For anxiety and loneliness, no significant effects 
of social technology use were observed.
CONCLUSION: Older adults with pain are at high risk of depression, anxiety, and 
loneliness during the pandemic. Although social technologies have become a 
common alternative to face-to-face interactions during the COVID-19 crisis, and 
overall they can provide mental health benefits, our results suggest that social 
technologies can be detrimental to psychological well-being among people with 
pain. These findings can inform technology-based interventions aiming to promote 
well-being among older adults with pain.

© The Author(s) 2021. Published by Oxford University Press on behalf of the 
American Academy of Pain Medicine. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/pm/pnab262
PMCID: PMC8499956
PMID: 34480572 [Indexed for MEDLINE]


3042. Eur J Sport Sci. 2022 Dec;22(12):1916-1925. doi: 10.1080/17461391.2021.1976841. 
Epub 2021 Sep 25.

Physical activity on mental wellbeing in senior English Premier League soccer 
players during the COVID-19 pandemic and the lockdown.

Grimson S(1), Brickley G(1), Smeeton NJ(1), Abbott W(2), Brett A(2).

Author information:
(1)Sport and Exercise Science and Medicine, University of Brighton, Eastbourne, 
UK.
(2)Brighton and Hove Albion FC, Brighton, UK.

The COVID-19 pandemic and the subsequent lockdown created new stressors that 
could potentially attenuate mental wellbeing (MW) in athletes, who are already 
susceptible to poor MW. This study aims to describe fluctuations to MW during 
"lockdown" and subsequent "return to sport" protocols, in comparison to the 
normal "in-season" in professional soccer. Twenty-five English Premier League 
(EPL) soccer players completed the Warwick-Edinburgh Mental Wellbeing Scale 
(WEMWBS) every two weeks, during the 2019/2020 season, and every week during 
"lockdown" and "return to training" for 28 weeks. The duration of each physical 
activity (PA) session completed was recorded. No significant differences were 
found for MW between time points (In-season, lockdown, return to training and 
the restart) (51.5 ± 5.6 vs. 50.7 ± 4.8 vs. 50.8 ± 5.7 vs. 50.7 ± 5.6 
(p > 0.05)) respectively. Individually, differences were identified; in-season 
weekly session duration (243 ± 38 min) was higher than during lockdown 
(180 ± 62 min) (p < 0.05). During lockdown, weekly MW scores were related to the 
previous 7-day number of sessions (r = 0.151) and active min (r = 0.142) 
(p < 0.05). Furthermore, participants that exercised >250 min in lockdown, had 
higher MW scores (52.46 ± 4.65) than <250 min (50.35 ± 6.55) (p < 0.05). MW 
responses to lockdown were best understood on an individual basis. Additionally, 
PA only had a measurable effect on MW when >250 min. Further, stressors imposed 
upon players during an EPL season, are potentially greater than those inflicted 
by the lockdown. Implications for monitoring MW in EPL soccer players and the 
potential inclusion of an in-season break are discussed.Highlights Mental 
Wellbeing Responses, as measured by the Warwick-Edinburgh Mental Wellbeing scale 
did not change significantly at a group level across the four phases of the 
season. However, on an individual level changes were evident.There was a decline 
in the trend of wellbeing scores during in-season, return to training and the 
restart, but an increase in wellbeing scores during lockdown.Physical Activity 
had a measurable effect on wellbeing, when physical activity was >250 min during 
lockdown.These findings highlight the need for individual monitoring of 
wellbeing and longitudinal monitoring in sport to identify decline in wellbeing 
and implement intervention. In addition, the prescription of physical activity 
>250 min per week during lockdown in trained athletes may promote positive 
mental health.

DOI: 10.1080/17461391.2021.1976841
PMID: 34479466 [Indexed for MEDLINE]


3043. Sci Rep. 2021 Sep 2;11(1):17723. doi: 10.1038/s41598-021-97065-1.

Longitudinal changes in physical activity during and after the first national 
lockdown due to the COVID-19 pandemic in England.

Bu F(1), Bone JK(2), Mitchell JJ(3), Steptoe A(2), Fancourt D(2).

Author information:
(1)Department of Behavioral Science and Health, University College London, 1-19 
Torrington Place, London, WC1E 7HB, UK. f.bu@ucl.ac.uk.
(2)Department of Behavioral Science and Health, University College London, 1-19 
Torrington Place, London, WC1E 7HB, UK.
(3)Institute of Epidemiology and Public Health, University College London, 
London, UK.

Recent studies have shown reduced physical activity at early stages of the 
COVID-19 pandemic. However, there is a lack of investigation on longitudinal 
changes in physical activity beyond lockdowns and stay-at-home orders. Moreover, 
it is unclear if there is heterogeneity in physical activity growth 
trajectories. This study aimed to explore longitudinal patterns of physical 
activity and factors associated with them. Data were from the UCL COVID-19 
Social Study. The analytical sample consisted of 35,915 adults in England who 
were followed up for 22 weeks from 24th March to 23rd August 2020. Data were 
analysed using growth mixture models. Our analyses identified six classes of 
growth trajectories, including three stable classes showing little change over 
time (62.4% in total), two classes showing decreasing physical activity (28.6%), 
and one class showing increasing physical activity over time (9%). A range of 
factors were found to be associated the class membership of physical activity 
trajectories, such as age, gender, education, income, employment status, and 
health. There is substantial heterogeneity in longitudinal changes in physical 
activity during the COVID-19 pandemic. However, a substantial proportion of our 
sample showed persistent physical inactivity or decreasing physical activity. 
Given the well-established link between physical activity and health, persistent 
or increased physical inactivity is likely to have both immediate and long-term 
implications for people's physical and mental health, as well as general 
wellbeing. More efforts are needed to promote physical activity during the 
pandemic and beyond.

© 2021. The Author(s).

DOI: 10.1038/s41598-021-97065-1
PMCID: PMC8413348
PMID: 34475465 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


3044. Sci Rep. 2021 Sep 2;11(1):17595. doi: 10.1038/s41598-021-96852-0.

Mental well-being during the first months of Covid-19 in adults and children: 
behavioral evidence and neural precursors.

Borbás R(1)(2), Fehlbaum LV(1)(2), Dimanova P(1)(3), Negri A(1), Arudchelvam 
J(1), Schnider CB(1), Raschle NM(4)(5)(6).

Author information:
(1)Jacobs Center for Productive Youth Development, University of Zurich, Zurich, 
Switzerland.
(2)University Psychiatric Clinics Basel and University of Basel, Basel, 
Switzerland.
(3)Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, 
Switzerland.
(4)Jacobs Center for Productive Youth Development, University of Zurich, Zurich, 
Switzerland. nora.raschle@jacobscenter.uzh.ch.
(5)University Psychiatric Clinics Basel and University of Basel, Basel, 
Switzerland. nora.raschle@jacobscenter.uzh.ch.
(6)Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, 
Switzerland. nora.raschle@jacobscenter.uzh.ch.

Pandemics such as the Covid-19 pandemic have shown to impact our physical and 
mental well-being, with particular challenges for children and families. We 
describe data from 43 adults (31♀, ages = 22-51; 21 mothers) and 26 children 
(10♀, ages = 7-17 years) including pre-pandemic brain function and seven 
assessment points during the first months of the pandemic. We investigated (1) 
changes in child and adult well-being, (2) mother-child associations of mental 
well-being, and (3) associations between pre-pandemic brain activation during 
mentalizing and later fears or burden. In adults the prevalence of clinically 
significant anxiety-levels was 34.88% and subthreshold depression 32.56%. 
Caregiver burden in parents was moderately elevated. Overall, scores of 
depression, anxiety, and caregiver burden decreased across the 11 weeks after 
Covid-19-onset. Children's behavioral and emotional problems during Covid-19 did 
not significantly differ from pre-pandemic levels and decreased during 
restrictions. Mothers' subjective burden of care was associated with children's 
emotional and behavioral problems, while depression levels in mothers were 
related to children's mood. Furthermore, meeting friends was a significant 
predictor of children's mood during early restrictions. Pre-pandemic neural 
correlates of mentalizing in prefrontal regions preceded later development of 
fear of illnesses and viruses in all participants, while temporoparietal 
activation preceded higher subjective burden in mothers.

© 2021. The Author(s).

DOI: 10.1038/s41598-021-96852-0
PMCID: PMC8413346
PMID: 34475457 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


3045. Korean J Med Educ. 2021 Sep;33(3):203-213. doi: 10.3946/kjme.2021.200. Epub 2021 
Aug 27.

Stress and associated factors with received and needed support in medical 
students during COVID-19 pandemic: a multicenter study.

Puranachaikere T(1), Hataiyusuk S(1), Anupansupsai R(1), In-Iw S(1), Saisavoey 
N(1), Techapanuwat T(1), Arunrodpanya F(2), Charonpongsuntorn C(3), 
Wiwattanaworaset P(4), Siripongpan A(5), Pruttithavorn W(6), Wonglertwisawakorn 
C(6), Pojanapotha P(7), Rueangrong B(8), Pattrakornkul N(9), Piyawattanametha 
N(10), Piyawattanametha S(10), Ratanapichayachai D(11).

Author information:
(1)Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
(2)Faculty of Medicine, Naresuan University, Phitsanulok, Thailand.
(3)Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand.
(4)Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
(5)Institute of Medicine, Suranaree University of Technology, Nakhon Ratchasima, 
Thailand.
(6)Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, 
Thailand.
(7)Faculty of Medicine, Chiangmai University, Chiang Mai, Thailand.
(8)Ratchaburi Hospital, Ratchaburi, Thailand.
(9)Faculty of Medicine, Burapha University, Chon Buri, Thailand.
(10)Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
(11)Rajavithi Hospital, Bangkok, Thailand.

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic is a global health 
crisis that has impacted daily life due to the policies created to contain the 
outbreak. Recent studies showed that medical students, a high-stress population, 
experienced deteriorated mental well-being during the pandemic. The aim of the 
present study was to assess stress and the need for support among Thai medical 
students during the COVID-19 pandemic, as a multicenter study.
METHODS: The present study was a cross-sectional questionnaire-based study which 
collected data from second through sixth year medical students. Data was 
collected during the pandemic from multiple medical schools spanning all six 
regions of Thailand. Questionnaires included: demographic data; the Thai version 
of the Perceived Stress Scale-10 (T-PSS-10) assessing stress level and the 
sources of stress; and the received supports from medical schools, the 
satisfaction with the supports, and the further necessary needs.
RESULTS: There were 1,395 medical students who responded to the questionnaires. 
Mean T-PSS-10 score was 17.8. Most of the sources of stress were related to the 
changing of teaching and evaluation system. Students residing in larger medical 
schools were significantly more satisfied with received support and tended to 
gain greater support than those in medium and small sized schools. 
Stress-relieving activities arrangement was considered the most sought after 
additional support by students.
CONCLUSION: Medical student stress levels were higher during the pandemic 
compared to pre-pandemic levels. Stress relieving activities, availability and 
access to mental health resources, and other strategies to reduce stress among 
medical students are urgently needed.

DOI: 10.3946/kjme.2021.200
PMCID: PMC8413847
PMID: 34474527 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of interest No potential conflict of 
interest relevant to this article was reported.


3046. PLoS One. 2021 Sep 2;16(9):e0256454. doi: 10.1371/journal.pone.0256454. 
eCollection 2021.

What support do frontline workers want? A qualitative study of health and social 
care workers' experiences and views of psychosocial support during the COVID-19 
pandemic.

Billings J(1), Abou Seif N(1), Hegarty S(1), Ondruskova T(1), Soulios E(1), 
Bloomfield M(1)(2)(3)(4), Greene T(1)(5).

Author information:
(1)Division of Psychiatry, University College London, London, United Kingdom.
(2)Traumatic Stress Clinic, Camden & Islington NHS Foundation Trust, London, 
United Kingdom.
(3)National Institute for Health Research University College London Hospitals 
Biomedical Research Centre, London, United Kingdom.
(4)University College London Hospitals NHS Foundation Trust, London, United 
Kingdom.
(5)Department of Community Mental Health, University of Haifa, Haifa, Israel.

BACKGROUND: The COVID-19 pandemic has placed a significant burden on the mental 
health and wellbeing of frontline health and social care workers. The need to 
support frontline staff has been recognised. However, there is to date little 
research specifically on how best to support the mental health needs of 
frontline workers, and none on their own experiences and views about what might 
be most helpful.
AIMS: We set out to redress this research gap by qualitatively exploring UK 
frontline health and social care workers' own experiences and views of 
psychosocial support during the pandemic.
METHOD: Frontline health and social care workers were recruited purposively 
through social media and by snowball sampling via healthcare colleagues. Workers 
who volunteered to take part in the study were interviewed remotely following a 
semi-structured interview guide. Transcripts of the interviews were analysed by 
the research team following the principles of Reflexive Thematic Analysis.
RESULTS: We conducted 25 interviews with frontline workers from a variety of 
professional groups working in health and social care settings across the UK. 
Themes derived from our analysis showed that workers' experiences and views 
about psychosocial support were complex. Peer support was many workers' first 
line of support but could also be experienced as a burden. Workers were 
ambivalent about support shown by organisations, media and the public. Whilst 
workers valued psychological support services, there were many disparities in 
provision and barriers to access.
CONCLUSIONS: The results of this study show that frontline health and social 
care workers are likely to need a flexible system of support including peer, 
organisational and professional support. More research is needed to fully unpack 
the structural, systemic and individual barriers to accessing psychosocial 
support. Greater collaboration, consultation and co-production of support 
services and their evaluation is warranted.

DOI: 10.1371/journal.pone.0256454
PMCID: PMC8412294
PMID: 34473755 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


3047. Mil Med. 2021 Sep 1;186(12 Suppl 2):23-34. doi: 10.1093/milmed/usab213.

We're Stronger Together: A Collaboration to Support Military Families During the 
COVID-19 Pandemic.

Urbieta DA(1), Akin JL(2), Hamilton WM(3), Brock WW(1), Yablonsky AM(1).

Author information:
(1)Directorate for Professional Education, Navy Medicine Readiness and Training 
Command San Diego, San Diego, CA 92134, USA.
(2)Applied Research Team, Blue Star Families, Encinitas, CA 92023, USA.
(3)Department of Inpatient Services, Evans Community Army Hospital, Fort Carson, 
CO 80913, USA.

INTRODUCTION: The COVID-19 pandemic has created challenges for every segment of 
the U.S. population, including military personnel and their families. The 
TriService Nursing Research Program's Military Family Research Interest Group 
(FIG) formed a collaboration with Blue Star Families, a civilian non-profit 
organization, to identify potential issues faced by military families during the 
pandemic.
DATA COLLECTION METHODS: The Pain Points Poll was introduced online by Blue Star 
Families, and findings were aggregated weekly between March 18 and May 26, 2020. 
Volunteer poll respondents were mainly recruited through social media outreach. 
FIG-informed questions were incorporated in week 4 of polling and focused on 
workplace environment, financial health, social support, physical and mental 
health, child behavior, utilization of family care plans, and general 
well-being. Data were collected to gain real-time insights into the major 
challenges posed by the pandemic. Findings from FIG-informed questions were 
collaboratively reviewed and analyzed by FIG and BSF teams. Data-driven 
recommendations were made to stakeholders to improve processes and reprioritize 
investments for services that aim to alleviate the impact of COVID-19 on 
military families.
FINDINGS: A total of 2,895 military family units (i.e., service members and 
spouses) responded to the poll, a majority of which (88%) represented active 
duty family units. Although the majority of families (range: 59%-69%) noted no 
impact to their finances, approximately one in five families endorsed dipping 
into their savings during the pandemic. A majority of respondents (69.5%) 
reported taking active measures to support their mental health, endorsing 
various strategies. Among parents of special needs children, 45% of active duty 
families and 60% of single-parent service members reported the inability to 
maintain continued services for their children. A majority of parents with 
school-aged children (65%) reported child behavioral changes due to their 
child's inability to socialize with peers. Among military service members, 41% 
were concerned about obtaining fair performance evaluations during the crisis.
CONCLUSIONS: The COVID-19 pandemic produced significant challenges for military 
families. Collaboration between military and civilian partners can inform 
policies and appropriate strategies to mitigate the impact of COVID-19 for 
military families. The findings presented here provide insight into areas where 
military families can be supported for optimal outcomes during unprecedented 
times.

Published by Oxford University Press on behalf of the Association of Military 
Surgeons of the United States 2021. This work is written by (a) US Government 
employee(s) and is in the public domain in the US.

DOI: 10.1093/milmed/usab213
PMID: 34469531 [Indexed for MEDLINE]


3048. J Clin Nurs. 2021 Aug 31. doi: 10.1111/jocn.16029. Online ahead of print.

'From Expert to Novice', Perceptions of General Ward Nurses on Deployment to 
Outbreak Intensive Care Units during the COVID-19 Pandemic: A Qualitative 
Descriptive Study.

Tang CJ(1), Lin YP(1), Chan EY(1)(2).

Author information:
(1)Nursing Research Unit, Nursing Service, Tan Tock Seng Hospital, Singapore 
City, Singapore.
(2)Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, 
National University of Singapore, Singapore City, Singapore.

Comment in
    Evid Based Nurs. 2023 Apr;26(2):53.

AIMS AND OBJECTIVES: This study aimed to explore the perceived preparedness and 
psychosocial well-being of general ward nurses prior to their deployment into 
the outbreak intensive care units (ICUs) during the COVID-19 pandemic.
BACKGROUND: With the surge in COVID-19 cases requiring ICU care, non-ICU nurses 
maybe deployed into the ICUs. Having experienced through SARS, hospitals in 
Singapore instituted upskilling programs to secure general ward nurses' 
competency in providing critical care nursing. However, no studies have explored 
the perceptions of general ward nurses on deployment into the ICUs during the 
COVID-19 pandemic.
DESIGN: Qualitative descriptive study.
METHODS: The study was conducted at Singapore's epicentre of COVID-19 
management. Five focus groups were conducted following purposive sampling of 30 
general ward nurses identified for outbreak ICU deployment. Focus groups were 
audio-recorded, transcribed verbatim and data thematically analysed. This study 
was conducted and reported in accordance with the COREQ checklist.
RESULTS: Three salient themes arose, exemplifying the transition from clinical 
experts in the general wards to practising novices in the outbreak ICUs. 
Firstly, 'Into the deep end of the pool' described general ward nurses' feelings 
of anxiety and stress associated with higher exposure risk and expanded 
responsibilities to nurse critically ill patients. Secondly, 'Preparing for 
"war"' illustrated deployed nurses' need for clear communication and essential 
critical care nursing training. Lastly, 'Call of duty' affirmed the nurses' 
personal and professional commitment to embrace this transition into the ICUs, 
and their desire for greater psychosocial support.
CONCLUSION: The study findings highlight that though general ward nurses 
perceived their impending ICU deployment positively, they require ongoing 
support to facilitate a smoother transition.
RELEVANCE TO CLINICAL PRACTICE: Findings provided an evidence base to improve 
the preparedness of general ward nurses deployed into the ICUs during the 
COVID-19 pandemic within key areas of training, information dissemination and 
psychosocial resilience.

© 2021 John Wiley & Sons Ltd.

DOI: 10.1111/jocn.16029
PMID: 34468053


3049. Workplace Health Saf. 2022 Jul;70(7):319-324. doi: 10.1177/21650799211030294. 
Epub 2021 Sep 1.

A Phenomenological Study of COVID-19's Impact on U.S. Nursing Personnel.

Patton CM(1).

Author information:
(1)Eastern University.

BACKGROUND: The COVID-19 pandemic overwhelmed the New York City area upon its 
arrival in the United States. Hospitals were unprepared to handle the influx of 
patients.
METHODS: This study explored nurse/nurse practitioner experiences when caring 
for COVID-19 patients in New York metropolitan hospitals, concentrating on 
physical well-being. Data collection involved in-depth interviews with eight 
participants.
FINDINGS: (A) physical safety of self, family members, colleagues, and patients 
greatly concerned participants; (B) caring for COVID-19 patients led to 
participants' physical exhaustion; and (C) most participants' sleep was impacted 
when caring for COVID-19 patients.
CONCLUSIONS: This study identified issues involving U.S. health care workplace 
safety during the COVID-19 pandemic, namely availability of personal protective 
equipment, lack of centralized knowledge-sharing capabilities, sleep problems, 
anxiety regarding physical safety of self and others, and 
insufficient/undertrained staffing. It serves as a foundation for future 
research and calls for changes in U.S. hospital policies and procedures during 
crises.

DOI: 10.1177/21650799211030294
PMID: 34467785 [Indexed for MEDLINE]


3050. Int J Psychol. 2022 Feb;57(1):146-152. doi: 10.1002/ijop.12806. Epub 2021 Sep 1.

Becoming a mother during the COVID-19 national lockdown in Italy: Issues linked 
to the wellbeing of pregnant women.

Smorti M(1), Ponti L(2), Ionio C(3), Gallese M(4), Andreol A(4), Bonassi L(4).

Author information:
(1)Department of Surgical, Medical and Molecular Pathology and Critical Care 
Medicine, University of Pisa, Pisa, Italy.
(2)Department of Education, Languages, Intercultures, Literatures and 
Psychology, University of Florence, Florence, Italy.
(3)Department of Psychology, Catholic University of Milan, Milan, Italy.
(4)ASST Bergamo Est Mental Health Department, Seriate, Italy.

The COVID-19 pandemic and consequent lockdown represent risk factors for the 
mental health of pregnant women. We explored the impact of COVID-19 restriction 
policies on psychological health, analysing the predictive role of social 
support on maternal wellbeing. A total of 212 pregnant women recruited from two 
public hospitals in Italy were divided into two groups: (a) a pre-COVID-19 group 
composed of 141 expectant women (mean age = 34.6; SD = 4.3) at their third 
trimester before the national lockdown period; (b) a COVID-19 group composed of 
71 pregnant women (mean age = 33.3; SD = 4.5) at their third trimester during 
the COVID-19 national lockdown. Participants completed two self-report 
questionnaires: the Profile of Mood States and the Multidimensional Scale of 
Perceived Social Support. Moreover, the COVID-19 group was asked to respond to 
an open question concerning worries about their pregnancies and COVID-19. 
Results showed that pregnant women during COVID-19 presented higher anxiety, 
depression and hostility, and lower vigour, than the pre-COVID-19 group. The 
main concerns were related to the effect of hospital restriction policies on 
childbirth and fears of contracting COVID-19. Perceived partner social support 
represented a protective factor only for the pre-COVID-19 women. Limitations, 
strengths, and theoretical and clinical implications are discussed.

© 2021 International Union of Psychological Science.

DOI: 10.1002/ijop.12806
PMCID: PMC8652732
PMID: 34467528 [Indexed for MEDLINE]


3051. BMJ. 2021 Aug 31;374:n1972. doi: 10.1136/bmj.n1972.

Women's wellbeing and the burden of unpaid work.

Seedat S(1), Rondon M(2).

Author information:
(1)Department of Psychiatry, Faculty of Medicine and Health Sciences, 
Stellenbosch University, Cape Town, South Africa.
(2)Instituto Nacional Materno Perintal, Lima, Peru.

Soraya Seedat and Marta Rondon examine how gender inequities in the time 
allocated to unpaid work, exacerbated by covid-19, are affecting women’s mental 
health

DOI: 10.1136/bmj.n1972
PMCID: PMC8406085
PMID: 34465574 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: We have read and understood 
BMJ policy on declaration of interests and have no relevant interests to 
declare.


3052. BMC Psychiatry. 2021 Aug 31;21(1):426. doi: 10.1186/s12888-021-03425-6.

The COVID-19 Pandemic Mental Health Questionnaire (CoPaQ): psychometric 
evaluation and compliance with countermeasures in psychiatric inpatients and 
non-clinical individuals.

Rek SV(1)(2), Bühner M(3), Reinhard MA(4), Freeman D(5), Keeser D(4), Adorjan 
K(4), Falkai P(4), Padberg F(4).

Author information:
(1)Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, 
Nussbaumstraße 7, Munich, Germany. s.rek@med.uni-muenchen.de.
(2)International Max Planck Research School for Translational Psychiatry 
(IMPRS-TP), Munich, Germany. s.rek@med.uni-muenchen.de.
(3)Department of Psychology, LMU Munich, Munich, Germany.
(4)Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, 
Nussbaumstraße 7, Munich, Germany.
(5)Department of Psychiatry, University of Oxford, Oxford, UK.

BACKGROUND: The COVID-19 pandemic has greatly impacted people's lives across a 
broad spectrum of psychosocial domains. We report the development and 
psychometric evaluation of the self-report COVID-19 Pandemic Mental Health 
Questionnaire (CoPaQ), which assesses COVID-19 contamination anxiety, 
countermeasure necessity and compliance, mental health impact, stressor impact, 
social media usage, interpersonal conflicts, paranoid ideations, institutional & 
political trust, conspiracy beliefs, and social cohesion. Further, we illustrate 
the questionnaire's utility in an applied example investigating if higher 
SARS-Cov-2 infection rates in psychiatric patients could be explained by reduced 
compliance with preventive countermeasures.
METHODS: A group of 511 non-clinical individuals completed an initial pool of 
111 CoPaQ items (Open Science Framework: https://osf.io/3evn9/ ) and additional 
scales measuring psychological distress, well-being, and paranoia to assess 
construct validity and lifetime mental health diagnosis for criterion validity. 
Factor structure was determined by exploratory factor analyses and validated by 
conducting confirmatory factor analysis in the accompanying longitudinal sample 
(n = 318) and an independent psychiatric inpatient sample primarily admitted for 
major depressive-, substance abuse-, personality-, and anxiety disorders 
(n = 113). Internal consistency was assessed by Cronbach's Alpha and McDonald's 
Omega. For the applied research example, Welch t-tests and correlational 
analyses were conducted.
RESULTS: Twelve out of 16 extracted subscales were retained in the final 
questionnaire version, which provided preliminary evidence for adequate 
psychometric properties in terms of factor structure, internal consistency, and 
construct and criterion validity. Our applied research example showed that 
patients exhibited greater support for COVID-19 countermeasures than 
non-clinical individuals. However, this requires replication in future studies.
CONCLUSIONS: We demonstrate that the CoPaQ is a comprehensive and valid measure 
of the psychosocial impact of the pandemic and could allow to a degree to 
disentangle the complex psychosocial phenomena of the pandemic as exemplified by 
our applied analyses.

© 2021. The Author(s).

DOI: 10.1186/s12888-021-03425-6
PMCID: PMC8406012
PMID: 34465319 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no competing interests as 
defined by BMC, or other interests that might be perceived to influence the 
results and/or discussion reported in this paper.


3053. J Neurodev Disord. 2021 Sep 1;13(1):31. doi: 10.1186/s11689-021-09376-z.

SARS-CoV-2 screening testing in schools for children with intellectual and 
developmental disabilities.

Sherby MR(#)(1), Walsh TJ(#)(2), Lai AM(3), Neidich JA(4), Balls-Berry JE(5), 
Morris SM(1), Head R(6), Prener CG(7), Newland JG(2), Gurnett CA(8); COMPASS-T 
Study Group.

Collaborators: Baldenweck M, Bono K, Brodsky VB, Caburnay CA, Constantino JN, 
Dougherty NL, Dubois JM, Fritz SA, Gotto GS 4th, Imbeah A, Kalb LG, Liu J, 
Maricque BB, McKay VR, Myers LS, Poor TJ, Powell BJ, Mueller NB, Schlaggar BL, 
Schmidt A, Snider E, Traughber MC, van Stone M, Vestal L, Wilcher-Roberts M.

Author information:
(1)Department of Neurology, Division of Pediatric and Developmental Neurology, 
Washington University in St. Louis, 660 S. Euclid Avenue Campus, Box 8111, St. 
Louis, MO, 63110, USA.
(2)Department of Pediatrics, Division of Pediatric Infectious Diseases, 
Washington University in St. Louis, St. Louis, MO, USA.
(3)Department of Medicine, Washington University in St. Louis, St. Louis, MO, 
USA.
(4)Department of Pathology and Immunology, Washington University in St. Louis, 
St. Louis, MO, USA.
(5)Department of Neurology, Division of Memory and Aging, Washington University 
in St. Louis, St. Louis, MO, USA.
(6)Department of Genetics, Washington University in St. Louis, St. Louis, MO, 
USA.
(7)Department of Sociology and Anthropology, Saint Louis University, St. Louis, 
MO, USA.
(8)Department of Neurology, Division of Pediatric and Developmental Neurology, 
Washington University in St. Louis, 660 S. Euclid Avenue Campus, Box 8111, St. 
Louis, MO, 63110, USA. gurnettc@wustl.edu.
(#)Contributed equally

Update of
    Res Sq. 2021 Jul 20;:

BACKGROUND: Transmission of SARS-CoV-2 in schools primarily for typically 
developing children is rare. However, less is known about transmission in 
schools for children with intellectual and developmental disabilities (IDD), who 
are often unable to mask or maintain social distancing. The objectives of this 
study were to determine SARS-CoV-2 positivity and in-school transmission rates 
using weekly screening tests for school staff and students and describe the 
concurrent deployment of mitigation strategies in six schools for children with 
IDD.
METHODS: From November 23, 2020, to May, 28, 2021, weekly voluntary screening 
for SARS-CoV-2 with a high sensitivity molecular-based saliva test was offered 
to school staff and students. Weekly positivity rates were determined and 
compared to local healthcare system and undergraduate student screening data. 
School-based transmission was assessed among participants quarantined for 
in-school exposure. School administrators completed a standardized survey to 
assess school mitigation strategies.
RESULTS: A total of 59 students and 416 staff participated. An average of 304 
school staff and students were tested per week. Of 7289 tests performed, 21 
(0.29%) new SARS-CoV-2 positive cases were identified. The highest weekly 
positivity rate was 1.2% (n = 4) across all schools, which was less than 
community positivity rates. Two cases of in-school transmission were identified, 
each among staff, representing 2% (2/103) of participants quarantined for 
in-school exposure. Mitigation strategies included higher than expected student 
mask compliance, reduced room capacity, and phased reopening.
CONCLUSIONS: During 24 weeks that included the peak of the COVID-19 pandemic in 
winter 2020-21, we found lower rates of SARS-CoV-2 screening test positivity 
among staff and students of six schools for children with IDD compared to 
community rates. In-school transmission of SARS-CoV-2 was low among those 
quarantined for in-school exposure. However, the impact of the emerging 
SARS-CoV-2 Delta variant on the effectiveness of these proven mitigation 
strategies remains unknown.
TRIAL REGISTRATION: Prior to enrollment, this study was registered at 
ClinicalTrials.gov on September 25, 2020, identifier NCT04565509 , titled 
Supporting the Health and Well-being of Children with Intellectual and 
Developmental Disability During COVID-19 Pandemic.

© 2021. The Author(s).

DOI: 10.1186/s11689-021-09376-z
PMCID: PMC8407928
PMID: 34465306 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no competing interests relevant 
to this article to disclose.


3054. Clin Gerontol. 2022 Jan-Feb;45(1):45-57. doi: 10.1080/07317115.2021.1966561. 
Epub 2021 Aug 31.

Impacts of the Coronavirus Pandemic on the Emotional and Physical Health of 
Older Adults Compared with Younger Cohorts.

Feliciano L(1), Johanson KA(1), Okun ML(1), Walden A(1).

Author information:
(1)Department of Psychology, University of Colorado Colorado Springs Colorado 
Springs, United States.

OBJECTIVES: This study compared emotional and physical health and overall 
well-being related to social restrictions during the pandemic among older, 
middle-aged, and younger adults in the United States (n = 276).
METHODS: Online surveys collected information on mental and physical health, as 
well as positive and negative impacts of the pandemic. One-way MANOVAs and 
hierarchical regressions were used to analyze data.
RESULTS: Depressive symptoms and coronavirus anxiety differed significantly by 
age, with older adults reporting less depressive and anxious symptoms than 
younger cohorts. Negative COVID experiences significantly predicted higher 
levels of stress, anxiety, and insomnia symptoms in younger adults as compared 
to older cohorts.
CONCLUSIONS: Findings indicate that social restrictions had a more substantial 
negative impact amongst younger adults compared to older adults, particularly in 
terms of mental health and well-being.
CLINICAL IMPLICATIONS: Older adults may be more resilient to the impacts of the 
pandemic than younger cohorts and thus may serve as a critical resource for how 
to navigate crisis situations of this nature. Future studies should continue to 
monitor health outcomes as the pandemic subsides in conjunction with the vaccine 
rollout, as the long-term effects of social distancing and stay-at-home measures 
are yet to be determined.

DOI: 10.1080/07317115.2021.1966561
PMID: 34463221 [Indexed for MEDLINE]


3055. Nurs Crit Care. 2023 Mar;28(2):177-183. doi: 10.1111/nicc.12708. Epub 2021 Aug 
31.

Predictors of critical care nurses' stress, anxiety, and depression in response 
to COVID-19 pandemic.

Baraka AAE(1), Ramadan FH(2), Hassan EA(1).

Author information:
(1)Critical Care and Emergency Nursing Department, Faculty of Nursing, 
Alexandria University, Alexandria, Egypt.
(2)Psychiatric Nursing and mental health Department, Faculty of Nursing, 
Alexandria University, Alexandria, Egypt.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic directly affects 
the psychological well-being of critical care nurses. Several studies had 
investigated the psychological impact of the pandemic on nurses caring for 
patients with COVID-19, but few were conducted to identify the predictors of 
this impact.
AIMS: The objective of this study is to identify the predictors of critical care 
nurses' stress, anxiety, and depression in response to the COVID-19 pandemic.
DESIGN: A cross-sectional survey was conducted in five intensive care units in 
five hospitals in Alexandria, Egypt.
METHODS: An online questionnaire was distributed. It included socio-demographic 
and work-related data and the depression, anxiety, and stress scale scores of 
the nurses under study. A multiple linear regression model was developed to 
identify the predictors of critical care nurses' stress, anxiety, and depression 
in response to the COVID-19 pandemic.
RESULTS: Two hundred (64%) of 308 nurses completed the electronic questionnaire. 
Significant predictors of stress included the number of infected colleagues 
(P < .001) and availability of hospital resources (P = .01). Significant 
predictors of anxiety were age, gender, satisfactory income (P < .001), years of 
experience, time spent caring for patients with COVID-19 (P = .04), continuous 
training, number of infected colleagues (P = .01), and availability of hospital 
resources (P = .02). Finally, significant predictors of depression included 
gender, history of physical problems (P = .04), educational attainment, 
availability of hospital resources, history of psychological problems 
(P < .001), and number of infected colleagues (P = .001).
CONCLUSION: The hospital's lack of human and physical resources and the number 
of colleagues infected with COVID-19 were the strongest predictors of stress, 
anxiety, and depression among nurses.
RELEVANCE TO CLINICAL PRACTICE: Identifying the predictors of stress, anxiety, 
and depression among nurses who care for patients with COVID-19 is a vital step 
in developing mental health promotion strategies to support nurses during this 
pandemic.

© 2021 British Association of Critical Care Nurses.

DOI: 10.1111/nicc.12708
PMCID: PMC8662302
PMID: 34463007 [Indexed for MEDLINE]


3056. Compr Psychiatry. 2021 Oct;110:152255. doi: 10.1016/j.comppsych.2021.152255. 
Epub 2021 Jun 12.

Impact of COVID-19 pandemic on emergency psychiatry-Millcreek community 
hospital, Erie, PA.

Janoczkin A(1), Kiers S(1), Edara N(1), He P(2), Li Y(3).

Author information:
(1)Department of Pre-Clinical medicine, Lake Erie College of Osteopathic 
Medicine, Erie, PA, USA.
(2)Department of Pre-Clinical medicine, Lake Erie College of Osteopathic 
Medicine, Erie, PA, USA. Electronic address: pinghe718@gmail.com.
(3)Department of Psychiatry, Millcreek Community Hospital, Lake Erie College of 
Osteopathic Medicine, Erie, PA, USA. Electronic address: yli46698@med.lecom.edu.

OBJECTIVE: Evidence suggested that traumatic events, including pandemics, can be 
associated with psychiatric symptoms like increased anxiety and depression. 
However, there were many unknowns concerning the emergent global coronavirus-19 
(COVID-19), including its impact on psychiatric health within the United States. 
Our study aimed to track trends of mental health problems in individuals who 
presented with psychiatric complaints in an emergent setting.
METHODS: A total of 1776 patients and 1610 patients presented to Emergency 
Department (ED) with psychiatric complaints between January 1 - July 9 of the 
years of 2019 and 2020, respectively, in Millcreek Community Hospital (MCH) 
Erie, PA. This study was an electronic medical record review (EMR), therefore 
the data were collected exclusively from EMR over the two-year span. ED 
prevalence was calculated as the number of total psychiatric MCH ED cases 
divided by the total number of all MCH ED patients, and prevalence ratio (PR) 
between 2019 and 2020 was used to reflect change of overall ED psychiatric 
prevalence.
RESULTS: Clinical notes revealed increased ED psychiatric chief complaint 
prevalence, as indicated by a PR greater than one, in multiple categories in 
comparison to before the COVID-19 outbreak. Concerning primary psychiatric 
disorders, there was increased ED prevalence in chief complaint of total mood 
disorders (PR = 1.21) with major depressive disorder (PR = 1.23) and bipolar 
disorder (PR = 1.47), neurodevelopment disorders (PR = 1.25) with attention 
deficit hyperactivity disorder (ADHD) (PR = 1.19) and intellectual disability 
(PR = 1.52), trauma- and stressor-related disorders (PR = 1.56) with 
post-traumatic stress disorder (PTSD) (PR = 1.39) and adjustment disorder 
(PR = 1.73), substance abuse and addiction disorders (PR = 1.29), and 
personality disorders (PR = 1.56).
CONCLUSIONS: The pandemic outbreak dramatically impacted mental health in an ER 
setting. Further research on mental health disparities in conjunction with the 
COVID-19 pandemic is critical to help predict and address risk for chronic 
symptoms and sequela to help anticipate and improve psychiatric patient care and 
well-being during potential future pandemics.

Copyright © 2021. Published by Elsevier Inc.

DOI: 10.1016/j.comppsych.2021.152255
PMID: 34461390 [Indexed for MEDLINE]


3057. Anim Sci J. 2021 Jan-Dec;92(1):e13624. doi: 10.1111/asj.13624.

Improvement to the subjective well-being of pet ownership may have positive 
psychological influence during COVID-19 epidemic.

Xin X(1), Cheng L(2), Li S(1), Feng L(1), Xin Y(3), Wang S(1).

Author information:
(1)Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical 
College, Huazhong University of Science and Technology, Wuhan, China.
(2)Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong 
University of Science and Technology, Wuhan, China.
(3)Academic Affairs Office, Center Primary School in Xichuan Town, Tianshui, 
China.

The COVID-19 epidemic and government intervention measures may have adverse 
effects on people's mental health. To explore the influence of pets on the 
intervention of people's psychological problems during the COVID-19 epidemic, an 
online survey was carried out between April 9 and April 29, 2020. A total of 756 
participants replied to this questionnaire. Mental health variables were 
assessed, and the comparison of behavior changes among pet owners and pets on 
positive mental well-being during COVID-19 epidemic. Comparative analysis was 
performed; compared with individuals without pets (n = 575), pet owners 
(n = 181) had a higher prevalence of insomnia (p = 0.006). Living in Wuhan city 
was a risk factor for people with psychological stress (p < 0.05). Dog owners 
exhibited lower than average scores of insomnia and uncertainty of infection 
than cat owners (p = 0.004). People with more than one pet exhibited lower than 
average scores of depression than having one pet (p = 0.040). For analysis of 
psychological effects of pets on people, the role of pets in subjective feeling 
and positive psychological changes of pet owner was significantly different. Pet 
owners relieve that psychological pressure through behavioral changes towards 
their pets in early stage. Pets provided positive subjective well-being and 
psychological effects for their owners.

© 2021 Japanese Society of Animal Science.

DOI: 10.1111/asj.13624
PMCID: PMC8646605
PMID: 34459072 [Indexed for MEDLINE]

Conflict of interest statement: Authors declare no conflict of interests for 
this article.


3058. J Eval Clin Pract. 2022 Feb;28(1):57-62. doi: 10.1111/jep.13601. Epub 2021 Aug 
29.

An iterative approach to promoting departmental wellbeing during COVID-19.

Acai A(1), Gonzalez A, Saperson K; on behalf of the Department of Psychiatry and 
Behavioural Neurosciences COVID-19 Wellness Working Group.

Author information:
(1)Department of Psychiatry and Behavioural Neurosciences, McMaster University, 
Hamilton, Ontario, Canada.

RATIONALE, AIMS, AND OBJECTIVES: Addressing wellbeing among learners, faculty, 
and staff during the COVID-19 pandemic is a challenge for many clinical 
departments. Continued and systemic supports are needed to combat the pandemic's 
impact on mental health and wellbeing. This article describes an iterative 
approach to conducting a needs assessment and implementing a COVID-19-related 
wellness initiative in a psychiatry department.
METHODS: Development of the initiative followed the Plan-Do-Study-Act (PDSA) 
quality improvement cycle and was informed by Shanafelt and colleagues' 
framework for supporting healthcare workers during the COVID-19 pandemic. Key 
features included the establishment of a Wellness Working Group, the curation of 
relevant resources on the Department's website, and the deployment of regular, 
monthly surveys that informed the creation of further supports, such as a weekly 
online drop-in support group.
RESULTS: Survey response rates ranged from 22% to 32% (n = 90-127) throughout 
our initiative. Across multiple surveys, approximately 80% of respondents 
reported feeling supported or very supported by the Department, and 90% were 
satisfied or very satisfied with the quantity and quality of information 
provided. Our support group and resources page were accessed by nearly 
one-quarter and one-third of respondents, respectively, with satisfaction rates 
of 81% or higher. Consistent with the Department's mandate, ensuring equity was 
a key focus of the Working Group throughout its operations.
CONCLUSIONS: There is potential for this model to be scaled to create a 
faculty-wide, institution-wide, or regional approach to addressing wellbeing. 
Other departments may also wish to adopt similar approaches to supporting their 
members during this challenging time.

© 2021 John Wiley & Sons Ltd.

DOI: 10.1111/jep.13601
PMCID: PMC8657357
PMID: 34459064 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3059. Child Psychiatry Hum Dev. 2023 Feb;54(1):176-188. doi: 
10.1007/s10578-021-01233-3. Epub 2021 Aug 29.

Cumulative Risk Exposure and Social Isolation as Correlates of Carer and Child 
Mental Health During the COVID-19 Pandemic: An Online Study with Families from 
Various Europeans Countries.

Pereira AI(1), Muris P(2), Roberto MS(3), Stallard P(4), Garcia-Lopez LJ(5), 
Tulbure BT(6), Podina I(7), Simon E(8), Sousa M(9), Barros L(3).

Author information:
(1)CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da 
Universidade, 1649-013, Lisbon, Portugal. aipereira@psicologia.ulisboa.pt.
(2)Maastricht University, Maastricht, The Netherlands.
(3)CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da 
Universidade, 1649-013, Lisbon, Portugal.
(4)Department for Health, University of Bath, Bath, UK.
(5)University of Jaén, Jaén, Spain.
(6)West University of Timişoara, Timişoara, Romania.
(7)Bucharest University, Bucharest, Romania.
(8)Open University, Heerlen, The Netherlands.
(9)ProChild CoLAB, Guimarães, Portugal.

This study adopted a cumulative risk approach to examine the relations between 
various domains of risk factors (i.e., social isolation and home confinement, 
other pandemic-related risk factors, and pre-existing psychosocial risk factors) 
and carers' and children's mental health during the first wave of the COVID-19 
pandemic in Europe. The sample consisted of 1475 carers of 6- to 16-year-old 
children and adolescents residing in five European countries (Portugal, United 
Kingdom, Romania, Spain, and The Netherlands) who completed an online survey. 
The results showed that each of the three domains of adversity accounted for 
unique variation in carers' and children's mental health outcomes. Also, the 
results indicated that pre-existing psychosocial risk factors moderated the 
relationship between pandemic-related risk factors and children and carers' 
anxiety and between social isolation and confinement and carers' well-being. 
Simple slopes analysis suggested a stronger relationship between these domains 
of adversities and mental health outcomes in already more vulnerable families. 
It is important to consider the implications of social isolation measures and 
confinement for families' mental health, paying special attention to families 
with pre-existing psychosocial vulnerabilities.

© 2021. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s10578-021-01233-3
PMCID: PMC8403498
PMID: 34458940 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that they have no 
competing or potential conflicts of interest.


3060. Am J Psychother. 2021 Dec 1;74(4):178-182. doi: 
10.1176/appi.psychotherapy.20210004. Epub 2021 Aug 30.

COVID-19 Inventory and Mental Health: Preliminary Analysis.

Faustino B(1), Vasco AB(1), Delgado J(1), Farinha-Fernandes A(1), Guerreiro 
JC(1), Matos M(1).

Author information:
(1)Department of Cognitive Behavior and Integrative Psychotherapy (Faustino, 
Vasco) and Faculty of Psychology (Faustino, Vasco, Delgado, Farinha-Fernandes, 
Guerreiro), University of Lisbon, Lisbon; ISCTE University, Lisbon (Matos).

OBJECTIVE: The COVID-19 pandemic imposed a set of drastic worldwide changes to 
and restrictions on daily life. Despite predictions of the harmful impacts of 
the pandemic on mental health, empirical data are lacking. This study sought to 
examine the relationship between individuals' perceptions about COVID-19 and 
scores on mental health indexes.
METHODS: In this cross-sectional study, 183 individuals answered self-report 
questionnaires. A new inventory based on the health belief model (HBM) developed 
in Portugal was explored with a factor analysis, which revealed two significant 
factors: COVID-19 anxiety and perceived severity of the disease.
RESULTS: Results showed that anxiety about COVID-19 was positively correlated 
with psychological distress, somatization, and paranoid ideation and was 
negatively correlated with psychological well-being. COVID-19 anxiety mediated 
the relationship between symptomatology and mental health.
CONCLUSIONS: Perceptions about COVID-19 seem to play pivotal roles in mental 
health. These results may inform interventions focused on reducing psychological 
distress and symptomatology and on increasing psychological well-being.

DOI: 10.1176/appi.psychotherapy.20210004
PMID: 34455854 [Indexed for MEDLINE]


3061. Intensive Crit Care Nurs. 2022 Feb;68:103125. doi: 10.1016/j.iccn.2021.103125. 
Epub 2021 Aug 26.

Burnout, compassion fatigue and work-related stressors among organ donation and 
transplantation coordinators: A qualitative study.

Silva E Silva V(1), Hornby L(2), Lotherington K(3), Rochon A(3), Regina Silva 
A(3), Pearson H(4), MacNutt L(4), Robertson A(5), Werestiuk K(5), Kuhl D(6), 
John P(3), Dhanani S(7), Sarti A(3).

Author information:
(1)Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario K1G 4J5, 
Canada; Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, 
Ottawa, Ontario K1H 5B2, Canada. Electronic address: vsilvaesilva@cheo.on.ca.
(2)University of Ottawa,75 Laurier Ave. E, Ottawa, ON K1N 6N5, Canada.
(3)Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario K1G 4J5, 
Canada; Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, 
Ottawa, Ontario K1H 5B2, Canada.
(4)HDL Consulting, 120 S. State College Blvd, CA 92821, Canada.
(5)Manitoba Transplant Program, 820 Sherbrook St, Winnipeg, MB R3A 1R9, Canada.
(6)HDL Consulting, 120 S. State College Blvd, CA 92821, Canada; University of 
British Columbia, Department of Family Practice, 3rd Floor David Strangway 
Building, 5950 University Boulevard, Vancouver, British Columbia V6T 1Z3, 
Canada.
(7)Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, 
Ottawa, Ontario K1H 5B2, Canada; University of Ottawa,75 Laurier Ave. E, Ottawa, 
ON K1N 6N5, Canada.

AIM: Organ and Tissue Donation Coordinators (OTDCs) are healthcare professionals 
who manage deceased organ donation cases. This study investigated the 
experiences and perceptions of OTDCs, pertaining to compassion fatigue, burnout, 
and resilience as it relates to their daily work.
METHODOLOGY: A qualitative descriptive study was undertaken using 
semi-structured interviews conducted with a convenience sample of OTDCs.
SETTING: A Canadian Organ Donation Organization.
FINDINGS: Seven out of the ten OTDCs contacted participated in this study. 
Coordinators all agreed that they work in a high-pressure and demanding 
environment and the constant exposure to work-related stress and grief has 
resulted in the majority of them experiencing signs and symptoms of burnout and 
compassion fatigue occurring throughout their career. Participants described 
that the emotional toll of work-related stressors and difficult cases led them 
to use a variety of defence strategies to protect and support their well-being. 
They also recognised that more strategies to help mitigate work-related 
stressors and to prevent burnout and compassion fatigue are needed and that 
management and institutions should lead the development of such interventions.
CONCLUSION: Our results describe how coordinators' mental health is affected by 
their daily work. Further research is needed to comprehensively examine these 
work-related stressors and to generate additional data to support the 
development of interventions to mitigate burnout and compassion fatigue among 
OTDCs.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.iccn.2021.103125
PMID: 34454831 [Indexed for MEDLINE]


3062. Health Qual Life Outcomes. 2021 Aug 28;19(1):207. doi: 
10.1186/s12955-021-01845-2.

Anxiety, trauma and well-being in health-care professionals during COVID-19 
first wave in Spain: the moderating role of personal protection equipment 
availability.

Bajo M(1), Gallego P(2), Stavraki M(3), Lamprinakos G(4), Luna P(3), Díaz D(2).

Author information:
(1)Department of Medical Psychology, Ciudad Real Medical School, Universidad de 
Castilla La Mancha, Camino de Moledores S/N, 13071, Ciudad Real, Spain. 
miriam.bajo@uclm.es.
(2)Department of Medical Psychology, Ciudad Real Medical School, Universidad de 
Castilla La Mancha, Camino de Moledores S/N, 13071, Ciudad Real, Spain.
(3)Department of Psychology, Ciudad Real Faculty of Education, Universidad de 
Castilla La Mancha, Ronda de Calatrava, 3, 13071, Ciudad Real, Spain.
(4)Birmingham Business School, Edgbaston, Birmingham, B15 2TT, UK.

BACKGROUND: The effect of COVID-19 on Health-Care Professionals' mental health 
has received increased attention in the last year's literature. However, 
previous studies essentially evaluated psychopathological symptoms and not the 
presence of positive mental health. Therefore, the first objective of the 
present research is to evaluate health-care professionals' mental illness (i.e., 
anxiety and traumatic intensity) and positive mental health (i.e., well-being) 
using the Complete State Model of Health. Our second objective is to study the 
effect of Personal Protection Equipment availability on professionals' mental 
health.
METHODS: Two-hundred and thirty-two health-care professionals working in Spain 
in the first line of COVID-19 patient care participated in the study. To measure 
anxiety, traumatic intensity and well-being participants completed the State 
Trait Anxiety Inventory, the Davidson Trauma Scale, and the Mental Health 
Continuum-Short Form. Pearson correlations were used to examine the 
relationships between all scales. In order to test the two continua model of 
mental health, we used parallel analysis and exploratory factor analysis. To 
analyze anxiety, traumatic intensity, and well-being differences between 
health-care professionals with and without Personal Protection Equipment 
availability we conducted different ANOVAS. To test our hypothesis regarding the 
moderating role of Personal Protection Equipment availability in the effect of 
mental illness on positive mental health, data were subjected to a hierarchical 
regression analysis.
RESULTS: As in previous studies, health-care professionals showed high levels of 
anxiety and traumatic intensity. They also presented low levels of well-being 
indicators. According to our hypothesis, results of parallel analysis and 
exploratory factorial analysis indicated that the measures of mental illness and 
positive mental health loaded on separate but correlated factors. Finally, 
Personal Protection Equipment availability moderated the effects of state 
anxiety and traumatic intensity on professionals' well-being.
CONCLUSIONS: Health-care professionals' mental illness and positive mental 
health reflect distinct continua, rather than the extreme ends of a single 
spectrum. Therefore, it is essential to measure both psychopathology and the 
presence of positive health to comprehensively evaluate professionals' mental 
health. Finally, our results indicated that Personal Protection Equipment 
availability is essential not only for professionals' physical health, but also 
for their mental health.

© 2021. The Author(s).

DOI: 10.1186/s12955-021-01845-2
PMCID: PMC8401363
PMID: 34454527 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


3063. Int J Equity Health. 2021 Aug 28;20(1):192. doi: 10.1186/s12939-021-01537-9.

The pathways from perceived discrimination to self-rated health among the 
Chinese diaspora during the COVID-19 pandemic: investigation of the roles of 
depression, anxiety, and social support.

Chen Y(1), Wang Z(1), Dong W(2), Xu JHC(3), Wu SJ(4), Zhang X(5), Chen C(6).

Author information:
(1)Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science 
and Technology, Wuhan, 430000, China.
(2)Department of Sociology and Legal Studies, University of Waterloo, 200 
University Avenue West, Waterloo, ON, N2L 3G1, Canada.
(3)School of International Studies, Wenzhou Medical University, Wenzhou, 325035, 
China.
(4)International School of Capital Medical University, Capital Medical 
University, Beijing, 100069, China.
(5)Purchasing Department, First Affiliated Hospital of Wenzhou Medical 
University, Wenzhou, 325000, China. zxyanghero@126.com.
(6)School of Public Health and Management, Wenzhou Medical University, Wenzhou 
Medical University Chashan Campus, Tongren Building 7B304, Wenzhou, 325035, 
China. chenchun408@126.com.

BACKGROUND: Research indicates the adverse impacts of perceived discrimination 
on health, and discrimination inflamed by the COVID-19 pandemic, a type of 
social exclusion, could affect the well-being of the Chinese diaspora. We 
analyzed the relationship and pathways of perceived discrimination's effect on 
health among the Chinese diaspora in the context of the pandemic to contribute 
to the literature on discrimination in this population under the global public 
health crisis.
METHODS: We analyzed data from 705 individuals of Chinese descent residing in 
countries outside of China who participated in a cross-sectional online survey 
between April 22 and May 9, 2020. This study utilized a structural equation 
model (SEM) to evaluate both direct and indirect effects of perceived 
discrimination on self-rated health (SRH) and to assess the mediating roles of 
psychological distress (namely, anxiety and depression) and social support from 
family and friends.
RESULTS: This online sample comprised predominantly young adults and those of 
relatively high socioeconomic status. This study confirmed the total and direct 
effect of recently perceived discrimination on SRH and found the indirect effect 
was mainly mediated by depression. Mediating roles of anxiety and social support 
on the discrimination-health relationship were found insignificant in this SEM.
CONCLUSIONS: Our findings suggest discrimination negatively affected the 
well-being of the Chinese diaspora, and depression acted as a major mediator 
between the discrimination-health relationship. Therefore, interventions for 
reducing discrimination to preserve the well-being of the Chinese diaspora are 
necessary. Prompt intervention to address depression may partially relieve the 
disease burden caused by the surge of discrimination.

© 2021. The Author(s).

DOI: 10.1186/s12939-021-01537-9
PMCID: PMC8401352
PMID: 34454508 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3064. Gen Hosp Psychiatry. 2021 Sep-Oct;72:124-130. doi: 
10.1016/j.genhosppsych.2021.08.008. Epub 2021 Aug 20.

Coping strategies adopted by Australian frontline health workers to address 
psychological distress during the COVID-19 pandemic.

Smallwood N(1), Karimi L(2), Pascoe A(3), Bismark M(4), Putland M(5), Johnson 
D(6), Dharmage SC(7), Barson E(8), Atkin N(9), Long C(10), Ng I(11), Holland 
A(12), Munro J(13), Thevarajan I(14), Moore C(15), McGillion A(16), Willis 
K(17).

Author information:
(1)Department of Respiratory Medicine, The Alfred Hospital, 55 Commercial Road, 
Prahran, Victoria 3004, Australia; Department of Allergy, Immunology and 
Respiratory Medicine, Central Clinical School, The Alfred Hospital, Monash 
University, Melbourne, Victoria 3004, Australia. Electronic address: 
Natasha.smallwood@monash.edu.
(2)School of Psychology and Public Health, La Trobe University, VIC 3083, 
Australia; School of Medicine and Healthcare Management, Caucasus University, 
Tbilisi, Georgia.
(3)Department of Allergy, Immunology and Respiratory Medicine, Central Clinical 
School, The Alfred Hospital, Monash University, Melbourne, Victoria 3004, 
Australia.
(4)Department of Psychiatry, Royal Melbourne Hospital, Grattan St Parkville, Vic 
3050, Australia; Centre for Health Policy, Melbourne School of Population and 
Global Health, The University of Melbourne, Parkville, Victoria 3050, Australia.
(5)Department of Emergency Services, Royal Melbourne Hospital, Grattan St 
Parkville, Vic 3050, Australia; Department of Critical Care, Faculty of Medicine 
Dentistry and Health Sciences, University of Melbourne, Australia.
(6)Departments of General Medicine and Infectious Diseases, Royal Melbourne 
Hospital, Grattan Street, Parkville, Victoria 3050, Australia; Department of 
Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria 
3050, Australia.
(7)Allergy and Lung Health Unit, School of Population and Global Health, The 
University of Melbourne, Parkville, Victoria 3050, Australia.
(8)Department of Allied Health, Royal Melbourne Hospital, Grattan Street, 
Parkville, Victoria 3050, Australia.
(9)Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre 
and Royal Melbourne Hospital, Melbourne, Victoria 3050, Australia; Sir Peter 
MacCallum Department of Oncology, The University of Melbourne, Parkville, 
Victoria 3050, Australia.
(10)Department of Geriatric Medicine, Western Health, 160 Gordon St, Footscray, 
VIC 3011, Australia.
(11)Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, 
Grattan Street, Parkville, Victoria 3050, Australia; Centre for Integrated 
Critical Care, Melbourne Medical School, The University of Melbourne, Grattan 
Street, Parkville, Victoria 3050, Australia.
(12)Department of Physiotherapy, Alfred Health, Melbourne, Australia; Department 
of Allergy, Immunology and Respiratory Medicine, Central Clinical School, Monash 
University, Melbourne, Australia; Institute for Breathing and Sleep, Melbourne, 
Australia.
(13)Rheumatology Unit, Royal Children's Hospital, Parkville, Victoria 3050, 
Australia; Arthritis and Rheumatology, Murdoch Children's Research Institute, 
Parkville, Victoria 3050, Australia; Department of Paediatrics, University of 
Melbourne, Parkville, Victoria 3050, Australia.
(14)Department of Infectious Diseases, Royal Melbourne Hospital, Grattan Street, 
Parkville, Victoria 3050, Australia.
(15)Department of Intensive Care Medicine, Royal Melbourne Hospital, Grattan 
Street, Parkville, Victoria 3050, Australia.
(16)School of Nursing and Midwifery, College of Science, Health and Engineering, 
La Trobe University, Australia; Royal Adelaide Hospital, University of South 
Australia, Australia.
(17)School of Allied Health, Human Services and Sport, La Trobe University, 
Bundoora, Melbourne, Vic 3083, Australia; Division of Critical Care and 
Investigative Services, Royal Melbourne Hospital, Grattan Street, Parkville, Vic 
3050, Australia.

OBJECTIVES: The Australian COVID-19 Frontline Healthcare Workers Study 
investigated coping strategies and help-seeking behaviours, and their 
relationship to mental health symptoms experienced by Australian healthcare 
workers (HCWs) during the COVID-19 pandemic.
METHODS: Australian HCWs were invited to participate a nationwide, voluntary, 
anonymous, single time-point, online survey between 27th August and 23rd October 
2020. Complete responses on demographics, home and work situation, and measures 
of health and psychological wellbeing were received from 7846 participants.
RESULTS: The most commonly reported adaptive coping strategies were maintaining 
exercise (44.9%) and social connections (31.7%). Over a quarter of HCWs (26.3%) 
reported increased alcohol use which was associated with a history of poor 
mental health and worse personal relationships. Few used psychological wellbeing 
apps or sought professional help; those who did were more likely to be suffering 
from moderate to severe symptoms of mental illness. People living in Victoria, 
in regional areas, and those with children at home were significantly less 
likely to report adaptive coping strategies.
CONCLUSIONS: Personal, social, and workplace predictors of coping strategies and 
help-seeking behaviour during the pandemic were identified. Use of maladaptive 
coping strategies and low rates of professional help-seeking indicate an urgent 
need to understand the effectiveness of, and the barriers and enablers of 
accessing, different coping strategies.

Copyright © 2021 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.genhosppsych.2021.08.008
PMCID: PMC8437691
PMID: 34454341 [Indexed for MEDLINE]


3065. BMJ Open. 2021 Aug 27;11(8):e049815. doi: 10.1136/bmjopen-2021-049815.

UK veterans' mental health and well-being before and during the COVID-19 
pandemic: a longitudinal cohort study.

Sharp ML(1), Serfioti D(2), Jones M(2), Burdett H(2), Pernet D(2), Hull L(2), 
Murphy D(2)(3), Wessely S(2), Fear NT(2)(4).

Author information:
(1)King's Centre for Military Health Research, Psychological Medicine, King's 
College London, London, UK marie-louise.sharp@kcl.ac.uk.
(2)King's Centre for Military Health Research, Psychological Medicine, King's 
College London, London, UK.
(3)Research Department, Combat Stress, Leatherhead, UK.
(4)Academic Department of Military Mental Health, Psychological Medicine, King's 
College London, London, UK.

OBJECTIVE: To investigate the impact of the COVID-19 pandemic on the health and 
well-being of UK ex-service personnel (veterans) before and during the pandemic, 
and to assess associations of COVID-19 experiences and stressors with mental 
health, alcohol use and loneliness.
DESIGN: An additional wave of data was collected from a longitudinal cohort 
study of the UK Armed Forces.
SETTING: Online survey June-September 2020.
PARTICIPANTS: Cohort members were included if they had completed a questionnaire 
at phase 3 of the King's Centre for Military Health Research health and 
well-being study (2014-2016), had left the Armed Forces after regular service, 
were living in the UK, had consented to follow-up and provided a valid email 
address. Invitation emails were sent to N=3547 with a 44% response rate 
(n=1562).
PRIMARY OUTCOME MEASURES: Common mental health disorders (CMDs) (measured using 
the General Health Questionnaire, 12 items-cut-off ≥4), hazardous alcohol use 
(measured using the Alcohol Use Disorder Identification Test, 10 items-cut off 
≥8) and loneliness (University of California, Los Angeles, Loneliness Scale- 3 
items-cut-off ≥6).
RESULTS: Veterans reported a statistically significant decrease in hazardous 
drinking of 48.5% to 27.6%, while CMD remained stable (non-statistically 
significant increase of 24.5% to 26.1%). 27.4% of veterans reported feelings of 
loneliness. The COVID-19 stressors of reporting difficulties with family/social 
relationships, boredom and difficulties with health were statistically 
significantly associated with CMD, hazardous drinking and loneliness, even after 
adjustment for previous mental health/hazardous alcohol use.
CONCLUSIONS: Our study suggests a COVID-19 impact on veterans' mental health, 
alcohol use and loneliness, particularly for those experiencing difficulties 
with family relationships. Veterans experienced the pandemic in similar ways to 
the general population and in some cases may have responded in resilient ways. 
While stable levels of CMD and reduction in alcohol use are positive, there 
remains a group of veterans who may need mental health and alcohol treatment 
services.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-049815
PMCID: PMC8406464
PMID: 34452965 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: SW is Honorary Civilian 
Consultant Advisor in Psychiatry for the British Army (unpaid). SW is affiliated 
to the National Institute for Health Research Health Protection Research Unit 
(NIHR HPRU) in Emergency Preparedness and Response at King’s College London in 
partnership with Public Health England, in collaboration with the University of 
East Anglia and Newcastle University. NTF is a trustee (unpaid) of The Warrior 
Programme, an independent advisor to the Independent Group Advising on the 
Release of Data (IGARD), a member of Independent Scientific Pandemic Insights 
Group on Behaviours (SPI-B) and their salary is part grant funded by the MoD. DM 
is a trustee of the Forces in Mind Trust (unpaid) and is employed as the Head of 
Research for Combat Stress, a UK Veterans Mental Health Charity.


3066. Fam Pract. 2021 Aug 27;38(Suppl 1):i9-i15. doi: 10.1093/fampra/cmab012.

The impact of the COVID-19 pandemic on family medicine residency training.

Awadallah NS(1)(2), Czaja AS(3), Fainstad T(4), McNulty MC(5), Jaiswal KR(6), 
Jones TS(2)(6), Rumack CM(2)(7).

Author information:
(1)Department of Family Medicine, University of Colorado School of Medicine, 
Aurora, CO, USA.
(2)Department of Graduate Medical Education, University of Colorado School of 
Medicine, Aurora, CO, USA.
(3)Department of Pediatrics, Critical Care Division, University of Colorado 
School of Medicine, Aurora, CO, USA.
(4)Department of Internal Medicine, University of Colorado School of Medicine, 
Aurora, CO, USA.
(5)Adult and Child Consortium for Health Outcomes Research and Delivery Science 
(ACCORDS), University of Colorado School of Medicine, Aurora, CO, USA.
(6)Department of Surgery, University of Colorado School of Medicine, Aurora, CO, 
USA.
(7)Department of Radiology, University of Colorado School of Medicine, Aurora, 
CO, USA.

BACKGROUND: Family physicians have played a unique clinical role during the 
COVID-19 pandemic. We hypothesized that the pandemic would be associated with 
significant deleterious effects on clinical activity, educational training, 
personal safety and well-being.
OBJECTIVE: We conducted a national survey to obtain preliminary data that would 
assist in future targeted data collection and subsequent evaluation of the 
impact of the pandemic on family medicine residents and teaching faculty.
METHODS: An anonymous online survey of residents and faculty was distributed via 
the Association of Family Medicine Residency Directors list serve between 
5/21/2020 and 6/18/2020. Survey questions focused on clinical and educational 
activities, safety and well-being.
RESULTS: One hundred and fifty-three residents and 151 teaching faculty 
participated in the survey. Decreased clinical activity was noted by 81.5% of 
residents and 80.9% of faculty and the majority began conducting telehealth 
visits (97.9% of residents, 91.0% of faculty). Distance learning platforms were 
used by all residents (100%) and 39.6% noted an overall positive impact on their 
education. Higher levels of burnout did not significantly correlate with 
reassignment of clinical duties (residents P = 0.164; faculty P = 0.064). 
Residents who showed significantly higher burnout scores (P = 0.035) and a 
decline in levels of well-being (P = 0.031) were more likely to participate in 
institutional well-being support activities.
CONCLUSIONS: Our preliminary data indicate that family medicine residents and 
teaching faculty were profoundly affected by the COVID-19 pandemic. Future 
studies can be directed by current findings with focus on mitigation factors in 
addressing globally disruptive events such as COVID-19.

Plain Language Summary: Family physicians have played a unique clinical role 
during the COVID-19 pandemic. We hypothesized that the pandemic would be 
associated with significant deleterious effects on clinical activity, 
educational training, personal safety and well-being. Towards setting a 
foundation for further studies, we conducted a national survey to obtain 
preliminary data that would assist in future targeted data collection and 
subsequent evaluation of the impact of the pandemic on family medicine residents 
and teaching faculty. Our preliminary data indicate that family medicine 
residents and teaching faculty were profoundly affected by the COVID-19 pandemic 
in all domains studied. Future studies can be directed by current findings with 
focus on mitigation factors in addressing globally disruptive events such as 
COVID-19.

© The Author(s) 2021. Published by Oxford University Press. All rights reserved. 
For permissions, please e-mail: journals.permissions@oup.com.

DOI: 10.1093/fampra/cmab012
PMCID: PMC8414919
PMID: 34448487 [Indexed for MEDLINE]


3067. J Res Adolesc. 2021 Sep;31(3):546-559. doi: 10.1111/jora.12667.

Risk and Protective Factors for Changes in Adolescent Psychosocial Adjustment 
During COVID-19.

Romm KF(1), Park YW(2), Hughes JL(2), Gentzler AL(2).

Author information:
(1)George Washington University.
(2)West Virginia University.

The current study examined (1) changes in psychosocial adjustment among 
adolescents completing two surveys before COVID-19 and those completing the 
final survey during COVID-19 and (2) related risk/protective factors. 
Participants were 208 US adolescents (Mage  = 15.09, SD = 0.50, 48.8% female, 
86.1% White; 40.9% COVID group) who completed longitudinal surveys assessing 
psychosocial adjustment and related risk/protective factors (e.g., emotion 
regulation, well-being pursuits). Only adolescents completing Wave 3 during 
COVID-19 experienced increases in depressive symptoms, negative affect, and 
isolation and decreases in positive affect and friendship. Several variables 
served as risk (i.e., dampening) and protective (i.e., eudaimonic and hedonic 
motives) factors of these changes. Findings highlight the range of factors that 
are distinctly associated with negative changes in adolescent adjustment during 
COVID-19.

© 2021 Society for Research on Adolescence.

DOI: 10.1111/jora.12667
PMCID: PMC8646485
PMID: 34448304 [Indexed for MEDLINE]


3068. BMJ Open. 2021 Aug 26;11(8):e048180. doi: 10.1136/bmjopen-2020-048180.

Food insecurity and the nutritional health and well-being of women and children 
in high-income countries: protocol for a qualitative systematic review.

Bell Z(1), Scott S(2), Visram S(2), Rankin J(2), Bambra C(2), Heslehurst N(2).

Author information:
(1)Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle 
University, Newcastle upon Tyne, UK z.bell2@ncl.ac.uk.
(2)Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle 
University, Newcastle upon Tyne, UK.

INTRODUCTION: Since the global financial crises of 2008, there has been a rise 
in the number of people experiencing food insecurity. The COVID-19 pandemic has 
exacerbated this. Many more are unable to afford or access food of sufficient 
quality and quantity to enable good health and well-being. Particularly 
vulnerable are mothers with young children, pregnant women and lone parents (the 
majority of whom are women). This review aims to understand experiences of food 
insecurity and how it affects women and children's nutritional health and 
well-being, focusing on experiences explicitly related to nutrition. Findings 
will help guide health policy and practice to support food-insecure women and 
children from high-income countries.
METHODS AND ANALYSIS: A systematic review and meta-ethnography exploring (1) 
food-insecure women's own accounts of their nutritional health and (2) 
food-insecure household's accounts of their children's nutritional health. Six 
major databases (MEDLINE, Scopus, Web of Science, EMBASE, CINAHL and ASSIA), 
grey literature databases and relevant stakeholder websites will be searched 
from 1 January 2008 to 30 March 2021. Reference list and citation searches will 
supplement electronic database searches. Outcomes of interest are accounts of 
nutrition and nutritional health, including diet, food practices, infant feeding 
practices and physical and mental health. The review will follow the Preferred 
Reporting Items for Systematic Review and Meta-Analysis Protocol guidelines, but 
as this is a meta-ethnography it will adhere to eMERGe Reporting Guidance for 
synthesis and writing findings of the final report. Critical Appraisal Skills 
Programme qualitative checklist will assess the quality of studies. A 
meta-ethnographic analysis will be conducted for all included studies.
ETHICS AND DISSEMINATION: As a qualitative systematic review, without primary 
data collection, ethical approval will not be required. Findings will be 
submitted for peer-reviewed publication.
PROSPERO REGISTRATION NUMBER: CRD42020214159.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/bmjopen-2020-048180
PMCID: PMC8395272
PMID: 34446488 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3069. BMJ Open. 2021 Aug 26;11(8):e048175. doi: 10.1136/bmjopen-2020-048175.

SafeFit Trial: virtual clinics to deliver a multimodal intervention to improve 
psychological and physical well-being in people with cancer. Protocol of a 
COVID-19 targeted non-randomised phase III trial.

Grimmett C(1), Bates A(2), West M(2)(3), Leggett S(2), Varkonyi-Sepp J(2), 
Campbell A(4), Davis J(5), Wootton S(6)(7), Shaw C(8), Barlow R(9), Ashcroft 
J(10), Scott A(11), Moyes H(2), Hawkins L(12), Levett DZH(2)(13), Williams 
F(14), Grocott MPW(2)(13), Jack S(2).

Author information:
(1)School of Health Sciences, University of Southampton, Southampton, UK 
C.Grimmett@soton.ac.uk.
(2)NIHR Southampton Biomedical Research Centre, University Hospital Southampton 
NHS Foundation Trust, Southampton, UK.
(3)School of Cancer Sciences, Faculty of Medicine, University of Southampton, 
Southampton, UK.
(4)School of Applied Science, Edinburgh Napier University, Edinburgh, UK.
(5)Macmillan Cancer Support, London, UK.
(6)School of Human Development and Health, Faculty of Medicine, University of 
Southampton, Southampton, UK.
(7)NIHR Cancer and Nutrition Collaboration, Southampton, UK.
(8)NIHR Biomedical Research Centre, Royal Marsden NHS Foundation Trust, London, 
UK.
(9)Cardiff and Vale University Health Board, University Hospital of Wales, 
Cardiff, UK.
(10)St George's University Hospitals NHS Foundation Trust, London, UK.
(11)School of Sport, Health and Exercise Science, University of Portsmouth, 
Portsmouth, UK.
(12)Critical Care/Anaesthesia and Perioperative Medicine Research Unit, 
University Hospital Southampton NHS Foundation Trust, Southampton, UK.
(13)School of Clinical and Experimental Sciences, Faculty of Medicine, 
University of Southampton, Southampton, UK.
(14)Wessex Cancer Alliance, Southampton, UK.

INTRODUCTION: The impact of the COVID-19 pandemic (caused by the SARS-CoV-2 
virus) on individuals with cancer has been profound. It has led to increased 
anxiety, distress and deconditioning due to reduced physical activity. We aim to 
investigate whether SafeFit, a multimodal intervention of physical activity, 
nutrition and psychological support delivered virtually by cancer exercise 
specialists (CES), can improve physical and emotional functionings during the 
COVID-19 pandemic.
METHODS AND ANALYSIS: A phase III non-randomised intervention trial, target 
recruitment of 1050 adults with suspected or confirmed diagnosis of cancer. All 
recruited participants will receive the multimodal intervention delivered by CES 
for 6 months. Sessions will be delivered 1-to-1 using telephone/video 
conferencing consultations. CES will work with each participant to devise a 
personalised programme of (1) physical activity, (2) basic dietary advice and 
(3) psychological support, all underpinned by behaviour change support.
PRIMARY OUTCOME: Physical and emotional functioning as measured by the European 
Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire 
(EORTC-QLQ-C30).
SECONDARY OUTCOMES: overall quality of life measured by EORTC-QLQ-C30 and 
EQ-5D-5L, health economics, patient activation, self-efficacy to self-manage 
chronic disease, distress, impact of COVID-19 on emotional functioning, 
self-reported physical activity, functional capacity and nutrition. Adherence to 
the intervention will also be measured and a process evaluation conducted.
ETHICS AND DISSEMINATION: Ethical approval was obtained from the Health Research 
Authority (reference number 20/NW/0254). Results of this trial will be 
disseminated through publication of peer-reviewed articles, presentations at 
scientific conferences, and to the public and people with cancer in 
collaboration with our patient and public involvement representatives and 
partners.
TRIAL REGISTRATION NUMBER: NCT04425616.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2020-048175
PMCID: PMC8392740
PMID: 34446487 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3070. J Adolesc Health. 2021 Nov;69(5):737-745. doi: 10.1016/j.jadohealth.2021.07.013. 
Epub 2021 Aug 24.

Gender-Specific Changes in Life Satisfaction After the COVID-19-Related Lockdown 
in Dutch Adolescents: A Longitudinal Study.

van der Laan SEI(1), Finkenauer C(2), Lenters VC(3), van Harmelen AL(4), van der 
Ent CK(5), Nijhof SL(6).

Author information:
(1)Julius Center for Health Sciences and Primary Care, University Medical Center 
Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Pediatric 
Pulmonology, Wilhelmina Children's Hospital, University Medical Center Utrecht, 
Utrecht University, Utrecht, the Netherlands. Electronic address: 
s.e.i.vanderlaan-4@umcutrecht.nl.
(2)Department of Interdisciplinary Social Sciences, Utrecht University, Utrecht, 
the Netherlands.
(3)Julius Center for Health Sciences and Primary Care, University Medical Center 
Utrecht, Utrecht University, Utrecht, the Netherlands.
(4)Education and Child Studies, Leiden University, Leiden, the Netherlands; 
Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
(5)Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, 
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
(6)Department of Pediatrics, Wilhelmina Children's Hospital, University Medical 
Center Utrecht, Utrecht University, Utrecht, the Netherlands.

PURPOSE: The purposes of this study were to assess whether mental well-being has 
changed after introduction of the lockdown measures compared with that before, 
whether this change differs between boys and girls, and whether this change is 
associated with COVID-19-related concerns.
METHODS: This is a two-wave prospective study among Dutch adolescents using data 
collected up to one year before the COVID-19 pandemic (n = 224) and 5-8 weeks 
after the first introduction of lockdown measures (n = 158). Mental well-being 
was assessed by three indicators: life satisfaction, internalizing symptoms, and 
psychosomatic health. General linear model repeated-measures analysis of 
variance was used to assess whether mental well-being has changed and if this 
differed by sex. Univariate linear regressions were used to assess associations 
between COVID-19-related concerns and a change in mental well-being.
RESULTS: Life satisfaction decreased (η2p = .079, p < .001), but no change in 
internalizing symptoms was observed (η2p = .014, p = .14), and psychosomatic 
health increased (η2p = .194, p < .001) after the introduction of lockdown 
measures. Boys scored significantly better on all mental health indicators 
compared with girls at baseline and follow-up. However, boys' life satisfaction 
significantly decreased at the follow-up (η2p = .038, p = .015), whereas girls' 
life satisfaction did not change. Concerns about COVID-19 were significantly 
associated with a lower life satisfaction and more internalizing symptoms.
CONCLUSIONS: Adolescents', especially boys', life satisfaction decreased during 
the lockdown. They reported no change in internalizing symptoms and an improved 
psychosomatic health. Adolescents' mental well-being is expected to vary during 
the COVID-19 pandemic and should continue to be monitored.

Copyright © 2021 Society for Adolescent Health and Medicine. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jadohealth.2021.07.013
PMCID: PMC8460170
PMID: 34446346 [Indexed for MEDLINE]


3071. Int J Environ Res Public Health. 2021 Aug 19;18(16):8755. doi: 
10.3390/ijerph18168755.

Changes in Adolescents' Psychosocial Functioning and Well-Being as a Consequence 
of Long-Term COVID-19 Restrictions.

Kerekes N(1), Bador K(2), Sfendla A(3)(4)(5), Belaatar M(4), Mzadi AE(4), Jovic 
V(6), Damjanovic R(7), Erlandsson M(1), Nguyen HTM(8), Nguyen NTA(9), Ulberg 
SF(10), Kuch-Cecconi RH(10), Szombathyne Meszaros Z(10), Stevanovic D(6), 
Senhaji M(4), Hedman Ahlström B(1), Zouini B(4).

Author information:
(1)Department of Health Sciences, University West, 46186 Trollhättan, Sweden.
(2)AGERA KBT AB, 41138 Gothenburg, Sweden.
(3)High Institute of Nursing Professions and Health Techniques, BP 57, 
Errachidia 52000, Morocco.
(4)Department of Biology, Faculty of Sciences, Abdelmalek Essaâdi University, 
Avenue de Sebta, Mhannech II, Tetouan 93002, Morocco.
(5)Department of Biology, Faculty of Sciences and Techniques, Moulay Ismail 
University, BP 509, Boutalamine, Errachidia 52000, Morocco.
(6)Department of Psychiatry, Clinic for Neurology and Psychiatry for Children 
and Youth, 11000 Belgrade, Serbia.
(7)Department of Social Sciences, Faculty of Education in Sombor, University of 
Novi Sad, 25000 Sombor, Serbia.
(8)Department of Clinical Psychology, Faculty of Psychology, University of 
Social Sciences and Humanities, VNU, Hanoi 100000, Vietnam.
(9)Department of Social Work with Children and Family, Faculty of Social Work, 
Hanoi National University of Education, Hanoi 100000, Vietnam.
(10)Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical 
University, Syracuse, NY 13210, USA.

This work studied self-reports from adolescents on how the COVID-19 pandemic has 
changed their behaviors, relationships, mood, and victimization. Data collection 
was conducted between September 2020 and February 2021 in five countries 
(Sweden, the USA, Serbia, Morocco, and Vietnam). In total, 5114 high school 
students (aged 15 to 19 years, 61.8% females) responded to our electronic 
survey. A substantial proportion of students reported decreased time being 
outside (41.7%), meeting friends in real life (59.4%), and school performance 
(30.7%), while reporting increased time to do things they did not have time for 
before (49.3%) and using social media to stay connected (44.9%). One third of 
the adolescents increased exercise and felt that they have more control over 
their life. Only a small proportion of adolescents reported substance use, 
norm-breaking behaviors, or victimization. The overall COVID-19 impact on 
adolescent life was gender-specific: we found a stronger negative impact on 
female students. The results indicated that the majority of adolescents could 
adapt to the dramatic changes in their environment. However, healthcare 
institutions, municipalities, schools, and social services could benefit from 
the findings of this study in their work to meet the needs of those young people 
who signaled worsened psychosocial functioning, increased stress, and 
victimization.

DOI: 10.3390/ijerph18168755
PMCID: PMC8392883
PMID: 34444502 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3072. Int J Environ Res Public Health. 2021 Aug 19;18(16):8745. doi: 
10.3390/ijerph18168745.

Health-Related Quality of Life and Risk Factors among Chinese Women in Japan 
Following the COVID-19 Outbreak.

Luo Y(1), Sato Y(2).

Author information:
(1)Graduate School of Health Sciences, Hokkaido University, Hokkaido 060-0812, 
Japan.
(2)Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido 060-0812, 
Japan.

The COVID-19 pandemic has significantly affected individuals' physical and 
mental health, including that of immigrant women. This study aimed to evaluate 
the health-related quality of life (HRQoL), identify the demographic factors and 
awareness of the COVID-19 pandemic contributing to physical and mental health, 
and examine the risk factors associated with poor physical and mental health of 
Chinese women in Japan following the COVID-19 pandemic outbreak. Using an 
electronic questionnaire survey, we collected data including items on HRQoL, 
awareness of the COVID-19 pandemic, and demographic factors. One hundred and 
ninety-three participants were analyzed. Approximately 98.9% of them thought 
that COVID-19 affected their daily lives, and 97.4% had COVID-19 concerns. 
Married status (OR = 2.88, 95%CI [1.07, 7.72], p = 0.036), high concerns (OR = 
3.99, 95%CI [1.46, 10.94], p = 0.007), and no concerns (OR = 8.75, 95%CI [1.17, 
65.52], p = 0.035) about the COVID-19 pandemic were significantly associated 
with poor physical health. Unmarried status (OR = 2.83, 95%CI [1.20, 6.70], p = 
0.018) and high COVID-19 concerns (OR = 2.17, 95%CI [1.04, 4.56], p = 0.040) 
were significantly associated with poor mental health. It is necessary to 
provide effective social support for Chinese women in Japan to improve their 
well-being, especially in terms of mental health.

DOI: 10.3390/ijerph18168745
PMCID: PMC8391302
PMID: 34444494 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3073. Int J Environ Res Public Health. 2021 Aug 15;18(16):8629. doi: 
10.3390/ijerph18168629.

A Qualitative Analysis of UK Wetland Visitor Centres as a Health Resource.

Reeves JP(1), John CHD(2), Wood KA(1), Maund PR(1).

Author information:
(1)Ecosystem Health & Social Dimensions Unit, Wildfowl & Wetlands Trust (WWT), 
Slimbridge, Glos GL2 7BT, UK.
(2)School of Psychology, Cardiff University, 70 Park Pl, Cardiff CF10 3AT, UK.

The health benefits associated with spending time in natural environments have 
been highlighted during the COVID-19 pandemic. Lockdowns and restrictions to 
safeguard public health have exacerbated the pre-existing mental health crisis 
and rise of non-communicable diseases. Thus, the importance of nature as a 
health resource has been elevated, hastening calls for a better understanding of 
how health benefits might differ across user groups and nature provisions. In 
this regard, urban green spaces have become the greatest research focus; 
however, blue spaces, especially inland freshwater (e.g., wetlands), remain less 
studied. First-hand user experiences are also under-represented. This 
exploratory study examines the motivations and benefits of active wetland centre 
users in the UK, both during and after visits. Responses to three open-ended 
questions were collated online from 385 participants, and a qualitative content 
analysis was conducted based on an existing taxonomy from users of urban green 
spaces. The results showed strong motivations to visit due to the biodiversity 
at the site (mainly the birdlife), while less tangible nature (e.g., fresh air) 
and amenities were also important. In contrast to other studies on natural 
environments, physical activity was a less influential motivation. Salient 
derived effects included positive and intensely positive emotions, relaxation 
and mental restoration. After visits to wetland centres, feelings of vitality 
and satisfaction were the most prominent effects that emerged. For 
decision-makers looking to leverage inland blue spaces for public health 
benefit, our results highlight the broad range and relative prominence of the 
reasons for use and the associated perceived health benefits derived by users of 
UK wetland centres. They highlight how biodiversity, abiotic nature and good 
amenities are important qualities to consider when planning, managing and 
encouraging people to use natural environments for health benefit, qualities 
that may also provide important environmental co-benefits.

DOI: 10.3390/ijerph18168629
PMCID: PMC8392124
PMID: 34444378 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3074. Int J Environ Res Public Health. 2021 Aug 14;18(16):8587. doi: 
10.3390/ijerph18168587.

"Hang in There!": Mental Health in a Sample of the Italian Civil Protection 
Volunteers during the COVID-19 Health Emergency.

Roncone R(1)(2), Giusti L(1), Mammarella S(1), Salza A(1), Bianchini V(1), 
Lombardi A(3), Prosperococco M(3), Ursini E(3), Scaletta V(3), Casacchia M(1).

Author information:
(1)Department of Life, Health and Environmental Sciences, University of 
L'Aquila, Via Spennati 1, Edificio Delta 6, Studio 110-Coppito, 67100 L'Aquila, 
Italy.
(2)University Unit Rehabilitation Treatment, Early Interventions in Mental 
Health, Hospital S. Salvatore, 67100 L'Aquila, Italy.
(3)LARES Italia-Unione Nazionale Laureati Esperti in Protezione Civile, 67100 
L'Aquila, Italy.

Few studies have been conducted on civil volunteers and their emotional 
conditions concerning the current COVID-19 pandemic. The present study aimed to 
evaluate the impact of the COVID-19 emergency on the mental health (general 
well-being, depression level, and post-traumatic distress), coping strategies, 
and training needs in an Italian sample of 331 Civil Protection volunteers of 
the L'Aquila province, during the first nationwide "lockdown" (8 March-3 June 
2020). The rate of respondents to the online survey was limited (11.5%), 
presumably because displaying distress would be considered a sign of "weakness", 
making volunteers unable to do their jobs. More than 90% of the volunteers 
showed good mental health conditions and a wide utilization of positive coping 
strategies, with the less experienced displaying better emotional conditions 
compared to colleagues with 10 or more years of experience. The type of 
emergency, the relatively few cases of contagion and mortality in the territory 
compared to the rest of Italy, and the sense of helping the community, together 
with the awareness of their group identity, could have contributed to the 
reported well-being. These results may help to identify the needs of volunteers 
related to this new "urban" emergency to improve both their technical and 
emotional skills.

DOI: 10.3390/ijerph18168587
PMCID: PMC8394470
PMID: 34444336 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3075. Int J Environ Res Public Health. 2021 Aug 12;18(16):8539. doi: 
10.3390/ijerph18168539.

Women Suffered More Emotional and Life Distress than Men during the COVID-19 
Pandemic: The Role of Pathogen Disgust Sensitivity.

Ding Y(1), Yang J(1), Ji T(1), Guo Y(1).

Author information:
(1)School of Psychology, Nanjing Normal University, Nanjing 201097, China.

The outbreak of the COVID-19 has brought upon unprecedented challenges to nearly 
all people around the globe. Yet, people may differ in their risks of social, 
economic, and health well-being. In this research, we take a gender-difference 
approach to examine whether and why women suffered greater emotional and life 
distress than men at the early stage of the COVID-19 outbreak in China. Using a 
large nationwide Chinese sample, we found that compared to men, women reported 
higher levels of anxiety and fear, as well as greater life disturbance during 
the COVID-19 pandemic. Importantly, that women suffered more was partly 
explained by their higher level of pathogen disgust sensitivity. Our findings 
highlight the important consequences of gender differences in response to the 
threat of the COVID-19 pandemic and suggest that policymakers pay more attention 
to gender inequalities regarding COVID-19 responses.

DOI: 10.3390/ijerph18168539
PMCID: PMC8394728
PMID: 34444288 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3076. Int J Environ Res Public Health. 2021 Aug 11;18(16):8485. doi: 
10.3390/ijerph18168485.

Traumatic Distress of COVID-19 and Depression in the General Population: 
Exploring the Role of Resilience, Anxiety, and Hope.

Nearchou F(1), Douglas E(1).

Author information:
(1)School of Psychology, University College Dublin, 4 Dublin, Ireland.

International evidence published so far shows that the COVID-19 pandemic has 
negatively impacted on global mental health. Specifically, there is some 
research suggesting that the psychological distress related to depression, 
anxiety and posttraumatic stress has impacted on the psychological well-being of 
the general population. Yet, there is limited evidence on the relational paths 
between COVID-19 traumatic distress and depression. Participants of this 
cross-sectional study were 456 adults 18 years old or older from the general 
population (Mean age = 41.2 years, SD = 11.7) who completed an online 
questionnaire including measures assessing depression, anxiety, resilience, hope 
and traumatic distress related to COVID-19. Structural equation modelling was 
applied to examine the proposed mediation model. The results confirmed the 
proposed model, with traumatic distress of COVID-19, resilience, anxiety and 
hope explaining a considerable amount of variance (59%) in depression scores. 
Traumatic distress of COVID-19 was a strong positive predictor of depression, 
while anxiety, hope and resilience were both joint and unique mediators of this 
relationship. Exposure to the COVID-19 pandemic is strongly associated with 
depression in adults of the general population. The co-occurrence of anxiety may 
negatively contribute to experiencing higher levels of depression, while 
resilience and hope may act as buffers against depression associated with the 
impact of this pandemic. Our findings suggest that wide community-based 
interventions designed to promote resilience, build hope and reduce anxiety may 
help mitigate depression associated with exposure to the COVID-19 pandemic.

DOI: 10.3390/ijerph18168485
PMCID: PMC8394400
PMID: 34444231 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3077. Int J Environ Res Public Health. 2021 Aug 4;18(16):8240. doi: 
10.3390/ijerph18168240.

Active Coping and Anxiety Symptoms during the COVID-19 Pandemic in Spanish 
Adults.

Lara R(1)(2), Fernández-Daza M(3)(4), Zabarain-Cogollo S(3)(4), 
Olivencia-Carrión MA(2), Jiménez-Torres M(2)(5), Olivencia-Carrión MD(6), 
Ogallar-Blanco A(2)(5), Godoy-Izquierdo D(2)(5).

Author information:
(1)Departamento Psicología Social, Facultad de Psicología, Universidad de 
Granada, 18071 Granada, Spain.
(2)Grupo de Investigación Psicología de la Salud/Medicina Conductual (CTS-267), 
Universidad de Granada, 18071 Granada, Spain.
(3)Psychology Department, Universidad Cooperativa de Colombia, Santa Marta 
110000, Colombia.
(4)Grupo de Investigación Estudios Sociales Interdisciplinares-ESI, Santa Marta 
110000, Colombia.
(5)Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad 
de Psicología, Universidad de Granada, 18071 Granada, Spain.
(6)Centro de Salud de Torredonjimeno, 23000 Jaén, Spain.

The features of the COVID-19 pandemic and the social operations to contain the 
spread of the virus might have limited or altered coping, including healthy 
habits such as exercise, this contributing to a myriad of negative consequences 
for the mental health of the global population. We explored the contribution of 
coping and physical activity to the management of anxiety in Spanish adults 
during an active phase of the epidemic, as well as the relationship between 
these strategies. A total of 200 young and adult individuals (70% women) 
voluntarily completed an anxiety inventory, a coping skills self-report and a 
personal data section including exercise practice. The participants reported in 
average a mild yet existing level of anxiety symptoms; a third reported 
noticeable symptoms. At the time of the study, the participants used more 
adaptive than maladaptive coping styles. Participants' anxiety was inversely 
correlated with an active coping style, and positively with an avoidant style; 
physical activity correlated positively with an active coping style, and regular 
exercisers used more frequently active coping. Controlling for confounders, 
active coping, avoidant coping and exercise during the pandemic predicted 
anxiety symptoms. Other findings indicated that exercise was used as a coping 
strategy for dealing with emotional distress. Our results highlight the positive 
impact of functional coping and exercise for the management of negative states 
such as anxiety during the pandemic, and underline the importance of developing 
interventions aimed at enhancing coping skills for promoting physical and mental 
well-being of the population during health and social crises.

DOI: 10.3390/ijerph18168240
PMCID: PMC8392463
PMID: 34443989 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3078. Cells. 2021 Aug 6;10(8):1993. doi: 10.3390/cells10081993.

Microbiota-Gut-Brain Communication in the SARS-CoV-2 Infection.

Manosso LM(1), Arent CO(1), Borba LA(1), Ceretta LB(2), Quevedo J(1)(3)(4)(5), 
Réus GZ(1).

Author information:
(1)Translational Psychiatry Laboratory, Graduate Program in Health Sciences, 
University of Southern Santa Catarina (UNESC), Criciúma 77054-000, SC, Brazil.
(2)Programa de Pós-Graduação em Saúde Coletiva, Universidade do Extremo Sul 
Catarinense, Criciúma 88806-000, SC, Brazil.
(3)Translational Psychiatry Program, Department of Psychiatry and Behavioral 
Sciences, McGovern Medical School, The University of Texas Health Science Center 
at Houston (UTHealth), Houston, TX 77030, USA.
(4)Center of Excellence on Mood Disorders, Department of Psychiatry and 
Behavioral Sciences, McGovern Medical School, The University of Texas Health 
Science Center at Houston (UTHealth), Houston, TX 77030, USA.
(5)Neuroscience Graduate Program, The University of Texas Graduate School of 
Biomedical Sciences at Houston, Houston, TX 77030, USA.

The coronavirus disease of 2019 (COVID-19) is an infectious disease caused by 
severe acute respiratory syndrome 2 (SARS-CoV-2). In addition to pneumonia, 
individuals affected by the disease have neurological symptoms. Indeed, 
SARS-CoV-2 has a neuroinvasive capacity. It is known that the infection caused 
by SARS-CoV-2 leads to a cytokine storm. An exacerbated inflammatory state can 
lead to the blood-brain barrier (BBB) damage as well as to intestinal dysbiosis. 
These changes, in turn, are associated with microglial activation and reactivity 
of astrocytes that can promote the degeneration of neurons and be associated 
with the development of psychiatric disorders and neurodegenerative diseases. 
Studies also have been shown that SARS-CoV-2 alters the composition and 
functional activity of the gut microbiota. The microbiota-gut-brain axis 
provides a bidirectional homeostatic communication pathway. Thus, this review 
focuses on studies that show the relationship between inflammation and the gut 
microbiota-brain axis in SARS-CoV-2 infection.

DOI: 10.3390/cells10081993
PMCID: PMC8391332
PMID: 34440767 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3079. Psychooncology. 2022 Feb;31(2):253-259. doi: 10.1002/pon.5793. Epub 2021 Aug 25.

Psychological distress in primary caregivers of children with cancer during 
COVID-19 pandemic-A single tertiary care center experience.

Cheriyalinkal Parambil B(1), Goswami S(2), Roy Moulik N(1), Sonkusare L(2), 
Dhamne C(1), Narula G(1), Vora T(1), Prasad M(1), Chichra A(1), Jatia S(1), 
Sarda H(1), Paradkar A(1), Deodhar J(2), Chinnaswamy G(1), Banavali S(1).

Author information:
(1)Department of Pediatric Oncology, Tata Memorial Hospital, Homi Bhabha 
National Institute (HBNI), Mumbai, India.
(2)Department of Psycho-Oncology, Tata Memorial Hospital, Homi Bhabha National 
Institute (HBNI), Mumbai, India.

OBJECTIVE: Families of children with cancer undergoing treatment during COVID-19 
pandemic represent a vulnerable population for psychological distress and early 
identification and remedial measures are imperative for wellbeing of both the 
children and the caregivers. This article reports the results of assessment of 
psychological distress in primary caregivers of children with cancer undergoing 
treatment at a tertiary care center.
METHODS: Primary caregivers of children with cancer (≤15 years) taking treatment 
at our institute during the period of July 2020 to August 2020 were 
prospectively evaluated for psychological distress using Patient Health 
Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) tools over a 
telephonic call. There were 2 cohorts, A and B (50 participants each) depending 
on whether child was diagnosed with COVID-19 or not respectively during the 
study period.
RESULTS: The assessment tool, PHQ-9 showed a score of ≥10 in 13% (n = 13) 
participants (95%CI:7.1%-21.2%) in the entire cohort and in 16% (n = 8, 
95%CI:5.8%-26.2%) and 10% (n = 5, 95%CI:1.7%-18.3%) participants in cohort A and 
cohort B respectively. GAD-7 showed a score of ≥8 in 18% (n = 18) participants 
(95%CI:11.0%-27.0%) in the entire cohort and in 20% (n = 10, 95%CI:8.9%-31.1%) 
and 16% (n = 8, 95%CI:5.8%-26.2%) participants in cohort A and cohort B 
respectively. All participants were assessed, and supportive psychotherapeutic 
interventions administered over telephonic call.
CONCLUSIONS: Primary caregivers should be assessed and followed up for 
psychological distress irrespective of other co-existing factors. Robust support 
systems built over time could help withstand the exceptional strain of a major 
surge during a pandemic.

© 2022 John Wiley & Sons Ltd.

DOI: 10.1002/pon.5793
PMCID: PMC8646668
PMID: 34435720 [Indexed for MEDLINE]


3080. Child Dev. 2021 Sep;92(5):e781-e797. doi: 10.1111/cdev.13659. Epub 2021 Aug 26.

Understanding patterns of food insecurity and family well-being amid the 
COVID-19 pandemic using daily surveys.

Steimle S(1), Gassman-Pines A(2), Johnson AD(1), Hines CT(1), Ryan RM(1).

Author information:
(1)Department of Psychology, Georgetown University, Washington, District of 
Columbia, USA.
(2)Sanford School of Public Policy, Duke University, Durham, North Carolina, 
USA.

This paper investigates economic and psychological hardship during the COVID-19 
pandemic among a diverse sample (61% Latinx; 16% White; 9% Black; 14% 
mixed/other race) of socioeconomically disadvantaged parents (90% mothers; mean 
age = 35 years) and their elementary school-aged children (ages 4-11; 49% 
female) in rural Pennsylvania (N = 272). Families participating in a local food 
assistance program reported on food insecurity (FI) and parent and child mood 
and behavior daily from January to May 2020. Longitudinal models revealed that 
FI, negative parent and child mood, and child misbehavior significantly 
increased when schools closed; only FI and parent depression later decreased. FI 
decreased most among those who received the local food assistance program; 
Supplemental Nutrition Assistance Program receipt uniquely predicted decreases 
in child FI.

© 2021 The Authors. Child Development © 2021 Society for Research in Child 
Development.

DOI: 10.1111/cdev.13659
PMCID: PMC8653334
PMID: 34435668 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3081. Health Soc Care Community. 2022 Sep;30(5):1754-1762. doi: 10.1111/hsc.13555. 
Epub 2021 Aug 25.

The experience of the COVID-19 pandemic for families of infants involved with 
Child Protection Services for maltreatment concerns.

Fogarty A(1), Jones A(2), Evans K(2), O'Brien J(2), Giallo R(1)(3).

Author information:
(1)Murdoch Children's Research Institute, Melbourne, Vic., Australia.
(2)Tweddle Child and Family Health Service, Melbourne, Vic., Australia.
(3)Department of Paediatrics, The University of Melbourne, Melbourne, Vic., 
Australia.

The COVID-19 pandemic and associated physical distancing restrictions have 
exacerbated social, economic and health disadvantage within our communities. 
With increases in mental health difficulties and family violence already being 
seen, there is concern that the risk of child maltreatment risk may also be 
increased. The current study aimed to explore the experience of the COVID-19 
pandemic for families identified to be at risk of child maltreatment in 
Victoria, Australia. Understanding the experiences of the pandemic for families 
already at risk is essential in identifying how to best support vulnerable 
parents and young children during this challenging time. Interviews were 
conducted with 11 parents currently involved with Child Protection Services, and 
nine clinicians working within a child and family health services, supporting 
clients with child protection involvement. Parents and clinicians described a 
range of pandemic related stressors including employment and financial stress, 
worry about infection and changes to service access. In addition, parents with 
children in out of home care discussed decreased access to their children 
resulting from physical distancing restrictions. Parents and clinicians 
perceived the pandemic to be having a negative impact on parent mental health, 
parenting stress and isolation. Although parents raised minimal concerns about 
the impact of the pandemic on child well-being, clinicians expressed concerns 
about the rise in risk factors for child maltreatment. Parents discussed a range 
of coping strategies which they perceived to be helpful during the pandemic, and 
clinicians and parents described the need for additional mental health support 
and support to access basic needs. The study highlights the importance of 
ensuring at risk families have access to parenting and mental health support 
throughout the pandemic and the importance of ensuring children within at-risk 
families are sighted and their safety assessed.

© 2021 John Wiley & Sons Ltd.

DOI: 10.1111/hsc.13555
PMCID: PMC8653246
PMID: 34435399 [Indexed for MEDLINE]


3082. J Grad Med Educ. 2021 Aug;13(4):515-525. doi: 10.4300/JGME-D-20-01497.1. Epub 
2021 Aug 13.

Dark Clouds With Silver Linings: Resident Anxieties About COVID-19 Coupled With 
Program Innovations and Increased Resident Well-Being.

Wietlisbach LE(1), Asch DA(2), Eriksen W(3), Barg FK(4), Bellini LM(5), Desai 
SV(6), Yakubu AR(7), Shea JA(8).

Author information:
(1)is a Medical Student and Research Assistant, Perelman School of Medicine, 
University of Pennsylvania.
(2)is Professor, Perelman School of Medicine and The Wharton School, and an 
Internal Medicine Physician, Department of Medicine, University of Pennsylvania.
(3)is a Senior Researcher, University of Pennsylvania Mixed Methods Research 
Lab.
(4)is Director, University of Pennsylvania Mixed Methods Research Lab, and 
Professor, Department of Family Medicine and Community Health, Perelman School 
of Medicine, University of Pennsylvania.
(5)is Senior Vice Dean for Academic Affairs, Department of Medicine, Perelman 
School of Medicine, University of Pennsylvania, and University of Pennsylvania.
(6)is Director, Osler Medical Residency, and Vice-Chair for Education, 
Department of Medicine, Johns Hopkins University.
(7)is a Research Assistant, University of Pennsylvania Mixed Methods Research 
Lab.
(8)is Associate Dean of Medical Education Research, Perelman School of Medicine, 
and Professor, Department of Medicine, University of Pennsylvania.

BACKGROUND: The COVID-19 pandemic forced numerous unprecedented systemic changes 
within residency programs and hospital systems.
OBJECTIVE: We explored how the COVID-19 pandemic, and associated changes in 
clinical and educational experiences, were related to internal medicine 
residents' well-being in the early months of the pandemic.
METHODS: Across 4 internal medicine residency programs in the Northeast United 
States that have previously participated in the iCOMPARE study, all 394 
residents were invited to participate in a study with open-ended survey prompts 
about well-being approximately every 2 weeks in academic year 2019-2020. In 
March and April 2020, survey prompts were refocused to COVID-19. Content 
analysis revealed themes in residents' open-ended responses to 4 prompts.
RESULTS: One hundred and eighty-six residents expressed interest, and 88 were 
randomly selected (47%). There were 4 main themes: (1) in early days of the 
pandemic, internal medicine residents reported fear and anxiety about 
uncertainty and lack of personal protective equipment; (2) residents adapted and 
soon were able to reflect, rest, and pursue personal wellness; (3) communication 
from programs and health systems was inconsistent early in the pandemic but 
improved in clarity and frequency; (4) residents appreciated the changes 
programs had made, including shorter shifts, removal of pre-rounding, and 
telemedicine.
CONCLUSIONS: COVID-19 introduced many challenges to internal medicine residency 
programs and to resident well-being. Programs made structural changes to 
clinical schedules, educational/conference options, and communication that 
boosted resident well-being. Many residents hoped these changes would continue 
regardless of the pandemic's course.

DOI: 10.4300/JGME-D-20-01497.1
PMCID: PMC8370362
PMID: 34434512 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest: The authors declare they 
have no competing interests.


3083. Qual Health Res. 2021 Nov;31(13):2414-2425. doi: 10.1177/10497323211039204. Epub 
2021 Aug 25.

Qualitative Findings on the Impact of COVID-19 Restrictions on Australian Gay 
and Bisexual Men: Community Belonging and Mental Well-being.

Philpot SP(1), Holt M(1), Murphy D(1), Haire B(1), Prestage G(1), Maher L(1), 
Bavinton BR(1), Hammoud MA(1), Jin F(1), Bourne A(2).

Author information:
(1)UNSW Sydney, Kensington, New South Wales, Australia.
(2)La Trobe University, Bundoora, Victoria, Australia.

COVID-19 may threaten the already poor mental health outcomes of Australian gay 
and bisexual men and cut ties to important social/sexual networks and community. 
Qualitative research into the experiences of gay and bisexual men during 
COVID-19 regulations is currently sparse. We report on 489 responses to a 
qualitative free-text question asking Australian gay and bisexual men about the 
impacts of COVID-19 during April 2020. Issues pertinent to gay and bisexual men 
include lost ties to gay and bisexual social/sexual communities, spaces, and 
activities, which can reduce a sense of belonging to important sexual identity 
spaces, as well as significant mental well-being vulnerabilities. Reminiscing 
the collective response to HIV/AIDS, findings reinforce the value of gay and 
bisexual community organizations, spaces, and networks as supports for gay and 
bisexual men and emphasize the need for delivering mental health services.

DOI: 10.1177/10497323211039204
PMID: 34433350 [Indexed for MEDLINE]


3084. J Women Aging. 2022 Sep-Oct;34(5):637-648. doi: 10.1080/08952841.2021.1967654. 
Epub 2021 Aug 25.

Changes in Life Circumstances and Mental Health Symptoms during the COVID-19 
Pandemic among Midlife Women with Elevated Risk for Cardiovascular Disease.

Brown MM(1), Arigo D(1).

Author information:
(1)Department of Psychology, Rowan University, Glassboro, New Jersey, USA.

Cardiovascular disease (CVD) remains the leading cause of death among women. 
During midlife (ages 40-60), universal aging processes, sex-specific factors 
such as menopause, psychological distress, and conditions such as hypertension 
substantially increase women's risk for CVD. The onset of the COVID-19 pandemic 
has impacted employment, social interactions, caregiving responsibilities, and 
overall well-being worldwide; however, little research has investigated how 
COVID-19 has affected women in midlife. The present study was designed to 
determine how COVID-19 has affected women in midlife with elevated risk for CVD, 
by examining changes in their mental health symptoms and life domains across 
three time points: prior to COVID-19 (2019), during stay-at-home orders 
(April-June 2020), and during initial reopening (August 2020). Women in midlife 
with one or more CVD risk conditions (e.g., hypertension; n = 35) responded to 
questions related to COVID-19, changes in life circumstances, and mental health 
symptoms at each time point. Findings showed meaningful changes in caregiving, 
medical visits, and employment status, as well as significant changes in 
depression and sleep quality scores across time. However, the findings also 
showed that women were distressed prior to COVID-19 and did not exhibit changes 
in perceived stress, body dissatisfaction, or anxiety symptoms over time. 
Findings from this study highlight the impact of the COVID-19 pandemic on an 
at-risk group of women, which may be used to help guide future health promotion 
efforts specifically tailored to this population.

DOI: 10.1080/08952841.2021.1967654
PMCID: PMC8873233
PMID: 34432597 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Interest Statement: No interests 
to disclose.


3085. Sleep. 2022 Feb 14;45(2):zsab216. doi: 10.1093/sleep/zsab216.

Evening-types show highest increase of sleep and mental health problems during 
the COVID-19 pandemic-multinational study on 19 267 adults.

Merikanto I(1)(2)(3), Kortesoja L(4), Benedict C(5), Chung F(6)(7), Cedernaes 
J(8)(9), Espie CA(10), Morin CM(11), Dauvilliers Y(12), Partinen M(13), De 
Gennaro L(14)(15), Wing YK(16), Chan NY(17), Inoue Y(18), Matsui K(19), 
Holzinger B(20), Plazzi G(21)(22), Mota-Rolim SA(23), Leger D(24), Penzel T(25), 
Bjorvatn B(26).

Author information:
(1)SleepWell Research Program Unit, Faculty of Medicine, University of Helsinki, 
Helsinki, Finland.
(2)Department of Public Health Solutions, Finnish Institute for Health and 
Welfare, Helsinki, Finland.
(3)Orton Orthopaedics Hospital, Helsinki, Finland.
(4)Centre for Educational Assessment, University of Helsinki, Helsinki, Finland.
(5)Department of Neuroscience, Sleep Science (BMC), Uppsala University, Uppsala, 
Sweden.
(6)Department of Anesthesia and Pain Medicine, Toronto Western Hospital, 
University Health Network, University of Toronto, Toronto, ON, Canada.
(7)Institute of Medical Science, Temerty Faculty of Medicine, University of 
Toronto, Toronto, ON, Canada.
(8)Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
(9)Department of Medicine, Division of Endocrinology, Metabolism, and Molecular 
Medicine, Northwestern University, Chicago, IL, USA.
(10)Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical 
Neurosciences, University of Oxford, Oxford, UK.
(11)École de Psychologie, Centre d'étude des troubles du sommeil, Centre de 
recherche CERVO/Brain Research Center, Université Laval, Québec, QC, Canada.
(12)Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac 
Hospital, Institute for Neurosciences of Montpellier INM, INSERM, University of 
Montpellier, Montpellier, France.
(13)Helsinki Sleep Clinic, Vitalmed Research Center, and Department of 
Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland.
(14)Department of Psychology, Sapienza University of Rome, Rome, Italy.
(15)IRCCS Fondazione Santa Lucia, Rome, Italy.
(16)Department of Psychiatry, Faculty of Medicine, The Chinese University of 
Hong Kong, Shatin, Hong Kong SAR, China.
(17)Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty 
of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
(18)Department of Somnology, Tokyo Medical University, Tokyo, Japan.
(19)Department of Laboratory Medicine, National Center Hospital, National Center 
of Neurology and Psychiatry, Tokyo, Japan.
(20)Institute for Dream and Consciousness Research, Medical University of 
Vienna, Vienna, Austria.
(21)IRCCS-Institute of the Neurological Sciences of Bologna, Bologna, Italy.
(22)Department of Biomedical, Metabolic and Neural Sciences, University of 
Modena and Reggio Emilia, Modena, Italy.
(23)Brain Institute, Physiology and Behaviour Department, and Onofre Lopes 
University Hospital-Federal University of Rio Grande do Norte, Natal, Brazil.
(24)Hopital Hotel-Dieu de Paris, Sleep and Vigilance Center, Universite de 
Paris, VIFASOM (EA 7331 Vigilance Fatigue Sommeil et Santé Publique), Paris, 
France.
(25)Sleep Medicine Center, Charite Universitätsmedizin Berlin, Berlin, Germany.
(26)Department of Global Public Health and Primary Care, University of Bergen, 
and Norwegian Competence Center for Sleep Disorders, Haukeland University 
Hospital, Bergen, Norway.

STUDY OBJECTIVES: Individual circadian type is a ubiquitous trait defining 
sleep, with eveningness often associated with poorer sleep and mental health 
than morningness. However, it is unknown whether COVID-19 pandemic has 
differentially affected sleep and mental health depending on the circadian type. 
Here, the differences in sleep and mental health between circadian types are 
examined globally before and during the COVID-19 pandemic.
METHODS: The sample collected between May and August 2020 across 12 
countries/regions consisted of 19 267 adults with information on their circadian 
type. Statistical analyses were performed by using Complex Sample procedures, 
stratified by country and weighted by the number of inhabitants in the 
country/area of interest and by the relative number of responders in that 
country/area.
RESULTS: Evening-types had poorer mental health, well-being, and quality of life 
or health than other circadian types during the pandemic. Sleep-wake schedules 
were delayed especially on working days, and evening-types reported an increase 
in sleep duration. Sleep problems increased in all circadian types, but 
especially among evening-types, moderated by financial suffering and 
confinement. Intermediate-types were less vulnerable to sleep changes, although 
morningness protected from most sleep problems. These findings were confirmed 
after adjusting for age, sex, duration of the confinement, or socio-economic 
status during the pandemic.
CONCLUSIONS: These findings indicate an alarming increase in sleep and mental 
health problems, especially among evening-types as compared to other circadian 
types during the pandemic.

© Sleep Research Society 2021. Published by Oxford University Press on behalf of 
the Sleep Research Society.

DOI: 10.1093/sleep/zsab216
PMCID: PMC8499764
PMID: 34432058 [Indexed for MEDLINE]


3086. Front Health Serv Manage. 2021 Oct 1;38(1):32-38. doi: 
10.1097/HAP.0000000000000122.

Behavioral Health in the Pandemic: Making the Shift from Mental Illness to 
Mental Well-Being.

Merz SM(1).

Author information:
(1)Stephen M. Merz, FACHE,is COO of Sheppard Pratt Solutions, part of Sheppard 
Pratt Health System in Baltimore, Maryland, an organization devoted to 
behavioral health care .

Fighting the global COVID-19 pandemic has shifted from immediate response 
efforts to recognition of the long-term effects on the mental health and 
well-being of the general population and healthcare workforce. Leaders need to 
understand the vital role of behavioral health services in a population-based, 
integrated healthcare framework and address the needs of the behavioral health 
workforce to successfully deploy services in their organizations and 
communities.During the ongoing national response to COVID-19, three major trends 
have emerged: (1) a shift to telehealth and digital care, (2) greater awareness 
of the impact on the workforce of the shift to digital care, and (3) an open 
dialogue to counteract the stigma and discrimination related to mental illness 
and to emphasize mental well-being instead. When they address stigma and 
discrimination, healthcare leaders embrace a more holistic approach that 
welcomes behavioral health professionals as equal, vital members of the care 
team. They help their organizations advance the mental well-being of all.

Copyright © 2021 Foundation of the American College of Healthcare Executives.

DOI: 10.1097/HAP.0000000000000122
PMID: 34431817 [Indexed for MEDLINE]

Conflict of interest statement: The author declares no conflicts of interest.


3087. J Sex Res. 2022 May;59(4):403-412. doi: 10.1080/00224499.2021.1966359. Epub 2021 
Aug 25.

COVID-19 and Sexual Desire: Perceived Fear Is Associated with Enhanced 
Relationship Functioning.

Rodrigues DL(1), Lehmiller JJ(2).

Author information:
(1)Department of Social and Organizational Psychology, Iscte-Instituto 
Universitário De Lisboa, CIS-Iscte.
(2)The Kinsey Institute, Indiana University, Indiana.

Lifestyle changes caused by the COVID-19 pandemic had mostly negative 
consequences for individual, relationship, and sexual functioning. However, some 
individuals have reported increases in sexual desire and made new additions to 
their sex lives. Given that stress-provoking situations can sometimes make 
mortality more salient and heighten sexual desire, it is possible that lifestyle 
changes and fear of COVID-19 infection may have benefited some relationships. We 
conducted a cross-sectional study with 303 romantically involved adults (58.1% 
men) and found that lifestyle changes were associated with negative changes in 
one's sex life, unrelated to wanting to spend time with one's partner, and 
positively associated with relationship quality. Lifestyle changes were also 
positively associated with sexual desire, but only for participants with high 
(vs. low) fear of COVID-19 infection. For these participants, sexual desire was 
associated with positive changes in one's sex life and wanting to spend time 
with one's partner, but not with overall relationship quality. Results were 
consistent after controlling for pandemic-related anxiety and demographic 
variables. This study advances literature focused on the importance of romantic 
relationships in stress-provoking situations such as the COVID-19 pandemic by 
shedding light on the association between sexual desire and personal and 
relational well-being.

DOI: 10.1080/00224499.2021.1966359
PMID: 34431724 [Indexed for MEDLINE]


3088. BMJ. 2021 Aug 24;374:n1730. doi: 10.1136/bmj.n1730.

Mental health and wellbeing of children and adolescents during the covid-19 
pandemic.

Rider EA(1), Ansari E(2), Varrin PH(3), Sparrow J(4).

Author information:
(1)Department of Pediatrics, Harvard Medical School; and Division of General 
Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, MA, 
USA elizabeth_rider@hms.harvard.edu elizabeth.rider@childrens.harvard.edu.
(2)Department of Pediatrics, Harvard Medical School; and Division of Emergency 
Medicine, Boston Children's Hospital, Boston, MA, USA.
(3)Mental Health Team, Cotting School, Lexington, MA, USA.
(4)Department of Psychiatry, Harvard Medical School; and Brazelton Touchpoints 
Center, Division of Developmental Medicine, and Department of Psychiatry, Boston 
Children's Hospital, Boston, MA, USA.

Comment in
    BMJ. 2021 Sep 24;374:n2324.

DOI: 10.1136/bmj.n1730
PMID: 34429302 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: We have read and understood 
BMJ policy on declaration of interests and declare that we have no competing 
interests.


3089. Pediatr Transplant. 2021 Dec;25(8):e14121. doi: 10.1111/petr.14121. Epub 2021 
Aug 24.

Psychosocial situation, adherence, and utilization of video consultation in 
young adult long-term pediatric liver transplant recipients during COVID-19 
pandemic.

Kröncke S(1), Lund LK(2), Buchholz A(1), Lang M(2), Briem-Richter A(3), Grabhorn 
EF(3), Sterneck M(2).

Author information:
(1)Department of Medical Psychology, University Medical Center 
Hamburg-Eppendorf, Hamburg, Germany.
(2)Department of Gastroenterology, University Transplant Center, University 
Medical Center Hamburg-Eppendorf, Hamburg, Germany.
(3)Department of Pediatrics, University Medical Center Hamburg-Eppendorf, 
Hamburg, Germany.

BACKGROUND: Young adults who underwent liver transplantation in childhood 
(YALTs) are highly vulnerable to non-adherent behavior and psychosocial 
problems. During the COVID-19 pandemic, special efforts may be necessary to 
maintain contact with these patients and offer support. This can be achieved 
through the use of telemedicine. The study's objective was to assess adherence 
and the psychosocial situation of YALTs during the COVID-19 pandemic in Germany 
and to evaluate the utilization of video consultations.
METHODS: In May 2020, a questionnaire was sent to YALTs treated at the Hamburg 
University Transplant Center, accompanied by the offer of video appointments 
with the attending physician. The questionnaire included the Generalized Anxiety 
Disorder Scale 7, the Patient Health Questionnaire 2, and questions compiled by 
the authors.
RESULTS: Of 98 YALTs, 12% used the video consultation, while 65% had an 
in-person appointment. The 56 patients who completed the questionnaire did not 
report reduced medication adherence during the pandemic, but 40% missed 
follow-up visits with their primary care physician or check-up laboratory tests. 
About 70% of YALTs were afraid to visit their physician and the transplant 
center, and 34% were afraid of a SARS-CoV-2 infection. Mental health and 
well-being were unimpaired.
CONCLUSIONS: During the COVID-19 pandemic, YALTs in our study did not show an 
increased need for psychosocial support, but a majority were afraid to attend 
medical appointments, and 40% reported lower appointment adherence. Acceptance 
of video consultations was lower than expected. The reasons for this need to be 
further investigated in order to optimize care.

© 2021 The Authors. Pediatric Transplantation published by Wiley Periodicals 
LLC.

DOI: 10.1111/petr.14121
PMCID: PMC8646625
PMID: 34428322 [Indexed for MEDLINE]

Conflict of interest statement: The authors of this manuscript have no conflicts 
of interest to disclose.


3090. Epilepsia. 2021 Oct;62(10):2322-2332. doi: 10.1111/epi.17045. Epub 2021 Aug 24.

Epilepsy care during the COVID-19 pandemic.

Cross JH(1), Kwon CS(2), Asadi-Pooya AA(3)(4), Balagura G(5), Gómez-Iglesias 
P(6), Guekht A(7)(8), Hall J(9), Ikeda A(10), Kishk NA(11), Murphy P(12), 
Kissani N(13)(14), Naji Y(13)(14), Perucca E(15)(16), Pérez-Poveda JC(17), Sanya 
EO(#)(18), Trinka E(19)(20)(21), Zhou D(22), Wiebe S(23), Jette N(2); ILAE Task 
Forces on COVID-19, Telemedicine.

Author information:
(1)Programme of Developmental Neurosciences, UCL NIHR BRC Great Ormond Street 
Institute of Child Health, Great Ormond Street Hospital for Children, London and 
Young Epilepsy Lingfield, London, UK.
(2)Division of Health Outcomes and Knowledge Translation Research, Department of 
Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
(3)Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, 
Iran.
(4)Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas 
Jefferson University, Philadelphia, USA.
(5)Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and 
Maternal and Child Health, Pediatric Neurology and Muscular Diseases Unit, IRCCS 
'G. Gaslini' Institute, University of Genoa, Genoa, Italy.
(6)Epilepsy Unit. Department of Neurology, Hospital Clínico San Carlos, Health 
Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, 
Madrid, Spain.
(7)Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia.
(8)Department of Neurology, Neurosurgery and Medical Genetics, Russian National 
Research Medical University, Moscow, Russia.
(9)Executive Director, International League Against Epilepsy, Flower Mound, TX, 
USA.
(10)Department of Epilepsy, Movement Disorders and Physiology, Kyoto University 
Graduate School of Medicine, Kyoto, Japan.
(11)Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
(12)Epilepsy Ireland, Dublin, Ireland.
(13)Neuroscience Research Laboratory, Marrakech Medical School, University Cadi 
Ayyad, Marrakesh, Morocco.
(14)Neurology Department, University Teaching Hospital Mohammed VI, Marrakesh, 
Morocco.
(15)Division of Clinical and Experimental Pharmacology, Department of Internal 
Medicine and Therapeutics, University of Pavia, Pavia, Italy.
(16)IRCCS Mondino Foundation (and member of the ERN EpiCARE), Pavia, Italy.
(17)Neuroscience Department, Faculty of Medicine, Xavierian University, and 
Hospital Universitario San Ignacio, Bogotá D. C, Colombia.
(18)Neurology division, Medicine Department, University of Ilorin Teaching 
Hospital, Kwara State, Nigeria.
(19)Department of Neurology, Centre for Cognitive Neuroscience, 
Christian-Doppler University Hospital, Paracelsus Medical University, Salzburg, 
Austria.
(20)Neuroscience Institute Christian-Doppler University Hospital, Centre for 
Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria.
(21)Institute of Public Health, Medical Decision-Making and HTA, UMIT, Medical 
Informatics and Technology, Private University for Health Sciences, Hall in 
Tyrol, Austria.
(22)Department of Neurology, West China Hospital, Sichuan University, Chengdu, 
China.
(23)Departments of Clinical Neurosciences and Community Health Sciences, Cumming 
School of Medicine, University of Calgary, Calgary, Canada.
(#)Contributed equally

The coronavirus disease 2019 (COVID-19) pandemic has affected the care of all 
patients around the world. The International League Against Epilepsy (ILAE) 
COVID-19 and Telemedicine Task Forces examined, through surveys to people with 
epilepsy (PWE), caregivers, and health care professionals, how the pandemic has 
affected the well-being, care, and services for PWE. The ILAE included a link on 
their website whereby PWE and/or their caregivers could fill out a survey (in 
11 languages) about the impact of the COVID-19 pandemic, including access to 
health services and impact on mental health, including the 6-item Kessler 
Psychological Distress Scale. An anonymous link was also provided whereby health 
care providers could report cases of new-onset seizures or an exacerbation of 
seizures in the context of COVID-19. Finally, a separate questionnaire aimed at 
exploring the utilization of telehealth by health care professionals since the 
pandemic began was available on the ILAE website and also disseminated to its 
members. Seventeen case reports were received; data were limited and therefore 
no firm conclusions could be drawn. Of 590 respondents to the well-being survey 
(422 PWE, 166 caregivers), 22.8% PWE and 27.5% caregivers reported an increase 
in seizure frequency, with difficulty in accessing medication and health care 
professionals reported as barriers to care. Of all respondents, 57.1% PWE and 
21.5% caregivers had severe psychological distress (k score >13), which was 
significantly higher among PWE than caregivers (p<0.01). An increase in 
telemedicine use during the COVID-19 pandemic was reported by health care 
professionals, with 40% of consultations conducted by this method. Although 
74.9% of health care providers thought that this impacted positively, barriers 
to care were also identified. As we move forward, there is a need to ensure 
ongoing support and care for PWE to prevent a parallel pandemic of unmet health 
care needs.

© 2021 International League Against Epilepsy.

DOI: 10.1111/epi.17045
PMCID: PMC8652685
PMID: 34428314 [Indexed for MEDLINE]


3091. Matern Child Health J. 2021 Nov;25(11):1655-1669. doi: 
10.1007/s10995-021-03207-2. Epub 2021 Aug 24.

COVID-19 and Children's Well-Being: A Rapid Research Agenda.

Dudovitz RN(1)(2), Russ S(1)(3), Berghaus M(1)(3), Iruka IU(4), DiBari J(5), 
Foney DM(5), Kogan M(5), Halfon N(6)(7)(8)(9).

Author information:
(1)Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, 
CA, USA.
(2)UCLA Children's Discovery and Innovation Institute, Los Angeles, CA, USA.
(3)UCLA Center for Healthier Children, Families and Communities, 10960 Wilshire 
Boulevard, Suite 960, Los Angeles, CA, 90024, USA.
(4)University of North Carolina At Chapel Hill, Chapel Hill, NC, USA.
(5)US Department of Health and Human Services, Maternal and Child Health Bureau, 
Health Resources and Services Administration, Rockville, MD, USA.
(6)Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, 
CA, USA. nhalfon@g.ucla.edu.
(7)UCLA Center for Healthier Children, Families and Communities, 10960 Wilshire 
Boulevard, Suite 960, Los Angeles, CA, 90024, USA. nhalfon@g.ucla.edu.
(8)Department of Health Policy and Management, Fielding School of Public Health, 
University of California Los Angeles, Los Angeles, CA, USA. nhalfon@g.ucla.edu.
(9)Department of Public Policy, Luskin School of Public Affairs, UCLA, Los 
Angeles, CA, USA. nhalfon@g.ucla.edu.

PURPOSE: Understanding the full impact of COVID-19 on U.S. children, families, 
and communities is critical to (a) document the scope of the problem, (b) 
identify solutions to mitigate harm, and (c) build more resilient response 
systems. We sought to develop a research agenda to understand the short- and 
long-term mechanisms and impacts of the COVID-19 pandemic on children's healthy 
development, with the goal of devising and ultimately testing interventions to 
respond to urgent needs and prepare for future pandemics.
DESCRIPTION: The Life Course Intervention Research Network facilitated a series 
of virtual meetings that included members of 10 Maternal and Child Health (MCH) 
research programs, their research and implementation partners, as well as family 
and community representatives, to develop an MCH COVID-19 Research Agenda. 
Stakeholders from academia, clinical practice, nonprofit organizations, and 
family advocates participated in four meetings, with 30-35 participants at each 
meeting.
ASSESSMENT: Investigating the impacts of COVID-19 on children's mental health 
and ways to address them emerged as the highest research priority, followed by 
studying resilience at individual and community levels; identifying and 
mitigating the disparate negative effects of the pandemic on children and 
families of color, prioritizing community-based research partnerships, and 
strengthening local, state and national measurement systems to monitor 
children's well-being during a national crisis.
CONCLUSION: Enacting this research agenda will require engaging the community, 
especially youth, as equal partners in research co-design processes; centering 
anti-racist perspectives; adopting a "strengths-based" approach; and integrating 
young researchers who identify as Black, Indigenous, and People of Color 
(BIPOC). New collaborative funding models and investments in data infrastructure 
are also needed.

© 2021. The Author(s).

DOI: 10.1007/s10995-021-03207-2
PMCID: PMC8383722
PMID: 34427834 [Indexed for MEDLINE]


3092. BMC Public Health. 2021 Aug 23;21(1):1586. doi: 10.1186/s12889-021-11622-x.

Exploring the beliefs and perceptions of spending time in nature among U.S. 
youth.

Zamora AN(1), Waselewski ME(2), Frank AJ(3), Nawrocki JR(4), Hanson AR(5), Chang 
T(6)(7).

Author information:
(1)Department of Nutritional Sciences, University of Michigan School of Public 
Health, Ann Arbor, MI, USA.
(2)Department of Family Medicine, University of Michigan, 2800 Plymouth Road, 
Building 14- Room G128, Ann Arbor, MI, USA.
(3)Community High School, Ann Arbor, MI, USA.
(4)College of Literature, Science, and The Arts, University of Michigan, Ann 
Arbor, MI, USA.
(5)College of Engineering, University of Michigan, Ann Arbor, MI, USA.
(6)Department of Family Medicine, University of Michigan, 2800 Plymouth Road, 
Building 14- Room G128, Ann Arbor, MI, USA. tachang@med.umich.edu.
(7)Institute for Healthcare Policy and Innovation, University of Michigan, Ann 
Arbor, MI, USA. tachang@med.umich.edu.

PURPOSE: The prevalence of poor mental health continues to rise among youth; 
however, large-scale interventions to improve mental and physical health remain 
a public health challenge. Time spent in nature is associated with improved 
health among youth. This study aimed to assess youth experiences with nature and 
the self-perceived impact on their mental and physical health among a nationwide 
sample of US youth.
METHODS: In September 2020, five open-ended questions that aimed to assess 
perceptions regarding nature were posed to 1174 MyVoice youth, aged 14-24 years. 
Qualitative responses were analyzed using thematic analysis, and data were 
summarized using descriptive statistics.
RESULTS: The mean (SD) age of the 994 respondents (RR = 84.7%) was 18.9 (2.7) 
years; 47.4% were female, and 57.4% Non-Hispanic White. Among youth, many felt 
that spending time in nature positively impacted their mental health, with 51.6% 
mentioning that it made them "feel calm when I am out in nature"; 22.1% said 
that it relieved stress or "reduces my anxiety," and 17.1% felt that being in 
nature positively impacted their physical health and "makes me feel more active 
and in shape." However, 7.0% said it negatively impacted their health, such as 
"It makes me feel isolated." Most youth (87.8%) want to spend more time in 
nature, with 22% mentioning barriers (i.e., busy schedules, built environment, 
and COVID-19) impeding them from doing so.
CONCLUSIONS: Youth in our sample generally report feeling physically and 
mentally better when spending time in nature and want to spend more time in 
nature. Public health policies and practices that eliminate barriers and 
actively support time spent outside may be a feasible and acceptable practice to 
promote overall well-being among youth.

© 2021. The Author(s).

DOI: 10.1186/s12889-021-11622-x
PMCID: PMC8381719
PMID: 34425797 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no competing interests to 
report.


3093. Int J Psychiatry Med. 2022 Jul;57(4):323-337. doi: 10.1177/00912174211042695. 
Epub 2021 Aug 23.

COVID-19 and mental health: Anxiety disorders among immigrants due to COVID-19 
outbreak in South Korea.

Acharya SR(1), Moon DH(1), Chun JH(2), Shin YC(3).

Author information:
(1)Department of Public Health, Busan Medical Campus, Inje University, Busan, 
South Korea.
(2)Department of Preventive Medicine, Busan Medical Campus, Inje University, 
Busan, South Korea.
(3)Department of Occupational Health and Safety, Inje University, Gimhae, South 
Korea.

BACKGROUND: The COVID-19 pandemic has affected various facets of health. While 
mental health became a major concern during the COVID-19 outbreak, the impact on 
the migrants' mental health has still been neglected. The purpose of this study 
was to examine the COVID-19 outbreak's impact on the mental health of immigrants 
in South Korea.
METHODS: A total number of 386 immigrants in South Korea participated in this 
quantitative cross-sectional study. The standardized e-questionnaire, including 
the General Anxiety Disorder (GAD-7) scale, was used to measure the anxiety 
level. Logistic regression analysis was performed to find out the determinants 
of anxiety disorders among immigrants.
RESULTS: The prevalence of severe anxiety among immigrants was found to be 
47.2%. Female immigrants (28.6%) had a lower anxiety disorder than males 
(71.4%). Immigrants who were married, living alone, had a low income, had a 
history of health problems were suffered from moderate to severe anxiety. 
Immigrants who were unemployed (OR 2.302, 95% CI = 1.353-3.917) and lost their 
jobs due to the COVID-19 outbreak (OR 2.197, 95% CI = 1.312-3.678) have a higher 
anxiety disorder. Immigrants aged over 30 years were found to suffer from a high 
level of anxiety (OR 2.285, 95% CI = 1.184-4.410). Relief support from the 
government was significantly associated with anxiety disorder among immigrants 
(p < 0.01, OR = 3.151, 95% CI = 1.962-5.061).
CONCLUSION: With very limited studies on immigrants' mental health during the 
COVID-19 pandemic, this paper provides scientific research evidence of the 
COVID-19 outbreak's impact on the mental health of migrants. Our study has 
consequences for implementing integrated psychological interventions and health 
promotion strategies for the well-being of immigrants' mental health.

DOI: 10.1177/00912174211042695
PMCID: PMC9209883
PMID: 34425688 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of conflicting interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


3094. Sci Prog. 2021 Jul-Sep;104(3):368504211029793. doi: 10.1177/00368504211029793.

Effect of emergency declaration on mental health during the COVID-19 pandemic in 
Japan: A social network service-based difference-in-differences approach.

Eguchi A(1)(2), Yoneoka D(2)(3)(4), Shi S(5)(6), Tanoue Y(7), Kawashima T(8), 
Nomura S(2)(4), Makiyama K(9)(10), Uryu S(11), Sawada M(12), Kawamura Y(13), 
Takayanagi S(9)(14), Gilmour S(3), Miyata H(2).

Author information:
(1)Department of Sustainable Health Science, Center for Preventive Medical 
Sciences, Chiba University, Chiba, Japan.
(2)Department of Health Policy and Management, School of Medicine, Keio 
University, Tokyo, Japan.
(3)Graduate School of Public Health, St. Luke's International University, Tokyo, 
Japan.
(4)Department of Global Health Policy, Graduate School of Medicine, The 
University of Tokyo, Tokyo, Japan.
(5)Department of Systems Pharmacology, Graduate School of Medicine, The 
University of Tokyo, Tokyo, Japan.
(6)Laboratory for Synthetic Biology, RIKEN Center for Biosystems Dynamics 
Research, Osaka, Japan.
(7)Institute for Business and Finance, Waseda University, Tokyo Japan.
(8)Department of Mathematical and Computing Science, Tokyo Institute of 
Technology, Tokyo, Japan.
(9)HOXO-M Inc., Tokyo, Japan.
(10)Yahoo Japan Corporation, Tokyo.
(11)Center for Environmental Biology and Ecosystem Studies, National Institute 
for Environmental Studies, Japan.
(12)Institute of Economic Research, Hitotsubashi University, Tokyo, Japan.
(13)RIKEN Center for Sustainable Resource Science, Saitama, Japan.
(14)Uzabase, Inc., Tokyo, Japan.

Strong lockdowns to control COVID-19 pandemic have been enforced globally and 
strongly restricted social activities with consequent negative effects on mental 
health. Japan has effectively implemented a unique voluntary policy to control 
COVID-19, but the mental health impact of the policy has not been examined on a 
large scale. In this study, we examined the effect of the first declaration on 
the mental health of affected residents. We used population-level questionnaire 
data of 17,400 people living under the state of emergency and 9208 who were not 
through a social-networking-service app and applied a difference-in-differences 
regression model to estimate the causal effect of the declaration of the state 
of emergency on psychological wellbeing, stratified by job category. No 
statistically significant effect of the declaration was observed among all job 
categories. This suggests that residents' psychological situation has gradually 
changed, possibly influenced by other factors such as the surrounding 
environment, rather than the declaration itself. Given that Japan has a unique 
policy to control COVID-19 instead of a strict lockdown, our results showed the 
Japanese-style policy may serve as a form of harm reduction strategy, to control 
the epidemic with minimal psychological harm, and enable a policy that balances 
disease control and mental health. Caution is necessary that this study used 
self-reported data from a limited time period before and after the first 
declaration in April 2020.

DOI: 10.1177/00368504211029793
PMCID: PMC10450761
PMID: 34424792 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared the following potential 
conflicts of interest with respect to the research, authorship, and/or 
publication of this article: Hiroaki Miyata reports a grant from the Ministry of 
Health, Labour and Welfare of Japan, outside the submitted work. All other 
authors declare no competing interests.


3095. Psychol Rep. 2023 Feb;126(1):117-132. doi: 10.1177/00332941211040428. Epub 2021 
Aug 23.

Covid-19 Effects on Psychological Outcomes: How Do Gender Responses Differ?

Lathabhavan R(1).

Author information:
(1)Department of Technology Management, VIT University, Vellore, India.

The study aims at understanding the relationships between the fear of COVID-19 
and perceived stress, wellbeing, and life satisfaction. The study also analyses 
the role of gender on the relationship of fear of COVID-19 with these study 
variables. For this, a cross-sectional study was conducted among 1125 
participants in India, comprising 638 men and 487 women. Structural equation 
model was used to analyse the data. It was found that the fear of COVID-19 is 
positively related to perceived stress and negatively related to wellbeing and 
life satisfaction. It was also found that, these relationships are stronger 
among women than among men. The study shows the importance of psychiatric 
assessment during pandemic times and alerts policy makers and society in 
general, to take measures for ensuring mental health among people during times 
of crisis. Future studies can include longitudinal research for a comprehensive 
understanding of the psychological impacts of the pandemic.

DOI: 10.1177/00332941211040428
PMID: 34424087 [Indexed for MEDLINE]


3096. Work. 2021;69(4):1153-1161. doi: 10.3233/WOR-205276.

University professors' mental and physical well-being during the COVID-19 
pandemic and distance teaching.

Almhdawi KA(1), Obeidat D(1), Kanaan SF(2), Hajela N(3), Bsoul M(4), Arabiat 
A(5), Alazrai A(1), Jaber H(1), Alrabbaie H(1).

Author information:
(1)Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, 
Jordan University of Science and Technology, Jordan.
(2)Department of Rehabilitation Sciences-Physical Therapy, Faculty of Applied 
Medical Sciences, Jordan University of Science and Technology, Jordan.
(3)Department of Physical Therapy, California State University - Fresno, Fresno, 
CA, USA.
(4)Department of Computer Science and Applications, Faculty of Prince Al-Hussein 
Bin Abdullah II for Information Technology, The Hashemite University, Zarqa, 
Jordan.
(5)Family Medicine Specialist, Department of Family Medicine, The Jordanian 
Ministry of Health, Jordan.

BACKGROUND: Strict strategies including lockdowns and working from home were 
adopted worldwide during the coronavirus (COVID-19) pandemic. University 
professors suddenly shifted to work from home adopting distance teaching.
OBJECTIVES: This study aimed to investigate Health-Related Quality of Life 
(HRQoL) and its associated occupational and health factors during COVID-19 among 
university professors.
METHODS: A cross-sectional design targeted university professors of all majors 
in Jordan. The study self-administered survey included demographics and 
lifestyle data, 12-item Short Form health survey (SF-12), Depression Anxiety 
Stress Scale (DASS 21), professor' evaluation of distance teaching, Neck 
Disability Index (NDI), and International Physical Activity Questionnaire 
(IPAQ). Descriptive analyses were conducted to demonstrate primary outcome 
measures data. Factors associated with HRQoL were determined using a multiple 
variable linear regression analysis.
RESULTS: A total of 299 university professors successfully completed the study. 
Participants' SF-12 physical health component score was 74.08 (±18.5) and 65.74 
(±21.4) for mental health component. Higher depression, stress, neck disability, 
and weight change were significantly associated with lower HRQoL level. While 
higher satisfaction with distance teaching, health self-evaluation, and work 
load change were significantly associated with higher HRQoL level. The 
regression model explained 66.7%of the variance in professors' HRQoL 
(r2 = 0.667, F = 82.83, P < 0.001).
CONCLUSIONS: Jordanian university professors demonstrated good HRQoL and mental 
health levels during COVID-19 lockdown. Factors associated with professors' 
HRQoL should be considered by academic institutions in determining the best 
occupational setup of teaching activities in future pandemics.

DOI: 10.3233/WOR-205276
PMID: 34420997 [Indexed for MEDLINE]


3097. Trials. 2021 Aug 21;22(1):559. doi: 10.1186/s13063-021-05512-1.

Internet-based stress recovery intervention FOREST for healthcare staff amid 
COVID-19 pandemic: study protocol for a randomized controlled trial.

Jovarauskaite L(1), Dumarkaite A(2), Truskauskaite-Kuneviciene I(2), Jovaisiene 
I(3), Andersson G(4)(5), Kazlauskas E(2).

Author information:
(1)Center for Psychotraumatology, Institute of Psychology, Vilnius University, 
M. K. Ciurlionio str. 29, Vilnius, Lithuania. lina.jovarauskaite@fsf.vu.lt.
(2)Center for Psychotraumatology, Institute of Psychology, Vilnius University, 
M. K. Ciurlionio str. 29, Vilnius, Lithuania.
(3)Clinic of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, 
Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str. 21, LT-03101, 
Vilnius, Lithuania.
(4)Department of Behavioural Sciences and Learning, Department of Biomedical and 
Clinical Sciences, Linköping University, SE-581 83, Linköping, Sweden.
(5)Department of Clinical Neuroscience, Karolinska Institute, Tomtebodavägen 
18A, 171 77, Stockholm, Sweden.

BACKGROUND: The demand for care during the COVID-19 pandemic has affected the 
mental health of healthcare workers (HCWs), thus increasing the need for 
psychosocial support services. Internet-based interventions have previously been 
found to reduce occupational stress. The study aims to test the effects of an 
Internet-based stress recovery intervention-FOREST-among HCWs.
METHODS: A randomized controlled trial (RCT) parallel group design with three 
measurement points will be conducted to assess the efficacy of an Internet-based 
stress recovery intervention FOREST for nurses. The FOREST intervention is a 
6-week Internet-based CBT and mindfulness-based program which comprises of six 
modules: (1) Introduction, (2) Detachment (relaxation and sleep), (3) 
Distancing, (4) Mastery (challenge), (5) Control, and (6) Keeping the change 
alive. We will compare the intervention against a waiting list group at 
pre-test, post-test, and follow-up. Stress recovery, PTSD, complex PTSD, moral 
injury, the level of stress, depression, anxiety, and psychological well-being 
will be measured.
DISCUSSION: The study will contribute to the development of mental healthcare 
programs for the HCWs. Based on the outcomes of the study, the FOREST 
intervention can be further developed or offered to healthcare staff as a tool 
to cope with occupational stress.
TRIAL REGISTRATION: ClinicalTrials.gov NCT04817995 . Registered on 30 March 
2021.

© 2021. The Author(s).

DOI: 10.1186/s13063-021-05512-1
PMCID: PMC8380103
PMID: 34419114 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3098. Ann Gen Psychiatry. 2021 Aug 21;20(1):38. doi: 10.1186/s12991-021-00363-1.

Perceived stress and post-traumatic stress disorder symptoms among intensive 
care unit staff caring for severely ill coronavirus disease 2019 patients during 
the pandemic: a national study.

Kader N(1), Elhusein B(2), Chandrappa NSK(1), Nashwan AJ(3), Chandra P(4), Khan 
AW(1), Alabdulla M(1)(5).

Author information:
(1)Mental Health Service, Hamad Medical Corporation, 3050, Doha, Qatar.
(2)Mental Health Service, Hamad Medical Corporation, 3050, Doha, Qatar. 
Drbushra1@hotmail.com.
(3)Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar.
(4)Medical Research Centre, Hamad Medical Corporation, Doha, Qatar.
(5)College of Medicine, Qatar University, Doha, Qatar.

BACKGROUND: Intensive care unit (ICU) staff have faced unprecedented challenges 
during the coronavirus disease 2019 (COVID-19) pandemic, which could 
significantly affect their mental health and well-being. The present study aimed 
to investigate perceived stress and post-traumatic stress disorder (PTSD) 
symptoms reported by ICU staff working directly with COVID-19 patients.
METHODS: The Perceived Stress Scale was used to assess perceived stress, the 
PTSD Diagnostic Scale for the Diagnostic and Statistical Manual of Mental 
Disorders (5th edition) was used to determine PTSD symptoms, and a 
sociodemographic questionnaire was used to record different sociodemographic 
variables.
RESULTS: Altogether, 124 participants (57.2% of whom were men) were included in 
the analysis. The majority of participants perceived working in the ICU with 
COVID-19 patients as moderately to severely stressful. Moreover, 71.4% of 
doctors and 74.4% of nurses experienced moderate-to-severe perceived stress. The 
staff with previous ICU experience were less likely to have a probable diagnosis 
of PTSD than those without previous ICU experience.
CONCLUSIONS: Assessing perceived stress levels and PTSD among ICU staff may 
enhance our understanding of COVID-19-induced mental health challenges. Specific 
strategies to enhance ICU staff's mental well-being during the COVID-19 pandemic 
should be employed and monitored regularly. Interventions aimed at alleviating 
sources of anxiety in a high-stress environment may reduce the likelihood of 
developing PTSD.

© 2021. The Author(s).

DOI: 10.1186/s12991-021-00363-1
PMCID: PMC8379565
PMID: 34419094

Conflict of interest statement: The authors declare that they have no competing 
interests.


3099. Psychiatr Q. 2021 Dec;92(4):1759-1769. doi: 10.1007/s11126-021-09943-6. Epub 
2021 Aug 20.

The Impact of SARS-CoV-2 (COVID-19) and its Lockdown Measures on the Mental and 
Functional Health of Older Individuals.

Fastame MC(1), Mulas I(2), Putzu V(3), Asoni G(3), Viale D(3), Mameli I(3), Pau 
M(2).

Author information:
(1)Department of Pedagogy, Psychology, Philosophy, University of Cagliari, Via 
Is Mirrionis 1, Cagliari, Italy. chiara.fastame@unica.it.
(2)Department of Mechanical, Chemical and Materials Engineering, University of 
Cagliari, Piazza D'Armi, 09123, Cagliari, Italy.
(3)Center for Cognitive Disorders and Dementia, Geriatric Unit SS. Trinità 
Hospital, Cagliari, Italy.

The effect of the COVID-19 on the physical and mental health of Italian older 
individuals displaying signs of cognitive deterioration has not been deeply 
investigated. This longitudinal study examined the impact of COVID-19 lockdown 
measures on the psychological well-being and motor efficiency of a sample of 
Italian community-dwellers with and without cognitive decline. Forty-seven 
participants underwent instrumental gait analysis performed in ecological 
setting using wearable sensors, and completed a battery of tasks assessing 
cognitive functioning and psychological well-being, before and after the full 
lockdown due to the COVID-19 spreading. A series of Multivariate Analyses of 
Variance (MANOVAs) documented that the superior gait performance of the 
cognitively healthy participants exhibited before the COVID-19 spread, vanished 
when they were tested at the end of the lockdown period. Moreover, before the 
outbreak of the COVID-19, cognitively healthy participants and those with signs 
of cognitive decline reported similar levels of psychological well-being, 
whereas, after the lockdown, the former group reported better coping, emotional 
competencies, and general well-being than the participants displaying signs of 
cognitive decline. In conclusion, the full COVID-19 outbreak had a significant 
impact on the mental and motor functioning of older individuals with and without 
signs of cognitive deterioration living in Italy.

© 2021. The Author(s).

DOI: 10.1007/s11126-021-09943-6
PMCID: PMC8378840
PMID: 34417728 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no conflict of 
interest exists.


3100. Am Psychol. 2021 May-Jun;76(4):643-657. doi: 10.1037/amp0000764.

Risk and resilience among Asian American youth: Ramifications of discrimination 
and low authenticity in self-presentations.

Luthar SS(1), Ebbert AM(1), Kumar NL(1).

Author information:
(1)Authentic Connections.

This study examines adjustment patterns among a group neglected in developmental 
science-Asian American students in high-achieving schools. National reports have 
declared such schools to connote risk for elevated problems among teens. Asian 
American students are commonly referred to as model minorities, but little is 
known about adjustment issues within academically competitive settings, 
specifically. Guided by past research on culturally salient issues, multiple 
U.S. high schools were examined to (a) determine areas of relative strength 
versus weakness in adjustment of Asian Americans compared with Whites, and (b) 
more importantly, to illuminate salient within-group processes related to Asian 
Americans' well-being. Risk modifiers examined were perceptions of ethnic 
discrimination, parent perfectionism, internalized achievement pressure, 
authenticity in self-presentation, and closeness to school adults. Outcome 
variables included depression, anxiety, and isolation at school. Results 
demonstrated that Asian Americans fared better than Whites on anxiety and school 
isolation, but with low effect sizes. By contrast, they fared more poorly on 
almost all risk modifiers, with a large effect size on discrimination. 
Regression results showed that among Asian Americans the most consistent 
associations, across cohorts and outcomes, were for discrimination and 
authenticity. Findings underscore the need for greater recognition that 
discrimination could be inimical for students not typically thought of as 
vulnerable-Asian Americans in high-achieving schools; these issues are 
especially pressing in light of increased racism following coronavirus disease 
2019 (COVID-19). Results also suggest that feelings of inauthenticity could be a 
marker of generalized vulnerability to internalizing symptoms. Implications for 
future theory and interventions are discussed. (PsycInfo Database Record (c) 
2021 APA, all rights reserved).

DOI: 10.1037/amp0000764
PMID: 34410740 [Indexed for MEDLINE]


3101. Brain Behav. 2021 Sep;11(9):e02182. doi: 10.1002/brb3.2182. Epub 2021 Aug 19.

COVID-19-related fears and information frequency predict sleep behavior in 
bipolar disorder.

Fellendorf FT(1), Reininghaus EZ(1), Ratzenhofer M(1), Lenger M(1), Maget A(1), 
Platzer M(1), Bengesser SA(1), Birner A(1), Queissner R(1), Hamm C(1), Pilz 
R(1), Dalkner N(1).

Author information:
(1)Department of Psychiatry and Psychotherapeutic Medicine, Medical University 
of Graz, Graz, Austria.

INTRODUCTION: The coronavirus disease (COVID-19) pandemic and consequent 
restrictions including social distancing had a great impact on everyday life. To 
date, little is known about how the restrictions affected sleep, which is 
commonly disturbed in bipolar disorder (BD). The aim of this study was to 
elucidate sleep patterns during the pandemic in Austrian BD individuals.
METHODS: An online survey assessed sleep with the Pittsburgh Sleep Quality Index 
(PSQI) and COVID-19-associated attitudes, fears, and emotional distress of 20 BD 
individuals and 19 controls (HC) during the pandemic. The survey was conducted 
in April 2020, when very strict regulations were declared, and repeated in May, 
when they were loosened.
RESULTS: Individuals with BD reported overall poor sleep according to PSQI sum 
at both time points. Subjective sleep quality, sleep latency, daytime 
sleepiness, and PSQI sum were worse in individuals with BD than in HC. 
Individuals with BD informed themselves more frequently about pandemic-related 
topics. Higher information frequency and more COVID-19 fears (about the virus, 
own infection, contracting others) correlated with worse PSQI values. Regression 
models found in BD group that higher information frequency as well as higher 
COVID-19 fears in April predicted worse sleep characteristics in May, in 
particular subjective sleep quality, sleep duration, sleep efficiency, and 
daytime sleepiness.
CONCLUSION: As sufficient sleep duration and quality are essential for 
well-being and particularly important for vulnerable BD individuals, it is 
important that information about the pandemic is gathered to a reasonable extent 
and mental health professionals include COVID-19-related fears when currently 
treating BD.

© 2021 The Authors. Brain and Behavior published by Wiley Periodicals LLC.

DOI: 10.1002/brb3.2182
PMCID: PMC8420206
PMID: 34409763 [Indexed for MEDLINE]


3102. J Sleep Res. 2022 Apr;31(2):e13461. doi: 10.1111/jsr.13461. Epub 2021 Aug 18.

Being creative during lockdown: The relationship between creative potential and 
COVID-19-related psychological distress in narcolepsy type 1.

D'Anselmo A(1)(2), Agnoli S(2)(3), Filardi M(4)(5), Pizza F(1)(6), Mastria 
S(2)(3), Corazza GE(2)(3)(7), Plazzi G(6)(8).

Author information:
(1)Department of Biomedical and Neuromotor Sciences (DIBINEM), University of 
Bologna, Bologna, Italy.
(2)Marconi Institute for Creativity (MIC), Bologna, Italy.
(3)Department of Electrical, Electronic, and Information Engineering "Guglielmo 
Marconi", University of Bologna, Bologna, Italy.
(4)Department of Basic Medicine, Neuroscience and Sense Organs, University Aldo 
Moro Bari, Bari, Italy.
(5)Department of Clinical Research in Neurology of the University of Bari at 
"Pia Fondazione Card G. Panico" Hospital, Lecce, Italy.
(6)IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
(7)Université de Paris and Univ Gustave Eiffel, LaPEA, Boulogne-Billancourt, 
France.
(8)Department of Biomedical, Metabolic and Neural Sciences, University of Modena 
and Reggio Emilia, Modena, Italy.

The national lockdown imposed in several countries to counteract the coronavirus 
disease 2019 (COVID-19) pandemic led to an unprecedented situation with serious 
effects on mental health of the general population and of subjects affected by 
heterogeneous diseases. Considering the positive association between narcoleptic 
symptoms and creativity, we aimed at exploring the psychological distress 
associated with COVID-19 restrictions and its relationship with depressive 
symptoms and creativity in patients with narcolepsy type 1 (NT1). A total of 52 
patients with NT1 and 50 healthy controls, who completed a previous study on 
creativity, were contacted during the first lockdown period to complete an 
online survey evaluating psychological distress related to the COVID-19 
outbreak, sleep quality, narcolepsy and depressive symptoms, and creative 
abilities. The patients with NT1 showed an improvement in subjective sleepiness 
while controls reported worsening of sleep quality during the lockdown. 
Depression and NT1 symptom severity proved significant predictors of 
COVID-19-related distress. Creative performance, namely generative fluency, 
turned out to be a favourable moderator in the relationship between depression 
and patients' distress, reducing the detrimental effect of depression on the 
patients' wellbeing. On the contrary, creative originality proved to be a 
disadvantageous moderator in the relationship between NT1 symptom severity and 
the distress associated with this traumatic event indicating a higher 
vulnerability to developing COVID-19-related distress, particularly evident in 
patients displaying higher originality. Overall, these results highlight a 
crucial role of creativity in patients with NT1, suggesting that creative 
potential could be used as a protective factor against the development of 
distress associated with the lockdown.

© 2021 European Sleep Research Society.

DOI: 10.1111/jsr.13461
PMCID: PMC8420284
PMID: 34409666 [Indexed for MEDLINE]

Conflict of interest statement: GP participated in advisory board for Jazz 
pharmaceuticals, Bioprojet, Takeda and Idorsia outside the submitted work. The 
other authors have no potential financial conflict of interest to disclose.


3103. Cancer Rep (Hoboken). 2022 May;5(5):e1506. doi: 10.1002/cnr2.1506. Epub 2021 Aug 
18.

Psychosocial perspectives among cancer patients during the coronavirus disease 
2019 (COVID-19) crisis: An observational longitudinal study.

Turgeman I(1), Goshen-Lago T(1), Waldhorn I(1), Karov K(1), Groisman L(1), 
Reiner Benaim A(2), Almog R(3)(4), Halberthal M(3)(5), Ben-Aharon I(1)(3).

Author information:
(1)Division of Oncology, Rambam Health Care Center, Haifa, Israel.
(2)Clinical Epidemiology Unit, Rambam Health Care Campus, Haifa, Israel.
(3)Technion Integrated Cancer Center (TICC), Faculty of Medicine, Haifa, Israel.
(4)Epidemiology Department and Biobank, Rambam Health Care Campus, Haifa, 
Israel.
(5)General Management, Rambam Health Care Campus, Haifa, Israel.

BACKGROUND: The coronavirus disease 2019 (COVID-19) crisis and consequent 
changes in medical practice have engendered feelings of distress in diverse 
populations, potentially adversely affecting the psychological well-being of 
cancer patients.
AIM: The purpose of this observational longitudinal study was to evaluate 
psychosocial perspectives among patients with cancer on intravenous treatment 
during the COVID-19 pandemic.
METHODS AND RESULTS: The study recruited 164 cancer patients undergoing 
intravenous anti-neoplastic therapy in a tertiary cancer center. Psychosocial 
indices were assessed at two points in time, corresponding with the beginning of 
the first wave of COVID-19 pandemic in Israel (March 2020) and the time of 
easing of restrictions implemented to curtail spread of infection (May 2020). At 
Time 1 (T1), elevated COVID-19 distress levels (score 1 and 2 on 5-point scale) 
were observed in 44% of patients, and associated with pre-existing hypertension 
and lung disease in multivariate analyses but no demographic or cancer related 
factors. At Time 2 (T2), 10% had elevated anxiety and 24% depression as 
indicated by Hospital Anxiety and Depression Scale (HADS-A/D). COVID-19 distress 
at T1 was related to higher levels of HADS-A at T2 (Spearman 0.33 p < .01), but 
not HADS-D. Patients with breast cancer expressed greater COVID-19 distress 
compared with other cancer types (p < .01), while both HADS-A and HADS-D were 
highest for patients with GI cancer. Patient report of loneliness and decreased 
support from relatives were factors associated with HADS-A (p = .03 and p < .01, 
respectively), while HADS-D was not similarly related to the factors evaluated.
CONCLUSION: Patients with cancer undergoing intravenous treatment may be 
vulnerable to acute adverse psychological ramifications of COVID-19, 
specifically exhibiting high levels of anxiety. These appear unrelated to 
patient age or disease stage. Those with underlying comorbidities, breast cancer 
or reduced social support may be at higher risk.

© 2021 The Authors. Cancer Reports published by Wiley Periodicals LLC.

DOI: 10.1002/cnr2.1506
PMCID: PMC8420321
PMID: 34405968 [Indexed for MEDLINE]

Conflict of interest statement: Authors have no conflicts of interests to 
disclose.


3104. J Pediatr Psychol. 2021 Oct 18;46(10):1162-1171. doi: 10.1093/jpepsy/jsab089.

Parents' Self-Reported Psychological Impacts of COVID-19: Associations With 
Parental Burnout, Child Behavior, and Income.

Kerr ML(1), Fanning KA(1), Huynh T(1), Botto I(1), Kim CN(1).

Author information:
(1)University of Wisconsin-Madison, Madison, WI, USA.

OBJECTIVE: The current study investigates associations between parents' 
perceived coronavirus disease 2019 (COVID-19) psychological impacts and 
experiences of parental burnout, children's behaviors, and income.
METHODS: Data were collected during an online survey of parents' (N = 1000) 
pandemic experiences in April 2020. Parents (M = 36.5 years old, SD = 6.0; 82.1% 
White) with at least one child 12 years or younger reported on measures of 
mental health, perceived COVID-19 impacts, parental burnout, and perceived 
increases in children's stress and positive behaviors.
RESULTS: Path model analyses revealed that parents who perceived increased 
psychological impacts from COVID-19 reported higher levels of parental burnout, 
greater increases in children's stress behaviors, and less positive behavior in 
children. Additionally, there were significant indirect effects of parental 
burnout on the link between COVID-19 psychological impacts and children's 
behaviors. Finally, family income moderated associations between psychological 
impacts and children's stress behaviors, such that the association was stronger 
for families with lower income.
CONCLUSIONS: These results suggest parents' perceptions of how the COVID-19 
pandemic has impacted their mental health has implications for parent and child 
well-being, with stronger associations for low-income families. Given the 
potential for spillover effects between parents and children, promoting family 
well-being through practice and policy initiatives is crucial, including 
providing financial and caregiving relief for parents, and mental and behavioral 
health support for families.

© The Author(s) 2021. Published by Oxford University Press on behalf of the 
Society of Pediatric Psychology. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/jpepsy/jsab089
PMCID: PMC8436390
PMID: 34405885 [Indexed for MEDLINE]


3105. BMJ Open. 2021 Aug 17;11(8):e047498. doi: 10.1136/bmjopen-2020-047498.

Interventions for the well-being of healthcare workers during a pandemic or 
other crisis: scoping review.

Cairns P(1), Aitken G(2), Pope LM(3), Cecil JE(4), Cunningham KB(4), Ferguson 
J(5), Gibson Smith K(6), Gordon L(7)(8), Johnston P(6)(9), Laidlaw A(4), Scanlan 
GM(7), Tooman TR(4), Wakeling J(10), Walker K(6).

Author information:
(1)School of Medicine, University of St Andrews, St Andrews, UK 
pc74@st-andrews.ac.uk.
(2)Centre for Medical Education, The University of Edinburgh, Edinburgh, UK.
(3)General Practice and Primary Care, University of Glasgow, Glasgow, UK.
(4)School of Medicine, University of St Andrews, St Andrews, UK.
(5)NHS Education for Scotland, Glasgow, UK.
(6)Centre for Healthcare Education Research and Innovation, University of 
Aberdeen, Aberdeen, UK.
(7)Centre for Medical Education, University of Dundee, Dundee, UK.
(8)Monash Centre for the Scholarship in Health Education, Monash University, 
Clayton, Victoria, Australia.
(9)NHS Education for Scotland, Aberdeen, UK.
(10)NHS Education for Scotland, Edinburgh, UK.

OBJECTIVES: The aim of this scoping review was to identify pre-existing 
interventions to support the well-being of healthcare workers during a pandemic 
or other crisis and to assess the quality of these interventions.
DESIGN: Arksey and O'Malley's five-stage scoping review framework was used to 
identify the types of evidence available in the field of well-being 
interventions for healthcare workers during a pandemic. PubMed, PsycINFO, 
Embase, Scopus, Web of Science, CINAHL and ERIC databases were searched to find 
interventions for the well-being of doctors during pandemics. Owing to a lack of 
results, this search was expanded to all healthcare workers and to include any 
crisis. Databases were searched in June 2020 and again in October 2020.
INCLUSION/EXCLUSION CRITERIA: Articles were included that studied healthcare 
workers, reported an intervention design and were specifically designed for use 
during a pandemic or other crisis. Well-being was defined broadly and could 
include psychological, physical, social or educational interventions.
RESULTS: Searching produced 10 529 total academic references of which 2062 were 
duplicates. This left 8467 references. Of these, 16 met our inclusion criteria 
and were included in data extraction. During data extraction, three more papers 
were excluded. This left 13 papers to summarise and report. Of these 13 papers, 
6 were prospective studies and 7 were purely descriptive. None of the 
interventions were theoretically informed in their development and the quality 
of the evidence was generally deemed poor.
CONCLUSIONS: There are no high-quality, theory-based interventions for the 
well-being of healthcare workers during a pandemic or other crisis. Given that 
previous pandemics have been shown to have a negative effect on healthcare 
workers well-being, it is imperative this shortcoming is addressed. This scoping 
review highlights the need for high-quality, theory-based and evidence-based 
interventions for the well-being of healthcare workers during a pandemic.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2020-047498
PMCID: PMC8375449
PMID: 34404701 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3106. J Laryngol Otol. 2021 Oct;135(10):918-925. doi: 10.1017/S002221512100219X. Epub 
2021 Aug 18.

Impact on patients of the coronovirus disease 2019 pandemic and postponement of 
cochlear implant surgery: a qualitative study.

Abrar R(1), Bruce IA(1)(2), O'Driscoll M(1), Freeman S(1), de Estibariz UM(1), 
Stapleton E(1).

Author information:
(1)Department of Otolaryngology, The Richard Ramsden Centre for Hearing 
Implants, Manchester University Hospitals NHS Foundation Trust, Manchester 
Academic Health Science Centre, Manchester, UK.
(2)Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, 
Medicine and Health, The University of Manchester, Manchester, UK.

OBJECTIVE: This study aimed to explore the impact of the coronavirus disease 
2019 pandemic and postponement of elective surgical procedures for profoundly 
deaf patients awaiting cochlear implantation.
METHOD: Open-ended questionnaires were sent to all adult patients awaiting 
cochlear implantation surgery. Qualitative analysis was performed using a 
grounded theory approach.
RESULTS: Participants described a primarily negative impact on wellbeing from 
the surgery delay, expressing feelings of isolation or loneliness. Low mood, 
depression or hopelessness were commonly expressed by elderly participants; 
frustration and anxiety were described by young adults. Participants described a 
negative impact on their general daily life, describing difficulties 
communicating with facemasks and struggles with reliance on telephone 
communication because of social distancing. Despite these significant 
psychosocial challenges, only a minority described adaptive coping strategies.
DISCUSSION: Profoundly deaf patients may be at greater psychosocial risk because 
of unique challenges from their hearing disability. Our findings can be used to 
develop evidence-driven strategies to improve communication, wellbeing and 
quality of life.

DOI: 10.1017/S002221512100219X
PMID: 34404494 [Indexed for MEDLINE]


3107. Nurs Crit Care. 2022 May;27(3):419-428. doi: 10.1111/nicc.12697. Epub 2021 Aug 
16.

Patients' experience while transitioning from the intensive care unit to a ward.

Cuzco C(1)(2)(3)(4), Delgado-Hito P(2)(4)(5)(6), Marín Pérez R(5)(7), Núñez 
Delgado A(8), Romero-García M(2)(4)(5)(6), Martínez-Momblan MA(2)(4), Martínez 
Estalella G(1)(2)(4)(5), Carmona Delgado I(1), Nicolas JM(1)(3)(4), Castro 
P(1)(3)(4).

Author information:
(1)Medical Intensive Care Unit, Hospital Clinic, Barcelona, Spain.
(2)Department of Fundamental and Medical-Surgical Nursing, School of Nursing, 
Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, 
Spain.
(3)Biomedical Research Institute August Pi Sunyer (IDIBAPS), Hospital Clínic 
Barcelona, Barcelona, Spain.
(4)Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, 
Spain.
(5)Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute 
(IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
(6)International Research Project: Proyecto HU-CI, Madrid, Spain.
(7)Department of Cardiology, Hospital Bellvitge, L'Hospitalet de Llobregat, 
Barcelona, Spain.
(8)Intensive Care Unit, Hospital Vall d'Hebron, Barcelona, Spain.

BACKGROUND: Intensive care unit (ICU) patients can experience emotional distress 
and post-traumatic stress disorder when they leave the ICU, also referred to as 
post-intensive care syndrome. A deeper understanding of what patients go through 
and what they need while they are transitioning from the ICU to the general ward 
may provide input on how to strengthen patient-centred care and, ultimately, 
contribute to a positive experience.
AIM: To describe the patients' experience while transitioning from the ICU to a 
general ward.
DESIGN: A descriptive qualitative study.
METHOD: Data were gathered through in-depth interviews and analysed using a 
qualitative content analysis. The qualitative study was reported in accordance 
with the Consolidated Criteria for Reporting Qualitative Research guidelines.
FINDINGS: Forty-eight interviews were conducted. Impact on emotional well-being 
emerged as a main theme, comprising four categories with six subcategories.
CONCLUSION: Transition from the ICU can be a shock for the patient, leading to 
the emergence of a need for information, and an impact on emotional well-being 
that has to be planned for carefully and addressed prior to, during, and 
following transition from the ICU to the general ward.
RELEVANCE TO CLINICAL PRACTICE: It is essential that nurses understand patients' 
experiences during transfer, identifying needs and concerns to be able to 
develop and implement new practices such as ICU Liaison Nurse or Nurse Outreach 
for the follow-up of these patients, the inclusion of a consultant mental health 
nurse, and the application of patient empowerment during ICU discharge.

© 2021 The Authors. Nursing in Critical Care published by John Wiley & Sons Ltd 
on behalf of British Association of Critical Care Nurses.

DOI: 10.1111/nicc.12697
PMID: 34402141 [Indexed for MEDLINE]


3108. J Child Psychol Psychiatry. 2021 Aug;62(8):919-921. doi: 10.1111/jcpp.13489.

Editorial: COVID-19: lessons learned for suicide prevention.

Asarnow JR(1), Chung B(1)(2).

Author information:
(1)Department of Psychiatry and Biobehavioral Sciences, University of 
California, Los Angeles, CA, USA.
(2)Harbor-UCLA Medical Center, Los Angeles, CA, USA.

This editorial discusses lessons learned from the COVID-19 public health 
emergency as they relate to the prevention of suicide, the second leading cause 
of death in adolescents and young adults globally. Recognizing that COVID-19 
impact and response varied across nations, we offer a US perspective, addressing 
two questions: (a) what have we learned from this pandemic and mitigation 
strategies used to reduce cases of COVID-19 illness and deaths; and (b) how can 
our research advance knowledge and be advanced by work aimed at understanding 
the impact of this 'unusual' period? Provisional data indicate that during the 
pandemic and lockdown period, there were some declines in suicide rates for the 
total US population and no change in youth. However, data also indicate 
increases in reported suicidal ideation and behavior, mental health-related ED 
visits, and ED visits for suicidal ideation and behavior in youth. Heterogeneity 
of pandemic effects is noteworthy, with ethnic and racial minority populations 
suffering the most from COVID-19, COVID-19-related risk factors, and possibly 
suicide deaths. As vaccinations can prevent severe COVID-19 cases and deaths, we 
also have demonstrations of effective 'psychological inoculations' such as 
community-based interventions for reducing suicide attempts and deaths. During 
COVID-19, we mobilized to provide clinical care through telehealth and digital 
interventions. The challenge now is to continue to put our science to work to 
mitigate the adverse impacts of the pandemic on suicide and suicide risk 
factors, our children's mental health, and enhance mental health and well-being 
in our communities.

© 2021 Association for Child and Adolescent Mental Health.

DOI: 10.1111/jcpp.13489
PMID: 34402061 [Indexed for MEDLINE]


3109. Sch Psychol. 2021 Sep;36(5):277-284. doi: 10.1037/spq0000438. Epub 2021 Aug 16.

Social and psychological effects of the COVID-19 pandemic on middle-school 
students: Attendance options and changes over time.

Walters GD(1), Runell L(1), Kremser J(1).

Author information:
(1)Department of Criminal Justice.

The purpose of this study was to determine whether restrictions put in place 
during the COVID-19 pandemic affected the social and psychological well-being of 
early adolescent schoolchildren. Participants were 309 youth (51% female, 
average age = 12.38 years) enrolled in the sixth, seventh, or eighth grades of a 
single middle school located in northeastern Pennsylvania, a state that took a 
moderately proactive approach to the pandemic. Employing a cross-sectional 
design, students in three instructional conditions (100% in-person, hybrid, 100% 
online) were compared on nine outcome measures (perceived parental support, 
perceived parental knowledge, peer deviance, neutralization, cognitive 
impulsivity, depression, delinquency, bullying victimization, and bullying 
perpetration). There were no significant between-groups differences, although 
there was a borderline significant effect for depression (100% online > 100% 
in-person, p = .06). A second set of analyses employed a longitudinal design and 
compared 174 children who completed the test battery in November 2019, 3 months 
before the start of the pandemic, and then again in November 2020, 9 months 
after the start of the pandemic. Three out of nine outcomes displayed 
significant change: A small reduction in parental support and modest increments 
in neutralization beliefs and cognitive impulsivity. Although there were no 
statistically significant differences between the three instructional conditions 
and only a handful of relatively small and predictable longitudinal changes 
between November 2019 and November 2020, there were a fair number of individual 
students who experienced moderate (≥ 50%) increases in depression (17.6%), 
cognitive impulsivity (15.8%), and bullying victimization (11.7%). (PsycInfo 
Database Record (c) 2021 APA, all rights reserved).

DOI: 10.1037/spq0000438
PMID: 34398634 [Indexed for MEDLINE]


3110. Cureus. 2021 Jul 13;13(7):e16369. doi: 10.7759/cureus.16369. eCollection 2021 
Jul.

Physician Wellness Measures and Clinical Performance on a Critically Ill 
Simulated Patient: Does a Lack of Well-Being Impact Patient Care?

Peng C(1), Lung L(2), Grade M(3), Wong N(4)(1)(5), Smith-Coggins R(1).

Author information:
(1)Emergency Medicine, Stanford School of Medicine, Palo Alto, USA.
(2)Emergency Medicine, Kaiser San Rafael Hospital, San Rafael, USA.
(3)Emergency Department, University of California San Francisco, San Francisco, 
USA.
(4)Emergency Medicine, VA Palo Alto Health Care System, Palo Alto, USA.
(5)Simulation, SimLEARN, Palo Alto, USA.

BACKGROUND/OBJECTIVE: Burnout is common among resident physicians, which has the 
potential to translate into diagnostic and management errors. Our study 
investigates the relationship between sleepiness, depression, anxiety, burnout, 
and lack of professional fulfillment with clinical performance during a 
critically ill patient simulation. Methods/Approach: Emergency medicine 
residents were recruited to participate in a high-fidelity simulation case of a 
critically ill patient. A survey with validated wellbeing measures (National 
Institutes of Health Patient-Reported Outcomes Measurement Information System 
(NIH PROMIS), Linzer burnout measure, and professional fulfillment index) was 
administered prior to the simulation. Each encounter was video-recorded and 
analyzed by two blinded raters based on a binary critical-actions checklist. 
Time-to-intubation, management errors, and misdiagnosis rates were assessed.
RESULTS: Twenty residents participated, with most subjects endorsing sleepiness 
(70%) and less than half reporting depression (40%) and anxiety (45%). Burnout 
was identified to be in 50% of participants by the Linzer measure and 85% by the 
professional fulfillment index. No significant difference was found between mean 
performance scores in sleepy, depressed, and anxious cohorts in comparison to 
groups without those symptoms. Similarly, burnout and professional fulfillment 
did not yield any significant difference, nor did comparisons with time to 
intubation, management errors, and frequency of misdiagnosis.
CONCLUSION: Resident burnout, depression, anxiety, sleepiness, and lack of 
professional fulfillment did not appear to have a measurable impact on clinical 
performance in managing a critically ill patient. There is no evidence from this 
study that the lack of resident physician well-being adversely impacts patient 
care by increasing errors in management or misdiagnoses during this 
high-fidelity simulation.

Copyright © 2021, Peng et al.

DOI: 10.7759/cureus.16369
PMCID: PMC8360316
PMID: 34395143

Conflict of interest statement: The authors have declared that no competing 
interests exist.


3111. Trends Psychiatry Psychother. 2022 Feb 17;44:e20210250. doi: 
10.47626/2237-6089-2021-0250.

Well-being at work, productivity, and coping with stress during the COVID-19 
pandemic.

Loreto BBL(1), de Azevedo SC(1), da Silva AG(2), Malloy-Diniz LF(3), Ornel F(4), 
Trés LMAM(5), Kessler FHP(4), de Castro MN(6).

Author information:
(1)Serviço de Psiquiatria, Hospital de Clínicas de Porto Alegre (HCPA), 
Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
(2)Universidade do Porto, Porto, Portugal. Associação Brasileira de Psiquiatria 
(ABP), Rio de Janeiro, RJ, Brazil. Asociación Psiquiátrica de América Latina 
(APAL), Brasília, DF, Brazil.
(3)Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil. 
Fundação Mineira de Educação e Cultura, Belo Horizonte, MG, Brazil. Associação 
Brasileira de Impulsividade e Patologia Dual, Brasília, DF, Brazil.
(4)Centro de Pesquisa em Álcool e Drogas, HCPA, UFRGS, Porto Alegre, RS, Brazil. 
Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, 
Departamento de Psiquiatria e Medicina Legal, Faculdade de Medicina, UFRGS, 
Porto Alegre, RS, Brazil.
(5)Universidade do Porto, Porto, Portugal.
(6)Serviço de Psiquiatria de Adições e Forense, HCPA, UFRGS, Porto Alegre, RS, 
Brazil.

This study aims to analyze the mechanisms through which the coronavirus disease 
(COVID-19) pandemic impacts on well-being at work and on productivity. The 
secondary objective is to identify stress management strategies for the work 
environment during the pandemic. This is an integrative review. Phase 1 
consisted of searches of open access electronic databases (MEDLINE, SciELO, 
Bireme, and LILACS) for papers published in 2020 addressing mental health, work, 
and pandemics. Phase 2 consisted of selecting literature recommended by 
specialists in occupational psychiatry and positive psychology. These materials 
were read and critically analyzed. Forty references were included in the 
literature review. The articles reviewed were classified into the following 
categories: articles concerning work relationships in Brazil; articles 
describing the impact of pandemics on mental health and work; articles focusing 
on the work of health professionals during pandemics; articles about well-being 
at work; and papers proposing strategies to improve well-being and productivity 
and to promote mental health. The COVID-19 pandemic can have a significant 
impact on workers' mental health and productivity. Most professionals face a 
need to adapt to changes, which can decrease their feeling of well-being. 
Consequently, strategies to promote well-being and mental health in the work 
environment should be a priority. Work routines were modified after the COVID-19 
pandemic set in and assessing these changes is essential to maintain workers' 
mental health. By so doing, it is possible to promote general well-being and 
post-traumatic recovery and reduce stress levels.

DOI: 10.47626/2237-6089-2021-0250
PMCID: PMC10039719
PMID: 34392664 [Indexed for MEDLINE]

Conflict of interest statement: No conflicts of interest declared concerning the 
publication of this article.


3112. Turk Psikiyatri Derg. 2021 Summer;32(2):75-86. doi: 10.5080/u25964.

Burnout in Healthcare Professionals During the Covid-19 Pandemic in a Tertiary 
Care University Hospital: Evaluation of the Need for Psychological Support.

[Article in English, Turkish]

Önen Sertöz Ö, Kuman Tunçel Ö, Sertöz N, Hepdurgun C, İşman Haznedaroğlu D, Bor 
C.

OBJECTIVE: Anxiety, stress and burnout are observed in healthcare workers during 
the Covid-19 pandemic. This study aimed to determine the levels of anxiety and 
burnout and related risk factors in the healthcare workers and assistant 
personnel at a tertiary referral university hospital.
METHOD: Hospital Anxiety Depression Scale (HADS), Maslach Burnout Inventory 
(MBI) and a sociodemographic questionnaire were delivered on-line to all 
employees of our hospital. 683 individuals were to the study who completed and 
returned the forms between April 15-30, 2020.
RESULTS: Stress, depression and anxiety levels were significantly higher in 
nurses. Emotional burnout and depersonalization symptoms were higher and 
personal accomplishment scores were lower in resident physicians and nurses in 
comparison to the other groups. Being single, having a child and living away 
from home were factors underlying the burnout severity. Frontline work in the 
Covid-19 clinics did not affect the levels of anxiety, stress and depression. On 
the basis of the cut off points of the HADS scores; anxiety disorder (OR: 7.19) 
and depression (OR 3.43) were the most relevant risk factors for emotional 
exhaustion. Anxiety disorder was also the main risk factor for 
depersonalization. Depersonalization was 2.7-fold more among the nurses 
complaining of being overworked. Social support from the work environment and 
the family was protective against depersonalization.
CONCLUSION: Covid-19 pandemic has adversely affected the wellbeing of healthcare 
workers. The presence of depression and anxiety increased the risk of burnout. 
Social support can be expected to protect against burnout. It is, therefore, of 
great importance to implement urgently effective psychosocial and organizational 
interventions in order to protect the mental health of healthcare workers and to 
prevent burnout.

DOI: 10.5080/u25964
PMID: 34392504 [Indexed for MEDLINE]


3113. J Neurol Sci. 2021 Sep 15;428:117608. doi: 10.1016/j.jns.2021.117608. Epub 2021 
Aug 4.

Emerging potential mechanisms and predispositions to the neurological 
manifestations of COVID-19.

Jesuthasan A(1), Massey F(2), Manji H(3), Zandi MS(3), Wiethoff S(4).

Author information:
(1)University College Hospital, University College London Hospitals NHS 
Foundation Trust, London, UK. Electronic address: a.jesuthasan@nhs.net.
(2)University College London Medical School, Gower Street, London, UK.
(3)National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
(4)UCL Institute of Neurology, Queen Square, London, UK; Klinik für Neurologie 
mit Institut für Translationale Neurologie, Albert Schweitzer Campus 1, Gebäude 
A1, D-48149 Münster, Germany.

A spectrum of neurological disease associated with COVID-19 is becoming 
increasingly apparent. However, the mechanisms behind these manifestations 
remain poorly understood, significantly hindering their management. The present 
review subsequently attempts to address the evolving molecular, cellular and 
systemic mechanisms of NeuroCOVID, which we have classified as the acute and 
long-term neurological effects of COVID-19. We place particular emphasis on 
cerebrovascular, demyelinating and encephalitic presentations, which have been 
reported. Several mechanisms are presented, especially the involvement of a 
"cytokine storm". We explore the genetic and demographic factors that may 
predispose individuals to NeuroCOVID. The increasingly evident long-term 
neurological effects are also presented, including the impact of the virus on 
cognition, autonomic function and mental wellbeing, which represent an impending 
burden on already stretched healthcare services. We subsequently reinforce the 
need for cautious surveillance, especially for those with predisposing factors, 
with effective clinical phenotyping, appropriate investigation and, if possible, 
prompt treatment. This will be imperative to prevent downstream neurological 
sequelae, including those related to the long COVID phenotypes that are being 
increasingly recognised.

Copyright © 2021 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jns.2021.117608
PMCID: PMC8332920
PMID: 34391037 [Indexed for MEDLINE]

Conflict of interest statement: MSZ has received honoraria for lecturing from 
Eisai and UCB Pharma. SW – Declarations of interest: none. AJ – Declarations of 
interest: none. FM – Declarations of interest: none. HM – Declarations of 
interest: none.


3114. J Epidemiol Community Health. 2022 Mar;76(3):285-292. doi: 
10.1136/jech-2021-216661. Epub 2021 Aug 13.

Prospective association between receipt of the economic impact payment and 
mental health outcomes.

Tsai J(1)(2)(3), Huang M(4), Rajan SS(5), Elbogen EB(2)(6).

Author information:
(1)School of Public Health, The University of Texas Health Science Center at 
Houston, Houston, Texas, USA Jack.Tsai@uth.tmc.edu.
(2)National Center on Homelessness Among Veterans, U.S. Department of Veterans 
Affairs, Tampa, Florida, USA.
(3)Department of Psychiatry and Behavioral Sciences, Duke University School of 
Medicine, Durham, North Carolina, USA.
(4)Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, 
USA.
(5)School of Public Health, The University of Texas Health Science Center at 
Houston, Houston, Texas, USA.
(6)Department of Psychology, University of Hartford, West Hartford, Connecticut, 
USA.

BACKGROUND: The Coronavirus Aid, Relief, and Economic Security Act of 2020 
provided 'economic impact payments' (EIPs) of $1200 to US adults with annual 
personal income of $75 000 or less. This study examined the prospective 
association between EIP receipt and mental health outcomes.
METHODS: A nationally representative sample of 3169 middle-income and low-income 
US adults completed a baseline assessment of their health and well-being in 
May-June 2020 and a 3-month follow-up assessment during the period of the 
COVID-19 pandemic when EIPs were distributed.
RESULTS: Controlling for sociodemographic characteristics, EIP recipients had 
higher odds of reporting a positive COVID-19 test, endorsing a history of 
post-traumatic stress disorder and reporting any illicit drug use in the past 
month than participants who did not receive EIP. Participants who did not 
receive EIP were more likely to report a history of anxiety disorder or alcohol 
use disorder and recent suicidal ideation than EIP recipients. There was no 
association between EIP receipt and financial distress, although over one-third 
to over half of EIP recipients were not employed at baseline. Between baseline 
and 3-month follow-up, receipt of EIP was significantly associated with reduced 
medical conditions and alcohol use problems, but increased depression, suicidal 
ideation and COVID-19 era-related stress.
CONCLUSION: The EIP provided a brief income stimulus to many adults in need but 
was not associated with improvements in financial distress or mental health 
among middle-income and low-income recipients. Long-term income security and 
employment may be more important to improving and sustaining positive mental 
health outcomes.

© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and 
permissions. Published by BMJ.

DOI: 10.1136/jech-2021-216661
PMID: 34389662 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3115. BMJ Open. 2021 Aug 13;11(8):e052383. doi: 10.1136/bmjopen-2021-052383.

Association between contact with a general practitioner and depressive symptoms 
during the COVID-19 pandemic and lockdown: a large community-based study in 
Hangzhou, China.

Yang F(1)(2), Lin W(1)(3), Frost E(4), Min Y(4)(5), Xu X(1)(2), Wang X(1)(2), Li 
W(1)(6), Leng Y(7), Zhao X(1)(2), He W(1)(2), Hsing AW(8)(5)(9), Zhu S(10)(2).

Author information:
(1)Chronic Disease Research Institute, The Children's Hospital, and National 
Clinical Research Center for Child Health, School of Public Health, School of 
Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
(2)Department of Nutrition and Food Hygiene,School of Public Health, Zhejiang 
University, Hangzhou, China.
(3)Department of Social Medicine and Health Administration,School of Public 
Health, Zhejiang University, Hangzhou, Zhejiang, China.
(4)Stanford Prevention Research Center, Department of Medicine, Stanford 
University School of Medicine, Stanford, California, USA.
(5)Department of Epidemiology and Population Health, Stanford University School 
of Medicine, Stanford, California, USA.
(6)Department of Hospital Management, Zhejiang University, Hangzhou, Zhejiang, 
China.
(7)Department of Psychiatry and Behavioral Sciences, University of California, 
San Francisco, California, USA.
(8)Stanford Prevention Research Center, Department of Medicine, Stanford 
University School of Medicine, Stanford, California, USA annhsing@stanford.ed 
zsk@zju.edu.cn.
(9)Stanford Cancer Institute, Stanford University School of Medicine, Stanford, 
California, USA.
(10)Chronic Disease Research Institute, The Children's Hospital, and National 
Clinical Research Center for Child Health, School of Public Health, School of 
Medicine, Zhejiang University, Hangzhou, Zhejiang, China annhsing@stanford.ed 
zsk@zju.edu.cn.

OBJECTIVES: To determine the association of general practitioner (GP) contact 
with depressive symptoms during the COVID-19 pandemic and lockdown in China.
DESIGN: In April 2020, a follow-up survey was conducted on the basis of a 
baseline survey conducted between October 2018 and May 2019.
SETTING: The survey was embedded in the Stanford Wellness Living 
Laboratory-China (WELL China) study, an ongoing prospective community-based 
cohort study during 2018-2019.
PARTICIPANTS: The survey was conducted by telephone interview among 4144 adult 
urban residents participating in the WELL China study at baseline. We collected 
information on sociodemographic characteristics, depressive symptoms and GP 
contact during the lockdown period (February to March 2020).
PRIMARY AND SECONDARY OUTCOME MEASURES: Depressive symptoms were measured using 
the WHO-Five Well-being Index, comprising five questionnaire items that briefly 
indicate psychological well-being. Logistic regression models were applied to 
assess the association between GP contact and depressive symptoms.
RESULTS: In total, 3356 participants responded to the survey; 203 were excluded 
owing to missing data on depressive symptoms, leaving 3153 participants in the 
present study. During lockdown, 449 participants had GP contact. GP contact was 
significantly negatively associated with prevalent depressive symptoms (OR, 
0.67; 95% CI 0.51 to 0.89; p<0.01) and incident depressive symptoms (OR 0.68; 
95% CI 0.51 to 0.93; p<0.05). Stratified analysis showed a significant negative 
association between depressive symptoms and GP contact in individuals who were 
45-64 years old (p<0.01), had a middle or high education (p<0.01) and had 
self-reported non-communicable diseases (p<0.05).
CONCLUSIONS: Contact with GPs during the COVID-19 pandemic and lockdowns may 
have a negative association with depressive symptoms in community-dwelling 
populations. Given the possibility of further surges in COVID-19 infections, 
GPs' contact in the community should be enhanced.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-052383
PMCID: PMC8366284
PMID: 34389582 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3116. J Atten Disord. 2022 Apr;26(6):902-914. doi: 10.1177/10870547211027640. Epub 
2021 Aug 13.

Distance Learning in Children with and without ADHD: A Case-control Study during 
the COVID-19 Pandemic.

Tessarollo V(1), Scarpellini F(2), Costantino I(1), Cartabia M(2), Canevini 
MP(1), Bonati M(2).

Author information:
(1)Università degli Studi di Milano, Milan, Italy.
(2)Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.

OBJECTIVE: This research involved the parents of ADHD students to explore how 
their children coped with online distance learning during COVID-19 pandemic and 
what implications this schooling method had on their emotional and behavioral 
well-being.
METHOD: Data were collected during lockdown using an online questionnaire 
addressed to 100 mothers and were compared with 184 matched controls from a 
national survey launched in the same period.
RESULTS: Attention span, spontaneous commitment, and autonomy in distance 
learning was found to be more limited in ADHD group. Compared to controls, 21.7% 
of ADHD students were not assessed and 40.9% did not receive grades. Behavioral 
changes were reported in both groups (64.2%), represented mainly by 
restlessness, aggressiveness, and anxiety.
CONCLUSION: Distance education increases academic difficulties, especially in 
ADHD pupils. The effects of lockdown should be adequately evaluated upon school 
reopening and appropriate recovery interventions should be planned.

DOI: 10.1177/10870547211027640
PMID: 34388941 [Indexed for MEDLINE]


3117. Asian J Psychiatr. 2021 Oct;64:102801. doi: 10.1016/j.ajp.2021.102801. Epub 2021 
Aug 4.

Children of parents with mental illness in the COVID-19pandemic: A 
cross-sectional survey in China.

Zhou T(1), Chen W(1), Liu X(2), Wu T(1), Wen L(3), Yang X(4), Hou Z(5), Chen 
B(6), Zhang T(7), Zhang C(8), Xie C(1), Zhou X(9), Wang L(10), Hua J(11), Tang 
Q(12), Zhao M(1), Hong X(6), Liu W(7), Du C(1), Li Y(2), Ma H(1), Guan L(13), Yu 
X(14).

Author information:
(1)Peking University Sixth Hospital, Peking University Institute of Mental 
Health, T++he Key Laboratory of the Ministry of Health (Peking University), 
National Clinical Research Center for Mental Disorders, Beijing, China.
(2)Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong 
University of Science & Technology, Wuhan, Hubei, China.
(3)Zigong Fifth People's Hospital, Zigong, Sichuan, China.
(4)The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, 
Sichuan, China.
(5)Zaozhuang Mental Health Center, Zaozhuang, Shandong, China.
(6)Xiamen City Xianyue Hospital, Xiamen, Fujian, China.
(7)Taiyuan Psychiatric Hospital, Shanxi Mental Health Center, Taiyuan, Shanxi, 
China.
(8)Beijing Fangshan District Psychiatric Hospital, Beijing, China.
(9)Wuhan Hanyang District Disease Control and Prevention Center, Wuhan, Hubei, 
China.
(10)Wuhan Xinzhou District Psychiatric Hospital, Wuhan, Hubei, China.
(11)Zigong Yantan District Mental Health Center, Zigong, Sichuan, China.
(12)Psychiatric Hospital of Jiangyou, Jiangyou, Sichuan, China.
(13)Peking University Sixth Hospital, Peking University Institute of Mental 
Health, T++he Key Laboratory of the Ministry of Health (Peking University), 
National Clinical Research Center for Mental Disorders, Beijing, China. 
Electronic address: guanlili@bjmu.edu.cn.
(14)Peking University Sixth Hospital, Peking University Institute of Mental 
Health, T++he Key Laboratory of the Ministry of Health (Peking University), 
National Clinical Research Center for Mental Disorders, Beijing, China. 
Electronic address: yuxin@bjmu.edu.cn.

OBJECTIVE: Children of parents with mental illness (COPMI) are vulnerable during 
the COVID-19 pandemic. The study aimed to assess the psychosocial impacts of the 
pandemic and identify potential factors influencing their mental health.
METHOD: 665 COPMI from six sites including Wuhan in China were enrolled. COPMI's 
mental health and the impacts of COVID-19 were assessed by an online survey. 
Univariate and multivariate analyses were performed to examine the association 
between impact factors and participants' mental health.
RESULTS: 16.1 % of participants were in abnormal range of mental health, with 
interpersonal relationship being the most common problem. 48.6 % of participants 
reported quite worried about the epidemic. All aspects of adverse effects of 
COVID-19 were more prevalent among COPMI in Wuhan than in other sites. Concerns 
about COVID-19 (OR = 1.7, p = 0.02), decreased family income (OR = 2.0, 
p = 0.02), being physically abused (OR = 2.1, p = 0.04), witnessing family 
members being physically abused (OR = 2.0, p = 0.03), and needs for promoting 
family members' mental health (OR = 2.2, p < 0.01) were independent risk factors 
for participants' mental health.
CONCLUSION: The findings raise our awareness of the impacts of COVID-19 pandemic 
on the wellbeing of COPMI. Multifaceted psychosocial support for COPMI is 
urgently needed to support them live through the pandemic.

Copyright © 2021 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.ajp.2021.102801
PMCID: PMC8419216
PMID: 34388668 [Indexed for MEDLINE]

Conflict of interest statement: We declared that there are no conflicts of 
interest in this work.


3118. Psychiatry Res. 2021 Oct;304:114138. doi: 10.1016/j.psychres.2021.114138. Epub 
2021 Jul 25.

Longitudinal analysis of the UK COVID-19 Psychological Wellbeing Study: 
Trajectories of anxiety, depression and COVID-19-related stress symptomology.

McPherson KE(1), McAloney-Kocaman K(2), McGlinchey E(3), Faeth P(4), Armour 
C(5).

Author information:
(1)Department of Psychology, Glasgow Caledonian University, Cowcaddens Road, 
Glasgow G4 0BA, United Kingdom. Electronic address: Kerri.mcpherson@gcu.ac.uk.
(2)Department of Psychology, Glasgow Caledonian University, Cowcaddens Road, 
Glasgow G4 0BA, United Kingdom. Electronic address: kareena.mcaloney@gcu.ac.uk.
(3)Stress Trauma and Related Conditions (STARC) Research Lab, School of 
Psychology, Queen's University Belfast, BT9 5BN, United Kingdom. Electronic 
address: E.McGlinchey@qub.ac.uk.
(4)Department of Psychology, Glasgow Caledonian University, Cowcaddens Road, 
Glasgow G4 0BA, United Kingdom. Electronic address: pia.faeth@gcu.ac.uk.
(5)Stress Trauma and Related Conditions (STARC) Research Lab, School of 
Psychology, Queen's University Belfast, BT9 5BN, United Kingdom. Electronic 
address: c.armour@qub.ac.uk.

COVID-19 has had a negative impact on the mental health of individuals. The aim 
of the COVID-19 Psychological Wellbeing Study was to identify trajectories of 
anxiety, depression and COVID-19-related traumatic stress (CV19TS) symptomology 
during the first UK national lockdown. We also sought to explore risk and 
protective factors. The study was a longitudinal, three-wave survey of UK adults 
conducted online. Analysis used growth mixture modelling and logistic 
regressions. Data was collected from 1958 adults. A robust 4-class model for 
anxiety, depression, and CV19TS symptomology distinguished participants in 
relation to the severity and stability of symptomology. Classes described low 
and stable and high and stable symptomology, and symptomology that improved or 
declined across the study period. Several risk and protection factors were 
identified as predicting membership of classes (e.g., mental health factors, 
sociodemographic factors and COVID-19 worries). This study reports trajectories 
describing a differential impact of COVID-19 on the mental health of UK adults. 
Some adults experienced psychological distress throughout, some were more 
vulnerable in the early weeks, and for others vulnerability was delayed. These 
findings emphasise the need for appropriate mental health support interventions 
to promote improved outcomes in the COVID-19 recovery phase and future 
pandemics.

Copyright © 2021. Published by Elsevier B.V.

DOI: 10.1016/j.psychres.2021.114138
PMCID: PMC8424320
PMID: 34388511 [Indexed for MEDLINE]

Conflict of interest statement: None.


3119. Sleep Med. 2021 Sep;85:259-267. doi: 10.1016/j.sleep.2021.07.033. Epub 2021 Jul 
24.

COVID-19 babies: auto-videosomnography and parent reports of infant sleep, 
screen time, and parent well-being in 2019 vs 2020.

Kahn M(1), Barnett N(2), Glazer A(2), Gradisar M(3).

Author information:
(1)Flinders University, College of Education, Psychology and Social Work, SA, 
Australia. Electronic address: michal.kahn@flinders.edu.au.
(2)Nanit, Research Department, New York, USA.
(3)Flinders University, College of Education, Psychology and Social Work, SA, 
Australia.

OBJECTIVE: The COVID-19 pandemic has profoundly impacted families, yet studies 
on its effects on infants and their parents have thus far been sparse and based 
mostly on retrospective parent reporting. This study aimed to prospectively 
evaluate the impact of COVID-19 living conditions on infant and parent sleep, as 
well as infant screen exposure, parent daytime sleepiness, and parent depression 
levels, using multi-method assessment.
METHODS: Infant and parent data collected in 2020 were compared with a matched 
cohort collected in 2019. The total sample included 1518 US infants aged 1-18 
months (M = 8.5, SD = 4.6; 54% boys). Auto-videosomnography metrics were 
obtained from the 14-day period prior to survey completion (number of analyzed 
nights: M = 12.11 SD = 2.66 in the 2019 cohort; and M = 11.91 SD = 2.41 in the 
2020 cohort). Parents completed online questionnaires regarding their infant's 
sleep and screen exposure, as well as their own sleep quality, daytime 
sleepiness, and depression levels.
RESULTS: Compared to 2019, infants in 2020 slept ∼40 min more per night on 
average, as indicated by auto-videosomnography. Infants additionally had earlier 
sleep timing, and increased parent-reported sleep-onset latency and nocturnal 
wakefulness. Infant screen time rose by 18.3 min per day for older infants, but 
remained stable for younger infants. Parents reported lower daytime sleepiness 
and higher depression symptomology during 2020, whereas no change was apparent 
in their sleep quality ratings.
CONCLUSIONS: Restricted living conditions during COVID-19 in the USA led to 
increased infant screen exposure and parental depression, but also to increased 
infant sleep duration and reduced parent sleepiness. Future research is needed 
to examine the mechanistic pathways through which COVID-19 impacted on infant 
and parent well-being.

Copyright © 2021 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.sleep.2021.07.033
PMCID: PMC8418313
PMID: 34388504 [Indexed for MEDLINE]

Conflict of interest statement: This work was supported by Nanit (Research grant 
to Flinders University). The ICMJE Uniform Disclosure Form for Potential 
Conflicts of Interest associated with this article can be viewed by clicking on 
the following link: https://doi.org/10.1016/j.sleep.2021.07.033.


3120. J Med Virol. 2022 Jan;94(1):110-118. doi: 10.1002/jmv.27272. Epub 2021 Aug 23.

Impact of COVID-19 on the mental health in a cohort of Italian rehabilitation 
healthcare workers.

Farì G(1), de Sire A(2), Giorgio V(1), Rizzo L(1), Bruni A(3), Bianchi FP(4), 
Zonno A(1), Pierucci P(5), Ranieri M(1), Megna M(1).

Author information:
(1)Department of Basic Medical Sciences, Neuroscience and Sensory Organs, 
University of Bari, Bari, Italy.
(2)Department of Medical and Surgical Sciences, University of Catanzaro "Magna 
Graecia", Catanzaro, Italy.
(3)Neuropsychiatric Rehabilitation Unit, Villa Patrizia Hospital, Piossasco, 
Turin, Italy.
(4)Department of Biomedical Science and Human Oncology, Aldo Moro University, 
Bari, Italy.
(5)Cardiothoracic Department, Respiratory and Sleep Medicine Unit, Aldo Moro 
University, Bari, Italy.

The COVID-19 pandemic has had a strong impact on healthcare workers (HCWs), 
affecting their physical and mental health. In Italy, HCWs have been among the 
first exposed to unprecedented pressure, dealing with large numbers of 
infections during the first pandemic wave. However, the severe psychological 
consequences on HCWs find little evidence in the literature, especially in terms 
of comparison to the status quo ante pandemic. The aim of this study was to 
provide an assessment of the mental health burden in a cohort of Italian HCWs 
during the COVID-19 pandemic, comparing their condition with that before the 
emergency, to direct the promotion of mental well-being among HCWs worldwide. In 
this retrospective study, we included physicians, physical therapists, and 
nurses working in the Respiratory Intensive Care Unit, Neurology Unit, and 
Rehabilitation Unit from a Southern Italy University Hospital. All study 
participants underwent a battery of psychological tests, aimed at verifying 
their state of mental health during the COVID-19 emergency and before it. 
Depressive, anxiety, and burnout symptoms were assessed using the following 
questionnaires: Maslach Burnout Inventory, Patient Health Questionnaire-9 
(PHQ-9), and General Anxiety Disorder-7. Depressive, anxiety, and burnout 
clinical relevance symptoms were present in HCWs during the COVID-19 pandemic 
more than those before the emergency. Fifty percent of the HCWs obtained a score 
clinically significant during the emergency. Moreover, a depersonalization 
factor showed a statistically significant increase in average scores 
(p < 0.0001). The PHQ-9 scale showed that 47.1% of the operators reported 
depressive state presence. The number of operators scoring above the cut-off for 
the anxiety scale tripled during the emergency (p < 0.0001). The female gender 
conferred greater risks for depression. Taken together, the findings of this 
study showed that our sample of Italian HCWs showed a greater risk for 
depression, anxiety, and stress during the COVID-19 pandemic. These data might 
be a starting point to plan mental health monitoring and prevention programs for 
HCWs, thus ensuring patients receive the best possible care performances even 
during healthcare crises such as the current pandemic.

© 2021 Wiley Periodicals LLC.

DOI: 10.1002/jmv.27272
PMCID: PMC8426878
PMID: 34387886 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that there are no conflict 
of interests.


3121. Appetite. 2021 Dec 1;167:105639. doi: 10.1016/j.appet.2021.105639. Epub 2021 Aug 
9.

Persistent effects of the COVID-19 pandemic on diet, exercise, risk for food 
insecurity, and quality of life: A longitudinal study among U.S. adults.

Rogers AM(1), Lauren BN(1), Woo Baidal JA(2), Ozanne EM(3), Hur C(4).

Author information:
(1)Department of General Medicine, Columbia University Irving Medical Center, 
New York, NY, USA; Healthcare Innovations Research and Evaluation, Columbia 
University Irving Medical Center, New York, NY, USA.
(2)Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, 
and Nutrition, Columbia University Irving Medical Center, New York, NY, USA.
(3)Department of Population Health Sciences, University of Utah School of 
Medicine, Salt Lake City, UT, USA.
(4)Department of General Medicine, Columbia University Irving Medical Center, 
New York, NY, USA; Healthcare Innovations Research and Evaluation, Columbia 
University Irving Medical Center, New York, NY, USA. Electronic address: 
ch447@cumc.columbia.edu.

Erratum in
    Appetite. 2022 Jan 1;168:105701.

COVID-19 has affected the health and well-being of almost every American. The 
aim of this study was to examine the sustained impacts of COVID-19 prevention 
measures on the diet and exercise habits, risk for food insecurity, and quality 
of life among adults in the U.S. We conducted a longitudinal study using a 
convenience sample of participants recruited via Amazon's Mechanical Turk 
(MTurk) platform between March 30 and April 7, 2020, and 8 months into the 
outbreak, from November 2 to November 21, 2020. We compared self-reported diet 
and exercise habits and risk for food insecurity shortly after the pandemic 
began, in April, to those reported in November. We also measured changes in 
quality-of-life using the PROMIS-29 + 2 (PROPr) scale. A total of 636 
respondents completed both surveys. Compared to reports in April, respondents 
ate lunch and dinner out more frequently in November and consumed more take-out 
and fast food. Weekly frequencies of consuming frozen food and the number of 
daily meals were slightly lower in November than they were in April. 54% of 
respondents screened positively for being at risk for food insecurity in April, 
reducing to 41% by November. In April, survey respondents were found to have 
lower quality-of-life relative to U.S. population norms, but by November levels 
of depression and cognitive function had improved. Our findings underscore how 
the initial effects of the pandemic on diet, exercise, risk for food insecurity, 
and quality of life have evolved. As U.S. states re-open, continued efforts to 
encourage healthy eating and support mental health, especially to reduce 
feelings of anxiety and social isolation, remain important to mitigate the 
potential long-term effects of the pandemic.

Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.appet.2021.105639
PMCID: PMC8990782
PMID: 34384807 [Indexed for MEDLINE]

Conflict of interest statement: None.


3122. AIDS Care. 2022 Jul;34(7):813-820. doi: 10.1080/09540121.2021.1966696. Epub 2021 
Aug 12.

Determinants of psychological well-being during the Covid-19 pandemic among 
"people living with HIV/AIDS" in India.

Chindarkar N(1), Kulkarni V(1), Chandwani R(1).

Author information:
(1)Indian Institute of Management, Ahmedabad, India.

Using survey data on 647 "people living with HIV/AIDS" (PLHIV) respondents from 
India, we examine the association between human, economic, and social capital 
and psychological well-being during the Covid-19 pandemic, and whether 
pandemic-induced job and financial insecurity are significant stressors. We find 
that among human capital indicators, family health status results in a more 
positive mental state and fewer personal conflicts among PLHIV while having more 
working-age adults in the household results in more conflict. With regards to 
economic capital, PLHIV in salaried jobs and self-employment have a less 
positive mental state compared to those in daily wage work. Compared to daily 
wage workers, those in salaried jobs and self-employment exhibit lower addictive 
behavior. Self-employed PLHIV respondents also engage in fewer conflicts with 
their significant other. We do not find any correlation between social capital 
and psychological well-being. Job and financial insecurity are negatively 
associated with psychological well-being. While job insecurity is associated 
with an increase in addictive behavior, financial insecurity increases the 
likelihood of more frequent personal conflicts. We conclude that there is a need 
for greater economic and psychological support from institutions, community, and 
family to assuage the pandemic-induced psychological distress among 
PLHIV.ABBREVIATIONS: ART: antiretroviral treatment; GSNP+: Gujarat State Network 
of Positive People; MHI: mental health inventory; OBC: other backward castes; 
PLHIV: people living with HIV/AIDS; SC: scheduled castes; SD: standard 
deviation; ST: scheduled tribes.

DOI: 10.1080/09540121.2021.1966696
PMID: 34383596 [Indexed for MEDLINE]


3123. Stress Health. 2022 Apr;38(2):304-317. doi: 10.1002/smi.3091. Epub 2021 Aug 18.

Stressors associated with the COVID-19 pandemic, disability, and mental health: 
Considerations from the Intermountain West.

Ciciurkaite G(1), Marquez-Velarde G(1), Brown RL(2).

Author information:
(1)Department of Sociology and Anthropology, Utah State University, Logan, Utah, 
USA.
(2)Department of Sociology, University of Kentucky, Lexington, Kentucky, USA.

The deleterious mental health effects associated with the COVID-19 pandemic are 
increasingly apparent, however, questions remain about the extent to which 
pandemic-related stressor exposure has contributed to increased psychological 
distress among an already disadvantaged group, individuals with disabilities. 
The first aim of the study was to examine the distribution of pandemic-related 
stressors across multiple dimensions-employment, personal and family finances, 
personal relationships, and quality of social life-among individuals with and 
without disabilities. The second aim of the study was to examine the association 
between a composite COVID-19 stressor score and two mental health 
outcomes-depressive and anxiety symptoms-among the two subsamples. The study 
used quota-based online survey data (N = 2043) collected in the summer of 2020 
from adults (18 and older) residing in the Intermountain West, half of whom had 
a self-reported disability. Study results demonstrated that individuals with 
disabilities experienced pandemic-related stressors at significantly higher 
rates relative to their non-disabled counterparts. Further, pandemic stressor 
exposure was associated with greater negative effects on their psychological 
well-being. We argue that the COVID-19 pandemic is generating a secondary mental 
illness pandemic, and that individuals with disabilities are affected by it at 
significantly higher proportions.

© 2021 John Wiley & Sons Ltd.

DOI: 10.1002/smi.3091
PMCID: PMC8420204
PMID: 34382736 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that they have no 
conflict of interest.


3124. Nurs Res. 2021 Nov-Dec 01;70(6):462-468. doi: 10.1097/NNR.0000000000000548.

Multi-Omics Analysis on Neurodevelopment in Preterm Neonates: A Protocol Paper.

Casavant SG, Chen J, Xu W, Lainwala S, Matson A, Chen MH, Starkweather A, Maas 
K, Cong XS.

BACKGROUND: The gut microbiome is an important determinant of health and disease 
in preterm infants.
OBJECTIVES: The objective of this article was to share our current protocol for 
other neonatal intensive care units to potentially expand their existing 
protocols, aiming to characterize the relationship between the intestinal 
microbiome and health outcomes in preterm infants.
METHODS: This prospective, longitudinal study planned to recruit 160 preterm 
infants born <32 weeks gestational age or weighing <1,500 g and admitted to one 
of two Level III/IV neonatal intensive care units. During the neonatal intensive 
care unit period, the primary measures included events of early life 
pain/stress, gut microbiome, host genetic variations, and neurobehavioral 
assessment. During follow-up visits, gut microbiome; pain sensitivity; and 
medical, growth, and developmental outcomes at 4, 8-12, and 18-24 months 
corrected age were measured.
DISCUSSION: As of February 14, 2020, 214 preterm infants have been recruited. We 
hypothesize that infants who experience greater levels of pain/stress will have 
altered gut microbiome, including potential adverse outcomes such as necrotizing 
enterocolitis and host genetic variations, feeding intolerance, and/or 
neurodevelopmental impairments. These will differ from the intestinal microbiome 
of preterm infants who do not develop these adverse outcomes. To test this 
hypothesis, we will determine how alterations in the intestinal microbiome 
affect the risk of developing necrotizing enterocolitis, feeding intolerance, 
and neurodevelopmental impairments in preterm infants. In addition, we will 
examine the interaction between the intestinal microbiome and host genetics in 
the regulation of intestinal health and neurodevelopmental outcomes.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/NNR.0000000000000548
PMCID: PMC8563389
PMID: 34380978 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
report.


3125. Aging Ment Health. 2022 Sep;26(9):1889-1898. doi: 10.1080/13607863.2021.1963950. 
Epub 2021 Aug 11.

Mental health and well-being for aging adults during the COVID-19 pandemic.

Martin M(1), Saltzman LY(1), Henry V(1), Broussard C(1), Hansel TC(1).

Author information:
(1)School of Social Work, Tulane University, New Orleans, LA, USA.

INTRODUCTION: The COVID-19 pandemic remains a significant mental health crisis. 
Although empirical research works to better understand the impact of COVID-19 on 
the mental health of the general population, some groups remain at greater risk 
for adverse mental health consequences. The purpose of this study is to better 
understand how COVID-19 experiences, food insecurities, and social support are 
associated with mental health and well-being for aging populations.
METHODS: Data collection began April 1, 2020 and continued through May 22, 2020. 
Study participants were recruited via website and media promotion and completed 
an anonymous survey. A sample of adults age 50 years and older (N = 136) were 
selected for the current analysis. Measures included scales of anxiety, 
depression, resilience, quality of life, COVID-19 experiences, interdependence, 
and insecurities. Three stepwise linear regression models were conducted using 
forward selection were estimated.
RESULTS: The first model found food insecurity, community closeness, and 
COVID-19 experiences predicted 23% of the variance in mental health. The second 
model found having enough money to meet needs, COVID-19 interdependence, and age 
predicted 20% of the variance in resilience. The final model found having enough 
money to meet needs, COVID-19 experiences, community closeness, and information 
access predicted 45% of the variance in quality of life.
DISCUSSION: Our discussion highlights the role of COVID-19 experiences, tangible 
resource losses, and community connection in mental health outcomes for aging 
populations during COVID-19. We suggest areas of future research and highlight 
the important role of technology in both scholarship and practice.

DOI: 10.1080/13607863.2021.1963950
PMID: 34380358 [Indexed for MEDLINE]


3126. PLoS One. 2021 Aug 11;16(8):e0255774. doi: 10.1371/journal.pone.0255774. 
eCollection 2021.

Psychological distress and health-related quality of life in patients after 
hospitalization during the COVID-19 pandemic: A single-center, observational 
study.

Vlake JH(1)(2), Wesselius S(1), van Genderen ME(1)(2), van Bommel J(2), Boxma-de 
Klerk B(3), Wils EJ(1).

Author information:
(1)Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The 
Netherlands.
(2)Department of Intensive Care, Erasmus Medical Centre, Rotterdam, The 
Netherlands.
(3)Department of Statistics and Education, Franciscus Academy, Franciscus 
Gasthuis & Vlietland, Rotterdam, The Netherlands.

INTRODUCTION: Illnesses requiring hospitalization are known to negatively impact 
psychological well-being and health-related quality of life (HRQoL) after 
discharge. The impact of hospitalization during the Severe Acute Respiratory 
Syndrome Corona Virus 2 (SARS-CoV-2) pandemic on psychological well-being and 
health-related quality of life is expected to be higher due to the exceptional 
circumstances within and outside the hospital during the pandemic surge. The 
objective of this study was to quantify psychological distress up to three 
months after discharge in patients hospitalized during the first coronavirus 
disease 2019 (COVID-19) pandemic wave. We also aimed to determine HRQoL, to 
explore predictors for psychological distress and HRQoL, and to examine whether 
psychological distress was higher in COVID-19 confirmed patients, and in those 
treated in Intensive Care Units (ICUs).
METHODS: In this single-center, observational cohort study, adult patients 
hospitalized with symptoms suggestive of COVID-19 between March 16 and April 28, 
2020, were enrolled. Patients were stratified in analyses based on SARS-CoV-2 
PCR results and the necessity for ICU treatment. The primary outcome was 
psychological distress, expressed as symptoms of post-traumatic stress disorder 
(PTSD), anxiety, and depression, up to three months post-discharge. 
Health-related quality of life (HRQoL) was the secondary outcome. Exploratory 
outcomes comprised predictors for psychological distress and HRQoL.
RESULTS: 294 of 622 eligible patients participated in this study (median age 64 
years, 36% female). 16% and 13% of these patients reported probable PTSD, 29% 
and 20% probable anxiety, and 32% and 24% probabledepression at one and three 
months after hospital discharge, respectively. ICU patients reported less 
frequently probable depression, but no differences were found in PTSD, anxiety, 
or overall HRQoL. COVID-19 patients had a worse physical quality of life one 
month after discharge, and ICU patients reported a better mental quality of life 
three months after discharge. PTSD severity was predicted by time after 
discharge and being Caucasian. Severity of anxiety was predicted by time after 
discharge and being Caucasian. Depression severity was predicted by time after 
discharge and educational level.
CONCLUSION: COVID-19 suspected patients hospitalized during the pandemic 
frequently suffer from psychological distress and poor health-related quality of 
life after hospital discharge. Non-COVID-19 and non-ICU patients appear to be at 
least as affected as COVID-19 and ICU patients, underscoring that 
(post-)hospital pandemic care should not predominantly focus on COVID-19 
infected patients.

DOI: 10.1371/journal.pone.0255774
PMCID: PMC8357130
PMID: 34379644 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


3127. Sao Paulo Med J. 2021 Aug-Sep;139(5):496-504. doi: 
10.1590/1516-3180.2021.0155.R1.22042021.

Women's health anxiety and psychological wellbeing during the COVID-19 pandemic. 
A descriptive study.

Akbas M(1), Sulu R(2), Gozuyesil E(3).

Author information:
(1)PhD. Assistant Professor, Department of Midwifery, Faculty of Health 
Sciences, Cukurova University, Adana, Turkey.
(2)Midwife and Master's Student, Department of Midwifery, Health Sciences 
Institute, Cukurova University, Adana, Turkey.
(3)PhD. Associate Professor, Department of Midwifery, Faculty of Health 
Sciences, Cukurova University, Adana, Turkey.

BACKGROUND: The rapid spread of the novel coronavirus (COVID-19) outbreak has 
led to extraordinary measures taken worldwide and has led to serious 
psychological disorders. With the measures taken, the difficulties in women's 
daily lives are increasing exponentially. This situation has caused women to 
experience more mental health problems.
OBJECTIVE: To identify the relationship between women's health anxiety and 
psychological wellbeing and the factors affecting these situations during the 
COVID-19 pandemic.
DESIGN AND SETTING: Descriptive study conducted online among women living in 
Adana, Turkey.
METHOD: This descriptive study was conducted among 623 married women between 
April 1 and April 20, 2020, using a SurveyMonkey online questionnaire. Data were 
collected using the link that was established. The questions comprised personal 
information, perceptions regarding the pandemic, the Health Anxiety Inventory 
(Short Form) and the Psychological Wellbeing Scale.
RESULTS: The women who participated were found to have a high level of anxiety 
and a moderate level of psychological wellbeing. A positive, moderate-level 
relationship was found between the scales.
CONCLUSIONS: The COVID-19 pandemic has had negative effects on both physical and 
psychological health. Support for women, to be provided within their holistic 
understanding of care, is of great importance for maintaining the psychological 
health of society.

DOI: 10.1590/1516-3180.2021.0155.R1.22042021
PMCID: PMC9632532
PMID: 34378738 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest: The authors declare that 
they have no conflict of interest


3128. EPMA J. 2021 Aug 6;12(3):349-363. doi: 10.1007/s13167-021-00250-5. eCollection 
2021 Sep.

Wrist actigraphic approach in primary, secondary and tertiary care based on the 
principles of predictive, preventive and personalised (3P) medicine.

Acker J(1), Golubnitschaja O(2), Büttner-Teleaga A(3)(4), Richter K(5)(6)(7).

Author information:
(1)Clinic for Sleep Medicine, Zurzach Care, Badstrasse 33, 5330 Bad Zurzach, 
Switzerland.
(2)Predictive, Preventive and Personalised (3P) Medicine, Department of 
Radiation Oncology, University Hospital Bonn, Rheinische 
Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
(3)Institute of Cognitive Science, Woosuk University, Samnye-up, South Korea.
(4)Department of Psychiatry, University Witten-Herdecke, Witten, Germany.
(5)Sleep Ambulance, University Clinic for Psychiatry and Psychotherapy, 
Paracelsus Medical University, Nuremberg, Germany.
(6)Institute for E-Counselling, Technical University for Applied Sciences 
Nuremberg Georg Simon Ohm, Nuremberg, Germany.
(7)Faculty for Medical Sciences, University Goce Delcev, Stip, Macedonia.

ABSTRACT: Sleep quality and duration as well as activity-rest-cycles at 
individual level are crucial for maintaining physical and mental health. 
Although several methods do exist to monitor these parameters, optimal 
approaches are still under consideration and technological development. Wrist 
actigraphy is a non-invasive electro-physical method validated in the field of 
chronobiology to record movements and to allow for monitoring human 
activity-rest-cycles. Based on the continuous recording of motor activity and 
light exposure, actigraphy provides valuable information about the quality and 
quantity of the sleep-wake rhythm and about the amount of motor activity at day 
and night that is highly relevant for predicting a potential disease and its 
targeted prevention as well as personalisation of medical services provided to 
individuals in suboptimal health conditions and patients. Being generally used 
in the field of sleep medicine, actigraphy demonstrates a great potential to be 
successfully implemented in primary, secondary and tertiary care, psychiatry, 
oncology, and intensive care, military and sports medicines as well as 
epidemiological monitoring of behavioural habits as well as well-being medical 
support, amongst others.
PREDICTION OF DISEASE DEVELOPMENT AND INDIVIDUAL OUTCOMES: Activity-rest-cycles 
have been demonstrated to be an important predictor for many diseases including 
but not restricted to the development of metabolic, psychiatric and malignant 
pathologies. Moreover, activity-rest-cycles directly impact individual outcomes 
in corresponding patient cohorts.
TARGETED PREVENTION: Data acquired by actigraphy are instrumental for the 
evidence-based targeted prevention by analysing individualised patient profiles 
including light exposure, sleep duration and quality, activity-rest-cycles, 
intensity and structure of motion pattern.
PERSONALISED THERAPY: Wrist actigraphic approach is increasingly used in 
clinical care. Personalised measurements of sedation/agitation rhythms are 
useful for ICU patients, for evaluation of motor fatigue in oncologic patients, 
for an individual enhancement of performance in military and sport medicine. In 
the framework of personalised therapy intervention, patients can be encouraged 
to optimise their behavioural habits improving recovery and activity patterns. 
This opens excellent perspectives for the sleep-inducing medication and 
stimulants replacement as well as for increasing the role of participatory 
medicine by visualising and encouraging optimal behavioural patterns of the 
individual.

© The Author(s) 2021.

DOI: 10.1007/s13167-021-00250-5
PMCID: PMC8342270
PMID: 34377218

Conflict of interest statement: Conflict of interestThe authors declare no 
competing interests.


3129. BMC Med Res Methodol. 2021 Aug 10;21(1):163. doi: 10.1186/s12874-021-01355-1.

Hospital workers mental health during the COVID-19 pandemic: methods of data 
collection and characteristics of study sample in a university hospital in Milan 
(Italy).

Fattori A(1), Cantù F(2), Comotti A(3), Tombola V(4), Colombo E(4), Nava C(3), 
Bordini L(3), Riboldi L(3), Bonzini M(3)(5), Brambilla P(2)(4).

Author information:
(1)Occupational Health Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore 
Policlinico, Milan, Italy. alice.fattori@policlinico.mi.it.
(2)Department of Pathophysiology and Transplantation, University of Milan, 
Milan, Italy.
(3)Occupational Health Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore 
Policlinico, Milan, Italy.
(4)Department of Neurosciences and Mental Health, Foundation IRCCS Ca' Granda 
Ospedale Maggiore Policlinico, Milan, Italy.
(5)Department of Clinical Science and Community Health, University of Milan, 
Milan, Italy.

BACKGROUND: The COVID-19 pandemic is currently a severe challenge for healthcare 
workers, with a considerable impact on their mental health. In order to focus 
preventive and rehabilitation measures it's fundamental to identify risk factors 
of such psychological impairment. We designed an observational longitudinal 
study to systematically examine the psychological wellbeing of all employees in 
a large University Hospital in Italy, using validated psychometric scales in the 
context of the occupational physician's health surveillance, in collaboration 
with Psychiatric Unit.
METHODS: The study started after ethical approval in August 2020. For each 
worker, the psychological wellbeing is screened in two steps. The first level 
questionnaire collects sociodemographic characteristics, personal and 
occupational COVID-19 exposure, worries and concerns about COVID-19, general 
psychological discomfort (GHQ-12), post-traumatic stress symptoms (IES-R) and 
anxiety (GAD-7). Workers who score above the cut-off in at least one scale are 
further investigated by the second level questionnaire composed by PHQ-9, DES-II 
and SCL-90. If second level shows psychological impairments, we offer individual 
specialist treatment (third level). We plan to follow-up all subjects to monitor 
symptoms and possible chronicization; we aim to investigate potential risk 
factors through univariate analysis and multivariate logistic regressions.
RESULTS: Preliminary results refer to a sample of 550 workers who completed the 
multi-step evaluation from August to December 2020, before vaccination campaign 
started. The participation rate was 90%. At first level screening, 39% of the 
subjects expressed general psychological discomfort (GHQ-12), 22% post-traumatic 
stress symptoms (IES-R), and 21% symptoms of anxiety (GAD-7). Women, nurses, 
younger workers, subjects with COVID-19 working exposure and with an infected 
family member showed significantly higher psychological impairment compared to 
colleagues. After the second level screening, 12% and 7% of all workers showed, 
respectively, depressive and dissociative symptoms; scorings were significantly 
associated with gender and occupational role. We are currently extending sample 
size and evaluating subjects over a period of further 12 months.
CONCLUSIONS: The possibility to perform a systematic follow-up of psychological 
wellbeing of all hospital workers, directly or indirectly exposed to pandemic 
consequences, constitutes a unique condition to detect individual, occupational, 
and non-occupational risk factors for psychological impairment in situations of 
prolonged stress, as well as variables associated with symptoms chronicization.

© 2021. The Author(s).

DOI: 10.1186/s12874-021-01355-1
PMCID: PMC8353421
PMID: 34376151 [Indexed for MEDLINE]

Conflict of interest statement: All the authors declare that there is no 
conflict of interest.


3130. J Affect Disord. 2021 Nov 1;294:753-760. doi: 10.1016/j.jad.2021.07.072. Epub 
2021 Jul 22.

Network analysis of anxiety and depressive symptoms among nursing students 
during the COVID-19 pandemic.

Bai W(1), Xi HT(2), Zhu Q(3), Ji M(4), Zhang H(5), Yang BX(6), Cai H(7), Liu 
R(8), Zhao YJ(7), Chen L(2), Ge ZM(2), Wang Z(4), Han L(5), Chen P(6), Liu S(6), 
Cheung T(9), Tang YL(10), Jackson T(11), An F(12), Xiang YT(13).

Author information:
(1)Unit of Psychiatry, Department of Public Health and Medicinal Administration, 
& Institute of Translational Medicine, Faculty of Health Sciences, University of 
Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of 
Macau, Macao SAR, China; Institute of Advanced Studies in Humanities and Social 
Sciences, University of Macau, Macao SAR, China. Electronic address: 
yc07611@connect.um.edu.mo.
(2)Jilin University Nursing College, Jilin province, China.
(3)School of Nursing, Capital Medical University, Beijing, China; The National 
Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental 
Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human 
Brain Protection, Capital Medical University, School of Mental Health, Beijing, 
China.
(4)Peking University School of Nursing, Beijing, China.
(5)Lanzhou University School of Nursing, Gansu province, China.
(6)Atlanta VA Medical Center, Decatur, Georgia, GA, USA.
(7)Unit of Psychiatry, Department of Public Health and Medicinal Administration, 
& Institute of Translational Medicine, Faculty of Health Sciences, University of 
Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of 
Macau, Macao SAR, China; Institute of Advanced Studies in Humanities and Social 
Sciences, University of Macau, Macao SAR, China.
(8)The National Clinical Research Center for Mental Disorders & Beijing Key 
Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation 
Center for Human Brain Protection, Capital Medical University, School of Mental 
Health, Beijing, China.
(9)School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China.
(10)Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, 
GA, USA; Atlanta VA Medical Center, Decatur, Georgia, GA, USA.
(11)Department of Psychology, University of Macau, Taipa, Macau SAR, China.
(12)The National Clinical Research Center for Mental Disorders & Beijing Key 
Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation 
Center for Human Brain Protection, Capital Medical University, School of Mental 
Health, Beijing, China. Electronic address: afrylm@sina.com.
(13)Unit of Psychiatry, Department of Public Health and Medicinal 
Administration, & Institute of Translational Medicine, Faculty of Health 
Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain 
Sciences, University of Macau, Macao SAR, China; Institute of Advanced Studies 
in Humanities and Social Sciences, University of Macau, Macao SAR, China. 
Electronic address: xyutly@gmail.com.

Erratum in
    J Affect Disord. 2023 May 1;328:355.

BACKGROUND: The 2019 coronavirus disease (COVID-19) pandemic has impacted the 
mental health and well-being of medical personnel, including nursing students. 
Network analysis provides a deeper characterization of symptom-symptom 
interactions in mental disorders. The aim of this study was to elucidate 
characteristics of anxiety and depressive symptom networks of Chinese nursing 
students during the COVID-19 pandemic.
METHOD: A total of 932 nursing students were included. Anxiety and depressive 
symptom were measured using the seven-item Generalized Anxiety Disorder Scale 
(GAD-7) and two-item Patient Health Questionnaire (PHQ-2), respectively. Central 
symptoms and bridge symptoms were identified via centrality indices and bridge 
centrality indices, respectively. Network stability was examined using the 
case-dropping procedure.
RESULTS: Irritability, Uncontrollable worry, Trouble relaxing, and Depressed 
mood had the highest centrality values. Three bridge symptoms (Depressed mood, 
Nervousness, and Anhedonia) were also identified. Neither gender nor region of 
residence was associated with network global strength, distribution of edge 
weights or individual edge weights.
LIMITATIONS: Data were collected in a cross-sectional study design, therefore, 
causal relations and dynamic changes between anxiety and depressive symptoms 
over time could not be inferred. Generalizability of findings may be limited to 
Chinese nursing students during a particular phase of the current pandemic.
CONCLUSIONS: Irritability, Uncontrollable worry, Trouble relaxing, and Depressed 
mood constituted central symptoms maintaining the anxiety-depression network 
structure of Chinese nursing students during the pandemic. Timely, systemic 
multi-level interventions targeting central symptoms and bridge symptoms may be 
effective in alleviating co-occurring experiences of anxiety and depression in 
this population.

Copyright © 2021. Published by Elsevier B.V.

DOI: 10.1016/j.jad.2021.07.072
PMCID: PMC8433813
PMID: 34375200 [Indexed for MEDLINE]


3131. Int J Ment Health Nurs. 2021 Dec;30(6):1674-1683. doi: 10.1111/inm.12920. Epub 
2021 Aug 10.

Perceived COVID-19-associated discrimination, mental health and 
professional-turnover intention among frontline clinical nurses: The mediating 
role of resilience.

Labrague LJ(1), De Los Santos JAA(2), Fronda DC(1).

Author information:
(1)Sultan Qaboos University, Muscat, Oman.
(2)Visayas State University, Baybay City, Philippines.

COVID-19-associated discrimination (CAD) is an important issue that may 
adversely affect frontline nurses' work effectiveness and well-being. This study 
examined the relationships between frontline nurses' perceptions of 
COVID-19-associated discrimination and their resilience, mental health, and 
professional-turnover intention. This cross-sectional descriptive study involved 
259 frontline nurses in the Central Philippines and used four online self-report 
measures. The results revealed that frontline nurses perceived a moderate level 
of COVID-19-associated discrimination. Frontline nurses who perceived a higher 
level of discrimination during the coronavirus pandemic reported poorer mental 
health and higher professional-turnover intention. Resilience acted as a 
mediator and reduced the effects of COVID-19-associated discrimination on 
nurses' mental health and their professional-turnover intention. Proactive 
measures to reduce the negative consequences of discrimination during the 
pandemic, and efforts to foster resilience in nurses who are in the forefront of 
the fight against the highly transmissible virus, should be given high priority 
by hospital and nursing administrators to better support nurses' mental health 
and foster retention.

© 2021 John Wiley & Sons Australia, Ltd.

DOI: 10.1111/inm.12920
PMCID: PMC8447016
PMID: 34374480 [Indexed for MEDLINE]


3132. JNCI Cancer Spectr. 2021 May 13;5(4):pkab047. doi: 10.1093/jncics/pkab047. 
eCollection 2021 Aug.

Colorectal Cancer Care and Patients' Perceptions Before and During COVID-19: 
Implications for Subsequent SARS-CoV-2 Infection Waves.

Derksen JWG(1)(2), May AM(1), van de Poll-Franse LV(3)(4)(5), de Rooij BH(3)(5), 
Hafkenscheid DA(1), Verkooijen HM(6), Koopman M(2), Vink GR(2)(3).

Author information:
(1)Julius Center for Health Sciences and Primary Care, University Medical Center 
Utrecht, Utrecht University, Utrecht, the Netherlands.
(2)Department of Medical Oncology, University Medical Center Utrecht, Utrecht 
University, Utrecht, the Netherlands.
(3)Department of Research and Development, Netherlands Comprehensive Cancer 
Organisation (IKNL), Utrecht, the Netherlands.
(4)Division of Psychosocial Research & Epidemiology, the Netherlands Cancer 
Institute, Amsterdam, the Netherlands.
(5)Department of Medical and Clinical Psychology, Center of Research on 
Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, the 
Netherlands.
(6)Imaging Division, University Medical Center Utrecht, Utrecht University, 
Utrecht, the Netherlands.

BACKGROUND: Changes in colorectal cancer (CRC) care planning because of the 
coronavirus disease 2019 (COVID-19) pandemic and associated health-related 
quality of life (HRQoL) and well-being of patients with CRC are unknown. We 
report changes in CRC care and patient-reported outcomes including HRQoL, 
distress, and loneliness during the first wave of severe acute respiratory 
syndrome coronavirus 2 (SARS-CoV-2).
METHODS: In April 2020, 4984 patients included in the nationwide Prospective 
Dutch Colorectal Cancer cohort were invited to complete a COVID-19-specific 
questionnaire, together with the validated European Organisation for Research 
and Treatment of Cancer Core Quality of Life Questionnaire (QLQ-C30), De Jong 
Gierveld, and Hospital Anxiety and Depression Scale. Clinical data were obtained 
from the Netherlands Cancer Registry. Scores were compared with the year prior 
to COVID-19 and with an age- and sex-matched control population during COVID-19.
RESULTS: In total, 3247 (65.1%) patients responded between April and June 2020. 
Of the patients, 17% had canceled, postponed, or changed hospital visits to a 
telephone or video consult, and 5.3% had adjusted, postponed, or canceled 
treatment. Compared with controls, patients reported worse HRQoL but comparable 
distress and less social loneliness (patients = 21.2%; controls = 32.9%). 
Compared with pre-COVID-19, clinically meaningful deterioration of HRQoL was 
more prevalent in patients with changes in cancer care planning than in patients 
without changes. Prior to undergoing or currently undergoing treatment and 
infection worries were associated with lower HRQoL.
CONCLUSIONS: CRC patients reported equal anxiety and depression but worse HRQoL 
than the control population. Changes in care planning were associated with 
deterioration of HRQoL and increased anxiety. In case of 1 or more risk factors, 
health-care specialists should discuss (mental) health status and possible 
support during future SARS-CoV-2 infection waves or comparable pandemics.

© The Author(s) 2021. Published by Oxford University Press.

DOI: 10.1093/jncics/pkab047
PMCID: PMC8243357
PMID: 34373848 [Indexed for MEDLINE]


3133. Nutrients. 2021 Jul 5;13(7):2311. doi: 10.3390/nu13072311.

The Impact of a Culinary Coaching Telemedicine Program on Home Cooking and 
Emotional Well-Being during the COVID-19 Pandemic.

Silver JK(1)(2)(3), Finkelstein A(4), Minezaki K(5), Parks K(6)(7), Budd 
MA(8)(9), Tello M(10), Paganoni S(1), Tirosh A(11), Polak R(3)(12).

Author information:
(1)Department of Physical Medicine and Rehabilitation, Massachusetts General 
Hospital, Harvard Medical School, Boston, MA 02129, USA.
(2)Department of Physical Medicine and Rehabilitation, Brigham and Women's 
Hospital, Harvard Medical School, Boston, MA 02129, USA.
(3)Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation 
Hospital, Harvard Medical School, Boston, MA 02129, USA.
(4)Department of Nursing, Faculty of Life and Health Sciences, Jerusalem College 
of Technology, Jerusalem 95483, Israel.
(5)Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
(6)Department of Cardiology, Massachusetts General Hospital, Harvard Medical 
School, Boston, MA 02462, USA.
(7)Department of Cardiology, Newton Wellesley Hospital, Harvard Medical School, 
Boston, MA 02462, USA.
(8)Department of Spinal Cord Medicine, VA Boston Healthcare System, Harvard 
Medical School, Boston, MA 02130, USA.
(9)Department of Psychiatry, Harvard Medical School, Boston, MA 02130, USA.
(10)Department of Internal Medicine, Massachusetts General Hospital, Harvard 
Medical School, Boston, MA 02114, USA.
(11)Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, 
Tel-Hashomer and Sackler School of Medicine, Tel-Aviv University, Tel Aviv 
5262000, Israel.
(12)Sheba Center of Lifestyle Medicine, Sheba Medical Center, Tel-Hashomer and 
Sackler School of Medicine, Tel-Aviv University, Tel Aviv 5262000, Israel.

The coronavirus pandemic enforced social restrictions with abrupt impacts on 
mental health and changes to health behaviors. From a randomized clinical trial, 
we assessed the impact of culinary education on home cooking practices, coping 
strategies and resiliency during the first wave of the COVID-19 pandemic 
(March/April 2020). Participants (n = 28) were aged 25-70 years with a BMI of 
27.5-35 kg/m2. The intervention consisted of 12 weekly 30-min one-on-one 
telemedicine culinary coaching sessions. Coping strategies were assessed through 
the Brief Coping with Problems Experienced Inventory, and resiliency using the 
Brief Resilient Coping Scale. Home cooking practices were assessed through 
qualitative analysis. The average use of self-care as a coping strategy by the 
intervention group was 6.14 (1.66), compared to the control with 4.64 (1.69); p 
= 0.03. While more intervention participants had high (n = 5) and medium (n = 8) 
resiliency compared to controls (n = 4, n = 6, respectively), this difference 
was not significant (p = 0.33). Intervention participants reported using home 
cooking skills such as meal planning and time saving techniques during the 
pandemic. The key findings were that culinary coaching via telemedicine may be 
an effective intervention for teaching home cooking skills and promoting the use 
of self-care as a coping strategy during times of stress, including the COVID-19 
pandemic.

DOI: 10.3390/nu13072311
PMCID: PMC8308430
PMID: 34371825 [Indexed for MEDLINE]

Conflict of interest statement: Silver discloses that she has participated in 
unrelated research funded by the Arnold P. Gold Foundation. Parks discloses that 
she is the owner of a culinary medicine practice. Polak discloses royalties from 
a home cooking book, and consultation fees from Gilead Science Inc., Hod 
Hasharon, Israel.


3134. J Infect Public Health. 2021 Sep;14(9):1155-1160. doi: 
10.1016/j.jiph.2021.06.016. Epub 2021 Jul 2.

Nursing strategic pillars to enhance nursing preparedness and response to 
COVID-19 pandemic at a tertiary care hospital in Saudi Arabia.

Tashkandi N(1), Aljuaid M(2), McKerry T(3), Alchin J(4), Taylor L(5), Catangui 
EJ(6), Mulla R(7), Sinnappan S(8), Nammour G(9), El-Saed A(10), Alshamrani 
MM(10).

Author information:
(1)Nursing Services, King Abdualziz Medical City (KAMC), Riyadh, Saudi Arabia. 
Electronic address: tashkann@ngha.med.sa.
(2)Clinical Nursing, Ambulatory and Haemodialysis Care, KAMC, Riyadh, Saudi 
Arabia.
(3)Clinical Nursing, Cardiac Services, KAMC, Riyadh, Saudi Arabia.
(4)Clinical Nursing, Critical Care, KAMC, Riyadh, Saudi Arabia.
(5)Clinical Nursing, Surgical Care, KAMC, Riyadh, Saudi Arabia.
(6)Clinical Nursing, Medical Care, KAMC, Riyadh, Saudi Arabia.
(7)Nursing Education and Clinical Practice, KAMC, Riyadh, Saudi Arabia.
(8)Clinical Nursing, Obstetrical, Gynecological and Neonatal Care, KAMC, Riyadh, 
Saudi Arabia.
(9)Clinical Nursing, Emergency Care, KAMC, Riyadh, Saudi Arabia.
(10)Infection Prevention and Control, KAMC, Riyadh, Saudi Arabia.

BACKGROUND: COVID-19 pandemic caused enormous implications on the frontline 
staff. The objective was to share our nursing experience in responding to 
COVID-19 pandemic at a large hospital and its impact on nursing safety and 
healthcare services.
METHODS: Six nursing strategic pillars were implemented. Pillar 1: establishing 
corona command centre. Pillar 2: limiting exposure by virtual care model, strict 
infection control measures, altered patient flow, active surveillance, and 
contact tracing. Pillar 3: maintaining sufficient supplies of personal 
protective equipment. Pillar 4: creating surge capacity by establishing 
dedicated COVID-19 units and increasing critical care beds. Pillar 5: training 
and redeployment of nurses and implementing alternate staffing models. Pillar 6: 
monitoring staff wellbeing, establishing mental health support hotline and 
clinic, providing hotel self-quarantine, and financial incentives.
RESULTS: Out of 5483 nurses, 543 (10%) were trained for redeployment, mainly at 
acute and intensive care units. After serving 11,623 infected patient including 
1646 hospitalizations during the first 9 months of the pandemic, only 385 (7.0%) 
nurses were infected with COVID-19. Out of them, only 10 (2.6%) required 
hospitalization, one (0.3%) required ICU admission, and none died. Although the 
number of patients hospitalized at our hospital during the current pandemic was 
17 folds higher than the 2015 outbreak of middle East respiratory syndrome 
coronavirus, the hospital administration did not have to close the hospital as 
they did in 2015.
CONCLUSIONS: Proactive nursing leadership and implementation of multiple nursing 
pillars enabled the facility to maintain the safety of nursing workforce while 
serving large influx of COVID-19 patients.

Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.jiph.2021.06.016
PMCID: PMC8252703
PMID: 34371365 [Indexed for MEDLINE]


3135. Res Dev Disabil. 2021 Oct;117:104057. doi: 10.1016/j.ridd.2021.104057. Epub 2021 
Aug 6.

Autistic adults' personal experiences of navigating a social world prior to and 
during Covid-19 lockdown in Spain.

Lois Mosquera M(1), Mandy W(2), Pavlopoulou G(3), Dimitriou D(4).

Author information:
(1)Sleep Education and Research Laboratory (SERL), UCL Institute of Education, 
London, UK. Electronic address: miguel.mosquera.16@ucl.ac.uk.
(2)Research Department of Clinical, Educational and Health Psychology, 
University College London, London, UK.
(3)UCL Institute of Education, Department of Psychology and Human Development, 
London, UK; Anna Freud National Centre for Children and Families, London, UK.
(4)Sleep Education and Research Laboratory (SERL), UCL Institute of Education, 
London, UK.

BACKGROUND: The SARS-CoV-2 coronavirus pandemic brought significant movement 
restrictions and national lockdowns. These drastic changes impacted routines, 
social life and support networks for the autistic community.
AIMS: This study investigated the lived experiences of autistic adults with 
social expectations before and during the first Covid-19 lockdown in Spain.
METHODS: A qualitative Reflexive Thematic Analysis was applied to 10 Photo 
Elicitation Interviews using images provided by five autistic adults. Interviews 
were conducted at two time points, before the pandemic and during the first 
lockdown.
FINDINGS: Three themes before the pandemic were identified: (1) everyday 
interactions, (2) finding sense of belonging, and (3) fractured wellbeing, which 
revealed the participants' eagerness to fit in socially whilst experiencing 
rejection, weakening their mental health. During the first Covid-19 lockdown, 
two master themes were identified: (1) daily, positive experiences, and (2) 
surfacing failures, which emphasised an increased lived stigma as well as an 
ineffective autism support network, contributing to a heightened anxiety.
CONCLUSIONS: The current study provides further support to the recent findings 
highlighting lack of appropriate mental health support for the autistic 
communities during the pandemic, across the world. Future research should aim to 
provide more data on the experiences and needs of autistic communities when 
sudden societal changes are imposed.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.ridd.2021.104057
PMCID: PMC8413264
PMID: 34371305 [Indexed for MEDLINE]

Conflict of interest statement: No competing financial interests exist.


3136. Psychiatr Serv. 2022 Apr 1;73(4):374-380. doi: 10.1176/appi.ps.202100080. Epub 
2021 Aug 9.

Well-Being of Health Care Professionals Treating Opioid Use Disorder During the 
COVID-19 Pandemic: Results From a National Survey.

Blevins D(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14), Henry 
BF(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14), Sung 
M(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14), Edelman 
EJ(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14), Black 
AC(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14), Dawes 
M(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14), Molfenter 
T(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14), Hagle 
H(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14), Drexler 
K(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14), Cates-Wessel 
K(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14), Levin 
FR(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14).

Author information:
(1)Department of Psychiatry, Columbia University Irving Medical Center, New York 
City (Blevins, Levin).
(2)New York State Psychiatric Institute, New York City (Blevins, Levin).
(3)Columbia University School of Social Work, New York City (Henry).
(4)Department of Educational Psychology, Counseling and Special Education, 
College of Education, Pennsylvania State University, University Park (Henry).
(5)U.S. Department of Veterans Affairs (VA) Health Services Research and 
Development, West Haven, Connecticut (Sung).
(6)VA Connecticut Healthcare System, West Haven (Sung, Black).
(7)Department of Internal Medicine, Yale School of Medicine, New Haven, 
Connecticut (Edelman, Black).
(8)Department of Psychiatry, Boston University School of Medicine, Boston 
(Dawes).
(9)Boston Medical Center, Boston (Dawes).
(10)Center for Health Enhancement System Studies, University of Wisconsin, 
Madison (Molfenter).
(11)Addiction Technology Transfer Center Network, Kansas City, Missouri (Hagle).
(12)School of Nursing and Health Studies, University of Missouri, Kansas City 
(Hagle).
(13)Department of Psychiatry and Behavioral Sciences, Emory University School of 
Medicine, Atlanta (Drexler).
(14)American Academy of Addiction Psychiatry, East Providence, Rhode Island 
(Cates-Wessel).

OBJECTIVE: The COVID-19 pandemic has dramatically affected health care delivery, 
effects that are juxtaposed with health care professional (HCP) burnout and 
mental distress. The Opioid Use Disorder Provider COVID-19 Survey was conducted 
to better understand the impact of COVID-19 on clinical practice and HCP 
well-being.
METHODS: The cross-sectional survey was e-mailed to listservs with approximately 
157,000 subscribers of diverse professions between July 14 and August 15, 2020. 
Two dependent variables evaluated HCP functioning and work-life balance. 
Independent variables assessed organizational practices and HCP experiences. 
Covariates included participant demographic characteristics, addiction board 
certification, and practice setting. Multilevel multivariate logistic regression 
models were used.
RESULTS: Among 812 survey respondents, most were men, White, and physicians, 
with 46% located in urban settings. Function-impairing anxiety was reported by 
17%, and 28% reported more difficulty with work-life balance. Difficulty with 
functioning was positively associated with having staff who were sick with 
COVID-19 and feeling close to patients, and was negatively associated with being 
male and having no staff changes. Difficulty with work-life balance was 
positively associated with addiction board certification; working in multiple 
settings; having layoffs, furloughs, or reduced hours; staff illness with 
COVID-19; and group well-being check-ins. It was negatively associated with male 
gender, older age, and no staff changes.
CONCLUSIONS: Demographic, provider, and organizational-practice variables were 
associated with reporting negative measures of well-being during the COVID-19 
pandemic. These results should inform HCPs and their organizations on factors 
that may lead to burnout, with particular focus on gender and age-related 
concerns and the role of well-being check-ins.

DOI: 10.1176/appi.ps.202100080
PMCID: PMC8825878
PMID: 34369804 [Indexed for MEDLINE]


3137. J Travel Med. 2021 Oct 11;28(7):taab123. doi: 10.1093/jtm/taab123.

Unintended health and societal consequences of international travel measures 
during the COVID-19 pandemic: a scoping review.

Klinger C(1)(2), Burns J(1)(2), Movsisyan A(1)(2), Biallas R(1)(2), Norris 
SL(1)(2)(3), Rabe JE(1)(2), Stratil JM(1)(2), Voss S(1)(2), Wabnitz K(1)(2), 
Rehfuess EA(1)(2), Verboom B(1)(2)(4); CEOsys Consortium.

Author information:
(1)Chair of Public Health and Health Services Research, Institute for Medical 
Information Processing, Biometry, and Epidemiology - IBE, LMU Munich, 
Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany.
(2)Pettenkofer School of Public Health, Chair of Public Health and Health 
Services Research, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, 
Germany.
(3)Department of Family Medicine, Oregon Health & Science University, 3181 SW 
Sam Jackson Park Rd, Portland, OR 97239, USA.
(4)Department of Social Policy and Intervention, University of Oxford, Barnett 
House, 32 Wellington Square Oxford OX1 2ER.

BACKGROUND/OBJECTIVE: International travel measures to contain the coronavirus 
disease of 2019 (COVID-19) pandemic represent a relatively intrusive form of 
non-pharmaceutical intervention. To inform decision-making on the 
(re)implementation, adaptation, relaxation or suspension of such measures, it is 
essential to not only assess their effectiveness but also their unintended 
effects.
METHODS: This scoping review maps existing empirical studies on the unintended 
consequences, both predicted and unforeseen, and beneficial or harmful, of 
international travel measures. We searched multiple health, non-health and 
COVID-19-specific databases. The evidence was charted in a map in relation to 
the study design, intervention and outcome categories identified and discussed 
narratively.
RESULTS: Twenty-three studies met our inclusion criteria-nine 
quasi-experimental, two observational, two mathematical modelling, six 
qualitative and four mixed-methods studies. Studies addressed different 
population groups across various countries worldwide. Seven studies provided 
information on unintended consequences of the closure of national borders, six 
looked at international travel restrictions and three investigated mandatory 
quarantine of international travellers. No studies looked at entry and/or exit 
screening at national borders exclusively, however six studies considered this 
intervention in combination with other international travel measures. In total, 
11 studies assessed various combinations of the aforementioned interventions. 
The outcomes were mostly referred to by the authors as harmful. Fifteen studies 
identified a variety of economic consequences, six reported on aspects related 
to quality of life, well-being, and mental health and five on social 
consequences. One study each provided information on equity, equality, and the 
fair distribution of benefits and burdens, environmental consequences and health 
system consequences.
CONCLUSION: This scoping review represents the first step towards a systematic 
assessment of the unintended benefits and harms of international travel measures 
during COVID-19. The key research gaps identified might be filled with targeted 
primary research, as well as the additional consideration of gray literature and 
non-empirical studies.

© International Society of Travel Medicine 2021. Published by Oxford University 
Press.

DOI: 10.1093/jtm/taab123
PMCID: PMC8436381
PMID: 34369562 [Indexed for MEDLINE]


3138. Acta Neuropsychiatr. 2021 Dec;33(6):331-334. doi: 10.1017/neu.2021.21. Epub 2021 
Aug 9.

Psychological well-being and symptoms of depression and anxiety across age 
groups during the second wave of the COVID-19 pandemic in Denmark.

Vistisen HT(1)(2), Sønderskov KM(3)(4), Dinesen PT(5), Østergaard SD(1)(2).

Author information:
(1)Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
(2)Department of Affective Disorders, Aarhus University Hospital - Psychiatry, 
Aarhus, Denmark.
(3)Department of Political Science, Aarhus University, Aarhus, Denmark.
(4)Centre for the Experimental-Philosophical Study of Discrimination, Aarhus 
University, Aarhus, Denmark.
(5)Department of Political Science, University of Copenhagen, Copenhagen, 
Denmark.

DOI: 10.1017/neu.2021.21
PMID: 34369332 [Indexed for MEDLINE]


3139. Autism Res. 2021 Oct;14(10):2183-2188. doi: 10.1002/aur.2589. Epub 2021 Aug 7.

Psychological distress among caregivers raising a child with autism spectrum 
disorder during the COVID-19 pandemic.

Kalb LG(1)(2), Badillo-Goicoechea E(2), Holingue C(1)(2), Riehm KE(2), Thrul 
J(2), Stuart EA(2), Smail EJ(2), Law K(1), White-Lehman C(3), Fallin D(2).

Author information:
(1)Kennedy Krieger Institute, Baltimore, Maryland, USA.
(2)Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 
Baltimore, Maryland, USA.
(3)Simons Foundation, New York, New York, USA.

The COVID-19 pandemic may disproportionately impact parents of children with 
autism spectrum disorder (ASD). Loss of services and supports, heightened fears 
about increased infection rates, and disruption of daily routines likely 
adversely affect the well-being of children with ASD and their families. The 
goal of this study was to examine differences in psychological distress-as 
defined by symptoms of anxiety, depression, loneliness, and hyperarousal-between 
parents raising a child with ASD and parents in the US as a whole during the 
early stages of the pandemic (March-April 2020). Parents raising a child with 
ASD (n = 3556) were recruited through SPARK, a national ASD research registry, 
whereas a representative sample of parents in the US (n = 5506) were recruited 
from the Pew Research Center's American Trends Panel. All data were captured via 
online surveys. Descriptive statistics and multivariable logistic regressions 
examined psychological distress at the item and summary score level. Parents of 
children with ASD reported higher levels of overall psychological distress (48% 
vs. 25%; aOR = 1.60, 95% CI: 1.32, 1.84, p < 0.001). Hyperarousal, or feelings 
of panic when thinking about COVID-19, was particularly prevalent among parents 
of children with ASD compared to parents in the US (25% vs. 9%; aOR = 2.38, 95% 
CI: 1.83, 3.07, p < 0.001). Findings highlight the importance of considering the 
policies and practices that contribute to poor mental health in parents, 
particularly those raising a child with ASD, to ensure mental health services 
remain accessible. LAY SUMMARY: This study examined the mental health of parents 
raising a child with ASD during the early stages of the COVID-19 pandemic. 
Results demonstrated substantially higher levels of psychological distress, 
particularly those related to feelings of panic, among parents raising a child 
with ASD when compared to parents in the US as a whole. These data suggest the 
need for ensuring mental health services are accessible to parents, particularly 
those raising a child with ASD, during and after the pandemic.

© 2021 International Society for Autism Research and Wiley Periodicals LLC.

DOI: 10.1002/aur.2589
PMCID: PMC8420467
PMID: 34363330 [Indexed for MEDLINE]


3140. Int J Environ Res Public Health. 2021 Aug 3;18(15):8202. doi: 
10.3390/ijerph18158202.

How Does the Assessment of Work Organization during the COVID-19 Pandemic Relate 
to Changes in the Well-Being of Health System Workers?

Kubilienė L(1), Griciūtė A(1), Miglinė V(2), Kukulskienė M(1), Stankūnienė A(3), 
Žemaitienė N(1).

Author information:
(1)Faculty of Public Health, Lithuanian University of Health Sciences, 44307 
Kaunas, Lithuania.
(2)Community Well-Being Center, Mykolas Romeris University, 08303 Vilnius, 
Lithuania.
(3)Department of Drug Technology and Social Pharmacy, Faculty of Pharmacy, 
Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania.

In the case of various emergencies, especially pandemics, healthcare workers are 
faced with disproportionate pressures. Organizational support plays a 
significant role in protecting the psychological and physical health of 
healthcare workers. This interdisciplinary research aims to determine how 
changes in the physical and psychological well-being of healthcare and pharmacy 
workers during the first wave of the COVID-19 lockdown are related to work 
organization factors that support safety and stability. A quantitative research 
strategy was applied in the research. Data from an electronic survey assessed 
the changes in the physical and psychological well-being of healthcare and 
pharmacy workers during the lockdown period and the organizational factors 
supporting safety and stability. The sample of the quantitative research 
consisted of 967 employees of healthcare institutions and pharmacies in 
Lithuania. This research broadens the concept of organizational factors and 
provides data on their interaction with the changes of employee well-being 
indicators in a pandemic situation. It was found that positive changes in the 
evaluation of physical as well as psychological well-being during the COVID-19 
lockdown could be consistently predicted by all the analyzed safety and 
stability supporting organizational factors that were found to be associated 
with subjective physical well-being and psychological well-being even when 
adjusting for the effect of socio-demographic factors (gender, age, work field, 
and specialty). The identification and proper management of organizational 
factors was significant for the psychological and physical well-being of 
healthcare workers during the lockdown period. It was found that all estimates 
of safety and stability supporting organizational factors during the first wave 
of the COVID-19 pandemic lockdown were positively related and could act as 
protective factors to the subjective physical and psychological well-being of 
healthcare and pharmacy workers.

DOI: 10.3390/ijerph18158202
PMCID: PMC8346129
PMID: 34360507 [Indexed for MEDLINE]

Conflict of interest statement: The authors declared no potential conflict of 
interest with respect to the research, authorship, and/or publication of this 
article.


3141. Int J Environ Res Public Health. 2021 Jul 30;18(15):8108. doi: 
10.3390/ijerph18158108.

Dental Nurses' Mental Health in Germany: A Nationwide Survey during the COVID-19 
Pandemic.

Mekhemar M(1), Attia S(2), Dörfer C(1), Conrad J(1).

Author information:
(1)Clinic for Conservative Dentistry and Periodontology, School of Dental 
Medicine, Kiel University, Arnold-Heller-Str. 3, Haus B, 24105 Kiel, Germany.
(2)Department of Oral and Maxillofacial Surgery, Justus-Liebig University 
Giessen, Klinik Str. 33, 35392 Giessen, Germany.

Several studies have found a rise in the rate of psychological discomfort among 
healthcare personnel since the COVID-19 pandemic outbreak. In this study, we 
analyzed the relationship between psychological variables of anxiety, 
depression, stress, avoidance, intrusion and hyperarousal and several factors 
among German dental nurses. For this poll, dental nurses were asked nationwide 
to take part via an online-based survey from July 2020 to January 2021. This 
survey gathered data on demographics, as well as psychological assessments 
through the Impact of Events Scale-Revised (IES-R) instrument, and the 
Depression Anxiety Stress Scales (DASS-21). The correlations between 
DASS-21/IES-R ratings and sociodemographic data were investigated using 
univariate analyses (Kruskal-Wallis and Mann-Whitney U tests). Single 
comparisons were performed using the Dunn-Bonferroni post hoc test if a relevant 
test result was significant followed by multiple linear regressions. 
Furthermore, 252 dental nurses took part in the study and showed overall normal 
or mild results of all psychological variables. Having immune-deficiency or 
chronic diseases, employment at a dental practice, being married, having no 
children and seeing the pandemic as a financial threat were presented as 
significant risk factors (p ≤ 0.05) with higher DASS-21 and IES-R scores. These 
results emphasize the aspects that must be considered to safeguard German dental 
nurses' mental wellbeing during the crisis.

DOI: 10.3390/ijerph18158108
PMCID: PMC8345776
PMID: 34360401 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3142. Int J Environ Res Public Health. 2021 Jul 28;18(15):7971. doi: 
10.3390/ijerph18157971.

Impact of COVID-19 on the Mental Health and Well-Being of Latinx Caregivers of 
Children with Intellectual and Developmental Disabilities.

Suarez-Balcazar Y(1), Mirza M(1), Errisuriz VL(2), Zeng W(3), Brown JP(1), 
Vanegas S(4), Heydarian N(3), Parra-Medina D(2), Morales P(3), Torres H(3), 
Magaña S(3).

Author information:
(1)Department of Occupational Therapy, University of Illinois Chicago, 1919 West 
Taylor, Chicago, IL 60612, USA.
(2)Latino Research Institute, University of Texas at Austin, 210 W. 24th St., 
Austin, TX 78712, USA.
(3)Steve Hicks School of Social Work, University of Texas at Austin, 1925 San 
Jacinto Blvd., Austin, TX 78712, USA.
(4)School of Social Work, Texas State University, Encino Hall, 712 North 
Commanche St., San Marcos, TX 78666, USA.

The COVID-19 pandemic has impacted the entire world in unprecedented ways. 
However, populations that have had a history of marginalization have experienced 
a more profound impact. One such group is Latinx families of children with 
intellectual and developmental disabilities (IDD) in the Unites States. In this 
study, we used a mixed methods approach to explore the impact of the pandemic on 
the mental health and well-being of Latinx caregivers of children with IDD. 
Specifically, we (1) identified which social determinants of health are 
correlated with maternal caregivers perceived general health, mental health, and 
well-being; (2) explored the impact of the pandemic on families' overall eating 
and physical activity routines; and (3) identified emergent themes from 
caregivers' experiences during the pandemic. Thirty-seven Latinx caregivers 
participated in three interviews in which several validated instruments were 
administered. The results indicated that perceived social support, annual family 
income, food security, and receipt of financial benefits were correlated with 
fewer depressive symptoms. Annual family income was also significantly 
correlated with perceived general health. Most caregivers reported that the 
pandemic had placed a strain on their economic situation; increased their 
isolation; and disrupted their child's therapeutic supports, online education, 
eating routines, and engagement in physical activity. Meanwhile, some caregivers 
reported positive changes as a result of the pandemic. Implications for future 
research and practice are discussed.

DOI: 10.3390/ijerph18157971
PMCID: PMC8345447
PMID: 34360263 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funder had no role in the content nor the writing of the manuscript.


3143. Int J Environ Res Public Health. 2021 Jul 22;18(15):7771. doi: 
10.3390/ijerph18157771.

The Effect of Pre-Quarantine Physical Activity on Anxiety and Depressive 
Symptoms during the COVID-19 Lockdown in the Kingdom of Saudi Arabia.

Alotaibi AS(1), Boukelia B(2).

Author information:
(1)Department of Education and Movement Sciences, College of Education, Qassim 
University. P.O. Box 6688, Qassim 51452, Saudi Arabia.
(2)Britannia Sport and Exercise Science Academy, 6/7 Duff Street Lane, Edinburgh 
EH11 2HS, UK.

The outbreak of COVID-19 and the changes to normal societal function and in 
particular quarantine has increased mental distress in many nations. A survey of 
22,112 COVID-19-negative quarantined participants in the Kingdom of Saudi Arabia 
(age: 18-40 years, 42.6%; 40-60 years, 53.3%; over 60 years, 4.1%; mass, 78.9 ± 
14.8 kg; stature, 167 ± 8.7 cm) were assessed for depressive symptoms using the 
online Beck Depression Inventory self-report questionnaire. The relationship 
between pre-quarantine physical activity and mental health and wellbeing during 
lockdown has been investigated. A significant difference in body mass index 
(BMI) between active and inactive participants (p = 0.03) was observed; with 
females also recording a 3% higher BMI than males. All participants showed a 
decrease in mental health compared to pre-quarantine. However, pre-quarantine 
inactivity was found to result in a greater negative impact on mental health and 
well-being than those active pre-quarantine (p < 0.01). The sedentary population 
had a 4-fold greater incidence of mild-depression than the active population. 
This suggests that activity level plays an important role in shielding people 
from anxiety and stress, whilst it builds mental strength in individuals that 
can be called upon in trying and difficult situations. Nevertheless, 
pre-quarantine activity levels did not lead to any significant change in levels 
of extreme depression in the sample population.

DOI: 10.3390/ijerph18157771
PMCID: PMC8345339
PMID: 34360091 [Indexed for MEDLINE]

Conflict of interest statement: The authors were wholly responsible for the 
research conducted in this paper and present the work without conflict of 
interest.


3144. Int J Environ Res Public Health. 2021 Jul 21;18(15):7736. doi: 
10.3390/ijerph18157736.

Smart City and Crisis Management: Lessons for the COVID-19 Pandemic.

Hassankhani M(1), Alidadi M(2), Sharifi A(3)(4), Azhdari A(2).

Author information:
(1)School of Planning and Design, Iran University of Science and Technology, 
Tehran 1684613114, Iran.
(2)Faculty of Arts and Architecture, Tarbiat Modares University, Tehran 
1411713116, Iran.
(3)Graduate School of Humanities and Social Sciences & Network for Education and 
Research on Peace and Sustainability (NERPS), Hiroshima University, Hiroshima 
739-8511, Japan.
(4)Graduate School of Advanced Science and Engineering, Hiroshima University, 
Hiroshima 739-8511, Japan.

COVID-19 shocked cities around the world and revealed the vulnerability of urban 
lives and functions. Most cities experienced a catastrophic disturbance that has 
lasted for a long time. Planning plays a critical role in responding efficiently 
to this crisis and enabling rapid functional recovery in the post-disaster era. 
Cities that have implemented digitalization initiatives and programs are likely 
to have more capacity to react appropriately. Specifically, digitalized cities 
could ensure the well-being of their residents and maintain continuity of urban 
functions. This research aims to analyze the role of technology in crisis 
management in the last two decades and provide appropriate policy 
recommendations for dealing with the COVID-19 pandemic. Systematic literature 
review and subjective content analysis are employed to investigate the effects 
of technology on community well-being and making cities more resilient in past 
crises. This study shows that different technology-driven policies and actions 
enable crisis management, enhance community well-being, and increase urban 
resilience. Technology has enhanced coping and recovery capacities by increasing 
participation and social connectedness, enhancing physical and mental health and 
maintaining the functionality of education and economic systems. These have been 
achieved through various solutions and technologies such as social media, 
telehealth, tracking and monitoring systems, sensors and locational 
applications, teleworking systems, etc. These solutions and technologies have 
also been used during the COVID-19 pandemic to enhance community well-being and 
sustain urban functions. However, technology deployment might have adverse 
effects such as social exclusion, digital divide, privacy and confidentiality 
violation, political bias and misinformation dissemination, and inefficient 
remote working and education. It is suggested that to mitigate these side 
effects, policymakers should liberate the process of digitalization, increase 
the accessibility to digital services, and enhance digital literacy.

DOI: 10.3390/ijerph18157736
PMCID: PMC8345545
PMID: 34360029 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3145. Healthcare (Basel). 2021 Jul 8;9(7):865. doi: 10.3390/healthcare9070865.

Six-Month Outcomes in COVID-19 ICU Patients and Their Family Members: A 
Prospective Cohort Study.

van Veenendaal N(1)(2), van der Meulen IC(1)(3), Onrust M(1)(3), Paans W(1)(3), 
Dieperink W(1)(3), van der Voort PHJ(1)(4).

Author information:
(1)Department of Critical Care, University Medical Center Groningen, University 
of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
(2)Department of Anesthesiology, University Medical Center Groningen, University 
of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
(3)School of Nursing, Professorship Nursing Diagnosis, Hanze University of 
Applied Science, P.O. Box 3109, 9701 DC Groningen, The Netherlands.
(4)TIAS School for Business and Society, Tilburg University, P.O. Box 90153, 
5000 LE Tilburg, The Netherlands.

BACKGROUND: The COVID-19 pandemic has resulted in a major influx of intensive 
care unit (ICU) admissions. Currently, there is limited knowledge on the 
long-term outcomes of COVID-19 ICU-survivors and the impact on family members. 
This study aimed to gain an insight into the long-term physical, social and 
psychological functioning of COVID-19 ICU-survivors and their family members at 
three- and six-months following ICU discharge.
METHODS: A single-center, prospective cohort study was conducted among COVID-19 
ICU-survivors and their family members. Participants received questionnaires at 
three and six months after ICU discharge. Physical functioning was evaluated 
using the MOS Short-Form General Health Survey, Clinical Frailty Scale and 
spirometry tests. Social functioning was determined using the McMaster Family 
Assessment Device and return to work. Psychological functioning was assessed 
using the Hospital Anxiety and Depression Scale.
RESULTS: Sixty COVID-19 ICU-survivors and 78 family members participated in this 
study. Physical functioning was impaired in ICU-survivors as reflected by a 
score of 33.3 (IQR 16.7-66.7) and 50 (IQR 16.7-83.3) out of 100 at 3- and 
6-month follow-ups, respectively. Ninety percent of ICU-survivors reported 
persistent symptoms after 6 months. Social functioning was impaired since 90% of 
COVID-19 ICU-survivors had not reached their pre-ICU work level 6 months after 
ICU-discharge. Psychological functioning was unaffected in COVID-19 
ICU-survivors. Family members experienced worse work status in 35% and 34% of 
cases, including a decrease in work rate among 18.3% and 7.4% of cases at 3- and 
6-months post ICU-discharge, respectively. Psychologically, 63% of family 
members reported ongoing impaired well-being due to the COVID-19-related 
mandatory physical distance from their relatives.
CONCLUSION: COVID-19 ICU-survivors suffer from a prolonged disease burden, which 
is prominent in physical and social functioning, work status and persisting 
symptoms among 90% of patients. Family members reported a reduction in return to 
work and impaired well-being. Further research is needed to extend the follow-up 
period and study the effects of standardized rehabilitation in COVID-19 patients 
and their family members.

DOI: 10.3390/healthcare9070865
PMCID: PMC8305246
PMID: 34356243

Conflict of interest statement: The authors declare no potential conflict of 
interest with respect to the research, authorship and/or publication of the 
article.


3146. BMC Public Health. 2021 Aug 5;21(1):1510. doi: 10.1186/s12889-021-11489-y.

A randomised controlled trial of the Nextdoor Kind Challenge: a study protocol.

Lim MH(1), Qualter P(2), Hennessey A(2), Smith BJ(3), Argent T(4), Holt-Lunstad 
J(4)(5).

Author information:
(1)Iverson Health Innovation Research Institute, Swinburne University of 
Technology, Hawthorn, Victoria, Australia. mlim@swin.edu.au.
(2)Manchester Institute of Education, University of Manchester, Manchester, UK.
(3)University of Sydney, Camperdown, NSW, Australia.
(4)Iverson Health Innovation Research Institute, Swinburne University of 
Technology, Hawthorn, Victoria, Australia.
(5)Brigham Young University, Provo, UT, USA.

BACKGROUND: Community interventions are often promoted as a way of reducing 
loneliness and social isolation in our neighbourhoods. However, those community 
interventions are rarely examined within rigorous study designs. One strategy 
that holds the potential to reduce loneliness and can promote health and 
wellbeing is doing acts of kindness. The current study involves evaluating the 
impact of kindness acts on loneliness in community-dwelling individuals using an 
online social networking platform.
METHODS: This study is made up of three randomised controlled trials conducted 
in three countries. Each randomised controlled trial has two arms (intervention 
vs waitlist control) and is designed to compare the effectiveness of the KIND 
challenge, which involves doing at least one act of kindness per week within a 
four-week period. This study will recruit users of an online community, be 
randomised online, and will be conducted using online assessments. We will first 
explore the effects of the intervention on the primary outcome of loneliness, 
followed by secondary outcomes, social isolation, neighbour relationship quality 
and contact, mental health symptoms, stress, quality of life, and positive 
affect. Further, we will assess the feasibility, acceptability, and safety of 
the KIND Challenge.
DISCUSSION: This study, designed to evaluate the impact of kindness on the 
community, will be the first large scale randomised control trial conducted 
across three countries, Australia, UK, and USA. It will examine the potential of 
community-led interventions to reduce loneliness, improve social isolation, and 
promote neighbourhood cohesion, health, and wellbeing, which is especially 
crucial during the COVID-19 public health crisis.
TRIAL REGISTRATION: Clinical Trials Registry. NCT04398472 . Registered 21st May 
2020.

© 2021. The Author(s).

DOI: 10.1186/s12889-021-11489-y
PMCID: PMC8339389
PMID: 34353299 [Indexed for MEDLINE]

Conflict of interest statement: Professor Julianne Holt-Lunstad is on the 
Nextdoor Neighborhood Vitality Board. The other authors declare no conflict of 
interest in relation to the project.


3147. J Community Psychol. 2022 Mar;50(2):760-777. doi: 10.1002/jcop.22678. Epub 2021 
Aug 5.

Associations between critical consciousness and well-being in a national sample 
of college students during the COVID-19 pandemic.

Maker Castro E(1), Dull B(2), Hoyt LT(2), Cohen AK(3).

Author information:
(1)Division of Human Development and Psychology, Graduate School of Education 
and Information Sciences, University of California, Los Angeles, California, 
USA.
(2)Department of Psychology, Fordham University, New York City, New York, USA.
(3)Department of Epidemiology and Biostatistics, School of Medicine, University 
of California San Francisco, San Francisco, California, USA.

Critical consciousness (CC) may promote well-being, particularly during the 
COVID-19 pandemic. In a national survey of 707 college students conducted in 
April 2020, we first validated the Short Critical Consciousness Scale (ShoCCS) 
among youth groups not often specifically examined in CC measurement (i.e., 
Asian, immigrant-origin, LGBQ+, and women youth). Next, we examined associations 
between ShoCCS subscales and validated measures of both anxiety (Generalized 
Anxiety Disorder-7) and hopefulness (The Individual-Differences Measure in 
Hopefulness). The ShoCCS achieved measurement invariance across racial/ethnic 
groups and immigrant-origin status, and partial invariance among LGBQ+ and 
women-identifying youth. We found critical reflection and action associated with 
anxiety for the full sample, but no evidence of moderation by sociodemographic 
factors. ShoCCS subscales were differentially associated with hopefulness for 
Asian youth and LGBQ+ youth. This study contributes to the evolution of CC 
measurement and extends the field by identifying well-being associations during 
the onset of the COVID-19 pandemic.

© 2021 Wiley Periodicals LLC.

DOI: 10.1002/jcop.22678
PMCID: PMC8426919
PMID: 34352131 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that there are no conflict 
of interests.


3148. J Med Internet Res. 2021 Sep 1;23(9):e29024. doi: 10.2196/29024.

Experience of and Worry About Discrimination, Social Media Use, and Depression 
Among Asians in the United States During the COVID-19 Pandemic: Cross-sectional 
Survey Study.

Pan S(1)(2), Yang CC(3), Tsai JY(4), Dong C(1).

Author information:
(1)School of Journalism and Communication, Renmin University of China, Beijing, 
China.
(2)Center of Journalism and Social Development, Renmin University of China, 
Beijing, China.
(3)School of Educational Foundations, Leadership and Aviation, Oklahoma State 
University, Stillwater, OK, United States.
(4)School of Communication, College of Social & Behavioral Sciences, Northern 
Arizona University, Flagstaff, AZ, United States.

BACKGROUND: The COVID-19 outbreak has spurred increasing anti-Asian racism and 
xenophobia in the United States, which might be detrimental to the psychological 
well-being of Asian people living in the United States.
OBJECTIVE: We studied three discrimination-related variables, including (1) 
experience of discrimination, (2) worry about discrimination, and (3) 
racism-related social media use during the COVID-19 pandemic among Asians in the 
United States. We examined how these three variables were related to depression, 
and how the association between racism-related social media use and depression 
was moderated by personal experience of and worry about racial discrimination.
METHODS: A web-based, cross-sectional survey was conducted. A total of 209 
people (mean age 33.69, SD 11.31 years; 96/209, 45.93% female) who identified 
themselves as Asian and resided in the United States were included in the study.
RESULTS: Experience of discrimination (β=.33, P=.001) and racism-related social 
media use (β=.14, P=.045) were positively associated with depressive symptoms. 
Worry about discrimination (β=.13, P=.14) was not associated with depression. 
Worry about discrimination moderated the relationship between racism-related 
social media use and depression (β=-.25, P=.003) such that a positive 
relationship was observed among those who had low and medium levels of worry.
CONCLUSIONS: The present study provided preliminary evidence that experience of 
discrimination during the COVID-19 pandemic was a risk factor of depressive 
symptoms among Asian people in the United States. Meanwhile, racism-related 
social media use was found to be negatively associated with the well-being of US 
Asians, and the relationship between social media use and depression was 
significantly moderated by worry about discrimination. It is critical to develop 
accessible programs to help US Asians cope with racial discrimination both in 
real lives and on social media during this unprecedented health crisis, 
especially among those who have not been mentally prepared for such challenges.

©Shuya Pan, Chia-chen Yang, Jiun-Yi Tsai, Chenyu Dong. Originally published in 
the Journal of Medical Internet Research (https://www.jmir.org), 01.09.2021.

DOI: 10.2196/29024
PMCID: PMC8412135
PMID: 34351304 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


3149. Intern Med J. 2021 Sep;51(9):1407-1413. doi: 10.1111/imj.15465.

Concerns and psychological well-being of healthcare workers during the COVID-19 
pandemic in a tertiary care hospital in New South Wales.

Naqvi SSB(1)(2), Davis J(1)(2)(3), Pickles RW(1)(2), Loewenthal MR(1)(2).

Author information:
(1)Infectious Diseases Department, John Hunter Hospital, Newcastle, New South 
Wales, Australia.
(2)School of Medicine and Public Health, University of Newcastle, Newcastle, New 
South Wales, Australia.
(3)Global and Tropical Health Division, Menzies School of Health Research, 
Darwin, Northern Territory, Australia.

BACKGROUND: In early 2020, the impending COVID-19 pandemic placed a 
once-in-a-generation professional and personal challenge on healthcare workers. 
Publications on direct physical disease abound. The authors wanted to focus on 
doctors' psychological well-being.
AIMS: To assess the impact of the COVID-19 pandemic on doctors' well-being and 
evaluate their concerns as the pandemic progressed.
METHODS: A mixed-methods, hospital-based survey was sent to doctors at the 
650-bed tertiary referral hospital in NSW at two different periods (late-March 
and early May 2020). A validated mental well-being tool (Short Warwick Edinburgh 
Mental Well-being Scale (SWEMWBS)) was combined with COVID-19-specific 
questions.
RESULTS: Two hundred and thirty-five responses were obtained from 450 doctors, 
with a response rate of 32% in the first survey and 20% in the second. The 
majority (35%) of respondents were doctors-in-training, followed by 
staff-specialists (23%). The highest response was from frontline workers in both 
surveys, including the intensive care unit (27%), anaesthesia (21%) and 
emergency department (13%). 'Extreme concern' regarding personal protective 
equipment (PPE) shortage dropped from 22.6% to 2.2% and 'extreme concern' of 
contracting COVID-19 fell from 22.6% to 3.4% in the second survey. The 
proportion of respondents with a 'low' psychological well-being score improved 
from 38% to 27% between the two surveys. The resulting mean improvement in the 
SWEMWBS was 3.49 (95% confidence interval = 3.06-3.91, P < 0.001).
CONCLUSION: Both COVID-19 specific concerns and psychological well-being 
improved greatly in the second survey. Possible explanations are the fall in 
COVID-19 cases in the district, improvements in PPE supply and supportive 
measures communicated to doctors during this period.

© 2021 Royal Australasian College of Physicians.

DOI: 10.1111/imj.15465
PMCID: PMC8447026
PMID: 34346147 [Indexed for MEDLINE]


3150. BMC Public Health. 2021 Aug 4;21(1):1502. doi: 10.1186/s12889-021-11476-3.

Perceptions of Covid-19 lockdowns and related public health measures in Austria: 
a longitudinal online survey.

Łaszewska A(1), Helter T(2), Simon J(2).

Author information:
(1)Medical University of Vienna, Center for Public Health, Department of Health 
Economics, Kinderspitalgasse 15, 1090, Vienna, Austria. 
agata.laszewska@meduniwien.ac.at.
(2)Medical University of Vienna, Center for Public Health, Department of Health 
Economics, Kinderspitalgasse 15, 1090, Vienna, Austria.

BACKGROUND: Introducing national lockdown has been effective in containing 
Covid-19. However, several studies indicated negative impacts of lockdowns on 
the well-being and mental health of many people. In Austria, the first 
Covid-19-related lockdown was introduced on 16 March 2020 with most restrictions 
being lifted 1 month later. Seven months after that, in November 2020, the 
second full lockdown was implemented. The aim of this study was to compare the 
perceptions and experiences of the general population related to the first and 
second Covid-19 lockdowns in Austria.
METHODS: Two waves of an online survey were conducted in May and December 2020 
asking respondents about their concerns related to the Covid-19 illness, 
personal experiences of the lockdowns, perceptions of and compliance with 
imposed public health measures, and the impact of the Covid-19 pandemic on 
different aspects of life during the two lockdowns. Descriptive statistics 
including frequency analysis were used to compare respondents' answers collected 
in the two waves of the survey. T-test and chi-square tests were used to test 
differences between the two lockdowns.
RESULTS: Five hundred sixty participants were included in the first wave and a 
sub-sample of 134 participants in the second wave of data collection. During the 
second lockdown, study respondents were more concerned about their family 
members contracting Covid-19 when compared with the first lockdown. Compliance 
with public health measures was overall lower during the second lockdown, 
although it varied according to the type of the measure. Closure of schools was 
seen as the least essential restriction during the second lockdown, while 
wearing masks gained additional approval between the first and the second 
lockdown. Larger negative impacts of the Covid-19 pandemic on friendships, 
leisure activities, education and community were reported during the second 
lockdown.
CONCLUSIONS: The study found that the extended duration of the pandemic and 
recurring lockdowns restricting freedom of movement and social contacts appear 
to have caused significant disruptions to many areas of life. Furthermore, 
declining adherence to most public health measures over time raises a question 
about the effectiveness of future lockdown measures.

© 2021. The Author(s).

DOI: 10.1186/s12889-021-11476-3
PMCID: PMC8331215
PMID: 34344343 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


3151. BMC Psychiatry. 2021 Aug 3;21(1):385. doi: 10.1186/s12888-021-03389-7.

COVID-19 related poor mental health and sleep disorders in rheumatic patients: a 
citizen science project.

Ingegnoli F(#)(1)(2), Buoli M(#)(3)(4), Posio C(4), Di Taranto R(5)(6), Lo 
Muscio A(4), Cumbo E(5)(6), Ostuzzi S(7), Caporali R(5)(6).

Author information:
(1)Division of Clinical Rheumatology, ASST Pini, Milan, Italy. 
francesca.ingegnoli@unimi.it.
(2)Department of Clinical Sciences & Community Health, Research Center for Adult 
and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Piazza 
Cardinal Ferrari 1, 20122, Milan, Italy. francesca.ingegnoli@unimi.it.
(3)Department of Neurosciences and Mental Health, Fondazione IRCCS Ca'Granda 
Ospedale Maggiore Policlinico, Milan, Italy.
(4)Department of Pathophysiology and Transplantation, Università degli Studi di 
Milano, Milan, Italy.
(5)Division of Clinical Rheumatology, ASST Pini, Milan, Italy.
(6)Department of Clinical Sciences & Community Health, Research Center for Adult 
and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Piazza 
Cardinal Ferrari 1, 20122, Milan, Italy.
(7)ALOMAR Lombard Association for Rheumatic Diseases, Milan, Italy.
(#)Contributed equally

BACKGROUND: Patients with chronic rheumatic diseases (RDs) are more vulnerable 
and the containment measures related to the COVID-19 pandemic might have severe 
psychological consequences. We investigated the presence of and risk factors 
associated with poor mental health, sleep disorders among RDs during the 
pandemic.
METHODS: This cross-sectional Italian citizen science project evaluated the 
psychological impact of the COVID-19 pandemic in patients with RDs. Between May 
and September 2020, eleven RD patients' associations sent the survey by using 
their mailing list and the related webpage and social network. 507 RD patients 
completed an ad-hoc anonymous online survey including the Perceived Stress Scale 
(PSS) and Impact Event Scale-Revised (IES-R).
RESULTS: The mean scores on the PSS-10 and the IES-R were 18.1 and 29.7, 
respectively. Higher PSS scores were associated with younger age (p <  0.01), 
female gender (p <  0.01), overweight/obesity (p = 0.01), psychiatric 
pharmacotherapy (p <  0.01), and anxiety for loss of income (p <  0.01). Higher 
IES-R scores were associated with female gender (p <  0.01), intestinal diseases 
(p = 0.03), anxiety (p <  0.01), and health concern (p <  0.01). Among 375 
patients with inflammatory arthritis, 246 (65.6%) had trouble staying asleep, 
238 (63.5%) falling asleep, and 112 (29.9%) had dreams about the pandemic. Older 
age (OR = 1.038, CI 1.002-1.076), psychiatric pharmacotherapy (OR = 25.819, CI 
11.465-58.143), and COVID infection (OR = 2.783, CI 1.215-6.372) were predictive 
of insomnia during the pandemic.
CONCLUSIONS: A considerable COVID-19 related psychosocial burden has been 
detected in RDs. Different factors were predictive of poor mental health and 
sleep disorders in these patients. Focused supportive strategies should be 
implemented to improve the psychological well-being of fragile patients during 
pandemics.

© 2021. The Author(s).

DOI: 10.1186/s12888-021-03389-7
PMCID: PMC8330176
PMID: 34344329 [Indexed for MEDLINE]

Conflict of interest statement: The authors report no conflicts of interest.


3152. PLoS One. 2021 Aug 3;16(8):e0255251. doi: 10.1371/journal.pone.0255251. 
eCollection 2021.

Patterns of mental health problems before and after easing COVID-19 
restrictions: Evidence from a 105248-subject survey in general population in 
China.

Jiang D(1), Chen J(2), Liu Y(1), Lin J(2), Liu K(1), Chen H(3), Jiang X(1), 
Zhang Y(2), Chen X(4), Cui B(2), Jiang S(5), Jiang J(6), Zhang H(7), Hu H(6), Li 
C(1)(8), Li W(9), Li E(3), Pan H(3).

Author information:
(1)Department of Community Health Sciences, University of Manitoba, Winnipeg, 
Canada.
(2)First Affiliated Hospital of Shantou University Medical College, Shantou, 
Guangdong, China.
(3)Shantou Longhu People's Hospital, Shantou, Guangdong, China.
(4)Manitoba Health, Seniors and Active Living, Government of Manitoba, Winnipeg, 
Canada.
(5)School of Mathematics and Statistics, Yunnan Minzu University, Kunming, 
China.
(6)Affiliated Nanhai Hospital of Southern Medical University, Foshan, Guangdong, 
China.
(7)School of Public Health, Southeast University, Nanjing, China.
(8)School of Sciences, Nanjing Forest University, Nanjing, China.
(9)AstraZeneca China Co. Ltd, Shanghai, China.

BACKGROUND: The COVID-19 pandemic has alarming implications for individual and 
population level mental health. Although the future of COVID-19 is unknown at 
present, more countries or regions start to ease restrictions. The findings from 
this study have provided the empirical evidence of prevalence and patterns of 
mental disorders in Chinese general population before and after easing most 
COVID-19 restrictions, and information of the factors associated with these 
patterns.
METHODS: A cross-sectional population-based online survey was carried out from 
February to March 2020 in the general population across all provinces in China. 
The 12-item General Health Questionnaire (GHQ-12) was incorporated in the 
survey. Latent class analyses were performed to investigate the patterns of 
mental disorders and multinomial logistic regressions were used to examine how 
individual and regional risk factors can predict mental disorder patterns.
RESULTS: Four distinctive patterns of mental health were revealed in the general 
population. After the ease of most COVID-19 restrictions, the prevalence of high 
risk of mental disorders decreased from 25.8% to 20.9% and prevalence of being 
high risk of unhappiness and loss of confidence decreased from 10.1% to 8.1%. 
However, the prevalence of stressed, social dysfunction and unhappy were 
consistently high before and after easing restrictions. Several regional 
factors, such as case mortality rate and healthcare resources, were associated 
with mental health status. Of note, healthcare workers were less likely to have 
mental disorders, compared to other professionals and students.
CONCLUSIONS: The dynamic management of mental health and psychosocial well-being 
is as important as that of physical health both before and after the ease of 
COVID-19 restrictions. Our findings may help in mental health interventions in 
other countries and regions while easing COVID-19 restrictions.

DOI: 10.1371/journal.pone.0255251
PMCID: PMC8331222
PMID: 34344018 [Indexed for MEDLINE]

Conflict of interest statement: No authors, including Wenjuan Li from Yunque 
Medical Technology Shanghai Co. Ltd who just moved to a new position at 
AstraZeneca China Co. Ltd, have competing interests. The funders, Li Ka Shing 
Foundation and Canadian Institute of Health Research, have not provided any 
salaries for any author, and have no role in study design, data collection and 
analysis, decision to publish, or preparation of the manuscript. The commercial 
affiliation (AstraZeneca China Co. Ltd) does not alter our adherence to PLOS ONE 
policies on sharing data and materials.


3153. Afr J Prim Health Care Fam Med. 2021 Jul 23;13(1):e1-e3. doi: 
10.4102/phcfm.v13i1.3045.

The contribution of family physicians to residential mental health care during 
the COVID-19 pandemic in Tshwane District, South Africa.

Kruger A(1), Eales OO, Jansen van Vuuren S.

Author information:
(1)Department of Family Medicine, Faculty of Health Sciences, University of 
Pretoria, Pretoria. annelet.kruger@up.ac.za.

During the start of the first wave of the coronavirus disease 2019 (COVID-19) 
pandemic, two family physicians in Tshwane, South Africa, reviewed the people at 
high-risk within their Health Catchment Area. The largest residential mental 
health care facility in Gauteng fell under their care, and they were responsible 
for providing care and support to this facility. Family physicians have to lead 
the primary care team and simultaneously take care of the well-being of their 
team members. This report discusses how these family physicians used digital 
platforms and virtual care to successfully coordinate and manage the response to 
an outbreak of COVID-19 at this mental healthcare facility.

DOI: 10.4102/phcfm.v13i1.3045
PMCID: PMC8335769
PMID: 34342476 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no financial 
or personal relationships that may have inappropriately influenced them in 
writing this article.


3154. Fam Process. 2022 Jun;61(2):722-744. doi: 10.1111/famp.12698. Epub 2021 Aug 2.

Differential impact of stay-at-home orders on mental health in adults who are 
homeschooling or "childless at home" in time of COVID-19.

Cuadrado E(1)(2), Arenas A(1)(3), Moyano M(1)(2), Tabernero C(4)(5).

Author information:
(1)Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain.
(2)University of Cordoba, Cordoba, Spain.
(3)University of Seville, Seville, Spain.
(4)University of Salamanca, Salamanca, Spain.
(5)Neurosciences Institute of Castilla y Leon (INCyL), Salamanca, Spain.

The COVID-19 pandemic has forced the confinement of most populations worldwide, 
through stay-at-home orders. Children have continued their education process at 
home, supervised by parents, who, in most cases, have adopted the role of prime 
drivers of their learning processes. In this study, the psychological impact of 
confinement was explored, as well as the relationship of the forced 
homeschooling situation with psychological well-being. During their confinement, 
400 individuals residing in Spain-165 without children at home (Group 1), 104 
parents who dedicated little time to homeschooling (Group 2), and 131 who 
dedicated more time to homeschooling (Group 3)-responded to an online 
questionnaire. The results show that confinement threatened the mental health of 
all the participants but especially Group 3 individuals, who had the highest 
loneliness, anxiety, and stress levels. Moreover, loneliness, perception of 
discomfort due to homeschooling, and anxiety exacerbated the stress experienced 
during confinement. Discomfort due to the homeschooling situation was especially 
relevant in explaining anxiety and stress for Group 3 individuals. These results 
suggest that forced homeschooling could be associated with the negative 
consequences that confinement has on individuals' mental health. Moreover, the 
results suggest that parents who dedicate more time to homeschooling feel more 
unprotected and more stressed due to the homeschooling in comparison to Group 2 
individuals. Health professionals must pay special attention to parents who 
dedicate more time to homeschooling, and governments and schools must emphasize 
social support provision to families during homeschooling situations.

Publisher: La pandemia de la COVID-19 ha impuesto el confinamiento de la mayoría 
de las poblaciones de todo el mundo mediante órdenes de quedarse en casa. Los 
niños han continuado su proceso de escolarización en sus hogares, supervisados 
por los padres, quienes, en la mayoría de los casos, han adoptado el papel de 
impulsores principales de sus procesos de aprendizaje. En este estudio se 
analizó el efecto psicológico del confinamiento, así como la relación de la 
situación forzada de enseñanza en el hogar con el bienestar psicológico. Durante 
su confinamiento, 400 personas residentes en España -165 sin niños en casa 
(grupo 1), 104 padres que dedicaron poco tiempo a la enseñanza en el hogar 
(grupo 2), y 131 que dedicaron más tiempo a la enseñanza en el hogar (grupo 3)- 
respondieron un cuestionario en línea. Los resultados demuestran que el 
confinamiento amenazó la salud mental de todos los participantes, pero 
especialmente la de las personas del grupo 3, quienes demostraron mayores 
niveles de soledad, ansiedad y estrés. Además, la soledad, la percepción de 
incomodidad a consecuencia de la enseñanza en el hogar, y la ansiedad agravaron 
el estrés sufrido durante el confinamiento. La incomodidad provocada por la 
situación de enseñanza en el hogar fue especialmente importante para explicar la 
ansiedad y el estrés de las personas del grupo 3. Estos resultados sugieren que 
la enseñanza forzada en el hogar podría estar asociada con las consecuencias 
negativas que tiene el confinamiento en la salud mental. Además, los resultados 
indican que los padres que dedican más tiempo a la enseñanza en el hogar se 
sienten más desprotegidos y más estresados debido a este tipo de enseñanza en 
comparación con las personas del grupo 2. Los profesionales de la salud deben 
prestar especial atención a los padres que dedican más tiempo a la enseñanza en 
el hogar, y los gobiernos y centros educativos deben brindar más apoyo social a 
las familias durante las situaciones de enseñanza en el hogar.

Publisher: 
2019新冠病毒(COVID-19)大流行病迫使世界各地的大多数人因为留在家里的命令被禁闭。孩子们在家里继续他们的教育过程，由父母监督，在大多数情况下，父母是他们学习过程的主要推动者。在这项研究中，我们探讨了禁闭的心理影响，以及强迫式的家庭教育境况与心理健康的关系。在禁闭期间，居住在西班牙的400名受试者--其中165名家中没有孩子的人（第1组），104名家长很少有时间致力于家庭教育的父母（第2组），以及131名花较多时间致力于家庭教育的父母（第3组）--回答了一份在线调查问卷。结果显示，禁闭威胁着所有参与者的心理健康，但特别是第3组的人，他们的孤独感、焦虑和压力水平最高。此外，孤独感、对家庭教育带来的不适感和焦虑感加剧了禁闭期间的压力。在解释第3组人的焦虑和压力时，由于家庭教育情况造成的不适感尤为重要。这些结果表明，强迫家庭教育可能与禁闭对个人心理健康产生的消极后果有关。此外，研究结果表明，与第2组个体相比，为家庭教育投入更多时间的父母感到更多的不受保护和更多的压力。卫生专业人员必须特别关注那些花更多时间在家庭教育上的父母，而政府和学校必须强调在在家上学的家庭教育情况下向家庭提供社会支持。.

© 2021 The Authors. Family Process published by Wiley Periodicals LLC on behalf 
of Family Process Institute.

DOI: 10.1111/famp.12698
PMCID: PMC8444921
PMID: 34341992 [Indexed for MEDLINE]

Conflict of interest statement: The authors report no conflict of interest.


3155. BMC Med Educ. 2021 Aug 2;21(1):413. doi: 10.1186/s12909-021-02798-2.

A longitudinal investigation of mental health, perceived learning environment 
and burdens in a cohort of first-year German medical students' before and during 
the COVID-19 'new normal'.

Schindler AK(1), Polujanski S(2), Rotthoff T(2).

Author information:
(1)Medical Didactics and Educational Research; DEMEDA (Department of Medical 
Education); Medical Faculty, University of Augsburg, Universitätsstr. 2, 86159, 
Augsburg, Germany. ann-kathrin.schindler@med.uni-augsburg.de.
(2)Medical Didactics and Educational Research; DEMEDA (Department of Medical 
Education); Medical Faculty, University of Augsburg, Universitätsstr. 2, 86159, 
Augsburg, Germany.

BACKGROUND: Medical students' propensity to develop mental morbidity has been 
described for decades but remains unresolved. To assess student mental health 
person-centred and longitudinally, we have been investigating a cohort of German 
students since October 2019. After their first semester under 'normal' 
conditions, rapid changes became necessary due to the COVID-19 situation. In 
line with the initial aim, we investigated students' change of mental health, 
perceived learning environment and burdens in the 'new normal'.
METHODS: Students in a newly founded German medical study programme (n = 63) 
answered a questionnaire each semester (October 2019 = entering medical school; 
December 2019 = 'old normal'; June 2020 = 'new normal'; December 2020 = 'new 
normal') on their well-being (FAHW-12), burnout (Maslach Inventory), depression 
(PHQ-9), perception of the learning environment (DREEM), burdens and protective 
attitudes in the 'new normal' (items designed for the study).
RESULTS: Friedman tests reveal overall significant differences (all p < .001) in 
depression and burnout (emotional exhaustion, depersonalisation, personal 
accomplishment); changes in well-being were identified as just non-significant 
(p = .05). The effects were explained by a significant increase in burnout and 
depression identified post-hoc from October 2019 to December 2019. No increase 
in severity was identified in the 'new normal' semesters. The learning 
environment was perceived positively even with a significant improvement for 
June 2020 (repeated measures ANOVA p < .001). Study-related burdens (e.g. 
procrastination of online-learning material) took on greater relevance than 
burdens related to physicians' occupation (e.g. potential for students' 
recruitment to the healthcare system during their studies).
CONCLUSIONS: The 'new' when entering medical school had a greater impact on our 
students' mental health than the 'new normal'. The readiness for change in the 
context of a newly designed study programme may have been beneficial with regard 
to students' positively perceived learning environment during the virtual 
semesters. Monitoring medical students' mental health longitudinally should be a 
concern regardless of a pandemic.

© 2021. The Author(s).

DOI: 10.1186/s12909-021-02798-2
PMCID: PMC8327055
PMID: 34340659 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3156. J Clin Nurs. 2021 Nov;30(21-22):3153-3162. doi: 10.1111/jocn.15783. Epub 2021 
Aug 1.

The relationship of nurses' psychological well-being with their coronaphobia and 
work-life balance during the COVID-19 pandemic: A cross-sectional study.

Yayla A(1), Eskici İlgin V(1).

Author information:
(1)Department of Surgical Nursing, Faculty of Nursing, Atatürk University, 
Erzurum, Turkey.

Comment in
    Evid Based Nurs. 2022 Jul;25(3):100.

AIMS AND OBJECTIVES: This study aimed to determine the relationship of nurses' 
psychological well-being with their coronaphobia and work-life balance during 
the COVID-19 pandemic.
BACKGROUND: COVID-19 is a global life-threatening disease. The COVID-19 pandemic 
negatively affects nurses' mental health. No studies have been conducted to 
determine the factors that affect nurses' psychological well-being during the 
COVID-19 pandemic in Turkey. If nurses' psychological well-being is impaired 
during the COVID-19 pandemic, the quality of nursing care and the nurses' 
performance may be negatively affected.
DESIGN: This is a descriptive, correlational and cross-sectional study. The 
Strengthening the Reporting of Observational studies in Epidemiology (STROBE) 
reporting guideline checklist for cross-sectional studies was used for reporting 
in this study.
METHODS: The study population consisted of the nurses working in a Health 
Application and Research Center in Turkey. Data were collected using Google 
forms between June-August 2020. The study sample consisted of 295 nurses who 
voluntarily agreed to participate in the study and used social media tools. The 
data were collected using a Sociodemographic Characteristics Form, the COVID-19 
Phobia Scale (C19P-S), the Work-Life Balance (WLB) Scale and the Psychological 
Well-Being (PWB) Scale. The factors that affect psychological well-being were 
determined using the stepwise multiple linear regression analysis.
RESULTS: The nurses' work-life balance and psychological well-being were 
negatively affected during the COVID-19 pandemic. Their COVID-19 phobia was 
mild-to-moderate level. The nurses' psychological well-being was significantly 
affected by the variable of neglecting life the most, followed by coronaphobia 
and work-life balance, which explain 75% of the variance.
CONCLUSIONS: This study shows that coronaphobia experienced by nurses and 
work-life balance was related to their psychological well-being during the 
COVID-19 pandemic. Managers should take measures (regulating the working hours) 
to decrease nurses' COVID-19 phobia (education, counselling or psychotherapy) 
and work-life imbalance.
RELEVANCE TO CLINICAL PRACTICE: Nurses' peers, managers and organisations need 
to take into account nurses' negative emotions and behaviours and organise 
training programmes to help them overcome their fears, communicate clearly and 
provide for their basic needs. Organisations, including managers and nurses, 
must recognise the distress being experienced by their nurses and create safe 
environments in which to have significant conversations. Nurses' mental health 
can be screened regularly by multidisciplinary teams, psychological support can 
be provided when required, and working hours can be regulated through 
appropriate shifts and breaks that will ensure work-life balance during and 
after the COVID-19 pandemic. Nurses receiving emotional support from their 
families and friends (via chatting and sharing troubles) can also contribute 
positively. These measures and regulations will positively affect nurses' 
psychological well-being and contribute to an increase in the quality of care 
and nurses' performance.

© 2021 John Wiley & Sons Ltd.

DOI: 10.1111/jocn.15783
PMCID: PMC8447145
PMID: 34337812 [Indexed for MEDLINE]

Conflict of interest statement: None of the authors declare any conflicts of 
interest relevant to the current work.


3157. Br J Educ Psychol. 2022 Mar;92(1):299-318. doi: 10.1111/bjep.12450. Epub 2021 
Aug 1.

"My brain feels like a browser with 100 tabs open": A longitudinal study of 
teachers' mental health and well-being during the COVID-19 pandemic.

Kim LE(1), Oxley L(1), Asbury K(1).

Author information:
(1)Department of Education, University of York, UK.

BACKGROUND: Teaching and caring for pupils during the COVID-19 pandemic has been 
a challenge for many teachers, and its impact on teachers' mental health and 
well-being (MHWB) should be of great national and international concern.
AIM AND PARTICIPANTS: This study examines 24 primary and secondary school 
teachers' MHWB experiences across three time points (April, July, and November 
2020) using longitudinal qualitative trajectory analysis.
METHOD: We used a mixture of inductive and deductive coding, based on the Job 
Demands-Resources Model, to identify the job demands (aspects of the job that 
can be physically or psychologically costly) and job resources (aspects of the 
job that can buffer the effects of job demands and promote achievement and 
growth) teachers reported experiencing across the three time points.
RESULTS: Generally, teachers' MHWB seemed to have declined throughout the 
pandemic, especially for primary school leaders. Six job demands contributed 
negatively to teachers' MHWB (i.e., uncertainty, workload, negative perception 
of the profession, concern for others' well-being, health struggles, and 
multiple roles) and three job resources contributed positively to their MHWB 
(i.e., social support, work autonomy, and coping strategies).
CONCLUSIONS: Policymakers and practitioners can support teachers' MHWB by 
engaging in more collaborative communication and ensuring greater accessibility 
to sources of social support. These discussions and provisions will be crucial 
in supporting teachers, and thereby the educational system, both during and 
after the pandemic.

© 2021 The Authors. British Journal of Educational Psychology published by John 
Wiley & Sons Ltd on behalf of British Psychological Society.

DOI: 10.1111/bjep.12450
PMCID: PMC8420299
PMID: 34337737 [Indexed for MEDLINE]

Conflict of interest statement: All authors declare no conflict of interest.


3158. Sleep Med. 2022 Mar;91:246-252. doi: 10.1016/j.sleep.2021.07.011. Epub 2021 Jul 
14.

Circadian disturbances, sleep difficulties and the COVID-19 pandemic.

Salehinejad MA(1), Azarkolah A(2), Ghanavati E(3), Nitsche MA(4).

Author information:
(1)Department of Psychology and Neurosciences, Leibniz Research Centre for 
Working Environment and Human Factors, Dortmund, Germany. Electronic address: 
salehinejad@ifado.de.
(2)Department of Psychiatry, Fatemi Hospital, Ardabil University of Medical 
Sciences, Ardabil, Iran.
(3)Department of Psychology and Neurosciences, Leibniz Research Centre for 
Working Environment and Human Factors, Dortmund, Germany.
(4)Department of Psychology and Neurosciences, Leibniz Research Centre for 
Working Environment and Human Factors, Dortmund, Germany; Department of 
Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany.

The COVID-19 pandemic has imposed extraordinary and unpredictable changes on our 
lifestyle for an unknown duration. Consequently, core aspects of wellbeing 
including behavior, emotion, cognition, and social interactions are negatively 
affected. Sleep and circadian rhythms, with an extensive impact on physiology, 
behavior, emotion, and cognition are affected too. We provided an updated 
overview of the impact of the COVID-19 pandemic on circadian rhythms and sleep 
based on the results of published studies (n = 48) in three sections. First, we 
focus on circadian misalignment due to the pandemic in the general population 
(including shift workers, health staff, students) and COVID-19 patients and 
summarize the most critically contributing factors to circadian misalignment. 
Next, we address sleep difficulties and poor sleep quality during the pandemic, 
their contributing factors, rate and prevalence, and their effects on both the 
general population and COVID-19 patients. Finally, we summarize the currently 
applied/recommended interventions for aligning circadian rhythms and improving 
sleep quality in both, the general population, and COVID-19 patients during the 
pandemic situation. Briefly, circadian misalignment and sleep difficulties are 
common consequences of the pandemic in the general population (with elderly, 
students, children, health and night-work shifters as risk groups) and COVID-19 
patients. Home confinement and its physiological, circadian, and psychological 
derivates are central to these difficulties. Symptoms severity, treatment 
progress, recovery duration, and even diagnosis of COVID-19 patients are 
considerably affected by circadian and sleep difficulties. Behavioral 
interventions for normalizing the factors that contribute to circadian and sleep 
difficulties are helpful.

Copyright © 2021 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.sleep.2021.07.011
PMCID: PMC8277544
PMID: 34334305 [Indexed for MEDLINE]

Conflict of interest statement: Authors declare no competing interests. The 
ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated 
with this article can be viewed by clicking on the following link: 
https://doi.org/10.1016/j.sleep.2021.07.011.


3159. Sleep Med. 2022 Mar;91:237-245. doi: 10.1016/j.sleep.2021.07.009. Epub 2021 Jul 
14.

A year in review: sleep dysfunction and psychological distress in healthcare 
workers during the COVID-19 pandemic.

Pappa S(1), Sakkas N(2), Sakka E(3).

Author information:
(1)Division of Psychiatry, Imperial College London, W12 0NN, London, United 
Kingdom; West London NHS Trust, UB2 4SD, London, United Kingdom. Electronic 
address: sofia.pappa@westlondon.nhs.uk.
(2)Oxleas NHS Foundation Trust, London, United Kingdom.
(3)School of Pharmacy and Biomolecular Sciences, University of Brighton, BN2 
4AT, Brighton, United Kingdom.

The Covid-19 outbreak has taken a substantial toll on the mental and physical 
wellbeing of healthcare workers (HCWs), impacting healthcare systems at a global 
scale. One year into the pandemic, the need to establish the prevalence of sleep 
dysfunction and psychological distress in the face of COVID-19, identify risk 
and protective factors and explore effective countermeasures remains of critical 
importance. Despite implicit limitations relating to the quality of available 
studies, a plethora of evidence to-date suggests that a considerable proportion 
of HCWs experience significant sleep disturbances (estimated to afflict every 
two in five HCWs) as well as mood symptoms (with more than one in five reporting 
high levels of depression or anxiety). Younger age, female gender, frontline 
status, fear or risk of infection, occupation, current or past mental health 
concerns, and a lower level of social support were all associated with a greater 
risk of disturbed sleep and adverse psychological outcomes. Furthermore, we 
discuss the link between sleep deprivation, susceptibility to viral infections 
and psychosocial wellbeing, in relevance to COVID-19 and summarize the existing 
evidence regarding the presence and predictors of traumatic stress/PTSD and 
burnout in HCWs. Finally, we highlight the role of resilience and tailored 
interventions in order to mitigate vulnerability and prevent long-term physical 
and psychological implications. Indeed, promoting psychological resilience 
through an enhanced social support network has proven crucial for HCWs in coping 
under these strenuous circumstances. Future research should aim to provide high 
quality information on the long-term consequences and the effectiveness of 
applied interventions.

Copyright © 2021 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.sleep.2021.07.009
PMCID: PMC8277954
PMID: 34334303 [Indexed for MEDLINE]

Conflict of interest statement: All authors have nothing to disclose in relation 
to the submitted work. The ICMJE Uniform Disclosure Form for Potential Conflicts 
of Interest associated with this article can be viewed by clicking on the 
following link: https://doi.org/10.1016/j.sleep.2021.07.009.


3160. Curr Probl Diagn Radiol. 2022 Jul-Aug;51(4):445-449. doi: 
10.1067/j.cpradiol.2021.06.010. Epub 2021 Jul 4.

Self-Care and Storytelling for Radiologists: A Feasibility Study.

Belfi LM(1), Jordan SG(2), Chetlen A(3), Deitte LA(4), Frigini LA(5), Methratta 
ST(6), Robbins J(7), Woods R(7), Benefield T(2), Jay AK(8).

Author information:
(1)Department of Radiology, Weill Cornell Medicine, New York, NY. Electronic 
address: lib9050@med.cornell.edu.
(2)Department of Radiology, University of North Carolina School of Medicine, NC.
(3)Department of Radiology, Penn State Health, Hershey Medical Center, PA.
(4)Department of Radiology, Vanderbilt University School of Medicine, Nashville, 
TN.
(5)Department of Radiology, Baylor College of Medicine, Houston, TX.
(6)Department of Radiology, Penn State Health, Milton S. Hershey Medical Center, 
Hershey, PA.
(7)Department of Radiology, University of Wisconsin School of Medicine and 
Public Health, Madison, WI.
(8)Department of Radiology, MedStar Georgetown University Hospital, Washington, 
DC.

RATIONALE AND OBJECTIVES: Physician wellness and burnout mitigation strategies 
have become priority practices in recent years. Despite these efforts, however, 
physicians living with the psychological effects of the current COVID-19 global 
pandemic, political stressors, and social injustices, face ever increasing 
threats to their personal and professional well-being. This manuscript 
investigates the process of storytelling as a self-care practice for 
radiologists.
MATERIALS AND METHODS: The AUR Well Being Ad-Hoc Committee introduced and 
approved Storytelling Geek Week, a virtual workshop held by The Moth, a Peabody 
award-winning storytelling nonprofit group. Nineteen AUR members applied and 
were selected for participation in the workshop which occurred over 5 days in 
November 2020. Anonymous electronic surveys were sent to participants before and 
after the workshop to gather feedback on their experience.
RESULTS: Of the 19 AUR member participants, 12 (63%) completed the pre-workshop 
survey and 8 (42%) completed the post-workshop survey. Participant current state 
of well-being was found to be increased between the pre- and post-course 
surveys, with a statistically significant adjusted P-value of 0.017. All 8 
post-workshop respondents reported that they would recommend the workshop to 
others. With regard to how participation in the workshop impacted their 
wellbeing, representative free text responses include, "helped with processing 
emotions," and "felt more connected to strangers." Regarding shifts in 
perspective as a result of workshop participation, representative free text 
responses include, "more empathetic" and "started focusing on hope and gratitude 
rather than sadness and anxiety."
CONCLUSION: Participants in a storytelling workshop reported a positive impact 
on their perceived sense of well-being. Respondents also reports shifts in their 
sense of empathy and connectedness to others. This type of intervention may help 
to mitigate burnout and build community during challenging times.

Copyright © 2021 Elsevier Inc. All rights reserved.

DOI: 10.1067/j.cpradiol.2021.06.010
PMCID: PMC9701313
PMID: 34334224 [Indexed for MEDLINE]


3161. Nurse Educ Today. 2021 Nov;106:105070. doi: 10.1016/j.nedt.2021.105070. Epub 
2021 Jul 23.

Predictors of university nursing students burnout at the time of the COVID-19 
pandemic: A cross-sectional study.

Sveinsdóttir H(1), Flygenring BG(2), Svavarsdóttir MH(3), Thorsteinsson HS(4), 
Kristófersson GK(3), Bernharðsdóttir J(2), Svavarsdóttir EK(5).

Author information:
(1)University of Iceland, School of Health Sciences, Faculty of Nursing, 
Eirberg, Eiríksgata 34, IS-101 Reykjavik, Iceland; Landspítali University 
Hospital, Division of Surgical Services, Hringbraut, IS-101 Reykjavík, Iceland. 
Electronic address: herdis@hi.is.
(2)University of Iceland, School of Health Sciences, Faculty of Nursing, 
Eirberg, Eiríksgata 34, IS-101 Reykjavik, Iceland.
(3)University of Akureyri, School of Health Sciences, Sólborg, Norðurslóð 2, 600 
Akureyri, Iceland.
(4)University of Iceland, School of Health Sciences, Faculty of Nursing, 
Eirberg, Eiríksgata 34, IS-101 Reykjavik, Iceland; Landspítali University 
Hospital, Division of Education, Hringbraut, IS-101 Reykjavík, Iceland.
(5)University of Iceland, School of Health Sciences, Faculty of Nursing, 
Eirberg, Eiríksgata 34, IS-101 Reykjavik, Iceland; Landspítali University 
Hospital, Office of the Director of Nursing, Hringbraut, IS-101 Reykjavík, 
Iceland.

BACKGROUND: Little is known about the stress and burnout experienced by 
undergraduate and graduate nursing students during the COVID-19 pandemic. 
Academic burnout among nursing students can have an impact on students' learning 
ability, health, and wellbeing and on the quality of care and intention to leave 
the profession post-graduation.
OBJECTIVES: Evaluate the predictors of nursing students' personal, academic, and 
collaboration-related burnout during the COVID-19 pandemic.
DESIGN: Cross-sectional two-site study.
SETTINGS: Icelandic universities offering nursing education.
PARTICIPANTS: Graduate and undergraduate nursing students in Iceland (N = 1044) 
were asked to participate in the study, with a response rate of 32.7%.
METHODS: An online survey was used to evaluate the students' stress and burnout 
in spring 2020.
RESULTS: The main findings show that 51% of the variability in the students' 
personal burnout was explained by their perceived stress, mental health, and 
perceived support. Furthermore, the students' perceived stress, support, and 
educational levels predicted 42% of the variability in their academic burnout. 
Burnout related to collaborating with fellow-students was explained by the 
nursing students' physical health and by their educational level, explaining 6% 
of the variability in fellow-students burnout.
CONCLUSION: University administrators might consider adding academic support 
facilities into their undergraduate nursing programs and teaching their students 
healthy coping skills.

Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.nedt.2021.105070
PMCID: PMC9756936
PMID: 34333259 [Indexed for MEDLINE]

Conflict of interest statement: The authors have nothing to declarate regarding 
this study (e.g., financial interests or personal relationships) that could have 
had an impact on the presentation of the manuscript.


3162. BMJ Open. 2021 Jul 30;11(7):e050092. doi: 10.1136/bmjopen-2021-050092.

Life under COVID-19 for LGBT+ people in the UK: systematic review of UK research 
on the impact of COVID-19 on sexual and gender minority populations.

McGowan VJ(1), Lowther HJ(2), Meads C(3).

Author information:
(1)Population Health Sciences Institute, Newcastle University, Newcastle upon 
Tyne, UK.
(2)Lancashire Applied Health Research Collaboration Hub (LARCH), University of 
Central Lancashire, Preston, UK.
(3)Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin 
University-Cambridge Campus, Cambridge, UK catherine.meads@aru.ac.uk.

OBJECTIVE: To systematically review all published and unpublished evidence on 
the impact of the COVID-19 pandemic on the health and well-being of UK sexual 
and gender minority (LGBT+; lesbian, gay, bisexual, transgender, non-binary, 
intersex and queer) people.
METHODS: Any relevant studies with or without comparator were included, with 
outcomes of: COVID-19 incidence, hospitalisation rates, illness severity, death 
rates, other health and well-being. Six databases (platforms) were 
searched-CINAHL Plus (Ovid), Cochrane Central (Cochrane Library), Medline 
(Ovid), Embase (Ovid), Science Citation Index (Web of Science) and Scopus 
between 2019 and 2020 in December 2020, using synonyms for sexual and gender 
minorities and COVID-19 search terms. Data extraction and quality assessment 
(using the relevant Joanna Briggs checklist) were in duplicate with differences 
resolved through discussion. Results were tabulated and synthesis was through 
narrative description.
RESULTS: No published research was found on any outcomes. Eleven grey literature 
reports found to be of low quality were included, mostly conducted by small 
LGBT+ charities. Only four had heterosexual/cisgender comparators. Mental health 
and well-being, health behaviours, safety, social connectedness and access to 
routine healthcare all showed poorer or worse outcomes than comparators.
CONCLUSIONS: Lack of research gives significant concern, given pre-existing 
health inequities. Social and structural factors may have contributed to poorer 
outcomes (mental health, well-being and access to healthcare). Paucity of 
evidence is driven by lack of routinely collected sexual orientation and gender 
identity data, possibly resulting from institutional homophobia/transphobia 
which needs to be addressed. Men are more at risk of serious illness from 
COVID-19 than women, so using data from trans women and men might have started 
to answer questions around whether higher rates were due to sex hormone or 
chromosomal effects. Routine data collection on sexual orientation and gender 
identity is required to examine the extent to which COVID-19 is widening 
pre-existing health inequalities.
PROSPERO REGISTRATION NUMBER: CRD42020224304.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-050092
PMCID: PMC8327638
PMID: 34330861 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3163. Am J Geriatr Psychiatry. 2021 Oct;29(10):995-999. doi: 
10.1016/j.jagp.2021.06.017. Epub 2021 Jul 7.

Ageism and the State of Older People With Mental Conditions During the Pandemic 
and Beyond: Manifestations, Etiology, Consequences, and Future Directions.

Ayalon L(1), Peisah C(2), Lima CM(3), Verbeek H(4), Rabheru K(5).

Author information:
(1)Louis and Gabi Weisfeld School of Social Work, Bar Ilan University (LA), 
Ramat Gan, Israel. Electronic address: liat.ayalon@biu.ac.il.
(2)University of New South Wales (CP), Sydney, Australia.
(3)World Psychiatric Association Section of Old Age Psychiatry (CdML), 
Jorat-Mézières, Switzerland.
(4)Department of Health Services Research, Care and Public Health Research 
Institute, Maastricht University (HV), Maastricht, the Netherlands.
(5)The Ottawa Hospital (KR), Ottawa, Ontario, Canada; University of Ottawa (KR), 
Ottawa, Ontario, Canada; International Psychogeriatric Association (IPA) (KR), 
Milwaukee, WI; Steering Group, Global Alliance on the Rights of Older People 
(GAROP) (KR); International Longevity Centre (ILC) (KR), Ottawa, Ontario, 
Canada.

The pandemic has put the spotlight on older people and on the topic of ageism. 
In early 2021, a call was made for input into the Thematic Report on Ageism and 
Discrimination to inform the United Nations Independent Expert on the Rights of 
Older Persons' forthcoming report to the 48th session of the Human Rights 
Council. The aim of this paper is to articulate the International 
Psychogeriatric Association (IPA) and the World Psychiatric Association Section 
of Old Age Psychiatry (WPA-SOAP) response to this call. This brief statement on 
ageism with a special focus on older people with mental health conditions is 
divided into three sections. We start by outlining the various manifestations of 
ageism in varied contexts and countries with a primary focus on the pandemic. 
Possible consequences of ageism with a focus on older people's mental health and 
well-being are outlined. We conclude by discussing ways to overcome ageism and 
reduce its occurrence, especially during times of extreme conditions.

Copyright © 2021 American Association for Geriatric Psychiatry. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jagp.2021.06.017
PMID: 34330627 [Indexed for MEDLINE]

Conflict of interest statement: Disclosure None.


3164. Semin Nephrol. 2021 May;41(3):253-261. doi: 10.1016/j.semnephrol.2021.05.006.

Moral Distress and Moral Injury in Nephrology During the COVID-19 Pandemic.

Ducharlet K(1), Trivedi M(2), Gelfand SL(3), Liew H(4), McMahon LP(5), 
Ashuntantang G(6), Brennan F(7), Brown M(7), Martin DE(8).

Author information:
(1)Department of Renal Medicine, Eastern Health, Box Hill, Eastern Health 
Clinical School, Monash University, Melbourne, Victoria, Australia. Electronic 
address: Kathryn.Ducharlet@easternhealth.org.au.
(2)Department of Medicine Nephrology Services, Lokmanya Tilak Municipal Medical 
College and Hospital, Mumbai, India.
(3)Department of Psychosocial Oncology and Palliative Care, Division of Renal 
(Kidney) Medicine, Dana Farber Cancer Institute, Brigham and Women's Hospital, 
Boston, MA.
(4)Richard Bright Renal Unit, Southmead Hospital, North Bristol National Health 
Service Trust, Bristol, United Kingdom.
(5)Department of Renal Medicine, Eastern Health, Box Hill, Eastern Health 
Clinical School, Monash University, Melbourne, Victoria, Australia.
(6)Department of Internal Medicine and Specialties, Faculty of Medicine and 
Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon, Africa.
(7)Department of Nephrology, St George Hospital, Kogarah, New South Wales, 
Australia.
(8)School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, 
Australia.

Across the world, challenges for clinicians providing health care during the 
coronavirus disease 2019 (COVID-19) pandemic are highly prevalent and have been 
widely reported. Perspectives of provider groups have conveyed wide-ranging 
experiences of adversity, distress, and resilience. In understanding and 
responding to the emotional and psychological implications of the pandemic for 
renal clinicians, it is vital to recognize that many experiences also have been 
ethically challenging. The COVID-19 pandemic has prompted rapid and extensive 
transformation of health care systems and widely impacted care provision, 
heightening the risk of barriers to fulfillment of ethical duties. Given this, 
it is likely that some clinicians also have experienced moral distress, which 
can occur if an individual is unable to act in accordance with their moral 
judgment owing to external barriers. This review presents a global perspective 
of potential experiences of moral distress in kidney care during the COVID-19 
pandemic. Using nephrology cases, we discuss why moral distress may be 
experienced by health professionals when withholding or withdrawing potentially 
beneficial treatments owing to resource constraints, when providing care that is 
inconsistent with local prepandemic best practice standards, and when managing 
dual professional and personal roles with conflicting responsibilities. We argue 
that in addition to responsive and appropriate health system supports, 
resources, and education, it is imperative for health care providers to 
recognize and prevent moral distress to foster the psychological well-being and 
moral resilience of clinicians during extended periods of crisis within health 
systems.

Crown Copyright © 2021. Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.semnephrol.2021.05.006
PMCID: PMC8820914
PMID: 34330365 [Indexed for MEDLINE]


3165. J Med Internet Res. 2021 Jul 30;23(7):e27619. doi: 10.2196/27619.

Self-guided Cognitive Behavioral Therapy Apps for Depression: Systematic 
Assessment of Features, Functionality, and Congruence With Evidence.

Martinengo L(1), Stona AC(1), Griva K(1), Dazzan P(2)(3), Pariante CM(4), von 
Wangenheim F(5), Car J(1)(6).

Author information:
(1)Centre for Population Health Sciences, Lee Kong Chian School of Medicine, 
Nanyang Technological University Singapore, Singapore, Singapore.
(2)Department of Psychological Medicine, Institute of Psychiatry, Psychology and 
Neuroscience, King's College London, London, United Kingdom.
(3)National Institute for Health Research Biomedical Research Centre at South 
London and Maudsley NHS Foundation Trust, London, United Kingdom.
(4)Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College 
London, London, United Kingdom.
(5)Professor of Technology Marketing, Department of Management, Technology & 
Economics, ETH Zurich, Zurich, Switzerland.
(6)Department of Primary Care and Public Health, School of Public Health, 
Imperial College London, London, United Kingdom.

BACKGROUND: Mental health disorders affect 1 in 10 people globally, of whom 
approximately 300 million are affected by depression. At least half of the 
people affected by depression remain untreated. Although cognitive behavioral 
therapy (CBT) is an effective treatment, access to mental health specialists, 
habitually challenging, has worsened because of the COVID-19 pandemic. 
Internet-based CBT is an effective and feasible strategy to increase access to 
treatment for people with depression. Mental health apps may further assist in 
facilitating self-management for people affected by depression; however, 
accessing the correct app may be cumbersome given the large number and wide 
variety of apps offered by public app marketplaces.
OBJECTIVE: This study aims to systematically assess the features, functionality, 
data security, and congruence with evidence of self-guided CBT-based apps 
targeting users affected by depression that are available in major app stores.
METHODS: We conducted a systematic assessment of self-guided CBT-based apps 
available in Google Play and the Apple App Store. Apps launched or updated since 
August 2018 were identified through a systematic search in the 42matters 
database using CBT-related terms. Apps meeting the inclusion criteria were 
downloaded and assessed using a Samsung Galaxy J7 Pro (Android 9) and iPhone 7 
(iOS 13.3.1). Apps were appraised using a 182-question checklist developed by 
the research team, assessing their general characteristics, technical aspects 
and quality assurance, and CBT-related features, including 6 evidence-based CBT 
techniques (ie, psychoeducation, behavioral activation, cognitive restructuring, 
problem solving, relaxation, and exposure for comorbid anxiety) as informed by a 
CBT manual, CBT competence framework, and a literature review of internet-based 
CBT clinical trial protocols. The results were reported as a narrative review 
using descriptive statistics.
RESULTS: The initial search yielded 3006 apps, of which 98 met the inclusion 
criteria and were systematically assessed. There were 20 well-being apps; 65 
mental health apps, targeting two or more common mental health disorders, 
including depression; and 13 depression apps. A total of 28 apps offered at 
least four evidence-based CBT techniques, particularly depression apps. 
Cognitive restructuring was the most common technique, offered by 79% (77/98) of 
the apps. Only one-third of the apps offered suicide risk management resources, 
whereas 17% (17/98) of the apps offered COVID-19-related information. Although 
most apps included a privacy policy, only a third of the apps presented it 
before account creation. In total, 82% (74/90) of privacy policies stated 
sharing data with third-party service providers. Half of the app development 
teams included academic institutions or health care providers.
CONCLUSIONS: Only a few self-guided CBT-based apps offer comprehensive CBT 
programs or suicide risk management resources. Sharing of users' data is 
widespread, highlighting shortcomings in health app market governance. To 
fulfill their potential, self-guided CBT-based apps should follow evidence-based 
clinical guidelines, be patient centered, and enhance users' data security.

©Laura Martinengo, Anne-Claire Stona, Konstadina Griva, Paola Dazzan, Carmine 
Maria Pariante, Florian von Wangenheim, Josip Car. Originally published in the 
Journal of Medical Internet Research (https://www.jmir.org), 30.07.2021.

DOI: 10.2196/27619
PMCID: PMC8367167
PMID: 34328431 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


3166. Front Nutr. 2021 Jul 13;8:701760. doi: 10.3389/fnut.2021.701760. eCollection 
2021.

NU9056, a KAT 5 Inhibitor, Treatment Alleviates Brain Dysfunction by Inhibiting 
NLRP3 Inflammasome Activation, Affecting Gut Microbiota, and Derived Metabolites 
in LPS-Treated Mice.

Chen L(1), Qing W(1), Yi Z(2), Lin G(1), Peng Q(3), Zhou F(4).

Author information:
(1)Department of Anesthesiology, The Third Xiangya Hospital, Central South 
University, Changsha, China.
(2)Medical College of Xiangya, Central South University, Changsha, China.
(3)Department of Critical Care Medicine, Xiangya Hospital, Central South 
University, Changsha, China.
(4)Department of Anesthesiology, The Second Xiangya Hospital, Central South 
University, Changsha, China.

Background: The pathogenesis of sepsis-associated encephalopathy (SAE) is 
complicated, while the efficacy of current treatment technologies is poor. 
Therefore, the discovery of related targets and the development of new drugs are 
essential. Methods: A mouse model of SAE was constructed by intraperitoneal 
injection of lipopolysaccharide (LPS). LPS treatment of microglia was used to 
build an in vitro model of inflammation. Nine-day survival rates, behavioral 
testing, transmission electron microscopy (TEM), immunohistochemical (IHC), 
immunofluorescence (IF), and ELISA were performed. The expression levels of 
Occludin, Claudin 5, NLRP3, caspase-1, and ASC genes and proteins were detected 
by RT-qPCR or Western blot. Caspase-1 P10 (Casp-1 P10) protein expression was 
detected. 16S rDNA sequencing and gas chromatography-mass spectrometer (GC-MS) 
were used to analyze the gut microbiota and metabolism. Flow cytometric 
experiment and Cell Counting Kit-8 (CCK8) assay were performed. Results: NU9056 
improved the survival rate of mice and alleviated LPS-induced cognitive 
impairment, anxiety, and depression in vivo. The tight junctions were thickened 
via NU9056 treatment. Further, the mRNAs and proteins expression levels of 
Occludin and Claudin 5 were up-regulated by NU9056. NU9056 increased the 
expression level of DCX. The expression levels of Iba-1, NLRP3, IL-1β, ASC, and 
Casp-1 P10 were down-regulated by NU9056. The composition of the gut microbiota 
changed. Kyoto Encyclopedia of Genes and Genomes data predicted that the effects 
of NU9056 might be related to apoptosis and tight junction pathways. NU9056 
up-regulated the concentration of acetate, propionate, and butyrate. NU9056 
significantly reduced LPS-induced apoptosis of microglia, the average 
fluorescence intensity of ROS, and the release of IL-1β and IL-18, while 
improving cell viability in vitro. Conclusions: NU9056 might effectively 
alleviate LPS-induced cognitive impairment and emotional disorder in 
experimental mice by inhibiting the NLRP3 inflammasome. The therapeutic effects 
may be related to gut microbiota and derived metabolites. NU9056 might be a 
potential drug of SAE prevention.

Copyright © 2021 Chen, Qing, Yi, Lin, Peng and Zhou.

DOI: 10.3389/fnut.2021.701760
PMCID: PMC8313765
PMID: 34327209

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


3167. Int J Gynecol Cancer. 2021 Sep;31(9):1268-1277. doi: 10.1136/ijgc-2021-002803. 
Epub 2021 Jul 29.

Impact of SARS-CoV-2 on training and mental well-being of surgical gynecological 
oncology trainees.

Gaba F(1)(2), Blyuss O(3)(4), Rodriguez I(5), Dilley J(6), Wan YL(7), Saiz A(8), 
Razumova Z(9), Zalewski K(10), Nikolova T(11), Selcuk I(12), Bizzarri N(13), 
Theofanakis C(14), Lanner M(15), Pletnev A(16), Gurumurthy M(17), Manchanda 
R(18)(19).

Author information:
(1)Department of Gynaecological Oncology, NHS Grampian, Aberdeen, UK 
faiza.gaba1@abdn.ac.uk r.manchanda@qmul.ac.uk.
(2)Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
(3)Department of Physics, Astronomy and Mathematics, University of 
Hertfordshire, Hatfield, UK.
(4)Department of Pediatrics and Pediatric Infectious Diseases, Institute of 
Child's Health, Sechenov University, Moskva, Russian Federation.
(5)Department of Gynecologic Oncology, University of Washington, Seattle, 
Washington, USA.
(6)Department of Gynaecological Oncology, Barts and The London NHS Trust, 
London, UK.
(7)Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, 
Medicine and Health, The University of Manchester, Manchester, UK.
(8)Department of Gynecologic Oncology, Northwestern University in Chicago, 
Chicago, Illinois, USA.
(9)Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
(10)Department of Gynecologic Oncology, Świętokrzyskie Cancer Centre, Kielce, 
Poland.
(11)Department of Gynecologic Oncology, Academic Teaching Hospital of Heidelberg 
University, Baden-Baden, Germany.
(12)Department of Gynecologic Oncology, Ankara City Hospital, Ankara, Turkey.
(13)UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del 
Bambino e della Salute Pubblica, Policlinico Agostino Gemelli IRCCS, Rome, 
Italy.
(14)Department of Gynaecological Oncology, General Hospital of Athens Alexandra, 
Athens, Attica, Greece.
(15)Department of Obstetrics/Gynaecology, Kardinal Schwarzenberg'sches 
Krankenhaus, Schwarzach, Steiermark, Austria.
(16)Department of Gynecology and Obstetrics, University of Zielona Góra, Zielona 
Góra, Poland.
(17)Department of Gynaecological Oncology, NHS Grampian, Aberdeen, UK.
(18)Department of Gynaecological Oncology, Barts and The London NHS Trust, 
London, UK faiza.gaba1@abdn.ac.uk r.manchanda@qmul.ac.uk.
(19)Wolfson Institute of Preventive Medicine, Barts CRUK Cancer Centre, Queen 
Mary University of London, London, UK.

Comment in
    Rev Esp Anestesiol Reanim (Engl Ed). 2021 Dec;68(10):612-613.
    Rev Bras Ginecol Obstet. 2021 Nov;43(11):803-804.

INTRODUCTION: The SARS-CoV-2 global pandemic has caused a crisis disrupting 
health systems worldwide. While efforts are being made to determine the extent 
of the disruption, the impact on gynecological oncology trainees/training has 
not been explored. We conducted an international survey of the impact of 
SARS-CoV-2 on clinical practice, medical education, and mental well-being of 
surgical gynecological oncology trainees.
METHODS: In our cross-sectional study, a customized web-based survey was 
circulated to surgical gynecological oncology trainees from 
national/international organizations from May to November 2020. Validated 
questionnaires assessed mental well-being. The Wilcoxon rank-sum test and 
Fisher's exact test were used to analyse differences in means and proportions. 
Multiple linear regression was used to evaluate the effect of variables on 
psychological/mental well-being outcomes. Outcomes included clinical practice, 
medical education, anxiety and depression, distress, and mental well-being.
RESULTS: A total of 127 trainees from 34 countries responded. Of these, 52% 
(66/127) were from countries with national training programs 
(UK/USA/Netherlands/Canada/Australia) and 48% (61/127) from countries with no 
national training programs. Altogether, 28% (35/125) had suspected/confirmed 
COVID-19, 28% (35/125) experienced a fall in household income, 20% (18/90) were 
self-isolated from households, 45% (57/126) had to re-use personal protective 
equipment, and 22% (28/126) purchased their own. In total, 32.3% (41/127) of 
trainees (16.6% (11/66) from countries with a national training program vs 49.1% 
(30/61) from countries with no national training program, p=0.02) perceived they 
would require additional time to complete their training fellowship. The 
additional training time anticipated did not differ between trainees from 
countries with or without national training programs (p=0.11) or trainees at the 
beginning or end of their fellowship (p=0.12). Surgical exposure was reduced for 
50% of trainees. Departmental teaching continued throughout the pandemic for 69% 
(87/126) of trainees, although at reduced frequency for 16.1% (14/87), and 
virtually for 88.5% (77/87). Trainees reporting adequate pastoral support 
(defined as allocation of a dedicated mentor/access to occupational health 
support services) had better mental well-being with lower levels of 
anxiety/depression (p=0.02) and distress (p<0.001). Trainees from countries with 
a national training program experienced higher levels of distress (p=0.01). Mean 
(SD) pre-pandemic mental well-being scores were significantly higher than 
post-pandemic scores (8.3 (1.6) vs 7 (1.8); p<0.01).
CONCLUSION: SARS-CoV-2 has negatively impacted the surgical training, household 
income, and psychological/mental well-being of surgical gynecological oncology 
trainees. The overall clinical impact was worse for trainees in countries with 
no national training program than for those in countries with a national 
training program, although national training program trainees reported greater 
distress. COVID-19 sickness increased anxiety/depression. The recovery phase 
must focus on improving mental well-being and addressing lost training 
opportunities.

© IGCS and ESGO 2021. No commercial re-use. See rights and permissions. 
Published by BMJ.

DOI: 10.1136/ijgc-2021-002803
PMID: 34326158 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: FG declares research 
funding from the NHS Grampian Endowment Fund, Medtronic and Karl Storz outside 
this work. RM declares research funding from Barts & the London Charity, Eve 
Appeal, British Gynaecological Cancer Society outside this work; an honorarium 
for grant review from Israel National Institute for Health Policy Research and 
honorarium for advisory board membership from AstraZeneca/MSD. RM is supported 
by an NHS Innovation Accelerator (NIA) Fellowship for population testing.


3168. PLoS One. 2021 Jul 29;16(7):e0255392. doi: 10.1371/journal.pone.0255392. 
eCollection 2021.

Food insecurity and mental health of women during COVID-19: Evidence from a 
developing country.

Rahman T(1), Hasnain MDG(1), Islam A(2).

Author information:
(1)School of Medicine and Public Health, College of Health, Medicine and 
Wellbeing, The University of Newcastle, Newcastle, Australia.
(2)Centre for Development Economics and Sustainability, Department of Economics, 
Monash University, Melbourne, Australia.

BACKGROUND: This study examines the association between food insecurity and 
mental health of women during the COVID-19 pandemic in a resource poor setting.
MATERIALS AND METHODS: Data were collected at two time-points (wave 1 and 2) 
from 2402 women, one per household, participating in a larger study during 
extended COVID-19 lockdown in the rural areas of the southwest region of 
Bangladesh. The primary outcome of the analyses is the association between food 
insecurity, measured using the Food Insecurity Experience Scale (FIES), and 
stress level, measured using the Perceived Stress Scale (PSS), for women during 
the lockdown. General awareness about COVID-19 and attitude towards prescribed 
preventive measures were also measured since COVID-19 health concerns could 
exacerbate food insecurity.
RESULTS: An individual-level evaluation of the effect of wave 2 FIES score on 
PSS score showed that worsening of the food security status increasing the 
stress level of the participants (95% CI: 1.61; 2.13; p-value: <0.001). 
Additionally, a significant negative association was observed between the PSS 
score and change in food security status between the two waves (Coefficient: 
-1.15, 95% CI: -1.30; -0.99, p-value: <0.001), indicating that deterioration in 
food security status over the pandemic period increasing the stress level. At 
the village level, the results showed a similar pattern. General awareness 
around ways coronavirus spreads was high, yet there were misperceptions at a 
higher level. Maintaining hand hygiene, wearing face masks outside the home, and 
going outside only when necessary were widely practised. Fewer respondents could 
maintain a 1.5-metre distance from others in the outside and maintained cough 
and sneeze etiquette.
CONCLUSION: The results indicate a higher stress level, a potential contributor 
to poor mental health, as food insecurity deteriorated. Policy initiatives in 
ameliorating immediate food insecurity during crises, improving long-term 
wellbeing, and expanding the reach of mental health support are warranted.

DOI: 10.1371/journal.pone.0255392
PMCID: PMC8321003
PMID: 34324606 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


3169. PLoS One. 2021 Jul 29;16(7):e0255149. doi: 10.1371/journal.pone.0255149. 
eCollection 2021.

Psychological adjustment of Spanish adolescents and their parents during 
COVID-19 lockdown: A mixed method approach.

Postigo-Zegarra S(1), Julián M(1), Schoeps K(2), Montoya-Castilla I(2).

Author information:
(1)Department of Psychology, Faculty of Health Sciences, Universidad Europea de 
Valencia, Valencia, Spain.
(2)Department of Personality, Assessment and Psychological Interventions, 
Faculty of Psychology, Universitat de València, Valencia, Spain.

Previous literature on the psychological impact of COVID-19 has shown a direct 
relationship between family conflicts and psychological distress among parents 
and their children during the domestic lockdown and social isolation; but there 
are also opportunities to enhance family bonding, encourage collective 
problem-solving and improve personal relationships. This study aimed to explore 
psychological adjustment processes of Spanish adolescents and their parents 
during the first month of lockdown by analyzing their narratives, perceived 
outcomes, protection and risk factors. A total of 142 people agreed to 
participate in this study. Of all participants, 61 were adolescents (M = 13.57; 
SD = 1.74; 57% women) and 81 were parents (M = 46.09; SD = 4.72; 91% mothers). 
All were Spanish residents and completed an online survey during the domestic 
lockdown in March 2020. From a qualitative design, methodology followed a mixed 
approach to analyze data. The results showed three different types of adaptation 
to lockdown and social isolation in both adolescents and their parents: 1) 
positive adjustment, 2) moderate adjustment, and 3) maladjustment. Most 
participants reported a good adjustment and only a 20% of parents and a 16% of 
adolescents stated that they had not been able to achieve a positive 
psychological adjustment. There are few significant quantitative differences 
between adolescents and their parents. The qualitative analysis of data showed 
that adolescents reported less psychological distress than their parents. The 
two most important protective factors were social support and keeping busy 
during lockdown. The most significant risk factors were loss of mobility and 
social isolation. The conclusions stressed that regarding psychological 
maladjustment, parents experienced feelings of uncertainty whereas adolescents 
experienced a kind of mourning process. These findings can be used to design and 
implement effective intervention measures for mental health and psychological 
well-being in such a difficult situation as domestic lockdown.

DOI: 10.1371/journal.pone.0255149
PMCID: PMC8321118
PMID: 34324579 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


3170. PLoS One. 2021 Jul 29;16(7):e0254989. doi: 10.1371/journal.pone.0254989. 
eCollection 2021.

Health worries, life satisfaction, and social well-being concerns during the 
COVID-19 pandemic: Insights from Lebanon.

Bou-Hamad I(1), Hoteit R(2), Harajli D(3).

Author information:
(1)Department of Business Information and Decision Systems, Suliman S. Olayan 
School of Business, American University of Beirut, Beirut, Lebanon.
(2)Department of Epidemiology and Population Health, Faculty of Health Sciences, 
American University of Beirut, Beirut, Lebanon.
(3)Department of Information Technology and Operations Management, Adnan Kassar 
School of Business, Lebanese American University, Beirut, Lebanon.

The COVID-19 outbreak has struck Lebanon in its worst period of instability, not 
only impacting physical health, but also increasing psychological distress. 
Using an online survey enhanced by response time measurement, this study 
describes the overall patterns in mental well-being outcomes and examines their 
association with sociodemographic characteristics during the COVID-19 pandemic. 
Furthermore, it identifies significant predictors for COVID-19 good practices. A 
total of 988 Lebanese were surveyed, with participants providing written online 
consent prior to filling the survey. Regression-based models were estimated. 
Findings show that individuals with higher education levels exhibit lower health 
concerns. People with children face higher health worries than those without. 
Men are more worried than women about their health and they are less satisfied 
with their lives during the pandemic. Descriptive statistics show that most 
Lebanese are very satisfied with their families (93.1%), but they are highly 
dissatisfied with their country (63%). Young adults and individuals who live 
alone exhibit significantly higher social well-being concerns. Age and having 
children were strong predictors for good COVID-19 practices. The odds of having 
good practices for older adults are 3.13 times higher than that of youth, while 
the odds for those with children are 3.18 times higher than those without. The 
findings of this study could pave the way for a well-coordinated national 
strategy and increased collaboration with public health professionals to 
mitigate the pandemic's adverse effects on mental health in the long-term.

DOI: 10.1371/journal.pone.0254989
PMCID: PMC8321151
PMID: 34324533 [Indexed for MEDLINE]

Conflict of interest statement: the authors have declared that no competing 
interests exist.


3171. PLoS One. 2021 Jul 29;16(7):e0255050. doi: 10.1371/journal.pone.0255050. 
eCollection 2021.

The psychological impact of the COVID-19 crisis is higher among young Swiss men 
with a lower socioeconomic status: Evidence from a cohort study.

Marmet S(1), Wicki M(1), Gmel G(1)(2)(3)(4), Gachoud C(1), Daeppen JB(1), 
Bertholet N(1), Studer J(1).

Author information:
(1)Addiction Medicine, Lausanne University Hospital and University of Lausanne, 
Lausanne, Switzerland.
(2)Addiction Switzerland, Lausanne, Switzerland.
(3)Centre for Addiction and Mental Health, Toronto, ON, Canada.
(4)University of the West of England, Bristol, United Kingdom.

AIMS: The present study aimed to investigate whether the psychological impact of 
the COVID-19 crisis varied with regards to young Swiss men's pre-crisis level of 
education and socioeconomic status and to changes in their work situation due to 
it.
METHODS: A cohort of 2345 young Swiss men (from 21 out of 26 Swiss cantons; mean 
age = 29) completed survey-based assessments shortly before (April 2019 to 
February 2020) and early on during the COVID-19 crisis (May to June 2020). 
Outcomes measured were psychological outcomes before and during the COVID-19 
crisis (depression, perceived stress and sleep quality), and the fear, isolation 
and psychological trauma induced by it. We investigated associations between 
these outcomes and their predictors: pre-crisis socioeconomic status (relative 
financial status, difficulty paying bills, level of education), changes in work 
situation during the crisis (job loss, partial unemployment, working from home, 
change in workload) and working in contact with potentially infected people, 
both inside and outside the healthcare sector. For outcomes measured before and 
during the crisis, the analyses were adjusted for their pre-crisis levels.
RESULTS: About 21% of participants changed their employment status (job loss, 
partial unemployment or lost money if self-employed) and more than 40% worked 
predominantly from home during the COVID-19 crisis. Participants with a lower 
relative socioeconomic status already before the crisis experienced a higher 
psychological impact due to the COVID-19 crisis, compared to participants with 
an average socioeconomic status (major depression (b = 0.12 [0.03, 0.22]), 
perceived stress (b = 0.15 [0.05, 0.25]), psychological trauma (b = 0.15 [0.04, 
0.26]), fear (b = 0.20 [0.10, 0.30]) and isolation (b = 0.19 [0.08, 0.29])). A 
higher impact was also felt by participants who lost their job due to the 
COVID-19 crisis, the partially unemployed, those with an increased workload or 
those who worked mainly from home (e.g. depression b = 0.25 [0.16, 0.34] for 
those working 90%+ at home, compared to those not working at home).
CONCLUSIONS: Even in a country like Switzerland, with relatively high social 
security benefits and universal healthcare, the COVID-19 crisis had a 
considerable psychological impact, especially among those with a lower 
socioeconomic status and those who experienced deteriorations in their work 
situation due to the COVID-19 crisis. Supporting these populations during the 
crisis may help to prevent an amplification of inequalities in mental health and 
social status. Such support could help to lower the overall impact of the crisis 
on the mental well-being of Switzerland's population.

DOI: 10.1371/journal.pone.0255050
PMCID: PMC8320994
PMID: 34324522 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


3172. J Ment Health. 2023 Dec;32(6):1040-1047. doi: 10.1080/09638237.2021.1952953. 
Epub 2021 Jul 29.

Impact of the COVID-19 pandemic on the mental health and well-being of adults 
with mental health conditions in the UK: a qualitative interview study.

Burton A(1), McKinlay A(1), Aughterson H(1), Fancourt D(1).

Author information:
(1)Department of Behavioural Science and Health, University College London, 
London, UK.

BACKGROUND: People with mental health conditions have been identified as 
particularly vulnerable to poor mental health during the coronavirus disease 
2019 (COVID-19) pandemic. However, why this population have faced these adverse 
effects, how they have experienced them and how they have coped remains 
under-explored.
AIMS: To explore how the COVID-19 pandemic affected the mental health of people 
with existing mental health conditions, and to identify coping strategies for 
positive mental health.
METHODS: Semi-structured qualitative interviews with 22 people with mental 
health conditions. Participants were purposively recruited via social media, 
study newsletters and third sector mental health organisations. Data were 
analysed using reflexive thematic analysis.
RESULTS: Participants were aged 23-70 (mean age 43), predominantly female 
(59.1%) and of white ethnicity (68.2%). Fifty percent were unable to work due to 
illness and the most frequently reported mental health condition was depression. 
Five pandemic-related factors contributed to deteriorating mental health: (i) 
feeling safe but isolated at home; (ii) disruption to mental health services; 
(iii) cancelled plans and changed routines; (iv) uncertainty and lack of 
control; (v) rolling media coverage. Five coping strategies were identified for 
maintaining mental health: (i) previous experience of adversity; (ii) social 
comparison and accountability; (iii) engaging in hobbies and activities; (iv) 
staying connected with others; (v) perceived social support.
CONCLUSIONS: Challenges were identified as a direct result of the pandemic and 
people with severe mental illnesses were particularly negatively affected. 
However, some found this period a time of respite, drew upon reserves of 
resilience and adapted their coping strategies to maintain positive well-being.

DOI: 10.1080/09638237.2021.1952953
PMID: 34323635 [Indexed for MEDLINE]


3173. Psychol Trauma. 2022 Feb;14(2):247-249. doi: 10.1037/tra0001064. Epub 2021 Jul 
29.

Human emotions during COVID-19: A lens through Kubler-Ross Grief theory.

Valliani K(1), Mughal FB(2).

Author information:
(1)Aga Khan Development Network Digital Health Resource Centre.
(2)School of Nursing and Midwifery.

The COVID-19 pandemic has constituted an extreme danger to global wellbeing and 
has become one of the major sources of morbidity and mortality around the world 
these days. It is quite challenging to accept and adapt to the drastic ongoing 
changes which have made people suffer from grief. The purpose of this commentary 
is to outline the Kubler-Ross Grief theory, explain its stages in the light of 
COVID-19, and consider factors that contribute to good health. It is more useful 
to examine responses to the pandemic utilizing contextualized grief and trauma 
aspects than to pathologize those reactions, particularly for those without 
existing mental health issues. Inability to address the squeezing needs of those 
encountering grief may bring about poor mental and physical wellbeing. 
Perceiving the uniqueness of every person and their stage of grief will allow 
providing individualized measures that encourage smooth adaptation to acceptance 
and promote psychological wellness and prosperity in this pandemic. (PsycInfo 
Database Record (c) 2022 APA, all rights reserved).

DOI: 10.1037/tra0001064
PMID: 34323565 [Indexed for MEDLINE]


3174. Health Psychol. 2021 Jun;40(6):347-356. doi: 10.1037/hea0001079.

Psychological and spiritual outcomes during the COVID-19 pandemic: A prospective 
longitudinal study of adults with chronic disease.

Davis EB(1), McElroy-Heltzel SE(2), Lemke AW(1), Cowden RG(3), VanderWeele 
TJ(3), Worthington EL(4), Glowiak KJ(1), Shannonhouse LR(5), Davis DE(5), Hook 
JN, Van Tongeren DR(6), Aten JD(7).

Author information:
(1)School of Psychology, Counseling, and Family Therapy, Wheaton College.
(2)Department of Psychological and Quantitative Foundations, University of Iowa.
(3)Human Flourishing Program, Institute for Quantitative Social Science, Harvard 
University.
(4)Department of Psychology, Virginia Commonwealth University.
(5)Department of Counseling and Psychological Services, Georgia State 
University.
(6)Department of Psychology, Hope College.
(7)Humanitarian Disaster Institute, Wheaton College.

OBJECTIVE: This prospective longitudinal study examined whether coronavirus 
disease 2019 (COVID-19) has led to changes in psychological and spiritual 
outcomes among adults with chronic disease.
METHOD: Participants (N = 302) were a stratified, nonrandom sample of adults 
(Mage = 64.46, SD = 10.86, 45.7% female). The sample was representative of the 
chronically ill, U.S. adult population in gender, race/ethnicity, region, and 
religious affiliation but older in age and higher in socioeconomic status. 
Participants completed online-administered measures 1 month before the March 11 
pandemic declaration (T1) and then 1 and 3 months after it (T2 and T3). At T1 
through T3, they completed measures of depression, anxiety, personal suffering, 
psychological well-being, trait resilience, optimism, hope, grit, spiritual 
struggles, spiritual fortitude, and positive religious coping. At T2 and T3, 
they also completed measures of social support, physical health, resource loss, 
perceived stress, and COVID-19 fears and exposure.
RESULTS: Overall, people did not change substantially in psychological or 
spiritual outcomes over time. However, trait resilience increased and personal 
suffering declined. People highest in prepandemic suffering increased in 
spiritual fortitude. Racial/ethnic minorities increased in religious importance. 
Roughly half (48.9%) of participants exhibited psychological resilience 
(no/minimal depression or anxiety symptoms) at both T2 and T3. Perceived stress 
and psychological resource loss were associated with adverse mental health 
outcomes, but social support and physical health were not. COVID-19 fears 
contributed more to mental health than COVID-19 exposure.
CONCLUSIONS: Even among vulnerable populations such as adults with chronic 
disease, during pandemic conditions like COVID-19, many people may exhibit-or 
even increase slightly in-psychological and spiritual resilience. (PsycInfo 
Database Record (c) 2021 APA, all rights reserved).

DOI: 10.1037/hea0001079
PMID: 34323537 [Indexed for MEDLINE]


3175. Trials. 2021 Jul 28;22(1):500. doi: 10.1186/s13063-021-05465-5.

Resiliency Engagement and Care in Health (REaCH): a telephone befriending 
intervention for upskilled rural youth in the context of COVID-19 pandemic-study 
protocol for a multi-centre cluster randomised controlled trial.

Devassy SM(1)(2), Allagh KP(3)(4), Benny AM(3)(4), Scaria L(3)(4), Cheguvera 
N(3)(4), Sunirose IP(3).

Author information:
(1)Rajagiri College of Social Sciences (Autonomous), Rajagiri P.O, Kalamassery, 
Cochin, Kerala, 683 104, India. saju@rajagiri.edu.
(2)Rajagiri International Centre for Consortium Research in Social Care (ICRS), 
Cochin, Kerala, India. saju@rajagiri.edu.
(3)Rajagiri College of Social Sciences (Autonomous), Rajagiri P.O, Kalamassery, 
Cochin, Kerala, 683 104, India.
(4)Rajagiri International Centre for Consortium Research in Social Care (ICRS), 
Cochin, Kerala, India.

BACKGROUND: The lockdown associated with the COVID-19 pandemic is likely to 
impact people's mental health, especially those from economically disadvantaged 
and vulnerable sections of society. Mental health can be affected by many 
factors, including fear of disease transmission, from response measures against 
the pandemic like social distancing, movement restriction, fear of being in 
quarantine, loneliness, depression due to isolation, fear of losing work and 
livelihood and avoiding health care due to fear of being infected. Telephonic 
befriending intervention by non-specialists will be used to provide social and 
emotional support to the youth from the Deen Dayal Upadhyaya Grameen Kaushalya 
Yojana (DDUGKY), an initiative of the Government of India. This study aims to 
promote mental wellbeing and reduce depressive symptoms by assisting 
participants to mobilise social support from family, friends and significant 
others by using the telephonic befriending intervention.
METHODS: In this article, we report the design and protocol of a multi-centre 
cluster randomised controlled trial. In total, 1440 participants aged 18-35 
years who have recently completed their course out of the DDU-GKY initiative 
will be recruited in the study from 12 project-implementing agencies (PIAs) 
across six geographical zones of India. Participants from 6 of these agencies 
will be assigned to the telephonic befriending intervention arm, and the other 
six agency participants will be assigned to the general enquiry phone call arm 
(control). The primary outcomes of this study are mental wellbeing, depressive 
symptoms and perceived social support. Baseline assessments and follow-up 
assessments will be carried out 1 month following the intervention using WHO-5, 
PHQ and MSPSS-12 questionnaires. The befriending intervention will be provided 
by DDU-GKY staff, whom a virtual training programme will train.
DISCUSSION: This trial will help assess whether participants who are offered 
emotional, social and practical support through befriending will experience 
lesser symptoms of depression and better mental health compared to participants 
who do not receive this intervention through mobilised social support from 
friends, family and others.
TRIAL REGISTRATION: Clinical Trial Registry India (ICMR-NIMS) 
CTRICTRI/2020/07/026834 . Registered on 27 July 2020.

© 2021. The Author(s).

DOI: 10.1186/s13063-021-05465-5
PMCID: PMC8318050
PMID: 34321057 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests


3176. Psychopathology. 2021;54(5):232-241. doi: 10.1159/000517447. Epub 2021 Jul 28.

Embitterment as a Specific Mental Health Reaction during the Coronavirus 
Pandemic.

Muschalla B(1), Vollborn C(1), Sondhof A(1).

Author information:
(1)Department of Psychotherapy and Diagnostics, Technische Universität 
Braunschweig, Braunschweig, Germany.

INTRODUCTION: Embitterment can occur as a reaction to perceived injustice. 
During the pandemic and restrictions in daily living due to infection risk 
management, a range of many smaller or severe injustices have occurred.
OBJECTIVE: The aim of this study is to investigate what characterizes persons 
with high embitterment, mental illness, embitterment and mental illness, and 
those without embitterment or mental health problems.
METHODS: We conducted an online survey including persons from the general 
population in November 2020 and December 2020, the phase during which a second 
lockdown took place, with closed shops, restaurants, cultural and activity 
sites. 3,208 participants (mean age 47 years) gave self-ratings on their present 
well-being, burdens experienced during the pandemic, embitterment, wisdom, and 
resilience.
RESULTS: Embitterment occurred among 16% of the sample, which is a high rate in 
comparison with 4% during pre-pandemic times. Embitterment was weakly correlated 
with unspecific mental well-being. There were more persons with embitterment 
than those with embitterment and a mental health problem. Persons with 
embitterment reported less coronavirus-related anxiety than persons without 
embitterment. However, embittered persons reported more social and economic 
burdens and more frequent experiences of losses (job loss and canceling of 
medical treatments). Embittered persons perceive their own wisdom competencies 
on a similar level as persons with mental health problems or persons without 
mental health problems.
CONCLUSION: Embitterment is a specific potentially alone-standing affective 
state, which is distinguishable from general mental health and coping capacities 
(here: wisdom). The economic and social consequences of pandemic management 
should be carefully recognized and prevented by policy.

© 2021 S. Karger AG, Basel.

DOI: 10.1159/000517447
PMCID: PMC8450861
PMID: 34320511 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflicts 
of interest.


3177. J Contemp Dent Pract. 2021 May 1;22(5):538-544.

Prevalence of Burnout among Dental Students during COVID-19 Lockdown in UAE.

Al-Rawi NH(1), Yacoub A(2), Zaouali A(2), Salloum L(2), Afash N(2), Shazli 
OA(2), Elyan Z(2).

Author information:
(1)Department of Oral and Craniofacial Health Sciences, College of Dental 
Medicine, University of Sharjah, Sharjah, United Arab Emirates, Phone: +971 
551100169, Fax: +971 65057606, e-mail: nhabdulla@sharjah.ac.ae.
(2)Department of Oral and Craniofacial Health Sciences, College of Dental 
Medicine, University of Sharjah, Sharjah, United Arab Emirates.

AIM: To estimate the prevalence of burnout among dental students in two major 
universities in the United Arab Emirates during the coronavirus disease-2019 
(COVID-19) lockdown.
MATERIALS AND METHODS: In this cross-sectional observational study, the burnout 
clinical subtype questionnaire (BCSQ-12-SS) (English version) was used. It 
consists of 12 questions covering domains of overload (4 questions), lack of 
development (4 questions), and neglect (4 questions). The questionnaire was sent 
to 500 dental students from the University of Sharjah (UOS) and Ajman University 
of Science and Technology (AUST). The association between burnout and 
sociodemographic variables was also investigated.
RESULTS: The majority of responders were females (74%). Socio-demographic and 
study characteristics of dental students from both universities were not 
remarkably different. However, the responses to the BCSQ-12-SS questions were 
not very different. In this study, there was no significant association between 
burnout and demographic variables, such as age, gender, relationships, distance 
from family, residency, year of study, studying hours, and number of failed 
subjects. However, there was a significant association between burnout and 
receiving a scholarship and family support.
CONCLUSION: Identifying individuals at risk for burnout may provide a potential 
intervention strategy and counseling to assist in dental student development, as 
it has good psychometric properties.
CLINICAL SIGNIFICANCE: Burnout among dental students could develop into anxiety 
and depressive disorders. Early identification and prevention will protect the 
psychological well-being of dentists. How to cite this article: Al-Rawi NH, 
Yacoub A, Zaouali A, et al. Prevalence of Burnout among Dental Students during 
COVID-19 Lockdown in UAE. J Contemp Dent Pract 2021;22(5):538-544.

PMID: 34318774 [Indexed for MEDLINE]


3178. BMJ Open. 2021 Jul 27;11(7):e047909. doi: 10.1136/bmjopen-2020-047909.

Cohort profile: the Men and Parenting Pathways (MAPP) Study: a longitudinal 
Australian cohort study of men's mental health and well-being at the normative 
age for first-time fatherhood.

Macdonald JA(1)(2)(3), Francis LM(4), Skouteris H(5)(6), Youssef GJ(4)(2), 
Graeme LG(4), Williams J(7)(8), Fletcher RJ(9), Knight T(10), Milgrom J(11)(12), 
Di Manno L(4), Olsson CA(4)(2)(3), Greenwood CJ(4)(2).

Author information:
(1)Centre for Social and Early Emotional Development, School of Psychology, 
Faculty of Health, Deakin University, Geelong, Victoria, Australia 
jacqui.macdonald@deakin.edu.au.
(2)Centre for Adolescent Health, Murdoch Childrens Research Institute, 
Parkville, Victoria, Australia.
(3)Department of Paediatrics, Faculty of Medicine, Dentistry and Health 
Sciences, University of Melbourne, Parkville, Victoria, Australia.
(4)Centre for Social and Early Emotional Development, School of Psychology, 
Faculty of Health, Deakin University, Geelong, Victoria, Australia.
(5)Health and Social Care Unit, School of Public Health and Preventive Medicine, 
Monash University, Clayton, Victoria, Australia.
(6)Warwick Business School, University of Warwick, Coventry, West Midlands, UK.
(7)Department of Health Sciences and Biostatistics, Swinburne University of 
Technology-Hawthorn Campus, Hawthorn, Victoria, Australia.
(8)School of Health and Social Development, Deakin University Faculty of Health, 
Burwood, Victoria, Australia.
(9)Family Action Centre, The University of Newcastle, Callaghan, New South 
Wales, Australia.
(10)Cairnmillar Institute, Camberwell, Victoria, Australia.
(11)Parent-Infant Research Institute, Austin Health, Heidelberg, Victoria, 
Australia.
(12)Melbourne School of Psychological Sciences, The University of Melbourne, 
Melbourne, Victoria, Australia.

PURPOSE: The Men and Parenting Pathways (MAPP) Study is a prospective 
investigation of men's mental health and well-being across the normative age for 
transitioning to fatherhood. This includes trajectories and outcomes for men who 
do and do not become fathers across five annual waves of the study.
PARTICIPANTS: Australian resident, English-speaking men aged 28-32 years at 
baseline were eligible. Recruitment was over a 2-year period (2015-2017) via 
social and traditional media and through engagement with study partners. Eight 
hundred and eighteen eligible men consented to participate. Of these, 664 men 
completed the first online survey of whom 608 consented to ongoing 
participation. Of the ongoing sample, 83% have participated in at least two of 
the first three annual online surveys.
FINDINGS TO DATE: Three waves of data collection are complete. The first 
longitudinal analysis of MAPP data, published in 2020, identified five profiles 
that characterise men's patterns of depressive symptom severity and 
presentations of anger. Profiles indicating pronounced anger and depressive 
symptoms were associated with fathers' lack of perceived social support, and 
problems with coparenting and bonding with infants. In a second study, MAPP data 
were combined with three other Australian cohorts in a meta-analysis of 
associations between fathers' self-reported sleep problems up to 3 years 
postpartum and symptoms of depression, anxiety and stress. Adjusted 
meta-analytic associations between paternal sleep and mental health risk ranged 
from 0.25 to 0.37.
FUTURE PLANS: MAPP is an ongoing cohort study. Waves 4 and 5 data will be ready 
for analyses at the end of 2021. Future investigations will include 
crossed-lagged and trajectory analyses that assess inter-relatedness and 
changing social networks, mental health, work and family life. A nested study of 
COVID-19 pandemic-related mental health and coping will add two further waves of 
data collection in a subsample of MAPP participants.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2020-047909
PMCID: PMC8317085
PMID: 34315795 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3179. Fam Process. 2021 Dec;60(4):1381-1388. doi: 10.1111/famp.12700. Epub 2021 Jul 
27.

Love in the time of COVID-19: A brief report on relationship and individual 
functioning among committed couples in the United States while under 
shelter-in-place orders.

Weber DM(1), Wojda AK(1), Carrino EA(1), Baucom DH(1).

Author information:
(1)University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 
USA.

The COVID-19 pandemic in the United States has changed many aspects of people's 
daily life, including increased time at home in response to shelter-in-place 
orders, heightened stress about health effects of COVID-19, and shifts in other 
domains of life (e.g., employment). These lifestyle changes are likely to impact 
the well-being of individuals and their romantic relationships. This 
investigation examined how COVID-19 influenced couple and individual well-being 
in real-time during the early phase of the pandemic. Data were collected in 
early May 2020 during shelter-in-place orders in the United States. Participants 
in committed relationships (n = 332) completed an online survey assessing their 
experiences currently and before the pandemic. Results suggested that while 
couple functioning overall maintained or even improved, individual well-being 
was more negatively impacted by the pandemic. Moreover, some groups who are at 
higher risk of a poor health outcome from COVID-19 or experience unique 
challenges as a result of COVID-19 reported worse outcomes (e.g., those whose 
employment changed) while others did not decline in their psychological and 
couple functioning (e.g., Black individuals and older individuals). These 
findings suggest that the pandemic has had varied impacts on couples and 
individuals, as well as across different virus-related risk factors. Further 
research is needed to understand the nuanced effects of this pandemic on couples 
and individuals across time.

Publisher: La pandemia de la COVID-19 en los Estados Unidos ha cambiado muchos 
aspectos de la vida diaria de las personas, por ejemplo, el aumento del tiempo 
que pasan en sus hogares en respuesta a órdenes de confinamiento, un estrés más 
elevado por los efectos de la COVID-19 en la salud, y cambios en otros aspectos 
de la vida (p. ej.: en el empleo). Estos cambios en el estilo de vida 
probablemente repercutan en el bienestar de las personas y en sus relaciones 
amorosas. En esta investigación se analizó cómo la COVID-19 influyó en el 
bienestar de las parejas y de los individuos en tiempo real durante la primera 
fase de la pandemia. A principios de mayo de 2020 se recopilaron datos durante 
las órdenes de confinamiento en los Estados Unidos. Los participantes que 
estaban en relaciones de pareja estables (n=332) contestaron una encuesta en 
línea donde se evaluaron sus experiencias de ese momento y las anteriores a la 
pandemia. Los resultados indicaron que, si bien el funcionamiento de la pareja 
en general se mantuvo o incluso mejoró, la pandemia afectó más negativamente el 
bienestar individual. Además, algunos grupos que tienen mayor riesgo de 
resultados desfavorables en la salud como consecuencia de la COVID-19 o 
enfrentan dificultades singulares como resultado de la COVID-19 informaron 
peores resultados (p. ej.: aquellos cuyos empleos cambiaron), mientras que otros 
no tuvieron un empeoramiento de su funcionamiento psicológico y de pareja (p. 
ej.: las personas de color y las personas mayores). Estos resultados sugieren 
que la pandemia ha tenido efectos variados en las parejas y en los individuos, 
así como entre los diferentes factores de riesgo relacionados con el virus. Se 
necesitan más investigaciones para comprender los efectos sutiles de esta 
pandemia en las parejas y en los individuos con el transcurso del tiempo.

Publisher: 
美国的COVID-19大流行改变了人们日常生活的许多方面，包括应对就地避难命令致使的在家时间增多、对COVID-19健康影响的压力增加，以及其他生活领域(如就业)的变化。这些生活方式的改变可能会影响个人的幸福和他们的恋爱关系。本调查研究了COVID-19在大流行早期阶段如何实时影响夫妻伴侣和个人的福祉。数据于2020年5月初在美国的就地避难所收集。有承诺关系的参与者(n 
= 
332)完成了一项在线调查，评估他们当前和新冠疫情大流行前的经历。结果表明，虽然伴侣的整体功能得到了维持甚至改善，但个人福祉受到了更大的负面影响。此外，一些因COVID-19而健康状况不佳的风险较高的群体或因COVID-19而经历独特挑战的群体报告了更糟糕的结果(例如，那些就业发生变化的群体)，而另外一些群体的心理功能和伴侣功能没有下降 
(例如，黑人和老年人)。这些发现表明，大流行对夫妇和个人以及不同的病毒相关风险因素产生了不同的影响。需要进一步的研究来了解这场大流行在不同时期对夫妇和个人的微妙影响。.

© 2021 Family Process Institute.

DOI: 10.1111/famp.12700
PMCID: PMC8444826
PMID: 34315187 [Indexed for MEDLINE]


3180. J Adv Nurs. 2021 Sep;77(9):3853-3866. doi: 10.1111/jan.14988. Epub 2021 Jul 27.

Voices from the COVID-19 frontline: Nurses' trauma and coping.

Foli KJ(1), Forster A(1), Cheng C(2), Zhang L(2)(2), Chiu YC(3).

Author information:
(1)School of Nursing, Purdue University, West Lafayette, Indiana, USA.
(2)Department of Statistics, Purdue University, West Lafayette, Indiana, USA.
(3)Department of Psychological Sciences, Purdue University, West Lafayette, 
Indiana, USA.

AIM: To describe the experiences of frontline nurses who are working in critical 
care areas during the COVID-19 pandemic with a focus on trauma and the use of 
substances as a coping mechanism.
DESIGN: A qualitative study based on content analysis.
METHODS: Data were collected from mid-June 2020 to early September 2020 via an 
online survey. Nurses were recruited through the research webpage of the 
American Association of Critical Care Nurses as well as an alumni list from a 
large, public Midwest university. Responses to two open-ended items were 
analysed: (1) personal or professional trauma the nurse had experienced; and (2) 
substance or alcohol use, or other mental health issues the nurse had 
experienced or witnessed in other nurses.
RESULTS: For the item related to psychological trauma five themes were 
identified from 70 nurses' comments: (1) Psychological distress in multiple 
forms; (2) Tsunami of death; (3) Torn between two masters; (4) Betrayal; and (5) 
Resiliency/posttraumatic growth through self and others. Sixty-five nurses 
responded to the second item related to substance use and other mental health 
issues. Data supported three themes: (1) Mental health crisis NOW!!: 'more 
stressed than ever and stretched thinner than ever'; (2) Nurses are turning to a 
variety of substances to cope; and (3) Weakened supports for coping and 
increased maladaptive coping due to ongoing pandemic.
CONCLUSIONS: This study brings novel findings to understand the experiences of 
nurses who care for patients with COVID-19, including trauma experienced during 
disasters, the use of substances to cope and the weakening of existing support 
systems. Findings also reveal nurses in crisis who are in need of mental health 
services.
IMPACT: Support for nurses' well-being and mental health should include current 
and ongoing services offered by the organization and include screening for 
substance use issues.

© 2021 John Wiley & Sons Ltd.

DOI: 10.1111/jan.14988
PMCID: PMC8447369
PMID: 34314068 [Indexed for MEDLINE]

Conflict of interest statement: No conflict of interest has been declared by the 
authors.


3181. Ir J Med Sci. 2022 Jun;191(3):1105-1113. doi: 10.1007/s11845-021-02648-6. Epub 
2021 Jul 27.

Consultant psychiatrists' perspectives on occupational stress in child and 
adolescent mental health services (CAMHS).

Doody N(1)(2), O'Connor C(3), McNicholas F(4)(5)(6).

Author information:
(1)School of Medicine and Medical Science, University College Dublin, Dublin, 
Ireland.
(2)Lucena Clinic, St John of God, Dublin, Ireland.
(3)Department of Psychology, University College Dublin, Dublin, Ireland.
(4)School of Medicine and Medical Science, University College Dublin, Dublin, 
Ireland. Fionamcn2008@gmail.com.
(5)Lucena Clinic, St John of God, Dublin, Ireland. Fionamcn2008@gmail.com.
(6)Children's Health Ireland (CHI) At Crumlin, Dublin, Ireland. 
Fionamcn2008@gmail.com.

BACKGROUND: Occupational stress is increasingly recognised as key factor 
contributing to service quality, safety, and worker wellbeing, with clinician 
providers most at high risk.
OBJECTIVES: To explore work-related stressors among consultant child and 
adolescent psychiatrists working in CAMHS.
METHODS: Fifty-two consultants completed an online questionnaire with free-text 
entries describing factors contributing to occupational stress in CAMHS in 
Ireland.
RESULTS: Content analysis indicated that consultants' perception of working 
conditions revolved around six factors: organisational factors, human resources, 
adequacy of services, professional relationships, socio-political factors, and 
public perception. Both adequate skilled staff and funding, identified by 54% 
and 34% of respondents, were viewed as essential factors associated with 
occupational wellbeing, the most often cited concern (raised by 56% consultants) 
which contributed to occupational stress was of widespread public 
misunderstanding of CAMHS' remit.
CONCLUSIONS: Given decades of under-resourcing, ensuring adequate levels and 
expertise of staffing in the post-COVID-19 era must become a reality. However, 
less obvious and equally important is that of correcting any public 
misperceptions regarding CAMHS "core" business to ensure that available scarce 
resources are utilised most effectively, and that staff stress levels are 
minimised. To achieve this, active engagement between service users, providers 
and planners must be undertaken.

© 2021. The Author(s).

DOI: 10.1007/s11845-021-02648-6
PMCID: PMC8313875
PMID: 34313943 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


3182. Aust N Z J Psychiatry. 2022 Jul;56(7):800-810. doi: 10.1177/00048674211034317. 
Epub 2021 Jul 27.

Psychological distress, loneliness, alcohol use and suicidality in New 
Zealanders with mental illness during a strict COVID-19 lockdown.

Bell C(1), Williman J(2), Beaglehole B(1), Stanley J(3), Jenkins M(4), Gendall 
P(3), Rapsey C(5), Every-Palmer S(4).

Author information:
(1)Department of Psychological Medicine, University of Otago, Christchurch, New 
Zealand.
(2)Department of Population Health, University of Otago, Christchurch, New 
Zealand.
(3)Department of Public Health, University of Otago, Wellington, New Zealand.
(4)Department of Psychological Medicine, University of Otago, Wellington, New 
Zealand.
(5)Department of Psychological Medicine, University of Otago, Dunedin, New 
Zealand.

INTRODUCTION: People with pre-existing mental health conditions may have been 
disproportionally impacted by the COVID-19 pandemic and associated public health 
restrictions. In this study, we compared psychological outcomes, experiences and 
sources of stress over the pandemic lockdown in New Zealanders with and without 
a previous diagnosis of mental illness.
METHODS: Two online surveys were conducted in New Zealand over the level 4 
lockdown in April 2020 measuring psychological distress, anxiety, well-being, 
suicidality, alcohol use and subjective experiences. They included 3389 
participants, of whom 18.4% reported having been previously diagnosed with a 
mental illness.
RESULTS: During the lockdown, people previously diagnosed with a mental illness 
had about twice the risk of reporting moderate-high levels of psychological 
distress (K10 ⩾ 12), at least moderate levels of anxiety (GAD-7 ⩾ 10) and poor 
well-being (WHO-5 ⩽ 12). They reported increased alcohol use and were about four 
times as likely to have experienced suicidal thoughts with 3% reporting having 
made a suicide attempt over the lockdown period. They reported less satisfaction 
with, and poorer relationships with people in their 'bubble', reduced social 
contacts and greater loneliness. They also reported higher levels of health and 
financial concerns.
CONCLUSION: During the COVID-19 lockdown in New Zealand, people with a previous 
diagnosis of a mental illness were at increased risk of detrimental 
psychological outcomes. This highlights the importance of recognising this and 
the challenges people face in pandemics.

DOI: 10.1177/00048674211034317
PMCID: PMC9218412
PMID: 34313158 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


3183. J Korean Med Sci. 2021 Jul 26;36(29):e214. doi: 10.3346/jkms.2021.36.e214.

The Prevalence of Depression, Anxiety and Associated Factors among the General 
Public during COVID-19 Pandemic: a Cross-sectional Study in Korea.

Kim DM(1), Bang YR(1), Kim JH(2), Park JH(1)(3).

Author information:
(1)Department of Psychiatry, Dong-A University Hospital, Busan, Korea.
(2)Busan Regional Mental Health Welfare Center, Busan, Korea.
(3)Busan Regional Mental Health Welfare Center, Busan, Korea. drpark@dau.ac.kr.

BACKGROUND: Since its first case confirmed on January 20, 2020, Korea has been 
through three waves of the COVID-19 pandemic. Fears of the fourth wave persist 
as new cases continue to emerge. In such unpredictable times, the mental 
well-being of people is of crucial importance. This study examined the levels of 
depression and anxiety and their predictors among the Korean general public in 
Busan, Korea, during the COVID-19 pandemic.
METHODS: We conducted a cross-sectional study via a self-reported questionnaire 
administered to 2,288 adult residents (aged 19-60 years) of Busan, Korea. 
Participants' depression and anxiety were assessed using the Korean version of 
the Patient Health Questionnaire-4 (PHQ-4), which consists of PHQ-2 and 
Generalized Anxiety Disorder-2 (GAD-2), with the cutoff score of 3.
RESULTS: The mean age of the participants was 39.71 years. COVID-19 had several 
psychosocial impacts on people. It was revealed that 80.3% had restrictions in 
outside activities, 47.3% reported financial difficulties, and 53.6% had a fear 
of death or fatal outcome when infected with COVID-19. We performed logistic 
regression analysis to identify the factors associated with depression and 
anxiety. A total of 30.7% participants were classified as at risk of depression 
based on cutoff score of 3 on PHQ-2. Logistic regression analysis revealed that 
changes in sleep pattern due to COVID-19 were most strongly associated with 
depression, followed by restrictions in outside activities due to social 
distancing and increased family conflicts due to COVID-19. Also, 22.6% 
participants were classified as at risk of anxiety based on a cutoff score of 3 
on GAD-2. Analysis revealed that changes in sleep pattern due to COVID-19 were 
most strongly associated with anxiety, followed by spending a lot of time 
searching for COVID-19-related information and having a fear of death or fatal 
outcome when infected with COVID-19.
CONCLUSION: The results are alarming; 30.7% had a PHQ-2 score of 3 or higher, 
indicating depression, and 22.6% had a GAD-2 score of 3 or higher, indicating 
anxiety. Changes in sleep pattern had the strongest association with both 
depression and anxiety. Our results can be used to formulate mental health 
policies tailored to the context of the city. Our findings suggest the high 
prevalence of depression and anxiety in the society during the COVID-19 
pandemic, which places growing importance on early intervention for mental 
health problems during these times.

© 2021 The Korean Academy of Medical Sciences.

DOI: 10.3346/jkms.2021.36.e214
PMCID: PMC8313395
PMID: 34313037 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no potential conflicts of 
interest to disclose.


3184. BMC Geriatr. 2021 Jul 26;21(1):439. doi: 10.1186/s12877-021-02367-8.

A qualitative study about the mental health and wellbeing of older adults in the 
UK during the COVID-19 pandemic.

McKinlay AR(1), Fancourt D(2), Burton A(2).

Author information:
(1)Research Department of Behavioural Science and Health, Institute of 
Epidemiology & Health Care, University College London, 1-19 Torrington Place, 
London, WC1E 7HB, UK. a.mckinlay@ucl.ac.uk.
(2)Research Department of Behavioural Science and Health, Institute of 
Epidemiology & Health Care, University College London, 1-19 Torrington Place, 
London, WC1E 7HB, UK.

OBJECTIVES: The objective of this study was to examine factors that threatened 
and protected the wellbeing of older adults living in the UK during social 
distancing restrictions due to the COVID-19 pandemic.
METHODS: Semi-structured telephone or video interviews with 20 adults aged over 
70. Purposive sampling methods were used to increase diversity within the group. 
Transcripts were analysed using reflexive thematic analysis.
RESULTS: Participants described potential threats to their wellbeing during the 
pandemic, including fears for mortality, grieving normal life, and concerns for 
the future. Participants also described activities and behaviours that helped to 
protect their mental health, including adopting a slower pace of life, 
maintaining routine, socialising, and using past coping skills. Many 
participants drew on their resilience and life experience to self-manage fear 
and uncertainty associated with the pandemic, using their time during lockdown 
to reflect or organise end-of-life affairs.
DISCUSSION: This study provides UK-based evidence that while some older adults 
experienced challenges during the first wave of COVID-19, many were resilient 
throughout social distancing restrictions despite early reported concerns of 
mental health consequences among the older adult population. Our findings 
highlight the importance of maintaining access to essentials to promote feelings 
of normality and use of social support to help reduce uncertainty in times of 
pandemics.

© 2021. The Author(s).

DOI: 10.1186/s12877-021-02367-8
PMCID: PMC8312210
PMID: 34311710 [Indexed for MEDLINE]

Conflict of interest statement: None declared.


3185. PLoS One. 2021 Jul 26;16(7):e0255211. doi: 10.1371/journal.pone.0255211. 
eCollection 2021.

Sense of coherence, social support and religiosity as resources for medical 
personnel during the COVID-19 pandemic: A web-based survey among 4324 health 
care workers within the German Network University Medicine.

Schmuck J(1), Hiebel N(1), Rabe M(1), Schneider J(1), Erim Y(2), Morawa E(2), 
Jerg-Bretzke L(3), Beschoner P(3), Albus C(4), Hannemann J(4), Weidner K(5), 
Steudte-Schmiedgen S(5), Radbruch L(6), Brunsch H(6), Geiser F(1).

Author information:
(1)Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, 
University Hospital Bonn, Bonn, Germany.
(2)Department of Psychosomatic Medicine and Psychotherapy, University Hospital 
of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, 
Germany.
(3)Department of Psychosomatic Medicine and Psychotherapy, Ulm University 
Medical Center, University Ulm, Ulm, Germany.
(4)Department of Psychosomatics and Psychotherapy, University Hospital Cologne, 
University Cologne, Cologne, Germany.
(5)Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, 
Technische Universität Dresden, Dresden, Germany.
(6)Department of Palliative Medicine, Medical Faculty, University Hospital Bonn, 
Bonn, Germany.

INTRODUCTION: The COVID-19 pandemic resulted in severe detrimental effects on 
the mental well-being of health care workers (HCW). Consequently, there has been 
a need to identify health-promoting resources in order to mitigate the 
psychological impact of the pandemic on HCW.
OBJECTIVE: Our objective was to investigate the association of sense of 
coherence (SOC), social support and religiosity with self-reported mental 
symptoms and increase of subjective burden during the COVID-19 pandemic in HCW.
METHODS: Our sample comprised 4324 HCW of four professions (physicians, nurses, 
medical technical assistants (MTA) and pastoral workers) who completed an online 
survey from 20 April to 5 July 2020. Health-promoting resources were assessed 
using the Sense of Coherence Scale Short Form (SOC-3), the ENRICHD Social 
Support Inventory (ESSI) and one item on religiosity derived from the Scale of 
Transpersonal Trust (TPV). Anxiety and depression symptoms were measured with 
the PHQ-2 and GAD-2. The increase of subjective burden due to the pandemic was 
assessed as the retrospective difference between burden during the pandemic and 
before the pandemic.
RESULTS: In multiple regressions, higher SOC was strongly associated with fewer 
anxiety and depression symptoms. Higher social support was also related to less 
severe mental symptoms, but with a smaller effect size, while religiosity showed 
minimal to no correlation with anxiety or depression. In professional group 
analysis, SOC was negatively associated with mental symptoms in all groups, 
while social support only correlated significantly with mental health outcomes 
in physicians and MTA. In the total sample and among subgroups, an increase of 
subjective burden was meaningfully associated only with a weaker SOC.
CONCLUSION: Perceived social support and especially higher SOC appeared to be 
beneficial for mental health of HCW during the COVID-19 pandemic. However, the 
different importance of the resources in the respective occupations requires 
further research to identify possible reasons.

DOI: 10.1371/journal.pone.0255211
PMCID: PMC8312980
PMID: 34310616 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


3186. Riv Psichiatr. 2021 Jul-Aug;56(4):189-197. doi: 10.1708/3654.36346.

Work and social functioning in frontline healthcare workers during the covid-19 
pandemic in Italy: role of acute post-traumatic stress, depressive and anxiety 
symptoms.

Carmassi C(1), Pedrinelli V(1), Dell'Oste V(2), Bertelloni CA(1), Cordone A(1), 
Bouanani S(3), Corsi M(4), Baldanzi S(4), Malacarne P(5), Dell'Osso L(1), 
Buselli R(4).

Author information:
(1)Department of Clinical and Experimental Medicine, University of Pisa, Pisa, 
Italy.
(2)Department of Clinical and Experimental Medicine, University of Pisa, Pisa, 
Italy - Department of Biotechnology, Chemistry and Pharmacy, University of 
Siena, Siena, Italy.
(3)Department of Mental Health and Addictions, Azienda USL Toscana Nord-Ovest, 
Lucca, Italy.
(4)Department of Occupational Health, Azienda Ospedaliero-Universitaria Pisana, 
Pisa, Italy.
(5)Anaesthesia and Intensive Care Unit, Azienda Ospedaliero-Universitaria 
Pisana, Pisa, Italy.

BACKGROUND: Evidence highlights healthcare workers (HCWs) facing outbreaks, 
particularly the ongoing covid-19 pandemic, are at increased risk of negative 
mental health outcomes, particularly post-traumatic stress symptoms (PTSS), 
anxiety and depression. Data from previous outbreaks highlighted the risk for a 
negative impact on HCWs' social and occupational functioning, but scant data 
have investigated this issue in the framework of the covid-19 pandemic. A number 
of effective interventions have been proposed to support mental health and 
well-being of HCWs in emerging infectious outbreaks, but it is important to 
acknowledge the differential impact of mental disorders on different dimensions 
of functioning.
METHODS: The study explored the associations between work and social functioning 
and PTSS, depression and anxiety in a sample of 265 frontline HCWs employed at a 
major university hospital in Italy (Pisa), facing the first period of the 
covid-19 pandemic. Individuals were assessed by means of the Impact of Event 
Scale-Revised (IES-R) for PTSS, the Patient Health Questionnaire-9 (PHQ-9) for 
depressive symptoms, the General Anxiety Disorder-7 Item (GAD-7) for anxiety 
symptoms and the Work and Social Adjustment Scale (WSAS) to assess work and 
social functioning.
RESULTS: Higher levels of functioning impairment were found among individuals 
with moderate to severe acute PTSS, depressive and anxiety symptoms with respect 
to those without. Acute PTSS and depressive symptoms were predictive factors of 
impairment in each domain of functioning analyzed. Anxiety symptoms were 
associated with impairment in both work and home management activities. 
Frontline activity was associated with impairment in both private and social 
leisure activities.
CONCLUSIONS: Long-term perspective studies are warranted to better investigate 
the psychopathological burden on HCWs' work and social functioning and to 
promote adequate intervention strategies.

DOI: 10.1708/3654.36346
PMID: 34310576 [Indexed for MEDLINE]


3187. Early Interv Psychiatry. 2022 Apr;16(4):433-443. doi: 10.1111/eip.13196. Epub 
2021 Jul 26.

Healthcare providers' perceptions of virtual-care with children's mental health 
in a pandemic: A hospital and community perspective.

Romanchych E(1), Desai R(1), Bartha C(1)(2), Carson N(2), Korenblum M(2)(3), 
Monga S(1)(3).

Author information:
(1)Department of Psychiatry, Hospital for Sick Children, Toronto, Canada.
(2)SickKids Centre for Community Mental Health, Toronto, Canada.
(3)Department of Psychiatry, University of Toronto, Toronto, Canada.

AIM: The purpose of the present study was to explore the experiences of a 
diverse group of mental health clinicians both in hospital and in the community, 
who were required to rapidly adopt virtual-care practices in the delivery of 
mental health services to children, adolescents, and their families.
METHODS: Mental health clinicians (N = 117) completed the Clinician Virtual-Care 
Experience Survey assessing the following domains: ease of technology use, 
client/patient-provider interaction quality, and clinician wellbeing.
RESULTS: Although over 70% of clinicians had not used virtual-care to deliver 
mental health services prior to the Coronavirus Disease 2019 pandemic, more than 
80% felt it was easy to operate the virtual platforms. Clinicians were divided 
in their perceptions of the effectiveness of virtual-care, with only 42% 
reporting that they felt they were as effective in delivering healthcare 
services virtually as compared to in-person. Virtual-care was described as being 
more effective for specific populations, while challenges were described in 
building rapport and when delivering difficult or unexpected feedback.
CONCLUSIONS: Clinicians felt there were some benefits of adopting virtual-care 
practices, while challenges were also identified. Understanding of the impact of 
virtual-care on service providers is essential in order to strengthen mental 
healthcare for children, adolescents, and their families even beyond the 
pandemic.

© 2021 John Wiley & Sons Australia, Ltd.

DOI: 10.1111/eip.13196
PMCID: PMC8444835
PMID: 34309196 [Indexed for MEDLINE]

Conflict of interest statement: The authors of this manuscript have no conflicts 
of interest to declare.


3188. Asia Pac J Public Health. 2021 Nov;33(8):839-846. doi: 
10.1177/10105395211025901. Epub 2021 Jul 26.

Mental Health and COVID-19: Policies, Guidelines, and Initiatives from the 
Asia-Pacific Region.

Samy AL(1)(2)(3), Awang Bono S(4), Tan SL(3)(5)(6), Low WY(1)(2)(3).

Author information:
(1)Asia-Europe Institute, University of Malaya, Kuala Lumpur, Malaysia.
(2)Centre for ASEAN Regionalism, University of Malaya, Kuala Lumpur, Malaysia.
(3)Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
(4)School of Social Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia.
(5)Department of Anaesthesiology & Intensive Care, Hospital Selayang, Selangor, 
Malaysia.
(6)Department of Anaesthesiology & Intensive Care, Hospital Tuanku Ja'afar, 
Seremban, Malaysia.

The COVID-19 outbreak was declared a pandemic by the World Health Organization 
in March 2020 due to rapid intercontinental spread and high morbidity and 
mortality. Globally, the disease has had a major impact on human lives, 
including health, economic, employment, psychological, and overall well-being. 
The COVID-19, besides causing respiratory, neurological, and cardiovascular 
diseases, has had significant impact on mental health. Major mental health 
disorders, including depression, anxiety, and stress, have risen in parallel 
with increasing prevalence of COVID-19. Many population groups, including 
children, the elderly, those with chronic illnesses, and health care workers, 
have been affected. This review gives an overall assessment of the prevalence of 
COVID-19-associated psychological morbidity. In countries in the Asia-Pacific 
region, prevalence of depression ranged between 4.9% and 43.1%, anxiety from 
7.0% to 43.0%, and stress from 3.4% to 35.7%. As COVID-19 continues to severely 
affect the psychosocial well-being of the population at large, countries have 
developed and revised policies, guidelines, and introduced new initiatives to 
curb mental health issues among their citizens. In the long run, pre-disaster 
preparedness is important to alleviate long-term post-pandemic psychiatric 
morbidity and to develop psychological resilience toward disasters and pandemic, 
alongside investment for better mental health coverage.

DOI: 10.1177/10105395211025901
PMID: 34308673 [Indexed for MEDLINE]


3189. J Public Health (Oxf). 2022 Aug 25;44(3):e463-e464. doi: 10.1093/pubmed/fdab299.

Entering a new academic year: the problem faced in online learning amid COVID-19 
pandemic.

Rosales RJJ(1), Pagsuyoin JCC(2).

Author information:
(1)Theology and Religious Education Department, De La Salle University, Manila 
1004, Philippines.
(2)Far Eastern University, Manila 1004, Philippines.

Comment on
    J Public Health (Oxf). 2021 Jun 7;43(2):e385-e386.

In the crisis, we are facing, the well-being of the students is given importance 
in their online learning. Attention has already been given as to how the school 
may support in making the parents mentally healthy as they assist their children 
in learning. The Philippines is already entering another online academic school 
year as part of the health and safety protocol during this pandemic. But with 
all the challenges experienced by the stakeholders, the education sector is also 
facing a problem as to the well-being of the teachers who are also struggling in 
this pandemic with all the changes in their routines since online learning 
began.

© Crown copyright 2021.

DOI: 10.1093/pubmed/fdab299
PMCID: PMC8344503
PMID: 34308477 [Indexed for MEDLINE]


3190. Front Public Health. 2021 Jul 8;9:655083. doi: 10.3389/fpubh.2021.655083. 
eCollection 2021.

Effects of the COVID-19 Pandemic on Psychological Well-Being and Mental Health 
Based on a German Online Survey.

Lingelbach K(1)(2), Piechnik D(1), Gado S(1), Janssen D(1), Eichler M(3), 
Hentschel L(3), Knopf D(4), Schuler M(5), Sernatinger D(4), Peissner M(1).

Author information:
(1)Fraunhofer IAO, Fraunhofer Institute for Industrial Engineering IAO, 
Stuttgart, Germany.
(2)Department of Psychology, University of Oldenburg, Oldenburg, Germany.
(3)National Center for Tumor Diseases (NCT/UCC), University Hospital Dresden, 
Technical University Dresden, Dresden, Germany.
(4)seracom GmbH, Stuttgart, Germany.
(5)Department of Internal Medicine I, University Hospital Dresden, Technical 
University Dresden, Dresden, Germany.

Objective and Background: To contain the COVID-19 pandemic, public health 
actions have changed the everyday life with an inevitable impact on individuals 
and their social life. Since intact (socio-)psychological functioning and mental 
health are protective factors contributing to the immune system and preventing 
diseases, it is crucial to identify individuals with increased vulnerability. 
Methods: We conducted a German online survey from April until August 2020 
investigating health-related, social, behavioral, and psychological effects of 
the COVID-19 pandemic. One hundred and seventy three adults participating in the 
survey were analyzed (39.9% male, age: M = 44.81±13.31). We explored effects on 
mental health by (a) clustering participants in two clusters and (b) analyzing 
the clusters using correlations and regression models. Results: Participants 
belonged either to a cluster characterized by higher general well-being or to a 
more concerned cluster depending on their responses. The correlation analysis 
revealed a significant negative relation between age and well-being with younger 
participants revealing higher depression scores in the concerned cluster. 
Furthermore, multiple regression models revealed that the number of risk factors 
only has a significant influence on psychological well-being in the concerned 
but not in the comfortable cluster. Conclusion: We found that especially 
participants at (a) younger age and (b) greater risk of a severe course of 
disease reported reduced mental well-being and seemed to be weakened in their 
psychological protective factors in our sample. These insights allow to provide 
tailored recommendations for preventive and immediate actions to promote 
psychological well-being and reduce stress.

Copyright © 2021 Lingelbach, Piechnik, Gado, Janssen, Eichler, Hentschel, Knopf, 
Schuler, Sernatinger and Peissner.

DOI: 10.3389/fpubh.2021.655083
PMCID: PMC8296300
PMID: 34307274 [Indexed for MEDLINE]

Conflict of interest statement: DK and DS were employed by the company seracom 
GmbH. The remaining authors declare that the research was conducted in the 
absence of any commercial or financial relationships that could be construed as 
a potential conflict of interest.


3191. Radiography (Lond). 2021 Nov;27(4):1219-1226. doi: 10.1016/j.radi.2021.07.004. 
Epub 2021 Jul 12.

The global impact of the COVID-19 pandemic on clinical radiography practice: A 
systematic literature review and recommendations for future services planning.

Akudjedu TN(1), Mishio NA(2), Elshami W(3), Culp MP(4), Lawal O(5), Botwe BO(6), 
Wuni AR(7), Julka-Anderson N(8), Shanahan M(9), Totman JJ(10), Franklin JM(10).

Author information:
(1)Institute of Medical Imaging & Visualisation (IMIV), Department of Medical 
Science & Public Health, Faculty of Health & Social Sciences, Bournemouth 
University, UK. Electronic address: takudjedu@bournemouth.ac.uk.
(2)Department of Psychology, University of Ghana, Ghana.
(3)Department of Medical Diagnostic Imaging, College of Health Sciences, 
University of Sharjah, United Arab Emirates.
(4)Department of Radiology, School of Medicine, The University of North Carolina 
at Chapel Hill, USA.
(5)Department of Allied Health Professions, Midwifery and Social Work, School of 
Health and Social Work, University of Hertfordshire, UK.
(6)Department of Radiography, School of Biomedical & Allied Health Sciences, 
College of Health Sciences, University of Ghana, Ghana.
(7)Department of Imaging Technology & Sonography, University of Cape Coast, 
Ghana.
(8)Radiotherapy Department, Imperial College Healthcare NHS Trust, UK.
(9)Faculty of Health, University of Canberra, Bruce, ACT, Australia.
(10)Institute of Medical Imaging & Visualisation (IMIV), Department of Medical 
Science & Public Health, Faculty of Health & Social Sciences, Bournemouth 
University, UK.

INTRODUCTION: Worldwide, reports and experiences indicate that there has been 
extensive re-organisation within diagnostic imaging and radiotherapy departments 
in response to the COVID-19 pandemic. This was necessary due to changes in 
workload and working practice guidelines that have evolved during the pandemic. 
This review provides a comprehensive summary of the global impact of the 
COVID-19 pandemic on radiography practice, service delivery and workforce 
wellbeing.
METHODS: A systematic review methodology was adopted to obtain data from primary 
studies of qualitative, quantitative, and mixed methods designs from databases 
(PubMed, Science Direct, Cumulative Index of Nursing and Allied Health 
Literature [CINAHL], and SCOPUS: all 2020 to present). The included articles 
were subjected to information extraction and results-based convergent synthesis.
RESULTS: The electronic database search yielded 10,420 articles after removal of 
duplicates. Of these, 31 articles met the final inclusion criteria with some 
(n = 8) fully focussed on radiotherapy workforce and service delivery. The 
pandemic impact on radiography practice is broadly themed around: training, 
communication, and information dissemination; infrastructure, technology, and 
clinical workflow; and workforce mental health and well-being.
CONCLUSION: Globally, most radiographers received inadequate training for 
managing COVID-19 patients during the initial acute phase of the pandemic. 
Additionally, there were significant changes to clinical practice, working 
patterns and perceived increase in workload due to surges in COVID-19 patients 
and the consequent strict adherence to new infection protocols. These changes, 
coupled with fear emanating from the increased risk of the workforce to 
contracting the infection, contributed to anxiety and workplace-related stress 
during the pandemic.
IMPLICATIONS FOR PRACTICE: Local pandemic response strategies must be 
appropriately developed from standard protocols in readiness for safe clinical 
practice and well-being management training of practitioners.

Crown Copyright © 2021. Published by Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.radi.2021.07.004
PMCID: PMC8272968
PMID: 34303601 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest statement None.


3192. Soc Sci Med. 2021 Sep;284:114193. doi: 10.1016/j.socscimed.2021.114193. Epub 
2021 Jul 2.

Sense of purpose in life predicts greater willingness for COVID-19 vaccination.

Hill PL(1), Burrow AL(2), Strecher VJ(3).

Author information:
(1)Department of Psychological and Brain Sciences, Washington University in St. 
Louis, St. Louis, MO, USA. Electronic address: patrick.hill@wustl.edu.
(2)Bronfenbrenner Center for Translational Research, Cornell University, Ithaca, 
NY, USA; Department of Psychology, Cornell University, Ithaca, NY, USA.
(3)School of Public Health, University of Michigan, Ann Arbor, MI, USA; Kumanu 
Inc., USA.

RATIONALE: Despite the clear public health significance of herd immunity to 
COVID-19, a host of individual differences influence willingness to get 
vaccinated. One factor likely to motivate individuals is the extent they have a 
sense of purpose in life, based on the health correlates of purpose and 
purposeful individuals' desire to return to their pre-pandemic environments.
OBJECTIVE: The current study examined sense of purpose as a predictor of 
COVID-19 vaccination willingness in the United States immediately following the 
initial approval of a COVID-19 vaccine in the United States in 2020.
METHODS: A nationwide sample of U. S. adults (N = 2009) completed a poll 
including information on their sense of purpose in life, demographic factors, 
and depressive symptoms, immediately following the initial approval of a 
COVID-19 vaccine in the United States in 2020. In addition, they reported on how 
willing they would be to get the vaccine, assuming that the costs would be 
covered, as well as their motivations to get the vaccine.
RESULTS: Multiple regression analyses found that sense of purpose predicted 
greater willingness to get vaccinated, even when accounting for demographic 
factors, political affiliation, and psychological wellbeing. Adults higher on 
sense of purpose reported greater importance of getting the vaccine for personal 
health, the health of others, and to return to regular activities. Exploratory 
analyses also suggest that purpose may provide a stronger impetus to vaccinate 
among those in age groups associated with lower risk for severe COVID-19 
complications.
CONCLUSIONS: Although cross-sectional in nature, the current findings suggest 
sense of purpose in life may be an important factor in encouraging vaccination. 
Implications are discussed regarding how purposeful messaging may yield greater 
vaccination rates among individuals who otherwise may be less motivated due to 
health concerns.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.socscimed.2021.114193
PMCID: PMC8249702
PMID: 34303295 [Indexed for MEDLINE]


3193. Eur Child Adolesc Psychiatry. 2023 Feb;32(2):223-233. doi: 
10.1007/s00787-021-01849-9. Epub 2021 Jul 24.

Child and family factors associated with child mental health and well-being 
during COVID-19.

McArthur BA(1), Racine N(1), McDonald S(2), Tough S(#)(3), Madigan S(#)(4).

Author information:
(1)Department of Psychology, Faculty of Arts, Alberta Children's Hospital 
Research Institute, University of Calgary, 2500 University Dr. NW., Calgary, AB, 
T2N 1N4, Canada.
(2)Department of Pediatrics, Cumming School of Medicine, University of Calgary, 
2500 University Dr. NW., Calgary, AB, T2N 1N4, Canada.
(3)Department of Pediatrics and Community Health Sciences, Cumming School of 
Medicine, Alberta Children's Hospital Research Institute, University of Calgary, 
2500 University Dr. NW., Calgary, AB, T2N 1N4, Canada.
(4)Department of Psychology, Faculty of Arts, Alberta Children's Hospital 
Research Institute, University of Calgary, 2500 University Dr. NW., Calgary, AB, 
T2N 1N4, Canada. sheri.madigan@ucalgary.ca.
(#)Contributed equally

Understanding the implications of the COVID-19 pandemic on the current 
generation of youth is critical for post-pandemic recovery planning. This study 
aimed to identify the most salient child (i.e., connectedness to caregivers, 
screen time, sleep, physical activity, peer relationships, and recreational 
activities) and family (i.e., COVID-19 financial impact, maternal depression and 
anxiety) factors associated with children's mental health and well-being during 
the COVID-19 pandemic, after controlling for pre-pandemic mental health. This 
study included 846 mother-child dyads (child age 9-11) from the All Our Families 
cohort. Mothers reported on the child's pre-pandemic mental health at age 8 
(2017-2019) and during COVID-19 (May-July 2020), the family's financial impact 
due to COVID-19, and maternal depression and anxiety. During COVID-19 
(July-August 2020), children reported on their screen time, sleep, physical 
activity, peer and family relationships, and recreational activities, as well as 
their happiness, anxiety and depression. After controlling for pre-pandemic 
anxiety, connectedness to caregivers (B - 0.16; 95% CI - 0.22 to - 0.09), child 
sleep (B - 0.11; 95% CI - 0.19 to - 0.04), and child screen time (B 0.11; 95% CI 
0.04-0.17) predicted child COVID-19 anxiety symptoms. After controlling for 
pre-pandemic depression, connectedness to caregivers (B - 0.26; 95% CI - 0.32 to 
- 0.21) and screen time (B 0.09; 95% CI 0.02-0.16) predicted child COVID-19 
depressive symptoms. After controlling for covariates, connectedness to 
caregivers (B 0.36; 95% CI 0.28-0.39) predicted child COVID-19 happiness. 
Fostering parent-child connections and promoting healthy device and sleep habits 
are critical modifiable factors that warrant attention in post-pandemic mental 
health recovery planning.

© 2021. Springer-Verlag GmbH Germany, part of Springer Nature.

DOI: 10.1007/s00787-021-01849-9
PMCID: PMC8302979
PMID: 34302530 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
disclose.


3194. Int J Environ Res Public Health. 2021 Jul 12;18(14):7445. doi: 
10.3390/ijerph18147445.

Psychological Distress among Students in Higher Education: One Year after the 
Beginning of the COVID-19 Pandemic.

Schmits E(1), Dekeyser S(2), Klein O(3), Luminet O(2), Yzerbyt V(2), Glowacz 
F(1).

Author information:
(1)Psychologie Clinique de la Délinquance, Unité de Recherche Adaptation, 
Résilience et Changement, Faculté de Psychologie, Logopédie et Sciences de 
l'Education, Université de Liège, 4000 Liège, Belgium.
(2)Centre d'Etude du Comportement Social, Institut de Recherche en Sciences 
Psychologiques, Faculté de Psychologie et des Sciences de l'Education, 
Université Catholique de Louvain-la-Neuve, 1348 Louvain-la-Neuve, Belgium.
(3)Center for Social and Cultural Psychology, Université Libre de Bruxelles, 
1050 Bruxelles, Belgium.

The COVID-19 pandemic has affected the psychological well-being of students. 
Several stressors (such as socioeconomic and education-related contexts) could 
influence mental health, as well as individual and relational dimensions. This 
study proposes to evaluate the predictive effect of these factors on anxiety and 
depressive symptoms among students in higher education one year after the 
beginning of the pandemic. A sample of 23,307 students (Mage = 20.89; SD = 1.96; 
69.08% of women) was assessed through an online self-report questionnaire 
including adapted and validated measures. The main rates were as follows: 50.6% 
of students presented anxiety symptoms; 55.1% reported depressive symptoms; 
20.8% manifested suicidal ideations; 42.4% saw their financial situation 
deteriorate; 39.1% felt they were dropping out of school. One year after the 
beginning of the pandemic, students in higher education are anxious and 
depressed, especially those who identify as women (for both anxiety and 
depression) and as a non-binary gender (only for anxiety), experience a 
deterioration in their financial situation, are dropping out of school, or 
manifest hostility (for both anxiety and depression). The degree of study 
affects the symptoms' severity (Bachelor 2 and 3 for anxiety and Master for 
depression). Contact with family and friends (for both anxiety and depression) 
as well as regular physical activity (only for depression) should provide some 
protection against psychological distress. Policy-makers must make a long-term 
investment in the well-being and positive mental health of the student 
community.

DOI: 10.3390/ijerph18147445
PMCID: PMC8308017
PMID: 34299896 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3195. Int J Environ Res Public Health. 2021 Jul 6;18(14):7221. doi: 
10.3390/ijerph18147221.

COVID-19 Pandemic-Related Anxiety in Pregnant Women.

Nowacka U(1), Kozlowski S(1), Januszewski M(2), Sierdzinski J(3), Jakimiuk A(2), 
Issat T(1).

Author information:
(1)Department of Obstetrics and Gynecology, Institute of Mother and Child, 
Kasprzaka 17a, 01-211 Warsaw, Poland.
(2)Department of Obstetrics and Gynecology CSKMSWiA, Woloska 137, 02-507 Warsaw, 
Poland.
(3)Department of Medical Informatics and Telemedicine, Medical University of 
Warsaw, Litewska 14/16, 00-581 Warsaw, Poland.

The COVID-19 pandemic outbreak influenced general and mental health worldwide. 
The objective of this study was to assess the anxiety level during the COVID-19 
pandemic among pregnant women and compare it between COVID-infected and 
non-infected groups. We prospectively assessed the daily routine and anxiety 
level using a bespoke questionnaire and GAD-7 scale validated for pregnant 
women. With logistic regression, we established possible risk factors of 
generalized anxiety disorder spectrum and main causes of concern. The dataset 
included 439 responders of our survey. Of which, 21% had COVID-19 infection 
during pregnancy; 38% were screened for possible generalized anxiety disorder 
and the proportion was higher in women who suffered from COVID-19 (48% vs. 35%, 
p = 0.03). Pre-pregnancy anxiety or depression diagnosis and intentional social 
contact avoidance increased the risk of anxiety (aOR 3.4 and 3.2). Fetal 
wellbeing was the main concern for 66% of the responders. The COVID-19 pandemic 
and related restrictions substantially altered daily lives of pregnant women, 
exaggerating the prevalence of anxiety compared with the pre-COVID-19 studies 
(38% vs. 15%). COVID-19 infection during pregnancy was associated with increased 
levels of generalized anxiety scores. Patient-tailored psychological support 
should be a mainstay of comprehensive antenatal medical care in order to avoid 
anxiety- and stress-related complications.

DOI: 10.3390/ijerph18147221
PMCID: PMC8307177
PMID: 34299673 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3196. Int J Environ Res Public Health. 2021 Jul 6;18(14):7215. doi: 
10.3390/ijerph18147215.

Demographics, Socioeconomic Status, Social Distancing, Psychosocial Factors and 
Psychological Well-Being among Undergraduate Students during the COVID-19 
Pandemic.

Silva AND(1), Guedes CR(1), Santos-Pinto CDB(2), Miranda ES(3), Ferreira LM(3), 
Vettore MV(4).

Author information:
(1)Department of Health and Society, Institute of Collective Health, Fluminense 
Federal University (UFF), Av. Marquês do Paraná, 303/3º andar, Niterói 
24070-035, Brazil.
(2)Integrated Health Institute, Mato Grosso do Sul Federal University (UFMS), 
Cidade Universitária, Av. Costa e Silva s/n, Campo Grande 79070-900, Brazil.
(3)Departament of Pharmacy and Pharmacy Administration, Faculty of Pharmacy, 
Fluminense Federal University (UFF), R. Dr. Mario Vianna, 523 Santa Rosa, 
Niterói 24241-000, Brazil.
(4)Department of Health and Nursing Sciences, University of Agder (UiA), 
Universitetsveien 25, 4630 Kristiansand, Norway.

The COVID-19 pandemic impacted on academic routine because of the social 
distancing measures. This study examined the relationships of sociodemographic 
characteristics, social distancing aspects and psychosocial factors on 
psychosocial well-being among undergraduate students during the social 
distancing period due to COVID-19. A web-based survey was conducted of 
undergraduate students at a public university in Brazil (n = 620). Demographics, 
socioeconomic status (SES), social distancing factors, negative affectivity 
(DASS-21), sense of coherence (SOC-13), social support and psychosocial 
well-being (GHQ-12) were measured. The direct and indirect links between was 
variables was tested using structural equation modelling. The estimated model 
showed that greater social support, higher sense of coherence and lower negative 
affectivity were directly associated with better psychological well-being. 
Female gender, higher SES, not working during the social distancing period and 
availability of online modules were indirectly associated with psychological 
well-being through psychosocial factors. Working during the social distancing 
period and availability of online modules mediated the link of age, gender, SES 
with psychological well-being. Our findings suggest the need to provide 
psychological support, online teaching and financial aid to undergraduate 
students during the social distancing period due to COVID-19 pandemic to improve 
their psychological well-being.

DOI: 10.3390/ijerph18147215
PMCID: PMC8306047
PMID: 34299665 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3197. JMIR Public Health Surveill. 2021 Sep 20;7(9):e30460. doi: 10.2196/30460.

Determinants of Shielding Behavior During the COVID-19 Pandemic and Associations 
With Well-being Among National Health Service Patients: Longitudinal 
Observational Study.

Bachtiger P(1)(2), Adamson A(1), Maclean WA(1), Kelshiker MA(1)(2), Quint 
JK(1)(2), Peters NS(1)(2).

Author information:
(1)National Heart and Lung Institute, Imperial College London, London, United 
Kingdom.
(2)Imperial College Healthcare NHS Trust, London, United Kingdom.

BACKGROUND: The UK National Health Service (NHS) classified 2.2 million people 
as clinically extremely vulnerable (CEV) during the first wave of the 2020 
COVID-19 pandemic, advising them to "shield" (to not leave home for any reason).
OBJECTIVE: The aim of this study was to measure the determinants of shielding 
behavior and associations with well-being in a large NHS patient population for 
informing future health policy.
METHODS: Patients contributing to an ongoing longitudinal participatory 
epidemiology study (Longitudinal Effects on Wellbeing of the COVID-19 Pandemic 
[LoC-19], n=42,924) received weekly email invitations to complete questionnaires 
(17-week shielding period starting April 9, 2020) within their NHS personal 
electronic health record. Question items focused on well-being. Participants 
were stratified into four groups by self-reported CEV status (qualifying 
condition) and adoption of shielding behavior (baselined at week 1 or 2). The 
distribution of CEV criteria was reported alongside situational variables and 
univariable and multivariable logistic regression. Longitudinal trends in 
physical and mental well-being were displayed graphically. Free-text responses 
reporting variables impacting well-being were semiquantified using natural 
language processing. In the lead up to a second national lockdown (October 23, 
2020), a follow-up questionnaire evaluated subjective concern if further 
shielding was advised.
RESULTS: The study included 7240 participants. In the CEV group (n=2391), 1133 
(47.3%) assumed shielding behavior at baseline, compared with 633 (13.0%) in the 
non-CEV group (n=4849). CEV participants who shielded were more likely to be 
Asian (odds ratio [OR] 2.02, 95% CI 1.49-2.76), female (OR 1.24, 95% CI 
1.05-1.45), older (OR per year increase 1.01, 95% CI 1.00-1.02), living in a 
home with an outdoor space (OR 1.34, 95% CI 1.06-1.70) or three to four other 
inhabitants (three: OR 1.49, 95% CI 1.15-1.94; four: OR 1.49, 95% CI 1.10-2.01), 
or solid organ transplant recipients (OR 2.85, 95% CI 2.18-3.77), or have severe 
chronic lung disease (OR 1.63, 95% CI 1.30-2.04). Receipt of a government letter 
advising shielding was reported in 1115 (46.6%) CEV participants and 180 (3.7%) 
non-CEV participants, and was associated with adopting shielding behavior (OR 
3.34, 95% CI 2.82-3.95 and OR 2.88, 95% CI 2.04-3.99, respectively). In CEV 
participants, shielding at baseline was associated with a lower rating of mental 
well-being and physical well-being. Similar results were found for non-CEV 
participants. Concern for well-being if future shielding was required was most 
prevalent among CEV participants who had originally shielded.
CONCLUSIONS: Future health policy must balance the potential protection from 
COVID-19 against our findings that shielding negatively impacted well-being and 
was adopted in many in whom it was not indicated and variably in whom it was 
indicated. This therefore also requires clearer public health messaging and 
support for well-being if shielding is to be advised in future pandemic 
scenarios.

©Patrik Bachtiger, Alexander Adamson, William A Maclean, Mihir A Kelshiker, 
Jennifer K Quint, Nicholas S Peters. Originally published in JMIR Public Health 
and Surveillance (https://publichealth.jmir.org), 20.09.2021.

DOI: 10.2196/30460
PMCID: PMC8454693
PMID: 34298499 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


3198. J Affect Disord. 2021 Nov 1;294:151-158. doi: 10.1016/j.jad.2021.07.042. Epub 
2021 Jul 16.

The changes of suicidal ideation status among young people in Hong Kong during 
COVID-19: A longitudinal survey.

Zhu S(1), Zhuang Y(2), Lee P(3), Wong PWC(4).

Author information:
(1)Department of Applied Social Sciences, The Hong Kong Polytechnic University, 
Hong Kong. Electronic address: jasmine.zhu@polyu.edu.hk.
(2)Department of Applied Social Sciences, The Hong Kong Polytechnic University, 
Hong Kong.
(3)Department of Health Sciences, University of Leicester, United Kingdom.
(4)The Department of Social Work and Social Administration, The University of 
Hong Kong, Hong Kong. Electronic address: paulw@hku.hk.

BACKGROUND: Pandemics affect the physical and mental well-being of all 
potentially at-risk young people globally. This longitudinal study examines 
changes of suicidal ideation status among adolescents during COVID-19.
METHOD: A follow-up after nine-months of a school-based survey among 1,491 
secondary school students was conducted during COVID-19. Psychological 
well-being, psychological factors, family support, and COVID-19-related 
experiences were examined.
RESULTS: The prevalence of suicidal ideation were 24% and 21% among the 
participants before and during COVID-19, respectively. In particular, 897 
(65.0%) remained non-suicidal, 193 (14.0%) recovered from being suicidal, 148 
(10.7%) newly reported being suicidal, and 143 (10.4%) remained suicidal. 
Respondents who remained suicidal were found to have significantly higher 
depression, anxiety, stress, loneliness, and social anxiety, fixed mind-set, 
lower meaning of life and self-control; and lower parental support and 
supervision than the other three groups. Participants with suicidal ideation 
reported more negative perceptions about COVID-19 than non-suicidal 
participants. Multinomial logistic regression showed that anxiety, trait anxiety 
and life satisfactory in baseline were associated with suicidal ideation at 
follow-up.
LIMITATION: This study was limited by the small number of protective variables 
being included in the baseline survey to examine the potential reasons for the 
recovery of suicidal ideation at follow-up.
CONCLUSION: Poor psychological well-being, lower level of family support, and 
negative impacts of the pandemic were consistently associated with students' 
presence of suicidal ideation during the pandemic. Further intervention studies 
are needed to examine effects of mental health consequences of COVID-19 on youth 
mental health and to promote positive youth well-being.

Copyright © 2021 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2021.07.042
PMCID: PMC9757145
PMID: 34298219 [Indexed for MEDLINE]

Conflict of interest statement: None declared.


3199. PLoS One. 2021 Jul 23;16(7):e0255156. doi: 10.1371/journal.pone.0255156. 
eCollection 2021.

The combined effect of Covid-19 and neighbourhood deprivation on two dimensions 
of subjective well-being: Empirical evidence from England.

Bonomi Bezzo F(1), Silva L(2)(3), van Ham M(4)(5).

Author information:
(1)La Statale, University of Milan, Milan, Italy.
(2)Department of Sociology, Sciences Po, Paris, France.
(3)CREST, ENSAE Paris, Palaiseau, France.
(4)Department of Urbanism, Faculty of Architecture and the Built Environment, 
Delft University of Technology, Delft, The Netherlands.
(5)School of Geography and Sustainable Development, University of St Andrews, 
Scotland, United Kingdom.

OBJECTIVES: The Covid-19 pandemic is hitting societies hard, and people living 
in disadvantaged circumstances are among the most affected. We investigate the 
combined effects of the Covid-19 crisis and living in a deprived neighbourhood 
on two dimensions of subjective well-being: hedonic (i.e. mental health) and 
evaluative (i.e. life satisfaction) subjective well-being.
METHODS: We use longitudinal data from the Understanding Society UK panel. We 
combine data gathered in the main survey between 2015 and 2019 with very recent 
data from the Covid-19 online survey between April and July 2020. Leveraging a 
sample of nearly 9,600 English individuals, we first run a set of 
cross-sectional OLS regressions to analyse changes over time in the relationship 
between neighbourhood deprivation and subjective well-being. Then, as our main 
model of interest, we use a fixed effect difference-in-differences model to 
provide more robust evidence.
RESULTS: Since the beginning of the crisis, both levels of hedonic and 
evaluative well-being have decreased as a result of the pandemic and lockdown. 
However, for those living in more deprived neighbourhoods the level of hedonic 
well-being decreased more than for those living in better areas. We found no 
such difference for evaluative well-being.
CONCLUSION: Our results highlight the importance of reducing neighbourhood 
inequalities as the spatial clustering of disadvantages has increased by the 
pandemic.

DOI: 10.1371/journal.pone.0255156
PMCID: PMC8301628
PMID: 34297763 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


3200. Psicothema. 2021 Aug;33(3):423-432. doi: 10.7334/psicothema2020.453.

Older People's Personal Strengths During the First Wave of the COVID-19 
Pandemic.

Pérez-Rojo G(1), López J, Noriega C, Martínez-Huertas JA, Velasco C, Carretero 
I, López-Frutos P, Galarraga L, Pillemer K.

Author information:
(1)Universidad San Pablo-CEU.

BACKGROUND: Although several biopsychosocial variables could play an important 
role as risk and protective factors of mental health, COVID-19 outbreak studies 
among older people have seldom focused on protective factors. The purpose of 
this study was to analyze how older adults' personal strengths predict their 
well-being and emotional distress.
METHOD: 783 Spanish people aged 60 and over completed a survey that included 
sociodemographic characteristics, perceived health, direct or indirect infection 
by COVID-19, resilience, gratitude, experiential avoidance, family functioning, 
emotional distress and well-being. Structural Equation Modelling (SEM) was 
performed. SEM invariance was also used to analyze whether there were 
differences between older people affected by COVID-19 and those not affected.
RESULTS: The best model supports the mediation effect of resilience, gratitude 
and experiential avoidance on older people's well-being and emotional distress. 
Whether participants or relatives had been infected by the virus or not did not 
affect the results.
CONCLUSIONS: Variables used as criteria in older adults are related to 
well-being and emotional distress, but only indirectly and mediated by 
resilience, gratitude and experiential avoidance. This confirms the importance 
of considering psychological strengths in older people's well-being. 
Interventions focused on these personal resources should be considered.

DOI: 10.7334/psicothema2020.453
PMID: 34297672 [Indexed for MEDLINE]


3201. Rheumatol Int. 2021 Oct;41(10):1763-1772. doi: 10.1007/s00296-021-04952-x. Epub 
2021 Jul 23.

Mental health and quality of life for people with rheumatoid arthritis or 
ankylosing spondylitis in Aotearoa New Zealand following the COVID-19 national 
lockdown.

Johnstone G(1), Treharne GJ(2), Fletcher BD(1), Lamar RSM(1), White D(3), 
Harrison A(4), Stebbings S(5).

Author information:
(1)Department of Psychology, University of Otago, Otago, New Zealand.
(2)Department of Psychology, University of Otago, Otago, New Zealand. 
gareth.treharne@otago.ac.nz.
(3)Waikato Clinical School, University of Auckland and Rheumatology Department, 
Waikato District Health Board, Waikato, New Zealand.
(4)Department of Medicine, Wellington School of Medicine, University of Otago, 
Otago, New Zealand.
(5)Department of Medicine, Dunedin School of Medicine, University of Otago, 
Otago, New Zealand.

The aim of this study was to investigate the effects of lockdown on the mental 
health (anxiety and depression) and quality of life (QOL) of people with 
rheumatoid arthritis (RA) and ankylosing spondylitis (AS) in the context of the 
COVID-19 pandemic and public health measures instituted at a national level by 
the New Zealand Government. The present cohort was 104 individuals with RA 
(73.1%) and AS (26.9%) who had previously completed surveys for the Patient 
Opinion Real-Time Anonymous Liaison (PORTAL) project in 2018. Participants 
completed an online survey between July and September 2020 assessing their 
experiences over the first national COVID-19 lockdown in New Zealand (March-May, 
2020). Fear of SARS-CoV-2 infection, baseline anxiety, and being younger in age 
were all predictors of participants' current anxiety levels. Current QOL scores 
were significantly lower than prior to lockdown and were predicted by baseline 
QOL and current depression. No variables predicted current depression other than 
baseline levels. The COVID-19 pandemic appears to have had an impact on QOL and 
anxiety levels, but not depression for people with RA and AS in New Zealand. 
These novel findings imply that appropriate screening of mental health issues 
should be included in planning within the ongoing COVID-19 pandemic and for 
future pandemics to optimise the wellbeing of people with RA and AS.

© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, 
part of Springer Nature.

DOI: 10.1007/s00296-021-04952-x
PMCID: PMC8298198
PMID: 34297180 [Indexed for MEDLINE]

Conflict of interest statement: All authors declare no conflict of interest.


3202. J Health Psychol. 2022 Sep;27(10):2330-2343. doi: 10.1177/13591053211029994. 
Epub 2021 Jul 23.

Locking down behavioural compliance: The role of emotion and emotion regulation 
in breaches of COVID-19 mitigation measures in Aotearoa New Zealand.

Broodryk T(1), Robinson K(1).

Author information:
(1)Victoria University of Wellington, New Zealand.

Although anxiety and worry can motivate engagement with COVID-19 preventative 
behaviours, people may cognitively reframe these unpleasant emotions, restoring 
wellbeing at the cost of public health behaviours. New Zealand young adults 
(n = 278) experiencing nationwide COVID-19 lockdown reported their worry, 
anxiety, reappraisal and lockdown compliance. Despite high knowledge of lockdown 
policies, 92.5% of participants reported one or more policy breaches (M = 2.74, 
SD = 1.86). Counter to predictions, no relationships were found between anxiety 
or worry with reappraisal or lockdown breaches. Findings highlight the 
importance of targeting young adults in promoting lockdown compliance and offer 
further insight into the role of emotion during a pandemic.

DOI: 10.1177/13591053211029994
PMID: 34296643 [Indexed for MEDLINE]


3203. Depress Anxiety. 2021 Oct;38(10):1018-1025. doi: 10.1002/da.23202. Epub 2021 Jul 
22.

Emotional intelligence training as a protective factor for mental health during 
the COVID-19 pandemic.

Persich MR(1), Smith R(2), Cloonan SA(1), Woods-Lubbert R(1), Strong M(1), 
Killgore WDS(1).

Author information:
(1)Department of Psychiatry, University of Arizona, Tucson, Arizona, USA.
(2)Department of Psychiatry, Laureate Institute for Brain Research, Tulsa, 
Oklahoma, USA.

INTRODUCTION: The COVID-19 pandemic has presented a major challenge to mental 
health and emotional wellbeing. The present study examined whether training in 
emotional intelligence (EI) skills, provided before the pandemic, would serve as 
a protective factor for sustaining mental health during the COVID-19 crisis.
METHODS: Data came from a longitudinal study (N = 89) that was initially 
designed to test the effectiveness of an EI training program versus a 
non-emotion-focused placebo program. The design and timing of the study were 
such that baseline and posttraining assessments of depression and anxiety had 
been completed before the pandemic, and planned 6-month follow-ups were 
serendipitously scheduled to occur after the onset of the COVID-19 crisis. This 
provided us with an unexpected real-world opportunity to investigate whether EI 
training would bolster emotional resilience to the challenges posed by the 
COVID-19 pandemic.
RESULTS: Although mental health concerns generally increased after the start of 
the pandemic, individuals who completed the EI training program scored lower on 
depression, suicidal ideation, and state anxiety relative to individuals who had 
been assigned to the placebo training program.
CONCLUSION: Online EI training appears to be effective at sustaining critical 
aspects of mental health during a subsequent real-life crisis.

© 2021 Wiley Periodicals LLC.

DOI: 10.1002/da.23202
PMCID: PMC8427055
PMID: 34293205 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that there are no conflict 
of interests.


3204. Can J Anaesth. 2021 Nov;68(11):1659-1667. doi: 10.1007/s12630-021-02073-4. Epub 
2021 Jul 22.

Provider attitudes and satisfaction with rapid preoperative point-of-care 
COVID-19 testing using ID NOW™.

Lee SM(1)(2), Meyler P(3)(4), Mozel M(3)(4), Choi J(4), Tauh T(3)(4).

Author information:
(1)Department of Anesthesia and Perioperative Medicine, Royal Columbian 
Hospital, 330 E Columbia St, New Westminster, BC, V3L 3W7, Canada. 
suze.lee@utoronto.ca.
(2)Department of Anesthesiology, Pharmacology & Therapeutics, The University of 
British Columbia, Vancouver, BC, Canada. suze.lee@utoronto.ca.
(3)Department of Anesthesia and Perioperative Medicine, Royal Columbian 
Hospital, 330 E Columbia St, New Westminster, BC, V3L 3W7, Canada.
(4)Department of Anesthesiology, Pharmacology & Therapeutics, The University of 
British Columbia, Vancouver, BC, Canada.

PURPOSE: Healthcare workers have experienced high levels of anxiety during the 
COVID-19 pandemic, particularly when caring for patients with unknown infection 
status. We trialled rapid preoperative point-of-care COVID-19 testing using the 
Abbott ID NOW™ COVID-19 for clinical validation in an urgent surgical population 
at a single centre in British Columbia, Canada. Here, we sought to determine the 
opinions and beliefs of operating room (OR) staff on the usefulness and 
effectiveness of point-of-care tests on workflow and wellbeing in the OR.
METHODS: This descriptive study used a mixed-methods cross-sectional survey of 
all OR staff (nurses, anesthesiologists, surgeons, and ancillary staff) at a 
single centre after using the ID NOW for three months. Outcomes of interest 
included healthcare worker satisfaction with the ID NOW, effects on OR workflow, 
and worries about COVID-19 transmission.
RESULTS: The overall response rate was 56% (n = 133), and was highest among 
anesthesiologists (100%, n = 38). Respondents were satisfied with the 
performance of the ID NOW for rapid COVID-19 testing in preoperative patients, 
giving it a mean (standard deviation [SD]) rate of 4.4 [1.4] on a five-point 
scale. Most (115/128, 90%) recommended continued use of the ID NOW on 
asymptomatic patients while there are active cases of COVID-19 in the community. 
Respondents felt that preoperative COVID-19 testing with the ID NOW made the OR 
safer for staff (mean [SD] rate, 4.2 [0.8]) and patients (mean [SD] rate, 4.0 
[0.9]).
CONCLUSION: During the COVID-19 pandemic, it is important to maintain the 
physical and mental wellbeing of hospital staff. Rapid point-of-care testing 
increased the sense of workplace safety, improved morale, and reduced worry 
associated with COVID-19 without excessive disruption of OR workflow.

Publisher: RéSUMé: OBJECTIF: Les travailleurs de la santé ont connu des niveaux 
élevés d’anxiété au cours de la pandémie de COVID-19, en particulier lorsqu’ils 
prenaient soin de patients dont le statut infectieux était inconnu. Nous avons 
testé le dépistage préopératoire rapide de la COVID-19 au point de service avec 
le dispositif ID NOW™ COVID-19 d’Abbott pour validation clinique auprès d’une 
population devant bénéficier de chirurgie urgente dans un seul centre en 
Colombie-Britannique, au Canada. Notre objectif était ici de déterminer les 
opinions et les croyances du personnel de la salle d’opération (SOP) quant à 
l’utilité et à l’efficacité des tests au point de service en matière de flux de 
travail et de bien-être en salle d’opération. MéTHODE: Cette étude descriptive a 
utilisé un sondage transversal à méthodes mixtes auprès de tout le personnel de 
la SOP (infirmières, anesthésiologistes, chirurgiens et personnel auxiliaire) 
dans un seul centre après avoir utilisé le système ID NOW pendant trois mois. 
Les issues de l’étude comprenaient la satisfaction des travailleurs de la santé 
à l’égard de ID NOW, les effets sur le flux de travail de la SOP et les 
inquiétudes concernant la transmission de la COVID-19. RéSULTATS: Le taux de 
réponse global a été de 56 % (n = 133), et était le plus élevé chez les 
anesthésiologistes (100 %, n = 38). Les répondants étaient satisfaits de la 
performance de ID NOW pour le dépistage rapide de la COVID-19 chez les patients 
préopératoires, lui accordant une note moyenne (écart type [ÉT]) de 4,4 [1,4] 
sur une échelle à cinq points. La plupart (115/128, 90 %) ont recommandé de 
continuer à utiliser ID NOW avec les patients asymptomatiques tant qu’il y a des 
cas actifs de COVID-19 dans la communauté. Les répondants étaient d’avis que le 
dépistage préopératoire de la COVID-19 avec ID NOW rendait la SOP plus 
sécuritaire pour le personnel (note moyenne [ÉT], 4,2 [0,8]) et les patients 
(note moyenne [ÉT], 4,0 [0,9]). CONCLUSION: Pendant la pandémie de COVID-19, il 
est important de maintenir le bien-être physique et mental du personnel 
hospitalier. Le dépistage rapide au point de service a accru le sentiment de 
sécurité au travail, amélioré le moral et réduit l’inquiétude associée à la 
COVID-19, sans perturbation excessive du flux de travail de la SOP.

© 2021. Canadian Anesthesiologists' Society.

DOI: 10.1007/s12630-021-02073-4
PMCID: PMC8296831
PMID: 34292525 [Indexed for MEDLINE]


3205. J Trauma Stress. 2022 Feb;35(1):308-313. doi: 10.1002/jts.22718. Epub 2021 Jul 
22.

The Impact of COVID-19 on Psychotherapy Participation Among Individuals With 
Posttraumatic Stress Disorder Enrolled in Treatment Research.

McLean CP(1)(2), Back SE(3)(4), Capone C(5)(6), Morland L(7)(8)(9), Norman 
SB(7)(9)(10), Rauch SAM(11)(12), Schnurr PP(10)(13), Teng E(14)(15), Acierno 
R(16).

Author information:
(1)Dissemination and Training Division, National Center for PTSD, VA Palo Alto 
Health Care System, Menlo Park, California, USA.
(2)Department of Psychiatry and Behavioral Sciences, School of Medicine, 
Stanford University, Stanford, California, USA.
(3)Department of Psychiatry and Behavioral Sciences, Medical University of South 
Carolina, Charleston, South Carolina, USA.
(4)Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina.
(5)Providence VA Medical Center, Providence, Rhode Island, USA.
(6)Department of Psychiatry and Human Behavior, Center for Alcohol and Addiction 
Studies, Brown University, Providence, Rhode Island, USA.
(7)VA San Diego Healthcare System, San Diego, California, USA.
(8)National Center for PTSD Pacific Islands Division, Honolulu, Hawaii, USA.
(9)Department of Psychiatry, University of California San Diego School of 
Medicine, San Diego, California, USA.
(10)Executive Division, National Center for PTSD, White River Junction, Vermont, 
USA.
(11)Health Service Line, Atlanta VA Medical Center, Atlanta, Georgia, USA.
(12)Department of Psychiatry and Behavioral Sciences, Emory University School of 
Medicine, Atlanta, Georgia, USA.
(13)Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
(14)Department of Psychiatry and Behavioral Sciences, Baylor College of 
Medicine, Houston, Texas, USA.
(15)Michael E. DeBakey VA Medical Center, Houston, Texas, USA.
(16)Louis Faillace Department of Psychiatry, McGovern Medical School at UTHealth 
Houston, Houston, Texas.

The onset of the COVID-19 pandemic disrupted many aspects of daily life and 
required a rapid and unprecedented shift in psychotherapy delivery from 
in-person to telemental health. In the present study, we explored the impact of 
the pandemic on individuals' ability to participate in posttraumatic stress 
disorder (PTSD) psychotherapy and the association between the impact of COVID-19 
impact on health and financial well-being and psychotherapy participation. 
Participants (N = 161, 63.2% male, Mage = 42.7 years) were United States 
military veterans (n = 108), active duty military personnel (n = 12), and 
civilians (n = 6), who were participating in one of nine PTSD treatment trials. 
The results indicate a predominately negative COVID-19 impact on therapy 
participation, although some participants (26.1%) found attending therapy 
sessions through telehealth to be easier than in-person therapy. Most 
participants (66.7%) reported that completing in vivo exposure homework became 
harder during the pandemic. Moreover, the impact of the pandemic on PTSD symptom 
severity and daily stress were each associated with increased difficulty with 
aspects of therapy participation. The findings highlight the unique challenges 
to engaging in PTSD treatment during the pandemic as well as a negative impact 
on daily stress and PTSD severity, both of which were related to treatment 
engagement difficulties.

Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic 
Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Traditional Chinese 
新冠肺炎對參與治療研究的創傷後壓力症臨床治療者心理治療參與的影響 摘要 新冠肺炎爆發的爆發擾亂了日常生活的許多方面, 
要求心理治療的提供從面對面到遠程心理健康的迅速及前所未有的轉變。在本研究中, 我們探討了新冠肺炎對個人參與創傷後壓力症心理治療能力的影響, 
以及新冠肺炎對健康及財務狀況的影響與心理治療參與之間的關係。參與者 (N = 161, 63.2%為男性, Mage = 42.7歲) 為美國退伍軍人 (N = 
108) 、現役軍人 (N = 12) 及平民 (N = 6) , 他們參加了九項創傷後壓力症治療試驗中的一項。結果表明, 新冠肺炎對治療參與的影響主要為負面, 
儘管一些參與者 (26.1%) 認為通過遠程保健參加治療課程比現場治療更容易。大多數參與者 (66.7%) 報告說, 在大流行期間, 
進行身體檢查變得更難。另外, 
大流行對創傷後壓力症嚴重程度及日常壓力的影響都與參與治療方面的困難增加有關。研究結果強調了在大流行期間參與創傷後壓力症治療的獨特挑戰, 
以及對日常壓力及創傷後壓力症嚴重程度的負面影響, 這兩者都與治療參與困難有關。 Simplified Chinese 
新冠肺炎对参与治疗研究的创伤后压力症临床治疗者心理治疗参与的影响 摘要 新冠肺炎爆发的爆发扰乱了日常生活的许多方面, 
要求心理治疗的提供从面对面到远程心理健康的迅速及前所未有的转变。在本研究中, 我们探讨了新冠肺炎对个人参与创伤后压力症心理治疗能力的影响, 
以及新冠肺炎对健康及财务状况的影响与心理治疗参与之间的关系。参与者 (N = 161, 63.2%为男性, Mage = 42.7岁) 为美国退伍军人 (N = 
108) 、现役军人 (N = 12) 及平民 (N = 6) , 他们参加了九项创伤后压力症治疗试验中的一项。结果表明, 新冠肺炎对治疗参与的影响主要为负面, 
尽管一些参与者 (26.1%) 认为通过远程保健参加治疗课程比现场治疗更容易。大多数参与者 (66.7%) 报告说, 在大流行期间, 
进行身体检查变得更难。另外, 
大流行对创伤后压力症严重程度及日常压力的影响都与参与治疗方面的困难增加有关。研究结果强调了在大流行期间参与创伤后压力症治疗的独特挑战, 
以及对日常压力及创伤后压力症严重程度的负面影响, 这两者都与治疗参与困难有关。

© 2021 International Society for Traumatic Stress Studies.

DOI: 10.1002/jts.22718
PMCID: PMC8426668
PMID: 34291832 [Indexed for MEDLINE]


3206. J Community Psychol. 2022 Aug;50(6):2562-2577. doi: 10.1002/jcop.22676. Epub 
2021 Jul 22.

Delayed educational services during Covid-19 and their relationships with the 
mental health of individuals with disabilities.

Sakız H(1).

Author information:
(1)Department of Educational Sciences, Mardin Artuklu University, Mardin, 
Turkey.

During the coronavirus disease 2019 (Covid-19) pandemic, individuals with 
disabilities (IWD), like many others, have not been able to benefit effectively 
from educational and school-based mental health services, which are vital to 
achieving mental good health. This study aimed to collect views of IWD about how 
their mental health was affected by the school closure during Covid-19. 
Thirty-one IWD were interviewed and data were analyzed thematically. Findings 
indicated that the educational delay, combined with the pressure of the 
preventive measures against Covid-19 was associated with (i) difficulties in 
emotional well-being, structured routines, learning, and socialization, (ii) 
enhanced feelings of isolation and pain, and (iii) negative perceptions of 
academic-self-efficacy and therapy-related outcomes. The findings of the study 
highlight the importance of urgent short-term and long-term measures to provide 
safe and individually oriented educational services to compensate for the 
consequences of the pandemic.

© 2021 Wiley Periodicals LLC.

DOI: 10.1002/jcop.22676
PMCID: PMC8426733
PMID: 34291811 [Indexed for MEDLINE]

Conflict of interest statement: The author declares that there is no conflict of 
interest.


3207. Inquiry. 2021 Jan-Dec;58:469580211025225. doi: 10.1177/00469580211025225.

COVID-19: Fear and Anxiety among Healthcare Workers in Saudi Arabia. A 
Cross-Sectional Study.

Mohsin SF(1), Agwan MA(1), Shaikh S(2), Alsuwaydani ZA(1), AlSuwaydani SA(3).

Author information:
(1)College of Dentistry Ar Rass, Qassim University, Ar Rass, Qassim, Saudi 
Arabia.
(2)College of Dentistry, University of Hail, Hail, Saudi Arabia.
(3)Unaizah College of Medicine, Qassim University, Unaizah, Qassim, Saudi 
Arabia.

The novel coronavirus (COVID-19) is an extremely contagious respiratory disease. 
It poses a serious threat to healthcare workers which may cause substantial 
degree of psychological distress. This study aimed to evaluate the level of fear 
and anxiety among healthcare workers. A cross sectional study was designed to 
collect data from healthcare workers in Saudi Arabia using an online 
questionnaire. A non-probability convenient sampling technique was used to 
collect the data from 1st August to 10th August 2020 with the exclusion of 
non-healthcare worker and general public. A 5-point Likert scale was used to 
evaluate the level of fear and anxiety. The data was analyzed by using Spss 
version 23 .The descriptive data were represented as frequencies and percentage. 
Multinomial logistic regression analysis was applied to control the confounding 
factors and assess the relationship between variables. Data analyzed 737 
participants revealed that 10.7%, 73.5%, and 15.7% of HCWs had a mild, moderate, 
and severe degree of fear and anxiety respectively. The multinomial logistic 
regression analysis revealed that gender and specialty of the participants were 
significantly associated with moderate and severe anxiety level. This study 
demonstrates that two-third of the healthcare workers had a moderate risk of 
fear and anxiety. However, females participants found to have elevated fear and 
anxiety level. Social distancing has a major impact on social well-being 
therefore its important to address social support through a policy. Further 
studies are needed to explore the mental health condition of healthcare workers 
in order to develop evidence based strategies.

DOI: 10.1177/00469580211025225
PMCID: PMC8312152
PMID: 34291693 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


3208. Int J Audiol. 2022 Apr;61(4):273-282. doi: 10.1080/14992027.2021.1944675. Epub 
2021 Jul 22.

International survey of audiologists during the COVID-19 pandemic: effects on 
mental well-being of audiologists.

Bennett RJ(1)(2), Manchaiah V(3)(4), Eikelboom RH(1)(2)(5), Badcock JC(6), 
Swanapoel W(1)(2)(5).

Author information:
(1)Ear Science Institute Australia, Subiaco, Australia.
(2)Ear Sciences Centre, The University of Western Australia, Nedlands, 
Australia.
(3)Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, 
United States.
(4)Department of Speech and Hearing, School of Allied Health Sciences, Manipal 
University, Manipal, India.
(5)Department of Speech-Language Pathology and Audiology, University of 
Pretoria, Gauteng, South Africa.
(6)School of Psychological Science, The University of Western Australia, Perth, 
Australia.

OBJECTIVE: The aim of the study was to examine the mental well-being of 
audiologists in the midst of the COVID-19 pandemic.
DESIGN: A cross-sectional online survey was conducted during the COVID-19 
pandemic, between 23 June and 13 August 2020. A self-report survey included 
screening measures for psychological distress (PHQ-4: anxiety and depression) 
and loneliness (UCLA-3).
STUDY SAMPLE: 239 audiologists from around the world.
RESULTS: The prevalence of psychological distress was 12.1% (subscales for 
anxiety 16.3% and depression 10.4%), and loneliness 32.2%. Depression and 
loneliness were higher in those participants self-reporting perceived job 
insecurity, with psychological distress (anxiety and depression) higher in those 
from South Africa. Accessibility to Employee Assistance Programs (EAPs) appears 
to be a protective factor.
CONCLUSIONS: Well-being interventions, such as EAPS, are needed to support 
audiologists during challenging times like the COVID-19 pandemic.

DOI: 10.1080/14992027.2021.1944675
PMID: 34289793 [Indexed for MEDLINE]


3209. J Psychol. 2021;155(7):657-677. doi: 10.1080/00223980.2021.1952151. Epub 2021 
Jul 21.

Sense of Coherence and COVID-19: A Longitudinal Study.

Danioni F(1), Sorgente A(2), Barni D(3), Canzi E(1)(2), Ferrari L(1)(2), Ranieri 
S(1)(2), Iafrate R(1)(2), Regalia C(1)(2), Rosnati R(1)(2), Lanz M(1)(2).

Author information:
(1)Family Studies and Research University Centre, Università Cattolica del Sacro 
Cuore.
(2)Department of Psychology, Università Cattolica del Sacro Cuore.
(3)Department of Human and Social Sciences, Università degli Studi di Bergamo.

The strong restrictive measures adopted in 2020 against the spread of the 
COVID-19 pandemic in Italy have deeply affected the general population's mental 
health. In the current longitudinal study, we specifically focus on sense of 
coherence (SOC), both in terms of comprehensibility/manageability and 
meaningfulness, among a large sample of Italian adults; SOC is a potential 
resource likely to foster the ability to cope with stressors. A total of 2,191 
Italian participants (65.8% female) aged 18-82 completed an anonymous online 
self-report questionnaire at Time 1 (during the lockdown, March 2020) and at 
Time 2 (at the resumption of most activities, July 2020). The Repeated Measures 
Latent Profile Analysis (RMLPA) allowed us to identify seven different SOC 
profiles based on the change in both SOC dimensions, ranging from a strong 
"crisis" in terms of this resource in the face of the pandemic to a solid 
possibility to count on it. Interestingly, female and younger respondents were 
more likely to belong to those profiles characterized by lower levels of SOC, 
and these profiles have specific relations with fear and wellbeing. The 
implications of these results and the further expansion of the study are 
discussed.Supplemental data for this article is available online at 
https://doi.org/10.1080/00223980.2021.1952151 .

DOI: 10.1080/00223980.2021.1952151
PMID: 34289329 [Indexed for MEDLINE]


3210. PLoS One. 2021 Jul 21;16(7):e0254954. doi: 10.1371/journal.pone.0254954. 
eCollection 2021.

Food insecurity during COVID-19 pandemic: A genuine concern for people from 
disadvantaged community and low-income families in Province 2 of Nepal.

Singh DR(1)(2)(3), Sunuwar DR(4), Shah SK(5), Sah LK(6), Karki K(1), Sah RK(7).

Author information:
(1)Department of Public Health, Asian College for Advance Studies, Purbanchal 
University, Lalitpur, Nepal.
(2)Research and Innovation Section, Southeast Asia Development Actions Network 
(SADAN), Lalitpur, Nepal.
(3)Research Section, Swadesh Development Foundation (SDF), Siraha, Province-2, 
Nepal.
(4)Department of Nutrition and Dietetics, Armed Police Force Hospital, 
Kathmandu, Nepal.
(5)Program Section, Bagmati Welfare Society Nepal, Sarlahi, Province-2, Nepal.
(6)Faculty of Medicine, Health and Social Care, Canterbury Christ Church 
University, Canterbury, Kent, United Kingdom.
(7)Department of Allied Health Professions, Sports and Exercise, School of Human 
and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom.

BACKGROUND: Food insecurity is a serious social and public health problem which 
is exacerbated by the COVID-19 pandemic especially in resource-poor countries 
such as Nepal. However, there is a paucity of evidence at local levels. This 
study aims to explore food insecurity among people from the disadvantaged 
community and low-income families during the COVID-19 pandemic in Province-2 of 
Nepal.
METHODS: The semi-structured qualitative interviews were conducted virtually 
among purposively selected participants (n = 41) from both urban and rural areas 
in eight districts of Province 2 in Nepal. All the interviews were conducted in 
the local language between July and August 2020. The data analysis was performed 
using thematic network analysis in Nvivo 12 Pro software.
RESULTS: The results of this study are grouped into four global themes: i) 
Impact of COVID-19 on food security; ii) Food insecurity and coping strategies 
during the COVID-19 pandemic, iii) Food relief and emergency support during the 
COVID-19 pandemic, and iv) Impact of COVID-19 and food insecurity on health and 
wellbeing. Most participants in the study expressed that families from low 
socioeconomic backgrounds and disadvantaged communities such as those working on 
daily wages and who rely on remittance had experienced increased food insecurity 
during the COVID-19 pandemic. Participants used different forms of coping 
strategies to meet their food requirements during the pandemic. Community 
members experienced favouritism, nepotism, and partiality from local politicians 
and authorities during the distribution of food relief. The food insecurity 
among low-income and disadvantaged families has affected their health and 
wellbeing making them increasingly vulnerable to the COVID-19 infection.
CONCLUSION: Food insecurity among low-income and disadvantaged families was 
found to be a serious problem during the COVID-19 pandemic. The study suggests 
that the relief support plan and policies should be focused on the 
implementation of immediate sustainable food security strategies to prevent 
hunger, malnutrition, and mental health problems among the most vulnerable 
groups in the community.

DOI: 10.1371/journal.pone.0254954
PMCID: PMC8294479
PMID: 34288965 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


3211. Res Gerontol Nurs. 2021 Jul-Aug;14(4):180-190. doi: 
10.3928/19404921-20210325-01. Epub 2021 May 19.

Staff's Psychological Well-Being and Coping Mechanisms During COVID-19 Lockdown 
in Care Homes for Older Adults: A Structural Equation Modeling Analysis.

Zhao Y, Cui Y, Liu S, Wen Y, Ding Y, Xu Q.

The current study investigated the psychological well-being and coping 
mechanisms of care home staff during the coronavirus disease 2019 (COVID-19) 
lockdown. Among 147 staff members, 21.8%, 24.5%, and 12.9% reported depression, 
anxiety, and stress, respectively. The results of structural equation modeling 
showed that self-efficacy and coping strategies had direct effects on 
psychological well-being. In the paths from self-perceived caregiving to 
psychological well-being, self-efficacy and positive coping strategies played 
mediating roles independently and together, and social support played a 
mediating role together with coping strategies. Care home staff's psychological 
well-being was undermined during the COVID-19 lockdown. Interventions aimed at 
improving staff's self-efficacy, adoption of positive coping strategies, and 
avoidance of negative coping strategies or considerations of social support 
along with coping strategies are suggested to decrease exhibited symptoms of 
depression, anxiety, and stress. [Research in Gerontological Nursing, 14(4), 
180-190.].

DOI: 10.3928/19404921-20210325-01
PMID: 34288785 [Indexed for MEDLINE]


3212. Int J Psychol. 2021 Aug;56(4):493-497. doi: 10.1002/ijop.12793.

Psychological implications of the COVID-19 pandemic around the world: 
Introduction to the special issue.

Obschonka M(1), Gewirtz AH(2)(3), Zhu L(4).

Author information:
(1)Queensland University of Technology, Brisbane, QLD, Australia.
(2)University of Minnesota, St Paul, MN, USA.
(3)Department of Psychology, Arizona State University, USA.
(4)Chinese Academy of Science, Beijing, China.

Although psychological researchers have long studied the implications of major 
crises, the outbreak and spread of the COVID-19 pandemic have confronted the 
global community of psychologists and psychological researchers with new 
challenges. This special issue contributes to the growing empirical literature 
on the immediate psychological implications of the COVID-19 pandemic. We present 
and discuss diverse work from authors that followed our call for papers in May 
2020, shortly after the World Health Organisation declared COVID-19 a global 
pandemic. The studies focus on the early phases of the pandemic by addressing 
(a) implications of the pandemic for psychological well-being and mental health, 
(b) psychological effects of lockdown scenarios as well as (c) individual 
compliance with COVID-19 prevention and intervention measures. We conclude by 
highlighting the need for new research efforts, with a special focus on low- and 
middle-income regions, international research collaborations and cross-cultural 
research designs.

© 2021 International Union of Psychological Science.

DOI: 10.1002/ijop.12793
PMCID: PMC8427042
PMID: 34286872 [Indexed for MEDLINE]


3213. Eur Rev Med Pharmacol Sci. 2021 Jul;25(13):4611-4615. doi: 
10.26355/eurrev_202107_26253.

The prolonged effects of COVID-19. A new "threat"?

Lagadinou M(1), Kostopoulou E, Karatza A, Marangos M, Gkentzi D.

Author information:
(1)Department of Internal Medicine, University General Hospital of Patras, 
Patras, Greece. m_lagad2004@yahoo.gr.

Coronavirus 'long-haulers" currently represent a significant public health 
concern. Recent reports suggest that persistent effects of COVID-19, such as 
fatigue, dyspnea, chest pain, anxiety, depression, arthralgia, may last for 
months and lead to a decline in quality of life. Risk factors for long COVID are 
still not very well understood. Survivors suffer from ongoing symptoms. This new 
entity highlights the need for a multidisciplinary approach that would enable 
closer monitoring of affected patients and implementation of measures that could 
reduce the impact of the pandemic on the overall patient wellbeing after the 
resolution of acute symptoms.

DOI: 10.26355/eurrev_202107_26253
PMID: 34286502 [Indexed for MEDLINE]


3214. BMJ Open. 2021 Jul 20;11(7):e046863. doi: 10.1136/bmjopen-2020-046863.

Economic and social impacts of COVID-19 and public health measures: results from 
an anonymous online survey in Thailand, Malaysia, the UK, Italy and Slovenia.

Osterrieder A(1)(2), Cuman G(3), Pan-Ngum W(1)(4), Cheah PK(5), Cheah PK(6)(7), 
Peerawaranun P(1), Silan M(8), Orazem M(9)(10), Perkovic K(11), Groselj 
U(9)(12), Schneiders ML(1)(2)(13), Poomchaichote T(1), Waithira N(1)(2), Asarath 
SA(1), Naemiratch B(1), Ruangkajorn S(1), Skof L(14), Kulpijit N(1), 
Mackworth-Young CRS(15), Ongkili D(16), Chanviriyavuth R(1), Mukaka M(1)(2), 
Cheah PY(17)(2)(13).

Author information:
(1)Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, 
Mahidol University, Bangkok, Thailand.
(2)Centre for Tropical Medicine and Global Health, Nuffield Department of 
Medicine, University of Oxford, Oxford, UK.
(3)Paediatric Ethics Committee; Research Ethics Committee, University Hospital 
of Padua, Padua, Italy.
(4)Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol 
University, Bangkok, Thailand.
(5)Faculty of Arts and Social Science, Universiti Tunku Abdul Rahman, Kampar, 
Malaysia.
(6)Emergency and Trauma Department, Sabah Women and Children's Hospital, 
Ministry of Health, Kota Kinabalu, Malaysia.
(7)Emergency Department, Loh Guan Lye Specialists Centre, Georgetown, Malaysia.
(8)Department of Statistical Sciences, University of Padua, Padua, Italy.
(9)Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
(10)Department of Radiation Oncology, Institute of Oncology, Ljubljana, 
Slovenia.
(11)Institute for Social Studies, Science and Research Centre Koper, Koper, 
Slovenia.
(12)Department of Endocrinology, Diabetes and Metabolic Diseases, University 
Children's Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia.
(13)The Ethox Centre, Nuffield Department of Population Health, University of 
Oxford, Oxford, UK.
(14)Institute for Philosophical Studies, Science and Research Centre Koper, 
Koper, Slovenia.
(15)Department of Global Health and Development, London School of Hygiene and 
Tropical Medicine, London, UK.
(16)Emergency and Trauma Department, Queen Elizabeth Hospital, Ministry of 
Health, Kota Kinabalu, Malaysia.
(17)Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical 
Medicine, Mahidol University, Bangkok, Thailand Phaikyeong@tropmedres.ac.

OBJECTIVES: To understand the impact of COVID-19 and public health measures on 
different social groups, we conducted a mixed-methods study in five countries 
('SEBCOV-social, ethical and behavioural aspects of COVID-19'). Here, we report 
the results of the online survey.
STUDY DESIGN AND STATISTICAL ANALYSIS: Overall, 5058 respondents from Thailand, 
Malaysia, the UK, Italy and Slovenia completed the self-administered survey 
between May and June 2020. Poststratification weighting was applied, and 
associations between categorical variables assessed. Frequency counts and 
percentages were used to summarise categorical data. Associations between 
categorical variables were assessed using Pearson's χ2 test. Data were analysed 
in Stata 15.0 RESULTS: Among the five countries, Thai respondents reported 
having been most, and Slovenian respondents least, affected economically. The 
following factors were associated with greater negative economic impacts: being 
18-24 years or 65 years or older; lower education levels; larger households; 
having children under 18 in the household and and having flexible/no income. 
Regarding social impact, respondents expressed most concern about their social 
life, physical health, mental health and well-being.There were large differences 
between countries in terms of voluntary behavioural change, and in compliance 
and agreement with COVID-19 restrictions. Overall, self-reported compliance was 
higher among respondents who self-reported a high understanding of COVID-19. UK 
respondents felt able to cope the longest and Thai respondents the shortest with 
only going out for essential needs or work. Many respondents reported seeing 
news perceived to be fake, the proportion varying between countries, with 
education level and self-reported levels of understanding of COVID-19.
CONCLUSIONS: Our data showed that COVID-19 and public health measures have 
uneven economic and social impacts on people from different countries and social 
groups. Understanding the factors associated with these impacts can help to 
inform future public health interventions and mitigate their negative 
consequences.
TRIAL REGISTRATION NUMBER: TCTR20200401002.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/bmjopen-2020-046863
PMCID: PMC8295020
PMID: 34285007 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3215. BMC Neurol. 2021 Jul 20;21(1):284. doi: 10.1186/s12883-021-02313-6.

COVID-19 social distancing: negative effects on people with Parkinson disease 
and their associations with confidence for self-management.

Yogev-Seligmann G(#)(1), Kafri M(#)(2).

Author information:
(1)Department of Occupational Therapy, Faculty of Social Welfare and Health 
Sciences, University of Haifa, 3498838, Haifa, Israel. galit.yogev@gmail.com.
(2)Department of Physical Therapy, Faculty of Social Welfare and Health 
Sciences, University of Haifa, Haifa, Israel.
(#)Contributed equally

BACKGROUND: The purpose of this study was to describe the effects of COVID-19 
social distancing on the function, health, and well-being of people with 
Parkinson disease (PD), and test the association of these effects with patients' 
activation levels, i.e., their skills and confidence in managing their health.
METHODS: Community-dwelling individuals with PD answered an anonymous web-based 
survey. Part 1 included 27 multiple-choice questions regarding changes in 
function, health, medical care, and well-being. Part 2 consisted of the Patient 
Activation Measure, which enquired about skills and confidence in managing one's 
health.
RESULTS: Respondents (N = 142) reported decreases in various function 
(24.8%-37.3%), health (33.8%-43%), and well-being (26.1%-47.1%) domains. 
Rehabilitation ceased for 61.2%. Among those reporting a worsening of health, 
67.8% associated this with the cessation of rehabilitative treatments or 
decrease in physical activity. Patients' activation levels were inversely 
correlated with increased assistance for activities of daily living, increased 
tiredness, worsening symptoms, and lack of support from family and friends.
CONCLUSIONS: Social distancing had a major negative impact on the health and 
function of people with PD.
PRACTICAL IMPLICATIONS: Supporting people with PD skills and confidence in 
managing health may preserve their physical and mental health during this period 
of dramatic changes in life's circumstances.

© 2021. The Author(s).

DOI: 10.1186/s12883-021-02313-6
PMCID: PMC8289714
PMID: 34284733 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that there is no conflict of 
interest regarding the publication of this paper.


3216. Women Health. 2021 Aug;61(7):668-679. doi: 10.1080/03630242.2021.1954133. Epub 
2021 Jul 20.

Psychological impact of COVID-19 lockdowns among adult women: the predictive 
role of individual differences and lockdown duration.

Muro A(1), Feliu-Soler A(1)(2)(3), Castellà J(1).

Author information:
(1)Department of Basic, Developmental, and Educational Psychology, Autonomous 
University of Barcelona, Barcelona, Spain.
(2)Department of Clinical and Health Psychology, Autonomous University of 
Barcelona, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.
(3)Teaching, Research & Innovation Unit,Parc Sanitari Sant Joan de Déu, St. Boi 
de Llobregat, Spain.

COVID-19 pandemic has altered women's mental health as a consequence of the 
global threat and the lockdown measures adopted by public health policies. It 
has been suggested that women are at a higher risk for mood alterations, but 
most of the studies are cross-sectional or have only considered the first days 
of the confinement in their longitudinal designs. The present study was aimed at 
evaluating temporal changes in anxiety and depression in a general sample of 155 
non-infected adult Spanish women after a complete quarantine. It also explored 
the predictive role of personality, the establishment of new routines and 
physical activity during lockdown in a pre-post design assessing temporal and 
clinical mood changes after 5 weeks of lockdown. Logistic regression analyses 
showed that higher neuroticism and depressive levels at baseline, lower routines 
engagement, and lower physical activity during lockdown predicted depression 
caseness, whereas anxiety caseness was best predicted by higher neuroticism, 
more days of lockdown and greater anxiety symptoms at baseline. It is concluded 
that lockdown duration, increased neuroticism and baseline levels of anxiety and 
depression are risk factors for women's mental health, while routines and 
physical activity emerge as protective factors for managing psychological 
wellbeing during the pandemic lockdowns.

DOI: 10.1080/03630242.2021.1954133
PMID: 34284689 [Indexed for MEDLINE]


3217. BMJ Open. 2021 Jul 19;11(7):e048107. doi: 10.1136/bmjopen-2020-048107.

Challenges facing essential workers: a cross-sectional survey of the subjective 
mental health and well-being of New Zealand healthcare and 'other' essential 
workers during the COVID-19 lockdown.

Bell C(1), Williman J(2), Beaglehole B(3), Stanley J(4), Jenkins M(5), Gendall 
P(4), Rapsey C(6), Every-Palmer S(5).

Author information:
(1)Department of Psychological Medicine, University of Otago, Christchurch, New 
Zealand caroline.bell@otago.ac.nz.
(2)Department of Population Health, University of Otago, Christchurch, New 
Zealand.
(3)Department of Psychological Medicine, University of Otago, Christchurch, New 
Zealand.
(4)Department of Public Health, University of Otago, Wellington, New Zealand.
(5)Department of Psychological Medicine, University of Otago, Wellington, New 
Zealand.
(6)Department of Psychological Medicine, University of Otago, Dunedin, New 
Zealand.

OBJECTIVES: To compare psychological outcomes, experiences and sources of stress 
over the COVID-19 lockdown in New Zealand in essential workers (healthcare and 
'other' essential workers) with that of workers in nonessential work roles.
DESIGN: Online cross-sectional survey.
SETTING: Conducted in New Zealand over level 4 lockdown in April/May 2020.
PARTICIPANTS: Findings from employed participants (2495) are included in this 
report; 381 healthcare workers, 649 'other' essential workers and 1465 
nonessential workers.
PRIMARY AND SECONDARY OUTCOME MEASURES: Measures included psychological distress 
(Kessler Psychological Distress Scale (K10)), anxiety (Generalised Anxiety 
Disorder (GAD-7)), well-being (WHO-5), alcohol use, subjective experiences and 
sources of stress. Differences between work categories were quantified as risk 
ratios or χ2 tests.
RESULTS: After controlling for confounders that differed between groups of 
essential and nonessential workers, those in healthcare and those in 'other' 
essential work were at 71% (95% CI 1.29 to 2.27) and 59% (95% CI 1.25 to 2.02) 
greater risk respectively, of moderate levels of anxiety (GAD-7 ≥10), than those 
in nonessential work. Those in healthcare were at 19% (95% CI 1.02 to 1.39) 
greater risk of poor well-being (WHO-5 <13). There was no evidence of 
differences across work roles in risk for psychological distress (K10 ≥12) or 
increased alcohol use. Healthcare and 'other' essential workers reported 
increased workload (p<0.001) and less uncertainty about finances and employment 
than those in nonessential work (p<0.001). Healthcare and nonessential workers 
reported decreased social contact. No difference by work category in health 
concerns was reported; 15% had concerns about participants' own health and 33% 
about other people's health.
CONCLUSIONS: During the pandemic lockdown, essential workers (those in 
healthcare and those providing 'other' essential work) were at increased risk of 
anxiety compared with those in nonessential work, with those in healthcare also 
being at increased risk of poor well-being. This highlights the need to 
recognise the challenges this vital workforce face in pandemics.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2020-048107
PMCID: PMC8290948
PMID: 34281926 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3218. Int J Environ Res Public Health. 2021 Jul 2;18(13):7117. doi: 
10.3390/ijerph18137117.

Direct and Stress-Buffering Effects of COVID-19-Related Changes in Exercise 
Activity on the Well-Being of German Sport Students.

Giessing L(1), Kannen J(1), Strahler J(2), Frenkel MO(1).

Author information:
(1)Institute of Sports and Sports Sciences, Heidelberg University, 69120 
Heidelberg, Germany.
(2)Faculty of Psychology and Sport Science, Justus-Liebig University Gießen, 
35394 Gießen, Germany.

Maintaining or initiating exercise activity in the COVID-19 pandemic may act as 
a buffer against the observed stress-related deterioration in well-being, with 
emotion regulation (ER) discussed as a possible moderator. Therefore, the 
present study investigated the interaction between stress, exercise activity 
(EA), and ER on mood. In an online survey, 366 German sports science students 
(56% women, Mage = 23.04, SD = 2.87) reported their stress levels (general and 
COVID-19-specific), mood (energy, valence, calmness), EA before and during the 
pandemic, and use of ER strategies in spring 2020. Pandemic-related change in EA 
was calculated as residual change. Due to gender differences in mental health 
and EA, the main and interaction effects were tested in twelve hierarchical 
regression analyses, separately for men and women. Overall, EA significantly 
decreased during the pandemic and was positively associated with energy in both 
men and women. ER was positively associated with women's energy, but negatively 
with all three mood dimensions in men. Only one three-way interaction appeared 
significant: in the case of high stress, low levels of EA and high use of ER 
were associated with the greatest deteriorations in energy in men. Our findings 
suggest that EA may buffer deteriorations in energy in men with high stress and 
difficulties in ER.

DOI: 10.3390/ijerph18137117
PMCID: PMC8297212
PMID: 34281054 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3219. Int J Environ Res Public Health. 2021 Jul 2;18(13):7112. doi: 
10.3390/ijerph18137112.

The Psychological Impact of COVID-19 Pandemic on Women's Mental Health during 
Pregnancy: A Rapid Evidence Review.

Ahmad M(1), Vismara L(1).

Author information:
(1)Department of Pedagogy, Psychology, Philosophy, Faculty of Human Studies, 
University of Cagliari, 09124 Cagliari, Italy.

BACKGROUND: The perinatal period is a particularly vulnerable period in women's 
lives that implies significant physiological and psychological changes that can 
place women at higher risk for depression and anxiety symptoms. In addition, the 
ongoing pandemic of coronavirus disease 2019 (COVID-19) is likely to increase 
this vulnerability and the prevalence of mental health problems. This review 
aimed to investigate the existing literature on the psychological impact of the 
COVID-19 pandemic on women during pregnancy and the first year postpartum.
METHOD: The literature search was conducted using the following databases: 
Pubmed, Scopus, WOS-web of science, PsycInfo and Google Scholar. Out of the 
total of 116 initially selected papers, 17 have been included in the final work, 
according to the inclusion criteria.
RESULTS: The reviewed contributions report a moderate to severe impact of the 
COVID-19 outbreak on the mental health of pregnant women, mainly in the form of 
a significant increase in depression-up to 58% in Spain-and anxiety symptoms-up 
to 72% in Canada. In addition to the common psychological symptoms, 
COVID-19-specific worries emerged with respect to its potential effects on 
pregnancy and the well-being of the unborn child. Social support and being 
engaged in regular physical activities appear to be protective factors able to 
buffer against the effects of the pandemic on maternal mental health.
CONCLUSIONS: Despite the limitations of the study design, the evidence suggests 
that it is essential to provide appropriate psychological support to pregnant 
women during the emergency in order to protect their mental health and to 
minimize the risks of long-term effects on child development.

DOI: 10.3390/ijerph18137112
PMCID: PMC8297318
PMID: 34281049 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3220. Int J Environ Res Public Health. 2021 Jul 2;18(13):7098. doi: 
10.3390/ijerph18137098.

Mediator Effect of Affinity for E-Learning on Mental Health: Buffering Strategy 
for the Resilience of University Students.

Di Giacomo D(1)(2), Martelli A(3), Guerra F(1), Cielo F(1)(2), Ranieri J(1).

Author information:
(1)Department of Life, Health and Environmental Sciences, University of 
L'Aquila, 67100 L'Aquila, Italy.
(2)Postgraduate School on Clinical Psychology, University of L'Aquila, 67100 
L'Aquila, Italy.
(3)Faculty of Biosciences and Agri-Food and Environmental Technologies, 
University of Teramo, 64100 Teramo, Italy.

The pandemic affected the quality of life and wellness of the population, 
changing living habits through restriction measures. This study aimed to analyze 
the psychological impact of the fear of the COVID-19 pandemic and the adoption 
of e-learning for university students. The study was articulated in two research 
applications: the first application was a rapid review on the psychological 
effects of the pandemic on the emotional dimension of undergraduate students; 
the second application was an observational study on the effect of e-learning 
adoption in the pandemic emergency. In the first step, we performed a systematic 
search of MEDLINE through PubMed and the Web of Science [Science Citation Index 
Expanded (SCI-EXPANDED); Social Sciences Citation Index (SSCI); Emerging Sources 
Citation Index (ESCI)] of all scientific literature published from May 2020 to 
February 2021. The reviewed articles suggest the impact of the pandemic and 
lockdown measures on university students due to several mental symptoms, 
including anxiety, stress, depression, event-specific distress, and a decrease 
in psychological well-being. Psychological symptoms were related to the 
experience of several stressors, such as the risk for a reduction of academic 
perspectives, massive e-learning adoption, economic issues, social restrictions, 
and implications for daily life related to the COVID-19 outbreak. The second 
scientific application was conducted to evaluate the affinity for e-learning on 
a sample composed of Italian undergraduates exposed to massive e-learning 
adoption. The results evidence the positive influence of e-learning in academic 
programs for the wellbeing of undergraduates. The mediator effect of the 
affinity of youth for e-learning can be considered to have had a buffering 
effect for professional advancement and for the mental health of university 
students in a public health emergency.

DOI: 10.3390/ijerph18137098
PMCID: PMC8297351
PMID: 34281044 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3221. Endocrinol Diabetes Metab. 2021 May 5;4(3):e00249. doi: 10.1002/edm2.249. 
eCollection 2021 Jul.

Psychological factors associated with changes in physical activity in Dutch 
people with type 2 diabetes under societal lockdown: A cross-sectional study.

Regeer H(1), Nieuwenhuijse EA(2), Vos RC(2), Kiefte-de Jong JC(2), van Empelen 
P(3), de Koning EJP(1), Bilo HJG(4)(5)(6), Huisman SD(1).

Author information:
(1)Division of Endocrinology Department of Medicine Leiden University Medical 
Center Leiden The Netherlands.
(2)Department of Public Health and Primary Care / LUMC-Campus The Hague Leiden 
University Medical Center Den Haag The Netherlands.
(3)TNO Research Group Child Health Leiden The Netherlands.
(4)Diabetes Knowledge Centre Isala Zwolle The Netherlands.
(5)Faculty of Medicine University of Groningen Groningen The Netherlands.
(6)Department of Internal Medicine University Medical Center Groningen Groningen 
The Netherlands.

AIMS: To investigate changes in physical activity (PA) and psychological factors 
during societal lockdown in people with type 2 diabetes.
METHODS: A cross-sectional study among Dutch adults with type 2 diabetes. Data 
were collected using online questionnaires. A multivariate multinomial logistic 
regression was performed with change in PA during societal lockdown as outcome 
and perceived change in stress, anxiety, perceived risk for COVID-19 infection, 
emotional well-being and former PA status as determinants.
RESULTS: Five hundred and sixty seven respondents filled out the questionnaire, 
536 were included in the final analysis: mean age of 65.9 ± 7.9 years; mean 
diabetes duration 13.3 ± 8 years; 54% men; 47% reported no change in PA, 27% 
became less active and 26% became more active during societal lockdown. 
Participants who were more likely to become less active were participants who 
experienced more stress (OR: 2.27; 95% CI 1.25-4.13) or less stress (OR: 2.20; 
95% CI 1.03-4.71). Participants who were more likely to become more active were 
participants who experienced more stress (OR: 2.31; 95% CI 1.25, 4.26). 
Participants with higher emotional well-being (OR: 0.98; 95% CI 0.97, 0.99) were 
less likely to become less active than to report no change in PA.
CONCLUSIONS: Changes in PA in people with type 2 diabetes during societal 
lockdown are associated with changes in psychological factors such as perceived 
stress and emotional well-being. People with diabetes and their caregivers 
should be aware of these possible changes.

© 2021 The Authors. Endocrinology, Diabetes & Metabolism published by John Wiley 
& Sons Ltd.

DOI: 10.1002/edm2.249
PMCID: PMC8279615
PMID: 34277973 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that there is no conflict of 
interest.


3222. Front Immunol. 2021 Jun 30;12:686029. doi: 10.3389/fimmu.2021.686029. 
eCollection 2021.

Unraveling the Mystery Surrounding Post-Acute Sequelae of COVID-19.

Ramakrishnan RK(1)(2), Kashour T(3), Hamid Q(1)(4), Halwani R(1)(2)(5), Tleyjeh 
IM(6)(7)(8)(9).

Author information:
(1)College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.
(2)Sharjah Institute for Medical Research, University of Sharjah, Sharjah, 
United Arab Emirates.
(3)Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud 
University Medical City, King Saud University, Riyadh, Saudi Arabia.
(4)Meakins-Christie Laboratories, Research Institute of the McGill University 
Healthy Center, McGill University, Montreal, QC, Canada.
(5)Prince Abdullah Ben Khaled Celiac Disease Chair, Department of Pediatrics, 
Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia.
(6)Infectious Diseases Section, Department of Medical Specialties, King Fahad 
Medical City, Riyadh, Saudi Arabia.
(7)College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
(8)Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, 
Rochester, MN, United States.
(9)Division of Epidemiology, Mayo Clinic College of Medicine and Science, 
Rochester, MN, United States.

More than one year since its emergence, corona virus disease 2019 (COVID-19) is 
still looming large with a paucity of treatment options. To add to this burden, 
a sizeable subset of patients who have recovered from acute COVID-19 infection 
have reported lingering symptoms, leading to significant disability and 
impairment of their daily life activities. These patients are considered to 
suffer from what has been termed as "chronic" or "long" COVID-19 or a form of 
post-acute sequelae of COVID-19, and patients experiencing this syndrome have 
been termed COVID-19 long-haulers. Despite recovery from infection, the 
persistence of atypical chronic symptoms, including extreme fatigue, shortness 
of breath, joint pains, brain fogs, anxiety and depression, that could last for 
months implies an underlying disease pathology that persist beyond the acute 
presentation of the disease. As opposed to the direct effects of the virus 
itself, the immune response to severe acute respiratory syndrome coronavirus 2 
(SARS-CoV-2) is believed to be largely responsible for the appearance of these 
lasting symptoms, possibly through facilitating an ongoing inflammatory process. 
In this review, we hypothesize potential immunological mechanisms underlying 
these persistent and prolonged effects, and describe the multi-organ long-term 
manifestations of COVID-19.

Copyright © 2021 Ramakrishnan, Kashour, Hamid, Halwani and Tleyjeh.

DOI: 10.3389/fimmu.2021.686029
PMCID: PMC8278217
PMID: 34276671 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


3223. Mil Med. 2021 Aug 28;186(9-10):259-262. doi: 10.1093/milmed/usab265.

Mitigating the Impact of Reemergence From a Pandemic on Healthcare.

Hall PL(1).

Author information:
(1)Harry S. Truman Memorial Veterans' Hospital, Columbia, MO 65201, USA.

Healthcare workers have never faced a medical crisis that compares to the 
coronavirus disease-2019 pandemic. This modern-day pandemic fight draws 
parallels to a war. Because of these similarities, it would make sense that the 
experiences frontline providers have when transitioning to a normal healthcare 
routine would emulate experiences service members voice when reintegrating home 
from a battlefield. These common experiences include a unified mission, an 
exhausting, adrenaline-packed responsibility, and a celebrity-like status to the 
public. The pandemic response consumed healthcare with one united mission, but 
as we reemerge from the pandemic and restore other aspects of our healthcare 
system, multiple missions develop and compete. Returning to a common routine and 
regular status can manifest feelings of disappointment in healthcare workers' 
everyday lives and career choices and lead to a reexamination of priorities and 
professions. As an organization with a focus on high reliability, mitigating the 
harm to staff and delivery system may be our new priority. The risk of not 
facing this situation head on is a potential exodus of seasoned professionals 
contemplating their future and selecting other career paths, thus draining the 
current institutional knowledge and potentially deterring future generations 
from healthcare. Leaders in the healthcare industry need to take a proactive 
stance in addressing this reemergence. Integrated, proactive programming is 
needed utilizing evidence-based resiliency training from professional 
organizations such as the National Alliance on Mental Illness, the Department of 
Health and Human Services' Substance Abuse and Mental Health Services 
Administration, as well as the existing Department of Defense programs. The 
Veterans Affairs has the backbone to develop and offer these programs and make a 
positive difference with Employee Whole Health efforts. Organized, 
evidence-based programming such as second victim education, mindfulness, and 
other personal skill building could be key to improving the lifelong well-being 
of our caregivers.

© The Association of Military Surgeons of the United States 2021. All rights 
reserved. For permissions, please e-mail: journals.permissions@oup.com.

DOI: 10.1093/milmed/usab265
PMCID: PMC8344899
PMID: 34273169 [Indexed for MEDLINE]


3224. Nat Commun. 2021 Jul 16;12(1):4111. doi: 10.1038/s41467-021-24365-5.

Associations between dimensions of behaviour, personality traits, and 
mental-health during the COVID-19 pandemic in the United Kingdom.

Hampshire A(1), Hellyer PJ(2)(3), Soreq E(2), Mehta MA(3), Ioannidis K(4)(5), 
Trender W(2), Grant JE(6), Chamberlain SR(7)(8).

Author information:
(1)Imperial College London, London, UK. a.hampshire@imperial.ac.uk.
(2)Imperial College London, London, UK.
(3)King's College London, London, UK.
(4)Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
(5)Department of Psychiatry, University of Cambridge, Cambridge, UK.
(6)Department of Psychiatry, University of Chicago, Chicago, IL, USA.
(7)Department of Psychiatry, University of Southampton, Southampton, UK.
(8)Southern Health NHS Foundation Trust, Southampton, UK.

Erratum in
    Nat Commun. 2021 Aug 16;12(1):5047.

The COVID-19 pandemic (including lockdown) is likely to have had profound but 
diverse implications for mental health and well-being, yet little is known about 
individual experiences of the pandemic (positive and negative) and how this 
relates to mental health and well-being, as well as other important contextual 
variables. Here, we analyse data sampled in a large-scale manner from 379,875 
people in the United Kingdom (UK) during 2020 to identify population variables 
associated with mood and mental health during the COVID-19 pandemic, and to 
investigate self-perceived pandemic impact in relation to those variables. We 
report that while there are relatively small population-level differences in 
mood assessment scores pre- to peak-UK lockdown, the size of the differences is 
larger for people from specific groups, e.g. older adults and people with lower 
incomes. Multiple dimensions underlie peoples' perceptions, both positive and 
negative, of the pandemic's impact on daily life. These dimensions explain 
variance in mental health and can be statistically predicted from age, 
demographics, home and work circumstances, pre-existing conditions, maladaptive 
technology use and personality traits (e.g., compulsivity). We conclude that a 
holistic view, incorporating the broad range of relevant population factors, can 
better characterise people whose mental health is most at risk during the 
COVID-19 pandemic.

© 2021. The Author(s).

DOI: 10.1038/s41467-021-24365-5
PMCID: PMC8285408
PMID: 34272365 [Indexed for MEDLINE]

Conflict of interest statement: S.R.C. previously consulted for Promentis. He 
receives honoraria for journal editorial work from Elsevier. J.E.G. has received 
research grants from the T.L.C. Foundation for Body-Focused Repetitive 
Behaviors, Biohaven, Promentis and Avanir Pharmaceuticals. M.A.M. has received 
grant income from Takeda Pharmaceuticals, Johnson & Johnson and Lundbeck. A.H. 
is owner and founder of Future Cognition Ltd. and H2 Cognitive Designs Ltd., 
which develop custom cognitive assessment software for other university-based 
research groups. P.J.H. is the owner and co-founder of H2 Cognitive Designs Ltd. 
The authors report no other conflicts of interest.


3225. J Psychiatr Res. 2021 Sep;141:276-286. doi: 10.1016/j.jpsychires.2021.07.001. 
Epub 2021 Jul 6.

Facing the "new normal": How adjusting to the easing of COVID-19 lockdown 
restrictions exposes mental health inequalities.

Fineberg NA(1), Pellegrini L(2), Wellsted D(3), Hall N(3), Corazza O(3), 
Giorgetti V(3), Cicconcelli D(3), Theofanous E(3), Sireau N(3), Adam D(3), 
Chamberlain SR(4), Laws KR(3).

Author information:
(1)School of Life and Medical Sciences, University of Hertfordshire, Hatfield, 
United Kingdom; Hertfordshire Partnership University NHS Foundation Trust, 
Welwyn Garden City, United Kingdom; University of Cambridge School of Clinical 
Medicine, Cambridge, United Kingdom.
(2)School of Life and Medical Sciences, University of Hertfordshire, Hatfield, 
United Kingdom; Hertfordshire Partnership University NHS Foundation Trust, 
Welwyn Garden City, United Kingdom; Department of Biomedical and Neuromotor 
Sciences, University of Bologna, Italy. Electronic address: 
luca.pellegrini@nhs.net.
(3)School of Life and Medical Sciences, University of Hertfordshire, Hatfield, 
United Kingdom.
(4)University of Southampton, Department of Psychiatry, Faculty of Medicine, 
Southampton, United Kingdom; Southern Health NHS Foundation Trust, Southampton, 
United Kingdom.

BACKGROUND: Re-establishing societal norms in the wake of the COVID-19 pandemic 
will be important for restoring public mental health and psychosocial wellbeing 
as well as economic recovery. We investigated the impact on post-pandemic 
adjustment of a history of mental disorder, with particular reference to 
obsessive-compulsive (OC) symptoms or traits.
METHODS: The study was pre-registered (Open Science Framework; 
https://osf.io/gs8j2/). Adult members of the public (n = 514) were surveyed 
between July and November 2020, to identify the extent to which they reported 
difficulties re-adjusting as lockdown conditions eased. All were assessed using 
validated scales to determine which demographic and mental health-related 
factors impacted adjustment. An exploratory analysis of a subgroup on an 
objective online test of cognitive inflexibility was also performed.
RESULTS: Adjustment was related to a history of mental disorder and the presence 
of OC symptoms and traits, all acting indirectly and statistically-mediated via 
depression, anxiety and stress; and in the case of OC symptoms, also via 
COVID-related anxiety (all p < 0.001). One hundred and twenty-eight (25%) 
participants reported significant adjustment difficulties and were compared with 
those self-identifying as "good adjusters" (n = 231). This comparison revealed 
over-representation of those with a history or family history of mental disorder 
in the poor adjustment category (all p < 0.05). 'Poor-adjusters' additionally 
reported higher COVID-related anxiety, depression, anxiety and stress and OC 
symptoms and traits (all p < 0.05). Furthermore, history of mental disorder 
directly statistically mediated adjustment status (p < 0.01), whereas OC 
symptoms (not OC traits) acted indirectly via COVID-related anxiety (p < 0.001). 
Poor-adjusters also showed evidence of greater cognitive inflexibility on the 
intra-extra-dimensional set-shift task.
CONCLUSION: Individuals with a history of mental disorder, OC symptoms and OC 
traits experienced greater difficulties adjusting after lockdown-release, 
largely statistically mediated by increased depression, anxiety, including 
COVID-related anxiety, and stress. The implications for clinical and public 
health policies and interventions are discussed.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.jpsychires.2021.07.001
PMCID: PMC7611491
PMID: 34271458 [Indexed for MEDLINE]

Conflict of interest statement: Prof. Naomi A. Fineberg declares that in the 
past 3 years she has held research or networking grants from the ECNP, UK NIHR, 
EU H2020, MRC, University of Hertfordshire, Wellcome Trust; she has accepted 
travel and/or hospitality expenses from the BAP, ECNP, RCPsych, CINP, 
International Forum of Mood and Anxiety Disorders, World Psychiatric 
Association, Indian Association for Biological Psychiatry, Sun; she has received 
payment from Taylor and Francis and Elsevier for editorial duties. In the past 3 
years, she has accepted a paid speaking engagement in a webinar sponsored by 
Abbott. Previously, she has accepted paid speaking engagements in various 
industry supported symposia and has recruited patients for various 
industry-sponsored studies in the field of OCD treatment. She leads an NHS 
treatment service for OCD. She holds Board membership for various registered 
charities linked to OCD. She gives expert advice on psychopharmacology to the UK 
MHRA. Prof. Samuel R. Chamberlain declares that his role in this research was 
funded by a Wellcome Trust Clinical Fellowship (110049/Z/15/Z & 110049/Z/15/A). 
Prof. Chamberlain previously consulted for Promentis (past 3 years) and receives 
a stipend from Elsevier for editorial work. Dr. Luca Pellegrini, Dr. David 
Wellsted, Natalie Hall, Prof. Ornella Corazza, Valentina Giorgetti, Dorotea 
Cicconcelli, Elena Theofanous, Nick Sireau, David Adam, Prof. Keith R. Laws 
report no financial relationships with commercial interests.


3226. J BUON. 2021 May-Jun;26(3):1127-1134.

Psychological well-being in cancer outpatients during COVID-19.

Bafunno D(1), Romito F, Lagattolla F, Delvino VA, Minoia C, Loseto G, Dellino M, 
Guarini A, Catino A, Montrone M, Longo V, Pizzutilo P, Galetta D, Giotta F, 
Latorre AC, Russo A, Lorusso V, Cormio C.

Author information:
(1)1 Thoracic Oncology Unit-IRCCS Istituto Tumori "Giovanni Paolo II", Bari, 
Italy.

PURPOSE: The psychological status of cancer outpatients receiving 
anti-neoplastic treatment during the lockdown in a Italian non-COVID Cancer 
Center, was been investigated with the following aims: to measure the levels of 
post-traumatic stress symptoms, depression and anxiety; to compare patients with 
different cancer sites; to compare the anxiety and depression levels measured in 
this emergency period between cancer and non-cancer patients and between cancer 
patients before and after the emergency.
METHODS: The following questionnaires were used: The Hospital Anxiety and 
Depression Scale (HADs) and the Impact of Event Scale-Revised (IES-R).Worries 
regarding the COVID-19 on patients' lives, socio-demographic and clinical 
details were collected using a brief structured questionnaire.
RESULTS: One-hundred seventy-eight outpatients were enrolled. We found that 55% 
of patients were above the cut-off for HADS general scale and 23.7% had severe 
level of PTSD. The 68% of patients declared that their worries have increased 
during the pandemic especially for women. Patients with lung cancer have higher 
general distress compared with patients with breast cancer and lymphoma. The non 
cancer sample had values significantly higher both for the IES-R scales and for 
HADS Depression subscale. Finally, cancer patients who experienced the health 
emergency showed higher levels of anxiety than those measured 2 years ago.
CONCLUSION: Cancer out-patients of the present sample have severe post-traumatic 
stress symptoms and psychological distress, those with lung cancer are at higher 
risk and may need special attention. Non-oncological subjects have higher 
depression levels than cancer patients.

PMID: 34268981 [Indexed for MEDLINE]


3227. Eur Arch Psychiatry Clin Neurosci. 2022 Feb;272(1):67-79. doi: 
10.1007/s00406-021-01291-7. Epub 2021 Jul 15.

Differential psychological response to the COVID-19 pandemic in psychiatric 
inpatients compared to a non-clinical population from Germany.

Rek SV(1)(2), Freeman D(3), Reinhard MA(4), Bühner M(5), Grosen S(4), Falkai 
P(4), Adorjan K(4), Padberg F(4).

Author information:
(1)Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, 
Nussbaumstraße 7, Munich, Germany. s.rek@med.uni-muenchen.de.
(2)International Max Planck Research School for Translational Psychiatry 
(IMPRS-TP), Munich, Germany. s.rek@med.uni-muenchen.de.
(3)Department of Psychiatry, University of Oxford, Oxford, UK.
(4)Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, 
Nussbaumstraße 7, Munich, Germany.
(5)Department of Psychology, LMU Munich, Munich, Germany.

The COVID-19 pandemic is an inherently stressful situation, which may lead to 
adverse psychosocial outcomes in various populations. Yet, individuals may not 
be affected equally by stressors posed by the pandemic and those with 
pre-existing mental disorders could be particularly vulnerable. To test this 
hypothesis, we assessed the psychological response to the pandemic in a 
case-control design. We used an age-, sex- and employment status-matched 
case-control sample (n = 216) of psychiatric inpatients, recruited from the LMU 
Psychiatry Biobank Munich study and non-clinical individuals from the general 
population. Participants completed validated self-report measures on stress, 
anxiety, depression, paranoia, rumination, loneliness, well-being, resilience, 
and a newly developed index of stressors associated with the COVID-19 pandemic. 
Multiple linear regression analyses were conducted to assess the effects of 
group, COVID-19-specific stressors, and their interaction on the different 
psychosocial outcomes. While psychiatric inpatients reported larger mental 
health difficulties overall, the impact of COVID-19-specific stressors was lower 
in patients and not associated with worse psychological functioning compared to 
non-clinical individuals. In contrast, depressive symptoms, rumination, 
loneliness, and well-being were more strongly associated with COVID-19-specific 
stressors in non-clinical individuals and similar to the severity of inpatients 
for those who experienced the greatest COVID-19-specific stressor impact 
Contrary to expectations, the psychological response to the pandemic may not be 
worse in psychiatric inpatients compared to non-clinical individuals. Yet, 
individuals from the general population, who were hit hardest by the pandemic, 
should be monitored and may be in need of mental health prevention and treatment 
efforts.

© 2021. The Author(s).

DOI: 10.1007/s00406-021-01291-7
PMCID: PMC8282176
PMID: 34268618 [Indexed for MEDLINE]

Conflict of interest statement: Prof. Padberg reports personal fees and 
non-financial support from Mag & More GmbH, Munich, Germany, personal fees and 
non-financial support from Brainsway Inc., Jerusalem, Israel, personal fees and 
non-financial support from neuroConn GmbH, Ilmenau, Germany, outside the 
submitted work. The other authors declare no competing interests.


3228. Am J Geriatr Psychiatry. 2021 Nov;29(11):1101-1116. doi: 
10.1016/j.jagp.2021.05.026. Epub 2021 Jun 12.

COVID-19 Associated Suicidal Ideation in Older Adults: Two Case Reports With a 
Review of the Literature.

Asthana NK(1), Mehaffey E(1), Sewell DD(2).

Author information:
(1)University of California, San Diego.
(2)University of California, San Diego. Electronic address: 
dsewell@health.ucsd.edu.

The COVID-19 pandemic may profoundly harm the mental health and emotional well- 
being of many older adults. Public health interventions to minimize the spread 
of the virus have had the unintended consequences of worsening social isolation, 
financial stress, and unemployment. Results of early research efforts assessing 
the impact of these interventions on the mental health of older adults have been 
mixed. Available findings suggest that a subset of community-dwelling older 
adults have been less negatively impacted than younger adults, while people of 
color, the poor, residents of nursing homes and other communal living 
environments, and those living with dementia and their caregivers are more 
likely to suffer from COVID-related health problems. This manuscript describes 
two older adults for whom COVID-19 associated stresses caused significant 
worsening in their psychiatric illnesses, including the emergence of suicidal 
ideation, summarizes the literature on the impact of interactions between 
psychosocial stresses and biological factors on the mental health and well-being 
of older adults, and discusses interventions to help older adults whose mental 
health has worsened due to COVID-19. Timely and accurate diagnosis, prompt 
provision of individualized care using both pharmacologic and psychotherapeutic 
interventions, adoption of new technologies that permit care to be provided 
safely at a distance and which allow for virtual social interactions, coupled 
with ongoing advocacy for policy changes that address significant health care 
disparities and provide older adults continued access to health care and relief 
from financial hardship, will help older adults remaining as healthy as possible 
during the pandemic.

Copyright © 2021 American Association for Geriatric Psychiatry. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jagp.2021.05.026
PMCID: PMC8196233
PMID: 34266752 [Indexed for MEDLINE]


3229. Epidemiol Health. 2021;43:e2021045. doi: 10.4178/epih.e2021045. Epub 2021 Jul 
13.

A closer look at the high burden of psychiatric disorders among healthcare 
workers in Egypt during the COVID-19 pandemic.

El-Qushayri AE(1), Dahy A(1), Reda A(2), Mahmoud MA(3), Mageed SA(3), Kamel 
AMA(4), Ghozy S(5).

Author information:
(1)Faculty of Medicine, Minia University, Minia, Egypt.
(2)Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
(3)Faculty of Medicine, Tanta University, Tanta, Egypt.
(4)Faculty of Pharmacy, Minia University, Minia, Egypt.
(5)Faculty of Medicine, Mansoura University, Mansoura, Egypt.

OBJECTIVES: This study aimed to examine the prevalence of psychiatric disorders 
among Egyptian healthcare workers (HCWs) during the coronavirus disease 2019 
(COVID-19) pandemic.
METHODS: Six databases were searched for relevant papers. The quality of the 
selected articles was measured using the National Institute of Health quality 
assessment tool. We used a fixed-effects model when there was no heterogeneity 
and a random-effects model when there was heterogeneity.
RESULTS: After screening 197 records, 10 studies were ultimately included. 
Anxiety was the most commonly reported psychiatric disorder among HCWs, with a 
prevalence of 71.8% (95% confidence interval [CI], 49.4 to 86.9), followed by 
stress (66.6%; 95% CI, 47.6 to 81.3), depression (65.5%; 95% CI, 46.9 to 80.3), 
and insomnia (57.9%; 95% CI, 45.9 to 69.0). As measured using the 21-item 
Depression, Anxiety, and Stress Scale, the most common level of severity was 
moderate for depression (22.5%; 95% CI, 19.8 to 25.5) and stress (14.5%; 95% CI, 
8.8 to 22.9), while high-severity anxiety was more common than other levels of 
severity (28.2%; 95% CI, 3.8 to 79.6).
CONCLUSIONS: The COVID-19 pandemic has had a negative effect on Egyptian HCWs' 
psychological well-being. More psychological support and preventive measures 
should be implemented to prevent the further development of psychiatric illness 
among physicians and other HCWs.

DOI: 10.4178/epih.e2021045
PMCID: PMC8602011
PMID: 34265893 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
declare for this study.


3230. Prim Care Companion CNS Disord. 2021 Jul 15;23(4):21m02977. doi: 
10.4088/PCC.21m02977.

Mental Health Effects of COVID-19 Within the Socioeconomic Crisis and After the 
Beirut Blast Among Health Care Workers and Medical Students in Lebanon.

Abed AE(1), Razzak RA(1), Hashim HT(2)(3).

Author information:
(1)Faculty of Medical Sciences, Lebanese University, Hadath, Beirut, Lebanon.
(2)University of Baghdad, College of Medicine, Nasiriyah, Thi-Qar, Iraq.
(3)Corresponding author: Hashim Talib Hashim, MBChB, University of Baghdad, 
College of Medicine, 400 St, 64001 Nasiriyah, Thi-Qar, Iraq 
(hashim.h.t.h@gmail.com).

Objective: To measure the mental health effects (perceived stress, anxiety, and 
depression) among health care workers and medical students in Lebanon during the 
coronavirus disease 2019 (COVID-19) pandemic and subsequent to the Beirut blast. 
Methods: In this cross-sectional study, a self-administered online questionnaire 
was developed and distributed between late December 2020 and early February 2021 
among health care workers and medical students via social media. The 10-item 
Perceived Stress Scale (PSS-10) and the 4-item Patient Health Questionnaire for 
Depression and Anxiety (PHQ-4) were administered. P values between variables 
were calculated using χ2 test. Results: Overall, 98% of the respondents had a 
low PSS-10 score and 89% had a low PHQ-4 score. About 58.1% of health care 
workers and 69.0% of student respondents had moderate to severe stress on the 
PSS-10, and 48.7% and 46.8%, respectively, reported moderate to severe anxiety 
and depression on the PHQ-4. Prevalence of depression and anxiety was relatively 
higher among health care workers with monthly incomes < LBP 4 million (57.1%) 
and higher in women (39.9%) compared to men (17.2%). Furthermore, the prevalence 
of depression and anxiety was higher among health care workers traveling between 
different districts (63.0%) compared to those with residence and work location 
within the same district and was higher among females (65.4%) compared to males 
(34.6%). Conclusions: The resilience of the Lebanese people as well as their 
ability to adapt in the face of trauma, tragedy, threats, or any significant 
source of stress is remarkable and seen in their everyday lives, especially 
subsequent to the Beirut blast. However, the psychological well-being and mental 
health of health care workers and medical students in Lebanon should be 
carefully surveilled and recorded during the COVID-19 pandemic, especially 
within the ongoing socioeconomic crisis.

© Copyright 2021 Physicians Postgraduate Press, Inc.

DOI: 10.4088/PCC.21m02977
PMID: 34265874 [Indexed for MEDLINE]


3231. Early Interv Psychiatry. 2022 May;16(5):544-551. doi: 10.1111/eip.13193. Epub 
2021 Jul 15.

The effects of the COVID-19 lockdown on adolescents with an eating disorder and 
identifying factors predicting disordered eating behaviour.

Akgül S(1), Akdemir D(2), Nalbant K(2), Derman O(1), Ersöz Alan B(2), Tüzün 
Z(1), Kanbur N(1).

Author information:
(1)Ihsan Dogramaci Children's Hospital, Department of Pediatrics, Division of 
Adolescent Medicine, Hacettepe University, Ankara, Turkey.
(2)Department of Child and Adolescent Psychiatry, Hacettepe University, Ankara, 
Turkey.

AIM: To evaluate the impact of the COVID-19 lockdown on adolescents with eating 
disorders (ED) and identify factors predicting ED behaviour.
METHOD: This study took place during an age-stratified lockdown for those under 
20 years in Turkey. Participants completed a survey developed to evaluate the 
effects of the lockdown on ED behaviour, well-being and quality of life (QoL) 
and additionally the eating disorder examination questionnaire (EDE-Q), and 
scales for depression, anxiety and obsessive-compulsive behaviour. The 
relationship between the EDE-Q-global score and other variables related to ED 
was examined. Linear regression analysis was performed to examine the predictive 
power of these variables on ED behaviour.
RESULTS: Thirty-eight ED patients with a mean age of 15.12 ± 1.56 years were 
included in the study. Of participants, 42.1% reported feeling an improvement in 
ED symptomatology, 71.0% reported none or rare conflict with parents due to 
eating, 39.5% reported often or always complying with their meal plan. Of 
participants, 92.0% agreed to 'understanding the value of being healthy' and 
stated realizing that 'they were in control' due to the pandemic. Of 
participants 36.9% scored 'bad' for both overall and ED related QoL. In the 
stepwise regression analysis depression score had the highest predictive value 
for ED behaviour.
CONCLUSION: Almost half of the participants felt an improvement in their ED and 
a majority reported rare parental conflict. However, less than half reported 
meal plan compliance. As depression had the highest positive predictive value 
for ED behaviour additional screening for depression during the pandemic maybe 
warranted in ED patients.

© 2021 John Wiley & Sons Australia, Ltd.

DOI: 10.1111/eip.13193
PMCID: PMC8444904
PMID: 34263541 [Indexed for MEDLINE]

Conflict of interest statement: Authors have no conflict of interest to declare.


3232. Aust N Z J Psychiatry. 2021 Dec;55(12):1144-1156. doi: 
10.1177/00048674211031489. Epub 2021 Jul 13.

COVID-19 and loneliness: A rapid systematic review.

Pai N(1), Vella SL(1).

Author information:
(1)Graduate Medicine, School of Medicine, Faculty of Science, Medicine and 
Health, University of Wollongong, Wollongong, NSW, Australia.

BACKGROUND: Loneliness is known to be associated with both poorer physical and 
mental health, being associated with increased mortality. Responses throughout 
the world to the current COVID-19 pandemic all incorporate varying degrees of 
social distancing and isolation. There is an imperative to provide a timely 
review and synthesis of the impact of COVID-19 on loneliness in the general 
population.
METHODS: PubMed was searched using the key terms 'COVID-19', 'coronavirus', 
'SARS-COV2' and 'loneliness'. Fifty-four articles were identified and screened 
against the inclusion criteria. The inclusion criteria stipulated that the study 
needed to incorporate a measure of loneliness with participants being drawn from 
the general adult population. Twenty-four studies met the inclusion criteria.
RESULTS: The key data extracted from the 24 reviewed studies are presented and 
summarised with a focus on key demographics of participants, the research 
designs utilised, the measures of loneliness employed and the other variables 
assessed in the studies. Overall, the findings indicate that loneliness has been 
a significant issue during the current COVID-19 pandemic and loneliness is 
positively associated with mental health symptoms. However, there were 
inconsistencies in the results evident across studies.
CONCLUSION: To our knowledge, this is the first systematic review of research 
investigating loneliness during the current COVID-19 pandemic in the general 
adult population. Despite the inconsistencies evident in some of the results 
across the studies, it is clearly apparent that loneliness is having an impact 
on the mental health and wellbeing of the general adult population. Furthermore, 
it is apparent that the current COVID-19 pandemic has had an impact on 
loneliness in the general adult population and that loneliness is significantly 
positively associated with mental illness symptomatology. Thus, there is an 
imperative to address loneliness through public policy and interventions. The 
limitations of this review are noted and directions given for future research.

DOI: 10.1177/00048674211031489
PMID: 34256632 [Indexed for MEDLINE]


3233. J Clin Nurs. 2022 Mar;31(5-6):497-507. doi: 10.1111/jocn.15962. Epub 2021 Jul 
12.

Psychological distress among the family members of Intensive Care Unit (ICU) 
patients: A scoping review.

Abdul Halain A(1)(2), Tang LY(1), Chong MC(1), Ibrahim NA(3), Abdullah KL(4).

Author information:
(1)Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala 
Lumpur, Malaysia.
(2)Department of Nursing, Faculty of Medicine and Health Sciences, Universiti 
Putra Malaysia, Serdang, Malaysia.
(3)Department of Anaesthesiology, Faculty of Medicine and Health Sciences, 
Universiti Putra Malaysia, Serdang, Malaysia.
(4)Department of Nursing School of Medical and Life Science, Sunway University, 
Selangor, Malaysia.

AIMS AND OBJECTIVES: To map research-based psychological distress among the 
family members with patients in the intensive care unit (ICU).
BACKGROUND: Having a loved one in the ICU is a stressful experience, which may 
cause psychological distress for family members. Depression, anxiety and stress 
are the common forms of psychological distress associated with ICU patient's 
family members. Directly or indirectly, psychological distress may have 
behavioural or physiological impacts on the family members and ICU patient's 
recovery.
DESIGN: The study was based on the five-stage methodological framework by Arksey 
and O'Malley (International Journal of Social Research Methodology, 2005, 8, 19) 
and were guided by the PRISMA-ScR Checklist.
METHODS: A comprehensive and systematic search was performed in five electronic 
databases, namely the Scopus, Web of Sciences, CINAHL® Complete @EBSCOhost, 
ScienceDirect and MEDLINE. Reference lists from the screened full-text articles 
were reviewed.
RESULTS: From a total of 1252 literature screened, 22 studies published between 
2010-2019 were included in the review. From those articles, four key themes were 
identified: (a) Prevalence of psychological distress; (b) Factors affecting 
family members; (c) Symptoms of psychological distress; and (d) Impact of 
psychological distress.
CONCLUSIONS: Family members with a critically ill patient in ICU show high 
levels of anxiety, depression and stress. They had moderate to major symptoms of 
psychological distress that negatively impacted both the patient and family 
members.
RELEVANCE TO CLINICAL PRACTICE: The review contributed further insights on 
psychological distress among ICU patient's family members and proposed 
psychological interventions that could positively impact the family well-being 
and improve the patients' recovery.

© 2021 John Wiley & Sons Ltd.

DOI: 10.1111/jocn.15962
PMID: 34254377 [Indexed for MEDLINE]


3234. Epilepsy Behav. 2021 Sep;122:108178. doi: 10.1016/j.yebeh.2021.108178. Epub 2021 
Jul 9.

Patients with epilepsy during the COVID-19 pandemic: Depressive symptoms and 
their association with healthcare access.

Dos Santos Lunardi M(1), Marin de Carvalho R(2), Alencastro Veiga Domingues 
Carneiro R(3), Giacomini F(3), Valente KD(4), Lin K(5).

Author information:
(1)Medical Sciences Graduate Program, Federal University of Santa Catarina 
(UFSC), Florianópolis, SC, Brazil. Electronic address: 
marianalunardi1408@gmail.com.
(2)Researcher from Coordination for the Improvement of Higher Education 
Personnel (CAPES), São Paulo, SP, Brazil.
(3)Neurology Division, Federal University of Santa Catarina (UFSC), 
Florianópolis, SC, Brazil.
(4)Psychiatry Department, Clinic's Hospital University of Sao Paulo Medical 
School (HCFMUSP), Sao Paulo, SP, Brazil.
(5)Medical Sciences Graduate Program, Federal University of Santa Catarina 
(UFSC), Florianópolis, SC, Brazil; Neurology Division, Federal University of 
Santa Catarina (UFSC), Florianópolis, SC, Brazil.

BACKGROUND: The coronavirus disease 2019 (COVID-19) outbreak impacted the lives 
of worldwide people with epilepsy (PWE) in various aspects, particularly in 
those countries most significantly affected by this pandemic, such as Brazil. We 
aimed to investigate the prevalence of depressive symptoms in PWE and their 
correlation with epilepsy features and access to treatment.
METHODS: PWE were invited to answer a cross-sectional online-based survey to 
assess and rate depressive symptoms using the NDDI-E during the first year of 
the COVID-19 pandemic and its relation to multiple lifestyles epilepsy clinical 
aspects.
RESULTS: A total of 490 PWE were recruited. The prevalence of depressive 
symptoms during the COVID-19 pandemic was 35.3% (cutoff score > 15 on NDDI-E). 
The factors associated with higher NDDI-E scores were: female sex, increased 
seizure frequency, barriers to access to their treating physician and 
antiseizure medication, and unemployment. Regarding the pandemic impact on PWE 
healthcare, 29.2% reported restricted access to their medication, 46.1% barriers 
to access their physicians, 94.2% had their consultations canceled due to the 
pandemic, and 28.4% had seizure worsening in this period.
CONCLUSION: The COVID-19 pandemic affected PWE access to the healthcare system. 
Depressive symptoms were more severe in patients with higher seizure frequency 
who had difficulties obtaining proper medical care. The COVID-19 pandemic may 
impact the healthcare and mental wellbeing of patients with chronic diseases 
such as epilepsy. Nevertheless, prospective studies on epilepsy and COVID-19 are 
still lacking.

Copyright © 2021 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.yebeh.2021.108178
PMCID: PMC8412878
PMID: 34252830 [Indexed for MEDLINE]


3235. Appetite. 2021 Dec 1;167:105596. doi: 10.1016/j.appet.2021.105596. Epub 2021 Jul 
9.

"It is the only constant in what feels like a completely upside down and scary 
world": Living with an eating disorder during COVID-19 and the importance of 
perceived control for recovery and relapse.

Branley-Bell D(1), Talbot CV(2).

Author information:
(1)Department of Psychology, Northumbria University, Newcastle Upon Tyne, 
England, UK. Electronic address: dawn.branley-bell@northumbria.ac.uk.
(2)Department of Psychology, Faculty of Science and Technology, Bournemouth 
University, England, UK.

The COVID-19 pandemic has had a profound, negative impact on the lives and 
wellbeing of much of the population, and it can raise additional challenges for 
individuals with eating disorders (EDs). During early stages of the UK lockdown, 
individuals reported disruptions to many aspects of their lives, including 
reduced feelings of control and serious concerns over the impact of the pandemic 
on ED symptoms and/or recovery. This study applied a mixed methods online survey 
to collect responses from 58 individuals (age 16-65yrs) with lived experience of 
EDs. Data was collected across two time points (April 2020 and June 2020) to 
explore the ongoing impacts of the pandemic on this population. The results 
suggest that higher perceptions of general, external control may be associated 
with ED recovery. Quantitative results show that individuals who reported 
recovering from their ED since the first time point, also reported significant 
increases in perceived control (compared to individuals who had relapsed or 
whose ED status was unchanged). Thematic analysis generated two themes: ED 
behaviours as an 'auxiliary control mechanism', and loss of auxiliary control 
after lockdown. Individuals who experienced less perceived control reported a 
tendency to rely upon eating disorder behaviours as an auxiliary coping 
mechanism, i.e., diminished external control was directed inwards and replaced 
with controlling their own behaviour. The preliminary results suggest that 
perceived control may be a significant factor in ED recovery. Individuals with 
EDs may be at significant risk of detrimental impacts on their recovery and 
wellbeing because of the pandemic reducing peoples' sense of control. These 
preliminary findings highlight the need for further research in this area, 
including investigation around potential interventions based upon strengthening 
perceptions of control to promote ED recovery.

Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.appet.2021.105596
PMCID: PMC8423590
PMID: 34252493 [Indexed for MEDLINE]


3236. Eur Child Adolesc Psychiatry. 2023 Jan;32(1):113-122. doi: 
10.1007/s00787-021-01843-1. Epub 2021 Jul 10.

The impact of COVID-19 related lockdown measures on self-reported 
psychopathology and health-related quality of life in German adolescents.

Koenig J(1)(2), Kohls E(3), Moessner M(4), Lustig S(5)(6), Bauer S(4), Becker 
K(7)(8), Thomasius R(9), Eschenbeck H(10), Diestelkamp S(9), Gillé V(10), Hiery 
A(7)(8), Rummel-Kluge C(#)(3), Kaess M(#)(11)(12); ProHEAD Consortium.

Collaborators: Kaess M, Bauer S, Moessner M, Koenig J, Bonnet S, Hammon S, 
Lustig S, Richter R, Bertsch K, Brunner R, Feldhege J, Gallinat C, Parzer P, 
Sander J, Thomasius R, Diestelkamp S, Schulz AL, Rummel-Kluge C, Baldofski S, 
Kohls E, Peter LJ, Rogalla M, Klemm SL, Eschenbeck H, Gillé V, Lehner L, Becker 
K, Hiery A, Karl J, Salize HJ, Voss E, Luntz S.

Author information:
(1)Section for Experimental Child and Adolescent Psychiatry, Department of Child 
and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany.
(2)University Hospital of Child and Adolescent Psychiatry and Psychotherapy, 
University of Bern, Bern, Switzerland.
(3)Department of Psychiatry and Psychotherapy, University Leipzig, Leipzig, 
Germany.
(4)Center for Psychotherapy Research, University Hospital Heidelberg, 
Heidelberg, Germany.
(5)Department of Child and Adolescent Psychiatry, University Hospital 
Heidelberg, Blumenstraße 8, 69115, Heidelberg, Germany.
(6)Institute of Psychology, Heidelberg University, Heidelberg, Germany.
(7)Department of Child and Adolescent Psychiatry, Psychosomatics and 
Psychotherapy, Philipps-University of Marburg, Marburg, Germany.
(8)Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus 
Liebig University Giessen, Giessen, Germany.
(9)German Center for Addiction Research in Childhood and Adolescence, University 
Hospital Hamburg-Eppendorf, Hamburg, Germany.
(10)Department of Psychology, University of Education Schwäbisch Gmünd, 
Schwäbisch Gmünd, Germany.
(11)University Hospital of Child and Adolescent Psychiatry and Psychotherapy, 
University of Bern, Bern, Switzerland. michael.kaess@med.uni-heidelberg.de.
(12)Department of Child and Adolescent Psychiatry, University Hospital 
Heidelberg, Blumenstraße 8, 69115, Heidelberg, Germany. 
michael.kaess@med.uni-heidelberg.de.
(#)Contributed equally

The impact of school-closings on adolescents' mental health and well-being in 
the management of the ongoing COVID-19 pandemic is subject to ongoing public 
debate. Reliable data to inform a balanced discussion are limited. Drawing on a 
large ongoing multi-site project in Germany, we assessed differences in 
self-reported psychopathology in a matched convenience-sample of adolescents 
assessed pre- (November 26, 2018 to March 13, 2020; n = 324) and post the first 
lockdown (March 18, 2020 to August 29, 2020; n = 324) early 2020 in Germany. We 
found no evidence for an increase in emotional and behavioral problems, 
depression, thoughts of suicide or suicide attempts, eating disorder symptoms, 
or a decrease in general health-related quality of life. Reported suicide plans 
significantly decreased from 6.14 to 2.16%. Similarly, conduct problems 
decreased in the post-lockdown period. Family risk-factors did not moderate 
these findings. The influence of socioeconomic status on emotional and 
behavioral problems as well as depression decreased during the lockdown. Based 
on the present findings, the first school-closing in Germany had no immediate 
and severe impact on adolescents' well-being. However, caution is warranted as 
our data covers a fairly small, affluent sample over a limited time-span and 
long-term consequences cannot be ruled out.

© 2021. The Author(s).

DOI: 10.1007/s00787-021-01843-1
PMCID: PMC8272610
PMID: 34247297 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflict of interest to 
declare.


3237. Ann Intensive Care. 2021 Jul 10;11(1):106. doi: 10.1186/s13613-021-00900-x.

Mental health outcomes of ICU and non-ICU healthcare workers during the COVID-19 
outbreak: a cross-sectional study.

Wozniak H(1), Benzakour L(2), Moullec G(3), Buetti N(4), Nguyen A(3), Corbaz 
S(5)(6), Roos P(6), Vieux L(5), Suard JC(5), Weissbrodt R(7), Pugin J(8)(9), 
Pralong JA(9)(10), Cereghetti S(#)(8).

Author information:
(1)Intensive Care Unit, Geneva University Hospitals, Geneva, Switzerland. 
hannah.wozniak@hcuge.ch.
(2)Psychiatric Liaison and Crisis Intervention Service, Geneva University 
Hospitals, Geneva, Switzerland.
(3)School of Public Health, University of Montréal, Montreal, QC, Canada.
(4)Infection Control Program and World Health Organization Collaborating Centre 
on Patient Safety, University Hospitals and Faculty of Medicine, University of 
Geneva, Geneva, Switzerland.
(5)Personnel Health Service, Geneva University Hospitals, Geneva, Switzerland.
(6)Arc School of Health, University of Applied Sciences and Arts Western 
Switzerland, Neuchâtel, Switzerland.
(7)School of Health Sciences, University of Applied Sciences and Arts Western 
Switzerland, Valais-Wallis, Sion, Switzerland.
(8)Intensive Care Unit, Geneva University Hospitals, Geneva, Switzerland.
(9)Faculty of Medicine, University of Geneva, Geneva, Switzerland.
(10)Pulmonary Division, Geneva University Hospitals, Geneva, Switzerland.
(#)Contributed equally

BACKGROUND: Intensive care workers are known for their stressful work 
environment and for a high prevalence of mental health outcomes. The aim of this 
study was to evaluate the mental health, well-being and changes in lifestyle 
among intensive care unit (ICU) healthcare workers (HCW) during the first wave 
of the COVID-19 pandemic and to compare these results with those of HCW in other 
hospital units. Another objective was to understand which associated factors 
aggravate their mental health during the COVID-19 outbreak.
METHODS: This cross-sectional survey collected socio-demographic data, lifestyle 
changes and mental health evaluations as assessed by the Generalized Anxiety 
Disorder 7 items (GAD-7), the Patient Health Questionnaire 9 items (PHQ-9), the 
Peritraumatic Distress Inventory (PDI) and the World Health Organization 
Well-Being Index (WHO-5) from the 28th May to 7th July 2020. The study was 
carried out at Geneva University Hospitals, a group of eight public hospitals in 
Switzerland. ICU HCW were analyzed for mental health outcomes and lifestyles 
changes and then compared to non-ICU HCW. A series of linear regression analyses 
were performed to assess factors associated with mental health scores.
RESULTS: A total of 3461 HCW were included in the study, with 352 ICU HCW. Among 
ICU HCW, 145 (41%) showed low well-being, 162 (46%) symptoms of anxiety, 163 
(46%) symptoms of depression and 76 (22%) had peritraumatic distress. The mean 
scores of GAD-7, PHQ-9 and WHO-5 were worse in ICU HCW than in non-ICU HCW 
(p < 0.01). Working in the ICU rather than in other departments resulted in a 
change of eating habits, sleeping patterns and alcohol consumption (p < 0.01). 
Being a woman, the fear of catching and transmitting COVID-19, anxiety of 
working with COVID-19 patients, work overload, eating and sleeping disorders as 
well as increased alcohol consumption were associated with worse mental health 
outcomes.
CONCLUSION: This study confirms the suspicion of a high prevalence of anxiety, 
depression, peritraumatic distress and low well-being during the first COVID-19 
wave among HCW, especially among ICU HCW. This allows for the identification of 
associated risk factors. Long-term psychological follow-up should be considered 
for HCW.

© 2021. The Author(s).

DOI: 10.1186/s13613-021-00900-x
PMCID: PMC8271328
PMID: 34245380

Conflict of interest statement: The authors declare that they have no competing 
interests.


3238. J Appl Res Intellect Disabil. 2022 Jan;35(1):60-74. doi: 10.1111/jar.12926. Epub 
2021 Jul 9.

People with intellectual disabilities living in care facilities engaging in 
virtual social contact: A systematic review of the feasibility and effects on 
well-being.

Bakkum L(1)(2)(3), Schuengel C(1)(2), Sterkenburg PS(1)(4)(5), Frielink N(6), 
Embregts PJCM(6), de Schipper JC(1)(2), Ten Brug A(7), Tharner A(1)(2).

Author information:
(1)Department of Clinical Child and Family Studies and Amsterdam Public Health 
Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
(2)Academische Werkplaats 's Heeren Loo - VU, Vrije Universiteit Amsterdam, 
Amsterdam, The Netherlands.
(3)Department of Public Health and Primary Care, University of Cambridge, 
Cambridge, UK.
(4)Bartiméus, Zeist, The Netherlands.
(5)Academische Werkplaats Sociale relaties en gehechtheid, Bartiméus - VU, Vrije 
Universiteit Amsterdam, Amsterdam, The Netherlands.
(6)Academische Werkplaats Leven met een verstandelijke beperking, Tranzo, 
Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, 
The Netherlands.
(7)Academische Werkplaats EMB, University of Groningen, Groningen, The 
Netherlands.

BACKGROUND: During the initial phase of the COVID-19 pandemic, many people with 
disabilities living in home care facilities could not receive visitors. The use 
of virtual social contact has been recommended by health authorities. This 
systematic review examined the scientific evidence of the use and feasibility of 
information and communication technology (ICT) for social contact by people with 
intellectual disabilities living in care facilities, and potential effects on 
well-being.
METHODS: Five databases were searched using traditional systematic screening and 
machine-learning supported screening. Findings are presented in a narrative 
synthesis using thematic analysis.
RESULTS: Nine studies were included. We described three themes: means of ICT 
used for social contact; effects on well-being; and benefits, barriers, and 
preconditions.
CONCLUSIONS: Engaging in virtual social contact may be feasible for people with 
severe to mild intellectual disabilities, but there is little concrete evidence 
that this can be used as an alternative for in-person contact.

© 2021 The Authors. Journal of Applied Research in Intellectual Disabilities 
published by John Wiley & Sons Ltd.

DOI: 10.1111/jar.12926
PMCID: PMC9291764
PMID: 34245077 [Indexed for MEDLINE]


3239. Intensive Crit Care Nurs. 2021 Dec;67:103096. doi: 10.1016/j.iccn.2021.103096. 
Epub 2021 Jul 7.

Stabilizing life: A grounded theory of surviving critical illness.

Vogel G(1), Joelsson-Alm E(2), Forinder U(3), Svensen C(4), Sandgren A(5).

Author information:
(1)Department of Clinical Science and Education, Karolinska Institutet, Unit of 
Anaesthesiology and Intensive Care, Södersjukhuset, Sjukhusbacken 10, 118 83 
Stockholm, Sweden. Electronic address: gisela.vogel@ki.se.
(2)Department of Clinical Science and Education, Karolinska Institutet, Unit of 
Anaesthesiology and Intensive Care, Södersjukhuset, Sjukhusbacken 10, 118 83 
Stockholm, Sweden. Electronic address: eva.joelsson-alm@ki.se.
(3)Faculty of Health and Occupational Studies, University of Gävle, 
Kungsbäcksvägen 47, 801 76 Gävle, Sweden. Electronic address: 
ulla.forinder@hig.se.
(4)Department of Clinical Science and Education, Karolinska Institutet, Unit of 
Anaesthesiology and Intensive Care, Södersjukhuset, Sjukhusbacken 10, 118 83 
Stockholm, Sweden. Electronic address: christer.svensen@ki.se.
(5)Center for Collaborative Palliative Care, Department of Health and Caring 
Sciences, Linnaeus University, Växjö, Universitetsplatsen 1, 352 52 Växjö, 
Sweden. Electronic address: anna.sandgren@lnu.se.

OBJECTIVES: The experience of critical illness among patients is both complex 
and multifaceted. It can make patients vulnerable to long-term consequences such 
as impairment in cognition, mental health and physical functional ability which 
affects health related quality of life. This study aims to explore patients' 
patterns of behaviour during the process from becoming critical ill to recovery 
at home.
DESIGN: We used a classic grounded theory methodology to explore the main 
concern for intensive care patients. Thirteen participants were interviewed and 
seven different participants were observed.
SETTING: Three general intensive care units in Sweden, consisting of a 
university hospital, a county hospital and a district hospital.
FINDINGS: The theory Stabilizing life explains how patients' main concern, being 
out of control, can be resolved. This theory involves two processes, recapturing 
life and recoding life, and one underlying strategy, emotional balancing that is 
used during the whole process.
CONCLUSION: The process from becoming critically ill until recovery home is 
perceived as a constant fight in actions and mind to achieve control and 
stabilize life. This theory can form the basis for further qualitative and 
quantitative research about interventions that promotes wellbeing during the 
whole process.

Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.iccn.2021.103096
PMID: 34244030 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


3240. Int J Nurs Stud. 2021 Sep;121:104000. doi: 10.1016/j.ijnurstu.2021.104000. Epub 
2021 Jun 12.

Consequences of visiting restrictions during the COVID-19 pandemic: An 
integrative review.

Hugelius K(1), Harada N(2), Marutani M(3).

Author information:
(1)Faculty of Medicine and Health, Örebro University, Sweden. Electronic 
address: karin.hugelius@oru.se.
(2)Department of Psychiatric and Mental Health Nursing, School of Nursing, 
University of Miyazaki, Japan.
(3)Department of Health Education, National Institute of Public Health, Saitama, 
Japan. Electronic address: marutani.m.aa@niph.go.jp.

BACKGROUND: During the COVID-19 pandemic, visiting restrictions of different 
extents have been implemented. However, despite the long history of visiting 
restrictions in health care systems, little is known about their effects.
OBJECTIVES: This review sought to explore the consequences of visitor 
restrictions in health care services during the COVID-19 pandemic.
METHODS: A systematic, integrative review was conducted in accordance with the 
PRISMA guidelines, based on a systematic search in PubMed, CHINAL full plus, Web 
of Science, PsychInfo, Scopus and the Cochrane Library.
RESULTS: A total of 17 scientific papers covering intensive care, pediatric 
care, general medical care, hospital care, palliative care and nursing home 
settings were included. Although appreciation for the technical solutions 
enabling remote meetings was reported, visiting restrictions had several 
consequences, mainly negative, for the patient's health, the health and 
wellbeing of family members and the provision of care. Among physical health 
consequences, reduced nutrition intake, decreased activities of daily living and 
increased physical pain and symptoms were reported. Among mental health 
consequences for the patient, loneliness, depressive symptoms, agitation, 
aggression, reduced cognitive ability and overall dissatisfaction were observed. 
For family members, worry, anxiety and uncertainty occurred, and they reported 
an increased need for information from care providers. Family members of 
neonatal intensive care unit patients reported less bonding with their child and 
family relation disturbances due to the restrictions. For care providers, 
visiting restrictions added the burdens of ethical dilemmas, learning new 
technical means to enable social interaction and an increased demand for 
communication with families and providing social support to both family members 
and patients.
CONCLUSIONS: When implementing visiting restrictions in health care services, 
decision makers and nurses need to be aware of their potential negative effects 
and adapt the provision of care to compensate for such effects. Nurses in all 
sectors should be aware that visiting restrictions may affect patients, 
families, and health care services for longer than the actual pandemic. Since 
the level of evidence regarding effect from visiting restrictions is low, 
further studies is strongly needed.

Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.ijnurstu.2021.104000
PMCID: PMC8196532
PMID: 34242976 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest None


3241. PLoS One. 2021 Jul 9;16(7):e0254446. doi: 10.1371/journal.pone.0254446. 
eCollection 2021.

Perceived ability to comply with national COVID-19 mitigation strategies and 
their impact on household finances, food security, and mental well-being of 
medical and pharmacy students in Liberia.

Davis EJ(1), Amorim G(2), Dahn B(1), Moon TD(3).

Author information:
(1)University of Liberia College of Health Sciences, Monrovia, Liberia.
(2)Department of Biostatistics, Vanderbilt University Medical Center, Nashville, 
Tennessee, United States of America.
(3)Division of Infectious Diseases, Department of Pediatrics, Vanderbilt 
University Medical Center, Nashville, Tennessee, United States of America.

INTRODUCTION: From the outset of the COVID-19 pandemic, guidance from WHO has 
promoted social distancing, wearing face masks, frequent hand washing, and 
staying-at-home as measures to prevent the spread of COVID-19. For many across 
Africa, compliance can be difficult. The aim of this study was to 1) understand 
the impact of student's household's ability to comply with COVID-19 mitigation 
strategies, 2) identify predictors of mitigation strategy compliance, and 3) 
describe the impact of COVID-19 on household economics, food-security, and 
mental well-being.
MATERIALS AND METHODS: We conducted an email-based survey among current medical 
and pharmacy students of the University of Liberia College of Health Sciences 
between July and October 2020. The questionnaire was designed to explore their 
household's ability to comply with current mitigation strategies, as well as the 
pandemic´s impact on the student's household's finances and food security. 
Descriptive statistics were used to delineate demographic characteristics. 
Logistic regression was used to model factors associated with ability to comply 
with COVID-19 mitigation strategies, as well as participant's food security.
RESULTS: 113 persons responded to the questionnaire. Seventy-six (67∙3%) 
reported income losses as a result of the pandemic, with 93 (82∙3%) reporting 
being "somewhat" or "very worried" about their households' finances. 
Seventy-seven (68∙1%) participants reported food stocks that were sufficient for 
one-week or less. Forty (35%) participants reported eating less preferred foods 
or skipping meals in the past week. Overall, 20 participants (19∙4%) had a 
positive depression screen.
CONCLUSIONS: Study participants showed mixed results in being able to adhere to 
national COVID-19 mitigation strategies, with household level stressors 
experienced around finances and food security. Until Liberia has access to 
vaccinations for most of its citizens, COVID-19 response measures need to 
provide social protections that address basic needs (shelter, clothing and 
food), and which specifically targets food insecurity. Preventative 
interventions for mental health problems must be incorporated into Liberia's 
response to the pandemic.

DOI: 10.1371/journal.pone.0254446
PMCID: PMC8270202
PMID: 34242378 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


3242. Int J Clin Pract. 2021 Oct;75(10):e14621. doi: 10.1111/ijcp.14621. Epub 2021 Jul 
16.

COVID-19 confinement and related well being measurement using the EQ-5D 
questionnaire: A survey among the Palestinian population.

Hamdan A(1), Ghanim M(2), Mosleh R(3).

Author information:
(1)Department of Allied and Applied Medical Sciences, Faculty of Medicine and 
Health Sciences, An-Najah National University, Nablus, Palestine.
(2)Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, 
An-Najah National University, Nablus, Palestine.
(3)Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah 
National University, Nablus, Palestine.

PURPOSE: This study aims to assess the effect of the COVID-19 confinement on the 
population wellbeing using the EQ-5D questionnaire.
METHODS: After receiving the written permission from the EuroQol Research 
Foundation, an online-based survey was prepared and a total of 1380 participants 
were recruited via social media. The relationships of all the factors were 
studied as well as the scores of the EQ-5D including EQ-5D Index, Visual 
Analogue Scale (VAS), and each of the EQ-5D dimension. Linear regression for the 
Index and VAS and Logistic regression model was used to examine each dimension.
RESULTS: The median EQ-5D Index and VAS scores were 0.65 (0.5-0.75) and 80 
(60-90), respectively. The most frequently reported problem was 
anxiety/depression (67.3%), followed by usual activities (48.6%). The 
statistical analysis showed that factors significantly associated with more 
reported problems in at least one EQ-5D dimension (P < .05) were: females, 
ageing, being unmarried, low income, school studies, living in refugee camps, 
and villages, unemployment, having chronic diseases or pain, and obesity. It is 
important to note that participants who responded in November showed more 
problems compared with December 2020. On the other hand, more problems were 
reported by participants who were infected, had known affected persons, had no 
enough information, perceived negative effect of confinement, and indicated 
having a high infection chance (P < .05).
CONCLUSIONS: This work provides important evidence on the health status and 
wellbeing during the COVID-19 confinement in a sample of the Palestinian 
population, affecting almost all the aspects of the health state and wellbeing. 
This effect could be minimised by improving the COVID-19 preventive education 
and monitoring that can play an important role in all health and life aspects 
among the Palestinian population in facing this pandemic.

© 2021 John Wiley & Sons Ltd.

DOI: 10.1111/ijcp.14621
PMCID: PMC8420358
PMID: 34240509 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts to declare.


3243. N Z Med J. 2021 Jul 9;134(1538):120-127.

Impact of the COVID-19 pandemic lockdown on public sector ophthalmic work by New 
Zealand's ophthalmologists.

Scott DAR(1), Hadden PW(2), Wilson GA(3).

Author information:
(1)Ophthalmology Non-Vocational Registrar, Department of Ophthalmology, Gisborne 
Hospital, Hauora Tairāwhiti, Gisborne.
(2)Ophthalmologist, Department of Ophthalmology, New Zealand National Eye 
Centre, Faculty of Medicine and Health Sciences, University of Auckland, 
Auckland.
(3)Ophthalmologist, Department of Ophthalmology, Gisborne Hospital, Hauora 
Tairāwhiti, Gisborne; Mātai Lab, Gisborne.

AIM: In response to the COVID-19 pandemic, the New Zealand government enforced a 
nationwide 'alert level 4' lockdown from 26 March to 27 April 2020. We assessed 
the impact of this lockdown on New Zealand's public ophthalmology service.
METHOD: An anonymous online survey was sent to all New Zealand-based fellows of 
the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) after 
lockdown. Respondents provided retrospective assessment of practice patterns and 
their personal health during the COVID-19 lockdown. This was supported by 
national-level administrative data, allowing survey findings to be 
contextualised.
RESULTS: Fifty-seven respondents (response rate 49%) working in the public 
health system participated. A large majority of respondents reduced elective 
clinic and surgical volumes by at least 75% (82% and 98%, respectively). 
National-level information confirmed clinic reduced to 38.2% of normal and 
elective operating volumes to 11.5%, with virtual visits increasing 17.9-fold. 
Elective clinic and elective operating volumes promptly recovered to usual 
volumes on the second month post lockdown. Most respondents (58%) followed the 
RANZCO triaging guideline, and 28% triaged emergencies only. At a personal 
level, respondents reported a significant physical health benefit (p<0.001) 
associated with the lockdown experience, but no change in mental health or 
social wellbeing.
CONCLUSIONS: Publicly employed ophthalmologists experienced dramatic reductions 
to elective clinic and operating volumes during the COVID-19 lockdown. The 
prompt recovery of service delivery volumes back to pre-lockdown levels supports 
the value of a COVID-19 elimination strategy in New Zealand. Virtual visits for 
selected patients allowed ongoing management without risking virus transmission.

PMID: 34239151 [Indexed for MEDLINE]

Conflict of interest statement: Dr Hadden reports that he is the current chair 
of the New Zealand branch of the Royal Australian and New Zealand College of 
Ophthalmologists, which formulated prioritisation guidelines for ophthalmology 
during the pandemic.


3244. PLoS One. 2021 Jul 8;16(7):e0254114. doi: 10.1371/journal.pone.0254114. 
eCollection 2021.

Declining well-being during the COVID-19 pandemic reveals US social inequities.

Bathina KC(1), Ten Thij M(1)(2), Valdez D(3), Rutter LA(4), Bollen J(1).

Author information:
(1)Luddy School of Informatics, Computing, and Engineering, Indiana University, 
Bloomington, IN, United States of America.
(2)Delft Institute of Applied Mathematics, Delft University of Technology, 
Delft, The Netherlands.
(3)School of Public Health, Indiana University, Bloomington, IN, United States 
of America.
(4)Psychological and Brain Sciences, Indiana University, Bloomington, IN, United 
States of America.

BACKGROUND: The COVID-19 pandemic led to mental health fallout in the US; yet 
research about mental health and COVID-19 primarily rely on samples that may 
overlook variance in regional mental health. Indeed, between-city comparisons of 
mental health decline in the US may provide further insight into how the 
pandemic is disproportionately affecting at-risk groups.
PURPOSE: This study leverages social media and COVID-19-city infection data to 
measure the longitudinal (January 22- July 31, 2020) mental health effects of 
the COVID-19 pandemic in 20 metropolitan areas.
METHODS: We used longitudinal VADER sentiment analysis of Twitter timelines 
(January-July 2020) for cohorts in 20 metropolitan areas to examine mood changes 
over time. We then conducted simple and multivariate Ordinary Least Squares 
(OLS) regressions to examine the relationship between COVID-19 infection city 
data, population, population density, and city demographics on sentiment across 
those 20 cities.
RESULTS: Longitudinal sentiment tracking showed mood declines over time. The 
univariate OLS regression highlighted a negative linear relationship between 
COVID-19 city data and online sentiment (β = -.017). Residing in predominantly 
white cities had a protective effect against COVID-19 driven negative mood (β = 
.0629, p < .001).
DISCUSSION: Our results reveal that metropolitan areas with larger communities 
of color experienced a greater subjective well-being decline than predominantly 
white cities, which we attribute to clinical and socioeconomic correlates that 
place communities of color at greater risk of COVID-19.
CONCLUSION: The COVID-19 pandemic is a driver of declining US mood in 20 
metropolitan cities. Other factors, including social unrest and local 
demographics, may compound and exacerbate mental health outlook in racially 
diverse cities.

DOI: 10.1371/journal.pone.0254114
PMCID: PMC8266050
PMID: 34237087 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


3245. Community Ment Health J. 2021 Oct;57(7):1255-1266. doi: 
10.1007/s10597-021-00871-0. Epub 2021 Jul 7.

COVID-19 and Psychosocial Support Services: Experiences of People Living with 
Enduring Mental Health Conditions.

Honey A(1), Waks S(2), Hines M(2), Glover H(3), Hancock N(2), Hamilton D(2), 
Smith-Merry J(2).

Author information:
(1)Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. 
anne.honey@sydney.edu.au.
(2)Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
(3)Enlightened Consultants, Brisbane, QLD, Australia.

This paper uses secondary analysis to understand how COVID-19 shaped people's 
experiences with psychosocial support services in Australia. Data are drawn from 
questionnaires (n = 66) and semi-structured interviews (n = 62), conducted for a 
national service evaluation, with 121 people living with enduring mental health 
conditions and using psychosocial support services. Data relating to COVID-19 
were inductively coded and analysed using constant comparative analysis. Most 
people's experiences included tele-support. While some people described minimal 
disruption to their support, many reported reduced engagement. People's 
wellbeing and engagement were influenced by: their location, living situation 
and pre-COVID lifestyles; physical health conditions; access to, comfort with, 
and support worker facilitation of technology; pre-COVID relationships with 
support workers; and communication from the organisation. The findings can help 
services prepare for future pandemics, adjust their services for a 
'COVID-normal' world, and consider how learnings from COVID-19 could be 
incorporated into a flexible suite of service delivery options.

© 2021. The Author(s).

DOI: 10.1007/s10597-021-00871-0
PMCID: PMC8262584
PMID: 34235615 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no relevant financial or 
nonfinancial interests to disclose.


3246. Br J Community Nurs. 2021 Jul 2;26(7):318-323. doi: 10.12968/bjcn.2021.26.7.318.

How district nurses can support team wellbeing during the pandemic and beyond.

Merchant J(1).

Author information:
(1)Community Team Sister, Burnley East District Nursing Team, East Lancashire 
Hospitals Trust, Burnley, Lancashire.

The COVID-19 pandemic has required rapid adaptation of the community nursing 
service, including the introduction of online communication platforms to prevent 
COVID-19 transmission among staff. Remote working has protected the workforce in 
the community from being decimated through team sickness, but has resulted in 
nurses who are feeling anxious and isolated from their colleagues while 
experiencing increased workloads, with complex and often emotionally challenging 
situations. The pressures of community nursing and the associated impact on 
sickness absence relating to mental health are well documented. The resources 
made available to support staff wellbeing were increased during the pandemic, 
but there remains some disparity of access to these resources. There is much 
that can be done by the district nurse as a leader of a team to ensure that the 
pressures are managed in a way that promotes team cohesion and mutual respect, 
while ensuring that open communication about wellbeing is encouraged.

DOI: 10.12968/bjcn.2021.26.7.318
PMID: 34232713 [Indexed for MEDLINE]


3247. Int J Geriatr Psychiatry. 2021 Nov;36(11):1785-1794. doi: 10.1002/gps.5600. Epub 
2021 Jul 19.

Assessment of anxiety in elderly population during the COVID-19 pandemic and the 
impact of compulsory home-stay in the central districts of Ankara, Turkey: 
A quantitative, qualitative mixed method study.

Sirin H(1), Ahmadi AA(1), Ketrez G(1), Ozbeyaz C(1), Dikmen AU(2), Ozkan S(2).

Author information:
(1)Public Health Department, University of Health Sciences, Ankara, Turkey.
(2)Public Health Department, Gazi University, Ankara, Turkey.

OBJECTIVE: This study aimed to determine the level of anxiety in elderly 
individuals during the COVID-19 pandemic in Ankara province of Turkey and 
determine its associated factors.
METHODS: A quantitative, qualitative mixed-method study performed in 1-10 June 
2020 during the compulsory home-stay for elderly people in Turkey. The 
quantitative study was conducted using a structured online questionnaire with 
278 participants aged 65 or older. The Geriatric Anxiety Inventory (GAI) was 
used to assess the anxiety. An in-depth interview with 20 participants was used 
to fill the gap of face-to-face interview due to pandemic situation and 
strengthen the results of quantitative survey. Qualitative and quantitative data 
were analyzed separately.
RESULTS: Of all participants, 88 (31.7%) had a score above the cut-off point for 
GAI. The prevalence of Generalized Anxiety Disorder (GAD) was significantly 
higher in female (37.8%) than in male (23.8%). Female gender, economic loss, 
uncertainty, and the time participants expend to follow news about COVID-19 
pandemic were risk factors of GAD. On the other hand, higher education level, 
hobbies, and regular physical activity were protective factors against GAD.
CONCLUSION: During the pandemic, social isolation and lockdown for elderly 
people make serious risk factor for their mental well-being. Measures must be 
taken to support the psychological well-being of elderly by promoting physical 
activity and hobbies at home, and reducing their economic concerns.

© 2021 John Wiley & Sons Ltd.

DOI: 10.1002/gps.5600
PMCID: PMC8420385
PMID: 34231924 [Indexed for MEDLINE]

Conflict of interest statement: The authors report no conflict of interest.


3248. Paediatr Respir Rev. 2021 Sep;39:16-21. doi: 10.1016/j.prrv.2021.05.009. Epub 
2021 May 31.

What we have learnt about trauma, loss and grief for children in response to 
COVID-19.

Fitzgerald DA(1), Nunn K(2), Isaacs D(3).

Author information:
(1)Department of Respiratory Medicine, The Children's Hospital at Westmead, 
Westmead, NSW 2145, Australia; Discipline of Child and Adolescent Health, Sydney 
Medical School, Faculty of Health Sciences, University of Sydney, NSW 2006, 
Australia. Electronic address: dominic.fitzgerald@health.nsw.gov.au.
(2)Department of Psychological Medicine, The Children's Hospital at Westmead, 
Westmead, NSW 2145, Australia.
(3)Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of 
Health Sciences, University of Sydney, NSW 2006, Australia; Department of 
Infectious Diseases, The Children's Hospital at Westmead, Westmead, NSW 2145, 
Australia.

The disruption of daily life resulting from COVID-19 and its precautions has 
taken an enormous emotional toll on children and families. The consequences of 
disrupted schooling, changed social interactions and altered family dynamics has 
had some unanticipated positives such as improved on-line educational upskilling 
and personal resilience. However, the potential longer term implications for 
educational outcomes, economic impacts of job loss and prolonged financial 
insecurity, physical wellbeing and mental health remain unclear. The potential 
for post-traumatic stress disorders from what is experienced by children with 
imposed isolation from friends and extended family, domestic violence and death 
of relatives remains concerning. Confronting images and stories relayed through 
social media and the popular press will challenge children's views of safety, 
security, trust and potentially rob them of much of the innocence of youth. In 
an overwhelming global response to the "adult" problems of the COVID-19 
pandemic, this article reflects on the consequences of trauma, loss and grief 
through the perspective of children and how they may alter their view of the 
world.

Copyright © 2021. Published by Elsevier Ltd.

DOI: 10.1016/j.prrv.2021.05.009
PMCID: PMC8437675
PMID: 34229965 [Indexed for MEDLINE]


3249. Am J Perinatol. 2021 Sep;38(11):1201-1208. doi: 10.1055/s-0041-1731649. Epub 
2021 Jul 5.

Impacts of Neonatal Hospitalization on Families during the 2019 Coronavirus 
Pandemic.

Vance AJ(1), Malin KJ(2), Chen B(3), Shuman CJ(3), Moore TA(4).

Author information:
(1)National Clinician Scholars Program, University of Michigan, School of 
Nursing, Ann Arbor, Michigan.
(2)College of Nursing, Marquette University, Milwaukee, Wisconsin.
(3)School of Nursing, University of Michigan, Ann Arbor, Michigan.
(4)College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska.

OBJECTIVE: Limited data are available regarding family and financial well-being 
among parents whose infants were hospitalized during the 2019 coronavirus 
(COVID-19) pandemic. The study objective was to evaluate the family and 
financial well-being of parents whose infants were hospitalized in the neonatal 
intensive care unit (NICU) during COVID-19.
STUDY DESIGN: Parents were recruited for this online, cross-sectional survey via 
support groups on social media. Data collection was completed between May 18, 
2020 and July 31, 2020. The final sample consisted of 178 parents, who had an 
infant hospitalized in an NICU between February 1, 2020 and July 31, 2020. The 
primary outcomes were impact on family life and financial stability, as measured 
by the Impact on Family scale, an instrument that evaluates changes to family 
life as a result of infant or childhood illness.
RESULTS: Of the 178 parent respondents, 173 (97%) were mothers, 107 (59.4%) were 
non-Hispanic White, and 127 (69.5%) of the infants were born prematurely. 
Parents reported significant family impact and greater financial difficulty. 
Extremely premature infants, lower household income, parent mental health, and 
lower parental confidence were predictive of greater impacts on family life.
CONCLUSION: Parents reported significant family and financial impacts during 
their infant's hospitalization amid COVID-19. Further studies are needed to 
guide clinical practice and inform family-supportive resources that can mitigate 
consequences to family well-being.
KEY POINTS: · Impact of infant hospitalization in the context of COVID-19 is 
largely unknown.. · In a cohort of NICU parents during COVID-19, they reported 
changes to family life and finances.. · Greater impacts were reported by parents 
with lower income, confidence, and very premature infants..

Thieme. All rights reserved.

DOI: 10.1055/s-0041-1731649
PMID: 34225372 [Indexed for MEDLINE]

Conflict of interest statement: None declared.


3250. Age Ageing. 2021 Nov 10;50(6):1876-1885. doi: 10.1093/ageing/afab156.

Impact of COVID-19 restrictions on carers of persons with dementia in the UK: a 
qualitative study.

Sriram V(1), Jenkinson C(1), Peters M(1).

Author information:
(1)Health Services Research Unit, Nuffield Department of Population Health, 
University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, 
UK.

BACKGROUND: informal carers provide the majority of the support for persons with 
dementia living at home. Restrictions imposed due to COVID-19 have had a 
profound impact on the daily life of the entire population. This study provides 
insight into the impact of these restrictions on carers of people with dementia 
living at home.
DESIGN: qualitative semi-structured interviews.
PARTICIPANTS: purposive sample of carers who provide at least 10 hours of care a 
week for the person with dementia living at home.
SETTING: UK.
RESULTS: twenty-three carers were interviewed, and thematic analysis identified 
three main themes-Changes to daily life, impact on carer health and wellbeing 
and reduced support from health and social support networks. The results 
highlight the impact of restrictions imposed on daily life and routines due to 
the pandemic, wellbeing of carers, reduced social support, lack of access to 
health and care professionals and respite for carers. The restrictions have had 
negative consequences on carers' wellbeing, and they have experienced 
difficulties in accessing formal care services and respite care.
CONCLUSION: carers attempt to continue to provide physical, emotional and 
practical support for persons with dementia in the community throughout the 
COVID-19 restrictions. To prevent a future carer crisis, carers need better 
support systems including formal carer services, telecare solutions that work 
for them and additional support for respite, as the restrictions from this 
pandemic continue.

© The Author(s) 2021. Published by Oxford University Press on behalf of the 
British Geriatrics Society. All rights reserved. For permissions, please email: 
journals.permissions@oup.com.

DOI: 10.1093/ageing/afab156
PMCID: PMC8384409
PMID: 34224555 [Indexed for MEDLINE]


3251. Chron Respir Dis. 2021 Jan-Dec;18:14799731211029658. doi: 
10.1177/14799731211029658.

Asthma patients experience increased symptoms of anxiety, depression and fear 
during the COVID-19 pandemic.

de Boer GM(1)(2), Houweling L(1), Hendriks RW(2), Vercoulen JH(3), 
Tramper-Stranders GA(4), Braunstahl GJ(1)(2).

Author information:
(1)Department of Pulmonary Medicine, 425659Franciscus Gasthuis & Vlietland, 
Rotterdam, the Netherlands.
(2)Department of Pulmonary Medicine, 6993Erasmus MC, University Medical Center, 
Rotterdam, the Netherlands.
(3)Department of Medical Psychology, 6029Radboud University Medical Center, 
Nijmegen, the Netherlands.
(4)Department of Paediatric Medicine, 425659Franciscus Gasthuis & Vlietland, 
Rotterdam, the Netherlands.

Population studies showed a decrease in psychological wellbeing during the 
COVID-19 pandemic. Asthma is associated with a negative effect on anxiety and 
depression, which might worsen during the COVID-19 lockdown. The aim of the 
study was to compare fear, anxiety and depression between asthma patients and 
patients wit hout asthma pre-COVID-19 and during COVID-19 pandemic.This study 
compares fear, anxiety and depression in asthma patients and controls between 
pre-COVID-19 and during COVID-19 lockdown with a cross-sectional online survey. 
Participants were invited to fill out several questionnaires pertaining to fear, 
anxiety, depression, asthma control and quality of life.Asthma patients (N = 37) 
displayed, during the course of the pandemic, a clinically relevant increase in 
anxiety (3.32 ± 2.95 vs. 6.68 ± 3.78; p < 0.001) and depression (1.30 ± 1.15 vs. 
3.65 ± 3.31; p < 0.001), according to the hospital anxiety and depression levels 
(HADS) compared to pre-COVID-19 assessment. This was not seen in controls. Also, 
asthma patients displayed more anxiety about acquiring COVID-19 disease compared 
to controls ((5.11 ± 1.99 vs. 3.50 ± 2.79), p = 0.006).Patients with asthma 
experienced an increase in anxiety and depression levels and were more afraid of 
acquiring COVID-19 disease compared to controls. Also, patients with asthma were 
more likely to avoid healthcare facilities due to fear of acquiring COVID-19 
disease compared to controls. Therefore, we advise health care workers to 
address these possible negative effects on mental health by phone or e-consults.

DOI: 10.1177/14799731211029658
PMCID: PMC8261840
PMID: 34219501 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of conflicting interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


3252. Pol Merkur Lekarski. 2021 Jun 16;49(291):235-237.

[Mental health protection associated with COVID-19].

[Article in Polish]

Ogłodek EA(1).

Author information:
(1)Faculty of Health Science, Jan Dlugosz University in Czestochowa, Poland.

Mental health is a state of mental well-being in which people are able to cope 
with stressful situations in life and can bring their life potential to their 
communities. Good mental health enables people to fulfill their roles in both 
family and society. When crises affect social life, people should be expected to 
experience high levels of stress. The COVID-19 pandemic, in addition to the 
physical health crisis, may also contribute to the exacerbation of stress and 
the emergence of mental illnesses. Many individuals suffer due to forced 
isolation or feel socially excluded. Also, many of them fear infection, death 
and losing family members. Moreover, specific population groups show varying 
degrees of COVID-19-related psychological stress. The paper presents the 
psychological problems of the consequences of COVID-19 in society based on a 
review of the latest articles available in the PubMed and Google Scholar 
databases. The discussed material points to different needs in terms of 
psychological support in the society. People in unstable living conditions are 
at a greater risk of losing their mental health. Moreover, their mental health 
needs may be completely overlooked. Emotional difficulties may worsen among 
children and adolescents as a result of both family stress and social isolation. 
It is essential to include mental health protection in health policy in response 
to the COVID-19 pandemic to accelerate the recovery of communities.

© 2021 MEDPRESS.

PMID: 34218247 [Indexed for MEDLINE]


3253. J Psychosom Res. 2021 Sep;148:110561. doi: 10.1016/j.jpsychores.2021.110561. 
Epub 2021 Jun 29.

The impact of the coronavirus (COVID-19) pandemic on individuals with 
gastrointestinal disorders: A protocol of an international collaborative study.

Ferreira N(1), Mikocka-Walus A(2), van Tilburg MAL(3), Graff LA(4), Apputhurai 
P(5), Barreiro-de Acosta M(6), Bennebroek Evertsz F(7), Burisch J(8), Lo B(8), 
Petrik M(9), Trindade IA(10), Jedel S(11), Moser G(12), Mokrowiecka A(13), 
Bernstein CN(4), Dumitrascu D(14), Ford AC(15), Stengel A(16), Gearry R(17), 
Knowles SR(5).

Author information:
(1)University of Nicosia, Department of Social Sciences, Nicosia, Cyprus. 
Electronic address: ferreira.n@unic.ac.cy.
(2)Deakin University Geelong, School of Psychology, Melbourne, Victoria, 
Australia.
(3)Department of Medicine, Division of Gastroenterology and Hepatology, 
University of North Carolina, Chapel Hill, NC, USA; College of Pharmacy and 
Health Sciences, Campbell University, Buies Creek, NC, USA; School of Social 
Work, University of Washington, Seattle, WA, USA.
(4)Max Rady College of Medicine, University of Manitoba Winnipeg, Manitoba, 
Canada.
(5)Swinburne University of Technology, Melbourne, Victoria, Australia.
(6)IBD Unit, University Hospital Santiago de Compostela, Spain.
(7)Amsterdam University Medical Centers, the Netherlands.
(8)Gastrounit, Medical Division, Hvidovre University Hospital, Denmark.
(9)University of Minnesota Medical School, USA.
(10)University of Coimbra, Portugal; Department of Molecular and Clinical 
Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 
Sweden.
(11)Rush University Medical Center, USA.
(12)Medical University of Vienna, Austria.
(13)Medical University of Lodz, Poland.
(14)Iuliu Haţieganu University of Medicine and Pharmacy, Romania.
(15)Leeds Institute of Medical Research at St. James's, University of Leeds, UK; 
Leeds Gastroenterology Institute, Leeds Teaching Hospitals Trust, UK.
(16)Department of Psychosomatic Medicine and Psychotherapy, University Hospital 
Tübingen, Germany; Charité Center for Internal Medicine and Dermatology, 
Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, 
Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 
and Berlin Institute of Health, 12203 Berlin, Germany.
(17)University of Otago, Christchurch, New Zealand.

OBJECTIVE: The COVID-19 pandemic has had a significant impact on mental health 
across the globe. People living with a chronic gastrointestinal (GI) disorder 
might be particularly at risk of mental health complications given higher rates 
of comorbid anxiety and depression compared to the healthy population. As GI 
disorders affect up to 40% of the population worldwide, this international 
collaborative study seeks to evaluate the extent of the impact of the COVID-19 
pandemic on GI symptoms specifically and more generally on the well-being of 
those living with chronic GI conditions.
METHODS: A longitudinal survey with three time points (baseline, 6-month, and 
12-month) will be conducted online. Adult participants with GI disorders from 
multiple countries will be recruited via patient associations, social media 
advertising, utilizing snowball sampling. Participants will be invited to 
complete a battery of questionnaires including demographic and health 
parameters, and measures of gastrointestinal symptoms, fear of COVID-19, 
perceived impact of COVID-19, illness perceptions, coping, depression, anxiety, 
stress, catastrophizing, and quality of life, using validated measures where 
available. Statistical analyses will include univariate descriptive models, 
multivariate models utilizing regression, mediation, and moderation, and latent 
growth models.
CONCLUSIONS: This project may present novel information to the field of 
psychogastroenterology and may provide crucial information regarding the areas 
of impact for individuals with GI disorders during and following the pandemic. 
Further, this information can guide healthcare providers and patient 
associations on how to target support related to the pandemic mental health 
sequelae for these patients.

Copyright © 2021 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jpsychores.2021.110561
PMCID: PMC8240440
PMID: 34217956 [Indexed for MEDLINE]

Conflict of interest statement: Outside the present work, A. Mikocka-Walus 
served as an invited speaker at IBD-related conferences co-organized by Crohn's 
& Colitis Australia (a charity), Janssen and Ferring and received a speaker's 
fee. Outside the present work, S. Knowles served as an invited speaker at 
IBD-related conferences co-organized by Crohn's & Colitis Australia (a charity), 
Janssen and Ferring and received a speaker's fee and is a member of Medical 
Advisory Committee for Glutagen Pty Ltd. Outside of the present work, M. van 
Tilburg was a consultant for Mahana Therapeutics Inc. Outside of the present 
work, L.A. Graff has been a consultant for Roche Canada. Outside of the present 
work, M Barreiro-de Acosta has served as a speaker, consultant and advisory 
member for or has received research funding from MSD, AbbVie, Janssen, Kern 
Pharma, Celltrion, Takeda, Gillead, Celgene, Pfizer, Ferring, Faes Farma, Shire 
Pharmaceuticals, Dr. Falk Pharma, Chiesi, Gebro Pharma, Adacyte and Vifor 
Pharma. Outside of the present work, I.A. Trindade received consultancy fees 
from Pfizer Inc. Outside of the present work Dr. C Bernstein has served on 
advisory Boards for AbbVie Canada, Amgen Canada, Bristol Myers Squibb Canada, 
Roche Canada, Janssen Canada, Sandoz Canada, Takeda Canada, and Pfizer Canada; 
Consultant for Mylan Pharmaceuticals and Takeda; Educational grants from Abbvie 
Canada, Pfizer Canada, Takeda Canada, and Janssen Canada. Speaker's panel for 
Abbvie Canada, Janssen Canada, Medtronic Canada, and Takeda Canada. Received 
research funding from Abbvie Canada and Pfizer Canada.


3254. Psychiatry Res. 2021 Sep;303:114070. doi: 10.1016/j.psychres.2021.114070. Epub 
2021 Jun 23.

Mental health issues and health disparities amid COVID-19 outbreak in China: 
Comparison of residents inside and outside the epicenter.

Cheng C(1), Wang HY(2), Chau CL(2).

Author information:
(1)Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong. 
Electronic address: ceccheng@hku.hk.
(2)Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong.

The Coronavirus Disease-2019 (COVID-19) has exerted an impact on not only 
individuals who have contracted the virus but also the general public. This 
study compared the mental health condition of residents in the epicenter 
province of Hubei with that of other Chinese residents during the initial stage 
of the COVID-19 outbreak, and to examine emerging issues revolving around health 
disparities in disease prevention. A survey was administered in February 2020 to 
433 Chinese adults spanning 28 regions across China. Participants residing in 
Hubei reported lower levels of affective and cognitive well-being than those in 
other regions. Perceived behavioral control and healthy lifestyle maintenance 
were associated with both dimensions of well-being and sleep quality for all 
participants. Income level was positively associated with facemask use and 
healthy lifestyle maintenance. These results indicate that Hubei residents 
reported poorer mental health than those of other regions, but perceived 
behavioral control and healthy lifestyle maintenance correlate with better 
mental health across regions. The likelihood of undertaking preventive measures 
for COVID-19 tends to be greater among residents with higher income, reflecting 
the need to address the oft-neglected concerns of health disparities in 
preventing this highly contagious novel disease.

Copyright © 2021 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.psychres.2021.114070
PMCID: PMC8219946
PMID: 34217100 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3255. Int J Geriatr Psychiatry. 2021 Nov;36(11):1748-1758. doi: 10.1002/gps.5596. Epub 
2021 Jul 9.

Impact of the COVID-19 pandemic on older adults mental health services: A mixed 
methods study.

Bhome R(1), Huntley J(2)(3), Dalton-Locke C(4), San Juan NV(5), Oram S(5)(6), 
Foye U(7), Livingston G(2)(3).

Author information:
(1)Queen Square Institute of Neurology, University College London, London, UK.
(2)Division of Psychiatry, University College London, London, UK.
(3)Camden and Islington NHS Foundation Trust, London, UK.
(4)NIHR Mental Health Policy Research Unit, Division of Psychiatry, University 
College London, London, UK.
(5)NIHR Mental Health Policy Research Unit, Institute of Psychiatry, 
Psychology & Neuroscience, King's College London, London, UK.
(6)Section of Women's Mental Health, Institute of Psychiatry, Psychology & 
Neuroscience, King's College London, London, UK.
(7)Mental Health Nursing and NIHR Mental Health Policy Research Unit, King's 
College London, London, UK.

OBJECTIVES: The COVID-19 pandemic has had a significant impact on older adults 
mental health care. Our study aimed to explore staff perspectives on key 
challenges and innovations in order to help inform the delivery of older adults 
mental health care in subsequent waves of the pandemic.
METHODS: A mixed methods online questionnaire developed by National Institute 
for Health Research Mental Health Policy Research Unit was used to gather staff 
perspectives on their challenges at work, problems faced by service users and 
their carers, and sources of help and support. Descriptive statistics were used 
for quantitative analysis and descriptive content analysis for qualitative 
analysis.
RESULTS: 158 participants, working in either community or inpatient settings, 
and from a range of professional disciplines, were included. For inpatient 
staff, a significant challenge was infection control. In the community, staff 
identified a lack of access to physical and social care as well as reduced 
contact with friends and families as being challenges for patients. Remote 
working was seen as a positive innovation along with COVID-19 related guidance 
from various sources and peer support.
CONCLUSION: Our study, with a focus on staff and patient well-being, helps to 
inform service development for future waves of the pandemic. We discuss measures 
to improve infection control in inpatient settings, the role of voluntary 
organisations in supporting socially isolated community patients, the need for 
better integration of physical and mental health services at an organisational 
level, and the importance of training staff to support patients and their 
families with end of life planning.

© 2021 John Wiley & Sons Ltd.

DOI: 10.1002/gps.5596
PMCID: PMC8420103
PMID: 34216045 [Indexed for MEDLINE]

Conflict of interest statement: On behalf of all authors, the corresponding 
author states that there is no conflict of interest.


3256. Diagnosis (Berl). 2021 Jul 2;8(4):403-412. doi: 10.1515/dx-2021-0046. Print 2021 
Nov 25.

An overview of mental health during the COVID-19 pandemic.

Chen PJ(1), Pusica Y(1), Sohaei D(2), Prassas I(3)(4), Diamandis EP(1)(2)(3)(4).

Author information:
(1)Department of Clinical Biochemistry, University Health Network, Toronto, 
Canada.
(2)Department of Laboratory Medicine and Pathobiology, University of Toronto, 
Toronto, Canada.
(3)Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, 
Toronto, Canada.
(4)Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, 
Canada.

Since its initial outbreak in late 2019, the COVID-19 pandemic has profoundly 
affected the global community. In addition to the negative health consequences 
of contracting COVID-19, the implementation of strict quarantine and lockdown 
measures has also disrupted social networks and devastated the global economy. 
As a result, there is rising concern that the pandemic has taken a toll on the 
mental health of the general population. To better understand its impact, an 
increasing number of studies examined the effects of the pandemic on mental 
health and psychosocial implications of enforced quarantine and lockdown. In 
this article, we aim to review and summarize the findings from a variety of 
studies that have explored the psychosociological effects of the pandemic and 
its impact on the mental well-being of the general population. We will also 
examine how various demographic groups, such as the elderly and youth, can be 
more susceptible or resilient to the pandemic's mental health effects. We hope 
to provide a broader understanding of the underlying causes of mental health 
issues triggered by the pandemic and provide recommendations that may be 
employed to address mental health issues in the population over the long-term.

© 2021 Walter de Gruyter GmbH, Berlin/Boston.

DOI: 10.1515/dx-2021-0046
PMID: 34214386 [Indexed for MEDLINE]


3257. Health Promot Int. 2022 Feb 17;37(1):daab070. doi: 10.1093/heapro/daab070.

University students' sense of coherence, future worries and mental health: 
findings from the German COVID-HL-survey.

Dadaczynski K(1)(2), Okan O(3), Messer M(4), Rathmann K(1).

Author information:
(1)Department of Nursing and Health Science, Fulda University of Applied 
Sciences, Germany.
(2)Centre for Applied Health Science, Leuphana University, Lueneburg, Germany.
(3)Interdisciplinary Centre for Health Literacy Research, Bielefeld University, 
Germany.
(4)Nursing Science with focus on Clinical Nursing across the Lifespan, Trier 
University, Germany.

Early-on in the COVID-19 pandemic when universities were closed as part of the 
nation-wide public health response to the COVID-19 outbreak, studying and 
student life significantly changed. Based on limited evidence the aim of this 
study was to explore the relationship between sense of coherence (SoC), future 
worries and mental health outcomes among German university students during the 
early phase of the pandemic. A cross-sectional online survey with n = 14 916 
participants was carried out by inviting all private and public universities in 
Germany. All data were analysed using univariate, bivariate and multivariate 
statistics. Findings indicate a low and very low wellbeing for 38% of university 
students. Moreover, 29% reported being affected by at least two health 
complaints more than once week. Both health outcomes follow a social gradient 
and could be more frequently observed for respondents with lower subjective 
social status and female students. Regression analysis revealed significant 
association between the SoC dimensions and wellbeing (OR: 1.2-2.03) as well as 
health complaints (OR: 1.58-1.71). A high level of future worries was associated 
with low/very low wellbeing (OR: 2.83) and multiple health complaints (OR: 
2.84). Based on the results, the public health response to the pandemic and 
university health promotion should therefore consider student mental health as 
an important target within their policy and action frameworks.

© The Author(s) 2021. Published by Oxford University Press.

DOI: 10.1093/heapro/daab070
PMCID: PMC8851400
PMID: 34214156 [Indexed for MEDLINE]


3258. Afr J Prim Health Care Fam Med. 2021 Jun 30;13(1):e1-e6. doi: 
10.4102/phcfm.v13i1.2823.

Assessing COVID-19-related anxiety and functional impairment amongst nurses in 
Malawi.

Chorwe-Sungani G(1).

Author information:
(1)School of Nursing, Kamuzu University of Health Sciences, Blantyre. 
genesischorwe@kcn.unima.mw.

BACKGROUND: Psychological well-being of nurses is crucial for them to 
effectively discharge their duties. However, coronavirus disease 2019 
(COVID-19)-related anxiety can interfere with nurses' performance and reduce 
their self-efficacy.
AIM: The primary aim of this study was to assess COVID-19-related anxiety and 
functional impairment amongst nurses in Malawi. The secondary aim of the study 
was to determine reliability and validity of the Coronavirus Anxiety Scale.
SETTING: The study was conducted in Malawi.
METHODS: This was a cross-sectional study that collected quantitative data from 
102 nurses in Malawi online. Data were analysed using descriptive statistics and 
receiver operating curve analysis.
RESULTS: This study found that 25.5% (26) of respondents had COVID-19-related 
anxiety and 48% (49) functional impairment. There were significant differences 
in the numbers of respondents who had functional impairment in relation to 
workplace (Χ2 = 8.7, p = 0.03), with many of those working in hospitals (58.6%, 
n = 34) having highest levels (mean = 20.6 ± 10.4). The Coronavirus Anxiety 
Scale proved to be an effective instrument (Sensitivity = 73.1%; Specificity = 
60.5%; area under the curve = 0.73) for assessing COVID-19-related anxiety 
amongst nurses.
CONCLUSION: It is necessary to screen nurses for COVID-19-related anxiety and 
functional impairment and provide them effective psychosocial interventions. 
Policymakers should place more emphasis on allocation of financial resources to 
mental health services and staff support programmes targeting nurses during 
pandemics. There is a need to conduct future research on mental health 
interventions that might be used to assist nurses with COVID-19-related anxiety 
and functional impairment.

DOI: 10.4102/phcfm.v13i1.2823
PMCID: PMC8252172
PMID: 34212743 [Indexed for MEDLINE]

Conflict of interest statement: The author declares that he has no financial or 
personal relationships that may have inappropriately influenced him in the 
writing of this article.


3259. Acad Radiol. 2021 Sep;28(9):1209-1218. doi: 10.1016/j.acra.2021.05.025. Epub 
2021 Jun 8.

Interventional Radiology in the Coronavirus Disease 2019 Pandemic: Impact on 
Practices and Wellbeing.

Woerner A(1), Chick JFB(2), Monroe EJ(2), Ingraham CR(1), Pereira K(3), Lee 
E(4), Hage AN(5), Makary MS(6), Shin DS(7).

Author information:
(1)Department of Radiology, Section of Vascular and Interventional Radiology, 
University of Washington, Seattle, Washington 98195.
(2)Department of Radiology, Section of Vascular and Interventional Radiology, 
University of Washington, Seattle, Washington 98195; Department of Radiology, 
Section of Interventional Radiology, Seattle Children's Hospital, University of 
Washington, Seattle, Washington 98105.
(3)Department of Radiology, Division of Vascular Interventional Radiology, Saint 
Louis University Hospital, St. Louis, Missouri 63110.
(4)Department of Information and Statistics, Chungnam National University, 
Yuseong-gu, Daejeon, South Korea.
(5)Department of Radiology, Division of Vascular and Interventional Radiology, 
Thomas Jefferson Hospital, Philadelphia, Pennsylvania 19107.
(6)Department of Radiology, Division of Vascular and Interventional Radiology, 
The Ohio State University Wexner Medical Center, Columbus, Ohio 43210.
(7)Department of Radiology, Section of Vascular and Interventional Radiology, 
University of Washington, Seattle, Washington 98195. Electronic address: 
dsshin@uw.edu.

Comment in
    Acad Radiol. 2021 Dec;28(12):1824-1825.
    Acad Radiol. 2021 Nov;28(11):1641-1642.

PURPOSE: To report the impact of the coronavirus disease 2019 (COVID-19) 
pandemic on interventional radiology (IR).
MATERIALS AND METHODS: A 78-question survey was distributed to practicing 
interventional radiologists and IR trainees. The survey consisted of demographic 
and practice environment queries. Anxiety symptoms were evaluated using the 
Generalized Anxiety Disorder-7 (GAD-7) screener, and coping strategies were 
assessed using the Brief-Coping Orientation to Problems Experienced (Brief-COPE) 
questionnaire.
RESULTS: There were 422 respondents including 333 (78.9%) attending 
interventional radiologists and 89 (21.1%) interventional 
radiologists-in-training from 15 counties. Most respondents were from academic 
medical centers (n = 218; 51.7%). A large majority (n = 391; 92.7%) performed a 
procedure on a patient with confirmed COVID-19 infection. An N95 mask was the 
most common (n = 366; 93.6%) safety measure employed. Cancellation or limitation 
of elective procedures were reported by 276 (65.4%) respondents. Many 
respondents (n = 177; 41.9%) had self-reported anxiety (GAD-7 score >5) with an 
overall mean GAD-7 score of 4.64 ± 4.63 (range: 0-21). Factors associated with 
reporting anxiety included female gender (p = 0.045), increased call coverage 
(p = 0.048), lack of adequate departmental adjustments (p <0.0001), and lack of 
adjustments in a timely manner (p <0.0001). The most utilized coping strategy 
was acceptance (mean of 5.49 ± 1.88), while the most employed dysfunctional 
coping strategy was self-distraction (mean of 4.16 ± 1.67). The odds of 
reporting anxiety increased by >125% with adoption of dysfunctional strategies.
CONCLUSION: The COVID-19 pandemic induced practice alterations and high rates of 
self-reported anxiety in IR. Female gender, increased call coverage, and lack of 
adequate or timely departmental adjustments were associated with increased 
anxiety levels.

Copyright © 2021 The Association of University Radiologists. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.acra.2021.05.025
PMCID: PMC8185184
PMID: 34210612 [Indexed for MEDLINE]


3260. Sci Total Environ. 2021 Oct 1;789:148123. doi: 10.1016/j.scitotenv.2021.148123. 
Epub 2021 Jun 2.

Associations between COVID-19 transmission rates, park use, and landscape 
structure.

Johnson TF(1), Hordley LA(2), Greenwell MP(2), Evans LC(2).

Author information:
(1)Ecology and Evolutionary Biology, School of Biological Sciences, University 
of Reading, Reading, UK. Electronic address: 
Thomas.frederick.johnson@outlook.com.
(2)Ecology and Evolutionary Biology, School of Biological Sciences, University 
of Reading, Reading, UK.

The COVID-19 pandemic has had severe impacts on global public health. In 
England, social distancing measures and a nationwide lockdown were introduced to 
reduce the spread of the virus. Green space accessibility may have been 
particularly important during this lockdown, as it could have provided benefits 
for physical and mental wellbeing. However, the associations between public 
green space use and the rate of COVID-19 transmission are yet to be quantified, 
and as the size and accessibility of green spaces vary within England's local 
authorities, the risks and benefits to the public of using green space may be 
context-dependent. To evaluate how green space affected COVID-19 transmission 
across 299 local authorities (small regions) in England, we calculated a daily 
case rate metric, based upon a seven-day moving average, for each day within the 
period June 1st - November 30th 2020 and assessed how baseline health and 
mobility variables influenced these rates. Next, looking at the residual case 
rates, we investigated how landscape structure (e.g. area and patchiness of 
green space) and park use influenced transmission. We first show that reducing 
mobility is associated with a decline in case rates, especially in areas with 
high population clustering. After accounting for known mechanisms behind 
transmission rates, we found that park use (showing a preference for park 
mobility) was associated with decreased residual case rates, especially when 
green space was low and contiguous (not patchy). Our results support that a 
reduction in overall mobility may be a good strategy for reducing case rates, 
endorsing the success of lockdown measures. However, if mobility is necessary, 
outdoor park use may be safer than other forms of mobility and associated 
activities (e.g. shopping or office-based working).

Copyright © 2021 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.scitotenv.2021.148123
PMCID: PMC8170904
PMID: 34210524 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


3261. Dev Psychopathol. 2023 Feb;35(1):35-43. doi: 10.1017/S0954579421000766. Epub 
2021 Jul 2.

Prenatal maternal stress during the COVID-19 pandemic and infant regulatory 
capacity at 3 months: A longitudinal study.

Provenzi L(1), Grumi S(1), Altieri L(2), Bensi G(3), Bertazzoli E(4), Biasucci 
G(3), Cavallini A(5), Decembrino L(2), Falcone R(2), Freddi A(6), Gardella B(7), 
Giacchero R(4), Giorda R(8), Grossi E(3), Guerini P(2), Magnani ML(2), Martelli 
P(9), Motta M(9), Nacinovich R(5)(10), Pantaleo D(2), Pisoni C(7), Prefumo 
F(9)(11), Riva L(6), Scelsa B(6), Spartà MV(4), Spinillo A(7)(12), Vergani 
P(5)(13), Orcesi S(1)(12), Borgatti R(1)(12); MOM-COPE Study Group.

Author information:
(1)Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy.
(2)ASST Pavia, Pavia, Italy.
(3)Guglielmo da Saliceto Hospital, Piacenza, Italy.
(4)ASST Lodi, Lodi, Italy.
(5)San Gerardo Hospital, Monza, Italy.
(6)ASST Sacco Fatebenefratelli, Milano, Italy.
(7)Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
(8)Scientific Institute IRCCS E. Medea, Bosisio Parini, Italy.
(9)ASST Spedali Civili, Brescia, Italy.
(10)School of Medicine and Surgery and Milan Center for Neuroscience, University 
of Milano Bicocca, Milano, Italy.
(11)Department of Obstetrics and Gynaecology, University of Brescia, Brescia, 
Italy.
(12)Department of Brain and Behavioral Sciences, University of Pavia, Pavia, 
Italy.
(13)Fondazione MBBM, Monza, Italy.

The COVID-19 pandemic is a global traumatic experience for citizens, especially 
during sensitive time windows of heightened plasticity such as pregnancy and 
neonatal life. Pandemic-related stress experienced by mothers during pregnancy 
may act as an early risk factor for infants' regulatory capacity development by 
altering maternal psychosocial well-being (e.g., increased anxiety, reduced 
social support) and caregiving environment (e.g., greater parenting stress, 
impaired mother-infant bonding). The aim of the present longitudinal study was 
to assess the consequences of pandemic-related prenatal stress on infants' 
regulatory capacity. A sample of 163 mother-infant dyads was enrolled at eight 
maternity units in northern Italy. They provided complete data about prenatal 
stress, perceived social support, postnatal anxiety symptoms, parenting stress, 
mother-infant bonding, and infants' regulatory capacity at 3 months of age. 
Women who experienced emotional stress and received partial social support 
during pregnancy reported higher anxious symptoms. Moreover, maternal postnatal 
anxiety was indirectly linked to the infants' regulatory capacity at 3 months, 
mediated by parenting stress and mother-infant bonding. Dedicated preventive 
interventions should be delivered to mothers and should be focused on protecting 
the mother-infant dyad from the detrimental effects of pandemic-related stress 
during the COVID-19 healthcare emergency.

DOI: 10.1017/S0954579421000766
PMID: 34210369 [Indexed for MEDLINE]


3262. BMC Pregnancy Childbirth. 2021 Jul 1;21(1):473. doi: 10.1186/s12884-021-03904-4.

The perception of Italian pregnant women and new mothers about their 
psychological wellbeing, lifestyle, delivery, and neonatal management experience 
during the COVID-19 pandemic lockdown: a web-based survey.

Stampini V(1), Monzani A(2), Caristia S(3), Ferrante G(4), Gerbino M(5), De 
Pedrini A(6), Amadori R(6), Rabbone I(2), Surico D(5).

Author information:
(1)Obstetrics and Gynecology Unit, Department of Translational Medicine, 
University of Eastern Piedmont, Via Solaroli 17, 28100, Novara, Italy. 
Viviana.stampini@med.uniupo.it.
(2)Division of Pediatric, Department of Health Sciences, University of Eastern 
Piedmont, Novara, Italy.
(3)Department of Translational Medicine, University of Eastern Piedmont, Novara, 
Italy.
(4)CPO Piemonte, Turin, Italy.
(5)Obstetrics and Gynecology Unit, Department of Translational Medicine, 
University of Eastern Piedmont, Via Solaroli 17, 28100, Novara, Italy.
(6)Obstetrics and Gynecology Unit, Maggiore della Carità Hospital, Novara, 
Italy.

BACKGROUND: In response to the COVID-19 pandemic, drastic measures for social 
distancing have been introduced also in Italy, likely with a substantial impact 
in delicate conditions like pregnancy and puerperium. The study aimed to 
investigate the changes in lifestyle, access to health services, and mental 
wellbeing during the first Italian lockdown in a sample of Italian pregnant 
women and new mothers.
METHODS: We carried out a web-based survey to evaluate how pregnant women and 
new mothers were coping with the lockdown. We collected data about healthy 
habits (physical exercise and dietary habits), access to health services (care 
access, delivery and obstetric care, neonatal care, and breastfeeding), and 
mental wellbeing (psychological well-being and emotive support). Descriptive 
analysis was performed for both groups of participants, whereas a Poisson 
analysis was used to measure the association between some structural variables 
(age, education, socio-economic data, partner support, contact, free time, 
previous children, and pregnancy trimester) and anxiety or depression, 
difficulties in healthy eating and reduction in physical activity after lockdown 
started. Chi2 and Adjusted Prevalence Ratios were estimated only for pregnant 
women.
RESULTS: We included 739 respondents (response rate 85.8 %), 600 were pregnant 
(81.2 %), and 139 (18.8 %) had delivered during lockdown (new mothers). We found 
a high score for anxiety and depression in 62.8 % of pregnant women and 61.9 % 
of new mothers. During the lockdown, 61.8 % of pregnant women reduced their 
physical exercise, and 44.3 % reported eating in a healthier way. 94.0 % of new 
mothers reported to have breastfed their babies during the hospital stay. 
Regarding the perceived impact of restrictive measures on breastfeeding, no 
impact was reported by 56.1 % of new mothers, whereas a negative one by 36.7 %.
CONCLUSIONS: The high prevalence of anxiety and depressive symptoms in pregnant 
women and new mothers should be a public health issue. Clinicians might also 
recommend and encourage "home" physical exercise. On the other hand, about half 
of the sample improved their approach towards healthy eating and a very high 
breastfeeding rate was reported soon after birth: these data are an interesting 
starting point to develop new strategies for public health.

DOI: 10.1186/s12884-021-03904-4
PMCID: PMC8246432
PMID: 34210276 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3263. Int J Environ Res Public Health. 2021 Jun 29;18(13):6958. doi: 
10.3390/ijerph18136958.

Can Positive Mindsets Be Protective Against Stress and Isolation Experienced 
during the COVID-19 Pandemic? A Mixed Methods Approach to Understanding 
Emotional Health and Wellbeing Needs of Perinatal Women.

Davis JA(1)(2)(3), Gibson LY(1)(2)(4), Bear NL(5), Finlay-Jones AL(1)(2), Ohan 
JL(1)(2), Silva DT(1)(2)(3)(4)(6), Prescott SL(1)(2)(3)(4)(5)(7).

Author information:
(1)Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA 6009, Australia.
(2)School of Medicine, The University of Western Australia, Perth, WA 6009, 
Australia.
(3)School of Public Health, Curtin University, Bentley, WA 6102, Australia.
(4)School of Medical and Health Sciences, Edith Cowan University, Perth, WA 
6027, Australia.
(5)Institute for Health Research, Notre Dame University, Fremantle, WA 6160, 
Australia.
(6)Joondalup Health Campus, Joondalup, WA 6027, Australia.
(7)inVIVO Planetary Health, Worldwide Universities Network (WUN), West New York, 
NJ 10704, USA.

The aim of this study was to explore the relationship between emotional health 
and wellbeing and support needs of perinatal women during the COVID-19 pandemic, 
and to understand their experiences and need for support. This is a potentially 
vulnerable group and a critical developmental phase for women and infants. A 
mixed methods design was used to collect quantitative and qualitative data that 
provided a robust insight into their unique needs. A total of 174 women who were 
either pregnant or post-birth participated. The main findings demonstrated that 
women in this cohort experienced varying levels of stress and isolation but also 
positive experiences. Exploring the relationship between mental health 
(perceived stress and wellbeing) and resilience (mindfulness and 
self-compassion) revealed an association between positive mental health and 
higher levels of mindfulness and self-compassion. Positive mindsets may be 
protective against psychological distress for the mother and her child, 
suggesting that meditation-based or similar training might help support 
expectant and post-birth mothers during times of crisis, such as a pandemic. 
This information could be used to make recommendations for future planning for 
practitioners and policymakers in preparing for prospective infection waves, 
pandemics, or natural disasters, and could be used to develop targeted tools, 
support, and care.

DOI: 10.3390/ijerph18136958
PMCID: PMC8297209
PMID: 34209693 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3264. Int J Environ Res Public Health. 2021 Jun 30;18(13):7010. doi: 
10.3390/ijerph18137010.

The Role of a Mentorship Program on the Relationship between Neglect and 
Depression among Adolescents in Low-Income Families.

Lee J(1), Allen J(2), Lim H(3), Choi G(4), Jung J(5).

Author information:
(1)Department of Social Welfare, Inha University, Incheon 22212, Korea.
(2)School of Social Work, Michigan State University, East Lansing, MI 48823, 
USA.
(3)School of Education, Korea University, Seoul 02841, Korea.
(4)Integrative Arts Therapy, Dongduk Women's University, Seoul 02748, Korea.
(5)Korea Development Bank Foundation, Seoul 07242, Korea.

This study examines the moderating effect of a mentorship program on the 
relationship between parental neglect and depression among adolescents from 
low-income households since COVID-19. A total of 264 participants from all 
provinces in South Korea were registered for a mentorship program provided by 
the Korea Development Bank [KDB] Foundation, which is a charitable and 
non-profit organization. Two-hundred fifty-five middle and high school students 
from low-income families were included in the final sample. The mentorship 
program was provided to students based on mentors' advice and feedback. A 
bootstrap method using the PROCESS macro 3.4 for SPSS was utilized to examine 
the moderating effect of satisfaction with the mentorship program. Neglect was 
positively related to depression among low-income students. Satisfaction with 
the mentorship program moderated the relationship between low-income students' 
neglect and depression. Visits from social workers or other advocates or 
volunteers to low-income families with children may be helpful to address 
depression among low-income students. High quality mentorship programs should be 
provided to more low-income students for their mental health, funded 
particularly in the context of corporate social responsibility. Particularly 
since the COVID-19 pandemic, financial contributions by corporations would be 
valuable to reconstruct the damage to quality of life and psychological 
well-being among low-income adolescents.

DOI: 10.3390/ijerph18137010
PMCID: PMC8296860
PMID: 34209069 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3265. Int J Environ Res Public Health. 2021 Jun 18;18(12):6579. doi: 
10.3390/ijerph18126579.

Hopelessness and Post-Traumatic Stress Symptoms among Healthcare Workers during 
the COVID-19 Pandemic: Any Role for Mediating Variables?

Aguglia A(1)(2), Amerio A(1)(2), Costanza A(3), Parodi N(1)(2), Copello F(2), 
Serafini G(1)(2), Amore M(1)(2).

Author information:
(1)Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal 
and Child Health, Section of Psychiatry, University of Genoa, Largo Paolo Daneo, 
3, 16132 Genoa, Italy.
(2)IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132 Genoa, 
Italy.
(3)Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), 
1206 Geneva, Switzerland.

The Coronavirus-19 (COVID-19) pandemic has many psychological consequences for 
the population, ranging from anxious-depressive symptoms and insomnia to complex 
post-traumatic syndromes. This study aimed to evaluate the impact of the 
Covid-19 pandemic on the mental well-being of healthcare workers, focusing on 
the association between hopelessness, death anxiety, and post-traumatic 
symptomatology. Eight hundred forty-two healthcare workers were recruited 
between 21 March 2020 and 15 May 2020. A specific questionnaire was administered 
to assess socio-demographic and clinical characteristics, together with 
psychometric scales: Beck Hopelessness Scale, Death Anxiety Scale (DAS), and 
Davidson Trauma Scale (DTS). Respondents with hopelessness scored higher in the 
DAS and DTS than respondents without hopelessness. Furthermore, death anxiety 
was identified as a potential mediator of the significant association between 
hopelessness and post-traumatic symptomatology. The impact of death anxiety 
should be recognized in vulnerable populations, such as frontline healthcare 
workers. Therefore, pharmacological and non-pharmacological strategies could be 
useful to attenuate the negative psychological consequences and reduce the 
burden worldwide.

DOI: 10.3390/ijerph18126579
PMCID: PMC8296351
PMID: 34207303 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3266. Int J Environ Res Public Health. 2021 Jun 22;18(13):6730. doi: 
10.3390/ijerph18136730.

Identifying Predictors of University Students' Wellbeing during the COVID-19 
Pandemic-A Data-Driven Approach.

Liu C(1), McCabe M(1), Dawson A(1), Cyrzon C(1), Shankar S(1), Gerges N(1), 
Kellett-Renzella S(1), Chye Y(1), Cornish K(1).

Author information:
(1)School of Psychological Sciences, Turner Institute for Brain and Mental 
Health, Monash University, Clayton, VIC 3800, Australia.

BACKGROUND: The COVID-19 pandemic has posed risks to public mental health 
worldwide. University students, who are already recognised as a vulnerable 
population, are at elevated risk of mental health issues given COVID-19-related 
disruptions to higher education. To assist universities in effectively 
allocating resources to the launch of targeted, population-level interventions, 
the current study aimed to uncover predictors of university students' 
psychological wellbeing during the pandemic via a data-driven approach.
METHODS: Data were collected from 3973 Australian university students ((median 
age = 22, aged from 18 to 79); 70.6% female)) at five time points during 2020. 
Feature selection was conducted via least absolute shrinkage and selection 
operator (LASSO) to identify predictors from a comprehensive set of variables. 
Selected variables were then entered into an ordinary least squares (OLS) model 
to compare coefficients and assess statistical significance.
RESULTS: Six negative predictors of university students' psychological wellbeing 
emerged: White/European ethnicity, restriction stress, perceived worry on mental 
health, dietary changes, perceived sufficiency of distancing communication, and 
social isolation. Physical health status, emotional support, and resilience were 
positively associated with students' psychological wellbeing. Social isolation 
has the largest effect on students' psychological wellbeing. Notably, age, 
gender, international status, and educational level did not emerge as predictors 
of wellbeing.
CONCLUSION: To cost-effectively support student wellbeing through 2021 and 
beyond, universities should consider investing in internet- and tele- based 
interventions explicitly targeting perceived social isolation among students. 
Course-based online forums as well as internet- and tele-based logotherapy may 
be promising candidates for improving students' psychological wellbeing.

DOI: 10.3390/ijerph18136730
PMCID: PMC8296899
PMID: 34206579 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3267. Int J Environ Res Public Health. 2021 Jun 19;18(12):6611. doi: 
10.3390/ijerph18126611.

Psychological Stress among Students in Health-Related Fields during the COVID-19 
Pandemic: Results of a Cross-Sectional Study at Selected Munich Universities.

Schröpfer K(1)(2), Schmidt N(3)(4), Kus S(1)(2), Koob C(5), Coenen M(1)(2).

Author information:
(1)Institute for Medical Information Processing, Biometry, and Epidemiology-IBE, 
Chair of Public Health and Health Services Research, LMU Munich, 81377 Munich, 
Germany.
(2)Pettenkofer School of Public Health, 81377 Munich, Germany.
(3)Department of Social Work, Catholic University of Applied Sciences, 81667 
Munich, Germany.
(4)Gynecology Division, Department of Pediatrics, Obstetrics and Gynecology, 
University Hospitals of Geneva, 1205 Genève, Switzerland.
(5)Department of Health and Nursing, Catholic University of Applied Sciences, 
81667 Munich, Germany.

The COVID-19 pandemic has been a challenging period of upheaval for higher 
education students. This study aims to assess the factors associated with 
psychological stress during the COVID-19 pandemic among a sample of students in 
health-related fields at Munich universities in Germany. Students (n = 623) from 
KSH Munich and LMU Munich completed an online cross-sectional survey. 
Information on demographics and academic and everyday difficulties due to the 
COVID-19 pandemic as well as data on physical and mental health were collected. 
Multivariable logistic regression analyses were performed to identify factors 
associated with the outcome. The prevalence for higher psychological stress was 
44% among the study population. Factors associated with higher psychological 
stress were: lower overall life satisfaction (p < 0.0001), worsened health 
situation (p < 0.0001), lack of social support (p = 0.0301) and social 
interaction (p = 0.0115), worries about financial difficulties due to loss of 
income (p = 0.0134), stressful thoughts about a second wave (p < 0.0001), 
feeling unable to positively influence the situation (p = 0.0262) and 
study-related effects, such as perceived study burden (p = 0.0003) and likely 
delay in studies (p = 0.0178)). The COVID-19 pandemic is having a significant 
negative impact on the mental health of students in health-related fields. 
Proactive efforts to support the mental health and well-being of students are 
needed.

DOI: 10.3390/ijerph18126611
PMCID: PMC8296436
PMID: 34205383 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3268. Int J Environ Res Public Health. 2021 Jun 6;18(11):6118. doi: 
10.3390/ijerph18116118.

Hemodynamic Response to Three Types of Urban Spaces before and after Lockdown 
during the COVID-19 Pandemic.

Olszewska-Guizzo A(1)(2), Mukoyama A(3), Naganawa S(3), Dan I(3), Husain SF(4), 
Ho CS(4), Ho R(1)(4).

Author information:
(1)Institute for Health Innovation & Technology (iHealthtech) MD6, 14 Medical 
Drive, #14-01, Singapore 117599, Singapore.
(2)NeuroLandscape Foundation, Suwalska 8/78, 03-252 Warsaw, Poland.
(3)Applied Cognitive Neuroscience Laboratory, Chuo University, 1-13-27 Kasuga, 
Bunkyo-ku, Tokyo 112-8551, Japan.
(4)Department of Psychological Medicine, Yong Loo Lin School of Medicine, 
National University of Singapore, NUHS Tower Block, Level 9, 1E Kent Ridge Road, 
Singapore 119228, Singapore.

(1) Background: Prolonged lockdowns with stay-at-home orders have been 
introduced in many countries since the outbreak of the COVID-19 pandemic. They 
have caused a drastic change in the everyday lives of people living in urbanized 
areas, and are considered to contribute to a modified perception of the public 
space. As research related to the impact of COVID-19 restrictions on mental 
health and well-being emerges, the associated longitudinal changes of brain 
hemodynamics in healthy adults remain largely unknown. (2) Methods: this study 
examined the hemodynamic activation patterns of the prefrontal and occipital 
cortices of 12 participants (5 male, Mage = 47.80, SDage = 17.79, range 25 to 
74, and 7 female, Mage = 39.00, SDage = 18.18, range 21 to 65) passively viewing 
videos from three urban sites in Singapore (Urban Park, Neighborhood Landscape 
and City Center) at two different time points-T1, before the COVID-19 pandemic 
and T2, soon after the lockdown was over. (3) Results: We observed a significant 
and marginally significant decrease in average oxyhemoglobin (Oxy-Hb) over time 
for each of the visual conditions. For both green spaces (Urban Park and 
Neighborhood Landscape), the decrease was in the visual cortex, while for the 
City Center with no green elements, the marginal decrease was observed in the 
visual cortex and the frontal eye fields. (4) Conclusions: The results suggest 
that the COVID-19-related lockdown experienced by urban inhabitants may have 
contributed to decreased brain hemodynamics, which are further related to a 
heightened risk of mental health disorders, such as depression or a decline in 
cognitive functions. Moreover, the busy City Center scenes induced a hemodynamic 
pattern associated with stress and anxiety, while urban green spaces did not 
cause such an effect. Urban green scenes can be an important factor to offset 
the negative neuropsychological impact of busy urban environments post-pandemic.

DOI: 10.3390/ijerph18116118
PMCID: PMC8200979
PMID: 34204034 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3269. Int J Environ Res Public Health. 2021 Jun 28;18(13):6939. doi: 
10.3390/ijerph18136939.

Psychological Support Interventions for Healthcare Providers and Informal 
Caregivers during the COVID-19 Pandemic: A Systematic Review of the Literature.

Bertuzzi V(1), Semonella M(2), Bruno D(1), Manna C(1), Edbrook-Childs J(3), 
Giusti EM(1)(4), Castelnuovo G(1)(4), Pietrabissa G(1)(4).

Author information:
(1)Department of Psychology, Catholic University of Milan, 20123 Milan, Italy.
(2)Department of Psychology, Bar-Ilan University, Ramat-Gan 52900, Israel.
(3)Evidence-Based Practices Unit, University College London and Anna Freud 
National Centre for Children and Families, London N1 6EB, UK.
(4)Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, 20145 
Milan, Italy.

BACKGROUND: During the COVID-19 pandemic, healthcare providers and informal 
caregivers were at an increased risk of adverse mental health effects. This 
systematic review provides a summary of the available evidence on the content 
and efficacy of the psychological support interventions in increasing mental 
health among healthcare providers and informal caregivers during the COVID-19 
pandemic.
METHODS: PubMed, Google Scholar, PsychINFO, and Scopus databases were 
systematically searched for relevant articles, and the methodological quality of 
selected articles was assessed using the Quality Assessment Tool for 
Quantitative Studies.
RESULTS: A search of electronic databases identified five reports based on 
inclusion and exclusion criteria. All psychological support interventions for 
caregivers were delivered digitally. Despite the large heterogeneity of the 
selected studies, the findings support the efficacy of mental health 
interventions in reducing distress and burnout, while promoting self-efficacy 
and well-being in both healthcare providers and informal caregivers.
CONCLUSION: Since mental health problems are expected to increase during, and as 
a result of, the COVID-19 pandemic, and digital tools might offer a range of 
mental health treatments to meet the unique and immediate needs of people, 
further research is needed to test the cost-effectiveness of digital 
psychological interventions.

DOI: 10.3390/ijerph18136939
PMCID: PMC8297206
PMID: 34203529 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3270. Int J Environ Res Public Health. 2021 Jun 24;18(13):6792. doi: 
10.3390/ijerph18136792.

Impact of COVID-19 on Medicine Lecturers' Mental Health and Emergency Remote 
Teaching Challenges.

Miguel C(1), Castro L(2)(3)(4), Marques Dos Santos JP(5)(6), Serrão C(7), Duarte 
I(2)(3).

Author information:
(1)Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal.
(2)Department of Community Medicine, Information and Decision in Health 
(MEDCIS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal.
(3)Centre for Health Technology and Services Research (CINTESIS), Faculty of 
Medicine, University of Porto, 4200-319 Porto, Portugal.
(4)School of Health, Polytechnic of Porto, 4400-330 Vila Nova de Gaia, Portugal.
(5)Department of Biomedicine, Faculty of Medicine, University of Porto, 4200-319 
Porto, Portugal.
(6)University Institute of Maia, 4475-690 Maia, Portugal.
(7)Centre for Research and Innovation in Education (inED), Porto Polytechnic 
School of Education, 4200-465 Porto, Portugal.

COVID-19 has presented a novel pedagogical challenge in dealing with the sudden 
shift from classic instruction to emergency remote teaching (ERT). It had an 
impact on the well-being and mental health of lecturers, increasing burnout 
risk. A cross-sectional, quantitative, qualitative and analytical online study 
was conducted to collect participants' sociodemographic data, responses to ERT 
open-ended questions and mental health assessments using relevant instruments 
(CBI for burnout, Resilience Scale, DASS for depression, anxiety and stress, 
SWLS for satisfaction with life). High personal burnout levels were found in 
41.2% of participants, high work-related burnout in 37.3% and high 
student-related burnout in 15.7%. Satisfaction with life, sleep routine changes 
and stress were determinants for personal burnout; stress and resilience for 
work-related burnout; satisfaction of life and sleep routine changes for 
students-related burnout. Opportunities for pedagogical innovation were pointed 
out as the main advantages to ERT, while the main negative impacts were on 
practical lessons and social interaction. Students and lecturers' safety and 
adequate institutional support might be insured, considering their expectations 
and needs, promoting mental health. Combining the advantages of online and 
traditional methods in a so-called "blended learning" approach, with close 
collaboration and communication between all those involved, appears to achieve 
better results.

DOI: 10.3390/ijerph18136792
PMCID: PMC8297013
PMID: 34202692 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3271. Int J Environ Res Public Health. 2021 Jun 8;18(12):6212. doi: 
10.3390/ijerph18126212.

"How Come You Don't Call Me?" Smartphone Communication App Usage as an Indicator 
of Loneliness and Social Well-Being across the Adult Lifespan during the 
COVID-19 Pandemic.

Wetzel B(1), Pryss R(2), Baumeister H(3), Edler JS(1), Gonçalves ASO(4), Cohrdes 
C(1).

Author information:
(1)Mental Health Research Unit, Department of Epidemiology and Health 
Monitoring, Robert Koch Institute, 12101 Berlin, Germany.
(2)Institute of Clinical Epidemiology and Biometry, 
Julius-Maximilians-University of Würzburg, 97080 Würzburg, Germany.
(3)Department of Clinical Psychology and Psychotherapy, Ulm University, 89081 
Ulm, Germany.
(4)Institute of Public Health, Charité-Universitätsmedizin Berlin, 10117 Berlin, 
Germany.

Loneliness and lack of social well-being are associated with adverse health 
outcomes and have increased during the COVID-19 pandemic. Smartphone 
communication data have been suggested to help monitor loneliness, but this 
requires further evidence. We investigated the informative value of smartphone 
communication app data for predicting subjective loneliness and social 
well-being in a sample of 364 participants ranging from 18 to 78 years of age 
(52.2% female; mean age = 42.54, SD = 13.22) derived from the CORONA HEALTH APP 
study from July to December 2020 in Germany. The participants experienced 
relatively high levels of loneliness and low social well-being during the time 
period characterized by the COVID-19 pandemic. Apart from positive associations 
with phone call use times, smartphone communication app use was associated with 
social well-being and loneliness only when considering the age of participants. 
Younger participants with higher use times tended to report less social 
well-being and higher loneliness, while the opposite association was found for 
older adults. Thus, the informative value of smartphone communication use time 
was rather small and became evident only in consideration of age. The results 
highlight the need for further investigations and the need to address several 
limitations in order to draw conclusions at the population level.

DOI: 10.3390/ijerph18126212
PMCID: PMC8227237
PMID: 34201322 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3272. Int J Environ Res Public Health. 2021 Jun 8;18(12):6190. doi: 
10.3390/ijerph18126190.

Confinement Situation of the Spanish Population during the Health Crisis of 
COVID-19: Resilience Mediation Process in the Relationship of Dispositional 
Optimism and Psychological Well-Being.

Zayas A(1), Merchán-Clavellino A(1), López-Sánchez JA(2), Guil R(1).

Author information:
(1)Departamento de Psicología, Instituto Universitario de Investigación para el 
Desarrollo Social y Sostenible (INDESS), Campus Universitario de Jerez, Avda. de 
la Universidad s/n., Universidad de Cádiz, 11405 Cádiz, Spain.
(2)Departamento de Historia, Geografía y Filosofía, Instituto Universitario de 
Investigación para el Desarrollo Social y Sostenible (INDESS), Campus 
Universitario de Jerez, Avda. de la Universidad s/n., Universidad de Cádiz, 
11405 Cádiz, Spain.

The pandemic generated by COVID-19 is one of the most complex challenges 
humanity has faced in recent years. This study aims to explore the levels of 
dispositional optimism, resilience and psychological well-being in the 
sociodemographic and economic situation produced during the state of alarm and 
to investigate the resilience mediation between optimism and psychological 
well-being. The sample included 566 volunteers from Spain (73.5% women; M = 40.2 
years, SD = 12.8). An ad hoc questionnaire was applied to request socioeconomic 
data and dispositional optimism (LOT-R). Resilience and psychological well-being 
were, respectively, evaluated by the Ryff scale and the Wagnild and Young scale. 
The results show that older and people with higher educational levels are more 
optimistic and have better psychological well-being. Well-being is also greater 
in married, divorced and widowed people and in those who have lived in outdoor 
spaces. However, those with spaced housing were more optimistic. Finally, it was 
found that the most optimistic people have better psychological well-being and 
that this is increased by the mediation process exercised by the ability to 
overcome adversity, provided age and educational level are controlled. It can be 
concluded that the design of preventive programs focused on improving strengths, 
positive emotions and skills in the population would be convenient to protect 
mental health.

DOI: 10.3390/ijerph18126190
PMCID: PMC8228093
PMID: 34201074 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3273. Int J Environ Res Public Health. 2021 Jun 10;18(12):6289. doi: 
10.3390/ijerph18126289.

Sources of Sleep Disturbances and Psychological Strain for Hospital Staff 
Working during the COVID-19 Pandemic.

Abdoli N(1), Farnia V(1), Jahangiri S(1), Radmehr F(2), Alikhani M(1), Abdoli 
P(1), Davarinejad O(2), Dürsteler KM(3)(4), Brühl AB(5), Sadeghi-Bahmani 
D(1)(5)(6)(7), Brand S(1)(5)(6)(8)(9).

Author information:
(1)Substance Abuse Prevention Research Center, Health Institute, Kermanshah 
University of Medical Sciences, Kermanshah 6719851115, Iran.
(2)Clinical Research Development Center, Imam Khomeini and Mohammad Kermanshahi 
and Farabi Hospitals, Kermanshah University of Medical Sciences, Kermanshah 
6719851451, Iran.
(3)Psychiatric Clinics, Division of Substance Use Disorders, University of 
Basel, 4002 Basel, Switzerland.
(4)Center for Addictive Disorders, Department of Psychiatry, Psychotherapy and 
Psychosomatics, Psychiatric Hospital, University of Zurich, 8001 Zurich, 
Switzerland.
(5)Center for Affective, Stress and Sleep Disorders (ZASS), Psychiatric 
University Hospital Basel, 4002 Basel, Switzerland.
(6)Sleep Disorders Research Center, Kermanshah University of Medical Sciences, 
Kermanshah 6719851451, Iran.
(7)Departments of Physical Therapy, University of Alabama at Birmingham, 
Birmingham, AL 35209, USA.
(8)Department of Sport, Exercise and Health, Division of Sport Science and 
Psychosocial Health, University of Basel, 4052 Basel, Switzerland.
(9)School of Medicine, Tehran University of Medical Sciences, Tehran 1417466191, 
Iran.

Hospital staff members reported increased stress-related workload when caring 
for inpatients with COVID-19 ("frontline hospital staff members"). Here, we 
tested if depression, anxiety, and stress were associated with poor sleep and 
lower general health, and if social support mediated these associations. 
Furthermore, we compared current insomnia scores and general health scores with 
normative data. A total of 321 full-time frontline hospital staff members (mean 
age: 36.86; 58% females) took part in the study during the COVID-19 pandemic. 
They completed a series of questionnaires covering demographic and work-related 
information, symptoms of depression, anxiety, stress, social support, 
self-efficacy, and symptoms of insomnia and general health. Higher symptoms of 
depression, anxiety, and stress were associated with higher symptoms of insomnia 
and lower general health. Higher scores of depression, anxiety, and stress 
directly predicted higher insomnia scores and lower general health scores, while 
the indirect effect of social support was modest. Compared to normative data, 
full-time frontline hospital staff members had a 3.14 higher chance to complain 
about insomnia and a significantly lower general health. Symptoms of insomnia 
and general health were unrelated to age, job experience, educational level, and 
gender. Given this background, it appears that the working context had a lower 
impact on individuals' well-being compared to individual characteristics.

DOI: 10.3390/ijerph18126289
PMCID: PMC8296056
PMID: 34200708 [Indexed for MEDLINE]

Conflict of interest statement: All authors declare no conflicts of interest.


3274. Int J Environ Res Public Health. 2021 Jun 10;18(12):6280. doi: 
10.3390/ijerph18126280.

The Role of Adolescents' Personal and Social Resources in Achieving Desired 
Emotional and Behavioral Outcomes during an Anxiety-Provoking Pandemic Outbreak.

Bukchin-Peles S(1), Ronen T(1).

Author information:
(1)Department of Social Science, Tel-Aviv University, Tel-Aviv 69978, Israel.

Considering adolescents' developmentally driven stressors and social needs, they 
may be particularly vulnerable to the anxiety associated with the public health 
and economic crises due to the COVID-19 pandemic. Furthermore, they may have 
difficulty following the mandated contagion prevention directives. The current 
study focused on the role of adolescents' positive personal resources 
(self-control, hope) and environmental resources (peer support) in two desired 
outcomes during the COVID-19 outbreak: wellbeing (i.e., maintaining/increasing 
positivity ratio) and contagion prevention behaviors (i.e., increasing 
handwashing). Path analysis was conducted using online survey data collected 
from a representative sample of 651 Israeli adolescents (ages 13-17). Positive 
resources were found to be both positively intercorrelated and negatively 
correlated with pandemic-related anxiety and positively with increased 
handwashing. Self-control correlated positively with social support, which, in 
turn, correlated positively with the positivity ratio (i.e., more positive than 
negative affects) and pandemic-related anxiety. Self-control and 
pandemic-related anxiety both correlated positively with increased prevention 
behavior. This study highlights the vital role of positive resources in 
achieving desired psychological and behavioral outcomes for adolescents during 
the anxiety-provoking pandemic. Beyond its theoretical innovation, this study 
offers practical value by focusing on malleable variables that could be the 
focus of dedicated interventions.

DOI: 10.3390/ijerph18126280
PMCID: PMC8296054
PMID: 34200652 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


3275. Int J Environ Res Public Health. 2021 Jun 4;18(11):6067. doi: 
10.3390/ijerph18116067.

Psychological Impact of the COVID-19 Outbreak on Mental Health Outcomes among 
Youth: A Rapid Narrative Review.

Cielo F(1)(2), Ulberg R(3)(4), Di Giacomo D(1)(2).

Author information:
(1)Department of Life, Health and Environmental Sciences, University of 
L'Aquila, 67100 L'Aquila, Italy.
(2)Postgraduate School on Clinical Psychology, University of L'Aquila, 67100 
L'Aquila, Italy.
(3)Division of Mental Health Addiction, University of Oslo, 0319 Oslo, Norway.
(4)Department of Psychiatry, Diakonhjemmet Hospital, 0319 Oslo, Norway.

The coronavirus disease (COVID-19) outbreak has affected not only physical 
health but also mental health and psychological wellbeing. This narrative review 
aimed to map the literature on the psychological impact on the young generation 
of the COVID-19 pandemic, social restrictions, and extraordinary measures to 
curb the spread of coronavirus. We performed a systematic search of MEDLINE 
through PubMed and Web of Science [Science Citation Index Expanded, 
SCI-EXPANDED), Social Sciences Citation Index (SSCI), and Emerging Sources 
Citation Index (ESCI)] of all scientific literature published from May 2020 
until 15 March 2021. Based on inclusion and exclusion criteria, a total of 15 
articles were included. We conducted a narrative review. The reviewed articles 
suggested the impact of the pandemic and lockdown measures on young persons for 
several mental symptoms as well as anxiety, stress, depression, event-specific 
distress, decrease in psychological wellbeing, and changes in sleep habits. 
Psychological symptoms were related to the experience of several stressors, such 
as risk for reduction of academic perspectives, massive e-learning adoption, 
economic issues, social restrictions, and implications for daily life related to 
the COVID-19 outbreak. This narrative review points out the negative 
psychological impact of the pandemic outbreak and the high vulnerability of the 
young in the development of psychological distress, highlighting the relevant 
focus on the mental health of young people during the pandemic and the need for 
structured and tailored psychological support and interventions focused to the 
improvement of Quality of Life of university students after the pandemic 
experience.

DOI: 10.3390/ijerph18116067
PMCID: PMC8200066
PMID: 34199896 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3276. Int J Environ Res Public Health. 2021 Jun 5;18(11):6101. doi: 
10.3390/ijerph18116101.

The Mental Well-Being of Health Care Workers during the Peak of the COVID-19 
Pandemic-A Nationwide Study in Poland.

Babicki M(1), Szewczykowska I(2), Mastalerz-Migas A(1).

Author information:
(1)Department of Family Medicine, Wroclaw Medical University, 51-141 Wroclaw, 
Poland.
(2)Intensive Care Unit, Wroclaw Medical University, Borowska Street 213, 50-556 
Wroclaw, Poland.

INTRODUCTION: The current epidemiological situation has quickly led to several 
changes in the daily functioning of people around the world, especially among 
medical personnel, who in this difficult period were burdened with new 
professional duties, which significantly affects their mental health.
MATERIALS: This study aims to assess the mental health of health professionals 
at a critical point in their workload, to compare the results with those the 
general population, and to explore the potential determinants affecting it. The 
CAWI survey includes a sociodemographic section, work experience and a 
standardised psychometric tool (GHQ-28). Data were collected during the second 
wave of the COVID-19 pandemic in Poland (3-29 November 2020), which had the 
highest mortality rates and SARS-CoV-2 morbidity rates, as well as during the 
period of a significant increase in deaths, compared to the corresponding 
pre-pandemic period.
RESULTS: A total of 2150 surveys were eligible for analysis. Among them, 848 
(39.4%) were active health professionals. In the analysis of the scores of the 
GHQ-28 scale and its sub-scales, evaluating anxiety/insomnia and somatic 
symptoms, medical workers scored significantly higher scores than non-medical 
professions (p < 0.001). Frontline medical workers (p < 0.001) and those who 
were forcibly seconded to work with COVID-19-infected patients (p = 0.011) 
achieved significantly higher GHQ-28 scores.
CONCLUSIONS: The COVID-19 pandemic has had a significant impact on mental 
deterioration among health professionals, especially among those directly 
working with SARS-CoV-2-infected patients and those who were forcibly seconded 
to work with such patients. To mitigate the effects of the pandemic, appropriate 
psychological care for medical personnel needs to be implemented.

DOI: 10.3390/ijerph18116101
PMCID: PMC8200963
PMID: 34198833 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3277. PLoS One. 2021 Jul 1;16(7):e0254074. doi: 10.1371/journal.pone.0254074. 
eCollection 2021.

COVID-19 and mental well-being of nurses in a tertiary facility in Kenya.

Ali SK(1), Shah J(1), Talib Z(2).

Author information:
(1)Department of Medicine, Aga Khan University Hospital, Nairobi, Kenya.
(2)Department of Medical Education, California University of Science and 
Medicine, Colton, California, United States of America.

BACKGROUND: The 2019 coronavirus disease (COVID-19) epidemic is a global health 
emergency which has been shown to pose a great challenge to mental health, 
well-being and resilience of healthcare workers, especially nurses. Little is 
known on the impact of COVID-19 among nurses in sub-Saharan Africa.
METHODS: A cross sectional study was carried out between August and November 
2020 among nurses recruited from the Aga Khan University Hospital, Nairobi. The 
survey questionnaire consisted of six components- demographic and work title 
characteristics, information regarding care of COVID-19 patients, symptoms of 
depression, anxiety, insomnia, distress and burnout, measured using standardized 
questionnaires. Multivariable logistic regression analysis was performed to 
identify factors associated with mental health disorders.
RESULTS: Of 255 nurses, 171 (67.1%) consented to complete the survey. The median 
age of the participants was 33.47 years, 70.2% were females and 60.8% were 
married. More than half, 64.9% were frontline workers directly engaged in 
COVID-19 care. Only 1.8% reported a prior history or diagnosis of any mental 
health disorder. Depression, anxiety, insomnia, distress, and burnout were 
reported in 45.9%, 48.2%, 37.0%, 28.8% and 47.9% of all nurses. Frontline nurses 
reported experiencing more moderate to severe symptoms of depression, distress 
and burnout. Furthermore, females reported more burnout as compared to males. 
Multivariate logistic regression analysis showed that after adjustment, working 
in the frontlines was an independent risk variable for depression and burnout.
CONCLUSION: This is one of the few studies looking at mental health outcomes 
among nurses during the COVID-19 pandemic in Kenya. Similar to other studies 
from around the world, nurses directly involved with COVID-19 patients reported 
higher rates of mental health symptoms. Burnout threatens to exacerbate the 
pre-existing severe nursing workforce shortage in low-resource settings. 
Cost-effective and feasible mitigating strategies, geared to low-middle income 
countries, are urgently needed to help cope with mental health symptoms during 
such a pandemic.

DOI: 10.1371/journal.pone.0254074
PMCID: PMC8248721
PMID: 34197540 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


3278. Nurs Leadersh (Tor Ont). 2021 Jun;34(2):75-85. doi: 10.12927/cjnl.2021.26527.

Holistic Supports for Street Nurses and Front-line Workers during the COVID-19 
Pandemic.

McMenemy C(1), Rolfe D(2), Van Herk K(3), Wait C(4), Jamison B(5), Quesnel S(6), 
Laroque C(7), Muckle W(8), Gifford W(9).

Author information:
(1)PhD Candidate, Social Work, Carleton University, Registered Social Worker, 
Ottawa, ON.
(2)Community-Based Health Researcher, Documentary Filmmaker, Coordinator, Soul 
Space, Ottawa, ON.
(3)Mental Health Team Lead, Ottawa Inner City Health, Ottawa, ON.
(4)MA Candidate, Sociology, Carleton University, Peer Support Worker, Ottawa 
Inner City Health, Ottawa, ON.
(5)Peer Support Worker, Ottawa, ON.
(6)MSW Candidate, Carleton University, Case Manager, Ottawa Inner City Health, 
Ottawa, ON.
(7)PhD candidate, Nursing, University of Ottawa, Ottawa, ON.
(8)Co-founder and Executive Director, Ottawa Inner City Health, Ottawa, ON.
(9)Associate Professor and Loyer-DaSilva, Research Chair in Community and 
Public, Health Nursing, University of Ottawa, Faculty of Health Sciences, School 
of Nursing, Ottawa, ON.

Street nurses who serve people experiencing homelessness and substance abuse are 
at risk of vicarious trauma and long-term mental health challenges. These risks 
have increased during the COVID-19 pandemic due to a concomitant spike in opioid 
overdoses and deaths in Canada, fewer available support services and worsening 
social challenges. This article describes innovative interdisciplinary and 
participatory research currently being undertaken to develop and evaluate a 
multifaceted support program to promote the holistic well-being of street nurses 
and their front-line colleagues.

Copyright © 2021 Longwoods Publishing.

DOI: 10.12927/cjnl.2021.26527
PMID: 34197297 [Indexed for MEDLINE]


3279. Nurs Leadersh (Tor Ont). 2021 Jun;34(2):62-74. doi: 10.12927/cjnl.2021.26528.

Effects of COVID-19 on Healthcare Providers: Opportunities for Education and 
Support (ECHOES).

Limoges J(1), Anzola JD(2), Kolla NJ(3).

Author information:
(1)Nursing Faculty, Georgian College, Barrie, ON.
(2)Research Associate, Department of Research and Innovation, Georgian College, 
Barrie, ON.
(3)Vice President, Research and Academics, Waypoint Centre for Mental Health 
Care, Penetanguishene, ON, Forensic Psychiatrist, Centre for Addiction and 
Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON.

Healthcare providers (HCPs) working at point of care with patients have 
experienced health-, home- and work-related stressors from the COVID-19 
pandemic. The magnitude and duration of the pandemic pose particular challenges 
for nursing leadership, and there is little research to guide them during this 
unprecedented time. This study was designed to explore how the pandemic 
influences HCP well-being, professional practice, inter-professional 
collaboration and the education and supports that would assist them during the 
pandemic recovery period. The article reports on the qualitative portion of a 
mixed-methods study, which included 56 HCPs who work in a large mental 
healthcare facility in Ontario. Witnessing the impact of the pandemic 
restrictions on patients was a significant source of stress for HCPs. HCPs 
recommended strategies, such as learning new therapeutic modalities and 
participating in the redesign of health services as key strategies to support 
them during the pandemic as these would promote patient well-being. Lastly, the 
pandemic provided opportunities for HCPs to deepen their understanding of other 
professions. This awareness was viewed as a strength that could support 
interprofessional collaboration and enhance health services redesign. The 
findings and recommendations can assist leaders to address the mental health 
challenges arising from the pandemic.

Copyright © 2021 Longwoods Publishing.

DOI: 10.12927/cjnl.2021.26528
PMID: 34197296 [Indexed for MEDLINE]


3280. J Autism Dev Disord. 2022 Jun;52(6):2656-2669. doi: 10.1007/s10803-021-05168-5. 
Epub 2021 Jul 1.

The Impact of COVID-19 on Anxiety and Worries for Families of Individuals with 
Special Education Needs and Disabilities in the UK.

Sideropoulos V(1), Dukes D(2)(3), Hanley M(4), Palikara O(5), Rhodes S(6), Riby 
DM(4), Samson AC(2)(7), Van Herwegen J(8).

Author information:
(1)Department of Psychology and Human Development, UCL, Institute of Education, 
University College London, London, UK.
(2)Institute of Special Education, University of Fribourg, Fribourg, 
Switzerland.
(3)Swiss Center for Affective Sciences, University of Geneva, Geneva, 
Switzerland.
(4)Department of Psychology, Centre for Developmental Disorders, Durham 
University, Durham, UK.
(5)Department for Education Studies, University of Warwick, Coventry, UK.
(6)Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
(7)Faculty of Psychology, Unidistance Suisse, Brig, Switzerland.
(8)Department of Psychology and Human Development, UCL, Institute of Education, 
University College London, London, UK. j.vanherwegen@ucl.ac.uk.

COVID-19 has affected people across the world. The current study examined 
anxiety and worries during the first UK national lockdown in March 2020. Parents 
(n = 402) reported on their own anxiety and worries as well as that of their 
son/daughter with Special Education Needs and Disabilities (SEND) and typically 
developing (TD) child (n = 186) at three time points. Although both groups 
showed increased anxiety across the three time points, levels of anxiety in the 
SEND group, but not the TD siblings, were predicted by awareness about COVID-19. 
In addition, worries differed between the groups showing that COVID-19 impacts 
the wellbeing of those with SEND differently to that of their TD siblings.

© 2021. The Author(s).

DOI: 10.1007/s10803-021-05168-5
PMCID: PMC8246131
PMID: 34196890 [Indexed for MEDLINE]


3281. Acta Neurol Scand. 2021 Oct;144(4):450-459. doi: 10.1111/ane.13481. Epub 2021 
Jun 30.

Medium-term changes in patients with epilepsy during the COVID-19 pandemic.

Gonzalez-Martinez A(1), Planchuelo-Gómez Á(2), Vieira Campos A(3), 
Martínez-Dubarbie F(4), Vivancos J(1), De Toledo-Heras M(3).

Author information:
(1)Neurology Department, Hospital Universitario de La Princesa & Instituto de 
Investigación Sanitaria La Princesa, Madrid, Spain.
(2)Imaging Processing Laboratory, Universidad de Valladolid, Valladolid, Spain.
(3)Epilepsy Unit, Neurology Department, Hospital Universitario de La Princesa & 
Instituto de Investigación Sanitaria La Princesa, Madrid, Spain.
(4)Neurology Department, Hospital Marqués de Valdecilla, Santander, Spain.

OBJECTIVES: The novel coronavirus disease (COVID-19) pandemic has led to social 
distancing measures and impaired medical care of chronic neurological diseases, 
including epilepsy, which may have adversely affected well-being and quality of 
life of patients with epilepsy (PWE). The objective of this study is to evaluate 
the impact of the COVID-19 pandemic in the levels of anxiety, depression, 
somnolence, and quality of life using validated scales in PWE in real-life 
clinical practice.
MATERIALS & METHODS: Self-administered scales of anxiety disorders (GAD-7), 
depression (NDDI-E), somnolence (Epworth Sleepiness Scale; ESS), and quality of 
life (QOLIE-31-P) in PWE treated in a Refractory Epilepsy Unit were 
longitudinally analyzed. Data were collected before the beginning (December 2019 
- March 2020) and during the COVID-19 pandemic (September 2020-January 2021).
RESULTS: 158 patients (85 from the first round and 73 from the second round) 
45.0 ± 17.3 years of age, 43.2% women, epilepsy duration 23.0 ± 14.9 years, 
number of antiepileptic drugs 2.1 ± 1.4, completed the survey. Significant 
longitudinal reduction of QOLIE-31-P (from 58.9 ± 19.7 to 56.2 ± 16.2, p = .035) 
and GAD-7 scores (from 8.8 ± 6.2 to 8.3 ± 5.9, corrected p = .024) was 
identified. No statistically significant longitudinal changes in the number of 
seizures (from 0.9 ± 1.9 to 2.5 ± 6.2, p = .125) or NDDI-E scores (from 
12.3 ± 4.3 to 13.4 ± 4.4, p = .065) were found. Significant longitudinal 
increase of ESS (from 4.9 ± 3.7 to 7.4 ± 4.9, p = .001) was found.
CONCLUSIONS: During the COVID-19 pandemic, quality of life and anxiety levels 
were lower in PWE, and sleepiness levels were raised, without seizure change.

© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

DOI: 10.1111/ane.13481
PMID: 34195984 [Indexed for MEDLINE]


3282. J Public Health (Oxf). 2021 Sep 22;43(3):e453-e461. doi: 10.1093/pubmed/fdab241.

COVID-19 stressors, wellbeing and health behaviours: a cross-sectional study.

Bell LM(1), Smith R(2), van de Venter EC(3), Shuttleworth C(4), Wilson K(4), 
Lycett D(1).

Author information:
(1)Centre for Intelligent Healthcare, Coventry University, Coventry CV1 5FB, UK.
(2)Business Intelligence Team, Warwickshire County Council, Warwick CV34 4RL, 
UK.
(3)Public Health Team, Warwickshire County Council, Warwick, CV34 4RL and NHS 
Coventry & Warwickshire CCG, Warwick CV34 4DE, UK.
(4)Public Health Team, Warwickshire County Council, Warwick, CV34 4RL, UK.

BACKGROUND: Following the implementation of pandemic response measures, concerns 
arose regarding the impact for population health and wellbeing.
METHODS: This study reports findings from a survey (N = 2510) conducted in 
Warwickshire (UK) during August and September 2020, and for the first time 
investigates behaviours which may worsen or mitigate the association between 
COVID-19-related stressors and wellbeing.
RESULTS: Increased stressors were associated with lower mental wellbeing and 
higher loneliness. Participants with a mental health condition reported lower 
wellbeing, as did younger groups, women and participants not in employment. To 
cope with restrictions, more participants engaged in healthier behaviours over 
unhealthy behaviours, and relaxing reduced the association between stressors and 
poor wellbeing. Some participants reported increasing alcohol and unhealthy 
dietary behaviours to cope with restrictions, however, these behaviours did not 
mitigate the impact of COVID-19 stressors and were instead negatively associated 
with wellbeing. Around half of participants helped neighbours during the 
pandemic, a behaviour positively associated with wellbeing particularly among 
older adults.
CONCLUSION: These findings contribute understanding about how various positive 
and negative health behaviours may mitigate or worsen the impact of COVID-19 on 
wellbeing, and how public health interventions may effectively target behaviours 
and groups in similar populations.

© The Author(s) 2021. Published by Oxford University Press on behalf of Faculty 
of Public Health. All rights reserved. For permissions, please e-mail: 
journals.permissions@oup.com.

DOI: 10.1093/pubmed/fdab241
PMID: 34195830 [Indexed for MEDLINE]


3283. BMJ Open. 2021 Jun 30;11(6):e051687. doi: 10.1136/bmjopen-2021-051687.

NHS CHECK: protocol for a cohort study investigating the psychosocial impact of 
the COVID-19 pandemic on healthcare workers.

Lamb D(1), Greenberg N(2), Hotopf M(2), Raine R(3), Razavi R(2), Bhundia R(2), 
Scott H(2), Carr E(2), Gafoor R(3), Bakolis I(2), Hegarty S(2), Souliou E(2), 
Rafferty AM(2), Rhead R(2), Weston D(2), Gnangapragasam S(2), Marlow S(2), 
Wessely S(2), Stevelink S(2).

Author information:
(1)Department of Applied Health Research, University College London, London, UK 
d.lamb@ucl.ac.uk.
(2)Institute of Psychiatry, Psychology & Neuroscience, King's College London, 
London, UK.
(3)Department of Applied Health Research, University College London, London, UK.

INTRODUCTION: The COVID-19 pandemic has had profound effects on the working 
lives of healthcare workers (HCWs), but the extent to which their well-being and 
mental health have been affected remains unclear. This longitudinal cohort study 
aims to recruit a cohort of National Health Service (NHS) HCWs, conducting 
surveys at regular intervals to provide evidence about the prevalence of 
symptoms of mental disorders, and investigate associated factors such as 
occupational contexts and support interventions available.
METHODS AND ANALYSIS: All staff, students and volunteers working in the 18 
participating NHS Trusts in England will be sent emails inviting them to 
complete a survey at baseline, with email invitations for the follow-up surveys 
sent 6 months and 12 months later. Opening in late April 2020, the baseline 
survey collects data on demographics, occupational/organisational factors, 
experiences of COVID-19, validated measures of symptoms of poor mental health 
(eg, depression, anxiety, post-traumatic stress disorder), and constructs such 
as resilience and moral injury. These surveys will be complemented by in-depth 
psychiatric interviews with a sample of HCWs. Qualitative interviews will also 
be conducted, to gain deeper understanding of the support programmes used or 
desired by staff, and facilitators and barriers to accessing such programmes.
ETHICS AND DISSEMINATION: Ethical approval for the study was granted by the 
Health Research Authority (reference: 20/HRA/210, IRAS: 282686) and local Trust 
Research and Development approval. Cohort data are collected via Qualtrics 
online survey software, pseudonymised and held on secure university servers. 
Participants are aware that they can withdraw from the study at any time, and 
there is signposting to support services if participants feel they need it. Only 
those consenting to be contacted about further research will be invited to 
participate in further components. Findings will be rapidly shared with NHS 
Trusts, and via academic publications in due course.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/bmjopen-2021-051687
PMCID: PMC8249177
PMID: 34193505 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: MH, RoR and SW are senior 
NIHR Investigators. This paper represents independent research part-funded by 
the NIHR Maudsley Biomedical Research Centre Trust and King’s College London 
(MH, SW, SS). The views expressed are those of the authors and not necessarily 
those of the NHS, the NIHR, or the Department of Health and Social Care. RoR 
reports grants from DHSC/UKRI/ESRC COVID-19 Rapid Response Call, grants from 
Rosetrees Trust, grants from King’s Together rapid response call, grants from 
University College London (UCL) (Wellcome Trust) rapid response call, during the 
conduct of the study; and grants from NIHR outside the submitted work. MH 
reports grants from DHSC/UKRI/ESRC COVID-19 Rapid Response Call, grants from 
Rosetrees Trust, grants from King’s Together rapid response call, grants from 
UCL Partners rapid response call, during the conduct of the study; grants from 
Innovative Medicines Initiative and EFPIA, RADAR-CNS consortium, grants from 
MRC, grants from NIHR, outside the submitted work. SS reports grants from 
UKRI/ESRC/DHSC, grants from UCL, grants from UKRI/MRC/DHSC, grants from 
Rosetrees Trust, grants from King’s Together Fund, during the conduct of the 
study. NG reports a potential COI with NHSEI, during the conduct of the study; 
and is the managing director of March on Stress Ltd which has provided training 
for a number of NHS organisations, although it is not clear if the company has 
delivered training to any of the participating trusts or not as NG is not 
directly involved in commissioning specific pieces of work.


3284. BMC Geriatr. 2021 Jun 30;21(1):400. doi: 10.1186/s12877-021-02352-1.

A national survey on COVID-19 second-wave lockdowns on older adults' mental 
wellbeing, health-seeking behaviours and social outcomes across Australia.

Siette J(1)(2), Seaman K(3), Dodds L(3), Ludlow K(3), Johnco C(4)(5), Wuthrich 
V(4)(5), Earl JK(4)(5), Dawes P(4)(6), Strutt P(4)(7), Westbrook JI(3).

Author information:
(1)Centre for Health Systems and Safety Research, Australian Institute of Health 
Innovation, Macquarie University, New South Wales, 2109, Macqaurie Park, 
Australia. joyce.siette@mq.edu.au.
(2)Centre for Ageing, Cognition and Wellbeing, Macquarie University, New South 
Wales, 2109, Macqaurie Park, Australia. joyce.siette@mq.edu.au.
(3)Centre for Health Systems and Safety Research, Australian Institute of Health 
Innovation, Macquarie University, New South Wales, 2109, Macqaurie Park, 
Australia.
(4)Centre for Ageing, Cognition and Wellbeing, Macquarie University, New South 
Wales, 2109, Macqaurie Park, Australia.
(5)Department of Psychology, Faculty of Medicine, Health & Human Sciences, 
Macquarie University, New South Wales, 2109, Macqaurie Park, Australia.
(6)Department of Linguistics, Faculty of Medicine, Health & Human Sciences, 
Macquarie University, New South Wales, 2109, Macqaurie Park, Australia.
(7)Department of Cognitive Science, Faculty of Medicine, Health & Human 
Sciences, Macquarie University, New South Wales, 2109, Macqaurie Park, 
Australia.

BACKGROUND: The impact of severe second lockdown measures on older adults' 
wellbeing is unknown. We aimed to (i) identify the impact of the second lockdown 
that resulted from the second wave of COVID-19 cases on older Australians' 
quality of life; (ii) compare the impact of second wave lockdowns in Victoria, 
Australia's second most populous State, to those in other States and Territories 
not in lockdown.
METHODS: A national cross-sectional study of community-dwelling older adults 
completed online questionnaires for quality of life, social networks, healthcare 
access, and perceived impact of COVID-19 between July to September 2020. Tobit 
regression was used to measure the relationships of healthcare service access 
and social networks with quality of life of older adults in Victoria compared to 
those in the rest of Australia.
RESULTS: A total of 2,990 respondents (mean [SD] age, 67.3 [7.0]; 66.8 % female) 
participated. At time of data collection, Victoria's second COVID-19 lockdown 
had been in force for an average 51.7 days. Median quality of life scores were 
significantly higher in Victoria compared to the rest of Australia (t2,827=2.25 
p = 0.025). Being female (95 % CI, -0.051-0.020), having lower educational 
attainment (95 % CI, -0.089--0.018), receiving government benefits (95 % CI, 
-0.054--0.024), having small social networks (95 % CI, 0.006-0.009) and 
self-reported physical chronic health conditions were all independent predictors 
of lower quality of life.
CONCLUSIONS: Longer-term studies are required to provide more robust evidence of 
the impact as restrictions lift and normal social conventions return.

DOI: 10.1186/s12877-021-02352-1
PMCID: PMC8243046
PMID: 34193070 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3285. Australas Psychiatry. 2021 Dec;29(6):617-624. doi: 10.1177/10398562211025040. 
Epub 2021 Jun 30.

Psychosocial and lifestyle predictors of distress and well-being in people with 
mental illness during the COVID-19 pandemic.

Chapman JJ(1)(2)(3)(4), Malacova E(1), Patterson S(5), Reavley N(6), Wyder M(2), 
Brown WJ(4), Hielscher E(1)(7), Childs S(8), Scott JG(1)(5)(9).

Author information:
(1)QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
(2)Metro South Addiction and Mental Health Service, Brisbane, Queensland, 
Australia.
(3)Queensland Police-Citizens Youth Welfare Association, Brisbane, Queensland, 
Australia.
(4)School of Human Movement and Nutrition Sciences, The University of 
Queensland, Brisbane, Queensland, Australia.
(5)Metro North Mental Health Service, Brisbane, Queensland, Australia.
(6)University of Melbourne, Victoria, Australia.
(7)School of Public Health, Faculty of Medicine, The University of Queensland, 
Brisbane, Queensland, Australia.
(8)Queensland Alliance for Mental health, Queensland, Australia.
(9)Queensland Centre for Mental Health Research, Wacol, Queensland, Australia.

OBJECTIVES: People with mental illness may be vulnerable to psychological 
distress and reduced well-being during the COVID-19 pandemic. The aim of this 
study was to assess psychosocial and lifestyle predictors of distress and 
well-being in people with mental illness during the pandemic.
METHOD: People with mental illness who participated in an exercise programme 
prior to the pandemic were invited to complete surveys about mental health and 
lifestyle corresponding to before and during the pandemic.
RESULTS: Social support reduced, alcohol intake increased, and sleep quality and 
diet worsened during the pandemic, contributing to distress. Psychological 
distress was associated with the two or more mental illnesses, and negatively 
associated with having a physical disease. Better diet appeared to protect 
against increases in distress; loneliness hindered improvements in well-being.
CONCLUSIONS: Healthy lifestyle programmes designed to improve social connection 
may improve health for people with mental illnesses during and after the 
COVID-19 pandemic.

DOI: 10.1177/10398562211025040
PMID: 34192474 [Indexed for MEDLINE]


3286. Gen Psychiatr. 2021 Mar 19;34(2):e100368. doi: 10.1136/gpsych-2020-100368. 
eCollection 2021.

NHS staff mental health status in the active phase of the COVID-19 era: a staff 
survey in a large London hospital.

Ike ID(1), Durand-Hill M(1), Elmusharaf E(1), Asemota N(1), Silva E(1), White 
E(1), Awad WI(1).

Author information:
(1)Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, UK.

BACKGROUND: Experiencing a pandemic can be very unsettling and may have a 
negative impact on the mental health of frontline healthcare workers (HCWs). 
This may have serious consequences for the overall well-being of HCWs, which in 
turn may adversely affect patient safety and the productivity of the 
institution.
AIMS: We designed a study to assess the prevalence of generalised anxiety 
disorder (GAD), depression and work-related stress experienced by the National 
Health Service staff in a large tertiary London hospital treating patients with 
COVID-19 during the current active phase of the COVID-19 era.
METHODS: An anonymous survey was designed with demographic data and three 
questionnaires. The Generalised Anxiety Disorder-7 (GAD-7) and Patient Health 
Questionnaire-9 were used to assess anxiety and depression, respectively. The 
Health and Safety Executive Management Standards Indicator Tool was used to 
assess work-related stress. Staff from multiple specialties embracing 
cardiothoracic surgery, cardiology, respiratory medicine, endocrinology, 
oncology, imaging, anaesthesia and intensive care at our hospital were asked to 
complete the questionnaire between 25 May and 15 June 2020.
RESULTS: A total of 302 staff members (106 males and 196 females) completed the 
survey. The overall prevalence of GAD and depression was 41.4% and 42.7%, 
respectively. The prevalence of GAD and depression was significantly higher in 
females than in males and was statistically significant. Nurses were four times 
more likely to report moderate to severe levels of anxiety and depression as 
compared with doctors. Work-related stress was also observed to be prevalent in 
our surveyed population with the following standards: relationships, role, 
control and change showing a need for improvement.
CONCLUSIONS: Our study presents early evidence suggestive of a high prevalence 
of GAD, depression and work-related stress in HCWs. It is imperative that 
coherent strategies are implemented to improve the healthcare work environment 
during this pandemic and mitigate further injury to the mental health status of 
the healthcare population.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/gpsych-2020-100368
PMCID: PMC7987534
PMID: 34192241

Conflict of interest statement: Competing interests: None declared.


3287. BMJ Paediatr Open. 2021 May 18;5(1):e001077. doi: 10.1136/bmjpo-2021-001077. 
eCollection 2021.

COVID-19 pandemic experiences of parents caring for children with oesophageal 
atresia/tracheo-oesophageal fistula.

Stewart A(1)(2), Smith CH(2), Eaton S(3), De Coppi P(3)(4), Wray J(5).

Author information:
(1)Department of Speech and Language Therapy, Great Ormond Street Hospital For 
Children NHS Trust, London, UK.
(2)Department of Language and Cognition, University College London, London, UK.
(3)Stem Cells and Regenerative Medicine Section, University College London 
Institute of Child Health, London, UK.
(4)Specialist Paediatric and Neonatal Surgery, Great Ormond Street Hospital For 
Children NHS Trust, London, UK.
(5)Centre for Outcomes and Experience Research in Children's Health, Illness and 
Disability (ORCHID), Great Ormond Street Hospital For Children NHS Trust, 
London, UK.

PURPOSE: The COVID-19 pandemic has resulted in a global health crisis of 
unparalleled magnitude. The direct risk to the health of children is low. 
However, disease-containment measures have society-wide impacts. This study 
explored the pandemic experiences of parents of children with oesophageal 
atresia/tracheo-oesophageal fistula (OA/TOF) in the UK.
DESIGN: A phenomenological approach underpinned use of an asynchronous online 
forum method, in collaboration with a patient support group. Data were evaluated 
using thematic analysis.
RESULTS: The online forum ran between 7 November and 18 December 2020 with 109 
participants.Pandemic experiences were divided into themes relating to 
healthcare and disease containment. Participants described positive experiences 
with remote healthcare but identified limitations. Delays and cancellations led 
to escalation of care to an emergency level, slower developmental progress and 
feelings of being abandoned by services. Inpatient care was perceived as safe 
but caring alone was emotionally and practically challenging. Disease 
containment themes revealed anxiety regarding health risks, 'collateral' damage 
to well-being because of isolation, and an impact on finances and employment. 
Parents described a transition from worry about direct health risks to concern 
about the impact of isolation on socialisation and development. A process of 
risk-benefit analysis led some to transition to a more 'normal life', while 
others continued to isolate. Benefits to their child's health from isolation 
were reported.
CONCLUSIONS: Parents' experiences of caring for a child with OA/TOF during the 
pandemic were varied. Rapid adoption of telehealth has demonstrated the enormous 
potential of remote healthcare delivery but requires refinement to meet the 
needs of the individual. Future pandemic planning should aim to retain community 
healthcare services to avoid escalation of care to an emergency, manage chronic 
and developmental concerns, and support parental well-being. Accurate and 
consistent disease-specific information is highly valued by parents. Third 
sector organisations are ideally positioned to support this.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/bmjpo-2021-001077
PMCID: PMC8136802
PMID: 34192203 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3288. BMJ Paediatr Open. 2021 May 25;5(1):e001043. doi: 10.1136/bmjpo-2021-001043. 
eCollection 2021.

Impact of lockdown and school closure on children's health and well-being during 
the first wave of COVID-19: a narrative review.

Rajmil L(1), Hjern A(2), Boran P(3), Gunnlaugsson G(4), Kraus de Camargo O(5), 
Raman S(6)(7); International Society for Social Pediatrics & Child Health 
(ISSOP) and International Network for Research on Inequalities in Child Health 
(INRICH) COVID-19 Working Group.

Author information:
(1)Pediatric and Public Health Specialist, Retired, Barcelona, Spain.
(2)Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, 
Stockholm, Sweden.
(3)Department of Pediatrics, Marmara University School of Medicine, Istanbul, 
Turkey.
(4)Faculty of Social and Human Sciences, University of Iceland, Reykjavík, 
Iceland.
(5)Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
(6)Department of Community Paediatrics, South Western Sydney Local Health 
District, Liverpool, New South Wales, Australia.
(7)Women's & Children's Health, University of New South Wales, Sydney, New South 
Wales, Australia.

BACKGROUND: In the context of containment measures against the COVID-19 
pandemic, the aims were to examine the impact of lockdown and school closures on 
childs' and adolescents' health and well-being and social inequalities in 
health.
METHODS: Literature review by searching five databases until November 2020. We 
included quantitative peer-reviewed studies reporting health and well-being 
outcomes in children (0-18 years) related to closure measures' impact due to 
COVID-19. A pair of authors assessed the risk of bias of included studies. A 
descriptive and narrative synthesis was carried out.
FINDINGS: Twenty-two studies, including high-income, middle-income and 
low-income countries, fulfilled our search criteria and were judged not to have 
an increased risk of bias. Studies from Australia, Spain and China showed an 
increase in depressive symptoms and decrease in life satisfaction. A decrease in 
physical activity and increase in unhealthy food consumption were shown in 
studies from two countries. There was a decrease in the number of visits to the 
emergency department in four countries, an increase in child mortality in 
Cameroon and a decrease by over 50% of immunisations administered in Pakistan. A 
significant drop of 39% in child protection medical examination referrals during 
2020 compared with the previous years was found in the UK, a decrease in 
allegations of child abuse and neglect by almost one-third due to school 
closures in Florida, and an increase in the number of children with physical 
child abuse trauma was found in one centre in the USA.
INTERPRETATION: From available reports, pandemic school closure and lockdown 
have adverse effects on child health and well-being in the short and probably 
long term. We urge governments to take the negative public health consequences 
into account before adopting restrictive measures in childhood.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjpo-2021-001043
PMCID: PMC8154298
PMID: 34192198 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3289. Telemed J E Health. 2022 Apr;28(4):486-494. doi: 10.1089/tmj.2020.0555. Epub 
2021 Jun 30.

Effectiveness of Evidence-Based Telecoaching Delivered Through an 
Employer-Sponsored Mental Health Benefits Platform.

Sagui-Henson SJ(1), Prescott MR(1), Corcoran JB(1), Pillai S(1), Mattila L(1), 
Mathur S(1), Adkins T(1), Altman M(1)(2).

Author information:
(1)Modern Health, San Francisco, California, USA.
(2)Clinical Excellence Research Center, Stanford School of Medicine, Palo Alto, 
California, USA.

Introduction: Coaches delivering telemental health services as part of an 
employer-sponsored benefit may increase access to affordable and effective care. 
We examined the effectiveness of evidence-based telecoaching delivered via 
videoconferencing to people requesting mental health services during the 
coronavirus disease 2019 (COVID-19) pandemic. Materials and Methods: We analyzed 
data from 1,228 employees (mean age = 35 ± 8 years; 67.2% female) who utilized 
telecoaching through the Modern Health benefits platform between March 11, 2020 
and March 11, 2021. We used paired samples t tests to examine changes in 
well-being, burnout, absenteeism, and presenteeism before and after telecoaching 
and moderated regressions to test whether these changes depended on visit 
utilization. We analyzed rates of clinical improvement for well-being and 
reduction from entry in symptoms for burnout. We conducted analyses in the full 
sample and participants presenting with elevated symptoms at baseline. Results: 
Participants utilized an average of 2.6 visits. Well-being (p = 0.02) 
significantly increased, while both presenteeism (p < 0.001) and absenteeism 
(p < 0.001) significantly decreased at follow-up in our full sample, but 
represented negligible effect sizes. Burnout was not found to have significantly 
changed at follow-up in our full sample (p = 0.69). In participants beginning 
care with elevated depressive-related symptoms, well-being significantly 
increased (p < 0.001) and 46.3% experienced a clinically relevant improvement. 
In participants beginning care with elevated levels of burnout, burnout 
significantly decreased (p < 0.001) and 20.9% experienced a reduction in 
symptoms from entry. Conclusions: Leveraging videoconferencing, telecoaching had 
positive effects on mental health and workplace outcomes, even during the 
COVID-19 pandemic. Evidence-based telecoaching represents a promising option for 
achieving optimal outcomes in people who need mental health services.

DOI: 10.1089/tmj.2020.0555
PMCID: PMC9058879
PMID: 34191616 [Indexed for MEDLINE]

Conflict of interest statement: S.J.S.-H., M.R.P., J.B.C., S.P., L.M., S.M., 
T.A., Jr., and M.A. are employed by and receive income from Modern Health and 
have been granted equity in Modern Health.


3290. Int J Psychol. 2022 Feb;57(1):49-62. doi: 10.1002/ijop.12770. Epub 2021 Jun 29.

Appraisal and coping predict health and well-being during the COVID-19 pandemic: 
An international approach.

Kirby LD(1), Qian W(1), Adiguzel Z(2), Afshar Jahanshahi A(3), Bakracheva M(4), 
Orejarena Ballestas MC(5), Cruz JFA(6), Dash A(7), Dias C(8), Ferreira MJ(9), 
Goosen JG(10), Kamble SV(11), Mihaylov NL(12), Pan F(13), Sofia R(8), Stallen 
M(10), Tamir M(14), van Dijk WW(10), Vittersø J(15), Smith CA(1).

Author information:
(1)Peabody College, Vanderbilt University, Nashville, TN, USA.
(2)Istanbul Medipol University, Istanbul, Turkey.
(3)CENTRUM Catølica Graduate Business School (CCGBS), Pontificia Universidad 
Católica del Perú (PUCP), Lima, Peru.
(4)Sofia University St. Kliment Ohridski, Sofia, Bulgaria.
(5)Universidad de La Sabana, Chía, Colombia.
(6)Psychology Research Centre (CiPsi/UM)|School of Psychology, University of 
Minho, Braga, Portugal.
(7)Leuphana University, Lüneburg, Germany and International University of 
Business Agriculture & Technology (IUBAT), Dhaka, Bangladesh.
(8)Centre of Research, Education, Innovation and Intervention in Sport (CIFI2D), 
Faculty of Sport, Porto, Portugal.
(9)HEI-Lab: Digital Human-Environment Interaction Lab, Faculty of Psychology, 
Education and Sports, Lusófona University, Porto, Portugal.
(10)Leiden University, The Netherlands and Knowledge Centre Psychology and 
Economic Behaviour, Leiden, The Netherlands.
(11)Karnatak University, Dharwad, India.
(12)Medical University Varna, Varna, Bulgaria.
(13)Nantong University, Nantong, China.
(14)The Hebrew University of Jerusalem, Jerusalem, Israel.
(15)UIT, The Arctic University, Tromsø, Norway.

COVID-19 has had a devastating impact on people worldwide. We conducted an 
international survey (n = 3646) examining the degree to which people's 
appraisals and coping activities around the pandemic predicted their health and 
well-being. We obtained subsamples from 12 countries-Bangladesh, Bulgaria, 
China, Colombia, India, Israel, the Netherlands, Norway, Peru, Portugal, Turkey 
and the United States. For each, we assessed appraisals and coping strategies as 
well as indicators of physical and mental health and well-being. Results 
indicated that, despite mean-level societal differences in outcomes, the pattern 
of appraisals and coping strategies predicting health and well-being was 
consistent across countries. Use of disengagement coping (particularly 
behavioural disengagement and self-isolation) was associated with relatively 
negative outcomes. In contrast, optimistic appraisals (particularly of high 
accommodation-focused coping potential and the ability to meet one's physical 
needs), use of problem-focused coping strategies (especially problem-solving) 
and accommodative coping strategies (especially positive reappraisal and 
self-encouragement) were associated with relatively positive outcomes. Our study 
highlights the critical importance of considering accommodative coping in stress 
and coping research. It also provides important information on how people have 
been dealing with the pandemic, the predictors of well-being under pandemic 
conditions and the generality of such relations.

© 2021 International Union of Psychological Science.

DOI: 10.1002/ijop.12770
PMID: 34189731 [Indexed for MEDLINE]


3291. Sci Rep. 2021 Jun 29;11(1):13535. doi: 10.1038/s41598-021-92985-4.

COVID-19 positivity associated with traumatic stress response to childbirth and 
no visitors and infant separation in the hospital.

Mayopoulos GA(1)(2), Ein-Dor T(3), Li KG(1), Chan SJ(1), Dekel S(4)(5).

Author information:
(1)Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
(2)Department of Counseling and Clinical Psychology, Teachers College, Columbia 
University, New York, NY, USA.
(3)School of Psychology, Interdisciplinary Center (IDC), Herzliya, Israel.
(4)Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA. 
sdekel@mgh.harvard.edu.
(5)Department of Psychiatry, Harvard Medical School, Boston, MA, USA. 
sdekel@mgh.harvard.edu.

Update of
    medRxiv. 2020 Dec 07;:
    Res Sq. 2020 Dec 09;:

As the novel coronavirus (COVID-19) has spread globally, a significant portion 
of pregnant and delivering women were infected with COVID-19. While emerging 
studies examined birth outcomes in COVID-19 positive women, knowledge of the 
psychological experience of childbirth and maternal wellness remains lacking. 
This matched-control survey-based study included a sample of women recruited 
during the first wave of the pandemic in the US who gave birth in the previous 
six months. Women reporting confirmed/suspected COVID-19 (n = 68) during 
pregnancy or childbirth were matched on background factors with women reporting 
COVID-19 negativity (n = 2,276). We found nearly 50% of COVID positive women 
endorsed acute traumatic stress symptoms at a clinical level in response to 
childbirth. This group was more than twice as likely to endorse acute stress and 
to have no visitors during maternity hospitalization than COVID negative women; 
they were also less likely to room-in with newborns. The COVID positive group 
reported higher levels of pain in delivery, lower newborn weights, and more 
infant admission to neonatal intensive care units. Our findings suggest COVID-19 
affected populations are at increased risk for traumatic childbirth and 
associated risk for psychiatric morbidity. Attention to delivering women's 
wellbeing is warranted during the pandemic.

DOI: 10.1038/s41598-021-92985-4
PMCID: PMC8241858
PMID: 34188137 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


3292. Diabetes Metab Syndr. 2021 Jul-Aug;15(4):102153. doi: 10.1016/j.dsx.2021.05.026. 
Epub 2021 Jun 5.

Fear of COVID-19 scale: Psychometric properties, reliability and validity in 
Egyptian population.

Fawzy El-Bardan M(1), Lathabhavan R(2).

Author information:
(1)Faculty of Commerce, University of Sadat City, Sadat City, Egypt.
(2)Department of Technology Management, VIT University, Vellore, India. 
Electronic address: remya.l@vit.ac.in.

BACKGROUND AND AIMS: The primary purpose of this study is to examine the 
psychometric qualities of the Fear of COVID-19 Scale (FCV-19S) in a sample of 
Egyptian college students. The researchers also aim at exploring the construct 
validity further through examining the relationship between FCV-19S, wellbeing 
and life satisfaction in Egyptian universities context. The current study aims 
to evaluate the psychometric properties of the Arabic version of the Fear of 
COVID-19 scale among Egyptian population.
METHODS: The FCV-19S is translated and validated in Egyptian context. The 
forward backward translation method is used to translate the English version of 
the survey into Arabic. The sample is comprised of 1832 Egyptian participants, 
who have conducted an online survey based on the Arabic versions of FCV-19S.
RESULTS: The Cronbach α value for the Egyptian FCV-19S is 0.87, indicating a 
good internal reliability. The results of the confirmatory factor analysis show 
that the unidimensional factor structure of the FCV-19S has fitted well with the 
data. The FCV-19S is significantly correlated with the seven-item survey. 
Moreover, the results show a significant negative relationship between Fear of 
COVID-19 and both wellbeing and life satisfaction (r = -0.42, p < 0.001; 
r = -0.24, p < 0.01.), respectively.
CONCLUSION: The study supports the one factor model of FCV-19S scale in Egyptian 
context. The Arabic scale version in the Egyptian context shows excellent 
reliability and validity. This ensures a good measure that can be accepted for 
both academia and practitioners for analyzing ill-effects of pandemic impacts 
and, thereby, reducing them.

Copyright © 2021 Diabetes India. Published by Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.dsx.2021.05.026
PMID: 34186355 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest No.


3293. J Affect Disord. 2021 Oct 1;293:141-147. doi: 10.1016/j.jad.2021.06.019. Epub 
2021 Jun 17.

The effects of narrative exposure therapy on COVID-19 patients with 
post-traumatic stress symptoms: A randomized controlled trial.

Fan Y(1), Shi Y(2), Zhang J(3), Sun D(4), Wang X(5), Fu G(6), Mo D(7), Wen J(8), 
Xiao X(9), Kong L(10).

Author information:
(1)Bachelor of Nursing, Wuhan University School of Health Sciences, Xiangzhou 
District People's Hospital in Hubei Province, China.
(2)Bachelor of Nursing, Wuhan University School of Health Sciences, China.
(3)Associate Professor, Wuhan University School of Health Sciences, China. 
Electronic address: junz@whu.edu.cn.
(4)Associate chief physician, Vice President of Xiangzhou District People's 
Hospital, Xiangyang city, Hubei Province, China.
(5)Bachelor of Nursing; Wuhan University School of Health Sciences, Xiangyang 
Central Hospital in Hubei Province, China.
(6)Associate professor of nursing, Director of psychological Outpatient 
Department, Xiangzhou District People's Hospital, Xiangyang city, Hubei 
Province, China.
(7)Associate professor of nursing; Xiangzhou District People's Hospital, 
Xiangyang city, Hubei Province, China.
(8)Associate professor of nursing, Xiangzhou District People's Hospital, 
Xiangyang city, Hubei Province, China.
(9)Associate professor of nursing, Xiangyang Hospital of Traditional Chinese 
Medicine in Hubei Province, China.
(10)Bachelor of Public health, Wuhan University School of Health Sciences, 
China.

BACKGROUND: With the global attack of Coronavirus Disease 2019 (COVID-19), cases 
with Post-traumatic Stress Disorder (PTSD) have been increasing steadily, which 
seriously affects the quality of life of patients and as such, seeking effective 
treatments is an urgent matter. Narrative Exposure Therapy (NET) is a typical 
cognitive behavioral therapy targeting trauma-related psychological disorders 
and may be an effective intervention.
METHODS: A total of 111 COVID-19 patients near the discharge stage with positive 
screening results for posttraumatic stress symptoms (PTSS) were randomly 
assigned (1:1) to either the study group or the control group. The study group 
received NET and personalized psychological intervention, while the control 
group only received personalized psychological intervention. PTSS, depression, 
anxiety and sleep quality were measured pre- and post-intervention to evaluate 
the effect of NET. This trial was registered with the International Standard 
Randomized Clinical Trial Registry (No. ChiCTR2000039369).
RESULTS: NET participants showed a significantly greater PTSS reduction in 
comparison with the control group after the intervention. Improvement in sleep 
quality, anxiety and depression after the intervention were pronounced but not 
significantly different between the two treatment groups.
LIMITATIONS: The assessors weren't blinded for the convenience of measurement 
and protection of participants' psychological security.
CONCLUSIONS: NET likely had a positive impact on PTSS of COVID-19 patients. 
Clinical staff should consider applying NET to improve the psychological 
well-being of patients who have experienced an epidemic such as COVID-19.

Copyright © 2021. Published by Elsevier B.V.

DOI: 10.1016/j.jad.2021.06.019
PMCID: PMC8234566
PMID: 34186232 [Indexed for MEDLINE]

Conflict of interest statement: None to be declared.


3294. Psychiatr Danub. 2021 Summer;33(2):225-230. doi: 10.24869/psyd.2021.225.

Stress and Burnout in Psychiatrists in Turkey during COVID-19 Pandemic.

Öğütlü H(1), McNicholas F, Türkçapar H.

Author information:
(1)Department of Child and Adolescent Psychiatry, Ankara City Hospital, 06000 
Ankara, Turkey, hogutlu@gmail.com.

BACKGROUND: Clinicians working in mental health (MH) services seem to be at 
increased risk of burnout. This study aimed to investigate the stress and 
burnout levels of psychiatrists working in MH services in Turkey and determine 
the relationship between stress, workload, and support during the COVID-19 
pandemic.
SUBJECTS AND METHODS: An online questionnaire was sent to child and adult 
psychiatrists registered with Turkish professional mail groups. 217 
psychiatrists replied, with equal numbers from child (n=108) and adult (n=109) 
MH services. The Copenhagen Burnout Inventory and study-specific questionnaire 
were used.
RESULTS: 60.8% of psychiatrists (n=132) experienced medium-or high-intensity 
work-related burnout, 49.8% (n=108) experienced patient-related burnout, and 
31.8% (n=69) experienced medium-or high-intensity personal burnout. 
Patient-related burnout scores were significantly higher in the child psychiatry 
group than in the adult psychiatry group. The majority (n=126, 58.1%) reported 
either moderate or higher stress levels linked to the COVID-19 pandemic. 
Turnover intention, reluctance to retrain in psychiatry and sense of lack of 
value in the job are all associated with higher levels of burnout.
CONCLUSIONS: The current COVID-19 pandemic is likely to bring additional 
stressors to psychiatrists. This study shows that psychiatrists in Turkey 
already exhibit high levels of work-related stress. Organizational interventions 
to ameliorate psychiatrists' wellbeing and work conditions are required.

DOI: 10.24869/psyd.2021.225
PMID: 34185754 [Indexed for MEDLINE]


3295. J Health Commun. 2021 May 4;26(5):317-327. doi: 10.1080/10810730.2021.1946219. 
Epub 2021 Jun 29.

The COVID-19 Pandemic and Positive Psychology: The Role of News and Trust in 
News on Mental Health and Well-Being.

Jain P(1).

Author information:
(1)Associate Professor, E.W. Scripps School of Journalism,Scripps College of 
Communication,Ohio University, Athens, OH.

As of writing of this paper, over 94 million people worldwide have been 
diagnosed with COVID-19 infection and over 2 million people have died. During 
crisis situations, people seek news to gain information and reduce uncertainty. 
Although news could provide some means of control, the constant access may also 
cause emotional distress. Research suggests that consumption of crisis news 
leads to high psychological distress and fear that may impact intentions to 
engage in healthy behavior. Fake news and widespread misinformation during this 
pandemic have obliterated public trust in news which can also affect mental 
health. Therefore, in this research we explore the impact of news exposure on 
mental well-being and test for plausible explanations. Utilizing survey 
methodology, we examine the role of news exposure on perceived stress, 
happiness, satisfaction, gratitude and the moderating impact of interest in 
COVID-19 news on the same. In addition, we propose trust in news as a mediator 
of the relationship between news exposure and abovementioned variables. The 
findings suggest that high levels of news exposure, combined with low levels of 
interest in COVID-19 news, led people to experience more stress and low 
satisfaction, gratitude, and happiness. However, when interest in COVID-19 news 
was high, people experienced more gratitude and happiness with increasing 
exposure. High levels of news exposure led to lower levels of trust that led to 
low satisfaction and happiness. Theoretical and practical implications of the 
study are discussed.

DOI: 10.1080/10810730.2021.1946219
PMID: 34185615 [Indexed for MEDLINE]


3296. J R Coll Physicians Edinb. 2021 Jun;51(S1):S34-S39. doi: 10.4997/JRCPE.2021.239.

Public Health Scotland - the first year: successes and lessons.

Phin N(1).

Author information:
(1)Faculty of Health and Social Care, University of Chester Parkgate Road, 
Chester CH1 4BJ, UK, Email: nicholas.phin@phs.scot.

Over its first year Public Health Scotland (PHS) played a key role in the 
national vaccination programme by providing professional leadership and 
expertise. We expedited the reporting of all aspects of the pandemic, and 
accelerated rapid evidence reviews. We contributed to rigorous research showing 
that: vaccination reduced hospitalisation by 90%, and the transmission of 
COVID-19 within households by 55%; hence vaccination works. Lessons for the 
future included strengthening whole genome sequencing to manage COVID-19 and to 
prepare for future pathogens. COVID-19 also stimulated the redesign of many 
health and social care services: by exploiting digital media; by implementing 
evidence on reducing barriers to service delivery; and by greater integration - 
of projects rather than organisations - enabling groups who had not worked 
together to address common issues. PHS and partners soon recognised the need to 
mitigate the adverse impact of the pandemic on existing inequalities. So we aim 
to 'build back fairer' as the pandemic recedes, by pursuing PHS's four 
priorities: poverty; children and young people; place and community; and mental 
health and well-being.

DOI: 10.4997/JRCPE.2021.239
PMID: 34185036 [Indexed for MEDLINE]

Conflict of interest statement: No conflict of interests declared


3297. Anxiety Stress Coping. 2022 Jan;35(1):86-100. doi: 
10.1080/10615806.2021.1946518. Epub 2021 Jun 29.

The moderating effects of reported pre-pandemic social anxiety, symptom 
impairment, and current stressors on mental health and affiliative adjustment 
during the first wave of the COVID-19 pandemic.

Ho JTK(1), Moscovitch DA(1).

Author information:
(1)Department of Psychology and Centre for Mental Health Research and Treatment, 
University of Waterloo, Waterloo, ON, Canada.

BACKGROUND AND OBJECTIVES: Individuals with social anxiety (SA) have 
well-established fears of being negatively evaluated and exposing self-perceived 
flaws to others. However, the unique impacts of pre-existing SA on well-being 
and interpersonal outcomes within the stressful context of the pandemic are 
currently unknown.
DESIGN: In a study that took place in May 2020, we surveyed 488 North American 
community participants online.
METHODS: We used multiple linear regression to analyze whether retrospective 
reports of pre-pandemic SA symptoms predicted current coronavirus anxiety, 
loneliness, fears of negative evaluation, use of preventive measures, and 
affiliative outcomes, and whether pre-pandemic functional impairment and recent 
COVID-related stressors moderated these relations.
RESULTS: Results highlighted the negative effects of pre-pandemic SA on current 
mental health functioning, especially for participants with higher pre-pandemic 
functional impairment and greater exposure to COVID-related stressors. Although 
participants with higher pre-pandemic SA reported currently feeling lonelier and 
more fearful of negative evaluation, they also endorsed greater efforts to 
affiliate with others.
CONCLUSIONS: High SA individuals may have heightened desire for social support 
within the isolating context of the pandemic, in which COVID-related social 
restrictions enable greater avoidance of social evaluation but may also mask the 
enduring impairment associated with pre-pandemic SA.

DOI: 10.1080/10615806.2021.1946518
PMID: 34184570 [Indexed for MEDLINE]


3298. Occup Environ Med. 2021 Nov;78(11):801-808. doi: 10.1136/oemed-2020-107276. Epub 
2021 Jun 28.

Psychosocial impact of the COVID-19 pandemic on 4378 UK healthcare workers and 
ancillary staff: initial baseline data from a cohort study collected during the 
first wave of the pandemic.

Lamb D(1), Gnanapragasam S(2), Greenberg N(3), Bhundia R(4), Carr E(5), Hotopf 
M(2)(6), Razavi R(7), Raine R(8), Cross S(4), Dewar A(9), Docherty M(4), 
Dorrington S(10), Hatch S(10), Wilson-Jones C(10), Leightley D(3)(4), Madan 
I(9), Marlow S(10), McMullen I(4), Rafferty AM(11), Parsons M(12), Polling 
C(10), Serfioti D(3), Gaunt H(13), Aitken P(14), Morris-Bone J(15), Simela C(9), 
French V(16), Harris R(17), Stevelink SAM(3)(4), Wessely S(4).

Author information:
(1)Department of Applied Health Research, University College London, London, UK 
d.lamb@ucl.ac.uk.
(2)Maudsley NHS Foundation Trust, London, UK.
(3)Academic Department of Military Mental Health, King's College London, London, 
UK.
(4)Department of Psychological Medicine, King's College London, London, UK.
(5)Department of Biostatistics and Health Informatics, King's College London, 
London, UK.
(6)National Institute of Health Research Biomedical Research Centre, London, UK.
(7)Life Sciences and Medicine, King's College London, London, UK.
(8)Department of Applied Health Research, University College London, London, UK.
(9)Guy's and St Thomas' NHS Foundation Trust, London, UK.
(10)Institute of Psychiatry, Psychology & Neuroscience, King's College London, 
London, UK.
(11)Adult Nursing, King's College London, London, UK.
(12)Mental Health Liaison Team, King's College London, London, UK.
(13)University Hospitals of Leicester NHS Trust, Leicester, UK.
(14)Devon Partnership NHS Trust, Exeter, UK.
(15)Avon & Wiltshire Mental Health Partnership NHS Trust, Bristol, UK.
(16)Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK.
(17)Cornwall Partnership Foundation NHS Trust, Cornwall, UK.

OBJECTIVES: This study reports preliminary findings on the prevalence of, and 
factors associated with, mental health and well-being outcomes of healthcare 
workers during the early months (April-June) of the COVID-19 pandemic in the UK.
METHODS: Preliminary cross-sectional data were analysed from a cohort study 
(n=4378). Clinical and non-clinical staff of three London-based NHS Trusts, 
including acute and mental health Trusts, took part in an online baseline 
survey. The primary outcome measure used is the presence of probable common 
mental disorders (CMDs), measured by the General Health Questionnaire. Secondary 
outcomes are probable anxiety (seven-item Generalised Anxiety Disorder), 
depression (nine-item Patient Health Questionnaire), post-traumatic stress 
disorder (PTSD) (six-item Post-Traumatic Stress Disorder checklist), suicidal 
ideation (Clinical Interview Schedule) and alcohol use (Alcohol Use Disorder 
Identification Test). Moral injury is measured using the Moray Injury Event 
Scale.
RESULTS: Analyses showed substantial levels of probable CMDs (58.9%, 95% CI 58.1 
to 60.8) and of PTSD (30.2%, 95% CI 28.1 to 32.5) with lower levels of 
depression (27.3%, 95% CI 25.3 to 29.4), anxiety (23.2%, 95% CI 21.3 to 25.3) 
and alcohol misuse (10.5%, 95% CI 9.2 to 11.9). Women, younger staff and nurses 
tended to have poorer outcomes than other staff, except for alcohol misuse. 
Higher reported exposure to moral injury (distress resulting from violation of 
one's moral code) was strongly associated with increased levels of probable 
CMDs, anxiety, depression, PTSD symptoms and alcohol misuse.
CONCLUSIONS: Our findings suggest that mental health support for healthcare 
workers should consider those demographics and occupations at highest risk. 
Rigorous longitudinal data are needed in order to respond to the potential 
long-term mental health impacts of the pandemic.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/oemed-2020-107276
PMCID: PMC8245285
PMID: 34183447 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: RoR reports grants from 
DHSC/UKRI/ESRC COVID-19 Rapid Response Call, grants from Rosetrees Trust, grants 
from King’s Together rapid response call, grants from UCL (Wellcome Trust) rapid 
response call, during the conduct of the study; grants from Innovative Medicines 
Initiative and EFPIA, RADAR-CNS consortium, grants from MRC, grants from NIHR, 
outside the submitted work. SH reports grants from NIHR, grants from Wellcome 
Trust, grants from ESRC, grants from Guy’s and St. Thomas’ Charity, grants from 
MRC, grants from UKRI, outside the submitted work; and a member of the following 
advisory groups: The Health Foundation – COVID-19 Research Programme Panel, NHS 
England and NHS Improvement – Patient and Carers Race Equalities Framework 
(PCREF) Steering Group, NHS England and NHS Improvement – Advancing Mental 
Health Equalities Taskforce, Health Education England – Mental Health Workforce 
Equalities Subgroup, Maudsley Learning – Maudsley Learning Advisory Board, South 
London and Maudsley NHS Foundation Trust (SLaM) – Independent Advisory Groups, 
the SLaM Partnership Group, Lambeth Public Health – Serious Youth Violence 
Public Health Task and Finish Group, NHS England – Workforce Race Equality 
Standard Advisory Group, Thrive London – Thrive London Advisory Board, Black 
Thrive – Black Thrive Advisory Board. Commissions: Welsh Government’s Race 
Equality Plan; contribution to the evidence review for Health and Social Care 
and Employment and Income policy areas. SAMS reports grants from UKRI/ESRC/DHSC, 
grants from UCL, grants from UKRI/MRC/DHSC, grants from Rosetrees Trust, grants 
from King’s Together Fund, during the conduct of the study. NG reports a 
potential COI with NHSEI, during the conduct of the study; and the managing 
director of March on Stress Ltd, which has provided training for a number of NHS 
organisations although NG is not clear if the company has delivered training to 
any of the participating trusts or not as NG does not get directly involved in 
commissioning specific pieces of work.


3299. Gerontology. 2022;68(4):412-417. doi: 10.1159/000516969. Epub 2021 Jun 28.

Management of Older Outpatients during the COVID-19 Pandemic: The GeroCovid 
Ambulatory Study.

Gareri P(1), Fumagalli S(2), Malara A(3), Mossello E(2), Trevisan C(4), Volpato 
S(5), Coin A(2), Calsolaro V(6), Bellelli G(7), Del Signore S(8), Zia G(8), 
Ranhoff AH(9), Incalzi RA(10); GeroCovid Ambulatory Study Group.

Author information:
(1)CDCD Catanzaro Lido - ASP Catanzaro, Catanzaro, Italy.
(2)Department of Experimental and Clinical Medicine, University of Florence and 
SOD Geriatrics-UTIG, AOU Careggi, Florence, Italy.
(3)Scientific Committee of National Association of Third Age Residences (ANASTE) 
Calabria, Lamezia Terme, Italy.
(4)Geriatrics Division, Department of Medicine (DIMED), University of Padua, 
Padua, Italy.
(5)Department of Medical Science, University of Ferrara, Ferrara, Italy.
(6)Geriatrics Unit, Department of Clinical and Experimental Medicine, University 
of Pisa, Pisa, Italy.
(7)School of Medicine and Surgery, University of Milano-Bicocca and Acute 
Geriatic Unit, San Gerardo Hospital, Monza, Italy.
(8)Blue Companion Ltd, London, United Kingdom.
(9)Department of Clinical Science, University of Bergen, Norway and 
Diakonhjemmet Hospital, Oslo, Norway.
(10)Unit of Geriatrics, Department of Medicine, Campus Bio-Medico University and 
Teaching Hospital, Rome, Italy.

OBJECTIVES: The GeroCovid Study is a multi-setting, multinational, and 
multi-scope registry that includes the GeroCovid home and outpatients' care 
cohort. The present study aims to evaluate whether outpatient and home care 
services with remote monitoring and consultation could mitigate the impact of 
the COVID-19 pandemic on mental and affective status, perceived well-being, and 
personal capabilities of outpatients and home care patients with cognitive 
disorders.
METHODS: Prospectively recorded patients in an electronic web registry provided 
by BlueCompanion Ltd. Up to October 31, 2020, the sample included 90 patients 
receiving regular care from the Center for Cognitive Disorders and Dementia in 
Catanzaro Lido, Italy. It was made of 52 ambulatory outpatients and 38 home care 
patients, mean age 83.3 ± 7.54 years. Participants underwent a multidimensional 
assessment at baseline (T0) and after 90 days (T1). For each patient, we 
administered the Mini-Mental State Examination (MMSE) for cognitive functions, 
the Activities of Daily Living (ADL) and Instrumental ADL (IADL) scales for 
functional capabilities, the Cumulative Illness Rating Scale (CIRS) for 
comorbidities and their impact on patients' health, the 5-items Geriatric 
Depression Scale (GDS) for mood, and the Euro Quality of Life (EuroQoL) for 
perceived quality of life. Contacts with both ambulatory and home care patients 
were managed in person or via telephone, preferably through video calls 
(WhatsApp or FaceTime).
RESULTS: Contacts with patients were kept at T0 through telephone. At T1, visits 
were made in person for over 95% out of the cases. The ADL, IADL, CIRS, GDS, 
MMSE, and EuroQoL changed slightly between T0 and T1. Most of the patients were 
clinically stable over time on the majority of the scales explored, but 
behavioral changes were found in 24.4% of patients and anxiety and insomnia in 
17.7% of patients.
CONCLUSION: Our study suggests that contacts through telephone and video 
consultations are likely associated with a health status preservation of the 
patients.

© 2021 S. Karger AG, Basel.

DOI: 10.1159/000516969
PMCID: PMC8339050
PMID: 34182557 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
declare.


3300. Neuroimage. 2021 Oct 1;239:118311. doi: 10.1016/j.neuroimage.2021.118311. Epub 
2021 Jun 26.

Brain volumetric changes in the general population following the COVID-19 
outbreak and lockdown.

Salomon T(1), Cohen A(2), Barazany D(3), Ben-Zvi G(2), Botvinik-Nezer R(4), Gera 
R(5), Oren S(2), Roll D(1), Rozic G(1), Saliy A(1), Tik N(6), Tsarfati G(7), 
Tavor I(8), Schonberg T(9), Assaf Y(10).

Author information:
(1)School of Neurobiology, Biochemistry and Biophysics, Faculty of Life Science, 
Tel Aviv University, Tel Aviv, Israel.
(2)School of Neurobiology, Biochemistry and Biophysics, Faculty of Life Science, 
Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv 
University, Tel Aviv, Israel.
(3)The Strauss Center for Computational Neuroimaging, Tel Aviv University, Tel 
Aviv, Israel.
(4)School of Neurobiology, Biochemistry and Biophysics, Faculty of Life Science, 
Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv 
University, Tel Aviv, Israel; Department of Psychological and Brain Sciences, 
Dartmouth College, Hanover, NH, USA.
(5)School of Neurobiology, Biochemistry and Biophysics, Faculty of Life Science, 
Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv 
University, Tel Aviv, Israel; School of Psychological Sciences, Tel Aviv 
University, Tel Aviv, Israel.
(6)Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; 
Department of Anatomy and Anthropology, Faculty of Medicine, Tel Aviv 
University, Tel Aviv, Israel.
(7)Division of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, 
affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
(8)Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; The 
Strauss Center for Computational Neuroimaging, Tel Aviv University, Tel Aviv, 
Israel; Department of Anatomy and Anthropology, Faculty of Medicine, Tel Aviv 
University, Tel Aviv, Israel.
(9)School of Neurobiology, Biochemistry and Biophysics, Faculty of Life Science, 
Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv 
University, Tel Aviv, Israel; The Strauss Center for Computational Neuroimaging, 
Tel Aviv University, Tel Aviv, Israel.
(10)School of Neurobiology, Biochemistry and Biophysics, Faculty of Life 
Science, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, 
Tel Aviv University, Tel Aviv, Israel; The Strauss Center for Computational 
Neuroimaging, Tel Aviv University, Tel Aviv, Israel. Electronic address: 
assafyan@tauex.tau.ac.il.

The coronavirus disease 2019 (COVID-19) outbreak introduced unprecedented 
health-risks, as well as pressure on the economy, society, and psychological 
well-being due to the response to the outbreak. In a preregistered study, we 
hypothesized that the intense experience of the outbreak potentially induced 
stress-related brain modifications in the healthy population, not infected with 
the virus. We examined volumetric changes in 50 participants who underwent MRI 
scans before and after the COVID-19 outbreak and lockdown in Israel. Their scans 
were compared with those of 50 control participants who were scanned twice prior 
to the pandemic. Following COVID-19 outbreak and lockdown, the test group 
participants uniquely showed volumetric increases in bilateral amygdalae, 
putamen, and the anterior temporal cortices. Changes in the amygdalae diminished 
as time elapsed from lockdown relief, suggesting that the intense experience 
associated with the pandemic induced transient volumetric changes in brain 
regions commonly associated with stress and anxiety. The current work utilizes a 
rare opportunity for real-life natural experiment, showing evidence for brain 
plasticity following the COVID-19 global pandemic. These findings have broad 
implications, relevant both for the scientific community as well as the general 
public.

Copyright © 2021. Published by Elsevier Inc.

DOI: 10.1016/j.neuroimage.2021.118311
PMID: 34182098 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare no competing interests.


3301. COPD. 2021 Aug;18(4):443-448. doi: 10.1080/15412555.2021.1941834. Epub 2021 Jun 
28.

Distancing Measures in COVID-19 Pandemic: Loneliness, More than Physical 
Isolation, Affects Health Status and Psycho-Cognitive Wellbeing in Elderly 
Patients with Chronic Obstructive Pulmonary Disease.

Scarlata S(1), Cardaci V(2), Santangelo C(3), Matarese M(3), Cesari M(4)(5), 
Antonelli Incalzi R(1).

Author information:
(1)Geriatrics, Unit of Respiratory Pathophysiology, Campus Bio-Medico University 
and Teaching Hospital, Rome, Italy.
(2)Pulmonary Rehabilitation, IRCCS San Raffaele Pisana Scientific Institute, 
Rome, Italy.
(3)Research Unit, Nursing Science, Campus Bio-Medico di Roma University, Rome, 
Italy.
(4)Geriatric Unit, Maugeri Clinical Research Institute (IRCCS), Milan, Italy.
(5)Department of Clinical Sciences and Community Health, University of Milan, 
Milan, Italy.

Since the outbreak of the SARS-CoV-2 pandemic in 2020, many governments have 
been imposing confinement and physical distancing measures. No data exist on the 
effects of lockdowns on the health status of patients affected by chronic 
pathologies, specifically those with Chronic Obstructive Pulmonary Disease 
(COPD). Our study aims to establish variations across the psychological and 
cognitive profile of patients during the isolation period in Italy, in a cohort 
of patients affected by COPD, between February and May 2020. Forty patients with 
established COPD were comprehensively evaluated by geriatric multidimensional 
assessment before the spread of the epidemic in Italy, and submitted to a second 
evaluation during the subsequent lockdown. We assessed functional ability, basic 
and instrumental Activities of Daily Living (ADL and IADL), cognition and mood 
status. We compared the scores obtained at baseline against those obtained 
during the pandemic, and used mean differences for correlation with major 
clinical and functional indexes. The score differences from MMSE, ADL and IADL 
were statistically significant. Such differences were correlated to the presence 
of a caregiver and to the total number of family members living together. 
Remarkably, the loneliness dimension, more than the restrictions themselves, 
seemed to represent the major determinant of altered health status and depressed 
psycho-cognitive profile in our population. Also remarkably, we detected no 
correlation between the score variation and the respiratory function indexes of 
disease severity. The isolation measures adopted during the SARS-CoV-2 pandemic 
have triggered the classic clinical string associated to geriatric isolation, 
which leads to a deterioration of cognitive functions, independence and frailty 
levels in a population affected by a chronic degenerative disease, such as COPD. 
If considered from a multidimensional geriatric point of view, the individual 
benefit of isolation measures could be small or non-existent.

DOI: 10.1080/15412555.2021.1941834
PMID: 34180766 [Indexed for MEDLINE]


3302. Front Public Health. 2021 Jun 10;9:674665. doi: 10.3389/fpubh.2021.674665. 
eCollection 2021.

Perceptions of Study Conditions and Depressive Symptoms During the COVID-19 
Pandemic Among University Students in Germany: Results of the International 
COVID-19 Student Well-Being Study.

Matos Fialho PM(1), Spatafora F(1), Kühne L(2), Busse H(2), Helmer SM(3), Zeeb 
H(2)(4), Stock C(3), Wendt C(5), Pischke CR(1).

Author information:
(1)Institute of Medical Sociology, Centre for Health and Society, Medical 
Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany.
(2)Department Prevention and Evaluation, Leibniz-Institute for Prevention 
Research and Epidemiology - BIPS, Bremen, Germany.
(3)Institute of Health and Nursing Science, Charité - Universitätsmedizin 
Berlin, Berlin, Germany.
(4)Health Sciences Bremen, University of Bremen, Bremen, Germany.
(5)Sociology of Health and Health Care Systems, University Siegen, Siegen, 
Germany.

Background: Results of previous studies examining the impact of the SARS-CoV-1 
epidemic in 2003 on university students' mental well-being indicated severe 
mental health consequences. It is unclear how the current COVID-19 pandemic and 
the changes in study conditions due to federal regulations affected mental 
well-being in the German student population. We examined university students' 
perceptions of study conditions during the COVID-19 pandemic and investigated 
associations between study conditions and depressive symptoms. Methods: A 
cross-sectional online survey was conducted in Germany in May 2020 at four 
universities (N = 5,021, 69% female, mean age: 24 years, SD: 5.1). Perceived 
study conditions, as well as sociodemographic information, were assessed with 
self-generated items and the CES-D 8 scale was used to determine depressive 
symptoms. Associations between perceived study conditions (academic stress and 
academic satisfaction), in general, and confidence to complete the semester, in 
particular, and depressive symptoms were analyzed using generalized linear 
regressions. Results: Fifty-four percent of survey participants felt that the 
university workload had significantly increased since the COVID-19 pandemic; 48% 
were worried that they would not be able to successfully complete the academic 
year; 47% agreed that the change in teaching methods caused significant stress. 
Regarding depressive symptoms, the mean score of the CES-D 8 scale was 9.25. 
Further, a positive association between perceived study conditions and 
depressive symptoms was found (p < 0.001), indicating that better study 
conditions were associated with fewer depressive symptoms. Results of the 
generalized linear regression suggest that better student mental well-being was 
related to higher confidence in completing the semester. Conclusions: This study 
provides first insights into perceived study conditions and associations with 
depressive symptoms among students during the COVID-19 pandemic in Germany. 
Findings underline the need for universities to provide intervention strategies 
targeting students' mental well-being during the course of the pandemic.

Copyright © 2021 Matos Fialho, Spatafora, Kühne, Busse, Helmer, Zeeb, Stock, 
Wendt and Pischke.

DOI: 10.3389/fpubh.2021.674665
PMCID: PMC8222519
PMID: 34178930 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


3303. Aust Crit Care. 2022 May;35(3):321-329. doi: 10.1016/j.aucc.2021.04.009. Epub 
2021 Jun 24.

The experiences of 'significant others' supporting people with severe burn 
injury: An integrative literature review.

Flannery E(1), Halcomb E(2), Peters K(3), Murphy G(4), Ramjan LM(5).

Author information:
(1)School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, 
Penrith, NSW, 2751, Australia. Electronic address: 
l.flannery@westernsydney.edu.au.
(2)Primary Health Care Nursing, School of Nursing, Faculty of Science, Medicine 
& Health, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, 
Australia. Electronic address: ehalcomb@uow.edu.au.
(3)School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, 
Penrith, NSW, 2751, Australia. Electronic address: 
k.peters@westernsydney.edu.au.
(4)School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, 
Penrith, NSW, 2751, Australia. Electronic address: 
g.murphy@westernsydney.edu.au.
(5)School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, 
Penrith, NSW, 2751, Australia. Electronic address: 
l.ramjan@westernsydney.edu.au.

BACKGROUND: Severe burn injury is a traumatic experience for both patients and 
their significant others. Although research has focused on the experience of 
people with burn injury, there is a paucity of research focusing on the 
experiences of the significant other. Significant others are frequently expected 
to advocate and make decisions on behalf of the patient, which may have an 
impact on their psychological wellbeing. An understanding of the experiences of 
significant others will inform strategies to better support their needs.
OBJECTIVES: The aim of this integrative literature review was to critically 
examine research related to the experiences of significant others supporting a 
patient with a severe burn injury in the hospital.
METHODS: CINAHL Plus with Full Text (EBSCO), MEDLINE ALL (Ovid), Scopus, and APA 
PsycINFO were searched up to December 2019 for English language studies using 
search terms burns, significant other, ICU, and psychological impact. Records 
were independently screened and assessed for methodological quality, and the 
data were synthesised.
RESULTS: Nine articles were included in the review. Three used a quantitative 
approach, and six were qualitative studies. Three major themes were identified, 
namely, (i) psychological consequences and emotional trauma, (ii) redefining 
relationships, and (iii) coping strategies.
CONCLUSION: The review identified that significant others experience adverse 
psychological consequences including post-traumatic stress, anxiety, and 
depression. The burn injury resulted in a redefining of relationships with 
others and particularly with the patient through this shared experience. 
Significant others found ways to adapt to stressors, including taking control of 
the situation and seeking greater involvement in the patient's care.

Copyright © 2021 Australian College of Critical Care Nurses Ltd. Published by 
Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.aucc.2021.04.009
PMID: 34176734 [Indexed for MEDLINE]


3304. Arch Psychiatr Nurs. 2021 Aug;35(4):401-406. doi: 10.1016/j.apnu.2021.05.003. 
Epub 2021 May 11.

Mental wellness among psychiatric-mental health nurses during the COVID-19 
pandemic.

Kameg BN(1), Fradkin D(2), Lee H(2), Mitchell A(2).

Author information:
(1)University of Pittsburgh School of Nursing, Department of Health and 
Community Systems, 3500 Victoria St., Pittsburgh, PA 15213, United States of 
America. Electronic address: Bnk13@pitt.edu.
(2)University of Pittsburgh School of Nursing, Department of Health and 
Community Systems, 3500 Victoria St., Pittsburgh, PA 15213, United States of 
America.

Psychiatric nursing providers and their unique challenges in the face of the 
COVID-19 pandemic are not well-represented in the literature. Therefore, this 
study sought to describe mental well-being of psychiatric nurses, and sought to 
elucidate factors related to mental wellness during the COVID-19 pandemic. This 
study utilized cross-sectional survey methodology to evaluate burnout, mental 
wellness, COVID-related anxiety, professional fulfillment, depressive symptoms, 
and anxiety symptoms among psychiatric nurses. There was a total of 151 
respondents. A linear regression model was employed to identify predictors of 
mental wellness. The final regression model included the following predictors: 
depressive symptoms, burnout, professional fulfillment, and educational status. 
These predictors together accounted for 73% of the variance for the outcome 
variable of mental well-being.

Copyright © 2021 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.apnu.2021.05.003
PMCID: PMC8110327
PMID: 34176581 [Indexed for MEDLINE]


3305. Child Psychiatry Hum Dev. 2022 Oct;53(5):853-862. doi: 
10.1007/s10578-021-01211-9. Epub 2021 Jun 26.

Psychological Symptoms in Italian, Spanish and Portuguese Youth During the 
COVID-19 Health Crisis: A Longitudinal Study.

Orgilés M(1), Francisco R(2), Delvecchio E(3), Espada JP(4), Mazzeschi C(3), 
Pedro M(2), Morales A(4).

Author information:
(1)Department of Health Psychology, Universidad Miguel Hernández, Avda. de La 
Universidad S/N, Elche, 03202, Alicante, Spain. morgiles@umh.es.
(2)Universidade Católica Portuguesa, Porto, Portugal.
(3)Università Degli Studi Di Perugia, Perugia, Italy.
(4)Department of Health Psychology, Universidad Miguel Hernández, Avda. de La 
Universidad S/N, Elche, 03202, Alicante, Spain.

Aiming to slow down the spread of the COVID-19, a lockdown was declared in the 
first term of 2020 in many European countries, applying different restrictions 
measures. Although the psychological effects of home confinement in children 
have been described, there is a lack of longitudinal research examining the 
impact of the confinement over time. The present study analyzes the evolution of 
the psychological wellbeing of children and adolescents from three European 
countries with different restrictions. Parents of 624 Italian, Spanish, and 
Portuguese children and adolescents aged 3 to 18 years old completed the "Impact 
Scale of COVID-19 and Home Confinement on Children and Adolescents" two, five, 
and eight weeks after the lockdown. Results show a different pattern for each 
country. Children from Italy, the first European country that applied a 
lockdown, were better adapted than Spanish and Portuguese children the first two 
weeks after confinement but they were more psychologically impacted by home 
confinement at the eight-week assessment. Portuguese children, who followed a 
general duty of home confinement, were the best adapted to the situation, with 
no significant differences over time. A significant change was found in anxiety 
symptoms in Spanish children, with a decrease at the last assessment. Findings 
suggest that long confinements and hard restrictions affect children, so 
prevention measures should be applied during confinements to prevent 
psychological problems in children.

© 2021. The Author(s).

DOI: 10.1007/s10578-021-01211-9
PMCID: PMC8233185
PMID: 34173126 [Indexed for MEDLINE]


3306. Evid Based Dent. 2021 Jan;22(2):69. doi: 10.1038/s41432-021-0181-3.

COVID-19, social media use and anxiety: more complex than it might appear?

Newton T(1).

Author information:
(1)King's College London, London, UK.

Comment on
    BMC Psychol. 2021 Jan 21;9(1):9.

Design Cross-sectional questionnaire survey of 403 dental healthcare 
workers.Sample selection Snowball sampling via social media.Data analysis 
Descriptive analysis of sample. Bivariate analysis of the relationship between 
demographic variables, social media use and anxiety. Binary logistic regression 
analysis predicting: 1) use of social media; and 2) general anxiety.Results 1) 
Social media use was predicted by moderate/severe anxiety level; 2) general 
anxiety level was predicted by being female and more frequent social media 
use.Conclusions The authors conclude that social media reporting of COVID-19 
information had adversely affected the psychological wellbeing of dental 
healthcare workers.

DOI: 10.1038/s41432-021-0181-3
PMCID: PMC8226352
PMID: 34172911 [Indexed for MEDLINE]


3307. J Pediatr Endocrinol Metab. 2021 Jun 28;34(9):1089-1093. doi: 
10.1515/jpem-2021-0153. Print 2021 Sep 27.

Anxiety, depression, and glycemic control during Covid-19 pandemic in youths 
with type 1 diabetes.

Cusinato M(1), Martino M(1), Sartori A(1), Gabrielli C(1), Tassara L(1), 
Debertolis G(1), Righetto E(1), Moretti C(1).

Author information:
(1)Pediatric Diabetes Unit, Department of Women's and Children's Health, Azienda 
Ospedale Università di Padova, Padua, Italy.

OBJECTIVES: Our study aims to assess the impact of lockdown during the 
coronavirus disease 2019 pandemic on glycemic control and psychological 
well-being in youths with type 1 diabetes.
METHODS: We compared glycemic metrics during lockdown with the same period of 
2019. The psychological impact was evaluated with the Test of Anxiety and 
Depression.
RESULTS: We analyzed metrics of 117 adolescents (87% on Multiple Daily 
Injections and 100% were flash glucose monitoring/continuous glucose monitoring 
users). During the lockdown, we observed an increase of the percentage of time 
in range (TIR) (p<0.001), with a significant reduction of time in moderate 
(p=0.002), and severe hypoglycemia (p=0.001), as well as the percentage of time 
in hyperglycemia (p<0.001). Glucose variability did not differ (p=0.863). The 
glucose management indicator was lower (p=0.001). 7% of youths reached the 
threshold-score (≥115) for anxiety and 16% for depression. A higher score was 
associated with lower TIR [p=0.028, p=0.012].
CONCLUSIONS: Glycemic control improved during the first lockdown period with 
respect to the previous year. Symptoms of depression and anxiety were associated 
with worse glycemic control; future researches are necessary to establish if 
this improvement is transient and if psychological difficulties will increase 
during the prolonged pandemic situation.

© 2021 Maria Cusinato et al., published by De Gruyter, Berlin/Boston.

DOI: 10.1515/jpem-2021-0153
PMID: 34171940 [Indexed for MEDLINE]


3308. J Assoc Physicians India. 2021 Apr;69(4):22-26. doi: 10.0104/japi.2021.03.

Psychiatric Sequelae and COVID Experiences of Post COVID -19 Recovered Resident 
Doctors and Interns of a Tertiary General Hospital in Mumbai.

Sawant N(1), Ingawale S(2), Lokhande U(3), Patil S(3), Ayub EFM(4), Rathi V(4).

Author information:
(1)Professor & HOU, Department of Psychiatry, Corresponding Author.
(2)PGY-3 Resident, Department of Medicine.
(3)Pre-Final year MBBS Student.
(4)Final Year MBBS Student, Seth GSMC & KEM Hospital, Mumbai, Maharashtra.

BACKGROUND: The wide and profound psychological impact of the COVID pandemic on 
people has been demonstrated by several studies. A survey from the Indian 
Medical Association (IMA) showed that at least 500 doctors have been infected 
across Maharashtra, with Mumbai doctors making it to the top of the list. The 
most infected are the resident doctors working in government hospitals. A few 
doctors also have lost their lives while working in this pandemic. The delicate 
balance between duty, altruism and fear for oneself and others often causes 
conflict and feelings of helplessness and dissonance in many health care 
personnel with a fear to resume back the duty, especially after being a COVID 
victim. There have been hardly any studies yet, related to understanding the 
emotional and general well being of COVID-19 positive health care workers who 
have recovered and resumed their duties.
AIMS AND OBJECTIVES: To study in post COVID-19 recovered resident doctors and 
interns the presence of anxiety and depressive symptoms, sleep changes, general 
well-being, perceptions of their COVID experience and association of general 
wellbeing with anxiety, depression and sleep changes.
METHODS: The study was conducted after institutional ethics committee permission 
and online informed consent from the participants which included medical interns 
and resident doctors of our institute. A Google form with questions and scales 
pertaining to the aims of the study (Patient Health Questionnaire, Zung Self 
Rating Anxiety Scale, Warwick Edinburgh Mental Well Being Scale and Insomnia 
Symptom Questionnaire) was sent on the Google link to the 150 interns and 
resident doctors via whatsapp who had recovered from COVID 19 infection. Their 
details were taken from hospital database with Dean permission.
RESULTS: 79 responded to the link with the mean duration of COVID infection 
being 16.1 ± 8.59 days. 64 participants were hospitalized and 18 participants 
had lung parenchymal involvement. 28 participants had depressive symptoms on the 
patient health questionnaire. Only 4 participants experienced anxiety as per 
Zung self rating anxiety scale. 69 participants had greater well being with 
scores higher than 40 on the Warwick Edinburgh mental well being scale. 8 
participants had sleep related issues affecting their work. A negative 
correlation of general well being was seen with depression, anxiety and insomnia 
which was highly significant. The most distressing of COVID experiences were 
being isolated in a room, transmitting disease to near and dear ones and 
possibility of a serious complication. Re infection, workload followed by use of 
PPE was the major concern.Many described their COVID experience as boring, 
depressing with feelings of loneliness.
CONCLUSIONS: Our study is the first of its kind to evaluate the psychiatric 
sequelae and COVID experiences of post COVID-19 recovered resident doctors and 
interns. Psychosocial and institutional support will definitely help in 
improving the post COVID sequelae in the resident doctors and interns.

DOI: 10.0104/japi.2021.03
PMID: 34170653 [Indexed for MEDLINE]


3309. World J Pediatr. 2021 Jun;17(3):280-289. doi: 10.1007/s12519-021-00439-8. Epub 
2021 Jun 25.

Maternal mental health and well-being during the COVID-19 pandemic in Beijing, 
China.

Wei Z(1), Gao MY(2), Fewtrell M(2), Wells J(2), Yu JY(3).

Author information:
(1)Department of Child Healthcare, Beijing Children's HospitalCapital Medical 
UniversityNational Center for Children's Health, Beijing, China.
(2)Population, Policy and Practice Research and Teaching Department, UCL Great 
Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, 
UK.
(3)Population, Policy and Practice Research and Teaching Department, UCL Great 
Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, 
UK. jin.yu.16@ucl.ac.uk.

BACKGROUND: The aim of this study is to evaluate the impact of the coronavirus 
disease 2019 (COVID-19) pandemic on breastfeeding women and to identify 
predictors of maternal mental health and coping.
METHODS: Mothers aged ≥ 18 years with a breast-fed infant ≤ 18 months of age 
during the COVID-19 pandemic in Beijing, China, completed a questionnaire. 
Descriptive analysis of lockdown consequences was performed and predictors of 
these outcomes were examined using stepwise linear regression.
RESULTS: Of 2233 participants, 29.9%, 20.0% and 34.7% felt down, lonely, and 
worried, respectively, during the lockdown; however, 85.3% felt able to cope. 
Poorer maternal mental health was predicted by maternal (younger age, higher 
education) and infant (older age, lower gestation) characteristics, and social 
circumstances (husband unemployed or working from home, receiving advice from 
family, having enough space for the baby, living close to a park or green 
space). Conversely, better maternal mental health was predicted by higher 
income, employment requiring higher qualifications, more personal space at home, 
shopping or walking > once/week and lack of impact of COVID-19 on job or income. 
Mothers with higher education, more bedrooms, fair division of household chores 
and attending an online mother and baby group > once/week reported better 
coping.
CONCLUSION: The findings highlight maternal characteristics and circumstances 
that predict poorer mental health and reduced coping which could be used to 
target interventions in any future public health emergencies requiring social 
restrictions.

DOI: 10.1007/s12519-021-00439-8
PMCID: PMC8231088
PMID: 34170504 [Indexed for MEDLINE]

Conflict of interest statement: No financial or non-financial benefits have been 
received or will be received from any party related directly or indirectly to 
the subject of this article. Professor Mary Fewtrell receives an unrestricted 
donation for research on infant nutrition from Philips. The remaining authors 
declare no other conflicts.


3310. Dan Med J. 2021 Jun 11;68(7):A11200805.

Academic stress in Danish medical and health science students during the 
COVID-19 lock-down.

Guldager JD(1), Jervelund S, Berg-Beckhoff G.

Author information:
(1)jguldager@health.sdu.dk.

INTRODUCTION: COVID-19 has disrupted normal life and resulted in an online 
transformation of teaching. Little is known about how these changes affected 
academic stress in students. This study examined the role of changes of teaching 
methods on academic stress among university students during the first lockdown 
in Denmark.
METHODS: The cross-sectional survey was part of the international "COVID-19 
International Student Well-being Study" and included responses on socio-economic 
characteristics, infection worries, academic stress, work capacity and 
satisfaction with teaching from 1,541 Danish health and medical science 
university students in May-June 2020. Changes in academic stress were analysed 
using descriptive statistics and multi-variable analyses using stepwise logistic 
regression.
RESULTS: A considerable part (39%) of students reported academic stress due to 
COVID-19. One third reported that their study workload had increased 
significantly due to the COVID-19 outbreak and that they were concerned about 
their ability to complete the academic year. Factors associated with academic 
stress were female sex, young age, bachelor level, knowing a COVID-19 patient 
and being worried about becoming infected, whereas immigration background, 
sufficient financial resources and living arrangements were not.
CONCLUSIONS: Our findings suggest that the COVID-19 outbreak has influenced 
university students' academic stress. It is important to set up structures to 
support students' mental health and educational trajectory during the pandemic.
FUNDING: none.
TRIAL REGISTRATION: not relevant.

Articles published in the DMJ are “open access”. This means that the articles 
are distributed under the terms of the Creative Commons Attribution 
Non-commercial License, which permits any non-commercial use, distribution, and 
reproduction in any medium, provided the original author(s) and source are 
credited.

PMID: 34169831 [Indexed for MEDLINE]


3311. PLoS One. 2021 Jun 24;16(6):e0253087. doi: 10.1371/journal.pone.0253087. 
eCollection 2021.

Mechanisms of parental distress during and after the first COVID-19 lockdown 
phase: A two-wave longitudinal study.

Johnson MS(1), Skjerdingstad N(2), Ebrahimi OV(2)(3), Hoffart A(2)(3), Urnes 
Johnson S(2)(3).

Author information:
(1)Oslo Metropolitan University, Oslo, Norway.
(2)Department of Psychology, University of Oslo, Oslo, Norway.
(3)Modum Bad Psychiatric Hospital, Vikersund, Norway.

BACKGROUND: In these unpredictable times of the global coronavirus disease 2019 
(COVID-19) pandemic, parents worldwide are affected by the stress and strain 
caused by the physical distancing protocols that have been put in place.
OBJECTIVE: In a two-wave longitudinal survey, we investigated the levels of 
parental stress and symptoms of anxiety and depression in a sample of parents at 
two time points; during the implementation of the strictest physical distancing 
protocols following the onset of the COVID-19 pandemic (T1, N = 2,868) and three 
months after the discontinuation of the protocols (T2, N = 1,489). Further, we 
investigated the relationships between parental stress and anxiety and 
depression relative to relationship quality and anger toward their children at 
the two aforementioned time points, including subgroups based on age, parental 
role, cultural background, relationship status, education level, number of 
children, employment status and pre-existing psychiatric diagnosis.
METHODS AND FINDINGS: Parents were asked to fill out a set of validated 
questionnaires on the two measurement points. Parental stress significantly 
decreased from T1 to T2, indicating that the cumulative stress that parents 
experienced during the implementation of the distancing protocols declined when 
the protocols were phased out. The decrease of perceived parental stress was 
accompanied by a significant decrease in the symptoms of both depression and 
anxiety among the participating parents. Symptoms meeting the clinical cut-offs 
for depression (23.0%) and generalized anxiety disorder (23.3%) were reported 
among participating parents at T1, compared to 16.8% and 13.8% at T2, 
respectively. The reduction in depression and anger toward their child(ren) from 
T1 to T2 was associated with a reduction of parental stress. Relationship 
quality and anger toward their child(ren) at T1 further predicted a change in 
the level of parental stress from T1 to T2.
CONCLUSIONS: The study underlines the negative psychological impacts of the 
implementation of the distancing protocols on parents' health and well-being. 
Uncovering the nature of how these constructs are associated with parents and 
families facing a social crisis such as the ongoing pandemic may contribute to 
the design of relevant interventions to reduce parental distress and strengthen 
parental coping and resilience.

DOI: 10.1371/journal.pone.0253087
PMCID: PMC8224894
PMID: 34166429 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


3312. Psychol Res. 2022 Jun;86(4):1203-1214. doi: 10.1007/s00426-021-01550-1. Epub 
2021 Jun 24.

Daily mindfulness training reduces negative impact of COVID-19 news exposure on 
affective well-being.

Kam JWY(1), Javed J(2), Hart CM(2), Andrews-Hanna JR(3), Tomfohr-Madsen LM(2), 
Mills C(4).

Author information:
(1)Department of Psychology, University of Calgary, 2500 University Drive NW, 
Calgary, AB, Canada. julia.kam@ucalgary.ca.
(2)Department of Psychology, University of Calgary, 2500 University Drive NW, 
Calgary, AB, Canada.
(3)Department of Psychology; Cognitive Science, University of Arizona, 1503 E 
University Blvd, Tucson, AZ, USA.
(4)Department of Psychology, University of New Hampshire, 105 Main St, Durham, 
NH, USA.

COVID-19 has led to mental health adversities worldwide. The current study 
examined whether daily practice of brief mindfulness training has a beneficial 
impact on affective well-being, and mitigates the negative impact of exposure to 
COVID-19 news during the pandemic. Participants were randomly assigned into a 
mindfulness training (MT) group or a waitlist control (WC) group. Participants 
in the MT group practiced guided mindfulness meditation for a minimum of 10 min 
each day for 10 days. Both groups completed questionnaires assessing well-being 
at baseline and after the 10-day period. We also included four ecological 
momentary assessments (EMA) interspersed throughout the day to measure 
fine-grained affective states and recent exposure to COVID-19-related news, 
which has been linked to negative affect. We observed an increase in positive 
affect in the MT group compared to the WC group in the post-training assessment. 
However, no group differences emerged in the other three post-training affective 
measures of negative affect, anxiety and depression. EMA revealed that the MT 
group also showed more positive affective valence than the WC group across the 
10 days. Notably, the WC group reported more negative affective valence 
following COVID-19 news exposure, whereas the MT group was not impacted. Taken 
together, our study indicates brief sessions of guided mindfulness meditation 
during COVID-19 may boost positive affect and serve as a protective buffer 
against the negative impact of exposure to COVID-19-related news on affective 
well-being. These findings highlight the utility of mindfulness meditation as an 
accessible and cost-effective technique to elevate positive affect amidst the 
COVID-19 pandemic.

© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, 
part of Springer Nature.

DOI: 10.1007/s00426-021-01550-1
PMCID: PMC8222951
PMID: 34165612 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare they have no conflicts of 
interest.


3313. J Intellect Disabil Res. 2021 Oct;65(10):879-889. doi: 10.1111/jir.12862. Epub 
2021 Jun 24.

The impact of COVID-19 on the social inclusion of older adults with an 
intellectual disability during the first wave of the pandemic in Ireland.

McCausland D(1), Luus R(1), McCallion P(2), Murphy E(1), McCarron M(1).

Author information:
(1)Trinity Centre for Ageing and Intellectual Disability, School of Nursing and 
Midwifery, Trinity College Dublin, Dublin, Ireland.
(2)Temple University, Philadelphia, PA, USA.

Comment in
    Evid Based Nurs. 2023 Jul;26(3):117.

BACKGROUND: Social restrictions and service closures from COVID-19 have 
negatively impacted social inclusion and well-being for some people with 
intellectual disabilities (IDs).
METHODS: The fourth wave of a national longitudinal study on ageing in people 
with ID in Ireland was interrupted during the COVID-19 outbreak. Social 
inclusion data for pre-existing participants interviewed before COVID-19 
(n = 444) were compared with data for pre-existing participants interviewed 
during/after lockdown (n = 62).
RESULTS: More people interviewed after lockdown reported frequent family 
contact. Significantly greater numbers in the post-lockdown group reported 
access to and use of technology than the pre-lockdown group. Technology use was 
higher among those living in grouped residences supported by services compared 
with individuals living independently or with family.
CONCLUSIONS: During the early stages of the COVID-19 pandemic in Ireland, many 
older adults with ID stayed connected with family and reported rates of contact 
higher than were reported by others before COVID-19. This connection may have 
been supported by a significant increase in technology use during the pandemic. 
However, uneven use of technology may disadvantage some including individuals 
living with family or independently. Given that COVID-19 restrictions are likely 
to continue to restrict social opportunities, increased digital support may 
assist more people with ID to use technology to maintain their social 
connections.

© 2021 The Authors. Journal of Intellectual Disability Research published by 
MENCAP and International Association of the Scientific Study of Intellectual and 
Developmental Disibilities and John Wiley & Sons Ltd.

DOI: 10.1111/jir.12862
PMCID: PMC8447302
PMID: 34165228 [Indexed for MEDLINE]

Conflict of interest statement: There are no conflicts of interest associated 
with this study.


3314. J Psychosom Obstet Gynaecol. 2022 Sep;43(3):315-326. doi: 
10.1080/0167482X.2021.1929162. Epub 2021 Jun 24.

Prevalence of anxiety and depression among pregnant women during the COVID-19 
pandemic: a meta-analysis.

Ghazanfarpour M(1), Bahrami F(2), Rashidi Fakari F(3), Ashrafinia F(1), 
Babakhanian M(4), Dordeh M(5), Abdi F(6).

Author information:
(1)Student Research Committee, Kerman University of Medical Sciences, Kerman, 
Iran.
(2)Shiraz University of Medical Science, Shiraz, Iran.
(3)Department of Midwifery, School of Medicine, North Khorasan University of 
Medical Sciences, Bojnurd, Iran.
(4)Abnormal Uterine Bleeding Research Center, Semnan University of Medical 
Sciences, Semnan, Iran.
(5)Department of Psychology, Bandar Abbas Branch, Islamic Azad University, 
Bandar Abbas, Iran.
(6)School of Nursing and Midwifery, Alborz University of Medical Sciences, 
Karaj, Iran.

PURPOSE: Coronavirus disease (COVID-19) is a newly emerged respiratory illness, 
which has spread around the world. Pregnant women are exposed to additional 
pressure due to the indirect adverse effects of this pandemic on their physical 
and mental health. Since the psychological wellness framework is weak in 
developing countries, it is likely that geographical factors affect the 
prevalence. Therefore, the goal of this meta-analysis is to investigate the 
prevalence of anxiety and depression among pregnant women during the COVID-19 
pandemic.
METHODS: We searched databases including PubMed/MEDLINE, Web of Science, 
Cochrane Library for articles. The quality of studies was determined based on 
the STROBE checklist. I2 and Cochrane Q-test were used to determine 
heterogeneity. Fixed effects and/or random effects models were also employed to 
estimate pooled prevalence.
RESULTS: Since heterogeneity was fairly high in all analyses, the random effect 
model was used. According to the results of random effects in the meta-analysis, 
the pooled prevalence was 18.7% (95% CI: 0.06-0.36%; I2 = 99%, P < 0.001) for 
anxiety and 25.1% (95% CI: 0.18-0.33%; I2 = 97%,  P < 0.001) for depression. The 
results of continent subgroup analysis showed that the prevalence of anxiety was 
higher in western country (38%) than in Asia country (7.8%). The prevalence of 
anxiety in Italy (38%), Canada (56%), Pakistan (14%), Greece (53%), Sri Lanka 
(17.5%), and China (0.3-29%) and Iran 3.8% as well as the prevalence of 
depression in Canada (37%), Belgium (25%), Turkey (35.4%), Sri Lanka (19.5%), 
and China (11-29%) has been reported.
CONCLUSION: Covid-19 may impose extra pressure on the emotional wellbeing of 
pregnant women. Therefore, there is an urgent need for resources to help 
mitigate anxiety and depression in pregnant women.

DOI: 10.1080/0167482X.2021.1929162
PMID: 34165032 [Indexed for MEDLINE]


3315. Health Promot Chronic Dis Prev Can. 2021 Sep 22;41(9):254-263. doi: 
10.24095/hpcdp.41.9.02. Epub 2021 Jun 23.

Changes in alcohol consumption during the COVID-19 pandemic: exploring gender 
differences and the role of emotional distress.

Thompson K(1), Dutton DJ(2), MacNabb K(2), Liu T(2), Blades S(3), Asbridge M(2).

Author information:
(1)Department of Psychology, Faculty of Arts, St. Francis Xavier University, 
Antigonish, Nova Scotia, Canada.
(2)Department of Community Health and Epidemiology, Faculty of Medicine, 
Dalhousie University, Halifax, Nova Scotia, Canada.
(3)Health Promotion Team, Mental Health and Addictions, IWK Health, Halifax, 
Nova Scotia, Canada.

INTRODUCTION: Restrictions to do with the COVID-19 pandemic have had substantial 
unintended consequences on Canadians' alcohol consumption patterns, including 
increased emotional distress and its potential impact on alcohol use. This study 
examines 1) changes in adults' alcohol consumption during the COVID-19 pandemic 
in New Brunswick and Nova Scotia; 2) whether drinking more frequently during the 
pandemic is associated with increased feelings of stress, loneliness and 
hopelessness; and 3) whether gender moderates this relationship.
METHODS: Participants were drawn from a cross-sectional survey of 2000 adults. 
Adjusted multinomial regression models were used to assess the association 
between drinking frequency and increased feelings of stress, loneliness and 
hopelessness. Additional analyses were stratified by gender.
RESULTS: About 12% of respondents reported drinking more frequently after the 
start of the COVID-19 pandemic, and 25%-40% reported increased emotional 
distress. Increased feelings of stress (odds ratio [OR] = 1.99; 95% confidence 
interval [CI]: 1.35-2.93), loneliness (OR = 1.79; 95% CI: 1.22-2.61) and 
hopelessness (OR = 1.98; 95% CI: 1.21-3.23) were all associated with drinking 
more frequently during the pandemic. While women respondents reported higher 
rates of emotional distress, significant associations with increased drinking 
frequency were only observed among men in gender-stratified analyses.
CONCLUSION: Individuals who report increased feelings of stress, loneliness and 
hopelessness during the COVID-19 pandemic were more likely to report increased 
drinking frequency; however, these associations were only significant for men in 
stratified analyses. Understanding how the pandemic is associated with mental 
health and drinking may inform alcohol control policies and public health 
interventions to minimize alcohol-related harm.

Publisher: INTRODUCTION: Les restrictions liées à la pandémie de COVID 19 ont eu 
des effets pervers importants sur les habitudes de consommation d’alcool des 
Canadiens, en particulier l’émergence d’une plus grande détresse émotionnelle et 
ses répercussions potentielles sur la consommation d’alcool. Cette étude examine 
: 1) les modifications de la consommation d’alcool des adultes pendant la 
pandémie de COVID 19 au Nouveau Brunswick et en Nouvelle Écosse, 2) si le fait 
de boire de l’alcool plus fréquemment pendant la pandémie est associé à des 
ressentis accrus de stress, de solitude et de désespoir et 3) si le genre a un 
effet modérateur sur cette relation.
MÉTHODOLOGIE: Les participants ont été sélectionnés à partir d’une enquête 
transversale menée auprès de 2 000 adultes. Des modèles de régression 
multinomiale ajustés ont été utilisés pour évaluer l’association entre la 
fréquence de consommation d’alcool et l’augmentation des ressentis de stress, de 
solitude et de désespoir. Des analyses supplémentaires ont été stratifiées selon 
le genre.
RÉSULTATS: Environ 12 % des répondants ont déclaré avoir bu de l’alccol plus 
fréquemment après le début de la pandémie de COVID 19, et 25 à 40 % ont fait 
état d’une augmentation de leur détresse émotionnelle. L’augmentation des 
ressentis de stress (rapport de cotes [RC] = 1,99; intervalle de confiance [IC] 
à 95 % : 1,35 à 2,93), de solitude (RC = 1,79; IC à 95 % : 1,22 à 2,61) et de 
désespoir (RC = 1,98; IC à 95 % : 1,21 à 3,23) était associée à une consommation 
d’alcool plus fréquente pendant la pandémie. Quoique les femmes interrogées 
aient signalé des taux supérieurs de détresse émotionnelle, les associations 
avec une augmentation de la fréquence de consommation d’alcool n’étaient 
significatives que chez les hommes dans les analyses stratifiées selon le genre.
CONCLUSION: Si les individus ayant fait état de ressentis accrus de stress, de 
solitude et de désespoir pendant la pandémie de COVID 19 étaient plus nombreux à 
déclarer une fréquence accrue de consommation d’alcool, ces associations 
n’étaient significatives que pour les hommes dans les analyses stratifiées. 
Comprendre comment la pandémie a eu une influence sur la santé mentale et à la 
consommation d’alcool peut éclairer les politiques de contrôle de l’alcool et 
les interventions en santé publique visant à limiter les méfaits de l’alcool.

Plain Language Summary: This study examines how alcohol use and emotional 
well-being changed among New Brunswick and Nova Scotia adults following the 
start of the COVID-19 pandemic in March 2020. Since the start of the pandemic, 
12.2% of respondents consumed alcohol more frequently than before. Between 25.3% 
and 43.5% of respondents reported increased stress, loneliness and hopelessness. 
A greater proportion of women reported increased emotional distress since the 
start of the pandemic. Significant associations between increased emotional 
distress and increased alcohol consumption during the pandemic were observed but 
only among men.

Plain Language Summary: Cette étude examine comment la consommation d’alcool et 
le bien-être émotionnel ont évolué chez les adultes du Nouveau Brunswick et de 
la Nouvelle Écosse après le début de la pandémie de COVID 19 en mars 2020. 
Depuis le début de la pandémie, 12,2 % des répondants ont consommé de l’alcool 
plus fréquemment qu’auparavant. Entre 25,3 % et 43,5 % des répondants ont fait 
état d’une augmentation de leurs ressentis de stress, de solitude et de 
désespoir. Une plus grande proportion de femmes ont fait état d’une détresse 
émotionnelle accrue depuis le début de la pandémie. Des associations 
significatives entre une détresse émotionnelle accrue et une augmentation de la 
consommation d’alcool pendant la pandémie ont été observées, mais uniquement 
chez les hommes.

DOI: 10.24095/hpcdp.41.9.02
PMCID: PMC8565493
PMID: 34164972 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest.


3316. Aust Vet J. 2021 Oct;99(10):423-426. doi: 10.1111/avj.13102. Epub 2021 Jun 23.

Pet ownership and mental health during COVID-19 lockdown.

Phillipou A(1)(2)(3)(4), Tan EJ(1)(2), Toh WL(1)(5), Van Rheenen TE(1)(6), Meyer 
D(1), Neill E(1)(2)(4), Sumner PJ(1), Rossell SL(1)(2).

Author information:
(1)Centre for Mental Health, Swinburne University of Technology, Melbourne, 
Victoria, Australia.
(2)Department of Mental Health, St Vincent's Hospital, Melbourne, Victoria, 
Australia.
(3)Department of Mental Health, Austin Hospital, Melbourne, Victoria, Australia.
(4)Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, 
Australia.
(5)Department of Psychiatry, Alfred Health, Melbourne, Victoria, Australia.
(6)Melbourne Neuropsychiatry Centre, The University of Melbourne, Victoria, 
Australia.

Owning a pet has often been associated with improved mental health among owners, 
including enhanced quality of life, and decreased levels of depression and 
loneliness. The aim of this study was to identify whether owning a cat and/or 
dog was associated with better psychological wellbeing during a strict lockdown 
period in Victoria, Australia, during the COVID-19 pandemic. Data were analysed 
from a large-scale mental health study: the COvid-19 and you: mentaL heaLth in 
AusTralia now survEy (COLLATE). The impact of pet ownership on levels of 
resilience, loneliness and quality of life were examined in a sample of 138 pet 
owners and 125 non-pet owners. Hierarchical linear regression analyses indicated 
that pet ownership was significantly associated with poorer quality of life, but 
not significantly associated with resilience or loneliness, after accounting for 
situational factors (e.g. job loss) and mood states. Contrary to expectations, 
the findings suggest that during a specific situation such as a pandemic, pets 
may contribute to increased burden among owners and contribute to poorer quality 
of life.

© 2021 Australian Veterinary Association.

DOI: 10.1111/avj.13102
PMID: 34164809 [Indexed for MEDLINE]


3317. BMJ Open. 2021 Jun 23;11(6):e045474. doi: 10.1136/bmjopen-2020-045474.

Internet-assisted cognitive behavioural therapy with telephone coaching for 
anxious Finnish children aged 10-13 years: study protocol for a randomised 
controlled trial.

Luntamo T(1), Korpilahti-Leino T(1), Ristkari T(1), Hinkka-Yli-Salomäki S(1), 
Kurki M(1), Sinokki A(1), Lamminen K(1), Saanakorpi K(1), Saarinen S(1), 
Maunuksela M(1), Sourander S(1), Toivonen K(1), Zadkova A(1), Suilamo M(1), 
Casagrande L(1), Palmroth J(1), Sourander A(2).

Author information:
(1)Department of Child Psychiatry, University of Turku and Turku University 
Hospital; INVEST Research Flagship Center, University of Turku, Finland.
(2)Department of Child Psychiatry, University of Turku and Turku University 
Hospital; INVEST Research Flagship Center, University of Turku, Finland 
andsou@utu.fi.

INTRODUCTION: Childhood anxiety is common, causes significant functional 
impairment and may lead to psychosocial problems by adulthood. Although 
cognitive behavioural therapy (CBT) is effective for treating anxiety, its 
availability is limited by the lack of trained CBT therapists and easily 
accessible local services. To address the challenges in both recognition and 
treatment, this study combines systematic anxiety screening in the general 
population with a randomised controlled trial (RCT) on internet-assisted CBT 
(ICBT) with telephone coaching. Child, family and intervention-related factors 
are studied as possible predictors or moderators, together with the COVID-19 
pandemic.
METHODS AND ANALYSIS: The study is an open two-parallel group RCT, stratified by 
sex, that compares ICBT with telephone coaching to an education control. 
Children aged 10-13 are screened at yearly school healthcare check-ups using 
five items from the Screen for Child Anxiety Related Disorders (SCARED) 
Questionnaire. The families of children who screen positive for anxiety are 
contacted to assess the family's eligibility for the RCT. The inclusion criteria 
include scoring at least 22 points in the 41-item SCARED Questionnaire. The 
primary outcome is the SCARED child and parent reports. The secondary outcomes 
include the impact of anxiety, quality of life, comorbidity, peer relationships, 
perceptions of school, parental well-being and service use. Additional measures 
include demographics and life events, anxiety disorder diagnoses, as well as 
therapeutic partnerships, the use of the programme and general satisfaction 
among the intervention group.
ETHICS AND DISSEMINATION: The study has been approved by the research ethics 
board of the Hospital District of South West Finland and local authorities. 
Participation is voluntary and based on informed consent. The anonymity of the 
participants will be protected and the results will be published in a scientific 
journal and disseminated to healthcare professionals and the general public.
TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT03310489, pre-results, 
initially released on 30 September 2017.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2020-045474
PMCID: PMC8230974
PMID: 34162641 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3318. Scand J Public Health. 2022 Nov;50(7):959-967. doi: 10.1177/14034948211022429. 
Epub 2021 Jun 24.

The Danish Health and Wellbeing Survey: Study design, response proportion and 
respondent characteristics.

Rosendahl Jensen HA(1), Thygesen LC(1), Møller SP(1), Dahl Nielsen MB(1), 
Ersbøll AK(1), Ekholm O(1).

Author information:
(1)National Institute of Public Health, University of Southern Denmark, Denmark.

AIMS: This study aimed to describe the study design and respondent 
characteristics (including non-response analyses) of the Danish Health and 
Wellbeing Surveys in 2015 and 2019 and a follow-up survey that was carried out 
during the COVID-19 pandemic in 2020.
METHODS: The Danish Health and Wellbeing Survey is the Danish part of the 
European Health Interview Survey (EHIS). The samples in 2015 (N=12,000) and 2019 
(N=14,000) were both based on a simple random selection of individuals aged ⩾15 
years from the Danish Civil Registration System. All individuals from the sample 
in 2019 who were still alive and living in Denmark were reinvited for a 
follow-up survey in 2020 (N=13,474). Data in all surveys were collected via 
self-administered questionnaires (web or paper based). The questionnaires in 
2015 and 2019 included the EHIS model questionnaire as well as national 
questions, whereas the questionnaire in 2020 mainly focused on physical and 
mental health, employment and working lives, and health behaviour.
RESULTS: The overall response proportion declined slightly between 2015 (48.4%) 
and 2019 (47.4%) but went up to 49.8% in the follow-up survey in 2020. Unit 
non-response was associated with, for example, male sex, younger age, being 
unmarried and lower educational level but not with degree of urbanisation. In 
all, 5000 individuals completed the questionnaire in both 2019 and 2020.
CONCLUSIONS: The results are in line with most previous research on non-response 
in health surveys. However, an association between degree of urbanisation and 
non-response has been suggested in previous studies. This association was not 
found in our study.

DOI: 10.1177/14034948211022429
PMID: 34162289 [Indexed for MEDLINE]


3319. Am J Crit Care. 2021 May 1;30(3):176-184. doi: 10.4037/ajcc2021301.

Critical Care Nurses' Physical and Mental Health, Worksite Wellness Support, and 
Medical Errors.

Melnyk BM(1), Tan A(2), Hsieh AP(3), Gawlik K(4), Arslanian-Engoren C(5), Braun 
LT(6), Dunbar S(7), Dunbar-Jacob J(8), Lewis LM(9), Millan A(10), Orsolini 
L(11), Robbins LB(12), Russell CL(13), Tucker S(14), Wilbur J(15).

Author information:
(1)Bernadette Mazurek Melnyk is vice president for health promotion, university 
chief wellness officer, dean and professor, and executive director, Helene Fuld 
Health Trust National Institute for Evidence-Based Practice in Nursing and 
Healthcare, The Ohio State University, Columbus.
(2)Alai Tan is a research professor, Center for Research and Health Analytics, 
College of Nursing, The Ohio State University.
(3)Andreanna Pavan Hsieh is a science writer, College of Nursing, The Ohio State 
University.
(4)Kate Gawlik is an assistant professor of clinical nursing at The Ohio State 
University College of Nursing.
(5)Cynthia Arslanian-Engoren is a professor and associate dean of faculty 
affairs and faculty development, Department of Health Behavior and Biological 
Sciences, University of Michigan School of Nursing, Ann Arbor.
(6)Lynne T. Braun is a professor, Rush University and Heart & Vascular 
Institute, Chicago, Illinois.
(7)Sandra Dunbar is associate dean for academic advancement, Nell Hodgson 
Woodruff School of Nursing, Emory University, Atlanta, Georgia.
(8)Jacqueline Dunbar-Jacob is dean and professor of psychology, epidemiology, 
and occupational therapy, University of Pittsburgh, Pittsburgh, Pennsylvania.
(9)Lisa M. Lewis is associate professor of nursing, Calvin Bland fellow, and 
assistant dean for diversity and inclusivity, University of Pennsylvania, 
Philadelphia.
(10)Angelica Millan is nursing director for children's medical services, County 
of Los Angeles Department of Public Health, Los Angeles, California.
(11)Liana Orsolini is vice president of nursing services, Armor Correctional 
Health, Inc, Miami, Florida.
(12)Lorraine B. Robbins is a professor, College of Nursing, Michigan State 
University, East Lansing.
(13)Cynthia L. Russell is a professor, School of Nursing and Health Studies, 
University of Missouri-Kansas City.
(14)Sharon Tucker is Grayce Sills Endowed Professor in psychiatric-mental health 
nursing, professor and director, DNP Nurse Executive Track, and director, 
Translational/Implementation Research Core, Helene Fuld Health Trust National 
Institute for Evidence-Based Practice in Nursing and Healthcare, The Ohio State 
University.
(15)JoEllen Wilbur is associate dean for research, Department of Women, Children 
and Family Nursing, College of Nursing, Rush University.

BACKGROUND: Critical care nurses experience higher rates of mental distress and 
poor health than other nurses, adversely affecting health care quality and 
safety. It is not known, however, how critical care nurses' overall health 
affects the occurrence of medical errors.
OBJECTIVE: To examine the associations among critical care nurses' physical and 
mental health, perception of workplace wellness support, and self-reported 
medical errors.
METHODS: This survey-based study used a cross-sectional, descriptive 
correlational design. A random sample of 2500 members of the American 
Association of Critical-Care Nurses was recruited to participate in the study. 
The outcomes of interest were level of overall health, symptoms of depression 
and anxiety, stress, burnout, perceived worksite wellness support, and medical 
errors.
RESULTS: A total of 771 critical care nurses participated in the study. Nurses 
in poor physical and mental health reported significantly more medical errors 
than nurses in better health (odds ratio [95% CI]: 1.31 [0.96-1.78] for physical 
health, 1.62 [1.17-2.29] for depressive symptoms). Nurses who perceived that 
their worksite was very supportive of their well-being were twice as likely to 
have better physical health (odds ratio [95% CI], 2.16 [1.33-3.52]; 55.8%).
CONCLUSION: Hospital leaders and health care systems need to prioritize the 
health of their nurses by resolving system issues, building wellness cultures, 
and providing evidence-based wellness support and programming, which will 
ultimately increase the quality of patient care and reduce the incidence of 
preventable medical errors.

© 2021 American Association of Critical-Care Nurses.

DOI: 10.4037/ajcc2021301
PMID: 34161980 [Indexed for MEDLINE]


3320. Rev Bras Enferm. 2021 Jun 16;74Suppl 1(Suppl 1):e20201154. doi: 
10.1590/0034-7167-2020-1154. eCollection 2021.

Coronavirus infection has reached Brazil, what now? Nurses' emotions.

[Article in English, Portuguese]

Eleres FB(1), Abreu RNDC(2), Magalhães FJ(3), Rolim KMC(2), Cestari VRF(4), 
Moreira TMM(4).

Author information:
(1)Faculdade dos Carajás. Marabá, Pará, Brazil.
(2)Universidade de Fortaleza. Fortaleza, Ceará, Brazil.
(3)Universidade de Pernambuco. Recife, Pernambuco, Brazil.
(4)Universidade Estadual do Ceará. Fortaleza, Ceará, Brazil.

OBJECTIVE: To investigate the nurse's emotions about coronavirus infection 
(COVID-19).
METHOD: We conducted a qualitative study with 58 nurses, students of the 
postgraduate course in Nursing of a higher education institution in Fortaleza, 
State of Ceará, Brazil. We obtained data through questionnaires with a 
sociodemographic approach and reflections on the emotions/perceptions of nurses, 
as well as a synchronous meeting to discuss strategies for worker health during 
the pandemic. We organized the results on the IRaMuTeQ software with a 
presentation in figures and speeches.
RESULTS: The speeches revealed emotions such as anxiety, tiredness, fear, 
insecurity, distress, and emotional pain. However, the occurrence of words such 
as "tranquility" and "well-being" emphasize comfort, overcoming, and hope.
FINAL CONSIDERATIONS: The Master's degree students showed concern for family 
members, fear, and anxiety, with requests for actions by people management to 
promote strategies to minimize and control such emotions.

DOI: 10.1590/0034-7167-2020-1154
PMID: 34161519 [Indexed for MEDLINE]


3321. Clin Exp Rheumatol. 2021 May-Jun;39 Suppl 130(3):153-160. doi: 
10.55563/clinexprheumatol/4nb0ku. Epub 2021 Jun 21.

Mental health and well-being during the COVID-19 pandemic: stress vulnerability, 
resilience and mood disturbances in fibromyalgia and rheumatoid arthritis.

Iannuccelli C(1), Lucchino B(2), Gioia C(1), Dolcini G(1), Favretti M(1), 
Franculli D(1), Di Franco M(1).

Author information:
(1)Rheumatology Unit, Department of Internal Clinical, Anaesthesiologic and 
Cardiovascular Sciences, Sapienza University of Rome, Italy.
(2)Rheumatology Unit, Department of Internal Clinical, Anaesthesiologic and 
Cardiovascular Sciences, Sapienza University of Rome, Italy. 
bruno.lucchino@uniroma1.it.

OBJECTIVES: The COVID-19 pandemic severely increased the stress levels in the 
population. The aim of present study was to investigate the impact of the 
lockdown measures on emotional well-being and disease activity in patients with 
fibromyalgia (FM) and rheumatoid arthritis (RA) through a telemedicine approach.
METHODS: An on-line survey, including demographic characteristics, 
disease-activity and psychometric scales (Stress-related Vulnerability Scale, 
Resiliency scale), Zung Anxiety and Depression Self-assessment Scale), was 
anonymously administered to FM, RA and healthy controls (HC). Disease activities 
were compared to the pre-lockdown cohort referring to our centre.
RESULTS: Levels of anxiety and depression worthy of psychiatric attention were 
documented in 36.7% of FM, 14.6% of RA, 12.5% of HC and in 50% of FM, 17.1% of 
RA, 15% of HC, respectively. HC featured the highest stress scores, followed FM 
and then RA. RA showed higher resiliency than FM. Both anxiety and depression 
scores were significantly higher in FM than RA and HC. Disease severity was 
higher in RA patients and lower in FM patients when compared to the respective 
historical cohorts.
CONCLUSIONS: Lockdown significantly affected emotional well-being and disease 
activity of patients suffering from rheumatic diseases. While HC showed a higher 
vulnerability to stress, RA patients showed a greater resilience compared to 
both HC and to FM patients, especially. Emotional disturbances are greater in 
patients with RDs and in particular with FM. The use of a telemedicine approach 
to screen for severe symptoms represents a useful addition to the overall 
management of rheumatic patients.

DOI: 10.55563/clinexprheumatol/4nb0ku
PMID: 34161226 [Indexed for MEDLINE]


3322. J Matern Fetal Neonatal Med. 2022 Dec;35(25):7043-7051. doi: 
10.1080/14767058.2021.1936489. Epub 2021 Jun 22.

Stress levels among an international sample of pregnant and postpartum women 
during the COVID-19 pandemic.

Wyszynski DF(1), Hernandez-Diaz S(2), Gordon-Dseagu V(1), Ramiro N(1), Koenen 
KC(2)(3).

Author information:
(1)Pregistry, Los Angeles, CA, USA.
(2)Harvard T.H. Chan School of Public Health, Boston, MA, USA.
(3)Massachusetts General Hospital, Boston, MA, USA.

BACKGROUND: Stress is a complex condition that can have a profound effect on an 
individual's sense of wellbeing and their ability to live a happy and healthy 
life. COVID-19 and its associated stressors have the potential to disrupt 
numerous facets of our everyday lives. Pregnant and postpartum women are 
especially vulnerable to changes in the availability of routine health and 
social care services and of their support networks. The current study sought to 
explore stress levels and their influencers among an international cohort of 
pregnant and postpartum women during the COVID-19 pandemic.
METHODS: We conducted an anonymous, online, cross-sectional survey in 64 
countries between May and June 2020. The survey was hosted on the Pregistry 
platform and made available in 12 languages, with respondents sought through a 
variety of social media platforms and parenting forums. In addition to levels of 
stress, we collected data related to demographics, COVID-19 exposure and 
worries, lifestyle changes, traditional and social media use, precautionary 
measures related to COVID-19, and mental health.
RESULTS: In total, 7185 women were included in our sample. We found 
statistically significant (p-value <0.05) reductions in stress score among older 
women (≥35 years of age), those either living with a partner or married, those 
who had graduated from college, and those with medical coverage. Higher stress 
scores were found among women who resided in Africa, Asia and the Pacific, the 
Middle East, and North America compared with those in Europe. When race and 
ethnicity were included in the model, black women were found to have higher 
stress compared to white women. Level of family and community support was 
inversely associated with level of stress.
CONCLUSION: Our study is one of the first to explore stress levels among 
pregnant and postpartum women during the COVID-19 pandemic. We found 
statistically significant differences in stress levels by age, education, 
marital status, region of residence, race/ethnicity and level of support. 
Understanding stress during the COVID-19 pandemic, and exploring ways to address 
it, will be key to contributing to the mental and physical health of expectant 
and new mothers, as well as their children, in both the short and long term.

DOI: 10.1080/14767058.2021.1936489
PMID: 34157929 [Indexed for MEDLINE]


3323. Psychol Health Med. 2022 Feb;27(2):453-465. doi: 10.1080/13548506.2021.1944655. 
Epub 2021 Jun 22.

Predictors of mental health during the COVID-19 pandemic in older adults: the 
role of socio-demographic variables and COVID-19 anxiety.

Caycho-Rodríguez T(1), Tomás JM(2), Vilca LW(3), García CH(4), Rojas-Jara C(5), 
White M(6), Peña-Calero BN(7).

Author information:
(1)Facultad de Ciencias de la Salud, Universidad Privada del Norte, Lima, Perú.
(2)Department of Methodology for the Behavioral Sciences, Universidad de 
Valencia, Valencia, España.
(3)Departamento de Psicología, Universidad Peruana Unión, Lima, Perú.
(4)Facultad de Psicología, Universidad Autónoma de Nuevo León, San Nicolás de 
los Garza, México.
(5)Facultad de Ciencias de la Salud, Universidad Católica del Maule, Talca, 
Chile.
(6)Dirección General de Investigación, Universidad Peruana Unión, Lima, Peru.
(7)Grupo de Estudios Avances en Medición Psicológica, Universidad Nacional Mayor 
de San Marcos, Lima, Perú.

The objective of this study was to evaluate factors related to the mental health 
of Peruvian older adults during the COVID-19 pandemic. The study had a 
cross-sectional and observational design. A total of 274 older adults in Lima, 
Peru (Mage = 67.86) filled out a sociodemographic survey, the Coronavirus 
Anxiety Scale, Mental Health Inventory-5, Patient Health Questionnaire-2 item, 
and Generalized Anxiety Disorder Scale. A Structural Equation Model (SEM) was 
estimated to test an a priori model that relates the sociodemographic variables, 
COVID-19 Anxiety, psychological well-being, anxiety and depression. The model 
fit indices indicated a good fit to the data. The socio-demographic variables 
explained 23.8% of the variance of the COVID-19 Anxiety (R2 = .238). 
Socio-demographic variables explained 50.5% of psychological well-being 
variance, 52% of anxiety and 46.9% of depression. Also, sex, work; being 
diagnosed with COVID-19; family member with COVID-19 diagnosis; and time of 
exposure to COVID-19 information had statistically significant effects 
psychological well-being, anxiety and depression. In conclusion, some 
sociodemographic characteristics and COVID-19 anxiety affect the psychological 
well-being, anxiety and depression. The findings may allow for a better 
understanding of the mental health of older adults during the COVID-19 pandemic 
and guide government responses to detect, anticipate and minimize its impact on 
the mental health of this population.

DOI: 10.1080/13548506.2021.1944655
PMID: 34157907 [Indexed for MEDLINE]


3324. J Gerontol B Psychol Sci Soc Sci. 2022 Jul 5;77(7):e150-e159. doi: 
10.1093/geronb/gbab110.

Associations Between Changes in Daily Behaviors and Self-Reported Feelings of 
Depression and Anxiety About the COVID-19 Pandemic Among Older Adults.

Robbins R(1)(2), Weaver MD(1)(2), Czeisler MÉ(3)(4), Barger LK(1)(2), Quan 
SF(1)(2), Czeisler CA(1)(2).

Author information:
(1)Division of Sleep and Circadian Disorders, Brigham & Women's Hospital, 
Boston, Massachusetts, USA.
(2)Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, 
USA.
(3)Turner Institute for Brain and Mental Health, Monash University, Melbourne, 
Victoria, Australia.
(4)Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, 
Australia.

OBJECTIVES: Due to the significant mortality and morbidity consequences of the 
coronavirus disease 2019 (COVID-19) pandemic among older adults, these 
individuals were urged to avoid going out in public and socializing with others, 
among other major disruptions to daily life. While these significant and often 
unavoidable disruptions have been shown to bear consequences for mental health, 
less attention has been devoted to behavioral changes, such as changes to 
sleeping or eating due to the COVID-19 pandemic, and their implications for 
emotional well-being.
METHODS: We utilized data from a nationally representative survey of Medicare 
beneficiaries (aged 65 and older), which was administered between June and 
October 2020 (n = 3,122). We examine the relationship between self-reported 
changes to daily behaviors (e.g., sleep, drinking alcohol, and exercise) and 
emotional impacts of the COVID-19 pandemic (i.e., feelings of depression and 
anxiety about the COVID-19 pandemic) using stepwise hierarchical multivariable 
Poisson regression.
RESULTS: We found that worse sleep quality, sleeping more or less, watching more 
television, and walking less were associated with more feelings of depression 
and anxiety about the COVID-19 pandemic.
DISCUSSION: Previous research has shown a connection between the significant and 
often unavoidable disruptions to daily life due to the COVID-19 pandemic (e.g., 
sheltering in place) and adverse mental health symptoms. Less attention has been 
paid to potentially modifiable behaviors, such as sleep and exercise. Our 
findings highlight the behavioral changes associated with adverse emotional 
impacts among older adults during the COVID-19 pandemic. Future research may 
evaluate whether behavioral interventions may aim to attenuate the impact of 
pandemics on daily, modifiable behaviors to buffer against adverse emotional 
impacts.

© The Author(s) 2021. Published by Oxford University Press on behalf of The 
Gerontological Society of America. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/geronb/gbab110
PMCID: PMC8411388
PMID: 34156467 [Indexed for MEDLINE]


3325. Transl Behav Med. 2021 Jul 29;11(7):1318-1329. doi: 10.1093/tbm/ibab072.

The psychological impact of threat and lockdowns during the COVID-19 pandemic: 
exacerbating factors and mitigating actions.

van Mulukom V(1)(2), Muzzulini B(2), Rutjens BT(3), van Lissa CJ(4), Farias 
M(1).

Author information:
(1)Centre for Trust, Peace, and Social Relations, Coventry University, UK.
(2)Centre for the Study of Social Cohesion, University of Oxford, UK.
(3)Psychology Research Institute, University of Amsterdam, Netherlands.
(4)Department of Methodology & Statistics, Utrecht University, Netherlands.

In spring 2020, the COVID-19 pandemic was declared. The threat the pandemic 
poses as well as associated lockdown measures created challenging times for 
many. This study aimed to investigate the individual and social factors 
associated with low mental health, particularly perceived threat and lockdown 
measures, and factors associated with psychological well-being, particularly 
sense of control. An online survey was completed by participants (N = 8,229) 
recruited from 79 countries. In line with pre-registered hypotheses, 
participants showed elevated levels of anxiety and depression worldwide. This 
poor mental health was predicted by perceived threat. The effect of threat on 
depression was further moderated by social isolation, but there was no effect of 
sense of control. Sense of control was low overall, and was predicted negatively 
by maladaptive coping, but positively by adaptive coping and the perception that 
the government is dealing with the outbreak. Social isolation increased with 
quarantine duration, but was mitigated by frequent communication with close 
ones. Engaging in individual actions to avoid contracting the virus was 
associated with higher anxiety, except when done professionally. We suggest that 
early lockdown of the pandemic may have had detrimental psychological effects, 
which may be alleviated by individual actions such as maintaining frequent 
social contact and adaptive coping, and by governmental actions which 
demonstrate support in a public health crisis. Citizens and governments can work 
together to adapt better to restrictive but necessary measures during the 
current and future pandemics.

Plain Language Summary: The COVID-19 pandemic is a difficult time for many; not 
only are people isolated at home, they may also experience the threat that 
COVID-19 will have a severe impact on their lives. We ran an online survey with 
8,229 individuals from 79 countries in April 2020. After establishing levels of 
psychological well-being, we investigated which factors contribute to better 
psychological well-being, and which to worse. We found that levels of anxiety 
and depression were markedly elevated worldwide. The more people thought that 
COVID-19 was going to have severe effects on their lives, the more anxious and 
depressed they felt. This effect was even stronger when the individuals felt 
socially isolated, which was increased when people had been in quarantine for a 
long time, but reduced when people frequently communicated with their close 
ones. People felt more in control of their lives when they engaged in positive 
coping behaviors, such as reframing their situation positively, but not negative 
coping behaviors, such as substance use. People also felt in control when their 
government was dealing with the crisis well. We conclude that there are several 
ways in which psychological well-being can be supported, in the current pandemic 
but also potential future pandemics.

© Society of Behavioral Medicine 2021. All rights reserved. For permissions, 
please e-mail: journals.permissions@oup.com.

DOI: 10.1093/tbm/ibab072
PMCID: PMC8420639
PMID: 34155522 [Indexed for MEDLINE]


3326. Psychol Rep. 2022 Oct;125(5):2456-2469. doi: 10.1177/00332941211025269. Epub 
2021 Jun 21.

Behaviour is the Key in a Pandemic: The Direct and Indirect Effects of 
COVID-19-Related Variables on Psychological Wellbeing.

Padmanabhanunni A(1), Pretorius T(1).

Author information:
(1)Department of Psychology, University of the Western Cape, Bellville, South 
Africa.

The aim of this study was to investigate the potential role of three 
COVID-19-related variables (i.e., risk perception, knowledge, and behaviour) on 
four indices of pandemic-related mental health (i.e., anxiety, depression, 
loneliness, and hopelessness). In total, 337 participants completed four 
self-report questionnaires: selected subscales of the World Health 
Organisation's COVID-19 Behavioural Insights Tool, UCLA Loneliness Scale, 
State-Trait Anxiety Inventory-Trait Scale, Center for Epidemiologic Studies 
Depression Scale, and Beck Hopelessness Scale. In addition to descriptive 
statistics and intercorrelations, structural equation modelling was used to 
compare three models of the potential role (predictor or moderator/mediator) 
that the three abovementioned COVID-19-related variables could play in 
psychological wellbeing. The results showed high levels of psychological 
distress among the current sample. Generally, better knowledge of COVID-19 and 
engaging in protective behaviours were found to be related to lower levels of 
psychological distress, whereas increased risk perception was found to be 
associated with increased feelings of loneliness, anxiety, and depression. It 
was also found that behaviour mediated the effect of knowledge on psychological 
wellbeing, suggesting that while publicising information about COVID-19 remains 
necessary, providing the public with a means to engage in protective behaviours 
is central for promoting psychological wellbeing.

DOI: 10.1177/00332941211025269
PMID: 34152883 [Indexed for MEDLINE]


3327. JCO Oncol Pract. 2021 Jul;17(7):e427-e438. doi: 10.1200/OP.21.00147. Epub 2021 
Jun 21.

Occupational and Personal Consequences of the COVID-19 Pandemic on US Oncologist 
Burnout and Well-Being: A Study From the ASCO Clinician Well-Being Task Force.

Hlubocky FJ(1), Back AL(2), Shanafelt TD(3), Gallagher CM(4)(5), Burke JM(6), 
Kamal AH(7), Paice JA(8), Page RD(9), Spence R(10), McGinnis M(10), McFarland 
DC(11), Srivastava P(12).

Author information:
(1)Section Hematology/Oncology, Department of Medicine, Maclean Center for 
Clinical Medical Ethics, University of Chicago Medicine, Chicago, IL.
(2)Department of Medicine/Oncology, University of Washington, Seattle, WA.
(3)VA Palo Alto Health Care System, Stanford University, Palo Alto, CA.
(4)Section of Integrated Ethics in Cancer Care, The University of Texas MD 
Anderson Cancer Center, Houston, TX.
(5)Research Scholar, UNESCO Chair for Bioethics and Human Rights.
(6)Rocky Mountain Cancer Centers, Aurora, CO.
(7)Population Health Sciences, Duke Cancer Institute, Duke University, Durham, 
NC.
(8)Division Hematology/Oncology, Department of Medicine, Northwestern University 
Feinberg School of Medicine, Chicago, IL.
(9)The Center for Cancer and Blood Disorders, Fort Worth, TX.
(10)American Society of Clinical Oncology, Alexandria, VA.
(11)Lenox Hill Hospital, Northwell Cancer Institute, New York, NY.
(12)Northern California (NCAL), Kaiser Permanente, Oakland, CA.

Comment in
    JCO Oncol Pract. 2021 Jul;17(7):375-377.

INTRODUCTION: The COVID-19 pandemic is an unprecedented global crisis profoundly 
affecting oncology care delivery.
PURPOSE: This study will describe the occupational and personal consequences of 
the COVID-19 pandemic on oncologist well-being and patient care.
MATERIALS AND METHODS: Four virtual focus groups were conducted with US ASCO 
member oncologists (September-November 2020). Inquiry and subsequent discussions 
centered on self-reported accounts of professional and personal COVID-19 
experiences affecting well-being, and oncologist recommendations for well-being 
interventions that the cancer organization and professional societies (ASCO) 
might implement were explored. Qualitative interviews were analyzed using 
Framework Analysis.
RESULTS: Twenty-five oncologists were interviewed: median age 44 years (range: 
35-69 years), 52% female, 52% racial or ethnic minority, 76% medical 
oncologists, 64% married, and an average of 51.5 patients seen per week (range: 
20-120). Five thematic consequences emerged: (1) impact of pre-COVID-19 burnout, 
(2) occupational or professional limitations and adaptations, (3) personal 
implications, (4) concern for the future of cancer care and the workforce, and 
(5) recommendations for physician well-being interventions. Underlying 
oncologist burnout exacerbated stressors associated with disruptions in care, 
education, research, financial practice health, and telemedicine. Many feared 
delays in cancer screening, diagnosis, and treatment. Oncologists noted personal 
and familial stressors related to COVID-19 exposure fears and loss of social 
support. Many participants strongly considered working part-time or taking early 
retirement. Yet, opportunities arose to facilitate personal growth and rise 
above pandemic adversity, fostering greater resilience. Recommendations for 
organizational well-being interventions included psychologic or peer support 
resources, flexible time-off, and ASCO and state oncology societies involvement 
to develop care guidelines, well-being resources, and mental health advocacy.
CONCLUSION: Our study suggests that the COVID-19 pandemic has adversely affected 
oncologist burnout, fulfillment, practice health, cancer care, and workforce. It 
illuminates where professional organizations could play a significant role in 
oncologist well-being.

DOI: 10.1200/OP.21.00147
PMID: 34152789 [Indexed for MEDLINE]

Conflict of interest statement: Tait D. ShanafeltHonoraria: Multiple Healthcare 
organizationsResearch Funding: Pharmacyclics, GlaxoSmithKline, Genentech, 
Celgene, Hospira, Cephalon, Polyphenon E InternationalPatents, Royalties, Other 
Intellectual Property: Dr Shanafelt is coinventor of the Well-being Index 
Instruments (Physician Well-being Index, Nurse Well-being Index, Medical Student 
Well-being Index, and Well-being Index) and the Mayo Clinic Participatory 
Management Leadership Index. Mayo Clinic holds the copyright to these 
instruments and has licensed them for use outside Mayo Clinic. Mayo Clinic pays, 
and Dr Shanafelt receives a portion of any royalties it receivesOther 
Relationship: Medical CentersOpen Payments Link: 
https://openpaymentsdata.cms.gov/physician/429217 John M. BurkeConsulting or 
Advisory Role: Genentech/Roche, AbbVie, Seattle Genetics, Bayer, AstraZeneca, 
Adaptive Biotechnologies, Verastem, MorphoSys, Kura Oncology, Epizyme, BeiGene, 
Kymera, NovartisSpeakers' Bureau: Seattle Genetics, Beigene Arif H. 
KamalEmployment: Prepped Health, Acclivity Health, Private Diagnostic 
ClinicLeadership: Prepped Health, Acclivity HealthStock and Other Ownership 
Interests: Acclivity HealthConsulting or Advisory Role: Medtronic, Huron 
Therapeutics, New Century Health, Compassus, AstraZeneca, Janssen Oncology, 
United Health Group, Care4wardTravel, Accommodations, Expenses: Janssen Oncology 
Ray D. PageEmployment: The Center for Cancer and Blood DisordersHonoraria: 
Cardinal HealthConsulting or Advisory Role: AstraZeneca, Tesaro, Amgen, Roche, 
Quality Cancer Care AllianceResearch Funding: E.R. Squibb Sons, LLC, Gilead 
Sciences, Takeda, AstraZeneca, Genentech, Roche, Janssen, Celgene, LillyTravel, 
Accommodations, Expenses: Amgen, Taiho Pharmaceutical, TakedaOpen Payments Link: 
https://openpaymentsdata.cms.gov/physician/166358/summaryNo other potential 
conflicts of interest were reported.


3328. Crit Care Explor. 2021 Jun 15;3(6):e0463. doi: 10.1097/CCE.0000000000000463. 
eCollection 2021 Jun.

Humanizing the ICU Patient: A Qualitative Exploration of Behaviors Experienced 
by Patients, Caregivers, and ICU Staff.

Basile MJ(1), Rubin E(2), Wilson ME(3)(4)(5), Polo J(1), Jacome SN(1), Brown 
SM(6)(7), Heras La Calle G(8)(9)(10), Montori VM(4), Hajizadeh N(1).

Author information:
(1)Division of Pulmonary Critical Care and Sleep Medicine, Department of 
Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell 
Health, Hempstead, NY.
(2)ARDS Foundation, Northbrook, IL.
(3)Division of Pulmonary and Critical Care Medicine, Department of Pulmonary 
Medicine, Mayo Clinic, Rochester, MN.
(4)Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN.
(5)Robert D. and Patricia E. Kern Center for the Science of Health Care 
Delivery, Mayo Clinic, Rochester, MN.
(6)Center for Humanizing Critical Care, Intermountain Medical Center, Murray, 
UT.
(7)Division of Pulmonary and Critical Care Medicine, Department of Medicine, 
University of Utah School of Medicine, Salt Lake City, UT.
(8)Hospital Universitario de Torrejón, Madrid, Spain.
(9)International Research Project for the Humanization of Intensive Care Units, 
Proyecto HU-CI, Madrid, Spain.
(10)School of Medicine, Francisco de Vitoria University, Madrid, Spain.

OBJECTIVES: To understand how patients and family members experience 
dehumanizing or humanizing treatment when in the ICU.
DESIGN: Qualitative study included web-based focus groups and open-ended surveys 
posted to ICU patient/family social media boards. Focus groups were audio 
recorded and transcribed. Social media responses were collected and organized by 
stakeholder group. Data underwent qualitative analysis.
SETTING: Remote focus groups and online surveys.
PATIENTS: ICU patient survivors, family members, and ICU teams.
INTERVENTIONS: Not available.
MEASUREMENTS AND MAIN RESULTS: Semi-structured questions and open-ended survey 
responses. We enrolled 40 patients/family members and 31 ICU team members. Focus 
groups and surveys revealed three primary themes orienting 
humanizing/dehumanizing ICU experiences: 1) communication, 2) outcomes, and 3) 
causes of dehumanization. Dehumanization occurred during "communication" 
exchanges when ICU team members talked "over" patients, made distressing remarks 
when patients were present, or failed to inform patients about ICU-related care. 
"Outcomes" of dehumanization were associated with patient loss of trust in the 
medical team, loss of motivation to participate in ICU recovery, feeling of 
distress, guilt, depression, and anxiety. Humanizing behaviors were associated 
with improved recovery, well-being, and trust. "Perceived causes" of 
dehumanizing behaviors were linked to patient, ICU team, and healthcare system 
factors.
CONCLUSIONS: Behaviors of ICU clinicians may cause patients and families to feel 
dehumanized when in the ICU. Negative behaviors are noticed by patients and 
families, possibly contributing to poor outcomes including mental health, 
recovery, and lack of trust in ICU teams. Supporting ICU clinicians may enable a 
more empathic environment and in turn more humanizing clinician-patient 
encounters.

Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf 
of the Society of Critical Care Medicine.

DOI: 10.1097/CCE.0000000000000463
PMCID: PMC8208441
PMID: 34151284

Conflict of interest statement: The authors have disclosed that they do not have 
any potential conflicts of interest.


3329. Omega (Westport). 2023 Jun;87(2):572-590. doi: 10.1177/00302228211026169. Epub 
2021 Jun 19.

Investigation of the Effect of COVID-19 Perceived Risk on Death Anxiety, 
Satisfaction With Life, and Psychological Well-Being.

Özer Ö(1), Özkan O(1), Özmen S(2), Erçoban N(3).

Author information:
(1)Department of Healthcare Management, Faculty of Gulhane Health Sciences, 
University of Health Sciences Turkey, Ankara, Turkey.
(2)Department of Healthcare Management, Faculty of Economics and Administrative 
Sciences, Burdur Mehmet Akif Ersoy University, Burdur, Turkey.
(3)Burdur Public Hospital, Burdur, Turkey.

This study aims to examine the effect of COVID-19 perceived risk on death 
anxiety, satisfaction with life, and psychological well-being. The application 
part of the research was conducted on staff working in a public hospital. A 
convenience sample of staff working in a public hospital was used and data were 
obtained from 573 individuals. The result of the analysis determined that the 
COVID-19 perceived risk explains 13.5% of the total variance on death anxiety. 
The regression models identified that the increase in COVID-19 risk perceptions 
of the participants statistically increased their death anxiety and decreased 
their satisfaction with life and psychological well-being.

DOI: 10.1177/00302228211026169
PMID: 34148401 [Indexed for MEDLINE]


3330. Neurogastroenterol Motil. 2022 Mar;34(3):e14198. doi: 10.1111/nmo.14198. Epub 
2021 Jun 18.

COVID-19-related personal product shortages are associated with psychological 
distress in people living with gastrointestinal disorders: A cross-sectional 
survey.

Mikocka-Walus A(1), Skvarc D(1), van Tilburg MAL(2)(3)(4), Barreiro-de Acosta 
M(5), Bennebroek Evertsz F(6), Bernstein CN(7), Burisch J(8), Ferreira N(9), 
Gearry RB(10), Graff LA(7), Jedel S(11), Mokrowiecka A(12), Stengel A(13)(14), 
Knowles S(15).

Author information:
(1)School of Psychology, Deakin University Geelong, Victoria, Australia.
(2)College of Pharmacy & Health Sciences, Campbell University, Buies Creek, NC, 
US.
(3)Division of Gastroenterology and Hepatology, University of North Carolina, 
Chapel Hill, NC, US.
(4)School of Social Work, University of Washington, Seattle, WA, US.
(5)IBD Unit, Department of Gastroenterology, University Hospital of Santiago de 
Compostela, Santiago de Compostela, Spain.
(6)Department of Medical Psychology, Amsterdam University Medical Centres, 
Amsterdam, the Netherlands.
(7)Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
(8)Gastrounit, Medical Division, Hvidovre Hospital, University of Copenhagen, 
Hvidovre, Denmark.
(9)Department of Social Sciences, University of Nicosia, Nicosia, Cyprus.
(10)Department of Medicine, University of Otago Christchurch, Christchurch, New 
Zealand.
(11)Division of Digestive Diseases, Rush University Medical Center, Chicago, IL, 
US.
(12)Department of Digestive Tract Diseases, Medical University of Lodz, Lodz, 
Poland.
(13)Charité Center for Internal Medicine and Dermatology, Department for 
Psychosomatic Medicine, Charité Universitätsmedizin Berlin, Berlin Institute of 
Health, Berlin, Germany.
(14)Department of Psychosomatic Medicine and Psychotherapy, University Hospital 
Tübingen, Tübingen, Germany.
(15)Department of Psychological Sciences, Swinburne University of Technology, 
Victoria, Australia.

BACKGROUND: The mental health response to the coronavirus (COVID-19) 
pandemic-related product shortages in those living with chronic gastrointestinal 
(GI) disorders has received little attention. We aimed to explore the 
association between the pandemic-related product shortages and psychological 
distress in people with GI disorders.
METHODS: This online cross-sectional survey was nested within an ongoing, 
international, prospective study of well-being in people with GI disorders. The 
study was advertised in multiple countries in May-September 2020 via patient 
organizations and social media. The primary outcome measure was distress, 
evaluated by the Depression Anxiety Stress Scale. We utilized linear 
regressions, adjusting for covariates and testing individual moderation effects.
KEY RESULTS: Overall, 831 people completed the survey from 27 countries, of whom 
82% were female (mean age = 49 years). The most common disorders included 
inflammatory bowel disease (n = 322), celiac disease (n = 273), and irritable 
bowel syndrome (n = 260). Significant problems accessing food were reported by 
19.8%, non-medical therapies by 16%, toilet paper by 10.8%, and essential 
medication by 8.9% of the sample (>5% pain medication). There was a positive 
association between toilet paper and pain medication shortages and distress, and 
a negative association between food shortages and distress. Significant 
moderation effects were identified for COVID-19 prevalence and toilet paper and 
food shortages, and between COVID-19 fear and pain medication shortages.
CONCLUSIONS AND INFERENCES: The study documented a significant relationship 
between product shortages and psychological distress, which were associated with 
COVID-19 prevalence and fear. Strategies addressing COVID-19 fear could 
potentially modify the relationship between shortages and distress.

© 2021 John Wiley & Sons Ltd.

DOI: 10.1111/nmo.14198
PMCID: PMC8420452
PMID: 34145689 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflict of interests in 
relation to this study. The other authors have nothing to report.


3331. Neurogastroenterol Motil. 2022 Feb;34(2):e14197. doi: 10.1111/nmo.14197. Epub 
2021 Jun 18.

Increased prevalence of gastrointestinal symptoms and disorders of gut-brain 
interaction during the COVID-19 pandemic: An internet-based survey.

Nakov R(1), Dimitrova-Yurukova D(2), Snegarova V(3), Nakov V(1), Fox M(4)(5), 
Heinrich H(4).

Author information:
(1)Clinic of Gastroenterology, Tsaritsa Yoanna University Hospital, Medical 
University of Sofia, Sofia, Bulgaria.
(2)Department of Gastroenterology, Pulmed University Hospital, Plovdiv, 
Bulgaria.
(3)Department of Hygiene and Epidemiology, Medical University of Varna, Varna, 
Bulgaria.
(4)Department of Gastroenterology and Hepatology, University Hospital Zürich, 
Zürich, Switzerland.
(5)Digestive Function: Basel, Laboratory and Clinic for Motility Disorders and 
Functional Digestive Diseases, Center for Integrative Gastroenterology, 
Arlesheim, Switzerland.

BACKGROUND: Quarantine with social distancing has reduced transmission of 
COVID-19; however, fear of the disease and these remedial measures cause anxiety 
and stress. It is not known whether these events have impacted the prevalence of 
gastrointestinal (GI) symptoms and disorders of brain-gut interaction (DGBI).
METHODS: An online platform evaluated the prevalence of GI symptoms during the 
COVID-19 pandemic. Data collection utilized validated questionnaires and was 
fully anonymized. Findings were compared with identical data acquired in 2019. 
The association of results with stress and anxiety was analyzed.
RESULTS: Data were collected from 1896 subjects May - August 2019 to 980 
non-identical subjects May - June 2020. GI symptoms were reported by 68.9% 
during the COVID-19 lockdown compared with 56.0% the previous year (p < 0.001). 
The prevalence of irritable bowel syndrome (26.3% vs. 20.0%; p < 0.001), 
functional dyspepsia (18.3% vs. 12.7%; p < 0.001), heartburn (31.7% vs. 26.2%, 
p = 0.002), and self-reported milk intolerance (43.5% vs. 37.8% p = 0.004) was 
higher during the pandemic. Many individuals reported multiple symptoms. Anxiety 
was associated with presence of all GI symptoms. High levels of stress impacted 
functional dyspepsia (p = 0.045) and abdominal pain (p = 0.013). The presence of 
DGBI (p < 0.001; OR 22.99), self-reported milk intolerance (p < 0.001; OR 2.50), 
and anxiety (p < 0.001; OR 2.18) was independently associated with increased GI 
symptoms during COVID-19 pandemic.
CONCLUSIONS: The prevalence of GI symptoms was significantly higher during the 
COVID-19 lockdown than under normal circumstances the previous year. This 
increase was attributable to increased numbers of patients with DGBI, an effect 
that was associated with anxiety.

© 2021 John Wiley & Sons Ltd.

DOI: 10.1111/nmo.14197
PMID: 34145679 [Indexed for MEDLINE]


3332. BMJ Open. 2021 Jun 18;11(6):e051417. doi: 10.1136/bmjopen-2021-051417.

Psychological resilience during COVID-19: a meta-review protocol.

Seaborn K(1), Chignell M(2), Gwizdka J(3).

Author information:
(1)Department of Industrial Engineering and Economics, Tokyo Institute of 
Technology, Tokyo, Japan seaborn.k.aa@m.titech.ac.jp.
(2)Department of Mechanical and Industrial Engineering, The University of 
Toronto, Toronto, Ontario, Canada.
(3)School of Information, The University of Texas at Austin, Austin, Texas, USA.

INTRODUCTION: The global COVID-19 pandemic continues to have wide-ranging 
implications for health, including psychological well-being. A growing corpus of 
research reviews has emerged on the topic of psychological resilience in the 
context of the pandemic. However, this body of work has not been systematically 
reviewed for its quality, nor with respect to findings on the effectiveness of 
tools and strategies for psychological resilience. To this end, a meta-review 
protocol is proposed with the following objectives: (1) identify review work on 
the topic of psychological resilience during COVID-19; (2) assess the quality of 
this review work using A MeaSurement Tool to Assess systematic Reviews; (3) 
assess the risk of bias in this work; (4) generate a narrative summary of the 
key points, strengths and weaknesses; (5) identify the psychological resilience 
strategies that have been reviewed; (6) identify how these strategies have been 
evaluated for their effectiveness; (7) identify what outcomes were measured and 
(8) summarise the findings on strategies for psychological resilience so far, 
providing recommendations, if possible.
METHODS AND ANALYSIS: A systematic meta-review will be conducted in accordance 
with the Preferred Reporting Items for Systematic Reviews for Protocols and 
Joanna Briggs Institute umbrella review guidelines. Electronic searches of 
general databases, especially Web of Science, Scopus and PubMed, will be 
conducted. Only results from January 2020 onwards will be considered, coinciding 
with the COVID-19 pandemic. Only results in English will be included. 
Descriptive statistics, thematic analysis and narrative summaries describing the 
nature of the reviewed work and evaluation of psychological resilience 
strategies will be carried out.
ETHICS AND DISSEMINATION: Ethical approval is not needed for systematic review 
protocols. The results of the meta-review will be published in an international 
peer-reviewed journal. The raw and summarised data will be shared in the journal 
or other open venues.
PROSPERO REGISTRATION NUMBER: CRD42021235288.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-051417
PMCID: PMC8214992
PMID: 34145023 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3333. BMJ Open. 2021 Jun 18;11(6):e048926. doi: 10.1136/bmjopen-2021-048926.

Patient experiences and perceptions of chronic disease care during the COVID-19 
pandemic in India: a qualitative study.

Singh K(1)(2), Kaushik A(3)(2), Johnson L(4), Jaganathan S(2), Jarhyan P(3), 
Deepa M(5), Kong S(6), Venkateshmurthy NS(3)(2), Kondal D(3)(2), Mohan S(3)(2), 
Anjana RM(5), Ali MK(7), Tandon N(8), Narayan KMV(7), Mohan V(5), Eggleston 
K(6), Prabhakaran D(3)(2)(9).

Author information:
(1)Centre for Chronic Conditions and Injuries, Public Health Foundation of 
India, New Delhi, India kavita@ccdcindia.org.
(2)Clinical Research, Centre for Chronic Disease Control, New Delhi, India.
(3)Centre for Chronic Conditions and Injuries, Public Health Foundation of 
India, New Delhi, India.
(4)School of Medicine, Emory University, Atlanta, Georgia, USA.
(5)Department of Epidemiology, Madras Diabetes Research Foundation & Dr. Mohan's 
Diabetes Specialities Centre, Chennai, India.
(6)Shorenstein Asia-Pacific Research Center, Stanford University, Stanford, 
California, USA.
(7)Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
(8)Departement of Endocrinology and Metabolism, All India Institute of Medical 
Sciences, New Delhi, India.
(9)Department of Epidemiology, London School of Hygiene and Tropical Medicine, 
London, UK.

OBJECTIVE: People with chronic conditions are known to be vulnerable to the 
COVID-19 pandemic. This study aims to describe patients' lived experiences, 
challenges faced by people with chronic conditions, their coping strategies, and 
the social and economic impacts of the COVID-19 pandemic.
DESIGN, SETTING AND PARTICIPANTS: We conducted a qualitative study using a 
syndemic framework to understand the patients' experiences of chronic disease 
care, challenges faced during the lockdown, their coping strategies and 
mitigators during the COVID-19 pandemic in the context of socioecological and 
biological factors. A diverse sample of 41 participants with chronic conditions 
(hypertension, diabetes, stroke and cardiovascular diseases) from four sites 
(Delhi, Haryana, Vizag and Chennai) in India participated in semistructured 
interviews. All interviews were audio recorded, transcribed, translated, 
anonymised and coded using MAXQDA software. We used the framework method to 
qualitatively analyse the COVID-19 pandemic impacts on health, social and 
economic well-being.
RESULTS: Participant experiences during the COVID-19 pandemic were categorised 
into four themes: challenges faced during the lockdown, experiences of the 
participants diagnosed with COVID-19, preventive measures taken and lessons 
learnt during the COVID-19 pandemic. A subgroup of participants faced 
difficulties in accessing healthcare while a few reported using 
teleconsultations. Most participants reported adverse economic impact of the 
pandemic which led to higher reporting of anxiety and stress. Participants who 
tested COVID-19 positive reported experiencing discrimination and stigma from 
neighbours. All participants reported taking essential preventive measures.
CONCLUSION: People with chronic conditions experienced a confluence (reciprocal 
effect) of COVID-19 pandemic and chronic diseases in the context of difficulty 
in accessing healthcare, sedentary lifestyle and increased stress and anxiety. 
Patients' lived experiences during the pandemic provide important insights to 
inform effective transition to a mixed realm of online consultations and 
'distanced' physical clinic visits.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-048926
PMCID: PMC8214993
PMID: 34145019 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3334. BMJ Mil Health. 2022 Apr;168(2):153-159. doi: 10.1136/bmjmilitary-2021-001854. 
Epub 2021 Jun 18.

Caring for the carers: a COVID-19 psychological support programme.

Lamb D(1), Simms A(2), Greenberg N(3), Withnall RDJ(4).

Author information:
(1)Academic Department of Military Nursing, Royal Centre for Defence Medicine, 
Birmingham, UK Prof.ADMN@rcdm.bham.ac.uk.
(2)Academic Department of Military Mental Health, King's College London, London, 
UK.
(3)Institute of Psychology, Psychiatry and Neuroscience, King's College London, 
London, UK.
(4)Headquarters DMS, Defence Medical Services, Lichfield, UK.

The outbreak of COVID-19 and the subsequent pandemic brought unprecedented 
worldwide challenges born out of a rapidly escalating health and economic 
crisis. From emergency planners to healthcare workers on the front line, and 
everyone in between, the pandemic, and the uncertainty surrounding it, was 
likely to become a significant stressor, one with no immediate solution but with 
the potential to cause enduring distress beyond its conclusion. The UK Defence 
Medical Services recognised the need to provide an evidence-based programme of 
care intended to support personnel transitioning from assisting the national 
response back to normal duties. This was informed by a narrative review that 
targeted literature exploring strategies for supporting the mental health and 
well-being of healthcare workers during 21st-century infectious disease 
outbreaks. The literature identified the experiences most likely to cause 
enduring distress, which comprised morally challenging decisions, vulnerability, 
death and suffering, professional and personal challenges, and expectations. The 
opportunity to find meaning in these experiences, by discussing them with peers 
who share a contextual understanding, is important to limit the longer-term 
psychosocial impact of such events. This paper will discuss the design 
considerations and planned implementation strategy of the Recovery, Readjustment 
and Reintegration Programme to limit the incidence of distress or longer-term 
mental ill health among military personnel.

© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and 
permissions. Published by BMJ.

DOI: 10.1136/bmjmilitary-2021-001854
PMID: 34144951 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3335. Altern Ther Health Med. 2021 Sep;27(5):46-50.

Nurses' Emotional Stress Levels When Caring for COVID-19 Patients in an 
Intensive Care Unit.

Lin Q, Zheng Y.

CONTEXT: The COVID-19 pandemic has had an effect on many communities' physical 
and mental well-being, especially that of healthcare workers. During the 
pandemic, health workers have shown signs of depression and anxiety and have 
experienced sleep disturbances. Few studies have examined health workers' 
resilience during the pandemic.
OBJECTIVE: The current study intended to examine the job stress and mental 
well-being of nurses who have supported, worked with, and cared for COVID-19 
patients in an intensive care unit.
DESIGN: The research team performed a narrative review by searching the 
Mendeley, ScienceDirect, Medline, PubMed, Google Scholar, and Springer 
databases. The search used many keywords, both alone and in combination, such as 
COVID-19, pandemic, nurses, healthcare professionals, stress, and frontline 
workers. The review considered only English journals.
SETTING: This study was take place in Second Affiliated Hospital of Hainan 
Medical University, Hainan Province, China.
RESULTS: During the current pandemic, COVID-19 prevention in social settings, 
governmental regulation during the pandemic, and provision of frontline care 
have faced notable challenges. In general, nurses who have assisted during the 
COVID-19 pandemic have been under severe strain. The key factors that influenced 
nurses' stress were being only children, their working time per week, and their 
levels of anxiety.
CONCLUSIONS: COVID-19 has posed a vast threat to public health worldwide. The 
psychological stress of nurses should be managed in public-health emergencies.

PMID: 34144534 [Indexed for MEDLINE]


3336. J Psychosoc Nurs Ment Health Serv. 2021 Oct;59(10):13-18. doi: 
10.3928/02793695-20210513-02. Epub 2021 Jun 18.

Specialization Within a Specialty: Advanced Practice Psychiatric Nursing 
Pathways for the Greatest Good.

Kverno KS, Fenton A.

Dr. Hildegard Peplau's theory on the primacy of the therapeutic interpersonal 
relationship remains central to the role of the psychiatric-mental health 
advanced practice nurse (PMH APN). In 1989, Peplau published her thoughts on how 
World War II (WWII) shaped early PMH APN practice. Following WWII and the return 
of hundreds of thousands of previously mentally healthy service members with 
combat-related psychiatric symptoms and disorders, the prevailing societal 
beliefs about mental illness began to shift from an innate/inherited etiological 
perspective to a broader appreciation of the additional contributions of social 
and environmental factors to mental well-being. With that awareness came a 
decrease in stigma and a shift from housing patients in psychiatric hospitals to 
treating them in community settings. The coronavirus 2019 (COVID-19) pandemic 
has likewise affected societal beliefs through exposure to the mental toll of 
massive infection rates, loss of life, social isolation, and other downstream 
consequences. During these times of crises, psychiatric nurses and educators are 
challenged to provide innovative solutions to meet the increased demands for 
psychosocial care. [Journal of Psychosocial Nursing and Mental Health Services, 
59(10), 13-18.].

DOI: 10.3928/02793695-20210513-02
PMID: 34142917 [Indexed for MEDLINE]


3337. J Adv Nurs. 2021 Sep;77(9):3820-3828. doi: 10.1111/jan.14937. Epub 2021 Jun 18.

The psychological well-being of primary healthcare nurses during COVID-19: A 
qualitative study.

Ashley C(1), James S(2), Williams A(3), Calma K(4), Mcinnes S(1), Mursa R(4), 
Stephen C(4), Halcomb E(4).

Author information:
(1)School of Nursing, Faculty of Science, Medicine & Health, University of 
Wollongong, Wollongong, NSW, Australia.
(2)Department of General Practice, School of Public Health and Preventative 
Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, 
Notting Hill, VIC, Australia.
(3)Nursing and Midwifery, Health Sciences and Physiotherapy, University of Notre 
Dame, Sydney, NSW, Australia.
(4)School of Nursing, Faculty of Science, Medicine & Health, Illawarra Health & 
Medical Research Institute, University of Wollongong, Wollongong, NSW, 
Australia.

AIM: To explore primary healthcare nurses' psychological well-being related to 
the COVID-19 pandemic.
DESIGN: Qualitative descriptive study.
METHODS: Semi-structured interviews were conducted with 25 participants between 
June and August 2020 who indicated their willingness to participate in an 
interview following a national survey. Interviews were audio-recorded and 
transcribed verbatim by professional transcribers. Data were analysed using 
thematic analysis.
RESULTS: The importance of professional and public support and acknowledgement 
of the nurses' role during the pandemic positively influenced feelings of being 
valued. The psychological impact of negative experiences increased anxiety and 
stress levels. Participants reported a range of self-care strategies, including 
increased vigilance with infection control at home and work and attention to 
physical exercise and diet. Most participants remained positive about their 
roles and career decisions, although some indicated that the negative 
psychological impacts prompted re-evaluation of their career.
CONCLUSIONS: Primary healthcare nurses have been exposed to a range of personal 
and professional stressors during the pandemic that have impacted their 
psychological well-being. Awareness of stressors and an understanding of what 
has helped and what has impacted well-being are important in guiding future 
workplace support systems. Further work to explore the long-term impact of these 
stressors and the effectiveness of coping strategies employed by primary 
healthcare nurses is warranted.
IMPACT: Managers and professional organisations need to consider the personal 
and professional stressors that have impacted on primary healthcare nurses' 
psychological well-being to promote health and well-being among nurses following 
COVID-19.

© 2021 John Wiley & Sons Ltd.

DOI: 10.1111/jan.14937
PMCID: PMC8447215
PMID: 34142734 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare there are no conflicts of 
interest.


3338. BMJ Open. 2021 Jun 17;11(6):e048677. doi: 10.1136/bmjopen-2021-048677.

Paramedic experiences of providing care in wales (UK) during the 2020 COVID-19 
pandemic (PECC-19): a qualitative study using evolved grounded theory.

Rees N(1), Smythe L(2), Hogan C(2), Williams J(3).

Author information:
(1)Pre-Hospital Emergency Research Unit, Welsh National Ambulance Service NHS 
Trust, Swansea, UK nigel.rees5@wales.nhs.uk.
(2)Pre-Hospital Emergency Research Unit, Welsh National Ambulance Service NHS 
Trust, Swansea, UK.
(3)School of Health and Social Work, University of Hertfordshire, Hatfield, UK.

OBJECTIVE: To explore paramedic experiences of providing care during the 2020 
COVID-19 pandemic and develop theory in order to inform future policy and 
practice.
DESIGN: Qualitative study using constructivist evolved grounded theory (EGT) 
methodology. One-to-one semistructured interviews were conducted using a general 
interview guide. Voice over Internet Protocol was used through Skype.
SETTING: Conducted between March 2020 and November 2020 in the Welsh Ambulance 
Services National Health Services Trust UK which serves a population of three 
million.
PARTICIPANTS: Paramedics were recruited through a poster circulated by email and 
social media. Following purposive sampling, 20 Paramedics were enrolled and 
interviewed.
RESULTS: Emergent categories included: Protect me to protect you, Rapid 
disruption and adaptation, Trust in communication and information and United in 
hardship. The Basic Social Process was recognised to involve Tragic Choices, 
conceptualised through an EGT including Tragic personal and professional choices 
including concerns over personnel protective equipment (PPE), protecting 
themselves and their families, impact on mental health and difficult clinical 
decisions, Tragic organisational choices including decision making support, 
communication, mental health and well-being and Tragic societal choices 
involving public shows of support, utilisation and resourcing of health 
services.
CONCLUSIONS: Rich insights were revealed into paramedic care during the COVID-19 
pandemic consistent with other research. This care was provided in the context 
of competing and conflicting decisions and resources, where Tragic Choices have 
to be made which may challenge life's pricelessness. Well-being support, 
clinical decision making, appropriate PPE and healthcare resourcing are all 
influenced by choices made before and during the pandemic, and will continue as 
we recover and plan for future pandemics. The impact of COVID-19 may persist, 
especially if we fail to learn, if not we risk losing more lives in this and 
future pandemics and threatening the overwhelming collective effort which united 
society in hardship when responding to the COVID-19 Pandemic.
TRIAL REGISTRATION NUMBER: IRAS ID: 282 623.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-048677
PMCID: PMC8212156
PMID: 34140344 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3339. PLoS One. 2021 Jun 17;16(6):e0253295. doi: 10.1371/journal.pone.0253295. 
eCollection 2021.

Impact of COVID-19 on medical students' mental wellbeing in Jordan.

Seetan K(1), Al-Zubi M(1), Rubbai Y(2), Athamneh M(1), Khamees A(3), Radaideh 
T(3).

Author information:
(1)Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, 
Irbid, Jordan.
(2)Princess Aisha Bint Al-Hussein College of Nursing and Health Sciences, 
Al-Hussein Bin Talal University, Maan, Jordan.
(3)Faculty of Medicine, Yarmouk University, Irbid, Jordan.

COVID-19 has spread throughout the world and has resulted in significant 
morbidity, mortality, and negative psychological impact. This prospective 
cross-sectional study is exploring the effect of the pandemic on mental health 
of medical students. The study was conducted at six Jordanian medical schools 
using an online survey to collect students' socio-demographic and academic data. 
Assessment of mental wellbeing status was done using Kessler's psychological 
stress scale (K10); the impact of COVID-19 on life activities and strategies 
followed to manage the situation were also examined. A total of 553 medical 
students were recruited for the study. Men constituted 40.1%, and women were 
59.9%. Students reported that COVID-19 has affected the aspects of physical 
fitness (73.1%), study (68.4%), and social relationships (65.6%) the most. 
Sixty-six percent of the students were concerned about family members' 
affection, and more than half (58.4%) explained their concerns about the 
inability to get clinical sessions and labs. Cooking, baking, and hobby 
practicing were the most popular methods to improve their mental wellbeing. 
About half of the participants had a severe mental disorder, and only 13.2% were 
likely to be well. The study indicates that half of our medical students suffer 
severe mental disorders, with physical fitness, exercise, and studying being 
among the most affected aspects during the COVID 19 pandemic. It is recommended 
that measures need be taken to alleviate students' stress, which might have 
deleterious effects in many aspects.

DOI: 10.1371/journal.pone.0253295
PMCID: PMC8211263
PMID: 34138964 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


3340. PLoS One. 2021 Jun 17;16(6):e0252962. doi: 10.1371/journal.pone.0252962. 
eCollection 2021.

Varied and unexpected changes in the well-being of seniors in the United States 
amid the COVID-19 pandemic.

Barcellos S(1)(2), Jacobson M(3)(4), Stone AA(1)(2)(4)(5)(6).

Author information:
(1)Center for Economic and Social Research (CESR), University of Southern 
California, Los Angeles, CA, United States of America.
(2)Department of Economics, University of Southern California, Los Angeles, CA, 
United States of America.
(3)Davis School of Gerontology, University of Southern California, Los Angeles, 
CA, United States of America.
(4)Schaeffer Center for Health Policy & Economics, University of Southern 
California, Los Angeles, CA, United States of America.
(5)Dornsife Center for Self-Report Science, University of Southern California, 
Los Angeles, CA, United States of America.
(6)Department of Psychology, University of Southern California, Los Angeles, CA, 
United States of America.

Recent evidence suggests that psychological health deteriorated during the 
COVID-19 pandemic but far less is known about changes in other measures of 
well-being. We examined changes in a broad set of measures of well-being among 
seniors just before and after the recognition of community spread of COVID-19 in 
the United States. We fielded two waves of a survey to a large, national online 
panel of adults ages 60 to 68 at wave 1. We measured depressive symptoms, 
negative affect, positive affect, pain, life satisfaction and self-rated health 
in each survey wave. 16,644 adults answered well-being questions in waves 1 and 
2 of our survey (mean[SD]: age 64 [2.6]; 10,165 women [61%]; 15,161 [91%] 
white). We found large (20%; p<0.001) increases in the rate of depressive 
symptoms (1.4 percentage points; 95% CI, 0.97 to 1.86) and negative mood (0.225 
scale points; 95% CI, 0.205 to 0.245) but no change in self-reported health and 
a decrease (12.5%; p<0.001) in the rate of self-reported pain (5 percentage 
points; 95% CI, -5.8 to -4.3). Depressive symptoms and negative affect increased 
more for women. Higher perceived risk of getting COVID-19 and of dying from the 
disease were associated with larger increases in the rate of depressive symptoms 
and negative affect and larger decreases in positive affect and life 
satsifaction. COVID-19 related job/income loss was the only pandemic-related 
factor predictive of the decline in pain. Although depressive symptoms and mood 
worsened during the COVID-19 pandemic, other measures of well-being were either 
not materially affected or even improved.

DOI: 10.1371/journal.pone.0252962
PMCID: PMC8211190
PMID: 34138938 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


3341. J Appl Psychol. 2021 Jun;106(6):839-855. doi: 10.1037/apl0000931.

Hot, cold, or both? A person-centered perspective on death awareness during the 
COVID-19 pandemic.

Zhong R(1), Paluch RM(1), Shum V(2), Zatzick CD(2), Robinson SL(1).

Author information:
(1)Organizational Behavior and Human Resources Division, Sauder School of 
Business, University of British Columbia.
(2)Management and Organization Studies, Beedie School of Business, Simon Fraser 
University.

The COVID-19 pandemic-as an omnipresent mortality cue-heightens employees' 
awareness of their mortality and vulnerability. Extant research has identified 
two distinct forms of death awareness: death anxiety and death reflection. 
Because researchers have exclusively examined death anxiety and death reflection 
as independent and unique variables across individuals while overlooking their 
interplay and co-existence within individuals, we know little about whether and 
why employees can have different combined experiences of two forms of death 
awareness over a certain period of time (e.g., during the pandemic), and how 
these different employee experiences relate to theoretically and practically 
important work-relevant consequences. To address this gap in our knowledge, we 
adopted a person-centered approach using latent profile analysis to consider 
death anxiety and death reflection conjointly within employees during the 
COVID-19 pandemic. Across two studies, we identified three distinct death 
awareness profiles-the disengaged, calm reflectors, and anxious reflectors-and 
found membership in these profiles systematically varied according to health- 
(e.g., risk of severe illness from COVID-19), work- (e.g., job-required human 
contact), and community-related (e.g., the number of regional infections) 
factors influencing the self-relevance of COVID-19 as a mortality cue. In 
addition, we found that these death awareness profiles differentially predicted 
important employee outcomes, including well-being (i.e., depression and 
emotional exhaustion) and prosocial behaviors at work (i.e., organizational 
citizenship behaviors and pro-diversity behavior). (PsycInfo Database Record (c) 
2021 APA, all rights reserved).

DOI: 10.1037/apl0000931
PMID: 34138590 [Indexed for MEDLINE]


3342. Emotion. 2021 Dec;21(8):1660-1670. doi: 10.1037/emo0000982. Epub 2021 Jun 17.

The relation between age and experienced stress, worry, affect, and depression 
during the spring 2020 phase of the COVID-19 pandemic in the United States.

Cunningham TJ(1), Fields EC(2), Garcia SM(2), Kensinger EA(2).

Author information:
(1)Department of Psychiatry, Harvard Medical School.
(2)Department of Psychology and Neuroscience, Boston College.

Advanced age is often associated with increased emotional well-being, with older 
adults reporting more positive and less negative affect than younger adults. 
Here, we test whether this pattern held during the initial outbreak of the 
COVID-19 pandemic that disproportionately put older adults at risk. We 
additionally examine potential moderating effects of daily activity and social 
connectedness, which have been shown to benefit mental health across the life 
span. We regularly assessed a large sample of adults ages 18-89 using online 
surveys. As preregistered for this report (https://osf.io/tb4qv), we focus on 
self-reported measures of affect, depression, stress, and worry as well as 
self-reported daily activity and perception of social isolation during two time 
windows for adults in the United States: early (mid-March to early April) and 
later (mid-April to early May) periods during the spring phase of the pandemic. 
Increased age benefited emotional well-being for multiple metrics during both 
time windows assessed. Furthermore, the results confirmed that exercise and 
perception of social connectedness can buffer against negative mental health 
outcomes across all ages, although the beneficial effects of age remained even 
when controlling for these influences. The one exception was worry about one's 
own health: Once exercise and social connectedness were controlled, increased 
age was associated with more worry. The results overall suggest that, at least 
among adults with access to technology, older age was associated with greater 
resilience during the spring phase of the pandemic. Thus, increased resilience 
of older adults demonstrated previously extends to the context of the onset of a 
pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

DOI: 10.1037/emo0000982
PMID: 34138584 [Indexed for MEDLINE]


3343. Pediatr Pulmonol. 2021 Sep;56(9):2845-2853. doi: 10.1002/ppul.25537. Epub 2021 
Jun 29.

COVID-19: Impact, experiences, and support needs of children and young adults 
with cystic fibrosis and parents.

Collaço N(1), Legg J(2)(3), Day M(2), Culliford D(4), Campion A(2), West C(2), 
Darlington AS(1).

Author information:
(1)School of Health Sciences, University of Southampton, Southampton, England.
(2)Cystic Fibrosis Department, Southampton Children's Hospital, Southampton, 
England.
(3)NIHR Southampton Respiratory Biomedical Research Centre, University Hospital 
Southampton NHS Foundation Trust, Southampton, England.
(4)NIHR Applied Research Collaboration Wessex, University of Southampton, 
Southampton, England.

BACKGROUND: Little is known about the impact of COVID-19 and the United 
Kingdom's (UK) national shielding advice on people with cystic fibrosis (CF) and 
their families. This study explored the experiences and support needs of 
children and young adults (CYAs) with CF, and parents who have a child with CF, 
during the COVID-19 pandemic.
METHODS: CYAs with CF and parents of CYAs with CF completed a UK wide online 
survey with open and closed questions exploring experiences, information and 
support needs and decision-making processes. Qualitative thematic content 
analysis and descriptive quantitative analyses were undertaken.
RESULTS: CYAs aged 10-30 years (n = 99) and parents of CYAs aged 0-34 years 
(n = 145) responded. Parents (72.7%) and CYAs (50.0%) worried about the virus, 
and both were vigilant for virus symptoms (82.7% and 79.7%). Over three-quarters 
of CYAs were worried about their own health if they caught the virus. CYAs 
worried about feeling more isolated during the virus (64.9%). Qualitative 
findings reported the following themes: (1) Disruption-caused by isolation, (2) 
impact on psychological wellbeing, (3) safety of shielding, and (4) healthcare 
and treatment provision-changes to care, access and support.
CONCLUSIONS: The impact of COVID-19 and UK shielding advice to have no contact 
with anyone outside the household caused disruption to the lives and routines of 
individuals in relation to work, education, social lives, relationships, CF 
management routines and support. Parents and CYAs highlighted the need for 
clear, up-to-date and tailored advice on individualized risks and shielding.

© 2021 The Authors. Pediatric Pulmonology Published by Wiley Periodicals LLC.

DOI: 10.1002/ppul.25537
PMCID: PMC8441823
PMID: 34138526 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that there are no conflict 
of interests.


3344. Sci Prog. 2021 Apr-Jun;104(2):368504211026121. doi: 10.1177/00368504211026121.

History of contact with the SARS-COV-2 virus and the sense of coherence in the 
development of psychological distress in the occupational health professionals 
in Spain.

Gómez-Salgado J(1)(2), Ortega-Moreno M(3), Soriano G(4), Fagundo-Rivera J(5)(6), 
Allande-Cussó R(7), Ruiz-Frutos C(1)(2).

Author information:
(1)Department of Sociology, Social Work and Public Health, Faculty of Labour 
Sciences, University of Huelva, Huelva, Spain.
(2)Safety and Health Postgraduate Programme, Universidad Espíritu Santo, 
Guayaquil, Ecuador.
(3)Department of Economy, Faculty of Labour Sciences, University of Huelva, 
Huelva, Spain.
(4)Spanish Association of Specialists in Occupational Medicine, Madrid, Spain.
(5)Health Sciences Doctorate School, University of Huelva, Huelva, Spain.
(6)Nursing Department, Atlântica Health School, Barcarena, Portugal.
(7)Nursing Department, University of Seville, Seville, Spain.

The COVID-19 pandemic has affected the psychological well-being of healthcare 
professionals, among them, on medical and nursing occupational specialists. This 
study describes the psychological distress that this group has suffered, 
analyzing the effect that the sense of coherence related with the history of 
contact with infected people has generated in their mental health. 
Cross-sectional descriptive study using online questionnaires. Data were 
collected on a sample of 499 subjects, representing 42.0% and 38.8% of the 
associations of specialists in Occupational Medicine and Nursing, respectively. 
A univariate data analysis, independence test, and the CHAID multivariate method 
were carried out. The percentage of workers with high psychological distress was 
higher among women than among men; this was also higher in public sector workers 
than in the private sector. No differences have been observed regarding 
psychological distress and educational level, coexistence, having children, 
working away from home, having a pet, or between being a physician or nurse. The 
most efficient measure to prevent psychological distress was acting regarding 
the comprehensibility dimension of the sense of coherence. Sex, contact with any 
infected person, age, living as a couple, working in public or private centers, 
the availability of diagnostic tests, and the correlation with the manageability 
dimension were modulating factors. Sense of coherence is an effective measure to 
prevent psychological distress due to contact with people affected by COVID-19 
in Occupational Health professionals.

DOI: 10.1177/00368504211026121
PMCID: PMC10454955
PMID: 34137643 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


3345. Br J Soc Psychol. 2022 Jan;61(1):55-82. doi: 10.1111/bjso.12470. Epub 2021 Jun 
16.

A trouble shared is a trouble halved: The role of family identification and 
identification with humankind in well-being during the COVID-19 pandemic.

Frenzel SB(1), Junker NM(1), Avanzi L(2), Bolatov A(3), Haslam SA(4), Häusser 
JA(5), Kark R(6)(7), Meyer I(8), Mojzisch A(9), Monzani L(10), Reicher S(11), 
Samekin A(12), Schury VA(5), Steffens NK(4), Sultanova L(13), Van Dijk D(14), 
van Zyl LE(1)(15)(16)(17), Van Dick R(1).

Author information:
(1)Department of Social Psychology, Goethe University Frankfurt, Germany.
(2)Department of Psychology and Cognitive Science, University of Trento, Italy.
(3)Department of Biochemistry, Astana Medical University, Nur-Sultan, 
Kazakhstan.
(4)School of Psychology, University of Queensland, Brisbane, Australia.
(5)Department of Social Psychology, Justus-Liebig-University Giessen, Germany.
(6)Department of Psychology, Bar-Ilan University, Ramat Gan, Israel.
(7)School of Business, University of Exeter, UK.
(8)School of Management Studies, University of Cape Town, South Africa.
(9)Department of Psychology, University Hildesheim, Germany.
(10)Ivey Business School, University of Western Ontario, London, Canada.
(11)School of Psychology and Neuroscience, University of St Andrews, UK.
(12)Department of Psychology of Religion and Pedagogy, International Islamic 
Academy of Uzbekistan, Tashkent, Uzbekistan.
(13)Department of Psychology, Branch of Moscow State University Named for M.V. 
Lomonosov in Tashkent, Uzbekistan.
(14)Department of Health Systems Management, Ben-Gurion University of the Negev, 
Beersheba, Israel.
(15)Human Performance Management, Eindhoven University of Technology, The 
Netherlands.
(16)Optentia Research Focus Area, North-West University, Vanderbijlpark, South 
Africa.
(17)Department of HRM, University of Twente, Enschede, The Netherlands.

The COVID-19 pandemic has triggered health-related anxiety in ways that 
undermine peoples' mental and physical health. Contextual factors such as living 
in a high-risk area might further increase the risk of health deterioration. 
Based on the Social Identity Approach, we argue that social identities can not 
only be local that are characterized by social interactions, but also be global 
that are characterized by a symbolic sense of togetherness and that both of 
these can be a basis for health. In line with these ideas, we tested how 
identification with one's family and with humankind relates to stress and 
physical symptoms while experiencing health-related anxiety and being exposed to 
contextual risk factors. We tested our assumptions in a representative sample 
(N = 974) two-wave survey study with a 4-week time lag. The results show that 
anxiety at Time 1 was positively related to stress and physical symptoms at Time 
2. Feeling exposed to risk factors related to lower physical health, but was 
unrelated to stress. Family identification and identification with humankind 
were both negatively associated with subsequent stress and family identification 
was negatively associated with subsequent physical symptoms. These findings 
suggest that for social identities to be beneficial for mental health, they can 
be embodied as well as symbolic.

© 2021 The Authors. British Journal of Social Psychology published by John Wiley 
& Sons Ltd on behalf of British Psychological Society.

DOI: 10.1111/bjso.12470
PMCID: PMC8420363
PMID: 34132410 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3346. J R Coll Physicians Edinb. 2021 Jun;51(2):177-183. doi: 10.4997/JRCPE.2021.220.

UK internal medicine training in the time of COVID-19.

Sharrack S(1), Zollinger-Read CA(1), Cox MF(1), Shiha MG(1), Song SH(2).

Author information:
(1)Sheffield Teaching Hospitals, Sheffield, UK.
(2)Northern General Hospital, Herries Road, Sheffield S5 7AU, UK, Email: 
soon.song@nhs.net.

COVID-19 has had a significant impact on internal medicine training in the UK. 
Many unprecedented changes have been made to prioritise the care of affected 
patients. The medical workforce was re-shaped, training programmes were 
disrupted, Membership of the Royal College of Physicians (MRCP) examinations 
were cancelled and their format changed on re-commencement, teaching programmes 
were suspended and delivery methods amended, out of programme (OOP) 
opportunities deferred, non-COVID related research halted, trainee progression 
impacted and trainee mental health and wellbeing suffered. Despite this, the 
pandemic has undoubtedly created a plethora of unique learning opportunities for 
trainees that could make them better doctors and healthcare leaders in the 
future.

DOI: 10.4997/JRCPE.2021.220
PMID: 34131681 [Indexed for MEDLINE]

Conflict of interest statement: No conflict of interests declared


3347. Psychol Health. 2022 Oct;37(10):1223-1240. doi: 10.1080/08870446.2021.1936521. 
Epub 2021 Jun 15.

Written benefit finding for improving psychological health during the Covid-19 
pandemic first wave lockdown.

Hansen SR(1), Wetherell MA(1), Smith MA(1)(2).

Author information:
(1)Department of Psychology, Psychobiology, Stress and Wellbeing Research Group, 
Northumbria University, Newcastle upon Tyne, UK.
(2)Faculty of Health and Medical Sciences, University of Western Australia, 
Crawley, Australia.

Objectives. Written benefit finding is known to improve psychological and 
physical health in a range of patient groups. Here, we tested the efficacy of 
written benefit finding, delivered online during the Covid-19 pandemic lockdown, 
on mood and physical symptoms. We also investigated perseverative thinking as a 
moderator of these effects. Design. A quantitative longitudinal design was 
employed. Main Outcome Measures. Participants (n = 91) completed self-report 
measures of anxiety, depression, stress and physical symptoms at baseline, and 
two weeks after being randomised to complete three consecutive days of writing 
about the positive thoughts and feelings they experienced during the pandemic 
(written benefit finding) or to unemotively describe the events of the previous 
day (control). State anxiety was measured immediately before and after writing. 
Perseverative thinking was measured at baseline. Results. Anxiety and depression 
symptoms decreased between baseline and the two week follow-up, but did not 
differ significantly between the two conditions. Perseverative thinking was 
negatively associated with changes in symptoms of anxiety, depression and 
stress, but did not moderate any writing effects. There was a significant 
reduction in state anxiety in the written benefit finding condition. 
Conclusions. Written benefit finding may be a useful intervention for short-term 
improvements in wellbeing.

DOI: 10.1080/08870446.2021.1936521
PMID: 34130556 [Indexed for MEDLINE]


3348. Med Educ Online. 2021 Dec;26(1):1940765. doi: 10.1080/10872981.2021.1940765.

Undergraduate medical education amid COVID-19: a qualitative analysis of 
enablers and barriers to acquiring competencies in distant learning using focus 
groups.

Reinhart A(1), Malzkorn B(2), Döing C(1), Beyer I(3), Jünger J(4), Bosse HM(1).

Author information:
(1)Department of General Paediatrics, Neonatology, and Paediatric Cardiology, 
Düsseldorf University Department (UKD), Heinrich-Heine-University, Düsseldorf, 
Germany.
(2)Medical Didactics Office, Medical Faculty of the Heinrich-Heine-University, 
Heinrich-Heine-University, Düsseldorf, Germany.
(3)Department of Obstetrics and Gynaecology, Düsseldorf University Department 
(UKD), Heinrich-Heine-University, Düsseldorf, Germany.
(4)The German National Institute for State Examinations in Medicine, Pharmacy 
and Psychotherapy, Mainz, Germany.

Due to comprehensive social distancing measures related to the COVID-19 
pandemic, medical faculties worldwide have made a virtue of necessity in 
resorting to online teaching. Medical faculties grapple with how to convey 
clinical competencies to students in this context. There is a need for research 
not only to map but also to explain the effect of these secondary measures on 
students' learning and mental wellbeing. During a period of ongoing 
comprehensive social distancing measures in Germany, we translated a 
competency-based curriculum including obstetrics, paediatrics, and human 
genetics to an e-learning course based on online patient and teacher encounters. 
In our qualitative study on students' and teachers' views, we identify potential 
enablers and drivers as well as barriers and challenges to undergraduate medical 
education under lockdown. In summer 2020, we conducted six focus group 
interviews to investigate medical students' and teachers' perspectives, 
experiences and attitudes. All focus groups were videotaped, transcribed 
verbatim and coded. To guide our deductive and inductive analysis, we applied 
the theoretical framework of Regmi and Jones. Content analysis was performed in 
a multi-perspective group. We identified five major themes contributing to a 
successful use of clinical competency-based e-learning under lockdown: 
Communication (with teachers, students, and patients), Mental wellbeing, 
Structure and self-organization, Technical issues, and Learning and commitment. 
We discuss enablers and potential barriers within all themes and their overlap 
and link them in an explanatory model. In our setting, students and teachers 
find e-learning holds strong potential and especially in times of COVID-19 it is 
greatly appreciated. We broaden the understanding of the impact of distant 
learning on acquiring competencies, on attitudes, and on mental wellbeing. Our 
model may serve for a thoughtful, necessary transition to future e-learning and 
hybrid programs for a competency-based medical education with ongoing social 
distancing measures.

DOI: 10.1080/10872981.2021.1940765
PMCID: PMC8208109
PMID: 34128776 [Indexed for MEDLINE]


3349. PLoS One. 2021 Jun 14;16(6):e0252681. doi: 10.1371/journal.pone.0252681. 
eCollection 2021.

Awareness of COVID-19 influences on the wellness of Thai health professional 
students: An ambulatory assessment during the early "new normal" informing 
policy.

Tiaprapong K(1), Sirikul A(1), Krajangmek C(1), Duangthongkul N(1), Pandam N(1), 
Piya-Amornphan N(1).

Author information:
(1)Department of Physical Therapy, School of Allied Health Sciences, Walailak 
University, Tha Sala, Nakhon Si Thammarat, Thailand.

The COVID-19 global pandemic has had a socioeconomic effect, including many 
people suffering from stress and mental disorders. Health professional students 
are at risk of health issues as well when compared to their age-matched 
counterpart in the population. The present study aimed to find out the impact of 
COVID-19 awareness on the wellness of Thai health professional students. The 
awareness of COVID-19 and wellness among Thai health professional students, such 
as medical, physical therapy, nursing, pharmacy, and medical technology students 
were surveyed during the early "new normal" informing policy. The participants 
included 1,001 students, aged 17 to 25 years old, who responded to a Google form 
questionnaire set by request. The results showed that the prominent health risks 
among the Thai health professional students included sedentary behavior, 
obesity, and mental symptoms. A positive rating in attitude towards the COVID-19 
epidemic was mostly observed. There was a negative influence on anxiety symptoms 
(standardized coefficient beta = -0.079, p-value = 0.012), but a positive impact 
on social well-being (standardized coefficient beta = 0.158, p-value < 0.001) 
and quality of life (standardized coefficient beta = 0.136, p-value < 0.001) 
among the students even when the situation was improving. To relieve the domino 
effect of the COVID-19 pandemic on students' wellness, an updated policy for 
enhancing awareness and providing updated information is continuously required. 
Improvements on self and situational awareness may help prevent health risk 
behaviors and promote health among Thai health professional students.

DOI: 10.1371/journal.pone.0252681
PMCID: PMC8202936
PMID: 34125868 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


3350. Int J Psychol. 2021 Dec;56(6):825-833. doi: 10.1002/ijop.12786. Epub 2021 Jun 
14.

In this together: Psychological wellbeing of foreign workers in the United Arab 
Emirates during the COVID-19 pandemic.

Barbato M(1), Thomas J(1).

Author information:
(1)Department of Psychology, College of Natural and Health Sciences, Zayed 
University, Dubai, United Arab Emirates.

The COVID-19 pandemic and the associated infection prevention and control 
measures (e.g. quarantine, lockdown and isolation), have had an adverse impact 
on mental health. To date, the mental health status and challenges of foreign 
workers during the pandemic have been neglected in the literature. This 
cross-sectional web-based survey assessed levels of post-traumatic stress, 
depression, anxiety and insomnia among an international sample of foreign 
workers (n = 319) resident in the United Arab Emirates (UAE). The majority of 
participants were female (76%), European (69%) and highly educated (83% had a 
bachelor's or higher degree). Results indicate high rates of post-traumatic 
stress, depression, anxiety, and insomnia, especially among women, younger 
individuals, and those with a previous diagnosis of a psychological disorder. 
Additionally, foreign workers' perceptions of pandemic severity in their home 
nations (mild, moderate, severe) were positively correlated with their symptom 
levels of depression, anxiety and insomnia. Overall, these findings may help 
inform future public mental health strategy and pandemic preparedness plans with 
reference to safeguarding the psychological wellbeing of foreign workers.

© 2021 International Union of Psychological Science.

DOI: 10.1002/ijop.12786
PMCID: PMC8426748
PMID: 34125435 [Indexed for MEDLINE]


3351. Psychol Health. 2022 Feb;37(2):178-193. doi: 10.1080/08870446.2021.1936520. Epub 
2021 Jun 12.

The effects of an intervention to improve mental health during the COVID-19 
quarantine: comparison with a COVID control group, and a pre-COVID intervention 
group.

Gorbeña S(1), Gómez I(2), Govillard L(3), Sarrionandia S(1), Macía P(1), Penas 
P(1), Iraurgi I(1).

Author information:
(1)Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, 
Facultad de Psicología y Educación, Universidad de Deusto, Bilbao, Spain.
(2)Departamento de Psicología Social y del Desarrollo, Facultad de Psicología y 
Educación, Universidad de Deusto, Bilbao, Spain.
(3)Departamento de Trabajo Social y Sociología, Facultad de Ciencias Sociales y 
Humanas, Universidad de Deusto, San Sebastián, Spain.

ObjectiveThe COVID-19 pandemic has constituted an unprecedented challenge to 
society and science and it has provided an unexpected opportunity to explore the 
effects of a positive intervention in times of adversity and confinement. The 
goal was to evaluate the effects of a theory driven group intervention to 
cultivate mental health and flourishing. Design: A pre post design with three 
groups (151 individuals) was conducted, including an experimental group that 
received the intervention during the pandemic, a pre-COVID intervention group, 
and a COVID control group. Main Outcome Measures: Based on Keyes' concept of 
positive mental health, measures of subjective, psychological and social 
well-being were obtained, as well as an indicator of psychological distress 
(GHQ12). Results: Intervention groups showed an increase in well-being and the 
COVID control group a decrease. Change scores revealed significant differences. 
Overall percentage of individuals at risk of ill health in baseline was 25.2%, 
but after the intervention, the COVID control group reached 64.1%. Conclusions: 
Despite the limitations, the present findings suggest that interventions to 
sustain and improve mental health in times of crisis and adversity can be an 
effective approach.

DOI: 10.1080/08870446.2021.1936520
PMID: 34121544 [Indexed for MEDLINE]


3352. Psychol Health. 2022 Oct;37(10):1200-1222. doi: 10.1080/08870446.2021.1934470. 
Epub 2021 Jun 12.

Emotional well-being in COVID-19 mass quarantine: the role of personal response 
and life activity: a 14-day diary study in China.

Ma S(1), Zeng W(2), Borges A(1), Xu Y(3), Zhang J(4).

Author information:
(1)Business Research Unit (BRU-IUL), ISCTE -Instituto Universitário de Lisboa, 
Lisboa, Portugal.
(2)The Fourth Affiliated Hospital of Guangxi Medical University, Liu Zhou, 
Guangxi, China.
(3)School of Business, Guangdong University of Foreign Studies, Guangzhou, 
China.
(4)Faculty of Governance and Global Affairs, Leiden University, Wijnhaven, Den 
Haag, Netherlands.

OBJECTIVES: This study aims to explore quarantined individuals' emotional 
well-being over time and how personal response and life activity predict 
emotional well-being and its change.
DESIGN/METHODS: Daily data were collected from 134 participants with 71 having 
14 consecutive days' data. Hierarchical linear modeling (HLM) and General Linear 
Model (GLM) were used to examine the primary tests.
RESULTS: Overall, positive and negative emotions declined significantly during 
the surveyed period. Meanwhile, differences were observed in the level of 
positive, depressed, and negative emotions and/or patterns of change among 
different population categories. The personal response of worrying about work 
and life was positively related to depressed and negative emotions at baseline, 
but was negatively related to the development of both depressed and negative 
emotions over time. Among life activities, family stressor was a significant 
predictor for both depressed and negative emotions while social support 
predicted positive emotions. Moreover, health & hygiene activity was positively 
related to positive emotions at baseline.
CONCLUSIONS: The results provide scientific evidence for public health 
policymakers on quarantine policies and inform the general public about 
quarantine life. They highlight the importance of addressing the needs of 
vulnerable groups (parents with young children, divorcees, clinicians) during 
the pandemic, and demonstrate the benefits of promoting healthcare and hygiene 
activity, having a sense of worry and access to social support.

DOI: 10.1080/08870446.2021.1934470
PMID: 34121542 [Indexed for MEDLINE]


3353. Work. 2021;69(2):331-349. doi: 10.3233/WOR-205325.

Feasibility and outcome of an online streamed yoga intervention on stress and 
wellbeing of people working from home during COVID-19.

Wadhen V(1), Cartwright T(1).

Author information:
(1)Psychology, School of Social Sciences, University of Westminster, London, 
United Kingdom.

BACKGROUND: The outbreak of COVID-19 and its associated measures has resulted in 
a sizeable working population transitioning to working from home (WFH), bringing 
additional challenges, and increasing work-related stress. Research has 
indicated that yoga has promising potential in reducing stress in the workplace. 
However, there are very few studies exploring the impact of online streamed yoga 
on stress management for people-WFH.
OBJECTIVE: To investigate the feasibility and outcome of an online streamed yoga 
intervention on stress and wellbeing of people-WFH during COVID-19.
METHODS: A six-week pilot randomized controlled trial (RCT) yoga intervention 
was designed with yoga (n = 26) and a wait-list control group (n = 26). A mixed 
two-way ANOVA was used to assess changes in standardised outcome measures at 
baseline and post-intervention. Likert and open-ended questions assessed 
enjoyment, acceptability and perceived benefits of the program, which were 
analysed thematically.
RESULTS: Compared with the control, the yoga group reported significant 
improvements in perceived stress, mental wellbeing, depression and coping 
self-efficacy, but not stress and anxiety. Participants experienced physical and 
mental health benefits and reported high acceptability and enjoyment of the 
intervention.
CONCLUSIONS: An online yoga intervention can help people WFH manage stress and 
enhance wellbeing and coping abilities.

DOI: 10.3233/WOR-205325
PMID: 34120925 [Indexed for MEDLINE]


3354. Dig Dis Sci. 2022 Jul;67(7):2876-2881. doi: 10.1007/s10620-021-07095-y. Epub 
2021 Jun 11.

COVID-19 Pandemic Increased Anxiety Among Patients with Inflammatory Bowel 
Disease: A Patient Survey in a Tertiary Referral Center.

Stone ML(1), Feng M(2), Forster EM(2).

Author information:
(1)Department of Internal Medicine, Medical University of South Carolina, 96 
Jonathan Lucas Stree, Suite 812, Charleston, SC, 29425, USA. stonemo@musc.edu.
(2)Division of Gastroenterology and Hepatology, Department of Internal Medicine, 
Medical University of South Carolina, Charleston, SC, USA.

BACKGROUND: COVID-19 is the first global pandemic in more than 100 years, and at 
its onset, the effects were largely unknown. Immunocompromised patients, 
including IBD, were presumed to have higher risk.
AIMS: We hypothesized patients with IBD would have higher-than-baseline anxiety, 
high perceived vulnerability and significant lifestyle impacts as a result of 
the pandemic. We sought to assess the impact of these changes on disease and 
management.
METHODS: A cross-sectional study of patients with Crohn's disease, ulcerative 
colitis and IBD-unspecified was conducted. Patients were invited to participate 
by email in an IRB-approved brief, voluntary survey. Survey questions focused on 
disease characteristics, healthcare access and self-reported psychological 
well-being.
RESULTS: Responses from 492 (CD = 337, UC = 141,IC = 14) patients were included 
in the analysis. The majority of patients with IBD had increased anxiety since 
the pandemic, which correlated with an increase in GI symptoms. This risk of 
symptoms was mitigated by communication with their provider. Many patients had 
lifestyle changes including requesting time off work due to perceived 
vulnerability and changes in eating habits.
CONCLUSIONS: Our findings support an increase in illness-associated anxiety and 
perceived vulnerability among patients with IBD during the COVID-19 pandemic. 
Open communication with providers is important to maintain adequate control of 
disease and reduce symptoms of flares triggered by ongoing stress.

© 2021. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s10620-021-07095-y
PMCID: PMC8193011
PMID: 34115232 [Indexed for MEDLINE]

Conflict of interest statement: None of the authors have a conflict of interest 
or disclosures.


3355. Adv Food Nutr Res. 2021;96:251-310. doi: 10.1016/bs.afnr.2021.01.003. Epub 2021 
May 24.

Zinc.

Skalny AV(1), Aschner M(2), Tinkov AA(3).

Author information:
(1)IM Sechenov First Moscow State Medical University (Sechenov University), 
Moscow, Russia; Yaroslavl State University, Yaroslavl, Russia.
(2)IM Sechenov First Moscow State Medical University (Sechenov University), 
Moscow, Russia; Department of Molecular Pharmacology, Albert Einstein College of 
Medicine, Bronx, NY, United States.
(3)IM Sechenov First Moscow State Medical University (Sechenov University), 
Moscow, Russia; Yaroslavl State University, Yaroslavl, Russia. Electronic 
address: tinkov.a.a@gmail.com.

Since the discovery of manifest Zn deficiency in 1961, the increasing number of 
studies demonstrated the association between altered Zn status and multiple 
diseases. In this chapter, we provide a review of the most recent advances on 
the role of Zn in health and disease (2010-20), with a special focus on the role 
of Zn in neurodegenerative and neurodevelopmental disorders, diabetes and 
obesity, male and female reproduction, as well as COVID-19. In parallel with the 
revealed tight association between ASD risk and severity and Zn status, the 
particular mechanisms linking Zn2+ and ASD pathogenesis like modulation of 
synaptic plasticity through ProSAP/Shank scaffold, neurotransmitter metabolism, 
and gut microbiota, have been elucidated. The increasing body of data indicate 
the potential involvement of Zn2+ metabolism in neurodegeneration. Systemic Zn 
levels in Alzheimer's and Parkinson's disease were found to be reduced, whereas 
its sequestration in brain may result in modulation of amyloid β and α-synuclein 
processing with subsequent toxic effects. Zn2+ was shown to possess adipotropic 
effects through the role of zinc transporters, zinc finger proteins, and 
Zn-α2-glycoprotein in adipose tissue physiology, underlying its particular role 
in pathogenesis of obesity and diabetes mellitus type 2. Recent findings also 
contribute to further understanding of the role of Zn2+ in spermatogenesis and 
sperm functioning, as well as oocyte development and fertilization. Finally, 
Zn2+ was shown to be the potential adjuvant therapy in management of novel 
coronavirus infection (COVID-19), underlining the perspectives of zinc in 
management of old and new threats.

Copyright © 2021 Elsevier Inc. All rights reserved.

DOI: 10.1016/bs.afnr.2021.01.003
PMCID: PMC8208231
PMID: 34112355 [Indexed for MEDLINE]


3356. PLoS One. 2021 Jun 10;16(6):e0252809. doi: 10.1371/journal.pone.0252809. 
eCollection 2021.

Perceived stress and associated factors among health care professionals working 
in the context of COVID-19 pandemic in public health institutions of southern 
Ethiopia 2020.

Teshome A(1), Shegaze M(2), Glagn M(2), Getie A(3), Tekabe B(2), Getahun D(3), 
Kanko T(1), Getachew T(4), Yenesew N(5), Meskele S(4), Tolosie K(6), Temtem 
Z(5), Yirgu T(7).

Author information:
(1)Department of Biomedical Science, Arba Minch University, Arba Minch, 
Ethiopia.
(2)School of Public Health, Arba Minch University, Arba Minch, Ethiopia.
(3)School of Nursing, Arba Minch University, Arba Minch, Ethiopia.
(4)Department of Anatomy, Arba Minch University, Arba Minch, Ethiopia.
(5)Department of Psychology, Arba Minch University, Arba Minch, Ethiopia.
(6)Department of Statistics, Arba Minch University, Arba Minch, Ethiopia.
(7)Department of Geography, Arba Minch University, Arba Minch, Ethiopia.

INTRODUCTION: Health care professionals are at higher risk of developing 
stress-related problems during outbreaks, due to the overwhelming clinical 
workload, fear of contagion, and inadequate protective gears. So, in order to 
monitoring mental health issues and to understand the factors evidence-based 
interventions is important. Therefore, this study was aimed to assess perceived 
stress and associated factors among health care professionals working in the 
context of COVID-19, Southern Ethiopia.
METHODS: Institution based cross-sectional study was conducted among 798 health 
care professionals from the 1st May to 1st June 2020. The study participants 
were selected using simple random sampling technique after allocating a 
proportion to each health institute based on the size of health care 
professionals. A pre-tested and structured interviewer-administered 
questionnaire using KOBO collect survey tool was used to collect data. A total 
score of >20 points was considered as the cut off for experiencing perceived 
stress based on perceived stress scale. Both bivariable and multivariable 
logistic regression analysis were performed to identify associated factors. The 
level of statistical significance was set at a p-value of less than 0.05 in 
multivariable logistic regression.
RESULT: Nearly two-thirds 61.8% (95% CI: 58.4%, 65.2%) of HCPs had perceived 
stress. Not having COVID-19 updated information (AOR = 2.41, 95% CI: 1.31, 
4.43), not at all confident on coping with stress (AOR = 9.94, 95% CI:3.74, 
26.41), somewhat confident in coping with stress (AOR = 4.69, 95% CI:2.81, 
7.84), moderately confident on coping with stress (AOR = 2.36, 95% CI: 1.46, 
3.82), and not getting along well with people (AOR = 4.88, 95% CI: 1.42, 16.72) 
were positively association with perceived stress. However, feeling overwhelmed 
by the demand of everyday life (AOR = 0.52 95% CI: 0.35, 0.77) and worrying 
about what other people think about them (AOR = 0.48, 95% CI: 0.24, 0.81) were 
negatively associated with perceived stress.
CONCLUSION: COVID-19 update, confidence in coping with stress, getting along 
with people, worrying about what other people think about them, and feeling 
overwhelmed by the demand of everyday life were factors significantly associated 
with perceived stress. The provision of COVID-19 update to HCPs along with wider 
strategies to support their psychological wellbeing is vital.

DOI: 10.1371/journal.pone.0252809
PMCID: PMC8191883
PMID: 34111170 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


3357. J Psychosoc Nurs Ment Health Serv. 2021 Aug;59(8):31-42. doi: 
10.3928/02793695-20210322-02. Epub 2021 Jun 8.

Work-Related Stress and Anxiety Among Frontline Nurses During the COVID-19 
Pandemic: A Cross-Sectional Study.

D'emeh WM, Yacoub MI, Shahwan BS.

The coronavirus disease 2019 (COVID-19) pandemic has strained the health system 
worldwide. Nurses caring for patients with COVID-19 reported experiencing 
significant work-related stress and anxiety. The current online descriptive 
cross-sectional correlational study aimed to investigate work-related stress and 
anxiety among nurses caring for patients with COVID-19. Data were collected from 
240 nurses using the Stress Overload Scale and Self-Rated Anxiety Scale. Average 
stress and anxiety scores were 34.96 (SD = 5.85) and 52.8 (SD = 5.48), 
respectively. Statistically significant differences were found in mean stress 
overload and anxiety scores based on gender, professional title, average working 
hours per week, working area, and presence of fear of being infected with 
COVID-19. These findings suggest the need to promote well-being in nurses and 
assist nurses and other health care workers experiencing mental and 
psychological health problems in the context of the COVID-19 pandemic. [Journal 
of Psychosocial Nursing and Mental Health Services, 59(8), 31-42.].

DOI: 10.3928/02793695-20210322-02
PMID: 34110949 [Indexed for MEDLINE]


3358. J Prim Care Community Health. 2021 Jan-Dec;12:21501327211024411. doi: 
10.1177/21501327211024411.

Perceived Adequacy of Tangible Support during Stay-at-Home Orders in Chicago and 
New York.

O'Conor R(1), Opsasnick L(1), Pack A(1), Yoshino Benavente J(1), Curtis LM(1), 
Lovett RM(1), Luu H(1), Wismer G(1), Kwasny MJ(2), Federman AD(3), Bailey SC(1), 
Wolf MS(1).

Author information:
(1)Division of General Internal Medicine & Geriatrics, Feinberg School of 
Medicine, Northwestern University, Chicago, IL, USA.
(2)Department of Preventive Medicine, Feinberg School of Medicine, Northwestern 
University, Chicago, IL, USA.
(3)Icahn School of Medicine at Mount Sinai, New York, NY, USA.

OBJECTIVES: Physical distancing precautions during the COVID-19 pandemic may 
challenge the provision of tangible support many middle age and older adults 
receive in managing their health. We examined the association between unmet 
tangible support needs and self-management behaviors and mental health status 
during the stay-at-home orders in Chicago and New York.
METHODS: We used data from the COVID-19 & Chronic Conditions study collected 
between May 1st and May 22nd, 2020. A total of 801 middle age and older adults 
with ≥1 chronic condition in Chicago and New York City completed the telephone 
interview. Adequacy of tangible social support was measured using a brief, 
validated scale that determined whether an individual needed assistance managing 
his or her health, and if yes, whether this need was met. Participants reported 
their level of difficulty engaging in self-management behaviors using 2 discrete 
items; they also self-reported medication adherence using the ASK-12 medication 
adherence scale. Mental health status was measured using the depression and 
anxiety PROMIS short-form instruments.
RESULTS: Participants' mean age was 63 years; 30% identified as Black, 26% 
identified as Latino, and 12% identified unmet support needs. Inadequacy of 
tangible support was associated with greater difficulty managing one's health 
and accessing medications due to COVID-19, as well as poorer medication 
adherence, increased anxiety and depressive symptoms, and poorer overall 
well-being (P's < .05).
CONCLUSIONS: Perceived unmet support needs during stay-at-home orders were 
associated with greater difficulty engaging in self-management behaviors and 
poorer overall well-being. Two brief items quickly identified individuals with 
unmet support needs.

DOI: 10.1177/21501327211024411
PMCID: PMC8202264
PMID: 34109874 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
author(s) declared the following potential conflicts of interest with respect to 
the research, authorship, and/or publication of this article: Dr. Bailey reports 
grants from the NIH during the conduct of the study; grants from Merck, the NIH, 
and Eli Lilly outside the submitted work; grants and personal fees from the 
Gordon and Betty Moore Foundation outside the submitted work; and personal fees 
from Sanofi, Pfizer, and Luto outside the submitted work. Dr. Wolf reports 
grants from the NIH during the conduct of the study; grants from Merck, the 
Gordon and Betty Moore Foundation, the NIH, and Eli Lilly outside the submitted 
work; and personal fees from Sanofi, Pfizer, and Luto outside the submitted 
work. All other authors report no conflicts of interest.


3359. Br J Nurs. 2021 Jun 10;30(11):634-642. doi: 10.12968/bjon.2021.30.11.634.

The global mental health burden of COVID-19 on critical care staff.

Ezzat A(1), Li Y(2), Holt J(3), Komorowski M(4).

Author information:
(1)General Surgery Registrar, Department of Surgery and Cancer, Imperial College 
Healthcare NHS Trust, London, and Honorary Research Clinical Fellow, Department 
of Surgery and Cancer, Imperial College London.
(2)Postgraduate Fellow, Department of Health Service and Population Research, 
King's College London, London.
(3)Foundation Doctor, Birmingham Heartlands Hospital, Bordesley Green, 
Birmingham.
(4)Clinical Senior Lecturer, Department of Surgery and Cancer, St Mary's Campus, 
and Consultant in Intensive Care, Intensive Care Unit, Charing Cross Hospital, 
Imperial College Healthcare NHS Trust, London.

BACKGROUND: Although the mental health burden in healthcare workers caused by 
COVID-19 has gained increasing attention both within the profession and through 
public opinion, there has been a lack of data describing their experience; 
specifically, the mental wellbeing of healthcare workers in the intensive care 
unit (ICU), including those redeployed.
AIMS: The authors aimed to compare the mental health status of ICU healthcare 
workers (physicians, nurses and allied health professionals) affected by various 
factors during the COVID-19 pandemic; and highlight to policymakers areas of 
staff vulnerabilities in order to improve wellbeing strategies within healthcare 
systems.
METHODS: An online survey using three validated scales was conducted in France, 
the UK, Italy, Mainland China, Taiwan, Egypt and Belgium.
FINDINGS: The proportion of respondents who screened positive on the three 
scales across the countries was 16-49% for depression, 60-86% for insomnia and 
17-35% for post-traumatic stress disorder. The authors also identified an 
increase in the scores with longer time spent in personal protective equipment, 
female gender, advancing age and redeployed status.
CONCLUSION: The high prevalence of mental disorders among ICU staff during the 
COVID-19 crisis should inform local and national wellbeing policies.

DOI: 10.12968/bjon.2021.30.11.634
PMID: 34109816 [Indexed for MEDLINE]


3360. Eur Rev Med Pharmacol Sci. 2021 May;25(10):3914-3922. doi: 
10.26355/eurrev_202105_25961.

Telework and its effects on mental health during the COVID-19 lockdown.

De Sio S(1), Cedrone F, Nieto HA, Lapteva E, Perri R, Greco E, Mucci N, Pacella 
E, Buomprisco G.

Author information:
(1)R.U. of Occupational Medicine, "Sapienza" University of Rome, Rome, Italy. 
simone.desio@uniroma1.it.

OBJECTIVE: During the Covid-19 pandemic, many governments promoted the adoption 
and development of telework to reduce some of the consequences of the current 
health crisis on the economy and favor social distancing. The aim of this 
web-based cross-sectional study was to assess the consequences of the Covid-19 
pandemic on job organization, exploring the effects of lockdown measures on the 
psychological distress and perceived well-being of workers experiencing 
telework.
SUBJECTS AND METHODS: A web-based cross-sectional survey has been used to 
collect data. The participants answered the questionnaire from April 1 to April 
30, 2020. The questionnaire consisted of three sections, which investigated: 1) 
demographic and occupational variables, 2) lifestyle and habits variables, 3) 
psychological distress and perceived well-being. The General Health 
Questionnaire (GHQ-12) has been used to evaluate psychological distress and the 
5-item World Health Organization Well-Being Index (WHO-5) to explore subjective 
well-being.
RESULTS: Psychological distress was associated with educational level, with 
habits, and with reporting poor well-being. Poor well-being was associated with 
a higher job demand during pandemic, lifestyle and habits variables, and 
psychological distress.
CONCLUSIONS: This is one of the first studies exploring the consequences of the 
COVID-19 pandemic and lockdown measures on the perceived well-being and 
psychological distress of workers experiencing telework. It is mandatory to pay 
more and more attention to the mental health of teleworkers, considering the 
increasing diffusion and adoption of this type of work organization.

DOI: 10.26355/eurrev_202105_25961
PMID: 34109606 [Indexed for MEDLINE]


3361. BMJ Open. 2021 Jun 9;11(6):e050316. doi: 10.1136/bmjopen-2021-050316.

Mental health disorders among healthcare workers during the COVID-19 pandemic: a 
cross-sectional survey from three major hospitals in Kenya.

Shah J(1), Monroe-Wise A(2), Talib Z(3), Nabiswa A(1), Said M(4), Abeid A(5), 
Ali Mohamed M(5), Mohamed S(5), Ali SK(6).

Author information:
(1)Department of Internal Medicine, Aga Khan University Hospital, Nairobi, 
Kenya.
(2)Department of Global Health, University of Washington Seattle Campus, 
Seattle, Washington, USA.
(3)Department of Medical Education, California University of Science and 
Medicine, San Bernardino, California, USA.
(4)Avenue Hospital, Nairobi, Kenya.
(5)Coast General Teaching and Referral Hospital, Nairobi, Kenya.
(6)Department of Internal Medicine, Aga Khan University Hospital, Nairobi, Kenya 
sayed.karar@aku.edu.

BACKGROUND: COVID-19 is an international global health emergency and has posed a 
great challenge to mental well-being and resilience. Little is known about the 
mental health impact of COVID-19 among healthcare workers (HCWs) in sub-Saharan 
Africa or other low-resource settings.
METHODS: We conducted a cross-sectional study between August and November 2020 
among HCWs recruited from three major hospitals in Kenya. The survey 
questionnaire consisted of six components: demographic and work title 
characteristics; information regarding care of patients with COVID-19; and 
symptoms of depression, anxiety, insomnia, distress and burnout, measured using 
standardised questionnaires. Multivariable logistic regression analysis was 
performed to identify factors associated with mental health disorders.
RESULTS: A total of 433 (65.2% response rate) individuals participated in the 
survey. Median age was 32.75 years, 58.4% were females and 68.8% were front-line 
workers. Depression, anxiety, insomnia, distress and burnout were reported in 
53.6%, 44.3%, 41.1%, 31.0% and 45.8% of all participants, respectively. 
Front-line HCWs, females and doctors were at higher risk of mental health 
symptoms. Nearly half of participants reported inadequate resources or training 
to care for patients with COVID-19, and those in the government hospital were 
more likely to report mental health symptoms.
CONCLUSIONS: This is among the first studies examining mental health outcomes 
among HCWs during the COVID-19 pandemic in Kenya. Similar to other studies from 
around the world, HCWs directly involved with patients with COVID-19 reported 
higher rates of mental health symptoms. Mitigating strategies specific to Kenyan 
HCWs are urgently needed to help them cope with mental health symptoms during 
the pandemic.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-050316
PMCID: PMC8190985
PMID: 34108174 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3362. BMJ Open. 2021 Jun 9;11(6):e048353. doi: 10.1136/bmjopen-2020-048353.

Evaluation of risk mitigation measures for people with substance use disorders 
to address the dual public health crises of COVID-19 and overdose in British 
Columbia: a mixed-method study protocol.

Nosyk B(1)(2), Slaunwhite A(3), Urbanoski K(4)(5), Hongdilokkul N(6), Palis 
H(3), Lock K(3), Min JE(2), Zhao B(3), Card KG(4)(5), Barker B(7)(8), Meilleur 
L(7), Burmeister C(9), Thomson E(10), Beck-McGreevy P(10), Pauly B(4)(11).

Author information:
(1)Faculty of Health Sciences, Simon Fraser University, Burnaby, British 
Columbia, Canada bnosyk@sfu.ca.
(2)Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 
Vancouver, British Columbia, Canada.
(3)BC Centre for Disease Control, Vancouver, British Columbia, Canada.
(4)Canadian Institute for Substance Use Research, Victoria, British Columbia, 
Canada.
(5)School of Public Health and Social Policy, University of Victoria, Victoria, 
British Columbia, Canada.
(6)British Columbia Office of the Human Rights Commissioner, Vancouver, British 
Columbia, Canada.
(7)First Nations Health Authority, West Vancouver, British Columbia, Canada.
(8)Department of Medicine, The University of British Columbia, Vancouver, 
British Columbia, Canada.
(9)Professionals for Ethical Engagement of Peers, Vancouver, British Columbia, 
Canada.
(10)BC/Yukon Association of Drug War Survivors, New Westminster, British 
Columbia, Canada.
(11)School of Nursing, University of Victoria, Victoria, British Columbia, 
Canada.

INTRODUCTION: The COVID-19 pandemic was preceded by an ongoing overdose crisis 
and linked to escalating drug overdose deaths in British Columbia (BC). At the 
outset of these dual public health emergencies, the BC government announced 
interim Risk Mitigation Guidance (RMG) that permitted prescribing medication 
alternatives to substances, including opioids, alcohol, stimulants and 
benzodiazepines, an intervention sometimes referred to as 'safe supply'. This 
protocol outlines the approach for a study of the implementation of RMG and its 
impacts on COVID-19 infection, drug-related and systemic harms, continuity of 
care for people with substance use disorder (SUD), as well as their behavioural, 
psychosocial and well-being outcomes.
METHODS AND ANALYSIS: We conducted a parallel mixed-method study that involved 
both analysis of population-level administrative health data and primary data 
collection, including a 10-week longitudinal observational study (target n=200), 
a cross-sectional survey (target n=200) and qualitative interviews (target 
n=60). We implemented a participatory approach to this evaluation, partnering 
with people with lived or living expertise of drug use, and researchers and 
public health decision-makers across the province. Linked population-level 
administrative databases will analyse data from a cohort of BC residents with an 
indication of SUD between 1996 and 2020. We will execute high-dimensional 
propensity score matching and marginal structural modelling to construct a 
control group and to assess the impact of RMG dispensation receipt on a 
collaboratively determined set of primary and secondary outcomes.
ETHICS AND DISSEMINATION: Study activities were developed to adhere to the 
Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans, 
recommended COVID-19 research practices, and guided by the Truth and 
Reconciliation Commission's Calls to Action for public health, data governance 
and research ethics related to Indigenous people. Results will be disseminated 
incrementally, on an ongoing basis, through the consortium established for this 
study, then published in peer-reviewed journals.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2020-048353
PMCID: PMC8190984
PMID: 34108170 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3363. BMC Med Educ. 2021 Jun 9;21(1):335. doi: 10.1186/s12909-021-02780-y.

Distance education during COVID 19: an Italian survey on the university 
teachers' perspectives and their emotional conditions.

Casacchia M(1), Cifone MG(1), Giusti L(1), Fabiani L(1), Gatto R(1), Lancia 
L(1), Cinque B(1), Petrucci C(1), Giannoni M(1), Ippoliti R(1), Frattaroli 
AR(1), Macchiarelli G(1), Roncone R(2).

Author information:
(1)Department of Life, Health and Environmental Science, University of L'Aquila, 
L'Aquila, Italy.
(2)Department of Life, Health and Environmental Science, University of L'Aquila, 
L'Aquila, Italy. rita.roncone@univaq.it.

BACKGROUND: Following the COVID-19 pandemic, distance education (DE) replaced 
traditional "face-to-face" teaching and has become the main method of teaching. 
The aim of this study was to 1) evaluate the impact of DE by teachers in our 
department during the second semester of the 2019-20 academic year following the 
March-May 2020 Italian national lockdown and 2) evaluate the relationship 
between DE and the emotional well-being of teachers during the period of home 
confinement.
METHODS: Ninety-seven university teachers (51.5% women; most represented age 
group 60-69 years range, 40.2%) responded to an anonymous online cross-sectional 
survey between July 15 - September 30, 2020, on the advantages and disadvantages 
of DE, developed by one online teacher focus group. The emotional conditions 
were assessed by a short version of the Beck Depression Inventory-II (BDI-II). 
The internal consistency reliability survey and the 10-item BDI-II were measured 
by Cronbach's alpha. A correlation analysis (r-Pearson) was conducted between 
the overall evaluation of the experience of DE and the variables included in the 
study.
RESULTS: Teachers reported difficulties in technical aspects, and in 
psychological factors, as the discomfort of "speaking in the void" (64.7%). The 
absence of "face-to-face" eye contact with the students was complained by 81% of 
teachers. Significant impairments in sleep patterns and loss of energy were 
reported, with female teachers having greater difficulty concentrating than 
their male colleagues. A quarter of teachers showed depressive symptoms of 
varying severity. The most satisfied teachers were those most stimulated by DE 
(r = 0.752, p < 0.000), who showed a lower impact of depressive symptoms 
(r = - 0.289, p = 0.005). The teaching load in hours influenced the perception 
of disadvantages (r = 0.214, p = 0.035) and contributed to a lower appreciation 
of the challenges of DE. The more significant the manifestation of depressive 
symptoms during the lockdown was, the greater the subjective recovery of a good 
emotional condition once the domestic confinement was over (r = 0.344, 
p = 0.001), despite maintaining DE.
CONCLUSIONS: Our study highlights the impact of technical, didactic, and 
psychological difficulties of DE, reported by our teachers. The appreciation of 
their new learning promoted by DE seemed related to better emotional well-being 
of university teachers accepting this "challenge" in their important role in the 
high-education system, influencing good learning and promoting students' 
professional success.

DOI: 10.1186/s12909-021-02780-y
PMCID: PMC8187887
PMID: 34107926 [Indexed for MEDLINE]

Conflict of interest statement: No additional financial or other affiliation 
relevant to the subject of this article is reported.


3364. J Psychiatr Res. 2021 Aug;140:95-100. doi: 10.1016/j.jpsychires.2021.05.027. 
Epub 2021 May 24.

Change in humor and sarcasm use based on anxiety and depression symptom severity 
during the COVID-19 pandemic.

Rothermich K(1), Ogunlana A(2), Jaworska N(3).

Author information:
(1)Department of Communication Sciences and Disorders, East Carolina University, 
USA.
(2)University of Ottawa's Institute of Mental Health Research, Canada.
(3)University of Ottawa's Institute of Mental Health Research, Canada; 
Department of Cellular and Molecular Medicine, University of Ottawa, Canada. 
Electronic address: natalia.jaworska@theroyal.ca.

BACKGROUND: Humor and sarcasm may be used as potential coping strategies during 
challenging times, and to improve wellbeing. We investigated changes in humor 
and sarcasm use during the COVID-19 pandemic in participants with varying 
anxiety and depression symptom severity, and in those with versus without 
psychiatric disorders.
METHODS: Online data was collected from N = 661 Canadian adults during the 
height of COVID-19-related restrictions. Depression and anxiety symptom severity 
were assessed using the Patient Health Questionnaire (PHQ-9) and General Anxiety 
Disorder (GAD-7) scale. Participants were queried on current presence/absence of 
a psychiatric disorder, and on changes in humor and sarcasm use during compared 
to before the pandemic.
RESULTS: Participants with any vs. no depression symptoms reported more sarcasm 
and humor use during the pandemic. Respondents with mild and severe vs. no 
anxiety symptoms reported using more sarcasm. However, those with any vs. no 
anxiety symptoms used less humor during the pandemic. Finally, less humor use 
was noted in those without vs. with a psychiatric disorder.
LIMITATIONS: The use of self-report measures and a sample that may limit 
generalizability.
CONCLUSIONS: Adults with depression symptoms used more humor and sarcasm as a 
potential coping strategy during COVID-19. While individuals with anxiety 
symptoms used more sarcasm, this was not true of humor, suggesting their 
decreased reliance on levity during a crisis. Humor use was greater in those 
with psychiatric disorders, perhaps due to self-preservation mechanisms during 
times of distress. Our findings have implications for using humor in therapy in 
individuals with mental health struggles and mood disorders.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.jpsychires.2021.05.027
PMCID: PMC8675002
PMID: 34102518 [Indexed for MEDLINE]

Conflict of interest statement: All authors declare that they have no conflicts 
of interest.


3365. PLoS One. 2021 Jun 8;16(6):e0252356. doi: 10.1371/journal.pone.0252356. 
eCollection 2021.

Well-being during COVID-19 pandemic: A comparison of individuals with 
minoritized sexual and gender identities and cis-heterosexual individuals.

Buspavanich P(1)(2)(3), Lech S(1)(2)(4), Lermer E(5)(6), Fischer M(7), Berger 
M(1)(2), Vilsmaier T(8), Kaltofen T(8), Keckstein S(8), Mahner S(8), Behr 
J(1)(9)(10), Thaler CJ(8), Batz F(8).

Author information:
(1)Department of Psychiatry, Psychotherapy and Psychosomatics, Brandenburg 
Medical School Theodor Fontane, Neuruppin, Germany.
(2)Department of Psychiatry and Psychotherapy, Charité -Universitätsmedizin 
Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu 
Berlin, Berlin, Germany.
(3)Institute of Sexology and Sexual Medicine, Charité -Universitätsmedizin 
Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu 
Berlin, Berlin, Germany.
(4)Institute of Medical Sociology and Rehabilitation Science, Charité 
-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and 
Humboldt-Universität zu Berlin, Berlin, Germany.
(5)Center for Leadership and People Management, LMU Munich, Munich, Germany.
(6)FOM University of Applied Sciences of Economics and Management, Essen, 
Germany.
(7)Institute of Sociology and Social Psychology, University of Cologne, Cologne, 
Germany.
(8)Department of Obstetrics and Gynecology and Center for Gynecological 
Endocrinology and Reproductive Medicine, University Hospital, LMU Munich, 
Munich, Germany.
(9)Research Department of Experimental and Molecular Psychiatry, Department of 
Psychiatry and Psychotherapy, Charité -Universitätsmedizin Berlin, Corporate 
Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, 
Germany.
(10)Faculty of Health Sciences Brandenburg, Joint Faculty of the University of 
Potsdam, Brandenburg University of Technology Cottbus-Senftenberg and 
Brandenburg Medical School, Potsdam, Germany.

BACKGROUND: Preliminary empirical data indicates a substantial impact of the 
COVID-19 pandemic on well-being and mental health. Individuals with minoritized 
sexual and gender identities are at a higher risk of experiencing such negative 
changes in their well-being. The objective of this study was to compare levels 
of well-being among cis-heterosexual individuals and individuals with 
minoritized sexual and gender identities during the COVID-19 pandemic.
METHODS: Using data obtained in a cross-sectional online survey between April 20 
to July 20, 2020 (N = 2332), we compared levels of well-being (WHO-5) across 
subgroups (cis-individuals with minoritized sexual identities, individuals with 
minoritized gender identities and cis-heterosexual individuals) applying 
univariate (two-sample t-test) and multivariate analysis (multivariate linear 
regression).
RESULTS: Results indicate overall lower levels of well-being as well as lower 
levels of well-being in minoritized sexual or gender identities compared to 
cis-heterosexual individuals. Further, multivariate analyses revealed that 
living in urban communities as well as being in a relationship were positively 
associated with higher levels of well-being. Furthermore, a moderation analysis 
showed that being in a relationship reduces the difference between groups in 
terms of well-being.
CONCLUSION: Access to mental healthcare for individuals with minoritized sexual 
and gender identities as well as access to gender-affirming resources should be 
strengthened during COVID-19 pandemic. Healthcare services with low barriers of 
access such as telehealth and online peer support groups should be made 
available, especially for vulnerable groups.

DOI: 10.1371/journal.pone.0252356
PMCID: PMC8186787
PMID: 34101746 [Indexed for MEDLINE]

Conflict of interest statement: Pichit Buspavanich received a research grant 
from Gilead. Sven Mahner reports Research support, advisory board, honoraria and 
travel expenses from AbbVie, AstraZeneca, Clovis, Eisai, GlaxoSmithKline, Medac, 
MSD, Novartis, Olympus, PharmaMar, Pfizer, Roche, Sensor Kinesis, Teva, and 
Tesaro. All other authors have no conflict of interest to declare We confirm 
that our Competing Interest statement does not alter the adherence to PLOS ONE 
policies on sharing data and materials.


3366. Pediatr Crit Care Med. 2021 Nov 1;22(11):935-943. doi: 
10.1097/PCC.0000000000002789.

PICU Follow-Up Clinic: Patient and Family Outcomes 2 Months After Discharge.

Ducharme-Crevier L(1), La KA(2), Francois T(1), Gerardis G(2), Beauchamp 
M(2)(3), Harrington K(1), Roumeliotis N(1), Farrell C(1), Toledano B(1), Lacroix 
J(1), Du Pont-Thibodeau G(1).

Author information:
(1)Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU 
Sainte-Justine, Université de Montréal, Montréal, QC, Canada.
(2)CHU Sainte-Justine Research Center, Montréal, QC, Canada.
(3)Department of Psychology, Université de Montréal, Montréal, QC, Canada.

OBJECTIVES: Hospitalization in a PICU is a life-altering experience for children 
and their families. Yet, little is known about the well-being of these children 
after their discharge. We are describing the outcome of PICU survivors at a PICU 
clinic 2 months after discharge.
DESIGN: Prospective cohort study.
SETTING: PICU and PICU clinic of CHU Sainte-Justine.
PATIENTS: Prospective cohort study of children admitted for greater than or 
equal to 4 days, greater than or equal to 2 days of invasive ventilation, odds 
ratio greater than or equal to 4 days of noninvasive ventilation at Centre 
Hospitalier Universitaire Sainte-Justine.
PATIENTS: Prospective cohort study of children admitted for greater than or 
equal to 4 days, greater than or equal to 2 days of invasive ventilation, or 
greater than or equal to 4 days of noninvasive ventilation at Centre Hospitalier 
Universitaire Sainte-Justine PICU.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Patients were evaluated by a pediatric 
intensivist 2 months after discharge at the follow-up clinic. They were asked to 
fill out validated questionnaires. One hundred thirty-two patients were followed 
from October 2018 to September 2020. The PICU diagnoses were respiratory illness 
(40.9%), head trauma, and septic shock (7.6%). Average length of PICU stay was 
28.5 ± 84.2 days (median 7 d). Sixty-one percent were intubated. Symptoms 
reported by families were as follows: fatigue (9.9%), sleep disturbances 
(20.5%), feeding difficulties (12.1%), and voice change and/or stridor (9.8%). 
Twenty-one percent of school-aged children reported school delays. Twenty-seven 
children demonstrated communication delays, 45% gross motor function delays, 41% 
fine motor delays, 37% delays in problem-solving, and 49% delays in 
personal-social functioning. Quality of Life scores were 78.1 ± 20.5 and 80.0 ± 
17.5 for physical and psychosocial aspects, respectively. Fourteen percent of 
parents reported financial difficulties, 42% reported symptoms of anxiety, 29% 
symptoms of depression.
CONCLUSIONS: PICU survivors and their families experience significant physical 
and psychosocial morbidities after their critical illness. PICU follow-up is 
crucial to determine the outcome of these children and develop interventions.

Copyright © 2021 by the Society of Critical Care Medicine and the World 
Federation of Pediatric Intensive and Critical Care Societies.

DOI: 10.1097/PCC.0000000000002789
PMID: 34101680 [Indexed for MEDLINE]

Conflict of interest statement: Dr. Farrell received funding from the Canadian 
Pediatric Society and the Royal College of Physicians and Surgeons of Canada; 
she disclosed she is a member of the Board of Directors and Executive of the 
Canadian Pediatric Society and was the past-chair of the Specialty Committee in 
Pediatrics and member of the Examination Board for the Royal College of 
Physicians and Surgeons of Canada. Dr. Lacroix received funding from the 
Canadian Institutes of Health Research. The remaining authors have disclosed 
that they do not have any potential conflicts of interest.


3367. Clin Gerontol. 2022 Jan-Feb;45(1):172-188. doi: 10.1080/07317115.2021.1933291. 
Epub 2021 Jun 8.

Making Meaning of Integrated Care during a Pandemic: Learning from Older Adults.

Beasley EA(1), Scott TL(1), Pachana NA(1)(2).

Author information:
(1)School of Psychology, Faculty of Health and Behavioural Sciences, University 
of Queensland, St Lucia, Queensland, Australia.
(2)School of Business, Faculty of Business, Economics and Law, University of 
Queensland, St Lucia, Queensland, Australia.

OBJECTIVES: The aim of the current study was to investigate meaning-making in 57 
older predominantly female adults (M = 72.68) required to temporarily cease 
attending a university-affiliated integrated care clinic in Australia with a 
focus on exercise and well-being due to COVID-19 restrictions, specifically 
regarding consequential grief, loss, hopelessness, and loss of purpose.
METHODS: Quantitative and qualitative data were collected by telephone 
interviews and an online survey.
RESULTS: Results indicated that most participants valued attending the Clinic, 
and experienced a number of physical, social and emotional benefits from 
attending, including a sense of meaning. Specifically, some participants 
developed social connections, learned to cope more effectively with mental 
health conditions, and regained strength following stressful or traumatic events 
through their attendance at the clinic.
CONCLUSIONS: Throughout the pandemic, most participants retained their 
resilience and continued to derive meaning from various sources, including their 
families, careers, interests, and attitude toward life.
CLINICAL IMPLICATIONS: Older adults may experience enhanced physical, emotional 
and social health from engaging in community-based programs focused on exercise 
and overall wellness. Furthermore, meaning-making has the potential to buffer 
the harmful effects of stress and traumatic events on the physical, emotional 
and social health of older adults.

DOI: 10.1080/07317115.2021.1933291
PMID: 34100336 [Indexed for MEDLINE]


3368. BMJ Open Diabetes Res Care. 2021 Jun;9(1):e002162. doi: 
10.1136/bmjdrc-2021-002162.

Exploring support needs of people living with diabetes during the coronavirus 
COVID-19 pandemic: insights from a UK survey.

Sauchelli S(1), Bradley J(2), England C(2), Searle A(2), Whitmarsh A(2).

Author information:
(1)National Institute for Health Research Bristol Biomedical Research Centre, 
University Hospitals of Bristol and Weston NHS Foundation Trust and University 
of Bristol, Bristol, UK sarah.sauchellitoran@bristol.ac.uk.
(2)National Institute for Health Research Bristol Biomedical Research Centre, 
University Hospitals of Bristol and Weston NHS Foundation Trust and University 
of Bristol, Bristol, UK.

INTRODUCTION: The coronavirus COVID-19 pandemic has radically compromised 
healthcare for people living with chronic conditions such as diabetes. 
Government-imposed restrictions to contain the spread of the virus have forced 
people to suddenly adjust their lifestyle. This study aimed to capture the 
impact of the pandemic on people living with diabetes and the views of these 
individuals on ways in which the information, advice and support they are 
receiving could be improved.
RESEARCH DESIGN AND METHODS: An online anonymous survey was distributed across 
the UK during the first lockdown and initial easing. The survey comprised 
questions about confidence in diabetes self-management, resources used to obtain 
information, advice and support, and opinions on how these could be improved. 
Open-ended questions captured subjective experiences.
RESULTS: The survey was completed by 773 adults with diabetes (69.2% type 1, 
28.5% type 2). There was notable variability in the impact of the pandemic on 
confidence in self-management, with confidence having deteriorated most commonly 
in the ability to take care of own mental well-being (37.0% respondents) and 
improved most commonly in maintaining a healthy weight (21.1% respondents). 
41.2% of respondents living alone reported not receiving any outside support. 
The quality of information, advice and support received from the healthcare team 
was rated poorly by 37.2%. Respondents sought greater communication and tailored 
advice from their care team, clear and consistent information from the 
government and news channels, and improved understanding of diabetes and its 
challenges from their personal networks and employers.
CONCLUSION: Adjusting to the COVID-19 pandemic has strained the mental health 
and well-being of people living with diabetes. Diabetes care teams must receive 
assistance to support these individuals without risking further inequalities in 
access to healthcare. Equipping personal networks and employers with knowledge 
on diabetes and skills to support self-management may reduce the burden on the 
National Health Service.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/bmjdrc-2021-002162
PMCID: PMC8186741
PMID: 34099440 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: To enable Diabetes UK to 
take timely action from survey outcomes, three interim summary reports were 
produced for the Diabetes UK team, as well as a final one upon survey closure. 
Preparation of these reports did not impact the research project.


3369. Enferm Intensiva (Engl Ed). 2021 Apr-Jun;32(2):79-87. doi: 
10.1016/j.enfie.2020.03.005. Epub 2021 May 16.

Effect of music therapy on anxiety and pain in the critical polytraumatised 
patient.

Contreras-Molina M(1), Rueda-Núñez A(1), Pérez-Collado ML(2), García-Maestro 
A(1).

Author information:
(1)Unidad de Reanimación, Complejo Hospitalario Universitario de Albacete, 
Albacete, Spain.
(2)Unidad de Reanimación, Complejo Hospitalario Universitario de Albacete, 
Albacete, Spain. Electronic address: m.luz.pc1@hotmail.com.

OBJECTIVE: To determine the effectiveness of music therapy on anxiety and pain 
in critical polytraumatised patients admitted to the resuscitation unit of a 
tertiary level hospital in Spain.
MATERIAL AND METHOD: Randomised clinical trial conducted in a tertiary level 
hospital, from June 2016 to May 2018. The study sample was 60 patients, 30 
belonging to the intervention group (IG), and 30 to the control group (CG). The 
IG were given a 30-minute music session and heart rate (HR) and blood pressure 
(BP) were measured. The VAS (Visual Analogue Scale) was applied for anxiety and 
pain before and after each session. The same measures and scales were applied in 
the CG who did not receive a music session. The music session comprised 3 parts: 
the first was standard music selected by music therapists; the second was 
personalised, chosen by the patient and the third was a new standard. The 
intervention took place in a booth with headphones.
RESULTS: Significant changes in anxiety levels (P<.01) were detected in the 
group of patients undergoing the intervention, measured with the VAS scale for 
anxiety, and pain levels (P<.01), measured with the VAS scale for pain. No 
significant differences were found in the physiological parameters of HR and BP.
CONCLUSION: The use of music in critical polytraumatised patients reduces 
anxiety and pain levels, increasing the patient's well-being and improving the 
quality of care. Music therapy, therefore, is considered beneficial as a 
complementary measure in critical care units. It would be worthwhile to continue 
studies in this and other hospital areas.

Copyright © 2020 Sociedad Española de Enfermería Intensiva y Unidades Coronarias 
(SEEIUC). Published by Elsevier España, S.L.U. All rights reserved.

DOI: 10.1016/j.enfie.2020.03.005
PMID: 34099268 [Indexed for MEDLINE]


3370. Healthc Manage Forum. 2021 Jul;34(4):205-210. doi: 10.1177/08404704211021109. 
Epub 2021 Jun 8.

Evaluating the mental health and well-being of Canadian healthcare workers 
during the COVID-19 outbreak.

Wilbiks JMP(1), Best LA(1), Law MA(1), Roach SP(1).

Author information:
(1)Department of Psychology, 96944University of New Brunswick, Saint John, New 
Brunswick, Canada.

During the COVID-19 pandemic, healthcare systems have been under extreme levels 
of stress due to increases in patient distress and patient deaths. While 
additional research and public health funding initiatives can alleviate these 
systemic issues, it is also important to consider the ongoing mental health and 
well-being of professionals working in healthcare. By surveying healthcare 
workers working in Canada during the COVID-19 pandemic, we found that there was 
an elevated level of depressive symptomatology in that population. We also found 
that when employees were provided with accurate and timely information about the 
pandemic, and additional protective measures in the workplace, they were less 
likely to report negative effects on well-being. We recommend that healthcare 
employers take these steps, as well as providing targeted mental health 
interventions, in order to maintain the mental health of their employees, which 
in turn will provide better healthcare at the population level.

DOI: 10.1177/08404704211021109
PMCID: PMC8225696
PMID: 34098760 [Indexed for MEDLINE]


3371. J Oral Maxillofac Surg. 2021 Sep;79(9):1828.e1-1828.e8. doi: 
10.1016/j.joms.2021.04.016. Epub 2021 Apr 23.

The Psychological Well-Being of Medical Versus Dental GME Residents During the 
COVID 19 Pandemic: A Cross-Sectional Study.

Bhalla N(1), Suneja N(2), Kobryn A(3), Lew S(4), Dym H(5).

Author information:
(1)Resident, Oral and Maxillofacial Surgery, Brooklyn Hospital Center, Brooklyn, 
NY. Electronic address: natashaa95@gmail.com.
(2)Chief of Orthopedic Trauma, SUNY Downstate Medical Center, Brooklyn, NY.
(3)Student, State University of New York (SUNY), Downstate Medical Center, 
Brooklyn, NY.
(4)Resident, Department of Family Medicine, Brooklyn Hospital Center, Brooklyn, 
NY.
(5)Chairman, Director, Oral and Maxillofacial Surgery, Brooklyn Hospital Center, 
Brooklyn, NY.

PURPOSE: Trainees are facing isolation and burnout, due to the fear of 
contracting and transmitting novel coronavirus-19 (COVID-19). There has been a 
reduction in clinical activities of residents. The purpose of this paper is to 
measure and compare the psychological well-being of dental versus medical 
residents during the COVID-19 outbreak.
METHODS: This is a cross-sectional study whereby trainees of a hospital in New 
York City were sent a questionnaire. Participants were from the dental and 
medical departments. Psychological measures of depression and post traumatic 
stress disorder were assessed utilizing the Patient Health Questionnaire-9 
(PHQ-9) and The Impact of Event Scale-Revised (IES-R) questionnaire. Other 
variables compared were age, gender, smoking status, living situation and 
comorbidities. Data analysis utilized chi-squared (X2) and t-tests. Bivariate 
correlation and linear regression analyses were also utilized.
RESULTS: The survey was sent to 19 dental (Dental) and 171 medical (MD) 
residents. There were 66 participants. The response rate was 63.16 and 35.09% 
for the Dental and MD residents, respectively. The mean age for the Dental and 
MD residents, respectively, was 29.62 ± 2.09 and 34.82 ± 9.32 (P = .014). 
Eighty-one percent of the Dental respondents were male and 33.3% of the MD 
respondents were male (P < .001). The mean PHQ-9 score was 18.29 ± 2.88 vs 7.24 
± 7.41 for Dental and MD residents, respectively (P < .001). A higher score 
represents increased severity of depression. The Dental residents scored 61.9 ± 
3.90 on the IES-R vs 30.36 ± 24.67 (P < .001). A higher score indicates a 
greater frequency of intrusive thoughts and avoidance. Forty-two percent of 
Dental and 13.3% of MD residents tested positive; 25% of Dental and 28.9% of MD 
residents self-reported symptoms for COVID-19. Being positive or symptomatic 
resulted in statistically significant higher IES-R and PHQ-9 scores.
CONCLUSIONS: Dental residents and being positive or symptomatic for COVID-19 
resulted in higher PHQ-9 and IES-R scores. Being aware of the impact of 
COVID-19 is an important step in providing intervention.

Copyright © 2021 The American Association of Oral and Maxillofacial Surgeons. 
Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.joms.2021.04.016
PMCID: PMC8062423
PMID: 34097864 [Indexed for MEDLINE]


3372. PLoS One. 2021 Jun 7;16(6):e0252835. doi: 10.1371/journal.pone.0252835. 
eCollection 2021.

Association between well-being and compliance with COVID-19 preventive measures 
by healthcare professionals: A cross-sectional study.

Shah SU(1)(2), Xiu Ling Loo E(3)(4), En Chua C(5), Sen Kew G(5)(6), Demutska 
A(7), Quek S(5), Wong S(8), Lau HX(4), Low EXS(8), Loh TL(9), Lung OS(10), Hung 
ECW(11), Rahman MM(12), Ghoshal UC(13), Wong SH(14), Cheung CKY(15), Syam 
AF(16), Tan N(17), Xiao Y(17), Liu JS(18), Lu F(19), Chen CL(20), Lee 
YY(21)(22), Maralit RM(23), Kim YS(24), Oshima T(25), Miwa H(25), Siah 
KTH(4)(5), Pang J(1)(2).

Author information:
(1)Saw Swee Hock School of Public Health, National University of Singapore and 
National University Health System, Singapore, Singapore.
(2)Centre for Infectious Disease Epidemiology and Research, National University 
of Singapore, Singapore, Singapore.
(3)Department of Paediatrics, Yong Loo Lin School of Medicine, National 
University of Singapore, Singapore, Singapore.
(4)Singapore Institute for Clinical Sciences (SICS), Agency for Science, 
Technology and Research (A*STAR), Singapore, Singapore.
(5)Department of Medicine, Yong Loo Lin School of Medicine, National University 
of Singapore, Singapore, Singapore.
(6)Division of Gastroenterology & Hepatology, Department of Medicine, National 
University Hospital, Singapore, Singapore.
(7)Department of Clinical Psychology, James Cook University, Singapore, 
Singapore.
(8)Department of Medicine, Ng Teng Fong General Hospital, Singapore, Singapore.
(9)Department of Otorhinolarygology, Head and Neck Surgery, Universiti Putra 
Malaysia, Selangor, Malaysia.
(10)Department of Anaesthesiology, Columbia Asia Hospital, Miri, Sarawak, 
Malaysia.
(11)Cambridge Paediatrics, Shatin, Hong Kong.
(12)Department of Gastroenterology, Sheikh Russel National Gastroliver Institute 
and Hospital, Dhaka, Bangladesh.
(13)Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute Medical 
Science, Lucknow, India.
(14)Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese 
University of Hong Kong, Shatin, Hong Kong.
(15)Department of Medicine, State Key Laboratory of Pharmaceutical 
Biotechnology, The University of Hong Kong, Hong Kong, China.
(16)Division of Gastroenterology, Department of Internal Medicine, Faculty of 
Medicine, University of Indonesia, Jakarta, Indonesia.
(17)Departments of Gastroenterology and Hepatology, The First Affiliated 
Hospital, Sun Yat-sen University, Guangzhou, China.
(18)Department of Gastroenterology, Wuhan Union Hospital of Huazhong University 
of Science and Technology, Wuhan, Hubei, China.
(19)Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
(20)Department of Medicine, Buddhist Tzu Chi Hospital and University School of 
Medicine, Hualien, Taiwan.
(21)St George & Sutherland Clinical School, University of New South Wales, 
Sydney, Australia.
(22)Gut Research Group, Faculty of Medicine, Universiti Kebangsaan Malaysia, 
Kuala Lumpur, Malaysia.
(23)The Medical City, Metro Manila, Philippines.
(24)Wonkwang Digestive Disease Research Institute, Gut and Food Healthcare, 
Wonkwang University School of Medicine, Iksan, South Korea.
(25)Division of Gastroenterology and Hepatology, Department of Internal 
Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.

IMPORTANCE: Knowledge and attitude influence compliance and individuals' 
practices. The risk and protective factors associated with high compliance to 
these preventive measures are critical to enhancing pandemic preparedness.
OBJECTIVE: This survey aims to assess differences in mental health, knowledge, 
attitudes, and practices (KAP) of preventive measures for COVID-19 amongst 
healthcare professionals (HCP) and non-healthcare professionals.
DESIGN: Multi-national cross-sectional study was carried out using electronic 
surveys between May-June 2020.
SETTING: Multi-national survey was distributed across 36 countries through 
social media, word-of-mouth, and electronic mail.
PARTICIPANTS: Participants ≥21 years working in healthcare and non-healthcare 
related professions.
MAIN OUTCOME: Risk factors determining the difference in KAP towards personal 
hygiene and social distancing measures during COVID-19 amongst HCP and non-HCP.
RESULTS: HCP were significantly more knowledgeable on personal hygiene (AdjOR 
1.45, 95% CI -1.14 to 1.83) and social distancing (AdjOR 1.31, 95% CI -1.06 to 
1.61) compared to non-HCP. They were more likely to have a positive attitude 
towards personal hygiene and 1.5 times more willing to participate in the 
contact tracing app. There was high compliance towards personal hygiene and 
social distancing measures amongst HCP. HCP with high compliance were 1.8 times 
more likely to flourish and more likely to have a high sense of emotional (AdjOR 
1.94, 95% CI (1.44 to 2.61), social (AdjOR 2.07, 95% CI -1.55 to 2.78), and 
psychological (AdjOR 2.13, 95% CI (1.59-2.85) well-being.
CONCLUSION AND RELEVANCE: While healthcare professionals were more 
knowledgeable, had more positive attitudes, their higher sense of total 
well-being was seen to be more critical to enhance compliance. Therefore, 
focusing on the well-being of the general population would help to enhance their 
compliance towards the preventive measures for COVID-19.

DOI: 10.1371/journal.pone.0252835
PMCID: PMC8183980
PMID: 34097719 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


3373. Aust N Z J Public Health. 2021 Aug;45(4):325-329. doi: 10.1111/1753-6405.13106. 
Epub 2021 Jun 7.

Holistic approach supporting mental wellbeing of people in enforced quarantine 
in South Australia during the COVID-19 pandemic.

D'Onise K(1), Meena S(2), Venugopal K(1), Currie M(3), Kirkpatrick E(3), Hurley 
J(3), Nolan R(1), Brayley J(3), Atherton B(4), Spurrier N(3).

Author information:
(1)Prevention and Population Health, Wellbeing, SA, South Australia.
(2)Health Protection and Licensing Services, Department for Health and Ageing, 
Government of South Australia.
(3)SA Health, South Australia.
(4)SA COVID-19 Mental Health Support Line, South Australia.

OBJECTIVES: To report the experience of quarantine for international arrivals to 
South Australia requiring quarantine in a medi-hotel setting during the COVID-19 
pandemic and to describe the range of evidence-based support services to 
mitigate the mental health impacts of quarantine.
METHODS: A range of services targeted at physical and mental wellbeing were 
provided. Data from 533 adult respondents out of 721 passengers were included. 
The Kessler 10 was used to measure psychological distress at two time points.
RESULTS: About 7.1% of respondents reported psychological distress at time one, 
reduced to 2.4% at time two. There was no significant difference in 
psychological distress by gender at either time point. The mean K10 score at 
time one was 13.6 (standard deviation=5.2) and the mean score at time two was 
11.5 (standard deviation=3.1), with a significant reduction in mean scores 
(p<0.001) between the two time points.
CONCLUSIONS: The level of psychological stress in repatriated Australians was 
low at arrival and improved further at the time of release from quarantine. 
Implications for public health: A collaborative multi-sector approach to provide 
support services for individuals in quarantine can mitigate risks to mental 
wellbeing.

© 2021 The Authors.

DOI: 10.1111/1753-6405.13106
PMCID: PMC8209925
PMID: 34097327 [Indexed for MEDLINE]


3374. Clin Gerontol. 2022 Jan-Feb;45(1):71-85. doi: 10.1080/07317115.2021.1928356. 
Epub 2021 Jun 6.

Caring for Relatives with Dementia in Times of COVID-19: Impact on Caregivers 
and Care-recipients.

Losada A(1), Vara-García C(1), Romero-Moreno R(1), Barrera-Caballero S(1), 
Pedroso-Chaparro MDS(2), Jiménez-Gonzalo L(1), Fernandes-Pires J(1), Cabrera 
I(2), Gallego-Alberto L(2), Huertas-Domingo C(1), Mérida-Herrera L(1), 
Olazarán-Rodríguez J(3), Márquez-González M(2).

Author information:
(1)Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain.
(2)Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, Spain.
(3)Servicio de Neurología, Hospital General Universitario Gregorio Marañón, 
Madrid, Spain.

OBJECTIVES: To analyze caregivers' perceived impact of the pandemic in their 
mental health and the well-being of the care-recipients.
METHODS: Caregivers (N = 88) were asked if they had COVID-19 and about their 
perceptions of change of care-recipients' health conditions as well as whether 
their own mental health, conflicts with care-recipients and other relatives, 
thoughts of giving up caregiving, and feelings of coping well with the 
situation.
RESULTS: A large percentage of caregivers perceived a worsening of 
care-recipients' symptoms and of their own negative emotions, an increase in the 
number of conflicts and thoughts of needing to give up caregiving. Having had 
COVID-19 and reporting higher levels of distress as well as giving up caregiving 
were related to perceived worsening in care-recipients well-being. Perceived 
increases were mainly reported by younger caregivers, those who perceived to 
have not coped well, and those reporting an increase in conflicts. Some 
caregivers perceived an increase in positive emotions.
CONCLUSIONS: The pandemic has a negative impact on caregivers' perceptions about 
the course of their own emotions and care-recipients' well-being.
CLINICAL IMPLICATIONS: Interventions are needed to train caregivers in 
strategies to cope with the sources of stress caused by the pandemic and to 
promote social support.

DOI: 10.1080/07317115.2021.1928356
PMID: 34096470 [Indexed for MEDLINE]


3375. J Adolesc Health. 2021 Aug;69(2):211-218. doi: 10.1016/j.jadohealth.2021.04.028. 
Epub 2021 Jun 3.

Subjective Well-Being of Adolescents in Luxembourg, Germany, and Brazil During 
the COVID-19 Pandemic.

Engel de Abreu PMJ(1), Neumann S(2), Wealer C(3), Abreu N(4), Coutinho Macedo 
E(5), Kirsch C(3).

Author information:
(1)Faculty of Humanities, Education and Social Sciences, University of 
Luxembourg, Esch-sur-Alzette, Luxembourg. Electronic address: 
pascale.engel@uni.lu.
(2)Faculty of Humanities, Education and Social Sciences, University of 
Luxembourg, Esch-sur-Alzette, Luxembourg; Faculty of Economics and Social 
Sciences, University of Tübingen, Tübingen, Baden-Württemberg, Germany.
(3)Faculty of Humanities, Education and Social Sciences, University of 
Luxembourg, Esch-sur-Alzette, Luxembourg.
(4)Institute of Psychology, Federal University of Bahia (UFBA), Salvador, Bahia, 
Brazil.
(5)Center for Biological and Health Sciences, Mackenzie Presbyterian University, 
São Paulo, São Paulo, Brazil.

PURPOSE: This study explores adolescent well-being during the first wave of the 
COVID-19 pandemic in two high-income countries from Europe and one middle-income 
country from South America. The aim is to investigate the correlates of 
different dimensions of subjective well-being in 10- to 16-year-olds from 
different cultural contexts.
METHODS: An online, self-report questionnaire was completed by 1,613 adolescents 
in Luxembourg, Germany, and Brazil between May and July 2020. The outcome 
variables were measures of life satisfaction and emotional well-being during the 
COVID-19 pandemic. The study included a range of sociodemographic, 
interpersonal, and intrapersonal covariates. Data were analyzed using 
descriptive statistics and latent variable structural equational modeling.
RESULTS: A two-factor model of subjective well-being, consisting of life 
satisfaction and emotional well-being latent constructs, fitted well with this 
sample data for Luxembourg, Germany, and Brazil. Results showed that gender, 
socioeconomic status, intrapersonal factors, quantity and type of schoolwork, 
and relationships with adults were important common predictors of individual 
differences in subjective well-being during COVID-19. Fear of illness emerged as 
the strongest correlate of emotional well-being across the three countries.
CONCLUSIONS: This study indicates that girls and adolescents from low-income 
homes may be especially vulnerable to negative secondary impacts of COVID-19 
that can affect mental health. It identified several common correlates of 
subjective well-being in adolescents from different cultural settings, including 
factors that may be changeable, such as the following: the way adults listen to 
adolescents, schoolwork during distant learning, and fear of illness. Findings 
can inform the development of quality interventions for promoting the well-being 
of adolescents during a global pandemic.

Copyright © 2021 Society for Adolescent Health and Medicine. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jadohealth.2021.04.028
PMCID: PMC8460548
PMID: 34092475 [Indexed for MEDLINE]


3376. J Safety Res. 2021 Jun;77:328-333. doi: 10.1016/j.jsr.2021.03.014. Epub 2021 May 
2.

Special Report from the CDC: Strengthening social connections to prevent suicide 
and adverse childhood experiences (ACEs): Actions and opportunities during the 
COVID-19 pandemic.

Bledsoe M(1), Captanian A(2), Somji A(2).

Author information:
(1)Oak Ridge Institute for Science and Education (ORISE), and Division of Injury 
Prevention (DIP), Centers for Disease Control and Prevention (CDC), USA. 
Electronic address: nui1@cdc.gov.
(2)Prevention Institute, USA.

INTRODUCTION: During this time ofintensified hardship and disruption due to the 
SARS-CoV-2 (COVID-19) pandemic, communities, practitioners, and state and local 
governments have had to rapidly implement and adapt strategies that support 
mental health and wellbeing during a global pandemic. Prior to the COVID-19 
pandemic, suicide was the 10th leading cause of death in the United States, and 
at least half of the top 10 leading causes of death have been associated with 
adverse childhood experiences (ACEs). A number of established risk factors for 
suicide and ACEs may have been exacerbated by the pandemic, including loneliness 
and the lack of connectedness.
METHOD: This article briefly considers the effects of COVID-19 on social 
connection and outlines the importance of adapting and developing programming 
and resources that address suicide and ACEs prevention during a time of 
infrastructure disruption. Practical Applications: The COVID-19 pandemic has 
affected the ways that many individuals are able to safely interact and socially 
connect due to public health prevention strategies implemented to slow the 
spread of COVID-19. Local, city, and state government, community organizations, 
and public health and medical practitioners should consider the adaptation and 
development of existing and new programming, resources, and activities that 
support and strengthen social connection. In addition to implementing programs, 
policies may help address systemic and structural barriers to social connection, 
such as access to parks and open space, public transportation, or digital 
connectivity.

Published by Elsevier Ltd.

DOI: 10.1016/j.jsr.2021.03.014
PMCID: PMC8603763
PMID: 34092325 [Indexed for MEDLINE]


3377. Am J Phys Med Rehabil. 2021 Sep 1;100(9):821-830. doi: 
10.1097/PHM.0000000000001818.

Disrupted Access to Therapies and Impact on Well-Being During the COVID-19 
Pandemic for Children With Motor Impairment and Their Caregivers.

Sutter EN(1), Francis LS, Francis SM, Lench DH, Nemanich ST, Krach LE, 
Sukal-Moulton T, Gillick BT.

Author information:
(1)From the Department of Rehabilitation Medicine, University of Minnesota, 
Minneapolis (ENS, DHL, LEK, BTG); Warner School of Education, University of 
Rochester, New York (LSF); Department of Psychiatry and Behavioral Sciences, 
University of Minnesota, Minneapolis (SMF); Department of Occupational Therapy, 
Marquette University, Milwaukee, Wisconsin (STN); Gillette Children's Specialty 
Healthcare, St. Paul, Minnesota (LEK); and Department of Physical Therapy and 
Human Movement Sciences, Northwestern University, Chicago, Illinois (TS-M).

Comment in
    Am J Phys Med Rehabil. 2021 Nov 1;100(11):1033.

OBJECTIVES: The aim of this study was to determine the impact of the COVID-19 
pandemic on access to rehabilitation therapies and the impact of changes in 
therapy access on the physical and mental well-being of children with motor 
impairment and their caregivers.
DESIGN: Caregivers of children younger than 18 yrs with childhood-onset motor 
impairment (primarily cerebral palsy) completed an anonymous survey through the 
online platform REDCap between May 5 and July 13, 2020.
RESULTS: The survey was completed by 102 participants. Before the pandemic, 92 
of 102 children (90%) were receiving one or more therapies; at the time 
surveyed, 55 children (54%) were receiving any therapies (P < 0.001). More than 
40% of the sample reported increased child stress, decreased physical activity, 
and/or decline in mobility/movement. Participants who reported a decrease in 
number of therapies at the time surveyed more frequently reported lower 
satisfaction with treatment delivery (P < 0.001), a decline in child's mobility 
(P = 0.001), and increased caregiver stress (P = 0.004). Five qualitative themes 
were identified from open-ended question responses related to therapies and 
well-being.
CONCLUSIONS: Access to pediatric rehabilitation therapies was disrupted during 
COVID-19. Disrupted access may be related to impact on physical and mental 
health. With the expansion of telehealth, caregiver and child feedback should be 
incorporated to optimize benefit.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/PHM.0000000000001818
PMCID: PMC8366513
PMID: 34091465 [Indexed for MEDLINE]

Conflict of interest statement: Financial disclosure statements have been 
obtained, and no conflicts of interest have been reported by the authors or by 
any individuals in control of the content of this article.


3378. Lancet Psychiatry. 2021 Aug;8(8):663-672. doi: 10.1016/S2215-0366(21)00156-5. 
Epub 2021 Jun 3.

Depressive symptoms, mental wellbeing, and substance use among adolescents 
before and during the COVID-19 pandemic in Iceland: a longitudinal, 
population-based study.

Thorisdottir IE(1), Asgeirsdottir BB(2), Kristjansson AL(3), Valdimarsdottir 
HB(4), Jonsdottir Tolgyes EM(1), Sigfusson J(1), Allegrante JP(5), Sigfusdottir 
ID(6), Halldorsdottir T(7).

Author information:
(1)Icelandic Center for Social Research and Analysis, Reykjavik, Iceland.
(2)Department of Psychology, Reykjavik University, Reykjavik, Iceland.
(3)Icelandic Center for Social Research and Analysis, Reykjavik, Iceland; 
Department of Social and Behavioral Sciences, School of Public Health, West 
Virginia University, Morgantown, WV, USA.
(4)Department of Psychology, Reykjavik University, Reykjavik, Iceland; 
Department of Population Health Science and Policy, Icahn School of Medicine at 
Mount Sinai, New York, NY, USA.
(5)Department of Health and Behavior Studies, Teachers College, Columbia 
University, New York, NY, USA; Department of Sociomedical Sciences, Mailman 
School of Public Health, Columbia University, New York, NY, USA.
(6)Icelandic Center for Social Research and Analysis, Reykjavik, Iceland; 
Department of Psychology, Reykjavik University, Reykjavik, Iceland; Department 
of Health and Behavior Studies, Teachers College, Columbia University, New York, 
NY, USA.
(7)Department of Psychology, Reykjavik University, Reykjavik, Iceland; Centre of 
Public Health Sciences, University of Iceland, Reykjavik, Iceland. Electronic 
address: thorhildurh@ru.is.

Comment in
    Lancet Psychiatry. 2021 Aug;8(8):640-641.

BACKGROUND: Adolescence represents a crucial developmental period in shaping 
mental health trajectories. In this study, we investigated the effect of the 
COVID-19 pandemic on mental health and substance use during this sensitive 
developmental stage.
METHODS: In this longitudinal, population-based study, surveys were administered 
to a nationwide sample of 13-18-year-olds in Iceland in October or February in 
2016 and 2018, and in October, 2020 (during the COVID-19 pandemic). The surveys 
assessed depressive symptoms with the Symptom Checklist-90, mental wellbeing 
with the Short Warwick Edinburgh Mental Wellbeing Scale, and the frequency of 
cigarette smoking, e-cigarette use, and alcohol intoxication. Demographic data 
were collected, which included language spoken at home although not ethnicity 
data. We used mixed effects models to study the effect of gender, age, and 
survey year on trends in mental health outcomes.
FINDINGS: 59 701 survey responses were included; response rates ranged from 63% 
to 86%. An increase in depressive symptoms (β 0·57, 95% CI 0·53 to 0·60) and 
worsened mental wellbeing (β -0·46, 95% CI -0·49 to -0·42) were observed across 
all age groups during the pandemic compared with same-aged peers before 
COVID-19. These outcomes were significantly worse in adolescent girls compared 
with boys (β 4·16, 95% CI 4·05 to 4·28, and β -1·13, 95% CI -1·23 to -1·03, 
respectively). Cigarette smoking (OR 2·61, 95% CI 2·59 to 2·66), e-cigarette use 
(OR 2·61, 95% CI 2·59 to 2·64), and alcohol intoxication (OR 2·59, 95% CI 2·56 
to 2·64) declined among 15-18-year-olds during COVID-19, with no similar gender 
differences.
INTERPRETATION: Our results suggest that COVID-19 has significantly impaired 
adolescent mental health. However, the decrease observed in substance use during 
the pandemic might be an unintended benefit of isolation, and might serve as a 
protective factor against future substance use disorders and dependence. 
Population-level prevention efforts, especially for girls, are warranted.
FUNDING: Icelandic Research Fund.
TRANSLATION: For the Icelandic translation of the abstract see Supplementary 
Materials section.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/S2215-0366(21)00156-5
PMID: 34090582 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of interests We declare no competing 
interests.


3379. J Am Board Fam Med. 2021 May-Jun;34(3):522-530. doi: 
10.3122/jabfm.2021.03.200523.

Burnout, Depression, Anxiety, and Stress Among Family Physicians in Kansas 
Responding to the COVID-19 Pandemic.

Ofei-Dodoo S(1), Loo-Gross C(2), Kellerman R(2).

Author information:
(1)From the Department of Family and Community Medicine, University of Kansas 
School of Medicine-Wichita (SO-D, CL-G, RK). sofeidodoo@kumc.edu.
(2)From the Department of Family and Community Medicine, University of Kansas 
School of Medicine-Wichita (SO-D, CL-G, RK).

INTRODUCTION: COVID-19 has spread rapidly, with vast global implications. This 
study assessed how family physicians in Kansas were responding to COVID-19 and 
the effects of the pandemic on their well-being.
METHODS: The authors conducted a cross-sectional survey of 113 family physicians 
in Kansas between May 22, 2020 and June 25, 2020. The study participants 
completed an anonymous, 36-item survey assessing their concerns about being 
exposed to COVID-19 and levels of personal depression, anxiety, stress, and 
burnout in addition to demographic information.
RESULTS: There was a 45.6% response rate, with 50.4% (n = 57) of the respondents 
reporting manifestations of burnout. The physicians who personally treated any 
presumptive or confirmed COVID-19 patient, compared with those who did not, were 
more likely to report at least 1 manifestation of burnout, experience emotional 
exhaustion, and feel a higher level of personal stress.
CONCLUSION: Our findings demonstrate that the COVID-19 pandemic may be taking an 
emotional toll on family physicians in Kansas. This study provides a baseline 
from which to continue further monitoring of outcomes. Data can help drive 
initiatives at local, state, and national levels to help diminish the negative 
impact of the COVID-19 pandemic on physicians.

© Copyright 2021 by the American Board of Family Medicine.

DOI: 10.3122/jabfm.2021.03.200523
PMID: 34088812 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest: None.


3380. BMJ Open. 2021 Jun 4;11(6):e044262. doi: 10.1136/bmjopen-2020-044262.

Relationship between wealth and emotional well-being before, during, versus 
after a nationwide disease outbreak: a large-scale investigation of disparities 
in psychological vulnerability across COVID-19 pandemic phases in China.

Yang H(1), Ma J(2).

Author information:
(1)Johns Hopkins University, Baltimore, Maryland, USA.
(2)Peking University, Beijing, China jingjingma@nsd.pku.edu.cn.

OBJECTIVES: This research investigated whether certain population segments might 
be more psychologically vulnerable in different phases of a pandemic. 
Specifically, the research examined how disparities in wealth might be 
associated with differences in emotional well-being before, during, versus after 
the nationwide COVID-19 outbreak in China.
SETTING, PARTICIPANTS AND OUTCOME MEASURES: In this large-scale cross-sectional 
study, three rounds of nationally representative data collection (N=27 760) were 
conducted immediately before (December 2019), in the midst of (February 2020), 
versus immediately after (April 2020) the countrywide COVID-19 outbreak in 
China. Participants' emotional well-being, wealth (income, property ownership) 
and demographic information were measured using established instruments. 
Statistical analyses examined relationships between disparities in different 
types of wealth and emotional well-being across the pandemic phases.
RESULTS: Although the onset of the coronavirus outbreak substantially degraded 
emotional well-being, having a higher income was associated with better 
emotional well-being during the outbreak. Property owners experienced a larger 
drop in emotional well-being during the outbreak than non-owners; however, the 
former was not emotionally worse off than the latter during the outbreak. After 
the nationwide COVID-19 outbreak had been contained and the economy reopened, 
those with more wealth of either type again became better off in emotional 
well-being than those with less. The highest income segment even experienced 
better emotional well-being after the end of the nationwide outbreak than prior 
to the outbreak. In contrast, the lowest income segment became worse off in 
emotional well-being after the nationwide outbreak ended than before the 
outbreak began.
CONCLUSION: People with less wealth tend to be emotionally worse off throughout 
the different phases of a disease outbreak. In particular, even after an 
outbreak has been contained, the poor are less able to restore their 
psychological well-being. Policies and interventions are needed to address 
disparities in mental health in the age of pandemics.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2020-044262
PMCID: PMC8184351
PMID: 34088706 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3381. J Hosp Palliat Nurs. 2021 Oct 1;23(5):403-405. doi: 
10.1097/NJH.0000000000000773.

Using the Nurse Coaching Process to Support Bereaved Staff During the COVID-19 
Crisis.

Rosa WE, Levoy K, Battista V, Dahlin C, Thaxton C, Greer K.

Nurses are confronting a number of negative mental health consequences owing to 
high burdens of grief during COVID-19. Despite increased vaccination efforts and 
lower hospitalization and mortality rates, the long-term effects of mass 
bereavement are certain to impact nurses for years to come. The nurse coaching 
process is an evidence-based strategy that nurse leaders can use to assist staff 
in mitigating negative mental health outcomes associated with bereavement. The 
End-of-Life Nursing Education Consortium brought together a team of palliative 
nursing experts early in the pandemic to create resources to support nurses 
across settings and promote nurse well-being. This article shares a timely 
resource for health systems and nursing administration that leverages the nurse 
coaching process to support bereaved staff in a safe and therapeutic 
environment.

Copyright © 2021 by The Hospice and Palliative Nurses Association. All rights 
reserved.

DOI: 10.1097/NJH.0000000000000773
PMCID: PMC8410627
PMID: 34081631 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
disclose.


3382. Mult Scler. 2022 Jun;28(7):1060-1071. doi: 10.1177/13524585211020435. Epub 2021 
Jun 3.

Mental health of people with multiple sclerosis during the COVID-19 outbreak: A 
prospective cohort and cross-sectional case-control study of the UK MS Register.

Garjani A(1), Hunter R(2), Law GR(3), Middleton RM(4), Tuite-Dalton KA(4), 
Dobson R(5), Ford DV(4), Hughes S(6), Pearson OR(7), Rog D(8), Tallantyre EC(9), 
Nicholas R(10), Morriss R(11), Evangelou N(1), das Nair R(11).

Author information:
(1)Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, 
University of Nottingham, Nottingham, UK/Department of Academic Clinical 
Neurology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
(2)College of Health and Human Science, Swansea University, Swansea, UK.
(3)School of Health and Social Care, University of Lincoln, Lincoln, UK.
(4)Population Data Science, Swansea University Medical School, Swansea, UK.
(5)Preventive Neurology Unit, Queen Mary University London, London, UK.
(6)Department of Neurology, Belfast Health and Social Care Trust, Belfast, UK.
(7)Neurology Department, Swansea Bay University Health Board, Swansea, UK.
(8)Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation 
Trust, Salford, UK.
(9)Division of Psychological Medicine and Clinical Neuroscience, Cardiff 
University, Cardiff, UK.
(10)Population Data Science, Swansea University Medical School, Swansea, 
UK/Department of Cellular and Molecular Neuroscience, Imperial College London, 
London, UK/Department of Visual Neuroscience, UCL Institute of Ophthalmology, 
London, UK.
(11)Mental Health and Clinical Neurosciences Academic Unit, University of 
Nottingham, Nottingham, UK/Institute of Mental Health, University of Nottingham, 
Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK.

BACKGROUND: People with MS (pwMS) have had higher rates of anxiety and 
depression than the general population before the COVID-19 pandemic, placing 
them at higher risk of experiencing poor psychological wellbeing during the 
pandemic.
OBJECTIVE: To assess mental health and its social/lifestyle determinants in pwMS 
during the first wave of the outbreak in the United Kingdom.
METHODS: This is a community-based, prospective longitudinal cohort and 
cross-sectional case-control online questionnaire study. It includes 2010 pwMS 
from the UK MS Register and 380 people without MS.
RESULTS: The Hospital Anxiety and Depression Scale scores of pwMS for anxiety 
and depression during the outbreak did not change from the previous year. PwMS 
were more likely to have anxiety (using General Anxiety Disorder-7) and/or 
depression (using Patient Health Questionnaire-9) than controls during the 
outbreak (OR: 2.14, 95% CI: 1.58-2.91). PwMS felt lonelier (OR: 1.37, 95% CI: 
1.04-1.80) reported worse social support (OR: 1.90, 95% CI: 1.18-3.07) and 
reported worsened exercise habits (OR: 1.65, 95% CI: 1.18-2.32) during the 
outbreak than controls.
CONCLUSION: Early in the pandemic, pwMS remained at higher risk of experiencing 
anxiety and depression than the general population. It is important that 
multidisciplinary teams improve their support for the wellbeing of pwMS, who are 
vulnerable to the negative effects of the pandemic on their lifestyle and social 
support.

DOI: 10.1177/13524585211020435
PMID: 34080892 [Indexed for MEDLINE]


3383. J Subst Abuse Treat. 2021 Oct;129:108387. doi: 10.1016/j.jsat.2021.108387. Epub 
2021 Apr 8.

Differential impacts of COVID-19 across racial-ethnic identities in persons with 
opioid use disorder.

Mistler CB(1), Sullivan MC(2), Copenhaver MM(3), Meyer JP(4), Roth AM(5), Shenoi 
SV(6), Edelman EJ(7), Wickersham JA(8), Shrestha R(3).

Author information:
(1)Department of Allied Health Sciences, University of Connecticut, Storrs, CT, 
USA; Institute for Collaboration on Health, Intervention, and Policy (InCHIP), 
University of Connecticut, Storrs, CT, USA. Electronic address: 
colleen.mistler@uconn.edu.
(2)Institute for Collaboration on Health, Intervention, and Policy (InCHIP), 
University of Connecticut, Storrs, CT, USA; Department of Psychological 
Sciences, University of Connecticut, Storrs, CT, USA.
(3)Department of Allied Health Sciences, University of Connecticut, Storrs, CT, 
USA; Institute for Collaboration on Health, Intervention, and Policy (InCHIP), 
University of Connecticut, Storrs, CT, USA.
(4)Department of Internal Medicine, Section of Infectious Diseases, AIDS 
Program, Yale School of Medicine, New Haven, CT, USA.
(5)Department of Community Health Prevention, Drexel University, Philadelphia, 
PA, USA.
(6)Department of Internal Medicine, Section of Infectious Diseases, AIDS 
Program, Yale School of Medicine, New Haven, CT, USA; Center for 
Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, 
USA.
(7)Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, 
USA; Center for Interdisciplinary Research on AIDS, Yale School of Public 
Health, New Haven, CT, USA; Department of Internal Medicine, Section of General 
Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
(8)Institute for Collaboration on Health, Intervention, and Policy (InCHIP), 
University of Connecticut, Storrs, CT, USA; Department of Internal Medicine, 
Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New 
Haven, CT, USA.

OBJECTIVE: The COVID-19 pandemic has exacerbated health disparities, 
particularly among at-risk people with opioid use disorder (OUD). We sought to 
characterize the direct and indirect impacts of COVID-19 on this group to 
understand how the pandemic has affected this group, this group's public health 
response to COVID-19, and whether there were differences by race/ethnicity.
METHODS: This study recruited its sample from a drug treatment setting in the 
northeast region of the United States. We surveyed 110 individuals on methadone 
as treatment for OUD and assessed COVID-19-related impacts on their health 
behaviors and other indices of social, physical, and mental well-being, 
including sexual health behaviors, substance use, mental health status, health 
care access, income, and employment.
RESULTS: Our findings highlight overall increases in depression, anxiety, 
loneliness, and frustration among the sample of people with OUD; the study also 
observed decreases in financial stability. Significant differences between 
groups indicated a greater financial burden among racial-ethnic minorities; this 
subgroup also reported greater direct adverse effects of COVID-19, including 
being more concerned about contracting COVID-19, not being able to get a 
COVID-19 test, and knowing someone who had died from COVID-19. A greater 
proportion of Whites indicated increases in alcohol consumption and 
non-prescription drug use than did racial-ethnic minorities.
CONCLUSIONS: Treatment providers must be vigilant in managing direct and 
indirect outcomes of COVID-19 among people with OUD. Findings highlight the need 
to develop culturally competent, differentiated interventions in partnership 
with community-based organizations to meet the unique challenges that the 
COVID-19 pandemic presents for people in treatment for OUD.

Copyright © 2021 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jsat.2021.108387
PMCID: PMC8380664
PMID: 34080555 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
declare. Dr. Shenoi's spouse worked for Merck pharmaceuticals 1997–2007 and 
retains company stock in his retirement account. There is no conflict of 
interest, but it is included for full disclosure.


3384. Clin Gerontol. 2022 Jan-Feb;45(1):4-19. doi: 10.1080/07317115.2021.1928355. Epub 
2021 Jun 3.

Emotional Resilience of Older Adults during COVID-19: A Systematic Review of 
Studies of Stress and Well-Being.

Sterina E(1), Hermida AP(2), Gerberi DJ(3), Lapid MI(4).

Author information:
(1)School of Medicine, Emory University, Atlanta, Georgia, USA.
(2)Department of Psychiatry and Behavioral Sciences, Emory University School of 
Medicine, Atlanta, Georgia, USA.
(3)Mayo Clinic Library, Mayo Clinic, Rochester, Minnesota, USA.
(4)Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, 
USA.

OBJECTIVES: To examine post-traumatic stress, depression, anxiety, and 
well-being in older adults under quarantine.
METHODS: A systematic review of CINAHL, Ovid EBM Reviews, Ovid Embase, Ovid 
Medline, Ovid PsycINFO, Scopus, and Web of Science from 2000 to 2020 was 
conducted. Keywords included coronavirus, epidemic, quarantine, stress, mental 
health, and similar terms. Included studies enrolled participants under 
quarantine, quantitatively measured mental health or well-being, and 
characterized outcomes by age.
RESULTS: Of 894 initial results, 20 studies met the criteria and were included. 
Studies comprise 106,553 participants from eight countries, ages 6-100, two 
epidemics (COVID-19, SARS), and 27 assessment tools. One study found greater 
distress in older adults relative to younger adults, one found no significant 
differences, and 18 found lower negative outcomes in older participants in at 
least one metric.
CONCLUSIONS: Older adults in this review generally have lower stress and less 
negative emotions under quarantine than younger adults. It is unknown how this 
compares to pre-pandemic measures. More representative and longitudinal studies 
are needed to measure the impact of quarantine on the mental health of older 
adults.
CLINICAL IMPLICATIONS: As existing scales may not capture the full extent of 
pandemic psychological effects on older adults, clinicians must vigilantly 
monitor older adults' mental health.

DOI: 10.1080/07317115.2021.1928355
PMCID: PMC8639827
PMID: 34080527 [Indexed for MEDLINE]

Conflict of interest statement: Disclosure statement No potential conflict of 
interest was reported by the author(s).


3385. Zh Nevrol Psikhiatr Im S S Korsakova. 2021;121(4. Vyp. 2):24-30. doi: 
10.17116/jnevro202112104224.

[Psychological factors of sleep and daytime complaints during the COVID-19 
Lockdown: the role of anxiety, well-being, autonomy, and coping].

[Article in Russian; Abstract available in Russian from the publisher]

Rasskazova EI(1)(2).

Author information:
(1)Lomonosov Moscow State University, Moscow, Russia.
(2)Mental Health Research Center, Moscow, Russia.

OBJECTIVE: To reveal psychological (anxiety, coping with pandemic stress, 
autonomy) and behavioral (compliance with recommendations, monitoring 
information) factors associated with complaints of sleep and daytime functioning 
disturbances during the lockdown period in the spring of 2020.
MATERIAL AND METHODS: Two hundred and three adults (106 men and 97 women), aged 
18 to 59 years, participated in the study. Participants filled the 
questionnaires 1-2 weeks after the start of the lockdown and 3-4 weeks after the 
first measurement.
RESULTS AND CONCLUSION: Complaints of sleep and daytime functioning difficulties 
during the period of self-isolation are common in 19-30% and depend not so much 
on the level and content of anxiety, but on its dysfunctional level that 
interferes with everyday activities (β=0.17-0.27, p<0.05, ΔR2=2.8-7.4%). 
Complaints of sleep are more often comorbid with complaints of pain (r=0.43) 
than with complaints of affective symptoms (r=0.33), and complaints of poor 
daytime functioning are more common among younger people and students (F=3.48, 
p<0.05, η2=0.05); 14.8-24.6% report improvement in sleep and daytime functioning 
during lockdown. Regardless of the presence of anxiety, more frequent monitoring 
of information about the coronavirus is associated with complaints of sleep 
(β=0.15, p<0.05, ΔR2=2.0%), while general negative emotions- with complaints of 
daytime functioning and affective symptoms (β=0.19-0.22, p<0.01, ΔR2=3.4-4.1%). 
Complaints of sleep and daytime functioning in a pandemic are more typical for 
people who tend to control themselves for extrinsic goals (β=0.17, p<0.05, 
ΔR2=2.1-2.8%).

Publisher: ЦЕЛЬ ИССЛЕДОВАНИЯ: Выявление психологических (тревоги, совладания со 
стрессом, автономии) и поведенческих (защитное поведение, отслеживание 
информации) факторов, связанных с жалобами на нарушения сна и дневного 
функционирования в период самоизоляции весной 2020 г. при пандемии новой 
коронавирусной инфекции (COVID-19).
МАТЕРИАЛ И МЕТОДЫ: В исследовании приняли участие 203 человека (106 мужчин и 97 
женщин) в возрасте от 18 до 59 лет. Заполнение опросников производилось через 
1—2 нед после начала самоизоляции и через 3—4 нед после первой оценки.
РЕЗУЛЬТАТЫ И ЗАКЛЮЧЕНИЕ: Жалобы на нарушения сна и дневного функционирования за 
период самоизоляции распространены в 19—30% случаев и зависят не столько от 
уровня и содержания тревоги, сколько от возможности повышения до 
дисфункционального уровня, мешающего повседневным делам (β=0,17—0,27, p<0,05, 
ΔR2=2,8—7,4%). Жалобы на нарушения сна чаще коморбидны жалобам на боли (r=0,43), 
чем жалобам на аффективные симптомы (r=0,33), а жалобы на нарушения дневного 
функционирования более распространены среди молодых людей и студентов (F=3,48, 
p<0,05, η2=0,05). 14,8—24,6% респондентов на фоне самоизоляции отмечали 
улучшение сна и дневного функционирования. Независимо от наличия тревоги более 
частое отслеживание информации о COVID-19 оказалось связано с жалобами на 
нарушения сна (β=0,15, p<0,05, ΔR2=2,0%), а общий отрицательный эмоциональный 
фон — с жалобами на нарушения дневного функционирования и аффективными 
симптомами (β=0,19—0,22, p<0,01, ΔR2=3,4—4,1%). Жалобы на нарушения сна и 
дневного функционирования в ситуации пандемии характерны для людей, склонных 
заставлять и контролировать себя ради внешних целей (β=0,17, p<0,05, 
ΔR2=2,1—2,8%).

DOI: 10.17116/jnevro202112104224
PMID: 34078856 [Indexed for MEDLINE]


3386. BMC Public Health. 2021 Jun 2;21(1):1035. doi: 10.1186/s12889-021-11026-x.

Distance learning in Italian primary and middle school children during the 
COVID-19 pandemic: a national survey.

Scarpellini F(1), Segre G(2), Cartabia M(2), Zanetti M(2), Campi R(2), Clavenna 
A(2), Bonati M(2).

Author information:
(1)Laboratory for Mother and Child Health, Department of Public Health, Istituto 
di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156, Milan, 
Italy. francesca.scarpellini@marionegri.it.
(2)Laboratory for Mother and Child Health, Department of Public Health, Istituto 
di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156, Milan, 
Italy.

BACKGROUND: School closure created difficulties for parents, who were asked to 
care for their children and help them with schooling, while working at home. We 
aimed to explore the experiences in organising school for children at home and 
its implications on children's psychological well-being and educational progress 
during the quarantine for the COVID-19 pandemic.
METHODS: A nationwide online survey of mothers of primary and middle school 
students was conducted during the COVID-19 pandemic. Demographic data and 
information on distance learning organisation and children's attitudes and 
behavioural changes were collected.
RESULTS: 2149 mothers completed the survey, with a final sample of 1601 
subjects. Large differences between primary and middle school emerged: lessons 
were less organised and routines were more instable for the youngest, who could 
not pay attention for more than 20 min (28.3%) and needed breaks every 10 min 
(21.6%), with lower quality of learning (40.6%), increased restlessness (69.1%), 
and aggressiveness (33.3%). A large use of screens was reported, with an abuse 
in screen time in 2%. Two thirds of mothers did not approve of distance learning 
(72.2%) because of their role in replacing teachers (77.8%), the effort required 
(66%), and the great commitment required (78.3%).
CONCLUSIONS: Distance learning increased educational deprivation and social 
inequalities, especially for the youngest children, who lost almost one year of 
school. The situation was even worse for children with disabilities, who were 
neglected by the institutions. This period should be considered as an 
opportunity to correct the weaknesses of our school system.

DOI: 10.1186/s12889-021-11026-x
PMCID: PMC8170444
PMID: 34078328 [Indexed for MEDLINE]

Conflict of interest statement: All authors declare that they have no conflicts 
of interest.


3387. Appl Clin Inform. 2021 May;12(3):507-517. doi: 10.1055/s-0041-1731000. Epub 2021 
Jun 2.

Impact of Changes in EHR Use during COVID-19 on Physician Trainee Mental Health.

Holzer KJ(1), Lou SS(1), Goss CW(2), Strickland J(3), Evanoff BA(3), Duncan 
JG(4), Kannampallil T(1)(5).

Author information:
(1)Department of Anesthesiology, Washington University School of Medicine, St. 
Louis, Missouri, United States.
(2)Division of Biostatistics, Washington University School of Medicine, St. 
Louis, Missouri, United States.
(3)Department of Medicine, Washington University School of Medicine, St. Louis, 
Missouri, United States.
(4)Department of Pediatrics, Washington University School of Medicine, St. 
Louis, Missouri, United States.
(5)Institute for Informatics, Washington University School of Medicine, St. 
Louis, Missouri, United States.

OBJECTIVES: This article investigates the association between changes in 
electronic health record (EHR) use during the coronavirus disease 2019 
(COVID-19) pandemic on the rate of burnout, stress, posttraumatic stress 
disorder (PTSD), depression, and anxiety among physician trainees (residents and 
fellows).
METHODS: A total of 222 (of 1,375, 16.2%) physician trainees from an academic 
medical center responded to a Web-based survey. We compared the physician 
trainees who reported that their EHR use increased versus those whose EHR use 
stayed the same or decreased on outcomes related to depression, anxiety, stress, 
PTSD, and burnout using univariable and multivariable models. We examined 
whether self-reported exposure to COVID-19 patients moderated these 
relationships.
RESULTS: Physician trainees who reported increased use of EHR had higher burnout 
(adjusted mean, 1.48 [95% confidence interval [CI] 1.24, 1.71] vs. 1.05 [95% CI 
0.93, 1.17]; p = 0.001) and were more likely to exhibit symptoms of PTSD 
(adjusted mean = 15.09 [95% CI 9.12, 21.05] vs. 9.36 [95% CI 7.38, 11.28]; 
p = 0.035). Physician trainees reporting increased EHR use outside of work were 
more likely to experience depression (adjusted mean, 8.37 [95% CI 5.68, 11.05] 
vs. 5.50 [95% CI 4.28, 6.72]; p = 0.035). Among physician trainees with 
increased EHR use, those exposed to COVID-19 patients had significantly higher 
burnout (2.04, p < 0.001) and depression scores (14.13, p = 0.003).
CONCLUSION: Increased EHR use was associated with higher burnout, depression, 
and PTSD outcomes among physician trainees. Although preliminary, these findings 
have implications for creating systemic changes to manage the wellness and 
well-being of trainees.

Thieme. All rights reserved.

DOI: 10.1055/s-0041-1731000
PMCID: PMC8172260
PMID: 34077972 [Indexed for MEDLINE]

Conflict of interest statement: T.K. reports grants from NIMH, grants from 
NCATS, grants from NINR, personal fees from Pfizer, outside the submitted work. 
B.A.E. reports grants from National Institute of Occupational Safety and Health, 
from null, during the conduct of the study; grants from National Institute of 
Occupational Safety and Health, grants from National Institute of Health, from 
null, outside the submitted work.


3388. J Intellect Disabil Res. 2021 Aug;65(8):760-771. doi: 10.1111/jir.12859. Epub 
2021 Jun 2.

Experiences of mothers caring for a child with an intellectual disability during 
the COVID-19 pandemic in the Netherlands.

Embregts P(1), Heerkens L(1), Frielink N(1), Giesbers S(1), Vromans L(1), Jahoda 
A(2).

Author information:
(1)Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, 
Tilburg, The Netherlands.
(2)Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.

BACKGROUND: During the first COVID-19 lockdown period, various restrictions led 
to diminished access to both educational and professional support systems for 
children with an intellectual disability and their families. The aim of this 
study was to explore the experiences and needs of parents caring for a child 
with an intellectual disability during the first lockdown period in the 
Netherlands.
METHOD: Five mothers caring for a child with an intellectual disability 
participated in this qualitative study. The participants were interviewed using 
a semi-structured interview guide. The interviews lasted between 26 and 48 min. 
The interview recordings were transcribed verbatim, and the transcripts were 
analysed thematically.
RESULTS: Three overarching themes emerged: (1) We need to stay healthy, which 
centres on the mother's urge to protect their child's well-being; (2) We make it 
work, which provides insight into how the mothers were handling the drastic 
changes in their family; and (3) My child's and family's place in the world, 
which focuses on the mothers' experienced position in the world around them.
CONCLUSIONS: The current study provides valuable insights into the experiences 
and needs of mothers caring for a child with an intellectual disability during 
the COVID-19 pandemic.

© 2021 The Authors. Journal of Intellectual Disability Research published by 
MENCAP and International Association of the Scientific Study of Intellectual and 
Developmental Disibilities and John Wiley & Sons Ltd.

DOI: 10.1111/jir.12859
PMCID: PMC8242374
PMID: 34076326 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare not to have any conflict of 
interest.


3389. Acta Chir Belg. 2021 Jun 2:1-18. Online ahead of print.

Let us ask the patient: Psychological well-being from a patients'-perspective 
due to postponed care of cardiac surgery during the COVID-19 lockdown.

Welch A(1), Nijs J(1), Van Loo I(1), Mallefroy M(2), La Meir M(1).

Author information:
(1)Department of Cardiac Surgery, UZ Brussel, Brussels, Belgium.
(2)Department of Clinical psychology, UZ Brussel, Brussels, Belgium.

Introduction: The onset of the COVID-19 pandemic has forced a rapid and 
extensive change in the need of intensive care beds. Therefore, we decided early 
in the pandemic to suspend all elective cases of cardiac surgery and closed the 
ambulatory clinic. The effect of this strategy on the mental well-being of the 
non-COVID-19 patients is unknown. The aim of this study is to assess whether 
planned or operated patients suffered from either anxiety or depression by their 
altered medical care trajectory and if their score influenced decision-making. 
The findings intend to anticipate individual needs during subsequent waves of 
the COVID-19 pandemic.Methods: The patient population consisted of two groups. 
The first group included planned patients whose operation date was delayed; in 
the second group, the postoperative control visit was postponed. Both groups 
received a twofold questionnaire. Part one was the Hospital Anxiety and 
Depression scale, part two a series of questions on the influence of the 
COVID-19 pandemic on cardiac surgical care from a patient's perspective.Results: 
The study population was composed of 46 patients (63% men). Most of them (82,6%) 
would like the surgery to be performed as fast as possible, even before the end 
of the first wave of COVID-19-related hospitalizations. Of all patients 30,4% 
have avoided to consult a physician because of fear and 34,8% consulted a 
physician by phone call. When they physically consulted a physician, there was a 
prominent role for the general practitioner (41,3% went to the GP vs 19,6% to 
the specialist). Most (58,7%) of the patients would have liked a 
(tele)consultation with the cardiac surgeon.Conclusions: Regardless of the HADS, 
one can state that a closer follow-up using telemedicine during the pandemic is 
expected by all patients. All patients prefer their surgery to take place even 
during a pandemic.

PMID: 34075844


3390. Int J Environ Res Public Health. 2021 May 26;18(11):5696. doi: 
10.3390/ijerph18115696.

How Will the Future of Work Shape OSH Research and Practice? A Workshop Summary.

Felknor SA(1), Streit JMK(2), McDaniel M(3), Schulte PA(2), Chosewood LC(1), 
Delclos GL(3), On Behalf Of The Workshop Presenters And Participants.

Author information:
(1)National Institute for Occupational Safety and Health, Atlanta, GA 30333, 
USA.
(2)National Institute for Occupational Safety and Health, Cincinnati, OH 45226, 
USA.
(3)Southwest Center for Occupational and Environmental Health, The University of 
Texas Health Science Center at Houston School of Public Health, Houston, TX 
77030, USA.

Growth of the information economy and globalization of labor markets will be 
marked by exponential growth in emerging technologies that will cause 
considerable disruption of the social and economic sectors that drive the global 
job market. These disruptions will alter the way we work, where we work, and 
will be further affected by the changing demographic characteristics and level 
of training of the available workforce. These changes will likely result in 
scenarios where existing workplace hazards are exacerbated and new hazards with 
unknown health effects are created. The pace of these changes heralds an urgent 
need for a proactive approach to understand the potential effects new and 
emerging workplace hazards will have on worker health, safety, and well-being. 
As employers increasingly rely on non-standard work arrangements, research is 
needed to better understand the work organization and employment models that 
best support decent work and improved worker health, safety, and well-being. 
This need has been made more acute by the SARS-CoV-2 global pandemic that has 
resulted in dramatic changes in employment patterns, millions of lost jobs, an 
erosion of many economic sectors, and widespread disparities which further 
challenge occupational safety and health (OSH) systems to ensure a healthy and 
productive workplace. To help identify new research approaches to address OSH 
challenges in the future, a virtual workshop was organized in June 2020 with 
leading experts in the fields of OSH, well-being, research methods, mental 
health, economics, and life-course analysis. A paradigm shift will be needed for 
OSH research in the future of work that embraces key stakeholders and thinks 
differently about research that will improve lives of workers and enhance 
enterprise success. A more transdisciplinary approach to research will be needed 
that integrates the skills of traditional and non-traditional OSH research 
disciplines, as well as broader research methods that support the 
transdisciplinary character of an expanded OSH paradigm. This article provides a 
summary of the presentations, discussion, and recommendations that will inform 
the agenda of the Expanded Focus for Occupational Safety and Health (Ex4OSH) 
International Conference, planned for December 2021.

DOI: 10.3390/ijerph18115696
PMCID: PMC8198798
PMID: 34073326 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3391. Int J Environ Res Public Health. 2021 May 29;18(11):5862. doi: 
10.3390/ijerph18115862.

Psychological Wellbeing during the COVID-19 Pandemic: The Influence of 
Personality Traits in the Italian Population.

Rossi C(1), Bonanomi A(2), Oasi O(1).

Author information:
(1)Department of Psychology, Catholic University of Milan, Largo Agostino 
Gemelli, 1, 20123 Milano, Italy.
(2)Department of Statistical Science, Catholic University of Milan, Largo 
Agostino Gemelli, 1, 20123 Milano, Italy.

Coronavirus disease 19 (COVID-19) has had a strong psychological impact on the 
Italian population. Italy was heavily affected by the virus before other 
countries in Europe, experiencing the highest number of deaths. Unknown symptoms 
in the early stages of the pandemic and the absence of clear transmission links 
affected people's wellbeing. Individual personality differences played a key 
role in perceived psychological wellbeing during the pandemic. The present 
exploratory study sought to evaluate the impact of COVID-19 on psychological 
health and identify how psychological wellbeing is influenced by personality 
traits. A total of 2103 participants (64% female and 36% male) completed an 
online survey that included the Psychological General Wellbeing Index (PGWBI), 
the Italian Short Personality Inventory (ITAPI), and a general questionnaire. 
Descriptive statistics and hierarchical regressions were performed using SPSS 
25.0 (IBM Corp., Armonk, NY, USA) (The findings showed poor psychological 
wellbeing in the Italian population. Young people reported the lowest scores. 
Vulnerability traits negatively influenced some PGWBI domains, such as the total 
score (β = -0.62), anxiety (β = -0.55), depression (β = -0.46), positivity and 
wellbeing (β = -0.51), vitality (β = -0.45), general health (β = -0.12), and 
self-control (β = -0.52). On the other hand, dynamism traits positively affected 
vitality (β = 0.12) and positivity and wellbeing (β = 0.14). In other words, 
personality factors related to vulnerability in particular created risk, whereas 
dynamism offered protection. The results highlight how COVID-19 helped to 
trigger anxious and depressive states. People feel helpless and vulnerable when 
facing new, unexpected conditions caused by the virus. These findings may assist 
mental healthcare professionals in safeguarding psychological wellbeing during 
emergencies such as the pandemic.

DOI: 10.3390/ijerph18115862
PMCID: PMC8198634
PMID: 34072561 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


3392. Nutrients. 2021 May 27;13(6):1831. doi: 10.3390/nu13061831.

Wellbeing of Breastfeeding Women in Australia and New Zealand during the 
COVID-19 Pandemic: A Cross-Sectional Study.

Sakalidis VS(1)(2), Rea A(3), Perrella SL(4)(5), McEachran J(4), Collis G(5), 
Miraudo J(5), Prosser SA(4)(5), Gibson LY(6)(7)(8), Silva D(6)(9)(10), Geddes 
DT(4)(6).

Author information:
(1)Swiss Tropical and Public Health Institute, 4051 Basel, Switzerland.
(2)University of Basel, 4001 Basel, Switzerland.
(3)Mathematics and Statistics, Murdoch University, Perth, WA 6150, Australia.
(4)School of Molecular Sciences, University of Western Australia, Perth, WA 
6009, Australia.
(5)One For Women, Mt Lawley, WA 6050, Australia.
(6)Telethon Kids Institute, Perth, WA 6009, Australia.
(7)The University of Western Australia, Perth, WA 6009, Australia.
(8)School of Health and Medical Sciences, Edith Cowan University, Perth, WA 
6027, Australia.
(9)Health and Medical Sciences, The University of Western Australia, Perth, WA 
6009, Australia.
(10)Joondalup Health Campus, Perth, WA 6027, Australia.

During the COVID-19 pandemic, breastfeeding women have experienced restricted 
access to support, placing them at increased risk of mental health concerns and 
limited breastfeeding assistance. This study investigated the effect of the 
pandemic on feeding choices and maternal wellbeing amongst breastfeeding mothers 
living in Australian and New Zealand. We conducted a cross-sectional online 
survey that examined feeding methods, maternal mental wellbeing, worries, 
challenges, and positive experiences during the pandemic. Most women were 
exclusively breastfeeding (82%). Partial breastfeeding was associated with 
perceived low milk supply and longer pregnancy duration during the pandemic. 
Reduced mental health and wellbeing was associated with lower levels of family 
functioning, increased perceived stress, and perinatal anxiety. Longer pregnancy 
duration during the pandemic was associated with lower mental health wellbeing 
scores, while higher perceived stress scores were reported for regions with 
higher COVID-19 infection rates and women with perceived low milk supply. Women 
reported that the pandemic resulted in less pressure and more time for family 
bonding, while worries about the pandemic, family health, and parenting 
challenges were also cited. Mental health concerns of breastfeeding women appear 
to be exacerbated by COVID-19, highlighting a critical need for access to mental 
health and broader family support during the pandemic.

DOI: 10.3390/nu13061831
PMCID: PMC8230305
PMID: 34072039 [Indexed for MEDLINE]

Conflict of interest statement: D.T.G. and S.L.P. receive salaries from an 
unrestricted research grant from Medela AG that is administered by The 
University of Western Australia. Medela AG had no role in the design of the 
study; in the collection, analyses, or interpretation of data; in the writing of 
the manuscript, or in the decision to publish the results.


3393. Nutrients. 2021 May 27;13(6):1820. doi: 10.3390/nu13061820.

Increased COVID-19 Lockdown Burden in Italian Adults with Gastrointestinal 
Diseases.

Ruotolo M(1), Gagliardi M(1), Ciacci C(1), Zingone F(2), de Santis Ciacci C(3), 
Santonicola A(1), D'Arcangelo G(4), Siniscalchi M(1).

Author information:
(1)Department of Medicine, Surgery, Dentistry, Scuola Medica Salernitana, 
University of Salerno, 84084 Fisciano, Italy.
(2)Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, 
University of Padua, 35122 Padua, Italy.
(3)School of Medicine, University of Naples Federico II, 80138 Napoli, Italy.
(4)Department of Systems Medicine, University of Tor Vergata, 00133 Rome, Italy.

BACKGROUND: Coronavirus disease 2019 (COVID-19) causes not only severe illness 
but also detrimental effects associated with the lockdown measures. The present 
study aimed to evaluate reported lifestyle changes in a cohort of adults in 
Italy, including physical exercise, food choices, and psychological wellbeing, 
after two months of lockdown.
METHODS: A web survey on social media (Facebook and LinkedIn) of 32 
multiple-choice questions aiming to evaluate the impact of the national COVID-19 
lockdown in a sample of Italian adults.
RESULTS: We received 1378 complete responses (women 68.3%, mean age 39.5 ± 12.5 
years). The percentage of participants reporting regular exercise decreased 
during lockdown (52 vs. 56.5%). The vast majority of people continued to consume 
the three traditional meals per day, but the consumption of meat, fish, and eggs 
significantly decreased. Women reported more frequent anxiety, sadness, fear, 
and feelings of insecurity than men. The factors predicting the worst outcome 
during the lockdown were being a woman, low education and income, 
gastrointestinal diseases.
CONCLUSION: The lockdown has had a limited impact on food choices and physical 
exercise in Italian adults of our series, since most of them made an effort to 
improve their lifestyle. However, women with gastrointestinal diseases reported 
more frequent negative feelings and poor adaptation to the lockdown.

DOI: 10.3390/nu13061820
PMCID: PMC8230132
PMID: 34071803 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3394. Int J Environ Res Public Health. 2021 May 28;18(11):5792. doi: 
10.3390/ijerph18115792.

COVID-19 Pandemic Affects the Medical Students' Learning Process and Assaults 
Their Psychological Wellbeing.

Aftab M(1), Abadi AM(2), Nahar S(2), Ahmed RA(2), Mahmood SE(2), Madaan M(3), 
Ahmad A(4).

Author information:
(1)Dow University of Health Sciences, Karachi 74200, Pakistan.
(2)Department of Family and Community Medicine, College of Medicine, King Khalid 
University, Guraiger, Abha 6252, Saudi Arabia.
(3)KIMS Medical College Bangalore, Bengaluru 560004, India.
(4)Department of Community Medicine, IIMSR, Integral University, Kursi Road, 
Lucknow, Uttar Pradesh 226026, India.

BACKGROUND: With the emergence of the COVID-19 pandemic, people are living 
within a milieu of stress, anxiety, and fear. Medical students are susceptible 
to these emotional injuries, but their psychological wellbeing and learning may 
further be assaulted by future uncertainties and altered teaching and training 
programs. Our objective was to find the extent of the psychological impact of 
the pandemic and the learning difficulties they are experiencing; Methodology: 
This cross-sectional study included 418 undergraduate and postgraduate medical 
students from all over the world. A questionnaire was uploaded in Google survey 
form. It included background characteristics, questions for psychiatric impact 
like PHQ-9, GAD-7, ZF-OCS, and questions for learning difficulties perceived in 
comparison to the pre-pandemic time.
RESULTS: Among participants, 34.9% of students were male and 65.1% female. 
Around 46.4% belonged to the WHO, Eastern Mediterranean region, 26.8% from South 
East Asia region, 17.5% from the region of America, 5.5% from the European 
region,2.2%from the Western Pacific region, and 1.7% from the African region. 
Symptoms due to psychiatric illness were noticed in 393 (93.1%); depression in 
386 (92.3%), anxiety in 158 (37.8%), obsessive compulsion disorder in 225 
(53.8%), and post-traumatic stress syndrome in 129 (39.9%). Female gender, 
geographical region, and history of previous psychiatric illness were 
significantly related to almost all the psychiatric illnesses. Regarding 
learning difficulty, 96% of students faced problems: trouble with memorizing in 
54.0%, concentration problems in 67.0%, about 55.5% of students made more 
mistakes, while 44.5% noted an increase in reaction time for solving questions. 
In addition, 90% experienced greater difficulty in overall learning during the 
pandemic in comparison to the pre-pandemic time.
CONCLUSION: Assault on psychological wellbeing, struggling to memorize, 
inattention and difficulty in concentration on studies, along with perceived 
overall trouble with learning, have emerged as collateral damage from the 
COVID-19 pandemic with respect to medical students.

DOI: 10.3390/ijerph18115792
PMCID: PMC8197969
PMID: 34071234 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3395. Int J Environ Res Public Health. 2021 May 30;18(11):5875. doi: 
10.3390/ijerph18115875.

Resilience in the Storm: Impacts of Changed Daily Lifestyles on Mental Health in 
Persons with Chronic Illnesses under the COVID-19 Pandemic.

Lau BHP(1), Cheung MKT(2), Chan LTH(2), Chan CLW(3), Leung PPY(2).

Author information:
(1)Department of Counselling and Psychology, Hong Kong Shue Yan University, Hong 
Kong, China.
(2)Hong Kong Society for Rehabilitation, Hong Kong, China.
(3)Department of Social Work and Social Administration, Center on Behavioral 
Health, The University of Hong Kong, Hong Kong, China.

Studies have shown individuals with chronic illnesses tend to experience poorer 
mental health compared to their counterparts without a chronic illness under the 
COVID-19 pandemic. The pervasive disruption on daily lifestyles due to social 
distancing could be a contributing factor. In this study, we collaborated with 
local patient support groups to explore the psychological adjustment among a 
group of community-dwelling individuals with chronic illnesses under the 
COVID-19 pandemic in Hong Kong. We collected responses from 408 adults with one 
or more chronic illnesses using an online survey. Results show that about one in 
four participants experienced moderate to high levels of depression (26.0%), 
anxiety (26.2%) and stress (20.1%) symptoms measured by the Depression, Anxiety 
and Stress Scale and the World Health Organisation-Five Well-Being Index. While 
62.3% (gatherings) to 91.9% (contact with others) of participants reported 
changes in their daily lifestyles, these changes-both an increase and a 
decrease-were related to poorer mental health. The relationship was mediated by 
psychological resilience, measured by the Connor-Davidson Resilience Scale, with 
an estimate of indirect effect of -0.28 (95% confidence interval -0.44 to 
-0.10). In light of our findings, we urge social and healthcare professionals to 
support chronic illness patients to continue their daily lifestyles such as 
exercises and social contacts as much as possible by educating the public on 
feasible and practical preventive measures and enhance the psychological 
resilience of community-dwelling patients with scalable and efficacious 
psychological interventions.

DOI: 10.3390/ijerph18115875
PMCID: PMC8198084
PMID: 34070782 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3396. Int J Environ Res Public Health. 2021 May 25;18(11):5655. doi: 
10.3390/ijerph18115655.

Positive Organisational Arts-Based Youth Scholarship: Redressing Discourse on 
Danger, Disquiet, and Distress during COVID-19.

Dadich A(1), Boydell KM(2), Habak S(2), Watfern C(2)(3).

Author information:
(1)School of Business, Western Sydney University, Locked Bag 1797, Penrith, NSW 
2751, Australia.
(2)Black Dog Institute, University of New South Wales (UNSW), Sydney, NSW 2031, 
Australia.
(3)Arts & Design, University of New South Wales (UNSW), Sydney, NSW 2052, 
Australia.

This methodological article argues for the potential of positive organisational 
arts-based youth scholarship as a methodology to understand and promote positive 
experiences among young people. With reference to COVID-19, exemplars sourced 
from social media platforms and relevant organisations demonstrate the 
remarkable creative brilliance of young people. During these difficult times, 
young people used song, dance, storytelling, and art to express themselves, 
(re)connect with others, champion social change, and promote health and 
wellbeing. This article demonstrates the power of positive organisational 
arts-based youth scholarship to understand how young people use art to redress 
negativity via a positive lens of agency, peace, collectedness, and calm.

DOI: 10.3390/ijerph18115655
PMCID: PMC8199347
PMID: 34070519 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflict to declare.


3397. Int J Environ Res Public Health. 2021 May 25;18(11):5651. doi: 
10.3390/ijerph18115651.

Across the COVID-19 Waves; Assessing Temporal Fluctuations in Perceived Stress, 
Post-Traumatic Symptoms, Worry, Anxiety and Civic Moral Disengagement over One 
Year of Pandemic.

Gori A(1), Topino E(2).

Author information:
(1)Department of Health Sciences, University of Florence, Via di San Salvi 12, 
pad. 26, 50135 Firenze, Italy.
(2)Department of Human Sciences, LUMSA University of Rome, Via della Traspontina 
21, 00193 Rome, Italy.

This study aimed at investigating the psychological effect of the COVID-19 
pandemic in Italy by analysing the trends of perceived stress, post-traumatic 
symptoms, state anxiety, worry, and civic moral disengagement in four different 
moments from March 2020 to March 2021. The study involved a total of 1827 
Italian participants (30% men and 70% women; Mage = 34.72; SD = 12.40) divided 
into four groups to which an online survey was administered. The first group 
completed the survey in March 2020, the second one in August 2020, the third one 
in November 2020, and the fourth one in March 2021. Results highlighted 
significant decreases in post-traumatic symptoms and a significant increase in 
civic moral disengagement over the first year of the COVID-19 pandemic. The 
levels of perceived stress, worry, and state anxiety remained constant. The 
correlations between the variables at different times were also explored, as 
well as gender differences over the year. The COVID-19 emergency has had 
significant effects on the mental state of the population, with important 
repercussions for individual and collective well-being during but probably also 
after the pandemic. This study offers a clear snapshot of the psychological 
outcomes over one COVID-19 pandemic year, providing important information that 
may contribute to tailor more effective interventions for mental health.

DOI: 10.3390/ijerph18115651
PMCID: PMC8197503
PMID: 34070478 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3398. Int J Environ Res Public Health. 2021 May 25;18(11):5649. doi: 
10.3390/ijerph18115649.

Hospital Employees' Well-Being Six Months after the COVID-19 Outbreak: Results 
from a Psychological Screening Program in Italy.

Lamiani G(1), Borghi L(1), Poli S(2), Razzini K(3), Colosio C(1)(4), Vegni 
E(1)(5).

Author information:
(1)Department of Health Sciences, University of Milan, 20142 Milan, Italy.
(2)Department of Neurosciences, Biomedicine and Movement Sciences, University of 
Verona, 37134 Verona, Italy.
(3)Prevention and Protection Service, ASST Santi Paolo e Carlo, 20142 Milan, 
Italy.
(4)Occupational Health Unit, ASST Santi Paolo e Carlo, 20142 Milan, Italy.
(5)Clinical Psychology Unit, ASST Santi Paolo e Carlo, 20142 Milan, Italy.

The COVID-19 outbreak has taken a heavy toll on the mental well-being of 
healthcare workers. This study aims to describe a psychological screening 
program developed at a large University Hospital in Milan, Italy, and assess the 
psychological outcomes of employees and associated factors. A survey was 
electronically conducted among hospital employees between July and October 2020. 
Sociodemographic data, information about COVID-19 experience and three scales 
assessing anxiety (STAI-Y1), depression (HAM-D) and post-traumatic stress 
disorder (PCL-5) were collected. A total of 308 employees (80% women; mean age 
45.1 years) responded: 16% physicians, 68% other healthcare professionals, and 
16% administrative staff. Employees reported moderate/severe symptoms of anxiety 
(23%), depression (53%), and post-traumatic stress disorder (40%). At 
multivariate logistic regression analysis, having suffered a loss for COVID-19 
in the personal context was independently associated with higher risk of 
moderate/severe anxiety (OR = 2.40; 95% CI 1.16-4.98), being female was 
associated with higher risk of moderate/severe depression (OR = 2.82; 95% CI 
1.43-5.59), and having had a family member affected by COVID-19 was associated 
with higher risk of moderate/severe post-traumatic stress disorder (OR = 2.75; 
95% CI 1.01-7.48). COVID-19 personal experience may have a profound impact on 
hospital workers' mental health and should be considered in supportive 
interventions.

DOI: 10.3390/ijerph18115649
PMCID: PMC8197452
PMID: 34070468 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3399. Int J Environ Res Public Health. 2021 May 25;18(11):5645. doi: 
10.3390/ijerph18115645.

Beyond the Pandemic: COVID-19 Pandemic Changed the Face of Life.

Khalifa SAM(1), Swilam MM(2), El-Wahed AAA(3), Du M(4), El-Seedi HHR(5), Kai 
G(6), Masry SHD(7)(8), Abdel-Daim MM(9), Zou X(10), Halabi MF(11), Alsharif 
SM(12), El-Seedi HR(2)(13)(14).

Author information:
(1)Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm 
University, S-106 91 Stockholm, Sweden.
(2)Department of Chemistry, Faculty of Science, Menoufia University, Shebin 
El-Kom 32512, Egypt.
(3)Department of Bee Research, Plant Protection Research Institute, Agricultural 
Research Centre, Giza 12627, Egypt.
(4)National Engineering Research Center of Seafood, School of Food Science and 
Technology, Dalian Polytechnic University, Dalian 116024, China.
(5)Faculty of Medicine, Riga Stradins University (RSU), LV-1007 Riga, Latvia.
(6)Laboratory of Medicinal Plant Biotechnology, College of Pharmacy, Zhejiang 
Chinese Medical University, Hangzhou 310053, China.
(7)Department of Plant Protection and Biomolecular Diagnosis, Arid Lands 
Cultivation Research Institute (ALCRI), City of Scientific Research and 
Technological Applications, New Borg El-Arab City 21934, Egypt.
(8)Abu Dhabi Agriculture and Food Safety Authority (ADAFSA), Al Ain 52150, 
United Arab Emirates.
(9)Pharmacology Department, Faculty of Veterinary Medicine, Suez Canal 
University, Ismailia 41522, Egypt.
(10)School of Food and Biological Engineering, Jiangsu University, Zhenjiang 
212013, China.
(11)Al-Rayan Research and Innovation Center, Al-Rayan Colleges, Medina 42541, 
Saudi Arabia.
(12)Department of Biology, College of Science, Taibah University, Al-Madinah 
887, Saudi Arabia.
(13)International Research Center for Food Nutrition and Safety, Jiangsu 
University, Zhenjiang 212013, China.
(14)Pharmacognosy Group, Department of Pharmaceutical Biosciences, Uppsala 
University, Biomedical Center, Box 574, 751 23 Uppsala, Sweden.

The COVID-19 pandemic is a serious challenge for societies around the globe as 
entire populations have fallen victim to the infectious spread and have taken up 
social distancing. In many countries, people have had to self-isolate and to be 
confined to their homes for several weeks to months to prevent the spread of the 
virus. Social distancing measures have had both negative and positive impacts on 
various aspects of economies, lifestyles, education, transportation, food 
supply, health, social life, and mental wellbeing. On other hands, due to 
reduced population movements and the decline in human activities, gas emissions 
decreased and the ozone layer improved; this had a positive impact on Earth's 
weather and environment. Overall, the COVID-19 pandemic has negative effects on 
human activities and positive impacts on nature. This study discusses the impact 
of the COVID-19 pandemic on different life aspects including the economy, social 
life, health, education, and the environment.

DOI: 10.3390/ijerph18115645
PMCID: PMC8197506
PMID: 34070448 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3400. Int J Environ Res Public Health. 2021 May 25;18(11):5630. doi: 
10.3390/ijerph18115630.

Mental Health of Young Australians during the COVID-19 Pandemic: Exploring the 
Roles of Employment Precarity, Screen Time, and Contact with Nature.

Oswald TK(1)(2), Rumbold AR(2)(3), Kedzior SGE(2), Kohler M(4)(5), Moore 
VM(1)(2).

Author information:
(1)Faculty of Health & Medical Sciences, School of Public Health, The University 
of Adelaide, Adelaide, SA 5005, Australia.
(2)Faculty of Health & Medical Sciences, Robinson Research Institute, The 
University of Adelaide, Adelaide, SA 5005, Australia.
(3)South Australian Health & Medical Research Institute, SAHMRI Women and Kids, 
North Adelaide, SA 5006, Australia.
(4)Faculty of Health & Medical Sciences, School of Psychology, The University of 
Adelaide, Adelaide, SA 5005, Australia.
(5)The Environment Institute, The University of Adelaide, Adelaide, SA 5005, 
Australia.

The coronavirus disease 2019 (COVID-19) pandemic is widely understood to have 
contributed to mental health problems. In Australia, young people (18-24 years) 
have been disproportionately affected. To date, research has predominantly 
focused on the presence or absence of mental illness symptoms, while aspects of 
mental well-being have been overlooked. We aimed to explore associations between 
potential risk and protective factors and mental health more comprehensively, 
using the Complete State Model of Mental Health. An online survey of 1004 young 
Australians (55% female; M age = 21.23) was undertaken. Assessment of both 
mental illness and mental well-being enabled participants to be cross-classified 
into four mental health states. Those with 'Floundering' (13%) or 'Struggling' 
(47.5%) mental health reported symptoms of mental illness; a 'Languishing' group 
(25.5%) did not report symptoms of mental illness but mental well-being was 
compromised relative to those who were 'Flourishing' (14%) with high mental 
well-being. Multinomial logistic regressions were used to examine associations, 
adjusting for socio-demographic confounders. Protective factors associated with 
Flourishing mental health included being in secure employment, using screen time 
to connect with others, and reporting high levels of hope. Both incidental and 
purposive contact with nature were also associated with Flourishing, while a 
lack of green/bluespace within walking distance was associated with Languishing, 
absence of outdoor residential space was associated with Floundering, and lower 
neighbourhood greenness was associated with all three suboptimal mental health 
states. Precarious employment, financial stress, living alone, reporting 
decreased screen time during lockdowns, lower levels of hope, and high 
disruption of core beliefs were also associated with Struggling and Floundering 
mental health. Those who were Languishing reported somewhat less hardship and 
little disruption to core beliefs, but lower levels of hope compared to young 
people who were Flourishing. This study highlights that young adults require 
dedicated mental health services to deal with current burden, but should also be 
supported through a range of preventive strategies which target mental health 
risk factors, like precarious employment, and enhance protective factors, such 
as urban green infrastructure.

DOI: 10.3390/ijerph18115630
PMCID: PMC8197562
PMID: 34070331 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3401. Int J Environ Res Public Health. 2021 May 14;18(10):5249. doi: 
10.3390/ijerph18105249.

Self-Perceived Impact of COVID-19 Pandemic by Dental Students in Bucharest.

Iosif L(1), Ţâncu AMC(1), Didilescu AC(2), Imre M(1), Gălbinașu BM(3), Ilinca 
R(4).

Author information:
(1)Department of Complete Denture, Faculty of Dental Medicine, Carol Davila 
University of Medicine and Pharmacy, 17-21 Calea Plevnei Street, Sector 1, 
010221 Bucharest, Romania.
(2)Department of Embryology, Faculty of Dental Medicine, Carol Davila University 
of Medicine and Pharmacy, 17-21 Calea Plevnei Street, Sector 1, 010221 
Bucharest, Romania.
(3)Department of Dental Prosthesis Technology and Dental Materials, Faculty of 
Dental Medicine, Carol Davila University of Medicine and Pharmacy, 17-21 Calea 
Plevnei Street, Sector 1, 010221 Bucharest, Romania.
(4)Department of Biophysics, Faculty of Dental Medicine, Carol Davila University 
of Medicine and Pharmacy, 17-21 Calea Plevnei Street, Sector 1, 010221 
Bucharest, Romania.

All social and economic systems worldwide, including the educational one have 
been disrupted by escalating the global COVID-19 pandemic. One of the most 
impacted areas were the medical and dental education fields, due to the forced 
break from clinical practice during the lockdown, which affected both the 
educational part, as well as the patients. Thus, the main goal of our research 
was to investigate the impact of the COVID-19 pandemic on the dental students' 
education as related to their perceptions and evaluations, in Carol Davila 
University of Medicine and Pharmacy, Bucharest, Romania. A cross-sectional study 
was conducted on 878 dental students who reported their perception of the 
psychological and educational impact of this period by completing a Google Forms 
questionnaire. Collected data were statistically analyzed using Stata/IC 16. 
There was a severe psychological impact among the respondents, the levels of 
stress being perceived as high and very high (33.83%, n = 297; 28.59%, n = 251), 
similar to high and very high anxiety feelings (26.54%, n = 233; 24.26%, n = 
213). Very high educational impact from the point of view of the acquisition of 
practical skills (48.52%, n = 426) and future professional perspectives (38.95%, 
n = 342) were recorded. While online theoretical learning ability was 
principally low (37.93%, n = 333) despite consistently modified time allocated 
to the individual study (44.35%, n = 389), most of the students evaluated the 
efficiency of lecturers in online courses as neutral (41.12%, n = 361). New 
dentistry teaching programs will have to be adopted taking into account the 
dynamics of the pandemic and its strong impact on our students, in order to 
improve both their wellbeing and the sustainability of dental education.

DOI: 10.3390/ijerph18105249
PMCID: PMC8156800
PMID: 34069311 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3402. Int J Environ Res Public Health. 2021 May 22;18(11):5549. doi: 
10.3390/ijerph18115549.

Short-Term Effects of COVID-19 Lockdown in Italian Children and Adolescents with 
Type 1 Diabetes Mellitus: The Role of Separation Anxiety.

Di Riso D(1), Bertini S(1), Spaggiari S(1), Olivieri F(2), Zaffani S(2), 
Comerlati L(2), Marigliano M(2), Piona C(2), Maffeis C(2).

Author information:
(1)Department of Developmental Psychology and Socialization, University of 
Padova, 35131 Padova, Italy.
(2)Pediatric Diabetes and Metabolic Disorders, Department of Surgical Sciences, 
Dentistry, Paediatrics and Gynaecology, University of Verona, 37134 Verona, 
Italy.

In March 2020, the Italian Government imposed mandatory home confinement to 
limit the spread of COVID-19. Few studies assessed the psychophysical impact of 
COVID-19 on chronically ill children. This study examined these effects on 
children with Type 1 Diabetes Mellitus (T1D) and their caregivers. Seventy-one 
patients (7-13 years) with T1D and their caregivers were administered a survey 
created ad hoc and some standardized questionnaires, assessing psychological 
well-being and anxiety. Medical data (physical and biochemical characteristics) 
were recorded before (T0, January-February) and after (T1, May-June) the 
lockdown. Paired Student t-test, Spearman two-tailed correlations, and a linear 
regression model were used for statistical analysis. Children at T1 showed 
higher BMI (body mass index), daily total and basal insulin dose, and time spent 
in therapeutic range, and they showed lower HbA1c (glycated hemoglobin), time 
spent above the therapeutic range, and standard deviations of the mean glucose 
values than at T0. A total of 32.9% scored in the clinical range for separation 
anxiety. The increase in separation anxiety was predicted by younger age, female 
gender, more recent T1D diagnosis, less time spent in therapeutic range at T1, 
and higher perceived fear of COVID-19 infection. In a pandemic context, 
separation anxiety may be stronger in younger females, with more recent T1D 
diagnosis and poor metabolic control, thus affecting the parent's ability to 
manage diabetes and to support children's autonomy.

DOI: 10.3390/ijerph18115549
PMCID: PMC8196957
PMID: 34067365 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3403. Int J Environ Res Public Health. 2021 May 22;18(11):5542. doi: 
10.3390/ijerph18115542.

Mental Health and the Symptoms of PTSD in People with Depression and Anxiety 
Disorders during the COVID-19 Pandemic.

Golińska PB(1), Cieślak M(2), Hubert O(3), Bidzan M(1).

Author information:
(1)Institute of Psychology, University of Gdansk, 80-557 Gdansk, Poland.
(2)Institute of Psychology, University of Lodz, 90-136 Lodz, Poland.
(3)Faculty of Psychology, University of Social Sciences and Humanities, 81-745 
Sopot, Poland.

The purpose of this study was to examine the severity of post-traumatic stress 
disorder (PTSD) symptoms related to the COVID-19 pandemic in people with no 
diagnosis of mental illness, as well as in people who were diagnosed with 
depression or anxiety. Moreover, this study aimed to investigate the interplay 
between PTSD symptoms and self-assessed mental health associated with 
well-being. The 210 participants were divided into 3 groups: mentally healthy, 
participants with diagnosed depression, and participants with anxiety disorders. 
To evaluate the subjective well-being of the participants, the Polish adaptation 
of the Mental Health Continuum-Short Form (MHC-SF) was applied. The Impact Event 
Scale-Revised (IES-R) was used to measure the severity of PTSD symptoms. At 
least a moderate worsening of PTSD symptoms was observed in participants of all 
groups. The results were as follows: healthy participants M = 37.35 (SD = 
18.46); participants with depression M = 36.05 (SD = 18.02); participants with 
anxiety M = 44.52 (SD = 18.08). The participants diagnosed with depression 
showed the lowest level of mental well-being M = 41.58 (SD = 15.02). Conclusion: 
People diagnosed with depression had both the lowest level of well-being and the 
lowest severity of symptoms specific to PTSD. In all three groups, lower 
emotional well-being was linked to greater PTSD symptoms.

DOI: 10.3390/ijerph18115542
PMCID: PMC8196908
PMID: 34067315 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3404. Int J Environ Res Public Health. 2021 May 7;18(9):4958. doi: 
10.3390/ijerph18094958.

Stress, Anxiety, and Depression for Chinese Residents in Japan during the 
COVID-19 Pandemic.

Hu Q(1), Umeda M(2).

Author information:
(1)Graduate School of Nursing Art and Science, University of Hyogo, Akashi 
673-8588, Hyogo, Japan.
(2)Research Institute of Nursing Care for People and Community, University of 
Hyogo, Akashi 673-8588, Hyogo, Japan.

The coronavirus disease 2019 (COVID-19) has profoundly affected the 
psychological well-being of foreign residents. This study examines stress, 
anxiety, and depression levels in Chinese residents in Japan during the COVID-19 
pandemic. It identifies risk factors and the roles of disaster preparedness and 
social support. An online survey among Chinese residents in Japan was conducted 
from 22 June to 14 July 2020. The Depression, Anxiety and Stress Scale, Disaster 
Preparedness for Resilience Checklist, and Social Support Rate Scale were used 
to measure psychological symptoms. Multivariable linear regressions identified 
the risk factors and positive effects of disaster preparedness and social 
support. Of the total 497 participants, 45.3%, 66.6%, and 54.3% reported severe 
stress, anxiety, and depressive symptoms, respectively. People with a lower 
level of education, a higher level of economic influence, the presence of 
COVID-19 symptoms, and confirmed or suspected family or friends in China were 
associated with higher levels of stress, anxiety, and depression. This study, to 
the best of our knowledge, is the first survey to reveal the protective role of 
disaster preparedness in reducing psychological symptoms during the pandemic. It 
offers unique data for further research on how to promote the mental health of 
vulnerable populations including foreign residents.

DOI: 10.3390/ijerph18094958
PMCID: PMC8124497
PMID: 34066924 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3405. Int J Environ Res Public Health. 2021 May 4;18(9):4888. doi: 
10.3390/ijerph18094888.

Sudden Changes and Their Associations with Quality of Life during COVID-19 
Lockdown: A Cross-Sectional Study in the French-Speaking Part of Switzerland.

Duay M(1), Morgiève M(2)(3)(4), Niculita-Hirzel H(1).

Author information:
(1)Department of Occupational Health and Environment, Centre for Primary Care 
and Public Health (Unisanté), University of Lausanne, CH-1066 Epalinges, 
Switzerland.
(2)Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU 
Montpellier, INSERM, Univ Montpellier, Neuropsychiatry: Epidemiological and 
Clinical Research, 34 000 Montpellier, France.
(3)Brain and Spine Institute (ICM), Hôpital de la Pitié-Salpetrière, 75 013 
Paris, France.
(4)Centre for Research on Medicine, Science, Health, Mental Health, and Society 
(Cermes3), 75 006 Paris, France.

The lockdown due to the COVID-19 pandemic has led to various sudden changes in a 
large number of individuals. In response, the question of how individuals from 
different social and economic strata cope with those changes has arisen, as well 
as how much they have affected their mental well-being. Choosing strategies that 
cope with both the pandemic and the well-being of the population has also been a 
challenge for different governments. While a large number of studies have 
investigated the mental health of people from different populations during the 
COVID-19 pandemic, few have explored the number and type of changes experienced 
during lockdown by the general population, alongside their relationships with 
health-related quality of life (HRQoL). To fill this research gap, an 
observational cross-sectional study on those associations was conducted in the 
French-speaking part of the Swiss general population. Data were collected from 
431 participants during the first four weeks of lockdown due to COVID-19. 
Multivariate regressions were used to identify the sociodemographic profile of 
the population that experienced different types and numbers of changes during 
this period, the association of those changes with the HRQoL-mental and 
physical-and infection beliefs, and the perception of the governmental measures. 
We show that the more changes people experienced, the lower their mental HRQoL; 
however, adherence to governmental measures has helped people to cope with the 
imposed changes, even though the number of unexpected and unwished changes have 
strained their mental HRQoL. The low-income population experienced financial 
difficulties and changes in their food intake more frequently, while 
dual-citizenship or non-Swiss individuals declared conflictual situations more 
frequently. Sport practice had a positive association with mental HRQoL; 
nevertheless, a decrease in sport practice was frequently reported, which 
correlated with a lower mental HRQoL. Risk perception of COVID-19 increased with 
lower physical HRQoL score, which supports the efficiency of governmental 
communication regarding the pandemic. Our results support that government 
measures should be accompanied by effective and targeted communication about the 
risk of infection, in order to encourage all strata of the general population to 
follow such measures and adapt to the changes without unduly affecting their 
mental health. The usage of such tools might help to reduce the impact of 
policy-imposed changes on the mental HRQoL of the general population, by 
inducing voluntary changes in informed and engaged populations.

DOI: 10.3390/ijerph18094888
PMCID: PMC8124785
PMID: 34064382 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript, or in the decision to 
publish the results.


3406. Int J Environ Res Public Health. 2021 May 21;18(11):5512. doi: 
10.3390/ijerph18115512.

Beneficial Effects of Mindfulness-Based Stress Reduction Training on the 
Well-Being of a Female Sample during the First Total Lockdown Due to COVID-19 
Pandemic in Italy.

Accoto A(1), Chiarella SG(1), Raffone A(1)(2), Montano A(3), de Marco A(1), 
Mainiero F(1), Rubbino R(3), Valzania A(3), Conversi D(1).

Author information:
(1)Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy.
(2)School of Buddhist Studies, Philosophy and Comparative Religions, Nalanda 
University, Rajgir 803116, India.
(3)A.T. Beck Institute, 00185 Rome, Italy.

The global pandemic caused by COVID-19 and the subsequent lockdown have been 
widely recognized as traumatic events that pose threats to psychological 
well-being. Recent studies reported that during such traumatic events, women 
tend to be at greater risk than men for developing symptoms of stress, anxiety, 
and depression. Several studies reported that a mindfulness-based stress 
reduction protocol (MBSR) provides useful skills for dealing with traumatic 
events. In our study, a sample of Italian females received an 8-week MBSR course 
plus 6 weeks of video support for meditation practice during the first total 
lockdown in Italy. We assessed the participants with questionnaires before and 
after this period to investigate their mindfulness skills, psychological 
well-being, post-traumatic growth, and psychological flexibility. After the 
intervention, the meditators group reported improvement in measures associated 
with self-acceptance, purpose in life, and relation to others compared to the 
control group. Furthermore, our results showed that participants with greater 
mindfulness scores showed high levels of psychological flexibility, which in 
turn was positively associated with higher levels of psychological well-being. 
We concluded that the MBSR could support psychological well-being, at least in 
female subjects, even during an unpredictable adverse event, such as the 
COVID-19 lockdown, by reinforcing key psychological aspects.

DOI: 10.3390/ijerph18115512
PMCID: PMC8196575
PMID: 34063864 [Indexed for MEDLINE]

Conflict of interest statement: The author reports no conflict of interest.


3407. Int J Environ Res Public Health. 2021 May 3;18(9):4879. doi: 
10.3390/ijerph18094879.

Health Anxiety and Its Correlations with Self-Perceived Risk and Attitude on 
COVID-19 among Malaysian Healthcare Workers during the Pandemic.

Mohd Salleh Sahimi H(1), Azman N(1), Nik Jaafar NR(1), Mohd Daud TI(1), 
Baharudin A(1), Ismail AK(2), Abdul Malek AZ(3), Hassan MR(4), Mohammed Nawi 
A(4).

Author information:
(1)Department of Psychiatry, Hospital Canselor Tuanku Muhriz, Kuala Lumpur 
56000, Malaysia.
(2)Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan 
Malaysia, Kuala Lumpur 56000, Malaysia.
(3)Department of Psychiatry and Mental Health, Ministry of Health Malaysia, 
Kuala Lumpur 50586, Malaysia.
(4)Department of Community Health, Faculty of Medicine, Universiti Kebangsaan 
Malaysia, Kuala Lumpur 56000, Malaysia.

Healthcare workers (HCW) are exposed to health-related anxiety in times of 
pandemic as they are considered to have a high risk of being infected whilst 
being the vital workforce to manage the outbreak. This study determined the 
factors that influence health anxiety and its extent in correlations with 
perceived risk, knowledge, attitude, and practice of HCW. A cross-sectional 
online survey was conducted on a total of 709 HCW from both public and private 
healthcare facilities who completed a set of questionnaires on sociodemographic 
data, knowledge, attitude, and practice of HCW on COVID-19, and health anxiety 
traits assessed using the short version Health Anxiety Inventory (HAI). Multiple 
linear regression (adjusted R2 = 0.06) revealed respondents with higher 
perceived risk for COVID-19 significantly predicted higher HAI scores (beta 
1.281, p < 0.001, 95%, CI: 0.64, 1.92), and those with a higher cautious 
attitude towards COVID-19 significantly predicted higher HAI scores (beta 0.686, 
p < 0.001, 95%CI: 0.35, 1.02). Healthcare workers' perceived risk and cautious 
attitude towards COVID-19 might be potentially influenced by management of the 
sources and approaches to the dissemination of information of the pandemic. The 
implementation of certain measures that minimize the infection risk and its 
related anxiety is important to preserve both their physical and psychological 
wellbeing.

DOI: 10.3390/ijerph18094879
PMCID: PMC8124576
PMID: 34063714 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3408. Int J Environ Res Public Health. 2021 May 15;18(10):5267. doi: 
10.3390/ijerph18105267.

The "Healthcare Workers' Wellbeing (Benessere Operatori)" Project: A Picture of 
the Mental Health Conditions of Italian Healthcare Workers during the First Wave 
of the COVID-19 Pandemic.

Di Mattei VE(1)(2), Perego G(3), Milano F(2), Mazzetti M(2), Taranto P(2), Di 
Pierro R(3), De Panfilis C(4), Madeddu F(3), Preti E(3).

Author information:
(1)School of Psychology, Vita-Salute San Raffaele University, 20132 Milan, 
Italy.
(2)Clinical and Health Psychology Unit, IRCCS San Raffaele Scientific Institute, 
20132 Milan, Italy.
(3)Department of Psychology, University of Milan-Bicocca, 20126 Milan, Italy.
(4)Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.

During the last year, the COVID-19 outbreak put all the healthcare workers 
around the world at risk of physical and psychological sequelae. The general 
purpose of the present study was to assess the mental health of Italian 
healthcare workers during the COVID-19 outbreak and to identify high-risk 
groups. Here, we present results from the baseline assessment of the "Healthcare 
workers' wellbeing (Benessere Operatori)" project on a sample of 1055 healthcare 
workers. Participants completed the Depression Anxiety Stress Scale-21, the 
Insomnia Severity Index, the Impact of Event Scale-Revised, the State-Trait 
Anger Expression Inventory-2, and the Maslach Burnout Inventory. Healthcare 
workers who worked in COVID wards reported higher levels of anxiety, insomnia, 
post-traumatic stress, anger, and burnout, compared to those reported by the 
healthcare workers who worked in non-COVID wards. Moreover, nurses, both in 
COVID and non-COVID wards, were at higher risk of experiencing psychological 
distress compared to other groups of healthcare workers. These findings 
highlight the importance of implementing targeted psychological interventions 
for healthcare workers operating in COVID wards and nurses, who seem to be the 
most vulnerable categories.

DOI: 10.3390/ijerph18105267
PMCID: PMC8156728
PMID: 34063421 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3409. Int J Environ Res Public Health. 2021 May 1;18(9):4847. doi: 
10.3390/ijerph18094847.

Exploring the Frequency of Anxiety and Depression Symptoms in a Brazilian Sample 
during the COVID-19 Outbreak.

Ribeiro FS(1), Santos FH(2), Anunciação L(3), Barrozo L(4), Landeira-Fernandez 
J(3), Leist AK(1).

Author information:
(1)Department of Social Sciences, University of Luxembourg, L-4366 
Esch-Sur-Alzette, Luxembourg.
(2)School of Psychology, University College Dublin, D04 V1W8 Dublin, Ireland.
(3)Department of Psychology, Pontifical Catholic University, 22541-041 Rio de 
Janeiro, Brazil.
(4)Institute of Psychology, Federal University of Rio de Janeiro, 21941-901 Rio 
de Janeiro, Brazil.

The COVID-19 pandemic is a public health emergency of international concern, and 
the main measures to contain the spread of the coronavirus causing COVID-19 were 
social distancing, quarantine, and self-isolation. Although these policies are 
effective in containing the spread of the virus, they might represent a 
challenge to psychological well-being, increasing levels of depressive and 
anxiety-related symptoms.
AIMS: We explored the frequency of anxiety and depression symptoms during 
COVID-19 restrictions and associations with sociodemographic factors in a 
Brazilian sample.
METHOD: Data of a total of 936 Brazilian adults (68.2% women) aged 18 to 77 
years old (M = 38.95, SD = 13.91) were collected through an online survey.
RESULTS: In general, we observed a frequency of 17.36% for severe anxiety and 
66.13% for severe depression symptoms, in which younger participants (18-39 
years old) and women showed higher scores in anxiety and depression scales 
compared to older age groups. Logistic regressions showed that women were more 
likely to present severe symptoms of anxiety (20.4%) compared to men (10.9%), as 
well as respondents in the educational sector (24.3%) compared to those in the 
health sector (10%).
CONCLUSIONS: We highlight the importance of mental health professionals in 
developing strategies to help younger adults to mitigate the effects of social 
restriction.

DOI: 10.3390/ijerph18094847
PMCID: PMC8125231
PMID: 34062783 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest


3410. Sci Prog. 2021 Apr-Jun;104(2):368504211019854. doi: 10.1177/00368504211019854.

COVID-19 pandemic: A review of the global lockdown and its far-reaching effects.

Onyeaka H(1), Anumudu CK(1), Al-Sharify ZT(1)(2), Egele-Godswill E(3), Mbaegbu 
P(4).

Author information:
(1)School of Chemical Engineering, University of Birmingham, Birmingham, UK.
(2)Department of Environmental Engineering, College of Engineering, 
Mustansiriyah University, Baghdad, Iraq.
(3)Center of African Studies, University of Edinburgh, Scotland, UK.
(4)Department of History, University of Jos, Jos, Plateau, Nigeria.

COVID-19, caused by the severe acute respiratory syndrome coronavirus-2 
(SARS-CoV-2), was declared a pandemic by the World Health Organization (WHO) on 
the 11th of March 2020, leading to some form of lockdown across almost all 
countries of the world. The extent of the global pandemic due to COVID-19 has a 
significant impact on our lives that must be studied carefully to combat it. 
This study highlights the impacts of the COVID-19 pandemic lockdown on crucial 
aspects of daily life globally, including; Food security, Global economy, 
Education, Tourism, hospitality, sports and leisure, Gender Relation, Domestic 
Violence/Abuse, Mental Health and Environmental air pollution through a 
systematic search of the literature. The COVID-19 global lockdown was initiated 
to stem the spread of the virus and 'flatten the curve' of the pandemic. 
However, the impact of the lockdown has had far-reaching effects in different 
strata of life, including; changes in the accessibility and structure of 
education delivery to students, food insecurity as a result of unavailability 
and fluctuation in prices, the depression of the global economy, increase in 
mental health challenges, wellbeing and quality of life amongst others. This 
review article highlights the impacts of the COVID-19 pandemic lockdown across 
the globe. As the global lockdown is being lifted in a phased manner in various 
countries of the world, it is necessary to explore its impacts to understand its 
consequences comprehensively. This will guide future decisions that will be made 
in a possible future wave of the COVID-19 pandemic or other global disease 
outbreak.

DOI: 10.1177/00368504211019854
PMCID: PMC10454957
PMID: 34061685 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


3411. J Empir Res Hum Res Ethics. 2021 Jul;16(3):179-187. doi: 
10.1177/15562646211019659. Epub 2021 May 31.

COVID-19 Survey Participation and Wellbeing: A Survey Experiment.

Sollis K(1), Biddle N(1), Edwards B(1), Herz D(2).

Author information:
(1)Centre for Social Research and Methods, 2219Australian National University, 
Canberra, ACT, Australia.
(2)Social Research Centre, Melbourne, Vic, Australia.

Individuals throughout the world are being recruited into studies to examine the 
social impacts of coronavirus disease 2019 (COVID-19). While previous literature 
has illustrated how research participation can impact distress and wellbeing, to 
the authors' best knowledge no study has examined this in the COVID-19 context. 
Using an innovative approach, this study analyses the impacts of participation 
in a COVID-19 survey in Australia on subjective wellbeing through a survey 
experiment. At a population level, we find no evidence that participation 
impacts subjective wellbeing. However, this may not hold for those with mental 
health concerns and those living in financial insecurity. These findings provide 
the research community with a deeper understanding of the potential wellbeing 
impacts from COVID-19-related research participation.

DOI: 10.1177/15562646211019659
PMID: 34057369 [Indexed for MEDLINE]


3412. Front Public Health. 2021 May 13;9:628333. doi: 10.3389/fpubh.2021.628333. 
eCollection 2021.

Scalable modEls of Community rehAbilitation for Individuals Recovering From 
COVID:19 reLated illnEss: A Longitudinal Service Evaluation Protocol-"SeaCole 
Cohort Evaluation".

Kelly B(1)(2), Innes A(1)(2), Holl M(1), Mould L(1)(3), Powell S(1)(2), Burns 
D(2), Doherty P(4), Whyte G(5), King J(6), Deniszczyc D(1).

Author information:
(1)Quality and Assurance Directorate, Nuffield Health, Epsom, United Kingdom.
(2)Department for Health, Psychology & Community, Manchester Metropolitan 
University, Manchester, United Kingdom.
(3)School of Clinical & Applied Sciences, Leeds Beckett University, Leeds, 
United Kingdom.
(4)Department of Health Sciences, York University, York, United Kingdom.
(5)School of Sport & Exercise Sciences, Liverpool John Moores University, 
Liverpool, United Kingdom.
(6)National Centre for Sports and Exercise Medicine, Loughborough University, 
Loughborough, United Kingdom.

Introduction: High levels of physical, cognitive, and psychosocial impairments 
are anticipated for those recovering from the COVID-19. In the UK, ~50% of 
survivors will require additional rehabilitation. Despite this, there is 
currently no evidence-based guideline available in England and Wales that 
addresses the identification, timing and nature of effective interventions to 
manage the morbidity associated following COVID-19. It is now timely to 
accelerate the development and evaluation of a rehabilitation service to support 
patients and healthcare services. Nuffield Health have responded by configuring 
a scalable rehabilitation pathway addressing the immediate requirements for 
those recovering from COVID-19 in the community. Methods and Analysis: This 
long-term evaluation will examine the effectiveness of a 12-week community 
rehabilitation programme for COVID-19 patients who have been discharged 
following in-patient treatment. Consisting of two distinct 6-week phases; Phase 
1 is an entirely remote service, delivered via digital applications. Phase 2 
sees the same patients transition into a gym-based setting for supervised 
group-based rehabilitation. Trained rehabilitation specialists will coach 
patients across areas such as goal setting, exercise prescription, symptom 
management and emotional well-being. Outcomes will be collected at 0, 6, and 12 
weeks and at 6- and 12-months. Primary outcome measures will assess changes in 
health-related quality of life (HR-QOL) and COVID-19 symptoms using EuroQol Five 
Dimension Five Level Version (EQ-5D-5L) and Dyspnea-12, respectively. Secondary 
outcome measures of the Duke Activity Status Questionnaire (DASI), 30 s sit to 
stand test, General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 
(PHQ-9), Patient Experience Questionnaire (PEQ) and Quality Adjusted Life Years 
(QALY) will allow for the evaluation of outcomes, mediators and moderators of 
outcome, and cost-effectiveness of treatment. Discussion: This evaluation will 
investigate the immediate and long-term impact, as well as the cost 
effectiveness of a blended rehabilitation programme for COVID-19 survivors. This 
evaluation will provide a founding contribution to the literature, evaluating 
one of the first programmes of this type in the UK. The evaluation has 
international relevance, with the potential to show how a new model of service 
provision can support health services in the wake of COVID-19. Trial 
Registration: Current Trials ISRCTN ISRCTN14707226 Web: 
http://www.isrctn.com/ISRCTN14707226.

Copyright © 2021 Kelly, Innes, Holl, Mould, Powell, Burns, Doherty, Whyte, King 
and Deniszczyc.

DOI: 10.3389/fpubh.2021.628333
PMCID: PMC8155345
PMID: 34055711 [Indexed for MEDLINE]

Conflict of interest statement: JK reports no conflict of interest however is a 
voluntary member of Nuffield Health's External Research Advisory Board. BK, AI, 
MH, LM, and DD report personal fees from Nuffield Health outside of the 
submitted work. SP was a member of Nuffield Health's External Research Advisory 
Board and holds a Chair of Public Health position within Manchester Metropolitan 
University, funded by Nuffield Health. The development of this pathway has been 
funded by Nuffield Health (Registered Charity Numbers: 205533 in England and 
Wales and SC041793 in Scotland). The remaining authors declare that the research 
was conducted in the absence of any commercial or financial relationships that 
could be construed as a potential conflict of interest.


3413. Adv Neonatal Care. 2022 Jun 1;22(3):261-269. doi: 10.1097/ANC.0000000000000907. 
Epub 2021 May 27.

Barriers to Kangaroo Care in the NICU: A Qualitative Study Analyzing Parent 
Survey Responses.

Saltzmann AM(1), Sigurdson K, Scala M.

Author information:
(1)Department of Pediatrics, Stanford University School of Medicine, Palo Alto, 
California.

BACKGROUND: Despite its benefits, parents in the neonatal intensive care unit 
(NICU) face significant barriers to kangaroo care (KC). Clinician-reported 
barriers to KC include staff education, environment, and equipment among others; 
however, parent-perceived barriers are underexplored.
PURPOSE: To examine parental understanding of KC, parental perception of 
experiences with KC, and parental views on the key factors that help or hinder 
KC.
METHODS: This is an observational, mixed-methods study that used an 
author-developed survey to assess parental feelings, perceived importance, and 
barriers to KC. Likert scale responses were analyzed using descriptive 
statistics. Free-text responses were analyzed using thematic analysis. A 
comparison of results was made between parents receiving and not receiving 
infant mental health services.
RESULTS: Fifty (N = 50) parents completed surveys. Eighty percent of parents 
stated they wanted more information on KC. Common barriers to KC were reported 
by parents, such as issues with space/environment. The most frequently reported 
barrier when asked openly was fear of hurting their infant. Ninety-six percent 
of parents believed that KC helped their emotional well-being. Parents receiving 
mental health services reported more fear but results did not reach 
significance.
IMPLICATIONS FOR PRACTICE AND RESEARCH: The frequency with which factors are 
reported as important to parents may allow a prioritization of barriers to KC, 
which may help focus quality improvement initiatives. The results of this study 
underscore the vital role nurses play in supporting KC. Additional attention 
needs to be given to the mental health of NICU parents and its impact on care 
practices.

Copyright © 2021 by The National Association of Neonatal Nurses.

DOI: 10.1097/ANC.0000000000000907
PMID: 34054009 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


3414. Radiography (Lond). 2021 Nov;27(4):1118-1123. doi: 10.1016/j.radi.2021.05.001. 
Epub 2021 May 18.

Burnout among Portuguese radiographers during the COVID-19 pandemic.

Pereira JM(1), Silva C(2), Freitas D(3), Salgado A(4).

Author information:
(1)Radiology Department, School of Health, Polytechnic Institute of Porto, 
Portugal; Department of Diagnostic Imaging, Centro Hospitalar Universitário do 
Porto (CHUP), Porto, Portugal; Department of Clinical Research, Centro 
Hospitalar Universitário do Porto (CHUP), Porto, Portugal. Electronic address: 
jro.pereira@gmail.com.
(2)Department of Diagnostic Imaging, Hospital Lusíadas Porto, Porto, Portugal. 
Electronic address: cristianaalexandravieirasilva@gmail.com.
(3)Radiology Department, School of Health, Polytechnic Institute of Porto, 
Portugal; Department of Diagnostic Imaging, Centro Hospitalar Universitário do 
Porto (CHUP), Porto, Portugal. Electronic address: davidefreitas@gmail.com.
(4)School of Health, Polytechnic Institute of Porto, Portugal; Higher School of 
Education of Paula Frassinetti, Porto, Portugal. Electronic address: 
anasalgada@gmail.com.

INTRODUCTION: The COVID-19 pandemic has had a global impact, including in health 
services, placing health professionals under enormous tension, pressure, and 
stress. Professionals involved in the care, diagnosis, and treatment of 
COVID-19-infected patients have been subject to emotional and physical distress 
that can potentially enhance the development of occupational diseases. The aim 
of this study was to assess the impact of the COVID-19 pandemic on the incidence 
of burnout among Portuguese radiographers.
METHODS: This was a cross-sectional, quantitative study. Burnout levels were 
estimated using the Maslach Burnout Inventory-Human Services Survey, composed of 
22 questions. Specific questions were developed to characterize the 
socio-demographic situation and the impact of the pandemic on the radiographers. 
Data were descriptively analyzed and Mann-Whitney and Kruskal-Wallis tests were 
used for correlation analysis.
RESULTS: The study sample comprised 386 radiographers, 68.7% of whom where 
female and 31.3% male. The mean sample age was 36.3 (±9.1) years. A total of 
43.5% and 45.5% of subjects had a high level of emotional exhaustion and 
depersonalization, respectively, and 59.8% experienced low personal 
accomplishment. Altogether, 23.3% of study participants were at high risk of 
burnout in the three dimensions assessed and 77.2% in at least one.
CONCLUSION: Study results showed that radiographers were at high risk of 
developing burnout in the COVID-19 pandemic setting. Health institutions should 
actively monitor these professional's mental health and develop restorative 
strategies that enable their emotional wellbeing, preventing absenteeism and 
increasing patients' quality of care.
IMPLICATIONS FOR PRACTICE: Burnout of health professionals has a strong impact 
on health services organization, resulting in increased absenteeism and error 
probability, frequent work delays, low productivity and job satisfaction, inter- 
and intra-professional conflicts, high job turnover, high job quit, and 
decreased quality of care perceived by users.

Copyright © 2021 The College of Radiographers. Published by Elsevier Ltd. All 
rights reserved.

DOI: 10.1016/j.radi.2021.05.001
PMCID: PMC8130549
PMID: 34053854 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest None.


3415. Diabet Med. 2021 Sep;38(9):e14611. doi: 10.1111/dme.14611. Epub 2021 Jun 18.

Impact of the COVID-19 pandemic and lockdown restrictions on psychosocial and 
behavioural outcomes among Australian adults with type 2 diabetes: Findings from 
the PREDICT cohort study.

Sacre JW(1), Holmes-Truscott E(2)(3), Salim A(1)(4)(5), Anstey KJ(6)(7), 
Drummond GR(1)(8), Huxley RR(9), Magliano DJ(1)(10), van Wijngaarden P(11)(12), 
Zimmet PZ(13), Speight J(2)(3), Shaw JE(1)(14).

Author information:
(1)Baker Heart and Diabetes Institute, Melbourne, Vic., Australia.
(2)School of Psychology, Deakin University, Geelong, Vic., Australia.
(3)The Australian Centre for Behavioural Research in Diabetes, Melbourne, Vic., 
Australia.
(4)Department of Mathematics and Statistics, La Trobe University, Melbourne, 
Vic., Australia.
(5)Centre for Epidemiology and Biostatistics, Melbourne School of Population and 
Global Health, The University of Melbourne, Melbourne, Vic., Australia.
(6)UNSW Ageing Futures Institute, University of New South Wales, Sydney, NSW, 
Australia.
(7)Neuroscience Research Australia, Sydney, NSW, Australia.
(8)Centre for Cardiovascular Biology and Disease Research, Department of 
Physiology, Anatomy and Microbiology, School of Life Sciences, La Trobe 
University, Melbourne, Vic., Australia.
(9)Faculty of Health, Deakin University, Melbourne, Vic., Australia.
(10)School of Public Health and Preventive Medicine, Monash University, 
Melbourne, Vic., Australia.
(11)Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, 
Melbourne, Vic., Australia.
(12)Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, 
Vic., Australia.
(13)Department of Diabetes, Central Clinical School, Monash University, 
Melbourne, Vic., Australia.
(14)School of Life Sciences, La Trobe University, Melbourne, Vic., Australia.

AIM: To examine psychosocial and behavioural impacts of the novel coronavirus 
disease 2019 (COVID-19) pandemic and lockdown restrictions among adults with 
type 2 diabetes.
METHODS: Participants enrolled in the PRogrEssion of DIabetic ComplicaTions 
(PREDICT) cohort study in Melbourne, Australia (n = 489 with a baseline 
assessment pre-2020) were invited to complete a phone/online follow-up 
assessment in mid-2020 (i.e., amidst COVID-19 lockdown restrictions). Repeated 
assessments that were compared with pre-COVID-19 baseline levels included 
anxiety symptoms (7-item Generalised Anxiety Disorder scale [GAD-7]), depressive 
symptoms (8-item Patient Health Questionnaire [PHQ-8]), diabetes distress 
(Problem Areas in Diabetes scale [PAID]), physical activity/sedentary behaviour, 
alcohol consumption and diabetes self-management behaviours. Additional once-off 
measures at follow-up included COVID-19-specific worry, quality of life (QoL), 
and healthcare appointment changes (telehealth engagement and appointment 
cancellations/avoidance).
RESULTS: Among 470 respondents (96%; aged 66 ± 9 years, 69% men), at least 
'moderate' worry about COVID-19 infection was reported by 31%, and 29%-73% 
reported negative impacts on QoL dimensions (greatest for: leisure activities, 
feelings about the future, emotional well-being). Younger participants reported 
more negative impacts (p < 0.05). Overall, anxiety/depressive symptoms were 
similar at follow-up compared with pre-COVID-19, but diabetes distress reduced 
(p < 0.001). Worse trajectories of anxiety/depressive symptoms were observed 
among those who reported COVID-19-specific worry or negative QoL impacts 
(p < 0.05). Physical activity trended lower (~10%), but sitting time, alcohol 
consumption and glucose-monitoring frequency remained unchanged. 73% of 
participants used telehealth, but 43% cancelled a healthcare appointment and 39% 
avoided new appointments despite perceived need.
CONCLUSIONS: COVID-19 lockdown restrictions negatively impacted QoL, some 
behavioural risk factors and healthcare utilisation in adults with type 2 
diabetes. However, generalised anxiety and depressive symptoms remained 
relatively stable.

© 2021 Diabetes UK.

DOI: 10.1111/dme.14611
PMCID: PMC8237067
PMID: 34053106 [Indexed for MEDLINE]

Conflict of interest statement: None declared.


3416. BMC Health Serv Res. 2021 May 29;21(1):525. doi: 10.1186/s12913-021-06555-5.

Holding the frontline: a cross-sectional survey of emergency department staff 
well-being and psychological distress in the course of the COVID-19 outbreak.

Hesselink G(1)(2), Straten L(3), Gallée L(3), Brants A(4), Holkenborg J(5), 
Barten DG(6), Schoon Y(3)(7).

Author information:
(1)Department of Emergency Medicine, Radboud Institute for Health Sciences, 
Radboud University Medical Center, Nijmegen, The Netherlands. 
gijs.hesselink@radboudumc.nl.
(2)IQ healthcare, Radboud Institute for Health Sciences, Radboud University 
Medical Center, P.O. Box 9101, 114 IQ healthcare, 6500 HB, Nijmegen, The 
Netherlands. gijs.hesselink@radboudumc.nl.
(3)Department of Emergency Medicine, Radboud Institute for Health Sciences, 
Radboud University Medical Center, Nijmegen, The Netherlands.
(4)Department of Emergency Medicine, Canisius-Wilhelmina Hospital, Nijmegen, The 
Netherlands.
(5)Department of Emergency Medicine, Rijnstate Hospital, Arnhem, The 
Netherlands.
(6)Department of Emergency Medicine, VieCuri Medical Center, Venlo, The 
Netherlands.
(7)Department of Geriatrics, Radboud Institute for Health Sciences, Radboud 
University Medical Center, Nijmegen, The Netherlands.

BACKGROUND: The coronavirus disease 2019 (COVID-19) outbreak has been associated 
with stress and challenges for healthcare professionals, especially for those 
working in the front-line of treating COVID-19 patients. This study aimed to: 1) 
assess changes in well-being and perceived stress symptoms of Dutch emergency 
department (ED) staff in the course of the first COVID-19 wave, and 2) assess 
and explore stressors experienced by ED staff since the COVID-19 outbreak.
METHODS: We conducted a cross-sectional study. An online questionnaire was 
administered during June-July 2020 to physicians, nurses and non-clinical staff 
of four EDs in the Netherlands. Well-being and stress symptoms (i.e., cognitive, 
emotional and physical) were scored for the periods pre, during and after the 
first COVID-19 wave using the World Health Organization Well-Being Index (WHO-5) 
and a 10-point Likert scale. Stressors were assessed and explored by rating 
experiences with specific situations (i.e., frequency and intensity of distress) 
and in free-text narratives. Quantitative data were analyzed with descriptive 
statistics and generalized estimating equations (GEE). Narratives were analyzed 
thematically.
RESULTS: In total, 192 questionnaires were returned (39% response). Compared to 
pre-COVID-19, the mean WHO-5 index score (range: 0-100) decreased significantly 
with 14.1 points (p < 0.001) during the peak of the first wave and 3.7 points 
(< 0.001) after the first wave. Mean self-perceived stress symptom levels almost 
doubled during the peak of the first wave (≤0.005). Half of the respondents 
reported experiencing more moral distress in the ED since the COVID-19 outbreak. 
High levels of distress were primarily found in situations where the staff was 
unable to provide or facilitate necessary emotional support to a patient or 
family. Analysis of 51 free-texts revealed witnessing suffering, high work 
pressure, fear of contamination, inability to provide comfort and support, 
rapidly changing protocols regarding COVID-19 care and personal protection, and 
shortage of protection equipment as important stressors.
CONCLUSIONS: The first COVID-19 wave took its toll on ED staff. Actions to limit 
drop-out and illness among staff resulting from psychological distress are vital 
to secure acute care for (non-)COVID-19 patients during future infection waves.

DOI: 10.1186/s12913-021-06555-5
PMCID: PMC8164246
PMID: 34051760 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3417. J Relig Health. 2021 Aug;60(4):2196-2208. doi: 10.1007/s10943-021-01296-5. Epub 
2021 May 29.

The Link Between COVID-19, Anxiety, and Religious Beliefs in the United States 
and the United Kingdom.

Rigoli F(1).

Author information:
(1)Department of Psychology, City, University of London, Northampton Square, 
London, EC1V 0HB, UK. francesco.rigoli@city.ac.uk.

Research has shown that stress impacts on people's religious beliefs. However, 
several aspects of this effect remain poorly understood, for example regarding 
the role of prior religiosity and stress-induced anxiety. This paper explores 
these aspects in the context of the recent coronavirus pandemic (COVID-19). The 
latter has impacted dramatically on many people's well-being; hence it can be 
considered a highly stressful event. Through online questionnaires administered 
to UK (n = 140) and USA (n = 140) citizens professing either Christian faith or 
no religion, this paper examines the impact of the coronavirus crisis upon 
common people's religious beliefs. Anxiety about the coronavirus and prior 
religiosity showed an interaction effect upon change in religious beliefs 
(t(276) = 2.27, p = .024): for strong believers higher anxiety about coronavirus 
was associated with increased strengthening of religious beliefs (r = .249), 
while for non-believers higher anxiety about coronavirus was associated with 
increased scepticism towards religious beliefs (r = - .157). These observations 
are consistent with the notion that stress-induced anxiety enhances support for 
an individual's existing ideology already embraced before a stressful event 
occurs. This study sheds light on the psychological and cultural implications of 
the coronavirus crisis, which represents one of the most serious health 
emergencies in recent times.

© 2021. The Author(s).

DOI: 10.1007/s10943-021-01296-5
PMCID: PMC8164065
PMID: 34050906 [Indexed for MEDLINE]

Conflict of interest statement: The author has no conflicts of interest to 
declare that are relevant to the content of this article.


3418. Pain. 2021 Jul 1;162(7):2132-2144. doi: 10.1097/j.pain.0000000000002290.

Longitudinal study of early adaptation to the coronavirus disease pandemic among 
youth with chronic pain and their parents: effects of direct exposures and 
economic stress.

Law EF(1)(2), Zhou C(1)(3), Seung F(1), Perry F(1), Palermo TM(1)(2).

Author information:
(1)Center for Child Health, Behavior and Development, Seattle Children's 
Research Institute Seattle, WA, United States.
(2)Department of Anesthesiology and Pain Medicine, University of Washington 
School of Medicine Seattle, WA, United States.
(3)Department of Pediatrics, University of Washington School of Medicine, 
Seattle, WA, United States.

The novel coronavirus disease (COVID-19) has caused prolonged disruptions in 
daily life for many communities. Little is known about the impact of the 
COVID-19 pandemic on the health and well-being of youth with chronic pain and 
their families. We conducted a longitudinal, mixed-methods study to characterize 
early adaptation to the COVID-19 pandemic among 250 families of youth (ages 
12-21 years) diagnosed with chronic headache (64%) or other chronic pain 
conditions (36%) and to determine whether direct exposures to COVID-19 and 
secondary economic stress modified symptom trajectories. Youth and parents 
reported on pain interference, anxiety, depression, and insomnia symptoms at 4 
waves of data collection from April 2020 to July 2020. We also collected 
qualitative data on the impact of the pandemic on the youth's pain problem. 
Nearly half of our sample (49.6%) experienced direct exposures to COVID-19. 
Secondary economic stress was also common, affecting 44.4% of families. Symptom 
trajectories for pain, insomnia, depression, and anxiety remained stable or 
improved for most participants, indicating adaptive adjustment. However, overall 
symptom burden was high with persistent and clinically elevated depression, 
anxiety, and insomnia symptoms common among youth and parents. Direct exposures 
to COVID-19 did not modify symptom trajectories. However, youth pain 
interference and parent insomnia worsened in families who experienced secondary 
economic stress. Qualitative data revealed perceived benefits and harms from 
school closures on the youth's pain problem. Our findings of high symptom burden 
suggest that pediatric pain clinicians should offer distance assessment and 
treatment (eg, through telemedicine) to avoid pandemic-related disruptions in 
pain care.

Copyright © 2021 International Association for the Study of Pain.

DOI: 10.1097/j.pain.0000000000002290
PMCID: PMC8205975
PMID: 34050112 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest Statement. We have no 
conflicts of interest to report.


3419. Res Dev Disabil. 2021 Jul;114:103985. doi: 10.1016/j.ridd.2021.103985. Epub 2021 
May 3.

The impact of the COVID-19 pandemic on the health, wellbeing, and access to 
services of people with intellectual and developmental disabilities.

Rosencrans M(1), Arango P(2), Sabat C(3), Buck A(4), Brown C(5), Tenorio M(6), 
Witwer A(7).

Author information:
(1)Ohio State University, 1581 Dodd Drive, #357, Nisonger Center, Ohio State 
University, Columbus, OH 43210, United States. Electronic address: 
Margaret.Rosencrans@osumc.edu.
(2)Universidad de los Andes, Monseñor Álvaro del Portillo 12.455, Las Condes, 
Santiago, Chile; Millenium Institute for Caregiving Research (MICARE), Chile. 
Electronic address: parango@uandes.cl.
(3)Universidad de los Andes, Monseñor Álvaro del Portillo 12.455, Las Condes, 
Santiago, Chile; Millenium Institute for Caregiving Research (MICARE), Chile. 
Electronic address: csabat@miuandes.cl.
(4)Ohio State University, 1581 Dodd Drive, #357, Nisonger Center, Ohio State 
University, Columbus, OH 43210, United States. Electronic address: 
Andrew.buck@osumc.edu.
(5)Ohio State University, 1581 Dodd Drive, #357, Nisonger Center, Ohio State 
University, Columbus, OH 43210, United States. Electronic address: 
Christine.brown@osumc.edu.
(6)Universidad de los Andes, Monseñor Álvaro del Portillo 12.455, Las Condes, 
Santiago, Chile; Millenium Institute for Caregiving Research (MICARE), Chile. 
Electronic address: mtenorio@uandes.cl.
(7)Ohio State University, 1581 Dodd Drive, #357, Nisonger Center, Ohio State 
University, Columbus, OH 43210, United States. Electronic address: 
andrea.witwer@osumc.edu.

BACKGROUND: Individuals with intellectual and developmental disabilities (IDD) 
may be especially vulnerable to changes associated with the COVID-19 pandemic 
given an increased likelihood of health concerns, low socioeconomic status, and 
difficulty accessing services.
AIMS: The purpose of this study was to explore mental health problems and 
services in individuals with IDD during the pandemic. We explored whether number 
of mental health problems differed by disability, age, gender, living situation, 
physical health, and access to services.
METHODS AND PROCEDURES: An online survey about experiences during the pandemic 
was administered to adults with IDD and their caregivers in the United States 
and in Chile.
OUTCOMES AND RESULTS: In both Chile and the United States, few people endorsed 
increased health problems. Half of the sample in Chile and 41 % of the sample in 
the United States endorsed increased mental health problems. Approximately 15 % 
of the sample in the US reported no longer receiving state developmental 
disability services.
CONCLUSIONS AND IMPLICATIONS: Healthcare and disability-specific agencies should 
consider strategies to tailor supports to improve mental health functioning and 
access to community.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.ridd.2021.103985
PMCID: PMC9758885
PMID: 34049229 [Indexed for MEDLINE]


3420. PLoS One. 2021 May 28;16(5):e0251670. doi: 10.1371/journal.pone.0251670. 
eCollection 2021.

Depression, anxiety, stress and their associated factors among Ethiopian 
University students during an early stage of COVID-19 pandemic: An online-based 
cross-sectional survey.

Simegn W(1), Dagnew B(2), Yeshaw Y(2)(3), Yitayih S(4), Woldegerima B(1), Dagne 
H(5).

Author information:
(1)Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College 
of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
(2)Department of Human Physiology, School of Medicine, College of Medicine and 
Health Sciences, University of Gondar, Gondar, Ethiopia.
(3)Department of Epidemiology and Biostatistics, Institute of Public Health, 
College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
(4)Department of Psychiatry, School of Medicine, College of Medicine and Health 
Sciences, University of Gondar, Gondar, Ethiopia.
(5)Department of Environmental and Occupational Health and Safety, Institute of 
Public Health, College of Medicine and Health Sciences, University of Gondar, 
Gondar, Ethiopia.

BACKGROUND: The occurrence of the Coronavirus Disease 2019 (COVID-19) affects 
the mental health situation of almost everyone, including University students 
who spent most of their time at home due to the closure of the Universities. 
Therefore, this study aimed at assessing depression, anxiety, stress and 
identifying their associated factors among university students in Ethiopia 
during the early stage of the COVID-19 pandemic.
METHODS: We invited students to complete an online survey using Google forms 
comprising consent, socio-demographic characteristics, and the standard 
validated depression, anxiety, and stress scale (DASS-21) questionnaire. After 
completion of the survey from June 30 to July 30, 2020, we exported the data 
into SPSS 22. Both descriptive and analytical statistics were computed. 
Associated factors were identified using binary logistic regression and 
variables with a p-value <0.05 were declared as statistically significant 
factors with the outcome variables.
RESULTS: A total of 423 students completed the online survey. The prevalence of 
depression, anxiety, and stress in this study was 46.3%, 52%, and 28.6%, 
respectively. In the multivariable model, female sex, poor self-efficacy to 
prevent COVID-19, those who do not read any material about COVID-19 prevention, 
lack of access to reading materials about their profession, and lack of access 
to uninterrupted internet access were significantly associated with depression. 
Female sex, lower ages, students with non-health-related departments, those who 
do not think that COVID-19 is preventable, and those who do not read any 
materials about COVID-19 prevention were significantly associated with anxiety. 
Whereas, being female, students attending 1st and 2nd years, those who do not 
think that COVID-19 is preventable, presence of confirmed COVID-19 patient at 
the town they are living in, and lack of access to reading materials about their 
profession were significantly associated with stress.
CONCLUSIONS: Depression, anxiety, and stress level among University students 
calls for addressing these problems by controlling the modifiable factors 
identified and promoting psychological wellbeing of students.

DOI: 10.1371/journal.pone.0251670
PMCID: PMC8162693
PMID: 34048434 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


3421. J Med Internet Res. 2021 Jun 15;23(6):e29036. doi: 10.2196/29036.

Professional Social Media Usage and Work Engagement Among Professionals in 
Finland Before and During the COVID-19 Pandemic: Four-Wave Follow-Up Study.

Oksa R(#)(1), Kaakinen M(#)(2), Savela N(#)(1), Hakanen JJ(#)(3), Oksanen 
A(#)(1).

Author information:
(1)Faculty of Social Sciences, Tampere University, Tampere, Finland.
(2)Institute of Criminology and Legal Policy, Faculty of Social Sciences, 
University of Helsinki, Helsinki, Finland.
(3)Work Ability and Working Careers, Finnish Institute of Occupational Health, 
Helsinki, Finland.
(#)Contributed equally

BACKGROUND: The COVID-19 pandemic has changed work life profoundly and concerns 
regarding the mental well-being of employees' have arisen. Organizations have 
made rapid digital advancements and have started to use new collaborative tools 
such as social media platforms overnight.
OBJECTIVE: Our study aimed to investigate how professional social media 
communication has affected work engagement before and during the COVID-19 
pandemic and the role of perceived social support, task resources, and 
psychological distress as predictors and moderators of work engagement.
METHODS: Nationally representative longitudinal survey data were collected in 
2019-2020, and 965 respondents participated in all 4 surveys. Measures included 
work engagement, perceived social support and task resources, and psychological 
distress. The data were analyzed using a hybrid linear regression model.
RESULTS: Work engagement remained stable and only decreased in autumn 2020. 
Within-person changes in social media communication at work, social support, 
task resources, and psychological distress were all associated with work 
engagement. The negative association between psychological distress and work 
engagement was stronger in autumn 2020 than before the COVID-19 outbreak.
CONCLUSIONS: The COVID-19 pandemic has exerted pressure on mental health at 
work. Fostering social support and task resources at work is important in 
maintaining work engagement. Social media communication could help maintain a 
supportive work environment.

©Reetta Oksa, Markus Kaakinen, Nina Savela, Jari J Hakanen, Atte Oksanen. 
Originally published in the Journal of Medical Internet Research 
(https://www.jmir.org), 15.06.2021.

DOI: 10.2196/29036
PMCID: PMC8208471
PMID: 34048356 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


3422. Psychol Rep. 2022 Oct;125(5):2709-2732. doi: 10.1177/00332941211016754. Epub 
2021 May 28.

Validation of the Fear of COVID-19 Scale in a Sample of Pakistan's University 
Students and Future Directions.

Green ZA(1), Noor U(2), Ahmed F(3), Himayat L(3).

Author information:
(1)Faculty of Business Administration, Preston University, Islamabad, Pakistan; 
Contemporary Research Initiative, Preston University, Islamabad, Pakistan.
(2)Contemporary Research Initiative, Preston University, Islamabad, Pakistan; 
Faculty of Social Sciences, Preston University, Islamabad, Pakistan.
(3)Contemporary Research Initiative, Preston University, Islamabad, Pakistan.

This study determined the psychometric validation of the English version of the 
Fear of COVID-19 Scale (FCV-19S). Findings demonstrated robust psychometric 
properties for the FCV-19S. CFA results showed that the FCV-19S was a good model 
fit to the data in a sample of 608 university students. The FCV-19S also showed 
good concurrent validity, as it was significantly and positively related to the 
Preventive Behaviors related to COVID-19 Scale and the Generalized Anxiety 
Disorder Scale as well as significantly and negatively related to the 
Warwick-Edinburgh Mental Well-being Scale. The scale also showed good internal 
consistency reliability. Further, the association of age with FCV-19S indicated 
that younger students experienced greater fear of COVID-19. The analyses of mean 
differences revealed that women as compared to men, bachelor's and master's 
students as compared to post-master's students, and unemployed students as 
compared to employed students experienced greater fear of the outbreak. Also, 
those suffering from severe anxiety experienced greater fear of COVID-19 
followed by those suffering from moderate, mild, and minimal anxiety. Moreover, 
knowing someone suffering from the coronavirus, being afraid that someone close 
might contract the virus, and believing that the current COVID-19 situation 
adversely affects academic performance were linked to higher levels of fear of 
the pandemic. Practice implications, limitations, and avenues for future 
research are also discussed.

DOI: 10.1177/00332941211016754
PMID: 34047221 [Indexed for MEDLINE]


3423. Int J Geriatr Psychiatry. 2021 Nov;36(11):1597-1639. doi: 10.1002/gps.5567. Epub 
2021 May 27.

Dementia wellbeing and COVID-19: Review and expert consensus on current research 
and knowledge gaps.

Liu KY(1), Howard R(1), Banerjee S(2), Comas-Herrera A(3), Goddard J(4), Knapp 
M(3), Livingston G(1), Manthorpe J(5), O'Brien JT(6), Paterson RW(7), Robinson 
L(8), Rossor M(7), Rowe JB(9)(10), Sharp DJ(11)(12), Sommerlad A(1), 
Suárez-González A(7), Burns A(13).

Author information:
(1)Division of Psychiatry, University College London, London, UK.
(2)Faculty of Health, University of Plymouth, Plymouth, UK.
(3)Department of Health Policy, London School of Economics and Political 
Science, Care Policy and Evaluation Centre, London, UK.
(4)Economic and Social Research Council, UK Research and Innovation, Swindon, 
UK.
(5)NIHR Policy Research Unit in Health and Social Care Workforce, King's College 
London, London, UK.
(6)Department of Psychiatry, University of Cambridge School of Clinical 
Medicine, Cambridge, UK.
(7)Dementia Research Centre, Queen Square UCL Institute of Neurology, University 
College London, London, UK.
(8)Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle 
University, Newcastle, UK.
(9)Medical Research Council Cognition and Brain Sciences Unit, University of 
Cambridge, Cambridge, UK.
(10)Department of Clinical Neurosciences, University of Cambridge, Cambridge, 
UK.
(11)Department of Brain Sciences, Imperial College London, London, UK.
(12)UK Dementia Research Institute, Care Research and Technology Centre, 
Imperial College London, London, UK.
(13)Division of Neuroscience and Experimental Psychology, The University of 
Manchester, Manchester, UK.

OBJECTIVES: In response to a commissioned research update on dementia during the 
COVID-19 pandemic, a UK-based working group, comprising dementia researchers 
from a range of fields and disciplines, aimed to describe the impact of the 
pandemic on dementia wellbeing and identify priorities for future research.
METHODS: We supplemented a rapid literature search (including unpublished, 
non-peer reviewed and ongoing studies/reports) on dementia wellbeing in the 
context of COVID-19 with expert group members' consensus about future research 
needs. From this we generated potential research questions the group judged to 
be relevant that were not covered by the existing literature.
RESULTS: Themes emerged from 141 studies within the six domains of the NHS 
England COVID-19 Dementia Wellbeing Pathway: Preventing Well, Diagnosing Well, 
Treating Well, Supporting Well, Living Well and Dying Well. We describe current 
research findings and knowledge gaps relating to the impact on people affected 
by dementia (individuals with a diagnosis, their carers and social contacts, 
health and social care practitioners and volunteers), services, research 
activities and organisations. Broad themes included the potential benefits and 
risks of new models of working including remote healthcare, the need for 
population-representative longitudinal studies to monitor longer-term impacts, 
and the importance of reporting dementia-related findings within broader health 
and care studies.
CONCLUSIONS: The COVID-19 pandemic has had a disproportionately negative impact 
on people affected by dementia. Researchers and funding organisations have 
responded rapidly to try to understand the impacts. Future research should 
highlight and resolve outstanding questions to develop evidence-based measures 
to improve the quality of life of people affected by dementia.

© 2021 The Authors. International Journal of Geriatric Psychiatry published by 
John Wiley & Sons Ltd.

DOI: 10.1002/gps.5567
PMCID: PMC8237017
PMID: 34043836 [Indexed for MEDLINE]

Conflict of interest statement: None.


3424. PLoS One. 2021 May 27;16(5):e0252481. doi: 10.1371/journal.pone.0252481. 
eCollection 2021.

Depression, anxiety, and the COVID-19 pandemic: Severity of symptoms and 
associated factors among university students after the end of the movement 
lockdown.

Woon LS(1), Leong Bin Abdullah MFI(2), Sidi H(1), Mansor NS(2), Nik Jaafar 
NR(1).

Author information:
(1)Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, 
Cheras, Kuala Lumpur, Malaysia.
(2)Lifestyle Science Cluster, Advanced Medical and Dental Institute, Universiti 
Sains Malaysia, Kepala Batas, Pulau Pinang, Malaysia.

BACKGROUND AND AIMS: This online cross-sectional study investigated the severity 
of depressive, anxiety, and stress symptoms among university students and 
determined the association between various factors and the levels of depressive 
and anxiety symptoms in response to the coronavirus disease 2019 (COVID-19) 
pandemic after the movement control order (MCO) was lifted.
METHODS: A total of 316 participants were administered a self-report 
questionnaire that collected data on sociodemographic attributes, personal 
characteristics, COVID-19-related stressors, religious coping, and clinical 
characteristics. In addition, the Multidimensional Scale of Perceived Social 
Support (MSPSS) and the 21-item Depression, Anxiety and Stress Scale (DASS-21) 
were administered.
RESULTS: Regarding depression, 15.5%, 11.7%, and 9.2% of the participants 
reported mild, moderate, and severe to extremely severe depression, 
respectively. For anxiety, 7.0%, 16.5%, and 13.2% of the respondents had mild, 
moderate, and severe to extremely severe anxiety, respectively. Moreover, 26.3% 
of participants had mild stress, 9.5% had moderate stress, and 6.6% had severe 
to extremely severe stress. The multiple linear regression model revealed that 
frustration because of loss of daily routine and study disruption and having 
preexisting medical, depressive, and anxiety disorders were associated with 
elevated depressive symptoms, while a greater degree of family and friends 
social support was associated with less depressive symptoms after adjusting for 
age, gender, and marital status. It was also found that frustration because of 
study disruption and having preexisting medical, depressive, and anxiety 
disorders were associated with elevated anxiety symptoms, while being enrolled 
in medicine-based courses and having a greater degree of family support were 
factors associated with less anxiety symptoms after adjusting for age, gender, 
and marital status.
CONCLUSION: There is a need to conduct a longitudinal study in the future to 
confirm the causal relationship between the significant predictive factors and 
depression and anxiety identified in this study, and maintenance of a persistent 
flow of academic activities and social interaction may be of utmost importance 
to safeguard the mental wellbeing of university students.

DOI: 10.1371/journal.pone.0252481
PMCID: PMC8158968
PMID: 34043731 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


3425. Psychol Trauma. 2022 Feb;14(2):250-257. doi: 10.1037/tra0001026. Epub 2021 May 
27.

Moral injury in Chinese health professionals during the COVID-19 pandemic.

Wang Z(1), Koenig HG(1), Tong Y(2), Wen J(1), Sui M(3), Liu H(3), Zaben FA(4), 
Liu G(5).

Author information:
(1)Department of Epidemiology and Health Statistics.
(2)Department of Infectious Disease Control.
(3)Department of Health Management.
(4)Department of Medicine.
(5)Department of Infectious Disease.

Objective: Caring for patients during the COVID-19 pandemic has placed 
considerable stress on health care professionals (HCPs), increasing their risk 
of moral injury (MI) and clinician burnout. The present study sought to examine 
the prevalence and correlates of MI among physicians and nurses in mainland 
China during the pandemic. Method: A cross-sectional study was performed via an 
online survey conducted from March 27, 2020 to April 26, 2020. The 10-item Moral 
Injury Symptoms Scale-Health Professional version (MISS-HP) was administered 
along with measures of clinician mental health and burnout. A total of 3,006 
physicians and nurses who completed the questionnaire were included in the final 
analysis. Unconditional logistic regression modeling was performed to determine 
the associations, including that between COVID-19 patient exposure and the risk 
of moral injury. Results: MISS-HP scores strongly and positively correlated with 
depression, anxiety, low well-being, and burnout symptoms. The estimated 
prevalence of MI in the total sample was 41.3%, 95% confidence interval (CI) 
[39.3%, 43.0%]. HCPs providing medical care to COVID-19 patients experienced a 
28% greater risk of MI than those providing medical care to patients without the 
coronavirus (odds ratio = 1.28, 95% CI [1.05, 1.56], p = .01). Conclusions: A 
significant proportion of HCPs in mainland China are at risk for significant MI 
symptoms as well as mental health problems and burnout during the COVID-19 
pandemic. MI symptoms are strongly correlated with higher clinician burnout, 
greater psychological distress, and lower level of subjective well-being. 
Effective strategies are needed to address MI and other mental health problems 
in frontline health care workers treating those with and without COVID-19 
disease. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

DOI: 10.1037/tra0001026
PMID: 34043381 [Indexed for MEDLINE]


3426. Stud Health Technol Inform. 2021 May 27;281:694-698. doi: 10.3233/SHTI210261.

Health and Social Care During Coronavirus Outbreak: The Exploitation of Long 
Lasting Memories - LLM Care.

Romanopoulou E(1), Zilidou V(1), Gylou S(1), Dratsiou I(1), Katsouli A(1), 
Karagianni M(1), Petronikolou V(1), Varella A(1), Bamidis P(1).

Author information:
(1)Lab of Medical Physics, School of Medicine, Aristotle University of 
Thessaloniki, Greece.

The Covid-19 pandemic has globally introduced a new crisis with severe 
consequences and led to a series of pandemic-related containment measures, 
including social distancing and self-isolation may cause significant impact on 
mental health. This study describes a social care initiative that was actualized 
during the Covid-19 outbreak with regard to the potential benefits in older 
adults' quality of life through the use of the Integrated Healthcare System Long 
Lasting Memories Care (LLM Care), and specifically the web-based cognitive 
training software. Online questionnaires, assessing various psychosocial and 
mental health domains, were distributed to 28 older adults before and after the 
interaction with the software aiming at evaluating the potential positive effect 
and usability of cognitive training software. Overall, the study demonstrates 
that the interaction with the web-based cognitive training software during the 
pandemic plays a significant role in maintaining mental health among older 
people, through improvements in well-being.

DOI: 10.3233/SHTI210261
PMID: 34042665 [Indexed for MEDLINE]


3427. BMC Public Health. 2021 May 26;21(1):984. doi: 10.1186/s12889-021-11020-3.

Risk of stress/depression and functional impairment in Denmark immediately 
following a COVID-19 shutdown.

Andersen LH(1), Fallesen P(2)(3), Bruckner TA(4).

Author information:
(1)ROCKWOOL Foundation, Ny Kongensgade 6, 1472, Copenhagen C, Denmark. 
lha@rff.dk.
(2)ROCKWOOL Foundation, Ny Kongensgade 6, 1472, Copenhagen C, Denmark.
(3)Swedish Institute for Social Research, Stockholm University, 106 91, 
Stockholm, Sweden.
(4)Program in Public Health and the Center for Population, Inequality and 
Policy, University of California, Irvine, CA, 92697-3957, USA.

Erratum in
    BMC Public Health. 2021 Jun 16;21(1):1155.

BACKGROUND: Existing estimates of the impact of the COVID-19 burden on mental 
wellbeing come from countries with high mortality rates. This study therefore 
aimed to investigate the impact of the first COVID-19 lockdown (March-April 
2020) on risk for stress/depression and functional impairment in a 
representative sample of adult individuals in Denmark, which had lower infection 
rates, and whether the impact of lockdown was heterogeneous across living 
situation.
METHODS: Using a representative, randomly drawn sample from the complete Danish 
adult population interviewed in March 2 to April 13, 2020 (n = 2836) and again 
in July 2020 (n = 1526, 54% retention rate), we study how the imposed lockdown 
announced March 11 following the onset of the first Danish wave of COVID-19 
infections affected mental wellbeing. We use the World Health Organization Five 
Well-being Index (WHO-5) and the Work and Social Adjustment Scale (WSAS) to 
capture risk for stress/depression (WHO-5 < 50) and functional impairment (WSAS 
> 10). Using covariate adjusted ordinary least squares linear probability models 
and exploiting variation in the timing of responses occurring just before and 
just after the introduction of lockdown, we compare respondents before lockdown 
to respondents that answered during lockdown, as well as to answers in 
re-interviews in July.
RESULTS: In our fully controlled models, we find reduced depressive symptoms 
among adults immediately after the shutdown, concentrated in adults with 
children living at home (-.089, p < .01 (from pre lockdown baseline .273)). 
Measures of functional impairment also declined immediately after the March 
shutdown among adults with children living at home (-.066, p < .05 (from pre 
lockdown baseline .150)). Impairment intensified for the entire sample between 
March and July (+.199, p < .001 (from pre lockdown baseline .248)), but 
depressive symptoms remained at lower rate in July (-.033, p < .05 (from pre 
lockdown baseline .332).
CONCLUSIONS: Findings in Denmark indicate that living with children at home may 
have, in the short term, buffered the potential mental health sequelae of the 
COVID-19 shutdown.

DOI: 10.1186/s12889-021-11020-3
PMCID: PMC8149922
PMID: 34039323 [Indexed for MEDLINE]

Conflict of interest statement: Non declared.


3428. BMC Public Health. 2021 May 26;21(1):985. doi: 10.1186/s12889-021-10998-0.

Prevalence and changes in boredom, anxiety and well-being among Ghanaians during 
the COVID-19 pandemic: a population-based study.

Boateng GO(#)(1), Doku DT(#)(2)(3), Enyan NIE(4), Owusu SA(5), Aboh IK(4), Kodom 
RV(6), Ekumah B(7), Quansah R(8), Boamah SA(9), Obiri-Yeboah D(5)(10), Nsabimana 
E(11), Jansen S(11), Armah FA(5)(7).

Author information:
(1)Department of Kinesiology, College of Nursing and Health Innovations, The 
University of Texas at Arlington, Arlington, TX, USA.
(2)Department of Population and Health, College of Humanities and Legal Studies, 
University of Cape Coast, Cape Coast, Ghana. ddoku@ucc.edu.gh.
(3)Directorate of Research, Innovation and Consultancy, University of Cape 
Coast, Cape Coast, Ghana. ddoku@ucc.edu.gh.
(4)School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana.
(5)Directorate of Research, Innovation and Consultancy, University of Cape 
Coast, Cape Coast, Ghana.
(6)Department of Distance Education, University of Ghana, Accra, Ghana.
(7)Department of Environmental Science, University of Cape Coast, Cape Coast, 
Ghana.
(8)Department of Biological and Environmental Health Sciences, School of Public 
Health, University of Ghana, Accra, Ghana.
(9)School of Nursing, McMaster University, Hamilton, Canada.
(10)Department of Microbiology and Immunology, School of Medical Sciences, 
University of Cape Coast, Cape Coast, Ghana.
(11)Mental Health & Behavior Research Group, College of Medicine and Health 
Sciences, University of Rwanda, Kigali, Rwanda.
(#)Contributed equally

BACKGROUND: The outbreak of the COVID-19 pandemic has been associated with 
several adverse health outcomes. However, few studies in sub-Saharan Africa have 
examined its deleterious consequences on mental health. Therefore, we 
investigated the prevalence and changes in boredom, anxiety and psychological 
well-being before and during the COVID-19 pandemic in Ghana.
METHODS: Data for this study were drawn from an online survey of 811 
participants that collected retrospective information on mental health measures 
including symptoms of generalized anxiety disorder, boredom, and well-being. 
Additional data were collected on COVID-19 related measures, biosocial (e.g. age 
and sex) and sociocultural factors (e.g., education, occupation, marital 
status). Following descriptive and psychometric evaluation of measures used, 
multiple linear regression was used to assess the relationships between 
predictor variables and boredom, anxiety and psychological well-being scores 
during the pandemic. Second, we assessed the effect of anxiety on psychological 
well-being. Next, we assessed predictors of the changes in boredom, anxiety, and 
well-being.
RESULTS: Before the COVID-19 pandemic, 63.5% reported better well-being, 11.6% 
symptoms of anxiety, and 29.6% symptoms of boredom. Comparing experiences before 
and during the pandemic, there was an increase in boredom and anxiety 
symptomatology, and a decrease in well-being mean scores. The adjusted model 
shows participants with existing medical conditions had higher scores on boredom 
(ß = 1.76, p < .001) and anxiety (ß = 1.83, p < .01). In a separate model, 
anxiety scores before the pandemic (ß = -0.25, p < .01) and having prior medical 
conditions (ß = -1.53, p < .001) were associated with decreased psychological 
well-being scores during the pandemic. In the change model, having a prior 
medical condition was associated with an increasing change in boredom, anxiety, 
and well-being. Older age was associated with decreasing changes in boredom and 
well-being scores.
CONCLUSIONS: This study is the first in Ghana to provide evidence of the changes 
in boredom, anxiety and psychological well-being during the COVID-19 pandemic. 
The findings underscore the need for the inclusion of mental health 
interventions as part of the current pandemic control protocol and public health 
preparedness towards infectious disease outbreaks.

DOI: 10.1186/s12889-021-10998-0
PMCID: PMC8149916
PMID: 34039313 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3429. BMC Public Health. 2021 May 27;21(1):988. doi: 10.1186/s12889-021-10931-5.

Physical activity and mental well-being under COVID-19 lockdown: a 
cross-sectional multination study.

Karageorghis CI(1), Bird JM(2), Hutchinson JC(3), Hamer M(4), Delevoye-Turrell 
YN(5), Guérin SMR(5), Mullin EM(3), Mellano KT(3), Parsons-Smith RL(6)(7), Terry 
VR(8), Terry PC(9).

Author information:
(1)Department of Life Sciences, Brunel University London, Middlesex, UB8 3PH, 
UK. costas.karageorghis@brunel.ac.uk.
(2)Department of Science, Innovation, Technology, and Entrepreneurship, 
University of Exeter, Exeter, UK.
(3)Department of Exercise Science and Athletic Training, Springfield College, 
Springfield, MA, USA.
(4)Institute of Sport, Exercise & Health, Research Department of Targeted 
Intervention, University College London, London, UK.
(5)Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences 
Affectives, F-59000, Lille, France.
(6)School of Psychology and Counselling, University of Southern Queensland, 
Toowoomba, Australia.
(7)School of Health and Behavioural Sciences, University of the Sunshine Coast, 
Sunshine Coast, Australia.
(8)School of Nursing and Midwifery, University of Southern Queensland, 
Toowoomba, Australia.
(9)Division of Research and Innovation, University of Southern Queensland, 
Toowoomba, Australia.

BACKGROUND: COVID-19 lockdowns have reduced opportunities for physical activity 
(PA) and encouraged more sedentary lifestyles. A concomitant of sedentariness is 
compromised mental health. We investigated the effects of COVID-19 lockdown on 
PA, sedentary behavior, and mental health across four Western nations (USA, UK, 
France, and Australia).
METHODS: An online survey was administered in the second quarter of 2020 
(N = 2541). We measured planned and unplanned dimensions of PA using the Brunel 
Lifestyle Physical Activity Questionnaire and mental health using the 12-item 
General Health Questionnaire. Steps per day were recorded only from participants 
who used an electronic device for this purpose, and sedentary behavior was 
reported in hours per day (sitting and screen time).
RESULTS: In the USA and Australia samples, there was a significant decline in 
planned PA from pre- to during lockdown. Among young adults, Australians 
exhibited the lowest planned PA scores, while in middle-aged groups, the UK 
recorded the highest. Young adults exhibited the largest reduction in unplanned 
PA. Across nations, there was a reduction of ~ 2000 steps per day. Large 
increases in sedentary behavior emerged during lockdown, which were most acute 
in young adults. Lockdown was associated with a decline in mental health that 
was more pronounced in women.
CONCLUSIONS: The findings illustrate the deleterious effects of lockdown on PA, 
sedentary behavior, and mental health across four Western nations. Australian 
young and lower middle-aged adults appeared to fare particularly badly in terms 
of planned PA. The reduction in steps per day is equivalent to the 
non-expenditure of ~ 100 kcal. Declines in mental health show how harmful 
lockdowns can be for women in particular.

DOI: 10.1186/s12889-021-10931-5
PMCID: PMC8154111
PMID: 34039306 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3430. BMC Psychiatry. 2021 May 26;21(1):273. doi: 10.1186/s12888-021-03246-7.

Depressive symptoms associated with COVID-19 preventive practice measures, daily 
activities in home quarantine and suicidal behaviors: Findings from a 
large-scale online survey in Bangladesh.

Islam MS(1)(2), Tasnim R(3)(4), Sujan MSH(3)(4), Ferdous MZ(3)(5), Sikder MT(3), 
Masud JHB(5)(6), Kundu S(5)(7), Tahsin P(5), Mosaddek ASM(5)(8), Griffiths 
MD(9).

Author information:
(1)Department of Public Health and Informatics, Jahangirnagar University, Savar, 
Dhaka, 1342, Bangladesh. islam.msaiful@outlook.com.
(2)Centre for Advanced Research Excellence in Public Health, Savar, Dhaka, 1342, 
Bangladesh. islam.msaiful@outlook.com.
(3)Department of Public Health and Informatics, Jahangirnagar University, Savar, 
Dhaka, 1342, Bangladesh.
(4)Centre for Advanced Research Excellence in Public Health, Savar, Dhaka, 1342, 
Bangladesh.
(5)Quest Bangladesh Biomedical Research Center, Lalmatia, Dhaka, 1207, 
Bangladesh.
(6)Public Health Informatics Foundation (PHIF), Mirpur, Dhaka, 1216, Bangladesh.
(7)Advanced Institute of Industrial Technology, Shinagawa City, Tokyo, 140-0011, 
Japan.
(8)Department of Pharmacology, Uttara Adhunik Medical College, Uttara, Dhaka, 
1230, Bangladesh.
(9)International Gaming Research Unit, Psychology Department, Nottingham Trent 
University, 50 Shakespeare Street, Nottingham, NG1 4FQ, UK.

BACKGROUND: The world is facing a public health emergency situation caused by 
the COVID-19 pandemic. Psychological wellbeing among individuals worldwide has 
been negatively affected by the pandemic especially in low- and middle-income 
countries such as Bangladesh. The present study aimed to assess the estimate of 
depressive symptoms and investigated its associations with COVID-19 preventive 
practice measures, daily activities in home quarantine, and suicidal behaviors 
in a large-scale Bangladeshi online survey.
METHODS: An online-based cross-sectional survey was widely distributed to 
Bangladeshi citizens. A total of 13,654 participants (61.0% male; mean 
age = 24.0 years [SD = 6.0]; age range 18-65 years) completed the survey between 
May and June (2020). The survey included socio-demographics and COVID-19-related 
questions, along with lifestyle, suicidal, and psychometric measures. 
Hierarchical regression was performed to determine significant associations 
between depression and examined variables.
RESULTS: The estimate of depressive symptoms during the COVID-19 pandemic was 
43.5%. Based on hierarchical regression analysis, depression was significantly 
associated with not engaging in COVID-19 preventive measures, daily activities 
in home quarantine (e.g., playing videogames), and suicidal behaviors.
CONCLUSIONS: Depressive symptoms appeared to be high during the COVID-19 
pandemic in Bangladesh. To fight against the pandemic, mental health issues as 
well as physical health issues need to be taken into consideration.

DOI: 10.1186/s12888-021-03246-7
PMCID: PMC8150150
PMID: 34039292 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no potential 
conflict of interest in the publication of this research output.


3431. JMIR Mhealth Uhealth. 2021 Jun 11;9(6):e25021. doi: 10.2196/25021.

Digital Solutions to Alleviate the Burden on Health Systems During a Public 
Health Care Crisis: COVID-19 as an Opportunity.

Willems SH(1), Rao J(1), Bhambere S(1), Patel D(1), Biggins Y(1), Guite 
JW(1)(2).

Author information:
(1)DayToDay Health, Health Innovators Inc, Boston, MA, United States.
(2)Center for Advancement in Managing Pain, School of Nursing, The University of 
Connecticut, Storrs, CT, United States.

The COVID-19 pandemic has generated unprecedented and sustained health 
management challenges worldwide. Health care systems continue to struggle to 
support the needs of the majority of infected individuals that are either 
asymptomatic or have mild symptoms. In addition, long-term effects in the form 
of long-lasting COVID-19 symptoms or widespread mental health issues aggravated 
by the pandemic pose a burden on health care systems worldwide. This viewpoint 
article considers aspects of digital health care solutions and how they can play 
an ongoing role in safely addressing gaps in the health care support available 
from initially and repeatedly overwhelmed providers and systems. Digital 
solutions can be readily designed to address this need and can be flexible 
enough to adapt to the evolving management requirements of various stakeholders 
to reduce COVID-19 infection rates, acute hospitalizations, and mortality. 
Multiplatform solutions provide a hybrid model of care, which can include mobile 
and online platforms accompanied by direct clinician input and feedback. 
Desirable components to be included are discussed, including symptom tracking, 
patient education, well-being support, and bidirectional communication between 
patients and clinicians. Customizable and scalable digital health platforms not 
only can be readily adapted to further meet the needs of employers and public 
health stakeholders during the ongoing pandemic, but also hold relevance for 
flexibly meeting broader care management needs into the future.

©Sofie H Willems, Jyotsna Rao, Sailee Bhambere, Dipu Patel, Yvonne Biggins, 
Jessica W Guite. Originally published in JMIR mHealth and uHealth 
(https://mhealth.jmir.org), 11.06.2021.

DOI: 10.2196/25021
PMCID: PMC8202659
PMID: 34033575 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


3432. Mol Neurobiol. 2021 Sep;58(9):4477-4486. doi: 10.1007/s12035-021-02408-8. Epub 
2021 May 25.

The Intersection of Parkinson's Disease, Viral Infections, and COVID-19.

Rosen B(1), Kurtishi A(1), Vazquez-Jimenez GR(1), Møller SG(2).

Author information:
(1)Department of Biological Sciences, St. John's University, New York, NY, 
11439, USA.
(2)Department of Biological Sciences, St. John's University, New York, NY, 
11439, USA. mollers@stjohns.edu.

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the causative 
agent of human COVID-19, not only causes flu-like symptoms and gut microbiome 
complications but a large number of infected individuals also experience a host 
of neurological symptoms including loss of smell and taste, seizures, difficulty 
concentrating, decreased alertness, and brain inflammation. Although SARS-CoV-2 
infections are not more prevalent in Parkinson's disease patients, a higher 
mortality rate has been reported not only associated with older age and longer 
disease duration, but also through several mechanisms, such as interactions with 
the brain dopaminergic system and through systemic inflammatory responses. 
Indeed, a number of the neurological symptoms seen in COVID-19 patients, as well 
as the alterations in the gut microbiome, are also prevalent in patients with 
Parkinson's disease. Furthermore, biochemical pathways such as oxidative stress, 
inflammation, and protein aggregation have shared commonalities between 
Parkinson's disease and COVID-19 disease progression. In this review, we 
describe and compare the numerous similarities and intersections between 
neurodegeneration in Parkinson's disease and RNA viral infections, emphasizing 
the current SARS-CoV-2 global health crisis.

© 2021. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s12035-021-02408-8
PMCID: PMC8143990
PMID: 34033061 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


3433. Ecol Food Nutr. 2021 Sep-Oct;60(5):580-595. doi: 10.1080/03670244.2021.1926245. 
Epub 2021 May 25.

Disentangling the Relationship between Food Insecurity and Poor Sleep Health.

Lee S(1), Deason K(1), Rancourt D(2), Gray HL(3).

Author information:
(1)School of Aging Studies, University of South Florida, Tampa, Florida, USA.
(2)Department of Psychology, University of South Florida, Tampa, Florida, USA.
(3)College of Public Health, University of South Florida, Tampa, Florida, USA.

The COVID-19 pandemic has created disruptions in global and national food supply 
chains. Along with an increase in the unemployment rate, this resulted in a rise 
in food insecurity at the community-level, threatening individual and family 
well-being. Food insecurity is associated with inadequate nutrient intakes, 
weight gain, and psychological distress, including anxiety and depressive 
symptoms, all of which are known to affect sleep. Yet, little is known about 
whether and how food insecurity is associated with sleep health, a critical but 
underrecognized health outcome. This paper reviews literature describing 
associations between food insecurity and sleep, summarizes key findings based on 
proposed mechanisms, and discusses directions for future research.

DOI: 10.1080/03670244.2021.1926245
PMID: 34032535 [Indexed for MEDLINE]


3434. Med J Malaysia. 2021 May;76(3):284-290.

Paediatric surgical response to an 'adult' COVID-19 pandemic.

Mahat N(1), Zubaidi SA(2), Soe HHK(3), Nah SA(4).

Author information:
(1)University of Malaya, Faculty of Medicine, Department of Surgery, Division of 
Paediatric Surgery, Kuala Lumpur, Malaysia.
(2)University of Malaya Medical Centre, Faculty of Medicine, Department of 
Surgery, Division of Paediatric Surgery, Kuala Lumpur, Malaysia.
(3)Melaka Manipal Medical College, Department of Community Medicine, Melaka, 
Malaysia.
(4)University of Malaya, Faculty of Medicine, Department of Surgery, Division of 
Paediatric Surgery, Kuala Lumpur, Malaysia. shireen.nah@ummc.edu.my.

INTRODUCTION: The Coronavirus Disease 2019 (COVID-19) has dramatically affected 
global healthcare systems. We aimed to determine the response of our paediatric 
surgical fraternity to a disease that overwhelmingly affects adults.
MATERIALS AND METHODS: We conducted a cross-sectional questionnaire-based study 
over 6 weeks during a federally mandated lockdown. Using snowball sampling, we 
recruited paediatric surgeons, trainees and medical officers from paediatric 
surgical units in Malaysia. The anonymous online questionnaire covered 
sociodemographic information, changes in patient care, redeployment, concerns 
regarding family members, and impact on training. Mental well-being was assessed 
using the Depression, Anxiety and Stress Scale (DASS-21). Kruskal-Wallis, ANOVA 
and multiple regression analysis was used, with significance level 0.05.
RESULTS: Of the 129 eligible participants, 100(77%) responded. Junior doctors 
had clinically higher levels of depression, anxiety, and stress. Age <30 years 
was significantly associated with anxiety. Junior doctors believed that 
redeployment led to loss of surgical skills (p<0.001) and trainees felt that 
clinical application of knowledge had reduced (p<0.020).
CONCLUSION: Specific to our paediatric surgical community, this study highlights 
areas of concern, particularly among junior doctors. It is likely that recurrent 
cycles of the pandemic will occur soon. These issues must be addressed to 
preserve the mental and emotional well-being of all health care workers.

PMID: 34031324 [Indexed for MEDLINE]


3435. Scand J Public Health. 2021 Nov;49(7):779-789. doi: 10.1177/14034948211017017. 
Epub 2021 May 24.

COVID-19 and disconnected youth: Lessons and opportunities from OECD countries.

Palmer AN(1), Small E(1).

Author information:
(1)School of Social Work, University of Texas at Arlington, USA.

AIMS: This paper highlights how the novel coronavirus pandemic (COVID-19) has 
amplified economic instability and health risks for disconnected youth and young 
adults (YYA). We offer a brief review of governmental policy responses in four 
OECD countries and how they may impact the disconnect YYA within those 
countries.
METHODS: Literature was reviewed utilizing Cochrane Library, ERIC, PsychINFO, 
PubMed/MEDLINE and Web of Science to outline existing inequities among 
disconnected YYA and COVID-19 economic and health impacts. Government responses 
to COVID-19 from four OECD countries were reviewed. Using the social protection 
model, we highlighted significant policy changes and developments that influence 
the protection of vulnerable populations and evaluated the potential effect of 
long-term economic dislocations prompted by the COVID-19 pandemic.
RESULTS: Disconnected YYA suffered significant financial and health burdens with 
no social protection floor in place. Lessons learned prior to and during the 
pandemic indicate that initiatives aimed at improving health and well-being 
among vulnerable YYA and their communities must be adequately funded, flexible, 
and comprehensive. Attempts to connect or reconnect YYA who were disconnected 
prior to the COVID-19 pandemic will require a re-envisioning of policy.
CONCLUSIONS: Globally, governments must invest in social safety net programs 
that focus on supporting those most at-risk. A concentrated focus on job 
creation, education and training, and paid work experience, investments in early 
childhood care and education, housing, health and mental health care is 
necessary to not only offset the pandemic's effects but also support thriving in 
the future for YYA.

DOI: 10.1177/14034948211017017
PMID: 34030549 [Indexed for MEDLINE]


3436. Front Public Health. 2021 May 7;9:679397. doi: 10.3389/fpubh.2021.679397. 
eCollection 2021.

Prioritizing the Mental Health and Well-Being of Healthcare Workers: An Urgent 
Global Public Health Priority.

Søvold LE(1), Naslund JA(2), Kousoulis AA(3), Saxena S(4), Qoronfleh MW(5), 
Grobler C(6), Münter L(7).

Author information:
(1)Independent Researcher, Oslo, Norway.
(2)Department of Global Health and Social Medicine and Harvard Medical School, 
Boston, MA, United States.
(3)Mental Health Foundation, London, United Kingdom.
(4)Department of Global Health and Population, School of Public Health, Harvard 
University, Boston, MA, United States.
(5)21HealthStreet, London, United Kingdom.
(6)Faculty of Health Sciences, School of Health Systems and Public Health, 
University of Pretoria, Pretoria, South Africa.
(7)Danish Committtee for Health Education, Copenhagen, Denmark.

The COVID-19 pandemic has had an unprecedented impact on health systems in most 
countries, and in particular, on the mental health and well-being of health 
workers on the frontlines of pandemic response efforts. The purpose of this 
article is to provide an evidence-based overview of the adverse mental health 
impacts on healthcare workers during times of crisis and other challenging 
working conditions and to highlight the importance of prioritizing and 
protecting the mental health and well-being of the healthcare workforce, 
particularly in the context of the COVID-19 pandemic. First, we provide a broad 
overview of the elevated risk of stress, burnout, moral injury, depression, 
trauma, and other mental health challenges among healthcare workers. Second, we 
consider how public health emergencies exacerbate these concerns, as reflected 
in emerging research on the negative mental health impacts of the COVID-19 
pandemic on healthcare workers. Further, we consider potential approaches for 
overcoming these threats to mental health by exploring the value of practicing 
self-care strategies, and implementing evidence based interventions and 
organizational measures to help protect and support the mental health and 
well-being of the healthcare workforce. Lastly, we highlight systemic changes to 
empower healthcare workers and protect their mental health and well-being in the 
long run, and propose policy recommendations to guide healthcare leaders and 
health systems in this endeavor. This paper acknowledges the stressors, burdens, 
and psychological needs of the healthcare workforce across health systems and 
disciplines, and calls for renewed efforts to mitigate these challenges among 
those working on the frontlines during public health emergencies such as the 
COVID-19 pandemic.

Copyright © 2021 Søvold, Naslund, Kousoulis, Saxena, Qoronfleh, Grobler and 
Münter.

DOI: 10.3389/fpubh.2021.679397
PMCID: PMC8137852
PMID: 34026720 [Indexed for MEDLINE]

Conflict of interest statement: MWQ was affiliated with the company 
21HealthStreet. The remaining authors declare that the research was conducted in 
the absence of any commercial or financial relationships that could be construed 
as a potential conflict of interest.


3437. Chest. 2021 Sep;160(3):944-955. doi: 10.1016/j.chest.2021.05.023. Epub 2021 May 
21.

Symptoms of Mental Health Disorders in Critical Care Physicians Facing the 
Second COVID-19 Wave: A Cross-Sectional Study.

Azoulay E(1), Pochard F(2), Reignier J(3), Argaud L(4), Bruneel F(5), Courbon 
P(6), Cariou A(6), Klouche K(7), Labbé V(8), Barbier F(9), Guitton C(10), 
Demoule A(11), Kouatchet A(12), Guisset O(13), Jourdain M(14), Papazian L(15), 
Van Der Meersch G(16), Reuter D(17), Souppart V(2), Resche-Rigon M(18), Darmon 
M(2), Kentish-Barnes N(2); FAMIREA Study Group.

Author information:
(1)Medical Intensive Care Unit, AP-HP, Saint Louis University Hospital, Paris, 
France. Electronic address: elie.azoulay@aphp.fr.
(2)Medical Intensive Care Unit, AP-HP, Saint Louis University Hospital, Paris, 
France.
(3)Medical Intensive Care Unit, University Hospital Center, Nantes, France.
(4)Medical Intensive Care Department, Edouard Herriot Hospital, Hospices Civils 
de Lyon, Lyon, France.
(5)Intensive Care Unit, André Mignot Hospital, Le Chesnay, France.
(6)Medical Intensive Care Unit, Cochin University Hospital, AP-HP, 
Centre-Université de Paris, Paris, France.
(7)Department of Intensive Care Medicine, Lapeyronie Hospital, Montpellier, 
France.
(8)Medical Intensive Care Unit, AP-HP, Tenon University Hospital, Paris, France.
(9)Medical Intensive Care Unit, La Source Hospital, Centre Hospitalier Régional 
d'Orléans, Orléans, France.
(10)Medical Intensive Care Unit, Le Mans Hospital, Le Mans, France.
(11)AP-HP, Groupe Hospitalier Universitaire AP-HP-Sorbonne Université, 
Pitié-Salpêtrière site, Service de Pneumologie, Médecine Intensive et 
Réanimation (Département R3S) and Sorbonne Université, INSERM, UMRS1158 
Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.
(12)Medical Intensive Care Unit, Angers Teaching Hospital, Angers, France.
(13)Medical Intensive Care Unit, Saint-André Hospital, Bordeaux, France.
(14)Centre Hospitalier Universitaire Lille, Department of Intensive Care, 
Hôpital Roger Salengro, INSERM, Lille University, U1190, Lille, France.
(15)Respiratory and Infectious Diseases ICU, AP-HM Hôpital Nord, Marseille, 
France.
(16)Medical-Surgical Intensive Care Unit, AP-HP, Avicenne University Hospital, 
Bobigny, France.
(17)Medical-Surgical Intensive Care Unit, Centre Hospitalier Sud Francilien, 
Corbeil, France.
(18)Clinical Research Unit, AP-HP, Saint Louis University Hospital, Paris, 
France.

Comment in
    Chest. 2021 Sep;160(3):797-798.

BACKGROUND: Working in the ICU during the first COVID-19 wave was associated 
with high levels of mental health disorders.
RESEARCH QUESTION: What are the mental health symptoms in health care providers 
(HCPs) facing the second wave?
STUDY DESIGN AND METHODS: A cross-sectional study (October 30-December 1, 2020) 
was conducted in 16 ICUs during the second wave in France. HCPs completed the 
Hospital Anxiety and Depression Scale, the Impact of Event Scale-Revised (for 
post-traumatic stress disorder), and the Maslach Burnout Inventory.
RESULTS: Of 1,203 HCPs, 845 responded (70%) (66% nursing staff, 32% medical 
staff, 2% other professionals); 487 (57.6%) had treated more than 10 new 
patients with COVID-19 in the previous week. Insomnia affected 320 (37.9%), and 
7.7% were taking a psychotropic drug daily. Symptoms of anxiety, depression, 
post-traumatic stress disorder, and burnout were reported in 60.0% (95% CI, 
56.6%-63.3%), 36.1% (95% CI, 32.9%-39.5%), 28.4% (95% CI, 25.4%-31.6%), and 
45.1% (95% CI, 41.7%-48.5%) of respondents, respectively. Independent predictors 
of such symptoms included respondent characteristics (sex, profession, 
experience, personality traits), work organization (ability to rest and to care 
for family), and self-perceptions (fear of becoming infected or of infecting 
family and friends, feeling pressure related to the surge, intention to leave 
the ICU, lassitude, working conditions, feeling they had a high-risk profession, 
and "missing the clapping"). The number of patients with COVID-19 treated in the 
first wave or over the last week was not associated with symptoms of mental 
health disorders.
INTERPRETATION: The prevalence of symptoms of mental health disorders is high in 
ICU HCPs managing the second COVID-19 surge. The highest tiers of hospital 
management urgently need to provide psychological support, peer-support groups, 
and a communication structure that ensure the well-being of HCPs.

Copyright © 2021. Published by Elsevier Inc.

DOI: 10.1016/j.chest.2021.05.023
PMCID: PMC8137352
PMID: 34023323 [Indexed for MEDLINE]


3438. Vaccine. 2021 Jun 11;39(26):3473-3479. doi: 10.1016/j.vaccine.2021.05.026. Epub 
2021 May 12.

Older adolescents and young adults willingness to receive the COVID-19 vaccine: 
Implications for informing public health strategies.

Afifi TO(1), Salmon S(2), Taillieu T(3), Stewart-Tufescu A(4), Fortier J(5), 
Driedger SM(6).

Author information:
(1)Departments of Community Health Sciences and Psychiatry, University of 
Manitoba, Winnipeg, Canada. Electronic address: tracie.afifi@umanitoba.ca.
(2)Department of Community Health Sciences, University of Manitoba, Winnipeg, 
Canada. Electronic address: samantha.salmon@umanitoba.ca.
(3)Instructor and Research Associate, Department of Community Health Sciences, 
University of Manitoba, Winnipeg, Canada. Electronic address: 
tamara.taillieu@umanitoba.ca.
(4)Faculty of Social Work, University of Manitoba, Winnipeg, Canada. Electronic 
address: ashley.stewart-tufescu@umanitoba.ca.
(5)Department of Community Health Sciences, University of Manitoba, Winnipeg, 
Canada. Electronic address: janique.fortier@umanitoba.ca.
(6)Department of Community Health Sciences, University of Manitoba, Winnipeg, 
Canada. Electronic address: Michelle.Driedger@umanitoba.ca.

IMPORTANCE: The success in ending the COVID-19 pandemic rests partly on the mass 
uptake of the COVID-19 vaccine. Little work has been done to understand vaccine 
willingness among older adolescents and young adults. This is important since 
this age group may be less likely to adhere to public health guidelines.
OBJECTIVE: To understand willingness of getting a vaccine and reasons for 
vaccine hesitancy among a sample of older adolescents and young adults.
DESIGN: Data were from the Well-Being and Experiences study (The WE Study), a 
longitudinal community-based sample of older adolescents and young adults 
collected from Winnipeg, Manitoba, Canada from 2017 to 2020 (n = 664).
SETTING: The study setting was a community-based observational longitudinal 
study.
PARTICIPANTS: Participants for the study were aged 14 to 17 years old at 
baseline in 2016-17 (n = 1000). Data were also collected on one 
parent/caregiver. Waves 2 (n = 747) and 3 (n = 664) were collected in 2019 and 
2020, respectively.
EXPOSURES: The main exposures were sociodemographic factors, health conditions, 
COVID-19 knowledge, and adversity history.
MAIN OUTCOMES: The main outcomes were COVID-19 vaccine willingness, hesitancy, 
and reasons for hesitancy.
RESULTS: Willingness to get a COVID-19 vaccine was 65.4%. Willingness did not 
differ by age, sex, or mental health conditions, but did differ for other 
sociodemographic characteristics, physical health conditions, COVID-19 
knowledge, practicing social/physical distancing, and adversity history. The 
most common reasons for not wanting a vaccine were related to safety, knowledge, 
and effectiveness. Sex differences were noted.
CONCLUSIONS AND RELEVANCE: Increasing uptake of the COVID-19 vaccine among older 
adolescents and young adults may rely on targeting individuals from households 
with lower income, financial burden, and adversity history, and generating 
public health messaging specifically aimed at vaccine safety, how it works to 
protect against illness, and why it is important to protect oneself against a 
COVID-19 infection.

Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.vaccine.2021.05.026
PMCID: PMC8114588
PMID: 34023134 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


3439. Psychiatry Res. 2021 Jul;301:113977. doi: 10.1016/j.psychres.2021.113977. Epub 
2021 May 1.

Mental health among pregnant women under public health interventions during 
COVID-19 outbreak in Wuhan, China.

Xu K(1), Zhang Y(1), Zhang Y(1), Xu Q(2), Lv L(2), Zhang J(3).

Author information:
(1)Department of Maternal and Child Health, School of Public Health, Tongji 
Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, 
Wuhan, Hubei, China.
(2)Maternal and Child Health Hospital of Jianghan District, 50 Machangjiao Rd, 
Wuhan, Hubei, China.
(3)Department of Maternal and Child Health, School of Public Health, Tongji 
Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, 
Wuhan, Hubei, China. Electronic address: jd_zh@mail.hust.edu.cn.

Coronavirus disease 2019 (COVID-19) has become a pandemic. As the first city 
struck by the COVID-19 outbreak, Wuhan had implemented unprecedented public 
health interventions. The mental health of pregnant women during these 
anti-epidemic controls remains unknown. A total of 274 pregnant women living in 
Wuhan during the COVID-19 outbreak took part in our investigation online. The 
data on mental health conditions were evaluated using Edinburgh Postnatal 
Depression Scale (EPDS), Self-Rating Anxiety Scale (SAS), Chinese Perceived 
Stress Scale (CPSS), and Pittsburgh Sleep Quality Index (PSQI). We also 
collected the information on physical health status and precautionary measures 
against COVID-19. The prevalence of depression, anxiety, stress, and poor sleep 
quality was 16.1%, 13.9%, 42.7%, 37.6%, respectively. Comparing to SAS, PSQI 
score in pregnant women who participated in the survey after April 8 (date of 
Wuhan reopening), those data collected before April 8 were significantly higher. 
High levels of stress, severe health concerns over the fetus, and poor hygienic 
practices were negatively associated with mental health conditions. In 
conclusion, a large proportion of pregnant women reported psychological symptoms 
during the epidemic, which negatively related to the severe health concerns over 
fetus and poor hygienic practices. More psychological support during the 
epidemic would promote maternal mental well-being.

Copyright © 2021. Published by Elsevier B.V.

DOI: 10.1016/j.psychres.2021.113977
PMCID: PMC8088032
PMID: 34020217 [Indexed for MEDLINE]

Conflict of interest statement: No conflict of interest was declared by the 
authors.


3440. Indian J Med Ethics. 2020 Oct-Dec;V(4):1-6. doi: 10.20529/IJME.2020.73.

Burnout among healthcare providers during COVID-19: Challenges and 
evidence-based interventions.

Sultana A(1), Sharma R(2), Hossain MM(3), Bhattacharya S(4), Purohit N(5).

Author information:
(1)Gazi Medical College, Khulna, BANGLADESH.
(2)The INCLEN Trust, New Delhi, INDIA.
(3)Texas A&M School of Public Health, TX 77843, USA.
(4)Department of Community Medicine, HIMS, Dehradun, INDIA.
(5)The IIHMR University, Jaipur, Rajasthan, INDIA.

Burnout is a major occupational problem among healthcare providers, especially 
during the Covid-19 pandemic. The frontline health workforce is experiencing a 
high workload and multiple psychosocial stressors which may affect their mental 
and emotional health, leading to burnout symptoms. Moreover, sleep deprivation 
and a critical lack of psychosocial support may aggravate such symptoms amidst 
Covid-19. From an ethical viewpoint, healthcare providers may experience moral 
distress while safeguarding patient welfare and autonomy. Moreover, social 
injustice and structural inequities may affect their emotional health while 
tackling a high volume of new cases and mortality. Global evidence indicates the 
need for adopting multipronged evidence-based approaches to address burnout 
during this pandemic, which may include increasing the awareness of work-related 
stress and burnout, promoting mindfulness and self-care practices for promoting 
mental wellbeing, ensuring optimal mental health services, using digital 
technologies to address workplace stress and deliver mental health 
interventions, and improving organisational policies and practices focusing on 
burnout among healthcare providers.

DOI: 10.20529/IJME.2020.73
PMID: 34018959 [Indexed for MEDLINE]


3441. RETRACTED ARTICLE

BMC Pregnancy Childbirth. 2021 May 20;21(1):395. doi: 
10.1186/s12884-021-03872-9.

Mothers' experiences of caring for preterm babies at home: qualitative insights 
from an urban setting in a middle-income country.

Garti I(1)(2), Donkor E(3), Musah N(4), Appiah EO(5), Gyekye S(5), Menlah 
A(6)(5), Akuoko CP(7)(8).

Author information:
(1)College of Nursing and Midwifery, Charles Darwin University, Darwin, 
Australia. Isabella.garti@cdu.edu.au.
(2)Department of Nursing and Midwifery, Valley View University, Accra, Ghana. 
Isabella.garti@cdu.edu.au.
(3)Department of Nursing and Midwifery, Greater Accra Regional Directorate, 
Ghana Health Service, Accra, Ghana.
(4)Department of Nursing and Midwifery, Trust Mother and Child Hospital, Accra, 
Ghana.
(5)Department of Nursing and Midwifery, Valley View University, Accra, Ghana.
(6)College of Nursing and Midwifery, Charles Darwin University, Darwin, 
Australia.
(7)Department of Nursing, Christian Service University College, Kumasi, Ghana.
(8)School of Nursing, Queensland University of Technology, Brisbane, Australia.

Retraction in
    BMC Pregnancy Childbirth. 2021 Oct 19;21(1):702.

BACKGROUND: Preterm delivery is the birth of a baby before 37 weeks of 
gestation. This global phenomenon is a critical issue of concern especially in 
developing countries that are resource-constrained when it comes to the 
management of preterm babies. Complications associated with prematurity 
contribute significantly to under-five mortality and are linked with feelings of 
despair, grief, and anxiety among mothers.
METHODS: This was a qualitative descriptive study in an urban setting in the 
Greater Accra region of Ghana. Eleven mothers whose babies had been discharged 
from the neonatal intensive care unit in a major hospital and resided in Accra 
were interviewed in their homes using a semi-structured interview guide. Data 
were audiotaped, transcribed verbatim, and analyzed inductively by content 
analysis.
RESULTS: All the mothers had formal education and the mean maternal age was 27.9 
years. The majority of the mothers were multiparous. The gestational age at 
birth ranged from 32 to 34 weeks and the average birth weight of their babies 
was 1.61 kg. Four major themes emerged which included: Around the clock care; 
mothers' self-perceptions and attitudes of significant others; mothers' health 
and wellbeing; and support. Most of the mothers experienced physical exhaustion 
from the extra demands involved with care, had negative emotions, and unmet 
social needs.
CONCLUSIONS: The findings indicate that home management of preterm babies poses 
multiple stressors and is associated with poor psychological and physical 
wellbeing among mothers. Hence, the need for extensive education and 
identification of other social support systems to augment facility-based care 
for mothers and their preterm babies.

DOI: 10.1186/s12884-021-03872-9
PMCID: PMC8136128
PMID: 34016064

Conflict of interest statement: The authors declare that they have no competing 
interests.


3442. Int J Soc Psychiatry. 2022 Aug;68(5):1116-1126. doi: 10.1177/00207640211020036. 
Epub 2021 May 21.

National identification, a social cure for COVID-19? Evidence from 67 countries.

Bonetto E(1)(2)(3), Delouvée S(4), Mahfud Y(5), Adam-Troian J(6).

Author information:
(1)Aix Marseille University, LPS, Aix-en-Provence, France.
(2)Aix Marseille University, PSYCLE (Center for Research on the Psychology of 
Cognition, Language and Emotion), Aix-en-Provence, France.
(3)Institute of Creativity and Innovation of Aix-Marseille, Aix-en-Provence, 
France.
(4)University Rennes, LP3C (Laboratoire de Psychologie : Cognition, 
Comportement, Communication) - EA 1285, Rennes, France.
(5)Paris 5 University, France.
(6)American University of Sharjah, Sharjah, United Arab Emirates.

BACKGROUND: Social distancing and mass quarantines were implemented worldwide in 
response to the current COVID-19 pandemic. Prior research has shown that such 
measures bear negative consequences for population mental health and well-being. 
Conversely, a growing body of evidence suggests that feeling positively 
identified with a group is associated with physical and mental health benefits.
AIMS: This study tested whether national identification could promote wellbeing 
and physical health during the COVID-19 pandemic.
METHOD: We used survey data conducted among 67 countries (N = 46,450).
RESULTS: Mixed-model analyses revealed that national identity was associated 
with wellbeing - despite adjustment on social belonging, COVID-19 perceived 
risk, exposure and ideology. This effect did not extend to physical health.
CONCLUSIONS: These results suggest that the mere feeling of belonging to a 
national group may have mental health benefits. We discuss the implications of 
our findings within the social cure framework and their relevance for population 
mental health under COVID-19.

DOI: 10.1177/00207640211020036
PMID: 34015976 [Indexed for MEDLINE]


3443. Psychiatr Prax. 2021 Jul;48(5):265-268. doi: 10.1055/a-1480-6761. Epub 2021 May 
20.

[COVID-19 and the Trajectory of Participation, Inclusion, and Psychological 
Well-Being Among Adults With and Without Mental Disorders - A Follow-up Study 
from Germany].

[Article in German; Abstract available in German from the publisher]

Mergel E(1), Schützwohl M(1).

Author information:
(1)Klinik für Psychiatrie und Psychotherapie, TU Dresden.

OBJECTIVE: To assess the impact of the Corona pandemic on participation, 
feelings of inclusion, and mental well-being among adults with and without 
current or chronic mental health problems.
METHODS: Follow-up study with pretest prior to the onset of the Corona pandemic 
and two follow-up assessments during a first lockdown in April 2020 and a second 
lockdown in November 2020. We used the Measure of Participation and Social 
Inclusion for Use in People with a Chronic Mental Disorder (F-INK) and the Brief 
Symptom Inventory BSI-18, a short instrument for the assessment of psychological 
distress (n = 112).
RESULTS: Across all groups, compared to the preceding surveys we found no 
detrimental effect on the mental health status four weeks after the beginning of 
the lockdown in November 2020.
CONCLUSION: Against the background of heterogeneous findings on the impact of 
the pandemic, this study confirms studies that found, on average, a general 
resilience in well-being.

Publisher: ZIEL DER STUDIE: Untersuchung zu den Auswirkungen der Corona-Pandemie 
auf Partizipation, Inklusionserleben und psychisches Befinden bei Personen, die 
sich mit Blick auf das Vorliegen einer akuten oder chronischen psychischen 
Störung unterschiedlichen Gruppen zuordnen lassen.
METHODIK: Follow-up-Erhebung mit Prätest vor Beginn der Corona-Pandemie und 2 
Nacherhebungen während bestehender Ausgangsbeschränkungen im April 2020 sowie im 
November 2020 mittels Fragebogen zur Erfassung von Partizipation und sozialer 
Inklusion (F-INK) und Brief Symptom Inventory (BSI-18) zur Erfassung subjektiv 
erlebter psychischer Belastung (n = 112).
ERGEBNISSE: In keiner der untersuchten Gruppen fand sich ein Hinweis dafür, dass 
es in den ersten 4 Wochen der im November 2020 geltenden Ausgangsbeschränkungen 
im Vergleich zu den Vorerhebungen zu negativen psychischen Folgen kam.
SCHLUSSFOLGERUNG: Das Ergebnis reiht sich in die Studien ein, die fanden, dass 
die Bevölkerung in den ersten Monaten der Pandemie im Durchschnitt resilient 
war.

Thieme. All rights reserved.

DOI: 10.1055/a-1480-6761
PMID: 34015848 [Indexed for MEDLINE]

Conflict of interest statement: Die Autoren geben an, dass kein 
Interessenkonflikt besteht.


3444. J Trop Pediatr. 2021 May 17;67(2):fmab038. doi: 10.1093/tropej/fmab038.

Effect of a Brief Supportive and Educational Intervention on the Psychological 
Well-Being of Mothers with Babies in Neonatal Wards of a Tertiary Hospital in 
Ibadan, Nigeria.

Oyekunle OO(1), Bella-Awusah T(1)(2), Ayede AI(3), Omigbodun OO(1)(2), Ani 
CC(4).

Author information:
(1)Centre for Child and Adolescent Mental Health, University of Ibadan, Ibadan, 
Nigeria.
(2)Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, 
Nigeria.
(3)Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, 
Nigeria.
(4)Division of Psychiatry, Imperial College London, and Surrey and Borders 
Partnership NHS Foundation Trust, Leatherhead, UK.

OBJECTIVE: To assess the effect of a supportive educational intervention on the 
psychological wellbeing of mothers whose babies were admitted to Neonatal Care 
Unit (NCU) in Nigeria.
METHODS: Controlled trial involving 41 mothers whose babies were consecutively 
admitted into two NCUs (21 in the intervention group and 19 controls). The 
intervention group received two group-based sessions which included 
psychological coping strategies, and familiarity with NCU environment, 
equipment, personnel and procedures. The control group received usual care. 
Outcome measures were depressive symptoms (Edinburg Postnatal Depression 
Scale-EPDS), stress-related to NCU (Parental Stressor Scale: Neonatal Intensive 
Care Unit-PSS: NICU) and post-traumatic symptoms (Impact Event 
Scale-Revised-IES-R).
RESULTS: Difference-in-Differences (DiD) analysis showed a difference of -4.70 
in PSS: NICU score in favour of the intervention group which was statistically 
significant [F(3, 75) = 9.47, p < 0.0001, R2 = 0.28]. The differences in EPDS 
(0.91) and IES-R (2.55) were not statistically significant [F(3, 75) = 10.10, 
p = 0.74] and [F(3, 75) = 10.13, p = 0.73], respectively. All the mothers in the 
treatment group expressed satisfaction with the intervention.
CONCLUSION: This brief group-based supportive educational intervention for 
mothers with babies in NCU was feasible, acceptable and helpful in reducing 
stress related to NCU. Larger controlled trials are recommended to establish the 
generalizability of these findings in this region.
LAY SUMMARY: Babies born too early and or with complications require admission 
to special hospital called Neonatal Care Unit (NCU) to help them to survive. 
However, parents whose babies are admitted to NCU can find the experience 
frightening. We examined how to reduce the fear and stress mothers in Nigeria 
experience when their babies are admitted to NCU.We had two groups of mothers. 
The first group made up of 21 mothers was taught how to cope with the stress of 
having a baby in NCU. They were also shown how the various equipment in the NCU 
work, what the staff in NCU do and what types of things need to be done to help 
their babies. The second group of 19 mothers received usual care but did not 
have the extra teaching the first group received. After 2 weeks, we checked the 
level of depression and stress the mothers in both groups had compared with the 
level before the first group received the extra teaching.We found that mothers 
in the first group who received the extra teaching were less stressed about 
having their babies in the NCU compared with the mothers that did not receive 
the teaching.

© The Author(s) [2021]. Published by Oxford University Press.

DOI: 10.1093/tropej/fmab038
PMCID: PMC8134906
PMID: 34013326 [Indexed for MEDLINE]


3445. Scand J Public Health. 2021 Nov;49(7):721-729. doi: 10.1177/14034948211013271. 
Epub 2021 May 20.

Depression and anxiety symptoms in pregnant women in Denmark during COVID-19.

Overbeck G(1), Rasmussen IS(1), Siersma V(1), Andersen JH(1), Kragstrup J(1), 
Wilson P(1)(2), Hauskov Graungaard A(1), Ertmann RK(1).

Author information:
(1)The Research Unit for General Practice and Section of General Practice, 
Department of Public Health, University of Copenhagen, Denmark.
(2)Centre for Rural Health, Institute of Applied Health Sciences, University of 
Aberdeen, UK.

AIMS: Maternal mental distress in pregnancy can be damaging to the mother's and 
child's physical and mental health. This study aimed to provide an insight into 
mental well-being of pregnant women in Denmark during COVID-19 by assessing 
symptoms of depression and anxiety.
METHODS: Data from two cohorts of pregnant women recruited from Danish general 
practice were compared. A COVID-19 lockdown cohort (N=330) completed 
questionnaires between 8 April and 6 May. Responses were compared to those from 
a control cohort of women from 2016 (N=1428). Mental well-being was measured 
with the Major Depression Inventory (MDI) and the Anxiety Symptom Scale (ASS).
RESULTS: Questionnaires were returned by 83% of the COVID-19 lockdown cohort and 
by 93% of the control cohort. Multivariable analysis controlling for age, 
cohabitation status, occupation, smoking, alcohol use, chronic disease, 
fertility treatment, parity and children living at home showed no difference in 
depressive symptoms (MDI). Anxiety symptoms (ASS) were slightly worse in the 
COVID-19 lockdown cohort (mean difference=1.4 points), mainly driven by 
questions concerning general anxiety. The largest differences in anxiety were 
seen in first trimester (adjusted mean difference=4.0 points).
CONCLUSIONS: Pregnant women questioned during the COVID-19 pandemic showed no 
change in symptoms of depression and only a modest elevation of anxiety when 
compared to pregnant women questioned during a non-pandemic period in 2016.

DOI: 10.1177/14034948211013271
PMID: 34011216 [Indexed for MEDLINE]


3446. PLoS One. 2021 May 19;16(5):e0251799. doi: 10.1371/journal.pone.0251799. 
eCollection 2021.

Public parks and the pandemic: How park usage has been affected by COVID-19 
policies.

Volenec ZM(1), Abraham JO(1), Becker AD(1)(2), Dobson AP(1).

Author information:
(1)Department of Ecology and Evolutionary Biology, Princeton University, 
Princeton, NJ, United States of America.
(2)Department of Biology, Stanford University, Stanford, CA, United States of 
America.

Public parks serve an important societal function as recreational spaces for 
diverse communities of people, with well documented physical and mental health 
benefits. As such, parks may be crucial for how people have handled effects of 
the COVID-19 pandemic, particularly the increasingly limited recreational 
opportunities, widespread financial uncertainty, and consequent heightened 
anxiety. Despite the documented benefits of parks, however, many states have 
instituted park shutdown orders due to fears that public parks could facilitate 
SARS-CoV-2 transmission. Here we use geotagged social media data from state, 
county, and local parks throughout New Jersey to examine whether park visitation 
increased when the COVID-19 pandemic began and whether park shutdown orders were 
effective at deterring park usage. We compare park usage during four discrete 
stages of spring 2020: (1) before the pandemic began, (2) during the beginning 
of the pandemic, (3) during the New Jersey governor's state-wide park shutdown 
order, and (4) following the lifting of the shutdown. We find that park 
visitation increased by 63.4% with the onset of the pandemic. The subsequent 
park shutdown order caused visitation in closed parks to decline by 76.1% while 
parks that remained open continued to experience elevated visitation levels. 
Visitation then returned to elevated pre-shutdown levels when closed parks were 
allowed to reopen. Altogether, our results indicate that parks continue to 
provide crucial services to society, particularly in stressful times when 
opportunities for recreation are limited. Furthermore, our results suggest that 
policies targeting human behavior can be effective and are largely reversible. 
As such, we should continue to invest in public parks and to explore the role of 
parks in managing public health and psychological well-being.

DOI: 10.1371/journal.pone.0251799
PMCID: PMC8133454
PMID: 34010353 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


3447. J Gen Psychol. 2023 Apr-Jun;150(2):143-170. doi: 10.1080/00221309.2021.1922346. 
Epub 2021 May 18.

Intolerance of uncertainty and reactions to the COVID-19 pandemic.

Bavolar J(1), Kacmar P(1), Hricova M(1), Schrötter J(1), Kovacova-Holevova B(1), 
Köverova M(1), Raczova B(1).

Author information:
(1)Pavol Jozef Safarik University in Kosice.

The COVID-19 pandemic has presented a threat to mental health worldwide. The 
current study aims to investigate the role of intolerance of uncertainty in 
cognitive, emotional and behavioral reactions to this pandemic and propose a 
path model of these reactions. In the first two months of the COVID-19 pandemic 
in Slovakia, participants in a general sample (n = 1,011) as well as an older 
adult sample (n = 655) completed measures regarding intolerance of uncertainty, 
mental health (anxiety, well-being, perceived stress) and adherence to 
preventive measures. Two rounds of data collection were carried out in the first 
sample. Intolerance of uncertainty was found to be related to mental health 
indicators and the structural equation model showed a direct and indirect effect 
on them as well as on the adherence to preventive measures. However, the 
comparison of data from different time points has brought inconsistent results. 
The findings highlight the role of intolerance of uncertainty in reaction to 
threat and indicate the potential of uncertainty reduction e.g., getting clear 
messages from authorities, as a way of decreasing mental health problems.

DOI: 10.1080/00221309.2021.1922346
PMID: 34006200 [Indexed for MEDLINE]


3448. BMJ Open. 2021 Mar 8;11(3):e044067. doi: 10.1136/bmjopen-2020-044067.

Change in time spent visiting and experiences of green space following 
restrictions on movement during the COVID-19 pandemic: a nationally 
representative cross-sectional study of UK adults.

Burnett H(1), Olsen JR(2), Nicholls N(2), Mitchell R(2).

Author information:
(1)MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 
Glasgow, UK h.burnett.1@research.gla.ac.uk.
(2)MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 
Glasgow, UK.

OBJECTIVES: Green space positively influences health and well-being; however, 
inequalities in use of green space are prevalent. Movement restrictions enforced 
due to the COVID-19 pandemic could have exacerbated existing inequalities 
regarding who visits green space. Therefore, this study aimed to explore how 
movement restrictions have changed the time spent visiting green space and 
experience of green space in the United Kingdom (UK) and how these differed by 
individual-level demographic characteristics.
DESIGN AND OUTCOME MEASURES: A nationally representative cross-sectional survey 
administered through YouGov between 30 April and 1 May 2020. Data were collected 
on the time spent visiting green space and change in the experience of green 
space, including missing social interaction, increased physical activity and 
feeling greater mental health benefits in green space. Demographic information 
was collected on sex, age, ethnicity, social grade and dog ownership. 
Associations between specific outcome variables and predictors were assessed 
using logistic regression.
SETTING: UK, with population weights applied.
PARTICIPANTS: 2252 adults aged 18 years and over.
RESULTS: Overall, 63% of respondents reported a decrease in time spent visiting 
green space following movement restrictions. Lower social grade respondents were 
less likely to visit green space before and after restrictions were enforced 
(OR: 0.35 (95% CI 0.24 to 0.51); OR: 0.77 (95% CI 0.63 to 0.95)). Female 
respondents were more likely than male respondents to agree that green space 
benefited their mental health more following restrictions (PP: 0.70 vs 0.59). 
Older (65+ years) respondents were less likely than middle-aged (25-64 years) 
respondents to have visited green space following the restrictions (OR: 0.79 
(95% CI 0.63 to 0.98)).
CONCLUSIONS: Inequalities in green space use were sustained, and possibly 
exacerbated, during movement restrictions. Our findings emphasise the importance 
of green spaces remaining open globally in any future 'lockdowns'/pandemics. 
Further investigation is required to determine how visit patterns and 
experiences change through the different stages of the COVID-19 pandemic in the 
UK.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/bmjopen-2020-044067
PMCID: PMC7942249
PMID: 34006030 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3449. Recenti Prog Med. 2021 May;112(5):360-370. doi: 10.1701/3608.35873.

[Impact of social distancing for covid-19 on the psychological well-being of 
youths: a systematic review of the literature.].

[Article in Italian]

Minozzi S(1), Saulle R(1), Amato L(1), Davoli M(1).

Author information:
(1)Dipartimento Epidemiologia del SSR - Regione Lazio, Roma.

BACKGROUND: During the first semester 2020 almost all country implemented rigid 
measures of social distances, including schools closure, to limit the 
transmission of SARS-CoV-2 infection. Up to now, however, the efficacy of school 
closure to reduce the spread of the disease in the community still remains 
unclear and no much is known about the potential negative effects of such 
measures on physical health and psychological wellbeing of youths, mainly if 
protracted for long periods.
OBJECTIVE: To summarize the data of a systematic review on the impact of the 
2020 school closure and social distances measures implemented in response to 
covid-19 pandemic on youths' physical health and psychological wellbeing. In the 
present paper we describe the impact on psychological wellbeing.
METHODS: We searched 11 international databases up to 1st September 2020 to 
retrieve cohort studies, cross sectional surveys, uncontrolled pre-post studies 
and modelling studies. Methodological quality of included studies has been 
assessed with validated checklists.
RESULTS: Sixty-four studies have been included; 27 assessed the impact on 
psychological wellbeing. All the studies have been conducted during the first 
wave of pandemic and assessed the short-term effect of social distances measures 
implemented for relatively short periods. The majority of the studies were 
conducted in the UK (37,6%) and China (27%). The 42.3% has been judged of high 
methodological quality. Two studies reported an increase of suicides, while two 
studies reported a reduction of the access to Psychiatric Emergency Department, 
Maltreatment allegations decreased substantially, likely due to a reduction in 
reports rather than actual incidence. Prevalence of anxiety among adolescents 
ranged between 19% and 64%, depression between 22.3% and 43.7%. Among children 
5-12 years old, prevalence of anxiety varied between 19% and 78%, while 
depression between 6.3% and 22.6%. Among pre-school children, some studies found 
worsening of behavioural and emotional problems while others did not.
CONCLUSIONS: Most of the studies reported relevant worsening of the 
psychological wellbeing, mainly among adolescents. If school closure and rigid 
social distances measures will extend for a long time, an even more pronounced 
negative effect can be expected. Further studies are needed on the long-term 
effect of prolonged social distances measures, as well as a careful harm-benefit 
analysis of the impact of such measures.

DOI: 10.1701/3608.35873
PMID: 34003188 [Indexed for MEDLINE]


3450. Infect Dis Poverty. 2021 May 17;10(1):69. doi: 10.1186/s40249-021-00836-1.

Mindfulness-based online intervention on mental health and quality of life among 
COVID-19 patients in China: an intervention design.

Si MY(#)(1), Xiao WJ(#)(1), Pan C(2), Wang H(1), Huang YM(1), Lian J(1), Mak 
WWS(3), Leng ZW(1), Su XY(4), Tang QP(5), Jiang Y(1), Feng LZ(6), Yang WZ(1), 
Wang C(1)(7)(8).

Author information:
(1)School of Population Medicine and Public Health, Chinese Academy of Medical 
Sciences and Peking Union Medical College, 9 DongDanSanTiao, Dongcheng, Beijing, 
China.
(2)Department of Clinical Psychology, The Third Xiangya Hospital of Central 
South University, No. 138 Tongzipo Road, Yuelu, Changsha, Hunan, China.
(3)Diversity and Well-Being Laboratory, Department of Psychology, The Chinese 
University of Hong Kong, Shatin, NT, Hong Kong, China.
(4)School of Population Medicine and Public Health, Chinese Academy of Medical 
Sciences and Peking Union Medical College, 9 DongDanSanTiao, Dongcheng, Beijing, 
China. suxiaoyou@hotmail.com.
(5)Department of Clinical Psychology, The Third Xiangya Hospital of Central 
South University, No. 138 Tongzipo Road, Yuelu, Changsha, Hunan, China. 
tt96@sina.com.
(6)School of Population Medicine and Public Health, Chinese Academy of Medical 
Sciences and Peking Union Medical College, 9 DongDanSanTiao, Dongcheng, Beijing, 
China. fengluzhao@cams.cn.
(7)Chinese Academy of Medical Sciences and Peking Union Medical College, 
Beijing, China.
(8)National Clinical Research Center for Respiratory Diseases, Beijing, China.
(#)Contributed equally

BACKGROUND: COVID-19 can lead to increased psychological symptoms such as 
post-traumatic stress disorder (PTSD), depression, and anxiety among patients 
with COVID-19. Based on the previous mindfulness-based interventions proved to 
be effective, this protocol reports a design of a randomized controlled trial 
aiming to explore the efficacy and possible mechanism of a mindful living with 
challenge (MLWC) intervention developed for COVID-19 survivors in alleviating 
their psychological problems caused by both the disease and the pandemic.
METHODS: In April 2021, more than 1600 eligible participants from Hubei Province 
of China will be assigned 1:1 to an online MLWC intervention group or a waitlist 
control group. All participants will be asked to complete online questionnaires 
at baseline, post-program, and 3-month follow-up. The differences of mental 
health status (e.g. PTSD) and physical symptoms including fatigue and 
sleeplessness between the COVID-19 survivors who receiving the online MLWC 
intervention and the control group will be assessed. In addition, the possible 
mediators and moderators of the link between the MLWC intervention and target 
outcomes will be evaluated by related verified scales, such as the Five Facets 
Mindfulness Questionnaire. Data will be analyzed based on an intention-to-treat 
approach, and SPSS software will be used to perform statistical analysis.
DISCUSSION: The efficacy and potential mechanism of MLWC intervention in 
improving the quality of life and psychological status of COVID-19 survivors in 
China are expected to be reported. Findings from this study will shed light on a 
novel and feasible model in improving the psychological well-being of people 
during such public health emergencies. Trial registration Chinese Clinical Trial 
Registry (ChiCTR), ChiCTR2000037524; Registered on August 29, 2020, 
http://www.chictr.org.cn/showproj.aspx?proj=60034 .

DOI: 10.1186/s40249-021-00836-1
PMCID: PMC8127244
PMID: 34001277 [Indexed for MEDLINE]

Conflict of interest statement: None.


3451. J Reprod Infant Psychol. 2022 Dec;40(6):577-589. doi: 
10.1080/02646838.2021.1928614. Epub 2021 May 18.

COVID-19: what about pregnant women during first lockdown in Italy?

Ionio C(1), Gallese M(2), Fenaroli V(1), Smorti M(3), Greco A(4), Testa I(2), 
Zilioli A(2), Bonassi L(2).

Author information:
(1)Dipartimento di Psicologia, Università Cattolica, Milano, Italy.
(2)Dipartimento Materno Infantile, Azienda Socio-Sanitaria Territoriale Bergamo 
Est, Seriate, Italy.
(3)Surgical Medical Molecular and Critical Pathology, S. Chiara Hospital, 
Università di Pisa, Pisa, Italy.
(4)Dipartimento di Scienze Umane e Sociali, Università degli Studi di Bergamo, 
Bergamo, Italy.

OBJECTIVE: Lombardy was the most affected Italian region by COVID-19. To limit 
the spread of infection, the government issued a national social lockdown. The 
obstetrical-gynaecological emergencies and essential services were guaranteed to 
protect pregnant women's health, and a return to a medicalised childbirth was 
necessary. This situation could had amplified risk factors on the psychological 
wellbeing of mothers-to-be. Indeed, the last trimester of pregnancy is a period 
of increased vulnerability itself.
METHOD: For better support women who experience pregnancy during social 
lockdown, we explored the impact of COVID-19 on psychic wellbeing of two samples 
of pregnant women (40 living in Lombardy and 35 in Tuscany).
RESULTS: T-test and correlations analyses revealed that women living in the 
Lombardy had a higher perception of the centrality of COVID-19. Further, women 
that considered the pandemic as a significant event, experienced a higher 
perinatal depressive symptom. Those symptoms also arose in women who presented 
a higher number of intrusion and hyperarousal symptoms and a lower ability to 
plan.
CONCLUSION: Pregnant women should be closely monitored and supported, especially 
those who live in high-risk areas, such as Lombardy Region. The target 
intervention could be focused on improving resilience to reduce depressive 
symptomatology.

DOI: 10.1080/02646838.2021.1928614
PMID: 34000926 [Indexed for MEDLINE]


3452. Arch Suicide Res. 2022 Jul-Sep;26(3):1487-1504. doi: 
10.1080/13811118.2021.1923599. Epub 2021 May 17.

The Role of Hope and Resilience in Protecting Against Suicidal thoughts and 
Behaviors During the COVID-19 Pandemic.

Knowles JRP, Gray NS, O'Connor C, Pink J, Simkiss NJ, Snowden RJ.

OBJECTIVE: The COVID-19 pandemic has impacted the mental health and wellbeing of 
populations across the world. This study aimed to examine: (1) which specific 
aspects of the COVID-19 pandemic were associated with the presence of suicidal 
thoughts and behaviors, and (2) the extent to which participants' hopelessness 
and resilience moderated the relationship between COVID-19 related stress and 
suicidal thoughts and behaviors.
METHOD: We administered an online survey to 12,989 adult (16+) participants 
across Wales from the 9th June to the 13th July 2020. Participants completed a 
series of questionnaires measuring the stressors they had experienced during the 
COVID-19 pandemic, their levels of hopelessness over the past two weeks, their 
levels of resilience, and whether they had experienced suicidal thoughts or 
behaviors since the onset of the COVID-19 pandemic.
RESULTS: Our findings revealed that: (1) food insecurity, domestic abuse, 
relationship problems, redundancy, social isolation and financial problems were 
the COVID-19 related stressors most strongly associated with suicidal thoughts 
and behaviors, and (2) that both hopelessness and resilience moderated the 
relationship between COVID-19 stress and suicidal thoughts, such that the 
relationship between COVID-19 stress and the presence of suicidal thoughts was 
much stronger for individuals with high hopelessness and low resilience.
CONCLUSIONS: These results highlight the aspects of the COVID-19 pandemic that 
are closely related to suicidal thoughts and behaviors and demonstrate the 
important role that hope for the future and resilience play in protecting 
individuals against the negative effects of the COVID-19 
pandemic.HighlightsStressors caused by the pandemic are linked to increased 
suicidal thoughts.Hope protects individuals against the negative impact of the 
COVID-19 pandemic.Resilience also protects people from the negative impact of 
the COVID-19 pandemic.

DOI: 10.1080/13811118.2021.1923599
PMID: 33999758 [Indexed for MEDLINE]


3453. J Community Psychol. 2022 Jan;50(1):502-514. doi: 10.1002/jcop.22600. Epub 2021 
May 17.

Validation of the Mental Health Checklist (MHCL) during COVID-19 lockdown.

So CJ(1), Kim J(1), Cifre AB(1), Gonzalez RD(1), Bower JL(2), Alfano CA(1).

Author information:
(1)Department of Psychology, University of Houston, Houston, Texas, USA.
(2)School of Psychology, University of East Anglia, Norwich, UK.

The COVID-19 pandemic resulted in unprecedented disruption to everyday life, 
including widespread social distancing and self-quarantining aimed at reducing 
the virus spread. The Mental Health Checklist (MHCL) is a measure developed to 
assess psychological health during extended periods of isolation and 
confinement, and has shown strong psychometric properties in community samples 
and during Antarctic missions. This study validated the MHCL in a sample of 359 
U.S. and U.K adults during the peak of the COVID-19 lockdown. Confirmatory 
factor analysis (CFA) tested model fit, and convergent validity analyses were 
conducted to compare the MHCL with validated measures of depression, anxiety and 
stress, as well as insomnia. The MHCL exhibited good model fit for most CFA 
indices, and showed strong convergent validity with other measures of 
psychological well-being. Findings suggest that the MHCL is useful for assessing 
mental health in a variety of environments and conditions.

© 2021 Wiley Periodicals LLC.

DOI: 10.1002/jcop.22600
PMCID: PMC8242690
PMID: 33999434 [Indexed for MEDLINE]


3454. Aging Clin Exp Res. 2021 Jun;33(6):1729-1743. doi: 10.1007/s40520-021-01873-4. 
Epub 2021 May 17.

A review on the COVID-19-related psychological impact on older adults: 
vulnerable or not?

Parlapani E(1), Holeva V(2), Nikopoulou VA(2), Kaprinis S(3), Nouskas I(4), 
Diakogiannis I(2).

Author information:
(1)Department of Psychiatry, School of Medicine, Faculty of Health Sciences, 
Aristotle University of Thessaloniki, General Hospital "Papageorgiou", Ring Road 
Thessaloniki, N. Efkarpia, 54603, Thessaloniki, Greece. eparlapa@auth.gr.
(2)Department of Psychiatry, School of Medicine, Faculty of Health Sciences, 
Aristotle University of Thessaloniki, General Hospital "Papageorgiou", Ring Road 
Thessaloniki, N. Efkarpia, 54603, Thessaloniki, Greece.
(3)Department of Psychiatry, School of Medicine, Faculty of Health Sciences, 
Aristotle University of Thessaloniki, Thessaloniki, Greece.
(4)AFFIDEA Center of Medical Diagnosis, Thessaloniki, Greece.

BACKGROUND: COVID-19 is a novel event of the twenty-first century. Therefore, 
contemporary research is required to determine the current pandemic's 
psychological impact on older populations. Soon after the COVID-19 outbreak, 
several narrative reviews and guidelines were released to support older adult's 
psychological wellbeing. However, a lack of data from original studies was 
reported until May 2020.
AIM: To identify studies published from May 2020 until January 2021 that 
quantitatively assessed the mental health impact of COVID-19 on older adults 
using validated psychometric tools.
METHOD: A comprehensive literature search of original research articles was 
conducted using specific terms. The screening procedure was conducted stepwise.
RESULTS: Among the 18 included studies, cross-sectional online surveys indicated 
that older adults were less psychologically distressed than younger ones. A 
longitudinal study revealed that COVID-19 did not have a major impact on 
loneliness and satisfaction with life. On the contrary, studies comparing pre- 
with peri-pandemic data revealed that older adults experienced more severe 
depressive/anxiety/stress symptoms and loneliness during the pandemic. Several 
studies reported though only subclinical symptoms, as well as low loneliness 
levels during the pandemic.
CONCLUSIONS: Research studies suggested that older age may buffer against the 
COVID-19-related impact on mental health. Despite evidence against generalised 
perceptions of vulnerability, older adults' ability to adapt to adversity may be 
uneven, depending on cultural, social, economic and other individual factors. 
Taken together, the impact, moreover the long-term impact of COVID-19, is 
expected to vary across countries and older subpopulations, and remains to be 
evaluated by prospective, longitudinal studies.

DOI: 10.1007/s40520-021-01873-4
PMCID: PMC8127443
PMID: 33999378 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflicts 
of interest.


3455. Clin Nurs Res. 2021 Sep;30(7):1088-1097. doi: 10.1177/10547738211014211. Epub 
2021 May 17.

Family Caregivers' Experiences and Changes in Caregiving Tasks During the 
COVID-19 Pandemic.

Irani E(1), Niyomyart A(1), Hickman RL Jr(1).

Author information:
(1)Frances Payne Bolton School of Nursing, Case Western Reserve University, 
Cleveland, OH, USA.

The purpose of this descriptive study was to describe family caregivers' 
experiences and changes in caregiving tasks and approaches during the COVID-19 
pandemic. Using web-based strategies, 69 family caregivers of adults with 
chronic or disabling conditions were recruited and completed an online survey 
about positive and negative caregiving experiences, and ways in which caregiving 
has changed. Data were analyzed using descriptive statistics (structured 
questions) and conventional content analysis (open-ended responses). 
Participants reported concerns about their loved one's physical and mental 
health, the limited access to other caregiving sources, and the limited 
opportunities to maintain personal well-being. Caregiving tasks completed more 
than usual included providing emotional support, shopping for groceries and 
essentials, and contacting healthcare providers. Participants modified their 
caregiving approach by assuming added responsibilities, leveraging technology, 
and managing a new caregiving routine. Findings indicate that family caregivers 
experienced additional caregiving challenges and changed caregiving tasks 
considering the limited resources available.

DOI: 10.1177/10547738211014211
PMCID: PMC8366190
PMID: 33998836 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


3456. J Gambl Stud. 2022 Mar;38(1):1-13. doi: 10.1007/s10899-021-10029-y. Epub 2021 
May 17.

Gambling by Young Adults in the UK During COVID-19 Lockdown.

Emond A(1), Nairn A(2), Collard S(3), Hollén L(4).

Author information:
(1)Centre for Academic Child Health, Bristol Medical School, University of 
Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK. alan.emond@bristol.ac.uk.
(2)School of Management, Faculty of Social Science and Law, University of 
Bristol, Bristol, UK.
(3)School of Geographical Sciences, University of Bristol, Bristol, UK.
(4)Centre for Academic Child Health, Bristol Medical School, University of 
Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK.

Gambling is a common activity amongst young adults in the UK, and was a behavior 
of interest during the early mitigation against COVID-19 (first lockdown). The 
Avon Longitudinal Study of Parents and Children (ALSPAC) was used to investigate 
attitudes, moods and behavior during lockdown in England. ALSPAC participants 
were invited to complete online questionnaires in May 2020, including a set of 
questions about frequency of gambling and gambling activities which had been 
asked three years previously. Mental health and wellbeing data and alcohol use 
were also collected as part of lockdown questionnaires. Gambling questions were 
completed by 2632 young adults, 71% female, with a mean age of 27.8 years. 
Overall, gambling frequency reduced during lockdown for both males and females, 
but more males engaged in regular (weekly) gambling. Gambling activities became 
more restricted compared to previous reports, but online gambling (e.g. online 
poker, bingo, casino games) was more frequent. Previous gambling behaviour 
predicted gambling frequency during lockdown. No associations were apparent 
between gambling frequency and measures of mental health and well-being. Heavy 
alcohol use was strongly linked with regular gambling during lockdown. Gamblers 
were more than twice as likely as non-gamblers to have experienced financial 
difficulties pre-COVID, but gambling frequency was not related to employment 
status during lockdown. Online gambling increased during lockdown, whilst 
offline gambling activities decreased in frequency. A small minority of regular 
weekly gamblers, who tended to be male and heavy users of alcohol, participated 
in a wide range of online and offline gambling activities.

© 2021. The Author(s).

DOI: 10.1007/s10899-021-10029-y
PMCID: PMC8126430
PMID: 33997939 [Indexed for MEDLINE]

Conflict of interest statement: The authors do not have any conflicts to 
declare.


3457. Patient Educ Couns. 2021 Jul;104(7):1526-1552. doi: 10.1016/j.pec.2021.04.023. 
Epub 2021 May 6.

Effects of parent-provider communication during infant hospitalization in the 
NICU on parents: A systematic review with meta-synthesis and narrative 
synthesis.

Labrie NHM(1), van Veenendaal NR(2), Ludolph RA(3), Ket JCF(4), van der Schoor 
SRD(5), van Kempen AAMW(5).

Author information:
(1)Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; 
Department of Pediatrics and Neonatology, OLVG, Amsterdam, The Netherlands. 
Electronic address: n.h.m.labrie@vu.nl.
(2)Department of Pediatrics and Neonatology, OLVG, Amsterdam, The Netherlands; 
Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's 
Hospital, Amsterdam, The Netherlands.
(3)Independent researcher, Switzerland.
(4)Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
(5)Department of Pediatrics and Neonatology, OLVG, Amsterdam, The Netherlands.

OBJECTIVE: To synthesize and analyse the literature on the effects of 
parent-provider communication during infant hospitalization in the neonatal 
(intensive) care unit (NICU) on parent-related outcomes.
METHODS: Systematic review with meta-synthesis and narrative synthesis. 
Databases (PubMed, PsycINFO, Cochrane Library, CINAHL, Web of Science, Scopus) 
were searched in October/November 2019. Studies reporting, observing, or 
measuring parent-related effects of parent-provider communication in the NICU 
were included. Study quality was assessed using the Quality Assessment Tool for 
Studies with Diverse Designs. Qualitative studies were meta-synthesized using 
deductive and inductive thematic analysis. Quantitative studies were analysed 
using narrative synthesis.
RESULTS: 5586 records were identified; 77 were included, reporting on N = 6960 
parents, N = 693 providers, and N = 300 NICUs. Analyses revealed five main 
(positive and negative) effects of parent-provider interaction on parents' (1) 
coping, (2) knowledge, (3) participation, (4) parenting, and (5) satisfaction. 
Communication interventions appeared impactful, particularly in reducing 
parental stress and anxiety. Findings confirm and refine the NICU Communication 
Framework.
CONCLUSIONS: Parent-provider communication is a crucial determinant for parental 
well-being and satisfaction with care, during and following infant 
hospitalization in the NICU. R. Practice Implications: Providers should 
particularly consider the impact on parents of their day-to-day interaction - 
the most occurring form of communication of all.

Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.pec.2021.04.023
PMID: 33994019 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests The authors declare to have 
to competing interests.


3458. J Public Health (Oxf). 2021 Dec 10;43(4):e757-e758. doi: 10.1093/pubmed/fdab148.

Self-actualization towards positive well-being: combating despair during the 
COVID-19 pandemic.

Del Castillo FA(1)(2).

Author information:
(1)Theology and Religious Education Department, De La Salle University, Manila, 
Philippines 0922.
(2)Graduate School of Religion and Religious Education, New York 10458, USA.

Comment in
    J Public Health (Oxf). 2021 Sep 22;43(3):e538.
    J Public Health (Oxf). 2022 Jun 27;44(2):e335.

The pandemic has brought great distress to the majority of the population in the 
world. Some adverse effects of the pandemic are depression and other mental 
illnesses. To attain positive well-being, self-actualization in the social 
determinants of health plays a crucial role. This paper hopes to contribute to 
the fight against despair during the COVID-19 pandemic.

© The Author(s) 2021. Published by Oxford University Press on behalf of Faculty 
of Public Health. All rights reserved. For permissions, please e-mail: 
journals.permissions@oup.com.

DOI: 10.1093/pubmed/fdab148
PMCID: PMC8194537
PMID: 33993314 [Indexed for MEDLINE]


3459. J Psychosom Res. 2021 Jul;146:110508. doi: 10.1016/j.jpsychores.2021.110508. 
Epub 2021 May 6.

"I'm in iso all the time anyway": A mixed methods study on the impact of 
COVID-19 on women with endometriosis.

Evans S(1), Dowding C(2), Druitt M(3), Mikocka-Walus A(4).

Author information:
(1)School of Psychology, Deakin University, Geelong, Australia; Faculty of 
Health, The Centre for Social and Early Emotional Development, Australia. 
Electronic address: subhadra.evans@deakin.edu.au.
(2)School of Psychology, Deakin University, Geelong, Australia.
(3)School of Psychology, Deakin University, Geelong, Australia; University 
Hospital Geelong, Australia.
(4)School of Psychology, Deakin University, Geelong, Australia; Faculty of 
Health, The Centre for Social and Early Emotional Development, Australia.

OBJECTIVE: The COVID-19 pandemic has resulted in restrictions and social 
isolation measures, which carry mental health risks. Cancellation of surgery and 
appointments, medication shortages and fear of the virus itself may have further 
challenged wellbeing. We aimed to understand how COVID-19 has affected people 
with endometriosis.
METHODS: Using a mixed methods design, we examined; 1) the impact of COVID-19 on 
endometriosis related healthcare, symptoms and functioning; and 2) the 
relationship between a measure of fear of COVID-19 and qualitative impact in 162 
women with endometriosis.
RESULTS: We found that 60% of women reported impact of the pandemic upon 
healthcare, with sub-themes documenting the difficulty of cancelled and delayed 
treatment, specific COVID-19 barriers, and the advantages and disadvantages of 
telehealth. Only 23% reported negative impact on symptoms, specifically stress; 
76% reported impact on daily functioning, with sub-themes related to compromised 
work, social life and healthy living. A 'hidden benefits' theme revealed ways 
that COVID-19 had improved some women's lives, including working from home, and 
the opportunity for healthy lifestyle choices. Logistic regressions revealed 
that fear of COVID-19 significantly predicted impact themes (healthcare odds 
ratio = 0.93, 95% confidence interval: 0.87-0.98; symptoms odds ratio = 0.88, 
95% confidence interval: 0.82-0.95; functioning odds ratio = 0.92, 95% 
confidence interval: 0.85-0.99).
CONCLUSION: Our findings indicate the need to provide patients with supportive 
care during pandemic restrictions that leverage self-management strategies.

Copyright © 2021 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jpsychores.2021.110508
PMCID: PMC8101001
PMID: 33993063 [Indexed for MEDLINE]


3460. J Infect. 2021 Jul;83(1):1-16. doi: 10.1016/j.jinf.2021.05.004. Epub 2021 May 
14.

Epidemiology and organ specific sequelae of post-acute COVID19: A narrative 
review.

Korompoki E(1), Gavriatopoulou M(2), Hicklen RS(3), Ntanasis-Stathopoulos I(2), 
Kastritis E(2), Fotiou D(2), Stamatelopoulos K(2), Terpos E(4), Kotanidou A(5), 
Hagberg CA(6), Dimopoulos MA(7), Kontoyiannis DP(8).

Author information:
(1)Department of Clinical Therapeutics, School of Medicine, National and 
Kapodistrian University of Athens, Athens 11528, Greece; Divison of Brain 
Sciences, Imperial College London, London, United Kingdom. Electronic address: 
e.korompoki@imperial.ac.uk.
(2)Department of Clinical Therapeutics, School of Medicine, National and 
Kapodistrian University of Athens, Athens 11528, Greece.
(3)Research Medical Library, The University of Texas MD Anderson Cancer Center, 
1515 Holcombe Boulevard, Unit 1460, Houston TX 77030, United States. Electronic 
address: rshicklen@mdanderson.org.
(4)Department of Clinical Therapeutics, School of Medicine, National and 
Kapodistrian University of Athens, Athens 11528, Greece. Electronic address: 
eterpos@med.uoa.gr.
(5)Department of Critical Care Medicine and Pulmonary Services, Evangelismos 
Hospital, National and Kapodistrian University of Athens, Athens 11528, Greece. 
Electronic address: akotanid@med.uoa.gr.
(6)Division of Anesthesiology, Critical Care and Pain Medicine, The University 
of Texas MD Anderson Cancer Center, Houston, TX 77030, United States. Electronic 
address: CHagberg@mdanderson.org.
(7)Department of Clinical Therapeutics, School of Medicine, National and 
Kapodistrian University of Athens, Athens 11528, Greece. Electronic address: 
mdimop@med.uoa.gr.
(8)Department of Infectious Diseases, Infection Control and Employee Health, The 
University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States. 
Electronic address: dkontoyi@mdanderson.org.

OBJECTIVES: "Long COVID", a term coined by COVID-19 survivors, describes 
persistent or new symptoms in a subset of patients who have recovered from acute 
illness. Globally, the population of people infected with SARS-CoV-2 continues 
to expand rapidly, necessitating the need for a more thorough understanding of 
the array of potential sequelae of COVID-19. The multisystemic aspects of acute 
COVID-19 have been the subject of intense investigation, but the long-term 
complications remain poorly understood. Emerging data from lay press, social 
media, commentaries, and emerging scientific reports suggest that some COVID-19 
survivors experience organ impairment and/or debilitating chronic symptoms, at 
times protean in nature, which impact their quality of life.
METHODS/RESULTS: In this review, by addressing separately each body system, we 
describe the pleiotropic manifestations reported post COVID-19, their putative 
pathophysiology and risk factors, and attempt to offer guidance regarding 
work-up, follow-up and management strategies. Long term sequelae involve all 
systems with a negative impact on mental health, well-being and quality of life, 
while a subset of patients, report debilitating chronic fatigue, with or without 
other fluctuating or persistent symptoms, such as pain or cognitive dysfunction. 
Although the pathogenesis is unclear, residual damage from acute infection, 
persistent immune activation, mental factors, or unmasking of underlying 
co-morbidities are considered as drivers. Comparing long COVID with other post 
viral chronic syndromes may help to contextualize the complex somatic and 
emotional sequalae of acute COVID-19. The pace of recovery of different aspects 
of the syndrome remains unclear as the pandemic began only a year ago.
CONCLUSIONS: Early recognition of long-term effects and thorough follow-up 
through dedicated multidisciplinary outpatient clinics with a carefully 
integrated research agenda are essential for treating COVID-19 survivors 
holistically.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.jinf.2021.05.004
PMCID: PMC8118709
PMID: 33992686 [Indexed for MEDLINE]


3461. BMC Psychol. 2021 May 15;9(1):79. doi: 10.1186/s40359-021-00583-w.

Mental health and wellbeing implications of the COVID-19 quarantine for disabled 
and disadvantaged children and young people: evidence from a cross-cultural 
study in Zambia and Sierra Leone.

Sharpe D(1), Rajabi M(2)(3), Chileshe C(4), Joseph SM(5)(6), Sesay I(7), 
Williams J(7), Sait S(8).

Author information:
(1)Institute for Connected Communities (ICC), University of East London, 
Stratford Campus, Water Lane, London, E15 4LZ, UK. d.sharpe@uel.ac.uk.
(2)Institute for Connected Communities (ICC), University of East London, 
Stratford Campus, Water Lane, London, E15 4LZ, UK. rajabimohsen@ut.ac.ir.
(3)Department of Psychology, University of Tehran, Tehran, Iran. 
rajabimohsen@ut.ac.ir.
(4)Founder and President of Sport in Action (SIA), Lusaka, Zambia.
(5)Department of Clinical Psychology, Kwame Nkrumah University, Kabwe, Zambia.
(6)Philosophy in Physical Education and Sport, University of Zambia, Lusaka, 
Zambia.
(7)Practical Tools Initiative, London, UK.
(8)School of Business and Law, University of East London, London, UK.

BACKGROUND: The mental health impact of the COVID-19 pandemic and quarantining 
on children and young people (CYP) living in low- and middle-income countries 
(LMICs) has yet to be fully comprehended. CYP in LMICs are at utmost risk, given 
the COVID-19-related restrictions and social distancing measures, resulting in 
reduced access to school-based services for nutritional and mental health needs. 
This study examined mental health of CYP during the first COVID-19 lockdown in 
Zambia and Sierra Leone.
METHOD: A total of 468 disabled and disadvantaged CYP aged 12 to 25 completed a 
planning tool that comprised the short Warwick-Edinburgh Mental Wellbeing Scale 
(SWEMWBS), as well as open-ended questions covering social connectedness, 
physical distancing and educational challenges during the lockdown. The 
community coaches screened individuals and families who could be eligible to 
receive emergency aid, and based on a convenience sample following distribution 
of aid, recipients were invited to complete the planning tool.
RESULTS: The data showed that participants in the global south have increasing 
anxieties and fears centred on accessing offline educational resources and 
income loss in the family effecting food security and their ability to return to 
education. Mean (SD) SWEMWBS scores for all participants in Zambia and Sierra 
Leone, were 19.61 (3.45) and 21.65 (2.84), respectively. Mental well-being 
scores were lower in females, children aged 12-14 and participants with two or 
more disabilities. Factors significantly associated with poor mental wellbeing 
in the sample were: type of disability, nationality, peer relationships, 
connection to others during the pandemic, knowledge about COVID-19, worry about 
the long-term impact of COVID-19, and the types of self-isolating.
CONCLUSION: The study shows that participants who self-reported low levels of 
COVID-19 health literacy also scored low on the mental wellbeing 
self-assessment. Yet, despite undoubted limited resources, these CYP are doing 
well in identifying their needs and maintaining hope in the face of the problems 
associated with COVID-19 in countries where stigma persists around mental 
ill-health.

DOI: 10.1186/s40359-021-00583-w
PMCID: PMC8123096
PMID: 33992113 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3462. J Clin Psychiatry. 2021 Mar 16;82(2):20m13815. doi: 10.4088/JCP.20m13815.

Telehealth Treatment of Patients in an Intensive Acute Care Psychiatric Setting 
During the COVID-19 Pandemic: Comparative Safety and Effectiveness to In-Person 
Treatment.

Zimmerman M(1)(2), Terrill D(1), D'Avanzato C(1), Tirpak JW(1).

Author information:
(1)Department of Psychiatry and Human Behavior, Brown Medical School, and 
Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island.
(2)Corresponding author: Mark Zimmerman, MD, 146 West River St, Providence, RI 
02904 (mzimmerman@lifespan.org).

Comment in
    J Clin Psychiatry. 2021 Aug 17;82(5):
    J Clin Psychiatry. 2021 Aug 17;82(5):

BACKGROUND: Most research evaluating telehealth psychiatric treatment has been 
conducted in outpatient settings. There is a great lack of research assessing 
the efficacy of telehealth treatment in more acute, intensive treatment settings 
such as a partial hospital. In the face of the COVID-19 pandemic, much of 
behavioral health treatment has transitioned to a virtual format. In the present 
report from the Rhode Island Methods to Improve Diagnostic Assessment and 
Services (MIDAS) project, we examined the effectiveness of our partial hospital 
program (PHP).
METHOD: The sample included 207 patients who were treated virtually from May 
2020 to September 2020 and a comparison group of 207 patients who were treated 
in the in-person partial program a year earlier. Patients completed 
self-administered measures of patient satisfaction, symptoms, coping ability, 
functioning, and general well-being.
RESULTS: For both the in-person and telehealth methods of delivering partial 
hospital level of care, patients were highly satisfied with treatment and 
reported a significant reduction in symptoms and suicidality from admission to 
discharge. On the modified Remission from Depression Questionnaire, the primary 
outcome measure, both groups reported a significant (P < .01) improvement in 
functioning, coping ability, positive mental health, and general well-being. A 
large effect size of treatment (Cohen d > 0.8) was found in both treatment 
groups. The only significant difference in outcome between the patients treated 
in the different formats was a greater length of stay (mean ± SD of 13.5 ± 8.1 
vs 8.5 ± 5.0 days, t = 7.61, P < .001) and greater likelihood of staying in 
treatment until completion (72.9% vs 62.3%, χ2 = 5.34, P < .05) in the virtually 
treated patients.
CONCLUSIONS: Telehealth partial hospital treatment was as effective as in-person 
treatment in terms of patient satisfaction, symptom reduction, suicidal ideation 
reduction, and improved functioning and well-being. The treatment completion 
rate was higher in the telehealth cohort, and several patients who were treated 
virtually commented that they never would have presented for in-person treatment 
even if there was no pandemic. Telehealth PHPs should be considered a viable 
treatment option even after the pandemic has resolved.

© Copyright 2021 Physicians Postgraduate Press, Inc.

DOI: 10.4088/JCP.20m13815
PMID: 33989463 [Indexed for MEDLINE]


3463. JAMA Netw Open. 2021 May 3;4(5):e2110090. doi: 
10.1001/jamanetworkopen.2021.10090.

Assessment of a Crowdsourcing Open Call for Approaches to University Community 
Engagement and Strategic Planning During COVID-19.

Day S(1), Li C(2), Hlatshwako TG(1)(3), Abu-Hijleh F(4), Han L(5), Deitelzweig 
C(6), Bayus B(7), Ramaswamy R(8), Tang W(9)(10)(11), Tucker 
JD(1)(9)(10)(12)(13).

Author information:
(1)Institute for Global Health and Infectious Diseases, University of North 
Carolina at Chapel Hill, Chapel Hill.
(2)Department of Health Behavior, Gillings School of Global Public Health, 
University of North Carolina at Chapel Hill, Chapel Hill.
(3)Department of Health Policy and Management, Gillings School of Global Public 
Health, University of North Carolina at Chapel Hill, Chapel Hill.
(4)Department of Global Health, Gillings School of Global Public Health, 
University of North Carolina at Chapel Hill, Chapel Hill.
(5)Department of Biostatistics, Harvard T.H. Chan School of Public Health, 
Boston, Massachusetts.
(6)Department of English and Comparative Literature, University of North 
Carolina at Chapel Hill, Chapel Hill.
(7)Kenan-Flagler Business School, University of North Carolina at Chapel Hill, 
Chapel Hill.
(8)Public Health Leadership Program, Gillings School of Global Public Health, 
University of North Carolina at Chapel Hill, Chapel Hill.
(9)Social Entrepreneurship to Spur Health, Guangzhou, China.
(10)University of North Carolina at Chapel Hill Project-China, Guangzhou.
(11)Dermatology Hospital, Southern Medical University, Guangzhou, China.
(12)Department of Medicine, University of North Carolina at Chapel Hill, Chapel 
Hill.
(13)Faculty of Infectious and Tropical Diseases, London School of Hygiene and 
Tropical Medicine, London, United Kingdom.

IMPORTANCE: Reimagining university life during COVID-19 requires substantial 
innovation and meaningful community input. One method for obtaining community 
input is crowdsourcing, which involves having a group of individuals work to 
solve a problem and then publicly share solutions.
OBJECTIVE: To evaluate a crowdsourcing open call as an approach to COVID-19 
university community engagement and strategic planning.
DESIGN, SETTING, AND PARTICIPANTS: This qualitative study assessed a 
crowdsourcing open call offered from June 16 to July 16, 2020, that sought ideas 
to inform safety in the fall 2020 semester at the University of North Carolina 
at Chapel Hill (UNC). Digital methods (email and social media) were used for 
promotion, and submissions were collected online for 4 weeks. Participation was 
open to UNC students, staff, faculty, and others.
MAIN OUTCOMES AND MEASURES: Submissions were evaluated for innovation, 
feasibility, inclusivity, and potential to improve safety and well-being. 
Demographic data were collected from submitting individuals, and submissions 
were qualitatively analyzed for emergent themes on challenges with and solutions 
for addressing safety and well-being in the fall semester. Data were shared with 
UNC leadership to inform decision-making.
RESULTS: The open call received 82 submissions from 110 participants, including 
current UNC students (56 submissions [68%]), people younger than 30 years (67 
[82%]), women (55 [67%]), and individuals identifying as a racial/ethnic 
minority or as multiracial/ethnic (49 [60%]). Seven submissions were identified 
as finalists and received cash prizes with the encouragement to use these funds 
toward idea development and implementation. Seventeen runner-up teams were 
linked to university resources for further development. Thematic analysis of 
submissions regarding challenges with the fall semester revealed not only 
physical health concerns and the limitations of remote learning but also 
challenges that have been exacerbated by the pandemic, such as a lack of mental 
health support, structural racism and inequality, and insufficient public 
transportation. Solutions included novel ideas to support mental health among 
specific populations (eg, graduate students and racial/ethnic minorities), 
improve health equity, and increase transit access. All 24 finalists and 
runners-up indicated interest in implementation after being notified of the open 
call results.
CONCLUSIONS AND RELEVANCE: This study suggests that open calls are a feasible 
strategy for university community engagement on COVID-19, providing a 
stakeholder-driven approach to identifying promising ideas for enhancing safety 
and well-being. Open calls could be formally incorporated into university 
planning processes to develop COVID-19 safety strategies that are responsive to 
diverse community members' concerns.

DOI: 10.1001/jamanetworkopen.2021.10090
PMCID: PMC8122225
PMID: 33988706 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest Disclosures: None reported.


3464. J Perinatol. 2021 Nov;41(11):2614-2620. doi: 10.1038/s41372-021-01016-7. Epub 
2021 May 13.

Infant delivery and maternal stress during the COVID-19 pandemic: a comparison 
of the well-baby versus neonatal intensive care environments.

Bin-Nun A(1)(2), Palmor-Haspal S(1)(3), Mimouni FB(1)(4), Kasirer Y(5)(6), 
Hammerman C(1)(2), Tuval-Moshiach R(7).

Author information:
(1)Shaare Zedek Medical Center, Jerusalem, Israel.
(2)The Faculty of Medicine of the Hebrew University, Jerusalem, Israel.
(3)Herzog Academic College, Jerusalem, Israel.
(4)Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
(5)Shaare Zedek Medical Center, Jerusalem, Israel. yairkasir@szmc.org.il.
(6)The Faculty of Medicine of the Hebrew University, Jerusalem, Israel. 
yairkasir@szmc.org.il.
(7)Department of Psychology, Bar Ilan University, Ramat Gan, Israel.

OBJECTIVE: To describe impact of COVID-19 pandemic on stress and mood of new 
mothers, in particular in neonatal intensive care unit (NICU); a secondary 
objective was to assess whether customary social gender distancing practiced by 
ultra-religious Jews and Muslims offers built-in anti-stress protection.
METHODS: Cross-sectional, observational survey of mothers of 52 normal newborn 
nursery (NNB) and 52 NICU infants. In all, 86 filled all the 6 questionnaires 
(Demographics, COVID-19 virus experience, Mental Health Inventory, Neonatal 
Satisfaction Survey, Parental Stressor Scale, and Questionnaire of Coping 
Strategies).
RESULTS: Most mothers stated that COVID-19 pandemic had hurt social and family 
relationships, maternal role, and expressed stress and loneliness. Mothers of 
NICU infants had higher degree of helplessness. Religious social distancing was 
not protective. Background tendency to coping poorly with stress and depression 
most highly predicted stress.
CONCLUSION: COVID-19 pandemic harms psychosocial well-being of most mothers. 
Detection of high-risk individuals is necessary to provide appropriate support.

© 2021. The Author(s), under exclusive licence to Springer Nature America, Inc.

DOI: 10.1038/s41372-021-01016-7
PMCID: PMC8117124
PMID: 33986472 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


3465. BMJ Open. 2021 May 13;11(5):e049851. doi: 10.1136/bmjopen-2021-049851.

When COVID-19 enters in a community setting: an exploratory qualitative study of 
community perspectives on COVID-19 affecting mental well-being.

Ali NA(1), Feroz AS(2), Akber N(3), Feroz R(4), Nazim Meghani S(2), Saleem S(2).

Author information:
(1)School of Nursing & Midwifery, Aga Khan University, Karachi, Pakistan 
naureenalimeghani@gmail.com.
(2)Community Health Sciences, Aga Khan University, Karachi, Pakistan.
(3)Department of Sociology, University of Karachi, Karachi, Pakistan.
(4)Aga Khan University Institute for Educational Development, Karachi, Pakistan.

Erratum in
    BMJ Open. 2021 Jul 7;11(7):e049851corr1.

OBJECTIVE: The COVID-19 pandemic has resulted in an increased level of anxiety 
and fear among the general population related to its management and infection 
spread. Considering the relevance of present circumstances, we explored 
perceptions and attitudes of community members towards their mental well-being 
during the COVID-19 pandemic.
SETTING: We conducted an exploratory qualitative study using a purposive 
sampling approach, at two communities of Karachi, Pakistan.
PARTICIPANTS: In-depth interviews were conducted with community members 
including, young adults, middle-aged adults and older adults of both genders. 
Study data were analysed manually using the thematic analysis technique.
PRIMARY OUTCOME: The primary outcome is assessing community perception towards 
their mental well-being amidst the COVID-19 pandemic.
RESULTS: A total of 27 in-depth interviews were conducted, between May and June 
2020. Three overarching themes were identified: (1) impact of COVID-19 on the 
mental health of the general communities; (2) current coping mechanisms to adapt 
to the new reality and (3) recommendations to address the mental health of 
communities. Generally, community members underwent increased anxiety and fear 
due to the contagious nature of the virus. Alongside, social, financial and 
religious repercussions of the pandemic have also heightened psychological 
distress among community members. However, community members were able to point 
out some of the coping mechanisms such as getting closer to God, connecting with 
family, participating in mental health sessions and resetting lives by indulging 
in diverse activities. Simultaneously, they also recommended the need for remote 
mental health services for elders and continuous efforts by the government to 
address the mental health needs of the community.
CONCLUSION: COVID-19-associated mental health consequences have hit every 
individual in society. The study finding has the potential to guide the 
development of context-specific innovative mental health programmes to overcome 
the pandemic repercussions.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-049851
PMCID: PMC8126434
PMID: 33986068 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3466. BMJ Open. 2021 May 13;11(5):e046547. doi: 10.1136/bmjopen-2020-046547.

Scoping review of mental health in prisons through the COVID-19 pandemic.

Johnson L(1), Gutridge K(2), Parkes J(3), Roy A(4), Plugge E(3)(4).

Author information:
(1)Department of Primary Care, Population Sciences and Medical Education, 
University of Southampton Faculty of Medicine, Southampton, UK 
l.johnson@soton.ac.uk.
(2)Centre for Women's Mental Health, Division of Psychology and Mental Health, 
School of Health Sciences, The University of Manchester Faculty of Biology 
Medicine and Health, Manchester, UK.
(3)Department of Primary Care, Population Sciences and Medical Education, 
University of Southampton Faculty of Medicine, Southampton, UK.
(4)Health and Justice Team, Alcohol, Drugs, Tobacco and Justice Division, Public 
Health England, London, UK.

OBJECTIVE: To examine the extent, nature and quality of literature on the impact 
of the COVID-19 pandemic on the mental health of imprisoned people and prison 
staff.
DESIGN: Scoping review.
DATA SOURCES: PubMed, Embase, CINAHL, Global Health, Cochrane, PsycINFO, 
PsychExtra, Web of Science and Scopus were searched for any paper from 2019 
onwards that focused on the mental health impact of COVID-19 on imprisoned 
people and prison staff. A grey literature search focused on international and 
government sources and professional bodies representing healthcare, public 
health and prison staff was also performed. We also performed hand searching of 
the reference lists of included studies.
ELIGIBILITY CRITERIA FOR SELECTION OF STUDIES: All papers, regardless of study 
design, were included if they examined the mental health of imprisoned people or 
prison staff specifically during the COVID-19 pandemic. Imprisoned people could 
be of any age and from any countries. All languages were included. Two 
independent reviewers quality assessed appropriate papers.
RESULTS: Of 647 articles found, 83 were eligible for inclusion, the majority 
(58%) of which were opinion pieces. The articles focused on the challenges to 
prisoner mental health. Fear of COVID-19, the impact of isolation, 
discontinuation of prison visits and reduced mental health services were all 
likely to have an adverse effect on the mental well-being of imprisoned people. 
The limited research and poor quality of articles included mean that the 
findings are not conclusive. However, they suggest a significant adverse impact 
on the mental health and well-being of those who live and work in prisons.
CONCLUSIONS: It is key to address the mental health impacts of the pandemic on 
people who live and work in prisons. These findings are discussed in terms of 
implications for getting the balance between infection control imperatives and 
the fundamental human rights of prison populations.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2020-046547
PMCID: PMC8727680
PMID: 33986064 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3467. BMJ Open. 2021 May 11;11(5):e048720. doi: 10.1136/bmjopen-2021-048720.

International survey for assessing COVID-19's impact on fear and health: study 
protocol.

Lok KY(1), Fong DYT(2), Wong JYH(1), Ho M(1), Choi EP(1), Pandian V(3), Davidson 
PM(3), Duan W(4), Tarrant M(5), Lee JJ(1), Lin CC(1); CARE group.

Collaborators: Alabdulwahhab KM, Ahmad MS, Ahmed NAM, Ahmed R, Alboraie M, 
Alzahrani MA, Bilimale A, Boonpatcharanon S, Byiringiro S, Hasan MKC, Clausi L, 
Corzo W, Dantsoho FA, De Leon JM, De Leon AS, Deek H, Efficace F, ElNayal MA, 
Ensaldo-Carrasco E, Escotorin P, Agnes Fadodun O, Fawole IO, Shawn Goh YS, 
Irawan D, Ebrahim Khan N, Koirala B, Krishna A, Kwok C, Le TT, Leal DG, 
Lezana-Fernández MÁ, Manirambona E, Mantoani LC, Mbakeh O, Meneses-González F, 
Mohamed IE, Mukeshimana M, Minh Nguyen CT, Thanh Nguyen HT, Nguyen KT, Nguyen 
ST, Nurumal MS, Ogungbe B, Oluwadamilare A, Poon AC, Puang-Ngern B, 
Reséndiz-Rodriguez A, Sagun CG, Shankar NG, Sommer K, Toro E, Hong Tran HT, 
Urgel EL, Uwiringiyimana E, Valdez OC, Vanichbuncha T, Youssef N.

Author information:
(1)School of Nursing, University of Hong Kong Li Ka Shing Faculty of Medicine, 
Hong Kong, Hong Kong.
(2)School of Nursing, University of Hong Kong Li Ka Shing Faculty of Medicine, 
Hong Kong, Hong Kong dytfong@hku.hk.
(3)School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA.
(4)Department of Social Work, East China University of Science and Technology, 
Shanghai, China.
(5)School of Nursing, The University of British Columbia, Vancouver, British 
Columbia, Canada.

INTRODUCTION: COVID-19, caused by the SARS-CoV-2, has been one of the most 
highly contagious and rapidly spreading virus outbreak. The pandemic not only 
has catastrophic impacts on physical health and economy around the world, but 
also the psychological well-being of individuals, communities and society. The 
psychological and social impacts of the COVID-19 pandemic internationally have 
not been well described. There is a lack of international study assessing 
health-related impacts of the COVID-19 pandemic, especially on the degree to 
which individuals are fearful of the pandemic. Therefore, this study aims to (1) 
assess the health-related impact of the COVID-19 pandemic in community-dwelling 
individuals around the world; (2) determine the extent various communities are 
fearful of COVID-19 and (3) identify perceived needs of the population to 
prepare for potential future pandemics.
METHODS AND ANALYSIS: This global study involves 30 countries. For each country, 
we target at least 500 subjects aged 18 years or above. The questionnaires will 
be available online and in local languages. The questionnaires include 
assessment of the health impacts of COVID-19, perceived importance of future 
preparation for the pandemic, fear, lifestyles, sociodemographics, 
COVID-19-related knowledge, e-health literacy, out-of-control scale and the 
Patient Health Questionnaire-4. Descriptive statistics will be used to describe 
participants' characteristics, perceptions on the health-related impacts of 
COVID-19, fear, anxiety and depression, lifestyles, COVID-19 knowledge, e-health 
literacy and other measures. Univariable and multivariable regression models 
will be used to assess the associations of covariates on the outcomes.
ETHICS AND DISSEMINATION: The study has been reviewed and approved by the local 
ethics committees in participating countries, where local ethics approval is 
needed. The results will be actively disseminated. This study aims to map an 
international perspective and comparison for future preparation in a pandemic.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-048720
PMCID: PMC8117470
PMID: 33980534 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3468. BMJ Open. 2021 May 11;11(5):e047135. doi: 10.1136/bmjopen-2020-047135.

Let It Out (LIO) study: protocol for a mixed-methods study to optimise the 
design and assess the feasibility of an online emotional disclosure-based 
intervention in UK hospices.

McInnerney D(1), Candy B(2), Stone P(2), Kupeli N(2).

Author information:
(1)Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, 
London, UK daisy.mcinnerney.18@ucl.ac.uk.
(2)Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, 
London, UK.

INTRODUCTION: The current COVID-19 pandemic has forced hospices to look for more 
ways to support people remotely, including psychological support. Emotional 
disclosure-based interventions hold potential as a way of providing support 
remotely. However, evidence of their efficacy in people with terminal illness is 
mixed. Reviews have highlighted this may be due to interventions not being 
tailored to the unique needs of this population. In response to this, we are 
developing Let It Out (LIO), an online, self-guided emotional disclosure-based 
intervention tailored for people living with terminal illness.
AIMS: The primary objective of the study is to optimise the design of the LIO 
intervention. Secondary objectives include assessing its acceptability and 
feasibility; exploring potential impact on well-being; identifying potential 
adverse effects; and informing choice of outcome measures for potential future 
evaluation.
METHODS AND ANALYSIS: A single arm, mixed-methods, multisite, longitudinal 
study. Up to 40 people living with a terminal illness under the care of hospices 
in England and Scotland will receive the online LIO intervention. LIO consists 
of 3, self-guided expression sessions over 2 weeks. The primary outcome measures 
are (1) a structured feedback form completed by participants after the final 
expression session; and (2) semi-structured interviews and focus groups with ≤15 
patient participants, ≤30 hospice staff and ≤15 informal carers. These 
quantitative and qualitative data will be triangulated via process evaluation to 
inform optimisation of the intervention design. Secondary outcome measures 
include validated measures of physical and psychological health collected at 
baseline and after the final expression session (immediately, 1, 4 and 8 weeks 
after); and data on recruitment, retention and fidelity.
ETHICS AND DISSEMINATION: The study is approved by the University College London 
Research Ethics Committee (reference: 15281/002). The findings will be shared 
through peer-reviewed scientific journals and conferences, and traditional, 
online and social media platforms.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/bmjopen-2020-047135
PMCID: PMC8117994
PMID: 33980530 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3469. BMC Psychiatry. 2021 May 12;21(1):250. doi: 10.1186/s12888-021-03261-8.

A qualitative study of experiences of NHS mental healthcare workers during the 
Covid-19 pandemic.

Liberati E(1), Richards N(1), Willars J(2), Scott D(3), Boydell N(4), Parker 
J(5), Pinfold V(5), Martin G(1), Dixon-Woods M(1), Jones PB(6).

Author information:
(1)Department of Public Health and Primary Care, THIS Institute (The Healthcare 
Improvement Studies Institute), University of Cambridge, Cambridge, UK.
(2)Department of Health Sciences, University of Leicester, Leicester, UK.
(3)Population Health and Genomics, University of Dundee, Dundee, UK.
(4)Centre for Biomedicine Self and Society, Usher Institute, University of 
Edinburgh, Edinburgh, UK.
(5)McPin Foundation, London, SE1 4YR, UK.
(6)Department of Psychiatry, Cambridgeshire & Peterborough NHS Foundation Trust, 
University of Cambridge, Cambridge, CB2 0SZ, UK. pbj21@cam.ac.uk.

BACKGROUND: The Covid-19 pandemic has imposed extraordinary strains on 
healthcare workers. But, in contrast with acute settings, relatively little 
attention has been given to those who work in mental health settings. We aimed 
to characterise the experiences of those working in English NHS secondary mental 
health services during the first wave of the pandemic.
METHODS: The design was a qualitative interview-based study. We conducted 
semi-structured, remote (telephone or online) interviews with 35 members of 
staff from NHS secondary (inpatient and community) mental health services in 
England. Analysis was based on the constant comparative method.
RESULTS: Participants reported wide-ranging changes in the organisation of 
secondary mental health care and the nature of work in response to the pandemic, 
including pausing of all services deemed to be "non-essential", deployment of 
staff across services to new and unfamiliar roles, and moves to remote working. 
The quality of participants' working life was impaired by increasing levels of 
daily challenge associated with trying to provide care in trying and constrained 
circumstances, the problems of forging new ways of working remotely, and 
constraints on ability to access informal support. Participants were confronted 
with difficult dilemmas relating to clinical decision-making, prioritisation of 
care, and compromises in ability to perform the therapeutic function of their 
roles. Other dilemmas centred on trying to balance the risks of controlling 
infection with the need for human contact. Many reported features of moral 
injury linked to their perceived failures in providing the quality or level of 
care that they felt service users needed. They sometimes sought to compensate 
for deficits in care through increased advocacy, taking on additional tasks, or 
making exceptions, but this led to further personal strain. Many experienced 
feelings of grief, helplessness, isolation, distress, and burnout. These 
problems were compounded by sometimes poor communication about service changes 
and by staff feeling that they could not take time off because of the potential 
impact on others. Some reported feeling poorly supported by organisations.
CONCLUSIONS: Mental health workers faced multiple adversities during the 
pandemic that were highly consequential for their wellbeing. These findings can 
help in identifying targets for support.

DOI: 10.1186/s12888-021-03261-8
PMCID: PMC8113793
PMID: 33980215 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3470. J Phys Act Health. 2021 May 11;18(6):677-685. doi: 10.1123/jpah.2020-0649. Print 
2021 Jun 1.

Changes in Physical Activity, Sleep, Mental Health, and Social Media Use During 
COVID-19 Lockdown Among Adolescent Girls: A Mixed-Methods Study.

O'Kane SM, Lahart IM, Gallagher AM, Carlin A, Faulkner M, Jago R, Murphy MH.

Erratum in
    J Phys Act Health. 2022 Nov 15;20(1):

BACKGROUND: To suppress the transmission of coronavirus, many governments, 
including that of the island of Ireland, implemented a societal lockdown, which 
included school closures, limits on social gatherings, and time outdoors. This 
study aimed to evaluate changes in physical activity (PA), mental health, sleep, 
and social media use among adolescent girls during lockdown.
METHODS: 281 female pupils (12-14 y) taking part in the ongoing Walking In 
Schools study on the island of Ireland self-reported PA, mental health, sleep, 
and social media use before (September-October 2019) and during lockdown 
(May-June 2020), via questionnaires. These were supplemented with open-ended 
structured interviews conducted with 16 girls during lockdown.
RESULTS: During the period of lockdown and school closures, pupils tried new 
forms of PA and undertook PA with family, but there was no significant change in 
self-reported PA. There was a decline in health-related quality of life and 
motivation for exercise; however, self-efficacy for walking and happiness with 
appearance increased. There was no change in sleep quality or social media 
usage.
CONCLUSIONS: Despite the many challenges that schools face as they reopen, there 
is a need to continue to prioritize PA and motivation for exercise to support 
health and well-being in adolescent girls.

DOI: 10.1123/jpah.2020-0649
PMID: 33979779 [Indexed for MEDLINE]


3471. Pediatr Hematol Oncol. 2021 Nov;38(8):683-694. doi: 
10.1080/08880018.2021.1922559. Epub 2021 May 11.

Impact of the COVID-19 pandemic on health-related quality of life and anxiety in 
pediatric hematology/oncology patients.

Hassan E(1)(2), Nagui Rizk D(3), Aly NM(4), El Chazli Y(1).

Author information:
(1)Department of Pediatrics, Hematology and Oncology Unit, Faculty of Medicine, 
Alexandria University, Alexandria, Egypt.
(2)Paediatric Haematology Department, Birmingham Children's Hospital, 
Birmingham, United Kingdom.
(3)Department of Neuropsychiatry, Psychiatry Unit, Faculty of Medicine, 
Alexandria, Egypt.
(4)Department of Pediatric Dentistry and Dental Public Health, Faculty of 
Dentistry, Alexandria University, Alexandria, Egypt.

Since the World Health Organization declared the COVID-19 pandemic in March 
2020, the strain on healthcare services affected patients suffering from various 
comorbidities and added to the psychological burden. The study aimed to assess 
the health-related quality of life (HRQoL) and anxiety levels of pediatric 
Hematology/Oncology patients during the COVID19 pandemic and evaluate the 
association between anxiety levels and physical, emotional, and social aspects 
of HRQoL. A cross-sectional study was conducted on 292 children between 
2.5 - 13 years with chronic hematological/oncological disorders. Pediatric 
Quality of Life Generic Core Scale and Spence Children's Anxiety Scale were used 
for assessment of HRQoL and anxiety, respectively. Linear regression was 
performed to assess the association between background and COVID-19 related 
factors with anxiety level. Multivariate Analysis of Variance (MANOVA) was 
performed to assess the association between the three HRQoL dimensions with 
child anxiety and different independent variables. Transfusion-dependent 
patients had lower anxiety levels than patients receiving chemotherapy 
(B=-14.45, 95% CI=-21.94,-6.95).Children who were aware of the pandemic had 
lower anxiety scores than those who were not, while those suffering from 
canceled clinic days had higher anxiety levels (B=-8.66,95% CI=-14.86,-2.45, and 
B = 7.33,95% CI =1.22,13.45, respectively). Anxiety significantly reduced the 
three HRQoL domains (B=-0.36, 95% CI=-0.47, -0.24 for physical functioning, 
B=-0.45, 95% CI =-0.56, -0.33 for social functioning and B=-0.50, 95% 
CI=-0.63,-0.38 for emotional functioning). This study highlights the effect of 
the pandemic on the anxiety level and hence the HRQoL of chronic 
hematological/oncological pediatric patients for guiding policies and 
interventions to maintain their psychological well-being.

DOI: 10.1080/08880018.2021.1922559
PMID: 33974490 [Indexed for MEDLINE]


3472. Int J Clin Pract. 2021 Aug;75(8):e14319. doi: 10.1111/ijcp.14319. Epub 2021 May 
21.

Impact of COVID-19 and partial lockdown on access to care, self-management and 
psychological well-being among people with diabetes: A cross-sectional study.

Yeoh E(1), Tan SG(2), Lee YS(3), Tan HH(1), Low YY(1), Lim SC(1)(4), Sum 
CF(1)(4), Tavintharan S(1)(4), Wee HL(2)(5).

Author information:
(1)Diabetes Centre, Admiralty Medical Centre, Khoo Teck Puat Hospital, 
Singapore, Singapore.
(2)Saw Swee Hock School of Public Health, National University of Singapore, 
Singapore, Singapore.
(3)Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore.
(4)Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore.
(5)Department of Pharmacy, Faculty of Science, National University of Singapore, 
Singapore, Singapore.

BACKGROUND: The impact of lockdown measures can be widespread, affecting both 
clinical and psychosocial aspects of health. This study aims to assess changes 
in health services access, self-care, behavioural, and psychological impact of 
COVID-19 and partial lockdown amongst diabetes patients in Singapore.
METHODS: We conducted a cross-sectional online survey amongst people with 
diabetes with the Diabetes Health Profile-18 (DHP-18). Hierarchical regression 
analyses were performed for each DHP-18 subscale (Psychological Distress, 
Disinhibited Eating and Barriers to Activity) as dependent variables in separate 
models.
RESULTS: Among 301 respondents, 45.2% were women, 67.1% of Chinese ethnicity, 
24.2% were aged 40 to 49 years, 68.4% have Type 2 diabetes and 42.2% on oral 
medications alone. During the pandemic and the lockdown, nearly all respondents 
were able to receive care safely from the clinics they attend (94%) and obtain 
their medications and diabetes equipment and supplies (97%) when needed. 
Respondents reported less frequent engagement in physical activity (38%), 
checking of blood pressure (29%) and blood glucose (22%). Previous diagnosis of 
mental health conditions (β = 9.33, P = .043), Type 1 diabetes (β = 12.92, 
P = .023), number of diabetes-related comorbidities (β = 3.16, P = .007) and 
Indian ethnicity (β = 6.65, P = .034) were associated with higher psychological 
distress. Comorbidities were associated with higher disinhibited eating 
(β = 2.49, P = .014) while ability to reach their doctor despite not going to 
the clinic is negatively associated with psychological distress (β = -9.50 
P = .002) and barriers to activity (β = -7.53, P = .007).
CONCLUSION: Health services access were minimally affected, but COVID-19 and 
lockdown had mixed impacts on self-care and management behaviours. Greater 
clinical care and attention should be provided to people with diabetes with 
multiple comorbidities and previous mental health disorders during the pandemic 
and lockdown.

© 2021 John Wiley & Sons Ltd.

DOI: 10.1111/ijcp.14319
PMCID: PMC8236933
PMID: 33974316 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared no conflict of 
interest.


3473. Neuroradiology. 2022 Jan;64(1):31-42. doi: 10.1007/s00234-021-02722-x. Epub 2021 
May 11.

The impact of the Covid-19 pandemic on adult diagnostic neuroradiology in 
Europe.

Smits M(1), Vernooij MW(2)(3), Bargalló N(4), Ramos A(5), Yousry TA(6).

Author information:
(1)Department of Radiology & Nuclear Medicine (Ne-515), Erasmus MC, University 
Medical Centre Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands. 
marion.smits@erasmusmc.nl.
(2)Department of Radiology & Nuclear Medicine (Ne-515), Erasmus MC, University 
Medical Centre Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
(3)Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, 
Rotterdam, the Netherlands.
(4)Magnetic Resonance Image Core Facility, IDIBAPS and Centre of Diagnostic 
Imaging (CDIC), Hospital Clinic, Barcelona, Spain.
(5)Department of Radiology, Hospital Universitario 12 de Octubre, Madrid, Spain.
(6)Division of Neuroradiology and Neurophysics, Lysholm Department of 
Neuroradiology, UCL IoN, UCLH, London, UK.

PURPOSE: The purpose of this survey was to understand the impact the Covid-19 
pandemic has or has had on the work, training, and wellbeing of professionals in 
the field of diagnostic neuroradiology.
METHODS: A survey was emailed to all ESNR members and associates as well as 
distributed via professional social media channels. The survey was held in the 
summer of 2020 when the first wave had subsided in most of Europe, while the 
second wave was not yet widespread. The questionnaire featured a total of 46 
questions on general demographics, the various phases of the healthcare crisis, 
and the numbers of Covid-19 patients.
RESULTS: One hundred sixty-seven responses were received from 48 countries 
mostly from neuroradiologists (72%). Most commonly taken measures during the 
crisis phase were reduction of outpatient exams (87%), reduction of number of 
staff present in the department (83%), reporting from home (62%), and shift work 
(54%). In the exit phase, these measures were less frequently applied, but 
reporting from home was still frequent (33%). However, only 22% had access to a 
fully equipped work station at home. While 81% felt safe at work during the 
crisis, fewer than 50% had sufficient personal protection equipment for the 
duration of the entire crisis. Mental wellbeing is an area of concern, with 61% 
feeling (much) worse than usual. Many followed online courses/congresses and 
considered these a viable alternative for the future.
CONCLUSION: The Covid-19 pandemic substantially affected the professional life 
as well as personal wellbeing of neuroradiologists.

© 2021. The Author(s).

DOI: 10.1007/s00234-021-02722-x
PMCID: PMC8110687
PMID: 33974110 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


3474. Adv Exp Med Biol. 2021;1318:785-813. doi: 10.1007/978-3-030-63761-3_44.

Reopening Schools After a Novel Coronavirus Surge.

Li D(1), Lin EZ(1), Brault MA(1), Paquette J(2), Vermund SH(3), Godri Pollitt 
KJ(4).

Author information:
(1)Yale School of Public Health, New Haven, CT, USA.
(2)Office of Facilities, Yale University, New Haven, CT, USA.
(3)Yale School of Public Health, New Haven, CT, USA. sten.vermund@yale.edu.
(4)Yale School of Public Health, New Haven, CT, USA. krystal.pollitt@yale.edu.

The coronavirus disease 2019 (COVID-19) pandemic shook the world in ways not 
seen since the pandemic influenza of 1918-1919. As of late August 2020, over 
25 million persons had been infected, and we will see the global death toll 
exceed one million by the end of 2020. Both are minimum estimates. All segments 
of society have been drastically affected. Schools worldwide have been forced to 
close due to illness and absenteeism, transmission and risk to vulnerable 
members of the school community, and community concerns. The decision to reopen 
school during a pandemic will have a tremendous impact on children's safety, 
growth, and well-being. Not opening invites social isolation and suboptimal 
educational experiences, especially for youth whose computing assets and online 
access are limited and those with special needs. The opening has hazards as 
well, and the mitigation of these risks is the topic of this chapter. Opening 
schools requires careful considerations of benefits, risks, and precautions. 
Guiding principles for safety and strategic application of the principles in 
each educational niche are critical issues to consider during school reopening. 
The fundamental principles of disease control involve school-directed 
initiatives (physical distancing and mask use, hand/face and surface cleansing, 
administrative controls, engineering controls) and individual-level risk 
reduction approaches to maximize adherence to new guidelines. The 
school-initiated "top-down" approaches and the individual-level "bottom-up" 
approaches must be synergized, as no single method will ensure safety. We 
discuss how to effectively layer strategies in each educational space to 
increase safety. Since the vulnerability of children has been heightened during 
this pandemic crisis, we highlight the special considerations for mental health 
support that should be considered by schools. The safety principles, disease 
control strategies, and other critical issues discussed here will serve as a 
starting point for developing a safe, comprehensive, and feasible reopening 
plan.

DOI: 10.1007/978-3-030-63761-3_44
PMID: 33973212 [Indexed for MEDLINE]


3475. Med Sci Monit. 2021 May 11;27:e932220. doi: 10.12659/MSM.932220.

A Review of the Global Impact of the COVID-19 Pandemic on Public Mental Health, 
with a Comparison Between the USA, Australia, and Poland with Taiwan and 
Thailand.

Bliźniewska-Kowalska KM(1), Halaris A(2), Wang SC(3)(4), Su KP(5)(6), Maes M(7), 
Berk M(8)(9), Gałecki P(1).

Author information:
(1)Department of Adult Psychiatry, Medical University of Łódź, Łódź, Poland.
(2)Department of Psychiatry and Behavioral Neurosciences, Loyola University 
Stritch School of Medicine, Chicago, IL, USA.
(3)Department of Forensic and Addiction Psychiatry, Jianan Psychiatric Center, 
Ministry of Health and Welfare, Tainan, Taiwan.
(4)Department of Medical Laboratory Science and Biotechnology, Chung Hwa 
University of Medical Technology, Tainan, Taiwan.
(5)Mind-Body Interface Laboratory (MBI-Lab) and Department of Psychiatry, China 
Medical University Hospital, Taichung, Taiwan.
(6)An-Nan Hospital, China Medical University, Tainan, Taiwan.
(7)Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, 
Bangkok, Thailand.
(8)IMPACT - The Institute for Mental and Physical Health and Clinical 
Translation, School of Medicine, Barwon Health, Deakin University, Geelong, 
Victoria, Australia.
(9)Orygen, The National Centre of Excellence in Youth Mental Health, The 
Department of Psychiatry, and The Florey Institute of Neuroscience and Mental 
Health, The University of Melbourne, Parkville, Victoria, Australia.

Coronavirus may have a negative impact not only on physical, but also on mental 
wellbeing. Despite the different approaches of countries to stop the spread of 
the virus and different infection rates, the dynamically developing pandemic has 
already affected the entire world. The consequences of the coronavirus for our 
mental health can be divided into those related to strategies for the prevention 
of infection, like isolation, quarantine, limitation of social contacts, and 
remote work, and those related to the direct impact of infection on our nervous 
system. This review aims to highlight the global effects of the Coronavirus 
Disease 2019 (COVID-19) pandemic on public mental health following social 
restrictions, to identify how infection with severe acute respiratory syndrome 
coronavirus 2 (SARS-CoV-2) may have direct neurophysiological effects and to 
compare the impact on public mental health between the USA, Australia, and 
Poland with Taiwan and Thailand.

DOI: 10.12659/MSM.932220
PMCID: PMC8122850
PMID: 33972496 [Indexed for MEDLINE]


3476. BMC Geriatr. 2021 May 10;21(1):301. doi: 10.1186/s12877-021-02257-z.

Life under lockdown and social restrictions - the experiences of people living 
with dementia and their carers during the COVID-19 pandemic in England.

Tuijt R(1), Frost R(2), Wilcock J(2), Robinson L(3), Manthorpe J(4), Rait G(2), 
Walters K(2).

Author information:
(1)Research Department of Primary Care and Population Health, University College 
London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK. 
r.tuijt@ucl.ac.uk.
(2)Research Department of Primary Care and Population Health, University College 
London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
(3)Newcastle University, Newcastle upon Tyne, UK.
(4)King's College London, London, UK.

BACKGROUND: The impact of COVID-19 restrictions on people living with dementia 
and their carers is an emerging focus of recent research determining how we can 
best support this population. People living with dementia have faced service 
curtailment, increased risk for COVID-19, as well as potential heightened 
deterioration. This study reports the experiences of people living with dementia 
and their family carers during the early months of the COVID-19 pandemic in 
England and the impact on them.
METHODS: We recruited and remotely interviewed 30 people living with dementia in 
their own homes and 31 family carers, via video or telephone call in mid-2020. 
Data were transcribed and analysed using thematic analysis.
RESULTS: People living with dementia often had a basic understanding of COVID-19 
restrictions but could have difficulty translating this into personalised 
risk-appraisal of their own actions. Managing COVID-19 risks facing people 
living with dementia at home was largely done by family carers, exemplified by 
changes to living arrangements, which could strain or sustain caring 
relationships. Well-established familial caring relationships contributed to the 
wellbeing of the person living with dementia and their carer, as well as keeping 
to simple routines that included leaving the home for exercise and stimulation. 
People living with dementia reported some negative psychological and cognitive 
effects due to the imposed restrictions, such as increased apathy, irritability, 
or anxiety, which were fuelled by lack of social engagement.
CONCLUSIONS: Structuring routine (remote) social interactions where possible 
could increase social engagement and improve wellbeing for people living with 
dementia, especially those with limited familial support in a post-COVID-19 
context. As some care relationships had been restructured to manage COVID-19 
risks, additional carer strain may emerge as a result of the impact on the 
independence of the person living with dementia and come to the attention of 
professionals in health and care services. People living with dementia and their 
carers highlighted the importance of maintaining or adapting routines which may 
be useful learning for professionals, although additional support may be 
necessary for those who are impacted by more severe or worsening symptoms of 
dementia.

DOI: 10.1186/s12877-021-02257-z
PMCID: PMC8107803
PMID: 33971847 [Indexed for MEDLINE]

Conflict of interest statement: None declared.


3477. Lancet. 2021 May 22;397(10288):1992-2011. doi: 10.1016/S0140-6736(21)00231-2. 
Epub 2021 May 6.

Securing a sustainable and fit-for-purpose UK health and care workforce.

Anderson M(1), O'Neill C(2), Macleod Clark J(3), Street A(4), Woods M(4), 
Johnston-Webber C(4), Charlesworth A(5), Whyte M(6), Foster M(7), Majeed A(8), 
Pitchforth E(9), Mossialos E(4), Asaria M(4), McGuire A(4).

Author information:
(1)Department of Health Policy, London School of Economics and Political 
Science, London, UK. Electronic address: m.anderson5@lse.ac.uk.
(2)School of Medicine, Dentistry and Biomedical Sciences, Queens University 
Belfast, Belfast, UK.
(3)Faculty of Health Sciences, University of Southampton, Southampton, UK.
(4)Department of Health Policy, London School of Economics and Political 
Science, London, UK.
(5)The Health Foundation, London, UK; College of Social Sciences, Health 
Services Management Centre, University of Birmingham, Birmingham, UK.
(6)College of Medicine and Veterinary Medicine, University of Edinburgh, 
Edinburgh, UK.
(7)NHS Wales Shared Services Partnership, Cardiff, UK.
(8)Department of Primary Care and Public Health, Imperial College London, 
London, UK.
(9)Department of Health Policy, London School of Economics and Political 
Science, London, UK; College of Medicine and Health, University of Exeter, 
Exeter, UK.

Approximately 13% of the total UK workforce is employed in the health and care 
sector. Despite substantial workforce planning efforts, the effectiveness of 
this planning has been criticised. Education, training, and workforce plans have 
typically considered each health-care profession in isolation and have not 
adequately responded to changing health and care needs. The results are 
persistent vacancies, poor morale, and low retention. Areas of particular 
concern highlighted in this Health Policy paper include primary care, mental 
health, nursing, clinical and non-clinical support, and social care. Responses 
to workforce shortfalls have included a high reliance on foreign and temporary 
staff, small-scale changes in skill mix, and enhanced recruitment drives. 
Impending challenges for the UK health and care workforce include growing 
multimorbidity, an increasing shortfall in the supply of unpaid carers, and the 
relative decline of the attractiveness of the National Health Service (NHS) as 
an employer internationally. We argue that to secure a sustainable and 
fit-for-purpose health and care workforce, integrated workforce approaches need 
to be developed alongside reforms to education and training that reflect changes 
in roles and skill mix, as well as the trend towards multidisciplinary working. 
Enhancing career development opportunities, promoting staff wellbeing, and 
tackling discrimination in the NHS are all needed to improve recruitment, 
retention, and morale of staff. An urgent priority is to offer sufficient 
aftercare and support to staff who have been exposed to high-risk situations and 
traumatic experiences during the COVID-19 pandemic. In response to growing calls 
to recognise and reward health and care staff, growth in pay must at least keep 
pace with projected rises in average earnings, which in turn will require 
linking future NHS funding allocations to rises in pay. Through illustrative 
projections, we show that, to sustain annual growth in the workforce at 
approximately 2·4%, increases in NHS expenditure of 4% annually in real terms 
will be required. Above all, a radical long-term strategic vision is needed to 
ensure that the future NHS workforce is fit for purpose.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/S0140-6736(21)00231-2
PMCID: PMC9634455
PMID: 33965066 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of interests MF is Chair of NHS 
Wales Shared Services Partnership Committee. MW was a non-executive director of 
NHS Lothian between February, 2015, to February, 2021. All other authors declare 
no competing interests.


3478. Gen Hosp Psychiatry. 2021 Jul-Aug;71:76-81. doi: 
10.1016/j.genhosppsych.2021.04.008. Epub 2021 Apr 29.

Use of virtual reality in the inpatient rehabilitation of COVID-19 patients.

Kolbe L(1), Jaywant A(2), Gupta A(3), Vanderlind WM(4), Jabbour G(5).

Author information:
(1)Department of Medicine, Weill Cornell Medicine, New York, NY. Electronic 
address: lek4002@med.cornell.edu.
(2)Department of Psychiatry, Department of Rehabilitation, Weill Cornell 
Medicine, New York, NY.
(3)Department of Medicine, Weill Cornell Medicine, New York, NY.
(4)Department of Psychiatry, Weill Cornell Medicine, New York, NY.
(5)Department of Medicine, Weill Cornell Medicine, New York, NY; Division of 
Hospital Medicine, Ascension Saint Thomas Hospital West, Nashville, TN.

INTRODUCTION: Use of virtual reality (VR) in healthcare has expanded in recent 
years. The challenges faced by patients with prolonged COVID-19-related 
hospitalizations - social isolation, disability, neurologic sequelae, 
adjustment-related anxiety, depression, and stress - may be mitigated by the 
novel use of VR as one modality of a comprehensive rehabilitation plan. This 
descriptive study aimed to understand patient satisfaction and perceived benefit 
of virtual reality on a COVID-19 recovery unit, as well as the logistical and 
operational feasibility of providing VR content for patients and staff.
MATERIALS AND METHODS: During the COVID-19 surge in New York City in 2020, the 
COVID-19 Recovery Unit (CRU) of a large academic hospital invited patients and 
staff to participate in VR sessions with three categories of experience: (1) 
Guided meditation, (2) Exploration of natural environments, (3) Cognitive 
stimulation games. Patients and staff were surveyed about satisfaction and 
perceived benefit.
RESULTS: 13 patients and 11 staff were surveyed, with median patient 
satisfaction scores of 9 out of 10, with ten representing "extremely satisfied," 
and median staff satisfaction scores of 10. 13/13 patients answered "yes" to 
recommending the therapy to others, and 12/13 answered "yes" to perceived 
enhancement of their treatment. 11/11 staff answered "yes" to recommending the 
therapy to others, and 11/11 answered "yes" to perceived enhancement of their 
wellbeing.
DISCUSSION: A VR program implemented on a COVID-19 rehabilitation unit for 
patients and healthcare providers was rated as highly satisfactory with 
perceived benefit by survey respondents. Participants commented that the use of 
VR was useful in coping with isolation and loneliness, and could be implemented 
within the context of clinical care for COVID-19 patients as part of a 
comprehensive rehabilitation model. The use of VR was also logistically and 
operationally feasible on the CRU. Future work to compare benefits of VR to 
standard neuropsychological rehabilitation is needed.

Copyright © 2021 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.genhosppsych.2021.04.008
PMCID: PMC8081572
PMID: 33964789 [Indexed for MEDLINE]

Conflict of interest statement: Dr. Kolbe, Dr. Jaywant, Dr. Gupta, Dr. 
Vanderlind, and Dr. Jabbour have nothing to disclose.


3479. J Complement Integr Med. 2021 May 7;18(3):637-640. doi: 10.1515/jcim-2020-0404.

Yoga for children in the new normal - experience sharing.

Kuppusamy M(1), Ramaswamy V(2), Shanmugam P(3), Ramaswamy P(4).

Author information:
(1)Department of Physiology and Biochemistry, Government Yoga and Naturopathy 
Medical College and Hospital, Chennai, India.
(2)Head of Education, Samsidh Group of Schools, Bengaluru, Karnataka, India.
(3)Department of Community Medicine, Government Yoga and Naturopathy Medical 
College and Hospital, Chennai, India.
(4)Department of Physiology, Sri Ramachandra Medical College and Research 
Institute, Sri Ramachandra Institute of Higher Education and Research (SRIHER), 
Chennai, Tamilnadu, India.

OBJECTIVES: Covid-19 Pandemic has affected everyone's mental health. In addition 
to several preventive measures such as wearing a mask, using sanitizer, measures 
also need to be taken to prevent anxiety and depressive disorders due to this 
unexpected crisis situation. Practicing yoga is one of the simple, scientific 
methods to combat stress and prevent anxiety among children.
METHODS: The scientific evidence and anecdotal experiences on benefits of yoga 
is described in this paper, highlighting the importance of yoga in nurturing the 
mental well-being in children.
RESULTS: Scientifically designed and conducted studies as part of the research 
programs by health professionals objectively conclude that mental health 
parameters improve significantly with yoga as an intervention. In addition to 
mental health, yoga will also improve the physical health and boost immunity 
among children which will also help in reducing the infection rate in children.
CONCLUSIONS: As a way forward, authors strongly recommend establishing yoga as a 
curriculum at scale to cover the vast vulnerable population of young children 
who are the future of the nation.

© 2021 Walter de Gruyter GmbH, Berlin/Boston.

DOI: 10.1515/jcim-2020-0404
PMID: 33962512 [Indexed for MEDLINE]


3480. Public Health. 2021 May;194:196-201. doi: 10.1016/j.puhe.2021.03.002. Epub 2021 
May 4.

Online singing groups for people with dementia: scoping review.

Dowson B(1), Schneider J(2).

Author information:
(1)Institute of Mental Health & School of Sociology and Social Policy, 
University of Nottingham, Nottingham, UK. Electronic address: 
becky.dowson@nottingham.ac.uk.
(2)Institute of Mental Health & School of Sociology and Social Policy, 
University of Nottingham, Nottingham, UK.

OBJECTIVES: In the face of the SARS-CoV-2 pandemic, people with dementia and 
their carers are contending with serious challenges to their health and 
wellbeing, due to risk of severe illness, limiting of social contact and 
disruption to usual activities. Many forms of support for people with dementia 
and their carers, including singing groups, have moved online using 
videoconferencing. Previous research has demonstrated the benefits of group 
singing, which include cognitive stimulation, meaningful activity and peer 
support. However, although we know which aspects of the singing group experience 
participants find helpful, we do not know how this experience translates into an 
online videoconferencing format, and this is a very new field with little 
existing research. This article reviews the literature pertinent to online 
singing interventions and uses the findings to develop some suggestions for 
running an online singing group.
STUDY DESIGN: SCOPING REVIEW.
METHODS: Systematic literature searches were conducted in EMBASE, Medline, 
CINAHL, PsycINFO and Web of Science. Owing to the paucity of existing research, 
searches were also conducted in Google Scholar. The scope of the review covered 
five related areas: online music making and music therapy, telemedicine and 
telecare, everyday technology for people with dementia, digital arts and 
dementia, and use of technology for social interaction and leisure. Our analysis 
aimed to integrate the results to inform the implementation of online singing 
groups for people with dementia.
RESULTS: Scoping of evidence from discrete fields of enquiry and different 
disciplinary traditions can inform the delivery of online singing in dementia. 
This literature also yields useful insights into the role of the carer and how 
best to support participants to use technology. Barriers and facilitators to 
online singing were found to relate both to the technology and to the individual 
participant.
CONCLUSION: Lockdown restrictions have led to much innovation, and this is 
likely to lead to changes in practice even after normal life resumes. The 
suggestions in this article will be helpful primarily for practitioners moving 
into online work and researchers investigating this novel area. They may also be 
useful to commissioners and policymakers because they reflect current knowledge 
about best practice.

Copyright © 2021 The Royal Society for Public Health. Published by Elsevier Ltd. 
All rights reserved.

DOI: 10.1016/j.puhe.2021.03.002
PMCID: PMC9587898
PMID: 33962096 [Indexed for MEDLINE]


3481. Psychol Trauma. 2022 Feb;14(2):281-290. doi: 10.1037/tra0001037. Epub 2021 May 
6.

COVID-19 impact on employee flourishing: Parental stress as mediator.

Srinivasan T(1), Sulur Nachimuthu G(1).

Author information:
(1)Department of Management Studies, CEG, Anna University.

Objectives: Coronavirus disease (COVID-19) has adversely affected the global 
community's economic, social, emotional, and physical well-being. Although prior 
research works have rigorously explored the adverse effects of COVID-19 on 
mental health, investigations linking the impact of COVID-19 with parental 
stress and flourishing are very scarce. Rooted in boundary theory, the authors 
examined the influence of COVID-19 on flourishing and parental stress, 
respectively. Furthermore, predicated on spillover theory, the study explored 
the mediating effect of parental stress. Method: In this research, 259 IT 
employees in India were prospectively followed from the second week until the 
twentieth week of lockdown as part of a longitudinal population. A three-stage 
data collection method was employed. The employee completed the COVID-19 impact 
scale in the 2nd and 10th week of lockdown in India. Subsequently, the authors 
administered parental stress and flourishing surveys online in the 20th week. 
Results: Findings revealed that COVID-19 negatively impacted employee 
flourishing, via parental stress that had a partial mediating effect. 
Conclusion: This study is the first of its kind to theoretically and empirically 
investigate the direct and indirect impact of COVID-19 on employees' flourishing 
via parental stress. Based on the findings, the organizations can enhance their 
employees' flourishing by providing the autonomy to control their work time, and 
adequate training to better handle COVID-19 impact and parental stress to have 
better and sustainable human resources. (PsycInfo Database Record (c) 2022 APA, 
all rights reserved).

DOI: 10.1037/tra0001037
PMID: 33956481 [Indexed for MEDLINE]


3482. Am J Health Syst Pharm. 2021 May 6;78(10):872-878. doi: 10.1093/ajhp/zxab076.

Lessons learned from pharmacy learner and educator experiences during early 
stages of COVID-19 pandemic.

Sasser CW(1)(2), Wolcott MD(1)(3), Morbitzer KA(1), Eckel SF(1)(4).

Author information:
(1)Division of Practice Advancement and Clinical Education, University of North 
Carolina Eshelman School of Pharmacy, Chapel Hill, NC.
(2)Monash University, Melbourne, Australia.
(3)Division of Oral and Craniofacial Health Sciences, University of North 
Carolina Adams School of Dentistry, Chapel Hill, NC, USA.
(4)Department of Pharmacy, University of North Carolina Medical Center, Chapel 
Hill, NC, USA.

PURPOSE: To explore pharmacy learner (eg, resident, fellow) and educator (eg, 
residency program director, preceptor) experiences and lessons learned during 
the coronavirus disease 2019 (COVID-19) pandemic.
METHODS: In May 2020, attendees of the virtual Research in Education and 
Practice Symposium (REPS) were invited to participate in two 1-hour networking 
sessions. During these sessions, participants completed individual and group 
reflection exercises where they were asked questions about their experiences 
during the initial stages of the COVID-19 pandemic. Participants who volunteered 
submitted their responses through an electronic survey application. Anonymous 
responses were coded using thematic analysis to address the research questions.
RESULTS: Sixty-eight and 38 participants, respectively, attended the 2 
networking discussions. Participant-identified professional impacts of the 
COVID-19 crisis included unexpected learning experiences, greater adaptability, 
workflow and learning interruptions, and decreased productivity. Personal 
impacts included a greater focus on well-being, physical and social isolation, 
and changes in travel plans. Participants noted positive and negative emotions 
including acceptance, encouragement, anxiety, stress, and frustration. The main 
lessons learned focused on adaptability, gratitude, and empathy. Participants 
shared that they wished they would have known the anticipated duration of the 
pandemic, associated workflow changes, and reliance on technology prior to the 
start of the pandemic. In addition, they predicted that pharmacy practice will 
require changes to workflow flexibility, training expectations, the pharmacist's 
role, and organizational structure.
CONCLUSION: The COVID-19 pandemic has positively and negatively impacted the 
professional and personal lives of pharmacy learners and educators, with the 
most notable impacts being in the areas of well-being and adaptability. Future 
research should explore the experiences of other workforce personnel and 
evaluate the long-term impact on pharmacy practice, patient outcomes, and 
workforce well-being and resiliency.

© American Society of Health-System Pharmacists 2021. All rights reserved. For 
permissions, please e-mail: journals.permissions@oup.com.

DOI: 10.1093/ajhp/zxab076
PMCID: PMC7929438
PMID: 33954427 [Indexed for MEDLINE]


3483. Trials. 2021 May 5;22(1):328. doi: 10.1186/s13063-021-05271-z.

Effect of intensive care unit-specific virtual reality (ICU-VR) to improve 
psychological well-being and quality of life in COVID-19 ICU survivors: a study 
protocol for a multicentre, randomized controlled trial.

Vlake JH(1)(2), Van Bommel J(1), Wils EJ(2), Korevaar TIM(3), Hellemons ME(4), 
Schut AFC(5), Labout JAM(6), Schreuder LLH(1), Gommers D(1), Van Genderen ME(7).

Author information:
(1)Department of Intensive Care, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, 
Rotterdam, The Netherlands.
(2)Department of Intensive Care, Franciscus Gasthuis & Vlietland, Kleiweg 500, 
3045 PM, Rotterdam, The Netherlands.
(3)Department of Internal Medicine, Academic Centre for Thyroid Diseases, 
Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
(4)Department of Pulmonology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, 
Rotterdam, The Netherlands.
(5)Department of Intensive Care, Ikazia Hospital, Montessoriweg 1, 3083 AN, 
Rotterdam, The Netherlands.
(6)Department of Intensive Care, Maasstad Hospital, Maasstadweg 21, 3079 DZ, 
Rotterdam, The Netherlands.
(7)Department of Intensive Care, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, 
Rotterdam, The Netherlands. M.vanGenderen@erasmusmc.nl.

BACKGROUND: The SARS-CoV-2 outbreak has resulted in a tremendous increase in 
hospital and intensive care unit (ICU) admissions all over the world. Patients 
with severe coronavirus disease 2019 (COVID-19) warranting ICU treatment usually 
have prolonged mechanical ventilation and are expected to be prone to develop 
psychological impairments, such as post-traumatic stress disorder (PTSD), 
anxiety and depression, which negatively impact quality of life. To date, no 
effective treatment strategy is available. In the current trial, we aim to 
assess the effect of an ICU-specific virtual reality (ICU-VR) intervention on 
psychological well-being and quality of life after COVID-19 ICU treatment.
METHODS: In this multicentre, randomized controlled trial, we aim to examine 
whether COVID-19-specific ICU-VR, offered 3 months after hospital discharge, 
improves psychological well-being and quality of life. Secondary objectives are, 
firstly, to examine the intra-group changes in psychological well-being and 
quality of life and the inter-group differences in psychological well-being and 
quality of life during follow-up, up to 12 months after hospital discharge, and 
secondly, to examine patients' satisfaction with and rating of ICU care and 
aftercare and patients' perspectives on ICU-VR. Eighty adult patients treated 
for COVID-19 in the mixed-surgical ICUs of four hospitals in Rotterdam, the 
Netherlands, will be included and randomized (1:1) to either early or late 
ICU-VR between June 29 and December 31, 2020. Patients randomized to early 
ICU-VR will receive the ICU-VR intervention during an outpatient clinic visit 
3 months after hospital discharge, whereas patients randomized to late ICU-VR 
will receive ICU-VR 6 months after hospital discharge. Primary outcomes of this 
study are psychological well-being, assessed using the Impact of Event 
Scale-Revised (IES-R) and the Hospital Anxiety and Depression Scale (HADS), and 
quality of life, assessed using the European Quality of Life 5 Dimensions 
(EQ-5D) and RAND-36 questionnaires, up to 6 months after hospital discharge.
DISCUSSION: Currently, an effective treatment for psychological sequelae after 
ICU treatment for specific illnesses is unavailable. Results from this study 
will provide insight whether virtual reality is a modality that can be used in 
ICU aftercare to improve psychological well-being and quality of life, or 
satisfaction, after ICU treatment for specific illnesses such as COVID-19.
TRIAL REGISTRATION: This trial has been retrospectively registered on the 
Netherlands Trial Register on August 14, 2020 ( NL8835 ).

DOI: 10.1186/s13063-021-05271-z
PMCID: PMC8097671
PMID: 33952318 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3484. Clin Psychol Psychother. 2022 Jan;29(1):367-372. doi: 10.1002/cpp.2608. Epub 
2021 May 18.

Online psychological counselling during lockdown reduces anxiety symptoms and 
negative affect: Insights from Italian framework.

Carbone GA(1), Zarfati A(2), Nicoli MS(2), Paulis A(2), Tourjansky G(2), Valenti 
G(1), Valenti EM(2), Massullo C(1), Farina B(1)(2), Imperatori C(1).

Author information:
(1)Cognitive and Clinical Psychology Laboratory, Department of Human Science, 
European University of Rome, Rome, Italy.
(2)Janet Clinical Center, Rome, Italy.

Several studies have shown how COrona VIrus Disease 2019 (COVID-19) and the 
consequent isolation and quarantine measures could affect physical and mental 
well-being. Therefore, the increased request for support and assistance 
represents a critical challenge for clinicians requiring a reorganization of 
care systems. In this regard, online counselling has been identified as a useful 
tool in providing psychological assistance and support. Thus, the main purpose 
of the current study was to investigate the clinical usefulness of a single 
online counselling session in reducing psychopathological symptoms (i.e., state 
anxiety and negative affect) and increasing individual well-being and positive 
affect during the first Italian lockdown. Fifty-three subjects were enrolled and 
randomly assigned to receive an online counselling session [Online Counselling 
Group (OCG) = 26] or to act as controls [Waiting List Group (WLG) = 27]. In the 
post-assessment, compared to WLG, the OCG showed a significant decrease in 
negative affect (18.04 ± 6.30 vs. 30.26 ± 8.61; F1:47  = 29.45; p < .001; dppc2 
 = .92) and state anxiety (36.65 ± 8.35 vs. 48.04 ± 11.51; F1:47  = 17.86; 
p < .001; dppc2  = .49). Taking into account the cyclical nature of COVID-19, 
with the possibility of new peaks and waves, it would be appropriate to consider 
the versatility and usefulness of online psychological counselling in the 
management of COVID-19-related distress.

© 2021 John Wiley & Sons, Ltd.

DOI: 10.1002/cpp.2608
PMID: 33950537 [Indexed for MEDLINE]


3485. Cad Saude Publica. 2021 Apr 30;37(3):e00218320. doi: 10.1590/0102-311X00218320. 
eCollection 2021.

Association of social and economic conditions with the incidence of sleep 
disorders during the COVID-19 pandemic.

[Article in English, Portuguese; Abstract available in Portuguese from the 
publisher]

Lima MG(1), Barros MBA(1), Szwarcwald CL(2), Malta DC(3), Romero DE(2), Werneck 
AO(4), Souza Júnior PRB(2).

Author information:
(1)Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, 
Brasil.
(2)Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, 
Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
(3)Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, 
Brasil.
(4)Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brasil.

Sleep is a fundamental aspect for maintaining physical and emotional health, as 
well as one's well-being. Few studies have assessed the effect of socioeconomic 
conditions on sleep in the COVID-19 pandemic. Our objective was to analyze the 
increase or incidence of sleep disorders according to demographic and economic 
conditions, prior to the pandemic, and according to changes in financial, 
occupational, and household conditions during the pandemic. This study was 
conducted via web access, using data from April 24 to May 24, with 45,160 
Brazilians (aged 18 or older), with a sample weighted by Brazilian National 
Household Sample Survey (PNAD) data. Change in sleep quality (outcome), monthly 
income, effect on family income, occupation/work, gender, age group, marital 
status, and change in domestic work (exposures) were reported. The percentages 
of onset or increase of sleep disorders and adjusted odds ratio were estimated. 
The chance of exacerbation of sleep disorders was 34%, 71%, and twice as high in 
people with income less than one minimum wage before the pandemic, in those who 
lost their job and in those who had a great decrease in their income/were 
without income, respectively. The chance of worsening sleep disorders was 82% 
higher in women; three times higher (OR = 3.14) in the population aged from 18 
to 29, compared to the older adults; and higher with the increase in the amount 
of housework (OR = 2.21). Financial and occupational factors were determinants 
in the worsening of self-reported sleep quality, requiring rapid actions on 
these conditions in order to minimize this effect. Gender, age group, and 
household routines also deserve attention regarding sleep quality.

Publisher: O sono é importante para a manutenção da saúde física, emocional e 
para o bem-estar. Poucos estudos avaliaram o efeito das condições 
socioeconômicas no sono no período da COVID-19. O objetivo foi analisar o 
aumento ou a incidência dos problemas do sono segundo condições demográficas e 
econômicas, prévias à pandemia, e segundo mudanças nas condições financeiras, 
ocupacionais e tarefas domésticas durante a pandemia. Estudo realizado via web, 
usando dados de 24 de abril a 24 de maio, com 45.160 brasileiros (18 ou mais), 
com amostra ponderada pelos dados da Pesquisa Nacional por Amostra de Domicílios 
(PNAD). Mudança na qualidade do sono (desfecho), renda mensal, efeito na renda 
familiar, na ocupação/trabalho, sexo, faixa etária, situação conjugal e 
alteração no trabalho doméstico (exposições) foram reportados. Estimamos os 
percentuais de início ou aumento dos problemas com o sono e os OR ajustados. A 
chance de exacerbação dos problemas com o sono foi de 34%, 71% e duas vezes 
maior nas pessoas com renda inferior a um salário mínimo antes da pandemia, nas 
que perderam o emprego e naquelas que tiveram a renda muito diminuída/ficaram 
sem renda, respectivamente. A chance de piorar os problemas do sono foi 82% 
maior nas mulheres; três vezes maior (OR = 3,14) na população com 18 a 29 anos, 
em relação aos idosos; e maior com o incremento da quantidade de tarefas 
domésticas (OR = 2,21). Fatores financeiros e ocupacionais foram determinantes 
na deterioração da qualidade do sono autorreferida, demandando ações rápidas 
sobre essas condições a fim de minimizar esse impacto. Gênero, faixa etária e 
rotinas domésticas também merecem atenção em relação à qualidade do sono.

Publisher: El sueño es importante para mantener la salud física, emocional y 
bienestar. Pocos estudios evaluaron el efecto de las condiciones socioeconómicas 
en el sueño durante el período de la COVID-19. El objetivo fue analizar el 
aumento o incidencia de los problemas del sueño, según condiciones demográficas 
y económicas, previas a la pandemia, y según cambios en las condiciones 
financieras, ocupacionales y tareas domésticas durante la pandemia. Estudio 
realizado vía web, usando datos del 24 de abril al 24 de mayo, con 45 160 
brasileños (18 o más), con una muestra ponderada por los datos de la Encuesta 
Nacional por Muestreo de Hogares (PNAD). Se informó de cambio en la calidad de 
sueño (desenlace), renta mensual, efecto en la renta familiar, en la 
ocupación/trabajo, sexo, franja etaria, situación conyugal y alteración en el 
trabajo doméstico (exposiciones). Estimamos los porcentajes de inicio o aumento 
de los problemas con el sueño y los OR ajustados. La oportunidad de exacerbación 
de los problemas con el sueño fue un 34%, 71% y 2 veces mayor en las personas 
con renta inferior a 1 salarios mínimos antes de la pandemia, en las que 
perdieron el empleo y en aquellas que tuvieron la renta muy disminuida/se 
quedaron sin renta, respectivamente. La oportunidad de empeorar los problemas de 
sueño fue un 82% mayor en las mujeres; tres veces mayor (OR = 3,14) en la 
población con 18 a 29 años, en relación con los ancianos; y mayor con el 
incremento de la cantidad de tareas domésticas (OR = 2,21). Los factores 
financieros y ocupacionales fueron determinantes en el deterioro de la calidad 
del sueño autoinformada, demandando acciones rápidas sobre estas condiciones, a 
fin de minimizar este impacto. Género, franja de edad y rutinas domésticas 
también merecen atención en relación con la calidad del sueño.

DOI: 10.1590/0102-311X00218320
PMID: 33950076 [Indexed for MEDLINE]


3486. Int J Environ Res Public Health. 2021 Apr 29;18(9):4775. doi: 
10.3390/ijerph18094775.

The Impact of COVID-19 Restrictions on Mental Well-Being and Working Life among 
Faroese Employees.

Davidsen AH(1), Petersen MS(1).

Author information:
(1)Department of Occupational Medicine and Public Health, The Faroese Hospital 
System, 100 Torshavn, Faroe Islands.

The societal changes caused by COVID-19 have been far-reaching, causing 
challenges for employees around the world. The aim of this study was to assess 
the effect of the COVID-19 restrictions on mental well-being, working life, 
family life and social life among Faroese employees within a broad range of 
professions. A total of 1328 Faroese employees answered an anonymous self-report 
survey from 13 April to 4 May 2020. Employee mental well-being was only modestly 
affected by the restrictions and the respondents had a mean score of 50.7 on the 
Warwick-Edinburgh Mental Wellbeing Scale where a score between 41-44 is found to 
correspond with possible depression. Work commitment, work and family life, work 
satisfaction and work ability were all rated significantly worse after the 
COVID-19 outbreak than before (all p values < 0.005). Contrary to previous 
research, employees in health services assessed their work ability significantly 
higher than employees in teaching, and child and youth care (p < 0.05). Working 
parents had higher levels of stress and assessed their work ability 
significantly lower than employees without children (p < 0.05), and women tended 
to be more worried than men because of the pandemic. In conclusion, the overall 
mental well-being of Faroese employees was on an average level during lock-down 
in April and May 2020. Their working life seemed, however, to be worse than 
usual.

DOI: 10.3390/ijerph18094775
PMCID: PMC8125278
PMID: 33947133 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3487. Sensors (Basel). 2021 Apr 29;21(9):3090. doi: 10.3390/s21093090.

Decrease in Mobility during the COVID-19 Pandemic and Its Association with 
Increase in Depression among Older Adults: A Longitudinal Remote Mobility 
Monitoring Using a Wearable Sensor.

Mishra R(1), Park C(1), York MK(2)(3)(4), Kunik ME(4)(5)(6), Wung SF(7), Naik 
AD(5)(6)(8), Najafi B(1).

Author information:
(1)Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael 
E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, 
USA.
(2)Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA.
(3)Parkinson's Disease Research Education and Clinical Center, Michael E. 
DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX 
77030, USA.
(4)Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 
Houston, TX 77030, USA.
(5)VA Health Services Research and Development Center for Innovations in 
Quality, Effectiveness and Safety, Houston, TX 77021, USA.
(6)VA South Central Mental Illness Research, Education and Clinical Center (a 
Virtual Center), Houston, TX 77021, USA.
(7)College of Nursing, University of Arizona, Tucson, AZ 85721, USA.
(8)Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA.

BACKGROUND: Social isolation during COVID-19 may negatively impact older adults' 
wellbeing. To assess its impact, we measured changes in physical activity and 
sleep among community-dwelling older adults, from pre-to post-pandemic 
declaration.
METHOD: Physical activity and sleep in older adults (n = 10, age = 77.3 ± 1.9 
years, female = 40%) were remotely assessed within 3-month pre-to 6-month 
post-pandemic declaration using a pendant-wearable system. Depression was 
assessed pre-and post-pandemic declaration using the Center for Epidemiologic 
Studies Depression scale and was compared with 48 h continuous physical activity 
monitoring data before and during pandemic.
RESULTS: Compared to pre-pandemic, post-pandemic time spent in standing declined 
by 32.7% (Cohen's d = 0.78, p < 0.01), walking by 52.2% (d = 1.1, p < 0.01), 
step-counts by 55.1% (d = 1.0, p = 0.016), and postural transitions by 44.6% (d 
= 0.82, p = 0.017) with increase in sitting duration by 20.5% (d = 0.5, p = 
0.049). Depression symptoms increased by 150% (d = 0.8, p = 0.046). 
Interestingly, increase in depression was significantly correlated with 
unbroken-prolong sitting bout (ρ = 0.677, p = 0.032), cadence (ρ = -0.70, p = 
0.024), and sleep duration (ρ = -0.72, p = 0.019).
CONCLUSION: This is one of the early longitudinal studies highlighting adverse 
effect of the pandemic on objectively assessed physical activity and sleep in 
older adults. Our observations showed need for timely intervention to mitigate 
hard to reverse consequences of decreased physical activity such as depression.

DOI: 10.3390/s21093090
PMCID: PMC8125705
PMID: 33946664 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3488. Health Promot Pract. 2021 May;22(1_suppl):64S-69S. doi: 
10.1177/1524839921996332.

Dance as Lifeline: Transforming Means for Engagement and Connection in Times of 
Social Isolation.

Kelly MP(1), Leventhal D(1).

Author information:
(1)Dance for PD, Mark Morris Dance Group, Brooklyn, NY, USA.

Over the past 20 years, dance has emerged as a safe, effective, and 
evidence-based community intervention that helps thousands of people living with 
Parkinson's disease around the globe maintain well-being and improve quality of 
life. From its initial emergence to the present, COVID-19 has posed fundamental 
challenges to people living with Parkinson's, forcing them to balance the need 
and desire to stay active and socially connected with the requirement to adhere 
to strict shelter-at-home orders. As cities and towns worldwide began shutting 
down in early 2020, people living with Parkinson's found themselves unable to 
access live dance activities that had provided consistent, reliable physical 
support; joyful cognitive stimulation; emotional connection; and social 
engagement. Government sanctioned closures and stay-at-home orders increased the 
potential for apathy, isolation, anxiety, and stress-factors that are already 
heightened in people with Parkinson's. COVID-19 also exacerbated disparities 
based on race, language, socioeconomic background, and age, inequities already 
present in the Parkinson's community and in Parkinson's-focused dance 
programming. In this article, the authors provide a description and analysis of 
ways one dance for Parkinson's program addressed multiples challenges through 
three key initiatives: online group classes in English and Spanish, 
telephone-based resources for people without internet access, and robust online 
training opportunities for teaching artists. The authors outline ways in which 
the pandemic has increased the inclusive nature of dance for Parkinson's 
programming and suggest that changes implemented during the pandemic will 
permanently alter program delivery for the better when it is safe to restore 
group classes in community settings.

DOI: 10.1177/1524839921996332
PMID: 33942644 [Indexed for MEDLINE]


3489. Nurs Manag (Harrow). 2021 Aug 5;28(4):36-40. doi: 10.7748/nm.2021.e1970. Epub 
2021 May 4.

Supporting the well-being of nurses working during COVID-19.

Duncan D(1), Smart A(2).

Author information:
(1)Queen's University Belfast, Belfast, Northern Ireland.
(2)Queens University Belfast, Belfast, Northern Ireland.

On 11 March 2020, the World Health Organization declared that the coronavirus 
disease 2019 (COVID-19) was a pandemic. As the COVID-19 pandemic has developed 
there have been many parallels made with other pandemics and epidemics, such as 
the 1918 influenza A (H1N1) pandemic and the 2003 severe acute respiratory 
syndrome (SARS) epidemic. This article discusses the challenges experienced by 
healthcare staff working during COVID-19, and the lessons that can be learned, 
such as the enhanced support required for staff.

© 2021 RCN Publishing Company Ltd. All rights reserved. Not to be copied, 
transmitted or recorded in any way, in whole or part, without prior permission 
of the publishers.

DOI: 10.7748/nm.2021.e1970
PMID: 33942592 [Indexed for MEDLINE]

Conflict of interest statement: None declared


3490. BMJ Open. 2021 May 3;11(5):e045325. doi: 10.1136/bmjopen-2020-045325.

Depression, anxiety and stress during the COVID-19 pandemic: results from a New 
Zealand cohort study on mental well-being.

Gasteiger N(1), Vedhara K(2), Massey A(2), Jia R(2), Ayling K(2), Chalder T(3), 
Coupland C(2), Broadbent E(4).

Author information:
(1)Psychological Medicine, The University of Auckland, Auckland, New Zealand.
(2)Division of Primary Care, University of Nottingham, Nottingham, UK.
(3)Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, 
King's College London, London, UK.
(4)Psychological Medicine, The University of Auckland, Auckland, New Zealand 
e.broadbent@auckland.ac.nz.

OBJECTIVES: The COVID-19 pandemic has caused unprecedented disruption to daily 
life. This study investigated depression, anxiety and stress in New Zealand (NZ) 
during the first 10 weeks of the COVID-19 pandemic, and associated psychological 
and behavioural factors. It also compares the results with a similar 
cross-sectional study in the UK.
DESIGN: Cross-sectional study.
SETTING: NZ community cohort.
PARTICIPANTS: N=681 adults (≥18 years) in NZ. The cohort was predominantly 
female (89%) with a mean age of 42 years (range 18-87). Most (74%) identified as 
NZ European and almost half (46%) were keyworkers. Most were non-smokers (95%) 
and 20% identified themselves as having clinical risk factors which would put 
them at increased or greatest risk of COVID-19.
MAIN OUTCOME MEASURES: Depression, anxiety, stress, positive mood and engagement 
in health behaviours (smoking, exercise, alcohol consumption).
RESULTS: Depression and anxiety significantly exceeded population norms 
(p<0.0001). Being younger (p<0.0001) and most at risk of COVID-19 (p<0.05) were 
associated with greater depression, anxiety and stress. Greater positive mood, 
lower loneliness and greater exercise were protective factors for all outcomes 
(p<0.0001). Smoking (p=0.037) and alcohol consumption (p<0.05) were associated 
with increased anxiety. Pet ownership was associated with lower depression 
(p=0.006) and anxiety (p=0.008). When adjusting for age and gender differences, 
anxiety (p=0.002) and stress (p=0.007) were significantly lower in NZ than in 
the UK. The NZ sample reported lower perceived risk (p<0.0001) and worry about 
COVID-19 (p<0.0001) than the UK sample.
CONCLUSIONS: The NZ population had higher depression and anxiety compared with 
population norms. Younger people and those most at risk of COVID-19 reported 
poorer mental health. Interventions should promote frequent exercise, and reduce 
loneliness and unhealthy behaviours.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2020-045325
PMCID: PMC8098295
PMID: 33941630 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3491. BMC Psychiatry. 2021 May 3;21(1):224. doi: 10.1186/s12888-021-03213-2.

The psychological impact of the COVID-19 pandemic on adults and children in the 
United Arab Emirates: a nationwide cross-sectional study.

Saddik B(1)(2), Hussein A(1), Albanna A(3)(4), Elbarazi I(5), Al-Shujairi A(2), 
Temsah MH(6)(7), Saheb Sharif-Askari F(2), Stip E(8), Hamid Q(2)(9), Halwani 
R(10)(11).

Author information:
(1)Department of Family and Community Medicine and Behavioral Sciences, College 
of Medicine, University of Sharjah, Sharjah, United Arab Emirates.
(2)Sharjah Institute of Medical Research, University of Sharjah, Sharjah, United 
Arab Emirates.
(3)Child and Adolescent Mental Health Center of Excellence, Al Jalila Children's 
Specialty Hospital, Dubai, United Arab Emirates.
(4)Mohamed Bin Rashid University of Medicine and Health Sciences, Dubai, United 
Arab Emirates.
(5)Institute of Public Health, College of Medicine and Health Sciences, United 
Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates.
(6)Department of Pediatrics, College of Medicine, King Saud University, Riyadh, 
Kingdom of Saudi Arabia.
(7)Prince Abdullah Ben Khaled Celiac Disease Research Chair, Department of 
Pediatrics, Faculty of Medicine, King Saud University, Riyadh, Kingdom of Saudi 
Arabia.
(8)Department of Psychiatry and Behavioral Sciences, College of Medicine and 
Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
(9)Department of Clinical Sciences, College of Medicine, University of Sharjah, 
Sharjah, United Arab Emirates.
(10)Sharjah Institute of Medical Research, University of Sharjah, Sharjah, 
United Arab Emirates. rhalwani@sharjah.ac.ae.
(11)Department of Clinical Sciences, College of Medicine, University of Sharjah, 
Sharjah, United Arab Emirates. rhalwani@sharjah.ac.ae.

BACKGROUND: The psychosocial impact of previous infectious disease outbreaks in 
adults has been well documented, however, there is limited information on the 
mental health impact of the COVID-19 pandemic on adults and children in the 
United Arab Emirate (UAE) community. The aim of this study was to explore 
anxiety levels among adults and children in the UAE and to identify potential 
risk and protective factors for well-being during the COVID-19 pandemic.
METHODS: Using a web-based cross-sectional survey we collected data from 2200 
self-selected, assessed volunteers and their children. Demographic information, 
knowledge and beliefs about COVID-19, generalized anxiety disorder (GAD) using 
the (GAD-7) scale, emotional problems in children using the strengths and 
difficulties questionnaire (SDQ), worry and fear about COVID-19, coping 
mechanisms and general health information were collected. Descriptive analysis 
was carried out to summarize demographic and participant characteristics, 
Chi-square analysis to explore associations between categorical variables and 
anxiety levels and multivariable binary logistic regression analysis to 
determine predictors of anxiety levels in adults and emotional problems in 
children.
RESULTS: The overall prevalence of GAD in the general population was 71% with 
younger people (59.8%) and females (51.7%) reporting highest levels of anxiety. 
Parents who were teachers reported the highest percentage of emotional problems 
in children (26.7%). Adjusted multivariable logistic regression for GAD-7 scores 
showed that being female, high levels of worry associated with COVID-19, 
intention to take the COVID-19 vaccine and smoking were associated with higher 
levels of anxiety. Adjusted multivariable logistic regression for SDQ showed 
that higher emotional problems were reported for children in lower and higher 
secondary education, and parents who had severe anxiety were seven times more 
likely to report emotional problems in their children.
CONCLUSIONS: This study reports the psychological impact of COVID-19 among 
adults and children in the UAE and highlights the significant association 
between parental and child anxiety. Findings suggest the urgency for policy 
makers to develop effective screening and coping strategies for parents and 
especially children.

DOI: 10.1186/s12888-021-03213-2
PMCID: PMC8090921
PMID: 33941119 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3492. Bull Menninger Clin. 2021 Summer;85(3):283-297. doi: 10.1521/bumc_2021_85_02. 
Epub 2021 May 3.

Addressing the mental health needs of learners and nonlearners in an academic 
medical center during COVID-19.

Peters ZV(1), Norwood LN(2), Modi HP(3), Goodman H(4), Yang PH(5), Coleman N(6), 
Monroe A(7), Goodman WK(8); Baylor College of Medicine Mental Health and 
Wellness Support Team(9); Storch EA(10).

Author information:
(1)Postdoctoral Fellow, Department of Psychiatry and Behavioral Sciences, Baylor 
College of Medicine, Houston, Texas.
(2)Assistant Professor, Department of Psychiatry and Behavioral Sciences, Baylor 
College of Medicine, Houston, Texas.
(3)Research Coordinator III, Department of Psychiatry and Behavioral Sciences, 
Baylor College of Medicine, Houston, Texas.
(4)Associate Professor, Department of Psychiatry and Behavioral Sciences, Baylor 
College of Medicine, Houston, Texas.
(5)Director of Institutional Wellness, Department of Psychiatry and Behavioral 
Sciences, Baylor College of Medicine, Houston, Texas.
(6)Associate Provost for Academic Affairs & Health Systems Science, Department 
of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, 
Texas.
(7)Provost, Senior Vice President of Academic and Faculty Affairs, and Cullen 
Trust for Higher Education Provost Chair., Department of Psychiatry and 
Behavioral Sciences, Baylor College of Medicine, Houston, Texas.
(8)Professor and Chairperson, Department of Psychiatry and Behavioral Sciences, 
Baylor College of Medicine, Houston, Texas.
(9)Baylor College of Medicine Mental Health and Wellness Support Team: Doug 
Miller, Benjamin Chang, Patricia Daza, Michael Fordis, Toi Harris, Chelsea 
Jaeger, Jeff Khan, Karen Lawson, Delphine Lee, Jamie Loveland, Paige Morrison, 
Brittany O'Brien, Yasmine Omar, Luis Ordaz, Amanda Palo, Mayra Perez, Ana 
Ramirez, Mary Reissinger, Jessica Rohr, Asim Shah, Hilary Sherry, Patrick 
Tennant, Nizete-Ly Valles, Karissa Harris, Judy Hong, Laurel Williams.
(10)Professor and Vice Chair, Department of Psychiatry and Behavioral Sciences, 
Baylor College of Medicine, Houston, Texas.

The coronavirus disease (COVID-19) has impacted life for people throughout the 
world, especially for those in health care who experience unique stressors. To 
support the psychological needs of staff, faculty, and learners at a biomedical 
sciences university, faculty at Baylor College of Medicine created a mental 
health and wellness support program consisting of multiple behavioral health 
care pathways, including phone support, a self-guided mental health app, a 
coping skills group, and individual therapy services. The authors present this 
program as a model for academic institutions to support the well-being of 
faculty, staff, and learners.

DOI: 10.1521/bumc_2021_85_02
PMID: 33939499 [Indexed for MEDLINE]


3493. Psychosom Med. 2021 May 1;83(4):304-308. doi: 10.1097/PSY.0000000000000954.

Biopsychosocial Processes of Health and Disease During the COVID-19 Pandemic.

Kop WJ(1).

Author information:
(1)From the Department of Medical and Clinical Psychology, Tilburg University, 
Tilburg, the Netherlands; Center of Research on Psychology and Somatic diseases 
( CoRPS ), Tilburg, the Netherlands.

Comment in
    Psychosom Med. 2021 Nov-Dec 01;83(9):1091-1092.
    Psychosom Med. 2022 Feb-Mar 01;84(2):261.

Comment on
    Psychosom Med. 2021 May 1;83(4):309-321.

The biopsychosocial model provides a useful perspective for understanding the 
development and characteristics of the COVID-19 pandemic and its anticipated 
long-term consequences for society as well as individuals. This article provides 
a biopsychosocial perspective on the COVID pandemic and an editorial comment on 
the articles in this Special Issue of Psychosomatic Medicine. Based on analysis 
of the PubMed database, it is shown that the attention to psychological and 
social factors is 74% higher in COVID-19-related articles compared to all other 
health-related scientific articles published during the same time-period 
(between 1/1/2020 and 4/18/2021). Specifically, 18.6% of the ≈123,500 articles 
addressing COVID-19-related topics also included psychological or social factors 
in their content vs. 10.7% of articles that did not address COVID-19. The 
biopsychosocial model is relevant to understanding the interrelationships among 
risk factors and the multidimensional clinical and psychosocial COVID-19 
outcomes. Clinical outcomes directly related to COVID-19 range from severe but 
rare events (mortality and intensive care treatment) to less severe common 
outcomes such as positive screening tests for COVID-19 with or without symptoms. 
In addition, psychosocial outcomes range in severity from frequently observed 
reduced psychological wellbeing to less common clinical mood and anxiety 
disorders and, in rare cases, suicidality. The COVID-19 pandemic is 
characterized by an unusually strong and short-term link between social factors 
and biological aspects of the disease, without mediating psychological factors. 
After a review of the articles presented in this Special Issue, this editorial 
concludes with suggestions for biopsychosocial models in research on COVID-19 
and other large-scale health threats.

Copyright © 2021 by the American Psychosomatic Society.

DOI: 10.1097/PSY.0000000000000954
PMID: 33938503 [Indexed for MEDLINE]


3494. Front Public Health. 2021 Apr 16;9:641392. doi: 10.3389/fpubh.2021.641392. 
eCollection 2021.

Health and Well-Being of Athletes During the Coronavirus Pandemic: A Scoping 
Review.

Haan R(1), Ali Alblooshi ME(1), Syed DH(1), Dougman KK(2), Al Tunaiji H(3), 
Campos LA(4)(5)(6), Baltatu OC(1)(5)(6).

Author information:
(1)College of Medicine & Health Sciences, Khalifa University, Abu Dhabi, United 
Arab Emirates.
(2)Abu Dhabi Sports Council, Abu Dhabi, United Arab Emirates.
(3)Zayed Military Hospital, Abu Dhabi, United Arab Emirates.
(4)College of Health Sciences, Abu Dhabi University, Abu Dhabi, United Arab 
Emirates.
(5)Center of Innovation, Technology and Education (CITE) at Sao Jose dos Campos 
Technology Park, São Paulo, Brazil.
(6)Institute of Biomedical Engineering at Anhembi Morumbi University - Laureate 
International Universities, Sao Jose dos Campos, Brazil.

Background: The ongoing global pandemic has become the world's leading health 
problem, causing massive public fear and concern. Reports suggest that athletes 
are seeking mental health support, showing the pressures of boredom, and tension 
associated with their anticipated social isolation. The current study seeks to 
evaluate the evidence regarding the effects of the coronavirus pandemic on 
occupational stress in professional athletes. Method: A scoping review was 
conducted. A comprehensive search involving Embase and PubMed databases was 
conducted using a combination of the following key words: COVID-19, SARS-CoV-2, 
coronavirus, and athletes. In this study, articles were retained if they were 
original studies reporting on the impact of the pandemic on professional 
athletes. Results: Nine studies were identified as they investigated the impact 
of the pandemic on athletes. Most were observational and cross-sectional, and 
one was longitudinal. Outcome measures mainly investigated were level of 
depression, anxiety, and stress. Dependent variables were physical activity, 
nutrition, mental state, sleep quality, individual well-being, social identity, 
exclusivity, negative affectivity, alcohol consumption, psychological distress, 
and gambling habits. Conclusions: This review highlights the need for proactive 
engagement with professional athletes, coaches, trainers, and sports councils to 
facilitate understanding and awareness-raising, process optimization, and 
delivery of consistent training and psychosocial aid and occupational therapy 
programs that maintain the health and well-being of athletes while minimizing 
occupational stress during a pandemic.

Copyright © 2021 Haan, Ali Alblooshi, Syed, Dougman, Al Tunaiji, Campos and 
Baltatu.

DOI: 10.3389/fpubh.2021.641392
PMCID: PMC8085390
PMID: 33937171 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


3495. Front Public Health. 2021 Apr 15;9:567552. doi: 10.3389/fpubh.2021.567552. 
eCollection 2021.

Strange Days: Adult Physical Activity and Mental Health in the First Two Months 
of the COVID-19 Pandemic.

Gierc M(1), Riazi NA(1), Fagan MJ(1), Di Sebastiano KM(1), Kandola M(1), Priebe 
CS(1), Weatherson KA(1), Wunderlich KB(1), Faulkner G(1).

Author information:
(1)Population Physical Activity Lab, School of Kinesiology, University of 
British Columbia, Vancouver, BC, Canada.

Background: In addition to its physical health benefits, physical activity is 
increasingly recognized as a means to support mental health. Regular 
moderate-to-vigorous physical activity (MVPA) is associated with improved mental 
well-being, reduced likelihood of developing mental illness, and improved 
symptom management. Despite these benefits, most people fail to achieve minimum 
recommended levels of MVPA. Population levels of physical activity have further 
declined since the onset of the COVID-19 pandemic and implementation of public 
health measures (e.g., shelter-in-place protocols). The potential impact of this 
decline on mental heath outcomes warrants ongoing investigation. Purpose: To 
investigate associations between changes in MVPA and mental health (depressive 
symptoms, anxiety symptoms, and life satisfaction) in adults impacted by the 
COVID-19 pandemic. Method: Research followed a cross-sectional design. 
English-speaking adults were invited to complete an online questionnaire. MVPA 
was assessed retrospectively (before COVID-19) and currently (during COVID-19) 
with the International Physical Activity Questionnaire. Mental health was 
assessed with the Patient Health Questionnaire, 9-Item (PHQ-9), the Generalized 
Anxiety Disorder, 7-Item (GAD-7), and the Satisfaction with Life Scale (SWLS). 
Regression was used to assess relationships between MVPA and mental health. 
ANOVA with follow-up tests examined whether participants who differed in mental 
health status (e.g., no symptoms vs. severe symptoms) differed in their change 
in MVPA. T-tests were used to examine differences in mental health 
symptomatology between participants who were sufficiently (i.e., achieving MVPA 
guidelines of ≥ 150 min/week) vs. insufficiently active. Results: Prior to 
COVID-19, 68.2% of participants were classified as being sufficiently active, 
vs. 60.6% during COVID-19. The majority of participants reported experiencing 
some level of depressive symptoms (62.0%) or anxiety symptoms (53.7%). After 
controlling for covariates, changes in MVPA accounted for significant 
variability in the PHQ-9 (7.7%), GAD-7 (2.5%), and SWLS (1.5 %). Participants 
with clinically significant mental health symptomatology reported greater 
declines in MVPA than those who reported no symptoms. Conversely, participants 
who were sufficiently active during COVID-19 reported significantly lower 
depression and anxiety, and higher life satisfaction. Conclusion: Participants 
who experienced the greatest declines in MVPA reported relatively greater 
psychological distress and lower life satisfaction. While preliminary, these 
findings suggest the importance of maintaining and promoting physical activity 
during a period of pandemic.

Copyright © 2021 Gierc, Riazi, Fagan, Di Sebastiano, Kandola, Priebe, 
Weatherson, Wunderlich and Faulkner.

DOI: 10.3389/fpubh.2021.567552
PMCID: PMC8082023
PMID: 33937160 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


3496. BMC Public Health. 2021 May 1;21(1):837. doi: 10.1186/s12889-021-10899-2.

Functional health and symptoms in Spain before and during the COVID-19 pandemic.

Lehmann J(1)(2), Holzner B(3), Giesinger JM(3), Bottomley A(4), Ansari S(5), von 
Butler L(5), Kemmler G(6).

Author information:
(1)University Hospital of Psychiatry I, Medical University of Innsbruck, 
Anichstraße 35, 6020, Innsbruck, Austria. jens.lehmann@i-med.ac.at.
(2)University Hospital of Psychiatry II, Medical University of Innsbruck, 
Anichstraße 35, 6020, Innsbruck, Austria. jens.lehmann@i-med.ac.at.
(3)University Hospital of Psychiatry II, Medical University of Innsbruck, 
Anichstraße 35, 6020, Innsbruck, Austria.
(4)EORTC Department of Quality of Life, Headquarter, Brussels, Belgium.
(5)SurveyEngine GmbH, Berlin, Germany.
(6)University Hospital of Psychiatry I, Medical University of Innsbruck, 
Anichstraße 35, 6020, Innsbruck, Austria.

BACKGROUND: The impact of the coronavirus disease (COVID-19) pandemic on 
wellbeing and health has so far been studied using mostly cross-sectional 
designs. To place recent findings into context, we compared symptoms and 
functional health status in two independent samples assessed before and during 
the COVID-19 pandemic.
METHODS: Participants were recruited via an online panel using quota sampling. 
We assessed symptoms, functional health, and global quality of life with the 
EORTC QLQ-C30 in two general population samples in Spain (collected in July 2019 
and April 2020). We also assessed several COVID-19 related variables, such as 
adherence to social distancing.
RESULTS: Data from N = 1010 participants before the pandemic (mean age 
47.1 years, 50.5% female) were compared with data from N = 504 participants 
during the pandemic (mean age 47.1 years, 50.8% female). Participants during the 
pandemic (vs. before the pandemic) reported lower role functioning and emotional 
functioning, as well as less symptom burden. A lower degree of social distancing 
was associated with better functional health and lower symptom burden.
CONCLUSION: Our findings indicate an impact of the COVID-19 pandemic on 
functional health and symptom burden in the Spanish general population. The 
comparison of before and during the pandemic can be used to benchmark results 
raised only during the pandemic.

DOI: 10.1186/s12889-021-10899-2
PMCID: PMC8087887
PMID: 33933042 [Indexed for MEDLINE]

Conflict of interest statement: SA and LVB are both employed at SurveyEngine. 
The other authors (JL, BH, JMG, AB, GK) have no competing interests to declare.


3497. Perspect Psychiatr Care. 2022 Jan;58(1):108-113. doi: 10.1111/ppc.12819. Epub 
2021 Apr 30.

An investigation of smoking habits and mental well-being in healthcare personnel 
during COVID-19.

Firat M(1), Demir Gökmen B(2), Karakurt P(1)(3).

Author information:
(1)Department of Nursing, Mental Health and Psychiatry Nursing, Faculty of 
Health Sciences, Erzincan Binali Yıldırım University, Erzincan, Turkey.
(2)Department of Nursing, Mental Health and Psychiatry Nursing, Health High 
School,  Ağrı İbrahim Çeçen University, Ağrı, Turkey.
(3)Department of Nursing, Fundamental of Nursing, Faculty of Health Sciences, 
Erzincan Binali Yıldırım University, Erzincan, Turkey.

AIM: This study aimed to the smoking levels of the healthcare personnel 
(n = 761) in Turkey, the changes in their smoking levels, and their mental 
well-being levels.
DESIGN AND METHODS: Data were collected via social networks from various cities 
in Turkey using a personal information form, the Fagerstrom test for nicotine 
dependence, the Warwick-Edinburgh mental well-being scale.
FINDINGS: Their mean nicotine dependence score was 3.50 ± 2.57 and mental 
well-being score was 25.01 ± 5.44. The frequency of smoking during the pandemic 
was increased in 22.4% of the participants and was the same as that before the 
pandemic in 57.4% of the smokers.
PRACTICE IMPLICATIONS: It is an introductory study of the current situation for 
healthcare professionals and researchers. It suggests protecting mental 
well-being and reducing smoking.

© 2021 Wiley Periodicals LLC.

DOI: 10.1111/ppc.12819
PMCID: PMC8242534
PMID: 33931894 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that there are no conflict 
of interests.


3498. Perspect Psychiatr Care. 2022 Jan;58(1):97-107. doi: 10.1111/ppc.12818. Epub 
2021 Apr 30.

Mental wellbeing and perception of health in the era of COVID-19 pandemic: A 
cross-sectional study in the general population.

Gül İ(1), Yeşiltaş A(2).

Author information:
(1)Department of Health Management, Faculty of Health Sciences, Afyonkarahisar 
Health Sciences University, Afyonkarahisar, Turkey.
(2)Department of Health Management, Faculty of Health Sciences, Necmettin 
Erbakan University, Konya, Turkey.

PURPOSE: This study was aimed at evaluating mental wellbeing and health 
perception in the general population during the coronavirus disease 2019 
(COVID-19) pandemic and at highlighting the correlation between them and 
selected variables.
DESIGN AND METHODS: This descriptive and cross-sectional study was carried out 
in 374 individuals, who were remotely administered two scales ("Perception of 
Health Scale [PHS]" and "Warwick-Edinburgh Mental Wellbeing Scale [WEMWBS]") and 
a demographic and clinical questionnaire.
FINDINGS: PHS mean score was 53.24 ± 7.69 and the total WEMWBS score was 
52.95 ± 10.75. A positive statistically significant correlation was found 
between PHS and WEMWBS (p < 0.05). Gender, marital status, and education levels 
conditioned mental well-being in a statistically significant. Suffering from a 
chronic disorder, COVID-19 symptoms, or having a family member affected by 
COVID-19 infection influenced the health perception.
PRACTICAL IMPLICATIONS: Exposing the factors affecting the health and mental 
wellbeing perceptions of individuals, especially during the pandemic period, can 
guide policymakers.

© 2021 Wiley Periodicals LLC.

DOI: 10.1111/ppc.12818
PMCID: PMC8242898
PMID: 33931871 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that there are no conflict 
of interests.


3499. BMC Psychiatry. 2021 Apr 30;21(1):222. doi: 10.1186/s12888-021-03197-z.

Prevalence and associated factors of psychosocial distress among seafarers 
during COVID-19 pandemic.

Baygi F(1), Mohammadian Khonsari N(2), Agoushi A(2), Hassani Gelsefid S(2), 
Mahdavi Gorabi A(#)(3), Qorbani M(#)(4)(5).

Author information:
(1)Center of Maritime Health and Society, Department of Public Health, 
University of Southern Denmark, Esbjerg, Denmark.
(2)Student Research Committee, Alborz University of Medical Sciences, Karaj, 
Iran.
(3)Social Determinants of Health Research Center, Alborz University of Medical 
Sciences, Karaj, Iran. armitamahdavi61@gmail.com.
(4)Non-communicable Diseases Research Center, Alborz University of Medical 
Sciences, Karaj, Iran. mqorbani1379@yahoo.com.
(5)Chronic Diseases Research Center, Endocrinology and Metabolism Population 
Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. 
mqorbani1379@yahoo.com.
(#)Contributed equally

BACKGROUND: In the context of growing concerns about seafarers' mental health 
during the COVID-19 pandemic, this study aimed to assess the prevalence and 
associated factors of psychosocial distress among seafarers of ocean-going 
vessels during the current health emergency.
METHODS: This cross-sectional study was conducted among 470 multinational 
seafarers working on two oil tanker international shipping companies. 
Psychosocial distress was assessed by using Depression-Anxiety-Stress Scale 
(DASS-21). General Health Questionnaire-12 (GHQ-12) and Zung Self-Rating Anxiety 
Scale (SAS) were used to assessed genral psychiatry disorders and self-rate 
anxiety. Perceived health status was assessed by a single-item question. 
Multivariate logistic regression was used to determine the association between 
demographic and work-related variables with mental health outcomes.
RESULTS: Overall, 439 out of 470 invited seafarers with a mean age of 34.5 (SD: 
8.05) participated in this study (participation rate: 93.4%). The prevalence 
(95% confidence interval) of depression, anxiety, stress, self-rated anxiety, 
general psychiatric disorders, and poor perceived health status was 12.3% 
(9.4-15.7), 11.6% (8.7-15.0), 5.9% (3.9-8.5), 2.1% (0.9-3.8), 42.6% (38.0-47.4), 
and 4.3% (2.6-6.6), respectively. In the multivariate model, by increasing the 
duration of stay (per month) on board, the odds of depression increased by 20% 
(OR: 1.20 (95% CI: 1.02-1.40)). Also, non-officer seafarers experienced 
significantly lower psychosocial distress such as anxiety and stress levels than 
officers.
CONCLUSION: High prevalence of depression, anxiety, and general psychiatric 
disorders among seafarers during COVID-19 was observed. Our findings also 
highlight the factors that need to be considered to protect seafarers' mental 
well-being. Further studies to evaluate the impact of COVID-19 on psychological 
health issues at sea are recommended.

DOI: 10.1186/s12888-021-03197-z
PMCID: PMC8085649
PMID: 33931081 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


3500. Soc Sci Med. 2021 Jun;278:113956. doi: 10.1016/j.socscimed.2021.113956. Epub 
2021 Apr 23.

Overwhelmed by the news: A longitudinal study of prior trauma, posttraumatic 
stress disorder trajectories, and news watching during the COVID-19 pandemic.

Solomon Z(1), Ginzburg K(2), Ohry A(3), Mikulincer M(4).

Author information:
(1)The Bob Shapell Scholl of Social Work, Tel Aviv University, Israel.
(2)The Bob Shapell Scholl of Social Work, Tel Aviv University, Israel. 
Electronic address: karnig@tauex.tau.ac.il.
(3)Sackler Faculty of Medicine, Tel Aviv University and the Reuth Medical and 
Rehabilitation Center, Tel Aviv, Israel.
(4)School of Psychology, Interdisciplinary Center (IDC), Herzliya, Israel.

RATIONALE: It has been recognized that exposure to mass trauma tends to increase 
the time spent watching television (TV) news. Yet, research on the effects of 
this tendency on individuals' well-being yielded inconclusive findings.
OBJECTIVE: The aim of this longitudinal study is to examine the effects of prior 
trauma and posttraumatic stress disorder (PTSD) on changes in the amount of TV 
news watching and its effect on subsequent PTSD. More specifically, we examined 
the interrelations of prior exposure to war captivity, long-term PTSD 
trajectories, and amount of change TV news watching with PTSD severity during 
the COVID-19 pandemic, among aging Israeli combat veterans.
METHODS: One-hundred-and-twenty Israeli ex-prisoners of war (ex-POWs) from 1973 
Yom Kippur War and 65 matched controls (combat veterans from the same war) were 
followed up at five points of time: 1991 (T1), 2003 (T2), 2008 (T3), 2015 (T4), 
and in April-May 2020 (T5), during the outbreak of the COVID-19 pandemic.
RESULTS: Ex-POWs had higher odds of COVID-19 related increase in TV news 
watching, which, in turn, contributed to PTSD severity at T5. In addition, 
delayed PTSD trajectory was associated with COVID-19 related increase in TV news 
watching, which, in turn, contributed to more severe PTSD at T5.
CONCLUSIONS: These findings highlight the negative implications of TV news 
watching during a mass trauma for traumatized individuals. More specifically, 
they demonstrate its potential pathogenic role in exacerbating prior PTSD among 
trauma survivors.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.socscimed.2021.113956
PMCID: PMC9757611
PMID: 33930678 [Indexed for MEDLINE]


3501. J Gerontol B Psychol Sci Soc Sci. 2022 Apr 1;77(4):e30-e35. doi: 
10.1093/geronb/gbab070.

COVID-19, Time to Oneself, and Loneliness: Creativity as a Resource.

Pauly T(1), Chu L(2), Zambrano E(3), Gerstorf D(4), Hoppmann CA(3)(5).

Author information:
(1)Department of Psychology, University of Zurich, Switzerland.
(2)Department of Psychology, Stanford University, California, USA.
(3)Department of Psychology, The University of British Columbia, Vancouver, 
Canada.
(4)Department of Psychology, Humboldt University, Berlin, Germany.
(5)Centre for Hip Health and Mobility, The University of British Columbia, 
Vancouver,Canada.

Erratum in
    J Gerontol B Psychol Sci Soc Sci. 2022 Apr 1;77(4):e95.

OBJECTIVES: Physical distancing to reduce the spread of the coronavirus disease 
2019 has increased alone time, with unintended mental health ramifications 
including increased loneliness, which may be particularly detrimental for older 
adults. We investigated time-varying associations between daily time to oneself 
and loneliness, and the role of everyday creativity as a resource.
METHOD: 126 adults aged 18-84 completed online questionnaires including a 10-day 
daily diary module, during which they self-reported alone time, everyday 
creativity, and loneliness. Data were analyzed using multilevel models, 
controlling for study day, participation date, gender, and relationship status.
RESULTS: Greater average amounts of alone time were associated with greater 
loneliness, an association that was stronger in old age. In a daily context, 
individuals reported feeling lonelier on days when they had more time to 
themselves than usual. This within-person association was weaker with older age. 
Everyday creativity did not moderate alone time-loneliness associations. 
However, holding time to oneself constant, participants felt less lonely and 
less bothered by alone time on days when they were more creative than usual.
DISCUSSION: Participating in creative behaviors (e.g., pursuing arts and crafts) 
might be linked with reduced loneliness. Intervention studies are needed to 
investigate whether fostering creativity could help promote mental well-being in 
times when people, especially older adults, are vulnerable to loneliness and 
associated health risks.

© The Author(s) 2021. Published by Oxford University Press on behalf of The 
Gerontological Society of America. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/geronb/gbab070
PMCID: PMC8135566
PMID: 33930141 [Indexed for MEDLINE]


3502. Int J Environ Res Public Health. 2021 Apr 26;18(9):4585. doi: 
10.3390/ijerph18094585.

Physical Activity Supporting Connection to Nature, and Helping to Maintain 
Wellbeing during the Covid-19 Restrictions in England.

O'Brien L(1), Forster J(1).

Author information:
(1)Forest Research, Social and Economic Research Group, Farnham GU10 4LH, UK.

The Covid-19 pandemic and the restrictions put in place to prevent or reduce the 
spread of the disease led to anxiety, concern and stress for many people. In 
England restrictions varied at different times of the year, and throughout this 
time there was a lot of attention focused on the importance of exercise and on 
engaging with nature to maintain wellbeing. We undertook an online survey that 
ran for six weeks in June/July 2020 and gained a response from 2115 people, of 
which 25% were male and 74% female, with 35% aged 16-44 and 65% aged 45+. This 
survey focused on people who were already interested or engaged with nature. We 
explored whether being physically activity changed or not, if being active 
impacted people's wellbeing and whether those who were active benefited from 
connecting to nature. We found that those meeting the government recommended 
levels of physical activity in the previous week, of 150 min, were more likely 
to maintain their overall wellbeing through feeling that the things they did in 
their life were worthwhile (p < 0.0001) and reported an increase in feelings of 
connection to nature (p < 0.0001). While those who did less than 30 min of 
physical activity in the previous week were less happy (p < 0.0001) and more 
anxious than usual (p < 0.0001). The research highlights the importance of 
physical activity and contact with nature and how these can play important roles 
in maintaining people's everyday wellbeing under extremely difficult national 
circumstances.

DOI: 10.3390/ijerph18094585
PMCID: PMC8123673
PMID: 33926000 [Indexed for MEDLINE]

Conflict of interest statement: Sport England provided the Short Active Lives 
Survey for use in this study. Members of Sport England and Forestry England made 
a small number of suggestions to the questions developed in the questionnaire. 
They were not involved in data collection, analyses or interpretation of the 
data; or in the writing of the manuscript, or in the decision to publish the 
results.


3503. Int J Environ Res Public Health. 2021 Apr 27;18(9):4635. doi: 
10.3390/ijerph18094635.

Follow-Up Survey of the Impact of COVID-19 on People Living with HIV during the 
Second Semester of the Pandemic.

Siewe Fodjo JN(1), Faria de Moura Villela E(2)(3), Van Hees S(1), Vanholder 
P(4), Reyntiens P(5), Colebunders R(1).

Author information:
(1)Global Health Institute, University of Antwerp, 2610 Wilrijk, Belgium.
(2)Disease Control Coordination, State Health Department, São Paulo 01246000, 
Brazil.
(3)Institute of Tropical Pathology and Public Health, Federal University of 
Goiás, Goiânia 74605050, Brazil.
(4)European AIDS Treatment Group, 1000 Brussels, Belgium.
(5)Sensoa, Flemish Expertise Centre for Sexual Health, 2060 Antwerp, Belgium.

COVID-19 affects persons living with HIV (PLWH) both directly (via 
morbidity/mortality) and indirectly (via disruption of HIV care). From 
July-November 2020, an online survey was conducted to investigate the 
psychosocial well-being of PLWH and changes in HIV care during the second 
semester of the COVID-19 outbreak. Data were collected on the socio-demographic 
characteristics of PLWH, their psychosocial well-being, impact of COVID-19 
preventive measures on their daily routines and HIV follow-up. Of the 247 
responses analyzed (mean age: 44.5 ± 13.2 years; 73.7% male), 67 (27.1%) and 69 
(27.9%) respondents screened positive for anxiety (GAD-2 score ≥ 3) and 
depression (PHQ-2 score ≥ 3), respectively. HIV care had returned to 
pre-COVID-19 state for 48.6% PLWH, and 108 (43.7%) had no HIV follow-up during 
the past month. Over three quarters (76.1%) of respondents expressed willingness 
to receive the COVID-19 vaccine. Compared to previous findings in April 2020, 
substance use increased from 58.6% to 67.2% (p < 0.001). Our findings suggest 
that the well-being and medical follow-up of PLWH are still affected after 
almost a year into the COVID-19 outbreak. Remote HIV follow-up (telemedicine) 
with psychosocial support should be envisaged in the medium to long-term. Given 
that most PLWH accept COVID-19 vaccination, they may be prioritized for this 
intervention.

DOI: 10.3390/ijerph18094635
PMCID: PMC8123847
PMID: 33925506 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
declare.


3504. Int J Environ Res Public Health. 2021 Apr 27;18(9):4620. doi: 
10.3390/ijerph18094620.

Impact of Pandemic on European Well-Being: Visualizing Scenarios from the SHARE 
Database.

Grané A(1), Albarrán I(1), Merchán DE(1).

Author information:
(1)Statistics Department, Universidad Carlos III de Madrid, 28903 Getafe, Spain.

The objective of this study is to analyse the effect of a pandemic shock on the 
well-being of the European population aged 50 or over. Data comes from wave 7 of 
the Survey of Health, Ageing and Retirement in Europe (SHARE), carried out in 28 
countries and representing over 170 million aged individuals in Europe. We start 
by designing two indicators in order to capture the risk of being unhealthy and 
economically vulnerable; next, we combine them with socio-demographic 
information and obtain the vulnerability profiles by means of the k-prototypes 
clustering algorithm. Subsequently, we design a shock similar to the COVID-19 
pandemic and measure its effects on the vulnerability profiles. The results 
suggest that the average level of economic and health vulnerability is 
relatively low, although levels differ across European regions, with the most 
vulnerable being Eastern European countries. It was observed that the shock most 
affected countries with a greater proportion of individuals initially deemed 
vulnerable in terms of mental and physical health, as well as countries where 
tourism and retail sectors are the most vital for their economies. These 
findings led us to conclude that public policies should be differentiated by 
European regions, and Governments must establish action plans in order to better 
meet the physical and mental health needs of their citizens, as well as 
addressing monetary poverty and financial difficulties.

DOI: 10.3390/ijerph18094620
PMCID: PMC8123717
PMID: 33925357 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3505. Int J Environ Res Public Health. 2021 Apr 20;18(8):4345. doi: 
10.3390/ijerph18084345.

The Significance of Demographic Variables on Psychosocial Health from the Early 
Stage and Nine Months after the COVID-19 Pandemic Outbreak. A Cross-National 
Study.

Geirdal AKØ(1), Price D(2), Schoultz M(3), Thygesen H(4)(5), Ruffolo M(2), Leung 
J(6), Bonsaksen T(5)(7).

Author information:
(1)Department of Social Work, Faculty of Social Sciences, Oslo Metropolitan 
University, 0167 Oslo, Norway.
(2)School of Social Work, University of Michigan, Ann Arbor, MI 48109, USA.
(3)Department of Health and Life Sciences, Northumbria University, Newcastle 
upon Tyne NE1 8ST, UK.
(4)Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of 
Health Science, Oslo Metropolitan University, 0167 Oslo, Norway.
(5)Faculty of Health Studies, VID Specialized University, 4306 Sandnes, Norway.
(6)Faculty of Health and Behavioural Science, University of Queensland, 
Brisbane, QLD 4072, Australia.
(7)Department of Health and Nursing Science, Faculty of Social and Health 
Sciences, Inland Norway University of Applied Sciences, 2418 Elverum, Norway.

This cross-national study explored stability and change in mental health, 
quality of life, well-being and loneliness during the early stage and nine 
months after the implementation of COVID-19 pandemic social distancing measures 
and periodic lockdowns as adjusted by demographic variables. In the USA, the UK, 
Australia and Norway, 7284 individuals responded to the invitation to take part 
in two cross-sectional web-based surveys (April and November 2020), including 
questions about sociodemographic variables and psychosocial outcomes. 
Independent t-tests and generalized linear models (GLM) and estimated marginal 
means were used to analyze differences between subgroups and countries, multiple 
linear regression analyses were conducted on the psychosocial outcome measures 
by demographic variables and time in each country and mean responses presented 
by time after adjusting for all demographic variables in the model. Age, gender, 
civil status, education, employment, place of work and living area were all 
significant factors for psychosocial health across the countries. Differences in 
mental health, quality of life, well-being and loneliness were found between the 
countries in both April and November 2020, while time did not contribute to 
reducing the toll in any of the four countries over the nine-month period.

DOI: 10.3390/ijerph18084345
PMCID: PMC8073997
PMID: 33923936 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3506. Nutrients. 2021 Apr 24;13(5):1449. doi: 10.3390/nu13051449.

Physical Activity, Sedentariness, Eating Behaviour and Well-Being during a 
COVID-19 Lockdown Period in Greek Adolescents.

Morres ID(1), Galanis E(1), Hatzigeorgiadis A(1), Androutsos O(2), Theodorakis 
Y(1).

Author information:
(1)Department of Physical Education and Sport Science, University of Thessaly, 
42100 Trikala, Greece.
(2)Department of Nutrition and Dietetics, University of Thessaly, 42132 Trikala, 
Greece.

Adolescents' daily life has dramatically changed during the COVID-19 era due to 
the social restrictions that have been imposed, including closures of schools, 
leisure centers and sport facilities. The purpose of this study was to examine 
levels of well-being and mood and their relations with physical (in)activity and 
eating behaviors in adolescents during a lockdown period in Greece. A total of 
950 adolescents (Mean Age = 14.41 years ± 1.63) participated in a web-based 
survey while education was conducted online and organized sport activities were 
interrupted. Participants showed poor well-being, insufficient physical activity 
levels and moderate scores of healthy eating behavior. Hierarchical regression 
analysis showed that, after controlling for the effect of gender and body mass 
index, increased physical activity and healthier eating behavior predicted 
better well-being (b = 0.24, p < 0.01 and b = 0.19, p < 0.01, respectively), 
whereas sedentariness predicted worse well-being (b = -0.16, p < 0.01). 
Furthermore, it was revealed that days of physical activity per week was a 
stronger predictor of well-being than minutes of physical activity per week, and 
that both in-house and out-of-house physical activity were beneficial. 
Considering that well-being in our study was below the threshold recommended by 
the World Health Organization as indicative of possible depressive symptoms, 
measures to increase physical activity, decrease sedentariness and improve 
eating behavior should become a priority for communities and policy makers.

DOI: 10.3390/nu13051449
PMCID: PMC8147023
PMID: 33923341 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3507. Int J Environ Res Public Health. 2021 Apr 22;18(9):4457. doi: 
10.3390/ijerph18094457.

Tired, Worried and Burned Out, but Still Resilient: A Cross-Sectional Study of 
Mental Health Workers in the UK during the COVID-19 Pandemic.

Pappa S(1)(2), Barnett J(1), Berges I(1), Sakkas N(3).

Author information:
(1)Department of Community Mental Health Services, West London NHS Trust, London 
UB2 4SD, UK.
(2)Division of Brain Sciences, Imperial College London, London SW7 2BX, UK.
(3)Department of Adult Community Services, Oxleas NHS Foundation Trust, London 
SE2 OAS, UK.

The burden of the COVID-19 pandemic on health systems and the physical and 
mental health of healthcare workers (HCWs) has been substantial. This 
cross-sectional study aims to assess the effects of COVID-19 on the 
psychological wellbeing of mental health workers who provide care to a 
vulnerable patient population that have been particularly affected during this 
crisis. A total of 387 HCWs from across a large urban mental health service 
completed a self-administered questionnaire consisting of socio-demographic, 
lifestyle and work-based information and validated psychometric scales. 
Depression and anxiety were measured using the Patient Health Questionnaire 
(PHQ-9) and the Generalized Anxiety Disorder Scale (GAD-7), respectively; sleep 
problems with the Athens Insomnia Scale (AIS); burnout with the Maslach Burnout 
Inventory (MBI); and resilience with the Resilience Scale-14 (RS-14). 
Multivariable logistic regression analysis was performed to determine potential 
mediating factors. Prevalence of burnout was notable, with 52% recording 
moderate/severe in Emotional Exhaustion, 19.5% moderate/severe in 
Depersonalisation, and 55.5% low/moderate Personal Accomplishment. Over half of 
all respondents (52%) experienced sleep problems; the presence of depressive 
symptoms was a significant predictor of insomnia. An increase in potentially 
harmful lifestyle changes, such as smoking, alcohol consumption and overeating 
was also observed. However, high Resilience was reported by 70% of the samples 
and the importance of this is highlighted. Female gender was associated with 
increased levels of depression and emotional exhaustion while those with a 
history of mental health conditions were most at risk of affective symptoms, 
insomnia, and burnout. Overall, our study revealed considerable levels of 
psychological distress and maladaptive coping strategies but also resilience and 
satisfaction with organizational support provided. Findings can inform tailored 
interventions in order to mitigate vulnerability and prevent long-term 
psychological sequelae.

DOI: 10.3390/ijerph18094457
PMCID: PMC8122760
PMID: 33922281 [Indexed for MEDLINE]

Conflict of interest statement: All authors have nothing to disclose in relation 
to the submitted work.


3508. Int J Environ Res Public Health. 2021 Apr 22;18(9):4441. doi: 
10.3390/ijerph18094441.

Impact of the COVID-19 Pandemic on Physical Activity and Sedentary Behaviour: A 
Qualitative Study in a Canadian City.

Petersen JA(1)(2), Naish C(1)(3), Ghoneim D(1), Cabaj JL(1)(4), Doyle-Baker 
PK(5)(6), McCormack GR(1)(5)(6)(7).

Author information:
(1)Department of Community Health Sciences, Cumming School of Medicine, 
University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada.
(2)Faculty of Applied Health Sciences, Brock University, 1812 Sir Isaac Brock 
Way, St. Catharines, ON L2S 3A1, Canada.
(3)Department of Communication, Media and Film, Faculty of Arts, University of 
Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada.
(4)Provincial Population & Public Health, Alberta Health Services, 10301 
Southport Lane SW, Calgary, AB T2W 1S7, Canada.
(5)Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, 
Calgary, AB T2N 1N4, Canada.
(6)School of Planning, Architecture, and Landscape, University of Calgary, 2500 
University Drive NW, Calgary, AB T2N 1N4, Canada.
(7)Faculty of Sport Sciences, Waseda University, 1-104 Totsukamachi, 
Shinjuku-ku, Tokyo 169-8050, Japan.

Public health measures introduced to combat the COVID-19 pandemic have impacted 
the physical activity, health, and well-being of millions of people. This 
grounded theory study explored how the COVID-19 pandemic has affected physical 
activity and perceptions of health among adults in a Canadian city (Calgary). 
Twelve adults (50% females; 20-70 years) were interviewed between June and 
October (2020) via telephone or videoconferencing. Using a maximum variation 
strategy, participants with a range of sociodemographic characteristics, 
physical activity levels, and perceptions of seriousness and anxiety related to 
COVID-19 were selected. Semi-structured interviews captured participant 
perceptions of how their physical activity and perceptions of health changed 
during the pandemic. Using thematic analysis, four themes were identified: (1) 
Disruption to Daily Routines, (2) Changes in Physical Activity, (3) Balancing 
Health, and (4) Family Life. Participants experienced different degrees of 
disruption in their daily routines and physical activity based on their 
individual circumstances (e.g., pre-pandemic physical activity, family life, and 
access to resources). Although participants faced challenges in modifying their 
daily routines and physical activity, many adapted. Some participants reported 
enhanced feelings of well-being. Public health strategies that encourage 
physical activity and promote health should be supported as they are needed 
during pandemics, such as COVID-19.

DOI: 10.3390/ijerph18094441
PMCID: PMC8122654
PMID: 33922094 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3509. Int J Environ Res Public Health. 2021 Apr 19;18(8):4329. doi: 
10.3390/ijerph18084329.

Sleep Quality and Physical Activity as Predictors of Mental Wellbeing Variance 
in Older Adults during COVID-19 Lockdown: ECLB COVID-19 International Online 
Survey.

Trabelsi K(1)(2), Ammar A(3)(4), Masmoudi L(1)(2), Boukhris O(1)(5), Chtourou 
H(1)(5), Bouaziz B(6), Brach M(7), Bentlage E(7), How D(7), Ahmed M(7), Mueller 
P(8)(9), Mueller N(8)(9), Hsouna H(1)(5), Elghoul Y(1)(2), Romdhani M(5), 
Hammouda O(1)(4), Paineiras-Domingos LL(10)(11), Braakman-Jansen A(12), Wrede 
C(12), Bastoni S(12)(13), Pernambuco CS(14), Mataruna-Dos-Santos LJ(15), Taheri 
M(16), Irandoust K(16), Bragazzi NL(17)(18), Strahler J(19), Washif JA(20), 
Andreeva A(21), Bailey SJ(22), Acton J(22), Mitchell E(22), Bott NT(23), 
Gargouri F(6), Chaari L(24), Batatia H(24), Khoshnami SC(25), Samara E(26), Zisi 
V(27), Sankar P(28), Ahmed WN(29), Ali GM(30), Abdelkarim O(30)(31), Jarraya 
M(1), Abed KE(1), Moalla W(1), Souissi N(1), Aloui A(5), Souissi N(5), 
Gemert-Pijnen LV(12), Riemann BL(32), Riemann L(33), Delhey J(34), Gómez-Raja 
J(35), Epstein M(36), Sanderman R(37), Schulz S(38), Jerg A(38), Al-Horani 
R(39), Mansi T(40), Dergaa I(41), Jmail M(42), Barbosa F(43), Ferreira-Santos 
F(43), Šimunič B(44), Pišot R(44), Pišot S(44), Gaggioli A(45), Steinacker 
J(38), Zmijewski P(46), Apfelbacher C(47), Glenn JM(48), Khacharem A(49), Clark 
CCT(50), Saad HB(51), Chamari K(52)(53), Driss T(4), Hoekelmann A(3), On Behalf 
Of The Eclb-Covid Consortium(3).

Author information:
(1)High Institute of Sport and Physical Education of Sfax, University of Sfax, 
Sfax 3000, Tunisia.
(2)Research Laboratory: Education, Motricity, Sport and Health, EM2S, LR19JS01, 
University of Sfax, Sfax 3000, Tunisia.
(3)Institute of Sport Science, Otto-Von-Guericke University, 39106 Magdeburg, 
Germany.
(4)Interdisciplinary Laboratory in Neurosciences, Physiology and Psychology: 
Physical Activity, Health and Learning (LINP2), UFR STAPS, UPL, Paris Nanterre 
University, 92000 Nanterre, France.
(5)Physical Activity, Sport, and Health, UR18JS01, National Observatory of 
Sport, Tunis 1003, Tunisia.
(6)Multimedia InfoRmation Systems and Advanced Computing Laboratory (MIRACL), 
Higher Institute of Computer Science and Multimedia of Sfax, University of Sfax, 
Sfax 3000, Tunisia.
(7)Institute of Sport and Exercise Sciences, University of Münster, 48149 
Münster, Germany.
(8)Research Group Neuroprotection, German Center for Neurodegenerative Diseases 
(DZNE), 39120 Magdeburg, Germany.
(9)Department of Neurology, Medical Faculty, Otto-Von-Guericke University, 39120 
Magdeburg, Germany.
(10)Programa de Pós-graduação em Ciências Médicas, Faculdade de Ciências 
Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro 20550-170, 
Brazil.
(11)Departamento de Fisioterapia, Faculdade Bezerra de Araújo, Rio de Janeiro 
23052-180, Brazil.
(12)Department of Psychology, Health & Technology, University of Twente, 7522 
Enschede, The Netherlands.
(13)Department of Psychology, Università Cattolica del Sacro Cuore, 20123 
Milano, Italy.
(14)Laboratório de Fisiologia do Exercício, Estácio de Sá University, Rio de 
Janeiro 20261-063, Brasil.
(15)Department of Sport Management, Faculty of Management, Canadian University 
of Dubai, Dubai 117781, United Arab Emirates.
(16)Faculty of Social Science, Imam Khomeini International University, Qazvin 
34148-96818, Iran.
(17)Department of Health Sciences, Postgraduate School of Public Health, 
University of Genoa, 16132 Genoa, Italy.
(18)Laboratory for Industrial and Applied Mathematics, Department of Mathematics 
and Statistics, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada.
(19)Department of Psychology and Sport Science, University of Gießen, 35394 
Gießen, Germany.
(20)Sports Performance Division, National Sports Institute of Malaysia, Kuala 
Lumpur 57000, Malaysia.
(21)Department of Sports Biomechanics, Moscow Center of Advanced Sport 
Technologies, 129272 Moscow, Russia.
(22)School of Sport, Exercise and Health Sciences, Loughborough University, 
Loughborough E11 3TU, UK.
(23)Clinical Excellence Research Center, Department of Medicine, Stanford 
University School of Medicine, Stanford, CA 94305, USA.
(24)Computer Science Department, University of Toulouse, IRIT-INP-ENSEEIHT (UMR 
5505), BP 7122 Toulouse, France.
(25)UFR STAPS, UPL, Paris Nanterre University, 92000 Nanterre, France.
(26)Onassis Cardiac Surgery Center, 17674 Athens, Greece.
(27)Department of Physical Education and Sports Sciences, University of 
Thessaly, 421 00 Trikala, Greece.
(28)Consultant in Internal Medicine and Diabetes, MGM Muthoot Hospitals 
Pathanamthitta, Kerala 689645, India.
(29)Consultant Family Physician, CRAFT Hospital and Research Centre, 
Kodungallur, Kerala 680664, India.
(30)Faculty of Physical Education, Assiut University, Assiut 71515, Egypt.
(31)Institute for Sports and Sports Science, Karlsruher Institut für 
Technologie, 76131 Karlsruher, Germany.
(32)Department of Health Sciences and Kinesiology, Georgia Southern University, 
Statesboro, GA 30458, USA.
(33)PharmD, BCBS, PharmIAD, Inc., Savannah, GA 30458, USA.
(34)Institute of Social Science, Otto-Von-Guericke University, 39106 Magdeburg, 
Germany.
(35)FundeSalud, Department of Health and Social Services, Government of 
Extremadura, 06800 Merida, Spain.
(36)The E-Senior Association, 75020 Paris, France.
(37)Department of Health Psychology, University Medical Center Groningen, 
University of Groningen, 9712 Groningen, The Netherlands.
(38)Sports- and Rehabilitation Medicine, Ulm University Hospital, Leimgrubenweg 
14, 89075 Ulm, Germany.
(39)Department of Exercise Science, Yarmouk University, Irbid 21163, Jordan.
(40)Faculty of Physical Education, The University of Jordan, Amman 11942, 
Jordan.
(41)PHCC, Primary Health Care Corporation, Doha 3050, Qatar.
(42)Digital Research Centre of Sfax, Sfax 3000, Tunisia.
(43)Laboratory of Neuropsychophysiology, Faculty of Psychology and Education 
Sciences, University of Porto, 4200-135 Porto, Portugal.
(44)Institute for Kinesiology Research, Science and Research Centre Koper, 
Garibaldijeva 1, 6000 Koper, Slovenia.
(45)Department of Psychology, Catholic University of the Sacred Heart I UNICATT, 
20123 Milano, Italy.
(46)Faculty of Physical Education, Jozef Pilsudski University of Physical 
Education in Warsaw, 00-809 Warsaw, Poland.
(47)Institute for Social Medicine and Health Economy, Otto-Von-Guericke 
University, 39106 Magdeburg, Germany.
(48)Exercise Science Research Center, Department of Health, Human Performance 
and Recreation, University of Arkansas, Fayetteville, AR 72701, USA.
(49)UVHC, DeVisu, Valenciennes, LIRTES-EA 7313, Université Paris Est Créteil Val 
de Marne, 94000 Creteil, France.
(50)Centre for Intelligent Healthcare, Coventry University, Coventry CV1 5FB, 
UK.
(51)Hôpital Farhat HACHED de Sousse, Laboratoire de Recherche "Insuffisance 
Cardiaque", Université de Sousse, Sousse LR12SP09, Tunisie.
(52)ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha 29222, Qatar.
(53)Laboratory "Sport Performance Optimization", (CNMSS), ISSEP Ksar-Said, 
Manouba University, Manouba 2010, Tunisia.

BACKGROUND: The COVID-19 lockdown could engender disruption to lifestyle 
behaviors, thus impairing mental wellbeing in the general population. This study 
investigated whether sociodemographic variables, changes in physical activity, 
and sleep quality from pre- to during lockdown were predictors of change in 
mental wellbeing in quarantined older adults.
METHODS: A 12-week international online survey was launched in 14 languages on 6 
April 2020. Forty-one research institutions from Europe, Western-Asia, 
North-Africa, and the Americas, promoted the survey. The survey was presented in 
a differential format with questions related to responses "pre" and "during" the 
lockdown period. Participants responded to the Short Warwick-Edinburgh Mental 
Wellbeing Scale, the Pittsburgh Sleep Quality Index (PSQI) questionnaire, and 
the short form of the International Physical Activity Questionnaire.
RESULTS: Replies from older adults (aged >55 years, n = 517), mainly from Europe 
(50.1%), Western-Asia (6.8%), America (30%), and North-Africa (9.3%) were 
analyzed. The COVID-19 lockdown led to significantly decreased mental wellbeing, 
sleep quality, and total physical activity energy expenditure levels (all p < 
0.001). Regression analysis showed that the change in total PSQI score and total 
physical activity energy expenditure (F(2, 514) = 66.41 p < 0.001) were 
significant predictors of the decrease in mental wellbeing from pre- to during 
lockdown (p < 0.001, R2: 0.20).
CONCLUSION: COVID-19 lockdown deleteriously affected physical activity and sleep 
patterns. Furthermore, change in the total PSQI score and total physical 
activity energy expenditure were significant predictors for the decrease in 
mental wellbeing.

DOI: 10.3390/ijerph18084329
PMCID: PMC8073845
PMID: 33921852 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. 
Laura Riemann declare to have a commercial affiliation “PharmIAD, Inc., 
Savannah, GA, USA”. This funder provided support in the form of salaries for 
Laurel Riemann, but did not have any additional role in the study. This 
commercial affiliation does not alter our adherence to IJERPH policies on 
sharing data and materials.


3510. Int J Environ Res Public Health. 2021 Apr 12;18(8):4065. doi: 
10.3390/ijerph18084065.

COVID-19 Pandemic and Quality of Life among Romanian Athletes.

Cosma GA(1), Chiracu A(2), Stepan AR(1), Cosma MA(1), Nanu MC(1), Voinea F(3), 
Bibi KW(4), Păunescu C(5), Haddad M(4).

Author information:
(1)Faculty of Physical Education and Sport, University of Craiova, 200585 
Craiova, Romania.
(2)Faculty of Psychology and Science Education, University of Bucharest, 050663 
Bucharest, Romania.
(3)Faculty of Physical Education and Sport, University Ovidius of Constanța, 
900470 Constanța, Romania.
(4)Physical Education Department, College of Education, Qatar University, Doha 
2713, Qatar.
(5)Physical Education Department, University of Medicine and Pharmacy Carol 
Davila, 020021 Bucharest, Romania.

The aim of this study was to analyze athletes' quality of life during the 
COVID-19 pandemic. The study involved 249 athletes between 15 and 35 of age, M = 
21.22, SD = 5.12. The sample was composed of eight Olympic Games medalists, 
three European medalists, 67 international medalists, and 63 national medalists. 
The instruments used were: (1) COVID-19 Anxiety Scale, (2) Athlete Quality of 
Life Scale, (3) Impact of Pandemic on Athletes Questionnaire, and (4) 
International Personality Item Pool (IPIP Anxiety, Depression, and Vulnerability 
Scales). The results indicate significant differences in COVID-19 anxiety 
depending on the sport practiced, F (9239) = 3.81, p < 0.01, showing that there 
were significant differences between sports. The negative impact of the COVID-19 
pandemic mediates the relationship between trait anxiety and the athletes' 
quality of life. The percentage of mediation was 33.9%, and the indirect effect 
was -0.11, CI 95% (-0.18, -0.03), Z = -2.82, p < 0.01. Trait anxiety has an 
increasing effect on the intensity of the negative impact of the COVID-19 
pandemic, 0.23, CI 95% (.10, 0.35), Z = 3.56, p < 0.01, and the negative impact 
of the COVID-19 pandemic has a decreasing effect on quality of life, -0.47, CI 
95% (-0.67, -0.27), Z = -4.62, p < 0.01. Gender and age did not moderate the 
relationship between the negative impact of COVID-19 and athletes' quality of 
life. The results of the study highlighted the impact that social isolation and 
quarantine have on athletes' affective well-being.

DOI: 10.3390/ijerph18084065
PMCID: PMC8069478
PMID: 33921546 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interests.


3511. Int J Environ Res Public Health. 2021 Apr 15;18(8):4182. doi: 
10.3390/ijerph18084182.

Students' Views towards Sars-Cov-2 Mass Asymptomatic Testing, Social Distancing 
and Self-Isolation in a University Setting during the COVID-19 Pandemic: A 
Qualitative Study.

Blake H(1)(2), Knight H(3), Jia R(3), Corner J(4), Morling JR(2)(3), Denning 
C(5), Ball JK(5)(6), Bolton K(7), Figueredo G(8), Morris DE(9), Tighe P(6), 
Villalon AM(9), Ayling K(3), Vedhara K(3).

Author information:
(1)School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK.
(2)NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH, UK.
(3)School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK.
(4)University Executive Board, University of Nottingham, Nottingham NG7 2RD, UK.
(5)Biodiscovery Institute, School of Medicine, University of Nottingham, 
Nottingham NG7 2RD, UK.
(6)School of Life Sciences, University of Nottingham, Nottingham NG7 2RD, UK.
(7)School of Mathematical Sciences, University of Nottingham, Nottingham NG7 
2RD, UK.
(8)School of Computer Sciences, University of Nottingham, Nottingham NG8 1BB, 
UK.
(9)Faculty of Engineering, University of Nottingham, Nottingham NG7 2RD, UK.

We aimed to explore university students' perceptions and experiences of 
SARS-CoV-2 mass asymptomatic testing, social distancing and self-isolation, 
during the COVID-19 pandemic. This qualitative study comprised of four rapid 
online focus groups conducted at a higher education institution in England, 
during high alert (tier 2) national COVID-19 restrictions. Participants were 
purposively sampled university students (n = 25) representing a range of gender, 
age, living circumstances (on/off campus), and SARS-CoV-2 testing/self-isolation 
experiences. Data were analysed using an inductive thematic approach. Six themes 
with 16 sub-themes emerged from the analysis of the qualitative data: 'Term-time 
Experiences', 'Risk Perception and Worry', 'Engagement in Protective 
Behaviours', 'Openness to Testing', 'Barriers to Testing' and 'General 
Wellbeing'. Students described feeling safe on campus, believed most of their 
peers are adherent to protective behaviours and were positive towards 
asymptomatic testing in university settings. University communications about 
COVID-19 testing and social behaviours need to be timely and presented in a more 
inclusive way to reach groups of students who currently feel marginalised. 
Barriers to engagement with SARS-CoV-2 testing, social distancing and 
self-isolation were primarily associated with fear of the mental health impacts 
of self-isolation, including worry about how they will cope, high anxiety, low 
mood, guilt relating to impact on others and loneliness. Loneliness in students 
could be mitigated through increased intra-university communications and a focus 
on establishment of low COVID-risk social activities to help students build and 
enhance their social support networks. These findings are particularly pertinent 
in the context of mass asymptomatic testing programmes being implemented in 
educational settings and high numbers of students being required to 
self-isolate. Universities need to determine the support needs of students 
during self-isolation and prepare for the long-term impacts of the pandemic on 
student mental health and welfare support services.

DOI: 10.3390/ijerph18084182
PMCID: PMC8071290
PMID: 33920908 [Indexed for MEDLINE]

Conflict of interest statement: All authors were employees of University of 
Nottingham, the institution at which data were collected. J.C. sits on the 
Executive Board for UoN; C.D., J.K.B. and P.T. were involved in the delivery of 
the asymptomatic testing service, but none were involved in data collection or 
analysis for this research. No other conflicts of interest were declared.


3512. Int J Environ Res Public Health. 2021 Apr 6;18(7):3837. doi: 
10.3390/ijerph18073837.

'I'm Gonna Tell You about How Mrs Rona Has Affected Me'. Exploring Young 
People's Experiences of the COVID-19 Pandemic in North East England: A 
Qualitative Diary-Based Study.

Scott S(1)(2), McGowan VJ(1)(2), Visram S(1)(2).

Author information:
(1)Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle 
University, Sir James Spence Building, Royal Victoria Infirmary, Newcastle upon 
Tyne NE1 4LP, UK.
(2)NIHR Applied Research Collaboration North East and North Cumbria, St 
Nicholas' Hospital, Jubilee Road, Gosforth, Newcastle Upon Tyne NE3 3XT, UK.

Children and young people risk being 'disproportionately harmed' by the COVID-19 
pandemic. Whilst an evolving body of literature focuses on the impact of the 
pandemic on the mental health and wellbeing of children and young people, less 
attention has been paid to the collection of qualitative, exploratory data. The 
aim of this study was to examine young people in North East England's 
experiences of COVID-19 and associated control measures. Flexible, qualitative 
diaries were collected with 31 young people aged 13-17 for six weeks between 
July and October 2020. Diary extracts were curated using Instagram Direct 
Messaging (DM), email and text messaging. At the end of this study, participants 
took part in a follow-up interview (conducted by telephone or Zoom), asking them 
to reflect on their diary entries. Thematic analysis of diaries and interviews 
yielded three central themes: (1) impacts upon mental health and emotional 
wellbeing; (2) disruptions and changes to education and school life; and (3) 
frustration, burden and responsibility. These findings highlight acute mental 
health impacts (loneliness, isolation, anxiety) as well as longer-term 
repercussions from disrupted education (missed parts of curriculum, home 
schooling, cancelled exams, periods of isolation) on young people aged 13-17 as 
a result of the COVID-19 pandemic.

DOI: 10.3390/ijerph18073837
PMCID: PMC8038818
PMID: 33917557 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3513. Int J Environ Res Public Health. 2021 Apr 6;18(7):3810. doi: 
10.3390/ijerph18073810.

COVID-19 Lockdown and the Behavior Change on Physical Exercise, Pain and 
Psychological Well-Being: An International Multicentric Study.

Sonza A(1), da Cunha de Sá-Caputo D(2)(3), Sartorio A(4), Tamini S(4), Seixas 
A(5), Sanudo B(6), Süßenbach J(7), Provenza MM(8), Xavier VL(8), Taiar R(9), 
Bernardo-Filho M(2).

Author information:
(1)Programa de Pós-Graduação em Fisioterapia e Programa de Pós-Graduação em 
Ciências do Movimento Humano, Centro de Ciências da Saúde e do Esporte, 
Universidade do Estado de Santa Catarina, 88085-350 Florianópolis, Brazil.
(2)Laboratório de Vibrações Mecânicas, Policlínica Piquet Carneiro, Instituto de 
Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, 
20550-900 Rio de Janeiro, Brazil.
(3)Faculdade Bezerra de Araújo, 23052-090 Rio de Janeiro, Brazil.
(4)Istituto Auxologico Italiano, IRCCS, Experimental Laboratory for 
Auxo-endocrinological Research & Division of Auxology and Metabolic Diseases, 
28824 Piancavallo (VB), Italy.
(5)Escola Superior de Saúde, Universidade Fernando Pessoa, 4200-253 Porto, 
Portugal.
(6)Departamento de Educación Física y Deporte, Universidad de Sevilla, 41013 
Seville, Spain.
(7)Institut für Bewegung, Sport und Gesundheit, Leuphana Universität Lüneburg, 
78120 Lüneburg, Germany.
(8)Instituto de Matematica e Estatistica, Universidade do Estado do Rio de 
Janeiro, 20550-900 Rio de Janeiro, Brazil.
(9)MATIM, Université de Reims Champagne Ardenne, 51100 Reims, France.

OBJECTIVE: To evaluate the impact of the COVID-19 pandemic and the following 
lockdown on physical exercise (PEx) practice, pain, and psychological 
well-being.
METHODS: A cross-sectional multicentric study was performed using a nonrandom 
convenience sampling from the general population (≥18 years-old) of 6 countries 
(Brazil, Italy, France, Portugal, Germany, and Spain) adopting social isolation 
(SI). The validated self-administered online survey (PEF-COVID19) was used. The 
tests T-test and Chi-square with Bonferroni correction were used for statistical 
analysis and a multivariate logistic regression model (p ˂ 0.05).
RESULTS: We included 3194 replies and ~80% of the respondents were in SI. 
Brazilian sample was highly influenced by the pandemic considering PEx practice 
and habits, pain, anxiety, and stress (p ˂ 0.05). Among the European countries, 
Italy presented the major changes. The model to predict the non-practice of PEx 
during SI showed that the variables countries, smoking, SI, and PEx level were 
significant predictors (p ˂ 0.001).
CONCLUSION: The pandemic changed the PEx practice and habits, and the 
psychological well-being of populations in different manners. Countries, 
smoking, SI, and PEx level were predictors for the non-practice of PEx. Public 
health strategies are suggested to avoid sedentary lifestyles and quality of 
life decrease.

DOI: 10.3390/ijerph18073810
PMCID: PMC8038730
PMID: 33917363 [Indexed for MEDLINE]

Conflict of interest statement: No conflicts of interest have been identified by 
any of the authors.


3514. Int J Environ Res Public Health. 2021 Apr 1;18(7):3679. doi: 
10.3390/ijerph18073679.

Mental Health during the COVID-19 Lockdown over the Christmas Period in Austria 
and the Effects of Sociodemographic and Lifestyle Factors.

Dale R(1), Budimir S(1)(2), Probst T(1), Stippl P(3), Pieh C(1).

Author information:
(1)Department for Psychotherapy and Biopsychosocial Health, Danube University 
Krems, 3500 Krems, Austria.
(2)Department of Work, Organization and Society, Ghent University, 
Sint-Pietersnieuwstraat, 9000 Ghent, Belgium.
(3)Austrian Federal Association for Psychotherapy (ÖBVP), 1030 Vienna, Austria.

Since the beginning of the COVID-19 pandemic a decline in mental health has been 
reported. This online study investigated mental health and well-being in Austria 
during a strict lockdown. In total, N = 1505 participants were recruited between 
23 December 2020 and 4 January 2021 and levels of depression (PHQ-9), anxiety 
(GAD-7), sleep quality (ISI), well-being (WHO-5), quality of life (WHO-QOL) and 
stress (PSS-10) were measured. 26% scored above the cut-off for moderate 
depressive symptoms (PHQ-9 ≥ 10; ♀ = 32%; ♂ = 21%), 23% above the cut-off for 
moderate anxiety (GAF-7 ≥ 10; ♀ = 29%; ♂ = 17%) and 18% above the cut-off for 
moderate insomnia (ISI ≥ 15; ♀ = 21%; ♂ = 16%). Mean-scores for quality of life 
(psychological WHO-QOL) were 68.89, for well-being (WHO-5) 14.34, and for stress 
(PSS-10) 16.42. The youngest age group (18-24) was most burdened and showed 
significantly more mental health symptoms compared with the oldest age group 
(65+) in depressive symptoms (50% vs. 12%), anxiety symptoms (35% vs. 10%), and 
insomnia (25% vs. 11%, all p-values < 0.05). Mental health decreased compared to 
both the first lockdown earlier in 2020 and pre-pandemic data. Further analyses 
indicate these findings were especially apparent for the under 24-year-olds, 
women, single/separated people, low incomes and those who do not partake in any 
physical activity (all p-values < 0.05). We highlight the need for ongoing 
mental health support, particularly to the most burdened groups.

DOI: 10.3390/ijerph18073679
PMCID: PMC8036255
PMID: 33916019 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3515. JAMA Netw Open. 2021 Apr 1;4(4):e2111103. doi: 
10.1001/jamanetworkopen.2021.11103.

Caregiver Perceptions of Children's Psychological Well-being During the COVID-19 
Pandemic.

Raviv T(1)(2), Warren CM(3)(4), Washburn JJ(1)(2), Kanaley MK(3), Eihentale 
L(1), Goldenthal HJ(2), Russo J(1), Martin CP(1), Lombard LS(3), Tully J(5), Fox 
K(5), Gupta R(3)(4).

Author information:
(1)Center for Childhood Resilience, Pritzker Department of Psychiatry and 
Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, 
Chicago, Illinois.
(2)Department of Psychiatry and Behavioral Sciences, Feinberg School of 
Medicine, Northwestern University, Chicago, Illinois.
(3)Center for Food Allergy and Asthma Research, Institute for Public Health and 
Medicine, Feinberg School of Medicine, Northwestern University, Chicago, 
Illinois.
(4)Academic General Pediatrics, Ann & Robert H. Lurie Children's Hospital of 
Chicago, Chicago, Illinois.
(5)Chicago Public Schools, Chicago, Illinois.

Comment in
    JAMA Netw Open. 2021 Apr 1;4(4):e2111125.

IMPORTANCE: Understanding youth well-being during the COVID-19 pandemic can help 
appropriately allocate resources and inform policies to support youth.
OBJECTIVE: To examine caregiver-reported changes in the psychological well-being 
of their children 3 to 4 months after the start of COVID-19 stay-at-home orders, 
and to examine the association of caregiver-reported COVID-19 exposure and 
family stressors with caregiver perceptions of child psychological well-being.
DESIGN, SETTING, AND PARTICIPANTS: This survey study used an anonymous survey 
distributed via email from June 24 to July 15, 2020, to 350 000 families of 
students attending public schools in Chicago, Illinois. The a priori hypotheses 
were that caregivers would report worsening in child psychological well-being 
during the closure period compared with preclosure and that exposure to 
COVID-19-related stressors would be associated with a higher probability of 
worsening child psychological well-being. Data were analyzed from September 10, 
2020, to March 15, 2021.
MAIN OUTCOMES AND MEASURES: Outcomes were 7 mental health concerns and 5 
positive adjustment characteristics reported by caregivers using a retrospective 
pre-post design. COVID-19 exposure and family stressors were also reported by 
caregivers.
RESULTS: Among 350 000 families invited to participate, 32 217 caregivers 
(10 827 [39.3%] White, 8320 [30.2%] Latinx, 6168 [22.4%] Black; 2223 [8.1%] with 
multiple or other races/ethnicities) completed the survey on behalf of 49 397 
children in prekindergarten through 12th grade. Child-specific outcomes were 
reported for 40 723 to 40 852 children depending on the specific question. The 
frequency of caregiver endorsement of youth mental health concerns ranged from 
0.1 percentage point (suicidal ideation or self-harm, reported by 191 caregivers 
[0.5%] preclosure vs 246 caregivers [0.6%] during closure; P < .001) to 28.3 
percentage points (loneliness, reported by 1452 caregivers [3.6%] preclosure vs 
13 019 caregivers [31.9%] during closure; P < .001) higher after the end of 
in-person instruction compared with preclosure. Frequency of caregiver 
endorsement of youth positive adjustment characteristics ranged from -13.4 
percentage points (plans for the future, reported by 18 114 caregivers [44.3%] 
preclosure vs 12 601 caregivers [30.9%] during closure; P < .001) to -30.9 
percentage points (positive peer relationships, reported by 24 666 caregivers 
[60.4%] preclosure vs 19 130 caregivers [46.8%] during closure; P < .001) lower 
after the end of in-person instruction. Significant differences in COVID-19 
exposure were observed across racial/ethnic (F3,27 534 = 614.8; P < .001) and 
household income strata (F5,27 506 = 842.0; P < .001). After accounting for 
covariates, all mental health concerns increased in probability (eg, angry: odds 
ratio, 1.55 [95% CI, 1.48-1.62]; P < .001) and all the positive adjustment 
characteristics decreased in probability (eg, hopeful or positive: odds ratio, 
0.88 [95% CI, 0.84-0.92]; P < .001) as COVID-19 exposure and family stressors 
increased.
CONCLUSIONS AND RELEVANCE: In this survey study of caregivers during the 
COVID-19 pandemic, COVID-19 and resulting exposure to stress were associated 
with worse youth psychological well-being, demonstrating the need for a 
comprehensive public health approach that prioritizes children's well-being and 
draws broad public attention to the mental health needs of youth.

DOI: 10.1001/jamanetworkopen.2021.11103
PMCID: PMC8085728
PMID: 33914046 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest Disclosures: Dr Raviv 
reported receiving grants from Polk Bros. Foundation during the conduct of the 
study. Dr Gupta reported receiving grants from National Institutes of Health, 
Food Allergy Research Education (FARE), Rho, Melchiorre Family Foundation, 
Sunshine Charitable Foundation, Walder Foundation, UnitedHealth Group, 
ThermoFisher Scientific, Genentech, National Confectioners Association (NCA), 
and personal fees from AllerGenis, Kaléo, Novartis, FARE, Genentech, Aimmune, 
DBV Technologies, Pfizer, DOTS Technology, and BEFORE Brands outside the 
submitted work. No other disclosures were reported.


3516. Dementia (London). 2021 Nov;20(8):2779-2801. doi: 10.1177/14713012211014382. 
Epub 2021 Apr 29.

Social connectedness and dementia prevention: Pilot of the APPLE-Tree video-call 
intervention during the Covid-19 pandemic.

Cooper C(1), Mansour H(2), Carter C(2), Rapaport P(2), Morgan-Trimmer S(3), 
Marchant NL(4), Poppe M(4), Higgs P(4), Brierley J(4), Solomon N(4), Budgett 
J(4), Bird M(4), Walters K(4), Barber J(4), Wenborn J(5), Lang IA(6), Huntley 
J(2), Ritchie K(7), Kales HC(8), Brodaty H(9), Aguirre E(10), Betz A(11), Palomo 
M(11).

Author information:
(1)4919UCL, London, UK; 9747Camden and Islington NHS Foundation Trust, London, 
UK.
(2)4919UCL, London, UK.
(3)3286University of Exeter, Exeter, Devon, UK.
(4)66046UCL, London, UK.
(5)4919UCL, London, UK, 5098North East London NHS Foundation Trust (NELFT), 
Ilford, UK.
(6)3286University of Exeter, Exeter, UK.
(7)27102INSERM, Paris, France.
(8)8789University of California Davis, Davis, CA, USA.
(9)7800University of New South Wales, Sydney, New South Wales, Australia.
(10)4919UCL, London, UK; 5098North East London NHS Foundation Trust (NELFT), 
London, UK.
(11)9747Camden and Islington NHS Foundation Trust, London, UK.

BACKGROUND AND OBJECTIVES: The Covid-19 pandemic reduced access to social 
activities and routine health care that are central to dementia prevention. We 
developed a group-based, video-call, cognitive well-being intervention; and 
investigated its acceptability and feasibility; exploring through participants' 
accounts how the intervention was experienced and used in the pandemic context.
RESEARCH DESIGN AND METHOD: We recruited adults aged 60+ years with memory 
concerns (without dementia). Participants completed baseline assessments and 
qualitative interviews/focus groups before and after the 10-week intervention. 
Qualitative interview data and facilitator notes were integrated in a thematic 
analysis.
RESULTS: 12/17 participants approached completed baseline assessments, attended 
100/120 (83.3%) intervention sessions and met 140/170 (82.4%) of goals set. Most 
had not used video calling before. In the thematic analysis, our overarching 
theme was social connectedness. Three sub-themes were as follows: Retaining 
independence and social connectedness: social connectedness could not be at the 
expense of independence; Adapting social connectedness in the pandemic: 
participants strived to compensate for previous social connectedness as the 
pandemic reduced support networks; Managing social connections within and 
through the intervention: although there were tensions, for example, between 
sharing of achievements feeling supportive and competitive, participants engaged 
with various lifestyle changes; social connections supported group attendance 
and implementation of lifestyle changes.
DISCUSSION AND IMPLICATIONS: Our intervention was acceptable and feasible to 
deliver by group video-call. We argue that dementia prevention is both an 
individual and societal concern. For more vulnerable populations, messages that 
lifestyle change can help memory should be communicated alongside supportive, 
relational approaches to enabling lifestyle changes.

DOI: 10.1177/14713012211014382
PMCID: PMC8679164
PMID: 33913362 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


3517. J Health Psychol. 2022 Jul;27(8):1875-1896. doi: 10.1177/13591053211012759. Epub 
2021 Apr 29.

Factors mediating the psychological well-being of healthcare workers responding 
to global pandemics: A systematic review.

Schneider J(1), Talamonti D(2), Gibson B(3), Forshaw M(3).

Author information:
(1)University of Jyväskylä, Finland.
(2)Research centre and Centre EPIC, Montreal Heart Institute, Canada.
(3)Liverpool John Moores University, UK.

Update of
    doi: 10.31234/osf.io/c23tx.

This paper reviewed mediators of psychological well-being among healthcare 
workers responding to pandemics. After registration on PROSPERO, a systematic 
review was performed in four databases and 39 studies were included. Worse 
mental health outcomes, such as stress, depressive symptoms, anxiety and burnout 
were related to demographic characteristics, contact with infected patients and 
poor perceived support. Self-efficacy, coping ability, altruism and 
organisational support were protective factors. Despite limitations in the 
quality of available evidence, this review highlights the prevalence of poor 
mental health in healthcare workers and proposes target mediators for future 
interventions.

DOI: 10.1177/13591053211012759
PMCID: PMC9272518
PMID: 33913356 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of conflicting interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


3518. J Health Psychol. 2022 Jul;27(8):1913-1925. doi: 10.1177/13591053211012771. Epub 
2021 Apr 29.

The relationship between psychological capital and mental health during the 
Covid-19 pandemic: A longitudinal mediation model.

Turliuc MN(1), Candel OS(1).

Author information:
(1)Alexandru Ioan Cuza University of Iasi, Romania.

The new Coronavirus has impacted people's lifestyles, stress, and well-being. 
Thus, they need personal positive resources to help them during challenging 
circumstances. With this longitudinal study on 290 participants, we analyzed the 
relationship between psychological capital (PsyCap), measured at the beginning 
of the lockdown period and some indicators of mental health (depression, 
anxiety, satisfaction with life) measured after 2 months. Moreover, we examined 
whether stress (at Time 2) mediates the relationships. Following structural 
equation modeling (SEM) analyses, the results show that PsyCap has a significant 
positive effect on satisfaction with life and significant negative effects on 
depression and anxiety. Stress mediated all the relationships.

DOI: 10.1177/13591053211012771
PMID: 33913353 [Indexed for MEDLINE]


3519. Autism Res. 2021 Jul;14(7):1496-1511. doi: 10.1002/aur.2521. Epub 2021 Apr 29.

The impact of COVID-19 on stress, anxiety, and coping in youth with and without 
autism and their parents.

Corbett BA(1)(2)(3), Muscatello RA(1), Klemencic ME(1), Schwartzman JM(1).

Author information:
(1)Department of Psychiatry and Behavioral Sciences, Vanderbilt University 
Medical Center, Nashville, Tennessee, USA.
(2)Vanderbilt University Medical Center, Vanderbilt Kennedy Center, Nashville, 
Tennessee, USA.
(3)Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA.

In the wake of COVID-19, the world has become a more uncertain environment-a 
breeding ground for stress and anxiety, especially for individuals with autism 
spectrum disorder (ASD). The study examined stress, anxiety, and coping in a 
data-driven, real-time assessment of 122 youth with and without ASD and their 
parents at the height of the COVID-19 shutdown and three-months later. 
Standardized measures were administered to ascertain stress and coping 
explicitly related to the pandemic (RSQ COVID-19-Child [self-report], Adult 
[self-report from the guardian of youth], Parent [report about child]) and 
anxiety (STAI-C, STAI-A). Multivariate, univariate analyses of variance and 
hierarchical regression were used. ASD youth endorsed more Trait anxiety and 
response to specific stressors (e.g., virus). Caregivers of youth with ASD 
(Adults) self-reported higher anxiety, yet scores were elevated for both groups. 
Adults of youth with ASD reported more stress, especially related to the virus, 
access to healthcare, and concern for the future. In the TD group, youth and 
adults used more Primary and Secondary Control Coping whereas ASD youth and 
adults used more Disengagement Coping. Adult stress was the primary predictor of 
parent perception of child stress as well as Child self-reported stress. While 
the ASD group was consistently high compared to the TD group, there were no 
significant changes over time for stress or anxiety. Results reveal striking 
differences in youth with ASD and their parents regarding stress, anxiety, and 
coping. Findings highlight the need for essential support, access to services, 
and strategies to enhance psychological and emotional well-being. LAY SUMMARY: 
This study examined stress, anxiety, and coping related to the COVID-19 pandemic 
in 61 youth with autism spectrum disorder (ASD) and 61 youth with typical 
development (TD) and their parents. Results showed that ASD youth reported more 
anxiety and stress. Adults of youth with ASD indicated higher self-reported 
anxiety and stress than adults of TD youth. TD youth and their parents reported 
using more adaptive coping strategies. Findings highlight the need for 
strategies to enhance psychological and emotional well-being.

© 2021 International Society for Autism Research and Wiley Periodicals LLC.

DOI: 10.1002/aur.2521
PMCID: PMC8237027
PMID: 33913261 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


3520. Eur Child Adolesc Psychiatry. 2022 Sep;31(9):1465-1477. doi: 
10.1007/s00787-021-01790-x. Epub 2021 Apr 28.

The impact of COVID-19 on the lives and mental health of Australian adolescents.

Li SH(1), Beames JR(1), Newby JM(1)(2), Maston K(1), Christensen H(1), 
Werner-Seidler A(3).

Author information:
(1)Black Dog Institute, UNSW, Hospital Road, Randwick, Sydney, 2022, Australia.
(2)School of Psychology, UNSW, Sydney, NSW, Australia.
(3)Black Dog Institute, UNSW, Hospital Road, Randwick, Sydney, 2022, Australia. 
a.werner-seidler@blackdog.org.au.

There has been significant disruption to the lives and mental health of 
adolescents during the COVID-19 pandemic. The purpose of this study was to 
assess the psychological and lifestyle impact of the pandemic on Australian 
adolescents, using an online survey, administered during the outbreak. 
Self-report surveys were administered online to a sample of 760 Australian 
adolescents aged 12-18 years assessing impact on a range of domains including 
behaviour, education, relationships, lifestyle factors (exercise, technology 
use, and sleep), and mental health outcomes (psychological distress, loneliness, 
health anxiety and well-being). Results showed that three quarters of the sample 
experienced a worsening in mental health, since the pandemic began, with 
negative impacts reported on learning, friendships and family relationships. 
There were also high higher levels of sleep disturbance, psychological distress 
and health anxiety, relative to normative samples. Effects on mental health were 
worse among those who reported a previous diagnosis of depression and/or anxiety 
relative to those without no such history. Adolescents are already vulnerable to 
the onset of mental illness at this developmental stage, and the current 
research underscores the need to find rapid and accessible ways to support 
adolescent mental health during times of crisis.

© 2021. The Author(s).

DOI: 10.1007/s00787-021-01790-x
PMCID: PMC8080862
PMID: 33913036 [Indexed for MEDLINE]

Conflict of interest statement: None to declare.


3521. Ir J Psychol Med. 2022 Dec;39(4):373-385. doi: 10.1017/ipm.2021.41. Epub 2021 
Apr 29.

Consultant psychiatrists' experience of the impact of the COVID-19 pandemic on 
mental health services.

Kelleher E(1)(2)(3), Geary EH(4), Tawfik M(4), Ní Mhuircheartaigh E(4), Gavin 
B(5), Wall M(6), Lyne JP(7)(8), Doherty AM(9)(10), McNicholas F(5)(11)(12).

Author information:
(1)Liaison Psychiatry Service, Cork University Hospital, Cork, Ireland.
(2)Liaison Psychiatry Service, Mercy University Hospital, Cork, Ireland.
(3)Department of Psychiatry, School of Medicine, University College Cork, Cork, 
Ireland.
(4)St Michael's Unit, Mercy University Hospital, Cork, Ireland.
(5)Department of Child & Adolescent Psychiatry, School Medicine and Medical 
Science, University College Dublin, Belfield, Dublin, Ireland.
(6)Acute Mental Health Unit, Cork University Hospital, Cork, Ireland.
(7)Wicklow Mental Health Services, Newcastle Hospital, Greystones, Co. Wicklow, 
Ireland.
(8)Royal College of Surgeons in Ireland, Dublin, Ireland.
(9)Liaison Psychiatry Service, Mater Misericordiae University Hospital, Dublin, 
Ireland.
(10)Department of Psychiatry, University College Dublin, Dublin, Ireland.
(11)Lucena Child and Adolescent Mental Health Services, St John of Gods, 
Rathgar, Dublin, Ireland.
(12)Children's Health Ireland, Crumlin, Dublin, Ireland.

OBJECTIVES: The novel coronavirus 2019 (COVID-19) has spread worldwide 
threatening human health. To reduce transmission, a 'lockdown' was introduced in 
Ireland between March and May 2020. The aim of this study is to capture the 
experiences of consultant psychiatrists during lockdown and their perception of 
it's impact on mental health services.
METHODS: A questionnaire designed by the Royal College of Psychiatrists was 
adapted and circulated to consultant members of the College of Psychiatrists of 
Ireland following the easing of restrictions. The questionnaire assessed the 
perceived impact on referral rates, mental health act provision, availability of 
information technology (IT), consultant well-being and availability of personal 
protective equipment (PPE). Thematic analysis was employed to analyse free-text 
sections.
RESULTS: Response rate was 32% (n = 197/623). Consultants reported an initial 
decrease/significant decrease in referrals in the first month of lockdown (68%, 
n = 95/140) followed by an increase/significant increase in the second month for 
both new (83%, n = 100/137) and previously attending patients (65%, n = 88/136). 
Social isolation and reduced face-to-face mental health supports were among the 
main reasons identified. The needs of children and older adults were 
highlighted. Most consultants (76%, n = 98/129) felt their working day was 
affected and their well-being reduced (52%, n = 61/119). The majority felt IT 
equipment availability was inadequate (67%, n = 88/132). Main themes identified 
from free-text sections were service management, relationship between patients 
and healthcare service and effects on consultants' lives.
CONCLUSIONS: The COVID-19 pandemic has placed increased pressure on service 
provision and consultant wellness. This further supports the longstanding need 
to increase mental health service investment.

DOI: 10.1017/ipm.2021.41
PMCID: PMC8503055
PMID: 33910665 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflict of interest to 
declare.


3522. BMC Public Health. 2021 Apr 28;21(1):811. doi: 10.1186/s12889-021-10897-4.

Occupational burnout and job satisfaction among physicians in times of COVID-19 
crisis: a convergent parallel mixed-method study.

Alrawashdeh HM(1), Al-Tammemi AB(2)(3), Alzawahreh MK(4), Al-Tamimi A(5), 
Elkholy M(6), Al Sarireh F(7), Abusamak M(8), Elehamer NMK(9)(10)(11), Malkawi 
A(12), Al-Dolat W(13), Abu-Ismail L(14), Al-Far A(15), Ghoul I(16).

Author information:
(1)Sharif Eye Centers, Irbid, Jordan.
(2)Department of Family and Occupational Medicine, Faculty of Medicine, 
University of Debrecen, Debrecen, Hungary. alaa.tammemi@med.unideb.hu.
(3)Doctoral School of Health Sciences, University of Debrecen, Debrecen, 
Hungary. alaa.tammemi@med.unideb.hu.
(4)Department of Special Surgery, Division of Urology, Al Bashir Hospital, 
Ministry of Health, Amman, Jordan.
(5)Department of Radiology, King Hussein Hospital, Jordanian Royal Medical 
Services, Amman, Jordan.
(6)Department of Epidemiology and Global Health, Faculty of Medicine, Umeå 
University, Umeå, Sweden.
(7)Department of Ophthalmology, College of Medicine, Mutah University, Karak, 
Jordan.
(8)Department of General and Special Surgery, Division of Ophthalmology, Faculty 
of Medicine, Al Balqa Applied University, Salt, Jordan.
(9)Doctoral School of Health Sciences, University of Debrecen, Debrecen, 
Hungary.
(10)Department of Public Health and Epidemiology, Faculty of Medicine, 
University of Debrecen, Debrecen, Hungary.
(11)Faculty of Public and Environmental Health, University of Khartoum, 
Khartoum, Sudan.
(12)School of Nutrition and Translational Research in Metabolism (NUTRIM), 
Department of Health Promotion, Maastricht University Medical Center, Maastricht 
University, Maastricht, The Netherlands.
(13)Department of Ophthalmology, Faculty of Medicine, Yarmouk University, Irbid, 
Jordan.
(14)Department of Clinical Medical Sciences, Faculty of Medicine, Yarmouk 
University, Irbid, Jordan.
(15)Department of Orthopedic and Trauma Surgery, Jordan Hospital, Amman, Jordan.
(16)Department of Pediatrics, Ibn Al Haytham Hospital, Amman, Jordan.

BACKGROUND: Healthcare professionals including physicians were subjected to an 
increased workload during the COVID-19 crisis, leaving them exposed to 
significant physical and psychological distress. Therefore, our present study 
aimed to (i) assess the prevalence of burnout and levels of job satisfaction 
among physicians in Jordan, and (ii) explore physicians' opinions, experiences, 
and perceptions during the pandemic crisis.
METHODS: This was a mixed-method study that utilized a structured web-based 
questionnaire and semi-structured individual interviews. The 10-Item Burnout 
Measure-Short version (BMS), and the 5-Item Short Index of Job Satisfaction 
(SIJS) were adopted to assess occupational burnout and job satisfaction, 
respectively. Semi-structured interviews were conducted, based on a conceptual 
framework that was developed from Herzberg's Two-Factor Theory of Motivation and 
Job Demands-Resources Model. Descriptive statistics and regression models, as 
well as inductive thematic analysis, were used to analyze quantitative and 
qualitative data, respectively.
RESULTS: A total of 973 survey responses and 11 interviews were included in our 
analysis. The prevalence of burnout among physicians was (57.7%). Several 
significant factors were positively associated with burnout, including female 
gender, working at highly loaded hospitals, working for long hours, doing night 
shifts, lack of sufficient access to personal protective equipment, and being 
positively tested for SARS-CoV-2. Regarding job satisfaction, regression 
analysis revealed that age was positively associated with higher levels of job 
satisfaction. On contrary, being a general practitioner or specialist, working 
at highly loaded hospitals, low salaries, and suffering from burnout have 
predicted lower levels of job satisfaction. Besides, four themes have emerged 
from the thematic analysis: (i) Work-induced psychological distress during the 
pandemic, (ii) Decision-driven satisfactory and dissatisfactory experiences, 
(iii) Impact of the pandemic on doctor-patient communication and professional 
skills, and (iv) Economic impacts of the pandemic crisis and lockdown.
CONCLUSION: A significant physical and psychological burden was associated with 
the COVID-19 pandemic. Reliable efforts should be implemented aiming at 
protecting physicians' physical and mental wellbeing, enhancing their working 
conditions, and raising awareness about burnout. Evidence-based decisions and 
proper utilization of financial and human resources at institutional and 
national levels are believed to be crucial for the sustainability of the health 
workforce, especially in crises.

DOI: 10.1186/s12889-021-10897-4
PMCID: PMC8079229
PMID: 33906619 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3523. Transl Behav Med. 2021 Jul 29;11(7):1299-1309. doi: 10.1093/tbm/ibab025.

Perceived impacts of the COVID-19 pandemic on cannabis-using emerging adults.

Bonar EE(1)(2)(3), Chapman L(1)(2), McAfee J(4), Goldstick JE(3)(5)(6), 
Bauermeister JA(7), Carter PM(3)(5)(6), Young SD(8)(9), Walton MA(1)(2)(3).

Author information:
(1)Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
(2)Addiction Center, University of Michigan, Ann Arbor, MI, USA.
(3)Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA.
(4)Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
(5)Department of Emergency Medicine, University of Michigan School of Medicine, 
Ann Arbor, MI, USA.
(6)Department of Health Behavior and Health Education, School of Public Health, 
University of Michigan, Ann Arbor, MI, USA.
(7)Department of Family and Community Health, School of Nursing, University of 
Pennsylvania, Philadelphia, PA, USA.
(8)Department of Informatics, Donald Bren School of Information and Computer 
Sciences, University of California Irvine, Irvine, CA, USA.
(9)Department of Emergency Medicine, School of Medicine, University of 
California Irvine, Irvine, CA, USA.

Cannabis-using youth are a large epidemiologic subgroup whose age and 
smoking-related risks underscore the importance of examining the impact of the 
COVID-19 pandemic in this population. Within a clinical trial (n = 36 received 
an intervention prior to data collection reported herein), we surveyed 
cannabis-using emerging adults (ages 18-25) about perceived COVID-19 impacts. 
Participants (n = 141) reporting weekly cannabis use (M = 18.6 use days in the 
past 30) were enrolled and completed online surveys as part of either their 
baseline or 3 month assessment. COVID-19-related measures included symptoms, 
substance use, mood, etc. Participants were 57% female (mean age = 21, standard 
deviation = 2.2), with 21% Hispanic/Latinx, 70% White, 20% Black/African 
American, and 10% of other races. Most participants (86%) reported 
quarantine/self-isolation (M = 59 days). Several had COVID-19 symptoms (16%), 
but none reported testing COVID-19 positive. Many respondents felt their 
cannabis use (35%-50%, across consumption methods) and negative emotions (e.g., 
loneliness, stress, and depression; 69.5%, 69.5%, and 61.8%, respectively) 
increased. They reported decreased in-person socialization (90.8%) and job 
losses (23.4%). Reports of increased cannabis smoking were associated with 
increased negative emotions. On an open-response item, employment/finances and 
social isolation were frequently named negative impacts (33.3% and 29.4%, 
respectively). Although cannabis-using emerging adults' reports of increases in 
cannabis use, coupled with mental health symptoms and social isolation, are 
concerning, the full impact of the pandemic on their health and well-being 
remains unknown. Future studies examining the relationship between social 
isolation, mental health, and cannabis use among young people are needed.

© Society of Behavioral Medicine 2021. All rights reserved. For permissions, 
please e-mail: journals.permissions@oup.com.

DOI: 10.1093/tbm/ibab025
PMCID: PMC8135484
PMID: 33904925 [Indexed for MEDLINE]


3524. Sci Rep. 2021 Apr 26;11(1):8925. doi: 10.1038/s41598-021-87771-1.

Dual impacts of coronavirus anxiety on mental health in 35 societies.

Chen SX(1)(2), Ng JCK(3), Hui BPH(4), Au AKY(4), Wu WCH(4), Lam BCP(5), Mak 
WWS(6), Liu JH(7).

Author information:
(1)The Hong Kong Polytechnic University, Hong Kong, China. 
ssxhchen@polyu.edu.hk.
(2)Department of Applied Social Sciences, Hong Kong Polytechnic University, Hung 
Hom, Kowloon, Hong Kong. ssxhchen@polyu.edu.hk.
(3)Hong Kong Shue Yan University, Hong Kong, China.
(4)The Hong Kong Polytechnic University, Hong Kong, China.
(5)The University of New South Wales, Sydney, Australia.
(6)The Chinese University of Hong Kong, Hong Kong, China.
(7)Massey University, Auckland, New Zealand.

The spread of coronavirus disease 2019 (COVID-19) has affected both physical 
health and mental well-being around the world. Stress-related reactions, if 
prolonged, may result in mental health problems. We examined the consequences of 
the COVID-19 pandemic on mental health in a multinational study and explored the 
effects of government responses to the outbreak. We sampled 18,171 community 
adults from 35 countries/societies, stratified by age, gender, and region of 
residence. Across the 35 societies, 26.6% of participants reported moderate to 
extremely severe depression symptoms, 28.2% moderate to extremely severe anxiety 
symptoms, and 18.3% moderate to extremely severe stress symptoms. Coronavirus 
anxiety comprises two factors, namely Perceived Vulnerability and Threat 
Response. After controlling for age, gender, and education level, perceived 
vulnerability predicted higher levels of negative emotional symptoms and 
psychological distress, whereas threat response predicted higher levels of 
self-rated health and subjective well-being. People in societies with more 
stringent control policies had more threat response and reported better 
subjective health. Coronavirus anxiety exerts detrimental effects on subjective 
health and well-being, but also has the adaptive function in mobilizing safety 
behaviors, providing support for an evolutionary perspective on psychological 
adaptation.

DOI: 10.1038/s41598-021-87771-1
PMCID: PMC8076265
PMID: 33903603 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


3525. Global Health. 2021 Apr 26;17(1):51. doi: 10.1186/s12992-021-00704-5.

Feelings of loneliness and mental health needs and services utilization 
among Chinese residents during the COVID-19 epidemic.

Bao L(#)(1)(2), Li WT(#)(1)(2), Zhong BL(3)(4).

Author information:
(1)Department of Psychiatry, Wuhan Mental Health Center, No. 89, Gongnongbing 
Road, Hubei Province, 430012, Wuhan, China.
(2)Department of Psychiatry, Affiliated Wuhan Mental Health Center, Tongji 
Medical College of Huazhong, University of Science & Technology, 430012, Wuhan, 
Hubei Province, China.
(3)Department of Psychiatry, Wuhan Mental Health Center, No. 89, Gongnongbing 
Road, Hubei Province, 430012, Wuhan, China. haizhilan@gmail.com.
(4)Department of Psychiatry, Affiliated Wuhan Mental Health Center, Tongji 
Medical College of Huazhong, University of Science & Technology, 430012, Wuhan, 
Hubei Province, China. haizhilan@gmail.com.
(#)Contributed equally

BACKGROUND: Due to the implementation of social distancing and quarantine 
measures, loneliness has been a major public health concern during the COVID-19 
pandemic. However, few studies have examined loneliness in Chinese residents 
during the COVID-19 epidemic, as well as its associations with mental health 
needs and services utilization.
METHODS: The present study was a cross-sectional survey during the COVID-19 
outbreak in China. A total of 7741 adults were invited and completed an online 
self-administered questionnaire. The Chinese 12-item General Health 
Questionnaire was used to screen for common mental health problems, loneliness 
was measured with a single-item self-report question ("How often do you feel 
lonely in recent days?"), and two standardized questions were used to assess 
perceived needs for and use of mental health services.
RESULTS: In total, 24.2 % of the participants felt lonely in recent days. Age of 
16-29 years (OR = 1.36, P = 0.020), marital status of never-married (OR = 1.47, 
P < 0.001), marital status of "others" (re-married, co-habiting, separated, 
divorced, and widowed) (OR = 1.72, P < 0.001), having infected family members or 
close relatives (OR = 1.64, P = 0.026), and having infected colleagues, friends, 
or classmates (OR = 1.62, P < 0.001) were significant correlates of loneliness. 
Rates of mental health needs (17.4 % vs. 4.9 %, P < 0.001) and services 
utilization (2.7 % vs. 1.0 %, P < 0.001) were significantly higher in lonely 
than not lonely participants. After adjusting for socio-demographic and epidemic 
characteristics and common mental health problems, loneliness was still 
significantly associated with mental health needs (OR = 2.50, P < 0.001) and 
services utilization (OR = 1.62, P = 0.020).
CONCLUSIONS: Feelings of loneliness are prevalent among Chinese residents 
affected by the COVID-19 epidemic and the presence of loneliness is associated 
with high levels of mental health needs and greater services utilization. 
Effective measures aiming at preventing or reducing loneliness are potentially 
beneficial for the mental wellbeing of COVID-19-affected population and reducing 
the use of the limited mental health service resources during the COVID-19 
pandemic.

DOI: 10.1186/s12992-021-00704-5
PMCID: PMC8072077
PMID: 33902638 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
declare.


3526. Front Public Health. 2021 Apr 7;9:643807. doi: 10.3389/fpubh.2021.643807. 
eCollection 2021.

Coping During the COVID-19 Pandemic: A Qualitative Study of Older Adults Across 
the United States.

Finlay JM(1), Kler JS(2), O'Shea BQ(2), Eastman MR(2), Vinson YR(2)(3), 
Kobayashi LC(2).

Author information:
(1)Social Environment and Health Program, Survey Research Center, Institute for 
Social Research, University of Michigan, Ann Arbor, MI, United States.
(2)Department of Epidemiology, Center for Social Epidemiology and Population 
Health, University of Michigan School of Public Health, Ann Arbor, MI, United 
States.
(3)Department of Health Management and Policy, University of Michigan School of 
Public Health, Ann Arbor, MI, United States.

Objective: Older adults may struggle with stresses and daily life challenges 
associated with the Coronavirus Disease 2019 (COVID-19) pandemic. Yet they may 
also utilize emotional and behavioral coping strategies. This qualitative paper 
aims to identify ways of coping with worries and stress during the pandemic from 
the perspectives of older adults in the United States. Methods: The COVID-19 
Coping Study recruited 6,938 adults aged ≥55 through online multi-frame sampling 
from April 2-May 31, 2020 across all 50 US states, the District of Columbia, and 
Puerto Rico. The online questionnaire focused on the effects of COVID-19 on 
daily life, mental health, and well-being. This included an open-ended question 
regarding participants' coping strategies. We used qualitative content analysis 
to identify and code diverse coping strategies. Our general inductive approach 
enabled findings to emerge from the most frequent and dominant themes in the raw 
data. Results: A total of 5,180 adults [74% of the total sample; mean age 67.3 
(SD 7.9); 63.8% female] responded to the question about using strategies to cope 
with living through the COVID-19 pandemic. Frequently-reported strategies 
included exercising and going outdoors, modifying routines, following public 
health guidelines, adjusting attitudes, and staying socially connected. Some 
coping strategies were health-limiting (e.g., overeating), while most strategies 
encouraged self-improvement, positive adjustment, and wellness. Conclusions: 
This study provides novel qualitative evidence on coping strategies of older 
adults early in the COVID-19 pandemic. Findings can inform community and 
clinical interventions to support older adults that harness positive coping 
strategies such as exercise, modified routines, and social strategies to improve 
physical and mental health, foster social support, and encourage meaningful 
daily activities during times of stress and trauma.

Copyright © 2021 Finlay, Kler, O'Shea, Eastman, Vinson and Kobayashi.

DOI: 10.3389/fpubh.2021.643807
PMCID: PMC8058195
PMID: 33898379 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


3527. Front Public Health. 2021 Apr 9;9:577079. doi: 10.3389/fpubh.2021.577079. 
eCollection 2021.

Evaluation of a Short-Term Digital Group Intervention to Relieve Mental Distress 
and Promote Well-Being Among Community-Dwelling Older Individuals During the 
COVID-19 Outbreak: A Study Protocol.

Shapira S(1)(2), Yeshua-Katz D(3), Goren G(4), Aharonson-Daniel L(1)(2), 
Clarfield AM(5)(6), Sarid O(4).

Author information:
(1)School of Public Health, Faculty of Health Sciences, Ben Gurion University of 
the Negev, Beer Sheva, Israel.
(2)PREPARED Center for Emergency Response Research, Ben Gurion University of the 
Negev, Beer Sheva, Israel.
(3)Department of Communication Studies, Faculty of Humanities and Social 
Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
(4)The Spitzer Department of Social Work, Faculty of Humanities and Social 
Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
(5)Faculty of Health Sciences, Medical School for International Health, 
Ben-Gurion University of the Negev, Beer Sheva, Israel.
(6)The Department of Geriatrics, McGill University, Montreal, QC, Canada.

Older individuals are at an increased risk of experiencing adverse social and 
health consequences due to both the COVID-19 pandemic and the measures taken to 
manage it, such as social distancing. To promote community-dwelling older 
individuals' well-being during this time, the aims of the current project are to 
develop effective strategies in order (a) to increase older individuals' digital 
literacy, and (b) to help them acquire behavioral and cognitive skills that will 
improve their coping abilities with the stressful situation created as a result 
of the pandemic, as well as reducing adverse mental health effects. The project 
comprises an intervention arm that includes digital group sessions for older 
individuals meant to improve their digital literacy, promote their effective 
coping, and relieve their mental distress and loneliness. Subjects receive a 
short-term (seven sessions), twice-weekly, digitally guided group intervention 
through Zoom (a video conferencing app), and WhatsApp (instant messaging app). 
The wait list control-group participants receive twice-weekly telephone calls 
from a research assistant during a parallel period. Web-based questionnaires are 
filled in pre- and post-participation. The effectiveness of the intervention 
will be analyzed by comparing pre- and post-measures, between intervention and 
control groups. This protocol offers a model for helping to support vulnerable 
populations during the COVID-19 pandemic. However, it is applicable regardless 
of the outbreak of a global health crisis or the imposition of lockdown rules; 
in fact, it has the potential to contribute to the social inclusion of 
vulnerable populations during routine times as well as during emergencies. 
Furthermore, ideas for future expansion include the integration of multilingual 
facilitators in order to reach seniors from underserved minority groups in 
various social contexts, even across borders.

Copyright © 2021 Shapira, Yeshua-Katz, Goren, Aharonson-Daniel, Clarfield and 
Sarid.

DOI: 10.3389/fpubh.2021.577079
PMCID: PMC8062707
PMID: 33898369 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


3528. J Huntingtons Dis. 2021;10(2):313-322. doi: 10.3233/JHD-200460.

Healthcare Delivery and Huntington's Disease During the Time of COVID-19.

Pfalzer AC(1), Hale LM(1), Huitz E(1), Buchanan DA(1), Brown BK(1), Moroz S(1), 
Rouleau RM(1), Hay KR(1), Hoadley J(1), Laird A(1), Ciriegio AE(2), Watson 
KH(2), Jones MT(2), Lin YC(3), Kang H(3), Riordan H(1), Isaacs DA(1), McDonell 
KE(1), Compas BE(2), Claassen DO(1).

Author information:
(1)Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, 
USA.
(2)Department of Psychology and Human Development, Vanderbilt University Medical 
Center, Nashville, TN, USA.
(3)Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN, 
USA.

BACKGROUND: Safer-at-home orders during the COVID-19 pandemic altered the 
structure of clinical care for Huntington's disease (HD) patients. This shift 
provided an opportunity to identify limitations in the current healthcare 
infrastructure and how these may impact the health and well-being of persons 
with HD.
OBJECTIVE: The study objectives were to assess the feasibility of remote 
healthcare delivery in HD patients, to identify socioeconomic factors which may 
explain differences in feasibility and to evaluate the impact of safer-at-home 
orders on HD patient stress levels.
METHODS: This observational study of a clinical HD population during the 
'safer-at-home' orders asked patients or caregivers about their current access 
to healthcare resources and patient stress levels. A chart review allowed for an 
assessment of socioeconomic status and characterization of HD severity.
RESULTS: Two-hundred and twelve HD patients were contacted with 156 completing 
the survey. During safer-at-home orders, the majority of HD patients were able 
to obtain medications and see a physician; however, 25% of patients would not 
commit to regular telehealth visits, and less than 50% utilized an online 
healthcare platform. We found that 37% of participants were divorced/single, 39% 
had less than a high school diploma, and nearly 20% were uninsured or on 
low-income health insurance. Patient stress levels correlated with disease 
burden.
CONCLUSION: A significant portion of HD participants were not willing to 
participate in telehealth services. Potential explanations for these limitations 
may include socioeconomic barriers and caregiving structure. These observations 
illustrate areas for clinical care improvement to address healthcare disparities 
in the HD community.

DOI: 10.3233/JHD-200460
PMID: 33896846 [Indexed for MEDLINE]


3529. J Affect Disord. 2021 Jun 1;288:145-147. doi: 10.1016/j.jad.2021.04.008. Epub 
2021 Apr 20.

Objectively measured digital technology use during the COVID-19 pandemic: Impact 
on depression, anxiety, and suicidal ideation among young adults.

Sewall CJR(1), Goldstein TR(2), Rosen D(3).

Author information:
(1)University of Pittsburgh, School of Social Work, United States. Electronic 
address: CJS227@pitt.edu.
(2)University of Pittsburgh School of Medicine, Department of Psychiatry and 
Psychology, United States.
(3)University of Pittsburgh, School of Social Work, United States.

BACKGROUND: Research suggests that the disruptions introduced by the COVID-19 
pandemic have led to increased psychological distress and time spent on digital 
technology among young people, thus intensifying pre-pandemic concerns regarding 
the putative effects of digital technology use on mental health. To robustly 
examine whether increases in digital technology use are associated with 
increases in psychological distress during the pandemic it is crucial to (1) 
collect objective data on digital technology use and (2) account for potential 
confounding caused by pandemic-related stressors.
METHODS: We conducted a four-wave panel study of U.S. young adults (N=384; 
Mage = 24.5 ± 5.1; 57% female) from August-November of 2020. Participants 
provided screenshots of their iPhone "Screen Time" application and completed 
measures assessing current mental health status (depression, anxiety, and 
suicidal ideation) and pandemic-related impacts on well-being. We used 
random-intercept multilevel models to examine the within- and between-person 
associations between mental health, objective digital technology use, and 
pandemic-related stressors.
RESULTS: Multilevel analyses revealed that none of the objectively-measured 
digital technology use variables were positively associated with depression, 
anxiety, or suicidal ideation at the within- or between-person levels. In 
contrast, pandemic-related impacts on mental health had by far the largest 
effects on depression, anxiety, and suicidal ideation.
LIMITATIONS: The convenience-based sample and use of single-item measures of 
pandemic-related impacts are limitations of the study.
CONCLUSIONS: Current speculations about the direct harms of digital technology 
use on mental health may be unfounded and risk diverting attention from a more 
likely cause: pandemic-related distress.

Copyright © 2021. Published by Elsevier B.V.

DOI: 10.1016/j.jad.2021.04.008
PMCID: PMC9754658
PMID: 33894615 [Indexed for MEDLINE]

Conflict of interest statement: Craig J.R. Sewall and Daniel Rosen have no 
conflicts of interest or financial disclosures to report. Tina R. Goldstein has 
received research support from NIMH, the American Foundation for Suicide 
Prevention (AFSP), the University of Pittsburgh Clinical and Translational 
Science Institute, and The Brain and Behavior Foundation, as well as royalties 
from Guilford Press.


3530. Lancet Public Health. 2021 Jun;6(6):e365-e373. doi: 
10.1016/S2468-2667(21)00069-4. Epub 2021 Apr 21.

Mental health and social interactions of older people with physical disabilities 
in England during the COVID-19 pandemic: a longitudinal cohort study.

Steptoe A(1), Di Gessa G(2).

Author information:
(1)Department of Epidemiology and Public Health, University College London, 
London, UK. Electronic address: a.steptoe@ucl.ac.uk.
(2)Department of Epidemiology and Public Health, University College London, 
London, UK.

Comment in
    Lancet Public Health. 2021 Jun;6(6):e347-e348.

BACKGROUND: The COVID-19 pandemic has affected mental health, psychological 
wellbeing, and social interactions. People with physical disabilities might be 
particularly likely to be negatively affected, but evidence is scarce. Our aim 
was to evaluate the emotional and social experience of older people with 
physical disabilities during the early months of the COVID-19 pandemic in 
England.
METHODS: In this longitudinal cohort study, we analysed data from the English 
Longitudinal Study of Ageing collected in 2018-19 and June-July, 2020, from 
participants aged 52 years and older and living in England. Physical disability 
was defined as impairment in basic and instrumental activities of daily living 
(ADL) and impaired mobility. Depression, anxiety, loneliness, quality of life, 
sleep quality, and amount of real-time and written social contact were assessed 
online or by computer-assisted telephone interviews. Comparisons of experiences 
during the COVID-19 pandemic of people with and without a physical disability 
were adjusted statistically for pre-pandemic outcome measures, age, sex, wealth, 
ethnicity, presence of a spouse or partner, number of people in the household, 
and chronic pain. All participants with full data available for both surveys 
were included in the analyses.
FINDINGS: Between June 3 and July 26, 2020, 5820 participants responded, 4887 of 
whom had full data available for both the pre-pandemic measures and the COVID-19 
survey and were included in the analysis. During the COVID-19 pandemic, 
significantly more people with ADL impairment had clinically significant 
symptoms of depression (odds ratio 1·78 [95% CI 1·44-2·19]; p<0·0001), anxiety 
(2·23 [1·72-2·89]; p<0·0001), and loneliness (1·52 [1·26-1·84]; p<0·0001) than 
people without ADL impairment. Significantly more people with ADL impairment 
also had impaired sleep quality (1·44 [1·20-1·72]; p<0·0001) and poor quality of 
life than people without ADL impairment. The results were similar when 
disability was defined by impaired mobility. People with ADL impairment had less 
frequent real-time contact (0·70 [0·55-0·89]; p=0·0037) and written social 
contact (0·54 [0·45-0·64]; p<0·0001) with family than people without ADL 
impairment. Results for social contact were similar when disability was defined 
by impaired mobility.
INTERPRETATION: People with physical disability might be at particular risk for 
emotional distress, poor quality of life, and low wellbeing during the COVID-19 
pandemic, highlighting the need for additional support and targeted mental 
health services.
FUNDING: Economic and Social Research Council/UK Research and Innovation, 
National Institute on Aging, National Institute for Health Research.

Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open 
Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. 
All rights reserved.

DOI: 10.1016/S2468-2667(21)00069-4
PMCID: PMC8517412
PMID: 33894138 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of interests We declare no competing 
interests.


3531. Int Nurs Rev. 2021 Jun;68(2):256-265. doi: 10.1111/inr.12679. Epub 2021 Apr 24.

Factors affecting frontline Korean nurses' mental health during the COVID-19 
pandemic.

Cho M(1), Kim O(1), Pang Y(1), Kim B(1), Jeong H(1), Lee J(1), Jung H(2), Jeong 
SY(2), Park HY(3), Choi H(4), Dan H(1).

Author information:
(1)College of Nursing, Ewha Womans University, Seoul, Korea.
(2)College of Nursing, Konyang University, Daejeon, Korea.
(3)Department of Precision Medicine, Korea National Institute of Health, 
Chungcheongbuk-do, Korea.
(4)Division of Population Research, Department of Precision Medicine, Korea 
National Institute of Health, Chungcheongbuk-do, Korea.

AIM: To identify the factors affecting fear, anxiety and depressive symptoms 
among frontline nurses working with COVID-19 patients or are in charge of 
COVID-19 screening in Korea.
BACKGROUND: Nurses are at a higher risk of COVID-19 infection because they are 
in closer, longer-duration contact with patients. These situations can 
negatively affect the mental health of nurses.
METHODS: This study analysed data from COVID-19 module in the Korean Nurses' 
Health Study. Data from 906 participants were analysed. To identify the factors 
influencing mental health, descriptive statistics, Pearson's correlation and 
hierarchical multiple regression analyses were performed.
RESULTS: Caring for patients who are COVID-19-positive increased levels of fear, 
anxiety and depressive symptoms of nurses. The hospital safety climate 
influenced mental well-being among nurses.
CONCLUSION: Caring for patients with COVID-19 had a negative impact on fear, 
anxiety and depressive symptoms. However, the higher was the perceived hospital 
safety climate, the lower were the nurses' psychological symptoms. Further 
research on the mental health of nurses is warranted.
IMPLICATIONS FOR NURSING AND HEALTH POLICY: Institutions should manage human 
resources to enable periodic rotation of nurses' work and working periods 
related to COVID-19. In addition, hospital managers should provide sufficient 
personal protective equipment, related education, and safety climate.

© 2021 International Council of Nurses.

DOI: 10.1111/inr.12679
PMCID: PMC8251381
PMID: 33894067 [Indexed for MEDLINE]


3532. J Psychiatr Ment Health Nurs. 2021 Dec;28(6):961-969. doi: 10.1111/jpm.12763. 
Epub 2021 Apr 28.

Dementia care from behind the mask? Maintaining well-being during COVID-19 
pandemic restrictions: Observations from Dementia Care Mapping on NHS mental 
health hospital wards in Wales.

Page S(1), Davies-Abbott I(2), Jones A(3).

Author information:
(1)Betsi Cadwaladr University Health Board & Senior Honorary Lecturer in 
dementia studies, School of Health Sciences, Bangor University, Bangor, UK.
(2)Lecturer in Mental Health Nursing, School of Health Sciences, Bangor 
University, Bangor, UK.
(3)Betsi Cadwaladr University Health Board, Bangor, UK.

WHAT IS KNOWN ON THE SUBJECT?: Coronavirus disease 2019 (COVID-19) is a new 
infectious disease that has spread across the world and infected a large number 
of people many of whom have died. People with moderate to severe dementia are at 
very high risk of becoming infected as the disease mainly impacts on older 
people with other health problems and once infected the person with dementia is 
more likely to become seriously ill than other people. To prevent infection, 
people are required to wear masks and isolate from contact with others. It is 
believed that these measures can reduce the quality of life and general 
well-being of people with moderate to severe dementia in hospital or social 
care. This belief has not yet been demonstrated by research. WHAT DOES THIS 
PAPER ADD TO THE EXISTING KNOWLEDGE?: We show that people with moderate to 
severe dementia receiving care on mental health hospital wards and subject to 
strict infection prevention measures can still achieve high levels of 
well-being. We show that mental health nurses alter the focus of their care to 
deliberately overcome the challenges and particularly the restrictions on 
visiting by families. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: We believe that 
the changes in practice we observed can occur in other healthcare and social 
care settings and that whilst restrictions remain in place care staff can 
protect and possibly enhance well-being for people with moderate to severe 
dementia. ABSTRACT: Introduction The effect of coronavirus (COVID-19) on people 
living with dementia is potentially severe in its clinical impacts. More widely, 
for this vulnerable group, the social restrictions to limit the spread of 
infection may be emotionally and psychologically damaging. Aim To explore the 
impact of restrictions on well-being for people with moderate to severe dementia 
in acute mental health hospital care. Method "Dementia Care Mapping" was the 
observational tool used to determine well- or ill-being. Observations were 
undertaken in two mental health hospital wards during a time of restrictions and 
the use of personal protective equipment. Results We report levels of well-being 
that are higher than might be expected alongside a change in the focus of 
psychological care delivered through mental health nursing interventions aimed 
at enhancing well-being. Discussion-We postulate that mental health nurses faced 
with an unprecedented challenge respond by changing practice to mitigate for 
infection prevention measures and to compensate for family absence. Implications 
for practice We suggest that the desirable enhancing actions by nursing staff 
which raise well-being in these hospital settings are readily transferable to 
other settings that are aiming to maintain well-being but also practising under 
COVID-19 restrictions.

© 2021 John Wiley & Sons Ltd.

DOI: 10.1111/jpm.12763
PMCID: PMC8250593
PMID: 33893693 [Indexed for MEDLINE]

Conflict of interest statement: All three authors assert that there are no 
conflicts of interest.


3533. BMJ Open. 2021 Apr 22;11(4):e049210. doi: 10.1136/bmjopen-2021-049210.

Remote care for mental health: qualitative study with service users, carers and 
staff during the COVID-19 pandemic.

Liberati E(1), Richards N(1), Parker J(2), Willars J(3), Scott D(4), Boydell 
N(5), Pinfold V(2), Martin G(1), Dixon-Woods M(1), Jones P(6).

Author information:
(1)Department of Public Health and Primary Care, University of Cambridge, THIS 
Institute, Cambridge, UK.
(2)McPin Foundation, London, UK.
(3)Department of Health Sciences, University of Leicester, Leicester, UK.
(4)Population Health and Genomics, University of Dundee, Dundee, UK.
(5)Centre for Biomedicine Self and Society, Usher Institute, The University of 
Edinburgh, Edinburgh, UK.
(6)Department of Psychiatry, Cambridge University, Cambridge, UK 
pbj21@cam.ac.uk.

OBJECTIVES: To explore the experiences of service users, carers and staff 
seeking or providing secondary mental health services during the COVID-19 
pandemic.
DESIGN: Qualitative interview study, codesigned with mental health service users 
and carers.
METHODS: We conducted semistructured, telephone or online interviews with a 
purposively constructed sample; a lived experience researcher conducted and 
analysed interviews with service users. Analysis was based on the constant 
comparison method.
SETTING: National Health Service (NHS) secondary mental health services in 
England between June and August 2020.
PARTICIPANTS: Of 65 participants, 20 had either accessed or needed to access 
English secondary mental healthcare during the pandemic; 10 were carers of 
people with mental health difficulties; 35 were members of staff working in NHS 
secondary mental health services during the pandemic.
RESULTS: Experiences of remote care were mixed. Some service users valued the 
convenience of remote methods in the context of maintaining contact with 
familiar clinicians. Most participants commented that a lack of non-verbal cues 
and the loss of a therapeutic 'safe space' challenged therapeutic relationship 
building, assessments and identification of deteriorating mental well-being. 
Some carers felt excluded from remote meetings and concerned that assessments 
were incomplete without their input. Like service users, remote methods posed 
challenges for clinicians who reported uncertainty about technical options and a 
lack of training. All groups expressed concern about intersectionality 
exacerbating inequalities and the exclusion of some service user groups if 
alternatives to remote care are lost.
CONCLUSIONS: Though remote mental healthcare is likely to become increasingly 
widespread in secondary mental health services, our findings highlight the 
continued importance of a tailored, personal approach to decision making in this 
area. Further research should focus on which types of consultations best suit 
face-to-face interaction, and for whom and why, and which can be provided 
remotely and by which medium.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/bmjopen-2021-049210
PMCID: PMC8068948
PMID: 33888531 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3534. LGBT Health. 2021 May-Jun;8(4):263-272. doi: 10.1089/lgbt.2020.0489. Epub 2021 
Apr 21.

Sexual Minority Disparities in Health and Well-Being as a Consequence of the 
COVID-19 Pandemic Differ by Sexual Identity.

Fish JN(1), Salerno J(2), Williams ND(1), Rinderknecht RG(3), Drotning KJ(4), 
Sayer L(4), Doan L(4).

Author information:
(1)Department of Family Science and School of Public Health, University of 
Maryland, College Park, Maryland, USA.
(2)Department of Behavioral and Community Health, School of Public Health, 
University of Maryland, College Park, Maryland, USA.
(3)Laboratory of Digital and Computational Demography, Max Planck Institute for 
Demographic Research, Rostock, Germany.
(4)Department of Sociology, College of Behavioral and Social Sciences, 
University of Maryland, College Park, Maryland, USA.

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has accentuated 
long-standing population health disparities in the United States. We examined 
how the pandemic and its social consequences may differentially impact sexual 
minority adults, relative to heterosexual adults. Methods: Data are from a U.S. 
national sample of adults (n = 2996; 18.06%) collected from online panels from 
April to May 2020. We used eight indicators of well-being-mental health, 
physical health, quality of life, stress, loneliness, psychological distress, 
alcohol use, and fatigue-to assess the degree to which sexual identity subgroups 
(i.e., heterosexual, gay/lesbian, bisexual, and "other" sexual minority) varied 
in retrospective pre- and postpandemic onset indicators of well-being and 
whether groups varied in their rate of change from pre- and postpandemic onset. 
Results: The results showed consistent patterns of decline in well-being across 
sexual identity subgroups, although changes in mental health, physical health, 
quality of life, stress, and psychological distress were more robust among 
sexual minority adults in general, relative to heterosexual adults. Adjusted 
multivariate models testing differences in change in retrospective pre- and 
postpandemic onset found that well-being among bisexual men and women was most 
negatively impacted by the pandemic. Conclusion: The COVID-19 pandemic may have 
distinct health consequences for sexual minority adults in the United States. 
Our findings support and further legitimize calls for more comprehensive 
surveillance and cultural responsiveness in emergency preparedness as it relates 
to sexual minority people and the COVID-19 pandemic.

DOI: 10.1089/lgbt.2020.0489
PMCID: PMC8213002
PMID: 33887160 [Indexed for MEDLINE]

Conflict of interest statement: No competing financial interests exist.


3535. PLoS One. 2021 Apr 21;16(4):e0249780. doi: 10.1371/journal.pone.0249780. 
eCollection 2021.

A cross-national study of factors associated with women's perinatal mental 
health and wellbeing during the COVID-19 pandemic.

Basu A(1)(2), Kim HH(1), Basaldua R(1), Choi KW(2), Charron L(3), Kelsall N(1), 
Hernandez-Diaz S(1), Wyszynski DF(4), Koenen KC(1)(2).

Author information:
(1)Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United 
States of America.
(2)Massachusetts General Hospital, Boston, Massachusetts, United States of 
America.
(3)Hamilton College, Clinton, New York, United States of America.
(4)Pregistry, Los Angeles, California, United States of America.

Pregnant and postpartum women face unique challenges during the COVID-19 
pandemic that may put them at elevated risk of mental health problems. However, 
few large-scale and no cross-national studies have been conducted to date that 
investigate modifiable pandemic-related behavioral or cognitive factors that may 
influence mental health in this vulnerable group. This international study 
sought to identify and measure the associations between pandemic-related 
information seeking, worries, and prevention behaviors on perinatal mental 
health during the COVID-19 pandemic. An anonymous, online, cross-sectional 
survey of pregnant and postpartum women was conducted in 64 countries between 
May 26, 2020 and June 13, 2020. The survey, available in twelve languages, was 
hosted on the Pregistry platform for COVID-19 studies 
(https://corona.pregistry.com) and advertised in social media channels and 
online parenting forums. Participants completed measures on demographics, 
COVID-19 exposure and worries, information seeking, COVID-19 prevention 
behaviors, and mental health symptoms including posttraumatic stress via the 
IES-6, anxiety/depression via the PHQ-4, and loneliness via the UCLA-3. Of the 
6,894 participants, substantial proportions of women scored at or above the 
cut-offs for elevated posttraumatic stress (2,979 [43%]), anxiety/depression 
(2,138 [31%], and loneliness (3,691 [53%]). Information seeking from any source 
(e.g., social media, news, talking to others) five or more times per day was 
associated with more than twice the odds of elevated posttraumatic stress and 
anxiety/depression, in adjusted models. A majority of women (86%) reported being 
somewhat or very worried about COVID-19. The most commonly reported worries were 
related to pregnancy and delivery, including family being unable to visit after 
delivery (59%), the baby contracting COVID-19 (59%), lack of a support person 
during delivery (55%), and COVID-19 causing changes to the delivery plan (41%). 
Greater worries related to children (i.e., inadequate childcare, their infection 
risk) and missing medical appointments were associated with significantly higher 
odds of posttraumatic stress, anxiety/depression and loneliness. Engaging in 
hygiene-related COVID-19 prevention behaviors (face mask-wearing, washing hands, 
disinfecting surfaces) were not related to mental health symptoms or loneliness. 
Elevated posttraumatic stress, anxiety/depression, and loneliness are highly 
prevalent in pregnant and postpartum women across 64 countries during the 
COVID-19 pandemic. Excessive information seeking and worries related to children 
and medical care are associated with elevated symptoms, whereas engaging in 
hygiene-related preventive measures were not. In addition to screening and 
monitoring mental health symptoms, addressing excessive information seeking and 
women's worries about access to medical care and their children's well-being, 
and developing strategies to target loneliness (e.g., online support groups) 
should be part of intervention efforts for perinatal women. Public health 
campaigns and medical care systems need to explicitly address the impact of 
COVID-19 related stressors on mental health in perinatal women, as prevention of 
viral exposure itself does not mitigate the pandemic's mental health impact.

DOI: 10.1371/journal.pone.0249780
PMCID: PMC8059819
PMID: 33882096 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


3536. Clin Psychol Psychother. 2021 Nov;28(6):1317-1333. doi: 10.1002/cpp.2601. Epub 
2021 May 15.

Fears of compassion magnify the harmful effects of threat of COVID-19 on mental 
health and social safeness across 21 countries.

Matos M(1), McEwan K(2), Kanovský M(3), Halamová J(4), Steindl SR(5), Ferreira 
N(6), Linharelhos M(1), Rijo D(1), Asano K(7), Gregório S(1)(8), Márquez MG(8), 
Vilas SP(8), Brito-Pons G(9), Lucena-Santos P(1), da Silva Oliveira M(10), de 
Souza EL(11), Llobenes L(12), Gumiy N(12), Costa MI(12), Habib N(13), Hakem 
R(13), Khrad H(13), Alzahrani A(13), Cheli S(14), Petrocchi N(15), Tholouli 
E(16), Issari P(16), Simos G(17), Lunding-Gregersen V(18), Elklit A(19), Kolts 
R(20), Kelly AC(21), Bortolon C(22)(23), Delamillieure P(24)(25), Paucsik M(22), 
Wahl JE(26)(27), Zieba M(27), Zatorski M(27), Komendziński T(28)(29), Zhang 
S(30), Basran J(2), Kagialis A(6), Kirby J(5), Gilbert P(2).

Author information:
(1)University of Coimbra, Center for Research in Neuropsychology and Cognitive 
Behavioral Intervention (CINEICC), Faculty of Psychology and Educational 
Sciences, Coimbra, Portugal.
(2)College of Health, Psychology and Social Care, Centre for Compassion Research 
and Training, University of Derby, Derby, UK.
(3)Institute of Social Anthropology, Faculty of Social and Economic Sciences, 
Comenius University, Bratislava, Slovakia.
(4)Institute of Applied Psychology, Faculty of Social and Economic Sciences, 
Comenius University, Bratislava, Slovakia.
(5)School of Psychology, Compassionate Mind Research Group, University of 
Queensland, Brisbane, Queensland, Australia.
(6)Department of Social Sciences, University of Nicosia, Nicosia, Cyprus.
(7)Department of Psychological Counseling, Faculty of Psychology, Mejiro 
University, Tokyo, Japan.
(8)Department of Psychology, Faculty of Biomedical and Health Sciences, 
Behavior, Emotions, and Health Research Group, Universidad Europea de Madrid, 
Madrid, Spain.
(9)Escuela de Psicología, Pontificia Universidad Católica de Chile, Santiago, 
Chile.
(10)Evaluation and Treatment in Cognitive and Behavioral 
Psychotherapies-Research Group (GAAPCC), Pontifical Catholic University of Rio 
Grande do Sul, Porto Alegre, Brazil.
(11)Conectta: Mindfulness & Compassion, São Paulo, Brazil.
(12)Motivación Compasiva, Buenos Aires, Argentina.
(13)Neuroscience Department, section of Psychiatry and Psychology, King Faisal 
Specialist Hospital and Research Centre (KFSH&RC), Jeddah, Saudi Arabia.
(14)School of Human Health Sciences, University of Florence, Florence, Italy.
(15)Department of Economics and Social Sciences, John Cabot University, Rome, 
Italy.
(16)Center for Qualitative Research in Psychology and Psychosocial Well-being, 
National and Kapodistrian University of Athens, Athens, Greece.
(17)Department of Educational and Social Policy, University of Macedonia, 
Thessaloniki, Greece.
(18)Mindwork Psycological Center, Copenhagen, Denmark.
(19)Department of Psychology, University of Southern Denmark, Odense, Denmark.
(20)Department of Psychology, Eastern Washington University, Cheney, Washington, 
USA.
(21)Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada.
(22)Laboratoire Inter-universitaire de Psychologie : Personnalité, Cognition et 
Changement Social, Grenoble Alpes University, Grenoble, France.
(23)C3R-Réhabilitation Psychosociale et Remédiation Cognitive, Centre 
Hospitalier Alpes Isère, Grenoble, France.
(24)Service de Psychiatrie Adulte, CHU de Caen, Caen, France.
(25)UNICAEN, ISTS, GIP Cyceron, University of Normandy, Caen, France.
(26)The Mind Institute Poland, Warsaw, Poland.
(27)SWPS University of Social Sciences and Humanities, Warsaw& Poznań, Poland.
(28)Department of Cognitive Science, Nicolaus Copernicus University, Torún, 
Poland.
(29)Neurocognitive Laboratory, Centre for Modern Interdisciplinary Technologies, 
Nicolaus Copernicus University, Torún, Poland.
(30)School of Human Sciences, University of Derby, Derby, UK.

BACKGROUND: The COVID-19 pandemic is a massive global health crisis with 
damaging consequences to mental health and social relationships. Exploring 
factors that may heighten or buffer the risk of mental health problems in this 
context is thus critical. Whilst compassion may be a protective factor, in 
contrast fears of compassion increase vulnerability to psychosocial distress and 
may amplify the impact of the pandemic on mental health. This study explores the 
magnifying effects of fears of compassion on the impact of perceived threat of 
COVID-19 on depression, anxiety and stress, and social safeness.
METHODS: Adult participants from the general population (N = 4057) were 
recruited across 21 countries worldwide, and completed self-report measures of 
perceived threat of COVID-19, fears of compassion (for self, from others, for 
others), depression, anxiety, stress and social safeness.
RESULTS: Perceived threat of COVID-19 predicted increased depression, anxiety 
and stress. The three flows of fears of compassion predicted higher levels of 
depression, anxiety and stress and lower social safeness. All fears of 
compassion moderated (heightened) the impact of perceived threat of COVID-19 on 
psychological distress. Only fears of compassion from others moderated the 
effects of likelihood of contracting COVID-19 on social safeness. These effects 
were consistent across all countries.
CONCLUSIONS: Fears of compassion have a universal magnifying effect on the 
damaging impact of the COVID-19 pandemic on mental health and social safeness. 
Compassion focused interventions and communications could be implemented to 
reduce resistances to compassion and promote mental wellbeing during and 
following the pandemic.

© 2021 John Wiley & Sons, Ltd.

DOI: 10.1002/cpp.2601
PMCID: PMC8251194
PMID: 33880832 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3537. Psychol Health Med. 2022 Feb;27(2):343-351. doi: 10.1080/13548506.2021.1916963. 
Epub 2021 Apr 20.

The role of the COVID-19 pandemic in altered psychological well-being, mental 
health and sleep: an online cross-sectional study.

Allen SF(1), Stevenson J(2), Lazuras L(3), Akram U(4)(5).

Author information:
(1)Psychology Department, School of Social Sciences, Humanities and Law, 
Teesside University, Middlesbrough, UK.
(2)School of Psychology, University of Lincoln, Lincoln, UK.
(3)Department of Psychology, The University of Sheffield, Sheffield, UK.
(4)Centre for Behavioural Science and Applied Psychology, Sheffield Hallam 
University, Sheffield, UK.
(5)Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, 
UK.

Coronavirus disease 2019 (COVID-19) is a global pandemic. Measures to reduce 
transmission of the virus have altered usual activities, routines, and 
livelihoods, and have had a significant impact on mental health. The current 
study aims to examine the potential alterations in psychological wellbeing, 
mental health, sleep and diurnal preference due to the COVID-19 pandemic. A 
cross sectional online questionnaire-based study with n = 200 participants (aged 
18-62; 7.86.0% female, 93.0% white, 92.5% UK-based, 73.5% students). Data were 
collected between 15th April and 8 June 2020. Participants answered questions on 
lifestyle changes and their concerns and worries about COVID-19, and completed 
the SCI, PHQ9, GAD7, PWB18, UCLA3 and MEQ. Results showed self-isolation was 
linked to lower psychological well-being, and increased loneliness, anxiety and 
depression. Home-working was related to a shift in diurnal preference. Reduced 
work/income was related to decreased psychological well-being and sleep quality 
and increased anxiety, depression, loneliness and. Intensity of worried thoughts 
and concerns about COVID-19 were positively correlated with anxiety, depression 
and negatively with sleep quality. In conclusion, the social, occupational and 
economic disruption due to COVID19 has had a negative impact on psychological 
well-being. However, the transition to home-working may have been somewhat 
beneficial for some individuals in terms of sleep. These findings should be 
taken into account by policy makers during the transition to the 'new normal' 
post-pandemic.

DOI: 10.1080/13548506.2021.1916963
PMID: 33878999 [Indexed for MEDLINE]


3538. J Med Internet Res. 2021 May 17;23(5):e24412. doi: 10.2196/24412.

Factors Influencing Anxiety Among WeChat Users During the Early Stages of the 
COVID-19 Pandemic in Mainland China: Cross-sectional Survey Study.

Zou C(#)(1), Zhang W(#)(2), Sznajder K(3), Yang F(2), Jia Y(2), Ma R(2), Cui 
C(2), Yang X(2).

Author information:
(1)Department of Humanities and Social Sciences, China Medical University, 
Shenyang, China.
(2)Department of Social Medicine, School of Public Health, China Medical 
University, Shenyang, China.
(3)Department of Public Health, College of Medicine, Pennsylvania State 
University, Philadelphia, PA, United States.
(#)Contributed equally

BACKGROUND: The rapid outbreak of COVID-19 around the world has adversely 
affected the mental health of the public. The prevalence of anxiety among the 
public has increased dramatically during the COVID-19 pandemic. However, there 
are few studies evaluating the effects of positive psychological responses and 
information-seeking behaviors on anxiety experienced among social media users 
during the COVID-19 pandemic.
OBJECTIVE: This study evaluated the prevalence of anxiety and its associated 
factors among WeChat users in mainland China during the early stages of the 
COVID-19 pandemic.
METHODS: From February 10 to February 24, 2020, a nationwide, web-based 
cross-sectional survey study was carried out using convenience sampling. 
Participants' levels of anxiety, positive psychological responses, and 
information-seeking behaviors were assessed. The survey was distributed among 
WeChat users via the WeChat smartphone platform. Chi-square tests and 
multivariable logistic regression analyses were performed to examine the factors 
associated with anxiety.
RESULTS: This study found that the prevalence of anxiety (Generalized Anxiety 
Disorder 7-item [GAD-7] scale score ≥7) among WeChat users in China was 17.96% 
(446/2483) during the early stages of the COVID-19 pandemic. Results of 
multivariable logistic regression analysis showed that information-seeking 
behaviors such as cannot stop searching for information on COVID-19, being 
concerned about the COVID-19 pandemic, and spending more than 1 hour per day 
consuming information about the pandemic were found to be associated with 
increased levels of anxiety. Additionally, participants who chose social media 
and commercial media as the primary sources to obtain information about the 
COVID-19 pandemic were found more likely to report anxiety. Conversely, 
participants who were confident or rational about the COVID-19 pandemic were 
less likely to report anxiety.
CONCLUSIONS: This study found that positive psychological responses and 
information-seeking behaviors were closely associated with anxiety among WeChat 
users during the COVID-19 pandemic in China. It might be paramount to enhance 
mental well-being by helping people respond to the COVID-19 pandemic more 
rationally and positively in order to decrease symptoms of anxiety.

©Changqing Zou, Weiyu Zhang, Kristin Sznajder, Fengzhi Yang, Yajing Jia, Ruqing 
Ma, Can Cui, Xiaoshi Yang. Originally published in the Journal of Medical 
Internet Research (https://www.jmir.org), 17.05.2021.

DOI: 10.2196/24412
PMCID: PMC8130820
PMID: 33878025 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


3539. J Adolesc Health. 2021 Jun;68(6):1053-1058. doi: 
10.1016/j.jadohealth.2021.03.013. Epub 2021 Apr 17.

"Trying My Best": Sexual Minority Adolescents' Self-Care During the COVID-19 
Pandemic.

O'Brien RP(1), Parra LA(2), Cederbaum JA(2).

Author information:
(1)Suzanne Dworak-Peck School of Social Work, University of Southern California, 
Los Angeles, California. Electronic address: rpobrien@usc.edu.
(2)Suzanne Dworak-Peck School of Social Work, University of Southern California, 
Los Angeles, California.

PURPOSE: The COVID-19 pandemic has resulted in major life disruptions for sexual 
minority adolescents (SMAs), who already face and cope with pervasive and 
disproportionate rates of social, behavioral, and mental health challenges. 
Current research suggests that SMAs are struggling with COVID-19-related shelter 
in place orders navigating family proximity and dynamics and experiencing 
isolation from SMA-specific supports. Given identified challenges that may 
exacerbate known mental health disparities in SMAs, this work explores self-care 
practices among SMAs during the COVID-19 pandemic.
METHODS: The present study uses data from open-ended questions to understand SMA 
experiences of self-care within a nationwide sample of SMAs (N = 770; M = 
17.48 years, SD = 1.00) who are part of an ongoing prospective study. Data were 
collected via online questionnaire between May 13 and 31, 2020. Thematic 
analysis guided data exploration.
RESULTS: Thematic analysis revealed five self-care practices among SMAs: (1) 
relationships, (2) routines, (3) body and mind, (4) rest and reset, and (5) 
tuning out. SMAs engaged in many positive coping strategies (i.e., exercise, 
establishing routine) and often linked these activities to positive well-being. 
Other SMAs engaged in activities to distract or disengage from stressors (i.e., 
excessive TV and alcohol and drug use).
CONCLUSIONS: These findings highlight the resiliency of SMAs during the current 
pandemic, opportunities for providers to emphasize adaptive coping skills with 
youths, and the need for more research on adolescent self-care practices.

Copyright © 2021 Society for Adolescent Health and Medicine. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jadohealth.2021.03.013
PMCID: PMC8154726
PMID: 33875330 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of conflicting interests The authors 
declared no potential conflicts of interest with respect to the research, 
authorship, and/or publication of this article.


3540. BMC Public Health. 2021 Apr 19;21(1):752. doi: 10.1186/s12889-021-10796-8.

COVID-19: challenges faced by Nepalese migrants living in Japan.

Bhandari D(1), Kotera Y(2), Ozaki A(3)(4), Abeysinghe S(5), Kosaka M(3), 
Tanimoto T(3).

Author information:
(1)Medical Governance Research Institute, Tokyo, Japan. rayordeal3@gmail.com.
(2)Human Sciences Research Centre, University of Derby, Derby, UK.
(3)Medical Governance Research Institute, Tokyo, Japan.
(4)Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, 
Japan.
(5)Global Health Policy Unit, School of Social & Political Science, University 
of Edinburgh, Edinburgh, UK.

BACKGROUND: Worldwide, COVID-19 has exacerbated the vulnerability of migrants, 
impacting many facets of their lives. Nepalese make up one of the largest groups 
of migrants residing in Japan. Crises, such as the ongoing COVID-19 pandemic 
could disproportionately affect migrants from low- and middle-income countries 
like Nepal, widening health and economic inequalities. An in-depth, 
comprehensive assessment is needed to appraise the diverse problems they 
encounter. Drawing upon qualitative interviews, this study aimed to identify 
challenges faced by Nepalese migrants in Japan as a consequence of the COVID-19 
pandemic and to discuss their needs to counter these challenges.
METHODS: This qualitative study employed an interpretivist approach to appraise 
the first-hand experience of Nepalese migrants living in Japan. Fourteen 
participants (8 males and 6 females, aged 21 to 47 years old) were recruited to 
participate in semi-structured in-depth telephone interviews (45-60 min) 
regarding: (a) their perceived current physical and mental health, (b) problems 
faced as a result of the COVID-19 pandemic, and (c) perception of available and 
necessary support structures. Purposive and snowball sampling techniques were 
used to recruit the participants. Interviews were recorded, transcribed, and 
thematically analyzed.
RESULTS: Six themes were identified: 1) experiencing psychosomatic symptoms, 2) 
adoption of new healthy behaviors, 3) financial hardship, 4) family concerns, 5) 
reflections on discrimination and 6) reflections of existing support and 
expectations of support systems. The findings of our study illustrate the 
specific impact of COVID-19 among Nepalese migrants regarding their unstable 
employment conditions, perceived lack of social support, possible obligation to 
send money home, difficulty in accessing services due to the language barrier, 
and a lack of effective governmental support from Nepal. Pandemic-related 
adversity has negatively impacted migrants' mental well-being, exacerbating 
their vulnerability.
CONCLUSIONS: Comprehensive and timely support should be provided to the 
vulnerable migrant population. Effective coordination among relevant parties in 
both countries, including the governments concerned, should be facilitated.

DOI: 10.1186/s12889-021-10796-8
PMCID: PMC8054259
PMID: 33874937 [Indexed for MEDLINE]

Conflict of interest statement: Dr. Akihiko Ozaki and Dr. Tetsuya Tanimoto 
received personal fees from MNES Inc., outside of the submitted work. All other 
authors have declared that no competing interests exist.


3541. BMC Public Health. 2021 Apr 19;21(1):755. doi: 10.1186/s12889-021-10825-6.

COVID-19 pandemic-related changes in wellness behavior among older Americans.

Harrison E(1)(2), Monroe-Lord L(3), Carson AD(3), Jean-Baptiste AM(3), Phoenix 
J(4), Jackson P(3), Harris BM(3), Asongwed E(3), Richardson ML(3).

Author information:
(1)College of Agriculture, Urban Sustainability and Environmental Sciences, 
University of the District of Columbia, 4250 Connecticut Ave, NW, Washington, 
DC, 20008, USA. Elgloria.Harrison@lehman.cuny.edu.
(2)Lehman College City University of New York, 250 Bedford Park Boulevard West, 
Bronx, NY, 10468, USA. Elgloria.Harrison@lehman.cuny.edu.
(3)College of Agriculture, Urban Sustainability and Environmental Sciences, 
University of the District of Columbia, 4250 Connecticut Ave, NW, Washington, 
DC, 20008, USA.
(4)The George Washington University Milken Institute School of Public Health, 
2175 'K' Street NW, Suite 500, Washington, DC, 20037, USA.

BACKGROUND: COVID-19 has taken its toll on citizens in all 50 states of the 
United States. The United States (U.S.) leads the world with 30,291,863 
confirmed reported cases and 549,664 deaths as of March 29, 2021 compared to 
globally confirmed cases at 127,442,926 and 2,787,915 deaths as of March 29, 
2021. The U.S. federal government primarily left the response to the virus to 
individual states, and each implemented varying measures designed to protect 
health of citizens and the state's economic well-being. Unintended consequences 
of the virus and measures to stop its spread may include decreased physical 
activity and exercise, shifting access and consumption of food, and lower 
quality-of-life. Therefore, our primary goal was to quantify the impact of 
COVID-19 on health and well-being by measuring changes in physical activity, 
mental health-quality of life, food security and nutrition in adults ages 40 and 
older. We believed shifts in health behaviors would be more prevalent in 
minorities, less educated, lower socio-economic status, older adults, and those 
with underlying health conditions, so a secondary goal was to determine the 
impact of COVID-19 on these sub-populations.
METHODS: We conducted an online survey with 9969 adults 40 years and older 
between 9 August and 15 September 2020 in urban areas across the four U.S. 
census regions. The survey included questions about demographic variables, 
pre-existing health conditions, physical activity, access to food, 
quality-of-life, and nutritional food status and asked participants to respond 
with information from pre-pandemic and pandemic conditions. We used 
paired-sample t-tests to detect changes in variables after the start of the 
pandemic and Cohen's d to determine effect sizes.
RESULTS: Our main findings showed a decrease in physical activity since the 
onset of COVID-19 for minorities and non-minorities. Food security also slightly 
increased for minorities during the pandemic, but we found no other changes in 
food security, quality-of-life indicators, or nutritional status of those who 
responded to this survey.
CONCLUSIONS: It is concerning that physical activity declined. Such activity 
helps maintain physical and mental health, and it is also an important time to 
socialize for many older adults. In many ways, our data indicate that the older 
adult population in U.S. cities may be more resilient than expected during the 
pandemic. However, the pandemic could have negative impacts that we did not 
detect, either due to the survey instrument or the timing of our survey, so the 
health and well-being of older adults should continue to be monitored in order 
to mitigate potential negative impacts.

DOI: 10.1186/s12889-021-10825-6
PMCID: PMC8054850
PMID: 33874931 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3542. Soc Sci Med. 2021 May;277:113933. doi: 10.1016/j.socscimed.2021.113933. Epub 
2021 Apr 16.

Coronavirus awareness, confinement stress, and mental health: Evidence from 
Honduras, Chile, Costa Rica, Mexico and Spain.

Landa-Blanco M(1), Mejía CJ(2), Landa-Blanco AL(2), Martínez-Martínez CA(2), 
Vásquez D(3), Vásquez G(2), Moraga-Vargas P(4), Echenique Y(2), Del Cid GM(5), 
Montoya BD(6).

Author information:
(1)National Autonomous University of Honduras, Honduras. Electronic address: 
miguel.landa@unah.edu.hn.
(2)National Autonomous University of Honduras, Honduras.
(3)University of Navarra, Spain.
(4)Neurolectura LTDA, Chile.
(5)Autonomous University of Coahuila, Mexico.
(6)National University of Costa Rica, Costa Rica.

RATIONALE: The purpose of the current study was to analyze the influence of 
coronavirus awareness, psychological stress responses, and sociodemographic 
variables on mental health indicators (somatization, depression, and anxiety) in 
residents of Honduras, Chile, Costa Rica, Mexico, and Spain.
METHODS: The study used a quantitative, cross-sectional approach. Data was 
collected online using the Brief Symptom Inventory-18 (BSI-18); the Coronavirus 
Awareness Scale-6 (CAS-6) and a questionnaire that included psychological and 
sociodemographic questions. The total sample size consisted of 1559 respondents 
from Honduras (34%), Chile (29%), Costa Rica (17%), Mexico (11%), and Spain 
(9%).
RESULTS: The most common stress domains correspond to family (22.97%), financial 
(22.53%), academic (16.47%), leisure time constraints (14.23%), health (12.48%), 
peer group (7.63%), and religious concerns (3.69%). These domains are 
significantly associated with the respondent's country, sex, employment status, 
and being or not a health worker. Respondents who reported confinement stress 
also reported higher scores in anxiety, depression, and somatization. The Global 
Severity Index was significantly predicted by confinement stress, health, 
academic, and leisure time-related stress, sex, age, being a health worker, 
COVID-19 Personal Concern, and Perceived Seriousness. Non-significant predictors 
were employment status, the number of people at home, presence of older adults 
and children at home, financial, peer group, family, and religious concerns; the 
regression model had an R2 of 0.26. Similar analyses were conducted for 
somatization, depression, and anxiety subscales.
CONCLUSIONS: The COVID-19 pandemic has adverse effects on the mental health of 
the general population, particularly regarding anxiety, depression, and 
somatization. Specific populations, such as women and healthcare workers, are at 
particular risk of suffering a deterioration in mental wellbeing. The 
implications of the study for public policy are discussed.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.socscimed.2021.113933
PMCID: PMC8634901
PMID: 33873009 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3543. Acta Clin Belg. 2022 Jun;77(3):588-595. doi: 10.1080/17843286.2021.1916687. Epub 
2021 Apr 17.

The associations of life quality, depression, and cognitive impairment with 
mortality in older adults with COVID-19: a prospective, observational study.

Bayrak M(1), Çadirci K(1).

Author information:
(1)Department of Internal Medicine, Erzurum Regional Training and Research 
Hospital, Health Sciences University, Erzurum, Turkey.

AIM: Associations of depression, dementia, and poor life quality with mortality 
of COVID-19have not been studied yet. We aimed to identify the risk factors for 
mortality and analyze the associations with patients' physiological and mental 
well-being, as reflected by comorbidities, life quality, depression, and 
cognitive impairment.
METHODS: : Older patients receiving inpatient hospital care for COVID-19 were 
included.Demographic data, medical history, symptoms at admission, laboratory 
findings, and treatment outcomes were recorded.
RESULTS: : There were 122 patients with a median age of 73.0 years. The 
mortality rate was 9.0% (n = 11 patients). Patients with mortality were 
significantly active smokers, obese, and having comorbidities using 
polypharmacy. Weight loss ≥of 10% during hospitalization was significantly 
associated with mortality.Poor life quality and a higher risk of depression, 
cognitive impairment, and falling were more frequently seen in non-survived 
patients. (p < 0.05). High ferritin was the only independent risk factor for 
mortality (OR = 15.61, 95% CI:1.08-226.09, p = 0.044).
CONCLUSION: : The presence of comorbidities, depression, cognitive impairment, 
higher falling risk, and poor life quality were significantly associated with 
higher mortality rates in older adults with COVID-19. High ferritin level was an 
independent risk factor for mortality.

DOI: 10.1080/17843286.2021.1916687
PMID: 33870876 [Indexed for MEDLINE]


3544. J Reprod Infant Psychol. 2022 Nov;40(5):465-478. doi: 
10.1080/02646838.2021.1916815. Epub 2021 Apr 17.

Substance use and mental health in pregnant women during the COVID-19 pandemic.

Smith CL(1)(2)(3), Waters SF(4), Spellacy D(1), Burduli E(2)(3)(5), Brooks 
O(1)(2), Carty CL(1), Ranjo S(5), McPherson S(1)(2)(3), Barbosa-Leiker C(3)(5).

Author information:
(1)Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, 
U.S.A.
(2)Program of Excellence in Addictions Research, Washington State University, 
Spokane, WA, U.S.A.
(3)Analytics and PsychoPharmacology Laboratory (APPL), Washington State 
University, Spokane, WA, U.S.A.
(4)Department of Human Development, Washington State University, Vancouver, WA, 
U.S.A.
(5)College of Nursing, Washington State University, Spokane, WA, U.S.A.

OBJECTIVES: We examined the prevalence of substance use as a coping mechanism 
and identified relationships between maternal mental health over time and use of 
substances to cope during the Coronavirus Disease 2019 (COVID-19) pandemic among 
pregnant women in the U.S.A.
METHODS: Self-reported repeated measures from 83 pregnant women were collected 
online in April 2020 and May 2020. Women retrospectively reported their 
mental/emotional health before the pandemic, as well as depression, stress, and 
substance use as a result of the pandemic at both time points. Linear regression 
measured cross-sectional and longitudinal associations between mental health and 
substance use.
RESULTS: Pre-COVID-19 reports of poorer mental/emotional health (b = 0.46) were 
significantly (p < .05) associated with number of substances used to cope with 
the pandemic. Elevated stress (b = 0.35) and depressive symptoms (b = 0.27) and 
poorer mental/emotional health (b = 0.14) in April were also significantly 
related to higher numbers of substances used in May (p < .05).
CONCLUSION: Pregnant women's psychological well-being may be a readily measured 
indicator substance use risk during crises such as the COVID-19 pandemic. 
Interventions addressing increased stress and depression may also mitigate the 
emergence of greater substance use among pregnant women.

DOI: 10.1080/02646838.2021.1916815
PMCID: PMC8963362
PMID: 33870821 [Indexed for MEDLINE]

Conflict of interest statement: Disclosure statement No potential conflict of 
interest was reported by the author(s).


3545. Med Sci Monit. 2021 Apr 19;27:e930812. doi: 10.12659/MSM.930812.

Use of the Depression, Anxiety and Stress Scale (DASS-21) Questionnaire to 
Assess Levels of Depression, Anxiety, and Stress in Healthcare and 
Administrative Staff in 5 Oncology Institutions in Bosnia and Herzegovina During 
the 2020 COVID-19 Pandemic.

Marijanović I(1), Kraljević M(1), Buhovac T(1), Cerić T(2), Mekić Abazović A(3), 
Alidžanović J(4), Gojković Z(5), Sokolović E(6).

Author information:
(1)Oncology Clinic, University Clinical Hospital Mostar, Mostar, Bosnia and 
Herzegovina.
(2)Clinic of Oncology, Clinical Center University of Sarajevo, Sarajevo, Bosnia 
and Herzegovina.
(3)Department of Oncology, Cantonal Hospital Zenica, Zenica, Bosnia and 
Herzegovina.
(4)Department of Oncology, University Clinical Center Tuzla, Tuzla, Bosnia and 
Herzegovina.
(5)Oncology Clinic, Clinical Center Banja Luka, Banja Luka, Bosnia and 
Herzegovina.
(6)Health Care Center of Sarajevo Canton, Sarajevo, Bosnia and Herzegovina.

BACKGROUND Providing oncology services during a pandemic can contribute to 
mental health challenges among healthcare workers. The present study aimed to 
evaluate the levels of depression, anxiety, and stress in healthcare and 
administrative staff in 5 oncology institutions in Bosnia and Herzegovina (BiH) 
in 2020 during the coronavirus disease 2019 (COVID-19) pandemic using the 
Depression, Anxiety and Stress Scale (DASS-21) questionnaire. MATERIAL AND 
METHODS A cross-sectional observational study enrolled 175 healthcare and 
administrative workers from 5 oncology institutions in BiH during December 2020. 
Data were collected using a questionnaire that captured general information 
about the participants and a DASS-21 questionnaire. RESULTS Statistical analysis 
revealed a statistically significant difference in the levels of depression, 
anxiety, and stress (P=0.003, P=0.011, and P=0.022, respectively) among 
participants with comorbidities connected with increased risk of severe illness 
caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) 
compared with participants without comorbidities. There was also a statistically 
significant difference in the levels of stress among participants from different 
cities (P=0.031). Supplement intake and educational level were significantly 
related (P=0.012). High levels of stress and anxiety were accompanied by high 
levels of depression among participants (P<0.01). CONCLUSIONS The findings from 
the present study showed that the COVID-19 pandemic has had an effect on 
depression, anxiety, and stress levels in oncology staff in BiH. Monitoring 
these levels and providing interventions and support to oncology staff are 
increasingly important for their wellbeing and retention at a time of global 
crisis in healthcare.

DOI: 10.12659/MSM.930812
PMCID: PMC8063632
PMID: 33867520 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest None.


3546. J Am Coll Radiol. 2021 Aug;18(8):1198-1207. doi: 10.1016/j.jacr.2021.03.016. 
Epub 2021 Apr 15.

Radiologist Well-Being and Professional Fulfillment in the COVID-19 Era: 
Fostering Posttraumatic Growth.

Kruskal JB(1), Shanafelt T(2).

Author information:
(1)Melvin E. Clouse, Professor of Radiology, Harvard Medical School, Chair, 
Department of Radiology, Beth Israel Deaconess Medical Center, Boston, 
Massachusetts. Electronic address: jkruskal@bidmc.harvard.edu.
(2)Chief Wellness Officer, Stanford Medicine, Associate Dean, Stanford 
University School of Medicine, Stanford, California.

The acute consequences of the COVID-19 pandemic have impacted wellness 
strategies aimed at mitigating the pre-existing epidemic of burnout in 
radiology. Specifically, safety measures including social distancing 
requirements, effective communications, supporting remote and distributed work 
teams, and newly exposed employment and treatment inequities have challenged 
many major efforts at fostering professional fulfillment. To get our wellness 
efforts back on track and to achieve a new and perhaps even a better "normal" 
will require refocusing and reconsidering ways to foster and build a culture of 
wellness, implementing practices that improve work efficiencies, and supporting 
personal health, wellness behaviors, and resilience. Optimizing meaning in work 
is also critical for well-being and professional fulfillment. In addition to 
these earlier approaches, organizations and leaders will need to reprioritize 
efforts to build high-functioning cohesive and connected teams; to train, 
implement, and manage peer-support practices; and to support posttraumatic 
growth. This growth represents the positive psychological changes that can occur 
after highly challenging life circumstances and, when successful, allows 
individuals to achieve a higher level of functioning by addressing and learning 
from the precipitating event. Our practices can support this growth through 
education, emotional regulation, and disclosure, by developing a narrative that 
reimagines a hoped-for better future and by finding meaning through services 
that benefit others.

Copyright © 2021 American College of Radiology. Published by Elsevier Inc. All 
rights reserved.

DOI: 10.1016/j.jacr.2021.03.016
PMID: 33865755 [Indexed for MEDLINE]


3547. Health Promot J Austr. 2022 Apr;33(2):311-319. doi: 10.1002/hpja.494. Epub 2021 
May 12.

Positive outcomes associated with the COVID-19 pandemic in Australia.

Cornell S(1), Nickel B(1), Cvejic E(1), Bonner C(1), McCaffery KJ(1), Ayre J(1), 
Copp T(1), Batcup C(1), Isautier J(1), Dakin T(1), Dodd R(1).

Author information:
(1)Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of 
Medicine and Health, University of Sydney, Sydney, NSW, Australia.

ISSUE ADDRESSED: To investigate whether Australians have experienced any 
positive effects during the COVID-19 pandemic.
METHODS: National online longitudinal survey. As part of a June 2020 survey, 
participants (n = 1370) were asked 'In your life, have you experienced any 
positive effects from the COVID-19 pandemic' (yes/no) and also completed the 
World Health Organisation-Five well-being index. Differences were explored by 
demographic variables. Free-text responses were thematically coded.
RESULTS: Nine hundred sixty participants (70%) reported experiencing at least 
one positive effect during the COVID-19 pandemic. Living with others (P = .045) 
and employment situation (P < .001) at baseline (April) were associated with 
experiencing positive effects. Individuals working for pay from home were more 
likely to experience positive effects compared to those who were not working for 
pay (aOR = 0.45, 95% CI: 0.32, 0.63, P < .001) or who were working for pay 
outside the home (aOR = 0.40, 95% CI: 0.28, 0.58, P < .001). 54.2% of 
participants reported a sufficient level of well-being, 23.2% low well-being and 
a further 22.6% very low well-being. Of those experiencing positive effects, 
945/960 (98%) provided an explanation. The three most common themes were 'Family 
time' (33%), 'Work flexibility' (29%) and 'Calmer life' (19%).
CONCLUSIONS: A large proportion of participants reported positive effects 
resulting from changes to daily life due to the COVID-19 pandemic in Australia.
SO WHAT: The needs of people living alone, and of those having to work outside 
the home or who are unemployed, should be considered by health policymakers and 
employers in future pandemic preparedness efforts.

© 2021 Australian Health Promotion Association.

DOI: 10.1002/hpja.494
PMCID: PMC8250613
PMID: 33864299 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3548. Int J Gynaecol Obstet. 2021 Jul;154(1):100-105. doi: 10.1002/ijgo.13711. Epub 
2021 May 6.

Health-related quality of life and quality of care in pregnant and postnatal 
women during the coronavirus disease 2019 pandemic: A cohort study.

Alaya F(1)(2), Worrall AP(1), O'Toole F(1), Doyle J(1), Duffy RM(1), Geary 
MP(1)(2).

Author information:
(1)Rotunda Hospital, Dublin, Ireland.
(2)Royal College of Surgeons Ireland, Dublin, Ireland.

OBJECTIVE: Health-related quality of life (HRQoL) and the delivery of 
high-quality care are ongoing concerns when caring for pregnant women during the 
coronavirus disease 2019 (COVID-19) pandemic. We compared self-reported HRQoL 
and hospital quality of care among perinatal women with and without COVID-19.
METHODS: This is a prospective cohort study of perinatal women attending a 
tertiary maternity unit during the pandemic. Eighteen women who tested positive 
for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and 20 
SARS-CoV-2-negative women were recruited. Participants completed the Short Form 
Health Survey (SF-12), Clinical Outcomes in Routine Evaluation-Outcome Measure, 
and Quality from the Patient's Perspective questionnaires. Mean scores were 
compared.
RESULTS: Of the Non-COVID-19 cohort, 95% (n = 19) were Caucasian, whereas 67% (n 
= 12) of the COVID-19 cohort were not Caucasian (χ2  = 16.01, P < 0.001). The 
mean SF-12 for physical health in the COVID-19 cohort had significantly lower 
scores (P < 0.002). There was no difference in mental health and well-being 
between cohorts. The quality of care experienced was notably similar and very 
positive.
CONCLUSION: There was a significantly greater burden on physical health among 
pregnant women with COVID-19. Mental health and psychological status were 
similar in both groups. High quality of care during a pandemic is possible to 
deliver in a maternity setting, irrespective of COVID-19 status.

© 2021 The Authors. International Journal of Gynecology & Obstetrics published 
by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and 
Obstetrics.

DOI: 10.1002/ijgo.13711
PMCID: PMC9087707
PMID: 33864252 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the principal 
investigator for this research, Professor Michael PP Geary, is the 
Editor‐in‐Chief of IJGO. The other authors have no conflicts of interest.


3549. Sci Data. 2021 Apr 16;8(1):110. doi: 10.1038/s41597-021-00886-y.

Boston College daily sleep and well-being survey data during early phase of the 
COVID-19 pandemic.

Cunningham TJ(1)(2)(3), Fields EC(4)(5), Kensinger EA(4).

Author information:
(1)Department of Psychiatry, Harvard Medical School, Boston, MA, 02215, USA. 
acunnin4@bidmc.harvard.edu.
(2)Department of Psychiatry, Beth Israel Deaconess Medical Center, 330 Brookline 
Ave, Boston, MA, 02215, USA. acunnin4@bidmc.harvard.edu.
(3)Department of Psychology and Neuroscience, 275 Beacon St, Chestnut Hill, MA, 
02467, USA. acunnin4@bidmc.harvard.edu.
(4)Department of Psychology and Neuroscience, 275 Beacon St, Chestnut Hill, MA, 
02467, USA.
(5)Department of Psychology, Brandeis University, 415 South Street, Waltham, MA, 
02453, USA.

While there was a necessary initial focus on physical health consequences of the 
COVID-19 pandemic, it is becoming increasingly clear that many have experienced 
significant social and mental health repercussions as well. It is important to 
understand the effects of the pandemic on well-being, both as the world 
continues to recover from the lasting impact of COVID-19 and in the eventual 
case of future pandemics. On March 20, 2020, we launched an online daily survey 
study tracking participants' sleep and mental well-being. Repeated reports of 
sleep and mental health metrics were collected from participants ages 18-90 
during the initial wave of the pandemic (March 20 - June 23, 2020). Given both 
the comprehensive nature and early start of this assessment, open access to this 
dataset will allow researchers to answer a range of questions regarding the 
psychiatric impact of the COVID-19 pandemic and the fallout left in its wake.

DOI: 10.1038/s41597-021-00886-y
PMCID: PMC8052376
PMID: 33863920 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


3550. Intensive Crit Care Nurs. 2021 Aug;65:103034. doi: 10.1016/j.iccn.2021.103034. 
Epub 2021 Mar 20.

The impact of the first COVID-19 surge on the mental well-being of ICU nurses: A 
nationwide survey study.

Heesakkers H(1), Zegers M(2), van Mol MMC(3), van den Boogaard M(2).

Author information:
(1)Radboud University Medical Center, Radboud Institute for Health Sciences, 
Department Intensive Care, Nijmegen, the Netherlands. Electronic address: 
hidde.heesakkers@radboudumc.nl.
(2)Radboud University Medical Center, Radboud Institute for Health Sciences, 
Department Intensive Care, Nijmegen, the Netherlands.
(3)Erasmus MC, University Medical Center Rotterdam, Department of Intensive Care 
Adults, the Netherlands.

OBJECTIVES: To determine the impact of the first COVID-19 surge (March through 
June 2020) on mental well-being and associated risk factors among intensive care 
unit nurses.
RESEARCH METHODOLOGY: In September 2020, a nationwide cross-sectional survey 
study among Dutch intensive care nurses was carried out to measure prevalence 
rates of symptoms of anxiety, depression, posttraumatic stress disorder, and 
need for recovery (NFR), objectified by the HADS-A, HADS-D, IES-6 and NFR 
questionnaires, respectively. Associated risk factors were determined using 
multivariate logistic regression analyses.
RESULTS: Symptoms of anxiety, depression, and post traumatic stress disorder 
were reported by 27.0%, 18.6% and 22.2% of the 726 respondents, respectively. 
The NFR was positive, meaning not being recovered from work, in 41.7%. Working 
in an academic hospital, being afraid of infecting relatives and experiencing 
insufficient numbers of colleagues were associated with more mental symptoms, 
while having been on holiday was associated with reduced depression symptoms and 
need for recovery.
CONCLUSION: The first COVID-19 surge had a high impact on the mental well-being 
of intensive care nurses, increasing the risk for drop out and jeopardising the 
continuity of care. Effort should be made to optimize working conditions and 
decrease workload to guarantee care in the next months of the COVID-19 pandemic.

Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.iccn.2021.103034
PMCID: PMC9759743
PMID: 33863609 [Indexed for MEDLINE]


3551. J Am Med Dir Assoc. 2021 May;22(5):948-954.e2. doi: 10.1016/j.jamda.2021.03.010. 
Epub 2021 Mar 20.

The Adverse Effects of the COVID-19 Pandemic on Nursing Home Resident 
Well-Being.

Levere M(1), Rowan P(2), Wysocki A(3).

Author information:
(1)Mathematica, Princeton, NJ, USA. Electronic address: 
mlevere@mathematica-mpr.com.
(2)Mathematica, Wellington, FL, USA.
(3)Mathematica, Chicago, IL, USA.

OBJECTIVE: Quantify the effects of the COVID-19 pandemic on nursing home 
resident well-being.
DESIGN: Quantitative analysis of resident-level assessment data.
SETTING AND PARTICIPANTS: Long-stay residents living in Connecticut nursing 
homes.
METHODS: We used Minimum Data Set assessments to measure nursing home resident 
outcomes observed in each week between March and July 2020 for long-stay 
residents (eg, those in the nursing home for at least 100 days) who lived in a 
nursing home at the beginning of the pandemic. We compared outcomes to those 
observed at the beginning of the pandemic, controlling for both resident 
characteristics and patterns for outcomes observed in 2017-2019.
RESULTS: We found that nursing home resident outcomes worsened on a broad array 
of measures. The prevalence of depressive symptoms increased by 6 percentage 
points relative to before the pandemic in the beginning of March-representing a 
15% increase. The share of residents with unplanned substantial weight loss also 
increased by 6 percentage points relative to the beginning of March-representing 
a 150% increase. We also found significant increases in episodes of incontinence 
(4 percentage points) and significant reductions in cognitive functioning. Our 
findings suggest that loneliness and isolation play an important role. Though 
unplanned substantial weight loss was greatest for those who contracted COVID-19 
(about 10% of residents observed in each week), residents who did not contract 
COVID-19 also physically deteriorated (about 7.5% of residents in each week).
CONCLUSIONS AND IMPLICATIONS: These analyses show that the pandemic had 
substantial impacts on nursing home residents beyond what can be quantified by 
cases and deaths, adversely affecting the physical and emotional well-being of 
residents. Future policy changes to limit the spread of COVID-19 or other 
infectious disease outbreaks should consider any additional costs beyond the 
direct effects of morbidity and mortality due to COVID-19.

Copyright © 2021 AMDA – The Society for Post-Acute and Long-Term Care Medicine. 
Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jamda.2021.03.010
PMCID: PMC7980137
PMID: 33861980 [Indexed for MEDLINE]


3552. PLoS One. 2021 Apr 16;16(4):e0238666. doi: 10.1371/journal.pone.0238666. 
eCollection 2021.

Determinants of burnout and other aspects of psychological well-being in 
healthcare workers during the Covid-19 pandemic: A multinational cross-sectional 
study.

Denning M(1), Goh ET(1), Tan B(2), Kanneganti A(3), Almonte M(1), Scott A(1), 
Martin G(1), Clarke J(1), Sounderajah V(1), Markar S(1), Przybylowicz J(1), Chan 
YH(4), Sia CH(2)(5), Chua YX(6), Sim K(7)(8), Lim L(9), Tan L(10), Tan M(11), 
Sharma V(2), Ooi S(12)(13), Winter Beatty J(1), Flott K(1), Mason S(1), 
Chidambaram S(1), Yalamanchili S(1), Zbikowska G(1), Fedorowski J(14), Dykowska 
G(15), Wells M(1), Purkayastha S(1), Kinross J(1).

Author information:
(1)Department of Surgery and Cancer, Imperial College London, London, United 
Kingdom.
(2)Department of Medicine, Yong Loo Lin School of Medicine, National University 
of Singapore, Singapore, Singapore.
(3)Department of Obstetrics and Gynaecology, National University Hospital, 
Singapore, Singapore.
(4)Biostatistics Unit, Yong Loo Lin School of Medicine, National University of 
Singapore, Singapore, Singapore.
(5)Department of Cardiology, National University Heart Centre, Singapore, 
Singapore.
(6)Pioneer Polyclinic, National University Polyclinic, National University 
Health System, Singapore, Singapore.
(7)Institute of Mental Health, Singapore, Singapore.
(8)Department of Psychological Medicine, Yong Loo Lin School of Medicine, 
National University of Singapore, Singapore, Singapore.
(9)Department of Forensic Psychiatry, Institute of Mental Health, Singapore, 
Singapore.
(10)Division of Healthy Ageing, Alexandra Hospital, Singapore, Singapore.
(11)Department of Geriatric Medicine, Ng Teng Fong General Hospital, Singapore, 
Singapore.
(12)Department of Surgery, Yong Loo Lin School of Medicine, National University 
of Singapore, Singapore, Singapore.
(13)Emergency Medicine Department, National University Hospital, Singapore, 
Singapore.
(14)Polish Hospital Federation, Poland.
(15)Department of Economics of Health and Medical Law, Medical University of 
Warsaw, Poland.

The Covid-19 pandemic has placed unprecedented pressure on healthcare systems 
and workers around the world. Such pressures may impact on working conditions, 
psychological wellbeing and perception of safety. In spite of this, no study has 
assessed the relationship between safety attitudes and psychological outcomes. 
Moreover, only limited studies have examined the relationship between personal 
characteristics and psychological outcomes during Covid-19. From 22nd March 2020 
to 18th June 2020, healthcare workers from the United Kingdom, Poland, and 
Singapore were invited to participate using a self-administered questionnaire 
comprising the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory 
(OLBI) and Hospital Anxiety and Depression Scale (HADS) to evaluate safety 
culture, burnout and anxiety/depression. Multivariate logistic regression was 
used to determine predictors of burnout, anxiety and depression. Of 3,537 
healthcare workers who participated in the study, 2,364 (67%) screened positive 
for burnout, 701 (20%) for anxiety, and 389 (11%) for depression. Significant 
predictors of burnout included patient-facing roles: doctor (OR 2.10; 95% CI 
1.49-2.95), nurse (OR 1.38; 95% CI 1.04-1.84), and 'other clinical' (OR 2.02; 
95% CI 1.45-2.82); being redeployed (OR 1.27; 95% CI 1.02-1.58), bottom quartile 
SAQ score (OR 2.43; 95% CI 1.98-2.99), anxiety (OR 4.87; 95% CI 3.92-6.06) and 
depression (OR 4.06; 95% CI 3.04-5.42). Significant factors inversely correlated 
with burnout included being tested for SARS-CoV-2 (OR 0.64; 95% CI 0.51-0.82) 
and top quartile SAQ score (OR 0.30; 95% CI 0.22-0.40). Significant factors 
associated with anxiety and depression, included burnout, gender, safety 
attitudes and job role. Our findings demonstrate a significant burden of 
burnout, anxiety, and depression amongst healthcare workers. A strong 
association was seen between SARS-CoV-2 testing, safety attitudes, gender, job 
role, redeployment and psychological state. These findings highlight the 
importance of targeted support services for at risk groups and proactive 
SARS-CoV-2 testing of healthcare workers.

DOI: 10.1371/journal.pone.0238666
PMCID: PMC8051812
PMID: 33861739 [Indexed for MEDLINE]

Conflict of interest statement: JK has received an educational grant from 
Johnson and Johnson. This does not alter our adherence to PLOS ONE policies on 
sharing data and materials.


3553. Neurol Sci. 2021 Jul;42(7):2615-2618. doi: 10.1007/s10072-021-05253-8. Epub 2021 
Apr 15.

Fear of relapse, social support, and psychological well-being (depression, 
anxiety, and stress level) of patients with multiple sclerosis (MS) during the 
COVID-19 pandemic stage.

Shaygannejad V(1)(2), Mirmosayyeb O(1)(2)(3), Nehzat N(2), Ghajarzadeh M(4)(5).

Author information:
(1)Department of Neurology, School of Medicine, Isfahan University of Medical 
Sciences, Isfahan, Iran.
(2)Isfahan Neurosciences Research Center, Isfahan University of Medical 
Sciences, Isfahan, Iran.
(3)Universal Council of Epidemiology (UCE), Universal Scientific Education and 
Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran.
(4)Universal Council of Epidemiology (UCE), Universal Scientific Education and 
Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran. 
m.ghajarzadeh@gmail.com.
(5)Multiple Sclerosis Research Center Neuroscience Institute, Tehran University 
of Medical Sciences , Tehran, Iran. m.ghajarzadeh@gmail.com.

BACKGROUND: Psychological well-being assessment during the COVID-19 pandemic is 
essential for patients with multiple sclerosis (MS). The goal of this study is 
to evaluate fear of relapse, social support, and psychological well-being 
(depression, anxiety, and stress level) of Iranian patients with MS during the 
COVID-19 pandemic stage.
METHODS: One hundred and sixty-five patients were enrolled. We asked all cases 
to fill valid and reliable Persian version of depression, anxiety, and stress 
scale (DASS-21), perceived social support, and fear of relapse scale 
questionnaires.
RESULTS: One hundred and sixty-five patients were enrolled. Female to male ratio 
was (F/M) = 4.6. Mean age and mean duration of disease were 35.3±8.6 and 7.1±5 
years, respectively. Mean scores of social support, DASS, and FoR questionnaires 
were 63.1±16.8, 16.4±13.4, and 51.4±17.3, respectively. There was a significant 
negative correlation between social support and FoR scores and also significant 
positive correlations between components of DASS and FoR. Linear regression 
analysis by considering FoR as dependent variable and age, sex, marital status, 
duration of the disease, and EDSS as dependent variables showed that sex was an 
independent predictor of FoR score.
CONCLUSION: Psychological well-being as well as fear of relapse should be 
considered in patients with MS during the COVID-19 pandemic stage.

DOI: 10.1007/s10072-021-05253-8
PMCID: PMC8049617
PMID: 33860396 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


3554. BMJ Open. 2021 Apr 15;11(4):e049653. doi: 10.1136/bmjopen-2021-049653.

Impact of the COVID-19 pandemic on anxiety and depression symptoms of young 
people in the global south: evidence from a four-country cohort study.

Porter C(1), Favara M(2), Hittmeyer A(2), Scott D(2), Sánchez Jiménez A(3), 
Ellanki R(4), Woldehanna T(5), Duc LT(6), Craske MG(7), Stein A(8)(9).

Author information:
(1)Management School, Lancaster University, Lancaster, UK 
catherine.porter@lancaster.ac.uk.
(2)Oxford Department of International Development, University of Oxford, Oxford, 
UK.
(3)Niños del Milenio, Grupo de Análisis para el Desarrollo (GRADE), Lima, Peru.
(4)Director, Centre for Economic and Social Studies, Begumpet, India.
(5)Department of Economics, Addis Ababa University, Addis Ababa, Ethiopia.
(6)Centre for Analysis and Forecasting, Vietnam Academy of Social Sciences, 
Hanoi, Vietnam.
(7)Department of Psychology, University of California Los Angeles, Los Angeles, 
California, USA.
(8)Department of Psychiatry, University of Oxford, Oxford, UK.
(9)School of Public Health, University of the Witwatersrand, 
Johannesburg-Braamfontein, South Africa.

OBJECTIVE: To provide evidence on the effect of the COVID-19 pandemic on the 
mental health of young people who grew up in poverty in low/middle-income 
countries (LMICs).
DESIGN: A phone survey administered between August and October 2020 to 
participants of a population-based longitudinal cohort study established in 2002 
comprising two cohorts born in 1994-1995 and 2001-2002 in Ethiopia, India 
(Andhra Pradesh and Telangana), Peru and Vietnam. We use logistic regressions to 
examine associations between mental health and pandemic-related stressors, 
structural factors (gender, age), and lifelong protective/risk factors (parent 
and peer relationship, wealth, long-term health problems, past emotional 
problems, subjective well-being) measured at younger ages.
SETTING: A geographically diverse, poverty-focused sample, also reaching those 
without mobile phones or internet access.
PARTICIPANTS: 10 496 individuals were approached; 9730 participated. Overall, 
8988 individuals were included in this study; 4610 (51%) men and 4378 (49%) 
women. Non-inclusion was due to non-location or missing data.
MAIN OUTCOME MEASURES: Symptoms consistent with at least mild anxiety or 
depression were measured by Generalized Anxiety Disorder-7 (≥5) or Patient 
Health Questionnaire-8 (≥5).
RESULTS: Rates of symptoms of at least mild anxiety (depression) were highest in 
Peru at 41% (32%) (95% CI 38.63% to 43.12%; (29.49-33.74)), and lowest in 
Vietnam at 9% (9%) (95% CI 8.16% to 10.58%; (8.33-10.77)), mirroring COVID-19 
mortality rates. Women were most affected in all countries except Ethiopia. 
Pandemic-related stressors such as health risks/expenses, economic adversity, 
food insecurity, and educational or employment disruption were risk factors for 
anxiety and depression, though showed varying levels of importance across 
countries. Prior parent/peer relationships were protective factors, while 
long-term health or emotional problems were risk factors.
CONCLUSION: Pandemic-related health, economic and social stress present 
significant risks to the mental health of young people in LMICs where mental 
health support is limited, but urgently needed to prevent long-term 
consequences.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/bmjopen-2021-049653
PMCID: PMC8053815
PMID: 33858874 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: CP, MF, AH, DS, ASJ, RE, TW 
and LTD report grants from the FCDO, during the conduct of the study.


3555. Ir J Psychol Med. 2021 Dec;38(4):272-277. doi: 10.1017/ipm.2021.37. Epub 2021 
Apr 16.

Comorbidity and COVID-19: investigating the relationship between medical and 
psychological well-being.

Stafford O(1), Berry A(1)(2), Taylor LK(1)(3), Wearen S(1), Prendergast C(1), 
Murphy E(1)(2), Shevlin M(4), McHugh L(1), Carr A(1), Burke T(5).

Author information:
(1)School of Psychology, University College Dublin, Dublin, Ireland.
(2)Psychology Services, Health Service Executive, CHO 8, Laois and Offaly, 
Ireland.
(3)School of Psychology, Queen's UniversityBelfast, Northern Ireland.
(4)University of Ulster (Psychology), Coleraine, Northern Ireland.
(5)School of Psychology, National University of Ireland, Galway, Ireland.

OBJECTIVE: The unprecedented occurrence of a global pandemic is accompanied by 
both physical and psychological burdens that may impair quality of life. 
Research relating to COVID-19 aims to determine the effects of the pandemic on 
vulnerable populations who are at high risk of developing negative health or 
psychosocial outcomes. Having an ongoing medical condition during a pandemic may 
lead to greater psychological distress. Increased psychological distress may be 
due to preventative public health measures (e.g. lockdown), having an ongoing 
medical condition, or a combination of these factors.
METHODS: This study analyses data from an online cross-sectional national survey 
of adults in Ireland and investigates the relationship between comorbidity and 
psychological distress. Those with a medical condition (n = 128) were compared 
to a control group without a medical condition (n = 128) and matched according 
to age, gender, annual income, education, and work status during COVID-19. 
Participants and data were obtained during the first public lockdown in Ireland 
(27 March 2020-8 June 2020).
RESULTS: Individuals with existing medical conditions reported significantly 
higher levels of anxiety (p < .01) and felt less gratitude (p ≤ .001). 
Exploratory analysis indicated that anxiety levels were significantly associated 
with illness perceptions specific to COVID-19. Post hoc analysis revealed that 
psychological well-being was not significantly related to condition type (e.g. 
respiratory disorders).
CONCLUSION: This research supports individualised supports for people with 
ongoing medical conditions during the COVID-19 pandemic, and has implications 
for the consideration of follow-up care specifically for mental health. Findings 
may also inform future public health policies and post-vaccine support 
strategies for vulnerable populations.

DOI: 10.1017/ipm.2021.37
PMCID: PMC8144807
PMID: 33858542 [Indexed for MEDLINE]


3556. Anesth Analg. 2021 May 1;132(5):1338-1343. doi: 10.1213/ANE.0000000000005369.

Effect of Inadequate Sleep on Clinician Performance.

Saadat H(1).

Author information:
(1)From the Department of Anesthesiology, Frank H Netter School of Medicine, 
Quinnipiac University, Hartford Health Care, St. Vincent's Medical Center, 
Bridgeport, Connecticut.

The negative impacts of sleep deprivation and fatigue have long been recognized. 
Numerous studies have documented the ill effects of impaired alertness 
associated with the disruption of the sleep-wake cycle; these include an 
increased incidence of human error-related accidents, increased morbidity and 
mortality, and an overall decrement in social, financial, and human 
productivity. While there are multiple studies on the impact of sleep 
deprivation and fatigue in resident physicians, far fewer have examined the 
effects on attending physicians, and only a handful addresses the accumulated 
effects of chronic sleep disturbances on acute sleep loss during a night 
call-shift. Moreover, the rapid and unprecedented spread of coronavirus disease 
2019 (COVID-19) pandemic significantly increased the level of anxiety and stress 
on the physical, psychological, and the economic well-being of the entire world, 
with heightened effect on frontline clinicians. Additional studies are necessary 
to evaluate the emotional and physical toll of the pandemic in clinicians, and 
its impact on sleep health, general well-being, and performance.

Copyright © 2021 International Anesthesia Research Society.

DOI: 10.1213/ANE.0000000000005369
PMID: 33857976 [Indexed for MEDLINE]

Conflict of interest statement: The author declares no conflicts of interest.


3557. PLoS One. 2021 Apr 15;16(4):e0250104. doi: 10.1371/journal.pone.0250104. 
eCollection 2021.

Insight into resident burnout, mental wellness, and coping mechanisms early in 
the COVID-19 pandemic.

Zoorob D(1), Shah S(2), La Saevig D(2), Murphy C(1), Aouthmany S(3), Brickman 
K(3).

Author information:
(1)Department of Obstetrics and Gynecology, University of Toledo-College of 
Medicine and Life Sciences, Toledo, Ohio, United States of America.
(2)University of Toledo-College of Medicine and Life Sciences, Toledo, Ohio, 
United States of America.
(3)Department of Emergency Medicine, University of Toledo-College of Medicine 
and Life Sciences, Toledo, Ohio, United States of America.

BACKGROUND: Acute augmentation of stress and disruption of training, such as 
during the COVID-19 pandemic, may impact resident wellbeing.
OBJECTIVES: We investigated how residents in various specialties in the United 
States were impacted by COVID-19 on mental wellbeing and resilience levels, and 
the methodology for coping with the stress incurred.
METHODS: In April 2020, the authors electronically surveyed 200 residency 
programs of all specialties nationally. The survey utilized two validated 
questionnaires to assess wellbeing and resilience, while investigating 
demographics and coping mechanisms. The authors used student t-test and ANOVA to 
quantitatively analyze the data.
RESULTS: The sample consisted of 1115 respondents (with an 18% response rate). 
Male gender & Age >39 years were associated with more favorable average 
well-being indices (both p<0.01). Regarding resources, institutional support 
(IS) appeared favorable for resident well-being (IS 2.74, SD1.96 vs NoIS 3.71, 
SD2.29, p<0.01) & resilience (IS 3.72, SD0.70 vs NoIS 3.53, SD0.73, p = 0.05). 
The effects of mindfulness practices (MP) were not statistically significant for 
improvement of wellness (MP 2.87, SD 1.99 vs No MP 2.76, SD 2.15, p = 0.85) or 
resilience (MP 3.71, SD 0.70 vs No MP 3.72, SD 0.68, p = 0.87).
CONCLUSIONS: Findings highlight the critical importance of resident mental 
status in cases of augmented stress situations. Institutional support may 
contribute to promotion of resident wellbeing.

DOI: 10.1371/journal.pone.0250104
PMCID: PMC8049262
PMID: 33857247 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


3558. Psychiatr Danub. 2021 Spring;33(1):86-94. doi: 10.24869/psyd.2021.86.

Intervention Effect of the Integration Model on Negative Emotions of Adolescents 
during the Outbreak of Corona Virus Disease 2019.

Chen J(1), Sang G, Zhang Y, Jiang A.

Author information:
(1)Institute of Physical Education and Health, Wenzhou University, Wenzhou 
325035, China,orientationchen@163.com.

BACKGROUND: The World Health Organization has declared the Corona Virus Disease 
2019 (COVID-19) epidemic as a public health emergency of international concern. 
Given the sudden infection from and extensive dispersion of COVID-19 and the 
absence of specific drugs, those infected are in danger if they are not treated 
in time. Consequently, COVID-19 has become an important factor influencing 
adolescents' mental health. The purpose of this study is to explore the 
intervention effect of the integration model on the negative emotions of 
adolescents during the COVID-19 epidemic.
SUBJECTS AND METHODS: Adolescents were randomly selected from five middle 
schools in Zhejiang Province of China from May 2020 to July 2020. First, the 
Self-rating Anxiety Scale, Positive and Negative Affect Scale, and Psychological 
Well-Being Scale were used for measurement. Then, 72 patients with moderate and 
severe anxiety symptoms were chosen as the research objects, and the 
intervention and comparison time was determined to be eight weeks. The subjects 
were randomly divided into the experiment group (35 members) and the control 
group (34 members). The integration model was employed on the experiment group.
RESULTS: Grade, physical condition, and sleep time are important factors 
influencing the anxiety level of adolescents during the COVID-19 period, and the 
anxiety risk of adolescents is higher during their third year of junior high 
school. After the intervention, the SAS score of the experiment group is lower 
than that of the control group, and the decrease in the SAS score is higher in 
the experiment group than in the control group (P<0.01). Moreover, the positive 
emotion score of the experiment group is higher than that of the control group, 
and the negative emotion score of the former is lower than that of the latter. 
The variances in the positive and negative emotion scores are higher in the 
experiment group than in the control group (P<0.01). The variance in the overall 
well-being index is also greater in the experiment group than in the control 
group (P<0.01).
CONCLUSION: The intervention using the integrated model can significantly reduce 
negative emotions such as anxiety, increase positive emotions, and improve the 
overall well-being of adolescents during the epidemic period.

DOI: 10.24869/psyd.2021.86
PMID: 33857051 [Indexed for MEDLINE]


3559. Australas Psychiatry. 2021 Jun;29(3):340-343. doi: 10.1177/1039856221992937. 
Epub 2021 Apr 15.

Increased referrals to an Australian Consultation Liaison Psychiatry service 
during the COVID-19 pandemic.

Lele K(1), Cartoon J(1), Griffiths A(1).

Author information:
(1)Westmead Hospital, Westmead, NSW, Australia.

OBJECTIVE: It has been widely predicted that the COVID-19 pandemic will have a 
detrimental impact on the mental health (MH) of individuals. This has been 
dubbed as the MH 'second wave'. In Australia, these impacts have been partly 
mitigated by institutional responses such as increased access to psychotherapy. 
Consultation Liaison (CL) psychiatry services provide MH care to acutely unwell 
patients in general hospitals. It was hypothesised that the number of referrals 
to the studied service had increased since the start of the pandemic.
METHODS: From the Electronic medical records (eMRs), the authors collected daily 
referral numbers, over 3 consecutive years, to a large CL service in 
metropolitan Sydney.
RESULTS: Referrals were significantly increased by 25%, 95% CI [1.14, 1.36], p < 
.001 since the start of the pandemic. This increase was delayed, and remained 
elevated despite a reduction in COVID-19 infections.
CONCLUSION: This study adds evidence to the existence of the MH 'second wave', 
highlights a key impact on healthcare workers' well-being and will assist in 
guiding resource allocation decisions in the near future.

DOI: 10.1177/1039856221992937
PMID: 33856921 [Indexed for MEDLINE]


3560. BMC Psychiatry. 2021 Apr 14;21(1):194. doi: 10.1186/s12888-021-03191-5.

Mental ill-health during COVID-19 confinement.

Jané-Llopis E(1)(2)(3), Anderson P(4)(5), Segura L(6), Zabaleta E(7)(8)(9)(10), 
Muñoz R(6), Ruiz G(6), Rehm J(3)(11)(12)(13), Cabezas C(6), Colom J(6).

Author information:
(1)Ramon Llull University, ESADE Business School, Barcelona, Spain.
(2)CAPHRI Care and Public Health Research Institute, Maastricht University, POB 
616, Maastricht, MD, 6200, The Netherlands.
(3)Institute for Mental Health Policy Research, CAMH, 33 Russell Street, 
Toronto, ON, M5S 2S1, Canada.
(4)CAPHRI Care and Public Health Research Institute, Maastricht University, POB 
616, Maastricht, MD, 6200, The Netherlands. peteranderson.mail@gmail.com.
(5)Population Health Sciences Institute, Newcastle University, Baddiley-Clark 
Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK. 
peteranderson.mail@gmail.com.
(6)Public Health Agency of Catalonia, Department of Health, Government of 
Catalonia, Programme on Substance Abuse, Roc Boronat 81-95, 08005, Barcelona, 
Spain.
(7)Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut 
Jordi Gol i Gurina (IDIAPJGol), Gran Via de les Corts Catalanes 587, 08007, 
Barcelona, Spain.
(8)Gerència Territorial de Barcelona, Institut Català de la Salut, Balmes 22, 
08007, Barcelona, Spain.
(9)Nursing Department, Nursing Faculty, Universitat de Girona, Emili Grahit 77, 
17003, Girona, Spain.
(10)Universitat Autònoma de Barcelona, Bellaterra, 08193, Cerdanyola del Vallès, 
Spain.
(11)Dalla Lana School of Public Health & Department of Psychiatry, University of 
Toronto, 6th Floor, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.
(12)Institute of Clinical Psychology and Psychotherapy & Center for Clinical 
Epidemiology and Longitudinal Studies, Technische Universität Dresden, 
Chemnitzer Str. 46, D-01187, Dresden, Germany.
(13)Department of International Health Projects, Institute for Leadership and 
Health Management, I.M. Sechenov First Moscow State Medical University, 
Trubetskaya str., 8, b. 2, Moscow, Russian Federation, 119992.

BACKGROUND: Confinement due to COVID-19 has increased mental ill-health. Few 
studies unpack the risk and protective factors associated with mental ill-health 
and addictions that might inform future preparedness.
METHODS: Cross-sectional on-line survey with 37,810 Catalan residents aged 16+ 
years from 21 April to 20 May 2020 reporting prevalence of mental ill-health and 
substance use and associated coping strategies and behaviours.
RESULTS: Weighted prevalence of reported depression, anxiety and lack of mental 
well-being was, respectively, 23, 26, and 75%, each three-fold higher than 
before confinement. The use of prescribed hypnosedatives was two-fold and of 
non-prescribed hypnosedatives ten-fold higher than in 2018. Women, younger 
adults and students were considerably more likely, and older and retired people 
considerably less likely to report mental ill-health. High levels of social 
support, dedicating time to oneself, following a routine, and undertaking 
relaxing activities were associated with half the likelihood of reported mental 
ill-health. Worrying about problems living at home, the uncertainty of when 
normality would return, and job loss were associated with more than one and a 
half times the likelihood of mental ill-health. With the possible exception of 
moderately severe and severe depression, length of confinement had no 
association with reported mental ill-health.
CONCLUSIONS: The trebling of psychiatric symptomatology might lead to either to 
under-identification of cases and treatment gap, or a saturation of mental 
health services if these are not matched with prevalence increases. Special 
attention is needed for the younger adult population. In the presence of 
potential new confinement, improved mental health literacy of evidence-based 
coping strategies and resilience building are urgently needed to mitigate mental 
ill-health.

DOI: 10.1186/s12888-021-03191-5
PMCID: PMC8045571
PMID: 33853562 [Indexed for MEDLINE]

Conflict of interest statement: None declared


3561. Am J Alzheimers Dis Other Demen. 2021 Jan-Dec;36:15333175211008768. doi: 
10.1177/15333175211008768.

Impact of COVID-19 on Dementia Caregivers and Factors Associated With their 
Anxiety Symptoms.

Hwang Y(1), Connell LM(1), Rajpara AR(1), Hodgson NA(1).

Author information:
(1)University of Pennsylvania School of Nursing, Philadelphia, PA, USA.

Little is known about the family experience of caregiving for persons living 
with dementia (PLWD) at home during the COVID-19 pandemic. The purpose of this 
study was to examine the influence of COVID-19 on concerns of current family 
caregivers of PLWD. Study participants were recruited from the parent study, 
Healthy Patterns Clinical Trial (NCT03682185). Data was collected from 34 
caregivers via semi-structured telephone interviews. Over 70% of the study 
participants reported worrying about spreading COVID-19 to the PLWD, 41% 
reported they had taken on additional caregiving duties for others in their 
family since COVID-19, and 62% reported one or more anxiety symptoms. Dementia 
caregivers who reported anxiety symptoms reported lower scores on functional 
independence of their care recipients compared to dementia caregivers who did 
not report anxiety symptoms (p=0.036). Health care professionals should be alert 
to the concerns expressed by dementia caregivers for their well-being during 
this unprecedented pandemic.

DOI: 10.1177/15333175211008768
PMCID: PMC8573819
PMID: 33853394 [Indexed for MEDLINE]

Conflict of interest statement: The author(s) declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


3562. Psychiatry Res. 2021 Jun;300:113927. doi: 10.1016/j.psychres.2021.113927. Epub 
2021 Apr 6.

Optimism, mindfulness, and resilience as potential protective factors for the 
mental health consequences of fear of the coronavirus.

Vos LMW(1), Habibović M(1), Nyklíček I(1), Smeets T(1), Mertens G(2).

Author information:
(1)Department of Medical and Clinical Psychology, Tilburg University, Postal 
address: Warandelaan 2, Tilburg University, 5037AB Tilburg, the Netherlands.
(2)Department of Medical and Clinical Psychology, Tilburg University, Postal 
address: Warandelaan 2, Tilburg University, 5037AB Tilburg, the Netherlands. 
Electronic address: g.mertens@tilburguniversity.edu.

The COVID-19 pandemic has a substantial impact on mental health. Prior reports 
have shown that depression, anxiety, and stress have increased throughout the 
pandemic. Nonetheless, not everyone is affected by these negative consequences 
and some people may be relatively unaffected. In this online study in a 
predominantly Dutch and Belgian sample (N = 546), we investigated whether 
positive personality traits such as optimism, mindfulness, and resilience may 
protect against the negative mental health consequences (i.e., fear of the 
coronavirus, depression, stress, and anxiety) of the COVID-19 pandemic. We found 
that fear of COVID-19 was related to higher depression, stress, and anxiety. 
However, for participants scoring high on mindfulness, optimism, and resilience, 
this relationship was weakened. In addition to these findings, we present the 
results of network analyses to explore the network structure between these 
constructs. These results help to identify possible ways through which 
psychological well-being can be promoted during the COVID-19 pandemic.

Copyright © 2021. Published by Elsevier B.V.

DOI: 10.1016/j.psychres.2021.113927
PMCID: PMC9755114
PMID: 33848964 [Indexed for MEDLINE]

Conflict of interest statement: The authors declared no conflicts of interest 
regarding this work.


3563. Public Health. 2021 Apr;193:150-152. doi: 10.1016/j.puhe.2021.01.030. Epub 2021 
Apr 10.

A survey of the contribution made by UK orchestras to the health and well-being 
sectors.

Derbyshire S(1), Harvey F(2), Swann M(3).

Author information:
(1)Orchestras Live, UK. Electronic address: sarah@orchestraslive.org.uk.
(2)Association of British Orchestras, UK. Electronic address: Fiona@abo.org.uk.
(3)City of London Sinfonia, UK. Electronic address: mswann@cls.co.uk.

OBJECTIVE: To provide a comprehensive picture of the contribution that 
orchestras currently make in the public health sector.
STUDY DESIGN: An online survey of member orchestras of the Association of 
British Orchestras.
METHODS: Data gathered covered geographical, financial and musical aspects, the 
type of healthcare settings in which the work takes place, orchestras' 
motivation for their involvement in the healthcare sector, the role health and 
well-being delivery plays in their business models, and finally, the impact of 
COVID-19 on orchestras' current and future plans.
RESULTS: Approximately half of UK orchestras are engaged significantly in the 
area of health and well-being in all four UK nations and a wide range of 
healthcare settings. There is a strong appetite to develop this work among those 
orchestras not yet involved. At the same time, the extent of this work is not 
formally recognised or paid for by the healthcare sector.
CONCLUSIONS: While there is considerable unevenness in the provision, it is 
clear that UK professional orchestras made a significant contribution to the 
health and well-being sectors in hospitals and other healthcare settings. There 
is scope for a greater contribution by orchestras to the healthcare sector, 
which will require more formal recognition of the value of this work.

Crown Copyright © 2021. Published by Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.puhe.2021.01.030
PMID: 33848907 [Indexed for MEDLINE]


3564. Medicine (Baltimore). 2021 Apr 16;100(15):e25290. doi: 
10.1097/MD.0000000000025290.

Depression among physicians and other medical employees involved in the COVID-19 
outbreak: A cross-sectional study.

ALGhasab NS(1), ALJadani AH(1), ALMesned SS(2), Hersi AS(3).

Author information:
(1)Department of Internal Medicine, Medical College, Ha'il University, Ha'il.
(2)Department of Surgery, Medical College, Qassim University, Buraydah.
(3)Department Cardiology, College of medicine, King Saud University, Riyadh, 
Saudi Arabia.

Health care employees are the front liners whom are directly involved in the 
management of COVID-19 at high risk of developing psychological distress and 
other mental health illness. We aim to assess the burden of depression during 
this pandemic on health care employees treating COVID-19 in Saudi Arabia. We 
also will shed the light on the best solutions of how to encounter depression.A 
cross-sectional, hospital-based survey conducted via a region-stratified, 
2-stage cluster sample was conducted for 554 participants in >15 hospitals from 
April 29, 2020, to June 30, 2020. Depression is measured using the established 
PHQ9 score system. We grade PHQ9 depression scores as: normal, 0 to 4, mild, 5 
to 9, significant (moderate or severe), 10 to 27. χ2/Fisher exact test was used; 
significant association between level of depression and survey characteristics 
were made. P value <0.05 was considered statistically significant.A total of 554 
participants completed the survey. A total of 18.9% (n = 105) were aged 
<29 years, 51.2% (n = 284) were between 30 to 39 years and female represent 70% 
of all participants. Of all participants, 53.7% (n = 298) were nurses, and 38.6% 
(n = 214) were physicians; 68.5% (n = 380) worked in central area hospitals in 
Saudi Arabia. No significant (P = .432, 95% confidence interval [CI]) 
association was observed between sex and depression classifications. However, 
female had high proportion of significant depression 75.0% (n = 76) was observed 
as compared to male 24.8% (n = 25). Depression was significant in Saudis 61.4% 
(n = 62) (P < .001, 95% CI) and medical staff who encountered corona patients 
51.5% (n = 52) (P < .002, 95% CI). Hospital preparedness associated with more 
freedom of depression symptoms 69.1% (n = 199/288) (P < .001, 95% CI).Frontline 
young health care workers especially physician in Saudi Arabia reported a high 
rate of depression symptoms. Countermeasures for health care workers represent a 
key component for the mental and physical well-being as part of public health 
measures during this pandemic. Attention to hospital preparedness and adequacy 
of personal protective equipment contributed to milder depression symptoms. 
Further studies need to be conducted on crisis management and depression.

Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

DOI: 10.1097/MD.0000000000025290
PMCID: PMC8052024
PMID: 33847627 [Indexed for MEDLINE]

Conflict of interest statement: The authors report no conflicts of interest.


3565. Gerontologist. 2021 Jul 13;61(5):650-660. doi: 10.1093/geront/gnab049.

Family Caregiving During the COVID-19 Pandemic.

Beach SR(1), Schulz R(1), Donovan H(2), Rosland AM(3).

Author information:
(1)University Center for Social and Urban Research, University of Pittsburgh, 
Pennsylvania, USA.
(2)School of Nursing, University of Pittsburgh, Pennsylvania, USA.
(3)Department of Medicine, University of Pittsburgh, Pennsylvania, USA.

BACKGROUND AND OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has 
negatively affected persons with existing chronic health conditions. The 
pandemic also has the potential to exacerbate the stresses of family caregiving. 
We compare family caregivers with noncaregivers on physical, psychosocial, and 
financial well-being outcomes during the pandemic and determine family 
caregivers most at risk for adverse outcomes.
RESEARCH DESIGN AND METHODS: We conducted a cross-sectional online survey of 576 
family caregivers and 2,933 noncaregivers from April to May 2020 in Pittsburgh, 
PA region with a national supplement. Outcome measures included concurrent 
anxiety, depression, fatigue, sleep disturbance, social participation, and 
financial well-being and perceived changes due to COVID-19 (loneliness, 
financial well-being, food security). We also measured sociodemographic, 
caregiving contextual variables, and COVID-19-related caregiver stressors (COVID 
Caregiver Risk Index).
RESULTS: Controlling for sociodemographics, family caregivers reported higher 
anxiety, depression, fatigue, sleep disturbance, lower social participation, 
lower financial well-being, increased food insecurity (all p < .01), and 
increased financial worries (p = .01). Caregivers who reported more 
COVID-19-related caregiver stressors and disruptions reported more adverse 
outcomes (all p < .01). In addition, caregivers who were female, younger, lower 
income, providing both personal/medical care, and providing care for 
cognitive/behavioral/emotional problems reported more adverse outcomes.
DISCUSSION AND IMPLICATIONS: Challenges of caregiving are exacerbated by the 
COVID-19 pandemic. Family caregivers reported increased duties, burdens, and 
resulting adverse health, psychosocial, and financial outcomes. Results were 
generally consistent with caregiver stress-health process models. Family 
caregivers should receive increased support during this serious public health 
crisis.

© The Author(s) 2021. Published by Oxford University Press on behalf of The 
Gerontological Society of America. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/geront/gnab049
PMCID: PMC8083337
PMID: 33847355 [Indexed for MEDLINE]


3566. Trends Neurosci Educ. 2021 Mar;22:100151. doi: 10.1016/j.tine.2021.100151. Epub 
2021 Feb 21.

Open schools! Weighing the effects of viruses and lockdowns on children.

Spitzer M(1).

Author information:
(1)University of Ulm, Department of Psychiatry, Leimgrubenweg 12-14, D-89075 
Ulm, Germany. Electronic address: manfred.spitzer@uni-ulm.de.

This review weighs the risk of infection with SARS-CoV-2 against the side 
effects of school closures on physical and mental health, education, and 
well-being of those affected by the school closures. Whereas short term effects 
- decreased learning and food security, and increased anxiety, violence against 
children, child labor and teen pregnancies - are frequently discussed, the 
long-term effects of school closures will be much more detrimental across the 
lifespan of the "Generation Corona": Existing pandemics of inactivity and 
myopia, already affecting billions of people, are worsening due to less physical 
exercise and less time spent outdoors, poor diet, weight gain, and increased 
screen time during lockdowns, causing future increases of stroke, heart attack, 
cancer, and blindness. Socio-emotional complications of isolation, learned 
helplessness, economic and existential insecurity will include increased 
depression and suicide, decreased empathy and increased loneliness. Together 
with decreased educational attainment and economic productivity, the amount of 
ensuing increased future global morbidity and mortality justifies immediate 
action of school reopening.

Copyright © 2021.

DOI: 10.1016/j.tine.2021.100151
PMCID: PMC9764796
PMID: 33845978 [Indexed for MEDLINE]

Conflict of interest statement: There are no known conflicts of interest 
associated with this publication.


3567. Am J Mens Health. 2021 Mar-Apr;15(2):15579883211005617. doi: 
10.1177/15579883211005617.

Black American Fathers Employed in Higher-Risk Contexts for Contracting 
COVID-19: Implications for Individual Wellbeing and Work-Family Spillover.

Cooper SM(1), Thomas A(2), Bamishigbin O(3).

Author information:
(1)University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
(2)University of Wisconsin-Madison, Madison, WI, USA.
(3)California State University, Long Beach, CA, USA.

Black Americans remain disproportionately affected by the COVID-19 pandemic. 
Emerging data suggests that employment in certain occupations (e.g., essential; 
frontline) may place individuals at higher-risk for contracting COVID-19. The 
current investigation examined how Black American fathers' COVID-19 perceived 
work risk was associated with their individual well-being (COVID-19 diagnosis; 
depressive and anxiety symptoms; sleep disturbance; sleep quality) as well as 
spillover into family contexts. Participants were 466 Black American fathers (M 
= 36.63; SD = 11.00) who completed online surveys in June-July 2020. Adjusted 
binomial logistic and multiple regressions were estimated to examine how 
fathers' work context was associated with COVID-19 health outcomes, 
psychological functioning, sleep health, and family stress. Descriptive analyses 
revealed that 32% of fathers reported a personal diagnosis of COVID-19 and 21% 
indicated that an immediate family member had been diagnosed. Adjusted binomial 
logistic regression analyses revealed that fathers working in higher-risk 
contexts for contracting COVID-19 had a greater odds ratio for both a personal 
(OR: 1.68, 95% CI: 1.05, 2.68) and an immediate family member diagnosis (OR: 
2.58, 95% CI: 1.52, 4.36). Working in a higher-risk context for contracting 
COVID-19 was associated with poorer psychological functioning, greater sleep 
disturbance, and higher levels of family discord. Findings suggest that Black 
fathers working in higher risk contexts may be at risk for COVID-19 exposure and 
infection. Further, this study indicates that these effects extend to their own 
well-being, including mental and sleep health as well as increased family 
stress.

DOI: 10.1177/15579883211005617
PMCID: PMC8047509
PMID: 33845678 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


3568. Int J Soc Psychiatry. 2022 Jun;68(4):783-790. doi: 10.1177/00207640211006153. 
Epub 2021 Apr 13.

Experiences and emotional strain of NHS frontline workers during the peak of the 
COVID-19 pandemic.

Newman KL(1)(2), Jeve Y(3), Majumder P(4)(5).

Author information:
(1)Psychology Department, Nottingham Trent University, UK.
(2)Nottinghamshire NHS Healthcare Trust, Institute of Mental Health, University 
of Nottingham, UK.
(3)Birmingham Women's & Children Hospital NHS Trust, UK.
(4)Nottingham City CAMHS Looked After Children's Team, UK.
(5)Division of Psychiatry & Applied Psychology, School of Medicine, University 
of Nottingham, UK.

BACKGROUND: The mental health of the population has been negatively affected due 
to the pandemic. Frontline healthcare workers with increased exposure to COVID 
diagnosis, treatment and care were especially likely to report psychological 
burden, fear, anxiety and depression.
AIM: To elicit how working as a health professional during the pandemic is 
impacting on the psychological wellbeing of frontline staff.
METHOD: United Kingdom population of healthcare workers were approached by 
advertising the survey via social media, NHS trusts and other organisations. 
Open-ended survey answers were qualitatively explored using content analysis.
RESULTS: Survey collected data from 395 NHS staff was developed into three 
themes; (1) Despair and uncertainty: feeling overwhelmed trying to protect 
everyone, (2) Behavioural and psychological impact: affecting wellbeing and 
functioning and (3) Coping and employer support: getting the right help.
CONCLUSION: NHS staff felt enormous burden to adequately complete their 
professional, personal and civil responsibility to keep everyone safe leading to 
negative psychological and behavioural consequences and desire for NHS employers 
to offer better support. As the pandemic progresses, the results of this study 
may inform NHS employers on how optimum support can be offered to help them cope 
with negative psychological consequences of the pandemic.

DOI: 10.1177/00207640211006153
PMCID: PMC9014765
PMID: 33845624 [Indexed for MEDLINE]


3569. J Womens Health (Larchmt). 2021 May;30(5):654-664. doi: 10.1089/jwh.2020.8866. 
Epub 2021 Apr 12.

Depression, Anxiety, Resilience, and Coping: The Experience of Pregnant and New 
Mothers During the First Few Months of the COVID-19 Pandemic.

Kinser PA(1), Jallo N, Amstadter AB(2), Thacker LR(3), Jones E(4), Moyer S(1), 
Rider A(1), Karjane N(1), Salisbury AL(1).

Author information:
(1)School of Nursing, Virginia Commonwealth University, Richmond, Virginia, USA.
(2)Department of Psychiatry, Virginia Institute of Psychiatric and Behavioral 
Genetics, Virginia Commonwealth University, Richmond, Virginia, USA.
(3)Department of Biostatistics and Virginia Commonwealth University, Richmond, 
Virginia, USA.
(4)Department of Family Medicine and Epidemiology, Virginia Commonwealth 
University, Richmond, Virginia, USA.

Background: It is well-documented that the mental health of pregnant and 
postpartum women is essential for maternal, child, and family well-being. Of 
major public health concern is the perinatal mental health impacts that may 
occur during the ongoing coronavirus disease 2019 (COVID-19) pandemic. It is 
essential to explore the symptom experience and predictors of mental health 
status, including the relationship between media use and mental health. 
Materials and Methods: The purpose of this study is to evaluate the experiences 
of pregnant and postpartum women (n = 524) in the United States in the early 
phase of the COVID-19 pandemic. This cross-sectional online observational study 
collected psychosocial quantitative and qualitative survey data in adult 
pregnant and postpartum (up to 6 months postdelivery) women in April-June 2020. 
Results: Multivariable linear regression models were used to evaluate predictors 
of depressive symptoms, anxiety, and post-traumatic stress disorder. The most 
common predictors were job insecurity, family concerns, eating comfort foods, 
resilience/adaptability score, sleep, and use of social and news media. 
Qualitative themes centered on pervasive uncertainty and anxiety; grief about 
losses; gratitude for shifting priorities; and use of self-care methods 
including changing media use. Conclusions: This study provides information to 
identify risk for anxiety, depression, and PTSD symptoms in perinatal women 
during acute public health situations. Women with family and job concerns and 
low resilience/adaptability scores seem to be at high risk of psychological 
sequelae. Although use of social media is thought to improve social 
connectedness, our results indicate that increased media consumption is related 
to increased anxiety symptoms.

DOI: 10.1089/jwh.2020.8866
PMCID: PMC8182651
PMID: 33844945 [Indexed for MEDLINE]

Conflict of interest statement: No competing financial interests exist. All 
authors having nothing to disclose with regard to competing interests, personal 
financial interests, funding, employment, or other competing interests.


3570. Can J Aging. 2021 Sep;40(3):405-423. doi: 10.1017/S0714980820000355. Epub 2021 
Apr 12.

Cognitive Impairment and Length of Stay in Acute Care Hospitals: A Scoping 
Review of the Literature.

Plante J(1)(2), Latulippe K(3)(4), Kröger E(1)(4), Giroux D(1)(3), Marcotte 
M(1), Nadeau S(5), Doyle E(5), Rockwood K(5).

Author information:
(1)Quebec City Center of Excellence on Aging (CEVQ), Quebec City, Quebec.
(2)Faculty of Medicine, Université Laval, Quebec City, Quebec.
(3)Department of Rehabilitation, Université Laval, Quebec City, Quebec.
(4)Faculty of Pharmacy, Université Laval, Quebec City, Quebec.
(5)Geriatric Medicine Research, Nova Scotia Health Authority/Dalhousie 
University, Halifax, Nova Scotia.

Older persons experiencing a longer length of stay (LOS) or delayed discharge 
(DD) may see a decline in their health and well-being, generating significant 
costs. This review aimed to identify evidence on the impact of cognitive 
impairment (CI) on acute care hospital LOS/DD. A scoping review of studies 
examining the association between CI and LOS/DD was performed. We searched six 
databases; two reviewers independently screened references until November 2019. 
A narrative synthesis was used to answer the research question; 58 studies were 
included of which 33 found a positive association between CI and LOS or DD, 8 
studies had mixed results, 3 found an inverse relationship, and 14 showed an 
indirect link between CI-related syndromes and LOS/DD. Thus, cognitive 
impairment seemed to be frequently associated with increased LOS/DD. Future 
research should consider CI together with other risks for LOS/DD and also focus 
on explaining the association between the two.

DOI: 10.1017/S0714980820000355
PMID: 33843528 [Indexed for MEDLINE]


3571. Clin Gerontol. 2022 Jan-Feb;45(1):97-105. doi: 10.1080/07317115.2021.1910394. 
Epub 2021 Apr 12.

COVID-19 Public Health Restrictions and Older Adults' Well-being in Uganda: 
Psychological Impacts and Coping Mechanisms.

Giebel C(1)(2), Ivan B(3), Ddumba I(3).

Author information:
(1)Department of Primary Care & Mental Health, University of Liverpool, UK.
(2)NIHR ARC NWC, Liverpool, UK.
(3)African Research Centre for Ageing and Dementia (ARCAD), Mukono, Uganda.

OBJECTIVES: Older adults across the globe have been particularly affected by the 
novel coronavirus due to their increased susceptibility to the virus. With 
limited existing research, the aim of this study was to explore the 
psychological effects of COVID-19 public health measures on older adults in 
Uganda and their coping mechanisms.
METHODS: Thirty semi-structured interviews were conducted with older Ugandans 
(aged 60+) in June 2020. Participants were asked about their experiences of 
public health measures, and their effects on the lives of older adults compared 
to pre-pandemic.
RESULTS: Three themes were identified: Impact on emotional well-being; 
Implications on physical well-being; and Coping mechanisms. Older adults 
experienced both psychological and physical effects, including upset, fear, and 
frustration about restrictions and the virus, as well as early signs of 
increased frailty, thus causing concerns for the long-term emotional and 
physical health of older Ugandans.
CONCLUSIONS: Public health measures need to be considerate of the potential 
long-term implications on the well-being of older adults in low-, middle-, and 
high-income countries, and ensure the possibility for continued physical 
exercise and social connection. This can be particularly challenging for people 
from more disadvantaged backgrounds who may not be able to afford a smartphone 
or laptop, with older adults further requiring support in using digital 
technologies.
CLINICAL IMPLICATIONS: Older adults need to receive adequate psychological 
support to cope with the mental health impacts of the pandemic.

DOI: 10.1080/07317115.2021.1910394
PMID: 33843497 [Indexed for MEDLINE]


3572. Glob Public Health. 2021 Jun;16(6):964-973. doi: 10.1080/17441692.2021.1912137. 
Epub 2021 Apr 11.

Alleviating psychological distress and promoting mental wellbeing among 
adolescents living with HIV in sub-Saharan Africa, during and after COVID-19.

Okumu M(1), Nyoni T(2), Byansi W(2).

Author information:
(1)School of Social Work, University of North Carolina, Chapel Hill, NC, USA.
(2)Brown School of Social Work, Washington University, St. Louis, MO, USA.

COVID-19 social control measures (e.g. physical distancing and lockdowns) can 
have both immediate (social isolation, loneliness, anxiety, stress) and 
long-term effects (depression, post-traumatic stress disorder) on individuals' 
mental health. This may be particularly true of adolescents living with HIV 
(ALHIV) and their caregivers - populations already overburdened by intersecting 
stressors (e.g. psychosocial, biomedical, familial, economic, social, or 
environmental). Addressing the adverse mental health sequelae of COVID-19 among 
ALHIV requires a multi-dimensional approach that at once (a) economically 
empowers ALHIV and their households and (b) trains, mentors, and supervises 
community members as lay mental health services providers. Mental health 
literacy programming can also be implemented to increase mental health 
knowledge, reduce stigma, and improve service use among ALHIV. Schools and HIV 
care clinics offer ideal environments for increasing mental health literacy and 
improving access to mental health services.

DOI: 10.1080/17441692.2021.1912137
PMCID: PMC9318353
PMID: 33843460 [Indexed for MEDLINE]

Conflict of interest statement: Disclosure statement No potential conflict of 
interest was reported by the author(s).


3573. Health Care Manag Sci. 2021 Jun;24(2):286-304. doi: 10.1007/s10729-020-09543-z. 
Epub 2021 Apr 11.

An integer programming model to assign patients based on mental health impact 
for tele-psychotherapy intervention during the Covid-19 emergency.

Miniguano-Trujillo A(1), Salazar F(2), Torres R(2), Arias P(3), Sotomayor K(4).

Author information:
(1)Maxwell Institute for Mathematical Sciences, The University of Edinburgh, 
Bayes Centre, 47 Potterrow, Edinburgh, United Kingdom. 
Andres.Miniguano-Trujillo@ed.ac.uk.
(2)Department of Mathematics - Escuela Politécnica Nacional, Quito, Ecuador.
(3)Ecuadorian Association of Evidence-Based Psychology and Psychotherapy 
(AEPPBE), Quito, Ecuador.
(4)Human Cognitive Neuroscience, Psychology, The University of Edinburgh, 
Edinburgh, United Kingdom.

The Covid-19 pandemic challenges healthcare systems worldwide while severely 
impacting mental health. As a result, the rising demand for psychological 
assistance during crisis times requires early and effective intervention. This 
contributes to the well-being of the public and front-line workers and prevents 
mental health disorders. Many countries are offering diverse and accessible 
services of tele-psychological intervention; Ecuador is not the exception. The 
present study combines statistical analyses and discrete optimization techniques 
to solve the problem of assigning patients to therapists for crisis intervention 
with a single tele-psychotherapy session. The statistical analyses showed that 
professionals and healthcare workers in contact with Covid-19 patients or with a 
confirmed diagnosis had a significant relationship with suicide risk, sadness, 
experiential avoidance, and perception of severity. Moreover, some 
Covid-19-related variables were found to be predictors of sadness and suicide 
risk as unveiled via path analysis. This allowed categorizing patients according 
to their screening and grouping therapists according to their qualifications. 
With this stratification, a multi-periodic optimization model and a heuristic 
are proposed to find an adequate assignment of patients to therapists over time. 
The integer programming model was validated with real-world data, and its 
results were applied in a volunteer program in Ecuador.

DOI: 10.1007/s10729-020-09543-z
PMCID: PMC8036244
PMID: 33839993 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


3574. J Pediatr Nurs. 2021 Nov-Dec;61:109-114. doi: 10.1016/j.pedn.2021.03.020. Epub 
2021 Apr 8.

Effectiveness of a One Day Self-Compassion Training for Pediatric Nurses' 
Resilience.

Franco PL(1), Christie LM(2).

Author information:
(1)Center for Resiliency, Dell Children's Medical Center, USA. Electronic 
address: phoebe.long@ascension.org.
(2)Quality Improvement and Patient Safety, Dell Children's Medical Center, USA.

BACKGROUND: Resilience is a critical skill for nurses and other healthcare 
professionals, especially during the COVID-19 pandemic, yet few nurses receive 
training that promotes emotional awareness and regulation, resilience, and 
self-compassion.
PURPOSE: The purpose of this study was to understand if attending a one-day 
workshop format of the Self Compassion for Healthcare Communities (SCHC) program 
would improve pediatric nurses' resilience, well-being, and professional quality 
of life.
DESIGN AND METHODS: Following a quasi-experimental design, pre, post, and 
follow-up surveys were acquired from 22 nurses who attended the training and 26 
nurses who did not attend the training. In a linear mixed models regression 
analysis, changes in self-compassion, mindfulness, compassion, resilience, job 
engagement, professional quality of life (compassion satisfaction, burnout, and 
secondary traumatic stress), depression, anxiety and stress were analyzed 
between groups.
RESULTS: Participants in the intervention exhibited significant increases in 
self-compassion, mindfulness, compassion to others, resilience and compassion 
satisfaction, and significant decreases in burnout, anxiety, and stress compared 
to the non-intervention group.
CONCLUSIONS: A one-day SCHC training program provides nurses with knowledge and 
skills to increase their resilience and support their emotional well-being and 
professional quality of life.
PRACTICE IMPLICATIONS: Nurses' schedules may hamper their ability to attend 
lengthy resilience trainings, yet the skills needed for resilience are crucial 
to decreasing burnout, empathy fatigue, and turnover. Offering an effective, 
one-day training provides an accessible alternative for nurses to gain knowledge 
and skills that increase resilience.

Copyright © 2021 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.pedn.2021.03.020
PMID: 33839602 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


3575. Am J Emerg Med. 2021 Oct;48:38-47. doi: 10.1016/j.ajem.2021.03.088. Epub 2021 
Apr 2.

Impacts and challenges of the COVID-19 pandemic on emergency medicine physicians 
in the United States.

Nguyen J(1), Liu A(1), McKenney M(2), Liu H(3), Ang D(4), Elkbuli A(5).

Author information:
(1)Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall 
Regional Medical Center, Miami, FL, USA.
(2)Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall 
Regional Medical Center, Miami, FL, USA; Department of Surgery, University of 
South Florida, Tampa, FL, USA.
(3)Department of Surgery, Ocala Regional Medical Center, Ocala, FL, USA.
(4)Department of Surgery, Ocala Regional Medical Center, Ocala, FL, USA; 
Department of Surgery, University of Central Florida, Ocala, FL, USA.
(5)Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall 
Regional Medical Center, Miami, FL, USA. Electronic address: 
Adel.Elkbulli@HCAHealthcare.com.

BACKGROUND: Emergency medicine (EM) physicians have been on the front line of 
the COVID-19 pandemic. This study aims to determine the impact of COVID-19 
pandemic and other related factors such as resource availability and 
institutional support on well-being, burnout and job-satisfaction of EM 
physicians in the United States.
METHODS: A cross-sectional survey study of EM physicians was conducted through 
the Emergency Medicine Practice Research Network of the ACEP. The survey focused 
on resource adequacy, institutional support, well-being, and burnout. A total of 
890 EM physicians were invited to participate. Both descriptive and risk 
adjusted, and multivariate regressions were performed with a statistical 
significance defined as p < 0.05.
RESULTS: EM physicians' response rate was 18.7% (166) from 39 states. Burnout 
was reported by 74.7% (124) since the start of the pandemic. Factors 
contributing included work-related emotional strain and anxiety, isolation from 
family and friends, and increased workload. Those reporting inadequate resources 
felt ignored by their institutions (p < 0.0001). Physicians who felt there was 
inadequate institutional support, were also dissatisfied with patient care 
resources (p = 0.001). Physicians expressing job dissatisfaction were more 
likely to report feelings of burnout (p = 0.001).
CONCLUSION: EM physicians face greater burnout in the COVID-19 pandemic. This 
may be compounded by resource scarcity, psychological stress, isolation, and job 
dissatisfaction. Many of the survey respondents reported inadequate mental 
health services and resources. The findings of this study may help identify 
solutions to mitigate these issues.

Copyright © 2021. Published by Elsevier Inc.

DOI: 10.1016/j.ajem.2021.03.088
PMCID: PMC8016733
PMID: 33836387 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest Authors 
disclose no competing interest.


3576. JMIR Public Health Surveill. 2021 May 25;7(5):e24623. doi: 10.2196/24623.

The Differential Effects of Social Media on Depressive Symptoms and Suicidal 
Ideation Among the Younger and Older Adult Population in Hong Kong During the 
COVID-19 Pandemic: Population-Based Cross-sectional Survey Study.

Yang X(1)(2), Yip BHK(1), Mak ADP(3), Zhang D(1), Lee EKP(1), Wong SYS(1).

Author information:
(1)Jockey Club School of Public Health and Primary Care, Faculty of Medicine, 
The Chinese University of Hong Kong, Hong Kong, Hong Kong.
(2)The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, 
China.
(3)Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, 
Hong Kong.

BACKGROUND: Social media has become a ubiquitous part of daily life during the 
COVID-19 pandemic isolation. However, the role of social media use in depression 
and suicidal ideation of the general public remains unclear. Related empirical 
studies were limited and reported inconsistent findings. Little is known about 
the potential underlying mechanisms that may illustrate the relationship between 
social media use and depression and suicidal ideation during the COVID-19 
pandemic.
OBJECTIVE: This study tested the mediation effects of social loneliness and 
posttraumatic stress disorder (PTSD) symptoms on the relationship between social 
media use and depressive symptoms and suicidal ideation, as well as the 
moderation effect of age on the mediation models.
METHODS: We administered a population-based random telephone survey in May and 
June 2020, when infection control measures were being vigorously implemented in 
Hong Kong. A total of 1070 adults (658 social media users and 412 nonusers) 
completed the survey. Structural equation modeling (SEM) and multigroup SEM were 
conducted to test the mediation and moderation effects.
RESULTS: The weighted prevalence of probable depression was 11.6%; 1.6% had 
suicidal ideation in the past 2 weeks. Both moderated mediation models of 
depressive symptoms (χ262=335.3; P<.05; comparative fit index [CFI]=0.94; 
nonnormed fit index [NNFI]=0.92; root mean square error of approximation 
[RMSEA]=0.06) and suicidal ideation (χ234=50.8; P<.05; CFI=0.99; NNFI=0.99; 
RMSEA=0.02) showed acceptable model fit. There was a significantly negative 
direct effect of social media use on depressive symptoms among older people 
(β=-.07; P=.04) but not among younger people (β=.04; P=.55). The indirect effect 
via PTSD symptoms was significantly positive among both younger people (β=.09; 
P=.02) and older people (β=.10; P=.01). The indirect effect via social 
loneliness was significant among older people (β=-.01; P=.04) but not among 
younger people (β=.01; P=.31). The direct effect of social media use on suicidal 
ideation was not statistically significant in either age group (P>.05). The 
indirect effects via PTSD symptoms were statistically significant among younger 
people (β=.02; P=.04) and older people (β=.03; P=.01). Social loneliness was not 
a significant mediator between social media use and suicidal ideation among 
either age group (P>.05).
CONCLUSIONS: Social media may be a "double-edged sword" for psychosocial 
well-being during the COVID-19 pandemic, and its roles vary across age groups. 
The mediators identified in this study can be addressed by psychological 
interventions to prevent severe mental health problems during and after the 
COVID-19 pandemic.

©Xue Yang, Benjamin H K Yip, Arthur D P Mak, Dexing Zhang, Eric K P Lee, Samuel 
Y S Wong. Originally published in JMIR Public Health and Surveillance 
(https://publichealth.jmir.org), 25.05.2021.

DOI: 10.2196/24623
PMCID: PMC8153033
PMID: 33835937 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


3577. Neuropsychopharmacol Hung. 2021 Mar;23(1):208-214.

Coronavirus Pandemic - #STAYHOME: How Are You Holding Up? Questions And Tips For 
11-18-Year-Olds To Make It Better.

[Article in English]

Szentiványi D(1), Horvath LO, Kjeldsen A, L Buist K, Farkas BF, Ferenczi-Dallos 
G, Garas P, Gyori D, Gyorfi A, Gyorfi D, Ravens-Sieberer U, Balazs J.

Author information:
(1)Eötvös Loránd Tudományegyetem, Pszichológiai Intézet, Budapest, Hungary. 
balazs.judit@ppk.elte.hu.

PURPOSE: Adolescents have to cope with several challenges and restrictions due 
to the COVID-19 pandemic, with many of those incongruent with the typical 
developmental tasks of adolescent age. Some adolescents might be particularly 
vulnerable in this situation, including those who are deprived of psychological, 
social or health care services and/or are exposed to abuse or neglect in their 
home environment. The aims of the current international multicentre follow-up 
study are to: 1. collect data on the mental health and quality of life of 
adolescents during and after the pandemic; 2. improve their mental health by 
providing an online prevention program that addresses their actual needs; 3. 
accelerate the development of culturally adapted prevention programs by 
involving an international team, and 4. to contribute to adequate preparation 
for any potentially occurring, similar situationin the future.
METHODS: Participants aged 11-18 years and their parents/caregivers from diff 
erent parts of Europe and non-European countries are recruited online. Data are 
collected regularly in a follow-up study by means of structured 
self-administered online questionnaires on adolescents' mental health, quality 
of life and current attitudes and needs. The baseline data collection was in 
March 2020 at first restrictions of the COVID pandemic in Europe. It is followed 
up several times (at the beginning weekly, later monthly, bi-monthly, 
three-monthly) to study changes in mental health, quality of life and attitudes 
of children and adolescents during the coronavirus disease pandemic. Data were 
collected by means of structured questionnaires (see below). The time frame of 
the study is set to one year from study start, March 2021. The last data 
collection was done in December 2020. The prevention program is developed and 
provided based on continuously analysed incoming data.
CONCLUSIONS: Prevention based on the results of the study is expected to 
contribute to maintaining adolescents' mental health, improve their quality of 
life, increase their and their environment's cooperation with the necessary 
restrictions during the pandemic, and to make reintegration easier once the 
restrictions are over. Furthermore, the study has the potential to inform on the 
wellbeing of children and adolescents in extreme situations in general, thus 
contribute to future preventive measures and policymaking. Implications and 
Contribution: The proposed international online follow-up study is expected to 
provide scientifi c evidence for 1. possible changes in the mental health and 
quality of life of adolescents during and after a pandemic situation, 2. the eff 
ectiveness of a culturally adapted prevention program developed to address 
challenges associated with these changes.

PMID: 33835042 [Indexed for MEDLINE]


3578. Perspect Psychiatr Care. 2022 Jan;58(1):17-30. doi: 10.1111/ppc.12798. Epub 2021 
Apr 8.

The impact of confinement on older Jordanian adults' mental distress during the 
COVID-19 pandemic: A web-based cross-sectional study.

Abu Kamel AK(1), Alnazly EK(2).

Author information:
(1)Nursing Department-Community Health, Al-Zaytoonah University of Jordan, 
Amman, Jordan.
(2)Nursing Department-Mental Health, Al-Ahliyya Amman University, Amman, Jordan.

PURPOSE: This study aimed to determine the impact of Coronavirus disease, 2019 
(COVID-19) confinement on older Jordanian adults' mental distress and to assess 
which study variables that predict Posttraumatic Stress disorder.
DESIGN AND METHODS: This cross-sectional study was conducted on 315 older 
Jordanian adults using an online survey in Amman, Jordan between May 28 and June 
12.
FINDINGS: The assessment revealed a moderate level of avoidance (M = 1.97, 
SD = 0.7), a higher effect of intrusion (M = 2.08, SD = 0.9), an above midpoint 
level of fear 18.50 ± 8.6, and mild depression (M = 6.96, SD = 7.3). 
Hierarchical Multiple Regression model revealed that 77.8% of the Impact of 
Event Scale-Revised was explained by both Fear of COVID-19 Scale and Patient 
Health Questionnaire-9 (R change = 0.66, SE = 8.4, p < 0.001).
PRACTICE IMPLICATION: This suggests that confinement affects different aspects 
of the psychological well-being of older Jordanian adults. An early assessment 
and intervention can make confinement as tolerable as possible.

© 2021 Wiley Periodicals LLC.

DOI: 10.1111/ppc.12798
PMCID: PMC8250810
PMID: 33834502 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that there are no conflict 
of interests.


3579. Fam Process. 2022 Mar;61(1):361-374. doi: 10.1111/famp.12649. Epub 2021 Apr 8.

Impact of the COVID-19 Pandemic on Parent, Child, and Family Functioning.

Feinberg ME(1), A Mogle J(1), Lee JK(2), Tornello SL(3), Hostetler ML(1), 
Cifelli JA(1), Bai S(3), Hotez E(4).

Author information:
(1)Prevention Research Center, College of Health and Human Development, Human 
Development and Family Studies, The Pennsylvania State University, University 
Park, PA, USA.
(2)Department of Psychology, College of Liberal Arts, The Pennsylvania State 
University, University Park, PA, USA.
(3)Human Development and Family Studies, College of Health and Human 
Development, The Pennsylvania State University, University Park, PA, USA.
(4)Department of Medicine, University of California, Los Angeles (UCLA), Los 
Angeles, CA, USA.

To quantify the impact of the COVID-19 pandemic and public health interventions 
on parent and child mental health and family relationships, we examined change 
in individual and family functioning in a sample of parents enrolled in a 
prevention trial; we examined change before the pandemic (2017-2019) when 
children were an average of 7 years old to the first months after the imposition 
of widespread public health interventions in the United States (2020) with 
paired t tests and HLM models. We examined moderation by parent gender, 
education, family income, and coparenting conflict. We found large 
deteriorations from before the pandemic to the first months of the pandemic in 
child internalizing and externalizing problems and parent depression, and a 
moderate decline in coparenting quality. Smaller changes were found for parent 
anxiety and parenting quality. Mothers and families with lower levels of income 
were at particular risk for deterioration in well-being. Results indicate a need 
for widespread family support and intervention to prevent potential family 
"scarring," that is, prolonged, intertwined individual mental health and family 
relationship problems.

Publisher: Para cuantificar el efecto de la pandemia de la COVID-19 y de las 
intervenciones de salud pública en la salud mental de los padres y los niños y 
en las relaciones familiares, analizamos los cambios en el funcionamiento 
individual y familiar en una muestra de padres inscriptos en un ensayo de 
prevención; estudiamos el cambio antes de la pandemia (2017-2019) cuando los 
niños tenían un promedio de 7 años hasta los primeros meses después de la 
imposición de las intervenciones generalizadas de salud pública en los Estados 
Unidos (2020) con pruebas t apareadas y modelos lineales jerárquicos. Analizamos 
la moderación por género, educación, ingresos familiares y conflicto de 
cocrianza de los padres. Hallamos grandes deterioros desde antes de la pandemia 
hasta los primeros meses de la pandemia en problemas de interiorización y 
exteriorización de los niños y depresión de los padres, y una disminución 
moderada de la calidad de la cocrianza. También encontramos cambios más pequeños 
en la ansiedad de los padres y la calidad de la crianza. Las madres y las 
familias con niveles más bajos de ingresos estuvieron en riesgo particular de 
deterioro del bienestar. Los resultados indican la necesidad de apoyo familiar 
generalizado y de intervenciones para prevenir posibles «secuelas» familiares, 
p. ej.: salud mental individual interconectada y prolongada y problemas en las 
relaciones familiares.

Publisher: 
本文把COVID-19和公共健康干预措施对父母和儿童的心理健康以及对家庭关系的影响进行量化，对参加一项预防试验的人群样本进行了研究，主要关于这些受试父母的个体功能和家庭功能产生了哪些变化; 
我们采用配对t检验和HLM模型，研究了新冠肺炎(2017-2019年)前的变化，即平均年龄为7岁的儿童至美国实施广泛公共健康干预措施(2020年)后的第一个月。我们通过父母性别、教育程度、家庭收入和养育子女的冲突来考察这些因素的调适作用。我们发现，儿童对很多问题以及父母的抑郁表现都进行内化和外化，从新冠肺炎流行发生前到新冠大流行的头几个月出现了严重恶化倾向，亲子教育的质量略有下降。父母的焦虑和培养孩子方面的质量也有较小的变化。收入水平较低的母亲和家庭的福祉尤其有恶化的风险。结果表明，需要给予广泛的家庭支持和干预，以防止潜在的家庭"伤疤"，即长期错综搅合在一起的个人心理健康和家庭关系问题。.

© 2021 Family Process Institute.

DOI: 10.1111/famp.12649
PMCID: PMC8250962
PMID: 33830510 [Indexed for MEDLINE]


3580. RMD Open. 2021 Apr;7(1):e001546. doi: 10.1136/rmdopen-2020-001546.

Assessment of impact of the COVID-19 pandemic from the perspective of patients 
with rheumatic and musculoskeletal diseases in Europe: results from the REUMAVID 
study (phase 1).

Garrido-Cumbrera M(1)(2), Marzo-Ortega H(3)(4), Christen L(5), Plazuelo-Ramos 
P(2), Webb D(6), Jacklin C(7), Irwin S(8), Grange L(9)(10), Makri S(11), Frazão 
Mateus E(12), Mingolla S(13), Antonopoulou K(14), Sanz-Gómez S(1), 
Correa-Fernández J(1), Carmona L(15), Navarro-Compán V(16).

Author information:
(1)Health & Territory Research (HTR), Universidad de Sevilla, Sevilla, Spain.
(2)Spanish Federation of Spondyloarthritis Associations (CEADE), Madrid, Spain.
(3)Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of 
Leeds, Leeds, UK.
(4)Musculoskeletal Biomedical Research Unit, NHR Leeds, Leeds, UK.
(5)Patient Engagement, Novartis Pharma AG, Basel, Switzerland.
(6)National Axial Spondyloarthritis Society (NASS), London, UK.
(7)National Rheumatoid Arthritis Society (NRAS), Maidenhead, UK.
(8)Arthritis Action, London, UK.
(9)Rheumatology Department, University Hospital of Grenoble, Grenoble, France.
(10)French League Against Rheumatism (AFLAR), Paris, France.
(11)Cyprus League Against Rheumatism (CYPLAR), Nicosia, Cyprus.
(12)Portuguese League Against Rheumatic Diseases (LPCDR), Lisbon, Portugal.
(13)Italian National Association of People with Rheumatic and Rare Diseases 
(APMARR), Lecce, Italy.
(14)Hellenic League Against Rheumatism (ELEANA), Athens, Greece.
(15)Insitute for Musculoskeletal Health (InMusc), Madrid, Spain.
(16)IdiPaz, La Paz University Hospital, Madrid, Spain 
mvictoria.navarroc@gmail.com.

AIM: To assess the impact of the COVID-19 pandemic on patients with rheumatic 
and musculoskeletal diseases (RMDs).
METHODS: REUMAVID is a cross-sectional study using an online survey developed by 
an international multidisciplinary patient-led collaboration across seven 
European countries targeting unselected patients with RMDs. Healthcare access, 
daily activities, disease activity and function, well-being (WHO Five Well-Being 
Index (WHO-5)), health status, anxiety/depression (Hospital Anxiety and 
Depression Scale (HADS)) and access to information were evaluated. Data were 
collected in April-July 2020 (first phase).
RESULTS: Data from the first phase included 1800 patients with 15 different RMDs 
(37.2% axial spondyloarthritis, 29.2% rheumatoid arthritis, 17.2% osteoarthritis 
and others). Mean age was 53, 80% female and 49% had undertaken university 
studies. During the beginning of the pandemic, 58.4% had their rheumatology 
appointment cancelled and 45.6% reported not having received any information 
relating to the possible impact of SARS-CoV-2 infection in their RMDs, with the 
main source being patient organisations (27.6%).Regarding habits, 24.6% 
increased smoking, 18.2% raised their alcohol consumption, and 45.6% were unable 
to continue exercising. Self-reported disease activity was high (5.3±2.7) and 
75.6% reported elevated pain. Half the patients (49.0%) reported poor well-being 
(WHO-5) and 46.6% that their health had changed for the worse during lockdown. 
According to HADS, 57.3% were at risk of anxiety and 45.9% of depression.
CONCLUSION: Throughout the first wave of the COVID-19 pandemic, patients with 
RMDs have experienced disruption in access to healthcare services, poor 
lifestyle habits and negative effects on their overall health, well-being and 
mental health. Furthermore, information on COVID-19 has not reached patients 
appropriately.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/rmdopen-2020-001546
PMCID: PMC8029094
PMID: 33827969 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: HM-O reports grant/research 
support from: Janssen and Novartis, consultant for: AbbVie, Celgene, Janssen, 
Lilly, Novartis, Pfizer and UCB, speakers’ bureau: AbbVie, Biogen, Celgene, 
Janssen, Lilly, Novartis, Pfizer, Takeda and UCB. HM-O is supportedby the 
National Institute for Health Research (NIHR) Leeds Biomedical Research 
Centre.LC is an employee of Novartis Pharma AG. CJ has received grant funding 
from Abbvie, Amgen, Biogen, Eli Lilly, Gilead, Janssen, Pfizer, Roche, Sanofi 
and UCB. DW has received grant funding from AbbVie, Biogen, Janssen, Lilly, 
Novartis and UCB. SI has received funding from the Coronavirus Community Support 
Fund, distributed by The National Lottery Community Fund. SM reports unrelated 
honoraria from Novartis, GSK and Bayer. EF-M has received support for specific 
activities: grants and non-financial from Pfizer, grants from Lilly Portugal, 
Sanofi, AbbVie, Novartis, Grünenthal. SA., MSD, Celgene, Medac, Janssen-Cilag, 
Pharmakern and GAfPA, and non-financial support from Grünenthal GmbH. VN-C 
reports honoraria/research support from: Abbvie, BMS, Janssen, Lilly, MSD, 
Novartis, Pfizer, Roche and UCB.


3581. Trials. 2021 Apr 7;22(1):254. doi: 10.1186/s13063-021-05213-9.

Update to the effectiveness and cost-effectiveness of a mindfulness training 
programme in schools compared with normal school provision (MYRIAD): study 
protocol for a randomised controlled trial.

Montero-Marin J(1), Nuthall E(1), Byford S(2), Crane C(3), Dalgleish T(4), Ford 
T(5), Ganguli P(2), Greenberg MT(6), Ukoumunne OC(7), Viner RM(8), Williams 
JMG(1); MYRIAD team; Kuyken W(9).

Collaborators: Ahmed S, Allwood M, Auckland L, Baer R, Ball S, Bennett M, 
Blakemore SJ, Brett D, Casey T, De Wilde K, Dunning D, Farley ER, Fletcher K, 
Foulkes L, Griffin C, Griffiths K, Kapplemann N, Knight R, Laws S, Leung J, Lord 
L, Medlicott E, Palmer L, Parker J, Petit A, Pi-Sunyer BP, Pryor-Nitsch I, 
Radley L, Raja A, Sakhardande A, Shackleford J, Sonley A, Taylor L, Vainre M, 
Warriner L, Wainman B.

Author information:
(1)Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, 
UK.
(2)Kings Health Economics, Kings College London, London, UK.
(3)Oxford Institute of Clinical Psychology Training, Warneford Hospital, Oxford, 
UK.
(4)MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, 
UK.
(5)Department of Psychiatry, University of Cambridge, Cambridge, UK.
(6)Prevention Research Center, Pennsylvania State University, State College, PA, 
USA.
(7)NIHR ARC South West Peninsula (PenARC), University of Exeter Medical School, 
Exeter, UK.
(8)UCL Institute of Child Health, London, UK.
(9)Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, 
UK. willem.kuyken@psych.ox.ac.uk.

BACKGROUND: MYRIAD (My Resilience in Adolescence) is a superiority, parallel 
group, cluster randomised controlled trial designed to examine the effectiveness 
and cost-effectiveness of a mindfulness training (MT) programme, compared with 
normal social and emotional learning (SEL) school provision to enhance mental 
health, social-emotional-behavioural functioning and well-being in adolescence. 
The original trial protocol was published in Trials (accessible at 
https://doi.org/10.1186/s13063-017-1917-4 ). This included recruitment in two 
cohorts, enabling the learning from the smaller first cohort to be incorporated 
in the second cohort. Here we describe final amendments to the study protocol 
and discuss their underlying rationale.
METHODS: Four major changes were introduced into the study protocol: (1) there 
were changes in eligibility criteria, including a clearer operational definition 
to assess the degree of SEL implementation in schools, and also new criteria to 
avoid experimental contamination; (2) the number of schools and pupils that had 
to be recruited was increased based on what we learned in the first cohort; (3) 
some changes were made to the secondary outcome measures to improve their 
validity and ability to measure constructs of interest and to reduce the burden 
on school staff; and (4) the current Coronavirus Disease 2019 (SARS-CoV-2 or 
COVID-19) pandemic both influences and makes it difficult to interpret the 
2-year follow-up primary endpoint results, so we changed our primary endpoint to 
1-year follow-up.
DISCUSSION: These changes to the study protocol were approved by the Trial 
Management Group, Trial Steering Committee and Data and Ethics Monitoring 
Committees and improved the enrolment of participants and quality of measures. 
Furthermore, the change in the primary endpoint will give a more reliable answer 
to our primary question because it was collected prior to the COVID-19 pandemic 
in both cohort 1 and cohort 2. Nevertheless, the longer 2-year follow-up data 
will still be acquired, although this time-point will be now framed as a second 
major investigation to answer some new important questions presented by the 
combination of the pandemic and our study design.
TRIAL REGISTRATION: International Standard Randomised Controlled Trials 
ISRCTN86619085 . Registered on 3 June 2016.

DOI: 10.1186/s13063-021-05213-9
PMCID: PMC8024679
PMID: 33827652 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare they have no competing 
interests.


3582. HERD. 2021 Oct;14(4):227-241. doi: 10.1177/19375867211006654. Epub 2021 Apr 8.

Benefits of Indirect Contact With Nature on the Physiopsychological Well-Being 
of Elderly People.

Elsadek M(1)(2), Shao Y(1), Liu B(1).

Author information:
(1)Department of Landscape Architecture, College of Architecture and Urban 
Planning, 12476Tongji University, Shanghai, China.
(2)Department of Horticulture, Faculty of Agriculture, Suez Canal University, 
Ismailia, Egypt.

OBJECTIVES: Exposure to nature or to green space has positive mental health 
benefits. Closing of parks and green spaces during the COVID-19 pandemic has 
reduced options for mental health and well-being benefits and could have a 
greater impact on vulnerable populations, especially the elderly. The present 
study, therefore, explores the physiopsychological impacts of indirect contact 
with nature, using forest imagery, on the brain activity and autonomic nervous 
systems of elderly people.
STUDY DESIGN: A within-subject design experiment was used.
METHODS: Thirty-four participants aged 82.9 ± 0.78 years were asked to look at 
bamboo and urban images for 2 min. During the visual stimulation, α relative 
waves were measured using electroencephalography as an indicator of brain 
activity. Heart rate variability and skin conductance (SC) responses were 
utilized as indicators of arousal. Afterward, psychological responses were 
evaluated using the semantic differential and the Profile of Mood States 
questionnaires.
RESULTS: Visual stimulation with bamboo image induced a significant increase in 
α relative waves and parasympathetic nervous activity and a significant decrease 
in SC. In addition, a significant increase in perceptions of "comfortable," 
"relaxed," "cheerful," and "vigorous" feelings was observed.
CONCLUSIONS: Indirect contact with nature enhances the physiological and 
psychological conditions of the elderly. Findings can be used to guide the new 
design, renewal, and modification of the living environments of the elderly and 
those who are unable to get outside.

DOI: 10.1177/19375867211006654
PMID: 33827295 [Indexed for MEDLINE]


3583. JMIR Public Health Surveill. 2021 May 13;7(5):e26073. doi: 10.2196/26073.

Protective Behaviors and Secondary Harms Resulting From Nonpharmaceutical 
Interventions During the COVID-19 Epidemic in South Africa: Multisite, 
Prospective Longitudinal Study.

Harling G(1)(2)(3)(4)(5)(6), Gómez-Olivé FX(3)(7), Tlouyamma J(8)(9), Mutevedzi 
T(10), Kabudula CW(3), Mahlako R(8), Singh U(1), Ohene-Kwofie D(3), Buckland 
R(2), Ndagurwa P(3), Gareta D(1), Gunda R(1)(6), Mngomezulu T(1), Nxumalo S(1), 
Wong EB(1)(11), Kahn K(3)(7), Siedner MJ(1)(12), Maimela E(8)(13), Tollman 
S(3)(7), Collinson M(3)(10), Herbst K(1)(10).

Author information:
(1)Africa Health Research Institute, KwaZulu-Natal, South Africa.
(2)Institute for Global Health, University College London, London, United 
Kingdom.
(3)Medical Research Council/Wits Rural Public Health and Health Transitions 
Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, 
University of the Witwatersrand, Johannesburg, South Africa.
(4)Department of Epidemiology, Harvard T.H. Chan School of Public Health, 
Harvard University, Boston, MA, United States.
(5)Center for Population and Development Studies, Harvard T.H. Chan School of 
Public Health, Harvard University, Boston, MA, United States.
(6)School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 
South Africa.
(7)International Network for the Demographic Evaluation of Populations and Their 
Health Network, Accra, Ghana.
(8)Dikgale-Mamabolo-Mothiba Population Health Research Centre, School of Health 
Care Sciences, Faculty of Health Sciences, University of Limpopo, Mankweng, 
South Africa.
(9)Department of Computer Science, School of Mathematical and Computer Sciences, 
Faculty of Science and Agriculture, University of Limpopo, Mankweng, South 
Africa.
(10)Department of Science and Innovation-Medical Research Council South African 
Population Research Infrastructure Network, Johannesburg, South Africa.
(11)Division of Infectious Diseases, University of Alabama, Birmingham, 
Birmingham, AL, United States.
(12)Harvard Medical School and the Medical Practice Evaluation Center, 
Massachusetts General Hospital, Boston, MA, United States.
(13)Department of Public Health, School of Health Care Sciences, Faculty of 
Health Sciences, University of Limpopo, Mankweng, South Africa.

Update of
    medRxiv. 2020 Nov 15;:

BACKGROUND: In March 2020, South Africa implemented strict nonpharmaceutical 
interventions (NPIs) to contain the spread of COVID-19. Over the subsequent 5 
months, NPI policies were eased in stages according to a national strategy. 
COVID-19 spread throughout the country heterogeneously; the disease reached 
rural areas by July and case numbers peaked from July to August. A second 
COVID-19 wave began in late 2020. Data on the impact of NPI policies on social 
and economic well-being and access to health care are limited.
OBJECTIVE: We aimed to determine how rural residents in three South African 
provinces changed their behaviors during the first COVID-19 epidemic wave.
METHODS: The South African Population Research Infrastructure Network nodes in 
the Mpumalanga (Agincourt), KwaZulu-Natal, (Africa Health Research Institute) 
and Limpopo (Dikgale-Mamabolo-Mothiba) provinces conducted up to 14 rounds of 
longitudinal telephone surveys among randomly sampled households from rural and 
periurban surveillance populations every 2-3 weeks. Interviews included 
questions on the following topics: COVID-19-related knowledge and behaviors, the 
health and economic impacts of NPIs, and mental health. We analyzed how 
responses varied based on NPI stringency and household sociodemographics.
RESULTS: In total, 5120 households completed 23,095 interviews between April and 
December 2020. Respondents' self-reported satisfaction with their 
COVID-19-related knowledge and face mask use rapidly rose to 85% and 95%, 
respectively, by August. As selected NPIs were eased, the amount of travel 
increased, economic losses were reduced, and the prevalence of anxiety and 
depression symptoms fell. When the number of COVID-19 cases spiked at one node 
in July, the amount of travel dropped rapidly and the rate of missed daily 
medications doubled. Households where more adults received government-funded 
old-age pensions reported concerns about economic matters and medication access 
less often.
CONCLUSIONS: South Africans complied with stringent, COVID-19-related NPIs 
despite the threat of substantial social, economic, and health repercussions. 
Government-supported social welfare programs appeared to buffer interruptions in 
income and health care access during local outbreaks. Epidemic control policies 
must be balanced against the broader well-being of people in resource-limited 
settings and designed with parallel support systems when such policies threaten 
peoples' income and access to basic services.

©Guy Harling, Francesc Xavier Gómez-Olivé, Joseph Tlouyamma, Tinofa Mutevedzi, 
Chodziwadziwa Whiteson Kabudula, Ruth Mahlako, Urisha Singh, Daniel 
Ohene-Kwofie, Rose Buckland, Pedzisai Ndagurwa, Dickman Gareta, Resign Gunda, 
Thobeka Mngomezulu, Siyabonga Nxumalo, Emily B Wong, Kathleen Kahn, Mark J 
Siedner, Eric Maimela, Stephen Tollman, Mark Collinson, Kobus Herbst. Originally 
published in JMIR Public Health and Surveillance 
(https://publichealth.jmir.org), 13.05.2021.

DOI: 10.2196/26073
PMCID: PMC8121138
PMID: 33827046 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


3584. PLoS One. 2021 Apr 7;16(4):e0249768. doi: 10.1371/journal.pone.0249768. 
eCollection 2021.

Experiences, impacts and mental health functioning during a COVID-19 outbreak 
and lockdown: Data from a diverse New York City sample of college students.

López-Castro T(1), Brandt L(2), Anthonipillai NJ(1), Espinosa A(1), Melara R(1).

Author information:
(1)Psychology Department, The City College of New York, New York, New York, 
United States of America.
(2)Division on Substance Use Disorders, New York State Psychiatric Institute and 
Department of Psychiatry, Columbia University Medical Center, New York, New 
York, United States of America.

In March 2020, New York City (NYC) experienced an outbreak of coronavirus 
disease 2019 (COVID-19) which resulted in a 78-day mass confinement of all 
residents other than essential workers. The aims of the current study were to 
(1) document the breadth of COVID-19 experiences and their impacts on college 
students of a minority-serving academic institution in NYC; (2) explore 
associations between patterns of COVID-19 experiences and psychosocial 
functioning during the prolonged lockdown, and (3) explore sex and racial/ethnic 
differences in COVID-19-related experiences and mental health correlates. A 
total of 909 ethnically and racially diverse students completed an online survey 
in May 2020. Findings highlight significant impediments to multiple areas of 
students' daily life during this period (i.e., home life, work life, social 
environment, and emotional and physical health) and a vast majority reported 
heightened symptoms of depression and generalized anxiety. These life 
disruptions were significantly related to poorer mental health. Moreover, those 
who reported the loss of a close friend or loved one from COVID-19 (17%) 
experienced significantly more psychological distress than counterparts with 
other types of infection-related histories. Nonetheless, the majority (96%) 
reported at least one positive experience since the pandemic began. Our findings 
add to a growing understanding of COVID-19 impacts on psychological health and 
contribute the important perspective of the North American epicenter of the 
pandemic during the time frame of this investigation. We discuss how the results 
may inform best practices to support students' well-being and serve as a 
benchmark for future studies of US student populations facing COVID-19 and its 
aftermath.

DOI: 10.1371/journal.pone.0249768
PMCID: PMC8026074
PMID: 33826654 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


3585. JAMA Netw Open. 2021 Apr 1;4(4):e217373. doi: 10.1001/jamanetworkopen.2021.7373.

Association of Human Mobility Restrictions and Race/Ethnicity-Based, Sex-Based, 
and Income-Based Factors With Inequities in Well-being During the COVID-19 
Pandemic in the United States.

Chakrabarti S(1), Hamlet LC(2), Kaminsky J(2), Subramanian SV(3).

Author information:
(1)Department of Global Health, University of Washington Schools of Public 
Health and Medicine, Seattle.
(2)Department of Civil and Environmental Engineering, University of Washington 
College of Engineering, Seattle.
(3)Harvard Center for Population and Development Studies, Department of Social 
and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, 
Massachusetts.

IMPORTANCE: An accurate understanding of the distributional implications of 
public health policies is critical for ensuring equitable responses to the 
COVID-19 pandemic and future public health threats.
OBJECTIVE: To identify and quantify the association of race/ethnicity-based, 
sex-based, and income-based inequities of state-specific lockdowns with 6 
well-being dimensions in the United States.
DESIGN, SETTING, AND PARTICIPANTS: This pooled, repeated cross-sectional study 
used data from 14 187 762 households who participated in phase 1 of the 
population-representative US 2020 Household Pulse Survey (HPS). Households were 
invited to participate by email, text message, and/or telephone as many as 3 
times. Data were collected via an online questionnaire from April 23 to July 21, 
2020, and participants lived in all 50 US states and the District of Columbia.
EXPOSURES: Indicators of race/ethnicity, sex, and income and their 
intersections.
MAIN OUTCOMES AND MEASURES: Unemployment; food insufficiency; mental health 
problems; no medical care received for health problems; default on last month's 
rent or mortgage; and class cancellations with no distance learning. 
Race/ethnicity, sex, income, and their intersections were used to measure 
distributional implications across historically marginalized populations; 
state-specific, time-varying population mobility was used to measure lockdown 
intensity. Logistic regression models with pooled repeated cross-sections were 
used to estimate risk of dichotomous outcomes by social group, adjusted for 
confounding variables.
RESULTS: The 1 088 314 respondents (561 570 [51.6%; 95% CI, 51.4%-51.9%] women) 
were aged 18 to 88 years (mean [SD], 51.55 [15.74] years), and 826 039 (62.8%; 
95% CI, 62.5%-63.1%) were non-Hispanic White individuals; 86 958 (12.5%; 95% CI, 
12.4%-12.7%), African American individuals; 86 062 (15.2%; 95% CI, 15.0%-15.4%), 
Hispanic individuals; and 50 227 (5.6%; 95% CI, 5.5%-5.7%), Asian individuals. 
On average, every 10% reduction in mobility was associated with higher odds of 
unemployment (odds ratio [OR], 1.3; 95% CI, 1.2-1.4), food insufficiency (OR, 
1.1; 95% CI, 1.1-1.2), mental health problems (OR, 1.04; 95% CI, 1.0-1.1), and 
class cancellations (OR, 1.1; 95% CI, 1.1-1.2). Across most dimensions compared 
with White men with high income, African American individuals with low income 
experienced the highest risks (eg, food insufficiency, men: OR, 3.3; 95% CI, 
2.8-3.7; mental health problems, women: OR, 1.9; 95% CI, 1.8-2.1; medical care 
inaccessibility, women: OR, 1.7; 95% CI, 1.6-1.9; unemployment, men: OR, 2.8; 
95% CI, 2.5-3.2; rent/mortgage defaults, men: OR, 5.7; 95% CI, 4.7-7.1). Other 
high-risk groups were Hispanic individuals (eg, unemployment, Hispanic men with 
low income: OR, 2.9; 95% CI, 2.5-3.4) and women with low income across all 
races/ethnicities (eg, medical care inaccessibility, non-Hispanic White women: 
OR, 1.8; 95% CI, 1.7-2.0).
CONCLUSIONS AND RELEVANCE: In this cross-sectional study, African American and 
Hispanic individuals, women, and households with low income had higher odds of 
experiencing adverse outcomes associated with the COVID-19 pandemic and 
stay-at-home orders. Blanket public health policies ignoring existing 
distributions of risk to well-being may be associated with increased 
race/ethnicity-based, sex-based, and income-based inequities.

DOI: 10.1001/jamanetworkopen.2021.7373
PMCID: PMC8027913
PMID: 33825836 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest Disclosures: None reported.


3586. Health Soc Care Community. 2022 Jan;30(1):114-123. doi: 10.1111/hsc.13378. Epub 
2021 Apr 6.

Music-making in the community with people living with dementia and care-partners 
- 'I'm leaving feeling on top of the world'.

Smith SK(1), Innes A(1), Bushell S(1).

Author information:
(1)Salford Institute for Dementia and Ageing, School of Health & Society, 
University of Salford, Manchester, UK.

Evidence exists relating to music-based initiatives and positive health outcomes 
for people living with dementia who can access them. Yet, knowledge about the 
impact of 'music-making' on the well-being of community-dwelling people with 
dementia is limited. Much of the existing evidence about the benefits of music 
is focused on care home settings where initiatives can be readily applied as 
part of a weekly schedule of activities. Therefore, this initiative aimed to 
provide opportunities to participate in music-making, to increase social 
interaction and ultimately well-being in a community environment. Ten 
music-making session were scheduled for community-dwelling people living with 
dementia and care-partners, once a month between September 2019 and March 2020. 
Three sessions did not take place due to Covid19. Eighteen participants 
consented to take part including seven people living with dementia, five 
care-partners and six former care-partners. Baseline semi-structured interviews 
explored the lived experience of music and expectations of the upcoming 
music-making cafes. Self-report questionnaires captured 'in the moment' 
experiences of each music-making cafe. Follow-up semi-structured interviews 
explored the impact of music-making on participants' self-reported well-being. 
Interviews were transcribed verbatim and analysed thematically. The findings 
demonstrate that participating in the music-making café benefitted the 
self-reported well-being of participants in three ways: first, a sense of 
camaraderie that enabled the facilitation of connections with others; second, 
creating opportunities to 'level the playing field' by always assuming a 
person's strengths and abilities; and third, group participation in music-making 
meets a need for meaningful musical experiences. We conclude that participating 
in music-making is a powerful medium to promote well-being for 
community-dwelling people living with dementia and care-partners.

© 2021 The Authors. Health and Social Care in the Community published by John 
Wiley & Sons Ltd.

DOI: 10.1111/hsc.13378
PMID: 33825264 [Indexed for MEDLINE]


3587. Global Health. 2021 Apr 6;17(1):39. doi: 10.1186/s12992-021-00680-w.

Impact of the COVID-19 pandemic on psychological well-being of students in an 
Italian university: a web-based cross-sectional survey.

Villani L(#)(1), Pastorino R(#)(2), Molinari E(3)(4), Anelli F(5), Ricciardi 
W(6)(2), Graffigna G(3)(4), Boccia S(6)(2).

Author information:
(1)Section of Hygiene, University Department of Life Sciences and Public Health 
-Università Cattolica del Sacro Cuore, Rome, Italy. leonardovillani92@gmail.com.
(2)Department of Woman and Child Health and Public Health - Public Health Area, 
Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
(3)Dipartimento di Psicologia, Università Cattolica del Sacro Cuore, Milan, 
Italy.
(4)EngageMinds HUB - Consumer, Food & Health Engagement Research Center, 
Università Cattolica del Sacro Cuore, Cremona, Italy.
(5)Università Cattolica del Sacro Cuore, Milan, Italy.
(6)Section of Hygiene, University Department of Life Sciences and Public Health 
-Università Cattolica del Sacro Cuore, Rome, Italy.
(#)Contributed equally

BACKGROUND: Italy was the first European country to implement a national 
lockdown because of the COVID-19 pandemic. Worldwide, this pandemic had a huge 
impact on the mental health of people in many countries causing similar reaction 
in terms of emotions and concerns at the population level. Our study 
investigated the impact of the COVID-19 pandemic on psychological well-being in 
a cohort of Italian university students.
METHODS: We conducted a cross-sectional survey in the period immediately after 
the first lockdown through the administration of a questionnaire on the personal 
websites of students attending their undergraduate courses at the Università 
Cattolica del Sacro Cuore. We used the Patient-Health-Engagement-Scale, 
Self-Rating-Anxiety-Scale, and Self-Rating-Depression-Scale to assess 
engagement, anxiety symptoms, and depression symptoms of our sample.
RESULTS: The sample size was 501 subjects, of which 35.33% were classified as 
anxious and 72.93% as depressed. Over 90% of respondents had good understanding 
of the preventive measures despite over 70% suffered from the impossibility of 
physically seeing friends and partners. Around 55% of students would have been 
willing to contribute much more to face the pandemic. An increase in the 
occurrences of anxiety was associated with being female, being student of the 
Rome campus, suffering from the impossibility of attending university, being 
distant from colleagues, and being unable of physically seeing one's partner. 
Performing physical activity reduced this likelihood.
CONCLUSION: University students are at risk of psychological distress in the 
case of traumatic events. The evolution of the pandemic is uncertain and may 
have long-term effects on mental health. Therefore, it is crucial to study the 
most effective interventions to identify vulnerable subgroups and to plan for 
acute and long-term psychological services to control and reduce the burden of 
psychological problems.

DOI: 10.1186/s12992-021-00680-w
PMCID: PMC8022300
PMID: 33823897 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3588. Int J Equity Health. 2021 Apr 6;20(1):91. doi: 10.1186/s12939-021-01435-0.

Gender-based disparities on health indices during COVID-19 crisis: a nationwide 
cross-sectional study in Jordan.

Abufaraj M(1)(2), Eyadat Z(3), Al-Sabbagh MQ(4), Nimer A(4), Moonesar IA(5), 
Yang L(6)(7)(8), Al Khatib W(3), Al-Qutob R(9).

Author information:
(1)Division of Urology, Department of Special Surgery, Jordan University 
Hospital, The University of Jordan, Amman, 11942, Jordan. mabufaraj@ju.ediu.jo.
(2)Department of Urology, the Medical University of Vienna, Vienna, Austria. 
mabufaraj@ju.ediu.jo.
(3)Center of strategic studies, the University of Jordan, Amman, Jordan.
(4)School of Medicine, The University of Jordan, Amman, Jordan.
(5)Health Administration & Policy, Mohammed Bin Rashid School of Government, 
Dubai, United Arab Emirates.
(6)Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta 
Health Services, Calgary, Canada.
(7)Department of Community Health Sciences, Cumming School of Medicine, 
University of Calgary, Calgary, Alberta, Canada.
(8)Department of Epidemiology, Center for Public Health, Medical University of 
Vienna, Vienna, Austria.
(9)Department of Family and Community Medicine, Faculty of medicine, The 
University of Jordan, Amman, Jordan.

BACKGROUND: COVID-19 has an inevitable burden on public health, potentially 
widening the gender gap in healthcare and the economy. We aimed to assess 
gender-based desparities during COVID-19 in Jordan in terms of health indices, 
mental well-being and economic burden.
METHODS: A nationally representative sample of 1300 participants ≥18 years 
living in Jordan were selected using stratified random sampling. Data were 
collected via telephone interviews in this cross-sectional study. Chi-square was 
used to test age and gender differences according to demographics, economic 
burden, and health indices (access to healthcare, health insurance, antenatal 
and reproductive services). A multivariable logistic regression analysis was 
used to estimate the beta-coefficient (β) and 95% confidence interval (CI) of 
factors correlated with mental well-being, assessed by patients' health 
questionnaire 4 (PHQ-4).
RESULTS: 656 (50.5%) men and 644 (49.5%) women completed the interview. 
Three-fourths of the participants had health insurance during the COVID-19 
crisis. There was no significant difference in healthcare coverage or access 
between women and men (p > 0.05). Half of pregnant women were unable to access 
antenatal care. Gender was a significant predictor of higher PHQ-4 scores (women 
vs. men: β: 0.88, 95% CI: 0.54-1.22). Among women, age ≥ 60 years and being 
married were associated with significantly lower PHQ-4 scores. Only 0.38% of the 
overall participants lost their jobs; however, 8.3% reported a reduced payment. 
More women (13.89%) were not paid during the crisis as compared with men (6.92%) 
(P = 0.01).
CONCLUSIONS: Our results showed no gender differences in healthcare coverage or 
access during the COVID-19 crisis generally. Women in Jordan are experiencing 
worse outcomes in terms of mental well-being and economic burden. Policymakers 
should give priority to women's mental health and antenatal and reproductive 
services. Financial security should be addressed in all Jordanian COVID-19 
national plans because the crisis appears widening the gender gap in the 
economy.

DOI: 10.1186/s12939-021-01435-0
PMCID: PMC8022313
PMID: 33823852 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3589. RETRACTED ARTICLE

Transl Behav Med. 2021 Oct 23;11(10):1947-1956. doi: 10.1093/tbm/ibab030.

Trends in mental health symptoms, service use, and unmet need for services among 
U.S. adults through the first 9 months of the COVID-19 pandemic.

Coley RL(1), Baum CF(2).

Author information:
(1)Department of Counseling, Developmental, and Educational Psychology, Boston 
College, Chestnut Hill, MA, USA.
(2)Department of Economics and School of Social Work, Boston College, Chestnut 
Hill, MA, USA.

Retraction in
    Transl Behav Med. 2022 Jul 18;12(7):782.

Expression of concern in
    Transl Behav Med. 2021 Jun 11;:
    Transl Behav Med. 2022 Jul 18;12(7):781.

Corrected and republished in
    Transl Behav Med. 2022 Feb 16;12(2):273-283.

The COVID-19 pandemic has led to rising morbidity, mortality, and social and 
economic disruption, likely impairing mental health. The purpose of this study 
was to track trends in mental health symptoms, use of services, and unmet need 
for services among U.S. adults and to delineate variation across demographic 
strata. Data were drawn from the 2020 U.S. Household Pulse Survey from repeated 
cross-sectional online surveys collected between April 23 and November 23, 2020 
from 1,483,378 US adults, weighted to represent the U.S. population. Survey 
respondents self-reported their symptoms of anxiety and depression, use of 
medication, counseling services, and unmet need for services. Reports of 
probable anxiety and depression rose significantly through the study period, to 
prevalence rates of 50% and 44%, respectively, by November 2020, rates six times 
higher than early 2019 U.S. norms. Use of prescription medication, counseling 
services, and unmet need for mental health services also rose significantly. 
Prevalence rates of probable mental health disorders were highest among young, 
less educated, single, female, Black and Hispanic respondents, with age and 
education disparities growing over cohorts. Young, female, and moderately 
educated respondents also reported higher unmet needs for services. Disparities 
in estimates of mental health disorders and mental health treatment indicate a 
striking disequilibrium between the potential need for and the use of mental 
health services during the COVID-19 pandemic. Rising mental health challenges 
are being borne largely by young, less advantaged people of color and women, 
with the potential for expanded interruptions to optimal functioning and 
societal recovery from COVID-19.

Plain Language Summary: The myriad stressors imposed by the COVID-19 pandemic 
have impaired mental health and well-being. Although evidence from early in the 
pandemic revealed elevated rates of mental health conditions, research has not 
documented whether psychological disorders have continued to rise as the 
pandemic has persisted. In this research, we assess data from nearly 1.5 million 
U.S. adults who participated in cross-sectional surveys each week from April 
through November 2020 to track trends in mental health disorder symptoms and 
services. Our results show that reports of anxiety and depression rose 
significantly from April to November 2020 to rates six times higher than in 
2019. We also found evidence of growing unmet need for mental health services. 
Rising mental health challenges are being borne largely by young, less 
advantaged people of color and women. Growing disparities in mental health 
disorders and treatment raise concerns for psychological, social, and economic 
recovery from COVID-19.

© Society of Behavioral Medicine 2021. All rights reserved. For permissions, 
please e-mail: journals.permissions@oup.com.

DOI: 10.1093/tbm/ibab030
PMCID: PMC8139151
PMID: 33823047 [Indexed for MEDLINE]


3590. Psychiatr Q. 2021 Dec;92(4):1393-1411. doi: 10.1007/s11126-021-09912-z. Epub 
2021 Apr 5.

Mental Health and Quality & Safety of Care in Czech Residential Institutions 
during the COVID-19 Pandemic: A Mixed-Methods Study.

Guerrero Z(#)(1), Aliev AA(#)(2), Kondrátová L(1), Jozefiaková B(1)(3), 
Nesázalová N(1), Saňáková JG(1), Winkler P(1)(4).

Author information:
(1)Department of Public Mental Health, National Institute of Mental Health, 
Topolová 748, 250 67, Klecany, Czech Republic.
(2)Department of Public Mental Health, National Institute of Mental Health, 
Topolová 748, 250 67, Klecany, Czech Republic. Akmal.aliev@hotmail.com.
(3)Social Health Institute, Palacky University, Univerzitní 22, 771 11, Olomouc, 
Czech Republic.
(4)Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College 
London, 16 De Crespigny Park, London, SE5 8AF, UK.
(#)Contributed equally

Long-stay institutions have been considerably affected by the COVID-19 pandemic. 
We aimed to assess the mental health of clients and staff as well as quality and 
safety of care in long-stay institutions during the state-of-emergency in the 
Czech Republic in response to COVID-19 pandemic. We found a high prevalence of 
poor mental health outcomes in clients (46% poor well-being, 58% depression, 45% 
anxiety) and staff (17% poor well-being, 22% depression, 14% anxiety). In 
clients, COVID-19 health-related and economic worries were associated with 
depression (1.79, 95% CI = 1.14; 2.8 and 2.28, 95% CI = 1.27; 4.08 respectively) 
and anxiety (1.63, 95% CI = 1.11; 2.4 and 1.85, 95% CI = 1.2; 2.85 respectively) 
and in staff with any mental health outcome (1.92, 95% CI = 1.33; 2.77 and 1.75, 
95% CI = 1.15; 2.66 respectively). Lack of information and communication from 
authorities, lack of protective equipment and logistic difficulties were 
reported as challenges. Delivery of care was mostly disrupted as well as 
admission and discharge processes. Other reported issues included lack of staff, 
lack of activities for patients or an increase in usage of restrictive measures. 
Best practices and key future measures were identified by each institution, a 
summary of which is presented in the article.

© 2021. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s11126-021-09912-z
PMCID: PMC8021439
PMID: 33821407 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


3591. J Psychosom Res. 2021 Jun;145:110482. doi: 10.1016/j.jpsychores.2021.110482. 
Epub 2021 Apr 1.

Subjective wellbeing in parents during the COVID-19 pandemic in Australia.

Westrupp EM(1), Stokes MA(2), Fuller-Tyszkiewicz M(2), Berkowitz TS(2), Capic 
T(2), Khor S(2), Greenwood CJ(2), Mikocka-Walus A(2), Sciberras E(3), Youssef 
GJ(2), Olsson CA(4), Hutchinson D(5).

Author information:
(1)Deakin University, Centre for Social and Early Emotional Development, School 
of Psychology, Victoria, Australia; University of Melbourne, Department of 
Paediatrics, Victoria, Australia; La Trobe University, Judith Lumley Centre, 
Victoria, Australia. Electronic address: elizabeth.westrupp@deakin.edu.au.
(2)Deakin University, Centre for Social and Early Emotional Development, School 
of Psychology, Victoria, Australia.
(3)Deakin University, Centre for Social and Early Emotional Development, School 
of Psychology, Victoria, Australia; University of Melbourne, Department of 
Paediatrics, Victoria, Australia; La Trobe University, Judith Lumley Centre, 
Victoria, Australia; Murdoch Children's Research Institute, Melbourne Royal 
Children's Hospital, Victoria, Australia.
(4)Deakin University, Centre for Social and Early Emotional Development, School 
of Psychology, Victoria, Australia; University of Melbourne, Department of 
Paediatrics, Victoria, Australia; Murdoch Children's Research Institute, 
Melbourne Royal Children's Hospital, Victoria, Australia.
(5)Deakin University, Centre for Social and Early Emotional Development, School 
of Psychology, Victoria, Australia; University of Melbourne, Department of 
Paediatrics, Victoria, Australia; Murdoch Children's Research Institute, 
Melbourne Royal Children's Hospital, Victoria, Australia; The University of New 
South Wales, The National Drug and Alcohol Research Centre, Australia.

OBJECTIVES: To examine (1) the subjective wellbeing of Australian parents 
raising children and adolescents (0-18 years) during April 2020 'stage three' 
COVID-19 restrictions, in comparison with parents assessed over 18-years prior 
to the pandemic; and (2) socio-demographic and COVID-19 predictors of subjective 
wellbeing during the pandemic.
METHODS: Cross-sectional data were from the COVID-19 Pandemic Adjustment Survey 
(CPAS, N = 2365 parents of a child 0-18 years, 8-28th April 2020); and a 
pre-pandemic national database containing 18 years of annual surveys collected 
in 2002-2019 (N = 17,529 parents).
RESULTS: Levels of subjective wellbeing during the pandemic were considerably 
lower than ratings prior to the pandemic (Personal Wellbeing Index, 
mean[SD] = 65.3 [17.0]; compared to [SD] = 75.8 [11.9], p < 0.001). During the 
pandemic, lower subjective wellbeing was associated with low education (adjusted 
regression coefficient, 95% confidence interval [95% CI] = -5.19, -0.93), 
language other-than-English (95% CI = -7.22, -1.30), government benefit (95% 
CI = -6.99, -0.96), single parents (95% CI = -8.84, -4.59), child 
neurodevelopmental condition (95% CI = -3.44, -0.76), parent physical/mental 
health problems (95% CI = -3.23, -0.67), COVID-environmental stressors (95% 
CI = -3.48, -2.44), and fear/worry about COVID-19 (95% CI = -8.13, -5.96). 
Unexpectedly, parent engagement with news media about the pandemic was 
associated with higher subjective wellbeing (95% CI = 0.35, 1.61).
CONCLUSION: Subjective wellbeing in parents raising children aged 0-18 years 
appears to be disproportionately impacted by the COVID-19 pandemic and 
restrictions in Australia. Specific at-risk groups, for which government 
intervention may be warranted, include parents in socially disadvantaged 
contexts, parents with pre-existing mental health difficulties, and parents 
facing significant COVID-19-related work changes.

Copyright © 2021. Published by Elsevier Inc.

DOI: 10.1016/j.jpsychores.2021.110482
PMCID: PMC9750621
PMID: 33820645 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest All authors 
have completed the Unified Competing Interest form at 
http://www.icmje.org/coi_disclosure.pdf and declare that the authors have no 
competing interests to report.


3592. Int Emerg Nurs. 2021 May;56:100996. doi: 10.1016/j.ienj.2021.100996. Epub 2021 
Mar 9.

Impact of COVID-19 on paramedicine students: A mixed methods study.

Brett Williams(1), King C(2), Shannon B(2), Gosling C(2).

Author information:
(1)Department of Paramedicine, Monash University, VIC, Australia. Electronic 
address: brett.williams@monash.edu.
(2)Department of Paramedicine, Monash University, VIC, Australia.

BACKGROUND: Viral epidemics have negative and sometimes extreme impacts on 
psychological well-being, particularly in health care workers. Studies have 
reported higher levels of depression, anxiety, insomnia, stress, distress, fear, 
burnout, and post-traumatic symptoms.
OBJECTIVE: This research aimed to explore the psychological impacts of COVID 19 
on paramedicine students.
METHODS: A convergent mixed method design study was undertaken using 
self-reporting instruments and qualitative interviews.
RESULTS: Responses were received from 151 students (38.3% responses rate). Most 
students experienced some level of anxiety (62%), although severe levels were 
only reported by 6% of respondents. Students had significantly greater odds 
(OR = 2.05, p = 0.045, 95% CI: 1.02, 4.12) of higher anxiety levels if they were 
female. Thematic analysis of the interviews largely supported these results, 
with themes focused on changing approaches to study, financial situation, social 
support, University adaptation, acceptance and career pathway choice.
CONCLUSIONS: This study identified and explored the anxiety and coping 
strategies in an undergraduate paramedicine cohort when faced with a viral 
epidemic. Although most of the responding paramedic students reported above 
normal levels of anxiety in the initial stages of the COVID-19 outbreak, many 
students, with the help of learning, financial and social support, and a range 
of positive coping strategies, have adapted well to the impact of the pandemic 
and associated lockdown period.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.ienj.2021.100996
PMCID: PMC8577810
PMID: 33819846 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no potential conflicts of 
interest concerning the research, authorship, and/or publication of this 
article.


3593. J Med Internet Res. 2021 Apr 30;23(4):e27341. doi: 10.2196/27341.

Emotions of COVID-19: Content Analysis of Self-Reported Information Using 
Artificial Intelligence.

Adikari A(#)(1), Nawaratne R(#)(1), De Silva D(#)(1), Ranasinghe S(#)(1), 
Alahakoon O(#)(2), Alahakoon D(#)(1).

Author information:
(1)Research Centre for Data Analytics and Cognition, La Trobe University, 
Melbourne, Australia.
(2)College of Engineering and Science, Victoria University, Melbourne, 
Australia.
(#)Contributed equally

BACKGROUND: The COVID-19 pandemic has disrupted human societies around the 
world. This public health emergency was followed by a significant loss of human 
life; the ensuing social restrictions led to loss of employment, lack of 
interactions, and burgeoning psychological distress. As physical distancing 
regulations were introduced to manage outbreaks, individuals, groups, and 
communities engaged extensively on social media to express their thoughts and 
emotions. This internet-mediated communication of self-reported information 
encapsulates the emotional health and mental well-being of all individuals 
impacted by the pandemic.
OBJECTIVE: This research aims to investigate the human emotions related to the 
COVID-19 pandemic expressed on social media over time, using an artificial 
intelligence (AI) framework.
METHODS: Our study explores emotion classifications, intensities, transitions, 
and profiles, as well as alignment to key themes and topics, across the four 
stages of the pandemic: declaration of a global health crisis (ie, prepandemic), 
the first lockdown, easing of restrictions, and the second lockdown. This study 
employs an AI framework comprised of natural language processing, word 
embeddings, Markov models, and the growing self-organizing map algorithm, which 
are collectively used to investigate social media conversations. The 
investigation was carried out using 73,000 public Twitter conversations posted 
by users in Australia from January to September 2020.
RESULTS: The outcomes of this study enabled us to analyze and visualize 
different emotions and related concerns that were expressed and reflected on 
social media during the COVID-19 pandemic, which could be used to gain insights 
into citizens' mental health. First, the topic analysis showed the diverse as 
well as common concerns people had expressed during the four stages of the 
pandemic. It was noted that personal-level concerns expressed on social media 
had escalated to broader concerns over time. Second, the emotion intensity and 
emotion state transitions showed that fear and sadness emotions were more 
prominently expressed at first; however, emotions transitioned into anger and 
disgust over time. Negative emotions, except for sadness, were significantly 
higher (P<.05) in the second lockdown, showing increased frustration. Temporal 
emotion analysis was conducted by modeling the emotion state changes across the 
four stages of the pandemic, which demonstrated how different emotions emerged 
and shifted over time. Third, the concerns expressed by social media users were 
categorized into profiles, where differences could be seen between the first and 
second lockdown profiles.
CONCLUSIONS: This study showed that the diverse emotions and concerns that were 
expressed and recorded on social media during the COVID-19 pandemic reflected 
the mental health of the general public. While this study established the use of 
social media to discover informed insights during a time when physical 
communication was impossible, the outcomes could also contribute toward 
postpandemic recovery and understanding psychological impact via emotion 
changes, and they could potentially inform health care decision making. This 
study exploited AI and social media to enhance our understanding of human 
behaviors in global emergencies, which could lead to improved planning and 
policy making for future crises.

©Achini Adikari, Rashmika Nawaratne, Daswin De Silva, Sajani Ranasinghe, Oshadi 
Alahakoon, Damminda Alahakoon. Originally published in the Journal of Medical 
Internet Research (https://www.jmir.org), 30.04.2021.

DOI: 10.2196/27341
PMCID: PMC8092030
PMID: 33819167 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


3594. Omega (Westport). 2023 Mar;86(4):1176-1189. doi: 10.1177/00302228211000952. Epub 
2021 Apr 4.

Psychological Consequences of the Delay in the Silent Mentor Programme During 
the COVID-19 Pandemic: Perspectives From Family Members of Silent Mentors.

Wong LP(1)(2), Tan SL(2)(3), Alias H(1)(2), Sia TE(2), Saw A(2)(3).

Author information:
(1)Center for Epidemiology and Evidence-Based Practice, Department of Social and 
Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, 
Malaysia.
(2)Unit of Silent Mentor Program, Faculty of Medicine, University of Malaya, 
Kuala Lumpur, Malaysia.
(3)National Orthopaedic Center of Excellence for Research & Learning (NOCERAL), 
Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, 
50603 Kuala Lumpur, Malaysia.

The COVID-19 pandemic has put a hold on the Silent Mentor Programme (SMP); this 
pause has not only caused unprecedented challenges for the delivery of medical 
education but has forced changes in the programme ceremony sessions. We aimed to 
describe the psychological impact and experiences of family members of silent 
mentors during the COVID-19 pandemic using qualitative interviews. Many 
expressed feelings of remorse and unrest about the unprecedented delay of the 
SMP. The delay increased negative emotions particularly among some elderly 
family members; however, there was no prominent negative effect on their 
functional health and well-being. Several participants relayed the belief that 
the soul cannot rest until the body receives a proper burial while some worried 
about the deterioration of the physical condition of the mentors. In conclusion, 
findings provide insights into the importance of not overlooking the mental 
health implications of delaying the SMP in future outbreaks or crises.

DOI: 10.1177/00302228211000952
PMID: 33818157 [Indexed for MEDLINE]


3595. Front Public Health. 2021 Mar 19;9:628341. doi: 10.3389/fpubh.2021.628341. 
eCollection 2021.

Psychological Stress Risk Factors, Concerns and Mental Health Support Among 
Health Care Workers in Vietnam During the Coronavirus Disease 2019 (COVID-19) 
Outbreak.

Nguyen PTL(1), Nguyen TBL(2), Pham AG(3), Duong KNC(4)(5)(6), Gloria MAJ(4)(7), 
Vo TV(2)(8), Vo BV(9), Phung TL(4)(10).

Author information:
(1)Social Economics and Administrative Pharmacy Program, Department of Pharmacy, 
Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
(2)Institute of Orthopaedics and Trauma Surgery, Viet Duc Hospital, Hanoi, 
Vietnam.
(3)Oncology Department, Viet Duc Hospital, Hanoi, Vietnam.
(4)Mahidol University Health Technology Assessment Graduate Program, Mahidol 
University, Bangkok, Thailand.
(5)School of Medicine, Vietnam National University, Ho Chi Minh City, Vietnam.
(6)Vietnam National University, Ho Chi Minh City, Vietnam.
(7)Department of Pharmacy, College of Pharmacy, University of the Philippines 
Manila, Manila, The Philippines.
(8)Department of Surgery, Hanoi Medical University, Hanoi, Vietnam.
(9)Department of Pharmacy, Thong Nhat Hospital, Ho Chi Minh City, Vietnam.
(10)Health Strategy and Policy Institute, Ministry of Health, Hanoi, Vietnam.

Introduction: Coronavirus disease 2019 (COVID-19) has significantly affected 
health care workers (HCWs), including their mental health. However, there has 
been limited evidence on this topic in the Vietnamese context. Therefore, this 
study aimed to explore COVID-19-related, psychological stress risk factors among 
HCWs, their concerns and demands for mental health support during the pandemic 
period. Methods: We employed a cross-sectional study design with convenience 
sampling. An online, self-administered questionnaire was used and distributed 
through social media among medical and non-medical HCWs from April 22 to May 12, 
2020. HCWs were categorized either as frontline or non-frontline. We measured 
the prevalence of psychological stress using the Impact of Event Scale-Revised 
(IES-R) instrument. Multivariate binary logistic regression analysis was 
performed to identify risk factors associated with psychological stress among 
HCWs. Results: Among the 774 enrolled participants, 761 (98.3%) eligible 
subjects were included in the analysis. Most respondents were females (58.2%), 
between 31 and 40 years of age (37.1%), lived in areas where confirmed COVID-19 
cases had been reported (61.9%), medical HCWs (59.9%) and practiced being at the 
frontline (46.3%). The prevalence of stress was 34.3%. We identified significant 
risk factors such as being frontline HCWs (odds ratio [OR] = 1.77 [95% 
confidence interval [CI]: 1.17-2.67]), perceiving worse well-being as compared 
to those before the COVID-19 outbreak [OR = 4.06 (95% CI: 2.15-7.67)], and 
experiencing chronic diseases [OR = 1.67 (95% CI: (1.01-2.77)]. Majority (73.9%) 
were concerned about testing positive for COVID-19 and exposing the infection to 
their families. Web-based psychological interventions that could provide 
knowledge on managing mental distress and consulting services were highly 
demanded among HCWs. Conclusion: The prevalence of psychological stress among 
HCWs in Vietnam during the COVID-19 pandemic was high. There were also 
significant risk factors associated with it. Psychological interventions 
involving web-based consulting services are highly recommended to provide mental 
health support among HCWs.

Copyright © 2021 Nguyen, Nguyen, Pham, Duong, Gloria, Vo, Vo and Phung.

DOI: 10.3389/fpubh.2021.628341
PMCID: PMC8017279
PMID: 33816419 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


3596. Midwifery. 2021 Jul;98:102996. doi: 10.1016/j.midw.2021.102996. Epub 2021 Mar 
21.

Becoming a mother in the 'new' social world in Australia during the first wave 
of the COVID-19 pandemic.

Sweet L(1), Bradfield Z(2), Vasilevski V(3), Wynter K(3), Hauck Y(2), Kuliukas 
L(4), Homer CSE(5), Szabo RA(6), Wilson AN(5).

Author information:
(1)School of Nursing and Midwifery, Deakin University, Victoria, Australia; 
Centre for Quality and Patient Safety Research, Western Health Partnership, 
Victoria, Australia. Electronic address: l.sweet@deakin.edu.au.
(2)School of Nursing, Midwifery and Paramedicine, Curtin University, Western 
Australia, Australia; Department of Nursing, Midwifery Education and Research, 
King Edward Memorial Hospital, Western Australia, Australia.
(3)School of Nursing and Midwifery, Deakin University, Victoria, Australia; 
Centre for Quality and Patient Safety Research, Western Health Partnership, 
Victoria, Australia.
(4)School of Nursing, Midwifery and Paramedicine, Curtin University, Western 
Australia, Australia.
(5)Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, 
Australia.
(6)Gandel Simulation Service, Royal Women's Hospital in partnership with The 
University of Melbourne, Melbourne, Victoria, Australia; Melbourne Medical 
School, The University of Melbourne, Melbourne, Australia.

BACKGROUND: Substantial public health measures occurred in Australian society 
during the COVID-19 pandemic to reduce the risk of community transmission. 
Little was known about the impact of these changes on childbearing women.
AIM: To describe childbearing women's experiences of becoming a mother during 
the COVID-19 pandemic in Australia.
METHODS: A qualitative exploratory design using semi-structured interviews was 
used. Women were recruited through social media and self-nominated to 
participate in an interview. Maximum variation sampling was used. A total of 27 
interviews were conducted with women across Australia. Data were analysed 
thematically.
FINDINGS: The thematic analysis resulted in four primary themes and ten 
sub-themes. The themes were 'going it alone - having a baby was an isolating 
experience' ('receiving maternity care alone', 'dealing with government 
restrictions', and 'desiring social support'), 'advocating for self or others' 
('seeking reliable information', 'valuing peersupport', and 'having to be 
resourceful'), 'finding a way through' ('a changed experience for all', 
'managing stress and anxiety', 'requiring constant adjustments', and 'managing 
fear mongering'), and 'keeping safe'.
CONCLUSION: Becoming a mother during the COVID-19 pandemic in Australia was a 
profound experience for the women. Following the public health initiatives which 
resulted in physical distancing restrictions, isolation, and the need to provide 
and receive social and peer support were common experiences. Whilst public 
health initiatives are implemented to keep people safe, the social and emotional 
toll on childbearing women should be considered by healthcare professionals. 
Childbearing women need to be safe but also require support and reassurance.

Copyright © 2021. Published by Elsevier Ltd.

DOI: 10.1016/j.midw.2021.102996
PMCID: PMC9756084
PMID: 33813305 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest Not 
applicable.


3597. Support Care Cancer. 2021 Oct;29(10):6135-6143. doi: 10.1007/s00520-021-06165-1. 
Epub 2021 Apr 3.

Impact of COVID-19 on an established physical activity and behaviour change 
support programme for cancer survivors: An exploratory survey of the Macmillan 
Move More service for Northern Ireland.

Brown M(1), O'Connor D(2), Murphy C(3), McClean M(3), McMeekin A(3), Prue G(2).

Author information:
(1)School of Nursing and Midwifery, Queen's University Belfast, Medical Biology 
Centre, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland. m.brown@qub.ac.uk.
(2)School of Nursing and Midwifery, Queen's University Belfast, Medical Biology 
Centre, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland.
(3)Macmillan Cancer Support, Belfast, Northern Ireland.

PURPOSE: The recent coronavirus pandemic (COVID-19) has affected the delivery of 
routine cancer care and supportive services. The Macmillan Move More Northern 
Ireland (MMNI) programme provides access to physical activity and behavioural 
change support before, during and after cancer treatment. This evaluation 
details the impact of the pandemic on the MMNI participants and identifies 
methods to adapt service delivery.
METHODS: A multiple-choice and short answer online survey was sent to 730 MMNI 
participants, to investigate the impact of the initial, national COVID-19 
lockdown. Specifically, the survey examined physical activity patterns, the 
physical/emotional/social impact of restrictions and attitudes towards digitally 
supported exercise. Free text responses were analysed thematically with findings 
verified within the research team.
RESULTS: 377 participants completed the survey (52% response rate). 50% of 
respondents had breast cancer, with 36 other diagnoses registered (82% were 
female). Participants reported physical activity levels decreased during 
restrictions, citing isolation; declining health/fitness; lack of access and 
motivation. The dataset trended towards women and those diagnosed with breast 
cancer. 71% reported the pandemic impacted their physical (n=119) and/or 
psychosocial (n=231) wellbeing. Many respondents were availing of digitally 
supported exercise, whilst half of males did not engage (46%). Finally, 80% of 
respondents were interested in using a MMNI smart application.
CONCLUSION: The COVID-19 pandemic has affected participant physical activity 
levels. Supervised classes were the most popular (pre-pandemic), with enforced 
leisure centre closures prompting this reduction. The pandemic has negatively 
affected the psychosocial wellbeing (mental health) of participants, compounded 
by the restrictions imposed on the traditional delivery of MMNI. This impact is 
felt equally across cancer types. Participants with breast cancer are the most 
engaged in using digital technology to access exercise. Although 
underrepresented, men require greater targeting to ensure equality in access to 
online services.

© 2021. The Author(s).

DOI: 10.1007/s00520-021-06165-1
PMCID: PMC8019085
PMID: 33811517 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflicts 
of interest.


3598. Int J Ment Health Nurs. 2021 Aug;30(4):975-987. doi: 10.1111/inm.12852. Epub 
2021 Apr 2.

The mental health status among nurses from low-risk areas under normalized 
COVID-19 pandemic prevention and control in China: A cross-sectional study.

Chen X(1), Arber A(2), Gao J(3), Zhang L(4), Ji M(5), Wang D(6), Wu J(7), Du 
J(8).

Author information:
(1)Jiangsu Nursing Association, Nanjing, China.
(2)Faculty of Health and Medical Sciences, The University of Surrey, Guildford, 
UK.
(3)Emergency Department, The First Affiliated Hospital of Nanjing Medical 
University, Nanjing, China.
(4)Nephrology Department, Zhongda Hospital Southeast University, Nanjing, China.
(5)Department of Geriatrics, Nanjing First Hospital Nanjing Medical University, 
Nanjing, China.
(6)Oncology Department, The Affiliated Hospital of Xuzhou Medical University, 
Xuzhou, China.
(7)Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical 
University, Nanjing, China.
(8)Department of Cardiovascular Surgery, The First Affiliated Hospital of 
Nanjing Medical University, Nanjing, China.

This study aimed to investigate the mental health status of nurses from low-risk 
areas of novel coronavirus (COVID-19) pandemic, its potential impact factors, 
and the main stressors under the normalized prevention and control in China. A 
mobile phone app-based survey was conducted among registered nurses in Jiangsu 
province via a region-stratified sampling method. The questionnaire consisted of 
items on the demographic characteristics of the nursing staff and their 
Depression, Anxiety, Stress Scale-21 (DASS-21) along with questions for 
self-assessment of stressors that are associated with COVID-19. STROBE guideline 
was used. Among 1803 nurses who were working in the low-risk areas in Jiangsu, 
22.0%, 29.8%, and 16.1% of them reported moderate to extreme levels of 
depression, anxiety, and stress, respectively. Having 11-15 years of working 
experience and being a fixed-term contract nurse were associated with 
experiencing worse mental health outcomes while supporting-Wuhan working 
experience and having mental health preparation course training were independent 
factors that had beneficial impact on their psychological well-being afterward. 
In terms of source of pressure, a key finding of this study is that the main 
stressor among these nurses was the lack of patient's understanding and 
cooperation (71.2%) which calls for better psychosocial communication between 
nurses and patients. The present findings would provide information for other 
regions at low risk of COVID-19 and may aid the provision of support and 
interventions for the benefit of the psychological well-being of nurses who are 
exposed to life-threatening occupational risks and are more vulnerable to the 
pandemic than others.

© 2021 John Wiley & Sons Australia, Ltd.

DOI: 10.1111/inm.12852
PMCID: PMC8250992
PMID: 33811426 [Indexed for MEDLINE]


3599. Int J Environ Res Public Health. 2021 Mar 26;18(7):3432. doi: 
10.3390/ijerph18073432.

Mental Health of Children and Adolescents Amidst COVID-19 and Past Pandemics: A 
Rapid Systematic Review.

Meherali S(1), Punjani N(1), Louie-Poon S(1), Abdul Rahim K(2), Das JK(2), Salam 
RA(2), Lassi ZS(3).

Author information:
(1)Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada.
(2)Aga Khan University Hospital, Karachi City, Sindh 74800, Pakistan.
(3)Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, 
Australia.

Background: The COVID‑19 pandemic and associated public health measures have 
disrupted the lives of people around the world. It is already evident that the 
direct and indirect psychological and social effects of the COVID‑19 pandemic 
are insidious and affect the mental health of young children and adolescents now 
and will in the future. The aim and objectives of this knowledge-synthesis study 
were to identify the impact of the pandemic on children's and adolescent's 
mental health and to evaluate the effectiveness of different interventions 
employed during previous and the current pandemic to promote children's and 
adolescents' mental health. Methodology: We conducted the systematic review 
according to the Preferred Reporting Items for Systematic Reviews and 
Meta-Analyses (PRISMA) guidelines and included experimental randomized and 
nonrandomized controlled trials, observational studies, and qualitative studies. 
Results: Of the 5828 articles that we retrieved, 18 articles met the inclusion 
criteria. We thematically analyzed them and put the major findings under the 
thematic areas of impact of the pandemic on children's and adolescents' mental 
health. These studies reported that pandemics cause stress, worry, helplessness, 
and social and risky behavioral problems among children and adolescents (e.g., 
substance abuse, suicide, relationship problems, academic issues, and 
absenteeism from work). Interventions such as art-based programs, support 
services, and clinician-led mental health and psychosocial services effectively 
decrease mental health issues among children and adolescents. Conclusion: 
Children and adolescents are more likely to experience high rates of depression 
and anxiety during and after a pandemic. It is critical that future researchers 
explore effective mental health strategies that are tailored to the needs of 
children and adolescents. Explorations of effective channels regarding the 
development and delivery of evidenced-based, age-appropriate services are vital 
to lessen the effects and improve long-term capacities for mental health 
services for children and adolescents. Key Practitioner Message: The COVID-19 
pandemic's physical restrictions and social distancing measures have affected 
each and every domain of life. Although the number of children and adolescents 
affected by the disease is small, the disease and the containment measures such 
as social distancing, school closure, and isolation have negatively impacted the 
mental health and well-being of children and adolescents. The impact of COVID-19 
on the mental health of children and adolescents is of great concern. Anxiety, 
depression, disturbances in sleep and appetite, as well as impairment in social 
interactions are the most common presentations. It has been indicated that 
compared to adults, this pandemic may continue to have increased long term 
adverse consequences on children's and adolescents' mental health. As the 
pandemic continues, it is important to monitor the impact on children's and 
adolescents' mental health status and how to help them to improve their mental 
health outcomes in the time of the current or future pandemics.

DOI: 10.3390/ijerph18073432
PMCID: PMC8038056
PMID: 33810225 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3600. Int J Environ Res Public Health. 2021 Mar 12;18(6):2930. doi: 
10.3390/ijerph18062930.

Nine Months into the COVID-19 Pandemic: A Longitudinal Study Showing Mental 
Health and Movement Behaviours Are Impaired in UK Students.

Savage MJ(1), Hennis PJ(1), Magistro D(1), Donaldson J(1), Healy LC(1), James 
RM(1).

Author information:
(1)SHAPE Research Group, School of Science and Technology, Nottingham Trent 
University, Nottingham NG11 8NS, UK.

Initial studies indicated that student mental health was impaired during the 
early stages of the pandemic and that maintaining/improving physical activity 
gave some protection from mental illness. However, as the pandemic persists, 
these data may not reflect current circumstances and may have been confounded by 
exam stress.
METHODS: This study used an online survey to assess the changes in, and 
associations between, mental health and movement behaviours in 255 UK university 
students from before the COVID-19 pandemic (October 2019) to 9 months following 
the UK's first confirmed case (October 2020). Changes in and associations 
between mental wellbeing, perceived stress, physical activity, and sedentary 
behaviour were assessed using a mixed model ANOVA; a multiple linear regression 
model determined the predictive value of variables associated with Δ mental 
wellbeing.
RESULTS: Mental wellbeing and physical activity decreased (45.2 to 42.3 (p < 
0.001); 223 to 173 min/week (p < 0.001)), whereas perceived stress and time 
spent sedentary increased (19.8 to 22.8 (p < 0.001); 66.0 to 71.2 h/week (p = 
0.036)). Δ perceived stress, Δ sedentary behaviour and university year accounted 
for 64.7%, 12.9%, and 10.1% of the variance in Δ mental wellbeing (p < 0.001; p 
= 0.006; p = 0.035).
CONCLUSION: The COVID-19 pandemic is having a sustained negative impact on 
student mental health and movement behaviour.

DOI: 10.3390/ijerph18062930
PMCID: PMC7999965
PMID: 33809313 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3601. Int J Environ Res Public Health. 2021 Mar 12;18(6):2898. doi: 
10.3390/ijerph18062898.

Furloughs, Teleworking and Other Work Situations during the COVID-19 Lockdown: 
Impact on Mental Well-Being.

Escudero-Castillo I(1), Mato-Díaz FJ(1), Rodriguez-Alvarez A(2).

Author information:
(1)Department of Applied Economics, University of Oviedo, 33007 Oviedo, Spain.
(2)Department of Economics, University of Oviedo, 33007 Oviedo, Spain.

As a consequence of the Spring 2020 lockdown that occurred in Spain due to the 
COVID-19 pandemic, many people lost their jobs or had to be furloughed. The 
objective of this study is to analyse the influence of the latter changes in 
labour market status on psychological well-being. For this purpose, an ad-hoc 
questionnaire featuring socio-demographic and mental health criteria was 
created. Granted that the pandemic can be viewed as an exogenous shock, the bias 
caused by the bidirectional problems between the work situation and mental 
well-being can be tackled. Results indicate that the lockdown exerted a greater 
negative effect on the self-perceived well-being of unemployed and furloughed 
persons than on those in employment. Moreover, among those in continuous 
employment, teleworkers experienced a lesser degree of self-perceived well-being 
post lockdown as compared to those people remaining in the same work location 
throughout the COVID-19 crisis. Finally, the lockdown provoked worse effects on 
the self-perceived well-being of women as compared to men, a result that appears 
to be related to gender differences in household production. In conclusion, 
these results could be especially relevant given that the evolution of the 
pandemic is having ongoing effects on employment and, therefore, on the mental 
health of workers.

DOI: 10.3390/ijerph18062898
PMCID: PMC8000869
PMID: 33809017 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3602. Int J Environ Res Public Health. 2021 Mar 5;18(5):2619. doi: 
10.3390/ijerph18052619.

Psychosocial Effects and Use of Communication Technologies during Home 
Confinement in the First Wave of the COVID-19 Pandemic in Italy and The 
Netherlands.

Bastoni S(1), Wrede C(1), Ammar A(2)(3), Braakman-Jansen A(1), Sanderman 
R(1)(4), Gaggioli A(5)(6), Trabelsi K(7)(8), Masmoudi L(7), Boukhris O(7), Glenn 
JM(9), Bouaziz B(10), Chtourou H(7)(11), van Gemert-Pijnen L(1).

Author information:
(1)Centre for eHealth and Wellbeing Research, Department of Psychology, Health 
and Technology, University of Twente, 7522 NB Enschede, The Netherlands.
(2)Institute of Sport Science, Otto-von-Guericke University, 39106 Magdeburg, 
Germany.
(3)Interdisciplinary Laboratory in Neurosciences, Physiology and Psychology: 
Physical Activity, Health and Learning (LINP2), UFR STAPS, UPL, Paris Nanterre 
University, 92000 Nanterre, France.
(4)Department of Health Psychology, University Medical Center Groningen, 9712 
Groningen, The Netherlands.
(5)Department of Psychology, Universitá Cattolica del Sacro Cuore, 20123 Milan, 
Italy.
(6)Applied Technology for Neuro-Psychology Lab, I.r.c.c.s. Istituto Auxologico 
Italiano, 20149 Milan, Italy.
(7)High Institute of Sport and Physical Education of Sfax, University of Sfax, 
3000 Sfax, Tunisia.
(8)Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, 
High Institute of Sport and Physical Education of Sfax, University of Sfax, 3000 
Sfax, Tunisia.
(9)Exercise Science Research Center, Department of Health, Human Performance and 
Recreation, University of Arkansas, Fayetteville, NC AR72701, USA.
(10)Multimedia Information Systems and Advanced Computing Laboratory (MIRACL), 
University of Sfax, 3021 Sfax, Tunisia.
(11)Activité Physique, Sport et Santé, UR18JS01, Observatoire National du Sport, 
1003 Tunis, Tunisia.

(1) Background: The COVID-19 pandemic forced people from all around the globe to 
strongly modify their daily routines, putting a significant strain on the social 
aspects of daily lives. While the first wave of the pandemic was a very 
challenging time in all countries, it is still uncertain whether various 
lockdown intensities and infection rates differed regarding their psychosocial 
impact. This work therefore aimed to investigate (i) the psychosocial effects of 
home confinement in two European countries that underwent different lockdown 
intensities: Italy and the Netherlands and (ii) the role of communication 
technology in relation to feelings of loneliness. (2) Methods: A cross-sectional 
online survey inquiring about different psychosocial variables and the use of 
and satisfaction towards communication technology was circulated among the 
general public during the first wave of the COVID-19 pandemic. In total, 629 
participants (66% female, 68% from the Netherlands) answered each question 
twice, referring to "before" and "during" the pandemic. (3) Results: We found 
significant negative effects of COVID-19 home confinement on depressive feelings 
(p < 0.001, %∆ = +54%), loneliness (p < 0.001, %∆ = +37.3%), life satisfaction 
(p < 0.001, %∆ = -19.8%) and mental wellbeing (p < 0.001, %∆ = -10.6%) which 
were accompanied with a significantly increased need for psychosocial support (p 
< 0.001, %∆ = +17.3%). However, the magnitude of psychosocial impact did not 
significantly differ between residents undergoing a more intense (Italy) versus 
a less intense (Netherlands) lockdown, although the decrease in social 
participation was found to be significantly different for both countries (z = 
-7.714, p < 0.001). Furthermore, our findings demonstrate that the increase in 
loneliness was associated with the adoption of new digital communication tools 
(r = 0.21, p < 0.001), and significantly higher for individuals who started to 
adopt at least one new digital communication tool during confinement than for 
those who did not (z = -4.252, p < 0.001). (4) Conclusions: This study 
highlights that, although COVID-19 home confinement significantly impacted 
psychosocial wellbeing during the first wave of the pandemic, this impact did 
not differ based on lockdown intensity. Recognizing the increasing adoption of 
digital communication technology in an attempt to reduce lockdown loneliness, 
future studies should investigate what is needed from the technology to achieve 
this effect.

DOI: 10.3390/ijerph18052619
PMCID: PMC7967354
PMID: 33807851 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3603. Viruses. 2021 Mar 5;13(3):418. doi: 10.3390/v13030418.

Target Product Profile Analysis of COVID-19 Vaccines in Phase III Clinical 
Trials and Beyond: An Early 2021 Perspective.

Funk CD(1)(2), Laferrière C(2), Ardakani A(2).

Author information:
(1)Department of Biomedical and Molecular Sciences, Queen's University, 
Kingston, ON K7L 3N6, Canada.
(2)Scientific Research Division, Novateur Ventures Inc., Vancouver, BC V6E 3P3, 
Canada.

The coronavirus SARS-CoV-2, which causes Coronavirus disease 2019 (COVID-19), 
has infected more than 100 million people globally and caused over 2.5 million 
deaths in just over one year since its discovery in Wuhan, China in December 
2019. The pandemic has evoked widespread collateral damage to societies and 
economies, and has destabilized mental health and well-being. Early in 2020, 
unprecedented efforts went into the development of vaccines that generate 
effective antibodies to the SARS-CoV-2 virus. Teams developing twelve candidate 
vaccines, based on four platforms (messenger RNA, non-replicating viral vector, 
protein/virus-like particle, and inactivated virus) had initiated or announced 
the Phase III clinical trial stage by early November 2020, with several having 
received emergency use authorization in less than a year. Vaccine rollout has 
proceeded around the globe. Previously, we and others had proposed a target 
product profile (TPP) for ideal/optimal and acceptable/minimal COVID-19 
vaccines. How well do these candidate vaccines stack up to a harmonized TPP? 
Here, we perform a comparative analysis in several categories of these candidate 
vaccines based on the latest available trial data and highlight the early 
successes as well as the hurdles and barriers yet to be overcome for ending the 
global COVID-19 pandemic.

DOI: 10.3390/v13030418
PMCID: PMC7998902
PMID: 33807839 [Indexed for MEDLINE]

Conflict of interest statement: Author A.A. is founder and managing director of 
Novateur Ventures, Inc. C.D.K. and C.L. are consultants with Novateur Ventures 
Inc. The authors have no associations with the makers of the twelve vaccine 
candidates presented here.


3604. Int J Environ Res Public Health. 2021 Mar 5;18(5):2586. doi: 
10.3390/ijerph18052586.

A Cross-Country Examination on the Fear of COVID-19 and the Sense of Loneliness 
during the First Wave of COVID-19 Outbreak.

Lo Coco G(1), Gentile A(1), Bosnar K(2), Milovanović I(3), Bianco A(1), Drid 
P(3), Pišot S(4).

Author information:
(1)Department of Psychology, Educational Science and Human Movement, University 
of Palermo, Viale delle Scienze, Edificio 15, 90128 Palermo, Italy.
(2)Faculty of Kinesiology, University of Zagreb, 10000 Zagreb, Croatia.
(3)Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi 
Sad, Serbia.
(4)Institute for Kinesiology Research, Science and Research Center Koper, 6000 
Koper, Slovenia.

The aim of the current study is to examine gender, age. and cross-country 
differences in fear of COVID-19 and sense of loneliness during the lockdown, by 
comparing people from those countries with a high rate of infections and deaths 
(e.g., Spain and Italy) and from countries with a mild spread of infection 
(e.g., Croatia, Serbia, Slovakia, Slovenia, and Bosnia and Herzegovina). A total 
of 3876 participants (63% female) completed an online survey on "Everyday life 
practices in COVID-19 time" in April 2020, including measures of fear of 
COVID-19 and loneliness. Males and females of all age groups in countries 
suffering from the powerful impact of the COVID-19 pandemic reported greater 
fear of COVID-19 and sense of loneliness. In less endangered countries, females 
and the elderly reported more symptoms than males and the young; in Spanish and 
Italian samples, the pattern of differences is considerably more complex. Future 
research should thoroughly examine different age and gender groups. The analysis 
of emotional well-being in groups at risk of mental health issues may help to 
lessen the long term social and economic costs due to the COVID-19 outbreak.

DOI: 10.3390/ijerph18052586
PMCID: PMC7967533
PMID: 33807549 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3605. Int J Environ Res Public Health. 2021 Mar 31;18(7):3615. doi: 
10.3390/ijerph18073615.

Social Isolation and Loneliness during COVID-19 Lockdown: Associations with 
Depressive Symptoms in the German Old-Age Population.

Müller F(1), Röhr S(1)(2), Reininghaus U(3)(4)(5), Riedel-Heller SG(1).

Author information:
(1)Institute of Social Medicine, Occupational Health and Public Health (ISAP), 
Medical Faculty, University of Leipzig, 04103 Leipzig, Germany.
(2)Global Brain Health Institute (GBHI), Trinity College Dublin, D02 PN40 
Dublin, Ireland.
(3)Department of Public Mental Health, Central Institute of Mental Health, 
Medical Faculty Mannheim, Heidelberg University, 68159 Mannheim, Germany.
(4)Centre for Epidemiology and Public Health, Health Service and Population 
Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's 
College London, London WC2R 2LS, UK.
(5)ESRC Centre for Society and Mental Health, King's College London, London WC2R 
2LS, UK.

Lockdowns during the COVID-19 pandemic increase the risk of social isolation and 
loneliness, which may affect mental wellbeing. Therefore, we aimed to 
investigate associations between social isolation and loneliness with depressive 
symptoms in the German old-age population during the first COVID-19 lockdown. A 
representative sample of randomly selected individuals at least 65 years old (n 
= 1005) participated in a computer-assisted standardized telephone interview in 
April 2020. Sociodemographic data, aspects of the personal life situation, 
attitudes towards COVID-19 and standardized screening measures on loneliness 
(UCLA 3-item loneliness scale), depression (Brief Symptom Inventory/BSI-18), and 
resilience (Brief Resilience Scale/BRS) were assessed. Associations were 
inspected using multivariate regression models. Being lonely, but not isolated 
(β = 0.276; p < 0.001) and being both isolated and lonely (β = 0.136; p < 0.001) 
were associated with higher depressive symptoms. Being isolated, but not lonely 
was not associated with depressive symptoms. Thus, the subjective emotional 
evaluation, i.e., feeling lonely, of the social situation during lockdown seems 
more relevant than the objective state, i.e., being isolated. Normal (β = 
-0.203; p < 0.001) and high resilience (β = -0.308; p < 0.001) were associated 
with lower depressive symptoms across groups. Therefore, strengthening coping 
skills may be a support strategy during lockdowns, especially for lonely older 
individuals.

DOI: 10.3390/ijerph18073615
PMCID: PMC8036754
PMID: 33807232 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3606. Int J Environ Res Public Health. 2021 Mar 31;18(7):3613. doi: 
10.3390/ijerph18073613.

The Loneliness-Life Satisfaction Relationship: The Parallel and Serial Mediating 
Role of Hopelessness, Depression and Ego-Resilience among Young Adults in South 
Africa during COVID-19.

Padmanabhanunni A(1), Pretorius T(1).

Author information:
(1)Department of Psychology, University of the Western Cape, Cape Town 7535, 
South Africa.

Recently, with the onset of the COVID-19 pandemic, several lockdown and 
stay-at-home regulations have been implemented worldwide. In this regard, 
loneliness has been identified as the signature mental health consequence of 
this pandemic. The aim of this study is to explore the associations among 
loneliness, hopelessness, depression, ego-resilience and life satisfaction in a 
random sample of young adults (N = 337) at a university in the Western Cape of 
South Africa. Parallel and serial mediation analysis supported the hypothesis 
that loneliness is associated with hopelessness, which in turn is associated 
with depression, and that ego-resilience mediates the association between all 
the negative indices of psychological well-being and life satisfaction. These 
findings suggest that mental health interventions that boost ego-resilience and 
target loneliness may help in dealing with the mental health consequences of 
COVID-19.

DOI: 10.3390/ijerph18073613
PMCID: PMC8036627
PMID: 33807204 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3607. Int J Environ Res Public Health. 2021 Mar 23;18(6):3303. doi: 
10.3390/ijerph18063303.

Mental Health, Greenness, and Nature Related Behaviors in the Adult Population 
of Stockholm County during COVID-19-Related Restrictions.

Lõhmus M(1)(2), Stenfors CUD(3)(4), Lind T(1), Lauber A(1)(2), Georgelis 
A(1)(2).

Author information:
(1)Center for Occupational and Environmental Medicine, Region Stockholm, 113 65 
Stockholm, Sweden.
(2)Institute of Environmental Medicine, Karolinska Institute, Box 210, 171 77 
Stockholm, Sweden.
(3)Department of Psychology, Stockholm University, 106 91 Stockholm, Sweden.
(4)Aging Research Center, Department of Neurobiology, Care Science and Society, 
Karolinska Institute, 171 77 Stockholm, Sweden.

International data suggest that exposure to nature is beneficial for mental 
health and well-being. The restrictions related to the COVID-19 pandemic have 
created a setting that allows us to investigate the importance of greenness 
exposure on mental health during a period of increased isolation and worry. 
Based on 2060 responses from an online survey in Stockholm County, Sweden, we 
investigated: (1) whether the COVID-19 pandemic changed peoples' lifestyle and 
nature-related habits, and (2) if peoples' mental health differed depending on 
their exposure to greenness. Neighborhood greenness levels were quantified by 
using the average normalized difference vegetation index (NDVI) within 50 m, 100 
m, 300 m, and 500 m buffers surrounding the participant's place of residence. We 
found that the number of individuals that reported that they visited natural 
areas "often" was significantly higher during the pandemic than before the 
pandemic. Higher levels of greenness surrounding one's location of residence 
were in general associated with higher mental health/well-being and vitality 
scores, and less symptoms of depression, anxiety, and perceived and cognitive 
stress, after adjustments for demographic variables and walkability. In 
conclusion, the results from the present study provided support to the 
suggestion that contact with nature may be important for mental health in 
extreme circumstances.

DOI: 10.3390/ijerph18063303
PMCID: PMC8004976
PMID: 33806787 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3608. Int J Environ Res Public Health. 2021 Mar 24;18(7):3330. doi: 
10.3390/ijerph18073330.

Telecommuting, Off-Time Work, and Intrusive Leadership in Workers' Well-Being.

Magnavita N(1)(2), Tripepi G(3), Chiorri C(4).

Author information:
(1)Postgraduate School of Occupational Medicine, Università Cattolica del Sacro 
Cuore, 00168 Roma, Italy.
(2)Department of Woman/Child & Public Health, Fondazione Policlinico 
Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy.
(3)CNR-IFC Research Unit of Reggio Calabria, Institute of Clinical Physiology 
IFC, Italian National Research Council CNR, R Via Vallone Petrara, 65, 89124 
Reggio Calabria, Italy.
(4)Department of Educational Sciences, University of Genova (Italy), 16126 
Genova, Italy.

Telecommuting is a flexible form of work that has progressively spread over the 
last 40 years and which has been strongly encouraged by the measures to limit 
the COVID-19 pandemic. There is still limited evidence on the effects it has on 
workers' health. In this survey we invited 905 workers of companies that made a 
limited use of telecommuting to fill out a questionnaire to evaluate intrusive 
leadership of managers (IL), the request for work outside traditional hours 
(OFF-TAJD), workaholism (Bergen Work Addiction Scale (BWAS)), effort/reward 
imbalance (ERI), happiness, and common mental issues (CMIs), anxiety and 
depression, assessed by the Goldberg scale (GADS). The interaction between these 
variables has been studied by structural equation modeling (SEM). Intrusive 
leadership and working after hours were significantly associated with 
occupational stress. Workaholism is a relevant moderator of this interaction: 
intrusive leadership significantly increased the stress of workaholic workers. 
Intrusive leadership and overtime work were associated with reduced happiness, 
anxiety, and depression. These results indicate the need to guarantee the right 
to disconnect to limit the effect of the OFF-TAJD. In addition to this, 
companies should implement policies to prevent intrusive leadership and 
workaholism.

DOI: 10.3390/ijerph18073330
PMCID: PMC8037393
PMID: 33804828 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3609. Int J Environ Res Public Health. 2021 Mar 20;18(6):3228. doi: 
10.3390/ijerph18063228.

COVID-19 and Health-Related Quality of Life: A Community-Based Online Survey in 
Hong Kong.

Choi EPH(1), Hui BPH(2), Wan EYF(3)(4), Kwok JYY(1), Tam THL(5), Wu C(1).

Author information:
(1)School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong 
Kong, China.
(2)Department of Applied Social Sciences, The Hong Kong Polytechnic University, 
Hong Kong, China.
(3)Department of Family Medicine and Primary Care, LKS Faculty of Medicine, The 
University of Hong Kong, Hong Kong, China.
(4)Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The 
University of Hong Kong, Hong Kong, China.
(5)LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.

The COVID-19 pandemic itself and related public health measurements have had 
substantial impacts on individual social lives and psychological and mental 
health, all to the detriment of health-related quality of life (HRQoL). There 
have been extensive studies investigating the mental health of people in 
different populations during the COVID-19 pandemic. However, few studies have 
explored the impact of COVID-19 and its association with HRQoL. To fill this 
research gap and provide further empirical evidence, this study examined the 
impact of COVID-19 on Hong Kong people and evaluated its association with HRQoL. 
A total of 500 participants were randomly recruited to complete an online 
questionnaire on their concerns related to COVID-19. This entailed responding to 
the World Health Organization Quality of Life-BREF instrument. Data were 
collected between 24 April and 3 May 2020. Independent t-tests and multiple 
linear regressions were used to examine the association between the impact of 
COVID-19 and HRQoL. Overall, 69.6% of participants were worried about 
contracting COVID-19, and 41.4% frequently suspected themselves of being 
infected. Furthermore, 29.0% were concerned by the lack of disinfectants. All of 
these findings were associated with poorer HRQoL in the physical and 
psychological health, social relationships, and environment domains. On the 
other hand, 47.4% of participants were concerned that they may lose their job 
because of the pandemic, while 39.4% were bothered by the insufficient supply of 
surgical masks. These two factors were associated with poorer HRQoL in the 
physical and psychological health and environment domains. The adverse impact of 
COVID-19 on individuals is multifactorial, affecting all aspects of HRQoL. In 
addition to enhancing anti-epidemic efforts, it is equally important to 
implement public health and social welfare measures, thereby diminishing the 
adverse impact of COVID-19 on overall well-being.

DOI: 10.3390/ijerph18063228
PMCID: PMC8003940
PMID: 33804725 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3610. Int J Environ Res Public Health. 2021 Mar 1;18(5):2390. doi: 
10.3390/ijerph18052390.

From Recession to Depression? Prevalence and Correlates of Depression, Anxiety, 
Traumatic Stress and Burnout in Healthcare Workers during the COVID-19 Pandemic 
in Greece: A Multi-Center, Cross-Sectional Study.

Pappa S(1)(2), Athanasiou N(2), Sakkas N(2), Patrinos S(2), Sakka E(2)(3), 
Barmparessou Z(2), Tsikrika S(4), Adraktas A(5), Pataka A(6), Migdalis I(7), 
Gida S(8), Katsaounou P(2)(9).

Author information:
(1)Department of Psychiatry, Imperial College London, London W12 0NN, UK.
(2)Department of Respiratory Medicine, National and Kapodistrian University of 
Athens, 157 72 Athens, Greece.
(3)School of Pharmacy and Biomolecular Science, University of Brighton, Brighton 
BN2 4AT, UK.
(4)Respiratory Failure Clinic, Sotiria Hospital, 115 27 Athens, Greece.
(5)Pammakaristos Hospital, 111 44 Athens, Greece.
(6)Respiratory Failure Unit, Papanikolaou Hospital Thessaloniki, 570 10 
Thessaloniki, Greece.
(7)417 Army Equity Fund Hospital (NIMTS), 115 21 Athens, Greece.
(8)Trikala Hospital, 421 00 Trikala, Greece.
(9)Pulmonary and Respiratory Failure Department, First ICU, Evaggelismos 
Hospital, 106 76 Athens, Greece.

The COVID-19 pandemic has the potential to adversely affect the mental health of 
healthcare workers (HCWs). The public healthcare system in Greece was already 
facing serious challenges at the outset of the outbreak following years of 
austerity and an escalating refugee crisis. This multi-center, cross-sectional 
study aims to assess the levels and associated risk factors of anxiety, 
depression, traumatic stress and burnout of frontline staff in Greece. A total 
of 464 self-selected HCWs in six reference hospitals completed a questionnaire 
comprising sociodemographic and work-related information and validated 
psychometric scales. The proportion of HCWs with symptoms of moderate/severe 
depression, anxiety and traumatic stress were 30%, 25% and 33%, respectively. 
Burnout levels were particularly high with 65% of respondents scoring 
moderate/severe in emotional exhaustion, 92% severe in depersonalization and 51% 
low/moderate in personal accomplishment. Predictive factors of adverse 
psychological outcomes included fear, perceived stress, risk of infection, lack 
of protective equipment and low social support. The psychological burden 
associated with COVID-19 in healthcare professionals in Greece is considerable, 
with more than half experiencing at least mild mental health difficulties. 
Findings signal the need for immediate organizational and individually tailored 
interventions to enhance resilience and support wellbeing under pandemic 
conditions.

DOI: 10.3390/ijerph18052390
PMCID: PMC7967750
PMID: 33804505 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3611. Int J Environ Res Public Health. 2021 Mar 18;18(6):3158. doi: 
10.3390/ijerph18063158.

Time in Nature Associated with Decreased Fatigue in UK Truck Drivers.

Longman DP(1), Shaw CN(2), Varela-Mato V(1), Sherry AP(1)(3), Ruettger K(1), 
Sayyah M(1), Guest A(1), Chen YL(1), Paine NJ(1)(3), King JA(1)(3), Clemes 
SA(1)(3).

Author information:
(1)School of Sport, Exercise and Health Sciences, Loughborough University, 
Loughborough LE11 3TU, UK.
(2)Department of Anthropology, University of Zurich, 8050 Zurich, Switzerland.
(3)National Institute for Health Research (NIHR) Leicester Biomedical Research 
Centre, University Hospitals of Leicester NHS Trust and University of Leicester, 
Leicester LE5 4PW, UK.

Heavy goods vehicle (HGV) driving is recognised as a highly hazardous occupation 
due to the long periods of sedentary behaviour, low levels of physical activity 
and unhealthy food options when working. These risk factors combine with shift 
work and concomitant irregular sleep patterns to increase the prevalence of 
fatigue. Fatigue is closely linked with stress and, subsequently, poor 
physiological and psychological health. In parallel, a wealth of evidence has 
demonstrated the health and wellbeing benefits of spending time in nature. Here, 
we sought to examine whether spending time in nature was associated with lower 
levels of fatigue, anxiety and depression in HGV drivers. 89 long-distance 
drivers (98.9% male, mean ± SD age: 51.0 ± 9 years, body mass index: 29.8 ± 4.7 
kg/m2) participating in a wider health promotion programme reported time spent 
in nature (during and before the Covid-19 pandemic) and symptoms of occupational 
fatigue, depression and anxiety. After controlling for covariates, truck drivers 
who visited nature at least once a week exhibited 16% less chronic fatigue prior 
to the pandemic, and 23% less chronic fatigue and 20% less acute fatigue during 
the pandemic. No significant differences were observed for either anxiety or 
depression. As fatigue has a range of physical and mental health sequelae, we 
propose that increased exposure to natural settings may make a valuable 
contribution to interventions to promote the health and wellbeing of this 
underserved group.

DOI: 10.3390/ijerph18063158
PMCID: PMC8003164
PMID: 33803843 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3612. Int J Environ Res Public Health. 2021 Mar 18;18(6):3119. doi: 
10.3390/ijerph18063119.

Physical Sports Activities and Exercise Addiction during Lockdown in the Spanish 
Population.

Berengüí R(1), López-Gullón JM(2), Angosto S(2).

Author information:
(1)Faculty of Social Sciences and Communication, Catholic University of Murcia, 
30107 Guadalupe, Spain.
(2)Faculty of Sport Sciences, University of Murcia, 30720 Santiago de la Ribera, 
Spain.

The coronavirus disease 2019 (COVID-19) pandemic has led to the paralysis of the 
worldwide economy caused by the population's lockdown to stop the virus 
spreading, making it difficult to do exercise. The aim of this study is to 
analyse the commitment to and feeling of insecurity related to practising sport, 
sports habits and the profile of the Spanish population during lockdown 
according to the level of addiction to exercise. The sample consisted of 1019 
subjects with a mean age of 35 years old. The variables analysed were exercise 
addiction, commitment to and feeling of insecurity related to sport, and sport 
habits. Three groups were identified according to their addiction level to 
exercise: asymptomatic (n = 202), symptomatic (n = 756), and at risk of 
addiction (n = 61). The main results indicated that a higher addiction level was 
associated with a higher number of days and time spent on exercise per week. Six 
percent of the subjects were at addiction risk, and they had a lower feeling of 
insecurity towards sport. These findings provide information to governments on 
the need to promote physical activity programmes at home to promote adequate 
fitness and mental wellbeing in the population.

DOI: 10.3390/ijerph18063119
PMCID: PMC8003043
PMID: 33803533 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3613. Int J Environ Res Public Health. 2021 Mar 3;18(5):2506. doi: 
10.3390/ijerph18052506.

Outdoor Activity Participation Improves Adolescents' Mental Health and 
Well-Being during the COVID-19 Pandemic.

Jackson SB(1), Stevenson KT(2), Larson LR(2), Peterson MN(1), Seekamp E(2).

Author information:
(1)Fisheries, Wildlife and Conservation Biology Program, College of Natural 
Resources, North Carolina State University, Raleigh, NC 27695, USA.
(2)Department of Parks, Recreation and Tourism Management, College of Natural 
Resources, North Carolina State University, Raleigh, NC 27695, USA.

COVID-19 is reshaping human interactions with the natural environment, 
potentially generating profound consequences for health and well-being. To 
assess the effects of COVID-19 on the outdoor recreation participation and 
subjective well-being of adolescents, as well as how participation in outdoor 
activities may mitigate declines in subjective well-being, we used a Qualtrics 
XM panel to conduct a nationally representative survey of youth ages 10-18 
across the United States (n = 624) between 30 April and 15 June 2020. Survey 
questions focused on frequency of participation in outdoor activities before and 
during the pandemic, as well as changes in subjective well-being. Paired t-tests 
revealed decreases in both outdoor recreation participation (64% reported 
declines) and subjective well-being (52% reported declines). A regression model 
examining correlates of changes in subjective well-being (R2 = 0.42) revealed 
strong associations with changes in outdoor play (B = 0.44, p < 0.001) and 
nature-based (B = 0.21, p = 0.016) activities. Adolescents' from all backgrounds 
who participated in these activities during the pandemic reported smaller 
declines in subjective well-being. Results highlight the critical role that time 
outdoors and time in nature play in bolstering adolescents' resilience to 
stressors such as the COVID-19 pandemic and underscore the need to facilitate 
outdoor recreation opportunities for youth during times of crisis.

DOI: 10.3390/ijerph18052506
PMCID: PMC7967628
PMID: 33802521 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3614. Int J Environ Res Public Health. 2021 Mar 6;18(5):2660. doi: 
10.3390/ijerph18052660.

'Should I Stay, or Should I Go?' Psychological Distress Predicts Career Change 
Ideation among Intensive Care Staff in Lithuania and the UK Amid COVID-19 
Pandemic.

Norkiene I(1), Jovarauskaite L(2), Kvedaraite M(2), Uppal E(3), Phull MK(4)(5), 
Chander H(4), Halford K(4), Kazlauskas E(2).

Author information:
(1)Clinic of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, 
Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str. 21, LT-03101 
Vilnius, Lithuania.
(2)Center for Psychotraumatology, Institute of Psychology, Vilnius University, 
M. K. Ciurlionio Str. 29, LT-03100 Vilnius, Lithuania.
(3)The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, 
Whitechapel, London E1 1FR, UK.
(4)Barking Havering and Redbridge University NHS Trust, Rom Valley Way, Romford 
Essex, London RM7 0AG, UK.
(5)Queen Mary University of London, Mile End Rd, Bethnal Green, London E1 4NS, 
UK.

The COVID-19 pandemic had a significant effect on healthcare globally. 
Additional pressure created by coronavirus adversely affected the mental health 
and psychological well-being of healthcare workers, leading many to question 
their desire and willingness to continue working in healthcare. This study aimed 
to identify predictors for career change ideation among healthcare professionals 
in two countries; Lithuania and the United Kingdom amid the coronavirus 
pandemic. In total, 610 healthcare professionals from Lithuania and the UK (285 
and 325, respectively) participated in a survey from May to August 2020. 
Psychological distress and psychological well-being were measured using the 
self-report scales "DASS-21" and "WHO-5". Almost half of the sample (49.2%), 
59.6% and 40.0% in Lithuanian and the UK, respectively, exhibited career change 
ideation, the country effect was significant (AOR = 2.21, p < 0.001). Stronger 
ideation to leave healthcare was predicted by higher levels of depression (AOR = 
1.10, p = 0.005), stress (AOR = 1.10, p = 0.007), anxiety surrounding inadequate 
personal protective equipment (AOR = 2.27, p = 0.009), and lower psychological 
well-being scores (AOR = 1.10, p = 0.007). We conclude that psychosocial support 
must be provided for healthcare professionals to prevent burnout and loss of 
staff amid the pandemic.

DOI: 10.3390/ijerph18052660
PMCID: PMC7967320
PMID: 33800903 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3615. Int J Environ Res Public Health. 2021 Mar 11;18(6):2869. doi: 
10.3390/ijerph18062869.

Associations between Relationship Quality and Mental Health during COVID-19 in 
the United Kingdom.

Pieh C(1), Probst T(1), Budimir S(1)(2), Humer E(1).

Author information:
(1)Department for Psychotherapy and Biopsychosocial Health, Danube University 
Krems, 3500 Krems an der Donau, Austria.
(2)Department of Work, Organization and Society, Ghent University, 9000 Gent, 
Belgium.

This study investigated the association of relationship quality with several 
well-being measures during the COVID-19 lockdown in the United Kingdom. An 
online survey was conducted on a study sample (n = 682) measuring relationship 
quality with the Quality of Marriage Index, and well-being measures including 
quality of life (WHO-QoL BREF), well-being (WHO-5), perceived stress (PSS-10), 
depressive (PHQ-9), and anxiety (GAD-7) symptoms. Good relationship quality goes 
along with higher scores in well-being (WHO-5), quality of life (WHO-QoL BREF), 
psychological domain, physical health, social relationships, environment, and 
reduced scores in stress (PSS-10), depressive (PHQ-9) and anxiety (GAD-7) 
symptoms compared with poor relationship quality (p < 0.001). Moreover, 21% of 
participants living in relationships with poor quality stated that they drink 
significantly more alcohol since the initial COVID-19 restrictions, compared to 
10% of participants with good quality (p = 0.002). Living in a good relationship 
seems to be an advantage, whereas those with poor relationship quality are 
particularly more burdened and drink significantly more alcohol during the 
COVID-19 lockdown.

DOI: 10.3390/ijerph18062869
PMCID: PMC7999639
PMID: 33799677 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript, or in the decision to 
publish the results.


3616. J Affect Disord. 2021 May 15;287:145-157. doi: 10.1016/j.jad.2021.03.016. Epub 
2021 Mar 11.

The prevalence of psychiatric comorbidities during the SARS and COVID-19 
epidemics: a systematic review and meta-analysis of observational studies.

Zhao YJ(1), Jin Y(2), Rao WW(1), Li W(1), Zhao N(3), Cheung T(4), Ng CH(5), Wang 
YY(6), Zhang QE(7), Xiang YT(8).

Author information:
(1)Unit of Psychiatry, Department of Public Health and Medicinal Administration, 
& Institute of Translational Medicine, Faculty of Health Sciences, University of 
Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of 
Macau, Macao SAR, China; Institute of Advanced Studies in Humanities and Social 
Sciences, University of Macau, Macao SAR, China.
(2)College of Education for the Future, Beijing Normal University, Zhuhai, 
Guangdong province, China.
(3)Unit of Psychiatry, Department of Public Health and Medicinal Administration, 
& Institute of Translational Medicine, Faculty of Health Sciences, University of 
Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of 
Macau, Macao SAR, China; Institute of Advanced Studies in Humanities and Social 
Sciences, University of Macau, Macao SAR, China; Center for Cognition and Brain 
Disorders, the Affiliated Hospital, Institutes of Psychological Sciences, 
Hangzhou Normal University, Hangzhou,China.
(4)School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China.
(5)Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, 
University of Melbourne, Richmond, Victoria, Australia.
(6)Faculty of Health and Life Sciences, De Montfort University, Leicester, UK.
(7)The National Clinical Research Center for Mental Disorders & Beijing Key 
Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced 
Innovation Center for Human Brain Protection, Capital Medical University, 
Beijing, China. Electronic address: zqe81@126.com.
(8)Unit of Psychiatry, Department of Public Health and Medicinal Administration, 
& Institute of Translational Medicine, Faculty of Health Sciences, University of 
Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of 
Macau, Macao SAR, China; Institute of Advanced Studies in Humanities and Social 
Sciences, University of Macau, Macao SAR, China. Electronic address: 
xyutly@gmail.com.

The coronavirus disease 2019 (COVID-19) and Severe Acute Respiratory Syndrome 
(SARS) are associated with various psychiatric comorbidities. This is a 
systematic review and meta-analysis comparing the prevalence of psychiatric 
comorbidities in all subpopulations during the SARS and COVID-19 epidemics. A 
systematic literature search was conducted in major international (PubMed, 
EMBASE, Web of Science, PsycINFO) and Chinese (China National Knowledge Internet 
[CNKI] and Wanfang) databases to identify studies reporting prevalence of 
psychiatric comorbidities in all subpopulations during the SARS and COVID-19 
epidemics. Data analyses were conducted using the Comprehensive Meta-Analysis 
Version 2.0 (CMA V2.0). Eighty-two studies involving 96,100 participants were 
included. The overall prevalence of depressive symptoms (depression 
hereinafter), anxiety symptoms (anxiety hereinafter), stress, distress, insomnia 
symptoms, post-traumatic stress symptoms (PTSS) and poor mental health during 
the COVID-19 epidemic were 23.9% (95% CI: 18.4%-30.3%), 23.4% (95% CI: 
19.9%-27.3%), 14.2% (95% CI: 8.4%-22.9%), 16.0% (95% CI: 8.4%-28.5%), 26.5% (95% 
CI: 19.1%-35.5%), 24.9% (95% CI: 11.0%-46.8%), and 19.9% (95% CI: 11.7%-31.9%), 
respectively. Prevalence of poor mental health was higher in general populations 
than in health professionals (29.0% vs. 11.6%; Q=10.99, p=0.001). The prevalence 
of depression, anxiety, PTSS and poor mental health were similar between SARS 
and COVID-19 epidemics (all p values>0.05). Psychiatric comorbidities were 
common in different subpopulations during both the SARS and COVID-19 epidemics. 
Considering the negative impact of psychiatric comorbidities on health and 
wellbeing, timely screening and appropriate interventions for psychiatric 
comorbidities should be conducted for subpopulations affected by such serious 
epidemics.

Copyright © 2021 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2021.03.016
PMCID: PMC7948672
PMID: 33799032 [Indexed for MEDLINE]

Conflict of interest statement: There is no conflict of interest related to the 
topic of this manuscript.


3617. PLoS One. 2021 Apr 2;16(4):e0249609. doi: 10.1371/journal.pone.0249609. 
eCollection 2021.

Ethical and psychosocial considerations for hospital personnel in the Covid-19 
crisis: Moral injury and resilience.

Kreh A(1), Brancaleoni R(2), Magalini SC(3), Chieffo DPR(2), Flad B(4), 
Ellebrecht N(5), Juen B(1).

Author information:
(1)University of Innsbruck, Innsbruck, Austria.
(2)Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
(3)Catholic University of the Sacred Heart, Rome, Italy.
(4)A.ö. Krankenhaus St. Vinzenz, Zams, Austria.
(5)Albert-Ludwigs-University, Freiburg, Germany.

This study aims at investigating the nature of resilience and stress experience 
of health care workers during the COVID-19 pandemic. Thirteen healthcare workers 
from Italian and Austrian hospitals specifically dealing with COVID-19 patients 
during the first phase of the pandemic were interviewed. Data was analysed using 
grounded theory methodology. Psychosocial effects on stress experience, 
stressors and resilience factors were identified. We generated three hypotheses. 
Hypothesis one is that moral distress and moral injury are main stressors 
experienced by healthcare workers. Hypothesis two states that organisational 
resilience plays an important part in how healthcare workers experience the 
crisis. Organisational justice and decentralized decision making are essential 
elements of staff wellbeing. Hypothesis three refers to effective psychosocial 
support: Basic on scene psychosocial support based on the Hobfoll principles 
given by trusted and well-known mental health professionals and peers in an 
integrated approach works best during the pandemic.

DOI: 10.1371/journal.pone.0249609
PMCID: PMC8018614
PMID: 33798251 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


3618. Ann Ist Super Sanita. 2021 Jan-Mar;57(1):67-71. doi: 10.4415/ANN_21_01_10.

A structured program for perinatal depression and anxiety to be adopted in the 
emergencies.

Camoni L(1), Brescianini S(1), Mirabella F(1), Calamandrei G(1), Barbano G(2), 
Cattaneo M(3), Del Re D(1), Michielin P(4), Palumbo G(1), Gigantesco A(1).

Author information:
(1)Centro di Riferimento per le Scienze Comportamentali e la Salute Mentale, 
Istituto Superiore di Sanità.
(2)AULSS 2 Marca Trevigiana, Treviso, Italy.
(3)ASST Azienda Socio Sanitaria Territoriale, Bergamo Ovest, Bergamo, Italy.
(4)Università degli Studi di Padova, Padua, Italy.

Quarantine, loss of routine and social support can negatively impact mothers who 
have just given birth and their babies, generating concerns and reactions of 
intense fear. Following the COVID-19 emergency, we described a structured 
program for screening and treatment of perinatal depression and anxiety as a 
medium for constant monitoring of perinatal risk factors and early screening, 
which can also be implemented in emergencies with remote intervention methods, 
to offer women an appropriate, timely and effective treatment. In this scenario, 
it is desirable that the monitoring of the psychological well-being of women in 
postpartum is maintained over time, with the participation of all the 
professional figures with whom the woman comes into contact, to intercept any 
forms of psychological distress related to the epidemic and that could occur 
even after some time.

DOI: 10.4415/ANN_21_01_10
PMID: 33797407 [Indexed for MEDLINE]


3619. Front Public Health. 2021 Mar 16;9:641754. doi: 10.3389/fpubh.2021.641754. 
eCollection 2021.

A Novel BrainHealth Index Prototype Improved by Telehealth-Delivered Training 
During COVID-19.

Chapman SB(1), Fratantoni JM(1), Robertson IH(1)(2), D'Esposito M(3), Ling 
GSF(4), Zientz J(1), Vernon S(1), Venza E(1), Cook LG(1), Tate A(1), Spence 
JS(1).

Author information:
(1)Center for BrainHealth®, School of Behavioral and Brain Sciences, The 
University of Texas at Dallas, Dallas, TX, United States.
(2)Institute of Neuroscience, Global Brain Health Institute, Trinity College 
Dublin, Dublin, Ireland.
(3)Department of Molecular and Cell Biology, Helen Wills Neuroscience Institute, 
University of California, Berkeley, Berkeley, CA, United States.
(4)Department of Neurology and Neuroscience, School of Medicine, Johns Hopkins 
University, Baltimore, MD, United States.

Introduction: Brain health is neglected in public health, receiving attention 
after something goes wrong. Neuroplasticity research illustrates that preventive 
steps strengthen the brain's component systems; however, this information is not 
widely known. Actionable steps are needed to scale proven population-level 
interventions. Objectives: This pilot tested two main objectives: (1) the 
feasibility/ease of use of an online platform to measure brain health, deliver 
training, and offer virtual coaching to healthy adults and (2) to develop a data 
driven index of brain health. Methods: 180 participants, ages 18-87, enrolled in 
this 12-week pilot. Participants took a BrainHealth Index™ (BHI), a composite of 
assessments encompassing cognition, well-being, daily-life and social, pre-post 
training. Participants engaged in online training with three coaching sessions. 
We assessed changes in BHI, effects of training utilization and demographics, 
contributions of sub-domain measures to the BHI and development of a factor 
analytic structure of latent BrainHealth constructs. Results: The results 
indicated that 75% of participants showed at least a 5-point gain on their BHI 
which did not depend on age, education, or gender. The contribution to these 
gains were from all sub-domains, including stress, anxiety and resilience, even 
though training focused largely on cognition. Some individuals improved due to 
increased resilience and decreased anxiety, whereas others improved due to 
increased innovation and social engagement. Larger gains depended on module 
utilization, especially strategy training. An exploratory factor analytic 
solution to the correlation matrix of online assessments identified three latent 
constructs. Discussion/Conclusion: This pilot study demonstrated the efficacy of 
an online platform to assess changes on a composite BrainHealth Index and 
efficacy in delivering training modules and coaching. We found that adults, 
college age to late life, were motivated to learn about their brain and engage 
in virtual-training with coaching to improve their brain health. This effort 
intends to scale up to thousands, thus the pilot data, tested by an impending 
imaging pilot, will be utilized in ongoing machine learning (ML) algorithms to 
develop a precision brain health model. This pilot is a first step in scaling 
evidence-based brain health protocols to reach individuals and positively affect 
public health globally.

Copyright © 2021 Chapman, Fratantoni, Robertson, D'Esposito, Ling, Zientz, 
Vernon, Venza, Cook, Tate and Spence.

DOI: 10.3389/fpubh.2021.641754
PMCID: PMC8007793
PMID: 33796498 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


3620. Rev Cardiovasc Med. 2021 Mar 30;22(1):115-125. doi: 10.31083/j.rcm.2021.01.187.

Promoting healthy lifestyles using information technology during the COVID-19 
pandemic.

Dixit S(1), Nandakumar G(2).

Author information:
(1)Department of Medical Rehabilitation Sciences, College of Applied Medical 
Sciences, King Khalid University, 61321 Abha, Kingdom of Saudi Arabia.
(2)Department of Physiotherapy, Manipal College of Health Professions, Manipal 
Academy of Higher Education, Manipal, 576104 Karnataka, India.

In this pandemic era there exist a relationship between a sedentary lifestyle 
during lockdown with periods of anxiety and stress among the population. 
Moreover, the population with chronic disease will be vulnerable to the ill 
effects of a physically inactive lifestyle. Besides, social media platforms and 
technological advances also appear to be another potential tool for promoting 
health and wellbeing, however, the capability of these interventions during the 
pandemic era is largely unknown. To explore the possible role of technological 
advances and social media platforms as an alternate tool in promoting a healthy 
living style during the COVID-19 era. The studies with the predefined criteria 
were used to synthesize information regarding the opportunities and challenges. 
Studies delivering lifestyle intervention using social media platforms, 
technologies for health promotion were considered for the review. The studies 
included to synthesize evidence were randomized controlled trials, systematic 
reviews and meta-analysis. Database like Medline, Scopus, and Science Direct 
were searched independently by two reviewers. A total of 17 studies were 
included in the review, Internet and lifestyle modification n = 2, mHealth and 
lifestyle modification n = 3, Social media and lifestyle modifications n = 3, 
technology adoption for lifestyle modification n = 4, and hazards = 5. 
Technology and social media-based interventions appear to be a promising 
technique for promoting health and wellbeing and it is the only effective method 
for delivering an intervention during a pandemic situation. However, there also 
appears a need for the development of guidelines for social media usage to 
prevent probable hazards.

© 2021 The Authors. Published by IMR Press.

DOI: 10.31083/j.rcm.2021.01.187
PMID: 33792253 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest 
statement.


3621. Pediatr Int. 2022 Jan;64(1):e14718. doi: 10.1111/ped.14718. Epub 2021 Nov 22.

Mental health in Japanese children during school closures due to the COVID-19.

Saito M(1), Kikuchi Y(1), Lefor AK(2), Hoshina M(1).

Author information:
(1)Department of Pediatrics, Haga Red Cross Hospital, Mouka, Tochigi, Japan.
(2)Department of Surgery, Jichi Medical University, Simotsuke, Tochigi, Japan.

BACKGROUND: Changes in relationships, sleep rhythms, and physical activity 
caused by school closures instituted to curb the spread of COVID-19 influenced 
children's mental health. We explored changes in children's daily life and 
effects on their mental health during school closures.
METHODS: Participants included elementary and junior high school students 
9 years of age and older seen in the outpatient clinic during school closures 
and were required to complete the Japanese version of WHO Five Well-Being Index 
(WHO-5-J). The results were compared with those of students seen after schools 
reopened.
RESULTS: Participants included 78 students in the school closure group and 113 
in the school reopening group. Although those in the closure group devoted more 
time to family and sleep, their sleep rhythms, eating habits, and physical 
activities were disrupted. Although there were no significant differences 
between the two groups in total WHO-5-J scores, single WHO-5-J items such as 
activity and vigor and interest were significantly worse and rest was 
significantly better in the school closure group.
CONCLUSION: Although school closures resulted in elementary and junior high 
school students spending more time with family and sleeping, their sleep 
rhythms, eating habits, and physical activities were disrupted. As the 
children's living environment changed, they felt less active and vigorous and 
had difficulty finding things that interested them. However, their sleep 
improved and overall, the number of children with potential mental health 
problems did not change.

© 2021 Japan Pediatric Society.

DOI: 10.1111/ped.14718
PMCID: PMC8250533
PMID: 33792099 [Indexed for MEDLINE]

Conflict of interest statement: No potential conflicts of interest was 
disclosed.


3622. J Nutr Health Aging. 2021;25(4):440-447. doi: 10.1007/s12603-020-1532-z.

The Impact of Frailty on the Relationship between Life-Space Mobility and 
Quality of Life in Older Adults during the COVID-19 Pandemic.

Saraiva MD(1), Apolinario D, Avelino-Silva TJ, de Assis Moura Tavares C, 
Gattás-Vernaglia IF, Marques Fernandes C, Rabelo LM, Tavares Fernandes Yamaguti 
S, Karnakis T, Kalil-Filho R, Jacob-Filho W, Romero Aliberti MJ.

Author information:
(1)Márlon Juliano Romero Aliberti, Laboratorio de Investigacao Medica em 
Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas, Faculdade 
de Medicina, Universidade de Sao Paulo. Av. Dr. Eneas de Carvalho Aguiar 155, 8º 
andar, Clinica Medica, LIM-66, Cerqueira Cesar, Sao Paulo - SP, 05403-000, 
Brazil. Tel.: +55-11-26618116. E-mail address: maliberti@usp.br.

BACKGROUND: The COVID-19 pandemic has led to abrupt restrictions of life-space 
mobility. The impact of shelter-in-place orders on older adults' health and 
well-being is still unclear.
OBJECTIVE: To investigate the relationship between life-space mobility and 
quality of life (QoL) in older adults with and without frailty during the 
COVID-19 pandemic.
DESIGN: Multicenter prospective cohort study based on structured telephone 
interviews.
SETTING: Four geriatric outpatient clinics in the metropolitan area of Sao 
Paulo, Brazil.
PARTICIPANTS: 557 community-dwelling adults aged 60 years and older.
MEASUREMENTS: The Life-Space Assessment was used to measure community mobility 
before and during the COVID-19 pandemic, and a previously validated decrease of 
≥ 5 points defined restricted life-space mobility. Frailty was assessed through 
the FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) 
scale. The impact of shelter-in-place orders on QoL was evaluated with the 
question «How is the COVID-19 pandemic affecting your QoL?», to which 
participants could respond «not at all», «to some extent», or «to a great 
extent». We used ordinal logistic regressions to investigate the relationship 
between restricted life-space mobility and impact on QoL, adjusting our analyses 
for demographics, frailty, comorbidities, cognition, functionality, loneliness, 
depression, and anxiety. We explored whether frailty modified the association 
between life-space mobility and impact on QoL.
RESULTS: Participants were on average 80±8 years old, 65% were women, and 33% 
were frail. The COVID-19 quarantine led to a restriction of community mobility 
in 79% of participants and affected the QoL for 77% of participants. We found 
that restricted life-space mobility was associated with impact on QoL in older 
adults during the pandemic, although frailty modified the magnitude of the 
association (P-value for interaction=0.03). Frail participants who experienced 
restricted life-space mobility had twice the odds of reporting an impact on QoL 
when compared with non-frail individuals, with respective adjusted odds ratios 
of 4.20 (95% CI=2.36-7.50) and 2.18 (95% CI=1.33-3.58).
CONCLUSION: Older adults experienced substantial decreases in life-space 
mobility during the COVID-19 pandemic, and this unexpected change impacted their 
QoL. Providers should be particularly watchful for the consequences of abrupt 
life-space restrictions on frail individuals.

DOI: 10.1007/s12603-020-1532-z
PMCID: PMC7678592
PMID: 33786560 [Indexed for MEDLINE]

Conflict of interest statement: All authors declare no conflict of interest to 
disclose.


3623. Psychol Health Med. 2022 Jan;27(1):280-288. doi: 10.1080/13548506.2021.1906436. 
Epub 2021 Mar 31.

How does stress affect life satisfaction during the COVID-19 pandemic? Moderated 
mediation analysis of sense of coherence and fear of coronavirus.

Dymecka J(1), Gerymski R(1), Machnik-Czerwik A(1).

Author information:
(1)Department of Health Psychology and Quality of Life, Institute of Psychology, 
Opole University, Opole, Poland.

The aim of the present study was to determine the relationship between fear of 
COVID-19, stress, sense of coherence, and life satisfaction during the 
coronavirus pandemic. Participants were 907 Polish people (522 women and 385 
men). We used the Perceived Stress Scale (PSS-10), Fear of COVID-19 Scale 
(FOC-6), Sense of Coherence Scale (SOC-29) and the Satisfaction with Life Scale. 
The relationship between stress and life satisfaction was mediated by the sense 
of coherence, and the relationship between stress and sense of coherence was 
moderated by fear of COVID-19. The fear of COVID-19 acted as a buffer in the 
relationship between stress and sense of coherence weakening the impact of 
stress on the sense of coherence. This study is the first to verify the proposed 
model of moderated mediation during the COVID-19 pandemic and was undertaken in 
a very large sample. This manuscript highlights the important role of the fear 
of COVID-19 and sense of coherence in our well-being. An individual's sense of 
coherence can affect their subjective well-being and help them to effectively 
manage stress and reduce anxiety.

DOI: 10.1080/13548506.2021.1906436
PMID: 33784897 [Indexed for MEDLINE]


3624. PLoS One. 2021 Mar 30;16(3):e0249352. doi: 10.1371/journal.pone.0249352. 
eCollection 2021.

Job loss and mental health during the COVID-19 lockdown: Evidence from South 
Africa.

Posel D(1), Oyenubi A(1), Kollamparambil U(1).

Author information:
(1)School of Economics and Finance, University of the Witwatersrand, 
Johannesburg, South Africa.

OBJECTIVES: Existing literature on how employment loss affects depression has 
struggled to address potential endogeneity bias caused by reverse causality. The 
COVID-19 pandemic offers a unique natural experiment because the source of 
unemployment is very likely to be exogenous to the individual. This study 
assessed the effect of job loss and job furlough on the mental health of 
individuals in South Africa during the COVID-19 pandemic.
DATA AND METHODS: The data for the study came from the first and second waves of 
the national survey, the National Income Dynamics-Coronavirus Rapid Mobile 
Survey (NIDS-CRAM), conducted during May-June and July-August 2020, 
respectively. The sample for NIDS-CRAM was drawn from an earlier national 
survey, conducted in 2017, which had collected data on mental health. Questions 
on depressive symptoms during the lockdown were asked in Wave 2 of NIDS-CRAM, 
using a 2-question version of the Patient Health Questionnaire (PHQ-2). The 
PHQ-2 responses (0-6 on the discrete scale) were regrouped into four categories 
making the ordered logit regression model the most suited for assessing the 
impact of employment status on depressive symptoms.
RESULTS: The study revealed that adults who retained paid employment during the 
COVID-19 lockdown had significantly lower depression scores than adults who lost 
employment. The benefits of employment also accumulated over time, underscoring 
the effect of unemployment duration on mental health. The analysis revealed no 
mental health benefits to being furloughed (on unpaid leave), but paid leave had 
a strong and significant positive effect on the mental health of adults.
CONCLUSIONS: The economic fallout of the COVID-19 pandemic resulted in 
unprecedented job losses, which impaired mental wellbeing significantly. Health 
policy responses to the crisis therefore need to focus on both physical and 
mental health interventions.

DOI: 10.1371/journal.pone.0249352
PMCID: PMC8009396
PMID: 33784339 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


3625. Sex Transm Infect. 2021 Sep;97(6):402-410. doi: 10.1136/sextrans-2020-054896. 
Epub 2021 Mar 29.

Sexual health (excluding reproductive health, intimate partner violence and 
gender-based violence) and COVID-19: a scoping review.

Kumar N(1), Janmohamed K(2), Nyhan K(3)(4), Forastiere L(5), Zhang WH(6)(7), 
Kågesten A(8), Uhlich M(9), Sarpong Frimpong A(2), Van de Velde S(10), Francis 
JM(11), Erausquin JT(12), Larrson E(8)(13), Callander D(14), Scott J(15), 
Minichiello V(15)(16), Tucker J(17)(18)(19).

Author information:
(1)Department of Sociology, Yale University, New Haven, Connecticut, USA 
navin183@gmail.com.
(2)Department of Sociology, Yale University, New Haven, Connecticut, USA.
(3)Harvey Cushing/John Hay Whitney Medical Library, Yale University School of 
Medicine, New Haven, Connecticut, USA.
(4)Department of Environmental Health Sciences, Yale School of Public Health, 
New Haven, CT, USA.
(5)Department of Biostatistics, Yale School of Public Health, New Haven, CT, 
USA.
(6)School of Public Health, Free University of Brussels, Brussels, Belgium.
(7)International Centre for Reproductive Health, Department of Public Health and 
Primary Care, Ghent University, Ghent, Belgium.
(8)Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
(9)Department of Psychology, University of Friborg, Fribourg, Switzerland.
(10)Department of Sociology, Centre for Population, Family and Health, 
University of Antwerp, Antwerp, Belgium.
(11)Department of Family Medicine and Primary Care, School of Clinical Medicine, 
Faculty of Health Sciences, University of the Witwatersrand, 
Johannesburg-Braamfontein, Gauteng, South Africa.
(12)Public Health Education, University of North Carolina at Greensboro, 
Greensboro, North Carolina, USA.
(13)Department of Women's and Children's Health, Karolinska Institutet, 
Stockholm, Sweden.
(14)Department of Epidemiology, Mailman School of Public Health, Columbia 
University, New York, NY, USA.
(15)School of Social Justice, Queensland University of Technology, Brisbane, 
Queensland, Australia.
(16)Faculty of Medicine and Health, University of New England, Armidale, New 
South Wales, Australia.
(17)University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, 
North Carolina, USA.
(18)School of Medicine, University of North Carolina at Chapel Hill, Chapel 
Hill, NC, USA.
(19)Faculty of Infectious and Tropical Diseases, London School of Hygiene and 
Tropical Medicine, London, UK.

OBJECTIVES: The COVID-19 pandemic has exposed and exacerbated existing 
socioeconomic and health disparities, including disparities in sexual health and 
well-being. While there have been several reviews published on COVID-19 and 
population health disparities generally-including some with attention to 
HIV-none has focused on sexual health (ie, STI care, female sexual health, 
sexual behaviour). We have conducted a scoping review focused on sexual health 
(excluding reproductive health (RH), intimate partner violence (IPV) and 
gender-based violence (GBV)) in the COVID-19 era, examining sexual behaviours 
and sexual health outcomes.
METHODS: A scoping review, compiling both peer-reviewed and grey literature, 
focused on sexual health (excluding RH, IPV and GBV) and COVID-19 was conducted 
on 15 September 2020. Multiple bibliographical databases were searched. Study 
selection conformed to Joanna Briggs Institute (JBI) Reviewers' Manual 2015 
Methodology for JBI Scoping Reviews. We only included English-language original 
studies.
RESULTS: We found that men who have sex with men may be moving back toward 
pre-pandemic levels of sexual activity, and that STI and HIV testing rates seem 
to have decreased. There was minimal focus on outcomes such as the economic 
impact on sexual health (excluding RH, IPV and GBV) and STI care, especially STI 
care of marginalised populations. In terms of population groups, there was 
limited focus on sex workers or on women, especially women's sexual behaviour 
and mental health. We noticed limited use of qualitative techniques. Very few 
studies were in low/middle-income countries (LMICs).
CONCLUSIONS: Sexual health research is critical during a global infectious 
disease pandemic and our review of studies suggested notable research gaps. 
Researchers can focus efforts on LMICs and under-researched topics within sexual 
health and explore the use of qualitative techniques and interventions where 
appropriate.

© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and 
permissions. Published by BMJ.

DOI: 10.1136/sextrans-2020-054896
PMCID: PMC8380886
PMID: 33782145 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3626. Clin Orthop Relat Res. 2021 Sep 1;479(9):1947-1954. doi: 
10.1097/CORR.0000000000001728.

Has the COVID-19 Pandemic Changed the Daily Practices and Psychological State of 
Orthopaedic Residents?

Castioni D(1), Galasso O(1), Rava A(2), Massè A(2), Gasparini G(1), Mercurio 
M(1); Associazione Italiana Specializzandi in Ortopedia e Traumatologia,.

Author information:
(1)Department of Orthopaedic and Trauma Surgery, Magna Graecia University, Mater 
Domini University Hospital, Catanzaro, Italy.
(2)Department of Orthopaedic and Traumatology, CTO Hospital, University of 
Turin, Turin, Italy.

Comment in
    Clin Orthop Relat Res. 2021 Sep 1;479(9):1955-1956.

BACKGROUND: The coronavirus-19 (COVID-19) pandemic has been an unprecedented 
time for healthcare and has substantially changed resource availability in 
surgeons' work practices and routines. Many orthopaedic departments suspended 
elective surgery, and some re-deployed orthopaedic residents to stressful 
nonorthopaedic tasks; long hours were commonplace. Stress-reaction symptoms such 
as anxiety and depression have been reported in about 10% of healthcare workers 
during previous infectious-diseases outbreaks (including the Ebola virus), but 
little is known about the psychological needs of residents faced with this 
global disaster.
QUESTIONS/PURPOSES: (1) Have anxiety and depression symptoms among orthopaedic 
residents worsened from the period before to the period after the lockdown in 
Italy? (2) Are there differences in anxiety and depression symptoms between 
residents who worked in a COVID-19 department and those who did not?
METHODS: The Italian Association of Orthopaedic and Traumatology Residents is 
comprised of 365 members who were recruited through the organization's mailing 
list; they were asked to respond to a survey about their health and well-being 
at the beginning and end of the first COVID-19 Italian lockdown (March 9, 2020 
to May 3, 2020). For the survey's development, 10 orthopaedic surgery residents 
at the Magna Graecia University of Catanzaro were preliminarily asked to answer 
the surveys, and both face validity and content validity were tested. The 
test-retest reliability was 0.9. Impact on and future concerns about family life 
and daily work practice, as well as sleep disorders, were investigated. Anxiety 
and depression were assessed with the Hospital Anxiety and Depression Scale 
(HADS), which includes 14 questions (seven for anxiety, HADS-A; and seven for 
depression, HADS-D) on a Likert scale (0-3); thus, a patient can have a score 
between 0 and 21 for either the HADS-A or HADS-D, with higher scores indicating 
a greater likelihood of anxiety or depression. Previously reported minimum 
clinically important differences ranged from 1.5 to 1.7. For each scale, total 
scores of ≤ 7 , 8 to 10, and ≥ 11 were taken to represent normal, borderline, or 
abnormal level of anxiety or depression, respectively. Overall, 75% (272 of 365) 
of residents completed the survey at both the beginning and end of the lockdown; 
72% (196 of 272) were men, the mean ± SD age was 30 ± 3 years, 72% (197 of 272) 
worked in a hospital setting with patients who were COVID-19-positive, 20% (55 
of 272) served in a COVID-19 department, and 5% (7 of 139) tested positive for 
COVID-19 by nasal-pharyngeal swab. Overall, 9% (24 of 272) of residents had 
family members who contracted COVID-19, and 3% (8 of 272) had a relative who 
died. Because of the risk of possible COVID-19 exposure, 18% (48 of 272) of 
residents needed to temporarily change their household given that social 
distancing was considered the best way to slow the spread of COVID-19.
RESULTS: At the end of the lockdown, orthopaedic residents exhibited signs of 
worsening anxiety and depression as measured by the overall HADS score (median 9 
[IQR 5 to 14] versus median 11 [IQR 6 to 17.8], respectively; median difference 
-1 [95% CI -1.5 to -0.5]; effect size [r] = -0.24; p < 0.001) as well as in the 
depression subscale (median 4 [IQR 2 to 7] versus median 5.5 [IQR 3 to 8], 
respectively; median difference -1 [95% CI -1.5 to -0.5]; r = -0.36; p < 0.001). 
We found no difference in the development of anxiety or depression between 
residents who worked in a COVID-19 department and those who did not, as 
demonstrated by comparing the change in HADS scores between these groups (median 
1 [IQR -3 to 4] versus median 1 [IQR -2 to 4] in HADS change score over time; 
median difference 0 [95% CI -1 to 2]; r = -0.03; p = 0.61).
CONCLUSION: The COVID-19 pandemic has affected the daily practice of orthopaedic 
residents and has had important, far-reaching consequences on their health and 
well-being, including social implications. Residents showed higher anxiety and 
depression symptoms at the end of the lockdown. No differences were found in 
changes of anxiety and depression, over time, for residents who worked in a 
COVID-19 department compared with those who did not. The evaluation of anxiety 
and depression through standardized questionnaires could help to identify 
residents at risk of higher psychological distress who could be referred to 
regular psychological counseling as a possible prevention strategy during 
stressful times. Future studies should confirm the long-term effects of these 
findings.
LEVEL OF EVIDENCE: Level II, prognostic study.

Copyright © 2021 by the Association of Bone and Joint Surgeons.

DOI: 10.1097/CORR.0000000000001728
PMCID: PMC8373398
PMID: 33780402 [Indexed for MEDLINE]

Conflict of interest statement: Each author certifies that neither he, nor any 
member of his immediate family, has funding or commercial associations 
(consultancies, stock ownership, equity interest, patent/licensing arrangements, 
etc.) that might pose a conflict of interest in connection with the submitted 
article. All ICMJE Conflict of Interest Forms for authors and Clinical 
Orthopaedics and Related Research® editors and board members are on file with 
the publication and can be viewed on request.


3627. Ann Ig. 2022 Jan-Feb;34(1):27-44. doi: 10.7416/ai.2021.2445. Epub 2021 Mar 30.

The impact of Covid-19 healthcare emergency on the psychological well-being of 
health professionals: a review of literature.

Della Monica A(1), Ferrara P(2), Dal Mas F(3), Cobianchi L(4), Scannapieco F(5), 
Ruta F(6).

Author information:
(1)San Giovanni di Dio e Ruggi D'Aragona University Hospital, Cava de' Tirreni, 
Italy.
(2)School of Nursing, S. Paolo Teaching Hospital, University of Milan, Italy.
(3)Department of Management, Lincoln International Business School, University 
of Lincoln, Lincoln, United Kingdom.
(4)Department of Clinic, Diagnostic and Pediatric Science. University of Pavia, 
Italy IRCCS Policlinico San Matteo Founda-tion, General Surgery. Pavia, Italy.
(5)Department of languages and intercultural communication in the 
Euro-Mediterranean area, Orientale University of Naples, Italy.
(6)ASL Barletta-Andria-Trani, Italy.

INTRODUCTION: The Coronavirus pandemic (Covid-19) was first identified in 
December 2019 in the city of Wuhan, China, and later caused a severe health 
crisis, causing massive disruptions to most healthcare sy-stems worldwide. The 
Covid-19 health emergency has seen healthcare workers in the front line facing 
all the difficulties related to the care burden. One of the most significant and 
probably underinvestigated aspects is the psychological stress of the healthcare 
staff managing the emergency. The aim of the paper is to analyze the literature 
on the impact of the Covid-19 crisis on the psychological well-being of health 
professionals.
METHODOLOGY: We conducted a systematic review of articles published on this 
topic during the months from January 2020 to December 2020, searching on Pub 
Med, Scopus and Web of Science databases.
RESULTS: Most of the issues can be summarized into five conceptual categories: 
Stress, Depression and Infec-tion Anxiety, Anguish, Insomnia, Post Traumatic 
Stress Disorder, and Suicide. The literature identifies many factors 
contributing to the onset of anxiety, depression, and stress, like the fear of 
contracting the disease and transmitting it to family members and friends, 
stressful shifts, and little rest among several others. The literature 
highlights the needs for adequate measures, including proper psychological 
support.
CONCLUSION: The conducted review suggests that the behaviours of healthcare 
professionals during the emer-gency phase of the Covid-19 pandemic show 
psychological disorders that can compromise mental health. Therefore, there is a 
call for those in chief like hospital managers and policymakers to take action, 
promoting measures like surveillance, monitoring, and psychological support 
among others, to increase the resilience of healthcare workers, limiting stress 
and anxiety and allowing them to keep their performance at work.

DOI: 10.7416/ai.2021.2445
PMID: 33779676 [Indexed for MEDLINE]


3628. Aging Ment Health. 2022 Mar;26(3):570-577. doi: 10.1080/13607863.2021.1902469. 
Epub 2021 Mar 29.

Psychological well-being and coping strategies of elderly people during the 
COVID-19 pandemic in Hungary.

Lábadi B(1), Arató N(1), Budai T(1), Inhóf O(1), Stecina DT(1), Sík A(2), Zsidó 
AN(1).

Author information:
(1)Institute of Psychology, Faculty of Humanities, University of Pécs, Pécs, 
Hungary.
(2)Institute of Transdisciplinary Discoveries, Medical School, University of 
Pécs, Pécs, Hungary.

OBJECTIVE: During COVID-19 lockdown the enforced social isolation and other 
pandemic-related changes highly increased the risk of mental health problems. We 
aimed to discover how elderly people coped with the psychological burdens of 
pandemic and the social isolation in Hungary.
METHODS: This study included 589 (441 females) Hungarian individuals, aged 60-83 
(M = 68.1, SD = 4.46). We collected online survey data to reach a wide 
population of elderly. Results of hierarchical linear modelling and structural 
equation modelling (SEM) analyses established how the current life-changing 
circumstances, the intolerance of uncertainty, loneliness and social support 
influence the mental health (e.g. depression, anxiety, well-being) of the 
elderly. The model was used to explore how adaptive and maladaptive emotion 
regulation strategies mediated the effects.
RESULTS: Findings showed that perceived change in mood, social connectedness, 
and quality of life was negatively affected by catastrophizing and loneliness; 
whereas positive refocusing and contamination fear had a positive effect. 
According to the SEM analysis, intolerance of uncertainty and loneliness 
directly affected mental health. Further, maladaptive emotion regulation 
strategies mediated the connection between intolerance of uncertainty, 
contamination fear, loneliness and mental health. Whereas adaptive emotion 
regulation strategy mediated the connection between social support from friends, 
contamination fear, loneliness and mental health.
CONCLUSION: Overall, our research might help the understanding of how external 
and internal factors contributed to the well-being of elderly people during the 
COVID-19. The model can also be translated into professional interventions to 
develop coping strategies among elderly for the challenges of COVID-19 pandemic 
in their lives.

DOI: 10.1080/13607863.2021.1902469
PMID: 33779424 [Indexed for MEDLINE]


3629. Intensive Crit Care Nurs. 2021 Aug;65:103036. doi: 10.1016/j.iccn.2021.103036. 
Epub 2021 Mar 26.

The impact of visiting the Intensive Care Unit on children's and adolescents' 
psychological well-being: A systematic review.

Lamiani G(1), Bonazza F(2), Del Negro S(3), Meyer EC(4).

Author information:
(1)Department of Health Sciences, University of Milan, Via Di Rudinì 8, 20142 
Milan, Italy. Electronic address: giulia.lamiani@unimi.it.
(2)Department of Health Sciences, University of Milan, Via Di Rudinì 8, 20142 
Milan, Italy.
(3)ASST Santi Paolo e Carlo, San Carlo Hospital, Via Pio II 3, 20153 Milan, 
Italy.
(4)Department of Psychiatry, Boston Children's Hospital, 300 Longwood Ave, 
Boston, MA 02115, USA; Center for Bioethics, Harvard Medical School, 641 
Huntington Avenue, Boston, MA 02115, USA.

OBJECTIVES: The visits of children/adolescents in adult intensive care units are 
increasingly more common. However, few studies examine the psychological impact 
of visiting. This systematic review aims to summarise the psychological effects 
that visiting family members has on children/adolescents.
RESEARCH METHODOLOGY: A systematic review of research articles published from 
1990 to January 2021 was conducted using PsycInfo, PubMed, and CINAHL. 
Inclusion/exclusion criteria were applied. Those studies included were evaluated 
using the Joanna Briggs Institute Critical Appraisal tools. A narrative 
synthesis of the results was conducted.
SETTING: Adult intensive care unit.
RESULTS: The review identified five studies (three of which qualitative), 
involving 141 children/adolescents. Although the experience of visiting was 
potentially traumatic, it enabled children/adolescents to better understand the 
reality and to preserve their relationships with family members. The impact of 
visiting was influenced by individual characteristics (e.g., age, past traumatic 
experiences) and by organisational characteristics (e.g., facilitated visit or 
not). Regardless of visitation, most children/adolescents presented anxiety and 
depression symptoms that need to be addressed.
CONCLUSIONS: Child/adolescent visitation seems to have positive effects, 
provided there is preparation and facilitation. Clinicians should pay attention 
to individual characteristics and optimise organisational factors (e.g., 
environment) in order to minimise potentially trauma-inducing aspects.

Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.iccn.2021.103036
PMID: 33775551 [Indexed for MEDLINE]


3630. Acta Med Port. 2021 May 2;34(5):355-361. doi: 10.20344/amp.14805. Epub 2021 Mar 
26.

The Impact of the COVID-19 Pandemic on Children's Health in Portugal: The 
Parental Perspective.

Poppe M(1), Aguiar B(1), Sousa R(1), Oom P(1).

Author information:
(1)Department of Pediatrics. Hospital Beatriz Ângelo. Loures. Portugal.

Comment in
    Acta Med Port. 2021 Oct 1;34(10):707-708.

INTRODUCTION: The COVID-19 pandemic poses unprecedented challenges for 
healthcare services and has led to changes in the usage pattern of the pediatric 
population. We aimed to describe the impact of COVID-19 on children's health, 
wellbeing, and access to medical care in Portugal.
MATERIAL AND METHODS: We conducted a cross-sectional study through an anonymous 
online survey via social media. The collected data refers to a period between 
the 16th of March and the 17th of May 2020.
RESULTS: We obtained responses to the survey on 19 745 children. Of the 
previously scheduled outpatient consultations, 54.2% were postponed by 
healthcare institutions and 21.6% of planned vaccinations were missed. Parents 
expressed concerns regarding psychological, social, and physical consequences 
for their children due to the pandemic.
DISCUSSION: The observed reduction of pediatric emergency department visits and 
the postponement of outpatient consultations and vaccine administrations are 
potentially harmful for non-COVID patients. The current pandemic and the imposed 
social distance might have an important negative impact on the mental health of 
children.
CONCLUSION: Further studies are necessary to fully comprehend the outcomes of 
the decreased access to medical care, as well as the collateral damage for 
children beyond the clinical aspects of the pandemic. Defining strategies 
regarding the urge to vaccinate children and not postpone urgent evaluations 
should be a public health priority.

Publisher: Introdução: A pandemia COVID-19 constitui um desafio sem precedentes 
para os serviços de saúde e conduziu a alterações no padrão de utilização dos 
recursos pela população pediátrica. Procurámos descrever o impacto da pandemia 
COVID-19 na saúde infantil e no acesso à saúde em Portugal. Material e Métodos: 
Realizámos um estudo retrospetivo, recolhendo dados através da aplicação de um 
inquérito anónimo online nas redes sociais. Os dados referem-se ao período entre 
16 de março e 17 de maio de 2020. Resultados: Obtivemos respostas ao inquérito 
relativas a 19 745 crianças. Da análise às respostas, concluímos que 54,2% das 
consultas previamente agendadas foram adiadas pelas instituições de saúde e 
21,6% das vacinações previstas não se realizaram. Os pais expressaram 
preocupação quanto às consequências psicológicas, sociais e físicas da pandemia 
nos seus filhos. Discussão: A reduzida utilização dos serviços de urgência 
pediátricos, bem como a não realização de consultas e vacinações previamente 
agendadas é potencialmente lesiva para os doentes não-COVID. A pandemia e o 
isolamento social imposto poderão causar um impacto negativo na saúde mental das 
crianças. Conclusão: Estudos adicionais são necessários para melhor compreender 
as consequências da diminuição do acesso à saúde, bem como os efeitos 
psicológicos, sociais e físicos nas crianças. A definição de estratégias para 
incentivar a vacinação e o não adiamento de avaliações médicas urgentes deveriam 
ser prioridades de Saúde Pública.

DOI: 10.20344/amp.14805
PMID: 33775275 [Indexed for MEDLINE]


3631. Turk J Med Sci. 2021 Aug 30;51(4):1631-1639. doi: 10.3906/sag-2011-188.

Effects of the COVID-19 pandemic on psychology and disease activity in patients 
with ankylosing spondylitis and rheumatoid arthritis.

Gıca Ş(1), Akkubak Y(2), Aksoy ZK(1), Küçük A(3), Cüre E(4).

Author information:
(1)Department of Psychiatry, Meram Medical Faculty, Necmettin Erbakan 
University, Konya, Turkey
(2)Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, 
Necmettin Erbakan University, Konya, Turkey
(3)Department of Rheumatology, Meram Medical Faculty, Necmettin Erbakan 
University, Konya, Turkey
(4)Department of Internal Medicine, Ota Jinemed Hospital, İstanbul, Turkey

BACKGROUND/AIM: The COVID-19 outbreak is known to increase stress levels of most 
patients with chronic diseases. Patients with ankylosing spondylitis (AS) and 
rheumatoid arthritis (RA) are highly susceptible to environmental stress. In the 
current study, we aimed to determine how the COVID-19 pandemic psychologically 
affected patients with chronic progressive diseases such as AS and RA and the 
effects of these psychological factors on disease activity.
MATERIALS AND METHODS: Age and sex-matched patients with AS (n = 80), RA (n = 
80), and healthy controls (n = 80) were included in the study. All participants 
were evaluated with the “Perceived COVID-19 Threat Form (PCTF)”, 
“Suicide-Ideation Scale (SIS)”, “Hospital Anxiety and Depression Scale (HADS)”, 
“The Ability to Cope with Trauma (PACT)”, and “Psychological General Well-Being 
Index (PGWB)” scales. BASDAI was used in patients with AS, and DAS28 was used in 
patients with RA to assess disease severity.
RESULTS: Compared to healthy individuals, patients with RA and AS had lower PGWB 
scores and higher HADS depression and anxiety subscale scores. Almost all 
psychometric assessment test scores were worse in AS patients with high-disease 
activity compared to those in low-disease activity. PACT scores were higher in 
patients with moderate RA compared to patients with mild RA (p = 0.006). While a 
positive correlation was identified between BASDAI and most of the psychometric 
assessment test scores (r = 0 .36 for PCTF, r = 0.53 for depressive scores, r = 
0.54 for anxiety scores, r = 0.57 for suicidal ideation), DAS28 scores were 
found to be associated only with PACT total and PACT perceived forward-focused 
subscale scores (r = –.26 and r = .33, respectively).
CONCLUSION: Psychologically, AS and RA patients were found to be worse off 
compared to healthy controls. The perceived COVID threat and psychological 
status were associated with disease activity in AS, but not RA patients. 
Patients with chronic illnesses may be more vulnerable to the psychological 
effects of the pandemic, which can worsen disease activity.

This work is licensed under a Creative Commons Attribution 4.0 International 
License.

DOI: 10.3906/sag-2011-188
PMCID: PMC8569757
PMID: 33773523 [Indexed for MEDLINE]

Conflict of interest statement: CONFLICT OF INTEREST: none declared


3632. PLoS One. 2021 Mar 26;16(3):e0249098. doi: 10.1371/journal.pone.0249098. 
eCollection 2021.

How to bring residents' psychosocial well-being to the heart of the fight 
against Covid-19 in Belgian nursing homes-A qualitative study.

Kaelen S(1), van den Boogaard W(2), Pellecchia U(2), Spiers S(1), De Cramer 
C(1), Demaegd G(1), Fouqueray E(1), Van den Bergh R(1), Goublomme S(1), Decroo 
T(3), Quinet M(4), Van Hoof E(5)(6)(7), Draguez B(1).

Author information:
(1)Belgium Covid-19 Project, Médecins Sans Frontières, Operational Centre 
Brussels, Brussels, Belgium.
(2)Médecins Sans Frontières, Operational Centre Brussels, Operational Research 
Unit (LuxOR), Luxembourg, Luxembourg/Brussels, Belgium.
(3)Institute of Tropical Medicine, Antwerp, Belgium.
(4)Iriscare, Public Health Institute, Brussels, Belgium.
(5)Working Group on the Psychosocial Impact of the COVID-19 Pandemic Within the 
Superior Health Council, Brussels, Belgium.
(6)Mental Health Sub-working Group, GEES, Brussels, Belgium.
(7)Vrije Universiteit Brussel, Brussels, Belgium.

Erratum in
    PLoS One. 2024 Feb 22;19(2):e0299576.

BACKGROUND: Nursing homes (NH) for the elderly have been particularly affected 
by the Covid-19 pandemic mainly due to their hosted vulnerable populations and 
poor outbreak preparedness. In Belgium, the medical humanitarian organization 
Médecins Sans Frontières (MSF) implemented a support project for NH including 
training on infection prevention and control (IPC), (re)-organization of care, 
and psychosocial support for NH staff. As psychosocial and mental health needs 
of NH residents in times of Covid-19 are poorly understood and addressed, this 
study aimed to better understand these needs and how staff could respond 
accordingly.
METHODS: A qualitative study adopting thematic content analysis. Eight focus 
group discussions with direct caring staff and 56 in-depth interviews with 
residents were conducted in eight purposively and conveniently selected NHs in 
Brussels, Belgium, June 2020.
RESULTS: NH residents experienced losses of freedom, social life, autonomy, and 
recreational activities that deprived them of their basic psychological needs. 
This had a massive impact on their mental well-being expressed in feeling 
depressed, anxious, and frustrated as well as decreased meaning and quality of 
life. Staff felt unprepared for the challenges posed by the pandemic; lacking 
guidelines, personal protective equipment and clarity around organization of 
care. They were confronted with professional and ethical dilemmas, feeling 
'trapped' between IPC and the residents' wellbeing. They witnessed the 
detrimental effects of the measures imposed on their residents.
CONCLUSION: This study revealed the insights of residents' and NH staff at the 
height of the early Covid-19 pandemic. Clearer outbreak plans, including 
psychosocial support, could have prevented the aggravated mental health 
conditions of both residents and staff. A holistic approach is needed in NHs in 
which tailor-made essential restrictive IPC measures are combined with 
psychosocial support measures to reduce the impact on residents' mental health 
impact and to enhance their quality of life.

DOI: 10.1371/journal.pone.0249098
PMCID: PMC7997017
PMID: 33770110 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


3633. Cerebellum. 2021 Dec;20(6):896-903. doi: 10.1007/s12311-021-01260-9. Epub 2021 
Mar 25.

Impacts of the COVID-19 Pandemic on the Mental Health and Motor Deficits in 
Cuban Patients with Cerebellar Ataxias.

González-Garcés Y(1), Domínguez-Barrios Y(2), Zayas-Hernández A(3), 
Sigler-Villanueva AA(4), Canales-Ochoa N(1), Hernández Oliver MO(5), 
Ramírez-Bautista MB(6), Caballero-Laguna A(7), Arrufat-Pie E(8), Carrillo-Rodes 
FJ(1), Medrano-Montero J(1), Rodríguez-Álvarez Y(9), Gámez-Rodríguez O(10), 
Guerra-Rondón LA(11), Aguilera-Batista O(12), Vazquez-Mojena Y(13), 
Rodríguez-Labrada R(14), Velázquez-Pérez L(15); Cuban Hereditary Ataxias 
Network.

Author information:
(1)Centre for the Research and Rehabilitation of Hereditary Ataxias, Libertad 
26, Holguín, Cuba.
(2)National Institute of Neurology and Neurosurgery "Rafael Estrada", 29th 
Street 139, Vedado, Plaza de la Revolución, Havana, Cuba.
(3)Polyclinic "Manuel Fajardo Rivero", Urbano Noris, Holguín, Cuba.
(4)University Hospital "Antonio Luaces", "Máximo Gomez" 257, Ciego de Avila, 
Cuba.
(5)Pediatric Hospital "José Luis Miranda", "26 de Julio" Ave, Escambray, Santa 
Clara, Cuba.
(6)University Hospital "Lucía Iñíguez", "Celia Sánchez" Avenue 1, Holguín, Cuba.
(7)Clinical & Surgical Hospital "Guillermo Domínguez" Puerto Padre, Las Tunas, 
Cuba.
(8)Clinical & Surgical Hospital "Manuel Piti Fajardo", Plaza de la Revolución, 
Cuba.
(9)University of Camagüey, Camagüey, Cuba.
(10)University Hospital "Juan Bruno Zayas", Carretera del Caney Street. 
Pastorita, Santiago de Cuba, Cuba.
(11)Municipal Center of Medical Genetics, 1st Street, Cauto Cristo, Granma, 
Cuba.
(12)Medical University of Holguin, Holguin, Cuba.
(13)Cuban Centre for Neuroscience, Playa. 190 St. And 25th Ave., 19818, Playa, 
Havana, Cuba.
(14)Cuban Centre for Neuroscience, Playa. 190 St. And 25th Ave., 19818, Playa, 
Havana, Cuba. roberto.rodriguez@cneuro.edu.cu.
(15)Cuban Academy of Sciences, Cuba St. 460, between Teniente Rey St. and 
Compostela St. Habana Vieja, 19100, Havana, Cuba. velazq63@gmail.com.

Although there are no convincing evidences of detrimental effect of SARS-CoV2 
infection on the cerebellum, the COVID-19 pandemic could impact the life quality 
of patients with cerebellar ataxias, but few studies have addressed this 
concern. To assess the motor and mental health changes caused by the COVID-19 
pandemics in Cuban patients with cerebellar ataxias, three hundred four patients 
with cerebellar ataxias and 167 healthy controls were interviewed for risks of 
exposure to COVID-19, and the self-perception of the pandemics' impact on the 
disease progression and on the mental health. All subjects underwent the 
Hospital Anxiety and Depression Scale. The patients reported low exposition to 
SARS-CoV2 infection, but one case was confirmed with a mild COVID-19. Overall, 
depressive and anxiety symptoms were significantly and marginally increased in 
patients, respectively, with higher scores in cases with severe and moderate 
ataxia. Positive patient's impression of psychopathological changes was 
associated to increased age, age at onset, and anxiety. Sixty-seven patients had 
a positive self-perception of ataxia progression, which was mainly influenced by 
higher anxiety scores but not by the adherence to at-home exercise programs. 
However, the practice of physical exercise was related with lower depression and 
anxiety scores, but this therapeutical effect was not significantly influenced 
by the disease stage. We demonstrated the negative effect of the COVID-19 
pandemic on the mental and motor deficits in Cuban patients with cerebellar 
ataxias and the positive effect of the at-home physical exercise programs on 
their mental well-being. These findings give rationales to develop tele-medicine 
approaches to minimize these health impacts and to study the long-term effects 
of such sequelae and accordingly define their treatments.

© 2021. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s12311-021-01260-9
PMCID: PMC7993441
PMID: 33768478 [Indexed for MEDLINE]

Conflict of interest statement: All authors declare no competing interests.


3634. Eur Respir J. 2021 Jul 29;58(1):2004497. doi: 10.1183/13993003.04497-2020. Print 
2021 Jul.

The impact of asthma on mental health and wellbeing during COVID-19 lockdown.

Higbee DH(1)(2), Nava GW(2), Kwong ASF(1)(3), Dodd JW(4)(2)(5), Granell R(1)(5).

Author information:
(1)MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK.
(2)Academic Respiratory Unit, University of Bristol, Southmead Hospital, 
Bristol, UK.
(3)Division of Psychiatry, Centre for Clinical Brain Sciences, University of 
Edinburgh, Edinburgh, UK.
(4)MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK 
james.dodd@bristol.ac.uk.
(5)Joint senior authors.

People with asthma are more vulnerable to the negative mental health impact of 
lockdown. This is not explained by mental or physical comorbidities and 
highlights the need to provide support for anxiety and depression in younger 
people with asthma. https://bit.ly/3tEblYS

It has been assumed that people with asthma would be at a high risk of 
developing severe illness from coronavirus disease 2019 (COVID-19), despite a 
lack of evidence [1]. Social isolation measures have aimed to mitigate this risk 
to vulnerable groups; however, such interventions can have negative mental 
health impacts [2].

DOI: 10.1183/13993003.04497-2020
PMCID: PMC7996219
PMID: 33766952 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest: G.W. Nava has nothing to 
disclose. Conflict of interest: A.S.F. Kwong has nothing to disclose. Conflict 
of interest: J.W. Dodd reports non-financial support for meeting attendance from 
Chiesi, personal fees for lectures from Chiesi, Boehringer Ingelheim and 
AstraZeneca, personal fees for advisory board work from GSK, outside the 
submitted work. Conflict of interest: R. Granell has nothing to disclose. 
Conflict of interest: D.H. Higbee has nothing to disclose.


3635. BMC Health Serv Res. 2021 Mar 25;21(1):279. doi: 10.1186/s12913-021-06284-9.

The impact of the COVID-19 pandemic on child health and the provision of Care in 
Paediatric Emergency Departments: a qualitative study of frontline emergency 
care staff.

Conlon C(1), McDonnell T(1), Barrett M(2), Cummins F(3), Deasy C(4), Hensey 
C(5), McAuliffe E(1), Nicholson E(6).

Author information:
(1)UCD Centre for Interdisciplinary Research Education and Innovation in Health 
Systems, UCD School of Nursing, Midwifery & Health Systems, University College 
Dublin, Dublin, Ireland.
(2)Children's Health Ireland at Crumlin, Dublin; Women's and Children's Health, 
School of Medicine, University College Dublin; National Children's Research 
Centre, Dublin, Ireland.
(3)REDSPOT, Emergency Department, Limerick University Hospital, Limerick, 
Ireland.
(4)Cork University Hospital, Cork, Ireland.
(5)Children's Health Ireland at Temple Street, Dublin, Ireland.
(6)UCD Centre for Interdisciplinary Research Education and Innovation in Health 
Systems, UCD School of Nursing, Midwifery & Health Systems, University College 
Dublin, Dublin, Ireland. emma.nicholson@ucd.ie.

BACKGROUND: The COVID-19 pandemic and subsequent public health guidance to 
reduce the spread of the disease have wide-reaching implications for children's 
health and wellbeing. Furthermore, paediatric emergency departments (EDs) have 
rapidly adapted provision of care in response to the pandemic. This qualitative 
study utilized insight from multidisciplinary frontline staff to understand 1) 
the changes in paediatric emergency healthcare utilization during COVID-19 2) 
the experiences of working within the restructured health system.
METHODS: Fifteen semi-structured interviews were conducted with frontline staff 
working in two paediatric EDs and two mixed adult and children EDs. Participants 
included emergency medicine clinicians (n = 5), nursing managerial staff 
(n = 6), social workers (n = 2) and nursing staff (n = 2). Thematic Analysis 
(TA) was applied to the data to identify key themes.
RESULTS: The pandemic and public health restrictions have had an adverse impact 
on children's health and psychosocial wellbeing, compounded by difficulty in 
accessing primary and community services. The impact may have been more acute 
for children with disabilities and chronic health conditions and has raised 
child protection issues for vulnerable children. EDs have shown innovation and 
agility in the structural and operational changes they have implemented to 
continue to deliver care to children, however resource limitations and other 
challenges must be addressed to ensure high quality care delivery and protect 
the wellbeing of those tasked with delivering this care.
CONCLUSIONS: The spread of COVID-19 and subsequent policies to address the 
pandemic has had wide-reaching implications for children's health and wellbeing. 
The interruption to health and social care services is manifesting in myriad 
ways in the ED, such as a rise in psychosocial presentations. As the pandemic 
continues to progress, policy makers and service providers must ensure the 
continued provision of essential health and social services, including targeted 
responses for those with existing conditions.

DOI: 10.1186/s12913-021-06284-9
PMCID: PMC7993902
PMID: 33766026 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3636. PLoS One. 2021 Mar 25;16(3):e0248509. doi: 10.1371/journal.pone.0248509. 
eCollection 2021.

In the long shadow of our best intentions: Model-based assessment of the 
consequences of school reopening during the COVID-19 pandemic.

Johnson KE(1)(2), Stoddard M(2), Nolan RP(3), White DE(4), Hochberg NS(5)(6), 
Chakravarty A(2).

Author information:
(1)Department of Integrative Biology, The University of Texas at Austin, Austin, 
TX, United States of America.
(2)Fractal Therapeutics, Cambridge, MA, United States of America.
(3)Halozyme Therapeutics, San Diego, CA, United States of America.
(4)Independent Researcher, Atlanta, GA, United States of America.
(5)Department of Epidemiology, Boston University School of Public Health, 
Boston, MA, United States of America.
(6)Department of Medicine, Boston University School of Medicine, Boston, MA, 
United States of America.

As the world grapples with the ongoing COVID-19 pandemic, a particularly thorny 
set of questions surrounds the reopening of primary and secondary (K-12) 
schools. The benefits of in-person learning are numerous, in terms of education 
quality, mental health, emotional well-being, equity and access to food and 
shelter. Early reports suggested that children might have reduced susceptibility 
to COVID-19, and children have been shown to experience fewer complications than 
older adults. Over the past few months, our understanding of COVID-19 has been 
further shaped by emerging data, and it is now understood that children are as 
susceptible to infection as adults and have a similar viral load during 
infection, even if asymptomatic. Based on this updated understanding of the 
disease, we have used epidemiological modeling to explore the feasibility and 
consequences of school reopening in the face of differing rates of COVID-19 
prevalence and transmission. We focused our analysis on the United States, but 
the results are applicable to other countries as well. We demonstrate the 
potential for a large discrepancy between detected cases and true infections in 
schools due to the combination of high asymptomatic rates in children coupled 
with delays in seeking testing and receiving results from diagnostic tests. Our 
findings indicate that, regardless of the initial prevalence of the disease, and 
in the absence of robust surveillance testing and contact-tracing, most schools 
in the United States can expect to remain open for 20-60 days without the 
emergence of sizeable disease clusters. At this point, even if schools choose to 
close after outbreaks occur, COVID-19 cases will be seeded from these school 
clusters and amplified into the community. Thus, our findings suggest that the 
debate between the risks to student safety and benefits of in-person learning 
frames a false dual choice. Reopening schools without surveillance testing and 
contact tracing measures in place will lead to spread within the schools and 
within the communities that eventually forces a return to remote learning and 
leaves a trail of infection in its wake.

DOI: 10.1371/journal.pone.0248509
PMCID: PMC7993767
PMID: 33765026 [Indexed for MEDLINE]

Conflict of interest statement: AC and MS are employees of Fractal Therapeutics, 
Inc, and AC, MS, RN and DEW are shareholders in Fractal Therapeutics, Inc. RN is 
a shareholder of Halozyme Therapeutics, Inc. This does not alter our adherence 
to PLOS ONE policies on sharing data and materials. Neither organization has a 
commercial interest in any products or services related to the subject of this 
paper (the implications of school reopening without adequate surveillance 
testing). The authors have no other commercial competing interests to declare. 
AC, NH and RN are parents of school and preschool-age children, and thus have a 
personal competing interest in the topic of this paper. All authors are members 
of the community, and thus have a personal stake in the topic of this paper 
given the current circumstances.


3637. Eur J Cancer Care (Engl). 2021 Sep;30(5):e13442. doi: 10.1111/ecc.13442. Epub 
2021 Mar 25.

Evaluating the impact of COVID-19 on supportive care needs, psychological 
distress and quality of life in UK cancer survivors and their support network.

Hulbert-Williams NJ(1), Leslie M(1), Hulbert-Williams L(1), Smith E(1), Howells 
L(2), Pinato DJ(3).

Author information:
(1)Centre for Contextual Behavioural Science, School of Psychology, University 
of Chester, Chester, UK.
(2)Maggie's Cancer Centres, London, UK.
(3)Department of Surgery & Cancer, Imperial College London, Hammersmith 
Hospital, London, UK.

OBJECTIVES: The COVID-19 pandemic is having considerable impact on cancer care, 
including restricted access to hospital-based care, treatment and psychosocial 
support. We investigated the impact on unmet needs and psychosocial well-being.
METHODS: One hundred and forty four participants (77% female), including people 
with cancer and their support networks, were recruited. The most prevalent 
diagnosis was breast cancer. Forty-one participants recruited pre-pandemic were 
compared with 103 participants recruited during the COVID-19 pandemic. We 
measured participants' unmet supportive care needs, psychological distress and 
quality of life.
RESULTS: Half of our patient respondents reported unexpected changes to 
treatment following pandemic onset, with widespread confusion about their 
longer-term consequences. Although overall need levels have not increased, 
specific needs have changed in prominence. People with cancer reported 
significantly reduced anxiety (p = 0.049) and improved quality of life 
(p = 0.032) following pandemic onset, but support network participants reported 
reduced quality of life (p = 0.009), and non-significantly elevated anxiety, 
stress and depression.
CONCLUSION: Psychological well-being of people with cancer has not been 
detrimentally affected by pandemic onset. Reliance on home-based support to 
compensate for the lost availability of structured healthcare pathways may, 
however, explain significant and detrimental effects on the well-being and 
quality of life of people in their support and informal care networks.

© 2021 The Authors. European Journal of Cancer Care published by John Wiley & 
Sons Ltd.

DOI: 10.1111/ecc.13442
PMCID: PMC8250124
PMID: 33764611 [Indexed for MEDLINE]

Conflict of interest statement: DJP received lecture fees from ViiV Healthcare, 
Bayer Healthcare and travel expenses from BMS and Bayer Healthcare; consulting 
fees for Mina Therapeutics, EISAI, Roche, Astra Zeneca; received research 
funding (to institution) from MSD, BMS. All other authors declare no conflict of 
interest.


3638. BMC Emerg Med. 2021 Mar 24;21(1):36. doi: 10.1186/s12873-021-00425-3.

Prospective study of emergency medicine provider wellness across ten academic 
and community hospitals during the initial surge of the COVID-19 pandemic.

Kelker H(1), Yoder K(1), Musey P Jr(1), Harris M(2), Johnson O(2), Sarmiento 
E(2), Vyas P(2), Henderson B(1), Adams Z(3), Welch J(4).

Author information:
(1)Department of Emergency Medicine, Indiana University School of Medicine, 1701 
N. Senate Blvd, Indianapolis, IN, 46202, USA.
(2)Indiana University School of Medicine, Indianapolis, IN, USA.
(3)Department of Psychiatry, Indiana University School of Medicine, 
Indianapolis, IN, USA.
(4)Department of Emergency Medicine, Indiana University School of Medicine, 1701 
N. Senate Blvd, Indianapolis, IN, 46202, USA. jlwelch@iu.edu.

Update of
    Res Sq. 2020 Oct 15;:

BACKGROUND: While COVID-19 has had far-reaching consequences on society and 
health care providers, there is a paucity of research exploring frontline 
emergency medicine (EM) provider wellness over the course of a pandemic. The 
objective of this study was to assess the well-being, resilience, burnout, and 
wellness factors and needs of EM physicians and advanced practice providers 
(e.g., nurse practitioners and physician assistants; APPs) during the initial 
phase of the COVID-19 pandemic.
METHODS: A descriptive, prospective, cohort survey study of EM physicians and 
APPs was performed across ten emergency departments in a single state, including 
academic and community settings. Participants were recruited via email to 
complete four weekly, voluntary, anonymous questionnaires comprised of 
customized and validated tools for assessing wellness (Well Being Index), 
burnout (Physician Work Life Study item), and resilience (Brief Resilience 
Scale) during the initial acceleration phase of COVID-19. Univariate and 
multivariate analysis with Chi-squared, Fisher's Exact, and logistic regression 
was performed.
RESULTS: Of 213 eligible participants, response rates ranged from 31 to 53% over 
four weeks. Women comprised 54 to 60% of responses. Nonrespondent 
characteristics were similar to respondents. Concern for personal safety 
decreased from 85 to 61% (p < 0.001). Impact on basic self-care declined from 66 
to 32% (p < 0.001). Symptoms of stress, anxiety, or fear was initially 83% and 
reduced to 66% (p = 0.009). Reported strain on relationships and feelings of 
isolation affected > 50% of respondents initially without significant change 
(p = 0.05 and p = 0.30 respectively). Women were nearly twice as likely to 
report feelings of isolation as men (OR 1.95; 95% CI 1.82-5.88). Working 
part-time carried twice the risk of burnout (OR, 2.45; 95% CI, 1.10-5.47). 
Baseline resilience was normal to high. Provider well-being improved over the 
four weeks (30 to 14%; p = 0.01), but burnout did not significantly change (30 
to 22%; p = 0.39).
CONCLUSION: This survey of frontline EM providers, including physicians and 
APPs, during the initial surge of COVID-19 found that despite being a resilient 
group, the majority experienced stress, anxiety, fear, and concerns about 
personal safety due to COVID-19, putting many at risk for burnout. The sustained 
impact of the pandemic on EM provider wellness deserves further investigation to 
guide targeted interventions.

DOI: 10.1186/s12873-021-00425-3
PMCID: PMC7988634
PMID: 33761876 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3639. Arq Neuropsiquiatr. 2021 Feb;79(2):149-155. doi: 
10.1590/0004-282X-anp-2020-0449.

Impact of COVID-19 pandemic on the sleep quality of medical professionals in 
Brazil.

Brito-Marques JMAM(1), Franco CMR(1)(2)(3), Brito-Marques PR(1)(4), Martinez 
SCG(2)(3), Prado GFD(3)(5).

Author information:
(1)Universidade de Pernambuco, Hospital Universitário Oswaldo Cruz, Departamento 
de Neurologia, Recife PE, Brazil.
(2)Universidade Federal de Pernambuco, Unidade de Neurologia e Neurocirurgia, 
Departamento de Neuropsiquiatria, Recife PE, Brazil.
(3)Academia Brasileira de Neurologia, Departamento Científico de Sono, São Paulo 
SP, Brazil.
(4)Universidade de Pernambuco, Faculdade de Ciências Médicas, Recife PE, Brazil.
(5)Universidade Federal de São Paulo, Unidade de Neurologia, São Paulo SP, 
Brazil.

INTRODUCTION: Coronavirus pandemic began in China in 2019 (COVID-19), causing 
not only public health problems but also great psychological distress, 
especially for physicians involved in coping with the virus or those of the risk 
group in social isolation, and this represents a challenge for the psychological 
resilience in the world population. Studies showed that health professionals had 
psychological symptoms such as depression, anxiety, insomnia, stress, among 
others.
OBJECTIVES: To investigate the quality of sleep and the prevalence rate of 
sleeping disorders among physicians during COVID-19 pandemic, and identify the 
psychological and social factors associated with the condition.
METHODS: A cross-sectional study of an online questionnaire was applied for 
physicians in Brazil. Among the 332 participants included, 227 were women. 
Sociodemographic assessment was used in the questionnaire, as well as the scale 
of impact on the events of modifications caused by COVID-19, assessment on sleep 
quality (PSQI), presence and severity of insomnia (ISI), depressive symptoms 
(PHQ-9), and anxiety (GAD-7).
RESULTS: Most physicians (65.6%) had changes in sleep. Poor sleep quality was 
reported by 73.1%, depressive symptoms were present in 75.8%, and anxiety in 
73.4%.
CONCLUSION: Our study found that more than 70% of the physicians assessed had 
impaired sleep quality, characterizing insomnia symptoms during COVID-19 
outbreak. Related factors included an environment of isolation, concerns about 
COVID-19 outbreak and symptoms of anxiety and depression. Special interventions 
are needed to promote health professionals' mental well-being and implement 
changes in this scenario.

DOI: 10.1590/0004-282X-anp-2020-0449
PMID: 33759982 [Indexed for MEDLINE]


3640. Psychiatriki. 2021 Apr 19;32(1):19-25. doi: 10.22365/jpsych.2021.001. Epub 2021 
Mar 8.

Secondary traumatic stress and vicarious posttraumatic growth in healthcare 
workers during the first COVID-19 lockdown in Greece: The role of resilience and 
coping strategies.

Kalaitzaki A(1), Rovithis M(1).

Author information:
(1)Laboratory of Interdisciplinary Approaches to the Enhancement of Quality of 
Life, Social Work Department, Hellenic Mediterranean University, Heraklion, 
Crete, Greece.

Despite the indisputable negative psychosocial consequences of the COVID-19 
pandemic, positive consequences are also possible. Resilience and coping 
strategies have been assumed to contribute to these outcomes. However, findings 
are still scarce and inconclusive. The study aimed to examine the role of 
resilience and coping strategies in the secondary stress for the Greek 
healthcare workers (HCWs) and in the posttraumatic growth following the COVID-19 
lockdown in Greece. A sample of 673 HCWs coming from Greece were recruited. A 
convenience and snowball mixed sampling procedure were used. A questionnaire was 
distributed through social networking sites, webpages, and personal contacts of 
the author. Participants were asked to distribute it to their own contacts. 
Recruitment occurred during April 5 - 30, 2000, amid the lockdown (March 23-May 
03), when people were asked to follow the stringent lockdown constraint enforced 
by the Greek government. Sociodemographic data were collected. The Secondary 
Traumatic Stress Scale measured secondary traumatic stress (STS) for the HCWs. 
The Post-Traumatic Growth Inventory, the Brief Resilience Scale, and the Coping 
Orientation to Problems Experienced Inventory measured posttraumatic growth, 
resilience, and coping strategies, respectively. Regression analyses 
demonstrated that resilience and coping strategies were differentially 
associated with positive and negative (stress/growth) lockdown outcomes. 
Resilience and mostly maladaptive coping strategies predicted STS. A mixture of 
adaptive and maladaptive coping strategies predicted PTG. The so-called "second 
wave" of the outbreak that started in August 2020 indicates that the study of 
the psychosocial impact of the COVID-19 pandemic and lockdown and of the 
internal resources (resilience and coping) to deal with, is necessary. The 
findings contribute to a more comprehensive understanding of the coping 
strategies used by population subgroups (e.g., HCWs) in dealing with the 
COVID-19 lockdown in Greece. Enhancing internal resources through supportive 
services will ameliorate HCWs ability to withstand, recover, and thrive with 
benefits in their psychological health and well-being. Despite the indisputable 
negative psychosocial consequences of the COVID-19 pandemic, positive 
consequences are also possible. Resilience and coping strategies have been 
assumed to contribute to these outcomes. However, findings are still scarce and 
inconclusive. The study aimed to examine the role of resilience and coping 
strategies in the secondary stress for the Greek healthcare workers (HCWs) and 
in the posttraumatic growth following the COVID-19 lockdown in Greece. A sample 
of 673 HCWs coming from Greece were recruited. A convenience and snowball mixed 
sampling procedure were used. A questionnaire was distributed through social 
networking sites, webpages, and personal contacts of the author. Participants 
were asked to distribute it to their own contacts. Recruitment occurred during 
April 5 - 30, 2000, amid the lockdown (March 23-May 03), when people were asked 
to follow the stringent lockdown constraint enforced by the Greek government. 
Sociodemographic data were collected. The Secondary Traumatic Stress Scale 
measured secondary traumatic stress (STS) for the HCWs. The Post-Traumatic 
Growth Inventory, the Brief Resilience Scale, and the Coping Orientation to 
Problems Experienced Inventory measured posttraumatic growth, resilience, and 
coping strategies, respectively. Regression analyses demonstrated that 
resilience and coping strategies were differentially associated with positive 
and negative (stress/growth) lockdown outcomes. Resilience and mostly 
maladaptive coping strategies predicted STS. A mixture of adaptive and 
maladaptive coping strategies predicted PTG. The so-called "second wave" of the 
outbreak that started in August 2020 indicates that the study of the 
psychosocial impact of the COVID-19 pandemic and lockdown and of the internal 
resources (resilience and coping) to deal with, is necessary. The findings 
contribute to a more comprehensive understanding of the coping strategies used 
by population subgroups (e.g., HCWs) in dealing with the COVID-19 lockdown in 
Greece. Enhancing internal resources through supportive services will ameliorate 
HCWs ability to withstand, recover, and thrive with benefits in their 
psychological health and well-being.

DOI: 10.22365/jpsych.2021.001
PMID: 33759805 [Indexed for MEDLINE]


3641. Psychiatriki. 2021 Apr 19;32(1):15-18. doi: 10.22365/jpsych.2021.010. Epub 2021 
Mar 8.

The need for holistic, longitudinal and comparable, real-time assessment of the 
emotional, behavioral and societal impact of the COVID-19 pandemic across 
nations.

[Article in English, Greek, Modern]

Agorastos A(1), Tsamakis K(2), Solmi M(3), Correll CU(4), Bozikas VP(5).

Author information:
(1)Assistant Professor of Psychiatry, 2nd Department of Psychiatry, School of 
Medicine, Aristotle University of Thessaloniki, Greece.
(2)Research Associate, Institute of Psychiatry, Psychology and Neuroscience, 
King's College London, UK.
(3)Assistant Professor of Psychiatry Department of Neuroscience, University of 
Padua, Italy.
(4)Professor of Child and Adolescent Psychiatry Department of Child & Adolescent 
Psychiatry, Psychotherapy and Psychosomatics, Charité University Medical Center 
Berlin, Germany Professor of Psychiatry and Molecular Medicine Donald and 
Barbara Zucker School of Medicine at Hofstra/Northwell Hempstead, NY, USA.
(5)Professor of Psychiatry 2nd Department of Psychiatry, School of Medicine, 
Aristotle University of Thessaloniki, Greece.

As of the end of 2020, the COVID-19 pandemic has led to over 82 million verified 
infections and almost 1.8 million COVID-19-related deaths worldwide,1 resulting 
to an unprecedented public health response around the globe. The COVID-19 
pandemic, together with the applied multi-level restrictive measures, has 
generated a unique combination of an unpredictable and stressful biomedical and 
socioeconomic environment (i.e., syndemic),2 introducing real-life threat, 
involuntary and drastic every-day life-style changes with uncertain financial 
and future prospects, alongside with minimized coping and stress management 
possibilities.3 This combination of so many different and vital stressors may 
lead to acute as well as long-term, direct, indirect and even transgenerational 
unfavourable effects on physical and mental health and functioning, which might 
even represent the most precarious and still unpredictable public-health-related 
part of the pandemic.4 Thereby, specific population groups could be at 
particular risk of poor health outcomes in relation to applied public health 
measures.4, 5 However, not every individual will experience the same level of 
negative impact on health and well-being during the pandemic, as several 
additional national, socioeconomic, environmental, behavioural, emotional and 
cognitive factors can moderate individual resilience and coping.6 
Pandemic-related research should, thus, assess as many multidimensional risk and 
protective factors as possible in a longitudinal, large-scale and multi-national 
manner, enabling a profound and comprehensive understanding of the complex 
health and societal impact of the pandemic worldwide.7 Nevertheless, to date, 
most research findings are cross-sectional, report on small and non- 
representative samples from individual countries, or on specific population 
groups (e.g., health care workers, students, clinical populations) and usually 
assess only a very restricted set of outcomes and time-points. Thereby, only few 
studies assess coping strategies, medical history or detailed socioeconomic, 
demographic and environmental data. In addition, most studies leave behind 
linguistic differences, being available in one or at best two different 
languages. Such investigations of small outcome subsets within a narrow 
framework preclude a broader and clear understanding of the multifaceted 
pandemic impact on the general population and specific subgroups. Acknowledging 
these gaps in the existing literature, large- scale, collaborative research 
prospectively collecting and monitoring a broad range of real- time, 
multi-dimensional health-related, societal and behavioural outcome data from 
countries across the globe is currently explicitly needed. The Collaborative 
Outcomes study on Health and Functioning during Infection Times (COH- FIT) 
envisions to fill this gap. Based on an easy-to-access webpage 
(www.coh-fit.com), COH- FIT is the currently largest-scale known international 
collaborative study of over 200 researchers around the globe, prospectively 
collecting the biggest set of multi-dimensional and multi-disciplinary data from 
150 high, middle, and low-income countries in over 30 languages and in three 
different age groups (adults, adolescents, children) of the general population, 
focusing also on relevant at-risk subgroups. Albeit being a cross-sectional 
anonymous survey on an individual level, it is a longitudinal study on a 
population level, as data are collected continuously since April 2020 and until 
the WHO declares the end of the pandemic. In addition to snowball recruitment, 
this project also collects information from nationally representative samples. 
Furthermore, COH-FIT is the first study of this scale investigating pandemic 
effects on health and functioning measures between family members, while it also 
specifically assesses a large list of behavioral and coping factors (e.g., 
screen time, social media usage, physical activity, social interaction, 
religious practices, etc.) on outcomes of interest. COH-FIT also monitors 
changes in public health restrictive measures to enhance data harmonization 
across nations and time, and to better investigate their impact on physical and 
mental health, while it also collects information on changes in healthcare 
systems functioning. The COH-FIT project was worldwide first initiated in Greece 
after the ethics committee approval of the School of Medicine of the Aristotle 
University of Thessaloniki and is officially supported by the Hellenic 
Psychiatric Association, European Psychiatric Association, World Association of 
Social Psychiatry, ECNP Network on the Prevention of Mental Disorders and Mental 
Health Promotion, among many other national and international scientific 
associations. To date, COH-FIT has already collected >115,000 participations 
worldwide (>8,000 in Greece), but more participants are still needed, both 
during the second and third wave of the pandemic, as in the future, after the 
pandemic has ended. Currently, the COH-FIT survey actively collects the largest 
sample on multifactorial data on the impact of the COVD-19 pandemic on health 
and functioning not only in Greece, but around the globe. The elaborated design 
of COH-FIT and similar studies may allow a better identification of key 
parameters and population groups at increased risk during the pandemic, as well 
as potential targets for acute and long-term prevention or intervention 
strategies in the current as in possible future pandemics. A profound 
understanding of the health and societal impact of the pandemic could facilitate 
an optimized governmental, social and individual health preparedness during 
infection times8 and the bridging of individuals', societal and systemic needs 
and actions through multi-level guideline development with the aim to improve 
mental health outcomes globally.

DOI: 10.22365/jpsych.2021.010
PMID: 33759804 [Indexed for MEDLINE]


3642. J Am Coll Health. 2023 Jan;71(1):242-248. doi: 10.1080/07448481.2021.1890606. 
Epub 2021 Mar 24.

Racial and ethnic minority disparities in COVID-19 related health, health 
beliefs and behaviors, and well-being among students.

Trammell PhD JP(1), Joseph PhD NT(1), Harriger PhD JA(1).

Author information:
(1)Social Science Division, Pepperdine University, Malibu, California, USA.

Objective: The purpose of this study was to examine undergraduate racial/ethnic 
disparities in physical, mental, behavioral, and psychosocial COVID-19 impacts. 
Participants: In May 2020, 403 undergraduates (74% women; Mage = 20.4; 65% 
White, 19% Asian, 10% Latinx, 6% Black) were recruited. Methods: Participants 
completed a survey 2 months after their university switched to remote 
instruction due to COVID-19. Results: 15.2% reported either COVID-19 diagnosis 
or perceived symptoms, but there were no racial/ethnic disparities in this 
health outcome. Latinx and Asian students experienced higher COVID-19 related 
threat and negative beliefs than White students. Asian students experienced more 
discrimination and Latinx students experienced greater economic impacts. There 
were no differences in mental health or health behaviors. Conclusion: Results 
suggest that psychosocial impacts of a pandemic on undergraduate students vary 
by race/ethnicity, although mental health responses may be more universal. 
Implications for how colleges and universities can best serve student needs are 
discussed.

DOI: 10.1080/07448481.2021.1890606
PMID: 33759734 [Indexed for MEDLINE]


3643. J Appl Res Intellect Disabil. 2021 Nov;34(6):1421-1430. doi: 10.1111/jar.12884. 
Epub 2021 Mar 23.

The experiences of mothers of children and young people with intellectual 
disabilities during the first COVID-19 lockdown period.

Rogers G(1)(2), Perez-Olivas G(3), Stenfert Kroese B(4), Patel V(5), Murphy 
G(6), Rose J(4), Cooper V(7), Langdon PE(8)(9)(10), Hiles S(11), Clifford C, 
Willner P(11).

Author information:
(1)The Tarentfort Centre, Kent and Medway NHS and Social Care Partnership Trust, 
Dartford, UK.
(2)Division of Psychiatry, University College London, London, UK.
(3)Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK.
(4)School of Psychology, University of Birmingham, Birmingham, UK.
(5)Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK.
(6)Tizard Centre, University of Kent, Canterbury, UK.
(7)Challenging Behaviour Foundation, Chatham, UK.
(8)Centre for Educational Development, Appraisal and Research, University of 
Warwick, Coventry, UK.
(9)Centre for Mental Health and Wellbeing Research, Warwick Medical School, 
University of Warwick, Coventry, UK.
(10)Coventry and Warwickshire Partnership NHS Trust, Coventry, UK.
(11)Swansea Trials Unit, Clinical Research Facility, Institute of Life Science, 
Swansea University, Swansea, UK.

BACKGROUND: Recent COVID-19 lockdown restrictions resulted in reduced access to 
educational, professional and social support systems for children with 
intellectual disabilities and their carers.
AIM: The aim of this study was to gain insight into the ways mothers of children 
with intellectual disabilities coped during the first 2020 lockdown period.
METHODS: Eight mothers of children with intellectual disabilities were 
interviewed. The recordings of these interviews were subjected to a thematic 
analysis.
RESULTS: Three main themes were identified: carrying the burden; a time of 
stress; and embracing change and looking to the future.
CONCLUSIONS: All mothers experienced increased burden and stress. However, some 
also described some positive impact of lockdown conditions on them as well as on 
their child's well-being and behaviour. These findings are discussed in the 
light of the (Journal of Applied Research in Intellectual Disabilities, 33, 
2020, 1523) survey results on parental coping and suggestions for future service 
provision during pandemic conditions are proposed.

© 2021 The Authors. Journal of Applied Research in Intellectual Disabilities 
published by John Wiley & Sons Ltd.

DOI: 10.1111/jar.12884
PMCID: PMC8250127
PMID: 33759291 [Indexed for MEDLINE]


3644. J Pediatr Psychol. 2021 Jun 3;46(5):514-525. doi: 10.1093/jpepsy/jsab029.

Families With Children With Neurodevelopmental Disorders During COVID-19: A 
Scoping Review.

Shorey S(1), Lau LST(1), Tan JX(2), Ng ED(1), Aishworiya R(3)(4).

Author information:
(1)Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, 
National University of Singapore.
(2)Department of Rehabilitation, National University Hospital.
(3)Department of Paediatrics, Khoo Teck Puat-National University Children's 
Medical Institute (KTP-NUCMI), National University Hospital.
(4)Department of Paediatrics, Yong Loo Lin School of Medicine, National 
University of Singapore.

Erratum in
    J Pediatr Psychol. 2021 Jul 20;46(6):729.

OBJECTIVE: Prolonged home isolation may lead to long-term negative consequences 
for both children and caregivers' psychological wellbeing, especially in 
families with children with neurodevelopmental disorders. Therefore, a scoping 
review was conducted to identify challenges faced by caregivers of children with 
neurodevelopmental disorders during the coronavirus disease 2019 (COVID-19) 
pandemic and to consolidate parenting interventions and guidelines.
METHODS: A systematic search was conducted on Embase, PsycInfo, PubMed, Scopus, 
and LitCovid. All article types published between December 2019 and November 
2020 which reported on intervention guidelines and experiences of families with 
children with neurodevelopmental disorders during the COVID-19 pandemic were 
included. Qualitative themes, quantitative data, and article summaries were 
charted, and a thematic analysis was conducted.
RESULTS: Twenty-nine articles were included in the review. Three themes were 
generated: (a) behavioral issues and health concerns, (b) disruptions of 
lifelines and daily routines, and (c) existing programs, models, and guidelines 
to support families. Additionally, a list of caregiver strategies such as 
scheduling regular online consultations, maintaining online therapy, educating a 
child on COVID-19, and preventive behaviors, creating a structured daily 
schedule and reinforcement system, and selecting child-appropriate activities 
was consolidated.
CONCLUSION: This review revealed a lack of evidence-based studies and articles 
on children with other neurodevelopmental disorders apart from autism and 
attention-deficit hyperactivity disorder. It also places emphasis on the 
importance of telehealth services as major lifelines to parents during this 
pandemic and urges healthcare organizations to provide funding to increase 
telehealth services to afflicted families.

© The Author(s) 2021. Published by Oxford University Press on behalf of the 
Society of Pediatric Psychology. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/jpepsy/jsab029
PMCID: PMC8083717
PMID: 33758930 [Indexed for MEDLINE]


3645. Women Birth. 2022 May;35(3):272-279. doi: 10.1016/j.wombi.2021.03.007. Epub 2021 
Mar 19.

Prenatal stress, health, and health behaviours during the COVID-19 pandemic: An 
international survey.

Pope J(1), Olander EK(2), Leitao S(3), Meaney S(3), Matvienko-Sikar K(4).

Author information:
(1)School of Public Health, University College Cork, Ireland. Electronic 
address: 119222524@umail.ucc.ie.
(2)Centre for Maternal and Child Health Research, School of Health Sciences, 
City, University of London, London, UK.
(3)National Perinatal Epidemiology Centre, Department of Obstetrics and 
Gynaecology, University College Cork, Ireland.
(4)School of Public Health, University College Cork, Ireland.

BACKGROUND: Pregnant women's stress, mental and physical health, and health 
behaviours can have important implications for maternal and child health 
outcomes.
AIM: To examine pregnant women's levels of stress, mental and physical health, 
and health behaviours during the COVID-19 pandemic.
METHODS: A cross-sectional survey was conducted online, with recruitment and 
data collection occurring between 16/6/20 and 17/7/20. Participants were 
pregnant women recruited via online pregnancy/parenting communities. 
Participants self-reported their levels of general stress, pregnancy-specific 
stress and COVID-19 related stress, mental and physical health, general health 
behaviours, and COVID-19 related health behaviours.
FINDINGS: 573 pregnant women participated in the survey. Participants were most 
commonly resident in the United States (42.6%, n=243), Ireland (41.2%, n=235) or 
the United Kingdom (10%, n=57). The majority (80.0%, n=457) were married and 
educated to degree level or above (79.3, n=453). Pregnant women reported high 
levels of pregnancy-specific and COVID-19-related stress, and low levels of 
mental and physical health, during the pandemic. Encouragingly, pregnant women 
in this study generally reported high levels of adherence to public health 
advice and pregnancy health behaviours. Stress and general mental health 
outcomes were best predicted by well-being factors (including stress and social 
support). Health impairing behaviours (e.g. poor diet) were predicted by both 
well-being and demographic factors.
DISCUSSION: Interventions targeting pregnancy- and pandemic-specific stress at 
the population level will be essential to support mental health and minimise 
adverse outcomes for women and children during the pandemic.

Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.wombi.2021.03.007
PMCID: PMC9051042
PMID: 33757750 [Indexed for MEDLINE]


3646. J Immigr Minor Health. 2021 Oct;23(5):885-894. doi: 10.1007/s10903-021-01187-7. 
Epub 2021 Mar 23.

Another Brick in the Wall: Healthcare Access Difficulties and Their Implications 
for Undocumented Latino/a Immigrants.

Galvan T(1), Lill S(2), Garcini LM(2)(3).

Author information:
(1)Department of Psychology, University of Denver, 2155 S Race St, Denver, CO, 
80210, USA. thania.galvan@du.edu.
(2)Center for Research To Advance Community Health, Joe R. and Teresa Lozano 
Long School of Medicine, The University of Texas Health Science Center at San 
Antonio, San Antonio, TX, USA.
(3)Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, The 
University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.

The mounting evidence highlighting the disproportionate impact of the COVID-19 
pandemic in ethnic minority communities underscores the need to understand how 
distress and healthcare access impacts the well-being of undocumented Latino/a 
immigrants (ULIs), one of the most marginalized and vulnerable ethnic minority 
communities in the U.S. We used existing data from a cross sectional study 
(Proyecto Voces) of 252 ULIs to conduct path analyses that explored the 
relations among distress due to immigration legal status, healthcare access 
difficulties, and the health of ULIs. Results demonstrated that distress due to 
immigration legal status is related to the physical and mental health of ULIs, 
and that difficulties in accessing healthcare explained these relations. These 
data support the importance of immediate, targeted efforts for increasing access 
to healthcare among undocumented immigrants and highlight the long-term 
importance of a much-needed healthcare reform for improving access to 
marginalized populations.

© 2021. The Author(s), under exclusive licence to Springer Science+Business 
Media, LLC, part of Springer Nature.

DOI: 10.1007/s10903-021-01187-7
PMCID: PMC7985739
PMID: 33755839 [Indexed for MEDLINE]


3647. Transl Behav Med. 2021 Apr 7;11(3):793-801. doi: 10.1093/tbm/ibab018.

Fear of COVID-19 and its associations with perceived personal and family 
benefits and harms in Hong Kong.

Sit SM(1), Lam TH(1), Lai AY(2), Wong BY(1), Wang MP(2), Ho SY(1).

Author information:
(1)School of Public Health, The University of Hong Kong, Hong Kong SAR, China.
(2)School of Nursing, The University of Hong Kong, Hong Kong SAR, China.

Fear of COVID-19 is associated with public health compliance but also with 
negative well-being; however, no articles have reported associations of such 
fear with perceived benefits and harms. We assessed the level of fear of 
COVID-19 in Hong Kong adults and its associations with sociodemographic factors 
and perceived benefits and harms of COVID-19. In a 6-day population-based 
cross-sectional online survey in May 2020, 4,890 adults provided data on fear 
and perceived benefits and harms, personal happiness and family well-being, and 
sociodemographic characteristics. Linear regression was used to analyze 
associations. The level of fear was moderate (mean score 6.3/10). Fewer 
respondents reported perceived benefits (10.6%-21.7%) than harms (13.4%-43.5%). 
Females, younger age groups, and respondents with lower education or more 
cohabitants had greater fear. Fear was associated with perceived personal 
(increased knowledge of personal epidemic prevention) and family benefits 
(improved family hygiene), both with a very small effect size (Cohen's d = 
0.03). Fear was also associated with lower personal happiness and perceived 
personal (increased negative emotions, feeling depressed and anxious, decreased 
income, and decreased work efficiency) and family harms (increased conflicts and 
negative emotions among family members), with small effect sizes (0.08-0.37). We 
have first shown sociodemographic differences in the fear of COVID-19 and such 
fear was associated with both perceived personal and family benefits and harms 
of COVID-19. Our findings may guide the management of fear to reduce 
sociodemographic differences, and maximize benefits and minimize harms.

© The Author(s) 2021. Published by Oxford University Press on behalf of the 
Society of Behavioral Medicine.

DOI: 10.1093/tbm/ibab018
PMCID: PMC8033593
PMID: 33755146 [Indexed for MEDLINE]


3648. Palliat Med. 2021 May;35(5):814-829. doi: 10.1177/02692163211000660. Epub 2021 
Mar 23.

'Necessity is the mother of invention': Specialist palliative care service 
innovation and practice change in response to COVID-19. Results from a 
multinational survey (CovPall).

Dunleavy L(1), Preston N(1), Bajwah S(2), Bradshaw A(3), Cripps R(2), Fraser 
LK(4), Maddocks M(2), Hocaoglu M(2), Murtagh FE(3), Oluyase AO(2), Sleeman 
KE(2), Higginson IJ(2), Walshe C(1).

Author information:
(1)International Observatory on End of Life Care, Lancaster University, 
Lancaster, UK.
(2)Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, 
King's College London, London, UK.
(3)Wolfson Palliative Care Research Centre, Hull York Medical School, University 
of Hull, Hull, UK.
(4)Martin House Research Centre, Department of Health Sciences, University of 
York, UK.

BACKGROUND: Specialist palliative care services have a key role in a whole 
system response to COVID-19, a disease caused by the SARS-CoV-2 virus. There is 
a need to understand service response to share good practice and prepare for 
future care.
AIM: To map and understand specialist palliative care services innovations and 
practice changes in response to COVID-19.
DESIGN: Online survey of specialist palliative care providers (CovPall), 
disseminated via key stakeholders. Data collected on service characteristics, 
innovations and changes in response to COVID-19. Statistical analysis included 
frequencies, proportions and means, and free-text comments were analysed using a 
qualitative framework approach.
SETTING/PARTICIPANTS: Inpatient palliative care units, home nursing services, 
hospital and home palliative care teams from any country.
RESULTS: Four hundred and fifty-eight respondents: 277 UK, 85 Europe (except 
UK), 95 World (except UK and Europe), 1 missing country. 54.8% provided care 
across 2+ settings; 47.4% hospital palliative care teams, 57% in-patient 
palliative care units and 57% home palliative care teams. The crisis context 
meant services implemented rapid changes. Changes involved streamlining, 
extending and increasing outreach of services, using technology to facilitate 
communication, and implementing staff wellbeing innovations. Barriers included; 
fear and anxiety, duplication of effort, information overload and funding. 
Enablers included; collaborative teamwork, staff flexibility, a pre-existing IT 
infrastructure and strong leadership.
CONCLUSIONS: Specialist palliative care services have been flexible, highly 
adaptive and have adopted low-cost solutions, also called 'frugal innovations', 
in response to COVID-19. In addition to financial support, greater collaboration 
is essential to minimise duplication of effort and optimise resource 
use.ISRCTN16561225 https://doi.org/10.1186/ISRCTN16561225.

DOI: 10.1177/02692163211000660
PMCID: PMC8114457
PMID: 33754892 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of conflicting interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


3649. BMJ Open. 2021 Mar 22;11(3):e050223. doi: 10.1136/bmjopen-2021-050223.

Beyond PPE: a mixed qualitative-quantitative study capturing the wider issues 
affecting doctors' well-being during the COVID-19 pandemic.

Cubitt LJ(1), Im YR(2)(3), Scott CJ(1), Jeynes LC(1), Molyneux PD(4)(5).

Author information:
(1)Dept of Anaesthetics, West Suffolk NHS Foundation Trust, Bury Saint Edmunds, 
UK.
(2)Faculty of Medicine, Imperial College London, London, UK.
(3)Dept of Medicine, West Suffolk NHS Foundation Trust, Bury Saint Edmunds, UK.
(4)Neurology, West Suffolk NHS Foundation Trust, Bury Saint Edmunds, UK 
paul.molyneux@wsh.nhs.uk.
(5)Department of Neurology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, 
UK.

The COVID-19 pandemic has brought unprecedented challenges to the medical 
workforce. This has put them at increased risk of burnout at a time when levels 
are already worryingly high in the profession, with recent studies consistently 
showing that around half of doctors meet the validated criteria for burnout.
OBJECTIVES: To understand the wider factors influencing and impacting upon 
hospital doctors' well-being during the COVID-19 pandemic in England.
DESIGN: Cross-sectional survey and mixed quantitative-qualitative analysis.
SETTING: Acute National Health Service (NHS) Foundation Trust in England.
PARTICIPANTS: An online survey was circulated in early June 2020 to all 449 
doctors employed by the Trust. 242 doctors completed the survey (54% response 
rate).
PRIMARY OUTCOME MEASURES: Questions assessed occupational details, self-reported 
changes in physical and mental health, satisfaction with working hours and 
patterns, availability of personal protective equipment (PPE), medication and 
facilities, communication and sought to identify areas seen as having a 
significant effect on doctors' well-being.
RESULTS: 96% of respondents requiring PPE were able to access it. Nearly half of 
the respondents felt that their mental health had deteriorated since the start 
of the pandemic. Over a third stated that their physical health had also 
declined. Issues identified as having a negative impact on doctors included 
increased workload, redeployment, loss of autonomy, personal issues affecting 
family members, anxiety around recovery plans, inadequate access to changing and 
storage facilities and to rest areas that allow for social distancing. Doctors 
appreciated access to 'calm rooms' that were made available for staff, access to 
clinical psychology support, free drinks and free car parking on site.
CONCLUSION: The emerging themes are suggestive of increased burnout risk among 
doctors during the COVID-19 pandemic and encompass factors well beyond shortage 
of PPE. Small organisational initiatives and the implementation of changes 
suggested by survey respondents can have a positive impact on doctors' 
well-being.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-050223
PMCID: PMC7985981
PMID: 33753449 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: LJC, YRI, CJS, LCJ and PDM 
were employed by the Trust at the time the survey was undertaken and declare no 
further competing interests.


3650. Compr Psychiatry. 2021 May;107:152237. doi: 10.1016/j.comppsych.2021.152237. 
Epub 2021 Mar 9.

Inpatient psychiatry unit devoted to COVID-19 patients.

Mahgoub N(1), Agarkar S(2), Radosta M(3), Fakih F(4), Calleran B(5), Clark R(6), 
Cherubin D(7), Faour F(8), Anthony D(9).

Author information:
(1)Clinical Associate Professor of Psychiatry, Weill Cornell Medicine/Gracie 
Square Hospital, 420 E. 76th Street, New York, NY 10021, United States of 
America. Electronic address: nam2024@med.cornell.edu.
(2)Clinical Associate Professor of Psychiatry, Weill Cornell Medicine/Gracie 
Square Hospital, 420 E. 76th Street, New York, NY 10021, United States of 
America. Electronic address: smd9004@med.cornell.edu.
(3)Gracie Square Hospital, 420 E. 76th Street, New York, NY 10021, United States 
of America. Electronic address: mir9044@nyp.org.
(4)Gracie Square Hospital, 420 E. 76th Street, New York, NY 10021, United States 
of America. Electronic address: frf9029@nyp.org.
(5)Gracie Square Hospital, 420 E. 76th Street, New York, NY 10021, United States 
of America. Electronic address: brc9055@nyp.org.
(6)Gracie Square Hospital, 420 E. 76th Street, New York, NY 10021, United States 
of America. Electronic address: roc9191@nyp.org.
(7)Gracie Square Hospital, 420 E. 76th Street, New York, NY 10021, United States 
of America. Electronic address: dec9124@nyp.org.
(8)Gracie Square Hospital, 420 E. 76th Street, New York, NY 10021, United States 
of America. Electronic address: faf9022@nyp.org.
(9)Clinical Associate Professor of Psychiatry, Weill Cornell Medicine/Gracie 
Square Hospital, 420 E. 76th Street, New York, NY 10021, United States of 
America. Electronic address: dta2001@nyp.org.

The COVID-19 pandemic has significantly changed the mental health care. Treating 
psychiatric patients with COVID-19 poses multiple challenges in the inpatient 
psychiatric setting in terms of mitigating transmission of the virus. Gracie 
Square Hospital, a freestanding psychiatric hospital located in New York City, 
dedicated a unit for treating COVID-19 patients requiring inpatient psychiatric 
treatment. We faced different challenges including treatment refusal, difficulty 
complying with safety precautions due to psychosis, agitated behavior, and staff 
psychological well-being. We considered reformation of protocols, expansion of 
the use of technology, development of a supportive platform, and standardization 
of clinical practice. This paper describes our strategies to manage the 
challenges while providing acute psychiatric treatment to COVID-19 patients.

Copyright © 2021. Published by Elsevier Inc.

DOI: 10.1016/j.comppsych.2021.152237
PMCID: PMC7942147
PMID: 33751977 [Indexed for MEDLINE]


3651. Adm Policy Ment Health. 2021 May;48(3):379-387. doi: 10.1007/s10488-021-01125-7. 
Epub 2021 Mar 22.

Promoting Children's Mental, Emotional, and Behavioral (MEB) Health in All 
Public Systems, Post-COVID-19.

Hoagwood KE(1)(2), Gardner W(3), Kelleher KJ(4)(5).

Author information:
(1)Department of Child and Adolescent Psychiatry, New York University, New York, 
NY, USA. Kimberly.hoagwood@nyulangone.org.
(2), 2543 Painter Court, Annapolis, MD, 21401, USA. 
Kimberly.hoagwood@nyulangone.org.
(3)Senior Research Chair in Child and Adolescent Psychiatry, Children's Hospital 
of Eastern Ontario Research Institute and Professor of Epidemiology, University 
of Ottawa, Ottawa, ON, Canada.
(4)Abigail Wexner Research Institute At Nationwide Children's Hospital, 
Columbus, OH, USA.
(5)The Ohio State University College of Medicine, Columbus, OH, USA.

The COVID-19 pandemic exacerbates the mental, emotional, and behavioral (MEB) 
health problems of children and adolescents in the United States (U.S.). A 
collective and coordinated national economic and social reconstruction effort 
aimed at shoring up services to promote children's MEB, like the Marshall Plan 
that helped rebuild Europe post-World War II, has been proposed to buttress 
against the expected retrenchment. The plan prioritizes children's well-being as 
a social objective. We propose strategically reconstructing the public 
safety-net systems serving youth, including early education, maternal and child 
health, child welfare, corrections, and mental health. That plan called for a 
concentrated focus on coalition-building and contracting by state mental health 
systems to establish a foundation for an improved health system. This paper 
offers a complementary set of suggestions for the four non-mental health systems 
mentioned above by recommending actionable steps based on scientific evidence to 
support improved services for children at risk for MEB problems. For each system 
we describe examples of evidence-informed services, policies or programs that 
(1) prevent disabilities and promote health, (2) protect and preserve families 
and neighborhoods, and (3) provide quality care. Prioritizing the promotion of 
children's MEB health by all state systems can shape U.S. children's health and 
well-being for generations to come.

DOI: 10.1007/s10488-021-01125-7
PMCID: PMC7982338
PMID: 33751270 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no relevant financial or 
non-financial interests to disclose. The authors have no conflicts of interest 
to declare that are relevant to the content of this article. All authors certify 
that they have no affiliations with or involvement in any organization or entity 
with any financial interest or non-financial interest in the subject matter or 
materials discussed in this manuscript. The authors have no financial or 
proprietary interests in any material discussed in this article.


3652. JMIR Mhealth Uhealth. 2021 Apr 15;9(4):e24184. doi: 10.2196/24184.

Gender Differences in Satisfaction With a Text Messaging Program (Text4Hope) and 
Anticipated Receptivity to Technology-Based Health Support During the COVID-19 
Pandemic: Cross-sectional Survey Study.

Shalaby R(1), Vuong W(2), Hrabok M(3), Gusnowski A(2), Mrklas K(4)(5), Li D(2), 
Snaterse M(2), Surood S(2), Cao B(1), Li XM(1), Greiner R(1), Greenshaw AJ(1), 
Agyapong VIO(1).

Author information:
(1)Department of Psychiatry, Faculty of Medicine and Dentistry, University of 
Alberta, Edmonton, AB, Canada.
(2)Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada.
(3)Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
(4)Strategic Clinical Networks, Provincial Clinical Excellence, Alberta Health 
Services, Calgary, AB, Canada.
(5)Department of Community Health Sciences, Cumming School of Medicine, 
University of Calgary, Edmonton, AB, Canada.

BACKGROUND: In March 2020, Text4Hope-a community health service-was provided to 
Alberta residents. This free service aims to promote psychological resilience 
and alleviate pandemic-associated stress, anxiety, and depression symptoms 
during the COVID-19 pandemic.
OBJECTIVE: This study aimed to evaluate the feedback, satisfaction, experience, 
and perceptions of Text4Hope subscribers and to examine any differences based on 
gender after subscribers received 6 weeks of daily supportive text messages. 
Additionally, this study examined subscribers' anticipated receptivity to 
technology-based medical services that could be offered during major crises, 
emergencies, or pandemics.
METHODS: Individuals self-subscribed to Text4Hope to receive daily supportive 
text messages for 3 months. Subscribers were invited to complete a web-based 
survey at 6 weeks postintervention to provide service satisfaction-related 
information. Overall satisfaction was assessed on a scale of 0-10, and 
satisfaction scores were analyzed using a related-measures t test. Likert scale 
satisfaction responses were used to assess various aspects of the Text4Hope 
program. Gender differences were analyzed using one-way analysis of variance 
(ANOVA) and Chi-square analyses.
RESULTS: A total of 2032 subscribers completed the baseline and 6-week surveys; 
1788 (88%) were female, 219 (10.8%) were male, and 25 (1.2%) were other gender. 
The mean age of study participants was 44.58 years (SD 13.45 years). The mean 
overall satisfaction score was 8.55 (SD 1.78), suggesting high overall 
satisfaction with Text4Hope. The ANOVA analysis, which was conducted using the 
Welch test (n=1716), demonstrated that females had significantly higher mean 
satisfaction scores than males (8.65 vs 8.11, respectively; mean 
difference=0.546; 95% CI 0.19 to 0.91; P<.001) and nonsignificantly lower 
satisfaction scores than other gender respondents (mean difference=-0.938; 95% 
CI -0.37 to 2.25; P=.15). More than 70% of subscribers agreed that Text4Hope 
helped them cope with stress (1334/1731, 77.1%) and anxiety (1309/1728, 75.8%), 
feel connected to a support system (1400/1729, 81%), manage COVID-19-related 
issues (1279/1728, 74%), and improve mental well-being (1308/1731, 75.6%). 
Similarly, subscribers agreed that messages were positive, affirmative, and 
succinct. Messages were always or often read by 97.9% (1681/1716) of 
respondents, and more than 20% (401/1716, 23.4%) always or often returned to 
messages. The majority of subscribers (1471/1666, 88.3%) read the messages and 
either reflected upon them or took a positive action. Subscribers welcomed 
almost all technology-based services as part of their health care during crisis 
or emergency situations. Text4Hope was perceived to be effective by many female 
subscribers, who reported higher satisfaction and improved coping after 
receiving text messages for 6 weeks.
CONCLUSIONS: Respondents affirmed the high quality of the text messages with 
their positive feedback. Technology-based services can provide remotely 
accessible and population-level interventions that align with the recommended 
physical distancing practices for pandemics. Text4Hope subscriber feedback 
revealed high satisfaction and acceptance at 6 weeks postintervention.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/19292.

©Reham Shalaby, Wesley Vuong, Marianne Hrabok, April Gusnowski, Kelly Mrklas, 
Daniel Li, Mark Snaterse, Shireen Surood, Bo Cao, Xin-Min Li, Russell Greiner, 
Andrew James Greenshaw, Vincent Israel Opoku Agyapong. Originally published in 
JMIR mHealth and uHealth (http://mhealth.jmir.org), 15.04.2021.

DOI: 10.2196/24184
PMCID: PMC8051435
PMID: 33750738 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


3653. BMC Public Health. 2021 Mar 9;21(1):474. doi: 10.1186/s12889-021-10529-x.

Brief videoconferencing psychological intervention for reducing COVID-19 related 
distress: study protocol for a randomized controlled trial.

Keyan D(1), Dawson K(1), Azevado S(1), Yadav S(1), Tran J(1), Bryant RA(2).

Author information:
(1)School of Psychology, University of New South Wales, Sydney, NSW, 2052, 
Australia.
(2)School of Psychology, University of New South Wales, Sydney, NSW, 2052, 
Australia. r.bryant@unsw.edu.au.

BACKGROUND: Globally COVID-19 has had a profound impact on the psychological 
wellbeing of millions of people, and there is an urgent imperative to address 
elevated levels of distress during the COVID-19 pandemic. The World Health 
Organization (WHO) has developed Problem Management Plus (PM+), a low intensity 
psychological intervention for adults experiencing psychological distress. This 
paper outlines the study protocol for a trial that tests the effectiveness of an 
adapted version of PM+ to reduce distress associated with COVID-19.
METHODS: A single-blind, parallel, randomized controlled trial will be carried 
out for distressed people across Australia. via video conferencing on a small 
group basis. Following informed consent, adults that screen positive for levels 
of psychological distress (General Health Questionnaire-12 (GHQ-12 score ≥ 3) 
and have access to videoconferencing platform will be randomised to an adapted 
version of gPM+ (n = 120) or enhanced treatment as usual (ETAU) (n = 120). The 
primary outcome will be reduction in psychological distress including anxiety 
and depression at 2-months post treatment. Secondary outcomes include worry, 
sleep problems, anhedonia, social support, and stress in relation to COVID-19.
DISCUSSION: The trial aims assess whether an adapted version of 
videoconferencing PM+ that is specifically designed to target COVI-19 related 
distress will result in reduced distress relative to enhanced usual care.
TRIAL REGISTRATION: This trial was prospectively registered on the ANZCTR on 
14/4/20 ( ACTRN12620000468921 ).

DOI: 10.1186/s12889-021-10529-x
PMCID: PMC7942517
PMID: 33750351 [Indexed for MEDLINE]

Conflict of interest statement: No authors are declaring any competing 
interests.


3654. Transl Behav Med. 2021 Apr 7;11(3):802-807. doi: 10.1093/tbm/ibab020.

Disruptions in the management and care of university students with preexisting 
mental health conditions during the COVID-19 pandemic.

Ligus K(1), Fritzson E(1), Hennessy EA(2), Acabchuk RL(1), Bellizzi K(1).

Author information:
(1)Human Development and Family Sciences, University of Connecticut, Storrs, CT, 
USA.
(2)Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

Students with preexisting mental health conditions or disabilities may fair 
worse due to virus mitigation strategies during the COVID-19 pandemic. This 
study was conducted to understand the experiences of students with preexisting 
mental health conditions or disabilities at a public university during COVID-19. 
We examined disruptions in the management of preexisting mental health 
conditions or disabilities and its impact on psychological well-being. Students 
were surveyed about their health care experiences during the COVID-19 pandemic 
between June and September 2020. Linear regressions and mediation analyses were 
conducted to examine the relationships between disruption to care, mental health 
self-efficacy, and four psychological well-being outcomes (stress, anxiety, 
depression, and overall distress). Of the total (N = 1,082) study participants, 
258 (24%) reported having a preexisting mental health condition(s) or 
disabilities (81% female; Mage = 23.47). Of those, 155 (61%) reported that 
COVID-19 disrupted health care delivery and management of their conditions or 
disabilities. Of those who reported this disruption, 51% (n = 109) of 
participants reported a disruption in their ability to see a health care 
professional and 58% (n = 69) reported either that they lost care or that the 
quality of the new telemedicine care was not sufficient. A series of linear 
regressions revealed significant relationships between disruption to care and 
the four psychological outcomes. Mediation analyses revealed that depression, 
stress, anxiety, and overall distress were mediated by self-efficacy in managing 
mental health. University administrators and health care providers should 
evaluate the scope of mental health care and telemedicine services for students 
to help long-term psychological effects of COVID-19.

© Society of Behavioral Medicine 2021. All rights reserved. For permissions, 
please e-mail: journals.permissions@oup.com.

DOI: 10.1093/tbm/ibab020
PMCID: PMC8083644
PMID: 33749756 [Indexed for MEDLINE]


3655. Anaesth Crit Care Pain Med. 2021 Jun;40(3):100830. doi: 
10.1016/j.accpm.2021.100830. Epub 2021 Mar 17.

Perceived stress, anxiety and depressive symptoms among anaesthesia and 
intensive care residents: A French national survey.

Jaulin F(1), Nguyen DP(2), Marty F(3), Druette L(4), Plaud B(5); Regional 
coordinators of teaching in Anaesthesia and Intensive Care; Duret C(6), Fletcher 
D(7).

Author information:
(1)Facteur Humains en Santé Association, Patient Safety Database, Young 
Anaesthetists Association (AJAR), Sorbonne University, Paris, France.
(2)Sorbonne University, Paris, France.
(3)Young Anaesthetists Association (AJAR), Bicêtre Hospital, Kremlin Bicêtre, 
France.
(4)Claude Bernard Lyon 1 University, Lyon, France.
(5)Université de Paris & APHP. Nord, DMU PARABOL, hôpital Saint-Louis, service 
d'anesthésie, de réanimation et centre de traitement des brûlés, 1, avenue 
Claude Vellefaux, 75010 Paris, France.
(6)Occupational Health Unit, Raymond Poincaré Hospital, Assistance Publique 
Hôpitaux de Paris, Garches, France.
(7)Ambroise Paré Hospital, Assistance Publique Hôpitaux de Paris, Boulogne 
Billancourt, France; Versailles Saint-Quentin University, France; Paris Saclay 
University, Saint-Aubin, France. Electronic address: dominique.fletcher@aphp.fr.

BACKGROUND: Mental health and well-being is a significant problem for medical 
students in training. In this study, we aim to estimate the prevalence of 
anxiety and depressive symptoms, burnout and psychosocial distress in French 
anaesthesia and intensive care residents.
METHODS: A national online observational study used validated questionnaires 
(Hospital Anxiety and Depression Scale (HADS), Copenhagen Burnout Inventory 
(CBI), Perceived Stress Scale (PSS) and work-related questions (work-hours per 
week, night shift per month, safety rest after night shift, average time to 
start and end work, break time and time for lunch) to assess mental health and 
well-being of French residents in anaesthesia and intensive care.
RESULTS: We obtained 519 answers (22.5% of 2302 students), 55% of respondents 
working in anaesthesia, 41% in intensive care at the time of study. Residents 
describe certain symptomatology in anxiety (19.8%) and depressive symptoms 
(7.8%). PSS identifies a perceived high stress (score > 27) for 55.7% of the 
subjects. The CBI questionnaire identifies 205 (38.9%) residents undergoing 
burnout, 80.7% working more than 48 h per week and 39.1% more than 60 h. The 
duration of work per week (> 50 h), gender (female) and on-going training in 
intensive care are independent risk factors of psychological suffering. 
Lifestyle and level of training are not statistically identified risk factors.
CONCLUSION: This first online survey of French anaesthesia and intensive care 
residents reveals a significant frequency of anxiety and depressive symptoms, 
burnout and a link to potential targets of improvement in work conditions mainly 
related to the number of work hours per week.

Copyright © 2021 Société française d'anesthésie et de réanimation (Sfar). 
Published by Elsevier Masson SAS. All rights reserved.

DOI: 10.1016/j.accpm.2021.100830
PMID: 33744493 [Indexed for MEDLINE]


3656. Soc Sci Med. 2021 May;276:113826. doi: 10.1016/j.socscimed.2021.113826. Epub 
2021 Mar 6.

Understanding the impact of the COVID-19 pandemic on stress, mood, and substance 
use among young adults in the greater Minneapolis-St. Paul area: Findings from 
project EAT.

Emery RL(1), Johnson ST(2), Simone M(3), Loth KA(4), Berge JM(4), 
Neumark-Sztainer D(2).

Author information:
(1)Division of Epidemiology and Community Health, School of Public Health, 
University of Minnesota, Minneapolis, MN, 55454, USA. Electronic address: 
emery049@umn.edu.
(2)Division of Epidemiology and Community Health, School of Public Health, 
University of Minnesota, Minneapolis, MN, 55454, USA.
(3)Division of Epidemiology and Community Health, School of Public Health, 
University of Minnesota, Minneapolis, MN, 55454, USA; Department of Psychiatry & 
Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, 
55454, USA.
(4)Department of Family Medicine and Community Health, Medical School, 
University of Minnesota, Minneapolis, MN, 55212, USA.

RATIONALE: There is a need to understand how the ongoing COVID-19 pandemic has 
affected the mental and behavioral health of young adults in the U.S.
OBJECTIVE: This study used quantitative and qualitative survey data to identify 
young adults at highest risk for psychological distress during the U.S. outbreak 
of COVID-19 and to further understand how the pandemic has impacted their 
stress, mood, and substance use.
METHODS: Participants were 670 young adult cohort members (ages 21-29) of the 
population-based longitudinal study EAT 2010-2018 who participated in the C-EAT 
study (COVID-19 Eating and Activity over Time).
RESULTS: Among the sample, 84% (n = 561) reported pandemic-related changes to 
their mood or stress and 33% (n = 221) reported changes to their substance use. 
Linear regression analyses identified several meaningful risk factors for higher 
psychological distress during the pandemic, including female gender, White race, 
higher pre-pandemic depressive symptoms and perceived stress, and lower 
pre-pandemic stress management ability. A thematic analysis further identified 
five major themes related to changes in stress and mood following the COVID-19 
outbreak describing specific emotional reactions, stress related to the direct 
impact of the pandemic as well as interpersonal connectedness and economic 
factors, and strategies for managing stress. In addition, two major themes were 
identified related to substance use during the pandemic detailing specific 
changes in and motivations for substance use.
CONCLUSIONS: These findings underscore the need to develop effective, scalable, 
and rapidly deployable public health resources that target the stressors 
commonly experienced among young adults to improve their psychological wellbeing 
during this pandemic.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.socscimed.2021.113826
PMCID: PMC8058317
PMID: 33743209 [Indexed for MEDLINE]

Conflict of interest statement: None.


3657. BMJ Open. 2021 Mar 19;11(3):e045949. doi: 10.1136/bmjopen-2020-045949.

Stressors and coping strategies of migrant workers diagnosed with COVID-19 in 
Singapore: a qualitative study.

Yee K(1)(2), Peh HP(3)(2), Tan YP(3)(4), Teo I(4)(5), Tan EUT(3)(6), Paul J(7), 
Rangabashyam M(8), Ramalingam MB(9), Chow W(3)(10), Tan HK(3)(8)(11).

Author information:
(1)COVID-19 Community Care Facilities, SingHealth, Singapore 
kaisin.yee@gmail.com.
(2)Speech Therapy Department, Singapore General Hospital, Singapore.
(3)COVID-19 Community Care Facilities, SingHealth, Singapore.
(4)Division of Psychosocial Oncology, National Cancer Centre Singapore, 
Singapore.
(5)Health Services and Systems Research, Duke-NUS Medical School, Singapore.
(6)Department of Medical Social Services, Singapore General Hospital, Singapore.
(7)HealthServe, Singapore.
(8)Division of Surgery and Surgical Oncology, Singapore General Hospital, 
National Cancer Centre Singapore, Singapore.
(9)Department of Rehabilitation Medicine, Singapore General Hospital, Singapore.
(10)Department of Cardiology, Changi General Hospital, Singapore.
(11)SingHealth Duke-NUS Global Health Institute, Singapore.

INTRODUCTION: The health, psychological and socioeconomic vulnerabilities of 
low-wage migrant workers have been magnified in the COVID-19 pandemic, 
especially in high-income receiving countries such as Singapore. We aimed to 
understand migrant worker concerns and coping strategies during the COVID-19 
pandemic to address these during the crisis and inform on comprehensive support 
needed after the crisis.
METHODS: In-depth semi-structured interviews were carried out with migrant 
workers diagnosed with COVID-19. The participants were recruited from a COVID-19 
mass quarantine facility in Singapore through a purposive sampling approach. 
Interviews were transcribed verbatim and thematic analysis performed to derive 
themes in their collective experience during the crisis.
RESULTS: Three theme categories were derived from 27 interviews: migrant worker 
concerns during COVID-19, coping during COVID-19 and priorities after COVID-19. 
Major stressors in the crisis included the inability to continue providing for 
their families when work is disrupted, their susceptibility to infection in 
crowded dormitories, the shock of receiving the COVID-19 diagnosis while 
asymptomatic, as well as the isolating conditions of the quarantine environment. 
The workers coped by keeping in contact with their families, accessing 
healthcare, keeping updated with the news and continuing to practise their faith 
and religion. They looked forward to a return to normalcy after the crisis with 
keeping healthy and having access to healthcare as new priorities.
CONCLUSION: We identified coping strategies employed by the workers in 
quarantine, many of which were made possible through the considered design of 
care and service delivery in mass quarantine facilities in Singapore. These can 
be adopted in the set-up of other mass quarantine facilities around the world to 
support the health and mental well-being of those quarantined. Our findings 
highlight the importance of targeted policy intervention for migrant workers, in 
areas such as housing and working environments, equitable access to healthcare, 
and social protection during and after this crisis.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2020-045949
PMCID: PMC7985935
PMID: 33741672 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3658. Clin J Oncol Nurs. 2021 Apr 1;25(2):210-214. doi: 10.1188/21.CJON.210-214.

Take-a-Break Intervention: Improving Oncology Nurse Wellness.

Rettig AE(1), Moore K(1), Savona E(1), Scala A(1).

Author information:
(1)Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.

Staff stress, burnout, and compassion fatigue related to increasing demands of 
oncology care have been further compounded by the impact of the COVID-19 
pandemic. Ambulatory oncology nursing care, with a central focus on the 
collaborative partnership with patients and families, requires cultivation of 
the caring and healing environment. The relationships that the oncology nurse 
has with self, colleagues, and the community support safe, high-quality, and 
patient- and family-centered oncology care. To foster a caring environment, 
Take-a-Break, a well-being intervention for oncology clinic nurses, was 
designed, implemented, and promoted by an oncology clinic nurse and an 
ambulatory oncology mental health advanced practice RN.

DOI: 10.1188/21.CJON.210-214
PMID: 33739348 [Indexed for MEDLINE]


3659. J Child Adolesc Psychiatr Nurs. 2021 Aug;34(3):225-235. doi: 10.1111/jcap.12311. 
Epub 2021 Mar 19.

Wellbeing of CAMHS staff and changes in working practices during the COVID-19 
pandemic.

Bentham C(1), Driver K(2), Stark D(2).

Author information:
(1)Department of Psychology, University of Sheffield, Sheffield, UK.
(2)Sheffield Child and Adolescent Mental Health Service, Sheffield Children's 
Hospital Foundation Trust, Sheffield, UK.

INTRODUCTION: The coronavirus disease 2019 pandemic has necessitated significant 
changes in working practices across healthcare services. The current study aimed 
to assess the wellbeing of health professionals and quantify the adaptations to 
working practices in a Child and Adolescent Mental Health Service (CAMHS) during 
the pandemic.
METHOD: The study was conducted in a UK CAMH team six weeks into lockdown 
measures. All clinicians were invited to complete a survey eliciting their 
experiences of working practices during the pandemic, degree of worry about the 
virus and mental wellbeing.
RESULTS: Clinicians had significantly lower levels of mental wellbeing during 
the pandemic than population normative data, to the extent that some clinicians 
were classified as at heightened risk of depression. A significant shift to 
remote working, reduction in face-to-face appointments, and decrease in 
clinicians' perceived ability to undertake clinical tasks was observed. Themes 
emerging from clinicians' experiences of working during the pandemic include 
being supported within the team, providing a service, working adaptations, and 
working as a team. A further theme highlights the needs of clinicians to 
complete their clinical role effectively.
CONCLUSION: CAMHS clinicians require additional support, training, and guidance 
during a pandemic to promote mental wellbeing and effectiveness in completing 
clinical tasks.

© 2021 The Authors. Journal of Child and Adolescent Psychiatric Nursing 
Published by Wiley Periodicals LLC.

DOI: 10.1111/jcap.12311
PMCID: PMC8250400
PMID: 33738882 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that there are no conflict 
of interests.


3660. BMJ Open. 2021 Mar 17;11(3):e043983. doi: 10.1136/bmjopen-2020-043983.

Metro and elderly health in Hong Kong: protocol for a natural experiment study 
in a high-density city.

Sun G(1), Du Y(2), Ni MY(2)(3)(4), Zhao J(2), Webster C(2).

Author information:
(1)Healthy High Density Cities Lab, Faculty of Architecture, The University of 
Hong Kong, Hong Kong, China gbsun@hku.hk.
(2)Healthy High Density Cities Lab, Faculty of Architecture, The University of 
Hong Kong, Hong Kong, China.
(3)School of Public Health, Li Ka Shing Faculty of Medicine, The University of 
Hong Kong, Hong Kong, China.
(4)The State Key Laboratory of Brain and Cognitive Sciences, The University of 
Hong Kong, Hong Kong, China.

INTRODUCTION: Public transport accessible to older people may offer a 
transformative solution to achieving healthy ageing. However, the evidence to 
support such transport infrastructure modifications is unclear. Previous studies 
on public transport use and elderly health were mostly observational studies 
using cross-sectional data. Few studies have examined the before-and-after 
effects of a new metro, for example, to see if it leads to improved elderly 
health.
METHODS AND ANALYSIS: We use a new metro line in Hong Kong as a natural 
experiment to examine the impact of the metro-led public transport intervention 
on elderly health. In Hong Kong, more than 90% of daily travels are made by 
public transport. The public transport modifications consist of the new metro 
line with eight stations and changes in the walking environment and bus services 
around the stations. We will look at the before-and-after differences in public 
transport use and health outcomes between elderly participants living in 
treatment neighbourhoods (400 m walking buffered areas of the new metro 
stations) and in control groups (living in comparable areas but unaffected by 
the new metro). Questionnaire-based baseline data were collected in 2019 before 
the COVID-19 pandemic, while some qualitative interviews are ongoing. Amid the 
pandemic, we conducted a quick telephone-based survey of COVID-19's potential 
impact on public transport use behaviours of our elderly cohort in September 
2020. Note there is no lockdown in Hong Kong until the writing of the paper 
(January 2021). After the new metro opens, we will conduct a follow-up survey, 
tentatively in late 2022. We aim to investigate if the new metro and the 
associated changes in the built environment have any effects on public transport 
use behaviours, physical activity and wider health outcomes among the elderly 
(eg, social inclusion, quality of life, subjective well-being).
ETHICS AND DISSEMINATION: The Human Research Ethics Committee of the University 
of Hong Kong reviewed and approved the study procedures and materials (reference 
number: EA1710040). Results will be communicated through scientific papers and 
research reports.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2020-043983
PMCID: PMC7978095
PMID: 33737434 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3661. Exp Clin Transplant. 2021 Aug;19(8):763-770. doi: 10.6002/ect.2020.0458. Epub 
2021 Mar 17.

Mental Health Support in the Transplantation Workforce: What Can We Learn From 
the COVID-19 Pandemic?

Fernando B(#)(1), Reynolds T(#)(2), Izzy M, Kirchner VA, Wren B, Spiro M.

Author information:
(1)From the Royal Free Hospital, London, United Kingdom.
(2)From the Royal London Hospital, London, United Kingdom.
(#)Contributed equally

Burnout (defined as a state of depersonalization, emotional exhaustion, and a 
sense of reduced achievement) is a risk to all health care workers. The 
transplantation workforce not only faces the same challenges but also many 
others linked to the unique work and setting in which they deliver health care. 
In the past, the mental health care of the transplantation workforce has been 
sidelined, rather than prioritized. The coronavirus disease 2019 pandemic has 
not only compromised the safe delivery of transplant organs worldwide but has 
magnified the challenges for the transplantation workforce. especially with the 
high mortality in transplant patients who are infected with SARS-CoV-2. This 
review addresses the challenges to the mental well-being and psychological 
health of health care providers, both generally and within the sphere of 
transplantation, and not only highlights some of the inadequacies but also 
proposes strategies to establish psychological interventions that could benefit 
health care professionals within transplantation.

DOI: 10.6002/ect.2020.0458
PMID: 33736587 [Indexed for MEDLINE]


3662. PLoS One. 2021 Mar 18;16(3):e0248811. doi: 10.1371/journal.pone.0248811. 
eCollection 2021.

Psychosocial effects of social media on the Saudi society during the Coronavirus 
Disease 2019 pandemic: A cross-sectional study.

Hammad MA(1), Alqarni TM(1).

Author information:
(1)Special Education Department, Faculty of Education, Najran University, 
Najran, Kingdom of Saudi Arabia.

The Coronavirus Disease 2019 (COVID-19) pandemic has been posing a substantial 
challenge to human survival and well-being, which rely on the actions and 
behaviors of individuals. It is essential that accurate information is 
distributed; however, misinformation has been spread via social media. 
Consequently, the resulting panic has to be addressed while putting essential 
public health measures in place. It is also important to explore the link 
between the social media exposure and well-being. Therefore, in the current 
study, we aimed to identify the levels of anxiety, depression, and social 
isolation among individuals during the COVID-19 pandemic. Additionally, we 
explored the relationship between exposure to misleading social media news and 
anxiety, depression, and social isolation. A cross sectional design was employed 
to collect data from 371 Saudi participants (aged 16-60 years), using the 
Generalized Anxiety Disorder-7, Centre for Epidemiological Studies Depression 
Scale, and de Jong Gierveld Loneliness Scale. Results showed that the prevalence 
of anxiety, depression, and social isolation was 47.82%, 47.57%, and 46.42%, 
respectively. Further, more than 83% of the participants reported using social 
media frequently during the pandemic. We found that exposure to misinformation 
via social media has a significant positive relationship with anxiety, 
depression, and social isolation. However, Due to the cross-sectional nature of 
this study it cannot be determined whether social media causes negative mental 
health outcomes, or if individuals experiencing greater depression, anxiety and 
social isolation turn to social media more than others, or if some third 
variable might explain both. Based on our findings, we present specific 
suggestions related to the COVID-19 pandemic to the government of Saudi Arabia. 
Minoring and filtering out misleading information with the cooperation of the 
World Health Organization (WHO) can promote the spread of accurate news in Saudi 
Arabia.

DOI: 10.1371/journal.pone.0248811
PMCID: PMC7971843
PMID: 33735309 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


3663. MMWR Morb Mortal Wkly Rep. 2021 Mar 19;70(11):369-376. doi: 
10.15585/mmwr.mm7011a1.

Association of Children's Mode of School Instruction with Child and Parent 
Experiences and Well-Being During the COVID-19 Pandemic - COVID Experiences 
Survey, United States, October 8-November 13, 2020.

Verlenden JV, Pampati S, Rasberry CN, Liddon N, Hertz M, Kilmer G, Viox MH, Lee 
S, Cramer NK, Barrios LC, Ethier KA.

In March 2020, efforts to slow transmission of SARS-CoV-2, the virus that causes 
COVID-19, resulted in widespread closures of school buildings, shifts to virtual 
educational models, modifications to school-based services, and disruptions in 
the educational experiences of school-aged children. Changes in modes of 
instruction have presented psychosocial stressors to children and parents that 
can increase risks to mental health and well-being and might exacerbate 
educational and health disparities (1,2). CDC examined differences in child and 
parent experiences and indicators of well-being according to children's mode of 
school instruction (i.e., in-person only [in-person], virtual-only [virtual], or 
combined virtual and in-person [combined]) using data from the COVID Experiences 
nationwide survey. During October 8-November 13, 2020, parents or legal 
guardians (parents) of children aged 5-12 years were surveyed using the NORC at 
the University of Chicago AmeriSpeak panel,* a probability-based panel designed 
to be representative of the U.S. household population. Among 1,290 respondents 
with a child enrolled in public or private school, 45.7% reported that their 
child received virtual instruction, 30.9% in-person instruction, and 23.4% 
combined instruction. For 11 of 17 stress and well-being indicators concerning 
child mental health and physical activity and parental emotional distress, 
findings were worse for parents of children receiving virtual or combined 
instruction than were those for parents of children receiving in-person 
instruction. Children not receiving in-person instruction and their parents 
might experience increased risk for negative mental, emotional, or physical 
health outcomes and might need additional support to mitigate pandemic effects. 
Community-wide actions to reduce COVID-19 incidence and support mitigation 
strategies in schools are critically important to support students' return to 
in-person learning.

DOI: 10.15585/mmwr.mm7011a1
PMCID: PMC7976614
PMID: 33735164 [Indexed for MEDLINE]

Conflict of interest statement: All authors have completed and submitted the 
International Committee of Medical Journal Editors form for disclosure of 
potential conflicts of interest. No potential conflicts of interest were 
disclosed.


3664. J Occup Health Psychol. 2021 Aug;26(4):276-290. doi: 10.1037/ocp0000271. Epub 
2021 Mar 18.

Depending on your own kindness: The moderating role of self-compassion on the 
within-person consequences of work loneliness during the COVID-19 pandemic.

Andel SA(1), Shen W(2), Arvan ML(3).

Author information:
(1)Department of Psychology, Indiana University-Purdue University Indianapolis.
(2)Schulich School of Business, York University.
(3)Department of Psychological Sciences, University of North Carolina at 
Charlotte.

The coronavirus (COVID-19) pandemic has transformed the way we work, with many 
employees working under isolating and difficult conditions. However, research on 
the antecedents, consequences, and buffers of work loneliness is scarce. 
Integrating research on need for belonging, regulatory loop models of 
loneliness, and self-compassion, the current study addresses this critical issue 
by developing and testing a conceptual model that highlights how COVID-related 
stressors frustrate employees' need for belonging (i.e., telecommuting 
frequency, job insecurity, and a lack of COVID-related informational justice), 
negatively impacting worker well-being (i.e., depression) and helping behaviors 
[i.e., organizational citizenship behavior (OCB)] through work loneliness. 
Furthermore, we examine the buffering role of self-compassion in this process. 
Results from a weekly diary study of U.S. employees conducted over 2 months 
during the initial stage of the pandemic provide support for the mediating role 
of work loneliness in relations between all three proposed antecedents and both 
outcomes. In addition, self-compassion mitigated the positive within-person 
relationship between work loneliness and employee depression, indicating that 
more self-compassionate employees were better able to cope with their feelings 
of work loneliness. Although self-compassion also moderated the within-person 
relationship between work loneliness and OCB, this interaction was different in 
form from our prediction. Implications for enhancing employee well-being and 
helping behaviors during and beyond the pandemic are discussed. (PsycInfo 
Database Record (c) 2021 APA, all rights reserved).

DOI: 10.1037/ocp0000271
PMID: 33734740 [Indexed for MEDLINE]


3665. Int J Occup Med Environ Health. 2021 May 27;34(2):251-262. doi: 
10.13075/ijomeh.1896.01778. Epub 2021 Mar 17.

Changes in mental well-being of adult Poles in the early period of the COVID-19 
pandemic with reference to their occupational activity and remote work.

Izdebski ZW(1), Mazur J(2).

Author information:
(1)University of Warsaw, Warsaw, Poland (Department of Biomedical Foundations of 
Development and Sexology, Faculty of Education).
(2)University of Zielona Gora, Zielona Góra, Poland (Department of Humanization 
in Medicine and Sexology, Collegium Medicum).

OBJECTIVES: The present study focused on the relationship between occupational 
activity and mental health during the first COVID-19 lockdown.
MATERIAL AND METHODS: At the turn of May and June 2020, an online survey was 
conducted on a representative sample of 3000 Poles (age: Me = 45 years). Working 
persons accounted for 52% of the respondents, while 38.1% were hired workers. 
Two standardized (0-100 pts) indices were defined. The level of mental health 
symptoms index (LMHSI) concerned the incidence of 4 problems within the past 2 
months, whereas the change in mental health symptoms index (CMHSI) concerned the 
degree of mental health deterioration.
RESULTS: The mean value of LMHSI was 40.91 (SD = 26.97), and that of CMHSI 60.51 
(SD = 23.97). In both cases, a worse assessment was obtained among women than 
among men. In the group of working respondents, the least advantageous results 
were found among those who worked casually or under a commission contract. Among 
the non-employed respondents, jobless persons and students were the group at 
risk. Remote work resulted in the deterioration of mental health in the light of 
CMHSI; however, a threat of changes in the professional situation affected LMHSI 
variability to the greatest extent The results of linear regression (R2 = 0.339) 
suggest that the increase in the CMHSI score (adjusted for LMHSI) is 
independently influenced by female sex, university education, remote work and a 
threat of the worsening of employment terms. The analysis of the interaction 
effect showed a stronger impact of the last factor in the group of women (p = 
0.001).
CONCLUSIONS: To conclude, COVID-19 restrictions were associated with a negative 
impact on mental health which should be analyzed in the occupational context. 
Int J Occup Med Environ Health. 2021;34(2):251-62.

This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL 
license.

DOI: 10.13075/ijomeh.1896.01778
PMID: 33734213 [Indexed for MEDLINE]


3666. J Prim Care Community Health. 2021 Jan-Dec;12:21501327211000245. doi: 
10.1177/21501327211000245.

Concerns, Perceived Impact, Preparedness in Coronavirus Disease (COVID-19) 
Pandemic and Health Outcomes among Italian Physicians: A Cross-Sectional Study.

Portoghese I(1), Meloni F(1), Galletta M(1), Piras I(1)(2), D'Aloja E(1), Finco 
G(1), Campagna M(1).

Author information:
(1)Università degli Studi di Cagliari, Monserrato (Ca), Italy.
(2)University of Sassari, Sassari (SS), Italy.

BACKGROUND: Health care workers (HCWs) are among the professionals at serious 
risk for the impact of the COVID-19 pandemic on their mental health. In this 
sense, the next public health challenge globally will be to preserving healthy 
HCWs during this pandemic.
AIM: The present study has the aim of investigating the relationship among 
concerns, perceived impact, preparedness for the COVID-19 pandemic and the 
mental health of Italian physicians.
METHODS: From March 29th to April 15th 2020, we conducted an online survey using 
snowball sampling techniques through Limesurvey platform. Data were analyzed 
using descriptive statistics and multiple binary logistic regressions.
RESULTS: Multivariate analysis showed that the risk factors for perceived job 
stress were concerns about catching COVID-19 (OR = 3.18 [95% CI = 2.00-5.05] 
P < .001), perceived impact on job demands (OR = 1.63 [95% CI = 1.05-2.52] 
P < .05), perceived impact on job role (OR = 2.50 [95% CI = 1.60-3.90] 
P < .001), and non-working concerns (OR = 1.86 [95% CI = 1.15-3.03] P < .05). 
With respect to the risk factors for rumination about the pandemic emerged 
concerns about catching COVID-19 (OR 1.74, [95% CI = 1.12-2.71] P < .05), 
perceived impact on job role (OR = 1.68 [95% CI = 1.12-2.52] P < .05), and 
impact on personal life (OR = 2.04 [95% CI = 1.08-3.86] P < .05). Finally, the 
risk factors for crying at work were perceived impact on job role (OR = 2.47, 
[95% CI = 1.20-5.09] P < .05), rumination about the pandemic (OR = 3.027 [95% 
CI = 1.27-7.19] P < .01), watching colleagues crying at work (OR = 3.82 [95% 
CI = 1.88-7.77] P < .01), and perceived job stress (OR = 3.53 [95% 
CI = 1.24-10.07] P < .05).
CONCLUSION: In general, our results highlighted that being concerned about being 
infected/infecting other people, carrying out new and unusual tasks, and 
witnessing colleagues crying at work were important risk factors for physicians' 
well-being. Additional data are necessary to advance understanding of these risk 
factors in a long-term perspective.

DOI: 10.1177/21501327211000245
PMCID: PMC7983480
PMID: 33733901 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


3667. Int J Pharm Pract. 2021 Mar 17;29(2):186-188. doi: 10.1093/ijpp/riaa020.

Bushfires, COVID-19 and Australian community pharmacists: ongoing impact on 
mental health and wellbeing.

McCallum BA(1), Dunkley K(2), Hotham E(1), Suppiah V(1)(3).

Author information:
(1)UniSA Clinical and Health Sciences, University of South Australia, Adelaide, 
South Australia, Australia.
(2)The Pharmacists' Support Service, Melbourne, Victoria, Australia.
(3)Australian Centre for Precision Health, University of South Australia, 
Adelaide, South Australia, Australia.

OBJECTIVES: The nation was recovering from the aftermath of the catastrophic 
2019-2020 bushfires when the first cases of the COVID-19 pandemic emerged in 
Australia. During the peak of the pandemic, Australia closed both its state and 
international borders to all travelers and interstate travel was very tightly 
regulated. Community pharmacists and pharmacy staff were one of the very few 
primary healthcare workers still serving their communities during these periods 
of strict lockdown. In this personal view article, the challenges and their toll 
on the mental health and wellbeing of these "essential workers" are described.
KEY FINDINGS: Community pharmacists and pharmacy staff were under immense 
pressure to remain open and serve their communities amidst rapidly changing 
legislation and, at times, conflicting advice from the range of Australian 
health agencies. Rapid changes to workload and workflow were combined with the 
dilemma of balancing professional obligations with the personal duty of keeping 
themselves and their sometimes geographically distant families safe. Fluctuating 
demands and traumatic situations found community pharmacy staff often feeling 
distressed and underprepared.
SUMMARY: Despite a global pandemic following a season of extraordinary 
bushfires, it has barely been acknowledged that community pharmacy staff are one 
of the highest risk groups for long-term psychological impacts. To our 
knowledge, very little research has addressed the toll of these cataclysmic 
events on this group of essential healthcare workers.

© The Author(s) 2021. Published by Oxford University Press on behalf of the 
Royal Pharmaceutical Society. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/ijpp/riaa020
PMCID: PMC7928840
PMID: 33729532 [Indexed for MEDLINE]


3668. BMC Psychiatry. 2021 Mar 16;21(1):152. doi: 10.1186/s12888-021-03143-z.

The prevalence and risk factors for depressive symptoms in frontline nurses 
under COVID-19 pandemic based on a large cross-sectional study using the 
propensity score-matched method.

Wang H(1), Dai X(2), Yao Z(2), Zhu X(2), Jiang Y(2), Li J(3), Han B(4).

Author information:
(1)Department of Thoracic Surgery, Shengjing Hospital of China Medical 
University, Shenyang, China.
(2)Department of Urology, Shengjing Hospital of China Medical University, No. 
36, San Hao Street, Shenyang, 110004, Liaoning, China.
(3)Department of Urology, Shengjing Hospital of China Medical University, No. 
36, San Hao Street, Shenyang, 110004, Liaoning, China. lijiacmu@163.com.
(4)Department of Urology, Shengjing Hospital of China Medical University, No. 
36, San Hao Street, Shenyang, 110004, Liaoning, China. hanbincmu81@163.com.

INTRODUCTION: To explore the prevalence of depressive symptoms and the 
associated risk factors in frontline nurses under COVID-19 pandemic.
METHODS: This cross-sectional study was conducted from February 20, 2020 to 
March 20, 2020 and involved 562 frontline nurses. The effective response rate 
was 87.68%. After propensity score matched, there were 498 participants left. 
Extensive characteristics, including demographics, dietary habits, life-related 
factors, work-related factors, and psychological factors were collected based on 
a self-reported questionnaire. Specific scales measured the levels of sleep 
quality, physical activity, depressive symptoms, perceived organization support 
and psychological capital. Adjusted odds ratios and 95% confidence intervals 
were determined by binary paired logistic regression.
RESULTS: Of the nurses enrolled in the study, 50.90% had depressive symptoms. 
Three independent risk factors were identified: poor sleep quality (OR = 1.608, 
95% CI: 1.384-1.896), lower optimism of psychological capital (OR = 0.879, 95% 
CI: 0.805-0.960) and no visiting friend constantly (OR = 0.513, 95% CI: 
0.286-0.920).
CONCLUSIONS: This study revealed a considerable high prevalence of depressive 
symptoms in frontline nurses during the COVID-19 outbreak, and identified three 
risk factors, which were poor sleep quality, lower optimism of psychological 
capital, and no visiting friend constantly. Protecting mental health of nurses 
is important for COVID-19 pandemic control and their wellbeing. These findings 
enrich the existing theoretical model of depression and demonstrated a critical 
need for additional strategies that could address the mental health in frontline 
nurses for policymakers.

DOI: 10.1186/s12888-021-03143-z
PMCID: PMC7961324
PMID: 33726704 [Indexed for MEDLINE]


3669. BMJ Open. 2021 Mar 15;11(3):e048012. doi: 10.1136/bmjopen-2020-048012.

Exploring correlates of depression, quality of life and alcohol misuse: a 
nationwide cross-sectional study of international migrants during the COVID-19 
epidemic in China.

Hall BJ(#)(1)(2), Zhao P(#)(3)(4), Xiong MZ(3)(4), Latkin C(2), Yang B(3)(4), 
Wang C(5)(4).

Author information:
(1)Department of Global Public Health, New York University Shanghai, Shanghai, 
China.
(2)Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School 
of Public Health, Baltimore, Maryland, USA.
(3)STD Control Department, Dermatology Hospital of Southern Medical University, 
Guangzhou, China.
(4)STD Control Department, Southern Medical University Institute for Global 
Health and Sexually Transmitted Diseases, Guangzhou, China.
(5)STD Control Department, Dermatology Hospital of Southern Medical University, 
Guangzhou, China wangcheng090705@gmail.com.
(#)Contributed equally

OBJECTIVES: The COVID-19 pandemic has overwhelmed health systems globally. With 
the increase of global migration, quantifying the health needs and key 
correlates of these outcomes is a global health priority. This study assessed 
migration characteristics, COVID-19 attitudes and the postmigration social 
environment as key correlates of depression, quality of life and alcohol misuse 
among international migrants in China.
DESIGN: A nationwide cross-sectional online survey was conducted from 17 
February and 1 March 2020.
SETTING: Links to the online survey were disseminated by migrant-focused 
community-based organisations through WeChat.
PARTICIPANTS: English speaking international migrants who met the inclusion 
criteria. Inclusion criteria were being born in a country outside of China, aged 
18 years or over, cumulatively living in China for 1 month or more and staying 
in China between December 2019 and February 2020.
OUTCOME MEASURES: Depression, quality of life and alcohol misuse.
RESULTS: Regression models indicated that planning or considering leaving China 
due to COVID-19, lacking the confidence to protect themselves and not being 
confident that the epidemic would end soon was associated with greater 
depression, lower quality of life and greater levels of alcohol misuse. Worry 
about contracting COVID-19 and feeling helpless to prevent infection were 
associated with greater depression and lower quality of life. General perceived 
social support, and trust in Chinese people, institutions and systems were 
protective factors for depression and associated with higher reported quality of 
life.
CONCLUSIONS: This study identifies key correlates that, if adequately addressed 
through public health outreach, may safeguard migrant well-being during a public 
health emergency. Trust in people and systems within the postmigration 
environment is an important consideration for future public health planning 
efforts.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2020-048012
PMCID: PMC7959221
PMID: 33722876 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3670. Asian J Psychiatr. 2021 Apr;58:102626. doi: 10.1016/j.ajp.2021.102626. Epub 2021 
Mar 10.

Mental health issues among health care workers during the COVID-19 pandemic - A 
study from India.

Parthasarathy R(1), Ts J(2), K T(3), Murthy P(4).

Author information:
(1)Government of Karnataka, India. Electronic address: drrajanibalaji@gmail.com.
(2)NIMHANS, Bengaluru, India. Electronic address: tsjaisoorya@gmail.com.
(3)NIMHANS, Bengaluru, India. Electronic address: kthenna@gmail.com.
(4)NIMHANS, Bengaluru, India. Electronic address: pratimamurthy@gmail.com.

Mental health issues among health care workers (HCWs) in treatment settings 
during COVID-19 remains understudied in India. This study examines its 
prevalence and correlates among HCWs in Karnataka State, India. HCWs who 
attended a workshop to improve mental health well-being during COVID-19 
completed an anonymous online questionnaire. In addition to socio-demographics, 
domains assessed include occupational characteristics, COVID-19 related 
concerns, anxiety/depression, substance use, suicidality, lifestyle and family 
functioning. Of the 3083 HCWs who completed the survey (response rate-51.4 %), 
anxiety disorder and depression was highest among those with frontline COVID-19 
responsibilities (anxiety disorder-26.6 %, depression-23.8 %). Prevalence was 
significantly higher among those with clinical responsibilities compared to 
those with supportive responsibilities (anxiety disorder: 23.9 % vs 15.5 %), 
(depression: 20.0 % vs 14.2 %). In the backward step-wise logistic regression 
analysis, HCWs with anxiety disorder were more likely to be 
doctors/nurses/hospital assistants, older, female, unmarried, without a leisure 
activity, report increased alcohol use and suicidal thoughts after pandemic 
onset, and having a history of receiving mental health interventions. 
Participants with depression additionally had family distress and hardly ever 
exercised. To conclude, mental health issues are common among HCWs in India. 
Interventions need to ensure that HCWs are protected from mental health 
consequences of working in COVID-19 treatment settings.

Copyright © 2021 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.ajp.2021.102626
PMCID: PMC9760419
PMID: 33721830 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflict of interest to 
declare.


3671. Psychiatry Res. 2021 May;299:113847. doi: 10.1016/j.psychres.2021.113847. Epub 
2021 Mar 2.

Mental health of Health Care Workers (HCWs): a review of organizational 
interventions put in place by local institutions to cope with new psychosocial 
challenges resulting from COVID-19.

Buselli R(1), Corsi M(2), Veltri A(1), Baldanzi S(1), Chiumiento M(1), Lupo 
ED(1), Marino R(1), Necciari G(1), Caldi F(1), Foddis R(1), Guglielmi G(1), 
Cristaudo A(1).

Author information:
(1)Occupational Health Department, U.O. Medicina Preventiva del Lavoro, Azienda 
Ospedaliero-Universitaria Pisana, 56124 Pisa (PI), Italy.
(2)Occupational Health Department, U.O. Medicina Preventiva del Lavoro, Azienda 
Ospedaliero-Universitaria Pisana, 56124 Pisa (PI), Italy. Electronic address: 
dott.martinacorsi@gmail.com.

The COVID-19 outbreak has been associated with significant occupational 
stressors and challenges for healthcare workers (HCWs) including the risk of 
exposure to SARS-CoV-2. Many reports from all over the world have already found 
that HCWs have significant levels of self-reported anxiety, depression and even 
symptoms of post-traumatic stress disorder. Therefore, supporting mental health 
of HCWs is a crucial part of the public health response to the COVID-19 
pandemic. The aim of the present review is to ascertain the interventions put in 
place worldwide in reducing stress in HCWs during the COVID-19 outbreak. We 
evidenced how only few countries have published specific psychological support 
intervention protocols for HCWs. All programs were developed in university 
associated hospitals and highlighted the importance of multidisciplinary 
collaboration. All of them had as their purpose to manage the psychosocial 
challenges to HCW's during the pandemic in order to prevent mental health 
problems.Whether one program offers distinct benefit compared to the others 
cannot be known given the heterogeneity of the protocols and the lack of a 
rigorous protocol and clinical outcomes. Further research is crucial to find out 
the best ways to support the resilience and mental well-being of HCWs.

Copyright © 2021. Published by Elsevier B.V.

DOI: 10.1016/j.psychres.2021.113847
PMCID: PMC7920813
PMID: 33721785 [Indexed for MEDLINE]

Conflict of interest statement: The Authors declare that there is no conflict of 
interest.


3672. J Affect Disord. 2021 May 1;286:134-141. doi: 10.1016/j.jad.2021.02.028. Epub 
2021 Feb 10.

The Impact of a Harry Potter-Based Cognitive-Behavioral Therapy Skills 
Curriculum on Suicidality and Well-being in Middle Schoolers: A Randomized 
Controlled Trial.

Klim-Conforti P(1), Zaheer R(2), Levitt AJ(3), Cheung AH(3), Schachar R(4), 
Schaffer A(5), Goldstein BI(6), Fefergrad M(3), Niederkrotenthaler T(7), Sinyor 
M(8).

Author information:
(1)Member of the College of Psychologists of Ontario, Toronto, Ontario, Canada; 
Institute of Medical Science, Faculty of Medicine, University of Toronto, 
Ontario, Canada.
(2)Sunnybrook Health Sciences Centre, Toronto, Canada.
(3)Department of Psychiatry, University of Toronto, Psychiatrist, Sunnybrook 
Health Sciences Centre, Toronto, Canada.
(4)The Hospital for Sick Children. Professor, Department of Psychiatry, 
University of Toronto, Canada.
(5)Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook 
Health Sciences Centre, Professor, Department of Psychiatry, University of 
Toronto, Canada.
(6)Department of Psychiatry, University of Toronto, Psychiatrist, The Centre for 
Addiction and Mental Health, Toronto, Canada.
(7)Medical University of Vienna, Centre for Public Health, Department of Social 
and Preventive Medicine, Unit Suicide Research and Mental Health Promotion.
(8)Department of Psychiatry, University of Toronto, Psychiatrist, Sunnybrook 
Health Sciences Centre, Toronto, Canada. Electronic address: 
mark.sinyor@sunnybrook.ca.

OBJECTIVE: To evaluate the impact of a Harry Potter-based mental health literacy 
curriculum, imparting cognitive behavioral therapy (CBT) skills, on suicidality 
and well-being in middle-schoolers.
METHODS: Students (aged 11-14; grades 7-8) who received a 3-month 
teacher-delivered intervention embedded in the language arts curriculum (N=200) 
were compared to a wait-list control group (N=230) in the largest urban school 
board in Canada. Suicidality defined as a composite measure of self-reported 
suicidal ideation and attempts [primary outcome], self-reported emotion 
dysregulation, interpersonal chaos, confusion about self, and impulsivity [Life 
Problems Inventory (LPI)] and self-reported depression and anxiety symptoms 
[Revised Child Anxiety and Depression Scale (RCADS)] were the outcomes of 
interest. Measurements occurred prior to and after curriculum delivery with 
independent t-tests used to compare mean change scores between groups clustered 
by class.
RESULTS: Thirty-seven English teachers in 46 classes across 15 schools comprised 
the planned study cohort. Composite suicidality scores were significantly worse 
in the control than intervention group at endpoint (0.05±0.54 vs. 0.17±0.47, t= 
-2.60, df=428, p=0.01). There were also significant improvements in LPI and 
RCADS scores in the intervention group compared to controls (LPI:-3.74±7.98 vs. 
1.16±10.77 t=5.28, df=428, p<.001; RCADS: (-3.08±5.49 vs. -1.51±6.53 t=2.96, 
df=429, p=0.01). Sub-analyses revealed that these improvements were largely 
driven by a significant difference in scores in girls.
LIMITATIONS: Sample size constraints as study terminated prematurely during 
COVID pandemic.
CONCLUSIONS: This study demonstrates significant improvement in suicidality, 
emotional regulation, self-concept, interpersonal difficulties, depression and 
anxiety in youth, particularly girls following this intervention. Replication 
studies in larger samples are needed to confirm these results.

Copyright © 2021 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2021.02.028
PMID: 33721740 [Indexed for MEDLINE]


3673. Healthc Policy. 2021 Feb;16(3):26-29. doi: 10.12927/hcpol.2021.26436.

Commentary: Time to Improve Access to Psychotherapies - A Family Medicine 
Perspective.

Lemire F(1), Chomienne MH(2).

Author information:
(1)Executive Director and CEO, The College of Family Physicians of Canada, 
Mississauga, ON.
(2)Assistant Professor, Department of Family Medicine, University of Ottawa; 
Physician, Montfort Hospital, Ottawa, ON.

The COVID pandemic - despite the dire economic and personal toll on all 
Canadians - is helping us move forward. It bears light on the most vulnerable. 
Indeed, it has aggravated the mental health of those with such disorders as 
anxiety or depression and revealed the precarity of our mental well-being. The 
health system, and most particularly our primary care system, is overwhelmed and 
its capacity to answer to the mental healthcare of Canadians is put to the test. 
It is, therefore, time for family physicians to be able to find support in 
various ways and means to answer the needs of their patients. This support may 
be through public coverage to psychotherapies, which has been proven effective 
in Australia and the UK since the last decade, or open access to various 
validated web-based tools offering cognitive behavioural therapies for the most 
common mental health disorders in both official languages.

Malgré des conséquences économiques et personnelles désastreuses pour tous les 
Canadiens, la pandémie de COVID présente l'occasion d'aller de l'avant. Elle met 
au jour les plus vulnérables. En effet, la pandémie a aggravé la santé mentale 
de ceux qui souffrent de troubles tels que l'anxiété ou la dépression et a 
révélé la précarité de notre bien-être mental. Le système de santé, et plus 
particulièrement le système de soins primaires, est débordé et sa capacité à 
répondre aux besoins en santé mentale des Canadiens est mise à rude épreuve. Il 
est temps que les médecins de famille soient en mesure de trouver du soutien 
sous divers formes et moyens afin de répondre aux besoins de leurs patients. Ce 
soutien peut prendre la forme d'une couverture publique des psychothérapies – 
laquelle s'est avérée efficace en Australie et au Royaume-Uni depuis une dizaine 
d'années – ou d'un accès libre à divers outils Web validés qui proposent des 
thérapies cognitivo-comportementales pour les troubles de santé mentale les plus 
courants, dans les deux langues officielles.

Copyright © 2021 Longwoods Publishing.

DOI: 10.12927/hcpol.2021.26436
PMCID: PMC7957356
PMID: 33720821 [Indexed for MEDLINE]


3674. Curr Neuropharmacol. 2021;19(8):1161-1163. doi: 
10.2174/1570159X19666210311103136.

The Stress of the COVID-19 Pandemic: Beyond the Data.

Salim S(1).

Author information:
(1)Department of Pharmacological & Pharmaceutical Sciences, University of 
Houston, Houston, TX, United States.

BACKGROUND: The year 2020 will go down in modern history as the one ravaged by a 
pandemic, the one which humbled the entire world. From the richest and most 
advanced nations to the poorest and least developed ones, it exposed all of our 
vulnerabilities. The loss of life, health disparities and economic adversities, 
aggravated by political and ideological tensions, added multiple layers of 
stress and anxieties to an already stressed American society.
METHODS: The educational institutions in the United States from the central to 
the local units demonstrated coherence in leadership, guided with flexibility 
and compassion, which paved the way for smooth operations. However, anxiety 
among students and faculty of university and college campuses is undeniable. 
In-person instruction was halted. Research labs and offices were locked down or 
operating with limited personnel. Thus, the challenges to have timely 
instruction and to move the research enterprise forward have been enormous. 
Provided here is a perspective based on a literature search using PubMed and 
Google with search words "COVID-19, stress, college students", "COVID-19, 
stress, US graduate students", and "COVID-19, stress, postdoc researchers".
RESULTS: This article is an opinion piece, part personal and part peer 
experiences. It is presented in light of studies suggesting that the COVID-19 
pandemic has imposed significant mental stress and anxiety upon students and 
faculty members within the academy.
CONCLUSION: Loss of face-to-face interactions as a result of virtual 
instructions, lack of in-person mentoring, and loss of research productivity 
have affected mental health and well-being of the academic community. Despite 
the challenges of the pandemic, the ingenuity of the human spirit has innovated 
solutions to catch up on research productivity and to pursue academic 
excellence.

Copyright© Bentham Science Publishers; For any queries, please email at 
epub@benthamscience.net.

DOI: 10.2174/1570159X19666210311103136
PMCID: PMC8719285
PMID: 33719975 [Indexed for MEDLINE]


3675. Soc Sci Med. 2021 Apr;275:113801. doi: 10.1016/j.socscimed.2021.113801. Epub 
2021 Feb 24.

The disparate impact of COVID-19 on the mental health of female and male 
caregivers.

Wade M(1), Prime H(2), Johnson D(3), May SS(4), Jenkins JM(3), Browne DT(4).

Author information:
(1)Department of Applied Psychology and Human Development, University of 
Toronto, Toronto, ON, Canada. Electronic address: m.wade@utoronto.ca.
(2)Department of Psychology, York University, Toronto, ON, Canada.
(3)Department of Applied Psychology and Human Development, University of 
Toronto, Toronto, ON, Canada.
(4)Centre for Mental Health Research and Treatment, Department of Psychology, 
University of Waterloo, Waterloo, ON, Canada.

Caregiver mental health is crucial to the wellbeing of children. This is most 
apparent when caregivers face high levels of stress or life adversity. To study 
this phenomenon in the current global context, this study examined the relation 
between stress/disruption from the COVID-19 pandemic and the mental health of 
female and male caregivers. Pre-pandemic childhood adversity was considered as a 
moderator of this association. A multi-national sample (United Kingdom, 76%; 
United States, 19%; Canada, 4%, and Australia, 1%) was recruited in May 2020, of 
whom 348 female and 143 male caregivers of 5-18 year-old children provided data 
on the constructs of interest. At this time, caregivers reported on their 
history of adverse childhood experiences (ACEs) and COVID stress/disruption. 
About two months later (July 2020) caregiver mental health was evaluated. We 
examined differences between female and male caregivers on ACEs, COVID 
stress/disruption, and mental health (distress, anxiety, substance use, and 
posttraumatic stress). Main and interactive effects of ACEs and COVID 
stress/disruption on each mental health outcome were examined. Female caregivers 
reported higher COVID stress/disruption, more ACEs, and greater distress, 
anxiety, and posttraumatic stress symptoms compared to male caregivers. Among 
female caregivers, higher COVID stress/disruption and more adverse childhood 
experiences (ACEs) independently predicted all mental health outcomes, 
consistent with a stress accumulation model. Among male caregivers, a pattern of 
interactions between COVID stress/disruption and ACEs suggested that the effects 
of COVID stress/disruption on mental health was stronger for those with higher 
ACEs, especially for substance use, consistent with a stress sensitization 
model. Higher levels of stress and mental health difficulties among female 
caregivers suggests a disproportionate burden due to pandemic-related disruption 
compared to male caregivers. Findings speak to the disparate effects of COVID-19 
on the mental health of female compared to male caregivers, and the role of 
pre-existing vulnerabilities in shaping current adaptation.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.socscimed.2021.113801
PMCID: PMC9756753
PMID: 33713927 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no financial interests or 
conflicts to disclose.


3676. Med Care. 2021 Apr 1;59(Suppl 2):S101-S102. doi: 10.1097/MLR.0000000000001518.

Multimorbidity and Social Drivers of Homelessness and Health: Introduction to 
This Special Issue.

Tsai J(1)(2)(3), King B(4), Elder J(5).

Author information:
(1)National Center on Homelessness Among Veterans, Homeless Programs Office, US 
Department of Veterans Affairs Central Office, Washington, DC.
(2)School of Public Health, University of Texas Health Science Center at 
Houston, Houston, TX.
(3)Department of Psychiatry, Yale University School of Medicine, New Haven, CT.
(4)Department of Health Systems and Population Health Sciences, College of 
Medicine, University of Houston, Houston, TX.
(5)Policy Research Inc., Delmar, NY.

This introduction describes the impetus and context for this special issue on 
multimorbidity in homeless populations. The guest editors begin the introduction 
by describing the problem of homelessness which has been exacerbated by the 
coronavirus disease 2019 (COVID-19) pandemic. The editors then describe the 
content of this special issue, which includes original research examining 
special populations such as homeless youth, aging populations, and Veterans as 
well as medical and behavioral health conditions such as tuberculosis, HIV, and 
opioid use disorder. Two editorials are also included in this special issue that 
comment on the history of homelessness and the link between homelessness and 
suicide. The editors acknowledge the different stakeholders that helped support 
this special issue and highlight the need for continued research and innovative 
solutions to improve the health, housing, and well-being of homeless 
populations.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/MLR.0000000000001518
PMID: 33710079 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3677. J Psychiatr Ment Health Nurs. 2022 Apr;29(2):381-385. doi: 10.1111/jpm.12752. 
Epub 2021 Mar 31.

Silver linings: Observed reductions in aggression and use of restraints and 
seclusion in psychiatric inpatient care during COVID-19.

Martin K(1)(2), Arbour S(1), McGregor C(1)(2), Rice M(1).

Author information:
(1)Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada.
(2)Ontario Tech University, Oshawa, ON, Canada.

WHAT IS KNOWN ABOUT THE SUBJECT?: In a survey conducted by the World Health 
Organization (WHO) in the summer of 2020, 93% of countries worldwide 
acknowledged negative impacts on their mental health services. Previous research 
during the H1N1 pandemic in 2009 established an increase of patient aggression 
in psychiatric facilities. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Despite 
expected worsening of mental health, our hospital observed reductions in 
aggressive behaviour among inpatients and subsequent use of coercive 
interventions by staff in the months following Covid-19 pandemic restrictions 
being implemented. The downward trend in incidents observed during the pandemic 
has suggested that aggression in mental health hospitals may be more 
situation-specific and less so a factor of mental illness. WHAT ARE THE 
IMPLICATIONS FOR PRACTICE?: We believe that the reduction in aggressive 
behaviour observed during the pandemic is related to changes in our organization 
that occurred in response to concerns about patient well-being; our co-design 
approach shifted trust, choice and power. Therefore, practices that support 
these constructs are needed to maintain the outcomes we experienced. Rather than 
return to normal in the wake of the pandemic, we are strongly encouraged to 
sustain the changes we made and continue to find better ways to support and work 
with the individuals who rely on or use our services. ABSTRACT: The global 
COVID-19 pandemic has dramatically changed the operation of health care such 
that many services were put on hold as patients were triaged differently, people 
delayed seeking care, and transition to virtual care was enacted, including in 
psychiatric facilities. Most of the media dialogue has been negative; however, 
there have been some silver linings observed. Coinciding with the pandemic has 
been a reduction in aggressive incidents at our psychiatric hospital, along with 
the decreased need to use restraints and seclusion to manage behaviour. In this 
paper, we are taking stock of the changes that have occurred in response to the 
pandemic in an attempt to share our learnings and offer suggestions so that 
health care does not necessarily return to "normal".

© 2021 John Wiley & Sons Ltd.

DOI: 10.1111/jpm.12752
PMCID: PMC8242738
PMID: 33704877 [Indexed for MEDLINE]


3678. J Osteopath Med. 2021 Feb 18;121(5):455-461. doi: 10.1515/jom-2020-0272.

Predictors of emotional wellbeing in osteopathic medical students in a COVID-19 
world.

Jacobs R(1), Lanspa M(1), Kane M(2), Caballero J(3).

Author information:
(1)Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern 
University, Fort Lauderdale, FL, USA.
(2)The Phyllis and Harvey Sandler School of Social Work, Florida Atlantic 
University, Boca Raton, FL, USA.
(3)College of Pharmacy, Larkin University, Miami, FL, USA.

Comment in
    J Osteopath Med. 2021 May 31;121(7):607-609.

CONTEXT: In March 2020, the World Health Organization declared the novel 
coronavirus disease 2019 (COVID-19) outbreak a pandemic. Due to the rapid 
spread, strong contagion, high incidence of lethality in severe cases, and the 
lack of a pharmaceutical prevention or cure, COVID-19 has posed a serious threat 
to human life and health. It has also had a tremendous impact on mental health, 
including fear and worry, difficulty sleeping or concentrating, and increased 
use of poor coping mechanisms. Osteopathic medical students have had additional 
concerns regarding the interruption of their studies, closing of clinical 
rotations, and postponed licensing exams. To date, few reports have focused on 
osteopathic medical students and their reactions to the outbreak.
OBJECTIVES: To assess resilience, coping, health behaviors, and emotional 
wellbeing of osteopathic medical students during the onset of the COVID-19 
pandemic.
METHODS: In this cross-sectional study, we distributed an anonymous online 
survey to all medical students enrolled at Nova Southeastern University in May 
2020 (n=1,310) via an e-mail invitation using the institution's student 
listservs. Our major study variables were based on published reports and 
anecdotal evidence; we subsequently developed the Emotional Wellbeing in 
Healthcare Professions Students Questionnaire (EWB-Q). This EWB-Q contained 
validated scales to assess the contribution of levels of coping strategies used, 
personal resilience, and health behaviors on the emotional wellbeing of 
osteopathic medical students. Multiple linear regression and other statistical 
analyses were conducted using SPSS v0.26.
RESULTS: Of the 1,310 students invited to participate, 335 (25.5%) surveys were 
returned. Of those, 133 had more than 33% of the necessary data missing and were 
removed, resulting in 202 (15.4%) completed questionnaires. The mean age of the 
participants was 26.7 years. About half (n=92; 45.5%) were in the clinical phase 
(years 3 and 4) of their medical school training (in rotations). A significant 
regression equation was found (F[4,171]=17.481, p<0.000, R2 =0.290, 
R2adjusted=0.274), indicating that levels of coping, personal resilience, and 
health behaviors (i.e., not sleeping more than usual, not exercising less than 
usual) accounted for a significant amount of the variance in emotional wellbeing 
scores in osteopathic medical students. Higher levels of resilience, greater use 
of coping strategies, not sleeping more than usual, and not exercising less than 
usual were predictors of emotional wellbeing.
CONCLUSIONS: Cultivating positive mental health should be a high priority for 
medical educators as they develop and implement curriculum-based initiatives to 
help medical students bolster their personal resilience and to encourage healthy 
coping behaviors during times of crisis and beyond. A proactive position that 
assists with building personal resilience and developing stress management 
habits is paramount in assisting students who are grappling not only with the 
challenges of rigorous medical training, but also with the uncertainty and 
stress that exists during any major global health or socioeconomic crisis.

© 2021 Robin Jacobs et al., published by De Gruyter, Berlin/Boston.

DOI: 10.1515/jom-2020-0272
PMID: 33694347 [Indexed for MEDLINE]


3679. J Public Health (Oxf). 2021 Jun 7;43(2):e352-e353. doi: 10.1093/pubmed/fdab064.

Psychospiritual care for parents during the COVID-19 pandemic.

Quendan RG(1), Lingad RB(1), Gozum IEA(1).

Author information:
(1)Angeles University Foundation, Angeles, Philippines.

Comment on
    J Public Health (Oxf). 2021 Feb 03;:null.

In a recent article, energy poverty increases the likelihood of depression in 
parents. The authors responded that this situation must be given attention 
because parental well-being can influence child development and outcomes. With 
this, we propose, in this paper, that an avenue that can be done is by providing 
a psychospiritual care for parents especially during the COVID-19 pandemic in 
which anxieties among family members arise.

© The Author(s) 2021. Published by Oxford University Press on behalf of Faculty 
of Public Health. All rights reserved. For permissions, please e-mail: 
journals.permissions@oup.com.

DOI: 10.1093/pubmed/fdab064
PMCID: PMC7989342
PMID: 33693850 [Indexed for MEDLINE]


3680. Front Public Health. 2021 Feb 22;9:636921. doi: 10.3389/fpubh.2021.636921. 
eCollection 2021.

DETECT Schools Study Protocol: A Prospective Observational Cohort Surveillance 
Study Investigating the Impact of COVID-19 in Western Australian Schools.

Mullane MJ(1), Thomas HM(1), Epstein M(1)(2), Mandzufas J(1), Mullan N(1), 
Whelan A(1), Lombardi K(1)(2)(3), Barrow T(1), Ang S(1), Leahy A(1), Cameron 
E(1)(4), Lester L(2), Cooper M(1), Stevenson P(1), Hartman M(1), McKenzie A(1), 
Mitrou F(1), Zubrick SR(1), Coffin J(1)(5), Cross D(1)(5), Bowen AC(1)(5)(6), 
Gething P(1)(4).

Author information:
(1)Telethon Kids Institute, Perth, WA, Australia.
(2)Cancer Council Western Australia, Perth, WA, Australia.
(3)Edith Cowan University, Perth, WA, Australia.
(4)Curtin University, Perth, WA, Australia.
(5)University of Western Australia, Perth, WA, Australia.
(6)Child and Adolescent Health Service, Perth, WA, Australia.

Introduction: Amidst the evolving COVID-19 pandemic, understanding the 
transmission dynamics of the SARS-CoV-2 virus is key to providing peace of mind 
for the community and informing policy-making decisions. While available data 
suggest that school-aged children are not significant spreaders of SARS-CoV-2, 
the possibility of transmission in schools remains an ongoing concern, 
especially among an aging teaching workforce. Even in low-prevalence settings, 
communities must balance the potential risk of transmission with the need for 
students' ongoing education. Through the roll out of high-throughput 
school-based SARS-CoV-2 testing, enhanced follow-up for individuals exposed to 
COVID-19 and wellbeing surveys, this study investigates the dynamics of 
SARS-CoV-2 transmission and the current psychosocial wellbeing impacts of the 
pandemic in school communities. Methods: The DETECT Schools Study is a 
prospective observational cohort surveillance study in 79 schools across Western 
Australia (WA), Australia. To investigate the incidence, transmission and impact 
of SARS-CoV-2 in schools, the study comprises three "modules": Module 1) 
Spot-testing in schools to screen for asymptomatic SARS-CoV-2; Module 2) 
Enhanced surveillance of close contacts following the identification of any 
COVID-19 case to determine the secondary attack rate of SARS-CoV-2 in a school 
setting; and Module 3) Survey monitoring of school staff, students and their 
parents to assess psycho-social wellbeing following the first wave of the 
COVID-19 pandemic in WA. Clinical Trial Registration: Trial registration number: 
ACTRN12620000922976.

Copyright © 2021 Mullane, Thomas, Epstein, Mandzufas, Mullan, Whelan, Lombardi, 
Barrow, Ang, Leahy, Cameron, Lester, Cooper, Stevenson, Hartman, McKenzie, 
Mitrou, Zubrick, Coffin, Cross, Bowen and Gething.

DOI: 10.3389/fpubh.2021.636921
PMCID: PMC7937789
PMID: 33692984 [Indexed for MEDLINE]

Conflict of interest statement: Telethon Kids Institute authors report grants 
from the Western Australian Department of Health during the conduct of this 
study. DC and AB report grants from the Western Australian Department of Health 
outside the submitted work. AB is an employee of the Western Australian 
Department of Health. The remaining authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


3681. Psychother Psychosom. 2021;90(3):200-206. doi: 10.1159/000514331. Epub 2021 Mar 
10.

Physical Exercise as a Resilience Factor to Mitigate COVID-Related Allostatic 
Overload.

Eöry A(1)(2), Békési D(3), Eöry A(4), Rózsa S(5)(6).

Author information:
(1)Division of Integrative Medicine, Department of Family Medicine, Semmelweis 
University, Budapest, Hungary, ajandekeory@gmail.com.
(2)Hungarian Acupuncture and Moxibustion Society, Budapest, Hungary, 
ajandekeory@gmail.com.
(3)Rácz Károly Clinical Medicine PhD School Semmelweis University Hungary, 
Budapest, Hungary.
(4)Hungarian Acupuncture and Moxibustion Society, Budapest, Hungary.
(5)Károli Gáspár University of the Reformed Church in Hungary, Budapest, 
Hungary.
(6)Department of Psychiatry, Washington University in St Louis, St Louis, 
Missouri, USA.

INTRODUCTION: The long-lasting threat of COVID-19 makes it necessary to explore 
strategies to improve coping skills which enable us to master a balanced life in 
the face of adversity.
OBJECTIVE: To unravel the most challenging aspects of COVID-19 in a nonclinical 
adult population and identify predictors of lost balance and consequent 
allostatic overload (AO). We examined the role of regular, moderate-intensity 
formula aerobic exercise (312 meridian exercise) in preventing allostatic 
overload through increasing well-being.
METHODS: An online survey was conducted to measure CO-VID-related allostatic 
overload according to clinimetric criteria. The Psychosocial Index (PSI), 
Kellner's Symptom Questionnaire (KSQ), short Depression Anxiety Stress Scales 
(DASS-21), Public Health Surveillance Well-Being Scale -(PHS-WB), and Whiteley-7 
were used to explore mental health characteristics. Univariate statistics 
logistic regression analysis and a general linear model were used.
RESULTS: According to 442 valid answers, 217 adults practiced physical exercise 
(PE) frequently (fPE, 3-5 times/every day) while 120 did it less regularly (1-2 
times/week), and 105 did not exercise/practiced irregularly (controls). 
Restriction-related stressors were most challenging, resulting in AO in 29% (n = 
128) of the sample. The main predictors were additional stressors (p = 0.005) 
and anxiety symptoms (p < 0.001). The prevalence of AO was lower (p = 0.018) in 
the fPE group when compared to controls. KSQ distress symptoms were also lower 
in fPE (p < 0.0001), while total well-being was increased (p < 0.001) after 
adjusting for sex, age, and number of chronic diseases. According to the PHS-WB, 
both physical and mental well-being were higher (p = 0.003 and p = 0.004, 
respectively) in fPE.
CONCLUSIONS: Frequent moderate exercise is associated with better mental and 
physical well-being and a lower prevalence of AO.

© 2021 S. Karger AG, Basel.

DOI: 10.1159/000514331
PMCID: PMC8678241
PMID: 33691321 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
declare.


3682. J Ment Health. 2021 Apr;30(2):148-155. doi: 10.1080/09638237.2021.1875413. Epub 
2021 Mar 9.

Mental health, quality of life, wellbeing, loneliness and use of social media in 
a time of social distancing during the COVID-19 outbreak. A cross-country 
comparative study.

Geirdal AØ(1), Ruffolo M(2), Leung J(3), Thygesen H(4)(5), Price D(2), Bonsaksen 
T(4)(5)(6), Schoultz M(7).

Author information:
(1)Faculty of Social Sciences, Department of Social Work, Child Welfare and 
Social Policy, OsloMet - Oslo Metropolitan University, Oslo, Norway.
(2)School of Social Work, University of Michigan, Ann Arbor, MI, USA.
(3)Faculty of Health and Behavioural Science, The University of Queensland, St 
Lucia, QLD, Australia.
(4)Faculty of Health Sciences, Department of Occupational Therapy, Prosthetics 
and Orthotics, Oslo Metropolitan University, Oslo, Norway.
(5)Faculty of Health Studies, VID Specialized University, Sandnes, Norway.
(6)Department of Health and Nursing Sciences, Faculty of Social and Health 
Sciences, Inland Norway University of Applied Sciences, Elverum, Norway.
(7)School of Health and Society, University of Salford, Manchester, UK.

BACKGROUND: The COVID-19 outbreak raised questions about how people experience 
their mental health, quality of life (QoL), wellbeing and loneliness in the 
context of social distancing, and the use of social media during this time.
AIMS: To examine the experience of mental health, QoL, wellbeing and loneliness 
and use of social media among people living in Norway, USA, UK and Australia.
METHODS: A cross-country comparative survey of people living in Norway, USA, UK 
and Australia. Relevant statistical analyses were used to examine differences 
between the countries and to explore associations between demographic, mental 
health and psychosocial variables and use of social media.
RESULTS: There were 3810 respondents from four countries, of which 50 - 74% 
showed a high level of emotional distress. The Norwegian population reported 
significantly better mental health, QoL and wellbeing and lower levels of 
loneliness compared to the other countries. High-frequent use of social media 
after the COVID-19 outbreak was associated with poorer mental- and psychosocial 
health.
CONCLUSIONS: The results suggest that the COVID-19 outbreak took a toll on 
people's experience of mental health, QoL, wellbeing and experienced loneliness, 
and high-frequent use of social media was associated with these factors.

DOI: 10.1080/09638237.2021.1875413
PMID: 33689546 [Indexed for MEDLINE]


3683. J Sleep Res. 2021 Oct;30(5):e13313. doi: 10.1111/jsr.13313. Epub 2021 Mar 9.

Sleeping under the waves: A longitudinal study across the contagion peaks of the 
COVID-19 pandemic in Italy.

Salfi F(1), D'Atri A(1), Tempesta D(1), Ferrara M(1).

Author information:
(1)Department of Biotechnological and Applied Clinical Sciences, University of 
L'Aquila, L'Aquila, Italy.

After the March-April 2020 coronavirus disease 2019 (COVID-19) outbreak, a 
second contagion wave afflicted Europe in the autumn. The present study aimed to 
evaluate sleep health/patterns of Italians during this further challenging 
situation. A total of 2,013 Italians longitudinally participated in a web-based 
survey during the two contagion peaks of the COVID-19 outbreak. We investigated 
the risk factors for sleep disturbances during the second wave, and we compared 
sleep quality and psychological well-being between the two assessments 
(March-April and November-December 2020). Female gender, low education, evening 
chronotype, being a high-risk person for COVID-19 infection, reporting negative 
social or economic impact, and evening smartphone overuse predicted a higher 
risk of poor sleep and insomnia symptoms during the second wave. Advanced age, 
living with a high-risk person for COVID-19 infection, and having a 
relative/friend infected with COVID-19 before the prior 2 weeks were risk 
categories for poor sleep quality. Living with children, having contracted 
COVID-19 before the prior 2 weeks, being pessimistic about the vaccine and 
working in healthcare, were risk factors for insomnia symptoms. The follow-up 
assessment highlighted reduced insomnia symptoms and anxiety. Nevertheless, we 
found reduced sleep duration, higher daytime dysfunction, advanced bedtime and 
wake-up time, and a shift to morningness, confirming the alarming prevalence of 
poor sleepers (~60%) and severe depression (~20%) in a context of increased 
perceived stress. The present study showed a persistent impact of the COVID-19 
pandemic on sleep and mental health. Large-scale interventions to counteract the 
chronicity and exacerbation of sleep and psychological disturbances are 
necessary, especially for the at-risk categories.

© 2021 European Sleep Research Society.

DOI: 10.1111/jsr.13313
PMCID: PMC8250209
PMID: 33687798 [Indexed for MEDLINE]

Conflict of interest statement: None of the authors have potential conflicts of 
interest to be disclosed. All authors have seen and approved the manuscript.


3684. Recenti Prog Med. 2021 Mar;112(3):207-215. doi: 10.1701/3565.35460.

[Impact of the lockdown on children and families: a survey of family 
pediatricians within a community.].

[Article in Italian]

Brunelli A(1), Silvestrini G(2), Palestini L(3), Vitali P(2), Nanni R(4), 
Belluzzi A(5), Ciambra R(5), De Logu M(5), Degli Angeli M(5), Dessì FL(5), 
Donati D(5), Gaspari L(5), Ghini T(5), Giovannini M(5), Iaia M(5), Mazzini F(5), 
Mollace R(5), Nanni V(5), Perra AP(5), Poggioli B(5), Ponton I(5), Russo G(5), 
Saletti A(5), Selli A(5), Stazzoni A(5), Vignutelli L(5), Zamuner E(5), 
Venturini L(6), Zamprogno E(6), Valletta E(7), Marchetti F(8).

Author information:
(1)Rete Infanzia e Adolescenza, AUSL Romagna.
(2)UO Epidemiologia, AUSL Romagna.
(3)Agenzia Sanitaria e Sociale Regionale, Regione Emilia-Romagna.
(4)Programma di Psicologia, AUSL Romagna.
(5)Pediatria di famiglia e di comunità AUSL Romagna.
(6)Redazione Web Corporate University, AUSL Romagna (CURA).
(7)Dipartimento Salute Donna, Infanzia e Adolescenza di Forlì-Cesena, AUSL 
Romagna.
(8)Dipartimento Salute Donna, Infanzia e Adolescenza di Ravenna, AUSL Romagna.

OBJECTIVES: The recent lockdown, resulting from the SARS-CoV-2 pandemic, has had 
a strong social and psychological impact on the most fragile individuals and 
family structures. In the present work we investigated the experience of 
families without specific elements of social or health vulnerability during the 
quarantine period that occurred in the spring of 2020.
MATERIALS AND METHODS: Between May and July 2020, 22 primary care pediatricians 
belonging to AUSL Romagna administered to a number of families a questionnaire 
to detect changes that occurred, during the lockdown, in family environment, 
school attendance and personal attitudes.
RESULTS: A total of 721 questionnaires were collected, analyzing the 
associations between variables relating to home environment, daily rhythms, 
school and warning signs in relation to the age of children. As a result of the 
lockdown, family habits changed in 31% of cases, with a greater presence of the 
reference figure in 68% of these. Three out of four families reported they had 
sufficient domestic spaces, and nine out of ten had access to an outdoor, 
private or condominium space. Daily rhythms were preserved in 56.7% of cases; 
mood disorders appeared in 30% of adolescent children, followed by sleep, 
appetite and psychosomatic disorders. One in three children has made progress in 
terms of evolution and behavior, and one in 5 children has seen their 
relationships improve. The overall resilience of families during the lockdown 
period was considered good in 66.3%, sufficient in 31.3% and not satisfactory in 
only 2.4% of cases.
CONCLUSIONS: Our data show that, in the interviewed families, the simultaneous 
presence of adults and children at home has generally intensified. Families 
refer, on the whole, a positive and resilient behavior in the lockdown period, 
even if initial emotional problems are reported in one out of three 
children-adolescents. The ability to maintain a family organized structure seems 
to be partially compromised. Forced cohabitation leads to competition for the 
same resources of time and space and affects the entire family unit. The school 
institution emerges as a protective factor for children, young people and also 
for the well-being of families themselves.

DOI: 10.1701/3565.35460
PMID: 33687359 [Indexed for MEDLINE]


3685. Sleep Med. 2022 Mar;91:189-195. doi: 10.1016/j.sleep.2021.02.028. Epub 2021 Feb 
19.

Not so sweet dreams: adults' quantity, quality, and disruptions of sleep during 
the initial stages of the COVID-19 pandemic.

Shillington KJ(1), Vanderloo LM(2), Burke SM(3), Ng V(4), Tucker P(5), Irwin 
JD(6).

Author information:
(1)Health and Rehabilitation Sciences Program, Faculty of Health Sciences, The 
University of Western Ontario, London, Ontario, Canada.
(2)Child Health Evaluative Science, The Hospital for Sick Children, Toronto, 
Canada.
(3)Health and Rehabilitation Sciences Program, Faculty of Health Sciences, The 
University of Western Ontario, London, Ontario, Canada; School of Health 
Studies, Faculty of Health Sciences, The University of Western Ontario, London, 
Ontario, Canada.
(4)Schulich School of Medicine and Dentistry, Western University, London, 
Ontario, Canada; Department of Family and Community Medicine, University of 
Toronto, Toronto, Ontario, Canada; Division of Professional and Practice 
Support, College of Family Physicians of Canada, Mississauga, Ontario, Canada.
(5)Health and Rehabilitation Sciences Program, Faculty of Health Sciences, The 
University of Western Ontario, London, Ontario, Canada; School of Occupational 
Therapy, Faculty of Health Sciences, The University of Western Ontario, London, 
Ontario, Canada.
(6)Health and Rehabilitation Sciences Program, Faculty of Health Sciences, The 
University of Western Ontario, London, Ontario, Canada; School of Health 
Studies, Faculty of Health Sciences, The University of Western Ontario, London, 
Ontario, Canada. Electronic address: jenirwin@uwo.ca.

OBJECTIVES: The purpose of this study was to investigate Ontario adults' 
reported sleep quantity, quality, and disturbances during the early months of 
the COVID-19 pandemic (April-July 2020).
METHODS: As part of a larger, chronic disease-focused, and ongoing longitudinal 
study designed to explore Ontario adults' health and wellness-related behaviors 
during the pandemic, participants completed an online survey that included 
demographic information and the Pittsburgh Sleep Quality Index (PSQI). The PSQI 
consists of 19 items, one of which is open-ended, designed to assess an 
individual's quantity, quality, and patterns of sleep on seven domains (ie, 
subjective sleep quality, sleep latency, sleep duration, habitual sleep 
efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction 
over the last month). Summative content analysis was used to analyze responses 
to the open-ended question regarding participants' sleep disturbances.
RESULTS: This study included 2192 individuals, 85% of whom slept 6+ hours/night. 
The mean global PSQI score was 7.57, out of a possible 21 (SD = 4.09). The 
self-reported sleep disturbances of largest concern were: (1) general 
fear/anxiety/worry (n = 203); (2) children (n = 167); (3) mind 
wandering/overthinking (n = 118); (4) pain/injury (n = 78); (5) partner 
(n = 78); and (6) fear/anxiety/stress related to COVID-19 (n = 74).
CONCLUSION: The global PSQI score was indicative of poor sleep quality, and 
Ontario adults experienced a number of sleep disturbances during early days of 
the COVID-19 pandemic. These findings are noteworthy as sleep is a crucial 
component in positive health and wellbeing.

Copyright © 2021 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.sleep.2021.02.028
PMCID: PMC9017869
PMID: 33685852 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest. The ICMJE Uniform Disclosure Form for Potential Conflicts of 
Interest associated with this article can be viewed by clicking on the following 
link: https://doi.org/10.1016/j.sleep.2021.02.028.


3686. J Health Psychol. 2022 Jun;27(7):1583-1600. doi: 10.1177/1359105321999711. Epub 
2021 Mar 8.

Life on pause: An analysis of UK fertility patients' coping mechanisms after the 
cancellation of fertility treatment due to COVID-19.

Tippett A(1).

Author information:
(1)University of Hertfordshire, UK.

In March 2020, fertility clinics across the UK began cancelling all assisted 
reproductive technology (ART) treatment, with the Human Fertilisation and 
Embryology Authority (HFEA) stopping all ART treatment from going ahead beyond 
the 15th April 2020 due to the COVID-19 pandemic. This article examines the 
coping mechanisms adopted by fertility patients during this time, focussing on 
the emotional support received from online fertility forums and fertility 
clinics during the indeterminate wait for treatment to resume. The study draws 
upon an online survey which assessed the mental health and wellbeing of 124 
female fertility patients whose ART treatment was cancelled due to the 
Coronavirus pandemic. The findings indicate a potential for improved 
communication between fertility clinics and patients in order to reduce 
psychological stress and isolation during the postponement of ART treatment, 
alongside better utilisation of online platforms as mechanisms for support. This 
article adds to the growing body of knowledge concerned with the implications of 
denying reproductive rights to the infertility community during a global 
pandemic. It also contributes to sociological discussions on the support 
mechanisms available to those navigating infertility and the wider social 
management of uncertainty.

DOI: 10.1177/1359105321999711
PMCID: PMC9092918
PMID: 33685265 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of conflicting interests: The author 
declared no potential conflicts of interest with respect to the research, 
authorship, and/or publication of this article.


3687. Int J Environ Health Res. 2022 Jun;32(6):1329-1336. doi: 
10.1080/09603123.2021.1879739. Epub 2021 Mar 7.

Older people and nature: the benefits of outdoors, parks and nature in light of 
COVID-19 and beyond- where to from here?

Levinger P(1)(2)(3), Cerin E(4)(5), Milner C(6), Hill KD(3).

Author information:
(1)National Ageing Research Institute, Melbourne Australia.
(2)Institute for Health and Sport, Victoria University, Melbourne Australia.
(3)Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash 
University, Melbourne Australia.
(4)Mary MacKillop Institute for Health Research, Australian Catholic University, 
Melbourne Australia.
(5)School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong 
SAR, China.
(6)International Council on Active Aging, Vancouver, BC Canada.

The COVID-19 pandemic has taken a significant toll on people's health and 
wellbeing globally. In the pandemic, parks, gardens and other local green spaces 
have been recognised as vital to people's physical and mental health. Emerging 
global evidence shows increased access to local parks and recreational 
activities and a new appreciation of the natural surroundings. Various movements 
and organisations globally have called for actions to embrace recent trends and 
changes in relation to the planning of public spaces and urban built 
environments to enable better access to parks and nature. The crisis, however, 
has exposed the inequities around access to green space where vulnerable 
populations such as older people and those in low socioeconomic areas are 
particularly affected. The crisis presents an opportunity to positively impact 
on society, and an opportunity to consolidate new emerging trends to better 
integrate nature into the architecture, infrastructure, and public spaces of 
urban areas.

DOI: 10.1080/09603123.2021.1879739
PMID: 33682531 [Indexed for MEDLINE]


3688. Arq Neuropsiquiatr. 2021 Apr;79(4):310-314. doi: 
10.1590/0004-282X-ANP-2020-0517.

The impact of COVID-19 on patients with epilepsy.

Tedrus GMAS(1), Silva JFCPD(2), Barros GS(2).

Author information:
(1)Pontifícia Universidade Católica de Campinas, Programa de Pós-Graduação em 
Ciências da Saúde, Campinas SP, Brazil.
(2)Pontifícia Universidade Católica de Campinas, Faculdade de Medicina, Campinas 
SP, Brazil.

BACKGROUND: The COVID-19 pandemic and social distancing can have adverse impacts 
on adult people with epilepsy (PWE).
OBJECTIVE: To investigate the seizure frequency, the perceived well-being, and 
the presence of anxiety symptoms in PWE during the COVID-19 pandemic period.
METHODS: Data from a questionnaire on the repercussions of COVID-19 were 
analyzed in relation to the clinical variables of 114 PWE, with a significance 
level of p<0.05.
RESULTS: There were 26 cases of COVID-19 in PWE and/or family members (22.8%). 
During the pandemic period, 11 PWE (9.6%) reported an increase in seizures, but 
unrelated to COVID-19. Also, the number of crises in PWE with previous 
depressive disorders increased, with differences between epilepsies. Symptoms of 
depression, impaired well-being, and concern for their lifestyle were 
significant in PWE with a previous diagnosis of depression. Impaired well-being, 
increased anxiety, nervousness, and tiredness, and the concern with being 
infected were mentioned by a high number of PWE in the pandemic.
CONCLUSION: Seizure frequency increased during the pandemic period, a finding 
associated with clinical variables of epilepsy. PWE with depression had worse 
perceived well-being. Changes in well-being and increased anxiety and 
nervousness were frequent in the pandemic.

INTRODUÇÃO: A pandemia por COVID-19 e o isolamento social podem ter impactos 
adversos em pessoas adultas com epilepsia (PCE).
OBJETIVO: Investigar a frequência das crises, a percepção de bem-estar e a 
presença de sintomas de ansiedade em PCE no período da pandemia da COVID-19.
MÉTODOS: Foram relacionados os dados de um questionário de repercussões da 
COVID-19 com as variáveis clínicas de 114 PCE, com nível de significância 
p<0,05.
RESULTADOS: A COVID-19 ocorreu em 26 (22,8%) PCE e/ou familiares. Durante o 
período da pandemia, houve aumento das crises epilépticas em 11 (9,6%) PCE, mas 
sem relação com o diagnóstico de COVID-19. No período da pandemia, houve aumento 
do número de crises nos PCE com transtorno depressivo prévio e de modo distinto 
entre as epilepsias. Sintomas de depressão, comprometimento do bem-estar e 
preocupação com o estilo de vida ocorreram significativamente nos PCE com 
diagnostico anterior de depressão. O comprometimento do bem-estar, o aumento da 
ansiedade, do nervosismo e do cansaço, e a preocupação em contrair a doença 
foram referidos na maior parte do tempo em elevado número de PCE na pandemia.
CONCLUSÃO: Houve aumento da ocorrência de crises epilépticas durante o período 
pandêmico e isso foi associado a variáveis clínicas da epilepsia. Pior percepção 
de bem-estar ocorreu nos PCE com depressão. Alteração do bem-estar e aumento de 
ansiedade e de nervosismo foram frequentes na pandemia.

DOI: 10.1590/0004-282X-ANP-2020-0517
PMCID: PMC9231454
PMID: 33681882 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest: There is no conflict of 
interest to declare.


3689. Obstet Gynecol Int. 2021 Feb 17;2021:5720264. doi: 10.1155/2021/5720264. 
eCollection 2021.

Evaluation of Peripartum Hysterectomy in a Tertiary Care Unit and Its Effect on 
Patients' Long-Term Physical and Mental Wellbeing: Quest Is Not Over When You 
Save the Life.

Pathiraja PDM(1), Jayawardane A(2).

Author information:
(1)Obstetrics and Gynaecology, Ministry of Health, Colombo, Sri Lanka.
(2)Obstetrics and Gynecology, University of Colombo, Colombo, Sri Lanka.

OBJECTIVES: Peripartum hysterectomy can be performed as an elective procedure or 
as a life-saving emergency procedure in obstetrics. It is associated with 
significant maternal morbidity and mortality. We report peripartum 
hysterectomies done during the study period in a tertiary referral centre, 
Colombo, Sri Lanka. Methodology. We collected data on all severe acute maternal 
morbidity and mortality events (SAMM) from June 01, 2014, to June 01, 2015, at 
De Soysa Hospital for Women (DSHW). We invited all women who underwent PPH to 
complete the 36-Item Short Form Health Survey questionnaire (SF-36) before 
hospital discharge and at six months after the hysterectomy date to assess their 
general and mental health before and after surgery. Focus group discussions 
(FGD) were used to further evaluate the patient experience and to identify 
service delivery improvements.
RESULTS: There were eleven peripartum hysterectomies done during the study 
period for 7160 deliveries. None were primigravida. Median age and gestation 
were 36 years and 37 weeks, respectively. The commonest indication for 
peripartum hysterectomy was a morbidly adherent placenta (seven). Nine of the 
deliveries were elective lower-segment caesarean section and two were vaginal 
deliveries. Four emergency peripartum hysterectomies were done for primary 
postpartum haemorrhage (PPH) and two for secondary PPH. All patients required 
intensive care and there were no maternal deaths. The analysis of SF-36 data 
revealed that all patients suffered a significant reduction in the quality of 
life at six months after the surgery. FGD highlighted that most patients needed 
further counselling and support to improve their physical, psychological, and 
social wellbeing. Some of the patients were willing to share their experience on 
voluntary basis to help those undergoing peripartum hysterectomies in the 
future.
CONCLUSION: Peripartum hysterectomy is an important life-saving procedure 
associated with severe maternal morbidity and mortality. This study reveals that 
the physical, psychological, and social adverse effects would remain in the long 
term.

Copyright © 2021 P. D. M. Pathiraja and Asanka Jayawardane.

DOI: 10.1155/2021/5720264
PMCID: PMC7906802
PMID: 33679986

Conflict of interest statement: The authors declare that there are no conflicts 
of interest regarding the publication of this paper.


3690. Facial Plast Surg. 2021 Oct;37(5):625-631. doi: 10.1055/s-0041-1725162. Epub 
2021 Mar 6.

The Evidence Base for the Benefits of Functional Septorhinoplasty and its Future 
Post COVID-19.

Unadkat SN(1), Pendolino AL(1)(2), Auer D(3), Khwaja S(4), Randhawa PS(1), 
Andrews PJ(1)(2), Saleh HA(3).

Author information:
(1)Department of Rhinology and Facial Plastic Surgery, Royal National ENT and 
Eastman Dental Hospitals, London, United Kingdom.
(2)Ear Institute, University College London, United Kingdom.
(3)Department of Otolaryngology, Charing Cross Hospital, London, United Kingdom.
(4)Department of Otolaryngology, Manchester University NHS Foundation Trust, 
Manchester, United Kingdom.

Ever since the introduction of the concept of Procedures of Limited Clinical 
Value (PoLCV), procedures such as functional septorhinoplasty have been subject 
to additional funding restrictions within the British National Health Service. 
Recent publications have suggested that 10% of Clinical Commissioning Groups in 
the United Kingdom no longer fund septorhinoplasty surgery irrespective of the 
indications, including congenital malformations or post-trauma, and despite the 
strong evidence available in the literature in treating a range of health 
conditions. Thus, inequity exists across the country. At present functional 
septorhinoplasty surgery is frequently but incorrectly grouped together with 
aesthetic rhinoplasty, both of which are deemed to be cosmetic interventions. 
Moreover, as we exit the peak of the current coronavirus disease 2019 (COVID-19) 
pandemic, procedures deemed to be of lower clinical priority will potentially be 
at risk throughout Europe. The purpose of this review is twofold; the first is 
to put forward the evidence to commissioners in favor of functional 
septorhinoplasty surgery on patient well-being and mental health; the second is 
to demonstrate why functional septorhinoplasty surgery is a distinct procedure 
from aesthetic rhinoplasty and why it ought not to be classified as a procedure 
of limited clinical value.

Thieme. All rights reserved.

DOI: 10.1055/s-0041-1725162
PMID: 33676375 [Indexed for MEDLINE]

Conflict of interest statement: None declared.


3691. BMC Public Health. 2021 Mar 5;21(1):448. doi: 10.1186/s12889-021-10505-5.

Understanding the impact of COVID-19 on youth sport in Australia and 
consequences for future participation and retention.

Elliott S(1), Drummond MJ(2), Prichard I(2), Eime R(3)(4), Drummond C(2), Mason 
R(2)(5).

Author information:
(1)SHAPE Research Centre, Flinders University, Adelaide, South Australia. 
sam.elliott@flinders.edu.au.
(2)SHAPE Research Centre, Flinders University, Adelaide, South Australia.
(3)School of Science, Psychology and Sport, Federation University, Ballarat, 
Victoria, Australia.
(4)Institute for Health and Sport, Victoria University, Melbourne, Victoria, 
Australia.
(5)Melbourne Graduate School of Education, University of Melbourne, Melbourne, 
Victoria, Australia.

BACKGROUND: COVID-19 continues to represent the single biggest challenge to 
contemporary community sport globally. Compliance with social distancing 
policies, strict return-to-play protocols, and COVID-19 specific training has, 
perhaps, forever changed the way that children and young people engage in 
organised sport. Within this context, and while many children and families seek 
to re-engage with community sport, we (researchers and sport practitioners) have 
an obligation to ask questions about how the pandemic has impacted youth sport, 
understand the short- and long-term consequences, and explore what (if any) 
opportunities can be seized to assist and improve future participation and 
retention. The aim of this paper was to present an in-depth exploration of the 
impact of COVID-19 on youth sport in South Australia.
METHODS: Within an interpretive descriptive methodology, this qualitative 
investigation draws on rich, individual interview and focus group data with 39 
youth (ages 15-18), parents, coaches, and sport administrators. A reflexive 
thematic analysis was undertaken, leading to the development of four substantive 
themes.
RESULTS: We conceptualised the '4 Rs' to advance theoretical understandings 
about the pandemic's impact on youth sport, including the themes 'recognising 
struggle', 'reconnection', 're-engaging after restrictions, and 'reimagining 
sport'. The themes captured insights about a decline in mental wellbeing and 
physical activity, an increase in family connectedness, the challenge for sports 
to attract volunteers and participants back into sport, and the opportunities to 
reset values and philosophies underpinning the provision of youth sport.
CONCLUSION: The findings provide valuable insight into the youth sport setting 
as a result of the global pandemic and suggest that families, sporting clubs and 
sporting organisations require additional resources and tools (for example, 
support for parents to facilitate their children's training at home during 
lockdown) to aid recovery efforts and to ensure the survival and prosperity of 
youth sport into the future.

DOI: 10.1186/s12889-021-10505-5
PMCID: PMC7935002
PMID: 33673812 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3692. Int J Environ Res Public Health. 2021 Feb 23;18(4):2203. doi: 
10.3390/ijerph18042203.

Mental Health Status of Healthcare Professionals and Students of Health Sciences 
Faculties in Kuwait during the COVID-19 Pandemic.

Alsairafi Z(1), Naser AY(2), Alsaleh FM(1), Awad A(1), Jalal Z(3).

Author information:
(1)Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, 
Kuwait City 12037, Kuwait.
(2)Department of Pharmaceutical Sciences and Clinical Pharmacy, Isra University, 
Amman 33, Jordan.
(3)School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, 
Edgbaston B15 2TT, UK.

OBJECTIVES: This study aimed to assess the impact of the COVID-19 pandemic on 
the mental health status of healthcare professionals (HCPs) and undergraduate 
students in the health sciences center (HSCUs). In addition, it explored the 
factors associated with the increased levels of mental health burden among the 
study population.
METHODS: A cross-sectional study was performed using two online-administered 
questionnaires: the Patient Health Questionnaire (PHQ-9) and the Generalized 
Anxiety Disorder 7-item (GAD-7), which were distributed in parallel to HCPs and 
HSCUs in Kuwait. These instruments are validated assessment scales to assess 
mental health status: depression (PHQ-9) and anxiety (GAD-7). Statistical 
analyses were carried out using SPSS- version 25.
RESULTS: A total of 857 individuals (559 HCPs and 298 HSCUs) participated in 
this study. The prevalence of moderately severe depression or severe depression 
(PHQ-9 total score of ≥15) among respondents was 66.6%. The median 
(interquartile range, IQR) PHQ-9 score was significantly higher among HSCUs (20 
{11.5}) compared to HCPs (17 {8}). The prevalence of severe anxiety (GAD-7 total 
score of ≥15) among respondents was 36.7%. There were no significant differences 
between the median (IQR) GAD-7 scores among the HCPs (14 {7}) and HSCUs (13 
{8}). Binary logistic regression analysis revealed that three variables were 
significantly and independently associated with severe depression among HCPs. 
The prevalence of severe depression was found to be greater among females 
compared to males. In addition, it was significantly lower among those who were 
aged ≥50 years, and those who reported that they were not in direct contact with 
COVID-19 patients. Among HSCUs, females showed greater depression than males. In 
contrast, those aged >29 years and who had no history of chronic disease showed 
lower depression compared to their counterparts in the 18-29 years age group and 
who had a chronic disease history.
CONCLUSIONS: The COVID-19 pandemic had a significant negative impact on the 
mental health of HCPs and HSCUs in Kuwait. This highlights the need for 
proactive efforts to support their mental health and well-being through 
educational campaigns and psychological support programs.

DOI: 10.3390/ijerph18042203
PMCID: PMC7926878
PMID: 33672372 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3693. Int J Environ Res Public Health. 2021 Feb 22;18(4):2141. doi: 
10.3390/ijerph18042141.

Connection to... Addressing Digital Inequities in Supporting the Well-Being of 
Young Indigenous Australians in the Wake of COVID-19.

Walker R(1)(2), Usher K(1)(3), Jackson D(1)(4), Reid C(5), Hopkins K(1), 
Shepherd C(1)(6), Smallwood R(4)(7), Marriott R(1).

Author information:
(1)Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch 
University, Murdoch, WA 6150, Australia.
(2)School of Indigenous Studies, The University of Western Australia, Crawley, 
WA 6009, Australia.
(3)School of Health, University of New England, Armidale, NSW 2351, Australia.
(4)Susan Wakil School of Nursing, University of Sydney, Sydney, NSW 2006, 
Australia.
(5)Chancellory, Victoria University, Footscray, VIC 3011, Australia.
(6)Curtin Medical School, Curtin University, Bentley, WA 6102, Australia.
(7)School of Nursing and Midwifery, Faculty of Health, University of Technology, 
Ultimo, NSW 2007, Australia.

(1) Background: This article examines whether connection to digital technologies 
helps connect young Indigenous people in Australia to culture, community and 
country to support good mental health and well-being and protect against 
indirect and potentially long-term effects of COVID-19. (2) Method: We reviewed 
literature published between February and November 2020 and policy responses 
related to digital strategies. We searched PubMed, Google Scholar, government 
policy websites and key Indigenous literature sources, identifying 3460 
articles. Of these, 30 articles and 26 policy documents were included and 
analysed to identify existing and expected mental health outcomes among 
Indigenous young people associated with COVID-19 and more broadly. (3) Results: 
There are inequities in affordable access to digital technologies. Only 63% of 
Indigenous people have access to internet at home. Digital technologies and 
social media contribute to strong cultural identity, enhance connections to 
community and country and improve mental health and social and emotional 
well-being outcomes. (4) Discussion: Access to digital technologies can 
facilitate healing and cultural continuity, self-determination and empowerment 
for young people to thrive, not just survive, in the future. (5) Conclusion: 
More targeted policies and funding is urgently needed to promote digital 
technologies to enhance Indigenous young people's access to mental health and 
well-being services, maintain cultural connections and evaluate the 
effectiveness of these initiatives using Indigenous well-being indicators.

DOI: 10.3390/ijerph18042141
PMCID: PMC7926327
PMID: 33671737 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3694. Int J Environ Res Public Health. 2021 Feb 28;18(5):2361. doi: 
10.3390/ijerph18052361.

Interventions to Ameliorate the Psychosocial Effects of the COVID-19 Pandemic on 
Children-A Systematic Review.

Boldt K(1)(2), Coenen M(1)(2), Movsisyan A(1)(2), Voss S(1)(2), Rehfuess 
E(1)(2), Kunzler AM(3)(4), Lieb K(3)(4), Jung-Sievers C(1)(2).

Author information:
(1)Institute for Medical Information Processing, Biometry and Epidemiology-IBE, 
Chair of Public Health and Health Services Research, LMU Munich, 
Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany.
(2)Pettenkofer School of Public Health, 81377 Munich, Germany.
(3)Department of Psychiatry and Psychotherapy, University Medical Center 55131 
Mainz, Germany.
(4)Leibniz Institute for Resilience Research (LIR), 55122 Mainz, Germany.

The aim of this study was to identify interventions targeting children and their 
caregivers to reduce psychosocial problems in the course of the COVID-19 
pandemic and comparable outbreaks. The review was performed using systematic 
literature searches in MEDLINE, Embase, PsycINFO and COVID-19-specific 
databases, including the CDC COVID-19 Research Database, the World Health 
Organisation (WHO) Global Database on COVID-19 Research and the Cochrane 
COVID-19 Study Register, ClinicalTrials.gov, the EU Clinical Trials Register and 
the German Clinical Trials Register (DRKS) up to 25th September 2020. The search 
yielded 6657 unique citations. After title/abstract and full text screening, 11 
study protocols reporting on trials planned in China, the US, Canada, the UK, 
and Hungary during the COVID-19 pandemic were included. Four interventions 
targeted children ≥10 years directly, seven system-based interventions targeted 
the parents and caregivers of younger children and adolescents. Outcome measures 
encompassed mainly anxiety and depressive symptoms, different dimensions of 
stress or psychosocial well-being, and quality of supportive relationships. In 
conclusion, this systematic review revealed a paucity of studies on psychosocial 
interventions for children during the COVID-19 pandemic. Further research should 
be encouraged in light of the expected demand for child mental health 
management.

DOI: 10.3390/ijerph18052361
PMCID: PMC7967755
PMID: 33670974 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3695. Int J Environ Res Public Health. 2021 Feb 21;18(4):2093. doi: 
10.3390/ijerph18042093.

Family Physicians' Standpoint and Mental Health Assessment in the Light of 
COVID-19 Pandemic-A Nationwide Survey Study.

Vilovic T(1)(2), Bozic J(3), Vilovic M(3), Rusic D(4), Zuzic Furlan S(1)(2), 
Rada M(1)(2), Tomicic M(1)(2).

Author information:
(1)Department of Family Medicine, University of Split School of Medicine, 21000 
Split, Croatia.
(2)Department of Family Medicine, Split-Dalmatia Health Center, 21000 Split, 
Croatia.
(3)Department of Pathophysiology, University of Split School of Medicine, 21000 
Split, Croatia.
(4)Department of Pharmacy, University of Split School of Medicine, 21000 Split, 
Croatia.

During the coronavirus disease 2019 (COVID-19) outbreak, family physicians (FPs) 
are the backbone of the healthcare system with considerable impact on the 
general population, and their well-being is of great importance. The aim of this 
investigation was to assess FPs mental health, as well as knowledge, attitudes 
and practices (KAPs) regarding the pandemic, and opinions on non-communicable 
disease (NCD) health care provided to patients. A cross-sectional study was 
carried out with a sample of 613 FPs. Anxiety and depression levels were 
estimated with the Hospital Anxiety and Depression Scale, subjective perceived 
stress with the Perceived Stress Scale, while trauma-related symptoms were 
assessed using the Impact on Event Scale-COVID19. KAPs toward the pandemic and 
opinions regarding NCD patients were evaluated with questionnaires accordingly. 
Results have shown that age (β = -0.02, p = 0.013) and personal risk of COVID‑19 
(β = 1.05, p < 0.001) were significant independent correlates of the knowledge 
score. A total of 87.7% FPs expressed moderate/high perceived stress, 45.2% 
moderate/severe trauma-related symptoms, 60.4% borderline/abnormal anxiety 
levels, and 52.4% borderline/abnormal depression levels. Knowledge score was an 
independent predictor of perceived stress (β = -0.33, p = 0.023) and anxiety (β 
= -0.31, p = 0.006) levels. Limited accessibility to healthcare services and 
decreased number of newly-diagnosed NCD cases were mostly agreed on. The 
pandemic puts a considerable strain on FPs mental health, as well as on public 
health measures, due to the decreased overall quality of NCD patient health 
care. Educational programs may bridge the gaps between FPs' knowledge. Thus 
lowering anxiety and improving patient care.

DOI: 10.3390/ijerph18042093
PMCID: PMC7924834
PMID: 33669982 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3696. Int J Environ Res Public Health. 2021 Feb 19;18(4):2051. doi: 
10.3390/ijerph18042051.

"We All Really Need to just Take a Breath": Composite Narratives of Hospital 
Doctors' Well-Being during the COVID-19 Pandemic.

Creese J(1), Byrne JP(1), Conway E(2), Barrett E(3)(4), Prihodova L(1), 
Humphries N(1).

Author information:
(1)Royal College of Physicians of Ireland, Dublin D02 X266, Ireland.
(2)DCU Business School, Dublin City University, Dublin D09 V209, Ireland.
(3)School of Medicine, University College Dublin, Dublin D04 V1W8, Ireland.
(4)Children's University Hospital Temple Street, Dublin D01 F772, Ireland.

The coronavirus disease 2019 (COVID-19) pandemic poses a challenge to the 
physical and mental well-being of doctors worldwide. Countries around the world 
introduced severe social restrictions, and significant changes to health service 
provision in the first wave of the pandemic to suppress the spread of the virus 
and prioritize healthcare for those who contracted it. This study interviewed 48 
hospital doctors who worked in Ireland during the first wave of the pandemic and 
investigated their conceptualizations of their own well-being during that time 
(March-May 2020). Doctors were interviewed via Zoom™ or telephone. Interview 
transcripts were analyzed using structured thematic analysis. Five composite 
narratives are presented which have been crafted to illustrate themes and 
experiences emerging from the data. This study found that despite the risks of 
contracting COVID-19, many doctors saw some improvements to their physical 
well-being in the first wave of the pandemic. However, most also experienced a 
decline in their mental well-being due to anxiety, emotional exhaustion, guilt, 
isolation and poor support. These findings shed light on doctor well-being 
during COVID-19, and the ways in which they have been affected by the pandemic, 
both professionally and personally. The paper concludes by highlighting how 
doctors' work life and well-being can be better supported during and after the 
COVID-19 pandemic.

DOI: 10.3390/ijerph18042051
PMCID: PMC7921910
PMID: 33669828 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study, or in the collection, analysis, 
and interpretation of data, in writing the manuscript, or in the decision to 
publish the results.


3697. Int J Environ Res Public Health. 2021 Feb 19;18(4):2045. doi: 
10.3390/ijerph18042045.

Promoting Mental Health and Well-Being among Adolescent Young Carers in Europe: 
A Randomized Controlled Trial Protocol.

Casu G(1), Hlebec V(2)(3), Boccaletti L(4), Bolko I(2), Manattini A(4), Hanson 
E(5).

Author information:
(1)Department of Psychology, University of Bologna, 40127 Bologna, Italy.
(2)Faculty of Social Sciences, University of Ljubljana, 1000 Ljubljana, 
Slovenia.
(3)Faculty of Health Sciences, University of Ljubljana, 1000 Ljubljana, 
Slovenia.
(4)Anziani e Non Solo Società Cooperativa Sociale, 41012 Carpi, Italy.
(5)Department of Health and Caring Sciences, Linnaeus University, SE-39182 
Kalmar, Sweden.

It is estimated that 4-8% of youth in Europe carry out substantial care for a 
family member or significant other. To prevent adverse psychosocial outcomes in 
young carers (YCs), primary prevention resilience building interventions have 
been recommended. We describe the study protocol of an international randomized 
controlled trial (RCT) of an innovative group intervention designed to promote 
the mental health and well-being of adolescent YCs (AYCs) aged 15-17. The RCT 
will be conducted in six European countries in the context of the Horizon 2020 
European funded research and innovation project "Psychosocial support for 
promoting mental health and well-being among adolescent young caregivers in 
Europe" ("ME-WE"). The ME-WE intervention is based on Hayes and Ciarrochi's 
psychoeducational model for adolescents and will consist of seven 2-h sessions 
in a group format, aimed to help AYCs build psychological flexibility and live 
according to their values. The control group will be a waitlist. Primary and 
secondary outcomes and control variables will be measured at baseline (T0), 
post-intervention (T1) and 3 months follow-up (T2). The COVID-19 pandemic has 
made amendments necessary to the original study protocol methodology, which we 
describe in detail. This study will contribute to building an evidence-based 
manualized program that educators and health and social care professionals can 
use to support AYCs in their transition to adulthood. From a research 
perspective, the outcomes of this study will contribute to evidence-based 
practices in primary prevention of psychosocial difficulties in AYCs and will 
gather novel knowledge on the effectiveness of Hayes and Ciarrochi's model for 
use with middle adolescents with caring responsibilities. The trial has been 
preregistered (registration number: NCT04114864).

DOI: 10.3390/ijerph18042045
PMCID: PMC7922705
PMID: 33669796 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funder had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript, or in the decision to 
publish the results.


3698. Int J Environ Res Public Health. 2021 Feb 16;18(4):1910. doi: 
10.3390/ijerph18041910.

Protective Elements of Mental Health Status during the COVID-19 Outbreak in the 
Portuguese Population.

Silva Moreira P(1)(2)(3), Ferreira S(1)(2), Couto B(1)(2), Machado-Sousa 
M(1)(2), Fernández M(1)(2), Raposo-Lima C(1)(2), Sousa N(1)(2), Picó-Pérez 
M(1)(2), Morgado P(1)(2).

Author information:
(1)Life and Health Sciences Research Institute (ICVS), School of Medicine, 
University of Minho, 4710-057 Braga, Portugal.
(2)ICVS/3B's, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, 
Portugal.
(3)Psychological Neuroscience Lab, CIPsi, School of Psychology, University of 
Minho, 4710-057 Braga, Portugal.

The outbreak of COVID-19 might produce dramatic psychological effects on 
individuals' lives. In this study, we aimed to explore the elements that may 
reduce the negative effects on mental health of the quarantine period imposed by 
most governments during this worldwide crisis. We conducted an online survey to 
evaluate demographic, lifestyle and mental health variables in a sample of 1280 
Portuguese individuals (79.8% females) with an average age of 37 years. We 
observed that factors related to living conditions, maintaining work either 
online or in the workplace, frequency of exercise and absence of previous 
psychological or physic disorders are protective features of psychological 
well-being (anxiety, depression, stress and obsessive-compulsive symptoms). 
Finally, the individuals previously receiving psychotherapeutic support 
exhibited better psychological indicators if they did not interrupt the process 
as a consequence of the outbreak. Our results indicate that the practice of 
physical exercise, reduced consumption of COVID-19 information and the 
implementation of remote mental healthcare measures might prevent larger impacts 
on mental health during the COVID-19 outbreak.

DOI: 10.3390/ijerph18041910
PMCID: PMC7920474
PMID: 33669453 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3699. Int J Environ Res Public Health. 2021 Feb 16;18(4):1903. doi: 
10.3390/ijerph18041903.

The Role of Employee Relations in Shaping Job Satisfaction as an Element 
Promoting Positive Mental Health at Work in the Era of COVID-19.

Bulińska-Stangrecka H(1), Bagieńska A(2).

Author information:
(1)Faculty of Administration and Social Sciences, Warsaw University of 
Technology, 02-786 Warsaw, Poland.
(2)Faculty of Engineering Management, Bialystok University of Technology, 15-351 
Bialystok, Poland.

The COVID-19 pandemic is affecting the mental health of employees. Deterioration 
of the well-being of workers is also caused by changes in the working 
environment. Remote working can affect both social interactions and job 
satisfaction. The purpose of the study is to examine what factors influence job 
satisfaction in the context of remote work caused by a pandemic. The study 
analyses whether employee relations and interpersonal trust are related to the 
level of perceived job satisfaction. The investigation started with a literature 
review and then research hypotheses have been formulated. Based on an empirical 
study, carried out on a sample of 220 IT employees during the pandemic, an 
analysis of the mediating role of trust in links between employee relations and 
perceived job satisfaction was conducted. The current study found that positive 
employee relations contribute to the level of job satisfaction. Additionally, 
trust is an important factor that mediates these relationships. Based on the 
results of the research, it was possible to describe the mechanism of shaping a 
supportive work environment during a pandemic.

DOI: 10.3390/ijerph18041903
PMCID: PMC7920272
PMID: 33669365 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3700. Int J Environ Res Public Health. 2021 Feb 13;18(4):1822. doi: 
10.3390/ijerph18041822.

What Predicts Adherence to Governmental COVID-19 Measures among Danish Students?

Berg-Beckhoff G(1)(2), Dalgaard Guldager J(1)(3), Tanggaard Andersen P(1), Stock 
C(1)(4), Smith Jervelund S(5).

Author information:
(1)Unit for Health Promotion Research, Department of Public Health, University 
of Southern Denmark, 6700 Esbjerg, Denmark.
(2)Unit for Health Research, University of Southern Denmark, Hospital South West 
Jutland, 5000 Odense, Denmark.
(3)Research Department, University College South Denmark, 6100 Haderslev, 
Denmark.
(4)Institute of Health and Nursing Science, Berlin Institute of Health, Freie 
Universität Berlin, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany.
(5)Department of Public Health, Section for Health Services Research, University 
of Copenhagen, 1014 Copenhagen, Denmark.

Knowledge on compliance with governmental recommendations in combating the 
spread of COVID-19 in different groups is important to target efforts. This 
study investigated the adherence to the governmental implemented COVID-19 
measures and its predictors in Danish university students, a not-at-risk group 
for COVID-19 mortality and normally characterized by many social contacts. As 
part of the COVID-19 International Student Wellbeing Study, a survey on 
socio-demographic situation, study information, living arrangements, lifestyle 
behaviors, stress, questions about COVID-19 infection and knowledge and concern 
about COVID-19 infection was sent via email to relevant university students in 
Denmark in May, 2020 (n = 2.945). Stepwise multiple linear regression analysis 
was employed. Our results showed that around 60% of the students were not 
concerned about COVID-19, while 68% reported that they followed governmental 
measures. The main facilitators for following the recommendations were older 
age, concern about COVID-19 and depression, while barriers were living in a 
student hall, being physical active or reporting mental stress. Only 9% of the 
variation in adhering to governmental recommendations could be explained by the 
analyzed predictors. Results may inform health communication. Emotionally 
appealing information rather than knowledge-based information may be more 
effective in motivating students to follow COVID-19 measures.

DOI: 10.3390/ijerph18041822
PMCID: PMC7918694
PMID: 33668540 [Indexed for MEDLINE]

Conflict of interest statement: There is no conflict of interest.


3701. Int J Environ Res Public Health. 2021 Feb 24;18(5):2228. doi: 
10.3390/ijerph18052228.

Telephone Emergency Service 142 (TelefonSeelsorge) during the COVID-19 Pandemic: 
Cross-Sectional Survey among Counselors in Austria.

Humer E(1), Pieh C(1), Probst T(1), Kisler IM(2), Schimböck W(2), Schadenhofer 
P(2)(3).

Author information:
(1)Department for Psychotherapy and Biopsychosocial Health, Danube University 
Krems, 3500 Krems, Austria.
(2)ABILE-Viktor Frankl Education Austria, 3390 Melk, Austria.
(3)Telephone Emergency Service-Lower Austria (TelefonSeelsorge NÖ), Diocese St. 
Pölten, 3100 St. Pölten, Austria.

Telephone emergency services play an important role in providing low-threshold, 
anonymous crisis intervention free of cost. The current study aims to examine 
the mental well-being and perceived stress level of counselors as well as the 
main topics of helpline callers during the COVID-19 pandemic in Austria. In the 
current study, 374 counselors were recruited within the Austrian nationwide 
organization TelefonSeelsorge during the second wave of COVID-19 infection in 
Austria. The mental well-being (WHO-5) and perceived stress-level (PSS-10) were 
assessed and counselors were asked about the frequency of different topics 
thematized by callers and changes compared to pre-pandemic times. Compared to a 
reference group of the Austrian general population, counselors experienced less 
stress (13.22 vs. 16.42) and higher mental well-being (66.26 vs. 57.36; p < 
0.001). The most frequent topics during the second wave of the COVID-19 pandemic 
in Austria were loneliness and mental health. More calls were registered in 2020 
compared to 2019 and especially the topics loneliness, mental health, 
professional activities and relationships were reported to be thematized more 
often during the COVID-19 pandemic compared to the time before (p < 0.001). The 
results contribute to an understanding of the impact of the COVID-19 pandemic on 
telephone crisis intervention.

DOI: 10.3390/ijerph18052228
PMCID: PMC7967694
PMID: 33668235 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3702. Int J Environ Res Public Health. 2021 Feb 24;18(5):2227. doi: 
10.3390/ijerph18052227.

Nature's Role in Supporting Health during the COVID-19 Pandemic: A Geospatial 
and Socioecological Study.

Robinson JM(1)(2)(3), Brindley P(1), Cameron R(1), MacCarthy D(4), Jorgensen 
A(1).

Author information:
(1)Department of Landscape Architecture, The University of Sheffield, Sheffield 
S10 2TN, UK.
(2)inVIVO Planetary Health, of the Worldwide Universities Network, West New 
York, NJ 10704, USA.
(3)The Healthy Urban Microbiome Initiative (HUMI), Adelaide SA5005, Australia.
(4)School of Natural and Built Environment, Queen's University Belfast, Belfast 
BT9 5AG, UK.

The COVID-19 pandemic has brought about unprecedented changes to human 
lifestyles across the world. The virus and associated social restriction 
measures have been linked to an increase in mental health conditions. A 
considerable body of evidence shows that spending time in and engaging with 
nature can improve human health and wellbeing. Our study explores nature's role 
in supporting health during the COVID-19 pandemic. We created web-based 
questionnaires with validated health instruments and conducted spatial analyses 
in a geographic information system (GIS). We collected data (n = 1184) on 
people's patterns of nature exposure, associated health and wellbeing responses, 
and potential socioecological drivers such as relative deprivation, access to 
greenspaces, and land-cover greenness. The majority of responses came from 
England, UK (n = 993). We applied a range of statistical analyses including 
bootstrap-resampled correlations and binomial regression models, adjusting for 
several potential confounding factors. We found that respondents significantly 
changed their patterns of visiting nature as a result of the COVID-19 pandemic. 
People spent more time in nature and visited nature more often during the 
pandemic. People generally visited nature for a health and wellbeing benefit and 
felt that nature helped them cope during the pandemic. Greater land-cover 
greenness within a 250 m radius around a respondent's postcode was important in 
predicting higher levels of mental wellbeing. There were significantly more 
food-growing allotments within 100 and 250 m around respondents with high mental 
wellbeing scores. The need for a mutually-advantageous relationship between 
humans and the wider biotic community has never been more important. We must 
conserve, restore and design nature-centric environments to maintain resilient 
societies and promote planetary health.

DOI: 10.3390/ijerph18052227
PMCID: PMC7967714
PMID: 33668228 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest 
regarding this study. J.M.R. is affiliated with inVIVO Planetary Health and is 
an Assistant Guest Editor on this Special Issue.


3703. J Public Health (Oxf). 2021 Dec 10;43(4):687-694. doi: 10.1093/pubmed/fdab009.

Changes in dietary fat intake and associations with mental health in a UK public 
sample during the COVID-19 pandemic.

Wilson JJ(1)(2)(3), McMullan I(1)(2), Blackburn NE(1), Klempel N(1)(2), Yakkundi 
A(4), Armstrong NC(5), Brolly C(6), Butler LT(7), Barnett Y(8), Jacob L(9)(10), 
Koyanagi A(10)(11), Smith L(12), Tully MA(1)(2).

Author information:
(1)Centre for Health and Rehabilitation Technologies, Institute of Nursing and 
Health Research, School of Health Sciences, Ulster University, Newtownabbey, 
BT37 0QB, UK.
(2)Institute of Mental Health Sciences, School of Health Sciences, Ulster 
University, Newtownabbey, BT37 0QB, UK.
(3)Sport and Exercise Sciences Research Institute, School of Sport, Ulster 
University, Newtownabbey, BT37 0QB, UK.
(4)Northern Ireland Public Health Research Network, School of Health Sciences, 
Ulster University, Newtownabbey, BT37 0QB, UK.
(5)Health and Social Care Research & Development Division, Public Health Agency 
(Northern Ireland), Belfast, BT2 8BS, UK.
(6)Health and Social Care Health Improvement Division, Public Health Agency 
(Northern Ireland), Belfast, BT2 8BS, UK.
(7)School of Psychology and Sports Sciences, Anglia Ruskin University, 
Cambridge, CB1 1PT, UK.
(8)School of Life Sciences, Anglia Ruskin University, Cambridge, CB1 1PT, UK.
(9)Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, 
Montigny-le-Bretonneux 78180, France.
(10)Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. 
Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain.
(11)ICREA, Pg. Lluis Companys 23, 08010 Barcelona, Spain.
(12)The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin 
University, Cambridge, CB1 1PT, UK.

BACKGROUND: Consumption of unhealthy foods may have changed during the COVID-19 
pandemic. This study explored how dietary fat intake was impacted in a sample of 
the UK public who were social distancing during the COVID-19 pandemic.
METHODS: Data were collected from a UK COVID-19 online survey. Fat intake was 
measured using the Dietary Instrument for Nutrition Education questionnaire. 
Anxiety and depressive symptoms were assessed using Becks' Anxiety and 
Depression Inventories, while the short-form Warwick-Edinburgh Mental Well-being 
Scale assessed mental well-being. Differences between individuals who increased 
versus decreased fat intake were explored using chi-square or independent sample 
t-tests. Association between fat intake and mental health was explored using 
adjusted linear regression models.
RESULTS: Eight hundred and eighty-seven adults were included. Approximately, 34% 
recorded medium-to-high levels of fat consumption during social distancing. 
Around 48% reported decreased fat intake during social distancing compared to 
usual levels, while 41.3% documented increased fat intake. Fat intake was not 
significantly associated (P > 0.05) with any measures of mental health.
CONCLUSIONS: A higher proportion of a sample of UK adults social distancing 
during the COVID-19 pandemic recorded decreased fat intake when compared to 
levels prior to social distancing. There appeared to be no associations between 
fat intake and mental health.

© The Author(s) 2021. Published by Oxford University Press on behalf of Faculty 
of Public Health.

DOI: 10.1093/pubmed/fdab009
PMCID: PMC7989334
PMID: 33667296 [Indexed for MEDLINE]


3704. BMJ Paediatr Open. 2021 Feb 16;5(1):e000981. doi: 10.1136/bmjpo-2020-000981. 
eCollection 2021.

Impact of lockdown and school closure on children in special schools: a 
single-centre survey.

Banerjee T(1), Khan A(1), Kesavan P(1).

Author information:
(1)Paediatrics, Cambridgeshire Community Services NHS Trust, Bedford, 
Bedfordshire, UK.

Special schools play a significant role in the daily lives of children and young 
people with special educational needs and disabilities. We explored the impact 
of the COVID-19-related first lockdown and resulting school closure by surveying 
parents whose children attended three special schools in Bedford, UK. We asked 
about anxiety and impact on emotional well-being and education. We received 53 
responses from parents: 31 felt their child was more anxious during the lockdown 
period/school closure compared with beforehand and 42 felt their child's 
emotional well-being had been affected. Children and young people attending 
special schools may have struggled both academically and emotionally during the 
COVID-19 pandemic.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjpo-2020-000981
PMCID: PMC7888363
PMID: 33665375 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3705. Infez Med. 2021 Mar 1;29(1):54-64.

Psychological distress during the initial stage of the COVID-19 pandemic in an 
Italian population living with HIV: an online survey.

Delle Donne V(1), Ciccarelli N(2), Massaroni V(1), Lombardi F(3), Lamonica S(3), 
Borghetti A(3), Fabbiani M(4), Cauda R(5), Di Giambenedetto S(5).

Author information:
(1)Infectious Diseases Institute, Department of Safety and Bioethics, Catholic 
University of Sacred Heart, Rome, Italy.
(2)Department of Psychology, Catholic University, Milan, Italy.
(3)UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli 
IRCCS, Rome, Italy.
(4)Infectious and Tropical Diseases Unit, Department of Medical Sciences, 
University Hospital of Siena, Siena, Italy.
(5)Infectious Diseases Institute, Department of Safety and Bioethics, Catholic 
University of Sacred Heart, Rome, Italy; UOC Infectious Diseases, Fondazione 
Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

The aim of this study was to explore the psychological impact of the initial 
stage of the 2019 coronavirus (COVID-19) pandemic on people living with HIV 
(PLWH), a population at increased risk of psychological distress. PLWH 
participated in an online survey exploring demographic and clinical data, 
physical symptoms, contact history, knowledge and concerns, precautionary 
measures and additional information about COVID-19 during the first phase of the 
pandemic in Italy. The Impact of Event Scale-Revised (IES-R) (identifying the 
COVID-19 pandemic as a specific traumatic life event) and the Depression, 
Anxiety and Stress Scale (DASS-21) also formed part of the survey. Out of 98 
participants, 45% revealed from mild to severe psychological impact from 
COVID-19 according to IES-R. A lower percentage, instead, complained of 
significant levels of depression (14%), anxiety (11%) or stress (6%) according 
to DASS-21. Higher education, being unemployed, number of perceived COVID-19 
physical symptoms, concerns about risk of contracting COVID-19 and the pandemic 
situation in Italy, and needing additional information to prevent COVID-19 
infection were positively associated to a higher risk of negative psychological 
impact. Moreover, among the participants, female gender, age, fewer years from 
HIV diagnosis and not being aware of their own viremia were associated to a 
higher risk of negative psychological outcomes. Almost half of our PLWH sample 
experienced significant levels of distress related to the COVID-19 pandemic. 
Women, elderly patients and those with recent HIV diagnosis appear to be the 
more psychologically fragile subgroups. Our findings could help identify 
patients most in need of psychological interventions to improve the wellbeing of 
PLWH.

PMID: 33664173 [Indexed for MEDLINE]


3706. Prog Neuropsychopharmacol Biol Psychiatry. 2021 Aug 30;110:110292. doi: 
10.1016/j.pnpbp.2021.110292. Epub 2021 Mar 2.

Psychological distress and sleep problems in healthcare workers in a developing 
context during COVID-19 pandemic: Implications for workplace wellbeing.

Olagunju AT(1), Bioku AA(2), Olagunju TO(3), Sarimiye FO(4), Onwuameze OE(5), 
Halbreich U(6).

Author information:
(1)Department of Psychiatry and Behavioral Neurosciences, McMaster University/St 
Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Discipline of Psychiatry, 
University of Adelaide, North Terrace, Adelaide, SA, Australia. Electronic 
address: olagunja@mcmaster.ca.
(2)Federal Medical Centre, Birnin Kebbi, Kebbi State, Nigeria.
(3)Department of Health Research Method, Evidence and Impact, McMaster 
University, Hamilton, ON, Canada.
(4)Department of Radiation Oncology, University of Ibadan, Ibadan, Oyo State, 
Nigeria.
(5)Department of Psychiatry, Southern Illinois University School of Medicine, 
Springfield, IL 62794, USA.
(6)Bio-Behavioral Research, SUNY-AB, WPA Section on Interdisciplinary 
Collaboration, Buffalo, NY, USA.

BACKGROUND: Emotional wellbeing of healthcare workers is critical to the quality 
of patient care, and effective function of health services. The corona virus 
disease-2019 (COVID-19) pandemic exerted unique physical and emotional demands 
on healthcare workers, however little is known about the emotional wellbeing of 
healthcare workers during the COVID-19 pandemic in resource-restricted settings. 
This study investigated the prevalence of psychological distress, and sleep 
problems in healthcare workers in a COVID-19 referral hospital in Nigeria.
METHODS: A total of 303 healthcare workers were interviewed with the 12-item 
General Health Questionnaire (GHQ-12) to evaluate psychological distress, and 
the Pittsburgh Sleep Quality Index (PSQI) to assess multidimensional aspects of 
sleep, including quality, latency, duration, habitual efficiency, disturbances, 
use of sleeping medications and daytime dysfunction.
RESULTS: The participants were mostly males, 183(60.4%) and mean age was 
38.8(SD = 8.9) years. Most of the participants were married (70.3%), had spent 
less than 10 years in service (72.9%), and had no medical comorbidity (92.1%). 
The prevalence of psychological distress was 23.4%, and six in every ten 
participants reported sleep problems. The largest proportion of participants 
reported difficulty in sleep latency (81.5%), duration (71.3%), and daytime 
dysfunction (69.6%), while approximately one third (32%) each reported using 
sleep medication, and had difficulty with sleep quality. Psychological distress 
was inter-related with poor sleep problems (p = 0.001; effect size = 0.2).
CONCLUSION: The prevalence rates of psychological distress and sleep problems 
during the COVID-19 pandemic were several folds the rates previously reported in 
similar contexts. Preventative psychosocial support services for healthcare 
workers are indicated. The creation of a culturally-sensitive interdisciplinary 
blueprint for locally-viable actions model are strongly suggested ahead of 
future emergency situations.

Copyright © 2021 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.pnpbp.2021.110292
PMCID: PMC7920822
PMID: 33662533 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


3707. Ir J Med Sci. 2022 Feb;191(1):93-96. doi: 10.1007/s11845-021-02513-6. Epub 2021 
Mar 4.

Impact on mental health of the COVID-19 outbreak among general practitioners 
during the sanitary lockdown period.

Lange M(1)(2), Joo S(3)(4), Couette PA(3)(4), Le Bas F(3)(4), Humbert X(5)(6).

Author information:
(1)Clinical Research Department, Centre François Baclesse, 14000, Caen, France.
(2)Normandie University, UNICAEN, INSERM, ANTICIPE, 14000, Caen, France.
(3)Family Medicine Department, Normandie University, UNICAEN, UFR Santé, 2, rue 
des Rochambelles, 14000, Caen, France.
(4)EA 4650 Signalisation, électrophysiologie et imagerie des lésions 
d'ischémie-reperfusion myocardique, Normandie University, 14000, Caen, France.
(5)Family Medicine Department, Normandie University, UNICAEN, UFR Santé, 2, rue 
des Rochambelles, 14000, Caen, France. xavier.humbert@unicaen.fr.
(6)EA 4650 Signalisation, électrophysiologie et imagerie des lésions 
d'ischémie-reperfusion myocardique, Normandie University, 14000, Caen, France. 
xavier.humbert@unicaen.fr.

BACKGROUND: COVID-19 outbreak can impact mental health including health care 
workers.
AIM: The aim of this study was to assess the mental health impact of COVID-19 in 
French General Practitioners (GPs).
METHODS: We carried out a postal-based survey during the first lockdown. Four 
psychological validated self-report questionnaires were used to assess 
stress,post-traumatic stress symptoms, burnout and self-efficacy (Perceived 
Stress scale, Impact of Event Scale-revised, Maslach Burnout Inventory and 
General Self-Efficacy scale).
RESULTS: The sample consists of 332 general practitioners (43.50% women, mean 
age = 50.74 ± 11.91). General practitioners working in high epidemic location 
represented 27.71% of the sample (n = 92). Thirty four GPs reported significant 
post-traumatic stress symptoms (10.59%). High burnout symptoms were found in 79 
(24.46%), 137 (42.41%) and 17 (5.26%) participants. Only General Self-Efficacy 
scores were significantly different according to epidemic location status with 
lower scores in GPs working in high epidemic location (33.37 ± 4.64 vs. 
32.06 ± 5.43; P = 0.04). Women reported more stress and burnout symptoms than 
men (P = 0.01).
CONCLUSIONS: This study showed the psychological impact of COVID-19 in GPs 
during the sanitary lockdown period including burnout and post-traumatic stress 
symptoms. Up to 42% of GPs reported psychological disturbances. Interventions to 
promote mental health well-being of healthcare workers need to be developing.

© 2021. Royal Academy of Medicine in Ireland.

DOI: 10.1007/s11845-021-02513-6
PMCID: PMC7929901
PMID: 33660115 [Indexed for MEDLINE]

Conflict of interest statement: We have no conflicts of interest.


3708. J Health Psychol. 2022 May;27(6):1432-1444. doi: 10.1177/1359105321999710. Epub 
2021 Mar 3.

A cross-sectional study of physical activity behaviour and associations with 
wellbeing during the UK coronavirus lockdown.

Wood CJ(1), Barton J(1), Smyth N(2).

Author information:
(1)University of Essex, UK.
(2)University of Westminster, UK.

This study assessed physical activity (PA) and wellbeing during lockdown. UK 
adults reported their PA in the previous week, perception of PA importance 
(more, less, same) and wellbeing, depression, anxiety and stress. One-way ANOVA 
compared PA and wellbeing by PA importance. The 'less' importance group did less 
PA than the 'more' and 'same' (p < 0.05) importance group; and scored worse on 
all wellbeing measures than the 'same' importance group (p < 0.01). They also 
had worse wellbeing, depression and anxiety than the 'more' importance group 
(p < 0.05). Strategies to overcome the impact of the pandemic should aim to 
increase PA.

DOI: 10.1177/1359105321999710
PMCID: PMC9036158
PMID: 33657907 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of conflicting interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship and/or publication of this article.


3709. Int J Psychol. 2021 Oct;56(5):766-771. doi: 10.1002/ijop.12750. Epub 2021 Mar 3.

Posttraumatic symptoms, posttraumatic growth, and internal resources among the 
general population in Greece: A nation-wide survey amid the first COVID-19 
lockdown.

Kalaitzaki A(1).

Author information:
(1)Laboratory of Interdisciplinary Approaches to the Enhancement of Quality of 
Life, Social Work Department, Affiliated Researcher of the Research Centre 
'Institute of Agri-Food and Life Sciences', Health Sciences Faculty, Hellenic 
Mediterranean University, Crete, Greece.

Scarce and inconclusive evidence exists on the mental health consequences of the 
COVID-19 lockdown. This study examined the psychological impact of the lockdown 
in Greece, resilience levels, use of coping strategies, and identified high-risk 
groups. A sample of 1661 participants (mean age = 39.5, SD = 12.2; 75.5% 
females) completed a web-based survey, which was distributed through social 
networking sites, webpages, and personal contacts. Posttraumatic symptoms, 
posttraumatic growth, resilience, and coping strategies were assessed. Different 
population subgroups suffered the impact of lockdown disproportionately. 
Healthcare workers, females, younger, less educated, and those living alone 
reported higher rates of posttraumatic stress symptoms. Females achieved more 
posttraumatic growth and were using coping strategies more frequently than men. 
Men, older, healthcare workers, and those with a partner were more resilient. 
Interventions need to be developed to target personal resources, protect 
vulnerable populations, facilitate posttraumatic growth, and ameliorate 
wellbeing and quality of life.

© 2021 International Union of Psychological Science.

DOI: 10.1002/ijop.12750
PMCID: PMC8014530
PMID: 33656173 [Indexed for MEDLINE]


3710. Psychiatry Res. 2021 Apr;298:113822. doi: 10.1016/j.psychres.2021.113822. Epub 
2021 Feb 24.

Mental health status of healthcare versus other essential workers in Australia 
amidst the COVID-19 pandemic: Initial results from the collate project.

Toh WL(1), Meyer D(2), Phillipou A(3), Tan EJ(4), Van Rheenen TE(5), Neill E(6), 
Rossell SL(4).

Author information:
(1)Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne 
University of Technology, Melbourne, VIC, Australia. Electronic address: 
wtoh@swin.edu.au.
(2)Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne 
University of Technology, Melbourne, VIC, Australia.
(3)Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne 
University of Technology, Melbourne, VIC, Australia; Department of Mental 
Health, St Vincent's Hospital, Melbourne, VIC, Australia; Department of 
Psychiatry, University of Melbourne, Melbourne, VIC, Australia; Department of 
Mental Health, Austin Hospital, Melbourne, VIC, Australia.
(4)Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne 
University of Technology, Melbourne, VIC, Australia; Department of Mental 
Health, St Vincent's Hospital, Melbourne, VIC, Australia.
(5)Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne 
University of Technology, Melbourne, VIC, Australia; Melbourne Neuropsychiatry 
Centre, Department of Psychiatry, University of Melbourne & Melbourne Health, 
Melbourne, VIC, Australia.
(6)Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne 
University of Technology, Melbourne, VIC, Australia; Department of Mental 
Health, St Vincent's Hospital, Melbourne, VIC, Australia; Department of 
Psychiatry, University of Melbourne, Melbourne, VIC, Australia.

The novel coronavirus (COVID-19) has necessitated many healthcare workers 
operating on the frontlines. Another segment of the population whose mental 
well-being is being tested are the 'other essential workers' (e.g. supermarket 
workers). The current study aimed to compare the mental health of healthcare 
versus other essential workers in the early stages of the COVID-19 outbreak. The 
COVID-19 and you: mentaL heaLth in AusTralia now survEy (COLLATE) project is a 
nationwide online mental health survey launched on 1 April 2020, aimed at 
identifying key mental health concerns. Adults currently living in Australia 
were invited to take part, and non-discriminative snowball sampling was 
employed. Participants were partitioned into healthcare workers (HCW; n=905), 
other essential workers (OEW; n=810), and the general population (GNP; n=3443). 
Across all groups, top COVID-19 related concerns were primarily associated with 
the health and well-being of loved ones. In terms of current levels of 
depression, anxiety, stress and quality of life, HCWs fared the best, and OEWs 
fared the worst (with the GNP falling in between). In the face of this medical 
crisis, Australian HCWs seem to be managing their mental health relatively well, 
but more supports need to be devoted to OEWs to safeguard their mental 
well-being.

Copyright © 2021. Published by Elsevier B.V.

DOI: 10.1016/j.psychres.2021.113822
PMCID: PMC7902230
PMID: 33652251 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared no potential conflicts 
of interest with respect to the research, authorship, and publication of this 
article.


3711. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2021 
Dec;64(12):1512-1521. doi: 10.1007/s00103-021-03291-3. Epub 2021 Mar 1.

[Mental health and psychological burden of children and adolescents during the 
first wave of the COVID-19 pandemic-results of the COPSY study].

[Article in German; Abstract available in German from the publisher]

Ravens-Sieberer U(1), Kaman A(2), Otto C(2), Adedeji A(2), Napp AK(2), Becker 
M(2), Blanck-Stellmacher U(2), Löffler C(2), Schlack R(3), Hölling H(3), Devine 
J(2), Erhart M(2)(4)(5), Hurrelmann K(6).

Author information:
(1)Zentrum für Psychosoziale Medizin, Klinik für Kinder- und Jugendpsychiatrie, 
-psychotherapie und -psychosomatik, Universitätsklinikum Hamburg-Eppendorf, 
Martinistraße 52, 20246, Hamburg, Deutschland. ravens-sieberer@uke.de.
(2)Zentrum für Psychosoziale Medizin, Klinik für Kinder- und Jugendpsychiatrie, 
-psychotherapie und -psychosomatik, Universitätsklinikum Hamburg-Eppendorf, 
Martinistraße 52, 20246, Hamburg, Deutschland.
(3)Abteilung für Epidemiologie und Gesundheitsmonitoring, Fachgebiet Psychische 
Gesundheit, Robert Koch-Institut, Berlin, Deutschland.
(4)Alice Salomon Hochschule, Berlin, Deutschland.
(5)Apollon Hochschule der Gesundheitswirtschaft, Bremen, Deutschland.
(6)Hertie School, Berlin, Deutschland.

BACKGROUND: The drastic changes during the COVID-19 pandemic may have a negative 
impact on the psychological wellbeing of children and adolescents.
OBJECTIVES: COPSY is the first national, representative German study to examine 
mental health and quality of life of children and adolescents during the 
pandemic. Results are compared with data of the representative longitudinal 
BELLA study conducted before the pandemic.
MATERIALS AND METHODS: Internationally established instruments for measuring 
health-related quality of life and mental health (including anxiety and 
depressive symptoms) were administered to n = 1586 parents with 7‑ to 
17-year-old children and adolescents, of whom n = 1040 11- to 17-year-olds also 
provided self-reports, from 26 May to 10 June 2020. Data were analyzed using 
descriptive statistics and bivariate tests.
RESULTS: Seventy-one percent of the children and adolescents and 75% of the 
parents felt burdened by the first wave of the COVID-19 pandemic. Compared to 
the time before the pandemic, the children and adolescents reported a lower 
health-related quality of life, the percentage of children and adolescents with 
mental health problems almost doubled, and their health behavior worsened. 
Socially disadvantaged children felt particularly burdened by the COVID-19 
pandemic. Two-thirds of the parents would like to receive support in coping with 
their child during the pandemic.
CONCLUSIONS: The COVID-19 pandemic poses a mental health risk to children and 
adolescents. Schools, doctors, and society are called to react by providing 
low-threshold and target-group-specific prevention and mental health promotion 
programs.

Publisher: ZUSAMMENFASSUNG: HINTERGRUND: Die mit der COVID-19-Pandemie 
einhergehenden Veränderungen und Kontaktbeschränkungen können das psychische 
Wohlbefinden von Kindern und Jugendlichen beeinflussen.
ZIEL DER ARBEIT: COPSY ist die erste deutschlandweite repräsentative Studie, 
welche die psychische Gesundheit und Lebensqualität von Kindern und Jugendlichen 
während der Pandemie untersucht. Die Ergebnisse werden mit denen der 
repräsentativen longitudinalen BELLA-Studie aus der Zeit vor der Pandemie 
verglichen.
MATERIAL UND METHODEN: Vom 26.05. bis zum 10.06.2020 wurden n = 1586 Eltern mit 
7‑ bis 17-jährigen Kindern und Jugendlichen, von denen n = 1040 11- bis 
17-Jährige auch Selbstangaben machten, befragt. Dabei wurden international 
etablierte Instrumente zur Erfassung von gesundheitsbezogener Lebensqualität, 
psychischen Auffälligkeiten, Ängstlichkeit und depressiven Symptomen eingesetzt. 
Die Daten wurden mittels deskriptiver Statistiken und bivariater Tests 
ausgewertet.
ERGEBNISSE: 71 % der Kinder und Jugendlichen und 75 % der Eltern fühlten sich 
durch die erste Welle der Pandemie belastet. Im Vergleich zu der Zeit vor der 
Pandemie gaben die Kinder und Jugendlichen eine geminderte Lebensqualität an, 
der Anteil von Kindern und Jugendlichen mit psychischen Auffälligkeiten hat sich 
in etwa verdoppelt und ihr Gesundheitsverhalten hat sich verschlechtert. Sozial 
benachteiligte Kinder erlebten die Belastungen durch die Pandemie besonders 
stark. Zwei Drittel der Eltern wünschten sich Unterstützung im Umgang mit ihrem 
Kind.
DISKUSSION: Die COVID-19-Pandemie führt zu einer psychischen 
Gesundheitsgefährdung der Kinder und Jugendlichen, auf die präventiv mit 
niedrigschwelligen und zielgruppenspezifischen Angeboten in der Schule, in der 
ärztlichen Praxis und in der Gesellschaft im Sinne des Kinderschutzes reagiert 
werden sollte.

© 2021. The Author(s).

DOI: 10.1007/s00103-021-03291-3
PMCID: PMC7920639
PMID: 33649901 [Indexed for MEDLINE]


3712. J Perinatol. 2021 Aug;41(8):2057-2062. doi: 10.1038/s41372-021-00983-1. Epub 
2021 Mar 1.

Uptake and impact of journaling program on wellbeing of NICU parents.

Russell LN(1), Gregory ML(2), Warren ZE(2), Weitlauf AS(2).

Author information:
(1)Vanderbilt University Medical Center, Nashville, TN, USA. 
laura.n.russell@vumc.org.
(2)Vanderbilt University Medical Center, Nashville, TN, USA.

OBJECTIVE: This pilot study evaluated a brief parent journaling program in the 
neonatal intensive care unit (NICU).
STUDY DESIGN: Hundred NICU parents were randomized to a control group (no 
journal) or an intervention group (journal provided). Parents reported pre- and 
post-intervention anxiety and depression symptoms using the hospital anxiety and 
depression scale (HADS) and qualitative journal use data. The analysis included 
Student's paired two-tailed t-test and two-way ANOVA. This study was registered 
with clinicaltrials.gov on April 1, 2020, NCT04331925.
RESULT: At baseline, clinically significant anxiety was more prevalent than 
depression (66% vs. 23%). Post-intervention scores were best predicted by 
baseline scores. Relative to controls, intervention group parents experienced a 
decrease in anxiety from baseline (t = -1.983, p = 0.056). The same effect was 
not seen for depression. Most intervention group parents used the journal and 
provided positive feedback.
CONCLUSION: Journal use rates and positive feedback support the acceptability of 
a NICU journaling program.

© 2021. The Author(s), under exclusive licence to Springer Nature America, Inc. 
part of Springer Nature.

DOI: 10.1038/s41372-021-00983-1
PMID: 33649444 [Indexed for MEDLINE]


3713. Addict Behav. 2021 Jul;118:106876. doi: 10.1016/j.addbeh.2021.106876. Epub 2021 
Feb 23.

The impact of the initial Covid-19 lockdown upon regular sports bettors in 
Britain: Findings from a cross-sectional online study.

Wardle H(1), Donnachie C(2), Critchlow N(3), Brown A(3), Bunn C(2), Dobbie F(4), 
Gray C(5), Mitchell D(3), Purves R(3), Reith G(2), Stead M(3), Hunt K(3).

Author information:
(1)School of Social and Political Sciences, University of Glasgow, Adam Smith 
Building, Bute Gardens, Glasgow G12 8RT, UK; Faculty of Public Health and 
Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, 
London WC1H 9SH, UK. Electronic address: Heather.wardle@glasgow.ac.uk.
(2)School of Social and Political Sciences, University of Glasgow, Adam Smith 
Building, Bute Gardens, Glasgow G12 8RT, UK.
(3)Institute of Social Marketing, University of Stirling, Stirling FK9 4LA, UK.
(4)Usher Institute, University of Edinburgh, Doorway 1, Old Medical School, 
Teviot Place, Edinburgh EH8 9AG, UK.
(5)Institute of Health and Wellbeing, Room 230, 25-29 Bute Gardens, Glasgow G12 
8RS, UK.

BACKGROUND: In Britain, unprecedented restrictions on daily life associated with 
the Covid-19 pandemic included the suspension of professional sports events 
during the initial 'lockdown'. This provides opportunities to observe changes in 
sports bettors' behaviour when their primary form of activity is removed and 
assess the impact of Covid-19 related circumstances upon gambling.
METHODS: In July 2020, we conducted an online cross-sectional survey of people 
who bet regularly (at least monthly) on sports before Covid-19 (n = 3866). 
Bi-variate analyses compared changes in gambling behaviours before and during 
the initial lockdown. Multi-variate logistic regression models explored 
associations between problem gambling (men) and moderate risk or problem 
gambling (MRPG) (women) with changes in Covid-19 related circumstances and 
changing gambling behaviours during Britain's initial 'lockdown' (March-June 
2020).
RESULTS: 29.8% of male sports bettors and 33.4% of female sports bettors stopped 
gambling altogether during the initial Covid-19 lockdown, though 17.3% of men 
and 16.5% of women started a new form of gambling during lockdown. Among men, 
adjusted odds ratios of problem gambling were higher among those starting a new 
gambling activity during lockdown (OR = 2.50 [95% CI 1.38-4.53]). Among women, 
adjusted odds ratios of MRPG were higher among those whose frequency of gambling 
on any activity increased during lockdown (OR = 4.21 [1.99-8.92] and among those 
shielding for health reasons. Poorer wellbeing was associated with problem 
gambling for men and MRPG for women.
CONCLUSIONS: Those changing gambling behaviours during the initial Covid-19 
lockdown (e.g. increasing gambling frequency or starting a new gambling 
activity) are potentially vulnerable to gambling harms.

Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.addbeh.2021.106876
PMCID: PMC9757982
PMID: 33647707 [Indexed for MEDLINE]


3714. Prev Med. 2021 May;146:106465. doi: 10.1016/j.ypmed.2021.106465. Epub 2021 Feb 
27.

Addressing the critical need for long-term mental health data during the 
COVID-19 pandemic: Changes in mental health from April to September 2020.

Veldhuis CB(1), Nesoff ED(2), McKowen ALW(3), Rice DR(4), Ghoneima H(3), Wootton 
AR(5), Papautsky EL(6), Arigo D(7), Goldberg S(8), Anderson JC(9).

Author information:
(1)Columbia University, New York, NY, United States of America. Electronic 
address: c.veldhuis@columbia.edu.
(2)University of Pennsylvania, Philadelphia, PA, United States of America.
(3)Columbia University, New York, NY, United States of America.
(4)Harvard University, Cambridge, MA, United States of America.
(5)UC Berkeley, Berkeley, CA, United States of America.
(6)University of Illinois at Chicago, Chicago, IL, United States of America.
(7)Rowan University, Glassboro, NJ, United States of America.
(8)University of North Carolina, Chapel Hill, NC, United States of America.
(9)Pennsylvania State University, State College, PA, United States of America.

Despite the large amounts of research currently being conducted and the high 
number of editorials warning about the potential mental health impacts, there is 
a stunning lack of longitudinal mental health data on the effects of the 
pandemic. Yet, the pandemic may have sizable long-term impacts on psychological 
distress and health behaviors-these effects may be long-lasting and may 
disproportionately affect some demographic groups more than others. Data came 
from a longitudinal international study of the impacts of the COVID-19 pandemic 
on adults' psychological distress and wellbeing (N = 1567). We found high rates 
of depression (55% were diagnosable with probable depression at baseline), 
anxiety (65%), and risk for PTSD (51%). More than one-third of participants who 
reported that they drank alcohol indicated that their drinking had increased 
since the start of the pandemic. Over time, depressive symptoms and suicidal 
thoughts and behaviors increased significantly, but acute stress symptoms 
decreased. Specific demographic groups (people of color and sexual and gender 
minorities) appeared to be at high risk of distress across analyses. Our 
findings suggest high rates of depression, anxiety, acute stress, and other 
signs of distress like isolation, hopelessness, and use of substances to 
cope-even at five-month follow-up. Our findings suggest a need to prioritize 
availability of, and access to, mental health care during both the pandemic and 
the recovery.

Copyright © 2021 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.ypmed.2021.106465
PMCID: PMC8136863
PMID: 33647353 [Indexed for MEDLINE]


3715. J Glob Health. 2021 Jan 16;11:05003. doi: 10.7189/jogh.11.05003.

The multidimensional burden of COVID-19 on Syrian refugees in Lebanon.

Hajjar MS(1), Abu-Sittah GS(2).

Author information:
(1)Faculty of Medicine - American University of Beirut, Beirut, Lebanon.
(2)Department of Surgery, Division of Plastic Surgery - American University of 
Beirut Medical Center, Beirut, Lebanon.

BACKGROUND: The COVID-19 pandemic is a global phenomenon that is spreading at an 
alarmingly high rate, increasing morbidity, mortality as well as affecting the 
global economy, education sector and psychological well-being of the public. 
Measures, taken to mitigate the spread of the virus during this pandemic, 
created challenges to humanitarian communities preventing them from carrying out 
their responsibilities towards vulnerable populations. The aim of this study is 
to assess the burden of COVID-19 by looking at the current living conditions, 
examining available services provided, and identifying the economic and health 
challenges of Syrian refugee families living in Lebanon.
METHODS: This is a cross-sectional study conducted on 129 Syrian refugee 
families living in Lebanon during the COVID-19 pandemic. All participants 
provided consent prior to completion of the standardized questionnaire.
RESULTS: During the pandemic, 79% of breadwinners lost their jobs; of those who 
kept their jobs, 68% had their wages reduced. None of the families was capable 
of affording all of their basic needs with 55% only partially affording and 45% 
not able to afford. Thirty percent of Syrian refugee families did not receive 
support from organizations during the pandemic reflecting the impact of this 
crisis on humanitarian organizations. Education was also affected as 70% of 
children did not continue their education at home. Stress and anxiety were the 
most commonly reported behavioral changes among both children and adults.
CONCLUSIONS: The impact of this crisis is multidimensional affecting the 
economy, global health and education level of the public. Measures should be 
taken to lessen the detrimental effect of this crisis on the community as a 
whole and on vulnerable populations in particular.

Copyright © 2021 by the Journal of Global Health. All rights reserved.

DOI: 10.7189/jogh.11.05003
PMCID: PMC7897425
PMID: 33643636 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: The authors completed the 
ICMJE Unified Competing Interest form (available upon request from the 
corresponding author), and declare no conflicts of interest.


3716. Neurol India. 2021 Jan-Feb;69(1):26-31. doi: 10.4103/0028-3886.310073.

Sleep and Covid-19.

Datta K(1), Tripathi M(2).

Author information:
(1)Department of Sports Medicine, Armed Forces Medical College, Pune, India.
(2)Department of Neurology, All India Institute of Medical Sciences, New Delhi, 
India.

BACKGROUND: COVID-19 pandemic has affected the world globally causing widespread 
repercussions on individuals' physical, mental and emotional well-being. In such 
times, sleep is likely to be affected.
OBJECTIVE: The aim of this study was to present the available literature on 
sleep and also the foresight as to the future national strategy to mitigate the 
effects of this pandemic.
MATERIALS AND METHODS: An extensive literature search on PubMed, Google Scholar, 
Epistemonikos database (https://www.epistemonikos.org), PsycINFO for available 
literature on the prevalence of sleep problem on COVID-19 was done. 
Cross-citation search was also conducted to increase relevance of the review. 
The key words used were- (((((((((((insomnia)) OR (sleep)) OR (sleepiness)) OR 
("sleep quality")) OR (OSA)) OR ("obstructive sleep apnoea")) OR ("obstructive 
sleep apnea")) OR (("sleep problem")) AND "covid-19" OR covid19* OR "COVID-19" 
OR "2019-nCoV" OR cv19* OR "cv-19" OR "cv 19" OR "n-cov" OR ncov* OR 
"sars-cov-2" OR "sars-cov2" OR "2019-ncov" OR "SARS-Coronavirus-2" OR 
"SARS-Coronavirus2" OR (wuhan* AND (virus OR viruses OR viral)) OR (covid* AND 
(virus OR viruses OR viral)) OR "covid-19-related" OR "SARS-CoV-2-related" OR 
"SARS-CoV2-related" OR "2019-nCoV-related" OR "cv-19-related" OR 
"n-cov-related"). Inclusion criteria consisted of articles in English, published 
from Jan 2020 till 19 Apr 2020. Two reviewers independently screened each 
research study for inclusion and eligibility.
RESULTS AND CONCLUSION: Sleep is affected during COVID-19 pandemic in patients, 
their families, health-care workers and their families, population in isolation, 
and quarantine and as such in public. Limited literature exists with subjective 
data and no objective criteria were found to study sleep in COVID-19 pandemic. 
OSA was found to be a frequent baseline characteristic of COVID-19 patients. A 
need to follow guidelines is of paramount importance and strategies to better 
sleep in the population needs to be addressed.

DOI: 10.4103/0028-3886.310073
PMID: 33642266 [Indexed for MEDLINE]

Conflict of interest statement: None


3717. J Reprod Infant Psychol. 2022 Sep;40(4):420-432. doi: 
10.1080/02646838.2021.1886259. Epub 2021 Mar 1.

Predictors of postpartum depression among an obstetric population in 
South-Western Nigeria.

Okunola TO(1), Awoleke JO(1), Olofinbiyi B(1), Rosiji B(2), Olubiyi AO(2), Omoya 
S(2).

Author information:
(1)Department of Obstetrics and Gynaecology, Ekiti State University, Ado-Ekiti, 
Ekiti State, Nigeria.
(2)State Specialist Hospital, Ikole-Ekiti, Ekiti State, Nigeria.

BACKGROUND: Perinatal maternal depression is the most common mood disturbance 
associated with pregnancy. It has grave consequences on both maternal health and 
wellbeing of offsprings, albeit usually neglected in low- and middle-income 
countries.
OBJECTIVE: To evaluate the relationship between antenatal depression(APD) and 
postpartum depression(PPD) and predictors of postpartum depression among an 
obstetric population in South-western Nigeria.
METHODS: This was a prospective longitudinal cohort study involving272 pregnant 
women recruited between 34 and 36 weeks of pregnancy and followed up to till 
6 weeks after delivery. Edinburgh Postnatal Depression Scale (EPDS) 
questionnaires were administered to collect data. Data were analysed with SPSS 
version 23.A p-value < 0.05 was taken as statistically significant.
RESULTS: The prevalences of antepartum and postpartum depression were 6.3%, (95% 
CI 3.4%-9.2%) and 8.8% (95% CI 5.4%-12.1%) respectively. The Spearman 
correlation coefficient for antepartum EPDS and postpartum EPDS scores was 0.52, 
p < 0.001.The predictors of postpartum depression were antepartum depression 
(adjusted OR 10.6, 95% CI 8.33-48.60, p < 0.001), puerperal sepsis (adjusted OR 
4.33, 95% CI 3.89-8.69, p = 0.03), domestic violence (adjusted OR 3.40, 95% CI 
1.94-15.67, p = 0.01) and age group 25-34 years (adjusted OR 0.11, 95% CI 
0.02-0.75, p = 0.02), and household income $1671-$3330 (adjusted OR 0.10, 95% CI 
0.02-0.56, p = 0.01).
CONCLUSION: There was a positive association between the antenatal EPDS and 
postnatal EPDS scores. Screening for maternal depression should be considered in 
prenatal period. Further studies are necessary to explore the novel finding of 
predictive role of puerperal sepsis in PPD.

DOI: 10.1080/02646838.2021.1886259
PMID: 33641549 [Indexed for MEDLINE]


3718. Gerontologist. 2022 Apr 20;62(4):616-628. doi: 10.1093/geront/gnab029.

Results of a Randomized Trial Testing the Efficacy of Tele-Savvy, an Online 
Synchronous/Asynchronous Psychoeducation Program for Family Caregivers of 
Persons Living with Dementia.

Hepburn K(1), Nocera J(2), Higgins M(1), Epps F(1), Brewster GS(1), Lindauer 
A(3), Morhardt D(4), Shah R(5), Bonds K(1), Nash R(1), Griffiths PC(2).

Author information:
(1)Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, 
USA.
(2)Department of Medicine, Emory University, Atlanta, Georgia, USA.
(3)Alzheimer's Disease Research Center, Oregon Health and Sciences University, 
Portland, USA.
(4)Alzheimer's Disease Research Center, Northwestern University, Chicago, 
Illinois, USA.
(5)Department of Family Medicine and Rush Alzheimer's Disease Center, Rush 
University Medical Center, Chicago, Illinois, USA.

BACKGROUND AND OBJECTIVES: Family caregivers will grow in number as dementia 
prevalence increases, underscoring the continued importance of equipping these 
individuals for their new roles and ameliorating the adverse effects of 
caregiving.
RESEARCH DESIGN AND METHODS: A three-armed, waitlist, randomized trial design 
tested Tele-Savvy, an online adaptation of a successful in-person 
psychoeducation program, the Savvy Caregiver. Tele-Savvy is delivered over 43 
days to groups of 6-8 caregivers in 7 weekly synchronous sessions accompanied by 
36 brief asynchronous video lessons. We enrolled 23 cohorts of 15 eligible 
caregivers (N = 261), randomized 2:2:1 to active, attention control, and usual 
care arms. We assessed caregiver psychological well-being and caregiving mastery 
at baseline and 3, 6, 9, and 12 months. Multilevel linear models assessed 
outcomes over the 3 time points examined. The trial was slightly truncated, with 
Data and Safety Monitoring Board approval, because of the apparent confounding 
psychological effects of coronavirus disease 2019 restrictions.
RESULTS: Study findings indicate statistically and clinically significant 
benefits to Tele-Savvy arm caregivers (with moderate to large effect sizes) in 
the areas of depression, perceived stress, reaction to care recipients' 
behaviors, and enhancement of caregiver mastery. Expected benefits for caregiver 
burden and anxiety were not found.
DISCUSSION AND IMPLICATIONS: Findings attest to program efficacy and the 
viability of employing distance means to improve family caregivers' emotional 
well-being and sense of mastery in the caregiving role over a 6-month period. 
Next steps entail finding alternate ways to deliver the program to those with 
connectivity and/or time constraint problems.

© The Author(s) 2021. Published by Oxford University Press on behalf of The 
Gerontological Society of America. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/geront/gnab029
PMCID: PMC7989248
PMID: 33640979 [Indexed for MEDLINE]


3719. Psychiatry Res. 2021 Apr;298:113819. doi: 10.1016/j.psychres.2021.113819. Epub 
2021 Feb 23.

Effects of the COVID-19 lockdown on mental health, wellbeing, sleep, and alcohol 
use in a UK student sample.

Evans S(1), Alkan E(2), Bhangoo JK(2), Tenenbaum H(2), Ng-Knight T(2).

Author information:
(1)Faculty of Health and Medical Sciences, University of Surrey, Guildford, 
Surrey GU2 7XH, United Kingdom. Electronic address: se0016@surrey.ac.uk.
(2)Faculty of Health and Medical Sciences, University of Surrey, Guildford, 
Surrey GU2 7XH, United Kingdom.

The COVID-19 pandemic and the consequent restrictions imposed by governments 
worldwide have had profound social and psychological effects, particularly for 
young adults. This study used longitudinal data to characterise effects on 
mental health and behaviour in a UK student sample, measuring sleep quality and 
diurnal preference, depression and anxiety symptoms, wellbeing and loneliness, 
and alcohol use. Self-report data was collected from 254 undergraduates (219 
females) at a UK university at two-time points: autumn 2019 (baseline, 
pre-pandemic) and April/May 2020 (under 'lockdown' conditions).  Longitudinal 
analyses showed a significant rise in depression symptoms and a reduction in 
wellbeing at lockdown. Over a third of the sample could be classed as clinically 
depressed at lockdown compared to 15% at baseline. Sleep quality was not 
affected across the sample as a whole. The increase in depression symptoms was 
highly correlated with worsened sleep quality. A reduction in alcohol use, and a 
significant shift towards an 'evening' diurnal preference, were also 
observed. Levels of worry surrounding contracting COVID-19 were high. Results 
highlight the urgent need for strategies to support young people's mental 
health: alleviating worries around contracting COVID, and supporting good sleep 
quality, could benefit young adults' mental health as the COVID-19 crisis 
unfolds.

Copyright © 2021 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.psychres.2021.113819
PMCID: PMC9754711
PMID: 33640864 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


3720. Arch Womens Ment Health. 2021 Aug;24(4):681-686. doi: 
10.1007/s00737-021-01110-x. Epub 2021 Feb 27.

Google search behaviour relating to perinatal mental wellbeing during the United 
Kingdom's first COVID-19 lockdown period: a warning for future restrictions.

Chapman GE(1), Ishlek I(2), Spoors J(3)(4).

Author information:
(1)Southampton General Hospital, University Hospital Southampton NHS Foundation 
Trust, Southampton, Hampshire, UK. George.Chapman4@nhs.net.
(2)Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, Kent, UK.
(3)Hampshire Perinatal Mental Health Service, Southern Health NHS Foundation 
Trust, Winchester, Hampshire, UK.
(4)School of Psychiatry, Wessex Deanery, Health Education England, Winchester, 
UK.

Infodemiological studies derive public health information from internet 
activity. Here we compare Google searches of perinatal mental health-related 
terms during the U.K.'s first COVID-19 lockdown with the corresponding period in 
2019. We report evidence of reduced pathologising/recognition of perinatal 
mental illness; increased perceived maternal inadequacy and estrangement from 
newborn baby; increased maternal domestic abuse; and increased domestic and 
substance abuse generally. These insights offer important population-level 
considerations ahead of further U.K. restrictions, and should be imminently 
confirmed with epidemiological work.

DOI: 10.1007/s00737-021-01110-x
PMCID: PMC7913043
PMID: 33638708 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


3721. Aust Crit Care. 2021 Nov;34(6):594-603. doi: 10.1016/j.aucc.2020.10.014. Epub 
2021 Feb 24.

Impact of a nurse-led family support intervention on family members' 
satisfaction with intensive care and psychological wellbeing: A mixed-methods 
evaluation.

Naef R(1), von Felten S(2), Petry H(3), Ernst J(4), Massarotto P(5).

Author information:
(1)Centre of Clinical Nursing Science, University Hospital Zurich, Raemistrasse 
100, 8091 Zurich, Switzerland; Institute for Implementation Science in Health 
Care, Faculty of Medicine, University of Zurich, Universitätsstrasse 84, 8006 
Zurich, Switzerland. Electronic address: rahel.naef@usz.ch.
(2)Department of Biostatistics, Institute of Epidemiology, Biostatistics, and 
Prevention, Faculty of Medicine, University of Zurich, Hirschengraben 84, 8001 
Zurich, Switzerland. Electronic address: stefanie.vonfelten@uzh.ch.
(3)Centre of Clinical Nursing Science, University Hospital Zurich, Raemistrasse 
100, 8091 Zurich, Switzerland. Electronic address: heidi.petry@usz.ch.
(4)Centre of Clinical Nursing Science, University Hospital Zurich, Raemistrasse 
100, 8091 Zurich, Switzerland. Electronic address: jutta.ernst@usz.ch.
(5)Institute of Intensive Medicine, University Hospital Zurich, Raemistrasse 
100, 8091 Zurich, Switzerland. Electronic address: paola.massarotto@usz.ch.

BACKGROUND: Families of critically ill persons face uncertainty and experience 
distress during and after their close other's stay in an intensive care unit 
(ICU). Proactive nurse engagement and support is recommended to meet families' 
needs in the ICU, but little is known about its impact on quality of family 
care. We introduced a family support intervention that consisted of an 
interprofessional family support pathway and a new role of an advanced practice 
family nurse.
OBJECTIVES: The aim of the study was to examine the effect of an advanced 
practice nurse-led family support intervention on family members' satisfaction, 
wellbeing, and psychological distress.
METHODS: We conducted a quasi-experimental before-and-after study with embedded 
qualitative interviews in a Swiss University Hospital from March 2018 to July 
2019 using a questionnaire (Family Satisfaction in the ICU-24 Survey, Hospital 
Anxiety and Depression Scale, and Impact of Event Scale-Revised-6) and 
qualitative interviews (n = 19) after patient discharge.
RESULTS: Families in the intervention group (n = 75) showed a trend for 
increased overall satisfaction (difference of 5.544, 95% confidence interval 
[CI]: -0.11 to 11.20), a statistically significant increase in satisfaction with 
decision-making (7.258, 95% CI: 0.89 to 13.63), and a nonsignificant increase in 
satisfaction with care (4.178, 95% CI: -1.53 to 9.89). Psychological distress 
was higher in the intervention group, with depression reaching statistical 
significance (difference of 1.706, 95% CI: 0.16 to 3.25), which may be explained 
by longer ICU stays and higher proportion of deaths in the intervention group. 
Families receiving the intervention reported to be feeling cared for, well 
informed, and better able to cope. Data integration suggests that early onset, 
fit to need, and quality of intervention were the most important intervention 
characteristics impacting family wellbeing.
CONCLUSIONS: Our study found that family members experience a nurse-led support 
intervention as beneficial for their wellbeing. It increased their satisfaction, 
but was unable to demonstrate a favourable impact on psychological distress.

Copyright © 2021 Australian College of Critical Care Nurses Ltd. Published by 
Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.aucc.2020.10.014
PMID: 33637427 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest No conflict of interest has 
been declared by the authors.


3722. BMC Geriatr. 2021 Feb 26;21(1):143. doi: 10.1186/s12877-021-02110-3.

A longitudinal study monitoring the quality of life in a national cohort of 
older adults in Chile before and during the COVID-19 outbreak.

Herrera MS(1), Elgueta R(2), Fernández MB(3), Giacoman C(3), Leal D(3), Marshall 
P(3), Rubio M(4), Bustamante F(3).

Author information:
(1)Instituto de Sociología (Department of Sociology), Pontificia Universidad 
Católica de Chile, Av.Vicuña Mackenna 4860 Macul, Santiago, Chile. 
mherrepo@uc.cl.
(2)Instituto de Estudios Avanzados (Institute of Advanced Studies), Universidad 
de Santiago de Chile, Santiago, Chile.
(3)Instituto de Sociología (Department of Sociology), Pontificia Universidad 
Católica de Chile, Av.Vicuña Mackenna 4860 Macul, Santiago, Chile.
(4)Escuela de Enfermería (Nursing School), Pontificia Universidad Católica de 
Chile, Santiago, Chile.

BACKGROUND: Confinement during the COVID-19 pandemic has placed great stress on 
older adults, which may be affecting their quality of life. Thus, this study 
aims to describe the changes in mental and physical health, isolation and 
loneliness, residence and socioeconomic resources in a national cohort of 
Chilean older adults before and during the COVID-19 outbreak. It also analyzes 
the changes in depressive symptoms by changes in the other quality of life 
indicators before and during the COVID-19 outbreak. Possible methodological 
biases of telephone surveys in older adults living in non-developed countries 
are also discussed.
METHODS: Between June and September 2020, a random subsample of 720 people who 
had participated in the face-to-face V National Survey on Quality of Life in 
Older Adults in Chile conducted at the end of 2019 was followed up by telephone. 
Descriptive bivariate analyses were performed using t-test and non-parametric 
tests for independent variables, comparing the baseline sample with the current 
2020 follow-up sample during the peak of the pandemic outbreak in Latin America. 
Furthermore, descriptive bivariate analysis through t-test and non-parametric 
test for paired samples compared the follow-up subsample at baseline with the 
not-included sample, examining possible biases of the telephone interview 
compared with the face-to-face interview.
RESULTS: In the panel, there was no variation in self-rated health. The health 
symptoms that worsened were memory, stomach, and mood problems. Depressive 
symptoms and anxiety increased; similarly, smartphone users, social contacts, 
intergenerational co-residence and resilience increased. The telephone follow-up 
sample had a higher educational level and greater smartphone use than those not 
included in the subsample.
CONCLUSIONS: Although some physical and mental health indicators have worsened 
during the pandemic, older adults mobilized resources that could allow them to 
maintain their quality of life, such as improved resilience. Thus, these 
findings can guide future research and the development of efficient strategies 
to improve these resources among older adults to ensure wellbeing.

DOI: 10.1186/s12877-021-02110-3
PMCID: PMC7908522
PMID: 33637054 [Indexed for MEDLINE]

Conflict of interest statement: The authors declared no potential conflicts of 
interest concerning the research, authorship, and publication of this article.


3723. Acad Med. 2021 May 1;96(5):632-634. doi: 10.1097/ACM.0000000000004023.

Reimagining Well-Being Initiatives in Medical Education: Shifting From Promoting 
Wellness to Increasing Satisfaction.

Slavin S(1).

Author information:
(1)S. Slavin is senior scholar for well-being, Accreditation Council for 
Graduate Medical Education, Chicago, Illinois.

The well-being movement in medical education has been underway for over a 
decade. It seems appropriate to examine and evaluate these efforts to support 
the mental health needs of learners, faculty, and staff as medicine and medical 
education evolve in response to the COVID-19 pandemic and beyond. To date, most 
interventions intended to promote well-being have focused on individual 
strategies rather than environmental drivers of distress, and the primary 
offerings have comprised strategies such as mindfulness, meditation, yoga, 
nutrition, exercise, and sleep. Responses to this programming from medical 
learners have primarily ranged from ambivalence to resentment, with many feeling 
that the programming failed to adequately address their particular needs and the 
challenges they were experiencing. In this commentary, the author challenges the 
assumption that well-being per se should be the ideal target or goal. Learners 
and faculty may be better served by considering other goals-those that do not 
focus directly on well-being but that are instead foundational for well-being in 
that they directly address the challenges that students, residents, and faculty 
are facing. In other words, goals and associated interventions would focus on 
the experience of school and work rather than focusing primarily on encouraging 
healthy practices outside of school and work. The author proposes using the lens 
of satisfaction through which to view and assess progress toward well-being, 
increasing satisfaction within 3 interconnected domains: (1) school and/or work, 
(2) self, and (3) life in general. Attention to these domains may be more likely 
to produce improvements in well-being that have been sought for years but that 
remain elusive.

Copyright © 2021 by the Association of American Medical Colleges.

DOI: 10.1097/ACM.0000000000004023
PMID: 33635840 [Indexed for MEDLINE]


3724. J Intellect Disabil Res. 2021 May;65(5):397-404. doi: 10.1111/jir.12818. Epub 
2021 Feb 25.

COVID-19 impact on psychological outcomes of parents, siblings and children with 
intellectual disability: longitudinal before and during lockdown design.

Bailey T(1), Hastings RP(1)(2), Totsika V(1)(2)(3).

Author information:
(1)CEDAR, University of Warwick, Coventry, UK.
(2)Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, 
School of Clinical Sciences at Monash Health, Monash University, Melbourne, Vic, 
Australia.
(3)Department of Psychiatry, University College London, London, UK.

BACKGROUND: Parents of children with intellectual disability (ID) report 
comparatively lower levels of well-being than parents of children without ID. 
Similarly, children with ID, and to a lesser extent their siblings, are reported 
to show comparatively higher levels of behaviour and emotional problems. 
Psychological problems may be accentuated by restrictions associated with the 
COVID-19 pandemic, due to increased social, caring and economic stressors and 
reduced social support. However, existing studies have not been able to examine 
the impact of COVID-19 restrictions accounting for pre-COVID levels of 
well-being in these families. In a naturalistic design, we examined outcomes for 
parents, siblings and children with ID in a two-wave longitudinal study where 
Wave 2 data were gathered for some families before and some during COVID-19 
restrictions.
METHODS: Parents of children with ID who took part in a Wave 2 survey 
pre-lockdown (n = 294) and during/post-lockdown (n = 103) completed a number of 
measures about their well-being and the behaviour and emotional problems of both 
their child with ID and their nearest-in-age sibling. These same measures had 
also been completed for all families 2-3 years previously in Wave 1 of the 
study.
RESULTS: After accounting for covariates including family socio-economic 
circumstances, pre-lockdown and post-lockdown groups did not differ on Waves 1 
to 2 change for measures of parental psychological distress, life satisfaction, 
the impact of caregiving on their lives or perceived positive gains; nor child 
or sibling internalising or externalising behaviour problems.
CONCLUSIONS: Findings of the current study indicate that during and shortly 
after the COVID-19 lockdown in the United Kingdom, well-being in families of 
children with an ID (as reported by parents) was at similar levels compared with 
prior to the lockdown period.

© 2021 The Authors. Journal of Intellectual Disability Research published by 
MENCAP and International Association of the Scientific Study of Intellectual and 
Developmental Disibilities and John Wiley & Sons Ltd.

DOI: 10.1111/jir.12818
PMCID: PMC8013753
PMID: 33634520 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


3725. Sci Rep. 2021 Feb 25;11(1):4636. doi: 10.1038/s41598-021-84127-7.

The impact of the COVID-19 pandemic on wellbeing and cognitive functioning of 
older adults.

De Pue S(1), Gillebert C(2), Dierckx E(3)(4), Vanderhasselt MA(5)(6), De Raedt 
R(6), Van den Bussche E(2).

Author information:
(1)Brain & Cognition, KU Leuven, Leuven, Belgium. sarah.depue@kuleuven.be.
(2)Brain & Cognition, KU Leuven, Leuven, Belgium.
(3)Personality and Psychopathology, Vrije Universiteit Brussel, Brussels, 
Belgium.
(4)Psychiatric Hospital, Alexianen Zorggroep Tienen, Tienen, Belgium.
(5)Department of Head and Skin, Ghent University, University Hospital Ghent (UZ 
Ghent), Ghent, Belgium.
(6)Department of Experimental Clinical and Health Psychology, Ghent University, 
Ghent, Belgium.

COVID-19 took a heavy toll on older adults. In Belgium, by the end of August, 
93% of deaths due to COVID-19 were aged 65 or older. Similar trends were 
observed in other countries. As a consequence, older adults were identified as a 
group at risk, and strict governmental restrictions were imposed on them. This 
has caused concerns about their mental health. Using an online survey, this 
study established the impact of the COVID-19 pandemic on adults aged 65 years or 
older, and which factors moderate this impact. Participants reported a 
significant decrease in activity level, sleep quality and wellbeing during the 
COVID-19 pandemic. Depression was strongly related to reported declines in 
activity level, sleep quality, wellbeing and cognitive functioning. Our study 
shows that the COVID-19 pandemic had a severe impact on the mental health of 
older adults. This implies that this group at risk requires attention of 
governments and healthcare.

DOI: 10.1038/s41598-021-84127-7
PMCID: PMC7907111
PMID: 33633303 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


3726. J Epidemiol Community Health. 2021 Sep;75(9):836-842. doi: 
10.1136/jech-2020-215927. Epub 2021 Feb 25.

Incidence of psychological illness after coronavirus outbreak: a meta-analysis 
study.

Fan FC(#)(1), Zhang SY(#)(2), Cheng Y(3)(2).

Author information:
(1)Key Laboratory of Ethnomedicine of Ministry of Education, Center on 
Translational Neuroscience, School of Pharmacy, Minzu University of China, 
Beijing, China.
(2)College of Life and Environmental Sciences, Minzu University of China, 
Beijing, China.
(3)Key Laboratory of Ethnomedicine of Ministry of Education, Center on 
Translational Neuroscience, School of Pharmacy, Minzu University of China, 
Beijing, China yongcheng@muc.edu.cn.
(#)Contributed equally

BACKGROUND: The COVID-19 has had an enormous impact worldwide and is still 
spreading. Globally confirmed infections have surpassed 41.1 million, of which 
more than 1 million resulted in deaths. Considering the relationship between 
public health disasters and emotional disorders, it is essential to examine 
psychological well-being related to this pandemic.
METHOD: We performed a systematic search on psychological problems from PubMed 
to 10 October 2020, and conducted a meta-analysis using Comprehensive 
Meta-Analysis V.3 software.
RESULTS: The results showed a 19.4% and 26.8% pooled incidence for depression 
and post-traumatic stress disorder (PTSD), respectively, during the SARS and 
Middle East Respiratory Syndrome (MERS)-related coronavirus outbreaks. However, 
overall prevalence of depression was somewhat higher at 27.0% during the 
COVID-19 period. The pooled incidence of PTSD during COVID-19 compared with SARS 
and MERS outbreaks, was lower, at 16.4%.
CONCLUSION: The results suggest that there are shared and distinct psychological 
responses following SARS, MERS and COVID-19, and show pessimistic estimates of a 
wide range of potentially upcoming psychological problems.

© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and 
permissions. Published by BMJ.

DOI: 10.1136/jech-2020-215927
PMCID: PMC7908057
PMID: 33632722 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3727. Geriatr Nurs. 2021 Mar-Apr;42(2):605-607. doi: 10.1016/j.gerinurse.2021.02.005. 
Epub 2021 Feb 16.

Opportunities for the advanced practice nurse in improving the wellbeing of 
older adults during the COVID-19 pandemic.

Parish AL(1).

Author information:
(1)Director of Education Innovation and Associate Professor at Vanderbilt 
University, School of Nursing, Nashville, TN, United States. Electronic address: 
abby.parish@vanderbilt.edu.

The prevalence of stress, anxiety, and depression have increased during the 
coronavirus disease (COVID-19) pandemic across age groups. Older adults may 
additionally be experiencing accelerated cognitive decline and increased 
behavioral and psychological symptoms of dementia related to the pandemic and 
associated isolation precautions. The advanced practice nurse has an opportunity 
to holistically intervene to mitigate the negative effects of isolation and 
promote older adults' wellbeing during challenging times.

Copyright © 2021 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.gerinurse.2021.02.005
PMCID: PMC8021454
PMID: 33632614 [Indexed for MEDLINE]


3728. Aust Crit Care. 2021 Mar;34(2):146-154. doi: 10.1016/j.aucc.2020.12.004. Epub 
2020 Dec 26.

Impact of the coronavirus disease 2019 pandemic on critical care healthcare 
workers' depression, anxiety, and stress levels.

Hammond NE(1), Crowe L(2), Abbenbroek B(3), Elliott R(4), Tian DH(5), Donaldson 
LH(6), Fitzgerald E(6), Flower O(4), Grattan S(3), Harris R(4), Sayers L(4), 
Delaney A(6).

Author information:
(1)Critical Care Division, The George Institute for Global Health, Faculty of 
Medicine, UNSW Sydney, Sydney, Australia; Malcolm Fisher Department of Intensive 
Care, Royal North Shore Hospital, Sydney, Australia. Electronic address: 
nhammond@georgeinstitute.org.au.
(2)The University of Queensland, Australia; Queensland Children's Hospital, 
Brisbane, Australia.
(3)Critical Care Division, The George Institute for Global Health, Faculty of 
Medicine, UNSW Sydney, Sydney, Australia.
(4)Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, 
Sydney, Australia.
(5)Critical Care Division, The George Institute for Global Health, Faculty of 
Medicine, UNSW Sydney, Sydney, Australia; Department of Anaesthesia and 
Perioperative Medicine, Westmead Hospital, Sydney, Australia.
(6)Critical Care Division, The George Institute for Global Health, Faculty of 
Medicine, UNSW Sydney, Sydney, Australia; Malcolm Fisher Department of Intensive 
Care, Royal North Shore Hospital, Sydney, Australia.

AIM: The aim of the study was to determine levels of depression, anxiety, and 
stress symptoms and factors associated with psychological burden amongst 
critical care healthcare workers in the early stages of the coronavirus disease 
2019 pandemic.
METHODS: An anonymous Web-based survey distributed in April 2020. All healthcare 
workers employed in a critical care setting were eligible to participate. 
Invitations to the survey were distributed through Australian and New Zealand 
critical care societies and social media platforms. The primary outcome was the 
proportion of healthcare workers who reported moderate to extremely severe 
scores on the Depression, Anxiety, and Stress Scale-21 (DASS-21).
RESULTS: Of the 3770 complete responses, 3039 (80.6%) were from Australia. A 
total of 2871 respondents (76.2%) were women; the median age was 41 years. 
Nurses made up 2269 (60.2%) of respondents, with most (2029 [53.8%]) working in 
intensive care units. Overall, 813 (21.6%) respondents reported moderate to 
extremely severe depression, 1078 (28.6%) reported moderate to extremely severe 
anxiety, and 1057 (28.0%) reported moderate to extremely severe stress scores. 
Mean ± standard deviation values of DASS-21 depression, anxiety, and stress 
scores amongst woman vs men was as follows: 8.0 ± 8.2 vs 7.1 ± 8.2 (p = 0.003), 
7.2 ± 7.5 vs 5.0 ± 6.7 (p < 0.001), and 14.4 ± 9.6 vs 12.5 ± 9.4 (p < 0.001), 
respectively. After adjusting for significant confounders, clinical concerns 
associated with higher DASS-21 scores included not being clinically prepared (β 
= 4.2, p < 0.001), an inadequate workforce (β = 2.4, p = 0.001), having to 
triage patients owing to lack of beds and/or equipment (β = 2.6, p = 0.001), 
virus transmission to friends and family (β = 2.1, p = 0.009), contracting 
coronavirus disease 2019 (β = 2.8, p = 0.011), being responsible for other staff 
members (β = 3.1, p < 0.001), and being asked to work in an area that was not in 
the respondents' expertise (β = 5.7, p < 0.001).
CONCLUSION: In this survey of critical care healthcare workers, between 22 and 
29% of respondents reported moderate to extremely severe depression, anxiety, 
and stress symptoms, with women reporting higher scores than men. Although 
female gender appears to play a role, modifiable factors also contribute to 
psychological burden and should be studied further.

Copyright © 2020 Australian College of Critical Care Nurses Ltd. Published by 
Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.aucc.2020.12.004
PMCID: PMC7762707
PMID: 33632606 [Indexed for MEDLINE]


3729. J Am Acad Child Adolesc Psychiatry. 2021 Jun;60(6):675-677. doi: 
10.1016/j.jaac.2021.02.007. Epub 2021 Feb 22.

The Parents Are Not Alright: A Call for Caregiver Mental Health Screening During 
the COVID-19 Pandemic.

Peris TS(1), Ehrenreich-May J(2).

Author information:
(1)University of California, Los Angeles. Electronic address: 
tperis@mednet.ucla.edu.
(2)University of Miami, Florida.

Nearly a year into the COVID-19 pandemic, conversations about the impact of 
COVID-19 on children and families have shifted. Initial advice for parents 
stressed topics such as how to talk about the pandemic with children or cope 
with illness-related distress. They now focus on youth adjustment to a heavily 
disrupted school year and on strategies for building long-term resilience. 
Although these conversations often center on youth adjustment, they have-at 
last-started to consider the well-being of parents (and other caregivers) as 
well. This shift in focus is crucial given the enormous challenges that parents 
face right now and the direct links between their well-being and that of their 
children. What continues to lag, even well into the pandemic, however, is the 
provision of workable solutions for addressing parents' mental health. While we 
applaud the renewed focus on parenting stress and well-being, we remain deeply 
concerned by the absence of a plan for intervening.

Copyright © 2021 American Academy of Child and Adolescent Psychiatry. Published 
by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jaac.2021.02.007
PMCID: PMC8926163
PMID: 33631311 [Indexed for MEDLINE]


3730. Int Arch Occup Environ Health. 2021 Oct;94(7):1721-1737. doi: 
10.1007/s00420-021-01670-6. Epub 2021 Feb 25.

A model for occupational stress amongst paediatric and adult critical care staff 
during COVID-19 pandemic.

Feeley T(1), Ffrench-O'Carroll R(2), Tan MH(3), Magner C(4), L'Estrange K(3), 
O'Rathallaigh E(5), Whelan S(6), Lyons B(2), O'Connor E(5).

Author information:
(1)Anaesthesia Department, National Women's Health, Auckland City Hospital, 
Level 9, 2 Park Road, Grafton, Auckland, 1023, New Zealand. 
tfeeley@adhb.govt.nz.
(2)Department of Anaesthesia and Intensive Care, Children's Health Ireland at 
Crumlin, Dublin, Ireland.
(3)Paediatric Intensive Care Department, Children's Health Ireland at Crumlin, 
Dublin, Ireland.
(4)Midwifery and Health Systems, University College Dublin School of Nursing, 
Dublin, Ireland.
(5)Department of Anaesthesia and Intensive Care, St James's Hospital, Dublin, 
Ireland.
(6)Department of Anaesthesia and Intensive Care, Children's Health Ireland at 
Temple Street Dublin, Dublin, Ireland.

PURPOSE: The coronavirus 2019 pandemic has placed all intensive care unit (ICU) 
staff at increased risk of psychological distress. To date, measurement of this 
distress has largely been by means of validated assessment tools. We believe 
that qualitative data may provide a richer view of staff experiences during this 
pandemic.
METHODS: We conducted a cross-sectional, observational study using online and 
written questionnaires to all ICU staff which consisted of validated tools to 
measure psychological distress (quantitative findings) and open-ended questions 
with free-text boxes (qualitative findings). Here, we report our qualitative 
findings. We asked four questions to explore causes of stress, need for supports 
and barriers to accessing supports. A conventional content analysis was 
undertaken.
RESULTS: In total, 269 of the 408 respondents (65.9%) gave at least one response 
to a free-text question. Seven overarching themes were found, which contribute 
to our proposed model for occupational stress amongst critical care staff. The 
work environment played an important role in influencing the perceived 
psychological impact on healthcare workers. Extra-organisational factors, which 
we termed the "home-work interface" and uncertainty about the future, manifested 
as anticipatory anxiety, had a proportionally larger influence on worker 
well-being than would be expected in non-pandemic conditions.
CONCLUSION: Our findings have important implications for appropriate allocation 
of resources and ensuring well-being of the ICU multidisciplinary team for this 
and future pandemics.

© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part 
of Springer Nature.

DOI: 10.1007/s00420-021-01670-6
PMCID: PMC7905984
PMID: 33630134 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
declare that are relevant to the content of this article.


3731. BMJ Open. 2021 Feb 24;11(2):e044945. doi: 10.1136/bmjopen-2020-044945.

To burn-out or not to burn-out: a cross-sectional study in healthcare 
professionals in Spain during COVID-19 pandemic.

Torrente M(1), Sousa PA(2), Sánchez-Ramos A(3), Pimentao J(2), Royuela A(4), 
Franco F(5), Collazo-Lorduy A(5), Menasalvas E(6), Provencio M(5).

Author information:
(1)Medical Oncology, Hospital Universitario Puerta de Hierro Majadahonda, 
Madrid, Spain maria.torrente@salud.madrid.org.
(2)Department of Electrical Engineering, Faculty of Science and Technology, 
Universidade Nova de Lisboa, Lisbon, Portugal.
(3)General and Digestive Surgery, Hospital Universitario Puerta de Hierro 
Majadahonda, Madrid, Spain.
(4)Clinical Biostatistics Unit, Health Research Institute Puerta de 
Hierro-Segovia de Arana; CIBERESP, Madrid, Spain.
(5)Medical Oncology, Hospital Universitario Puerta de Hierro Majadahonda, 
Madrid, Spain.
(6)Center of Biomedical Technology, Politécnica University of Madrid, Madrid, 
Spain.

OBJECTIVE: To assess the prevalence of burn-out syndrome in healthcare workers 
working on the front line (FL) in Spain during COVID-19.
DESIGN: Cross-sectional, online survey-based study.
SETTINGS: Sampling was performed between 21st April and 3rd May 2020. The survey 
collected demographic data and questions regarding participants' working 
position since pandemic outbreak.
PARTICIPANTS: Spanish healthcare workers working on the FL or usual ward were 
eligible. A total of 674 healthcare professionals answered the survey.
MAIN OUTCOMES AND MEASURES: Burn-out syndrome was assessed by the Maslach 
Burnout Inventory-Medical Personnel.
RESULTS: Of the 643 eligible responding participants, 408 (63.5%) were 
physicians, 172 (26.8%) were nurses and 63 (9.8%) other technical occupations. 
377 (58.6%) worked on the FL. Most participants were women (472 (73.4%)), aged 
31-40 years (163 (25.3%)) and worked in tertiary hospitals (>600 beds) (260 
(40.4%)). Prevalence of burn-out syndrome was 43.4% (95% CI 39.5% to 47.2%), 
higher in COVID-19 FL workers (49.6%, p<0.001) than in non- COVID-19 FL workers 
(34.6%, p<0.001). Women felt more burn-out (60.8%, p=0.016), were more afraid of 
self-infection (61.9%, p=0.021) and of their performance and quality of care 
provided to the patients (75.8%, p=0.015) than men. More burn-out were those 
between 20 and 30 years old (65.2%, p=0.026) and those with more than 15 years 
of experience (53.7%, p=0.035).Multivariable logistic regression analysis 
revealed that, working on COVID-19 FL (OR 1.93; 95% CI 1.37 to 2.71, p<0.001), 
being a woman (OR 1.56; 95% CI 1.06 to 2.29, p=0.022), being under 30 years old 
(OR 1.75; 95% CI 1.06 to 2.89, p=0.028) and being a physician (OR 1.64; 95% CI 
1.11 to 2.41, p=0.011) were associated with high risk of burn-out syndrome.
CONCLUSIONS: This survey study of healthcare professionals reported high rates 
of burn-out syndrome. Interventions to promote mental well-being in healthcare 
workers exposed to COVID-19 need to be immediately implemented.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2020-044945
PMCID: PMC7907836
PMID: 33627353 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3732. J Geriatr Psychiatry Neurol. 2022 May;35(3):344-352. doi: 
10.1177/0891988721996816. Epub 2021 Feb 25.

Emotional and Mental Wellbeing Following COVID-19 Public Health Measures on 
People Living With Dementia and Carers.

Hanna K(1)(2), Giebel C(1)(3)(2), Tetlow H(4), Ward K(5), Shenton J(6), Cannon 
J(7)(8), Komuravelli A(9), Gaughan A(10), Eley R(11), Rogers C(12), Rajagopal 
M(13), Limbert S(3), Callaghan S(14), Whittington R(15), Butchard S(1)(3), Shaw 
L(16), Gabbay M(1)(3).

Author information:
(1)Department of Primary Care & Mental Health, 4591University of Liverpool, 
Liverpool, UK.
(2)Kerry Hanna and Clarissa Giebel are joint first authors.
(3)NIHR ARC NWC, Liverpool, UK.
(4)SURF Liverpool, Liverpool, UK.
(5)130122The Brain Charity, Liverpool, UK.
(6)Sefton Older People's Forum, Liverpool, UK.
(7)Wigan Dementia Action Alliance, Liverpool, UK.
(8)Lewy Body Society, Liverpool, UK.
(9)8255North West Boroughs NHS Trust, Warrington, UK.
(10)Together In Dementia Everyday (TIDE), Liverpool, UK.
(11)Liverpool Dementia Action Alliance, Liverpool, UK.
(12)71283National Museums Liverpool, Liverpool, UK.
(13)Lancashire and South Cumbria NHS Trust, Liverpool, UK.
(14)EQE Health, Liverpool, UK.
(15)Me2U Day Care Centre, Liverpool, UK.
(16)Department of Modern Languages and Cultures, 4591University of Liverpool, 
Liverpool, UK.

BACKGROUND: To date, there appears to be no evidence on the longer-term impacts 
caused by COVID-19 and its related public health restrictions on some of the 
most vulnerable in our societies. The aim of this research was to explore the 
change in impact of COVID-19 public health measures on the mental wellbeing of 
people living with dementia (PLWD) and unpaid carers.
METHOD: Semi-structured, follow-up telephone interviews were conducted with PLWD 
and unpaid carers between June and July 2020. Participants were asked about 
their experiences of accessing social support services during the pandemic, and 
the impact of restrictions on their daily lives.
RESULTS: 20 interviews were conducted and thematically analyzed, which produced 
3 primary themes concerning emotional responses and impact to mental health and 
wellbeing during the course of the pandemic: 1) Impact on mental health during 
lockdown, 2) Changes to mental health following easing of public health, and 3) 
The long-term effect of public health measures.
CONCLUSIONS: The findings from this research shed light on the longer-term 
psychological impacts of the UK Government's public health measures on PLWD and 
their carers. The loss of social support services was key in impacting this 
cohort mentally and emotionally, displaying a need for better psychological 
support, for both carers and PLWD.

DOI: 10.1177/0891988721996816
PMCID: PMC8996307
PMID: 33626977 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


3733. Z Gerontol Geriatr. 2021 Mar;54(2):141-145. doi: 10.1007/s00391-021-01859-x. 
Epub 2021 Feb 23.

[Psychosocial effects of the pandemic on staff and residents of nursing homes as 
well as their relatives-A systematic review].

[Article in German; Abstract available in German from the publisher]

Benzinger P(1)(2), Kuru S(3), Keilhauer A(3), Hoch J(3), Prestel P(4), Bauer 
JM(3), Wahl HW(5).

Author information:
(1)Institut für Gesundheit und Generationen, Hochschule für angewandte 
Wissenschaften Kempten, Bahnhofstraße 61, 87435, Kempten, Deutschland. 
Petra.benzinger@bethanien-heidelberg.de.
(2)Geriatrisches Zentrum der Universität Heidelberg, AGAPLESION Bethanien 
Krankenhaus Heidelberg, Rohrbacher Str. 149, 69126, Heidelberg, Deutschland. 
Petra.benzinger@bethanien-heidelberg.de.
(3)Geriatrisches Zentrum der Universität Heidelberg, AGAPLESION Bethanien 
Krankenhaus Heidelberg, Rohrbacher Str. 149, 69126, Heidelberg, Deutschland.
(4)Institut für Gesundheit und Generationen, Hochschule für angewandte 
Wissenschaften Kempten, Bahnhofstraße 61, 87435, Kempten, Deutschland.
(5)Netzwerk Alternsforschung (NAR), Universität Heidelberg, Bergheimer Str. 20, 
69115, Heidelberg, Deutschland.

BACKGROUND: Following the COVID-19 pandemic residents of nursing homes, their 
visitors and families as well as employees are faced with new challenges. 
Protective measures have a strong impact on the well-being of all these groups 
of persons.
MATERIAL AND METHODS: A systematic search was carried out for studies 
investigating the psychosocial consequences of the COVID-19 pandemic for 
residents, their visitors and families as well as nursing home staff. Results 
were analyzed by narrative synthesis.
RESULTS: A total of 756 studies were screened and 15 studies were included. 
These studies were conducted between February and June 2020 with participants 
from 14 countries. Participants reported loneliness, grief and depressive 
symptoms among residents. Some gave an account of fear as a reaction of 
residents to social distancing. Residents with cognitive impairment suffered 
more although there are conflicting reports. The well-being of visitors and 
friends was compromised and their feeling of loneliness increased. Nursing home 
personnel reported fear of getting infected and of infecting residents or their 
own families. Infected workers in the USA expressed anger about a lack of 
protection. Furthermore, an increase in workload was reported.
CONCLUSION: Studies conducted during the first months of the pandemic reported 
negative consequences for the psychosocial well-being of residents, their 
visitors and nursing home staff. Individual needs for future support of these 
groups are distinct and need further evaluation during the on-going pandemic.

Publisher: ZUSAMMENFASSUNG: HINTERGRUND: Die COVID-19-Pandemie stellt Bewohner 
von Altenpflegeeinrichtungen, deren Angehörige bzw. Besucher ebenso wie 
Mitarbeitende vor große Herausforderungen. Viruseindämmende Maßnahmen wirken 
sich stark auf das Wohlbefinden der betroffenen Personengruppen aus.
MATERIAL UND METHODE: Systematische Literatursuche nach Studien zu 
psychosozialen Folgen der Pandemie für Bewohner, deren Angehörige bzw. Besucher 
sowie Mitarbeitende und Zusammenführung der Ergebnisse mittels narrativer 
Synthese.
ERGEBNISSE: Es wurden 756 Studien gesichtet, davon 15 Arbeiten eingeschlossen. 
Die Daten wurden zwischen Februar und Juni 2020 mit Teilnehmenden aus 14 Ländern 
erhoben. Es wurden v. a. Einsamkeit, Trauer und Depressivität, aber auch Angst, 
als häufige Reaktionen der Bewohner auf die Kontakt- und Besuchsrestriktionen 
berichtet. Bewohner mit kognitiven Einschränkungen litten stärker unter den 
Auswirkungen, auch wenn es gegenteilige Hinweise gibt. Angehörige bzw. Besucher 
berichteten ebenfalls von einer Zunahme ihrer Einsamkeit und einer reduzierten 
Lebensqualität. In den Befragungen der Mitarbeitenden schildern diese Angst vor 
einer Infektion sowohl bei sich als auch bei den Bewohnern. Infizierte 
Mitarbeitende in den USA äußerten Wut darüber, nicht ausreichend geschützt 
worden zu sein. Darüber hinaus berichteten Mitarbeitende von einer erheblichen 
Mehrbelastung.
SCHLUSSFOLGERUNG: Infolge der Pandemie und der ergriffenen Maßnahmen wurden 
negative psychosozialen Folgen bei Bewohnern, deren Angehörigen bzw. Besuchern 
und den Mitarbeitenden berichtet. Die abzuleitenden Unterstützungsbedarfe der 3 
Personengruppen sind unterschiedlich und sollten bei zukünftigen Maßnahmen 
hinsichtlich der Pandemie stärker mitevaluiert werden.

DOI: 10.1007/s00391-021-01859-x
PMCID: PMC7901511
PMID: 33624143 [Indexed for MEDLINE]


3734. Pan Afr Med J. 2020 Jun 25;35(Suppl 2):92. doi: 
10.11604/pamj.supp.2020.35.2.24345. eCollection 2020.

Assessment of burnout among primary teachers in confinement during the COVID-19 
period in Morocco: case of the Kenitra.

Amri A(1), Abidli Z(1), Elhamzaoui M(2), Bouzaboul M(1)(2), Rabea Z(1), Ahami 
AOT(1).

Author information:
(1)Cognitive Behavioral Neuroscience and Applied Nutrition Team, Laboratory 
Nutrition-Health and Environment, Department of Biology, Faculty of Sciences, 
University IBN TOFAIL, Kenitra, Morocco.
(2)Ministry of National Education, Professional Training, Higher Education and 
Scientific Research, Kenitra, Morocco.

INTRODUCTION: Confinement, because of the COVID-19 pandemic, could have problems 
on the mental health of the population. Teachers responsible for giving distance 
courses during this period could be psychologically stressed. The aim is to 
assess the magnitude results of burnout and associated factors among primary 
school teachers in Kenitra in Morocco during this confinement period.
METHODS: This is a cross-sectional study, which was conducted during the two 
months of April and May 2020. Burnout was evaluated by the Maslach Burnout 
Inventory MBI with 16 items, specific to the context of Moroccan teachers and 
the factors of stress were assessed using a questionnaire developed by the 
research team. We used the Chi-square test to determine the association between 
two qualitative variables anda logistic regression for an overall statistical 
analysis.
RESULTS: The average age was 38.6 ± 9.9 years. The MBI revealed that 68 teachers 
(54%) were victims of burnout, of which 47 (38%) had a low level; 15 (12%) had a 
moderate level and six (5%) had a severe burnout. Logistic regression analysis 
has shown that the risk factors for burnout during this confinement period are: 
the use and development of skills in new information and communication 
technologies (p<0,05); work/family conflict (p<0,05); social support (p<0,05); 
and the workload related to distance education (p≤0,05).
CONCLUSION: In light of these results, interventions aimed at promoting mental 
well-being teachers during and after confinement should be implemented 
immediately.

© Abdeslam Amri et al.

DOI: 10.11604/pamj.supp.2020.35.2.24345
PMCID: PMC7875804
PMID: 33623616 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


3735. Psychiatr Serv. 2021 Oct 1;72(10):1193-1198. doi: 10.1176/appi.ps.202000725. 
Epub 2021 Feb 24.

COVID-19, Structural Racism, and Mental Health Inequities: Policy Implications 
for an Emerging Syndemic.

Shim RS(1), Starks SM(1).

Author information:
(1)Department of Psychiatry and Behavioral Sciences, University of California, 
Davis, Sacramento (Shim); Department of Clinical Sciences, University of Houston 
College of Medicine, Houston (Starks).

The complex interactions between the 2019 coronavirus disease (COVID-19) 
pandemic, structural racism, and mental health inequities have led to 
devastating health, economic, and social consequences. The intersection of these 
three conditions, which meets criteria for a syndemic (synergistic epidemics), 
presents numerous policy challenges-and opportunities. Addressing these issues 
in a unified manner, using a syndemic theory approach, can lead to significant 
progress and effective solutions for otherwise intransigent problems in society. 
This article proposes steps that can be taken to protect "essential workers" and 
other "vulnerable" populations; engage and empower communities; optimize 
community-led crisis response interventions; improve data collection about the 
intersection of COVID-19, structural racism, and mental health inequities; 
support school-based interventions; expand financial supports for mental health 
service delivery; expand health care insurance coverage to increase access and 
lower out-of-pocket costs; and promote workforce diversity. Emphasis on local, 
state, and federal policy interventions that prioritize equity and justice and 
focus on collective health and well-being will ultimately lead us on a more 
sustainable and equitable path.

DOI: 10.1176/appi.ps.202000725
PMID: 33622042 [Indexed for MEDLINE]


3736. Ann Am Thorac Soc. 2021 May;18(5):757-768. doi: 10.1513/AnnalsATS.202006-696FR.

Excessive Daytime Sleepiness in Obstructive Sleep Apnea. Mechanisms and Clinical 
Management.

Lal C(1), Weaver TE(2), Bae CJ(3), Strohl KP(4).

Author information:
(1)Medical University of South Carolina, Charleston, South Carolina.
(2)College of Nursing, University of Illinois at Chicago, Chicago, Illinois.
(3)Penn Sleep Center, University of Pennsylvania, Philadelphia, Pennsylvania; 
and.
(4)Case Western Reserve University, Cleveland, Ohio.

Many patients with obstructive sleep apnea (OSA) experience excessive daytime 
sleepiness (EDS), which can negatively affect daily functioning, cognition, 
mood, and other aspects of well-being. Although EDS can be reduced with primary 
OSA treatment, such as continuous positive airway pressure (CPAP) therapy, a 
significant proportion of patients continue to experience EDS despite receiving 
optimized therapy for OSA. This article reviews the pathophysiology and clinical 
evaluation and management of EDS in patients with OSA. The mechanisms underlying 
EDS in CPAP-treated patients remain unclear. Experimental risk factors include 
chronic intermittent hypoxia and sleep fragmentation, which lead to oxidative 
injury and changes in neurons and brain circuit connectedness involving 
noradrenergic and dopaminergic neurotransmission in wake-promoting regions of 
the brain. In addition, neuroimaging studies have shown alterations in the 
brain's white matter and gray matter in patients with OSA and EDS. Clinical 
management of EDS begins with ruling out other potential causes of EDS and 
evaluating its severity. Tools to evaluate EDS include objective and 
self-reported assessments of sleepiness, as well as cognitive assessments. 
Patients who experience residual EDS despite primary OSA therapy may benefit 
from wake-promoting pharmacotherapy. Agents that inhibit reuptake of dopamine or 
of dopamine and norepinephrine (modafinil/armodafinil and solriamfetol, 
respectively) have demonstrated efficacy in reducing EDS and improving quality 
of life in patients with OSA. Additional research is needed on the effects of 
wake-promoting treatments on cognition in these patients and to identify 
individual or disorder-specific responses.

DOI: 10.1513/AnnalsATS.202006-696FR
PMCID: PMC8086534
PMID: 33621163 [Indexed for MEDLINE]


3737. Child Psychiatry Hum Dev. 2021 Apr;52(2):200-204. doi: 
10.1007/s10578-021-01140-7. Epub 2021 Feb 22.

COVID-19 threatens maternal mental health and infant development: possible paths 
from stress and isolation to adverse outcomes and a call for research and 
practice.

Venta A(1), Bick J(2), Bechelli J(3).

Author information:
(1)Department of Psychology, University of Houston, 4849 Calhoun Rd., Room 373, 
Houston, TX, 77204-6022, USA. aventa@uh.edu.
(2)Department of Psychology, University of Houston, 4849 Calhoun Rd., Room 373, 
Houston, TX, 77204-6022, USA.
(3)Department of Biological Sciences, Sam Houston State University, Huntsville, 
TX, USA.

The COVID-19 pandemic exposed mothers to stress and social isolation during the 
pre- and post-natal periods. The deleterious effects of stress on both pregnant 
women and their infants are well documented, with research suggesting that 
effects are exacerbated by reduced social support. In this brief report, we 
summarize evidence linking stress and social isolation to negative outcomes for 
mothers and infants and present a conceptual model featuring inflammation as a 
driving mechanism. There is strong evidence that the coronavirus pandemic will 
affect mothers and infants through immune pathways that, in previous research, 
have been shown to link stress and social isolation during the pre- and 
post-natal periods with deficits in maternal mental health and infant well-being 
and development across developmental stages. We close with recommendations for 
novel research, policy changes, and integrated clinical care that can address 
these biological threats to infants and mothers while leveraging the 
anti-inflammatory effects of social support.

DOI: 10.1007/s10578-021-01140-7
PMCID: PMC7899198
PMID: 33619672 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


3738. Ther Adv Infect Dis. 2021 Jan 25;8:2049936120981526. doi: 
10.1177/2049936120981526. eCollection 2021 Jan-Dec.

The role of faecal microbiota transplantation: looking beyond Clostridioides 
difficile infection.

D Goldenberg S(1), Merrick B(2).

Author information:
(1)Centre for Clinical Infection & Diagnostics Research, King's College London 
and Guy's & St. Thomas' NHS Foundation Trust, 5th floor, North Wing, St Thomas' 
hospital, Westminster Bridge Road, London, SE1 7EH, UK.
(2)Centre for Clinical Infection & Diagnostics Research, King's College London 
and Guy's & St. Thomas' NHS Foundation Trust, London, UK.

Faecal microbiota transplantation (FMT) is the transfer of screened and 
minimally processed faecal material from a 'healthy' donor to 'diseased' 
recipient. It has an established role, and is recommended as a therapeutic 
strategy, in the management of recurrent Clostridioides difficile infection 
(CDI). Recognition that gut dysbiosis is associated with, and may contribute to, 
numerous disease states has led to interest in exploiting FMT to 'correct' this 
microbial imbalance. Conditions for which it is proposed to be beneficial 
include inflammatory bowel disease, irritable bowel syndrome, liver disease and 
hepatic encephalopathy, neuropsychiatric conditions such as depression and 
anxiety, systemic inflammatory states like sepsis, and even coronavirus disease 
2019. To understand what role, if any, FMT may play in the management of these 
conditions, it is important to consider the potential risks and benefits of the 
therapy. Regardless, there are several barriers to its more widespread adoption, 
which include incompletely understood mechanism of action (especially outside of 
CDI), inability to standardise treatment, disagreement on its active ingredients 
and how it should be regulated, and lack of long-term outcome and safety data. 
Whilst the transfer of faecal material from one individual to another to treat 
ailments or improve health has a history dating back thousands of years, there 
are fewer than 10 randomised controlled trials supporting its use. Moving 
forward, it will be imperative to gather as much data from FMT donors and 
recipients over as long a timeframe as possible, and for trials to be conducted 
with rigorous methodology, including appropriate control groups, in order to 
best understand the utility of FMT for indications beyond CDI. This review 
discusses the history of FMT, its appreciable mechanisms of action with 
reference to CDI, indications for FMT with an emerging evidence base above and 
beyond CDI, and future perspectives on the field.

© The Author(s), 2021.

DOI: 10.1177/2049936120981526
PMCID: PMC7841662
PMID: 33614028

Conflict of interest statement: Conflict of interest statement: Simon Goldenberg 
reports consulting fees from Astellas, Enterobiotix, MSD, Pfizer, and Shionogi.


3739. Int J Soc Psychiatry. 2022 Feb;68(1):216-222. doi: 10.1177/0020764020988878. 
Epub 2021 Feb 21.

The psychological effects of COVID-19 spread in young Canadian adults.

Gill PK(1), Du C(1), Khan F(1), Karimi N(1), Sabharwal K(1), Agarwal M(1).

Author information:
(1)Independent Researchers, Toronto, ON, Canada.

BACKGROUND AND AIM: The novel coronavirus disease 2019 (COVID-19) not only 
threatens physical health but also psychological well-being. As a result of the 
pandemic, increased mental health burdens have been recorded in young adults 
around the world. We sought to understand the association of stressors related 
to the COVID-19 pandemic with symptoms of psychological and emotional distress 
in young Canadian adults.
METHOD: Questionnaire respondents were asked about the extent to which they were 
personally impacted by COVID-19, and symptoms related to depression, anxiety, 
post-traumatic disorder, and emotional distress.
RESULTS: Of 84 respondents, most identified as female (74%; 62/84). Overall, 61% 
(51/84) reported experiencing symptoms of psychological distress related to 
depression, anxiety, or post-traumatic stress disorder (PTSD); specifically, 43% 
(36/84) reported anxiety-related symptoms, 33% (28/84) reported 
depression-related symptoms, and 6% (5/84) reported PTSD-related symptoms. 
Individuals with family in settings high risk for COVID-19 infection and 
individuals who received government aid with a reduction in income were 
4.30-fold and 2.80-fold more likely, respectively, to experience symptoms of 
psychological distress (95% CI 1.31-14.14; p = .013 and 95% CI 1.08-7.25; 
p = .038, respectively). Visits to social media daily to hourly for COVID-19 
related news resulted in a 3.24-fold increase in the likelihood of experiencing 
depression-related symptoms (95% CI 1.26-8.35; p = .020).
CONCLUSION: We demonstrate a necessity to focus on alleviating the mental health 
burdens and contributing stressors within young Canadian adults. Though the 
mental health burdens are currently exacerbated by the effects of the COVID-19 
pandemic, they may persist after the pandemic ends if left unaddressed.

DOI: 10.1177/0020764020988878
PMID: 33611957 [Indexed for MEDLINE]


3740. J Affect Disord. 2021 Apr 15;285:1-9. doi: 10.1016/j.jad.2021.02.033. Epub 2021 
Feb 15.

Examining temporal interactions between loneliness and depressive symptoms and 
the mediating role of emotion regulation difficulties among UK residents during 
the COVID-19 lockdown: Longitudinal results from the COVID-19 psychological 
wellbeing study.

Groarke JM(1), McGlinchey E(2), McKenna-Plumley PE(3), Berry E(3), 
Graham-Wisener L(3), Armour C(4).

Author information:
(1)Centre for Improving Health-Related Quality of Life, School of Psychology, 
Queen's University Belfast, UK. Electronic address: j.groarke@qub.ac.uk.
(2)Stress Trauma and Related Conditions (STARC) Research Lab, School of 
Psychology, Queen's University Belfast, UK.
(3)Centre for Improving Health-Related Quality of Life, School of Psychology, 
Queen's University Belfast, UK.
(4)Centre for Improving Health-Related Quality of Life, School of Psychology, 
Queen's University Belfast, UK; Stress Trauma and Related Conditions (STARC) 
Research Lab, School of Psychology, Queen's University Belfast, UK.

BACKGROUND: Longitudinal studies examining the temporal association between 
mental health outcomes during the COVID-19 outbreak are needed. It is important 
to determine how relationships between key outcomes, specifically loneliness and 
depressive symptoms, manifest over a brief timeframe and in a pandemic context.
METHOD: Data was gathered over 4 months (March - June 2020) using an online 
survey with three repeated measures at monthly intervals (N = 1958; 69.8% 
females; Age 18-87 years, M = 37.01, SD = 12.81). Associations between 
loneliness, depression symptoms, and emotion regulation difficulty were tested 
using Pearson's product moment correlations, and descriptive statistics were 
calculated for all study variables. Cross-lagged structural equation modelling 
was used to examine the temporal relationships between variables.
RESULTS: The longitudinal association between loneliness and depressive symptoms 
was reciprocal. Loneliness predicted higher depressive symptoms one month later, 
and depressive symptoms predicted higher loneliness one month later. The 
relationship was not mediated by emotion regulation difficulties. Emotion 
regulation difficulties and depressive symptoms were also reciprocally related 
over time.
LIMITATIONS: Limitations include the reliance on self-report data and the 
non-representative sample. There was no pre-pandemic assessment limiting the 
conclusions that can be drawn regarding the mental health impact of the COVID-19 
crisis.
CONCLUSIONS: Loneliness should be considered an important feature of case 
conceptualisation for depression during this time. Clinical efforts to improve 
mental health during the pandemic could focus on interventions that target 
either loneliness, depression, or both. Potential approaches include increasing 
physical activity or low-intensity cognitive therapies delivered remotely.

Copyright © 2021 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2021.02.033
PMCID: PMC9755807
PMID: 33610876 [Indexed for MEDLINE]

Conflict of interest statement: All authors declare that they have no conflicts 
of interest.


3741. Appetite. 2021 Jul 1;162:105166. doi: 10.1016/j.appet.2021.105166. Epub 2021 Feb 
19.

The impact of COVID-19 pandemic on bariatric patients' self-management 
post-surgery.

Youssef A(1), Cassin SE(2), Wnuk S(3), Leung S(4), Jackson T(5), Sockalingam 
S(6).

Author information:
(1)Bariatric Surgery Program, University Health Network, Toronto, Ontario, 
Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of 
Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of 
Toronto, Toronto, Ontario, Canada.
(2)Bariatric Surgery Program, University Health Network, Toronto, Ontario, 
Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of 
Toronto, Toronto, Ontario, Canada; Department of Psychology, Ryerson University, 
Toronto, Ontario, Canada.
(3)Bariatric Surgery Program, University Health Network, Toronto, Ontario, 
Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of 
Toronto, Toronto, Ontario, Canada.
(4)Bariatric Surgery Program, University Health Network, Toronto, Ontario, 
Canada.
(5)Bariatric Surgery Program, University Health Network, Toronto, Ontario, 
Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
(6)Bariatric Surgery Program, University Health Network, Toronto, Ontario, 
Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of 
Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of 
Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health 
(CAMH), Toronto, Ontario, Canada. Electronic address: 
sanjeev.sockalingam@camh.ca.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has had far 
reaching consequences on the health and well-being of the general public. 
Evidence from previous pandemics suggest that bariatric patients may experience 
increased emotional distress and difficulty adhering to healthy lifestyle 
changes post-surgery.
OBJECTIVE: We aimed to examine the impact of the novel COVID-19 public health 
crisis on bariatric patients' self-management post-surgery.
METHOD: In a nested-qualitative study, semi-structured telephone interviews were 
conducted with 23 post-operative bariatric patients who had undergone Roux-en-Y 
gastric bypass (RYGB) at a Canadian Bariatric Surgery Program between 2014 and 
2020. A constant comparative approach was used to systematically analyze the 
data and identify the overarching themes.
RESULTS: Participants (n = 23) had a mean age of (48.82 ± 10.03) years and most 
were female (n = 19). The median time post-surgery was 2 years (range: 6 
months-7 years). Themes describing the impact of COVID-19 pandemic on patients' 
post-bariatric surgery self-management included: coping with COVID-19; 
vulnerability factors and physical isolation; resiliency factors during 
pandemic; and valuing access to support by virtual care. The need for patients 
to access post-operative bariatric care during COVID-19 differed based on gender 
and socioeconomic status.
CONCLUSION: This study showed that the COVID-19 pandemic has impacted patients' 
ability to self-manage obesity and their mental health in a variety of ways. 
These findings suggest that patients may experience unique psychological 
distress and challenges requiring personalized care strategies to improve 
obesity self-care and overall well-being.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.appet.2021.105166
PMCID: PMC7892317
PMID: 33610640 [Indexed for MEDLINE]

Conflict of interest statement: None to Declare.


3742. Res Dev Disabil. 2021 May;112:103890. doi: 10.1016/j.ridd.2021.103890. Epub 2021 
Feb 16.

Predictors of mental health among parents of children with cerebral palsy during 
the COVID-19 pandemic in Iran: A web-based cross-sectional study.

Farajzadeh A(1), Dehghanizadeh M(2), Maroufizadeh S(3), Amini M(4), Shamili 
A(5).

Author information:
(1)Rehabilitation Research Center, Department of Occupational Therapy, School of 
Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran. 
Electronic address: Ata.farajzadeh@gmail.com.
(2)Department of Physical Medicine and Rehabilitation, Shahid Sadoughi 
University of Medical Sciences, Yazd, Iran. Electronic address: 
Moslemdot@gmail.com.
(3)Department of Biostatistics, School of Nursing and Midwifery, Guilan 
University of Medical Sciences, Rasht, Iran. Electronic address: 
saman.maroufizadeh@gmail.com.
(4)Rehabilitation Research Center, Department of Occupational Therapy, School of 
Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran. 
Electronic address: malekamini8@gmail.com.
(5)Rehabilitation Research Center, Department of Occupational Therapy, School of 
Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran. 
Electronic address: shamili.a@iums.ac.ir.

BACKGROUND: Caring for children with cerebral palsy (CP) for many aspects of 
their lives may affect caregiver's psychological health. Emergence of COVID-19 
put added pressure on caregivers.
AIMS: The aim of this study was to investigate the psychological health of 
Iranian caregivers of children with CP and associated risks during a lockdown 
period.
METHODS: Using online snowball sampling, 160 caregivers of children with CP 
participated in this web-based cross-sectional study. The Hospital Anxiety and 
Depression Scale (HADS), Perceived Stress Scale (PSS-4), Caregiver Difficulties 
Scale (CDS), and a demographic questionnaire were administered. Hierarchical 
multiple linear regression analysis was applied to identify risk factors related 
to caregiver psychological health.
OUTCOMES AND RESULTS: Mental health problems were prevalent; (depression = 45.0% 
and anxiety = 40.6%). Significant correlations were found between CDS and 
HADS-Anxiety (r = 0.472, P < 0.001), HADS-depression (r = 0.513, P < 0.001), and 
perceived stress (PSS) related to COVID-19 (r = 0.425, P < 0.001). After 
controlling for demographic and clinical variables, burden (CDS) was found to 
significantly predict caregiver anxiety, depression and stress. Furthermore, 
several demographic characteristics (being married, low educational level and 
low income) were significantly related to high HADS Anxiety scores. For 
depression, only having a physical problem was significantly related to HADS 
among demographic variables. No significant correlations were found between 
PSS-4 and demographic variables.
CONCLUSIONS AND IMPLICATIONS: During COVID-19 outbreak, the mental health of 
caregivers of children with CP is affected by multiple factors such as burden of 
care and demographic characteristics. Due to the importance of well-being among 
caregivers of disabled children, a comprehensive plan including psychological 
consultation, remote education, or in-person handouts for the self-care or 
handling of the children and adequate distance support may enable better mental 
health for these caregivers.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.ridd.2021.103890
PMCID: PMC9758061
PMID: 33607484 [Indexed for MEDLINE]


3743. J Med Internet Res. 2021 Mar 1;23(3):e26559. doi: 10.2196/26559.

Exploring Usage of COVID Coach, a Public Mental Health App Designed for the 
COVID-19 Pandemic: Evaluation of Analytics Data.

Jaworski BK(#)(1), Taylor K(#)(1), Ramsey KM(#)(1), Heinz A(#)(1)(2), Steinmetz 
S(#)(1), Pagano I(#)(3), Moraja G(#)(4), Owen JE(#)(1).

Author information:
(1)National Center for PTSD, Dissemination & Training Division, US Department of 
Veterans Affairs, Menlo Park, CA, United States.
(2)School of Medicine, Stanford University, Stanford, CA, United States.
(3)University of Hawaii Cancer Center, Honolulu, HI, United States.
(4)Vertical Design, LLC, Berkeley, CA, United States.
(#)Contributed equally

BACKGROUND: The COVID-19 pandemic has significantly impacted mental health and 
well-being. Mobile mental health apps can be scalable and useful tools in 
large-scale disaster responses and are particularly promising for reaching 
vulnerable populations. COVID Coach is a free, evidence-informed mobile app 
designed specifically to provide tools and resources for addressing 
COVID-19-related stress.
OBJECTIVE: The purpose of this study was to characterize the overall usage of 
COVID Coach, explore retention and return usage, and assess whether the app was 
reaching individuals who may benefit from mental health resources.
METHODS: Anonymous usage data collected from COVID Coach between May 1, 2020, 
through October 31, 2020, were extracted and analyzed for this study. The sample 
included 49,287 unique user codes and 3,368,931 in-app events.
RESULTS: Usage of interactive tools for coping and stress management comprised 
the majority of key app events (n=325,691, 70.4%), and the majority of app users 
tried a tool for managing stress (n=28,009, 58.8%). COVID Coach was utilized for 
≤3 days by 80.9% (n=34,611) of the sample whose first day of app use occurred 
within the 6-month observation window. Usage of the key content in COVID Coach 
predicted returning to the app for a second day. Among those who tried at least 
one coping tool on their first day of app use, 57.2% (n=11,444) returned for a 
second visit; whereas only 46.3% (n=10,546) of those who did not try a tool 
returned (P<.001). Symptoms of anxiety, depression, and posttraumatic stress 
disorder (PTSD) were prevalent among app users. For example, among app users who 
completed an anxiety assessment on their first day of app use (n=4870, 11.4% of 
users), 55.1% (n=2680) reported levels of anxiety that were moderate to severe, 
and 29.9% (n=1455) of scores fell into the severe symptom range. On average, 
those with moderate levels of depression on their first day of app use returned 
to the app for a greater number of days (mean 3.72 days) than those with minimal 
symptoms (mean 3.08 days; t1=3.01, P=.003). Individuals with significant PTSD 
symptoms on their first day of app use utilized the app for a significantly 
greater number of days (mean 3.79 days) than those with fewer symptoms (mean 
3.13 days; t1=2.29, P=.02).
CONCLUSIONS: As the mental health impacts of the pandemic continue to be 
widespread and increasing, digital health resources, such as apps like COVID 
Coach, are a scalable way to provide evidence-informed tools and resources. 
Future research is needed to better understand for whom and under what 
conditions the app is most helpful and how to increase and sustain engagement.

©Beth K Jaworski, Katherine Taylor, Kelly M Ramsey, Adrienne Heinz, Sarah 
Steinmetz, Ian Pagano, Giovanni Moraja, Jason E Owen. Originally published in 
the Journal of Medical Internet Research (http://www.jmir.org), 01.03.2021.

DOI: 10.2196/26559
PMCID: PMC7924218
PMID: 33606656 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


3744. Kathmandu Univ Med J (KUMJ). 2020 COVID-19 SPECIAL ISSUE;18(70):113-114.

The Impact of COVID-19 on Women's Health in Nepal.

Poudel R (1), Dangal G (1), Caagbay D (2).

Author information:
(1)Kathmandu Model Hospital, Kathmandu, Nepal.
(2)The University of Sydney, Sydney, Australia.

COVID-19 has significantly impacted the world and Nepal is no exception. The 
pandemic has caused a reduction in health service delivery, especially for 
women's health conditions, resulting in an increase in challenges for an already 
vulnerable group. Maternity care, reproductive health services, preventive 
interventions, nutritional advice and mental health care are not being addressed 
and with an increase in domestic violence, the health and wellbeing of women in 
Nepal is precarious and needs to be addressed immediately.

PMID: 33605252 [Indexed for MEDLINE]


3745. Kathmandu Univ Med J (KUMJ). 2020 COVID-19 SPECIAL ISSUE;18(70):3-9.

Knowledge, Attitude and Practice Regarding COVID-19 and its Impact on Dentistry: 
A Cross-sectional Survey among Nepalese Dentists.

Khanal N (1), Singh AK (2).

Author information:
(1)Department of Dentistry and Oral Health, Bharatpur Samudayik Hospital, 
Bharatpur, Nepal.
(2)Department of Oral and Maxillofacial Surgery, College Of Medical 
Sciences-Teaching Hospital, Bharatpur, Nepal.

Background Coronavirus Disease, 2019 (COVID-19) is a highly infectious 
respiratory disease with high transmissibility. Dentists are at inherent risk 
because of aerosol generating procedures exposing dentists to the respiratory 
and oral secretions of the patients. Objective To assess the knowledge, 
awareness, and practice (KAP) of the Dentists to combat the pandemic which could 
help shape future guidelines and policies to be implemented in dental settings. 
Method This cross-sectional descriptive study included series of multiple-choice 
questions distributed online, assessing dentists' KAP towards COVID-19, its 
impact on dentistry and their psychological well-being. Statistical analysis was 
performed using SPSS (Statistical Package for Social Sciences) version 20 for 
mac Operating System (OS). Descriptive statistics was performed, and frequencies 
of responses were reported in proportion. Non-parametric tests of independence 
and Chi-square test were performed to see the association between the 
categorical variables. Result Around 84% of the respondents accurately answered 
mode of transmission, 68% inquired about the travel history while only 49% 
measured the body temperature. Also, only 42% were receiving salary. A 
statistically significant difference concerning impact and practice during the 
COVID-19 was observed between general practitioner and specialist working at 
different work places. Conclusion Majority of Dentists have good knowledge and 
awareness but there were certain pitfalls in attitude and practice level calling 
out for more efficient training programs, precise guidelines, and treatment 
protocols to put into practice. Also, the mental distress and the financial 
impact subjected upon dentist require to be further explored determining the 
association between their mental health during and post COVID-19 outbreak.

PMID: 33605231 [Indexed for MEDLINE]


3746. J Nurs Manag. 2021 Sep;29(6):1653-1659. doi: 10.1111/jonm.13285. Epub 2021 Mar 
1.

Nursing professionals' mental well-being and workplace impairment during the 
COVID-19 crisis: A Network analysis.

Tokac U(1), Razon S(2).

Author information:
(1)College of Nursing, University of Missouri St. Louis, St. Louis, MO, USA.
(2)College of Health, West Chester University, West Chester, PA, USA.

AIM: To investigate the effects of years of nursing experience and mental health 
on work impairment among nurses during the COVID-19 crisis.
BACKGROUND: During the COVID-19 crisis, nurses experience a greater 
psychological burden than other health care workers. Studies have not yet 
investigated the effects of years in nursing and mental health on potential work 
impairment during the COVID-19 crisis in nurses.
METHODS: A survey was administered to 83 nurses on active duty during the 
COVID-19 crisis. The graphical LASSO and the DAG helped estimate the 
associations between years of nursing experience, mental health and work 
impairment.
RESULTS: A moderate negative correlation emerged between years of nursing 
experience, avoidance and work impairment. A direct effect was observed between 
anxiety and work impairment. A moderate positive correlation emerged between 
anxiety, depression and work impairment. An indirect effect was observed between 
depression, burnout, insomnia, years of nursing experience and work impairment.
CONCLUSIONS: In the present sample, nurses' work impairment decreased with 
greater years of nursing experience and increased with higher anxiety, 
depression, burnout and avoidance levels.
IMPLICATIONS FOR NURSING MANAGEMENT: These findings can help design effective 
infectious disease management programmes for students and professionals in 
nursing to prevent breakdowns and avoid work impairment.

© 2021 John Wiley & Sons Ltd.

DOI: 10.1111/jonm.13285
PMCID: PMC8014287
PMID: 33604981 [Indexed for MEDLINE]

Conflict of interest statement: None of the authors have conflicts of interest 
to report.


3747. BMC Psychiatry. 2021 Feb 18;21(1):111. doi: 10.1186/s12888-021-03107-3.

Depressive symptoms among Peruvian adult residents amidst a National Lockdown 
during the COVID-19 pandemic.

Antiporta DA(1), Cutipé YL(2), Mendoza M(2), Celentano DD(3), Stuart EA(4), 
Bruni A(5).

Author information:
(1)Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 
Baltimore, MD, USA. dantiporta@jhu.edu.
(2)Mental Health Direction, Ministry of Health, Lima, Peru.
(3)Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 
Baltimore, MD, USA.
(4)Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 
Baltimore, MD, USA.
(5)Pan American Health Organization/World Health Organization, Lima, Peru.

BACKGROUND: Population health and well-being in Latin America, the current 
epicenter of the COVID-19 pandemic, has been severely affected during the past 
semester. Despite the growing evidence about the link between the pandemic, its 
control measures, and mental health worldwide, there is still no regional 
evidence of the potential mental health impact. We describe the prevalence and 
distribution of depressive symptoms across demographic and socioeconomic risk 
factors in the Peruvian population amidst a national lockdown during the 
COVID-19 pandemic.
METHODS: Cross-sectional study conducted during the community transmission phase 
and national lockdown in Peru (May 4th-16th, 2020). We recorded 64,493 responses 
from adult Peruvian residents through an opt-in online questionnaire. All 
analyses were weighted using raking based on proportions of sociodemographic 
variables from the last Peruvian census in 2017. The prevalence of depressive 
symptoms was calculated using the Patient Health Questionnaire (PHQ-9) score of 
10 or more. We identified associated demographic and socioeconomic factors by 
prior mental health diagnosis. Sensitivity analysis considered an alternative 
cut-off point for depressive symptoms of PHQ-9 ≥ 14.
RESULTS: A total of 57,446 participants were included in the analytical sample. 
A third of the participants (n = 23,526, unweighted) showed depressive symptoms 
in the 2 weeks prior to the study. Participants who reported a previous mental 
health diagnosis doubled the sample prevalence of depressive symptoms (59, 95%CI 
56.7, 61.4%) of those without a prior diagnosis. Psychosocial and functioning 
reactions were largely more prevalent among females and young adults. A 
dose-response relationship was found between household income and depressive 
symptoms across previous mental health diagnosis strata, being as low as 32% 
less in the wealthiest than the most impoverished group (PR: 0.68, 95%CI 
0.58,0.79). Other critical factors associated with a higher burden of depressive 
symptoms were lower education level, single, unemployed, and chronic 
comorbidity.
CONCLUSIONS: An increased burden of depressive symptoms and psychosocial 
reactions has emerged during the COVID-19 pandemic in Peru compared to previous 
years. The mental health burden disproportionately affects women, the younger 
population, and those with low income and education. As the country eases the 
social distancing measures, it is crucial to use local evidence to adjust public 
health policies and mental health services to the renewed population needs.

DOI: 10.1186/s12888-021-03107-3
PMCID: PMC7890781
PMID: 33602157 [Indexed for MEDLINE]

Conflict of interest statement: We declare no competing interests.


3748. Health Commun. 2022 Sep;37(10):1337-1344. doi: 10.1080/10410236.2021.1888438. 
Epub 2021 Feb 18.

The Effect of Social Media on Stress among Young Adults during COVID-19 
Pandemic: Taking into Account Fatalism and Social Media Exhaustion.

Ngien A(1), Jiang S(1).

Author information:
(1)Department of Communications and New Media, National University of Singapore.

Social media has been widely used as an important source of health information, 
particularly during public health crises. However, findings regarding social 
media's impact on young adults' mental health are mixed. There is a need to 
identify social mechanisms underlying the effect of social media on mental 
health outcomes. Our study breaks new ground by proposing and testing a 
moderated mediation pathway from social media use to stress in young adults 
during the COVID-19 pandemic. We conducted a two-wave online panel survey in the 
context of China. With a general basis of the Street's three-stage model, our 
results indicated that social media failed to directly affect young adults' 
stress. Instead, fatalism completely mediated this relationship. Also, one's 
perceived social media exhaustion negatively moderated this mediation pathway. 
The findings have significant theoretical and practical implications for the use 
of social media to promote health, well-being, and quality of life among young 
people during public health crises.

DOI: 10.1080/10410236.2021.1888438
PMID: 33601985 [Indexed for MEDLINE]


3749. J Adolesc Young Adult Oncol. 2021 Apr;10(2):142-147. doi: 
10.1089/jayao.2020.0202. Epub 2021 Feb 18.

Experiences of Social Isolation During the COVID-19 Lockdown Among Adolescents 
and Young Adult Cancer Patients and Survivors.

Hanghøj S(1), Pappot N(2), Hjerming M(3), Taarnhøj GA(4), Boisen KA(1), Pappot 
H(4)(5).

Author information:
(1)Center of Adolescent Medicine, Department of Paediatrics and Adolescent 
Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
(2)Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 
Denmark.
(3)Department of Hematology and Rigshospitalet, Copenhagen University Hospital, 
Copenhagen, Denmark.
(4)Department of Oncology, Rigshospitalet, Copenhagen University Hospital, 
Copenhagen, Denmark.
(5)Faculty of Health and Medical Sciences, Institute for Clinical Medicine, 
Copenhagen, Denmark.

Purpose: COVID-19 is a worldwide pandemic affecting populations by massive 
lockdowns, including strict precautions and quarantines. Research on the lives 
of adolescents and young adults (AYAs) with cancer during the COVID-19 pandemic 
is highly relevant to meet potential challenges regarding their physical and 
mental well-being. Therefore, the purpose of this study was to investigate how 
AYA cancer patients and survivors experience social isolation during the 
COVID-19 lockdown. Methods: Individual semistructured telephone interviews were 
performed with 13 AYA cancer patients and survivors aged 18-29 years. All 
participants were users of Kræftværket, a youth support center and social 
organization for AYAs with cancer at The University Hospital Rigshospitalet, 
Denmark. Data were analyzed by using thematic analysis. Results: The following 
themes were found. The need for giving and receiving support, Difficulty of the 
community spirit, The lockdown's effect on recovery, Disrupted youth, and Being 
alone. Conclusion: The participants in this study experienced loneliness, 
anxiety, lack of psychosocial support, and lack of physical contact. In 
addition, lack of rehabilitation and lack of support during hospital visits, 
which may specifically influence the disease trajectory, were reported. Thus, 
health care professionals have an important task to follow up on the AYA's 
well-being during and after the COVID-19 lockdown. A positive side effect of the 
lockdown period was the experience of getting a respite to recover physically 
and mentally after cancer.

DOI: 10.1089/jayao.2020.0202
PMID: 33601980 [Indexed for MEDLINE]


3750. J Health Psychol. 2022 Apr;27(5):1099-1110. doi: 10.1177/1359105321995962. Epub 
2021 Feb 18.

Acute impact of a national lockdown during the COVID-19 pandemic on wellbeing 
outcomes among individuals with chronic pain.

Zambelli Z(1), Fidalgo AR(2), Halstead EJ(1), Dimitriou D(1).

Author information:
(1)University College London-Institute of Education, UK.
(2)University of East London, UK.

Changes to wellbeing in a community-based sample of 638 adults with 
non-malignant chronic pain were assessed during a period of mandated lockdown 
measures in the UK to control the COVID-19 outbreak. Participants completed an 
online survey pre-lockdown and were followed up during lockdown. Multivariate 
analysis demonstrated that decreased ability to self-manage pain, restricted 
access to healthcare and increased dependence on others were associated with 
negative wellbeing outcomes related to sleep, anxiety and depression. Essential 
but non-urgent services are required during periods of lockdown to maintain 
independence and self-management in order to preserve wellbeing in this 
population.

DOI: 10.1177/1359105321995962
PMCID: PMC8978477
PMID: 33601977 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of conflicting interest: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


3751. J Phys Act Health. 2021 Mar 1;18(3):272-278. doi: 10.1123/jpah.2020-0325. Epub 
2021 Feb 18.

The Impact of the COVID-19 Pandemic on US College Students' Physical Activity 
and Mental Health.

Wilson OWA, Holland KE, Elliott LD, Duffey M, Bopp M.

BACKGROUND: Investigating the impact of the COVID-19 pandemic on both physical 
activity (PA) and mental health is important to demonstrate the need for 
interventions. This study examined the apparent impact of the pandemic on 
college students' PA, perceived stress, and depressive symptoms.
METHODS: From 2015 through 2020, data were collected at the beginning and end of 
the spring semester at a large Northeastern US university via an online survey 
assessing student demographics, PA, perceived stress, and depressive symptoms. 
Mixed ANOVA examined differences in PA and mental health changes over the spring 
semester between "normal" and COVID-19 circumstances. Two-way ANOVA examined the 
interaction between circumstance and changes in PA in relation to changes in 
mental health.
RESULTS: Participants (n = 1019) were predominately women and non-Hispanic 
white. There was a significant decline in PA and an increase in perceived stress 
under COVID-19, but not normal, circumstances and a significant increase in 
depressive symptoms under COVID-19, but not normal, circumstances among women.
CONCLUSIONS: A significant decline in PA and mental health among college 
students occurred under COVID-19 circumstances, and PA did not appear to protect 
against deterioration in mental health. Proactive and innovative policies, 
programs, and practices to promote student health and well-being must be 
explored immediately.

DOI: 10.1123/jpah.2020-0325
PMID: 33601332 [Indexed for MEDLINE]


3752. Occup Med (Lond). 2021 Apr 9;71(2):86-94. doi: 10.1093/occmed/kqab011.

Covid-19 shelter-at-home and work, lifestyle and well-being in desk workers.

Barone Gibbs B(1), Kline CE(1), Huber KA(1), Paley JL(1), Perera S(2).

Author information:
(1)Department of Health and Human Development, University of Pittsburgh, 
Pittsburgh, PA, USA.
(2)Departments of Medicine and Biostatistics, University of Pittsburgh, 
Pittsburgh, PA, USA.

BACKGROUND: Emerging cross-sectional reports find that the COVID-19 pandemic and 
related social restrictions negatively affect lifestyle behaviours and mental 
health in general populations.
AIMS: To study the longitudinal impact of COVID-19 on work practices, lifestyle 
and well-being among desk workers during shelter-at-home restrictions.
METHODS: We added follow-up after completion of a clinical trial among desk 
workers to longitudinally measure sedentary behaviour, physical activity, sleep, 
diet, mood, quality of life and work-related health using validated 
questionnaires and surveys. We compared outcomes assessed before and during 
COVID-19 shelter-at-home restrictions. We assessed whether changes in outcomes 
differed by remote working status (always, changed to or never remote) using 
analysis of covariance (ANCOVA).
RESULTS: Participants (N = 112; 69% female; mean (SD) age = 45.4 (12.3) years; 
follow-up = 13.5 (6.8) months) had substantial changes to work practices, 
including 72% changing to remote work. Deleterious changes from before to during 
shelter-at-home included: 1.3 (3.5)-h increase in non-workday sedentary 
behaviour; 0.7 (2.8)-point worsening of sleep quality; 8.5 (21.2)-point increase 
in mood disturbance; reductions in five of eight quality of life subscales; 0.5 
(1.1)-point decrease in work-related health (P < 0.05). Other outcomes, 
including diet, physical activity and workday sedentary behaviour, remained 
stable (P ≥ 0.05). Workers who were remote before and during the pandemic had 
greater increases in non-workday sedentary behaviour and stress, with greater 
declines in physical functioning. Wake time was delayed overall by 41 (61) min, 
and more so in workers who changed to remote.
CONCLUSIONS: Employers should consider supporting healthy lifestyle and 
well-being among desk workers during pandemic-related social restrictions, 
regardless of remote working status.

© The Author(s) 2021. Published by Oxford University Press on behalf of the 
Society of Occupational Medicine. All rights reserved. For Permissions, please 
email: journals.permissions@oup.com.

DOI: 10.1093/occmed/kqab011
PMCID: PMC7928687
PMID: 33598681 [Indexed for MEDLINE]


3753. BMC Public Health. 2021 Feb 17;21(1):368. doi: 10.1186/s12889-021-10330-w.

Impact of the Covid-19 pandemic on perinatal mental health 
(Riseup-PPD-COVID-19): protocol for an international prospective cohort study.

Motrico E(1), Bina R(2), Domínguez-Salas S(3), Mateus V(4), Contreras-García 
Y(5), Carrasco-Portiño M(5), Ajaz E(6), Apter G(7), Christoforou A(8), 
Dikmen-Yildiz P(9), Felice E(10), Hancheva C(11), Vousoura E(12), Wilson CA(13), 
Buhagiar R(10), Cadarso-Suárez C(14), Costa R(15)(16), Devouche E(17), 
Ganho-Ávila A(18), Gómez-Baya D(19), Gude F(20), Hadjigeorgiou E(21), Levy D(2), 
Osorio A(4), Rodriguez MF(22), Saldivia S(23), González MF(24), Mattioli M(25), 
Mesquita A(26); Riseup-PPD-COVID-19 Group.

Author information:
(1)Psychology Department, Universidad Loyola Andalucia, Avenida de las 
Universidades s/n, Dos Hermanas (Sevilla), Spain. emotrico@uloyola.es.
(2)School of Social Work, Bar Ilan University, Ramat Gan, Israel.
(3)Psychology Department, Universidad Loyola Andalucia, Avenida de las 
Universidades s/n, Dos Hermanas (Sevilla), Spain.
(4)Graduate Program on Developmental Disorders, Center for Biological and Health 
Sciences - Mackenzie Presbyterian University, São Paulo, Brazil.
(5)Departamento de Obstetricia y Puericultura, Facultad de Medicina, Universidad 
de Concepción, Concepción, Chile.
(6)Department of Education Sciences and Psychology, Beder College University, 
Tirana, Albania.
(7)Perinatal and Child Psychiatry, Le Havre Hospital, Normandie University 
Rouen, Rouen, France.
(8)Department of Social and Behavioral Sciences, European University Cyprus, 
Nicosia, Cyprus.
(9)Department of Psychology, Kirklareli University, Kirklareli, Turkey.
(10)University of Malta, Msida, MSD, 2080, Malta.
(11)Sofia University "St. Kliment Ochridski", Sofia, Bulgaria.
(12)Department of Psychology, American College of Greece, Gravias 6, 15342, Agia 
Paraskevi, Greece.
(13)Section of Women's Mental Health, King's College London and South London and 
Maudsley NHS Foundation Trust, London, United Kingdom.
(14)Department of Statistics, Mathematical Analysis and Optimization, Group of 
Biostatistics and Biomedical Data Science, Faculty of Medicine, University of 
Santiago de Compostela, Rúa San Francisco, S/N, 15895, Santiago de Compostela, 
Spain.
(15)Unidade de Investigação em Epidemiologia (EPIUnit, UIDB/04750/2020), 
Instituto de Saúde Pública da Universidade do Porto (ISPUP). Rua das Taipas, 
135, 4050-600, Porto, Portugal.
(16)Universidade Europeia, Lisbon, Portugal.
(17)Université de Paris, Laboratoire de Psychopathologie et Processus de Santé 
(LPPS, UR4057), Groupe Hospitalier du Havre, Paris, France.
(18)Univ Coimbra, Center for Research in Neuropsychology and Cognitive 
Behavioral Intervention, Faculty of Psychology and Educational Sciences, 
3000-115, Coimbra, Portugal.
(19)Department of Social, Developmental and Educational Psychology, Universidad 
de Huelva, Avda. de las Fuerzas Armadas, 21007, Huelva, Spain.
(20)Department of Epidemiology, University Clinical Hospital of Santiago, 
Research Group on Epidemiology of Common Diseases, Santiago de Compostela Health 
Research Institute (IDIS), Santiago de Compostela, Spain.
(21)Department of Nursing, Midwifery, School of Health Science, Cyprus 
University of Technology, Limassol, Cyprus.
(22)Faculty of Psychology, Universidad Nacional de Educación a Distancia, 
(UNED), Madrid, Spain.
(23)Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, 
Universidad de Concepción, Concepción, Chile.
(24)Faculty of Health Sciences, National University of Entre Rios, Concepción 
del Uruguay, Entre Ríos, Argentina.
(25)Faculty of Humanities, Arts and Social Sciences, Universidad Autónoma de 
Entre Ríos, Concepción del Uruguay, Entre Ríos, Argentina.
(26)School of Psychology, University of Minho, Campus Gualtar, 4710-057, Braga, 
Portugal. ana.mesquita@psi.uminho.pt.

BACKGROUND: Corona Virus Disease 19 (COVID-19) is a new pandemic, declared a 
public health emergency by the World Health Organization, which could have 
negative consequences for pregnant and postpartum women. The scarce evidence 
published to date suggests that perinatal mental health has deteriorated since 
the COVID-19 outbreak. However, the few studies published so far have some 
limitations, such as a cross-sectional design and the omission of important 
factors for the understanding of perinatal mental health, including governmental 
restriction measures and healthcare practices implemented at the maternity 
hospitals. Within the Riseup-PPD COST Action, a study is underway to assess the 
impact of COVID-19 in perinatal mental health. The primary objectives are to (1) 
evaluate changes in perinatal mental health outcomes; and (2) determine the risk 
and protective factors for perinatal mental health during the COVID-19 pandemic. 
Additionally, we will compare the results between the countries participating in 
the study.
METHODS: This is an international prospective cohort study, with a baseline and 
three follow-up assessments over a six-month period. It is being carried out in 
11 European countries (Albania, Bulgaria, Cyprus, France, Greece, Israel, Malta, 
Portugal, Spain, Turkey, and the United Kingdom), Argentina, Brazil and Chile. 
The sample consists of adult pregnant and postpartum women (with infants up to 
6 months of age). The assessment includes measures on COVID-19 epidemiology and 
public health measures (Oxford COVID-19 Government Response Tracker dataset), 
Coronavirus Perinatal Experiences (COPE questionnaires), psychological distress 
(BSI-18), depression (EPDS), anxiety (GAD-7) and post-traumatic stress symptoms 
(PTSD checklist for DSM-V).
DISCUSSION: This study will provide important information for understanding the 
impact of the COVID-19 pandemic on perinatal mental health and well-being, 
including the identification of potential risk and protective factors by 
implementing predictive models using machine learning techniques. The findings 
will help policymakers develop suitable guidelines and prevention strategies for 
perinatal mental health and contribute to designing tailored mental health 
interventions.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04595123 .

DOI: 10.1186/s12889-021-10330-w
PMCID: PMC7887558
PMID: 33596889 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interest.


3754. HERD. 2021 Apr;14(2):49-65. doi: 10.1177/1937586721991113. Epub 2021 Feb 18.

Influence of Nature at the Time of the Pandemic: An Experience-Based Survey at 
the Time of SARS-CoV-2 to Demonstrate How Even a Short Break in Nature Can 
Reduce Stress for Healthcare Staff.

Gola M(1), Botta M(2), D'Aniello AL(3), Capolongo S(1).

Author information:
(1)Design & Health Lab, Dep. Architecture, Built environment and Construction 
engineering, 119598Politecnico di Milano, Italy.
(2)Studio Monica Botta, Novara, Italy.
(3)Hub4Mind, Varese, Italy.

AIM: The current COVID-19 pandemic has been causing significant upheavals in the 
daily lives of citizens and consequently also their mood (stress, distraction, 
anxiety, etc.), especially during the lockdown phase. The aim of the 
investigation is to evaluate the benefits of 20-30 minutes in contact with 
nature.
BACKGROUND: The Scientific Community, also through the evidence-based design 
approach, has already demonstrated the importance of greenery and nature on the 
psychophysical well-being of people and, in a moment of emergency, contact with 
the nature can be therapeutic and quite influential on the mental health of 
staff subject to stress.
METHOD: During the lockdown, an Italian multidisciplinary working group promoted 
an experience-based survey, based on the Profile of Mood States methodology, for 
measuring the psychophysical well-being of hospital staff.
RESULTS: The author collected 77 questionnaires. The benefits that users have 
obtained from the experience in nature have been investigated by comparing the 
type of stresses they were subjected to and highlighting various peculiarities 
in the data analysis associated with the type of green in which they carried out 
the survey, the healthcare areas in which they worked during the pandemic 
emergency, and the moment in which the survey was conducted.
CONCLUSIONS: The study has highlighted that a short break in green spaces 
strongly influenced the mental and psychophysical well-being of hospital staff, 
emphasizing the importance of nearby green spaces in architectures for health. 
Even a brief break in nature can regenerate users, especially in times of a 
stressful health emergency.

DOI: 10.1177/1937586721991113
PMID: 33596709 [Indexed for MEDLINE]


3755. JCO Oncol Pract. 2021 Jul;17(7):e925-e935. doi: 10.1200/OP.20.00882. Epub 2021 
Feb 17.

Well-Being of Pediatric Hematology Oncology Providers and Staff During the 
COVID-19 Pandemic in the New York and New Jersey Epicenter.

Moerdler S(1)(2), Steinberg DM(3)(4), Jin Z(5), Cole PD(1)(2), Levy AS(6), 
Rosenthal SL(4)(7).

Author information:
(1)Pediatric Hematology Oncology, Rutgers Cancer Institute of New Jersey, New 
Brunswick, NJ.
(2)Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New 
Brunswick, NJ.
(3)Department of Pediatrics, Division of Hematology, Oncology and Stem Cell 
Transplantation, Columbia University Irving Medical Center, New York, NY.
(4)Department of Psychiatry, Division of Child and Adolescent Psychiatry, 
Columbia University Irving Medical Center, New York, NY.
(5)Department of Biostatistics, Mailman School of Public Health, Columbia 
University, New York, NY.
(6)Division of Pediatric Hematology, Oncology and Cellular Therapy, Children's 
Hospital at Montefiore, Bronx, NY.
(7)Department of Pediatrics, Columbia University Irving Medical Center, New 
York, NY.

PURPOSE: The COVID-19 pandemic has significantly affected the well-being of 
healthcare workers to varying degrees. The aim of the current study was to 
investigate how the pandemic has affected the burnout, stress, and emotional 
well-being of pediatric hematology oncology (PHO) providers and staff in the New 
York and New Jersey epicenter.
METHODS: The study was conducted in June 2020 during the pandemic through an 
electronic survey. The survey contained questions surrounding demographics, 
pandemic experiences, and validated burnout, stress, and emotional well-being 
measures.
RESULTS: Two hundred fifty-two PHO providers and staff responded to the survey. 
Overall, half of the participants reported high levels of burnout, average 
stress scores were in the mild-moderate range, and the majority scored in the 
none-to-mild symptomatology range for their well-being. Self-reported burnout 
levels before the pandemic and geographic work location were statistically 
significant risk factors for all outcomes. Additional predictors for some 
outcomes included hospital role, lack of trust in leadership, and deployment. 
The majority of participants (87.0%) reported that their hospitals had made 
mental health resources related to COVID-19 available to them but only 8.4% 
reported having used them.
CONCLUSION: PHO providers and staff in the NYC/NJ area are experiencing a range 
of emotional experiences during the COVID-19 pandemic, but the majority are not 
using current resources. With the continuation of the pandemic, we must continue 
efforts to improve provider and staff distress to mitigate the degree of 
potential negative short-term and long-term impact.

DOI: 10.1200/OP.20.00882
PMID: 33596094 [Indexed for MEDLINE]

Conflict of interest statement: Adam S. LevyConsulting or Advisory Role: 
AstraZenecaNo other potential conflicts of interest were reported.


3756. J Affect Disord. 2021 Apr 1;284:98-103. doi: 10.1016/j.jad.2021.02.001. Epub 
2021 Feb 5.

Associations between feelings/behaviors during COVID-19 pandemic lockdown and 
depression/anxiety after lockdown in a sample of Chinese children and 
adolescents.

Liu Y(1), Yue S(2), Hu X(3), Zhu J(1), Wu Z(4), Wang J(5), Wu Y(6).

Author information:
(1)Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, 
Jining Medical University, Jining 272013, China; Shandong Collaborative 
Innovation Center for Diagnosis & Treatment & Behavioral Interventions of Mental 
Disorders, Institute of Mental Health, Jining Medical University, Jining 272013, 
China; Center of Evidence-based Medicine, Jining Medical University, Jining 
272013, China.
(2)Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, 
Jining Medical University, Jining 272013, China; Department of Pathology, 
Weifang Medical University, Weifang 261053, China.
(3)College of Liberal Arts, University of Minnesota, Twin Cities, MN 55455, USA.
(4)Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, 
Jining Medical University, Jining 272013, China.
(5)Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, 
Jining Medical University, Jining 272013, China; The Royal's Institute of Mental 
Health Research, University of Ottawa, Ottawa K1Z 7K4, Canada; School of 
Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 
Ottawa K1Z 7K4, Canada.
(6)Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, 
Jining Medical University, Jining 272013, China; Shandong Collaborative 
Innovation Center for Diagnosis & Treatment & Behavioral Interventions of Mental 
Disorders, Institute of Mental Health, Jining Medical University, Jining 272013, 
China; Center of Evidence-based Medicine, Jining Medical University, Jining 
272013, China. Electronic address: yili_wu2004@yahoo.ca.

BACKGROUND: Children and adolescents may be more susceptible to mental disorders 
due to COVID-19 pandemic than adults. This study aimed to identify correlated 
factors for depression/anxiety among children and adolescents after COVID-19 
pandemic lockdown.
METHODS: An online survey by cluster sampling was conducted after lockdown in 
5175 Chinese children and adolescents with informed consents from their parents. 
The 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety 
Disorder scales with 10-point cutoff were used to measure depression and 
anxiety, separately. Stepwise logistic regression was conducted. Stata 15.1 
Version was used.
RESULTS: 12.33% and 6.26% of all participants reported depression and anxiety 
after lockdown, separately. Suicidal ideation, quarreling with parents, 
insomnia, difficulty in concentrating during online learning, and anxious and 
depressed mood during lockdown were positively associated with depression and 
anxiety after lockdown. Missing teachers was negatively associated with both 
depression and anxiety. Living in urban and not living with parents were 
positively associated with depression.
LIMITATIONS: The past history and familial history of mental disorders have not 
been collected. The recall biases for collecting self-reporting information 
might exist, and the causal inferences cannot be drawn.
CONCLUSIONS: The prevalence of depression and anxiety in children and 
adolescents might decline a bit after lockdown but is still at a high level 
after lockdown. Gatekeepers should pay more attention to modifiable factors of 
psychological well-being in children and adolescents, including family and 
school contexts and even feelings and behaviors during COVID-19 pandemic 
lockdown.

Copyright © 2021. Published by Elsevier B.V.

DOI: 10.1016/j.jad.2021.02.001
PMCID: PMC8771471
PMID: 33592433 [Indexed for MEDLINE]

Conflict of interest statement: None.


3757. J Med Radiat Sci. 2021 Jun;68(2):111-120. doi: 10.1002/jmrs.462. Epub 2021 Feb 
15.

Australian radiographers' and radiation therapists' experiences during the 
COVID-19 pandemic.

Shanahan MC(1), Akudjedu TN(2).

Author information:
(1)Discipline of Medical Radiation Science, Faculty of Health, University of 
Canberra, Bruce, ACT, Australia.
(2)Institute of Medical Imaging & Visualisation, Faculty of Health & Social 
Sciences, Bournemouth University, Bournemouth, UK.

INTRODUCTION: Radiographers and radiation therapists are key patient-facing 
health practitioners supporting the delivery of optimal patient care during the 
COVID-19 pandemic. The aim of this research was to investigate the impact of 
COVID-19 on clinical service delivery and well-being of these healthcare 
professionals in Australia.
METHODS: A cross-sectional online survey of Australian radiographers and 
radiation therapists was conducted in June-July 2020. The survey collected data 
on demographic characteristics, and the impact of COVID-19 on professional 
practice, infection control and workplace-related stress.
RESULTS: A total of 218 responses were received. Changes in work hours 
(P < 0.001) and workload (P = 0.022) were experienced due to COVID-19. 
Diagnostic radiographers reported increased procedural pressure on mobile 
radiography, computed tomography and general radiography. For radiation 
therapists, most pressure included areas of simulation and linear accelerator. 
PPE was in short supply at the start of the pandemic, and at the time of the 
study, shortages were identified for all PPE items. There was no difference in 
PPE supply reported by diagnostic radiographers and radiation therapists except 
for hand sanitiser (P = 0.003). Respondents experienced increased personal 
stress (61.4%) and anxiety (58.2%) at work due to COVID-19. In addition, their 
work caused increased stress to their family, partners or friends (57.4%).
CONCLUSIONS: COVID-19 has resulted in changes to clinical working patterns and 
service delivery. PPE shortages, as well as increased workplace-related stress, 
were identified. Workplaces should seek to mitigate the pandemic impact through 
the provision of adequate PPE for safe practice as well as implement strategies 
to support and enhance staff well-being.

© 2021 The Authors. Journal of Medical Radiation Sciences published by John 
Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging 
and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.

DOI: 10.1002/jmrs.462
PMCID: PMC8013350
PMID: 33590670 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3758. Biopsychosoc Med. 2021 Feb 15;15(1):4. doi: 10.1186/s13030-021-00206-1.

Factors influencing post-ICU psychological distress in family members of 
critically ill patients: a linear mixed-effects model.

Naef R(1)(2), von Felten S(3), Ernst J(4).

Author information:
(1)Centre of Clinical Nursing Science, University Hospital Zurich, Raemistrasse 
100, 8091, Zurich, Switzerland. rahel.naef@usz.ch.
(2)Institute for Implementation Science in Health Care, Faculty of Medicine, 
University of Zurich, Zurich, Switzerland. rahel.naef@usz.ch.
(3)Department of Biostatistics, Institute of Epidemiology, Biostatistics, and 
Prevention, Faculty of Medicine, University of Zurich, Zurich, Switzerland.
(4)Centre of Clinical Nursing Science, University Hospital Zurich, Raemistrasse 
100, 8091, Zurich, Switzerland.

BACKGROUND: Adverse responses to critical illness, such as symptoms of 
depression, anxiety or posttraumatic stress, are relatively common among family 
members. The role of risk factors, however, remains insufficiently understood, 
but may be important to target those family members most in need for support. We 
therefore examined the association of patient-, family member- and care-related 
factors with post-ICU psychological distress in family members in a general 
population of critical ill patients.
METHODS: We conducted a prospective, single-centre observational study in a 
twelve-bed surgical ICU in a 900-bed University Hospital in Switzerland. 
Participants were family members of patients treated in ICU who completed the 
Family Satisfaction in ICU-24 Survey, the Hospital Anxiety Depression Scale, 
Impact of Event Scale-Revised-6, and a demographic form within the first 
3 months after their close other's ICU stay. Data were analysed using linear 
mixed-effects models, with depression, anxiety, and posttraumatic stress as 
outcome measures.
RESULTS: A total of 214 family members (53% return rate) returned a completed 
questionnaire. We found that higher levels of satisfaction were significantly 
associated with lower levels of depression, anxiety and posttraumatic stress. 
There was no statistically significant association between family member 
characteristics and any measure of psychological distress. Among the included 
patient characteristics, younger patient age was associated with higher levels 
of depression, and patient death was associated with higher levels of depression 
and posttraumatic stress.
CONCLUSIONS: Our results suggest that satisfaction with ICU care is strongly 
associated with family well-being post-ICU. Family members of younger patients 
and of those who die seem to be most at risk for psychological distress, 
requiring specific support, whereas family member characteristics may have less 
relevance.

DOI: 10.1186/s13030-021-00206-1
PMCID: PMC7885222
PMID: 33588895

Conflict of interest statement: The authors declare that they have no competing 
interests.


3759. Tumori. 2022 Feb;108(1):77-85. doi: 10.1177/0300891621992129. Epub 2021 Feb 15.

COVID-19 pandemic distress among a sample of Italian psycho-oncologists: risk of 
isolation and loneliness.

Costantini A(1), Mazzotti E(2), Serpentini S(3), Piattelli A(4), Scarponi D(5), 
De Benedetta G(6), Bellani M(7).

Author information:
(1)Psycho-Oncology Departmental Unit, Sant'Andrea Hospital, Sapienza University 
of Rome, Rome, Italy.
(2)Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza 
University of Rome, Rome, Italy.
(3)Psycho-Oncology Unit, Veneto Institute of Oncology IOV-IRCCS Comprehensive 
Cancer Center, Padua, Italy.
(4)UOC Oncologia-Dipartimento Oncoematologico, Azienda Ospedaliera Cosenza, 
Cosenza, Italy.
(5)Paediatric Unit, Sant'Orsola Hospital, Bologna University, Bologna, Italy.
(6)Hematology Department, National Cancer Institute, Foundation Pascale, Naples, 
Italy.
(7)Psycho-oncology Unit, Department of Medicine and Surgery, University of 
Insubria, Varese, Italy.

PURPOSE: To measure the prevalence and characteristics of distress and hope for 
the future among psycho-oncologists, who faced the coronavirus disease 2019 
(COVID-19) emergency along with other healthcare workers.
METHODS: A web-based study was conducted among members of the Italian Society of 
Psycho-Oncology between May 29 and June 5, 2020.
RESULTS: A total of 237 members, aged 28-72 years, completed the COVID-19 
Peritraumatic Distress Index (CPDI), Impact of Event Scale-Revised (IES-R), and 
HOPE questionnaires; 86.92% were female, 58.65% worked in hospitals, 21.10% were 
exposed to COVID-19, 11.39% experienced peritraumatic distress, and 3.38% had 
posttraumatic stress disorder symptoms. Peritraumatic distress was associated 
with living alone (adjusted odds ratio [AOR] 3.05; 95% confidence interval [CI] 
1.41-8.13), using sleep remedies (AOR 3.79; 95% CI 1.41-10.21), and the 
perception of being avoided by family or friends because of work (AOR 2.69; 95% 
CI 1.02-7.11); high HOPE-Agency scores were associated with the absence of 
peritraumatic stress (AOR 0.40; 95% CI 0.16-0.96) after adjustment for age and 
sex.
CONCLUSIONS: Psycho-oncologists showed greater resilience than other healthcare 
workers as they are trained to help others, but also to review their own values 
and behavior in light of stressful events. Of interest is the association 
between peritraumatic distress and social isolation, real or perceived. 
Healthcare institutions should pay attention to the mental well-being of their 
employees by promoting distress screening using simple tools such as the CPDI 
and implementing support interventions. Psycho-oncology associations should 
introduce policies aimed at developing a sense of social connectedness by 
providing an interactive system of orientation and scientific reference.

DOI: 10.1177/0300891621992129
PMCID: PMC7890420
PMID: 33588706 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of conflicting interests: The 
authors declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


3760. Int J Ment Health Nurs. 2021 Jun;30(3):759-771. doi: 10.1111/inm.12830. Epub 
2021 Feb 15.

The mediating role of regulatory emotional self-efficacy on negative emotions 
during the COVID-19 pandemic: A cross-sectional study.

Sui W(1), Gong X(1), Zhuang Y(1).

Author information:
(1)Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of 
Medicine, Hangzhou, China, China.

Nurses exposed to coronavirus disease 2019 (COVID-19) are psychologically 
stressed. This study examines the characteristics and distribution of negative 
emotions among Chinese nurses during the COVID-19 pandemic and explores 
regulatory emotional self-efficacy (RESE) as the underlying mechanism in the 
relationship between nurses' personalities and negative emotions. A 
cross-sectional design with convenience sampling was utilized. Three 
comprehensive tertiary hospitals located in China were selected. Nurses 
(n = 339) who cared for COVID-19 patients were enrolled. Recruitment was 
conducted between 14 February 2020 and 1 March 2020. Self-reported 
questionnaires about personality, RESE, and epidemic-related negative emotions 
were completed online. A correlation analysis, structural equation modelling, 
and the bootstrapping method were used to analyse the data. This study 
identified a 24.9% incidence of negative emotions in nurses. RESE was a 
significant mediator explaining the effect of personality on epidemic-related 
negative emotions. RESE mediated the effect of introversion-extroversion on 
depression (β = -0.151, P = 0.015), neuroticism (β = -0.182, P = 0.007), fear 
(β = -0.142, P = 0.006), anxiety (β = -0.189, P = 0.015), and hypochondria 
(β = -0.118, P = 0.010); it also mediated the effect of neuroticism on 
depression (β = 0.313, P = 0.002), neuroticism (β = 0.394, P = 0.003), fear 
(β = 0.345, P = 0.005), anxiety (β = 0.384, P = 0.003), and hypochondria 
(β = 0.259, P = 0.004). Nurses caring for COVID-19 patients displayed negative 
emotions, particularly emotionally unstable and introverted nurses with a low 
RESE level. RESE is often essential for interventions because it significantly 
influences the relationship between personality and negative emotions. In the 
event of a major outbreak, tailored psychological well-being education, which 
includes emotional self-efficacy strategies, should be provided by organizations 
to help nurses manage stress related to the outbreak.

© 2021 Australian College of Mental Health Nurses Inc.

DOI: 10.1111/inm.12830
PMCID: PMC8013741
PMID: 33586868 [Indexed for MEDLINE]


3761. J Reprod Infant Psychol. 2022 Nov;40(5):516-531. doi: 
10.1080/02646838.2021.1886260. Epub 2021 Feb 13.

Support from friends moderates the relationship between repetitive negative 
thinking and postnatal wellbeing during COVID-19.

Harrison V(1), Moulds ML(2), Jones K(1).

Author information:
(1)School of Psychology and Counselling, The Open University, Milton Keynes, UK.
(2)School of Psychology and Counselling, The University of New South Wales, 
Sydney, Australia.

BACKGROUND: Increasing evidence has linked repetitive negative thinking (RNT) to 
postnatal depression and anxiety, yet the factors moderating this relationship 
have been minimally investigated. During the COVID-19 pandemic of 2020, social 
restrictions imposed to reduce viral transmission limited access to social 
support, which is critical to postnatal psychological wellbeing - potentially 
intensifying RNT.
OBJECTIVE: We examined whether perceived social support (from friends, family, 
and a significant other) played a moderating role in the relationship between 
RNT and maternal postnatal anxiety and depressive symptoms.
METHODS: A sample of women (N = 251) who had given birth in the preceding 
12 months completed an online battery of standardised measures during the 
COVID-19 'lockdown' of May 2020.
RESULTS: As predicted, social support moderated the relationship between RNT and 
depression such that the association between RNT and depression was stronger for 
women who reported lower levels of social support. Interestingly, this finding 
emerged for social support from friends only; for support from family and 
significant other, social support did not play a moderating role. Further, and 
unexpectedly, overall social support did not moderate the relationship between 
RNT and postnatal anxiety, however, social support from friends was a 
significant moderator.
CONCLUSIONS: High levels of perceived social support from friends (but not 
family or significant others) buffered the effects of RNT on depression and 
anxiety during the postpartum period. Strategies to bolster peer social support 
may be a valuable inclusion in interventions to prevent and treat postnatal 
depression and anxiety.

DOI: 10.1080/02646838.2021.1886260
PMID: 33586544 [Indexed for MEDLINE]


3762. Front Public Health. 2021 Jan 26;9:619129. doi: 10.3389/fpubh.2021.619129. 
eCollection 2021.

Associations Between Change in Outside Time Pre- and Post-COVID-19 Public Health 
Restrictions and Mental Health: Brief Research Report.

Cindrich SL(1), Lansing JE(1), Brower CS(1), McDowell CP(2)(3), Herring 
MP(2)(4)(5), Meyer JD(1).

Author information:
(1)Department of Kinesiology, Iowa State University, Ames, IA, United States.
(2)The Irish Longitudinal Study of Ageing, Trinity College Dublin, The 
University of Dublin, Dublin, Ireland.
(3)School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, 
Ireland.
(4)Physical Activity for Health Research Cluster, Health Research Institute, 
University of Limerick, Limerick, Ireland.
(5)Department of Physical Education and Sport Sciences, University of Limerick, 
Limerick, Ireland.

The novel coronavirus disease 2019 (COVID-19) and associated pandemic has 
resulted in systemic changes to much of life, affecting both physical and mental 
health. Time spent outside is associated with positive mental health; however, 
opportunities to be outside were likely affected by the COVID-19 public health 
restrictions that encouraged people not to leave their homes unless it was 
required. This study investigated the impact of acute COVID-19 public health 
restrictions on outside time in April 2020, and quantified the association 
between outside time and both stress and positive mental health, using secondary 
analyses of cross-sectional data from the COVID and Well-being Study. 
Participants (n = 3,291) reported demographics, health behaviors, amount of time 
they spent outside pre/post COVID-19 public health restrictions (categorized as 
increased, maintained, or decreased), current stress (Perceived Stress Scale-4), 
and positive mental health (Short Warwick-Edinburgh Mental Well-being Scale). 
Outside time was lower following COVID-19 restrictions (p < 0.001; Cohen's d = 
-0.19). Participants who increased or maintained outside time following COVID-19 
restrictions reported lower stress (p < 0.001, 5.93 [5.74-6.12], Hedges' g = 
-0.18; p < 0.001, mean = 5.85 [5.67-6.02], Hedges' g = -0.21; respectively) and 
higher positive mental health (p < 0.001, 24.49 [24.20-24.77], Hedges' g = 0.21; 
p < 0.001, 24.78 [24.52-25.03], Hedges' g = 0.28) compared to those who 
decreased outside time. These findings indicate that there are likely to be 
negative stress and mental health implications if strategies are not implemented 
to encourage and maintain safe time outside during large-scale workplace and 
societal changes (e.g., during a pandemic).

Copyright © 2021 Cindrich, Lansing, Brower, McDowell, Herring and Meyer.

DOI: 10.3389/fpubh.2021.619129
PMCID: PMC7874172
PMID: 33585393 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


3763. Front Public Health. 2021 Jan 27;8:589966. doi: 10.3389/fpubh.2020.589966. 
eCollection 2020.

Social Distancing: Prevalence of Depressive, Anxiety, and Stress Symptoms Among 
Brazilian Students During the COVID-19 Pandemic.

Esteves CS(1), de Oliveira CR(2), Argimon IIL(3).

Author information:
(1)Instituto Federal de Educação, Ciência e Tecnologia do Rio Grande do Sul, 
Porto Alegre, Brazil.
(2)Faculdade Meridional IMED, Passo Fundo, Brazil.
(3)Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.

Social distancing due to the COVID-19 pandemic can impact mental health, 
triggering symptoms such as anxiety, stress and depression. Therefore, this 
study aimed to assess the levels of anxiety, depression and stress during the 
period of social distancing due to COVID-19 in students from a campus of the 
Federal Institute in the metropolitan area of Porto Alegre/RS. A correlational 
and exploratory study was performed. The sample of the present research was 
composed by 208 students, who responded to a self-administered online 
questionnaire with sociodemographic variables and the Depression, Anxiety and 
Stress Scale Short Form - DASS-21. The detected prevalence of symptoms 
classified as moderate-severe was 49% for stress, 39% for depression and 33% for 
anxiety. An association was found between higher levels of anxiety symptoms (OR 
= 5.652; 95% CI = 2.872-11.123; p < 0.001), depression (OR = 3.289; 95% CI = 
1.810-5.978; p < 0.001) and stress (OR = 5.684; 95% CI = 3.120-10.355; p < 
0.001) with occurrence of sleep problems during the period of social distancing. 
There was a protective factor provided by regular physical exercise in relation 
to depressive symptoms (OR = 0.490; 95% CI = 0.250-0.960; p =0.033). These data 
are extremely important for understanding the adverse effect on the mental 
health of students and for developing psychological support strategies, thus 
promoting well-being during and after the pandemic.

Copyright © 2021 Esteves, Oliveira and Argimon.

DOI: 10.3389/fpubh.2020.589966
PMCID: PMC7873553
PMID: 33585381 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


3764. Eat Weight Disord. 2021 Dec;26(8):2771-2777. doi: 10.1007/s40519-021-01137-0. 
Epub 2021 Feb 13.

The psychological impact of COVID-19-related lockdown measures among a sample of 
Italian patients with eating disorders: a preliminary longitudinal study.

Nisticò V(1)(2), Bertelli S(3)(4), Tedesco R(1)(3), Anselmetti S(4), Priori 
A(1)(2)(5), Gambini O(1)(2)(3), Demartini B(6)(7)(8).

Author information:
(1)Dipartimento Di Scienze Della Salute, Università Degli Studi Di Milano, ASST 
Santi Paolo E Carlo, Presidio San Paolo, via A. di Rudinì, 8, 20100, Milano, 
Italy.
(2)Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain 
Therapeutics, Università Degli Studi Di Milano, Milano, Italy.
(3)Unità Di Psichiatria II, ASST Santi Paolo E Carlo, Presidio San Paolo, 
Milano, Italy.
(4)NutriMente Onlus, Milano, Italy.
(5)III Clinica Neurologica, ASST Santi Paolo E Carlo, Presidio San Paolo, 
Milano, Italy.
(6)Dipartimento Di Scienze Della Salute, Università Degli Studi Di Milano, ASST 
Santi Paolo E Carlo, Presidio San Paolo, via A. di Rudinì, 8, 20100, Milano, 
Italy. benedetta.demartini@unimi.it.
(7)Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain 
Therapeutics, Università Degli Studi Di Milano, Milano, Italy. 
benedetta.demartini@unimi.it.
(8)Unità Di Psichiatria II, ASST Santi Paolo E Carlo, Presidio San Paolo, 
Milano, Italy. benedetta.demartini@unimi.it.

PURPOSE: To explore the prevalence of symptoms of anxiety and depression, along 
with PTSD- and ED-related symptoms, across a sample of patients with Eating 
Disorders (EDs) compared to a group of healthy controls (HC) during the lockdown 
period in Italy; to assess whether patients' reported aforementioned psychiatric 
symptoms improved, remained stable or worsened with the easing of the lockdown 
measures.
METHODS: t0 assessment (during lockdown): 59 ED patients and 43 HC completed an 
online survey, including the Depression, Anxiety and Stress Scale-21 items 
(DASS-21), the Impact of Event Scale-Revised (IES-R), the Perceived Stress Scale 
(PSS), and specific ad-hoc questions extracted from the Eating Disorder 
Examination-Questionnaire; t1 assessment (post-lockdown): 40 EDs patients, a 
subset of the t0 sample, completed the same assessment 2 months after t0.
RESULTS: EDs patients scored higher than HC at the DASS-21, IES-R and PSS. At 
t1, levels of stress, anxiety and depression were not different than at t0, but 
symptoms related to post-traumatic stress disorder (PTSD), patients' reported 
level of psychological wellbeing and specific EDs symptomatology improved.
DISCUSSION: During the lockdown, EDs patients presented significantly higher 
levels of stress, anxiety, depression, PTSD- and ED-related symptoms than HC. 
With the easing of the lockdown, PTSD- and ED-related symptoms improved, but 
high levels of stress, anxiety and depression persisted.
LEVEL OF EVIDENCE: Level I, experimental study.

© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG 
part of Springer Nature.

DOI: 10.1007/s40519-021-01137-0
PMCID: PMC7882047
PMID: 33582970 [Indexed for MEDLINE]

Conflict of interest statement: Authors have no conflict of interests to 
declare.


3765. J Psychosom Res. 2021 Apr;143:110365. doi: 10.1016/j.jpsychores.2021.110365. 
Epub 2021 Jan 19.

Effects of centralized isolation vs. home isolation on psychological distress in 
patients with COVID-19.

Ju Y(1), Chen W(1), Liu J(1), Yang A(2), Shu K(3), Zhou Y(4), Wang M(1), Huang 
M(1), Liao M(1), Liu J(5), Liu B(6), Zhang Y(7).

Author information:
(1)Department of Psychiatry, The Second Xiangya Hospital of Central South 
University, Changsha, Hunan, China; Mental Health Institute of Central South 
University, China National Clinical Research Center on Mental Disorders 
(Xiangya), China National Technology Institute on Mental Disorders, Hunan 
Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and 
Mental Health, Changsha, Hunan, China.
(2)Department of Obstetrics & Gynecology, The First Hospital of Changsha, 
Changsha, Hunan, China.
(3)Department of Neurology, The First Hospital of Changsha, Changsha, Hunan, 
China.
(4)Department of Orthopedics, The First Hospital of Changsha, Changsha, Hunan, 
China.
(5)Administrative Office, The First Hospital of Changsha, Changsha, Hunan, 
China. Electronic address: csphq@163.com.
(6)Department of Psychiatry, The Second Xiangya Hospital of Central South 
University, Changsha, Hunan, China; Mental Health Institute of Central South 
University, China National Clinical Research Center on Mental Disorders 
(Xiangya), China National Technology Institute on Mental Disorders, Hunan 
Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and 
Mental Health, Changsha, Hunan, China. Electronic address: 
bangshan.liu@csu.edu.cn.
(7)Department of Psychiatry, The Second Xiangya Hospital of Central South 
University, Changsha, Hunan, China; Mental Health Institute of Central South 
University, China National Clinical Research Center on Mental Disorders 
(Xiangya), China National Technology Institute on Mental Disorders, Hunan 
Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and 
Mental Health, Changsha, Hunan, China. Electronic address: zydd7877@csu.edc.cn.

OBJECTIVE: This study aimed to evaluate the impact of isolation form on the 
recovery of psychological distress in patients with coronavirus disease 2019 
(COVID-19) after being discharged from hospital.
METHODS: Baseline survey was conducted from February 10, 2020 to February 25, 
2020 in patients with COVID-19 in a designated hospital on the discharge day. 
After discharge, patients were free to choose whether isolate in a centralized 
isolation site (i.e. designated hotel) or their own home for another two weeks. 
A follow-up survey was conducted at the end of the 2-week post-discharge 
isolation. Depression, anxiety as well as self-rated health were assessed at 
both time points using the 9-item patient health questionnaire, 7-item 
generalized anxiety disorder scale and self-rated health scores, respectively.
RESULTS: Fifty centrally isolated and 45 home isolated patients completed both 
the baseline and the follow-up assessments. Significant effects of time and time 
by isolation form were found on depression and anxiety levels, with a 
significant decrease in depression and anxiety shown in home isolated but not in 
centrally isolated patients. Besides, a significant time effect was identified 
on self-rated health with significant improvement found in home isolated but not 
in centrally isolated patients.
CONCLUSIONS: Home isolation is superior to centralized isolation in the recovery 
of COVID-19-associated depression, anxiety as well as self-rated health. More 
attention needs to be paid to the psychological well-being of centrally isolated 
patients. A sustained and integrated rehabilitation plan is warranted for 
patients with COVID-19 to achieve both physical and psychological recovery.

Copyright © 2021. Published by Elsevier Inc.

DOI: 10.1016/j.jpsychores.2021.110365
PMCID: PMC7816602
PMID: 33581399 [Indexed for MEDLINE]

Conflict of interest statement: The authors report no conflicts of interest 
concerning the content of this manuscript.


3766. J Am Acad Child Adolesc Psychiatry. 2021 Apr;60(4):445-447. doi: 
10.1016/j.jaac.2021.02.001. Epub 2021 Feb 10.

Editorial: Learning From the Pandemic: "Building Back Better" Through Research 
on Risk and Resilience With Diverse Populations.

Biel MG(1), Hamrah O(2).

Author information:
(1)Georgetown University Medical Center; Georgetown University School of 
Medicine; MedStar Georgetown University Hospital, Washington, DC. Electronic 
address: mgb101@gunet.georgetown.edu.
(2)Georgetown University Medical Center; Georgetown University School of 
Medicine; MedStar Georgetown University Hospital, Washington, DC.

The COVID-19 pandemic is responsible for over 2 million deaths and unprecedented 
disruption in the daily lives of people in communities worldwide. Efforts to 
slow viral transmission including quarantine and school closures have introduced 
profound changes in children's lives. Decreased opportunities for social 
interaction and physical activity, reduced instruction time impacting academic 
progress, changing nutritional habits and soaring rates of hunger, and 
increasing digital media use are just several of the myriad ways in which young 
people's lives have been altered. Emerging studies suggest that health and 
emotional wellbeing has been negatively impacted across developmental. There are 
many reasons to suspect that minoritized communities are particularly 
vulnerable, given the disproportionate toll COVID-19 has taken on the physical 
health and economic stability of Black, Latinx/Hispanic, and Native American 
communities who have experienced generations of structural racism and related 
health disparities. These indications of a percolating national and global 
crisis in children's mental health occur against a pre-COVID backdrop of 
inadequate health care infrastructure to meet the needs of children and families 
requiring mental health support. With these deeply concerning trends in mind, 
this month's Journal features new research from Penner et al.1 in which 
investigators found a protective effect of stay-at-home regulations on the 
mental health of a cohort of middle school students in the United States early 
in the pandemic. This study deserves our attention as we seek to understand the 
complex and evolving impacts of the pandemic upon youth mental health, and 
raises important questions about cultural, biological, and social factors that 
might contribute to resilience in specific youth and communities.

Copyright © 2021 American Academy of Child and Adolescent Psychiatry. Published 
by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jaac.2021.02.001
PMID: 33581228 [Indexed for MEDLINE]


3767. Int J Environ Res Public Health. 2021 Feb 10;18(4):1719. doi: 
10.3390/ijerph18041719.

The Effect of the COVID-19 Pandemic Movement Restrictions on Self-Reported 
Physical Activity and Health in New Zealand: A Cross-Sectional Survey.

Meiring RM(1)(2), Gusso S(1), McCullough E(1), Bradnam L(1).

Author information:
(1)Department of Exercise Sciences, Faculty of Science, University of Auckland, 
Auckland 1023, New Zealand.
(2)Movement Physiology Research Laboratory, School of Physiology, University of 
the Witwatersrand, Johannesburg 2193, South Africa.

This study describes self-reported physical activity (PA), motivation to 
exercise, physical and mental health and feelings towards PA during the 
March-May 2020 COVID-19 lockdown in New Zealand. Adults over the age of 18 years 
(n = 238; 80.2% female) completed the International Physical Activity 
Questionnaire (IPAQ), the Behavioural Regulation in Exercise Questionnaire 3, 
the Short Form-36 and open-ended questions about PA through an anonymous online 
survey. Regular exercise was undertaken by 85% of respondents prior to lockdown, 
but only 49.8% were able to maintain their usual level of PA. Although 
respondents were considered sufficiently physically active from the IPAQ, 51.5% 
reported not being able to maintain their usual level of PA primarily due to the 
closure of their gym facilities. Sixty percent of respondents reported that PA 
had a positive effect on their overall wellbeing. When asked to specify which 
aspects of wellbeing were affected, the effect on mental health was reported the 
most while the effect on body image or fitness was reported the least. 
Strategies to increase or maintain engagement in physical activity during 
lockdowns should be encouraged to promote positive mental health during the 
COVID-19 pandemic.

DOI: 10.3390/ijerph18041719
PMCID: PMC7916664
PMID: 33578964 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3768. Int J Environ Res Public Health. 2021 Feb 10;18(4):1710. doi: 
10.3390/ijerph18041710.

The Psychological Impact of Strict and Prolonged Confinement on Business 
Students during the COVID-19 Pandemic at a Spanish University.

Garvey AM(1), García IJ(1), Otal Franco SH(1), Fernández CM(1).

Author information:
(1)Social Dimension and COVID-19, Interdisciplinary Research, Department of 
Economics and Management, Universidad de Alcalá, 28802 Madrid, Spain.

The study was carried out to examine the situation of university students from 
one month after the beginning of a very strict confinement process in Spain 
during the COVID-19 pandemic. Students responded to a survey which included the 
7-item Generalized Anxiety Disorder Scale (GAD-7) together with other questions 
relating to their general well-being from the European Quality of Life Survey 
(EQLS). A total of 198 university students answered the web-based survey. The 
questionnaire was generated using Microsoft Forms and was explained and 
distributed online. The results indicated that around 18.7% of students were 
suffering from severe anxiety and 70.2% were suffering either mild or moderate 
anxiety at this point of the strict confinement process. The findings show that 
when emotional well-being (quality of sleep, the perception of feeling fear, 
death of a relative) is reduced and material well-being is negatively affected 
(income level) anxiety levels are increased. On the other hand, the results show 
that having good interpersonal relationships with family members and taking care 
of personal development (routines and habits that make them feel good) help 
reduce anxiety levels. The female students in the sample also suffered higher 
levels of anxiety than males during strict confinement.

DOI: 10.3390/ijerph18041710
PMCID: PMC7916562
PMID: 33578867 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3769. J Am Coll Health. 2022 Nov-Dec;70(8):2270-2275. doi: 
10.1080/07448481.2020.1869750. Epub 2021 Feb 12.

Substance use, sexual behavior, and general well-being of U.S. college students 
during the COVID-19 pandemic: A brief report.

Firkey MK(1), Sheinfil AZ(1), Woolf-King SE(1).

Author information:
(1)Department of Psychology, Syracuse University, Syracuse, NY, USA.

This study gathered preliminary data on the impact of the U.S. response to the 
COVID-19 pandemic on the substance use, sexual behavior, and general well-being 
of U.S. college students. Participants from colleges across the U.S. (N = 212; 
50.5% female; M age = 22.09) completed an online survey between May 20th and 
July 5th, 2020 about COVID-19-related behavior change. Most students reported a 
decrease in quality of life (71.7%), an increase in levels of anxiety (63.7%), 
and problems with basic resource needs (53.8%). Reports of alcohol consumption 
increased for 26.9% of students and 15.1% reported an increase in cannabis use. 
Most students (57.5%) reported a decrease in sexual activity, yet access to, and 
use of, condoms generally remained unchanged. As universities resume residential 
instruction, existing prevention and intervention services will need to be 
adapted to address the mental and behavioral health needs of college students 
during the era of COVID-19.

DOI: 10.1080/07448481.2020.1869750
PMID: 33577419 [Indexed for MEDLINE]


3770. Pediatr Ann. 2021 Feb 1;50(2):e77-e83. doi: 10.3928/19382359-20210117-01.

Mindfulness in Pediatrics: Practices to Improve Clinician and Patient Mental 
Health and Enhance Well-Being.

Kohut SA, Saltzman A.

Children and adolescents with symptoms of mental health disorders often present 
to primary care settings. In the context of the coronavirus disease 2019 
pandemic, mental health symptoms in children, adolescents, families, and health 
care clinicians are rising. Mindfulness is an approach to improve both mental 
and physical health that can be practiced freely in any circumstance. Although 
not a panacea, research does support the use of mindfulness-based practices not 
only to improve overall well-being but also to address a variety of symptoms and 
diagnoses in numerous populations. This review defines mindfulness, describes 
the current state of the literature, outlines ways to support youth and families 
in cultivating and applying mindfulness in their daily lives, and provides 
guidance for health care clinicians on how to begin a personal practice to 
support their own health and well-being. [Pediatr Ann. 2021;50(2):e77-e83.].

Copyright 2021, SLACK Incorporated.

DOI: 10.3928/19382359-20210117-01
PMID: 33576833 [Indexed for MEDLINE]


3771. Int J Environ Res Public Health. 2021 Jan 29;18(3):1217. doi: 
10.3390/ijerph18031217.

Perceived Benefits and Harms of the COVID-19 Pandemic on Family Well-Being and 
Their Sociodemographic Disparities in Hong Kong: A Cross-Sectional Study.

Wong BY(1), Lam TH(1), Lai AY(2), Wang MP(2), Ho SY(1).

Author information:
(1)School of Public Health, The University of Hong Kong, Hong Kong, China.
(2)School of Nursing, The University of Hong Kong, Hong Kong, China.

We assessed the perceived benefits and harms of COVID-19 on family and their 
associations with sociodemographic factors in Chinese adults in Hong Kong. We 
conducted an online population-based survey and collected 4891 responses in 6 
days. Prevalence estimates were weighted by sex, age, and education of the 
general population, and associations were analyzed using logistic regression. 
Our results showed both perceived benefits: 19.0% for family physical health, 
7.2% family mental health, and 13.5% family relationships; and harms: 2.3% for 
family physical health, 37.9% family mental health, 18.6% family relationships, 
and 37.8% decreased family income. More female or older respondents reported 
perceived benefits but fewer of them reported perceived harms. More respondents 
with higher than lower socioeconomic scores (SES) reported perceived benefits on 
family physical and mental health and family relationships, but more respondents 
with lower than higher SES reported perceived harm on family income. As the 
pandemic continues with uncertainties, further studies on the dynamics of 
benefits and harms are needed. Urgent and additional assistance to 
underprivileged families and at-risk individuals are needed to reduce the 
inequities amidst the COVID-19 pandemic.

DOI: 10.3390/ijerph18031217
PMCID: PMC7908477
PMID: 33572977 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funder had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript, or in the decision to 
publish the results.


3772. Epilepsy Behav. 2021 Mar;116:107800. doi: 10.1016/j.yebeh.2021.107800. Epub 2021 
Jan 29.

Impact of COVID-19 on the lives and psychosocial well-being of persons with 
epilepsy during the third trimester of the pandemic: Results from an 
international, online survey.

Millevert C(1), Van Hees S(2), Siewe Fodjo JN(3), Wijtvliet V(4), Faria de Moura 
Villela E(5), Rosso B(6), Gil-Nagel A(7), Weckhuysen S(1), Colebunders R(8).

Author information:
(1)Department of Neurology, University Hospital Antwerp, Belgium; VIB-Center for 
Molecular Neurology, VIB, University of Antwerp, Belgium.
(2)Global Health Institute, University of Antwerp, Belgium; Laboratory of 
Experimental Medicine and Pediatrics, University of Antwerp, Belgium.
(3)Global Health Institute, University of Antwerp, Belgium.
(4)Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, 
Belgium.
(5)School of Medicine, Health Sciences Unit, Federal University of Jataí, 
Brazil.
(6)Department of Neurology, Italian Hospital of Buenos Aires, Argentina.
(7)Department of Neurology, Hospital Ruber Internacional, Madrid, Spain.
(8)Global Health Institute, University of Antwerp, Belgium. Electronic address: 
Robert.colebunders@uantwerpen.be.

OBJECTIVE: To evaluate the impact of the coronavirus disease 2019 (COVID-19) 
measures on the lives and psychosocial well-being of persons with epilepsy (PWE) 
during the third trimester of the COVID-19 pandemic.
METHODS: A structured questionnaire investigating different aspects of the lives 
and psychosocial well-being of PWE during the COVID-19 pandemic was developed. 
Persons with epilepsy were invited via social media to anonymously respond to a 
secure web-based online questionnaire (www.icpcovid.com). Responses were 
collected between July 26th and December 3rd, 2020. Hospital anxiety and 
depression scales (HADS) were used to screen respondents for depression (HADS-D) 
and anxiety (HADS-A).
RESULTS: Responses of 407 PWE were included in the analysis; 304 (74.7%) 
respondents were female and 245 (60.2%) living in Europe, 157 (38.6%) in South 
America, and 5 (1.2%) in Canada. Seventy-six (18.7%) reported a decrease of 
income during the COVID-19 lockdown, and 122 (30.0%) experienced difficulties in 
obtaining anti-seizure medication (ASM), mostly (72/122, 59.0%) due to 
unavailability. Seizure frequency increased in 122 (30.0%); 295 (72.5%) screened 
positive for anxiety, and 159 (39.1%) for depression. Hundred eighty-eight 
(46.2%) reported reluctance to seek medical care; 27.3% believed that epilepsy 
was associated with an increased risk of COVID-19 disease. Forty-six (74.2%) of 
62 PWE who were followed up by telephone or video consult were satisfied with 
this consult. Fifty-five respondents, most (89.1%) of whom were from Europe, had 
also participated in a previous survey during the early months of the pandemic. 
In this subgroup, although there was no difference in prevalence of a positive 
screening for depression or anxiety, mean scores on HADS-A and HADS-D increased 
from 6.65 ± 3.99 to 7.27 ± 4.01 (p = 0.418), and from 5.84 ± 4.43 to 6.60 ± 4.45 
(p = 0.371), respectively.
CONCLUSIONS: The COVID-19 pandemic continues to impact the psychosocial and 
somatic well-being of PWE. To minimize this impact, ensuring uninterrupted 
access to ASM is essential. Teleconsultations are valid alternatives for 
continued follow-up, but should include attention to psychosocial well-being. 
Persons with epilepsy should be more actively informed that epilepsy is not a 
risk factor for developing (more severe) COVID-19 disease.

Copyright © 2021 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.yebeh.2021.107800
PMCID: PMC8803628
PMID: 33571838 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


3773. PLoS One. 2021 Feb 11;16(2):e0246824. doi: 10.1371/journal.pone.0246824. 
eCollection 2021.

The impact of COVID-19 pandemic on physical and mental health of Asians: A study 
of seven middle-income countries in Asia.

Wang C(1), Tee M(2), Roy AE(3), Fardin MA(4), Srichokchatchawan W(5), Habib 
HA(6), Tran BX(7)(8), Hussain S(9), Hoang MT(10), Le XT(7), Ma W(1), Pham 
HQ(11), Shirazi M(12), Taneepanichskul N(5), Tan Y(1), Tee C(2), Xu L(1), Xu 
Z(1), Vu GT(13), Zhou D(1), Koh BJ(14), McIntyre RS(15), Ho C(16), Ho RC(17), 
Kuruchittham V(18).

Author information:
(1)Institute of Cognitive Neuroscience, Faculty of Education, Huaibei Normal 
University, Huaibei, China.
(2)College of Medicine, University of the Philippines, Manila, Philippines.
(3)University Malaysia Sarawak (UNIMAS), Sarawak, Malaysia.
(4)Department of Psychology, Zahedan Branch, Islamic Azad University, Zahedan, 
Iran.
(5)College of Public Health Sciences, Chulalongkorn University, a member of 
Thailand One Health University Network (THOHUN), Bangkok, Thailand.
(6)Institute of Clinical Psychology, University of Karachi, Karachi, Pakistan.
(7)Institute for Preventive Medicine and Public Health, Hanoi Medical 
University, Hanoi, Vietnam.
(8)Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 
United States of America.
(9)DHQ Hospital Jhelum, Jhelum, Pakistan.
(10)Institute for Global Health Innovations, Duy Tan University, Da Nang, 
Vietnam.
(11)Faculty of Medicine, Duy Tan University, Da Nang, Vietnam.
(12)Department of Psychology, University of Sistan and Baluchestan, Zahedan, 
Iran.
(13)Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh 
University, Ho Chi Minh City, Vietnam.
(14)Department of Psychological Medicine, Yong Loo Lin School of Medicine, 
National University of Singapore, Singapore, Singapore.
(15)Mood Disorders Psychopharmacology Unit, University Health Network, 
University of Toronto, Toronto, Canada.
(16)Department of Psychological Medicine, National University Health System, 
Singapore, Singapore.
(17)Institute for Health Innovation and Technology (iHealthtech), Yong Loo Lin 
School of Medicine, National University of Singapore, Singapore, Singapore.
(18)Southeast Asia One Health University Network (SEAOHUN), Chiang Mai, 
Thailand.

The coronavirus disease (COVID-19) pandemic has impacted the economy, 
livelihood, and physical and mental well-being of people worldwide. This study 
aimed to compare the mental health status during the pandemic in the general 
population of seven middle income countries (MICs) in Asia (China, Iran, 
Malaysia, Pakistan, Philippines, Thailand, and Vietnam). All the countries used 
the Impact of Event Scale-Revised (IES-R) and Depression, Anxiety and Stress 
Scale (DASS-21) to measure mental health. There were 4479 Asians completed the 
questionnaire with demographic characteristics, physical symptoms and health 
service utilization, contact history, knowledge and concern, precautionary 
measure, and rated their mental health with the IES-R and DASS-21. Descriptive 
statistics, One-Way analysis of variance (ANOVA), and linear regression were 
used to identify protective and risk factors associated with mental health 
parameters. There were significant differences in IES-R and DASS-21 scores 
between 7 MICs (p<0.05). Thailand had all the highest scores of IES-R, DASS-21 
stress, anxiety, and depression scores whereas Vietnam had all the lowest 
scores. The risk factors for adverse mental health during the COVID-19 pandemic 
include age <30 years, high education background, single and separated status, 
discrimination by other countries and contact with people with COVID-19 
(p<0.05). The protective factors for mental health include male gender, staying 
with children or more than 6 people in the same household, employment, 
confidence in doctors, high perceived likelihood of survival, and spending less 
time on health information (p<0.05). This comparative study among 7 MICs 
enhanced the understanding of metal health in the general population during the 
COVID-19 pandemic.

DOI: 10.1371/journal.pone.0246824
PMCID: PMC7877638
PMID: 33571297 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


3774. Proc Natl Acad Sci U S A. 2021 Mar 2;118(9):e2016632118. doi: 
10.1073/pnas.2016632118.

Lifestyle and mental health disruptions during COVID-19.

Giuntella O(1), Hyde K(1), Saccardo S(2), Sadoff S(3).

Author information:
(1)Department of Economics, University of Pittsburgh, Pittsburgh, PA 15260.
(2)Department of Social and Decision Sciences, Carnegie Mellon University, 
Pittsburgh, PA 15213.
(3)Rady School of Management, University of California San Diego, La Jolla, CA 
92093.

Using a longitudinal dataset linking biometric and survey data from several 
cohorts of young adults before and during the COVID-19 pandemic ([Formula: see 
text]), we document large disruptions to physical activity, sleep, time use, and 
mental health. At the onset of the pandemic, average steps decline from 10,000 
to 4,600 steps per day, sleep increases by 25 to 30 min per night, time spent 
socializing declines by over half to less than 30 min, and screen time more than 
doubles to over 5 h per day. Over the course of the pandemic from March to July 
2020 the proportion of participants at risk for clinical depression ranges from 
46% to 61%, up to a 90% increase in depression rates compared to the same 
population just prior to the pandemic. Our analyses suggest that disruption to 
physical activity is a leading risk factor for depression during the pandemic. 
However, restoration of those habits through a short-term intervention does not 
meaningfully improve mental well-being.

DOI: 10.1073/pnas.2016632118
PMCID: PMC7936339
PMID: 33571107 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interest.


3775. Nurs Adm Q. 2021 Apr-Jun 01;45(2):169-174. doi: 10.1097/NAQ.0000000000000457.

An Innovative Wellness Partner Program to Support the Health and Well-being of 
Nurses During the COVID-19 Pandemic: Implementation and Outcomes.

Teall AM(1), Mazurek Melnyk B.

Author information:
(1)The Ohio State University College of Nursing, Columbus (Dr Teall); and The 
Ohio State University, Columbus (Dr Melnyk).

Responding to the coronavirus disease-2019 (COVID-19) pandemic is likely to 
exacerbate anxiety, burnout, fatigue, and distress already being experienced by 
nurses in ever greater numbers. An innovative Wellness Partner Program was 
developed with an aim to enhance the health and well-being of nurses on the 
front lines during the COVID-19 pandemic and beyond. Nurses across the country 
opted in to the program, and were paired with advanced practice nursing (APN) 
graduate students who served as the nurses' wellness partners. Areas emphasized 
in the program included (1) personalized support for wellness; (2) prioritizing 
physical activity, healthy eating, sleep, and stress management; and (3) 
establishment of strength-based, sustainable solutions to improve health and 
well-being. Partnerships were implemented for 188 nurses who were coached by 49 
APN students; 104 nurses participated for 6 weeks. In the program evaluation, 
98% of nurses shared that the wellness support program helped them engage in 
self-care and wellness, and 94.7% agreed or strongly agreed that The Wellness 
Partner Program helped them improve their mental and physical health. In the 
midst of the pandemic, nurses were supported to cope with stress, focus on 
self-care and wellness goals, and address challenges to their well-being.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/NAQ.0000000000000457
PMID: 33570883 [Indexed for MEDLINE]

Conflict of interest statement: Drs Teall and Melnyk received a grant from 
Trusted Health to initiate the Wellness Partner Program. No other conflicts of 
interest were declared by either author.


3776. J Urban Health. 2021 Apr;98(2):187-196. doi: 10.1007/s11524-020-00506-x. Epub 
2021 Feb 11.

The Impact of the COVID-19 Pandemic on College Students' Health and Financial 
Stability in New York City: Findings from a Population-Based Sample of City 
University of New York (CUNY) Students.

Jones HE(1)(2), Manze M(3), Ngo V(3)(4), Lamberson P(5), Freudenberg N(3)(5).

Author information:
(1)Department of Epidemiology & Biostatistics, City University of New York 
Graduate School of Public Health and Health Policy (CUNY SPH), New York, NY, 
USA. heidi.jones@sph.cuny.edu.
(2)City University of New York Institute for Implementation Science in 
Population Health, New York, NY, USA. heidi.jones@sph.cuny.edu.
(3)Department of Community Health and Social Sciences, CUNY SPH, New York, NY, 
USA.
(4)City University of New York Center for Innovation in Mental Health, New York, 
NY, USA.
(5)Healthy CUNY, New York, NY, USA.

Understanding the effect of the coronavirus disease 2019 (COVID-19) pandemic on 
students' health and financial stability is important to establish effective 
interventions to mitigate these effects, which may have long-term consequences 
on their health and well-being. Public universities in urban centers represent a 
substantial proportion of college students in the USA. We implemented a 
cross-sectional population-based online survey of 2282 students in a large, 
public university in New York City in April 2020. We created weights to account 
for non-response and used Poisson regression with robust standard errors to 
estimate adjusted prevalence ratios (aPR) for factors associated with mental 
health outcomes. Students experienced high rates of anxiety/depression and 
financial instability due to the pandemic. Half of the students reported 
anxiety/depression (54.5%) and an increased need for mental health services 
(49.0%) as a result of the COVID-19 pandemic. The majority (81.1%) reported loss 
of household income, and half (49.8%) reported worries about losing housing. 
High levels of food (aPR  = 1.4, 95% CI 1.2, 1.6) and housing (aPR = 1.3, 95% CI 
1.2, 1.4) insecurity were the strongest predictors of anxiety/depression. 
Household and personal experiences with possible COVID-19 symptoms were also 
associated with anxiety/depression or the need for increased mental health 
services. Addressing student needs at public urban universities requires an 
integrated holistic approach that targets urgent mental health and economic 
needs related to the impact of COVID-19. Students who become infected need 
mental health services as well as health monitoring.

DOI: 10.1007/s11524-020-00506-x
PMCID: PMC7877316
PMID: 33570739 [Indexed for MEDLINE]


3777. J Nurs Adm. 2021 Mar 1;51(3):156-161. doi: 10.1097/NNA.0000000000000987.

Nurse Leaders Employ Contemplative Practices to Promote Healthcare Professional 
Well-being and Decrease Anxiety.

Cunningham T(1), Çayir E.

Author information:
(1)Author Affiliations: Vice President (Dr Cunningham), Practice & Innovation, 
Emory Healthcare Nell Hodgson Woodruff School of Nursing, Emory University, 
Atlanta, GA; Postdoctoral Research Associate (Dr Cayir), University of Virginia 
School of Nursing, Charlottesville.

OBJECTIVE: The purpose of this study was to test the effectiveness of a daylong 
resilience retreat on healthcare professionals' anxiety levels, intention to 
engage in mindfulness practices, and self-efficacy around mindfulness.
BACKGROUND: Caregiver burnout is a concern that needs to be addressed at the 
organizational level so that professionals can reduce their risk of 
psychological injury while providing high-quality care. The COVID-19 (novel 
coronavirus) pandemic has exacerbated symptoms of burnout among nurses 
nationally.
METHODS: Ten sessions of daylong resilience retreats were delivered to 
independent groups of nurses, nurse practitioners, and other healthcare 
professionals. Preretreat and postretreat assessments were completed using a 
19-item survey developed by the research team to assess state anxiety, intention 
to engage in mindfulness practices, and self-efficacy around mindfulness.
RESULTS: One hundred six healthcare professionals completed the resilience 
retreats. There was a statistically significant decrease in state anxiety scores 
following the retreat. The majority of the participants reported high intentions 
to engage in mindfulness practices and felt confident about incorporating 
mindfulness in their lives.
CONCLUSIONS: Brief resilience retreats endorsed by nurse leadership can reduce 
perceived anxiety and facilitate engagement in contemplative practices, which 
are associated with a decrease in the risk of burnout.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/NNA.0000000000000987
PMID: 33570373 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


3778. Int J Behav Med. 2021 Feb;28(1):1-5. doi: 10.1007/s12529-020-09953-x. Epub 2021 
Feb 10.

Translational Sleep Science in Behavioral Medicine: Introduction to this Special 
Issue.

Williams N(1), Trevorrow T(2).

Author information:
(1)NYU Grossman School of Medicine Division of Health and Behavior Center for 
Healthful Behavior Change, NYU, Langone Health, New York, NY, USA. 
Natasha.williams2@nyulangone.org.
(2)Center for Medical Psychology, Chaminade University Honolulu, Honolulu, HI, 
96816, USA.

The consideration of sleep and circadian rhythms in the context of health is a 
relatively recent development in the history of the field of behavioral 
medicine. This special issue of the International Journal of Behavioral Medicine 
recognizes that sleep and circadian rhythms are fundamental to appreciating 
physiological, psychological, social, and environmental factors in the health 
and well-being of the population. The articles included in this issue draw 
attention to the breadth and saliency of sleep as a marker of health status and 
as a target of behavioral intervention to promote health. Such research 
highlights the diversity of participants, research methods, and clinical 
significance of translational sleep science allowing us to recognize the role of 
sleep in the context of health in new ways. These studies also illustrate 
progress in integrating theory, employing prospective and longitudinal designs 
and multimodal and integrative assessments. This introduction to the special 
issue concludes by discussing challenges and opportunities in the field of 
behavioral sleep medicine, including those posed by the coronavirus disease 2019 
(COVID-19) pandemic and the need to more effectively provide sleep disorder 
treatment among underserved populations.

DOI: 10.1007/s12529-020-09953-x
PMCID: PMC7875169
PMID: 33569758 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


3779. Soc Psychiatry Psychiatr Epidemiol. 2021 Aug;56(8):1459-1468. doi: 
10.1007/s00127-021-02025-9. Epub 2021 Feb 10.

A longitudinal study on the COVID-19 pandemic and its divergent effects on 
social participation and mental health across different study groups with and 
without mental disorders.

Mergel E(1), Schützwohl M(2).

Author information:
(1)Department of Psychiatry and Psychotherapy, Technische Universität Dresden, 
Fetscherstraße 74, 01307, Dresden, Germany.
(2)Department of Psychiatry and Psychotherapy, Technische Universität Dresden, 
Fetscherstraße 74, 01307, Dresden, Germany. matthias.schuetzwohl@ukdd.de.

PURPOSE: With the rapid spread of COVID-19 and the restrictions imposed in many 
parts of the world, there is growing concern about its impact on mental health. 
This longitudinal study investigated the social participation, social inclusion 
and psychological well-being in adults with and without mental disorders before 
the beginning of the pandemic, as well as during and after strict lockdown 
restrictions in Germany.
METHODS: The sample (n = 106) consisted of three groups: participants with a 
chronic mental disorder, with an acute mental disorder, and without a mental 
disorder at the time of the initial survey. Parameters of interest were assessed 
using the Measure of Participation and Social Inclusion for Use in People with a 
Chronic Mental Disorder (F-INK), the Index for the Assessment of Health 
Impairments (IMET) and the Brief Symptom Inventory (BSI-18).
RESULTS: The perceived impairments in social participation and the associated 
changes in behaviour varied depending on the presence of a mental disorder at 
the time of the initial survey and were largely temporary, i.e. limited to the 
period of strict lockdown restrictions. We found no further detrimental effects 
on mental health 4 weeks after lockdown or later, when a policy of physical 
distancing was in place.
CONCLUSION: Overall, our findings suggest a general resilience to the official 
restrictions and measures as well as the pandemic itself. However, further 
efforts are needed to improve the situation of people with chronic mental 
disorders and their limited opportunities for social participation.

© 2021. The Author(s).

DOI: 10.1007/s00127-021-02025-9
PMCID: PMC7875168
PMID: 33569650 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no known 
competing financial interests or personal relationships that could have appeared 
to influence the work reported in this paper.


3780. BMJ Open. 2021 Feb 10;11(2):e044965. doi: 10.1136/bmjopen-2020-044965.

Cohort profile: the COVID-19 Coping Study, a longitudinal mixed-methods study of 
middle-aged and older adults' mental health and well-being during the COVID-19 
pandemic in the USA.

Kobayashi LC(1), O'Shea BQ(2), Kler JS(2), Nishimura R(3), Palavicino-Maggio 
CB(4), Eastman MR(2), Vinson YR(2)(5), Finlay JM(6).

Author information:
(1)Center for Social Epidemiology and Population Health, Department of 
Epidemiology, University of Michigan School of Public Health, Ann Arbor, 
Michigan, USA lkob@umich.edu.
(2)Center for Social Epidemiology and Population Health, Department of 
Epidemiology, University of Michigan School of Public Health, Ann Arbor, 
Michigan, USA.
(3)Survey Research Center, University of Michigan Institute for Social Research, 
Ann Arbor, Michigan, USA.
(4)Department of Neurobiology, Harvard Medical School, Boston, Massachusetts, 
USA.
(5)Department of Health Management and Policy, University of Michigan School of 
Public Health, Ann Arbor, Michigan, USA.
(6)Social Environment and Health Program, Survey Research Center, University of 
Michigan Institute for Social Research, Ann Arbor, Michigan, USA.

PURPOSE: The COVID-19 pandemic, beginning in early 2020, has resulted in massive 
social, economic, political and public health upheaval around the world. We 
established a national longitudinal cohort study, the COVID-19 Coping Study, to 
investigate the effects of pandemic-related stressors and changes in life 
circumstances on mental health and well-being among middle-aged and older adults 
in the USA.
PARTICIPANTS: From 2 April to 31 May 2020, 6938 adults aged ≥55 years were 
recruited from all 50 US states, the District of Columbia and Puerto Rico using 
online, multi-frame non-probability-based sampling.
FINDINGS TO DATE: Mean age of the baseline sample was 67.3 years (SD: 7.9 years) 
and 64% were women. Two in three adults reported leaving home only for essential 
purposes in the past week (population-weighted proportion: 69%; 95% CI: 68% to 
71%). Nearly one in five workers aged 55-64 years was placed on a leave of 
absence or furloughed since the start of the pandemic (17%; 95% CI: 14% to 20%), 
compared with one in three workers aged ≥75 years (31%; 95% CI: 21% to 44%). 
Nearly one-third of adults screened positive for each of depression (32%; 
95% CI: 30% to 34%), anxiety (29%; 28% to 31%) and loneliness (29%; 95% CI: 27% 
to 31%), with decreasing prevalence of each with increasing age.
FUTURE PLANS: Monthly and annual follow-ups of the COVID-19 Coping Study cohort 
will assess longitudinal changes to mental health, cognitive health and 
well-being in relation to social, behavioural, economic and other 
COVID-19-related changes to life circumstances. Quantitative and in-depth 
qualitative interview data will be collected through online questionnaires and 
telephone interviews. Cohort data will be archived for public use.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2020-044965
PMCID: PMC7878052
PMID: 33568377 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3781. BMC Psychiatry. 2021 Feb 10;21(1):91. doi: 10.1186/s12888-021-03090-9.

Experiences and management of physician psychological symptoms during infectious 
disease outbreaks: a rapid review.

Fiest KM(#)(1)(2)(3), Parsons Leigh J(#)(4)(5), Krewulak KD(6), Plotnikoff 
KM(6), Kemp LG(6), Ng-Kamstra J(6), Stelfox HT(6)(7)(4).

Author information:
(1)Department of Critical Care Medicine, Cumming School of Medicine, University 
of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, 
Canada. kmfiest@ucalgary.ca.
(2)Department of Community Health Sciences, Cumming School of Medicine, 
University of Calgary, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada. 
kmfiest@ucalgary.ca.
(3)O'Brien Institute for Public Health, Cumming School of Medicine, University 
of Calgary, 3134 Hospital Drive NW, Calgary, Alberta, T2N4Z6, Canada. 
kmfiest@ucalgary.ca.
(4)O'Brien Institute for Public Health, Cumming School of Medicine, University 
of Calgary, 3134 Hospital Drive NW, Calgary, Alberta, T2N4Z6, Canada.
(5)School of Health Administration, Faculty of Health and Department of Critical 
Care Medicine, Faculty of Medicine, Dalhousie University, 5850 College Street, 
Halifax, Nova Scotia, B3H4R2, Canada.
(6)Department of Critical Care Medicine, Cumming School of Medicine, University 
of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, 
Canada.
(7)Department of Community Health Sciences, Cumming School of Medicine, 
University of Calgary, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada.
(#)Contributed equally

BACKGROUND: Prior to the COVID-19 pandemic, physicians experienced unprecedented 
levels of burnout. The uncertainty of the ongoing COVID-19 pandemic along with 
increased workload and difficult medical triage decisions may lead to a further 
decline in physician psychological health.
METHODS: We searched Medline, EMBASE, and PsycINFO for primary research from 
database inception (Medline [1946], EMBASE [1974], PsycINFO [1806]) to November 
17, 2020. Titles and abstracts were screened by one of three reviewers and 
full-text article screening and data abstraction were conducted independently, 
and in duplicate, by three reviewers.
RESULTS: From 6223 unique citations, 480 articles were reviewed in full-text, 
with 193 studies (of 90,499 physicians) included in the final review. Studies 
reported on physician psychological symptoms and management during seven 
infectious disease outbreaks (severe acute respiratory syndrome [SARS], three 
strains of Influenza A virus [H1N1, H5N1, H7N9], Ebola, Middle East respiratory 
syndrome [MERS], and COVID-19) in 57 countries. Psychological symptoms of 
anxiety (14.3-92.3%), stress (11.9-93.7%), depression (17-80.5%), post-traumatic 
stress disorder (13.2-75.2%) and burnout (14.7-76%) were commonly reported among 
physicians, regardless of infectious disease outbreak or country. Younger, 
female (vs. male), single (vs. married), early career physicians, and those 
providing direct care to infected patients were associated with worse 
psychological symptoms.
INTERPRETATION: Physicians should be aware that psychological symptoms of 
anxiety, depression, fear and distress are common, manifest differently and 
self-management strategies to improve psychological well-being exist. Health 
systems should implement short and long-term psychological supports for 
physicians caring for patients with COVID-19.

DOI: 10.1186/s12888-021-03090-9
PMCID: PMC7875435
PMID: 33568141 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3782. PLoS One. 2021 Feb 10;16(2):e0245214. doi: 10.1371/journal.pone.0245214. 
eCollection 2021.

Yoga an effective strategy for self-management of stress-related problems and 
wellbeing during COVID19 lockdown: A cross-sectional study.

Sahni PS(1), Singh K(1)(2), Sharma N(1), Garg R(1)(3)(4).

Author information:
(1)National Resource Centre for Value Education in Engineering, Indian Institute 
of Technology Delhi, Noida, India.
(2)Department of Humanities and Social Sciences, Indian Institute of Technology 
Delhi, New Delhi, India.
(3)Department of Computer Science and Engineering, Indian Institute of 
Technology Delhi, New Delhi, India.
(4)Amar Nath and Shahsi Khosla School of Information Technology, Indian 
Institute of Technology Delhi, New Delhi, India.

This cross-sectional research aims to study the effect of yoga practice on the 
illness perception, and wellbeing of healthy adults during 4-10 weeks of 
lockdown due to COVID19 outbreak. A total of 668 adults (64.7% males, M = 28.12 
years, SD = 9.09 years) participated in the online survey. The participants were 
grouped as; yoga practitioners, other spiritual practitioners, and 
non-practitioners based on their responses to daily practices that they follow. 
Yoga practitioners were further examined based on the duration of practice as; 
long-term, mid-term and beginners. Multivariate analysis indicates that yoga 
practitioners had significantly lower depression, anxiety, & stress (DASS), and 
higher general wellbeing (SWGB) as well as higher peace of mind (POMS) than the 
other two groups. The results further revealed that the yoga practitioners 
significantly differed in the perception of personal control, illness concern 
and emotional impact of COVID19. However, there was no significant difference 
found for the measure of resilience (BRS) in this study. Yoga practitioners also 
significantly differed in the cognitive reappraisal strategy for regulating 
their emotions than the other two groups. Interestingly, it was found that 
beginners -those who had started practicing yoga only during the lockdown period 
reported no significant difference for general wellbeing and peace of mind when 
compared to the mid- term practitioner. Evidence supports that yoga was found as 
an effective self- management strategy to cope with stress, anxiety and 
depression, and maintain wellbeing during COVID19 lockdown.

DOI: 10.1371/journal.pone.0245214
PMCID: PMC7875402
PMID: 33566848 [Indexed for MEDLINE]

Conflict of interest statement: No authors have competing interests.


3783. Pacing Clin Electrophysiol. 2021 Mar;44(3):451-461. doi: 10.1111/pace.14188. 
Epub 2021 Feb 17.

Effect of a virtual self-management intervention for atrial fibrillation during 
the outbreak of COVID-19.

Rosman L(1), Armbruster T(1), Kyazimzade S(2), Tugaoen Z(2), Mazzella AJ(1), 
Deyo Z(3)(4), Walker J(1), Machineni S(5), Gehi A(1).

Author information:
(1)Department of Medicine, Division of Cardiology, University of North Carolina 
at Chapel Hill, Chapel Hill, North Carolina, USA.
(2)Department of Medicine, University of North Carolina at Chapel Hill, Chapel 
Hill, North Carolina, USA.
(3)Department of Pharmacy, University of North Carolina Hospitals, Chapel Hill, 
North Carolina, USA.
(4)Division of Practice Advancement and Clinical Education, University of North 
Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA.
(5)Department of Medicine, Division of Endocrinology & Metabolism, University of 
North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

BACKGROUND: As the pandemic continues to unfold, effective, technology-based 
solutions are needed to help patients with atrial fibrillation (AF) maintain 
their health and well-being during the outbreak of COVID-19.
METHODS: This single-center, pilot study investigated the effects of a 4-week 
(eight sessions) virtual AF self-management program. Questionnaires were 
completed at baseline and 1 week after the intervention, and assessed AF 
knowledge, adherence to self-management behaviors, mental health, physical 
function, and disease-specific quality of life in patients with AF. Secondary 
outcomes included knowledge of COVID-19, intervention, acceptability, and 
satisfaction.
RESULTS: Of 68 patients who completed baseline questionnaires, 57 participated 
in the intervention and were included in the analysis (mean age of 73.4 ± 10.0 
years, 60% male). Adherence to AF self-monitoring behaviors, including 
monitoring their heart rate (p < .001), heart rhythm (p = .003), and blood 
pressure (p = .013) were significantly improved at the end of the intervention 
compared with baseline. Symptom identification (p = .007) and management 
(p < .001) also improved. Reductions in sleep disturbance (p < .001), anxiety 
(p = .014), and depression (p = .046) were also observed. Misinformation and 
inaccurate beliefs about COVID-19 were significantly reduced at the end of the 
intervention compared with baseline.
CONCLUSIONS: This pilot study suggests that a virtual patient education program 
could have beneficial effects on adherence to guideline-recommend self-care of 
AF, emotional wellbeing, physical function, and knowledge of COVID-19 in 
patients with AF. Future randomized studies in larger samples are needed to 
determine the clinical benefits of the intervention.

© 2021 Wiley Periodicals LLC.

DOI: 10.1111/pace.14188
PMCID: PMC8014277
PMID: 33565642 [Indexed for MEDLINE]

Conflict of interest statement: Anil K. Gehi, MD: Research Grant: Bristol‐Myers 
Squib Foundation, Honoraria/Consulting Fees: Biosense‐Webster, Abbott, 
Biotronik, Zoll Medical. Jennifer Walker, MSN, ANP has received salary support 
from the Bristol‐Myers Squib Foundation. Sriram Machineni, MD: Research funding: 
Novo Nordisk, Boeringher Ingelheim, Consulting Fees: Novo Nordisk, Rhythm 
Pharmaceuticals.


3784. Pediatr Blood Cancer. 2021 Apr;68(4):e28943. doi: 10.1002/pbc.28943. Epub 2021 
Feb 9.

Impacts of COVID-19 on caregivers of childhood cancer survivors.

Wimberly CE(1), Towry L(2), Caudill C(3), Johnston EE(4), Walsh KM(1)(5)(6).

Author information:
(1)Division of Neuro-Epidemiology, Department of Neurosurgery, Duke University 
School of Medicine, Durham, North Carolina, USA.
(2)Alex's Lemonade Stand Foundation, Bala Cynwyd, Pennsylvania, USA.
(3)Institute for Cancer Survivorship and Outcomes, University of Alabama at 
Birmingham, Birmingham, Alabama, USA.
(4)Division of Pediatric Hematology/Oncology, Department of Pediatrics, 
University of Alabama at Birmingham, Birmingham, Alabama, USA.
(5)Duke Cancer Institute, Duke University School of Medicine, Durham, North 
Carolina, USA.
(6)Children's Health and Discovery Institute, Department of Pediatrics, Duke 
University School of Medicine, Durham, North Carolina, USA.

PURPOSE: We sought to assess the impact of disruptions due to coronavirus 
disease 2019 (COVID-19) on caregivers of childhood cancer survivors.
METHODS: A 13-question survey containing multiple-choice, Likert-type, and 
free-text questions on experiences, behaviors, and attitudes during the COVID-19 
outbreak was sent to childhood cancer caregivers and completed between April 13 
and May 17, 2020. Ordered logistic regression was used to investigate 
relationships between demographics, COVID-related experiences, and caregiver 
well-being.
RESULTS: Caregivers from 321 unique families completed the survey, including 175 
with children under active surveillance/follow-up care and 146 with children no 
longer receiving oncology care. Overall, caregivers expressed exceptional 
resiliency, highlighting commonalities between caring for a child with cancer 
and adopting COVID-19 prophylactic measures. However, respondents reported 
delayed/canceled appointments (50%) and delayed/canceled imaging (19%). Eleven 
percent of caregivers reported struggling to pay for basic needs, which was 
associated with greater disruption to daily life, greater feelings of anxiety, 
poorer sleep, and less access to social support (p < .05). Caregivers who were 
self-isolating reported greater feelings of anxiety and poorer sleep (p < .05). 
Respondents who expressed confidence in the government response to COVID-19 
reported less disruption to their daily life, decreased feelings of depression 
and anxiety, better sleep, and greater hopefulness (p < .001) CONCLUSIONS: 
Caregivers are experiencing changes to medical care, financial disruptions, and 
emotional distress due to COVID-19. To better serve caregivers and medically 
at-risk children, clinicians must evaluate financial toxicity and feelings of 
isolation in families affected by childhood cancer, and work to provide reliable 
information on how COVID-19 may differentially impact their children.

© 2021 Wiley Periodicals LLC.

DOI: 10.1002/pbc.28943
PMCID: PMC7995053
PMID: 33565259 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that there is no conflict of 
interest.


3785. Public Health Nutr. 2021 May;24(7):1836-1840. doi: 10.1017/S1368980021000628. 
Epub 2021 Feb 10.

Coronavirus disease 2019, food security and maternal mental health in Ceará, 
Brazil: a repeated cross-sectional survey.

Rocha HA(1)(2)(3), Sudfeld CR(1), Leite ÁJ(3)(4), Rocha SG(4), Machado MM(3), 
Campos JS(4), Silva AC(4), Correia LL(3).

Author information:
(1)Department of Global Health and Population, Harvard T. H. Chan School of 
Public Health, Boston, MA, USA.
(2)Department of Maternal and Child Health, Federal University of Ceará, 
Fortaleza, Brazil.
(3)Department of Community Health, Federal University of Ceará, Fortaleza, 
Brazil.
(4)Service, Education and Community Integration, University Center Unichristus, 
Fortaleza, Brazil.

OBJECTIVE: To quantify the change in the risk of food insecurity and maternal 
mental disorder (MMD) before and during the coronavirus disease 2019 (COVID-19) 
pandemic.
DESIGN: Repeated cross-sectional survey. Between 17 July and 10 September 2020, 
mother-child pairs who were enrolled in a population-based survey in 2017 were 
re-contacted by telephone for consent and to complete a telephonic COVID-19 
survey. We used the Brazilian Food Insecurity Scale to assess food security and 
the Self Reporting Questionnaire-20 to assess MMD. McNemar's test for paired 
data that also accounted for clustering was used. Logistic regression was used 
to assess the relationship of unemployment and receipt of government assistance 
with food insecurity and MMD in 2020.
SETTING: Ceará, Brazil.
PARTICIPANTS: Five hundred and seventy-seven mother-child pairs completed the 
2017 and 2020 surveys. At the time of the 2020 interview, the child cohort was 
36-108 months of age.
RESULTS: The proportion of mothers reporting food insecurity was 15·5 % higher 
(95 % CI 5·9, 25·1, P value < 0·001) during the pandemic in July-August 2020 as 
compared with November 2017, while the prevalence of MMD was 40·2 % higher 
during the pandemic (95 % CI 32·6, 47·8, P value < 0·001). Loss of formal 
employment was associated with increased risk of food insecurity, but not with 
the risk of MMD.
CONCLUSIONS: The risk of food insecurity and MMD in Ceará increased during the 
COVID-19 pandemic. These findings highlight the need for policies and 
interventions to reduce the impact of the COVID-19 pandemic on maternal and 
child health, nutrition and well-being in Brazil.

DOI: 10.1017/S1368980021000628
PMCID: PMC7948104
PMID: 33563355 [Indexed for MEDLINE]


3786. Int J Environ Res Public Health. 2021 Feb 5;18(4):1453. doi: 
10.3390/ijerph18041453.

Treatment, Persistent Symptoms, and Depression in People Infected with COVID-19 
in Bangladesh.

Islam MS(1)(2), Ferdous MZ(1), Islam US(1), Mosaddek ASM(3)(4), Potenza 
MN(5)(6)(7)(8), Pardhan S(9).

Author information:
(1)Department of Public Health and Informatics, Jahangirnagar University, Savar, 
Dhaka 1342, Bangladesh.
(2)Youth Research Association, Savar, Dhaka 1342, Bangladesh.
(3)Department of Pharmacology, Uttara Adhunik Medical College, Uttara, Dhaka 
1230, Bangladesh.
(4)Quest Bangladesh Biomedical Research Center, Lalmatia, Dhaka 1207, 
Bangladesh.
(5)Department of Psychiatry, and Child Study Center, Yale School of Medicine, 
New Haven, CT 06510, USA.
(6)Connecticut Mental Health Center, New Haven, CT 06519, USA.
(7)Connecticut Council on Problem Gambling, Wethersfield, CT 06519, USA.
(8)Department of Neuroscience, Yale University, New Haven, CT 06510, USA.
(9)Vision and Eye Research Institute, School of Medicine, Anglia Ruskin 
University, Young Street, Cambridge CB1 2LZ, UK.

Background: Coronavirus disease (COVID-19) has affected people's lives globally. 
While important research has been conducted, much remains to be known. In 
Bangladesh, initial treatment (self-administered, hospitalized), persistent 
COVID-19 symptoms ("long COVID-19"), and whether COVID-19 leads to changes in 
mental state, such as depressive symptoms, of people are not known. This study 
aimed to examine treatment, persistent symptoms, and depression in people who 
had been infected with COVID-19 in Bangladesh. Methods: A cross-sectional survey 
was conducted on 1002 individuals infected with COVID-19 (60% male; mean age = 
34.7 ± 13.9; age range = 18-81 years), with data taken over a one-month period 
(11 September 2020 to 13 October 2020). A self-reported online questionnaire was 
used to collect data on socio-demographics, lifestyle, COVID-19 symptoms (during 
and beyond COVID-19), medication (over-the-counter or doctor-prescribed), and 
depression (assessed using the Patient Health Questionnaire (PHQ-9)). Results: 
Twenty-four percent of participants self-medicated with over-the-counter 
medicine when they were first diagnosed with COVID-19. Self-medication was 
higher among female vs. male respondents (29.6% vs. 20.2%, respectively, p = 
0.002). A minority (20%) reported that they experienced persistent COVID-like 
symptoms after recovering from COVID-19. The most reported persistent symptoms 
were diarrhea (12.7%) and fatigue (11.5%). Forty-eight percent of participants 
were categorized as having moderate to severe depression. Based on multivariate 
regression analysis, depression during COVID-19 was positively associated with 
lower family income, poor health status, sleep disturbance, lack of physical 
activity, hypertension, asthma/respiratory problems, fear of COVID-19 
re-infection, and persistent COVID-19 symptoms. Conclusions: The findings 
suggest a need for appropriate interventions for COVID-19 patients to promote 
physical and mental wellbeing.

DOI: 10.3390/ijerph18041453
PMCID: PMC7914967
PMID: 33562427 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. 
Potenza has consulted for and advised the Addiction Policy Forum, Game Day Data, 
AXA, Idorsia and Opiant/Lakelight Therapeutics; received research support from 
the Mohegan Sun Casino and the National Center for Responsible Gaming (now the 
International Center for Responsible Gaming); participated in surveys, mailings, 
or telephone consultations related to drug addiction, impulse-control disorders, 
or other health topics; consulted for legal and gambling entities on issues 
related to impulse-control and addictive disorders; performed grant reviews for 
the National Institutes of Health and other agencies; edited journals and 
journal sections; given academic lectures in grand rounds, CME events, and other 
clinical/scientific venues; and generated books or chapters for publishers of 
mental health texts. The other authors report no disclosures. The views 
presented in this manuscript represent those of the authors and not necessarily 
those of the funding agencies.


3787. Int Arch Occup Environ Health. 2021 Jul;94(5):1023-1032. doi: 
10.1007/s00420-021-01656-4. Epub 2021 Feb 9.

Symptoms related to mental disorder in healthcare workers during the COVID-19 
pandemic in Brazil.

Campos JADB(1), Martins BG(2), Campos LA(3)(4), de Fátima Valadão-Dias F(5), 
Marôco J(6).

Author information:
(1)School of Pharmaceutical Sciences, São Paulo State University (UNESP), 
Rodovia Araraquara Jaú, Km 01, Araraquara, São Paulo, 14800-903, Brazil. 
juliana.campos@unesp.br.
(2)School of Pharmaceutical Sciences, São Paulo State University (UNESP), 
Rodovia Araraquara Jaú, Km 01, Araraquara, São Paulo, 14800-903, Brazil.
(3)School of Dentistry, São Paulo State University (UNESP), Campus (Araraquara), 
Rua Humaitá, 1680, Centro, Araraquara, SP, 14801-140, Brazil.
(4)Faculty of Medicine and Health Technology, Tampere University, Finn-Medi 2, 
FI-33520, Tampere, Finland.
(5)PsiRelacional (Relational Psychoanalysis Association), Consultório Almirante 
Reis, Almirante Reis, nº 238/1° Direito, 1000-166, Lisbon, Portugal.
(6)William James Center for Research (WJCR), University Institute of 
Psychological, Social, and Life Sciences (ISPA), Rua Jardim Do Tabaco, nº34, 
1149-041, Lisbon, Portugal.

BACKGROUND: Studies of previous pandemics indicate that healthcare workers have 
a high risk of developing symptoms related to mental health, especially 
depression, anxiety, and stress.
OBJECTIVE: To identify mental disorder symptoms among Brazilian healthcare 
workers during the Sars-Cov-2 pandemic and compare findings in different work 
categories.
METHODS: This was an online cross-sectional study. Information related to the 
pandemic and mental disorder symptoms was collected. The Depression, Anxiety, 
and Stress Scale and the Impact of Event Scale-revised were used. Associations 
were estimated by the chi-square test. The mean scores were compared among work 
categories with ANOVA (α = 5%) and the prevalence of symptoms was estimated.
RESULTS: 1,609 healthcare workers participated in the survey [mean age: 36.9 
(SD = 11.6) years, women = 83.6%]. There was no association between work 
category and changes in mental health during the pandemic (p = 0.288) or 
prevalence of unsafe feeling (p = 0.218). A significant relationship was 
observed between maintaining work activities during the pandemic and work 
category (p < 0.001). Physicians had the lowest out-of-work prevalence (9.5%) 
while dentists had the highest (32.3%). Physicians and nurses showed the highest 
prevalence of in-person work routine. Psychologists presented the highest 
prevalence of remote work (64.0%) while dentists had the lowest (20.2%). A high 
prevalence of depression (D), anxiety (A), and stress (S) symptoms was observed 
in all professional categories (D: 57.2, 95% CI 48.3-66.1%; A: 46.20%, 95% 
CI = 37.2-55.2%; S: 55.80%, 95% CI = 46.8-64.8%), with physicians (D = 38.4%, 
A = 25.80%, S = 37.90%), psychologists (D = 50.2%, A = 39.0%, S = 43.1%), and 
nurses (D = 50.0%, A = 40.9%, S = 49.0%) having significantly lower scores. 
Psychologists had the lowest pandemic-related psychological impact (42.70%, 95% 
CI 36.8-48.6%).
CONCLUSION: Extreme changes in the work routine of dentists and psychologists 
and an overall high prevalence of mental symptoms due to the pandemic were 
found. Researchers should focus on gathering information that can identify 
workers at increased risk of mental illness to guide discussions and develop 
actions to minimize the harm of the pandemic. In addition, we suggest that 
healthcare and support systems urgently adopt mental health care measures with 
specialized professionals to protect the psychological well-being of the 
healthcare community.

DOI: 10.1007/s00420-021-01656-4
PMCID: PMC7871020
PMID: 33559748 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


3788. Psychol Health Med. 2022 Jan;27(1):249-256. doi: 10.1080/13548506.2021.1883687. 
Epub 2021 Feb 9.

Disordered eating behaviors and psychological health during the COVID-19 
pandemic.

Chan CY(1), Chiu CY(1).

Author information:
(1)The Felizberta Lo Padilla Tong School of Social Sciences, Caritas Institute 
of Higher Education, Hong Kong, China.

This study aims to investigate dietary changes, psychological well-being, 
symptoms of anxiety and depression occurring during the 2019 novel coronavirus 
disease (COVID-19) and their associations with symptoms of eating disorders. A 
sample of 316 Hong Kong Chinese was assessed using standardized instruments from 
March to April 2020. 86.1% of participants indicated that they had made at least 
one dietary change due to the pandemic. 26.5% of participants have a possible 
case of eating disorders. Participants with a possible case of eating disorders 
reported significantly higher levels of depression and anxiety symptoms and 
lower levels of three dimensions of psychological well-being (environmental 
mastery, purpose in life and self-acceptance). The result pointed to the need 
for more clinical attention to eating disorders during the COVID-19 Pandemic.

DOI: 10.1080/13548506.2021.1883687
PMID: 33559483 [Indexed for MEDLINE]


3789. BMJ Open. 2021 Feb 8;11(2):e047353. doi: 10.1136/bmjopen-2020-047353.

Psychosocial impact on frontline health and social care professionals in the UK 
during the COVID-19 pandemic: a qualitative interview study.

Aughterson H(1), McKinlay AR(2), Fancourt D(2), Burton A(2).

Author information:
(1)Department of Behavioural Science and Health, University College London 
Research Department of Epidemiology and Public Health, London, UK 
henry.aughterson.14@ucl.ac.uk.
(2)Department of Behavioural Science and Health, University College London 
Research Department of Epidemiology and Public Health, London, UK.

OBJECTIVES: To explore the psychosocial well-being of health and social care 
professionals working during the COVID-19 pandemic.
DESIGN: This was a qualitative study deploying in-depth, individual interviews, 
which were audio-recorded and transcribed verbatim. Thematic analysis was used 
for coding.
PARTICIPANTS: This study involved 25 participants from a range of frontline 
professions in health and social care.
SETTING: Interviews were conducted over the phone or video call, depending on 
participant preference.
RESULTS: From the analysis, we identified 5 overarching themes: communication 
challenges, work-related stressors, support structures, personal growth and 
individual resilience. The participants expressed difficulties such as 
communication challenges and changing work conditions, but also positive factors 
such as increased team unity at work, and a greater reflection on what matters 
in life.
CONCLUSIONS: This study provides evidence on the support needs of health and 
social care professionals amid continued and future disruptions caused by the 
pandemic. It also elucidates some of the successful strategies (such as 
mindfulness, hobbies, restricting news intake, virtual socialising activities) 
deployed by health and social care professionals that can support their 
resilience and well-being and be used to guide future interventions.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/bmjopen-2020-047353
PMCID: PMC7871227
PMID: 33558364 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3790. BMC Public Health. 2021 Feb 8;21(1):314. doi: 10.1186/s12889-021-10351-5.

Impacts of the Covid-19 lockdown and relevant vulnerabilities on capability 
well-being, mental health and social support: an Austrian survey study.

Simon J(1)(2), Helter TM(3), White RG(4), van der Boor C(4), Łaszewska A(3).

Author information:
(1)Department of Health Economics, Center for Public Health, Medical University 
of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria. 
judit.simon@meduniwien.ac.at.
(2)Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, 
OX3 7JX, UK. judit.simon@meduniwien.ac.at.
(3)Department of Health Economics, Center for Public Health, Medical University 
of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria.
(4)Primary Care and Mental Health, Institute of Population Health, University of 
Liverpool, School of Psychology, Brownlow Hill, Liverpool, L69 3GB, UK.

BACKGROUND: Impacts of the Covid-19 pandemic and its public health measures go 
beyond physical and mental health and incorporate wider well-being impacts in 
terms of what people are free to do or be. We explored the impacts of the 
Covid-19 lockdown and relevant vulnerabilities on capability well-being, mental 
health and social support in Austria.
METHODS: Adult Austrian residents (n = 560) provided responses to a 
cross-sectional online survey about their experiences during Covid-19 lockdown 
(15 March-15 April 2020). Instruments measuring capabilities (OxCAP-MH), 
depression and anxiety (HADS), social support (MSPSS) and mental well-being 
(WHO-5) were used in association with six pre-defined vulnerabilities using 
multivariable linear regression.
RESULTS: 31% of the participants reported low mental well-being and only 30% of 
those with a history of mental health treatment received treatment during 
lockdown. Past mental health treatment had a significant negative effect across 
all outcome measures with an associated capability well-being score reduction of 
- 6.54 (95%CI, - 9.26, - 3.82). Direct Covid-19 experience and being 'at risk' 
due to age and/or physical health conditions were also associated with 
significant capability deprivations. When adjusted for vulnerabilities, 
significant capability reductions were observed in association with increased 
levels of depression (- 1.77) and anxiety (- 1.50), and significantly higher 
capability levels (+ 3.75) were associated with higher levels of social support. 
Compared to the cohort average, individual capability impacts varied between 
- 9% for those reporting past mental health treatment and + 5% for those 
reporting one score higher on the social support scale.
CONCLUSIONS: Our study is the first to assess the capability limiting aspects of 
lockdown and relevant vulnerabilities alongside their impacts on mental health 
and social support. The negative capability well-being, mental health and social 
support impacts of the Covid-19 lockdown were strongest for people with a 
history of mental health treatment. Future public health policies concerning 
lockdowns should pay special attention to improve social support levels in order 
to increase public resilience.

DOI: 10.1186/s12889-021-10351-5
PMCID: PMC7868863
PMID: 33557816 [Indexed for MEDLINE]

Conflict of interest statement: JS has led the development of the OxCAP-MH 
measure. The remaining authors declare that they have no conflict of interest.


3791. BMC Psychiatry. 2021 Feb 8;21(1):80. doi: 10.1186/s12888-021-03076-7.

Prevalence and predictors of posttraumatic stress disorder, depression and 
anxiety among hospitalized patients with coronavirus disease 2019 in China.

Chen Y(#)(1)(2), Huang X(#)(1)(2), Zhang C(3), An Y(4), Liang Y(1)(2), Yang 
Y(1)(2), Liu Z(5)(6).

Author information:
(1)CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy 
of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China.
(2)Department of Psychology, University of Chinese Academy of Sciences, Beijing, 
China.
(3)Department of Respiratory and Critical Care Medicine, East District of the 
First Affiliated Hospital of Anhui Medical University (Feidong People's 
Hospital), Feidong, China.
(4)School of Psychology, Nanjing Normal University, Nanjing, China.
(5)CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy 
of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China. 
liuzk@psych.ac.cn.
(6)Department of Psychology, University of Chinese Academy of Sciences, Beijing, 
China. liuzk@psych.ac.cn.
(#)Contributed equally

BACKGROUND: Coronavirus disease 2019 (COVID-19) has affected more than 5 million 
people around the world and killed more than 300,000 people; thus, it has become 
a global public health emergency. Our objective was to investigate the mental 
health of hospitalized patients diagnosed with COVID-19.
METHODS: The PTSD checklist for DSM-5 (PCL-5), Patient Health Questionnaire 
(PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), Trauma Exposure Scale, 
abbreviated version of the Connor-Davidson Resilience Scale (CD-RISC-10), 
Perceived Social Support Scale (PSSS) and Demographic Questionnaire were used to 
examine posttraumatic stress disorder (PTSD), depression, anxiety, trauma 
exposure, resilience and perceived social support among 898 patients who were 
hospitalized after being diagnosed with COVID-19 in China. The data were 
analyzed with t tests, one-way ANOVA and multivariable logistic regression 
analysis.
RESULTS: The results showed that the prevalence of PTSD, depression and anxiety 
was 13.2, 21.0 and 16.4%, respectively. Hospitalized patients who were more 
impacted by negative news reports, had greater exposure to traumatic 
experiences, and had lower levels of perceived social support reported higher 
PTSD, depression and anxiety.
CONCLUSIONS: Effective professional mental health services should be designed to 
support the psychological wellbeing of hospitalized patients, especially those 
who have severe disease, are strongly affected by negative news and have high 
levels of exposure to trauma.

DOI: 10.1186/s12888-021-03076-7
PMCID: PMC7868672
PMID: 33557776 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3792. Neurobiol Dis. 2021 May;152:105292. doi: 10.1016/j.nbd.2021.105292. Epub 2021 
Feb 5.

Bacterial sepsis increases hippocampal fibrillar amyloid plaque load and 
neuroinflammation in a mouse model of Alzheimer's disease.

Basak JM(1), Ferreiro A(2), Cohen LS(3), Sheehan PW(3), Nadarajah CJ(3), Kanan 
MF(3), Sukhum KV(4), Dantas G(5), Musiek ES(6).

Author information:
(1)Department of Anesthesiology, Washington University School of Medicine in St. 
Louis, St. Louis, MO 63110, USA.
(2)Edison Family Center for Genome Sciences & Systems Biology, Washington 
University School of Medicine in St. Louis, St. Louis, MO 63110, USA.
(3)Department of Neurology, Washington University School of Medicine in St. 
Louis, St. Louis, MO 63110, USA; Hope Center for Neurological Disorders, 
Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA.
(4)Edison Family Center for Genome Sciences & Systems Biology, Washington 
University School of Medicine in St. Louis, St. Louis, MO 63110, USA; Department 
of Pathology and Immunology, Washington University School of Medicine in St. 
Louis, St. Louis, MO 63110, USA.
(5)Edison Family Center for Genome Sciences & Systems Biology, Washington 
University School of Medicine in St. Louis, St. Louis, MO 63110, USA; Department 
of Pathology and Immunology, Washington University School of Medicine in St. 
Louis, St. Louis, MO 63110, USA; Department of Molecular Microbiology, 
Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA; 
Department of Biomedical Engineering, Washington University in St. Louis, St. 
Louis, MO 63130, USA.
(6)Department of Neurology, Washington University School of Medicine in St. 
Louis, St. Louis, MO 63110, USA; Hope Center for Neurological Disorders, 
Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA; 
Charles F. and Joanne Knight Alzheimer's Disease Research Center, Washington 
University School of Medicine in St. Louis, St. Louis, MO 63110, USA. Electronic 
address: musieke@wustl.edu.

BACKGROUND: Sepsis, a leading cause for intensive care unit admissions, causes 
both an acute encephalopathy and chronic brain dysfunction in survivors. A 
history of sepsis is also a risk factor for future development of dementia 
symptoms. Similar neuropathologic changes are associated with the cognitive 
decline of sepsis and Alzheimer's disease (AD), including neuroinflammation, 
neuronal death, and synaptic loss. Amyloid plaque pathology is the earliest 
pathological hallmark of AD, appearing 10 to 20 years prior to cognitive 
decline, and is present in 30% of people over 65. As sepsis is also more common 
in older adults, we hypothesized that sepsis might exacerbate amyloid plaque 
deposition and plaque-related injury, promoting the progression of AD-related 
pathology.
METHODS: We evaluated whether the brain's response to sepsis modulates 
AD-related neurodegenerative changes by driving amyloid deposition and 
neuroinflammation in mice. We induced polymicrobial sepsis by cecal ligation and 
puncture (CLP) in APP/PS1-21 mice, a model of AD-related β-amyloidosis. We 
performed CLP or sham surgery at plaque onset (2 months of age) and examined 
pathology 2 months after CLP in surviving mice.
RESULTS: Sepsis significantly increased fibrillar amyloid plaque formation in 
the hippocampus of APP/PS1-21 mice. Sepsis enhanced plaque-related astrocyte 
activation and complement C4b gene expression in the brain, both of which may 
play a role in modulating amyloid formation. CLP also caused large scale changes 
in the gut microbiome of APP/PS1 mice, which have been associated with a 
pro-amyloidogenic and neuroinflammatory state.
CONCLUSIONS: Our results suggest that experimental sepsis can exacerbate amyloid 
plaque deposition and plaque-related inflammation, providing a potential 
mechanism for increased dementia in older sepsis survivors.

Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.nbd.2021.105292
PMCID: PMC8057119
PMID: 33556539 [Indexed for MEDLINE]

Conflict of interest statement: Competing Interests: The authors declare no 
competing interests related to this work.


3793. J Intellect Disabil Res. 2021 May;65(5):381-396. doi: 10.1111/jir.12821. Epub 
2021 Feb 8.

Perceptions of people with intellectual and developmental disabilities about 
COVID-19 in Spain: a cross-sectional study.

Amor AM(1), Navas P(1), Verdugo MÁ(1), Crespo M(1).

Author information:
(1)Institute for Community Inclusion (INICO), Department of Personality, 
Assessment and Psychological Treatments, Faculty of Psychology, University of 
Salamanca, Salamanca, Spain.

BACKGROUND: As the world battles COVID-19, there is a need to study the 
perceptions of people with intellectual and developmental disabilities (IDD) 
about the effects of the pandemic and associated lockdown on their lives. This 
work explores the perceptions of Spaniards with IDD during the lockdown with 
respect to four topics: access to information, emotional experiences, effects on 
living conditions and access to support.
METHODS: The topics were explored using a subset of 16 closed-ended questions 
from an online survey. In total, 582 participants with IDD completed the survey. 
The frequencies and percentages of responses to the questions were calculated, 
and chi-square tests performed to explore the relationship between participants' 
sociodemographic characteristics and responses. Given that people differed in 
the way in which they completed the survey, the relationship between 
participants' responses and completion method was also analysed.
RESULTS: Participants reported that the pandemic and subsequent lockdown have 
had a deleterious effect on their emotional well-being (around 60.0% of 
participants) and occupations (48.0% of students and 72.7% of workers). Although 
access to information and support was reportedly good overall, being under the 
age of 21 years and studying were associated with perceptions reflecting poorer 
access to information (V = .20 and V = .13, respectively) and well-being support 
(V = .15 and V = .13, respectively). Being supported by a third party to 
complete the survey was consistently related to perceptions of worse outcomes.
CONCLUSIONS: The study yielded data on the perceptions of people with IDD 
regarding the effects that COVID-19 and the subsequent lockdown have had on 
their lives. Suggestions on how to overcome the difficulties reported and future 
lines of research are discussed.

© 2021 MENCAP and International Association of the Scientific Study of 
Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

DOI: 10.1111/jir.12821
PMCID: PMC8013361
PMID: 33555099 [Indexed for MEDLINE]

Conflict of interest statement: Nothing to declare.


3794. Am J Health Promot. 2021 Feb;35(2):299-319. doi: 10.1177/0890117120983982.

Knowing Well, Being Well: well-being born of understanding: Addressing Mental 
Health and Substance Use Disorders Amid and Beyond the COVID-19 Pandemic.

Johnson SS, Czeisler MÉ, Howard ME, Rajaratnam SMW, Sumner JA, Koenen KC, 
Kubzansky LD, Mochari-Greenberger H, Pande RL, Mendell G.

DOI: 10.1177/0890117120983982
PMID: 33554627 [Indexed for MEDLINE]


3795. Paediatr Child Health. 2020 Feb 29;26(1):e1-e3. doi: 10.1093/pch/pxaa003. 
eCollection 2021 Feb.

Exploring Acceptance and Commitment Therapy for parents of preterm infants.

Esser K(1), Barreira L(1), Miller D(2), Church P(3), Major N(4), Cohen E(1)(5), 
Orkin J(1)(5).

Author information:
(1)Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, 
Ontario.
(2)Faculty of Health Sciences, McMaster University, Hamilton, Ontario.
(3)Department of Newborn and Developmental Paediatrics, Sunnybrook Health 
Sciences Centre, Toronto, Ontario.
(4)Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, 
Ontario.
(5)Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, 
Ontario.

The start of a parenting journey in the neonatal intensive care unit (NICU) 
presents many stressors to parents. Previous research has shown parents of 
infants admitted to the NICU experience heightened stress, anxiety, and 
depression. Mental health support varies across Canadian NICUs with mixed 
results. One promising intervention that has not been explored in the NICU is 
Acceptance and Commitment Therapy (ACT), a behavioural therapy that has had 
positive mental health-related outcomes in similar parental populations. ACT 
differs from previous mental health interventions such as traditional Cognitive 
Behavioural Therapy (CBT) as it involves mindfulness and acceptance to increase 
psychological flexibility. Increased psychological flexibility is linked to 
greater emotional well-being, a higher quality of life, and decreased stress, 
anxiety, and depression. There is a need for research investigating the utility 
of ACT in improving mental health outcomes for parents of preterm infants.

© The Author(s) 2020. Published by Oxford University Press on behalf of the 
Canadian Paediatric Society. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/pch/pxaa003
PMCID: PMC7850279
PMID: 33552323


3796. Mo Med. 2021 Jan-Feb;118(1):7-12.

Mental Health from Medical School to Medical Practice: Finding a Path Forward.

Slavin S(1).

Author information:
(1)Senior Scholar for Well-Being, Accreditation Council for Graduate Medical 
Education, Chicago, Illinois.

Medical students, residents, and practicing physicians experience high burnout, 
depression, and suicide rates, and the COVID-19 pandemic has exacerbated stress 
for many.1-6 While laudable, current well-being efforts appear insufficient to 
meet the challenges that so many are facing. This essay explores approaches that 
individuals and organizations can take to promote mental health and well-being 
from medical school to practice.

Copyright 2021 by the Missouri State Medical Association.

PMCID: PMC7861588
PMID: 33551470 [Indexed for MEDLINE]


3797. Span J Psychol. 2021 Feb 8;24:e8. doi: 10.1017/SJP.2021.7.

Psychological Adjustment in Spain during the COVID-19 Pandemic: Positive and 
Negative Mental Health Outcomes in the General Population.

Valiente C(1), Contreras A(1), Peinado V(1), Trucharte A(1), Martínez AP(2), 
Vázquez C(1).

Author information:
(1)Universidad Complutense de Madrid (Spain).
(2)The University of Sheffield (UK).

In the midst of the COVID-19 epidemic, Spain was one of the countries with the 
highest number of infections and a high mortality rate. The threat of the virus 
and consequences of the pandemic have a discernible impact on the mental health 
of citizens. This study aims to (a) evaluate the levels of anxiety, depression 
and well-being in a large Spanish sample during the confinement, (b) identify 
potential predictor variables associated to experiencing both clinical levels of 
distress and well-being in a sample of 2,122 Spanish people. By using 
descriptive analyses and logistic regression results revealed high rates of 
depression, anxiety and well-being. Specifically, our findings revealed that 
high levels of anxiety about COVID-19, increased substance use and loneliness as 
the strongest predictors of distress, while gross annual incomes and loneliness 
were strongest predictors of well-being. Finding of the present study provide a 
better insight about psychological adjustment to a pandemic and allows us to 
identify which population groups are at risk of experiencing higher levels of 
distress and which factors contribute to greater well-being, which could help in 
the treatments and prevention in similar stressful and traumatic situations.

DOI: 10.1017/SJP.2021.7
PMID: 33551011 [Indexed for MEDLINE]


3798. Lancet Psychiatry. 2021 Apr;8(4):340-346. doi: 10.1016/S2215-0366(20)30382-5. 
Epub 2021 Feb 4.

Integrating youth mental health into cash transfer programmes in response to the 
COVID-19 crisis in low-income and middle-income countries.

Bauer A(1), Garman E(2), McDaid D(3), Avendano M(4), Hessel P(5), Díaz Y(5), 
Araya R(6), Lund C(7), Malvasi P(8), Matijasevich A(9), Park AL(3), Paula 
CS(10), Ziebold C(10), Zimmerman A(11), Evans-Lacko S(3).

Author information:
(1)Care Policy and Evaluation Centre, Department of Health Policy, London School 
of Economics and Political Science, London, UK. Electronic address: 
a.bauer@lse.ac.uk.
(2)Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and 
Mental Health, University of Cape Town, Cape Town, South Africa.
(3)Care Policy and Evaluation Centre, Department of Health Policy, London School 
of Economics and Political Science, London, UK.
(4)Department of Global Health & Social Medicine, King's College London, London, 
UK; Department of Social and Behavioural Sciences, Harvard School of Public 
Health Boston, Massachusetts, MA, USA.
(5)Escuela de Gobierno Alberto Lleras Camargo, Universidad de Los Andes, Bogotá, 
Colombia.
(6)Centre for Global Mental Health, Health Service & Population Research 
Department, Institute of Psychiatry, Psychology and Neuroscience, King's College 
London, London, UK.
(7)Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and 
Mental Health, University of Cape Town, Cape Town, South Africa; Centre for 
Global Mental Health, Health Service & Population Research Department, Institute 
of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
(8)Faculdade de Ciências Médicas da Santa Casa de São Paulo, Department of 
Public Health, São Paulo, Brasil.
(9)Faculdade de Medicina FMUSP, Departamento de Medicina Preventiva, 
Universidade de São Paulo, São Paulo, Brasil.
(10)Programa de Pós-graduação em Distúrbios do Desenvolvimento, Universidade 
Presbiteriana Mackenzie, São Paulo, Brasil.
(11)Department of Global Health & Social Medicine, King's College London, 
London, UK; Centre for Global Mental Health, Health Service & Population 
Research Department, Institute of Psychiatry, Psychology and Neuroscience, 
King's College London, London, UK.

Social protection measures can play an important part in securing livelihoods 
and in mitigating short-term and long-term economic, social, and mental health 
impacts of the COVID-19 pandemic. In particular, cash transfer programmes are 
currently being adapted or expanded in various low-income and middle-income 
countries to support individuals and families during the pandemic. We argue that 
the current crisis offers an opportunity for these programmes to focus on 
susceptible young people (aged 15-24 years), including those with mental health 
conditions. Young people living in poverty and with mental health problems are 
at particular risk of experiencing adverse health, wellbeing, and employment 
outcomes with long-term consequences. They are also at risk of developing mental 
health conditions during this pandemic. To support this population, cash 
transfer programmes should not only address urgent needs around food security 
and survival but expand their focus to address longer-term mental health impacts 
of pandemics and economic crises. Such an approach could help support young 
people's future life chances and break the vicious cycle between mental illness 
and poverty that spirals many young people into both socioeconomic and mental 
health disadvantage.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/S2215-0366(20)30382-5
PMCID: PMC9215313
PMID: 33549174 [Indexed for MEDLINE]


3799. Brain Behav Immun. 2021 Mar;93:409-414. doi: 10.1016/j.bbi.2021.01.030. Epub 
2021 Feb 4.

The three frontlines against COVID-19: Brain, Behavior, and Immunity.

Wang SC(1), Su KP(2), Pariante CM(3).

Author information:
(1)Department of Forensic and Addiction Psychiatry, Jianan Psychiatric Center, 
Ministry of Health and Welfare, Tainan City 717, Taiwan; Department of Mental 
Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, 
USA; Department of Medical Laboratory Science and Biotechnology, Chung Hwa 
University of Medical Technology, Tainan City 717, Taiwan.
(2)College of Medicine, China Medical University, Taichung, Taiwan; Mind-Body 
Interface Laboratory (MBI-Lab) and Department of Psychiatry, China Medical 
University Hospital, Taichung, Taiwan; An-Nan Hospital, China Medical 
University, Tainan, Taiwan; Institute of Psychiatry, Psychology and 
Neuroscience, King's College London, London, UK. Electronic address: 
cobolsu@gmail.com.
(3)Institute of Psychiatry, Psychology and Neuroscience, King's College London, 
London, UK.

The pandemic outbreak of coronavirus disease 2019 (COVID-19) is raising global 
anxiety and fear of both real and perceived health threat from the virus. 
Overwhelming evidence shows infected patients experiencing neuropsychiatric 
complications, suggesting that the "psychoneuroimmunity" model might be 
beneficial in understanding the impact of the virus. Therefore, this Special 
Issue on "Immunopsychiatry of COVID-19 Pandemic" was launched immediately after 
the pandemic was declared, with the first paper accepted on the March 25th, 
2020. A total of ninety-three papers were accepted, the last one was on the July 
10th, 2020 when the initial acute phase started declining. The papers of this 
Special Issue have illuminated the social impact, psychopathology, neurological 
manifestation, immunity responses, and potential treatments and prevention on 
COVID-19. For example, anxiety disorders, mood disorders, and suicidal ideation 
are most common psychiatric manifestations. COVID-19 infection can have central 
and/or peripheral nervous system symptoms, including headache, sleep disorders, 
encephalopathy, and loss of taste and smell. A "three-steps" Neuro-COVID 
infection model (neuro-invasion, clearance and immune response) was established. 
The current therapeutic interventions for COVID-19 include supportive 
intervention, immunomodulatory agents, antiviral therapy, and plasma 
transfusion. Psychological support should be implemented, improving the 
psychological wellbeing, as well as to enhance psychoneuroimmunity against 
COVID-19.

Copyright © 2021 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.bbi.2021.01.030
PMCID: PMC7857976
PMID: 33548496 [Indexed for MEDLINE]


3800. J Sleep Res. 2021 Oct;30(5):e13300. doi: 10.1111/jsr.13300. Epub 2021 Feb 6.

Pandemic nightmares: Effects on dream activity of the COVID-19 lockdown in 
Italy.

Scarpelli S(1)(2), Alfonsi V(2), Mangiaruga A(3), Musetti A(4), Quattropani 
MC(5), Lenzo V(5), Freda MF(6), Lemmo D(6), Vegni E(7), Borghi L(7), Saita E(8), 
Cattivelli R(8)(9), Castelnuovo G(8)(9), Plazzi G(10)(11), De Gennaro L(1)(2), 
Franceschini C(12).

Author information:
(1)IRCCS Fondazione Santa Lucia, Rome, Italy.
(2)Department of Psychology, Sapienza University of Rome, Rome, Italy.
(3)Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 
Bologna, Italy.
(4)Department of Humanities, Social Sciences and Cultural Industries, University 
of Parma, Parma, Italy.
(5)Department of Clinical and Experimental Medicine, University of Messina, 
Messina, Italy.
(6)Department of Humanistic Studies, Federico II University, Naples, Italy.
(7)Department of Health Sciences, University of Milan, Milan, Italy.
(8)Department of Psychology, Catholic University of Milan, Milan, Italy.
(9)Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Verbania, 
Italy.
(10)IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
(11)Department of Biomedical, Metabolic and Neural Sciences, University of 
Modena and Reggio Emilia, Modena, Italy.
(12)Department of Medicine and Surgery, University of Parma, Parma, Italy.

COVID-19 has critically impacted the world. Recent works have found substantial 
changes in sleep and mental health during the COVID-19 pandemic. Dreams could 
give us crucial information about people's well-being, so here we have directly 
investigated the consequences of lockdown on the oneiric activity in a large 
Italian sample: 5,988 adults completed a web-survey during lockdown. We 
investigated sociodemographic and COVID-19-related information, sleep quality 
(by the Medical Outcomes Study-Sleep Scale), mental health (by the Depression, 
Anxiety, and Stress Scales), dream and nightmare frequency, and related 
emotional aspects (by the Mannheim Dream Questionnaire). Comparisons between our 
sample and a population-based sample revealed that Italians are having more 
frequent nightmares and dreams during the pandemic. A multiple logistic 
regression model showed the predictors of high dream recall (young age, female 
gender, not having children, sleep duration) and high nightmare frequency (young 
age, female gender, modification of napping, sleep duration, intrasleep 
wakefulness, sleep problem index, anxiety, depression). Moreover, we found 
higher emotional features of dream activity in workers who have stopped working, 
in people who have relatives/friends infected by or who have died from COVID-19 
and in subjects who have changed their sleep habits. Our findings point to the 
fact that the predictors of high dream recall and nightmares are consistent with 
the continuity between sleep mentation and daily experiences. According to the 
arousal-retrieval model, we found that poor sleep predicts a high nightmare 
frequency. We suggest monitoring dream changes during the epidemic, and also 
considering the implications for clinical treatment and prevention of mental and 
sleep disorders.

© 2021 European Sleep Research Society.

DOI: 10.1111/jsr.13300
PMCID: PMC7994972
PMID: 33547703 [Indexed for MEDLINE]

Conflict of interest statement: GP served on advisory boards for Jazz, UCB, 
Bioprojet and Idorsia.


3801. Perspect Psychiatr Care. 2021 Oct;57(4):1707-1711. doi: 10.1111/ppc.12739. Epub 
2021 Feb 5.

COVID-19 suicide and its causative factors among the healthcare professionals: 
Case study evidence from press reports.

Jahan I(1)(2), Ullah I(3)(4), Griffiths MD(5), Mamun MA(3)(6).

Author information:
(1)Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical 
University, Dhaka, Bangladesh.
(2)Harirampur Upazila Health Complex - Manikgonj, Ministry of Health and Family 
Welfare, Dhaka, Bangladesh.
(3)Center for Health Innovation, Networking, Training, Action and Research - 
Bangladesh (CHINTA Research Bangladesh), Dhaka, Bangladesh.
(4)Kabir Medical College, Gandhara University, Peshawar, Pakistan.
(5)International Gaming Research Unit, Department of Psychology, Nottingham 
Trent University, Nottingham, UK.
(6)Department of Public Health and Informatics, Jahanginagar University, Dhaka, 
Bangladesh.

PURPOSE: Recent research has demonstrated the psychological impact of the 
coronavirus disease 2019 (COVID-19) pandemic among the general population. 
However, COVID-19-related suicides among healthcare professionals (HCPs) have 
yet to be investigated.
FINDINGS: The present study utilized retrospective press media suicide reports 
and identified a total of 26 worldwide HCP COVID-19-related suicide cases (aged 
22-60 years; 14 females; most of the cases from India). The cases comprised 
doctors (n = 11), nurses (n = 9), paramedics (n = 5), and one medical student. 
Being infected with the COVID-19 was the most common suicide reason, followed by 
work-related stress, and fear related to COVID-19 infection/transmission. Among 
the eight cases diagnosed with COVID-19, most were female (n = 6), and either 
doctors (n = 4) or nurses (n = 4).
PRACTICE IMPLICATIONS: The present findings will be helpful for human resources 
departments in healthcare workplaces in ensuring HCP's mental wellbeing.

© 2021 Wiley Periodicals LLC.

DOI: 10.1111/ppc.12739
PMCID: PMC8014758
PMID: 33547666 [Indexed for MEDLINE]


3802. Clin Med (Lond). 2021 Mar;21(2):e150-e154. doi: 10.7861/clinmed.2020-0547. Epub 
2021 Feb 5.

The effects of COVID-19 on sickness of medical staff across departments: A 
single centre experience.

Khorasanee R(1), Grundy T(2), Isted A(2), Breeze R(2).

Author information:
(1)Department of Intensive Care, University Hospital Lewisham, London, UK 
reza.khorasanee@nhs.net.
(2)Department of Intensive Care, University Hospital Lewisham, London, UK.

INTRODUCTION: COVID-19 presents a risk to healthcare workers, incurring harm to 
staff physical and mental wellbeing and difficulties in provision of care and 
service planning.
METHODOLOGY: Doctors' anonymised demographic and staff sickness data were 
collected between 16 March and 26 April 2020, corresponding with the single 
centre's greatest COVID-19 caseload.
FINDINGS: 128 (39%) of doctors experienced at least one sickness episode. 
Episodes totalled 1,240 days, equating to a sickness absence rate of 9.1%. Rates 
varied between departments and grades. High levels of sickness were seen in 
medicine and both adult and paediatric emergency departments with the lowest 
levels seen in intensive care.
DISCUSSION: COVID-19 caused a burden of sickness on the medical workforce which 
must be accounted for in future workforce planning. The disparity in sickness 
rates across departments is likely to be multi-factorial. Further study is 
needed to investigate these factors to protect healthcare staff and their 
patients.

© Royal College of Physicians 2021. All rights reserved.

DOI: 10.7861/clinmed.2020-0547
PMCID: PMC8002809
PMID: 33547066 [Indexed for MEDLINE]


3803. Int J Environ Res Public Health. 2021 Feb 3;18(4):1421. doi: 
10.3390/ijerph18041421.

Mental Health and Psychological Impact on Students with or without Hearing Loss 
during the Recurrence of the COVID-19 Pandemic in China.

Yang Y(1), Xiao Y(1), Liu Y(1), Li Q(1), Shan C(1), Chang S(1), Jen PH(1)(2).

Author information:
(1)Department of Hearing and Speech Rehabilitation, Binzhou Medical University, 
Yantai 264003, China.
(2)Division of Biological Sciences and Interdisciplinary Neuroscience Program, 
University of Missouri-Columbia, Missouri, MO 65211, USA.

BACKGROUND: This study compares the mental health and psychological response of 
students with or without hearing loss during the recurrence of the COVID-19 
pandemic in Beijing, the capital of China. It explores the relevant factors 
affecting mental health and provides evidence-driven strategies to reduce 
adverse psychological impacts during the COVID-19 pandemic.
METHODS: We used the Chinese version of depression, anxiety, and stress scale 21 
(DASS-21) to assess the mental health and the impact of events scale-revised 
(IES-R) to assess the COVID-19 psychological impact.
RESULTS: The students with hearing loss are frustrated with their disability and 
particularly vulnerable to stress symptoms, but they are highly endurable in 
mitigating this negative impact on coping with their well-being and 
responsibilities. They are also more resilient psychologically but less 
resistant mentally to the pandemic impacts than the students with normal 
hearing. Their mental and psychological response to the pandemic is associated 
with more related factors and variables than that of the students with normal 
hearing is.
CONCLUSIONS: To safeguard the welfare of society, timely information on the 
pandemic, essential services for communication disorders, additional assistance 
and support in mental counseling should be provided to the vulnerable persons 
with hearing loss that are more susceptible to a public health emergency.

DOI: 10.3390/ijerph18041421
PMCID: PMC7913727
PMID: 33546488 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3804. Int J Environ Res Public Health. 2021 Feb 3;18(4):1410. doi: 
10.3390/ijerph18041410.

Engagement in Health Risk Behaviours before and during the COVID-19 Pandemic in 
German University Students: Results of a Cross-Sectional Study.

Busse H(1), Buck C(1), Stock C(2), Zeeb H(1)(3), Pischke CR(4), Fialho PMM(4), 
Wendt C(5), Helmer SM(2).

Author information:
(1)Leibniz Institute for Prevention Research and Epidemiology-BIPS, 28359 
Bremen, Germany.
(2)Institute of Health and Nursing Science, Charité-Universitätsmedizin Berlin, 
Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 
and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany.
(3)Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany.
(4)Institute of Medical Sociology, Centre for Health and Society, Medical 
Faculty, Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany.
(5)Department Sociology of Health and Healthcare Systems, University Siegen, 
57068 Siegen, Germany.

Tobacco and cannabis use, alcohol consumption and inactivity are health risk 
behaviors (HRB) of crucial importance for health and wellbeing. The impact of 
the COVID-19 pandemic on university students' engagement in HRB has yet received 
limited attention. We investigated whether HRB changed during the COVID-19 
pandemic, assessed factors associated with change and profiles of HRB changes in 
university students. A web-based survey was conducted in May 2020, including 
5021 students of four German universities (69% female, the mean age of 24.4 
years (SD = 5.1)). Sixty-one percent of students reported consuming alcohol, 
45.8% binge drinking, 44% inactivity, 19.4% smoking and 10.8% cannabis use. 
While smoking and cannabis use remained unchanged during the COVID-19 pandemic, 
24.4% reported a decrease in binge drinking while 5.4% reported an increase. 
Changes to physical activity were most frequently reported, with 30.6% reporting 
an increase and 19.3% reporting a decrease in vigorous physical activity. Being 
female, younger age, being bored, not having a trusted person and depressive 
symptoms were factors associated with a change in HRB. Five substance use 
behavior profiles were identified, which also remained fairly unchanged. Efforts 
to promote student health and wellbeing continue to be required, also in times 
of the COVID-19 pandemic.

DOI: 10.3390/ijerph18041410
PMCID: PMC7913592
PMID: 33546344 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3805. Medicine (Baltimore). 2021 Jan 22;100(3):e23690. doi: 
10.1097/MD.0000000000023690.

The coronavirus disease of 2019 pandemic-associated stress among medical 
students in middle east respiratory syndrome-CoV endemic area: An observational 
study.

Batais MA(1)(2), Temsah MH(1)(3)(4), AlGhofili H(1), AlRuwayshid N(1), Alsohime 
F(1)(3), Almigbal TH(1)(2), Al-Rabiaah A(1)(3), Al-Eyadhy AA(1)(3), Mujammami 
MH(1)(5), Halwani R(6), Jamal AA(1)(2)(7), Somily AM(1)(8).

Author information:
(1)College of Medicine, King Saud University, PO Box 242069.
(2)Department of Family and Community Medicine.
(3)Pediatric Department, College of Medicine.
(4)Prince Abdullah Bin Khaled Coeliac Disease Chair, Faculty of Medicine.
(5)Endocrinology and Metabolism Unit, Department of Medicine, College of 
Medicine, King Saud University, Riyadh, Saudi Arabia.
(6)Sharjah Institute for Medical Research (SIMR), Department of Clinical 
Sciences, College of Medicine, University of Sharjah, PO. Box 27272, Sharjah, 
United Arab Emirates.
(7)Evidence-Based Health Care & Knowledge Translation Research Chair, King Saud 
University.
(8)Department of Pathology and Laboratory Medicine, College of Medicine, King 
Saud University Medical City, Riyadh, Saudi Arabia.

The coronavirus disease of 2019 (COVID-19) pandemic significantly affected 
different life aspects, including healthcare communities and academic 
institutes. We aimed to assess the level of stress and risk factors among 
medical students and interns during the COVID-19 pandemic in the setting of the 
middle east respiratory syndrome -CoV endemic area.A questionnaire-based 
cross-sectional study was conducted on a randomly selected sample of medical 
students and interns. The questionnaire was anonymously self-administered to 
indicate perceive hygienic practice change, importance of viral prevention 
domestic hygiene, perceive adequacy of received information, perceived agreement 
to facilitators to alleviate covid stress, self-reported stress level, and 
generalized anxiety disorder score.A total of 322 returned the questionnaire 
(69.7% response rate). Participants had good knowledge regarding severe acute 
respiratory syndrome -CoV2 in multiple aspects, with an average score of 13.8 
out of 14. Two-thirds (62.4%) of the students experienced mild anxiety, (23.9%) 
had moderate anxiety, (6.8%) had clinically high anxiety level, and another 
(6.8%) had a clinically very high anxiety level. The stress level, as reported 
by the respondents (on a 1-10 scale), showed a correlation with the Generalized 
Anxiety Disorder scale. We observed an increased level of social avoidance and 
hygienic practice facilitated by availability of hand sanitizers. Majority of 
the students receive information regarding COVID-19 from reliable and official 
resourcesMost students reported mild to moderate levels of anxiety, and was 
associated with enhancement of their universal precaution measures. The 
availability of alcohol-based hand sanitizers and the off-campus study were 
great relievers. The importance of reliable pandemic resources in educating 
students during pandemics is emphasized. Furthermore, this study indicate the 
importance of students' support services to address mental health and students' 
wellbeing in the era of pandemics.

Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

DOI: 10.1097/MD.0000000000023690
PMCID: PMC7837988
PMID: 33545936 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no funding and conflicts of 
interest to disclose.


3806. Rev Invest Clin. 2020 May 7;73(1):1-5. doi: 10.24875/RIC.20000385.

Bioethics in Medical Care Rationing During the Coronavirus Disease-19 Pandemic.

González-Duarte A(1), Kaufer-Horwitz M(2), Gamba G(3), Rivera-Moscoso R(4), 
Aguilar-Salinas CA(5).

Author information:
(1)Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición 
Salvador Zubirán (INCMyNSZ), Mexico City, Mexico.
(2)Department of Endocrinology, Instituto Nacional de Ciencias Médicas y 
Nutrición Salvador Zubirán, Mexico City, Mexico.
(3)Direction of Research, Instituto Nacional de Ciencias Médicas y Nutrición 
Salvador Zubirán (INCMyNSZ), Mexico City; Molecular Physiology Unit, Instituto 
de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico 
City; Mexico.
(4)Direction of Strategic Planning, Instituto Nacional de Ciencias Médicas y 
Nutrición Salvador Zubirán (INCMyNSZ), Mexico City, Mexico.
(5)Direction of Nutrition; Metabolic Diseases Research Unit,and Department of 
Endocrinology and Metabolism, INCMNSZ, Mexico City; School of Medicine and 
Health Sciences, Tecnológico de Monterrey, Monterrey, N.L., Mexico.

BACKGROUND: Coronavirus (CoV) disease (COVID)-19 poses difficult situations in 
which the ethical course of action is not clear, or choices are made between 
equally unacceptable responses.
METHODS: A web search was performed using the terms "bioethics; COVID-19; 
ethics; severe acute respiratory syndrome CoV-2; emergent care; pandemic; and 
public health emergencies."
RESULTS: Protection from COVID-19 has resulted in the cancellation of necessary 
medical interventions, lengthened suffering, and potential non-COVID-19 deaths. 
Prolonged lockdown reduced well-being, triggering or aggravating mental 
illnesses and violence, and escalated medical risks. Collateral damage includes 
restrictions on visitations to hospitals, alienation from the deceased relative, 
or lack of warm caring of patients. Finally, in a public health crisis, public 
health interest overrides individual rights if it results in severe harm to the 
community.
CONCLUSION: Balancing ethical dilemmas are one more challenge in the COVID-19 
pandemic.

DOI: 10.24875/RIC.20000385
PMID: 33544699 [Indexed for MEDLINE]


3807. Eur Arch Psychiatry Clin Neurosci. 2021 Mar;271(2):259-270. doi: 
10.1007/s00406-020-01228-6. Epub 2021 Feb 5.

Peripandemic psychiatric emergencies: impact of the COVID-19 pandemic on 
patients according to diagnostic subgroup.

Seifert J(#)(1), Meissner C(#)(2), Birkenstock A(2), Bleich S(2), Toto S(2), 
Ihlefeld C(#)(2), Zindler T(#)(2).

Author information:
(1)Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hanover 
Medical School, Hanover, Germany. seifert.johanna@mh-hannover.de.
(2)Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hanover 
Medical School, Hanover, Germany.
(#)Contributed equally

On March 11th, 2020, the outbreak of coronavirus disease 2019 (COVID-19) was 
declared a pandemic. Governments took drastic measures in an effort to reduce 
transmission rates and virus-associated morbidity. This study aims to present 
the immediate effects of the pandemic on patients presenting in the psychiatric 
emergency department (PED) of Hannover Medical School. Patients presenting 
during the same timeframe in 2019 served as a control group. A decrease in PED 
visits was observed during the COVID-19 pandemic with an increase in repeat 
visits within 1 month (30.2 vs. 20.4%, pBA = 0.001). Fewer patients with 
affective disorders utilized the PED (15.2 vs. 22.2%, pBA = 0.010). Suicidal 
ideation was stated more frequently among patients suffering from substance use 
disorders (47.4 vs. 26.8%, pBA = 0.004), while patients with schizophrenia more 
commonly had persecutory delusions (68.7 vs. 43.5%, pBA = 0.023) and visual 
hallucinations (18.6 vs. 3.3%, pBA = 0.011). Presentation rate of patients with 
neurotic, stress-related, and somatoform disorders increased. These patients 
were more likely to be male (48.6 vs. 28.9%, pBA = 0.060) and without previous 
psychiatric treatment (55.7 vs. 36.8%, pBA = 0.089). Patients with 
personality/behavioral disorders were more often inhabitants of psychiatric 
residencies (43.5 vs. 10.8%, pBA = 0.008). 20.1% of patients stated an 
association between psychological well-being and COVID-19. Most often patients 
suffered from the consequences pertaining to social measures or changes within 
the medical care system. By understanding how patients react to such a crisis 
situation, we can consider how to improve care for patients in the future and 
which measures need to be taken to protect these particularly vulnerable 
patients.

DOI: 10.1007/s00406-020-01228-6
PMCID: PMC7862867
PMID: 33544227 [Indexed for MEDLINE]

Conflict of interest statement: JS and CM took part in an educational event 
sponsored by Otsuka/Lundbeck. ST is a member of the advisory board for Otsuka 
and Janssen-Cilag and has received speaker´s honoraria from Janssen-Cilag, 
Lundbeck/Otsuka, and Servier. All other authors state they have no conflicts of 
interest to declare.


3808. Cogn Behav Ther. 2021 May;50(3):234-245. doi: 10.1080/16506073.2021.1877341. 
Epub 2021 Feb 5.

Examining the longitudinal effects and potential mechanisms of hope on COVID-19 
stress, anxiety, and well-being.

Gallagher MW(1), Smith LJ(1), Richardson AL(1), D'Souza JM(1), Long LJ(1).

Author information:
(1)Department of Psychology, University of Houston, Houston, TX, USA.

Hope is a cognitive trait that predicts both resilience to and recovery from 
anxiety and stress-related disorders. The present study examines the prospective 
associations of hope with subsequent anxiety, stress, and well-being during the 
COVID-19 pandemic. Perceived emotional control, a transdiagnostic vulnerability 
factor, was also examined as a potential mediator of these relationships. 
American adults (N = 822) were recruited during the COVID-19 pandemic using 
Amazon mTURK and structural equation modeling was used to examine how trait hope 
predicted outcomes approximately one month later. Higher hope was associated 
with greater well-being and perceived emotional control, as well as lower levels 
of anxiety and COVID-19 perceived stress. Results also indicated an indirect 
effect of hope with all outcomes via perceived emotional control. These findings 
suggest that hope may associated with resilience to the chronic stressors 
associated with the COVID-19 pandemic.

DOI: 10.1080/16506073.2021.1877341
PMID: 33544032 [Indexed for MEDLINE]


3809. MMWR Morb Mortal Wkly Rep. 2021 Feb 5;70(5):162-166. doi: 
10.15585/mmwr.mm7005a3.

Racial and Ethnic Disparities in the Prevalence of Stress and Worry, Mental 
Health Conditions, and Increased Substance Use Among Adults During the COVID-19 
Pandemic - United States, April and May 2020.

McKnight-Eily LR, Okoro CA, Strine TW, Verlenden J, Hollis ND, Njai R, Mitchell 
EW, Board A, Puddy R, Thomas C.

In 2019, approximately 51 million U.S. adults aged ≥18 years reported any mental 
illness,* and 7.7% reported a past-year substance use disorder† (1). Although 
reported prevalence estimates of certain mental disorders, substance use, or 
substance use disorders are not generally higher among racial and ethnic 
minority groups, persons in these groups are often less likely to receive 
treatment services (1). Persistent systemic social inequities and discrimination 
related to living conditions and work environments, which contribute to 
disparities in underlying medical conditions, can further compound health 
problems faced by members of racial and ethnic minority groups during the 
coronavirus disease 2019 (COVID-19) pandemic and worsen stress and associated 
mental health concerns (2,3). In April and May 2020, opt-in Internet panel 
surveys of English-speaking U.S. adults aged ≥18 years were conducted to assess 
the prevalence of self-reported mental health conditions and initiation of or 
increases in substance use to cope with stress, psychosocial stressors, and 
social determinants of health. Combined prevalence estimates of current 
depression, initiating or increasing substance use, and suicidal 
thoughts/ideation were 28.6%, 18.2%, and 8.4%, respectively. Hispanic/Latino 
(Hispanic) adults reported a higher prevalence of psychosocial stress related to 
not having enough food or stable housing than did adults in other racial and 
ethnic groups. These estimates highlight the importance of population-level and 
tailored interventions for mental health promotion and mental illness 
prevention, substance use prevention, screening and treatment services, and 
increased provision of resources to address social determinants of health. How 
Right Now (Qué Hacer Ahora) is an evidence-based and culturally appropriate 
communications campaign designed to promote and strengthen the emotional 
well-being and resiliency of populations adversely affected by COVID-19-related 
stress, grief, and loss (4).

DOI: 10.15585/mmwr.mm7005a3
PMCID: PMC7861483
PMID: 33539336 [Indexed for MEDLINE]

Conflict of interest statement: All authors have completed and submitted the 
International Committee of Medical Journal Editors form for disclosure of 
potential conflicts of interest. No potential conflicts of interest were 
disclosed.


3810. Sci Rep. 2021 Feb 3;11(1):2971. doi: 10.1038/s41598-021-81720-8.

Perceived stress as mediator for longitudinal effects of the COVID-19 lockdown 
on wellbeing of parents and children.

Achterberg M(1)(2), Dobbelaar S(3)(4)(5), Boer OD(3)(4), Crone EA(3)(4).

Author information:
(1)Department of Psychology, Education and Child studies, Erasmus School of 
Social and Behavioral Sciences, Erasmus University Rotterdam, Rotterdam, The 
Netherlands. achterberg@essb.eur.nl.
(2)Faculty of Behavioral and Social Sciences, Leiden Consortium Individual 
Development, Leiden University, Leiden, The Netherlands. achterberg@essb.eur.nl.
(3)Department of Psychology, Education and Child studies, Erasmus School of 
Social and Behavioral Sciences, Erasmus University Rotterdam, Rotterdam, The 
Netherlands.
(4)Faculty of Behavioral and Social Sciences, Leiden Consortium Individual 
Development, Leiden University, Leiden, The Netherlands.
(5)Developmental and Educational Psychology, Faculty of Behavioral and Social 
Sciences, Leiden University, Leiden, The Netherlands.

Dealing with a COVID-19 lockdown may have negative effects on children, but at 
the same time might facilitate parent-child bonding. Perceived stress may 
influence the direction of these effects. Using a longitudinal twin design, we 
investigated how perceived stress influenced lockdown induced changes in 
wellbeing of parents and children. A total of 106 parents and 151 children 
(10-13-year-olds) filled in questionnaires during lockdown and data were 
combined with data of previous years. We report a significant increase in 
parental negative feelings (anxiety, depression, hostility and interpersonal 
sensitivity). Longitudinal child measures showed a gradual decrease in 
internalizing and externalizing behavior, which seemed decelerated by the 
COVID-19 lockdown. Changes in parental negative feelings and children's 
externalizing behavior were mediated by perceived stress: higher scores prior to 
the lockdown were related to more stress during the lockdown, which in turn was 
associated with an increase in parental negative feelings and children's' 
externalizing behavior. Perceived stress in parents and children was associated 
with negative coping strategies. Additionally, children's stress levels were 
influenced by prior and current parental overreactivity. These results suggest 
that children in families with negative coping strategies and (a history of) 
parental overreactivity might be at risk for negative consequences of the 
lockdown.

DOI: 10.1038/s41598-021-81720-8
PMCID: PMC7859207
PMID: 33536464 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


3811. Quintessence Int. 2021;52(5):444-453. doi: 10.3290/j.qi.b936999.

Dental personnel in Israel, Canada, and France during the COVID-19 pandemic: 
attitudes, worries, emotional responses, and posttraumatic growth.

Uziel N, Gilon E, Meyerson J, Levin L, Khehra A, Emodi-Perlman A, Eli I.

OBJECTIVES: The spread of COVID-19 has posed significant challenges for dental 
professionals worldwide. The aims of the present study were twofold: (i) to 
study the attitudes, emotional responses, and worries among the dental 
personnel; and (ii) to look for the ability of dental personnel to experience 
posttraumatic self-growth as a result of the distress caused by the pandemic.
METHOD AND MATERIALS: A cross-sectional online survey using an anonymous 
questionnaire was performed simultaneously in Israel, Canada, and France during 
the initial lockdown period.
RESULTS: Israeli dental practitioners were less worried about their physical 
health, mental health, or relationships with family and friends than their 
Canadian and French counterparts. The Canadian dental practitioners were most 
committed and most willing to treat their patients, as well as most concerned 
about not being able to treat patients in the same personal way as before the 
lockdown. French dental practitioners showed the highest level of fear to treat 
patients. There were no differences in dental practitioners' levels of anxiety, 
depression, or posttraumatic growth among the countries. Dental practitioners' 
posttraumatic growth was significantly associated with worries regarding their 
physical health.
CONCLUSION: Responses of dental personnel to the COVID-19 pandemic varied 
worldwide. Despite the differences, evidence exists that some of the dental 
practitioners' worries and concerns are associated with psychologic growth as a 
result of the pandemic. Better understanding and acknowledgment of dental 
personnel's worries and concerns can facilitate growth and enable positive 
functioning under the continuous situation of uncertainty.

DOI: 10.3290/j.qi.b936999
PMID: 33533236 [Indexed for MEDLINE]


3812. Arch Phys Med Rehabil. 2021 Jun;102(6):1075-1083. doi: 
10.1016/j.apmr.2021.01.064. Epub 2021 Jan 30.

Disability and the COVID-19 Pandemic: A Survey of Individuals With Traumatic 
Brain Injury.

Morrow EL(1), Patel NN(2), Duff MC(2).

Author information:
(1)Department of Hearing & Speech Sciences, Vanderbilt University Medical 
Center, Nashville, TN. Electronic address: emily.l.morrow@vanderbilt.edu.
(2)Department of Hearing & Speech Sciences, Vanderbilt University Medical 
Center, Nashville, TN.

OBJECTIVES: To identify the consequences of the coronavirus 2019 (COVID-19) 
pandemic for individuals with traumatic brain injury (TBI), with particular 
attention to unique effects for individuals with chronic disability.
DESIGN: Individuals with and without a history of TBI completed a web-based 
survey.
SETTING: Participants were recruited from the Vanderbilt Brain Injury Patient 
Registry in Nashville, TN, and completed the survey from their homes between May 
and June 2020, during social distancing related to the COVID-19 pandemic.
PARTICIPANTS: Participants (N=47) in the chronic phase of moderate-severe TBI 
(>6mo postinjury) and 51 noninjured comparison (NC) peers completed the survey.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Participants, or respondents, answered a mix of multiple 
choice and free text questions about how the COVID-19 pandemic has affected 
their work, education, medical care, social communication, sources of 
information and decision making, and mental and physical well-being. Individuals 
with TBI also answered questions about how TBI has affected their experiences of 
the pandemic.
RESULTS: As a group, respondents with TBI reported less pandemic-related 
behavior change (eg, daily habits, virtual social visits, and masking) than NC 
peers. Both NCs and respondents with TBI identified health care providers as 
trusted sources of public health information. One-third of individuals with TBI 
indicated that brain injury has made coping with the pandemic more difficult, 
and respondents identified mental health challenges and social isolation as key 
barriers.
CONCLUSIONS: These results suggest that health care providers should look for 
ways to provide tailored education and reduce social isolation for individuals 
with disability during the ongoing COVID-19 pandemic. We discuss several direct 
suggestions from participant responses.

Copyright © 2021 American Congress of Rehabilitation Medicine. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.apmr.2021.01.064
PMCID: PMC7846880
PMID: 33529614 [Indexed for MEDLINE]


3813. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2021 
Mar;64(3):334-341. doi: 10.1007/s00103-021-03281-5. Epub 2021 Feb 2.

[Health-related consequences of social isolation: a qualitative study on 
psychosocial stress and resources among older adults in the COVID-19 pandemic].

[Article in German; Abstract available in German from the publisher]

Welzel FD(1), Schladitz K(2), Förster F(2), Löbner M(2), Riedel-Heller SG(2).

Author information:
(1)Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), 
Medizinische Fakultät, Universität Leipzig, Philipp-Rosenthal-Straße 55, 04103, 
Leipzig, Deutschland. Franziska.Welzel@medizin.uni-leipzig.de.
(2)Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), 
Medizinische Fakultät, Universität Leipzig, Philipp-Rosenthal-Straße 55, 04103, 
Leipzig, Deutschland.

BACKGROUND: The SARS-CoV-2 pandemic led to a general uncertainty about risk and 
consequences of the disease. Older adults are specifically vulnerable with 
regard to severe courses of the disease and have been particularly encouraged to 
self-isolate during the pandemic. Subsequently, expressions of concern have been 
raised regarding the negative impact of disease risk and quarantine on the 
mental health of older people.
OBJECTIVES: Assessment of psychosocial stress, coping strategies, need for 
support, and sense of coherence of older people during the COVID-19 pandemic.
MATERIALS AND METHODS: The study follows a qualitative research design. Between 
May and June 2020 N = 11 guided telephone interviews were conducted with older 
adults (70+ years). Telephone interviews were recorded by audio tape and fully 
transcribed. A qualitative content analysis was performed according to Mayring 
and Fenzl (2019) using MAXQDA.
RESULTS: Participants were 74.8 years old on average. Participants showed 
predominantly good psychosocial health and functional coping strategies. Life 
experience, an optimistic attitude, understanding of the necessity of 
restrictions, and previous crises that have been mastered were the most 
important resources during the COVID-19 pandemic for older adults. Offers of 
support were rarely used. Participants were critical of the closing of centers 
or meeting points for older people.
CONCLUSION: Older adults appear to be able to preserve their mental wellbeing 
during the COVID-19 pandemic. The relevance of mental resources of older adults 
for supporting younger generations seems to be unrecognized.

Publisher: ZUSAMMENFASSUNG: HINTERGRUND: Mit dem SARS-CoV-2-Ausbruchsgeschehen 
(„Severe acute respiratory syndrome coronavirus type 2“, COVID-19) ist es zu 
einer Verunsicherung über Erkrankungsrisiko und Folgen der Virusinfektion in der 
Bevölkerung gekommen. Ältere Menschen gelten als Risikogruppe für schwere 
Infektionsverläufe und wurden im besonderen Maße zu sozialer Distanzierung 
aufgerufen. Gleichzeitig wurde die Sorge geäußert, dass sich Erkrankungsrisiko 
und soziale Isolation negativ auf die psychische Gesundheit älterer Menschen 
auswirken würden.
ZIELE DER ARBEIT: Erfassung von psychosozialen Belastungen, vorhandenen 
Bewältigungsstrategien, Unterstützungsbedarfen und Kohärenzerleben älterer 
Menschen im Zusammenhang mit dem COVID-19-Ausbruchsgeschehen.
MATERIAL UND METHODEN: Die Studie folgt einem qualitativen Untersuchungsdesign. 
Zwischen Mai und Juni 2020 wurden telefonische Interviews mit 11 älteren 
Personen (70+) durchgeführt. Die Durchführung der Interviews erfolgte 
leitfadengestützt. Die Daten wurden mittels Audioaufzeichnung festgehalten, 
transkribiert und inhaltsanalytisch nach Mayring und Fenzl (2019) unter Nutzung 
von MAXQDA ausgewertet.
ERGEBNISSE: Die Probanden waren im Durchschnitt 74,8 Jahre alt. Bei den 
Befragten zeigte sich ein überwiegend stabiles Befinden und gutes Zurechtkommen 
mit dem COVID-19-Geschehen. Als wesentliche Ressourcen wurden Lebenserfahrung, 
frühere bewältigte Krisen, eine optimistische Grundhaltung und Einsicht in die 
Notwendigkeit der Maßnahmen genannt. Externe Unterstützungsangebote seien kaum 
in Anspruch genommen worden. Das Schließen seniorenspezifischer Treffpunkte 
wurde kritisch bewertet.
DISKUSSION: Ältere Menschen scheinen sich ihre psychosoziale Gesundheit trotz 
COVID-19-Pandemie überwiegend zu erhalten. Die Bedeutsamkeit mentaler Ressourcen 
älterer Menschen für die Unterstützung jüngerer Generationen bleibt bisher 
unerkannt.

DOI: 10.1007/s00103-021-03281-5
PMCID: PMC7852481
PMID: 33528612 [Indexed for MEDLINE]


3814. J Perinat Neonatal Nurs. 2021 Jan-Mar 01;35(1):68-78. doi: 
10.1097/JPN.0000000000000545.

Infant-Family Mental Health in the NICU: A Mixed-Methods Study Exploring 
Referral Pathways and Family Engagement.

Driver M(1), Mikhail S, Carson MC, Lakatos PP, Matic T, Chin S, Williams ME.

Author information:
(1)USC University Center for Excellence in Developmental Disabilities (Drs 
Driver, Mikhail, and Matic) and Fetal and Neonatal Institute, Division of 
Neonatology (Dr Chin), Children's Hospital Los Angeles, Los Angeles, California; 
and Department of Pediatrics, Keck School of Medicine of University of Southern 
California, Los Angeles (Drs Carson, Lakatos, Williams, and Chin).

Parents and infants in the neonatal intensive care unit (NICU) are exposed to 
considerable stress, and infant-family mental health (IFMH) services foster 
emotional well-being in the context of the parent-infant relationship. This 
mixed-methods study examined the role of an IFMH program introduced in a level 4 
NICU. The study included (1) retrospective medical record review of NICU 
patients who were referred to the IFMH program and (2) qualitative interviews 
with NICU nurse managers, neonatologists, and medical social workers to explore 
their understanding of the IFMH program, explore the referral pathways and 
factors that supported family engagement, and identify specific recommendations 
for program improvement. Of the 311 infant-parent dyads referred to the IFMH 
program, 62% had at least one session and Spanish-speaking families were more 
likely to engage. Of those families receiving services, about one-third had 
brief intervention, one-third had 4 to 10 sessions, and one-third had long-term 
services, including in-home after-discharge services. Qualitative interviews 
with health providers identified unique qualities of the IFMH program and why 
families were and were not referred to the program. Recommendations centered on 
adding a full-time IFMH mental health provider to the NICU and increasing 
communication and integration between the IFMH program and the medical team.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/JPN.0000000000000545
PMID: 33528190 [Indexed for MEDLINE]


3815. J Perinat Neonatal Nurs. 2021 Jan-Mar 01;35(1):57-67. doi: 
10.1097/JPN.0000000000000543.

NICU-Specific Stress Following Traumatic Childbirth and Its Relationship With 
Posttraumatic Stress.

Sharp M(1), Huber N, Ward LG, Dolbier C.

Author information:
(1)Department of Psychiatry and Human Behavior, Alpert Medical School of Brown 
University, Providence, Rhode Island (Drs Sharp and Ward); Women's Medicine 
Collaborative, The Miriam Hospital, Providence, Rhode Island (Dr Sharp); 
Department of Psychology, East Carolina University, Greenville, North Carolina 
(Ms Huber and Dr Dolbier); and Center for Behavioral and Preventative Medicine, 
The Miriam Hospital, Providence, Rhode Island (Dr Ward).

This mixed-methods pilot study investigated maternal perceived stress specific 
to infant neonatal intensive care unit (NICU) hospitalization as a moderator of 
the relationship between traumatic childbirth appraisal and symptoms of 
posttraumatic stress disorder (PTSD). NICU mothers (N = 77) were recruited via 
social media 1 to 4 months postpartum for a cross-sectional survey about 
perinatal experiences. Measures included traumatic childbirth, PTSD Checklist 
for DSM-5, and Parental Stressor Scale (PSS): NICU. Quantitative results 
indicated that, only at high levels of stress, women who reported traumatic 
childbirth (68%) reported significantly higher PTSD symptoms [b = 18.00, 
standard error = 7.18, t = 2.51, P = .015, 95% confidence interval (3.65, 
32.36)]. Qualitative analysis identified additional stressors: maternal 
emotional well-being, dissatisfaction with care, infant health problems, 
breastfeeding, and additional characteristics of the NICU environment. Results 
provide supportive evidence that NICU mothers are at high risk for 
childbirth-related trauma and PTSD. Perceived stress related to the NICU may be 
an important intervention target when developing trauma-informed patient care. 
In addition to the domains captured by the PSS: NICU, maternal emotional 
well-being, interpersonal relationships with NICU staff, and stress related to 
breastfeeding are additional areas for improvement in the family-centered NICU.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/JPN.0000000000000543
PMCID: PMC10405171
PMID: 33528188 [Indexed for MEDLINE]


3816. Health Promot Pract. 2021 Mar;22(2):163-166. doi: 10.1177/1524839920963703. Epub 
2020 Oct 14.

Changing the Game: College Dance Training for Well-Being and Resilience Amidst 
the COVID-19 Crisis.

Bohn J(1), Hogue S(1).

Author information:
(1)University of South Florida, Tampa, FL, USA.

The COVID-19 pandemic has disrupted all aspects of life, from health to 
financial to social. College students in particular have faced difficulties 
adjusting to an entirely virtual atmosphere, compounding the normal stressors 
that come with full class loads and transitioning into more independent adult 
lives. In response to the onset of the COVID-19 crisis, a faculty member at the 
University of South Florida's College of Public Health designed impromptu, free 
dance lessons offered through a virtual video platform to the college and 
broader community. The lessons were offered with the intent of providing a 
healthy and engaging environment to help students and others in the community 
cope with lockdown stress, depression, and anxiety throughout spring and summer 
2020. This article summarizes the structure of the intervention, lessons learned 
throughout implementation, and the broader practice potential during the 
COVID-19 pandemic and beyond.

DOI: 10.1177/1524839920963703
PMID: 33527854 [Indexed for MEDLINE]


3817. Breast Cancer Res Treat. 2021 Apr;186(3):625-635. doi: 
10.1007/s10549-021-06101-1. Epub 2021 Jan 31.

Covid-19 related oncologist's concerns about breast cancer treatment delays and 
physician well-being (the CROWN study).

Yao KA(1), Attai D(2), Bleicher R(3), Kuchta K(4), Moran M(5), Boughey J(6), 
Wilke LG(7), Dietz JR(8), Stevens R(9), Pesce C(10), Kopkash K(10), Kurtzman 
S(11), Sarantou T(12), Victorson D(13).

Author information:
(1)Division of Surgical Oncology, Department of Surgery, Clinical Professor of 
Surgery, Pritzker School of Medicine, NorthShore University HealthSystem, 
University of Chicago, 2650 Ridge Ave, Evanston, IL, 60201, USA. 
kyao@northshore.org.
(2)Department of Surgery, David Geffen School of Medicine, University of 
California, Los Angeles, Westwood, CA, USA.
(3)Division of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, 
USA.
(4)Biostatistical Core, NorthShore University HealthSystem Research Institute, 
Evanston, IL, USA.
(5)Yale Medicine, New Haven, CT, USA.
(6)Department of Surgery, Mayo Clinic, Rochester, MN, USA.
(7)Department of Surgery, University of Wisconsin, Madison, WI, USA.
(8)Case Western Reserve University, Cleveland, OH, USA.
(9)White Plains Hospital Center for Cancer Care, Westchester, NY, USA.
(10)Division of Surgical Oncology, Department of Surgery, Clinical Professor of 
Surgery, Pritzker School of Medicine, NorthShore University HealthSystem, 
University of Chicago, 2650 Ridge Ave, Evanston, IL, 60201, USA.
(11)Waterbury Hospital, Waterbury, CT, USA.
(12)Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA.
(13)Department of Medical Social Sciences, Northwestern University Feinberg 
School of Medicine, Chicago, IL, USA.

PURPOSE: To examine how treatment delays brought on by the COVID-19 pandemic 
impacted the physical and emotional well-being of physicians treating these 
patients.
METHODS: A cross-sectional survey of physician breast specialists was posted 
from April 23rd to June 11th, 2020 on membership list serves and social media 
platforms of the National Accreditation Program for Breast Centers and the 
American Society of Breast Surgeons. Physician well-being was measured using 6 
COVID-19 burnout emotions and the 4-item PROMIS short form for anxiety and sleep 
disturbance. We examined associations between treatment delays and physician 
well-being, adjusting for demographic factors, COVID-19 testing and ten COVID-19 
pandemic concerns.
RESULTS: 870 physicians completed the survey, 61% were surgeons. The mean age of 
physicians was 52 and 548 (63.9%) were female. 669 (79.4%) reported some delay 
in patient care as a result of the COVID-19 pandemic. 384 (44.1%) and 529 
(60.8%) of physicians scored outside normal limits for anxiety and sleep 
disturbance, respectively. After adjusting for demographic factors and COVID-19 
testing, mean anxiety and COVID-19 burnout scores were significantly higher 
among physicians whose patients experienced either delays in surgery, adjuvant 
chemotherapy, radiation, breast imaging or specialty consultation. A 
multivariable model adjusting for ten physician COVID-19 concerns and delays 
showed that "delays will impact my emotional well-being" was the strongest 
concern associated with anxiety, sleep disturbance and COVID-19 burnout factors.
CONCLUSIONS: Breast cancer treatment delays during the initial surge of the 
COVID-19 pandemic in the United States were associated with a negative impact on 
physician emotional wellness.

DOI: 10.1007/s10549-021-06101-1
PMCID: PMC7847535
PMID: 33517522 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no disclosures or conflicts to 
report.


3818. Prim Care. 2021 Mar;48(1):57-66. doi: 10.1016/j.pop.2020.10.001. Epub 2020 Oct 
6.

Impact of COVID-19 on Resettled Refugees.

Brickhill-Atkinson M(1), Hauck FR(2).

Author information:
(1)Department of Family Medicine, University of Virginia, PO Box 800729, 
Charlottesville, VA 22908-0729, USA.
(2)Department of Family Medicine, University of Virginia, PO Box 800729, 
Charlottesville, VA 22908-0729, USA. Electronic address: frh8e@virginia.edu.

Refugees are among the world's most vulnerable people, and COVID-19 presents 
novel threats to their well-being. Suspension of resettlement prolongs 
persecution for those accepted but not yet relocated to a host country and 
delays family reunification. For new arrivals, pandemic-related modifications to 
resettlement services impair smooth transitions. Refugees are additionally more 
vulnerable to economic hardship, COVID-19 infection, and mental illness 
exacerbations. Communication barriers make telehealth access uniquely difficult, 
and children lose the school environment that is essential for their adaptation 
in a new country. Providers can mitigate pandemic-related harms by assessing 
barriers, disseminating information, and advocating for inclusive policies.

Copyright © 2020 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.pop.2020.10.001
PMCID: PMC7538065
PMID: 33516424 [Indexed for MEDLINE]

Conflict of interest statement: Disclosure The authors have nothing to disclose.


3819. J Am Coll Health. 2022 Nov-Dec;70(8):2266-2269. doi: 
10.1080/07448481.2020.1865379. Epub 2021 Jan 29.

Coping during COVID-19: examining student stress and depressive symptoms.

Mushquash AR(1), Grassia E(1).

Author information:
(1)Department of Psychology, Lakehead University, Thunder Bay, Canada.

Objective: College students have faced widespread changes and challenges as a 
result of the novel coronavirus disease of 2019 (COVID-19) pandemic. How 
students cope with these disruptions is important in determining the ongoing 
impacts of the pandemic on mental health and well-being. We evaluated the 
associations between COVID-19 stress, coping responses, and symptoms of 
depression. Participants: A sample of 131 students (106 female; 25 male) was 
recruited throughout May 2020. Methods: Participants completed online 
self-report measures of study constructs. Results: As predicted, students 
experiencing more stress related to COVID-19 endorsed more symptoms of 
depression. Student stress was also associated with less use of engagement 
coping responses. Primary engagement and secondary engagement coping responses 
mediated the relationship between COVID-19 stress and symptoms of depression. 
Conclusions: Students lacking in adaptive, engagement coping responses may be 
particularly at risk for psychopathology when faced with high levels of stress 
related to COVID-19.

DOI: 10.1080/07448481.2020.1865379
PMID: 33513079 [Indexed for MEDLINE]


3820. J Nepal Health Res Counc. 2021 Jan 21;18(4):655-660. doi: 
10.33314/jnhrc.v18i4.3190.

Stress, Anxiety, Depression and Their Associated Factors among Health Care 
Workers During COVID -19 Pandemic in Nepal.

Pandey A(1), Sharma C(1), Chapagain RH(2), Devkota N(2), Ranabhat K(3), Pant 
S(4), Adhikari K(4).

Author information:
(1)Maharajgunj Nursing Campus, Institute of Medicine, Tribhuwan University, 
Kathmandu.
(2)Kanti Children Hospital, Maharajgunj, Kathmandu.
(3)Central Department of Public Health, Institute of Medicine, Tribhuwan 
University, Kathmandu, Nepal.
(4)Nepal Health Research Council, Ram Shah Path, Kathmandu, Nepal.

BACKGROUND: Frontline Health Care Workers are at risk of developing mental and 
psychological distress during Corona virus disease 2019 pandemic. This study 
aimed to assess level of stress, anxiety, depression and their associated 
factors among health care workers during Corona virus disease 2019 pandemic in 
Nepal.
METHODS: This is a web based cross-sectional survey conducted among 404 Health 
Care Workers during early phase of Corona virus disease 2019 pandemic. The 
participants were selected using convenience sampling technique and were invited 
to participate via various online networks. Depression, anxiety and stress were 
assessed using the Depression Anxiety Stress Scale-21 (DASS-21) and their 
associated factors were measured using structured questionnaires. Multivariable 
logistic regression was carried out to determine the associated factors.
RESULTS: The symptoms of stress, anxiety and depression among health care 
workers were found to be 28.9%, 35.6% and 17.0% respectively. Females were found 
to be 2 fold more likely to have anxiety and depression than male. Nurses were 
found to be two times more likely to have anxiety than doctors. Laboratory 
personnel were almost three folds more likely to have anxiety than doctors. 
Health care workers with insufficient/ no PPE were almost three fold more likely 
to have depression. health care workers working in high-risk areas had almost 2 
fold higher odds of having depression.
CONCLUSIONS: Health care workers experienced symptoms of stress, anxiety and 
depression in varied level of severity. This experience was higher among the 
nurses and laboratory workers than doctors. Pandemic preparedness assuring PPE 
and appropriate psychological interventions may be beneficial to promote mental 
health and well-being of health care workers.

DOI: 10.33314/jnhrc.v18i4.3190
PMID: 33510505 [Indexed for MEDLINE]


3821. BMC Public Health. 2021 Jan 28;21(1):227. doi: 10.1186/s12889-021-10299-6.

Depressive, anxiety, and burnout symptoms on health care personnel at a month 
after COVID-19 outbreak in Indonesia.

Sunjaya DK(1), Herawati DMD(2), Siregar AYM(3).

Author information:
(1)Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, 
Jalan Eyckman No 38, Bandung, West Java, 40161, Indonesia. 
d.k.sunjaya@unpad.ac.id.
(2)Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, 
Jalan Eyckman No 38, Bandung, West Java, 40161, Indonesia.
(3)Department of Economic, Faculty of Economic and Business, Universitas 
Padjadjaran, Bandung, West Java, 40161, Indonesia.

BACKGROUND: Health care personnel (HCP) who demonstrated close contact with 
Corona virus disease (COVID-19) patients might experience a higher risk of 
infection and psychological problems. This study aims to explore depressive, 
anxiety, and burnout symptoms among HCP with a higher risk for psychological 
trauma.
METHODS: This study was a cross-sectional study using secondary data from an 
online assessment, which was conducted 1 month after the COVID-19 outbreak. A 
total of 544 respondents from 21 provinces in Indonesia were included. Data on 
depressive, anxiety, and burnout symptoms were transformed first using the Rasch 
model and then categorized. Data from HCP in the higher risk group and the lower 
risk group were analyzed.
RESULTS: A higher percentage of HCP experiencing depressive symptoms (22.8%), 
anxiety (28.1%), and burnout (26.8%) are found in the higher risk group. The 
chance for the higher risk group's HCP to present with moderate and severe 
depressive symptoms, anxiety, and burnout are: 5.28 (Confidence interval (CI): 
2.01-13.89; p < 0.05), 1.36 (CI: 0.09-1.96; p >  0.05), and 3.92 (CI: 2.08-7.40; 
p < 0.05) times higher, respectively. The probability for patient-induced 
burnout is 2.13 (CI: 1.51-3.007; p < 0.05) times higher and highest among the 
other burn out dimensions. The depressive symptoms complained were similar 
between groups: loneliness, sleep disturbances, difficulty concentrating, and 
inability to initiate activities. Loneliness demonstrates the highest logit 
value among the symptoms.
CONCLUSIONS: HCP with direct contact and responsibility to treat COVID-19 
patients exhibit a higher risk to experience depressive symptoms and burnout. 
Communication with peers and staying in contact with family needs to be 
encouraged. Psychological well-being should be considered for high-risk HCP. 
Incentive or insurance guaranteed by the government or institution is essential 
as a reward and compensation during this period.

DOI: 10.1186/s12889-021-10299-6
PMCID: PMC7840791
PMID: 33509159 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3822. Psychol Trauma. 2021 May;13(4):422-431. doi: 10.1037/tra0000931. Epub 2021 Jan 
28.

Americans' distress early in the COVID-19 pandemic: Protective resources and 
coping strategies.

Park CL(1), Finkelstein-Fox L(1), Russell BS(2), Fendrich M(3), Hutchison M(2), 
Becker J(3).

Author information:
(1)Department of Psychological Sciences, University of Connecticut.
(2)Department of Human Development and Family Sciences, University of 
Connecticut.
(3)School of Social Work, University of Connecticut.

OBJECTIVE: The rapid emergence of the coronavirus disease 2019 (COVID-19) 
pandemic in the United States has dramatically altered daily life and taken a 
toll on Americans' physical, mental, social, and financial well-being. Based on 
previous widespread disasters, future high prevalence of short- and long-term 
adverse mental health consequences are anticipated. Studies of COVID-19 outside 
the United States indicated moderately high levels of distress, but we have 
little information regarding Americans' distress nor the factors associated with 
relative distress or adjustment during this unprecedented time. This study 
represents the first national view of Americans' distress during the massive 
disruption of COVID-19 and identifies levels of stress exposure, protective 
psychosocial resources, and coping strategies.
METHOD: Data were collected April 7-9, 2020 from an online platform, using best 
practices for ensuring high-quality data; 1,015 completed respondents are 
included ([53.9%] women; average age = 38.9 years; mostly White [82.4%] and 
non-Hispanic [91.5%]). Respondents' locations ranged across the United States, 
from 18.5% in the Northeast to 37.8% in the South.
RESULTS: Fairly high levels of stress exposure and peritraumatic and general 
distress (depression, anxiety, and stress) were reported. Emotion regulation 
skills along with active and distraction coping emerged as the strongest 
predictors of lower distress levels.
CONCLUSIONS: These results identify potential targets for online mental health 
interventions-focusing on engaging in adaptive emotion regulation and coping 
(e.g., through telehealth mental health first aid)-during the pandemic to offset 
the likely rise in distress over the months ahead. (PsycInfo Database Record (c) 
2021 APA, all rights reserved).

DOI: 10.1037/tra0000931
PMCID: PMC8448577
PMID: 33507795 [Indexed for MEDLINE]


3823. Tech Coloproctol. 2021 May;25(5):505-520. doi: 10.1007/s10151-020-02404-5. Epub 
2021 Jan 28.

The impact of COVID-19 on surgical training: a systematic review.

Hope C(1), Reilly JJ(2), Griffiths G(3), Lund J(4), Humes D(5)(6)(7).

Author information:
(1)Division of Medical Sciences and Graduate Entry Medicine, University of 
Nottingham, Derby, DE22 3NE, UK. carlahope@nhs.net.
(2)Queen's Medical Centre, Nottingham University Hospitals NHS Trust, 
Nottingham, NG7 2UH, UK.
(3)Ninewells Hospital, Dundee, UK.
(4)Division of Medical Sciences and Graduate Entry Medicine, University of 
Nottingham, Derby, DE22 3NE, UK.
(5)Division of Epidemiology and Public Health, School of Medicine, University of 
Nottingham, Nottingham, UK.
(6)Nottingham Digestive Diseases Centre, School of Medicine, University of 
Nottingham, Nottingham, UK.
(7)National Institute for Health Research Nottingham Digestive Diseases 
Biomedical Research Unit, Nottingham University Hospitals NHS Trust, E Floor 
West Block, QMC Campus, Nottingham, NG7 2UH, UK.

Erratum in
    Tech Coloproctol. 2021 Nov;25(11):1267-1268.

BACKGROUND: Coronavirus disease (COVID-19) has caused global disruption to 
health care. Non-urgent elective surgical cases have been cancelled, outpatient 
clinics have reduced and there has been a reduction in the number of patients 
presenting as an emergency. These factors will drastically affect the training 
opportunities of surgical trainees. The aim of this systematic review is to 
describe the impact of COVID-19 on surgical training globally.
METHODS: The review was performed in line with Preferred Reporting Items for 
Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered with the 
Open Science Framework (OSF). Medline, EMBASE, PubMed and the Cochrane Central 
Register of Controlled Trials were searched.
RESULTS: The searches identified 499 articles, 29 of which were included in the 
review. This contained data from more than 20 countries with 5260 trainees and 
339 programme directors. Redeployment to non-surgical roles varied across 
studies from 6% to 35.1%. According to all of the studies, operative experience 
has been reduced. Knowledge learning had been switched to online platforms 
across 17 of the studies and 7 reported trainees had increased time to devote to 
educational/academic activities. All of the studies reporting on mental health 
report negative associations with increased stress, ranging from 54.9% to 91.6% 
of trainees.
CONCLUSIONS: The impact of COVID-19 on surgical trainees has been experienced 
globally and across all specialities. Negative effects are not limited to 
operative and clinical experience, but also the mental health and wellbeing of 
trainees. Delivery of surgical training will need to move away from traditional 
models of learning to ensure trainees are competent and well supported.

DOI: 10.1007/s10151-020-02404-5
PMCID: PMC7841379
PMID: 33507436 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


3824. Eur Rev Med Pharmacol Sci. 2021 Jan;25(1):498-502. doi: 
10.26355/eurrev_202101_24421.

The effects of psychological intervention on anxiety symptoms of 
COVID19-positive patients isolated in hospital wards.

Sun P(1), Fan DJ, He T, Li HZ, Wang G, Zhang XZ, Wu YQ, Dai YH.

Author information:
(1)Department of Emergency Medicine, Baoding Second Hospital, Baoding, China. 
sunpeng66_dr@163.com.

OBJECTIVE: The study aimed to explore the effects of psychological intervention 
on alleviating anxiety in patients in novel coronavirus (2019-nCoV) isolation 
wards.
PATIENTS AND METHODS: Between January 24th, 2020 and March 5th, 2020, 103 
patients were studied. Among these, 32 were patients in the isolation ward of 
the Infectious Disease Department in Baoding Second Hospital with suspected 
2019-nCoV, and 71 patients diagnosed with 2019-nCoV were in the Tangshan 
Infectious Disease Hospital. Of the 103 patients included, 97 cases were 
observed in isolation. Using a self-control study design, each patient's anxiety 
was scored on a self-rating anxiety scale before receiving the psychological 
intervention (on the 7th day of isolation) and after receiving the intervention 
(on the 14th day of isolation). The severity of anxiety was evaluated based on 
the anxiety score before receiving the intervention. The anxiety scores before 
and after receiving the intervention were then compared using the paired t-test, 
and p<0.05 was considered statistically significant.
RESULTS: After receiving the psychological intervention once or twice a week, 
the anxiety of the patients improved significantly after one week.
CONCLUSIONS: The anxiety of patients with 2019-nCoV in isolation wards can be 
alleviated through psychological intervention. By alleviating patient anxiety, 
this intervention also helps patients maintain their psychological wellbeing, 
which promotes rehabilitation and helps with the control of 2019-nCoV.

DOI: 10.26355/eurrev_202101_24421
PMID: 33506941 [Indexed for MEDLINE]


3825. Int J Environ Res Public Health. 2021 Jan 25;18(3):1062. doi: 
10.3390/ijerph18031062.

A Qualitative Study of Child and Adolescent Mental Health during the COVID-19 
Pandemic in Ireland.

O'Sullivan K(1), Clark S(1), McGrane A(1), Rock N(1), Burke L(1), Boyle N(1), 
Joksimovic N(1), Marshall K(1).

Author information:
(1)Department of Psychology, The National University of Ireland, Maynooth W23 
F2H, Ireland.

Mitigating the adverse physical health risks associated with COVID-19 has been a 
priority of public health incentives. Less attention has been placed on 
understanding the psychological factors related to the global pandemic, 
especially among vulnerable populations. This qualitative study sought to 
understand the experiences of children and adolescents during COVID-19. This 
study interviewed 48 families during the COVID-19 pandemic restrictions, and a 
national lockdown, to understand its impacts. The study used an Interpretative 
Phenomenological Analysis (IPA) methodology. Parents and children discussed the 
negative impact of the restrictions on young people's wellbeing. Children and 
adolescents experienced adverse mental health effects, including feelings of 
social isolation, depression, anxiety, and increases in maladaptive behaviour. 
Families with children with Autism Spectrum Disorders reported increased mental 
health difficulties during this period mostly due to changes to routine. The 
findings highlight the impact of severe restrictions on vulnerable populations' 
wellbeing and mental health outcomes, including children, adolescents, and those 
with Autism spectrum disorder (ASD).

DOI: 10.3390/ijerph18031062
PMCID: PMC7908364
PMID: 33504101 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3826. J Psychosom Res. 2021 Mar;142:110367. doi: 10.1016/j.jpsychores.2021.110367. 
Epub 2021 Jan 19.

Examining the impact of psychological distress on short-term postoperative 
outcomes after elective endovascular aneurysm repair (EVAR).

Scantling-Birch Y(1), Martin G(2), Balaji S(3), Trant J(4), Nordon I(5), Malina 
M(4), Riga C(6), Bicknell C(6).

Author information:
(1)Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
(2)Department of Surgery and Cancer, Imperial College London, London, United 
Kingdom; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, 
United Kingdom. Electronic address: guy.martin@imperial.ac.uk.
(3)Department of Surgery and Cancer, Imperial College London, London, United 
Kingdom.
(4)West London Vascular and Interventional Centre, London North West University 
Healthcare NHS Trust, London, United Kingdom.
(5)Vascular Surgery Unit, University Hospital Southampton NHS Foundation Trust, 
Southampton, United Kingdom.
(6)Department of Surgery and Cancer, Imperial College London, London, United 
Kingdom; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, 
United Kingdom.

PURPOSE: Preoperative psychological factors have an impact on postoperative 
outcomes and there is a paucity of research in vascular surgery. The objective 
of this study was to examine the impact of preoperative psychological factors on 
short-term postoperative outcomes in an infrarenal endovascular aneurysm repair 
(EVAR) cohort.
METHODS: A prospective, multi-centre observational study was conducted across 
three vascular units in England. English-speaking participants who were older 
than 18 years, able to provide informed consent and awaiting an elective 
standard infrarenal EVAR were eligible for the study. A total of 46 patients 
undergoing elective infrarenal AAA repair were assessed preoperatively with the 
State Trait Anxiety Inventory (STAI), Beck's Depression Inventory (BDI-II) and 
Life Orientation Test-Revised (LOT-R). Data on five short-term postoperative 
outcomes was collected and analysed using Spearman's rank correlations.
RESULTS: Higher preoperative anxiety levels (ρ = 0.38, p = 0.01), and depression 
scores (ρ = 0.36, p = 0.02) were moderately correlated with an increased length 
of postoperative critical care stay. Higher levels of preoperative depression 
were moderately correlated with greater postoperative opioid analgesia use 
(ρ = 0.34, p = 0.02). No correlation was witnessed between optimism scores and 
postoperative outcomes. No correlation was witnessed with respect to total 
length of stay, number of complications, or time to mobilisation.
CONCLUSIONS: There is a potential link between preoperative psychological 
well-being and short-term postoperative outcomes in an EVAR cohort. Further work 
is necessary to validate this link and examine the role of preoperative 
interventions in optimising the psychological well-being of patients undergoing 
EVAR.

Copyright © 2021 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jpsychores.2021.110367
PMID: 33503514 [Indexed for MEDLINE]


3827. PLoS One. 2021 Jan 27;16(1):e0245865. doi: 10.1371/journal.pone.0245865. 
eCollection 2021.

Using prosocial behavior to safeguard mental health and foster emotional 
well-being during the COVID-19 pandemic: A registered report protocol for a 
randomized trial.

Miles A(1), Andiappan M(2), Upenieks L(3), Orfanidis C(1).

Author information:
(1)Department of Sociology, University of Toronto, Toronto, Canada.
(2)Institute of Health Policy, Management, and Evaluation, University of 
Toronto, Toronto, Canada.
(3)Department of Sociology, Baylor University, Waco TX, United States of 
America.

Update in
    PLoS One. 2022 Jul 28;17(7):e0272152.

The COVID-19 pandemic, the accompanying lockdown measures, and their possible 
long-term effects have made mental health a pressing public health concern. Acts 
that focus on benefiting others-known as prosocial behaviors-offer one promising 
intervention that is both flexible and low cost. However, neither the range of 
emotional states prosocial acts impact nor the size of those effects is 
currently clear, both of which directly influence its attractiveness as a 
treatment option. Using a large online sample from Canada and the United States, 
we will examine the effect of a three-week prosocial intervention on two 
indicators of emotional well-being (happiness and the belief that one's life is 
valuable) and mental health (anxiety and depression). Respondents will be 
randomly assigned to perform prosocial, self-focused, or neutral behaviors each 
week. Two weeks after the intervention, a final survey will assess whether the 
intervention has a lasting effect on mental health and emotional well-being. Our 
results will illuminate whether prosocial interventions are a viable approach to 
addressing mental health needs during the current COVID-19 pandemic, as well for 
those who face emotional challenges during normal times.

DOI: 10.1371/journal.pone.0245865
PMCID: PMC7840018
PMID: 33503045 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


3828. J Am Coll Health. 2022 Nov-Dec;70(8):2399-2405. doi: 
10.1080/07448481.2020.1865380. Epub 2021 Jan 27.

The impact of COVID-19 on college students from communities of color.

Molock SD(1), Parchem B(1).

Author information:
(1)Department of Psychological and Brain Sciences, George Washington University, 
Washington, DC, USA.

Objective: To assess the impact of the COVID-19 pandemic on daily living, mental 
well-being, and experiences of racial discrimination among college students from 
communities of color. Participants: Sample comprised 193 ethnically diverse 
college students, aged 18 to 25 years (M = 20.5 years), who were participating 
in virtual internships due to the COVID-19 pandemic. Methods: A cross-sectional 
16-item survey was developed as a partnership between two nonprofit 
organizations. The survey included both close-ended and open-ended questions 
assessing the impact of COVID-19. Results: The students of color reported 
disruptive changes in finances (54%), living situation (35%), academic 
performance (46%), educational plans (49%), and career goals (36%). Primary 
mental health challenges included stress (41%), anxiety (33%), and depression 
(18%). Students also noted challenges managing racial injustice during the 
COVID-19 pandemic. Conclusions: Higher education institutions will benefit from 
financially and emotionally supporting students of color during the COVID-19 
pandemic and growing visibility of systemic racism.

DOI: 10.1080/07448481.2020.1865380
PMID: 33502970 [Indexed for MEDLINE]


3829. J Ment Health. 2021 Apr;30(2):138-147. doi: 10.1080/09638237.2021.1875424. Epub 
2021 Jan 27.

Keeping well in a COVID-19 crisis: a qualitative study formulating the 
perspectives of mental health service users and carers.

Simblett SK(1), Wilson E(1), Morris D(1), Evans J(1), Odoi C(1)(2), Mutepua 
M(1), Dawe-Lane E(1), Jilka S(1)(2), Pinfold V(3), Wykes T(1)(2).

Author information:
(1)Department of Psychology, Institute of Psychiatry, Psychology and 
Neuroscience, King's College London, London, UK.
(2)Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, 
London, UK.
(3)The McPin Foundation, London, UK.

BACKGROUND: People with existing mental health conditions may be particularly 
vulnerable to the psychological effect of the COVID-19 pandemic. But their 
positive and negative appraisals, and coping behaviour could prevent or 
ameliorate future problems.
OBJECTIVE: To explore the emotional experiences, thought processes and coping 
behaviours of people with existing mental health problems and carers living 
through the pandemic.
METHODS: UK participants who identified as a mental health service user (N18), a 
carer (N5) or both (N8) participated in 30-minute semi-structured remote 
interviews (31 March 2020 to 9 April 2020). The interviews investigated the 
effects of social distancing and self-isolation on mental health and the ways in 
which people were coping. Data were analysed using a framework analysis. Three 
service user researchers charted data into a framework matrix (consisting of 
three broad categories: "emotional responses", "thoughts" and "behaviours") and 
then used an inductive process to capture other contextual themes.
RESULTS: Common emotional responses were fear, sadness and anger but despite 
negative emotions and uncertainty appraisals, participants described efforts to 
cope and maintain their mental wellbeing. This emphasised an increased reliance 
on technology, which enabled social contact and occupational or leisure 
activities. Participants also spoke about the importance of continued and 
adapted mental health service provision, and the advantages and disadvantages 
associated with changes in their living environment, life schedule and social 
interactions.
CONCLUSION: This study builds on a growing number of qualitative accounts of how 
mental health service users and carers experienced and coped with extreme social 
distancing measures early in the COVID-19 pandemic. Rather than a state of 
helplessness this study contains a clear message of resourcefulness and 
resilience in the context of fear and uncertainty.

DOI: 10.1080/09638237.2021.1875424
PMID: 33502941 [Indexed for MEDLINE]


3830. J Ment Health. 2021 Apr;30(2):156-163. doi: 10.1080/09638237.2021.1875412. Epub 
2021 Jan 27.

Coping strategies and mental health during COVID-19 lockdown.

Budimir S(1)(2), Probst T(1), Pieh C(1).

Author information:
(1)Department for Psychotherapy and Biopsychosocial Health, Danube University 
Krems, Krems an der Donau, Austria.
(2)Department of Work, Organization and Society, Ghent University, Ghent, 
Belgium.

BACKGROUND: COVID-19 pandemic lockdown measures changed the everyday lives of 
people around the world.
AIMS: To evaluate the effects of different coping strategies on mental health 
during COVID-19 lockdown.
METHODS: A representative sample for Austria was recruited through Qualtrics® in 
a period of 4 weeks after the lockdown started. Measurements were coping 
inventory (SCI), psychological quality of life (WHO-QOL BREF, psychological 
domain), well-being (WHO-5), depression (PHQ-9), anxiety (GAD-7), stress 
(PSS-10), and insomnia (ISI). Regression analyses were performed with coping 
strategies as predictors and mental health measures as dependent variables.
RESULTS: The representative sample included N = 1,005 respondents (52.7% women). 
Positive thinking, active stress coping and social support were found to be 
positive predictors for psychological life quality, well-being, and negative 
predictors for perceived stress, depression, anxiety, and insomnia. Alcohol and 
cigarette consumption was a negative predictor for psychological life quality, 
and well-being, and a positive predictor for perceived stress, depression, 
anxiety, and insomnia. Support in faith was a positive predictor for perceived 
stress, depression, anxiety, and insomnia.
CONCLUSIONS: Coping strategies are significant predictors for mental health 
measures. Education about positive thinking, active coping, and social support 
could be beneficial for dealing with a decrease in mental health due to COVID-19 
pandemic.

DOI: 10.1080/09638237.2021.1875412
PMID: 33502917 [Indexed for MEDLINE]


3831. Int J Environ Res Public Health. 2021 Jan 22;18(3):976. doi: 
10.3390/ijerph18030976.

The Influence of Human-Animal Interactions on Mental and Physical Health during 
the First COVID-19 Lockdown Phase in the U.K.: A Qualitative Exploration.

Shoesmith E(1), Shahab L(2), Kale D(2), Mills DS(3), Reeve C(4), Toner P(4), 
Santos de Assis L(3), Ratschen E(1).

Author information:
(1)Department of Health Sciences, University of York, York YO10 5DD, UK.
(2)Department of Behavioural Science and Health, University College London, 
London WC1E 7HB, UK.
(3)School of Life Sciences, University of Lincoln, Lincoln LN6 7DL, UK.
(4)School of Psychology, Queen's University Belfast, Belfast BT9 5BN, UK.

The coronavirus disease 2019 (COVID-19) pandemic presents an opportunity to 
explore the role of animals as sources of emotional and physical support during 
a period when most of the population is experiencing social and environmental 
challenges. We investigated how companion animal owners perceived the influence 
of human-animal interaction on their physical and mental health during the first 
COVID-19 lockdown phase in the U.K., and what concerns they had regarding their 
animals at this time. We also explored the impact of participants' interaction 
with non-companion animals during this phase. A cross-sectional online survey of 
U.K. residents aged over 18 was conducted between April and June 2020. The final 
item of the survey invited open-ended free-text responses, allowing participants 
to describe any experiences and/or perceptions of their human-animal 
relationships during the COVID-19 lockdown phase. A qualitative thematic 
analysis of responses was undertaken. Four main themes related to the following 
aspects of human-animal interactions during the COVID-19 lockdown phase were 
identified: the positive impact of animal ownership during the COVID-19 lockdown 
(e.g., amelioration of wellbeing and mental health), concerns relating to animal 
ownership during the COVID-19 lockdown (e.g., concerns over animals carrying the 
COVID-19 virus), grief and loss of an animal during the COVID-19 lockdown and 
the impact of engaging with non-companion animals during the COVID-19 lockdown. 
The findings complement and extend previous insights into the impact of 
human-animal interaction with both companion and non-companion animals. They 
also highlight the challenges of caring for an animal during the lockdown phase 
and indicate the need to consider the development of further targeted support 
strategies, such as "day care" for the companion animals of key workers in this 
context.

DOI: 10.3390/ijerph18030976
PMCID: PMC7908431
PMID: 33499354 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3832. Int J Environ Res Public Health. 2021 Jan 24;18(3):1014. doi: 
10.3390/ijerph18031014.

Inequality-Related Health and Social Factors and Their Impact on Well-Being 
during the COVID-19 Pandemic: Findings from a National Survey in the UK.

Chen DT(1), Wang YJ(1)(2).

Author information:
(1)Public Health Policy Evaluation Unit, School of Public Health, Imperial 
College London, London W6 8RP, UK.
(2)Department of Family Medicine, Taipei Veterans General Hospital, Taipei 112, 
Taiwan.

Background: Lower socioeconomic groups and disadvantaged populations across the 
world suffer disproportionately from the coronavirus disease 2019 (COVID-19) 
pandemic. This study aimed to examine the impact of health- and 
social-inequality-related factors on well-being in order to further distinguish 
each of their effects during the pandemic. Methods: A nationally-representative 
sample of 5077 UK respondents aged 18 years or older was recruited through an 
online survey panel during the COVID-19 pandemic. Their subjective well-being 
was measured using the 11-point Cantril Ladder of Life Scale. The impact of 
inequality-related health and social factors (pre-existing medical conditions, 
household size and occupation), as well as COVID-19-related risk factors 
(symptoms, confirmed infections, and social distancing behaviours) on well-being 
were analysed using multiple linear regression models. The associations between 
the COVID-19-related risk factors and well-being according to the respondents' 
household size and occupation were modelled in order to test the differences by 
their socioeconomic profile. Results: We identified inverted V-shaped 
associations between household size and subjective well-being during the 
COVID-19 pandemic. Compared to single-person households, respondents from 
households of two to four persons showed better well-being (β = 0.57; CI (0.44, 
0.72)), whereas living in crowded households of five persons or more was 
associated with decreased well-being (β = -0.48; CI (-0.71, -0.25)). 
Furthermore, lower-skilled occupations (elementary occupations: β = -0.31; CI 
(-0.58, -0.03); logistics and transport services: β = -0.37; CI (-0.74, -0.01)) 
and chronic medical conditions (cardiometabolic or respiratory diseases: β = 
-0.25; CI (-0.41, -0.1); and mental health conditions: β = -1.12; CI (-1.28, 
-0.96)) were factors associated with reduced well-being during the pandemic. 
Interactions between a positive COVID-19 diagnosis, symptoms, and crowded 
households were identified (β = -0.95; CI (-1.76, -0.14) and β = -4.74; CI 
(-9.87, -1.61), respectively). Conclusions: In a national sample, the levels of 
general subjective well-being during the COVID-19 pandemic and lockdowns were 
disproportionately distributed across different groups within society. 
Preventive policies should explicitly focus on reaching lower socioeconomic 
groups; more emphasis should be placed on the coordination of multisectoral 
support in order to tackle existing health and social inequalities.

DOI: 10.3390/ijerph18031014
PMCID: PMC7908210
PMID: 33498842 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3833. Int J Environ Res Public Health. 2021 Jan 20;18(3):866. doi: 
10.3390/ijerph18030866.

Psychological Wellbeing and Academic Experience of University Students in 
Australia during COVID-19.

Dodd RH(1), Dadaczynski K(2)(3), Okan O(4), McCaffery KJ(1), Pickles K(1).

Author information:
(1)Faculty of Medicine and Health, School of Public Health, The University of 
Sydney, Sydney 2006, Australia.
(2)Department of Nursing and Health Science, Fulda University of Applied 
Sciences, 36037 Fulda, Germany.
(3)Centre for Applied Health Science, Leuphana University Lueneburg, 21335 
Lueneburg, Germany.
(4)Interdisciplinary Centre for Health Literacy Research, Bielefeld University, 
33615 Bielefeld, Germany.

COVID-19 has created significant challenges for higher education institutions 
and major disruptions in teaching and learning. To explore the psychological 
wellbeing of domestic and international university students during the COVID-19 
pandemic, an online cross-sectional survey recruited 787 university students 
(18+ years) currently studying at an Australian university. In total, 86.8% 
reported that COVID-19 had significantly impacted their studies. Overall, 34.7% 
of students reported a sufficient level of wellbeing, while 33.8% showed low 
wellbeing and 31.5% very low wellbeing. Wellbeing was significantly higher in 
postgraduate students compared with undergraduate students. Future anxiety was 
significantly greater among undergraduate than postgraduate students. 
Multivariable regression models showed female gender, low subjective social 
status, negative overall learning experience or reporting COVID-19 having a huge 
impact on study, were associated with lower wellbeing in the first few months 
(May-July) of the pandemic. Supporting the health, wellbeing, and learning 
experiences of all students should be of high priority now and post-pandemic. 
Strategies specifically targeting female students, and those with low 
self-reported social status are urgently needed to avoid exacerbating existing 
disparities.

DOI: 10.3390/ijerph18030866
PMCID: PMC7908219
PMID: 33498376 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3834. Econ Hum Biol. 2021 May;41:100979. doi: 10.1016/j.ehb.2021.100979. Epub 2021 Jan 
19.

The psychological burden of the COVID-19 pandemic severity.

Le K(1), Nguyen M(2).

Author information:
(1)The Faculty of Economics and Public Management, Ho Chi Minh City Open 
University, Vietnam. Electronic address: kien.le@ou.edu.vn.
(2)The Faculty of Economics and Public Management, Ho Chi Minh City Open 
University, Vietnam. Electronic address: my.ngt@ou.edu.vn.

The alarming levels of spread and severity of COVID-19 have dominated global 
attention. In this time of crisis, there is an urgent need for studies 
identifying the linkages between the pandemic and social welfare. To help 
policymakers respond to the situation better, we investigate how the severity of 
the COVID-19 pandemic can condition people's psychological well-being. Employing 
the latest weekly panel data within an individual fixed effects framework, we 
uncover the damaging consequences of the COVID-19 severity, as measured by 
mortality rate, on the incidences of daily anxiety, worry, displeasure, and 
depression in the United States. Our work underlines the importance of public 
spending on mental health, both during and after the pandemic.

Copyright © 2021 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.ehb.2021.100979
PMCID: PMC7817435
PMID: 33497964 [Indexed for MEDLINE]


3835. J Am Med Dir Assoc. 2021 Jun;22(6):1199-1205. doi: 10.1016/j.jamda.2020.12.029. 
Epub 2021 Jan 23.

Management of Chronic Pain in Nursing Homes: Navigating Challenges to Improve 
Person-Centered Care.

Sheikh F(1), Brandt N(2), Vinh D(3), Elon RD(4).

Author information:
(1)Department of Medicine, Johns Hopkins University School of Medicine, 
Baltimore, MD, USA. Electronic address: fshaikh1@jhmi.edu.
(2)University of Maryland School of Pharmacy, Peter Lamy Center on Drug Therapy 
and Aging, and Center for Successful Aging at MedStar Good Samaritan Hospital, 
Baltimore, MD, USA.
(3)Department of Physical Medicine and Rehabilitation, Johns Hopkins University 
School of Medicine, Baltimore, MD, USA.
(4)Department of Medicine, Johns Hopkins University School of Medicine, 
Baltimore, MD, USA.

Despite the dynamic demands in the nursing home (NH), a definitive approach to 
managing chronic pain in older adults has yet to be established. Due to concerns 
for potential adverse pharmacologic effects, balancing appropriate pain 
management is a challenge among NH residents. The challenges encompass but are 
not limited to medical complexities, functional disabilities, and physical 
frailty. Barriers to the successful implementation of a comprehensive chronic 
pain management at the NH may include ambiguous directions on specific 
therapeutic interventions, insufficient guidance on treatment duration, and 
limited available treatment options. The Centers for Medicare and Medicaid 
Services' reporting requirement of adequate pain control among NH residents 
coupled with widely variable clinician-prescribing habits highlights the 
difficulties in overcoming the preceding challenges and barriers. The 
Coronavirus Disease 2019 (COVID-19) pandemic has further complicated pain 
management due to its negative consequences on well-being of residents of NHs. 
Associated symptoms of psychosocial stress, anxiety and depression, and chronic 
pain symptoms can exacerbate during the COVID-19 pandemic, leading to increased 
requirement for pain medications including but not limited to opioids. Pain is a 
multidimensional symptom and requires a strategic multimodal approach for its 
management. Nonpharmacologic modalities are underutilized in the NH setting and 
are the preferred first steps for mild pain, and nonopioid pharmacological 
agents can be added as a second step for a synergistic effect for moderate to 
severe pain. Opioids should be used as a last resort. Short-acting opioids are 
preferred over extended-release/long-acting opioids for chronic pain. Clinicians 
are encouraged to engage residents in proactive strategies in managing their 
pain, and to set realistic expectations toward improving their quality of life, 
as complete elimination of pain is not feasible in most cases. This review 
article provides the interdisciplinary team with a contemporary perspective of 
the multitude of changes and challenges influencing the prescribing as well as 
deprescribing of various pain medications.

Copyright © 2020 AMDA – The Society for Post-Acute and Long-Term Care Medicine. 
Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jamda.2020.12.029
PMID: 33497656 [Indexed for MEDLINE]


3836. Clin Rheumatol. 2021 Jun;40(6):2499-2504. doi: 10.1007/s10067-021-05601-1. Epub 
2021 Jan 25.

Impact of COVID-19 on rheumatology practice in the UK-a pan-regional 
rheumatology survey.

Nune A(1), Iyengar KP(2), Ahmed A(2), Bilgrami S(3), Sapkota HR(4).

Author information:
(1)Consultant Rheumatologist, Southport and Ormskirk NHS Trust, Southport, PR8 
6PN, UK. arvind.nune@nhs.net.
(2)Consultant Rheumatologist, Southport and Ormskirk NHS Trust, Southport, PR8 
6PN, UK.
(3)Consultant Rheumatologist, Royal Lancaster Infirmary, Lancaster, LA1 4RP, UK.
(4)Consultant Rheumatologist, The Royal Wolverhampton NHS Trust, Wolverhampton, 
WV10 0QP, UK.

The COVID-19 pandemic has disrupted healthcare services and rheumatology staff 
were redeployed to the frontline. The purpose of this survey was to evaluate the 
impact of the COVID-19 pandemic on the provision of rheumatology services as 
viewed by rheumatologists in the UK. Survey monkey questionnaire weblink was 
sent to 804 clinicians including consultant rheumatologists, speciality 
trainees, nurse specialists, and allied health professionals in 4 regions of the 
UK to evaluate personal effects of COVID-19 and redeployment, impact on current 
out-patient clinic activity, immunosuppressive drug use, and future rheumatology 
care. Response rate was 21%. One-fifth of the responders reported that their 
rheumatology departments were functioning less than 50% capacity during the 
pandemic. Two-third of responders felt anxious about the ill-effects of COVID-19 
on their health and well-being, and one-third of them were redeployed. During 
the peak of the pandemic, 75% of clinicians stopped intravenous biologics. 
Although access to video consultation was available for up to three-fourths of 
the clinicians, the majority (90%) used this modality in less than 1 in 4 
consultations. This survey highlights rheumatologists' perception in the 
delivery of future care and anxiety they faced. As demonstrated by this survey, 
the National Institute for Health and Care Excellence (NICE) guidance did not 
influence clinician decision making in some aspects of patient care. 
Underutilization of tele-rheumatology in this survey should be considered whilst 
planning the restoration of rheumatology services in the post-COVID era. Key 
points • COVID-19 has generated significant concerns among rheumatology 
community about their mental well-being. • In over 50% of cases, rheumatologists 
stopped IV biologic drugs as per patients' wishes during the first wave of the 
pandemic. • Tele-rheumatology has been used more widely during the pandemic, but 
the extent of its use in the post-COVID era is less clear. Evolving evidence 
will determine its future wider use.

DOI: 10.1007/s10067-021-05601-1
PMCID: PMC7832421
PMID: 33495972 [Indexed for MEDLINE]


3837. BMJ Open. 2021 Jan 25;11(1):e043418. doi: 10.1136/bmjopen-2020-043418.

COVID-19 welbeing study: a protocol examining perceived coercion and 
psychological well-being during the COVID-19 pandemic by means of an online 
survey, asynchronous virtual focus groups and individual interviews.

Ranieri V(1)(2), Sem Stoltenberg A(3), Pizzo E(4), Montaldo C(5), Bizzi E(6), 
Edwards S(2), Kamboj S(7).

Author information:
(1)Psychology and Language Sciences, University College London, London, UK 
v.ranieri@ucl.ac.uk.
(2)Science and Technology Studies, University College London, London, UK.
(3)Psychology and Language Sciences, University College London, London, UK.
(4)Applied Health Research, University College London, London, UK.
(5)Ambulatorio di Medicina Tropicale e del Viaggiatore, Istituto Nazionale per 
le Malattie Infettive Lazzaro Spallanzani, Roma, Lazio, Italy.
(6)Dipartimento di Medicina Interna, San Pietro Fatebenefratelli Hospital, Rome, 
UK.
(7)Psychology, University College London, London, UK.

INTRODUCTION: The COVID-19 pandemic has resulted in many countries applying 
restrictive measures, such as lockdown, to contain and prevent further spread. 
The psychological impact of lockdown and working as a healthcare worker on the 
frontline has been chronicled in studies pertaining to previous infectious 
disease pandemics that have reported the presence of depressive symptoms, 
anxiety, insomnia, and post-traumatic stress symptoms. Potentially linked to 
psychological well-being and not yet studied is the possibility that lockdown 
and working on the frontline of the pandemic are associated with perceptions of 
coercion.
METHODS AND ANALYSIS: The present study aimed to examine perceived coercion in 
those who have experienced COVID-19-related lockdown and/or worked as a 
frontline healthcare worker across three European countries. It aimed to 
describe how such perceptions may impact on psychological well-being, coping and 
post-traumatic growth. It will employ an explanatory mixed-methods research 
methodology consisting of an online survey and online asynchronous virtual focus 
groups (AVFGs) and individual interviews. χ2 tests and analyses of variance will 
be used to examine whether participants from different countries differ 
according to demographic factors, whether there are differences between cohorts 
on perceived coercion, depression, anxiety and post-traumatic growth scores. The 
relationship between coercion and symptoms of distress will be assessed using 
multiple regression. Both the AVFGs and the narrative interviews will be 
analysed using thematic narrative analysis.
ETHICS AND DISSEMINATION: The study has been approved by University College 
London's Research Ethics Committee under Project ID Number 7335/004. Results 
will be disseminated by means of peer-reviewed publications and at national 
and/or international conferences.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2020-043418
PMCID: PMC7839305
PMID: 33495259 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3838. J Homosex. 2021 Mar 21;68(4):647-662. doi: 10.1080/00918369.2020.1868188. Epub 
2021 Jan 25.

The Spatial Impacts of COVID-19 Restrictions on LGBTIQ Wellbeing, Visibility, 
and Belonging in Tasmania, Australia.

Grant R(1), Gorman-Murray A(2), Briohny Walker B(3).

Author information:
(1)Sociology School of Social Sciences, University of Tasmania , Launceston, 
Australia.
(2)Geography School of Social Sciences, Western Sydney University , Penrith, 
Australia.
(3)Philosophy and Gender Studies School of Humanities, University of Tasmania , 
Hobart, Australia.

International emergency management and disaster risk reduction policies and 
planning have rarely included lesbian, gay, bisexual, transgender, intersex, and 
queer (LGBTIQ) people's specific health and wellbeing concerns, despite 
increasing research showing that these groups face some specific vulnerabilities 
and additional challenges. Emerging studies in the US and UK noted increased 
feelings of loneliness, minority stress, and vulnerability to family violence 
since the outbreak of COVID-19. However, little is known about LGBTIQ people's 
experiences of COVID-19 in Australia. This article explores the effects of 
COVID-19 on LGBTIQ mental health and wellbeing in Tasmania, Australia. Drawing 
on a survey of 231 LGBTIQ respondents aged 14-78, we use the spaces of wellbeing 
framework to examine the impacts of COVID-19 restrictions on LGBTIQ 
(in)visibility in relation to the public, private, and online spaces, arguing 
that COVID-19 restrictions affected LGBTIQ Tasmanians' experiences and use of 
spaces in ways that detracted from wellbeing, visibility, and belonging.

DOI: 10.1080/00918369.2020.1868188
PMID: 33492203 [Indexed for MEDLINE]


3839. Front Public Health. 2021 Jan 8;8:573932. doi: 10.3389/fpubh.2020.573932. 
eCollection 2020.

Hospital Preparedness, Resilience, and Psychological Burden Among Clinical 
Nurses in Addressing the COVID-19 Crisis in Riyadh, Saudi Arabia.

Balay-Odao EM(1), Alquwez N(1), Inocian EP(2), Alotaibi RS(3).

Author information:
(1)Nursing Department, College of Applied Medical Sciences, Shaqra University, 
Shaqra, Saudi Arabia.
(2)School of Nursing, Duquesne University, Pittsburgh, PA, United States.
(3)Dawadmi General Hospital, Al Dawadmi, Saudi Arabia.

In the continuous effort to minimize the devastating effects of coronavirus 
disease (COVID-19) and to curb the spread of the disease, hospital preparedness 
and resilience play significant roles in the psychological well-being of 
clinical nurses given that their work demands immediate action to adapt and 
adjust to stressors. Thus, this study investigates the hospital preparedness, 
psychological burden, and resilience of clinical nurses in addressing COVID-19 
in Riyadh, Saudi Arabia. A total of 281 clinical nurses participated in the 
survey from April 2020 to June 2020. Results show that clinical nurses perceived 
a high self-assessed COVID-19 hospital preparedness (49.65, SD = 2.30); high 
self-assessed nurses' resilience (4.03, SD = 0.36); and most have normal levels 
of depression, anxiety, and stress. The variables were predicted to be 
statistically significant (F 18,262 = 4.14, p = 0.001) and accounted for 16.8% 
of the variance in the nurses' perception of hospital preparedness (R 2 = 0.221; 
adjusted R 2 = 0.168). The regression analysis was statistically significant (F 
30,250 = 6.71, p = 0.001) and accounted for 38% of the variance in nurses' 
resilience (R 2 = 0.446, Adjusted R 2 = 0.380). The predictors of depression, 
anxiety, and stress show that the overall relationship was statistically 
significant at (F 23,257 = 6.71, p < 0.001), (F 23,257 = 6.675, p 0.000), and (F 
23,257 = 6.692, p 0.000) with 31.9% of the variance (R 2 = 0.375, Adjusted R 2 = 
0.319), 31.8% of the variance (R 2 = 0.374, Adjusted R 2 = 0.318), and 31.9 % of 
the variance (R 2 = 0.375, Adjusted R 2 = 0.319), respectively. The findings of 
this study helps in improving the continuing education program, psychological 
support, and mental health program to ensure that the needs of clinical nurses 
are addressed during the outbreak of a disease.

Copyright © 2021 Balay-odao, Alquwez, Inocian and Alotaibi.

DOI: 10.3389/fpubh.2020.573932
PMCID: PMC7821043
PMID: 33490012 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


3840. Psychol Health Med. 2022 Apr;27(4):803-814. doi: 10.1080/13548506.2021.1876892. 
Epub 2021 Jan 25.

Exploring the association between coronavirus stress, meaning in life, 
psychological flexibility, and subjective well-being .

Arslan G(1)(2), Allen KA(3)(4).

Author information:
(1)Department of Psychological Counseling and Guidance, Mehmet Akif Ersoy 
University, Burdur, Turkey.
(2)International Network on Personal Meaning, Toronto, Ontario, Canada.
(3)Educational Psychology and Inclusive Education, Faculty of Education, Monash 
University, Clayton, Victoria, Australia.
(4)Centre for Positive Psychology, Melbourne Graduate School of Education, 
University of Melbourne, Victoria, Parkville, Australia.

There has been a call to action from much of the community to urgently 
investigate stress and well-being during the global health crisis instigated by 
COVID-19. This study seeks to investigate well-being, meaning in life, and 
psychological flexibility in relation to COVID-19 stress. Participants of the 
study consisted of 417 students from a public university, and they were 40.3% 
male and 59.7% female, ranging in age from 18 to 40 years (M = 23.36, 
SD = 5.96). The study's findings indicated that meaning in life and 
psychological flexibility mediated the effect of coronavirus stress on student 
well-being. Psychological flexibility also mitigated the effect of stress on 
meaning in life. The study findings offer implications for mental health 
professionals and officials responding to COVID-19 and provide insights into 
future planning and preparedness for disasters of this scale that may occur in 
future years.

DOI: 10.1080/13548506.2021.1876892
PMID: 33487048 [Indexed for MEDLINE]


3841. Acta Paediatr. 2021 Apr;110(4):1281-1288. doi: 10.1111/apa.15775. Epub 2021 Feb 
9.

Impact of the COVID-19 pandemic on children with and without risk for 
neurodevelopmental impairments.

Ehrler M(1)(2), Werninger I(1), Schnider B(2)(3), Eichelberger DA(1)(2), Naef 
N(1)(2), Disselhoff V(2)(3), Kretschmar O(2)(4)(5), Hagmann CF(2)(3)(5), Latal 
B(1)(2)(5), Wehrle FM(1)(2)(3).

Author information:
(1)Child Development Center, University Children's Hospital Zurich, Zurich, 
Switzerland.
(2)Children's Research Center, University Children's Hospital Zurich, Zurich, 
Switzerland.
(3)Department of Neonatology and Intensive Care, University Children's Hospital 
Zurich, Zurich, Switzerland.
(4)Department of Pediatric Cardiology, University Children's Hospital Zurich, 
Zurich, Switzerland.
(5)University of Zurich, Zurich, Switzerland.

AIM: To examine how the ongoing COVID-19 pandemic impacts child well-being and 
family functioning, particularly among children at risk for neurodevelopmental 
impairments.
METHODS: Families of 73 typically developing children, 54 children born very 
preterm (VPT) and 73 children with congenital heart disease (CHD) from two 
prospective cohort studies were assessed prior to (mean age: 10.4 [SD: 1.2] 
years) and during (mean age: 12.8 [SD: 2.0] years) the pandemic, more 
specifically, in April/May 2020. Child well-being and family functioning were 
assessed with validated, parent-reported questionnaires and tested with linear 
mixed models. Group comparison of child distress and parental concerns related 
to medical implications of COVID-19 and homeschooling, assessed with 5-point 
Likert scales, was done with Mann-Whitney U tests.
RESULTS: Children's psychological well-being and family functioning (both, 
p < 0.001) decreased significantly during the pandemic, irrespective of group. 
Children with CHD were reported to be more concerned about becoming infected 
with SARS-CoV-2 than were others. Child distress due to homeschooling and 
parents' concerns about children's academic achievements were significantly 
higher in VPT and CHD children than in typically developing peers (all 
p < 0.001).
CONCLUSION: The COVID-19 pandemic substantially impacts the whole family and 
leads to additional distress in families with children at risk for 
neurodevelopmental impairments. These families should receive individualised 
counselling and assistance from healthcare providers and schools during the 
pandemic.

©2021 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

DOI: 10.1111/apa.15775
PMID: 33486835 [Indexed for MEDLINE]


3842. Gen Hosp Psychiatry. 2021 May-Jun;70:137-138. doi: 
10.1016/j.genhosppsych.2021.01.004. Epub 2021 Jan 15.

Diminished well-being persists beyond the end of the COVID-19 lockdown.

Pieh C(1), Probst T(2), Budimir S(3), Humer E(2).

Author information:
(1)Department for Psychotherapy and Biopsychosocial Health, Danube University 
Krems, Austria. Electronic address: Christoph.Pieh@donau-uni.ac.at.
(2)Department for Psychotherapy and Biopsychosocial Health, Danube University 
Krems, Austria.
(3)Department for Psychotherapy and Biopsychosocial Health, Danube University 
Krems, Austria; Department of Work, Organization and Society, Ghent University, 
Belgium.

DOI: 10.1016/j.genhosppsych.2021.01.004
PMCID: PMC7833457
PMID: 33485671 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3843. Sleep Med. 2021 Mar;79:29-39. doi: 10.1016/j.sleep.2020.12.041. Epub 2021 Jan 2.

People with dyssomnia showed increased vulnerability to CoVID-19 pandemic: a 
questionnaire-based study exploring the patterns and predictors of sleep quality 
using the latent class analysis technique in Indian population.

Radhakrishnan A(1), Govindaraj R(1), Sasidharan A(1), Ravindra PN(1), Yadav 
R(2), Kutty BM(3).

Author information:
(1)Centre for Consciousness Studies, Department of Neurophysiology, National 
Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India.
(2)Department of Neurology, National Institute of Mental Health and Neuro 
Sciences (NIMHANS), Bengaluru, India.
(3)Centre for Consciousness Studies, Department of Neurophysiology, National 
Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India. 
Electronic address: bindu.nimhans@gmail.com.

INTRODUCTION: CoVID-19 pandemic and the subsequent lockdown have impacted the 
sleep quality and the overall wellbeing of mankind. The present epidemiological 
study measured various aspects of sleep disturbance such as sleep quality, 
daytime impairments, negative emotionality, sleep hygiene, and well-being 
associated with CoVID-19 pandemic among the Indian population.
METHODS: This cross-sectional voluntary online survey (using Google form) was 
communicated across the country from 4th June to 3rd July 2020 through mail and 
social media applications. The responses received (N = 450) were categorized and 
validated using the latent class analysis and logistic regression tests 
respectively, and the classes and subclasses derived were profiled. These 
techniques are used for the first time in a CoVID-19 sleep study.
RESULTS: Out of the three classes derived from the LCA, people with severe 
dyssomnia belonging to class 1 (33.3%) showed high daytime impairments, negative 
emotionality and high vulnerability towards CoVID-19 pandemic measures. In 
addition, the two subclasses derived from the severe dyssomnia group; one with 
negative emotionality predominance and the other with excessive daytime 
sleepiness, were similarly affected by CoVID-19 measures. People with moderate 
dyssomnia (class 2, 28.5%) showed frequent arousals with daytime impairments and 
the majority (38.2%) which fell in to class 3, the 'no dyssomnia' category, were 
not impacted by CoVID-19 pandemic.
CONCLUSION: People with existing sleep problems or those who were vulnerable to 
the same were the ones affected by CoVID-19 pandemic. Those with inadequate 
emotional coping styles have showed heightened vulnerability. Proper medical and 
cognitive interventions are highly recommended for this population. No or 
moderate dyssomnia categories (class 3 and 2 respectively) were less impacted by 
CoVID-19.

Copyright © 2021 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.sleep.2020.12.041
PMCID: PMC7834060
PMID: 33485259 [Indexed for MEDLINE]

Conflict of interest statement: All the authors have declared that there are no 
conflicts of interest in relation to the subject of this study. The ICMJE 
Uniform Disclosure Form for Potential Conflicts of Interest associated with this 
article can be viewed by clicking on the following link: 
https://doi.org/10.1016/j.sleep.2020.12.041.


3844. Mol Psychiatry. 2021 Sep;26(9):4813-4822. doi: 10.1038/s41380-021-01019-y. Epub 
2021 Jan 22.

The impact of quarantine on mental health status among general population in 
China during the COVID-19 pandemic.

Wang Y(#)(1)(2), Shi L(#)(3), Que J(#)(3), Lu Q(1)(2), Liu L(1)(2), Lu Z(3), Xu 
Y(1)(2), Liu J(3), Sun Y(3), Meng S(1), Yuan K(3), Ran M(4), Lu L(5)(6), Bao 
Y(7)(8), Shi J(9).

Author information:
(1)National Institute on Drug Dependence, Peking University, Beijing, 100191, 
China.
(2)School of Public Health, Peking University, Beijing, 100191, China.
(3)Institute of Mental Health, National Clinical Research Center for Mental 
Disorders, Key Laboratory of Mental Health and Peking University Sixth Hospital, 
Peking University, Beijing, 100191, China.
(4)Department of Social Work and Social Administration, University of Hong Kong, 
Hong Kong, China.
(5)Institute of Mental Health, National Clinical Research Center for Mental 
Disorders, Key Laboratory of Mental Health and Peking University Sixth Hospital, 
Peking University, Beijing, 100191, China. linlu@bjmu.edu.cn.
(6)Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for 
Brain Research, Peking University, Beijing, 100191, China. linlu@bjmu.edu.cn.
(7)National Institute on Drug Dependence, Peking University, Beijing, 100191, 
China. baoyp@bjmu.edu.cn.
(8)School of Public Health, Peking University, Beijing, 100191, China. 
baoyp@bjmu.edu.cn.
(9)National Institute on Drug Dependence, Peking University, Beijing, 100191, 
China. shijie@bjmu.edu.cn.
(#)Contributed equally

Quarantine and isolation measures urgently adopted to control the COVID-19 
pandemic might potentially have negative psychological and social effects. We 
conducted this cross-sectional, nationwide study to ascertain the psychological 
effect of quarantine and identify factors associated with mental health outcomes 
among population quarantined to further inform interventions of mitigating 
mental health risk especially for vulnerable groups under pandemic conditions. 
Sociodemographic data, attitudes toward the COVID-19, and mental health 
measurements of 56,679 participants from 34 provinces in China were collected by 
an online survey from February 28 to March 11, 2020. Of the 56,679 participants 
included in the study (mean [SD] age, 36.0 [8.2] years), 27,149 (47.9%) were 
male and 16,454 (29.0%) ever experienced home confinement or centralized 
quarantine during COVID-19 outbreak. Compared those without quarantine and 
adjusted for potential confounders, quarantine measures were associated with 
increased risk of total psychological outcomes (prevalence, 34.1% vs 27.3%; odds 
ratio [OR], 1.34; 95% CI, 1.28-1.39; P < 0.001). Multivariable logistic 
regression analyses showed that vulnerable groups of the quarantined population 
included those with pre-existing mental disorders or chronic physical diseases, 
frontline workers, those in the most severely affected areas during outbreak, 
infected or suspected patients, and those who are less financially well-off. 
Complying with quarantine, being able to take part in usual work, and having 
adequate understanding of information related to the outbreak were associated 
with less mental health issues. These results suggest that quarantine measures 
during COVID-19 pandemic are associated with increased risk of experiencing 
mental health burden, especially for vulnerable groups. Further study is needed 
to establish interventions to reduce mental health consequences of quarantine 
and empower wellbeing especially in vulnerable groups under pandemic conditions.

© 2021. The Author(s), under exclusive licence to Springer Nature Limited part 
of Springer Nature.

DOI: 10.1038/s41380-021-01019-y
PMCID: PMC7821451
PMID: 33483692 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


3845. Psychiatry Res. 2021 Feb;296:113706. doi: 10.1016/j.psychres.2021.113706. Epub 
2021 Jan 5.

Increased mood disorder symptoms, perceived stress, and alcohol use among 
college students during the COVID-19 pandemic.

Charles NE(1), Strong SJ(2), Burns LC(2), Bullerjahn MR(2), Serafine KM(3).

Author information:
(1)School of Psychology, The University of Southern Mississippi, Hattiesburg, MS 
USA. Electronic address: nora.charles@usm.edu.
(2)School of Psychology, The University of Southern Mississippi, Hattiesburg, MS 
USA.
(3)Department of Psychology, The University of Texas at El Paso, El Paso, TX 
USA.

The COVID-19 pandemic caused significant disruption during the spring of 2020. 
Many college students were told to leave campus at spring break and to complete 
the semester remotely. This study evaluates effects of this disruption on 
student well-being. Measures of psychological symptoms, perceived stress, and 
alcohol use during the pandemic were completed by 148 students in spring 2020 
and 352 students in fall 2020 at a university in the southeastern U.S. Results 
from both cohorts were compared to 240 students who completed the same measures 
in the fall 2019 semester. Participants in spring 2020 reported more mood 
disorder symptoms, perceived stress, and alcohol use than did pre-pandemic 
participants and worry about COVID-19 was negatively associated with well-being. 
By fall 2020 symptoms had largely returned to pre-pandemic levels. In general, 
White students reported a greater effect of the pandemic on well-being than did 
African American students. Young adults appear to be less vulnerable to the most 
serious medical complications associated with COVID-19, but nonetheless 
experience psychological effects from the pandemic. Universities and 
practitioners who work with college students can help young adults manage their 
symptoms and avoid behaviors like risky alcohol use when confronted with 
stressors such as the COVID-19 pandemic.

Copyright © 2021. Published by Elsevier B.V.

DOI: 10.1016/j.psychres.2021.113706
PMCID: PMC7781902
PMID: 33482422 [Indexed for MEDLINE]

Conflict of interest statement: None


3846. Age Ageing. 2021 May 5;50(3):657-663. doi: 10.1093/ageing/afab012.

'Getting back to normality seems as big of a step as going into lockdown': the 
impact of the COVID-19 pandemic on people with early to middle stage dementia.

Talbot CV(1)(2), Briggs P(1).

Author information:
(1)Department of Psychology, Northumbria University, Newcastle upon Tyne, UK.
(2)Department of Psychology, Bournemouth University, Poole, UK.

People with dementia can experience shrinkage of their social worlds, leading to 
a loss of independence, control and reduced well-being. We used 'the shrinking 
world' theory to examine how the COVID 19 pandemic has impacted the lives of 
people with early to middle stage dementia and what longer-term impacts may 
result. Interviews were conducted with 19 people with dementia and a thematic 
analysis generated five themes: the forgotten person with dementia, confusion 
over government guidance, deterioration of cognitive function, loss of meaning 
and social isolation, safety of the lockdown bubble. The findings suggest that 
the pandemic has accelerated the 'shrinking world' effect and created tension in 
how people with dementia perceive the outside world. Participants felt safe and 
secure in lockdown but also missed the social interaction, cognitive stimulation 
and meaningful activities that took place outdoors. As time in lockdown 
continued, these individuals experienced a loss of confidence and were anxious 
about their ability to re-engage in the everyday practises that allow them to 
participate in society. We recommend ways in which the government, communities 
and organisations might counteract some of the harms posed by this shrinking 
world.

© The Author(s) 2021. Published by Oxford University Press on behalf of the 
British Geriatrics Society.

DOI: 10.1093/ageing/afab012
PMCID: PMC7929391
PMID: 33481988 [Indexed for MEDLINE]


3847. JMIR Public Health Surveill. 2021 Feb 1;7(2):e22581. doi: 10.2196/22581.

COVID-19 and Black, Asian, and Minority Ethnic Communities: A Complex 
Relationship Without Just Cause.

Phiri P(1)(2), Delanerolle G(#)(3), Al-Sudani A(1), Rathod S(1).

Author information:
(1)Research & Development Department, Tom Rudd Unit, Moorgreen Hospital, 
Southern Health NHS Foundation Trust, Southampton, United Kingdom.
(2)University of Southampton, Primary Care, Population Sciences and Medical 
Education, Faculty of Medicine, Aldermoor Health Centre, Southampton, United 
Kingdom.
(3)Oxford Brain Health Clinical Trials Unit, Department of Psychiatry, Warnford 
Hospital, University of Oxford, Oxford, United Kingdom.
(#)Contributed equally

Emerging evidence has indicated a negative and disproportionate impact of 
COVID-19 on Black, Asian, and minority ethnic (BAME) communities. Previous 
studies have already reported that biological and social risk factors increase 
disease susceptibility, particularly in BAME communities. Despite frontline 
workers in ethnic minority communities in the United Kingdom's National Health 
Service attempting to quell the pandemic, disproportionate numbers of BAME 
physicians and other health care workers have died of COVID-19. This 
unprecedented situation highlights ethical and moral implications, which could 
further augment the impact of the pandemic on their mental health. While the 
government attempts to mitigate the rate of virus transmission, certain key 
factors inadvertently augment the negative impact of the pandemic on the mental 
health and general well-being of BAME communities. This study examined the 
available literature to explore the association between, and the wider impact 
of, COVID-19 on BAME communities. Furthermore, this study aims to raise 
awareness and provide a deeper insight into current scientific discussions.

©Peter Phiri, Gayathri Delanerolle, Ayaat Al-Sudani, Shanaya Rathod. Originally 
published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 
01.02.2021.

DOI: 10.2196/22581
PMCID: PMC7857527
PMID: 33481752 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: PP received grants from 
NovoNordisk, Queen Mary University of London, and John Wiley & Sons during the 
conduct of the study.


3848. Clin Med (Lond). 2021 Jan;21(1):66-72. doi: 10.7861/clinmed.2020-0502.

COVID-19: Causes of anxiety and wellbeing support needs of healthcare 
professionals in the UK: A cross-sectional survey.

Siddiqui I(1), Aurelio M(2), Gupta A(3), Blythe J(4), Khanji MY(5).

Author information:
(1)Woodgrange Medical Practice, London, UK, Wellbeing Hub lead, Newham Training 
Hub, London, UK and clinical lead for mental health and learning disabilities, 
Waltham Forest and East London clinical commissioning groups, London, UK 
imranasiddiqui@nhs.net.
(2)East London NHS Foundation Trust, London, UK.
(3)Barts Health NHS Trust, London, UK and senior clinical lecture, Barts 
Cardiovascular Clinical Trials Unit, London, UK.
(4)Liberty Bridge Road Practice, London, UK and senior clinical lecturer, Queen 
Mary University of London, London, UK.
(5)Newham University Hospital, London, UK and honorary senior clinical lecturer, 
William Harvey Research Institute, London, UK.

BACKGROUND: COVID-19 has caused acute changes in healthcare delivery; this may 
impact mental health and wellbeing needs of healthcare professionals (HCPs).
AIMS: We aimed to identify the causes of anxiety in HCPs during the COVID-19 
pandemic, to assess whether HCPs felt they had adequate mental health and 
wellbeing support and to identify their unmet support needs.
METHOD: We used a web-based survey utilising an online tool circulated to UK 
HCPs over 5 weeks. Self-perceived anxiety levels prior to and during the 
COVID-19 pandemic were measured on a 10-point Likert-type rating scale.
RESULTS: The survey was completed by 558 HCPs. During the pandemic, 
self-perceived anxiety scores significantly increased from a median of 2 to 7 
(paired Wilcoxon signed-rank test; p<0.001). The main reasons were concerns 
about exposure to SARS-CoV-2 and lack of personal protective equipment. Other 
wide-ranging reasons were identified. Only 41% of respondents felt there was 
adequate support. Thematic analysis of what support HCPs wanted identified 13 
wide-ranging themes; including effective leadership and peer support.
CONCLUSION: Anxiety levels in HCPs significantly increased during the COVID-19 
pandemic and the main causes were identified. Many HCPs felt there was 
inadequate support and identified what support they needed. Implementing 
effective strategies to support HCPs' unmet wellbeing needs are required as a 
matter of urgency.

© Royal College of Physicians 2021. All rights reserved.

DOI: 10.7861/clinmed.2020-0502
PMCID: PMC7850214
PMID: 33479070 [Indexed for MEDLINE]


3849. BMC Psychol. 2021 Jan 21;9(1):9. doi: 10.1186/s40359-020-00509-y.

Anxiety among dental professionals and its association with their dependency on 
social media for health information: insights from the COVID-19 pandemic.

Al-Amad SH(1), Hussein A(2).

Author information:
(1)Department of Oral and Craniofacial Health Sciences, Room M28-132, College of 
Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates. 
salamad@sharjah.ac.ae.
(2)Department of Family and Community Medicine and Behavioural Sciences, College 
of Medicine, University of Sharjah, Sharjah, United Arab Emirates.

Comment in
    Evid Based Dent. 2021 Jan;22(2):69.

BACKGROUND: Social media can play a detrimental role during a global health 
emergency. In this study, we aimed at assessing the impact social media has on 
the anxiety level of dental healthcare workers (DHCWs) whilst living through the 
COVID-19 pandemic.
METHODS: An online questionnaire was disseminated to a cross-sectional sample of 
DHCWs from 19 countries using social media platforms. The questionnaire enquired 
about DHCWs' frequency of using social media and their dependency on 
health-related information posted on those platforms. Anxiety was measured using 
General Anxiety Disorder scale (GAD-7).
RESULTS: Four-hundred and three (403) DHCWs completed the online questionnaire. 
Sixty-eight percent (68%) frequently use social media for information on 
COVID-19. The frequency of social media use was higher among younger DHCWs, with 
shorter clinical experience, and holders of undergraduate qualifications 
(p = 0.009, p = 0.002, and p = 0.023, respectively). Almost one third of DHCWs 
had moderate to severe anxiety (31.7%), which was significantly associated with 
the frequency of social media use (p = 0.016). This association was adjusted for 
age, years of experience and qualification level (OR 1.75; 95% CI 1.05-2.93; 
p = 0.032).
CONCLUSION: COVID-19 social media infodemic has been adversely impacting the 
psychological wellbeing of DHCWs. More effective measures are needed to control 
the quality and spreadability of health information on social media platforms.

DOI: 10.1186/s40359-020-00509-y
PMCID: PMC7819620
PMID: 33478591 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3850. Int J Environ Res Public Health. 2021 Jan 19;18(2):794. doi: 
10.3390/ijerph18020794.

COVID-19 Anxiety-A Longitudinal Survey Study of Psychological and Situational 
Risks among Finnish Workers.

Savolainen I(1), Oksa R(1), Savela N(1), Celuch M(1), Oksanen A(1).

Author information:
(1)Faculty of Social Sciences, Tampere University, Kalevantie 5, 33100 Tampere, 
Finland.

Background: The COVID-19 crisis has changed the conditions of many all over the 
globe. One negative consequence of the ongoing pandemic is anxiety brought about 
by uncertainty and the COVID-19 disease. Increased anxiety is a potential risk 
factor for wellbeing at work. This study investigated psychological, 
situational, and socio-demographic predictors of COVID-19 anxiety using 
longitudinal data. Methods: A nationally representative sample of Finnish 
workers (N = 1308) was collected before and during the COVID-19 crisis. Eighty 
percent of the participants responded to the follow-up study (N = 1044). 
COVID-19 anxiety was measured with a modified Spielberger State-Trait Anxiety 
Inventory. Psychological and situational predictors included perceived 
loneliness, psychological distress, technostress, personality, social support 
received from the work community, and remote working. A number of 
socio-demographic factors were also investigated. Results: Perceived loneliness, 
psychological distress, technostress, and neuroticism were identified as robust 
psychological predictors of COVID-19 anxiety. Increase in psychological distress 
and technostress during the COVID-19 crisis predicted higher COVID-19 anxiety. A 
recent change in their field of work and decreased social support from work 
communities predicted COVID-19 anxiety. Women and young people experienced 
higher anxiety. Conclusions: Different factors explain workers' COVID-19 
anxiety. Increased anxiety can disrupt wellbeing at work, emphasizing the 
organizations' role in maintaining an inclusive and caring work culture and 
providing technical and psychological support to workers during crisis.

DOI: 10.3390/ijerph18020794
PMCID: PMC7832302
PMID: 33477756 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3851. Eur Addict Res. 2021;27(4):239-241. doi: 10.1159/000513883. Epub 2021 Jan 21.

The Double Effect of COVID-19 Confinement Measures and Economic Recession on 
High-Risk Drug Users and Drug Services.

Costa Storti C(1), Bretteville-Jensen AL(2), De Grauwe P(3), Moeller K(4), 
Mounteney J(5), Stevens A(6).

Author information:
(1)European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal, 
claudia.costa-storti@emcdda.europa.eu.
(2)Norwegian Institute of Public Health, Oslo, Norway.
(3)European Institute, London School of Economics, London, United Kingdom.
(4)Department of Criminology, Malmö University, Malmö, Sweden.
(5)European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal.
(6)School of Social Policy, Sociology and Social Research, University of Kent, 
Medway, United Kingdom.

The ongoing COVID-19 pandemic is likely to have a profound impact on the lives 
of high-risk drug users and on the services responding to their needs in at 
least two important ways: first, through the restrictive measures introduced to 
mitigate the spread of the virus and, second, as a result of extensive economic 
downturn. Currently there is great uncertainty as to the future intensity and 
duration of the pandemic. In addition, the lessons we have been able to learn 
from previous economic downturns may be of limited applicability to the current 
situation, which differs in a number of significant respects. Experience 
nevertheless suggests that the potential consequences for drug users' health and 
well-being may be severe. The ongoing uncertainty serves to underline the 
importance of close monitoring of the drug situation and preparing flexible and 
innovative solutions to be able to meet new challenges which may arise.

© 2021 S. Karger AG, Basel.

DOI: 10.1159/000513883
PMCID: PMC7900462
PMID: 33477135 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
declare. The work described in this article does not express the views of the 
European Centre for Drugs and Drug Addiction. The views and opinions expressed 
are those of the authors.


3852. BMJ Open. 2021 Jan 20;11(1):e042270. doi: 10.1136/bmjopen-2020-042270.

COVID-19 and healthcare workers: a rapid systematic review into risks and 
preventive measures.

Gross JV(1), Mohren J(2), Erren TC(2).

Author information:
(1)Institute and Policlinic for Occupational Medicine, Environmental Medicine 
and Prevention Research, University Hospital Cologne, Koln, Nordrhein-Westfalen, 
Germany juliane.gross@uk-koeln.de.
(2)Institute and Policlinic for Occupational Medicine, Environmental Medicine 
and Prevention Research, University Hospital Cologne, Koln, Nordrhein-Westfalen, 
Germany.

OBJECTIVE: The COVID-19 pandemic is demanding for occupational medicine and for 
public health. As healthcare workers (HCWs) fight impacts of SARS-CoV-2 on front 
lines, we must create safe work environments through comprehensive risk 
assessments, evaluation and effective implementation of counter-measures. We 
ask: 'What does current literature report on health risks at workplaces 
regarding COVID-19?' and 'What do current studies report on the effectiveness of 
enacted preventative recommendations?'
METHODS: As a snapshot of early HCW research, on 26 April 2020, we conducted a 
rapid systematic literature search in three databases (PubMed, Web of Science 
and PsycInfo) for COVID-19-related health outcomes and preventive measures in 
healthcare-associated workplaces.
RESULTS: 27 studies were identified as relevant for exploring the risk of 
infection, 11 studies evaluated preventive measures. The studies described that 
SARS-CoV-2 impacts significantly on HCW's health and well-being, not only 
through infections (n=6), but also from a mental health perspective (n=16). 4 
studies reported indirect risks such as skin injuries, one study described 
headaches to result from the use of personal protective equipment. Few studies 
provided information on the effectiveness of prevention strategies. Overall, 
most studies on health risks as well as on the effectiveness of preventive 
measures were of a moderate-to-low quality; this was mainly due to limitations 
in study design, imprecise exposure and outcome assessments.
CONCLUSIONS: Due to widespread exposure of HCW to SARS-CoV-2, workplaces in 
healthcare must be as safe as possible. Information from HCW can provide 
valuable insights into how infections spread, into direct and indirect health 
effects and into how effectively counter-measures mitigate adverse health 
outcomes. However, available research disallows to judge which 
counter-measure(s) of a current 'mix' should be prioritised for HCW. To arrive 
at evidence-based cost-effective prevention strategies, more well-conceived 
studies on the effectiveness of counter-measures are needed.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2020-042270
PMCID: PMC7818819
PMID: 33472783 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3853. AIDS Behav. 2021 May;25(5):1331-1339. doi: 10.1007/s10461-020-03141-4. Epub 2021 
Jan 20.

Harm Reduction and Adaptations Among PWUD in Rural Oregon During COVID-19.

Seaman A(1), Leichtling G(2), Stack E(2), Gray M(2), Pope J(2), Larsen JE(3), 
Leahy JM(4), Gelberg L(4)(5), Korthuis PT(3).

Author information:
(1)Section of Addiction Medicine, Department of Medicine, Oregon Health & 
Science University, 3181 SW Sam Jackson Park Road, Mail Code - L475, Portland, 
97239-3098, OR, USA. seaman@ohsu.edu.
(2)Comagine Health, Portland, OR, USA.
(3)Section of Addiction Medicine, Department of Medicine, Oregon Health & 
Science University, 3181 SW Sam Jackson Park Road, Mail Code - L475, Portland, 
97239-3098, OR, USA.
(4)Oregon Health Authority, Acute and Communicable Disease Prevention, Public 
Health Division, Oregon Health Authority, Salem, OR, USA.
(5)Department of Health Policy and Management, UCLA Fielding School of Public 
Health, Los Angeles, USA.

Coronavirus Disease 2019 (COVID-19) may influence HIV/HCV transmission risk 
behaviors in rural communities. We conducted semi-structured qualitative 
interviews with people who use drugs (PWUD) in five rural Oregon counties and 
asked about COVID-19 impact on substance use and harm reduction practices and 
their advice for improving public health responses. Participants (n = 36) 
reported using only methamphetamine (52.8%), only heroin (16.7%), or both 
(30.6%); 75% of participants reported recent injection. Three thematic 
categories emerged: SSP adaptations and accessibility, PWUD harm reduction 
practices, and policy suggestions. Participants noted the importance of SSPs to 
COVID-19 prevention and wellbeing, though some experienced increased barriers, 
leading to increased risky injection practices. Participants suggested 
need-based rather than one-for-one exchange, increasing syringe delivery 
services, encouraging secondary exchange by PWUD, and peers as trusted voices 
for information exchange. Rapid implementation of policy and practice changes 
are urgently required to improve SSP access, reinforce safer use, and prevent 
HIV/HCV and COVID-19 transmission.

DOI: 10.1007/s10461-020-03141-4
PMCID: PMC7816753
PMID: 33471243 [Indexed for MEDLINE]

Conflict of interest statement: Andrew Seaman has received 
investigator-initiated research funding from Gilead Sciences and Merck & Co 
Pharmaceuticals unrelated to the content of this research. All other authors 
report no financial conflicts of interest. Dr. Korthuis serves as principal 
investigator for NIH-funded studies that accept donated study medications from 
Alkermes (extended-release naltrexone) and Indivior (buprenorphine).


3854. MCN Am J Matern Child Nurs. 2021 Mar-Apr 01;46(2):103-109. doi: 
10.1097/NMC.0000000000000692.

Impact of COVID-19 on Maternal Mental Health.

Goyal D, Selix NW.

The COVID-19 pandemic led to several states mandating social distancing and 
sheltering in place along with a shift in health care delivery, unprecedented 
unemployment rates, financial stress, and emotional concerns. For pregnant and 
postpartum women, limited social support and social isolation with social 
distancing and fear of COVID-19 exposure or infection for themselves, their 
fetus, or their newborn infants, have implications for maternal mental health. 
An overview of the potential impact of COVID-19 on mental health risk for 
pregnant and postpartum women is presented with implications for nursing 
practice to promote maternal-infant wellbeing.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/NMC.0000000000000692
PMCID: PMC7924923
PMID: 33470613 [Indexed for MEDLINE]


3855. BMJ Open. 2021 Jan 19;11(1):e043590. doi: 10.1136/bmjopen-2020-043590.

Impact on health and provision of healthcare services during the COVID-19 
lockdown in India: a multicentre cross-sectional study.

Raman R(1), Rajalakshmi R(2), Surya J(3), Ramakrishnan R(4), Sivaprasad S(5), 
Conroy D(4), Thethi JP(6), Mohan V(7), Netuveli G(8).

Author information:
(1)Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, 
Sankara Nethralaya, Chennai, India rajivpgraman@gmail.com.
(2)Dr.Mohan's Diabetes Specialities Centre and Madras Diabetes Research 
Foundation, Chennai, India.
(3)Diabetic Retinopathy Project, Sankara Nethralaya, Chennai, India.
(4)UCL Institute of Ophthalmology, London, UK.
(5)NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hosp NHS 
Foundation Trust, London, UK.
(6)B005 Meenakshi Classic, Bangalore, India.
(7)Madras Diabetes Research Foundation, Chennai, India.
(8)University of East London, London, UK.

INTRODUCTION: The COVID-19 pandemic resulted in a national lockdown in India 
from midnight on 25 March 2020, with conditional relaxation by phases and zones 
from 20 April. We evaluated the impact of the lockdown in terms of healthcare 
provisions, physical health, mental health and social well-being within a 
multicentre cross-sectional study in India.
METHODS: The SMART India study is an ongoing house-to-house survey conducted 
across 20 regions including 11 states and 1 union territory in India to study 
diabetes and its complications in the community. During the lockdown, we 
developed an online questionnaire and delivered it in English and seven popular 
Indian languages (Hindi, Tamil, Marathi, Telegu, Kannada, Bengali, Malayalam) to 
random samples of SMART-India participants in two rounds from 5 May 2020 to 24 
May 2020. We used multivariable logistic regression to evaluate the overall 
impact on health and healthcare provision in phases 3 and 4 of lockdown in red 
and non-red zones and their interactions.
RESULTS: A total of 2003 participants completed this multicentre survey. The 
bivariate relationships between the outcomes and lockdown showed significant 
negative associations. In the multivariable analyses, the interactions between 
the red zones and lockdown showed that all five dimensions of healthcare 
provision were negatively affected (non-affordability: OR 1.917 (95% CI 1.126 to 
3.264), non-accessibility: OR 2.458 (95% CI 1.549 to 3.902), inadequacy: OR 
3.015 (95% CI 1.616 to 5.625), inappropriateness: OR 2.225 (95% CI 1.200 to 
4.126) and discontinuity of care: OR 6.756 (95% CI 3.79 to 12.042)) and 
associated depression and social loneliness.
CONCLUSION: The impact of COVID-19 pandemic and lockdown on health and 
healthcare was negative. The exaggeration of income inequality during lockdown 
can be expected to extend the negative impacts beyond the lockdown.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2020-043590
PMCID: PMC7817386
PMID: 33468529 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3856. Soc Sci Med. 2021 Feb;270:113687. doi: 10.1016/j.socscimed.2021.113687. Epub 
2021 Jan 7.

Psychological distress in North America during COVID-19: The role of 
pandemic-related stressors.

Zheng J(1), Morstead T(1), Sin N(1), Klaiber P(1), Umberson D(2), Kamble S(3), 
DeLongis A(4).

Author information:
(1)Department of Psychology, University of British Columbia, 2136 West Mall, 
Vancouver, BC, V6T1Z4, Canada.
(2)Department of Sociology, The University of Texas at Austin, 305 E 23rd St, 
A1700, RLP 3.306, Austin, TX, 78712-1086, USA.
(3)Department of Psychology, Karnatak University Dharwad, Pavate Nagar, Dharwad, 
Karnataka State, 580 003, India.
(4)Department of Psychology, University of British Columbia, 2136 West Mall, 
Vancouver, BC, V6T1Z4, Canada. Electronic address: adelongis@psych.ubc.ca.

RATIONALE: The COVID-19 pandemic has wreaked havoc on lives around the globe. In 
addition to the primary threat of infection, widespread secondary stressors 
associated with the pandemic have included social isolation, financial 
insecurity, resource scarcity, and occupational difficulties.
OBJECTIVE: The current study examined the impact of these disruptions on 
psychological distress during the initial adjustment phase to the pandemic in 
North America.
METHOD: A sample of 2463 residents of the US and Canada completed both baseline 
and follow-up surveys across several weeks between March and May 2020.
RESULTS: Those participants perceiving stress related to higher levels of 
personal threat to health and to the well-being of family members at baseline 
reported higher levels of depressive symptoms at follow-up, even after 
controlling for baseline depressive symptoms. In addition, pandemic-related 
secondary stressors (social isolation, financial insecurity, occupational 
difficulty, and resource scarcity) were all independently associated with 
depressive symptoms at follow-up, controlling for both baseline depression and 
perceived health threats. The results were robust and held up after controlling 
for demographic factors. Women, young adults, and those who reported lower 
income were all at higher risk for subsequent depressive symptoms.
CONCLUSION: Findings from the present study can help to identify key groups at 
risk for mental health problems during the pandemic, and indicate actionable 
areas for targeted intervention.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.socscimed.2021.113687
PMCID: PMC9757831
PMID: 33465600 [Indexed for MEDLINE]

Conflict of interest statement: None.


3857. Aging Ment Health. 2022 Feb;26(2):413-422. doi: 10.1080/13607863.2020.1870207. 
Epub 2021 Jan 19.

Psychometric properties of the Cognitive Emotion Regulation Questionnaire (CERQ) 
in Spanish older adults.

Carvajal BP(1), Molina-Martínez MÁ(1), Fernández-Fernández V(2), 
Paniagua-Granados T(1), Lasa-Aristu A(3), Luque-Reca O(4).

Author information:
(1)Faculty of Education and Psychology, Universidad Francisco de Vitoria, 
Madrid, Spain.
(2)Department of Psychology of Personality, Evaluation and Psychology Treatment, 
Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain.
(3)Faculty of Psychology, Universidad Nacional de Educación a Distancia (UNED), 
Madrid, Spain.
(4)Department of Psychology, Universidad Rey Juan Carlos, Madrid, Spain.

The Cognitive Emotion Regulation Questionnaire (CERQ) assesses nine cognitive 
strategies used to cope with negative events. The aim of this study was to 
generate validity evidences of this instrument in an older Spanish population. 
The Spanish version of the CERQ (CERQ-S) and self-report scales, measuring 
psychological well-being, depression and resilience, were administered to 305 
older adults aged 65-90 (70.0 ± 4.7) residents in the Autonomous Community of 
Madrid, Spain. 150 participants completed the 6-month follow-up in April 2020 
(during the COVID-19 pandemic). Confirmatory factor analyses supported 
9-strategy structure, with an improved fit 27-item version (CERQ-S-27). 
Generally adequate composite reliability (CR between 0.63 and 0.84) and temporal 
stability (ICC between 0.38 and 0.71; p < 0.001) were found. Subscales 
correlated coherently with measures of depression, well-being and resilience, 
and T-tests indicated different use between older adults who did or did not have 
depressive symptoms. Multiple linear regression analysis indicated that 
subscales predicted depressive symptoms (R2 = 0.17; p < 0.001) and psychological 
well-being after six months (R2 = 0.21; p < 0.001). Results provided evidences 
of concurrent, predictive and criterion validity, suggesting that the CERQ-S-27 
could be useful for studying use of cognitive emotion regulation strategies 
among older adults and understanding their influence in ageing and mental 
health.

DOI: 10.1080/13607863.2020.1870207
PMID: 33463369 [Indexed for MEDLINE]


3858. Sex Transm Infect. 2021 Nov;97(7):521-524. doi: 10.1136/sextrans-2020-054768. 
Epub 2021 Jan 18.

COVID-19 restrictions and changing sexual behaviours in HIV-negative MSM at high 
risk of HIV infection in London, UK.

Hyndman I(1), Nugent D(1), Whitlock GG(1), McOwan A(1), Girometti N(2).

Author information:
(1)56 Dean Street, Chelsea and Westminster Hospital NHS Foundation Trust, 
London, UK.
(2)56 Dean Street, Chelsea and Westminster Hospital NHS Foundation Trust, 
London, UK nicogir@hotmail.it.

OBJECTIVES: The COVID-19 pandemic and its related restrictions have affected 
attendance to and delivery of UK sexual healthcare services (SHS). We surveyed 
the impact on sexual behaviour of men having sex with men (MSM) to inform future 
SHS provision.
METHODS: We conducted a cross-sectional, anonymous, web-based survey among 
HIV-negative MSM at high risk of HIV infection who attended 56 Dean Street, a 
sexual health and HIV clinic. The survey was conducted over a 7-day period in 
August 2020. Data on sociodemographic characteristics, sexual behaviour and 
related mental well-being experienced during lockdown (defined as 23 March-30 
June 2020) were extracted. Categorical and non-categorical variables were 
compared according to HIV pre-exposure prophylaxis (PrEP) use.
RESULTS: 814 MSM completed the questionnaire: 75% were PrEP users; 76% reported 
they have been sexually active, of which 76% reported sex outside their 
household. 75% reported fewer partners than prior to lockdown. 
Isolation/loneliness (48%) and anxiety/stress (27%) triggered sexual activity, 
and 73% had discussed COVID-19 transmission risks with their sexual partners. 
While 46% reported no change to emotions ordinarily experienced following sex, 
20% reported guilt for breaching COVID-19 restrictions. 76% implemented one or 
more changes to their sexual behaviour, while 58% applied one or more steps to 
reduce COVID-19 transmission during sex. 36% accessed SHS and 30% reported 
difficulties in accessing testing/treatment. Of those who accessed SHS, 28% 
reported an STI diagnosis. PrEP users reported higher partner number, engagement 
in 'chemsex' and use of SHS than non-PrEP users.
CONCLUSIONS: COVID-19 restrictions had a considerable impact on sexual behaviour 
and mental well-being in our survey respondents. High rates of sexual activity 
and STI diagnoses were reported during lockdown. Changes to SHS provision for 
MSM must respond to high rates of psychological and STI-related morbidity and 
the challenges faced by this population in accessing services.

© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and 
permissions. Published by BMJ.

DOI: 10.1136/sextrans-2020-054768
PMID: 33462118 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3859. Women Birth. 2022 May;35(3):254-261. doi: 10.1016/j.wombi.2021.01.007. Epub 2021 
Jan 16.

Effects of the COVID-19 pandemic on perinatal mental health in Spain: Positive 
and negative outcomes.

Chaves C(1), Marchena C(2), Palacios B(3), Salgado A(4), Duque A(5).

Author information:
(1)Universidad Complutense de Madrid, Madrid, Spain.
(2)Universidad Francisco de Vitoria, Madrid, Spain.
(3)Universidad Pontificia de Salamanca, Salamanca, Spain.
(4)Universidad Complutense de Madrid, Madrid, Spain; Universidad Pontificia de 
Salamanca, Salamanca, Spain.
(5)Universidad Pontificia de Salamanca, Salamanca, Spain. Electronic address: 
aduquesa@upsa.es.

BACKGROUND: Previous studies have shown that perinatal distress has a negative 
influence on pregnancy outcome and the physiological development of the baby.
OBJECTIVE: The aim of this study was to describe the effects of the COVID-19 
pandemic on maternal perinatal mental health in Spain.
METHODS: Seven hundred and twenty-four women (N=450 pregnancy, N=274 postpartum) 
were recruited online during the pandemic. The Edinburgh Postnatal Depression 
Scale, the Positive and Negative Affect Schedule, and the Satisfaction With Life 
Scale were administered. Variables related to sociodemographic information, the 
COVID-19 pandemic, and perinatal care were also assessed.
FINDINGS: The results showed that 58% of women reported depressive symptoms. 
Moreover, 51% of women reported anxiety symptoms. On the other hand, a 
regression analysis for life satisfaction showed that besides the perception 
about their own health, marital status or being a health practitioner were also 
significant predictors during pregnancy. However, perception about baby's health 
and sleep, perception about their own health, and marital status were 
significant predictors of life satisfaction during the postpartum stage.
DISCUSSION: Women assessed during the COVID-19 pandemic reported high rates of 
psychological distress.
CONCLUSION: These results highlight the need of clinical support during this 
period. Knowing the routes to both distress and well-being may help maternity 
services to effectively cope with the pandemic.

Copyright © 2021 Australian College of Midwives. Published by Elsevier Ltd. All 
rights reserved.

DOI: 10.1016/j.wombi.2021.01.007
PMCID: PMC9051254
PMID: 33461897 [Indexed for MEDLINE]


3860. Reprod Health. 2021 Jan 18;18(1):10. doi: 10.1186/s12978-021-01070-6.

The impact of the COVID-19 pandemic on maternal and perinatal health: a scoping 
review.

Kotlar B(1), Gerson EM(2), Petrillo S(3), Langer A(1), Tiemeier H(4)(5).

Author information:
(1)Harvard T.H. Chan School of Public Health, Boston, MA, USA.
(2)George Washington University, Washington, DC, USA.
(3)Brown University, Providence, Rhode Island, USA.
(4)Harvard T.H. Chan School of Public Health, Boston, MA, USA. 
tiemeier@hsph.harvard.edu.
(5)Department of Social and Behavioral Science, Harvard T.H. Chan School of 
Public Health, 677 Huntington Ave., Boston, MA, 02115, USA. 
tiemeier@hsph.harvard.edu.

Erratum in
    Reprod Health. 2023 Mar 30;20(1):52.

INTRODUCTION: The Covid-19 pandemic affects maternal health both directly and 
indirectly, and direct and indirect effects are intertwined. To provide a 
comprehensive overview on this broad topic in a rapid format behooving an 
emergent pandemic we conducted a scoping review.
METHODS: A scoping review was conducted to compile evidence on direct and 
indirect impacts of the pandemic on maternal health and provide an overview of 
the most significant outcomes thus far. Working papers and news articles were 
considered appropriate evidence along with peer-reviewed publications in order 
to capture rapidly evolving updates. Literature in English published from 
January 1st to September 11 2020 was included if it pertained to the direct or 
indirect effects of the COVID-19 pandemic on the physical, mental, economic, or 
social health and wellbeing of pregnant people. Narrative descriptions were 
written about subject areas for which the authors found the most evidence.
RESULTS: The search yielded 396 publications, of which 95 were included. 
Pregnant individuals were found to be at a heightened risk of more severe 
symptoms than people who are not pregnant. Intrauterine, vertical, and 
breastmilk transmission were unlikely. Labor, delivery, and breastfeeding 
guidelines for COVID-19 positive patients varied. Severe increases in maternal 
mental health issues, such as clinically relevant anxiety and depression, were 
reported. Domestic violence appeared to spike. Prenatal care visits decreased, 
healthcare infrastructure was strained, and potentially harmful policies 
implemented with little evidence. Women were more likely to lose their income 
due to the pandemic than men, and working mothers struggled with increased 
childcare demands.
CONCLUSION: Pregnant women and mothers were not found to be at higher risk for 
COVID-19 infection than people who are not pregnant, however pregnant people 
with symptomatic COVID-19 may experience more adverse outcomes compared to 
non-pregnant people and seem to face disproportionate adverse socio-economic 
consequences. High income and low- and middle-income countries alike faced 
significant struggles. Further resources should be directed towards quality 
epidemiological studies. The Covid-19 pandemic impacts reproductive and 
perinatal health both directly through infection itself but also indirectly as a 
consequence of changes in health care, social policy, or social and economic 
circumstances. The direct and indirect consequences of COVID-19 on maternal 
health are intertwined. To provide a comprehensive overview on this broad topic 
we conducted a scoping review. Pregnant women who have symptomatic COVID-19 may 
experience more severe outcomes than people who are not pregnant. Intrauterine 
and breastmilk transmission, and the passage of the virus from mother to baby 
during delivery are unlikely. The guidelines for labor, delivery, and 
breastfeeding for COVID-19 positive patients vary, and this variability could 
create uncertainty and unnecessary harm. Prenatal care visits decreased, 
healthcare infrastructure was strained, and potentially harmful policies are 
implemented with little evidence in high and low/middle income countries. The 
social and economic impact of COVID-19 on maternal health is marked. A high 
frequency of maternal mental health problems, such as clinically relevant 
anxiety and depression, during the epidemic are reported in many countries. This 
likely reflects an increase in problems, but studies demonstrating a true change 
are lacking. Domestic violence appeared to spike. Women were more vulnerable to 
losing their income due to the pandemic than men, and working mothers struggled 
with increased childcare demands. We make several recommendations: more 
resources should be directed to epidemiological studies, health and social 
services for pregnant women and mothers should not be diminished, and more focus 
on maternal mental health during the epidemic is needed.

DOI: 10.1186/s12978-021-01070-6
PMCID: PMC7812564
PMID: 33461593 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3861. BMJ Open. 2021 Jan 17;11(1):e045889. doi: 10.1136/bmjopen-2020-045889.

COVID-19-related social support service closures and mental well-being in older 
adults and those affected by dementia: a UK longitudinal survey.

Giebel C(1)(2), Pulford D(3), Cooper C(4), Lord K(5), Shenton J(6), Cannon J(7), 
Shaw L(8), Tetlow H(9), Limbert S(2), Callaghan S(10), Whittington R(11), Rogers 
C(12), Komuravelli A(13), Rajagopal M(3), Eley R(14), Downs M(15), Reilly S(16), 
Ward K(17), Gaughan A(18), Butchard S(19), Beresford J(5), Watkins C(20), 
Bennett K(19), Gabbay M(19)(2).

Author information:
(1)Institute of Psychology, Health and Society, University of Liverpool, 
Liverpool, UK clarissa.giebel@liverpool.ac.uk.
(2)NIHR ARC NWC, Liverpool, UK.
(3)Lancashire Care NHS Foundation Trust, Preston, Lancashire, UK.
(4)University College London, London, UK.
(5)University of Bradford, Bradford, West Yorkshire, UK.
(6)Sefton Older People's Forum, Sefton, UK.
(7)Lewy Body Society, Wigan, UK.
(8)Department of Modern Languages and Cultures, University of Liverpool, 
Liverpool, UK.
(9)SURF Liverpool, Liverpool, UK.
(10)EQE Health, Liverpool, UK.
(11)Me2U Care, Liverpool, UK.
(12)National Museums Liverpool, Liverpool, UK.
(13)North West Boroughs Healthcare NHS Foundation Trust, Warrington, UK.
(14)Liverpool DAA, Liverpool, UK.
(15)Bradford Dementia Group, University of Bradford, Bradford, UK.
(16)Division of Health Research, Lancaster University, Lancaster, UK.
(17)The Brain Charity, Liverpool, UK.
(18)TIDE, Liverpool, UK.
(19)Institute of Psychology, Health and Society, University of Liverpool, 
Liverpool, UK.
(20)Faculty of Health and Wellbeing, University of Central Lancashire, Preston, 
UK.

BACKGROUND: The COVID-19 pandemic has had a major impact on delivery of social 
support services. This might be expected to particularly affect older adults and 
people living with dementia (PLWD), and to reduce their well-being.
AIMS: To explore how social support service use by older adults, carers and 
PLWD, and their mental well-being changed over the first 3 months since the 
pandemic outbreak.
METHODS: Unpaid dementia carers, PLWD and older adults took part in a 
longitudinal online or telephone survey collected between April and May 2020, 
and at two subsequent timepoints 6 and 12 weeks after baseline. Participants 
were asked about their social support service usage in a typical week prior to 
the pandemic (at baseline), and in the past week at each of the three 
timepoints. They also completed measures of levels of depression, anxiety and 
mental well-being.
RESULTS: 377 participants had complete data at all three timepoints. Social 
support service usage dropped shortly after lockdown measures were imposed at 
timepoint 1 (T1), to then increase again by T3. The access to paid care was 
least affected by COVID-19. Cases of anxiety dropped significantly across the 
study period, while cases of depression rose. Well-being increased significantly 
for older adults and PLWD from T1 to T3.
CONCLUSIONS: Access to social support services has been significantly affected 
by the pandemic, which is starting to recover slowly. With mental well-being 
differently affected across groups, support needs to be put in place to maintain 
better well-being across those vulnerable groups during the ongoing pandemic.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/bmjopen-2020-045889
PMCID: PMC7813330
PMID: 33455941 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3862. Ir J Psychol Med. 2023 Jun;40(2):282-287. doi: 10.1017/ipm.2021.2. Epub 2021 Jan 
18.

Food for thought: the importance of nutritional well-being during COVID-19.

Burke-Furey L(1), McNicholas F(1)(2)(3).

Author information:
(1)Department of Child & Adolescent Psychiatry, SMMS, UCD, Dublin, Ireland.
(2)Paediatric Liaison Psychiatry, Children Hospital, Crumlin, Dublin 12, 
Ireland.
(3)Child & Adolescent Psychiatry, Lucena Clinic, RathgarDublin 6, Ireland.

Individuals with mental illness have poorer physical health, nutritional status, 
and lowered life expectancy. Optimising their physical and nutritional status 
has become an increasingly important therapeutic goal. Current experience with 
COVID-19 has further emphasised the susceptibility to physical illness and 
poorer outcomes amongst individuals with mental illness and those who are 
nutritionally compromised. Although life as we knew it has been suspended until 
the widespread roll-out of a vaccine, individuals can take immediate action to 
improve physical and mental health by attending to and optimising their 
nutritional well-being. Clinicians within mental health services have a crucial 
role to play in assisting such change, and reminding their patients of the 
importance of pursuing a healthy and balanced diet.

DOI: 10.1017/ipm.2021.2
PMCID: PMC7900659
PMID: 33455607 [Indexed for MEDLINE]


3863. Psicothema. 2021 Feb;33(1):125-130. doi: 10.7334/psicothema2020.287.

Anxiety and Depressive Symptoms in Children and Adolescents during COVID-19 
Pandemic: A Transcultural Approach.

Orgilés M(1), Espada JP, Delvecchio E, Francisco R, Mazzeschi C, Pedro M, 
Morales A.

Author information:
(1)Universidad Miguel Hernández.

BACKGROUND: Despite being necessary to delay the spread of COVID-19, home 
confinement could have affected the emotional well-being of children and 
adolescents. Knowing which variables are involved in anxiety and depressive 
symptoms could help to prevent young people's psychological problems related to 
lockdown as early as possible. This cross-sectional study aims to examine 
anxiety and depressive symptomatology in Italian, Spanish, and Portuguese 
children and adolescents in order to determine which variables are related to 
poorer well-being during the pandemic.
METHOD: The parents of 515 children, aged 3-18 years old, completed an online 
survey. Children's anxiety symptoms were assessed using the Spence Children's 
Anxiety Scale-Parent Version, and depressive symptoms were measured with the 
Short Mood and Feelings Questionnaire-Parent Version.
RESULTS: We found differences in anxiety and depression between countries, with 
higher anxiety scores in Spanish children, and higher depression scores in 
Spanish and Italian children compared to the Portuguese. Anxiety and depressive 
symptoms were more likely in children whose parents reported higher levels of 
stress.
CONCLUSIONS: These findings are discussed in the light of detecting and 
supporting affected children as early as possible.

DOI: 10.7334/psicothema2020.287
PMID: 33453745 [Indexed for MEDLINE]


3864. Seizure. 2021 Feb;85:111-114. doi: 10.1016/j.seizure.2020.12.024. Epub 2021 Jan 
8.

The perceived impact of COVID-19 and associated restrictions on young people 
with epilepsy in the UK: Young people and caregiver survey.

Reilly C(1), Muggeridge A(2), Cross JH(3).

Author information:
(1)Research Department, Young Epilepsy, Lingfield, Surrey, RH7 6PW, UK; UCL 
Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street London 
WC1N 1EH UK. Electronic address: creilly@youngepilepsy.org.uk.
(2)Research Department, Young Epilepsy, Lingfield, Surrey, RH7 6PW, UK.
(3)Research Department, Young Epilepsy, Lingfield, Surrey, RH7 6PW, UK; UCL 
Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street London 
WC1N 1EH UK; Great Ormond Street Hospital for Children NHS Trust, Great Ormond 
Street, London WC1N 3JH, UK.

PURPOSE: To garner the views of young people with epilepsy and caregivers 
regarding the impact of COVID-19 and subsequent restrictions in the UK.
MEHODS: An online survey was used to explore the views of young people with 
epilepsy (n = 71) and caregivers (n = 130) in June 2020. It included questions 
on the impact of the pandemic and associated restrictions on the child's 
epilepsy and on child and parental wellbeing.
RESULTS: One in three young people and 29 % of caregivers reported that the 
young person's seizures had increased during the pandemic (only 10 % of young 
people and 8% of caregivers reported a decrease). Half of young people reported 
that they were more reluctant to go to hospital. Thirty-one percent of young 
people and 20 % of parents reported difficulties getting epilepsy medication 
whilst a significant minority of young people (18 %) and caregivers (25 %) 
reported that the young person had investigations/assessments cancelled by their 
hospital. The majority of young people reported their sleep (72 %), mood (64 %) 
and levels of physical activity (53 %) had deteriorated. Caregivers experienced 
increases in stress (55 %) and anxiety (52 %). Epilepsy nurses were seen as the 
most helpful support CONCLUSIONS: Results indicate that the pandemic and 
associated restrictions have had a negative impact on young people with 
epilepsy. Perceived increases in seizures, reluctance to go to hospital and 
cancelled investigations are likely to impact on epilepsy management. The wider 
psychosocial impact is also likely to be significant with increases in child and 
caregiver mental health problems in an already vulnerable group.

Copyright © 2021 British Epilepsy Association. Published by Elsevier Ltd. All 
rights reserved.

DOI: 10.1016/j.seizure.2020.12.024
PMCID: PMC7791316
PMID: 33453591 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no other conflicts of interest 
to report.


3865. Appetite. 2021 May 1;160:105122. doi: 10.1016/j.appet.2021.105122. Epub 2021 Jan 
14.

Increased emotional eating during COVID-19 associated with lockdown, 
psychological and social distress.

Cecchetto C(1), Aiello M(2), Gentili C(3), Ionta S(4), Osimo SA(5).

Author information:
(1)Department of General Psychology, University of Padova, Via Venezia 8 - 
35131, Padua, Italy.
(2)Scuola Internazionale Superiore di Studi Avanzati, Trieste, Italy.
(3)Department of General Psychology, University of Padova, Via Venezia 8 - 
35131, Padua, Italy; Padova Neuroscience Center (PNC), University of Padova, Via 
Orus 2/B - 35131, Padua, Italy.
(4)Sensory-Motor Lab (SeMoLa), Department of Ophthalmology, University of 
Lausanne, Jules Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, 
Switzerland.
(5)Sensory-Motor Lab (SeMoLa), Department of Ophthalmology, University of 
Lausanne, Jules Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, 
Switzerland. Electronic address: sofia.osimo@gmail.com.

Due to the spread of COVID 2019, the Italian government imposed a lockdown on 
the national territory. Initially, citizens were required to stay at home and 
not to mix with others outside of their household (Phase 1); eventually, some of 
these restrictions were lifted (Phase 2). To investigate the impact of lockdown 
on emotional and binge eating, an online survey was conducted to compare 
measures of self-reported physical (BMI), psychological (Alexithymia), affective 
(anxiety, stress, and depression) and social (income, workload) state during 
Phase 1 and Phase 2. Data from 365 Italian residents showed that increased 
emotional eating was predicted by higher depression, anxiety, quality of 
personal relationships, and quality of life, while the increase of bingeing was 
predicted by higher stress. Moreover, we showed that higher alexithymia scores 
were associated by increased emotional eating and higher BMI scores were 
associated with both increased emotional eating and binge eating. Finally, we 
found that from Phase 1 to Phase 2 binge and emotional eating decreased. These 
data provide evidence of the negative effects of isolation and lockdown on 
emotional wellbeing, and, relatedly, on eating behaviour.

Copyright © 2021 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.appet.2021.105122
PMCID: PMC9755826
PMID: 33453336 [Indexed for MEDLINE]


3866. Intern Emerg Med. 2021 Oct;16(7):1967-1974. doi: 10.1007/s11739-020-02629-0. 
Epub 2021 Jan 16.

And if we had to do it all over again, would we send medical students to the 
emergency departments during a pandemic? Lessons learned from the COVID-19 
outbreak.

Pelaccia T(1)(2), Sibilia J(3), Fels É(3), Gauer L(4), Musanda A(3), Severac 
F(5), Abbiati M(6)(7).

Author information:
(1)Prehospital Emergency Care Service (SAMU 67), Strasbourg University Hospital, 
Strasbourg, France. pelaccia@unistra.fr.
(2)Centre for Training and Research in Health Sciences Education (CFRPS), 
Faculty of Medicine, University of Strasbourg, Strasbourg, France. 
pelaccia@unistra.fr.
(3)Faculty of Medicine, University of Strasbourg, Strasbourg, France.
(4)Strasbourg University Hospital, 1 place de l'Hôpital, Strasbourg, France.
(5)Public Health Service, GMRC, Strasbourg University Hospital, Strasbourg, 
France.
(6)Institute of Legal Psychiatry, Lausanne University Hospitals, Lausanne, 
Switzerland.
(7)Unit of Development and Research (UDREM), Faculty of Medicine, University of 
Geneva, Geneva, Switzerland.

The COVID-19 pandemic has led to increased staffing needs in emergency 
departments. The question quickly arose as to whether it was appropriate to 
offer medical students the opportunity to assist this staff. The dilemma stems 
in part from the potential impact on their psychological well-being as well as 
their academic and clinical performances. We sought to determine the level of 
anxiety of medical students during the COVID-19 outbreak, and whether it was 
higher among the students who chose to return to the clinical setting, 
especially in first-line units (i.e., emergency departments and resuscitation 
units). In May 2020, 1180/1502 (78.5%) undergraduate medical students at 
Strasbourg Medical School (France) completed a questionnaire assessing their 
anxiety and clinical experience. A 2018 cohort of undergraduate medical students 
served as the baseline. The 2020 COVID cohort had higher rates of anxiety than 
the 2018 cohort. This difference was specifically observed in the students who 
chose not to return to the clinical setting during the crisis (N = 684, 59%). At 
linear regression, the main factors associated with anxiety were gender 
(p < 0.005) and perceived clinical activity personal conditions (p < 0.001). 
Employment site, including COVID first-line units, was not correlated with 
anxiety. Working in the clinical setting during the COVID-19 outbreak is not a 
risk factor for anxiety in medical students. Instead, it is an active coping 
strategy, suggesting that there are no barriers to allowing students to return 
to clinical settings during a pandemic, including first-line units, in terms of 
their psychological well-being.

© 2021. Società Italiana di Medicina Interna (SIMI).

DOI: 10.1007/s11739-020-02629-0
PMCID: PMC7811345
PMID: 33453012 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


3867. BMC Pregnancy Childbirth. 2021 Jan 15;21(1):59. doi: 10.1186/s12884-021-03548-4.

Pregnant women's well-being and worry during the COVID-19 pandemic: a 
cross-sectional study.

Mortazavi F(1), Mehrabadi M(2), KiaeeTabar R(3).

Author information:
(1)Non-Communicable Diseases Research Center, Sabzevar University of Medical 
Sciences, Pardis Building, Towhid Blvd, Sabzevar, Khorasan Razavi, Iran. 
frmortazavi@yahoo.com.
(2)Health Chancellery, Sabzevar University of Medical Sciences, Sabzevar, Iran.
(3)Mobini hospital, Sabzevar University of Medical Sciences, Sabzevar, Iran.

BACKGROUND: COVID-19 caused some worries among pregnant women. Worries during 
pregnancy can affect women's well-being. We investigated worry and well-being 
and associated factors among pregnant women during the COVID-19 pandemic.
METHODS: This descriptive cross-sectional study was conducted on 484 pregnant 
women using an online questionnaire. Sampling was performed in a period between 
May 5 and Aug 5, 2020. Inclusion criteria were having a single healthy fetus and 
having no significant psychological disorder. We collected the data using the 
Persian versions of the World Health Organization's Well-Being Index (WHO-5 
Well-Being Index) and the Cambridge Worry Scale. We used univariate and 
multivariate logistic regression analyses to identify predictors of women's 
worry and well-being.
RESULTS: The mean total scores of the WHO-5 Well-Being Index and the percentage 
of WHO-5 score < 50 were 64.9 ± 29.0 and 24.4%, respectively. Predictors of 
women's worry are the increased level of fear of COVID-19 (OR = 6.40, 
p <  0.001), a low family income (OR = 3.41, p <  0.001), employment status 
(OR = 1.86, p = 0.019), nulliparity (OR = 1.68, p = 0.024), having a COVID-19 
infected person among relatives (OR = 2.45, p = 0.036), having a history of 
abortion (OR = 1.86, p = 0.012), having participated in the study after the 
first wave of COVID-19 outbreak (OR = 2.328, p = 0.003), and women's 
age < 30 year (OR = 2.11, p = 0.002). Predictors of low level of well-being in 
pregnant women are worry about their own health and relationships (OR = 1.789, 
p = .017), worry about fetus health (OR = 1.946, p = 0.009), and having at least 
one infected person with COVID-19 among relatives (OR = 2.135, p = 0.036).
CONCLUSIONS: The percentage of women experiencing a low well-being state was 
relatively high. This result is worthy of attention by health care providers and 
policy makers. Providing care and support to pregnant women should have high 
priority during the COVID-19 pandemic.

DOI: 10.1186/s12884-021-03548-4
PMCID: PMC7809640
PMID: 33451292 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3868. Aging Ment Health. 2022 Mar;26(3):534-543. doi: 10.1080/13607863.2020.1870210. 
Epub 2021 Jan 15.

Life during COVID-19 lockdown in Italy: the influence of cognitive state on 
psychosocial, behavioral and lifestyle profiles of older adults.

Carlos AF(1), Poloni TE(1), Caridi M(1), Pozzolini M(1), Vaccaro R(2), Rolandi 
E(2), Cirrincione A(1), Pettinato L(2)(3), Vitali SF(3), Tronconi L(4), Ceroni 
M(5), Guaita A(1)(2).

Author information:
(1)Department of Neurology and Neuropathology, Golgi-Cenci Foundation, 
Abbiategrasso, Milan, Italy.
(2)Department of Neuropsychology, Golgi-Cenci Foundation, Abbiategrasso, Milan, 
Italy.
(3)Department of Dementia Care, ASP Golgi-Redaelli, Abbiategrasso, Milan, Italy.
(4)Department of Public Health, Experimental and Forensic Medicine, IRCCS 
National Neurologic Institute C. Mondino Foundation, University of Pavia, Pavia, 
Italy.
(5)Department of Brain and Behavioral Disorders, IRCCS National Neurologic 
Institute C. Mondino Foundation, University of Pavia, Pavia, Italy.

OBJECTIVE: Few studies have examined lockdown effects on the way of living and 
well-being of older adults stratified by cognitive state. Since cognitive 
deficits are common in this population, we investigated how cognition influenced 
their understanding of the pandemic, socio-behavioral responses and lifestyle 
adaptations during lockdown, and how these factors affected their mood or 
memory.
METHOD: Telephone-based survey involving 204 older adults ≥65 y/o (median: 82) 
with previous assessments of cognitive state: 164 normal-old (NOLD), 24 
mild-neurocognitive disorder (mild-NCD), 18 mild-moderate dementia. A structured 
questionnaire was developed to assess psychological and socio-behavioral 
variables. Logistic regression was used to ascertain their effects on mood and 
memory.
RESULTS: With increasing cognitive deficits, understanding of the pandemic and 
the ability to follow lockdown policies, adapt to lifestyle changes, and 
maintain remote interactions decreased. Participants with dementia were more 
depressed; NOLDs remained physically and mentally active but were more bored and 
anxious. Sleeping and health problems independently increased the likelihood of 
depression (OR: 2.29; CI: 1.06-4.93; p = 0.034 and OR: 2.45; CI: 1.16-5.16; 
p = 0.018, respectively); Regular exercise was protective (OR: 0.30; CI: 
0.12-0.72; p = 0.007). Worsening subjective memory complaints were associated 
with dementia (p = 0.006) and depression (p = 0.004); New-onset sleeping 
problems raised their odds (OR: 10.26; CI: 1.13-93.41; p = 0.039). Finally, >40% 
with health problems avoided healthcare mainly due to fear of contagion.
DISCUSSION: NOLD and mild-NCD groups showed similar mood-behavioral profiles 
suggesting better tolerance of lockdown. Those with dementia were unable to 
adapt and suffered from depression and cognitive complaints. To counteract 
lockdown effects, physical and mental activities and digital literacy should be 
encouraged.

DOI: 10.1080/13607863.2020.1870210
PMID: 33445968 [Indexed for MEDLINE]


3869. Int J Environ Res Public Health. 2021 Jan 12;18(2):580. doi: 
10.3390/ijerph18020580.

Psychological Impact on the Nursing Professionals of the Rioja Health Service 
(Spain) Due to the SARS-CoV-2 Virus.

Del Pozo-Herce P(1)(2), Garrido-García R(2)(3), Santolalla-Arnedo I(2)(4), 
Gea-Caballero V(5)(6), García-Molina P(7)(8), Ruiz de Viñaspre-Hernández 
R(2)(4), Rodríguez-Velasco FJ(9), Juárez-Vela R(2)(4).

Author information:
(1)Department of Psychiatry, Fundación Jiménez Díaz University Hospital, 28040 
Madrid, Spain.
(2)Group of Research in Sustainability of the Health System, Biomedical Research 
Center of La Rioja (CIBIR), 26006 Logroño, Spain.
(3)Rioja Health Service, Najera Health Center, 26300 La Rioja, Spain.
(4)Department of Nursing, GRUPAC, University of La Rioja, 26006 Logroño, Spain.
(5)Nursing School La Fe, Adscript Center Universidad de Valencia, 46010 
Valencia, Spain.
(6)Research Group GREIACC, Health Research Institute La Fe, 46026 Valencia, 
Spain.
(7)Department of Nursing, University of Valencia, 46010 Valencia, Spain.
(8)Grupo Asociado de Investigación en Cuidados, Fundación Incliva, 46010 
Valencia, Spain.
(9)Department of Nursing, Faculty of Medicine, Badajoz University of 
Extremadura, 06006 Extremadura, Spain.

BACKGROUND: The COVID-19 pandemic is a public health emergency that has affected 
health professionals around the world, causing physical and mental exhaustion 
with a greater probability of developing mental disorders in professionals who 
provide healthcare.
OBJECTIVE: The objective of this study was to know the psychological impact of 
the SARS-CoV-2 virus on the nursing professionals working for the Rioja Health 
Service.
METHODS: We conducted an observational and descriptive cross-sectional study. 
The nursing staff at the Rioja Health Service were invited to respond to a 
self-administered questionnaire between June and August 2020.
RESULTS: A total of 605 health professionals participated in the questionnaire; 
91.9% were women, 63.14% were registered nurses, and 36.28% were auxiliary 
nurses. Risk factors for mental health professionals were identified in more 
than 90% of nurses (p = 0.009), affecting their psychological state with 
feelings of exhaustion, emotional overload (p = 0.002), and less use of coping 
strategies among women. Younger professionals with less experience had higher 
levels of stress compared to those with more than five years of experience, who 
showed a progressive reduction in the impact of stressors (p < 0.001). 
Professionals with dependent family members presented higher levels of emotional 
overload and coping problems (p = 0.009).
CONCLUSION: The COVID-19 pandemic has had a significant psychological impact on 
health professionals in terms of stress, emotional well-being, and the use of 
coping strategies. Female health professionals with dependents, a temporary 
contract, and less work experience have been more psychologically affected.

DOI: 10.3390/ijerph18020580
PMCID: PMC7827934
PMID: 33445563 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3870. J Homosex. 2021 Mar 21;68(4):545-559. doi: 10.1080/00918369.2020.1868182. Epub 
2021 Jan 13.

Introduction to Special Issue: Impacts of the COVID-19 Pandemic on LGBTQ+ Health 
and Well-Being.

Drabble LA(1), Eliason MJ(2).

Author information:
(1)Professor and Associate Dean for Research and Faculty, College of Health and 
Human Sciences, San Jose State University, San Jose, California, USA.
(2)Professor and Assistant Dean for Faculty Development/Scholarship, College of 
Health & Social Sciences, San Francisco State University, San Francisco, 
California, USA.

This special issue on the impacts of COVID-19 on LGBTQ+ health and well-being 
reports findings from nine articles with varied study designs, including data 
from multiple countries and all segments of LGBTQ+ communities. Key findings 
included the observation that pre-COVID mental health disparities predispose 
LGBTQ+ people to poorer outcomes; that technological communication aids are 
essential in maintaining some sense of community; and that substance use is 
perceived by sexual minority women as a means of coping with fears, stress, 
loneliness, and boredom. Studies in this special issue also document that 
community support is still a critical need, particularly among those who are 
sheltering at home with families of origin. Findings underscore the importance 
of addressing structural inequities, including advocating for rights; providing 
financial support for LGBTQ+ community organizations and networks; ensuring 
access to competent and affirming healthcare; and including vulnerable 
communities in disaster response and planning.

DOI: 10.1080/00918369.2020.1868182
PMID: 33439789 [Indexed for MEDLINE]


3871. Anesth Analg. 2022 Feb 1;134(2):348-356. doi: 10.1213/ANE.0000000000005422.

The Effects of Coronavirus Disease 2019 on Pediatric Anesthesiologists: A Survey 
of the Members of the Society for Pediatric Anesthesia.

Margolis RD(1), Strupp KM(2), Beacham AO(3), Yaster M(2), Austin TM(4), Macrae 
AW(4), Diaz-Berenstain L(5), Janosy NR(2).

Author information:
(1)From the Department of Anesthesiology and Critical Care Medicine, Children's 
Hospital Los Angeles, Los Angeles, California.
(2)Department of Anesthesiology, Children's Hospital Colorado, University of 
Colorado School of Medicine, Aurora, Colorado.
(3)Department of Behavioral Science, University of Louisville School of 
Dentistry, Louisville, Kentucky.
(4)Department of Anesthesiology, Emory University School of Medicine, Atlanta, 
Georgia.
(5)Division of Pediatric Cardiac Anesthesiology, Department of Anesthesiology, 
Children's Hospital of Cincinnati, Cincinnati, Ohio.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has affected the 
personal and professional lives of all health care workers. Anesthesiologists 
frequently perform virus-aerosolizing procedures (eg, intubation and extubation) 
that place them at increased risk of infection. We sought to determine how the 
initial COVID-19 outbreak affected members of the Society for Pediatric 
Anesthesia (SPA) on both personal and professional levels. Specifically, we 
examined the potential effects of gender and age on personal stress, burnout, 
sleep deprivation, anxiety, depression, assessed job satisfaction, and explored 
financial impact.
METHODS: After receiving approval from the SPA Committees for Research and 
Quality and Safety and the Colorado Multiple Institutional Review Board, we 
e-mailed a questionnaire to all 3245 SPA members. The survey included 22 
questions related to well-being and 13 questions related to effects of COVID-19 
on current and future practice, finances, retirement planning, academic time and 
productivity, and clinical and home responsibilities. To address low initial 
response rates and quantify nonresponse bias, we sent a shortened follow-up 
survey to a randomly selected subsample (n = 100) of SPA members who did not 
respond to the initial survey. Response differences between the 2 cohorts were 
determined.
RESULTS: A total of 561 (17%) members responded to the initial questionnaire. 
Because of COVID-19, 21.7% of respondents said they would change their clinical 
responsibilities, and 10.6% would decrease their professional working time. 
Women were more likely than men to anticipate a future COVID-19-related job 
change (odds ratio [OR] = 1.92, 95% confidence interval [CI], 1.12-2.63; P = 
.011), perhaps because of increased home responsibilities (OR = 2.63, 95% CI, 
1.74-4.00; P < .001). Additionally, 14.2% of respondents planned to retire 
early, and 11.9% planned to retire later. Women and non-White respondents had 
higher likelihoods of burnout on univariate analysis (OR = 1.75, 95% CI, 
1.06-2.94, P = .026 and OR = 1.82, 95% CI, 1.08-3.04, P = .017, respectively), 
and 25.1% of all respondents felt socially isolated. In addition, both changes 
in retirement planning and future occupational planning were strongly associated 
with total job satisfaction scores (both P < .001).
CONCLUSIONS: The COVID-19 pandemic has affected the personal and professional 
lives of pediatric anesthesiologists, albeit not equally, as women and 
non-Whites have been disproportionately impacted. The pandemic has significantly 
affected personal finances, home responsibilities, and retirement planning; 
reduced clinical and academic practice time and responsibilities; and increased 
feelings of social isolation, stress, burnout, and depression/anxiety.

Copyright © 2021 International Anesthesia Research Society.

DOI: 10.1213/ANE.0000000000005422
PMID: 33439606 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


3872. JNCI Cancer Spectr. 2020 Nov 5;5(1):pkaa104. doi: 10.1093/jncics/pkaa104. 
eCollection 2021 Feb.

Impact of the COVID-19 Pandemic on Patient-Reported Outcomes of Breast Cancer 
Patients and Survivors.

Bargon CA(1)(2), Batenburg MCT(3), van Stam LE(1), Mink van der Molen DR(1), van 
Dam IE(3), van der Leij F(3), Baas IO(4), Ernst MF(5), Maarse W(6), Vermulst 
N(7), Schoenmaeckers EJP(8), van Dalen T(9), Bijlsma RM(4), Young-Afat DA(10), 
Doeksen A(2), Verkooijen HM(1)(11).

Author information:
(1)Division of Imaging and Oncology, University Medical Centre Utrecht, 
Heidelberglaan, Utrecht, the Netherlands.
(2)Department of Surgery, St Antonius Hospital, Soestwetering, Utrecht, the 
Netherlands.
(3)Department of Radiation Oncology, University Medical Centre Utrecht, Cancer 
Centre, Utrecht, the Netherlands.
(4)Department of Medical Oncology, University Medical Centre Utrecht, Cancer 
Centre, Utrecht, the Netherlands.
(5)Department of Surgery, Alexander Monro Clinics, Bilthoven, the Netherlands.
(6)Department of Plastic, Reconstructive and Hand Surgery, University Medical 
Centre Utrecht, Utrecht, the Netherlands.
(7)Department of Surgery, Rivierenland Hospital, Tiel, the Netherlands.
(8)Department of Surgery, Meander Medisch Centrum, Amersfoort, the Netherlands.
(9)Department of Surgery, Diakonessenhuis Utrecht, Utrecht, the Netherlands.
(10)Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University 
Medical Centre, Location VUmc, the Netherlands.
(11)Utrecht University, Heidelberglaan, Utrecht, the Netherlands.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic (officially 
declared on the March 11, 2020), and the resulting measures, are impacting daily 
life and medical management of breast cancer patients and survivors. We 
evaluated to what extent these changes have affected quality of life, physical, 
and psychosocial well-being of patients previously or currently being treated 
for breast cancer.
METHODS: This study was conducted within a prospective, multicenter cohort of 
breast cancer patients and survivors (Utrecht cohort for Multiple BREast cancer 
intervention studies and Long-term evaLuAtion). Shortly after the implementation 
of COVID-19 measures, an extra survey was sent to 1595 participants, including 
the validated European Organization for Research and Treatment of Cancer (EORTC) 
core (C30) and breast cancer-specific (BR23) Quality of Life Questionnaire 
(EORTC QLQ-C30/BR23) and Hospital Anxiety and Depression Scale (HADS) 
questionnaire. Patient-reported outcomes (PROs) were compared with the most 
recent PROs collected within UMBRELLA pre-COVID-19. The impact of COVID-19 on 
PROs was assessed using mixed model analysis, adjusting for potential 
confounders.
RESULTS: 1051 patients and survivors (65.9%) completed the survey; 31.1% 
(n = 327) reported a higher threshold to contact their general practitioner amid 
the COVID-19 pandemic. A statistically significant deterioration in emotional 
functioning was observed (mean = 82.6 [SD = 18.7] to 77.9 [SD = 17.3]; 
P < .001), and 505 (48.0%, 95% confidence interval [CI] = 45.0% to 51.1%) 
patients and survivors reported moderate to severe loneliness. Small 
improvements were observed in quality of life and physical, social, and role 
functioning. In the subgroup of 51 patients under active treatment, social 
functioning strongly deteriorated (77.3 [95% CI = 69.4 to 85.2] to 61.3 [95% 
CI = 52.6 to 70.1]; P = .002).
CONCLUSION: During the COVID-19 pandemic, breast cancer patients and survivors 
were less likely to contact physicians and experienced a deterioration in their 
emotional functioning. Patients undergoing active treatment reported a 
substantial drop in social functioning. One in 2 reported loneliness that was 
moderate or severe. Online interventions supporting mental health and social 
interaction are needed during times of social distancing and lockdowns.

© The Author(s) 2020. Published by Oxford University Press.

DOI: 10.1093/jncics/pkaa104
PMCID: PMC7665619
PMID: 33437925 [Indexed for MEDLINE]


3873. J Palliat Care. 2022 Apr;37(2):97-98. doi: 10.1177/0825859720984567. Epub 2021 
Jan 12.

COP(2)ING With a New Normal: Navigating the Return to Society for Older Adults 
With Dementia and Their Caregivers.

Hamilton CK(1), Paniagua MA(2), Jones CA(3).

Author information:
(1)Division of Gerontology and Geriatrics, 1501Johns Hopkins University, 
Baltimore, MD, USA.
(2)Section of Palliative Care, Department of Medicine, 14640University of 
Pennsylvania, Philadelphia, PA, USA.
(3)Department of Medicine and Palliative and Advanced Illness Research Center, 
14640University of Pennsylvania, Philadelphia, PA, USA.

COVID-19 has stressed the healthcare system in ways our society has not seen 
before. Less visibly, elderly patients and their caregivers have been stressed 
as well, both by the virus and by the public health measures required to slow 
its spread. After months of isolating, patients with dementia and their 
caregivers are worried about reentering a society with different rules and 
expectations. Although an extremely complex topic, the re-entry of individuals 
with cognitive impairment back into society is critical for both the wellbeing 
of the person as well as the caregiver. Successful re-entry into society will 
vary based on a person's interests and baseline cognition, however, the ability 
to participate in activities and events that previously provided joy and 
stimulation is the first step. This paper, written by practicing geriatricians 
and palliative clinicians, offers some concrete counseling strategies and tips 
for caregivers to help navigate re-entry into society with their loved ones.

DOI: 10.1177/0825859720984567
PMID: 33435850 [Indexed for MEDLINE]


3874. Medicina (Kaunas). 2021 Jan 9;57(1):53. doi: 10.3390/medicina57010053.

Increased Psychological Distress, Loneliness, and Unemployment in the Spread of 
COVID-19 over 6 Months in Germany.

Liu S(1), Heinzel S(2), Haucke MN(1)(2), Heinz A(1).

Author information:
(1)Department of Psychiatry and Psychotherapy, Campus Charité Mitte, 
Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany.
(2)Department of Education and Psychology, Clinical Psychology and 
Psychotherapy, Freie Universität Berlin, 14195 Berlin, Germany.

Background: The COVID-19 pandemic poses a challenge to global mental health. 
Loneliness and isolation may put people at higher risk for increased 
psychological distress. However, there is a lack of research investigating the 
development of COVID-19-related distress over time. Materials and Methods: We 
undertook an online survey among general population (N = 1903) in Germany 
throughout 6 months from the peak transmission period in April to the off-peak 
period by September 2020. Results: We found that the average prevalence of 
psychological distress caused by the COVID-19 pandemic significantly rose from 
24% to 66% between the peak and off-peak transmission period, respectively. 
Unemployment rate and loneliness increased negative mental health outcomes, 
although the number of active COVID-19 cases decreased from April to September. 
Psychological distress scores increased mostly in female, young, and lonely 
people. Conclusions: Our results underline the importance of considering 
innovative alternatives to facilitate employment opportunities, distant 
contacts, and self-help over the course of the pandemic. Our study highlights 
the urgent need to pay attention to mental health services specifically 
targeting female, young, unemployed, and lonely people.

DOI: 10.3390/medicina57010053
PMCID: PMC7827929
PMID: 33435368 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3875. Occup Med (Lond). 2021 Apr 9;71(2):62-67. doi: 10.1093/occmed/kqaa220.

Mental health of staff working in intensive care during Covid-19.

Greenberg N(1)(2), Weston D(3), Hall C(3), Caulfield T(4), Williamson V(1)(5), 
Fong K(6)(7).

Author information:
(1)King's Centre for Military Health Research, Institute of Psychology, 
Psychiatry and Neuroscience, King's College London, London, UK.
(2)Health Protection Research Unit, Institute of Psychology, Psychiatry and 
Neuroscience, King's College London, London, UK.
(3)Behavioural Science Team, Emergency Response Department Science & Technology, 
Public Health England, Salisbury, UK.
(4)Department of Computer Science, University College London, London, UK.
(5)Department of Experimental Psychology, Anna Watts Building, University of 
Oxford, Oxford, UK.
(6)Department of Science, Technology, Engineering and Public Policy (STEaPP), 
University College London, London, UK.
(7)Department of Anaesthesia, University College London Hospital, London, UK.

Comment in
    Occup Med (Lond). 2021 Nov 6;71(8):386-387.
    Occup Med (Lond). 2021 Nov 6;71(8):387-388.

BACKGROUND: Staff working in intensive care units (ICUs) have faced significant 
challenges during the COVID-19 pandemic which have the potential to adversely 
affect their mental health.
AIMS: To identify the rates of probable mental health disorder in staff working 
in ICUs in nine English hospitals during June and July 2020.
METHODS: An anonymized brief web-based survey comprising standardized 
questionnaires examining depression, anxiety symptoms, symptoms of 
post-traumatic stress disorder (PTSD), well-being and alcohol use was 
administered to staff.
RESULTS: Seven hundred and nine participants completed the surveys comprising 
291 (41%) doctors, 344 (49%) nurses and 74 (10%) other healthcare staff. Over 
half (59%) reported good well-being; however, 45% met the threshold for probable 
clinical significance on at least one of the following measures: severe 
depression (6%), PTSD (40%), severe anxiety (11%) or problem drinking (7%). 
Thirteen per cent of respondents reported frequent thoughts of being better off 
dead, or of hurting themselves in the past 2 weeks. Within the sample used in 
this study, we found that doctors reported better mental health than nurses 
across a range of measures.
CONCLUSIONS: We found substantial rates of probable mental health disorders, and 
thoughts of self-harm, amongst ICU staff; these difficulties were especially 
prevalent in nurses. Whilst further work is needed to better understand the real 
level of clinical need amongst ICU staff, these results indicate the need for a 
national strategy to protect the mental health, and decrease the risk of 
functional impairment, of ICU staff whilst they carry out their essential work 
during COVID-19.

© The Author(s) 2021. Published by Oxford University Press on behalf of the 
Society of Occupational Medicine. All rights reserved. For Permissions, please 
email: journals.permissions@oup.com.

DOI: 10.1093/occmed/kqaa220
PMCID: PMC7928568
PMID: 33434920 [Indexed for MEDLINE]


3876. J Clin Nurs. 2021 Apr;30(7-8):1018-1025. doi: 10.1111/jocn.15647. Epub 2021 Jan 
25.

Predicting nurses' intentions in allowing family presence during resuscitation: 
A cross-sectional survey.

Park JY(1), Ha J(1).

Author information:
(1)College of Nursing, Konyang University, Daejeon, South Korea.

AIMS AND OBJECTIVES: This study examined nurses' intention to allow family 
presence during resuscitation (FPDR) by applying the theory of planned behaviour 
with an extended concept.
BACKGROUND: Medical institutions, including nurses and other medical 
professionals working in emergency and intensive care units, are reluctant to 
allow FPDR. However, this practice reduces the family's anxiety and stress while 
fostering well-being and minimises their feelings of helplessness and distress 
by making them believe that they have helped the patient.
DESIGN: A cross-sectional descriptive design was used in this study.
METHODS: The participants were 252 nurses who had been working for at least 
3 months in a general hospital in South Korea. Data were collected using 
self-report questionnaires in April 2020 and were analysed using descriptive 
statistics, Pearson's correlation analysis and multiple regression analysis. The 
instruments were intention to allow FPDR (five constructs: intention to allow 
FPDR, positive attitude, negative attitude, subjective norm and perceived 
behavioural control), perception of FPDR and self-confidence. The STROBE 
checklist was used for reporting this study.
RESULTS: The mean score for the intention to allow FPDR was 3.47 out of 5. The 
regression analysis results indicated that perception of FPDR, positive attitude 
and negative attitude predicted the intention to allow FPDR.
CONCLUSIONS: It is necessary to develop educational programmes to change the 
perceptions of and attitudes towards FPDR. Additionally, written policies and 
protocols for FPDR in South Korea are needed to develop systematic care for 
patients' families during cardiopulmonary resuscitation.
RELEVANCE TO CLINICAL PRACTICE: The findings of this study provide baseline data 
for developing FPDR policies and guidelines that could minimise the family's 
distress and allow them to feel that they have helped the patient.

© 2021 John Wiley & Sons Ltd.

DOI: 10.1111/jocn.15647
PMID: 33434307 [Indexed for MEDLINE]


3877. Minerva Anestesiol. 2021 May;87(5):556-566. doi: 10.23736/S0375-9393.20.14853-3. 
Epub 2021 Jan 12.

Post-traumatic stress disorder, burnout and their impact on global functioning 
in Italian emergency healthcare workers.

Carmassi C(1), Malacarne P(2), Dell'oste V(3), Bertelloni CA(1), Cordone A(1), 
Foghi C(1), Dell'osso L(1).

Author information:
(1)Department of Clinical and Experimental Medicine, University of Pisa, Pisa, 
Italy.
(2)Anesthesia and Intensive Care Unit, Azienda Ospedaliero-Universitaria Pisana 
(AOUP), Pisa, Italy.
(3)Department of Clinical and Experimental Medicine, University of Pisa, Pisa, 
Italy - valerio.delloste@gmail.com.

BACKGROUND: Post-traumatic stress disorder (PTSD) and burnout are severe and 
frequent conditions among emergency healthcare workers exposed to repeated 
work-related traumatic experiences. The aim of the present study was to 
investigate PTSD, burnout and global functioning in a sample of emergency 
healthcare workers (HCWs) of a major university hospital in Italy, exploring 
possible correlations between the two constructs.
METHODS: The study sample included 137 medical and nursing Emergency Room and 
Intensive Care Unit staff members of a major University Hospital in Italy 
(Pisa), all assessed by means of the Trauma and Loss Spectrum - Self Report 
(TALS-SR), for post-traumatic stress spectrum, the Professional Quality of Life 
Scale - Revision IV (ProQOL R-IV), for burnout related to work activities, and 
the Work and Social Adjustment Scale (WSAS), for global functioning.
RESULTS: Forty-nine subjects reported a full (18, 14.3%) or partial (31, 24.6%) 
symptomatological DSM-5 PTSD. HCWs with PTSD reported significantly higher 
burnout scores and global functioning impairment compared to those without PTSD. 
Mean to good significant correlations emerged between the TALS-SR total and 
domains scores, the ProQOL subscales and the WSAS scores.
CONCLUSIONS: This work, conducted before the COVID-19 pandemic, underlines a 
positive correlation between burnout and post-traumatic stress spectrum symptoms 
in emergency HCWs, showing the need for a deeper assessment of work-related 
post-traumatic stress symptoms in such population in order to improve the 
well-being and to prevent burnout.

DOI: 10.23736/S0375-9393.20.14853-3
PMID: 33432793 [Indexed for MEDLINE]


3878. J Adv Nurs. 2021 Apr;77(4):2092-2101. doi: 10.1111/jan.14736. Epub 2021 Jan 11.

Peer Support for Post Intensive Care Syndrome Self-Management (PS-PICS): Study 
protocol for peer mentor training.

Danesh V(1)(2), Hecht J(1), Hao R(3), Boehm L(4), Jimenez EJ(5), Arroliga AC(5), 
Sanghi S(2), Stevens A(2).

Author information:
(1)School of Nursing, University of Texas at Austin, Austin, TX, USA.
(2)Center for Applied Health Research, Baylor Scott & White Research Institute, 
Temple, TX, USA.
(3)Baylor Scott & White Research Institute, Dallas, TX, USA.
(4)School of Nursing, Vanderbilt University, Nashville, TN, USA.
(5)Baylor Scott & White Health, Dallas, TX, USA.

AIMS: The primary aim of the Peer Support for Post Intensive Care Syndrome 
Self-Management (PS-PICS) peer mentor training trial is to determine the 
feasibility for peer mentor training to connect new ICU survivors with survivors 
who have made successful recoveries. Secondary aims are to also examine peer 
mentor eligibility, recruitment and retention rates and assess changes in 
participant knowledge of Post Intensive Care Syndrome (PICS), reported symptoms 
and health-related quality of life.
DESIGN: Prospective clinical feasibility trial.
METHODS: This study received funding from the National Institutes of Health 
funded P30 Center for Excellence (2014-2020). Up to 20 adult patients who have 
had an ICU stay of 3 days or longer more than 3 months ago will be enrolled into 
the study. Participants will undergo a 6-week peer mentor training program to 
learn how to promote healthy self-management behaviours, social connections, and 
well-being using motivational interviewing (MI). Participants will complete 
surveys about their recovery at 3 points during the study: prior to training, 
6 weeks post-training and 3 months post-training. Survey questions will be used 
to assess trends in participant social isolation, depression, functional status, 
and self-management behaviours.
DISCUSSION: Enrollment closes by December 2020. As a feasibility trial, power 
sufficient for hypothesis testing will not be available. However, study 
operations and intervention fidelity contribute to future research knowledge and 
participant characteristics and longitudinal outcomes will yield data on 
intervention feasibility. This study is the first use of embedding peer-led 
motivational interviewing training into a peer support intervention for ICU 
survivors.
IMPACT: Current self-management interventions are limited for ICU survivors and 
do not sufficiently address barriers to promoting self-management behaviours or 
improving their health status, well-being and cost of health. This study will 
provide data to develop and implement interventions for the self-management of 
PICS-related symptoms and sequelae.

Publisher: 目的: 重症监护后综合征自我管理同伴支持 (PS-PICS) 同伴导师培训试验的开展主要是为了确定同伴导师培训的可行性, 
以便最终将新ICU幸存者和成功康复的幸存者相联系。次要目标是检查同伴导师的资格、招生情况和保留率, 并评估参与者重症监护后综合征 (PICS) 
知识、报告症状和健康相关生活质量的变更。 设计: 前瞻性临床可行性试验。 方法: 本研究由国家卫生研究院资助的P30卓越中心 (2014年-2020年) 
供资。最多将招募20名成年患者参与本研究, 但应确保所招募的患者均于3个月前进入ICU , 且至少在ICU停留3天。参与者将接受为期6周的同伴导师培训计划, 
在此期间, 学习如何通过动机式访谈 (MI) 改善自我健康管理行为、社会关系和幸福感。研究期间, 参与者将在3个时间点参与恢复情况调查, 分别是: 
培训前、培训后6周和培训后3个月。通过调查问题, 可对参与者社会隔离、抑郁、功能状态和自我管理行为进行评估。 讨论: 
招募于2020年12月截止。由于本项试验仅具有可行性, 因此, 不可据此检验假设内容。然而, 研究的执行和有效干预措施的采取将有助于促进未来研究知识发展, 
记录参与者特征, 并且, 将可通过纵向结果获知干预可行性数据。本研究首次将同伴主导的动机式访谈培训应用于ICU幸存者的同伴支持干预中。 影响: 目前, 
自我管理干预措施仅适用于ICU幸存者, 
且此类干预措施无法充分解决自我管理行为和健康状况改善、幸福感提升及健康成本缩减过程中所面临的障碍。本研究将可提供相关数据, 
促进重症监护后综合征相关症状和后遗症患者的自我管理, 从而制定和实施干预措施。.

© 2021 John Wiley & Sons Ltd.

DOI: 10.1111/jan.14736
PMCID: PMC8138945
PMID: 33432618 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest There are no conflicts of 
interest to report.


3879. Trials. 2021 Jan 11;22(1):44. doi: 10.1186/s13063-020-04989-6.

Hydroxychloroquine in the treatment of adult patients with Covid-19 infection in 
a primary care setting (LIBERTY): A structured summary of a study protocol for a 
randomised controlled trial.

Vainio PJ(1)(2), Hietasalo P(3), Koivisto AL(3), Kääriäinen S(4), Turunen J(5), 
Virtala M(3), Vuorinen J(5), Scheinin M(6)(7)(8).

Author information:
(1)Institute of Biomedicine, University of Turku, Turku, Finland.
(2)Unit of Clinical Pharmacology, Turku University Hospital, Turku, Finland.
(3)Porin perusturva, Pori, Finland.
(4)Clinical Research Services Turku - CRST Oy, Turku, Finland.
(5)Oy 4Pharma Ltd., Turku, Finland.
(6)Institute of Biomedicine, University of Turku, Turku, Finland. 
mschein@utu.fi.
(7)Unit of Clinical Pharmacology, Turku University Hospital, Turku, Finland. 
mschein@utu.fi.
(8)Clinical Research Services Turku - CRST Oy, Turku, Finland. mschein@utu.fi.

OBJECTIVES: The primary objective of this study is to evaluate the therapeutic 
potential of hydroxychloroquine (HCQ) in the treatment of adult patients with 
PCR-confirmed Covid-19 infection in a primary open-care setting, as compared to 
placebo. The study hypothesis is that treatment with HCQ will reduce the risk of 
hospitalization because of Covid-19 infection, and the sample size estimate of 
the study is based on the need to test this hypothesis. The secondary objectives 
of the study are: to evaluate the safety and tolerability of HCQ in the 
treatment of adult patients with PCR-confirmed Covid-19 infection in a primary 
open-care setting, as compared to placebo; to collect experience of the use of 
HCQ in the treatment of Covid-19 infection in outpatients, in order to be able 
to identify patient characteristics that predict specific treatment responses 
(favourable or unfavourable); this objective will also be addressed by post-hoc 
subgroup analysis of the study results and by meta-analysis of pooled patient 
data from other clinical trials of HCQ in outpatients; and to evaluate the 
impact of Covid-19 infection and its treatment on the mental health and 
well-being of the study participants. In addition, if the data allow, the study 
has the following exploratory objectives: to evaluate the extent and duration of 
SARS-CoV-2 viral shedding by PCR testing of nasopharyngeal swab samples in study 
subjects treated with HCQ, as compared to placebo; to evaluate the extent and 
time course of SARS-CoV-2 virus-specific antibody responses in serum of study 
subjects treated with HCQ, as compared to placebo; to evaluate other possible 
biomarker changes in blood in study subjects treated with HCQ, as compared to 
placebo; to explore the possible effects of genetic variation in drug 
metabolizing enzymes on HCQ-related outcomes in the study population; to explore 
the associations of HCQ-related outcome variables with other patient 
characteristics, e.g. HLA haplotypes, HCQ concentrations, demographic variables, 
disease history and concomitant medications.
TRIAL DESIGN: This is a phase 2, placebo-controlled, double-blind, randomized, 
parallel-group treatment trial comparing HCQ with placebo in outpatients with 
Covid-19 infection. Participants will be randomized in a 1:1 ratio to the two 
treatment arms.
PARTICIPANTS: Main inclusion criteria: 1. Males and females >40 years of age, or 
18-40 years of age with one or both of the following: i. diabetes mellitus (type 
1 or type 2); ii. BMI > 35 kg/m2; 2. Valid independent informed consent 
obtained; 3. Symptoms typical of Covid-19 infection, according to criteria 
specified in the study protocol. The onset of symptoms must be within 5 days of 
enrolment; 4. Positive SARS-CoV-2 PCR test result of a nasopharyngeal swab 
sample. Main exclusion criteria: 1. Suspected severe or moderately severe 
pneumonia, presenting with any of the following: respiratory rate > 26 
breaths/min; significant respiratory distress; or SpO2 ≤94% on room air; 2. 
Requiring treatment in the hospital, according to the treating physician's 
judgement; 3. Any contraindication to treatment with HCQ; 4. Pregnancy or 
lactation. The trial will be conducted at seven study sites in a primary public 
health care setting in the region of Satakunta, Finland.
INTERVENTION AND COMPARATOR: Participants will be randomized to receive either 
HCQ capsules at 300 mg twice a day for one day and then 200 mg twice a day for 6 
days, or placebo capsules for 7 days.
MAIN OUTCOMES: The primary endpoint of the study is the number of 
hospitalizations due to Covid-19 infection within four weeks of entry into the 
study. The secondary endpoints of the study include the following: duration and 
severity of Covid-19-related symptoms, as reported by daily self-assessments; 
number of Intensive Care Unit treatment episodes due to Covid-19 infection 
within four weeks of entry into the study; number of deaths due to Covid-19 
infection within four weeks of entry into the study; number of treatment-related 
adverse events (AEs) and serious AEs (SAEs); all-cause hospitalizations and 
mortality within six months of entry into the study; and self-assessed symptoms 
of anxiety, as assessed with repeated administration of the Generalized Anxiety 
Disorder 7-item scale (GAD-7). The exploratory endpoints of the study include 
the following: extent and duration of SARS-CoV-2 viral shedding and 
virus-specific antibody responses in serum; and possible other blood biomarker 
changes.
RANDOMISATION: Eligible study participants are randomly allocated into two 
treatment arms (1:1 ratio). The randomization list has been generated using 
Viedoc™ (Viedoc Technologies AB, Uppsala, Sweden) that is used as an electronic 
data capture system for this study.
BLINDING (MASKING): The participants and all study personnel remain blinded to 
the treatment allocation by having both IMPs packed in identical containers. 
Masking of the treatments was performed by re-formulation of the IMPs so that 
the HCQ capsules and the placebo capsules have identical appearance.
NUMBERS TO BE RANDOMISED (SAMPLE SIZE): 600 participants are to be randomised 
with 300 in each arm.
TRIAL STATUS: Protocol version 2, dated 14 July 2020; recruitment is expected to 
start in December, 2020, and to be completed in June, 2021.
TRIAL REGISTRATION: EudraCT 2020-002038-33 , registered 26 June 2020 FULL 
PROTOCOL: The full protocol is attached as an additional file, accessible from 
the Trials website (Additional file 1). The protocol has been redacted to 
conform with privacy regulations by deleting the names and contact information 
of individuals mentioned in the protocol but not listed as authors in this 
communication. In the interest of expediting dissemination of this material, the 
familiar formatting has been eliminated; this Letter serves as a summary of the 
key elements of the full protocol.

DOI: 10.1186/s13063-020-04989-6
PMCID: PMC7797713
PMID: 33430933 [Indexed for MEDLINE]

Conflict of interest statement: SK and MS are employed by Clinical Research 
Services Turku – CRST Oy, a contract research organization engaged in commercial 
clinical trials for the pharmaceutical industry. All authors declare that they 
have no competing interests related to this trial.


3880. BMC Public Health. 2021 Jan 11;21(1):118. doi: 10.1186/s12889-020-10134-4.

Anxiety amongst physicians during COVID-19: cross-sectional study in Pakistan.

Mahmood QK(1), Jafree SR(2), Jalil A(3), Nadir SMH(4), Fischer F(5)(6).

Author information:
(1)Department of Sociology, International Islamic University Islamabad, 
Islamabad, Pakistan.
(2)Department of Sociology, Forman Christian College (A Chartered University), 
Lahore, Pakistan.
(3)School of Integrated Social Sciences, University of Lahore, Lahore, Pakistan.
(4)Health Education England, North West Deanery, UK.
(5)Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, 
Germany. florian.fischer1@charite.de.
(6)Institute of Gerontological Health Services and Nursing Research, 
Ravensburg-Weingarten University of Applied Sciences, Weingarten, Germany. 
florian.fischer1@charite.de.

BACKGROUND: Ensuring safety and wellbeing of healthcare providers is crucial, 
particularly during times of a pandemic. In this study, we aim to identify the 
determinants of anxiety in physicians on duty in coronavirus wards or quarantine 
centers.
METHODS: We conducted a cross-sectional quantitative survey with an additional 
qualitative item. Five constructs of workload, exhaustion, family strain, 
feeling of protection, and anxiety were measured using items from two validated 
tools. Modifications were made for regional relevance. Factor analysis was 
performed showing satisfactory Cronbach alpha results. Overall, 103 physicians 
completed the questionnaire.
RESULTS: T-test results revealed significant associations between gender and 
anxiety. Structural equation modeling identified that high workload contributed 
to greater exhaustion (β = 0.41, R2 = 0.17, p < 0.001) and greater family strain 
(β = 0.47, R2 = 0.22, p < 0.001). Exhaustion (β = 0.17, p < 0.005), family 
strain (β = 0.34, p < 0.001), and feelings of protection (β = - 0.30, p < 0.001) 
significantly explained anxiety (R2 = 0.28). Qualitative findings further 
identified specific needs of physicians with regard to protective equipment, 
compensation, quarantine management, resource allocation, security and public 
support, governance improvement, and health sector development.
CONCLUSIONS: It is imperative to improve governmental and social support for 
physicians and other healthcare providers during the corona pandemic. Immediate 
attention is needed to reduce anxiety, workload, and family strain in frontline 
practitioners treating coronavirus patients, and to improve their (perceptions 
of) protection. This is a precondition for patient safety.

DOI: 10.1186/s12889-020-10134-4
PMCID: PMC7797886
PMID: 33430852 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that no competing interest 
exist. FF serves on the Editorial Board of BMC Public Health as Associate 
Editor.


3881. PLoS One. 2021 Jan 11;16(1):e0240146. doi: 10.1371/journal.pone.0240146. 
eCollection 2021.

Why the COVID-19 pandemic is a traumatic stressor.

Bridgland VME(1), Moeck EK(1)(2), Green DM(1), Swain TL(1), Nayda DM(1), Matson 
LA(1), Hutchison NP(1), Takarangi MKT(1).

Author information:
(1)College of Education, Psychology & Social Work, Flinders University, 
Adelaide, South Australia, Australia.
(2)Turner Institute for Brain and Mental Health, Monash University, Melbourne, 
Victoria, Australia.

The COVID-19 pandemic does not fit into prevailing Post-traumatic Stress 
Disorder (PTSD) models, or diagnostic criteria, yet emerging research shows 
traumatic stress symptoms as a result of this ongoing global stressor. Current 
pathogenic event models focus on past, and largely direct, trauma exposure to 
certain kinds of life-threatening events. Yet, traumatic stress reactions to 
future, indirect trauma exposure, and non-Criterion A events exist, suggesting 
COVID-19 is also a traumatic stressor which could lead to PTSD symptomology. To 
examine this idea, we asked a sample of online participants (N = 1,040), in five 
western countries, to indicate the COVID-19 events they had been directly 
exposed to, events they anticipated would happen in the future, and other forms 
of indirect exposure such as through media coverage. We then asked participants 
to complete the Posttraumatic Stress Disorder Checklist-5, adapted to measure 
pre/peri/post-traumatic reactions in relation to COVID-19. We also measured 
general emotional reactions (e.g., angry, anxious, helpless), well-being, 
psychosocial functioning, and depression, anxiety, and stress symptoms. We found 
participants had PTSD-like symptoms for events that had not happened and when 
participants had been directly (e.g., contact with virus) or indirectly exposed 
to COVID-19 (e.g., via media). Moreover, 13.2% of our sample were likely 
PTSD-positive, despite types of COVID-19 "exposure" (e.g., lockdown) not fitting 
DSM-5 criteria. The emotional impact of "worst" experienced/anticipated events 
best predicted PTSD-like symptoms. Taken together, our findings support emerging 
research that COVID-19 can be understood as a traumatic stressor event capable 
of eliciting PTSD-like responses and exacerbating other related mental health 
problems (e.g., anxiety, depression, psychosocial functioning, etc.). Our 
findings add to existing literature supporting a pathogenic event memory model 
of traumatic stress.

DOI: 10.1371/journal.pone.0240146
PMCID: PMC7799777
PMID: 33428630 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


3882. J Med Internet Res. 2021 Jan 11;23(1):e21445. doi: 10.2196/21445.

Resource-Based Internet Intervention (Med-Stress) to Improve Well-Being Among 
Medical Professionals: Randomized Controlled Trial.

Smoktunowicz E(1)(2), Lesnierowska M(1), Carlbring P(2), Andersson G(3)(4), 
Cieslak R(1)(5).

Author information:
(1)Department of Psychology, SWPS University of Social Sciences and Humanities, 
Warsaw, Poland.
(2)Department of Psychology, Stockholm University, Stockholm, Sweden.
(3)Department of Behavioural Sciences and Learning, Linköping University, 
Linköping, Sweden.
(4)Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, 
Sweden.
(5)Trauma, Health, and Hazards Center, University of Colorado Colorado Springs, 
Colorado Springs, CO, United States.

BACKGROUND: Medical professionals are exposed to multiple and often excessive 
demands in their work environment. Low-intensity internet interventions allow 
them to benefit from psychological support even when institutional help is not 
available. Focusing on enhancing psychological resources-self-efficacy and 
perceived social support-makes an intervention relevant for various occupations 
within the medical profession. Previously, these resources were found to operate 
both individually or sequentially with self-efficacy either preceding social 
support (cultivation process) or following it (enabling process).
OBJECTIVE: The objective of this randomized controlled trial is to compare the 
efficacy of 4 variants of Med-Stress, a self-guided internet intervention that 
aims to improve the multifaceted well-being of medical professionals.
METHODS: This study was conducted before the COVID-19 pandemic. Participants 
(N=1240) were recruited mainly via media campaigns and social media targeted 
ads. They were assigned to 1 of the following 4 groups: experimental condition 
reflecting the cultivation process, experimental condition reflecting the 
enabling process, active comparator enhancing only self-efficacy, and active 
comparator enhancing only perceived social support. Outcomes included 5 facets 
of well-being: job stress, job burnout, work engagement, depression, and 
job-related traumatic stress. Measurements were taken on the web at baseline 
(time 1), immediately after intervention (time 2), and at a 6-month follow-up 
(time 3). To analyze the data, linear mixed effects models were used on the 
intention-to-treat sample. The trial was partially blinded as the information 
about the duration of the trial, which was different for experimental and 
control conditions, was public.
RESULTS: At time 2, job stress was lower in the condition reflecting the 
cultivation process than in the one enhancing social support only (d=-0.21), and 
at time 3, participants in that experimental condition reported the lowest job 
stress when compared with all 3 remaining study groups (ds between -0.24 and 
-0.41). For job-related traumatic stress, we found a significant difference 
between study groups only at time 3: stress was lower in the experimental 
condition in which self-efficacy was enhanced first than in the active 
comparator enhancing solely social support (d=-0.24). The same result was found 
for work engagement (d=-0.20), which means that it was lower in exactly the same 
condition that was found beneficial for stress relief. There were no differences 
between study conditions for burnout and depression neither at time 2 nor at 
time 3. There was a high dropout in the study (1023/1240, 82.50% at posttest), 
reflecting the pragmatic nature of this trial.
CONCLUSIONS: The Med-Stress internet intervention improves some components of 
well-being-most notably job stress-when activities are completed in a specific 
sequence. The decrease in work engagement could support the notion of dark side 
of this phenomenon, but further research is needed.
TRIAL REGISTRATION: ClinicalTrials.gov NCT03475290; 
https://clinicaltrials.gov/ct2/show/NCT03475290.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): 
RR2-10.1186/s13063-019-3401-9.

©Ewelina Smoktunowicz, Magdalena Lesnierowska, Per Carlbring, Gerhard Andersson, 
Roman Cieslak. Originally published in the Journal of Medical Internet Research 
(http://www.jmir.org), 11.01.2021.

DOI: 10.2196/21445
PMCID: PMC7834939
PMID: 33427674 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


3883. Acta Neuropsychiatr. 2021 Jun;33(3):156-159. doi: 10.1017/neu.2020.47. Epub 2021 
Jan 11.

Variation in psychological well-being and symptoms of anxiety and depression 
during the COVID-19 pandemic: results from a three-wave panel survey.

Sønderskov KM(1), Dinesen PT(2), Vistisen HT(3)(4), Østergaard SD(3)(4).

Author information:
(1)Department of Political Science, Aarhus University, Aarhus, Denmark.
(2)Department of Political Science, University of Copenhagen, Copenhagen, 
Denmark.
(3)Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
(4)Department of Affective Disorders, Aarhus University Hospital - Psychiatry, 
Aarhus, Denmark.

DOI: 10.1017/neu.2020.47
PMCID: PMC7884728
PMID: 33427155 [Indexed for MEDLINE]


3884. J Paediatr Child Health. 2021 May;57(5):631-636. doi: 10.1111/jpc.15285. Epub 
2021 Jan 10.

Impact of the COVID-19 pandemic on the well-being of children with 
neurodevelopmental disabilities and their parents.

Masi A(1), Mendoza Diaz A(1)(2), Tully L(3), Azim SI(1), Woolfenden S(4), Efron 
D(5)(6)(7), Eapen V(1)(8).

Author information:
(1)School of Psychiatry, University of New South Wales, Sydney, New South Wales, 
Australia.
(2)Infant, Child and Adolescent Mental Health Services (ICAMHS), South Western 
Sydney Local Health District Liverpool, Sydney, New South Wales, Australia.
(3)Child Behaviour Research Clinic, Brain and Mind Centre, University of Sydney, 
Sydney, New South Wales, Australia.
(4)School of Women's and Children's Health, University of New South Wales, 
Sydney, New South Wales, Australia.
(5)Murdoch Children's Research Institute, Health Services Research, Melbourne, 
Victoria, Australia.
(6)Royal Children's Hospital, General Medicine, Melbourne, Victoria, Australia.
(7)Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, 
Australia.
(8)Academic Unit of Child Psychiatry, South Western Sydney Local Health 
District, Ingham Institute for Medical Research, Sydney, New South Wales, 
Australia.

AIMS: To examine the impact of COVID-19 pandemic on child mental health and 
socio-emotional and physical well-being (including sleep, diet, exercise, use of 
electronic media; care giver perceptions of symptoms of child neurodevelopmental 
disability [NDD] and comorbidities), and care giver mental health and 
well-being, social support and service use.
METHODS: An online cross-sectional self-report survey was distributed via 
disability service providers and support groups. Care givers of children aged 
2-17 years with a NDD were invited to respond to questions on child symptom 
severity and well-being, parent well-being and service access and satisfaction.
RESULTS: Overall, 302 care givers (94.7% female) completed the survey. Average 
child age was 9.7 years and 66.9% were male. Worsening of any child NDD or 
comorbid mental health symptom was reported by 64.5% of respondents and 76.9% 
reported child health and well-being was impacted by COVID-19. Children were 
viewing more television and digital media (81.6%), exercising less (68.0%), 
experiencing reduced sleep quality (43.6%) and had a poorer diet (32.4%). Almost 
one fifth (18.8%) of families reported an increase in the dosage of medication 
administered to their child. Parents reported COVID-19 had impacted their own 
well-being (76.1%). Over half of respondents were not satisfied with services 
received during COVID-19 (54.8%) and just 30% reported that telehealth works 
well for their child.
CONCLUSION: Targeted interventions are required to address worsening child 
neurodevelopmental disability, mental health symptoms and poor diet, sleep and 
exercise patterns. Improved access to telehealth services is indicated, as is 
further research on barriers and enablers of effective telehealth services.

© 2021 Paediatrics and Child Health Division (The Royal Australasian College of 
Physicians).

DOI: 10.1111/jpc.15285
PMCID: PMC8014782
PMID: 33426739 [Indexed for MEDLINE]


3885. Women Birth. 2022 May;35(3):232-241. doi: 10.1016/j.wombi.2020.12.014. Epub 2021 
Jan 7.

Perceived social support and prenatal wellbeing; The mediating effects of 
loneliness and repetitive negative thinking on anxiety and depression during the 
COVID-19 pandemic.

Harrison V(1), Moulds ML(2), Jones K(3).

Author information:
(1)The Open University, Walton Hall, Milton Keynes, MK7 6AA, United Kingdom. 
Electronic address: gini.harrison@open.ac.uk.
(2)The University of New South Wales, UNSW Sydney, Australia. Electronic 
address: https://www.twitter.com/MichelleMoulds.
(3)The Open University, Walton Hall, Milton Keynes, MK7 6AA, United Kingdom. 
Electronic address: https://www.twitter.com/Katie_Jones2.

PROBLEM: Prenatal depression and anxiety are linked to poor maternal and infant 
outcomes. We need to understand predictors of poor mental health to identify 
at-risk women, and targets for support.
BACKGROUND: Previous research has demonstrated a relationship between low levels 
of perceived social support, and depression and anxiety in pregnant women. 
However, there is a lack of research into the factors that may mediate this 
relationship.
AIM: As social distancing measures (e.g., lockdown) are likely to negatively 
affect women's perceived support in the prenatal period, we investigated the 
relationship between perceived social support and both anxiety and depression in 
UK-based pregnant women during the COVID-19 pandemic. Further, we examined two 
potential mediators that may contribute to psychological symptoms: repetitive 
negative thinking and loneliness.
METHODS: We administered a battery of online measures to a sample of pregnant 
women (N=205) between May-June 2020, during the first peak of the pandemic in 
the UK, when perceived social support was likely to be low.
RESULTS: Consistent with predictions, perceived social support was significantly 
negatively related to depression, anxiety, loneliness and repetitive negative 
thinking. Furthermore, repetitive negative thinking and loneliness mediated the 
relationship between perceived social support and both depression and anxiety. 
Moreover, perceived social support and loneliness were associated with specific 
types of online behaviours.
CONCLUSIONS: Taken together, the findings shed light on the processes through 
which social support may exert its effects on depression and anxiety and 
highlight potential therapeutic targets for interventions which aim to prevent 
and treat mood disorders in perinatal cohorts.

Copyright © 2021 Australian College of Midwives. Published by Elsevier Ltd. All 
rights reserved.

DOI: 10.1016/j.wombi.2020.12.014
PMCID: PMC9051127
PMID: 33422441 [Indexed for MEDLINE]


3886. BMC Public Health. 2021 Jan 9;21(1):104. doi: 10.1186/s12889-020-10070-3.

A rapid review of the impact of COVID-19 on the mental health of healthcare 
workers: implications for supporting psychological well-being.

De Kock JH(1)(2), Latham HA(3), Leslie SJ(4), Grindle M(5), Munoz SA(5), Ellis 
L(5), Polson R(5), O'Malley CM(5).

Author information:
(1)University of the Highlands and Islands, Institute for Health Research and 
Innovation, University of the Highlands and Islands, Old Perth Road, Inverness, 
IV2 3JH, UK. hannes.dekock@uhi.ac.uk.
(2)NHS Highland, Department of Clinical Psychology, New Craigs Hospital, 
Inverness, IV3 8NP, UK. hannes.dekock@uhi.ac.uk.
(3)NHS Highland, Nairn Healthcare Group, Cawdor Rd, Nairn, IV12 5EE, UK.
(4)NHS Highland, NHS Highland Cardiac Unit Raigmore Hospital, Inverness, IV2 
3UJ, UK.
(5)University of the Highlands and Islands, Institute for Health Research and 
Innovation, University of the Highlands and Islands, Old Perth Road, Inverness, 
IV2 3JH, UK.

BACKGROUND: Health and social care workers (HSCWs) have carried a heavy burden 
during the COVID-19 crisis and, in the challenge to control the virus, have 
directly faced its consequences. Supporting their psychological wellbeing 
continues, therefore, to be a priority. This rapid review was carried out to 
establish whether there are any identifiable risk factors for adverse mental 
health outcomes amongst HSCWs during the COVID-19 crisis.
METHODS: We undertook a rapid review of the literature following guidelines by 
the WHO and the Cochrane Collaboration's recommendations. We searched across 14 
databases, executing the search at two different time points. We included 
published, observational and experimental studies that reported the 
psychological effects on HSCWs during the COVID-19 pandemic.
RESULTS: The 24 studies included in this review reported data predominantly from 
China (18 out of 24 included studies) and most sampled urban hospital staff. Our 
study indicates that COVID-19 has a considerable impact on the psychological 
wellbeing of front-line hospital staff. Results suggest that nurses may be at 
higher risk of adverse mental health outcomes during this pandemic, but no 
studies compare this group with the primary care workforce. Furthermore, no 
studies investigated the psychological impact of the COVID-19 pandemic on social 
care staff. Other risk factors identified were underlying organic illness, 
gender (female), concern about family, fear of infection, lack of personal 
protective equipment (PPE) and close contact with COVID-19. Systemic support, 
adequate knowledge and resilience were identified as factors protecting against 
adverse mental health outcomes.
CONCLUSIONS: The evidence to date suggests that female nurses with close contact 
with COVID-19 patients may have the most to gain from efforts aimed at 
supporting psychological well-being. However, inconsistencies in findings and a 
lack of data collected outside of hospital settings, suggest that we should not 
exclude any groups when addressing psychological well-being in health and social 
care workers. Whilst psychological interventions aimed at enhancing resilience 
in the individual may be of benefit, it is evident that to build a resilient 
workforce, occupational and environmental factors must be addressed. Further 
research including social care workers and analysis of wider societal structural 
factors is recommended.

DOI: 10.1186/s12889-020-10070-3
PMCID: PMC7794640
PMID: 33422039 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3887. Midwifery. 2021 Mar;94:102902. doi: 10.1016/j.midw.2020.102902. Epub 2020 Dec 
19.

Mental Health & Parental Concerns during COVID-19: The Experiences of New 
Mothers Amidst Social Isolation.

Ollivier R(1), Aston DM(2), Price DS(3), Sim DM(4), Benoit DB(5), Joy DP(6), 
Iduye D(7), Nassaji NA(8).

Author information:
(1)School of Nursing, Dalhousie University, PO Box 15000, 5869 University 
Avenue, Halifax, Nova Scotia, Canada, B3H 4R2. Electronic address: 
rachel.ollivier@dal.ca.
(2)School of Nursing, Dalhousie University, PO Box 15000, 5869 University 
Avenue, Halifax, Nova Scotia, Canada, B3H 4R2. Electronic address: 
megan.aston@dal.ca.
(3)School of Nursing, Dalhousie University, PO Box 15000, 5869 University 
Avenue, Halifax, Nova Scotia, Canada, B3H 4R2. Electronic address: 
pricesl@dal.ca.
(4)Nova Scotia Health Authority, Healthy Populations Institute, Dalhousie 
University, PO Box 15000, 5869 University Avenue, Halifax, Nova Scotia, Canada, 
B3H 4R2. Electronic address: meaghan.sim@dal.ca.
(5)Rankin School of Nursing, St. Francis Xavier University, C251, Camden Hall, 
PO Box 5000, 2340 Notre Dame Avenue, Antigonish, Nova Scotia, Canada B2G 2W5. 
Electronic address: bbenoit@stfx.ca.
(6)Applied Human Nutrition, Mount Saint Vincent University, 166 Bedford Highway, 
Halifax, Nova Scotia, Canada B3M 2J6. Electronic address: phillip.joy@msvu.ca.
(7)School of Nursing, Dalhousie University, PO Box 15000, 5869 University 
Avenue, Halifax, Nova Scotia, Canada, B3H 4R2. Electronic address: 
damilola.iduye@dal.ca.
(8)School of Nursing, Dalhousie University, PO Box 15000, 5869 University 
Avenue, Halifax, Nova Scotia, Canada, B3H 4R2. Electronic address: 
neda.akbari@dal.ca.

BACKGROUND: The COVID-19 pandemic has resulted in an unprecedented situation for 
new parents, with public health orders greatly affecting daily life as well as 
various aspects of parenting and new parent wellbeing.
OBJECTIVES: To understand the impact of the COVID-19 pandemic on mothers/parents 
across Nova Scotia who are caring for a child 0-12 months of age.
DESIGN: This study utilized an online qualitative survey to collect data. 
Feminist poststructuralism and discourse analysis guided the analysis and 
discussion.
SETTING: Nova Scotia, Canada PARTICIPANTS: : 68 participants were recruited from 
across the province of Nova Scotia.
FINDINGS: Mental health and socialization were both major concerns for new 
mothers/parents, as many expressed feelings of worry, anxiety, loneliness, 
isolation, and stress.
KEY CONCLUSIONS: Online support was sought by many new mothers/parents as a way 
of supporting their own mental health. Some found ways to make it meaningful for 
them, while others believed that it could not replace or offer the same benefits 
as in-person interaction and support.
IMPLICATIONS FOR PRACTICE: Informal and formal support systems are both 
essential for new mothers. As public health systems and health care services 
learn to adapt to COVID-19, further research is required to examine how health 
services may best meet the needs of new mothers/parents.

Copyright © 2020. Published by Elsevier Ltd.

DOI: 10.1016/j.midw.2020.102902
PMCID: PMC9756383
PMID: 33421662 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
have no conflicts of interests to declare.


3888. J Trauma Nurs. 2021 Jan-Mar 01;28(1):26-36. doi: 10.1097/JTN.0000000000000554.

Burnout and Anxiety Among Trauma Nursing Specialties in a Rural Level I Trauma 
Center.

Cook A(1), Sigler C, Allen L, Peters JA, Guthrie C, Marroquin M, Ndetan H, Singh 
KP, Murry J, Norwood S, Philley JV.

Author information:
(1)Trauma Services, UT Health East Texas, Tyler (Mss Allen, Peters, and 
Marroquin and Drs Murry and Norwood); and Epidemiology and Biostatistics (Drs 
Cook, Ndetan, and Singh) and Medicine/Pulmonology (Mss Sigler and Guthrie and Dr 
Philley), The University of Texas Health Science Center at Tyler.

BACKGROUND: Burnout and anxiety compromise physical and mental well-being of 
nurses and jeopardize patient safety. Personal, professional, and workplace 
characteristics have been associated with burnout and anxiety across diverse 
practice settings, yet none in rural, community trauma centers. We sought to 
identify the severity and predictors of burnout and anxiety in the trauma 
nursing staff of a rural Level I trauma center.
METHODS: A convenience sample of trauma nurses from the emergency department 
(ED), intensive care unit (ICU), and trauma ward was voluntarily surveyed using 
a demographic questionnaire, the Maslach Burnout Inventory (MBI) subscales: 
depersonalization (DP), emotional exhaustion (EE), and reduced personal 
accomplishment, as well as the Generalized Anxiety Disorder seven-item (GAD-7) 
scale. Multivariable linear regression identified the significant predictors of 
burnout and anxiety.
RESULTS: Ninety-six nurses completed surveys (response rate: 83.5%). Married or 
divorced status, and ICU or trauma ward job assignments were associated with 
significantly lower adjusted DP scores. Thus, the model-predicted score for a 
single ED nurse was 15 versus a predicted score of 7 for a divorced ICU or 
trauma ward nurse, p < .001 for each group. The GAD-7 model demonstrated that 
race/ethnicity (Asian compared with White, coefficient: -5.06, p = .03), number 
of children (2 compared with 0, coefficient: -2.54, p = .02), and job tenure 
(5-10 years vs. <2, coefficient: -3.18, p = .01) were each associated with fewer 
GAD-7 points.
CONCLUSION: Depersonalization and anxiety vary across the trauma nursing 
workforce based on identifiable personal and work-related risk factors. 
Group-specific, targeted interventions are needed to effectively reduce burnout 
and anxiety in trauma nursing staff.

Copyright © 2021 Society of Trauma Nurses.

DOI: 10.1097/JTN.0000000000000554
PMID: 33417400 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


3889. Perspect Biol Med. 2020;63(4):669-682. doi: 10.1353/pbm.2020.0054.

Fighting Words in the Antipodes.

Lacey C, Kelly MP, Jutel A.

In this commentary, written in two bursts-the first completed in April 2020, and 
the second at the end of July-we explore how media metaphors of COVID-19 
constitute the pandemic in Australia and New Zealand. We argue that the media's 
rhetorical strategies play an important role not only in describing the illness, 
but in influencing and shaping individual and collective responses to the 
pandemic, with significant consequences for mental health and well-being in the 
context of crisis. We align this commentary with the tenets of the sociology of 
diagnosis, which argue that even though there are material realities of disease, 
their social form and consequence cannot be separated from the tangible nature 
of illness and its management. We also lean on Derrida's approach to metaphor, 
which underlines how even observable viral entities such as COVID-19 are 
simultaneously material, abstract, and in flux. We describe the metaphors used 
by local media to describe the pandemic-including combat, bush fires, 
earthquakes, and other natural disasters-and we explore how and why these 
metaphors construct the pandemic locally and farther afield.

DOI: 10.1353/pbm.2020.0054
PMID: 33416804 [Indexed for MEDLINE]


3890. Front Psychol. 2020 Dec 22;11:535634. doi: 10.3389/fpsyg.2020.535634. 
eCollection 2020.

Serial Multiple Mediation of Professional Identity, and Psychological Capital in 
the Relationship Between Work-Related Stress and Work-Related Well-Being of ICU 
Nurses in China: A Cross-Sectional Questionnaire Survey.

Hao C(1), Zhu L(1), Zhang S(1), Rong S(1), Zhang Y(1), Ye J(1), Yang F(2).

Author information:
(1)Department of Critical Medicine, Affiliated Hospital of Jining Medical 
University, Jining, China.
(2)School of Nursing, Qingdao University, Qingdao, China.

This study aimed to investigate the serial-multiple mediation effect of 
professional identity, psychological capital (PsyCap), work-related stress, and 
work-related wellbeing among intensive care unit (ICU) nurses in China. The 
cross-sectional survey was conducted from January 2017 to May 2017 in two Grade 
III A general hospitals (with more than 2000 beds) in Jining, Shandong Province, 
China. Cluster sampling was used to recruit participants from the two hospitals. 
A total of 330 ICU nurses participated in the study. The nurses' work stress 
scale, Chinese nurse's professional identity scale, the PsyCap questionnaire, 
and Chinese work-related wellbeing scale were used to collect the data. 
Descriptive analysis, independent-samples t-test, one-way analysis of variance, 
Pearson correlation analysis, linear regression analysis, and structural 
equation modeling were used to analyze the data (P < 0.05 was considered 
statistically significant). The average score for the work-related wellbeing of 
ICU nurses was 85.91 ± 13.94. Work-related stress, professional identity, and 
PsyCap correlated significantly with work-related wellbeing. The major 
predictors of work-related wellbeing were PsyCap, work-related stress, 
professional identity, and monthly salary. The serial-multiple mediation effects 
of professional identity and PsyCap in the relationship between work-related 
stress and work-related wellbeing were statistically significant. Positive 
professional identity and PsyCap were sequentially associated with decreased 
work-related stress, which in turn was related to increased work-related 
wellbeing among ICU nurses. Therefore, this study aims to explore the impact of 
ICU nurses' work-related stress on work-related wellbeing, as well as the 
mediating effect of professional identity and PsyCap. It is hoped that hospital 
care managers will pay attention to the mental health of ICU nurses, increase 
their professional identity, and reduce work-related stress to improve the 
quality of the ICU nursing service and stabilize nursing work.

Copyright © 2020 Hao, Zhu, Zhang, Rong, Zhang, Ye and Yang.

DOI: 10.3389/fpsyg.2020.535634
PMCID: PMC7782242
PMID: 33414737

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


3891. Psychol Health Med. 2022 Jun;27(5):1095-1106. doi: 
10.1080/13548506.2021.1871771. Epub 2021 Jan 7.

Perceived risk and parental coronavirus anxiety in healthcare workers: a 
moderated mediation role of coronavirus fear and mental well-being.

Yıldırım M(1)(2), Özaslan A(3), Arslan G(4).

Author information:
(1)Department of Psychology, Ağrı İbrahim Çeçen University, Ağrı, Turkey.
(2)Department of Neuroscience, Psychology and Behaviour, University of 
Leicester, Leicester, UK.
(3)Department of Child and Adolescent Psychiatry, Gazi University, Yıldırım 
Beyazıt Univesity Yenimahalle Training and Research Hospital, Ankara, Turkey.
(4)Department of Psychological Counseling and Guidance, Mehmet Akif Ersoy 
University, Burdur, Turkey.

This study aimed to examine the associations between perceived coronavirus risk, 
coronavirus fear, mental well-being and parental coronavirus anxiety, as well as 
the mediating role of coronavirus fear and moderating role of mental 
well-being.The sample comprised 189 healthcare workers (M = 33.06 ± 6.92), who 
were treating patients with COVID-19 in a pandemic hospital in Turkey. 
Ninety-one participants were males and 98 females. Participants completed 
measures of perceived coronavirus risk, coronavirus fear, mental well-being and 
parental coronavirus anxiety.Parental Coronavirus Anxiety Scale had a one-factor 
structure, with satisfactory reliability. Main findings showed that coronavirus 
fear mediated the relationship between coronavirus risk and parental coronavirus 
anxiety. Mental well-being moderated the effect of coronavirus risk on parental 
coronavirus anxiety. The mediation effect of coronavirus fear was moderated by 
mental well-being.These findings explain why and when mental well-being-based 
interventions could be effective in reducing perceived coronavirus risk, fear 
and parental coronavirus anxiety about their children.

DOI: 10.1080/13548506.2021.1871771
PMID: 33410335 [Indexed for MEDLINE]


3892. Br J Health Psychol. 2021 May;26(2):644-656. doi: 10.1111/bjhp.12502. Epub 2021 
Jan 7.

Mental health of Italian adults during COVID-19 pandemic.

Amendola S(1), Spensieri V(1), Hengartner MP(2), Cerutti R(1).

Author information:
(1)Department of Dynamic and Clinical Psychology, Sapienza University of Rome, 
Italy.
(2)Department of Applied Psychology, Zurich University of Applied Sciences, 
Switzerland.

OBJECTIVES: On 31 January 2020, a new type of coronavirus was first confirmed in 
Italy and spread rapidly across the country leading to a national lockdown. The 
aim of this pilot study was to explore the impact of the public health emergency 
due to COVID-19 on individual's mental health among 299 Italian adults after a 
month of home isolation due to COVID-19.
DESIGN: Cross-sectional study design. Adults of the general population were 
invited to a voluntary online health survey.
METHODS: Hierarchical multiple regressions were used to examine diverse 
psycho-social and stressful contextual factors associated with symptoms of 
psychopathology.
RESULTS: Results indicated that females reported higher symptoms of depression, 
anxiety and circadian rhythm dysregulation, than males. Age and the capacity to 
adapt to a new environment and to cope with illness were negatively associated 
with all symptoms of psychopathology. Conversely, engaging in verbally 
aggressive behaviours and having experienced stressful events related to 
COVID-19 were positively related to psychopathological symptoms. Finally, social 
support was negatively associated with depressive symptoms, and substance use 
during the past months was related to circadian rhythm dysregulation.
CONCLUSIONS: The findings of this study raise particular concern about 
psychological well-being considering the negative associations between stressful 
events during the COVID-19 pandemic, symptoms of psychological distress, and 
perceived social support. These results have possible significant clinical 
implications.

© 2021 The British Psychological Society.

DOI: 10.1111/bjhp.12502
PMID: 33410243 [Indexed for MEDLINE]


3893. Br J Health Psychol. 2021 May;26(2):624-643. doi: 10.1111/bjhp.12500. Epub 2021 
Jan 6.

Health behaviour change during the UK COVID-19 lockdown: Findings from the first 
wave of the C-19 health behaviour and well-being daily tracker study.

Naughton F(1), Ward E(2), Khondoker M(3), Belderson P(2), Marie Minihane A(4), 
Dainty J(3), Hanson S(1), Holland R(5), Brown T(2), Notley C(2).

Author information:
(1)Behavioural and Implementation Science Group, School of Health Sciences, 
University of East Anglia, UK.
(2)Addictions Research Group, Norwich Medical School, University of East Anglia, 
UK.
(3)Norwich Medical School, University of East Anglia, Norwich, UK.
(4)Nutrition and Preventive Medicine Group, Norwich Medical School, University 
of East Anglia, UK.
(5)Leicester Medical School, University of Leicester, UK.

OBJECTIVES: To provide baseline cohort descriptives and assess change in health 
behaviours since the UK COVID-19 lockdown.
DESIGN: A prospective cohort (N = 1,044) of people recruited online, purposively 
targeting vulnerable populations.
METHODS: After a baseline survey (April 2020), participants completed 3 months 
of daily ecological momentary assessments (EMA). Dietary, physical activity, 
alcohol, smoking, vaping and substance use behaviours collected retrospectively 
for the pre-COVID-19 period were compared with daily EMA surveys over the first 
30 days during early lockdown. Predictors of behaviour change were assessed 
using multivariable regression models.
RESULTS: 30% of the cohort had a COVID-19 at risk health condition, 37% were 
classed as deprived and 6% self-reported a mental health condition. Relative to 
pre-pandemic levels, participants ate almost one portion of fruit and vegetables 
less per day (vegetables mean difference -0.33, 95% CI -0.40, -0.25; fruit 
-0.57, 95% CI -0.64, -0.50), but showed no change in high sugar portions per day 
(-0.03, 95% CI -0.12, 0.06). Participants spent half a day less per week doing 
≥30 min of moderate to vigorous physical activity (-0.57, 95% CI -0.73, -0.40) 
but slightly increased days of strength training (0.21, 95% CI 0.09, 0.34), 
increased alcohol intake (AUDIT-C score change 0.25, 95% CI 0.13, 0.37), though 
did not change smoking, vaping or substance use behaviour. Worsening health 
behaviour change was associated with being younger, female and higher body mass 
index.
CONCLUSIONS: The cohort reported worsening health behaviours during early 
lockdown. Longer term changes will be investigated using further waves of data 
collection.

© 2021 The Authors. British Journal of Health Psychology published by John Wiley 
& Sons Ltd on behalf of British Psychological Society.

DOI: 10.1111/bjhp.12500
PMCID: PMC9291054
PMID: 33410229 [Indexed for MEDLINE]

Conflict of interest statement: All authors declare no conflict of interest.


3894. Ir J Med Sci. 2021 Nov;190(4):1633-1635. doi: 10.1007/s11845-020-02448-4. Epub 
2021 Jan 6.

Step zero: optimising nutrition for physical and mental health wellbeing during 
COVID-19.

McNicholas F(1)(2)(3), Furey-Burke L(4).

Author information:
(1)Department of Child & Adolescent Psychiatry, SMMS, UCD, Dublin, Ireland. 
Fiona.mcnicholas@ucd.ie.
(2)Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland. 
Fiona.mcnicholas@ucd.ie.
(3)Lucena Clinic Rathgar, Dublin 6, Ireland. Fiona.mcnicholas@ucd.ie.
(4)Department of Child & Adolescent Psychiatry, SMMS, UCD, Dublin, Ireland.

DOI: 10.1007/s11845-020-02448-4
PMCID: PMC7787618
PMID: 33409844 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


3895. BMC Public Health. 2021 Jan 6;21(1):59. doi: 10.1186/s12889-020-10057-0.

Evaluating the impact of Archway: a personalized program for 1st year student 
success and mental health and wellbeing.

Kwan MYW(1)(2), Brown D(3), MacKillop J(4), Beaudette S(5), Van Koughnett S(6), 
Munn C(4).

Author information:
(1)Department of Child and Youth Studies, Brock University, 812 Sir Isaac Brock 
Way, St. Catharines, Ontario, L2S 3A1, Canada. mkwan@brocku.ca.
(2)Department of Family Medicine, McMaster University, Hamilton, Ontario, L8S 
4L8, Canada. mkwan@brocku.ca.
(3)Department of Family Medicine, McMaster University, Hamilton, Ontario, L8S 
4L8, Canada.
(4)Department of Psychiatry and Behavioural Neurosciences, McMaster University, 
Hamilton, Ontario, L8S 4L8, Canada.
(5)Housing and Conference Services, McMaster University, Hamilton, Ontario, L8S 
4L8, Canada.
(6)Student Affairs, McMaster University, Hamilton, Ontario, L8S 4L8, Canada.

BACKGROUND: First-year students entering postsecondary education must navigate a 
new and complex academic and social environment. Research indicates that this 
transition and developmental period can be challenging and stressful - 
academically, emotionally and socially - and that mental health and wellbeing 
can be compromised. Additionally, mental health disorders can also compromise 
students' ability to successfully navigate this transition. In the COVID-19 
pandemic, the incoming 2020 cohort of first-year students face heightened and 
new challenges. Most will have spent the conclusion of high school learning 
virtually, in quarantine, in an uncertain and difficult time, and are then 
experiencing their first year of university while living, learning and 
socializing off-campus, virtually and remotely. In response to COVID-19 and with 
an appreciation of the considerable stresses students face generally and 
particularly in 2020-21, and the potential effects on mental health and 
wellbeing, McMaster University, a mid-sized research intensive university with 
approximately 30,000 students, has developed an innovative program to support 
students, called Archway. This initiative has been developed to help to prevent 
and to intervene early to address common transitional issues students experience 
that can influence mental health and wellbeing, with the ultimate goals of 
increasing student connectedness, supports, and retention.
METHODS: The current study will use a mixed-method design to evaluate Archway 
and gain a better understanding of the transition into first-year postsecondary 
for students who engage and participate in Archway at various levels. The study 
will not only help to determine the effect of this program for students during 
COVID-19, but it will help us to better understand the challenges of this 
transition more broadly.
DISCUSSION: Findings have the potential to inform future efforts to support 
students and protect their mental health and wellbeing through the use of 
virtual and remote platforms and mechanisms that meet their increasingly diverse 
needs and circumstances.

DOI: 10.1186/s12889-020-10057-0
PMCID: PMC7787416
PMID: 33407303 [Indexed for MEDLINE]

Conflict of interest statement: JM is a principal in BEAM Diagnostics, Inc. The 
remaining authors declare that they have no competing interests.


3896. Int J Impot Res. 2021 Jan;33(1):131-136. doi: 10.1038/s41443-020-00393-5. Epub 
2021 Jan 5.

Sexuality during COVID lockdown: a cross-sectional Italian study among hospital 
workers and their relatives.

De Rose AF(#)(1), Chierigo F(#)(2), Ambrosini F(1), Mantica G(1), Borghesi 
M(1)(3), Suardi N(1)(3), Terrone C(1)(3).

Author information:
(1)Department of Urology, Policlinico San Martino Hospital, University of 
Genova, Genova, Italy.
(2)Department of Urology, Policlinico San Martino Hospital, University of 
Genova, Genova, Italy. francesco.chierigo@gmail.com.
(3)Department of Surgical and Diagnostic Integrated Sciences (DISC), University 
of Genova, Genova, Italy.
(#)Contributed equally

In March 2020, the Italian Government introduced measures to reduce the spread 
of COVID-19 infection. Between 8th April and 2nd May 2020 we investigated levels 
and correlates of sexual activity and depression during COVID-19 lockdown in a 
sample of hospital workers and their acquaintances by an online survey on 
SurveyMonkey. Socio-demographic data, International Index of Erectile Function, 
Female Sexual Function Index, and Beck Depression Inventory were recorded. 
Multivariable logistic regression analysis (MLRA) was used to test predictors of 
depressive symptoms and low sexual desire and satisfaction. A statistically 
significant difference in age, change in working habit, sexual satisfaction, 
sexual desire, and depressive symptoms was found between males and females. A 
statistically significant higher proportion of health care workers had low 
sexual desire (65.3% vs 56.8%, p = 0.042). At MLRA, age, being female, being a 
health care worker, having children at home, living with the partner, and having 
low sexual satisfaction were predictors of low level of sexual desire. To our 
knowledge, this is one of the few studies using validated questionnaires for 
both males and females to assess sexual well-being and psychometric alterations 
during COVID quarantine.

DOI: 10.1038/s41443-020-00393-5
PMCID: PMC7782561
PMID: 33402720 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


3897. Am J Health Behav. 2021 Jan 1;45(1):44-61. doi: 10.5993/AJHB.45.1.4.

Health Behaviors at the Onset of the COVID-19 Pandemic.

Weaver RH(1), Jackson A(2), Lanigan J(3), Power TG(4), Anderson A(5), Cox AE(6), 
Eddy L(7), Parker L(8), Sano Y(9), Weybright E(10).

Author information:
(1)Raven H. Weaver, Assistant Professor, Human Development, Washington State 
University, Pullman, WA, United States;, Email: raven.weaver@wsu.edu.
(2)Alexandra Jackson, PhD Candidate, Human Development, Washington State 
University, Vancouver, WA, United States.
(3)Jane Lanigan, Professor, Human Development, Washington State University, 
Vancouver, WA, United States.
(4)Thomas G. Power, Emeritus Professor, Human Development, Washington State 
University, Pullman, WA, United States.
(5)Atlana Anderson, PhD Candidate, Human Development, Washington State 
University, Pullman, WA, United States.
(6)Anne E. Cox, Associate Professor, Kinesiology and Educational Psychology, 
Washington State University, Pullman, WA, United States.
(7)Linda Eddy, Professor, Nursing, Washington State University, Vancouver, WA, 
United States.
(8)Louise Parker, Professor, Human Development and Extension Youth and Families 
Unit, Washington State University, Seattle, WA, United States.
(9)Yoshie Sano, Associate Professor, Human Development, Washington State 
University, Vancouver, WA, United States.
(10)Elizabeth Weybright, Associate Professor, Human Development, Washington 
State University, Pullman, WA, United States.

Objectives: We examined perceived behavior change since implementation of 
physical distancing restrictions and identified modifiable (self-rated health, 
resilience, depressive symptoms, social support and subjective wellbeing) and 
non-modifiable (demographics) risk/protective factors. Methods: A representative 
US sample (N = 362) completed an online survey about potential risk/protective 
factors and health behaviors prior to the pandemic and after 
implemented/recommended restrictions. We assessed change in perceived health 
behaviors prior to and following introduction of COVID-19. We conducted 
hierarchical linear regression to explore and identify risk/protective factors 
related to physical activity, diet quality, and social isolation. Results: There 
have been substantial decreases in physical activity and increases in sedentary 
behavior and social isolation, but no changes in diet quality since COVID-19. We 
identified modifiable and non-modifiable factors associated with each health 
behavior. Conclusions: Negative effects indicate the need for universal 
intervention to promote health behaviors. Inequalities in health behaviors among 
vulnerable populations may be exacerbated since COVID-19, suggesting need for 
targeted invention. Social support may be a mechanism to promote health 
behaviors. We suggest scaling out effective health behavior interventions with 
the same intensity in which physical distancing recommendations were 
implemented.

DOI: 10.5993/AJHB.45.1.4
PMID: 33402237 [Indexed for MEDLINE]


3898. Postgrad Med. 2021 Sep;133(7):750-759. doi: 10.1080/00325481.2021.1873027. Epub 
2021 Jan 18.

Psychosocial impact of the COVID-19 pandemic: a cross-sectional study of online 
help-seeking Canadian men.

Ogrodniczuk JS(1), Rice SM(2)(3), Kealy D(1), Seidler ZE(2)(3), Delara M(1)(4), 
Oliffe JL(4)(5).

Author information:
(1)Department of Psychiatry, University of British Columbia, Vancouver, Canada.
(2)Orygen, Parkville, Melbourne, Australia.
(3)Centre for Youth Mental Health, The University of Melbourne, Melbourne, 
Australia.
(4)School of Nursing, University of British Columbia, Vancouver, Canada.
(5)Department of Nursing, The University of Melbourne, Australia.

Purpose: The COVID-19 pandemic has had a profound impact on the lives of men. 
The present study investigated psychosocial impacts of the COVID-19 pandemic on 
a help-seeking sample of Canadian men, focusing on diverse aspects of their 
psychosocial well-being.Methods: A cross-sectional, open survey study design was 
used. Canadian adult men who were visiting an eHealth depression resource 
(HeadsUpGuys.org) were recruited to complete an online survey. Descriptive 
statistics, including means and standard deviations for continuous variables and 
frequency and percentages for categorical variables, were used to summarize 
survey responses. Regression analysis was utilized to identify factors 
associated with various mental health indicators (anxiety, depression, fear of 
COVID-19, suicidality). The Patient Health Questionnaire-4, Fear of COVID-19 
Scale, and item 9 (suicidality item) from the Patient Health Questionnaire-9 
were used to assess the mental health indicators.Results: A total of 434 men 
completed the study. Most respondents (79.3%; N = 344) indicated that their 
mental health was negatively affected by COVID-19, and two-thirds (65.5%; N 
= 284) conveyed that government-imposed physical distancing measures had 
negatively affected their mental health. Half the sample (51.2%; N = 222) 
reported at least moderate financial stress due to COVID-19. Nearly a third of 
respondents (31.1%; N = 135) reported that their current living situation has 
had a considerable or severe negative impact on their mental health since 
COVID-19. About two-fifths (37.7%; N = 94) of men felt that COVID-19 has had a 
negative impact on their relationship with their intimate partner. Nearly a 
third of respondents who were in a relationship (30.9%; N = 77) reported that 
they engaged in some type of abuse (primarily verbal abuse, 22.9%; N = 57) 
toward their intimate partner during COVID-19, and more than a quarter (27.3%; N 
= 68) reported being abused by their intimate partner (also primarily verbal 
abuse, 22.5%; N = 56). Just under half (42.2%; N = 183) of the respondents 
indicated experiencing suicidal ideation.Conclusion: These findings can help 
inform providers of health services to Canadian men, as well as policies that 
will be implemented during subsequent waves of COVID-19 or during future 
infectious outbreaks.

DOI: 10.1080/00325481.2021.1873027
PMID: 33402003 [Indexed for MEDLINE]


3899. J Assist Reprod Genet. 2021 Feb;38(2):333-341. doi: 10.1007/s10815-020-02023-x. 
Epub 2021 Jan 5.

Psychological distress and postponed fertility care during the COVID-19 
pandemic.

Lawson AK(1), McQueen DB(1), Swanson AC(1), Confino R(1), Feinberg EC(1), Pavone 
ME(2)(3).

Author information:
(1)Department of Obstetrics and Gynecology, Northwestern University Feinberg 
School of Medicine, Chicago, IL, 60611, USA.
(2)Department of Obstetrics and Gynecology, Northwestern University Feinberg 
School of Medicine, Chicago, IL, 60611, USA. MaryEllen.Pavone@nm.org.
(3), Chicago, USA. MaryEllen.Pavone@nm.org.

PURPOSE: To evaluate perceptions of delayed fertility care secondary to the 
COVID-19 pandemic.
METHODS: This was a cross-sectional anonymous survey of N = 787/2,287 patients 
(response rate = 42.6%) from a single academic fertility center. Participants 
were randomized 1:1 to receive supplemental educational explaining the rationale 
behind recommendations to delay fertility treatments due to the COVID-19 
pandemic. Assessment of well-being was conducted via the Personal Health 
Questionnaire Depression Scale, the Generalized Anxiety Disorder-7, the Ways of 
Coping-Revised, the Appraisal of Life Events Scale, and influence of 
supplemental education on agreement with ASRM COVID-19 Taskforce recommendations 
and associated distress.
RESULTS: Participants in the education v. no education groups were 35.51 (SD = 
4.06) and 37.24 (SD = 5.34) years old, married (90.8% v. 89.8%), had a graduate 
degree (53.9% v. 55.4%), > 1 year of infertility (73.4% v. 74.4%), and were 
nulliparous (69.0% v. 72.6%), with moderate to high distress (64.9% v. 64.2%) 
(ns). Distress was related to age, duration of infertility, and engagement in 
social support seeking and avoidant coping strategies (P < 0.001). Agreement 
with recommendations was related to receipt of supplemental education, history 
of pregnancy loss, and use of cognitive coping (P = 0.001).
CONCLUSION: Most participants were distressed by the delay of treatments. 
Supplemental education increased acceptance of recommendations but did not 
decrease distress. Future treatment delays should include education related to 
and assessment of understanding of recommendations, and inclusion of mental 
health professionals in patient care.

DOI: 10.1007/s10815-020-02023-x
PMCID: PMC7783482
PMID: 33400078 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


3900. J Gen Psychol. 2021 Jul;148(3):226-248. doi: 10.1080/00221309.2020.1867494. Epub 
2021 Jan 5.

The psychological effects of staying home due to the COVID-19 pandemic.

Bozdağ F(1).

Author information:
(1)Istanbul University-Cerrahpasa.

The most significant individual safety measures taken during the COVID-19 
pandemic include physical distancing, quarantine, and isolation. Although such 
steps are taken to control the spread of the pandemic, they may also cause 
various psychological problems. This study attempts to identify individual 
perceptions of staying home due to the COVID-19 pandemic through metaphors, and 
examines the relationship between these perceptions and stress, depression, and 
anxiety. This research utilizes a mixed method design called the embedded 
design. The analyses were performed on data collected from 96 women and 80 men 
aged 18-57. Qualitative data were analyzed using a content analysis technique, 
while quantitative data were analyzed through the Kruskal-Wallis test. The 
findings showed that most of the participants viewed staying home as 
confinement, experienced boredom/depression because of staying home, and felt 
helpless. On the other hand, some participants concentrated on the positive 
sides of staying home and considered it a responsible behavior, an opportunity, 
and a requirement for feeling safe. The individuals who viewed staying home as 
confinement and a cause for boredom/depression experienced more psychological 
problems, whereas those who perceived it as a responsibility or opportunity 
experienced fewer psychological problems. Considering the literature on the 
contribution of positive thinking to the well-being of individuals, as well as 
the lower levels of psychological problems in individuals who maintain their 
positive perspectives despite the negativities of staying home due to the 
pandemic, we recommend that mental health professionals focus on the development 
of positive feelings and thoughts in their interventions.

DOI: 10.1080/00221309.2020.1867494
PMID: 33397214 [Indexed for MEDLINE]


3901. Nutrients. 2020 Dec 30;13(1):97. doi: 10.3390/nu13010097.

Have Lifestyle Habits and Psychological Well-Being Changed among Adolescents and 
Medical Students Due to COVID-19 Lockdown in Croatia?

Dragun R(1), Veček NN(1), Marendić M(2), Pribisalić A(3), Đivić G(4), Cena 
H(5)(6), Polašek O(3), Kolčić I(3).

Author information:
(1)University Postgraduate Doctoral Study Program Evidence-Based Medicine, 
University of Split School of Medicine, 21000 Split, Croatia.
(2)University Department of Health Studies, University of Split, 21000 Split, 
Croatia.
(3)Department of Public Health, University of Split School of Medicine, 21000 
Split, Croatia.
(4)ENT Clinic, University Clinical Hospital Mostar, Bijeli Brijeg B.B., 88000 
Mostar, Bosnia and Herzegovina.
(5)Clinical Nutrition Laboratory, Department of Public Health, Experimental and 
Forensic Medicine, University of Pavia, 27100 Pavia, Italy.
(6)Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and 
Endocrinology, ICS Maugeri IRCCS, University of Pavia, 27100 Pavia, Italy.

OBJECTIVE: To investigate dietary habits, sleep and psychological well-being of 
adolescents and medical students during COVID-19 lockdown in Split, Croatia.
METHODS: We surveyed 1326 students during 2018 and 2019, and compared their 
responses with 531 students enrolled in May 2020. Perceived stress, quality of 
life (QoL), happiness, anxiety, and optimism were assessed as proxies of 
psychological well-being, using general linear modelling.
RESULTS: We found no substantial differences in dietary pattern between 
pre-lockdown and lockdown periods, including the overall Mediterranean diet (MD) 
adherence. However, the MD pattern changed, showing increased adherence to the 
MD pyramid for fruit, legumes, fish, and sweets, while cereals, nuts, and dairy 
intake decreased during COVID-19 lockdown. A third of students reported weight 
loss during lockdown, 19% reported weight gain, while physical activity remained 
rather stable. The most prominent change was feeling refreshed after a night's 
sleep, reported by 31.5% of students during lockdown vs. 8.5% before; median 
length of sleep duration increased by 1.5 h. Lockdown significantly affected 
QoL, happiness, optimism (all p < 0.001), and perceived stress in students (p = 
0.005). MD adherence was positively correlated with QoL and study time, and 
negatively with TV and mobile phone use in pre-lockdown period (all p < 0.001). 
Interestingly, higher MD adherence was correlated with less perceived hardship 
and greater happiness and QoL during lockdown.
CONCLUSION: These insights provide valuable information for tailored 
interventions aimed at maintaining healthy lifestyle in young population. Given 
the numerous beneficial effects associated with MD adherence, modification of 
lifestyle through application of lifestyle medicine deserves a priority 
approach.

DOI: 10.3390/nu13010097
PMCID: PMC7830522
PMID: 33396690 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funder had no role in the design of the study, in data collection, analyses, or 
interpretation of data, in the writing of the manuscript, or in the decision to 
publish the results.


3902. Int J Environ Res Public Health. 2020 Dec 30;18(1):210. doi: 
10.3390/ijerph18010210.

Change in Physical Activity, Sleep Quality, and Psychosocial Variables during 
COVID-19 Lockdown: Evidence from the Lothian Birth Cohort 1936.

Okely JA(1), Corley J(1), Welstead M(1), Taylor AM(1), Page D(1), Skarabela 
B(1), Redmond P(1), Cox SR(1), Russ TC(1)(2).

Author information:
(1)Lothian Birth Cohort Studies, Department of Psychology, University of 
Edinburgh, Edinburgh EH8 9JZ, UK.
(2)Alzheimer Scotland Dementia Research Centre, University of Edinburgh, 
Edinburgh EH8 9JZ, UK.

(1) Objectives: The COVID-19 pandemic has disproportionately affected the lives 
of older people. In this study, we examine changes in physical activity, sleep 
quality, and psychosocial variables among older people during COVID-19 lockdown. 
We build on cross-sectional studies on this topic by assessing change 
longitudinally. We also examined whether participant characteristics including 
demographic, cognitive, personality, and health variables were related to more 
positive or negative changes during lockdown. (2) Methods: 137 older 
participants (mean age 84 years) from the Lothian Birth Cohort 1936 study were 
included in the analysis. They completed the same questionnaires assessing 
physical activity, sleep quality, mental wellbeing, social support, loneliness, 
neighbourhood cohesion, and memory problems before (mostly 2 years earlier) and 
again during national lockdown. (3) Results: On average, levels of physical 
activity were reduced (those doing minimal physical activity increased from 10% 
to 19%) and perceived social support increased during lockdown (effect size drm 
= 0.178). More positive change in the psychosocial and behavioural outcome 
variables during lockdown was associated with personality traits (greater 
intellect, emotional stability, and extraversion) and having a higher general 
cognitive ability. Participants with a history of cardiovascular disease, more 
symptoms of anxiety, or who lived alone were more likely to experience negative 
changes in the outcome variables during lockdown. (4) Discussion: These results 
provide further insight into the experiences of older people during the COVID-19 
pandemic and could help to identify those at greatest risk of negative 
psychosocial or behavioural changes during this time.

DOI: 10.3390/ijerph18010210
PMCID: PMC7795040
PMID: 33396611 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflict of interest to 
declare.


3903. Int J Environ Res Public Health. 2020 Dec 31;18(1):265. doi: 
10.3390/ijerph18010265.

Creative Music Therapy with Premature Infants and Their Parents: A Mixed-Method 
Pilot Study on Parents' Anxiety, Stress and Depressive Symptoms and 
Parent-Infant Attachment.

Kehl SM(1)(2)(3), La Marca-Ghaemmaghami P(4)(5), Haller M(6), Pichler-Stachl 
E(7), Bucher HU(1), Bassler D(1), Haslbeck FB(1).

Author information:
(1)Department of Neonatology, University Hospital Zurich, University of Zurich, 
Frauenklinikstrasse 10, 8091 Zurich, Switzerland.
(2)Department of Clinical Music Therapy, Zurich University of the Arts, 
Pfingstweidstrasse 96, 8005 Zurich, Switzerland.
(3)Department of Neonatology and Pediatric Intensive Care, Children's University 
Hospital of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland.
(4)Department of Clinical Psychology and Psychotherapy, University of Zurich, 
Binzmuehlestrasse 14/Box 26, 8050 Zurich, Switzerland.
(5)Psychology Research and Counselling Institute for Sexuality, Marriage and 
Family, International Academy for Human Sciences and Culture, Staadweg 3, P.O. 
Box 57, 8880 Walenstadt, Switzerland.
(6)Department of Psychological Methods, Evaluation and Statistics, University of 
Zurich, Binzmuehlestrasse 14/Box 27, 8050 Zurich, Switzerland.
(7)Division of Neonatology, Department of Pediatrics, Medical University, 
Auenbruggerplatz/38/III. OG, 8036 Graz, Austria.

Premature birth is stressful for infants and parents and can adversely affect 
the parent-infant dyad. This mixed-methods pilot study evaluates whether 
creative music therapy (CMT) can alleviate anxiety, stress, and depressive 
symptoms in parents and support the bonding process with their infant. Sixteen 
parent couples were included. Ten couples were randomly allocated to the music 
therapy group (MTG) and six to the control group (CG). All couples completed 
psychological questionnaires measuring anxiety and depressive symptoms as well 
as an implicit measure of parent-infant attachment at two weeks postpartum (T1), 
at approximate neonatal intensive care unit (NICU) hospitalization halftime 
(T2), and two weeks after the infant had been discharged (T3). At T1 and T2, the 
parents additionally completed a questionnaire assessing the degree of stress 
they experienced at the NICU. Qualitative data were collected through a 
semi-structured, problem-centered interview with MTG parents at T3. The results 
of the quantitative analyses revealed reductions in anxiety levels from T1 to T2 
(p = 0.002) as well as decreases in depressive symptoms from T2 to T3 (p = 
0.022). No such changes were apparent in the CG. In fact, parental stress 
increased from T1 to T2 (p = 0.016). Significant increases in attachment across 
time were also observed within the MTG, but not in the CG. The qualitative 
inquiry confirmed that CMT can support the parent-infant relationship. Being in 
musical interaction evoked feelings of joy and relaxation in the parents and 
encouraged them to interact more profoundly with their infant. The results call 
for a more extensive powered follow-up study to further investigate CMT's 
potential for parental well-being and parent-infant bonding.

DOI: 10.3390/ijerph18010265
PMCID: PMC7795112
PMID: 33396496 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3904. Addiction. 2021 Aug;116(8):2104-2115. doi: 10.1111/add.15387. Epub 2021 Jan 12.

For better or for worse? A pre-post exploration of the impact of the COVID-19 
lockdown on cannabis users.

Cousijn J(1)(2)(3), Kuhns L(1)(2)(3), Larsen H(3)(4), Kroon E(1)(2)(3).

Author information:
(1)Neuroscience of Addiction (NofA) Laboratory, Department of Psychology, 
University of Amsterdam, Amsterdam, the Netherlands.
(2)The Amsterdam Brain and Cognition Center (ABC), University of Amsterdam, 
Amsterdam, the Netherlands.
(3)ADAPT-laboratory, Department of Psychology, University of Amsterdam, the 
Netherlands.
(4)Research Priority Area Yield, University of Amsterdam, the Netherlands.

Comment in
    Rev Mal Respir. 2021 May;38(5):535-538.

BACKGROUND AND AIMS: Lockdown measures aimed at limiting the number of 
infections and deaths from the coronavirus disease 2019 (COVID-19) have 
introduced substantial psychosocial stressors in everyday life. We aimed to 
investigate the influence of the Dutch lockdown on cannabis use and cannabis use 
disorder (CUD) and investigate relations with change in mental wellbeing and 
experienced psychosocial stressors during the lockdown.
DESIGN: Explorative longitudinal baseline-, pre- and during lockdown survey 
study.
SETTING: The Netherlands, on-line between January 2019 and May 2020.
PARTICIPANTS: Community sample of 120 monthly to daily cannabis users and 
reference group of 63 non-using controls.
MEASUREMENTS: Change in cannabis use and CUD symptom severity from baseline to 
pre- to post-lockdown. Change in cannabis use motives, mental health, quality of 
social relationships and job status from pre- to post-lockdown.
FINDINGS: In cannabis users, lockdown related to increased cannabis use [B = 
1.96, 95% confidence interval (CI) = 0.26-3.66, P = 0.024], but not CUD symptom 
severity. Cannabis users experienced 30% job loss and increased loneliness [P < 
0.001, Bayes factor (BF)10 > 100], while contact with partners (P = 0.005, BF10 
= 8.21) and families improved (P < 0.001, BF10  = 19.73), with no differences 
between cannabis users and control. Generally, mental health problems (all Ps > 
0.277, all BF10  < 0.139) did not change, but individual differences were 
significant and severity of cannabis use pre-lockdown, COVID-19-related worries, 
change in anxiety, expansion motives, social motives and family contact all 
uniquely related to variance in change in cannabis use or CUD.
CONCLUSIONS: While cannabis use among daily cannabis users in the Netherlands 
increased at the group level during the period of COVID-19 lockdown, the effect 
of the first months of lockdown on cannabis use disorder severity and mental 
wellbeing varied significantly among individual daily cannabis users.

© 2021 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of 
Society for the Study of Addiction..

DOI: 10.1111/add.15387
PMCID: PMC8254730
PMID: 33394560 [Indexed for MEDLINE]


3905. Int J Ment Health Nurs. 2021 Jun;30(3):694-702. doi: 10.1111/inm.12827. Epub 
2021 Jan 3.

The influence of COVID-19 on the mental health of final-year nursing students: 
comparing the situation before and during the pandemic.

Reverté-Villarroya S(1), Ortega L(2)(3), Lavedán A(4)(5), Masot O(4)(5), 
Burjalés-Martí MD(2), Ballester-Ferrando D(6), Fuentes-Pumarola C(6), Botigué 
T(4)(5).

Author information:
(1)Department d'Infermeria, Facultat d'Infermeria Campus Terres de l'Ebre, 
Universitat Rovira Virgili, Tortosa, Spain.
(2)Departament d'Infermeria, Facultat d'Infermeria, Universitat Rovira i 
Virgili, Tarragona, Spain.
(3)Hospital Universitari Institut Pere Mata, Institut d'Investigació Sanitària 
Pere Virgili (IISPV), CIBERSAM, Universitat Rovira i Virgili, Reus, Spain.
(4)Nursing and Physiotherapy Department, University of Lleida, St. Lleida, 
Spain.
(5)Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, 
St. Lleida, Spain.
(6)Nursing Department, University of Girona, St. Girona, Spain.

The COVID-19 pandemic has had an important impact on the academic world. It is 
known that university studies can influence the mental health of students, and 
especially those studying health sciences. In this study, we therefore sought to 
analyse whether the current pandemic has affected the mental well-being of 
final-year nursing students. This was a multi-centre study, with a descriptive, 
longitudinal, and prospective design. Mental well-being was evaluated using the 
General Health Questionnaire. A total of 305 participants were included in the 
study, of whom 52.1% had experienced the COVID-19 pandemic. Statistically 
significant differences were found between the two groups analysed in terms of 
age, access to university, average marks, mental well-being self-esteem, 
emotional exhaustion, and sense of coherence. In the case of mental well-being, 
a direct association was found with both the pandemic situation (OR = 2.32, 
P = 0.010) and emotional exhaustion scores (OR = 1.20, P < 0.001), while an 
inverse association was found with sense of coherence scores (OR = 0.45, 
P < 0.001). This study shows that the mental health of students is a significant 
factor and one that must be taken into consideration when training nursing staff 
at university. There is a need to promote healthy habits and provide appropriate 
coping strategies. It is also important to train and prepare students for 
pandemic situations as these can have an important impact on the mental health 
of both the members of the public who will be treated by these future nursing 
professionals and the students themselves.

© 2021 John Wiley & Sons Australia, Ltd.

DOI: 10.1111/inm.12827
PMID: 33393201 [Indexed for MEDLINE]


3906. Surg Obes Relat Dis. 2021 Apr;17(4):756-764. doi: 10.1016/j.soard.2020.11.021. 
Epub 2020 Nov 28.

How are bariatric patients coping during the coronavirus disease 2019 (COVID-19) 
pandemic? Analysis of factors known to cause weight regain among postoperative 
bariatric patients.

Athanasiadis DI(1), Hernandez E(1), Hilgendorf W(2), Roper A(3), Embry M(4), 
Selzer D(5), Stefanidis D(6).

Author information:
(1)Department of Surgery, Indiana University School of Medicine, Indianapolis, 
Indiana.
(2)Department of Surgery, Indiana University Health North Hospital, 
Indianapolis, Indiana; Indiana University School of Medicine, Indianapolis, 
Indiana.
(3)Indiana University School of Medicine, Indianapolis, Indiana.
(4)Department of Surgery, Indiana University Health North Hospital, 
Indianapolis, Indiana.
(5)Department of Surgery, Indiana University School of Medicine, Indianapolis, 
Indiana; Department of Surgery, Indiana University Health North Hospital, 
Indianapolis, Indiana.
(6)Department of Surgery, Indiana University School of Medicine, Indianapolis, 
Indiana; Department of Surgery, Indiana University Health North Hospital, 
Indianapolis, Indiana. Electronic address: dimstefa@iu.edu.

BACKGROUND: The global coronavirus disease 2019 (COVID-19) pandemic is wreaking 
havoc on society. Bariatric patients are more prone to severe infection due to 
their high body mass index (BMI) and are more vulnerable to the effects of 
isolation, such as depression or disruption of their health habits.
OBJECTIVES: To quantify the impact of self-quarantine on bariatric patients and 
self-quarantine's relationship with weight gain.
SETTING: Academic hospital, United States.
METHODS: A 30-item survey examining several known contributors to weight regain 
was distributed among the postoperative bariatric patients of our clinic. 
Changes in eating habits, exercise, depression, social support, loneliness, and 
anxiety were studied, among others.
RESULTS: A total of 208 patients completed the survey (29.3% response rate). A 
large percentage of patients reported increases in their depression (44.2%), 
loneliness (36.2%), nervousness (54.7%), snacking (62.6%), loss of control when 
eating (48.2%), and binge eating (19.5%) and decreases in their social support 
(23.2%), healthy food eating (45.5%), and activity (55.2%). Difficulty in 
accessing vitamins was reported by 13%. Patients more than 18 months out of 
surgery regained more than 2 kg during an average of 47 days. Risk factors for 
weight regain were found to be loss of control when eating, increases in 
snacking and binge eating, reduced consumption of healthy food, and reduced 
physical activity.
CONCLUSION: Bariatric patients are negatively affected by the COVID-19 pandemic 
and subsequent social isolation on many levels. This patient population is 
vulnerable to crisis situations; thus, additional intervention is needed to 
address behaviors that lead to weight regain.

Copyright © 2020 American Society for Bariatric Surgery. Published by Elsevier 
Inc. All rights reserved.

DOI: 10.1016/j.soard.2020.11.021
PMCID: PMC7699156
PMID: 33390351 [Indexed for MEDLINE]


3907. J Relig Health. 2021 Feb;60(1):34-49. doi: 10.1007/s10943-020-01121-5. Epub 2021 
Jan 2.

The Association Between Positive Religious Coping, Perceived Stress, and 
Depressive Symptoms During the Spread of Coronavirus (COVID-19) Among a Sample 
of Adults in Palestine: Across Sectional Study.

Mahamid FA(1), Bdier D(2).

Author information:
(1)Psychology and Counseling Department, An-Najah National University, Nablus, 
Palestine. mahamid@najah.edu.
(2)Psychology and Counseling Department, An-Najah National University, Nablus, 
Palestine.

OBJECTIVES: The current study was designed to investigate the relationship 
between positive religious coping, perceived stress, and depressive symptoms 
among Palestinian adults in response to the emergence of coronavirus (COVID-19), 
and the quarantine system implemented in the city of Tulkarem, Palestine.
METHODS: A correlational study was conducted to examine the relationship between 
study variables. Participants were 400 Palestinian adults, involving 172 males 
and 228 females, living in the city of Tulkarem, Palestine, during the spread of 
coronavirus. Participants were selected using convenience and snowball sampling 
techniques.
RESULTS: Pearson's correlation coefficient was used to test the relationship 
between positive religious coping, depressive symptoms, and perceived stress. 
Findings revealed a statistically significant negative correlation between 
positive religious coping and depressive symptoms (r = - .17, p < .01). Results 
also indicated a statistically significant negative correlation between positive 
religious coping and perceived stress (r = - .15, p < .01). The regression 
analysis for predicting depressive symptoms found that both positive religious 
coping (B = - .21, SE = .05, β = - .18) and perceived stress (B = .41, SE = .05, 
β = .35) were statistically significant toward explaining variance in depressive 
symptoms.
CONCLUSION: The importance of developing intervention programs that take into 
consideration religious/spiritual struggles and positive religious strategies 
may help improve resilience and well-being among affected populations. With the 
recent spread of COVID-19, findings of this current study have presented 
important practical implications for improving the mental health and well-being 
among Palestinians, especially since Palestinian society continues to face 
different types of stressors, such as illegal occupation. Further studies are 
recommended to test the relationship between current study variables and other 
related variables.

DOI: 10.1007/s10943-020-01121-5
PMCID: PMC7778573
PMID: 33389439 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


3908. Sleep Med. 2021 Feb;78:51-56. doi: 10.1016/j.sleep.2020.12.009. Epub 2020 Dec 
10.

Psychological correlates of poor sleep quality among U.S. young adults during 
the COVID-19 pandemic.

Hyun S(1), Hahm HC(2), Wong GTF(3), Zhang E(3), Liu CH(4).

Author information:
(1)Department of Newborn Medicine, Brigham and Women's Hospital, 221 Longwood 
Avenue, Boston, MA, 02115, USA; Harvard Medical School, 25 Shattuck St, Boston, 
MA, 02115, USA.
(2)School of Social Work, Boston University, 264 Bay State Road, Boston, MA 
02215, USA.
(3)Department of Newborn Medicine, Brigham and Women's Hospital, 221 Longwood 
Avenue, Boston, MA, 02115, USA.
(4)Department of Newborn Medicine, Brigham and Women's Hospital, 221 Longwood 
Avenue, Boston, MA, 02115, USA; Harvard Medical School, 25 Shattuck St, Boston, 
MA, 02115, USA; Department of Psychiatry, Brigham and Women's Hospital, 60 
Fenwood Road, Boston, MA, 02115, USA. Electronic address: chliu@bwh.harvard.edu.

OBJECTIVE: Uncertainty due to the COVID-19 pandemic may result in problematic 
sleep that can lead to negative effects on overall health. This unprecedented 
and stressful time can be even more detrimental for young adults with 
pre-existing mental health conditions. The purpose of this study is to 
investigate potential risk factors (i.e., current mental health symptoms, and 
COVID-19-related grief and worry) on sleep quality of U.S. young adults during 
the initial months of the global pandemic.
METHOD: This cross-sectional study examined 908 young adults in the weeks 
following the declaration of the coronavirus pandemic as a national emergency by 
the United States. A series of hierarchical multiple regression analyses 
examined depression, anxiety, and PTSD, as well as COVID-19-related grief and 
worry as predictors of young adults' sleep quality.
RESULTS: Young adults experienced high rates of sleep problems during the first 
two months (April to May 2020) of the pandemic. Depressive and anxiety symptoms 
appear to be predictors of sleep quality regardless of any pre-existing 
diagnosis. Furthermore, high levels of PTSD symptoms and COVID-19-related worry 
were associated with young adults' poor sleep.
CONCLUSIONS: Our findings point to possible psychological factors that uniquely 
explain young adults' poor sleep quality during the COVID-19 pandemic in the 
U.S. This study shed new light on how the COVID-19 pandemic might affect the 
sleep behaviors of young adults without a pre-existing mental health diagnosis. 
Implications for supporting young adults sleep and well-being during the 
pandemic are addressed.

Copyright © 2020 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.sleep.2020.12.009
PMCID: PMC7887075
PMID: 33385779 [Indexed for MEDLINE]

Conflict of interest statement: The ICMJE Uniform Disclosure Form for Potential 
Conflicts of Interest associated with this article can be viewed by clicking on 
the following link: https://doi.org/10.1016/j.sleep.2020.12.009.


3909. BMJ Open. 2020 Dec 31;10(12):e041641. doi: 10.1136/bmjopen-2020-041641.

Impact of the COVID-19 pandemic on mental health and well-being of communities: 
an exploratory qualitative study protocol.

Shahil Feroz A(1)(2), Akber Ali N(3), Akber Ali N(4), Feroz R(5), Nazim Meghani 
S(4), Saleem S(4).

Author information:
(1)Community Health Sciences, Aga Khan University, Karachi, Pakistan 
anam.sahyl@gmail.com.
(2)Institute of Health Policy, Management and Evaluation, University of Toronto, 
Toronto, Ontario, Canada.
(3)School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan.
(4)Community Health Sciences, Aga Khan University, Karachi, Pakistan.
(5)Aga Khan University Institute for Educational Development, Karachi, Pakistan.

INTRODUCTION: The COVID-19 pandemic has certainly resulted in an increased level 
of anxiety and fear in communities in terms of disease management and infection 
spread. Due to fear and social stigma linked with COVID-19, many individuals in 
the community hide their disease and do not access healthcare facilities in a 
timely manner. In addition, with the widespread use of social media, rumours, 
myths and inaccurate information about the virus are spreading rapidly, leading 
to intensified irritability, fearfulness, insomnia, oppositional behaviours and 
somatic complaints. Considering the relevance of all these factors, we aim to 
explore the perceptions and attitudes of community members towards COVID-19 and 
its impact on their daily lives and mental well-being.
METHODS AND ANALYSIS: This formative research will employ an exploratory 
qualitative research design using semistructured interviews and a purposive 
sampling approach. The data collection methods for this formative research will 
include indepth interviews with community members. The study will be conducted 
in the Karimabad Federal B Area and in the Garden (East and West) community 
settings in Karachi, Pakistan. The community members of these areas have been 
selected purposively for the interview. Study data will be analysed thematically 
using NVivo V.12 Plus software.
ETHICS AND DISSEMINATION: Ethical approval for this study has been obtained from 
the Aga Khan University Ethical Review Committee (2020-4825-10599). The results 
of the study will be disseminated to the scientific community and to the 
research subjects participating in the study. The findings will help us explore 
the perceptions and attitudes of different community members towards the 
COVID-19 pandemic and its impact on their daily lives and mental well-being.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2020-041641
PMCID: PMC7780420
PMID: 33384393 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3910. Int J Environ Res Public Health. 2020 Dec 29;18(1):188. doi: 
10.3390/ijerph18010188.

Perceptions and Experiences of the University of Nottingham Pilot SARS-CoV-2 
Asymptomatic Testing Service: A Mixed-Methods Study.

Blake H(1)(2), Corner J(3), Cirelli C(4), Hassard J(4), Briggs L(1), Daly JM(5), 
Bennett M(5), Chappell JG(2)(6), Fairclough L(6), McClure CP(2)(6), Tarr 
A(2)(6), Tighe P(2)(6), Favier A(7), Irving W(2)(6), Ball J(2)(6).

Author information:
(1)School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK.
(2)NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH/NG7 2RD, UK.
(3)University Executive Board, University of Nottingham, Nottingham NG7 2RD, UK.
(4)School of Medicine, University of Nottingham, Nottingham NG7 2UH/NG7 2TU, UK.
(5)School of Veterinary Medicine and Science, University of Nottingham, 
Loughborough LE12 5RD, UK.
(6)School of Life Sciences, University of Nottingham, Nottingham NG7 2RD/NG7 
2UH, UK.
(7)Faculty of Registrars, University of Nottingham, Nottingham NG7 2RD, UK.

We aimed to explore student and staff perceptions and experiences of a pilot 
SARS-CoV-2 asymptomatic testing service (P-ATS) in a UK university campus 
setting. This was a mixed-method study comprised of an online survey, and 
thematic analysis of qualitative data from interviews and focus groups conducted 
at the mid-point and end of the 12-week P-ATS programme. Ninety-nine students 
(84.8% female, 70% first year; 93.9% P-ATS participants) completed an online 
survey, 41 individuals attended interviews or focus groups, including 31 
students (21 first year; 10 final year) and 10 staff. All types of testing and 
logistics were highly acceptable (virus: swab, saliva; antibody: finger prick) 
and 94.9% would participate again. Reported adherence to weekly virus testing 
was high (92.4% completed ≥6 tests; 70.8% submitted all 10 swabs; 89.2% 
completed ≥1 saliva sample) and 76.9% submitted ≥3 blood samples. Students 
tested to "keep campus safe", "contribute to national efforts to control 
COVID-19", and "protect others". In total, 31.3% had high anxiety as measured by 
the Generalized Anxiety Disorder scale (GAD-7) (27.1% of first year). Students 
with lower levels of anxiety and greater satisfaction with university 
communications around P-ATS were more likely to adhere to virus and antibody 
tests. Increased adherence to testing was associated with higher perceived risk 
of COVID-19 to self and others. Qualitative findings revealed 5 themes and 13 
sub-themes: "emotional responses to COVID-19", "university life during 
COVID-19", "influences on testing participation", "testing physical and 
logistical factors" and "testing effects on mental wellbeing". Asymptomatic 
COVID-19 testing (SARS-CoV-2 virus/antibodies) is highly acceptable to students 
and staff in a university campus setting. Clear communications and strategies to 
reduce anxiety are likely to be important for testing uptake and adherence. 
Strategies are needed to facilitate social connections and mitigate the mental 
health impacts of COVID-19 and self-isolation.

DOI: 10.3390/ijerph18010188
PMCID: PMC7796111
PMID: 33383781 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3911. Przegl Epidemiol. 2021;75(4):484-489. doi: 10.32394/pe.75.44.

Effects of COVID-19 pandemic and lockdown on mental health of Iranian people.

Mowla A(1), Ardekani A(2), Feili A(2), Rahimian Z(2).

Author information:
(1)Substance Abuse and Mental Health Research Center, Shiraz University of 
Medical Sciences, Shiraz, Iran.
(2)Student Research Committee, Shiraz University of Medical Sciences, Shiraz, 
Iran.

INTRODUCTION: The highly contagious novel coronavirus disease 2019 (COVID-19) 
emerged recently as a global pandemic. An efficient way to mitigate the spread 
of the disease is lockdown and quarantine.
OBJECTIVE: This study aimed to evaluate the Iranian population's mental health 
under lockdown during the COVID-19 pandemic.
MATERIAL AND METHODS: The General Health Questionnaire-28 (GHQ-28) was utilized 
to assess the mental health and psychosocial wellbeing of Iranian residents 
through an online survey. The questionnaire was sent on April 3, 2020, and 
remained open to responses until April 10, 2020. This period was the time of 
complete lockdown in Iran. Inclusion criteria included either gender, reading 
Farsi, internet access, and being between the ages of 18 and 65. Respondents 
with scores ≥ 24 were classified as having psychiatric problems.
RESULTS: Of 35,529 completed surveys, 28,790 were eligible for analysis. 73.4% 
of the respondents were female. The majority of the participants were between 
the ages of 26 to 45. Of the participants, 35.5% had scores in the pathological 
range. We found that females, younger residents, singles, and individuals with 
lower education had higher levels of psychopathology.
CONCLUSIONS: Our study suggests that the psychological impacts of the COVID-19 
pandemic and quarantine are wide-ranging, substantial, and can be long-lasting.

© National Institute of Public Health NIH – National Research Institute.

DOI: 10.32394/pe.75.44
PMID: 35543421 [Indexed for MEDLINE]

Conflict of interest statement: All authors declare no conflicts of interest.


3912. Drug Alcohol Depend. 2021 Feb 1;219:108488. doi: 
10.1016/j.drugalcdep.2020.108488. Epub 2020 Dec 28.

Alcohol use and mental health during COVID-19 lockdown: A cross-sectional study 
in a sample of UK adults.

Jacob L(1), Smith L(2), Armstrong NC(3), Yakkundi A(4), Barnett Y(5), Butler 
L(6), McDermott DT(7), Koyanagi A(8), Shin JI(9), Meyer J(10), Firth J(11), 
Remes O(12), López-Sánchez GF(13), Tully MA(14).

Author information:
(1)Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. 
Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, 08830, Spain; Faculty of 
Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le- 
Bretonneux, France.
(2)The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin 
University, Cambridge, CB1 1PT, United Kingdom. Electronic address: 
lee.smith@aru.ac.uk.
(3)HSC R&D Division, Public Health Agency (Northern Ireland), Belfast, Ireland.
(4)Northern Ireland Public Health Research Network, School of Health Sciences, 
Ulster University, Ulster, Ireland.
(5)Anglia Ruskin University, Cambridge, United Kingdom.
(6)Faculty of Science and Engineering, Anglia Ruskin University, Cambridge, 
United Kingdom.
(7)School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, 
United Kingdom.
(8)Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. 
Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, 08830, Spain; ICREA, Pg. 
Lluis Companys 23, Barcelona, Spain.
(9)Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 
50, Seodaemun-gu, Seoul, 03722, Republic of Korea.
(10)Department of Kinesiology, Iowa State University, Iowa, MI, USA.
(11)Division of Psychology and Mental Health, University of Manchester, 
Manchester, M13 9PL, United Kingdom; NICM Health Research Institute, Western 
Sydney University, Westmead, Australia.
(12)Department of Engineering, University of Cambridge, Cambridge, United 
Kingdom.
(13)Vision and Eye Research Institute, School of Medicine, Faculty of Health, 
Education, Medicine and Social Care, Anglia Ruskin University-Cambridge Campus, 
Cambridge, United Kingdom.
(14)Institute of Mental Health Sciences, School of Health Sciences, Ulster 
University, Newtownabbey, United Kingdom.

Comment in
    Tijdschr Psychiatr. 2021;63(5):331-332.

BACKGROUND: The aim was to examine the correlates of increased alcohol 
consumption during the COVID-19 pandemic-related restrictions that were 
implemented in a sample of UK adults.
METHODS: This paper presents analyses of data from a cross-sectional study. 
Adults aged 18 years and over, residing in the UK and self-isolating from others 
outside their own household were eligible to participate. Participants reported 
increase or no increase in their level of alcohol consumption from before to 
during lockdown, as well as symptoms of anxiety, depression and mental 
wellbeing. Socio-demographic characteristics were compared between adults with 
and without reported increased alcohol consumption. The associations between 
reported increased alcohol consumption and mental health outcomes were 
investigated using logistic and linear regression analyses.
RESULTS: 691 adults (61.1 % women; 48.8 % aged 35-64 years) were included in the 
analysis. Of these, 17 % reported increased alcohol consumption after lockdown. 
A higher proportion of 18-34-year olds reported increased alcohol consumption 
compared to older groups. The prevalence of poor overall mental health was 
significantly higher in individuals with increased alcohol consumption (vs. no 
increase) (45.4 % versus 32.7 %; p-value = 0.01). There was a significant 
association between increased alcohol consumption and poor overall mental health 
(OR = 1.64; 95 % CI = 1.01, 2.66), depressive symptoms (unstandardized 
beta = 2.93; 95 % CI = 0.91, 4.95) and mental wellbeing (unstandardized 
beta=-1.38; 95 % CI=-2.38, -0.39).
CONCLUSIONS: More than one in six UK adults increased their alcohol consumption 
during lockdown and a higher proportion of these were younger adults. Increased 
alcohol consumption was independently associated with poor overall mental 
health, increased depressive symptoms and lower mental wellbeing. These findings 
highlight the importance of planning targeted support as we emerge from lockdown 
and plan for potential second and subsequent waves.

Copyright © 2020 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.drugalcdep.2020.108488
PMCID: PMC7768217
PMID: 33383352 [Indexed for MEDLINE]

Conflict of interest statement: No conflict declared.


3913. PLoS One. 2020 Dec 31;15(12):e0244809. doi: 10.1371/journal.pone.0244809. 
eCollection 2020.

Impact of COVID-19 pandemic on mental health: An international study.

Gloster AT(1), Lamnisos D(2), Lubenko J(3), Presti G(4), Squatrito V(4), 
Constantinou M(5), Nicolaou C(6), Papacostas S(7), Aydın G(8), Chong YY(9), 
Chien WT(9), Cheng HY(9), Ruiz FJ(10), Garcia-Martin MB(11), Obando-Posada 
DP(11), Segura-Vargas MA(10), Vasiliou VS(12), McHugh L(13), Höfer S(14), Baban 
A(15), Dias Neto D(16), Nunes da Silva A(17), Monestès JL(18), Alvarez-Galvez 
J(19), Paez-Blarrina M(20), Montesinos F(21), Valdivia-Salas S(22), Ori D(23), 
Kleszcz B(24), Lappalainen R(25), Ivanović I(26), Gosar D(27), Dionne F(28), 
Merwin RM(29), Kassianos AP(30), Karekla M(30).

Author information:
(1)Division of Clinical Psychology & Intervention Science, Department of 
Psychology, University of Basel, Basel, Switzerland.
(2)Department of Health Sciences, European University Cyprus, Nicosia, Cyprus.
(3)Psychological Laboratory, Faculty of Public Health and Social Welfare, Riga 
Stradiņš University, Riga, Latvia.
(4)Kore University Behavioral Lab (KUBeLab), Faculty of Human and Social 
Sciences, Kore University of Enna, Enna, Italy.
(5)Department of Social Sciences, School of Humanities and Social Sciences, 
University of Nicosia, Nicosia, Cyprus.
(6)Department of Nursing, Cyprus University of Technology, Limassol, Cyprus.
(7)Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.
(8)Department of Psychological Counseling and Guidance, Faculty of Education, 
Hasan Kalyoncu University, Gaziantep, Turkey.
(9)The Nethersole School of Nursing, Faculty of Medicine, The Chinese University 
of Hong Kong, Hong Kong.
(10)Department of Psychology, Fundación Universitaria Konrad Lorenz, Bogotà, 
Columbia.
(11)Faculty of Psychology, University of La Sabana, Chía, Columbia.
(12)School of Applied Psychology, University College Cork, Cork, Ireland.
(13)School of Psychology, University College Dublin, Dublin, Ireland.
(14)Medical University Innsbruck, Innsbruck, Austria.
(15)Department of Psychology, Babeş-Bolyai University (UBB), Cluj-Napoca, 
Romania.
(16)Instituto Superior de Psicologia Aplicada (ISPA), Instituto Universitário; 
APPsyCI-Applied Psychology Research Center Capabilities & Inclusion, Lisboa, 
Portugal.
(17)Faculdade de Psicologia, Alameda da Universidade, Universidade de Lisboa, 
Lisboa, Portugal.
(18)LIP/PC2S, Université Grenoble Alpes, Grenoble, France.
(19)Department of Biomedicine, Biotechnology and Public Health, University of 
Cadiz, Cadiz, Spain.
(20)Instituto ACT, Madrid, Spain.
(21)Department of Psychology, European University of Madrid, Madrid, Spain.
(22)Department of Psychology and Sociology, University of Zaragoza, Zaragoza, 
Spain.
(23)Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary.
(24)Private Pratice, Poland.
(25)Department of Psychology, University of Jyväskylä, Jyväskylä, Finland.
(26)Clinic for Psychiatry, Clinical Center of Montenegro, Podgorica, Montenegro.
(27)Ljubljana University Medical Centre, Ljubljana, Slovania.
(28)Département de Psychologie, Université du Québec à Trois-Rivières, 
Trois-Rivières, Canada.
(29)Department of Psychiatry and Behavioral Science, Duke University, Durham, 
North Carolina, United States of America.
(30)Department of Psychology, University of Cyprus, Nicosia, Cyprus.

BACKGROUND: The COVID-19 pandemic triggered vast governmental lockdowns. The 
impact of these lockdowns on mental health is inadequately understood. On the 
one hand such drastic changes in daily routines could be detrimental to mental 
health. On the other hand, it might not be experienced negatively, especially 
because the entire population was affected.
METHODS: The aim of this study was to determine mental health outcomes during 
pandemic induced lockdowns and to examine known predictors of mental health 
outcomes. We therefore surveyed n = 9,565 people from 78 countries and 18 
languages. Outcomes assessed were stress, depression, affect, and wellbeing. 
Predictors included country, sociodemographic factors, lockdown characteristics, 
social factors, and psychological factors.
RESULTS: Results indicated that on average about 10% of the sample was 
languishing from low levels of mental health and about 50% had only moderate 
mental health. Importantly, three consistent predictors of mental health 
emerged: social support, education level, and psychologically flexible (vs. 
rigid) responding. Poorer outcomes were most strongly predicted by a worsening 
of finances and not having access to basic supplies.
CONCLUSIONS: These results suggest that on whole, respondents were moderately 
mentally healthy at the time of a population-wide lockdown. The highest level of 
mental health difficulties were found in approximately 10% of the population. 
Findings suggest that public health initiatives should target people without 
social support and those whose finances worsen as a result of the lockdown. 
Interventions that promote psychological flexibility may mitigate the impact of 
the pandemic.

DOI: 10.1371/journal.pone.0244809
PMCID: PMC7774914
PMID: 33382859 [Indexed for MEDLINE]

Conflict of interest statement: One of the authors is employed by a commercial 
affiliation: Private Pratice, Poland. This affiliation provided support in the 
form of salaries for author BK, but did not have any additional role in the 
study design, data collection and analysis, decision to publish, or preparation 
of the manuscript. This does not alter our adherence to PLOS ONE policies on 
sharing data and materials. No other authors have competing interests to 
declare.


3914. PLoS One. 2020 Dec 31;15(12):e0244421. doi: 10.1371/journal.pone.0244421. 
eCollection 2020.

Rapid mixed-methods assessment of COVID-19 impact on Latinx sexual minority men 
and Latinx transgender women.

MacCarthy S(1), Izenberg M(2), Barreras JL(3)(4), Brooks RA(4), Gonzalez A(4), 
Linnemayr S(5).

Author information:
(1)Behavioral and Policy Sciences, RAND Corporation, Santa Monica, California, 
United States of America.
(2)Pardee RAND Graduate School, RAND Corporation, Santa Monica, California, 
United States of America.
(3)School of Social Work, California State University, Long Beach, California, 
United States of America.
(4)Bienestar Human Services, Inc., Los Angeles, California, United States of 
America.
(5)Economics, Sociology, and Statistics, RAND Corporation, Santa Monica, 
California, United States of America.

We conducted a rapid, mixed-methods assessment to understand how COVID-19 
affected Latinx sexual minority men (LSMM) and transgender women (LTGW). Using a 
computer-assisted telephone interviewing software, one interviewer called 52 
participants (randomly sampled from a larger HIV prevention pilot study aiming 
to increase HIV knowledge and testing frequency; n = 36 LSMM and n = 16 LTGW) 
between 04/27/20-05/18/20. We quantified core domains using the 
Epidemic-Pandemic Impacts Inventory scale and provided important context through 
open-ended qualitative questions assessing: 1) COVID-19 infection history and 
experiences with quarantine; 2) Health and healthcare access; 3) Employment and 
economic impact of COVID-19. Participants reported increases in physical 
conflict or verbal arguments with a partner (13.5%) or other adult(s) (19.2%) 
due to stressors associated with the safer-at-home order. Participants also 
reported increased alcohol consumption (23.1%), problems with sleep (67.3%) and 
mental health (78.4%). Further, disruptions in access to Pre-Exposure 
Prophylaxis or PrEP-a daily pill to prevent HIV-occurred (33.3% of 18 
participants who reported being on PrEP). Many said they received less medical 
attention than usual (34.6%), and LTGW reported delays in critical 
gender-affirming hormones/procedures. Half of the participants lost their jobs 
(50.0%); many undocumented participants relayed additional financial concerns 
because they did not qualify for financial assistance. Though no COVID-19 
infections were noted, COVID-19 dramatically impacted other aspects of health 
and overall wellbeing of LSMM and LTGW. Public health responses should address 
the stressors faced by LSMM and LTGW during the COVID-19 pandemic and the impact 
on wellbeing.

DOI: 10.1371/journal.pone.0244421
PMCID: PMC7774921
PMID: 33382752 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


3915. Dementia (London). 2021 Aug;20(6):2007-2023. doi: 10.1177/1471301220977639. Epub 
2020 Dec 31.

Understanding the impact of the COVID-19 pandemic on well-being and virtual care 
for people living with dementia and care partners living in the community.

Roach P(1), Zwiers A(2), Cox E(2), Fischer K(2), Charlton A(2), Josephson CB(3), 
Patten SB(4), Seitz D(5), Ismail Z(6), Smith EE(7).

Author information:
(1)Department of Family Medicine, University of Calgary; Department of Community 
Health Sciences, University of Calgary, Canada; Hotchkiss Brain Institute, 
University of Calgary, Canada; O'Brien Institute of Public Health, University of 
Calgary, Canada.
(2)Department of Clinical Neurosciences, University of Calgary, Canada.
(3)Department of Community Health Sciences, University of Calgary, Canada; 
Hotchkiss Brain Institute, University of Calgary, Canada; O'Brien Institute of 
Public Health, University of Calgary, Canada; Department of Clinical 
Neurosciences, University of Calgary, Canada; Centre for Health Informatics, 
University of Calgary, Canada.
(4)Department of Community Health Sciences, University of Calgary, Canada; 
Cuthbertson & Fischer Chair in Pediatric Mental Health, University of Calgary, 
Canada.
(5)Department of Community Health Sciences, University of Calgary, Canada; 
Hotchkiss Brain Institute, University of Calgary, Canada; O'Brien Institute of 
Public Health, University of Calgary, Canada; Department of Psychiatry, 
University of Calgary, Canada.
(6)Department of Community Health Sciences, University of Calgary, Canada; 
Hotchkiss Brain Institute, University of Calgary, Canada; O'Brien Institute of 
Public Health, University of Calgary, Canada; Department of Clinical 
Neurosciences, University of Calgary, Canada; Department of Psychiatry, 
University of Calgary, Canada.
(7)Hotchkiss Brain Institute, University of Calgary, Canada; Department of 
Clinical Neurosciences, University of Calgary, Canada.

The COVID-19 pandemic has necessitated public health measures that have impacted 
the provision of care for people living with dementia and their families. 
Additionally, the isolation that results from social distancing may be harming 
well-being for families as formal and informal supports become less accessible. 
For those living with dementia and experiencing agitation, social distancing may 
be even harder to maintain, or social distancing could potentially aggravate 
dementia-related neuropsychiatric symptoms. To understand the lived experience 
of social and physical distancing during the COVID-19 pandemic in Canada, we 
remotely interviewed 21 participants who normally attend a dementia specialty 
clinic in Calgary, Alberta, during a period where essential businesses were 
closed and health care had abruptly transitioned to telemedicine. A reflexive 
thematic analysis was used to analyze the interview and field note data. The 
impacts of the public health measures in response to the pandemic emerged 
through iterative analysis in three main categories of experience: (1) personal, 
(2) health services, and (3) health status (of both persons living with dementia 
and care partner). Isolation and mental health needs emerged as important 
impacts to family experiences. This in-depth understanding of the needs and 
experiences of the pandemic for people living with dementia suggests that 
innovative means are urgently needed to facilitate provision of remote medicine 
and also social interaction and integration.

DOI: 10.1177/1471301220977639
PMCID: PMC7952494
PMID: 33381996 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


3916. Australas Psychiatry. 2021 Apr;29(2):175-179. doi: 10.1177/1039856220975299. 
Epub 2020 Dec 30.

Preferences of people with mental illness for engaging in exercise programs 
under COVID-19 restrictions.

Chapman JJ(1)(2)(3)(4), Hielscher E(1), Patterson S(5), Reavley N(6), Brown 
WJ(4), Wyder M(2), Childs S(7), Russell A(8), Suetani S(2)(9)(10), Scott 
JG(1)(5)(10).

Author information:
(1)QIMR Berghofer Medical Research Institute, Australia.
(2)Metro South Addiction and Mental Health Service, Australia.
(3)Queensland Police-Citizens Youth Welfare Association, Australia.
(4)School of Human Movement and Nutrition Sciences, The University of 
Queensland, Australia.
(5)Metro North Mental Health Service, Australia.
(6)University of Melbourne, Australia.
(7)Queensland Alliance for Mental Health, Australia.
(8)Richmond Fellowship Queensland, Australia.
(9)School of Medicine, Griffith University, Australia.
(10)School of Medicine, The University of Queensland, Australia.

OBJECTIVES: People with mental illness may be vulnerable to decline in mental 
health and reduced physical activity because of the COVID-19 pandemic and 
associated restrictions. The aim of this study was to inform the design of 
physical activity interventions for implementation under these conditions to 
improve/maintain well-being and physical activity in this population.
METHODS: People with mental illness who had participated in a physical activity 
program prior to the pandemic were invited to complete a survey about the impact 
of COVID-19 on mental health and physical activity and their preferences for 
engaging in a physical activity program under pandemic-related restrictions.
RESULTS: More than half the 59 respondents reported worse mental health and 
lower physical activity during the pandemic. The preferred format for a physical 
activity program was one-on-one exercise instruction in-person in a park. 
Program components endorsed as helpful included incentivization, provision of 
exercise equipment and fitness devices, and daily exercise programs. About a 
third of the participants reported limitations in using technology for a 
physical activity program.
CONCLUSIONS: In-person exercise support is preferred by people with mental 
illnesses during pandemic-related restrictions. Enablement strategies such as 
providing equipment and self-monitoring devices should be utilized; assistance 
may be needed to incorporate the use of technology in exercise programs.

DOI: 10.1177/1039856220975299
PMCID: PMC7780068
PMID: 33380159 [Indexed for MEDLINE]

Conflict of interest statement: Disclosure: JJC is employed by PCYC Queensland 
as a program manager for the Healthy Bodies, Healthy Minds program, from which 
the register of potential study participants was accessed. JGS is supported by a 
National Health and Medical Research Council Practitioner Fellowship 
(APP1105807).


3917. Mil Med. 2021 Aug 28;186(9-10):e956-e961. doi: 10.1093/milmed/usaa559.

Longitudinal Examination of COVID-19 Public Health Measures on Mental Health for 
Rural Patients With Serious Mental Illness.

Riblet NB(1)(2), Stevens SP(1)(3), Shiner B(1)(2)(4), Cornelius S(1), Forehand 
J(1), Scott RC(1)(3), Watts BV(3)(5).

Author information:
(1)White River Junction Veterans Affairs Medical Center, White River Junction, 
VT 05009, USA.
(2)Department of Psychiatry and Dartmouth Institute, Geisel School of Medicine 
at Dartmouth College, Hanover, NH 03755, USA.
(3)Department of Psychiatry, Geisel School of Medicine at Dartmouth College, 
Hanover, NH 03755, USA.
(4)Mental Health National Center for PTSD, White River Junction, VT 05009, USA.
(5)Systems Redesign and Improvement, VA Office of Systems Redesign and 
Improvement, White River Junction, VT 05009, USA.

INTRODUCTION: There is emerging evidence to support that the COVID-19 pandemic 
and related public health measures may be associated with negative mental health 
sequelae. Rural populations in particular may fair worse because they share many 
unique characteristics that may put them at higher risk for adverse outcomes 
with the pandemic. Yet, rural populations may also be more resilient due to 
increased sense of community. Little is known about the impact of the pandemic 
on the mental health and well-being of a rural population pre- and 
post-pandemic, especially those with serious mental illness.
MATERIAL AND METHODS: We conducted a longitudinal, mixed-methods study with 
assessments preceding the pandemic (between October 2019 and March 2020) and 
during the stay-at-home orders (between April 23, 2020, and May 4, 2020). 
Changes in hopelessness, suicidal ideation, connectedness, and treatment 
engagement were assessed using a repeated-measures ANOVA or Friedman test.
RESULTS: Among 17 eligible participants, 11 people were interviewed. Overall, 
there were no notable changes in any symptom scale in the first 3-5 months 
before the pandemic or during the stay-at-home orders. The few patients who 
reported worse symptoms were significantly older (mean age: 71.7 years, SD: 
4.0). Most patients denied disruptions to treatment, and some perceived 
telepsychiatry as beneficial.
CONCLUSIONS: Rural patients with serious mental illness may be fairly resilient 
in the face of the COVID-19 pandemic when they have access to treatment and 
supports. Longer-term outcomes are needed in rural patients with serious mental 
illness to better understand the impact of the pandemic on this population.

Published by Oxford University Press on behalf of the Association of Military 
Surgeons of the United States 2020. This work is written by (a) US Government 
employee(s) and is in the public domain in the US.

DOI: 10.1093/milmed/usaa559
PMCID: PMC7798823
PMID: 33377975 [Indexed for MEDLINE]


3918. Nephrol Nurs J. 2020 Nov-Dec;47(6):511-572.

Helping Patients and Health Care Providers Through the COVID-19 Pandemic: 
Empirically Based Tips and Strategies to Manage Mental and Physical Health.

Lee-Baggley D(1)(2)(3)(4), Thakrar S(5)(6).

Author information:
(1)Psychologist, Cancer Care Nova Scotia.
(2)Director, Behaviour Change Research Institute, Nova Scotia Health.
(3)Assistant Professor, Faculty of Medicine, Dalhousie University.
(4)Adjunct Professor, Industrial/Organizational Psychology, Saint Mary's 
University, Halifax, Nova Scotia, Canada.
(5)Psychologist, Nova Scotia Health.
(6)Psychologist and Research Associate, Behaviour Change Research Institute, 
Nova Scotia Health, Halifax, Nova Scotia, Canada.

The COVID-19 pandemic is enacting a heavy mental health toll on people around 
the world. This article provides evidence-based information and techniques to 
promote and foster mental and physical health for our patients and health care 
providers. The article 1) reviews common emotional reactions faced by patients 
during the COVID-19 pandemic, 2) reviews how health care providers can help 
patients make sense of their experiences, and 3) teaches evidence-based skills 
that health care providers can use to support patients during the COVID-19 
pandemic and care for themselves. The article provides tips and strategies that 
can be helpful in interacting with patients and supporting the well-being of 
health care providers. These strategies are based on empirically supported 
knowledge and skills drawn from literature on stress, coping, emotional 
management, chronic disease management, and behavior changes, and provides ways 
to discuss these tips with patients in applicable, understandable ways.

Copyright© by the American Nephrology Nurses Association.

PMID: 33377751 [Indexed for MEDLINE]

Conflict of interest statement: The authors reported no actual or potential 
conflict of interest in relation to this continuing nursing education activity.


3919. BMJ Open. 2020 Dec 29;10(12):e045309. doi: 10.1136/bmjopen-2020-045309.

Cross-sectional analysis to explore the awareness, attitudes and actions of UK 
adults at high risk of severe illness from COVID-19.

Flint SW(1)(2), Brown A(3)(4), Tahrani AA(5)(6)(7), Piotrkowicz A(2)(8), Joseph 
AC(9).

Author information:
(1)School of Psychology, University of Leeds, Leeds, UK s.w.flint@leeds.ac.uk.
(2)Scaled Insights, Leeds, UK.
(3)Centre for Obesity Research, University College London, London, UK.
(4)National Institute of Health Research, University College London, London, UK.
(5)Institute of Metabolism and Systems Research, University of Birmingham, 
Birmingham, UK.
(6)Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS 
Foundation Trust, Birmingham, UK.
(7)Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health 
Partners, Birmingham, UK.
(8)School of Computing, University of Leeds, Leeds, UK.
(9)US Military Academy, West Point, New York, USA.

OBJECTIVES: This study explored the impact of COVID-19 on people identified as 
at high risk of severe illness by UK government, and in particular, the impact 
of lockdown on access to healthcare, medications and use of technological 
platforms.
DESIGN: Online survey methodology.
SETTING: UK.
PARTICIPANTS: 1038 UK adults were recruited who were either identified by UK 
government as at high risk of severe illness from COVID-19 or self-identified as 
at high risk with acute or other chronic health conditions not included in the 
UK government list. Participants were recruited through social media 
advertisements, health charities and patient organisations.
MAIN OUTCOMES MEASURES: The awareness, attitudes and actions survey which 
explores the impact of COVID-19, on including access to healthcare, use of 
technology for health condition management, mental health, depression, 
well-being and lifestyle behaviours.
RESULTS: Nearly half of the sample (44.5%) reported that their mental health had 
worsened during the COVID-19 lockdown. Management of health conditions changed 
including access to medications (28.5%) and delayed surgery (11.9%), with nearly 
half of the sample using telephone care (45.5%). Artificial Intelligence 
identified that participants in the negative cluster had higher neuroticism, 
insecurity and negative sentiment. Participants in this cluster reported more 
negative impacts on lifestyle behaviours, higher depression and lower 
well-being, alongside lower satisfaction with platforms to deliver healthcare.
CONCLUSIONS: This study provides novel evidence of the impact of COVID-19 on 
people identified as at high risk of severe illness. These findings should be 
considered by policy-makers and healthcare professionals to avoid unintended 
consequences of continued restrictions and future pandemic responses.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2020-045309
PMCID: PMC7778740
PMID: 33376185 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: SWF and AP are employed by 
Scaled Insights.


3920. Int J Environ Res Public Health. 2020 Dec 24;18(1):70. doi: 
10.3390/ijerph18010070.

Mental and Physical Factors Influencing Wellbeing among South Korean Emergency 
Workers.

Choi MY(1).

Author information:
(1)Department of Emergency Medical Services, Sun Moon University, 70, Sunmoon-Ro 
221 Beon-Gil, Tangjeong-Myeon, Asan-City 31459, Chungcheongnam-do, Korea.

Emergency workers are frequently exposed to hazardous situations and such life 
patterns can influence their wellbeing. This study examined the relationships 
among South Korean emergency workers' precedents and consequences of positive 
emotion, engagement, relationship, meaning, and achievement (PERMA), a wellbeing 
concept, and offered solutions. A total of 597 emergency workers in Daegu, South 
Korea, participated in a survey. This study measured post-traumatic stress 
disorder syndrome, burnout, depression, PERMA, quality of life, life 
satisfaction, and sleep quality to test the relationships. Results demonstrated 
that post-traumatic stress disorder syndrome and burnout predicted distracting 
sleep behavior and sleep health. Depression was significantly related to PERMA. 
The better the emergency workers' PERMA was, the better their quality of life 
and life satisfaction were. PERMA significantly predicted sleep behavior, a 
portion of sleep quality. Depression had an indirect influence on quality of 
life mediated by PERMA. Post-traumatic stress disorder syndrome, burnout, and 
PERMA were significant predictors of low sleep health and sleep behavior. The 
results indicate that South Korean emergency workers struggle with depression 
and sleep quality. As the data were collected during the coronavirus disease 19 
pandemic, individual efforts and relevant programs to improve South Korean 
emergency workers' PERMA and sleep quality in a crisis are recommended. Possible 
solutions to improve the wellbeing of South Korean emergency workers are 
suggested.

DOI: 10.3390/ijerph18010070
PMCID: PMC7795396
PMID: 33374138 [Indexed for MEDLINE]

Conflict of interest statement: The author declares no conflict of interest.


3921. Psychiatry Res. 2021 Feb;296:113660. doi: 10.1016/j.psychres.2020.113660. Epub 
2020 Dec 26.

An overview of current mental health in the general population of Australia 
during the COVID-19 pandemic: Results from the COLLATE project.

Rossell SL(1), Neill E(2), Phillipou A(3), Tan EJ(4), Toh WL(5), Van Rheenen 
TE(6), Meyer D(5).

Author information:
(1)Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne 
University of Technology, Melbourne, VIC, Australia; Department of Mental 
Health, St Vincent's Hospital, Melbourne, VIC, Australia. Electronic address: 
srossell@swin.edu.au.
(2)Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne 
University of Technology, Melbourne, VIC, Australia; Department of Mental 
Health, St Vincent's Hospital, Melbourne, VIC, Australia; Department of 
Psychiatry, University of Melbourne, Melbourne, VIC, Australia.
(3)Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne 
University of Technology, Melbourne, VIC, Australia; Department of Mental 
Health, St Vincent's Hospital, Melbourne, VIC, Australia; Department of 
Psychiatry, University of Melbourne, Melbourne, VIC, Australia; Department of 
Mental Health, Austin Hospital, Melbourne, VIC, Australia.
(4)Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne 
University of Technology, Melbourne, VIC, Australia; Department of Mental 
Health, St Vincent's Hospital, Melbourne, VIC, Australia.
(5)Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne 
University of Technology, Melbourne, VIC, Australia.
(6)Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne 
University of Technology, Melbourne, VIC, Australia; Melbourne Neuropsychiatry 
Centre, Department of Psychiatry, University of Melbourne & Melbourne Health, 
Melbourne, VIC, Australia.

The novel coronavirus disease (COVID-19) poses mental health challenges 
globally; however, to date, there is limited community level data. This study 
reports on the COLLATE project (COvid-19 and you: mentaL heaLth in AusTralia now 
survEy), an ongoing study aimed at understanding the impact of the COVID-19 
pandemic on Australian mental health and well-being. We addressed prevailing 
primary concerns related to the COVID-19 pandemic, current levels of negative 
emotions and risk factors predicting negative emotions. On April 1st to 4th 
2020, 5158 adults from the general public completed an online survey. 
Participants ranked their top ten current primary concerns about COVID-19, and 
completed standardized measures of negative emotions. The top three primary 
concerns were related to health and well-being of family and loved ones. Levels 
of negative emotion were high. Modelling of predictors of negative emotions 
established several risk factors related to demographic variables, personal 
vulnerabilities, financial stresses, and social distancing perceptions; 
particularly being young, female, or having a mental illness diagnosis. The data 
provides important characterization of the current Australian mental health. It 
appears that specific groups may need special attention to ensure their mental 
health is protected. These results may provide direction for international 
researchers characterizing similar issues.

Copyright © 2021 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.psychres.2020.113660
PMCID: PMC7836867
PMID: 33373808 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared no potential conflicts 
of interest with respect to the research, authorship, and publication of this 
article.


3922. Prog Neuropsychopharmacol Biol Psychiatry. 2021 Jul 13;109:110236. doi: 
10.1016/j.pnpbp.2020.110236. Epub 2020 Dec 26.

Younger people are more vulnerable to stress, anxiety and depression during 
COVID-19 pandemic: A global cross-sectional survey.

Varma P(1), Junge M(1), Meaklim H(1), Jackson ML(2).

Author information:
(1)Turner Institute for Brain and Mental Health, School of Psychological 
Sciences, Monash University, Victoria, Australia.
(2)Turner Institute for Brain and Mental Health, School of Psychological 
Sciences, Monash University, Victoria, Australia. Electronic address: 
melinda.jackson@monash.edu.

The COVID-19 pandemic has had far-ranging consequences for general physical and 
mental health. Country-specific research reveals a general reduction in mental 
and physical well-being, due to measures undertaken to stop the spread of 
COVID-19 disease. However, research is yet to examine the impact of the pandemic 
on global psychological distress and its effects upon vulnerable groups. 
Exploration of the factors that potentially mediate the relationship between 
stress and mental health during this period is needed, to assist in undertaking 
concrete measures to mitigate psychological distress and support vulnerable 
groups. Therefore, this study examined the impact of the COVID-19 pandemic on 
psychological distress globally, and identified factors that may exacerbate 
decline in mental health. N = 1653 participants (mean age 42.90 ± 13.63 years; 
30.3% males) from 63 countries responded to the survey. Depression and anxiety 
were assessed using the Patient Health Questionnaire and State Trait Anxiety 
Inventory, respectively. Other measures included the Perceived Stress Scale, the 
Pittsburgh Sleep Quality Index, 3-item UCLA Loneliness Scale and the Brief 
Resilient Coping Scale. Globally, consistently high levels of stress, anxiety, 
depression and poor sleep were observed regardless of number of COVID-19 cases. 
Over 70% of the respondents had greater than moderate levels of stress, with 59% 
meeting the criteria for clinically significant anxiety and 39% reporting 
moderate depressive symptoms. People with a prior mental health diagnosis 
experienced greater psychological distress. Poor sleep, lower levels of 
resilience, younger age and loneliness significantly mediated the links between 
stress and depression, and stress and anxiety. Age-based differences revealed 
that younger age-groups were more vulnerable to stress, depression and anxiety 
symptoms. Results show that these vulnerable individuals need more support. 
Age-specific interventions for modifiable factors that mediate the psychological 
distress need to urgently deployed to address the global mental health pandemic.

Copyright © 2020 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.pnpbp.2020.110236
PMCID: PMC7834119
PMID: 33373680 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no known 
competing financial interests or personal relationships that could have appeared 
to influence the work reported in this paper.


3923. BMJ Open. 2020 Dec 18;10(12):e042930. doi: 10.1136/bmjopen-2020-042930.

Psychological impact of the COVID-19 pandemic on healthcare workers at acute 
hospital settings in the South-East of Ireland: an observational cohort 
multicentre study.

Ali S(1), Maguire S(2), Marks E(3), Doyle M(4), Sheehy C(5).

Author information:
(1)Department of General Medicine, University Hospital Waterford, Waterford, 
Ireland saiedali@rcsi.ie.
(2)Department of Rheumatology, St James' Hospital, Dublin, Ireland.
(3)Department of Geriatric Medicine, St. Luke's General Hospital, Kilkenny, 
Ireland.
(4)Department of Microbiology, University Hospital Waterford, Waterford, 
Ireland.
(5)Department of Rheumatology, University Hospital Waterford, Waterford, 
Ireland.

OBJECTIVE: Our study aims to understand the psychological impact of the COVID-19 
pandemic among healthcare workers (HCWs) at acute hospital settings in the 
South-East of Ireland, as a crucial step in guiding policies and interventions 
to maintain their psychological well-being.
DESIGN: Observational cohort study.
PARTICIPANTS AND SETTING: 472 HCWs participated from two distinct acute hospital 
settings, A and B, in the South-East of Ireland.
PRIMARY AND SECONDARY OUTCOME MEASURES: Measures of psychological 
distress-depression, anxiety, acute and post-traumatic stress disorder (PTSD)-as 
dictated by the Depression, Anxiety and Stress Scale (DASS-21) and Impact of 
Event Scale-Revised (IES-R). An independent sample t-test and a Mann-Whitney U 
test was used to determine significance of difference in continuous variables 
between groups. Categorical variables were assessed for significance with a χ2 
test for independence.
RESULTS: The DASS-21 provided independent measures of depression (mean 4.57, IQR 
2-7), anxiety (mean 3.87, IQR 1-6) and stress (mean 7.41, IQR 4-10). Positive 
scores were reflected in 201 workers (42.6%) for depression and 213 (45.1%) for 
both anxiety and stress. The IES-R measured subjective distress on three 
subscales: intrusion (mean 1.085, IQR 0.375-1.72), avoidance (mean 1.008, IQR 
0.375-1.5) and hyperarousal (mean 1.084, IQR 0.5-1.667). Overall, 195 cases 
(41.3%) were concerning for PTSD. Site B scored significantly higher across all 
parameters of depression (5.24 vs 4.08, p<0.01), anxiety (4.66 vs 3.3, p<0.01), 
stress (8.91 vs 6.33, p<0.01) and PTSD (0.058 vs 0.043, p<0.01). Worse outcomes 
were also noted in HCWs with underlying medical ailments.
CONCLUSION: Psychological distress is prevalent among HCWs during the COVID-19 
pandemic; screening for adverse mental and emotional outcomes and developing 
timely tailored preventative measures with effective feedback are vital to 
protect their psychological well-being, both in the immediate and long-term.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2020-042930
PMCID: PMC7750872
PMID: 33371046 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3924. Psychiatr Danub. 2020 Autumn-Winter;32(3-4):557-562. doi: 
10.24869/psyd.2020.557.

Self-care of Frontline Health Care Workers: During COVID-19 Pandemic.

Waris Nawaz M(1), Imtiaz S, Kausar E.

Author information:
(1)Institute of Professional Psychology, Bahria University Karachi Campus, 
Karachi, Pakistan, mariawaris@outlook.com.

The world is amidst the COVID-19 pandemic that has used social distancing as a 
tool for containing the virus from spreading exponentially among other 
individuals. Previous literature suggests that human contact and attachment is a 
key for well-being which is why punishments like solitary confinement in 
detention centers like jail has always been debated as being torturous 
(Wolfendal 2020). With this notion, anxiety and stress may become more prevalent 
in individuals who experience self-isolation or are under a forced lockdown. For 
health-care workers like doctors and psychologists, who advocate for physical 
health, mental health and wellbeing; the challenges might increase during the 
pandemic phase as they are expected to go through the crises just like others 
while simultaneously contributing in rendering services related to dealing with 
physical and psychological health issues present in patients and clients with 
their continued practice from either on-site or online platforms. Although all 
health care professional's training inoculates the ill effects of compassion 
fatigue by other's overwhelming situations and discussions but they might still 
be prone to vicarious burnout, trauma and stress. Hence, they may become exposed 
to being at risk of experiencing anxiety more than the general population. This 
review discusses facets of the importance of self-care as mental health first 
aid tool for health care professionals including doctors and psychologists using 
research and supportive techniques to help them process stress and anxiety 
during and after the global pandemic.

DOI: 10.24869/psyd.2020.557
PMID: 33370766 [Indexed for MEDLINE]


3925. Psychiatr Danub. 2020 Autumn-Winter;32(3-4):472-477. doi: 
10.24869/psyd.2020.472.

The Impact of Coronavirus (SARS-CoV2) Epidemic on Individuals Mental Health: The 
Protective Measures of Pakistan in Managing and Sustaining Transmissible 
Disease.

Abbas J(1).

Author information:
(1)Antai College of Economics and Management (ACM), School of Media and 
Communication (SMC), Shanghai Jiao Tong University (SJTU), No. 800 Dongchuan 
Road, Minhang District, Postcode 200240, Shanghai, China, abbas512@sjtu.edu.cn.

BACKGROUND: This study performed a focalized examination of the global impact of 
the coronavirus epidemic. This current review is one of the few kinds of 
research, which has sought to check the effect of the coronavirus on mental 
health issues and the need for psychological well-being in the standard 
population and patients in response to the global wake of the epidemic and its 
effects in Pakistan.
SUBJECTS AND METHODS: This study has utilized the data on coronavirus patients 
from the Ministry of Health, National Institute of Health Pakistan. The age of 
the confirmed coronavirus patients ranged from 12 to over 80 years, including 
international and local transmitters.
RESULTS: Recorded data delivered by the National Institute of Health, Pakistan 
has quantified that the outbreak of coronavirus (SARS-CoV-2) entered Pakistan 
through international travelers. They carried the virus after they visited 
different countries, such as Saudi Arabia, Iran, Iraq, the USA, China, and 
European countries. By April 30, 2020, there were 16,473 confirmed cases of 
coronavirus. Total deaths are 361, with a mortality rate of 2.20%, and 
ultimately recovered cases reported 4,105 with a percentage of 24.90%. As of 
October 24, 2020, there were 327,063 confirmed cases of the COVID-19 in 
Pakistan, which posed vast social, economic, health, and environmental problems 
in the society. The epidemic has affected individuals across the country and 
confirmed patients in the country increased rapidly.
CONCLUSION: The government officials had initially estimated over 50,000 corona 
patents by April 30, which would be a great challenge; however, the situation 
remained under control because of suppression and smart-lockdown strategies by 
the Government. This study's findings reported that superior health facilities 
are required to treat the patients. This research review incorporated data 
generated by NIH, and respondents are from all the regions of Pakistan, 
subsequently restricting its generalizability to experimental results.

DOI: 10.24869/psyd.2020.472
PMID: 33370755 [Indexed for MEDLINE]


3926. Clin Psychol Psychother. 2021 Jul;28(4):891-906. doi: 10.1002/cpp.2543. Epub 
2021 Jan 6.

Predicting outcomes and sudden gains from initial in-session interactions during 
remote cognitive-behavioural therapy for severe health anxiety.

Malins S(1)(2), Moghaddam N(3), Morriss R(1), Schröder T(1), Brown P(1), Boycott 
N(1).

Author information:
(1)University of Nottingham, Division of Psychiatry and Applied Psychology, 
Institute of Mental Health, Nottingham, UK.
(2)Nottinghamshire Healthcare NHS Foundation Trust, Specialist Service, 
Nottingham, UK.
(3)University of Lincoln, School of Psychology, Lincoln, UK.

There has been a dramatic increase in remote psychotherapy since the onset of 
the COVID-19 crisis. There is also expected to be an increase in mental health 
problems in the wake of the COVID-19 pandemic. An increase in severe health 
anxiety (SHA) is particularly anticipated, for which cognitive-behavioural 
therapy (CBT) is a frontline treatment. However, it is unclear what interaction 
types are associated with outcome-improvement in remote-CBT (rCBT) for SHA. This 
study aimed to identify interaction types that predict outcomes and sudden gains 
in rCBT for SHA using initial therapy session content. Forty-eight participants 
in rCBT for SHA had interactions at their first sessions categorized and rated 
in terms of patient activation: an individual's confidence and ability to manage 
their health. Multilevel modelling assessed whether early interaction types 
predicted session-by-session wellbeing. For participants experiencing sudden 
gains (n = 12) interactions at the session directly prior to the gain were 
similarly categorized and rated. The scores were then compared with ratings for 
the preceding session. A smaller proportion of early sessions was taken up with 
problem descriptions among those with greater outcome improvements. There was 
also a significant reduction in the proportion of the session spent describing 
problems in the session directly prior to a sudden gain, as compared with the 
previous session. Conversely, clients with better outcomes made more positive 
evaluations of themselves and therapy, noticed more positive changes and made 
more contributions to structuring interactions at initial sessions. Specific 
early interaction types predict session-by-session outcomes and precede sudden 
gains in rCBT for SHA.

© 2020 John Wiley & Sons, Ltd.

DOI: 10.1002/cpp.2543
PMID: 33368731 [Indexed for MEDLINE]


3927. J Child Psychol Psychiatry. 2021 Jan;62(1):1-4. doi: 10.1111/jcpp.13364.

"School of hard knocks" - what can mental health researchers learn from the 
COVID-19 crisis?

Sonuga-Barke EJS(1).

Author information:
(1)School of Psychiatry, Institute of Psychaitry, Psychology & Neuroscience, 
London, UK.

Since the COVID-19 pandemic took hold in the first quarter of 2020, children and 
their families across the world have experienced extraordinary changes to the 
way they live their lives - creating enormous practical and psychological 
challenges for them at many levels. While some of these effects are directly 
linked to COVID-related morbidity and mortality, many are indirect - due rather 
to governmental public health responses designed to slow the spread of infection 
and minimise the numbers of deaths. These have often involved aggressive 
programmes of social distancing and quarantine, including extended periods of 
national social and economic lockdown, unprecedented in the modern age. Debates 
about the appropriateness of these measures have often referenced their 
potentially negative impact on people's mental health and well-being - impacts 
which both opponents and advocates appear to accept as being inevitable.

© 2020 Association for Child and Adolescent Mental Health.

DOI: 10.1111/jcpp.13364
PMID: 33368223 [Indexed for MEDLINE]


3928. RETRACTED ARTICLE

Front Public Health. 2020 Dec 10;8:604440. doi: 10.3389/fpubh.2020.604440. 
eCollection 2020.

"Recovering With Nature": A Review of Ecotherapy and Implications for the 
COVID-19 Pandemic.

Chaudhury P(1), Banerjee D(2).

Author information:
(1)Department of Clinical Psychology, Institute of Psychiatry (IOP), Kolkata, 
India.
(2)Department of Psychiatry, National Institute of Mental Health and 
Neurosciences (NIMHANS), Bengaluru, India.

Retraction in
    Front Public Health. 2023 Jan 04;10:1124835.

Connection with nature has been considered beneficial for psychological 
well-being since times of evolution. Differences in Indian and Western thoughts 
have viewed natural elements in different lights, varying between eco-centrism 
to anthropocentrism. The intrusion of technology and digitalized lives as a 
result of globalization has decreased connectedness with nature. Ecotherapy is a 
novel form of psychotherapeutic technique based on explicit environmental or 
ecological interventions. Social and therapeutic horticulture, animal-assisted 
interventions, care farming, green exercise, environmental conservation and 
wilderness therapy are some of the ecosystem-based approaches used in mental 
health. Based on the principles of positive and client-centered psychology, 
ecotherapy-related techniques have been shown to be effective in medical 
disorders like hypertension, obesity, post-surgical recovery and psychosocial 
conditions like depression, stress reduction, post-traumatic stress disorder 
(PTSD), attention deficit hyperkinetic disorder (ADHD) and adjustment disorders. 
The principles of ecotherapy have been integrated into other psychotherapeutic 
techniques for better efficacy. This review attempts provides an overview of 
techniques, applications and challenges related to ecotherapy in psychology. The 
implications of its use during the ongoing Coronavirus 2019 (COVID-19) crisis, 
social isolation and consequent psychosocial aftermath are also discussed.

Copyright © 2020 Chaudhury and Banerjee.

DOI: 10.3389/fpubh.2020.604440
PMCID: PMC7758313
PMID: 33363096 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


3929. Assist Inferm Ric. 2020 Oct-Dec;39(4):201-204. doi: 10.1702/3508.34953.

[We were told "everything will be all right", but we were afraid].

[Article in Italian]

Cura Della Redazione A.

. We were told "everything will be all right", but we were afraid.
INTRODUCTION: During the pandemic, the elderly were an at-risk group.
OBJECTIVE: To explore how older people >65 years lived through the pandemic.
METHODS: Questionnaire available online for all members of the Italian 
Pensioners' Union of the CGL Lombardy, which explored the state of health, 
activities carried out, contacts with the doctor, psychological conditions.
RESULTS: 1480 people responded, in good health and with a good level of 
schooling. Half did not change their habits during the pandemic. For 2/3 the 
psychological well-being did not change, with a substantially positive vision of 
the future, even if 64% reported having had stress symptoms. The aspect that was 
missing the most, as expected, was not being able to see their families. A very 
common feeling (60% of respondents) was a sense of isolation and abandonment.
CONCLUSIONS: As shown in other papers, older people do not seem particularly at 
risk of psychological problems during the pandemic.

DOI: 10.1702/3508.34953
PMID: 33362190 [Indexed for MEDLINE]


3930. BMJ Open. 2020 Dec 23;10(12):e044726. doi: 10.1136/bmjopen-2020-044726.

Changes in demand for emergency ambulances during a nationwide lockdown that 
resulted in elimination of COVID-19: an observational study from New Zealand.

Dicker B(1)(2), Swain A(3)(4), Todd VF(3)(2), Tunnage B(3)(2), McConachy E(3), 
Drake H(3), Brett M(2), Spearing D(2), Howie GJ(3)(2).

Author information:
(1)Paramedicine Department, Auckland University of Technology, Auckland, New 
Zealand bridget.dicker@stjohn.org.nz.
(2)Clinical Audit and Research, St John New Zealand, Auckland, New Zealand.
(3)Paramedicine Department, Auckland University of Technology, Auckland, New 
Zealand.
(4)Wellington Free Ambulance, Wellington, New Zealand.

OBJECTIVE: To examine the impact of a 5-week national lockdown on ambulance 
service demand during the COVID-19 pandemic in New Zealand.
DESIGN: A descriptive cross-sectional, observational study.
SETTING: High-quality data from ambulance electronic clinical records, New 
Zealand.
PARTICIPANTS: Ambulance records were obtained from 588 690 attendances during 
pre-lockdown (prior to 17 February 2020) and from 36 238 records during the 
lockdown period (23 March to 26 April 2020).
MAIN OUTCOME MEASURES: Ambulance service utilisation during lockdown was 
compared with pre-lockdown: (a) descriptive analyses of ambulance events and 
proportions of event types for each period, (b) absolute rates of ambulance 
attendance (event types/week) for each period.
RESULTS: During lockdown, ambulance patients were more likely to be attended at 
home and less likely to be aged between 16 and 25 years. There was a significant 
increase in the proportion of lower acuity patients (Status 3 and Status 4) 
attended (p<0.001) and a corresponding increase in patients not transported from 
scene (p<0.001). Road traffic crashes (p<0.001) and alcohol-related incidents 
(p<0.001) significantly decreased. There was a decrease in the absolute number 
of weekly ambulance attendances (ratio (95% CI), 0.89 (0.87 to 0.91), p<0.001), 
attendances to respiratory conditions (0.74 (0.61 to 0.86), p=0.01), and trauma 
(0.81 (0.77 to 0.85), p<0.001). However, there was a significant increase in 
ambulance attendances for mental health conditions (1.37 (1.22 to 1.51), 
p=0.005).
CONCLUSIONS: Despite the relative absence of COVID-19 in the community during 
the 5-week nationwide lockdown, there were significant differences in ambulance 
utilisation during this period. The lockdown was associated with an increase in 
ambulance attendances for mental health conditions and is of concern. In 
considering future lockdowns, the potential implications on a population's 
mental well-being will need to be seriously considered against the benefits of 
elimination of virus transmission.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2020-044726
PMCID: PMC7759754
PMID: 33361171 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


3931. Psychiatry Res. 2021 Feb;296:113654. doi: 10.1016/j.psychres.2020.113654. Epub 
2020 Dec 17.

Suicidal and self-harm ideation among Chinese hospital staff during the COVID-19 
pandemic: Prevalence and correlates.

Xu X(1), Wang W(2), Chen J(1), Ai M(1), Shi L(2), Wang L(1), Hong S(1), Zhang 
Q(1), Hu H(1), Li X(1), Cao J(1), Lv Z(2), Du L(1), Li J(1), Yang H(2), He X(2), 
Chen X(2), Chen R(2), Luo Q(1), Zhou X(1), Tan J(3), Tu J(4), Jiang G(3), Han 
Z(3), Kuang L(5).

Author information:
(1)Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical 
University, Chongqing 400016, China.
(2)Mental Health Center, University-Town Hospital of Chongqing Medical 
University, Chongqing 401331, China.
(3)Chongqing Changshou Mental Health Center, Chongqing 401220, China.
(4)Chongqing Iron and Steel General Hospital, Chongqing 400037, China.
(5)Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical 
University, Chongqing 400016, China; Mental Health Center, University-Town 
Hospital of Chongqing Medical University, Chongqing 401331, China.

The COVID-19 pandemic put global medical systems under massive pressure for its 
uncertainty, severity, and persistence. For detecting the prevalence of suicidal 
and self-harm ideation (SSI) and its related risk factors among hospital staff 
during the COVID-19 pandemic, this cross-sectional study collected the 
sociodemographic data, epidemic-related information, the psychological status 
and need, and perceived stress and support from 11507 staff in 46 hospitals by 
an online survey from February 14 to March 2, 2020. The prevalence of SSI was 
6.47%. Hospital staff with SSI had high family members or relatives infected 
number and the self-rated probability of infection. Additionally, they had more 
perceived stress, psychological need, and psychological impact. On the contrary, 
hospital staff without SSI reported high self-rated health, willingness to work 
in a COVID-19 ward, confidence in defeating COVID-19, and perceived support. 
Furthermore, they reported better marital or family relationship, longer sleep 
hours, and shorter work hours. The infection of family members or relatives, 
poor marital status, poor self-rated health, the current need for psychological 
intervention, perceived high stress, perceived low support, depression, and 
anxiety were independent factors to SSI. A systematic psychological intervention 
strategy during a public health crisis was needed for the hospital staff's 
mental well-being.

Copyright © 2020. Published by Elsevier B.V.

DOI: 10.1016/j.psychres.2020.113654
PMCID: PMC7836678
PMID: 33360965 [Indexed for MEDLINE]

Conflict of interest statement: None


3932. Asian J Psychiatr. 2021 Jan;55:102517. doi: 10.1016/j.ajp.2020.102517. Epub 2020 
Dec 25.

Mental wellbeing of frontline healthcare workers during COVID-19 pandemic in 
Qatar.

Wadoo O(1), Latoo J(2), Iqbal Y(2), Chandrappa NSK(2), Chandra P(3), Masoodi 
NA(4), Al-Maslamani MARS(5), Alabdulla M(6).

Author information:
(1)Mental Health Services, Hamad Medical Corporation, Doha, Qatar. Electronic 
address: owadoo@hamad.qa.
(2)Mental Health Services, Hamad Medical Corporation, Doha, Qatar.
(3)Medical Research Center, Hamad Medical Corporation, Doha, Qatar.
(4)Ambulatory General Internal Medicine, Hamad Medical Corporation, Doha, Qatar.
(5)Communicable Disease Center Hamad Medical Corporation, Doha, Qatar.
(6)Mental Health Services, Hamad Medical Corporation, Doha, Qatar; Qatar 
University, College of Medicine, Doha, Qatar.

DOI: 10.1016/j.ajp.2020.102517
PMCID: PMC7834208
PMID: 33360712 [Indexed for MEDLINE]


3933. J Psychiatr Res. 2021 Feb;134:32-38. doi: 10.1016/j.jpsychires.2020.12.037. Epub 
2020 Dec 15.

Preliminary investigation of the association between COVID-19 and suicidal 
thoughts and behaviors in the U.S.

Ammerman BA(1), Burke TA(2), Jacobucci R(3), McClure K(3).

Author information:
(1)University of Notre Dame, Department of Psychology, Notre Dame, IN, USA. 
Electronic address: bammerm1@nd.edu.
(2)Alpert Medical School of Brown University, Department of Psychiatry and Human 
Behavior, Providence, RI, USA.
(3)University of Notre Dame, Department of Psychology, Notre Dame, IN, USA.

Evidence suggests that the negative consequences of COVID-19 may extend far 
beyond its considerable death toll, having a significant impact on psychological 
well-being. Despite work highlighting the link between previous epidemics and 
elevated suicide rates, there is limited research on the relationship between 
the COVID-19 pandemic and suicidal thoughts and behaviors. Utilizing an online 
survey, the current study aimed to better understand the presence, and extent, 
of the association between COVID-19-related experiences and past-month suicidal 
thoughts and behaviors among adults in the United States recruited via Amazon 
Mechanical Turk (n = 907). Results support an association between several 
COVID-19-related experiences (i.e., general distress, fear of physical harm, 
effects of social distancing policies) and past-month suicidal ideation and 
suicide attempts. Further, a significant proportion of those with recent 
suicidal ideation explicitly link their suicidal thoughts to COVID-19. 
Exploratory analyses highlight a potential additional link between COVID-19 and 
suicidal behavior, suggesting that a portion of individuals may be intentionally 
exposing themselves to the virus with intent to kill themselves. These findings 
underscore the need for suicide risk screening and access to mental health 
services during the current pandemic. Particular attention should be paid to 
employing public health campaigns to disseminate information on such services to 
reduce the enormity of distress and emotional impairment associated with 
COVID-19 in the United States.

Copyright © 2020 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.jpsychires.2020.12.037
PMID: 33360222 [Indexed for MEDLINE]


3934. Women Birth. 2021 Sep;34(5):465-472. doi: 10.1016/j.wombi.2020.12.001. Epub 2020 
Dec 9.

Experiences and attitudes of midwives during the birth of a pregnant woman with 
COVID-19 infection: A qualitative study.

González-Timoneda A(1), Hernández Hernández V(2), Pardo Moya S(3), Alfaro 
Blazquez R(4).

Author information:
(1)Midwife. Department of Obstetrics and Gynaecology, University and Polytechnic 
Hospital "La Fe", Valencia, Spain; School of Nursing and Podiatry, University of 
Valencia, Spain.
(2)Midwife. Department of Obstetrics and Gynaecology, Gregorio Marañón 
University Hospital, Madrid, Spain.
(3)Midwife. Department of Obstetrics and Gynaecology, University and Polytechnic 
Hospital "La Fe", Valencia, Spain.
(4)Midwife. Department of Obstetrics and Gynaecology, University and Polytechnic 
Hospital "La Fe", Valencia, Spain; School of Nursing and Podiatry, University of 
Valencia, Spain. Electronic address: ruben.ab87@hotmail.com.

BACKGROUND: The COVID-19 pandemic has become one of the most important threats 
to global health. Midwives are at the core of the response to the pandemic. 
Women still need midwifery support and care. The work of midwives is 
acknowledged as emotionally demanding, and their welfare may be compromised by a 
range of workplace and personal stress factors.
AIM: To investigate the experiences and attitudes of midwives who have provided 
pregnancy and childbirth care to women with a confirmed or suspected COVID-19 
infection.
METHODS: A qualitative phenomenological study was carried out in two Spanish 
tertiary hospitals. Fourteen midwives were recruited by purposive sampling 
technique. Data were collected through individual in-depth interviews and 
analysed using Giorgi's descriptive method.
FINDINGS: Three themes emerged: "challenges and differences when working in a 
pandemic", "emotional and mental health and wellbeing" and "women's emotional 
impact perceived by midwives". Midwives pointed to several factors tied to a 
safe, supportive and empowering work place: support from staff and managers, 
access to adequate personal protective equipment, and reliable guidelines. They 
also dealt with professional and personal challenges during the pandemic, 
showing feelings of fear, anxiety, uncertainty, discomfort, lack of support, and 
knowledge. Finally, midwives expressed their concerns about the feelings of 
pregnant women with COVID-19, such as fear, anxiety, and loneliness.
CONCLUSION: The results of this study show some of the challenges for midwives 
during the course of the COVID-19 pandemic, emphasizing the value of a good 
communication, emotional support, and stress management, to provide 
woman-centred care.

Copyright © 2020 Australian College of Midwives. Published by Elsevier Ltd. All 
rights reserved.

DOI: 10.1016/j.wombi.2020.12.001
PMCID: PMC7724562
PMID: 33358355 [Indexed for MEDLINE]


3935. Jt Comm J Qual Patient Saf. 2021 Mar;47(3):185-189. doi: 
10.1016/j.jcjq.2020.11.009. Epub 2020 Nov 18.

Staff Emotional Support at Montefiore Medical Center During the COVID-19 
Pandemic.

Bernstein CA, Bhattacharyya S, Adler S, Alpert JE.

Comment in
    Jt Comm J Qual Patient Saf. 2021 Mar;47(3):141-142.

CONTEXT: During the COVID-19 pandemic, frontline workers have experienced high 
levels of stress and anxiety. Montefiore Medical Center recognized the urgent 
need for mental health support to mitigate and treat psychological distress 
among staff. Various mental health support services were implemented. This 
report provides an overview of the interventions implemented at Montefiore and 
provides preliminary insights on the utilization and value of these ongoing 
services.
OUTCOMES: The interventions instituted at Montefiore included psychoeducational 
resources, a phone support line, Staff Support Centers (SSCs), a clinical 
treatment program, team support sessions, peer support outreach, mental health 
and wellness programs, and clergy support. The most heavily used service during 
the pandemic were the SSCs, and the least used service was the clergy support.
INSIGHTS: With institutional encouragement and the collective efforts of more 
than 150 mental health professionals and other staff, it was possible to set up 
durable mental health supports with multiple points of access. Although many 
services were available to both clinical and nonclinical staff, outreach was 
primarily to clinical staff. Additional efforts in the future are needed to more 
fully reach nonclinical frontline workers.
NEXT STEPS: The organization's next steps include evaluation of emotional health 
and distress among clinical and nonclinical staff using validated self-report 
measures administered over multiple time intervals. Lessons learned about staff 
support during COVID-19 will also be integrated into future efforts to support 
staff well-being more broadly.

Copyright © 2020 The Joint Commission. Published by Elsevier Inc. All rights 
reserved.

DOI: 10.1016/j.jcjq.2020.11.009
PMCID: PMC7673209
PMID: 33353851 [Indexed for MEDLINE]


3936. Ann Med. 2021 Dec;53(1):237-246. doi: 10.1080/07853890.2020.1862905.

COVID-19: anxiety among hospital staff and associated factors.

Mattila E(1), Peltokoski J(2), Neva MH(3), Kaunonen M(1)(4), Helminen M(5)(6), 
Parkkila AK(1).

Author information:
(1)Administration Centre, Tampere University Hospital, Tampere, Finland.
(2)Central Finland Health Care District, Jyväskylä, Finland.
(3)Department of Orthopaedic and Trauma Surgery, Tampere University Hospital, 
Tampere, Finland.
(4)Faculty of Social Sciences, Tampere University, Tampere, Finland.
(5)Tays Research Services, Tampere University Hospital, Tampere, Finland.
(6)Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, 
Finland.

BACKGROUND: During the COVID-19 pandemic, hospital staff have experienced a 
variety of mental health challenges. European research on anxiety and stress 
among hospital workers during the pandemic is limited. This study aimed to 
describe the anxiety levels of Finnish hospital workers during the COVID-19 
pandemic.
METHODS: The multidimensional, cross-sectional survey was distributed to all 
hospital staff working at two Finnish specialized medical care centres in the 
spring of 2020 (n = 1,995). The Generalized Anxiety Disorder 7-item (GAD-7) 
scale was used to measure the workers' anxiety.
RESULTS: The total mean GAD-7 score was 4.88, indicating normal anxiety levels. 
However, 30% (n =  1,079) of the respondents had mild, 10% (n = 194) moderate 
and 5% (n = 88) severe anxiety. Key risk factors were young age, working in a 
university hospital, problems in cooperation between co-workers, difficulty 
concentrating at work, a health-threatening physical and psychological workload, 
and a fear of being infected at work.
CONCLUSION: Hospital staff experienced a variety of work-related stress and 
anxiety issues that should be visible to hospital administrators and 
policymakers alike. The anxiety is independent of whether the worker is directly 
involved in caring for or in any way coming into contact with COVID-19 patients. 
Key message Fifty-five percent of hospital staff have normal anxiety levels. The 
remaining workers may need targeted support interventions, and a smaller 
proportion (15%) are in danger of developing longer-term problems affecting 
their well-being. The anxiety experienced by hospital workers during the 
COVID-19 pandemic is more severe than that of the population on average. If the 
pandemic continues, the well-being of hospital staff may be widely threatened. 
Despite the different geographical locations and COVID-19 situations, hospital 
workers in Finland and China had similar anxiety levels. The anxiety is 
independent of whether staff are working in the front line of managing the 
COVID-19 pandemic or of the number of covid-19 patients admitted to the 
hospital. The hospital workers felt anxiety because they were facing a new 
situation which causes changes in their work and daily routine. Health care 
employers should engage in long-term follow-up as regards the personnel's 
recovery from the burden caused by the pandemic and from work in general. It is 
necessary to make easily attainable, flexibly delivered and cost-effective 
treatment interventions for anxiety available to hospital staff.

DOI: 10.1080/07853890.2020.1862905
PMCID: PMC7877952
PMID: 33350869 [Indexed for MEDLINE]

Conflict of interest statement: The authors report no conflict of interest.


3937. J Occup Environ Med. 2021 Apr 1;63(4):296-301. doi: 
10.1097/JOM.0000000000002113.

The Factors That Influenced Medical Students' Decision to Work Within the NHS 
During the COVID-19 Pandemic-A National, Cross-sectional Study.

Georgiou I(1), Hounat A, Park JJ, Gillespie C, Bandyopadhyay S, Saunders KEA.

Author information:
(1)University of Aberdeen, Aberdeen (Mr Georgiou); School of Medicine, 
University of Dundee, Dundee (Mr Hounat); Edinburgh Medical School, University 
of Edinburgh, Edinburgh (Mr Park), Scotland; School of Medicine, University of 
Liverpool, Liverpool (Mr Gillespie); Nuffield Department of Surgical Sciences 
(Dr Bandyopadhyay); Department of Psychiatry, Warneford Hospital (Dr Saunders), 
University of Oxford, Oxford, UK.

PURPOSE: Medical students across the United Kingdom helped the National Health 
Service (NHS) with the increased workload caused by the COVID-19 pandemic. This 
study was conducted to better understand the implications of COVID-19 on the 
intricate relationship between the psychological wellbeing of students and 
working within the NHS.
METHOD: This was a cross-sectional, national UK study analyzing the 
self-reported pandemic anxiety scale (PAS) of participants during the pandemic, 
using an online questionnaire.
RESULTS: 25.2% of participants worked within the NHS. Working significantly 
reduced anxiety levels of participants. Concerns around the training and 
information provided on personal protective equipment (PPE) (odds ratio [OR] 
2.57, 95% confidence interval [CI] OR: 1.93, 3.43) (P < 0.001) and Ethnicity (OR 
2.15, 95% CI OR: 1.54, 2.99) (P < 0.001) were the most significant covariates 
affecting the likelihood of working.
CONCLUSION: Working during the pandemic was influenced by age, ethnicity, and 
information surrounding PPE. On average those who worked experienced less 
anxiety and were more cheerful and energetic.

Copyright © 2021 American College of Occupational and Environmental Medicine.

DOI: 10.1097/JOM.0000000000002113
PMID: 33350663 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest: This research has received 
no specific grant from any funding agency in the public, commercial, or 
not-for-profit sectors.


3938. Phytother Res. 2021 Mar;35(3):1237-1247. doi: 10.1002/ptr.6888. Epub 2020 Dec 
22.

Traditional herbal medicines to overcome stress, anxiety and improve mental 
health in outbreaks of human coronaviruses.

Shahrajabian MH(1)(2), Sun W(1), Soleymani A(2), Cheng Q(1)(3)(4).

Author information:
(1)Biotechnology Research Institute, Chinese Academy of Agricultural Sciences, 
Beijing, China.
(2)Department of Agronomy and Plant Breeding, Khorasgan Branch, Islamic Azad 
University, Isfahan, Iran.
(3)College of Life Sciences, Hebei Agricultural University, Baoding, China.
(4)Global Alliance of HeBAU-CLS&HeQiS for BioAl-Manufacturing, Baoding, China.

Mental health condition is including depression and anxiety, and they may impact 
wellbeing, personal relationships and productivity of both genders. Herbal 
medicines have been used to treatment of anxiety and depression symptoms for 
centuries. SARS, MERS and COVID-19 are related to coronavirus types. SARS (sever 
acute respiratory syndrome, China, 2002), MERS (Middle East respiratory 
syndrome, Saudi Arabia, 2012), and SARS-CoV-2 (2019-2020) are the main 
coronavirus outbreaks. Both anxiety and depression are more serious to be 
considered and improved for all general public during fight with these diseases. 
In this mini-review article, we have mentioned the key role some of the most 
important plants and herbs for treatment of stress and anxiety and improve 
mental health against SARS and SARS-CoV-2 on the basis of traditional Asian 
medicine, especially traditional Chinese and Persian medicine.

© 2020 John Wiley & Sons Ltd.

DOI: 10.1002/ptr.6888
PMID: 33350538 [Indexed for MEDLINE]


3939. Cereb Cortex. 2021 Mar 31;31(5):2574-2585. doi: 10.1093/cercor/bhaa375.

Face Tuning in Depression.

Kubon J(1), Sokolov AN(1), Popp R(1), Fallgatter AJ(1)(2)(3), Pavlova MA(1).

Author information:
(1)Department of Psychiatry and Psychotherapy, Medical School and University 
Hospital, Eberhard Karls University of Tübingen, 72076 Tübingen, Germany.
(2)LEAD Graduate School & Research Network, Eberhard Karls University of 
Tübingen, 72076 Tübingen, Germany.
(3)German Center for Neurodegenerative Disorders (DZNE), Medical School and 
University Hospital, Eberhard Karls University of Tübingen, 72076 Tübingen, 
Germany.

The latest COVID-19 pandemic reveals that unexpected changes elevate depression 
bringing people apart, but also calling for social sharing. Yet the impact of 
depression on social cognition and functioning is not well understood. 
Assessment of social cognition is crucial not only for a better understanding of 
major depressive disorder (MDD), but also for screening, intervention, and 
remediation. Here by applying a novel experimental tool, a Face-n-Food task 
comprising a set of images bordering on the Giuseppe Arcimboldo style, we 
assessed the face tuning in patients with MDD and person-by-person matched 
controls. The key benefit of these images is that single components do not 
trigger face processing. Contrary to common beliefs, the outcome indicates that 
individuals with depression express intact face responsiveness. Yet, while in 
depression face sensitivity is tied with perceptual organization, in typical 
development, it is knotted with social cognition capabilities. Face tuning in 
depression, therefore, may rely upon altered behavioral strategies and 
underwriting brain mechanisms. To exclude a possible camouflaging effect of 
female social skills, we examined gender impact. Neither in depression nor in 
typical individuals had females excelled in face tuning. The outcome sheds light 
on the origins of the face sensitivity and alterations in social functioning in 
depression and mental well-being at large. Aberrant social functioning in 
depression is likely to be the result of deeply-rooted maladaptive strategies 
rather than of poor sensitivity to social signals. This has implications for 
mental well-being under the current pandemic conditions.

© The Author(s) 2020. Published by Oxford University Press. All rights reserved. 
For permissions, please e-mail: journals.permission@oup.com.

DOI: 10.1093/cercor/bhaa375
PMCID: PMC7799219
PMID: 33350440 [Indexed for MEDLINE]


3940. Anxiety Stress Coping. 2021 Mar;34(2):145-156. doi: 
10.1080/10615806.2020.1861253. Epub 2020 Dec 22.

Mental health and its psychosocial predictors during national quarantine in 
Italy against the coronavirus disease 2019 (COVID-19).

Prati G(1).

Author information:
(1)Department of Psychology, University of Bologna (Italy), Cesena (FC), Italy.

Background and Objectives: This research aimed at investigating the 
psychological impact of national quarantine in Italy, and the psychosocial 
factors that are may influence this impact.Methods: A convenience sample of 1569 
people living in Italy responded to an online survey using virtual snowball 
sampling. The questionnaire included measures of mental health symptoms, 
well-being, worry about the epidemic of COVID-19, likelihood of infection, 
coping efficacy, trust in the institutional response to the epidemic of 
COVID-19, financial loss, perceived house size, and media exposure to COVID-19 
outbreak.Results: Gender (women), lower age, occupational status (employed), 
lower media exposure, higher worry, lower coping efficacy, lower trust in 
institutions, and negative attitudes toward quarantine measures predicted mental 
health symptoms. In addition, results showed that gender (men), higher age, 
socioeconomic status, occupational status (unemployed), higher coping efficacy 
and trust in institutions, and positive attitudes toward quarantine measures 
predicted well-being. The estimated prevalence of common mental disorders was 
31.7% among men and 52.3% among women. The scores on well-being were 
significantly lower in the current study than in a previous validation 
study.Conclusion: The results of the study provided both theory and practical 
implications in understanding mental health and its psychosocial predictors 
during national quarantine.

DOI: 10.1080/10615806.2020.1861253
PMID: 33350343 [Indexed for MEDLINE]


3941. BMC Med Educ. 2020 Dec 21;20(1):515. doi: 10.1186/s12909-020-02427-4.

Impact of simulation-based teamwork training on COVID-19 distress in healthcare 
professionals.

Beneria A(1)(2), Arnedo M(2), Contreras S(2)(3), Pérez-Carrasco M(2)(3), 
Garcia-Ruiz I(2)(4), Rodríguez-Carballeira M(2), Raduà J(5)(6)(7)(8), Rius 
JB(9)(10).

Author information:
(1)Departament Psiquiatria, Vall d'Hebron Hospital Universitari, Barcelona, 
Spain.
(2)Vall Hebron centre Simulació Clínica Avançada (VHiSCA), Direcció Docència, 
Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, 
Barcelona, Spain.
(3)Servei de Medicina Intensiva, Vall d'Hebron Hospital Universitari, Barcelona, 
Spain.
(4)Unitat Medicina Materna i Fetal, Department d'Obstetrícia, Vall d'Hebron 
Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain.
(5)Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 
Barcelona, Spain.
(6)CIBERSAM, ISC-III, Madrid, Spain.
(7)King's College London, London, UK.
(8)Karolinska Institutet, Stockholm, Sweden.
(9)Vall Hebron centre Simulació Clínica Avançada (VHiSCA), Direcció Docència, 
Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, 
Barcelona, Spain. jbaneras@vhebron.net.
(10)Cardiology Vall d'Hebron Hospital Universitari, 08036, Barcelona, Spain. 
jbaneras@vhebron.net.

CONTEXT: Non-technical skills such as leadership, communication, or situation 
awareness should lead to effective teamwork in a crisis. This study aimed to 
analyse the role of these skills in the emotional response of health 
professionals to the COVID-19 pandemic.
METHODS: Before the COVID-19 outbreak, 48 doctors and 48 nurses participated in 
a simulation-based teamwork training program based on teaching non-technical 
skills through simulation. In May 2020, this group of professionals from a 
COVID-19 referral hospital was invited to participate in a survey exploring 
stress, anxiety, and depression, using the PSS-14 (Perceived Stress Scale) and 
the HADS (Hospital Anxiety and Depression Scale) measures. A control group that 
did not receive the training was included. We conducted a logistic regression to 
assess whether having attended a simulation-based teamwork training program 
modified the probability of presenting psychological distress (PSS-14 > 18 or 
HADS> 12).
RESULTS: A total of 141 healthcare professionals were included, 77 in the 
intervention group and 64 in the control group. Based on the PSS-14, 70.1% of 
the intervention group and 75% of the control group (p = 0.342) had symptoms of 
stress. Having contact with COVID-19 patients [OR 4.16(1.64-10.52)]; having 
minors in charge [OR 2.75 (1.15-6.53)]; working as a doctor [0.39(0.16-0.95)], 
and being a woman [OR 2.94(1.09-7.91)] were related with PSS14 symptoms. Based 
on the HADS, 54.6% of the intervention group and 42.2% of the control group 
(p = 0.346) had symptoms of anxiety or depression. Having contact with COVID-19 
patients [OR 2.17(1.05-4.48)] and having minors in charge [OR 2.14(1.06-4.32)] 
were related to HADS symptoms. Healthcare professionals who attended COVID-19 
patients showed higher levels of anxiety and depression [OR 2.56(1.03-6.36) 
(p = 0.043)].
CONCLUSION: Healthcare professionals trained in non-technical skills through 
simulation tended towards higher levels of anxiety and depression and fewer 
levels of stress, during the COVID-19 pandemic.

DOI: 10.1186/s12909-020-02427-4
PMCID: PMC7751744
PMID: 33349248 [Indexed for MEDLINE]

Conflict of interest statement: No additional financial or other affiliation 
relevant to the subject of this article is reported.


3942. Sleep Med. 2021 Jan;77:112-119. doi: 10.1016/j.sleep.2020.11.027. Epub 2020 Dec 
3.

Changes in sleep timing and subjective sleep quality during the COVID-19 
lockdown in Italy and Belgium: age, gender and working status as modulating 
factors.

Cellini N(1), Conte F(2), De Rosa O(2), Giganti F(3), Malloggi S(3), Reyt M(4), 
Guillemin C(4), Schmidt C(4), Muto V(4), Ficca G(2).

Author information:
(1)Department of General Psychology, University of Padova, Padova, Italy; 
Department of Biomedical Sciences, University of Padova, Padova, Italy; Padova 
Neuroscience Center, University of Padova, Padova, Italy; Human Inspired 
Technology Center, University of Padova, Padova, Italy. Electronic address: 
nicola.cellini@unipd.it.
(2)Department of Psychology, University of Campania "L. Vanvitelli", Caserta, 
Italy.
(3)Department of Neuroscience, Psychology, Drug Research and Child Health, 
University of Firenze, Firenze, Italy.
(4)GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, Liège, 
Belgium; Psychology and Cognitive Neuroscience Research Unit, University of 
Liège, Liège, Belgium.

Italy and Belgium have been among the first western countries to face the 
Coronavirus disease 2019 (COVID-19) emergency, imposing a total lockdown over 
the entire national territories. These limitations have proven effective in 
slowing down the spread of the infection. However, the benefits obtained in 
public health have come with huge costs in terms of social, economic, and 
psychological well-being. In the current study, we aimed to investigate how the 
period of home confinement affected self-reported sleep characteristics in 
Italians and Belgians, with special regard to sleep timing and subjective 
quality. Using an online survey we collected data from 2272 participants, 1622 
Italians (Mage = 34.1 ± 13.6 years, 1171 F), and 650 Belgian (Mage = 43.0 ± 16.8 
years, 509 F). Participants reported their sleep pattern (eg, bedtime, risetime) 
and perceived sleep quality during and, retrospectively, before the lockdown. 
During the lockdown, sleep timing was significantly delayed, time spent in bed 
increased, and sleep quality was markedly impaired in both Italians and 
Belgians. The most vulnerable individuals appeared to be women, subjects 
experiencing a more negative mood, and those perceiving the pandemic situation 
as highly stressful. However, the two samples differed in the subgroups most 
affected by the changes, possibly because of the different welfare systems of 
the two countries. In fact, in the Italian sample sleep quality and timing 
underwent significant modifications especially in unemployed participants, 
whereas in the Belgian sample this category was the one who suffered less from 
the restrictions. Considering that the novel coronavirus has spread across the 
whole globe, involving countries with different types of health and welfare 
systems, understanding which policy measures have the most effective protective 
role on physical and mental health is of primary importance.

Copyright © 2020 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.sleep.2020.11.027
PMCID: PMC9183798
PMID: 33348298 [Indexed for MEDLINE]

Conflict of interest statement: The Authors declare that there is no conflict of 
interest. The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest 
associated with this article can be viewed by clicking on the following link: 
https://doi.org/10.1016/j.sleep.2020.11.027.


3943. J Am Med Dir Assoc. 2021 Feb;22(2):228-237.e25. doi: 
10.1016/j.jamda.2020.11.025. Epub 2020 Nov 26.

Social Connection in Long-Term Care Homes: A Scoping Review of Published 
Research on the Mental Health Impacts and Potential Strategies During COVID-19.

Bethell J(1), Aelick K(2), Babineau J(3), Bretzlaff M(2), Edwards C(4), Gibson 
JL(5), Hewitt Colborne D(2), Iaboni A(6), Lender D(5), Schon D(7), McGilton 
KS(8).

Author information:
(1)KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, 
Canada; Institute of Health Policy, Management and Evaluation, University of 
Toronto, Toronto, Canada. Electronic address: jennifer.bethell@uhn.ca.
(2)Behavioural Supports Ontario Provincial Coordinating Office, North Bay 
Regional Health Centre, North Bay, Canada.
(3)Library and Information Services, University Health Network, Toronto, Canada; 
The Institute for Education Research, University Health Network, Toronto, 
Canada.
(4)Family Councils Ontario, Toronto, Canada.
(5)Ontario Association of Residents' Councils, Newmarket, Canada.
(6)KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, 
Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
(7)Lakeside Long-Term Care Centre Family Council, Toronto, Canada.
(8)KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, 
Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 
Toronto, Canada.

OBJECTIVES: Good social connection is associated with better health and 
wellbeing. However, social connection has distinct considerations for people 
living in long-term care (LTC) homes. The objective of this scoping review was 
to summarize research literature linking social connection to mental health 
outcomes, specifically among LTC residents, as well as research to identify 
strategies to help build and maintain social connection in this population 
during COVID-19.
DESIGN: Scoping review.
SETTINGS AND PARTICIPANTS: Residents of LTC homes, care homes, and nursing 
homes.
METHODS: We searched MEDLINE(R) ALL (Ovid), CINAHL (EBSCO), PsycINFO (Ovid), 
Scopus, Sociological Abstracts (ProQuest), Embase and Embase Classic (Ovid), 
Emcare Nursing (Ovid), and AgeLine (EBSCO) for research that quantified an 
aspect of social connection among LTC residents; we limited searches to 
English-language articles published from database inception to search date (July 
2019). For the current analysis, we included studies that reported (1) the 
association between social connection and a mental health outcome, (2) the 
association between a modifiable risk factor and social connection, or (3) 
intervention studies with social connection as an outcome. From studies in (2) 
and (3), we identified strategies that could be implemented and adapted by LTC 
residents, families and staff during COVID-19 and included the articles that 
informed these strategies.
RESULTS: We included 133 studies in our review. We found 61 studies that tested 
the association between social connection and a mental health outcome. We 
highlighted 12 strategies, informed by 72 observational and intervention 
studies, that might help LTC residents, families, and staff build and maintain 
social connection for LTC residents.
CONCLUSIONS AND IMPLICATIONS: Published research conducted among LTC residents 
has linked good social connection to better mental health outcomes. 
Observational and intervention studies provide some evidence on approaches to 
address social connection in this population. Although further research is 
needed, it does not obviate the need to act given the sudden and severe impact 
of COVID-19 on social connection in LTC residents.

Copyright © 2020 AMDA – The Society for Post-Acute and Long-Term Care Medicine. 
Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jamda.2020.11.025
PMCID: PMC9186333
PMID: 33347846 [Indexed for MEDLINE]


3944. Gerontologist. 2021 Feb 23;61(2):205-216. doi: 10.1093/geront/gnaa204.

Age Differences in Stress, Life Changes, and Social Ties During the COVID-19 
Pandemic: Implications for Psychological Well-Being.

Birditt KS(1), Turkelson A(1), Fingerman KL(2), Polenick CA(3), Oya A(1).

Author information:
(1)Institute for Social Research, University of Michigan, Ann Arbor, USA.
(2)Human Development and Family Sciences, University of Texas at Austin, USA.
(3)Department of Psychiatry, University of Michigan, Ann Arbor, USA.

BACKGROUND AND OBJECTIVES: Experiences of the coronavirus disease 2019 
(COVID-19) pandemic and its implications for psychological well-being may vary 
widely across the adult life span. The present study examined age differences in 
pandemic-related stress and social ties, and links with psychological 
well-being.
RESEARCH DESIGN AND METHODS: Participants included 645 adults (43% women) aged 
18-97 (M = 50.8; SD = 17.7) from the May 2020 nationally representative Survey 
of Consumers. Participants reported the extent to which they felt stress related 
to the pandemic in the last month, the extent to which their lives had changed 
due to the pandemic, as well as social isolation, negative relationship quality, 
positive relationship quality, and frequency of depression, anxiety, and 
rumination in the past week.
RESULTS: Results showed that older people reported less pandemic-related stress, 
less life change, less social isolation, and lower negative relationship quality 
than younger people. Greater pandemic-related stress, life change, social 
isolation, and negative relationship quality were associated with poorer 
psychological well-being. Poorer social ties (i.e., greater social isolation and 
negative quality) exacerbated the effects of the COVID-19 pandemic (stress, life 
change) on psychological well-being.
DISCUSSION AND IMPLICATIONS: Researchers have indicated that older adults may be 
more vulnerable to COVID-19 pandemic-related stress and social isolation, but 
this study indicates that young adults may be relatively more vulnerable. 
Because isolation and negative relationship quality appear to exacerbate the 
deleterious effects of the COVID-19 pandemic on psychological well-being, 
reducing social isolation and negative relations are potential targets for 
intervention.

© The Author(s) 2020. Published by Oxford University Press on behalf of The 
Gerontological Society of America. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/geront/gnaa204
PMCID: PMC7799124
PMID: 33346806 [Indexed for MEDLINE]


3945. Epilepsy Behav. 2021 Feb;115:107658. doi: 10.1016/j.yebeh.2020.107658. Epub 2020 
Nov 28.

Evaluating risk to people with epilepsy during the COVID-19 pandemic: 
Preliminary findings from the COV-E study.

Thorpe J(1), Ashby S(2), Hallab A(3), Ding D(4), Andraus M(5), Dugan P(6), 
Perucca P(7), Costello D(8), French JA(6), O'Brien TJ(7), Depondt C(9), Andrade 
DM(10), Sengupta R(11), Delanty N(12), Jette N(13), Newton CR(14), Brodie 
MJ(15), Devinsky O(6), Helen Cross J(16), Sander JW(17), Hanna J(2), Sen A(18); 
COVID-19 and Epilepsy (COV-E) Study Group.

Author information:
(1)Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield 
Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford OX3 9DU, 
UK; SUDEP Action, 18 Newbury Street, Wantage, Oxfordshire OX12 8DA. UK.
(2)SUDEP Action, 18 Newbury Street, Wantage, Oxfordshire OX12 8DA. UK.
(3)Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, 
Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and 
Berlin Institute of Health, Berlin, Germany.
(4)Institute of Neurology, Fudan University Huashan Hospital, Shanghai, China.
(5)Department of Internal Medicine, Neurology Service, Epilepsy Program, 
Clementino Fraga Filho University Hospital, Federal University of Rio de 
Janeiro, Rio de Janeiro, Brazil.
(6)Department of Neurology, NYU Grossman School of Medicine, USA.
(7)Department of Neuroscience, Central Clinical School, The Alfred Hospital, 
Monash University, Melbourne, Australia & Departments of Medicine and Neurology, 
The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia.
(8)Epilepsy Service, Cork University Hospital & College of Medicine and Health, 
University College Cork, Ireland.
(9)Department of Neurology, Hôpital Erasme - Université Libre de Bruxelles, 
Brussels, Belgium.
(10)Adult Epilepsy Genetics Program, Toronto Western Hospital, University of 
Toronto, Toronto, Canada.
(11)The Institute of Neurosciences, Kolkata, India.
(12)Beaumont Hospital, and School of Pharmacy and Biomolecular Sciences, 
FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, 
Ireland.
(13)Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, 
USA.
(14)Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield 
Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford OX3 9DU, 
UK; University Department of Psychiatry, University of Oxford, UK.
(15)Epilepsy Unit, West Glasgow Ambulatory Care Hospital-Yorkhill, Glasgow, UK.
(16)UCL NIHR BRC Great Ormond Street Institute of Child Health, London, UK; 
Young Epilepsy, St Pier's Lane, Dormansland, Lingfield RH7 6P, UK.
(17)UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG & 
Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK; Stichting Epilepsie 
Instellingen Nederland (SEIN), Heemstede, Netherlands.
(18)Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield 
Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford OX3 9DU, 
UK. Electronic address: arjune.sen@ndcn.ox.ac.uk.

The COVID-19 pandemic has caused global anguish unparalleled in recent times. As 
cases rise, increased pressure on health services, combined with severe 
disruption to people's everyday lives, can adversely affect individuals living 
with chronic illnesses, including people with epilepsy. Stressors related to 
disruption to healthcare, finances, mental well-being, relationships, schooling, 
physical activity, and increased isolation could increase seizures and impair 
epilepsy self-management. We aim to understand the impact that COVID-19 has had 
on the health and well-being of people with epilepsy focusing on exposure to 
increased risk of seizures, associated comorbidity, and mortality. We designed 
two online surveys with one addressing people with epilepsy directly and the 
second for caregivers to report on behalf of a person with epilepsy. The survey 
is ongoing and has yielded 463 UK-based responses by the end of September 2020. 
Forty percent of respondents reported health changes during the pandemic 
(n = 185). Respondents cited a change in seizures (19%, n = 88), mental health 
difficulties (34%, n = 161), and sleep disruption (26%, n = 121) as the main 
reasons. Thirteen percent found it difficult to take medication on time. A third 
had difficulty accessing medical services (n = 154), with 8% having had an 
appointment canceled (n = 39). Only a small proportion reported having had 
discussions about epilepsy-related risks, such as safety precautions (16%, 
n = 74); mental health (29%, n = 134); sleep (30%, n = 140); and Sudden 
Unexpected Death in Epilepsy (SUDEP; 15%, n = 69) in the previous 12 months. 
These findings suggest that people with epilepsy are currently experiencing 
health changes, coupled with inadequate access to services. Also, there seems to 
be a history of poor risk communication in the months preceding the pandemic. As 
the UK witnesses a second COVID-19 wave, those involved in healthcare delivery 
must ensure optimal care is provided for people with chronic conditions, such as 
epilepsy, to ensure that avoidable morbidity and mortality is prevented during 
the pandemic, and beyond.

Copyright © 2020 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.yebeh.2020.107658
PMCID: PMC7698680
PMID: 33341393 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


3946. J Sci Med Sport. 2021 Apr;24(4):320-326. doi: 10.1016/j.jsams.2020.11.016. Epub 
2020 Dec 3.

Physical activity, mental health and well-being of adults during initial 
COVID-19 containment strategies: A multi-country cross-sectional analysis.

Faulkner J(1), O'Brien WJ(2), McGrane B(3), Wadsworth D(4), Batten J(5), Askew 
CD(6), Badenhorst C(2), Byrd E(7), Coulter M(3), Draper N(8), Elliot C(9), Fryer 
S(10), Hamlin MJ(9), Jakeman J(7), Mackintosh KA(11), McNarry MA(11), 
Mitchelmore A(7), Murphy J(3), Ryan-Stewart H(5), Saynor Z(12), Schaumberg 
M(13), Stone K(10), Stoner L(14), Stuart B(15), Lambrick D(16).

Author information:
(1)School of Sport, Health and Community, University of Winchester, UK. 
Electronic address: James.Faulkner@winchester.ac.uk.
(2)School of Sport, Exercise and Nutrition, Massey University, New Zealand.
(3)School of Arts Education and Movement, Dublin City University, Ireland.
(4)School of Nursing, Midwifery and Paramedicine, University of the Sunshine 
Coast, Australia; Sunshine Coast Health Institute, Sunshine Coast Hospital and 
Health Service, Australia.
(5)School of Sport, Health and Community, University of Winchester, UK.
(6)School of Health and Sports Sciences, University of the Sunshine Coast, 
Australia; Sunshine Coast Health Institute, Sunshine Coast Hospital and Health 
Service, Australia.
(7)Department of Sport, Health Sciences and Social Work, Oxford Brookes 
University, UK.
(8)School of Health Sciences, University of Canterbury, New Zealand.
(9)Department of Tourism, Sport and Society, Lincoln University, New Zealand.
(10)School of Sport and Exercise, University of Gloucestershire, UK.
(11)School of Sport and Exercise Sciences, Swansea University, UK.
(12)Physical Activity, Health and Rehabilitation Thematic Research Group, School 
of Sport, Health and Exercise Science, University of Portsmouth, UK.
(13)School of Health and Sports Sciences, University of the Sunshine Coast, 
Australia; Sunshine Coast Health Institute, Sunshine Coast Hospital and Health 
Service, Australia; School of Human Movement and Nutrition Sciences, The 
University of Queensland, Australia.
(14)Department of Exercise and Sport Science, University of North Carolina at 
Chapel Hill, USA.
(15)Southampton Clinical Trials Unit, Faculty of Medicine, University of 
Southampton, UK.
(16)Health and Life Sciences, University of Southampton, UK.

OBJECTIVES: To assess physical activity (PA), mental health and well-being of 
adults in the United Kingdom (UK), Ireland, New Zealand and Australia during the 
initial stages of National governments' Coronavirus disease (COVID-19) 
containment responses.
DESIGN: Observational, cross-sectional.
METHODS: An online survey was disseminated to adults (n=8,425; 44.5±14.8y) 
residing in the UK, Ireland, New Zealand and Australia within the first 2-6 
weeks of government-mandated COVID-19 restrictions. Main outcome measures 
included: Stages of Change scale for exercise behaviour change; International 
Physical Activity Questionnaire (short-form); World Health Organisation-5 
Well-being Index; and the Depression Anxiety and Stress Scale-9.
RESULTS: Participants who reported a negative change in exercise behaviour from 
before initial COVID-19 restrictions to during the initial COVID-19 restrictions 
demonstrated poorer mental health and well-being compared to those demonstrating 
either a positive-or no change in their exercise behaviour (p<0.001). Whilst 
women reported more positive changes in exercise behaviour, young people 
(18-29y) reported more negative changes (both p<0.001). Individuals who had more 
positive exercise behaviours reported better mental health and well-being 
(p<0.001). Although there were no differences in PA between countries, 
individuals in New Zealand reported better mental health and well-being 
(p<0.001).
CONCLUSION: The initial COVID-19 restrictions have differentially impacted upon 
PA habits of individuals based upon their age and sex, and therefore have 
important implications for international policy and guideline recommendations. 
Public health interventions that encourage PA should target specific groups 
(e.g., men, young adults) who are most vulnerable to the negative effects of 
physical distancing and/or self-isolation.

Copyright © 2020 Sports Medicine Australia. Published by Elsevier Ltd. All 
rights reserved.

DOI: 10.1016/j.jsams.2020.11.016
PMCID: PMC7711171
PMID: 33341382 [Indexed for MEDLINE]


3947. Prog Neuropsychopharmacol Biol Psychiatry. 2021 Jul 13;109:110207. doi: 
10.1016/j.pnpbp.2020.110207. Epub 2020 Dec 15.

Prevalence of anxiety in the COVID-19 pandemic: An updated meta-analysis of 
community-based studies.

Santabárbara J(1), Lasheras I(2), Lipnicki DM(3), Bueno-Notivol J(4), 
Pérez-Moreno M(5), López-Antón R(6), De la Cámara C(7), Lobo A(8), Gracia-García 
P(9).

Author information:
(1)Department of Microbiology, Pediatrics, Radiology and Public Health, 
University of Zaragoza, Faculty of Medicine, Building A, 50009 Zaragoza, Spain; 
Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of 
Science and Innovation, Avenue Monforte de Lemos, 3-5, Pavilion 11, Floor 0, 
28029 Madrid, Spain; Instituto de Investigación Sanitaria de Aragón (IIS 
Aragón), Zaragoza, Avenue San Juan Bosco, 13, 50009 Zaragoza, Spain. Electronic 
address: jsantabarbara@unizar.es.
(2)Department of Microbiology, Pediatrics, Radiology and Public Health, 
University of Zaragoza, Faculty of Medicine, Building A, 50009 Zaragoza, Spain. 
Electronic address: 738605@unizar.es.
(3)Centre for Healthy Brain Ageing, School of Psychiatry, University of New 
South Wales Medicine, Randwick 2052, Australia. Electronic address: 
d.lipnicki@unsw.edu.au.
(4)Psychiatry Service, Hospital Universitario Miguel Servet, Paseo Isabel la 
Católica, 1-3, 50009 Zaragoza, Spain. Electronic address: 
jbuenon@salud.aragon.es.
(5)Pharmacy Service. Hospital Universitario Miguel Servet, Paseo Isabel la 
Católica, 1-3, 50009 Zaragoza, Spain. Electronic address: 
marpermor159@gmail.com.
(6)Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry 
of Science and Innovation, Avenue Monforte de Lemos, 3-5, Pavilion 11, Floor 0, 
28029 Madrid, Spain; Instituto de Investigación Sanitaria de Aragón (IIS 
Aragón), Zaragoza, Avenue San Juan Bosco, 13, 50009 Zaragoza, Spain; Department 
of Psychology and Sociology, Universidad de Zaragoza, Pedro Cerbuna, 12, 50009 
Zaragoza, Spain. Electronic address: rlanton@unizar.es.
(7)Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry 
of Science and Innovation, Avenue Monforte de Lemos, 3-5, Pavilion 11, Floor 0, 
28029 Madrid, Spain; Instituto de Investigación Sanitaria de Aragón (IIS 
Aragón), Zaragoza, Avenue San Juan Bosco, 13, 50009 Zaragoza, Spain.
(8)Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Avenue 
San Juan Bosco, 13, 50009 Zaragoza, Spain. Electronic address: alobo@unizar.es.
(9)Psychiatry Service, Hospital Universitario Miguel Servet, Paseo Isabel la 
Católica, 1-3, 50009 Zaragoza, Spain. Electronic address: 
pgraciag@salud.aragon.es.

BACKGROUND: The unprecedented worldwide crisis caused by the rapid spread of 
COVID-19 and the restrictive public health measures enforced by some countries 
to slow down its transmission have severely threatened the physical and mental 
wellbeing of communities globally.
METHODS: We conducted a systematic review and meta-analysis to determine the 
prevalence of anxiety in the general population during the COVID-19 pandemic. 
Two researchers independently searched for cross-sectional community-based 
studies published between December 1, 2019 and August 23, 2020, using PubMed, 
WoS, Embase, and other sources (e.g., grey literature, manual search).
RESULTS: Of 3049 records retrieved, 43 studies were included. These studies 
yielded an estimated overall prevalence of anxiety of 25%, which varied 
significantly across the different tools used to measure anxiety. Consistently 
reported risk factors for the development of anxiety included initial or peak 
phase of the outbreak, female sex, younger age, marriage, social isolation, 
unemployment and student status, financial hardship, low educational level, 
insufficient knowledge of COVID-19, epidemiological or clinical risk of disease 
and some lifestyle and personality variables.
CONCLUSIONS: As the overall global prevalence of anxiety disorders is estimated 
to be 7.3% normally, our results suggest that rates of anxiety in the general 
population could be more than 3 times higher during the COVID-19 pandemic. These 
findings suggest a substantial impact on mental health that should be targeted 
by individual and population-level strategies.

Copyright © 2020. Published by Elsevier Inc.

DOI: 10.1016/j.pnpbp.2020.110207
PMCID: PMC7834650
PMID: 33338558 [Indexed for MEDLINE]

Conflict of interest statement: We declare that Dr. P. Gracia-García has 
received Grant support from Janssen, AstraZeneca and the Ilustre Colegio de 
Médicos de Zaragoza; she has received Honorarium from AstraZeneca and Lilly; and 
she has received travel support from Lilly, Almirall, Lundbeck, Rovi, Pfizer and 
Janssen-Cilag. None of these activities is related to the current project. For 
the remaining authors, none were declared.


3948. Prog Neuropsychopharmacol Biol Psychiatry. 2021 Apr 20;107:110219. doi: 
10.1016/j.pnpbp.2020.110219. Epub 2020 Dec 15.

Mental health consequences of the Covid-19 outbreak in Spain. A longitudinal 
study of the alarm situation and return to the new normality.

González-Sanguino C(1), Ausín B(2), Castellanos MA(3), Saiz J(4), Muñoz M(2).

Author information:
(1)Chair Against Stigma Grupo 5-Complutense University of Madrid, School of 
Psychology, Personality, Evaluation and Clinical Psychology Department, 
Complutense University of Madrid, Spain. Electronic address: clagon06@ucm.es.
(2)Chair Against Stigma Grupo 5-Complutense University of Madrid, School of 
Psychology, Personality, Evaluation and Clinical Psychology Department, 
Complutense University of Madrid, Spain.
(3)Chair Against Stigma Grupo 5-Complutense University of Madrid, School of 
Psychology, Psychobiology and Methodology in Behavioral Sciences Department, 
Complutense University of Madrid, Spain.
(4)Chair Against Stigma Grupo 5-Complutense University of Madrid, School of 
Psychology, Social, Labor and Differential Psychology Department, Complutense 
University of Madrid, Spain.

AIMS: The objective is to conduct a longitudinal analysis of the effects of the 
pandemic and alarm situation on the mental health of the general population at 
three points in time: two weeks after beginning the confinement, after a month, 
and after two months, when the lockdown was lifted and the country returned to 
the new normality.
METHODS: The evaluations were carried out by means of an online survey, with a 
sample of 3480 persons in the first data collection and 1041 and 569 persons in 
the successive evaluation periods. The presence of depressive symptoms, anxiety 
and posttraumatic stress disorder (PTSD) was evaluated by means of screening 
tests. Sociodemographic data, Covid-19 variables, loneliness, psychological 
well-being, social support, discrimination and a sense of belonging, were 
collected.
RESULTS: Depressive symptoms increased significantly throughout the confinement, 
decreasing at the last assessment but not dropping to previous levels. In 
anxiety, there are no significant changes between the three evaluations, but a 
downward trend can be seen over time. Regarding the symptomatology of PTSD, a 
downward trend is observed throughout the three evaluations, with significantly 
lower scores between the first and third assessments. The different regression 
models developed reveal the importance of perceived loneliness and spiritual 
well-being as the main predictors of mental health, as well as the importance of 
the lower age for depression and the female gender for anxiety and PSTD.
CONCLUSIONS: This research shows that the pandemic has had a negative impact on 
our mental health, which still does not seem to be at pre-crisis levels, 
although it has improved as the emergency situation subsides. These results 
underline the importance of paying greater attention to mental health, and 
reveal key variables such as spiritual well-being and perceived loneliness in 
which to intervene from different care services, as well as younger people and 
women as vulnerable groups on which to focus more attention.

Copyright © 2020 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.pnpbp.2020.110219
PMCID: PMC7833458
PMID: 33338556 [Indexed for MEDLINE]

Conflict of interest statement: None of the authors have a conflict of interest.


3949. Perspect Psychiatr Care. 2021 Jul;57(3):1449-1458. doi: 10.1111/ppc.12711. Epub 
2020 Dec 18.

Anxiety, depression, and knowledge level in postpartum women during the COVID-19 
pandemic.

Guvenc G(1), Yesilcinar İ(2), Ozkececi F(3), Öksüz E(4), Ozkececi CF(5), 
Konukbay D(6), Kok G(1), Karasahin KE(7).

Author information:
(1)Department of Obstetrics and Gynecology Nursing, Gulhane Faculty of Nursing, 
University of Health Sciences Turkey, Ankara, Turkey.
(2)Department of Nursing, Faculty of Health Sciences, Izmir Katip Celebi 
University, İzmir, Turkey.
(3)Department of Nursing, Faculty of Health Sciences, Yuksek Ihtisas University, 
Ankara, Turkey.
(4)Department of Psychiatric and Mental Health Nursing, Gulhane Faculty of 
Nursing, University of Health Sciences Turkey, Ankara, Turkey.
(5)Department of Pediatrics, Gulhane Education and Research Hospital, University 
of Health Sciences Turkey, Ankara, Turkey.
(6)Department of Pediatric Nursing, Gulhane Faculty of Nursing, University of 
Health Sciences Turkey, Ankara, Turkey.
(7)Department of Obstetrics and Gynecology, Gulhane Education and Research 
Hospital, University of Health Sciences Turkey, Ankara, Turkey.

PURPOSE: This study aimed to assess anxiety, depression, and knowledge level in 
postpartum women during the COVID-19 pandemic.
DESIGN AND METHODS: This cross-sectional study was conducted on 212 postpartum 
women using a web-based online survey in Ankara, Turkey.
FINDINGS: The prevalence of depression was 34.0%. The mean anxiety and COVID-19 
knowledge scores were 42.69 ± 9.93 and 9.69 ± 1.94, respectively. There was a 
statistically significant difference between the anxiety scores and depression 
status (p < 0.001) of women. There were statistically significant differences 
between fear about being infected with COVID-19 for themselves (p = 0.01) and 
for babies (p = 0.01) and the postpartum depression (PPD).
PRACTICE IMPLICATIONS: During the COVID-19 pandemic, early detection 
and appropriate and timely intervention to prevent and detect anxiety and PPD 
are crucial to the well-being of a woman.

© 2020 Wiley Periodicals LLC.

DOI: 10.1111/ppc.12711
PMID: 33336416 [Indexed for MEDLINE]


3950. Int J Environ Res Public Health. 2020 Dec 15;17(24):9419. doi: 
10.3390/ijerph17249419.

Psychological Health and Physical Activity Levels during the COVID-19 Pandemic: 
A Systematic Review.

Violant-Holz V(1), Gallego-Jiménez MG(2), González-González CS(3), Muñoz-Violant 
S(4), Rodríguez MJ(5), Sansano-Nadal O(6), Guerra-Balic M(6).

Author information:
(1)Faculty of Education, Universitat de Barcelona, 08035 Barcelona, Spain.
(2)Faculty of Education, Universidad Internacional de la Rioja, 08014 Barcelona, 
Spain.
(3)Department of Computer Engineering and Systems, Universidad de la Laguna, 
38293 La Laguna, Spain.
(4)Department of Psychology, The University of British Columbia, Vancouver, BC 
V6T 1Z4, Canada.
(5)Department of Biomedical Sciences, School of Medicine and Health Sciences, 
Institute of Neurosciences, Universitat de Barcelona, 08036 Barcelona, Spain.
(6)Faculty of Psychology, Education and Sports Sciences, University Ramon Llull, 
Spain FPCEE-Blanquerna, 08022 Barcelona, Spain.

The coronavirus disease (COVID-19) pandemic has been devastating in all senses, 
particularly psychologically. Physical activity (PA) is known to aid 
psychological well-being, and it is worth investigating whether PA has been a 
coping strategy during this pandemic. The objective of this literature review is 
to analyze the extent to which engaging in PA during the COVID-19 pandemic 
impacts psychological health in the adult population. The literature was 
searched in all databases from the EBSCOhost Research Database-MEDLINE, APA 
PsycArticles, between others-published between 1 January 2019 and 15 July 2020. 
From 180 articles found, 15 were eligible. The reviewed articles showed an 
association between mental health distress-e.g., stress, anxiety, depressive 
symptoms, social isolation, psychological distress-and PA. This research 
concludes that the COVID-19 pandemic and the lockdown measures caused 
psychological distress. Those studies that analyzed PA showed that, during 
quarantine, adults increased their sedentary time and reduced their PA levels, 
showing controversial psychological outcomes. This review discusses whether PA 
is an effective strategy to face the COVID-19 pandemic psychological effects 
contributing to a further putative increase in the prevalence of psychiatric 
disorders.

DOI: 10.3390/ijerph17249419
PMCID: PMC7765528
PMID: 33334073 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3951. Int J Environ Res Public Health. 2020 Dec 15;17(24):9401. doi: 
10.3390/ijerph17249401.

COVID-Well: Evaluation of the Implementation of Supported Wellbeing Centres for 
Hospital Employees during the COVID-19 Pandemic.

Blake H(1)(2), Yildirim M(1), Wood B(3), Knowles S(3), Mancini H(3), Coyne E(4), 
Cooper J(5).

Author information:
(1)School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK.
(2)NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH, UK.
(3)Human Resources, Nottingham University Hospitals NHS Trust, Nottingham NG7 
2UH, UK.
(4)Clinical Psychology Department, Nottingham University Hospitals NHS Trust, 
Nottingham NG7 2UH, UK.
(5)Nursing and Midwifery, Nottingham University Hospitals NHS Trust, Nottingham 
NG7 2UH, UK.

Supported Wellbeing Centres have been set up in UK hospital trusts in an effort 
to mitigate the psychological impact of COVID-19 on healthcare workers, although 
the extent to which these are utilised and the barriers and facilitators to 
access are not known. The aim of the study was to determine facility usage and 
gather insight into employee wellbeing and the views of employees towards this 
provision. The study included (i) 17-week service use monitoring, (ii) employee 
online survey with measures of wellbeing, job stressfulness, presenteeism, 
turnover intentions, job satisfaction, and work engagement, as well as barriers 
and facilitators to accessing the Wellbeing Centres. Over 17 weeks, 14,934 
facility visits were recorded across two sites (peak attendance in single week n 
= 2605). Facilities were highly valued, but the service model was resource 
intensive with 134 wellbeing buddies supporting the centres in pairs. 819 
hospital employees completed an online survey (88% female; 37.7% working in 
COVID-19 high risk areas; 52.4% frontline workers; 55.2% had accessed a 
wellbeing centre). There was moderate-to-high job stress (62.9%), low wellbeing 
(26.1%), presenteeism (68%), and intentions to leave (31.6%). Wellbeing was 
higher in those that accessed a wellbeing centre. Work engagement and job 
satisfaction were high. Healthcare organisations are urged to mobilise access to 
high-quality rest spaces and psychological first aid, but this should be 
localised and diversified. Strategies to address presenteeism and staff 
retention should be prioritised, and the high dedication of healthcare workers 
should be recognised.

DOI: 10.3390/ijerph17249401
PMCID: PMC7768437
PMID: 33333913 [Indexed for MEDLINE]

Conflict of interest statement: B.W., S.K., H.M., E.C., and J.C. are employed by 
the participating hospital trust but were not involved in data curation, 
analysis, or interpretation of findings. H.M. and E.C. were involved in service 
delivery. No other conflicts of interest were declared.


3952. Ned Tijdschr Geneeskd. 2020 Dec 10;164:D5358.

[COVID-19: recovering at home is not easy].

[Article in Dutch]

Landsman JA(1)(2), Verheij NP(1), Alma MA(1), van den Boogaard J(3), 
Luning-Koster M(4), Evenboer KE(1), van der Mei SF(1), Reijneveld SA(1).

Author information:
(1)UMCG, afd. Gezondheidswetenschappen, Groningen.
(2)Contact: J. A. Landsman (j.a.landsman@umcg.nl).
(3)GGD Groningen, afd. Infectieziektebestrijding, Groningen.
(4)GGD Fryslân, Leeuwarden.

OBJECTIVE: To gain insight into 1) the symptoms and the disease process of 
healthcare professionals (HCPs) who tested positive for COVID-19 and were not 
hospitalized because of mild symptoms, 2) the impact on their psychological 
well-being and 3) the experiences with (after) care and infection prevention 
measures.
DESIGN: Explorative mixed-methods study.
METHOD: The municipal public health services of Groningen and Fryslân invited 
all HCPs aged above 18 years who tested positive for COVID-19 between March 18th 
and April 3rd 2020 to fill out an online questionnaire (n = 109), on average one 
month after diagnosis. 18 HCPs participated in telephone interviews.
RESULTS: Almost all HCPs mentioned fatigue as a long-term symptom, less 
frequently mentioned were, among other things, feeling physically weak and 
having a cold. Nearly half of them did not have a fever, two-thirds experienced 
stress. HCPs with comorbidity had more symptoms. The interviews showed that 
stress in particular occurred in families with children and because of 
uncertainty about the duration of infectiousness, with lack of good (after)care. 
Respondents experienced many negative reactions of people in their environment 
that felt stigmatizing. The isolation at home was considered bearable.
CONCLUSION: A COVID-19 infection has a significant impact on physical and mental 
health, even in HCPs with mild symptoms. Persistent fatigue in particular 
hinders patients' functioning. The absence of fever in almost half of the 
respondents is remarkable, as well as the negative impact on psychological 
well-being. HCPs are also dissatisfied with after-care. Infection prevention 
measures were relatively well-adhered too.

PMID: 33332052 [Indexed for MEDLINE]


3953. Res Sq [Preprint]. 2020 Dec 9:rs.3.rs-112882. doi: 10.21203/rs.3.rs-112882/v1.

Giving birth under hospital visitor restrictions: Heightened acute stress in 
childbirth in COVID-19 positive women.

Mayopoulos G(1), Ein-Dor T(2), Li K(1), Chan S(1), Dekel S(3).

Author information:
(1)Massachusetts General Hospital.
(2)Interdisciplinary Center Herzliya.
(3)Harvard Medical School.

Update in
    Sci Rep. 2021 Jun 29;11(1):13535.

As the novel coronavirus (COVID-19) has spread globally, a significant portion 
of women have undergone childbirth while possibly infected with the virus and 
also under social isolation due to hospital visitor restrictions. Emerging 
studies examined birth outcomes in COVID-19 positive women, but knowledge of the 
psychological experience of childbirth remains lacking. This study survey 
concerning childbirth and mental health launched during the first wave of the 
pandemic in the US. Women reporting confirmed/suspected COVID-19 during 
childbirth were matched on various background factors with women reporting 
COVID-19 negative. We found higher prevalence of clinically significant acute 
stress in birth in COVID-19 positive women. This group was 11 times as likely to 
have no visitors than matched controls and reported higher levels of pain in 
delivery, lower newborn weights, and more infant admission to neonatal intensive 
care units. Visitor restrictions were associated with these birth outcomes. 
COVID-19 positive women with no visitors were 6 times as likely to report 
clinical acute stress in birth than COVID-19 positive women with visitors. The 
findings underscore increased risk for childbirth-induced psychological 
morbidity in COVID-19-affected populations. As hospitals continue to revise 
policies concerning visitor restrictions, attention to the wellbeing of new 
mothers is warranted.

DOI: 10.21203/rs.3.rs-112882/v1
PMCID: PMC7743075
PMID: 33330856

Conflict of interest statement: Additional Information The authors declare no 
competing interests.


3954. Front Public Health. 2020 Nov 27;8:589669. doi: 10.3389/fpubh.2020.589669. 
eCollection 2020.

Addressing the Covid-19 Burden on Medical Education and Training: The Role of 
Telemedicine and Tele-Education During and Beyond the Pandemic.

Sharma D(1)(2)(3), Bhaskar S(1)(2)(3)(4)(5).

Author information:
(1)Pandemic Health System REsilience PROGRAM (REPROGRAM) Global, Sydney, NSW, 
Australia.
(2)Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute 
for Applied Medical Research, Sydney, NSW, Australia.
(3)South Western Sydney Clinical School, University of New South Wales (UNSW), 
Sydney, NSW, Australia.
(4)Department of Neurology and Neurophysiology, Liverpool Hospital and South 
West Sydney Local Health District (SWSLHD), Sydney, NSW, Australia.
(5)NSW Brain Clot Bank, NSW Health Statewide Biobank and NSW Health Pathology, 
Sydney, NSW, Australia.

Medical students are the future of sustainable health systems that are severely 
under pressure during COVID-19. The disruption in medical education and training 
has adversely impacted traditional medical education and medical students and is 
likely to have long-term implications beyond COVID-19. In this article, we 
present a comprehensive analysis of the existing structural and systemic 
challenges applicable to medical students and teaching/training programs and the 
impact of COVID-19 on medical students and education. Use of technologies such 
as telemedicine or remote education platforms can minimize increased mental 
health risks to this population. An overview of challenges during and beyond the 
COVID-19 pandemic are also discussed, and targeted recommendations to address 
acute and systemic issues in medical education and training are presented. 
During the transition from conventional in-person or classroom teaching to 
tele-delivery of educational programs, medical students have to navigate various 
social, economic and cultural factors which interfere with their personal and 
academic lives. This is especially relevant for those from vulnerable, 
underprivileged or minority backgrounds. Students from vulnerable backgrounds 
are influenced by environmental factors such as unemployment of themselves and 
family members, lack of or inequity in provision and access to educational 
technologies and remote delivery-platforms, and increased levels of mental 
health stressors due to prolonged isolation and self-quarantine measures. 
Technologies for remote education and training delivery as well as sustenance 
and increased delivery of general well-being and mental health services to 
medical students, especially to those at high-risk, are pivotal to our response 
to COVID-19 and beyond.

Copyright © 2020 Sharma and Bhaskar.

DOI: 10.3389/fpubh.2020.589669
PMCID: PMC7728659
PMID: 33330333 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


3955. Proc Natl Acad Sci U S A. 2021 Jan 5;118(1):2019378118. doi: 
10.1073/pnas.2019378118.

Impacts of the COVID-19 pandemic on rural America.

Mueller JT(1), McConnell K(2), Burow PB(3), Pofahl K(2), Merdjanoff AA(4), 
Farrell J(2).

Author information:
(1)Department of Sociology, Social Work, and Anthropology, Utah State 
University, Logan, UT 84321; Tom.Mueller@usu.edu.
(2)Yale School of the Environment, Yale University, New Haven, CT 06510.
(3)Department of Anthropology, Yale University, New Haven, CT 06510.
(4)New York University School of Global Public Health, New York University, New 
York, NY 10012.

Despite considerable social scientific attention to the impacts of the COVID-19 
pandemic on urbanized areas, very little research has examined its impact on 
rural populations. Yet rural communities-which make up tens of millions of 
people from diverse backgrounds in the United States-are among the nation's most 
vulnerable populations and may be less resilient to the effects of such a 
large-scale exogenous shock. We address this critical knowledge gap with data 
from a new survey designed to assess the impacts of the pandemic on 
health-related and economic dimensions of rural well-being in the North American 
West. Notably, we find that the effects of the COVID-19 pandemic on rural 
populations have been severe, with significant negative impacts on unemployment, 
overall life satisfaction, mental health, and economic outlook. Further, we find 
that these impacts have been generally consistent across age, ethnicity, 
education, and sex. We discuss how these findings constitute the beginning of a 
much larger interdisciplinary COVID-19 research effort that integrates rural 
areas and pushes beyond the predominant focus on cities and nation-states.

DOI: 10.1073/pnas.2019378118
PMCID: PMC7817144
PMID: 33328335 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interest.


3956. Int J Environ Res Public Health. 2020 Dec 14;17(24):9340. doi: 
10.3390/ijerph17249340.

Mindfulness and Shinrin-Yoku: Potential for Physiological and Psychological 
Interventions during Uncertain Times.

Timko Olson ER(1), Hansen MM(2), Vermeesch A(3).

Author information:
(1)School of Nursing, University of Minnesota, Twin Cities Campus, 308 Harvard 
Street SE, Minneapolis, MN 55455, USA.
(2)School of Nursing and Health Professions, University of San Francisco, 2130 
Fulton Street, San Francisco, CA 94117, USA.
(3)School of Nursing, University of Portland, 5000 N. Willamette Blvd, Portland, 
OR 97203, USA.

Mindfulness and Shinrin-yoku (SY) translated as forest bathing, is potentially 
effective to alleviate mental health issues related to the COVID-19 pandemic and 
beyond. The purpose of this article is to provide a translational and pragmatic 
approach to understanding mindfulness in the context of SY and psychological 
wellbeing through a rapid review of the literature. The background of 
mindfulness and SY practice are discussed and the emotional, neuroendocrine, and 
neurobiological responses are examined. Next, a rapid review of the literature 
examined six studies, published between 2010 and 2020 to determine what is known 
regarding the relationship between SY, mindfulness, and psychological wellbeing. 
The studies included 21-360 participants with a mean age of 20-55 years. The 
results demonstrated a significant positive correlation between nature, 
mindfulness, and measures of psychological wellbeing. During uncertain events, 
including COVID-19, weaving mindfulness with SY may be specifically important to 
at-risk groups, those experiencing depression, loneliness, and social isolation, 
and at-risk populations such as college students, veterans, and professionals 
with high levels of stress. The goal of this review is to provide a thorough 
background and support of this cost-effective modality to promote overall 
psychological wellbeing as a preventative measure to those at risk or 
experiencing psychological illnesses.

DOI: 10.3390/ijerph17249340
PMCID: PMC7764859
PMID: 33327407 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3957. Nurs Ethics. 2021 Feb;28(1):46-57. doi: 10.1177/0969733020976194. Epub 2020 Dec 
16.

Ethical care during COVID-19 for care home residents with dementia.

Cousins E, de Vries K(1), Dening KH(2).

Author information:
(1)De Montfort University, UK.
(2)Dementia UK, UK.

The COVID-19 pandemic has had a devastating impact on care homes in the United 
Kingdom, particularly for those residents living with dementia. The impetus for 
this article comes from a recent review conducted by the authors. That review, a 
qualitative media analysis of news and academic articles published during the 
first few months of the outbreak, identified ethical care as a key theme 
warranting further investigation within the context of the crisis. To explore 
ethical care further, a set of salient ethical values for delivering care to 
care home residents living with dementia during the pandemic was derived from a 
synthesis of relevant ethical standards, codes and philosophical approaches. The 
ethical values identified were caring, non-maleficence, beneficence, procedural 
justice, dignity in death and dying, well-being, safety, and personhood. Using 
these ethical values as a framework, alongside examples from contemporaneous 
media and academic sources, this article discusses the delivery of ethical care 
to care home residents with dementia within the context of COVID-19. The 
analysis identifies positive examples of ethical values displayed by care home 
staff, care sector organisations, healthcare professionals and third sector 
advocacy organisations. However, concerns relating to the death rates, dignity, 
safety, well-being and personhood - of residents and staff - are also evident. 
These shortcomings are attributable to negligent government strategy, which 
resulted in delayed guidance, lack of resources and Personal Protective 
Equipment, unclear data, and inconsistent testing. Consequently, this review 
demonstrates the ways in which care homes are underfunded, under resourced and 
undervalued.

DOI: 10.1177/0969733020976194
PMID: 33325324 [Indexed for MEDLINE]


3958. J Nerv Ment Dis. 2021 Jan;209(1):85-87. doi: 10.1097/NMD.0000000000001242.

Psychiatry's Past Can Be Psychiatry's Future.

Becker RE(1).

Author information:
(1)Clinical Pharmacology, Drug Design and Development Section, Translational 
Gerontology Branch, Intramural Research Program, National Institute on Aging, 
Baltimore, Maryland; and Aristea Translational Medicine Corporation, Park City, 
Utah.

In the last half of the 20th century, psychiatry lost many of the conditions 
needed for unhindered practice. I compiled from searches of the literature the 
20th century changes in the arenas of psychiatric practice and the sources of 
these changes. I determined how these changes are shaping 21st century health 
and well-being. The neglect of the severely mentally ill, first in Bedlams and 
now on Boulevards, reflects a wide loss of resources. Psychiatry's patients have 
lost a past of community-based mental health services, interdisciplinary care 
teams, preventive consultation with social agencies, and, with reimbursements 
targeted for 15-minute visits, time adequate with the physician to individualize 
diagnosis and treatment. With the Covid-19 and other epidemics, economic 
inequalities, an economic crisis, unrest over police violence, and racism, 
psychiatry can find in its past the resources to engage 21st century psychiatric 
and other problems.

DOI: 10.1097/NMD.0000000000001242
PMID: 33323794 [Indexed for MEDLINE]


3959. Enferm Clin (Engl Ed). 2021 May-Jun;31(3):175-183. doi: 
10.1016/j.enfcli.2020.10.034. Epub 2020 Nov 6.

Design and validation of a scale to measure worry for contagion of the COVID-19 
(PRE-COVID-19).

Caycho-Rodríguez T(1), Ventura-León J(2), Barboza-Palomino M(2).

Author information:
(1)Facultad de Ciencias de la Salud, Universidad Privada del Norte, Lima, Perú. 
Electronic address: tomas.caycho@upn.pe.
(2)Facultad de Ciencias de la Salud, Universidad Privada del Norte, Lima, Perú.

OBJECTIVE: The increase in COVID-19 cases is generating fear and concern in 
society, which generates an emotional response that influences the adoption of 
health-related behaviors. The objective of the study is to design and validate 
the Scale of Worry for Contagion of COVID-19 (PRE-COVID-19).
METHOD: The study had a descriptive cross-sectional design. The population were 
young people and adults who resided in the cities of Lima and Callao (Perú) 
during the declaration of the national health emergency due to the COVID-19 
pandemic, during the period from March 16 to 27, 2020, who were recruited 
through a non-probability sample. The PRE-COVID-19, the WHO-Five Well-Being 
Index, the Generalized Anxiety Disorder Scale-2 and a single item were applied 
to measure the general perception of health. The scales were shared using a 
Google form through social networks. An internal consistency reliability 
analysis and structural equation models were performed, specifically 
confirmatory factor analysis. The recommendations of the Declaration of Helsinki 
and the principles that guide the ethical practice of online studies were 
followed.
RESULTS: Eight hundred and sixteen young people and adults from Lima and Callao 
(200 men and 616 women; mean age 28.40, SD 7.10) participated. The results show 
a one-dimensional model with satisfactory goodness-of-fit indices: χ2 (9)=52.00; 
CFI=0.99; RMSEA=0.09 [0.07, 0.12]; WRMR=0.85. The λ of the model were higher 
than 0.50 and the reliability had an excellent value (ω=0.90). Likewise, the 
convergent and discriminant validity is evident between PRE-COVID-19 and 
measures of anxiety, well-being and self-reported health.
CONCLUSION: The results indicate that the PRE-COVID-19 is a valid and reliable 
instrument to measure concern about the spread of COVID-19 and the emotional 
impact on people.

OBJETIVO: El incremento de los casos de la COVID-19 está generando miedo y 
preocupación en la sociedad, lo que genera una respuesta emocional que influye 
en la adopción de comportamientos relacionados con la salud. El objetivo del 
estudio fue diseñar y validar la Escala de Preocupación por el Contagio de la 
COVID-19 (PRE-COVID-19).
MÉTODO: El estudio tiene diseño descriptivo transversal. La población han sido 
jóvenes y adultos residentes en las ciudades de Lima y Callao durante la 
declaración de la emergencia sanitaria nacional por la pandemia del COVID-19 
durante el periodo del 16 al 27 de marzo de 2020 quienes fueron reclutados a 
través de un muestreo no probabilístico. Se aplicaron la PRE-COVID-19, la 
WHO-Five Well-Being Index, Generalized Anxiety Disorder Scale-2 y un ítem único 
para medir la percepción general de salud. Las escalas fueron compartidas 
mediante un formulario de Google a través de redes sociales. Se realizó un 
análisis de fiabilidad por consistencia interna y modelos de ecuaciones 
estructurales, específicamente el análisis factorial confirmatorio (AFC). Se 
siguieron las recomendaciones de la Declaración de Helsinki y los principios que 
guían la práctica ética de los estudios vía online.
RESULTADOS: Participaron 816 jóvenes y adultos de Lima y Callao (200 varones y 
616 mujeres, Medad = 28.40; DEedad = 7.10). Los resultados muestran un modelo 
unidimensional con índices de bondad de ajuste satisfactorios (χ2 (9) = 52.00; 
CFI = .99; RMSEA = .09 [.07, .12]; WRMR = .85). Las λ del modelo fueron 
superiores a 0.50 y la fiabilidad tuvo un valor excelente (ω = .90). Asimismo, 
se evidencia la validez convergente y discriminante entre la PRE-COVID-19 y 
medidas de ansiedad, bienestar y salud autoinformada.
CONCLUSIÓN: Los resultados indican que la PRE-COVID-19 es un instrumento válido 
y fiable para medir la preocupación por el contagio de la COVID-19 y el impacto 
emocional en las personas.

Copyright © 2020 Elsevier España, S.L.U. All rights reserved.

DOI: 10.1016/j.enfcli.2020.10.034
PMCID: PMC7951881
PMID: 33323307 [Indexed for MEDLINE]


3960. Int J Environ Res Public Health. 2020 Dec 12;17(24):9308. doi: 
10.3390/ijerph17249308.

University Students' Perceived Peer Support and Experienced Depressive Symptoms 
during the COVID-19 Pandemic: The Mediating Role of Emotional Well-Being.

Sun Y(1), Lin SY(1), Chung KKH(1)(2).

Author information:
(1)Centre for Child and Family Science, The Education University of Hong Kong, 
Hong Kong, China.
(2)Department of Early Childhood Education, The Education University of Hong 
Kong, Hong Kong, China.

The coronavirus (COVID-19) pandemic has adversely affected individuals' mental 
health. Social isolation as a result of social distancing during the pandemic 
potentially affects the associations among perceived available peer support, 
emotional well-being, and depression in university students. The present study 
examined the associations among university students' perceived available peer 
support, emotional well-being (as indicated negatively by loneliness and 
negative affects and positively by positive affects and hope), and depressive 
symptoms. During the third wave of the COVID-19 outbreak in July, 2020, 255 
students at a public university in Hong Kong participated in an online-based 
survey that assessed their perceived available peer support, emotional 
well-being, and depressive symptoms. Results showed that perceived available 
peer support negatively contributed to depressive symptoms; both negative and 
positive indicators of emotional well-being mediated the association between 
perceived available peer support and depressive symptoms. Our results also 
suggested that university students showed signs of elevated depressive symptoms 
during the pandemic. Thus, our study advanced the theoretical understanding of 
university students' mental health in the time of a global pandemic. Our study 
also highlighted the practical needs for preventive efforts and accessible care 
to support the psychological and emotional needs of young people during the 
COVID-19 pandemic.

DOI: 10.3390/ijerph17249308
PMCID: PMC7763059
PMID: 33322751 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3961. J Med Internet Res. 2020 Dec 24;22(12):e22740. doi: 10.2196/22740.

Social Capital-Accrual, Escape-From-Self, and Time-Displacement Effects of 
Internet Use During the COVID-19 Stay-at-Home Period: Prospective, Quantitative 
Survey Study.

Cheng C(1), Lau YC(2), Luk JW(3).

Author information:
(1)Social and Health Psychology Laboratory, Department of Psychology, The 
University of Hong Kong, Hong Kong, Hong Kong.
(2)Division of Psychology and Language Sciences, University College London, 
London, United Kingdom.
(3)National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United 
States.

BACKGROUND: COVID-19 has spread like wildfire across the globe, prompting many 
governments to impose unprecedented stay-at-home orders to limit its 
transmission. During an extended stay-at-home period, individuals may engage in 
more online leisure activities. Internet use is a double-edged sword that may 
have both desirable and undesirable effects on psychological well-being, and 
this study sought to disentangle adaptive from maladaptive internet use amidst 
this unusual health crisis.
OBJECTIVE: The objectives of this study were to assess the prevalence of 
probable depression during the COVID-19 stay-at-home period and to test three 
hypothesized risk reduction or risk elevation mechanisms, namely social 
capital-accrual, escape-from-self, and time-displacement effects.
METHODS: This study took place from March to May 2020 at the early stage of the 
pandemic. The study adopted a prospective design, with an online survey 
administered to 573 UK and 474 US adult residents at two assessment points 2 
months apart.
RESULTS: The prevalence of moderate to severe depression was 36% (bootstrap 
bias-corrected and accelerated [BCa] 95% CI 33%-39%) at Time 1 (ie, initial time 
point) and 27% (bootstrap BCa 95% CI 25%-30%) at Time 2 (ie, follow-up time 
point). The results supported the social capital-accrual hypothesis by showing 
that the approach coping style was inversely associated with Time 2 depression 
through its positive associations with both social networking and perceived 
family support. The results also supported the escape-from-self hypothesis by 
revealing that the avoidant coping style was positively associated with Time 2 
depression through its positive associations with both gaming and cyberbullying 
victimization, but the serial mediation model was no longer significant after 
Time 1 depression and some demographic risk factors had been controlled for. 
Finally, the results supported the time-displacement hypothesis by showing that 
gaming was positively associated with Time 2 depression through its inverse 
associations with social networking and perceived family support.
CONCLUSIONS: During the extended stay-at-home period in the early stages of the 
COVID-19 pandemic, the prevalence of probable depression during the 2-month 
study period was high among the UK and US residents. Individuals with distinct 
coping styles may engage in different types of online leisure activities and 
perceive varying levels of social support, which are associated with risks of 
probable depression.

©Cecilia Cheng, Yan-Ching Lau, Jeremy W Luk. Originally published in the Journal 
of Medical Internet Research (http://www.jmir.org), 24.12.2020.

DOI: 10.2196/22740
PMCID: PMC7772052
PMID: 33320824 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


3962. Psychol Health Med. 2021 Jan;26(1):85-97. doi: 10.1080/13548506.2020.1859566. 
Epub 2020 Dec 15.

Psychological Well-Being, Depression and Stress During COVID-19 Pandemic in 
Turkey: A Comparative Study of Healthcare Professionals and Non-Healthcare 
Professionals.

Ceri V(1), Cicek I(1).

Author information:
(1)Department of Child Development, Batman University , Batman, Turkey.

In this study, we aimed to investigate psychological well-being, depression, and 
stress among healthcare professionals and non-healthcare professionals in 
Turkey. An online questionnaire was prepared and shared with participants using 
social networking sites. Participants were 546 healthcare professionals 
(females = 313) and 445 non-healthcare professionals (females = 333), aged 
between 20 and 67 years. All participants completed measures of Depression 
Anxiety and Stress Scale-21 and Psychological Well-Being Scale. The results 
showed no significant difference in the scores of psychological well-being, 
depression and stress of healthcare professionals and non-healthcare 
professionals. However, the psychological well-being of healthcare professionals 
and stress varied in terms of age, gender, marital status, job descriptions, and 
ways of working in clinic. Women, non-physician healthcare professionals, young 
and single people and those who worked in COVID-19 service and stayed at least 
one week away from their families during the pandemic were found to have poor 
mental well-being. Psychological well-being was significantly and negatively 
correlated with depression and anxiety. Our findings indicate that healthcare 
professionals who are at the frontline of the fight against the COVID-19, and 
nurses, women, single person and those who are away from their family for more 
than a week during the pandemic are at greater risk.

DOI: 10.1080/13548506.2020.1859566
PMID: 33320723 [Indexed for MEDLINE]


3963. Gerontologist. 2021 Feb 23;61(2):228-239. doi: 10.1093/geront/gnaa205.

The COVID-19 Pandemic and Psychosocial Outcomes Across Age Through the Stress 
and Coping Framework.

Minahan J(1), Falzarano F(2), Yazdani N(1), Siedlecki KL(1).

Author information:
(1)Department of Psychology, Fordham University, Bronx, New York, USA.
(2)Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New 
York, New York, USA.

BACKGROUND AND OBJECTIVES: The emergence of the Coronavirus Disease 2019 
(COVID-19) and the measures implemented to curb its spread may have deleterious 
effects on mental health. Older adults may be at increased risk for adverse 
psychosocial outcomes because opportunities to remain socially connected have 
diminished. Research is needed to better understand the impact of 
pandemic-related stress on mental health. The purpose of this study is 3-fold: 
(a) to examine the influences of COVID-19 pandemic-related stress on depression, 
anxiety, and loneliness; (b) to assess the mediating role of coping style and 
social support; and (c) to investigate whether these relationships vary across 
age.
RESEARCH DESIGN AND METHODS: Participants (N = 1,318) aged 18-92 years completed 
an online survey assessing pandemic-related stress, mental health, social 
support, coping, and their experiences with social distancing, during the 
initial implementation of social distancing measures in the United States.
RESULTS: Social support and coping style were found to relate to psychosocial 
outcomes. Avoidant coping was the strongest mediator of the relationship between 
pandemic-related stress and psychosocial outcomes, particularly depression. 
Avoidant coping more strongly mediated the relationship between stress and 
depression in younger adults compared to older adults.
DISCUSSION AND IMPLICATIONS: Results were consistent with the stress and coping 
framework and recent work highlighting older adults' resilience during the 
COVID-19 pandemic. Findings highlight the associations between positive coping 
behaviors and psychosocial well-being and indicate that older adults may use 
unique adaptive mechanisms to preserve well-being during the COVID-19 pandemic.

© The Author(s) 2020. Published by Oxford University Press on behalf of The 
Gerontological Society of America. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/geront/gnaa205
PMCID: PMC7799081
PMID: 33320191 [Indexed for MEDLINE]


3964. Int J Environ Res Public Health. 2020 Dec 9;17(24):9183. doi: 
10.3390/ijerph17249183.

Prevalence of Depression, Anxiety, and Stress among the General Population in 
Saudi Arabia during Covid-19 Pandemic.

Alamri HS(1), Algarni A(2), Shehata SF(3)(4), Al Bshabshe A(1), Alshehri NN(1), 
ALAsiri AM(2), Hussain AH(5), Alalmay AY(5), Alshehri EA(2), Alqarni Y(6), Saleh 
NF(2).

Author information:
(1)Department of Medicine, College of Medicine, King Khalid University, Abha 
61421, Saudi Arabia.
(2)Ministry of Health, Abha 11176, Saudi Arabia.
(3)Department of Family and Community Medicine, College of Medicine, King Khalid 
University, Abha 62529, Saudi Arabia.
(4)Biostatistics Department, High Institute of Public Health, Alexandria 
University, 65 Garidet St., El Horeya Rd., El Shatby, Alexandria 21526, Egypt.
(5)Medical City, King Khalid University, Abha 61421, Saudi Arabia.
(6)Critical Care Medicine, National Guard Hospital, Riyadh 14611, Saudi Arabia.

Coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on 
public mental health. Our objective was to assess prevalence of depression, 
anxiety, and stress among the general population in Saudi Arabia during this 
pandemic. A descriptive cross-sectional approach was used targeting all 
accessible populations in Saudi Arabia. Data were collected from participants 
using an electronic pre-structured questionnaire. Psychological impact was 
assessed using the Arabic version of Depression, Anxiety, and Stress Scale 
(DASS-21). A total of 1597 participants completed the survey. In total, 17.1% 
reported moderate to severe depressive symptoms; 10% reported moderate to severe 
anxiety symptoms; and 12% reported moderate to severe stress levels. Depression, 
anxiety, and stress were significantly higher among females, younger 
respondents, and health care providers. Depression was higher among smokers, 
singles, and non-working respondents. Anxiety was higher among those reporting 
contacts with COVID-19 positive cases, previously quarantined and those with 
chronic health problems. Our findings reaffirm the importance of providing 
appropriate knowledge and specialized interventions to promote the mental 
well-being of the Saudi population, paying particular attention to high-risk 
groups.

DOI: 10.3390/ijerph17249183
PMCID: PMC7764434
PMID: 33316900 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3965. Laryngorhinootologie. 2021 Feb;100(2):104-110. doi: 10.1055/a-1327-4234. Epub 
2020 Dec 14.

[Oncology Services for Patients with Head Neck Cancer during Corona-Times - 
Patients' Perspective].

[Article in German; Abstract available in German from the publisher]

Büntzel J(1), Walter S(1), Hellmund H(2), Klein M(3), Hübner J(1), Vitek P(4), 
Büntzel J(5), Koscielny S(6), Sesterhenn AM(7), Büssing A(8).

Author information:
(1)AG Prävention und Integrative Onkologie (PRIO), German Cancer Society, 
Berlin, Germany.
(2)Geschäftsstelle, Bundesverband der Kehlkopfoperierten e. V., Bonn, Germany.
(3)Klinik für Hämatoonkologie, Universitätsklinikum Jena, Germany.
(4)HNO-Klinik, Südharz Klinikum Nordhausen gGmbH, Nordhausen, Germany.
(5)Klinik für Hämatologie und medizinische Onkologie, Universitätsmedizin 
Göttingen, Göttingen, Germany.
(6)HNO-Klinik, Universitätsklinikum Jena, Germany.
(7)Klinik für Hals-Nasen-Ohrenheilkunde, Städtisches Klinikum Solingen, Germany.
(8)Professur für Lebensqualität, Spiritualität und Coping, Universität 
Witten-Herdecke, Witten, Germany.

OBJECTIVE: COVID-19 pandemic has impact on the oncology service system for tumor 
patients. What is the view of head and neck cancer patients (HNC) on this 
situation and which coping strategies were developed?
MATERIAL & METHODS: In study 1 PRIO asked 433 tumor patients regarding their 
impressions/fears during the lockdown between April 15 and May 15, 2020 (online, 
standardized questionnaire). In 2nd study 292 tumor patients reported their 
pandemic-induced perceived changes and coping strategies by established 
questionnaires (WHO-5, MLQ, GrAw-7). An analysis of the HNC-data obtained by 
standardized questionnaires was performed.
RESULTS: Study 1 had 91 HNC, study 2-84 HNC. Study 1 shows high stress levels 
for the majority of HNC (53,8 %). Personal fears regarding the own disease and 
therapies (39.6 %) are a central problem. The participants await physical 
(24.7 %) as well as psychological (21.3 %) consequences due to the pandemic and 
its current management. During the lockdown the isolation (banned visitors at 
any hospital) was discussed as critical main point by 58.5 % of HNC patients. 
Study 2 (after lockdown) underlined the mental stress caused by pandemic. 
Intensified relations within the families (58/100 points) as well as more 
intensive experience of nature and silence (58/60 points) are the most perceived 
changes in corona-times. HNC showed increased own inactivity (MLQ) and depressed 
well-being (WHO-5) and attention to the moment (GrAw-7).
CONCLUSIONS: HNC patients have had high burden and fears due to the COVID-19 
pandemic in spring 2020. Their views are important for further strategies to 
organize and stabilize the oncology service system during further pandemic 
periods.

Publisher: FRAGESTELLUNG: Die COVID-19-Pandemie hat Auswirkungen auf die 
Versorgung von Tumorpatienten. Wie erleben Patienten mit Kopf-Hals-Tumoren (KHT) 
diese Situation und welche Coping-Strategien ergeben sich?
MATERIAL UND METHODE: Wir befragten in Studie 1 während des Lockdowns 
(15.04.–15.05.2020) 433 Tumorpatienten nach ihren Eindrücken/Belastungen 
(online, standardisiert, anonym). In Studie 2 wurden 292 Patienten nach dem 
Lockdown (06.05.–10.06.2020) zu ihren wahrgenommenen Veränderungen, 
Perspektivwechseln und Coping-Strategien mit standardisierten Tools (WHO-5, 
MLQ-10, GrAw-7) befragt. Für beide Studien analysierten wir die KHT.
ERGEBNISSE: An Studie 1 nahmen 91 Patienten mit KHT teil, in Studie 2 wurden 84 
Patienten mit KHT aufgenommen. Studie 1 zeigte im Lockdown einen hohen Druck auf 
die Mehrheit der Patienten mit KHT (53,8 %). Es waren Ängste bezüglich der 
eigenen Krankheit (39,6 %), aber auch erwartete physische (24,7 %) und 
psychische Folgen (21,3 %) der Pandemie. Die soziale Isolation (Besuchsverbot) 
wurde als ein Hauptproblem (58,5 %) beschrieben. Studie 2 bestätigte diese 
Belastungen auch nach dem Lockdown. Intensivere Beziehungen in der Familie 
(60/100 Punkten) sowie eine Zuwendung zu Natur und Stille (58/100 Punkten) 
wurden als entlastend beschrieben. Eine hohe Inaktivität (MLQ-10) sowie ein 
vermindertes Wohlbefinden (WHO-5) und eine reduzierte Achtsamkeit (GrAw-7) waren 
Charakteristiken der KHT, die Ansatzpunkte für eine Stärkung der Resilienz sein 
können.
SCHLUSSFOLGERUNG: Patienten mit KHT haben einen hohen mentalen und psychischen 
Druck durch die Pandemie. Ihr Blickwinkel ergänzt unsere bisherige Sicht und 
kann zu einer verbesserten Gesamtversorgung dieser Patienten beitragen.

Thieme. All rights reserved.

DOI: 10.1055/a-1327-4234
PMID: 33316831 [Indexed for MEDLINE]

Conflict of interest statement: Die Autorinnen/Autoren geben an, dass kein 
Interessenkonflikt besteht.


3966. Headache. 2021 Jan;61(1):149-156. doi: 10.1111/head.14030. Epub 2020 Dec 14.

Early impact of the COVID-19 pandemic on outpatient migraine care in Hawaii: 
Results of a quality improvement survey.

Smith M(1), Nakamoto M(1), Crocker J(1), Tiffany Morden F(1), Liu K(1), Ma E(1), 
Chong A(2), Van N(2), Vajjala V(3), Carrazana E(4), Viereck J(4), Liow K(4).

Author information:
(1)John Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.
(2)Undergraduate Education, University of Hawaii at Manoa, Honolulu, HI, USA.
(3)Headache & Facial Pain Center, Hawaii Pacific Neuroscience, Honolulu, HI, 
USA.
(4)Clinical Research Center, Brain Research, Innovation & Translation Labs, 
Hawaii Pacific Neuroscience, Honolulu, HI, USA.

OBJECTIVE: A survey was implemented for early assessment of pandemic-related 
practice processes and quality improvement (QI).
BACKGROUND: In response to the public health measures in Hawaii to curtail the 
coronavirus 2019 pandemic, Hawaii Pacific Neuroscience (HPN) adapted their 
patient care to ensure continuity of neurological treatment.
METHODS: The telephone survey was conducted on patients seen at HPN during the 
period of April 22, 2020-May 18, 2020 to address four areas related to patients' 
outpatient experience: delivery of care, general well-being, experience with 
telemedicine, and disease-specific questions.
RESULTS: A total of 928 patients were contacted of which 429 (46.2%) patients 
responded and 367 (85.5%) agreed to participate. A total of 133 patients with 
migraine and 234 patients with other neurological conditions provided responses. 
Our migraine patients' survey responses suggest that their well-being was 
disproportionately negatively affected by the pandemic. Survey respondents with 
migraine were significantly more likely than their non-migraine peers to report 
worsening anxiety and sleep problems [62/132 (47.0%) vs. 78/234 (33.3%), χ2 
 = 6.64, p = 0.010, and 64/132 (48.5%) vs. 73/234 (31.2%), χ2  = 10.77, 
p = 0.001]; migraine patients also reported worsening of depression as a result 
of the pandemic more than patients with other diagnoses, though this was not 
statistically significant [44/132 (33.3%) vs. 57/234 (24.4%), χ2  = 3.40, 
p = 0.065]. In regard to access to healthcare, significantly more migraine 
patients reported running out of medications than those with other diagnoses 
[20/133 (15.0%) vs. 18/234 (7.7%), χ2  = 4.93, p = 0.026]. More avoided seeking 
medical help for new health problems because of the pandemic [30/133 (22.6%) vs. 
30/234 (12.8%), χ2  = 5.88, p = 0.015]. Migraine patients were also 
significantly impacted economically by the pandemic; 43/132 (32.4%) of migraine 
patients reported losing their jobs as the result of the pandemic versus 34/234 
(14.5%) of their peers (χ2  = 11.20, p < 0.001). An increase in headache 
severity or frequency was reported in 39/118 (33.1%) of respondents and 19/118 
(16.1%) reported to using more abortive therapy than usual. Telemedicine was 
well received by almost all patients who took advantage of the option. Most of 
those patients found telemedicine to be easy to use and as valuable as an 
in-person visit. Migraine patients indicated with more frequency that without 
the telemedicine option, they would have missed their medical appointments 
[37/68 (54.4%) vs. 56/144 (38.6%), χ2  = 4.31, p = 0.038]; a majority would 
prefer or consider telemedicine for future appointments over in-person visits.
CONCLUSIONS: Insights gained from this QI survey to the practice's new 
pandemic-related processes include stressing lifestyle modification, optimizing 
treatment plans, and continuing the option of telemedicine.

© 2020 American Headache Society.

DOI: 10.1111/head.14030
PMID: 33316097 [Indexed for MEDLINE]


3967. PLoS One. 2020 Dec 14;15(12):e0243524. doi: 10.1371/journal.pone.0243524. 
eCollection 2020.

Healthy lifestyle behaviors are major predictors of mental wellbeing during 
COVID-19 pandemic confinement: A study on adult Arabs in higher educational 
institutions.

Kilani HA(1), Bataineh MF(2), Al-Nawayseh A(2), Atiyat K(1), Obeid O(3), 
Abu-Hilal MM(4), Mansi T(1), Al-Kilani M(2), Al-Kitani M(5), El-Saleh M(6), 
Jaber RM(7), Sweidan A(8), Himsi M(9), Yousef I(10), Alzeer F(11), Nasrallah 
M(12), Al Dhaheri AS(13), Al-Za'abi A(14), Allala O(15), Al-Kilani L(16), 
Alhasan AM(8), Ghieda M(17), Najah Y(18), Alsheekhly S(19), Alhaifi A(20), 
Shukri R(21), Al Adwani J(22), Waly M(23), Kilani L(24), Kilani LH(25), Al 
Shareef AS(26), Kilani A(27).

Author information:
(1)Kinesiology and Training Department, School of Sport Sciences, University of 
Jordan, Amman, Jordan.
(2)Department of Sport Rehabilitation, College of Physical Education and Sport 
Science, Hashemite University, Zarqa, Jordan.
(3)Department of Nutrition and Food Sciences, American University of Beirut, 
Beirut, Lebanon.
(4)Psychology Department, College of Education, Sultan Qaboos University, 
Muscat, Oman.
(5)Physical Education & Sports Sciences, College of Education, Sultan Qaboos 
University, Muscat, Oman.
(6)College of Education, Humanities and Social Sciences, Al-Ain University, 
Al-Ain, United Arab Emirates.
(7)School of Medicine, Family Medicine, University of Jordan, Amman, Jordan.
(8)Ministry of Education, Amman, Jordan.
(9)Wellness Department, Actness Academy, Amman, Jordan.
(10)Physical Education Department, Beir Zeit University, Ramallah, Palestine.
(11)Physical Education Department, Khadouri University, Ramallah, Palestine.
(12)Military Physical Training Department, Al Istiqlal University, Jericho, 
Palestine.
(13)Food, Nutrition and Health Department, United Arab Emirates University, 
Al-Ain, United Arab Emirates.
(14)Health and Physical Education Department, College of Education, UAEU, 
Al-Ain, Abu Dhabi, United Arab Emirates.
(15)Sports Health Specialist, Abu Dhabi Sports Council, Abu Dhabi, United Arab 
Emirates.
(16)Department of Physical & Sport Sciences, Princess Nourah bint Abdulrahman 
University, Riyadh, Saudi Arabia.
(17)Sport Kinesiology Department, Mansoura University, Mansoura, Egypt.
(18)College of Physical Education and Sports Science, University of Baghdad, 
Baghdad, Iraq.
(19)College of Political Science, University of Baghdad, Baghdad, Iraq.
(20)College of Health Sciences, The Public Authority for Applied Education and 
Training, Adailiya, Kuwait.
(21)Nursing Department, Head of Nursing Department, Tokyo Human Health Sciences 
University Vietnam, Ho Chi Minh City, Vietnam.
(22)Ministry of Awqaf and Islamic Affairs, Kuwait City, Kuwait.
(23)Food Science and Nutrition Department, College of Agricultural and Marine 
Sciences, Sultan Qaboos University, Muscat, Oman.
(24)Clinical Pharmacist, University of Jordan, Amman, Jordan.
(25)College of Engineering, University of Jordan, Amman, Jordan.
(26)Drassa Academy, Dubai, United Arab Emirates.
(27)Internal Medicine Department, Jordan University Hospital, Amman, Jordan.

Erratum in
    PLoS One. 2022 Aug 15;17(8):e0273276.

BACKGROUND: In the past infectious diseases affected the quality of lifestyle 
during home confinement. The study conducted examines the influence of home 
confinement during the COVID-19 pandemic outbreak on lifestyle, mental 
wellbeing, nutritional status, and sleeping pattern.
METHOD: An online multicategorical questionnaire was distributed to collect 
demographic information combined with the following tools: Food Frequency 
Questionnaire (FFQ), International Physical Activity Questionnaire (IPAQ), WHO-5 
wellbeing score, and Pittsburgh Sleep Quality Index (PSQI). A snowball 
non-discriminate sampling procedure was conducted to collect data from people 
attending or working at higher institutions from March 1, 2020 to April 24, 
2020. A total of 1723 completed responses (917 males, 37.4 ±13.4 years old and 
806 females 32.2 ± 11.5 years old) were collected.
RESULTS: The female participants had significantly lower mental health scores 
than males (53.9% vs. 46.1%). The mental wellbeing scores were higher among 
participants with medium and high physical activity (PA) levels (p < 0.00). 
Additionally, the mental wellbeing scores were significantly improved by dietary 
quality and it's sleeping score (p < 0.001). However, PA was by far the major 
determinant of the mental health scores.
CONCLUSION: Factors such as PA, diet, and sleeping patterns were associated with 
mental wellbeing during the COVID-19 confinement among Arab participants.

DOI: 10.1371/journal.pone.0243524
PMCID: PMC7735567
PMID: 33315880 [Indexed for MEDLINE]

Conflict of interest statement: MH is an employee of Actness. This does not 
alter our adherence to PLOS ONE policies on sharing data and materials.


3968. Health Care Women Int. 2020 Nov-Dec;41(11-12):1349-1362. doi: 
10.1080/07399332.2020.1841194. Epub 2020 Dec 14.

An analysis of mother stress before and during COVID-19 pandemic: The case of 
China.

Tchimtchoua Tamo AR(1).

Author information:
(1)Department of Psychology and Behavioural Sciences, Zhejiang University, 
Hangzhou, P.R. China.

In this study, the authors aimed to examine relations between mothers' stress 
(PSI-SF) and their children during the COVID-19 pandemic confinement in mainland 
China (N  = 274; mean age = 32.95, SD = 5.59). Our analyses revealed mothers 
identified more stress problems during the confinement than before including 
Difficult Child, Parental Distress, and Parent-Child Dysfunctional Interaction, 
which predicted requests for clinical or parents support services. Mothers 
living in rural areas reported less stress. Single mothers and those in small 
households displayed a higher level of stress. Our research results may assist 
policymakers, professionals, and researchers to design support needed to promote 
families' psychological well-being.

DOI: 10.1080/07399332.2020.1841194
PMID: 33315545 [Indexed for MEDLINE]


3969. Psychol Health Med. 2021 Jan;26(1):75-84. doi: 10.1080/13548506.2020.1858490. 
Epub 2020 Dec 14.

Emotional reactions and subjective health status during the COVID-19 pandemic in 
Israel: the mediating role of perceived susceptibility.

Inbar L(1), Shinan-Altman S(2).

Author information:
(1)Faculty of Graduate Studies, Oranim Academic College of Education , Kiryat 
Tiv'on, Israel.
(2)The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University , 
Ramat Gan, Israel.

The general consensus is that COVID-19, the virus spreading rapidly across the 
globe, affects physical health but also mental health and mental well-being. 
This study aimed to assess the associations among emotional reactions toward 
COVID-19, knowledge about COVID-19, perceived susceptibility to this disease, 
and subjective health status. This study was a cross-sectional study conducted 
among 1,085 Israeli adults who completed an online survey between April 23 and 
May 5, 2020. The self-administered questionnaire included questions about 
emotional reactions to COVID-19, knowledge about COVID-19, perceived 
susceptibility, subjective health status, and sociodemographic variables. 
Participants (aged 18-96) reported high levels of emotional reactions to 
COVID-19. Most respondents were worried (77.4%), afraid (62.8%) or stressed 
(55.3%). Emotional reaction scores were higher among women than among men. In 
the regression model, emotional reactions were higher for older participants, 
those who rated their subjective health status as poorer, and those who were 
employed, with the final model explaining 11.6% of the variance in emotional 
reactions. Perceived susceptibility significantly mediated the relationship 
between subjective health status and emotional reactions. The high prevalence of 
emotional responses among women, older people and those with lower subjective 
health ratings points to the need for intervention programs primarily targeting 
these groups.

DOI: 10.1080/13548506.2020.1858490
PMID: 33315513 [Indexed for MEDLINE]


3970. Int J Clin Pract. 2021 Apr;75(4):e13933. doi: 10.1111/ijcp.13933. Epub 2020 Dec 
25.

Lockdown, Social Media exposure regarding COVID-19 and the relation with 
self-assessment depression and anxiety. Is the medical staff different?

Cordoș AA(1), Bolboacă SD(1).

Author information:
(1)Medical Informatics and Biostatistics, Department XII - Medical Education, 
Faculty of Medicine, "Iuliu Haţieganu" University of Medicine and Pharmacy, 
Cluj-Napoca, Romania.

INTRODUCTION: Locking the humanity in their homes, COVID-19 forced people to use 
the technology at hand to keep informed about the outbreak and to keep close to 
their loved ones. During this time, even if physical health is theoretically 
unaffected, keeping calm and sane can be challenging. The aim of this research 
was to evaluate whether exposure to COVID-19 information available in the 
digital space has a different impact on the mental condition of Romanian medical 
staff, compared with the general population, particularly searching for 
depression and anxiety symptoms.
MATERIALS AND METHODS: An online survey was conducted from April 6 to 16, 2020 
within the Romanian users of Social Media platforms. The questionnaire assessed 
depression with the WHO-Five Well-Being Index, anxiety with the Generalised 
Anxiety Disorder Scale and Social Media exposure by asking how often the 
respondents saw COVID-19 related information on the most popular Social Media 
channels in Romania. Information about: gender, age, educational level, 
occupation, area of living and risk category was also collected. The risk 
categories were defined as no risk, medium risk and medical staff.
RESULTS: Almost 90% of the 402 participants received daily through at least one 
Social Media channel information related to the COVID-19 outbreak. Social Media 
Exposure significantly associated with the risk group only for Facebook and 
LinkedIn. However, exposure to information regarding COVID-19 was neither 
associated with anxiety nor depression. No significant association was 
identified neither between age class and self-assessed anxiety nor self-assessed 
depression. The self-assessment of depression was significantly more frequent as 
compared with the self-assessment of anxiety.
CONCLUSION: The results of this research are opposite to most of the already 
published literature. Depression and anxiety could not be correlated with the 
context of lockdown and excessive COVID-19-related information.

© 2020 John Wiley & Sons Ltd.

DOI: 10.1111/ijcp.13933
PMCID: PMC7883026
PMID: 33314469 [Indexed for MEDLINE]


3971. Rheumatology (Oxford). 2021 Aug 2;60(8):3709-3715. doi: 
10.1093/rheumatology/keaa842.

The psychological impact of the COVID-19 pandemic on Dutch people with and 
without an inflammatory rheumatic disease.

Koppert TY(1), Jacobs JWG(2), Geenen R(3).

Author information:
(1)Department of Psychology, Leiden University, Leiden, The Netherlands.
(2)Department of Rheumatology and Clinical Immunology, University Medical Center 
Utrecht, The Netherlands.
(3)Department of Psychology, Utrecht University, Utrecht, The Netherlands.

OBJECTIVES: To determine the psychological impact of the COVID-19 pandemic on 
people with and without an inflammatory rheumatic disease and establish whether 
psychological flexibility buffers this impact.
METHODS: From online surveys in the general Dutch population in 2018 and during 
the peak of the COVID-19 pandemic in 2020, we analysed data of people with 
(index group, n = 239) and without (control group, n = 1821) an inflammatory 
rheumatic disease. Worry, stress, mental well-being (SF-36) and psychological 
flexibility levels were subjected to covariate-adjusted analyses of variance or 
linear regression analyses.
RESULTS: During the peak of the COVID-19 pandemic in 2020, as compared with the 
control group, the index group was more worried about getting infected with the 
virus (partial η2=0.098; medium effect) and more stressed (partial η2=0.040; 
small effect). However, as compared with data acquired in 2018, the level of 
mental well-being during the COVID-19 pandemic peak was not lower in both 
groups. Levels of psychological flexibility did not moderate associations of 
group or year with mental well-being.
CONCLUSIONS: Although patients with an inflammatory rheumatic disease were more 
worried and stressed during the peak of the COVID-19 pandemic, their level of 
mental well-being was not reduced, which may have prevented us from finding a 
buffering effect of psychological flexibility. Overall, our results suggest that 
the psychological impact of the COVID-19 pandemic in patients with inflammatory 
rheumatic disease is modest, which could imply that common education and health 
care will do for most patients.

© The Author(s) 2020. Published by Oxford University Press on behalf of the 
British Society for Rheumatology. All rights reserved. For permissions, please 
email: journals.permissions@oup.com.

DOI: 10.1093/rheumatology/keaa842
PMCID: PMC7798513
PMID: 33313870 [Indexed for MEDLINE]


3972. Front Public Health. 2020 Nov 17;8:582699. doi: 10.3389/fpubh.2020.582699. 
eCollection 2020.

Bariatric Surgery Closure During COVID-19 Lockdown in Italy: The Perspective of 
Waiting List Candidates.

Bianciardi E(1), Imperatori C(2), Niolu C(1), Campanelli M(3), Franceschilli 
M(3), Petagna L(3), Zerbin F(1), Siracusano A(1), Gentileschi P(3).

Author information:
(1)Chair of Psychiatry, Department of Systems Medicine, University of Rome "Tor 
Vergata", Rome, Italy.
(2)Cognitive and Clinical Psychology Laboratory, Department of Human Science, 
European University of Rome, Rome, Italy.
(3)Obesity Unit, Department of Surgery, University of Rome "Tor Vergata", Rome, 
Italy.

Background: From the beginning of March 2020, lockdown regimens prevented 
patients with obesity from receiving bariatric surgery. Surgical emergencies and 
oncological procedures were the only operations allowed in public hospitals. 
Consequently, patients with morbid obesity were put in a standby situation. With 
the aim at exploring the viewpoint of our future bariatric surgery patients, we 
built a questionnaire concerning obesity and COVID-19. Method: A total of 116 
bariatric surgery candidates were approached using a telephonic interview during 
the Italian lockdown. Results: Of the total sample, 73.8% were favorable to 
regular bariatric surgery execution. Forty percent were concerned about their 
own health status due to the COVID-19 emergency, and 61.1% were troubled by the 
temporary closure of the bariatric unit. The majority of the sample were eating 
more. Forty-five percent and the 27.5% of patients reported a worsening of the 
emotional state and physical health, respectively. Most of the patients (52.2%) 
considered themselves more vulnerable to COVID-19, especially individuals with 
class III obesity. Patients who reported an increased consumption of food were 
younger (43.44 ± 12.16 vs. 49.18 ± 12.66; F = 4.28, p = 0.042). No gender 
difference emerged. Conclusion: The lockdown had a negative result on Italian 
patients' psychological well-being and eating habits. The majority of patients 
would have proceeded with the surgery even during the COVID-19 emergency. 
Effective management and bariatric surgery should be restarted as soon as 
possible.

Copyright © 2020 Bianciardi, Imperatori, Niolu, Campanelli, Franceschilli, 
Petagna, Zerbin, Siracusano and Gentileschi.

DOI: 10.3389/fpubh.2020.582699
PMCID: PMC7706656
PMID: 33313038 [Indexed for MEDLINE]


3973. Diabetes Metab Syndr. 2021 Jan-Feb;15(1):63-68. doi: 10.1016/j.dsx.2020.12.013. 
Epub 2020 Dec 6.

Managing Type 1 Diabetes among Saudi adults on insulin pump therapy during the 
COVID-19 lockdown.

Magliah SF(1), Zarif HA(2), Althubaiti A(3), Sabban MF(1).

Author information:
(1)Department of Family Medicine, Ministry of the National Guard-Health Affairs, 
King Abdulaziz Medical City, P.O. Box 9515, Jeddah, 21423, Saudi Arabia.
(2)Department of Medicine, Ministry of the National Guard-Health Affairs, King 
Abdulaziz Medical City, P.O. Box 9515, Jeddah, 21423, Saudi Arabia; College of 
Medicine, King Saud bin Abdulaziz University for Health Sciences, P.O. Box 9515, 
Jeddah, 21423, Saudi Arabia; King Abdullah International Medical Research 
Center, P.O. Box 9515, Jeddah, 21423, Saudi Arabia.
(3)College of Medicine, King Saud bin Abdulaziz University for Health Sciences, 
P.O. Box 9515, Jeddah, 21423, Saudi Arabia; King Abdullah International Medical 
Research Center, P.O. Box 9515, Jeddah, 21423, Saudi Arabia. Electronic address: 
thubaitia@ksau-hs.edu.sa.

BACKGROUND AND AIMS: The coronavirus disease 2019 (COVID-19) pandemic has 
affected people's lives including patients with type 1 diabetes mellitus (T1DM). 
We aimed to investigate the impact of the COVID-19 lockdown on psychological 
status, self-management behaviors, and diabetes care maintenance among Saudi 
adults with T1DM using insulin pump therapy.
METHODS: This cross-sectional study used a web survey to collect data on Saudi 
adults with T1DM who were treated in the specialized insulin pump clinic at King 
Abdulaziz Medical City-Jeddah, Saudi Arabia. We used the Patient Health 
Questionnaire-9 and General Anxiety Disorder-7 scales to measure depression and 
anxiety.
RESULTS: Of the 70 patients who received the survey, 65 completed it. Overall, 
23.1% and 29.2% of the patients reported moderate to severe and mild depression, 
respectively; 18.5% and 24.6% reported moderate to severe and mild anxiety, 
respectively. Compared with pre-lockdown, adherence to a healthy diet and 
regular physical activity decreased in 67.7% and 41.5% of the patients, 
respectively. Most patients maintained their adherence to insulin pump 
behaviors; frequent self-monitoring of blood glucose increased in 47% of 
glucometer users. Most patients benefited from phone visits or virtual education 
sessions, but 66.2% of the patients reported difficulty obtaining at least one 
type of insulin pump supply.
CONCLUSIONS: Promoting self-management behaviors and psychological wellbeing of 
patients with T1DM using insulin pump therapy is crucial during a lockdown. 
Telemedicine is a useful alternative to in-person appointments, but strategies 
to ensure that patients have access to adequate resources during lockdown must 
be developed.

Copyright © 2020 Diabetes India. Published by Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.dsx.2020.12.013
PMCID: PMC7719196
PMID: 33310178 [Indexed for MEDLINE]


3974. J Hosp Infect. 2021 Feb;108:185-188. doi: 10.1016/j.jhin.2020.11.027. Epub 2020 
Dec 7.

Heat stress and PPE during COVID-19: impact on healthcare workers' performance, 
safety and well-being in NHS settings.

Davey SL(1), Lee BJ(2), Robbins T(3), Randeva H(4), Thake CD(2).

Author information:
(1)Occupational and Environmental Physiology Group, Centre for Sport, Exercise 
and Life Sciences, Faculty of Health and Life Sciences, Coventry University, 
Coventry, UK. Electronic address: ad4782@coventry.ac.uk.
(2)Occupational and Environmental Physiology Group, Centre for Sport, Exercise 
and Life Sciences, Faculty of Health and Life Sciences, Coventry University, 
Coventry, UK.
(3)University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; 
Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK.
(4)University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK.

Personal protective equipment (PPE) can potentiate heat stress, which may have a 
negative impact on the wearer's performance, safety and well-being. In view of 
this, a survey was distributed to healthcare workers (HCWs) required to wear PPE 
during the coronavirus disease 2019 pandemic in the UK to evaluate perceived 
levels of heat stress and its consequences. Respondents reported experiencing 
several heat-related illness symptoms, and heat stress impaired both cognitive 
and physical performance. The majority of respondents stated that wearing PPE 
made their job more difficult. These, and additional, responses suggest that 
modification to current working practices is required urgently to improve the 
resilience of HCWs to wearing PPE during pandemics.

Copyright © 2020 The Healthcare Infection Society. Published by Elsevier Ltd. 
All rights reserved.

DOI: 10.1016/j.jhin.2020.11.027
PMCID: PMC7720696
PMID: 33301841 [Indexed for MEDLINE]


3975. medRxiv [Preprint]. 2020 Dec 7:2020.11.30.20241026. doi: 
10.1101/2020.11.30.20241026.

Giving birth under hospital visitor restrictions: Heightened acute stress in 
childbirth in COVID-19 positive women.

Mayopoulos G, Ein-Dor T, Li KG, Chan SJ, Dekel S.

Update in
    Sci Rep. 2021 Jun 29;11(1):13535.

As the novel coronavirus (COVID-19) has spread globally, a significant portion 
of women have undergone childbirth while possibly infected with the virus and 
also under social isolation due to hospital visitor restrictions. Emerging 
studies examined birth outcomes in COVID-19 positive women, but knowledge of the 
psychological experience of childbirth remains lacking. This study survey 
concerning childbirth and mental health launched during the first wave of the 
pandemic in the US. Women reporting confirmed/suspected COVID-19 during 
childbirth were matched on various background factors with women reporting 
COVID-19 negative. We found higher prevalence of clinically significant acute 
stress in birth in COVID-19 positive women. This group was 11 times as likely to 
have no visitors than matched controls and reported higher levels of pain in 
delivery, lower newborn weights, and more infant admission to neonatal intensive 
care units. Visitor restrictions were associated with these birth outcomes. 
COVID-19 positive women with no visitors were 6 times as likely to report 
clinical acute stress in birth than COVID-19 positive women with visitors. The 
findings underscore increased risk for childbirth-induced psychological 
morbidity in COVID-19-affected populations. As hospitals continue to revise 
policies concerning visitor restrictions, attention to the wellbeing of new 
mothers is warranted.

DOI: 10.1101/2020.11.30.20241026
PMCID: PMC7724672
PMID: 33300005


3976. BMC Psychol. 2020 Dec 9;8(1):127. doi: 10.1186/s40359-020-00497-z.

Self-reported psychological distress during the COVID-19 outbreak in Nepal: 
findings from an online survey.

Gautam K(1), Adhikari RP(2)(3), Gupta AS(2), Shrestha RK(2), Koirala P(4), 
Koirala S(4).

Author information:
(1)Transcultural Psychosocial Organization Nepal (TPO Nepal), Baluwatar, 
Kathmandu, Nepal. kgautam@tponepal.org.np.
(2)Suaahara II, Helen Keller International Nepal, Lalitpur, Nepal.
(3)Padma Kanya Multiple Campus, Tribhuvan University, Kathmandu, Nepal.
(4)Transcultural Psychosocial Organization Nepal (TPO Nepal), Baluwatar, 
Kathmandu, Nepal.

BACKGROUND: A lower respiratory tract infection caused by novel coronavirus 
termed as Corona Virus Disease (COVID-19) was first identified in China and 
subsequently took the form of pandemic. Studies on disease outbreak in the past 
and recent COVID-19 outbreak have demonstrated increased psychological distress 
and adverse impacts on mental health and psychological wellbeing of people. 
However, the impact of COVID-19 on psychological wellbeing of people in Nepal 
hasn't been studied adequately. So, this paper aims to report the findings from 
a social media survey on psychological impacts of COVID-19 in Nepal.
METHODS: Data were collected through social media from 2082 Nepalese respondents 
between 23rd April, 2020 and 3rd May, 2020. A total of 2014 respondents who were 
currently residing in Nepal were included in the analysis.
RESULTS: The study suggested that half of the respondents suffered from at least 
one symptom of psychological distress whereas 32% suffered from two or more 
symptoms of psychological distress such as restlessness, fearfulness, anxiety 
and worry and sadness in the past 2 weeks preceding the survey date. The 
findings further suggested that respondents having lower family income, residing 
in rented room, and participants from province 2 were more likely to suffer from 
both single and multiple symptoms of psychological distress.
CONCLUSION: The study has shown high prevalence of psychological distress 
amongst the Nepalese respondents following COVID-19 outbreak. Appropriate mental 
health and psychosocial support response needs to be instituted to adequately 
respond to psychological impacts of the epidemic.

DOI: 10.1186/s40359-020-00497-z
PMCID: PMC7724457
PMID: 33298196 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3977. Trials. 2020 Dec 9;21(1):1006. doi: 10.1186/s13063-020-04935-6.

Effectiveness of using a meditation app in reducing anxiety and improving 
well-being during the COVID-19 pandemic: A structured summary of a study 
protocol for a randomized controlled trial.

O'Donnell KT(1), Dunbar M(1), Speelman DL(2).

Author information:
(1)Lake Erie College of Osteopathic Medicine, Erie, PA, USA.
(2)Lake Erie College of Osteopathic Medicine, Erie, PA, USA. 
dspeelman@lecom.edu.

OBJECTIVES: This interventional study will investigate the effect of daily use 
of a mindfulness app on measures of participant anxiety, well-being, and 
perceived outlook during the COVID-19 pandemic, by comparing pre-intervention 
survey responses to post-intervention survey responses.
TRIAL DESIGN: Randomized, controlled trial with parallel assignment. Adults will 
be assigned either to daily use of a meditation app for 30 days or to a control 
group (no usage of meditation app) with a 1:1 equivalence allocation ratio.
PARTICIPANTS: Inclusion Criteria: Participants must be 18 or older, have a 
smartphone, able to download apps to their smartphone, must be fluent in the 
English language, able to complete surveys on their own, and must be in the 
United States for the duration of the study.
EXCLUSION CRITERIA: Current regular use of a mindfulness or meditation app, 
regular practice of mindfulness or meditation, regular therapy sessions, 
inability to complete surveys independently, or any mental health restrictions 
that would prevent participation. All data will be collected through the Insight 
Timer Meditation App and Google Forms. This trial is being conducted through the 
Lake Erie College of Osteopathic Medicine in Erie, PA, with all data collected 
digitally.
INTERVENTION AND COMPARATOR: Intervention: Participants will be sent a link to a 
pre-intervention survey prior to first use of the mindfulness app. Participants 
will be instructed to use the Insight Timer app for 10 minutes daily for 30 
days. At the end of the 30-day intervention period, participants will be sent a 
link for the post-intervention survey. Two months after the conclusion of the 
30-day intervention period, participants will be sent a link for another 
post-intervention survey. Comparator: Participants will receive the same 
surveys, but will not use any mindfulness app for the 30-day intervention 
period. After this 30-day period, participants are invited to use the Insight 
Timer app if they so choose.
MAIN OUTCOMES: The main outcomes are (1) anxiety as assessed by survey questions 
adapted from the GAD7, comparing pre-intervention to post-30-days of app usage 
and (2) well-being as assessed by survey questions adapted from the WHO-5, 
comparing pre-intervention and post-30-days of app usage.
RANDOMIZATION: Participants will be allocated to interventions via a block 
random sequence generator with a 1:1 allocation ratio in blocks of 8.
BLINDING (MASKING): No masking is being used in this study (open label).
NUMBERS TO BE RANDOMIZED (SAMPLE SIZE): Approximately 75 participants will be 
randomized to each group, with an estimated enrollment of 150 participants.
TRIAL STATUS: This study is protocol version number 27-126 and was approved on 
May 10, 2020. Recruitment began on August 19, 2020 and will end February 28, 
2021. The study is estimated to complete on April 30, 2021.
TRIAL REGISTRATION: This trial was registered to ClinicalTrials.gov on 30 April 
2020. The ClinicalTrials.gov Identifier is NCT04369378 .
FULL PROTOCOL: The full protocol is attached as an additional file, accessible 
from the Trials website (Additional File 1). In the interest in expediting 
dissemination of this material, the familiar formatting has been eliminated; 
this Letter serves as a summary of the key elements of the full protocol.

DOI: 10.1186/s13063-020-04935-6
PMCID: PMC7724449
PMID: 33298117 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3978. Am J Alzheimers Dis Other Demen. 2020 Jan-Dec;35:1533317520976720. doi: 
10.1177/1533317520976720.

The Effects of COVID-19 Home Confinement in Dementia Care: Physical and 
Cognitive Decline, Severe Neuropsychiatric Symptoms and Increased Caregiving 
Burden.

Borges-Machado F(1), Barros D(1), Ribeiro Ó(2), Carvalho J(1)(3).

Author information:
(1)CIAFEL, Centro de Investigação em Atividade Física, Saúde e Lazer, 
Universidade do Porto, Porto, Portugal.
(2)Departamento de Educação e Psicologia, CINTESIS, Centro de Investigação em 
Tecnologias e Serviços de Saúde, Universidade de Aveiro, Aveiro, Portugal.
(3)Faculdade de Desporto da Universidade do Porto, Porto, Portugal.

PURPOSE: This study aims to analyze home confinement impact on individuals with 
neurocognitive disorders (NCD) through informal caregiver's perspective and 
examine how it has affected caregiving burden.
METHODS: Thirty-six caregivers (64.94 ± 13.54 years, 41.7% female) of 
individuals with NCD (74.28 ± 6.76 years, 66.7% female) selected from the Body & 
Brain exercise program were interviewed over the phone. The following 
instruments were used: Barthel Index (BI) to assess care recipients' ability to 
function independently on activities of daily living (ADL), the Neuropsychiatric 
Inventory (NPI) to evaluate neuropsychiatric symptoms, and the CarerQol-7D/ 
CarerQol-VAS to determine caregiver subjective burden/well-being.
RESULTS: Pre and post-confinement comparisons showed that care recipients 
significantly declined their independence in ADL (p = 0.003) and increased NPI 
total score (MD = 5.72; 95% CI: 1.19 to 10.25, p = 0.015). As for caregivers, 
results also showed an increased caregiving burden (MD = -0.17; 95% CI: -0.27 to 
-0.08; p = 0.001) and a decline in their well-being (p = 0.015).
DISCUSSION: COVID-19 crisis sheds light on how imperative it is to find 
solutions and design contingency plans for future crisis, in order to ensure 
properly sustained support to dementia caregiving dyads and mitigate caregivers' 
burden.

DOI: 10.1177/1533317520976720
PMCID: PMC10623939
PMID: 33295781 [Indexed for MEDLINE]

Conflict of interest statement: The authors declared no potential conflicts of 
interest with respect to the research, authorship, and/or publication of this 
article.


3979. J Clin Sleep Med. 2021 Apr 1;17(4):859-862. doi: 10.5664/jcsm.9040.

Two sides of a coin: differential response to COVID-19 distancing measures in 
children with narcolepsy.

Quaedackers L(1)(2), Overeem S(1)(3), Pillen S(1)(3).

Author information:
(1)Center for Sleep Medicine Kempenhaeghe, Heeze, the Netherlands.
(2)Department of Industrial Design, Eindhoven University of Technology, 
Eindhoven, the Netherlands.
(3)Biomedical Diagnostics Group, Department of Electrical Engineering, Eindhoven 
University of Technology, Eindhoven, the Netherlands.

Narcolepsy is a chronic neurological sleep disorder, debuting before age 15 
years in one-third of patients. Narcolepsy has a negative influence on quality 
of life, with daily functioning being affected by concomitant cognitive, 
behavioral, and social problems. In December 2019, a new coronavirus emerged 
worldwide, causing the severe respiratory disease COVID-19. In the Netherlands, 
a partial lockdown was implemented that included the closure of schools. Here we 
present 3 illustrative case reports that teach important lessons for the 
treatment of pediatric narcolepsy. We observed significant consequences of the 
partial lockdown measures on daytime functioning, well-being, and school 
performance, both negative and positive. The consequences of the lockdown led to 
valuable insights for further treatment, substantiating the importance of 
personalizing education. Involvement of specialized student counselors, 
flexibility in the way that education is delivered, and enhancement of 
environmental factors could help in guiding young patients with narcolepsy 
through challenges at school.

© 2021 American Academy of Sleep Medicine.

DOI: 10.5664/jcsm.9040
PMCID: PMC8020707
PMID: 33295278 [Indexed for MEDLINE]

Conflict of interest statement: All authors have seen and approved the 
manuscript. This work was performed within the IMPULS framework of the Eindhoven 
MedTech Innovation Center (e/MTIC). LQ has not received any financial support, 
nor is there any conflict of interest. SO has received unrestricted research 
support by UCB Pharma and consulted for Bioproject and Jazz Pharmaceuticals, all 
paid to the institution, and unrelated to the present work. SP consulted for 
Conect4Children, which is unrelated to the present work.


3980. Aging Ment Health. 2021 Jul;25(7):1289-1296. doi: 10.1080/13607863.2020.1856778. 
Epub 2020 Dec 9.

COVID-19 worries and mental health: the moderating effect of age.

Wilson JM(1), Lee J(2), Shook NJ(3).

Author information:
(1)Department of Psychology, West Virginia University, Morgantown, WV, USA.
(2)Department of Psychological Sciences, University of Connecticut, Storrs, CT, 
USA.
(3)School of Nursing, University of Connecticut, Storrs, CT, USA.

BACKGROUND: Older age (60+ years) increases the risk of contracting and dying 
from coronavirus disease 2019 (COVID-19), which might suggest worse mental 
health for those in this age range during the pandemic. Indeed, greater worry 
about COVID-19 is associated with poorer mental health. However, older age is 
generally associated with better emotional well-being, despite increased 
likelihood of negative events (e.g. death of a spouse) with age. This study 
examined whether age moderated the relation between COVID-19 worries and mental 
health.
METHODS: A national sample of U.S. adults (N = 848; aged 18-85 years) completed 
an online survey from March 30 to April 5, 2020. The survey assessed anxiety, 
depression, general concern about COVID-19, perceived likelihood of contracting 
COVID-19, social distancing, self-quarantining, current mood, health, and 
demographics.
RESULTS: Older age was associated with better mental health (i.e. lower levels 
of anxiety and depression). Greater perceived likelihood of contracting COVID-19 
was related to higher anxiety. However, this effect was moderated by age. At 
younger ages (18-49 years), the positive association between perceived 
likelihood of contracting COVID-19 and anxiety was significant, but the 
association was not significant at older ages (50+ years).
CONCLUSION: Older age may buffer against the negative impact of the COVID-19 
pandemic on mental health. More research is necessary to understand the 
potential protective nature of age during the pandemic, as well as the recovery 
period.

DOI: 10.1080/13607863.2020.1856778
PMID: 33291948 [Indexed for MEDLINE]


3981. Int J Environ Res Public Health. 2020 Dec 4;17(23):9073. doi: 
10.3390/ijerph17239073.

The Bittersweet Effects of COVID-19 on Mental Health: Results of an Online 
Survey among a Sample of the Dutch Population Five Weeks after Relaxation of 
Lockdown Restrictions.

Gijzen M(1)(2), Shields-Zeeman L(1), Kleinjan M(1)(3), Kroon H(1)(4), van der 
Roest H(1), Bolier L(1), Smit F(1)(5), de Beurs D(1)(5).

Author information:
(1)Trimbos Institute, Netherlands Institute of Mental Health and Addiction, P.O. 
Box 725, 3500 AS Utrecht, The Netherlands.
(2)Department of Child and Adolescent Psychiatry, GGZ Oost Brabant, P.O. Box 
35427, 5427 ZG Boekel, The Netherlands.
(3)Interdisciplinary Social Science, Utrecht University, P.O. Box 80140, 3508 TC 
Utrecht, The Netherlands.
(4)Tranzo, School of Social and Behavioural Sciences, Tilburg University, P.O. 
Box 90153, 5000 LE Tilburg, The Netherlands.
(5)Department of Clinical, Neuro and Developmental Psychology and Department of 
Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, 
University Medical Centers, Location VUmc, P.O. Box 7057, 1007 MB Amsterdam, The 
Netherlands.

Previous research shows that crises can have both negative and positive mental 
health effects on the population. The current study explored these effects in 
the context of the COVID-19 pandemic after relaxation of governmental measures. 
An online survey was administered among a representative sample of the Dutch 
population (n = 1519) in June 2020, ten weeks after the peak of COVID-19 had 
passed, and five weeks after restrictions were relaxed. Participants were asked 
about mental health, adverse events during COVID-19, and about any positive 
effects of the pandemic. Most participants (80%, n = 1207) reported no change in 
mental health since the COVID-19 pandemic. This was also the case among 
respondents who had experienced an adverse event. Protective factors of mental 
health were being male and high levels of positive mental well-being. Risk 
factors were emotional loneliness and the experience of adverse life events. 
Social loneliness was positively associated with stable mental health, stressing 
the importance of meaningful relationships. Note that 58% of participants 
reported positive effects of the pandemic, the most common of which were rest, 
working from home, and feeling more socially connected. In summary, 10 weeks 
after the start of the crisis, and 5 weeks after relaxation of the restrictions, 
most people remained stable during the crisis, and were even able to report 
positive effects.

DOI: 10.3390/ijerph17239073
PMCID: PMC7730169
PMID: 33291765 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3982. Int J Environ Res Public Health. 2020 Dec 4;17(23):9036. doi: 
10.3390/ijerph17239036.

The Impact of COVID-19 on Women's Physical Activity Behavior and Mental 
Well-Being.

Nienhuis CP(1), Lesser IA(1).

Author information:
(1)Faculty of Health Sciences, Kinesiology, University of the Fraser Valley, 
45190 Caen Ave, Chilliwack, BC V2R 0N3, Canada.

BACKGROUND: A global pandemic caused by COVID-19 resulted in restrictions to 
daily living for Canadians, including social distancing and closure of 
recreation facilities and provincial parks.
METHODS: The objective of this study was to assess whether sex differences exist 
in physical activity and well-being since COVID-19 and to explore how barriers 
or facilitators to physical activity may explain these differences. Chi-square 
tests, independent t-tests and one-way ANOVAs were conducted to evaluate data 
provided by 1098 Canadians-215 men and 871 women.
RESULTS: Women were significantly less physically active than men and reported 
more barriers and fewer facilitators to physical activity and experienced 
significantly more generalized anxiety than men. Women who were engaged in less 
physical activity due to COVID-19 reported significantly lower mental health 
scores, lower social, emotional and psychological well-being, and significantly 
higher generalized anxiety, while women who engaged in more physical activity 
had improved mental health scores.
CONCLUSIONS: Given the challenges that women uniquely face due to restrictions, 
it is imperative to advocate and provide environmental opportunity and support 
for physical activity to reduce the mental duress women may be experiencing. 
Specific physical activity programming that is inclusive of lifestyle physical 
activity and can engage children is encouraged.

DOI: 10.3390/ijerph17239036
PMCID: PMC7729617
PMID: 33291530 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3983. Int J Environ Res Public Health. 2020 Dec 5;17(23):9083. doi: 
10.3390/ijerph17239083.

Psychological Impact of Corona Lockdown in Germany: Changes in Need 
Satisfaction, Well-Being, Anxiety, and Depression.

Schwinger M(1), Trautner M(1), Kärchner H(1), Otterpohl N(2).

Author information:
(1)Department of Psychology, University of Marburg, 35032 Marburg, Germany.
(2)Department of Psychology, University of Giessen, 35394 Giessen, Germany.

All over the world; measures have been implemented to contain the novel 
Sars-CoV-2 virus since its outbreak in the beginning of 2020. These 
measures-among which social distancing and contact restrictions were most 
prominent-may have an overall effect on people's psychological well-being. The 
present study seeks to examine whether lockdown measures affected people's 
well-being; anxiety; depressive symptoms during the lockdown and whether these 
effects could be explained by reduced satisfaction of the basic psychological 
needs of autonomy and relatedness. N = 1086 participants of different ages and 
educational levels from all over Germany reported strong declines in autonomy 
and well-being; small declines in relatedness satisfaction; moderate increases 
in anxiety and depressive symptoms. These effects were stronger for people with 
moderate to bad subjective overall health. Latent change modeling revealed that, 
especially, decreases in autonomy satisfaction led to stronger decreases in 
well-being as well as stronger increases in anxiety and depressive symptoms; 
whereas decreases in relatedness had much weaker effects. Our results imply 
differential effects depending on individual preconditions; but also more 
generally that peoples' need for autonomy was most strongly affected by the 
lockdown measures, which should be considered as important information in 
planning future lockdowns.

DOI: 10.3390/ijerph17239083
PMCID: PMC7731307
PMID: 33291377 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3984. Int J Environ Res Public Health. 2020 Dec 6;17(23):9111. doi: 
10.3390/ijerph17239111.

The Impact of the COVID-19 Pandemic on Mental Health and Psychological 
Well-Being of Young People Living in Austria and Turkey: A Multicenter Study.

Akkaya-Kalayci T(1)(2), Kothgassner OD(3), Wenzel T(4)(5), Goreis A(6)(7), Chen 
A(5), Ceri V(8), Özlü-Erkilic Z(1)(2).

Author information:
(1)Department of Child and Adolescent Psychiatry, Outpatient Clinic of 
Transcultural Psychiatry and Migration Induced Disorders in Childhood and 
Adolescence, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, 
Austria.
(2)Postgraduate University Program Transcultural Medicine and Diversity Care, 
Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria.
(3)Department of Child and Adolescent Psychiatry, Medical University of Vienna, 
Währinger Gürtel 18-20, 1090 Vienna, Austria.
(4)Department of Psychiatry and Psychotherapy, Medical University of Vienna, 
Währinger Gürtel 18-20, 1090 Vienna, Austria.
(5)Scientific Section on Psychological Aspects of Torture and Persecution, World 
Psychiatric Association (WPA), 1226 Thônex, Switzerland.
(6)Department of Clinical and Health Psychology, Faculty of Psychology, 
University of Vienna, 1010 Vienna, Austria.
(7)Outpatient Unit for Research, Teaching and Practice, Faculty of Psychology, 
University of Vienna, 1010 Vienna, Austria.
(8)Department of Child Development, Faculty of Health Sciences, Batman 
University, Batman Üniversitesi, Merkez Kampüsü, 72060 Batman, Turkey.

Little is known about the impact of the COVID-19 pandemic on the mental health 
and psychological well-being of young people. The aim of this study is to 
investigate the psychological well-being and changes in the mental-health state 
of young people living in Austria and Turkey. By using an anonymous online 
survey, we recruited 1240 people aged 15-25 years from these two countries. We 
used the "Psychological General Well-being" and a self-created questionnaire to 
capture individual experiences during the COVID-19 pandemic and quarantine 
period. The native Turks indicated higher "anxiety" (ps < 0.010), lower 
"vitality" (ps < 0.011), and lower "general health" (ps < 0.011) than native 
Austrians or Austrian migrants and increased "depression" (p = 0.005) and lower 
"self-control" (p = 0.022), than Austrian migrants. Moreover, 50.9% of native 
Turks reported a decrease in their mental health status, compared to 31.1% of 
native Austrians and 23.7% of Austrian migrants. Participants with financial 
problems (OR = 1.68) and prior mental health problems (i.e., already in 
treatment by the time of COVID-19, OR = 5.83) reported a higher probability for 
a worsening in their mental health status. Our results show that the COVID-19 
pandemic impaired the psychological well-being and mental health of young 
people. Especially people in Turkey were most affected, probably due to the 
stringent policies to fight COVID-19.

DOI: 10.3390/ijerph17239111
PMCID: PMC7730981
PMID: 33291276 [Indexed for MEDLINE]

Conflict of interest statement: All authors declare no competing interest. T.W.: 
No conflict of interest. I had been invited to comment on the original proposal 
by the donor, but I see no conflict of interest as I receive no funding or any 
renumeration myself. I only participated as independent advisor and in writing 
of the final paper based on a request to WPA section. I do not work in the same 
department as the other authors.


3985. J Adolesc Health. 2021 Feb;68(2):270-276. doi: 10.1016/j.jadohealth.2020.10.030. 
Epub 2020 Dec 4.

"Constant Stress Has Become the New Normal": Stress and Anxiety Inequalities 
Among U.S. College Students in the Time of COVID-19.

Hoyt LT(1), Cohen AK(2), Dull B(3), Maker Castro E(4), Yazdani N(3).

Author information:
(1)Department of Psychology, Fordham University, Bronx, New York. Electronic 
address: lhoyt1@fordham.edu.
(2)Department of Epidemiology & Population Health, School of Medicine, Stanford 
University, Stanford, California.
(3)Department of Psychology, Fordham University, Bronx, New York.
(4)Department of Psychology and Human Development, School of Education & 
Information Sciences, University of California Los Angeles, Los Angeles, 
California.

Comment in
    J Adolesc Health. 2021 May;68(5):1023.

PURPOSE: The purpose of this study is to document young adults' perceived stress 
and anxiety in a diverse sample of college students across the U.S. during the 
COVID-19 pandemic.
METHODS: We recruited, via Instagram, a sample of full-time college students 
aged 18-22 from across the U.S. We surveyed them in April (baseline; N = 707; 
mean age = 20.0, SD = 1.3) and July (follow-up) 2020. This study presents 
overall levels of perceived stress and general anxiety symptoms and inequalities 
across each of these outcomes by gender, sexual orientation, race/ethnicity, and 
household income. We also explore potential explanations for these health issues 
by analyzing baseline qualitative data.
RESULTS: All students, on average, were suffering from perceived stress and 
anxiety, with especially high levels in April. We also identified inequalities 
in college student mental well-being, particularly by gender identity and sexual 
orientation. Women reported worse well-being compared with men; transgender and 
gender diverse and sexual minority youths reported worse outcomes than their 
cisgender, heterosexual peers at both time points. Qualitative data illustrate 
how the COVID-19 pandemic has generated educational, economic, and environmental 
stressors that are affecting college students' well-being.
CONCLUSIONS: As colleges and universities think about how to manage and mitigate 
the infectious disease dimensions of COVID-19 among their student populations, 
they must also consider who is most at risk for increased stress and anxiety 
during the pandemic.

Copyright © 2020 Society for Adolescent Health and Medicine. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jadohealth.2020.10.030
PMID: 33288459 [Indexed for MEDLINE]


3986. BMC Public Health. 2020 Dec 7;20(1):1867. doi: 10.1186/s12889-020-09952-3.

Information uncertainty: a correlate for acute stress disorder during the 
COVID-19 outbreak in China.

Lin D(1), Friedman DB(2), Qiao S(2)(3), Tam CC(2)(3), Li X(1), Li X(4)(5).

Author information:
(1)Faculty of Psychology, Beijing Normal University, Beijing, China.
(2)Department of Health Promotion, Education, and Behavior, University of South 
Carolina, Columbia, SC, USA.
(3)South Carolina SmartState Center for Healthcare Quality, Arnold School of 
Public Health, University of South Carolina, 915 Greene Street, Room 408, 
Columbia, SC, 29208, USA.
(4)Department of Health Promotion, Education, and Behavior, University of South 
Carolina, Columbia, SC, USA. xiaoming@mailbox.sc.edu.
(5)South Carolina SmartState Center for Healthcare Quality, Arnold School of 
Public Health, University of South Carolina, 915 Greene Street, Room 408, 
Columbia, SC, 29208, USA. xiaoming@mailbox.sc.edu.

BACKGROUND: Individuals' stress in responding to the current COVID-19 pandemic 
may be exacerbated by information uncertainty driven by inconsistent, 
unverified, and conflicting news from various sources. The current study aims to 
test if information uncertainty during the COVID-19 outbreak was related to 
acute stress disorder (ASD) over and above other psychosocial stressors.
METHODS: An anonymous online survey was conducted with 7800 college students 
throughout China from January 31 through February 11, 2020. Existing scales were 
modified to measure ASD and six potential stressors including information 
uncertainty during the COVID-19 outbreak. Hierarchical regression analysis was 
conducted to assess the unique association of information uncertainty with ASD. 
To minimize the effect of large sample size and also to get a sense of whether 
the effects of information uncertainty were similar to people at the center of 
the epidemic, we repeated the hierarchical regression among 10% of the students 
who were randomly selected from the entire sample ("10% random sample"; n = 780) 
and 226 students from Hubei Province where the outbreak started.
RESULTS: Information uncertainty was highly prevalent among the respondents 
(64%). It was significantly associated with ASD beyond other key variables and 
potential stressors across three samples. In the hierarchical regression among 
the entire sample, demographic variables accounted for 9.4% of the variance in 
ASD. The other five stressors added 5.1% of the variance. The information 
uncertainty (β = .159; p < .001) explained an additional 2.1% of the variance. 
Likewise, the information uncertainty explained an additional 2.1 and 3.4% of 
the variance in ASD beyond all other variables among the 10% random sample 
(β = .165; p < .001) and the Hubei sample (β = .196; p < .01), respectively.
CONCLUSION: Information uncertainty is a unique correlate of psychological 
stress during the COVID-19 outbreak. Reducing information uncertainty is 
essential not only for halting virus transmission but also for mitigating 
negative impacts of the pandemic on people's psychosocial wellbeing. 
Transparent, timely, and accurate communication can reduce public confusion, 
fear, and stress. Capacity building in governments, communities, and media 
outlets to prevent, reduce and manage information uncertainty should be a 
critical part of the response to an emerging global health crisis such as the 
COVID-19 pandemic.

DOI: 10.1186/s12889-020-09952-3
PMCID: PMC7719728
PMID: 33287780 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3987. BMC Public Health. 2020 Dec 7;20(1):1866. doi: 10.1186/s12889-020-09928-3.

Mental health status during COVID-19 pandemic in Fars Province, Iran: timely 
measures.

Mani A(1), Estedlal AR(2), Kamali M(2), Ghaemi SZ(2), Zarei L(2), Shokrpour 
N(3), Heydari ST(4), Lankarani KB(2).

Author information:
(1)Research Center for Psychiatry and Behavioral Sciences, Shiraz University of 
Medical Sciences, Shiraz, Iran.
(2)Health Policy Research Center, Institute of Heath, Shiraz University of 
Medical Sciences, Shiraz, Iran.
(3)English Department, Shiraz University of Medical Sciences, Shiraz, Iran.
(4)Health Policy Research Center, Institute of Heath, Shiraz University of 
Medical Sciences, Shiraz, Iran. heydari.st@gmail.com.

BACKGROUND: The current corona virus pandemic is acting as a stressor or trauma, 
which not only threats physical health status, but also threats mental health 
status and well-being of people. Currently, COVID-19 pandemic is a 
life-threatening unpredictable condition accompanied with a large number of 
uncertainties. The present study has mainly aimed to assess mental health and 
the relevant social factors during this pandemic in Fars province.
METHODS: This cross-sectional study was performed on 922 participants in Fars 
province, Iran, using internet-based data collection technique. All the included 
participants filled out the General Health Questionnaire (GHQ-28). Moreover, 
demographic variables and some social factors were evaluated by asking some 
questions. All the participants were ensured of the confidentiality of the 
collected data, and willingly completed the questionnaire.
RESULTS: Among the participants, there were 629 women (68.2%) and 293 men 
(31.2%). The mean age of the participants was 36.98 ± 11.08 years old. Four 
hundred twenty-five subjects (46.1%) obtained GHQ-28 scores above the cut-off 
point, and accordingly, they were suspected of having poor mental health 
statuses. Women, in comparison to men (OR = 2.034, 95%:1.62-3.28), and 
individuals aged < 50 years old, in comparison to those aged > 50 years old (OR: 
4.01 95%:2.15-7.50), have poorer mental health statuses. Trusting on media, 
health authorities, and cooperation with policy makers, as well as having 
uncertainty on information about Coronavirus pandemic were also shown to be 
associated with poor mental health condition (P < 0.05).
CONCLUSION: The present study revealed that the number of those people with 
suspected poor mental health in Fars province significantly increased compared 
to a previous study using the same questionnaire. Furthermore, the participants 
who had less trust in media and policymakers were more prone to mental health 
problems. Therefore, it can be concluded that supporting people in these 
life-threatening pandemic crises is of great importance, so the policy makers 
and media must present reliable and valid information to people as soon as 
possible.

DOI: 10.1186/s12889-020-09928-3
PMCID: PMC7719730
PMID: 33287775 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


3988. J Gerontol B Psychol Sci Soc Sci. 2022 Apr 1;77(4):e36-e45. doi: 
10.1093/geronb/gbaa220.

Feeling Gratitude Is Associated With Better Well-being Across the Life Span: A 
Daily Diary Study During the COVID-19 Outbreak.

Jiang D(1).

Author information:
(1)Department of Special Education and Counselling, Integrated Centre for 
Wellbeing, Centre for Psychosocial Health, Education University of Hong Kong, 
China.

OBJECTIVES: Numerous studies have shown that gratitude can improve mental health 
of people facing stressful events. However, most studies in this area have been 
based on laboratory experiments and retrospective surveys, rather than actual 
situations in which people are experiencing stress. Moreover, few studies have 
examined whether age moderates the benefits of gratitude. Coronavirus disease 
2019 (COVID-19) has caused enormous psychological distress worldwide. 
Evidence-based strategies are needed to enhance well-being during this stressful 
time. This study attempted to fill these gaps by examining the benefits of 
feeling gratitude every day during the COVID-19 outbreak.
METHOD: A sample of 231 participants from mainland China aged 18-85 years 
participated in a 14-day daily diary study. After a pretest to collect 
demographic data, information on gratitude, daily positive and negative affect, 
perceived stress related to COVID-19, and subjective health were measured using 
daily questionnaires on 14 consecutive days. One month after the daily diary 
period, information on affective experiences, life satisfaction, and subjective 
health was collected as a follow-up survey.
RESULTS: On days when individuals feel more gratitude than usual, they report 
more positive affect, a lower level of perceived stress related to COVID-19, and 
better subjective health on the concurrent day (Day N). Individuals also report 
a lower level of stress related to COVID-19 on the following day (Day N + 1), 
when they feel more gratitude than usual on Day N. Higher levels of gratitude 
across the 14-day study period was associated with a higher level of positive 
affect and a lower level of negative affect, but was not associated with life 
satisfaction or subjective health at the 1-month follow-up assessment.
DISCUSSION: These findings demonstrate the benefits of gratitude in a 
naturalistic situation that induced stress and anxiety.

© The Author(s) 2020. Published by Oxford University Press on behalf of The 
Gerontological Society of America. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/geronb/gbaa220
PMCID: PMC7798492
PMID: 33284976 [Indexed for MEDLINE]


3989. J Med Internet Res. 2020 Dec 14;22(12):e21418. doi: 10.2196/21418.

Social Media Insights Into US Mental Health During the COVID-19 Pandemic: 
Longitudinal Analysis of Twitter Data.

Valdez D(1), Ten Thij M(2), Bathina K(2), Rutter LA(3), Bollen J(2).

Author information:
(1)Department of Applied Health Science, School of Public Health, Indiana 
University, Bloomington, IN, United States.
(2)Luddy School of Informatics, Computing, and Engineering, Indiana University, 
Bloomington, IN, United States.
(3)Psychological and Brain Sciences, Indiana University, Bloomington, IN, United 
States.

BACKGROUND: The COVID-19 pandemic led to unprecedented mitigation efforts that 
disrupted the daily lives of millions. Beyond the general health repercussions 
of the pandemic itself, these measures also present a challenge to the world's 
mental health and health care systems. Considering that traditional survey 
methods are time-consuming and expensive, we need timely and proactive data 
sources to respond to the rapidly evolving effects of health policy on our 
population's mental health. Many people in the United States now use social 
media platforms such as Twitter to express the most minute details of their 
daily lives and social relations. This behavior is expected to increase during 
the COVID-19 pandemic, rendering social media data a rich field to understand 
personal well-being.
OBJECTIVE: This study aims to answer three research questions: (1) What themes 
emerge from a corpus of US tweets about COVID-19? (2) To what extent did social 
media use increase during the onset of the COVID-19 pandemic? and (3) Does 
sentiment change in response to the COVID-19 pandemic?
METHODS: We analyzed 86,581,237 public domain English language US tweets 
collected from an open-access public repository in three steps. First, we 
characterized the evolution of hashtags over time using latent Dirichlet 
allocation (LDA) topic modeling. Second, we increased the granularity of this 
analysis by downloading Twitter timelines of a large cohort of individuals 
(n=354,738) in 20 major US cities to assess changes in social media use. 
Finally, using this timeline data, we examined collective shifts in public mood 
in relation to evolving pandemic news cycles by analyzing the average daily 
sentiment of all timeline tweets with the Valence Aware Dictionary and Sentiment 
Reasoner (VADER) tool.
RESULTS: LDA topics generated in the early months of the data set corresponded 
to major COVID-19-specific events. However, as state and municipal governments 
began issuing stay-at-home orders, latent themes shifted toward US-related 
lifestyle changes rather than global pandemic-related events. Social media 
volume also increased significantly, peaking during stay-at-home mandates. 
Finally, VADER sentiment analysis scores of user timelines were initially high 
and stable but decreased significantly, and continuously, by late March.
CONCLUSIONS: Our findings underscore the negative effects of the pandemic on 
overall population sentiment. Increased use rates suggest that, for some, social 
media may be a coping mechanism to combat feelings of isolation related to 
long-term social distancing. However, in light of the documented negative effect 
of heavy social media use on mental health, social media may further exacerbate 
negative feelings in the long-term for many individuals. Thus, considering the 
overburdened US mental health care structure, these findings have important 
implications for ongoing mitigation efforts.

©Danny Valdez, Marijn ten Thij, Krishna Bathina, Lauren A Rutter, Johan Bollen. 
Originally published in the Journal of Medical Internet Research 
(http://www.jmir.org), 14.12.2020.

DOI: 10.2196/21418
PMCID: PMC7744146
PMID: 33284783 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


3990. J Med Internet Res. 2020 Dec 22;22(12):e25117. doi: 10.2196/25117.

COVID-19 as 'Game Changer' for the Physical Activity and Mental Well-Being of 
Augmented Reality Game Players During the Pandemic: Mixed Methods Survey Study.

Ellis LA(#)(1)(2), Lee MD(#)(3), Ijaz K(4), Smith J(1), Braithwaite J(1)(2), Yin 
K(4).

Author information:
(1)Centre for Healthcare Resilience and Implementation Science, Australian 
Institute of Health Innovation, Macquarie University, North Ryde, Australia.
(2)NHMRC Partnership Centre in Health System Sustainability, Australian 
Institute of Health Innovation, Macquarie University, North Ryde, Australia.
(3)School of Nursing, University of Pennsylvania, Philadelphia, PA, United 
States.
(4)Centre for Health Informatics, Australian Institute of Health Innovation, 
Macquarie University, North Ryde, Australia.
(#)Contributed equally

BACKGROUND: Location-based augmented reality (AR) games, such as Pokémon GO and 
Harry Potter: Wizards Unite, have been shown to have a beneficial impact on the 
physical activity, social connectedness, and mental health of their players. In 
March 2020, global social distancing measures related to the COVID-19 pandemic 
prompted the AR games developer Niantic Inc to implement several changes to 
ensure continued player engagement with Pokémon GO and Harry Potter: Wizards 
Unite. We sought to examine how the physical and mental well-being of players of 
these games were affected during the unprecedented COVID-19 restriction period 
as well as how their video game engagement was affected.
OBJECTIVE: The aims of this study were to examine the impact of COVID-19-related 
social restrictions on the physical and mental well-being of AR game players; to 
examine the impact of COVID-19-related social restrictions on the use of video 
games and motivations for their use; and to explore the potential role of AR 
games (and video games in general) in supporting well-being during 
COVID-19-related social restrictions.
METHODS: A mixed methods web-based self-reported survey was conducted in May 
2020, during which COVID-19-related social restrictions were enforced in many 
countries. Participants were recruited on the web via four subreddits dedicated 
to Pokémon GO or Harry Potter: Wizards Unite. Data collected included 
quantitative data on demographics, time spent playing video games, physical 
activity, and mental health; qualitative data included motivations to play and 
the impact of video games on mental health during COVID-19 lockdown.
RESULTS: We report results for 2004 participants (1153/1960 male, 58.8%, average 
age 30.5 years). Self-reported physical activity during COVID-19-related social 
restrictions significantly decreased from 7.50 hours per week on average (SD 
11.12) to 6.50 hours (SD 7.81) (P<.001). More than half of the participants 
reported poor mental health (925/1766, 52.4%; raw World Health Organization-5 
Well-Being Index score <13). Female gender, younger age, and reduced exercise 
were significant predictors of poor mental health. Participants reported a 
significant increase in video game play time from 16.38 hours per week on 
average (SD 19.12) to 20.82 hours (SD 17.49) (P<.001). Approximately three 
quarters of the participants (n=1102/1427, 77.2%) reported that playing video 
games had been beneficial to their mental health. The changes made to Pokémon GO 
and Harry Potter: Wizards Unite were very well received by players, and the 
players continued to use these games while exercising and to maintain social 
connection. In addition to seeking an escape during the pandemic and as a form 
of entertainment, participants reported that they used video games for emotional 
coping and to lower stress, relax, and alleviate mental health conditions.
CONCLUSIONS: AR games have the potential to promote physical and mental health 
during the COVID-19 pandemic. Used by populations under isolation and distress, 
these games can improve physical and mental health by providing virtual 
socialization, sustained exercise, temporal routine, and mental structure. 
Further research is needed to explore the potential of AR games as digital 
behavioral interventions to maintain human well-being in the wider population.

©Louise A Ellis, Matthew D Lee, Kiran Ijaz, James Smith, Jeffrey Braithwaite, 
Kathleen Yin. Originally published in the Journal of Medical Internet Research 
(http://www.jmir.org), 22.12.2020.

DOI: 10.2196/25117
PMCID: PMC7758086
PMID: 33284781 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


3991. J Relig Health. 2021 Feb;60(1):50-63. doi: 10.1007/s10943-020-01129-x. Epub 2020 
Dec 7.

Association of Death Anxiety with Spiritual Well-Being and Religious Coping in 
Older Adults During the COVID-19 Pandemic.

Rababa M(1), Hayajneh AA(2), Bani-Iss W(3).

Author information:
(1)Department of Adult Health Nursing, Faculty of Nursing, Jordan University of 
Science and Technology, Irbid, P.O. Box 3030, 22110, Jordan. 
mjrababa@just.edu.jo.
(2)Department of Adult Health Nursing, Faculty of Nursing, Jordan University of 
Science and Technology, Irbid, P.O. Box 3030, 22110, Jordan.
(3)Department of Nursing, College of Health Sciences, Research Institute for 
Medical and Health Sciences/Health Promotion Research Group, University of 
Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates.

Erratum in
    J Relig Health. 2021 Jan 21;:

This descriptive study aimed to examine the association of death anxiety with 
religious coping and spiritual well-being among 248 community-dwelling older 
adults during the COVID-19 pandemic. The brief Arab religious coping scale, the 
Arabic version of the spiritual well-being Scale, and the Arabic Scale of death 
anxiety were used to measure religious coping, spiritual well-being, and death 
anxiety, respectively. The majority of the participating older adults were found 
to have low levels of religious coping and spiritual well-being and high levels 
of death anxiety. Further, in comparison to male older adults, female older 
adults were found to have higher levels of religious coping and lower levels of 
death anxiety. Moreover, in comparison to widowed older adults, married older 
adults were found to have higher levels of death anxiety. After controlling for 
sociodemographic characteristics, religious coping, and spiritual well-being 
were found to be significant predictors of death anxiety in older adults.

DOI: 10.1007/s10943-020-01129-x
PMCID: PMC7719733
PMID: 33284402 [Indexed for MEDLINE]


3992. J Hosp Palliat Nurs. 2021 Feb 1;23(1):89-97. doi: 10.1097/NJH.0000000000000717.

Feasibility of an Intervention Study to Support Families When Their Loved One 
Has Life-sustaining Therapy Withdrawn.

Scharf B, Zhu S, Tomlin S, Cheon J, Mooney-Doyle K, Baggs JG, Weigand D.

This investigation addressed family member perceptions of preparation for 
withdrawal of life-sustaining treatment in the intensive care unit. These 
families are at a high risk for psychosocial and physical sequelae. The 
quantitative results of this mixed methods study are reported. A control group 
received usual care and an educational booklet component of the intervention. 
The experimental group received the above plus exposure to comfort cart items 
and additional psychological support. Twenty-eight family members enrolled over 
a 13-month period. Sixty-one percent (10 intervention, 7 control) completed the 
follow-up. Fourteen family members (82%) recalled the booklet. Some family 
members reported moderate to severe depression (12.5%), anxiety (12.5%), and 
stress (12.6%). Satisfaction with care (83.7%-85.2%) and family member 
well-being (44.1) were within the norm. Short Form-36 physical component score 
was higher than the norm, and the mental component score was lower than the 
norm. This study demonstrated feasibility and acceptability of the interventions 
and follow-up questionnaires when families make the difficult decision to 
withdraw treatment. Strategies are suggested to strengthen statistical power.

Copyright © 2020 by The Hospice and Palliative Nurses Association. All rights 
reserved.

DOI: 10.1097/NJH.0000000000000717
PMCID: PMC7903882
PMID: 33284144 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
disclose.


3993. Front Public Health. 2020 Nov 12;8:583181. doi: 10.3389/fpubh.2020.583181. 
eCollection 2020.

The Role of Basic Psychological Needs in Well-Being During the COVID-19 
Outbreak: A Self-Determination Theory Perspective.

Šakan D(1), Žuljević D(1), Rokvić N(1).

Author information:
(1)Faculty of Legal and Business Studies Dr Lazar Vrtakic, Department of 
Psychology, Novi Sad, Serbia.

Due to the coronavirus outbreak, people around the world are facing various 
challenges in maintaining their well-being, which can be compromised due to risk 
of illness and harsh measures of social distancing. As proposed by the 
Self-Determination Theory, basic psychological needs are essential nutrients of 
well-being. The aim of this study was to examine the role of basic psychological 
needs in well-being during the pandemic. A sequential mediation model was 
examined, that links positive and negative affectivity to well-being 
(satisfaction with life and general distress) through satisfaction and 
frustration of the basic psychological needs (for autonomy, competence, and 
relatedness). The study involved 965 participants (Mage = 29; 57% females) from 
Serbia. The Basic Psychological Needs Satisfaction and Frustration scale, 
Satisfaction with Life Scale, Depression Anxiety Stress Scale 21, and The 
Serbian Inventory of Affect based on the Panas-X were used. All the tested 
models were statistically significant. Controlling for age, gender, having 
children, health, employment, and marital status, direct effects in all models 
were highly significant, explaining up to 59% of criteria variance. The 
proportion of the explained variance was even higher when accounting for 
indirect effects. Sequential mediation models revealed that the indirect 
relationships between positive and negative affectivity and satisfaction with 
life and general distress were serially mediated by autonomy satisfaction, 
competence frustration, relatedness satisfaction, and relatedness frustration. 
This study raised an important question on how the disposition to experience 
more positive or negative emotions affects the change in subjective well-being. 
These results, coherent with the Self-Determination Theory postulates, add to 
the understanding of human functioning in the times of extraordinary 
circumstances during a pandemic, by suggesting that satisfaction and frustration 
of basic psychological needs might have a key role in obtaining optimal 
well-being.

Copyright © 2020 Šakan, Žuljević and Rokvić.

DOI: 10.3389/fpubh.2020.583181
PMCID: PMC7689268
PMID: 33282817 [Indexed for MEDLINE]


3994. Arch Psychiatr Nurs. 2020 Dec;34(6):481-491. doi: 10.1016/j.apnu.2020.08.008. 
Epub 2020 Sep 3.

Investigating the impact of a psychoanalytic nursing development group within an 
adolescent psychiatric intensive care unit (PICU).

Foster C(1).

Author information:
(1)Child and Adolescent Mental Health, School of Health & Society, University of 
Salford, Mary Seacole Building, University of Salford, Fredrick Road, Salford M6 
6PU, United Kingdom of Great Britain and Northern Ireland. Electronic address: 
c.m.foster@salford.ac.uk.

OBJECTIVE: To evaluate the impact of an adapted psychoanalytic work discussion 
group for mental health nurses working in adolescent PICU.
BACKGROUND: There is no prior research investigating interventions that 
effectively support and enable adolescent PICU nursing teams to sustain the 
therapeutic tasks of their work and their own sense of wellbeing.
METHODS: A bespoke psychoanalytic work discussion group was implemented within 
an adolescent PICU. Data was collected using in-depth semi-structured interviews 
with participants, about the impact of the group upon their practice. Data 
analysis used thematic analysis.
RESULTS: The group positively impacted upon participant knowledge and 
understanding, emotion management, personal efficacy, therapeutic relationship 
building, managing challenging behaviour, leadership, professional identity and 
team cohesion.
CONCLUSION: Mechanisms by which these outcomes were achieved are elaborated 
utilising the concepts of projective identification, emotional containment and 
'temporary outsider-ship'. There is a need to account for the interplay between 
adolescent defense mechanisms, nursing anxieties and setting-specific 
organisational dynamics, in the design of effective support interventions for 
adolescent mental health nurses.

Copyright © 2020 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.apnu.2020.08.008
PMID: 33280670 [Indexed for MEDLINE]


3995. Sci Total Environ. 2021 Feb 20;756:143984. doi: 10.1016/j.scitotenv.2020.143984. 
Epub 2020 Nov 26.

Contact with blue-green spaces during the COVID-19 pandemic lockdown beneficial 
for mental health.

Pouso S(1), Borja Á(2), Fleming LE(3), Gómez-Baggethun E(4), White MP(5), Uyarra 
MC(6).

Author information:
(1)AZTI, Marine Research, Basque Research and Technology Alliance (BRTA), 
Herrera Kaia, Portualdea z/g, 20110 Pasaia, Gipuzkoa, Spain. Electronic address: 
spouso@azti.es.
(2)AZTI, Marine Research, Basque Research and Technology Alliance (BRTA), 
Herrera Kaia, Portualdea z/g, 20110 Pasaia, Gipuzkoa, Spain; King Abdulaziz 
University, Faculty of Marine Sciences, Jeddah, Saudi Arabia.
(3)European Centre for Environment and Human Health, University of Exeter, 
Knowledge Spa, Truro, UK.
(4)Department of International Environment and Development Studies (Noragric), 
Norwegian University of Life Sciences (NMBU), P.O. Box 5003, Ås N-1432, Norway; 
Norwegian Institute for Nature Research (NINA), Gaustadalleen 21, Oslo 0349, 
Norway.
(5)European Centre for Environment and Human Health, University of Exeter, 
Knowledge Spa, Truro, UK; Cognitive Science Hub, University of Vienna, 
Liebiggasse 5, Viena, Austria.
(6)AZTI, Marine Research, Basque Research and Technology Alliance (BRTA), 
Herrera Kaia, Portualdea z/g, 20110 Pasaia, Gipuzkoa, Spain.

There is growing evidence that ecosystem services and especially the exposure to 
the natural world (blue-green spaces) have potential benefits for mental health 
and well-being. The COVID-19 pandemic and the measures adopted to control it 
provide a natural experiment to investigate the links between nature exposure 
and mental health under extreme conditions. Using a survey distributed online, 
we tested the following hypotheses: 1) People will show greater symptoms of 
depression and anxiety under lockdown conditions that did not allow contact with 
outdoor nature spaces; 2) Where access to public outdoor nature spaces was 
strictly restricted, (2a) those with green/blue nature view or (2b) access to 
private outdoor spaces such as a garden or balcony will show fewer symptoms of 
depression and anxiety, and a more positive mood. Based on 5218 responses from 9 
countries, we found that lockdown severity significantly affected mental health, 
while contact with nature helped people to cope with these impacts, especially 
for those under strict lockdown. People under strict lockdown in Spain (3403 
responses), perceived that nature helped them to cope with lockdown measures; 
and emotions were more positive among individuals with accessible outdoor spaces 
and blue-green elements in their views. These findings can help decision-makers 
in developing potential future lockdown measures to mitigate the negative 
impacts, helping people to be more resilient and maintain better mental health, 
using the benefits that ecosystem services are providing us.

Copyright © 2020 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.scitotenv.2020.143984
PMCID: PMC7688424
PMID: 33277006 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


3996. Int J Environ Res Public Health. 2020 Dec 2;17(23):8961. doi: 
10.3390/ijerph17238961.

Exploring Perceived Stress among Students in Turkey during the COVID-19 
Pandemic.

Aslan I(1), Ochnik D(2), Çınar O(3)(4).

Author information:
(1)Faculty of Health Sciences, Bingöl University, 12000 Bingöl, Turkey.
(2)Faculty of Medicine, University of Technology, 40-555 Katowice, Poland.
(3)Faculty of Economics and Administrative Sciences, Ağrı İbrahim Çeçen 
University, 04000 Ağrı, Turkey.
(4)Atatürk University, 2500 Erzurum, Turkey.

Students have been highly vulnerable to mental health issues during the COVID-19 
pandemic, and researchers have shown that perceived stress and mental health 
problems have increased during the pandemic. The aim of this study was to reveal 
the prevalence of perceived stress and mental health among students during the 
pandemic and to explore predictors of stress levels. A cross-sectional study was 
conducted on a sample of 358 undergraduates from 14 universities in Turkey, 
including 200 female students (56%). The measurements used in the study were the 
Generalized Anxiety Disorder 7-item (GAD-7) scale, Patient Health Questionnaire 
(PHQ-8), Satisfaction with Life Scale (SWLS), Perception of COVID Impact on 
Student Well-Being (CI), Perceived Stress Scale (PSS-10), Physical Activity 
Scale (PA), and a sociodemographic survey. Students reported high perceived 
stress, mild generalized anxiety, and low satisfaction with life. More than half 
of the students met the diagnostic criteria of GAD (52%) and depression (63%). 
Female and physically inactive students had higher PSS-10 levels. A hierarchical 
linear regression model showed that after controlling for gender and negative 
CI, anxiety and physical inactivity significantly predicted high perceived 
stress. The study shows that students' mental health during the pandemic is at 
high risk.

DOI: 10.3390/ijerph17238961
PMCID: PMC7729602
PMID: 33276520 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


3997. Postgrad Med. 2021 Jun;133(5):469-480. doi: 10.1080/00325481.2020.1860394. Epub 
2020 Dec 30.

Home-based exercise can be beneficial for counteracting sedentary behavior and 
physical inactivity during the COVID-19 pandemic in older adults.

Ghram A(1)(2), Briki W(3), Mansoor H(4), Al-Mohannadi AS(5)(6), Lavie CJ(7), 
Chamari K(8).

Author information:
(1)Department of Exercise Physiology, Faculty of Physical Education and Sport 
Sciences, University of Tehran, Tehran, Iran.
(2)Department of Cardiac Rehabilitation, Tehran Heart Center, Tehran University 
of Medical Sciences, Tehran, Iran.
(3)Sport Science Program, College of Arts and Sciences, Qatar University, Doha, 
Qatar.
(4)College of Health and Life Sciences,Hamad Bin Khalifa University, Doha, 
Qatar.
(5)Research and Scientific Support Department, Aspetar Orthopaedic and Sports 
Medicine Hospital, Qatar.
(6)World Innovation Summit for Health (WISH), Qatar Foundation, Doha, Qatar.
(7)Department of Cardiovascular Diseases, John Ochsner Heart and Vascular 
Institute, Ochsner Clinical School the University of Queensland School of 
Medicine, New Orleans, Louisiana, USA.
(8)Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.

The novel pandemic called coronavirus disease 2019 (COVID-19), as a global 
public health emergency, seems to be having a major impact on physical activity 
(PA) behaviors. Older adults are at high risk of death from the severe acute 
respiratory syndrome coronavirus 2 (SARS CoV-2). Health authorities around the 
world have been implementing preventive health measures, including quarantine 
and self-isolation, to mitigate the COVID-19 outbreak. This period is 
characterized by the cessation of outdoor exercising. During this period of 
lockdown, PA has been one of the rare reasons for going out in some countries. 
To avoid the harmful effects of periods of exercise cessation, PA could be 
prescribed to older adults, which is of great importance for breaking their 
sedentary lifestyle and improving their immunity. The present review discusses 
the potential impacts of the COVID-19 pandemic on sedentary behavior and 
physical inactivity in older adults. The importance of performing PA to reduce 
the harmful effects of the COVID-19 pandemic is discussed, and useful 
recommendations on home-based exercise for the older adults to maintain their 
level of independence, physical and mental health as well as their well-being 
are provided.

DOI: 10.1080/00325481.2020.1860394
PMID: 33275479 [Indexed for MEDLINE]


3998. Eur Rev Med Pharmacol Sci. 2020 Nov;24(22):11964-11970. doi: 
10.26355/eurrev_202011_23858.

Psychopathological profile in COVID-19 patients including healthcare workers: 
the implications.

Chieffo DPR(1), Delle Donne V, Massaroni V, Mastrilli L, Belella D, Monti L, 
Silveri MC, Cauda R.

Author information:
(1)Clinical Psychology Unit, Fondazione Policlinico Universitario A. Gemelli 
IRCCS, Rome, Italy. valentina.delledonne@unicatt.it.

OBJECTIVE: The effects of COVID-19 seem to extend beyond the physical pain and 
is showing psychiatric implications as well. Moreover, psychopathological 
implications seem to last also after patients' discharge. Our goal is to 
investigate the psychological impact and psychopathological outcome of patients 
affected by COVID-19.
PATIENTS AND METHODS: We have engaged 34 patients with COVID-19 conditions 
[eight of them were healthcare workers patients (HCW)] hospitalized at 
"Policlinico Gemelli Foundation" of Rome, Italy. All patients were evaluated 
through the Impact of Event Scale-Revised (IES-R) and the Symptom Checklist 90-R 
(SCL-90-R) first, during their hospitalization (baseline), and then, after 4 
months from hospital discharge (follow-up), through phone interviews.
RESULTS: At baseline, 82% of patients revealed from mild to severe psychological 
impact of COVID-19, according to the IES-R. At follow-up, the mean IES-R total 
score was significantly decreased (p<0.001) even if almost half (46.6%) of our 
cohort still showed it. HCW patients showed a significantly higher score than 
other patients at IES-R scale, both at baseline (p=0.005) and at follow-up 
(p<0.001). Moreover, at 4 months from discharge, they showed a significantly 
higher percentage of moderate and severe distress (p=0.015). In addition to 
this, at follow-up, our cohort of patients showed an increase of anxiety 
symptoms, even if not significant compared to baseline (46.7% vs. 35.3% 
respectively; p=1.000), and HCW patients suffered more sleep disorders (p=0.019) 
and anxiety symptoms (p=0.019) compared to other patients.
CONCLUSIONS: We indicate the importance of assessing psychopathology of COVID-19 
survivors, monitoring their changes over time, and providing psychological 
support to improve their psychological well-being.

DOI: 10.26355/eurrev_202011_23858
PMID: 33275271 [Indexed for MEDLINE]


3999. Postgrad Med J. 2022 Mar;98(1157):231-233. doi: 
10.1136/postgradmedj-2020-139150. Epub 2020 Dec 3.

Impact of enhanced personal protective equipment on the physical and mental 
well-being of healthcare workers during COVID-19.

Swaminathan R(1), Mukundadura BP(2), Prasad S(3).

Author information:
(1)Ear, Nose and Throat Department, Warwick Hospital, Warwick, UK 
arrassu@hotmail.com.
(2)Ear, Nose and Throat Department, Warwick Hospital, Warwick, UK.
(3)Ear, Nose and Throat, University Hospital Coventry, Coventry, UK.

Comment in
    Postgrad Med J. 2022 Apr;98(1158):310.

BACKGROUND: The COVID-19 pandemic has necessitated the use of enhanced personal 
protective equipment (PPE) in healthcare workers in patient-facing roles. We 
describe the impact on the physical and mental well-being of healthcare 
professionals who use enhanced PPE consistently.
METHODS: We conducted a single-centre, cross-sectional study among healthcare 
professionals who use enhanced PPE. A web-based questionnaire was disseminated 
to evaluate the effects on individuals' physical and mental well-being. Physical 
and mental impact was assessed through a visual analogue scale.
RESULTS: Prospective analysis of the views of 72 respondents is reported. 63.9% 
were women and 36.1% were men. Physical impact included exhaustion, headache, 
skin changes, breathlessness and a negative impact on vision. Communication 
difficulties, somnolence, negative impact on overall performance and 
difficulties in using surgical instrumentation were reported.
CONCLUSION: Our study demonstrates the undeniable negative impact on the 
front-line healthcare workers using enhanced PPE and lays the ground for larger 
multicentric assessments given for it to potentially be the norm for the 
foreseeable future.

© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and 
permissions. Published by BMJ.

DOI: 10.1136/postgradmedj-2020-139150
PMID: 33273107 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


4000. J Subst Abuse Treat. 2021 Mar;122:108208. doi: 10.1016/j.jsat.2020.108208. Epub 
2020 Nov 24.

A delicate compromise: Striking a balance between public safety measures and the 
psychosocial needs of staff and clients in residential substance use disorder 
treatment amid COVID-19.

Herrera A(1).

Author information:
(1)California State University, Bakersfield, 9001 Stockdale Highway, Bakersfield 
93311-1022, CA, USA. Electronic address: aherrera5@csub.edu.

In response to COVID-19, residential SUD treatment providers have significantly 
changed operations and clinical care to mitigate risk of infection for both 
clients and staff. While treatment facilities must enforce public safety 
measures in residential SUD treatment to protect the health of clients and 
staff, these measures create additional barriers to treatment engagement as well 
as health anxiety. We consider strategies to adjust clinical programming, 
enhance treatment engagement, and promote employee well-being in light of public 
safety measures and the chronic stressor of COVID-19.

Copyright © 2020 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jsat.2020.108208
PMCID: PMC7683954
PMID: 33272732 [Indexed for MEDLINE]


4001. Int J Environ Res Public Health. 2020 Dec 1;17(23):8931. doi: 
10.3390/ijerph17238931.

Social Media Activities, Emotion Regulation Strategies, and Their Interactions 
on People's Mental Health in COVID-19 Pandemic.

Yang Y(1)(2), Liu K(3), Li S(2)(4), Shu M(5).

Author information:
(1)Institute of Advanced Studies in Humanities and Social Sciences, Beijing 
Normal University at Zhuhai, Zhuhai 519087, China.
(2)Research Institute of Science Education, Beijing Normal University, Beijing 
100875, China.
(3)School of Public Finance and Public Administration, Jiangxi University of 
Finance and Economics, Nanchang 330013, China.
(4)College of Education for the Future, Beijing Normal University at Zhuhai, 
Zhuhai 519087, China.
(5)Institute of Psychological Quality and Education, East China Jiaotong 
University, Nanchang 330013, China.

The COVID-19 pandemic has dramatically changed the general population's life 
worldwide. People may spend more time on social media because of policies like 
"work at home". Using a cross-sectional dataset collected through an online 
survey in February 2020, in China, we examined (1) the relationships between 
social media activities and people's mental health status and (2) the moderation 
effect of emotional-regulation strategies. The sample included people aged ≥18 
years from 32 provinces and regions in China (N = 3159). The inferential 
analyses included a set of multiple linear regressions with interactions. Our 
results showed that sharing timely, accurate, and positive COVID-19 information, 
reducing excessive discussions on COVID-19, and promoting caring online 
interactions rather than being judgmental, might positively associate with the 
general public's psychological well-being. Additionally, the relationships 
between social media activities and psychological well-being varied at different 
emotion-regulation strategy levels. Adopting the cognitive reappraisal strategy 
might allay the adverse relationships between certain social media activities 
and mental health indicators. Our findings expanded the theory of how social 
media activities can be associated with a human being's mental health and how it 
can interact with emotion-regulation strategies during the COVID-19 pandemic.

DOI: 10.3390/ijerph17238931
PMCID: PMC7730977
PMID: 33271779 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


4002. Res Dev Disabil. 2021 Jan;108:103822. doi: 10.1016/j.ridd.2020.103822. Epub 2020 
Nov 30.

Stress and emotional wellbeing of parents due to change in routine for children 
with Autism Spectrum Disorder (ASD) at home during COVID-19 pandemic in Saudi 
Arabia.

Alhuzimi T(1).

Author information:
(1)Department of Special Education, College of Education, King Saud University, 
Riyadh, Saudi Arabia. Electronic address: Talhuzimi@ksu.edu.sa.

BACKGROUND: Parents of children with Autism Spectrum Disorder (ASD) experience 
considerable amounts of stress and impaired emotional well-being. Consequently, 
it is likely that these have been adversely impacted by COVID-19 outbreak due to 
disruptions to the schedules of children with ASD.
AIM: This study investigated the stress and emotional well-being of parents of 
children with ASD in Saudi Arabia during the COVID-19 pandemic.
METHOD: The study obtained quantitative data from 150 parents of children with 
ASD from different regions in Saudi Arabia using an online survey. The data 
collected included demographic data of the parents, ASD status of the family, 
ASD support during COVID-19 pandemic, severity of ASD behaviours in comparison 
to the pre- COVID-19 status eating behaviour of the child with ASD, Parental 
Stress, and emotional well-being. The PSI-short form (PSI-SF) (Abidin, 1995) 
scale was utilised to obtain data related to parental stress and the General 
Health Questionnaire (GHQ-12) (Goldberg, 1992) scale was utilised to obtain data 
related to parents' emotional well-being.
RESULTS: The study found that family ASD status (in particular, age and gender 
of child with ASD, and severity of his/her symptoms) had a significant impact on 
parental stress and emotional well-being. Moreover, parental stress and 
emotional well-being were negatively impacted by the frequency and usefulness of 
ASD support received during COVID-19 pandemic. These were also adversely 
impacted by the change in severity of ASD behaviours of the children with ASD. 
Finally, parental stress was found to have a negative impact on the emotional 
well-being of parents. Overall, the study found that the parental stress and 
emotional well-being of parents of children with ASD in Saudi Arabia had been 
unfavourably impacted by COVID-19 pandemic.
CONCLUSIONS: Overall, the study found that the parental stress and emotional 
well-being of parents with ASD in Saudi Arabia had been unfavourably impacted by 
COVID-19 pandemic. This study recommends the involvement of the Saudi Ministry 
of Health to establish and extend support services to support parents of 
children with ASD. Moreover, the provision of training programs to help parents 
deal with the characteristic behaviour of their children with ASD such as, the 
ability to maintain routines, aggressive or repetitive behaviour, is also 
recommended.

Copyright © 2020 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.ridd.2020.103822
PMID: 33271447 [Indexed for MEDLINE]


4003. Int J Qual Health Care. 2021 Feb 20;33(1):mzaa158. doi: 10.1093/intqhc/mzaa158.

COVID-19 is having a destructive impact on health-care workers' mental 
well-being.

Vanhaecht K(1), Seys D(1), Bruyneel L(1), Cox B(1), Kaesemans G(2), Cloet M(2), 
Van Den Broeck K(3), Cools O(4), De Witte A(5), Lowet K(6), Hellings J(7), 
Bilsen J(8), Lemmens G(9), Claes S(10).

Author information:
(1)Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, 
Kapucijnenvoer 35, 3000 Leuven, Belgium.
(2)Zorgnet Icuro, Brussels, Belgium.
(3)Department of Primary Care, University of Antwerp, Doornstraat 331, 2610 
Antwerp, Belgium.
(4)KARUS vzw, Melle, Belgium.
(5)Doctors4Doctors, GZA Hospitals, Antwerp, Belgium.
(6)Flemish Association for Clinical Psychologists, Brussels, Belgium.
(7)Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 
BE3500 Hasselt, Belgium.
(8)Mental Health and Wellbeing Research Group, VUB, Laarbeeklaan 103, 1050 
Brussels, Belgium.
(9)Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 
9000 Ghent, Belgium.
(10)Department of Adult Psychiatry, KU Leuven-University of Leuven, Herestraat 
49, 3000 Leuven, Belgium.

BACKGROUND: The coronavirus disease 2019 (COVID-19) may aggravate workplace 
conditions that impact health-care workers' mental health. However, it can also 
place other stresses on workers outside of their work. This study determines the 
effect of COVID-19 on symptoms of negative and positive mental health and the 
workforce's experience with various sources of support. Effect modification by 
demographic variables was also studied.
METHODS: A cross-sectional survey study, conducted between 2 April and 4 May 
2020 (two waves), led to a convenience sample of 4509 health-care workers in 
Flanders (Belgium), including paramedics (40.6%), nurses (33.4%), doctors 
(13.4%) and management staff (12.2%). About three in four were employed in 
university and acute hospitals (29.6%), primary care practices (25.7%), 
residential care centers (21.3%) or care sites for disabled and mental health 
care. In each of the two waves, participants were asked how frequently (on a 
scale of 0-10) they experienced positive and negative mental health symptoms 
during normal circumstances and during last week, referred to as before and 
during COVID-19, respectively. These symptoms were stress, hypervigilance, 
fatigue, difficulty sleeping, unable to relax, fear, irregular lifestyle, 
flashback, difficulty concentrating, feeling unhappy and dejected, failing to 
recognize their own emotional response, doubting knowledge and skills and 
feeling uncomfortable within the team. Associations between COVID-19 and mental 
health symptoms were estimated by cumulative logit models and reported as odds 
ratios. The needed support was our secondary outcome and was reported as the 
degree to which health-care workers relied on sources of support and how they 
experienced them.
RESULTS: All symptoms were significantly more pronounced during versus before 
COVID-19. For hypervigilance, there was a 12-fold odds (odds ratio 12.24, 95% 
confidence interval 11.11-13.49) during versus before COVID-19. Positive 
professional symptoms such as the feeling that one can make a difference were 
less frequently experienced. The association between COVID-19 and mental health 
was generally strongest for the age group 30-49 years, females, nurses and 
residential care centers. Health-care workers reported to rely on support from 
relatives and peers. A considerable proportion, respectively, 18 and 27%, 
reported the need for professional guidance from psychologists and more support 
from their leadership.
CONCLUSIONS: The toll of the crisis has been heavy on health-care workers. Those 
who carry leadership positions at an organizational or system level should take 
this opportunity to develop targeted strategies to mitigate key stressors of 
health-care workers' mental well-being.

© The Author(s) 2020. Published by Oxford University Press on behalf of 
International Society for Quality in Health Care. All rights reserved. For 
permissions, please e-mail: journals.permissions@oup.com.

DOI: 10.1093/intqhc/mzaa158
PMCID: PMC7799030
PMID: 33270881 [Indexed for MEDLINE]


4004. Health Promot Int. 2021 Aug 30;36(4):1007-1019. doi: 10.1093/heapro/daaa113.

The impact of the COVID-19 pandemic on the wellbeing of Irish Men's Shed 
members.

McGrath A(1), Murphy N(1), Richardson N(2).

Author information:
(1)Centre for Health Behavior Research, Waterford Institute of Technology, 
Waterford, Ireland.
(2)National Centre for Men's Health, Institute of Technology Carlow, Carlow, 
Ireland.

COVID-19 disproportionately affects males especially those who are older and 
more socio-economically disadvantaged. This study assessed wellbeing outcomes 
among men's shed members (Shedders) in Ireland at baseline (T1), 3 (T2), 6 (T3) 
and 12 months (T4) in response to a 10-week health promotion program 'Sheds for 
Life' (SFL). Two cohorts participated in SFL commencing in March and September 
2019. This study compares the T3 findings from one cohort carried out during the 
COVID-19 pandemic [COVID cohort (n = 185)] with T3 findings from a comparator 
cohort [pre-COVID cohort (n = 195)], completed pre-COVID-19. Questionnaires 
assessing wellbeing [life satisfaction, mental health, loneliness, physical 
activity (PA), self-rated health and other lifestyle measures] were analyzed in 
both cohorts T1, T2 and T3. Self-rated Health and life satisfaction decreased in 
the COVID cohort at T3 (p < 0.001), while loneliness scores increased 
(p < 0.0005). Higher loneliness scores were correlated with lower health 
ratings, life satisfaction and PA during COVID-19 (p < 0.001). Days PA decreased 
in the COVID cluster at T3 from T2 (p < 0.01) with those in urban areas 
reporting lower activity levels than rural areas (p < 0.05). Those sufficiently 
active at baseline managed to maintain PA during COVID-19 while those not 
meeting guidelines were more likely to report decreases (p < 0.001). Shedders 
experiencing COVID-19 restrictions are at an increased risk of poorer wellbeing 
and increased levels of loneliness. Support and guidance are needed to safely 
encourage this cohort back into men's sheds, settings that protect against 
loneliness and positively promote health and wellbeing. Lay summary The COVID-19 
pandemic will have wide-reaching implications on wellbeing, particularly on 
those who are older and more vulnerable. Evidence also suggests that COVID-19 
disproportionately affects males. This study aimed to understand the impact that 
COVID-19 has had on men in the setting of Men's Sheds in Ireland. Two cohorts of 
men who were participating in a 10-week health and wellbeing program (Sheds for 
Life) at different stages were followed over time. At 6 months follow-up the 
first Cohort had not experienced COVID-19 whereas the second cohort was actively 
experiencing the COVID-19 pandemic. We measured wellbeing using questionnaires, 
comparing both groups of men for differences. We found that the men who were 
experiencing COVID-19 had lower self-rated health, physical activity and life 
satisfaction as well as higher rates of loneliness, with those who were more 
lonely reporting lower wellbeing scores. We also found that men in rural areas 
were more physically active during COVID-19 and that those were not active were 
more likely to become more inactive during COVID-19. This study suggests that 
support and guidance is needed to safely encourage this cohort back into Men's 
Sheds, settings that protect against loneliness and positively promote health 
and wellbeing.

© The Author(s) 2020. Published by Oxford University Press. All rights reserved. 
For permissions, please email: journals.permissions@oup.com.

DOI: 10.1093/heapro/daaa113
PMCID: PMC7799116
PMID: 33270821 [Indexed for MEDLINE]


4005. PLoS One. 2020 Dec 3;15(12):e0243125. doi: 10.1371/journal.pone.0243125. 
eCollection 2020.

A rapid review of home-based activities that can promote mental wellness during 
the COVID-19 pandemic.

Puyat JH(1)(2), Ahmad H(3), Avina-Galindo AM(4), Kazanjian A(2), Gupta A(1)(2), 
Ellis U(5), Ashe MC(6), Vila-Rodriguez F(4), Halli P(3), Salmon A(1)(2), Vigo 
D(2)(3), Almeida A(7), De Bono CE(8).

Author information:
(1)Centre for Health Evaluation and Outcome Sciences, Providence Health Care and 
The University of British Columbia, Vancouver, Canada.
(2)School of Population & Public Health, The University of British Columbia, 
Vancouver, Canada.
(3)Department of Psychiatry, Faculty of Medicine, The University of British 
Columbia, Vancouver, Canada.
(4)Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, 
The University of British Columbia, Vancouver, Canada.
(5)Woodward Library, The University of British Columbia, Vancouver, Canada.
(6)Department of Family Practice, The University of British Columbia, Vancouver, 
Canada.
(7)Mental Health Program, Providence Health Care, Vancouver, British Columbia, 
Canada.
(8)Providence Health Care, Vancouver, British Columbia, Canada.

BACKGROUND: During the COVID-19 pandemic, public health measures such as 
isolation, quarantine, and social distancing are needed. Some of these measures 
can adversely affect mental health. Activities that can be performed at home may 
mitigate these consequences and improve overall mental well-being. In this 
study, home-based activities that have potential beneficial effects on mental 
health were examined.
METHODS: A rapid review was conducted based on a search of the following 
databases: MEDLINE, EMBASE, CINAHL, PyscINFO, Global Health, epistemonikos.org, 
covid19reviews.org, and eppi.ioe.ac.uk/covid19_map_v13.html. Eligible studies 
include randomized controlled trials and non-randomized studies published 
between 1/1/2000 and 28/05/2020 and that examined the impact of various 
activities on mental health outcomes in low-resource settings and contexts that 
lead to social isolation. Studies of activities that require mental health 
professionals or that could not be done at home were excluded. Two review 
authors performed title/abstract screening. At the full-text review stage, 25% 
of the potentially eligible studies were reviewed in full by two review authors; 
the rest were reviewed by one review author. Risk of bias assessment and data 
extraction were performed by one review author and checked by a second review 
author. The main outcome assessed was change or differences in mental health as 
expressed in Cohen's d; analysis was conducted following the synthesis without 
meta-analysis guidelines (SWiM). PROSPERO registration: CRD42020186082.
RESULTS: Of 1,236 unique records identified, 160 were reviewed in full, 
resulting in 16 included studies. The included studies reported on the 
beneficial effects of exercise, yoga, progressive muscle relaxation, and 
listening to relaxing music. One study reported on the association between 
solitary religious activities and post traumatic stress disorder symptoms. While 
most of the included studies examined activities in group settings, particularly 
among individuals in prisons, the activities were described as something that 
can be performed at home and alone. All included studies were assessed to be at 
risk of bias in one or more of the bias domains examined.
CONCLUSIONS: There is some evidence that certain home-based activities can 
promote mental wellness during the COVID-19 pandemic. Guidelines are needed to 
help optimize benefits while minimizing potential risks when performing these 
activities.

DOI: 10.1371/journal.pone.0243125
PMCID: PMC7714353
PMID: 33270755 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


4006. J Nurs Manag. 2021 May;29(4):805-812. doi: 10.1111/jonm.13221. Epub 2020 Dec 21.

Relationship between eHealth literacy and psychological status during COVID-19 
pandemic: A survey of Chinese residents.

Yang BX(1)(2)(3), Xia L(1), Huang R(1), Chen P(1), Luo D(1), Liu Q(1), Kang 
LJ(2), Zhang ZJ(4), Liu Z(2), Yu S(1), Li X(2), Wang XQ(1).

Author information:
(1)Faculty of School of Health Sciences, Wuhan University, Wuhan, China.
(2)Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China.
(3)Population and Health Research Center, Wuhan University, Wuhan, China.
(4)Department of Preventive Medicine, School of Health Sciences, Wuhan 
University, Wuhan, China.

AIMS: To investigate the eHealth literacy and the psychological status of 
Chinese residents during the COVID-19 pandemic and explore their 
interrelationship.
BACKGROUND: The COVID-19 outbreak has placed intense psychological pressure on 
community residents. Their psychological status may be affected by eHealth 
literacy due to home isolation during this rampant pandemic.
METHODS: This is a Web-based cross-sectional survey conducted on the JD Health 
platform, which resulted in 15,000 respondents having participated in this 
survey. The eHealth Literacy Questionnaire (EHLQ), Patient Health 
Questionnaire-9 (PHQ-9), Insomnia Severity Index (ISI) and Impact of Event 
Scale-Revised (IES-R) were used. The Pearson correlation was used to analyse the 
relationship between eHealth literacy and depression, insomnia and 
post-traumatic stress disorder.
RESULTS: The score of eHealth literacy was 48.88 ± 8.46, and 11.4%, 6.8% and 
20.1% of respondents experienced moderate to severe depression, insomnia and 
post-traumatic stress disorder. eHealth literacy negatively correlated with 
depression (r = -0.331), insomnia (r = -0.366) and post-traumatic stress 
disorder (r = -0.320).
CONCLUSION: eHealth literacy is closely related to psychological status. 
Improving eHealth literacy may contribute to maintaining good psychological 
well-being.
IMPLICATIONS FOR NURSING MANAGEMENT: It is necessary to strengthen the education 
of primary health care providers to enhance their ability to help community 
residents effectively use eHealth information.

© 2020 John Wiley & Sons Ltd.

DOI: 10.1111/jonm.13221
PMCID: PMC7753302
PMID: 33269492 [Indexed for MEDLINE]


4007. Palliat Support Care. 2021 Oct;19(5):530-539. doi: 10.1017/S1478951520001224.

Empowering families facing end-stage nonmalignant chronic diseases with a 
holistic, transdisciplinary, community-based intervention: 3 months outcome of 
the Life Rainbow Program.

Law MC(1), Lau BH(2), Kwok AYY(1), Lee JSH(1), Lui RNY(3), Liu KH(1), Leung 
PPY(1), Chan CLW(4)(5).

Author information:
(1)Hong Kong Society for Rehabilitation, Hong Kong.
(2)Department of Counselling and Psychology, Hong Kong Shue Yan University, 
North Point, Hong Kong.
(3)Faculty of Social Sciences, University of Hong Kong, Hong Kong.
(4)Department of Social Work and Social Administration, University of Hong Kong, 
Hong Kong.
(5)Centre on Behavioral Health, University of Hong Kong, Hong Kong.

Erratum in
    Palliat Support Care. 2021 Oct;19(5):640.

OBJECTIVES: Families facing end-stage nonmalignant chronic diseases (NMCDs) are 
presented with similar symptom burdens and need for psycho-social-spiritual 
support as their counterparts with advanced cancers. However, NMCD patients tend 
to face more variable disease trajectories, and thus may require different 
anticipatory supports, delivered in familiar environments. The Life Rainbow 
Programme (LRP) provides holistic, transdisciplinary, community-based 
end-of-life care for patients with NMCDs and their caregivers. This paper 
reports on the 3-month outcomes using a single-group, pre-post comparison.
METHOD: Patients with end-stage NMCDs were screened for eligibility by a medical 
team before being referred to the LRP. Patients were assessed at baseline (T0), 
1 month (T1), and 3 months (T2) using the Integrated Palliative Outcome Scale 
(IPOS). Their hospital use in the previous month was also measured by 
presentations at accident and emergency services, admissions to intensive care 
units, and number of hospital bed-days. Caregivers were assessed at T0 and T2 
using the Chinese version of the Modified Caregiver Strain Index, and 
self-reported health, psychological, spiritual, and overall well-being. 
Over-time changes in outcomes for patients, and caregivers, were tested using 
paired-sample t-tests, Wilcoxon-signed rank tests, and chi-square tests.
RESULTS: Seventy-four patients and 36 caregivers participated in this research 
study. Patients reported significant improvements in all IPOS domains at both 1 
and 3 months [ranging from Cohen's d = 0.495 (nausea) to 1.793 (depression and 
information needs fulfilled)]. Average hospital bed-days in the previous month 
fell from 3.50 to 1.68, comparing baseline and 1 month (p < 0.05). At 3 months, 
caregiver strain was significantly reduced (r = 0.332), while spiritual 
well-being was enhanced (r = 0.333).
SIGNIFICANCE: After receiving 3 month's LRP services, patients with end-stage 
NMCDs and their caregivers experienced significant improvements in the quality 
of life and well-being, and their hospital bed-days were reduced.

DOI: 10.1017/S1478951520001224
PMID: 33267934 [Indexed for MEDLINE]


4008. J Clin Rheumatol. 2021 Apr 1;27(3):120-126. doi: 10.1097/RHU.0000000000001686.

Variables Associated With Perceived Risk of Contracting SARS-CoV-2 Infection 
During the COVID-19 Pandemic Among Patients With Systemic Rheumatic Diseases.

Duculan R(1), Jannat-Khah D, Mehta B, Mandl LA, Barbhaiya M, Bass AR, Mancuso 
CA.

Author information:
(1)From the Department of Orthopedic Surgery.

OBJECTIVE: The aim of this study was to assess patients' perceived risk of 
contracting SARS-CoV-2 at the peak of the pandemic in NYC in terms of their 
systemic rheumatic disease and medications.
METHODS: With the approval of their rheumatologists, patients were interviewed 
by telephone and were asked about their perceived risk of contracting SARS-CoV-2 
considering their rheumatic condition and whether medications increased this 
risk. Patients also completed surveys assessing beliefs about medication and 
multidimensions of physical/mental well-being. Information about current 
medications and rheumatologist-initiated changes in medications during the 
pandemic were reported by patients and verified from medical records.
RESULTS: One hundred twelve patients (86% women; mean age, 50 years; 81% White, 
15% Latino) with diverse diagnoses were enrolled. Fifty-four percent thought 
they were at "very much greater risk" of COVID-19 because of their rheumatic 
condition, and 57% thought medications "definitely" put them at greater risk. In 
multivariable analysis, the perception of "very much greater risk" was 
associated with greater belief that rheumatic disease medications were 
necessary, worse physical function, chronic pulmonary comorbidity, and more 
anxiety. In a separate model, the perception that medications "definitely" 
caused greater risk was associated with White race, not taking 
hydroxychloroquine, rheumatologists initiating change in medications, more 
anxiety, and taking biologics and corticosteroids.
CONCLUSIONS: Patients' perceived increased risk of contracting SARS-CoV-2 was 
associated with beliefs about their rheumatic disease, medications, comorbidity, 
and anxiety. Clinicians should be aware of patients' perceptions and foster 
self-management practices that will alleviate anxiety, minimize exposure to the 
virus, and optimize systemic rheumatic disease outcomes.

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/RHU.0000000000001686
PMID: 33264246 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


4009. JMIR Mhealth Uhealth. 2020 Dec 9;8(12):e23157. doi: 10.2196/23157.

Experiences, Attitudes, and Needs of Users of a Pregnancy and Parenting App 
(Baby Buddy) During the COVID-19 Pandemic: Mixed Methods Study.

Rhodes A(1), Kheireddine S(1), Smith AD(1).

Author information:
(1)Department of Behavioural Science and Health, Institute of Epidemiology and 
Health Care, University College London, London, United Kingdom.

BACKGROUND: The COVID-19 pandemic has impacted the lives of expectant parents 
and parents of young babies, with disruptions in health care provision and loss 
of social support.
OBJECTIVE: This study investigated the impact of the COVID-19 pandemic and its 
associated lockdown on this population through the lens of users of the UK 
National Health Service-approved pregnancy and parenting smartphone app, Baby 
Buddy. The study aims were threefold: to gain insights into the attitudes and 
experiences of expectant and recent parents (with babies under 24 weeks of age) 
during the COVID-19 pandemic; to investigate whether Baby Buddy is meeting 
users' needs during this time; and to identify ways to revise the content of 
Baby Buddy to better support its users now and in future.
METHODS: A mixed methods study design combining a web-based survey with 
semistructured telephone interviews among Baby Buddy users in the United Kingdom 
was applied. Data were collected from April 15 to mid-June 2020, corresponding 
to weeks 4-13 of the lockdown in the United Kingdom.
RESULTS: A total of 436 expectant (n=244, 56.0%) and recent (n=192, 44.0%) 
parents responded to the web-based survey, of which 79.1% (n=345) were aged 
25-39 years and 17.2% (n=75) spoke English as their second language. Of the 436 
respondents, 88.5% (386/436) reported increased levels of anxiety around 
pregnancy, birth, and being a new parent, and 58.0% (253/436) were concerned 
about their emotional and mental health. Of the 244 pregnant respondents, 43.4% 
(n=106) were concerned about their physical health. Telephone interviews with 13 
pregnant women and 19 recent parents revealed similarly increased levels of 
anxiety due to reduced health care provision and loss of support from friends 
and family. Although a minority of respondents identified some positive outcomes 
of lockdown, such as family bonding, many telephone interviewees reported 
feeling isolated, disregarded, and overwhelmed. Recent parents were particularly 
anxious about the impact of the lockdown on their baby's development and 
socialization. Many interviewees were also concerned about their physical health 
as a consequence of both limited access to face-to-face medical appointments and 
their own poorer dietary and physical activity behaviors. Across both samples, 
97.0% (423/436) of respondents reported that Baby Buddy was currently helping 
them, with many commenting that its role was even more important given the lack 
of face-to-face support from health care and parenting organizations. Greater 
speed in updating digital content to reflect changes due to the pandemic was 
suggested.
CONCLUSIONS: The COVID-19 pandemic has created heightened anxiety and stress 
among expectant parents and those with a young baby, and for many, lockdown has 
had an adverse impact on their physical and mental well-being. With reductions 
in health care and social support, expectant and new parents are increasingly 
relying on web-based resources. As a free, evidence-based app, Baby Buddy is 
well positioned to meet this need. The app could support its users even more by 
actively directing them to the wealth of existing content relevant to their 
concerns and by adding content to give users the knowledge and confidence to 
meet new challenges.

©Alexandra Rhodes, Sara Kheireddine, Andrea D Smith. Originally published in 
JMIR mHealth and uHealth (http://mhealth.jmir.org), 09.12.2020.

DOI: 10.2196/23157
PMCID: PMC7732354
PMID: 33264100 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: AR is supported by the 
ESRC through a UCL, Bloomsbury, East London Doctoral Training Partnership (UBEL 
DTP). The studentship is cofunded by the UK charity Best Beginnings (charity 
number 1120054).


4010. Br J Hosp Med (Lond). 2020 Nov 2;81(11):1-9. doi: 10.12968/hmed.2020.0611. Epub 
2020 Nov 17.

Leadership in a crisis: doing things differently, doing different things.

Paixão G(1), Mills C(2), McKimm J(3), Hassanien MA(4)(5), Al-Hayani AA(6).

Author information:
(1)Nuclear Medicine and PET/CT Department, University Hospitals Birmingham, NHS 
Foundation Trust, Birmingham, UK.
(2)Department of Applied Linguistics, Swansea University, Swansea, UK.
(3)Swansea University Medical School, Swansea University, Swansea, UK.
(4)Department of Pharmacy Practice, College of Pharmacy, King Abdulaziz 
University, Jeddah, Saudi Arabia.
(5)College of Medicine, Tanta University, Tanta, Egypt.
(6)Department of Anatomy, Faculty of Medicine, King Abdulaziz University, 
Jeddah, Saudi Arabia.

This article summarises the findings from a review of publications related to 
healthcare leadership that were published during the first wave of the COVID-19 
crisis in 2020. The review discusses a range of strategies for leaders to adopt 
in challenging situations and identifies three aspects of leadership which are 
considered essential when leading teams during a crisis: 1) communication, 2) 
decision making and 3) mental health and wellbeing. This article identifies key 
principles for each of these three aspects and provides practical tips for how 
leaders can use the lessons learned from the pandemic in their own contexts.

DOI: 10.12968/hmed.2020.0611
PMID: 33263482 [Indexed for MEDLINE]


4011. Acta Biomed. 2020 Nov 30;91(12-S):e2020007. doi: 10.23750/abm.v91i12-S.9860.

How the Italian Nursing students deal the pandemic Covid-19 condition.

Vitale E(1), Moretti B(2), Noternicola A(3), Covelli I(4).

Author information:
(1)Array. vitaleelsa@libero.it.
(2)Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, 
Neuroscience and Sense Organs, School of Medicine, University of Bari Aldo Moro, 
AOU Consorziale Policlinico, Bari, Italy.. biagio.moretti@uniba.it.
(3)Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, 
Neuroscience and Sense Organs, School of Medicine, University of Bari Aldo Moro, 
AOU Consorziale Policlinico, Bari, Italy.. angela.notarnicola@uniba.it.
(4)Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, 
Neuroscience and Sense Organs, School of Medicine, University of Bari Aldo Moro, 
AOU Consorziale Policlinico, Bari, Italy.. ilaria.covelli@uniba.it.

BACKGROUND AND AIM OF THE WORK: Since December 2019, a new infectious disease 
known as Coronavirus disease (Covid-19) has rapidly spread globally until it has 
been declared a pandemic by the World Health Organization. At the same time, if 
we consider the University context, there is little attention paid during basic 
nursing education to emergency response, and faculty members report feeling 
poorly prepared to teach students about this topic. The present study aims to 
investigate how the Covid-19 pandemic condition influenced the psychological 
well-being of the Italian nursing students.
METHODS: An online questionnaire was administered to Italian nursing students 
which contains two parts: a demographic section and the assessment to the 
psychological well-being nursing student with the Impact of Event Scale-Revised 
and the Patient Health Questionnaire-9.
RESULTS: Given the emergency health situation from Covid-19, our initial concern 
was to find a large number of students with difficulties in mentally processing 
this situation even with problems such as depression, as their future profession 
is heavily involved in the management of this pandemic. Fortunately our results 
have denied our initial hypothesis since both the impact management levels of 
the event, assessed with the IES-R scale, and the depression levels, assessed 
with the PHQ-9 recorded values ​​that were almost normal.
CONCLUSIONS: Nursing students are better able to face the situation since they 
find themselves in the role of spectators and not in the role of actors in the 
care of patients with Covid-19. If the training ameliorates psychological well 
being, therefore, it is necessary to provide and preserve nurses expertise to 
encourage teaching in nursing degree courses on maxi emergencies to prepare 
future nurses to face them adequately.

DOI: 10.23750/abm.v91i12-S.9860
PMCID: PMC8023108
PMID: 33263339 [Indexed for MEDLINE]

Conflict of interest statement: Each author declares that he or she has no 
commercial associations (e.g. consultancies, stock ownership, equity interest, 
patent/licensing arrangement etc.) that might pose a conflict of interest in 
connection with the submitted article


4012. Dtsch Med Wochenschr. 2021 Jan;146(2):e11-e20. doi: 10.1055/a-1275-3792. Epub 
2020 Dec 1.

[Stress, coping strategies and health-related quality of life during the corona 
pandemic in April 2020 in Germany].

[Article in German; Abstract available in German from the publisher]

Peters E(1), Hübner J(1), Katalinic A(1)(2).

Author information:
(1)Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck, Lübeck.
(2)Institut für Krebsepidemiologie e. V., Universität zu Lübeck, Lübeck.

INTRODUCTION: International studies indicate that pandemics and quarantine can 
lead to significantly increased stress levels and mental illness in those 
affected. Stress levels and quality of life in selected population groups in the 
early phase of the lockdown of the corona pandemic were examined. Associations 
of coping strategies with perceived stress levels and associations of activities 
to increase well-being with health-related quality of life as an aspect of 
well-being are presented.
METHODS: Data from the first survey wave of the CoPa study were evaluated, which 
were collected via online survey. Group differences regarding stress and quality 
of life were explorative tested by means of Chi-square tests and T-tests. 
Associations of coping strategies with stress and of activities to increase 
well-being with health-related quality of life were calculated using linear 
regression analysis.
RESULTS: Among the 5315 participants, persons at risk of mental health and those 
who did not go out in public showed signs of depression, anxiety disorders and 
stress significantly more often than other participants. Persons with children 
under 12 years of age showed significantly higher stress levels than others and 
their health-related quality of life was comparable. Perceived social support 
and self-efficacy proved to be resources for stress. Humor, physical activity, 
healthy eating, maintaining daily routines and pursuing specific goals were 
positively associated with health-related quality of life.
DISCUSSION: Persons with mental health risks need therapeutic services in times 
of reduced contact. Selected measures to increase well-being appear to be 
effective and should be recommended.

Publisher: EINLEITUNG: Internationale Studien zeigen, dass Pandemien und 
Quarantäne zu einem signifikant erhöhten Stressniveau und psychischen 
Erkrankungen bei Betroffenen führen können. Untersucht wurden die 
Stressbelastung und Lebensqualität in ausgewählten Bevölkerungsgruppen in der 
Frühphase des Lockdowns der Corona-Pandemie. Vorgestellt werden Assoziationen 
von Copingstrategien mit wahrgenommener Stressbelastung und Assoziationen von 
Aktivitäten zur Steigerung des Wohlbefindens mit der gesundheitsbezogenen 
Lebensqualität als ein Aspekt des Wohlbefindens.
METHODIK: Es wurden Daten der ersten Befragungswelle der CoPa-Studie 
ausgewertet, die mittels Online-Befragung erhoben wurden. Gruppenunterschiede 
hinsichtlich Stress und Lebensqualität wurden mittels Chi-Quadrat-Tests bzw. 
T-Tests explorativ geprüft. Assoziationen von Copingstrategien mit Stress und 
von Aktivitäten zur Steigerung des Wohlbefindens mit der gesundheitsbezogenen 
Lebensqualität wurden mit linearen Regressionsanalysen berechnet.
ERGEBNISSE: Unter den 5315 Teilnehmenden zeigten Personen mit gefährdeter 
psychischer Gesundheit und Personen, die nicht in die Öffentlichkeit gingen, 
signifikant häufiger als andere Teilnehmende Anzeichen für Depressionen, 
Angststörungen und Stress. Personen mit Kindern bis 12 Jahren zeigten 
signifikant höhere Stresswerte als andere, ihre gesundheitsbezogene 
Lebensqualität war vergleichbar. Wahrgenommene soziale Unterstützung und 
Selbstwirksamkeit erwiesen sich als Ressourcen für die Stressbelastung. Humor, 
körperliche Aktivitäten, gesunde Ernährung, die Beibehaltung von Tagesroutinen 
und die Verfolgung von konkreten Zielen waren positiv mit der 
gesundheitsbezogenen Lebensqualität assoziiert.
DISKUSSION: Personen mit gefährdeter psychischer Gesundheit benötigen in Zeiten 
mit reduzierten Kontaktmöglichkeiten therapeutische Angebote. Ausgewählte 
Maßnahmen zur Steigerung des Wohlbefindens scheinen wirksam zu sein und sollten 
empfohlen werden.

The Author(s). This is an open access article published by Thieme under the 
terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, 
permitting copying and reproduction so long as the original work is given 
appropriate credit. Contents may not be used for commecial purposes, or adapted, 
remixed, transformed or built upon. 
(https://creativecommons.org/licenses/by-nc-nd/4.0/).

DOI: 10.1055/a-1275-3792
PMCID: PMC7815330
PMID: 33260231 [Indexed for MEDLINE]

Conflict of interest statement: Die Autorinnen/Autoren geben an, dass kein 
Interessenkonflikt besteht.


4013. Jpn J Nurs Sci. 2021 Apr;18(2):e12398. doi: 10.1111/jjns.12398. Epub 2020 Dec 1.

Current status of and factors influencing anxiety and depression in front-line 
medical staff supporting Wuhan in containing the novel coronavirus pneumonia 
epidemic.

Li L(1), Sun N(#)(1), Fei S(#)(1), Yu L(1), Chen S(1), Yang S(1), Li H(1).

Author information:
(1)NingBo College of Health Sciences, Ningbo, China.
(#)Contributed equally

AIM: This research aimed to shed light on the relationship between the 
sociodemographic characteristics of front-line medical workers and their anxiety 
and depression, to provide the basis and reference for targeted mental health 
education and for relevant departments to formulate appropriate policies during 
the COVID-19 outbreak.
METHODS: This study adopted a convenient sampling method and examined the 
psychological status of 150 front-line medical workers from Zhejiang Province 
with questionnaire surveys using the Hamilton Anxiety and Depression Scale.
RESULTS: The participants had severe anxiety and depression; the top three items 
under the category of anxiety were genitourinary symptoms, behavior at 
interview, and respiratory symptoms, whereas the top three items under 
depression were feelings of guilt, weight loss, and retardation. Among all 
personal data, the following factors influenced anxiety, in decreasing order: 
degree of suspicion of being infected when showing associated symptoms, degree 
of fear of yourself and your family being infected, and the affiliated hospital 
(p < .05). As for depression, the factors were the degree of suspicion of being 
infected when showing associated symptoms and the degree of fear of yourself and 
your family being infected (p < .05).
CONCLUSION: This study revealed that front-line medical staff presented symptoms 
of anxiety and depression when dealing with the COVID-19 outbreak and the 
factors influencing their psychological stress. Guiding policies and 
psychological interventions is crucial to maintaining their psychological 
well-being. Different measures may be implemented to solve this problem.

© 2020 Japan Academy of Nursing Science.

DOI: 10.1111/jjns.12398
PMCID: PMC7744847
PMID: 33258559 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare they have no any 
involvement, financial or otherwise, that may potentially bias their work.


4014. J Urban Health. 2021 Feb;98(1):41-52. doi: 10.1007/s11524-020-00498-8. Epub 2020 
Nov 30.

Response to the COVID-19 Outbreak in Urban Settings in China.

Ni Z(1), Lebowitz ER(2), Zou Z(3), Wang H(4), Liu H(5), Shrestha R(2)(6), Zhang 
Q(7), Hu J(8), Yang S(9), Xu L(10), Wu J(11), Altice FL(2)(12)(13).

Author information:
(1)School of Medicine, Yale University, New Haven, Connecticut, USA. 
zhao.ni@yale.edu.
(2)School of Medicine, Yale University, New Haven, Connecticut, USA.
(3)School of Health Sciences, Wuhan University, Wuhan, Hubei, China. 
zouzhijiehope@163.com.
(4)Xiangya School of Nursing, Central South University, Changsha, Hunan, China.
(5)School of Nursing, Peking Union Medical College, Beijing, China.
(6)Institute for Collaboration on Health, Intervention, & Policy, University of 
Connecticut, Storrs, Connecticut, USA.
(7)School of Health Sciences, Wuhan University, Wuhan, Hubei, China.
(8)College of Nursing, Xi'an Medical University, Xi'an, Shaanxi, China.
(9)Hohhot Vocational College, Hohhot, Inner Mongolia, China.
(10)School of Nursing, Fudan University, Shanghai, China.
(11)Gansu University of Chinese Medicine, Lanzhou, Gansu, China.
(12)West China Hospital/West China School of Nursing, Sichuan University, 
Chengdu, Sichuan, China.
(13)School of Public Health, Yale University, New Haven, Connecticut, USA.

Update of
    Res Sq. 2020 Sep 09;:

The COVID-19 outbreak in China was devastating and spread throughout the country 
before being contained. Stringent physical distancing recommendations and 
shelter-in-place were first introduced in the hardest-hit provinces, and by 
March, these recommendations were uniform throughout the country. In the 
presence of an evolving and deadly pandemic, we sought to investigate the impact 
of this pandemic on individual well-being and prevention practices among Chinese 
urban residents. From March 2-11, 2020, 4607 individuals were recruited from 11 
provinces with varying numbers of COVID-19 cases using the social networking app 
WeChat to complete a brief, anonymous, online survey. The analytical sample was 
restricted to 2551 urban residents. Standardized scales measured generalized 
anxiety disorder (GAD), the primary outcome. Multiple logistic regression was 
conducted to identify correlates of GAD alongside assessment of community 
practices in response to the COVID-19 pandemic. We found that during the 
COVID-19 pandemic, the recommended public health practices significantly 
(p < 0.001) increased, including wearing facial mask, practicing physical 
distancing, handwashing, decreased public spitting, and going outside in urban 
communities. Overall, 40.3% of participants met screening criteria for GAD and 
49.3%, 62.6%, and 55.4% reported that their work, social life, and family life 
were interrupted by anxious feelings, respectively. Independent correlates of 
having anxiety symptoms included being a healthcare provider (aOR = 1.58, 
p < 0.01), living in regions with a higher density of COVID-19 cases 
(aOR = 2.13, p < 0.01), having completed college (aOR = 1.38, p = 0.03), meeting 
screening criteria for depression (aOR = 6.03, p < 0.01), and poorer perceived 
health status (aOR = 1.54, p < 0.01). COVID-19 had a profound impact on the 
health of urban dwellers throughout China. Not only did they markedly increase 
their self- and community-protective behaviors, but they also experienced high 
levels of anxiety associated with a heightened vulnerability like depression, 
having poor perceived health, and the potential of increased exposure to 
COVID-19 such as living closer to the epicenter of the pandemic.

DOI: 10.1007/s11524-020-00498-8
PMCID: PMC7703725
PMID: 33258088 [Indexed for MEDLINE]


4015. Rheumatol Int. 2021 Feb;41(2):335-344. doi: 10.1007/s00296-020-04751-w. Epub 
2020 Nov 30.

Different types of physical activity are positively associated with indicators 
of mental health and psychological wellbeing in rheumatoid arthritis during 
COVID-19.

Brady SM(1)(2)(3), Fenton SAM(1)(2)(3), Metsios GS(2)(4), Bosworth A(5), Duda 
JL(1)(3), Kitas GD(1)(2), Veldhuijzen van Zanten JJCS(6)(7)(8).

Author information:
(1)School of Sport, Exercise and Rehabilitation Sciences, University of 
Birmingham, Birmingham, B15 2TT, UK.
(2)Rheumatology Department, Dudley Group NHS Foundation Trust, Dudley, UK.
(3)Medical Research Council-Versus Arthritis Centre for Musculoskeletal Ageing, 
University of Birmingham, Birmingham, UK.
(4)Faculty of Education, Health and Wellbeing, University of Wolverhampton, 
Wolverhampton, UK.
(5)National Rheumatoid Arthritis Society, Maidenhead, UK.
(6)School of Sport, Exercise and Rehabilitation Sciences, University of 
Birmingham, Birmingham, B15 2TT, UK. veldhujj@bham.ac.uk.
(7)Rheumatology Department, Dudley Group NHS Foundation Trust, Dudley, UK. 
veldhujj@bham.ac.uk.
(8)Medical Research Council-Versus Arthritis Centre for Musculoskeletal Ageing, 
University of Birmingham, Birmingham, UK. veldhujj@bham.ac.uk.

Nationwide lockdowns during SARS-CoV-2 (COVID-19) can compromise mental health 
and psychological wellbeing and limit opportunities for physical activity (PA), 
particularly in clinical populations, such as people with rheumatoid arthritis 
(RA), who are considered at risk for COVID-19 complications. This study aimed to 
investigate associations between PA and sedentary time (ST) with indicators of 
mental health and wellbeing in RA during COVID-19 lockdown, and examine the 
moderation effects of self-isolating. 345 RA patients completed an online 
questionnaire measuring PA (NIH-AARP Diet and Health Study Questionnaire), ST 
(International Physical Activity Questionnaire-Short Form), pain (McGill Pain 
Questionnaire and Visual Analogue Scale), fatigue (Multidimensional Fatigue 
Inventory), depressive and anxious symptoms (Hospital Anxiety and Depression 
Scale), and vitality (Subjective Vitality Scale) during the United Kingdom 
COVID-19 lockdown. Associations between PA and ST with mental health and 
wellbeing were examined using hierarchical multiple linear regressions. Light PA 
(LPA) was significantly negatively associated with mental fatigue (β = - .11), 
depressive symptoms (β = - .14), and positively with vitality (β = .13). Walking 
was negatively related to physical fatigue (β = - .11) and depressive symptoms 
(β = - .12) and positively with vitality (β = .15). Exercise was negatively 
associated with physical (β = - .19) and general (β = - .12) fatigue and 
depressive symptoms (β = - .09). ST was positively associated with physical 
fatigue (β = .19). Moderation analyses showed that LPA was related to lower 
mental fatigue and better vitality in people not self-isolating, and walking 
with lower physical fatigue in people self-isolating. These findings show the 
importance of encouraging PA for people with RA during a lockdown period for 
mental health and wellbeing.

DOI: 10.1007/s00296-020-04751-w
PMCID: PMC7703721
PMID: 33258004 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


4016. Neuropsychopharmacol Hung. 2020 Dec;22(4):154-165.

[Effects of COVID-19 on psychological well-being, lifestyle and attitudes 
towards the origins of the pandemic in psychiatric patients and mentally healthy 
subjects: fi rst Hungarian descriptive results from a large international online 
study].

[Article in Hungarian]

Kulig B(1), Erdelyi-Hamza B, Elek LP, Kovacs I, Smirnova D, Fountoulakis K, 
Gonda X.

Author information:
(1)Semmelweis Egyetem Pszichiátriai és Pszichoterápiás Klinika, Szent Rókus 
Klinikai Tömb, Budapest, Hungary. gonda.xenia@med.semmelweis-univ.hu.

The COVID-2019 pandemic has presented a new situation affecting not only the 
somatic but the mental health of people worldwide and exposing the world 
including healthcare professionals to a challenge never experienced before. 
Therefore its effects on mental health, although can be estimated, but cannot be 
predicted, thus we are only halfways prepared for understanding as well as 
screening, preventing and treating the pandemic-related mental health problems. 
For this reason, the Mental Health Sector of the Scientific Researches Institute 
of the Pan-Hellenic Medical Association prepared a large, international online, 
general population study with participation from over 42 countries, assessing 
various aspects of general mental function, needs and behaviors that could occur 
during the COVID-19 outbreak, as a result of either the outbreak itself or the 
social measures adopted in order to control it. While the study is ongoing, here 
we present the first descriptive results from the Hungarian study sample 
including 738 adult participants collected during the first wave of 
COVID-19-associated lockdown, focusing on differences in the effect of COVID-19 
on psychological and lifestyle measures, as well as attitudes towards the 
pandemic between mentally healthy participants and people with mental disorders.

PMID: 33257593 [Indexed for MEDLINE]


4017. BMC Public Health. 2020 Nov 30;20(1):1825. doi: 10.1186/s12889-020-09875-z.

A rapid review of mental and physical health effects of working at home: how do 
we optimise health?

Oakman J(1), Kinsman N(2), Stuckey R(2), Graham M(2), Weale V(2).

Author information:
(1)Centre for Ergonomics and Human Factors; Department of Public Health, La 
Trobe University, Kingsbury Drive, Bundoora, 3086, Australia. 
j.oakman@latrobe.edu.au.
(2)Centre for Ergonomics and Human Factors; Department of Public Health, La 
Trobe University, Kingsbury Drive, Bundoora, 3086, Australia.

BACKGROUND: The coronavirus (COVID-19) pandemic has resulted in changes to the 
working arrangements of millions of employees who are now based at home and may 
continue to work at home, in some capacity, for the foreseeable future. 
Decisions on how to promote employees' health whilst working at home (WAH) need 
to be based on the best available evidence to optimise worker outcomes. The aim 
of this rapid review was to review the impact of WAH on individual workers' 
mental and physical health, and determine any gender difference, to develop 
recommendations for employers and employees to optimise workers' health.
METHOD: A search was undertaken in three databases, PsychInfo, ProQuest, and Web 
of Science, from 2007 to May 2020. Selection criteria included studies which 
involved employees who regularly worked at home, and specifically reported on 
physical or mental health-related outcomes. Two review authors independently 
screened studies for inclusion, one author extracted data and conducted risk of 
bias assessments with review by a second author.
RESULTS: Twenty-three papers meet the selection criteria for this review. Ten 
health outcomes were reported: pain, self-reported health, safety, well-being, 
stress, depression, fatigue, quality of life, strain and happiness. The impact 
on health outcomes was strongly influenced by the degree of organisational 
support available to employees, colleague support, social connectedness (outside 
of work), and levels of work to family conflict. Overall, women were less likely 
to experience improved health outcomes when WAH.
CONCLUSIONS: This review identified several health outcomes affected by WAH. The 
health/work relationship is complex and requires consideration of broader system 
factors to optimise the effects of WAH on workers' health. It is likely mandated 
WAH will continue to some degree for the foreseeable future; organisations will 
need to implement formalised WAH policies that consider work-home boundary 
management support, role clarity, workload, performance indicators, technical 
support, facilitation of co-worker networking, and training for managers.

DOI: 10.1186/s12889-020-09875-z
PMCID: PMC7703513
PMID: 33256652 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


4018. BMC Public Health. 2020 Nov 30;20(1):1814. doi: 10.1186/s12889-020-09900-1.

Impact of COVID-19 on the health and psychosocial status of vulnerable older 
adults: study protocol for an observational study.

Cheung G(1)(2), Rivera-Rodriguez C(3), Martinez-Ruiz A(4)(5)(6), Ma'u E(4), Ryan 
B(5)(7), Burholt V(8)(9), Bissielo A(10), Meehan B(10).

Author information:
(1)Department of Psychological Medicine, The University of Auckland, Private Bag 
92019, Auckland Mail Centre, Auckland, 1142, New Zealand. 
g.cheung@auckland.ac.nz.
(2)Brain Research New Zealand - Rangahau Roro Aotearoa, The University of 
Auckland, Auckland, New Zealand. g.cheung@auckland.ac.nz.
(3)Department of Statistics, The University of Auckland, Auckland, New Zealand.
(4)Department of Psychological Medicine, The University of Auckland, Private Bag 
92019, Auckland Mail Centre, Auckland, 1142, New Zealand.
(5)Brain Research New Zealand - Rangahau Roro Aotearoa, The University of 
Auckland, Auckland, New Zealand.
(6)Department of Demographic Epidemiology and Social Determinants, National 
Institute of Geriatrics of Mexico, Mexico City, Mexico.
(7)Department of Anatomy and Medical Imaging, The University of Auckland, 
Auckland, New Zealand.
(8)School of Nursing / School of Population Health, The University of Auckland, 
Auckland, UK.
(9)Centre for Innovative Ageing, College of Human and Health Sciences, Swansea 
University, Wales, New Zealand.
(10)interRAI Services, Technical Advisory Services (TAS) Limited, Wellington, 
UK.

BACKGROUND: Many countries around the world have adopted social distancing as 
one of the public health measures to reduce COVID-19 transmissions in the 
community. Such measures could have negative effects on the mental health of the 
population. The aims of this study are to (1) track the impact of COVID-19 on 
self-reported mood, self-rated health, other health and psychosocial indicators, 
and health services utilization of people who have an interRAI assessment during 
the first year of COVID-19; (2) compare these indicators with the same 
indicators in people who had an interRAI assessment in the year before COVID-19; 
and (3) report these indicators publicly as soon as data analysis is completed 
every 3 months.
METHODS: interRAI COVID-19 Study (iCoS) is an observational study on routinely 
collected national data using the interRAI Home Care and Contact Assessment, 
which are standardized geriatric assessment tools mandated for all people 
assessed for publicly funded home support services and aged residential care in 
New Zealand. Based on the 2018/19 figures, we estimated there are 36,000 
interRAI assessments per annum. We will compare the four post-lockdown quarters 
(from 25th March 2020) with the respective pre-lockdown quarters. The primary 
outcomes are self-reported mood (feeling sad, depressed or hopeless: 0 = no, 
1 = yes) and self-rated health (0 = excellent, 1 = good, 2 = fair, 3 = poor). We 
will also analyze sociodemographics, other secondary health and psychosocial 
indicators, and health services utilization. Descriptive statistics will be 
conducted for primary outcomes and other indicators for each of the eight 
quarters. We will compare the quarters using regression models adjusted for 
demographic characteristics using weights or additional variables. Key health 
and psychosocial indicators will be reported publicly as soon as data analysis 
is completed for each quarter in the 12-month post-lockdown period by using a 
data visualization tool.
DISCUSSION: This rapid translation of routinely collected national interRAI data 
will provide a means to monitor the health and psychosocial well-being of 
vulnerable older New Zealanders. Insights from this study can be shared with 
other countries that use interRAI and prepare health and social services for 
similar epidemics/pandemics in the future.

DOI: 10.1186/s12889-020-09900-1
PMCID: PMC7702201
PMID: 33256649 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


4019. Int J Environ Res Public Health. 2020 Nov 25;17(23):8764. doi: 
10.3390/ijerph17238764.

Examining the Associations between Psychological Flexibility, Mindfulness, 
Psychosomatic Functioning, and Anxiety during the COVID-19 Pandemic: A Path 
Analysis.

Wielgus B(1), Urban W(2), Patriak A(3), Cichocki Ł(4).

Author information:
(1)The Education of Research and Development Center, Babinski Clinical Hospital, 
30-393 Cracow, Poland.
(2)Department of Psychiatry, Rydygier Specialist Hospital, 31-826 Cracow, 
Poland.
(3)Faculty of Philosophy, Institute of Psychology, Jagiellonian University, 
30-060 Cracow, Poland.
(4)Department of Psychiatry, Andrzej Frycz Modrzewski Cracow Academy, 30-705 
Cracow, Poland.

Social distancing plays a leading role in controlling the spread of coronavirus. 
However, prolonged lockdown can lead to negative consequences in terms of mental 
health. The goal of the research is to examine the relationship between anxiety 
and general psychosomatic functioning during the COVID-19 pandemic; the impact 
of psychological flexibility and mindfulness is also considered. Variables were 
measured with self-report questionnaires and symptom checklists. The sample 
included 170 people (M = 27.79, SD = 8.16). Pearson's correlation, stepwise 
regression, and path analysis were conducted. The results showed a significant 
positive relationship between state anxiety and somatic and psychological 
responses to the pandemic. Path analysis revealed that mindfulness had a direct 
negative impact on and decreased the level of state anxiety (b = -0.22, p = 
0.002), whereas psychological flexibility influenced the variable indirectly (b 
= 0.23, p = 0.002) by enhancing psychosomatic functioning (b = -0.64, p < 
0.001). Psychological flexibility and mindfulness may mediate the development of 
mental disorders and facilitate achieving overall wellbeing. The study points to 
the usefulness of mindfulness practice as a form of self-help with anxiety 
symptoms; this is crucial during the pandemic because contact with clients is 
restricted.

DOI: 10.3390/ijerph17238764
PMCID: PMC7728363
PMID: 33255758 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


4020. Medicina (Kaunas). 2020 Nov 25;56(12):640. doi: 10.3390/medicina56120640.

The Social Brain and Emotional Contagion: COVID-19 Effects.

Valenzano A(1), Scarinci A(2), Monda V(3), Sessa F(1), Messina A(3), Monda M(3), 
Precenzano F(4), Mollica MP(5), Carotenuto M(4), Messina G(1), Cibelli G(1).

Author information:
(1)Department of Clinical and Experimental Medicine, University of Foggia, 71122 
Foggia, Italy.
(2)Department of Education Sciences, Psychology, and Communication, University 
of Bari, 70121 Bari, Italy.
(3)Department of Experimental Medicine, Section of Human Physiology and Unit of 
Dietetics and Sports Medicine, Università degli Studi della Campania "Luigi 
Vanvitelli", 80100 Naples, Italy.
(4)Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, 
Physical and Preventive Medicine, Università degli Studi della Campania "Luigi 
Vanvitelli", 80100 Naples, Italy.
(5)Department of Clinical and Experimental Medicine, University of Naples, 80138 
Naples, Italy.

BACKGROUND AND OBJECTIVES: Coronavirus disease 2019 (COVID-19) is a highly 
contagious infectious disease, responsible for a global pandemic that began in 
January 2020. Human/COVID-19 interactions cause different outcomes ranging from 
minor health consequences to death. Since social interaction is the default mode 
by which individuals communicate with their surroundings, different modes of 
contagion can play a role in determining the long-term consequences for mental 
health and emotional well-being. We examined some basic aspects of human social 
interaction, emphasizing some particular features of the emotional contagion. 
Moreover, we analyzed the main report that described brain damage related to the 
COVID-19 infection. Indeed, the goal of this review is to suggest a possible 
explanation for the relationships among emotionally impaired people, brain 
damage, and COVID-19 infection.
RESULTS: COVID-19 can cause several significant neurological disorders and the 
pandemic has been linked to a rise in people reporting mental health problems, 
such as depression and anxiety. Neurocognitive symptoms associated with COVID-19 
include delirium, both acute and chronic attention and memory impairment related 
to hippocampal and cortical damage, as well as learning deficits in both adults 
and children.
CONCLUSIONS: Although our knowledge on the biology and long-term clinical 
outcomes of the COVID-19 infection is largely limited, approaching the pandemic 
based on lessons learnt from previous outbreaks of infectious diseases and the 
biology of other coronaviruses will provide a suitable pathway for developing 
public mental health strategies, which could be positively translated into 
therapeutic approaches, attempting to improve stress coping responses, thus 
contributing to alleviate the burden driven by the pandemic.

DOI: 10.3390/medicina56120640
PMCID: PMC7760735
PMID: 33255569 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


4021. Int J Environ Res Public Health. 2020 Nov 24;17(23):8730. doi: 
10.3390/ijerph17238730.

Co-Creating and Evaluating an App-Based Well-Being Intervention: The HOW 
(Healthier Outcomes at Work) Social Work Project.

Ravalier JM(1), Wainwright E(1), Smyth N(2), Clabburn O(3), Wegrzynek P(1), Loon 
M(1).

Author information:
(1)Newton Park Campus, School of Science, Bath Spa University, Bath BA29BN, UK.
(2)School of Social Sciences, Psychology, University of Westminster, London W1W 
6UW, UK.
(3)Wellcome Centre for Cultures and Environments of Health, Streatham Campus, 
University of Exeter, Exeter EX4 4QH, UK.

Stress and mental health at work are the leading causes of long-term sickness 
absence in the UK, with chronically poor working conditions impacting employee 
physiological and psychological health. Social workers play a significant part 
in the fabric of UK society, but have one of the most stressful occupations in 
the country. The aim of this project was to work with UK social workers to 
co-develop, implement, and evaluate a series of smartphone-based mental health 
initiatives. A Participatory Action Research (PAR) approach, consisting of 
semi-structured interviews and focus group and steering group discussions, was 
utilized to design the mental health and well-being interventions. Study 
efficacy was evaluated via a pre- and post-intervention survey and 
post-intervention semi-structured interviews. Interventions developed were 
psycho-educational, improved top-down and bottom-up communication, and provided 
access to a Vocational Rehabilitation Assistant for those struggling and at risk 
of sickness absence. Six months following dissemination, surveys demonstrated 
significant improvements in communication, and mean score improvements in four 
other working conditions. This project, therefore, demonstrates that 
co-developed initiatives can be positively impactful, despite post-intervention 
data collection being impacted by COVID-19. Future studies should build upon 
these findings and broaden the PAR approach nationally while taking a robust 
approach to evaluation.

DOI: 10.3390/ijerph17238730
PMCID: PMC7727806
PMID: 33255460 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


4022. Aust J Gen Pract. 2020 Dec;49(12):785-789. doi: 10.31128/AJGP-07-20-5557.

Diagnosis and treatment of post-traumatic stress disorder during the COVID-19 
pandemic.

Cooper J(1), Phelps AJ(2), Ng CH(3), Forbes D(4).

Author information:
(1)MBBS, MPM, FRANZCP, Consultant@Psychiatrist, Phoenix Australia Centre for 
Posttraumatic Mental Health and Department of@Psychiatry, The University of 
Melbourne, Vic.
(2)BA (Hons), MPsych (Clin), PhD, Deputy Director and Associate Professor, 
Phoenix Australia Centre for Posttraumatic Mental Health and Department of 
Psychiatry, The University of Melbourne, Vic.
(3)MBBS, MMed (Psych), MD, FRANZCP, Healthscope Chair of Psychiatry, The 
Professorial Unit, The Melbourne Clinic, Vic; Professor of Psychiatry, The 
University of Melbourne, Vic; Director, WHO Collaborating Centre in Mental 
Health, St Vincent@s Hospital, Vic.
(4)BA (Hons), M.A (Clin Psych), PhD, Director and Professor, Phoenix Australia 
Centre for Posttraumatic Mental Health and Department of Psychiatry, The 
University of Melbourne, Vic.

BACKGROUND: The COVID-19 pandemic has caused unprecedented stress globally, and 
the associated medical and health-related traumatic experiences pose significant 
risks for the development of post-traumatic stress disorder (PTSD), and the 
exacerbation of pre-existing PTSD, among patients, general practitioners (GPs) 
and healthcare staff.
OBJECTIVE: The aim of this article is to provide guidance to GPs and healthcare 
staff working in Australia about the diagnosis and treatment of both newly 
developed and pre-existing PTSD in the COVID-19 context. Case studies are 
presented; the authors discuss whether pandemic-related PTSD is different to 
PTSD caused by different types of traumatic exposure, and the associated 
implications for treatment.
DISCUSSION: The role of GPs in the management of PTSD during the COVID-19 
pandemic remains central, involving early detection, assessment and referral. 
Moreover, health professionals are not immune to the mental health effects of 
the pandemic and are encouraged to maintain their wellbeing and to seek 
professional treatment if needed.

DOI: 10.31128/AJGP-07-20-5557
PMID: 33254204 [Indexed for MEDLINE]


4023. Clin Nurs Res. 2021 May;30(4):401-405. doi: 10.1177/1054773820977198. Epub 2020 
Nov 26.

The Experience of Animal Assisted Therapy on Patients in an Acute Care Setting.

Coakley AB(1), Annese CD(1), Empoliti JH(1), Flanagan JM(1)(2).

Author information:
(1)Massachusetts General Hospital, Boston, USA.
(2)Boston College, William F. Connell School of Nursing, Chestnut Hill, MA, USA.

Animal assisted therapy (AAT) programs are popular and there has been a 
proliferation of programs across settings. However, the research to support this 
intervention has not kept pace. This is particularly so for people who are 
hospitalized. This investigation aimed to explore the effects of the AAT dog 
visitation program on patients. A single group pre-post quasi-experimental 
design evaluated the effect of pet therapy on patients. Measures included 
salivary cortisol, anxiety, wellbeing, comfort, respiratory and heart rate. 
Analysis indicates a significant reduction in heart and respiratory rates 
p < .01 and level of anxiety p < .000 with improved levels of comfort and 
well-being p < .000. The salivary cortisol result was non-significant p = .623. 
This ATT dog program resulted in reduced anxiety levels and decreased heart and 
respiratory rates while improving subjective measures of comfort and wellbeing.

DOI: 10.1177/1054773820977198
PMID: 33242977 [Indexed for MEDLINE]


4024. Neuroendocrinology. 2021;111(11):1066-1085. doi: 10.1159/000513346. Epub 2020 
Nov 26.

Sex Disparities in COVID-19 Severity and Outcome: Are Men Weaker or Women 
Stronger?

Pivonello R(1)(2), Auriemma RS(3), Pivonello C(3), Isidori AM(4), Corona G(5), 
Colao A(6)(3), Millar RP(7)(8).

Author information:
(1)Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, 
Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e 
Femminile (FERTISEXCARES), Università Federico II di Napoli, Naples, Italy, 
rosario.pivonello@unina.it.
(2)UNESCO Chair for Health Education and Sustainable Development, Federico II 
University, Naples, Italy, rosario.pivonello@unina.it.
(3)Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, 
Università Federico II di Napoli, Naples, Italy.
(4)Department of Experimental Medicine, "Sapienza" University of Rome, Rome, 
Italy.
(5)Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Bologna, 
Italy.
(6)UNESCO Chair for Health Education and Sustainable Development, Federico II 
University, Naples, Italy.
(7)Centre for Neuroendocrinology, Department of Immunology, Faculty of Health 
Sciences, University of Pretoria, Pretoria, South Africa.
(8)Neurosciences Institute and Institute of Infectious Diseases and Molecular 
Medicine, University of Cape Town, Cape Town, South Africa.

The coronavirus disease 2019 (COVID-19) outbreak, caused by severe acute 
respiratory syndrome coronavirus 2 (SARS-CoV-2), is a global public health issue 
which has profound effects on most aspects of societal well-being, including 
physical and mental health. A plethora of studies globally have suggested the 
existence of a sex disparity in the severity and outcome of COVID-19 patients, 
mainly due to mechanisms of virus infection, immune response to the virus, 
development of systemic inflammation, and consequent systemic complications, 
particularly thromboembolism. Epidemiological data report a sex difference in 
the severity of COVID-19, with a more favorable course of the disease in women 
compared to men regardless of age, although the rate of SARS-CoV-2 infection 
seems to be similar in both sexes. Sex hormones, including androgens and 
estrogens, may not only impact virus entry and load, but also shape the clinical 
manifestations, complications, and ultimately the outcome of the disease. The 
current review comprehensively summarizes the current literature on sex 
disparities in susceptibility and outcome of COVID-19 as well as the literature 
underpinning the pathophysiological and molecular mechanisms, which may provide 
a rationale to a sex disparity. These mechanisms include sex hormone influence 
on factors that facilitate virus entry and priming, immune and inflammatory 
response, as well as coagulation and thrombosis diathesis. Based on present 
evidence, women appear to be relatively protected from COVID-19 because of a 
more effective immune response and a less pronounced systemic inflammation, with 
consequent moderate clinical manifestations of the disease, together with a 
lesser predisposition to thromboembolism. Conversely, men appear to be 
particularly susceptible to COVID-19 because of a less effective immune response 
with consequent severe clinical manifestations of the disease, together with a 
greater predisposition to thromboembolism. In the elderly, generally 
characterized by the phenomenon of inflammaging, sex disparities in overall 
mortality following SARS-CoV-2 infection are even more palpable as elderly men 
appear to be more prone to severe COVID-19 because of a greater predisposition 
to infections, a weaker immune defense, and an enhanced thrombotic state 
compared to women. The information revealed from the review highlights potential 
novel therapeutic approaches employing the administration of hormonal or 
antihormonal therapy in combination with antiviral drugs in COVID-19 patients.

© 2020 S. Karger AG, Basel.

DOI: 10.1159/000513346
PMCID: PMC7900484
PMID: 33242856 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
declare.


4025. JPEN J Parenter Enteral Nutr. 2021 Jan;45(1):43-49. doi: 10.1002/jpen.2050. Epub 
2020 Dec 22.

An International Survey of Clinicians' Experience Caring for Patients Receiving 
Home Parenteral Nutrition for Chronic Intestinal Failure During the COVID-19 
Pandemic.

Allan PJ(1), Pironi L(2)(3), Joly F(4), Lal S(5)(6), Van Gossum A(7); Home 
Artificial Nutrition & Chronic Intestinal Failure special interest group of 
ESPEN.

Author information:
(1)Translational Gastroenterology Unit, Nuffield Department of Medicine, 
National Institute for Health Research Oxford Biomedical Research Centre, Oxford 
University Hospitals NHS Foundation Trust, Headley Way, Oxford, UK.
(2)Center for Chronic Intestinal Failure - Clinical Nutrition and Metabolism 
Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
(3)Department of Medical and Surgical Sciences, University of Bologna, Bologna, 
Italy.
(4)Centre for Intestinal Failure, Department of Gastroenterology and Nutritional 
Support, Hôpital Beaujon, Clichy, France.
(5)Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Stott Lane, 
Salford, UK.
(6)Division of Diabetes, Endocrinology and Gastroenterology, School of Medical 
Sciences, Faculty of Biology, Medicine and Health, The University of Manchester 
and Manchester Academic Health Sciences Centre, Manchester, UK.
(7)Medico-Surgical Department of Gastroenterology, Hôpital Erasme, Brussels, 
Belgium.

BACKGROUND: This survey of centers caring for patients receiving home parenteral 
nutrition (HPN) was conducted to assess the impact of the coronavirus disease 
2019 (COVID-19) crisis on the management of these patients regarding provision 
of care, monitoring, regular follow-up, and any changes to service 
infrastructure.
METHODS: A survey was devised and publically published on the Research 
Electronic Data Capture database management system, with individual centers 
responding to a public link.
RESULTS: A total of 78 adult and pediatric centers worldwide contributed to the 
survey, representing ≥3500 patients' experiences. Centers reported 
infrastructure maintenance for Parenteral Nutrition (PN) bag deliveries to 
patients (60, 76.92%) or delivery of ancillary items (57, 73.08%), home delivery 
and HPN administration (65, 83.33%), and home care nurse shortages (25, 32.05%). 
Routine follow-up of HPN patients changed to either all telemed or mixed with 
emergency clinic review (70, 89.74%). In 26 centers (33.33%), HPN for newly 
discharged patients with benign conditions was reduced or stopped. Based on 
clinical history, the centers reported psychological distress for patients (52, 
66.67%), with anxiety, worry, concern, and apprehension reported most frequently 
(37 of 52, 71.15%) but also fear (10 of 52, 19.23%), depression (5 of 52, 
9.62%), and issues related to isolation/confinement (12 of 52, 23.08%).
CONCLUSIONS: The COVID-19 pandemic was reported by clinicians to have had a 
far-reaching adverse impact on patients receiving HPN, especially their safety 
in terms of provision of personal protective equipment, PN bags, available 
nursing staff, and psychological well-being. Healthcare systems responded to the 
challenge and presented new ways of working.

© 2020 American Society for Parenteral and Enteral Nutrition.

DOI: 10.1002/jpen.2050
PMCID: PMC7753815
PMID: 33241555 [Indexed for MEDLINE]

Conflict of interest statement: L. Pironi is on the advisatory board for Baxter 
and Takeda, provides scientific communication for Fresenius Kabi, and is a 
consultant for B Braun. All other authors have no conflicts of interest to 
disclose.


4026. BMC Psychiatry. 2020 Nov 25;20(1):556. doi: 10.1186/s12888-020-02954-w.

Psychometric properties of the moral injury symptom scale among Chinese health 
professionals during the COVID-19 pandemic.

Zhizhong W(1)(2), Koenig HG(3)(4), Yan T(5), Jing W(6), Mu S(7), Hongyu L(7), 
Guangtian L(8).

Author information:
(1)Department of Research, Futian Center for Chronic Disease Control, #9 Xinsha 
Road, Shenzhen, 518000, People's Republic of China. wzhzh_lion@126.com.
(2)Department of Epidemiology and Health Statistics, School of Public Health and 
Management at Ningxia Medical University, Yinchuan, 750004, People's Republic of 
China. wzhzh_lion@126.com.
(3)Department of Medicine, King Abdulaziz University, Jeddah, 21589, Saudi 
Arabia.
(4)Department of Psychiatry, Duke University Medical Center, Durham, NC, 27710, 
USA.
(5)Department of Infectious Disease Control, Center for Disease Control and 
Prevention at Shizuishan City, Shizuishan, 750000, People's Republic of China.
(6)Department of Epidemiology and Health Statistics, School of Public Health and 
Management at Ningxia Medical University, Yinchuan, 750004, People's Republic of 
China.
(7)Department of Health Management, School of Public Health and Management, 
Ningxia Medical University, Yinchuan, 750004, People's Republic of China.
(8)Department of Infectious Disease at the Fourth People Hospital of Ningxia, 
Yinchuan, 750004, People's Republic of China.

BACKGROUND: Moral injury among physicians and other health professionals has 
attracted attention in the mainstream literature, this study aim to assess the 
psychometric properties of the 10-item Moral Injury Symptoms Scale-Health 
Professional (MISS-HP) among healthcare professionals in China.
METHODS: A total of 583 nurses and 2423 physicians were recruited from across 
mainland China. An online survey was conducted from March 27 to April 26, 2020 
(during the middle of the COVID-19 pandemic) using the Chinese version of the 
MISS-HP. Reliability was assessed by internal consistency reliability and 
test-retest reliability. Exploratory factor analysis (EFA) and confirmatory 
factor analysis (CFA) were performed to determine scale structure.
RESULTS: Cronbach's α of the scale for both samples was acceptable (0.71 for 
nurses and 0.70 for physicians), as was test-retest reliability (ICCs for the 
individual items ranged from 0.41 to 0.74, with 0.77 for the overall scale in 
physicians). EFA suggested three factors, and the CFA indicated good fit to the 
data. Convergent validity was demonstrated with the 4-item Expressions of Moral 
Injury Scale (r = 0.45 for physicians, r = 0.43 for nurses). Discriminant 
validity was demonstrated by correlations with burnout and well-being 
(r = 0.34-0.47), and concurrent validity was suggested by correlations with 
depression and anxiety symptoms (r = 0.37-0.45). Known groups validity was 
indicated by a higher score in those exposed to workplace violence (B = 4.16, 
95%CI: 3.21-5.10, p < 0.001).
CONCLUSIONS: The MISS-HP demonstrated acceptable reliability and validity in a 
large sample of physicians and nurses in mainland China, supporting its use as a 
screening measure for moral injury symptoms among increasingly stressed health 
professionals in this country during the COVID-19 pandemic.

DOI: 10.1186/s12888-020-02954-w
PMCID: PMC7686837
PMID: 33238949 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


4027. Epilepsy Behav. 2020 Dec;113:107599. doi: 10.1016/j.yebeh.2020.107599. Epub 2020 
Nov 4.

Examining the impacts of the COVID-19 pandemic on the well-being and virtual 
care of patients with epilepsy.

Subotic A(1), Pricop DF(1), Josephson CB(2), Patten SB(3), Smith EE(1), Roach 
P(4); Calgary Comprehensive Epilepsy Program Collaborators.

Author information:
(1)Hotchkiss Brain Institute, University of Calgary, Canada; Department of 
Clinical Neurosciences, University of Calgary, Canada.
(2)Hotchkiss Brain Institute, University of Calgary, Canada; Department of 
Community Health Sciences, University of Calgary, Canada; O'Brien Institute of 
Public Health, University of Calgary, Canada; Department of Clinical 
Neurosciences, University of Calgary, Canada; Centre for Health Informatics, 
University of Calgary, Canada.
(3)Department of Community Health Sciences, University of Calgary, Canada; 
Cuthbertson & Fischer Chair in Pediatric Mental Health, University of Calgary, 
Canada.
(4)Hotchkiss Brain Institute, University of Calgary, Canada; Department of 
Community Health Sciences, University of Calgary, Canada; O'Brien Institute of 
Public Health, University of Calgary, Canada; Department of Family Medicine, 
University of Calgary, Canada. Electronic address: pamela.roach@ucalgary.ca.

OBJECTIVE: The emergence of SARS-CoV-2 (COVID-19) as a novel coronavirus 
resulted in a global pandemic that necessitated the implementation of social 
distancing measures. These public health measures may have affected the 
provision of care for patients with epilepsy. Social isolation may have also 
adversely affected well-being and quality of life due to informal and formal 
support networks becoming less accessible. The purpose of this qualitative study 
was to examine the lived experiences of patients with epilepsy and to see how 
their quality of life and healthcare has been affected by the COVID-19 pandemic.
METHODS: From April 27 to May 15, 2020 we performed remote interviews with 18 
participants who had virtual appointments with their healthcare providers and 
were enrolled in the Calgary Comprehensive Epilepsy Program registry. Interviews 
were recorded and transcribed, after which transcripts were analyzed and coded 
into relevant themes using NVivo 12.
RESULTS: Three broad themes emerged throughout the interviews:1) impact of 
pandemic on informal and formal support systems; 2) impact of pandemic on 
healthcare provision; and 3) concerns about the impact of the pandemic on 
personal situations and society in the future. Participants reported anxiety and 
stress about decreased social engagement and activity cessations. Although 
face-to-face appointments were preferred, virtual care was well-received. Common 
concerns about the future included securing employment and burnout from 
balancing family responsibilities. Some patients also feared they would be 
stigmatized as society adapted to the situation.
SIGNIFICANCE: This study highlights the need for additional research in 
anticipation of the implementation of remote medicine in the management and 
treatment of epilepsy. It also highlights the tenacity of those living with 
epilepsy during difficult periods despite social and familial pressures. Raising 
awareness during this time about the lives and experiences of epilepsy patients 
can help challenge misconceptions and stigma in the workplace and wider society.

Copyright © 2020 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.yebeh.2020.107599
PMID: 33238236 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


4028. JAMA Oncol. 2021 Feb 1;7(2):279-284. doi: 10.1001/jamaoncol.2020.6093.

Perceived Care and Well-being of Patients With Cancer and Matched Norm 
Participants in the COVID-19 Crisis: Results of a Survey of Participants in the 
Dutch PROFILES Registry.

van de Poll-Franse LV(1)(2)(3), de Rooij BH(1)(3), Horevoorts NJE(1)(3), May 
AM(4), Vink GR(1)(5), Koopman M(5), van Laarhoven HWM(6), Besselink MG(7), 
Oerlemans S(1), Husson O(1)(8)(9), Beijer S(1), Ezendam NPM(1)(3), Raijmakers 
NJH(1)(10), Wollersheim BM(2), Hoedjes M(3), Siesling S(1)(11), van Eenbergen 
MC(1), Mols F(1)(3).

Author information:
(1)Department of Research and Development, Netherlands Comprehensive Cancer 
Organisation (IKNL), Utrecht, the Netherlands.
(2)Division of Psychosocial Research & Epidemiology, the Netherlands Cancer 
Institute, Amsterdam, the Netherlands.
(3)Department of Medical and Clinical Psychology, Center of Research on 
Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, the 
Netherlands.
(4)Julius Center for Health Sciences and Primary Care, University Medical Center 
Utrecht, Utrecht University, Utrecht, the Netherlands.
(5)Department of Medical Oncology, University Medical Center Utrecht, Utrecht 
University, the Netherlands.
(6)Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University 
Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
(7)Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of 
Amsterdam, Amsterdam, the Netherlands.
(8)Department of Medical Oncology, the Netherlands Cancer Institute, Amsterdam, 
the Netherlands.
(9)Division of Clinical Studies, Institute of Cancer Research, London, United 
Kingdom.
(10)Netherlands Association for Palliative Care (PZNL), Utrecht, the 
Netherlands.
(11)Department of Health Technology and Services Research, Technical Medical 
Centre, University of Twente, Enschede, the Netherlands.

IMPORTANCE: As the resolution of the coronavirus disease 2019 (COVID-19) crisis 
is unforeseeable, and/or a second wave of infections may arrive in the fall of 
2020, it is important to evaluate patients' perspectives to learn from this.
OBJECTIVE: To assess how Dutch patients with cancer perceive cancer treatment 
and follow-up care (including experiences with telephone and video consultations 
[TC/VC]) and patients' well-being in comparison with a norm population during 
the COVID-19 crisis.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of patients 
participating in the Dutch Patient Reported Outcomes Following Initial Treatment 
and Long-term Evaluation of Survivorship (PROFILES) registry and a norm 
population who completed a questionnaire from April to May 2020.
MAIN OUTCOMES AND MEASURES: Logistic regression analysis assessed factors 
associated with changes in cancer care (treatment or follow-up appointment 
postponed/canceled or changed to TC/VC). Differences in quality of life, 
anxiety/depression, and loneliness between patients and age-matched and 
sex-matched norm participants were evaluated with regression models.
RESULTS: The online questionnaire was completed by 4094 patients (48.6% 
response), of whom most were male (2493 [60.9%]) and had a mean (SD) age of 63.0 
(11.1) years. Of these respondents, 886 (21.7%) patients received treatment; 
2725 (55.6%) received follow-up care. Treatment or follow-up appointments were 
canceled for 390 (10.8%) patients, whereas 160 of 886 (18.1%) in treatment and 
234 of 2725 (8.6%) in follow-up had it replaced by a TC/VC. Systemic therapy, 
active surveillance, or surgery were associated with cancellation of treatment 
or follow-up appointment. Younger age, female sex, comorbidities, metastasized 
cancer, being worried about getting severe acute respiratory syndrome 
coronavirus 2 (SARS-CoV-2), and receiving supportive care were associated with 
replacement of a consultation with a TC/VC. Patients and norm participants 
reported that the COVID-19 crisis made them contact their general practitioner 
(852 of 4068 [20.9%] and 218 of 979 [22.3%]) or medical specialist/nurse (585 of 
4068 [14.4%] and 144 of 979 [14.7%]) less quickly when they had physical 
complaints or concerns. Most patients who had a TC/VC preferred a face-to-face 
consultation, but 151 of 394 (38.3%) were willing to use a TC/VC again. Patients 
with cancer were more worried about getting infected with SARS-CoV-2 compared 
with the 977 norm participants (917 of 4094 [22.4%] vs 175 of 977 [17.9%]). 
Quality of life, anxiety, and depression were comparable, but norm participants 
more often reported loneliness (114 of 977 [11.7%] vs 287 of 4094 [7.0%]) than 
patients with cancer (P = .009).
CONCLUSIONS AND RELEVANCE: Among patients with cancer in the Netherlands, 1 in 3 
reported changes in cancer care in the first weeks of the COVID-19 crisis. 
Long-term outcomes need to be monitored. The crisis may affect the mental 
well-being of the general population relatively more than that of patients with 
cancer.

DOI: 10.1001/jamaoncol.2020.6093
PMCID: PMC7689559
PMID: 33237294 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest Disclosures: Dr Vink 
reported receiving grants from Servier, Bristol Myers Squibb, Sirtex Medical, 
Personal Genome Diagnostics, Bayer, and Merck outside the submitted work. Dr 
Koopman reported receiving grants from KWF during the conduct of the study; 
grants from ZonMw, MLDS, Oncode Institute, Amgen, Bayer, Bristol Myers Squibb, 
Merck-Serono, Roche, Servier, Nordic Pharma, Sirtex Medical, and Sanofi-Aventis 
outside the submitted work. Dr van Laarhoven reported receiving grants from the 
Dutch Cancer Society and grants and nonfinancial support from the Dutch Cancer 
Registry during the conduct of the study; and grants from Phillips; grants, 
nonfinancial support, and personal fees from Bristol Myers Squibb, Lilly, Merck, 
Nordic Pharma, and Servier; grants and nonfinancial support from Bayer, Celgene, 
Janssen, and Roche; and personal fees from Merck Sharp & Dohme outside the 
submitted work. No other disclosures were reported.


4029. Transl Behav Med. 2021 Mar 16;11(2):305-313. doi: 10.1093/tbm/ibaa124.

Risk and resilience of well-being in caregivers of young children in response to 
the COVID-19 pandemic.

Davidson B(1), Schmidt E(1), Mallar C(1), Mahmoud F(1), Rothenberg W(1), 
Hernandez J(1), Berkovits M(1), Jent J(1), Delamater A(1), Natale R(1).

Author information:
(1)Department of Pediatrics, University of Miami School of Medicine, Miami, FL, 
USA.

The COVID-19 pandemic is impacting communities worldwide, with direct effects of 
illness and mortality, and indirect effects on economies, workplaces, 
schools/daycares, and social life. However, we understand very little about the 
effects of this pandemic on families of young children. We used a risk and 
resilience model to evaluate the effects of the pandemic on mental health in 
diverse caregivers (N = 286) with children ages birth to 5. We evaluated the 
hypotheses that (a) pandemic stress and caregiver-reported child psychosocial 
concerns correlate with caregivers' mental health symptoms and (b) caregivers' 
pandemic-related self-efficacy and coping mediate these relationships. 
Caregivers completed surveys in April-May 2020 assessing pandemic stress (e.g., 
health, finances, and housing), child psychosocial problems, coping strategies, 
and self-efficacy to manage family needs. Our primary outcome was caregivers' 
self-reported changes in mental health symptoms since the outbreak. Path 
analysis revealed that higher pandemic stress was associated with caregivers' 
reduced confidence in meeting their family's needs related to COVID-19, which 
correlated with worse caregiver mental health symptoms. Greater child 
psychosocial problems also predicted worse caregiver mental health symptoms. 
Findings suggest that pandemic stress, child psychosocial problems, and 
caregiver self-efficacy are interrelated in their influence on caregivers' 
mental health. While further research is needed to examine strategies to foster 
resilience and buffer the pandemic's effects on caregiver mental health, this is 
a first step in evaluating the psychosocial effects of this pandemic in families 
of young children. Clinical implications are discussed for a tiered response to 
mitigate the pandemic's impacts on family functioning.

© Society of Behavioral Medicine 2020. All rights reserved. For permissions, 
please e-mail: journals.permissions@oup.com.

DOI: 10.1093/tbm/ibaa124
PMCID: PMC7890655
PMID: 33236766 [Indexed for MEDLINE]


4030. Pan Afr Med J. 2020 Aug 28;36:366. doi: 10.11604/pamj.2020.36.366.25115. 
eCollection 2020.

Mainstream reintegration of COVID-19 survivors and its implications for mental 
health care in Africa.

Ameyaw EK(1), Hagan JE(2)(3), Ahinkorah BO(1), Seidu AA(4)(5), Schack T(3).

Author information:
(1)The Australian Centre for Public and Population Health Research, Faculty of 
Health, University of Technology Sydney, Sydney, Australia.
(2)Department of Health, Physical Education and Recreation, University of Cape 
Coast, Cape Coast, Ghana.
(3)Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology 
and Sport Sciences, Bielefeld University, Bielefeld, Germany.
(4)Department of Population and Health, University of Cape Coast, Cape Coast, 
Ghana.
(5)College of Public Health, Medical and Veterinary Sciences, James Cook 
University, Townsville, Queensland 4811, Australia.

The novel coronavirus pandemic has undoubtedly emerged as a serious public 
health threat in many societies across the world. Due to the sporadic and 
unpredictable nature of the pandemic, it is important to admit that the virus 
can cause psychological distress and emotional instability that might impact on 
people in diverse ways at the individual, community and national levels, with 
serious mental health implications (e.g. depression, mood disorders, 
obsessive-compulsive disorder, other anxiety disorders). Due to the weak 
healthcare challenges inherent in Africa, these mental health challenges require 
urgent redress to ensure mental health well-being for all, especially 
COVID-19-positive patients who have recovered (i.e. survivors). This essay 
outlines some of these challenges and offers strategies to address them. Broader 
mental health training for facility and community-based health workers are 
urgently required and should be coordinated within countries with specific 
guidelines for psychosocial support during outbreaks such as the current 
pandemic. A framework that promotes reintegration for COVID-19 survivors could 
also be designed based on context-specific needs through individualized 
protocols such as the "RAPID-Psychological First Aid [PFA]". This tool kit, if 
effectively employed, would help facilitate optimal well-being of the people 
devoid of any psychological challenges created by the pandemic.

Copyright: Edward Kwabena Ameyaw et al.

DOI: 10.11604/pamj.2020.36.366.25115
PMCID: PMC7666698
PMID: 33235643 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


4031. J Occup Environ Med. 2021 Mar 1;63(3):181-190. doi: 
10.1097/JOM.0000000000002097.

Impacts of Working From Home During COVID-19 Pandemic on Physical and Mental 
Well-Being of Office Workstation Users.

Xiao Y(1), Becerik-Gerber B, Lucas G, Roll SC.

Author information:
(1)Department of Civil and Environmental Engineering, University of Southern 
California, Los Angeles, California (Ms Xiao, Dr Becerik-Gerber); USC Institute 
for Creative Technologies, University of Southern California, Los Angeles, 
California (Dr Lucas); Chan Division of Occupational Science and Occupational 
Therapy, University of Southern California, Los Angeles, California (Dr Roll).

Comment in
    J Occup Environ Med. 2021 Oct 1;63(10):e755-e756.

OBJECTIVE: To understand impacts of social, behavioral and physical factors on 
well-being of office workstation users during COVID-19 work from home (WFH).
METHODS: A questionnaire was deployed from April 24 to June 11, 2020 and 988 
responses were valid. Linear regression, multinomial logistic regression and 
chi-square tests were used to understand factors associated with overall 
physical and mental health statuses and number of new physical and mental health 
issues.
RESULTS: Decreased overall physical and mental well-being after WFH were 
associated with physical exercise, food intake, communication with coworkers, 
children at home, distractions while working, adjusted work hours, workstation 
set-up and satisfaction with workspace indoor environmental factors.
CONCLUSION: This study highlights factors that impact workers' physical and 
mental health well-being while WFH and provides a foundation for considering how 
to best support a positive WFH experience.

Copyright © 2021 American College of Occupational and Environmental Medicine.

DOI: 10.1097/JOM.0000000000002097
PMCID: PMC7934324
PMID: 33234875 [Indexed for MEDLINE]

Conflict of interest statement: Becerik-Gerber, Xiao, Lucas, and Roll have no 
relationships/conditions/circumstances that present potential conflict of 
interest.


4032. J Sex Med. 2021 Jan;18(1):35-49. doi: 10.1016/j.jsxm.2020.10.008. Epub 2020 Oct 
23.

Benefits of Sexual Activity on Psychological, Relational, and Sexual Health 
During the COVID-19 Breakout.

Mollaioli D(1), Sansone A(1), Ciocca G(2), Limoncin E(1), Colonnello E(1), Di 
Lorenzo G(3), Jannini EA(4).

Author information:
(1)Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems 
Medicine, University of Rome Tor Vergata, Rome, Italy.
(2)Department of Dynamic and Clinical Psychology, Sapienza University of Rome, 
Rome, Italy.
(3)Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor 
Vergata, Rome, Italy.
(4)Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems 
Medicine, University of Rome Tor Vergata, Rome, Italy. Electronic address: 
eajannini@gmail.com.

Comment in
    J Sex Med. 2021 Feb;18(2):430-431.

BACKGROUND: The COVID-19-related lockdown has profoundly changed human behaviors 
and habits, impairing general and psychological well-being. Along with 
psychosocial consequences, it is possible that sexual behavior was also 
affected.
AIMS: With the present study, we evaluated the impact of the community-wide 
containment and consequent social distancing on the intrapsychic, relational, 
and sexual health through standardized psychometric tools.
METHODS: A case-control study was performed through a web-based survey and 
comparing subjects of both genders with (group A, N = 2,608) and without (group 
B, N = 4,213) sexual activity during lockdown. The Welch and chi-square tests 
were used to assess differences between groups. Univariate analysis of 
covariance, logistic regression models, and structural equation modeling were 
performed to measure influence and mediation effects of sexual activity on 
psychological, relational, and sexual outcomes.
OUTCOMES: Main outcome measures were General Anxiety Disorder-7 for anxiety, 
Patient Health Questionnaire-9 for depression, Dyadic Adjustment Scale for 
quality of relationship and a set of well-validated sexological inventories 
(International Index of Erectile Function, Female Sexual Function Index, and 
male-female versions of the Orgasmometer).
RESULTS: Anxiety and depression scores were significantly lower in subjects 
sexually active during lockdown. Analysis of covariance identified gender, 
sexual activity, and living without partner during lockdown as significantly 
affecting anxiety and depression scores (P < .0001). Logistic regression models 
showed that lack of sexual activity during lockdown was associated with a 
significantly higher risk of developing anxiety and depression (OR: 1.32 [95% 
CI: 1.12 - 1.57, P < .001] and 1.34 [95% CI: 1.15 - 1.57, P < .0001], 
respectively). Structural equation modeling evidenced the protective role of 
sexual activity toward psychological distress (βmales = -0.18 and 
βfemales = -0.14), relational health (βmales = 0.26 and βfemales = 0.29) and 
sexual health, both directly (βmales = 0.43 and βfemales = 0.31), and indirectly 
(βmales = 0.13 and βfemales = 0.13).
CLINICAL TRANSLATION: The demonstrated mutual influence of sexual health on 
psychological and relational health could direct the clinical community toward a 
reinterpretation of the relationship among these factors.
STRENGTHS AND LIMITATIONS: Based on a large number of subjects and 
well-validated psychometric tools, this study elucidated the protective role of 
sexual activity for psychological distress, as well for relational and sexual 
health. Main limitations were the web-based characteristics of the protocol and 
the retrospective nature of prelockdown data on psychorelational and sexual 
health of subjects recruited.
CONCLUSIONS: COVID-19 lockdown dramatically impacted on psychological, 
relational, and sexual health of the population. In this scenario, sexual 
activity played a protective effect, in both genders, on the quarantine-related 
plague of anxiety and mood disorders. Mollaioli D, Sansone A, Ciocca G, et al. 
Benefits of Sexual Activity on Psychological, Relational, and Sexual Health 
During the COVID-19 Breakout. J Sex Med 2021;18:35-49.

Copyright © 2020 International Society for Sexual Medicine. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jsxm.2020.10.008
PMCID: PMC7584428
PMID: 33234430 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest: The authors report no 
conflicts of interest.


4033. Res Aging. 2022 Jan;44(1):10-21. doi: 10.1177/0164027520975145. Epub 2020 Nov 
25.

Subjective Well-being and Mental Health During the Pandemic Outbreak: Exploring 
the Role of Institutional Trust.

Lee S(1).

Author information:
(1)Faculty of Physical Education and Sport, Charles University, Prague, Czech 
Republic.

Comment in
    Br Dent J. 2021 Feb;230(3):158.

This study examined the relationship between material adversities due to 
pandemic crisis, institutional trust, and subjective well-being and mental 
health among middle-aged and older adults aged 50+ in Europe. The study used a 
cross-sectional design to examine Eurofound COVID-19 survey data collected from 
27 European countries in April 2020. A total of 31,757 European middle aged and 
older adults aged 50 + were analyzed (Mean = 59.99, SD = 7.03). Analysis focused 
on the financial impact and material security in relation to pandemic lockdown, 
institutional trust (news media, police, national government, European Union, 
and healthcare system), and subjective well-being and mental health. Regression 
analysis indicated perceived insecurity in employment and housing, worsening 
finances, and difficulty paying for basic necessities were significantly related 
to respondents' life satisfaction, happiness, self-rated health, mental health 
index, and psychological distress. Institutional trust partially mediated the 
relationship between perceived adversities and subjective well-being and mental 
health.

DOI: 10.1177/0164027520975145
PMID: 33234059 [Indexed for MEDLINE]


4034. Int J Environ Res Public Health. 2020 Nov 20;17(22):8615. doi: 
10.3390/ijerph17228615.

The Early Impact of the Covid-19 Emergency on Mental Health Workers: A Survey in 
Lombardy, Italy.

Rapisarda F(1), Vallarino M(2), Cavallini E(2), Barbato A(3), Brousseau-Paradis 
C(4), De Benedictis L(4), Lesage A(4).

Author information:
(1)Research and Development Team, Sociosfera ONLUS SCS, Via Antonio Gramsci 8, 
20831 Seregno, Italy.
(2)Department of Brain and Behavioral Sciences, University of Pavia, 27100 
Pavia, Italy.
(3)IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Via Mario Negri 2, 
20156 Milano, Italy.
(4)Institut Universitaire en Santé Mentale de Montréal, CIUSSS de 
l'Est-de-l'Île-de-Montréal, 7401 Rue Hochelaga, Montreal, QC H1N 3M5, Canada.

Lombardy was the epicenter of the Covid-19 outbreak in Italy, and in March 2020 
the rapid escalation in cases prompted the Italian Government to decree a 
mandatory lockdown and to introduce safety practices in mental health services. 
The general objective of the study is to evaluate the early impact of the 
Covid-19 emergency and quarantine on the well-being and work practices of mental 
health service personnel and professionals. Data were collected through an 
online survey of workers and professionals working with people with mental 
health problems in Lombardy in several outpatient and inpatient services. Their 
socio-demographic characteristics, professional background, description of 
working conditions during lockdown and psychological distress levels were 
collected. All analyses were performed on a sample of 241. Approximately, 31% of 
the participants obtained a severe score in at least one of the burnout 
dimensions, 11.6% showed moderate or severe levels of anxiety, and 6.6% had a 
moderate or severe level of depression. Different work conditions and patterns 
of distress were found for outpatient service workers and inpatient service 
workers. The overall impact of the Covid-19 emergency on mental health workers' 
level of distress was mild, although a significant number of workers experienced 
severe levels of depersonalization and anxiety. More research is needed to 
assess specific predictive factors.

DOI: 10.3390/ijerph17228615
PMCID: PMC7699473
PMID: 33233513 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


4035. PLoS One. 2020 Nov 24;15(11):e0242767. doi: 10.1371/journal.pone.0242767. 
eCollection 2020.

Emotional health concerns of oncology physicians in the United States: Fallout 
during the COVID-19 pandemic.

Thomaier L(1), Teoh D(1), Jewett P(2), Beckwith H(2), Parsons H(3), Yuan J(4), 
Blaes AH(2), Lou E(2), Hui JYC(5), Vogel RI(1).

Author information:
(1)Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, 
United States of America.
(2)Division of Hematology, Oncology and Transplantation, University of 
Minnesota, Minneapolis, MN, United States of America.
(3)Division of Health Policy and Management, University of Minnesota, 
Minneapolis, MN, United States of America.
(4)Department of Radiation Oncology, University of Minnesota, Minneapolis, MN, 
United States of America.
(5)Department of Surgery, University of Minnesota, Minneapolis, MN, United 
States of America.

Update of
    medRxiv. 2020 Jun 12;:

INTRODUCTION: Cancer care is significantly impacted by the Coronavirus Disease 
2019 (COVID-19) pandemic. Our objective was to evaluate the early effects of the 
pandemic on the emotional well-being of oncology providers across the United 
States and explore factors associated with anxiety and depression symptoms.
MATERIALS AND METHODS: A cross-sectional survey was administered to United 
States cancer-care physicians recruited over a two-week period 
(3/27/2020-4/10/2020) using snowball-convenience sampling through social media. 
Symptoms of anxiety and depression were measured using the Patient Health 
Questionnaire (PHQ-4).
RESULTS: Of 486 participants, 374 (77.0%) completed the PHQ-4: median age was 43 
years; 63.2% female; all oncologic specialties were represented. The rates of 
anxiety and depression symptoms were 62.0% and 23.5%, respectively. Demographic 
factors associated with anxiety included female sex, younger age, and less time 
in clinical practice. Perception of inadequate personal protective equipment 
(68.6% vs. 57.4%, p = 0.03) and practicing in a state with more COVID-19 cases 
(65.8% vs. 51.1%, p = 0.01) were associated with anxiety symptoms. Factors 
significantly associated with both anxiety and depression included the degree to 
which COVID-19 has interfered with the ability to provide treatment to cancer 
patients and concern that patients will not receive the level of care needed for 
non-COVID-19 illness (all p-values <0.01).
CONCLUSION: The perceived degree of interference with clinical practice along 
with personal concerns about COVID-19 were significantly associated with both 
anxiety and depression among oncology physicians in the United States during the 
COVID-19 pandemic. Our findings highlight factors associated with and sources of 
psychological distress to be addressed to protect the well-being of oncology 
physicians.

DOI: 10.1371/journal.pone.0242767
PMCID: PMC7685431
PMID: 33232377 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


4036. Br J Psychiatry. 2021 Jun;218(6):334-343. doi: 10.1192/bjp.2020.242.

Mental health before and during the COVID-19 pandemic in two longitudinal UK 
population cohorts.

Kwong ASF(1), Pearson RM(2), Adams MJ(3), Northstone K(4), Tilling K(1), Smith 
D(1), Fawns-Ritchie C(5), Bould H(6), Warne N(4), Zammit S(7), Gunnell DJ(8), 
Moran PA(9), Micali N(10), Reichenberg A(11), Hickman M(4), Rai D(9), Haworth 
S(12), Campbell A(13), Altschul D(14), Flaig R(13), McIntosh AM(3), Lawlor 
DA(15), Porteous D(14), Timpson NJ(16).

Author information:
(1)MRC Integrative Epidemiology Unit, University of Bristol, UK; Population 
Health Sciences, Bristol Medical School, University of Bristol, UK; and Division 
of Psychiatry, University of Edinburgh, UK.
(2)MRC Integrative Epidemiology Unit, University of Bristol, UK; and Population 
Health Sciences, Bristol Medical School, University of Bristol, UK.
(3)Division of Psychiatry, University of Edinburgh, UK.
(4)Population Health Sciences, Bristol Medical School, University of Bristol, 
UK.
(5)Department of Psychology, University of Edinburgh, UK.
(6)Population Health Sciences, Bristol Medical School, University of Bristol, 
UK; and Gloucestershire Health and Care NHS Foundation Trust, UK.
(7)Population Health Sciences, Bristol Medical School, University of Bristol, 
UK; and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of 
Psychological Medicine and Clinical Neurosciences, Cardiff University, UK.
(8)Population Health Sciences, Bristol Medical School, University of Bristol, 
UK; and National Institute of Health Research Biomedical Research Centre, 
University of Bristol, UK.
(9)Population Health Sciences, Bristol Medical School, University of Bristol, 
UK; National Institute of Health Research Biomedical Research Centre, University 
of Bristol, UK; and Avon and Wiltshire Mental Health Partnership NHS Trust, UK.
(10)Great Ormond Street Institute of Child Health, University College London, 
UK; Department of Psychiatry, Faculty of Medicine, University of Geneva, 
Switzerland; and Department of Paediatrics Gynaecology and Obstetrics, Faculty 
of Medicine, University of Geneva, Switzerland.
(11)Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, 
USA.
(12)1MRC Integrative Epidemiology Unit, University of Bristol, UK; and 
Population Health Sciences, Bristol Medical School, University of Bristol, UK.
(13)Centre for Genomic and Experimental Medicine, Institute of Genetics & 
Molecular Medicine, University of Edinburgh, UK; and Usher Institute for 
Population Health Sciences and Informatics, University of Edinburgh, UK.
(14)Centre for Genomic and Experimental Medicine, Institute of Genetics & 
Molecular Medicine, University of Edinburgh, UK.
(15)MRC Integrative Epidemiology Unit at the University of Bristol, UK; 
Population Health Sciences, Bristol Medical School, University of Bristol, UK; 
and National Institute of Health Research Biomedical Research Centre, University 
of Bristol, UK.
(16)MRC Integrative Epidemiology Unit at the University of Bristol, UK; and 
Population Health Sciences, Bristol Medical School, University of Bristol, UK.

BACKGROUND: The COVID-19 pandemic and mitigation measures are likely to have a 
marked effect on mental health. It is important to use longitudinal data to 
improve inferences.
AIMS: To quantify the prevalence of depression, anxiety and mental well-being 
before and during the COVID-19 pandemic. Also, to identify groups at risk of 
depression and/or anxiety during the pandemic.
METHOD: Data were from the Avon Longitudinal Study of Parents and Children 
(ALSPAC) index generation (n = 2850, mean age 28 years) and parent generation (n 
= 3720, mean age 59 years), and Generation Scotland (n = 4233, mean age 59 
years). Depression was measured with the Short Mood and Feelings Questionnaire 
in ALSPAC and the Patient Health Questionnaire-9 in Generation Scotland. Anxiety 
and mental well-being were measured with the Generalised Anxiety Disorder 
Assessment-7 and the Short Warwick Edinburgh Mental Wellbeing Scale.
RESULTS: Depression during the pandemic was similar to pre-pandemic levels in 
the ALSPAC index generation, but those experiencing anxiety had almost doubled, 
at 24% (95% CI 23-26%) compared with a pre-pandemic level of 13% (95% CI 
12-14%). In both studies, anxiety and depression during the pandemic was greater 
in younger members, women, those with pre-existing mental/physical health 
conditions and individuals in socioeconomic adversity, even when controlling for 
pre-pandemic anxiety and depression.
CONCLUSIONS: These results provide evidence for increased anxiety in young 
people that is coincident with the pandemic. Specific groups are at elevated 
risk of depression and anxiety during the COVID-19 pandemic. This is important 
for planning current mental health provisions and for long-term impact beyond 
this pandemic.

DOI: 10.1192/bjp.2020.242
PMCID: PMC7844173
PMID: 33228822 [Indexed for MEDLINE]

Conflict of interest statement: D.A.L. declares receiving research support from 
several national and international government and charity funders and Roche 
Diagnostics and Medtronic Ltd for research unrelated to that presented here. All 
other authors declare no competing interests.


4037. Int J Environ Res Public Health. 2020 Nov 19;17(22):8578. doi: 
10.3390/ijerph17228578.

The Psychological Consequences of COVID-19 and Lockdown in the Spanish 
Population: An Exploratory Sequential Design.

Hidalgo MD(1), Balluerka N(2), Gorostiaga A(2), Espada JP(3), Santed MÁ(4), 
Padilla JL(5), Gómez-Benito J(6)(7).

Author information:
(1)Department of Basic Psychology and Methodology, Faculty of Psychology, 
University of Murcia, 30100 Murcia, Spain.
(2)Department of Clinical and Health Psychology, and Research Methods, Faculty 
of Psychology, University of the Basque Country UPV/EHU, 20018 Donostia, Spain.
(3)Department of Health Psychology, Faculty of Social Health Sciences, Miguel 
Hernández University, 03202 Elche, Spain.
(4)Department of Personality Psychology, Psychological Assessment and Treatment, 
Faculty of Psychology, National Distance Education University (UNED), 28040 
Madrid, Spain.
(5)Department of Methodology for Behavioural Science, Faculty of Psychology, 
University of Granada, 18071 Granada, Spain.
(6)Department of Social Psychology and Quantitative Psychology, Faculty of 
Psychology, University of Barcelona, 08035 Barcelona, Spain.
(7)Group on Measurement Invariance and Analysis of Change (GEIMAC), Institute of 
Neuroscience, University of Barcelona, 08035 Barcelona, Spain.

The objectives of this study were to analyze the psychological impact of the 
COVID-19 pandemic and the lockdown in the Spanish population and to identify 
what population profiles were most affected. The study used a sequential 
exploratory design. In the qualitative phase, 40 participants were recruited 
based on theoretically relevant criteria and the saturation of the information 
provided by the interviews. In the quantitative phase, a large representative 
sample was applied. The universe considered was the adult population of Spain. A 
total of 6789 surveys were conducted. Both the analysis of the narratives of the 
interviews and the responses to the panel survey showed relevant changes in 
attitudes and mood swings compared to the period prior to lockdown. These 
changes include dysphoric moods (i.e., experiences of distress such as 
sadness/depression, anxiety, rage, feeling of unreality, worry, etc.) and also 
some euphoric moods (i.e., feelings of well-being, happiness, etc.). A higher 
number of women were affected than men and a greater increase was observed in 
younger people. The findings of the study may serve as a basis for detecting 
needs and providing psychological support, as the symptoms detected as the most 
common are key for the processes of screening at-risk individuals.

DOI: 10.3390/ijerph17228578
PMCID: PMC7699190
PMID: 33227938 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


4038. BMC Geriatr. 2020 Nov 23;20(1):489. doi: 10.1186/s12877-020-01889-x.

Mental wellbeing in the German old age population largely unaltered during 
COVID-19 lockdown: results of a representative survey.

Röhr S(1)(2), Reininghaus U(3)(4)(5), Riedel-Heller SG(6).

Author information:
(1)Institute of Social Medicine, Occupational Health and Public Health (ISAP), 
Medical Faculty, University of Leipzig, Leipzig, Germany. 
Susanne.Roehr@medizin.uni-leipzig.de.
(2)Global Brain Health Institute (GBHI), Trinity College Dublin, Dublin, 
Ireland. Susanne.Roehr@medizin.uni-leipzig.de.
(3)Department of Public Mental Health, Central Institute of Mental Health, 
Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
(4)Centre for Epidemiology and Public Health, Health Service and Population 
Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's 
College London, London, UK.
(5)ESRC Centre for Society and Mental Health, King's College London, London, UK.
(6)Institute of Social Medicine, Occupational Health and Public Health (ISAP), 
Medical Faculty, University of Leipzig, Leipzig, Germany.

BACKGROUND: Older individuals are at increased risk of a severe and lethal 
course of COVID-19. They have typically been advised to practice particularly 
restrictive social distancing ('cocooning'), which has sparked much debate on 
the consequences for their mental wellbeing. We aimed to provide evidence by 
conducting a representative survey among the German old population during 
COVID-19 lockdown.
METHODS: A computer-assisted standardized telephone interview was conducted in a 
randomly selected and representative sample of the German old age population 
(n = 1005; age ≥ 65 years) during the first lockdown in April 2020. Assessments 
included sociodemographic factors, aspects of the personal life situation during 
lockdown, attitudes towards COVID-19, and standardized screening measures on 
depression, anxiety, somatization, overall psychological distress (Brief Symptom 
Inventory/BSI-18) and loneliness (UCLA 3-item loneliness scale). 
Sampling-weighted descriptive statistics and multiple multivariable regression 
analyses were conducted.
RESULTS: Participants were M = 75.5 (SD = 7.1) years old; 56.3% were women. At 
data collection, COVID-19 lockdown had been in force for M = 28.0 (SD = 4.8) 
days. Overall, older individuals were worried about COVID-19, but supportive of 
the lockdown. Mean BSI-18 scores were 1.4 for depression, 1.6 for anxiety and 
2.2 for somatization as well as 5.1 for global psychological distress. These 
figures did not indicate worse mental wellbeing, given normative values 
established by studies before the pandemic (2.0, 1.6, 2.4, 6.0, respectively). 
The prevalence of loneliness was 13.1%, which also fell within a range of 
estimates reported by studies before the pandemic. There were only few 
significant associations of aspects of the personal life situation during 
lockdown and attitudes towards COVID-19 with mental wellbeing. Resilience 
explained a large amount of variance.
CONCLUSIONS: In the short-term, the mental wellbeing of the German old age 
population was largely unaltered during COVID-19 lockdown, suggesting resilience 
against the challenging pandemic situation. Our results refute common ageist 
stereotypes of "the weak and vulnerable older adults" that were present during 
the pandemic. Long-term observations are needed to provide robust evidence.

DOI: 10.1186/s12877-020-01889-x
PMCID: PMC7681185
PMID: 33225912 [Indexed for MEDLINE]

Conflict of interest statement: None.


4039. Int J Ment Health Nurs. 2021 Apr;30(2):533-543. doi: 10.1111/inm.12818. Epub 
2020 Nov 21.

Determination of stress, depression and burnout levels of front-line nurses 
during the COVID-19 pandemic.

Murat M(1), Köse S(1), Savaşer S(2).

Author information:
(1)Department of Nursing, Health Sciences Faculty, Biruni University, Istanbul, 
Turkey.
(2)Vice Rector, Biruni University, Istanbul, Turkey.

All healthcare professionals, especially nurses, are affected psychosocially due 
to reasons such as uncertainty and work intensity experienced during the 
COVID-19 pandemic. In this descriptive study, it was aimed to determine the 
stress, depression and burnout levels of front-line nurses. Data were obtained 
from 705 nurses who worked at hospitals during the COVID-19 pandemic between May 
and July 2020, using a Personal Information Form, the Perceived Stress Scale, 
Beck Depression Inventory and Maslach Burnout Inventory. The data collection 
tools were sent online to nurse managers, requesting front-line nurses to answer 
the forms and scales. The nurses were mostly women and had bachelor's degrees, 
single and worked as nurses for between 1 and 10 years. They had high levels of 
stress and burnout and moderate depression. Those who were younger and had fewer 
years of work experience felt inadequate about nursing care and had higher 
levels of stress and burnout. More burnout was detected in nurses who had a 
positive COVID-19 test and did not want to work voluntarily during the pandemic. 
The authors suggest that preventive and promotive interventions in mental health 
should be planned and implemented to improve the mental health and maintain the 
well-being of front-line nurses during the pandemic, and to prepare nurses who 
may work during pandemics in the future.

© 2020 Australian College of Mental Health Nurses Inc.

DOI: 10.1111/inm.12818
PMCID: PMC7753629
PMID: 33222350 [Indexed for MEDLINE]


4040. Early Hum Dev. 2021 Mar;154:105278. doi: 10.1016/j.earlhumdev.2020.105278. Epub 
2020 Nov 16.

Parent mental health and neurodevelopmental outcomes of children hospitalized in 
the neonatal intensive care unit.

Erdei C(1), Liu CH(2), Machie M(3), Church PT(4), Heyne R(5).

Author information:
(1)Brigham and Women's Hospital, Department of Pediatric Newborn Medicine, 75 
Francis St, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA. 
Electronic address: CErdei@bwh.harvard.edu.
(2)Brigham and Women's Hospital, Department of Pediatric Newborn Medicine, 75 
Francis St, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA. 
Electronic address: CHLiu@bwh.harvard.edu.
(3)University of Texas Southwestern Medical Center, Department Pediatrics - 
Neurology and Neurotherapeutics, 5323 Harry Hines Blvd, Dallas, TX 75390, USA. 
Electronic address: Michelle.Machie@UTSouthwestern.edu.
(4)Sunnybrook Health Sciences Centre, Department of Paediatrics - Neonatology, 
2075 Bayview Ave, Toronto, ON M4N 3M5, Canada; University of Toronto, Toronto, 
Ontario, Canada. Electronic address: Paige.Church@sunnybrook.ca.
(5)University of Texas Southwestern Medical Center, Department Pediatrics - 
Neurology and Neurotherapeutics, 5323 Harry Hines Blvd, Dallas, TX 75390, USA. 
Electronic address: Roy.Heyne@UTSouthwestern.edu.

High-risk infants hospitalized in the Neonatal Intensive Care Unit (NICU) often 
receive life-saving interventions during a critical period of development, when 
their brain is highly sensitive to both positive and negative environmental 
factors. It is no surprise that this time is particularly challenging for 
families. In fact, parents of hospitalized newborns are likely to experience 
clinically-significant symptoms of stress, anxiety, and depression. These 
symptoms have the potential to impact the nature and quality of the early 
parent-infant relationship and can lead to long-term problematic consequences 
for the infant and the family. As such, perinatal parent mental health 
represents a key factor that impacts outcomes of high-risk children. We discuss 
future practices to optimize the wellbeing of NICU infants and their families in 
the long-term, including increasing awareness and screening for parent mental 
health in the NICU, as well as building systems for support and early 
intervention.

Copyright © 2020 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.earlhumdev.2020.105278
PMID: 33221031 [Indexed for MEDLINE]


4041. J Clin Nurs. 2023 Aug;32(15-16):5382-5395. doi: 10.1111/jocn.15566. Epub 2020 
Dec 5.

Insomnia, fatigue and psychosocial well-being during COVID-19 pandemic: A 
cross-sectional survey of hospital nursing staff in the United States.

Sagherian K(1), Steege LM(2), Cobb SJ(1), Cho H(2).

Author information:
(1)College of Nursing, The University of Tennessee Knoxville, Knoxville, 
Tennessee, USA.
(2)School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA.

AIMS AND OBJECTIVES: To describe the levels of insomnia, fatigue and intershift 
recovery, and psychological well-being (burnout, post-traumatic stress and 
psychological distress), and to examine differences in these measures based on 
work-related characteristics among nursing staff during COVID-19 pandemic in the 
United States.
BACKGROUND: The COVID-19 pandemic has created a major physical and psychological 
burden on nursing staff in the United States and worldwide. A better 
understanding of these conditions will lead to tailored support and resources 
for nursing staff during and after the pandemic.
DESIGN: Cross-sectional study.
METHODS: Hospital nurses and nursing assistants (N = 587) were recruited online 
between May-June 2020. The survey included measures on insomnia (Insomnia 
Severity Index) fatigue and intershift recovery (Occupational Fatigue and 
Exhaustion Recovery-15), burnout (Maslach Burnout Inventory-Human Services 
Survey), post-traumatic stress (Short Post-Traumatic Stress Disorder Rating 
Interview) and psychological distress (Patient Health Questionnaire-4), and 
questions on work and demographics. The STROBE checklist was followed for 
reporting.
RESULTS: The sample had subthreshold insomnia, moderate-to-high chronic fatigue, 
high acute fatigue and low-to-moderate intershift recovery. The sample 
experienced increased emotional exhaustion and depersonalisation, increased 
personal accomplishment, moderate psychological distress and high post-traumatic 
stress. Nurses who cared for COVID-19 patients had significantly scored worse on 
almost all measures than their co-workers. Certain factors such as working hours 
per week and the frequency of 30-min breaks were significant.
CONCLUSION: Nursing staff experienced poor sleep, fatigue and multiple 
psychological problems during the COVID-19 pandemic. Moreover, staff who were 
involved in the care of COVID-19 patients, worked more than 40 h per week and 
skipped 30-min breaks showed generally worse self-reported outcomes.
RELEVANCE TO CLINICAL PRACTICE: Nursing administration is recommended to monitor 
for fatigue and distress on nursing units, re-visit current scheduling 
practices, reinforce rest breaks and provide access to mental health and sleep 
wellness resources with additional support for their front-line nursing groups.

© 2020 John Wiley & Sons Ltd.

DOI: 10.1111/jocn.15566
PMCID: PMC7753687
PMID: 33219569 [Indexed for MEDLINE]

Conflict of interest statement: No conflict of interest has been declared by the 
authors.


4042. Int J Environ Res Public Health. 2020 Nov 18;17(22):8547. doi: 
10.3390/ijerph17228547.

Prevalence of Internet Addiction during the COVID-19 Outbreak and Its Risk 
Factors among Junior High School Students in Taiwan.

Lin MP(1).

Author information:
(1)Department of Educational Psychology and Counseling, National Taiwan Normal 
University, Taipei 10610, Taiwan.

The coronavirus disease 2019 (COVID-19) outbreak has significantly disrupted 
normal activities globally. During this epidemic, people around the world were 
expected to encounter several mental health challenges. In particular, Internet 
addiction may become a serious issue among teens. Consequently, this study aimed 
to examine the prevalence of Internet addiction and identify the psychosocial 
risk factors during the COVID-19 outbreak. This study was constructed using a 
cross-sectional design with 1060 participants recruited from among junior high 
school students around Taiwan using stratified and cluster sampling methods. 
Taiwan's first COVID-19 case was diagnosed on 28 January 2020. New cases 
exploded rapidly in February, and as a result, participants were surveyed during 
March 2 through 27 March 2020. The prevalence of Internet addiction was found to 
be 24.4% during this period. High impulsivity, high virtual social support, 
older in age, low subjective well-being, low family function, and high 
alexithymia was all independently predictive in the forward logistic regression 
analyses. The prevalence rate of Internet addiction was high among junior high 
school students during the COVID-19 outbreak. Results from this study can be 
used to help mental health organizations and educational agencies design 
programs that will help prevent Internet addiction in adolescents during the 
COVID-19 pandemic.

DOI: 10.3390/ijerph17228547
PMCID: PMC7698622
PMID: 33218018 [Indexed for MEDLINE]

Conflict of interest statement: The author declares no conflict of interest.


4043. Int J Environ Res Public Health. 2020 Nov 17;17(22):8522. doi: 
10.3390/ijerph17228522.

The Psychological Impact of Movement Restriction during the COVID-19 Outbreak on 
Clinical Undergraduates: A Cross-Sectional Study.

Kalok A(1), Sharip S(2), Abdul Hafizz AM(1), Zainuddin ZM(3), Shafiee MN(1).

Author information:
(1)Department of Obstetrics and Gynaecology, Faculty of Medicine, National 
University of Malaysia, Universiti Kebangsaan Malaysia Medical Center, Cheras 
56000, Malaysia.
(2)Department of Psychiatry, Faculty of Medicine, National University of 
Malaysia, Universiti Kebangsaan Malaysia Medical Center, Cheras 56000, Malaysia.
(3)Department of Surgery, Faculty of Medicine, National University of Malaysia, 
Universiti Kebangsaan Malaysia Medical Center, Cheras 56000, Malaysia.

The COVID-19 pandemic has resulted in a Movement Control Order (MCO) in Malaysia 
and the subsequent closure of all educational institutions. We aimed to examine 
the psychological impact of the MCO among clinical undergraduates. A 
cross-sectional study was conducted using self-reported questionnaires that were 
distributed online using the Depression, Anxiety and Stress Scale-21 (DASS 21), 
Short Warwick Edinburgh Mental Well-Being Scale (SWEMWBS), and the newly 
designed MCO effect questionnaire. Seven hundred seventy-two students completed 
the survey. The prevalence of psychological distress was 52.8%, with around 60% 
of respondents reporting disruption to their daily lives. Older (p = 0.015) and 
more senior students (p < 0.001) were less likely to be anxious than their 
younger and junior counterparts, respectively. A greater number of social 
support (three or more) was linked to a lower score of depression (p = 0.005) 
and stress (p = 0.045). Undergraduates who received family support demonstrated 
lower depression scores (p = 0.037) and higher mental wellbeing (p = 0.020) 
compared to those without. Government support was independently associated with 
a lesser risk of depressive symptoms (Adjusted odds ratio, AOR 0.68; 95% 
confidence interval, CI 0.47-0.99) and a greater sense of mental wellbeing (AOR 
1.54; 95% CI 1.06-2.22). The present finding provides evidence of a high 
prevalence of psychological distress among clinical undergraduates during the 
COVID-19 pandemic. Appropriate social support is important in alleviating 
anxiety and stress and promoting greater mental wellbeing amongst students 
during the nationwide quarantine.

DOI: 10.3390/ijerph17228522
PMCID: PMC7698578
PMID: 33212969 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


4044. Acad Med. 2021 May 1;96(5):655-660. doi: 10.1097/ACM.0000000000003853.

Trainee Wellness and Safety in the Context of COVID-19: The Experience of One 
Institution.

Kemp MT(1), Rivard SJ(2), Anderson S(3), Audu CO(4), Barrett M(5), Fry BT(6), 
Lane M(7), Vu JV(8), Young BAC(9), Englesbe M(10), Sandhu G(11), Coleman DM(12).

Author information:
(1)M.T. Kemp is a general surgery resident, Department of Surgery, University of 
Michigan, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-8287-9984 .
(2)S.J. Rivard is a general surgery resident, Department of Surgery, University 
of Michigan, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0003-1274-1183 .
(3)S. Anderson is an oral and maxillofacial surgery resident, Department of 
Surgery, University of Michigan, Ann Arbor, Michigan.
(4)C.O. Audu is a vascular surgery resident, Department of Surgery, University 
of Michigan, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-4183-8825 .
(5)M. Barrett is a transplant surgery fellow, Department of Surgery, University 
of Michigan, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-5476-0118 .
(6)B.T. Fry is a general surgery resident, Department of Surgery, University of 
Michigan, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-7185-8579 .
(7)M. Lane is a plastic surgery resident, Department of Surgery, University of 
Michigan, Ann Arbor, Michigan.
(8)J.V. Vu is a general surgery resident, Department of Surgery, University of 
Michigan, Ann Arbor, Michigan.
(9)B.A.C. Young is a thoracic surgery resident, Department of Surgery, 
University of Michigan, Ann Arbor, Michigan.
(10)M. Englesbe is professor of surgery, Section of Transplant Surgery, 
Department of Surgery, University of Michigan, Ann Arbor, Michigan; ORCID: 
https://orcid.org/0000-0001-8691-9111 .
(11)G. Sandhu is associate professor of surgery and learning health sciences and 
vice chair of resident professional development, Department of Surgery, 
University of Michigan, Ann Arbor, Michigan; ORCID: 
https://orcid.org/0000-0003-0258-7899 .
(12)D.M. Coleman is associate professor of surgery, Section of Vascular Surgery, 
Department of Surgery, University of Michigan, Ann Arbor, Michigan.

The COVID-19 pandemic has had significant ramifications for provider well-being. 
During these unprecedented and challenging times, one institution's Department 
of Surgery put in place several important initiatives for promoting the 
well-being of trainees as they were redeployed to provide care to COVID-19 
patients. In this article, the authors describe these initiatives, which fall 
into 3 broad categories: redeploying faculty and trainees, ensuring provider 
safety, and promoting trainee wellness. The redeployment initiatives are the 
following: reframing the team mindset, creating a culture of grace and 
forgiveness, establishing a multidisciplinary wellness committee, promoting 
centralized leadership, providing clear communication, coordinating between 
departments and programs, implementing phased restructuring of the department's 
services, establishing scheduling flexibility and redundancy, adhering to 
training regulations, designating a trainee ombudsperson, assessing physical 
health risks for high-risk individuals, and planning for structured 
deimplementation. Initiatives specific to promoting provider safety are 
appointing a trainee safety advocate, guaranteeing personal protective equipment 
and relevant information about these materials, providing guidance regarding 
safe practices at home, and offering alternative housing options when necessary. 
Finally, the initiatives put in place to directly promote trainee wellness are 
establishing an environment of psychological safety, providing mental health 
resources, maintaining the educational missions, solidifying a sense of 
community by showing appreciation, being attentive to childcare, and using 
social media to promote community morale. The initiatives to carry out the 
department's strategy presented in this article, which were well received by 
both faculty and trainee members of the authors' community, may be employed in 
other departments and even outside the context of COVID-19. The authors hope 
that colleagues at other institutions and departments, independent of specialty, 
will find the initiatives described here helpful during, and perhaps after, the 
pandemic as they develop their own institution-specific strategies to promote 
trainee wellness.

Copyright © 2020 by the Association of American Medical Colleges.

DOI: 10.1097/ACM.0000000000003853
PMID: 33208674 [Indexed for MEDLINE]


4045. Int J Nurs Stud. 2021 Feb;114:103809. doi: 10.1016/j.ijnurstu.2020.103809. Epub 
2020 Oct 23.

Prevalence and associated factors of depression and anxiety among nurses during 
the outbreak of COVID-19 in China: A cross-sectional study.

Zheng R(1), Zhou Y(1), Fu Y(1), Xiang Q(1), Cheng F(2), Chen H(3), Xu H(4), Fu 
L(5), Wu X(6), Feng M(6), Ye L(7), Tian Y(8), Deng R(9), Liu S(9), Jiang Y(10), 
Yu C(11), Li J(12).

Author information:
(1)West China School of Nursing, Sichuan University/ Department of Thoracic 
Oncology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou 
District, Chengdu, Sichuan Province 610041, China.
(2)Department of Oncology, Union Hospital, Tongji Medical College, Huazhong 
University of Science and Technology, Wuhan 430022, China.
(3)Department of Head and Neck Oncology, West China Hospital, Sichuan 
University, Chengdu 610041, China.
(4)Department of Abdominal Oncology, West China Hospital, Sichuan University, 
Chengdu 610041, China.
(5)Breast Surgery, West China Hospital, Sichuan University, Chengdu 610041, 
China.
(6)Department of Respiratory and Critical Care Medicine, West China Hospital, 
Sichuan University, Chengdu 610041, China.
(7)Emergency Department, West China Hospital, Sichuan University, Chengdu 
610041, China.
(8)Department of Intensive Medicine, West China Hospital, Sichuan University, 
Chengdu 610041, China.
(9)Center of Infectious Diseases, West China Hospital, Sichuan University, 
Chengdu 610041, China.
(10)Department of Nursing/Evidence-based Nursing Center, West China Hospital, 
Sichuan University, Chengdu 610041, China. Electronic address: 
jiangyanhuaxi@sohu.com.
(11)West China School of Nursing, Sichuan University/ Department of Thoracic 
Oncology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou 
District, Chengdu, Sichuan Province 610041, China. Electronic address: 
chunhua1995@126.com.
(12)West China School of Nursing, Sichuan University/ Department of Thoracic 
Oncology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou 
District, Chengdu, Sichuan Province 610041, China. Electronic address: 
aaa111www@yeah.net.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a public health emergency of 
international concern and has caused traumatic experience for nurses worldwide. 
However, the prevalence of depression and anxiety symptoms in nurses, and how 
psychosocial factors influence nurses in this public crisis are unknown.
OBJECTIVES: To determine the effect of COVID-19 on the mental health of nurses 
and the prevalence of anxiety and depression symptoms among nurses in China 
during the outbreak.
DESIGN: A cross-sectional study.
SETTINGS AND PARTICIPANTS: A total of 3,228 nurses in Sichuan Province and Wuhan 
City were selected by convenience sampling. All participants were invited to 
complete the questionnaire through WeChat from January 27 to February 3, 2020.
METHODS: A self-reported questionnaire combining depression and anxiety scale 
was used to collect data anonymously. Binary and multivariate logistic 
regression was applied to measure the odds of psychosocial factors of anxiety 
and depression and perceived health, respectively.
RESULTS: The total incidence of depression (34.3%) and anxiety (18.1%) during 
the COVID-19 outbreak was lower than that during the SARS outbreak; however, the 
rate of depression in our study (47.1%) was high and similar in a recent study 
(50.4%) about the health care workers exposed to COVID-19 in China. The results 
indicated that COVID-19-related stress, relationship quality with family, and 
demographic characteristics were associated with depression, anxiety, and 
perceived health status. Furthermore, the prevalence of depression was similar 
between nurses working in low-risk COVID-19 wards was as high as working in 
high-risk COVID-19 wards (OR, 1.078; 95% CI, 0.784-1.481).
CONCLUSIONS: Our study revealed the high prevalence of depression and anxiety 
among nurses during the outbreak of COVID-19. COVID-19 factors and psychosocial 
factors were associated with mental health of nurses. The results suggest that 
hospitals should implement effective mental health promotion programs focused on 
occupational safety and family support to improve the well-being of nurses.

Copyright © 2020. Published by Elsevier Ltd.

DOI: 10.1016/j.ijnurstu.2020.103809
PMCID: PMC7583612
PMID: 33207297 [Indexed for MEDLINE]


4046. PLoS One. 2020 Nov 18;15(11):e0241660. doi: 10.1371/journal.pone.0241660. 
eCollection 2020.

Medical education in times of COVID-19: German students' expectations - A 
cross-sectional study.

Loda T(1), Löffler T(2), Erschens R(1), Zipfel S(1)(2), Herrmann-Werner A(1)(3).

Author information:
(1)Department of Internal Medicine VI/Psychosomatic Medicine and Psychotherapy, 
University Hospital Tuebingen, Tuebingen, Germany.
(2)Faculty of Medicine, Eberhard-Karls University of Tuebingen, Tuebingen, 
Germany.
(3)Competence Center for University Teaching in Medicine, Faculty of Medicine, 
University of Tuebingen, Tuebingen, Germany.

BACKGROUND: Since the COVID-19 pandemic has affected the education of medical 
students, medical faculties have faced the challenge of adapting instruction to 
digital platforms. Although medical students are willing to support pandemic 
response efforts, how the crisis will affect their medical training remains 
uncertain. Thus, in this study, we investigated the teaching- and 
learning-related stressors and expectations of medical students in Germany 
during the COVID-19 pandemic.
METHODS: A cross-sectional survey was distributed online to undergraduate 
medical students at medical faculties in Germany. Students answered questions 
about COVID-19 and teaching (on a 7-point Likert scale from 0 ("not at all") to 
6 ("completely")) and completed mental well-being measurements, including the 
State-Trait Anxiety Inventory (STAI), the Generalised Anxiety Disorder scale 
(GAD-7) and the Perceived Health Questionnaire (PHQ-9). Descriptive data 
analysis, a t-test and Pearson correlations were performed to process the data.
RESULTS: Medical students felt well-informed about COVID-19 in general (M = 
5.64, SD = 1.28) and in the medical context (M = 5.14, SD = 1.34) but 
significantly less informed about the pandemic in the academic context, M = 
2.47, SD = 1.49, t(371) = 31.98, p < .001. Their distress levels were high 
(STAI: M = 45.12, SD = 4.73) and significantly correlated with the academic 
context (rp = .164, p < .01) but not their private lives. Concerning how they 
were taught, they most often expected online lectures (91.7%) and live 
broadcasts (67.2%) and less often expected innovative digital teaching 
strategies, including serious games (17.3%) and virtual-reality exercises 
(16.7%).
DISCUSSION: Medical students seem to be aware of the COVID-19 pandemic and its 
consequences for academic and healthcare contexts. They also seem to think that 
their teachers will enhance their digital competencies during the pandemic. 
Therefore, faculties of medicine need to rapidly and adequately digitalise their 
approaches to teaching.

DOI: 10.1371/journal.pone.0241660
PMCID: PMC7673791
PMID: 33206678 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


4047. Am J Trop Med Hyg. 2021 Jan;104(1):95-102. doi: 10.4269/ajtmh.20-1302.

Predictive Factors for Impaired Mental Health among Medical Students during the 
Early Stage of the COVID-19 Pandemic in Morocco.

Essangri H(1), Sabir M(2), Benkabbou A(1)(3), Majbar MA(1)(3), Amrani L(1), 
Ghannam A(4), Lekehal B(5), Mohsine R(1), Souadka A(1)(3).

Author information:
(1)1Surgical Oncology Department, National Institute of Oncology, University 
Mohammed V in Rabat, Rabat, Morocco.
(2)2Arrazi University Psychiatric Hospital, University Mohammed V in Rabat, 
Rabat, Morocco.
(3)3Equipe de Recherche en Oncologie Translationnelle (EROT), Faculty of 
Medicine and Pharmacy, University Mohamed V in Rabat, Rabat, Morocco.
(4)4Anesthesia and Intensive Care Department, National Institute of Oncology, 
University Mohammed V in Rabat, Rabat, Morocco.
(5)5Department of Academic Affairs, Faculty of Medicine and Pharmacy, University 
Mohammed V in Rabat, Rabat, Morocco.

The COVID-19 pandemic has great consequences on mental health. We aimed to 
assess medical students' psychological condition and influencing factors as a 
baseline evidence for interventions promoting their mental wellbeing. We 
conducted an online survey from April 8 to April 18, 2020 to examine the mental 
health of medical students by the nine-item Patient Health Questionnaire, 
seven-item Generalized Anxiety Disorder Scale, seven-item Insomnia Severity 
Index, and six-item Kessler psychological distress scale. Factors associated 
with mental health outcomes were identified by multivariable logistic regression 
analysis. Five hundred forty-nine students completed the survey; 341 (62.3%), 
410 (74.6%), 344 (62.6%), and 379 (69%) reported anxiety, depression, insomnia, 
and distress, respectively. Female students, living in high COVID-19 prevalence 
locations, more than 25 days confinement, psychiatric consult history, and being 
in a preclinical level of studies had higher median scores and severe symptom 
levels. Multivariable logistic regression showed female gender as a risk factor 
for severe symptoms of anxiety (odds ratio [OR]: 1.653; 95% CI: 1.020-2.679; P = 
0.042), depression (OR: 2.167; 95% CI: 1.435-3.271; P < 0.001), insomnia (OR: 
1.830; 95% CI: 1.176-2.847; P = 0.007), and distress (OR: 1.994; 95% CI: 
1.338-2.972; P = 0.001); preclinical level of enrollment as a risk factor for 
depression (OR: 0.679; 95% CI: 0.521-0.885; P = 0.004), insomnia (OR: 0.720; 95% 
CI: 0.545-0.949; P = 0.02), and distress (OR: 0.650; 95% CI: 0.499-0.847; P = 
0.001), whereas living in high COVID-19 prevalence locations was a risk factor 
for severe anxiety (OR: 1.628; 95% CI: 1.090-2.432; P = 0.017) and depression 
(OR: 1.438; 95% CI: 1.002-2.097; P = 0.05). Currently, medical students 
experience high levels of mental health symptoms, especially female students, 
those at a preclinical level and living in regions with a high prevalence of 
COVID-19 cases. Screening for mental health issues, psychological support, and 
long-term follow-up could alleviate the burden and protect future physicians.

DOI: 10.4269/ajtmh.20-1302
PMCID: PMC7790070
PMID: 33205748 [Indexed for MEDLINE]


4048. Eur Child Adolesc Psychiatry. 2022 Jan;31(1):161-176. doi: 
10.1007/s00787-020-01680-8. Epub 2020 Nov 17.

Vulnerability and resilience in children during the COVID-19 pandemic.

Tso WWY(#)(1), Wong RS(1), Tung KTS(1), Rao N(1), Fu KW(1), Yam JCS(2), Chua 
GT(1), Chen EYH(1), Lee TMC(1), Chan SKW(1), Wong WHS(1), Xiong X(3), Chui 
CS(1), Li X(1), Wong K(1)(4), Leung C(5), Tsang SKM(1), Chan GCF(1), Tam PKH(1), 
Chan KL(5), Kwan MYW(6), Ho MHK(1), Chow CB(1), Wong ICK(7)(8)(9), Lp P(10)(11).

Author information:
(1)The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
(2)The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
(3)Huazhong University of Science and Technology, Wuhan, China.
(4)UCL School of Pharmacy, London, UK.
(5)The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China.
(6)Princess Margaret Hospital, Kwai Chung, Hong Kong SAR, China.
(7)The University of Hong Kong, Pokfulam, Hong Kong SAR, China. wongick@hku.hk.
(8)UCL School of Pharmacy, London, UK. wongick@hku.hk.
(9)Department of Pharmacology and Pharmacy, The University of Hong Kong, L02-56, 
2/F, Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China. 
wongick@hku.hk.
(10)The University of Hong Kong, Pokfulam, Hong Kong SAR, China. 
patricip@hku.hk.
(11)Department of Paediatrics and Adolescent Medicine, The University of Hong 
Kong, Room 115, 1/F, New Clinical Building, 102 Pokfulam Road, Queen Mary 
Hospital, Pokfulam, Hong Kong SAR, China. patricip@hku.hk.
(#)Contributed equally

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is having a 
profound impact on the health and development of children worldwide. There is 
limited evidence on the impact of COVID-19 and its related school closures and 
disease-containment measures on the psychosocial wellbeing of children; little 
research has been done on the characteristics of vulnerable groups and factors 
that promote resilience.
METHODS: We conducted a large-scale cross-sectional population study of Hong 
Kong families with children aged 2-12 years. Parents completed an online survey 
on family demographics, child psychosocial wellbeing, functioning and lifestyle 
habits, parent-child interactions, and parental stress during school closures 
due to COVID-19. We used simple and multiple linear regression analyses to 
explore factors associated with child psychosocial problems and parental stress 
during the pandemic.
RESULTS: The study included 29,202 individual families; of which 12,163 had 
children aged 2-5 years and 17,029 had children aged 6-12 years. The risk of 
child psychosocial problems was higher in children with special educational 
needs, and/or acute or chronic disease, mothers with mental illness, 
single-parent families, and low-income families. Delayed bedtime and/or 
inadequate sleep or exercise duration, extended use of electronic devices were 
associated with significantly higher parental stress and more psychosocial 
problems among pre-schoolers.
CONCLUSIONS: This study identifies vulnerable groups of children and highlights 
the importance of strengthening family coherence, adequate sleep and exercise, 
and responsible use of electronic devices in promoting psychosocial wellbeing 
during the COVID-19 pandemic.

© 2020. Springer-Verlag GmbH Germany, part of Springer Nature.

DOI: 10.1007/s00787-020-01680-8
PMCID: PMC7671186
PMID: 33205284 [Indexed for MEDLINE]

Conflict of interest statement: All authors have indicated they have no 
potential conflicts of interest to disclose.


4049. BMJ Open. 2020 Nov 17;10(11):e041191. doi: 10.1136/bmjopen-2020-041191.

Characteristics and well-being of urban informal home care providers during 
COVID-19 pandemic: a population-based study.

Chan EY(1)(2)(3), Lo ES(4)(3), Huang Z(4)(3), Kim JH(3), Hung H(4)(3), Hung 
KK(4)(5), Wong EL(3), Wong SY(3), Gobat N(6).

Author information:
(1)Collaborating Centre for Oxford University and CUHK for Disaster and Medical 
Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, 
China emily.chan@cuhk.edu.hk.
(2)Nuffield Department of Medicine, University of Oxford, Oxford, UK.
(3)JC School of Public Health and Primary Care, The Chinese University of Hong 
Kong, Hong Kong, China.
(4)Collaborating Centre for Oxford University and CUHK for Disaster and Medical 
Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong, 
China.
(5)Accident & Emergency Medicine Academic Unit, The Chinese University of Hong 
Kong, Prince of Wales Hospital, Hong Kong, China.
(6)Nuffield Department of Primary Care Health Sciences, University of Oxford, 
Oxford, UK.

OBJECTIVES: Globally, the COVID-19 pandemic has overwhelmed many healthcare 
systems, which has hampered access to routine clinical care during lockdowns. 
Informal home care, care provided by non-healthcare professionals, increases the 
community's healthcare capacity during pandemics. There is, however, limited 
research about the characteristics of informal home care providers and the 
challenges they face during such public health emergencies.
DESIGN: A random, cross-sectional, population-based, RDD, telephone survey study 
was conducted to examine patterns of home care, characteristics of informal home 
care providers and the challenges experienced by these care providers during 
this pandemic.
SETTING: Data were collected from 22 March to 1 April 2020 in Hong Kong, China.
PARTICIPANTS: A population representative study sample of Chinese-speaking 
adults (n=765) was interviewed.
PRIMARY AND SECONDARY OUTCOME MEASURES: The study examined the characteristics 
of informal home care providers and self-reported health requirements of those 
who needed care. The study also examined providers' self-perceived knowledge to 
provide routine home care as well as COVID-19 risk reduction care. Respondents 
were asked of their mental health status related to COVID-19.
RESULTS: Of the respondents, 25.1% of 765 provided informal home care during the 
studied COVID-19 pandemic period. Among the informal home care providers, 18.4% 
of respondents took leave from school/work during the epidemic to provide care 
for the sick, fragile elderly and small children. Care providers tended to be 
younger aged, female and housewives. Approximately half of care providers 
reported additional mental strain and 37.2% reported of challenges in daily 
living during epidemic. Although most informal home care providers felt 
competent to provide routine care, 49.5% felt inadequately prepared to cope with 
the additional health risks of COVID-19.
CONCLUSION: During public health emergencies, heavy reliance on informal home 
healthcare providers necessitates better understanding of their specific needs 
and increased government services to support informal home care.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2020-041191
PMCID: PMC7674019
PMID: 33203637 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


4050. Res Dev Disabil. 2021 Jan;108:103812. doi: 10.1016/j.ridd.2020.103812. Epub 2020 
Nov 9.

Staying connected during COVID-19: Family engagement with adults with 
developmental disabilities in supported accommodation.

Araten-Bergman T(1), Shpigelman CN(2).

Author information:
(1)Social Work and Social Policy, School of Allied Health, Human Services and 
Sport, and Living with Disability Research Centre, La Trobe University, 
Melbourne, Australia.
(2)Department of Community Mental Health, University of Haifa, Israel. 
Electronic address: carmits@univ.haifa.ac.il.

BACKGROUND: Enduring family engagement and informal support is crucial to the 
health and well-being of adults with developmental disabilities (DD) residing in 
supported accommodation. The COVID-19 pandemic and restrictive measures enforced 
in residential settings have resulted in changes in daily routine and modified 
the ways families can interact with and provide support to residents. Yet, the 
impact of these changes has not been empirically explored.
AIM: Explore how family caregivers have interacted with and supported their 
relatives with DD residing in supported accommodation during the pandemic.
METHODS: Changes in frequencies of communication modes and types of informal 
support were measured through a cross-sectional and anonymous online survey 
which completed by 108 family caregivers of adults with DD.
RESULTS: Most family caregivers adopted remote communication technologies; 
however, these were not perceived to be effective in filling the gap created by 
reduced face-to-face contact. While families were able to provide emotional 
support and advocacy using digital technologies, they were limited in their 
ability to provide significant social support.
CONCLUSIONS: Findings may help key stakeholders develop and implement novel 
strategies and policies to accommodate the changing circumstances and to ensure 
continuity of family engagement and informal support in the context of COVID-19.

Copyright © 2020 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.ridd.2020.103812
PMID: 33202349 [Indexed for MEDLINE]


4051. J Adv Nurs. 2021 Feb;77(2):635-652. doi: 10.1111/jan.14630. Epub 2020 Nov 17.

Effect of music therapy on preterm infants in neonatal intensive care unit: 
Systematic review and meta-analysis of randomized controlled trials.

Yue W(1), Han X(1), Luo J(1), Zeng Z(1), Yang M(1)(2).

Author information:
(1)School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, 
China.
(2)Guangzhou University City, Guangzhou, China.

AIM: To systematically examine the effectiveness of music therapy on preterm 
infants in neonatal intensive care unit.
BACKGROUND: In recent years, the application of music therapy for preterm 
infants in neonatal intensive care unit has attracted more and more attention 
because of its clinical effects. However, there still exist disputes among 
different studies.
DESIGN: A systematic review and meta-analysis.
DATA SOURCES: Eleven databases were searched over the period from 1910 -4 
November 2019.
REVIEW METHODS: Papers were selected for analysis in accordance with the PRISMA 
guidelines. The meta-analysis was carried out by using Review Manager 5.3 
software.
RESULTS: A total of 13 trials involving 1,093 participants were included. 
Meta-analysis showed music therapy had a significant influence on preterm 
infant's heart rate, respiratory rate, oral feeding volume, stress level, and 
maternal anxiety with moderate-to-high heterogeneity among studies. Also, music 
therapy had no influences on oxygen saturation and behavioural state.
CONCLUSIONS: Music therapy can not only effectively improve preterm infant's 
heart rate, stable respiratory rate, and attenuate stress level but also exert 
positive impact on oral feeding volume. In addition, music therapy also plays a 
role in reducing maternal anxiety. However, due to the heterogeneity across 
studies in some outcomes, further studies with larger sample size and more 
stringent design should be conducted before recommendation.
IMPACT: Music therapy can significantly improve preterm infant's heart rate, 
respiratory rate, and stress level, as well as increase oral feeding volume. 
These results may exert a positive impact on well-being and quality of life in 
preterm infants in the neonatal intensive care unit. Hospitals can apply music 
therapy which has been considered a non-pharmacological and no-invasive 
treatment to preterm infants in the neonatal intensive care unit.

Publisher: 目的: 系统性地检查音乐疗法对新生儿重症监护室内的早产儿的效果。 背景: 
近年来,由于临床效果显著,音乐疗法对于新生儿重症监护室内早产儿的应用受到越来越多的关注。然而,不同的研究之间仍存在争议。 设计: 采用系统评估和荟萃分析。 
数据来源: 对11个数据库自1910年至2019年11月4日期间的数据进行检索。 评估方法: 根据RPISMA指南选择用于分析的论文。通过Review 
Manager 5.3软件进行荟萃分析。 结果: 
共涉及13次试验以及1,093位参与者。荟萃分析显示,音乐疗法对早产儿心率、呼吸频率、经口喂养量、压力水平以及母亲焦虑度有显著影响,各研究间存在中等到高度异质性。但音乐疗法对氧饱和度和行为状态并无影响。 
结论: 
音乐疗法不仅可以有效改善早产儿心率、稳定呼吸速率、改善压力水平,还对经口喂养量产生积极的影响。此外,音乐疗法在减少母亲的焦虑度方面也起着重要的作用。但是,因部分研究结果的异质性,在推荐使用该疗法前还应进一步研究更多的样本和进行更严格的设计。 
影响: 
音乐疗法可以显著改善早产儿心率、呼吸速率、压力水平,并增加经口喂养量。这些结果可能对新生儿重症监护室内早产儿的健康和生活质量带来积极的影响。医院可采用被认为是非药物和无创伤治疗的音乐疗法,为新生儿重症监护室内的早产儿提供治疗。.

© 2020 John Wiley & Sons Ltd.

DOI: 10.1111/jan.14630
PMID: 33200833 [Indexed for MEDLINE]


4052. Aging (Albany NY). 2020 Nov 10;12(23):23739-23760. doi: 10.18632/aging.103940. 
Epub 2020 Nov 10.

Red light exaggerated sepsis-induced learning impairments and anxiety-like 
behaviors.

Xie B(1)(2), Zhang Y(1)(2), Qi H(1)(2), Yao H(1)(2), Shang Y(1)(2), Yuan 
S(1)(2), Zhang J(1)(2).

Author information:
(1)Department of Critical Care Medicine, Union Hospital, Tongji Medical College, 
Huazhong University of Science and Technology, Wuhan 430022, China.
(2)Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji 
Medical College, Huazhong University of Science and Technology, Wuhan 430022, 
China.

Erratum in
    Aging (Albany NY). 2022 Aug 14;14(15):6377-6378.

Light exerts critical non-visual effects on a multitude of physiological 
processes and behaviors, including sleep-wake behavior and cognitive function. 
In this study, we investigated the effects of continued exposure to different 
colors of light on cognitive function after sepsis in old mice. We found that 
exposure to red light, but not green light, exaggerated learning impairments and 
anxiety-like behaviors after sepsis. Red light also induced remarkable 
splenomegaly and altered the diversity and composition of the fecal microbiota. 
Pseudo germ-free mice transplanted with fecal bacteria from septic mice exposed 
to red light developed the same behavioral defects and splenomegaly as their 
donors. Intriguingly, splenectomy and subdiaphragmatic vagotomy reversed the 
learning impairments and anxiety-like behaviors resulting from red light 
exposure after sepsis. After subdiaphragmatic vagotomy, no differences in 
behavior or spleen size were observed among pseudo germ-free mice transplanted 
with fecal bacteria from septic mice exposed to different colors of light. Our 
results suggested that red light exposure after sepsis in old mice causes gut 
microbiota dysfunction, thus stimulating signaling through the subdiaphragmatic 
vagus nerve that induces splenomegaly and aggravates learning impairments and 
anxiety-like behaviors.

DOI: 10.18632/aging.103940
PMCID: PMC7762485
PMID: 33197883 [Indexed for MEDLINE]

Conflict of interest statement: CONFLICTS OF INTEREST: The authors declare no 
financial or other conflicts of interest.


4053. Perspect Psychiatr Care. 2021 Apr;57(2):473-480. doi: 10.1111/ppc.12651. Epub 
2020 Nov 16.

Factors that predict the perception of spirituality and spiritual care of nurses 
working in high-risk units and the effect of death anxiety.

Rahman S(1), Elbi H(2), Cakmakci Cetinkaya A(3), Altan S(4), Ozan E(5), Pirincci 
E(6).

Author information:
(1)Department of Medical Education, Faculty of Medicine, Manisa Celal Bayar 
University, Manisa, Turkey.
(2)Department of Family Medicine, Faculty of Medicine, Manisa Celal Bayar 
University, Manisa, Turkey.
(3)Department of Nursing, Faculty of Health Sciences, Manisa Celal Bayar 
University, Manisa, Turkey.
(4)Department of Medical History and Ethics, Faculty of Medicine, Manisa Celal 
Bayar University, Manisa, Turkey.
(5)Department of Psychiatry, Faculty of Medicine, Manisa Celal Bayar University, 
Manisa, Turkey.
(6)Department of Public Health, Faculty of Medicine, Fırat University, Elazığ, 
Turkey.

PURPOSE: Spirituality contributes to the health and well-being of individuals. 
This study investigates the factors that predict the spirituality perceptions 
and the effect of death anxiety of nurses.
DESIGN AND METHODS: This was a cross-sectional study, 382 nurses working in four 
public hospitals intensive care and emergency departments setting in two 
different cities in Turkey.
FINDINGS: Variables predicting the total and subscale scores of the Spirituality 
and Spiritual Care Rating Scale of nurses were determined by linear multiple 
regression analysis. Except for the religiousness subscale, the satisfaction 
level of nurses was found to be a significant predictor in total of Spirituality 
and Spiritual Care Scale.
PRACTICE IMPLICATIONS: Nurses working in high-risk units are unclear about their 
perception of spirituality and spiritual care.

© 2020 Wiley Periodicals LLC.

DOI: 10.1111/ppc.12651
PMID: 33196114 [Indexed for MEDLINE]


4054. Front Public Health. 2020 Oct 27;8:573397. doi: 10.3389/fpubh.2020.573397. 
eCollection 2020.

Public Health and Risk Communication During COVID-19-Enhancing Psychological 
Needs to Promote Sustainable Behavior Change.

Porat T(1), Nyrup R(2), Calvo RA(1), Paudyal P(3), Ford E(3).

Author information:
(1)Dyson School of Design Engineering, Imperial College London, London, United 
Kingdom.
(2)Leverhulme Centre for the Future of Intelligence, University of Cambridge, 
Cambridge, United Kingdom.
(3)Brighton and Sussex Medical School, University of Sussex, Brighton, United 
Kingdom.

Background: The current COVID-19 pandemic requires sustainable behavior change 
to mitigate the impact of the virus. A phenomenon which has arisen in parallel 
with this pandemic is an infodemic-an over-abundance of information, of which 
some is accurate and some is not, making it hard for people to find trustworthy 
and reliable guidance to make informed decisions. This infodemic has also been 
found to create distress and increase risks for mental health disorders, such as 
depression and anxiety. Aim: To propose practical guidelines for public health 
and risk communication that will enhance current recommendations and will cut 
through the infodemic, supporting accessible, reliable, actionable, and 
inclusive communication. The guidelines aim to support basic human psychological 
needs of autonomy, competence, and relatedness to support well-being and 
sustainable behavior change. Method: We applied the Self-Determination Theory 
(SDT) and concepts from psychology, philosophy and human computer interaction to 
better understand human behaviors and motivations and propose practical 
guidelines for public health communication focusing on well-being and 
sustainable behavior change. We then systematically searched the literature for 
research on health communication strategies during COVID-19 to discuss our 
proposed guidelines in light of the emerging literature. We illustrate the 
guidelines in a communication case study: wearing face-coverings. Findings: We 
propose five practical guidelines for public health and risk communication that 
will cut through the infodemic and support well-being and sustainable behavior 
change: (1) create an autonomy-supportive health care climate; (2) provide 
choice; (3) apply a bottom-up approach to communication; (4) create solidarity; 
(5) be transparent and acknowledge uncertainty. Conclusion: Health communication 
that starts by fostering well-being and basic human psychological needs has the 
potential to cut through the infodemic and promote effective and sustainable 
behavior change during such pandemics. Our guidelines provide a starting point 
for developing a concrete public health communication strategy.

Copyright © 2020 Porat, Nyrup, Calvo, Paudyal and Ford.

DOI: 10.3389/fpubh.2020.573397
PMCID: PMC7652763
PMID: 33194973 [Indexed for MEDLINE]


4055. Mult Scler Relat Disord. 2021 Jan;47:102618. doi: 10.1016/j.msard.2020.102618. 
Epub 2020 Nov 5.

Distress and risk perception in people living with multiple sclerosis during the 
early phase of the COVID-19 pandemic.

Alschuler KN(1), Roberts MK(2), Herring TE(2), Ehde DM(2).

Author information:
(1)Department of Rehabilitation Medicine, University of Washington, Seattle, WA, 
USA; Department of Neurology, University of Washington, Seattle, WA, USA. 
Electronic address: kalschul@uw.edu.
(2)Department of Rehabilitation Medicine, University of Washington, Seattle, WA, 
USA.

BACKGROUND: People living with MS during COVID-19 are experiencing the 
disruptions of the pandemic and concerns that their health status may place them 
at greater risk for worse COVID-19 outcomes.
OBJECTIVE: This study sought to understand how people living with MS in the 
United States experienced distress and perceived their COVID-19-related risk 
during the first surge of the pandemic.
METHODS: This was a web-based, self-report survey of people with MS who were 
living in the United States during the early stage of COVID-19. Primary outcomes 
were depression, anxiety, and positive-affect and well-being. Participants 
(N = 491) also provided data on demographics, MS-related factors, COVID-19 
factors, and psychological coping.
RESULTS: Psychological distress was associated with age, psychological coping 
strategies, and having had symptoms consistent with COVID-19, but not with MS 
disease-related variables and COVID-19 risk factors. Perception of 
COVID-19-related risk was associated with age, MS disease severity, 
COVID-19-related factors, and anxiety.
CONCLUSION: This study demonstrated that even during COVID-19, distress and risk 
perception are primarily driven by psychological factors, experiencing symptoms 
consistent with COVID-19 and age, with minimal contribution from individual 
differences in health status, providing an impetus for continued efforts to 
optimize psychological interventions for people living with MS.

Copyright © 2020 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.msard.2020.102618
PMCID: PMC7644263
PMID: 33186805 [Indexed for MEDLINE]

Conflict of interest statement: The Authors declare that there are no conflicts 
of interest.


4056. Pediatr Res. 2021 Jan;89(2):326-335. doi: 10.1038/s41390-020-01236-1. Epub 2020 
Nov 12.

Placental programming, perinatal inflammation, and neurodevelopment impairment 
among those born extremely preterm.

Bangma JT(1), Hartwell H(1), Santos HP Jr(2)(3), O'Shea TM(4), Fry RC(5)(6)(7).

Author information:
(1)Department of Environmental Sciences and Engineering, Gillings School of 
Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, 
NC, USA.
(2)Biobehavioral Laboratory, School of Nursing, University of North Carolina at 
Chapel Hill, Chapel Hill, NC, USA.
(3)Institute for Environmental Health Solutions, Gillings School of Global 
Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 
USA.
(4)Department of Pediatrics, School of Medicine, University of North Carolina at 
Chapel Hill, Chapel Hill, NC, USA.
(5)Biobehavioral Laboratory, School of Nursing, University of North Carolina at 
Chapel Hill, Chapel Hill, NC, USA. rfry@unc.edu.
(6)Institute for Environmental Health Solutions, Gillings School of Global 
Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 
USA. rfry@unc.edu.
(7)Curriculum in Toxicology and Environmental Medicine, The University of North 
Carolina at Chapel Hill, Chapel Hill, NC, USA. rfry@unc.edu.

Individuals born extremely preterm are at significant risk for impaired 
neurodevelopment. After discharge from the neonatal intensive care, associations 
between the child's well-being and factors in the home and social environment 
become increasingly apparent. Mothers' prenatal health and socioeconomic status 
are associated with neurodevelopmental outcomes, and emotional and behavioral 
problems. Research on early life risk factors and on mechanisms underlying 
inter-individual differences in neurodevelopment later in life can inform the 
design of personalized approaches to prevention. Here, we review early life 
predictors of inter-individual differences in later life neurodevelopment among 
those born extremely preterm. Among biological mechanisms that mediate 
relationships between early life predictors and later neurodevelopmental 
outcomes, we highlight evidence for disrupted placental processes and regulated 
at least in part via epigenetic mechanisms, as well as perinatal inflammation. 
In relation to these mechanisms, we focus on four prenatal antecedents of 
impaired neurodevelopment, namely, (1) fetal growth restriction, (2) maternal 
obesity, (3) placental microorganisms, and (4) socioeconomic adversity. In the 
future, this knowledge may inform efforts to detect and prevent adverse outcomes 
in infants born extremely preterm. IMPACT: This review highlights early life 
risk factors and mechanisms underlying inter-individual differences in 
neurodevelopment later in life. The review emphasizes research on early life 
risk factors (fetal growth restriction, maternal obesity, placental 
microorganisms, and socioeconomic adversity) and on mechanisms (disrupted 
placental processes and perinatal inflammation) underlying inter-individual 
differences in neurodevelopment later in life. The findings highlighted here may 
inform efforts to detect and prevent adverse outcomes in infants born extremely 
preterm.

DOI: 10.1038/s41390-020-01236-1
PMCID: PMC7658618
PMID: 33184498 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


4057. Int J Soc Psychiatry. 2021 Sep;67(6):761-769. doi: 10.1177/0020764020972439. 
Epub 2020 Nov 12.

Psychological response of children to home confinement during COVID-19: A 
qualitative arts-based research.

Abdulah DM(1), Abdulla BMO(2), Liamputtong P(3).

Author information:
(1)Community Health Unit, College of Nursing, University of Duhok, Iraqi 
Kurdistan.
(2)Institute of Fine Arts, Administration of Institutes, Ministry of Education, 
Duhok, Iraqi Kurdistan.
(3)School of Health Sciences, Western Sydney University, NSW, Australia.

BACKGROUND: The evidence has shown that children are more susceptible to the 
emotional effects of traumatic events such as outbreaks with the possible 
disruption in their daily lives.
AIM: In this paper, we discussed the psychological wellbeing of children during 
the COVID-19 outbreak through the art-based qualitative study using the drawing 
method among children in Iraqi Kurdistan.
METHODS: In this qualitative arts-based research study, 15 children aged 6 to 
13 years old who were confined at home during the COVID-19 outbreak for at least 
1 month were included following obtaining the consent from their parents. The 
children were asked to draw his/her feelings, reflections, and responses during 
the COVID-19 on a paper. The children were guided to paint their reflections 
during the COVID-19 based on the following criteria: if they experienced 
loneliness, tiredness, insomnia, depression, worry or anxiety, or have behavior 
changes and their relationship with their parents and other siblings.
RESULTS: This study showed that children have a high level of stress at home 
during the COVID-19 outbreak. The children had great fear about the coronavirus. 
They experienced loneliness and stress, and felt sad, depressed due to home 
confinement and social distancing. The possibility of infection by coronavirus 
has occupied their entire mind. Mental health care providers must take the 
experiences of children who are caught in this global pandemic seriously and 
ensure that appropriate care is offered to the children and their parents.
CONCLUSIONS: The children exhibited a strong feeling of distress, loneliness, 
and fear during the COVID-19 outbreak. This has implications for mental health 
care.

DOI: 10.1177/0020764020972439
PMID: 33183155 [Indexed for MEDLINE]


4058. Int J Environ Res Public Health. 2020 Nov 10;17(22):8297. doi: 
10.3390/ijerph17228297.

Stress, Resilience, and Well-Being in Italian Children and Their Parents during 
the COVID-19 Pandemic.

Cusinato M(1), Iannattone S(2)(3), Spoto A(3), Poli M(4), Moretti C(1), Gatta 
M(2), Miscioscia M(2)(4).

Author information:
(1)Pediatric Diabetes Unit, Department of Women's and Children's Health, Padua 
University Hospital, 35128 Padua, Italy.
(2)Child and Adolescent Neuropsychiatry Unit, Department of Women's and 
Children's Health, Padua University Hospital, 35128 Padua, Italy.
(3)Department of General Psychology, University of Padua, 35131 Padua, Italy.
(4)Department of Developmental Psychology and Socialization, University of 
Padova, 35131 Padua, Italy.

The novel coronavirus (COVID-19) outbreak has forced parents and children to 
adopt significant changes in their daily routine, which has been a big challenge 
for families, with important implications for family stress. In this study, we 
aimed to analyze the potential risk and protective factors for parents' and 
children's well-being during a potentially traumatic event such as the COVID-19 
quarantine. Specifically, we investigated parents' and children's well-being, 
parental stress, and children's resilience. The study involved 463 Italian 
parents of children aged 5-17. All participants completed an online survey 
consisting of the Psychological General Well Being Index (PGWB) to assess 
parental well-being, the Strengths and Difficulties Questionnaire (SDQ) to 
measure children's well-being, the Parent Stress Scale (PSS) to investigate 
parental stress, and the Child and Youth Resilience Measure (CYRM-R) to measure 
children's resilience. The results show that confinement measures and changes in 
daily routine negatively affect parents' psychological dimensions, thus exposing 
children to a significant risk for their well-being. Our results also detect 
some risk factors for psychological maladjustments, such as parental stress, 
lower levels of resilience in children, changes in working conditions, and 
parental psychological, physical, or genetic problems. In this study, we 
attempted to identify the personal and contextual variables involved in the 
psychological adjustment to the COVID-19 quarantine to identify families at risk 
for maladjustment and pave the way for ad hoc intervention programs intended to 
support them. Our data show promising results for the early detection of the 
determinants of families' psychological health. It is important to focus 
attention on the needs of families and children-including their mental health-to 
mitigate the health and economic implications of the COVID-19 pandemic.

DOI: 10.3390/ijerph17228297
PMCID: PMC7696524
PMID: 33182661 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


4059. PLoS One. 2020 Nov 12;15(11):e0242303. doi: 10.1371/journal.pone.0242303. 
eCollection 2020.

Effects of COVID-19 lockdown on heart rate variability.

Bourdillon N(1)(2), Yazdani S(2), Schmitt L(3), Millet GP(1).

Author information:
(1)Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland.
(2)be.care SA, Renens, Switzerland.
(3)National Centre of Nordic-Ski, Research and Performance, Prémanon, France.

INTRODUCTION: Strict lockdown rules were imposed to the French population from 
17 March to 11 May 2020, which may result in limited possibilities of physical 
activity, modified psychological and health states. This report is focused on 
HRV parameters kinetics before, during and after this lockdown period.
METHODS: 95 participants were included in this study (27 women, 68 men, 37 ± 11 
years, 176 ± 8 cm, 71 ± 12 kg), who underwent regular orthostatic tests (a 
5-minute supine followed by a 5-minute standing recording of heart rate (HR)) on 
a regular basis before (BSL), during (CFN) and after (RCV) the lockdown. HR, 
power in low- and high-frequency bands (LF, HF, respectively) and root mean 
square of the successive differences (RMSSD) were computed for each orthostatic 
test, and for each position. Subjective well-being was assessed on a 0-10 visual 
analogic scale (VAS). The participants were split in two groups, those who 
reported an improved well-being (WB+, increase >2 in VAS score) and those who 
did not (WB-) during CFN.
RESULTS: Out of the 95 participants, 19 were classified WB+ and 76 WB-. There 
was an increase in HR and a decrease in RMSSD when measured supine in CFN and 
RCV, compared to BSL in WB-, whilst opposite results were found in WB+ (i.e. 
decrease in HR and increase in RMSSD in CFN and RCV; increase in LF and HF in 
RCV). When pooling data of the three phases, there were significant correlations 
between VAS and HR, RMSSD, HF, respectively, in the supine position; the higher 
the VAS score (i.e., subjective well-being), the higher the RMSSD and HF and the 
lower the HR. In standing position, HRV parameters were not modified during CFN 
but RMSSD was correlated to VAS.
CONCLUSION: Our results suggest that the strict COVID-19 lockdown likely had 
opposite effects on French population as 20% of participants improved 
parasympathetic activation (RMSSD, HF) and rated positively this period, whilst 
80% showed altered responses and deteriorated well-being. The changes in HRV 
parameters during and after the lockdown period were in line with subjective 
well-being responses. The observed recordings may reflect a large variety of 
responses (anxiety, anticipatory stress, change on physical activity…) beyond 
the scope of the present study. However, these results confirmed the usefulness 
of HRV as a non-invasive means for monitoring well-being and health in this 
population.

DOI: 10.1371/journal.pone.0242303
PMCID: PMC7660489
PMID: 33180839 [Indexed for MEDLINE]

Conflict of interest statement: NB and SY are employees of becare SA. GPM and LS 
have no conflict of interests. becare SA did not play a role in the study 
design, data collection and analysis, decision to publish, or preparation of the 
manuscript and only provided financial support in the form of NB and SY 
salaries. The funder provided support in the form of salaries for authors NB and 
SY, but did not have any additional role in the study design, data collection 
and analysis, decision to publish, or preparation of the manuscript. The 
specific roles of these authors are articulated in the ‘author contributions’ 
section. NB and SY were employed by the company be.care SA. The remaining 
authors declare that the research was conducted in the absence of any commercial 
or financial relationships that could be construed as a potential conflict of 
interest. This does not alter our adherence to PLOS ONE policies on sharing data 
and materials.


4060. JMIR Mhealth Uhealth. 2020 Nov 12;8(11):e19836. doi: 10.2196/19836.

Standalone Smartphone Cognitive Behavioral Therapy-Based Ecological Momentary 
Interventions to Increase Mental Health: Narrative Review.

Marciniak MA(1), Shanahan L(2), Rohde J(1), Schulz A(1), Wackerhagen C(3), 
Kobylińska D(4), Tuescher O(5), Binder H(6), Walter H(3), Kalisch R(5), Kleim 
B(1).

Author information:
(1)University of Zurich, Psychiatric University Hospital, Zurich, Switzerland.
(2)Jacobs Centre of Productive Youth Development, University of Zurich, Zurich, 
Switzerland.
(3)Charite Berlin Universitätsmedizin, Berlin, Germany.
(4)University of Warsaw, Warsaw, Poland.
(5)Gutenberg University Medical Center, Mainz, Germany.
(6)Institute for Medical Biometry and Statistics, Faculty of Medicine, 
University of Freiburg, Freiburg, Germany.

BACKGROUND: A growing number of psychological interventions are delivered via 
smartphones with the aim of increasing the efficacy and effectiveness of these 
treatments and providing scalable access to interventions for improving mental 
health. Most of the scientifically tested apps are based on cognitive behavioral 
therapy (CBT) principles, which are considered the gold standard for the 
treatment of most mental health problems.
OBJECTIVE: This review investigates standalone smartphone-based ecological 
momentary interventions (EMIs) built on principles derived from CBT that aim to 
improve mental health.
METHODS: We searched the MEDLINE, PsycINFO, EMBASE, and PubMed databases for 
peer-reviewed studies published between January 1, 2007, and January 15, 2020. 
We included studies focusing on standalone app-based approaches to improve 
mental health and their feasibility, efficacy, or effectiveness. Both within- 
and between-group designs and studies with both healthy and clinical samples 
were included. Blended interventions, for example, app-based treatments in 
combination with psychotherapy, were not included. Selected studies were 
evaluated in terms of their design, that is, choice of the control condition, 
sample characteristics, EMI content, EMI delivery characteristics, feasibility, 
efficacy, and effectiveness. The latter was defined in terms of improvement in 
the primary outcomes used in the studies.
RESULTS: A total of 26 studies were selected. The results show that EMIs based 
on CBT principles can be successfully delivered, significantly increase 
well-being among users, and reduce mental health symptoms. Standalone EMIs were 
rated as helpful (mean 70.8%, SD 15.3; n=4 studies) and satisfying for users 
(mean 72.6%, SD 17.2; n=7 studies).
CONCLUSIONS: Study quality was heterogeneous, and feasibility was often not 
reported in the reviewed studies, thus limiting the conclusions that can be 
drawn from the existing data. Together, the studies show that EMIs may help 
increase mental health and thus support individuals in their daily lives. Such 
EMIs provide readily available, scalable, and evidence-based mental health 
support. These characteristics appear crucial in the context of a global crisis 
such as the COVID-19 pandemic but may also help reduce personal and economic 
costs of mental health impairment beyond this situation or in the context of 
potential future pandemics.

©Marta Anna Marciniak, Lilly Shanahan, Judith Rohde, Ava Schulz, Carolin 
Wackerhagen, Dorota Kobylińska, Oliver Tuescher, Harald Binder, Henrik Walter, 
Raffael Kalisch, Birgit Kleim. Originally published in JMIR mHealth and uHealth 
(http://mhealth.jmir.org), 12.11.2020.

DOI: 10.2196/19836
PMCID: PMC7691088
PMID: 33180027 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


4061. Life Sci. 2021 Jan 15;265:118736. doi: 10.1016/j.lfs.2020.118736. Epub 2020 Nov 
8.

A key role of gut microbiota-vagus nerve/spleen axis in sleep 
deprivation-mediated aggravation of systemic inflammation after LPS 
administration.

Zhang Y(1), Xie B(1), Chen X(1), Zhang J(2), Yuan S(3).

Author information:
(1)Department of Critical Care Medicine, Union Hospital, Tongji Medical College, 
Huazhong University of Science and Technology, Wuhan, 430022, China; Institute 
of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical 
College, Huazhong University of Science and Technology, Wuhan, 430022, China.
(2)Department of Critical Care Medicine, Union Hospital, Tongji Medical College, 
Huazhong University of Science and Technology, Wuhan, 430022, China; Institute 
of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical 
College, Huazhong University of Science and Technology, Wuhan, 430022, China. 
Electronic address: zhjcheng1@126.com.
(3)Department of Critical Care Medicine, Union Hospital, Tongji Medical College, 
Huazhong University of Science and Technology, Wuhan, 430022, China; Institute 
of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical 
College, Huazhong University of Science and Technology, Wuhan, 430022, China. 
Electronic address: yuan_shiying@163.com.

AIMS: Sleep deprivation (SD) correlates with exacerbated systemic inflammation 
after sepsis. However, the underlying mechanisms remain unclear. This study 
aimed to evaluate the roles and mechanisms of SD in inflammatory organ injury 
after lipopolysaccharide (LPS) administration.
MAIN METHODS: Mice were intraperitoneally injected with LPS followed by 3 
consecutive days of SD. The pseudo germ-free (PGF) mice received fecal 
microbiota transplant by being gavaged with supernatant from fecal suspension of 
septic mice with or without SD. The subdiaphragmatic vagotomy (SDV) or 
splenectomy was performed 14 days prior to LPS injection or antibiotics 
administration.
KEY FINDINGS: Post-septic SD increased the plasma levels of interleukin (IL)-6 
and tumor necrosis factor-α (TNF-α), reduced IL-10 plasma level, increased 
spleen weight, and promoted inflammatory injury of the lung, liver and kidney. 
The relative abundance of Proteobacteria and its subgroups were increased after 
post-septic SD. PGF mice transplanted with fecal bacteria from septic mice 
subjected to SD developed splenomegaly, systemic inflammation, organ 
inflammation and damage as their donors did. Intriguingly, SDV abolished the 
aggravated effects of SD on splenomegaly and inflammatory organ injury in septic 
mice received SD or in PGF mice transplanted with fecal bacteria from septic 
mice subjected to SD. Furthermore, splenectomy also abrogated the increase in 
IL-6 and TNF-α plasma levels and the decrease in IL-10 plasma level in PGF mice 
transplanted with fecal bacteria from septic mice subjected to SD.
SIGNIFICANCE: Gut microbiota-vagus nerve axis and gut microbiota-spleen axis 
play key roles in modulating systemic inflammation induced by SD after LPS 
administration.

Copyright © 2020 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.lfs.2020.118736
PMID: 33176177 [Indexed for MEDLINE]


4062. Paediatr Anaesth. 2021 Jan;31(1):53-60. doi: 10.1111/pan.14067. Epub 2020 Nov 
30.

Workplace well-being in pediatric anesthesia: How to design and implement a 
bespoke evidence-based framework in your department.

Shrivastava PP(1), McDonald JM(2).

Author information:
(1)Department of Anaesthesia and Pain Medicine, Perth Children's and Sir Charles 
Gairdner Hospitals, Perth, WA, Australia.
(2)Department of Anaesthesia and Perioperative Medicine, Westmead Hospital, 
Sydney, NSW, Australia.

BACKGROUND: All anesthetists are at risk of mental ill health and pediatric 
anesthetists face additional stressors that may impact upon well-being, 
particularly after an adverse outcome. The SARS COV-2 pandemic has resulted in a 
plethora of resources to support the well-being of frontline workers. Developing 
a well-being system for an anesthesia department using these resources may be 
complex to implement.
AIMS: In this article we outline how an anesthesia department can design and 
implement a framework for wellbeing, regardless of resources and financial 
constraints. We use the example of a free online toolkit developed in Australia 
for anesthetists.
METHODS: The "Long lives, Healthy Workplaces toolkit" is a framework which has 
been specifically developed by mental health experts for anesthetists, and does 
not require departments to pay for external experts.1 Departments can design a 
long-term model of evidence-based mental health strategies to meet their unique 
needs using five steps outlined in the toolkit and detailed in this article. The 
framework uses cycles of assessment and review to create an adaptable approach 
to incorporate emerging evidence. We explain how culture can impact the 
implementation of a well-being framework and we outline how departments can set 
goals and priorities.
CONCLUSION: Departments have different constraints which will alter how they 
approach supporting anaesthetists' wellbeing. Regardless of location or funding 
all departments should explicitly address anesthetists well-being. Long term 
sustainable well-being programs require a strategic and coordinated approach.

© 2020 John Wiley & Sons Ltd.

DOI: 10.1111/pan.14067
PMID: 33176027 [Indexed for MEDLINE]


4063. PLoS One. 2020 Nov 11;15(11):e0242129. doi: 10.1371/journal.pone.0242129. 
eCollection 2020.

The COVID-19 Social Monitor longitudinal online panel: Real-time monitoring of 
social and public health consequences of the COVID-19 emergency in Switzerland.

Moser A(1), Carlander M(2), Wieser S(2), Hämmig O(1), Puhan MA(1), Höglinger 
M(2).

Author information:
(1)Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 
Zurich, Switzerland.
(2)Winterthur Institute of Health Economics, Zurich University of Applied 
Sciences, Winterthur, Switzerland.

BACKGROUND: The COVID-19 pandemic challenges societies in unknown ways, and 
individuals experience a substantial change in their daily lives and activities. 
Our study aims to describe these changes using population-based self-reported 
data about social and health behavior in a random sample of the Swiss population 
during the COVID-19 pandemic. The aim of the present article is two-fold: First, 
we want to describe the study methodology. Second, we want to report participant 
characteristics and study findings of the first survey wave to provide some 
baseline results for our study.
METHODS: Our study design is a longitudinal online panel of a random sample of 
the Swiss population. We measure outcome indicators covering general well-being, 
physical and mental health, social support, healthcare use and working state 
over multiple survey waves.
RESULTS: From 8,174 contacted individuals, 2,026 individuals participated in the 
first survey wave which corresponds to a response rate of 24.8%. Most survey 
participants reported a good to very good general life satisfaction (93.3%). 
41.4% of the participants reported a worsened quality of life compared to before 
the COVID-19 emergency and 9.8% feelings of loneliness.
DISCUSSION: The COVID-19 Social Monitor is a population-based online survey 
which informs the public, health authorities, and the scientific community about 
relevant aspects and potential changes in social and health behavior during the 
COVID-19 emergency and beyond. Future research will follow up on the described 
study population focusing on COVID-19 relevant topics such as subgroup 
differences in the impact of the pandemic on well-being and quality of life or 
different dynamics of perceived psychological distress.

DOI: 10.1371/journal.pone.0242129
PMCID: PMC7657546
PMID: 33175906 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


4064. BMC Womens Health. 2020 Nov 10;20(1):249. doi: 10.1186/s12905-020-01115-1.

COVID-19 and violence: a research call to action.

Evans DP(1).

Author information:
(1)Hubert Department of Global Health, Emory University, 1518 Clifton Rd, NE, 
Atlanta, GA, 30322, USA. Dabney.evans@emory.edu.

COVID-19 related guidelines and movement restrictions are designed to protect 
the public's health and reduce disease transmission; yet, COVID-19 related 
restrictions on movement including social distancing, isolation, quarantine, and 
shelter-in-place orders have an unknown effect on violence and abuse within 
relationships. As the pandemic has progressed, many have justifiably speculated 
that such restrictions may pose a danger to the safety and well-being of people 
experiencing such violence. Early in the pandemic, countries hard hit by 
COVID-19 began raising the alarm bell about the impacts of the disease on IPV 
occurrence. Police in China report that 90% of the causes of recent IPV cases 
could be attributed to the COVID-19 epidemic. Rising fears and anxiety about 
prolonged movement restrictions, increased economic strain and diminished health 
care capacity to support survivors are among the potential reasons for such 
dramatic effects. Under normal circumstances: low income, unemployment, economic 
stress, depression, emotional insecurity and social isolation are all risk 
factors for using violence against partners. Many of these factors may worsen in 
the context of COVID-19. Despite the urgency in addressing COVID-19, existing 
health concerns like Intimate Partner Violence (IPV) persist-and may well be 
worsened by the virus. We simply do not yet know the effects of COVID-19 on 
violence, nor do we know which interventions work best to prevent and respond to 
it within the context of the pandemic. The vast majority of information 
available about IPV and violence during the pandemic has been based on anecdotal 
reports. The call to action for the research community is clear. We must 
systematically measure the effects of COVID-19 and movement related restrictions 
on violence. As always when researching violence, serious consideration must be 
given to ethics and safety. Violence researchers must mobilize to investigate 
the impacts of COVID-19 on violence and human health.

DOI: 10.1186/s12905-020-01115-1
PMCID: PMC7653443
PMID: 33172466 [Indexed for MEDLINE]

Conflict of interest statement: The author declares that she has no competing 
interests.


4065. J Bioeth Inq. 2020 Dec;17(4):539-541. doi: 10.1007/s11673-020-10066-z. Epub 2020 
Nov 9.

The Way We Live Now.

Wiltshire J(1).

Author information:
(1)La Trobe University, Melbourne, Australia. zaiga@tpg.com.au.

This is a personal account of one man's experience of the months during which 
COVID-19 spread in Australia. Though personal, it aims to also be 
representative, so that readers will find in it reflections of their own 
experiences. Various social incidents are described, some in which social 
distancing is involved. The altering states of the author's mind as time passes 
are carefully described in sequence, and the impact of continued anxiety and 
isolation on his mental well-being is presented as a form of madness, in one 
dramatic incident.

DOI: 10.1007/s11673-020-10066-z
PMCID: PMC7651832
PMID: 33169268 [Indexed for MEDLINE]


4066. Radiography (Lond). 2021 May;27(2):443-452. doi: 10.1016/j.radi.2020.10.013. 
Epub 2020 Oct 27.

Impact of the COVID-19 pandemic on clinical radiography practice in low resource 
settings: The Ghanaian radiographers' perspective.

Akudjedu TN(1), Botwe BO(2), Wuni AR(3), Mishio NA(4).

Author information:
(1)Institute of Medical Imaging & Visualisation, Department of Medical Science & 
Public Health, Faculty of Health & Social Sciences, Bournemouth University, UK. 
Electronic address: takudjedu@bournemouth.ac.uk.
(2)Department of Radiography, School of Biomedical and Allied Health Sciences, 
College of Health Sciences, University of Ghana, Box KB143, Korle Bu, Accra, 
Ghana.
(3)School of Healthcare Sciences, Cardiff University, UK.
(4)Department of Psychology, University of Ghana, Legon, Accra, Ghana.

INTRODUCTION: The COVID-19 pandemic has altered the professional practice of all 
healthcare workers, including radiographers. In the pandemic, clinical practice 
of radiographers was centred mostly on chest imaging of COVID-19 patients and 
radiotherapy treatment care delivery to those with cancer. This study aimed to 
assess the radiographers' perspective on the impact of the pandemic on their 
wellbeing and imaging service delivery in Ghana.
METHODS: A cross-sectional survey of practising radiographers in Ghana was 
conducted online from March 26th to May 6th, 2020. A previously validated 
questionnaire that sought information regarding demographics, general 
perspectives on personal and professional impact of the pandemic was used as the 
research instrument. Data obtained was analysed using Microsoft Excel® 2016.
RESULTS: A response rate of 57.3% (134/234) was obtained. Of the respondents, 
75.4% (n = 101) reported to have started experiencing high levels of 
workplace-related stress after the outbreak. Three-quarters (n = 98, 73.1%) of 
respondents reported limited access to any form of psychosocial support systems 
at work during the study period. Half (n = 67, 50%) of the respondents reported 
a decline in general workload during the study period while only a minority 
(n = 18, 13.4%) reported an increase in workload due to COVID-19 cases.
CONCLUSION: This national survey indicated that majority of the workforce 
started experiencing coronavirus-specific workplace-related stress after the 
outbreak. Albeit speculative, low patient confidence and fear of contracting the 
COVID-19 infection on hospital attendance contributed to the decline in general 
workload during the study period.
IMPLICATIONS FOR PRACTICE: In order to mitigate the burden of workplace-related 
stress on frontline workers, including radiographers, and in keeping to standard 
practices for staff mental wellbeing and patient safety, institutional support 
structures are necessary in similar future pandemics.

Copyright © 2020 The College of Radiographers. All rights reserved.

DOI: 10.1016/j.radi.2020.10.013
PMCID: PMC7590818
PMID: 33168371 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest statement All the authors 
declare no financial relationships with any organisations that might have an 
interest in the submitted work; no other relationships or activities that could 
appear to have influenced the submitted work.


4067. BMC Med. 2020 Nov 10;18(1):355. doi: 10.1186/s12916-020-01822-4.

Comparison of two different frailty measurements and risk of hospitalisation or 
death from COVID-19: findings from UK Biobank.

Petermann-Rocha F(1)(2), Hanlon P(1), Gray SR(2), Welsh P(2), Gill JMR(1), 
Foster H(1), Katikireddi SV(1), Lyall D(1), Mackay DF(1), O'Donnell CA(1), 
Sattar N(2), Nicholl BI(1), Pell JP(1), Jani BD(1), Ho FK(1), Mair FS(1), 
Celis-Morales C(3)(4)(5)(6).

Author information:
(1)Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
(2)British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of 
Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life 
Sciences, University of Glasgow, Glasgow, G12 8TA, UK.
(3)Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK. 
Carlos.Celis@glasgow.ac.uk.
(4)British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of 
Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life 
Sciences, University of Glasgow, Glasgow, G12 8TA, UK. 
Carlos.Celis@glasgow.ac.uk.
(5)Centre of Exercise Physiology Research (CIFE), Universidad Mayor, Santiago, 
Chile. Carlos.Celis@glasgow.ac.uk.
(6)Laboratorio de Rendimiento Humano, Grupo de Estudio en Educación, Actividad 
Física y Salud (GEEAFyS), Universidad Católica del Maule, Talca, Chile. 
Carlos.Celis@glasgow.ac.uk.

BACKGROUND: Frailty has been associated with worse prognosis following COVID-19 
infection. While several studies have reported the association between frailty 
and COVID-19 mortality or length of hospital stay, there have been no 
community-based studies on the association between frailty and risk of severe 
infection. Considering that different definitions have been identified to assess 
frailty, this study aimed to compare the association between frailty and severe 
COVID-19 infection in UK Biobank using two frailty classifications: the frailty 
phenotype and the frailty index.
METHODS: A total of 383,845 UK Biobank participants recruited 2006-2010 in 
England (211,310 [55.1%] women, baseline age 37-73 years) were included. 
COVID-19 test data were provided by Public Health England (available up to 28 
June 2020). An adapted version of the frailty phenotype derived by Fried et al. 
was used to define frailty phenotype (robust, pre-frail, or frail). A previously 
validated frailty index was derived from 49 self-reported questionnaire items 
related to health, disease and disability, and mental wellbeing (robust, mild 
frailty, and moderate/severe frailty). Both classifications were derived from 
baseline data (2006-2010). Poisson regression models with robust standard errors 
were used to analyse the associations between both frailty classifications and 
severe COVID-19 infection (resulting in hospital admission or death), adjusted 
for sociodemographic and lifestyle factors.
RESULTS: Of UK Biobank participants included, 802 were admitted to hospital with 
and/or died from COVID19 (323 deaths and 479 hospitalisations). After analyses 
were adjusted for sociodemographic and lifestyle factors, a higher risk of 
COVID-19 was observed for pre-frail (risk ratio (RR) 1.47 [95% CI 1.26; 1.71]) 
and frail (RR 2.66 [95% CI 2.04; 3.47]) individuals compared to those classified 
as robust using the frailty phenotype. Similar results were observed when the 
frailty index was used (RR mildly frail 1.46 [95% CI 1.26; 1.71] and RR 
moderate/severe frailty 2.43 [95% CI 1.91; 3.10]).
CONCLUSIONS: Frailty was associated with a higher risk of severe COVID-19 
infection resulting in hospital admission or death, irrespective of how it was 
measured and independent of sociodemographic and lifestyle factors. Public 
health strategies need to consider the additional risk that COVID-19 poses in 
individuals with frailty, including which additional preventive measures might 
be required.

DOI: 10.1186/s12916-020-01822-4
PMCID: PMC7652674
PMID: 33167965 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


4068. Clin Rehabil. 2021 Apr;35(4):471-480. doi: 10.1177/0269215520971145. Epub 2020 
Nov 9.

The future of rehabilitation in the United Kingdom National Health Service: 
Using the COVID-19 crisis to promote change, increasing efficiency and 
effectiveness.

Wade DT(1).

Author information:
(1)Professor of Neurological Rehabilitation, OxINMAHR, and Movement Science 
Group, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, 
UK.

THE PROBLEM: Rehabilitation services in the UK are inadequate, with insufficient 
capacity or flexibility to meet the needs of patients after Covid-19.
HISTORY: Rehabilitation developed in a piecemeal way, focused on specific 
problems: spinal cord injury, burns, polio, stroke, back pain, equipment and 
adaptations etc. Rehabilitation is also provided using other names (e.g. 
intermediate care). Patients with complex needs do not fit easily within this 
system.
SYSTEM FAILURE: After Covid-19, patients have problems that cross existing 
condition-specific and/or treatment-specific services. Covid-19 has exposed the 
lack of any coherent organisational principle underlying development or 
commissioning of rehabilitation services. Consequently, in order to have their 
needs met, patients either have to engage with two or more separate services or 
they receive good management for some problems and sub-optimal management for 
other problems.
THE GOALS: The multitude of small specific services need to coalesce into an 
integrated service able to meet all the needs of any patient referred. Second, 
rehabilitation needs to be fully integrated into all healthcare services.
A SOLUTION: The purpose of healthcare is to 'improve our health and well-being 
. . . to stay as well as we can to the end of our lives'. (NHS constitution) All 
healthcare services need to consider patients holistically, giving equal 
attention to disease, disability, and distress. Rehabilitation, acute care, 
mental health and palliative care services need to work in parallel to achieve 
this purpose. Healthcare providers, supported by commissioners and 
rehabilitation experts, could achieve structural and organisational change, 
meeting the needs of patients.

DOI: 10.1177/0269215520971145
PMID: 33167682 [Indexed for MEDLINE]


4069. Eur J Phys Rehabil Med. 2021 Feb;57(1):158-165. doi: 
10.23736/S1973-9087.20.06535-1. Epub 2020 Nov 9.

Psycho-social impact of social distancing and isolation due to the COVID-19 
containment measures on patients with physical disabilities.

Dalise S(1), Tramonti F(2), Armienti E(3)(4), Niccolini V(3), Caniglia-Tenaglia 
M(3), Morganti R(5), Chisari C(3).

Author information:
(1)Unit of Neurorehabilitation, Department of Medical Specialties, University 
Hospital of Pisa, Pisa, Italy - stefania.dalise@ao-pisa.toscana.it.
(2)Unit of Relational Psychotherapy of Pisa, ASL Toscana Nord-Ovest, Pisa, 
Italy.
(3)Unit of Neurorehabilitation, Department of Medical Specialties, University 
Hospital of Pisa, Pisa, Italy.
(4)Unit of Physical Medicine and Rehabilitation, Sant'Andrea Hospital, Sapienza 
University, Rome, Italy.
(5)Section of Statistics, University Hospital of Pisa, Pisa, Italy.

BACKGROUND: While the COVID-19 pandemic was spreading worldwide, the Italian 
government stated lockdown, with a drastic reorganization of healthcare systems. 
The psychological and social effects of the pandemic and the restrictions of 
freedom could have had a detrimental impact on people with physical 
disabilities, for whom well-being depends strongly on their social environment.
AIM: Our main aim was to describe the overall impact of the pandemic on mental 
health, social condition and illness perception among patients with 
disabilities, to provide early interventions for this particularly vulnerable 
population. For this purpose, we performed a specific screening protocol to 
detect the prevalence of any psychological distress.
DESIGN: Cross-sectional observational study.
SETTING: Telephonic interview administered to patients and their caregivers 
attending the Unit of Neurorehabilitation at the University Hospital of Pisa.
POPULATION: 134 patients with physical disability related to neurological 
disorders, who had their outpatient appointment cancelled, because of the 
government dispositions, were enrolled.
METHODS: A specific questionnaire (COVID19-q) was designed to test patients' 
psycho-social state, including a section addressed to the caregiver. Moreover, a 
standardized psychological evaluation, using the Clinical Outcomes in Routine 
Evaluation-Outcome Measure (CORE-OM), was also performed.
RESULTS: Results show a different impact in our study population compared to the 
general population on psychological aspect. Patients did not manifest any 
clinically relevant distress, as assessed with CORE-OM. However, patients with 
higher disability degree reported a statistically lower outcome in the social 
function, in the well-being domains and an increase in risk behavior. Results 
from COVID19-q show that most of our patients reported none or mild change in 
their psycho-social habits and perception of illness during lockdown. However, 
reduction of family cohesion and lack of healthcare support are two important 
aspects that people with disability had to face with during the pandemic 
emergency.
CONCLUSIONS: People with physical disabilities surprisingly shown milder effects 
of the pandemic on their psychological state and good coping skills in facing 
social isolation, manifesting resilience resources. However, the is a need to 
give concrete support to healthcare and social care, especially in the 
management of severe disability.
CLINICAL REHABILITATION IMPACT: This unexpected and reassuring result may reveal 
a worrying scenario regarding-the social participation and quality of life of 
people with disabilities: were they already in lockdown?

DOI: 10.23736/S1973-9087.20.06535-1
PMID: 33165314 [Indexed for MEDLINE]


4070. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2020 Sep;28(5):922-927. doi: 
10.32687/0869-866X-2020-28-5-922-927.

[THE COVID-19 PANDEMIC: DEPRESSION, ANXIETY, STIGMA AND IMPACT ON MENTAL 
HEALTH].

[Article in Russian]

Lipai TP(1).

Author information:
(1)Minsk City Institute for the Development of Education, 220034, Minsk, 
Republic of Belarus, lipai@tut.by.

World Health Organization (WHO) declared the COVID-19 «outbreak a public health 
emergency of international concern», characterized it as a pandemic in order to 
emphasize the gravity of the situation and urged to take actions in detecting 
the infection and preventing its spread. The article considers the issues 
related to the occurrence of fear, depression, and stigmatization, analyses the 
causes of these phenomena, and identifies practical solutions for addressing 
mental health issues related by the precipitate coronavirus (COVID-19 Pandemic). 
During the quarantine, taking care of your mental health is essential more than 
ever, as one needs to remain calm, not stressed, and promote a positive 
well-being. Fear and self-stigmatization in both long-term and brief periods of 
isolation and loneliness can have negative consequences on both physical and 
mental well-being. Stigma can also create mental distress following the 
quarantine. Social and emotional support should be given to family members by 
mental health professionals. In addition, the author concludes that in order to 
maintain the mental health, it is necessary to examine the unique contribution 
of the salience of positive aspect stigma. A number of concrete scientific and 
organizational approaches to improve the actual situation were proposed.

DOI: 10.32687/0869-866X-2020-28-5-922-927
PMID: 33161662 [Indexed for MEDLINE]


4071. BMJ Open. 2020 Nov 5;10(11):e040503. doi: 10.1136/bmjopen-2020-040503.

Perceptions and experiences of healthcare workers during the COVID-19 pandemic 
in the UK.

Vindrola-Padros C(1), Andrews L(2), Dowrick A(3), Djellouli N(4), Fillmore H(5), 
Bautista Gonzalez E(2), Javadi D(6), Lewis-Jackson S(5), Manby L(2), Mitchinson 
L(7), Mulcahy Symmons S(2), Martin S(8), Regenold N(5), Robinson H(9), Sumray 
K(2), Singleton G(10), Syversen A(2), Vanderslott S(8), Johnson G(10).

Author information:
(1)Department of Targeted Intervention, University College London, London, UK 
c.vindrola@ucl.ac.uk.
(2)Institute of Epidemiology and Healthcare, University College London, London, 
UK.
(3)Institute of Population Health Sciences, Queen Mary University of London, 
London, UK.
(4)Institute of Global Health, University College London, London, UK.
(5)Department of Anthropology, University College London, London, UK.
(6)Harvard TH Chan School of Public Health, Department of Social and Behavioral 
Sciences, Harvard University, Cambridge, Massachusetts, USA.
(7)Marie Curie Palliative Care Research Department, Division of Psychiatry, 
University College London, London, United Kingdom.
(8)Oxford Vaccine Group, Centre for Clinical Vaccinology and Tropical Medicine 
(CCVTM), Oxford University, Oxford, Oxfordshire, UK.
(9)School for Policy Studies, Bristol University, Bristol, United Kingdom.
(10)Department of Targeted Intervention, University College London, London, UK.

OBJECTIVE: The COVID-19 pandemic has set unprecedented demand on the healthcare 
workforce around the world. The UK has been one of the most affected countries 
in Europe. The aim of this study was to explore the perceptions and experiences 
of healthcare workers (HCWs) in relation to COVID-19 and care delivery models 
implemented to deal with the pandemic in the UK.
METHODS: The study was designed as a rapid appraisal combining: (1) a review of 
UK healthcare policies (n=35 policies), (2) mass media and social media analysis 
of front-line staff experiences and perceptions (n=101 newspaper articles, n=1 
46 000 posts) and (3) in-depth (telephone) interviews with front-line staff 
(n=30 interviews). The findings from all streams were analysed using framework 
analysis.
RESULTS: Limited personal protective equipment (PPE) and lack of routine testing 
created anxiety and distress and had a tangible impact on the workforce. When 
PPE was available, incorrect size and overheating complicated routine work. Lack 
of training for redeployed staff and the failure to consider the skills of 
redeployed staff for new areas were identified as problems. Positive aspects of 
daily work reported by HCWs included solidarity between colleagues, the 
establishment of well-being support structures and feeling valued by society.
CONCLUSION: Our study highlighted the importance of taking into consideration 
the experiences and concerns of front-line staff during a pandemic. Staff 
working in the UK during the COVID-19 pandemic advocated clear and consistent 
guidelines, streamlined testing of HCWs, administration of PPE and 
acknowledgement of the effects of PPE on routine practice.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2020-040503
PMCID: PMC7646318
PMID: 33154060 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


4072. Int J Environ Res Public Health. 2020 Nov 3;17(21):8102. doi: 
10.3390/ijerph17218102.

Feeling Anxious amid the COVID-19 Pandemic: Psychosocial Correlates of Anxiety 
Symptoms among Filipina Domestic Helpers in Hong Kong.

C Y Yeung N(1), Huang B(1), Lau CYK(1), Lau JTF(1).

Author information:
(1)The Jockey Club School of Public Health and Primary Care, The Chinese 
University of Hong Kong, Hong Kong, China.

The COVID-19 pandemic negatively impacts psychological well-being (e.g., anxiety 
symptoms) among the general population of Hong Kong and migrant Filipina 
domestic helpers (FDHs). Having to live with the employers by law, FDHs' working 
environment might affect their well-being during COVID-19 (e.g., household 
crowdedness/size, insufficiency of protective equipment against COVID-19, 
increased workload). Research has suggested that coping resources (e.g., social 
support, COVID-19-related information literacy) and COVID-19-specific worries 
are associated with people's well-being during COVID-19. This study examined the 
psychosocial correlates of probable anxiety among FDHs in Hong Kong amid the 
COVID-19 pandemic. By purposive sampling, FDHs (n = 295) were recruited and 
invited to complete a cross-sectional survey. Participants' working environment 
(crowdedness, household size), COVID-19 job arrangements (workload, provision of 
protective equipment), coping resources (social support, COVID-19 information 
literacy), COVID-19-specific worries (contracting COVID-19, getting fired if 
contracting COVID-19), and anxiety symptoms were measured. Multivariate 
regression results showed that the insufficiency of protective equipment (OR = 
1.58, 95%CI: 1.18, 2.11), increased workload (OR = 1.51, 95%CI: 1.02, 2.25), and 
worries about being fired if getting COVID-19 (OR = 1.32, 95%CI: 1.04, 1.68) 
were significantly associated with probable anxiety. This was one of the 
earliest studies to indicate that job arrangements and COVID-19-specific worries 
significantly contributed to FDHs' anxiety symptoms. Our findings shed light on 
the importance of addressing employment-related rights and pandemic-specific 
worries through interventions among FDHs in Hong Kong during pandemic 
situations.

DOI: 10.3390/ijerph17218102
PMCID: PMC7662612
PMID: 33153082 [Indexed for MEDLINE]

Conflict of interest statement: All authors have no competing interests to 
declare.


4073. Psychother Psychosom. 2021;90(2):127-136. doi: 10.1159/000511823. Epub 2020 Nov 
5.

Post-COVID-19 Epidemic: Allostatic Load among Medical and Nonmedical Workers in 
China.

Peng M(1), Wang L(1), Xue Q(1), Yin L(2), Zhu BH(3), Wang K(1)(4), Shangguan 
FF(5), Zhang PR(6), Niu YY(7), Zhang WR(1), Zhao WF(1), Wang H(1), Lv J(1), Song 
HQ(1), Min BQ(1), Leng HX(1), Jia Y(1), Chang H(1), Yu ZP(1), Tian Q(8), Yang 
Y(9), Zhu Z(9), Li W(10), Gao XL(11), Liu XL(12), Yang M(13), Wang P(14), Wei 
PH(15), Wang CX(16), Li JN(17), Jia LB(17), Huang XM(18), Li DN(18), Xu DJ(19), 
Deng YL(20), Si TM(21), Dong HQ(1), Wang YP(1), Cosci F(22), Wang 
HX(23)(24)(25)(26)(27).

Author information:
(1)Division of Neuropsychiatry and Psychosomatics, Department of Neurology, 
Xuanwu Hospital, Capital Medical University, Beijing, China.
(2)Medical Research and Biometrics Center, Fuwai Hospital, National Center for 
Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of 
Medical Sciences, Beijing, China.
(3)Department of Psychology, University of Bologna, Bologna, Italy.
(4)Department of Neurology, Beijing Puren Hospital, Beijing, China.
(5)School of Psychology, Capital Normal University, Beijing, China.
(6)Department of Public Economics, School of Economics, Fudan University, 
Shanghai, China.
(7)Department of Orthopedics, Jincheng People's Hospital, Shanxi Medical 
University, Jincheng, China.
(8)Beijing Institute of Brain Disorders, Capital Medical University, Beijing, 
China.
(9)Department of Psychiatry, Tongji Hospital, Tongji Medical College, Huazhong 
University of Science and Technology, Wuhan, China.
(10)Department of Neurology, The Third People's Hospital of Chengdu, Chengdu, 
China.
(11)Department of Respiratory and Critical Care Medicine, The Second Hospital of 
Shanxi Medical University, Taiyuan, China.
(12)Department of Neurology, The First Affiliated Hospital of Kunming Medical 
University, Kunming, China.
(13)Department of Psychology, Ningxia Fifth People's Hospital, Ningxia Medical 
University, Shizuishan, China.
(14)Department of Neurology, The Second Hospital, Cheeloo College of Medicine, 
Shandong University, Jinan, China.
(15)Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 
Beijing, China.
(16)Department of Neuropsychiatry and Behavioral Neurology and Clinical 
Psychology Center, Beijing Tiantan Hospital, Capital Medical University, 
Beijing, China.
(17)Department of Neurology, Jincheng People's Hospital, Shanxi Medical 
University, Jincheng, China.
(18)Department of Neurology, Ningcheng Center Hospital, Ningcheng, China.
(19)Department of Neurology, Dongyang People's Hospital, Wenzhou Medical 
University, Dongyang, China.
(20)Psychosomatic Health Institute, The Third Xiangya Hospital, Central South 
University, Changsha, China.
(21)Peking University Sixth Hospital, National Clinical Research Center for 
Mental Health Disorders and Key Laboratory of Mental Health, Ministry of Health, 
Peking University, Beijing, China.
(22)Department of Health Sciences, University of Florence, Florence, Italy.
(23)Division of Neuropsychiatry and Psychosomatics, Department of Neurology, 
Xuanwu Hospital, Capital Medical University, Beijing, China, 
wanghongxing@xwh.ccmu.edu.cn.
(24)Department of Neurology, Jincheng People's Hospital, Shanxi Medical 
University, Jincheng, China, wanghongxing@xwh.ccmu.edu.cn.
(25)Department of Neurology, Ningcheng Center Hospital, Ningcheng, China, 
wanghongxing@xwh.ccmu.edu.cn.
(26)Department of Neurology, Dongyang People's Hospital, Wenzhou Medical 
University, Dongyang, China, wanghongxing@xwh.ccmu.edu.cn.
(27)Beijing Psychosomatic Disease Consultation Center, Xuanwu Hospital, Capital 
Medical University, Beijing, China, wanghongxing@xwh.ccmu.edu.cn.

BACKGROUND: As the fight against the COVID-19 epidemic continues, medical 
workers may have allostatic load.
OBJECTIVE: During the reopening of society, medical and nonmedical workers were 
compared in terms of allostatic load.
METHODS: An online study was performed; 3,590 Chinese subjects were analyzed. 
Socio-demographic variables, allostatic load, stress, abnormal illness behavior, 
global well-being, mental status, and social support were assessed.
RESULTS: There was no difference in allostatic load in medical workers compared 
to nonmedical workers (15.8 vs. 17.8%; p = 0.22). Multivariate conditional 
logistic regression revealed that anxiety (OR = 1.24; 95% CI 1.18-1.31; p < 
0.01), depression (OR = 1.23; 95% CI 1.17-1.29; p < 0.01), somatization (OR = 
1.20; 95% CI 1.14-1.25; p < 0.01), hostility (OR = 1.24; 95% CI 1.18-1.30; p < 
0.01), and abnormal illness behavior (OR = 1.49; 95% CI 1.34-1.66; p < 0.01) 
were positively associated with allostatic load, while objective support (OR = 
0.84; 95% CI 0.78-0.89; p < 0.01), subjective support (OR = 0.84; 95% CI 
0.80-0.88; p < 0.01), utilization of support (OR = 0.80; 95% CI 0.72-0.88; p < 
0.01), social support (OR = 0.90; 95% CI 0.87-0.93; p < 0.01), and global 
well-being (OR = 0.30; 95% CI 0.22-0.41; p < 0.01) were negatively associated.
CONCLUSIONS: In the post-COVID-19 epidemic time, medical and nonmedical workers 
had similar allostatic load. Psychological distress and abnormal illness 
behavior were risk factors for it, while social support could relieve it.

© 2020 The Author(s) Published by S. Karger AG, Basel.

DOI: 10.1159/000511823
PMCID: PMC7705943
PMID: 33152729 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have had no 
financial relationship with any organization that might have an interest in the 
submitted study in the last 3 years.


4074. PLoS One. 2020 Nov 5;15(11):e0240204. doi: 10.1371/journal.pone.0240204. 
eCollection 2020.

Psychological consequences of COVID-19 home confinement: The ECLB-COVID19 
multicenter study.

Ammar A(1)(2), Mueller P(3)(4), Trabelsi K(5)(6), Chtourou H(5)(7), Boukhris 
O(5)(7), Masmoudi L(5), Bouaziz B(8), Brach M(9), Schmicker M(3), Bentlage E(9), 
How D(9), Ahmed M(9), Aloui A(7)(10), Hammouda O(5)(11), Paineiras-Domingos 
LL(12)(13), Braakman-Jansen A(14), Wrede C(14), Bastoni S(14)(15), Pernambuco 
CS(16), Mataruna-Dos-Santos LJ(17), Taheri M(18), Irandoust K(18), Khacharem 
A(19), Bragazzi NL(20)(21), Adrian Washif J(22), Glenn JM(23), Bott NT(24), 
Gargouri F(8), Chaari L(25), Batatia H(25), Khoshnami SC(26), Samara E(27), Zisi 
V(28), Sankar P(29), Ahmed WN(30), Ali GM(31), Abdelkarim O(31)(32), Jarraya 
M(5), El Abed K(5), Romdhani M(7), Souissi N(7), Van Gemert-Pijnen L(14), Bailey 
SJ(33), Moalla W(5), Gómez-Raja J(34), Epstein M(35), Sanderman R(36), Schulz 
S(37), Jerg A(37), Al-Horani R(38), Mansi T(39), Jmail M(40), Barbosa F(41), 
Ferreira-Santos F(41), Šimunič B(42), Pišot R(42), Gaggioli A(43)(44), Zmijewski 
P(45), Steinacker JM(37), Strahler J(46), Riemann L(47), Riemann BL(48), Mueller 
N(3)(4), Chamari K(49)(50), Driss T(2), Hoekelmann A(1); ECLB-COVID19 
Consortium.

Author information:
(1)Institute of Sport Science, Otto-von-Guericke University, Magdeburg, Germany.
(2)Interdisciplinary Laboratory in Neurosciences, Physiology and Psychology: 
Physical Activity, Health and Learning, UFR STAPS, UPL, Paris Nanterre 
University, Nanterre, France.
(3)Research Group Neuroprotection, German Center for Neurodegenerative Diseases 
(DZNE), Magdeburg, Germany.
(4)Medical Faculty, Department of Neurology, Otto-von-Guericke University, 
Magdeburg, Germany.
(5)High Institute of Sport and Physical Education of Sfax, University of Sfax, 
Sfax, Tunisia.
(6)Research Laboratory: Education, Motricity, Sport and Health, EM2S, LR19JS01, 
University of Sfax, Sfax, Tunisia.
(7)Physical Activity, Sport, and Health, UR18JS01, National Observatory of 
Sport, Tunis, Tunisia.
(8)Higher Institute of Computer Science and Multimedia of Sfax, University of 
Sfax, Sfax, Tunisia.
(9)Institute of Sport and Exercise Sciences, University of Münster, Münster, 
Germany.
(10)High Institute of Sport and Physical Education, University of Gafsa, Gafsa, 
Tunisia.
(11)Research Laboratory, Molecular Bases of Human Pathology, LR12ES17, Faculty 
of Medicine, University of Sfax, Sfax, Tunisia.
(12)Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
(13)Faculdade Bezerra de Araújo, Rio de Janeiro, Brazil.
(14)Department of Psychology, Health & Technology, University of Twente, 
Enschede, The Netherlands.
(15)Department of Psychology, Università Cattolica del Sacro Cuore, Milano, 
Italy.
(16)Laboratório de Fisiologia do Exercício, Estácio de Sá University, Rio de 
Janeiro, Brasil.
(17)Faculty of Management, Sport Management Department, Canadian University of 
Dubai, Dubai, United Arab Emirates.
(18)Faculty of Social Science, Imam Khomeini International University, Qazvin, 
Iran.
(19)UVHC, DeVisu, Valenciennes; LIRTES-EA 7313. Université Paris Est Créteil Val 
de Marne, Créteil, France.
(20)Department of Health Sciences, Postgraduate School of Public Health, 
University of Genoa, Genoa, Italy.
(21)Department of Mathematics and Statistics, Laboratory for Industrial and 
Applied Mathematics, York University, Toronto, ON, Canada.
(22)Sports Performance Division, National Sports Institute of Malaysia, Kuala 
Lumpur, Malaysia.
(23)Exercise Science Research Center, Department of Health, Human Performance 
and Recreation, University of Arkansas, Fayetteville, Arkansas, United States of 
America.
(24)Clinical Excellence Research Center, Department of Medicine, Stanford 
University School of Medicine, Stanford, California, United States of America.
(25)Computer Science Department, University of Toulouse, IRIT-INP-ENSEEIHT, 
Toulouse, France.
(26)UFR STAPS, UPL, Paris Nanterre University, Nanterre, France.
(27)Onassis Cardiac Surgery Center, Athens, Greece.
(28)Department of Physical Education and Sports Sciences, University of 
Thessaly, Volos, Greece.
(29)Consultant in Internal Medicine and Diabetes, MGM Muthoot Hospitals 
Pathanamthitta, Pathanamthitta, Kerala, India.
(30)Consultant Family Physician, CRAFT Hospital and Research Centre, 
Kodungallur, Kerala, India.
(31)Faculty of Physical Education, Assiut University, Assiut, Egypt.
(32)Institute for Sports and Sports Science, Karlsruher Institut für 
Technologie, Karlsruher, Germany.
(33)School of Sport, Exercise and Health Sciences, Loughborough University, 
Loughborough, United Kingdom.
(34)FundeSalud, Dept. of Health and Social Services, Government of Extremadura, 
Merida, Spain.
(35)The E-Senior Association, Paris, France.
(36)Department of Health Psychology, University Medical Center Groningen, 
University of Groningen, Groningen, The Netherlands.
(37)Sports- and Rehabilitation Medicine, Ulm University Hospital, Ulm, Germany.
(38)Department of Exercise Science, Yarmouk University, Irbid, Jordan.
(39)Faculty of Physical Education, The University of Jordan, Amman, Jordan.
(40)Digital Research Centre of Sfax, Sfax, Tunisia.
(41)Laboratory of Neuropsychophysiology, Faculty of Psychology and Education 
Sciences, University of Porto, Porto, Portugal.
(42)Institute for Kinesiology Research, Science and Research Centre Koper, 
Koper, Slovenia.
(43)Department of Psychology, Università Cattolica del Sacro Cuore, Milan, 
Italy.
(44)I.R.C.C.S. Istituto Auxologico Italiano, Milan, Italy.
(45)Jozef Pilsudski University of Physical Education in Warsaw, Warsaw, Poland.
(46)Department of Psychology and Sport Science, University of Gießen, Gießen, 
Germany.
(47)PharmD, BCBS; PharmIAD, Inc, Savannah, GA, United States of America.
(48)Department of Health Sciences and Kinesiology, Georgia Southern University, 
Statesboro, GA, United States of America.
(49)ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
(50)Laboratory ''Sport Performance Optimization'', ISSEP Ksar-Said, Manouba 
University, Manouba, Tunisia.

BACKGROUND: Public health recommendations and government measures during the 
COVID-19 pandemic have enforced restrictions on daily-living. While these 
measures are imperative to abate the spreading of COVID-19, the impact of these 
restrictions on mental health and emotional wellbeing is undefined. Therefore, 
an international online survey (ECLB-COVID19) was launched on April 6, 2020 in 
seven languages to elucidate the impact of COVID-19 restrictions on mental 
health and emotional wellbeing.
METHODS: The ECLB-COVID19 electronic survey was designed by a steering group of 
multidisciplinary scientists, following a structured review of the literature. 
The survey was uploaded and shared on the Google online-survey-platform and was 
promoted by thirty-five research organizations from Europe, North-Africa, 
Western-Asia and the Americas. All participants were asked for their mental 
wellbeing (SWEMWS) and depressive symptoms (SMFQ) with regard to "during" and 
"before" home confinement.
RESULTS: Analysis was conducted on the first 1047 replies (54% women) from Asia 
(36%), Africa (40%), Europe (21%) and other (3%). The COVID-19 home confinement 
had a negative effect on both mental-wellbeing and on mood and feelings. 
Specifically, a significant decrease (p < .001 and Δ% = 9.4%) in total score of 
the SWEMWS questionnaire was noted. More individuals (+12.89%) reported a low 
mental wellbeing "during" compared to "before" home confinement. Furthermore, 
results from the mood and feelings questionnaire showed a significant increase 
by 44.9% (p < .001) in SMFQ total score with more people (+10%) showing 
depressive symptoms "during" compared to "before" home confinement.
CONCLUSION: The ECLB-COVID19 survey revealed an increased psychosocial strain 
triggered by the home confinement. To mitigate this high risk of mental 
disorders and to foster an Active and Healthy Confinement Lifestyle (AHCL), a 
crisis-oriented interdisciplinary intervention is urgently needed.

DOI: 10.1371/journal.pone.0240204
PMCID: PMC7643949
PMID: 33152030 [Indexed for MEDLINE]

Conflict of interest statement: All authors have completed the Unified Competing 
Interest form (available on request from the corresponding author). Authors 
except Laura Riemann declare: no support from any organisation for the submitted 
work; no financial relationships with any organisations that might have an 
interest in the submitted work in the previous three years, no other 
relationships or activities that could appear to have influenced the submitted 
work. Laura Riemann declare to have a commercial affiliation “PharmIAD, Inc, 
Savannah, GA, USA”. This funder provided support in the form of salaries for 
Laurel Riemann, but did not have any additional role in the study design, data 
collection and analysis, decision to publish, or preparation of the manuscript. 
The specific roles of this author are articulated in the ‘author contributions’ 
section. This commercial affiliation does not alter our adherence to PLOS ONE 
policies on sharing data and materials.


4075. Cochrane Database Syst Rev. 2020 Nov 5;11(11):CD013779. doi: 
10.1002/14651858.CD013779.

Interventions to support the resilience and mental health of frontline health 
and social care professionals during and after a disease outbreak, epidemic or 
pandemic: a mixed methods systematic review.

Pollock A(1), Campbell P(1), Cheyne J(2), Cowie J(1), Davis B(1), McCallum J(3), 
McGill K(1), Elders A(1), Hagen S(1), McClurg D(1), Torrens C(4), Maxwell M(4).

Author information:
(1)Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow 
Caledonian University, Glasgow, UK.
(2)Centre for Clinical Brain Sciences (CCBS), University of Edinburgh, 
Edinburgh, UK.
(3)Department of Nursing and Community Health, Glasgow Caledonian University, 
Glasgow, UK.
(4)Nursing, Midwifery and Allied Health Professions Research Unit, University of 
Stirling, Glasgow, UK.

Comment in
    Evid Based Nurs. 2022 Jul;25(3):104.

BACKGROUND: Evidence from disease epidemics shows that healthcare workers are at 
risk of developing short- and long-term mental health problems. The World Health 
Organization (WHO) has warned about the potential negative impact of the 
COVID-19 crisis on the mental well-being of health and social care 
professionals. Symptoms of mental health problems commonly include depression, 
anxiety, stress, and additional cognitive and social problems; these can impact 
on function in the workplace. The mental health and resilience (ability to cope 
with the negative effects of stress) of frontline health and social care 
professionals ('frontline workers' in this review) could be supported during 
disease epidemics by workplace interventions, interventions to support basic 
daily needs, psychological support interventions, pharmacological interventions, 
or a combination of any or all of these.
OBJECTIVES: Objective 1: to assess the effects of interventions aimed at 
supporting the resilience and mental health of frontline health and social care 
professionals during and after a disease outbreak, epidemic or pandemic. 
Objective 2: to identify barriers and facilitators that may impact on the 
implementation of interventions aimed at supporting the resilience and mental 
health of frontline health and social care professionals during and after a 
disease outbreak, epidemic or pandemic.
SEARCH METHODS: On 28 May 2020 we searched the Cochrane Database of Systematic 
Reviews, CENTRAL, MEDLINE, Embase, Web of Science, PsycINFO, CINAHL, Global 
Index Medicus databases and WHO Institutional Repository for Information 
Sharing. We also searched ongoing trials registers and Google Scholar. We ran 
all searches from the year 2002 onwards, with no language restrictions.
SELECTION CRITERIA: We included studies in which participants were health and 
social care professionals working at the front line during infectious disease 
outbreaks, categorised as epidemics or pandemics by WHO, from 2002 onwards. For 
objective 1 we included quantitative evidence from randomised trials, 
non-randomised trials, controlled before-after studies and interrupted time 
series studies, which investigated the effect of any intervention to support 
mental health or resilience, compared to no intervention, standard care, placebo 
or attention control intervention, or other active interventions. For objective 
2 we included qualitative evidence from studies that described barriers and 
facilitators to the implementation of interventions. Outcomes critical to this 
review were general mental health and resilience. Additional outcomes included 
psychological symptoms of anxiety, depression or stress; burnout; other mental 
health disorders; workplace staffing; and adverse events arising from 
interventions.
DATA COLLECTION AND ANALYSIS: Pairs of review authors independently applied 
selection criteria to abstracts and full papers, with disagreements resolved 
through discussion. One review author systematically extracted data, 
cross-checked by a second review author. For objective 1, we assessed risk of 
bias of studies of effectiveness using the Cochrane 'Risk of bias' tool. For 
objective 2, we assessed methodological limitations using either the CASP 
(Critical Appraisal Skills Programme) qualitative study tool, for qualitative 
studies, or WEIRD (Ways of Evaluating Important and Relevant Data) tool, for 
descriptive studies. We planned meta-analyses of pairwise comparisons for 
outcomes if direct evidence were available. Two review authors extracted 
evidence relating to barriers and facilitators to implementation, organised 
these around the domains of the Consolidated Framework of Implementation 
Research, and used the GRADE-CERQual approach to assess confidence in each 
finding. We planned to produce an overarching synthesis, bringing quantitative 
and qualitative findings together.
MAIN RESULTS: We included 16 studies that reported implementation of an 
intervention aimed at supporting the resilience or mental health of frontline 
workers during disease outbreaks (severe acute respiratory syndrome (SARS): 2; 
Ebola: 9; Middle East respiratory syndrome (MERS): 1; COVID-19: 4). 
Interventions studied included workplace interventions, such as training, 
structure and communication (6 studies); psychological support interventions, 
such as counselling and psychology services (8 studies); and multifaceted 
interventions (2 studies). Objective 1: a mixed-methods study that incorporated 
a cluster-randomised trial, investigating the effect of a work-based 
intervention, provided very low-certainty evidence about the effect of training 
frontline healthcare workers to deliver psychological first aid on a measure of 
burnout. Objective 2: we included all 16 studies in our qualitative evidence 
synthesis; we classified seven as qualitative and nine as descriptive studies. 
We identified 17 key findings from multiple barriers and facilitators reported 
in studies. We did not have high confidence in any of the findings; we had 
moderate confidence in six findings and low to very low confidence in 11 
findings. We are moderately confident that the following two factors were 
barriers to intervention implementation: frontline workers, or the organisations 
in which they worked, not being fully aware of what they needed to support their 
mental well-being; and a lack of equipment, staff time or skills needed for an 
intervention. We are moderately confident that the following three factors were 
facilitators of intervention implementation: interventions that could be adapted 
for local needs; having effective communication, both formally and socially; and 
having positive, safe and supportive learning environments for frontline 
workers. We are moderately confident that the knowledge or beliefs, or both, 
that people have about an intervention can act as either barriers or 
facilitators to implementation of the intervention.
AUTHORS' CONCLUSIONS: There is a lack of both quantitative and qualitative 
evidence from studies carried out during or after disease epidemics and 
pandemics that can inform the selection of interventions that are beneficial to 
the resilience and mental health of frontline workers. Alternative sources of 
evidence (e.g. from other healthcare crises, and general evidence about 
interventions that support mental well-being) could therefore be used to inform 
decision making. When selecting interventions aimed at supporting frontline 
workers' mental health, organisational, social, personal, and psychological 
factors may all be important. Research to determine the effectiveness of 
interventions is a high priority. The COVID-19 pandemic provides unique 
opportunities for robust evaluation of interventions. Future studies must be 
developed with appropriately rigorous planning, including development, peer 
review and transparent reporting of research protocols, following guidance and 
standards for best practice, and with appropriate length of follow-up. Factors 
that may act as barriers and facilitators to implementation of interventions 
should be considered during the planning of future research and when selecting 
interventions to deliver within local settings.

Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, 
Ltd.

DOI: 10.1002/14651858.CD013779
PMCID: PMC8226433
PMID: 33150970 [Indexed for MEDLINE]

Conflict of interest statement: Alex Pollock: grant holder on funding from the 
Chief Scientist Office, Scottish Government to support this review. Employed 
within a post at the NMAHP Research Unit, which is supported by the Chief 
Scientist Office, Scottish Government. No other known conflict of interest 
Pauline Campbell: grant holder on funding from the Chief Scientist Office, 
Scottish Government to support this review. No other known conflict of interest 
Joshua Cheyne: no known conflict of interest Julie Cowie: grant holder on 
funding from the Chief Scientist Office, Scottish Government to support this 
review. No other known conflict of interest Bridget Davis: employed as paid 
researcher for this grant. No other known conflict of interest. Jacqueline 
McCallum: grant holder on funding from the Chief Scientist Office, Scottish 
Government to support this review. No other known conflict of interest Kris 
McGill: no known conflict of interest Andrew Elders: grant holder on funding 
from the Chief Scientist Office, Scottish Government to support this review. 
Employed within a post at the NMAHP Research Unit, which is supported by the 
Chief Scientist Office, Scottish Government. No other known conflict of interest 
Suzanne Hagen: grant holder on funding from the Chief Scientist Office, Scottish 
Government to support this review. Employed within a post at the NMAHP Research 
Unit, which is supported by the Chief Scientist Office, Scottish Government. No 
other known conflict of interest Doreen McClurg: grant holder on funding from 
the Chief Scientist Office, Scottish Government to support this review. Employed 
within a post at the NMAHP Research Unit, which is supported by the Chief 
Scientist Office, Scottish Government. DM was the chair of the Pelvic, Obstetric 
and Gynaecological Physiotherapy Professional Network of the Chartered Society 
of Physiotherapists in the UK and was the Chair of the International Continence 
Society Physiotherapy Committee. No other known conflict of interest Claire 
Torrens: employed by the Priory Hospital Group, Glasgow and previously delivered 
modules within BSc Mental Health Nursing at the University of Stirling. No known 
conflict of interest Margaret Maxwell: grant holder on funding from the Chief 
Scientist Office, Scottish Government to support this review. Employed within a 
post at the NMAHP Research Unit, which is supported by the Chief Scientist 
Office, Scottish Government. No other known conflict of interest


4076. Ir J Med Sci. 2021 Aug;190(3):925-926. doi: 10.1007/s11845-020-02423-z. Epub 
2020 Nov 4.

The mental health and well-being benefits of exercise during the COVID-19 
pandemic: a cross-sectional study of medical students and newly qualified 
doctors in the UK.

Coyle C(1), Ghazi H(2), Georgiou I(3).

Author information:
(1)St. George's University of London, London, UK. M1501493@sgul.ac.uk.
(2)Hull-York Medical School, York, UK.
(3)Aberdeen University, Aberdeen, UK.

BACKGROUND: University students have been uniquely affected by the COVID-19 
pandemic. However, there is currently little data upon the measures that medical 
students and newly qualified doctors have taken to help their mental well-being 
and mood during the COVID-19 pandemic.
AIM: We aimed to identify the activities respondents found beneficial for their 
well-being and mental health and recorded a mood score from survey respondents.
METHODS: A nationwide study was completed to investigate the mental health 
impact of the COVID-19 pandemic upon medical students and newly qualified 
doctors (interim foundation year one). We received 2075 respondents from across 
the UK.
RESULTS: Physical activity was found to be the most common activity used by the 
survey respondents to help with their mental well-being (80.1%) (medical 
students, 83.7%; interim foundation doctors, 72.3%). Participants who stated 
that exercise helped their well-being had a mean score (SD) of 52.3 (20.7) which 
was significantly higher (P = 0.048) than those who reported that they did not 
exercise (49.8 (21.1)). Respondents who stated they had used exercise to help 
with their mental well-being had (on average) a higher mood score than those who 
did not. This was seen in both the medical student and interim foundation doctor 
subgroups.
DISCUSSION: Exercise can help to benefit the well-being of medical students and 
interim foundation doctors. It is hoped that higher education providers and 
employers recognise the importance of promoting physical activity for the 
well-being of their students and staff, respectively.

© 2020. The Author(s).

DOI: 10.1007/s11845-020-02423-z
PMCID: PMC7641255
PMID: 33150537 [Indexed for MEDLINE]

Conflict of interest statement: The authors of this paper declare that they have 
no conflicts of interest. All procedures performed involving human participants 
were in accordance with the ethical standards of the University of Oxford 
Medical Sciences Inter-Divisional Research Ethics Committee and with the 1964 
Helsinki declaration and its later amendments. Informed consent was obtained 
from all individual participants included in the study.


4077. Rev Recent Clin Trials. 2021;16(2):146-150. doi: 
10.2174/1574887115666201104154713.

Can Nutrition Play a Role as a Stimulant for COVID 19 in Children?

Kesavelu D(1), Franklyn N(2), Sreedharan L(3).

Author information:
(1)Apollo Children's Hospital, Chennai, India.
(2)Vijaya Health Centre, Chennai, India.
(3)Department of Dietetics and Nutrition, Apollo Children's Hospital, Chennai, 
India.

BACKGROUND: Nutrition plays a major role in the growth and well-being of 
children and forms the basis of their existence. A pandemic like COVID19 poses 
some serious questions and challenges in the minds of practicing pediatricians 
as to what support they should offer children, their parents and carers 
alleviating their anxiety about their children's diet and nutrition, that is 
critical at this time of crisis. Although the evidence for pediatric nutrition 
and COVID19 is not strong, this article aims to critically look into pediatric 
nutrition during the COVID19 pandemic and bring the most recent evidence into 
the limelight to facilitate making the right choices with respect to pediatric 
nutrition.
METHODS: We performed a search on recent literature using the search terms 
"Covid19" + "Children" + "Nutrition" to analyze the current evidence supporting 
nutrition as a stimulant for covid19. A review article based on the above search 
results was written to highlight the importance of nutrition during this 
pandemic.
RESULTS: Strong recommendations remain unchanged for breastfeeding, healthy 
complementary feeding, use of supplemental formula where appropriate, oral 
nutritional supplements, zinc, n-3& n- 6 fatty acids, and probiotics all have a 
certain role to play as a stimulant for Covid19 in children.
CONCLUSION: Current evidence emphasizes the use of additional nutritional 
supplements, especially in the "at risk" groups, low socio-economic status and 
children with chronic medical problems. Paediatric nutrition should never be 
overlooked and "one size does not fit all" as every child is different and 
children's individual nutritional needs vary. This review points to the 
importance of nutrition as a stimulant to covid19 in the pediatric population.

Copyright© Bentham Science Publishers; For any queries, please email at 
epub@benthamscience.net.

DOI: 10.2174/1574887115666201104154713
PMID: 33148157 [Indexed for MEDLINE]


4078. PLoS One. 2020 Nov 4;15(11):e0241658. doi: 10.1371/journal.pone.0241658. 
eCollection 2020.

Psychological distress, anxiety, family violence, suicidality, and wellbeing in 
New Zealand during the COVID-19 lockdown: A cross-sectional study.

Every-Palmer S(1), Jenkins M(1), Gendall P(2), Hoek J(2), Beaglehole B(3), Bell 
C(3), Williman J(4), Rapsey C(5), Stanley J(2).

Author information:
(1)Department of Psychological Medicine, University of Otago, Wellington, New 
Zealand.
(2)Department of Public Health, University of Otago, Wellington, New Zealand.
(3)Department of Psychological Medicine, University of Otago, Christchurch, New 
Zealand.
(4)Department of Population Health, University of Otago, Christchurch, New 
Zealand.
(5)Department of Psychological Medicine, University of Otago, Dunedin, New 
Zealand.

New Zealand's early response to the novel coronavirus pandemic included a strict 
lockdown which eliminated community transmission of COVID-19. However, this 
success was not without cost, both economic and social. In our study, we 
examined the psychological wellbeing of New Zealanders during the COVID-19 
lockdown when restrictions reduced social contact, limited recreation 
opportunities, and resulted in job losses and financial insecurity. We conducted 
an online panel survey of a demographically representative sample of 2010 adult 
New Zealanders in April 2020. The survey contained three standardised 
measures-the Kessler Psychological Distress Scale (K10), the GAD-7, and the 
Well-Being Index (WHO-5)-as well as questions designed specifically to measure 
family violence, suicidal ideation, and alcohol consumption. It also included 
items assessing positive aspects of the lockdown. Thirty percent of respondents 
reported moderate to severe psychological distress (K10), 16% moderate to high 
levels of anxiety, and 39% low wellbeing; well above baseline measures. Poorer 
outcomes were seen among young people and those who had lost jobs or had less 
work, those with poor health status, and who had past diagnoses of mental 
illness. Suicidal ideation was reported by 6%, with 2% reporting making plans 
for suicide and 2% reporting suicide attempts. Suicidality was highest in those 
aged 18-34. Just under 10% of participants had directly experienced some form of 
family harm over the lockdown period. However, not all consequences of the 
lockdown were negative, with 62% reporting 'silver linings', which included 
enjoying working from home, spending more time with family, and a quieter, less 
polluted environment. New Zealand's lockdown successfully eliminated COVID-19 
from the community, but our results show this achievement brought a significant 
psychological toll. Although much of the debate about lockdown measures has 
focused on their economic effects, our findings emphasise the need to pay equal 
attention to their effects on psychological wellbeing.

DOI: 10.1371/journal.pone.0241658
PMCID: PMC7641386
PMID: 33147259 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


4079. Int J Environ Res Public Health. 2020 Oct 30;17(21):8011. doi: 
10.3390/ijerph17218011.

Comparative Study of the Restorative Effects of Forest and Urban Videos during 
COVID-19 Lockdown: Intrinsic and Benchmark Values.

Zabini F(1), Albanese L(1), Becheri FR(2), Gavazzi G(3), Giganti F(3), 
Giovanelli F(3), Gronchi G(3), Guazzini A(4), Laurino M(5), Li Q(6), Marzi T(3), 
Mastorci F(5), Meneguzzo F(1)(7), Righi S(3), Viggiano MP(3).

Author information:
(1)Institute for Bioeconomy, National Research Council, 10 Via Madonna del 
Piano, I-50019 Sesto Fiorentino (FI), Italy.
(2)Pian dei Termini Forest Therapy Station, 2311 Via Pratorsi, I-51028 San 
Marcello Piteglio, Italy.
(3)Section of Psychology-Department of Neuroscience, Psychology, Drug Research 
and Child's Health (NEUROFARBA), University of Florence, 12 Via di San Salvi, 
I-50135 Firenze, Italy.
(4)Department of Education, Languages, Intercultural Studies, Literatures, and 
Psychology (FORLILPSI), University of Florence, 12 Via di San Salvi, I-50135 
Firenze, Italy.
(5)Institute of Clinical Physiology, National Research Council, 1 Via Giuseppe 
Moruzzi, I-56124 Pisa, Italy.
(6)Department of Rehabilitation and Physical Medicine, Graduate School of 
Medicine-Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
(7)Central Scientific Committee, Italian Alpine Club, 19 Via E. Petrella, 
I-20124 Milano, Italy.

The prolonged lockdown imposed to contain the COrona VIrus Disease 19 COVID-19 
pandemic prevented many people from direct contact with nature and greenspaces, 
raising alarms for a possible worsening of mental health. This study 
investigated the effectiveness of a simple and affordable remedy for improving 
psychological well-being, based on audio-visual stimuli brought by a short 
computer video showing forest environments, with an urban video as a control. 
Randomly selected participants were assigned the forest or urban video, to look 
at and listen to early in the morning, and questionnaires to fill out. In 
particular, the State-Trait Anxiety Inventory (STAI) Form Y collected in 
baseline condition and at the end of the study and the Part II of the Sheehan 
Patient Rated Anxiety Scale (SPRAS) collected every day immediately before and 
after watching the video. The virtual exposure to forest environments showed 
effective to reduce perceived anxiety levels in people forced by lockdown in 
limited spaces and environmental deprivation. Although significant, the effects 
were observed only in the short term, highlighting the limitation of the virtual 
experiences. The reported effects might also represent a benchmark to 
disentangle the determinants of health effects due to real forest experiences, 
for example, the inhalation of biogenic volatile organic compounds (BVOC).

DOI: 10.3390/ijerph17218011
PMCID: PMC7672570
PMID: 33143327 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


4080. Int J Environ Res Public Health. 2020 Oct 31;17(21):8035. doi: 
10.3390/ijerph17218035.

H-WORK Project: Multilevel Interventions to Promote Mental Health in SMEs and 
Public Workplaces.

De Angelis M(1), Giusino D(1), Nielsen K(2), Aboagye E(3), Christensen M(4), 
Innstrand ST(4), Mazzetti G(5), van den Heuvel M(6), Sijbom RBL(6), Pelzer V(6), 
Chiesa R(1), Pietrantoni L(1).

Author information:
(1)Department of Psychology, Alma Mater Studiorum-University of Bologna, 40126 
Bologna, Italy.
(2)Institute of Work Psychology, Sheffield University Management School, 
University of Sheffield, Sheffield S10 FL, UK.
(3)Institute of Environmental Medicine, Karolinska Institute, 171 65 Stockholm, 
Sweden.
(4)Department of Psychology, Norwegian University of Science and Technology, 
N-7941 Trondheim, Norway.
(5)Department of Education Studies, Alma Mater Studiorum-University of Bologna, 
40126 Bologna, Italy.
(6)Department of Work and Organizational Psychology, University of Amsterdam, 
1018 WS Amsterdam, The Netherlands.

The paper describes the study design, research questions and methods of a large, 
international intervention project aimed at improving employee mental health and 
well-being in SMEs and public organisations. The study is innovative in multiple 
ways. First, it goes beyond the current debate on whether individual- or 
organisational-level interventions are most effective in improving employee 
health and well-being and tests the cumulative effects of multilevel 
interventions, that is, interventions addressing individual, group, leader and 
organisational levels. Second, it tailors its interventions to address the 
aftermaths of the Covid-19 pandemic and develop suitable multilevel 
interventions for dealing with new ways of working. Third, it uses realist 
evaluation to explore and identify the working ingredients of and the conditions 
required for each level of intervention, and their outcomes. Finally, an 
economic evaluation will assess both the cost-effectiveness analysis and the 
affordability of the interventions from the employer perspective. The study 
integrates the training transfer and the organisational process evaluation 
literature to develop toolkits helping end-users to promote mental health and 
well-being in the workplace.

DOI: 10.3390/ijerph17218035
PMCID: PMC7662282
PMID: 33142745 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


4081. Isr J Health Policy Res. 2020 Nov 2;9(1):61. doi: 10.1186/s13584-020-00422-0.

A rapid assessment of migrant careworkers' psychosocial status during Israel's 
COVID-19 lockdown.

Attal JH(1), Lurie I(2)(3), Neumark Y(4).

Author information:
(1)Braun School of Public Health and Community Medicine, Hebrew University of 
Jerusalem, Jerusalem, Israel. jordan.hannink@mail.huji.ac.il.
(2)Shalvata Mental Health Center, Hod HaSharon, Israel.
(3)Department of Psychiatry, Sackler School of Medicine, Tel Aviv University, 
Tel Aviv, Israel.
(4)Braun School of Public Health and Community Medicine, Hebrew University of 
Jerusalem, Jerusalem, Israel.

BACKGROUND: Israel hosts nearly 70,000 migrant careworkers. Migrant careworkers 
work and live with populations extremely vulnerable to the novel Coronavirus, 
including the elderly and people with pre-existing physical conditions. This 
rapid assessment aimed to explore psychosocial status and mental wellbeing of 
migrant careworkers in Israel during the ongoing Covid-19 pandemic and determine 
risk and protective factors associated with mental distress, anxiety, and 
depression.
METHODS: This quantitative study was conducted via an online survey. The online 
survey collected social and demographic data, including country of origin, 
residence, age, sex, and time in Israel. In addition, questions were asked about 
knowledge of COVID-19 guidelines, access to supplies, and COVID-related racism. 
Respondents also completed a psychosocial screening tools, the Hopkins Symptom 
Checklist-10 (HSCL-10), which was used to screen for depression and anxiety.
RESULTS: As of May 3rd, 2020, 307 careworkers responded to the online survey, of 
whom 120 (39.1%) were found symptomatic using the HSCL-10. Separating the 
HSCL-10 into subscales, 28.0% were symptomatically anxious, and 38.1% were 
symptomatic for depression. In multivariate regression, emotional distress was 
associated with household food insecurity (OR: 5.85; p < 0.001), lack of 
confidence to care for oneself and employer during the pandemic (OR: 3.85; 
p < 0.001), poorer general health (OR: 2.98; p < 0.003), non-Philippine country 
of origin (OR: 2.83; p < 0.01), female sex (OR: 2.34; p < 0.04),, and inversely 
associated with age (p < 0.03). While 87.6% of careworkers reported having 
access to hand sanitization materials regularly, only 58.0% had regular access 
to a medical grade mask, and 21.5% reported household food insecurity. Moreover, 
40.0% of careworkers claimed to lack confidence to care for themselves and their 
employer during the COVID-19 pandemic.
CONCLUSIONS: Migrant careworkers exhibited high levels of mental distress during 
the COVID-19 lockdown, associated with lack of confidence or resources to 
properly care for themselves and their employer. Guidelines and support programs 
specific to the carework sector, that respect their rights and guard their 
health, must be developed as part of a coordinated COVID-19 response.

DOI: 10.1186/s13584-020-00422-0
PMCID: PMC7605873
PMID: 33138855 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no competing interests to 
report.


4082. BMC Public Health. 2020 Nov 2;20(1):1636. doi: 10.1186/s12889-020-09743-w.

Covid-19 effects on the workload of Iranian healthcare workers.

Shoja E(1), Aghamohammadi V(2), Bazyar H(3), Moghaddam HR(4), Nasiri K(5), 
Dashti M(6), Choupani A(1), Garaee M(1), Aliasgharzadeh S(7), Asgari A(8).

Author information:
(1)School of Medical Sciences Esfarayen Faculty of Medical Sciences, Esfarayen, 
Iran.
(2)Department of Nutrition, Khalkhal University of Medical Sciences, Khalkhal, 
Iran. v_agamohammadi@yahoo.com.
(3)Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, 
Ahvaz, Iran.
(4)Department of Public Health, Khalkhal University of Medical Sciences, 
Khalkhal, Iran.
(5)Department of Nursing, Khalkhal University of Medical Sciences, Khalkhal, 
Iran.
(6)Department of Ergonomics, Sharif Safety Index, Tehran, Iran.
(7)Department of Internal Medicine, School of Medicine and Allied Medical 
Sciences, Imam Khomeini Hospital, Ardabil University of Medical Sciences, 
Ardabil, Iran.
(8)Department of Environmental Health, Khalkhal University of Medical Sciences, 
Khalkhal, Iran. asgariamin65@gmail.com.

BACKGROUND: In this study, we aimed to evaluate the impact of the COVID-19 
epidemic on the workload and mental health of Iranian medical staff using the 
General Health Questionnaire (GHQ-12) and NASA -Task Load Index (NASA-TLX) 
Questionnaire between March and April 2020, respectively.
METHODS: The present cross-sectional study was conducted from March 5th to April 
5th, 2020. To evaluate the workload and mental health of participants NASA-TLX 
and GHQ-12 online questionnaires were distributed. Data were entered into 
software SPSS (Version 23) and T-test, ANOVA, Regression methods were used for 
data analysis.
RESULTS: Health workers who encountered COVID- 19 patients, were subjected to 
more task load compared to those who had no contact with COVID- 19 patients at 
the workplace (p <  0.001). In terms of the subscale score of NASA-TLX, nurses 
had more scores in mental pressure, physical pressure, time pressure (temporal), 
and frustration compared to the other jobs (p <  0.05). Moreover, nurses had 
significantly more workload compared to the other jobs.
CONCLUSIONS: Type of job, the shift of work, educational level, and facing 
COVID-19 affected the score of NASA-TLX. NASA-TLX scores were higher in nursing 
compared to the scores of other health staff groups. The results of this study 
indicate that the scores of NASA-TLX and GHQ-12 among staff who had contact with 
COVID-19 patients were significantly higher than those who did not face COVID-19 
patients. We suggested that a comprehensive assistance should be provided to 
support the well-being of healthcare workers especially nurses and healthcare 
workers who treated COVID-19 patients.

DOI: 10.1186/s12889-020-09743-w
PMCID: PMC7605333
PMID: 33138798 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no competing interests to 
declare.


4083. Gerontologist. 2021 Jan 21;61(1):114-125. doi: 10.1093/geront/gnaa170.

Lessons in Resilience: Initial Coping Among Older Adults During the COVID-19 
Pandemic.

Fuller HR(1), Huseth-Zosel A(2).

Author information:
(1)Department of Human Development and Family Science, North Dakota State 
University, Fargo, USA.
(2)Department of Public Health, North Dakota State University, Fargo, USA.

BACKGROUND AND OBJECTIVES: In addition to increased physical health risks, older 
adults may also experience risks to their mental health and social well-being 
due to coronavirus disease 2019 (COVID-19). Yet, older adults may be uniquely 
able to cope given their life experiences and coping mechanisms. This study 
explores older adults' coping experiences and strategies during the initial 
weeks of the COVID-19 pandemic.
RESEARCH DESIGN AND METHODS: A Midwestern sample of 76 older adults aged 70-97 
years completed a phone interview about their experiences with social distancing 
due to COVID-19. Interviews were conducted during the early weeks of regional 
social distancing (March 28-April 20, 2020). Participants rated their level of 
perceived coping and responded to open-ended questions about their daily life 
and coping.
RESULTS: Mean perceived coping level (on a scale from 1 to 10) was 7.9, with 87% 
of participants rating their coping positively. Primary themes that emerged 
included (a) staying busy, (b) seeking social support, and (c) having a positive 
mindset. These emotion-focused coping strategies appeared adaptive in the early 
weeks of the pandemic for most older adults.
DISCUSSION AND IMPLICATIONS: Contrary to predominant messaging about the 
vulnerability of older adults, these findings highlight the resilient nature of 
older adults in terms of their psychological coping and adaptability during 
COVID-19. Future research should build upon these findings to better understand 
and promote late-life coping during crises. Practitioners should seek to support 
older adults' engagement in such proactive coping, and social policies should be 
developed to acknowledge the variable needs of older adults.

© The Author(s) 2020. Published by Oxford University Press on behalf of The 
Gerontological Society of America. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/geront/gnaa170
PMCID: PMC7665461
PMID: 33136144 [Indexed for MEDLINE]


4084. Health Educ Behav. 2021 Feb;48(1):14-19. doi: 10.1177/1090198120969372. Epub 
2020 Oct 31.

More Than Inconvenienced: The Unique Needs of U.S. College Students During the 
COVID-19 Pandemic.

Lederer AM(1)(2), Hoban MT(3)(2), Lipson SK(4)(5), Zhou S(6)(5), Eisenberg 
D(6)(5).

Author information:
(1)Tulane University, New Orleans, LA, USA.
(2)American College Health Association-National College Health Assessment 
Advisory Committee.
(3)American College Health Association, Silver Spring, MD, USA.
(4)Boston University, Boston, MA, USA.
(5)Healthy Minds Network.
(6)University of Michigan, Ann Arbor, MI, USA.

U.S. college students are a distinct population facing major challenges due to 
the COVID-19 pandemic. Before the pandemic, students were already experiencing 
substantial mental health concerns, putting both their health and academic 
success in jeopardy. College students now face increasing housing and food 
insecurity, financial hardships, a lack of social connectedness and sense of 
belonging, uncertainty about the future, and access issues that impede their 
academic performance and well-being. There is also reason to believe that 
COVID-19 is exacerbating inequalities for students of color and low-income 
students. We provide several recommendations for institutions of higher 
education to mitigate these obstacles, including engaging in data-driven 
decision making, delivering clear and informative messaging to students, 
prioritizing and expanding student support services, and using an equity 
framework to guide all processes.

DOI: 10.1177/1090198120969372
PMCID: PMC8356799
PMID: 33131325 [Indexed for MEDLINE]


4085. Int J Environ Res Public Health. 2020 Oct 28;17(21):7905. doi: 
10.3390/ijerph17217905.

Personnel Well-Being in the Helsinki University Hospital during the COVID-19 
Pandemic-A Prospective Cohort Study.

Haravuori H(1), Junttila K(2), Haapa T(2), Tuisku K(3), Kujala A(4), Rosenström 
T(5), Suvisaari J(6), Pukkala E(7), Laukkala T(3), Jylhä P(3).

Author information:
(1)Department of Psychiatry, University of Helsinki and HUS Helsinki University 
Hospital, and Finnish Institute for Health and Welfare, 00029 HUS Helsinki, 
Finland.
(2)HUS Helsinki University Hospital, Nursing Research Center and University of 
Helsinki, 00029 HUS Helsinki, Finland.
(3)Department of Psychiatry, University of Helsinki and Acute Psychiatry and 
Consultations, HUS Helsinki University Hospital, 00029 HUS Helsinki, Finland.
(4)HUS Helsinki University Hospital and University of Helsinki, 00029 HUS 
Helsinki, Finland.
(5)Department of Psychology and Logopedics, Faculty of Medicine, University of 
Helsinki, 00014 Helsinki, Finland.
(6)Department of Public Health Solutions, Finnish Institute for Health and 
Welfare, Mental Health Unit, 00271 Helsinki, Finland.
(7)Faculty of Social Sciences, Tampere University, 33100 Tampere, Finland.

In March 2020, strict measures took place in Finland to limit the COVID-19 
pandemic. Majority of Finnish COVID-19 patients have been located in southern 
Finland and consequently cared for at the Hospital District of Helsinki and 
Uusimaa (HUS) Helsinki University Hospital. During the pandemic, HUS personnel's 
psychological symptoms are followed via an electronic survey, which also 
delivers information on psychosocial support services. In June 2020, the 
baseline survey was sent to 25,494 HUS employees, 4804 (19%) of whom answered; 
altogether, 62.4% of the respondents were nursing staff and 8.9% were medical 
doctors. While the follow-up continues for a year and a half, this report shares 
the sociodemographic characteristics of the respondents and the first results of 
psychological symptoms from our baseline survey. Out of those who were directly 
involved in the pandemic patient care, 43.4% reported potentially traumatic 
COVID-19 pandemic-related events (PTEs) vs. 21.8% among the others (p < 0.001). 
While over a half of the personnel were asymptomatic, a group of respondents 
reported PTEs and concurrent depression, insomnia, and anxiety symptoms. This 
highlights the need to ensure appropriate psychosocial support services to all 
traumatized personnel; especially, nursing staff may require attention.

DOI: 10.3390/ijerph17217905
PMCID: PMC7662585
PMID: 33126583 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


4086. Gerontologist. 2021 Jan 21;61(1):103-113. doi: 10.1093/geront/gnaa168.

Social Isolation and Psychological Distress During the COVID-19 Pandemic: A 
Cross-National Analysis.

Kim HH(1), Jung JH(2).

Author information:
(1)Department of Sociology, Ewha Womans University, Seoul, Republic of Korea.
(2)School of Social Sciences, Nanyang Technological University, Singapore.

BACKGROUND AND OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic 
resulted in social isolation globally, creating heightened levels of stress and 
anxiety. This study investigates the link between social isolation and mental 
well-being in later life, and how it varies across countries.
RESEARCH DESIGN AND METHODS: We draw on a subset of older adults from Global 
Behaviors and Perceptions in the COVID-19 Pandemic, a unique global online 
survey of 13,660 participants from 62 countries. We use mixed-effects models to 
analyze the data.
RESULTS: Social isolation (distancing) significantly predicts poor mental health 
operationalized as coronavirus-induced distress (p < .01). At the aggregate 
level, average distress varies positively across countries with higher numbers 
of coronavirus-related deaths (p < .10) and more fragile state capacity (p < 
.05), while varying negatively across those with more stringent anticoronavirus 
policies (p < .05). Finally, we report several cross-level interactions between 
social isolation and the total number of deaths (p = .025), policy stringency (p 
= .065), state fragility (p = .061), and globalization index (p = .071).
DISCUSSION AND IMPLICATIONS: Our study shows that a proper understanding of the 
impact of COVID-19 on the mental well-being of older adults should consider the 
moderating role of national context.

© The Author(s) 2020. Published by Oxford University Press on behalf of The 
Gerontological Society of America. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/geront/gnaa168
PMCID: PMC7665475
PMID: 33125065 [Indexed for MEDLINE]


4087. J Intellect Disabil Res. 2021 Jan;65(1):1-10. doi: 10.1111/jir.12793. Epub 2020 
Oct 30.

Exploring the experiences of siblings of adults with intellectual/developmental 
disabilities during the COVID-19 pandemic.

Redquest BK(1), Tint A(1), Ries H(2), Lunsky Y(1).

Author information:
(1)Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental 
Health, Toronto, Ontario, Canada.
(2)The Sibling Collaborative, Canada.

BACKGROUND: The COVID-19 pandemic has caused many adults with 
intellectual/developmental disabilities (IDD) to lose their daily routines and 
social support, and as a result, many adults with IDD are increasingly reliant 
on their family caregivers. Siblings often play a crucial support role for their 
brothers and sisters with IDD. As such, this study aimed to describe the 
experiences of adult siblings of people with IDD during the COVID-19 pandemic.
METHODS: The Sibling Collaborative worked with researchers to codesign an online 
survey, completed by 91 people, exploring sibling supports and concerns during 
the COVID-19 pandemic. The survey also aimed to identify helpful resources for 
siblings during this time.
RESULTS: The results showed that the majority of siblings are supporting their 
brother or sister with IDD during the COVID-19 pandemic and are concerned about 
the health and well-being of their brother/sister. The most common concern 
related to disruption of their brother's or sister's routine and activities. 
Although responses of older and younger siblings did not differ from each other, 
siblings whose brother or sister with IDD lived with family had some unique 
concerns relative to those whose siblings no longer lived with family. Siblings 
described how their own self-care and relationships with others, as well as 
support for their brother/sister, were particularly helpful during the COVID-19 
pandemic.
CONCLUSIONS: Siblings are providing key support to their brother or sister with 
IDD during the COVID-19 pandemic, and they too must be supported. Siblings 
should be included in efforts to disseminate resources targeting people with IDD 
and their feedback and input must be obtained. It is also important to include 
sibling mental wellness as caregiver supports are created and implemented. More 
research is needed to further understand how to support sibling caregivers.

© 2020 MENCAP and International Association of the Scientific Study of 
Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

DOI: 10.1111/jir.12793
PMID: 33124773 [Indexed for MEDLINE]


4088. Nurs Ethics. 2021 Feb;28(1):23-32. doi: 10.1177/0969733020961825. Epub 2020 Oct 
30.

Self-care strategies in response to nurses' moral injury during COVID-19 
pandemic.

Hossain F(1), Clatty A(2).

Author information:
(1)6613Duquesne University, USA.
(2)6595University of Pittsburgh Medical Center, USA.

These are strange and unprecedented times in the wake of the COVID-19 pandemic. 
Most frontline healthcare professionals have never witnessed anything like this 
before. As a result, staff may experience numerous and continuous traumatic 
events, which in many instances, will negatively affect their psychological 
well-being. Particularly, nurses face extraordinary challenges in response to 
shifting protocols, triage, shortages of resources, and the astonishing numbers 
of patients who require care in expedited time constraints. As most healthcare 
workers are passionate nursing professionals, frustration and often a sense of 
powerlessness occur when they find themselves unable to provide needed care to 
their patients. The overwhelming number of deaths, patients isolated and dying 
alone, and the ever-present fear of being infected and then infecting 
colleagues, family, friends due to the lack of protective gear or known 
protocols takes its toll on emotional and psychological well-being. For nurses, 
the experience of this significant (hopefully once-in-a-lifetime) event can 
inflict on-going moral injury. Nurses affected by this trauma require education, 
coping tools, and therapy to help avoid or alleviate the adverse effects on 
their well-being. Institutions must provide these resources to tend to the 
well-being of their healthcare staff, during and beyond the pandemic. This 
article aims to investigate moral distress-considering it as a moral injury-and 
offer tools and recommendations to support healthcare nurses as they respond to 
this crisis and its aftermath.

DOI: 10.1177/0969733020961825
PMCID: PMC7604672
PMID: 33124492 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest: The author(s) declared no 
potential conflicts of interest with respect to the research, authorship, and/or 
publication of this article.


4089. Crit Care Med. 2021 Jan 1;49(1):27-37. doi: 10.1097/CCM.0000000000004703.

End-of-Life-Care Quality in ICUs Is Associated With Family Surrogates' Severe 
Anxiety and Depressive Symptoms During Their First 6 Months of Bereavement.

Tang ST(1)(2)(3)(4)(5)(6)(7)(8), Huang CC(4)(5), Hu TH(6), Lo ML(1)(7), Chou 
WC(2)(8), Chuang LP(4), Chiang MC(3).

Author information:
(1)School of Nursing, Medical College, Chang Gung University, Taoyuan, Taiwan, 
Republic of China.
(2)Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, 
Taoyuan, Taiwan, Republic of China.
(3)Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, 
Taiwan, Republic of China.
(4)Department of Internal Medicine, Division of Pulmonary and Critical Care 
Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan, Republic of 
China.
(5)Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan, 
Republic of China.
(6)Department of Internal Medicine, Division of Hepato-Gastroenterology, Chang 
Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan, Republic of China.
(7)Department of Nursing, Chang Gung Memorial Hospital at Linkou, Taoyuan, 
Taiwan, R.O.C.
(8)College of Medicine, Chang Gung University, Taoyuan, Taiwan, R.O.C.

Comment in
    Crit Care Med. 2021 Jan 1;49(1):162-164.

OBJECTIVES: Evidence linking end-of-life-care quality in ICUs to bereaved family 
members' psychologic distress remains limited by methodological insufficiencies 
of the few studies on this topic. To examine comprehensively the associations of 
family surrogates' severe anxiety and depressive symptoms with end-of-life-care 
quality in ICUs over their first 6 months of bereavement.
DESIGN: Prospective, longitudinal, observational study.
SETTING/PARTICIPANTS: Family surrogates (n = 278) were consecutively recruited 
from seven medical ICUs at two academically affiliated medical centers in 
Taiwan.
MEASUREMENTS AND STATISTICAL ANALYSIS: Family surrogates' anxiety and depressive 
symptoms were assessed 1, 3, and 6 months postloss using the Hospital Anxiety 
and Depression Scale. Family satisfaction with end-of-life care in ICUs was 
assessed 1-month postloss by the Family Satisfaction in the ICU questionnaire. 
Patients' end-of-life care was documented over the patient's ICU stay. 
Associations of severe anxiety and depressive symptoms (scores ≥ 8 for each 
subscale) with end-of-life-care quality in ICUs (documented by patient care 
received and family satisfaction with end-of-life care in ICUs) were examined by 
multivariate logistic regression models with generalized estimating equation.
MAIN RESULTS: Prevalence of severe anxiety and depressive symptoms decreased 
significantly over time. Surrogates' lower likelihood of severe anxiety or 
depressive symptoms 3-6 month postloss was associated with death without 
cardiopulmonary resuscitation, withdrawing life-sustaining treatments, and 
higher family satisfaction with end-of-life care in ICUs. Bereaved surrogates' 
higher likelihood of these symptoms was associated with physician-surrogate 
prognostic communication and conducting family meetings before patients died.
CONCLUSIONS: End-of-life-care quality in ICUs is associated with bereaved 
surrogates' psychologic well-being. Enhancing end-of-life-care quality in ICUs 
by improving the process of end-of-life care, for example, promoting death 
without cardiopulmonary resuscitation, withdrawing life-sustaining treatments, 
and increasing family satisfaction with end-of-life care, can lighten bereaved 
family surrogates' severe anxiety symptoms and severe depressive symptoms.

Copyright © 2020 by the Society of Critical Care Medicine and Wolters Kluwer 
Health, Inc. All Rights Reserved.

DOI: 10.1097/CCM.0000000000004703
PMID: 33116053 [Indexed for MEDLINE]

Conflict of interest statement: Dr. Tang received support from the National 
Health Research Institutes (TW) with partial support from Ministry of Science 
and Technology (TW) and Chang Gung Memorial Hospital. Dr. Chuang disclosed work 
for hire. The remaining authors have disclosed that they do not have any 
potential conflicts of interest.


4090. J Coll Physicians Surg Pak. 2020 Oct;30(10):106-109. doi: 
10.29271/jcpsp.2020.supp2.106.

COVID-19 and Anxiety amongst Doctors: A Pakistani Perspective.

Arshad AR(1), Islam F(2).

Author information:
(1)Department of Nephrology, Combined Military Hospital Peshawar, Peshawar 
Cantt, Pakistan.
(2)Department of Nephrology, Combined Military Hospital Malir, Karachi, 
Pakistan.

OBJECTIVE: To assess anxiety in Pakistani doctors in context of COVID-19 
pandemic and evaluate possible causes.
STUDY DESIGN: Cross-sectional study.
PLACE AND DURATION OF STUDY: Departments of Nephrology, Combined Military 
Hospital Peshawar and Combined Military Hospital Malir, Karachi, during March 
2020.
METHODOLOGY: Doctors working in different parts of Pakistan were approached 
online through snowball sampling technique. Those with history of psychiatric 
disorders were excluded. They were administered a questionnaire including 
Seven-item Generalised Anxiety Disorder Scale (GAD-7). Reasons why they felt 
anxious were also explored.
RESULTS: Responses from 431 doctors, including 238 (55.2%) males, were 
evaluated. Most of them were younger than 30 years (286; 66.4%), in training 
(335; 77.7%), and working in public hospitals (347; 80.5%). Mild, moderate and 
severe anxiety was seen in 120 (27.8%), 103 (23.9%) and 42 (9.7%) doctors, 
respectively. Median score on GAD-7 was 6 (interquartile range = 3 - 11). Lady 
doctors had higher scores than males (7 vs. 5; p=0.024). No significant 
differences in scores were found amongst doctors from different workplaces or of 
different professional status. A greater proportion of females had anxiety as 
compared to males (67.9% vs. 56.3%; p=0.014). Frequency of anxiety was not 
different amongst doctors of different professional status, types of workplace 
and amongst different age groups. Commonest reasons for anxiety were lack of 
personal protective equipment (83.8% doctors); and the fear that they could 
spread infection to family members (79.8% doctors).
CONCLUSION: COVID-19 pandemic has had a major impact on the psychological 
well-being of doctors. Greater attention needs to be paid towards lady doctors 
to ensure their mental well-being. Key Words: Anxiety disorders, Pandemic, 
Personal protective equipment, Workforce.

DOI: 10.29271/jcpsp.2020.supp2.106
PMID: 33115580 [Indexed for MEDLINE]


4091. Int J Environ Res Public Health. 2020 Oct 26;17(21):7834. doi: 
10.3390/ijerph17217834.

Development and Psychometric Testing of the Self-Care in COVID-19 (SCOVID) 
Scale, an Instrument for Measuring Self-Care in the COVID-19 Pandemic.

De Maria M(1), Ferro F(1), Ausili D(2), Alvaro R(1), De Marinis MG(3), Di Mauro 
S(2), Matarese M(3), Vellone E(1).

Author information:
(1)Department of Biomedicine and Prevention, Faculty of Medicine and Surgery, 
University of Rome Tor Vergata, Via Montpellier, 1, 00133 Rome, Italy.
(2)Department of Medicine and Surgery, Faculty of Medicine and Surgery, 
University of Milan-Bicocca, Via Cadore 48, 20900 Monza, Italy.
(3)Research Unit of Nursing Science, Faculty of Medicine and Surgery, Campus 
Bio-medico University of Rome, Via Alvaro del Portillo, 21 00128 Rome, Italy.

AIM: To develop the Self-Care in COVID-19 (SCOVID) scale and to test its 
psychometric characteristics in the general population.
METHODS: We tested SCOVID scale content validity with 19 experts. For factorial 
and construct validity, reliability, and measurement error, we administered the 
20-item SCOVID scale to a sample of 461 Italians in May/June 2020 (mean age: 
48.8, SD ± 15.8).
RESULTS: SCOVID scale item content validity ranged between 0.85-1.00, and the 
total scale content validity was 0.94. Confirmatory factor analysis supported 
SCOVID scale factorial validity (comparative fit index = 0.91; root mean square 
error of approximation = 0.05). Construct validity was supported by significant 
correlations with other instrument scores measuring self-efficacy, positivity, 
quality of life, anxiety, and depression. Reliability estimates were good with 
factor score determinacy, composite reliability, global reliability index, 
Cronbach's alpha, and test-retest reliability ranging between 0.71-0.91. The 
standard error of measurement was adequate.
CONCLUSIONS: The SCOVID scale is a new instrument measuring self-care in the 
COVID-19 pandemic with adequate validity and reliability. The SCOVID scale can 
be used in practice and research for assessing self-care in the COVID-19 
pandemic to preventing COVID-19 infection and maintaining wellbeing in the 
general population.

DOI: 10.3390/ijerph17217834
PMCID: PMC7663643
PMID: 33114651 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


4092. J Glob Health. 2020 Dec;10(2):020505. doi: 10.7189/jogh.10.020505.

Early psychological impact of the 2019 coronavirus disease (COVID-19) pandemic 
and lockdown in a large Spanish sample.

García-Álvarez L(1)(2), de la Fuente-Tomás L(1)(3), García-Portilla 
MP(1)(4)(5)(3)(6), Sáiz PA(1)(4)(5)(3)(6), Lacasa CM(6), Dal Santo F(6), 
González-Blanco L(1)(4)(5)(3)(6), Bobes-Bascarán MT(4)(5)(2)(6), García MV(6), 
Vázquez CÁ(6), Iglesias ÁV(1)(4)(3), Cao CM(1)(4), Fernández AG(1), Bascarán 
Fernández MT(1)(3), Fernández AP(6), Revuelta JR(1)(5)(6), Zazo ES(6), Madera 
PZ(1)(5)(6), Álvarez MS(6), Sánchez ÁP(6), Delgado CF(6), Suárez SC(6), Miranda 
IM(5)(6), Treviño LJ(1)(5)(6), Calzón GP(6), Abad I(6), Duque CP(6), Riera L(6), 
González PM(6), Pedrero EF(4)(7), Bobes J(1)(4)(5)(3)(6).

Author information:
(1)Department of Psychiatry, Universidad de Oviedo, Oviedo, Spain.
(2)Department of Psychology, Universidad de Oviedo, Oviedo, Spain.
(3)Instituto Universitario de Neurociencias del Principado de Asturias 
(INEUROPA), Oviedo, Spain.
(4)Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain.
(5)Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 
Oviedo, Spain.
(6)Servicio de Salud del Principado de Asturias (SESPA) Oviedo, Spain.
(7)Department of Educational Sciences, Universidad de la Rioja, Spain.

BACKGROUND: Epidemic outbreaks have significant impact on psychological 
well-being, increasing psychiatric morbidity among the population. We aimed to 
describe the early psychological impact of COVID-19 and its contributing factors 
in a large Spanish sample, globally and according to mental status (never mental 
disorder NMD, past mental disorder PMD, current mental disorder CMD).
METHODS: An online questionnaire was conducted between 19 and 26 March, five 
days after the official declaration of alarm and the lockdown order. Data 
included sociodemographic and clinical information and the DASS-21 and IES 
questionnaires. We analysed 21 207 responses using the appropriate descriptive 
and univariate tests as well as binary logistic regression to identify 
psychological risk and protective factors.
RESULTS: We found a statistically significant gradient in the psychological 
impact experienced in five domains according to mental status, with the NMD 
group being the least affected and the CMD group being the most affected. In the 
three groups, the depressive response was the most prevalent (NMD = 40.9%, 
PMD = 51.9%, CMD = 74.4%, F = 1011.459, P < 0.001). Risk factors were female sex 
and classification as a case in any psychological domain. Protective factors 
were younger age and ability to enjoy free time. Variables related to COVID-19 
had almost no impact except for having COVID-19 symptoms, which was a risk 
factor for anxiety in all three groups.
CONCLUSIONS: Our results can help develop coping strategies addressing 
modifiable risk and protective factors for each mental status for early 
implementation in future outbreaks.

Copyright © 2020 by the Journal of Global Health. All rights reserved.

DOI: 10.7189/jogh.10.020505
PMCID: PMC7567432
PMID: 33110588 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: The authors completed the 
ICMJE Unified Competing Interest form (available upon request from the 
corresponding author), and declare no conflicts of interest.


4093. Ir J Psychol Med. 2021 Sep;38(3):186-191. doi: 10.1017/ipm.2020.119. Epub 2020 
Oct 28.

The psychological impacts of COVID-19: a study of frontline physicians and 
nurses in the Arab world.

Al Mahyijari N(1), Badahdah A(2), Khamis F(1).

Author information:
(1)The Royal Hospital, Ministry of Health, P.O. Box 1331 PC111, Muscat, Oman.
(2)Department of Sociology and Rural Studies, South Dakota State University, 
Hansen Hall 004, Brookings, SD57007-2201, USA.

OBJECTIVES: The COVID-19 (SARS-CoV2) pandemic is wreaking havoc on healthcare 
systems and causing serious economic, social, and psychological anguish around 
the globe. Healthcare workers (HCWs) who diagnose and care for COVID-19 patients 
have been shown to suffer burnout, stress, and anxiety.
METHODS: In this study, we collected data from 150 frontline HCWs who had close 
contact with COVID-19 patients at several health facilities in the Sultanate of 
Oman. The participants completed an online survey that included the Perceived 
Stress Scale, the Generalized Anxiety Disorder Scale, and the WHO-5 Well-Being 
Index.
RESULTS: The study found that a substantial number of healthcare professionals 
experienced relatively high levels of stress and anxiety, as well as suboptimal 
levels of well-being. Perceived stress and anxiety were significant predictors 
of HCWs' well-being.
CONCLUSIONS: This study adds to the increasing literature indicating harmful 
effects of COVID-19 on the mental health of HCWs.

DOI: 10.1017/ipm.2020.119
PMCID: PMC7683819
PMID: 33109291 [Indexed for MEDLINE]


4094. Infect Dis Poverty. 2020 Oct 26;9(1):148. doi: 10.1186/s40249-020-00770-8.

Perceived psychosocial health and its sociodemographic correlates in times of 
the COVID-19 pandemic: a community-based online study in China.

Wang GY(1), Tang SF(2)(3).

Author information:
(1)Henan Medical Products Administration & Center for ADR Monitoring of Henan, 
127 Huayuan Road, Zhengzhou, 450008, Henan, China.
(2)School of Medicine and Health Management, Tongji Medical College, Huazhong 
University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, 
China. sftang2018@hust.edu.cn.
(3)Center for Health Service Research in Rural Areas, Key Research Institute of 
Humanities & Social Sciences at Universities in Hubei Province, 13 Hangkong 
Road, Wuhan, 430030, Hubei, China. sftang2018@hust.edu.cn.

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic has been affecting 
people's psychosocial health and well-being through various complex pathways. 
The present study aims to investigate the perceived psychosocial health and its 
sociodemographic correlates among Chinese community-dwelling residents.
METHODS: This cross-sectional survey was carried out online and using a 
structured questionnaire during April 2020. In total, 4788 men and women with 
the age range of 11-98 years from eight provinces in eastern, central and 
western China were included in the analysis. We adopted a tactical approach to 
capture three key domains of perceived psychosocial health that are more likely 
to occur during a pandemic including hopelessness, loneliness, and depression. 
Multiple regression method, binary logistic regression model and variance 
inflation factor (VIF) were used to conduct data analysis.
RESULTS: Respectively 34.8%, 32.5% and 44.8% of the participants expressed 
feeling more hopeless, lonely, and depressed during the pandemic. The percentage 
of all three indicators was comparatively higher among women than among men: 
hopelessness (50.7% vs 49.3%), loneliness (52.4% vs 47.6%), and depression 
(56.2% vs 43.8%). Being married was associated with lower odds of loneliness 
among men (odds ratio [OR] = 0.63, 95% CI: 0.45-0.90). Loneliness was negatively 
associated with smoking (OR = 0.67, 95% CI: 0.45-0.99) and positively associated 
with drinking (OR = 1.45, 95% CI: 1.04-2.02). Compared with those in the lowest 
income bracket (< CNY 10 000), men (OR = 0.34, 95% CI: 0.21-0.55) and women 
(OR = 0.36, 95% CI: 0.23-0.56) in the highest level of annually housed income 
(> CNY 40 000) had the lowest odds of reporting perceived hopelessness 
(OR = 0.35, 95% CI: 0.25-0.48). Smoking also showed negative association with 
depression only among men (OR = 0.63, 95% CI: 0.43-0.91).
CONCLUSIONS: More than one-third of the participants reported worsening in the 
experience of hopelessness and loneliness, with more than two-fifth of worsening 
depression during the pandemic compared with before the outbreak. Several 
socioeconomic and lifestyle factors were found to be associated with the outcome 
variables, most notably participants' marital status, household income, smoking, 
alcohol drinking, existing chronic conditions. These findings may be of 
significance to treat patients and help them recover from the pandemic.

DOI: 10.1186/s40249-020-00770-8
PMCID: PMC7586696
PMID: 33106187 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


4095. Molecules. 2020 Oct 22;25(21):4891. doi: 10.3390/molecules25214891.

Probiotics in Treatment of Viral Respiratory Infections and Neuroinflammatory 
Disorders.

Shahbazi R(1), Yasavoli-Sharahi H(1), Alsadi N(1), Ismail N(2), Matar C(1)(3).

Author information:
(1)Cellular and Molecular Medicine Department, Faculty of Medicine, University 
of Ottawa, Ottawa, ON K1H 8M5, Canada.
(2)School of Psychology, Faculty of Social Sciences, University of Ottawa, 
Ottawa, ON K1N 6N5, Canada.
(3)School of Nutrition, Faculty of Health Sciences, University of Ottawa, 
Ottawa, ON K1H 8M5, Canada.

Inflammation is a biological response to the activation of the immune system by 
various infectious or non-infectious agents, which may lead to tissue damage and 
various diseases. Gut commensal bacteria maintain a symbiotic relationship with 
the host and display a critical function in the homeostasis of the host immune 
system. Disturbance to the gut microbiota leads to immune dysfunction both 
locally and at distant sites, which causes inflammatory conditions not only in 
the intestine but also in the other organs such as lungs and brain, and may 
induce a disease state. Probiotics are well known to reinforce immunity and 
counteract inflammation by restoring symbiosis within the gut microbiota. As a 
result, probiotics protect against various diseases, including respiratory 
infections and neuroinflammatory disorders. A growing body of research supports 
the beneficial role of probiotics in lung and mental health through modulating 
the gut-lung and gut-brain axes. In the current paper, we discuss the potential 
role of probiotics in the treatment of viral respiratory infections, including 
the COVID-19 disease, as major public health crisis in 2020, and influenza virus 
infection, as well as treatment of neurological disorders like multiple 
sclerosis and other mental illnesses.

DOI: 10.3390/molecules25214891
PMCID: PMC7660077
PMID: 33105830 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


4096. PLoS One. 2020 Oct 26;15(10):e0240646. doi: 10.1371/journal.pone.0240646. 
eCollection 2020.

A hybrid inductive-abductive analysis of health workers' experiences and 
wellbeing during the COVID-19 pandemic in the United States.

Hennein R(1)(2), Lowe S(1).

Author information:
(1)Department of Social and Behavioral Sciences, Yale School of Public Health, 
New Haven, Connecticut, United States of America.
(2)Yale School of Medicine, New Haven, Connecticut, United States of America.

The COVID-19 pandemic puts health workers at increased risk of adverse mental 
health outcomes. However, no studies have assessed health workers' experiences 
using qualitative methods during the COVID-19 outbreak in the United States to 
identify novel factors that could relate to their mental health. In May 2020, we 
distributed an online survey to health workers across 25 medical centers 
throughout the United States. The Patient Health Questionnaire-9, Generalized 
Anxiety Disorder-7, Primary Care-Post-Traumatic Stress Disorder, and Alcohol Use 
Disorders Identification Test-Concise and associated cutoff values were used to 
assess rates of probable major depression, generalized anxiety disorder, 
post-traumatic stress disorder, and alcohol use disorder, respectively. To 
provide insight into the factors shaping these and other mental health 
conditions, we included two open-ended questions asking respondents to recount 
their most upsetting and hopeful experiences during the COVID-19 pandemic and 
how it made them feel. Using a hybrid inductive-abductive approach and thematic 
content analysis, we created a Social Ecological Model to represent themes among 
health workers' experiences within five ecological levels: individual, 
interpersonal, organization, community, and public policy. Of the 1,132 
participants who completed the survey, 14.0% had probable major depression, 
15.8% probable generalized anxiety disorder, 23.1% probable post-traumatic 
stress disorder, and 42.6% probable alcohol use disorder. Individual level 
themes included participants' personal health and self-care behaviors. 
Interpersonal level themes included the health of their social circle, family 
functioning, and social support. Organization level themes included their 
hospital's management, resources, patient care, routine, and teams. Themes in 
the community level included the media, scientific knowledge about COVID-19, 
morale, behavior, and support of health workers. Lastly, government and health 
system leadership and shelter-in-place policy were themes within the public 
policy level. Our findings provide insights into novel factors that have 
impacted health workers' wellbeing during the COVID-19 pandemic. These factors 
should be further explored to inform interventions and public policy that 
mitigate mental health morbidities among health workers during this and future 
outbreaks.

DOI: 10.1371/journal.pone.0240646
PMCID: PMC7588050
PMID: 33104711 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


4097. JAMA Netw Open. 2020 Oct 1;3(10):e2026064. doi: 
10.1001/jamanetworkopen.2020.26064.

Levels of Severity of Depressive Symptoms Among At-Risk Groups in the UK During 
the COVID-19 Pandemic.

Iob E(1), Frank P(1), Steptoe A(1), Fancourt D(1).

Author information:
(1)Research Department of Behavioural Science and Health, University College 
London, London, United Kingdom.

IMPORTANCE: An immediate research priority is to investigate and monitor the 
psychological well-being among high-risk groups during the coronavirus disease 
2019 (COVID-19) pandemic.
OBJECTIVE: To examine levels of severity of depressive symptoms over time among 
individuals with high risk in the UK during the COVID-19 pandemic.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study is part of an ongoing large 
panel study of adults aged 18 years and older residing in the UK, the COVID-19 
Social Study, established on March 21, 2020. Data analysis was conducted in May 
2020.
EXPOSURES: Sociodemographic risk factors included belonging to the Black, Asian, 
and minority racial/ethnic communities, low socioeconomic position (SEP), and 
essential worker roles (eg, workers in health and social care, education, 
childcare, or key public services). Health-related and psychosocial risk factors 
included preexisting physical and mental health conditions, experience of 
psychological or physical abuse, and low social support.
MAIN OUTCOMES AND MEASURES: Depressive symptoms were measured on 7 occasions 
from March 21 to April 2, 2020, using the 9-item Patient Health Questionnaire 
(PHQ-9). Group-based depressive symptom trajectories were derived using latent 
growth mixture modeling.
RESULTS: The analytical sample comprised 51 417 adults aged 18 years and older 
(mean [SD] age, 48.8 [16.8] years; 26 276 [51.1%] women; 6145 members [12.0%] of 
Black, Asian, and minority racial/ethnic communities). Among these, 17 143 
participants (33.3%) were in the lowest SEP quartile, and 11 342 participants 
(22.1%) were classified as essential workers. Three levels of severity of 
depressive symptoms were identified: low (30 850 participants [60.0%]), moderate 
(14 911 participants [29.0%]), and severe (5656 participants [11.0%]). After 
adjusting for covariates, experiences of physical or psychological abuse (odds 
ratio [OR], 13.16; 95% CI, 12.95-13.37; P < .001), preexisting mental health 
conditions (OR, 12.99; 95% CI, 12.87-13.11; P < .001), preexisting physical 
health conditions (OR, 3.41; 95% CI, 3.29-3.54; P < .001), low social support 
(OR, 12.72; 95% CI, 12.57-12.86; P < .001), and low SEP (OR, 5.22; 95% CI, 
5.08-5.36; P < .001) were significantly associated with severe depressive 
symptoms. No significant association was found for race/ethnicity (OR, 1.07; 95% 
CI, 0.85-1.28; P = .56). Participants with essential worker roles were less 
likely to experience severe depressive symptoms (OR, 0.66; 95% CI, 0.53-0.80; 
P < .001). Similar patterns of associations were found for the group of 
participants with moderate depressive symptoms (abuse: OR, 5.34; 95% CI, 
5.15-5.54; P < .001; mental health condition: OR, 4.24; 95% CI, 4.24-4.24; 
P < .001; physical health condition: OR, 1.89; 95% CI, 1.80-1.98; P < .001; low 
social support: OR, 4.71; 95% CI, 4.60-4.82; P < .001; low SEP: OR, 1.97; 95% 
CI, 1.87-2.08; P < .001).
CONCLUSIONS AND RELEVANCE: In this cohort study of UK adults participating in 
the COVID-19 Social Study, people with psychosocial and health-related risk 
factors, as well as those with low SEP, were at the most risk of experiencing 
moderate or severe depressive symptoms during the COVID-19 pandemic.

DOI: 10.1001/jamanetworkopen.2020.26064
PMCID: PMC7588938
PMID: 33104209 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest Disclosures: None reported.


4098. Perspect Psychiatr Care. 2021 Jul;57(3):1041-1051. doi: 10.1111/ppc.12655. Epub 
2020 Oct 26.

The effect of coronavirus (COVID-19) outbreak on the mental well-being and 
mental health of individuals.

Sümen A(1), Adibelli D(1).

Author information:
(1)Department of Public Health Nursing, Kumluca Faculty of Health Sciences, 
Akdeniz University, Antalya, Turkey.

AIM: This study was conducted to examine the effect of COVID-19 pandemic on the 
mental well-being and mental health of individuals.
DESIGN AND METHOD: This cross-sectional questionnaire study was conducted with 
614 individuals over the age of 18.
FINDINGS: Regarding the coronavirus outbreak, it was found that 84.9% of the 
participants are afraid/anxious. The psychiatric problems of the individuals who 
fear/worry about coronavirus becoming a pandemic, who stated that staying at 
home because of the outbreak negatively affect their mental health and that 
domestic violence cases have increased due to the outbreak were found to be 
higher (p < 0.05).
PRACTICE IMPLICATION: The coronavirus outbreak causes fear and anxiety in 
society. This triggers so many psychological symptoms.

© 2020 Wiley Periodicals LLC.

DOI: 10.1111/ppc.12655
PMID: 33103787 [Indexed for MEDLINE]


4099. East Mediterr Health J. 2020 Oct 13;26(10):1148-1150. doi: 
10.26719/2020.26.10.1148.

From adversity to resilience in the COVID-19 era: strengthening mental health 
systems in the Eastern Mediterranean Region.

Eaton J(1), Rahman A(2), Gater R(3), Saxena S(4), Hammerich A(5), Saeed K(6).

Author information:
(1)Mental Health Director CBM Global; Assistant Professor, Centre for Global 
Mental Health, London School of Hygiene and Tropical Medicine, London, United 
Kingdom.
(2)Professor of Child Psychiatry and Global Mental Health, University of 
Liverpool, Child Mental Health Unit Royal Liverpool Children's Hospital, 
Liverpool, United Kingdom.
(3)Honorary Senior Lecturer in Psychiatry, University of Manchester (retd.), 
Manchester, United Kingdom.
(4)Professor of the Practice of Global Mental Health, Global Health and 
Population, Harvard TH Chan School of Public Health, Boston, United States of 
America.
(5)Director, Department of Noncommunicable Diseases and Mental Health, World 
Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt.
(6)Regional Advisor for Mental Health and Substance Use, World Health 
Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt.

The global COVID-19 pandemic has demonstrated the impact of a major public 
health emergency on mental health, and the ways that individuals, communities, 
professionals and systems can react positively to such a crisis. The Eastern 
Mediterranean Region (EMR) has substantial experience in mental health and 
psychosocial support (MHPSS) in crises, and COVID-19 has driven further 
innovation to support mental health and well-being. Global and regional guidance 
has been developed quickly, applying lessons learnt from previous disease 
outbreaks to respond to the pandemic at a systems level, for different 
population groups, and for countries of different income levels. Preliminary 
results from a global rapid assessment survey to assess the impact of COVID-19 
on MHPSS services, indicate that 20 of the 22 EMR Member States have MHPSS as 
integral components of national COVID-19 response plans; one-third have 
allocated additional funding. However, MHPSS services have been severely 
impacted by the pandemic, including psychotherapy, psychosocial interventions, 
community services, and services for children/adolescents. Innovative solutions 
such as crisis hotlines, tele-consultations, digital self-help platforms, novel 
approaches to ensure supply of psychotropic medicines, and task sharing/shifting 
for basic psychosocial support, are being used in many countries to overcome 
service disruptions and maintain care for those with mental conditions.

Copyright © World Health Organization (WHO) 2020. Open Access. Some rights 
reserved. This work is available under the CC BY-NC-SA 3.0 IGO license 
(https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

DOI: 10.26719/2020.26.10.1148
PMID: 33103740 [Indexed for MEDLINE]


4100. Int J Soc Psychiatry. 2021 Sep;67(6):656-663. doi: 10.1177/0020764020968119. 
Epub 2020 Oct 24.

Anxiety and depression in frontline health care workers during the outbreak of 
Covid-19.

Xing LQ(1), Xu ML(1), Sun J(1), Wang QX(1), Ge DD(1), Jiang MM(2), Du W(2), Li 
Q(2).

Author information:
(1)Nursing Department, Jinan Infectious Disease Hospital, Cheeloo College of 
Medicine, Shandong University, Jinan, Shandong, China.
(2)Division of Liver Diseases, Jinan Infectious Disease Hospital, Cheeloo 
College of Medicine, Shandong University, Jinan, Shandong, China.

Comment in
    Int J Soc Psychiatry. 2022 Feb;68(1):223.

BACKGROUND: The pandemic of coronavirus disease (Covid-19) seriously impacts the 
health and well-being of all of us.
AIMS: We aim to assess the psychological impact of Covid-19 on frontline health 
care workers (HCWs), including anxiety, depression and stress of threat of the 
disease.
METHOD: The study was a cross-sectional survey among the frontline HCWs in a 
hospital at Jinan, China. Data were collected through an anonymous, self-rated 
questionnaire, including basic demographic data, a 10-item Covid-19 stress 
questionnaire, the Self-Rating Anxiety Scale (SAS) and the Self-Rating 
Depression Scale (SDS). The risk and rate of anxiety, depression and stress of 
Covid-19 were estimated.
RESULTS: Among the 309 participants, there were 88 (28.5%) with anxiety and 172 
(56.0%) with depression. Multivariate logistic regression analyses showed that 
age ⩽ 30 years, age > 30 to 45 years, working in confirmed case isolation wards, 
and worrying about disinfection measures being not sufficient were independently 
associated with anxiety with an odds ratio (95% confidence interval, CI) of 4.4 
(1.6-12.2), 3.1 (1.1-8.8), 2.3 (1.4-4.0) and 2.5 (1.5-4.3), respectively; 
age ⩽ 30 years, age > 30 to 45 years, nurse and worrying about disinfection 
measure being not sufficient were independently associated with depression with 
an odds ratio (95% CI) of 3.8 (1.8-7.8), 2.7 (1.3-5.7), 2.5 (1.1-5.6) and 2.1 
(1.3-3.5), respectively.
CONCLUSIONS: A high prevalence of anxiety and depression was found among 
frontline HCWs during the COVID-19 outbreak. More psychological care should be 
given to young staffs and nurses. Measures to prevent professional exposure is 
important for HCWs' physical and mental health.

DOI: 10.1177/0020764020968119
PMID: 33100114 [Indexed for MEDLINE]


4101. Br J Health Psychol. 2021 May;26(2):553-569. doi: 10.1111/bjhp.12485. Epub 2020 
Oct 25.

Resilience during uncertainty? Greater social connectedness during COVID-19 
lockdown is associated with reduced distress and fatigue.

Nitschke JP(1)(2), Forbes PAG(1), Ali N(3), Cutler J(4)(5), Apps MAJ(4)(5), 
Lockwood PL(4)(5), Lamm C(1).

Author information:
(1)Faculty of Psychology, Department of Cognition, Emotion, and Methods in 
Psychology, University of Vienna, Vienna, Austria.
(2)Department of Psychology, McGill University, Montreal, Quebec, Canada.
(3)Faculty of Psychology, Department of Clinical and Health Psychology, 
University of Vienna, Vienna, Austria.
(4)Department of Experimental Psychology, University of Oxford, Oxford, UK.
(5)Centre for Human Brain Health, School of Psychology, University of 
Birmingham, Birmingham, UK.

BACKGROUND: Social connections are crucial for our health and well-being. This 
is especially true during times of high uncertainty and distress, such as during 
the COVID-19 lockdown. This period was characterized by unprecedented physical 
distancing (often communicated as social distancing) measures resulting in 
significant changes to people's usual social lives. Given the potential effects 
of this disruption on people's well-being, it is crucial to identify factors 
which are associated with negative health outcomes, and conversely, those that 
promote resilience during times of adversity.
AIMS: We examined the relationship between individuals' levels of social 
connectedness during lockdown and self-reported stress, worry, and fatigue.
METHOD: Survey data were collected from 981 individuals in a representative 
sample of Austrian citizens. Data collection occurred during the last week of a 
six-week nationwide lockdown due to the COVID-19 pandemic. The final sample 
consisted of 902 participants. Participants were asked to complete validated 
questionnaires to assess levels of social connectedness as well as measures of 
perceived stress, worry-both general and COVID-19 specific-and symptoms of 
fatigue during the previous two weeks.
RESULTS: Our results demonstrate that greater social connectedness during the 
lockdown period was associated with lower levels of perceived stress, as well as 
general and COVID-19-specific worries. Furthermore, we found a negative 
relationship between fatigue and social connectedness, which was mediated by 
feelings of stress, general worries, and COVID-19-specific worries-respectively, 
indicating that individuals with smaller network sizes, who were highly 
distressed during the pandemic, were also likely to report feeling more 
fatigued.
CONCLUSION: Our findings highlight the important role that social connections 
play in promoting resilience by buffering against negative physical and mental 
health outcomes, particularly in times of adversity in times of adversity.

© 2020 The Authors. British Journal of Health Psychology published by John Wiley 
& Sons Ltd on behalf of British Psychological Society.

DOI: 10.1111/bjhp.12485
PMCID: PMC8247344
PMID: 33099800 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no financial or other conflicts 
of interest to declare.


4102. J Adolesc Health. 2020 Nov;67(5):653-661. doi: 10.1016/j.jadohealth.2020.08.008.

The Impact of Physical Distancing Policies During the COVID-19 Pandemic on 
Health and Well-Being Among Australian Adolescents.

Munasinghe S(1), Sperandei S(1), Freebairn L(2), Conroy E(1), Jani H(1), 
Marjanovic S(1), Page A(3).

Author information:
(1)Translational Health Research Institute, Western Sydney University, Penrith, 
New South Wales, Australia.
(2)The Australian Prevention Partnership Centre, Sax Institute, Haymarket, New 
South Wales, Australia; Preventive and Population Health, Health Systems, Policy 
and Research, Health Directorate, ACT Government, Woden, Australian Capital 
Territory, Australia.
(3)Translational Health Research Institute, Western Sydney University, Penrith, 
New South Wales, Australia. Electronic address: a.page@westernsydney.edu.au.

PURPOSE: Physical distancing policies in the state of New South Wales 
(Australia) were implemented on March 23, 2020, because of the COVID-19 
pandemic. This study investigated changes in physical activity, dietary 
behaviors, and well-being during the early period of this policy.
METHODS: A cohort of young people aged 13-19 years from Sydney (N = 582) were 
prospectively followed for 22 weeks (November 18, 2019, to April 19, 2020). 
Daily, weekly, and monthly trajectories of diet, physical activity, sedentary 
behavior, well-being, and psychological distress were collected via smartphone, 
using a series of ecological momentary assessments and smartphone sensors. 
Differences in health and well-being outcomes were compared pre- and 
post-implementation of physical distancing guidelines.
RESULTS: After the implementation of physical distancing measures in NSW, there 
were significant decreases in physical activity (odds ratio [OR] = .53, 95% 
confidence interval [CI] = .34-.83), increases in social media and Internet use 
(OR = 1.86, 95% CI = 1.15-3.00), and increased screen time based on 
participants' smartphone screen state. Physical distancing measures were also 
associated with being alone in the previous hour (OR = 2.09, 95% CI: 1.33-3.28), 
decreases in happiness (OR = .38, 95% CI = .18-.82), and fast food consumption 
(OR = .46, 95% CI = .29-.73).
CONCLUSIONS: Physical distancing and social restrictions had a contemporaneous 
impact on health and well-being outcomes associated with chronic disease among 
young people. As the pandemic evolves, it will be important to consider how to 
mitigate against any longer term health impacts of physical distancing 
restrictions.

Crown Copyright © 2020. Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jadohealth.2020.08.008
PMCID: PMC7577185
PMID: 33099413 [Indexed for MEDLINE]


4103. Int J Ment Health Nurs. 2021 Apr;30(2):440-450. doi: 10.1111/inm.12804. Epub 
2020 Oct 23.

Hospital staff well-being during the first wave of COVID-19: Staff perspectives.

Digby R(1)(2), Winton-Brown T(3)(4), Finlayson F(3), Dobson H(5), Bucknall 
T(6)(7).

Author information:
(1)School of Nursing and Midwifery, Deakin University, Geelong, Victoria, 
Australia.
(2)QPS Alfred partnership, Melbourne, Victoria, Australia.
(3)Alfred Health, Melbourne, Victoria, Australia.
(4)Central Clinical School, Level 6 Alfred Centre, Alfred Hospital, Melbourne, 
Victoria, Australia.
(5)Alfred Health, Monash Alfred Psychiatry Research Centre, Melbourne, Victoria, 
Australia.
(6)School of Nursing and Midwifery, Faculty of Health, Deakin University, 
Geelong, Victoria, Australia.
(7)Centre for Quality and Patient Safety Research Alfred Health Partnership, 
Alfred Health, Melbourne, Victoria, Australia.

The purpose of this research is to determine the impact of working during the 
early stage of the COVID-19 pandemic on the well-being of staff at one 600-bed 
acute hospital in metropolitan Melbourne, Australia. This exploratory study is 
part of a larger mixed methods survey project, reporting the qualitative data 
from an on-line survey of clinical staff working at one acute hospital between 
April 16th and May 13th, 2020 during the COVID-19 pandemic. Responses to five 
free-text questions were analysed using inductive content analysis. 321 medical, 
nursing, allied health and non-clinical staff responded to the survey. 
Respondents reported anxiety, fear and uncertainty related to the pandemic, from 
the perspectives of work, home, family and community. They reported feeling 
confused by inconsistent messages received from government, hospital executive, 
managers and media. Seven themes were identified: (i) worrying about patient 
care, (ii) changed working conditions, (iii) working in the changed hospital 
environment, (iv) impact of the pandemic, (v) personal isolation and 
uncertainty, (vi) leadership and management and (vii) additional support needed 
for staff. Despite the pandemic being comparatively well-controlled in 
Australia, all disciplines reported a high degree of anticipatory anxiety. Staff 
working in healthcare require both managerial and psychological support to 
minimise anxiety and promote well-being and resilience in order to deal with the 
health crisis. Regular unambiguous communication directing the way forward is 
crucial.

© 2020 Australian College of Mental Health Nurses Inc.

DOI: 10.1111/inm.12804
PMID: 33098222 [Indexed for MEDLINE]


4104. ESMO Open. 2020 Oct;5(5):e000970. doi: 10.1136/esmoopen-2020-000970.

Impact of COVID-19 on anxiety levels among patients with cancer actively treated 
with systemic therapy.

Sigorski D(1), Sobczuk P(2), Osmola M(3), Kuć K(4), Walerzak A(5), Wilk M(6), 
Ciszewski T(4), Kopeć S(2), Hryń K(4), Rutkowski P(2), Stec R(7), Szczylik C(6), 
Bodnar L(8).

Author information:
(1)Department of Oncology, University of Warmia and Mazury in Olsztyn, Olsztyn, 
Poland. Electronic address: dawidsigorski@wp.pl.
(2)Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie 
National Research Institute of Oncology, Warsaw, Poland.
(3)Department of Hematology, Transplantation and Internal Medicine, University 
Clinical Centre, Medical University of Warsaw, Warsaw, Poland.
(4)Department of Oncology, St. Pio's Provincial Hospital, Przemyśl, Poland.
(5)Clinical Department of Oncological Surgery, Warmian-Masurian Cancer Center of 
The Ministry of The Interior and Administration's Hospital, Olsztyn, Poland.
(6)Department of Oncology, Centre of Postgraduate Medical Education, European 
Health Centre, Otwock, Poland.
(7)Department of Oncology, Medical University of Warsaw, Warsaw, Poland.
(8)Clinical Department of Oncology and Immuno-Oncology, Warmian-Masurian Cancer 
Center of The Ministry of The Interior and Administration's Hospital, Olsztyn, 
Poland.

BACKGROUND: Life-threatening diseases have a negative impact on emotional 
well-being and psychosocial functioning. This study aimed to assess the 
relationship between the level of anxiety caused by a neoplasm and the threat of 
coronavirus infection among patients with cancer actively treated with systemic 
therapy during the COVID-19 pandemic. Additionally, we searched for clinical 
factors associated with a higher level of anxiety.
METHODS: In this multicentre, prospective, non-interventional study conducted in 
Poland, we enrolled 306 actively treated patients with cancer and collected 
their clinical data, including age, gender, cancer type and treatment intention. 
The fear/anxiety of SARS-CoV-2 were rated in Fear of COVID-19 Scale 
(SRA-FCV-19S) and Numerical Anxiety Scale (SRA-NAS). The fear and anxiety 
associated with cancer (CRA) were rated with the NAS (CRA-NAS).
RESULTS: The mean level of SRA-FCV-19S was 18.5±7.44, which was correlated with 
the SRA-NAS (r=0.741, p<0.001). SRA-FCV-19S was significantly higher in women 
versus men (20.18±7.56 vs 16.54±6.83; p<0.001) and was tumour type-dependent 
(p=0.037), with the highest anxiety observed in patients with breast cancer 
(17.63±8.75). In the multivariate analysis, only the female gender was 
significantly associated with higher SRA. CRA-NAS was higher in women versus men 
(7.07±2.99 vs 5.47±3.01; p<0.001), in patients treated with curative versus 
palliative intention (7.14±3.06 vs 5.99±3.06; p=0.01) and in individuals aged 
≤65 years versus >65 years (6.73±2.96 vs 5.66±3.24; p=0.007).
CONCLUSIONS: For an actively treated patient with cancer, cancer remains the 
main life-threatening disease during the COVID-19 pandemic. The need for more 
attentive psychological care should be provided especially to female patients, 
patients with breast cancer, those under 65 years of age and treated with 
curative intention, as these factors are associated with a higher level of 
anxiety.

© Author (s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No 
commercial re-use. Published by BMJ on behalf of the European Society for 
Medical Oncology.

DOI: 10.1136/esmoopen-2020-000970
PMCID: PMC7590347
PMID: 33097653 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


4105. Enferm Intensiva (Engl Ed). 2021 Apr-Jun;32(2):79-87. doi: 
10.1016/j.enfi.2020.03.003. Epub 2020 Oct 21.

Effect of music therapy on anxiety and pain in the critical polytraumatised 
patient.

[Article in English, Spanish]

Contreras-Molina M(1), Rueda-Núñez A(1), Pérez-Collado ML(2), García-Maestro 
A(1).

Author information:
(1)Unidad de Reanimación, Complejo Hospitalario Universitario de Albacete, 
Albacete, España.
(2)Unidad de Reanimación, Complejo Hospitalario Universitario de Albacete, 
Albacete, España. Electronic address: m.luz.pc1@hotmail.com.

OBJECTIVE: To determine the effectiveness of music therapy on anxiety and pain 
in critical polytraumatised patients admitted to the resuscitation unit of a 
tertiary level hospital in Spain.
MATERIAL AND METHOD: Randomised clinical trial conducted in a tertiary level 
hospital, from June 2016 to May 2018. The study sample was 60 patients, 30 
belonging to the intervention group (IG), and 30 to the control group (CG). The 
IG were given a 30-minute music session and heart rate (HR) and blood pressure 
(BP) were measured. The VAS (Visual Analogue Scale) was applied for anxiety and 
pain before and after each session. The same measures and scales were applied in 
the CG who did not receive a music session. The music session comprised 3 parts: 
the first was standard music selected by music therapists; the second was 
personalised, chosen by the patient and the third was a new standard. The 
intervention took place in a booth with headphones.
RESULTS: Significant changes in anxiety levels (P<.01) were detected in the 
group of patients undergoing the intervention, measured with the VAS scale for 
anxiety, and pain levels (P<.01), measured with the VAS scale for pain. No 
significant differences were found in the physiological parameters of HR and BP.
CONCLUSION: The use of music in critical polytraumatised patients reduces 
anxiety and pain levels, increasing the patient's well-being and improving the 
quality of care. Music therapy, therefore, is considered beneficial as a 
complementary measure in critical care units. It would be worthwhile to continue 
studies in this and other hospital areas.

Copyright © 2020 Sociedad Española de Enfermería Intensiva y Unidades Coronarias 
(SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.

DOI: 10.1016/j.enfi.2020.03.003
PMID: 33097396


4106. F1000Res. 2020 Jun 23;9:636. doi: 10.12688/f1000research.24457.1. eCollection 
2020.

Epidemiology of mental health problems in COVID-19: a review.

Hossain MM(1)(2), Tasnim S(2)(3), Sultana A(4), Faizah F(5), Mazumder H(6), Zou 
L(7), McKyer ELJ(2), Ahmed HU(8), Ma P(2).

Author information:
(1)Nature Study Society of Bangladesh, Khulna, 09000, Bangladesh.
(2)Texas A&M School of Public Health, College Station, TX, 77843, USA.
(3)Bangladesh Medical Association, Dhaka, 09000, Bangladesh.
(4)Gazi Medical College, Khulna, 09000, Bangladesh.
(5)United Nations Population Fund, Cox's Bazar, Bangladesh.
(6)Ipas, Dhaka, Bangladesh.
(7)Exercise & Mental Health Laboratory, School of Psychology, Shenzhen 
University, Shenzen, 518060, China.
(8)National Institute of Mental Health (NIMH), Dhaka, 1207, Bangladesh.

The novel coronavirus disease 2019 (COVID-19) has become a pandemic affecting 
health and wellbeing globally. In addition to the physical health, economic, and 
social implications, the psychological impacts of this pandemic are increasingly 
being reported in the scientific literature. This narrative review reflected on 
scholarly articles on the epidemiology of mental health problems in COVID-19. 
The current literature suggests that people affected by COVID-19 may have a high 
burden of mental health problems, including depression, anxiety disorders, 
stress, panic attack, irrational anger, impulsivity, somatization disorder, 
sleep disorders, emotional disturbance, posttraumatic stress symptoms, and 
suicidal behavior. Moreover, several factors associated with mental health 
problems in COVID-19 are found, which include age, gender, marital status, 
education, occupation, income, place of living, close contact with people with 
COVID-19, comorbid physical and mental health problems, exposure to COVID-19 
related news and social media, coping styles, stigma, psychosocial support, 
health communication, confidence in health services, personal protective 
measures, risk of contracting COVID-19, and perceived likelihood of survival. 
Furthermore, the epidemiological distribution of mental health problems and 
associated factors were heterogeneous among the general public, COVID-19 
patients, and healthcare providers. The current evidence suggests that a 
psychiatric epidemic is cooccurring with the COVID-19 pandemic, which 
necessitates the attention of the global health community. Future 
epidemiological studies should emphasize on psychopathological variations and 
temporality of mental health problems in different populations. Nonetheless, 
multipronged interventions should be developed and adopted to address the 
existing psychosocial challenges and promote mental health amid the COVID-19 
pandemic.

Copyright: © 2020 Hossain MM et al.

DOI: 10.12688/f1000research.24457.1
PMCID: PMC7549174
PMID: 33093946 [Indexed for MEDLINE]

Conflict of interest statement: No competing interests were disclosed.


4107. BMC Res Notes. 2020 Oct 22;13(1):494. doi: 10.1186/s13104-020-05345-2.

Immediate impact of stay-at-home orders to control COVID-19 transmission on 
mental well-being in Bangladeshi adults: Patterns, Explanations, and future 
directions.

Ali M(1)(2), Ahsan GU(3), Khan R(4), Khan HR(5), Hossain A(3)(6)(7).

Author information:
(1)Department of Physiotherapy and Rehabilitation, Uttara Adhunik Medical 
College and Hospital, Uttara, Dhaka, 1230, Bangladesh. 
m180002@student.bup.edu.bd.
(2)NSU Global Health Institute, North South University, Dhaka, 1229, Bangladesh. 
m180002@student.bup.edu.bd.
(3)Department of Public Health, North South University, Bashundhara, Dhaka, 
1229, Bangladesh.
(4)International Dhaka School, Dhaka, Bangladesh.
(5)Institute of Statistical Research and Training, Dhaka University, Dhaka, 
Bangladesh.
(6)NSU Global Health Institute, North South University, Dhaka, 1229, Bangladesh.
(7)Health Management BD Foundation, Dhaka, Bangladesh.

OBJECTIVE: We aim to evaluate the immediate impacts of COVID-19 stay-at-home 
orders on the mental well-being of Bangladeshi adults. We recruited 1404 healthy 
adults following the Bangladesh government's lockdown announcement. A 
questionnaire comprising the Warwick Edinburgh Mental Well-being Scale was used 
to define mental health.
RESULTS: The overall mean score for well-being was 42.4, indicating that 51.9% 
of adults suffered from poor mental health. And within that 48% of males and 57% 
of females were depressed. The mean scores for government workers, unemployed 
workers, and business employees were 45.1, 39.6, and 39.5, respectively. 
Confounding adjustments in multivariable linear regression models revealed that 
married women, unemployed and business communities, and individuals returning to 
villages were heavily depressed. Stay-at-home orders had significant 
repercussions on mental health and created a gender disparity in depression 
among adults. Suggestions include promoting mental health for women, unemployed, 
and business individuals. Married women need to be taken into special 
consideration as their mental well-being is worse. Older people (50 years of age 
and over) reported a high day-to-day variation in their mental health. These 
results should be factored in when discussing the mental health of adults and 
communities to cope with quarantine.

DOI: 10.1186/s13104-020-05345-2
PMCID: PMC7578585
PMID: 33092649 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


4108. J Appl Psychol. 2020 Dec;105(12):1382-1396. doi: 10.1037/apl0000831. Epub 2020 
Oct 22.

Socioeconomic status and well-being during COVID-19: A resource-based 
examination.

Wanberg CR(1), Csillag B(1), Douglass RP(1), Zhou L(1), Pollard MS(2).

Author information:
(1)University of Minnesota.
(2)RAND Corporation.

The authors assess levels and within-person changes in psychological well-being 
(i.e., depressive symptoms and life satisfaction) from before to during the 
COVID-19 pandemic for individuals in the United States, in general and by 
socioeconomic status (SES). The data is from 2 surveys of 1,143 adults from RAND 
Corporation's nationally representative American Life Panel, the first 
administered between April-June, 2019 and the second during the initial peak of 
the pandemic in the United States in April, 2020. Depressive symptoms during the 
pandemic were higher than population norms before the pandemic. Depressive 
symptoms increased from before to during COVID-19 and life satisfaction 
decreased. Individuals with higher education experienced a greater increase in 
depressive symptoms and a greater decrease in life satisfaction from before to 
during COVID-19 in comparison to those with lower education. Supplemental 
analysis illustrates that income had a curvilinear relationship with changes in 
well-being, such that individuals at the highest levels of income experienced a 
greater decrease in life satisfaction from before to during COVID-19 than 
individuals with lower levels of income. We draw on conservation of resources 
theory and the theory of fundamental social causes to examine four key 
mechanisms (perceived financial resources, perceived control, interpersonal 
resources, and COVID-19-related knowledge/news consumption) underlying the 
relationship between SES and well-being during COVID-19. These resources 
explained changes in well-being for the sample as a whole but did not provide 
insight into why individuals of higher education experienced a greater decline 
in well-being from before to during COVID-19. (PsycInfo Database Record (c) 2020 
APA, all rights reserved).

DOI: 10.1037/apl0000831
PMCID: PMC7899012
PMID: 33090858 [Indexed for MEDLINE]


4109. Nurs Crit Care. 2022 May;27(3):296-325. doi: 10.1111/nicc.12564. Epub 2020 Oct 
21.

Systematic review of family engagement interventions in neonatal, paediatric, 
and adult ICUs.

McAndrew NS(1)(2), Jerofke-Owen T(3), Fortney CA(4), Costa DK(5), Hetland B(6), 
Guttormson J(3), Harding E(7).

Author information:
(1)College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, 
USA.
(2)Froedtert & the Medical College of Wisconsin Froedtert Hospital, Milwaukee, 
Wisconsin, USA.
(3)College of Nursing, Marquette University, Milwaukee, Wisconsin, USA.
(4)College of Nursing, The Ohio State University, Martha S. Pitzer Center for 
Women, Children & Youth, Columbus, Ohio, USA.
(5)School of Nursing, University of Michigan, Ann Arbor, Michigan, USA.
(6)Omaha Division, College of Nursing, University of Nebraska Medical Center, 
Omaha, Nebraska, USA.
(7)Medical College of Wisconsin Libraries, Medical College of Wisconsin, 
Milwaukee, Wisconsin, USA.

AIMS AND OBJECTIVES: The purpose of this systematic review was to evaluate 
interventions that have been used to engage families in direct care activities 
(active family engagement) in adult, paediatric, and neonatal intensive care 
unit (ICU) settings.
BACKGROUND: Family engagement is universally advocated across ICU populations 
and practice settings; however, appraisal of the active family engagement 
intervention literature remains limited.
SEARCH STRATEGY: Ovid Medline, PsycArticles & PsycInfo, Scopus, and CINAHL were 
searched for family interventions that involved direct care of the patient to 
enhance the psychological, physical, or emotional well-being of the patient or 
family in neonatal, paediatric, or adult ICUs.
INCLUSION/EXCLUSION CRITERIA: Studies were included if an active family 
engagement intervention was evaluated. Studies were excluded if they were not 
published in English or reported non-interventional research.
RESULTS: A total of 6210 abstracts were screened and 19 studies were included. 
Most studies were of low to moderate quality and were conducted in neonatal ICUs 
within the United States. Intervention dosage and frequency varied widely across 
studies. The interventions focused on developmental care (neonatal ICU) and 
involved families in basic patient care. Family member outcomes measured 
included satisfaction, stress, family-centred care, confidence, anxiety, and 
depression. Most studies found improvements in one or more outcomes.
CONCLUSIONS: There is a paucity of literature about active family engagement 
interventions, especially in adult and paediatric populations. The optimal 
dosage and frequency of family engagement interventions remains unknown. Our 
systematic review found that data are limited on the relationship between family 
engagement and patient outcomes, and provides a timely appraisal to guide future 
research.
RELEVANCE TO CLINICAL PRACTICE: Further research on the efficacy of family 
engagement interventions is warranted. The translation of active family 
engagement interventions into clinical practice should also be supported.

© 2020 British Association of Critical Care Nurses.

DOI: 10.1111/nicc.12564
PMID: 33089659 [Indexed for MEDLINE]


4110. BMJ Open. 2020 Oct 21;10(10):e042752. doi: 10.1136/bmjopen-2020-042752.

Protecting the front line: a cross-sectional survey analysis of the occupational 
factors contributing to healthcare workers' infection and psychological distress 
during the COVID-19 pandemic in the USA.

Firew T(1)(2), Sano ED(3), Lee JW(3)(4), Flores S(3), Lang K(5), Salman K(6), 
Greene MC(7)(8), Chang BP(3).

Author information:
(1)Department of Emergency Medicine, Columbia University Irving Medical Center, 
New York, New York, USA tsionfirew@gmail.com.
(2)Office of the Minister, Ethiopia Ministry of Health, Addis Ababa, Ethiopia.
(3)Department of Emergency Medicine, Columbia University Irving Medical Center, 
New York, New York, USA.
(4)Department of Emergnecy Medicine, Mount Sinai Medical Center, New York, New 
York, USA.
(5)School of Medicine, Columbia University Vagelos College of Physicians and 
Surgeons, New York, New York, USA.
(6)General Public Health, Columbia University Mailman School of Public Health, 
New York, New York, USA.
(7)Global Mental Health Program, New York State Psychiatric Institute, New York, 
New York, USA.
(8)Heilbrunn Department of Population and Family Health, Mailman School of 
Public Health, Columbia University, New York, New York, USA.

OBJECTIVE: The COVID-19 pandemic has been associated with significant 
occupational stressors and challenges for front-line healthcare workers (HCWs), 
including COVID-19 exposure risk. Our study sought to assess factors 
contributing to HCW infection and psychological distress during the COVID-19 
pandemic in the USA.
DESIGN: We conducted a cross sectional survey of HCWs (physicians, nurses, 
emergency medical technicians (EMTs), non-clinical staff) during May 2020. 
Participants completed a 42-item survey assessing disease transmission risk 
(clinical role, work environment, availability of personal protective equipment) 
and mental health (anxiety, depression and burn-out).
SETTING: The questionnaire was disseminated over various social media platforms. 
3083 respondents from 48 states, the District of Columbia and US territories 
accessed the survey.
PARTICIPANTS: Using a convenience sample of HCWs who worked during the pandemic, 
3083 respondents accessed the survey and 2040 participants completed at least 
80% of the survey.
PRIMARY OUTCOME: Prevalence of self-reported COVID-19 infection, in addition to 
burn-out, depression and anxiety symptoms.
RESULTS: Participants were largely from the Northeast and Southern USA, with 
attending physicians (31.12%), nurses (26.80%), EMTs (13.04%) with emergency 
medicine department (38.30%) being the most common department and specialty 
represented. Twenty-nine per cent of respondents met the criteria for being a 
probable case due to reported COVID-19 symptoms or a positive test. HCWs in the 
emergency department (31.64%) were more likely to contract COVID-19 compared 
with HCWs in the ICU (23.17%) and inpatient settings (25.53%). HCWs that 
contracted COVID-19 also reported higher levels of depressive symptoms (mean 
diff.=0.31; 95% CI 0.16 to 0.47), anxiety symptoms (mean diff.=0.34; 95% CI 0.17 
to 0.52) and burn-out (mean diff.=0.54; 95% CI 0.36 to 0.71).
CONCLUSION: HCWs have experienced significant physical and psychological risk 
while working during the COVID-19 pandemic. These findings highlight the urgent 
need for increased support for provider physical and mental health well-being.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2020-042752
PMCID: PMC7580061
PMID: 33087382 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: BPC receives support from 
NIH listed here: NHLBI: HL R01 141811, and HL R01 146911.


4111. J Dent Educ. 2021 Mar;85(3):401-410. doi: 10.1002/jdd.12456. Epub 2020 Oct 20.

A descriptive pilot study of the immediate impacts of COVID-19 on dental and 
dental hygiene students' readiness and wellness.

Akinkugbe AA(1)(2), Garcia DT(2)(3), Smith CS(4), Brickhouse TH(1)(2), Mosavel 
M(3).

Author information:
(1)Department of Dental Public Health and Policy, School of Dentistry, Virginia 
Commonwealth University, Richmond, Virginia, USA.
(2)Institute for Inclusion, Inquiry, and Innovation, Virginia Commonwealth 
University, Richmond, Virginia, USA.
(3)Department of Health Behavior and Policy, School of Medicine, Virginia 
Commonwealth University, Richmond, Virginia, USA.
(4)Director, Ethics Curriculum & Director, Pre-Doctoral Practice Group, 
Department of General Practice, Virginia Commonwealth University School of 
Dentistry, Richmond, Virginia, USA.

BACKGROUND: The ongoing novel coronavirus disease 2019 (COVID-19) pandemic has 
impacted dental students training across the U.S. academic dental institutions 
by moving classroom instruction to an online modality, limiting patient care, 
canceling external rotations, and rescheduling of licensure examinations.
OBJECTIVE: The aim of this study was to assess the immediate impacts of COVID-19 
on students' readiness to enter clinical practice or residency and its 
association with well-being (anxiety, perceived stress, coping and social 
support, and resilience).
METHODS: An online REDCap survey was distributed to 407 D1-D4 year dental 
students and 29 DH3-DH4 year dental hygiene students enrolled at a U.S. dental 
school. The survey consisted of readiness and wellness measures as well as 
socio-demographic variables.
RESULTS: Overall response rate was 58% (N = 252) ranging from 40% among D4 
students to 72% among D1 students. About half (55%) of the respondents were 
White, a third (34%) Asians and 5% were African Americans. Ninety-two percent 
were non-Hispanics while 62% were female. Overall mean (SD) anxiety score was 
6.5 (5.3) and 26% of respondents reported moderate or severe levels of anxiety. 
Anxiety score differed significantly by gender with females reporting higher 
anxiety levels, mean (SD) = 7.3 (5.5) versus 5.2 (4.7) for males; P = 0.002). 
Furthermore, mean anxiety score differed significantly among the dental school 
classes, ranging from 5.5 (5.3) among D2 students to 11.8 (6.2) in DH4 students 
(P = 0.02).
CONCLUSION: Academic dental institutions need to be responsive to the heightened 
anxiety and uncertainly levels of students and provide responsive training and 
support to mitigate its effects.

© 2020 American Dental Education Association.

DOI: 10.1002/jdd.12456
PMCID: PMC8043566
PMID: 33084054 [Indexed for MEDLINE]


4112. J Pediatr Psychol. 2020 Nov 1;45(10):1124-1143. doi: 10.1093/jpepsy/jsaa092.

Child and Family Outcomes Following Pandemics: A Systematic Review and 
Recommendations on COVID-19 Policies.

C Fong V(1), Iarocci G(1).

Author information:
(1)Department of Psychology, Simon Fraser University.

OBJECTIVE: A systematic review of mental health outcomes and needs of children 
and families during past pandemics was conducted based on the PRISMA protocol. 
The objectives were to evaluate the quality of existing studies on this topic, 
determine what is known about mental health outcomes and needs of children and 
families, and provide recommendations for how COVID-19 policies can best support 
children and families.
METHODS: Seventeen studies were identified through a search of PsycINFO, PubMed, 
Scopus, Web of Science, and Google Scholar.
RESULTS: Studies examining child outcomes indicate that social isolation and 
quarantining practices exert a substantial negative impact on child anxiety, 
post-traumatic stress disorder, and fear symptoms. Potential risk factors such 
as living in rural areas, being female, and increasing grade level may 
exacerbate negative mental health outcomes for children. Studies examining 
parental and family outcomes indicate that parents experience high stress, 
anxiety, and financial burden during pandemics. The age of the parent and family 
socioeconomic status (SES) appeared to mitigate negative outcomes, where older 
parents and higher SES families had lower rates of mental health problems. 
Parents' fear over the physical and mental health of their children, concerns 
over potential job loss and arranging childcare contributes to elevated stress 
and poorer well-being.
CONCLUSIONS: Findings from this review suggest current gaps in COVID-19 policies 
and provide recommendations such implementing "family-friendly" policies that 
are inclusive and have flexible eligibility criteria. Examples include universal 
paid sick leave for parents and financial supports for parents who are also 
frontline workers and are at an elevated risk for contracting the disease.

© The Author(s) 2020. Published by Oxford University Press on behalf of the 
Society of Pediatric Psychology. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/jpepsy/jsaa092
PMCID: PMC7665615
PMID: 33083817 [Indexed for MEDLINE]


4113. Br J Psychiatry. 2021 Jun;218(6):326-333. doi: 10.1192/bjp.2020.212.

Mental health and well-being during the COVID-19 pandemic: longitudinal analyses 
of adults in the UK COVID-19 Mental Health & Wellbeing study.

O'Connor RC(1), Wetherall K(1), Cleare S(1), McClelland H(1), Melson AJ(1), 
Niedzwiedz CL(2), O'Carroll RE(3), O'Connor DB(4), Platt S(5), Scowcroft E(6), 
Watson B(7), Zortea T(1), Ferguson E(8), Robb KA(2).

Author information:
(1)Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, 
University of Glasgow, UK.
(2)Institute of Health & Wellbeing, University of Glasgow, UK.
(3)Division of Psychology, University of Stirling, UK.
(4)School of Psychology, University of Leeds, UK.
(5)Usher Institute, University of Edinburgh, UK.
(6)Samaritans, UK.
(7)Scottish Association for Mental Health, UK.
(8)School of Psychology, Nottingham University, UK.

BACKGROUND: The effects of coronavirus disease 2019 (COVID-19) on the 
population's mental health and well-being are likely to be profound and long 
lasting.
AIMS: To investigate the trajectory of mental health and well-being during the 
first 6 weeks of lockdown in adults in the UK.
METHOD: A quota survey design and a sampling frame that permitted recruitment of 
a national sample was employed. Findings for waves 1 (31 March to 9 April 2020), 
2 (10 April to 27 April 2020) and 3 (28 April to 11 May 2020) are reported here. 
A range of mental health factors was assessed: pre-existing mental health 
problems, suicide attempts and self-harm, suicidal ideation, depression, 
anxiety, defeat, entrapment, mental well-being and loneliness.
RESULTS: A total of 3077 adults in the UK completed the survey at wave 1. 
Suicidal ideation increased over time. Symptoms of anxiety, and levels of defeat 
and entrapment decreased across waves whereas levels of depressive symptoms did 
not change significantly. Positive well-being also increased. Levels of 
loneliness did not change significantly over waves. Subgroup analyses showed 
that women, young people (18-29 years), those from more socially disadvantaged 
backgrounds and those with pre-existing mental health problems have worse mental 
health outcomes during the pandemic across most factors.
CONCLUSIONS: The mental health and well-being of the UK adult population appears 
to have been affected in the initial phase of the COVID-19 pandemic. The 
increasing rates of suicidal thoughts across waves, especially among young 
adults, are concerning.

DOI: 10.1192/bjp.2020.212
PMCID: PMC7684009
PMID: 33081860 [Indexed for MEDLINE]

Conflict of interest statement: R.C.O'C. reports grants from Samaritans, grants 
from Scottish Association for Mental Health, grants from Mindstep Foundation, 
during the conduct of the study; grants from National Institute for Health 
Research, grants from Medical Research Foundation, grants from Scottish 
Government, grants from NHS Health Scotland/Public Health Scotland, outside the 
submitted work; and he is co-chair of the Academic Advisory Group to the 
Scottish Government's National Suicide Prevention Leadership Group. He is also a 
member of the National Institute for Health and Care Excellence's guideline 
development group for their new self-harm guidelines. C.L.N. reports grants from 
Medical Research Council, during the conduct of the study. S.P. reports personal 
fees from Health Service Executive, Dublin, Ireland, personal fees from NHS 
Health Scotland, Edinburgh, Scotland, outside the submitted work. T.Z. reports 
being employed by the Scottish Government Scotland National Suicide Prevention 
Leadership Group, during the conduct of the study. Outside the submitted work, 
reports grants from NHS Scotland Endowment Funds; and is a co-chair of the Early 
Career Group of the International Association for Suicide Prevention. E.F. 
reports grants from Pfizer Limited and Versus Arthritis, grants from Versus 
Arthritis, grants from Football Association, grants from Medical Research 
Foundation, grants from U. S. Army Medical Research and Materiel Command, 
outside the submitted work. E.S. (Samaritans) and B.W. (Scottish Association for 
Mental Health) are employees of two of the funders of this research. K.W., S.C., 
H.McC., A.J.M., R.E.O'C., D.B.O'C. and K.A.R. have nothing to disclose.


4114. Crit Care. 2020 Oct 15;24(1):611. doi: 10.1186/s13054-020-03320-8.

Antibiotic-related gut dysbiosis induces lung immunodepression and worsens lung 
infection in mice.

Dessein R(1), Bauduin M(1), Grandjean T(1), Le Guern R(1), Figeac M(2), Beury 
D(2), Faure K(1), Faveeuw C(1), Guery B(3), Gosset P(1), Kipnis E(4).

Author information:
(1)Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, 
U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, Lille, France, 
University Lille, F-59000, Lille, France.
(2)CHU Lille, Institut Pasteur de Lille, Inserm, CNRS, UMR2014-US41-PLBS-6 
Plateformes Lilloises de Biologie & Santé, University Lille, F-59000, Lille, 
France.
(3)Infectious Diseases Service, Department of Medicine, University Hospital and 
University of Lausanne, Lausanne, Switzerland.
(4)Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, 
U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, Lille, France, 
University Lille, F-59000, Lille, France. eric.kipnis@univ-lille.fr.

BACKGROUND: Gut dysbiosis due to the adverse effects of antibiotics affects 
outcomes of lung infection. Previous murine models relied on significant 
depletion of both gut and lung microbiota, rendering the analysis of immune 
gut-lung cross-talk difficult. Here, we study the effects of antibiotic-induced 
gut dysbiosis without lung dysbiosis on lung immunity and the consequences on 
acute P. aeruginosa lung infection.
METHODS: C57BL6 mice received 7 days oral vancomycin-colistin, followed by 
normal regimen or fecal microbial transplant or Fms-related tyrosine kinase 3 
ligand (Flt3-Ligand) over 2 days, and then intra-nasal P. aeruginosa strain 
PAO1. Gut and lung microbiota were studied by next-generation sequencing, and 
lung infection outcomes were studied at 24 h. Effects of vancomycin-colistin on 
underlying immunity and bone marrow progenitors were studied in uninfected mice 
by flow cytometry in the lung, spleen, and bone marrow.
RESULTS: Vancomycin-colistin administration induces widespread cellular 
immunosuppression in both the lung and spleen, decreases circulating 
hematopoietic cytokine Flt3-Ligand, and depresses dendritic cell bone marrow 
progenitors leading to worsening of P. aeruginosa lung infection outcomes 
(bacterial loads, lung injury, and survival). Reversal of these effects by fecal 
microbial transplant shows that these alterations are related to gut dysbiosis. 
Recombinant Flt3-Ligand reverses the effects of antibiotics on subsequent lung 
infection.
CONCLUSIONS: These results show that gut dysbiosis strongly impairs 
monocyte/dendritic progenitors and lung immunity, worsening outcomes of P. 
aeruginosa lung infection. Treatment with a fecal microbial transplant or immune 
stimulation by Flt3-Ligand both restore lung cellular responses to and outcomes 
of P. aeruginosa following antibiotic-induced gut dysbiosis.

DOI: 10.1186/s13054-020-03320-8
PMCID: PMC7574210
PMID: 33076936 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


4115. Psicothema. 2020 Nov;32(4):501-507. doi: 10.7334/psicothema2020.218.

Psychological Wellbeing of Vulnerable Children During the COVID-19 Pandemic.

Vallejo-Slocker L(1), Fresneda J, Vallejo MA.

Author information:
(1)Aldeas Infantiles SOS España.

BACKGROUND: A pandemic disaster has specific effects on mental health, however, 
little is known about those specific effects in children and adolescents. Thus, 
the aim of this study is to describe the psychological impact of the COVID-19 
pandemic on a sample of children and adolescents and to compare the results with 
previous national data and other studies to determine variations.
METHOD: A total of 459 children and adolescents in residential care, foster 
families, kinship families, or family strengthening programs under SOS 
Children's Villages Spain were evaluated using the SDQ to measure internalizing 
and externalizing problems and using KIDSCREEN-10 index to measure heath related 
quality of life. An independent sample t-test, one-way ANOVA and the chi-square 
test were used.
RESULTS: The children and adolescents in this study had worse psychological 
wellbeing than those in the 2017 Spanish reference, that is, before the COVID-19 
outbreak. Quality of life remained the same. No differences between care 
modalities were found.
CONCLUSION: It is necessary to monitor the mental health status of children and 
adolescents to prevent possible problems. Additionally, it is necessary to use 
well-known assessment instruments because it is essential to have a reference to 
other situations and populations.

DOI: 10.7334/psicothema2020.218
PMID: 33073755 [Indexed for MEDLINE]


4116. J Pediatr Psychol. 2020 Nov 1;45(10):1114-1123. doi: 10.1093/jpepsy/jsaa093.

Parenting-Related Exhaustion During the Italian COVID-19 Lockdown.

Marchetti D(1), Fontanesi L(1), Mazza C(2), Di Giandomenico S(1), Roma P(3), 
Verrocchio MC(1).

Author information:
(1)Department of Psychological, Health and Territorial Sciences, G. d'Annunzio 
University of Chieti-Pescara.
(2)Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio 
University of Chieti-Pescara.
(3)Department of Human Neuroscience, Sapienza University of Rome.

OBJECTIVE: Worldwide, the coronavirus disease 2019 (COVID-19) pandemic has 
generated significant worry, uncertainty, anxiety, sadness, and loneliness. In 
Italy, these effects have been particularly pronounced. While research on the 
COVID-19 outbreak has mainly focused on the clinical features of infected 
patients and the psychological impact on the general population and health 
professionals, no investigation has yet assessed the psychological impact of the 
pandemic on parents. In the present research, we conducted a web-based survey of 
Italian parents to examine the prevalence of parenting-related exhaustion-and to 
identify its associated risk and protective factors-4 weeks into the lockdown.
METHODS: A total of 1,226 parents provided their consent to participate in the 
study and completed a demographic questionnaire, information relating to 
particular COVID-19 experiences, and measures of emotional exhaustion, parental 
resilience, social connections, and psychological distress during the lockdown.
RESULTS: Seventeen percent of our sample experienced significant 
parenting-related exhaustion, with mothers more severely affected. Multiple 
regression analyses showed that greater parenting-related exhaustion was 
predicted by psychological distress, lower parental resilience, motherhood, 
fewer perceived social connections, and being single, as well as having a child 
with special needs, having a large number of children, and having younger 
children.
CONCLUSION: The findings add further support to the call for preventive programs 
to support parents throughout the COVID-19 pandemic. Mental health professionals 
and social workers should be warned of the effects of lockdown and social 
distancing on parenting and, consequently, the well-being of children.

© The Author(s) 2020. Published by Oxford University Press on behalf of the 
Society of Pediatric Psychology. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/jpepsy/jsaa093
PMCID: PMC7665691
PMID: 33068403 [Indexed for MEDLINE]


4117. Int J Environ Res Public Health. 2020 Oct 13;17(20):7433. doi: 
10.3390/ijerph17207433.

Swiss University Students' Risk Perception and General Anxiety during the 
COVID-19 Pandemic.

Dratva J(1)(2), Zysset A(1), Schlatter N(1), von Wyl A(3), Huber M(1), Volken 
T(1).

Author information:
(1)Department of Health, Institute of Health Sciences, Zurich University of 
Applied Sciences Winterthur, 8400 Winterthur, Switzerland.
(2)Medical Faculty, University of Basel, 4001 Basel, Switzerland.
(3)Department of Psychology, Zurich University of Applied Sciences Winterthur, 
8400 Winterthur, Switzerland.

University students were confronted with abrupt changes to their daily lives by 
the COVID-19 lock-down. We investigated Generalized Anxiety Disorder Scale-7 
(GAD-7) and anxiety levels, and the association between perceived impact on 
well-being, studies, and daily lives and anxiety levels, adjusted for gender, 
age, social class and affiliation. Early in the lock-down all students of the 
Zurich University of Applied Sciences (N = 12,429) were invited to a voluntary 
longitudinal health survey. Participation rate was 20% (n = 2437): 70% females, 
median age 25 yrs. (IQR 23-28). A total of 10% reported a deterioration of 
well-being compared to pre-Corona. LCA yielded three classes varying in 
perceived COVID-19 impact: 1 (low, n = 675), 2 (moderate, n = 1098), and 3 
(strong, n = 656). Adjusted proportion of moderate to severe anxiety by class 
were 45% (95% CI: 28.0-62.0), 15.5% (95% CI: 13.1-17.9), and 5.1% (95% CI: 
4.7-5.6), respectively. Multivariate regression analyses yielded an OR for 
moderate to severe anxiety of 3.88 (95% CI: 2.5-6.0, class 2) and 22.43 (95% CI: 
14.5-34.6, class 3) compared to class-1. The investigated association implies 
that containment measures have a selective effect on anxiety in students. The 
diversity of students' perception and associated anxiety should be monitored and 
considered in future response to pandemics.

DOI: 10.3390/ijerph17207433
PMCID: PMC7599649
PMID: 33066008 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


4118. PLoS One. 2020 Oct 16;15(10):e0240962. doi: 10.1371/journal.pone.0240962. 
eCollection 2020.

Does the COVID-19 pandemic impact parents' and adolescents' well-being? An 
EMA-study on daily affect and parenting.

Janssen LHC(1)(2), Kullberg MJ(1), Verkuil B(1)(2), van Zwieten N(1), Wever 
MCM(1)(2), van Houtum LAEM(1)(2), Wentholt WGM(1)(2), Elzinga BM(1)(2).

Author information:
(1)Department of Clinical Psychology, Institute of Psychology, Leiden 
University, Leiden, The Netherlands.
(2)Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, 
The Netherlands.

Due to the COVID- 19 outbreak in the Netherlands (March 2020) and the associated 
social distancing measures, families were enforced to stay at home as much as 
possible. Adolescents and their families may be particularly affected by this 
enforced proximity, as adolescents strive to become more independent. Yet, 
whether these measures impact emotional well-being in families with adolescents 
has not been examined. In this ecological momentary assessment study, we 
investigated if the COVID-19 pandemic affected positive and negative affect of 
parents and adolescents and parenting behaviors (warmth and criticism). 
Additionally, we examined possible explanations for the hypothesized changes in 
affect and parenting. To do so, we compared daily reports on affect and 
parenting that were gathered during two periods of 14 consecutive days, once 
before the COVID-19 pandemic (2018-2019) and once during the COVID-19 pandemic. 
Multilevel analyses showed that only parents' negative affect increased as 
compared to the period before the pandemic, whereas this was not the case for 
adolescents' negative affect, positive affect and parenting behaviors (from both 
the adolescent and parent perspective). In general, intolerance of uncertainty 
was linked to adolescents' and parents' negative affect and adolescents' 
positive affect. However, Intolerance of uncertainty, nor any pandemic related 
characteristics (i.e. living surface, income, relatives with COVID-19, hours of 
working at home, helping children with school and contact with COVID-19 patients 
at work) were linked to the increase of parents' negative affect during 
COVID-19. It can be concluded that on average, our sample (consisting of 
relatively healthy parents and adolescents) seems to deal fairly well with the 
circumstances. The substantial heterogeneity in the data however, also suggest 
that whether or not parents and adolescents experience (emotional) problems can 
vary from household to household. Implications for researchers, mental health 
care professionals and policy makers are discussed.

DOI: 10.1371/journal.pone.0240962
PMCID: PMC7567366
PMID: 33064778 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


4119. BMC Emerg Med. 2020 Oct 15;20(1):82. doi: 10.1186/s12873-020-00372-5.

Baseline well-being, perceptions of critical incidents, and openness to 
debriefing in community hospital emergency department clinical staff before 
COVID-19, a cross-sectional study.

Cantu L(1), Thomas L(2).

Author information:
(1)Frank H. Netter MD School of Medicine, 370 Bassett Rd, North Haven, CT, 
06473, USA. lacantu@qu.edu.
(2)Frank H. Netter MD School of Medicine, 370 Bassett Rd, North Haven, CT, 
06473, USA.

BACKGROUND: Emergency department personnel routinely bear witness to traumatic 
experiences and critical incidents that can affect their own well-being. Peer 
support through debriefing has demonstrated positive impacts on clinicians' 
well-being following critical incidents. This study explored community hospital 
emergency department staff's perceptions of critical incidents, assessed 
openness to debriefing and measured baseline well-being. Our analysis provides a 
baseline of provider well-being immediately prior to the local onset of 
COVID-19. The potential need for additional resources to support frontline 
providers during the pandemic can be evaluated.
METHOD: We conducted a cross-sectional study for 4-weeks prior to the first 
COVID-19 case in Connecticut using a survey offered to an interprofessional 
group of emergency department clinical staff. The main outcome measures were the 
Hospital Anxiety and Depression Scale (HADS) and the Professional Quality of 
Life (ProQOL) scale. Pearson's chi-square test was used to identify significant 
differences in perceptions of critical incidents and debriefings between 
professional categories. One-way ANOVA and Tukey's test were used to analyze 
significant differences in well-being between professional categories.
RESULTS: Thirty-nine clinical personnel from St. Vincent's Emergency Department 
responded to the survey. Events frequently selected as critical incidents were 
caring for critically ill children (89.7%), mass casualty events (84.6%), and 
death of a patient (69.2%). Critical incidents were commonly reported (81.6%) as 
occurring once per week. Additionally, 76.2% of participants reported wanting to 
discuss a critical incident with their team. Across all respondents, 45.7% 
scored borderline or abnormal for anxiety, 55.9% scored moderate for burnout, 
and 55.8% scored moderate to high for secondary traumatic stress.
CONCLUSIONS: At baseline, providers reported caring for critically ill children, 
mass casualty events, and death of a patient as critical incidents, which 
typically occurred once per week. Death of a patient occurs at increased 
frequency during the protracted mass casualty experience of COVID-19 and 
threatens provider well-being. Receptiveness to post-event debriefing is high 
but the method is still underutilized. With nearly half of staff scoring 
borderline or abnormal for anxiety, burnout, and secondary traumatic stress at 
baseline, peer support measures should be implemented to protect frontline 
providers' well-being during and after the pandemic.

DOI: 10.1186/s12873-020-00372-5
PMCID: PMC7558255
PMID: 33059583 [Indexed for MEDLINE]

Conflict of interest statement: LC and LT are currently researching the efficacy 
of debriefing methods for interprofessional use in acute care settings. The 
authors have no other competing interests to declare.


4120. Sleep Med. 2020 Dec;76:16-25. doi: 10.1016/j.sleep.2020.09.022. Epub 2020 Sep 
25.

The endless quarantine: the impact of the COVID-19 outbreak on healthcare 
workers after three months of mandatory social isolation in Argentina.

Giardino DL(1), Huck-Iriart C(2), Riddick M(3), Garay A(4).

Author information:
(1)Medicina del Sueño-Neurología-Centro de Educación Médica e Investigaciones 
Clínicas "Norberto Quirno" (CEMIC), Buenos Aires, Argentina. Electronic address: 
giardinodaniela@gmail.com.
(2)Escuela de Ciencia y Tecnología (ECyT), Universidad Nacional de San Martín 
(UNSAM), Buenos Aires, Argentina.
(3)Centro de Matemática de La Plata (CMaLP), Departamento de Matemáticas, 
Facultad de Ciencias Exactas, UNLP, CONICET, Buenos Aires, Argentina.
(4)Medicina del Sueño-Neurología-Centro de Educación Médica e Investigaciones 
Clínicas "Norberto Quirno" (CEMIC), Buenos Aires, Argentina.

OBJECTIVES: At the end of 2019 the SARS-CoV-2 outbreak spread around the globe 
with a late arrival to South America. The objective of this study was to 
evaluate the impact of the long period of mandatory social isolation that took 
place in Argentina on the general psychological well-being of healthcare workers 
due to the COVID-19 pandemic.
METHODS: A survey was conducted during June 2020, in healthcare workers. 
Pittsburgh Sleep Quality Index, Insomnia Severity Index, Sleepiness-Wakefulness 
Inability and Fatigue Test, and Goldberg depression and anxiety scale, were used 
to analyze the effects of the SARS-Cov 2 outbreak after three months of 
mandatory social isolation. Analyses were performed by logistic regression and a 
clustering algorithm in order to classify subjects in the function of their 
outcome's severity.
RESULTS: From 1059 surveys, the majority reported symptoms of depression 
(81.0%), anxiety (76.5%), poor sleep quality (84.7%), and insomnia (73.7%) with 
58.9% suffering from nightmares. Logistic regression showed that being in 
contact with COVID-19 patients, age, gender and the consumption of sleep 
medication during the mandatory social isolation were relevant predictors for 
insomnia, anxiety, and depression. Clustering analysis classified healthcare 
workers in three groups with healthy/mild, moderate, and severe outcomes. The 
most vulnerable group was composed mainly of younger people, female, non-medical 
staff, or physicians in training.
CONCLUSION: An extremely high proportion of Argentinian healthcare workers 
suffered from sleep problems, anxiety, and depression symptoms. The clustering 
algorithm successfully separates vulnerable from non-vulnerable populations 
suggesting the need to carry out future studies involving resilience and 
vulnerability factors.

Copyright © 2020 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.sleep.2020.09.022
PMCID: PMC7518855
PMID: 33059247 [Indexed for MEDLINE]

Conflict of interest statement: On behalf of all authors, the corresponding 
author states that there is no conflict of interest. The ICMJE Uniform 
Disclosure Form for Potential Conflicts of Interest associated with this article 
can be viewed by clicking on the following link: 
https://doi.org/10.1016/j.sleep.2020.09.022.


4121. Gen Hosp Psychiatry. 2020 Nov-Dec;67:62-69. doi: 
10.1016/j.genhosppsych.2020.08.013. Epub 2020 Sep 9.

Supporting the well-being of health care providers during the COVID-19 pandemic: 
The CopeColumbia response.

Mellins CA(1), Mayer LES(2), Glasofer DR(3), Devlin MJ(4), Albano AM(5), Nash 
SS(6), Engle E(7), Cullen C(8), Ng WYK(9), Allmann AE(10), Fitelson EM(11), 
Vieira A(12), Remien RH(13), Malone P(14), Wainberg ML(15), Baptista-Neto L(16).

Author information:
(1)Department of Psychiatry, Columbia University Irving Medical Center and the 
New York State Psychiatric Institute, New York, NY, USA. Electronic address: 
cam14@cumc.columbia.edu.
(2)Department of Psychiatry, Columbia University Irving Medical Center and the 
New York State Psychiatric Institute, New York, NY, USA. Electronic address: 
lsm16@cumc.columbia.edu.
(3)Department of Psychiatry, Columbia University Irving Medical Center and the 
New York State Psychiatric Institute, New York, NY, USA. Electronic address: 
deborah.glasofer@nyspi.columbia.edu.
(4)Department of Psychiatry, Columbia University Irving Medical Center and the 
New York State Psychiatric Institute, New York, NY, USA. Electronic address: 
mjd5@cumc.columbia.edu.
(5)Department of Psychiatry, Columbia University Irving Medical Center, New York 
City, New York, USA. Electronic address: aa2289@cumc.columbia.edu.
(6)Department of Psychiatry, Columbia University Irving Medical Center, New York 
City, New York, USA. Electronic address: sas2007@cumc.columbia.edu.
(7)Department of Psychiatry, Columbia University Irving Medical Center, New York 
City, New York, USA. Electronic address: eke2101@cumc.columbia.edu.
(8)Department of Psychiatry, Columbia University Irving Medical Center, New York 
City, New York, USA. Electronic address: ccc2159@cumc.columbia.edu.
(9)Department of Psychiatry, Columbia University Irving Medical Center, New York 
City, New York, USA. Electronic address: yyn2@cumc.columbia.edu.
(10)Department of Psychiatry, Columbia University Irving Medical Center and the 
New York State Psychiatric Institute, New York, NY, USA. Electronic address: 
aa4540@cumc.columbia.edu.
(11)Department of Psychiatry, Columbia University Irving Medical Center, New 
York City, New York, USA. Electronic address: eem36@cumc.columbia.edu.
(12)Department of Human Resources, Columbia University Irving Medical Center, 
New York City, New York, USA. Electronic address: av2548@cumc.columbia.edu.
(13)Department of Psychiatry, Columbia University Irving Medical Center and the 
New York State Psychiatric Institute, New York, NY, USA. Electronic address: 
rhr1@cumc.columbia.edu.
(14)Department of Psychiatry, Columbia University Irving Medical Center, New 
York City, New York, USA. Electronic address: pkw2105@cumc.columbia.edu.
(15)Department of Psychiatry, Columbia University Irving Medical Center and the 
New York State Psychiatric Institute, New York, NY, USA. Electronic address: 
milton.wainberg@nyspi.columbia.edu.
(16)Department of Psychiatry, Columbia University Irving Medical Center and the 
New York State Psychiatric Institute, New York, NY, USA. Electronic address: 
lb2602@cumc.columbia.edu.

OBJECTIVE: COVID-19 is an international public health crisis, putting 
substantial burden on medical centers and increasing the psychological toll on 
health care workers (HCW).
METHODS: This paper describes CopeColumbia, a peer support program developed by 
faculty in a large urban medical center's Department of Psychiatry to support 
emotional well-being and enhance the professional resilience of HCW.
RESULTS: Grounded in evidence-based clinical practice and research, peer support 
was offered in three formats: groups, individual sessions, and town halls. Also, 
psychoeducational resources were centralized on a website. A Facilitator's Guide 
informed group and individual work by including: (1) emotional themes likely to 
arise (e.g., stress, anxiety, trauma, grief, and anger) and (2) suggested 
facilitator responses and interventions, drawing upon evidence-based principles 
from peer support, stress and coping models, and problem-solving, cognitive 
behavioral, and acceptance and commitment therapies. Feedback from group 
sessions was overwhelmingly positive. Approximately 1/3 of individual sessions 
led to treatment referrals.
CONCLUSIONS: Lessons learned include: (1) there is likely an ongoing need for 
both well-being programs and linkages to mental health services for HCW, (2) the 
workforce with proper support, will emerge emotionally resilient, and (3) 
organizational support for programs like CopeColumbia is critical for 
sustainability.

Copyright © 2020. Published by Elsevier Inc.

DOI: 10.1016/j.genhosppsych.2020.08.013
PMCID: PMC7480793
PMID: 33059217 [Indexed for MEDLINE]


4122. Adv Neonatal Care. 2021 Feb 1;21(1):23-31. doi: 10.1097/ANC.0000000000000811.

Nurse Perceptions of Babywearing for Neonates With Neonatal Abstinence Syndrome 
in the Neonatal Intensive Care Unit.

Williams LR(1), Grisham LM, Gebler-Wolfe M, Kelsch K, Bedrick A, Bader MY.

Author information:
(1)School of Social Work, Tucson, Arizona State University (Dr Williams and Mss 
Gebler-Wolfe and Kelsch); Division of Neonatology, Department of Pediatrics, 
Banner University Medical Center, Tucson, Arizona (Ms Grisham and Drs Bedrick 
and Bader); and Division of Neonatology and Developmental Biology, Department of 
Pediatrics, University of Arizona College of Medicine, Tucson(Drs Bedrick and 
Bader).

BACKGROUND: Infants diagnosed with neonatal abstinence syndrome (NAS) often 
spend several weeks in a neonatal intensive care unit (NICU) and have difficulty 
being consoled. Infant carriers may be used to help with irritability, while 
allowing the adult user to be more mobile, through the practice of babywearing 
(the facilitated holding of an infant using a soft cloth infant carrier worn on 
the body).
PURPOSE: To examine the experience of babywearing infants diagnosed with NAS 
while admitted in the NICU from the perspective of the nurses who care for them.
METHODS: Nurses (N = 18; mean age = 35.44 years, SD = 9.45) were recruited and 
interviewed using a semistructured interview method from a 38-bed NICU in the 
Southwestern United States.
RESULTS: A thematic content analyses using an open coding scheme yielded 6 
themes that fell into 2 categories: (1) benefits of babywearing infants with NAS 
in the NICU (Infant Consoling, Adult Multitasking, Caregiver-Infant Trust); and 
(2) suggestions to maximize babywearing in the NICU (Infection Control, 
Reoccurring Infant Carrier Education, and Reduced Patient Load).
IMPLICATIONS FOR PRACTICE: Many NICUs incorporate kangaroo care (or skin-to-skin 
contact) as a treatment option; however, NICU staff cannot participate in 
kangaroo care. Babywearing is a practical alternative for nurses and support 
staff. Nurses supported the practice of babywearing as a means to improve the 
well-being of infants with NAS while also allowing for increased efficiency in 
nursing tasks.
IMPLICATIONS FOR RESEARCH: More prospective studies are needed that evaluate the 
carryover effects and long-term impact of babywearing for infants diagnosed with 
NAS.

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/ANC.0000000000000811
PMID: 33055521 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest: None.


4123. BMJ Mil Health. 2021 Aug;167(4):266-268. doi: 10.1136/bmjmilitary-2020-001603. 
Epub 2020 Oct 14.

Recovery of individual Service personnel in the COVID-19 recovery phase.

Taylor H(1), Quantick O(2), Ross D(3).

Author information:
(1)Robertson House, HQ Army Medical Services, Camberley, UK 
Hannah.Taylor43@nhs.net.
(2)Public Health, Army HQ, Andover, Hampshire, UK.
(3)HQ Army Medical Services - Robertson House, Camberley, Surrey, UK.

To deny the SARS-CoV-2 virus easy options for sustained transmission, commanders 
should model adherence to, and ensure implementation of, social mitigation 
measures. While some measures can be achieved at the organisational level 
through policy, every Service person's experience of the COVID-19 pandemic will 
have differed, affected by a range of personal, occupational and geographical 
factors. A successful recovery phase for each Service personnel (SP) therefore 
relies on localised assessments and individualised support plans. The return of 
SP to the physical environment must be safe, and the financial needs of their 
whole family must be considered. Commanders must understand the need for balance 
in supporting social reconnection both personally and in the workplace. 
Commanders have an important role in the development of SPs' mental resilience; 
supporting mental well-being, early recognition of deteriorating mental health 
and signposting, and compassionate understanding of the needs of SP deployed or 
bereaved. Disruptions to healthcare service provision will impact the duration 
of medical downgrading, workforce capacity and operational effectiveness 
according to extant parameters, which must be understood by commanders. 
Likewise, functional fitness may have been adversely affected. Physical health 
and fitness recovery can be supported by time-based extensions to occupational 
health policy and graduated return to work physical training programmes.

© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and 
permissions. Published by BMJ.

DOI: 10.1136/bmjmilitary-2020-001603
PMID: 33055189 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


4124. Int J Environ Res Public Health. 2020 Oct 12;17(20):7417. doi: 
10.3390/ijerph17207417.

Mental Well-Being (Depression, Loneliness, Insomnia, Daily Life Fatigue) during 
COVID-19 Related Home-Confinement-A Study from Poland.

Bartoszek A(1)(2), Walkowiak D(3), Bartoszek A(4), Kardas G(5).

Author information:
(1)Faculty of Medicine, Medical University of Lodz, 90-001 Lodz, Poland.
(2)Department of Pathophysiology, Medical University of Lublin, Lublin, 20-090, 
Poland.
(3)Department of Organization and Management in Health Care Poznan University of 
Medical Sciences, 60-356 Poznań, Poland.
(4)Department of Family Medicine and Community Nursing, Medical University of 
Lublin, 20-081 Lublin, Poland.
(5)Clinic of Internal Medicine, Asthma and Allergy, Medical University of Lodz, 
90-001 Lodz, Poland.

The COVID-19 pandemic is a great threat to both physical and mental health as it 
may lead to psychological stress connected with an economic crisis, threat of 
unemployment, or fear of losing family members. Emerging data shows that the 
general public may be vulnerable to the pandemic-related stress and experience 
frequently prevalent anxiety. A study involving 471 subjects (85.6% female) was 
conducted online during the COVID-19 pandemic. We used the following scales: 
Insomnia Severity Index (ISI), Beck Depression Inventory (BDI), Revised 
University of California, Los Angeles (R-UCLA) Loneliness Scale, and Daily Life 
Fatigue scale (DLF). Women had higher mean scores of depression, loneliness, and 
daily life fatigue and more often than males started exercising. Among people 
professionally active before the pandemic, there were more cases of increased 
alcohol consumption than among students. No differences in alcohol consumption 
patterns were found between genders. People living alone had higher scores of 
loneliness and daily life fatigue compared to those living with someone. 
Respondents who started taking any new drugs during COVID-19 home confinement 
had higher outcomes in all questionnaires. During home confinement, high scores 
of depression, insomnia, loneliness, and everyday fatigue were observed.

DOI: 10.3390/ijerph17207417
PMCID: PMC7599953
PMID: 33053787 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


4125. Int J Environ Res Public Health. 2020 Oct 12;17(20):7413. doi: 
10.3390/ijerph17207413.

Group Membership and Social and Personal Identities as Psychosocial Coping 
Resources to Psychological Consequences of the COVID-19 Confinement.

Alcover CM(1), Rodríguez F(1), Pastor Y(1), Thomas H(1), Rey M(2), Del Barrio 
JL(3).

Author information:
(1)Department of Psychology, Universidad Rey Juan Carlos, 28922 Alcorcón, 
Madrid, Spain.
(2)Centro de Salud Mental de Ciudad Lineal, Hospital Universitario Ramón y 
Cajal, 28017 Madrid, Spain.
(3)Department of Medical Specialties and Public Health, Universidad Rey Juan 
Carlos, 28922 Alcorcón, Madrid, Spain.

The confinement imposed by measures to deal with the COVID-19 pandemic may in 
the short and medium term have psychological and psychosocial consequences 
affecting the well-being and mental health of individuals. This study aims to 
explore the role played by group membership and social and personal identities 
as coping resources to face the experience of the COVID-19 confinement and 
radical disruption of social, work, family and personal life in a sample of 421 
people who have experienced a month of strict confinement in the Region of 
Madrid. Our results show that identity-resources (membership continuity/new 
group memberships, and personal identity strength) are positively related to 
process-resources (social support and perceived personal control), and that both 
are related to better perceived mental health, lower levels of anxiety and 
depression, and higher well-being (life satisfaction and resilience) during 
confinement. These results, in addition to providing relevant information about 
the psychological consequences of this experience, constitute a solid basis for 
the design of psychosocial interventions based on group memberships and social 
identity as coping resources.

DOI: 10.3390/ijerph17207413
PMCID: PMC7601487
PMID: 33053738 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


4126. West J Emerg Med. 2020 Sep 25;21(6):88-92. doi: 10.5811/westjem.2020.8.48579.

A Video-based Debriefing Program to Support Emergency Medicine Clinician 
Well-being During the COVID-19 Pandemic.

Monette DL(1), Macias-Konstantopoulos WL(1), Brown DFM(1), Raja AS(1), Takayesu 
JK(1).

Author information:
(1)Massachusetts General Hospital and Harvard Medical School, Department of 
Emergency Medicine, Boston, Massachusetts.

INTRODUCTION: Emergency clinicians on the frontline of the coronavirus pandemic 
experience a range of emotions including anxiety, fear, and grief. Debriefing 
can help clinicians process these emotions, but the coronavirus pandemic makes 
it difficult to create a physically and psychologically safe space in the 
emergency department (ED) to perform this intervention. In response, we piloted 
a video-based debriefing program to support emergency clinician well-being. We 
report the details of our program and results of our evaluation of its 
acceptability and perceived value to emergency clinicians during the pandemic.
METHODS: ED attending physicians, resident physicians, and non-physician 
practitioners (NPP) at our quaternary-care academic medical center were invited 
to participate in role-based, weekly one-hour facilitated debriefings using 
Zoom. ED attendings with experience in debriefing led each session and used an 
explorative approach that focused on empathy and normalizing reactions. At the 
end of the pilot, we distributed to participants an anonymous 10-point survey 
that included multiple-answer questions and visual analogue scales.
RESULTS: We completed 18 debriefings with 68 unique participants (29 attending 
physicians, 6 resident physicians, and 33 NPPs. A total of 76% of participants 
responded to our survey and 77% of respondents participated in at least two 
debriefings. Emergency clinicians reported that the most common reasons to 
participate in the debriefings were "to enhance my sense of community and 
connection" (81%) followed by "to support colleagues" (75%). Debriefing with 
members of the same role group (92%) and the Zoom platform (81%) were considered 
to be helpful aspects of the debriefing structure. Although emergency clinicians 
found these sessions to be useful (78.8 +/- 17.6) interquartile range: 73-89), 
NPPs were less comfortable speaking up (58.5 +/- 23.6) than attending physicians 
(77.8 +/- 25.0) (p = < 0.008).
CONCLUSION: Emergency clinicians participating in a video-based debriefing 
program during the coronavirus pandemic found it to be an acceptable and useful 
approach to support emotional well-being. Our program provided participants with 
a platform to support each other and maintain a sense of community and 
connection. Other EDs should consider implementing a debriefing program to 
safeguard the emotional well-being of their emergency clinician workforce.

DOI: 10.5811/westjem.2020.8.48579
PMCID: PMC7673898
PMID: 33052815 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: By the WestJEM article 
submission agreement, all authors are required to disclose all affiliations, 
funding sources and financial or management relationships that could be 
perceived as potential sources of bias. No author has professional or financial 
relationships with any companies that are relevant to this study. There are no 
conflicts of interest or sources of funding to declare.


4127. Public Health Nutr. 2021 Feb;24(3):412-421. doi: 10.1017/S1368980020004000. Epub 
2020 Oct 14.

Food insecurity measurement and prevalence estimates during the COVID-19 
pandemic in a repeated cross-sectional survey in Mexico.

Gaitán-Rossi P(1), Vilar-Compte M(1), Teruel G(1), Pérez-Escamilla R(2).

Author information:
(1)Research Institute for Equitable Development EQUIDE, Universidad 
Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fé, Mexico 
City01219, Mexico.
(2)Department of Social and Behavioral Sciences, Yale School of Public Health, 
New Haven, CT, USA.

OBJECTIVE: To validate the telephone modality of the Latin American and 
Caribbean Food Security Scale (ELCSA) included in three waves of a phone survey 
to estimate the monthly household food insecurity prevalence during the COVID-19 
pandemic in Mexico.
DESIGN: We examined the reliability and internal validity of the ELCSA scale in 
three repeated waves of cross-sectional surveys with Rasch models. We estimated 
the monthly prevalence of food insecurity in the general population and in 
households with and without children and compared them with a national 2018 
survey. We tested concurrent validity by testing associations of food insecurity 
with socio-economic status and anxiety.
SETTING: ENCOVID-19 is a monthly telephone cross-sectional survey collecting 
information on the well-being of Mexican households during the pandemic 
lockdown. Surveys used probabilistic samples, and we used data from April (n 
833), May (n 850) and June 2020 (n 1674).
PARTICIPANTS: Mexicans 18 years or older who had a mobile telephone.
RESULTS: ELCSA had an adequate model fit and food insecurity was associated, 
within each wave, with more poverty and anxiety. The COVID-19 lockdown was 
associated with an important reduction in food security, decreasing stepwise 
from 38·9 % in 2018 to 24·9 % in June 2020 in households with children.
CONCLUSIONS: Telephone surveys were a feasible strategy to monitor reductions in 
food security during the COVID-19 lockdown.

DOI: 10.1017/S1368980020004000
PMCID: PMC7653232
PMID: 33050968 [Indexed for MEDLINE]


4128. Psychol Rep. 2021 Dec;124(6):2567-2586. doi: 10.1177/0033294120965477. Epub 2020 
Oct 13.

Psychological Resilience of Healthcare Professionals During COVID-19 Pandemic.

Bozdağ F(1)(2), Ergün N(2).

Author information:
(1)Guidance and Psychological Counseling, Department of Educational Sciences, 
Faculty of Education, Istanbul University-Cerrahpasa, Istanbul, Turkey.
(2)Department of Educational Sciences, Faculty of Letters, Mardin Artuklu 
University, Mardin, Turkey.

The COVID-19 pandemic as a public health issue has spread to the rest of the 
world. Although the wellbeing and emotional resilience of healthcare 
professionals are key components of continuing healthcare services during the 
COVID-19 pandemic, healthcare professionals have been observed in this period to 
experience serious psychological problems and to be at risk in terms of mental 
health. Therefore, this study aims to probe psychological resilience of 
healthcare workers. The findings of this study showed that in order to raise 
psychological resilience of healthcare professionals working during the COVID-19 
pandemic their quality of sleep, positive emotions and life satisfaction need to 
be enhanced. Psychological resilience levels of healthcare workers in their 
later years were found to be higher. Doctors constitute the group with the 
lowest levels of psychological resilience among healthcare workers. The current 
study is considered to have contributed to the literature in this regard. 
Primary needs such as sleep which are determinants of quality of life, life 
satisfaction and psychological resilience should be met.

DOI: 10.1177/0033294120965477
PMCID: PMC7557235
PMID: 33050800 [Indexed for MEDLINE]


4129. Child Adolesc Ment Health. 2020 Nov;25(4):265-266. doi: 10.1111/camh.12428. Epub 
2020 Oct 13.

Debate: The impact of school closures and lockdown on mental health in young 
people.

Townsend E(1).

Author information:
(1)School of Psychology, University of Nottingham, Nottingham, UK.

The COVID-19 pandemic lockdown response has had a disproportionate and damaging 
effect on the lives, mental health and well-being of young people globally. They 
have been neglected in policy-making and their needs have been subjugated to 
those of adults which contravenes the UN Convention on the Rights of the Child. 
Here, I argue that the needs and rights of young people must come first to 
protect their health, mental health and futures. If we do not do this, we will 
let down a generation of children who will bear the brunt of the fallout of the 
economic burden of the global COVID-19 crisis.

© 2020 The Authors. Child and Adolescent Mental Health published by John Wiley & 
Sons Ltd on behalf of Association for Child and Adolescent Mental Health.

DOI: 10.1111/camh.12428
PMCID: PMC7675670
PMID: 33049100 [Indexed for MEDLINE]


4130. PLoS One. 2020 Oct 13;15(10):e0240650. doi: 10.1371/journal.pone.0240650. 
eCollection 2020.

Dynamics of psychological responses to COVID-19 in India: A longitudinal study.

Gopal A(1), Sharma AJ(2), Subramanyam MA(2).

Author information:
(1)Cognitive Science, Indian Institute of Technology Gandhinagar, Gujarat, 
India.
(2)Social Epidemiology, Indian Institute of Technology Gandhinagar, Gujarat, 
India.

The novel COVID-19 pandemic has created chaos around the globe. To curb its 
spread, the Government of India announced a nationwide lockdown on March 24th, 
2020 for 21 days, which was extended further for a longer time. This long period 
of lockdown disrupted the routine of all citizens, affecting their psychological 
well-being. While recent studies showed the psychological burden of Indians 
during the pandemic, no study has assessed whether the psychological toll 
changed over time due to repeated extensions of the lockdown. We followed up 159 
Indian adults during the first two months of the lockdown to assess any change 
in their anxiety, stress, and depressive symptoms. Multilevel linear regression 
models of repeated observations nested within individuals adjusted for 
sociodemographic covariates showed that anxiety (β = 0.81, 95% CI: 0.03, 1.60), 
stress (β = 0.51, CI: 0.32, 0.70), and depressive symptoms (β = 0.37, CI: 0.13, 
0.60) increased over time during the lockdown. This increase was higher among 
women than men independent of covariates. Individual resilience was negatively 
associated with adverse psychological outcomes. Our findings suggested that 
while the lockdown may help in effectively addressing this pandemic, the state 
and society at large need to be sensitive to the mental health impacts of a 
long-drawn-out lockdown. Such effects likely have long-term sequelae. The 
disproportionate impact on women needs immediate attention. Moreover, it 
behooves society to address the root causes driving the unequal distribution of 
psychological distress during such crises.

DOI: 10.1371/journal.pone.0240650
PMCID: PMC7553269
PMID: 33048979 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


4131. J Am Coll Health. 2022 Jul;70(5):1356-1358. doi: 10.1080/07448481.2020.1803882. 
Epub 2020 Oct 13.

Priorities for addressing the impact of the COVID-19 pandemic on college student 
mental health.

Liu CH(1), Pinder-Amaker S(2), Hahm HC(3), Chen JA(4).

Author information:
(1)Departments of Newborn Medicine and Psychiatry, Brigham and Women's Hospital, 
Harvard Medical School, Boston, Massachusetts, USA.
(2)Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, 
Massachusetts, USA.
(3)School of Social Work, Boston University, Boston, Massachusetts, USA.
(4)Department of Psychiatry, Massachusetts General Hospital, Harvard Medical 
School, Boston, Massachusetts, USA.

The COVID-19 pandemic has already produced profound impacts on college students, 
with unprecedented directives for student relocation from their college campuses 
and dormitories mid-semester and coursework that took place through virtual 
learning. The current disruptions and anticipated potential long-term changes 
call for immediate prioritization regarding next steps for addressing college 
mental health and well-being. This viewpoint article highlights two urgent 
priorities for addressing current college mental health needs: the development 
of strategies for ensuring mental health service access, and intentional 
outreach to college students with special circumstances. The current crisis also 
represents an opportunity for campus administrators, mental health 
professionals, researchers, and policymakers to leverage innovative models of 
care as well as identity-related student assets, strengths, and 
resilience-promoting factors to support students' eventual return to campus and 
to respond more effectively to future massive disruptions.

DOI: 10.1080/07448481.2020.1803882
PMCID: PMC8041897
PMID: 33048654 [Indexed for MEDLINE]


4132. Inflamm Bowel Dis. 2021 Jul 27;27(8):1224-1229. doi: 10.1093/ibd/izaa261.

COVID-19 Pandemic's Effects on Disease and Psychological Outcomes of People With 
Inflammatory Bowel Disease in Portugal: A Preliminary Research.

Trindade IA(1), Ferreira NB(2).

Author information:
(1)Center for Research in Neuropsychology and Cognitive and Behavioral 
Intervention (CINEICC), Faculty of Psychology and Education Sciences, University 
of Coimbra, Coimbra, Portugal.
(2)University of Nicosia, Cyprus.

AIMS: No empirical research on the psychological impact of the coronavirus 
disease 2019 (COVID-19) pandemic on people living with IBD, a population known 
to typically present high levels of anxiety and depression and to be potentially 
vulnerable to COVID-19, has yet been conducted. This study aimed to explore the 
links between contextual variables related to the COVID-19 pandemic and disease 
and psychological outcomes.
METHODS: The sample included 124 Portuguese patients with Crohn's disease or 
ulcerative colitis (85.48% women) who completed self-reported measures in an 
online survey during April 2020.
RESULTS: Fear of contracting COVID-19 and medication adherence were both high 
and unrelated. About half of the sample presented moderate (37.10%) to severe 
(14.50%) anxiety. Normal and mild anxiety levels were at 29.80% and 18.50%, 
respectively. Regarding depressive symptoms, 51.60% of the sample presented 
normal levels, 27.40% mild severity, 16.10% moderate, and 4.8% severe. No 
differences were found between Crohn's disease and ulcerative colitis patients. 
Regression analyses showed that anxiety explained IBD symptom perception (β = 
0.29; P = 0.022); fear of contracting COVID-19 (β = 0.35; P < 0.001) and IBD 
symptom perception (β = -0.22; P = 0.009) explained depressive symptoms; and 
fear of contracting COVID-19 (β = 0.41; P < 0.001), IBD symptom perception (β = 
0.26, P < 0.001), and being in isolation (β = -0.16, P = 0.041) explained 
anxiety. Type of medication was not linked to these outcomes.
CONCLUSIONS: The COVID-19 pandemic does not seem to be affecting adherence to 
medication but seems to present relevant effects on psychological well-being. 
Inflammatory bowel disease health care professionals should be attentive of 
patients' psychological response to this pandemic and of its possible 
consequences on disease expression. This study additionally provided a 
psychometrically sound measure of fear of contracting COVID-19.

© 2020 Crohn’s & Colitis Foundation. Published by Oxford University Press. All 
rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

DOI: 10.1093/ibd/izaa261
PMCID: PMC7665477
PMID: 33043977 [Indexed for MEDLINE]


4133. Australas Psychiatry. 2021 Feb;29(1):26-30. doi: 10.1177/1039856220965045. Epub 
2020 Oct 12.

Burnout and psychological distress amongst Australian healthcare workers during 
the COVID-19 pandemic.

Dobson H(1)(2), Malpas CB(3), Burrell AJ(4), Gurvich C(5), Chen L(5), Kulkarni 
J(5), Winton-Brown T(1)(6).

Author information:
(1)Department of Psychiatry, The Alfred Hospital, Melbourne, VIC, Australia.
(2)The Monash Alfred Psychiatry Research Centre, Monash University, VIC, 
Australia.
(3)Department of Neuroscience, Central Clinical School, Monash University, 
Melbourne, VIC, Australia.
(4)Department of Intensive Care, The Alfred Hospital, Melbourne, VIC, Australia.
(5)The Monash Alfred Psychiatry Research Centre, Monash University, Melbourne, 
VIC, Australia.
(6)Department of Neuroscience, Central Clinical School, Monash University, VIC, 
Australia.

Erratum in
    Australas Psychiatry. 2022 Apr;30(2):280.

OBJECTIVE: To examine psychological distress in healthcare workers (HCWs) during 
the COVID-19 pandemic in April-May 2020.
METHODS: A cross-sectional survey examining demographic, employment and mental 
health characteristics of HCWs in a large metropolitan hospital in Australia.
RESULTS: HCWs showed significant symptoms of moderate-severe level depression 
(21%), anxiety (20%) and posttraumatic stress disorder (PTSD; 29%), associated 
with burnout, prior psychiatric history, profession and resilience.
CONCLUSION: Despite low levels of COVID contact, moderate to high levels of 
psychological distress were reported. Continued monitoring and support for HCWs' 
mental well-being is warranted as the COVID-19 pandemic develops.

DOI: 10.1177/1039856220965045
PMCID: PMC7554409
PMID: 33043677 [Indexed for MEDLINE]

Conflict of interest statement: Disclosure: The authors report no conflict of 
interest. The authors alone are responsible for the content and writing of the 
paper.


4134. Eur J Neurol. 2021 Oct;28(10):3375-3383. doi: 10.1111/ene.14580. Epub 2020 Nov 
3.

COVID-19 pandemic and mental distress in multiple sclerosis: Implications for 
clinical management.

Costabile T(1), Carotenuto A(1), Lavorgna L(2), Borriello G(3), Moiola L(4), 
Inglese M(5)(6), Petruzzo M(1), Trojsi F(2), Ianniello A(3), Nozzolillo A(4), 
Cellerino M(5), Boffa G(5), Rosa L(1), Servillo G(1), Moccia M(1), Bonavita 
S(2), Filippi M(4)(7)(8)(9), Lanzillo R(1), Brescia Morra V(1), Petracca M(1).

Author information:
(1)Department of Neurosciences, Reproductive and Odontostomatological Sciences, 
University of Naples Federico II, Naples, Italy.
(2)Second Division of Neurology, Multiple Sclerosis Center, University of 
Campania Luigi Vanvitelli, Naples, Italy.
(3)MS Center, S. Andrea Hospital, Sapienza University, Rome, Italy.
(4)Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
(5)Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal 
and Child Health (DINOGMI), University of Genoa, Genoa, Italy.
(6)Ospedale Policlinico San Martino IRCCS, Genoa, Italy.
(7)Neuroimaging Research Unit, Division of Neuroscience, Institute of 
Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
(8)Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
(9)Vita-Salute San Raffaele University, Milan, Italy.

BACKGROUND AND PURPOSE: In multiple sclerosis (MS), disease-related factors and 
dysfunctional coping might favor the development of mental distress induced by 
COVID-19 containment measures. Aim of this study was exploring the relationship 
between disability, coping strategies, daily life reorganization and 
neuropsychiatric symptoms in an Italian MS population during the COVID-19 
lockdown, in order to identify potentially modifiable factors that could inform 
clinical management of mental distress in people with MS.
METHODS: We explored the relationship between mental distress, disability and 
coping strategies in the Italian MS population under lockdown. Structural 
equation modeling was applied to information collected via web survey to 
identify modifiable factors that could account for mental distress.
RESULTS: A total of 845 participants (497 with MS and 348 controls) were 
included in the study. The MS group had higher scores than the control group for 
depression (p = 0.005), but not for anxiety, emotional dyscontrol or sleep 
disturbances. The structural equation modeling explained 74% of the variance 
observed in depression score. Within the model, three latent factors were 
characterized from measured variables: motor disability and cognitive 
dysfunction contributed to disability (β = 0.509 and β = 0.836; p < 0.001); 
positive attitude and exercise contributed to active attitude (β = 0.386 and 
β = 0.297; p < 0.001); and avoidance, social support and watching television 
contributed to passive attitude (β = 0.301, β = 0.243 and β = 0.212; p < 0.001). 
With regard to the relationship between latent factors and their influence on 
depression, disability contributed to passive attitude (β = 0.855; p < 0.001), 
while both passive and active attitude significantly influenced depression 
(β = 0.729 and β = -0.456; p < 0.001).
CONCLUSION: As a practical implication of our model, favoring exercise would 
enhance active attitude and its positive impact on mental well-being while, at 
the same time, reducing the negative impact of disability on depression, 
representing a valuable tool in facing COVID-19-related mental distress.

© 2021 European Academy of Neurology.

DOI: 10.1111/ene.14580
PMCID: PMC7675416
PMID: 33043560 [Indexed for MEDLINE]

Conflict of interest statement: T.C. has received honoraria from Roche and 
Novartis. A.C. has received research grants from ALMIRALL, and honoraria from 
Novartis, Merck and Biogen. L.L. received speaker honoraria and travel grants 
from Teva, Merck, Sanofi, Novartis, Biogen, Roche and Bayer. G.B. received fees 
for consultation and Advisory board from Biogen, Almirall, Novartis, Merck, 
Teva, Roche and Sanofi Genzyme. L.M. has received speaker's honoraria from the 
following companies: Biogen, Merck, Novartis, Roche, Sanofi‐Genzyme and TEVA. 
M.I. received research grants from the National Institute of Health, Department 
of Defense (DOD), National Multiple Sclerosis Society (NMSS), Federazione 
Italiana Sclerosi Multipla (FISM), and Teva Neuroscience. M. Petruzzo, F.T., 
A.I., A.N., M.C., G.B., L.R., G.S. and S.B. have nothing to disclose. M.M. has 
received research grants from ECTRIMS‐MAGNIMS, the UK MS Society and Merck, 
honoraria from Biogen, Merck, Novartis and Roche, and consulting fees from 
Veterans Evaluation Services. M.F. is Editor‐in‐Chief of the Journal of 
Neurology, has received compensation for consulting services and/or speaking 
activities from Biogen Idec, Merck‐Serono, Novartis, Teva Pharmaceutical 
Industries, and receives research support from Biogen Idec, Merck‐Serono, 
Novartis, Teva Pharmaceutical Industries, Roche, Italian Ministry of Health, 
Fondazione Italiana Sclerosi Multipla and ARiSLA (Fondazione Italiana di Ricerca 
per la SLA). R.L. has received personal compensation for speaking or consultancy 
from Biogen, Teva, Genzyme, Merck, Novartis and Almirall. M. Petracca has 
received travel grants from Novartis. V.B.M. has received personal compensations 
for speaking or consultancy from Biogen, Teva, Genzyme, Merck, Novartis and 
Almirall.


4135. Soc Sci Med. 2020 Nov;265:113389. doi: 10.1016/j.socscimed.2020.113389. Epub 
2020 Sep 25.

Resilience and demographic characteristics predicting distress during the 
COVID-19 crisis.

Kimhi S(1), Marciano H(2), Eshel Y(3), Adini B(4).

Author information:
(1)Head of the Stress and Resilience Research Center, Tel-Hai College, Israel; 
Stress and Resilience Research Center, Tel-Hai College, and the Ergonomics and 
Human Factors Unit, University of Haifa, Israel. Electronic address: 
shaulkim@telhai.ac.il.
(2)Stress and Resilience Research Center, Tel-Hai College, and the Ergonomics 
and Human Factors Unit, University of Haifa, Israel. Electronic address: 
hmarcia1@univ.haifa.ac.il.
(3)Stress, and Resilience Research Center, Tel-Hai College, and University of 
Haifa, Israel. Electronic address: yeshel@psy.haifa.ac.il.
(4)Head of the Department of Emergency Management and Disaster Management School 
of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Israel. 
Electronic address: adini@netvision.net.il.

RATIONALE: Due to lack of vaccine or cure, the COVID-19 pandemic presents a 
threat to all human beings, undermining people's basic sense of safety and 
increasing distress symptoms.
OBJECTIVE: To investigate the extent to which individual resilience, well-being 
and demographic characteristics may predict two indicators of Coronavirus 
pandemic: distress symptoms and perceived danger.
METHOD: Two independent samples were employed: 1) 605 respondents recruited 
through an internet panel company; 2) 741 respondents recruited through social 
media, using snowball sampling. Both samples filled a structured online 
questionnaire. Correlations between psychological/demographic variables and 
distress and perceived danger were examined. Path analysis was conducted to 
identify predictive indicators of distress and perceived danger.
RESULTS: Significant negative correlations were found between 
individual/community resilience and sense of danger (-0.220 and -0.255 
respectively; p < .001) and distress symptoms (- 0.398 and -0.544 respectively; 
p < .001). Significant positive correlations were found between gender, 
community size, economic difficulties and sense of danger (0.192, 0.117 and 
0.244 respectively; p < .001). Gender and economic difficulties also positively 
correlated with distress symptoms (0.130 and 0.214 respectively; p < .001). Path 
analysis revealed that all paths were significant (p < .008 to .001) except 
between family income and distress symptoms (p = .12). The seven predictors 
explained 20% of sense of danger variance and 34% the distress symptoms 
variance. The most highly predictive indicators were the two psychological 
characteristics, individual resilience, and well-being. Age, gender, community 
size, and economic difficulties due to COVID-19 further add to predicting 
distress, while community and national resilience do not. .
CONCLUSIONS: Individual resilience and well-being have been found as the first 
and foremost predictors of COVID-19 anxiety. Though both predictors are complex 
and may be influenced by many factors, given the potential return of COVID-19 
threat and other future health pandemic threats to our world, we must rethink 
and develop ways to reinforce them.

Copyright © 2020 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.socscimed.2020.113389
PMCID: PMC7518838
PMID: 33039732 [Indexed for MEDLINE]


4136. J Adolesc Health. 2020 Dec;67(6):756-762. doi: 10.1016/j.jadohealth.2020.08.027. 
Epub 2020 Oct 7.

"Physical Sex Is Over for Now": Impact of COVID-19 on the Well-Being and Sexual 
Health of Adolescent Sexual Minority Males in the U.S.

Nelson KM(1), Gordon AR(2), John SA(3), Stout CD(4), Macapagal K(5).

Author information:
(1)Department of Community Health Sciences, Boston University School of Public 
Health, Boston, Massachusetts. Electronic address: knel@bu.edu.
(2)Department of Community Health Sciences, Boston University School of Public 
Health, Boston, Massachusetts; Division of Adolescent/Young Adult Medicine, 
Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, 
Harvard Medical School, Boston, Massachusetts.
(3)Center for AIDS Intervention Research, Department of Psychiatry and 
Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
(4)Department of Community Health Sciences, Boston University School of Public 
Health, Boston, Massachusetts.
(5)Department of Medical Social Sciences, Northwestern University Feinberg 
School of Medicine, Chicago, Illinois; Institute for Sexual and Gender Minority 
Health and Wellbeing, Northwestern University, Chicago, Illinois.

PURPOSE: This study aimed to explore how the COVID-19 pandemic and physical 
distancing measures have impacted the well-being and sexual health among 
adolescent sexual minority males (ASMM) during the initial phase of physical 
distancing mandates in the U.S.
METHODS: From March 27, 2020, to May 8, 2020, U.S. ASMM (N = 151; aged 14-17 
years) completed the online baseline survey of a sexual health intervention 
trial. COVID-19-related closed- and open-ended questions were included. A 
mixed-methods approach assessed COVID-19-related changes in well-being and 
sexual health by outness with an accepting guardian.
RESULTS: The majority (57%) of participants reported being worried about 
COVID-19. Almost all (91%) were physically distancing. Participants noted that 
COVID-19 changed school, home, work, and family life. Participants highlighted 
that COVID-19 reduced their ability to socialize and had a deleterious effect on 
their mental health. In the past 3 months, participants reported seeing sexual 
partners in person less often, masturbating and viewing pornography more often, 
and sexting and messaging on men-seeking-men websites/phone applications about 
the same amount. Many described being physically distanced from sexual partners, 
and some noted an increase in their use of virtual ways to connect with partners 
(e.g., video chatting). There were no differences by outness with an accepting 
guardian in quantitative or qualitative responses.
CONCLUSIONS: These findings provide a snapshot of the initial effects of the 
COVID-19 pandemic among a convenience sample of U.S. ASMM and underscore the 
need to provide access to resources sensitive to their social, developmental, 
and sexual health needs during this crisis.

Copyright © 2020 Society for Adolescent Health and Medicine. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jadohealth.2020.08.027
PMCID: PMC7683377
PMID: 33039273 [Indexed for MEDLINE]


4137. Psychiatry Res. 2020 Dec;294:113493. doi: 10.1016/j.psychres.2020.113493. Epub 
2020 Oct 1.

A Longitudinal Investigation of the Effects of the COVID-19 Pandemic on the 
Mental Health of Individuals with Pre-existing Severe Mental Illnesses.

Pinkham AE(1), Ackerman RA(2), Depp CA(3), Harvey PD(4), Moore RC(5).

Author information:
(1)School of Behavioral and Brain Sciences, The University of Texas at Dallas, 
Richardson, TX; Department of Psychiatry, University of Texas Southwestern 
Medical School, Dallas, TX. Electronic address: amy.pinkham@utdallas.edu.
(2)School of Behavioral and Brain Sciences, The University of Texas at Dallas, 
Richardson, TX.
(3)Department of Psychiatry, University of California San Diego, San Diego, CA; 
VA San Diego Healthcare System, San Diego, CA.
(4)Department of Psychiatry, University of Miami Miller School of Medicine, 
Miami, FL; Research Service, Bruce W. Carter VA Medical Center, Miami, FL.
(5)Department of Psychiatry, University of California San Diego, San Diego, CA.

OBJECTIVE: Individuals with severe mental illnesses (SMI), including 
schizophrenia spectrum illnesses and affective disorders, may be at increased 
risk for negative mental health outcomes related to the COVID-19 pandemic. This 
study compared the severity of pre-pandemic symptoms and affective experiences 
to current symptoms to evaluate this possibility.
METHODS: 148 individuals with SMI (92 with schizophrenia spectrum illnesses and 
56 with affective disorders) were recruited from ongoing ecological momentary 
assessment studies that sampled day-to-day experiences and symptom severity 
prior to the pandemic. Participants completed a one-time phone survey that 
queried these same experiences/symptoms between April and June of 2020.
RESULTS: Severity of affective experiences and psychotic symptoms remained 
stable across time, as did sleep duration. Well-being and the number of 
substances used increased during the early months of the pandemic. Increases in 
well-being were associated with being female and spending less time alone 
pre-pandemic. Patterns of stability/change did not differ according to 
diagnostic category.
CONCLUSIONS: At this relatively early stage, individuals with SMI are not 
reporting a worsening of symptoms or affective experiences and instead appear to 
be resilient in the face of the pandemic. Continued assessment is needed to 
determine whether this resilience will persist as the pandemic progresses.

Copyright © 2020 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.psychres.2020.113493
PMCID: PMC7528831
PMID: 33038789 [Indexed for MEDLINE]

Conflict of interest statement: Dr. Moore is a co-founder of KeyWise AI, Inc. 
and a consultant for NeuroUX. Dr. Harvey has received consulting fees or travel 
reimbursements from Acadia Pharma, Alkermes, Bio Excel, Boehringer Ingelheim, 
Minerva Pharma, Otsuka Pharma, Regeneron Pharma, Roche Pharma, and Sunovion 
Pharma during the past year. He receives royalties from the Brief Assessment of 
Cognition in Schizophrenia. He is chief scientific officer of i-Function, Inc. 
He had a research grant from Takeda and from the Stanley Medical Research 
Foundation. No other authors have conflicts of interest to report.


4138. Ann Pharm Fr. 2020 Nov;78(6):459-463. doi: 10.1016/j.pharma.2020.09.002. Epub 
2020 Oct 7.

Impact on mental health of the COVID-19 outbreak among community pharmacists 
during the sanitary lockdown period.

Lange M(1), Joo S(2), Couette PA(2), de Jaegher S(2), Joly F(1), Humbert X(3).

Author information:
(1)Clinical research department, centre François-Baclesse, 14000 Caen, France; 
Normandie university, UNICAEN, Inserm U1086, ANTICIPE, 14000 Caen, France.
(2)Normandie university, UNICAEN, UFR santé, family medicine department, 14000 
Caen, France.
(3)Normandie university, UNICAEN, UFR santé, family medicine department, 14000 
Caen, France; EA 4650, UNICAEN, GIP Cyceron, 14000 Caen, France. Electronic 
address: xavier.humbert@unicaen.fr.

OBJECTIVES: COVID-19 outbreak can impact mental health including health care 
workers. The aim of this study was to assess the psychological impact of 
COVID-19 in French community pharmacists.
MATERIAL AND METHODS: We carried out a postal-based survey to assess the 
psychological impact of COVID-19 in French owner community pharmacists based on 
three validated self-report questionnaires: Perceived Stress scale, Impact of 
Event Scale-revised and Maslach Burnout Inventory.
RESULTS: The sample consists of 135 community pharmacists. Twenty-three 
pharmacists reported significant post-traumatic stress symptoms (17%). High 
burnout symptoms were found in 33 (25%), 46 (34.9%) and 4 (3%) participants. 
Females scored higher than males for all questionnaires (P=0.01).
CONCLUSIONS: This study is the first study which showed the psychological impact 
of COVID-19 in community pharmacists. Based on validated self-report 
questionnaires, up to 35% of pharmacists reported psychological disturbances. 
Interventions to promote psychological well-being of healthcare workers need to 
be developing.

OBJECTIF: L’épidémie de COVID-19 a pu avoir un impact sur la santé mentale y 
compris celle des professionnels de santé. L’objectif de cette étude était 
d’évaluer l’impact psychologique de la COVID-19 sur les pharmaciens d’officine 
français.
MATÉRIELS ET MÉTHODES: Nous avons réalisé une enquête postale pour évaluer 
l’impact psychologique de la COVID-19 chez des pharmaciens d’officine français 
titulaires à partir de 3 autoquestionnaires validés : l’échelle de stress perçu, 
l’échelle révisée Impact of Event et l’inventaire de Burnout de Maslach.
RÉSULTATS: L’échantillon consistait en 135 pharmaciens d’offine. Vingt-trois 
pharmaciens rapportaient des symptômes significatifs de stress post-traumatique 
(17 %). Un burnout élevé était observé chez 33 (25 %), 46 (34,9 %) et 4 (3 %) 
des participants. Les femmes avaient des scores plus élevés que les hommes à 
l’ensemble des questionnaires.
CONCLUSION: Cette étude est la première montrant l’impact psychologique de la 
COVID-19 chez les pharmaciens d’officine. Basée sur des questionnaires validés, 
jusqu’à 35 % des pharmaciens rapportent des difficultés psychologiques. Des 
interventions visant à promouvoir le bien-être psychologique des professionnels 
de santé devraient être développées.

Copyright © 2020 Académie Nationale de Pharmacie. Published by Elsevier Masson 
SAS. All rights reserved.

DOI: 10.1016/j.pharma.2020.09.002
PMCID: PMC7539790
PMID: 33038309 [Indexed for MEDLINE]


4139. Clin Psychol Psychother. 2021 Mar;28(2):409-421. doi: 10.1002/cpp.2521. Epub 
2020 Oct 24.

Videotherapy and therapeutic alliance in the age of COVID-19.

Simpson S(1)(2), Richardson L(3), Pietrabissa G(4)(5), Castelnuovo G(4)(5), Reid 
C(6).

Author information:
(1)NHS Lothian, St. John's Hospital, Livingston, UK.
(2)Department of Justice & Society, University of South Australia, Adelaide, SA, 
Australia.
(3)North Metropolitan Health Service, MHPHDS, Perth, WA, Australia.
(4)Psychology Research Laboratory, I.R.C.C.S. Istituto Auxologico Italiano, 
Milan, Italy.
(5)Department of Psychology, Catholic University of the Sacred Heart, Milan, 
Italy.
(6)Deputy Vice Chancellor, Research, Victoria University, Melbourne, VIC, 
Australia.

The arrival of the coronavirus (COVID-19) pandemic has confronted us with a 
global and unprecedented challenge of community-wide psychological distress 
alongside reduced access to therapeutic services in the traditional face-to-face 
format, due to the need to self-isolate. This previously unimagineable set of 
circumstances provides a unique opportunity, and indeed an imperative, for 
videotherapy to fulfil its potential in addressing mental health and well-being 
needs from a distance. Historically, the uptake of videotherapy has been 
hindered by psychotherapist expectations of inferior therapeutic alliance and 
outcomes, in spite of considerable research evidence to the contrary. Research 
suggests that videotherapy provides a powerful pathway for clients to experience 
enhanced opportunities for self-expression, connection and intimacy. This more 
neutral therapeutic 'space' provides clients with multifarious opportunities for 
self-awareness, creative experience and collaboration, with potentially a 
greater sense of agency over their own experience. This paper explores ways in 
which videotherapy can lead to a revitalisation of the concept of the 
therapeutic relationship, in order to meet the challenges associated with 
COVID-19. A number of specific considerations for videotherapy adaptations and 
etiquette in the midst of COVID-19 are described.

© 2020 The Authors. Clinical Psychology & Psychotherapy published by John Wiley 
& Sons Ltd.

DOI: 10.1002/cpp.2521
PMCID: PMC7675483
PMID: 33037682 [Indexed for MEDLINE]

Conflict of interest statement: The authors report no conflicts of interest.


4140. Global Health. 2020 Oct 9;16(1):96. doi: 10.1186/s12992-020-00627-7.

Risk factors for adolescents' mental health during the COVID-19 pandemic: a 
comparison between Wuhan and other urban areas in China.

Chen S(1), Cheng Z(2), Wu J(2).

Author information:
(1)Faculty of Psychology, Beijing Normal University, Beijing, 100875, China. 
chenshitao@bnu.edu.cn.
(2)Faculty of Psychology, Beijing Normal University, Beijing, 100875, China.

BACKGROUND: The outbreak of Coronavirus Disease is causing considerable acute 
risk to public health and might also have an unanticipated impact on the mental 
health of children and adolescents in the long run. This study collected data 
during the national lockdown period in China and aims to understand whether 
there is a clinically significant difference in anxiety, depression, and 
parental rearing style when comparing adolescents from Wuhan and other cities in 
China. This study also intends to examine whether gender, grade in school, 
single child status, online learning participation, parents' involvement in 
COVID-19 related work, and parents being quarantined or infected due to the 
disease would lead to clinically significant differences in anxiety and 
depression. Beyond that, this study explored the pathways among the different 
variables in order to better understand how these factors play a part in 
impacting adolescents' mental health condition.
RESULTS: Results showed that there was a statistically significant difference in 
anxiety symptoms between participants who were from Wuhan compared to other 
urban areas, but not in depressive symptoms. In addition, participants' grade 
level, gender, relative being infected, and study online have direct positive 
predictive value for depressive and anxiety symptoms, whereas location and 
sibling status have indirect predictive value. Having relatives who participated 
in COVID-19 related work only had positive direct predictive value toward 
depression, but not anxiety.
CONCLUSIONS: This study discovered several risk factors for adolescents' 
depression and anxiety during the pandemic. It also called for a greater 
awareness of Wuhan parents' mental wellbeing and recommended a systematic 
approach for mental health prevention and intervention.

DOI: 10.1186/s12992-020-00627-7
PMCID: PMC7545801
PMID: 33036622 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


4141. Soc Psychiatry Psychiatr Epidemiol. 2021 Jan;56(1):165-167. doi: 
10.1007/s00127-020-01971-0. Epub 2020 Oct 9.

Monitoring the impact of COVID-19 pandemic on mental health: a public health 
challenge? Reflection on Italian data.

Gualano MR(1), Lo Moro G(1), Voglino G(2), Bert F(1)(3), Siliquini R(1)(3).

Author information:
(1)Department of Public Health Sciences and Paediatrics, University of Torino, 
Via Santena 5 bis 10126, Torino, Italy.
(2)Department of Public Health Sciences and Paediatrics, University of Torino, 
Via Santena 5 bis 10126, Torino, Italy. gianluca.voglino@unito.it.
(3)AOU City of Health and Science of Turin, Torino, Italy.

A recent Italian report on medicines use during COVID-19 epidemic outlined a 
non-significant increase in outpatient pharmaceutical antidepressant consumption 
in March and a significant increase in anxiolytic consumption. Along with this, 
an analysis of psychiatric hospitalizations in Lombardy revealed a reduction in 
voluntary admissions in the 40 days after the beginning of COVID-19 epidemic in 
Italy. Nevertheless, several studies reported a greater prevalence of depressive 
and anxiety symptoms in the Italian general population during the lockdown 
compared to before the pandemic. Furthermore, the request for psychological 
support by the Italian population appeared to be high during lockdown. Indeed, 
the Italian Ministry of Health declared that more than 50,000 calls to the 
telephone number for psychological support activated by the Ministry of Health 
and the Civil Protection because of the pandemic, with peaks during the 
lockdown. In addition, looking at Google Trends, the greatest searching activity 
for "psychological support" in recent years was detected the week of the 26th 
April 2020, followed by the week of the 22nd March 2020. We think that stronger 
indicators of mental health status and psychological well-being should be found 
to understand the long-term effects of the pandemic. The necessity of research 
for population-level and universal strategies is urgent, through repurposing, 
developing, and testing interventions to create evidence-based action plans for 
the entire population. Lastly, it is also essential to keep offering a 
psychological support suitable for all as done in past months to help 
individuals who have fewer opportunities to access care.

DOI: 10.1007/s00127-020-01971-0
PMCID: PMC7545814
PMID: 33034669 [Indexed for MEDLINE]

Conflict of interest statement: On behalf of all authors, the corresponding 
author states that there is no conflict of interest.


4142. J Infect Public Health. 2020 Nov;13(11):1645-1651. doi: 
10.1016/j.jiph.2020.09.001. Epub 2020 Oct 5.

Prevalence and predictors of anxiety among healthcare workers in Saudi Arabia 
during the COVID-19 pandemic.

Alenazi TH(1), BinDhim NF(2), Alenazi MH(3), Tamim H(4), Almagrabi RS(5), 
Aljohani SM(6), H Basyouni M(7), Almubark RA(8), Althumiri NA(8), Alqahtani 
SA(9).

Author information:
(1)Ministry of National Guard Health-Affairs, Riyadh, Saudi Arabia; King Saud 
Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. Electronic 
address: thamer.alenazi@gmail.com.
(2)Sharik Association for Health Research, Riyadh, Saudi Arabia; College of 
Medicine, Al-Faisal University, Riyadh, Saudi Arabia; Saudi Food and Drug 
Authority, Riyadh, Saudi Arabia.
(3)Department of Psychiatry, College of Medicine, King Saud University, Riyadh, 
Saudi Arabia; King Saud University Medical City, King Saud University, Riyadh, 
Saudi Arabia.
(4)Department of Internal Medicine, American University of Beirut Medical 
Center, Beirut, Lebanon.
(5)Department of Medicine, King Faisal Specialist Hospital & Research Center, 
Riyadh, Saudi Arabia.
(6)Ministry of National Guard Health-Affairs, Riyadh, Saudi Arabia; King Saud 
Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
(7)Ministry of Health, Saudi Arabia.
(8)Sharik Association for Health Research, Riyadh, Saudi Arabia.
(9)Liver Transplantation Unit, King Faisal Specialist Hospital & Research 
Center, Riyadh, Saudi Arabia; Division of Gastroenterology and Hepatology, John 
Hopkins University, Baltimore, USA.

BACKGROUND: During pandemics, healthcare workers (HCWs) may be prone to higher 
levels of anxiety than those of the general population. This study aimed to 
explore the anxiety levels among HCWs in Saudi Arabia during the COVID-19 
pandemic and the predictors of increased anxiety levels.
METHOD: HCW participants in this cross-section study were solicited by email 
from the database of registered practitioners of the Saudi Commission for Health 
Specialties between 15 May and 18 May 2020. Sociodemographic characteristics, 
work-related factors, and organization-related factors were collected.
RESULTS: Four thousand nine hundred and twenty HCWs (3.4%) responded. Reported 
levels of anxiety were low anxiety (31.5%; n = 1552), medium (36.1%; n = 1778), 
and high (32.3%; n = 1590). Participants reporting high anxiety levels were more 
likely to be unmarried (OR = 1.32, 95% CI: 1.14-1.52); nurses (OR = 1.54, 95% 
1.24-1.91); workers in radiology (OR = 1.52, 95% CI: 1.01-2.28); or respiratory 
therapists (OR = 2.28, 95% CI: 1.14-4.54). Social factors associated with high 
anxiety levels were: living with a person who is elderly (p = 0.01), has a 
chronic disease (p < 0.0001), has immune deficiency (p < 0.0001), or has a 
respiratory disease (p-value <0.0001). Organization-related factors associated 
with a high level of anxiety were: working in an organization that hosts 
COVID-19 patients and working with such patients (p-value <0.0001).
CONCLUSION: Self-reported medium and high levels of anxiety were present in 
68.5% of HCWs in the COVID-19 pandemic. This highlights the urgent need to 
identify high-risk individuals to offer psychological support and provide up to 
date information on the pandemic. These data should help policymakers drive 
initiatives forward to protect and prepare HCWs psychological wellbeing.

Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.jiph.2020.09.001
PMCID: PMC7535800
PMID: 33032969 [Indexed for MEDLINE]


4143. Aust Health Rev. 2021 Jun;45(3):297-305. doi: 10.1071/AH20203.

Psychological well-being of Australian hospital clinical staff during the 
COVID-19 pandemic.

Holton S(1), Wynter K(2), Trueman M(3), Bruce S(4), Sweeney S(3), Crowe S(3), 
Dabscheck A(5), Eleftheriou P(5), Booth S(6), Hitch D(6), Said CM(7), Haines 
KJ(6), Rasmussen B(8).

Author information:
(1)School of Nursing and Midwifery, Deakin University, 1 Gheringhap Street, 
Geelong, Vic. 3220, Australia. Email: k.wynter@deakin.edu.au; 
bodil.rasmussen@deakin.edu.au; and Centre for Quality and Patient Safety 
Research - Western Health Partnership, Deakin University, 221 Burwood Highway, 
Burwood, Vic. 3125, Australia; and Corresponding author. Email: 
s.holton@deakin.edu.au.
(2)School of Nursing and Midwifery, Deakin University, 1 Gheringhap Street, 
Geelong, Vic. 3220, Australia. Email: k.wynter@deakin.edu.au; 
bodil.rasmussen@deakin.edu.au; and Centre for Quality and Patient Safety 
Research - Western Health Partnership, Deakin University, 221 Burwood Highway, 
Burwood, Vic. 3125, Australia.
(3)Nursing and Midwifery, Western Health, PO Box 294, St Albans, Vic. 3021, 
Australia. Email: melody.trueman@wh.org.au; sue.sweeney@wh.org.au; 
shane.crowe@wh.org.au.
(4)People, Culture and Communications, Western Health, Locked Bag 2, Footscray, 
Vic. 3011, Australia. Email: suellen.bruce@wh.org.au.
(5)Medical Services, Western Health, Locked Bag 2, Footscray, Vic. 3011, 
Australia. Email: adrian.dabscheck@wh.org.au; paul.eleftheriou@wh.org.au.
(6)Allied Health, Western Health, PO Box 294, St Albans, Vic. 3021, Australia. 
Email: sarah.booth@wh.org.au; danielle.hitch@wh.org.au; cathy.said@wh.org.au; 
kimberley.haines@wh.org.au.
(7)Allied Health, Western Health, PO Box 294, St Albans, Vic. 3021, Australia. 
Email: sarah.booth@wh.org.au; danielle.hitch@wh.org.au; cathy.said@wh.org.au; 
kimberley.haines@wh.org.au; and Physiotherapy, Melbourne School of Health 
Sciences, The University of Melbourne, Alan Gilbert Building, 161 Barry Street, 
Carlton, Vic. 3053, Australia; and Australian Institute for Musculoskeletal 
Science, 176 Furlong Road, St Albans, Vic. 3021, Australia.
(8)School of Nursing and Midwifery, Deakin University, 1 Gheringhap Street, 
Geelong, Vic. 3220, Australia. Email: k.wynter@deakin.edu.au; 
bodil.rasmussen@deakin.edu.au; and Centre for Quality and Patient Safety 
Research - Western Health Partnership, Deakin University, 221 Burwood Highway, 
Burwood, Vic. 3125, Australia; and Department of Public Health, Faculty of 
Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 
København, Denmark; and Faculty of Health Sciences, University of Southern 
Denmark, Campusvej 55, DK-5230 Odense M, Denmark.

Objective This study assessed the psychological well-being of Australian 
hospital clinical staff during the COVID-19 pandemic. Methods An anonymous 
online cross-sectional survey was conducted in a large metropolitan tertiary 
health service located in Melbourne, Australia. The survey was completed by 
nurses, midwives, doctors and allied health (AH) staff between 15 May and 10 
June 2020. The Depression, Anxiety and Stress Scale - 21 items (DASS-21) 
assessed the psychological well-being of respondents in the previous week. 
Results In all, 668 people responded to the survey (nurses/midwives, n=391; 
doctors, n=138; AH staff, n=139). Of these, 108 (16.2%) had direct contact with 
people with a COVID-19 diagnosis. Approximately one-quarter of respondents 
reported symptoms of psychological distress. Between 11% (AH staff) and 29% 
(nurses/midwives) had anxiety scores in the mild to extremely severe ranges. 
Nurses and midwives had significantly higher anxiety scores than doctors 
(P<0.001) and AH staff (P<0.001). Direct contact with people with a COVID-19 
diagnosis (P<0.001) and being a nurse or midwife (P<0.001) were associated with 
higher anxiety scores. Higher ratings of the health service's pandemic response 
and staff support strategies were protective against depression (P<0.001), 
anxiety (P<0.05) and stress (P<0.001). Conclusions The COVID-19 pandemic had a 
significant effect on the psychological well-being of hospital clinical staff, 
particularly nurses and midwives. Staff would benefit from (additional) targeted 
supportive interventions during the current and future outbreaks of infectious 
diseases. What is known about the topic? The outbreak of COVID-19 is having, and 
will have, a considerable effect on health services. No Australian data about 
the effect of COVID-19 on the psychological well-being of hospital clinical 
staff are available. What does this paper add? Australia healthcare providers 
have experienced considerable emotional distress during the COVID-19 pandemic, 
particularly nurses and midwives and clinical staff who have had direct contact 
with people with a COVID-19 diagnosis. In this study, nurses and midwives had 
significantly higher levels of anxiety, depression and stress during the 
pandemic than general Australian adult population norms, and significantly more 
severe anxiety symptoms than medical and AH staff. Despite a lower number of 
COVID-19 cases and a lower death rate than in other countries, the proportion of 
Australian hospital clinical staff experiencing distress is similar to that 
found in other countries. What are the implications for practitioners? Targeted 
well-being interventions are required to support hospital clinical staff during 
the current and future outbreaks of infectious diseases and other 'crises' or 
adverse events.

DOI: 10.1071/AH20203
PMID: 33032681 [Indexed for MEDLINE]


4144. Dev Psychopathol. 2021 May;33(2):565-580. doi: 10.1017/S0954579420001388.

Risk and resilience during COVID-19: A new study in the Zigler paradigm of 
developmental science.

Luthar SS(1)(2), Ebbert AM(1), Kumar NL(1).

Author information:
(1)Authentic Connections, Tempe, AZ,USA.
(2)Columbia University's Teachers College - Emerita.

When children are exposed to serious life adversities, Ed Zigler believed that 
developmental scientists must expediently strive to illuminate the most critical 
directions for beneficial interventions. In this paper, we present a new study 
on risk and resilience on adolescents during COVID-19, bookended - in 
introductory and concluding discussions - by descriptions of programmatic work 
anchored in lessons learned from Zigler. The new study was conducted during the 
first two months of the pandemic, using a mixed-methods approach with a sample 
of over 2,000 students across five high schools. Overall, rates of clinically 
significant symptoms were generally lower as compared to norms documented in 
2019. Multivariate regressions showed that the most robust, unique associations 
with teens' distress were with feelings of stress around parents and support 
received from them. Open ended responses to three questions highlighted concerns 
about schoolwork and college, but equally, emphasized worries about families' 
well-being, and positive outreach from school adults. The findings have recurred 
across subsequent school assessments, and strongly resonate with contemporary 
perspectives on resilience in science and policy. If serious distress is to be 
averted among youth under high stress, interventions must attend not just to the 
children's mental health but that of salient caregiving adults at home and 
school. The article concludes with some specific recommendations for 
community-based initiatives to address mental health through continued 
uncertainties of the pandemic.

DOI: 10.1017/S0954579420001388
PMID: 33032677 [Indexed for MEDLINE]


4145. Global Health. 2020 Oct 8;16(1):95. doi: 10.1186/s12992-020-00624-w.

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

Rahman MA(1)(2)(3), Hoque N(4)(5), Alif SM(4)(6), Salehin M(7), Islam SMS(8), 
Banik B(7), Sharif A(4)(9)(10), Nazim NB(4)(11), Sultana F(12), Cross W(7).

Author information:
(1)School of Health, Federation University Australia, 100 Clyde Road, Berwick, 
Victoria, 3806, Australia. ma.rahman@federation.edu.au.
(2)Australian Institute of Primary Care and Ageing, La Trobe University, Plenty 
Road and Kingsbury Drive, Melbourne, Victoria, 3086, Australia. 
ma.rahman@federation.edu.au.
(3)Bangladesh Medical Society of Victoria (BMSV), Melbourne, VIC, 3000, 
Australia. ma.rahman@federation.edu.au.
(4)Bangladesh Medical Society of Victoria (BMSV), Melbourne, VIC, 3000, 
Australia.
(5)Emerald Medical Centre, 1 Murphys Way, Emerald, Victoria, 3782, Australia.
(6)School of Public Health and Preventive Medicine, Monash University, 553 St 
Kilda Road, Melbourne, Victoria, 3004, Australia.
(7)School of Health, Federation University Australia, 100 Clyde Road, Berwick, 
Victoria, 3806, Australia.
(8)Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood 
Highway, Burwood, Victoria, 3125, Australia.
(9)Station Street Clinic, 34 Station Street, Pakenham, Burwood, Victoria, 3810, 
Australia.
(10)Bangladesh Institute of Family Medicine and Research, University of Science 
& Technology Chittagong, Zakir Hossain Road, Foy's Lake, Khulshi, Chittagong, 
4202, Bangladesh.
(11)Greenvale Medical Centre, 1/11 Greenvale Drive, Greenvale, Burwood, 
Victoria, 3059, Australia.
(12)Telstra Health, 222 Lonsdale Street, Melbourne, Victoria, 3000, Australia.

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

DOI: 10.1186/s12992-020-00624-w
PMCID: PMC7542573
PMID: 33032629 [Indexed for MEDLINE]

Conflict of interest statement: The authors confirm that there are no known 
conflicts of interest associated with this publication.


4146. N Z Med J. 2020 Oct 9;133(1523):110-112.

The mental wellbeing of New Zealanders during and post-lockdown.

Nicolson MN(1), Flett JA(1).

Author information:
(1)Senior Researcher, Te Hiringa Hauora/Health Promotion Agency, Te Whanganui a 
Tara/Wellington.

PMID: 33032310 [Indexed for MEDLINE]

Conflict of interest statement: Nil.


4147. Nicotine Tob Res. 2021 Mar 19;23(4):765-769. doi: 10.1093/ntr/ntaa207.

The Impact of COVID-19 on Smoking Patterns in Pakistan: Findings From a 
Longitudinal Survey of Smokers.

Siddiqi K(1), Siddiqui F(1), Khan A(2), Ansaari S(2), Kanaan M(1), Khokhar M(1), 
Islam Z(3), Mishu MP(1), Bauld L(4).

Author information:
(1)Department of Health Sciences, University of York, York, UK.
(2)The Initiative, Orange Grove Farm, Banigala, Islamabad, Pakistan.
(3)Tobacco Control Cell, Ministry of National Health Services, Regulations and 
Coordination, Islamabad, Pakistan.
(4)Usher Institute and SPECTRUM Consortium, College of Medicine and Veterinary 
Medicine, University of Edinburgh, Edinburgh, UK.

INTRODUCTION: We investigated the influence of COVID-19 on smoking patterns in 
Pakistan.
METHODS: In a longitudinal survey, we asked cigarette smokers in Pakistan about 
their smoking behaviors before and since COVID-19. Smokers were recruited before 
COVID-19 using two-stage random probability sampling. Since COVID-19, three 
subsequent waves were conducted over the telephone, asking additional questions 
on social determinants, mental health, and well-being. Based on the first two 
waves, we estimated the proportion of smokers who stopped, decreased, 
maintained, or increased smoking. We also explored any factors associated with 
the change in smoking patterns. In those who stopped smoking soon after 
COVID-19, we estimated the proportion relapsed in subsequent waves. We estimated 
all proportions based on complete-case analysis.
RESULTS: We recruited 6014 smokers between September 2019 and February 2020; of 
these, 2087 (2062 reported smoking outcomes) were followed up in May 2020 after 
COVID-19. Since COVID-19, 14% (290/2062) smokers reported quitting. Among those 
who continued smoking: 68% (1210/1772) reduced, 14% (239/1772) maintained, and 
18% (323/1772) increased cigarette consumption; 37% (351/938) reported at least 
one quit attempt; 41% (669/1619) were more motivated; while 21% (333/1619) were 
less motivated to quit. Changes in smoking patterns varied with nicotine 
dependence, motivation to quit, and financial stability since COVID-19. Among 
those reporting quitting soon after COVID-19, 39% (81/206) relapsed in the 
subsequent months (June-July 2020).
CONCLUSIONS: There have been significant bidirectional changes in smoking 
patterns since COVID-19 in Pakistan. Although many people stopped, reduced, or 
tried quitting smoking, some increased smoking and some relapsed after quitting.
IMPLICATIONS: We observed significant and complex changes in people's smoking 
patterns, which are likely to be attributable to the COVID-19 pandemic and 
replicated in similar events in the future. Assessing these changes is essential 
for most low- and middle-income countries like Pakistan, where the vast majority 
of tobacco users live, but cessation support is still rudimentary. If provided 
routinely, smoking cessation interventions can potentially support millions of 
highly motivated individuals in quitting successfully both in general and in 
global events like COVID-19, in particular.

© The Author(s) 2020. Published by Oxford University Press on behalf of the 
Society for Research on Nicotine and Tobacco. All rights reserved. For 
permissions, please e-mail: journals.permissions@oup.com.

DOI: 10.1093/ntr/ntaa207
PMCID: PMC7665599
PMID: 33029618 [Indexed for MEDLINE]


4148. Pediatr Neonatol. 2021 Jan;62(1):70-79. doi: 10.1016/j.pedneo.2020.09.003. Epub 
2020 Sep 7.

Innovations in practice: Adaptation of developmental and behavioral pediatric 
service in a tertiary center in Singapore during the COVID-19 pandemic.

Mulay KV(1), Aishworiya R(1), Lim TSH(2), Tan MY(1), Kiing JSH(1), Chong SC(1), 
Kang YQ(1).

Author information:
(1)Khoo Teck Puat-National University Children's Medical Institute, National 
University Health System, Singapore.
(2)Khoo Teck Puat-National University Children's Medical Institute, National 
University Health System, Singapore. Electronic address: 
tammy_sh_lim@nuhs.edu.sg.

BACKGROUND: As the coronavirus 2019 pandemic continues, healthcare services need 
to adapt to continue providing optimal and safe services for patients. We detail 
our adaptive framework as a large Developmental and Behavioral Pediatrics 
service in a tertiary academic institution in Singapore.
METHODS: The multidisciplinary team at our unit implemented various adaptations 
and workflow processes during this evolving pandemic in providing continued 
clinical care tailored to the challenges specific to our patient population. 
Services were continued via teleconsultation mode during the 'Circuit Breaker' 
(enhanced movement restriction) period. Specific workflow processes, IT 
infrastructure, and staff training were put in place to support smooth running 
of this service. Segregation of services into two teams based at two separate 
sites and implementation of stringent infection control measures surrounding the 
clinic visit by providers, patients and their families were incorporated to 
ensure safety. Measures were also taken to ensure providers' mental wellbeing.
RESULTS: The clinical service was continued for the majority of our patients 
with a lowest reduction in patient consultations to half of baseline during the 
'Circuit Breaker' period. We received positive feedback from families for 
teleconsultation services provided.
CONCLUSION: We have been able to continue services in our DBP clinics due to our 
dynamic reassessment of workflow processes and their prompt implementation in 
conjunction with the hospital and national public health response to the 
pandemic. Given that this pandemic is likely to be long drawn, our unit remains 
ready to constantly adjust these workflows and make adaptations as we go along, 
together with the support for mental health of patients, parents and staff. 
Continual improvements in workflows will be helpful even beyond the pandemic to 
ensure good continuity of care for our patients and families.

Copyright © 2020. Published by Elsevier B.V.

DOI: 10.1016/j.pedneo.2020.09.003
PMCID: PMC7475770
PMID: 33028511 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest None.


4149. Public Health Rep. 2020 Nov/Dec;135(6):721-727. doi: 10.1177/0033354920954511. 
Epub 2020 Oct 7.

Sexual and Gender Minority Stress Amid the COVID-19 Pandemic: Implications for 
LGBTQ Young Persons' Mental Health and Well-Being.

Salerno JP(1)(2)(3), Devadas J(2)(4), Pease M(2)(5), Nketia B(2)(6), Fish 
JN(3)(7).

Author information:
(1)1068 Department of Behavioral & Community Health, School of Public Health, 
University of Maryland, College Park, MD, USA.
(2)LGBTQ+ Students and Allies in Public Health, University of Maryland, College 
Park, MD, USA.
(3)University of Maryland Prevention Research Center, College Park, MD, USA.
(4)Department of Biology, College of Computer, Math, and Natural Sciences, 
University of Maryland, College Park, MD, USA.
(5)Department of Psychology, College of Behavioral and Social Sciences, 
University of Maryland, College Park, MD, USA.
(6)Department of Public Health Science, School of Public Health, University of 
Maryland, College Park, MD, USA.
(7)Department of Family Science, School of Public Health, University of 
Maryland, College Park, MD, USA.

DOI: 10.1177/0033354920954511
PMCID: PMC7649999
PMID: 33026972 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
authors declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


4150. Child Adolesc Ment Health. 2020 Nov;25(4):267-269. doi: 10.1111/camh.12429. Epub 
2020 Oct 7.

Debate: Supporting the mental health of school students in the COVID-19 pandemic 
in New Zealand - a digital ecosystem approach.

Merry SN(1), Cargo T(1), Christie G(1), Donkin L(1), Hetrick S(1), Fleming T(2), 
Holt-Quick C(3), Hopkins S(1), Stasiak K(1), Warren J(3).

Author information:
(1)Department of Psychological Medicine, University of Auckland, Auckland, New 
Zealand.
(2)School of Health, Victoria University of Wellington, Wellington, New Zealand.
(3)School of Computer Science, University of Auckland, Auckland, New Zealand.

The pandemic is creating unprecedented demand for mental health support for 
young people. While schools often facilitate mental health support for their 
students, the demands for online teaching and the uncertainty created by the 
pandemic make traditional delivery of support through schools challenging. 
Technology provides a potential way forward. We have developed a digital 
ecosystem, HABITS, that can be integrated into school and healthcare systems. 
This has allowed us to deploy specific evidence-based interventions directly, 
and through schools, to students and to parents in New Zealand during the 
current pandemic. Chatbot architecture is particularly suited to rapid iteration 
to provide specific information while apps can provide more generalised support. 
While technology can provide some solutions, it is important to be aware of the 
potential to increase current inequities, with those facing the greatest 
challenges to health and well-being, also least able to afford the resources to 
access digital interventions. Development of an integrated and equitable digital 
system will take time and collaboration.

© 2020 Association for Child and Adolescent Mental Health.

DOI: 10.1111/camh.12429
PMCID: PMC7675492
PMID: 33025729 [Indexed for MEDLINE]


4151. Sleep Med. 2021 Jan;77:297-301. doi: 10.1016/j.sleep.2020.09.014. Epub 2020 Sep 
22.

The importance of sleep and physical activity on well-being during COVID-19 
lockdown: reunion island as a case study.

Chouchou F(1), Augustini M(2), Caderby T(2), Caron N(2), Turpin NA(2), Dalleau 
G(2).

Author information:
(1)IRISSE Laboratory (EA4075), UFR SHE, University of La Réunion, Le Tampon, La 
Reunion, France. Electronic address: florianchouchou@gmail.com.
(2)IRISSE Laboratory (EA4075), UFR SHE, University of La Réunion, Le Tampon, La 
Reunion, France.

Comment in
    Sleep Med. 2021 Jan;77:295-296.

BACKGROUND: Lockdown has been one of the major worldwide strategies to control 
the spread of coronavirus disease 2019 (COVID-19). Its consequences on the 
well-being of individuals needs to be better understood. The objective of this 
work was to evaluate the impact of lockdown on the well-being of a general 
population and the factors associated with this potential impairment of 
well-being in a population that has been only lightly affected by COVID-19 such 
as in Reunion island, an overseas French department.
METHODS: An online survey was proposed to the population of Reunion Island 
between the 35th and 54th days of lockdown relative to pre- and per-lockdown 
periods. Well-being was measured by the 5-item World Health Organization 
Well-Being Index, with some questions about sleep habits (Pittsburgh 
questionnaire), weekly physical activity (IPAQ), health, and lifestyle.
RESULTS: Four hundred volunteers answered the survey. They reported a 15.7% 
decrease in well-being (p < 0.001), accompanied by increased anxiety 
(p < 0.001), decreased weekly physical activity (p < 0.001), delayed and poorer 
quality sleep (p < 0.001). Multivariate logistical analysis showed that 
impairment in well-being during lockdown was independently associated with an 
increase in anxiety (odds ratio (OR): 4.77 (3.26-6.98), p < 0.001), decrease in 
weekly physical activity (OR: 0.58 (0.43-0.79), p < 0.001), and poor-quality 
sleep (OR: 0.29 (0.19-0.43), p < 0.001).
CONCLUSIONS: This study suggested an impairment in well-being during lockdown, 
associated with anxiety, lack of physical activity and sleep disruptions. Public 
policies must consider these factors as levers for improving the well-being of 
the population in order to effectively combat the spread of COVID-19.

Copyright © 2020 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.sleep.2020.09.014
PMCID: PMC7505872
PMID: 33020037 [Indexed for MEDLINE]

Conflict of interest statement: None of the authors has any conflict of interest 
to disclose. The ICMJE Uniform Disclosure Form for Potential Conflicts of 
Interest associated with this article can be viewed by clicking on the following 
link: https://doi.org/10.1016/j.sleep.2020.09.014.


4152. Int J Environ Res Public Health. 2020 Oct 1;17(19):7205. doi: 
10.3390/ijerph17197205.

What Is Rural Adversity, How Does It Affect Wellbeing and What Are the 
Implications for Action?

Lawrence-Bourne J(1), Dalton H(1), Perkins D(1), Farmer J(2), Luscombe G(3), 
Oelke N(4), Bagheri N(5).

Author information:
(1)Centre for Rural and Remote Mental Health, University of Newcastle, Orange, 
NSW 2800, Australia.
(2)Social Innovation Research Institute, Swinburne University of Technology, 
Hawthorn, VIC 3122, Australia.
(3)School of Rural Health, University of Sydney, Orange, NSW 2800, Australia.
(4)School of Nursing, Faculty of Health and Social Development, University of 
British Columbia, Kelowna, BC V1V 1V7, Canada.
(5)Centre for Mental Health Research, Australian National University, Acton, ACT 
2601, Australia.

A growing body of literature recognises the profound impact of adversity on 
mental health outcomes for people living in rural and remote areas. With the 
cumulative effects of persistent drought, record-breaking bushfires, limited 
access to quality health services, the COVID-19 pandemic and ongoing economic 
and social challenges, there is much to understand about the impact of adversity 
on mental health and wellbeing in rural populations. In this conceptual paper, 
we aim to review and adapt our existing understanding of rural adversity. We 
undertook a wide-ranging review of the literature, sought insights from multiple 
disciplines and critically developed our findings with an expert disciplinary 
group from across Australia. We propose that rural adversity be understood using 
a rural ecosystem lens to develop greater clarity around the dimensions and 
experiences of adversity, and to help identify the opportunities for 
interventions. We put forward a dynamic conceptual model of the impact of rural 
adversity on mental health and wellbeing, and close with a discussion of the 
implications for policy and practice. Whilst this paper has been written from an 
Australian perspective, it has implications for rural communities 
internationally.

DOI: 10.3390/ijerph17197205
PMCID: PMC7578975
PMID: 33019735 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


4153. Annu Int Conf IEEE Eng Med Biol Soc. 2020 Jul;2020:4294-4297. doi: 
10.1109/EMBC44109.2020.9176514.

Electroencephalography Data-Driven Lighting System to Improve Sleep Quality in 
Intensive Care Unit Patients: A Case Study.

Koh AP, van Schie T, Park Y, Kalantari S.

Sleep disturbance and deprivation are major factors in delayed recovery, which 
can affect both the physical and emotional well-being of patients. Patients 
hospitalized in the Intensive Care Unit (ICU) are especially vulnerable to sleep 
deprivation due to light-induced disturbances. A desirable lighting intervention 
in the ICU would minimize light-induced disturbances while simultaneously 
providing feedback for the staff on when to perform patient care activities that 
require high intensity lighting. To this end, we performed a first phase testing 
for a biometrics-integrated lighting system that serves a dual function of sleep 
initiation and maintenance to improve the patient's quality of sleep. 
Preliminary findings are presented as a case study to assess the feasibility of 
scaling up the experimental model. While findings point to additional testing 
being necessary to determine whether the lighting system will be effective, the 
experiment detailed in this report establishes a starting paradigm upon which to 
base further investigation.Clinical Relevance- A biometrics-integrated lighting 
system that can improve sleep quality of the patient will not only reduce cost 
of care for the patients, but also increase the level of satisfaction for both 
patients and the hospital staff.

DOI: 10.1109/EMBC44109.2020.9176514
PMID: 33018945 [Indexed for MEDLINE]


4154. JCO Glob Oncol. 2020 Oct;6:1494-1509. doi: 10.1200/GO.20.00374.

Understanding the Psychological Impact of COVID-19 Pandemic on Patients With 
Cancer, Their Caregivers, and Health Care Workers in Singapore.

Ng KYY(1), Zhou S(2), Tan SH(2)(3), Ishak NDB(1), Goh ZZS(4), Chua ZY(4), Chia 
JMX(4), Chew EL(1), Shwe T(5), Mok JKY(5), Leong SS(1), Lo JSY(1), Ang ZLT(1), 
Leow JL(6), Lam CWJ(7), Kwek JW(8), Dent R(1), Tuan J(5), Lim ST(1)(3), Hwang 
WYK(1)(3), Griva K(4), Ngeow J(1)(3)(4).

Author information:
(1)Division of Medical Oncology, National Cancer Centre, Singapore.
(2)Division of Clinical Trials and Epidemiological Sciences, National Cancer 
Centre, Singapore.
(3)Oncology Academic Clinical Program, Duke-NUS Graduate Medical School, 
Singapore.
(4)Lee Kong Chian School of Medicine, Nanyang Technological University, 
Singapore.
(5)Division of Radiation Oncology, National Cancer Centre, Singapore.
(6)Department of Pharmacy, National Cancer Centre, Singapore.
(7)Department of Nursing, National Cancer Centre, Singapore.
(8)Division of Oncological Imaging, National Cancer Centre, Singapore.

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has had a global 
impact, and Singapore has seen 33,000 confirmed cases. Patients with cancer, 
their caregivers, and health care workers (HCWs) need to balance the challenges 
associated with COVID-19 while ensuring that cancer care is not compromised. 
This study aimed to evaluate the psychological effect of COVID-19 on these 
groups and the prevalence of burnout among HCWs.
METHODS: A cross-sectional survey of patients, caregivers, and HCWs at the 
National Cancer Centre Singapore was performed over 17 days during the lockdown. 
The Generalized Anxiety Disorder-7 and Maslach Burnout Inventory were used to 
assess for anxiety and burnout, respectively. Self-reported fears related to 
COVID-19 were collected.
RESULTS: A total of 624 patients, 408 caregivers, and 421 HCWs participated in 
the study, with a response rate of 84%, 88%, and 92% respectively. Sixty-six 
percent of patients, 72.8% of caregivers, and 41.6% of HCWs reported a high 
level of fear from COVID-19. The top concern of patients was the wide community 
spread of COVID-19. Caregivers were primarily worried about patients dying 
alone. HCWs were most worried about the relatively mild symptoms of COVID-19. 
The prevalence of anxiety was 19.1%, 22.5%, and 14.0% for patients, caregivers, 
and HCWs, respectively. Patients who were nongraduates and married, and 
caregivers who were married were more anxious. The prevalence of burnout in HCWs 
was 43.5%, with more anxious and fearful HCWs reporting higher burnout rates.
CONCLUSION: Fears and anxiety related to COVID-19 are high. Burnout among HCWs 
is similar to rates reported prepandemic. An individualized approach to target 
the specific fears of each group will be crucial to maintain the well-being of 
these vulnerable groups and prevent burnout of HCWs.

DOI: 10.1200/GO.20.00374
PMCID: PMC7640379
PMID: 33017179 [Indexed for MEDLINE]

Conflict of interest statement: The following represents disclosure information 
provided by authors of this manuscript. All relationships are considered 
compensated unless otherwise noted. Relationships are self-held unless noted. I 
= Immediate Family Member, Inst = My Institution. Relationships may not relate 
to the subject matter of this manuscript. For more information about ASCO's 
conflict of interest policy, please refer to www.asco.org/rwc or 
ascopubs.org/go/site/misc/authors.html. Open Payments is a public database 
containing information reported by companies about payments made to US-licensed 
physicians (Open Payments). REBECCA DENT: Honoraria: Genentech, AstraZeneca, 
Pfizer, MSD Consulting or Advisory Role: Roche, Pfizer, Merck, Eisai, 
AstraZeneca, Novartis Travel, Accommodations, Expenses: Roche, Pfizer, Amgen, 
Merck WILLIAM YING KHEE HWANG: Honoraria: Johnson & Johnson, Novartis Patents, 
Royalties, Other Intellectual Property: PCT/SG2017/050409; Title: Substituted 
azole derivatives for generation, proliferation, and differentiation of 
hematopoietic stem and progenitor cells Travel, Accommodations, Expenses: Abbvie 
JOANNE NGEOW: Honoraria: AstraZeneca Consulting or Advisory Role: AstraZeneca 
Research Funding: AstraZeneca No other potential conflicts of interest were 
reported.


4155. Appl Psychol Health Well Being. 2020 Dec;12(4):1054-1073. doi: 
10.1111/aphw.12239. Epub 2020 Oct 5.

Mental Health Conditions of Italian Healthcare Professionals during the COVID-19 
Disease Outbreak.

Bettinsoli ML(1), Di Riso D(2), Napier JL(1), Moretti L(3), Bettinsoli P(4), 
Delmedico M(3), Piazzolla A(3), Moretti B(3).

Author information:
(1)New York University Abu Dhabi, United Arab Emirates.
(2)Università degli Studi di Padova, Italy.
(3)Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, Italy.
(4)Istituto Clinico Sant'Anna Brescia, Italy.

BACKGROUND: The COVID-19 pandemic in Italy represents a unique threat in terms 
of psychological distress. This cross-sectional study aims to investigate the 
psychological health of Italian healthcare professionals during the COVID-19 
outbreak. We assessed participants' current psychological distress and coping 
strategies in the midst of the COVID outbreak (March-April 2020), and also asked 
them to retrospectively report how they remember feeling before the COVID-19 
outbreak (December 2019). We examined associations between psychological 
distress and coping strategies with mental health and infection perceptions.
METHODS: Self-administered questionnaires were distributed online to healthcare 
professionals (N = 580) residing in different Italian regions from 26 March to 9 
April 2020. The questionnaire measured changes in psychological states, coping 
strategies, and demographic variables testing variations in mental health and 
infection risk perception among Italian healthcare workers.
RESULTS: Overall, approximately 33.5 per cent of healthcare professionals in our 
sample meet the threshold for psychiatric morbidity. Participants perceive their 
current psychological health to be worse during the COVID-19 emergency outbreak 
as compared to before the outbreak, and this was especially true among women.
CONCLUSIONS: Both immediate and long-term monitoring psychological assistance 
services for healthcare workers should be implemented by national institutions 
to re-establish the psychological well-being and enhance the self-confidence and 
resilience of hospital personnel.

© 2020 International Association of Applied Psychology.

DOI: 10.1111/aphw.12239
PMCID: PMC7675316
PMID: 33016564 [Indexed for MEDLINE]

Conflict of interest statement: None.


4156. Hosp Pract (1995). 2021 Feb;49(1):47-55. doi: 10.1080/21548331.2020.1832792. 
Epub 2020 Oct 22.

Psychological wellness of internal medicine hospitalists during the COVID-19 
pandemic.

Dugani SB(1), Geyer HL(2), Maniaci MJ(3), Fischer KM(4), Croghan IT(5)(6)(7), 
Burton C(1).

Author information:
(1)Division of Hospital Internal Medicine, Mayo Clinic , Rochester, MN, USA.
(2)Division of Hospital Internal Medicine, Mayo Clinic , Scottsdale, AZ, USA.
(3)Division of Hospital Internal Medicine, Mayo Clinic , Jacksonville, FL, USA.
(4)Department of Health Sciences Research, Mayo Clinic , Rochester, MN.
(5)Department of Medicine, Division of General Internal Medicine, Mayo Clinic , 
Rochester, MN.
(6)Robert D. and Patricia E. Kern Center for the Science of Health Care 
Delivery, Mayo Clinic , Rochester, MN.
(7)Department of Medicine, Clinical Research Office, Mayo Clinic , Rochester, 
MN.

BACKGROUND: Patients with COVID-19 infection requiring in-hospital care are 
frequently managed by Internal Medicine hospitalists, comprised of physicians, 
nurse practitioners and physician assistants. There is sparse information on the 
psychological impact of the COVID-19 pandemic on Internal Medicine hospitalists.
METHODS: We surveyed Internal Medicine hospitalists at Mayo Clinic sites in four 
states (Arizona, Florida, Minnesota, and Wisconsin). We collected demographic 
information, and used Patient-Reported Outcomes Measurement Information System 
(PROMIS®) measures to assess global well-being, anxiety, social isolation, and 
emotional support. Descriptive statistics were used to compare responses between 
two periods: prior to the pandemic (before March 15th, 2020), and during the 
pandemic (March 15 through 30 April 2020). The survey was conducted from May 
4-25, 2020.
RESULTS: Of 295 Internal Medicine hospitalists, 154 (52%) responded. Fifty-six 
percent were women (n = 85/154) and 54% were physicians (n = 84/154). Most 
hospitalists (75%; n = 115/154) reported concerns about contracting COVID-19 
infection at work, and 5% (n = 8/154) reported changing where they lived during 
the pandemic. Most hospitalists (73%; n = 112/154) reported relying primarily on 
institutional resources for COVID-19 information. During the pandemic, the 
percentage of participants with excellent or very good global well-being 
decreased (90% prior to pandemic vs. 53% during pandemic), with increases in 
mean anxiety (-4.88 [95% confidence interval, - 5.61 to - 4.16]; P<.001) and 
social isolation (-3.91[95% confidence interval, - 4.68 to - 3.13]; P<.001). 
During the same period, there was a small decrease in mean emotional support 
(1.46 [95% confidence interval, 0.83 to 2.09]; P<.001).
CONCLUSION: During the COVID-19 pandemic, Internal Medicine hospitalists 
reported lower global well-being, higher anxiety and social isolation, and a 
small decrease in emotional support. These results provide a framework to 
develop programs to support hospitalists and potentially mitigate long-term 
psychological sequelae including burnout.

DOI: 10.1080/21548331.2020.1832792
PMID: 33012183 [Indexed for MEDLINE]


4157. Psychosom Med. 2021 May 1;83(4):328-337. doi: 10.1097/PSY.0000000000000871.

Mental Health During COVID-19 Lockdown in the United Kingdom.

Pieh C(1), Budimir S, Delgadillo J, Barkham M, Fontaine JRJ, Probst T.

Author information:
(1)From the Department for Psychotherapy and Biopsychosocial Health (Pieh, 
Budimir, Probst), Danube University Krems, Krems an der Donau, Austria; Clinical 
Psychology Unit, Department of Psychology (Delgadillo, Barkham), University of 
Sheffield, Sheffield, United Kingdom; and Department of Work, Organization and 
Society (Budimir, Fontaine), Ghent University, Ghent, Belgium.

OBJECTIVE: The coronavirus disease (COVID-19) pandemic and related lockdown 
measures have raised important questions about the impact on mental health. This 
study evaluated several mental health and well-being indicators in a large 
sample from the United Kingdom (UK) during the COVID-19 lockdown where the death 
rate is currently among the highest in Europe.
METHODS: A cross-sectional online survey with a study sample that mirrors 
general population norms according to sex, age, education, and region was 
launched 4 weeks after lockdown measures were implemented in the UK. Measures 
included mental health-related quality of life (World Health Organization 
Quality-of-Life Brief Version psychological domain), well-being (World Health 
Organization Well-Being Index), depression (Patient Health Questionnaire-9), 
anxiety (Generalized Anxiety Disorder-7), perceived stress (Perceived Stress 
Scale-10), and insomnia (Insomnia Severity Index). Analyses of variances, 
Bonferroni-corrected post hoc tests, and t tests were applied to examine mental 
health indicators across different sociodemographic groups (age, sex, 
employment, income, physical activity, relationship status).
RESULTS: The sample comprised n = 1006 respondents (54% women) from all regions 
of the UK. Approximately 52% of respondents screened positive for a common 
mental disorder, and 28% screened positive for clinical insomnia. Mean scores 
and standard deviations were as follows: Patient Health Questionnaire-9, mean = 
9.0 ± 7.7; Generalized Anxiety Disorder-7, mean = 8.0 ± 6.5; Insomnia Severity 
Index, mean = 10.4 ± 7.0; Perceived Stress Scale-10, mean = 17.7 ± 7.9; World 
Health Organization Quality-of-Life Brief Version, mean = 58.6 ± 21.4; and World 
Health Organization Well-Being Index score, mean = 13.0 ± 6.0. Statistical 
analyses consistently indicated more severe mental health problems in adults 
younger than 35 years, women, people with no work, and people with low income 
(all p values < .05). Mental health indices also varied across UK regions.
CONCLUSIONS: The prevalence of depressive, anxiety, and insomnia symptoms is 
significantly higher in the UK relative to prepandemic epidemiological data. 
Further studies are needed to clarify the causes for these high rates of mental 
health symptoms.

Copyright © 2020 by the American Psychosomatic Society.

DOI: 10.1097/PSY.0000000000000871
PMID: 33009276 [Indexed for MEDLINE]


4158. BMC Med Educ. 2020 Oct 2;20(1):342. doi: 10.1186/s12909-020-02261-8.

Why should medical students (not) be recruited to care for patients with 
COVID-19?

Bank I(1), Wijnen-Meijer M(2).

Author information:
(1)Department of Transfusion Medicine, Sanquin Blood Bank, Amsterdam, The 
Netherlands.
(2)Technical University of Munich, School of Medicine, TUM Medical Education 
Center, Ismaninger Straße 22, 81675, Munich, Germany. 
marjo.wijnen-meijer@tum.de.

Worldwide it is being discussed whether medical students might be of help during 
the present COVID-19 epidemic. Although this question is probably a legitimate 
one, one should however discuss this thoroughly before deciding whether medical 
students are to be included in this kind of medical care on a larger 
scale.Various arguments should be weighted, and potential tasks should be chosen 
carefully. This period could however be also an opportunity for medical students 
to learn things they would probably never learn about. Nevertheless, medical 
students have a deficit concerning knowledge about epidemics, and they are also 
not really well skilled in many hygiene measures. Furthermore, some of the known 
medical students' behaviour could be a risk factor for further spread of the 
virus as well. Then, young adults are at risk of getting infected themselves. 
Last but not least, medical students in general are under a great deal of 
pressure from their studies which could lead to the development of anxiety and 
other mental disorders. One could only speculate on the effects of this epidemic 
on their further mental well-being. Therefore, medical students participating in 
direct care of patients with COVID-19 should first be trained well, and then 
properly supervised at all times. Only then it might be a really useful and 
exceptional experience, for healthcare, medical schools as well as for society.

DOI: 10.1186/s12909-020-02261-8
PMCID: PMC7530858
PMID: 33008374 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


4159. Aust N Z J Psychiatry. 2020 Dec;54(12):1157-1161. doi: 10.1177/0004867420963724. 
Epub 2020 Oct 2.

Whither economic evaluation in the case of COVID-19: What can the field of 
mental health economics contribute within the Australian context?

Mihalopoulos C(1), Chatterton ML(1), Engel L(1), Le LK(1), Lee YY(1).

Author information:
(1)Deakin Health Economics, Institute for Health Transformation, Deakin 
University, Burwood, VIC, Australia.

COVID-19 has resulted in broad impacts on the economy and aspects of daily life 
including our collective mental health and well-being. The Australian health 
care system already faces limitations in its ability to treat people with mental 
health diagnoses. Australia has responded to the COVID-19 outbreak by, among 
other initiatives, providing reimbursement for telehealth services. However, it 
is unclear if these measures will be enough to manage the psychological 
distress, depression, anxiety and post-traumatic distress shown to accompany 
infectious disease outbreaks and economic shocks. Decision making has focused on 
the physical health ramifications of COVID-19, the avoidance of over-burdening 
the health care system and saving lives. We propose an alternative framework for 
decision making that combines life years saved with impacts on quality of life. 
A framework that simultaneously includes mental health and broader economic 
impacts into a single decision-making process would facilitate transparent and 
accountable decision making that can improve the overall welfare of Australian 
society as we continue to address the considerable challenges that the COVID-19 
pandemic is creating.

DOI: 10.1177/0004867420963724
PMID: 33008268 [Indexed for MEDLINE]


4160. Psychiatry Res. 2020 Nov;293:113475. doi: 10.1016/j.psychres.2020.113475. Epub 
2020 Sep 24.

The Disproportionate Burden of the COVID-19 Pandemic Among Pregnant Black Women.

Gur RE(1), White LK(2), Waller R(3), Barzilay R(2), Moore TM(4), Kornfield S(5), 
Njoroge WFM(6), Duncan AF(7), Chaiyachati BH(4), Parish-Morris J(8), Maayan 
L(3), Himes MM(4), Laney N(4), Simonette K(9), Riis V(9), Elovitz MA(9).

Author information:
(1)Department of Psychiatry, Perelman School of Medicine, University of 
Pennsylvania, Philadelphia, PA 19104, USA; Lifespan Brain Institute, Children's 
Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, 
Philadelphia, PA 19104, USA; Department of Child and Adolescent Psychiatry and 
Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA 
19104, USA. Electronic address: raquel@pennmedicine.upenn.edu.
(2)Department of Psychiatry, Perelman School of Medicine, University of 
Pennsylvania, Philadelphia, PA 19104, USA; Lifespan Brain Institute, Children's 
Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, 
Philadelphia, PA 19104, USA; Department of Child and Adolescent Psychiatry and 
Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA 
19104, USA.
(3)Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104, 
USA.
(4)Department of Psychiatry, Perelman School of Medicine, University of 
Pennsylvania, Philadelphia, PA 19104, USA; Lifespan Brain Institute, Children's 
Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, 
Philadelphia, PA 19104, USA.
(5)Department of Psychiatry, Perelman School of Medicine, University of 
Pennsylvania, Philadelphia, PA 19104, USA.
(6)Department of Psychiatry, Perelman School of Medicine, University of 
Pennsylvania, Philadelphia, PA 19104, USA; Policy Lab, Children's Hospital of 
Philadelphia, Philadelphia, PA 19104, USA; Department of Pediatrics, Children's 
Hospital of Philadelphia and Perelman School of Medicine, University of 
Pennsylvania, Philadelphia, PA 19104, USA.
(7)Center for Autism Research, Children's Hospital of Philadelphia, 
Philadelphia, PA, USA.
(8)Department of Psychiatry, Perelman School of Medicine, University of 
Pennsylvania, Philadelphia, PA 19104, USA; Center for Autism Research, 
Children's Hospital of Philadelphia, Philadelphia, PA, USA.
(9)Maternal and Child Health Research Center, Department of Obstetrics and 
Gynecology, Perelman School of Medicine, University of Pennsylvania, 
Philadelphia, PA, 19104, USA.

The COVID-19 pandemic has disproportionately impacted the well-being of 
vulnerable populations in the US, including Black people. The impact on pregnant 
women is of special concern for the intrauterine and post-natal development of 
their offspring. We evaluated in an online survey a sample of 913 pregnant 
women, 216 Black, 571 White, 126 Other, during a 2-week stay-at-home mandate in 
the Philadelphia region. We applied logistic regression models and analysis of 
covariance to examine general and pregnancy-specific worries and negative 
consequences arising from the COVID-19 pandemic, symptoms of anxiety and 
depression, and resilience. Black pregnant women reported greater likelihood of 
having their employment negatively impacted, more concerns about a lasting 
economic burden, and more worries about their prenatal care, birth experience, 
and post-natal needs. In the full sample, 11.1% of women met screening criteria 
for anxiety and 9.9% met criteria for depression. Black women were more likely 
to meet criteria for depression than White women, but this difference was not 
significant accounting for covariates. Resilience factors including 
self-reliance and emotion regulation were higher in Black women. Racial 
disparities related to COVID-19 in pregnant women can advance the understanding 
of pregnancy related stressors and improve early identification of mental health 
needs.

Copyright © 2020 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.psychres.2020.113475
PMCID: PMC7513921
PMID: 33007683 [Indexed for MEDLINE]

Conflict of interest statement: RB serves on the scientific board and reports 
stock ownership in ‘Taliaz Health’, with no conflict of interest relevant to 
this work. All other authors have nothing to disclose.


4161. J Clin Nurs. 2021 Jan;30(1-2):298-305. doi: 10.1111/jocn.15520. Epub 2020 Oct 
15.

Strategies and resources for nurse leaders to use to lead with empathy and 
prudence so they understand and address sources of anxiety among nurses 
practising in the era of COVID-19.

Hofmeyer A(1)(2), Taylor R(3).

Author information:
(1)Rosemary Bryant AO Research Centre, UniSA Clinical & Health Sciences, 
University of South Australia, Adelaide, SA, Australia.
(2)Anglia Ruskin University, Cambridge, UK.
(3)King's College, The University of Aberdeen, Aberdeen, UK.

AIMS: Identify strategies and resources for nurse leaders to use to lead with 
empathy and prudence to improve quality of care and to ease the psychological 
toll on nurses caring for patients with COVID-19.
BACKGROUND: In a 2020 report, clinicians caring for patients during the COVID-19 
pandemic said their healthcare leaders needed to: 'hear me, protect me, prepare 
me, support me, and care for me'. These words provide an action plan for nurse 
leaders to communicate, educate and support nurses to practice competently and 
safely (physically and mentally) in the context of COVID-19.
DESIGN: Discursive paper.
METHOD: Identification and inclusion of relevant international evidence with 
clinical discussion.
FINDINGS: Nurse leaders can mobilise system and individual level strategies and 
resources to support nurses to manage pandemic-related issues including: anxiety 
due to the risk of infection, supporting anxious children, mitigating moral 
injury; providing safe and quality nursing care for patients with COVID-19 and 
end-of-life care as needed; supporting relatives who cannot be present with a 
dying relative and care for grieving relatives and colleagues. We categorise a 
selection of evidence-based, online sources providing current COVID-19 
information, practice updates and resources to develop personalised self-care 
plans to ease anxiety and support renewal and resilience.
CONCLUSIONS: Nurse leaders must ensure adequate PPE supply, upskill nurses to 
provide safe, quality care for patients with COVID-19 and promote restorative 
self-care plans.
RELEVANCE TO CLINICAL PRACTICE: The strategic actions nurse leaders take today 
can positively impact nurses' well-being and ability to provide safe and quality 
care for patients in the context of COVID-19.

© 2020 John Wiley & Sons Ltd.

DOI: 10.1111/jocn.15520
PMCID: PMC7537231
PMID: 33006794 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


4162. J Racial Ethn Health Disparities. 2021 Feb;8(1):7-11. doi: 
10.1007/s40615-020-00887-4. Epub 2020 Oct 2.

Coping with Racism: a Perspective of COVID-19 Church Closures on the Mental 
Health of African Americans.

DeSouza F(1), Parker CB(2), Spearman-McCarthy EV(3), Duncan GN(4), Black RMM(5).

Author information:
(1)Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 
USA.
(2)Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 
USA. carmen.parker@yale.edu.
(3)Department of Psychiatry and Health Behavior, Medical College of Georgia, 
Augusta University, Augusta, GA, USA.
(4)Eastover Psychological and Psychiatric Group, P.A, Charlotte, NC, USA.
(5)African Methodist Episcopal Church, Augusta, GA, USA.

Academic medical literature and news outlets extensively document how older 
individuals in communities of color, especially African American communities, 
are dying disproportionately of COVID-19 due to ongoing societal, racial, and 
healthcare disparities. Fear of death and suffering are acutely elevated in 
Black communities; yet, African Americans have been facing, coping with, and 
overcoming American societal racism and subsequent detriments to our mental 
health for centuries. Predominately African American churches (hereafter 
referred to as the "Black Church") have always served a historical, cultural, 
contextual, and scientifically validated role in the mental health well-being of 
African American communities coping with American racism. Nonetheless, buildings 
of worship closed due to the COVID-19 pandemic in mid-March 2020. This article 
is a first-hand perspective of five Black internists/psychiatrists who are 
deeply involved in both academic medicine and leadership positions within the 
Black Church. It will explore how the physical closure of Black Churches during 
this period of increased mental stress, as caused by healthcare inequities 
revealed by the COVID-19 epidemic, is likely to be uniquely taxing to the mental 
health of African Americans, particularly older African Americans, who must cope 
with American racism without physical access to the Black Church for the first 
time in history.

DOI: 10.1007/s40615-020-00887-4
PMCID: PMC7531268
PMID: 33006753 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


4163. Am J Geriatr Psychiatry. 2020 Dec;28(12):1299-1307. doi: 
10.1016/j.jagp.2020.09.008. Epub 2020 Sep 12.

Family Communication in Long-Term Care During a Pandemic: Lessons for Enhancing 
Emotional Experiences.

Monin JK(1), Ali T(2), Syed S(3), Piechota A(3), Lepore M(4), Mourgues C(3), 
Gaugler JE(5), Marottoli R(6), David D(7).

Author information:
(1)Department of Social and Behavioral Sciences, Yale School of Public Health 
(JKM, SS, AP, CM), New Haven, CT. Electronic address: joan.monin@yale.edu.
(2)Department of Geriatrics, Yale School of Medicine (TA, RM), New Haven, CT.
(3)Department of Social and Behavioral Sciences, Yale School of Public Health 
(JKM, SS, AP, CM), New Haven, CT.
(4)LiveWell Institute (ML), Plantsville, CT.
(5)School of Public Health, University of Minnesota (JG), Minneapolis, MN.
(6)Department of Geriatrics, Yale School of Medicine (TA, RM), New Haven, CT; VA 
Connecticut Healthcare System (RM), West Haven, CT.
(7)Rory Meyers College of Nursing, New York University (DD), New York, NY.

OBJECTIVE: Family visits with residents at long-term care (LTC) facilities have 
been restricted during the COVID-19 pandemic. The objective was to examine what 
communication methods, other than in-person visits, during the pandemic were 
associated with greater positive and lower negative emotional experiences for 
LTC residents and their family members and friends.
DESIGN: Cross-sectional.
SETTING: Nationally targeted online survey.
PARTICIPANTS: One hundred sixty-one community-dwelling adults who had a family 
member or friend in a LTC facility.
MEASUREMENTS: The Positive and Negative Affect Scale was used to assess 
participant's own emotions and perceived resident emotions during the pandemic. 
Questions were asked about nine communication methods other than physical visits 
(e.g., phone, video-conference, e-mail, and letters) in terms of frequency of 
use during the pandemic. Sociodemographics, resident health, and facility 
factors were assessed and used as covariates where indicated.
RESULTS: During the pandemic, greater phone frequency was associated with less 
participant negative emotions (β = -0.17). Greater e-mail frequency was 
associated with more perceived resident positive emotions (β = 0.28). Greater 
frequency of letters delivered by staff was associated with more participant 
negative emotions (β = 0.23). Greater frequency of letters delivered by staff 
and the postal service were associated with more perceived resident negative 
emotions (β = 0.28; β = 0.34, respectively).
CONCLUSION: These findings highlight the importance of synchronous, familiar 
methods of communication like the phone and email between families and LTC 
residents to maintain their emotional well-being when in-person visits are 
restricted.

Copyright © 2020 American Association for Geriatric Psychiatry. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jagp.2020.09.008
PMCID: PMC7486818
PMID: 33004262 [Indexed for MEDLINE]


4164. Best Pract Res Clin Anaesthesiol. 2020 Sep;34(3):553-560. doi: 
10.1016/j.bpa.2020.07.008. Epub 2020 Jul 18.

Occupational burnout syndrome and post-traumatic stress among healthcare 
professionals during the novel coronavirus disease 2019 (COVID-19) pandemic.

Raudenská J(1), Steinerová V(2), Javůrková A(1), Urits I(3), Kaye AD(4), 
Viswanath O(5), Varrassi G(6).

Author information:
(1)Department of Psychology, Faculty of Arts, Charles University, Department of 
Nursing, 2nd Medical School and University Hospital Motol, Charles University, 
Prague, Czech Republic.
(2)Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry 
and Health Sciences at the University of Melbourne, Australia.
(3)Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical 
Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA.
(4)Department of Anesthesiology, Louisiana State University Health Shreveport, 
Department of Anesthesiology, Shreveport, LA, USA.
(5)Department of Anesthesiology, Louisiana State University Health Shreveport, 
Department of Anesthesiology, Shreveport, LA, USA; Valley Pain Consultants - 
Envision Physician Services, Phoenix, AZ, USA; University of Arizona College of 
Medicine-Phoenix, Department of Anesthesiology Phoenix, AZ, USA; Creighton 
University School of Medicine, Department of Anesthesiology, Omaha, NE, USA.
(6)Paolo Procacci Fdn, Via Tacito 7, 00193, Roma, Italy; World Institute of 
Pain, Winston-Salem, NC, USA. Electronic address: giuvarr@gmail.com.

This comprehensive review aims to explain the potential impact of coronavirus 
disease 2019 (COVID-19) on mental wellbeing of healthcare professionals (HCPs). 
Based on up-to-date research and psychological diagnostic manuals of Diagnostic 
and Statistical Manual of Mental Disorders, 5th edition and International 
Classification of Diseases, 11th revision, we describe associated psychological 
disorders and experiences that may arise related to COVID-19. Appropriate 
psychological measures are introduced, along with potential methodological 
limitations. Lastly, resilience building and preventative measures with 
interventions that may mitigate the impact on mental health of HCPs are 
described.

Copyright © 2020 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.bpa.2020.07.008
PMCID: PMC7367798
PMID: 33004166 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest Dr Kaye serves 
on the Speakers Bureau for Merck, Inc.


4165. Int Marit Health. 2020;71(3):184-190. doi: 10.5603/IMH.2020.0033.

Wellbeing of a selection of seafarers in Eastern Adriatic Sea during the 
COVID-19 pandemic 2020.

Pesel G(1), Canals ML(2), Sandrin M(3), Jensen O(4).

Author information:
(1)Policlinico Triestino SPA, Via Bonaparte, 4-6, 34132 Trieste, Italy. 
g.pesel@salustrieste.it.
(2)2. Sociedad Española de Medicina Marítima (SEMM) / University of Cadiz FUECA, 
Spain, General Mola, 33, Bajos Derecha, 39004 Santander, Spain.
(3)3. Adriatic Nautical Academy of Trieste, Via Karl Ludwig Von Bruck, 32, 34144 
Trieste, Italy.
(4)4. Centre of Maritime Health and Society, Department of Public Health, 
University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark.

BACKGROUND: Work-related stress among seafarers is well known but a suspected 
excess of work-related stress due to the COVID-19 so far has not been published. 
The aim of the study was to evaluate the well- -being of the seafarers during 
the outbreak of COVID-19 pandemic and their evaluation of the precautions taken 
by the shipping companies.
MATERIALS AND METHODS: Seventy-two seafarers completed the General Health 
Questionnaire (GHQ12) with three extra questions on how the COVID-19 precautions 
were taken on board.
RESULTS: The mean Likert score was 13.9 for the whole sample, corresponding to 
"no problems" while a subgroup of 40% had mean Likert sum scores of 16.1 (level 
15-23) corresponding to "starting problems." In response to the extra items, 50% 
of the seafarers did not feel safe doing their job in relation to the epidemic 
and 60% did not think everything has been done to ensure their health at work in 
relation to the epidemic. Thirty per cent suffered of insomnia to the extent of 
becoming concerned and 26% had been unhappy and depressed during the latest 
tours of duty.
CONCLUSIONS: The hypothesis that excess work-related stress has been put on the 
seafarers in this specific situation was confirmed and calls for prevention. A 
combination of person-focused and organisation-focused prevention approaches has 
been advocated as the most promising for alleviation of job stress in the 
workplaces at sea.

DOI: 10.5603/IMH.2020.0033
PMID: 33001430 [Indexed for MEDLINE]


4166. J Am Acad Child Adolesc Psychiatry. 2021 Jan;60(1):2-6. doi: 
10.1016/j.jaac.2020.09.011. Epub 2020 Sep 27.

Supporting Children With Neurodevelopmental Disorders During the COVID-19 
Pandemic.

Summers J(1), Baribeau D(1), Mockford M(2), Goldhopf L(2), Ambrozewicz P(2), 
Szatmari P(3), Vorstman J(4).

Author information:
(1)The Hospital for Sick Children, Toronto, Ontario, Canada; University of 
Toronto, Ontario, Canada.
(2)The Hospital for Sick Children, Toronto, Ontario, Canada.
(3)The Hospital for Sick Children, Toronto, Ontario, Canada; University of 
Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, 
Ontario, Canada.
(4)The Hospital for Sick Children, Toronto, Ontario, Canada; University of 
Toronto, Ontario, Canada. Electronic address: jacob.vorstman@sickkids.ca.

Families of children with neurodevelopmental disorders are especially vulnerable 
during the COVID-19 pandemic. Physical distancing requirements and closure of 
schools and services in the context of the COVID-19 pandemic are likely 
challenging to everyone but may be particularly impactful for families with 
children with neurodevelopmental disorders ([NDDs], eg, intellectual disability, 
attention-deficit/hyperactivity disorder [ADHD], autism spectrum disorder 
[ASD]). Although a small number of children may experience less stress or 
anxiety due to reduced social and academic expectations,1 for many children with 
NDDs, and particularly those with ASD, carefully developed behavioral and 
environmental supports, and consistent and predictable routines and 
expectations, are vital for their mental well-being.2 Consequently, abrupt 
discontinuation of these supports during quarantine and prolonged isolation 
creates a real risk for behavioral exacerbations in this vulnerable 
population.3-6 Possible consequences for family members include physical and 
mental strain,7 whereas for the child with an NDD, increased emotional distress 
and challenging behavior may create safety concerns and the need for 
hospitalization.4,6 Children with NDDs may be at increased risk for COVID and 
COVID-related complications,8 emphasizing the need for preventive and/or crisis 
behavioral health care availability outside of emergency and hospital settings.

Copyright © 2020 American Academy of Child and Adolescent Psychiatry. Published 
by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jaac.2020.09.011
PMID: 32998024 [Indexed for MEDLINE]


4167. PLoS One. 2020 Sep 30;15(9):e0239696. doi: 10.1371/journal.pone.0239696. 
eCollection 2020.

The impact of the COVID-19 epidemic on mental health of undergraduate students 
in New Jersey, cross-sectional study.

Kecojevic A(1), Basch CH(1), Sullivan M(1), Davi NK(2).

Author information:
(1)Department of Public Health, College of Science and Health, William Paterson 
University, Wayne, NJ, United States of America.
(2)Department of Environmental Science, College of Science and Health, William 
Paterson University, Wayne, NJ, United States of America.

OBJECTIVE: The COVID-19 pandemic has been a period of upheaval for college 
students. The objective of this study was to assess the factors associated with 
the increased levels of mental health burden among a sample of undergraduate 
college students in Northern New Jersey, the region of the U.S. severely 
impacted by the outbreak of COVID-19.
METHODS: College students (N = 162) enrolled in an introductory core curriculum 
course completed a cross-sectional survey. The survey collected information on 
demographics, knowledge levels and sources of COVID-19 information, behavior 
changes, academic and everyday difficulties, and mental health measurements 
(depression, anxiety, somatization, and stress). Multivariable regression 
analysis was performed to identify factors associated with mental health 
outcomes.
RESULTS: Descriptive findings indicate that students have a fundamental 
knowledge of COVID-19 transmission and common symptoms. Students tend to use and 
trust the official sources and have changed their behaviors in accordance with 
public health recommendations (i.e., increased hand washing, wearing mask). 
However, students reported a number of academic and everyday difficulties and 
high levels of mental health distress. High levels of depression were associated 
with difficulties in focusing on academic work and with employment losses, while 
higher levels of anxiety were more likely to be reported by students other than 
freshmen and those who spend more than one hour per day looking for information 
on COVID-19. Inability to focus on academic work and an elevated concern with 
COVID-19 were more likely to be associated with higher levels of somatization, 
while trusting news sources was associated with lower levels of somatization. 
Those with higher levels of perceived stress were more likely to be females, 
unable to focus on academic work, and report difficulties in obtaining 
medications and cleaning supplies.
CONCLUSIONS: The COVID-19 pandemic is making a significant negative impact on 
mental health of college students. Proactive efforts to support the mental 
health and well-being of students are needed.

DOI: 10.1371/journal.pone.0239696
PMCID: PMC7526896
PMID: 32997683 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


4168. Am J Surg. 2021 Feb;221(2):277-284. doi: 10.1016/j.amjsurg.2020.09.005. Epub 
2020 Sep 12.

How resilient is your team? Exploring healthcare providers' well-being during 
the COVID-19 pandemic.

Huffman EM(1), Athanasiadis DI(1), Anton NE(1), Haskett LA(1), Doster DL(1), 
Stefanidis D(1), Lee NK(2).

Author information:
(1)Indiana University School of Medicine, Department of Surgery, USA.
(2)Indiana University School of Medicine, Department of Surgery, USA. Electronic 
address: leenk@iu.edu.

BACKGROUND: The global COVID-19 pandemic has placed tremendous physical and 
mental strain on the US healthcare system. Studies examining the effects of 
outbreaks have demonstrated both an increased prevalence and long-term 
development of Post-Traumatic Stress Disorder (PTSD) symptoms in healthcare 
providers. We sought to assess the impact of the COVID-19 pandemic on the 
psychological well-being of medical providers, medical trainees, and 
administrators at a large academic center to identify stressors and moderators 
to guide future mental health and hospital-system interventions.
METHODS: A 42-item survey examining specific stressors, grit, and resilience was 
widely distributed to physicians, residents, fellows, and administrators a large 
academic institution for departmental distribution. Survey results were analyzed 
using descriptive statistics, ANOVA, and multivariate linear regressions. A 
p-value <0.05 was considered statistically significant.
RESULTS: A total of 785 participants completed the survey. The majority of 
respondents rated their stress to be significantly increased during the 
pandemic. Respondents' fear of transmitting the virus to their family members 
was a significant stressor. Higher resilience was associated with lower stress, 
anxiety, fatigue, and sleep disturbances. Overall, respondents felt supported by 
their departments and institution and felt contingency plans and personal 
protective equipment were adequate.
CONCLUSIONS: Healthcare workers have increased resilience in the face of 
heightened stress during a pandemic. Higher resilience and grit were protective 
factors in managing personal and system-level stressors at the peak of the 
COVID-19 pandemic in our institution. Implementing an intervention designed to 
enhance healthcare workers' resilience in response to the COVID-19 pandemic is 
warranted.

Copyright © 2020 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.amjsurg.2020.09.005
PMCID: PMC7486626
PMID: 32994041 [Indexed for MEDLINE]


4169. Int J Environ Res Public Health. 2020 Sep 25;17(19):7015. doi: 
10.3390/ijerph17197015.

Mental Health and the SARS-COV-2 Epidemic-Polish Research Study.

Talarowska M(1), Chodkiewicz J(1), Nawrocka N(1), Miniszewska J(1), Biliński 
P(2)(3).

Author information:
(1)Institute of Psychology, University of Lodz, 91-433 Lodz, Poland.
(2)The President Stanisław Wojciechowski State University of Applied Sciences in 
Kalisz, 92-800 Kalisz, Poland.
(3)Copernicus Memorial Multidisciplinary Comprehensive Cancer and Traumatology 
Center, 93-513 Lodz, Poland.

Background: The aim of this study was to assess the mental state of Poles in the 
first weeks of the SARS-COV-2 epidemic. Methods: In the study, the General 
Health Questionnaire-28 (GHQ-18), The Perceived Stress Scale (PSS-10), and 
Mini-Cope were used. Results: The study was conducted on a group of 443 
individuals, including 348 women (78.6%) and 95 men (21.4%). There were more 
women (χ2 = 6.42, p = 0.02) in the group of people with high results in the 
GHQ-28 questionnaire and the differentiating factors between those with sten 
scores above 7 (significantly deteriorated mental health) and those with average 
or low results (sten score below 7) turned out to be: treatment for mental 
disorders before the pandemic (χ2 = 19.57, p < 0.001) and the use of 
psychotherapy during the pandemic (χ2 = 4.21, p = 0.04) and psychiatric 
pharmacotherapy (χ2 = 8.31, p = 0.01). The presence of suicidal thoughts since 
the appearance of the pandemic-related restraints and limitations significantly 
differentiates the compared groups (χ2 = 38.48, p < 0.001). Conclusions: Every 
fourth person in the examined group (over 26% of the respondents) recorded 
results that indicate a high probability of mental functioning disorders. 
Approximately 10% of the respondents signalled the occurrence of suicidal 
thoughts since the beginning of the pandemic. The respondents complain mainly 
about problems in everyday life, lack of satisfaction from one's own activities, 
tension, trouble sleeping, and feelings of exhaustion. Individuals with 
significantly reduced mental well-being use non-adaptive coping strategies, such 
as denying problems, emotional discharge, taking substances, discontinuation of 
action, and blaming themselves for the situation. The risk factors for the 
deterioration of the mental state of the respondents during the pandemic include 
psychiatric treatment before the beginning of the pandemic, the presence of 
suicidal thoughts during forced isolation, and the use of non-adaptive coping 
strategies (denial of the existence of problems, emotional discharge, use of 
psychoactive substances, discontinuation of action, and blaming oneself for the 
situation).

DOI: 10.3390/ijerph17197015
PMCID: PMC7579123
PMID: 32992807 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


4170. Ethn Dis. 2020 Sep 24;30(4):695-700. doi: 10.18865/ed.30.4.695. eCollection 2020 
Fall.

Mental Health Community and Health System Issues in COVID-19: Lessons from 
Academic, Community, Provider and Policy Stakeholders.

Arevian AC(1)(2), Jones F(3), Moore EM(4)(5), Goodsmith N(4)(5), Aguilar-Gaxiola 
S(6), Ewing T(7), Siddiq H(5)(8), Lester P(1)(9), Cheung E(1), Ijadi-Maghsoodi 
R(1)(4)(9)(10), Gabrielian S(1)(4)(10), Sugarman OK(11), Bonds C(1)(12), Benitez 
C(1)(12), Innes-Gomberg D(12), Springgate B(11), Haywood C(13), Meyers D(14), 
Sherin JE(1)(12)(15), Wells K(1)(4)(9)(10)(16)(2).

Author information:
(1)Resnick Neuropsychiatric Hospital and Department of Psychiatry and 
Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, 
CA.
(2)UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, 
Center for Health Services and Society, Los Angeles, CA.
(3)Healthy African American Families II, Los Angeles, CA.
(4)VA Greater Los Angeles Healthcare System HSR&D Center for the Study of 
Healthcare Innovation Implementation & Policy, Los Angeles, CA.
(5)UCLA National Clinician Scholars Program, Los Angeles, CA.
(6)Department of Clinical Internal Medicine, School of Medicine, and Center for 
Reducing Health Disparities, UC Davis, Davis, CA.
(7)California Mental Health Services Oversight and Accountability Commission, 
Sacramento, CA.
(8)UCLA Resource Center for Minority Aging Research, Resource Centers for 
Minority Aging and for Health Improvement of Minority Elderly, Los Angeles, CA.
(9)UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, 
Division of Population Behavioral Health, Los Angeles, CA.
(10)UCLA/VA Center of Excellence for Veteran Resilience and Recovery, Los 
Angeles, CA.
(11)Louisiana State University Health Sciences Center - New Orleans School of 
Medicine and School of Public Health, New Orleans, LA.
(12)Los Angeles County Department of Mental Health, Los Angeles, CA.
(13)Louisiana Community Health Outreach Network, New Orleans, LA.
(14)St. Anna's Episcopal Church, New Orleans, LA.
(15)University of Southern California, Los Angeles, CA.
(16)UCLA Fielding School of Public Health, Los Angeles, CA.

The coronavirus pandemic of 2019 (COVID-19) has created unprecedented changes to 
everyday life for millions of Americans due to job loss, school closures, 
stay-at-home orders and health and mortality consequences. In turn, physicians, 
academics, and policymakers have turned their attention to the public mental 
health toll of COVID-19. This commentary reporting from the field integrates 
perceptions of academic, community, health system, and policy leaders from 
state, county, and local levels in commenting on community mental health needs 
in the COVID-19 pandemic. Stakeholders noted the broad public health scope of 
mental health challenges while expressing concern about exacerbation of existing 
disparities in access and adverse social determinants, including for communities 
with high COVID-19 infection rates, such as African Americans and Latinos. They 
noted rapid changes toward telehealth and remote care, and the importance of 
understanding impacts of changes, including who may benefit or have limited 
access, with implications for future services delivery. Needs for expanded 
workforce and training in mental health were noted, as well as potential public 
health value of expanding digital resources tailored to local populations for 
enhancing resilience to stressors. The COVID-19 pandemic has led to changes in 
delivery of health care services across populations and systems. Concerns over 
the mental health impact of COVID-19 has enhanced interest in remote mental care 
delivery and preventive services, while being mindful of potential for enhanced 
disparities and needs to address social determinants of health. Ongoing quality 
improvement across systems can integrate lessons learned to enhance a public 
mental well-being.

Copyright © 2020, Ethnicity & Disease, Inc.

DOI: 10.18865/ed.30.4.695
PMCID: PMC7518533
PMID: 32989370 [Indexed for MEDLINE]

Conflict of interest statement: Competing Interests: ACA is founder of Chorus 
Innovations, Inc., Open Science Initiative, and Arevian Technologies, Inc.


4171. Am J Psychother. 2020 Dec 1;73(4):144-148. doi: 
10.1176/appi.psychotherapy.20200020. Epub 2020 Sep 28.

Applying Psychotherapeutic Principles to Bolster Resilience Among Health Care 
Workers During the COVID-19 Pandemic.

Rosen B(1), Preisman M(1), Hunter J(1), Maunder R(1).

Author information:
(1)Department of Psychiatry, University of Toronto, and Department of 
Psychiatry, Sinai Health, Toronto.

The COVID-19 pandemic has affected the entire globe with overwhelming speed and 
impact. The pandemic is both highly threatening and poorly understood, typical 
of deeply distressing conditions. Stress associated with uncertain 
recommendations from authorities, fear of illness and contagion for oneself and 
one's loved ones, extended periods of isolation, moral conflicts, financial 
instability, perception of discrimination and/or stigma, and ongoing loss and 
grief imperil mental health and resilience among the general population and 
high-risk groups. Health care workers (HCWs) face additional challenges that 
increase their vulnerability to distress and burnout. Bolstering resilience 
among HCWs can allow them to continue working with the intensity and focus their 
jobs require, which in turn supports the overall functioning of the health care 
system. Given their training in understanding wellness, distress, and 
psychotherapeutic treatment, mental health clinicians are well positioned to 
respond to this need. By studying the lessons from past and present experiences 
with public health emergencies and by incorporating principles from 
psychotherapeutic literature and training, clinicians can help facilitate an 
informed and effective response. The goal of this article is to discuss the 
development of a resilience coaching model that is rooted in principles from 
psychotherapeutic literature and practice to support psychological well-being 
among hospital-based HCWs. This model, developed to support the authors' health 
care colleagues working in a Toronto hospital, is generalizable, can be adapted 
for use by any mental health clinician, and makes explicit how previous training 
in psychotherapy may be applied to coaching and supporting frontline HCWs.

DOI: 10.1176/appi.psychotherapy.20200020
PMID: 32985915 [Indexed for MEDLINE]


4172. Fam Process. 2021 Jun;60(2):639-653. doi: 10.1111/famp.12601. Epub 2020 Sep 28.

Parenting Stress During the COVID-19 Outbreak: Socioeconomic and Environmental 
Risk Factors and Implications for Children Emotion Regulation.

Spinelli M(1), Lionetti F(1), Setti A(2), Fasolo M(1).

Author information:
(1)Department of Neurosciences Imaging and Clinical Sciences, University G. 
D'Annunzio Chieti-Pescara, Chieti, Italy.
(2)University College Cork, Cork, Ireland.

The COVID-19 outbreak imposed to Italian families many changes in their daily 
life increasing the risk of developing psychological problems. The present study 
explored risk factors associated with parenting stress and implications for 
children's emotion regulation in families with different socioeconomic risks. 
Parents of 2-14 years old children completed a survey reporting difficulties 
experienced due to the lockdown, level of household chaos, parenting stress, 
parent involvement in the child's daily life, and children emotion regulation 
competences. The general mean levels of parenting stress and children emotion 
regulation abilities were not at clinical level compared with Italian norms. 
Household chaos predicted higher levels of parenting stress, which, in turn, was 
associated with less effective emotion regulation in children through the 
mediating role of parental involvement. More stressed parents were less involved 
in their children's activities, decreasing children's effective emotion 
regulation. Only for SES no-risk families, the lockdown constraints increased 
parenting stress. For SES at-risk families, the impact of parenting stress and 
involvement on children regulation strategies was stronger, with a protective 
role played by parental involvement on children's negativity not evident for SES 
no-risk families. Dealing with the lockdown is a stressful experience for 
parents who have to balance personal life, work, and children upbringing, 
without other help. This situation potentially impairs their ability to be 
supportive caregivers and is consequently detrimental for children well-being. 
Policies should take into consideration the implications of the lockdown for 
families' mental health and tailor supportive interventions according to 
family's risk factors.

Publisher: El brote de la COVID-19 impuso a las familias italianas muchos 
cambios en su vida cotidiana, los cuales aumentaron el riesgo de desarrollar 
problemas psicológicos. El presente estudio analizó los factores de riesgo 
asociados con el estrés de la crianza y las consecuencias para la regulación 
emocional de los hijos en familias con diferentes riesgos socioeconómicos. Un 
grupo de padres de niños de entre dos y 14 años contestó una encuesta donde 
informó las dificultades vividas debido al confinamiento, el nivel de caos en el 
hogar, el estrés en la crianza, la participación de los padres en la vida diaria 
de los hijos y las competencias de los hijos para regular sus emociones. Los 
niveles promedio generales de estrés en la crianza y las habilidades de 
regulación emocional en los niños no estuvieron a nivel clínico en comparación 
con las normas italianas. El caos en el hogar predijo niveles más altos de 
estrés en la crianza, el cual, a su vez, estuvo asociado con una menor 
regulación emocional eficaz en los niños mediante el rol mediador de la 
participación de los padres. Los padres más estresados participaron menos en las 
actividades de sus hijos, lo cual disminuyó la regulación emocional eficaz en 
los niños. Solo en los casos de las familias sin riesgo socioeconómico las 
limitaciones del confinamiento aumentaron el estrés en la crianza. Para las 
familias de riesgo socioeconómico, el efecto del estrés en la crianza y la 
participación en las estrategias de regulación emocional de los niños fue más 
profundo, y en el caso de las familias sin riesgo socioeconómico, no se 
evidenció el papel protector desempeñado por la participación de los padres en 
la negatividad de los niños. Lidiar con el confinamiento es una experiencia 
estresante para los padres que tienen que compatibilizar la vida personal, el 
trabajo y la educación de los niños sin ninguna otra ayuda. Esta situación puede 
deteriorar su capacidad de ser cuidadores comprensivos y, como consecuencia, ser 
perjudicial para el bienestar de los niños. Las políticas deberían tener en 
cuenta las consecuencias del confinamiento en la salud mental de las familias y 
adaptar intervenciones de apoyo de acuerdo con los factores de riesgo de las 
familias.

Publisher: 
新冠肺炎疫情给意大利家庭的日常生活带来许多变化，增加了出现心理问题的风险。本研究探讨不同社会经济风险家庭中，与父母压力相关的风险因素及它们对儿童情绪调节的影响。2至14岁儿童的父母完成了一项调查，报告了由于禁闭、家庭混乱程度、父母压力、父母参与儿童日常生活和儿童情绪调节能力所经历的困境。与意大利标准相比，养育压力和儿童情绪调节能力的一般平均水平没有达到临床水平。家庭混乱预示着更高程度的父母压力，反过来，通过父母参与的中介作用，孩子的情绪调节能力更低。父母压力越大，参与孩子活动就越少，孩子有效情绪调节能力就越弱。只有对没有社会经济地位风险的家庭来说，禁闭才会增加养育子女的压力。在有社会经济地位风险的家庭中，父母的压力和参与对儿童调节策略的影响更大，而父母参与对儿童消极情绪的保护作用在没有社会经济地位风险的家庭中并不明显。 
对于那些不得不在没有其他帮助的情况下平衡个人生活、工作和抚养孩子的父母来说，应对禁闭是一件很有压力的事情。这种情况可能损害他们成为支持性照顾者的能力，因此对儿童的福祉有害。政策应考虑到封锁对家庭心理健康的影响，并根据家庭的风险因素制定支持性干预措施。.

© 2020 Family Process Institute.

DOI: 10.1111/famp.12601
PMID: 32985703 [Indexed for MEDLINE]


4173. J Nurs Manag. 2021 Apr;29(3):395-403. doi: 10.1111/jonm.13168. Epub 2020 Oct 11.

Fear of COVID-19, psychological distress, work satisfaction and turnover 
intention among frontline nurses.

Labrague LJ(1), de Los Santos JAA(2).

Author information:
(1)College of Nursing, Sultan Qaboos University, Muscat, Oman.
(2)College of Nursing, Visayas State University, Baybay, Philippines.

AIM: To examine the relative influence of fear of COVID-19 on nurses' 
psychological distress, work satisfaction and intent to leave their organisation 
and the profession.
BACKGROUND: The emergence of COVID-19 has significantly impacted the 
psychological and mental well-being of frontline health care workers, including 
nurses. To date, no studies have been conducted examining how this fear of 
COVID-19 contributes to health, well-being and work outcomes in frontline 
nurses.
METHODS: This is a cross-sectional research design involving 261 frontline 
nurses in the Philippines. Five standardized scales were used for data 
collection.
RESULTS: Overall, the composite score of the fear of COVID-19 scale was 19.92. 
Job role and attendance of COVID-19-related training predicted fear of COVID-19. 
An increased level of fear of COVID-19 was associated with decreased job 
satisfaction, increased psychological distress and increased organisational and 
professional turnover intentions.
CONCLUSIONS: Frontline nurses who reported not having attended COVID-19-related 
training and those who held part-time job roles reported increased fears of 
COVID-19. Addressing the fear of COVID-19 may result in improved job outcomes in 
frontline nurses, such as increased job satisfaction, decreased stress levels 
and lower intent to leave the organisation and the profession.
IMPLICATIONS FOR NURSING MANAGEMENT: Organisational measures are vital to 
support the mental health of nurses and address their fear of COVID-19 through 
peer and social support, psychological and mental support services (e.g. 
counselling or psychotherapy), provision of training related to COVID-19 and 
accurate and regular information updates.

© 2020 John Wiley & Sons Ltd.

DOI: 10.1111/jonm.13168
PMCID: PMC7537256
PMID: 32985046 [Indexed for MEDLINE]


4174. Eur Psychiatry. 2020 Sep 28;63(1):e87. doi: 10.1192/j.eurpsy.2020.89.

Effects of the lockdown on the mental health of the general population during 
the COVID-19 pandemic in Italy: Results from the COMET collaborative network.

Fiorillo A(1), Sampogna G(1), Giallonardo V(1), Del Vecchio V(1), Luciano M(1), 
Albert U(2), Carmassi C(3), Carrà G(4), Cirulli F(5), Dell'Osso B(6), Nanni 
MG(7), Pompili M(8), Sani G(9)(10), Tortorella A(11), Volpe U(12).

Author information:
(1)Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, 
Italy.
(2)Department of Medicine, Surgery and Health Sciences, University of Trieste 
and Department of Mental Health, Azienda Sanitaria Universitaria Giuliano 
Isontina - ASUGI, Trieste, Italy.
(3)Department of Clinical and Experimental Medicine, University of Pisa, Pisa, 
Italy.
(4)Department of Medicine and Surgery, University of Milan Bicocca, Milan, 
Italy.
(5)Center for Behavioral Sciences and Mental Health, National Institute of 
Health, Rome, Italy.
(6)Department of Biomedical and Clinical Sciences Luigi Sacco and Aldo Ravelli 
Center for Neurotechnology and Brain Therapeutic, University of Milan, Milano, 
Italy.
(7)Institute of Psychiatry, Department of Biomedical and Specialty Surgical 
Sciences, University of Ferrara, Ferrara, Italy.
(8)Department of Neurosciences, Mental Health and Sensory Organs, Faculty of 
Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
(9)Department of Neuroscience, Section of Psychiatry, University Cattolica del 
Sacro Cuore, Rome, Italy.
(10)Department of Psychiatry, Fondazione Policlinico Agostino Gemelli IRCCS, 
Rome, Italy.
(11)Department of Psychiatry, University of Perugia, Perugia, Italy.
(12)Clinical Psychiatry Unit, Department of Clinical Neurosciences, Università 
Politecnica delle Marche, Ancona, Italy.

BACKGROUND: The Coronavirus disease 2019 (COVID-19) pandemic is an unprecedented 
traumatic event influencing the healthcare, economic, and social welfare systems 
worldwide. In order to slow the infection rates, lockdown has been implemented 
almost everywhere. Italy, one of the countries most severely affected, entered 
the "lockdown" on March 8, 2020.
METHODS: The COvid Mental hEalth Trial (COMET) network includes 10 Italian 
university sites and the National Institute of Health. The whole study has three 
different phases. The first phase includes an online survey conducted between 
March and May 2020 in the Italian population. Recruitment took place through 
email invitation letters, social media, mailing lists of universities, national 
medical associations, and associations of stakeholders (e.g., associations of 
users/carers). In order to evaluate the impact of lockdown on depressive, 
anxiety and stress symptoms, multivariate linear regression models were 
performed, weighted for the propensity score.
RESULTS: The final sample consisted of 20,720 participants. Among them, 12.4% of 
respondents (N = 2,555) reported severe or extremely severe levels of depressive 
symptoms, 17.6% (N = 3,627) of anxiety symptoms and 41.6% (N = 8,619) reported 
to feel at least moderately stressed by the situation at the DASS-21.According 
to the multivariate regression models, the depressive, anxiety and stress 
symptoms significantly worsened from the week April 9-15 to the week April 30 to 
May 4 (p < 0.0001). Moreover, female respondents and people with pre-existing 
mental health problems were at higher risk of developing severe depression and 
anxiety symptoms (p < 0.0001).
CONCLUSIONS: Although physical isolation and lockdown represent essential public 
health measures for containing the spread of the COVID-19 pandemic, they are a 
serious threat for mental health and well-being of the general population. As an 
integral part of COVID-19 response, mental health needs should be addressed.

DOI: 10.1192/j.eurpsy.2020.89
PMCID: PMC7556907
PMID: 32981568 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to 
disclose.


4175. Hu Li Za Zhi. 2020 Oct;67(5):56-64. doi: 10.6224/JN.202010_67(5).08.

[The Impact of the COVID-19 Pandemic on the Health and Coping Behaviors of 
Patients With Treatment-Resistant Depression].

[Article in Chinese; Abstract available in Chinese from the publisher]

Chen KL(1), Hung WC(2), Lee MB(3), Chen IM(4), Wu CY(5).

Author information:
(1)MSc, Research Assistant, School of Nursing, College of Medicine, National 
Taiwan University, and Doctoral Student, Institute of Public Health, National 
Yang-Ming University, Taiwan, ROC.
(2)MSN, RN, NP, Department of Nursing, Far Eastern Memorial Hospital, and 
Doctoral Student, School of Nursing, College of Medicine, National Taiwan 
University, Taiwan, ROC.
(3)MD, Emeritus Professor, Department of Psychiatry, National Taiwan University 
Hospital, Taiwan, ROC.
(4)PhD, MD, Visiting Psychiatrist, Department of Psychiatry, National Taiwan 
University Hospital, Taiwan, ROC.
(5)PhD, RN, Associate Professor, School of Nursing, College of Medicine, 
National Taiwan University, and Adjunct Supervisor, Department of Nursing, 
National Taiwan University Hospital., Taiwan, ROC. jennycyw@ntu.edu.tw.

BACKGROUND: The COVID-19 pandemic has had a disastrous impact globally. For the 
general public and for people with mental illnesses, this pandemic may cause 
mental/physical stress and major life impacts.
PURPOSE: This study was designed to explore the related changes in daily life 
and impacts on the well-being of a group of patients with chronic 
treatment-resistant depression (TRD) during the COVID-19 pandemic.
METHODS: This study was a part of a long-term, follow-up study of a cohort of 
patients with TRD collected in 2018. All of the subjects who were diagnosed with 
major depression and fit the inclusion criteria were referred by the 
psychiatrists from two teaching hospitals. Structured interviews were used to 
collect data on physical and psychological changes during the pandemic period 
between January and May 2020. The researchers organized the key points by 
recording or note taking. Thematic analysis was used to summarize and classify 
themes and units.
RESULTS: The 116 respondents revealed that the COVID-19 pandemic affected their 
health in the biological, psychological, and social dimensions. The three 
emerging themes included: The threatening of homogeneity in the whole person's 
health, the interaction between bio-psycho-social aspects, and positive growth 
of individuals with TRD. Although the participants had confidence in the 
prevention strategies of the government related to COVID-19, they expressed 
feelings of distress and restlessness with regard to COVID-19-related news 
reports.
CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The COVID-19 pandemic has affected the 
health of patients with TRD in both positive and negative ways. As the goal of 
government preventive strategies is to protect and promote public health, 
regular attention should be paid to the negative effects of long-term exposure 
to pandemic-related news on this vulnerable population.

Publisher: TITLE: 探索COVID-19疫情對難治型憂鬱症病人健康與因應行為之影響.
背景: COVID-19新冠肺炎帶來全球性災難，對一般民眾或精神疾病病人而言都可能造成身心壓力與生活衝擊。.
目的: 本研究旨在探討難治型憂鬱症病人在經歷COVID-19疫情爆發後的生活轉變暨身心影響。.
方法: 
本研究為團隊於2018年針對難治型憂鬱症病人進行長期追蹤研究的一部分，受訪者來自兩家教學醫院，由精神科專科醫師確診重鬱症且符合收入條件之病人，研究者於2020年1–5月期間以結構化訪談指引收集COVID-19疫情爆發後身心變化之資料，並以錄音或重點記錄方式彙整，採主題分析法進行主題歸納與分類及單元架構分析。.
結果: 
116位受訪者因COVID-19疫情導致生理、心理、社會三個健康層面受到明顯的衝擊，個案陳述中浮現出三大主題：憂鬱症病人的全人健康恆定性受到威脅、生理、心理及社會面向之交互作用、以及個體的正向成長。受訪者表達對政府防疫措施有信心，但觀看過多疫情報導會造成苦惱與不安。.
結論／實務應用: COVID-19對憂鬱症病人產生多重健康影響及正向轉變；政府防疫策略帶來保護作用，然仍須注意長期暴露於疫情報導下的負向影響。.

DOI: 10.6224/JN.202010_67(5).08
PMID: 32978766 [Indexed for MEDLINE]


4176. J Surg Educ. 2021 May-Jun;78(3):813-819. doi: 10.1016/j.jsurg.2020.09.009. Epub 
2020 Sep 14.

Redeployment of Surgical Trainees to Intensive Care During the COVID-19 
Pandemic: Evaluation of the Impact on Training and Wellbeing.

Payne A(1), Rahman R(2), Bullingham R(2), Vamadeva S(1), Alfa-Wali M(3).

Author information:
(1)Royal London Hospital, Department of Plastic and Reconstructive Surgery, 
London, United Kingdom.
(2)Royal London Hospital, Department of General Surgery, London, United Kingdom.
(3)Royal London Hospital, Department of General Surgery, London, United Kingdom. 
Electronic address: m.alfa@doctors.org.uk.

OBJECTIVE: The aim of this study was to evaluate the impact of redeployment of 
surgical trainees to intensive care units (ICUs) during the COVID-19 pandemic-in 
terms of transferrable technical and nontechnical skills and wellbeing.
DESIGN: This was a survey study consisting of a 23-point questionnaire.
SETTING: The study involved surgical trainees that had been redeployed to the 
(ICU) across all hospitals in London during the COVID-19 pandemic.
PARTICIPANTS: The survey was sent to 90 surgical trainees who were between 
postgraduate years 2 to 4. Trainees in specialty training programs (>5 years 
after graduation) were not included. Thirty-two trainees responded to the 
questionnaire and were included in the study results.
RESULTS: All respondents spent between 4 and 8 weeks working in ICU. Prior to 
redeployment, 78% of participants had previous experience of ICU or an 
affiliated specialty, and >90% had attended at least 1 educational course with 
relevance to ICU. There were statistically significant increases in confidence 
performing central venous cannulation and peripheral arterial catheterisation (p 
< 0.05). With regards to clinical skills, respondents reported feeling more 
confident managing ventilated patients, patients on noninvasive ventilation, 
dialysis, and circulatory failure patients after working in ICU. Respondents 
(97%) felt that the experience would be beneficial to their future careers but 
53% felt the redeployment had a negative impact on their mental health.
CONCLUSIONS: Redeployment of surgical trainees to ICU led to increased 
confidence in a number of technical and nontechnical skills. However, proactive 
interventions are needed for training surgeons with regard to their 
psychological wellbeing in these extraordinary circumstances and to improve 
workforce planning for future pandemics.

Copyright © 2020 Association of Program Directors in Surgery. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jsurg.2020.09.009
PMCID: PMC7490001
PMID: 32978093 [Indexed for MEDLINE]


4177. Global Health. 2020 Sep 25;16(1):89. doi: 10.1186/s12992-020-00621-z.

Mental health impacts among health workers during COVID-19 in a low resource 
setting: a cross-sectional survey from Nepal.

Khanal P(1), Devkota N(2), Dahal M(3), Paudel K(4), Joshi D(2).

Author information:
(1)Institute of Medicine, Tribhuvan University, Kathmandu, Nepal. 
pratikkhanal@iom.edu.np.
(2)National Academy for Medical Sciences, Kathmandu, Nepal.
(3)Center for Research on Environment, Health and Population Activities 
(CREHPA), Kathmandu, Nepal.
(4)Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.

BACKGROUND: Health care workers exposed to COVID-19 might be at increased risk 
of developing mental health problems. The study aimed to identify factors 
associated with anxiety, depression and insomnia among health workers involved 
in COVID-19 response in Nepal.
METHODS: This was a cross-sectional web-based survey conducted between April 26 
and May 12, 2020. A total of 475 health workers participated in the study. 
Anxiety and depression were measured using a 14-item Hospital Anxiety and 
Depression Scale (HADS: 0-21) and insomnia was measured by using a 7-item 
Insomnia Severity Index (ISI: 0-28). Multivariable logistic regression analysis 
was done to determine the risk factors of mental health outcomes.
RESULTS: Overall, 41.9% of health workers had symptoms of anxiety, 37.5% had 
depression symptoms and 33.9% had symptoms of insomnia. Stigma faced by health 
workers was significantly associated with higher odds of experiencing symptoms 
of anxiety (AOR: 2.47; 95% CI: 1.62-3.76), depression (AOR: 2.05; 95% CI: 
1.34-3.11) and insomnia (AOR: 2.37; 95% CI: 1.46-3.84). History of medication 
for mental health problems was significantly associated with a higher likelihood 
of experiencing symptoms of anxiety (AOR: 3.40; 95% CI:1.31-8.81), depression 
(AOR: 3.83; 95% CI: 1.45-10.14) and insomnia (AOR: 3.82; 95% CI: 1.52-9.62) 
while inadequate precautionary measures in the workplace was significantly 
associated with higher odds of exhibiting symptoms of anxiety (AOR: 1.89; 95% 
CI: 1.12-3.19) and depression (AOR: 1.97; 95% CI: 1.16-3.37). Nurses (AOR: 2.33; 
95% CI: 1.21-4.47) were significantly more likely to experience anxiety symptoms 
than other health workers.
CONCLUSION: The study findings revealed a considerate proportion of anxiety, 
depression and insomnia symptoms among health workers during the early phase of 
the pandemic in Nepal. Health workers facing stigma, those with history of 
medication for mental health problems, and those reporting inadequate 
precautionary measures in their workplace were more at risk of developing mental 
health outcomes. A focus on improving mental wellbeing of health workers should 
be immediately initiated with attention to reduction of stigma, ensuring an 
adequate support system such as personal protective equipments, and family 
support for those with history of mental health problems.

DOI: 10.1186/s12992-020-00621-z
PMCID: PMC7517059
PMID: 32977818 [Indexed for MEDLINE]

Conflict of interest statement: Authors have no competing interest associated 
with this paper. The author’s affiliation does not necessarily reflect the view 
of their employing organisations. The authors prepared a policy brief of 2 pages 
based on preliminary findings and have shared it with the Ministry of Health and 
Population.


4178. PLoS One. 2020 Sep 25;15(9):e0239397. doi: 10.1371/journal.pone.0239397. 
eCollection 2020.

Human-animal relationships and interactions during the Covid-19 lockdown phase 
in the UK: Investigating links with mental health and loneliness.

Ratschen E(1), Shoesmith E(1), Shahab L(2), Silva K(3), Kale D(2), Toner P(4), 
Reeve C(4), Mills DS(5).

Author information:
(1)Department of Health Sciences, University of York, York, United Kingdom.
(2)Department of Behavioural Science and Health, University College London, 
London, United Kingdom.
(3)Department of Behavioural Sciences, University of Porto, Porto, Portugal.
(4)School of Psychology, Queen's University Belfast, Belfast, United Kingdom.
(5)School of Life Sciences, University of Lincoln, Lincoln, United Kingdom.

BACKGROUND: The Covid-19 pandemic raises questions about the role that 
relationships and interactions between humans and animals play in the context of 
widespread social distancing and isolation measures. We aimed to investigate 
links between mental health and loneliness, companion animal ownership, the 
human-animal bond, and human-animal interactions; and to explore animal owners' 
perceptions related to the role of their animals during lockdown.
METHODS: A cross-sectional online survey of UK residents over 18 years of age 
was conducted between April and June 2020. The questionnaire included validated 
and bespoke items measuring demographics; exposures and outcomes related to 
mental health, wellbeing and loneliness; the human-animal bond and human-animal 
interactions.
RESULTS: Of 5,926 participants, 5,323 (89.8%) had at least one companion animal. 
Most perceived their animals to be a source of considerable support, but 
concerns were reported related to various practical aspects of providing care 
during lockdown. Strength of the human-animal bond did not differ significantly 
between species. Poorer mental health pre-lockdown was associated with a 
stronger reported human-animal bond (b = -.014, 95% CI [-.023 - -.005], p = 
.002). Animal ownership compared with non-ownership was associated with smaller 
decreases in mental health (b = .267, 95% CI [.079 - .455], p = .005) and 
smaller increases in loneliness (b = -.302, 95% CI [-.461 - -.144], p = .001) 
since lockdown.
CONCLUSION: The human-animal bond is a construct that may be linked to mental 
health vulnerability in animal owners. Strength of the human-animal bond in 
terms of emotional closeness or intimacy dimensions appears to be independent of 
animal species. Animal ownership seemed to mitigate some of the detrimental 
psychological effects of Covid-19 lockdown. Further targeted investigation of 
the role of human-animal relationships and interactions for human health, 
including testing of the social buffering hypothesis and the development of 
instruments suited for use across animal species, is required.

DOI: 10.1371/journal.pone.0239397
PMCID: PMC7518616
PMID: 32976500 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


4179. Obesity (Silver Spring). 2021 Jan;29(1):38-45. doi: 10.1002/oby.23048. Epub 2020 
Nov 29.

BMI, Weight Discrimination, and the Trajectory of Distress and Well-Being Across 
the Coronavirus Pandemic.

Sutin AR(1), Stephan Y(2), Luchetti M(1), Aschwanden D(3), Strickhouser JE(1), 
Lee JH(1), Sesker AA(1), Terracciano A(3).

Author information:
(1)Department of Behavioral Sciences and Social Medicine, Florida State 
University College of Medicine, Tallahassee, Florida, USA.
(2)Euromov, University of Montpellier, Montpellier, France.
(3)Department of Geriatrics, Florida State University College of Medicine, 
Tallahassee, Florida, USA.

OBJECTIVE: The purpose of this study was to examine the trajectory of 
psychological distress and well-being across the coronavirus pandemic by BMI 
category and weight discrimination.
METHODS: Participants (N = 1,590) were assessed three times: early February 2020 
before the coronavirus crisis in the United States and again in mid-March and 
late April 2020. Participants reported their weight, height, and weight 
discrimination in February. Depressed affect, loneliness, purpose in life, life 
satisfaction, and perceived support were assessed in all surveys; anxiety and 
stress were assessed in the March/April surveys.
RESULTS: Prior to the pandemic, reporting weight discrimination or being in the 
underweight or obesity 2 to 3 categories was associated with more distress and 
lower well-being. Weight discrimination, not BMI, was associated with a twofold 
increased risk of incident depression from before to during the pandemic. Weight 
discrimination was associated with declines in purpose in life and life 
satisfaction across the pandemic. BMI categories were unrelated to changes in 
distress/well-being across the pandemic.
CONCLUSIONS: Prior to the pandemic, BMI and weight discrimination were 
vulnerabilities for greater distress and lower well-being. Weight 
discrimination, but not BMI, increased risk for incident depression and declines 
in well-being during the coronavirus pandemic.

© 2020 The Obesity Society.

DOI: 10.1002/oby.23048
PMID: 32975032 [Indexed for MEDLINE]


4180. J Subst Abuse Treat. 2020 Nov;118:108103. doi: 10.1016/j.jsat.2020.108103. Epub 
2020 Aug 12.

Integrating harm reduction and clinical care: Lessons from Covid-19 respite and 
recuperation facilities.

Kimmel SD(1), Bazzi AR(2), Barocas JA(3).

Author information:
(1)Section of General Internal Medicine, Department of Medicine, Boston Medical 
Center, United States of America; Section of Infectious Diseases, Department of 
Medicine, Boston Medical Center, United States of America; Boston University 
School of Medicine, United States of America. Electronic address: 
simeon.kimmel@bmc.org.
(2)Department of Community Health Sciences, Boston University School of Public 
Health, United States of America.
(3)Section of Infectious Diseases, Department of Medicine, Boston Medical 
Center, United States of America; Boston University School of Medicine, United 
States of America.

In response to the novel coronavirus 2019 (Covid-19) pandemic, many people 
experiencing homelessness and substance use disorders entered respite and 
recuperation facilities for care and to isolate and prevent subsequent 
SARS-CoV-2 transmission. However, because drug use was officially prohibited in 
these facilities, we observed people who use substances leaving isolation 
temporarily or prematurely. The initial Covid-19 surge magnified the need for 
harm reduction access for those who use substances to ensure their safety and 
well-being and that of their local communities. In this commentary, we argue 
that expanding harm reduction access is crucial for subsequent waves of 
SARS-CoV-2 infection and also for patients who use substances and are 
hospitalized for other reasons.

Copyright © 2020 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jsat.2020.108103
PMCID: PMC7419278
PMID: 32972644 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest SDK reports 
consulting for Abt Associates on a Massachusetts Department of Public Health 
funded project to improve access to medications for opioid use disorder in 
skilled nursing facilities. JAB and ARB report no competing interests.


4181. J Headache Pain. 2020 Sep 24;21(1):115. doi: 10.1186/s10194-020-01183-6.

Impact of coronavirus disease 2019 (COVID-19) pandemic on patients with 
migraine: a web-based survey study.

Al-Hashel JY(1)(2), Ismail II(3).

Author information:
(1)Department of Neurology, Ibn Sina Hospital, Sabah Medical Region, Kuwait.
(2)Department of Medicine, Health Sciences Centre, Kuwait University, Jabriya, 
Kuwait.
(3)Department of Neurology, Ibn Sina Hospital, Sabah Medical Region, Kuwait. 
dr.ismail.ibrahim2012@gmail.com.

BACKGROUND: Since the declaration COVID-19 as a pandemic, healthcare systems 
around the world have faced a huge challenge in managing patients with chronic 
diseases. Patients with migraine were specifically vulnerable to inadequate 
medical care. We aimed to investigate the "real-world" impact of COVID-19 
pandemic on migraine patients, and to identify risk factors for poor outcome.
METHODS: We administered an online, self-reported survey that included 
demographic, migraine-related, COVID-19-specific and overall psychosocial 
variables between July 15 and July 30, 2020. We recruited a sample of patients 
with migraine from headache clinic registry and via social media to complete an 
anonymous survey. Outcomes included demographic variables, change in migraine 
frequency and severity during the lockdown period, communication with treating 
physician, compliance to migraine treatment, difficulty in getting medications, 
medication overuse, symptoms of anxiety and/or depression, sleep and eating 
habits disturbance, screen time exposure, work during pandemic, use of 
traditional medicine, effect of Botox injection cancellation, and overall 
worries and concerns during pandemic.
RESULTS: A total of 1018 patients completed the survey. Of the respondents, 859 
(84.3%) were females; 733 (71.9%) were aged 20 to 40 years, 630 (61.8%) were 
married, and 466 (45.7%) reported working during the pandemic. In comparison to 
pre-pandemic period, 607 respondents (59.6%) reported increase in migraine 
frequency, 163 (16%) reported decrease in frequency, and 105 (10.3%) transformed 
to chronic migraine. Severity was reported to increase by 653 (64.1%) 
respondents. The majority of respondents; 626 (61.5%) did not communicate with 
their neurologists, 477 (46.9%) reported compliance to treatment, and 597 
(58.7%) reported overuse of analgesics. Botox injections cancellation had a 
negative impact on 150 respondents (66.1%) from those receiving it. Forty-one 
respondents (4%) were infected with COVID-19; 26 (63.4%) reported worsening of 
their headaches amid infection period. Sleep disturbance was reported by 794 
(78.1%) of respondents, and 809 (79.5%) reported having symptoms of anxiety 
and/or depression.
CONCLUSIONS AND RELEVANCE: COVID-19 pandemic had an overall negative impact on 
patients with migraine. Several risk factors for poor outcome were identified. 
Long-term strategies should be validated and implemented to deliver quality care 
for patients with migraine, with emphasis on psychosocial well-being.

DOI: 10.1186/s10194-020-01183-6
PMCID: PMC7513457
PMID: 32972360 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflicts 
of interest.


4182. Int J Soc Psychiatry. 2021 Aug;67(5):522-531. doi: 10.1177/0020764020960192. 
Epub 2020 Sep 24.

Mental health of frontline healthcare workers exposed to COVID-19 in Egypt: A 
call for action.

Elkholy H(1)(2), Tawfik F(1), Ibrahim I(1), Salah El-Din W(3), Sabry M(4), 
Mohammed S(5), Hamza M(6), Alaa M(7), Fawzy AZ(8), Ashmawy R(9), Sayed M(1), 
Omar AN(1).

Author information:
(1)Department of Neurology and Psychiatry, Faculty of Medicine, Ain Shams 
University, Cairo, Egypt.
(2)Sussex Partnership Foundation Trust, Langley Green Hospital, Crawley UK.
(3)Department of Community and Occupational Medicine, Faculty of Medicine, Ain 
Shams University, Cairo, Egypt.
(4)Department of Chest, Faculty of Medicine, Alexandria University, Alexandria, 
Egypt.
(5)Department of Chest, Abbasiya Chest Hospital, Cairo, Egypt.
(6)Department of Infection control, Esna Hospital, Aswan, Egypt.
(7)Department of Chest, Faculty of Medicine, Helwan University, Cairo, Egypt.
(8)Department of Clinical Pathology, Shebin Elkoom Fever Hospital, Menofia, 
Egypt.
(9)Clinical Pharmacy, Maamoura Chest Hospital, Alexandria, Egypt.

BACKGROUND: World Health Organization (WHO) declared Coronavirus disease 2019 
(COVID-19) as a pandemic in March 2020. Such widespread outbreaks are associated 
with adverse mental health consequences.
AIMS: To evaluate mental health outcomes among Egyptian healthcare workers (HCW) 
treating patients with confirmed or suspected Coronavirus Disease 2019 
(COVID-19) to direct the promotion of mental wellbeing, by screening for 
symptoms of anxiety, insomnia, depression and stress, and analyzing potential 
risk factors.
METHODS: This cross-sectional, hospital-based survey study collected demographic 
data and mental health measurements from 502 HCW dealing with COVID-19. HCW were 
surveyed in 20 hospitals (Fever, Chest, and Quarantine hospitals) in different 
parts of Egypt, in April and May 2020.
RESULTS: Among the 502 HCW surveyed; 60.0% were physicians, 16.1% were 
specialized nurses, and 23.9% were non-specialized nurses. About 35.3% worked in 
chest hospitals, 17.5% in fever hospitals, and 47.2% in quarantine hospitals. A 
considerable proportion of HCW had symptoms of anxiety, insomnia, depression, 
and stress. Females were at higher risk of experiencing symptoms of severe 
anxiety (odds ratio [OR], 1.85; 95% CI, 1.12-3.05; p = .016), severe depression 
(OR, 2.013; 95% CI, 1.17-3.4; p = .011), and severe stress (OR, 2.68; 95% CI, 
1.5-4.6; p < .001). Fever hospital workers were at higher risk of severe 
depression (OR, 1.52; 95% CI, 1.11-2.09; p < .01), compared to Quarantine 
hospital workers.
CONCLUSION: Ensuring proper mental health support for HCW is an important 
component of public health measures for addressing the COVID-19 epidemic and 
safeguarding the continuity of appropriate medical service.

DOI: 10.1177/0020764020960192
PMID: 32972298 [Indexed for MEDLINE]


4183. PLoS One. 2020 Sep 24;15(9):e0239698. doi: 10.1371/journal.pone.0239698. 
eCollection 2020.

Loneliness in the UK during the COVID-19 pandemic: Cross-sectional results from 
the COVID-19 Psychological Wellbeing Study.

Groarke JM(1), Berry E(1), Graham-Wisener L(1), McKenna-Plumley PE(1), 
McGlinchey E(2), Armour C(1)(2).

Author information:
(1)Centre for Improving Health-Related Quality of Life (CIHRQoL), School of 
Psychology, Queen's University Belfast, Belfast, United Kingdom.
(2)Stress Trauma and Related Conditions (STARC) Research Lab, School of 
Psychology, Queen's University Belfast, Belfast, United Kingdom.

Comment in
    Psychiatry Res. 2021 Apr;298:113834.

OBJECTIVES: Loneliness is a significant public health issue. The COVID-19 
pandemic has resulted in lockdown measures limiting social contact. The UK 
public are worried about the impact of these measures on mental health outcomes. 
Understanding the prevalence and predictors of loneliness at this time is a 
priority issue for research.
METHOD: The study employed a cross-sectional online survey design. Baseline data 
collected between March 23rd and April 24th 2020 from UK adults in the COVID-19 
Psychological Wellbeing Study were analysed (N = 1964, 18-87 years, M = 37.11, 
SD = 12.86, 70% female). Logistic regression analysis examined the influence of 
sociodemographic, social, health and COVID-19 specific factors on loneliness.
RESULTS: The prevalence of loneliness was 27% (530/1964). Risk factors for 
loneliness were younger age group (OR: 4.67-5.31), being separated or divorced 
(OR: 2.29), scores meeting clinical criteria for depression (OR: 1.74), greater 
emotion regulation difficulties (OR: 1.04), and poor quality sleep due to the 
COVID-19 crisis (OR: 1.30). Higher levels of social support (OR: 0.92), being 
married/co-habiting (OR: 0.35) and living with a greater number of adults (OR: 
0.87) were protective factors.
CONCLUSIONS: Rates of loneliness during the initial phase of lockdown were high. 
Risk factors were not specific to the COVID-19 crisis. Findings suggest that 
supportive interventions to reduce loneliness should prioritise younger people 
and those with mental health symptoms. Improving emotion regulation and sleep 
quality, and increasing social support may be optimal initial targets to reduce 
the impact of COVID-19 regulations on mental health outcomes.

DOI: 10.1371/journal.pone.0239698
PMCID: PMC7513993
PMID: 32970764 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


4184. West J Emerg Med. 2020 Aug 17;21(5):1059-1066. doi: 
10.5811/westjem.2020.7.48684.

The Impact of COVID-19 on Healthcare Worker Wellness: A Scoping Review.

Shreffler J(1), Petrey J(2), Huecker M(1).

Author information:
(1)University of Louisville, Department of Emergency Medicine, Louisville, 
Kentucky.
(2)University of Louisville, Kornhauser Library, Louisville, Kentucky.

At the heart of the unparalleled crisis of COVID-19, healthcare workers (HCWs) 
face several challenges treating patients with COVID-19: reducing the spread of 
infection; developing suitable short-term strategies; and formulating long-term 
plans. The psychological burden and overall wellness of HCWs has received 
heightened awareness in news and research publications. The purpose of this 
study was to provide a review on current publications measuring the effects of 
COVID-19 on wellness of healthcare providers to inform interventional 
strategies. Between April 6-May 17, 2020, we conducted systematic searches using 
combinations of these keywords and synonyms in conjunction with the controlled 
vocabulary of the database: "physician," "wellness, "wellbeing," "stress," 
"burnout," "COVID-19," and "SARS-CoV-2." We excluded articles without original 
data, research studies regarding the wellness of non-healthcare occupations or 
the general public exclusively, other outbreaks, or wellness as an epidemic. A 
total of 37 studies were included in this review. The review of literature 
revealed consistent reports of stress, anxiety, and depressive symptoms in HCWs 
as a result of COVID-19. We describe published data on HCW distress and burnout 
but urge future research on strategies to enhance HCW well-being.

DOI: 10.5811/westjem.2020.7.48684
PMCID: PMC7514392
PMID: 32970555 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: By the WestJEM article 
submission agreement, all authors are required to disclose all affiliations, 
funding sources and financial or management relationships that could be 
perceived as potential sources of bias. No author has professional or financial 
relationships with any companies that are relevant to this study. There are no 
conflicts of interest or sources of funding to declare.


4185. J Appl Psychol. 2020 Nov;105(11):1234-1245. doi: 10.1037/apl0000739. Epub 2020 
Sep 24.

Working in a pandemic: Exploring the impact of COVID-19 health anxiety on work, 
family, and health outcomes.

Trougakos JP(1), Chawla N(1), McCarthy JM(1).

Author information:
(1)Department of Management.

The COVID-19 pandemic has unhinged the lives of employees across the globe, yet 
there is little understanding of how COVID-19 health anxiety (CovH anxiety)-that 
is, feelings of fear and apprehension about having or contracting 
COVID-19-impacts critical work, home, and health outcomes. In the current study, 
we integrate transactional stress theory (Lazarus & Folkman, 1984) with 
self-determination theory (Deci & Ryan, 2000) to advance and test a model 
predicting that CovH anxiety prompts individuals to suppress emotions, which has 
detrimental implications for their psychological need fulfillment. In turn, lack 
of psychological need fulfillment hinders employees' abilities to work 
effectively, engage with their family, and experience heightened well-being. Our 
model further predicts that handwashing frequency-a form of problem-focused 
coping-will mitigate the effects of CovH anxiety. We test our propositions using 
a longitudinal design that followed 503 employees across the first four weeks 
that stay-at-home and social distancing orders were enacted. Consistent with 
predictions, CovH anxiety was found to impair critical work (goal progress), 
home (family engagement) and health (somatic complaints) outcomes due to 
increased emotion suppression and lack of psychological need fulfillment. 
Further, individuals who frequently engage in handwashing behavior were buffered 
from the negative impact of CovH anxiety. Combined, our work integrates and 
extends existing theory and has a number of important practical implications. 
Our research represents a first step to understanding the work-, home-, and 
health-related implications of this unprecedented situation, highlighting the 
detrimental impact of the anxiety stemming from the COVID-19 pandemic. (PsycInfo 
Database Record (c) 2020 APA, all rights reserved).

DOI: 10.1037/apl0000739
PMID: 32969707 [Indexed for MEDLINE]


4186. Matern Child Nutr. 2021 Jan;17(1):e13088. doi: 10.1111/mcn.13088. Epub 2020 Sep 
23.

Experiences of breastfeeding during COVID-19: Lessons for future practical and 
emotional support.

Brown A(1)(2), Shenker N(3).

Author information:
(1)Department of Public Health, Policy and Social Sciences, Swansea University, 
Swansea, UK.
(2)Centre for Lactation, Infant Feeding and Translation, Swansea University, 
Swansea, UK.
(3)Department of Surgery and Cancer, Imperial College London, London, UK.

The COVID-19 pandemic and subsequent lockdown and social distancing led to 
changes to breastfeeding support available to women in the United Kingdom. 
Face-to-face professional support was reduced, and face-to-face peer support was 
cancelled. Anecdotal media accounts highlighted practices separating some 
mothers and babies in hospitals, alongside inaccurate stories of the safety of 
breastfeeding circulating. Meanwhile, new families were confined to their homes, 
separated from families and support networks. Given that we know breastfeeding 
is best supported by practices that keep mother and baby together, high-quality 
professional and peer-to-peer support, and positive maternal well-being, it is 
important to understand the impact of the pandemic upon the ability to 
breastfeed. To explore this, we conducted an online survey with 1219 
breastfeeding mothers in the United Kingdom with a baby 0-12 months old to 
understand the impact of the pandemic upon breastfeeding duration, experiences 
and support. The results highlighted two very different experiences: 41.8% of 
mothers felt that breastfeeding was protected due to lockdown, but 27.0% of 
mothers struggled to get support and had numerous barriers stemming from 
lockdown with some stopped breastfeeding before they were ready. Mothers with a 
lower education, with more challenging living circumstances and from Black and 
minority ethnic backgrounds were more likely to find the impact of lockdown 
challenging and stop breastfeeding. The findings are vital in understanding how 
we now support those women who may be grieving their loss of breastfeeding and 
are affected by their negative experiences and how we can learn from those with 
a positive experience to make sure all breastfeeding women are better supported 
if similar future events arise.

© 2020 The Authors. Maternal & Child Nutrition published by John Wiley & Sons 
Ltd.

DOI: 10.1111/mcn.13088
PMCID: PMC7537017
PMID: 32969184 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflicts 
of interest.


4187. Sex Transm Infect. 2021 Mar;97(2):85-87. doi: 10.1136/sextrans-2020-054598. Epub 
2020 Sep 23.

Early impact of COVID-19 social distancing measures on reported sexual behaviour 
of HIV pre-exposure prophylaxis users in Wales.

Gillespie D(1), Knapper C(2), Hughes D(3), Couzens Z(4), Wood F(5), de Bruin 
M(6), Ma R(7), Jones AT(8), Williams A(9), Hood K(9).

Author information:
(1)Centre for Trials Research, School of Medicine, College of Biomedical & Life 
Sciences, Cardiff University, Cardiff, Wales gillespied1@cardiff.ac.uk.
(2)Aneurin Bevan University Health Board, Newport, Wales.
(3)Centre for Health Economics and Medicines Evaluation, Bangor University, 
Bangor, Wales.
(4)Public Health Wales NHS Trust, Cardiff, UK.
(5)Division of Population Medicine, Cardiff University, Cardiff, UK.
(6)Radboud University Medical Center, Nijmegen, Netherlands.
(7)Imperial College London, London, UK.
(8)Policy, Research and International Development, Public Health Wales, Cardiff, 
UK.
(9)Centre for Trials Research, School of Medicine, College of Biomedical & Life 
Sciences, Cardiff University, Cardiff, Wales.

OBJECTIVES: To describe the early impact of COVID-19 and associated control 
measures on the sexual behaviour of pre-exposure prophylaxis (PrEP) users in 
Wales.
METHODS: Data were obtained from an ecological momentary assessment study of 
PrEP use and sexual behaviour. Participants were individuals accessing PrEP 
through the National Health Service (NHS) sexual health clinics across four 
health boards in Wales. Weekly data documenting condomless sex in the preceding 
week were analysed between 03/02/2020 and 10/05/2020. The introduction of social 
distancing measures and changes to sexual health clinics in Wales occurred on 
the week starting 16/03/2020. Two-level logistic regression models were fitted 
to condomless sex (yes/no) over time, included an indicator for the week 
starting 16/03/2020, and were extended to explore differential associations by 
relationship status and sexual health clinic.
RESULTS: Data were available from 56 participants and included 697 person-weeks 
(89% of the maximum number that could have been obtained). On average, 42% of 
participants reported condomless sex in the period prior to the introduction of 
social distancing measures and 20% reported condomless sex after (OR=0.16, 95% 
CI 0.07 to 0.37, p<0.001). There was some evidence to suggest that this 
association was moderated by relationship status (OR for single 
participants=0.09, 95% CI 0.06 to 0.23; OR for not single participants=0.46, 95% 
CI 0.16 to 1.25).
CONCLUSIONS: The introduction of social distancing measures and changes to PrEP 
services across Wales was associated with a marked reduction in reported 
instances of condomless sexual intercourse among respondents, with a larger 
reduction in those who were single compared with those who were not. The 
long-term impact of COVID-19 and associated control measures on this 
population's physical and mental health and well-being requires close 
examination.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/sextrans-2020-054598
PMCID: PMC7892366
PMID: 32967930 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: DG, KH and FW report 
receiving funding from Health and Care Research Wales during the conduct of this 
work. RM reports funding from National Institute for Health Research during the 
conduct of this study.


4188. Syst Rev. 2020 Sep 23;9(1):217. doi: 10.1186/s13643-020-01479-3.

The impact of eHealth group interventions on the mental, behavioral, and 
physical health of adults: a systematic review protocol.

Currie CL(1), Larouche R(2), Voss ML(2), Higa EK(2), Spiwak R(3), Scott D(4), 
Tallow T(5).

Author information:
(1)Faculty of Health Sciences, University of Lethbridge, 4401 University Dr, 
Lethbridge, AB, T1K 3M4, Canada. cheryl.currie@uleth.ca.
(2)Faculty of Health Sciences, University of Lethbridge, 4401 University Dr, 
Lethbridge, AB, T1K 3M4, Canada.
(3)Manitoba Population Mental Health Research Group, Department of Psychiatry, 
Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.
(4)University Library, University of Lethbridge, Lethbridge, Canada.
(5)Alberta Health Services, Lethbridge, Canada.

BACKGROUND: COVID-19 has resulted in an increased demand for eHealth services 
globally. There is emerging evidence for the efficacy for group eHealth 
interventions that support population-based mental health and wellbeing, but a 
systematic review is lacking. The primary objective of this systematic review is 
to summarize the evidence for eHealth group counseling and coaching programs for 
adults. A second objective is to assess, within studies selected for our primary 
objective, the impact of programs that encourage PA on outcomes compared to 
those that do not.
METHODS: Randomized controlled trials that assess the impact of eHealth group 
counseling or coaching programs on mental health, health behavior, or physical 
health activity among community-dwelling adults will be included. We will search 
the following electronic databases (from January 2005 onwards): MEDLINE, 
PsycINFO, CINHAL, and the Central Register of Controlled Trials. The primary 
outcomes will be changes in mental health conditions (e.g., depression, anxiety, 
stress, quality of life), behavioral health conditions (e.g., substance use, 
smoking, sexual behavior, eating behavior, medication adherence), and physical 
health conditions (e.g., coping with cancer, menopausal symptoms, arthritis 
pain). Secondary outcomes will be changes in physical activity. Two reviewers 
will independently screen all citations, full-text articles, and abstract data. 
Potential conflicts will be resolved through discussion with a third reviewer. A 
narrative synthesis without meta-analysis will be conducted. The strength of the 
body of evidence will be assessed using GRADE. The risk of bias in individual 
studies will be appraised using the Cochrane Risk of Bias 2.0 tool. Potential 
sources of gender bias in included studies will be considered at all stages of 
the planned review.
DISCUSSION: This review will contribute to the literature by providing evidence 
on the effectiveness of eHealth counseling and coaching programs delivered to 
adults in a group format.
SYSTEMATIC REVIEW REGISTRATION: The protocol has been registered at the 
International Prospective Register of Systematic Reviews (PROSPERO: 
CRD42020187551 ).

DOI: 10.1186/s13643-020-01479-3
PMCID: PMC7513289
PMID: 32967717 [Indexed for MEDLINE]

Conflict of interest statement: All authors report no conflicts of interest.


4189. BMC Psychiatry. 2020 Sep 23;20(1):459. doi: 10.1186/s12888-020-02864-x.

COVID-19 pandemic- knowledge, perception, anxiety and depression among frontline 
doctors of Pakistan.

Amin F(1), Sharif S(2), Saeed R(2), Durrani N(2), Jilani D(2).

Author information:
(1)Liaquat National Hospital and Medical College, Karachi, Pakistan. 
drfaridah.amin@lnh.edu.pk.
(2)Liaquat National Hospital and Medical College, Karachi, Pakistan.

BACKGROUND: COVID-19 is a global pandemic and has become a major public health 
burden worldwide. With already fragile healthcare systems it can have long 
lasting effects in developing countries. Outbreaks especially a pandemic 
situation evokes fear related behaviors among healthcare professionals and there 
is always an increased risk of mental health disorders. Therefore, this study 
aims to determine knowledge and perception about this pandemic, prevalence and 
factors associated with anxiety/depression among frontline physicians of 
Pakistan.
METHODS: Data were collected through an online survey released in the last week 
of March-2020. 389 frontline physicians from all four provinces and 65 cities of 
Pakistan participated. Survey questionnaire consisted of 4 parts including 
informed consent section, demographic section, knowledge and perception about 
COVID-19 pandemic and assessment of depression through World Health Organization 
Self-reporting questionnaire (SRQ-20). A score of 8 or above on SRQ-20 was used 
as cut-off to label the participant as depressed. Data was analyzed using SPSS 
version22.
RESULTS: A 43% prevalence of anxiety/depression among frontline physicians of 
Pakistan was reported. Almost all the doctors had moderate to high knowledge 
score. Majority of participants marked N-95 mask as "essential" during aerosol 
generating procedures, assessing patients with respiratory symptoms, in COVID 
patient-care area, ER triage and direct care of COVID-19 patient. Only 12% of 
the doctors were fully satisfied with the provision of PPEs and almost 94% felt 
unprotected. In multivariable model, assessing more than five COVID suspects/day 
(aOR = 2.73, 95% CI: 1.65-4.52), working 20 h/week or less (aOR = 2.11, 
1.27-3.49), having children among household members (aOR = 1.58, 95% CI: 
1.00-2.50) and moderate to low knowledge of the infection (aOR = 2.69, 95% CI: 
1.68-4.31) were found to be independent predictors of anxiety/depression among 
physicians.
CONCLUSION: Anxiety/depression among more than a third of frontline doctors of 
Pakistan warrants the need to address mental health of doctors caring for 
patients during this pandemic; control modifiable factors associated with it and 
explore the effectiveness of interventions to promote psychological well-being 
of physicians.

DOI: 10.1186/s12888-020-02864-x
PMCID: PMC7509498
PMID: 32967647 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare none of the competing 
interests.


4190. JAMA Netw Open. 2020 Sep 1;3(9):e2018119. doi: 
10.1001/jamanetworkopen.2020.18119.

Assessment of Neonatal Intensive Care Unit Practices and Preterm Newborn Gut 
Microbiota and 2-Year Neurodevelopmental Outcomes.

Rozé JC(1), Ancel PY(2)(3), Marchand-Martin L(2), Rousseau C(4)(5)(6), 
Montassier E(7), Monot C(8), Le Roux K(8), Butin M(9), Resche-Rigon M(10), Aires 
J(4)(5), Neu J(11), Lepage P(8), Butel MJ(4)(5); EPIFLORE Study Group.

Author information:
(1)Neonatal Department, INSERM-CHU Clinical Investigation Center 1413, et UMR- 
INRA 1280, Physiologie des Adaptations Nutritionnelles, Nantes University 
Hospital, Nantes, France.
(2)Université de Paris, Center for Epidemiology and Statistics/CRESS U1153/EPOPé 
Team, Paris, France.
(3)Clinical Investigation Center P1419, Assistance Publique-Hôpitaux de Paris, 
Paris, France.
(4)UMR-S INSERM U1139, Faculté de Pharmacie, Université de Paris, Paris, France.
(5)PremUp Foundation, Paris, France.
(6)Microbiology Department, AP-HP Hôpital Saint-Louis, Paris, France.
(7)Service des Urgences, Nantes University Hospital, Nantes, France.
(8)Micalis Institute, INRA, AgroParisTech, University Paris-Saclay, Paris, 
France.
(9)Neonatal Department, Hospices Civils de Lyon, Lyon, France.
(10)Biostatistics and Medical Information Department, AP-HP Hôpital Saint-Louis, 
Paris, France.
(11)College of Medicine, University of Florida, Gainesville, Florida.

IMPORTANCE: In very preterm newborns, gut microbiota is highly variable with 
major dysbiosis. Its association with short-term health is widely studied, but 
the association with long-term outcomes remains unknown.
OBJECTIVE: To investigate in preterm newborns the associations among practice 
strategies in neonatal intensive care units (NICUs), gut microbiota, and 
outcomes at 2 years.
DESIGN, SETTING, AND PARTICIPANTS: EPIFLORE is a prospective observational 
cohort study that includes a stool sample collection during the fourth week 
after birth. Preterm newborns of less than 32 weeks of gestational age (GA) born 
in 2011 were included from 24 NICUs as part of the French nationwide 
population-based cohort, EPIPAGE 2. Data were collected from May 2011 to 
December 2011 and analyzed from September 2016 to December 2018.
EXPOSURES: Eight NICU strategies concerning sedation, ventilation, skin-to-skin 
practice, antibiotherapy, ductus arteriosus, and breastfeeding were assessed. A 
NICU was considered favorable to a practice if the percentage of that practice 
in the NICU was more than the expected percentage.
MAIN OUTCOMES AND MEASURES: Gut microbiota was analyzed by 16S ribosomal RNA 
gene sequencing and characterized by a clustering-based method. The 2-year 
outcome was defined by death or neurodevelopmental delay using a Global Ages and 
Stages questionnaire score.
RESULTS: Of 577 newborns included in the study, the mean (SD) GA was 28.3 (2.0) 
weeks, and 303 (52.5%) were male. Collected gut microbiota was grouped into 5 
discrete clusters. A sixth cluster included nonamplifiable samples owing to low 
bacterial load. Cluster 4 (driven by Enterococcus [n = 63]), cluster 5 (driven 
by Staphylococcus [n = 52]), and cluster 6 (n = 93) were significantly 
associated with lower mean (SD) GA (26.7 [1.8] weeks and 26.8 [1.9] weeks, 
respectively) and cluster 3 (driven by Escherichia/Shigella [n = 61]) with 
higher mean (SD) GA (29.4 [1.6] weeks; P = .001). Cluster 3 was considered the 
reference. After adjustment for confounders, no assisted ventilation at day 1 
was associated with a decreased risk of belonging to cluster 5 or cluster 6 
(adjusted odds ratio [AOR], 0.21 [95% CI, 0.06-0.78] and 0.19 [95% CI, 
0.06-0.62], respectively) when sedation (AOR, 10.55 [95% CI, 2.28-48.87] and 
4.62 [1.32-16.18], respectively) and low volume of enteral nutrition (AOR, 10.48 
[95% CI, 2.48-44.29] and 7.28 [95% CI, 2.03-26.18], respectively) was associated 
with an increased risk. Skin-to-skin practice was associated with a decreased 
risk of being in cluster 5 (AOR, 0.14 [95% CI, 0.04-0.48]). Moreover, clusters 
4, 5, 6 were significantly associated with 2-year nonoptimal outcome (AOR, 6.17 
[95% CI, 1.46-26.0]; AOR, 4.53 [95% CI, 1.02-20.1]; and AOR, 5.42 [95% CI, 
1.36-21.6], respectively).
CONCLUSIONS AND RELEVANCE: Gut microbiota of very preterm newborns at week 4 is 
associated with NICU practices and 2-year outcomes. Microbiota could be a 
noninvasive biomarker of immaturity.

DOI: 10.1001/jamanetworkopen.2020.18119
PMCID: PMC7512059
PMID: 32965499 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest Disclosures: Dr Rozé 
reports receiving grants from the French National Agency for Research and the 
Nestec Research Center during the conduct of the study. Dr Rousseau reports 
receiving grants from the Nestec Research Center and the French National Agency 
for Research during the conduct of the study. Dr Neu is the principal 
investigator of a phase 3 multicenter trial of a microbial agent being studied 
by Infant Bacterial Therapeutics for the prevention of neonatal necrotizing 
enterocolitis and improvement of feeding tolerance in preterm infants. Dr Butel 
reports receiving grants from the French National Agency for Research and the 
Nestec Research Center during the conduct of the study, as well as consulting 
fees from Danone and grants from Biostime Institute for Nutrition and Care and 
Mead Johnson outside of the submitted work. No other disclosures were reported.


4191. J Urban Health. 2020 Dec;97(6):776-795. doi: 10.1007/s11524-020-00480-4. Epub 
2020 Sep 22.

Gig Workers during the COVID-19 Crisis in France: Financial Precarity and Mental 
Well-Being.

Apouey B(1), Roulet A(2), Solal I(3), Stabile M(4).

Author information:
(1)Paris School of Economics-CNRS, Paris, France.
(2)INSEAD and CEPR, Fontainebleau, France.
(3)ESSEC Business School, Cergy, France.
(4)INSEAD and CEPR, Fontainebleau, France. mark.stabile@insead.edu.

We set out to explore how precarious workers, particularly those employed in the 
gig economy, balance financial uncertainty, health risks, and mental well-being. 
We surveyed and interviewed precarious workers in France during the COVID-19 
crisis, in March and April 2020. We oversampled gig economy workers, in 
particular in driving and food delivery occupations (hereafter drivers and 
bikers), residing in metropolitan areas. These workers cannot rely on stable 
incomes and are excluded from the labor protections offered to employees, 
features which have been exacerbated by the crisis. We analyzed outcomes for 
precarious workers during the mandatory lockdown in France as an extreme case to 
better understand how financial precarity relates to health risks and mental 
well-being. Our analysis revealed that 3 weeks into the lockdown, 56% of our 
overall sample had stopped working and respondents had experienced a 28% income 
drop on average. Gig economy drivers reported a significant 20 percentage point 
larger income decrease than other workers in our sample. Bikers were 
significantly more likely to have continued working outside the home during the 
lockdown. Yet our quantitative analysis also revealed that stress and anxiety 
levels were not higher for these groups and that bikers in fact reported 
significantly lower stress levels during the lockdown. While this positive 
association between being a biker and mental health may be interpreted in 
different ways, our qualitative data led to a nuanced understanding of the 
effect of gig work on mental well-being in this population group.

DOI: 10.1007/s11524-020-00480-4
PMCID: PMC7508236
PMID: 32964368 [Indexed for MEDLINE]


4192. Australas Psychiatry. 2020 Dec;28(6):624-626. doi: 10.1177/1039856220956465. 
Epub 2020 Sep 22.

A hotel room on Mars: quarantine and the psychological view from the virtual 
front line.

Modini M(1)(2), Vrklevski L(1)(3)(4).

Author information:
(1)Concord Centre for Mental Health, Sydney Local Health District, NSW Health, 
Australia.
(2)School of Psychology, The University of Sydney, Australia.
(3)School of Business and Economics, University of Tasmania, Australia.
(4)Schools of Psychology at The University of Sydney, The University of New 
South Wales, University of Technology Sydney and the Australian Catholic 
University, Australia.

OBJECTIVE: Because of the COVID-19 pandemic, the implementation of quarantine 
for returning travellers and the effect this has on people's mental health has 
become a topical issue. This article briefly describes the historical context of 
quarantine, research around its impact on people's well-being, and the 
experiences of a clinical psychologist providing support to people in 
quarantine.
CONCLUSIONS: Mental health professionals are in a unique position to assist 
people in quarantine, both in terms of counselling and ongoing research.

DOI: 10.1177/1039856220956465
PMID: 32961102 [Indexed for MEDLINE]


4193. Int J Environ Res Public Health. 2020 Sep 17;17(18):6794. doi: 
10.3390/ijerph17186794.

Impact on Mental Health Due to COVID-19 Pandemic: Cross-Sectional Study in 
Portugal and Brazil.

Passos L(1), Prazeres F(2)(3)(4), Teixeira A(4)(5), Martins C(4)(5).

Author information:
(1)Department of Education and Psychology, University of Aveiro, 3810-193 
Aveiro, Portugal.
(2)Faculty of Health Sciences, University of Beira interior, 6200-506 Covilhã, 
Portugal.
(3)Family Health Unit Beira Ria, 3830-596 Gafanha da Nazaré, Portugal.
(4)Centre for Health Technology and Services Research (CINTESIS), University of 
Porto, 4200-450 Porto, Portugal.
(5)Department of Community Medicine, Information and Health Decision Sciences 
(MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal.

Mental health effects secondary to the COVID-19 pandemic were till recently 
considered less important or were neglected. Portugal and Brazil are facing the 
pandemic in quite different ways. This study aimed to describe the mental health 
status of the general adult population in Portugal and Brazil during the 
COVID-19 pandemic and analyze the differences between the two countries. A 
cross-sectional quantitative study was based on an online questionnaire. 
Socio-demographic data were collected in addition to four validated scales: CAGE 
(acronym cut-annoyed-guilty-eye) Questionnaire, Satisfaction with Life Scale, 
Generalized Anxiety Disorder-7 and Patient Health Questionnaire-2. For each 
outcome, a multiple linear regression was performed. Five hundred and fifty 
people answered the questionnaire (435 women). The median age was 38 (Q1, Q3: 
30, 47) years, 52.5% resided in Brazil and 47.5% in Portugal. The prevalence of 
anxiety was 71.3% (mild anxiety was present in 43.1%), the prevalence of 
depression was 24.7% and 23.8% of the sample had both depression and anxiety. 
Isolation was a significant factor for depression but not for anxiety. 
Well-being was below average. Mental illness was considerably higher than 
pre-COVID-19 levels. Portugal and Brazil will have to be prepared for future 
consequences of poor mental health and contribute immediate psychological 
support to their adult populations.

DOI: 10.3390/ijerph17186794
PMCID: PMC7557976
PMID: 32957702 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


4194. Anat Sci Educ. 2020 Nov;13(6):671-679. doi: 10.1002/ase.2020. Epub 2020 Oct 15.

Spotlight on the Shift to Remote Anatomical Teaching During Covid-19 Pandemic: 
Perspectives and Experiences from the University of Malta.

Cuschieri S(1), Calleja Agius J(1).

Author information:
(1)Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, 
Msida, Malta.

Covid-19 has spread globally, affecting all nations. Preventive measures were 
implemented by governments including the closure of universities. The aim of 
this study was to evaluate the student's perspectives and experiences on the 
shift to remote preclinical medical education while inquiring whether there has 
been any psychological impact on the students. A customized questionnaire 
utilizing Likert-scale-based questions and the Generalized Anxiety Disorder-7 
assessment tool was distributed online to enrolled preclinical medical students 
at the Faculty of Medicine and Surgery at the University of Malta. Quantitative 
and qualitative analyses of the data gathered was carried out. Multivariate 
logistic regression analyses was performed to establish independent variables 
associated with anxiety symptoms. A total of 172 responded out of a cohort of 
299 preclinical students (58%). The majority perceived a positive learning 
experience following the shift to remote lectures, however, it was not the case 
for small group teaching including dissection sessions. Nonetheless students 
reported concerns about their education, examinations, progression to next 
academic year and wellbeing. Less than half the students exhibited symptoms of 
anxiety. Students exhibiting "moderate" worry (OR:7.6; CI 95%:1.98-29.31; 
P < 0.01) and "severe" worry (OR: 2.0; CI 95%: 5.0-80.5; P < 0.01) on their 
mental, emotional, and wellbeing due to Covid-19 were associated with anxiety 
symptoms after adjusting for cofounders. Apart from the short-term effects, the 
Covid-19 pandemic may have a long-term impact on both the medical education and 
the students' future careers. It is important that the implemented changes in 
medical education are recorded and studied since such data will be essential on 
how to proceed post-Covid-19 pandemic.

© 2020 American Association for Anatomy.

DOI: 10.1002/ase.2020
PMCID: PMC7537517
PMID: 32956579 [Indexed for MEDLINE]


4195. Aging Ment Health. 2021 Jul;25(7):1281-1288. doi: 10.1080/13607863.2020.1822292. 
Epub 2020 Sep 21.

Impact of COVID-19 related social support service closures on people with 
dementia and unpaid carers: a qualitative study.

Giebel C(1)(2), Cannon J(3)(4), Hanna K(1), Butchard S(1)(2), Eley R(5), Gaughan 
A(6), Komuravelli A(7), Shenton J(8), Callaghan S(9), Tetlow H(10), Limbert 
S(2), Whittington R(11), Rogers C(12), Rajagopal M(13), Ward K(14), Shaw L(15), 
Corcoran R(1)(2), Bennett K(16), Gabbay M(1)(2).

Author information:
(1)Department of Primary Care & Mental Health, University of Liverpool, 
Liverpool, UK.
(2)NIHR ARC NWC, Liverpool, UK.
(3)Wigan Dementia Action Alliance, Liverpool, UK.
(4)Lewy Body Society, Liverpool, UK.
(5)Liverpool Dementia Action Alliance, Liverpool, UK.
(6)Together in Dementia Everyday (TIDE), Liverpool, UK.
(7)North West Boroughs NHS Trust, Warrington, UK.
(8)Sefton Older People's Forum, Sefton, UK.
(9)EQE Health, Liverpool, UK.
(10)SURF Liverpool, Liverpool, UK.
(11)Me2U Day Care Centre, Liverpool, UK.
(12)National Museums Liverpool, Liverpool, UK.
(13)Lancashire and South Cumbria NHS Trust, Lancaster, UK.
(14)The Brain Charity, Liverpool, UK.
(15)Department of Modern Languages and Cultures, University of Liverpool, 
Liverpool, UK.
(16)School of Psychology, University of Liverpool, Liverpool, UK.

OBJECTIVES: Accessing social care and social support services is key to support 
the well-being of people living with dementia (PLWD) and unpaid carers. COVID-19 
has caused sudden closures or radical modifications of these services, and is 
resulting in prolonged self-isolation. The aim of this study was to explore the 
effects of COVID-19 related social care and support service changes and closures 
on the lives of PLWD and unpaid carers.
METHOD: PLWD and unpaid carers were interviewed via telephone in April 2020. 
Transcripts were analysed using thematic analysis. Demographic characteristics 
including household Index of Multiple Deprivation score and weekly hours of 
social support service usage before and since the COVID-19 outbreak were also 
collected. Paired samples t-tests was used to compare the mean of weekly hours 
of social support service usage before and since the outbreak.
RESULTS: 50 semi-structured interviews were conducted with unpaid carers 
(n = 42) and PLWD (n = 8). There was a significant reduction in social support 
service usage since the outbreak. Thematic analysis identified three overarching 
themes: (1) Loss of control; (2) Uncertainty; (3) Adapting and having to adapt 
to the new normal. Carers and PLWD were greatly affected by the sudden removal 
of social support services, and concerned about when services would re-open. 
Carers were worried about whether the person they cared for would still be able 
to re-join social support services.
CONCLUSIONS: PLWD and carers need to receive specific practical and 
psychological support during the pandemic to support their well-being, which is 
severely affected by public health restrictions.

DOI: 10.1080/13607863.2020.1822292
PMID: 32954794 [Indexed for MEDLINE]


4196. Perspect Psychiatr Care. 2021 Apr;57(2):953-956. doi: 10.1111/ppc.12618. Epub 
2020 Sep 19.

The impact of COVID-19 pandemic on people with severe mental illness.

Sukut O(1), Ayhan Balik CH(1).

Author information:
(1)Department of Mental Health and Psychiatric Nursing, Florence Nightingale 
Nursing Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.

PURPOSE: The purpose of this review was to address the impact of the COVID-19 
pandemic on people with severe mental illness.
CONCLUSION: Given the psychosocial effects of the COVID-19 pandemic process and 
the vulnerability of individuals with mental illness, it is clear that some 
preventive measures will increase the well-being of these individuals and reduce 
relapses. Careful planning and execution of preventive measures to be taken at 
the individual, institutional, and social level are essential to minimize the 
negative consequences of this pandemic for this vulnerable population.
PRACTICE IMPLICATIONS: The results of this first review on the topic provide 
preliminary support for effectively address the needs and healthcare necessities 
of individuals with serious mental illness by raising awareness among healthcare 
workers during the COVID-19 pandemic.

© 2020 Wiley Periodicals LLC.

DOI: 10.1111/ppc.12618
PMCID: PMC7646271
PMID: 32949183 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that there are no conflict 
of interests.


4197. Health Place. 2020 Nov;66:102440. doi: 10.1016/j.healthplace.2020.102440. Epub 
2020 Sep 15.

Who maintains good mental health in a locked-down country? A French nationwide 
online survey of 11,391 participants.

Haesebaert F(1), Haesebaert J(2), Zante E(3), Franck N(4).

Author information:
(1)Centre Référent Lyonnais de Réhabilitation Psychosociale CL3R, Centre 
Hospitalier Le Vinatier, Lyon, France; INSERM U1028, CNRS UMR5292, PSYR2 Team, 
Lyon Neuroscience Research Center, Université Claude Bernard Lyon 1, Lyon, 
France. Electronic address: frederic.haesebaert@ch-le-vinatier.fr.
(2)HESPER, Université de Lyon, Université Claude Bernard Lyon 1, EA 7425, 69008, 
Lyon, France.
(3)Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive 
(Ressource Center for Psychosocial Rehabilitation and Cognitive Remediation), 
Hôpital Le Vinatier, France.
(4)Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive 
(Ressource Center for Psychosocial Rehabilitation and Cognitive Remediation), 
Hôpital Le Vinatier, France; UMR, 5229, CNRS & Université Lyon 1, Université de 
Lyon, Lyon, France.

Lockdown measures can differentially affect mental wellbeing in populations 
depending on individual determinants. We aim to investigate the sociodemographic 
and environmental determinants of wellbeing on the French population during 
lockdown due to the SARS-CoV-2 pandemic with an online survey. Among 11,391 
participants who completed the questionnaire, various factors negatively 
impacted wellbeing: being a female, a student, disabled, having no access to 
outdoor spaces, or living in a small home. Conversely, being employed and having 
more social contacts had a positive impact. During lockdowns, authorities should 
consider the vulnerability of specific populations, especially when they live in 
constrained housing conditions.

Copyright © 2020 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.healthplace.2020.102440
PMCID: PMC7490637
PMID: 32947185 [Indexed for MEDLINE]

Conflict of interest statement: FH has received personal fees and/or 
non-financial support outside of the submitted work from Janssen, Lundbeck and 
Otsuka. JH has received personal fees and/or non-financial support outside of 
the submitted work from Janssen.


4198. Int J Geriatr Psychiatry. 2021 Mar;36(3):393-402. doi: 10.1002/gps.5434. Epub 
2020 Sep 25.

A UK survey of COVID-19 related social support closures and their effects on 
older people, people with dementia, and carers.

Giebel C(1)(2), Lord K(3), Cooper C(4)(5), Shenton J(6), Cannon J(7), Pulford 
D(8), Shaw L(9), Gaughan A(10), Tetlow H(11), Butchard S(1)(12), Limbert S(2), 
Callaghan S(13), Whittington R(14), Rogers C(15), Komuravelli A(16), Rajagopal 
M(8), Eley R(17), Watkins C(2)(18), Downs M(3), Reilly S(2)(19), Ward K(20), 
Corcoran R(1)(2), Bennett K(21), Gabbay M(1)(2).

Author information:
(1)Department of Primary Care and Mental Health, University of Liverpool, 
Liverpool, UK.
(2)NIHR ARC NWC, Liverpool, UK.
(3)Centre for Applied Dementia Studies, University of Bradford, Bradford, UK.
(4)Division of Psychiatry, University College London, London, UK.
(5)Camden and Islington NHS Foundation Trust, London, UK.
(6)Sefton Older People's Forum, Sefton, UK.
(7)Lewy Body Society, Wigan, UK.
(8)Lancashire Care NHS Foundation Trust, Preston, UK.
(9)Department of Modern Languages and Cultures, University of Liverpool, 
Liverpool, UK.
(10)Together in Dementia Everyday (TIDE), Liverpool, UK.
(11)SURF Liverpool, Liverpool, UK.
(12)Mersey Care NHS Foundation Trust, Prescot, UK.
(13)EQE Health, Liverpool, UK.
(14)Me2U Day Care Centre, Liverpool, UK.
(15)National Museums Liverpool, Liverpool, UK.
(16)North West Boroughs NHS Trust, Warrington, UK.
(17)Liverpool Dementia Action Alliance, Liverpool, UK.
(18)Faculty of Health and Wellbeing, UCLAN, Preston, UK.
(19)Department of Health Research, Lancaster University, Lancaster, UK.
(20)The Brain Charity, Liverpool, UK.
(21)School of Psychology, University of Liverpool, Liverpool, UK.

OBJECTIVES: The aim of this national survey was to explore the impact of 
COVID-19 public health measures on access to social support services and the 
effects of closures of services on the mental well-being of older people and 
those affected by dementia.
METHODS: A UK-wide online and telephone survey was conducted with older adults, 
people with dementia, and carers between April and May 2020. The survey captured 
demographic and postcode data, social support service usage before and after 
COVID-19 public health measures, current quality of life, depression, and 
anxiety. Multiple linear regression analysis was used to explore the 
relationship between social support service variations and anxiety and 
well-being.
RESULTS: Five hundred and sixty-nine participants completed the survey (61 
people with dementia, 285 unpaid carers, and 223 older adults). Paired samples 
t-tests and X2 -tests showed that the mean hour of weekly social support service 
usage and the number of people having accessed various services was 
significantly reduced post COVID-19. Multiple regression analyses showed that 
higher variations in social support service hours significantly predicted 
increased levels of anxiety in people with dementia and older adults, and lower 
levels of mental well-being in unpaid carers and older adults.
CONCLUSIONS: Being unable to access social support services due to COVID 
contributed to worse quality of life and anxiety in those affected by dementia 
and older adults across the UK. Social support services need to be enabled to 
continue providing support in adapted formats, especially in light of continued 
public health restrictions for the foreseeable future.

© 2020 The Authors. International Journal of Geriatric Psychiatry published by 
John Wiley & Sons Ltd.

DOI: 10.1002/gps.5434
PMCID: PMC7536967
PMID: 32946619 [Indexed for MEDLINE]

Conflict of interest statement: We declare no competing interests. Clarissa 
Giebel conceptualised the study. Clarissa Giebel, Claudia Cooper, and Mark 
Gabbay developed the study analysis in consultation with the team. Daniel 
Pulford managed recruitment. Clarissa Giebel performed data analysis and 
draughted the manuscript. All co‐authors interpreted the findings jointly, 
provided feedback on drafts of the manuscript, and approved the final draft.


4199. J Agromedicine. 2020 Oct;25(4):396-401. doi: 10.1080/1059924X.2020.1815619. Epub 
2020 Sep 18.

Competing Roles and Expectations: Preliminary Data from an Agricultural 
Extension Survey on COVID-19 Impacts.

Sampson S(1), Mazur J(2), Israel G(3), Galindo S(4), Ward C(4).

Author information:
(1)College of Education Evaluation Center, University of Kentucky , Lexington, 
Kentucky, USA.
(2)Southeast Center for Agricultural Safety Health and Injury Prevention**, 
University of Kentucky , Lexington, Kentucky, USA.
(3)Southeastern Coastal Center for Agricultural Health and Safety***, University 
of Florida , Gainesville, Florida, USA.
(4)Southeastern Coastal Center for Agricultural Health and Safety, University of 
Florida , Gainesville, Florida, USA.

Agricultural Extension professionals play a critical role in outreach and 
translation of research to practice. Extension has not only been an audience for 
Agricultural Safety and Health Center work, but also an essential partner in 
promoting evidence-based farm health and safety in communities. This commentary 
stems from a collaborative effort among Center leaders across the nation who 
developed a set of surveys to explore the ways COVID-19 has affected Extension 
professionals. Preliminary data gathered from across the nation suggest that 
while many Extension professionals feel prepared to address challenges from the 
pandemic and are well supported by their State and Center's resources, over half 
also reported moderate to great difficulty in balancing personal and 
professional needs and, to a lesser extent, balancing remote work and family 
needs. Because Extension professionals act as connectors between Agricultural 
Safety and Health Centers and farmers and their families, they serve in a role 
similar to first-responders. COVID-19 has exacerbated the potential for anxiety, 
stress, and other mental health concerns among this group. With COVID-19 numbers 
rising at an especially fast rate among agricultural workers, it is important to 
attend to the wellbeing of the professionals who work with them.

DOI: 10.1080/1059924X.2020.1815619
PMID: 32945240 [Indexed for MEDLINE]


4200. J Adolesc Health. 2020 Nov;67(5):662-670. doi: 10.1016/j.jadohealth.2020.08.001. 
Epub 2020 Sep 14.

Social (Un)distancing: Teammate Interactions, Athletic Identity, and Mental 
Health of Student-Athletes During the COVID-19 Pandemic.

Graupensperger S(1), Benson AJ(2), Kilmer JR(3), Evans MB(4).

Author information:
(1)Department of Psychiatry and Behavioral Sciences, University of Washington, 
Seattle, Washington. Electronic address: Graups@uw.edu.
(2)Department of Psychology, University of Western Ontario, London, Ontario, 
Canada.
(3)Department of Psychiatry and Behavioral Sciences, University of Washington, 
Seattle, Washington.
(4)Department of Kinesiology, The Pennsylvania State University, University 
Park, Pennsylvania.

PURPOSE: Physical distancing measures to combat the spread of the novel 
coronavirus have presented challenges for the mental health and well-being of 
college students. As campus activities ceased, student-athletes abruptly became 
isolated from teammates and were no longer able to participate in sport 
activities that are often central to their identity as an athlete. However, 
student-athletes who have supportive social connections with teammates during 
this pandemic may maintain their athletic identity to a greater extent and 
report better mental health. The present study examined how student-athletes' 
mental health was associated with teammate social support, connectedness, and 
changes to athletic identity from before to during COVID-19.
METHOD: A sample of 234 student-athletes completed surveys before COVID-19 
physical distancing (February 2020), with 135 (63% female) participating in a 
follow-up in the month following school closures (April 2020). Path models 
estimated the effects of teammate social support and connectedness (during 
COVID-19), as well as changes in athletic identity on indices of mental health.
RESULTS: Considering all path models tested, student-athletes who received more 
social support and reported more connectedness with teammates reported less 
dissolution of their athletic identity and-in most models-reported better mental 
health and well-being. Indirect effects indicated that student-athletes' change 
in athletic identity mediated the effects of teammate social support on 
psychological well-being and depression symptoms.
CONCLUSIONS: In addition to advancing theory on how small groups relate to 
mental health, these findings demonstrate the value in remaining socially 
connected with peers and maintaining role identities during the COVID-19 
pandemic.

Copyright © 2020 Society for Adolescent Health and Medicine. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jadohealth.2020.08.001
PMCID: PMC7489994
PMID: 32943294 [Indexed for MEDLINE]


4201. Pain Physician. 2020 Aug;23(4S):S271-S282.

The Effect of COVID-19 on Interventional Pain Management Practices: A Physician 
Burnout Survey.

Jha SS(1), Shah S(2), Calderon MD(2), Soin A(3), Manchikanti L(4).

Author information:
(1)University of Southern California, Department of Anesthesiology, Los Angeles, 
CA.
(2)University of California, Irvine, Department of Anesthesiology, Orange, CA.
(3)Ohio Pain Clinic.
(4)Pain Management Centers of America, Paducah, KY and Evansville, IN; LSU 
Health Science Center, New Orleans, LA.

BACKGROUND: Burnout has been a commonly discussed issue for the past ten years 
among physicians and other health care workers. A survey of interventional pain 
physicians published in 2016 reported high levels of emotional exhaustion, often 
considered the most taxing aspect of burnout. Job dissatisfaction appeared to be 
the leading agent in the development of burnout in pain medicine physicians in 
the United States. The COVID-19 pandemic has drastically affected the entire 
health care workforce and interventional pain management, with other surgical 
specialties, has been affected significantly. The COVID-19 pandemic has placed 
several physical and emotional stressors on interventional pain management 
physicians and this may lead to increased physician burnout.
OBJECTIVE: To assess the presence of burnout specific to COVID-19 pandemic among 
practicing interventional pain physicians.
METHODS: American Society of Interventional Pain Physicians (ASIPP) administered 
a 32 question survey to their members by contacting them via commercially 
available online marketing company platform. The survey was completed on 
www.constantcontact.com.
RESULTS: Of 179 surveys sent, 100 responses were obtained. The data from the 
survey demonstrated that 98% of physician practices were affected by COVID and 
91% of physicians felt it had a significant financial impact. Sixty seven 
percent of the physicians responded that in-house billing was responsible for 
their increased level of burnout, whereas 73% responded that electronic medical 
records (EMRs) were one of the causes. Overall, 78% were very concerned. Almost 
all respondents have been affected with a reduction in interventional 
procedures. 60% had a negative opinion about the future of their practice, 
whereas 66% were negative about the entire health care industry.
LIMITATIONS: The survey included only a small number of member physicians. 
Consequently, it may not be generalized for other specialties or even pain 
medicine. However, it does represent the sentiment and present status of 
interventional pain management.
CONCLUSION: The COVID-19 pandemic has put interventional pain practices 
throughout the United States under considerable financial and psychological 
stress. It is essential to quantify the extent of economic loss, offer 
strategies to actively manage provider practice/wellbeing, and minimize risk to 
personnel to keep patients safe.

PMID: 32942787 [Indexed for MEDLINE]


4202. Int J Environ Res Public Health. 2020 Sep 14;17(18):6673. doi: 
10.3390/ijerph17186673.

A Review of Psychological Issues among Patients and Healthcare Staff during Two 
Major Coronavirus Disease Outbreaks in China: Contributory Factors and 
Management Strategies.

Chow KM(1), Law BMH(1), Ng MSN(1), Chan DNS(1), So WKW(1), Wong CL(1), Chan 
CWH(1).

Author information:
(1)The Nethersole School of Nursing, Faculty of Medicine, The Chinese University 
of Hong Kong, Hong Kong, China.

Outbreaks of severe acute respiratory syndrome (SARS) and coronavirus disease 
2019 (COVID-19) have affected populations worldwide. Our literature review 
summarises the studies reporting psychological issues among healthcare staff and 
infected patients in mainland China, Hong Kong, and Taiwan during these two 
outbreaks and the potential strategies for addressing these issues. Our review 
shows that patients and healthcare staff presented similar psychological 
symptoms, including anxiety, fear, distress, and depression, which may lead to 
stress-related complications such as insomnia. In patients, these psychological 
impairments can be contributed to by being quarantined, perceptions of threats 
to life, and uncertainty about health status. Quarantine is also a factor for 
distress among healthcare staff, together with their heavy workload, the fear 
that they and their families would become infected, witnessing their patients' 
poor and deteriorating conditions, and the requirement to wear protective gear. 
Strategies that are needed to address these factors include providing 
counselling services, implementing mindfulness-based therapies and optimism 
interventions, and providing telecommunication facilities for patients to 
communicate with their families. Healthcare staff should also be provided with 
these services, together with appropriate and flexible work shift arrangements 
and morale boosting. These strategies would improve not only the mental 
well-being of patients and healthcare staff, but also the self-efficacy and 
competence of the staff to provide quality healthcare services.

DOI: 10.3390/ijerph17186673
PMCID: PMC7557771
PMID: 32937749 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that no conflict of interest 
exist.


4203. J Pers. 2021 May;89(3):468-482. doi: 10.1111/jopy.12592. Epub 2020 Oct 16.

Change in mental health symptoms during the COVID-19 pandemic: The role of 
appraisals and daily life experiences.

Brose A(1)(2), Blanke ES(1), Schmiedek F(3)(4)(5), Kramer AC(3)(4), Schmidt 
A(3)(4), Neubauer AB(3)(4).

Author information:
(1)Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.
(2)German Institute for Economic Research (DIW Berlin), Berlin, Germany.
(3)DIPF, Leibniz Institute for Research and Information in Education, Frankfurt 
am Main, Germany.
(4)Center for Research on Individual Development and Adaptive Education of 
Children at Risk (IDeA), Frankfurt am Main, Germany.
(5)Goethe-University, Frankfurt am Main, Germany.

OBJECTIVE: When confronted with major threats, people often experience decline 
in well-being. The central purpose of this study was to identify mechanisms 
underlying change of well-being in times of threat, using the example of the 
COVID-19 pandemic, with a focus on appraisals of the pandemic and affective 
states, stress, as well as mindfulness in daily life.
METHOD: We conducted a study across 3.5 weeks, including pretest, posttest, and 
a diary phase in-between. We worked with a sample of 460 adults, pre- and 
post-test information, as well as 7,189 observations from the diary phase.
RESULTS: Results showed that deterioration in mental health symptoms across the 
duration of the study was associated with (a) change towards less fortunate 
appraisals of the pandemic and (b), more negative affect and less mindfulness in 
daily life. Furthermore, appraisals of the pandemic at pretest predicted 
experiences in daily life, with more negative appraisals of the pandemic 
predicting more negative affect and stressor occurrence as well as less 
mindfulness.
CONCLUSIONS: These findings speak to the dynamic nature of well-being and 
appraisals in times of threat, and highlight the role of experiences in daily 
life in changes in well-being.

© 2020 Wiley Periodicals LLC.

DOI: 10.1111/jopy.12592
PMID: 32936956 [Indexed for MEDLINE]


4204. J Infect Public Health. 2020 Oct;13(10):1432-1437. doi: 
10.1016/j.jiph.2020.08.013. Epub 2020 Sep 10.

Mental health among healthcare providers during coronavirus disease (COVID-19) 
outbreak in Saudi Arabia.

AlAteeq DA(1), Aljhani S(2), Althiyabi I(3), Majzoub S(4).

Author information:
(1)Clinical Sciences Department, College of Medicine, Princess Nourah Bint 
Abdulrahman University, Riyadh, Saudi Arabia. Electronic address: 
DAalateeq@pnu.edu.sa.
(2)Department of Psychiatry, College of Medicine, Qassim University, Qassim, 
Saudi Arabia. Electronic address: s.aljhani@qu.edu.sa.
(3)Department of Psychiatry, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, 
Saudi Arabia. Electronic address: althiyabii@pmah.med.sa.
(4)Ministry of Health - The National Transformation Program, Saudi Arabia. 
Electronic address: Samajzoub@moh.gov.sa.

BACKGROUND: The novel coronavirus (COVID-19) was recently declared a pandemic by 
the World Health Organization (WHO). The first confirmed case in Saudi Arabia 
was announced on March 2, 2020. Several psychiatric manifestations may appear 
during pandemics, especially among frontline healthcare providers.
OBJECTIVES: This study sought to explore depression and anxiety levels among 
healthcare providers during the COVID-19 outbreak in Saudi Arabia.
METHODS: This was a cross-sectional study of a convenience sample of 502 
healthcare providers in the Ministry of Health. Depression and anxiety were 
assessed via the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety 
Disorder 7 (GAD-7) questionnaires, respectively.
RESULTS: The respondents represented various healthcare occupations: 
administrators (28.49%), nurses (26.29%), physicians (22.11%), non-physician 
specialists (13.94%), technicians (6.77%), and pharmacists (2.30%). The majority 
of them were male (68.1%). More than half of them had depressive disorder 
(55.2%), which ranged from mild (24.9%), moderate (14.5%), and moderately severe 
(10%) to severe (5.8%). Half of the sample had generalized anxiety disorder 
(51.4%), which ranged from mild (25.1%) and moderate (11%) to severe (15.3%). 
Multivariate analysis showed that males were significantly less predicted to 
have anxiety (Beta=-0.22, P-value <0.04), 30-39 years age group were 
significantly more predicted to have depression and anxiety group (Beta=0.204, 
P-value <0.001 and beta=0.521, P-value <0.003 respectively), and nurses had 
significantly higher mean score of anxiety (Beta=0.445, P-value <0.026).
CONCLUSIONS: This study revealed that depression and anxiety are prevailing 
conditions among healthcare providers. Although efforts were accelerated to 
support their psychological well-being, more attention should be paid to the 
mental health of female, 30-39 age group and nursing staff. Promoting healthcare 
service as a humanitarian and national duty may contribute to making it a more 
meaningful experience in addition to advocating for solidarity, altruism, and 
social inclusion. Longitudinal research studies need to be conducted to follow 
up on healthcare providers' mental health symptoms and develop evidence-based 
interventions.

Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.jiph.2020.08.013
PMCID: PMC7834809
PMID: 32933881 [Indexed for MEDLINE]


4205. Medicina (Kaunas). 2020 Sep 13;56(9):469. doi: 10.3390/medicina56090469.

Pathomechanisms of Non-Traumatic Acute Brain Injury in Critically Ill Patients.

Dabrowski W(1), Siwicka-Gieroba D(1), Gasinska-Blotniak M(1), Zaid S(2), 
Jezierska M(1), Pakulski C(3), Williams Roberson S(4)(5)(6), Wesley Ely 
E(4)(7)(8), Kotfis K(9).

Author information:
(1)Department of Anaesthesiology and Intensive Care, Medical University of 
Lublin, 20-954 Lublin, Poland.
(2)Department of Anaesthesia, Al-Emadi-Hospital Doha, P.O. Box 5804 Doha, Qatar.
(3)Department of Anaesthesiology, Intensive Therapy and Emergency Medicine, 
Pomeranian Medical University in Szczecin, 71-252 Szczecin, Poland.
(4)Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, 
Vanderbilt University Medical Center, 1211, Nashville, TN 37232, USA.
(5)Department of Neurology, Vanderbilt University Medical Center, 1211, 
Nashville, TN 37232, USA.
(6)Department of Biomedical Engineering, Vanderbilt University, 1211, Nashville, 
TN 37232, USA.
(7)Geriatric Research, Education and Clinical Center (GRECC), Tennessee Valley 
Veterans Affairs Healthcare System, 1310, Nashville, TN 37212, USA.
(8)Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt 
University Medical Center, 1211, Nashville, TN 37232, USA.
(9)Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, 
Pomeranian Medical University, 70-111 Szczecin, Poland.

Delirium, an acute alteration in mental status characterized by confusion, 
inattention and a fluctuating level of arousal, is a common problem in 
critically ill patients. Delirium prolongs hospital stay and is associated with 
higher mortality. The pathophysiology of delirium has not been fully elucidated. 
Neuroinflammation and neurotransmitter imbalance seem to be the most important 
factors for delirium development. In this review, we present the most important 
pathomechanisms of delirium in critically ill patients, such as 
neuroinflammation, neurotransmitter imbalance, hypoxia and hyperoxia, tryptophan 
pathway disorders, and gut microbiota imbalance. A thorough understanding of 
delirium pathomechanisms is essential for effective prevention and treatment of 
this underestimated pathology in critically ill patients.

DOI: 10.3390/medicina56090469
PMCID: PMC7560040
PMID: 32933176 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


4206. Int J Environ Res Public Health. 2020 Sep 12;17(18):6653. doi: 
10.3390/ijerph17186653.

Relationships between Physical and Social Behavioural Changes and the Mental 
Status of Homebound Residents in Hong Kong during the COVID-19 Pandemic.

Fong BYF(1), Wong MCS(2), Law VTS(1), Lo MF(3), Ng TKC(1), Yee HHL(1), Leung 
TCH(4), Ho PWT(5).

Author information:
(1)School of Professional Education and Executive Development, The Hong Kong 
Polytechnic University, Hong Kong, China.
(2)The Jockey Club School of Public Health and Primary Care, The Chinese 
University of Hong Kong, Hong Kong, China.
(3)Department of Mathematics and Information Technology, The Education 
University of Hong Kong, Hong Kong, China.
(4)Faulty of Business, City University of Macau, Macau, China.
(5)Department of Orthopaedics & Traumatology, The Chinese University of Hong 
Kong, Hong Kong, China.

In Hong Kong, social distancing has been adopted in order to minimise the spread 
of COVID-19. This study aims to examine the changes in physical health, mental 
health, and social well-being experienced by local residents who were homebound 
during the pandemic. An online questionnaire in both Chinese and English 
versions was completed by 590 eligible participants from 24 April to 13 May 
2020. The questionnaire found that individuals aged 18 to 25 years spent more 
time resting and relaxing but experienced more physical strain. Working status 
was associated with social contact, with participants working full-time jobs 
scoring higher in "maintaining social communication via electronic means" and 
"avoiding social activities outside the home". Additionally, approximately one 
third of the participants (29.7%) had moderate to severe depression, and 
participants aged 18 to 25 were found to have higher scores in PHQ-9. Changes in 
physical health and social contact were significantly associated with developing 
depressive symptoms. From the results, it is clear that the COVID-19 pandemic 
has the potential to exert a negative impact on the mental health status of 
individuals.

DOI: 10.3390/ijerph17186653
PMCID: PMC7559497
PMID: 32932641 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


4207. Eur J Med Genet. 2020 Dec;63(12):104062. doi: 10.1016/j.ejmg.2020.104062. Epub 
2020 Sep 12.

Impact of COVID-19 pandemic on patients with rare disease in Hong Kong.

Chung CC(1), Wong WH(1), Fung JL(1), Hong Kong RD(2), Chung BH(3).

Author information:
(1)Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, 
The University of Hong Kong, Hong Kong.
(2)Rare Disease Hong Kong, Hong Kong.
(3)Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, 
The University of Hong Kong, Hong Kong. Electronic address: bhychung@hku.hk.

The COVID-19 pandemic has had significant health, social, and economic 
consequences internationally. While the pandemic has direct implications on 
infected patients and families, there is a need to examine the pandemic's effect 
on patients with non-COVID-19-related diseases. This study examines the impact 
of the COVID-19 pandemic on 272 rare disease patients with 89 distinct rare 
diseases in Hong Kong using a cross-sectional online survey between April 10 and 
April 29, 2020 from the patient and caregiver perspective. The pandemic has 
impacted patient's health status in 46%, service use patterns in 71%, mental 
health in 79%, daily living in 82%, social life in 92%, and financial status in 
81% of patients. Patient's health status, medical and rehabilitation, and mental 
health were more impacted by the COVID-19 pandemic in the group of patients with 
any level of dependency according to the Barthel Index for Activities of Daily 
Living compared with that in the group of patients who are fully independent 
(p < 0.0001; p < 0.0001; p = 0.0420). This study is the first study to examine 
the impact of COVID-19 pandemic on the rare disease population in Hong Kong, and 
demonstrates the pandemic's effect on service and resource utilization, and 
patient's physical and mental well-being.

Copyright © 2020 Elsevier Masson SAS. All rights reserved.

DOI: 10.1016/j.ejmg.2020.104062
PMCID: PMC7486880
PMID: 32931946 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


4208. J Paediatr Child Health. 2020 Dec;56(12):1851-1855. doi: 10.1111/jpc.15169. Epub 
2020 Sep 15.

COVID-19 pandemic: The impact on vulnerable children and young people in 
Australia.

Jones B(1)(2), Woolfenden S(1)(2), Pengilly S(1), Breen C(1), Cohn R(1)(2), 
Biviano L(1), Johns A(1), Worth A(1), Lamb R(1), Lingam R(1)(2), Silove N(1), 
Marks S(1), Tzioumi D(1), Zwi K(1)(2).

Author information:
(1)Community Child Health, Sydney Children's Hospital Network (Randwick and 
Westmead), Sydney, New South Wales, Australia.
(2)UNSW, Sydney, New South Wales, Australia.

The COVID-19 pandemic and associated system disruptions are impacting all 
children and young people (CYP) in Australia. For vulnerable groups of CYP, who 
already experience poorer health and well-being, these impacts are amplified. 
Challenges include reduced access to usual services, reduced community supports, 
financial instability, unemployment and other life circumstances that threaten 
to widen pre-existing inequities. This article aims to present the reasons for 
vulnerability of CYP during the pandemic, and to focus on actions by health 
professionals that mitigate additional challenges to their health and 
well-being. Using a rapid review of the literature and team-based discussions, 
eight vulnerable groups were identified: CYP with disabilities, mental health 
conditions and chronic diseases; CYP facing financial hardship; within the child 
protection system; Aboriginal; migrant and refugee; in residential care; rural; 
and isolated CYP. Recommendations for action are required at the level of 
governments, health professionals and researchers and include enhancing access 
to health and social supports, prioritising vulnerable CYP in resuming health 
activity and elevating the voice of CYP in designing the response. The pandemic 
can be conceptualised as an opportunity to create a more equitable society as we 
document the inequities that have been exacerbated. Vulnerable groups of CYP 
must be recognised and heard, and targeted actions must focus on improving their 
health outcomes during the pandemic and beyond.

© 2020 Paediatrics and Child Health Division (The Royal Australasian College of 
Physicians).

DOI: 10.1111/jpc.15169
PMID: 32931623 [Indexed for MEDLINE]


4209. Aust N Z J Obstet Gynaecol. 2020 Dec;60(6):983-986. doi: 10.1111/ajo.13249. Epub 
2020 Sep 15.

Well-being, obstetrics and gynaecology and COVID-19: Leaving no trainee behind.

Chan GMF(1), Kanneganti A(1), Yasin N(2), Ismail-Pratt I(1), Logan SJS(1).

Author information:
(1)Department of Obstetrics and Gynaecology, National University Hospital, 
Singapore, Singapore.
(2)Department of Gynaecology Oncology, Gold Coast University Hospital, 
Southport, Queensland, Australia.

The COVID-19 pandemic has significantly disrupted training in obstetrics and 
gynaecology. Past pandemics have been shown to result in significant 
psychological morbidity. As specialty trainees continue frontline work, they 
will face unprecedented work environments and may face delays in progression due 
to postponed examinations, case log shortfalls and inadequate clinical 
rotations. This contributes to burnout, anxiety and depression. We share 
technology-based suggestions as well as institutional, departmental and 
self-care tips on how to maintain trainees' mental well-being during the fight 
against COVID-19.

© 2020 The Royal Australian and New Zealand College of Obstetricians and 
Gynaecologists.

DOI: 10.1111/ajo.13249
PMID: 32929718 [Indexed for MEDLINE]


4210. Work. 2020;66(4):731-737. doi: 10.3233/WOR-203219.

The role of Yoga in working from home during the COVID-19 global lockdown.

Sharma K(1), Anand A(1), Kumar R(2).

Author information:
(1)Neuroscience Research Lab, Department of Neurology, PGIMER, Chandigarh, 
India.
(2)Department of English and Cultural Studies, Panjab University, Chandigarh, 
India.

BACKGROUND: The COVID-19 pandemic has become a major cause of stress and anxiety 
worldwide. Due to the global lockdown, work, employment, businesses and the 
economic climate have been severely affected. It has generated stress among 
people from all sections of society, especially to workers who have been 
assigned to cater to healthcare service or those constrained to secure daily 
essential items. It is widely perceived that elderly or those affected by 
diabetes, hypertension and other cardiovascular diseases are prone to COVID-19. 
As per an ongoing survey, the initial data shows that the above-mentioned 
anxiety and stress cause insomnia, and has the considerable potential to weaken 
the immune system, the sole protection against the virus.
OBJECTIVE: This study focuses on the need of Yoga practice at work places and at 
home during the global lockdown due to the COVID-19 pandemic.
METHODS: Literature was searched using PubMed and Google Scholar for 
COVID-19-related stress and anxiety at work and society due to the worldwide 
lockdown. The predisposing comorbidities, viral mechanism of action and 
treatment regimen were also searched. Yoga-based intervention studies and online 
programs were also searched.
RESULTS: As the lockdown cannot last forever and workplaces will have to be 
functional soon, there is an increased possibility of recurrent infection. 
Therefore, Yoga can provide the necessary tool for risk reduction, amelioration 
of stress and anxiety and strengthening of the immune function. The online 
platforms provide a good media for Yoga training at work places and homes.
CONCLUSION: Due to social distancing norms, the availability of Yoga trainers 
has become restricted. Yoga practice is actively sought to achieve reduced 
anxiety and stress so that improved sleep may positively impact immunity. As a 
consequence, there is a spurt in social media, catering to daily online Yoga 
sessions which apparently prove useful in providing accessible means to achieve 
mental as well as physical well-being.

DOI: 10.3233/WOR-203219
PMID: 32925134 [Indexed for MEDLINE]


4211. Med Educ Online. 2020 Dec;25(1):1818439. doi: 10.1080/10872981.2020.1818439.

Medicine and surgery residents' perspectives on the impact of COVID-19 on 
graduate medical education.

Rana T(1), Hackett C(2), Quezada T(2), Chaturvedi A(3), Bakalov V(3), Leonardo 
J(4), Rana S(2).

Author information:
(1)Sidney Kimmel Medical College , Philadelphia, PA, USA.
(2)Department of Neurology, Neuroscience Institute, Allegheny General Hospital, 
Allegheny Health Network, Pittsburgh, PA, USA.
(3)Department of Medicine, Medicine Institute, Allegheny General Hospital, 
Allegheny Health Network , Pittsburgh, PA, USA.
(4)Neurosurgery, Neuroscience Institute, Allegheny General Hospital, Allegheny 
Health Network , Pittsburgh, PA, USA.

The COVID-19 crisis has had an unprecedented impact on resident education and 
well-being: social distancing guidelines have limited patient volumes and forced 
virtual learning, while personal protective equipment (PPE) shortages, 
school/daycare closures, and visa restrictions have served as additional 
stressors. Our study aimed to analyze the effects of COVID-19 crisis-related 
stressors on residents' professional and personal lives. In April 2020, we 
administered a survey to residents at a large academic hospital system in order 
to assess the impact of the pandemic on residency training after >6 weeks of a 
modified schedule. The primary outcome was to determine which factors or 
resident characteristics were related to stress during the pandemic. Our 
secondary goals were to examine which resident characteristics were related to 
survey responses. Data were analyzed with regression analyses. Ninety-six of 205 
residents completed the survey (47% response rate). For our primary outcome, 
anxiety about PPE (P < 0.001), female gender (P = 0.03), and the interaction 
between female gender and anxiety about PPE (P = 0.04) were significantly 
related to increased stress during the COVID-19 pandemic. Secondary analyses 
suggested that medicine residents were more comfortable than surgical residents 
using telemedicine (P > 0.001). Additionally, compared to juniors, seniors 
believed that the pandemic was more disruptive, modified schedules were 
effective, and virtual meetings were less effective while virtual lectures were 
more effective (all P ≤ 0.05) Furthermore, the pandemic experience has allowed 
seniors in particular to feel more confident to lead in future health crises (P 
≤ 0.05). Medicine and surgery residency programs should be cognizant of and 
closely monitor the effects of COVID-19 crisis-related factors on residents' 
stress and anxiety levels. Transparent communication, telemedicine, online 
lectures/meetings, procedure simulations, advocacy groups, and wellness 
resources may help to mitigate some of the challenges posed by the pandemic.

DOI: 10.1080/10872981.2020.1818439
PMCID: PMC7534325
PMID: 32924869 [Indexed for MEDLINE]


4212. Am J Geriatr Psychiatry. 2020 Nov;28(11):1146-1155. doi: 
10.1016/j.jagp.2020.08.007. Epub 2020 Aug 22.

COVID-19, Psychological Well-being and Physical Activity Levels in Older Adults 
During the Nationwide Lockdown in Spain.

Carriedo A(1), Cecchini JA(2), Fernandez-Rio J(2), Méndez-Giménez A(2).

Author information:
(1)University of Oviedo, Oviedo, Asturias, Spain. Electronic address: 
carriedoalejandro@uniovi.es.
(2)University of Oviedo, Oviedo, Asturias, Spain.

OBJECTIVE: The novel coronavirus disease (COVID-19) has forced nationwide 
lockdowns in many countries. As a result, most of the Spanish population had to 
self-isolate at home. The physical and psychological consequences of this 
unexpected scenario could be particularly worrisome for people older than 60 
years. This study is aimed to examine the psychological well-being of older 
adults during the home isolation due to the COVID-19 pandemic and to investigate 
whether meeting the World Health Organization's global recommendations on 
physical activity (PA) for health is associated with their resilience, affect, 
and depressive symptoms.
DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, a total of 483 
citizens whose ages ranged from 60 to 92 years (overall sample: M = 65.49, 
SD = 5.14) were recruited via a snowball sampling strategy to answer to an 
online questionnaire.
MEASUREMENTS: The four instruments used were The Connor-Davidson CD-RISC 
resilience scale, The Positive and Negative Affect Schedule, the six-item 
self-report scale of Depressive Symptoms, and The international Physical 
Activity Questionnaire.
RESULTS: Results showed that older adults who regularly engaged in vigorous 
(VPA) and moderate-vigorous physical activity (MVPA) during the quarantine 
reported higher scores in resilience (Locus, Self-efficacy, and Optimism), 
positive affect, and lower in depressive symptoms.
CONCLUSION: These finding are the first quantitative evidence pointing toward a 
link between engagement in VPA and/or MVPA and resilience, positive affect, and 
depressive symptoms within the COVID-19 restrictions in Spain. Acknowledging 
these associations may be important in developing health promotion programs for 
older people during the remaining period of confinement or future ones.

Copyright © 2020 American Association for Geriatric Psychiatry. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jagp.2020.08.007
PMCID: PMC7443087
PMID: 32919872 [Indexed for MEDLINE]


4213. Sleep. 2021 Feb 12;44(2):zsaa179. doi: 10.1093/sleep/zsaa179.

COVID-19-related mobility reduction: heterogenous effects on sleep and physical 
activity rhythms.

Ong JL(1), Lau T(1), Massar SAA(1), Chong ZT(2), Ng BKL(2), Koek D(2), Zhao 
W(2)(3), Yeo BTT(1)(4)(5), Cheong K(2), Chee MWL(1).

Author information:
(1)Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National 
University of Singapore, Singapore.
(2)Health Promotion Board, Singapore.
(3)Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore.
(4)Department of Electrical and Computer Engineering, National University of 
Singapore, Singapore.
(5)N.1 Institute for Health, National University of Singapore, Singapore.

STUDY OBJECTIVES: Mobility restrictions imposed to suppress transmission of 
COVID-19 can alter physical activity (PA) and sleep patterns that are important 
for health and well-being. Characterization of response heterogeneity and their 
underlying associations may assist in stratifying the health impact of the 
pandemic.
METHODS: We obtained wearable data covering baseline, incremental mobility 
restriction, and lockdown periods from 1,824 city-dwelling, working adults aged 
21-40 years, incorporating 206,381 nights of sleep and 334,038 days of PA. 
Distinct rest-activity rhythm (RAR) profiles were identified using k-means 
clustering, indicating participants' temporal distribution of step counts over 
the day. Hierarchical clustering of the proportion of days spent in each of 
these RAR profiles revealed four groups who expressed different mixtures of RAR 
profiles before and during the lockdown.
RESULTS: Time in bed increased by 20 min during the lockdown without loss of 
sleep efficiency, while social jetlag measures decreased by 15 min. Resting 
heart rate declined by ~2 bpm. PA dropped an average of 42%. Four groups with 
different compositions of RAR profiles were found. Three were better able to 
maintain PA and weekday/weekend differentiation during lockdown. The least 
active group comprising ~51% of the sample, were younger and predominantly 
singles. Habitually less active already, this group showed the greatest 
reduction in PA during lockdown with little weekday/weekend differences.
CONCLUSION: In the early aftermath of COVID-19 mobility restriction, PA appears 
to be more severely affected than sleep. RAR evaluation uncovered heterogeneity 
of responses to lockdown that could associate with different outcomes should the 
resolution of COVID-19 be protracted.

© Sleep Research Society 2020. Published by Oxford University Press on behalf of 
the Sleep Research Society.

DOI: 10.1093/sleep/zsaa179
PMCID: PMC7543649
PMID: 32918076 [Indexed for MEDLINE]


4214. PLoS One. 2020 Sep 11;15(9):e0238906. doi: 10.1371/journal.pone.0238906. 
eCollection 2020.

Relationship quality and mental health during COVID-19 lockdown.

Pieh C(1), O Rourke T(1), Budimir S(1)(2), Probst T(1).

Author information:
(1)Department for Psychotherapy and Biopsychosocial Health, Danube University 
Krems, Krems an der Donau, Austria.
(2)Department of Work, Organization and Society, Ghent University, Ghent, 
Belgium.

Erratum in
    PLoS One. 2021 Sep 1;16(9):e0257118.

Catastrophes are known to have an impact on relationships as well as on mental 
health. This study evaluated differences in several mental health and well-being 
measures according to relationship quality during the Coronavirus Disease 
(COVID-19) pandemic and related lockdown measures. A cross-sectional online 
survey was launched four weeks after lockdown measures were implemented in 
Austria. Relationship quality was measured with the Quality of Marriage Index 
(QMI), and mental health measures included quality of life (WHO-QOL BREF 
psychological domain), well-being (WHO-5), depression (PHQ-9), anxiety (GAD-7), 
stress (PSS-10), and sleep quality (ISI). ANOVAs with Bonferroni-corrected 
post-hoc tests and Chisquared tests were applied. In all mental health scales, 
individuals with good relationship quality (n = 543) scored better than 
individuals with poor relationship quality (n = 190) or without relationship (n 
= 272). The odds ratios (OR) between the poor and good relationship quality 
groups were 3.5 for the PHQ-9, 3.4 for the GAD-7, and 2.0 for the ISI. 
Additionally, individuals without no relationship scored better on all scales 
than individuals with poor relationship quality (all p-values < .05). 
Relationship quality was related to mental health during COVID-19. The 
prevalence of depressive symptoms increased according to relationship quality 
from 13% up to 35%. Relationship per se was not associated with better mental 
health, but the quality of the relationship was essential. Compared to no 
relationship, a good relationship quality was a protective factor whereas a poor 
relationship quality was a risk factor.

DOI: 10.1371/journal.pone.0238906
PMCID: PMC7485771
PMID: 32915878 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


4215. J Appl Gerontol. 2021 Jan;40(1):3-13. doi: 10.1177/0733464820958550. Epub 2020 
Sep 11.

Social Isolation and Psychological Distress Among Older Adults Related to 
COVID-19: A Narrative Review of Remotely-Delivered Interventions and 
Recommendations.

Gorenko JA(1), Moran C(1), Flynn M(1), Dobson K(1), Konnert C(1).

Author information:
(1)University of Calgary, Alberta, Canada.

The COVID-19 pandemic is associated with several short- and long-term negative 
impacts on the well-being of older adults. Physical distancing recommendations 
to reduce transmission of the SARS-CoV2-19 virus increase the risk of social 
isolation and loneliness, which are associated with negative outcomes including 
anxiety, depression, cognitive decline, and mortality. Taken together, social 
isolation and additional psychological impacts of the pandemic (e.g., worry, 
grief) underscore the importance of intervention efforts to older adults. This 
narrative review draws upon a wide range of evidence to provide a comprehensive 
overview of appropriate remotely-delivered interventions for older adults that 
target loneliness and psychological symptoms. These include interventions 
delivered by a range of individuals (i.e., community members to mental health 
professionals), and interventions that vary by implementation (e.g., self-guided 
therapy, remotely-delivered interventions via telephone or video call). 
Recommendations to overcome barriers to implementation and delivery are 
provided, with consideration given to the different living situations.

DOI: 10.1177/0733464820958550
PMID: 32914668 [Indexed for MEDLINE]


4216. Australas Psychiatry. 2020 Oct;28(5):504-507. doi: 10.1177/1039856220953701. 
Epub 2020 Sep 10.

Making working from home work: reflections on adapting to change.

Khanna R(1)(2), Murnane T(1), Kumar S(1), Rolfe T(1), Dimitrieski S(1), McKeown 
M(1), Ejareh Dar M(1)(2), Gavson L(1), Gandhi C(1).

Author information:
(1)Mental Health Division, Austin Health, Australia.
(2)Department of Psychiatry, University of Melbourne, Australia.

OBJECTIVES: During the COVID-19 pandemic, our mental health service experimented 
with working from home. The flexibility of this practice can enable improved 
efficiency, staff well-being and expanded operating hours in the longer term. 
This paper shares our experiences and makes recommendations for being a part of 
and leading distributed clinical teams.
CONCLUSIONS: We saw a 3% increase in total appointment bookings and a 7% 
reduction in cancellations/non-attendance compared to the same period in 2019. 
Based on our experience and the literature, effective distributed teams have 
leaders that connect via video at least weekly; focus on transparency and output 
over micromanagement; prioritise staff relationships and err towards 
overcommunication.

DOI: 10.1177/1039856220953701
PMID: 32910690 [Indexed for MEDLINE]


4217. Health Promot Chronic Dis Prev Can. 2020 Dec 9;40(11-12):350-355. doi: 
10.24095/hpcdp.40.11/12.04. Epub 2020 Sep 9.

Rapid response to COVID-19: addressing challenges and increasing the mental 
readiness of public safety personnel.

Heber A(1)(2), Testa V(3)(4), Smith-MacDonald L(5)(6), Brémault-Phillips 
S(5)(6), Smith-MacDonald L(3)(7).

Author information:
(1)Veterans Affairs Canada, Ottawa, Ontario, Canada.
(2)Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, 
Ontario, Canada.
(3)Canadian Institute for Public Safety Research and Treatment, Regina, 
Saskatchewan, Canada.
(4)Interdisciplinary School of Health Sciences, Faculty of Health Sciences, 
University of Ottawa, Ottawa, Ontario, Canada.
(5)Heroes in Mind, Advocacy and Research Consortium, University of Alberta, 
Edmonton, Alberta, Canada.
(6)Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, 
Canada.
(7)Department of Psychology, University of Regina, Regina, Saskatchewan, Canada.

Plain Language Summary: The COVID-19 pandemic has underscored the essential role 
of public safety personnel in serving and protecting all Canadians. Public 
safety personnel were reporting challenges with mental health and well-being 
before the COVID-19 pandemic; accordingly, the new stressors may mean public 
safety personnel need additional resources to sustainably help them help us. 
This article suggests elements of support that may be attainable avenues for 
supporting the well-being of public safety personnel during the protracted 
stress caused by the COVID-19 pandemic. Sustained self-care may be critical for 
maintaining the mental health and well-being of public safety personnel during 
the COVID-19 pandemic.

Plain Language Summary: La pandémie de COVID-19 a mis en évidence le rôle 
essentiel du personnel de sécurité publique dans le service et la protection de 
l’ensemble des Canadiens. Le personnel de sécurité publique signalant déjà des 
problèmes de santé mentale et de bien-être avant même la pandémie de COVID-19, 
les nouveaux facteurs de stress pourraient augmenter les besoins en ressources 
supplémentaires chez ce personnel afin qu’il soit capable de nous aider à long 
terme. Cet article propose divers éléments de soutien pouvant constituer des 
pistes pertinentes en vue de favoriser le bien-être du personnel de sécurité 
publique pendant la période de stress prolongé provoqué par la pandémie de 
COVID-19. Les autosoins peuvent s’avérer essentiels au maintien de la santé 
mentale et du bien-être du personnel de sécurité publique pendant la pandémie de 
COVID-19.

DOI: 10.24095/hpcdp.40.11/12.04
PMCID: PMC7745835
PMID: 32909935 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflicts 
of interest to report.


4218. J Am Med Dir Assoc. 2021 Jun;22(6):1242-1247. doi: 10.1016/j.jamda.2020.07.037. 
Epub 2020 Sep 6.

Prolonged Mechanical Ventilation: Symptomatology, Well-Being, and Attitudes to 
Life.

Jacobs JM(1), Marcus EL(2), Stessman J(3).

Author information:
(1)Institute of Geriatric Medicine, Clalit Health Services, Jerusalem, Israel; 
Department of Geriatrics and Geriatric Rehabilitation, Hadassah-Hebrew 
University Medical Center, Jerusalem, Israel; Institute for Aging Research, 
Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Faculty of 
Medicine, Hebrew University of Jerusalem, Jerusalem, Israel. Electronic address: 
jacobsj@hadassah.org.il.
(2)Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; 
Chronic Ventilator-Dependent Division, Herzog Medical Center, Jerusalem, Israel.
(3)Institute of Geriatric Medicine, Clalit Health Services, Jerusalem, Israel; 
Department of Geriatrics and Geriatric Rehabilitation, Hadassah-Hebrew 
University Medical Center, Jerusalem, Israel; Institute for Aging Research, 
Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Faculty of 
Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.

OBJECTIVE: Although prolonged mechanical ventilation (PMV) is increasingly 
common, little is known concerning patient symptom burden or attitudes toward 
PMV. This study aims to describe the mood, well-being, distressing symptoms, and 
attitudes toward prolonged ventilation among PMV patients treated either at home 
or long-term acute care (LTAC).
DESIGN: An observational study.
SETTING AND PARTICIPANTS: 62 communicative participants treated with PMV, aged 
≥18 years, insurees of a single HMO, treated at home hospital or LTAC 
specializing in ventilation in Jerusalem.
MEASURES: Sociodemographic characteristics; chronic conditions; functional 
status; symptom burden measured by revised Edmonton Symptomatic Assessment 
System (r-ESAS); attitudes toward PVM.
RESULTS: Participants were aged 61.7 ± 20.7 years, commonly suffered progressive 
neuromuscular disease (43.5%) or chronic lung disease (29%), were functionally 
dependent, treated at home (64.5%) or LTAC (35.5%), and had a mean PMV duration 
of 36.6 months (interquartile range 10.8-114.1). The 5-item, short Geriatric 
Depression Scale identified depression among 38% of participants, and was less 
at home vs LTAC (34% vs 44%, P < .001). Mean revised Edmonton Symptom Assessment 
System score was 24.5 ± 14.8 (maximum severity = 100), and participants reported 
severe or distressing symptoms for tiredness (27%/20%), pain (10%/25%), anxiety 
(16%/14%), depression (9%/21%), drowsiness (12%/17%), shortness of breath 
(9%/15%), poor appetite (7%/9%), and nausea (0%/10%). Impaired general 
well-being was reported as severe, moderate, mild, or none among 15%, 40%, 30%, 
and 15%, respectively. Only 1 patient had advance directives concerning 
ventilation prior to intubation, and when asked if they had to choose again 
today, 85% of patients would again opt for ventilation.
CONCLUSIONS AND IMPLICATIONS: Few PMV patients reported distressing symptoms, 
and 85% would choose ventilation if asked again. These findings might be useful 
in clinical practice to assist in decision making concerning prolonged 
ventilation.

Copyright © 2020. Published by Elsevier Inc.

DOI: 10.1016/j.jamda.2020.07.037
PMCID: PMC7474963
PMID: 32907755 [Indexed for MEDLINE]


4219. Disaster Med Public Health Prep. 2022 Apr;16(2):449-454. doi: 
10.1017/dmp.2020.334. Epub 2020 Sep 10.

The COVID-19 Pandemic and Mental Well-Being of Pregnant Women in Japan: Need for 
Economic and Social Policy Interventions.

Matsushima M(1), Horiguchi H(2).

Author information:
(1)University of Tsukuba, Faculty of Humanities and Social Sciences, Tsukuba, 
Japan.
(2)Kobe University, School of Medicine Faculty of Health Sciences, Kobe, Japan.

OBJECTIVE: This study explores the mental well-being of pregnant women in Japan 
during the coronavirus disease (COVID-19) pandemic.
METHODS: We collected 1777 responses from pregnant women through an online 
survey. Using the Japanese version of the Edinburgh Postnatal Depression Scale 
(EPDS), we calculated the percentage of pregnant women above the cutoff (≥ 13), 
and the factor scores of anhedonia, anxiety, and depression. Regression analyses 
were performed to identify factors and socioeconomic characteristics correlated 
with depressive symptoms.
RESULTS: The point prevalence of pregnant women with an EPDS score of ≥ 13 was 
17%. The mean scores were 0.73, 3.68, and 1.82 for anhedonia, anxiety, and 
depression, respectively. The probability of becoming above the cutoff score 
positively correlated with the cancellation of planned informal support, higher 
perceived risk for infection of COVID-19, difficulties in household finances, 
and lack of social support. Moreover, being younger, less wealthy, unemployed, 
and without a partner showed a significantly higher possibility of having a 
score above the cutoff.
CONCLUSIONS: The present study found a high percentage of pregnant women with 
depressive symptoms. Notably, COVID-19-related variables, including perceived 
risk for the infection, fear of decreasing economic wealth, and social support, 
were significantly associated with depressive symptoms.

DOI: 10.1017/dmp.2020.334
PMCID: PMC7642494
PMID: 32907687 [Indexed for MEDLINE]


4220. Disaster Med Public Health Prep. 2022 Apr;16(2):734-740. doi: 
10.1017/dmp.2020.356. Epub 2020 Sep 10.

Responding to the Psychological Needs of Health Workers During Pandemic: Ten 
Lessons From Humanitarian Work.

Cherepanov E(1).

Author information:
(1)Cambridge College, Graduate School of Psychology and Counseling, Boston, 
Massachusetts.

When a complex emergency (CE) overwhelms infrastructure, the ability of 
health-care providers to work efficiently under duress saves lives. The author 
uses her experience of providing mental health supports to humanitarian aid 
workers and the pieces of training conducted for internal medicine practitioners 
to offer guidance on how to manage severe job-related stresses during the 
response to the coronavirus disease 2019 (COVID-19) pandemic. This work reminds 
responders about their professional mission and purpose, but its extreme 
physical and mental demands can take a toll on their well-being and health. In 
CEs, the sheer volume of work and the emotional over-engagement tend to produce 
toxic fantasies (eg, rescuer or helper fantasies), acting upon which threatens 
integrity of care and increases risks for both patients and providers. 
Accumulated fatigue and exposure to mass suffering and mortality can change the 
perceived value of life and increase reckless, risk-taking, and suicidal 
behaviors. Introducing a self-awareness framework prioritizes the awareness of 
the available choices and making situation-appropriate and informed decisions 
about balancing one's own and others' needs. The COVID-19 response has 
demonstrated that fostering peer supports, changing organizational culture, 
addressing self-awareness within a training and supervisory context, and 
strengthening supports for managers are important parts of disaster 
preparedness. It also revealed that more research is needed to better understand 
and meet the special psychological needs of health-care responders.

DOI: 10.1017/dmp.2020.356
PMCID: PMC7737122
PMID: 32907680 [Indexed for MEDLINE]


4221. Glob Health Res Policy. 2020 Sep 3;5:40. doi: 10.1186/s41256-020-00168-x. 
eCollection 2020.

Timely mental health services contribute to the containment of COVID-19 pandemic 
in China.

Zhang N(1), Wu K(2), Wang W(3).

Author information:
(1)School of Public Health and the Second Affiliated Hospital of Zhejiang 
University School of Medicine, Hangzhou, China.
(2)Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
(3)Tongde Hospital of Zhejiang Province, Hangzhou, China.

The COVID-19 pandemic is the most severe public health crisis in the 21st 
century. The pandemic not only posed great challenges to people's physical 
health but also induced wide-ranging impacts on mental health of infected and 
suspected patients, frontline healthcare workers, and the general public whose 
normal life was disrupted by the pandemic. In this commentary, we outline the 
initiatives and coordinated efforts on providing timely mental health services 
after the pandemic outbreak in China, including understanding the mental health 
impact of COVID-19, prioritizing and coordinating mental health services along 
with medical services in the efforts to contain the pandemic, initiating and 
implementing specific measures to improve mental wellbeing of frontline 
healthcare workers, and increasing the accessibility of mental health services 
to the general public. Theses services, along with other coordinated efforts, 
contribute to the containment of COVID-19 pandemic in China and could be 
valuable for other countries to take proactive measures to mitigate the mental 
health impacts of the pandemic now and in the future.

© The Author(s) 2020.

DOI: 10.1186/s41256-020-00168-x
PMCID: PMC7467755
PMID: 32905275 [Indexed for MEDLINE]

Conflict of interest statement: Competing interestsThe authors declare that they 
have no competing interests.


4222. J Nurs Manag. 2021 Mar;29(2):307-316. doi: 10.1111/jonm.13155. Epub 2020 Sep 23.

Correlates of post-traumatic growth among nursing professionals: A 
cross-sectional analysis.

Okoli CTC(1)(2), Seng S(1)(2), Lykins A(1)(2)(3), Higgins JT(1)(3).

Author information:
(1)University of Kentucky College of Nursing, Lexington, KY, USA.
(2)Eastern State Hospital, Lexington, KY, USA.
(3)UK HealthCare, Lexington, KY, USA.

AIMS: Among nursing professionals, our aims were to examine (a) self-reported 
traumatic experiences, (b) differences in post-traumatic growth (i.e. positive 
psychological growth after experiencing a traumatic event) by nursing 
professional level and (c) demographic, work-related, behavioural and traumatic 
experience covariates of post-traumatic growth.
BACKGROUND: Trauma experience among nursing professionals is higher than 
observed in the general population. Due to the nature of their work environment, 
workplace trauma rates are particularly alarming. Understanding post-traumatic 
growth among nursing professionals may guide interventions to enhance 
well-being.
METHOD: A secondary analysis of cross-sectional survey data from nursing 
professionals (N = 299). Demographic, work-related, behavioural, trauma 
experience categories and post-traumatic growth variables were examined.
RESULTS: Advanced practice nurses and clinical nurses reported higher rates of 
workplace trauma, as compared to nursing assistants. Higher post-traumatic 
growth scores were associated with having a postgraduate degree, serving the 
paediatric population and lower frequency of alcohol use. Lower post-traumatic 
growth scores were associated with being married/widowed, being an advanced 
practice provider or clinical nurse, working in the intensive care unit and 
reporting workplace, family/personal stress and undisclosed trauma.
CONCLUSIONS: Nursing professionals have several demographic, work-related, 
behavioural and traumatic experience-related variables associated with and that 
explain variances in post-traumatic growth.
IMPLICATION FOR NURSING MANAGEMENT: Targeted screening and individualized 
treatment based on nursing professional level should be considered to support 
trauma recovery and post-traumatic growth.

© 2020 John Wiley & Sons Ltd.

DOI: 10.1111/jonm.13155
PMID: 32901448 [Indexed for MEDLINE]


4223. Int J Environ Res Public Health. 2020 Sep 4;17(18):6450. doi: 
10.3390/ijerph17186450.

Positive Impact of Mindfulness Meditation on Mental Health of Female Teachers 
during the COVID-19 Outbreak in Italy.

Matiz A(1), Fabbro F(1)(2), Paschetto A(1), Cantone D(3), Paolone AR(1), 
Crescentini C(1).

Author information:
(1)Department of Languages and Literatures, Communication, Education and 
Society, University of Udine, 33100 Udine, Italy.
(2)Perceptual Robotics (PERCRO) Laboratory Scuola Superiore Sant'Anna, 56010 
Pisa, Italy.
(3)Department of Psychology, University of Rome La Sapienza, 00185 Rome, Italy.

The Covid-19 pandemic and subsequent public health measures were shown to impact 
negatively on people's mental health. In particular, women were reported to be 
at higher risk than men of developing symptoms of stress/anxiety/depression, and 
resilience was considered a key factor for positive mental health outcomes. In 
the present study, a sample of Italian female teachers (n = 66, age: 51.5 ± 7.9 
years) was assessed with self-report instruments one month before and one month 
after the start of the Covid-19 lockdown: mindfulness skills, empathy, 
personality profiles, interoceptive awareness, psychological well-being, 
emotional distress and burnout levels were measured. Meanwhile, they received an 
8-week Mindfulness-Oriented Meditation (MOM) course, through two group meetings 
and six individual video-lessons. Based on baseline personality profiles, 
analyses of variance were performed in a low-resilience (LR, n = 32) and a 
high-resilience (HR, n = 26) group. The LR and HR groups differed at baseline in 
most of the self-report measures. Pre-post MOM significant improvements were 
found in both groups in anxiety, depression, affective empathy, emotional 
exhaustion, psychological well-being, interoceptive awareness, character traits 
and mindfulness levels. Improvements in depression and psychological well-being 
were higher in the LR vs. HR group. We conclude that mindfulness-based training 
can effectively mitigate the psychological negative consequences of the Covid-19 
outbreak, helping in particular to restore well-being in the most vulnerable 
individuals.

DOI: 10.3390/ijerph17186450
PMCID: PMC7559290
PMID: 32899739 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest. The 
funders had no role in the design of the study; in the collection, analyses, or 
interpretation of data; in the writing of the manuscript, or in the decision to 
publish the results.


4224. J Psychosom Obstet Gynaecol. 2021 Jun;42(2):162-167. doi: 
10.1080/0167482X.2020.1808620. Epub 2020 Sep 8.

Fatherhood too soon. Anxiety, depression and quality of life in fathers of 
preterm and term babies: a longitudinal study.

Petersen IB(1), Quinlivan JA(2)(3).

Author information:
(1)College of Arts and College of Science, Australian National University, 
Canberra, Australia.
(2)Institute for Health Research, University of Notre Dame Australia, Fremantle, 
Australia.
(3)School of Medicine, Australian National University, Canberra, Australia.

INTRODUCTION: Fathers are increasingly recognized as playing a critical role in 
the family unit and emotional development of children. The birth of a preterm 
baby can be confronting, yet there is limited research that explores how preterm 
birth might impact on father's emotional wellbeing and quality of life. The aim 
of the study was to monitor quality of life and psychological wellbeing in a 
group of fathers to explore if a preterm birth altered outcomes in these two 
domains.
METHODS: Institutional ethics committee approval was obtained. Australian men 
(N = 1000) were recruited in the antenatal period via their pregnant partner, 
and completed the Hospital Anxiety and Depression Scale (HADS) and Satisfaction 
with Life Scale (SWLS) in the third trimester and again 6 weeks after the birth 
of their baby. Birth records were independently audited to determine which 
fathers experienced preterm birth.
RESULTS: Data was available for 1000 and 950 fathers at each time point. 
Overall, 72 (7.2%) of fathers experienced preterm birth and 928 (92.8%) had a 
term birth. Fathers of preterm infants were significantly older (p = 0.002) and 
less likely to be married or in a defacto relationship (p = 0.043). Preterm 
babies were more likely to be delivered by cesarean section, have a low 
birthweight and require admission to a special care or neonatal intensive care 
unit (p < 0.001). There were no significant differences in HADS total, anxiety 
or depression subscale and SWLS scores in the antenatal period. Six weeks after 
the birth, fathers of preterm babies were significantly more likely to meet the 
case criteria for anxiety compared to fathers of term babies (25 vs. 12%, 
p = 0.02). This was due to persisting anxiety in preterm fathers (p < 0.001). 
They also reported significantly lower SWLS scores compared to fathers of term 
infants (27.31 vs. 27.88, p = 0.011). However, there were no differences in 
depression or HADS total scores.
CONCLUSION: Following birth of a preterm baby, persisting anxiety may affect 
quality of life of fathers. Routine screening of fathers of preterm babies may 
identify men who could benefit from referral for psychological intervention.

DOI: 10.1080/0167482X.2020.1808620
PMID: 32897157 [Indexed for MEDLINE]


4225. J Nurs Manag. 2021 Mar;29(2):240-249. doi: 10.1111/jonm.13146. Epub 2020 Sep 16.

Factors associated with the psychological well-being among front-line nurses 
exposed to COVID-2019 in China: A predictive study.

Li X(1), Zhou Y(1), Xu X(2)(3).

Author information:
(1)The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, 
China.
(2)School of Population Health, University of New South Wales, Sydney, NSW, 
Australia.
(3)Improving Palliative, Aged and Chronic Care through Clinical Research and 
Translation (IMPACCT) Research Centre, Faculty of Health, University of 
Technology Sydney, Sydney, NSW, Australia.

AIMS: To evaluate psychological well-being and factors associated with 
post-traumatic stress disorder (PTSD) among front-line nurses during the 
coronavirus disease-2019 (COVID-19) pandemic.
BACKGROUND: Coronavirus disease-2019 is a pandemic that has posed a public 
health emergency of international concern. Psychological well-being of 
front-line nurses is a big concern during the COVID-19 pandemic.
METHODS: With a predictive study design, a same survey was sent separately at 
two time points (i.e. before and after nurses worked at COVID-19 units) between 
January and March 2020 among 356 front-line nurses in First Affiliated Hospital 
of Bengbu Medical College, Anhui, China.
RESULTS: Of a total 356 front-line nurses, stress level and the prevalence of 
PTSD were significantly increased after they worked at COVID-19 units. Nurses 
who had work experience less than 2 years were significantly associated with a 
high risk of developing PTSD. Nurses who worked in COVID-19 inpatients wards had 
significantly higher odds of being PTSD (odds ratio [OR] = 21.9, 95% confidence 
interval [CI]: 5.08; 94.5) than those who worked in other COVID-19-related 
units. Resilience was negatively associated with PTSD (OR = 0.96, 95% CI: 0.93; 
0.99).
CONCLUSION: Nurses had significantly increased risk to develop PTSD during 
COVID-19 pandemic.
IMPLICATIONS FOR NURSING MANAGEMENT: Clinical and policy strategies to support 
front-line nurses' psychological well-being, particularly young nurses, in 
response to COVID-19 crisis are urgently needed.

© 2020 John Wiley & Sons Ltd.

DOI: 10.1111/jonm.13146
PMID: 32890453 [Indexed for MEDLINE]


4226. Int J Public Health. 2020 Sep;65(7):1205-1216. doi: 10.1007/s00038-020-01463-7. 
Epub 2020 Sep 4.

The psychosocial impact of flu influenza pandemics on healthcare workers and 
lessons learnt for the COVID-19 emergency: a rapid review.

Barello S(1)(2), Falcó-Pegueroles A(3), Rosa D(4), Tolotti A(5), Graffigna 
G(6)(7), Bonetti L(8)(9).

Author information:
(1)EngageMinds HUB - Consumer, Food and Health Engagement Research Center, L.go 
Gemelli 1, 20123, Milan, Italy. serena.barello@unicatt.it.
(2)Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy. 
serena.barello@unicatt.it.
(3)Department of Fundamental Care and Medical-Surgical Nursing, School of 
Nursing, Faculty of Medicine and Health Sciences, Consolidated Research Group 
SGR 269 Quantitative Psychology, University of Barcelona, Barcelona, Spain.
(4)Don Carlo Gnocchi Foundation, Milan, Italy.
(5)Nursing Development and Research Unit, Oncology Institute of Southern 
Switzerland (IOSI), EOC, Via Ospedale, 1, 6500, Bellinzona, Switzerland.
(6)EngageMinds HUB - Consumer, Food and Health Engagement Research Center, L.go 
Gemelli 1, 20123, Milan, Italy.
(7)Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.
(8)Nursing Development and Research Unit, Oncology Institute of Southern 
Switzerland (IOSI), EOC, Via Ospedale, 1, 6500, Bellinzona, Switzerland. 
Loris.Bonetti@eoc.ch.
(9)Department of Business Economic Health and Social Care, University of Applied 
Sciences and Arts of Southern Switzerland, Manno, Switzerland. 
Loris.Bonetti@eoc.ch.

OBJECTIVES: During a pandemic, healthcare workers (HCWs) are essential to the 
health system response. Based on our knowledge, little information is available 
regarding the psychosocial impact on HCWs or interventions for supporting them 
during pandemics. Therefore, the study aimed to assess available literature on 
perceived stress and psychological responses to influenza pandemics in HCWs and 
identify implications for healthcare practice and future research.
METHODS: This is a rapid review of the literature. The review was conducted 
according to the Preferred Reporting Items for Systematic Review and 
Meta-Analysis.
RESULTS: Across all the studies-both qualitative and quantitative-HCWs working 
during the epidemic reported frequent concerns regarding their own health and 
the fear of infecting their families, friends and colleagues. Moreover, social 
isolation, uncertainty, fears of stigmatization and reluctance to work or 
considering absenteeism were frequently reported. Moreover, many studies 
highlighted a high prevalence of high levels of stress, anxiety and depression 
symptoms, which could have long-term psychological implications in HCWs.
CONCLUSIONS: This rapid review offers an overview of the major concerns 
regarding HCWs' psychosocial well-being and possible preventive strategies, 
which could be useful for the current COVID-19 outbreak and similar future 
pandemics. Studies suggested to invest on preventive psychological, social, 
family and physical support and to guaranteeing reasonable work conditions and 
others in order to protect HCWs from the long-lasting psychological effect of 
the COVID-19 pandemic.

DOI: 10.1007/s00038-020-01463-7
PMCID: PMC7472941
PMID: 32888048 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


4227. J Gerontol B Psychol Sci Soc Sci. 2021 Jan 18;76(2):e59-e64. doi: 
10.1093/geronb/gbaa153.

COVID-19 as a Stressor: Pandemic Expectations, Perceived Stress, and Negative 
Affect in Older Adults.

Whitehead BR(1).

Author information:
(1)Behavioral Sciences, University of Michigan-Dearborn.

OBJECTIVES: The extent to which the COVID-19 pandemic is appraised as a stressor 
influences perceived stress (PS) and psychological well-being during the event. 
Here, the association of older adults' expectations concerning the pandemic's 
duration and impact with PS and negative affect (NA) is investigated. Based on 
the stress and coping framework, PS is expected to mediate the association 
between COVID-19 expectations and NA.
METHODS: Seven hundred fourteen residents of the United States and aged 60 and 
older completed an anonymous online survey in late March 2020 reporting PS, NA, 
and expectations regarding the pandemic.
RESULTS: Regression analyses controlling for demographic factors revealed that 
more dire pandemic expectations significantly predicted PS and NA directly, and 
the effects on NA were significantly mediated by PS.
DISCUSSION: Findings provide evidence that expectations about a pandemic 
influence the extent to which older adults experience stress and NA in the midst 
of a pandemic event. Implications for mental health are discussed.

© The Author(s) 2020. Published by Oxford University Press on behalf of The 
Gerontological Society of America. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/geronb/gbaa153
PMCID: PMC7499769
PMID: 32886773 [Indexed for MEDLINE]


4228. J Vasc Surg. 2021 Mar;73(3):762-771.e4. doi: 10.1016/j.jvs.2020.08.030. Epub 
2020 Aug 31.

Global vascular surgeons' experience, stressors, and coping during the 
coronavirus disease 2019 pandemic.

Shalhub S(1), Mouawad NJ(2), Malgor RD(3), Johnson AP(4), Wohlauer MV(3), Coogan 
SM(5), Loveland KA(6), Cuff RF(7), Leonardi C(8), Coleman DM(9), Sheahan MG 
3rd(10), Woo K(11).

Author information:
(1)Division of Vascular Surgery, Department of Surgery, University of 
Washington, Seattle, Wash. Electronic address: shalhub@uw.edu.
(2)Department of Vascular and Endovascular Surgery, McLaren Health System, Bay 
City, Mich.
(3)Division of Vascular Surgery and Endovascular Therapy, The University of 
Colorado Anschutz Medical Center, Aurora, Colo.
(4)New York/Presbyterian Weill Cornell School of Medicine, New York, NY.
(5)Department of Cardiovascular Surgery, University of Texas at Houston, 
Houston, Tex.
(6)Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, 
McGovern Medical School, The University of Texas Health Science Center at 
Houston, Houston, Tex.
(7)Department of Vascular Surgery, Spectrum Health Medical Group, Grand Rapids, 
Mich.
(8)Department of Behavioral and Community Health Sciences, School of Public 
Health, Louisiana State University Health Sciences Center, New Orleans, La.
(9)Department of Surgery, University of Michigan, Ann Arbor, Mich.
(10)Division of Vascular and Endovascular Surgery, Louisiana State University 
Health Sciences Center, New Orleans, La.
(11)Division of Vascular Surgery, University of California, Los Angeles, Los 
Angeles, Calif.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to 
unprecedented challenges for health care systems globally. We designed and 
administered a global survey to examine the effects of COVID-19 on vascular 
surgeons and explore the COVID-19-related stressors faced, coping strategies 
used, and support structures available.
METHODS: The Pandemic Practice, Anxiety, Coping, and Support Survey for Vascular 
Surgeons was an anonymous cross-sectional survey sponsored by the Society for 
Vascular Surgery Wellness Task Force. The survey analysis evaluated the effects 
of COVID-19-related stressors on vascular surgeons measured using the 
Generalized Anxiety Disorder 7-item scale. The 28-item Brief Coping Orientation 
to Problems Experienced inventory was used to assess the active and avoidant 
coping strategies. Survey data were collected using REDCap (Research Electronic 
Data Capture) from April 14, 2020 to April 24, 2020 inclusive. Additional 
qualitative data were collected using open-ended questions. Univariable and 
multivariable analyses of the factors associated with the anxiety levels and 
qualitative analysis were performed.
RESULTS: A total of 1609 survey responses (70.5% male; 82.5% vascular surgeons 
in practice) from 58 countries (43.4% from United States; 43.4% from Brazil) 
were eligible for analysis. Some degree of anxiety was reported by 54.5% of the 
respondents, and 23.3% reported moderate or severe anxiety. Most respondents 
(∼60%) reported using active coping strategies and the avoidant coping strategy 
of "self-distraction," and 20% used other avoidant coping strategies. 
Multivariable analysis identified the following factors as significantly 
associated with increased self-reported anxiety levels: staying in a separate 
room at home or staying at the hospital or a hotel after work (odds ratio [OR], 
1.39; 95% confidence interval [CI], 1.08-1.79), donning and doffing personal 
protective equipment (OR, 1.81; 95% CI, 1.41-2.33), worry about potential 
adverse patient outcomes due to care delay (OR, 1.47; 95% CI, 1.16-1.87), and 
financial concerns (OR, 1.90; 95% CI, 1.49-2.42). The factors significantly 
associated with decreased self-reported anxiety levels were hospital support 
(OR, 0.83; 95% CI, 0.76-0.91) and the use of positive reframing as an active 
coping strategy (OR, 0.88; 95% CI, 0.81-0.95).
CONCLUSIONS: Vascular surgeons globally have been experiencing multiple 
COVID-19-related stressors during this devastating crisis. These findings have 
highlighted the continued need for hospital systems to support their vascular 
surgeons and the importance of national societies to continue to invest in 
peer-support programs as paramount to promoting the well-being of vascular 
surgeons during and after the COVID-19 pandemic.

Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All 
rights reserved.

DOI: 10.1016/j.jvs.2020.08.030
PMCID: PMC7457940
PMID: 32882345 [Indexed for MEDLINE]


4229. PLoS One. 2020 Sep 3;15(9):e0238761. doi: 10.1371/journal.pone.0238761. 
eCollection 2020.

A cross-sectional study of psychological wellbeing of Indian adults during the 
Covid-19 lockdown: Different strokes for different folks.

Sharma AJ(1), Subramanyam MA(1).

Author information:
(1)Social Epidemiology, Indian Institute of Technology Gandhinagar, Gandhinagar, 
Gujarat, India.

The psychological impacts of the lockdown due to the Covid-19 pandemic are 
widely documented. In India, a family-centric society with a high population 
density and extreme social stratification, the impact of the lockdown might vary 
across diverse social groups. However, the patterning in the psychological 
impact of the lockdown among LGBT adults and persons known to be at higher risk 
of the complications of Covid-19 (such as persons with comorbidities or a 
history of mental illness) is not known in the Indian context. We used mixed 
methods (online survey, n = 282 and in-depth interviews, n = 14) to investigate 
whether the psychological influence of the lockdown was different across these 
groups of Indian adults. We fitted linear and logistic regression models 
adjusted for sociodemographic covariates. Thematic analysis helped us identify 
emergent themes in our qualitative narratives. Anxiety was found to be higher 
among LGBT adults (β = 2.44, CI: 0.58, 4.31), the high-risk group (persons with 
comorbidities) (β = 2.20, CI:0.36, 4.05), and those with a history of 
depression/loneliness (β = 3.89, CI:2.34, 5.44). Persons belonging to the LGBT 
group reported a greater usage of pornography than the heterosexuals (β = 2.72, 
CI: 0.09, 5.36) during the lockdown. Qualitative findings suggested that LGBT 
adults likely used pornography and masturbation to cope with the lockdown, given 
the limited physical access to sexual partners in a society that stigmatizes 
homosexuality. Moreover, both qualitative and quantitative study findings 
suggested that greater frequency of calling family members during lockdown could 
strengthen social relationships and increase social empathy. The study thereby 
urgently calls for the attention of policymakers to take sensitive and inclusive 
health-related decisions for the marginalized and the vulnerable, both during 
and after the crisis.

DOI: 10.1371/journal.pone.0238761
PMCID: PMC7470332
PMID: 32881946 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


4230. S Afr Med J. 2020 Aug 31;110(9):864-868. doi: 10.7196/SAMJ.2020.v110i9.15023.

COVID-19 in children: Should we be worried?

Hendricks CL(1), Green RJ.

Author information:
(1)Department of Immunology, Institute for Cellular and Molecular Medicine and 
SAMRC Extramural Unit for Stem Cell Research and Therapy, Faculty of Health 
Sciences, University of Pretoria, South Africa. candice_hendricks@outlook.com.

Reports indicate that children infected with SARS-CoV-2 have thus far presented 
with less severe disease than adults. Anxiety regarding a greater ability to 
transmit the virus is largely unfounded and has played a significant role in the 
decision to allow children to return to school. In some patients, however, 
especially in infants and in those with underlying comorbidities, severe disease 
must be anticipated and planned for accordingly. The most relevant severe 
clinical presentation in addition to the established respiratory complications, 
is that of a multisystem inflammatory disorder, with features resembling 
Kawasaki disease. The impact of the pandemic on the economic and social 
wellbeing of children, including food insecurity and care when parents are ill, 
cannot be ignored. During this pandemic, it is imperative to ensure access to 
routine and emergency medical services to sick children. In so doing, 
potentially devastating medical and socioeconomic consequences can be mitigated.

DOI: 10.7196/SAMJ.2020.v110i9.15023
PMID: 32880269 [Indexed for MEDLINE]


4231. Clin Infect Dis. 2021 May 18;72(10):e566-e576. doi: 10.1093/cid/ciaa1311.

Health-care Professionals' Perceptions of Critical Care Resource Availability 
and Factors Associated With Mental Well-being During Coronavirus Disease 2019 
(COVID-19): Results from a US Survey.

Sharma M(1), Creutzfeldt CJ(2)(3)(4), Lewis A(5), Patel PV(6), Hartog C(7)(8), 
Jannotta GE(6), Blissitt P(9), Kross EK(3)(10), Kassebaum N(1)(6), Greer DM(11), 
Curtis JR(3)(4)(10), Wahlster S(2)(6)(12).

Author information:
(1)Department of Global Health, University of Washington, Seattle, Washington, 
USA.
(2)Department of Neurology, Harborview Medical Center, University of Washington, 
Seattle, Washington, USA.
(3)Cambia Palliative Care Center of Excellence, University of Washington, 
Seattle, Washington, USA.
(4)Cambia Health Foundation, Seattle, Washington, USA.
(5)Departments of Neurology and Neurosurgery, New York University, New York, New 
York, USA.
(6)Department of Anesthesiology and Pain Medicine, Harborview Medical Center, 
University of Washington, Seattle, Washington, USA.
(7)Klinik für Anaesthesie und Operative Intensivmedizin, Charité 
Universitaetsmedizin Berlin, Berlin, Germany.
(8)Klinik Bavaria Kreischa, Kreischa, Germany.
(9)Department of Biobehavioral Nursing and Health Informatics, University of 
Washington School of Nursing, Seattle, Washington, USA.
(10)Division of Pulmonary, Critical Care, and Sleep Medicine, Department of 
Medicine, University of Washington, Seattle, Washington, USA.
(11)Department of Neurology, Boston University, Boston, Massachusetts, USA.
(12)Department of Neurological Surgery, Harborview Medical Center, University of 
Washington, Seattle, Washington, USA.

Comment in
    Clin Infect Dis. 2021 May 18;72(10):e577-e579.

BACKGROUND: Assessing the impact of coronavirus disease 2019 (COVID-19) on 
intensive care unit (ICU) providers' perceptions of resource availability and 
evaluating the factors associated with emotional distress/burnout can inform 
interventions to promote provider well-being.
METHODS: Between 23 April and 7 May 2020, we electronically administered a 
survey to physicians, nurses, respiratory therapists (RTs), and advanced 
practice providers (APPs) caring for COVID-19 patients in the United States. We 
conducted a multivariate regression to assess associations between concerns, a 
reported lack of resources, and 3 outcomes: a primary outcome of emotional 
distress/burnout and 2 secondary outcomes of (1) fear that the hospital is 
unable to keep providers safe; and (2) concern about transmitting COVID-19 to 
their families/communities.
RESULTS: We included 1651 respondents from all 50 states: 47% were nurses, 25% 
physicians, 17% RTs, and 11% APPs. Shortages of intensivists and ICU nurses were 
reported by 12% and 28% of providers, respectively. The largest supply 
restrictions reported were for powered air purifying respirators (56% reporting 
restricted availability). Provider concerns included worries about transmitting 
COVID-19 to their families/communities (66%), emotional distress/burnout (58%), 
and insufficient personal protective equipment (PPE; 40%). After adjustment, 
emotional distress/burnout was significantly associated with insufficient PPE 
access (adjusted relative risk [aRR], 1.43; 95% confidence interval [CI], 
1.32-1.55), stigma from community (aRR, 1.32; 95% CI, 1.24-1.41), and poor 
communication with supervisors (aRR, 1.13; 95% CI, 1.06-1.21). Insufficient PPE 
access was the strongest predictor of feeling that the hospital is unable to 
keep providers safe and worries about transmitting infection to their 
families/communities.
CONCLUSIONS: Addressing insufficient PPE access, poor communication from 
supervisors, and community stigma may improve provider mental well-being during 
the COVID-19 pandemic.

© The Author(s) 2020. Published by Oxford University Press for the Infectious 
Diseases Society of America. All rights reserved. For permissions, e-mail: 
journals.permissions@oup.com.

DOI: 10.1093/cid/ciaa1311
PMCID: PMC7499503
PMID: 32877508 [Indexed for MEDLINE]


4232. J Med Internet Res. 2020 Sep 25;22(9):e22142. doi: 10.2196/22142.

The Relation Between Official WhatsApp-Distributed COVID-19 News Exposure and 
Psychological Symptoms: Cross-Sectional Survey Study.

Liu JCJ(1), Tong EMW(2).

Author information:
(1)Yale-NUS College, Singapore, Singapore.
(2)Department of Psychology, National University of Singapore, Singapore, 
Singapore.

BACKGROUND: In a global pandemic, digital technology offers innovative methods 
to disseminate public health messages. As an example, the messenger app WhatsApp 
was adopted by both the World Health Organization and government agencies to 
provide updates on the coronavirus disease (COVID-19). During a time when rumors 
and excessive news threaten psychological well-being, these services allow for 
rapid transmission of information and may boost resilience.
OBJECTIVE: In this study, we sought to accomplish the following: (1) assess 
well-being during the pandemic; (2) replicate prior findings linking exposure to 
COVID-19 news with psychological distress; and (3) examine whether subscription 
to an official WhatsApp channel can mitigate this risk.
METHODS: Across 8 weeks of the COVID-19 outbreak (March 7 to April 21, 2020), we 
conducted a survey of 1145 adults in Singapore. As the primary outcome measure, 
participants completed the Depression, Anxiety, and Stress Scale (DASS-21). As 
predictor variables, participants also answered questions pertaining to the 
following: (1) their exposure to COVID-19 news; (2) their use of the Singapore 
government's WhatsApp channel; and (3) their demographics.
RESULTS: Within the sample, 7.9% of participants had severe or extremely severe 
symptoms on at least one DASS-21 subscale. Depression scores were associated 
with increased time spent receiving COVID-19 updates, whereas use of the 
official WhatsApp channel emerged as a protective factor (b=-0.07, t[863]=-2.04, 
P=.04). Similarly, increased anxiety scores were associated with increased 
exposure to both updates and rumors, but this risk was mitigated by trust in the 
government's WhatsApp messages (b=-0.05, t[863]=-2.13, P=.03). Finally, although 
stress symptoms increased with the amount of time spent receiving updates, these 
symptoms were not significantly related to WhatsApp use.
CONCLUSIONS: Our findings suggest that messenger apps may be an effective medium 
for disseminating pandemic-related information, allowing official agencies to 
reach a broad sector of the population rapidly. In turn, this use may promote 
public well-being amid an "infodemic."
TRIAL REGISTRATION: ClinicalTrials.gov NCT04305574; 
https://clinicaltrials.gov/ct2/show/NCT04305574.

©Jean C J Liu, Eddie M W Tong. Originally published in the Journal of Medical 
Internet Research (http://www.jmir.org), 25.09.2020.

DOI: 10.2196/22142
PMCID: PMC7527032
PMID: 32877349 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


4233. JAMA Netw Open. 2020 Sep 1;3(9):e2019686. doi: 
10.1001/jamanetworkopen.2020.19686.

Prevalence of Depression Symptoms in US Adults Before and During the COVID-19 
Pandemic.

Ettman CK(1)(2), Abdalla SM(1), Cohen GH(1)(3), Sampson L(1), Vivier PM(2)(4), 
Galea S(1).

Author information:
(1)Boston University School of Public Health, Boston, Massachusetts.
(2)Brown University School of Public Health, Providence, Rhode Island.
(3)Columbia Mailman School of Public Health, New York, New York.
(4)Hassenfeld Child Health Innovation Institute, Providence, Rhode Island.

Comment in
    JAMA Netw Open. 2020 Sep 1;3(9):e2020104.

IMPORTANCE: The coronavirus disease 2019 (COVID-19) pandemic and the policies to 
contain it have been a near ubiquitous exposure in the US with unknown effects 
on depression symptoms.
OBJECTIVE: To estimate the prevalence of and risk factors associated with 
depression symptoms among US adults during vs before the COVID-19 pandemic.
DESIGN, SETTING, AND PARTICIPANTS: This nationally representative survey study 
used 2 population-based surveys of US adults aged 18 or older. During COVID-19, 
estimates were derived from the COVID-19 and Life Stressors Impact on Mental 
Health and Well-being study, conducted from March 31, 2020, to April 13, 2020. 
Before COVID-19 estimates were derived from the National Health and Nutrition 
Examination Survey, conducted from 2017 to 2018. Data were analyzed from April 
15 to 20, 2020.
EXPOSURES: The COVID-19 pandemic and outcomes associated with the measures to 
mitigate it.
MAIN OUTCOMES AND MEASURES: Depression symptoms, defined using the Patient 
Health Questionnaire-9 cutoff of 10 or higher. Categories of depression symptoms 
were defined as none (score, 0-4), mild (score, 5-9), moderate (score, 10-14), 
moderately severe (score, 15-19), and severe (score, ≥20).
RESULTS: A total of 1470 participants completed the COVID-19 and Life Stressors 
Impact on Mental Health and Well-being survey (completion rate, 64.3%), and 
after removing those with missing data, the final during-COVID-19 sample 
included 1441 participants (619 participants [43.0%] aged 18-39 years; 723 
[50.2%] men; 933 [64.7%] non-Hispanic White). The pre-COVID-19 sample included 
5065 participants (1704 participants [37.8%] aged 18-39 years; 2588 [51.4%] 
women; 1790 [62.9%] non-Hispanic White). Depression symptom prevalence was 
higher in every category during COVID-19 compared with before (mild: 24.6% [95% 
CI, 21.8%-27.7%] vs 16.2% [95% CI, 15.1%-17.4%]; moderate: 14.8% [95% CI, 
12.6%-17.4%] vs 5.7% [95% CI, 4.8%-6.9%]; moderately severe: 7.9% [95% CI, 
6.3%-9.8%] vs 2.1% [95% CI, 1.6%-2.8%]; severe: 5.1% [95% CI, 3.8%-6.9%] vs 0.7% 
[95% CI, 0.5%-0.9%]). Higher risk of depression symptoms during COVID-19 was 
associated with having lower income (odds ratio, 2.37 [95% CI, 1.26-4.43]), 
having less than $5000 in savings (odds ratio, 1.52 [95% CI, 1.02-2.26]), and 
exposure to more stressors (odds ratio, 3.05 [95% CI, 1.95-4.77]).
CONCLUSIONS AND RELEVANCE: These findings suggest that prevalence of depression 
symptoms in the US was more than 3-fold higher during COVID-19 compared with 
before the COVID-19 pandemic. Individuals with lower social resources, lower 
economic resources, and greater exposure to stressors (eg, job loss) reported a 
greater burden of depression symptoms. Post-COVID-19 plans should account for 
the probable increase in mental illness to come, particularly among at-risk 
populations.

DOI: 10.1001/jamanetworkopen.2020.19686
PMCID: PMC7489837
PMID: 32876685 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest Disclosures: Dr Galea 
reported serving as a consultant for Sharecare and Tivity Health. No other 
disclosures were reported.


4234. Am J Geriatr Psychiatry. 2020 Nov;28(11):1175-1184. doi: 
10.1016/j.jagp.2020.07.019. Epub 2020 Aug 8.

The Protective Impact of Telemedicine on Persons With Dementia and Their 
Caregivers During the COVID-19 Pandemic.

Lai FH(1), Yan EW(2), Yu KK(3), Tsui WS(4), Chan DT(5), Yee BK(5).

Author information:
(1)Department of Rehabilitation Sciences (FHYL, DTHC), The Hong Kong Polytechnic 
University, Hong Kong, China. Electronic address: frank.hy.lai@polyu.edu.hk.
(2)Occupational Therapy Department (EWHY), Kowloon Hospital, Hong Kong, China.
(3)Salvation Army Hong Kong & Macau Command, Tai Po Multi-service Centre for 
Senior Citizen.
(4)Women's Welfare Club Western District, Hong Kong Chung Hok Elderly Centre, 
Hong Kong, China.
(5)Department of Rehabilitation Sciences (FHYL, DTHC), The Hong Kong Polytechnic 
University, Hong Kong, China.

OBJECTIVES: Social distancing under the COVID-19 pandemic has restricted access 
to community services for older adults with neurocognitive disorder (NCD) and 
their caregivers. Telehealth is a viable alternative to face-to-face service 
delivery. Telephone calls alone, however, may be insufficient. Here, we 
evaluated whether supplementary telehealth via video-conferencing platforms 
could bring additional benefits to care-recipient with NCD and their spousal 
caregivers at home.
PARTICIPANTS: Sixty older adults NCD-and-caregiver dyads were recruited through 
an activity center.
DESIGN, INTERVENTION: The impact of additional services delivered to both 
care-recipient and caregiver through video conference (n = 30) was compared with 
telehealth targeted at caregivers by telephone only (n = 30), over 4 weeks in a 
pretest-post-test design. Interviews and questionnaires were conducted at 
baseline and study's end.
MEASUREMENTS, RESULTS: Supplementary telemedicine had averted the deterioration 
in the Montreal Cognitive Assessment evident in the telephone-only group 
(ηp2 = 0.50). It also reversed the falling trend in quality of life observed in 
the telephone only group (QoL-AD, ηp2 = 0.23). Varying degrees of improvements 
in physical and mental health (Short-Form 36 v2), perceived burden (Zarit Burden 
Interview Scale) and self-efficacy (Revised Caregiving Self-Efficacy Scale) were 
observed among caregivers in the video-conferencing group, which were absent in 
the telephone-only group (ηp2 = 0.23-0.51).
CONCLUSION: Telemedicine by video conference was associated with improved 
resilience and wellbeing to both people with NCD and their caregivers at home. 
The benefits were visible already after 4 weeks and unmatched by telephone 
alone. Video conference as the modus operandi of telehmedicine beyond the 
context of pandemic-related social distancing should be considered.

Copyright © 2020 American Association for Geriatric Psychiatry. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jagp.2020.07.019
PMCID: PMC7413846
PMID: 32873496 [Indexed for MEDLINE]


4235. Medicina (Kaunas). 2020 Aug 27;56(9):433. doi: 10.3390/medicina56090433.

Probiotics: Versatile Bioactive Components in Promoting Human Health.

Sharifi-Rad J(1), Rodrigues CF(2), Stojanović-Radić Z(3), Dimitrijević M(3), 
Aleksić A(3), Neffe-Skocińska K(4), Zielińska D(4), Kołożyn-Krajewska D(4), 
Salehi B(5)(6), Milton Prabu S(7), Schutz F(8), Docea AO(9), Martins 
N(8)(10)(11), Calina D(12).

Author information:
(1)Phytochemistry Research Center, Shahid Beheshti University of Medical 
Sciences, Tehran 1991953381, Iran.
(2)LEPABE-Department of Chemical Engineering, Faculty of Engineering, University 
of Porto, 4200-465 Porto, Portugal.
(3)Department of Biology and Ecology, Faculty of Science and Mathematics, 
University of Niš, 18000 Niš, Serbia.
(4)Department of Food Gastronomy and Food Hygiene, Warsaw University of Life 
Sciences (WULS), 02-776 Warszawa, Poland.
(5)Noncommunicable Diseases Research Center, Bam University of Medical Sciences, 
Bam 44340847, Iran.
(6)Student Research Committee, School of Medicine, Bam University of Medical 
Sciences, Bam 44340847, Iran.
(7)Department of Zoology, Annamalai University, Annamalai Nagar 608002, 
Chidambaram, India.
(8)Department of Biomedicine, Faculty of Medicine, University of Porto, 4200-319 
Porto, Portugal.
(9)Department of Toxicology, University of Medicine and Pharmacy of Craiova, 
200349 Craiova, Romania.
(10)Institute for Research and Innovation in Health (i3S), University of Porto, 
4200-135 Porto, Portugal.
(11)Laboratory of Neuropsychophysiology, Faculty of Psychology and Education 
Sciences, University of Porto, 4200-135 Porto, Portugal.
(12)Department of Clinical Pharmacy, University of Medicine and Pharmacy of 
Craiova, 200349 Craiova, Romania.

The positive impact of probiotic strains on human health has become more evident 
than ever before. Often delivered through food, dietary products, supplements, 
and drugs, different legislations for safety and efficacy issues have been 
prepared. Furthermore, regulatory agencies have addressed various approaches 
toward these products, whether they authorize claims mentioning a disease's 
diagnosis, prevention, or treatment. Due to the diversity of bacteria and yeast 
strains, strict approaches have been designed to assess for side effects and 
post-market surveillance. One of the most essential delivery systems of 
probiotics is within food, due to the great beneficial health effects of this 
system compared to pharmaceutical products and also due to the increasing 
importance of food and nutrition. Modern lifestyle or various diseases lead to 
an imbalance of the intestinal flora. Nonetheless, as the amount of probiotic 
use needs accurate calculations, different factors should also be taken into 
consideration. One of the novelties of this review is the presentation of the 
beneficial effects of the administration of probiotics as a potential adjuvant 
therapy in COVID-19. Thus, this paper provides an integrative overview of 
different aspects of probiotics, from human health care applications to safety, 
quality, and control.

DOI: 10.3390/medicina56090433
PMCID: PMC7560221
PMID: 32867260 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


4236. Clin Genitourin Cancer. 2021 Apr;19(2):e63-e68. doi: 10.1016/j.clgc.2020.07.008. 
Epub 2020 Jul 17.

Impact of COVID-19 Pandemic on Health-Related Quality of Life in Uro-oncologic 
Patients: What Should We Wait For?

Greco F(1), Altieri VM(2), Esperto F(3), Mirone V(4), Scarpa RM(3).

Author information:
(1)Department of Urology, Humanitas Gavazzeni, Bergamo, Italy; School of 
Medicine and Surgery, Humanitas University, Milan, Italy. Electronic address: 
francesco_greco@ymail.com.
(2)Department of Urology, Humanitas Gavazzeni, Bergamo, Italy.
(3)Department of Urology, Campus Biomedico, University of Rome, Rome, Italy.
(4)Department of Urology, Federico II University, Naples, Italy.

PURPOSE: To investigate the health-related quality of life of uro-oncologic 
patients whose surgery was postponed without being rescheduled during the 
coronavirus disease 2019 (COVID-19) pandemic.
PATIENTS AND METHODS: From the March 1 to April 26, 2020, major urologic 
surgeries were drastically reduced at our tertiary-care referral hospital. In 
order to evaluate health-related quality-of-life outcomes, the SF-36 
questionnaire was sent to all patients scheduled for major surgery at our 
department 3 weeks after the cancellation of the planned surgical procedures 
because of the COVID-19 emergency.
RESULTS: All patients included in the analysis had been awaiting surgery for a 
median (interquartile range) time of 52.85 (35-72) days. The SF-36 questionnaire 
measured 8 domains: physical functioning (PF), role limitations due to physical 
health (PH), role limitations due to emotional problems (RE), energy/fatigue 
(EF), emotional well-being (EWB), social functioning (SF), bodily pain (BP), 
general health perceptions (GHP). When considering physical characteristics as 
measured by the SF-36 questionnaire, PF was 91.5 (50-100) and PH was 82.75 
(50-100) with a BP of 79.56 (45-90). For emotional and social aspects, RE was 
36.83 (0-100) with a SF of 37.98 (12.5-90). Most patients reported loss of 
energy (EF 35.28 [15-55]) and increased anxiety (EWB 47.18 [interquartile range, 
20-75]). All patients perceived a reduction of their health conditions, with GHP 
of 49.47 (15-85). Generally, 86% of patients (n = 43) noted an almost intact 
physical function but a significant emotional alteration characterized by a 
prevalence of anxiety and loss of energy.
CONCLUSION: The lockdown due to the novel coronavirus that has affected most 
operating rooms in Italy could be responsible for the increased anxiety and 
decrement in health status of oncologic patients. Without any effective 
solution, we should expect a new medical catastrophe-one caused by the increased 
risk of tumor progression and mortality in uro-oncologic patients.

Copyright © 2020 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.clgc.2020.07.008
PMCID: PMC7366083
PMID: 32863188 [Indexed for MEDLINE]


4237. Child Abuse Negl. 2020 Dec;110(Pt 2):104699. doi: 10.1016/j.chiabu.2020.104699. 
Epub 2020 Aug 20.

Stress and parenting during the global COVID-19 pandemic.

Brown SM(1), Doom JR(2), Lechuga-Peña S(3), Watamura SE(4), Koppels T(5).

Author information:
(1)School of Social Work, Colorado State University, 1586 Campus Delivery, Fort 
Collins, CO, 80523, USA. Electronic address: Samantha.Brown@colostate.edu.
(2)Department of Psychology, University of Denver, 2155 S. Race St., Denver, CO, 
80210, USA. Electronic address: Jena.Doom@du.edu.
(3)School of Social Work, Arizona State University, 4701 W. Thunderbird Rd., 
Glendale, AZ, 85306, USA. Electronic address: Stephanie.L.Pena@asu.edu.
(4)Department of Psychology, University of Denver, 2155 S. Race St., Denver, CO, 
80210, USA. Electronic address: Sarah.Watamura@du.edu.
(5)School of Social Work, Colorado State University, 1586 Campus Delivery, Fort 
Collins, CO, 80523, USA. Electronic address: Tiffany.Koppels@colostate.edu.

BACKGROUND: Stress and compromised parenting often place children at risk of 
abuse and neglect. Child maltreatment has generally been viewed as a highly 
individualistic problem by focusing on stressors and parenting behaviors that 
impact individual families. However, because of the global coronavirus disease 
2019 (COVID-19), families across the world are experiencing a new range of 
stressors that threaten their health, safety, and economic well-being.
OBJECTIVE: This study examined the impacts of the COVID-19 pandemic in relation 
to parental perceived stress and child abuse potential.
PARTICIPANTS AND SETTING: Participants included parents (N = 183) with a child 
under the age of 18 years in the western United States.
METHOD: Tests of group differences and hierarchical multiple regression analyses 
were employed to assess the relationships among demographic characteristics, 
COVID-19 risk factors, mental health risk factors, protective factors, parental 
perceived stress, and child abuse potential.
RESULTS: Greater COVID-19 related stressors and high anxiety and depressive 
symptoms are associated with higher parental perceived stress. Receipt of 
financial assistance and high anxiety and depressive symptoms are associated 
with higher child abuse potential. Conversely, greater parental support and 
perceived control during the pandemic are associated with lower perceived stress 
and child abuse potential. Results also indicate racial and ethnic differences 
in COVID-19 related stressors, but not in mental health risk, protective 
factors, perceived stress, or child abuse potential.
CONCLUSION: Findings suggest that although families experience elevated 
stressors from COVID-19, providing parental support and increasing perceived 
control may be promising intervention targets.

Copyright © 2020 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.chiabu.2020.104699
PMCID: PMC7440155
PMID: 32859394 [Indexed for MEDLINE]

Conflict of interest statement: All authors declare that there are no conflicts 
of interest.


4238. Lancet Glob Health. 2020 Nov;8(11):e1380-e1389. doi: 
10.1016/S2214-109X(20)30366-1. Epub 2020 Aug 25.

Immediate impact of stay-at-home orders to control COVID-19 transmission on 
socioeconomic conditions, food insecurity, mental health, and intimate partner 
violence in Bangladeshi women and their families: an interrupted time series.

Hamadani JD(1), Hasan MI(1), Baldi AJ(2), Hossain SJ(1), Shiraji S(1), Bhuiyan 
MSA(1), Mehrin SF(1), Fisher J(3), Tofail F(1), Tipu SMMU(1), Grantham-McGregor 
S(4), Biggs BA(5), Braat S(6), Pasricha SR(7).

Author information:
(1)International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh.
(2)Population Health and Immunity Division, The Walter and Eliza Hall Institute 
of Medical Research, Parkville, VIC, Australia; Department of Medical Biology, 
The University of Melbourne, Parkville, VIC, Australia.
(3)Department of Public Health and Preventive Medicine, Monash University, 
Melbourne, VIC, Australia.
(4)Institute of Child Health, University College London, London, UK.
(5)Department of Medicine, Peter Doherty Institute, The University of Melbourne, 
Parkville, VIC, Australia; Victorian Infectious Diseases Service, Royal 
Melbourne Hospital, Parkville, VIC, Australia.
(6)Department of Medicine, Peter Doherty Institute, The University of Melbourne, 
Parkville, VIC, Australia; School of Population and Global Health, The 
University of Melbourne, Parkville, VIC, Australia.
(7)Population Health and Immunity Division, The Walter and Eliza Hall Institute 
of Medical Research, Parkville, VIC, Australia; Department of Medical Biology, 
The University of Melbourne, Parkville, VIC, Australia; Diagnostic Haematology, 
Royal Melbourne Hospital, Parkville, VIC, Australia; Clinical Haematology at the 
Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Parkville, VIC 
Australia. Electronic address: pasricha.s@wehi.edu.au.

BACKGROUND: Stay-at-home orders (lockdowns) have been deployed globally to 
control COVID-19 transmission, and might impair economic conditions and mental 
health, and exacerbate risk of food insecurity and intimate partner violence. 
The effect of lockdowns in low-income and middle-income countries must be 
understood to ensure safe deployment of these interventions in less affluent 
settings. We aimed to determine the immediate impact of COVID-19 lockdown orders 
on women and their families in rural Bangladesh.
METHODS: An interrupted time series was used to compare data collected from 
families in Rupganj upazila, rural Bangladesh (randomly selected from 
participants in a randomised controlled trial), on income, food security, and 
mental health a median of 1 year and 2 years before the COVID-19 pandemic to 
data collected during the lockdown. We also assessed women's experiences of 
intimate partner violence during the pandemic.
RESULTS: Between May 19 and June 18, 2020, we randomly selected and invited the 
mothers of 3016 children to participate in the study, 2424 of whom provided 
consent. 2414 (99·9%, 95% CI 99·6-99·9) of 2417 mothers were aware of, and 
adhering to, the stay-at-home advice. 2321 (96·0%, 95·2-96·7) of 2417 mothers 
reported a reduction in paid work for the family. Median monthly family income 
fell from US$212 at baseline to $59 during lockdown, and the proportion of 
families earning less than $1·90 per day rose from five (0·2%, 0·0-0·5) of 2422 
to 992 (47·3%, 45·2-49·5) of 2096 (p<0·0001 comparing baseline with lockdown 
period). Before the pandemic, 136 (5·6%, 4·7-6·6) of 2420 and 65 (2·7%, 2·1-3·4) 
of 2420 families experienced moderate and severe food insecurity, respectively. 
This increased to 881 (36·5%, 34·5-38·4) of 2417 and 371 (15·3%, 13·9-16·8) of 
2417 during the lockdown; the number of families experiencing any level of food 
insecurity increased by 51·7% (48·1-55·4; p<0·0001). Mothers' depression and 
anxiety symptoms increased during the lockdown. Among women experiencing 
emotional or moderate physical violence, over half reported it had increased 
since the lockdown.
INTERPRETATION: COVID-19 lockdowns present significant economic, psychosocial, 
and physical risks to the wellbeing of women and their families across economic 
strata in rural Bangladesh. Beyond supporting only the most socioeconomically 
deprived, support is needed for all affected families.
FUNDING: National Health and Medical Research Council, Australia.

Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open 
Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All 
rights reserved.

DOI: 10.1016/S2214-109X(20)30366-1
PMCID: PMC7447230
PMID: 32857955 [Indexed for MEDLINE]


4239. Z Gerontol Geriatr. 2021 Aug;54(5):513-516. doi: 10.1007/s00391-020-01776-5. 
Epub 2020 Aug 27.

Extending understanding of grandchild care on feelings of loneliness and 
isolation in later life : A literature review.

Quirke E(1), König HH(2), Hajek A(2).

Author information:
(1)Department of Health Economics and Health Services Research, University 
Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. 
e.quirke@uke.de.
(2)Department of Health Economics and Health Services Research, University 
Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.

The Coronavirus disease 2019 (COVID-19) pandemic presents serious challenges 
across the world. Among these challenges are the possible negative implications 
for the mental health and well-being of older persons that ongoing social 
distancing measures may cause. Prior to the COVID-19 pandemic, a growing body of 
literature explored the associations between grandchild caregiving, loneliness 
and social isolation. We summarize the existing literature on this topic. An 
association between the provision of grandchild care and reduced feelings of 
loneliness was found in cross-sectional studies; however, a longitudinal study 
identified possible gender differences in the impact of grandchild care on 
feelings of loneliness, with the commencement of grandchild care linked to 
grandfathers feeling lonelier. At the conclusion of the summary, we highlight 
the need for further research in this field. Further research is of particular 
relevance given the drastic changes to the way families and older people 
interact socially, brought about by the COVID-19 global pandemic.

Publisher: Die COVID-19-Pandemie stellt die Welt vor große Herausforderungen. Zu 
diesen Herausforderungen zählen die möglichen negativen Auswirkungen auf die 
psychische Gesundheit und das Wohlbefinden älterer Menschen die durch die 
anhaltenden sozialen Distanzierungsmaßnahmen verursacht werden können. Vor der 
COVID-19-Pandemie befasste sich eine zunehmende Zahl von Studien mit der 
Assoziation zwischen der Enkelkinderbetreuung sowie Einsamkeit und sozialer 
Isolation. Wir fassen die vorhandene Literatur zu diesem Thema zusammen. In 
Querschnittsstudien wurde festgestellt, dass die Enkelkinderbetreuung mit einer 
geminderten Einsamkeit bei den Großeltern assoziiert ist. Andererseits hat eine 
Längsschnittstudie mögliche geschlechtsspezifische Unterschiede in den 
Auswirkungen der Enkelkinderbetreuung auf das Gefühl der Einsamkeit 
identifiziert, wobei sich Großväter bei Beginn der Enkelkinderbetreuung einsamer 
fühlen. Am Ende unserer Zusammenfassung unterstreichen wir die Notwendigkeit 
weiterer Forschung auf diesem Gebiet, vor allem vor dem Hintergrund dieser 
Pandemie. Weitere Forschung ist angesichts der drastischen Veränderungen auf die 
Art und Weise wie Familien und ältere Menschen sozial interagieren von 
besonderer Bedeutung.

© 2020. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.

DOI: 10.1007/s00391-020-01776-5
PMCID: PMC7451229
PMID: 32856121 [Indexed for MEDLINE]

Conflict of interest statement: E. Quirke, H.-H. König and A. Hajek declare that 
they have no competing interests.


4240. Am J Otolaryngol. 2020 Nov-Dec;41(6):102694. doi: 10.1016/j.amjoto.2020.102694. 
Epub 2020 Aug 21.

Mental health among head and neck surgeons in Brazil during the COVID-19 
pandemic: A national study.

Civantos AM(1), Bertelli A(2), Gonçalves A(2), Getzen E(3), Chang C(3), Long 
Q(3), Rajasekaran K(4).

Author information:
(1)Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 
USA.
(2)Department of Surgery, Santa Casa De São Paulo Medical School, São Paulo, 
Brazil.
(3)Department of Biostatistics, Epidemiology and Informatics, University of 
Pennsylvania, Philadelphia, PA, USA.
(4)Department of Otorhinolaryngology - Head and Neck Surgery, University of 
Pennsylvania, Philadelphia, PA, USA. Electronic address: 
Karthik.Rajasekaran@pennmedicine.upenn.edu.

PURPOSE: Head and neck surgeons are among the highest risk for COVID-19 
exposure, which also brings great risk to their mental wellbeing. In this study, 
we aim to evaluate mental health symptoms among head and neck surgeons in Brazil 
surrounding the time it was declared the epicenter of the virus.
MATERIALS AND METHODS: A cross-sectional, survey-based study evaluating burnout, 
anxiety, distress, and depression among head and neck surgeons in Brazil, 
assessed through the single-item Mini-Z burnout assessment, 7-item Generalized 
Anxiety Disorder scale, 22-item Impact of Event Scale-Revised, and 2-item 
Patient Health Questionnaire, respectively.
RESULTS: 163 physicians completed the survey (74.2% males). Anxiety, distress, 
burnout, and depression symptoms were reported in 74 (45.5%), 43 (26.3%), 24 
(14.7%), and 26 (16.0%) physicians, respectively. On multivariable analysis, 
female physicians were more likely to report a positive screening for burnout 
compared to males (OR 2.88, CI [1.07-7.74]). Physicians 45 years or older were 
less likely to experience anxiety symptoms than those younger than 45 years (OR 
0.40, CI [0.20-0.81]). Physicians with no self-reported prior psychiatric 
conditions were less likely to have symptoms of distress compared to those with 
such history (OR 0.11, CI [0.33-0.38]).
CONCLUSION: Head and neck surgeons in Brazil reported symptoms of burnout, 
anxiety, distress and depression during our study period within the COVID-19 
pandemic. Institutions should monitor these symptoms throughout the pandemic. 
Further study is required to assess the long-term implications for physician 
wellness.

Copyright © 2020 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.amjoto.2020.102694
PMCID: PMC7442010
PMID: 32854041 [Indexed for MEDLINE]


4241. J Med Internet Res. 2020 Sep 11;22(9):e22288. doi: 10.2196/22288.

Association of Socioeconomic Changes due to the COVID-19 Pandemic With Health 
Outcomes in Patients With Skin Diseases: Cross-Sectional Survey Study.

Guo Y(#)(1)(2)(3), Shen M(#)(1)(2)(3)(4), Zhang X(1)(2)(3), Xiao Y(1)(2)(3), 
Zhao S(1)(2)(3), Yin M(1)(2)(3), Bu W(5), Wang Y(5), Chen X(#)(1)(2)(3), Su 
J(#)(1)(2)(3).

Author information:
(1)Department of Dermatology, Xiangya Hospital, Central South University, 
Changsha, China.
(2)National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, 
Changsha, China.
(3)Hunan Engineering Research Center of Skin Health and Disease, Hunan Key 
Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South 
University, Changsha, China.
(4)Department of Social Medicine and Health Management, Xiangya School of Public 
Health, Central South University, Changsha, China.
(5)Institute of Dermatology, Chinese Academy of Medical Science and Peking Union 
Medical College, Nanjing, China.
(#)Contributed equally

BACKGROUND: The outbreak of COVID-19 has profoundly influenced people's 
lifestyles; these impacts have varied across subgroups of people. The 
pandemic-related impacts on the health outcomes of people with dermatological 
conditions are unknown.
OBJECTIVE: The aim of this paper was to study the association of COVID-19 
pandemic-related impacts with health-related quality of life in patients with 
skin diseases.
METHODS: This was a cross-sectional study among Chinese patients with skin 
diseases. A self-administered web-based questionnaire was distributed through 
social media. Demographic and clinical data and pandemic-related impacts 
(isolation status, income changes, and employment status) were collected. The 
main outcomes included perceived stress (Visual Analog Scale), symptoms of 
anxiety (Generalized Anxiety Disorder-7) and depression (9-Item Patient Health 
Questionnaire), quality of life (Dermatology Life Quality Index), and health 
utility mapping based on the EQ-5D-3L descriptive system. Multivariable logistic 
regression was used to investigate the associations.
RESULTS: A total of 506 patients with skin diseases completed the survey. The 
mean age of the patients was 33.5 years (SD 14.0), and 217/506 patients (42.9%) 
were male. Among the 506 respondents, 128 (25.3%) were quarantined, 102 (20.2%) 
reported unemployment, and 317 (62.6%) reported decrease or loss of income since 
the pandemic. The pandemic-related impacts were significantly associated with 
impaired mental well-being and quality of life with different effects. 
Unemployment and complete loss of income were associated with the highest risks 
of adverse outcomes, with increases of 110% to 162% in the prevalence of 
anxiety, depression, and impaired quality of life.
CONCLUSIONS: Isolation, income loss, and unemployment are associated with 
impaired health-related quality of life in patients with skin diseases during 
the COVID-19 pandemic.

©Yeye Guo, Minxue Shen, Xu Zhang, Yi Xiao, Shuang Zhao, Mingzhu Yin, Wenbo Bu, 
Yan Wang, Xiang Chen, Juan Su. Originally published in the Journal of Medical 
Internet Research (http://www.jmir.org), 11.09.2020.

DOI: 10.2196/22288
PMCID: PMC7490117
PMID: 32845850 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


4242. Postgrad Med J. 2021 Oct;97(1152):632-637. doi: 
10.1136/postgradmedj-2020-138364. Epub 2020 Aug 25.

Psychological impact of COVID-19 pandemic on postgraduate trainees: a 
cross-sectional survey.

Imran N(1), Masood HMU(2), Ayub M(3), Gondal KM(4).

Author information:
(1)Child & Family Psychiatry Department, King Edward Medical University, Lahore, 
Pakistan nazishimrandr@gmail.com.
(2)Fatima Memorial College of Medicine and Dentistry, Lahore, Pakistan.
(3)Academic Department of Psychiatry &behavioural Sciences, King Edward Medical 
University, Lahore, Pakistan.
(4)King Edward Medical University, Lahore, Pakistan.

BACKGROUND: The present study aimed to evaluate psychological impact of COVID-19 
outbreak on postgraduate trainees in Pakistan by quantifying the symptoms of 
depression, anxiety and acute stress disorder and by analysing potential risk 
factors associated with these symptoms.
METHODS: Following Institutional Review Board approval, a cross-sectional study 
was conducted among 10,178 postgraduate trainees following COVID-19 outbreak 
through e-log system of College of Physicians and Surgeons of Pakistan. The 
nine-item Patient Health Questionnaire, seven-item Generalised Anxiety Disorder 
scale and Stanford Acute Stress Reaction Questionnaire were used to collect 
data. Statistical analyses were conducted using SPSS.26. Descriptive statistics, 
Mann-Whitney U test, the χ2 test and logistic regression analysis were 
performed. The significance level was set at α=0.05.
RESULTS: The prevalence of depressive symptoms, generalised anxiety disorder and 
acute stress disorder were 26.4%, 22.6% and 4.4%, respectively. Female 
postgraduate trainees, senior trainees and front-line workers reported 
experiencing more anxiety, depression and acute stress symptoms (p value<0.001). 
Logistic regression showed that being a front-line and senior staff member and 
female was associated with higher risk of experiencing symptoms of depression, 
anxiety and acute stress.
CONCLUSIONS: Our study findings raise concerns about the psychological 
well-being of postgraduate trainees during the acute COVID-19 outbreak in 
Pakistan. It is necessary to employ strategies to minimise the psychological 
distress and provide adequate psychosocial support for postgraduate trainees 
during crisis situation such as COVID-19 pandemic.

© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and 
permissions. Published by BMJ.

DOI: 10.1136/postgradmedj-2020-138364
PMCID: PMC7447959
PMID: 32843485 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


4243. Eur Psychiatry. 2020 Aug 26;63(1):e81. doi: 10.1192/j.eurpsy.2020.81.

Psychological impact of COVID-19 in the Swedish population: Depression, anxiety, 
and insomnia and their associations to risk and vulnerability factors.

McCracken LM(1), Badinlou F(2), Buhrman M(1), Brocki KC(2).

Author information:
(1)Division for Clinical Psychology, Department of Psychology, Uppsala 
University, Uppsala, Sweden.
(2)Division for Emotion Psychology, Department of Psychology, Uppsala 
University, Uppsala, Sweden.

BACKGROUND: The 2019 coronavirus disease (COVID-19) pandemic, with its 
associated restrictions on daily life, is like a perfect storm for poor mental 
health and wellbeing. The purpose of this study was therefore to examine the 
impacts of COVID-19 on mental health and wellbeing during the ongoing pandemic 
in Sweden.
METHOD: Standardized measures of depression, anxiety, and insomnia as well as 
measures of risk and vulnerability factors known to be associated with poor 
mental health outcomes were administered through a national, online, 
cross-sectional survey (n = 1,212; mean age 36.1 years; 73% women).
RESULT: Our findings show significant levels of depression, anxiety, and 
insomnia in Sweden, at rates of 30%, 24.2%, and 38%, respectively. The strongest 
predictors of these outcomes included poor self-rated overall health and a 
history of mental health problems. The presence of COVID-19 symptoms and 
specific health and financial worries related to the pandemic also appeared 
important.
CONCLUSIONS: The impacts of COVID-19 on mental health in Sweden are comparable 
to impacts shown in previous studies in Italy and China. Importantly, the 
pandemic seems to impose most on the mental health of those already burdened 
with the impacts of mental health problems. These results provide a basis for 
providing more support for vulnerable groups, and for developing psychological 
interventions suited to the ongoing pandemic and for similar events in the 
future.

DOI: 10.1192/j.eurpsy.2020.81
PMCID: PMC7503043
PMID: 32843115 [Indexed for MEDLINE]


4244. Clin Neuropsychol. 2020 Oct-Nov;34(7-8):1284-1313. doi: 
10.1080/13854046.2020.1809712. Epub 2020 Aug 26.

2020 COVID-19 American Academy of Clinical Neuropsychology (AACN) Student 
Affairs Committee survey of neuropsychology trainees.

Guidotti Breting LM(1), Towns SJ(2), Butts AM(3), Brett BL(3)(4), Leaffer EB(5), 
Whiteside DM(6).

Author information:
(1)Department of Psychiatry, Northshore University Health System, Evanston, IL, 
USA.
(2)Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
(3)Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.
(4)Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.
(5)Department of Child and Adolescent Psychiatry and Behavioral Science, 
Children's Hospital of Philadelphia, Philadelphia, PA, USA.
(6)Department of Rehabilitation Medicine, University of Minnesota Medical 
School, Minneapolis, MN, USA.

Objective: To conduct an online survey in order to understand neuropsychology 
trainees' perspectives during the COVID-19 pandemic and identify pertinent 
concerns, training gaps, and recommendations.Method: A total of 874 
neuropsychology trainees (81% female) completed the 69-item survey. Of the 
included trainees, 48% were doctoral students, 17% were interns, and 35% were 
postdoctoral residents (50% of resident respondents were in their first 
year).Results: The majority of neuropsychology trainees reported some impact of 
the pandemic on their professional and/or personal life. Overall, the impact did 
not differ by training level, geographic location, or demographic factors. 
Trainees' primary professional concerns included uncertainty about the impact of 
the pandemic on their professional future, loss of clinical hours, and desire 
for increased and ongoing communication from their leadership. A notable 
percentage of trainees reported increased personal mental health symptoms (i.e. 
anxiety/depression; 74%/54%), as well as a number of other personal stressors. 
Despite the transition to telehealth (mostly interviews/feedback sessions), few 
trainees have prior training or experience in providing neuropsychological 
services via phone or video platform. A limited proportion of trainees 
(approximately 10%) were still seeing patients face-to-face for 
neuropsychological evaluations during the COVID-19 pandemic as of 14 April 
2020.Conclusions: The COVID-19 pandemic is impacting neuropsychological training 
and the well-being of trainees. This survey highlights the importance of 
communication with trainees during uncertain times. Based on the survey results, 
recommendations were developed to assist neuropsychology organizations in 
developing initiatives to support trainees during the current pandemic and in 
the future.

DOI: 10.1080/13854046.2020.1809712
PMID: 32842877 [Indexed for MEDLINE]


4245. Sleep Med. 2020 Oct;74:81-85. doi: 10.1016/j.sleep.2020.07.012. Epub 2020 Jul 
17.

Sleep quality in times of Covid-19 pandemic.

Pinto J(1), van Zeller M(2), Amorim P(2), Pimentel A(2), Dantas P(3), Eusébio 
E(3), Neves A(3), Pipa J(3), Santa Clara E(3), Santiago T(3), Viana P(3), 
Drummond M(2).

Author information:
(1)Department of Pulmonology, Centro Hospitalar Universitário de São João, 
Porto, Portugal. Electronic address: josue.mpinto@gmail.com.
(2)Department of Pulmonology, Centro Hospitalar Universitário de São João, 
Porto, Portugal; Faculty of Medicine of Porto University, Portugal.
(3)Department of Pulmonology, Centro Hospitalar Universitário de São João, 
Porto, Portugal.

BACKGROUND: Due to the 2019 novel coronavirus (COVID-19) disease outbreak, 
social distancing measures were imposed to control the spread of the pandemic. 
However, isolation may affect negatively the psychological well-being and impair 
sleep quality. Our aim was to evaluate the sleep quality of respiratory patients 
during the COVID-19 pandemic lockdown.
METHODS: All patients who underwent a telemedicine appointment from March 30 to 
April 30 of 2020 were asked to participate in the survey. Sleep difficulties 
were measured using Jenkins Sleep Scale.
RESULTS: The study population consisted of 365 patients (mean age 63.9 years, 
55.6% male, 50.1% with sleep-disordered breathing [SDB]). During the lockdown, 
78.9% of participants were confined at home without working. Most patients 
(69.6%) reported at least one sleep difficulty and frequent awakenings was the 
most prevalent problem. Reporting at least one sleep difficulty was associated 
with home confinement without working, female gender and diagnosed or suspected 
SDB, after adjustment for cohabitation status and use of anxiolytics. Home 
confinement without working was associated with difficulties falling asleep and 
waking up too early in the morning. Older age was a protective factor for 
difficulties falling asleep, waking up too early and non-restorative sleep. 
Notably, SDB patients with good compliance to positive airway pressure therapy 
were less likely to report sleep difficulties.
CONCLUSIONS: Home confinement without working, female gender and SDB may predict 
a higher risk of reporting sleep difficulties. Medical support during major 
disasters should be strengthened and potentially delivered through telemedicine, 
as this comprehensive approach could reduce psychological distress and improve 
sleep quality.

Copyright © 2020 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.sleep.2020.07.012
PMCID: PMC7366086
PMID: 32841849 [Indexed for MEDLINE]

Conflict of interest statement: None. The ICMJE Uniform Disclosure Form for 
Potential Conflicts of Interest associated with this article can be viewed by 
clicking on the following link: https://doi.org/10.1016/j.sleep.2020.07.012.


4246. Kidney360. 2020 Aug 25;1(10):1077-1082. doi: 10.34067/KID.0003582020. 
eCollection 2020 Oct 29.

How Hemodialysis Patients Perceive the SARS-CoV-2 Health Crisis: Lessons from 
Austria.

Davidovic T(1), Sprenger-Mähr H(1), Abbassi-Nik A(1), Zitt E(1), Lhotta K(1).

Author information:
(1)Department of Internal Medicine III (Nephrology and Dialysis), Feldkirch 
Academic Teaching Hospital, Feldkirch, Austria.

BACKGROUND: The ongoing SARS-CoV-2 pandemic forced many countries to implement 
strict and unprecedented precautions to stop the spread of the virus. On top of 
these measures, hemodialysis units have adopted their own rules to protect wards 
and patients from infection with SARS-CoV-2. Despite the rapidly growing 
knowledge on epidemiology, virology, and clinical disease, little is known about 
how these measures are perceived by patients themselves on hemodialysis.
METHODS: The study was performed in the three hemodialysis units in Vorarlberg, 
Austria's westernmost state. A questionnaire was developed consisting of 22 
questions on patients' perceptions of the COVID-19 crisis and their feelings 
about the general precautions and specific steps implemented on dialysis wards. 
All adult patients were asked to fill out the questionnaire anonymously.
RESULTS: Of 202 patients on hemodialysis, 148 completed the questionnaire (66.9% 
men, mean age 68.3±13.3 years). The vast majority (83.1%) were worried by the 
COVID-19 crisis, but only 28.4% reported a negative effect on emotional 
well-being. Daily life was most affected by the general ban on visitors (58.6%) 
and home confinement (35.9%). Of the patients, 64.2% feared contracting 
COVID-19, 30.7% were afraid of financial consequences, and 14.6% were afraid of 
loneliness and isolation. The safety measures on dialysis wards were classified 
as adequate by 97.3% of the respondents. Of the patients, 78.2% felt safe during 
dialysis treatment. All dialysis-specific precautions (individual patient 
transport, health check, hand disinfection, wearing a face mask, and physical 
distancing) were rated important or very important by almost all patients. To 
date, none of the patients have acquired SARS-CoV-2 infection.
CONCLUSIONS: Although the SARS-CoV-2 crisis brought worry to and affected the 
lives of most patients on hemodialysis, its effect on their emotional well-being 
was moderate. Patients felt safe on dialysis wards, and acceptance of specific 
precautions was high.

Copyright © 2020 by the American Society of Nephrology.

DOI: 10.34067/KID.0003582020
PMCID: PMC8815492
PMID: 35368780 [Indexed for MEDLINE]

Conflict of interest statement: All authors have nothing to disclose.


4247. J Affect Disord. 2020 Dec 1;277:232-234. doi: 10.1016/j.jad.2020.07.137. Epub 
2020 Aug 12.

Standing up for health - improving mental wellbeing during COVID-19 isolation by 
reducing sedentary behaviour.

Diamond R(1), Byrd E(2).

Author information:
(1)Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford 
Lane, Oxford OX3 7JX, United Kingdom. Electronic address: 
rowan.diamond@psych.ox.ac.uk.
(2)Department of Sport and Health Sciences, Oxford Brookes University, Gipsy 
Lane, Oxford OX3 0BP, United Kingdom. Electronic address: e.byrd@brookes.ac.uk.

The global COVID-19 outbreak and its management are disrupting ways of life and 
increasing the risk of poor mental and physical health for many. The 
restrictions on movement have made some forms of physical activity harder to 
achieve and increased the chances of more sedentary behaviour. Independent of 
exercise taken, sedentary behaviour can have a negative impact upon mental 
health, especially by lowering mood. We suggest evidence-based ways of reducing 
sedentary behaviour with commentary on how they may be adapted for life at home. 
These include: ways to use external cues, moving more frequently, maximising 
movement whilst waiting, reallocating time, workstation alternatives, 
restructuring the physical environment and recruiting help from others. At a 
time in which our mental and physical health needs are more critical than ever, 
the relationship between sedentary behaviour and low mood is of particular 
importance. The current situation represents a good opportunity for us all to 
change habits to implement a less sedentary lifestyle, for now and the future. 
This can start with changes we can make at home during lockdown.

Crown Copyright © 2020. Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2020.07.137
PMCID: PMC7422799
PMID: 32836029 [Indexed for MEDLINE]

Conflict of interest statement: None.


4248. Nurs Philos. 2021 Apr;22(2):e12320. doi: 10.1111/nup.12320. Epub 2020 Aug 24.

Bowen Family Systems Theory: Mapping a framework to support critical care 
nurses' well-being and care quality.

Jakimowicz S(1), Perry L(1), Lewis J(1).

Author information:
(1)Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.

Intensive care nursing is prone to episodic anxiety linked to patients' 
immediate needs for treatment. Balancing biomedical interventions with 
compassionate patient-centred nursing can be particularly anxiety provoking. 
These patterns of anxiety may impact compassion and patient-centred nursing. The 
aim of this paper is to discuss the application of Bowen Family Systems Theory 
to intensive care nursing, mapping a framework to support critical care nurses' 
well-being and, consequently, the quality of care they provide. This article is 
founded on research, theoretical papers and texts focused on Bowen Family 
Systems Theory (BFST), and findings from a constructivist study on 
patient-centred nursing and compassion in the intensive care unit. The goal of 
Bowen Family Systems Theory is to empower individuals, decreasing blame and 
reactivity. Bowen Family Systems Theory can be applied to the sometimes intimate 
relationships that develop in this environment, aiding understanding of nurses' 
experience of compassion satisfaction and fatigue. Where organizational factors 
and management styles fall short in supporting critical care nurses to meet 
expectations, BFST can offer a perspective on the processes that occur within 
the intensive care unit, impacting nurse well-being and quality of care. This 
paper makes plain the importance of understanding the anxiety that occurs within 
the intensive care unit as a system, so that individuals, such as critical care 
nurses, can be supported appropriately to ensure nurse well-being and quality 
care.

© 2020 John Wiley & Sons Ltd.

DOI: 10.1111/nup.12320
PMID: 32835447 [Indexed for MEDLINE]


4249. Psychiatr Q. 2020 Dec;91(4):1135-1145. doi: 10.1007/s11126-020-09836-0.

"The COVID-19 Pandemic and its Effect on Mental Health in USA - A Review with 
Some Coping Strategies".

Bhattacharjee B(1), Acharya T(2).

Author information:
(1)Department of Medicine, Gauhati Medical College, Guwahati, Assam, India. 
barnali.bhattacharjee2018@gmail.com.
(2)California State University, Bakersfield, CA, USA.

The COVID-19 pandemic has resulted in enormous losses in terms of human lives 
and economy in United States. The outbreak has been continuing to heavily impact 
the mental health of people. Developing key strategies to prevent mental 
illnesses is extremely important for the well-being of people. A survey 
conducted during the last week of March 2020 showed that 72% of Americans felt 
that their lives were impacted by the outbreak, which was a 32% increase from 
the survey conducted only 2 weeks earlier. The results show a positive 
correlation between COVID-19 infections/casualties and growing public concern. 
These observations suggest possible increase in mental health illnesses in 
United States as a consequence of the pandemic. The authors review a recently 
published model on COVID-19 related fear among the people. The fear of being 
infected or dying from the disease is one of the most significant causes of 
mental health disorders. Loss of employment or the fear of losing employment is 
another major concern leading to mental illnesses. Several unique strategies to 
prevent or mitigate mental illnesses are discussed.

DOI: 10.1007/s11126-020-09836-0
PMCID: PMC7443176
PMID: 32829449 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


4250. J Gerontol B Psychol Sci Soc Sci. 2021 Mar 14;76(4):e241-e245. doi: 
10.1093/geronb/gbaa129.

Dementia Caregiving During the "Stay-at-Home" Phase of COVID-19 Pandemic.

Savla J(1)(2), Roberto KA(1)(3), Blieszner R(1), McCann BR(1), Hoyt E(1)(4), 
Knight AL(5)(6).

Author information:
(1)Center for Gerontology, Virginia Tech, Blacksburg.
(2)Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion 
School of Medicine, Roanoke.
(3)Institute for Society, Culture, and Environment, Virginia Tech, Blacksburg.
(4)Department of Population Health Sciences, Virginia Tech, Blacksburg.
(5)Department of Internal Medicine, Virginia Tech Carilion School of Medicine, 
Roanoke.
(6)Department of Family & Community Medicine, Virginia Tech Carilion School of 
Medicine, Roanoke.

OBJECTIVE: The objective of this study was to assess family caregivers' primary 
appraisal of stressors related to COVID-19 stay-at-home orders, secondary 
appraisal of resources and support availability, and use of coping strategies as 
predictors of perceived role overload during the stay-at-home phase of the 
pandemic.
METHOD: Telephone interviews with 53 family caregivers of persons with dementia 
from rural Virginia 2 weeks after enactment of the governor's stay-at-home order 
using structured and open-ended questions were conducted.
RESULTS: Caregivers who were more concerned about the COVID-19 pandemic were at 
greater odds of experiencing high role overload than those who recognized 
positive aspects of the pandemic, as were those who received insufficient 
support from family and friends.
DISCUSSION: Use of the transactional model of stress responses yielded important 
insights about families coping with dementia. Caregivers' perceptions of the 
pandemic's impact varied, with differential effects on their well-being.

© The Author(s) 2020. Published by Oxford University Press on behalf of The 
Gerontological Society of America. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/geronb/gbaa129
PMCID: PMC7546083
PMID: 32827214 [Indexed for MEDLINE]


4251. J Acquir Immune Defic Syndr. 2020 Nov 1;85(3):257-262. doi: 
10.1097/QAI.0000000000002468.

Impact of the COVID-19 Pandemic on the Medical Follow-up and Psychosocial 
Well-Being of People Living With HIV: A Cross-Sectional Survey.

Siewe Fodjo JN(1), Villela EFM(2), Van Hees S(1), Dos Santos TT(2), Vanholder 
P(3), Reyntiens P(4), Van den Bergh R(1), Colebunders R(1).

Author information:
(1)Global Health Institute, University of Antwerp, Antwerp, Belgium.
(2)School of Medicine, Health Sciences Unit, Federal University of Jataí, Jataí, 
Brazil.
(3)European AIDS Treatment Group, Brussels, Belgium; and.
(4)Sensoa, Antwerp, Belgium.

Comment in
    J Acquir Immune Defic Syndr. 2021 Oct 1;88(2):e14-e16.
    J Acquir Immune Defic Syndr. 2021 Oct 1;88(2):e11-e14.

BACKGROUND: Empirical data on the consequences of the novel coronavirus disease 
(COVID-19) pandemic on HIV care are lacking. We surveyed people living with HIV 
(PLWH) in different countries to investigate whether their medical follow-up and 
psychosocial well-being had been compromised due to COVID-19 and associated 
restrictions.
METHODS: In April 2020, a cross-sectional survey among PLWH was conducted using 
a web-based multilingual questionnaire. The research tool assessed HIV 
follow-up, psychosocial well-being, COVID-19 (flu-like) symptoms and prevention 
measures. Consenting respondents provided answers anonymously.
RESULTS: Three hundred seventeen PLWH were included (mean age 43.4 ± 11.7; 71.6% 
men); 60.3% of participants resided in Belgium and Brazil. One hundred forty 
(44.2%) reported experiencing a cold with at least one flu-like symptom since 
January 2020. Of the 18 who reported COVID-19 test results, 4 (22.2%) were 
positive. Seventy-four (23.3%) respondents screened positive for major 
depressive disorders, whereas 72 (22.7%) had generalized anxiety disorders. 
Fifty-six (17.7%) respondents reported difficulties in obtaining antiretroviral 
medications because of COVID-19-related measures. Adaptations of HIV care during 
the COVID-19 outbreak included greater quantities of antiretroviral refill in 67 
(21.1%), phone consultations in 25 (7.9%), and new refill sites in 12 (3.9%). 
Factors associated with a reduced risk of experiencing flu-like symptoms 
included flu vaccination during the past 12 months (P = 0.005) and adaptations 
of HIV care during the COVID-19 pandemic (P = 0.010).
CONCLUSION: COVID-19 and associated restrictive measures seem detrimental to the 
well-being and follow-up of PLWH. We recommend that health systems devise 
innovative approaches for antiretroviral provision and psychosocial support to 
PLWH during such outbreaks.

DOI: 10.1097/QAI.0000000000002468
PMID: 32826562 [Indexed for MEDLINE]


4252. BMJ Open Qual. 2020 Aug;9(3):e001008. doi: 10.1136/bmjoq-2020-001008.

Quality improvement report: setting up a staff well-being hub through continuous 
engagement.

Saqib A(1), Rampal T(2).

Author information:
(1)Royal College of Physicians Chief Registrar, Medway Maritime Hospital, 
Gillingham, UK aaishasaqib@nhs.net.
(2)Prehabilitation services lead, Medway Maritime Hospital, Gillingham, UK.

The coronavirus pandemic has presented a new set of challenges for the frontline 
National Health Service staff. It is not only the long working hours but also 
the uncertainty and increase in patient mortality that has affected mental 
health and staff well-being. Hospitals all around the country have rightly 
responded with various well-being initiatives to help their staff such as wobble 
rooms and developing online resources. Our vision was to set up a safe space for 
staff away from clinical noise to enable and encourage mindfulness and 
psychological resilience through a calm and serene environment. We used the 
continuous quality improvement methodology and administered an initial needs 
assessment survey to see if our trust staff will be interested in having such a 
space. Within our team, we managed to secure a place, and used donations to 
hospital charity and set up a space within a week. Since opening the hub, we 
have had excellent feedback from various staff groups. Immediate feedback was 
obtained using emoji stickers asking for feelings before and after visit. A mood 
board was put up allowing anonymous expression of feelings. Delayed feedback was 
requested using a repeat survey. We believe that while there is a lot of talk 
about well-being and an increasing number of resources being offered 
electronically, the need for a neat and quiet space cannot be overlooked. We 
collect feedback on a weekly basis and adapt the space to meet the needs of 
staff. Long-term impact of such spaces will be reassessed at a later stage.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjoq-2020-001008
PMCID: PMC7445343
PMID: 32826279 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


4253. J Voice. 2022 Jul;36(4):586.e1-586.e5. doi: 10.1016/j.jvoice.2020.07.030. Epub 
2020 Aug 18.

Songbirds Must Sing: How Artistic Voice Users Perceive Their Voice in Times of 
COVID-19.

Primov-Fever A(1), Roziner I(2), Amir O(3).

Author information:
(1)Department of Otorhinolaryngology Head and Neck Surgery, Sheba Medical 
Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, 
Tel-Aviv, Israel.
(2)Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel; 
Department of Communication Disorders, Tel Aviv University, Tel Aviv, Israel.
(3)Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel; 
Department of Communication Disorders, Tel Aviv University, Tel Aviv, Israel. 
Electronic address: oferamir@tauex.tau.ac.il.

OBJECTIVE: The COVID-19 pandemic has led to a critical disruption in the music 
and performing arts industry, and affected singers and other artists. This study 
was designed to examine the effect of this unique time on artistic voice users, 
the way they perceive their voice and their voice-related behaviors.
METHODS: A total of 110 participants volunteered for the study: 57 professional 
artistic voice users (34 singers and 19 actors) and a control group of 53 
nonprofessional voice users. All participants completed three questionnaires 
related to their self-assessment of their voice, their voice difficulties, vocal 
training, and current stress in the time of the COVID-19 pandemic.
RESULTS: Compared to the controls, artistic voice users were more concerned 
about their voice (P < 0.001), practiced their voice more often (P < 0.001), and 
experienced more anxiety and stress (P < 0.05). In addition, within the 
professional group, singers reported practicing their voice in the time of the 
COVID-19 significantly more than actors (P < 0.01).
CONCLUSIONS: Professional artistic voice users experience the COVID-19 pandemic 
as a stressful time, with negative effects on their well-being and specifically 
on their voice. This should be considered in the treatment and maintenance of 
their voice and professional career at current and future stressful times.

Copyright © 2020 The Voice Foundation. Published by Elsevier Inc. All rights 
reserved.

DOI: 10.1016/j.jvoice.2020.07.030
PMCID: PMC7434435
PMID: 32826119 [Indexed for MEDLINE]


4254. Int J Environ Res Public Health. 2020 Aug 17;17(16):5973. doi: 
10.3390/ijerph17165973.

COVID-19 Lockdown: Housing Built Environment's Effects on Mental Health.

Amerio A(1)(2)(3), Brambilla A(4), Morganti A(4), Aguglia A(1)(2), Bianchi 
D(1)(2), Santi F(1)(2), Costantini L(5), Odone A(6)(7), Costanza A(8)(9), 
Signorelli C(6), Serafini G(1)(2), Amore M(1)(2), Capolongo S(4).

Author information:
(1)Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal 
and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16132 
Genoa, Italy.
(2)IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
(3)Department of Psychiatry, Tufts University, Boston, MA 02111, USA.
(4)Department of Architecture, Built environment and Construction engineering 
(DABC), Design & Health Lab, Politecnico di Milano, 20133 Milan, Italy.
(5)Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy.
(6)School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy.
(7)Clinical Epidemiology and HTA, IRCCS San Raffaele Scientific Institute, 20132 
Milan, Italy.
(8)Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), 
1206 Geneva, Switzerland.
(9)Department of Psychiatry, ASO Santi Antonio e Biagio e Cesare Arrigo 
Hospital, 15121 Alessandria, Italy.

Since the World Health Organization (WHO) declared the coronavirus infectious 
disease 2019 (COVID-19) outbreak a pandemic on 11 March, severe lockdown 
measures have been adopted by the Italian Government. For over two months of 
stay-at-home orders, houses became the only place where people slept, ate, 
worked, practiced sports, and socialized. As consolidated evidence exists on 
housing as a determinant of health, it is of great interest to explore the 
impact that COVID-19 response-related lockdown measures have had on mental 
health and well-being. We conducted a large web-based survey on 8177 students 
from a university institute in Milan, Northern Italy, one of the regions most 
heavily hit by the pandemic in Europe. As emerged from our analysis, poor 
housing is associated with increased risk of depressive symptoms during 
lockdown. In particular, living in apartments <60 m2 with poor views and scarce 
indoor quality is associated with, respectively, 1.31 (95% CI: 1046-1637), 1.368 
(95% CI: 1166-1605), and 2.253 (95% CI: 1918-2647) times the risk of 
moderate-severe and severe depressive symptoms. Subjects reporting worsened 
working performance from home were over four times more likely to also report 
depression (OR = 4.28, 95% CI: 3713-4924). Housing design strategies should 
focus on larger and more livable living spaces facing green areas. We argue that 
a strengthened multi-interdisciplinary approach, involving urban planning, 
public mental health, environmental health, epidemiology, and sociology, is 
needed to investigate the effects of the built environment on mental health, so 
as to inform welfare and housing policies centered on population well-being.

DOI: 10.3390/ijerph17165973
PMCID: PMC7459481
PMID: 32824594 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


4255. Psychiatr Prax. 2020 Oct;47(7):361-369. doi: 10.1055/a-1222-9067. Epub 2020 Aug 
21.

[Mental Health Status in the Community During the COVID-19-Pandemic].

[Article in German; Abstract available in German from the publisher]

Kuehner C(1), Schultz K(1), Gass P(1), Meyer-Lindenberg A(1), Dreßing H(1).

Author information:
(1)Abteilung Psychiatrie und Psychotherapie, Zentralinstitut für Seelische 
Gesundheit, Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg.

OBJECTIVE: Analysis of associations between perceived daily life strain during 
the COVID-19-crisis and personality aspects with current psychological wellbeing 
in the general population and comparison of mental health indicators with those 
from a previous survey in 2018.
METHODS: Written survey in a random sample from the general population (n = 721) 
on Corona-related assessments, personality aspects and current mental health 
(WHO-5, PHQ-D).
RESULTS: Fear for the health of close persons, strain regarding going out 
restrictions, increased substance use and psychological risk- and resilience 
factors were independently related to current mental health. Extent and 
frequencies of mental health symptomatology did not differ between 2018 and 
2020.
CONCLUSION: This is a first study in Germany reporting results from a 
population-based random sample on determinants of mental health during the 
COVID-19-crisis and a comparison of mental health symptomatology with 
prepandemic data from the same population.

Publisher: ZIEL DER STUDIE: Zusammenhangsanalyse von wahrgenommenen 
Alltagsbelastungen während der COVID-19-Krise und Persönlichkeitsaspekten mit 
dem aktuellen psychischen Befinden in der Bevölkerung sowie Vergleich der 
psychischen Symptomatik mit einem Survey von 2018.
METHODIK: Zufallsstichprobe aus der Bevölkerung (n = 721), die zu 
coronabezogenen Einschätzungen, Persönlichkeitsaspekten und aktuellem 
psychischen Befinden (WHO-5, PHQ-D) schriftlich befragt wurde.
ERGEBNISSE: Angst um die Gesundheit Nahestehender, Belastungen durch 
Ausgangsbeschränkungen und vermehrter Substanzkonsum sowie psychische Risiko- 
und Resilienzfaktoren trugen im statistischen Modell unabhängig zur Vorhersage 
des psychischen Befindens bei. Ausprägungen und Häufigkeiten psychischer 
Symptomatik unterschieden sich nicht zwischen 2018 und 2020.
SCHLUSSFOLGERUNG: Dies ist eine erste Studie in Deutschland, die Ergebnisse aus 
einer bevölkerungsbezogenen Zufallsstichprobe zu Determinanten psychischen 
Befindens während der COVID-19-Krise und einen Vergleich der psychischen 
Symptomatik mit einer präpandemischen Referenzstichprobe vorlegt.

Thieme. All rights reserved.

DOI: 10.1055/a-1222-9067
PMCID: PMC7664009
PMID: 32823293 [Indexed for MEDLINE]

Conflict of interest statement: Die Autorinnen/Autoren geben an, dass kein 
Interessenkonflikt besteht.


4256. Ann Intern Med. 2020 Dec 15;173(12):981-988. doi: 10.7326/M20-4199. Epub 2020 
Aug 21.

Addressing Postpandemic Clinician Mental Health : A Narrative Review and 
Conceptual Framework.

Schwartz R(1), Sinskey JL(2), Anand U(3), Margolis RD(4).

Author information:
(1)WellMD and WellPhD Center, Stanford University School of Medicine, Stanford, 
California (R.S.).
(2)University of California, San Francisco, San Francisco, California (J.L.S.).
(3)Office of Wellness and Academic Success, Mayo Clinic College of Medicine and 
Science, Rochester, Minnesota (U.A.).
(4)Children's Hospital Los Angeles, University of Southern California Keck 
School of Medicine, Los Angeles, CA (R.D.M.).

Previous pandemics have seen high psychiatric morbidity among health care 
workers. Protecting clinician mental health in the aftermath of coronavirus 
disease 2019 (COVID-19) requires an evidence-based approach to developing and 
deploying comprehensive clinician mental health support. In a narrative review 
of 96 articles addressing clinician mental health in COVID-19 and prior 
pandemics, 7 themes emerged: 1) the need for resilience and stress reduction 
training; 2) providing for clinicians' basic needs (food, drink, adequate rest, 
quarantine-appropriate housing, transportation, child care, personal protective 
equipment); 3) the importance of specialized training for pandemic-induced 
changes in job roles; 4) recognition and clear communication from leadership; 5) 
acknowledgment of and strategies for addressing moral injury; 6) the need for 
peer and social support interventions; and 7) normalization and provision of 
mental health support programs. In addition to the literature review, in 
collaboration with the Collaborative for Healing and Renewal in Medicine (CHARM) 
network, the authors gathered practice guidelines and resources from health care 
organizations and professional societies worldwide to synthesize a list of 
resources deemed high-yield by well-being leaders. Studies of previous pandemics 
demonstrate heightened distress in health care workers years after the event. 
The COVID-19 pandemic presents unique challenges that surpass those of previous 
pandemics, suggesting a significant mental health toll on clinicians. Long-term, 
proactive individual, organizational, and societal infrastructures for clinician 
mental health support are needed to mitigate the psychological costs of 
providing care during the COVID-19 pandemic.

DOI: 10.7326/M20-4199
PMCID: PMC7450528
PMID: 32822206 [Indexed for MEDLINE]

Conflict of interest statement: Disclosures: Authors have disclosed no conflicts 
of interest. Forms can be viewed at 
www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-4199.


4257. J Affect Disord. 2020 Dec 1;277:121-128. doi: 10.1016/j.jad.2020.07.135. Epub 
2020 Aug 7.

The impact of COVID-19 pandemic on mental health & wellbeing among 
home-quarantined Bangladeshi students: A cross-sectional pilot study.

Khan AH(1), Sultana MS(1), Hossain S(2), Hasan MT(3), Ahmed HU(4), Sikder MT(1).

Author information:
(1)Department of Public Health and Informatics, Jahangirnagar University, Savar, 
Dhaka, Bangladesh.
(2)Department of Public Health and Informatics, Jahangirnagar University, Savar, 
Dhaka, Bangladesh. Electronic address: sahadat.hossain@juniv.edu.
(3)Department of Primary Care & Mental Health, University of Liverpool, United 
Kingdom.
(4)National Institute of Mental Health, Sher-E-Bangla Nagar, Dhaka, Bangladesh.

BACKGROUND: COVID-19 is imposing threat both on physical and mental health since 
its outbreak. Bangladesh adopted lockdown strategy with potential consequences 
on day to day life, mental and physical health and this study aims to explore 
the impact of COVID-19 on mental health and wellbeing among Bangladeshi 
students.
METHODS: A cross-sectional study was conducted between 9th and 23rd April 2020 
among 505 college and university students. Data was collected by using online 
questionnaire including DASS 21 and IES. Descriptive analysis and bivariate 
linear regression were performed to examine the association of variables.
RESULTS: 28.5 % of the respondents had stress, 33.3% anxiety, 46.92% depression 
from mild to extremely severe, according to DASS 21 and 69.31% had 
event-specific distress from mild to severe in terms of severity according to 
IES. Perceiving physical symptoms as COVID-19 was significantly associated with 
DASS stress subscale (B = 3.71, 95% CI: 1.01 to 6.40), DASS anxiety subscale 
(B = 3.95, 95% CI: 1.95 to 5.96), DASS depression subscale (B = 3.82, 95% CI: 
0.97 to 6.67) and IES scale (B = 7.52, 95% CI: 3.58 to 11.45). Additionally, 
fear of infection, financial uncertainty, inadequate food supply, absence of 
physical exercise and limited or no recreational activity had significant 
association with stress, anxiety, depression and post-traumatic symptoms.
CONCLUSION: This COVID-19 outbreak imposes psychological consequences on people 
to a great extent which requires attention from the concerned authorities to 
cope with this situation mentally. The perception about the outbreak can also 
play a big role in psychological impact.

Copyright © 2020 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.jad.2020.07.135
PMCID: PMC7410816
PMID: 32818775 [Indexed for MEDLINE]


4258. Ir Med J. 2020 Jun 11;113(6):100.

Impact and Mechanism of Covid-19 on Mental Health and Wellbeing.

Lynch D(1)(2), O'Brien M(3), O'Byrne L(2), Gavin B(2), McNicholas F(2)(3)(4).

Author information:
(1)University Hospital Galway, Newcastle Rd, Galway.
(2)Dept of Child & Adolescent Psychiatry, SMMS, UCD.
(3)Our Lady's Children's Hospital, Crumlin, Dublin 12.
(4)Lucena Clinic, Rathgar, Dublin 6.

The Covid-19 pandemic has brought unprecedented pressure to healthcare systems 
worldwide, resulting in significant and precipitous changes in demand, burden 
and method of delivery. The psychosocial impact of this crisis is likely to 
increase over the course of the pandemic, peak later than medical cases and 
endure for longer thereby significantly exceeding medical morbidity. It will 
have far reaching impact on the individual, their family and their care 
providers. Frontline healthcare workers and those with pre-existing mental 
health difficulties are recognised at increased risk. Now that the initial surge 
has been expertly curtailed, it is essential that urgent consideration is now 
directed towards the mental health implications of the current outbreak and 
ensure that we are as ready for the increased MH needs of the community as we 
were for the intensive medical care.

PMID: 32816435 [Indexed for MEDLINE]


4259. AIDS Behav. 2021 Jan;25(1):68-72. doi: 10.1007/s10461-020-03005-x.

The Psychosocial Effects of the COVID-19 Pandemic on Youth Living with HIV in 
Western Kenya.

Dyer J(1), Wilson K(2), Badia J(3), Agot K(3), Neary J(4), Njuguna I(5), Kibugi 
J(3), Healy E(6), Beima-Sofie K(2), John-Stewart G(2)(4)(7)(8), Kohler P(6)(2).

Author information:
(1)Department of Child, Family, Population Health Nursing, University of 
Washington, Box 359932, Seattle, WA, 98104, USA. jessd9@uw.edu.
(2)Department of Global Health, University of Washington, Seattle, WA, USA.
(3)Impact Research and Development Organization, Kisumu, Kenya.
(4)Department of Epidemiology, University of Washington, Seattle, WA, USA.
(5)Kenyatta National Hospital, Research and Programs, Nairobi, Kenya.
(6)Department of Child, Family, Population Health Nursing, University of 
Washington, Box 359932, Seattle, WA, 98104, USA.
(7)Department of Medicine, University of Washington, Seattle, WA, USA.
(8)Department of Pediatrics, University of Washington, Seattle, WA, USA.

The objective of this study was to assess psychosocial effects of COVID-19 among 
adolescents living with HIV (ALHIV) in Kenya and to assess the feasibility of 
conducting behavioral surveys by phone. We adapted our protocol to administer 
telephone rather than in-person follow-up surveys and included questions about 
COVID-19. The majority of participants (99%) reported having heard of COVID-19; 
23% reported no longer being able to go outside, 17% reported that they could no 
longer go to their regular clinic for medical care, and 3% reported that they 
could no longer get medication refills. PHQ-9 screening identified 9% (n = 45) 
with mild depression symptoms, and 1% (n = 3) with moderate-to-severe depression 
symptoms. Young adults 20-24 years old had more mild to severe depressive 
symptoms than the younger age groups (p < 0.001). Offering remote peer-support 
or mental health care, continuing to offer differentiated care services, and 
considering financial support will support the health and well-being of ALHIV.

DOI: 10.1007/s10461-020-03005-x
PMCID: PMC7438976
PMID: 32816193 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


4260. J Autism Dev Disord. 2021 Jun;51(6):2155-2158. doi: 10.1007/s10803-020-04670-6.

Including Children with Developmental Disabilities in the Equation During this 
COVID-19 Pandemic.

Aishworiya R(1), Kang YQ(2).

Author information:
(1)Khoo Teck Puat-National University Children's Medical Institute, National 
University Health System, Singapore, Singapore. aishworiya_ramkumar@nuhs.edu.sg.
(2)Khoo Teck Puat-National University Children's Medical Institute, National 
University Health System, Singapore, Singapore.

Amidst the ongoing novel Coronavirus disease pandemic, children with 
developmental disabilities warrant specific attention to minimise having 
disproportionate consequences. These children are especially vulnerable to the 
effects of the pandemic due to (1) Greater healthcare needs, (2) Dependency on 
community-based services and (3) Mental health concerns. Healthcare 
professionals, public health systems and the society needs to come together to 
advocate for these children by optimising access to healthcare and community 
intervention services, promoting mental well-being and caregiver welfare. The 
consequences of missed present-day opportunities might only be evident in the 
years to come in these children. Hence, despite the prolonged pandemic, with 
consequent limitations in availability of resources, children with developmental 
disabilities should continue to be supported.

DOI: 10.1007/s10803-020-04670-6
PMCID: PMC7438977
PMID: 32816170 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


4261. Psychosom Med. 2021 May 1;83(4):373-379. doi: 10.1097/PSY.0000000000000851.

Acute Stress Disorder Among Frontline Health Professionals During the COVID-19 
Outbreak: A Structural Equation Modeling Investigation.

Wang Y(1), Duan Z, Peng K, Li D, Ou J, Wilson A, Wang N, Si L, Chen R.

Author information:
(1)From the National Clinical Research Centre for Mental Disorders, Department 
of Psychiatry, and Hunan Medical Centre for Mental Health (Wang, Peng, Ou, Wang, 
Chen), The Second Xiangya Hospital of Central South University, Changsha, Hunan; 
School of Health Sciences (Duan), Wuhan University, Wuhan, China; The George 
Institute for Global Health (Peng, Si), UNSW, Sydney, Australia; Jin Yin-tan 
Hospital (Li), Wuhan, China; Division of Psychology, Faculty of Health and Life 
Sciences (Wilson, YuanYuan Wang), De Montfort University, Leicester, United 
Kingdom.

OBJECTIVE: The outbreak of COVID-19 that commenced in December 2019 in Wuhan, 
China, has caused extensive public health concerns and posed substantial 
challenges to health professionals, especially for those in the center of the 
epidemic. The current study aimed to assess the prevalence, related factors, and 
mechanism of acute stress disorder (ASD) among health professionals in Wuhan 
during this critical period.
METHODS: The study used a cross-sectional design. Self-administered 
questionnaires were distributed to the frontline health professionals in Wuhan 
hospitals from January 28 to February 1, 2020. Mental health-related 
measurements included ASD, depression, anxiety, conflict experiences, hostility, 
and psychosomatic symptoms. Structural equation modeling was used to analyze the 
factors associated with ASD among health professionals.
RESULTS: A total of 332 frontline health professionals were included in the 
analysis (mean [standard deviation] age = 32.21 [8.77] years; 78.0% women). ASD 
was a prominent mental health problem in the health professionals surveyed, with 
a prevalence of 38.3%. Anxiety (24.7%) and depression (20.2%) were also common. 
Structural equation modeling analyses revealed that emotional distress (i.e., 
anxiety and depressive symptoms) fully mediated the association between 
conflicts with ASD (the standardized indirect coefficient β = 0.47, p = .016). 
The most common reported symptom was chest pain (51.2%). ASD was significantly 
associated with psychosomatic symptoms. The majority (67.8%) reported being 
easily annoyed or irritated, and ASD was associated with hostility.
CONCLUSIONS: During the COVID-19 outbreak, a substantial number of health 
professionals in Wuhan suffered from ASD. Furthermore, ASD was found to be 
associated with psychosomatic symptoms as well as the hostility. The poor mental 
health of health professionals has detrimental impacts both on the well-being of 
staff in health care systems and may adversely affect the quality of patient 
care. We call for interventions that aim to relieve the psychological and 
occupational stress. Considering that most of our participants were young, 
female frontline health professionals, the results may not be generalized to 
more heterogenous samples.

Copyright © 2020 by the American Psychosomatic Society.

DOI: 10.1097/PSY.0000000000000851
PMID: 32815855 [Indexed for MEDLINE]


4262. Int J Soc Psychiatry. 2021 Jun;67(4):344-350. doi: 10.1177/0020764020952116. 
Epub 2020 Aug 20.

Psychological responses and lifestyle changes among pregnant women with respect 
to the early stages of COVID-19 pandemic.

Zhang Y(1), Ma ZF(2).

Author information:
(1)Mathematics Teaching and Research Office, Public Basic College, Jinzhou 
Medical University, Jinzhou, Liaoning, China.
(2)Department of Health and Environmental Sciences, Xi'an Jiaotong-Liverpool 
University, Suzhou, China.

OBJECTIVES: The COVID-19 pandemic has caused a profound impact on health and 
well-being of populations. However, there are limited studies that have 
investigated the psychological aspects of vulnerable groups including pregnant 
women amid the COVID-19 pandemic. Therefore, we aimed to assess the 
psychological impact of the COVID-19 pandemic among Chinese pregnant women from 
February 2020 until March 2020.
METHODS: Our study was conducted using a modified validated online questionnaire 
comprising of sociodemographic, the Impact of Event Scale (IES), attitude and 
mental health-related questions towards COVID-19.
RESULTS: A total of 560 women were included. The overall mean age and IES of 
women was 25.8 ± 2.7 years and 31.4 ± 13.7. Moreover, 67.1% of them had IES ⩾26. 
Psychological impact seemed to be more severe in women in second trimester of 
pregnancy (the highest IES) (p = .016). There was a significant association 
between trimesters of pregnancy and some indicators of negative health impacts 
(including increased stress from work, increased stress from home, feeling 
apprehensive and helpless during the early stages of the COVID-19 pandemic) (all 
p < .05).
CONCLUSIONS: Our results reported moderate-to-severe stressful impact among 
Chinese pregnant women. We recommend that appropriate measures should be taken 
to address the maternal mental health issues.

DOI: 10.1177/0020764020952116
PMCID: PMC8191160
PMID: 32815434 [Indexed for MEDLINE]


4263. J Neurol. 2021 May;268(5):1598-1607. doi: 10.1007/s00415-020-10160-7. Epub 2020 
Aug 19.

The emotional impact of the COVID-19 pandemic on individuals with progressive 
multiple sclerosis.

Chiaravalloti ND(1)(2), Amato MP(3)(4), Brichetto G(5)(6), Chataway J(7)(8), 
Dalgas U(9), DeLuca J(10)(11), Meza C(12), Moore NB(10), Feys P(13), Filippi 
M(14)(15)(16)(17), Freeman J(18), Inglese M(19)(20), Motl R(21), Rocca 
MA(14)(15), Sandroff BM(10)(21), Salter A(22), Cutter G(23), Feinstein A(12); 
CogEx Research Team.

Author information:
(1)Kessler Foundation, 120 Eagle Rock Avenue, Suite 100, East Hanover, NJ, 
07936, USA. nchiaravalloti@kesslerfoundation.org.
(2)Department of Physical Medicine and Rehabilitation, Rutgers New Jersey 
Medical School, Newark, NJ, USA. nchiaravalloti@kesslerfoundation.org.
(3)Department NEUROFARBA, Section Neurosciences, University of Florence, Largo 
Brambilla 3, 50134, Florence, Italy.
(4)IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.
(5)Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), via 
Operai 40, 16149, Genoa, Italy.
(6)AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, 
Italy.
(7)Department of Neuroinflammation, UCL Queen Square Institute of Neurology, 
Faculty of Brain Sciences, Queen Square Multiple Sclerosis Centre, University 
College London, London, WC1B 5EH, UK.
(8)National Institute for Health Research, University College London Hospitals, 
Biomedical Research Centre, London, UK.
(9)Exercise Biology, Department of Public Health, Aarhus University, Dalgas 
Avenue 4, 8000, Aarhus, Denmark.
(10)Kessler Foundation, 120 Eagle Rock Avenue, Suite 100, East Hanover, NJ, 
07936, USA.
(11)Department of Physical Medicine and Rehabilitation, Rutgers New Jersey 
Medical School, Newark, NJ, USA.
(12)Department of Psychiatry, University of Toronto and Sunnybrook Health 
Sciences Centre, Toronto, ON, M5R 3B6, Canada.
(13)REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, 
Belgium.
(14)Division of Neuroscience, Neuroimaging Research Unit, Institute of 
Experimental Neurology, IRCSS San Raffaele Scientific Institute, Vita-Salute San 
Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
(15)Neurology Unit, IRCSS San Raffaele Scientific Institute, Milan, Italy.
(16)Neurophysiology Unit, IRCSS San Raffaele Scientific Institute, Milan, Italy.
(17)Vita-Salute San Raffaele University, Milan, Italy.
(18)Faculty of Health, School of Health Professions, University of Plymouth, 
Devon, UK.
(19)Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, 
Maternal and Child Health, and Center of Excellence for Biomedical Research, 
University of Genoa, Genoa, Italy.
(20)Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.
(21)Department of Physical Therapy, University of Alabama at Birmingham, 
Birmingham, USA.
(22)Division of Biostatistics, Washington University School of Medicine, St. 
Louis, MO, USA.
(23)Department of Biostatistics, University of Alabama At Birmingham, 
Birmingham, USA.

OBJECTIVE: Individuals with pre-existing chronic illness have shown increased 
anxiety and depression due to COVID-19. Here, we examine the impact of the 
COVID-19 pandemic on emotional symptomatology and quality of life in individuals 
with Progressive Multiple Sclerosis (PMS).
METHODS: Data were obtained during a randomized clinical trial on rehabilitation 
taking place at 11 centers in North America and Europe. Participants included 
131 individuals with PMS. Study procedures were interrupted in accordance with 
governmental restrictions as COVID-19 spread. During study closure, a COVID 
Impact Survey was administered via telephone or email to all participants, along 
with measures of depressive symptoms, anxiety symptoms, quality of life, and MS 
symptomatology that were previously administered pre-pandemic.
RESULTS: 4% of respondents reported COVID-19 infection. No significant changes 
were noted in anxiety, quality of life, or the impact of MS symptomatology on 
daily life from baseline to lockdown. While total HADS-depression scores 
increased significantly at follow-up, this did not translate into more 
participants scoring above the HADS threshold for clinically significant 
depression. No significant relationships were noted between disease duration, 
processing speed ability or EDSS, and changes in symptoms of depression or 
anxiety. Most participants reported the impact of the virus on their 
psychological well-being, with a little impact on financial well-being. The 
perceived impact of the pandemic on physical and psychological well-being was 
correlated with the impact of MS symptomatology on daily life, as well as 
changes in depression.
CONCLUSIONS: Overall, little change was noted in symptoms of depression or 
anxiety or overall quality of life.

DOI: 10.1007/s00415-020-10160-7
PMCID: PMC7436067
PMID: 32813051 [Indexed for MEDLINE]

Conflict of interest statement: Nancy D. Chiaravalloti is on an Advisory Board 
for Akili Interactive and is a member of the Editorial Boards of Multiple 
Sclerosis Journal and Frontiers in NeuroTrauma. Maria Pia Amato received 
compensation for consulting services and/or speaking activities from Bayer, 
Biogen Idec, Merck-Serono, Novartis, Roche, Sanofi Genzyme, and Teva 
Pharmaceutical Industries; and receives research support from Biogen Idec, 
Merck-Serono, Roche, Pharmaceutical Industries, and Fondazione Italiana Sclerosi 
Multiplav. Giampaolo Brichetto has no disclosures to report. Jeremy Chataway has 
received support from the Efficacy and Evaluation (EME) Programme, a Medical 
Research Council (MRC) and National Institute for Health Research (NIHR) 
partnership and the Health Technology Assessment (HTA) Programme (NIHR), the UK 
MS Society, the US National MS Society, and the Rosetrees Trust. He is supported 
in part by the National Institute for Health Research, University College London 
Hospitals, Biomedical Research Centre, London, UK. He has been a local principal 
investigator for commercial trials funded by: Actelion, Biogen, Novartis, and 
Roche; has received an investigator grant from Novartis; and has taken part in 
advisory boards/consultancy for Azadyne, Biogen, Celgene, MedDay, Merck, and 
Roche. Ulrik Dalgas has received research support, travel grants, and/or 
teaching honorary from Biogen Idec, Merck Serono, Novartis, Bayer Schering, and 
Sanofi Aventis as well as honoraria from serving on scientific advisory boards 
of Biogen Idec and Genzyme. John DeLuca is an Associate Editor of the Archives 
of Physical Medicine and Rehabilitation, and Neuropsychology Review; received 
compensation for consulting services and/or speaking activities from Biogen 
Idec, Celgene, MedRhythms, and Novartis; and receives research support from 
Biogen Idec, National Multiple Sclerosis Society, Consortium of Multiple 
Sclerosis Centers, and National Institutes of Health. Cecilia Meza has no 
disclosures to report. Nancy B. Moore has no disclosures to report. Peter Feys 
is editorial board member of NNR and MSJ, provides consultancy to NeuroCompass 
and was board of advisory board meetings for BIOGEN. Massimo Filippi is the 
Editor-in-Chief of the Journal of Neurology; received compensation for 
consulting services and/or speaking activities from Bayer, Biogen Idec, 
Merck-Serono, Novartis, Roche, Sanofi Genzyme, Takeda, and Teva Pharmaceutical 
Industries; and receives research support from Biogen Idec, Merck-Serono, 
Novartis, Roche, Teva Pharmaceutical Industries, Italian Ministry of Health, 
Fondazione Italiana Sclerosi Multipla, and ARiSLA (Fondazione Italiana di 
Ricerca per la SLA). Jennifer Freeman has been awarded research grants from the 
NIHR, UK. Matilde Inglese is Co-Editor for Controversies for Multiple Sclerosis 
Journal; received compensation for consulting services and/or speaking 
activities from Biogen Idec, Merck-Serono, Novartis, Roche, Sanofi Genzyme; and 
received research support from NIH, NMSS Italian Ministry of Health, Fondazione 
Italiana Sclerosi Multipla. Robert W. Motl has no disclosures to report. Maria 
Assunta Rocca received speaker honoraria from Biogen Idec, Novartis, Teva 
Neurosciences, Merck Serono, Genzyme, Roche, Bayer, and Celgene, and receives 
research support from the Canadian MS Society and Fondazione Italiana Sclerosi 
Multipla. Brian Sandroff has no disclosures to report. Amber Salter is a 
statistical editor for Circulation: Cardiovascular Imaging. Gary Cutter is a 
member of Data and Safety Monitoring Boards for Astra-Zeneca, Avexis 
Pharmaceuticals, Biolinerx, Brainstorm Cell Therapeutics, Bristol Meyers 
Squibb/Celgene, CSL Behring, Galmed Pharmaceuticals, Horizon Pharmaceuticals, 
Hisun Pharmaceuticals, Mapi Pharmaceuticals Ltd, Merck, Merck/Pfizer, Opko 
Biologics, OncoImmune, Neurim, Novartis, Ophazyme, Sanofi-Aventis, Reata 
Pharmaceuticals, Teva pharmaceuticals, VielaBio Inc, Vivus, NHLBI (Protocol 
Review Committee), and NICHD (OPRU oversight committee). He is on Consulting or 
Advisory Boards for Biodelivery Sciences International, Biogen, Click 
Therapeutics, Genzyme, Genentech, GW Pharmaceuticals, Klein-Buendel 
Incorporated, Medimmune, Medday, Neurogenesis Ltd, Novartis, Osmotica 
Pharmaceuticals, Perception Neurosciences, Recursion/Cerexis Pharmaceuticals, 
Roche, and TG Therapeutics. Dr. Cutter is employed by the University of Alabama 
at Birmingham and President of Pythagoras, Inc. a private consulting company 
located in Birmingham AL. Anthony Feinstein is on an Advisory Board for Akili 
Interactive and reports grants from the MS Society of Canada, book royalties 
from Johns Hopkins University Press, Cambridge University Press, Amadeus Press, 
and Glitterati Editions, and speaker’s honoraria from Novartis, Biogen, Roche, 
and Sanofi-Genzyme.


4264. J Intellect Disabil Res. 2020 Oct;64(10):739-749. doi: 10.1111/jir.12769. Epub 
2020 Aug 18.

Examining the impact of COVID-19 in ethnically diverse families with young 
children with intellectual and developmental disabilities.

Neece C(1), McIntyre LL(2), Fenning R(3).

Author information:
(1)Department of Psychology, Loma Linda University, Loma Linda, CA, USA.
(2)Special Education & Clinical Sciences, University of Oregon, Eugene, OR, USA.
(3)Department of Child and Adolescent Studies, California State University 
Fullerton, Fullerton, CA, USA.

BACKGROUND: The COVID-19 pandemic introduced challenges to families with young 
children with developmental delays. Beyond the widespread concerns surrounding 
illness, loss of employment and social isolation, caregivers are responsible for 
overseeing their children's educational and therapeutic programmes at home often 
without the much needed support of professionals.
METHOD: The present study sought to examine the impact of COVID-19 in 77 
ethnically, linguistically and socioeconomically diverse families with young 
children with intellectual and developmental disabilities (IDDs) in California 
and Oregon, who were participating in larger intervention studies. Parents 
responded to five interview questions about the impact of the pandemic, services 
for their child, silver linings or positive aspects, coping and their concerns 
about the long-term impact of the pandemic.
RESULTS: Parents reported that their biggest challenge was being at home caring 
for their children with the loss of many essential services. Parents reported 
some positive aspects of the pandemic, especially being together as a family. 
Although there were positive aspects of the situation, many parents expressed 
concern about long-term impacts of the pandemic on their children's development, 
given the loss of services, education and social engagement opportunities.
CONCLUSION: Results suggest that parents of young children with IDD report 
significant challenges at home during the pandemic. Professional support, 
especially during the reopening phases, will be critical to support family 
well-being and child developmental outcomes.

© 2020 MENCAP and International Association of the Scientific Study of 
Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

DOI: 10.1111/jir.12769
PMCID: PMC7461180
PMID: 32808424 [Indexed for MEDLINE]

Conflict of interest statement: The Authors declare that there is no conflict of 
interest.


4265. J Med Internet Res. 2020 Sep 3;22(9):e21279. doi: 10.2196/21279.

Effects of COVID-19 on College Students' Mental Health in the United States: 
Interview Survey Study.

Son C(1), Hegde S(1), Smith A(1), Wang X(1), Sasangohar F(1)(2).

Author information:
(1)Department of Industrial and Systems Engineering, Texas A&M University, 
College Station, TX, United States.
(2)Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United 
States.

BACKGROUND: Student mental health in higher education has been an increasing 
concern. The COVID-19 pandemic situation has brought this vulnerable population 
into renewed focus.
OBJECTIVE: Our study aims to conduct a timely assessment of the effects of the 
COVID-19 pandemic on the mental health of college students.
METHODS: We conducted interview surveys with 195 students at a large public 
university in the United States to understand the effects of the pandemic on 
their mental health and well-being. The data were analyzed through quantitative 
and qualitative methods.
RESULTS: Of the 195 students, 138 (71%) indicated increased stress and anxiety 
due to the COVID-19 outbreak. Multiple stressors were identified that 
contributed to the increased levels of stress, anxiety, and depressive thoughts 
among students. These included fear and worry about their own health and of 
their loved ones (177/195, 91% reported negative impacts of the pandemic), 
difficulty in concentrating (173/195, 89%), disruptions to sleeping patterns 
(168/195, 86%), decreased social interactions due to physical distancing 
(167/195, 86%), and increased concerns on academic performance (159/195, 82%). 
To cope with stress and anxiety, participants have sought support from others 
and helped themselves by adopting either negative or positive coping mechanisms.
CONCLUSIONS: Due to the long-lasting pandemic situation and onerous measures 
such as lockdown and stay-at-home orders, the COVID-19 pandemic brings negative 
impacts on higher education. The findings of our study highlight the urgent need 
to develop interventions and preventive strategies to address the mental health 
of college students.

©Changwon Son, Sudeep Hegde, Alec Smith, Xiaomei Wang, Farzan Sasangohar. 
Originally published in the Journal of Medical Internet Research 
(http://www.jmir.org), 03.09.2020.

DOI: 10.2196/21279
PMCID: PMC7473764
PMID: 32805704 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


4266. Asian J Psychiatr. 2020 Dec;54:102341. doi: 10.1016/j.ajp.2020.102341. Epub 2020 
Jul 29.

Mental health in India: Neglected component of wellbeing in COVID-19 era.

Goyal K(1), Sheoran S(2), Chauhan P(3), Chhikara K(4), Gupta P(5), Singh MP(6).

Author information:
(1)Department of Virology, Postgraduate Institute of Medical Education and 
Research, Chandigarh, India. Electronic address: kapilgoyalpgi@gmail.com.
(2)Department of Virology, Postgraduate Institute of Medical Education and 
Research, Chandigarh, India. Electronic address: sunitasheoran643@gmail.com.
(3)Department of Virology, Postgraduate Institute of Medical Education and 
Research, Chandigarh, India. Electronic address: chauhan.poonamk@gmail.com.
(4)Department of Virology, Postgraduate Institute of Medical Education and 
Research, Chandigarh, India. Electronic address: dimpichhikara@gmail.com.
(5)Department of Virology, Postgraduate Institute of Medical Education and 
Research, Chandigarh, India. Electronic address: parakritii@gmail.com.
(6)Department of Virology, Postgraduate Institute of Medical Education and 
Research, Chandigarh, India. Electronic address: minipsingh@gmail.com.

DOI: 10.1016/j.ajp.2020.102341
PMCID: PMC7388818
PMID: 32805625 [Indexed for MEDLINE]

Conflict of interest statement: None.


4267. J Anesth. 2020 Dec;34(6):944-949. doi: 10.1007/s00540-020-02840-5. Epub 2020 Aug 
17.

Analogy between classical Yoga/Zen breathing and modern clinical respiratory 
therapy.

Tobe M(1), Saito S(2).

Author information:
(1)Department of Anesthesiology, Gunma University Graduate School of Medicine, 
3-39-22, Showa, Maebashi, Gunma, 371-8511, Japan. to-be@f3.dion.ne.jp.
(2)Department of Anesthesiology, Gunma University Graduate School of Medicine, 
3-39-22, Showa, Maebashi, Gunma, 371-8511, Japan.

Anesthesiologists and intensivists are modern-day professionals who provide 
appropriate respiratory care, vital for patient survival. Recently, 
anesthesiologists have increasingly focused their attention on the type of 
spontaneous breathing made by non-intubated patients with pulmonary disease 
cared for in an intensive care unit, and also patients with chronic pain 
receiving cognitive behavioral therapy. Prior to our modern understanding of 
respiratory physiology, Zen meditators recognized that breathing has a 
significant impact on a person's mental state and general physical well-being. 
Examples of this knowledge regarding respiration include the beneficial effects 
of deep inhalation and slow exhalation on anxiety and general wellness. The 
classical literature has noted many suggestions for breathing and its 
psycho-physical effects. In the present review, we examine the effect of 
classical breathing methods and find an analogy between typical Yoga/Zen 
breathing and modern clinical respiratory therapy. Evidence is increasing about 
historical breathing and related meditation techniques that may be effective in 
modern clinical practice, especially in the field of anesthesiology, such as in 
improving respiratory function and reducing chronic pain. Clarification of the 
detailed mechanisms involved is anticipated.

DOI: 10.1007/s00540-020-02840-5
PMCID: PMC7429199
PMID: 32803435 [Indexed for MEDLINE]


4268. Psychiatr Danub. 2020 Summer;32(2):280-286. doi: 10.24869/psyd.2020.280.

COVID-19 Pandemic: Psycho-social Consequences During the Social Distancing 
Period Among Najran City Population.

Al-Qahtani AM(1), Elgzar WT, Ibrahim HA.

Author information:
(1)Family Medicine Department, College of Medicine, Najran University, Najran, 
Saudi Arabia.

BACKGROUND: COVID-19 is a global pandemic that endanger the health and enforced 
social distancing for the whole world. Social distancing may generate stress, 
anxiety, and depression. Understanding the psychosocial consequences of COVID19 
during social distancing may help decision-makers to take suitable decisions 
that help in increasing awareness. Evaluate the psychosocial consequences of 
COVID-19 pandemic during the social distancing period and explore the 
relationship between social media use and psychological stress during COVID-19 
outbreak among Najran city population. Research design is descriptive 
correlational research design.
SUBJECTS AND METHODS: A snowball sampling technique, was used to recruit 
participants live in Najran city during the COVID-19 pandemic (1508 
participant).
RESULTS: A statistically significant differences (P<0.05) are observed between 
Saudi and non-Saudi participants in all social aspects assessed except for time 
spent on social media. In addition, a high mean of depression, stress, and 
anxiety subscale scores are observed in non-Saudi compared to the Saudi 
participants with statistically significant differences (p=0.000). As well as 
high DASS-21 total scores in non-Saudi compared to the Saudi participants. Also, 
there are positive statistically significant correlations (≤0.05) between 
participants' time spent in social media and their depression, stress, anxiety, 
and total DASS scores during the COVID-19 outbreak.
CONCLUSION: The findings of the present study indicate that COVID-19 pandemic 
generates stress, anxiety and depression among Najran population especially, 
non-Saudi. This poor psychological condition is exaggerated with prolonged 
social media use. COVID-19 also has negative impact on social wellbeing and use 
of social media cannot replace direct contact with friends. The current study 
results may be utilized to formulate interventions that enhance psychosocial 
health and resilience during the COVID-19 outbreak.

DOI: 10.24869/psyd.2020.280
PMID: 32796799 [Indexed for MEDLINE]


4269. Child Adolesc Ment Health. 2020 Sep;25(3):187-188. doi: 10.1111/camh.12409. Epub 
2020 Aug 13.

Debate: Promoting capabilities for young people's agency in the COVID-19 
outbreak.

Pavarini G(1), Lyreskog D(1), Manku K(1), Musesengwa R(1), Singh I(1).

Author information:
(1)Department of Psychiatry and Wellcome Centre for Ethics and Humanities, 
University of Oxford, Oxford, UK.

The COVID-19 pandemic is having a pervasive effect on young people's mental 
health and well-being, giving rise to feelings of deep uncertainty and lack of 
control. Inspired by Amartya Sen's capabilities framework, we argue that 
building capacity and creating opportunities for community and civic engagement 
during this time will help young people gain agency and well-being. We highlight 
two key areas for participatory engagement: coproduction of research, and 
peer-led interventions. Providing capabilities for young people's agency not 
only builds personal resilience, but also strengthens the quality of our 
research, interventions and overall response to the global health crisis.

© 2020 The Authors. Child and Adolescent Mental Health published by John Wiley & 
Sons Ltd on behalf of Association for Child and Adolescent Mental Health.

DOI: 10.1111/camh.12409
PMCID: PMC7436863
PMID: 32791558 [Indexed for MEDLINE]


4270. PLoS One. 2020 Aug 13;15(8):e0237631. doi: 10.1371/journal.pone.0237631. 
eCollection 2020.

Subjective ratings of emotive stimuli predict the impact of the COVID-19 
quarantine on affective states.

López-Carral H(1)(2), Grechuta K(1), Verschure PFMJ(1)(3).

Author information:
(1)Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems (SPECS), 
Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of 
Science and Technology (BIST), Barcelona, Spain.
(2)Universitat Pompeu Fabra (UPF), Barcelona, Spain.
(3)Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain.

The COVID-19 crisis resulted in a large proportion of the world's population 
having to employ social distancing measures and self-quarantine. Given that 
limiting social interaction impacts mental health, we assessed the effects of 
quarantine on emotive perception as a proxy of affective states. To this end, we 
conducted an online experiment whereby 112 participants provided affective 
ratings for a set of normative images and reported on their well-being during 
COVID-19 self-isolation. We found that current valence ratings were 
significantly lower than the original ones from 2015. This negative shift 
correlated with key aspects of the personal situation during the confinement, 
including working and living status, and subjective well-being. These findings 
indicate that quarantine impacts mood negatively, resulting in a negatively 
biased perception of emotive stimuli. Moreover, our online assessment method 
shows its validity for large-scale population studies on the impact of COVID-19 
related mitigation methods and well-being.

DOI: 10.1371/journal.pone.0237631
PMCID: PMC7425917
PMID: 32790759 [Indexed for MEDLINE]

Conflict of interest statement: The authors of this manuscript have the 
following competing interests: PFMJV is the founder and interim CEO of Eodyne 
S.L., which aims at bringing scientifically validated neurorehabilitation 
technology to society. This does not alter our adherence to PLOS ONE’s policies 
on sharing data and materials. The rest of the authors have nothing to disclose.


4271. J Med Internet Res. 2020 Sep 11;22(9):e20955. doi: 10.2196/20955.

Excessive Media Consumption About COVID-19 is Associated With Increased State 
Anxiety: Outcomes of a Large Online Survey in Russia.

Nekliudov NA(#)(1), Blyuss O(#)(1)(2), Cheung KY(3), Petrou L(3)(4), Genuneit 
J(5), Sushentsev N(6), Levadnaya A(7), Comberiati P(8), Warner JO(#)(3), 
Tudor-Williams G(#)(9), Teufel M(#)(10), Greenhawt M(#)(11), DunnGalvin 
A(#)(1)(12), Munblit D(#)(1)(9)(13).

Author information:
(1)Department of Paediatrics and Paediatric Infectious Diseases, Institute of 
Child's Health, Sechenov First Moscow State Medical University (Sechenov 
University), Moscow, Russian Federation.
(2)School of Physics, Astronomy and Mathematics, University of Hertfordshire, 
Hatfield, United Kingdom.
(3)Inflammation, Repair and Development Section, National Heart and Lung 
Institute, Faculty of Medicine, Imperial College London, London, United Kingdom.
(4)Department of Bioengineering, Imperial College London, London, United 
Kingdom.
(5)Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig 
University, Leipzig, Germany.
(6)Department of Radiology, Addenbrooke's Hospital and University of Cambridge, 
Cambridge, United Kingdom.
(7)National Medical Research Center for Obstetrics, Gynecology and Perinatology, 
Moscow, Russian Federation.
(8)Department of Clinical and Experimental Medicine, Section of Pediatrics, 
University of Pisa, Pisa, Italy.
(9)Department of Infectious Disease, Faculty of Medicine, Imperial College 
London, London, United Kingdom.
(10)Clinic for Psychosomatic Medicine and Psychotherapy, LVR University 
Hospital, University of Duisburg-Essen, Essen, Germany.
(11)Department of Pediatrics, Section of Allergy/Immunology, Children's Hospital 
Colorado, University of Colorado School of Medicine, Aurora, CO, United States.
(12)Applied Psychology and Paediatrics and Child Health, University College 
Cork, Cork, Ireland.
(13)Solov'ev Research and Clinical Center for Neuropsychiatry, Moscow, Russian 
Federation.
(#)Contributed equally

BACKGROUND: The COVID-19 pandemic has potentially had a negative impact on the 
mental health and well-being of individuals and families. Anxiety levels and 
risk factors within particular populations are poorly described.
OBJECTIVE: This study aims to evaluate confidence, understanding, trust, 
concerns, and levels of anxiety during the COVID-19 pandemic in the general 
population and assess risk factors for increased anxiety.
METHODS: We launched a cross-sectional online survey of a large Russian 
population between April 6 and 15, 2020, using multiple social media platforms. 
A set of questions targeted confidence, understanding, trust, and concerns in 
respondents. The State-Trait Anxiety Inventory was used to measure anxiety. 
Multiple linear regressions were used to model predictors of COVID-19-related 
anxiety.
RESULTS: The survey was completed by 23,756 out of 53,966 (44.0% response rate) 
unique visitors; of which, 21,364 were residing in 62 areas of Russia. State 
Anxiety Scale (S-Anxiety) scores were higher than Trait Anxiety Scale scores 
across all regions of Russia (median S-Anxiety score 52, IQR 44-60), exceeding 
published norms. Time spent following news on COVID-19 was strongly associated 
with an increased S-Anxiety adjusted for baseline anxiety level. One to two 
hours spent reading COVID-19 news was associated with a 5.46 (95% CI 5.03-5.90) 
point difference, 2-3 hours with a 7.06 (95% CI 6.37-7.74) point difference, and 
more than three hours with an 8.65 (95% CI 7.82-9.47) point difference, all 
compared to less than 30 minutes per day. Job loss during the pandemic was 
another important factor associated with higher S-Anxiety scores (3.95, 95% CI 
3.31-4.58). Despite survey respondents reporting high confidence in information 
regarding COVID-19 as well as an understanding of health care guidance, they 
reported low overall trust in state and local authorities, and perception of 
country readiness.
CONCLUSIONS: Among Russian respondents from multiple social media platforms, 
there was evidence of higher levels of state anxiety associated with recent job 
loss and increased news consumption, as well as lower than expected trust in 
government agencies. These findings can help inform the development of key 
public health messages to help reduce anxiety and raise perceived trust in 
governmental response to this current national emergency. Using a similar 
methodology, comparative surveys are ongoing in other national populations.

©Nikita A Nekliudov, Oleg Blyuss, Ka Yan Cheung, Loukia Petrou, Jon Genuneit, 
Nikita Sushentsev, Anna Levadnaya, Pasquale Comberiati, John O Warner, Gareth 
Tudor-Williams, Martin Teufel, Matthew Greenhawt, Audrey DunnGalvin, Daniel 
Munblit. Originally published in the Journal of Medical Internet Research 
(http://www.jmir.org), 11.09.2020.

DOI: 10.2196/20955
PMCID: PMC7490003
PMID: 32788143 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


4272. Psychol Med. 2022 May;52(7):1321-1332. doi: 10.1017/S0033291720003116. Epub 2020 
Aug 13.

Immediate and delayed psychological effects of province-wide lockdown and 
personal quarantine during the COVID-19 outbreak in China.

Gan Y(1), Ma J(1), Wu J(2), Chen Y(1), Zhu H(1), Hall BJ(3)(4).

Author information:
(1)School of Psychological and Cognitive Sciences and Beijing Key Laboratory of 
Behavior and Mental Health, Peking University, Beijing, People's Republic of 
China.
(2)School of Psychology, Shenzhen University, Shenzhen, People's Republic of 
China.
(3)Global and Community Mental Health Research Group, New York University 
(Shanghai), Shanghai, People's Republic of China.
(4)Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public 
Health, Baltimore, MD, USA.

BACKGROUND: The COVID-19 pandemic has greatly affected public health and 
wellbeing. In response to the pandemic threat of the coronavirus epidemic, 
several countries, including China, adopted lockdown and quarantine policies, 
which may cause psychological distress. This study aimed to explore the 
psychological impact of province-wide lockdown and personal quarantine during 
the COVID-19 outbreak in China as well as the corresponding risk factors and 
protective factors.
METHODS: We examined the immediate (2-week) and delayed (2-month) impact of 
province-wide lockdown and personal quarantine on psychological distress in a 
national sample of 1390 Chinese residents.
RESULTS: No immediate impact of province-wide lockdown on psychological distress 
was observed, whereas personal quarantine increased individuals' anxiety, fear, 
and anger. Despite the lack of initial association, psychological distress 
increased among those in province-wide lockdown. Self-stigma and personal 
control both significantly moderated the association between lockdown and 
psychological distress, but in different directions. Those with higher 
self-stigma and lower personal control were more impacted by the lockdown. 
Government support moderated the impact of quarantine on psychological distress, 
but not that of lockdown.
CONCLUSIONS: The delayed effects of lockdown and quarantine on psychological 
distress were observed, and self-stigma, social support, and perceived control 
moderate the relationships. This study is the first to demonstrate the 
psychological costs of province-wide lockdowns on individuals' mental health, 
providing evidence of the need for mitigation strategies and timely public 
mental health preparedness in countries with recent outbreaks of COVID-19.

DOI: 10.1017/S0033291720003116
PMCID: PMC7450230
PMID: 32787981 [Indexed for MEDLINE]

Conflict of interest statement: None.


4273. Psychol Med. 2022 May;52(7):1395-1398. doi: 10.1017/S0033291720003128. Epub 2020 
Aug 13.

Development of health care workers' mental health during the SARS-CoV-2 pandemic 
in Switzerland: two cross-sectional studies.

Spiller TR(1)(2), Méan M(3), Ernst J(4), Sazpinar O(5), Gehrke S(2), Paolercio 
F(6), Petry H(4), Pfaltz MC(1)(2), Morina N(1)(2), Aebischer O(7), Gachoud 
D(3)(7), von Känel R(1)(2), Weilenmann S(2)(6).

Author information:
(1)Department of Medicine, University of Zurich, Zurich, Switzerland.
(2)University of Zurich and Department of Consultation-Liaison Psychiatry and 
Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland.
(3)Department of Internal Medicine, Lausanne University Hospital, Lausanne, 
Switzerland.
(4)Center for Clinical Nursing Science, University Hospital Zurich, Zurich, 
Switzerland.
(5)Department of Internal Medicine, Spital Zollikerberg, Zollikon, Switzerland.
(6)Department of Psychology, University of Zurich, Zurich, Switzerland.
(7)Educational Unit, School of Medicine, Faculty of Biology and Medicine, 
University of Lausanne, Lausanne, Switzerland.

BACKGROUND: Virus outbreaks such as the current SARS-CoV-2 pandemic are 
challenging for health care workers (HCWs), affecting their workload and their 
mental health. Since both, workload and HCW's well-being are related to the 
quality of care, continuous monitoring of working hours and indicators of mental 
health in HCWs is of relevance during the current pandemic. The existing 
investigations, however, have been limited to a single study period. We examined 
changes in working hours and mental health in Swiss HCWs at the height of the 
pandemic (T1) and again after its flattening (T2).
METHODS: We conducted two cross-sectional online studies among Swiss HCWs 
assessing working hours, depression, anxiety, and burnout. From each study, 812 
demographics-matched participants were included into the analysis. Working hours 
and mental health were compared between the two samples.
RESULTS: Compared to prior to the pandemic, the share of participants working 
less hours was the same in both samples, whereas the share of those working more 
hours was lower in the T2 sample. The level of depression did not differ between 
the samples. In the T2 sample, participants reported more anxiety, however, this 
difference was below the minimal clinically important difference. Levels of 
burnout were slightly higher in the T2 sample.
CONCLUSIONS: Two weeks after the health care system started to transition back 
to normal operations, HCWs' working hours still differed from their regular 
hours in non-pandemic times. Overall anxiety and depression among HCWs did not 
change substantially over the course of the current SARS-CoV-2 pandemic.

DOI: 10.1017/S0033291720003128
PMCID: PMC7450239
PMID: 32787976 [Indexed for MEDLINE]

Conflict of interest statement: We have no conflict of interest to declare.


4274. J Orthop Surg Res. 2020 Aug 12;15(1):322. doi: 10.1186/s13018-020-01862-9.

The psychological impact on an orthopaedic outpatient setting in the early phase 
of the COVID-19 pandemic: a cross-sectional study.

Wong KC(1), Han XA(2), Tay KS(2), Koh SB(2), Howe TS(2).

Author information:
(1)Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, 
Singapore. khaicheong.wong@mohh.com.sg.
(2)Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, 
Singapore.

BACKGROUND: World Health Organization declared coronavirus disease-19 (COVID-19) 
a global pandemic on 11 March 2020, after the coronavirus claimed 4628 lives 
worldwide. Mental health challenges such as making impossible decisions and 
working under extreme pressures are expected to be faced by frontline healthcare 
workers who are directly involved in the care of COVID-19 patients. However, we 
question if significant stress levels might also be observed in a subspecialty 
musculoskeletal outpatient department, where staff are not first-line care 
providers of COVID-19 patients. We hypothesize that these healthcare workers 
also face significant psychological strain, and we aim to objectively determine 
the prevalence using a validated caregiver strain index.
METHODS: A cross-sectional study was conducted in outpatient musculoskeletal 
clinics in a tertiary hospital in Singapore. We collected basic demographic data 
and used a 13-question tool adapted from the validated Caregiver Strain Index 
(CSI) to measure psychological strain in these healthcare workers. Participants 
were divided into 2 groups depending on the level of strain experienced.
RESULTS: A total of 62 healthcare workers volunteered for this study. There were 
32 participants (51.6%) who had 7 or more positive responses (group 1) and the 
remaining 30 participants (48.4%) were allocated to group 2. There were no 
significant differences between the two groups in terms of demographic data. 
"Work adjustments" (74.2%), "changes in personal plans" (72.6%), and finding it 
"confining" (72.6%) garnered the most positive responses in the questionnaire. 
On the other hand, "financial concerns" garnered the least positive responses 
(21.0%).
CONCLUSION: The protracted duration of the COVID-19 outbreak and its resultant 
prolonged adjustments can have unintended consequences of wearing down 
healthcare resources otherwise allocated to chronic and elective conditions. 
Countries should ensure that measures are put in place to safeguard the mental 
well-being of our healthcare workers to avoid needing another reactive strategy 
in this battle against COVID-19.

DOI: 10.1186/s13018-020-01862-9
PMCID: PMC7422671
PMID: 32787965 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


4275. BMC Public Health. 2020 Aug 12;20(1):1230. doi: 10.1186/s12889-020-09322-z.

Psychological impact of an epidemic/pandemic on the mental health of healthcare 
professionals: a rapid review.

Stuijfzand S(1), Deforges C(1), Sandoz V(1), Sajin CT(1), Jaques C(2), Elmers 
J(2), Horsch A(3)(4).

Author information:
(1)Institute of Higher Education and Research in Healthcare (IUFRS), University 
of Lausanne, Route de la Corniche 10, 1010, Lausanne, Switzerland.
(2)Medical Library, Lausanne University Hospital and University of Lausanne, Rue 
du Bugnon 46, 1011, Lausanne, Switzerland.
(3)Institute of Higher Education and Research in Healthcare (IUFRS), University 
of Lausanne, Route de la Corniche 10, 1010, Lausanne, Switzerland. 
Antje.Horsch@chuv.ch.
(4)Department Woman-Mother-Child, Lausanne University Hospital, Avenue 
Pierre-Decker 2, 1011, Lausanne, Switzerland. Antje.Horsch@chuv.ch.

BACKGROUND: Epidemics or pandemics, such as the current Coronavirus Disease 2019 
(COVID-19) crisis, pose unique challenges to healthcare professionals (HCPs). 
Caring for patients during an epidemic/pandemic may impact negatively on the 
mental health of HCPs. There is a lack of evidence-based advice on what would be 
effective in mitigating this impact.
OBJECTIVES: This rapid review synthesizes the evidence on the psychological 
impact of pandemics/epidemics on the mental health of HCPs, what factors predict 
this impact, and the evidence of prevention/intervention strategies to reduce 
this impact.
METHOD: According to rapid review guidelines, systematic searches were carried 
out in Embase.com , PubMed, APA PsycINFO-Ovid SP, and Web of Science (core 
collection). Searches were restricted to the years 2003 or later to ensure 
inclusion of the most recent epidemic/pandemics, such as Severe Acute 
Respiratory Syndrome (SARS). Papers written in French or English, published in 
peer-reviewed journals, and of quantitative design using validated measures of 
mental health outcomes were included. Of 1308 papers found, 50 were included. 
The full protocol for this rapid review was registered with Prospero (reg.no. 
CRD42020175985).
RESULTS: Results show that exposed HCPs working with patients during an 
epidemic/pandemic are at heightened risk of mental health problems in the short 
and longer term, particularly: psychological distress, insomnia, alcohol/drug 
misuse, and symptoms of posttraumatic stress disorder (PTSD), depression, 
anxiety, burnout, anger, and higher perceived stress. These mental health 
problems are predicted by organizational, social, personal, and psychological 
factors and may interfere with the quality of patient care. Few evidence-based 
early interventions exist so far.
DISCUSSION: HCPs need to be provided with psychosocial support to protect their 
mental wellbeing if they are to continue to provide high quality patient care. 
Several recommendations relevant during and after an epidemic/pandemic, such as 
COVID-19, and in preparation for a future outbreak, are proposed.

DOI: 10.1186/s12889-020-09322-z
PMCID: PMC7422454
PMID: 32787815 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was 
conducted in the absence of any commercial or financial relationships that could 
be construed as a potential conflict of interest.


4276. Afr J Prim Health Care Fam Med. 2020 Aug 11;12(1):e1-e3. doi: 
10.4102/phcfm.v12i1.2512.

Recommendations for a national Coronavirus disease 2019 response guideline for 
the care of older persons in Nigeria during and post-pandemic: A family 
physician's perspective.

Olagundoye O(1), Enema O, Adebowale A.

Author information:
(1)Department of Family Medicine, General Hospital Lagos, Lagos Island. 
olabima@yahoo.com.

The older persons in our society are a special group of people in need of 
additional measures of care and protection. They have medical, financial, 
emotional and social needs. The novel Coronavirus disease 2019 (COVID-19) only 
exacerbates those needs. COVID-19 is a new disease, and there is limited 
information regarding the disease. Based on currently available information, 
older persons and people of any age who have serious underlying medical 
conditions may be at higher risk of severe illness from COVID-19. Family 
physicians provide care for individuals across their lifespan. Because 
geriatricians are internists or family physicians with post-residency training 
in geriatric medicine, they are major stakeholders in geriatric care. The 
authors are concerned about the absence of a COVID-19 response guideline/special 
advisory targeting the vulnerable population of older adults. The management and 
response to COVID-19 will be implemented in part based on the local context of 
available resources. Nigeria has been described as a resource-constrained 
nation. Infection prevention in older persons in Nigeria will far outweigh the 
possibilities of treatment given limited resources. The aim was to recommend 
actionable strategies to prevent COVID-19-related morbidity or mortality among 
older persons in Nigeria and to promote their overall well-being during and 
after the pandemic. These recommendations cut across the geriatric medicine 
domains of physical health, mental health, functioning ability and 
socio-environmental situation.

DOI: 10.4102/phcfm.v12i1.2512
PMCID: PMC7479416
PMID: 32787399 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


4277. Int J Environ Res Public Health. 2020 Aug 7;17(16):5728. doi: 
10.3390/ijerph17165728.

Risk Perception and Depression in Public Health Crises: Evidence from the 
COVID-19 Crisis in China.

Ding Y(1), Xu J(2), Huang S(2), Li P(2), Lu C(2), Xie S(2).

Author information:
(1)Undergraduate College, Central China Normal University, Wuhan 430079, China.
(2)College of Public Administration, Central China Normal University, Wuhan 
430079, China.

Background: Scant attention has been paid to how risk perceptions of public 
health crises may affect people's mental health. Aims: The aims of this study 
are to (1) construct a conceptual framework for risk perception and depression 
of people in public health crises, (2) examine how the mental health of people 
in the crisis of Coronavirus Disease 2019 (COVID-19) is affected by risk 
perception and its associated factors, including distance perception of the 
crisis and support of prevention and control policies, and (3) propose policy 
recommendations on how to deal with psychological problems in the current 
COVID-19 crisis. Methods: Online questionnaire survey was implemented. A total 
of 6373 people visited the questionnaire online, 1115 people completed the 
questionnaire, and the number of valid questionnaires was 1081. Structural 
equation modeling was employed for data analysis. Results: Risk perception and 
its associated factors significantly affect the mental health of people in 
public health crises. Specifically, (1) distance perception of public health 
crises is negatively associated with depression among people, (2) affective risk 
perception is positively associated with depression of people in public health 
crises, (3) cognitive risk perception is negatively associated with depression 
of people in public health crises, and (4) support of prevention and control 
policies is negatively associated with depression of people in public health 
crises. Conclusion: The findings of this study suggest that risk perception 
plays an important role in affecting the mental health of people in a public 
health crisis. Therefore, health policies aiming to improve the psychological 
wellbeing of the people in a public health crisis should take risk perception 
into consideration.

DOI: 10.3390/ijerph17165728
PMCID: PMC7460398
PMID: 32784792 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


4278. J Gerontol B Psychol Sci Soc Sci. 2021 Jan 18;76(2):e53-e58. doi: 
10.1093/geronb/gbaa110.

The Impact of Sheltering in Place During the COVID-19 Pandemic on Older Adults' 
Social and Mental Well-Being.

Krendl AC(1), Perry BL(2).

Author information:
(1)Department of Psychological & Brain Sciences, Indiana University, 
Bloomington.
(2)Department of Sociology, Indiana University, Bloomington.

OBJECTIVES: We examined whether social isolation due to the COVID-19 
shelter-in-place orders was associated with greater loneliness and depression 
for older adults, and, if so, whether declines in social engagement or 
relationship strength moderated that relationship.
METHODS: Between April 21 and May 21, 2020, 93 older adults in the United States 
who had completed measures characterizing their personal social networks, 
subjective loneliness, and depression 6-9 months prior to the pandemic completed 
the same measures via phone interview, as well as questions about the impact of 
the pandemic on their social relationships.
RESULTS: Older adults reported higher depression and greater loneliness 
following the onset of the pandemic. Loneliness positively predicted depression. 
Perceived relationship strength, but not social engagement, moderated this 
relationship such that loneliness only predicted depression for individuals who 
became closer to their networks during the pandemic. For those who felt less 
close, depression was higher irrespective of loneliness.
DISCUSSION: The COVID-19 pandemic negatively affected older adults' mental 
health and social well-being in the short term. Potential long-term impacts are 
considered.

© The Author(s) 2020. Published by Oxford University Press on behalf of The 
Gerontological Society of America. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/geronb/gbaa110
PMCID: PMC7454869
PMID: 32778899 [Indexed for MEDLINE]


4279. Asian J Psychiatr. 2020 Dec;54:102331. doi: 10.1016/j.ajp.2020.102331. Epub 2020 
Aug 2.

Iranian older adult's mental wellbeing during the COVID-19 epidemic.

Peyman N(1), Olyani S(2).

Author information:
(1)Professor of Health Education and Health Promotion, Department of Health 
Education and Health Promotion, School of Health, Mashhad University of Medical 
Sciences, Mashhad, Iran; Social Determinants of Health Research Center, Mashhad 
University of Medical Sciences, Mashhad, Iran. Electronic address: 
Peymann@mums.ac.ir.
(2)Student Research Committee, Mashhad University of Medical Sciences, Mashhad, 
Iran; PhD Student in Health Education and Health Promotion, Department of Health 
Education and Health Promotion, School of Health, Social Determinants of Health 
Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. 
Electronic address: Alianis971@mums.ac.ir.

DOI: 10.1016/j.ajp.2020.102331
PMCID: PMC7396135
PMID: 32777754 [Indexed for MEDLINE]

Conflict of interest statement: None.


4280. Br J Anaesth. 2020 Oct;125(4):450-455. doi: 10.1016/j.bja.2020.07.011. Epub 2020 
Jul 23.

Impact of the COVID-19 pandemic on anaesthesia trainees and their training.

Sneyd JR(1), Mathoulin SE(2), O'Sullivan EP(3), So VC(4), Roberts FR(5), Paul 
AA(6), Cortinez LI(7), Ampofo RS(8), Miller CJ(9), Balkisson MA(10).

Author information:
(1)Peninsula Medical School, University of Plymouth, Plymouth, UK. Electronic 
address: robert.sneyd@pms.ac.uk.
(2)Department of Anaesthesia, University Hospitals Plymouth NHS Trust, Plymouth, 
UK.
(3)Department of Anaesthesia, St James' Hospital, Dublin, Ireland.
(4)Department of Anaesthesiology, Queen Mary Hospital, Hong Kong; Department of 
Anaesthesiology, University of Hong Kong, Hong Kong.
(5)Department of Anaesthesia, St Vincent's University Hospital, Dublin, Ireland.
(6)Department of Anaesthesia, Alfred Hospital, Melbourne, Australia.
(7)Department of Anesthesia, Pontificia Universidad Catolica de Chile, Santiago, 
Chile.
(8)Department of Education, Training and Examinations, Royal College of 
Anaesthetists, London, UK.
(9)Department of Anesthesiology, University of Texas Health Science Centre at 
Houston, Houston, TX, USA.
(10)Department of Anaesthesia and Critical Care, Nelson R. Mandela School of 
Medicine, University of KwaZulu-Natal, Durban, South Africa.

Comment in
    J Neurosurg Anesthesiol. 2021 Apr 1;33(2):97-98.

Coronavirus disease 2019 (COVID-19; severe acute respiratory syndrome 
coronavirus 2 [SARS-CoV-2] has dislocated clinical services and postgraduate 
training. To better understand and to document these impacts, we contacted 
anaesthesia trainees and trainers across six continents and collated their 
experiences during the pandemic. All aspects of training programmes have been 
affected. Trainees report that reduced caseload, sub-specialty experience, and 
supervised procedures are impairing learning. Cancelled educational activities, 
postponed examinations, and altered rotations threaten progression through 
training. Job prospects and international opportunities are downgraded. 
Work-related anxieties about provision of personal protective equipment, and 
risks to self and to colleagues are superimposed on concerns for family and 
friends and domestic disruption. These seismic changes have had consequences for 
well-being and mental health. In response, anaesthetists have developed 
innovations in teaching and trainee support. New technologies support 
trainer-trainee interactions, with a focus on e-learning. National training 
bodies and medical regulators that specify training and oversee assessment of 
trainees and their progression have provided flexibility in their requirements. 
Within anaesthesia departments, support transcends grades and job titles with 
lessons for the future. Attention to wellness, awareness of mental health issues 
and multimodal support can attenuate but not eliminate trainee distress.

Copyright © 2020 British Journal of Anaesthesia. All rights reserved.

DOI: 10.1016/j.bja.2020.07.011
PMCID: PMC7377727
PMID: 32773215 [Indexed for MEDLINE]


4281. J Nurs Manag. 2020 Oct;28(7):1653-1661. doi: 10.1111/jonm.13121. Epub 2020 Aug 
21.

COVID-19 anxiety among front-line nurses: Predictive role of organisational 
support, personal resilience and social support.

Labrague LJ(1), De Los Santos JAA(2).

Author information:
(1)College of Nursing, Sultan Qaboos University, Muscat, Oman.
(2)College of Nursing, Visayas State University, Leyte, Philippines.

AIM: This study examines the relative influence of personal resilience, social 
support and organisational support in reducing COVID-19 anxiety in front-line 
nurses.
BACKGROUND: Anxiety related to the COVID-19 pandemic is prevalent in the nursing 
workforce, potentially affecting nurses' well-being and work performance. 
Identifying factors that could help maintain mental health and reduce 
coronavirus-related anxiety among front-line nurses is imperative. Currently, no 
studies have been conducted examining the influence of personal resilience, 
social support and organisational support in reducing COVID-19 anxiety among 
nurses.
METHODS: This cross-sectional study involved 325 registered nurses from the 
Philippines using four standardized scales.
RESULTS: Of the 325 nurses in the study, 123 (37.8%) were found to have 
dysfunctional levels of anxiety. Using multiple linear regression analyses, 
social support (β = -0.142, p = .011), personal resilience (β = -0.151, 
p = .008) and organisational support (β = -0.127, p = .023) predicted COVID-19 
anxiety. Nurse characteristics were not associated with COVID-19 anxiety.
CONCLUSIONS: Resilient nurses and those who perceived higher organisational and 
social support were more likely to report lower anxiety related to COVID-19.
IMPLICATION FOR NURSING MANAGEMENT: COVID-19 anxiety may be addressed through 
organisational interventions, including increasing social support, assuring 
adequate organisational support, providing psychological and mental support 
services and providing resilience-promoting and stress management interventions.

© 2020 John Wiley & Sons Ltd.

DOI: 10.1111/jonm.13121
PMCID: PMC7436313
PMID: 32770780 [Indexed for MEDLINE]

Conflict of interest statement: All authors declare no conflict of interest.


4282. Pediatr Crit Care Med. 2020 Dec;21(12):e1099-e1105. doi: 
10.1097/PCC.0000000000002564.

School Performance After Pediatric Intensive Care-Association of Mental 
Well-Being, Chronic Illnesses, and Family Socioeconomic Status.

Kyösti E(1)(2), Peltoniemi O(1)(2)(3)(4)(5)(6)(7), Liisanantti JH(1)(2), Ohtonen 
P(2), Ebeling H(3)(5), Spalding M(1)(2), Rautiainen P(6), Kataja J(7), Ala-Kokko 
TI(1)(2).

Author information:
(1)Research Group of Surgery, Anaesthesiology and Intensive Care Medicine, 
Division of Intensive Care Medicine, Oulu University Hospital, Oulu, Finland.
(2)Medical Research Center of Oulu University and Oulu University Hospital, 
Oulu, Finland.
(3)PEDEGO Research Unit, University of Oulu, Oulu, Finland.
(4)Division of Intensive Care Medicine, Department of Paediatrics, Oulu 
University Hospital, Oulu, Finland.
(5)Clinic of Child Psychiatry, Oulu University Hospital, Oulu, Finland.
(6)Department of Anaesthesia and Intensive Care, Children's Hospital, Helsinki 
University Hospital and University of Helsinki, Helsinki, Finland.
(7)Division of Intensive Care Medicine, Department of Paediatrics and Adolescent 
Medicine, Turku University Hospital, Turku, Finland.

OBJECTIVES: To describe school performance in pediatric intensive care 
survivors, as well as the influence of chronic diseases, psychological 
well-being, and family socioeconomic status on poor school performance.
DESIGN: Register-based observational descriptive follow-up study.
SETTING: A multicenter national study.
PATIENTS: All pediatric patients who were admitted to an ICU in Finland in 
2009-2010. Children and adolescents of or beyond school age.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Questionnaires regarding the child's coping in 
school classes, chronic illnesses, as well as family socioeconomic factors were 
sent to every child alive 6 years after discharge from intensive care in 
Finland. Mental well-being was measured with the Strengths and Difficulties 
Questionnaire. There were 1,109 responders in an ICU group of 3,674 children. 
Seven-hundred fifty-three of the respondents were of school age or older. Of 
these, 13% (101/753) demonstrated poor school performance. Children with 
difficulties in school more often had a need for regular medication (71.3% vs 
32.4%; p < 0.001), healthcare visits (91.1% vs 80.6%; p = 0.01), some regular 
therapy (60.4% vs 13.7%; p < 0.001), chronic illnesses (86.3% vs 48.4%; p < 
0.001), or additional ICU admissions (36.5% vs 14.9%; p = 0.003). Schooling 
difficulties were reported more often in children with abnormal Strengths and 
Difficulties Questionnaire scores compared to those with normal or borderline 
scores (24.8% vs 5.4%; p < 0.001). In an adjusted logistic regression model, 
which included age, number of chronic diseases, and need for therapy, poor 
school performance was predicted by abnormal Strengths and Difficulties 
Questionnaire scores, nonacademic parental education, and paternal manual labor 
status.
CONCLUSIONS: Difficulties in school were more frequent when the child had 
chronic comorbid illnesses, especially neurologic or chromosomal abnormalities, 
had poor mental health, father was employed in manual labor, or parents were 
uneducated.

DOI: 10.1097/PCC.0000000000002564
PMID: 32769702 [Indexed for MEDLINE]


4283. J Nurs Manag. 2020 Oct;28(7):1686-1695. doi: 10.1111/jonm.13124. Epub 2020 Aug 
30.

Acute stress disorder, coping self-efficacy and subsequent psychological 
distress among nurses amid COVID-19.

Shahrour G(1), Dardas LA(2).

Author information:
(1)School of Nursing, Jordan University of Science and Technology, Irbid, 
Jordan.
(2)School of Nursing, The University of Jordan, Amman, Jordan.

PURPOSE: Health care professionals, particularly nurses, are considered a 
vulnerable group to experience acute stress disorder (ASD) and subsequent 
psychological distress amid COVID-19 pandemic. This study aims to establish the 
prevalence of acute stress disorder and predictors of psychological distress 
among Jordanian nurses.
METHODS: A quantitative, cross-sectional, descriptive and comparative design was 
used. Data were collected using a Web-based survey. A total of 448 Jordanian 
nurses (73% females) completed and returned the study questionnaire.
RESULTS: The majority of nurses (64%) are experiencing ASD due to the COVID-19 
pandemic and thus are at risk for PTSD predisposition. More than one-third of 
nurses (41%) are also suffering significant psychological distress. Among our 
sample, age, ASD and coping self-efficacy significantly predicted psychological 
distress. More specifically, younger nurses are more prone to experience 
psychological distress than older ones. While higher scores on ASD showed more 
resultant psychological distress, coping self-efficacy was a protective factor.
CONCLUSION: Given that individuals who suffer from ASD are predisposed to PTSD, 
follow-up with nurses to screen for PTSD and referral to appropriate 
psychological services is pivotal. Coping self-efficacy is found to ameliorate 
the effect of psychological distress on nurses' traumatic experience. Such 
findings warrant intensive efforts from health care institutions to provide 
psychosocial support services for nurses and ongoing efforts to screen them for 
traumatic and psychological distress symptoms.
IMPLICATIONS FOR NURSING MANAGEMENT: Nursing leaders and managers are in the 
forefront of responding to the unique needs of their workforces during the 
COVID-19 crisis. They need to implement stress-reduction strategies for nurses 
through providing consecutive rest days, rotating allocations of complex 
patients, arranging support services and being accessible to staff. They also 
need to ensure nurses' personal safety through securing and providing personal 
safety measures and undertake briefings to ensure their staff's physical and 
mental well-being, as well as providing referrals to appropriate psychological 
services.

© 2020 John Wiley & Sons Ltd.

DOI: 10.1111/jonm.13124
PMCID: PMC7436502
PMID: 32767827 [Indexed for MEDLINE]

Conflict of interest statement: The author has declared that she has no 
competing or potential conflicts of interest.


4284. Pediatrics. 2020 Oct;146(4):e2020007294. doi: 10.1542/peds.2020-007294. Epub 
2020 Aug 6.

COVID-19 and Parent-Child Psychological Well-being.

Gassman-Pines A(1), Ananat EO(2), Fitz-Henley J 2nd(3).

Author information:
(1)Sanford School of Public Policy, Duke University, Durham, North Carolina; and 
agassman.pines@duke.edu.
(2)Department of Economics, Barnard College, Columbia University, New York, New 
York.
(3)Sanford School of Public Policy, Duke University, Durham, North Carolina; 
and.

BACKGROUND AND OBJECTIVES: The outbreak of coronavirus disease 2019 has changed 
American society in ways that are difficult to capture in a timely manner. With 
this study, we take advantage of daily survey data collected before and after 
the crisis started to investigate the hypothesis that the crisis has worsened 
parents' and children's psychological well-being. We also examine the extent of 
crisis-related hardships and evaluate the hypothesis that the accumulation of 
hardships will be associated with parent and child psychological well-being.
METHODS: Daily survey data were collected between February 20 and April 27, 
2020, from hourly service workers with a young child (aged 2-7) in a large US 
city (N = 8222 person-days from 645 individuals). A subsample completed a 
one-time survey about the effects of the crisis fielded between March 23 and 
April 26 (subsample n = 561).
RESULTS: Ordered probit models revealed that the frequency of parent-reported 
daily negative mood increased significantly since the start of the crisis. Many 
families have experienced hardships during the crisis, including job loss, 
income loss, caregiving burden, and illness. Both parents' and children's 
well-being in the postcrisis period was strongly associated with the number of 
crisis-related hardships that the family experienced.
CONCLUSIONS: Consistent with our hypotheses, in families that have experienced 
multiple hardships related to the coronavirus disease 2019 crisis, both parents' 
and children's mental health is worse. As the crisis continues to unfold, 
pediatricians should screen for mental health, with particular attention to 
children whose families are especially vulnerable to economic and disease 
aspects of the crisis.

Copyright © 2020 by the American Academy of Pediatrics.

DOI: 10.1542/peds.2020-007294
PMCID: PMC7546085
PMID: 32764151 [Indexed for MEDLINE]

Conflict of interest statement: POTENTIAL CONFLICT OF INTEREST: The authors have 
indicated they have no potential conflicts of interest to disclose.


4285. J Med Internet Res. 2020 Aug 25;22(8):e21366. doi: 10.2196/21366.

Work-Related and Personal Factors Associated With Mental Well-Being During the 
COVID-19 Response: Survey of Health Care and Other Workers.

Evanoff BA(1)(2), Strickland JR(1)(2), Dale AM(1)(2), Hayibor L(1), Page E(3), 
Duncan JG(1), Kannampallil T(1), Gray DL(1).

Author information:
(1)Washington University School of Medicine, St. Louis, MO, United States.
(2)Healthier Workforce Center of the Midwest, University of Iowa, Iowa City, IA, 
United States.
(3)Human Resources, Washington University in St. Louis, St. Louis, MO, United 
States.

Erratum in
    J Med Internet Res. 2021 Apr 9;23(4):e29069.

BACKGROUND: The response to the severe acute respiratory syndrome coronavirus 2 
(SARS-CoV-2) pandemic has created an unprecedented disruption in work 
conditions. This study describes the mental health and well-being of workers 
both with and without clinical exposure to patients with coronavirus disease 
(COVID-19).
OBJECTIVE: The aim of this study is to measure the prevalence of stress, 
anxiety, depression, work exhaustion, burnout, and decreased well-being among 
faculty and staff at a university and academic medical center during the 
SARS-CoV-2 pandemic and describe work-related and personal factors associated 
with their mental health and well-being.
METHODS: All faculty, staff, and postdoctoral fellows of a university, including 
its medical school, were invited in April 2020 to complete an online 
questionnaire measuring stress, anxiety, depression, work exhaustion, burnout, 
and decreased well-being. We examined associations between these outcomes and 
factors including work in high-risk clinical settings and family/home stressors.
RESULTS: There were 5550 respondents (overall response rate of 34.3%). Overall, 
34% of faculty and 14% of staff (n=915) were providing clinical care, while 61% 
of faculty and 77% of staff were working from home. Among all workers, anxiety 
(prevalence ratio 1.37, 95% CI 1.09-1.73), depression (prevalence ratio 1.28, 
95% CI 1.03-1.59), and high work exhaustion (prevalence ratio 1.24, 95% CI 
1.13-1.36) were independently associated with community or clinical exposure to 
COVID-19. Poor family-supportive behaviors by supervisors were also associated 
with these outcomes (prevalence ratio 1.40, 95% CI 1.21-1.62; prevalence ratio 
1.69, 95% CI 1.48-1.92; and prevalence ratio 1.54, 95% CI 1.44-1.64, 
respectively). Age <40 years and a greater number of family/home stressors were 
also associated with these poorer outcomes. Among the subset of clinicians, 
caring for patients with COVID-19 and working in high-risk clinical settings 
were additional risk factors.
CONCLUSIONS: Our findings suggest that the pandemic has had negative effects on 
the mental health and well-being of both clinical and nonclinical employees. 
Mitigating exposure to COVID-19 and increasing supervisor support are modifiable 
risk factors that may protect mental health and well-being for all workers.

©Bradley A Evanoff, Jaime R Strickland, Ann Marie Dale, Lisa Hayibor, Emily 
Page, Jennifer G Duncan, Thomas Kannampallil, Diana L Gray. Originally published 
in the Journal of Medical Internet Research (http://www.jmir.org), 25.08.2020.

DOI: 10.2196/21366
PMCID: PMC7470175
PMID: 32763891 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


4286. Hum Reprod. 2020 Nov 1;35(11):2556-2566. doi: 10.1093/humrep/deaa218.

Patient experiences of fertility clinic closure during the COVID-19 pandemic: 
appraisals, coping and emotions.

Boivin J(1), Harrison C(1), Mathur R(2)(3), Burns G(4), Pericleous-Smith A(5), 
Gameiro S(1).

Author information:
(1)Cardiff University, School of Psychology, Tower Building, 70 Park Place, 
Cardiff, UK.
(2)Manchester University NHS Foundation Trust, Manchester, UK.
(3)Manchester Academic Health Sciences Centre, Manchester, UK.
(4)Fertility Network UK, London, UK.
(5)British Infertility Counselling Association, York, UK.

STUDY QUESTION: What are appraisals, coping strategies and emotional reactions 
of patients to coronavirus disease 2019 (COVID-19) fertility clinic closures?
SUMMARY ANSWER: Clinic closure was appraised as stressful due to uncertainty and 
threat to the attainability of the parenthood goal but patients were able to 
cope using strategies that fit the uncertainty of the situation.
WHAT IS KNOWN ALREADY: Psychological research on COVID-19 suggests that people 
are more anxious than historical norms and moderately to extremely upset about 
fertility treatment cancellation owing to COVID-19.
STUDY DESIGN, SIZE, DURATION: The study was of cross-sectional design, 
comprising a mixed-methods, English language, anonymous, online survey posted 
from April 9 to 21 to social media. Eligibility criteria were being affected by 
COVID-19 fertility clinic closure, 18 years of age or older and able to complete 
the survey in English. In total, 946 people clicked on the survey link, 76 did 
not consent, 420 started but did not complete the survey and 450 completed (48% 
completion, 446 women, four men).
PARTICIPANTS/MATERIALS, SETTING, METHODS: Overall 74.7% (n = 336) of respondents 
were residents in the UK with an average age of 33.6 years (SD = 4.4) and 
average years trying to conceive, 3.5 years (SD = 2.22). The survey comprised 
quantitative questions about the intensity of cognitive appraisals and emotions 
about clinic closure, and ability to cope with clinic closure. Open-text 
questions covered their understanding of COVID-19 and its effect on reproductive 
health and fertility plans, concerns and perceived benefits of clinic closure, 
and knowledge about closure. Sociodemographic information was collected. 
Descriptive and inferential statistics were used on quantitative data. Thematic 
qualitative analysis (inductive coding) was performed on the textual data from 
each question. Deductive coding grouped themes from each question into 
meta-themes related to cognitive stress and coping theory.
MAIN RESULTS AND THE ROLE OF CHANCE: Most patients (81.6%, n = 367) had tests or 
treatments postponed, with these being self (41.3%, n = 186) or publicly (46.4%, 
n = 209) funded. Patients appraised fertility clinic closure as having potential 
for a more negative than positive impact on their lives, and to be very or 
extremely uncontrollable and stressful (P ≤ 0.001). Most reported a slight to 
moderate ability to cope with closure. Data saturation was achieved with all 
open-text questions, with 33 broad themes identified and four meta-themes linked 
to components of the cognitive stress and coping theory. First, participants 
understood clinic closure was precautionary due to unknown effects of COVID-19 
but some felt clinic closure was unfair relative to advice about getting 
pregnant given to the public. Second, closure was appraised as a threat to 
attainability of the parenthood goal largely due to uncertainty of the situation 
(e.g. re-opening, effect of delay) and intensification of pre-existing hardships 
of fertility problems (e.g. long time waiting for treatment, history of failed 
treatment). Third, closure taxed personal coping resources but most were able to 
cope using thought-management (e.g. distraction, focusing on positives), getting 
mentally and physically fit for next treatments, strengthening their social 
network, and keeping up-to-date. Finally, participants reported more negative 
than positive emotions (P ≤ 0.001) and, almost all participants reported stress, 
worry and frustration at the situation, while some expressed anger and 
resentment at the unfairness of the situation. Overall, 11.8% were not at all 
able to cope, with reports of intense feelings of hopelessness and deteriorating 
well-being and mental health.
LIMITATIONS, REASONS FOR CAUTION: The survey captures patient reactions at a 
specific point in time, during lockdown and before clinics announced re-opening. 
Participants were self-selected (e.g. UK residents, women, 48% starting but not 
completing the survey), which may affect generalisability.
WIDER IMPLICATIONS OF THE FINDINGS: Fertility stakeholders (e.g. clinics, 
patient support groups, regulators, professional societies) need to work 
together to address the great uncertainty from COVID-19. This goal can be met 
proactively by setting up transparent processes for COVID-19 eventualities and 
signposting to information and coping resources. Future psychological research 
priorities should be on identifying patients at risk of distress with 
standardised measures and developing digital technologies appropriate for the 
realities of fertility care under COVID-19.
STUDY FUNDING/COMPETING INTEREST(S): University funded research. Outside of the 
submitted work, Prof. J.B. reports personal fees from Merck KGaA, Merck AB, 
Theramex, Ferring Pharmaceuticals A/S; grants from Merck Serono Ltd; and that 
she is co-developer of the Fertility Quality of Life (FertiQoL) and MediEmo 
apps. Outside of the submitted work, Dr R.M. reports personal or consultancy 
fees from Manchester Fertility, Gedeon Richter, Ferring and Merck. Outside of 
the submitted work, Dr S.G. reports consultancy fees from Ferring 
Pharmaceuticals A/S, Access Fertility and SONA-Pharm LLC, and grants from Merck 
Serono Ltd. The other authors declare no conflicts of interest.
TRIAL REGISTRATION NUMBER: N/A.

© The Author(s) 2020. Published by Oxford University Press on behalf of European 
Society of Human Reproduction and Embryology. All rights reserved. For 
permissions, please email: journals.permissions@oup.com.

DOI: 10.1093/humrep/deaa218
PMCID: PMC7454659
PMID: 32761248 [Indexed for MEDLINE]


4287. J Med Internet Res. 2020 Aug 25;22(8):e21176. doi: 10.2196/21176.

Impact of the COVID-19 Epidemic on Lifestyle Behaviors and Their Association 
With Subjective Well-Being Among the General Population in Mainland China: 
Cross-Sectional Study.

Hu Z(1), Lin X(1), Chiwanda Kaminga A(2)(3), Xu H(1).

Author information:
(1)Department of Social Medicine and Health Management, Xiangya School of Public 
Health, Central South University, Changsha, China.
(2)Department of Mathematics and Statistics, Mzuzu University, Luwinga, Mzuzu, 
Malawi.
(3)Department of Epidemiology and Health Statistics, Xiangya School of Public 
Health, Central South University, Changsha, China.

BACKGROUND: The world is experiencing an unprecedented challenge due to the 
coronavirus disease (COVID-19) pandemic. However, it is unclear whether people's 
lifestyles will change as a result.
OBJECTIVE: The aim of this study is to explore perceived lifestyle changes after 
the outbreak of COVID-19 and their association with subjective well-being (SWB) 
among the general population in Mainland China.
METHODS: An online survey was conducted in May 2020. Lifestyle behaviors 
including leisure-time physical exercise, leisure-time screen time, and dietary 
intake were self-reported. SWB was measured using the General Wellbeing Schedule 
(GWS). Other covariates including sociodemographic factors, self-rated physical 
health, perceived social support, and loneliness were also assessed by a 
structured questionnaire. A multivariate ordinal regression method was used to 
analyze the association between SWB and lifestyle behaviors as well as perceived 
lifestyle changes.
RESULTS: A total of 1033 participants aged between 18 and 60 years were included 
in this study. The mean GWS score was 71.7 points. About 70% of the respondents 
reported spending more time looking at screens, whereas about 30% reported an 
increased frequency of vegetable and fruit intake after the outbreak of 
COVID-19. Inactive physical exercise (odds ratio [OR] 1.16, 95% CI 1.02-1.48), 
infrequent vegetable intake (OR 1.45, 95% CI 1.10-1.90), infrequent fruit intake 
(OR 1.31, 95% CI 1.01-1.70), and often skipping breakfast (OR 1.43, 95% CI 
1.08-1.91) were associated with lower SWB after adjusting for sociodemographic 
factors, self-rated physical health, perceived social support, and loneliness. 
Moreover, participants who perceived a decrease in the frequency of vegetable, 
fruit, and breakfast intake were more likely to report lower SWB.
CONCLUSIONS: The COVID-19 pandemic may have positive and negative impacts on 
different aspects of lifestyle behaviors. Both unhealthy lifestyle behaviors and 
negative lifestyle changes were associated with lower SWB. These findings 
provide scientific evidence that can inform lifestyle guidelines and public 
mental health interventions during the COVID-19 outbreak.

©Zhao Hu, Xuhui Lin, Atipatsa Chiwanda Kaminga, Huilan Xu. Originally published 
in the Journal of Medical Internet Research (http://www.jmir.org), 25.08.2020.

DOI: 10.2196/21176
PMCID: PMC7458584
PMID: 32759103 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


4288. Am J Perinatol. 2020 Oct;37(12):1271-1279. doi: 10.1055/s-0040-1715505. Epub 
2020 Aug 5.

The Psychological Experience of Obstetric Patients and Health Care Workers after 
Implementation of Universal SARS-CoV-2 Testing.

Bender WR(1), Srinivas S(1), Coutifaris P(2), Acker A(2), Hirshberg A(1).

Author information:
(1)Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, 
Maternal and Child Health Research Center, Perelman School of Medicine, 
University of Pennsylvania, Philadelphia, Pennsylvania.
(2)Perelman School of Medicine, University of Pennsylvania, Philadelphia, 
Pennsylvania.

OBJECTIVE: This study was aimed to describe the hospitalization and early 
postpartum psychological experience for asymptomatic obstetric patients tested 
for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) as part of a 
universal testing program and report the impact of this program on labor and 
delivery health care workers' job satisfaction and workplace anxiety.
STUDY DESIGN: This is a cohort study of asymptomatic pregnant women who 
underwent SARS-CoV-2 testing between April 13, 2020 and April 26, 2020. 
Semistructured interviews were conducted via telephone at 1 and 2 weeks 
posthospitalization to assess maternal mental health. Depression screening was 
conducted using the patient health questionnaire-2 (PHQ-2). An online survey of 
labor and delivery health care workers assessed job satisfaction and job-related 
anxiety before and during the novel coronavirus disease 2019 (COVID-19) 
pandemic, as well as employees' subjective experience with universal testing. 
Patient and employee responses were analyzed for recurring themes.
RESULTS: A total of 318 asymptomatic women underwent SARS-CoV-2 testing during 
this 2-week period. Six of the eight women (75%) who tested positive reported 
negative in-hospital experiences secondary to perceived lack of provider and 
partner support and neonatal separation after birth. Among the 310 women who 
tested negative, 34.4% of multiparous women reported increased postpartum 
anxiety compared with their prior deliveries due to concerns about infectious 
exposure in the hospital and lack of social support. Only 27.6% of women, tested 
negative, found their test result to be reassuring. Job satisfaction and 
job-related anxiety among health care workers were negatively affected. 
Universal testing was viewed favorably by the majority of health care workers 
despite concerns about delays or alterations in patient care and maternal and 
neonatal separation.
CONCLUSION: Universal testing for SARS-CoV-2 in obstetric units has mixed 
effects on maternal mental health but is viewed favorably by labor and delivery 
employees. Ongoing evaluation of new testing protocols is paramount to balance 
staff and patient safety with quality and equality of care.
KEY POINTS: · Women with SARS-CoV-2 had a negative hospital experience.. · A 
negative SARS-CoV-2 test was not reassuring for patients.. · COVID-19 negatively 
impacts healthcare workers' well-being..

Thieme. All rights reserved.

DOI: 10.1055/s-0040-1715505
PMCID: PMC7645811
PMID: 32757185 [Indexed for MEDLINE]

Conflict of interest statement: None declared.


4289. J Gerontol B Psychol Sci Soc Sci. 2021 Aug 13;76(7):e249-e255. doi: 
10.1093/geronb/gbaa111.

Loneliness and Mental Health During the COVID-19 Pandemic: A Study Among Dutch 
Older Adults.

van Tilburg TG(1), Steinmetz S(2)(3), Stolte E(1), van der Roest H(4), de Vries 
DH(3).

Author information:
(1)Department of Sociology, Vrije Universiteit Amsterdam, The Netherlands.
(2)Institute for Social and Political Sciences, University of Lausanne, 
Switzerland.
(3)Department of Anthropology, University of Amsterdam, The Netherlands.
(4)Department on Aging, Netherlands Institute of Mental Health and Addiction, 
Trimbos Institute, Utrecht, The Netherlands.

OBJECTIVES: With the spread of COVID-19, the Netherlands implemented a policy to 
keep citizens physically distanced. We hypothesize that consequent reduction in 
the frequency of social contacts, personal losses, and the experience of general 
threats in society reduced well-being.
METHODS: Data were collected from 1,679 Dutch community-dwelling participants 
aged 65-102 years comprising a longitudinal online panel. Social and emotional 
loneliness and mental health were measured in May 2020, that is, 2 months after 
the implementation of the measures, and earlier in October and November 2019.
RESULTS: In this pandemic, the loneliness of older people increased, but mental 
health remained roughly stable. The policy measures for physical distancing did 
not cause much social isolation but personal losses, worries about the pandemic, 
and a decline in trust in societal institutions were associated with increased 
mental health problems and especially emotional loneliness.
DISCUSSION: The consequences of long-term social isolation and well-being must 
be closely monitored.

© The Author(s) 2020. Published by Oxford University Press on behalf of The 
Gerontological Society of America.

DOI: 10.1093/geronb/gbaa111
PMCID: PMC7454922
PMID: 32756931 [Indexed for MEDLINE]


4290. J Surg Educ. 2021 Mar-Apr;78(2):366-369. doi: 10.1016/j.jsurg.2020.07.017. Epub 
2020 Jul 19.

Optimizing Resident Wellness During a Pandemic: University of British Columbia's 
General Surgery Program's COVID-19 Experience.

Lie JJ(1), Huynh C(1), Scott TM(2), Karimuddin AA(3).

Author information:
(1)Division of General Surgery, Department of Surgery, University of British 
Columbia, Vancouver, British Columbia, Canada.
(2)Division of General Surgery, Department of Surgery, University of British 
Columbia, Vancouver, British Columbia, Canada; General Surgery, St. Paul's 
Hospital, Providence Health Care, Vancouver, British Columbia, Canada.
(3)Division of General Surgery, Department of Surgery, University of British 
Columbia, Vancouver, British Columbia, Canada; General Surgery, St. Paul's 
Hospital, Providence Health Care, Vancouver, British Columbia, Canada. 
Electronic address: AKarimuddin@providencehealth.bc.ca.

OBJECTIVE: The University of British Columbia's General Surgery Program 
delineates a unique and systematic approach to wellness for surgical residents 
during a pandemic.
SUMMARY BACKGROUND DATA: During the COVID-19 pandemic, health care workers are 
suffering from increased rates of mental health disturbances. Residents' duty 
obligations put them at increased physical and mental health risk. It is only by 
prioritizing their well-being that we can better serve the patients and prepare 
for a surge. Therefore, it is imperative that measures are put in place to 
protect them.
METHODS: Resident wellness was optimized by targeting 3 domains: efficiency of 
practice, culture of wellness and personal resilience.
RESULTS: Efficiency in delivering information and patient care minimizes 
additional stress to residents that is caused by the pandemic. By having a 
reserve team, prioritizing the safety of residents and taking burnout seriously, 
the culture of wellness and sense of community in our program are emphasized. 
All of the residents' personal resilience was further optimized by the regular 
and mandatory measures put in place by the program.
CONCLUSIONS: The new challenges brought on by a pandemic puts increased pressure 
on residents. Measures must be put in place to protect resident from the 
increased physical and mental health stress in order to best serve patients 
during this difficult time.

Copyright © 2020 Association of Program Directors in Surgery. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jsurg.2020.07.017
PMCID: PMC7368914
PMID: 32747316 [Indexed for MEDLINE]


4291. Otolaryngol Head Neck Surg. 2021 Feb;164(2):277-284. doi: 
10.1177/0194599820948043. Epub 2020 Aug 4.

Patients With Voice Prosthesis Rehabilitation During the COVID-19 Pandemic: 
Analyzing the Effectiveness of Remote Triage and Management.

Longobardi Y(1), Galli J(1), D'Alatri L(1), Savoia V(2), Mari G(1), Rigante 
M(1), Passali GC(1), Bussu F(3), Parrilla C(1).

Author information:
(1)Unità Operativa Complessa di Otorinolaringoiatria, Area Testa-Collo, 
Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della 
Testa-collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, 
Italy.
(2)Servizio di Psicologia, Fondazione Policlinico Universitario A. Gemelli 
IRCCS, Rome, Italy.
(3)ENT Division, Azienda Ospedaliero Universitaria, Sassari, Italia.

OBJECTIVE: To describe a remote approach used with patients with voice 
prosthesis after laryngectomy during the COVID-19 pandemic and the resulting 
clinical outcomes in terms of voice prosthesis complications management, 
oncological monitoring, and psychophysical well-being.
STUDY DESIGN: Prospective cohort study.
SETTING: Otolaryngology Clinic of the University Polyclinic A. Gemelli, IRCCS 
Foundation.
SUBJECTS AND METHODS: All patients with voice prosthesis who underwent 
laryngectomy followed by our institute were offered enrollment. Patients who 
agreed to participate were interviewed to inquire about the nature of the need 
and to plan a video call with the appropriate clinician. Before and 1 week after 
the clinician's call, patients were tested with the Hospital Anxiety and 
Depression Scale. Degrees of satisfaction were investigated with a visual analog 
scale. A comparison between those who accepted and refused telematic support was 
carried out to identify factors that influence patient interest in teleservice.
RESULTS: Video call service allowed us to reach 37 (50.68%) of 73 patients. In 
23 (62.16%) of 37 cases, the video call was sufficient to manage the problem. In 
the remaining 14 cases (37.83%), an outpatient visit was necessary. Participants 
who refused telematic support had a significantly shorter time interval from the 
last ear, nose, and throat visit than patients who accepted (57.95 vs 96.14 
days, P = .03). Video-called patients showed significantly decreased levels of 
anxiety and depression (mean Hospital Anxiety and Depression Scale total score 
pre- vs post-video call: 13.97 vs. 10.23, P < .0001) and reported high levels of 
satisfaction about the service.
CONCLUSION: Remote approach may be a viable support in the management of 
patients with voice prosthesis rehabilitation.

DOI: 10.1177/0194599820948043
PMCID: PMC7404089
PMID: 32746738 [Indexed for MEDLINE]

Conflict of interest statement: Disclosures: Competing interests: None. 
Sponsorships: None. Funding source: None.


4292. Aust N Z J Psychiatry. 2020 Nov;54(11):1067-1071. doi: 10.1177/0004867420947815. 
Epub 2020 Aug 3.

Considerations for assessing the impact of the COVID-19 pandemic on mental 
health in Australia.

Tan EJ(1)(2), Meyer D(1), Neill E(1)(2)(3), Phillipou A(1)(2)(3)(4), Toh WL(1), 
Van Rheenen TE(1)(5), Rossell SL(1)(2).

Author information:
(1)Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne 
University of Technology, Melbourne, VIC, Australia.
(2)Department of Mental Health, St Vincent's Hospital - Melbourne, Melbourne, 
VIC, Australia.
(3)Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia.
(4)Department of Mental Health, Austin Hospital, Melbourne, VIC, Australia.
(5)Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of 
Melbourne and Melbourne Health, Melbourne, VIC, Australia.

During this unprecedented novel coronavirus (COVID-19) pandemic, there is an 
urgent need for empirical data to characterise its impact on the mental health 
and well-being of Australians. In this viewpoint, we outline a number of 
considerations for research on this topic, highlighting areas necessitating 
special attention, consideration of particular vulnerable groups and the need 
for longitudinal studies to track mental health fluctuations in the general 
population. We conclude by introducing the COLLATE (COvid-19 and you: mentaL 
heaLth in AusTralia now survEy) project, outlining its aims, addressing some 
considerations raised herein and detailing avenues for future research. Since 
the World Health Organization (WHO) declared the novel coronavirus (COVID-19) 
outbreak a Public Health Emergency of International Concern (PHEIC) on 30 
January 2020 (WHO, 2020), the COVID-19 pandemic has caused major upheaval both 
in Australia and globally. While the search for a vaccine continues, current 
efforts towards tackling the virus and limiting contagion in several nations 
have focused on social distancing and the shutdown of non-essential services. In 
Australia, the first case was reported on 13 January 2020 (COVID-19 National 
Incident Room Surveillance Team, 2020), the first death occurred on 24 February 
and a spate of progressive restrictions were enforced throughout the 2 weeks 
leading up to 31 March 2020 (COVID-19 National Incident Room Surveillance Team, 
2020a).

DOI: 10.1177/0004867420947815
PMCID: PMC7404085
PMID: 32746614 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship and/or publication of this article.


4293. Eur Rev Med Pharmacol Sci. 2020 Jul;24(14):7869-7879. doi: 
10.26355/eurrev_202007_22292.

The impact of COVID-19 on doctors' well-being: results of a web survey during 
the lockdown in Italy.

De Sio S(1), Buomprisco G, La Torre G, Lapteva E, Perri R, Greco E, Mucci N, 
Cedrone F.

Author information:
(1)R.U. of Occupational Medicine, "Sapienza" University of Rome, Rome, Italy. 
simone.desio@uniroma1.it.

OBJECTIVE: On March 12, 2020, the World Health Organization (WHO) declared the 
outbreak of a new Coronavirus disease (COVID-19), to be a pandemic. From the 
beginning, Italy (in particular the Northern regions) was the first large 
European country to be hit and one of the most affected countries worldwide. 
This had a significant impact on the workload and psychological health of health 
workers. The aim of this web-based cross-sectional study is to assess the 
consequences of the COVID-19 pandemic on Italian doctors' well-being and 
psychological distress, in respect of demographic and occupational 
characteristics, lifestyle and habits during the lockdown period.
PATIENTS AND METHODS: We conducted a web-based cross-sectional survey based on 
Google® Forms to collect data. The participation was available during the 
lockdown period that started in Italy on March 9, 2020 and it was voluntary and 
anonymous. The questionnaire explored demographic and occupational variables, 
lifestyle and habits during the lockdown, perceived well-being and psychological 
distress. Multivariate logistic regression models were fitted.
RESULTS: Our study reported the very alarming psychological conditions of 
Italian doctors, especially among those who worked in the most affected regions, 
where a level of psychological distress of 93.8% and poor well-being of 58.9% 
were registered. These percentages were even higher in the case of female 
hospital workers with low job seniority, and those caring for COVID-19 patients.
CONCLUSIONS: Our findings reported a significant psychosocial impact of the 
COVID-19 outbreak on Italian doctors, particularly among those working in the 
most affected regions of the country. Further studies are necessary to better 
understand the effects of the COVID-19 pandemic on doctors' well-being and 
mental health over time, in order to implement effective prevention measures.

DOI: 10.26355/eurrev_202007_22292
PMID: 32744715 [Indexed for MEDLINE]


4294. J Affect Disord. 2020 Nov 1;276:765-774. doi: 10.1016/j.jad.2020.07.081. Epub 
2020 Jul 20.

Maternal psychological distress & mental health service use during the COVID-19 
pandemic.

Cameron EE(1), Joyce KM(2), Delaquis CP(2), Reynolds K(2), Protudjer JLP(3), 
Roos LE(4).

Author information:
(1)Department of Psychology, University of Calgary, 2500 University Drive, NW, 
Calgary, AB T2N 1N4, Canada; Department of Clinical Health Psychology, 
University of Manitoba, Winnipeg, Canada. Electronic address: 
camerone@ucalgary.ca.
(2)Department of Psychology, University of Manitoba, Winnipeg, Canada.
(3)Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, 
Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; 
George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Canada; Institute 
of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department 
of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, 
Canada.
(4)Department of Psychology, University of Manitoba, Winnipeg, Canada; 
Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, 
Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.

BACKGROUND: Mental health problems are increasingly recognized as a significant 
and concerning secondary effect of the COVID-19 pandemic. Research on previous 
epidemics/pandemics suggest that families, particularly mothers, may be at 
increased risk, but this population has yet to be examined. The current study 
(1) described prevalence rates of maternal depressive and anxiety symptoms from 
an online convenience sample during the COVID-19 pandemic, (2) identified risk 
and protective factors for elevated symptoms, and (3) described current mental 
health service use and barriers.
METHODS: Participants (N = 641) were mothers of children age 0-8 years, 
including expectant mothers. Mothers completed an online survey assessing mental 
health, sociodemographic information, and COVID-19-related variables.
RESULTS: Clinically-relevant depression was indicated in 33.16%, 42.55%, and 
43.37% of mothers of children age 0-18 months, 18 months to 4 years, and 5 to 8 
years, respectively. Prevalence of anxiety was 36.27%, 32.62%, and 29.59% for 
mothers across age groups, respectively. Binary logistic regressions indicated 
significant associations between risk factors and depression/anxiety across 
child age groups.
LIMITATIONS: Cross-sectional data was used to describe maternal mental health 
problems during COVID-19 limiting the ability to make inferences about the 
long-term impact of maternal depression and anxiety on family well-being.
CONCLUSIONS: Maternal depression and anxiety appear to be elevated in the 
context of COVID-19 compared to previously reported population norms. Identified 
risk factors for depression and anxiety across different child age ranges can 
inform targeted early intervention strategies to prevent long-term impacts of 
the COVID-19 pandemic on family well-being and child development.

Copyright © 2020. Published by Elsevier B.V.

DOI: 10.1016/j.jad.2020.07.081
PMCID: PMC7370903
PMID: 32736186 [Indexed for MEDLINE]

Conflict of interest statement: None.


4295. Community Ment Health J. 2020 Oct;56(7):1202-1203. doi: 
10.1007/s10597-020-00689-2. Epub 2020 Jul 30.

The Use of Digital Applications and COVID-19.

Alexopoulos AR(1), Hudson JG(2), Otenigbagbe O(2).

Author information:
(1)Imperial College London, Exhibition Rd, London, SW7 2AZ, England, UK. 
ara215@ic.ac.uk.
(2)Imperial College London, Exhibition Rd, London, SW7 2AZ, England, UK.

Comment in
    Community Ment Health J. 2020 Oct;56(7):1204-1205.

Mobile health apps are becoming increasingly popular amongst users who are 
turning to digital platforms to aid their mental wellbeing. As a result of the 
current COVID-19 pandemic, healthcare staff as well as recovering patients may 
suffer from PTSD. We have therefore suggested to Reyes et al. ("Promoting 
Resilience Among College Student Veterans Through an 
Acceptance-and-Commitment-Therapy App: An Intervention Refinement Study", 2020) 
the importance of repurposing their app to help these users to improve their 
emotional resilience and subsequently their ability to cope with the trauma of 
their experience. We have also discussed the most pertinent barriers to mobile 
health app uptake including data privacy concerns and the role of stigma.

DOI: 10.1007/s10597-020-00689-2
PMCID: PMC7391475
PMID: 32734311 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


4296. J Public Health (Oxf). 2021 Apr 12;43(1):47-52. doi: 10.1093/pubmed/fdaa126.

The impact of COVID-19 on Bangladeshi readymade garment (RMG) workers.

Kabir H(1)(2), Maple M(1), Usher K(1).

Author information:
(1)School of Health, Faculty of Medicine and Health, University of New England, 
Armidale, NSW 2351, Australia.
(2)Department of Sociology, University of Dhaka, Dhaka-1000, Bangladesh.

This paper describes the potential impact of the coronavirus disease 2019 
(COVID-19) pandemic on the readymade garment (RMG) workers of Bangladesh. It 
articulates the RMG workers' existing vulnerability during the COVID-19 pandemic 
based on currently available evidence and personal conversations/communications 
with RMG workers. COVID-19 has already impacted RMG workers' health (both 
physical and mental health status) and wellbeing, and resulted in loss of 
employment. We argue that the COVID-19 pandemic will have long-lasting effects 
on the garment workers, especially related to their health issues, financial 
hardship and inability to pay for essentials such as food, and future employment 
opportunities. The stakeholders (such as the international retailers/brands, 
Bangladesh Garment Manufacturers and Exporters Association, Government of 
Bangladesh) responsible for the global supply chain RMG factories should 
reconsider the health and overall wellbeing needs of the RMG workers during the 
ongoing COVID-19 pandemic.

© The Author(s) 2020. Published by Oxford University Press on behalf of Faculty 
of Public Health. All rights reserved. For permissions, please e-mail: 
journals.permissions@oup.com.

DOI: 10.1093/pubmed/fdaa126
PMCID: PMC7454782
PMID: 32734293 [Indexed for MEDLINE]


4297. Health Promot Pract. 2021 Mar;22(2):181-192. doi: 10.1177/1524839920942511. Epub 
2020 Jul 30.

A Scoping Review of Literature About Mental Health and Well-Being Among 
Immigrant Communities in the United States.

Rodriguez DX(1), Hill J(1), McDaniel PN(1).

Author information:
(1)Kennesaw State University, Kennesaw, GA, USA.

Immigration-both the experience of migrating and events after migration-can 
affect the mental health and well-being of immigrants and their communities. 
However, evidence suggests that immigrants in the United States do not access 
mental health services to the same extent as nonimmigrants. In particular, 
immigrant adolescents and young adults may have unique stressors related to 
their developmental stage, experiences in school and with peer groups, and 
shifting roles within family systems. This scoping review summarizes findings 
from published research studies and practitioner-focused gray literature about 
the mental health needs of immigrant communities in the United States. The 
review finds that specific mental health needs vary across factors like age, 
racial/ethnic group, immigration status, and place of residency. Findings also 
indicate that structural factors like immigration-related laws affect both 
access to mental health services and stressors in the overall environment for 
immigrants and their families. This review also explores models of 
community-level initiatives that utilize strengths-based approaches to promoting 
mental health and well-being among immigrant communities. Findings highlight the 
need for a better understanding of the mental health needs and current barriers 
to care among diverse immigrant populations, as immigration continues to play a 
major role in U.S. public policy and discourse. The COVID-19 pandemic taking 
place as this article goes to press in 2020 also raises questions regarding 
health equity and access for marginalized populations, including immigrants and 
their communities, and so these findings also indicate the need for further 
interdisciplinary research to assess intersections among the pandemic's many 
impacts, including those related to mental health and well-being.

DOI: 10.1177/1524839920942511
PMID: 32729336 [Indexed for MEDLINE]


4298. J Coll Physicians Surg Pak. 2020 Jun;30(6):59-62. doi: 
10.29271/jcpsp.2020.Supp1.S59.

Mental Health Challenges and Psycho-social Interventions amid COVID-19 Pandemic: 
A Call to Action for Pakistan.

Farooq SM(1), Sachwani SAA(1), Haider SI(2), Iqbal SA(3), Parpio YN(1), Saeed 
H(4).

Author information:
(1)School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan.
(2)Department for Educational Development, Aga Khan University, Karachi, 
Pakistan.
(3)Aga Khan University, Karachi, Pakistan; School of Nursing, University of 
Faisalabad, Pakistan.
(4)Department of Psychiatry, Aga Khan University, Karachi, Pakistan.

The increase in death and spread-related coronavirus (COVID-19) has shifted the 
world focus to the containment of the disease by emphasising measures to prevent 
spread in the general population. Such a complex, threatening, and unprecedented 
situation has left the psycho-social wellbeing needs of general public 
unaddressed. This paper aims to review the current COVID-19 scenario and its 
effects on the psycho-social wellbeing of people; and an attempt to shed some 
light on the aforementioned questions. Furthermore, the review will propose some 
recommendations for overcoming the mental illness issues, during and after the 
COVID-19 outbreak. We extracted information from reliable published 
international and national literature and reviewed anecdotes from media content 
from January to June 2020. The mental health implications of this outbreak will 
be long-lasting; however, by prioritising, investing diligently, and taking a 
collective approach, this challenge can be dealt with in a promising manner. Key 
Words: Mental health, Psycho-social interventions, COVID-19, Pakistan.

DOI: 10.29271/jcpsp.2020.Supp1.S59
PMID: 32723454 [Indexed for MEDLINE]


4299. Int J Soc Psychiatry. 2021 Aug;67(5):576-586. doi: 10.1177/0020764020944200. 
Epub 2020 Jul 29.

Mental health in biological disasters: From SARS to COVID-19.

Hsieh KY(1)(2), Kao WT(1)(3), Li DJ(1)(2), Lu WC(1), Tsai KY(1), Chen WJ(1)(4), 
Chou LS(1), Huang JJ(5), Hsu ST(1)(4), Chou FH(1).

Author information:
(1)Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City.
(2)Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical 
University, Kaohsiung City.
(3)Department of Sports, Health and Leisure and Graduate Institute of Sports, 
Health and Leisure, Cheng Shiu University, Kaohsiung City.
(4)Graduate Institute of Counseling Psychology and Rehabilitation Counseling, 
National Kaohsiung Normal University, Kaohsiung City.
(5)Department of Family Medicine, Kaohsiung Medical University Hospital, 
Kaohsiung City.

BACKGROUND: The outbreak of coronavirus disease 2019 (COVID-19), like severe 
acute respiratory syndrome (SARS), provokes fear, anxiety and depression in the 
public, which further affects mental health issues. Taiwan has used their 
experience of the SARS epidemic for the management of foreseeable problems in 
COVID-19 endemic.
AIM/OBJECTIVE: This review summarizes issues concerning mental health problems 
related to infectious diseases from current literatures.
RESULTS: In suspected cases under quarantine, confirmed cases in isolation and 
their families, health care professionals, and the general population and 
related effective strategies to reduce these mental health issues, such as 
helping to identify stressors and normalizing their impact at all levels of 
response as well as public information and communication messages by electronic 
devices. The importance of community resilience was also addressed. 
Psychological first aid, psychological debriefing, mental health intervention 
and psychoeducation were also discussed. Issues concerning cultures and 
religions are also emphasized in the management plans.
CONCLUSION: Biological disaster like SARS and COVID-19 not only has strong 
impact on mental health in those being infected and their family, friends, and 
coworkers, but also affect wellbeing in general public. There are evidenced that 
clear and timely psychoeducation, psychological first aid and psychological 
debriefing could amileorate negative impact of disaster, thus might also be 
helpful amid COVID-19 pandemic.

DOI: 10.1177/0020764020944200
PMID: 32722974 [Indexed for MEDLINE]


4300. Int J Eat Disord. 2020 Nov;53(11):1780-1790. doi: 10.1002/eat.23353. Epub 2020 
Jul 28.

Early impact of COVID-19 on individuals with self-reported eating disorders: A 
survey of ~1,000 individuals in the United States and the Netherlands.

Termorshuizen JD(1)(2), Watson HJ(3)(4)(5), Thornton LM(3), Borg S(1), Flatt 
RE(3), MacDermod CM(3), Harper LE(3), van Furth EF(2)(6), Peat CM(3), Bulik 
CM(1)(3)(7).

Author information:
(1)Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 
Stockholm, Sweden.
(2)Rivierduinen Eating Disorders Ursula, Leiden, The Netherlands.
(3)Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel 
Hill, North Carolina, USA.
(4)School of Psychology, Curtin University, Perth, Western Australia, Australia.
(5)School of Paediatrics, Division of Medicine, The University of Western 
Australia, Perth, Western Australia, Australia.
(6)Department of Psychiatry, Leiden University Medical Center, Leiden, The 
Netherlands.
(7)Department of Nutrition, University of North Carolina at Chapel Hill, Chapel 
Hill, North Carolina, USA.

Update of
    medRxiv. 2020 May 29;:

OBJECTIVE: We evaluated the early impact of COVID-19 on people with 
self-reported eating disorders.
METHOD: Participants in the United States (US, N = 511) and the Netherlands (NL, 
N = 510), recruited through ongoing studies and social media, completed an 
online survey that included both quantitative measures and free-text responses 
assessing the impact of COVID-19 on situational circumstances, eating disorder 
symptoms, eating disorder treatment, and general well-being.
RESULTS: Results revealed strong and wide-ranging effects on eating disorder 
concerns and illness behaviors that were consistent with eating disorder type. 
Participants with anorexia nervosa (US 62% of sample; NL 69%) reported increased 
restriction and fears about being able to find foods consistent with their meal 
plan. Individuals with bulimia nervosa and binge-eating disorder (US 30% of 
sample; NL 15%) reported increases in their binge-eating episodes and urges to 
binge. Respondents noted marked increases in anxiety since 2019 and reported 
greater concerns about the impact of COVID-19 on their mental health than 
physical health. Although many participants acknowledged and appreciated the 
transition to telehealth, limitations of this treatment modality for this 
population were raised. Individuals with past histories of eating disorders 
noted concerns about relapse related to COVID-19 circumstances. Encouragingly, 
respondents also noted positive effects including greater connection with 
family, more time for self-care, and motivation to recover.
DISCUSSIONS: COVID-19 is associated with increased anxiety and poses specific 
disorder-related challenges for individuals with eating disorders that require 
attention by healthcare professionals and carers.

© 2020 Wiley Periodicals LLC.

DOI: 10.1002/eat.23353
PMID: 32720399 [Indexed for MEDLINE]


4301. Am J Geriatr Psychiatry. 2020 Oct;28(10):1040-1045. doi: 
10.1016/j.jagp.2020.06.027. Epub 2020 Jul 7.

Mental Health in Elderly Spanish People in Times of COVID-19 Outbreak.

García-Fernández L(1), Romero-Ferreiro V(2), López-Roldán PD(3), Padilla S(4), 
Rodriguez-Jimenez R(5).

Author information:
(1)Clinical Medicine Department, Universidad Miguel Hernández, Alicante, Spain; 
Department of Psychiatry, Hospital Universitario de San Juan, Alicante, Spain; 
CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain. 
Electronic address: lorena.garciaf@umh.es.
(2)CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain; 
Brain Mapping Unit, Instituto Pluridisciplinar Universidad Complutense de Madrid 
(UCM), Madrid, Spain; Department of Psychiatry. Instituto de Investigación 
Sanitaria Hospital 12 de Octubre (imas 12), Madrid, Spain.
(3)Department of Psychiatry, Hospital Universitario de San Juan, Alicante, 
Spain.
(4)Clinical Medicine Department, Universidad Miguel Hernández, Alicante, Spain; 
Infectious Diseases Unit, Hospital Universitario de Elche, Elche, Alicante, 
Spain.
(5)CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain; 
Department of Psychiatry. Instituto de Investigación Sanitaria Hospital 12 de 
Octubre (imas 12), Madrid, Spain; Facultad de Medicina, Universidad Complutense 
de Madrid (UCM), Madrid, Spain.

BACKGROUND: We aim to assess COVID-19 outbreak-related emotional symptoms, 
identify gender differences, and study the relationship between the emotional 
state and environmental features in the elderly.
METHODS: We conducted a cross-sectional study starting on March 29 to April 5, 
2020 based on a national online survey using snowball sampling techniques. 
Symptoms of anxiety (Hamilton Anxiety Scale), depression (Beck Depression 
Inventory) and acute stress (Acute Stress Disorder Inventory) were compared 
between people over and under 60 years old. Gender differences and the 
relationship of loneliness, regular exercise, economic losses and use of 
anxiolytics on the mental state were evaluated.
RESULTS: One thousand six hundred thirty-nine (150 [9.2%] aged ≥60) participants 
completed the survey. The greater than or equal to 60 group showed lower mean 
(SD) BDI levels than the less than 60 group (3.02 [3.28] versus 4.30 [4.93]); 
and lower mean (SD) acute stress disorder inventory scores than the less than 60 
group (3.68 [3.20] versus 4.45 [3.06]). There were no gender differences in any 
of the clinical measures. The presence of economic losses as well as the 
increase in the use of anxiolytics was significantly associated with higher 
emotional distress in the elderly compared to the younger group.
CONCLUSIONS: Older people have shown less emotional distress, with no 
differences between men and women. Economic loss and substance use should be 
monitored to guarantee the emotional well-being of the elderly.

Copyright © 2020 American Association for Geriatric Psychiatry. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jagp.2020.06.027
PMCID: PMC7340042
PMID: 32718855 [Indexed for MEDLINE]


4302. Br Dent J. 2020 Jul;229(2):127-132. doi: 10.1038/s41415-020-1792-3.

Psychosocial effects of the COVID-19 pandemic on staff in a dental teaching 
hospital.

Mahendran K(1), Patel S(2), Sproat C(3).

Author information:
(1)DCT (Oral Surgery), Floor 23, Oral Surgery Department, Guy's Dental Hospital, 
London, SE1 9RT, UK. krishantinimahendran@yahoo.com.
(2)DCT (Oral Surgery), Floor 23, Oral Surgery Department, Guy's Dental Hospital, 
London, SE1 9RT, UK.
(3)Consultant (Oral Surgery), Floor 23, Oral Surgery Department, Guy's Dental 
Hospital, London, SE1 9RT, UK.

Introduction As COVID-19 rapidly developed across the UK, health services were 
forced to make radical changes. Within the dental department, all elective 
procedures were cancelled and staff members were redeployed to support other 
services within the trust. Studies have demonstrated increased prevalence of 
psychiatric disorders among healthcare workers during virus pandemics.Aims To 
assess the psychosocial implications of COVID-19 on members of the dental team 
working within a large dental teaching hospital.Methodology A survey comprising 
a series of questions (closed and open) and a Generalised Anxiety Disorder 
assessment (GAD-7) was distributed to members of the dental team between 1-3 
April 2020.Results A total of 120 surveys were completed; 53.3% of respondents 
displayed symptoms of generalised anxiety. The highest average GAD-7 score was 
noted among dental nurses. The most common concern was the impact of COVID-19 on 
friends and family followed by personal health and nature of the 
disease.Conclusion(s) High anxiety levels and significant psychosocial 
implications were noted among dental staff during this virus pandemic. Our 
findings add to a growing body of data on the psychosocial impact of virus 
outbreaks on healthcare workers and highlight the importance of wellbeing 
initiatives for healthcare workers to be placed at the forefront of future 
pandemic crisis planning.

DOI: 10.1038/s41415-020-1792-3
PMCID: PMC7380160
PMID: 32710064 [Indexed for MEDLINE]

Conflict of interest statement: No conflict of interests noted.


4303. J Perinatol. 2020 Sep;40(9):1283-1285. doi: 10.1038/s41372-020-0745-7. Epub 2020 
Jul 24.

The downstream effects of COVID-19: a call for supporting family wellbeing in 
the NICU.

Erdei C(1)(2), Liu CH(3)(4).

Author information:
(1)Brigham and Women's Hospital, Boston, MA, USA. CErdei@bwh.harvard.edu.
(2)Harvard Medical School, Boston, MA, USA. CErdei@bwh.harvard.edu.
(3)Brigham and Women's Hospital, Boston, MA, USA.
(4)Harvard Medical School, Boston, MA, USA.

Parents of NICU infants are a vulnerable population from a psychological 
perspective, and often experience high levels of acute stress, depression, 
anxiety, and post-traumatic stress. The added burden of the current SARS CoV-2 
disease (COVID-19) pandemic is likely to exacerbate these issues, with potential 
implications for the wellbeing of infants and families in the short- and 
long-term. In this paper, we propose utilizing the stress contagion framework 
and consider how psychosocial stress can "spill over" into the parent-infant 
relationship domain, which can impact child development and family wellbeing 
longer term. As the effects of the pandemic will likely persist well beyond the 
acute stage, we offer advocacy points and general guidelines for healthcare 
professionals to consider in their quest to mitigate stress and build resilience 
in NICU families.

DOI: 10.1038/s41372-020-0745-7
PMCID: PMC7378407
PMID: 32709980 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


4304. Pediatrics. 2020 Oct;146(4):e2020016824. doi: 10.1542/peds.2020-016824. Epub 
2020 Jul 24.

Well-being of Parents and Children During the COVID-19 Pandemic: A National 
Survey.

Patrick SW(1)(2)(3)(4), Henkhaus LE(5)(3)(6), Zickafoose JS(5)(2)(7), Lovell 
K(5)(3), Halvorson A(8), Loch S(5), Letterie M(5), Davis MM(9)(10).

Author information:
(1)Vanderbilt Center for Child Health Policy and stephen.patrick@vanderbilt.edu.
(2)Departments of Pediatrics.
(3)Health Policy, and.
(4)Mildred Stahlman Division of Neonatology and.
(5)Vanderbilt Center for Child Health Policy and.
(6)Data Science Institute, Vanderbilt University, Nashville, Tennessee.
(7)Mathematica, Nashville, Tennessee.
(8)Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
(9)Mary Ann & J. Milburn Smith Child Health Research, Outreach, and Advocacy 
Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie 
Children's Hospital of Chicago, Chicago, Illinois; and.
(10)Departments of Pediatrics, Medicine, Medical Social Sciences, and Preventive 
Medicine, Feinberg School of Medicine, Northwestern University, Chicago, 
Illinois.

Comment in
    Pediatrics. 2020 Oct;146(4):

BACKGROUND: As the coronavirus disease pandemic spread across the United States 
and protective measures to mitigate its impact were enacted, parents and 
children experienced widespread disruptions in daily life. Our objective with 
this national survey was to determine how the pandemic and mitigation efforts 
affected the physical and emotional well-being of parents and children in the 
United States through early June 2020.
METHODS: In June 2020, we conducted a national survey of parents with children 
age <18 to measure changes in health status, insurance status, food security, 
use of public food assistance resources, child care, and use of health care 
services since the pandemic began.
RESULTS: Since March 2020, 27% of parents reported worsening mental health for 
themselves, and 14% reported worsening behavioral health for their children. The 
proportion of families with moderate or severe food insecurity increased from 6% 
before March 2020 to 8% after, employer-sponsored insurance coverage of children 
decreased from 63% to 60%, and 24% of parents reported a loss of regular child 
care. Worsening mental health for parents occurred alongside worsening 
behavioral health for children in nearly 1 in 10 families, among whom 48% 
reported loss of regular child care, 16% reported change in insurance status, 
and 11% reported worsening food security.
CONCLUSIONS: The coronavirus disease pandemic has had a substantial tandem 
impact on parents and children in the United States. As policy makers consider 
additional measures to mitigate the health and economic effects of the pandemic, 
they should consider the unique needs of families with children.

Copyright © 2020 by the American Academy of Pediatrics.

DOI: 10.1542/peds.2020-016824
PMID: 32709738 [Indexed for MEDLINE]

Conflict of interest statement: POTENTIAL CONFLICT OF INTEREST: The authors have 
indicated they have no potential conflicts of interest to disclose.


4305. Int J Environ Res Public Health. 2020 Jul 22;17(15):5293. doi: 
10.3390/ijerph17155293.

Psychological Factors that Lessen the Impact of COVID-19 on the Self-Employment 
Intention of Business Administration and Economics' Students from Latin America.

Hernández-Sánchez BR(1), Cardella GM(1), Sánchez-García JC(1).

Author information:
(1)Department of Social Psychology and Anthropology, University of Salamanca, 
37005 Salamanca, Spain.

BACKGROUND: The 2019 coronavirus disease epidemic (Covid-19) is a public health 
emergency of international concern and poses a challenge to the labor market. 
The pandemic has a devastating and disproportionate effect on young workers, 
their interest in entrepreneurship, and their mental health. Research is needed 
to develop evidence-based strategies to improve coping and reduce adverse 
psychological problems. The objective of this study was to analyze the impact 
that Covid-19 pandemic perception and psychological need satisfaction have on 
university students and their self-employment intention. In addition, we also 
analyzed the role of moderation played by psychological aspects. These 
psychological factors (i.e., Optimism and Proactiveness) can also improve young 
people's mental health and well-being.
METHODS: An explorative study (online survey) was conducted in March 2020 934 
university students from Latin America. Regression analysis models were built to 
examine the relationships between Covid-19 pandemic perception, personality 
variables, and entrepreneurial intention. Mediation models, through the 
bootstrapping method, were performed to analyze the mediating role of 
proactiveness and optimism.
RESULTS: Results indicate that students' perception of Covid-19 and 
psychological need satisfaction are associated with entrepreneurial intention. 
Additionally, the present study argues that proactiveness and optimism mediate 
these relationships.
CONCLUSIONS: This study identifies psychological factors associated with a lower 
level of Covid-19 impact and that can be used for psychological interventions 
that result in an improvement in the mental health of these vulnerable groups 
during and after the Covid-19 pandemic. Theoretical and practical implications 
are discussed.

DOI: 10.3390/ijerph17155293
PMCID: PMC7432839
PMID: 32708034 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest. 
The funders had no role in the design of the study; in the collection, analyses, 
or interpretation of data; in the writing of the manuscript, or in the decision 
to publish the results.


4306. JAMA Netw Open. 2020 Jul 1;3(7):e2015821. doi: 
10.1001/jamanetworkopen.2020.15821.

Knowledge, Concerns, and Behaviors of Individuals During the First Week of the 
Coronavirus Disease 2019 Pandemic in Italy.

Pagnini F(1)(2), Bonanomi A(3), Tagliabue S(1), Balconi M(1), Bertolotti M(1), 
Confalonieri E(1), Di Dio C(1), Gilli G(1), Graffigna G(1)(4), Regalia C(1), 
Saita E(1), Villani D(1).

Author information:
(1)Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.
(2)Department of Psychology, Harvard University, Cambridge, Massachusetts.
(3)Department of Statistical Sciences, Università Cattolica del Sacro Cuore, 
Milan, Italy".
(4)EngageMinds HUB, Consumer, Food & Health Engagement Research Center, 
Università Cattolica del Sacro Cuore, Milan, Italy.

IMPORTANCE: At the beginning of a public health crisis, such as the coronavirus 
disease 2019 (COVID-19) pandemic, it is important to collect information about 
people's knowledge, worries, and behaviors to examine their influence on quality 
of life and to understand individual characteristics associated with these 
reactions. Such information could help to guide health authorities in providing 
informed interventions and clear communications.
OBJECTIVES: To document the initial knowledge about COVID-19 and recommended 
health behaviors; to assess worries (ie, one's perception of the influence of 
the worries of others on oneself), social appraisal, and preventive behaviors, 
comparing respondents from areas under different movement restrictions during 
the first week after the outbreak; and to understand how worries, perceived 
risk, and preventive behaviors were associated with quality of life and 
individual characteristics among Italian adults.
DESIGN, SETTING, AND PARTICIPANTS: This convenience sample, nonprobablistic 
survey study recruited adult participants with a snowballing sampling method in 
any Italian region during the first week of the COVID-19 outbreak in Italy from 
February 26, 2020, to March 4, 2020. Data were analyzed from March 5 to 12, 
2020.
EXPOSURES: Information was collected from citizens living in the quarantine zone 
(ie, red zone), area with restricted movements (ie, yellow zone), and 
COVID-19-free regions (ie, green zone).
MAIN OUTCOMES AND MEASURES: Levels of knowledge on the virus, contagion-related 
worries, social appraisal, and preventive behaviors were assessed with ratings 
of quality of life (measured using the Short Form Health Survey). Additionally, 
some individual characteristics that may be associated with worries and 
behaviors were assessed, including demographic characteristics, personality 
traits (measured using Big Five Inventory-10), perceived health control 
(measured using the internal control measure in the Health Locus of Control 
scale), optimism (measured using the Revised Life Orientation Test), and the 
need for cognitive closure (measured using the Need for Closure Scale).
RESULTS: A total of 3109 individuals accessed the online questionnaire, and 2886 
individuals responded to the questionnaire at least partially (mean [SD] age, 
30.7 [13.2] years; 2203 [76.3%] women). Most participants were well informed 
about the virus characteristics and suggested behaviors, with a mean (SD) score 
of 77.4% (17.3%) correct answers. Quality of life was similar across the 3 zones 
(effect size = 0.02), but mental health was negatively associated with 
contagion-related worries (β = -0.066), social appraisal (β = -0.221), and 
preventive behaviors (β = -0.066) in the yellow zone (R2 = 0.108). Social 
appraisal was also associated with reduced psychological well-being in the green 
zone (β = -0.205; R2 = 0.121). In the yellow zone, higher worries were 
negatively correlated with emotional stability (β = -0.165; R2 = 0.047). 
Emotional stability was also negatively associated with perceived susceptibility 
in the yellow (β = -0.108; R2 = 0.040) and green (β = -0.170; R2 = 0.087) zones. 
Preventative behaviors and social appraisal were also associated with the need 
for cognitive closure in both yellow (preventive behavior: β = 0.110; 
R2 = 0.023; social appraisal β = 0.115; R2 = 0.104) and green (preventive 
behavior: β = 0.174; R2 = 0.022; social appraisal: 0.261; R2 = 0.137) zones.
CONCLUSIONS AND RELEVANCE: These findings suggest that during the first week of 
the COVID-19 outbreak in Italy, people were well informed and had a relatively 
stable level of worries. Quality of life did not vary across the areas, although 
mental well-being was challenged by the social appraisal and worries related to 
the contagion. Increased scores for worries and concerns were associated with 
more cognitive rigidity and emotional instability.

DOI: 10.1001/jamanetworkopen.2020.15821
PMCID: PMC7382000
PMID: 32706385 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest Disclosures: Dr Graffigna 
reported receiving grants from Merck Serono, Roche Diabetes Care, and Kedrion 
outside the submitted work. No other disclosures were reported.


4307. Acta Biomed. 2020 Jul 20;91(9-S):87-89. doi: 10.23750/abm.v91i9-S.10122.

COVID-19 lockdown impact on lifestyle habits of Italian adults.

Odone A(1), Lugo A(2), Amerio A(3), Borroni E(4), Bosetti C(5), Carreras G(6), 
Cavalieri d'Oro L(7), Colombo P(8), Fanucchi T(9), Ghislandi S(10), Gorini 
G(11), Iacoviello L(12)(13), Pacifici R(14), Santucci C(15), Serafini G(16), 
Signorelli C(17), Stival C(18), Stuckler D(19), Tersalvi CA(20), Gallus S(21).

Author information:
(1)School of Medicine, University Vita-Salute San Raffaele, Milan, Italy. 
odone.anna@hsr.it.
(2)Department of Environmental Health Sciences, Istituto di Ricerche 
Farmacologiche Mario Negri IRCCS, Milan, Italy. alessandra.lugo@marionegri.it.
(3)Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal 
and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy. 
andrea.amerio@unige.it.
(4)Department of Environmental Health Sciences, Istituto di Ricerche 
Farmacologiche Mario Negri IRCCS, Milan, Italy. elisa.borroni@marionegri.it.
(5)Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri 
IRCCS, Milan, Italy. cristina.bosetti@marionegri.it.
(6)Oncologic Network, Prevention and Research Institute (ISPRO), Florence, 
Italy. giulia.carreras@gmail.com.
(7)Epidemiology Unit, Local Health Authority (ATS) of Brianza, Monza, Italy. 
luca.cavalieridoro@ats-brianza.it.
(8)Istituto DOXA, Milan, Italy. paolo.colombo@bva-doxa.com.
(9)SOD Alcologia - Centro Alcologico Regionale Toscano, Azienda 
Ospedaliero-Universitaria Careggi, Florence, Italy. tiziana.fanucchi@gmail.com.
(10)CERGAS and Department of Social and Political Sciences, Bocconi University, 
Milan, Italy. simone.ghislandi@unibocconi.it.
(11)Oncologic Network, Prevention and Research Institute (ISPRO), Florence, 
Italy. g.gorini@ispro.toscana.it.
(12)Department of Medicine and Surgery, University of Insubria, Italy. 
licia.iacoviello@uninsubria.it.
(13)Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
(14)National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, 
Italy. roberta.pacifici@iss.it.
(15)Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri 
IRCCS, Milan, Italy. claudia.santucci@marionegri.it.
(16)Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, 
Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, 
Italy. gianluca.serafini@unige.it.
(17)School of Medicine, University Vita-Salute San Raffaele, Milan, Italy. 
signorelli.carlo@hsr.it.
(18)Department of Environmental Health Sciences, Istituto di Ricerche 
Farmacologiche Mario Negri IRCCS, Milan, Italy. chia.stival@gmail.com.
(19)Department of Social and Political Sciences, Bocconi University, Milan, 
Italy.. david.stuckler@unibocconi.it.
(20)Local Health Authority (ATS) of Bergamo, Bergamo, Italy. 
carlo.tersalvi@ats-bg.it.
(21)Department of Environmental Health Sciences, Istituto di Ricerche 
Farmacologiche Mario Negri IRCCS, Milan, Italy. silvano.gallus@marionegri.it.

In March 2020, when the Government imposed nation-wide lockdown measures to 
contrast the COVID-19 outbreak, the life of Italians suddenly changed. In order 
to evaluate the impact of lockdown on lifestyle habits and behavioral risk 
factors of the general adult population in Italy, we set up the Lost in Italy 
(LOckdown and lifeSTyles IN ITALY) project. Within this project, the online 
panel of Doxa was used to conduct a web-based cross-sectional study during the 
first phase of the lockdown, on a large representative sample of adults aged 
18-74 years (N=6003). The self-administered questionnaire included information 
on lifestyle habits and perceived physical and mental health, through the use of 
validated scales. As we are working within the Lost in Italy project, we got two 
additional grants to further research on the medium-term impact of lockdown, a 
topic of great interest and with anticipated large socio-economic and public 
health implications. In details: we obtained by the AXA Research Fund support to 
evaluate the impact of COVID-19 lockdown on physical, mental, and social 
wellbeing of elderly and fragile populations in the Lombardy region, the area 
most heavily hit by the pandemic in the country. Moreover, as a fruitful 
integration, we obtained support by the Directorate General for Welfare of the 
region to assess health services delivery and access to healthcare in the same 
study population, combining an analysis of administrative databases with an 
economic analysis. We are confident that the solid background of our partners, 
the multi-disciplinary competencies they bring, together with appropriate 
funding and access to rich data sources will allow us to fulfill our research 
objectives.

DOI: 10.23750/abm.v91i9-S.10122
PMCID: PMC8023096
PMID: 32701921 [Indexed for MEDLINE]

Conflict of interest statement: Each author declares that he or she has no 
commercial associations (e.g. consultancies, stock ownership, equity interest, 
patent/licensing arrangement etc.) that might pose a conflict of interest in 
connection with the submitted article


4308. Int J Soc Psychiatry. 2021 May;67(3):232-242. doi: 10.1177/0020764020944195. 
Epub 2020 Jul 23.

Puppy love in the time of Corona: Dog ownership protects against loneliness for 
those living alone during the COVID-19 lockdown.

Oliva JL(1), Johnston KL(1).

Author information:
(1)Monash University, Melbourne, VIC, Australia.

Erratum in
    Int J Soc Psychiatry. 2021 Feb 3;:20764021990603.

BACKGROUND: The COVID-19 pandemic has resulted in many countries enforcing a 
'lockdown', whereby people are instructed to stay at home.
AIM: The aim of this study was to capture the experience of such a lockdown in 
Australians living alone, with and without a dog or a cat.
METHOD: Three hundred and eighty-four participants completed an online survey 
evaluating their levels of loneliness, mindfulness and mood. For participants 
who owned a dog or a cat, a measure of dog/cat interactions was also 
administered as well as two open-ended questions about how being a pet owner 
affected their experience of COVID-19 and how COVID-19 affected their pet.
RESULTS: Contrary to expectations, cat owners were found to be less mindful than 
non-owners and pet interactions did not account for levels of loneliness or 
levels of mindfulness. In line with our expectations, however, stress and 
depression positively predicted loneliness, while mindfulness and being a dog 
owner were protective against it. Insights from qualitative responses suggest 
that this might be due to the fact that dogs encourage a routine which involves 
getting out of the house and walking, which itself offers opportunities to 
socialise with other people doing the same thing.
CONCLUSION: These findings add to the emerging literature on mental well-being 
during a lockdown and the unique role that pets play in their owners' 
experiences.

DOI: 10.1177/0020764020944195
PMCID: PMC7383093
PMID: 32701015 [Indexed for MEDLINE]


4309. Dialogues Clin Neurosci. 2020 Jun;22(2):93-97. doi: 
10.31887/DCNS.2020.22.2/mhoehe.

Going digital: how technology use may influence human brains and behavior .

Hoehe MR(1), Thibaut F(2).

Author information:
(1)Author affiliations: Department of Computational Molecular Biology, Max 
Planck Institute for Molecular Genetics, Berlin, Germany.
(2)University Hospital Cochin - site Tarnier; University of Paris; INSERM U1266, 
Institute of Psychiatry and Neuroscience, Paris, France.

The digital revolution has changed, and continues to change, our world and our 
lives. Currently, major aspects of our lives have moved online due to the 
coronavirus pandemic, and social distancing has necessitated virtual 
togetherness. In a synopsis of 10 articles we present ample evidence that the 
use of digital technology may influence human brains and behavior in both 
negative and positive ways. For instance, brain imaging techniques show concrete 
morphological alterations in early childhood and during adolescence that are 
associated with intensive digital media use. Technology use apparently affects 
brain functions, for example visual perception, language, and cognition. 
Extensive studies could not confirm common concerns that excessive screen time 
is linked to mental health problems, or the deterioration of well-being. 
Nevertheless, it is important to use digital technology consciously, creatively, 
and sensibly to improve personal and professional relationships. Digital 
technology has great potential for mental health assessment and treatment, and 
the improvement of personal mental performance. .

Publisher: La revolución digital ha cambiado y continúa cambiando nuestro mundo 
y nuestras vidas. Actualmente, los principales aspectos de nuestras vidas han 
migrado hacia el funcionamiento “online” debido a la pandemia del coronavirus, y 
el distanciamiento social ha requerido de cercanías virtuales. En una sinopsis 
de 10 artículos, se presenta una amplia evidencia de que el empleo de la 
tecnología digital puede influir en el cerebro y en el comportamiento humano de 
manera negativa y positiva. Por ejemplo, las técnicas de imágenes cerebrales 
muestran alteraciones morfológicas concretas en la primera infancia y durante la 
adolescencia, las cuales están asociadas con el empleo intenso de medios 
digitales. En apariencia, la utilización de la tecnología afecta las funciones 
cerebrales, como la percepción visual, el lenguaje y la cognición. Numerosos 
estudios no pudieron confirmar las preocupaciones comunes en cuanto a que el 
tiempo excesivo de pantalla esté relacionado con problemas de salud mental o el 
deterioro del bienestar. Sin embargo, es importante emplear la tecnología 
digital de manera consciente, creativa y sensata para mejorar las relaciones 
personales y profesionales. La tecnología digital tiene un gran potencial para 
la evaluación y el tratamiento de la salud mental, y el aumento del rendimiento 
mental personal.

Publisher: La révolution numérique a modifié et continue à modifier notre monde 
et nos vies. La pandémie actuelle due au coronavirus a fait basculer en ligne de 
nombreux pans de notre existence et la distanciation sociale a imposé la 
virtualité des rassemblements. Les données des dix articles présentés ici 
attestent de l’influence de la technologie numérique sur les cerveaux et les 
comportements, de manière positive et négative. Par exemple,l’imagerie cérébrale 
montre des altérations morphologiques concrètes apparaissant tôt dans l’enfance 
et pendant l’adolescence lors d’une pratique intensive des media numériques. 
Cela concernerait certaines fonctions cérébrales comme la perception visuelle, 
le langage et la cognition. Des études approfondies n’ont pas confirmé les 
inquiétudes courantes quant aux répercussions d’un temps excessif passé devant 
un écran en termes de santé mentale ou de qualité de vie. Il est néanmoins 
important de privilégier une utilisation consciente, créative et raisonnable des 
technologies numériques afin d’améliorer les relations personnelles et 
professionnelles. Ces technologies ont un grand potentiel dans l’évaluation et 
le traitement de la santé mentale ainsi que dans l’amélioration des performances 
mentales personnelles.

© 2020, AICHServier Group.

DOI: 10.31887/DCNS.2020.22.2/mhoehe
PMCID: PMC7366947
PMID: 32699509 [Indexed for MEDLINE]


4310. Rev Esp Salud Publica. 2020 Jul 23;94:e202007088.

[Impact of SARS-CoV-2 (Covid-19) on the mental health of healthcare 
professionals: a systematic review.].

[Article in Spanish; Abstract available in Spanish from the publisher]

García-Iglesias JJ(1)(2), Gómez-Salgado J(1)(3), Martín-Pereira J(4), 
Fagundo-Rivera J(2)(5), Ayuso-Murillo D(6), Martínez-Riera JR(7), Ruiz-Frutos 
C(1)(3).

Author information:
(1)Departamento de Sociología, Trabajo Social y Salud Pública. Universidad de 
Huelva. Huelva. España.
(2)Escuela Superior de Salud. Universidade Atlântica. Lisboa. Portugal.
(3)Programa de Posgrado de Seguridad y Salud. Universidad Espíritu Santo. 
Guayaquil. Ecuador.
(4)Consorcio de transporte sanitario onubense. Base en Centro de Salud de Isla 
Cristina. Huelva. España.
(5)Servicio Andaluz de Salud. Sevilla. España.
(6)Consejo General de Enfermería de España. Madrid. España.
(7)Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e 
Historia de la Ciencia. Facultad de Ciencias de la Salud. Universidad de 
Alicante. Alicante. España.

Comment in
    Isr Med Assoc J. 2022 May;24(5):342.

BACKGROUND: In times of this global pandemic situation, population's mental 
health is compromised, especially in those groups that are at the forefront of 
defence against the virus such as healthcare professionals. The objective of 
this study was to analyze the impact of the SARS-CoV-2 outbreak on healthcare 
professionals' mental health.
METHODS: A systematic review was carried out following the PRISMA format in 
Pubmed, Scopus, Web of Science, CINAHL, PsycINFO and ScienceDirect electronic 
databases between January and May 2020. Methodological quality was evaluated 
using the Joanna Briggs Institute (JBI) critical appraisal tools for 
non-randomized studies.
RESULTS: A total of 13 studies were included in this review. Professionals' 
mental health and mental functions were compromised, being especially affected 
those professionals on the front line of battle against the virus. However, 
these stats were below the general population data. Although there is wide 
variability of results, medium-high levels of anxiety (26,5%-44,6%), depression 
(8,1%-25%), concern and insomnia are detected (23,6%-38%). Paradoxically, stress 
levels were below expectations (3,8%-68,3%).
CONCLUSIONS: The mental well-being of health professionals working on the front 
line is compromised in times of pandemic by presenting medium-high levels of 
anxiety, depression, nervousness and insomnia, and, to a lesser extent, stress.

Publisher: OBJETIVO: Ante una situación de pandemia mundial, la salud mental de 
la población se ve comprometida, especialmente en los colectivos que están en 
primera línea de defensa contra el virus como son los profesionales sanitarios. 
El objetivo de este estudio fue analizar el impacto en la salud mental de los 
profesionales sanitarios que prestan atención a pacientes durante el brote de 
SARS-CoV-2.
METODOS: Se realizó una revisión sistemática siguiendo el formato PRISMA en las 
bases de datos electrónicas Pubmed, Scopus, Web of Science, CINAHL, PsycINFO y 
ScienceDirect entre los meses de enero y mayo de 2020. Se evaluó la calidad 
metodológica a partir de las herramientas de evaluación crítica para estudios no 
randomizados del Joanna Briggs Institute (JBI).
RESULTADOS: Un total de 13 estudios fueron incluidos en esta revisión. La salud 
mental de los profesionales sanitarios se vio comprometida ante la pandemia de 
SARS-CoV-2 en el ejercicio de sus funciones, siendo especialmente afectados los 
profesionales que se encontraban en la primera línea de batalla contra el virus, 
pero con valores por debajo de los de la población general. Aunque existió una 
amplia variabilidad de resultados, se observaron niveles medio-altos de ansiedad 
(26,5%-44,6%), depresión (8,1%-25%), preocupación e insomnio (23,6%-38%), y, 
paradójicamente, niveles de estrés por debajo de lo esperado (3,8%-68,3%).
CONCLUSIONES: La salud mental de los profesionales sanitarios que trabajan en 
primera línea de batalla se ve comprometida en tiempos de pandemia presentando 
niveles medio-altos de ansiedad, depresión, preocupación e insomnio, y, en menor 
medida, estrés.

PMID: 32699204 [Indexed for MEDLINE]


4311. Cancer. 2020 Oct 1;126(19):4414-4422. doi: 10.1002/cncr.33098. Epub 2020 Jul 22.

The impact of COVID-19 on the cancer care of adolescents and young adults and 
their well-being: Results from an online survey conducted in the early stages of 
the pandemic.

Košir U(1), Loades M(2), Wild J(1), Wiedemann M(1), Krajnc A(3), Roškar S(4), 
Bowes L(1).

Author information:
(1)Department of Experimental Psychology, University of Oxford, Oxford, United 
Kingdom.
(2)Department of Psychology, University of Bath, Bath, United Kingdom.
(3)Chemistry Research Laboratory, Department of Chemistry, University of Oxford, 
Oxford, United Kingdom.
(4)Centre for Hearing and Speech Maribor, Maribor, Slovenia.

BACKGROUND: Because of the global spread of coronavirus disease 2019 (COVID-19), 
oncology departments across the world have rapidly adapted their cancer care 
protocols to balance the risk of delaying cancer treatments and the risk of 
COVID-19 exposure. COVID-19 and associated changes may have an impact on the 
psychosocial functioning of patients with cancer and survivors. This study was 
designed to determine the impact of the COVID-19 pandemic on young people living 
with and beyond cancer.
METHODS: In this cross-sectional study, 177 individuals, aged 18 to 39 years, 
were surveyed about the impact of COVID-19 on their cancer care and 
psychological well-being. Participants also reported their information needs 
with respect to COVID-19. Responses were summarized with a content analysis 
approach.
RESULTS: This was the first study to examine the psychological functioning of 
young patients and survivors during the first weeks of the COVID-19 pandemic. A 
third of the respondents reported increased levels of psychological distress, 
and as many as 60% reported feeling more anxious than they did before COVID-19. 
More than half also wanted more information tailored to them as young patients 
with cancer.
CONCLUSIONS: The COVID-19 pandemic is rapidly evolving and changing the 
landscape of cancer care. Young people living with cancer are a unique 
population and might be more vulnerable during this time in comparison with 
their healthy peers. There is a need to screen for psychological distress and 
attend to young people whose cancer care has been delayed. As the lockdown 
begins to ease, the guidelines about cancer care should be updated according to 
this population's needs.

© 2020 The Authors. Cancer published by Wiley Periodicals LLC on behalf of 
American Cancer Society.

DOI: 10.1002/cncr.33098
PMCID: PMC7405129
PMID: 32697342 [Indexed for MEDLINE]

Conflict of interest statement: The authors made no disclosures.


4312. Curr Biol. 2020 Jul 20;30(14):R795-R797. doi: 10.1016/j.cub.2020.06.021. Epub 
2020 Jun 10.

Effects of the COVID-19 lockdown on human sleep and rest-activity rhythms.

Blume C(1), Schmidt MH(2), Cajochen C(2).

Author information:
(1)Centre for Chronobiology, Psychiatric Hospital of the University of Basel, 
Wilhelm-Klein-Str. 27, CH-4002 Basel, Switzerland; Transfaculty Research 
Platform Molecular and Cognitive Neurosciences, University of Basel, 
Birmannsgasse 8, CH-4055 Basel, Switzerland. Electronic address: 
christine.blume@upk.ch.
(2)Centre for Chronobiology, Psychiatric Hospital of the University of Basel, 
Wilhelm-Klein-Str. 27, CH-4002 Basel, Switzerland; Transfaculty Research 
Platform Molecular and Cognitive Neurosciences, University of Basel, 
Birmannsgasse 8, CH-4055 Basel, Switzerland.

Comment in
    Curr Biol. 2020 Jul 20;30(14):R822-R823.
    MMW Fortschr Med. 2021 Feb;163(2):18.

In modern societies, human rest-activity rhythms and sleep result from the 
tensions and dynamics between the conflicting poles of external social time 
(e.g., work hours and leisure activities) and an individual's internal 
biological time. A mismatch between the two has been suggested to induce 'social 
jetlag' [1] and 'social sleep restriction', that is, shifts in sleep timing and 
differences in sleep duration between work days and free days. Social jetlag 
[2,3] and sleep restrictions [4] have repeatedly been associated with negative 
consequences on health, mental wellbeing, and performance. In a large-scale 
quasi-experimental design, we investigated the effects of the phase with the 
most rigorous COVID-19 restrictions on the relationship between social and 
biological rhythms as well as sleep during a six-week period (mid-March until 
end of April 2020) in three European societies (Austria, Germany, Switzerland). 
We found that, on one hand, the restrictions reduced the mismatch between 
external (social) and internal (biological) sleep-wake timing, as indexed by 
significant reductions in social jetlag and social sleep restriction, with a 
concomitant increase in sleep duration. Sleep quality on the other hand was 
slightly reduced. The improved individual sleep-wake timing can presumably be 
attributed to an increased flexibility of social schedules, for instance due to 
more work being accomplished from home. However, this unprecedented situation 
also led to a significant increase in self-perceived burden, which was attendant 
to the decrease in sleep quality. These adverse effects may be alleviated by 
exposure to natural daylight as well as physical exercise.

Copyright © 2020 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.cub.2020.06.021
PMCID: PMC7284244
PMID: 32693067 [Indexed for MEDLINE]


4313. J Contemp Dent Pract. 2020 May 1;21(5):471-472.

Depression, Anxiety, and Psychological Distress among Healthcare Providers 
during the Outbreak of the Life-threatening Coronavirus Disease (COVID-19).

Khanagar SB(1), Al-Ehaideb A(2), Vishwanathaiah S(3), Maganur PC(3), Varadarajan 
S(4), Patil S(5).

Author information:
(1)Preventive Dental Science Department, College of Dentistry, King Saud Bin 
Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia, 
Phone: +966 592349770, e-mail: sanjeev.khanagar76@gmail.com.
(2)Department of Preventive Dental Sciences, College of Dentistry, King Saud bin 
Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Dental Services, 
King Abdulaziz Medical City-Ministry of National Guard Health Affairs, Riyadh, 
Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, 
Riyadh, Kingdom of Saudi Arabia.
(3)Department of Preventive Dental Sciences, Division of Pedodontics, College of 
Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia.
(4)Department of Oral Pathology and Microbiology, Sri Venkateswara Dental 
College and Hospital, Thalambur, Chennai, Tamil Nadu, India.
(5)Department of Maxillofacial Surgery and Diagnostic Sciences, Division of Oral 
Pathology, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi 
Arabia.

"The concept of total wellness recognizes that our every thought, word, and 
behavior affect our greater health and well-being. And we, in turn, are affected 
not only emotionally but also physically and spiritually."-Greg Anderson.

PMID: 32690824 [Indexed for MEDLINE]


4314. BMJ Open. 2020 Jul 20;10(7):e039334. doi: 10.1136/bmjopen-2020-039334.

Public perceptions and experiences of social distancing and social isolation 
during the COVID-19 pandemic: a UK-based focus group study.

Williams SN(1), Armitage CJ(2), Tampe T(3), Dienes K(2).

Author information:
(1)Centre for People and Organisation, School of Management, Swansea University, 
Swansea, UK s.n.williams@swansea.ac.uk.
(2)Manchester Centre for Health Psychology, University of Manchester, 
Manchester, UK.
(3)World Health Organization, Genève, Switzerland.

OBJECTIVE: This study explored UK public perceptions and experiences of social 
distancing and social isolation related to the COVID-19 pandemic.
DESIGN: This qualitative study comprised five focus groups, carried out online 
during the early stages of the UK's stay at home order ('lockdown'), and 
analysed using a thematic approach.
SETTING: Focus groups took place via online videoconferencing.
PARTICIPANTS: Participants (n=27) were all UK residents aged 18 years and older, 
representing a range of gender, ethnic, age and occupational backgrounds.
RESULTS: Qualitative analysis revealed four main themes: (1) loss-participants' 
loss of (in-person) social interaction, loss of income and loss of structure and 
routine led to psychological and emotional 'losses' such as loss of motivation, 
loss of meaning and loss of self-worth; (2) criticisms of government 
communication-participants reported a lack of trust in government and a lack of 
clarity in the guidelines around social distancing and isolation; (3) 
adherence-participants reported high self-adherence to social distancing 
guidelines but reported seeing or hearing of non-adherence in others; (4) 
uncertainty around social reintegration and the future-some participants felt 
they would have lingering concerns over social contact while others were eager 
to return to high levels of social activity.Most participants, and particularly 
those in low-paid or precarious employment, reported feeling that the social 
distancing and isolation associated with COVID-19 policy has had negative 
impacts on their mental health and well-being during the early stages of the 
UK's 'lockdown'.
CONCLUSIONS: A rapid response is necessary in terms of public health programming 
to mitigate the mental health impacts of COVID-19 social distancing and 
isolation. Social distancing and isolation 'exit strategies' must account for 
the fact that, although some individuals will voluntarily or habitually continue 
to socially distance, others will seek high levels of social engagement as soon 
as possible.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2020-039334
PMCID: PMC7387310
PMID: 32690752 [Indexed for MEDLINE]


4315. Psychiatr Prax. 2020 Sep;47(6):308-318. doi: 10.1055/a-1202-2427. Epub 2020 Jul 
20.

[Social Participation, Inclusion and Mental Well-Being Following SARS-CoV-2 
Related Restrictions on Going Out - A Follow-up Study from Germany].

[Article in German; Abstract available in German from the publisher]

Schützwohl M(1), Mergel E(1).

Author information:
(1)Klinik und Poliklinik für Psychiatrie und Psychotherapie, 
Universitätsklinikum C. G. Carus der TU Dresden.

OBJECTIVE: To assess the impact of the Corona pandemic and related restrictions 
on going out on social participation, social inclusion and well-being in adults 
with and without current or chronic mental health problems METHODS: Follow-up 
survey (n = 132) using the Measure of Participation and Social Inclusion for Use 
in People with a Chronic Mental Disorder (F-INK), the Index for the Assessment 
of Health Impairments (IMET), and the Brief Symptom Inventory (BSI-18).
RESULTS: The impact on social participation capabilities and social 
participation differed depending on the participants' mental health status at 
the first assessment. Independent of this, we found no detrimental effect on the 
mental health status four weeks after the enactment of restrictions on 
going-out.
CONCLUSION: Findings imply a general resilience in well-being in the preliminary 
stages of the Corona pandemic.

Publisher: ZIEL DER STUDIE: Untersuchung der Auswirkungen der Coronapandemie und 
der in diesem Zusammenhang ausgesprochenen Ausgangsbeschränkungen auf 
Teilhabemöglichkeiten, Partizipation, Inklusionserleben und psychisches Befinden 
bei Personen, die sich mit Blick auf das Vorliegen einer akuten oder chronischen 
psychischen Störung unterschiedlichen Gruppen zuordnen lassen.
METHODIK: Follow-up-Erhebung mittels Fragebogen zur Erfassung von Partizipation 
und sozialer Inklusion (F-INK), Index zur Messung von Einschränkungen der 
Teilhabe (IMET) und BSI-18 (n = 132).
ERGEBNISSE: In Abhängigkeit vom Vorliegen einer akuten oder chronischen 
psychischen Störung waren die Studienteilnehmer in ihren Teilhabemöglichkeiten 
sehr unterschiedlich betroffen. In keiner der untersuchten Gruppen kam es zu 
einem Anstieg psychischer Beschwerden.
SCHLUSSFOLGERUNG: Es fand sich kein Hinweis dafür, dass es zu Beginn der 
Coronapandemie und im Zusammenhang mit einer vierwöchigen Ausgangsbeschränkung 
zu negativen psychischen Folgen kam.

© Georg Thieme Verlag KG Stuttgart · New York.

DOI: 10.1055/a-1202-2427
PMID: 32688427 [Indexed for MEDLINE]

Conflict of interest statement: Die Autorinnen/Autoren geben an, dass kein 
Interessenkonflikt besteht.


4316. J Psychosom Res. 2020 Sep;136:110186. doi: 10.1016/j.jpsychores.2020.110186. 
Epub 2020 Jul 3.

The effect of age, gender, income, work, and physical activity on mental health 
during coronavirus disease (COVID-19) lockdown in Austria.

Pieh C(1), Budimir S(2), Probst T(3).

Author information:
(1)Department for Psychotherapy and Biopsychosocial Health, Danube University 
Krems, Krems, Austria. Electronic address: Christoph.pieh@donau-uni.ac.at.
(2)Department for Psychotherapy and Biopsychosocial Health, Danube University 
Krems, Krems, Austria; Department of Work, Organization and Society, Ghent 
University, Belgium.
(3)Department for Psychotherapy and Biopsychosocial Health, Danube University 
Krems, Krems, Austria.

Erratum in
    J Psychosom Res. 2020 Dec;139:110278.

BACKGROUND: The impact of Coronavirus disease (COVID-19) and the governmental 
restrictions on mental health have been reported for different countries. This 
study evaluated mental health during COVID-19 lockdown in Austria and the effect 
of age, gender, income, work, and physical activity.
METHODS: An online survey was performed through Qualtrics® after four weeks of 
lockdown in Austria to recruit a representative sample regarding gender, age, 
education, and region. Indicators of mental health were quality of life (WHO-QOL 
BREF), well-being (WHO-5), depression (PHQ-9), anxiety (GAD-7), stress (PSS-10), 
and sleep quality (ISI).
RESULTS: In total, N = 1005 individuals were included (53% women). 21% scored 
above the cut off ≥10 points (PHQ-9) for moderate depressive symptoms, 119% 
scored above the cut-off ≥10 points (GAD-7) for moderate anxiety symptoms, and 
16% above the cut-off ≥15 points (ISI) for clinical insomnia. ANOVAs, 
Bonferroni-corrected post-hoc tests, and t-tests showed highest mental health 
problems in adults under 35 years, women, people with no work, and low income 
(all p-values <.05). Comparisons with a large Austrian sample recruited within 
the ATHIS 2014 study showed increases of depression and decreases of quality of 
life in times of COVID-19 as compared to before COVID-19.
CONCLUSIONS: Depressive symptoms (21%) and anxiety symptoms (19%) are higher 
during COVID-19 compared to previous epidemiological data. 16% rated over the 
cut-off for moderate or severe clinical insomnia. The COVID-19 pandemic and 
lockdown seems particularly stressful for younger adults (<35 years), women, 
people without work, and low income.

Copyright © 2020. Published by Elsevier Inc.

DOI: 10.1016/j.jpsychores.2020.110186
PMCID: PMC7832650
PMID: 32682159 [Indexed for MEDLINE]


4317. Fam Process. 2020 Sep;59(3):1060-1079. doi: 10.1111/famp.12585. Epub 2020 Aug 
29.

A Mixed-method Study of Individual, Couple, and Parental Functioning During the 
State-regulated COVID-19 Lockdown in Spain.

Günther-Bel C(1), Vilaregut A(1), Carratala E(1), Torras-Garat S(1), 
Pérez-Testor C(1).

Author information:
(1)FPCEE Blanquerna, Ramon Llull University, Barcelona, Spain.

During the recent COVID-19 outbreak in Spain, we explored the individual and 
relational well-being of people confined together with their partners and/or 
children during the first 3 weeks of state-regulated lockdown. Adults 18 years 
or older (N = 407) completed an online survey that included demographic, 
household, and employment information along with standardized measures of 
psychological distress (State-Trait Anxiety and Beck Depression) and 
relationship functioning-either the Dyadic Adjustment Scale if there were no 
children in the household or a Basic Family Relations Evaluation Questionnaire 
(CERFB) measuring conjugal, parental, and coparental functions. Qualitative 
analyses of responses to an open-ended question about perceived changes in 
couple or family dynamics during lockdown revealed nine specific themes 
comprising two overarching categories: relational improvement and deterioration. 
The overall prevalence of improvement themes (61.7%) exceeded deterioration 
themes (41.0%), with increased (re)connection and conflict atmosphere cited most 
often. Quantitative analyses found elevated levels of state anxiety but not 
trait anxiety or depression during lockdown. Consistent with the qualitative 
results, couples having no children at home reported high levels of dyadic 
adjustment, but with children present CERFB parental functioning exceeded 
conjugal functioning, a pattern sometimes associated with child triangulation 
into adult conflicts. Although correlates of psychological distress (e.g., 
unemployment, perceived economic risk) were relatively stable across subgroups, 
predictors of relationship functioning varied substantially with 
household/parental status (e.g., telecommuting and employment facilitated 
conjugal functioning only for couples with children).

Publisher: Durante el reciente brote de la COVID-19 en España, analizamos el 
bienestar individual y relacional de las personas confinadas con sus parejas o 
hijos durante las primeras tres semanas de confinamiento regulado por el estado. 
Un grupo de adultos mayores de 18 años (N=407) completó una encuesta con datos 
demográficos, información sobre la vivienda y el empleo, evaluaciones 
estandarizadas de distrés psicológico (ansiedad-rasgo y ansiedad-estado, 
depresión de Beck) y funcionamiento familiar (la Escala de ajuste diádico si no 
había niños en la vivienda o un Cuestionario básico de evaluación de las 
relaciones familiares (CERFB) que miden las funciones conyugales, parentales y 
coparentales. Los análisis cualitativos de las respuestas a una pregunta abierta 
acerca de los cambios percibidos en la dinámica de pareja o familiar durante el 
confinamiento revelaron nueve temas específicos que comprenden dos categorías 
dominantes: la mejora y el deterioro relacional. La prevalencia general de los 
temas de mejora (61.7 %) excedió los temas de deterioro (41.0 %), y se mencionó 
con más frecuencia una mayor (re)conexión y un ambiente de conflicto. Los 
análisis cuantitativos indicaron niveles elevados de ansiedad-estado pero no de 
ansiedad-rasgo ni de depresión durante el confinamiento. De acuerdo con los 
resultados cualitativos, las parejas que no tienen hijos en la casa informaron 
niveles altos de ajuste diádico, pero con los niños presentes, el funcionamiento 
parental del CERFB excedió el funcionamiento conyugal, un patrón asociado a 
veces con la triangulación de los niños en los conflictos de los adultos. Aunque 
las relaciones de distrés psicológico (p. ej.: desempleo, riesgo económico 
percibido) fueron relativamente estables entre los subgrupos, los predictores 
del funcionamiento relacional variaron considerablemente con la situación 
habitacional/parental (p. ej: el teletrabajo y el empleo facilitaron el 
funcionamiento conyugal solo en el caso de las parejas con niños).

Publisher: 
最近在COVID-19新冠肺炎爆发期间的西班牙，我们探索了在国家管控封城禁足的头三个星期里，在人们与其伴侣和/或儿童一起被关闭起来的情况下，个体的健康状况和关系的健康情况。407位18岁或以上的成年人(N=407) 
完成了一项在线调查，内容包括人口、家庭和就业信息，还有标准化的心理困扰量表(状态-特质焦虑、贝克抑郁)以及关系功能----如果家庭中没有儿童，则采用二分调整量表，或者基本家庭关系评估问卷(CERFB)测量夫妻、父母和共同父母的功能。本研究对一个开放式问题的回答作了定性分析，结果揭示了9个特定的主题，两个大的类别即关系得到改善和关系走向恶化两种。使用的问题是关于伴侣关系方面或家庭互动方面发生的可觉察变化。关系有改善的主题占了主导，达测量对象的61.7%，超过了关系有所恶化的主题(占41.0%)，其中最常提到的是相互之间的（重新）连接增强了 
，还有更多的冲突情况。定量分析研究发现，在管制禁闭期间，情绪状态型的焦虑水平升高，但生理特质性焦虑或生理性抑郁的水平没有升高。与定性研究结果相一致的是，没有孩子的家庭报告了高水平的二元适应，但有孩子的情况下，问卷中归纳出的为人父母的功能超过了配偶的功能，这种模式有时和儿童构成的三角关系演变成成人冲突。虽然心理压力的相关因素(如失业、感知到的经济风险)在各个亚群体中相对稳定，但关系功能的预测因素因家庭/父母现状而显著不同(例如，远程办公和就业促进的婚姻功能仅适用于有孩子的夫妇)。.

© 2020 Family Process Institute.

DOI: 10.1111/famp.12585
PMCID: PMC7405150
PMID: 32678461 [Indexed for MEDLINE]


4318. Biol Res Nurs. 2020 Oct;22(4):485-494. doi: 10.1177/1099800420941923. Epub 2020 
Jul 17.

The Gut Microbiome as a Component of the Gut-Brain Axis in Cognitive Health.

Gao W(1)(2)(3)(4), Baumgartel KL(5), Alexander SA(4).

Author information:
(1)The Second Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, 
China.
(2)Nursing Department, School of Medicine, Zhejiang University, Hangzhou, 
Zhejiang, China.
(3)China Scholarship Council Program for Joint Training, China.
(4)School of Nursing, University of Pittsburgh, PA, USA.
(5)Targeted Research and Academic Training Program for Nurses in Genomics (T32 
NR009759 11), Health Promotion & Development, School of Nursing, 16144University 
of Pittsburgh, PA, USA.

INTRODUCTION: The human microbiome, the microorganisms living in and on the 
body, plays a vital role in brain physiology and pathophysiology. The gut 
microbiome (GMB) has been identified as a link in the gut-brain axis moderating 
cognitive development and health.
OBJECTIVES: The objectives of this scoping review are to discuss mechanisms of 
the microbiome-gut-brain axis in cognition, review the existing literature on 
the GMB and cognition, and discuss implications for nursing research.
METHODS: We searched Pubmed using the terms "gut microbiome," "brain," and 
"cognition" and the terms "gut brain axis," "microbiome," and "cognition"; 
removed duplicates, studies not published in English, and unrelated 
publications; and added additional articles identified through references. We 
retained the 85 most relevant publications for this review.
RESULTS: Common themes in the current literature include GMB components; 
interactions on cognitive development; effects of GMB-gut-brain interactions on 
cognition, mild cognitive impairment and Alzheimer's disease; effects of GMB 
interactions with physiologic stress on cognition in critical care; and GMB 
modification for improved cognition. Review of the literature on each of these 
topics reveals multiple theoretical mechanisms of action for GMB-gut-brain 
interaction that modify cognitive development and function across the lifespan.
DISCUSSION: GMB components and dysbiosis have been implicated in many cognitive 
states, and specific microbiota constituents contribute to cognitive 
development, stability, and impairment. The study of these interactions is 
relevant to nursing research as it addresses the holistic human experience and 
microbiome constituents are modifiable, facilitating translation into the 
clinical setting.

DOI: 10.1177/1099800420941923
PMCID: PMC7874359
PMID: 32677447 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


4319. Front Public Health. 2020 Jun 26;8:341. doi: 10.3389/fpubh.2020.00341. 
eCollection 2020.

Psychosocial and Socio-Economic Crisis in Bangladesh Due to COVID-19 Pandemic: A 
Perception-Based Assessment.

Bodrud-Doza M(1), Shammi M(2), Bahlman L(3), Islam ARMT(4), Rahman MM(2).

Author information:
(1)Climate Change Programme, BRAC, Dhaka, Bangladesh.
(2)Department of Environmental Sciences, Jahangirnagar University, Dhaka, 
Bangladesh.
(3)International Centre for Climate Change and Development (ICCCAD), Independent 
University Bangladesh (IUB), Dhaka, Bangladesh.
(4)Department of Disaster Management, Begum Rokeya University, Rangpur, 
Bangladesh.

Background: The spread of the COVID-19 pandemic, the partial lockdown, the 
disease intensity, weak governance in the healthcare system, insufficient 
medical facilities, unawareness, and the sharing of misinformation in the mass 
media has led to people experiencing fear and anxiety. The present study 
intended to conduct a perception-based analysis to get an idea of people's 
psychosocial and socio-economic crisis, and the possible environmental crisis, 
amidst the COVID-19 pandemic in Bangladesh. Methods: A perception-based 
questionnaire was put online for Bangladeshi citizens of 18 years and/or older. 
The sample size was 1,066 respondents. Datasets were analyzed through a set of 
statistical techniques including principal component and hierarchical cluster 
analysis. Results: There was a positive significant association between fear of 
the COVID-19 outbreak with the struggling healthcare system (p < 0.05) of the 
country. Also, there was a negative association between the fragile health 
system of Bangladesh and the government's ability to deal with the pandemic (p < 
0.05), revealing the poor governance in the healthcare system. A positive 
association of shutdown and social distancing with the fear of losing one's own 
or a family members' life, influenced by a lack of healthcare treatment (p < 
0.05), reveals that, due to the decision of shutting down normal activities, 
people may be experiencing mental and economic stress. However, a positive 
association of the socio-economic impact of the shutdown with poor people's 
suffering, the price hike of basic essentials, the hindering of formal education 
(p < 0.05), and the possibility of a severe socio-economic and health crisis 
will be aggravated. Moreover, there is a possibility of a climate change-induced 
disaster and infectious diseases like dengue during/after the COVID-19 
situation, which will create severe food insecurity (p < 0.01) and a further 
healthcare crisis. Conclusions: The partial lockdown in Bangladesh due to the 
COVID-19 pandemic increased community transmission and worsened the healthcare 
crisis, economic burden, and loss of GDP despite the resuming of industrial 
operations. In society, it has created psychosocial and socio-economic 
insecurity among people due to the loss of lives and livelihoods. The government 
should take proper inclusive steps for risk assessment, communications, and 
financial stimulus toward the public to alleviate their fear and anxiety, and to 
take proper action to boost mental health and well-being.

Copyright © 2020 Bodrud-Doza, Shammi, Bahlman, Islam and Rahman.

DOI: 10.3389/fpubh.2020.00341
PMCID: PMC7333562
PMID: 32676492 [Indexed for MEDLINE]


4320. J Prim Care Community Health. 2020 Jan-Dec;11:2150132720944074. doi: 
10.1177/2150132720944074.

A Mixed-Methods Pilot Study of Perinatal Risk and Resilience During COVID-19.

Farewell CV(1), Jewell J(1), Walls J(1), Leiferman JA(1).

Author information:
(1)University of Colorado Denver, Aurora, CO, USA.

Introduction/Objectives: National guidelines underscore the need for improvement 
in the detection and treatment of mood disorders in the perinatal period. 
Exposure to disasters can amplify perinatal mood disorders and even have 
intergenerational impacts. The primary aim of this pilot study was to use 
mixed-methods to better understand the mental health and well-being effects of 
the coronavirus disease 2019 (COVID-19) pandemic, as well as sources of 
resilience, among women during the perinatal period. Methods: The study team 
used a simultaneous exploratory mixed-methods design to investigate the primary 
objective. Thirty-one pregnant and postpartum women participated in phone 
interviews and were invited to complete an online survey which included 
validated mental health and well-being measures. Results: Approximately 12% of 
the sample reported high depressive symptomatology and 60% reported moderate or 
severe anxiety. Forty percent of the sample reported being lonely. The primary 
themes related to stress were uncertainty surrounding perinatal care, exposure 
risk for both mother and baby, inconsistent messaging from information sources 
and lack of support networks. Participants identified various sources of 
resilience, including the use of virtual communication platforms, engaging in 
self-care behaviors (eg, adequate sleep, physical activity, and healthy eating), 
partner emotional support, being outdoors, gratitude, and adhering to structures 
and routines. Conclusions: Since the onset of COVID-19, many pregnant and 
postpartum women report struggling with stress, depression, and anxiety 
symptomatology. Findings from this pilot study begin to inform future 
intervention work to best support this highly vulnerable population.

DOI: 10.1177/2150132720944074
PMCID: PMC7370556
PMID: 32674654 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


4321. Health Hum Rights. 2020 Jun;22(1):35-49.

Addressing the Problem of Severe Underinvestment in Mental Health and Well-Being 
from a Human Rights Perspective.

Mahomed F(1).

Author information:
(1)Program Officer for Mental Health and Rights at the Open Society Foundations, 
New York, USA, Research Associate, Harvard Law School Project on Disability and 
Visiting Research Fellow at the Centre for Applied Legal Studies, University of 
the Witwatersrand, Johannesburg, South Africa.

Throughout the world, mental health remains a neglected priority, low on the 
agenda of policy makers and funders at the national and international levels. 
While this is shifting somewhat, there remains a considerable need to address 
the underprioritization of mental health and well-being, perhaps even more so in 
the wake of the COVID-19 pandemic. However, given the history of mental health 
interventions-which have overemphasized the biomedical model and have thus 
resulted in coercion, denial of life in the community, and unnecessary 
pathologization of human experience-there is also a need to ensure that 
increased funding does not simply replicate these mistakes. This is particularly 
true in the current landscape, where efforts to "scale up" mental health and to 
reduce "treatment gaps" are gaining momentum and where post-pandemic responses 
are still being formulated. As the potential for global mechanisms for funding 
mental health increases, national and international funders should look to 
practices that are rights affirming and contextually relevant. In this paper, I 
explore the current landscape of mental health financing, in terms of both 
national resource allocation and development assistance. I then outline the 
momentum in global mental health that is likely to materialize through increased 
funding, before considering ways in which that funding might be utilized in a 
manner that promotes human rights.

Copyright © 2020 Mahomed.

PMCID: PMC7348439
PMID: 32669787 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


4322. Expert Rev Anti Infect Ther. 2020 Dec;18(12):1195-1200. doi: 
10.1080/14787210.2020.1794818. Epub 2020 Jul 23.

Exercise and well-being during COVID 19 - time to boost your immunity.

Ranasinghe C(1)(2), Ozemek C(2)(3), Arena R(2)(3).

Author information:
(1)Sports and Exercise Medicine Unit and Department of Allied Health Sciences, 
Faculty of Medicine, University of Colombo , Colombo, Sri Lanka.
(2)Healthy Living for Pandemic Event Protection (HL-PIVOT) Network , Chicago, 
IL, USA.
(3)Department of Physical Therapy, College of Applied Science, University of 
Illinois , Chicago, IL, USA.

INTRODUCTION: The COVID-19 pandemic is causing devastating global morbidity and 
mortality. Worldwide measures are taken to prevent human to human transmission 
and improve general health. Public lifestyle and health are affected by social 
distancing and isolation. A strong host immune response to the novel coronavirus 
is a key factor, for protection against infection and avoiding reaching severe 
stages of the disease.
AREAS COVERED: Pathophysiology and the human immune response of similar 
coronaviruses have been previously described. The novel coronavirus has distinct 
clinical stages related to the immune response. Exercise improves host innate 
immunity and affords protection to viral infections. Exercise also mitigates the 
negative effects of isolation including stress, anxiety, and sedentarism, all of 
which further reduces immunity and increases non-communicable disease risk.
EXPERT OPINION: Improving host immunity and mitigating the negative effects of 
isolation via physical activity is strongly justified. Exercise should be done 
in moderate intensities and volumes during the current pandemic, which is a 
nutritionally, psychologically, socially challenging environment in the presence 
of a virulent viral organism. Proactively creating innovative health promotion 
models with technology and government involvement with the best available 
evidence should be encouraged to reduce physical inactivity during the current 
COVID-19 pandemic and after.

DOI: 10.1080/14787210.2020.1794818
PMID: 32662717 [Indexed for MEDLINE]


4323. Can J Psychiatry. 2020 Oct;65(10):701-709. doi: 10.1177/0706743720940562. Epub 
2020 Jul 14.

Impacts of COVID-19 on Youth Mental Health, Substance Use, and Well-being: A 
Rapid Survey of Clinical and Community Samples: Répercussions de la COVID-19 sur 
la santé mentale, l'utilisation de substances et le bien-être des adolescents : 
un sondage rapide d'échantillons cliniques et communautaires.

Hawke LD(1), Barbic SP(2), Voineskos A(1), Szatmari P(1), Cleverley K(3), Hayes 
E(1), Relihan J(1), Daley M(1), Courtney D(1), Cheung A(4), Darnay K(1), 
Henderson JL(1).

Author information:
(1)Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
(2)Foundry, University of British Columbia, Vancouver, British Columbia, Canada.
(3)Lawrence S Bloomberg Faculty of Nursing, and Department of Psychiatry, 
Faculty of Medicine, University of Toronto, Ontario, Canada.
(4)Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.

Comment in
    Can J Psychiatry. 2021 Jan;66(1):65-66.

OBJECTIVES: The current novel coronavirus disease of 2019 (COVID-19) pandemic 
presents a time-sensitive opportunity to rapidly enhance our knowledge about the 
impacts of public health crises on youth mental health, substance use, and 
well-being. This study examines youth mental health and substance use during the 
pandemic period.
METHODS: A cross-sectional survey was conducted with 622 youth participants 
across existing clinical and community cohorts. Using the National Institute of 
Mental Health-developed CRISIS tool and other measures, participants reported on 
the impacts of COVID-19 on their mental health, substance use, and other 
constructs.
RESULTS: Reports of prepandemic mental health compared to intrapandemic mental 
health show a statistically significant deterioration of mental health across 
clinical and community samples (P < 0.001), with greater deterioration in the 
community sample. A total of 68.4% of youth in the clinical sample and 39.9% in 
the community sample met screening criteria for an internalizing disorder. 
Substance use declined in both clinical and community samples (P < 0.001), 
although 23.2% of youth in the clinical sample and 3.0% in the community sample 
met screening criteria for a substance use disorder. Participants across samples 
report substantial mental health service disruptions (48.7% and 10.8%) and unmet 
support needs (44.1% and 16.2%). Participants report some positive impacts, are 
using a variety of coping strategies to manage their wellness, and shared a 
variety of ideas of strategies to support youth during the pandemic.
CONCLUSIONS: Among youth with histories of mental health concerns, the pandemic 
context poses a significant risk for exacerbation of need. In addition, youth 
may experience the onset of new difficulties. We call on service planners to 
attend to youth mental health during COVID-19 by bolstering the accessibility of 
services. Moreover, there is an urgent need to engage young people as 
coresearchers to understand and address the impacts of the pandemic and the 
short, medium, and long terms.

OBJECTIFS : La pandémie actuelle de du nouveau coronavirus de 2019 (COVID-19) 
offre une occasion critique d’améliorer rapidement nos connaissances au sujet 
des répercussions des crises de santé publique sur la santé mentale, 
l’utilisation de substances et le bien-être des adolescents. La présente étude 
examine la santé mentale et l’utilisation de substances durant la période de la 
pandémie.
MÉTHODES : Un sondage transversal a été mené auprès de 622 adolescents 
participants issus de cohortes cliniques et communautaires existantes. À l’aide 
de l’instrument CRISIS mis au point par le NIMH et d’autres, mesures les 
participants ont fait état des répercussions de la COVID-19 sur leur santé 
mentale, leur utilisation de substances et d’autres concepts.
RÉSULTATS : Les rapports sur la santé mentale pré-pandémique comparés à la santé 
mentale intra-pandémique révèlent une détérioration statistiquement 
significative de la santé mentale dans les échantillons cliniques et 
communautaires (p < ,001), la détérioration étant plus marquée dans 
l’échantillon communautaire. Un total de 68,4 % d’adolescents de l’échantillon 
clinique et 39,9 % de l’échantillon communautaire satisfaisaient aux critères de 
dépistage d’un trouble d’internalisation. L’utilisation de substances a diminué 
dans les deux échantillons, cliniques et communautaires (p < ,001), bien que 
23,2 % des adolescents de l’échantillon clinique et 3,0 % de l’échantillon 
communautaire aient satisfait aux critères de dépistage d’un trouble 
d’utilisation de substances. Les participants des deux échantillons déclarent 
une interruption substantielle des services de santé mentale (48,7 % et 10,8 %) 
et des besoins de soutien non comblés (44,1 % et 16,2 %). Les participants 
mentionnent certains effets positifs, ils utilisent diverses stratégies 
d’adaptation pour gérer leur bien-être, et ils ont partagé diverses idées et 
stratégies pour soutenir les adolescents durant la pandémie.
CONCLUSIONS : Chez les adolescents ayant des antécédents de problèmes de santé 
mentale, le contexte de la pandémie pose un risque significatif à l’exacerbation 
des besoins. En les adolescents peuvent voir survenir de nouvelles difficultés. 
Nous demandons aux planificateurs des services de prendre soin de la santé 
mentale des adolescents durant la COVID-19 en renforçant l’accessibilité des 
services. De plus, il y a un besoin urgent de recruter des jeunes gens comme 
co-chercheurs, pour comprendre et gérer les répercussions de la pandémie à 
court, à moyen et à long terme.

DOI: 10.1177/0706743720940562
PMCID: PMC7502874
PMID: 32662303 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


4324. Chronobiol Int. 2020 Aug;37(8):1191-1200. doi: 10.1080/07420528.2020.1786107. 
Epub 2020 Jul 13.

COVID-19 pandemic and lockdown: cause of sleep disruption, depression, somatic 
pain, and increased screen exposure of office workers and students of India.

Majumdar P(1), Biswas A(1), Sahu S(1).

Author information:
(1)Ergonomics and Occupational Physiology Laboratory, Department of Physiology, 
University of Kalyani , Kalyani, Nadia, India.

COVID-19 has brought the world into uncharted waters. Many countries are under 
lockdown, the economy has ground to a halt, and almost everyone is afraid of 
dire consequences. The unprecedented changes that came on so quickly due to the 
pandemic and stay-at-home confinement to accomplish social distancing and 
mitigate risk for infection pose many challenges. These include compromised 
health, well-being, and sleep as a consequence of disruption of the daily life 
routine, anxiety, worry, isolation, greater family and work stress, and 
excessive screen time. Our study of 203 corporate sector professionals 
performing '9-5' work from home during this phase of the pandemic and of 325 
undergraduate and postgraduate university students substantiates, relative to 
the before lockdown condition, more extensive feelings of sleepiness, with 
significantly (p < .05) increased daytime nap duration, and depressive 
symptomatology (p < .001) that is a matter of concern. Moreover, the chronic 
stress of living through a pandemic led to a host of physical symptoms, like 
headaches, insomnia, digestive problems, hormonal imbalances, and fatigue.

DOI: 10.1080/07420528.2020.1786107
PMID: 32660352 [Indexed for MEDLINE]


4325. JMIR Public Health Surveill. 2020 Jul 21;6(3):e20737. doi: 10.2196/20737.

Belief in a COVID-19 Conspiracy Theory as a Predictor of Mental Health and 
Well-Being of Health Care Workers in Ecuador: Cross-Sectional Survey Study.

Chen X(1), Zhang SX(2), Jahanshahi AA(3), Alvarez-Risco A(4), Dai H(5), Li J(5), 
Ibarra VG(6).

Author information:
(1)Business School, University of Nottingham Ningbo China, Ningbo, China.
(2)Faculty of Professions, University of Adelaide, Adelaide, Australia.
(3)CENTRUM Catholica Graduate Business School, Pontifical Universidad Catholica 
del Peru, Lima, Peru.
(4)Facultad de Ciencias Empresariales y Económicas, Universidad de Lima, Lima, 
Peru.
(5)School of Economics and Management, Tsinghua University, Beijing, China.
(6)School of Business Administration, Carchi State Polytechnic University, 
Turkan, Ecuador.

Comment on
    Soc Psychiatry Psychiatr Epidemiol. 2017 May;52(5):595-604.

BACKGROUND: During the coronavirus disease (COVID-19) pandemic, social media 
platforms have become active sites for the dissemination of conspiracy theories 
that provide alternative explanations of the cause of the pandemic, such as 
secret plots by powerful and malicious groups. However, the association of 
individuals' beliefs in conspiracy theories about COVID-19 with mental health 
and well-being issues has not been investigated. This association creates an 
assessable channel to identify and provide assistance to people with mental 
health and well-being issues during the pandemic.
OBJECTIVE: Our aim was to provide the first evidence that belief in conspiracy 
theories regarding the COVID-19 pandemic is a predictor of the mental health and 
well-being of health care workers.
METHODS: We conducted a survey of 252 health care workers in Ecuador from April 
10 to May 2, 2020. We analyzed the data regarding distress and anxiety caseness 
with logistic regression and the data regarding life and job satisfaction with 
linear regression.
RESULTS: Among the 252 sampled health care workers in Ecuador, 61 (24.2%) 
believed that the virus was developed intentionally in a lab; 82 (32.5%) 
experienced psychological distress, and 71 (28.2%) had anxiety disorder. 
Compared to health care workers who were not sure where the virus originated, 
those who believed the virus was developed intentionally in a lab were more 
likely to report psychological distress and anxiety disorder and to have lower 
levels of job satisfaction and life satisfaction.
CONCLUSIONS: This paper identifies belief in COVID-19 conspiracy theories as an 
important predictor of distress, anxiety, and job and life satisfaction among 
health care workers. This finding will enable mental health services to better 
target and provide help to mentally vulnerable health care workers during the 
ongoing COVID-19 pandemic.

©Xi Chen, Stephen X Zhang, Asghar Afshar Jahanshahi, Aldo Alvarez-Risco, Huiyang 
Dai, Jizhen Li, Verónica García Ibarra. Originally published in JMIR Public 
Health and Surveillance (http://publichealth.jmir.org), 21.07.2020.

DOI: 10.2196/20737
PMCID: PMC7375774
PMID: 32658859 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


4326. Psychol Assess. 2020 Oct;32(10):903-914. doi: 10.1037/pas0000913. Epub 2020 Jul 
13.

The Well-Being Index (WBI) for schools: A brief measure of adolescents' mental 
health.

Luthar SS(1), Ebbert AM(1), Kumar NL(1).

Author information:
(1)Authentic Connections.

Schools are increasingly concerned with the well-being of the whole child - 
likely, more so since the COVID-19 pandemic - and goals here were to document 
the psychometric properties of a brief new measure of adolescent mental health, 
the Well-Being Index (WBI). The measure assesses 4 symptom areas, 2 each of 
internalizing and externalizing symptoms-Depression, Anxiety, Rule-Breaking, and 
Substance Use-and an optional scale on Isolation at School. A total of 2,444 
students from 2 high schools completed the WBI, the Youth Self-Report (YSR), and 
other related measures. Alpha coefficients showed acceptable internal 
consistency, with values for the 5 WBI subscales at .83, .84, .78, .79, and .74, 
respectively. Both exploratory and confirmatory factor analyses demonstrated 
consistent factorial validity. Correlations with corresponding YSR subscales 
indicated good convergent and discriminant validity. The WBI Substance Use and 
Isolation at School subscales, similarly, had high correlations with subscales 
from preexisting measures. Criterion-related validity was indicated in 
significant correlations between WBI subscales and conceptually related 
dimensions of close relationships. Also examined was the percentage of youth 
falling above clinical cutoffs on both the WBI and YSR, and findings 
demonstrated high concurrent validity. Collectively, results suggest the promise 
of the WBI as a brief, psychometrically sound measure to assess the adjustment 
of adolescents, along with perceptions of school climate that can be modified 
toward fostering their overall well-being. (PsycInfo Database Record (c) 2020 
APA, all rights reserved).

DOI: 10.1037/pas0000913
PMID: 32658519 [Indexed for MEDLINE]


4327. Child Adolesc Ment Health. 2020 Sep;25(3):167-168. doi: 10.1111/camh.12405. Epub 
2020 Jul 12.

Debate: COVID-19 and psychological well-being of children and adolescents in 
Italy.

Caffo E(1), Scandroglio F(1), Asta L(1).

Author information:
(1)Department of Biomedical, Metabolic and Neural Sciences, University of Modena 
and Reggio Emilia, Modena, Italy.

Italy was the first country in Europe to deal with COVID-19. Measures taken by 
the government to contain the spread of the virus were based mainly on 
quarantine and social distancing, with dramatic economic, social and 
psychological consequences. Since March, Italian children and adolescents are 
facing school closures, which have caused a disruption in the daily lives of 
millions of young people and their families. To date, despite the slow 
reopening, the government has decided to maintain school closures for the entire 
academic year, leaving the future of young people in uncertainty. There is 
already some evidence that quarantine and social isolation are having negative 
impact on children's and adolescents' psychological well-being. Moreover, this 
situation will mainly affect those children and adolescents with pre-existing 
vulnerabilities and those suffering of mental disorders. It is imperative to 
keep young people's needs at the core of reconstruction plans, allowing them to 
return to school safely, and providing them with some strategies to heal and 
dealing with this stressful and potentially traumatic situation.

© 2020 Association for Child and Adolescent Mental Health.

DOI: 10.1111/camh.12405
PMCID: PMC7405398
PMID: 32654361 [Indexed for MEDLINE]


4328. J Neurol. 2021 Jan;268(1):8-15. doi: 10.1007/s00415-020-10056-6. Epub 2020 Jul 
11.

Impact of COVID-19 lockdown on sleep quality in university students and 
administration staff.

Marelli S(1)(2), Castelnuovo A(1), Somma A(2), Castronovo V(1), Mombelli S(1), 
Bottoni D(1), Leitner C(1), Fossati A(2), Ferini-Strambi L(3)(4).

Author information:
(1)Department of Clinical Neurosciences, Neurology-Sleep Disorders Center, IRCCS 
San Raffaele Scientific Institute, Milan, Italy.
(2)Faculty of Psychology, "Vita-Salute" San Raffaele University, Milan, Italy.
(3)Department of Clinical Neurosciences, Neurology-Sleep Disorders Center, IRCCS 
San Raffaele Scientific Institute, Milan, Italy. ferinistrambi.luigi@hsr.it.
(4)Faculty of Psychology, "Vita-Salute" San Raffaele University, Milan, Italy. 
ferinistrambi.luigi@hsr.it.

INTRODUCTION: In Italy, lockdown due to COVID-19 health emergency started on 
March 10 and partially ended on May 3rd, 2020. There was a significant increase 
of psychological distress and symptoms of mental illness, and worsening of 
quality of sleep in the general population.
METHODS: Participants completed an anonymous web-based survey that include 
questionnaires about sleep and anxiety and depression symptoms. Our sample 
included 400 subjects: 307 students (mean age 22.84 ± 2.68) and 93 university 
administration staff workers (mean age 37.02 ± 12.46).
RESULTS: we found an increase in Bed Time hour, Sleep Latency, and Wake-Up time 
between before and during COVID-19 emergency and a worsening of sleep quality 
and of insomnia symptoms. In particular, during the lockdown, the impact of the 
delay in Bed Time and in Wake-Up was more pronounced in students. In workers, we 
observed a prevalence of maintenance insomnia before COVID-19 of 24% that 
significantly increase during COVID-19 reaching 40%, while workers with 
difficulties in sleep initiation were only 15% that increased to 42%. In our 
sample, 27.8% showed depressive symptoms, while 34.3% showed anxious symptoms, 
in particular in students.
CONCLUSION: The impact of lockdown was greater in students than in workers, and 
in females than in males. Concerning the psycho-emotional aspects, about 
one-third of our sample showed depressive or anxious symptoms. The results of 
our study may provide support for the implementation of some interventions for 
well-being in pandemic condition.

DOI: 10.1007/s00415-020-10056-6
PMCID: PMC7353829
PMID: 32654065 [Indexed for MEDLINE]

Conflict of interest statement: This work had no financial support. None of the 
authors of this manuscript had conflicts of interest.


4329. J Relig Health. 2020 Oct;59(5):2269-2282. doi: 10.1007/s10943-020-01064-x.

A Look at the First Quarantined Community in the USA: Response of Religious 
Communal Organizations and Implications for Public Health During the COVID-19 
Pandemic.

Weinberger-Litman SL(1), Litman L(2), Rosen Z(3), Rosmarin DH(4), Rosenzweig 
C(5).

Author information:
(1)Department of Psychology, Marymount Manhattan College, 221 East 71st St, New 
York, NY, 10021, USA. sweinberger@mmm.edu.
(2)Department of Psychology, Lander College, Flushing, NY, USA.
(3)Department of Health Policy and Management, Mailman School of Public Health, 
Columbia University, New York, NY, USA.
(4)Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
(5)Department of Clinical Psychology, Columbia University, New York, NY, USA.

The current study examined anxiety and distress among members of the first 
community to be quarantined in the USA due to the COVID-19 pandemic. In addition 
to being historically significant, the current sample was unusual in that those 
quarantined were all members of a Modern Orthodox Jewish community and were 
connected via religious institutions at which exposure may have occurred. We 
sought to explore the community and religious factors unique to this sample, as 
they relate to the psychological and public health impact of quarantine. 
Community organizations were trusted more than any other source of 
COVID-19-related information, including federal, state and other government 
agencies, including the CDC, WHO and media news sources. This was supported 
qualitatively with open-ended responses in which participants described the 
range of supports organized by community organizations. These included tangible 
needs (i.e., food delivery), social support, virtual religious services, and 
dissemination of COVID-19-related information. The overall levels of distress 
and anxiety were elevated and directly associated with what was reported to be 
largely inadequate and inconsistent health-related information received from 
local departments of health. In addition, the majority of participants felt that 
perception of or concern about future stigma related to a COVID-19 diagnosis or 
association of COVID-19 with the Jewish community was high and also 
significantly predicted distress and anxiety. The current study demonstrates the 
ways in which religious institutions can play a vital role in promoting the 
well-being of their constituents. During this unprecedented pandemic, public 
health authorities have an opportunity to form partnerships with religious 
institutions in the common interests of promoting health, relaying accurate 
information and supporting the psychosocial needs of community members, as well 
as protecting communities against stigma and discrimination.

DOI: 10.1007/s10943-020-01064-x
PMCID: PMC7347758
PMID: 32651728 [Indexed for MEDLINE]

Conflict of interest statement: There authors declare no ethical conflicts or 
conflict of interest.


4330. Nutr Rev. 2021 Jan 1;79(1):114-116. doi: 10.1093/nutrit/nuaa069.

A call to action to address COVID-19-induced global food insecurity to prevent 
hunger, malnutrition, and eating pathology.

Paslakis G(1)(2), Dimitropoulos G(3)(4), Katzman DK(5)(6).

Author information:
(1)Toronto General Hospital, University Health Network, Toronto, ON, Canada.
(2)Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
(3)Faculty of Social Work, University of Calgary, Calgary, AB, Canada.
(4)Mathison Centre for Mental Health Research and Education, University of 
Calgary, Calgary, AB, Canada.
(5)Division of Adolescent Medicine, Department of Pediatrics, Hospital for Sick 
Children, Toronto, ON, Canada.
(6)Department of Paediatrics, University of Toronto, Toronto, ON, Canada.

The coronavirus 2019 disease (COVID-19) pandemic has led to food shortages, 
increased food prices, and loss of income. As a result, global food insecurity 
alerts have been issued. The pandemic threatens millions of children and 
adolescents and their families currently living with or at risk for development 
of food insecurity. The lack of consistent access to nutritious food sources is 
associated with chronic physical and mental health problems and death. Studies 
on food insecurity and eating pathology have heightened our concern about the 
impact the added effect of the pandemic may have on eating behaviors of children 
and adolescents. Here, we want to draw attention to the need for making food 
security and healthy eating attitudes and behaviors a global priority during the 
COVID-19 pandemic to guarantee the current and future health and well-being of 
our children and adolescents.

© The Author(s) 2020. Published by Oxford University Press on behalf of the 
International Life Sciences Institute. All rights reserved. For permissions, 
please e-mail: journals.permissions@oup.com.

DOI: 10.1093/nutrit/nuaa069
PMCID: PMC7454780
PMID: 32651592 [Indexed for MEDLINE]


4331. Global Health. 2020 Jul 10;16(1):61. doi: 10.1186/s12992-020-00587-y.

When altruists cannot help: the influence of altruism on the mental health of 
university students during the COVID-19 pandemic.

Feng Y(1)(2), Zong M(1)(3), Yang Z(1), Gu W(1), Dong D(4), Qiao Z(5).

Author information:
(1)School of Psychology, Beijing Normal University, No.19, Xinjiekouwai St, 
Haidian District, Beijing, 100875, China.
(2)Mental Health Center, Central University of Finance and Economics, Beijing, 
China.
(3)Mental Health Center, China Foreign Affairs University, Beijing, China.
(4)School of Psychology, Beijing Normal University, No.19, Xinjiekouwai St, 
Haidian District, Beijing, 100875, China. dongdan92@outlook.com.
(5)School of Psychology, Beijing Normal University, No.19, Xinjiekouwai St, 
Haidian District, Beijing, 100875, China. qiaozhihong@bnu.edu.cn.

BACKGROUND: The positive predictive effect of altruism on physical and 
psychological well-being has been extensively demonstrated in previous studies, 
but few studies have examined the effect of altruism on negative mental health 
outcomes when altruists cannot perform altruistic behaviours. This study 
explored the influence of altruism on negative affect and mental health (anxiety 
and depressive symptoms) during the COVID-19 pandemic while people self-isolated 
at home in China.
METHOD: University students were recruited to participate in a cross-sectional 
online survey during the outbreak of COVID-19 in China. Self-reported perceived 
risk, altruism, negative affect, anxiety and depressive symptoms were measured 
using the Self-Report Altruism Scale (SRA scale), the Positive and Negative 
Affect Schedule (PANAS), the 7-item Generalized Anxiety Disorder Scale (GAD-7) 
and the 9-item Patient Health Questionnaire depression scale (PHQ-9). A 
structural equation model was used to analyse the mediating and moderating 
effects on mental health.
RESULTS: The final sample comprised 1346 Chinese participants 
(Mage = 19.76 ± 2.23 years, 73% female). Overall, the higher the risk the 
participants perceived, the more negative affect they exhibited (β = 0.16, 
p < .001), and thus, the more anxious and depressed they felt (β = 0.134, 
p < .001); however, this relationship between risk perception and negative 
affect was moderated by altruism. In contrast to previous studies, the increase 
in negative affect associated with the increased perceived risk was pronounced 
among individuals with high altruism (t = 7.68, p < .001).
CONCLUSIONS: Individuals with high altruism exhibited more negative affect than 
those with low altruism, which indirectly increased their anxiety and depressive 
symptoms. These findings enrich theories of altruism and provide valuable 
insight into the influence of altruism on mental health during the COVID-19 
outbreak.

DOI: 10.1186/s12992-020-00587-y
PMCID: PMC7348110
PMID: 32650785 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


4332. Eur Eat Disord Rev. 2020 Nov;28(6):826-835. doi: 10.1002/erv.2762. Epub 2020 Jul 
9.

Exploring the ways in which COVID-19 and lockdown has affected the lives of 
adult patients with anorexia nervosa and their carers.

Clark Bryan D(1), Macdonald P(1), Ambwani S(2), Cardi V(1)(3), Rowlands K(1), 
Willmott D(1), Treasure J(1).

Author information:
(1)Institute of Psychiatry, Psychology and Neuroscience, Department of 
Psychological Medicine, Section of Eating Disorders, King's College London, 
London, UK.
(2)Department of Psychology, Dickinson College, Carlisle, Pennsylvania, USA.
(3)Department of General Psychology, University of Padova, Padova, Italy.

OBJECTIVE: This qualitative study explores the ways in which the coronavirus 
disease 2019 (COVID-19) pandemic and associated lockdown measures have affected 
the lives of adult patients with anorexia nervosa (AN) and their carers.
METHOD: Semi-structured interviews were conducted with patients with AN (n = 21) 
and carers (n = 28) from the start of UK Government imposed lockdown. Data 
related directly to the impact of lockdown and COVID-19 were analysed using 
thematic analysis.
RESULTS: Four broad themes were identified for patients and carers separately. 
Patients experienced: 1. reduced access to eating disorder (ED) services; 2. 
disruption to routine and activities in the community; 3. heightened 
psychological distress and ED symptoms; 4. increased attempts at self-management 
in recovery. Carer themes included: 1. concern over provision of professional 
support for patients; 2. increased practical demands placed on carers in 
lockdown; 3. managing new challenges around patient wellbeing; 4. new 
opportunities.
CONCLUSIONS: Reduced access to ED services, loss of routine and heightened 
anxieties and ED symptoms resulting from COVID-19 and lockdown measures 
presented challenges for patients and carers. Increased remote support by ED 
services enabled the continuation of treatment and self-management resources and 
strategies promoted self-efficacy in both groups.

© 2020 The Authors. European Eating Disorders Review published by Eating 
Disorders Association and John Wiley & Sons Ltd.

DOI: 10.1002/erv.2762
PMCID: PMC7362064
PMID: 32643844 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


4333. Health Commun. 2021 Nov;36(13):1623-1633. doi: 10.1080/10410236.2020.1785373. 
Epub 2020 Jul 8.

Organizational Sensegiving in Family-Centered Care: How NICU Nurses Help 
Families Make Sense of the NICU Experience.

Gilstrap CM(1).

Author information:
(1)Romain College of Business, University of Southern Indiana.

As frontline caregivers, nurses play a central role in the coordination and 
delivery of family-centered care (FCC) in neonatal intensive care units (NICUs). 
Nurses see first-hand the fear, uncertainty, and anxiety parents experience due 
to unfamiliar and intimidating elements of neonatal care and the NICU 
environment. This study examines the sensegiving strategies nurses use to help 
families make sense of their NICU experience. In-depth, semi-structured 
interviews were conducted with 14 NICU nurses at a mid-size nonprofit hospital. 
Findings reveal nurses utilize four sensegiving strategies to influence parents' 
understanding of, response to, and participation in neonatal care practices: 
educate parents, personalize information, promote open communication, and 
encourage meaningful involvement. Overall, nurses rely on communication to align 
parents' meaning construction with FCC features and goals. Hospital 
administrators and nurse managers should integrate this study's findings into 
nurse training and professional development opportunities to teach nurses about 
parental sensemaking, factors that affect nurse sensegiving efforts, how to 
create effective sensegiving strategies, and sensegiving challenges they may 
face. Healthcare leaders should also provide organizational structures, 
resources, and continuing education programs that help nurses cope with the 
emotional demands of sensegiving. Moreover, nurses should talk to colleagues or 
supervisors and participate in self-care activities if sensegiving starts to 
impact their well-being or ability to provide effective FCC.

DOI: 10.1080/10410236.2020.1785373
PMID: 32643420 [Indexed for MEDLINE]


4334. Psychiatr Q. 2020 Dec;91(4):1033-1045. doi: 10.1007/s11126-020-09796-5.

Mental Health During the Covid-19 Outbreak in China: a Meta-Analysis.

Ren X(1), Huang W(1), Pan H(1), Huang T(1), Wang X(1), Ma Y(2).

Author information:
(1)Tongde Hospital of Zhejiang Province, Mental Health Center of Zhejiang 
Province, No. 234 Gucui Road, Xihu District, Hangzhou, Zhejiang Province, China.
(2)Tongde Hospital of Zhejiang Province, Mental Health Center of Zhejiang 
Province, No. 234 Gucui Road, Xihu District, Hangzhou, Zhejiang Province, China. 
13735806542@163.com.

BACKGROUND: Covid-19 has started to spread within China since the end of 
December 2019. Despite government's immediate actions and strict control, more 
and more people were infected every day. As such a contagious virus can spread 
easily and rapidly between people, the whole country was put into lockdown and 
people were forced into isolation. In order to understand the impact of Covid-19 
on mental health well-being, Chinese researchers have conducted several studies. 
However, no consistent results were obtained. Therefore, a meta-analysis was 
conducted.
METHODS: We searched Embase, PubMed, and Web of Science databases to find 
literature from December 2019 to April 2020 related to Covid-19 and mental 
health, among which results such as comments, letters, reviews and case reports 
were excluded. The incidence of anxiety and depression in the population was 
synthesized and discussed.
RESULTS: A total of 27,475 subjects were included in 12 studies. Random effect 
model is used to account for the data. The results showed that the incidence of 
anxiety was 25% (95% CI: 0.19-0.32), and the incidence of depression was 28% 
(95% CI: 0.17-0.38). Significant heterogeneity was detected across studies 
regarding these incidence estimates. Subgroup analysis included the study 
population and assessment tools, and sensitivity analysis was done to explore 
the sources of heterogeneity.
CONCLUSIONS: Owing to the significant heterogeneity detected in studies 
regarding this pooled prevalence of anxiety and depression, we must interpret 
the results with caution. As the epidemic is ongoing, it is vital to set up a 
comprehensive crisis prevention system, which integrating epidemiological 
monitoring, screening and psychological crisis prevention and interventions.

DOI: 10.1007/s11126-020-09796-5
PMCID: PMC7343383
PMID: 32642822 [Indexed for MEDLINE]

Conflict of interest statement: Not applicable.


4335. BMJ Open. 2020 Jul 6;10(7):e038938. doi: 10.1136/bmjopen-2020-038938.

Immediate parent-infant skin-to-skin study (IPISTOSS): study protocol of a 
randomised controlled trial on very preterm infants cared for in skin-to-skin 
contact immediately after birth and potential physiological, epigenetic, 
psychological and neurodevelopmental consequences.

Linnér A(1)(2), Westrup B(3), Lode-Kolz K(4), Klemming S(2), Lillieskold 
S(3)(2), Markhus Pike H(4), Morgan B(5)(6), Bergman NJ(3), Rettedal S(4), Jonas 
W(3).

Author information:
(1)Women's and Children's Health, Karolinska Institute, Stockholm, Sweden 
agnes.linner@ki.se.
(2)Neonatal Unit, Karolinska University Hospital, Stockholm, Sweden.
(3)Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
(4)Department of Paediatrics, Stavanger Universitetssjukehus, Stavanger, Norway.
(5)Global Risk Governance Programme, Law Faculty, University of Cape Town, 
Rondebosch, Western Cape, South Africa.
(6)NRF Centre of Excellence in Human Development, University of the 
Witwatersrand, Johannesburg-Braamfontein, Gauteng, South Africa.

INTRODUCTION: In Scandinavia, 6% of infants are born preterm, before 37 
gestational weeks. Instead of continuing in the in-utero environment, maturation 
needs to occur in a neonatal unit with support of vital functions, separated 
from the mother's warmth, nutrition and other benefits. Preterm infants face 
health and neurodevelopment challenges that may also affect the family and 
society at large. There is evidence of benefit from immediate and continued 
skin-to-skin contact (SSC) for term and moderately preterm infants and their 
parents but there is a knowledge gap on its effect on unstable very preterm 
infants when initiated immediately after birth.
METHODS AND ANALYSIS: In this ongoing randomised controlled trial from 
Stavanger, Norway and Stockholm, Sweden, we are studying 150 infants born at 
28+0 to 32+6 gestational weeks, randomised to receive care immediately after 
birth in SSC with a parent or conventionally in an incubator. The primary 
outcome is cardiorespiratory stability according to the stability of the 
cardiorespiratory system in the preterm score. Secondary outcomes are autonomic 
stability, thermal control, infection control, SSC time, breastfeeding and 
growth, epigenetic profile, microbiome profile, infant behaviour, stress 
resilience, sleep integrity, cortical maturation, neurodevelopment, 
mother-infant attachment and attunement, and parent experience and mental 
health.
ETHICS AND DISSEMINATION: The study has ethical approval from the Swedish 
Ethical Review Authority (2017/1135-31/3, 2019-03361) and the Norwegian Regional 
Ethical Committee (2015/889). The study is conducted according to good clinical 
practice and the Helsinki declaration. The results of the study will increase 
the knowledge about the mechanisms behind the effects of SSC for very preterm 
infants by dissemination to the scientific community through articles and at 
conferences, and to the society through parenting classes and magazines.
STUDY STATUS: Recruiting since April 2018. Expected trial termination June 2021.
TRIAL REGISTRATION NUMBER: NCT03521310 (ClinicalTrials.gov).

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2020-038938
PMCID: PMC7342825
PMID: 32636292 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


4336. Int J Soc Psychiatry. 2021 Feb;67(1):90-95. doi: 10.1177/0020764020939596. Epub 
2020 Jul 8.

The mental health of health care workers in Oman during the COVID-19 pandemic.

Badahdah A(1), Khamis F(2), Al Mahyijari N(2), Al Balushi M(2), Al Hatmi H(2), 
Al Salmi I(2), Albulushi Z(2), Al Noomani J(2).

Author information:
(1)South Dakota State University, Brookings, SD, USA.
(2)Royal Hospital, Muscat, Oman.

BACKGROUND: COVID-19 disease is one of the most destructive events that humanity 
has witnessed in the 21st century. It has impacted all aspects of life and all 
segments of populations, including already vulnerable health care providers.
AIMS: This study sought to detect the prevalence of mental health issues in 
sample of physicians and nurses working in several health facilities in Oman.
METHOD: We gauged the mental health conditions of 509 physicians (38.1%) and 
nurses (61.9 %) using the Perceived Stress Scale, Generalized Anxiety Disorder 
Scale and World Health Organization Well-Being Index.
RESULTS: The study revealed a high prevalence of stress, anxiety and poor 
psychological well-being, especially among females, young health care workers 
and those who interacted with known or suspected COVID-19 patients.
CONCLUSION: The outcomes of this study support the handful of studies published 
during this global health crisis that have found that the mental health of 
health care workers has been harshly affected and predicted that it will 
continue, to various degrees, to be affected in the foreseeable future. The 
results of this study highlight the urgency of providing administrative and 
psychological support as well as current and accurate information on COVID-19 to 
health care workers.

DOI: 10.1177/0020764020939596
PMCID: PMC8191150
PMID: 32635837 [Indexed for MEDLINE]


4337. Afr J Prim Health Care Fam Med. 2020 Jun 15;12(1):e1-e3. doi: 
10.4102/phcfm.v12i1.2456.

Spiritual care - 'A deeper immunity' - A response to Covid-19 pandemic.

Roman NV(1), Mthembu TG, Hoosen M.

Author information:
(1)Department of Child and Family Studies, Faculty of Community and Health 
Sciences, University of the Western Cape, Cape Town. nicoletteroman@gmail.com.

Coronavirus disease 2019 (COVID-19) has presented unprecedented health 
challenges across all strata in society throughout the world. The COVID 
experience has caused us to reflect on quality of life, health and well-being 
and, just as important, end of life. During this time, spiritual care forms a 
vital component of holistic health management, especially in terms of coping, 
coming to terms with illness, suffering and ultimately death. The relationship 
with the transcendent or sacred has a strong influence on a people's beliefs, 
attitudes, emotions and behaviour. Populations, communities, families and 
individuals have always found solace through their religious or philosophical 
beliefs during times of personal adversity and widespread anxiety or disaster. 
Although spiritual care has always been a part of the domain of religious 
beliefs, a more contemporary perspective is that spiritual care forms part of 
the human psyche and thus forms part of human care, health and well-being for 
families, patients and healthcare workers. Spiritual care deals with the 
provision of compassion and empathy during periods of heightened stress, 
distress and anxiety within care. This article provides insights into the 
necessity of providing spiritual care as a means of coping and well-being for 
families, patients and healthcare workers during the COVID-19 pandemic.

DOI: 10.4102/phcfm.v12i1.2456
PMCID: PMC7343955
PMID: 32634003 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


4338. Pain Med. 2020 Aug 1;21(8):1708-1717. doi: 10.1093/pm/pnaa168.

Maintaining High-Quality Multidisciplinary Pain Medicine Fellowship Programs: 
Part I: Innovations in Pain Fellows' Education, Research, Applicant Selection 
Process, Wellness, and ACGME Implementation During the COVID-19 Pandemic.

Kohan L(1), Moeschler S(2), Spektor B(3), Przkora R(4), Sobey C(5), Brancolini 
S(6), Wahezi S(7), Anitescu M(8).

Author information:
(1)Division of Pain Medicine, Department of Anesthesiology, University of 
Virginia, Charlottesville, Virginia.
(2)Division of Pain Medicine, Department of Anesthesiology and Perioperative 
Medicine, Mayo Clinic, Rochester, Minnesota.
(3)Department of Anesthesiology, Emory School of Medicine, Atlanta, Georgia.
(4)Pain Medicine Division, Department of Anesthesiology, College of Medicine, 
University of Florida, Gainesville, Florida.
(5)Clinical Anesthesiology, Vanderbilt University Medical Center, Nashville, 
Tennessee.
(6)Department of Anesthesia, University of Pittsburgh Medical Center, 
Pittsburgh, Pennsylvania.
(7)Physical Medicine and Rehabilitation, Anesthesiology, and Orthopedic, 
Montefiore Medical Center, New York, New York.
(8)Pain Management Department of Anesthesia and Critical Care Medicine, 
University of Chicago, Chicago, Illinois, USA.

BACKGROUND: Pain fellowship programs are facing unique challenges during the 
COVID-19 pandemic. Restrictions from state governments and the Centers for 
Disease Control and Prevention have resulted in a rapidly changing and evolving 
learning environment for todays' fellows. Innovative solutions must be sought to 
guarantee that proper education is maintained and to ensure the well-being of 
our trainees.
METHODS: We assembled a panel of pain program directors who serve as 
officers/board members of the Association of Pain Program Directors to provide 
guidance and formulate recommendations to pain fellowship directors nationally. 
This guidance is based on reviewing current changes to the Accreditation Council 
for Graduate Medical Education (ACGME) and American Board of Anesthesiology 
policies and best available evidence and expert opinion on the use of remote 
educational activities, research endeavors, and trainee wellness.
CONCLUSIONS: The country is in the midst of an unprecedented pandemic. The 
impact on pain management fellowships has been severe and will likely last for 
months, resulting in extraordinary challenges to the administration of pain 
fellowship programs and the education of our fellows. Understanding revisions to 
ACGME policies, using technology to promote remote learning opportunities, and 
providing trainees with opportunities to alleviate their anxiety and encourage 
mental health are beneficial strategies to implement. Together, we can implement 
innovative solutions to help overcome these challenges.

© The Author(s) 2020. Published by Oxford University Press on behalf of the 
American Academy of Pain Medicine. All rights reserved. For permissions, please 
e-mail: journals.permissions@oup.com.

DOI: 10.1093/pm/pnaa168
PMCID: PMC7197561
PMID: 32632454 [Indexed for MEDLINE]


4339. Acta Neuropsychiatr. 2020 Oct;32(5):277-279. doi: 10.1017/neu.2020.26. Epub 2020 
Jul 6.

Increased psychological well-being after the apex of the COVID-19 pandemic.

Sønderskov KM(1), Dinesen PT(2), Santini ZI(3), Østergaard SD(4)(5).

Author information:
(1)Department of Political Science, Aarhus University,Aarhus, Denmark.
(2)Department of Political Science, University of Copenhagen,Copenhagen, 
Denmark.
(3)The Danish National Institute of Public Health, University of Southern 
Denmark,Copenhagen, Denmark.
(4)Department of Affective Disorders, Aarhus University Hospital - 
Psychiatry,Aarhus, Denmark.
(5)Department of Clinical Medicine, Aarhus University,Aarhus, Denmark.

DOI: 10.1017/neu.2020.26
PMCID: PMC7385325
PMID: 32624036 [Indexed for MEDLINE]


4340. J Public Health (Oxf). 2020 Aug 18;42(3):486-492. doi: 10.1093/pubmed/fdaa096.

Emerging public health challenge in UK: perception and belief on increased 
COVID19 death among BAME healthcare workers.

Moorthy A(1), Sankar TK(2).

Author information:
(1)Department of Rheumatology, University Hospitals of Leicester NHS trust, 
Leicester LE1 5WW, UK.
(2)Dept of Plastic surgery, Department of Plastic Surgery Kettering General 
Hospital NHS Foundation Trust, Kettering, N16 8UZ, UK.

Comment in
    J Public Health (Oxf). 2022 Dec 1;44(4):e644.

BACKGROUND: Coronavirus infection Disease 19 impacted every part of the world 
and routine life. Recent report from the Office of national statistics in UK 
reported disproportionate death among Black Asian and minority ethnic (BAME) 
population. NHS is heavily relied on the BAME work force both in front line and 
in the community. We attempted to explore the beliefs and perception about 
reported worrying issue among BAME health work force in a Diverse city of 
Leicester.
METHODS: This is a cross-sectional survey using 20 questions in an electronic 
format. The target population was identified through Leicester Asian Doctors 
Society and Leicester Asian Nurses Society. The questionnaire was then 
distributed electronically to the members. Survey questionnaire was accessed by 
372, incomplete response (172) were excluded and 200 completed responses were 
analysed.
RESULTS: Majority of BAME workforce are routinely involved in front line duties. 
More than 70% were anxious about their role during this pandemic. The Personal 
Protective Equipment (PPE) supply was adequate, and the support received from 
the local healthcare providers was more than satisfactory. The work force 
perceived co-morbidity, lack of PPE and testing were one of the few reasons for 
increased death in BAME. BAME group felt adequate provision of PPE, increased 
testing and improving mental health well-being is required to alleviate concerns 
and improve BAME working life in NHS.
CONCLUSION: BAME workforce are routinely involved in front line work and current 
anxiety level is very high. Adequate provision of mental health support with 
clear risk stratification for return to work is required urgently.

© The Author(s) 2020. Published by Oxford University Press on behalf of Faculty 
of Public Health. All rights reserved. For permissions, please e-mail: 
journals.permissions@oup.com.

DOI: 10.1093/pubmed/fdaa096
PMCID: PMC7337745
PMID: 32618332 [Indexed for MEDLINE]


4341. J Thorac Cardiovasc Surg. 2020 Oct;160(4):980-987. doi: 
10.1016/j.jtcvs.2020.05.052. Epub 2020 Jun 1.

Impact of coronavirus 2019 (COVID-19) on training and well-being in subspecialty 
surgery: A national survey of cardiothoracic trainees in the United Kingdom.

Caruana EJ(1), Patel A(2), Kendall S(3), Rathinam S(4).

Author information:
(1)Department of Thoracic Surgery, Glenfield Hospital, University Hospitals of 
Leicester, Leicester, United Kingdom; NIHR Biomedical Research Centre, 
University of Nottingham, Nottingham, United Kingdom. Electronic address: 
edwardcaruana@nhs.net.
(2)Institute of Immunology and Immunotherapy, University of Birmingham, 
Birmingham, United Kingdom.
(3)Department of Cardiothoracic Surgery, James Cook University Hospital, 
Middlesborough, United Kingdom.
(4)Department of Thoracic Surgery, Glenfield Hospital, University Hospitals of 
Leicester, Leicester, United Kingdom.

Comment in
    J Thorac Cardiovasc Surg. 2020 Oct;160(4):989-990.
    J Thorac Cardiovasc Surg. 2020 Oct;160(4):988-989.

OBJECTIVES: The coronavirus 2019 (COVID-19) pandemic has overwhelmed health care 
systems and disrupted routine care internationally. Health care workers face 
disruption to their work routines and professional development, as well as an 
elevated risk of infection and morbidity. We sought to establish the impact of 
the COVID-19 pandemic on the well-being, practice, and progression of all 
trainees in cardiothoracic surgery in the United Kingdom.
METHODS: A 31-item questionnaire was designed, validated, and disseminated via 
e-mail and an instant-messaging platform.
RESULTS: In total, 76 (of 118, 64%) cardiothoracic surgical trainees responded, 
representing all training grades and programs nationally; 48 (63%) and 24 (32%) 
were concerned about their physical and mental health, respectively, 25 (33%) 
had taken time off work due to COVID-19, 65 (86%) had treated patients with 
COVID-19, 36 of whom (55%) were wearing satisfactory personal protective 
equipment at the time, 41 (54%) remain concerned about personal protective 
equipment provision at their institution, 42 (55%) had been redeployed to cover 
other specialties, and 23 (30%) had encountered ethical dilemmas related to care 
of patients. There was a significant impact on time spent in outpatient clinics 
(44% reduction), multidisciplinary team meetings (79% reduction), and operating 
theaters (78% reduction). In total, 67 (88%) of respondents were concerned about 
the impact on their training, and 54 (71%) felt that the deviation may require 
an extension in their planned training time.
CONCLUSIONS: The duration and impact of the current pandemic is, as yet, 
uncertain. Timely sharing of experiences, concerns, and expectations will inform 
health care and education policy and influence practice in the pandemic era and 
beyond.

Copyright © 2020 The American Association for Thoracic Surgery. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jtcvs.2020.05.052
PMCID: PMC7262521
PMID: 32605730 [Indexed for MEDLINE]


4342. Res Dev Disabil. 2020 Oct;105:103719. doi: 10.1016/j.ridd.2020.103719. Epub 2020 
Jun 27.

A balanced approach to decision-making in supporting people with IDD in 
extraordinarily challenging times.

Luckasson R(1), Schalock RL(2).

Author information:
(1)University of New Mexico, Albuquerque, NM, USA. Electronic address: 
ruthl@unm.edu.
(2)Hastings College, Hastings, NE, USA.

A balanced approach to decision-making during challenging times is necessary in 
order to avoid risks that jeopardize the lives and wellbeing of people with 
intellectual and developmental disabilities (IDD). The COVID-19 pandemic is the 
recent example of a crisis that places people with IDD at risk for lopsided 
societal reactions and threats to them or their wellbeing. Attention to 
decision-making is required to safeguard hard-earned achievements, including 
public policies and organization practices that emphasize human and legal 
rights, self-advocacy, individualized supports, inclusive environments, choices, 
and community inclusion. We suggest maintaining a holistic approach to 
understanding the lives and human functioning of people with IDD, a balanced 
approach to accountability and performance management, an understanding of the 
multidimensional properties of context, and a heightened vigilance in 
professional responsibility. A balanced approach will strengthen the likelihood 
of a return to high quality services and supports to people after the crisis, 
reduce loss of critical progress, and enhance stability across future social, 
political, and financial changes and challenges.

Copyright © 2020 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.ridd.2020.103719
PMCID: PMC7320664
PMID: 32603883 [Indexed for MEDLINE]


4343. Int J Gynaecol Obstet. 2020 Oct;151(1):67-73. doi: 10.1002/ijgo.13287. Epub 2020 
Aug 11.

Evaluating the effects of the COVID-19 pandemic on the physical and mental 
well-being of obstetricians and gynecologists in Turkey.

Yalçın Bahat P(1), Aldıkaçtıoğlu Talmaç M(1), Bestel A(1), Topbas Selcuki NF(2), 
Karadeniz O(1), Polat I(1).

Author information:
(1)Department of Obstetrics and Gynecology, Istanbul Kanuni Sultan Suleyman 
Training and Research Hospital, Health Sciences University, Istanbul, Turkey.
(2)Department of Obstetrics and Gynecology, Istanbul Sisli Hamidiye Etfal 
Training and Research Hospital, Health Sciences University, Istanbul, Turkey.

OBJECTIVE: To apply online surveying to assess the general physical and mental 
well-being of obstetricians/gynecologists (OB/GYNs) working in COVID-19 
designated hospitals in Turkey.
METHODS: A prospective survey-based study using an online survey platform. Three 
hundred participants working at COVID-19 designated hospitals in Turkey 
identified from a hospital database were sent a link to the survey by email 
between April 29 and May 20, 2020.
RESULTS: A total of 253 OB/GYNs (31 consultants and 222 residents) completed the 
survey, for a response rate of 84.3%. Of respondents, 191 (76.4%) were anxious 
about coming into contact with pregnant women infected with COVID-19. 74.4% 
stated that they were afraid of getting sick. 64.8% reported that they had 
fallen into despair at times because of the pandemic. 66.5% stated that their 
family lives were affected. 72.4% started living separately from their families 
because of the pandemic.
CONCLUSION: Despite the difficulties in patient care during the pandemic, 
OB/GYNs continued providing for their patients, which reflected positively on 
their perceptions of the profession. The importance of trust in the national 
healthcare system, presence of adequate PPE, finding a suitable coping 
mechanism, and family support were essential for Turkish OB/GYNs during the 
COVID-19 pandemic. ClinicalTrials.gov identifier: NCT04327531. Turkish 
obstetricians/gynecologists reported anxiety and stress caused by the current 
situation and future implications of the COVID-19 pandemic.

© 2020 International Federation of Gynecology and Obstetrics.

DOI: 10.1002/ijgo.13287
PMCID: PMC9087761
PMID: 32602562 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest.


4344. J Gerontol B Psychol Sci Soc Sci. 2021 Jan 18;76(2):e4-e9. doi: 
10.1093/geronb/gbaa084.

Up and About: Older Adults' Well-being During the COVID-19 Pandemic in a Swedish 
Longitudinal Study.

Kivi M(1)(2), Hansson I(1)(2), Bjälkebring P(1)(2).

Author information:
(1)Department of Psychology, University of Gothenburg, Sweden.
(2)Centre for Ageing and Health, University of Gothenburg, Sweden.

OBJECTIVES: To investigate early effects of the COVID-19 pandemic related to (a) 
levels of worry, risk perception, and social distancing; (b) longitudinal 
effects on well-being; and (c) effects of worry, risk perception, and social 
distancing on well-being.
METHODS: We analyzed annual changes in four aspects of well-being over 5 years 
(2015-2020): life satisfaction, financial satisfaction, self-rated health, and 
loneliness in a subsample (n = 1,071, aged 65-71) from a larger survey of 
Swedish older adults. The 2020 wave, collected March 26-April 2, included 
measures of worry, risk perception, and social distancing in response to 
COVID-19.
RESULTS: (a) In relation to COVID-19: 44.9% worried about health, 69.5% about 
societal consequences, 25.1% about financial consequences; 86.4% perceived a 
high societal risk, 42.3% a high risk of infection, and 71.2% reported high 
levels of social distancing. (b) Well-being remained stable (life satisfaction 
and loneliness) or even increased (self-rated health and financial satisfaction) 
in 2020 compared to previous years. (c) More worry about health and financial 
consequences was related to lower scores in all four well-being measures. Higher 
societal worry and more social distancing were related to higher well-being.
DISCUSSION: In the early stage of the pandemic, Swedish older adults on average 
rated their well-being as high as, or even higher than, previous years. However, 
those who worried more reported lower well-being. Our findings speak to the 
resilience, but also heterogeneity, among older adults during the pandemic. 
Further research, on a broad range of health factors and long-term psychological 
consequences, is needed.

© The Author(s) 2020. Published by Oxford University Press on behalf of The 
Gerontological Society of America.

DOI: 10.1093/geronb/gbaa084
PMCID: PMC7337833
PMID: 32599622 [Indexed for MEDLINE]


4345. Psychiatry Res. 2020 Sep;291:113230. doi: 10.1016/j.psychres.2020.113230. Epub 
2020 Jun 15.

Fear and agony of the pandemic leading to stress and mental illness: An emerging 
crisis in the novel coronavirus (COVID-19) outbreak.

Fofana NK(1), Latif F(2), Sarfraz S(2), Bilal(3), Bashir MF(4), Komal B(5).

Author information:
(1)Beijing Institute of Technology, China.
(2)FAST National University of Computer and Emerging Sciences, Pakistan.
(3)Hubei University of Economics, China. Electronic address: bilal@hbue.edu.cn.
(4)Central South University, China.
(5)University of International Business and Economics, China.

The outbreak of novel Coronavirus (COVID-19), later named as a pandemic 
affecting nearly 210 countries and territories has led to negative emotions of 
fear and agony in the general population and healthcare staff professionals. The 
healthcare regulators and the governments have imposed emergencies and lockdowns 
in their countries which has led to an adverse effect on the mental health of 
people ultimately leading to a rise in anxiety, depression, and associated 
mental illness. The fear and uncertainty increased by the COVID-19 crisis are 
putting extreme pressure on our finite resources. This report aims to synthesis 
the dilemma of mental illness as a result of pandemic and initiates suggestions 
to help the general public, healthcare professionals, and workers mitigate the 
negative emotions to improve the mental wellbeing in this detached period of 
isolation.

Copyright © 2020 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.psychres.2020.113230
PMCID: PMC7833263
PMID: 32593067 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest Authors 
declare no conflict of interests.


4346. Medicine (Baltimore). 2020 Jun 26;99(26):e20751. doi: 
10.1097/MD.0000000000020751.

Mental health circumstances among health care workers and general public under 
the pandemic situation of COVID-19 (HOME-COVID-19).

Nochaiwong S(1)(2), Ruengorn C(1)(2), Awiphan R(1)(2), Ruanta Y(1)(2), 
Boonchieng W(3), Nanta S(2)(4), Kowatcharakul W(5), Pumpaisalchai W(6), 
Kanjanarat P(1)(2), Mongkhon P(2)(7), Thavorn K(2)(8)(9)(10), Hutton 
B(8)(9)(10), Wongpakaran N(11), Wongpakaran T(11); Health Outcomes and Mental 
Health Care Evaluation Survey Research Group (HOME-Survey).

Author information:
(1)Department of Pharmaceutical Care.
(2)Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of 
Pharmacy.
(3)Faculty of Public Health, Chiang Mai University, Chiang Mai.
(4)Maesai Hospital, Maesai District, Chiang Rai Province.
(5)Sansai Hospital, Sansai District.
(6)Suanprung Psychiatric Hospital, Chiang Mai.
(7)Division of Pharmacy Practice, Department of Pharmaceutical Care, School of 
Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.
(8)Ottawa Hospital Research Institute, Ottawa Hospital.
(9)Institute of Clinical and Evaluative Sciences, ICES uOttawa.
(10)School of Epidemiology and Public Health, Faculty of Medicine, University of 
Ottawa, Ottawa, Ontario, Canada.
(11)Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang 
Mai, Thailand.

BACKGROUND: After the spread of the coronavirus disease 2019 (COVID-19) 
globally, upgraded quarantine and physical distancing strategy, strict infection 
measures, and government's strict lockdown have been abided to confront the 
spread of the COVID-19 in Thailand. During the COVID-19 pandemic, concerns about 
the mental health and psychosocial problems among health care workers and the 
general population are now arising. Yet, information on mental health and 
psychosocial problems among health care workers and the general population have 
not been comprehensively reported in Thailand. As such, we conduct a 
cross-sectional study, a national online survey to describe the short- and 
long-term consequences of the COVID-19 pandemic on mental health and 
psychosocial problems among health care workers and the general population in 
Thailand.
METHODS: This study is a repeated cross-sectional study, an open online 
voluntary national-based survey during the wave I (April 21-May 4, 2020) 
follow-up in the wave II (August 3-16, 2020), wave III (November 15-28, 2020), 
and a 1-year follow-up survey (wave IV: April 21-May 4, 2021) in Thailand. 
Health care workers at the hospitals and the adult general population will be 
invited to participate in the online survey via the SurveyMonkey that limits 
one-time participation per unique internet protocol address. The target sample 
size of at least 1182 health care workers and 1310 general populations will be 
required to complete the online survey for each wave of the survey. 
Sociodemographic characteristics and a set of measurement tools for mental and 
psychosocial problems for each subcohort including depression, anxiety, stress, 
resilient copings, neuroticism, perceived social support, wellbeing, somatic 
symptoms, insomnia, burnout (for healthcare workers), and public stigma toward 
COVID-19 infection (for the general population) will be collected. For all 
estimates of prevalence, we will weigh data for all wave analyses under the 
complex design of the survey. Subgroup analyses stratified by key 
characteristics will also be done to analyze the proportion differences. For the 
repeated cross-sectional survey, we will combine the data from the wave I to 
wave IV survey to analyze changes in the mental health status. We will perform 
multilevel logistic regression models with random intercepts to explore 
associations with individual-level and region-level/hospital-level predictors. 
We also plan to perform an ancillary systematic review and meta-analysis by 
incorporating data from our findings to all available evidence.
RESULTS: Our findings will provide information on the short- and long-term 
mental health status as well as the psychosocial responses to the COVID-19 
outbreak in a national sample of health care workers and the general population 
in Thailand.
CONCLUSION: This prospective, nationally based, a repeated cross-sectional study 
will describe the mental health status and psychosocial problems among health 
care workers and the general population in Thailand during the COVID-19 
pandemic.
ETHICS AND DISSEMINATION: Ethical approval for the study was obtained from the 
Faculty of Public Health and Faculty of Pharmacy, Chiang Mai University. The 
findings will be disseminated through public, scientific, and professional 
meetings, and publications in peer-reviewed journals.
THAI CLINICAL TRIALS REGISTRY (TCTR) REGISTRATION NUMBER: TCTR20200425001.

DOI: 10.1097/MD.0000000000020751
PMCID: PMC7329008
PMID: 32590751 [Indexed for MEDLINE]

Conflict of interest statement: The authors report no conflicts of interest.


4347. Fam Process. 2020 Sep;59(3):847-864. doi: 10.1111/famp.12570. Epub 2020 Aug 9.

Reaching Up, Down, In, and Around: Couple and Family Coping During the 
Coronavirus Pandemic.

Fraenkel P(1), Cho WL(2).

Author information:
(1)Department of Psychology, The City College of New York, New York, NY.
(2)Marriage, Couples, and Family Therapy Program, Lewis & Clark Graduate School 
of Education and Counseling, Portland, OR.

The worldwide coronavirus (COVID-19) has had profound effects on all aspects of 
life: physical health, the ability to travel locally or to more distant 
destinations, material and financial resources, and psychosocial wellbeing. 
Couples, families, and communities and individual persons in those relationships 
have struggled to cope with emerging depression, anxiety, and trauma, and the 
rise of relational conflict. In this article, we suggest that the existential 
nature of the pandemic's challenges requires more than just the usual 
psychosocial interventions. We propose a taxonomy of responses to foster coping 
and resilience-"Reaching Up, Down, In, and Around." "Reaching Up" includes 
accessing spiritual, religious, and ethical values. "Reaching Down" includes 
ideas and practices that foster a revised relationship with the Earth and its 
resources, and that engage families to participate in activities that aid the 
Earth's recovery from decades of human-caused damage. "Reaching In" represents a 
turn towards experiences available in the mind and in shared minds in 
relationships that provide pleasure, excitement, joy, and peace, given that 
external sources of these emotions are of limited availability due to 
quarantine. "Reaching Around" involves reframing the mandate for "social 
distancing" as fostering social connection and support while maintaining 
physical distancing. The challenges for family therapists, whose practices are 
confined largely to online therapy, and who are struggling with the same fears 
and constraints as those persons they are attempting to help, are also 
discussed.

Publisher: El coronavirus (la COVID-19) mundial ha tenido efectos profundos en 
todos los aspectos de la vida: en la salud física, en la posibilidad de viajar a 
nivel local o a destinos más distantes, en los recursos materiales y económicos 
y en el bienestar psicosocial. Las parejas, las familias, las comunidades y las 
personas individuales de esas relaciones se han esforzado para hacer frente a la 
depresión, la ansiedad y el trauma emergentes, y al aumento del conflicto 
relacional. En este artículo, sugerimos que la índole existencial de las 
dificultades de la pandemia necesita más que solo las intervenciones 
psicosociales habituales. Proponemos una taxonomía de respuestas para fomentar 
el afrontamiento y la resiliencia: “Llegar arriba, abajo, adentro y alrededor”. 
“Llegar arriba” implica acceder a valores espirituales, religiosos y éticos. 
“Llegar abajo” implica ideas y prácticas que fomenten una relación revisada con 
la Tierra y sus recursos, y que capten la atención de las familias para 
participar en actividades que ayuden a la recuperación de la Tierra de décadas 
de daño causado por los humanos. “Llegar adentro” representa un giro hacia 
experiencias que hay en la mente y entre mentes por relaciones que brindan 
placer, entusiasmo, alegría y paz, dado que la disponibilidad de las fuentes 
externas de estas emociones es limitada debido a la cuarentena. “Llegar 
alrededor” implica replantear la orden de “distanciamiento social” como fomento 
de la conexión social y el apoyo mientras se mantiene la distancia física. 
También se explican las dificultades para los terapeutas familiares, cuyas 
prácticas están limitadas en gran medida a la terapia en línea, y quienes están 
luchando contra los mismos miedos y limitaciones que esas personas a quienes 
intentan ayudar.

Publisher: 
全球范围内冠状病毒(COVID-19)对生活的所有方面都产生了深远影响：身体健康、当地的旅行或去往更遥远目的地的旅行能力、物质和财政资源以及心理社会方面的福祉。夫妻、家庭、社区和个人等各种关系中的人们都在努力应对较之以前有所增加的新出现的抑郁、焦虑、创伤和关系冲突。在这篇文章中，我们提出与大流行病随之而来的挑战其存在的本质要求的不再仅仅是平常的心理社会干预。我们提出了一种培养应对能力和复原力的分类应对措施--“向上、向下、向内和向周围求助”。“向上”包括获得精神、宗教和伦理价值。“向下”包括促进与地球及其资源的一种新型关系的思想和实践，以及让家庭参与帮助地球从几十年人为破坏中恢复的活动中来。“向内”代表着一种转向，转向在内心上和在人际关系中给大家提供快乐、兴奋、快乐和平静的经验，因为这些情绪其外部来源由于隔离变得有限。“向周围求助”包括重新定义“社会距离”的禁足令，即在保持身体距离的同时，培养社会联系和支持。家庭治疗师的实践大多局限于在线治疗，他们与那些他们试图帮助的人一样，也在与同样的恐惧和约束作斗争，本文也讨论了他们面临的挑战。.

© 2020 Family Process Institute.

DOI: 10.1111/famp.12570
PMCID: PMC7361908
PMID: 32589265 [Indexed for MEDLINE]


4348. JMIR Public Health Surveill. 2020 Sep 18;6(3):e19630. doi: 10.2196/19630.

Global Changes and Factors of Increase in Caloric/Salty Food Intake, Screen Use, 
and Substance Use During the Early COVID-19 Containment Phase in the General 
Population in France: Survey Study.

Rolland B(1)(2), Haesebaert F(3), Zante E(3), Benyamina A(4)(5), Haesebaert 
J(6), Franck N(5).

Author information:
(1)Service Universitaire d'Addictologie de Lyon, CH Le Vinatier, Hospices Civils 
de Lyon, Bron, France.
(2)Inserm U1028, CNRS UMR5292, Université Claude Bernard Lyon 1, Bron, France.
(3)Centre Ressource de Réhabilitation Psychosociale, CH Le Vinatier, Lyon, 
France.
(4)PSYCOMADD 4872, Université Paris-Saclay, Paris, France.
(5)CH Le Vinatier, Pôle Centre Rive Gauche, Bron, France.
(6)Service de recherche et d'épidémiologie, Pôle de santé publique, Hospices 
Civils de Lyon, Lyon, France.

Erratum in
    JMIR Public Health Surveill. 2021 Jul 20;7(7):e31906.

BACKGROUND: The international outbreak of coronavirus disease (COVID-19) has led 
many countries to enforce drastic containment measures. It has been suggested 
that this abrupt lockdown of populations will foster addiction-related habits 
such as caloric/salty food intake, screen use, and substance use.
OBJECTIVE: Our aim was to assess the global changes and factors of increase in 
addiction-related habits during the early COVID-19 containment phase in France.
METHODS: A web-based survey was provided from day 8 to day 13 of the containment 
and was completed by 11,391 participants. The questions explored 
sociodemographic features, psychiatric/addiction history, material conditions of 
lockdown, general stress, mental well-being, and reported changes in several 
addiction-related behaviors. Global changes were described and factors of 
increase were explored using population-weighted and adjusted logistic 
regression models, providing adjusted odds ratios (aORs) and their 95% 
confidence intervals.
RESULTS: Overall, the respondents reported more increases in addiction-related 
habits than decreases, specifically 28.4% (caloric/salty food intake), 64.6% 
(screen use), 35.6% (tobacco use), 24.8% (alcohol use), and 31.2% (cannabis 
use). Reduced well-being scores and increased stress scores were general factors 
of increase in addiction-related habits (P<.001 for all habits). Factors of 
increase in caloric/salty food intake (n=10,771) were female gender (aOR 1.62, 
95% CI 1.48-1.77), age less than 29 years (P<.001), having a partner (aOR 1.19, 
95% CI 1.06-1.35), being locked down in a more confined space (per 1 square 
meter/person decrease: aOR 1.02, 95% CI 1.01-1.03), being locked down alone (aOR 
1.29, 95% CI 1.11-1.49), and reporting current (aOR 1.94, 95% CI 1.62-2.31) or 
past (aOR 1.27, 95% CI 1.09-1.47) psychiatric treatment. Factors of increase in 
screen use (n=11,267) were female gender (aOR 1.31, 95% CI 1.21-1.43), age less 
than 29 years (P<.001), having no partner (aOR 1.18, 95% CI 1.06-1.32), being 
employed (P<.001), intermediate/high education level (P<.001), being locked down 
with no access to an outdoor space (aOR 1.16, 95% CI 1.05-1.29), being locked 
down alone (aOR 1.15, 95% CI 1.01-1.32), living in an urban environment (P<.01), 
and not working (P<.001). Factors of increase in tobacco use (n=2787) were 
female gender (aOR 1.31, 95% CI 1.11-1.55), having no partner (aOR 1.30, 95% CI 
1.06-1.59), intermediate/low education level (P<.01), and still working in the 
workplace (aOR 1.47, 95% CI 1.17-1.86). Factors of increase in alcohol use 
(n=7108) were age 30-49 years (P<.05), a high level of education (P<.001), and 
current psychiatric treatment (aOR 1.44, 95% CI 1.10-1.88). The only significant 
factor of increase in cannabis use (n=620) was intermediate/low level of 
education (P<.001).
CONCLUSIONS: The early phase of COVID-19 containment in France led to widespread 
increases in addiction-related habits in the general population. Reduced 
well-being and increased stress were universal factors of increase. More 
specific factors were associated with increases in each of the explored habits.

©Benjamin Rolland, Frédéric Haesebaert, Elodie Zante, Amine Benyamina, Julie 
Haesebaert, Nicolas Franck. Originally published in JMIR Public Health and 
Surveillance (http://publichealth.jmir.org), 18.09.2020.

DOI: 10.2196/19630
PMCID: PMC7505683
PMID: 32589149 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


4349. Psychol Psychother. 2021 Jun;94(2):357-364. doi: 10.1111/papt.12294. Epub 2020 
Jun 25.

Physical activity in a pandemic: A new treatment target for psychological 
therapy.

Diamond R(1)(2)(3), Waite F(1)(3).

Author information:
(1)Department of Psychiatry, University of Oxford, UK.
(2)Oxford Cognitive Therapy Centre, UK.
(3)Oxford Health NHS Foundation Trust, UK.

The COVID-19 pandemic and its management are placing significant new strains on 
people's well-being, particularly those with pre-existing mental health 
conditions. Physical activity has been shown to improve mental as well as 
physical health. Increasing activity levels should be prioritized as a treatment 
target, especially when the barriers to exercise are greater than ever. 
Promoting physical activity has not traditionally been the remit of 
psychologists. Yet psychological theory and therapeutic techniques can be 
readily applied to address physical inactivity. We present theoretical 
perspectives and therapy techniques relating to (1) beliefs about physical 
activity, (2) motivation to be physically active, and (3) the sense of reward 
achieved through being physically active. We outline strategies to initiate and 
maintain physical activity during the COVID-19 pandemic, thereby benefitting 
mental and physical health. COVID-19 is demanding rapid and substantial change 
across the whole health care system. Psychological therapists can respond 
creatively by addressing physical activity, a treatable clinical target which 
delivers both mental and physical health benefits. PRACTITIONER POINTS: Physical 
activity is essential for our mental and physical health. Yet COVID-19 presents 
novel barriers to physical activity. Psychological theory and techniques to 
address beliefs, motivation, and reward can be applied to increase physical 
activity during COVID-19. Physical activity is an important clinical target to 
sustain and improve mental health, especially in the current pandemic.

© 2020 The Authors. American Journal of Transplantation published by Wiley 
Periodicals LLC on behalf of The American Society of Transplantation and the 
American Society of Transplant Surgeons.

DOI: 10.1111/papt.12294
PMCID: PMC7361852
PMID: 32588499 [Indexed for MEDLINE]

Conflict of interest statement: All authors declare no conflict of interest.


4350. Brain Behav. 2020 Aug;10(8):e01730. doi: 10.1002/brb3.1730. Epub 2020 Jun 24.

Mental health status of the general population, healthcare professionals, and 
university students during 2019 coronavirus disease outbreak in Jordan: A 
cross-sectional study.

Naser AY(1), Dahmash EZ(1), Al-Rousan R(1), Alwafi H(2), Alrawashdeh HM(3), 
Ghoul I(4), Abidine A(5), Bokhary MA(5), Al-Hadithi HT(1), Ali D(1), Abuthawabeh 
R(1), Abdelwahab GM(1), Alhartani YJ(1), Al Muhaisen H(1), Dagash A(1), Alyami 
HS(6).

Author information:
(1)Faculty of Pharmacy, Isra University, Amman, Jordan.
(2)Department of Pharmacology and Toxicology, College of Medicine, Umm Alqura 
University, Mecca, Saudi Arabia.
(3)Amman Eye Clinic, Amman, Jordan.
(4)Paediatric Department, Ibn AL Haytham Hospital, Amman, Jordan.
(5)Department of Mental Health, King Abdulaziz Hospital, Makkah, Saudi Arabia.
(6)Department of Pharmaceutics, College of Pharmacy, Najran University, Najran, 
Saudi Arabia.

BACKGROUND: The emergence of COVID-19 global pandemic coupled with high 
transmission rate and mortality has created an unprecedented state of emergency 
worldwide. This global situation may have a negative impact on the psychological 
well-being of individuals which in turn impacts individuals' performance. This 
study aims to explore the prevalence of depression and anxiety among the GP, 
HCPs, and USs during COVID-19 outbreak, and to identify key population(s) who 
might need psychological intervention.
METHODS: A cross-sectional study using an online survey was conducted in Jordan 
between 22 and 28 March 2020 to explore the mental health status (depression and 
anxiety) of the general population, healthcare professionals, and university 
students during the COVID-19 outbreak. The Patient Health Questionnaire (PHQ-9) 
and Generalized Anxiety Disorder-7 (GAD-7) were used to assess depression and 
anxiety among the study participants. Logistic regression analysis was used to 
identify predictors of depression and anxiety.
RESULTS: The prevalence of depression and anxiety among the entire study 
participants was 23.8% and 13.1%, respectively. Anxiety was most prevalent 
across university students 21.5%, followed by healthcare professionals 11.3%, 
and general population 8.8%. Females among healthcare professionals and 
university students, divorced healthcare professionals, pulmonologists, and 
university students with history of chronic disease were at higher risk of 
developing depression. Females, divorced participants among the general 
population, and university students with history of chronic disease and those 
with high income (≥1,500 JD) were at higher risk of developing anxiety.
CONCLUSIONS: During outbreaks, individuals are put under extreme stressful 
condition resulting in higher risk of developing anxiety and depression 
particularly for students and healthcare professionals. Policymakers and mental 
healthcare providers are advised to provide further mental support to these 
vulnerable groups during this pandemic.

© 2020 The Authors. Brain and Behavior published by Wiley Periodicals LLC.

DOI: 10.1002/brb3.1730
PMCID: PMC7361060
PMID: 32578943 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


4351. Cochrane Database Syst Rev. 2020 Jun 24;6(6):CD012970. doi: 
10.1002/14651858.CD012970.pub2.

Probiotic treatment for women with gestational diabetes to improve maternal and 
infant health and well-being.

Okesene-Gafa KA(1), Moore AE(2), Jordan V(3), McCowan L(4), Crowther CA(2).

Author information:
(1)Department of Obstetrics and Gynecology, Faculty of Medical and Health 
Sciences, University of Auckland, Auckland, New Zealand.
(2)Liggins Institute, The University of Auckland, Auckland, New Zealand.
(3)Cochrane New Zealand, Department Obstetrics and Gynecology, University of 
Auckland, Auckland, New Zealand.
(4)Department of Obstetrics and Gynaecology, School of Population Health, 
University of Auckland, Auckland, New Zealand.

Update of
    doi: 10.1002/14651858.CD012970.

BACKGROUND: Gestational diabetes mellitus (GDM) is carbohydrate intolerance 
first recognised during pregnancy and associated with complications for mothers 
and babies. Probiotics are naturally occurring micro-organisms, which when 
ingested in adequate amounts, may confer health benefits. Evidence of the role 
of probiotics as treatment for GDM is limited.
OBJECTIVES: To evaluate the safety and effectiveness of probiotics in treating 
women with GDM on maternal and infant outcomes.
SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth's Trials 
Register ClinicalTrials.gov, WHO International Clinical Trials Registry Platform 
(ICTRP) (24 July 2019), and reference lists of retrieved studies.
SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing the use of 
probiotics versus placebo/standard care for the treatment of GDM.
DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study 
eligibility, extracted data, checked data accuracy, and assessed risk of bias of 
included trials. The certainty of evidence for selected maternal and 
infant/child outcomes was assessed using GRADE.
MAIN RESULTS: Nine RCTs (695 pregnant women with GDM) comparing probiotics 
versus placebo were identified. The overall risk of bias in the nine RCTs was 
low to unclear and the evidence was downgraded for imprecision due to the small 
numbers of women participating in the trials. The trials were carried out in 
hospitals and universities in Iran (seven trials), Thailand (one trial) and 
Ireland (one trial). All trials compared probiotics with placebo. Maternal 
outcomes We are uncertain if probiotics have any effect compared with placebo on 
hypertensive disorders of pregnancy, (risk ratio (RR) 1.50, 95% confidence 
interval (CI) 0.64 to 3.53; participants = 256; studies = 3; low-certainty 
evidence) and mode of birth as caesareans (average RR 0.64, 95% CI 0.30 to 1.35; 
participants = 267; studies = 3; low-certainty evidence) because the certainty 
of evidence is low and the 95% CIs span possible benefit and possible harm. No 
trials reported primary outcomes of: mode of birth as vaginal/assisted and 
subsequent development of type 2 diabetes. We are uncertain if probiotics have 
any effect compared with placebo on induction of labour (RR 1.33, 95% CI 0.74 to 
2.37; participants = 127; studies = 1; very low-certainty evidence). For other 
secondary maternal outcomes, we are uncertain if there are differences between 
probiotics and placebo for: postpartum haemorrhage; weight gain during pregnancy 
intervention and total gestational weight gain; fasting plasma glucose and need 
for extra pharmacotherapy (insulin). Probiotics may be associated with a slight 
reduction in triglycerides and total cholesterol. In probiotics compared with 
placebo, there was evidence of reduction in markers for insulin resistance 
(HOMA-IR) and HOMA-B; and insulin secretion. There was also an increase in 
quantitative insulin sensitivity check index (QUICKI). Probiotics were 
associated with minor benefits in relevant bio-markers with evidence of a 
reduction in inflammatory markers high-sensitivity C-reactive protein (hs-CRP), 
interleukin 6 (IL-6), and marker of oxidative stress malondialdehyde; and an 
increase in antioxidant total glutathione, but we are uncertain if there is any 
difference in total antioxidant capacity. No trials reported secondary outcomes: 
perineal trauma, postnatal weight retention or return to pre-pregnancy weight 
and postnatal depression. Infant/child/adult outcomes We are uncertain if 
probiotics have any effect, compared with placebo, on the risk of 
large-for-gestational-age babies (RR 0.73, 95% CI 0.35 to 1.52; participants = 
174; studies = 2; low-certainty evidence) or infant hypoglycaemia (RR 0.85, 95% 
CI 0.39 to 1.84; participants = 177; studies = 3; low-certainty evidence) 
because the certainty of evidence is low and the 95% CIs span possible benefit 
and possible harm. No trials reported primary outcomes of: perinatal 
(fetal/neonatal) mortality; or neurosensory disability. For other secondary 
outcomes, we are uncertain if there is any difference between probiotics and 
placebo in gestational age at birth, preterm birth, macrosomia, birthweight, 
head circumference, length, infant hypoglycaemia, and neonatal intensive care 
unit (NICU) admissions. There was evidence of a reduction in infant 
hyperbilirubinaemia with probiotics compared with placebo. No trials reported 
secondary outcomes: infant adiposity, and later childhood adiposity. There were 
no adverse events reported by any of the trials.
AUTHORS' CONCLUSIONS: Low-certainty evidence means we are not certain if there 
is any difference between probiotic and placebo groups in maternal hypertensive 
disorders of pregnancy, caesareans; and large-for-gestational-age babies. There 
were no adverse events reported by the trials. Due to the variability of 
probiotics used and small sample sizes of trials, evidence from this review has 
limited ability to inform practice. Well-designed adequately-powered trials are 
needed to identify whether probiotics may improve maternal blood glucose levels 
and/or infant/child/adult outcomes; and whether they can be used to treat GDM.

Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, 
Ltd.

DOI: 10.1002/14651858.CD012970.pub2
PMCID: PMC7386668
PMID: 32575163 [Indexed for MEDLINE]

Conflict of interest statement: Karaponi Okesene‐Gafa ‐ was recently involved 
with the Healthy Mums and Babies (HUMBA) randomised controlled demonstration 
trial, which has now been completed and published. The HUMBA RCT is not be 
eligible for inclusion in this review. In kind we have been provided with 
probiotics (Lactobacillus rhamnosus GG and Bifidobacterium lactis BB12) and 
placebo capsules free of charge from Christian Hansen Denmark 
(http://www.chr‐hansen.com/en) for our HUMBA trial (http://humba.ac.nz/). In 
this randomised controlled double‐blind trial, women were randomised to receive 
probiotics or placebo capsules with the main aim of reducing pregnancy weight 
gain and infant birthweight (ANZCTR registration number 12615000400561). In 
kind: Roche International‐ equipment and consumables for HBA1c for the HUMBA 
trial. National Heart Foundation assisted by letting us use some of their 
resources for the study and development of some of the content in the text 
messages as part of HUMBA trial. Public interest funding for the Healthy Mums 
and Babies (HUMBA) trial was received from Cure Kids, Counties Manukau Health, 
Mercia Barnes Trust Fund, University of Auckland Faculty Research Development 
Fund and Lottery Health Research Fund. Karaponi Okesene‐Gafa received funding 
from her organisation (Department of Obstetrics and Gynaecology, University of 
Auckland) for her PhD, with this review forming part of her thesis. Abigail 
Moore is a medical student and declares no conflict of interest. Vanessa Jordan 
is a Research Fellow in the University of Auckland and declares no conflict of 
interest. Lesley McCowan ‐ was also involved with the Healthy Mums and Babies 
(HUMBA) randomised controlled demonstration trial. The HUMBA RCT is not be 
eligible for inclusion in this review. In kind we have been provided with 
probiotics (Lactobacillus rhamnosus GG and Bifidobacterium lactis BB12) and 
placebo capsules free of charge from Christian Hansen Denmark 
(http://www.chr‐hansen.com/en) for our HUMBA trial (http://humba.ac.nz/). In 
this randomised controlled double‐blind trial, women are randomised to receive 
probiotics or placebo capsules with the main aim of reducing pregnancy weight 
gain and infant birthweight (ANZCTR registration number 12615000400561). In 
kind: Roche International‐ equipment and consumables for HBA1c for the HUMBA 
trial. National Heart Foundation assisted by letting us use some of their 
resources for the study and development of some of the content in the text 
messages as part of HUMBA trial. Caroline Crowther ‐ was also involved with the 
Healthy Mums and Babies (HUMBA) randomised controlled demonstration trial. The 
HUMBA RCT is not be eligible for inclusion in this review. In kind we have been 
provided with probiotics (Lactobacillus rhamnosus GG and Bifidobacterium lactis 
BB12) and placebo capsules free of charge from Christian Hansen Denmark 
(http://www.chr‐hansen.com/en) for our HUMBA trial (http://humba.ac.nz/). In 
this randomised controlled double‐blind trial, women are randomised to receive 
probiotics or placebo capsules with the main aim of reducing pregnancy weight 
gain and infant birthweight (ANZCTR registration number 12615000400561). In 
kind: Roche International‐ equipment and consumables for HBA1c for the HUMBA 
trial. National Heart Foundation assisted by letting us use some of their 
resources for the study and development of some of the content in the text 
messages as part of HUMBA trial.


4352. Front Public Health. 2020 May 27;8:236. doi: 10.3389/fpubh.2020.00236. 
eCollection 2020.

Knowledge, Attitudes, Impact, and Anxiety Regarding COVID-19 Infection Among the 
Public in China.

Lin Y(1), Hu Z(1), Alias H(2), Wong LP(2).

Author information:
(1)Fujian Provincial Key Laboratory of Environment Factors and Cancer, 
Department of Epidemiology and Health Statistics, School of Public Health, 
Fujian Medical University, Fuzhou, China.
(2)Centre for Epidemiology and Evidence-Based Practice, Department of Social and 
Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, 
Malaysia.

Objectives: Sufficient knowledge and positive attitudes are crucial to the 
prevention of COVID-19. However, little is known about public awareness and 
attitudes regarding COVID-19 in China. The impact of COVID-19 on the societal 
well-being and anxiety levels of the public has never been documented. The aim 
of this study was to survey the knowledge, attitudes, impact, and anxiety levels 
of the people of China in relation to the COVID-19 outbreak. Method: A 
cross-sectional population survey using an online questionnaire was undertaken 
between Jan 24 and Feb 24, 2020. The study participants were residents of 
mainland China over the age of 18 years. The attitude items in this study 
measured the perceived threat of COVID-19 based on the Health Belief Model. 
Anxiety was measured with the State-Trait Anxiety Inventory (STAI), a 
self-reported questionnaire that measure both state (STAI-S), and trait anxiety 
(STAI-T) Results: A total of 2,446 completed responses were received. The mean 
and standard deviation (SD) for the total knowledge score was 20.3 (SD ± 2.9) 
out of a possible score of 23. The social disruption and household economic 
impact were notable, particularly in provinces with higher cumulative confirmed 
cases. The majority of responses indicated a low perceived susceptibility of 
being infected (86.7% [95%CI 85.4-88.1]), with a fair proportion of respondents 
perceiving a higher severity (62.9% [95% CI 61.0-64.8]). The mean total impact 
score was 9.9 (SD ± 3.8) out of a possible score of 15. The mean score for 
STAI-S was 48.7 (SD ± 10.8), whereas the mean STAI-T score was 45.7 (SD ± 8.5). 
By demographics, women reported significantly higher odds for higher levels of 
both STAI-S (OR = 1.67) and STAI-T (OR = 1.30) compared to men. People of a 
younger age were also more likely to experience higher STAI-S and STAI-T. Higher 
perceived susceptibility and severity and impact were strong predictors of 
higher levels of STAI-S and STAI-T. Conclusion: Our findings can assist in 
tailoring public communication to change people's knowledge and attitudes. The 
present study also underlined the importance of the promotion of mental health 
during infectious disease outbreaks to help in moderating the perceived threat, 
social and household economic impact, targeting the vulnerable segment of the 
population.

Copyright © 2020 Lin, Hu, Alias and Wong.

DOI: 10.3389/fpubh.2020.00236
PMCID: PMC7266871
PMID: 32574305 [Indexed for MEDLINE]


4353. Front Immunol. 2020 May 7;11:944. doi: 10.3389/fimmu.2020.00944. eCollection 
2020.

Coronavirus Disease (COVID-19-SARS-CoV-2) and Nutrition: Is Infection in Italy 
Suggesting a Connection?

Cena H(1)(2), Chieppa M(3)(4).

Author information:
(1)Department of Public Health, Experimental and Forensic Medicine-Dietetics and 
Clinical Nutrition Laboratory, University of Pavia, Pavia, Italy.
(2)Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and 
Endocrinology, ICS Maugeri IRCCS, Pavia, Italy.
(3)National Institute of Gastroenterology "S. de Bellis", Institute of Research, 
Castellana Grotte, Italy.
(4)Depatrment of Immunology and Cell Biology, European Biomedical Research 
Institute of Salerno EBRIS, Salerno, Italy.

Novel coronavirus disease (COVID-19) was declared a global pandemic on March 11, 
2020. The outbreak first occurred in Wuhan, Hubei, China, in December 2019 and 
hit Italy heavily in February 2020. Several countries are adopting complete or 
partial lockdown to contain the growth of COVID-19 infection. These measures may 
affect people's mental health and well-being but are necessary to avoid 
spreading the pandemic. There has been a gradual increase in studies exploring 
prevention and control measures, and we recommend paying close attention to 
nutrition, which may contribute to modulating some important consequences of 
COVID-19 infection, as such pro-inflammatory cytokine storm.

Copyright © 2020 Cena and Chieppa.

DOI: 10.3389/fimmu.2020.00944
PMCID: PMC7221157
PMID: 32574257 [Indexed for MEDLINE]


4354. Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2020 Jun 1;41(1):33-45. doi: 
10.2478/prilozi-2020-0021.

History Information's are Indispensable in Developmental Assessment of Children.

Demerdzieva A(1), Pop-Jordanova N(2).

Author information:
(1)Acibadem Sistina Hospital, Skopje, R. N. Macedonia.
(2)Macedonian Academy of Sciences and Arts, Skopje, R. N. Macedonia.

For achieving the good health and wellbeing for all children, the main role of 
pediatrician and other health care professionals is to follow their development. 
We implemented developmental monitoring for 465 children at the age of 12 - 60 
months, in the period of 4 years (2016 - 2019), using standard algorithm in 
which start is always with child history. It should be comprehensive, and must 
include a detailed prenatal, perinatal, and postnatal history. Obtained results 
showed that 16.13% of participants have some serious illness in family history, 
and the same percentage (16.13%) manifested serious perinatal problems which 
imposed the support in intensive care unit. Breastfeed are 49,46 % of children. 
Only 7,53 % are not completely vaccinated. About the parameters for the 
development, we obtained that 11,83 % were not walking at the time of the 
assessment, and 65,81 % were not speaking. Toilet control was negative, and in 
75,27 % they still were wearing diapers. Allergic manifestations at the time 
when the assessment was done is present in 8,60%. Finally, serious illness in 
child past history was positive in 19.35 % of evaluated sample. We concluded 
that a good history is needed and indispensable in the assessment process, 
particularly when exogenous causes are identified as the risk for the 
developmental delay. Obtained positive answers are directory for further 
investigation as well to correlate risk-consequences relationship.

DOI: 10.2478/prilozi-2020-0021
PMID: 32573475 [Indexed for MEDLINE]


4355. Acad Radiol. 2020 Aug;27(8):1162-1172. doi: 10.1016/j.acra.2020.06.002. Epub 
2020 Jun 13.

COVID-19 Impact on Well-Being and Education in Radiology Residencies: A Survey 
of the Association of Program Directors in Radiology.

Robbins JB(1), England E(2), Patel MD(3), DeBenedectis CM(4), Sarkany DS(5), 
Heitkamp DE(6), Milburn JM(7), Kalia V(8), Ali K(9), Gaviola GC(10), Ho CP(11), 
Jay AK(12), Ong S(13), Jordan SG(14).

Author information:
(1)University of Wisconsin School of Medicine and Public Health, 600 Highland 
Avenue, E3/374 CSC, Madison, WI 53792. Electronic address: 
JRobbins@uwhealth.org.
(2)University of Cincinnati Medical Center, Department of Radiology, Cincinnati, 
Ohio.
(3)Mayo Clinic Arizona, Department of Radiology, Phoenix, Arizona.
(4)University of Massachusetts Medical School, Department of Radiology, 
Worcester, Massachusetts.
(5)Staten Island University Hospital Northwell Health, Department of Radiology, 
Staten Island, New York.
(6)AdventHealth Imaging, Orlando, Florida.
(7)Ochsner Clinic Foundation, Department of Radiology, New Orleans, Louisiana.
(8)University of Michigan Health System, Department of Radiology, Ann Arbor, 
Michigan.
(9)University of Kansas School of Medicine, Department of Radiology, Wichita, 
Kansas.
(10)Brigham and Women's Hospital, Department of Radiology, Boston, 
Massachusetts.
(11)Emory University School of Medicine, Department of Radiology and Imaging 
Sciences, Atlanta, Georgia.
(12)MedStar Georgetown University Hospital, Department of Radiology, Washington, 
District of Columbia.
(13)University of Chicago Medical Center, Department of Radiology, Chicago, 
Illinois.
(14)University of North Carolina School of Medicine, Chapel Hill, North 
Carolina.

Comment in
    Acad Radiol. 2020 Oct;27(10):1491.

RATIONALE AND OBJECTIVES: The COVID-19 pandemic has forced rapid evolution of 
the healthcare environment. Efforts to mitigate the spread of the virus through 
social distancing and shelter-at-home edicts have unintended consequences upon 
clinical and educational missions and mental well-being of radiology 
departments. We sought to understand the impact of the COVID-19 pandemic on 
radiology residencies with respect to the educational mission and perceptions of 
impact on well-being.
MATERIALS AND METHODS: This study was IRB exempt. An anonymous 22 question 
survey regarding the impact of COVID-19 pandemic on educational and clinical 
missions of residencies, its perceived impact upon morale of radiologists and 
trainees and a query of innovative solutions devised in response, was emailed to 
the Association of Program Directors in Radiology membership. Survey data were 
collected using SurveyMonkey (San Mateo, California).
RESULTS: Respondents felt the COVID-19 pandemic has negatively impacted their 
residency programs. Regarding the educational mission impact, 70.1% (75/107) 
report moderate/marked negative impact and 2.8% (3/107) that educational 
activities have ceased. Regarding the pandemic's impact on resident morale, 
44.8% (48/107) perceive moderate/marked negative effect; perceived resident 
morale in programs with redeployment is significantly worse with 57.1% (12/21) 
reporting moderate/marked decrease. Respondents overwhelmingly report adequate 
resident access to mental health resources during the acute phase of the 
pandemic (88.8%, 95/107). Regarding morale of program directors, 61% (65/106) 
report either mild or marked decreased morale. Program innovations reported by 
program directors were catalogued and shared.
CONCLUSION: The COVID-19 pandemic has markedly impacted the perceived well-being 
and educational missions of radiology residency programs across the United 
States.

Copyright © 2020 The Association of University Radiologists. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.acra.2020.06.002
PMCID: PMC7293482
PMID: 32571648 [Indexed for MEDLINE]


4356. Int J Environ Res Public Health. 2020 Jun 18;17(12):4360. doi: 
10.3390/ijerph17124360.

Exploring Lifestyle Habits, Physical Activity, Anxiety and Basic Psychological 
Needs in a Sample of Portuguese Adults during COVID-19.

Antunes R(1)(2)(3), Frontini R(4)(5), Amaro N(1)(2), Salvador R(1)(2), Matos 
R(1)(2), Morouço P(1)(6), Rebelo-Gonçalves R(1)(7).

Author information:
(1)Department of Human Kinetics, Polytechnic Institute of Leiria, 2411 Leiria, 
Portugal.
(2)Life Quality Research Centre (CIEQV), Polytechnic Institute of Leiria, 2411 
Leiria, Portugal.
(3)Sport Science School of Rio Maior (ESDRM), Polytechnic Institute of Santarém, 
2040 Santarem, Portugal.
(4)Center for Health Technology and Services Research (CINTESIS.UA), School of 
Health Sciences, University of Aveiro, (Campus Universitário de Santiago), 3810 
Aveiro, Portugal.
(5)Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of 
Leiria, 2411 Leiria, Portugal.
(6)CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, 1495 Cruz 
Quebrada Dafundo, 1649004 Lisbon, Portugal.
(7)Research Unit for Sport and Physical Activity, University of Coimbra, 3040 
Coimbra, Portugal.

This cross-sectional study aimed to characterize the lifestyle habits, anxiety 
levels and basic psychological needs (BPN), in Portuguese adults during the 
Coronavirus Disease 2019 (COVID-19) pandemic, including a comparison between 
genders and age groups. In total, 1404 adults (36.4 ± 11.7 years; 69.6% female) 
answered sociodemographic data and three instruments: the International Physical 
Activity Questionnaire, the Basic Need General Satisfaction Scale and the 
State-Trait Anxiety Inventory. Males revealed higher values for the total energy 
expenditure (z = -2.26; p = 0.024; η 2 = 0.004) and for the level of 
satisfaction of competence (z = -2.62; p = 0.009; η 2 = 0.005). Females showed 
higher scores for the anxiety state (z = -7.87; p ≤ 0.001; η 2 = 0.044) and 
anxiety trait (z = -6.49; p ≤ 0.001; η 2 = 0.030). Regarding age, higher values 
for the anxiety trait (p ≤ 0.001; η H 2 = 0.030) were found in the 18-34 
years-old group compared to all the other age groups, also presenting 
significantly higher values of total energy expenditure (χ² = 13.93; p = 0.008; 
η H 2 = 0.007) when compared to the 35-44 years-old group. Significant 
differences were observed between the 18-34 years-old group and the other age 
groups for the satisfaction of competence (χ² = 40.97; p ≤ 0.001; η H 2 = 
0.026), except for the >65 years-old group. Strategies for promoting well-being 
during periods of social isolation should consider the role of psychological 
dimensions and lifestyle habits according to the gender or age group.

DOI: 10.3390/ijerph17124360
PMCID: PMC7345948
PMID: 32570737 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


4357. Psychol Trauma. 2020 Jul;12(5):557-558. doi: 10.1037/tra0000704. Epub 2020 Jun 
22.

The need for psychosocial support amid COVID-19 crises in Nigeria.

Aluh DO(1), Onu JU(2).

Author information:
(1)Department of Clinical Pharmacy and Pharmacy Management, University of 
Nigeria, Nsukka.
(2)Department of Mental Health, Nnamdi Azikiwe University.

With the closure of all public places, the stay-at-home order and the worsening 
economic indices occasioned by the fall in the price of crude oil with no 
foreseeable end, learned helplessness, negative emotions, and other psychosocial 
problems are bound to thrive. Interventions to improve social capital, coping 
resources, resilience, and good community and family cohesion are needed to 
promote psychosocial well-being during and after the COVID-19 pandemic in 
Nigeria. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

DOI: 10.1037/tra0000704
PMID: 32567871 [Indexed for MEDLINE]


4358. Saudi J Gastroenterol. 2020 Sep-Oct;26(5):263-271. doi: 10.4103/sjg.SJG_220_20.

A cross-sectional survey on the psychological impact of the COVID-19 pandemic on 
inflammatory bowel disease patients in Saudi Arabia.

Mosli M(1), Alourfi M(2), Alamoudi A(1), Hashim A(3), Saadah O(4), Al Sulais 
E(5), AlAmeel T(6), Alharbi O(7), Bakari S(8), Meeralam Y(9), Alshobai S(1), 
Alsahafi M(1), Jawa H(1), Qari Y(1).

Author information:
(1)Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
(2)Department of Gastroenterology, King Faisal Medical City for Southern Region, 
Abha, Saudi Arabia.
(3)Department of Internal Medicine, University of Jeddah, Jeddah, Saudi Arabia.
(4)Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia.
(5)Department of Medicine, Royal Commission Hospital, Jubail, Saudi Arabia.
(6)Department of Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia.
(7)Department of Medicine, King Saud University, Riyadh, Saudi Arabia.
(8)Department of Gastroenterology, King Saud Medical City, Riyadh, Saudi Arabia.
(9)Department of Medicine, King Abdullah Medical City, Makkah, Saudi Arabia.

BACKGROUND/AIMS: The coronavirus (COVID-19) pandemic has caused significant 
disruption to patients with chronic illnesses. We explored the emotional state, 
perception, and concerns of Saudi patients with inflammatory bowel disease (IBD) 
during the crisis.
MATERIALS AND METHODS: We conducted a cross-sectional survey from 30 March to 5 
April, 2020 using a pre-designed questionnaire distributed through social media 
platforms to IBD patients. The five-part questionnaire included an assessment of 
psychological wellbeing using a previously validated Arabic version of the 
Hospital Anxiety and Depression Scale (HADS), which includes domains for anxiety 
(HADS-A) and depression (HADS-D). A logistic regression analysis was used to 
uncover possible associations between patient characteristics and anxiety and 
depression.
RESULTS: The data from 1156 IBD patients were analyzed. Normal, borderline, and 
HADS-A scores consistent with a diagnosis of anxiety were reported by 423 
(36.6%), 174 (15.1%), and 559 (48.4%) patients, respectively. However, 635 (69%) 
patients had normal scores and 273 (30.1%) had borderline HADS-D scores; no 
patients reported scores consistent with depression. Based on a multiple 
logistic regression analysis, patients educated till a high school diploma (OR = 
2.57, 95% CI: 0.09-6.05, P = 0.03) and that had indeterminate colitis (OR = 
2.23, 95% CI: 1.27-3.89, P = 0.005) were more likely to express anxiety.
CONCLUSIONS: Many patients expressed symptoms of anxiety, although not 
depression. Female patients, patients educated till a high school diploma, and 
those with indeterminate colitis were more likely to have anxiety. IBD patients 
require greater attention during a pandemic to avoid adverse disease-related 
outcomes.

DOI: 10.4103/sjg.SJG_220_20
PMCID: PMC7739990
PMID: 32567580 [Indexed for MEDLINE]

Conflict of interest statement: None


4359. Psychiatry Res. 2020 Sep;291:113138. doi: 10.1016/j.psychres.2020.113138. Epub 
2020 May 29.

Correlates of symptoms of anxiety and depression and mental wellbeing associated 
with COVID-19: a cross-sectional study of UK-based respondents.

Smith L(1), Jacob L(2), Yakkundi A(3), McDermott D(4), Armstrong NC(5), Barnett 
Y(6), López-Sánchez GF(7), Martin S(8), Butler L(9), Tully MA(10).

Author information:
(1)The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin 
University, Cambridge, UK. Electronic address: Lee.Smith@anglia.ac.uk.
(2)Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr Antoni Pujadas, 42, Sant Boi de 
Llobregat, Barcelona 08830, Spain.
(3)Northern Ireland Public Health Research Network, School of Health Sciences, 
Ulster University, Newtownabbey, UK.
(4)School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, 
UK.
(5)HSC R&D Division, Public Health Agency (Northern Ireland), Belfast, UK.
(6)Anglia Ruskin University, Cambridge, UK.
(7)Faculty of Sport Sciences, University of Murcia, Spain.
(8)School of Health Sciences, Ulster University, Newtownabbey, UK.
(9)Faculty of Science and Engineering, Anglia Ruskin.
(10)Institute of Mental Health Sciences, School of Health Sciences, Ulster 
University, Newtownabbey, UK. Electronic address: m.tully@ulster.ac.uk.

BACKGROUND: The aim was to assess the impact of COVID-19 self-isolation/social 
distancing on mental health, and potential correlates, among a sample of the UK 
population.
METHODS: A cross-sectional study. Mental health was measured using the Beck 
Anxiety and Depression Inventory. Mental wellbeing was measured using The Short 
Warwick-Edinburgh Mental Well-being Scale. Data collected on predictors included 
sex, age, marital status, employment, annual income, region, current smoking, 
current alcohol consumption, physical multimorbidity, any physical symptoms 
experienced during self-isolation/social distancing, and the number of days of 
self-isolation/social distancing. The association between potential predictors 
and poor mental health was studied using a multivariable logistic regression.
RESULTS: 932 participants were included. Factors associated with poor mental 
health were sex (reference: male; female: OR=1.89, 95%CI=1.34-2.68), age (18-24 
years: reference;45-54 years: OR=0.27, 95%CI=0.14-0.53; 55-64 years: OR=0.24, 
95%CI=0.12-0.47; 65-74years: OR=0.10, 95% CI=0.05-0.22; and ≥75years: 
OR=0.08,95% CI=0.03-0.24),annual income (<£15,000: reference; £25,000-<£40,000: 
OR=0.54, 95% CI=0.31-0.93; £40,000-<£60,000: OR=0.39, 95% CI=0.22-0.69; and 
≥£60,000: OR=0.38, 95% CI=0.21-0.67), current smoking (yes: OR=2.59, 
95%CI=1.62-4.20), and physical multimorbidity (OR=2.35, 95%CI=1.61-3.46).
CONCLUSIONS: In this sample of UK adults self-isolating/social distancing 
females, younger age groups, those with a lower annual income, current smokers 
and those with physical multimorbidity were associated with higher levels of 
poor mental health.

Copyright © 2020 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.psychres.2020.113138
PMCID: PMC7258801
PMID: 32562931 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


4360. Trends Cogn Sci. 2020 Sep;24(9):717-733. doi: 10.1016/j.tics.2020.05.016. Epub 
2020 Jun 3.

The Neurobiology of Social Distance.

Bzdok D(1), Dunbar RIM(2).

Author information:
(1)Department of Biomedical Engineering, McConnell Brain Imaging Centre (BIC), 
Montreal Neurological Institute (MNI), Faculty of Medicine, McGill University, 
Montreal, Canada; Quebec Artificial Intelligence Institute (Mila), Montreal, 
Canada. Electronic address: danilo.bzdok@mcgill.ca.
(2)Department of Experimental Psychology, University of Oxford, Oxford, UK. 
Electronic address: robin.dunbar@psy.ox.ac.uk.

Never before have we experienced social isolation on such a massive scale as we 
have in response to coronavirus disease 2019 (COVID-19). However, we know that 
the social environment has a dramatic impact on our sense of life satisfaction 
and well-being. In times of distress, crisis, or disaster, human resilience 
depends on the richness and strength of social connections, as well as on active 
engagement in groups and communities. Over recent years, evidence emerging from 
various disciplines has made it abundantly clear: perceived social isolation 
(i.e., loneliness) may be the most potent threat to survival and longevity. We 
highlight the benefits of social bonds, the choreographies of bond creation and 
maintenance, as well as the neurocognitive basis of social isolation and its 
deep consequences for mental and physical health.

Copyright © 2020 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.tics.2020.05.016
PMCID: PMC7266757
PMID: 32561254 [Indexed for MEDLINE]


4361. Psychol Trauma. 2020 Aug;12(S1):S55-S57. doi: 10.1037/tra0000703. Epub 2020 Jun 
18.

Loneliness, isolation, and social support factors in post-COVID-19 mental 
health.

Saltzman LY(1), Hansel TC(1), Bordnick PS(1).

Author information:
(1)School of Social Work, Tulane University.

Social support plays a key role in well-being, yet one of the major preventative 
efforts for reducing the spread of COVID-19 involves social distancing. During 
times of crisis, social support is emphasized as a coping mechanism. This 
requires many people to change their typical ways of connectedness and assumes 
that people have existing healthy relationships or access to technology. The 
purpose of this article was to explore the potential impact of COVID-19 on 
loneliness and well-being. Social support is an important consideration for 
understanding the impact of COVID-19 Psychological First Aid and Skills for 
Psychological Recovery, which are tools used to inform response methods to help 
people connect during isolation and are interventions that could be adapted to 
COVID-specific needs for what may be a prolonged isolation and postisolation. 
Given the many unknowns of COVID-19, studies are needed to understand the larger 
behavioral health impact to ensure resources are available, current, and 
evidence informed. Future studies are also needed to understand how access to 
technology may help buffer loneliness and isolation and thus improve the social 
outcomes of the current pandemic. (PsycInfo Database Record (c) 2020 APA, all 
rights reserved).

DOI: 10.1037/tra0000703
PMID: 32551762 [Indexed for MEDLINE]


4362. Psychol Trauma. 2020 Aug;12(S1):S186-S187. doi: 10.1037/tra0000721. Epub 2020 
Jun 18.

On the frontlines: Protecting low-wage workers during COVID-19.

Cubrich M(1).

Author information:
(1)Department of Psychology.

An examination of the trajectory of the coronavirus disease (COVID-19) pandemic 
and its subsequent economic impacts has revealed that this crisis will impact 
low-wage workers more severely than all others. The present commentary 
highlights the unique factors associated with low-wage work that make these 
workers particularly vulnerable to the effects of the pandemic, identifies 
potential adverse effects on the mental health of this population, and provides 
recommendations to maintain the safety, wellbeing, and dignity of low-wage 
workers. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

DOI: 10.1037/tra0000721
PMID: 32551757 [Indexed for MEDLINE]


4363. EClinicalMedicine. 2020 Jun 6;23:100388. doi: 10.1016/j.eclinm.2020.100388. 
eCollection 2020 Jun.

Hospitalising preterm infants in single family rooms versus open bay units: A 
systematic review and meta-analysis of impact on parents.

van Veenendaal NR(1)(2), van Kempen AAMW(1), Franck LS(3), O'Brien K(4), Limpens 
J(5), van der Lee JH(2)(6), van Goudoever JB(2), van der Schoor SRD(1).

Author information:
(1)Department of Pediatrics/Neonatology, OLVG, Amsterdam, Netherlands.
(2)Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's 
Hospital, Amsterdam, Netherlands.
(3)School of Nursing, University of California San Francisco, San Francisco, CA, 
United States.
(4)Department of Pediatrics, Mount Sinai Hospital, Toronto, Canada.
(5)Medical Library Amsterdam UMC, University of Amsterdam, Amsterdam, The 
Netherlands.
(6)Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, 
The Netherlands.

BACKGROUND: Many parents develop stress-related symptoms and depression when 
their preterm infant is hospitalised in the neonatal intensive care unit (NICU) 
after birth. We reviewed the evidence of parent well-being with preterm infants 
hospitalised in single family rooms (SFRs) or in open bay neonatal units (OBUs).
METHODS: For this systematic review and meta-analysis, we searched MEDLINE, 
EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), Web 
of Science, Clinicaltrials.gov, and International Clinical Trials Registry 
Platform (ICTRP) databases from inception through 22 November 2019 using 
controlled terms and text words related to prematurity and NICU-design. We 
included randomised and non-randomised studies comparing outcomes in parents 
with preterm infants admitted to SFRs or OBUs. Methodological quality was 
assessed using Cochrane Collaboration's Risk of Bias Tool for randomised 
controlled trials and the Risk of Bias Tool for Non-Randomised Studies of 
Interventions (ROBINS-I). Outcomes included: parental stress, satisfaction, 
participation (presence/involvement/skin-to-skin care), self-efficacy, 
parent-infant-bonding, depression, anxiety, post-traumatic stress, empowerment, 
and degree of family-centred care. Summary estimates were calculated using 
random effects models with standardised mean differences (SMDs). PROSPERO 
registration: CRD42016050643.
FINDINGS: We identified 614 unique publications. Eleven study populations (1, 
850 preterm infants, 1, 549 mothers and 379 fathers) were included. All but one 
study were at serious to critical risk of bias. SFRs were associated with higher 
levels of parental presence, involvement, and skin-to-skin care. Upon discharge, 
SFRs were associated with lower stress levels (n = 828 parents, SMD-0·30,95%CI 
-0·50;-0·09, p<0·004, I2=46%), specifically NICU-related stress (n = 573, 
SMD-0·42,95%CI -0·61;-0·23, p<0·0001, I2=0%). In majority of studies higher 
levels of empowerment, family-centred care, and satisfaction was present with 
SFRs. No differences were found for anxiety, parent-infant bonding, or 
self-efficacy. Depression was high (up to 29%) but not different between 
settings. No studies described post-traumatic stress.
INTERPRETATION: Single family rooms seem to facilitate parental presence, 
involvement, skin-to-skin care, and reduce NICU-related parental stress.

© 2020 The Author(s).

DOI: 10.1016/j.eclinm.2020.100388
PMCID: PMC7284081
PMID: 32548575


4364. Contemp Nurse. 2020 Apr;56(2):171-184. doi: 10.1080/10376178.2020.1782762. Epub 
2020 Jun 24.

Examination of the psychological changes in nurses due to workload in an 
intensive care unit: a mixed method study.

Turan N(1), Ançel G(2).

Author information:
(1)School of Nursing, Ufuk University, Akara, Turkey.
(2)Faculty of Nursing, Psychiatry Nursing Department, Ankara University, Ankara, 
Turkey.

Background: The workload is the impinged stress due to several inter-related 
factors, including the competence of the intensive care unit nurse. Objectives: 
The objective of this study was to investigate the workload-related 
psychological changes in intensive care nurses. Methods: The study had a 
two-phase explanatory mixed method design. Data were collected through in-depth 
personal interviews and with other instruments. The obtained data were analyzed 
with SPSS 18.0 and MAXQDA plus10. Results: The workload of intensive care nurses 
was 315.8 per minute and the mean TISS 28 score was as high as 65.00. The 
in-depth interviews with intensive care nurses revealed that participants 
experienced professional stress due to high workload and went through 
psychological changes. Conclusion: The study findings demonstrate that 
psychological symptoms seen in intensive care nurses relate to a high workload. 
Impact Statement: The results of this study can be used by hospital 
administrators to create a healthy work environment with a moderated workload 
and optimized shift schedules so that the mental well-being of nurses can be 
promoted.

DOI: 10.1080/10376178.2020.1782762
PMID: 32543344 [Indexed for MEDLINE]


4365. Gastrointest Endosc. 2020 Oct;92(4):925-935. doi: 10.1016/j.gie.2020.06.010. 
Epub 2020 Jun 11.

Impact of COVID-19 on endoscopy trainees: an international survey.

Pawlak KM(1), Kral J(2), Khan R(3), Amin S(4), Bilal M(5), Lui RN(6), Sandhu 
DS(7), Hashim A(8), Bollipo S(9), Charabaty A(10), de-Madaria E(11), 
Rodríguez-Parra AF(12), Sánchez-Luna SA(13), Żorniak M(14), Walsh CM(15), Grover 
SC(16), Siau K(17).

Author information:
(1)Department of Internal Medicine, Cardiology, Gastroenterology and 
Endocrinology, Hospital of the Ministry of Interior and Administration, 
Szczecin, Poland.
(2)Hepatogastroenterology Department, Institution for Clinical and Experimental 
Medicine, Prague, Czech Republic.
(3)Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
(4)Division of Digestive Health and Liver Diseases, Department of Medicine, 
University of Miami Miller School of Medicine, Miami, Florida, USA.
(5)Division of Gastroenterology & Hepatology, Beth Israel Deaconess Medical 
Center, Harvard Medical School, Boston, Massachusetts, USA.
(6)Division of Gastroenterology and Hepatology, Institute of Digestive Disease, 
The Chinese University of Hong Kong, Hong Kong, China.
(7)Case Western Reserve University, Division of Gastroenterology, Hepatology & 
Nutrition, Cleveland Clinic, Cleveland, Ohio, USA.
(8)The University Of Jeddah, Jeddah, Saudi Arabia.
(9)Gastroenterology & Endoscopy, John Hunter Hospital, Newcastle, Australia; 
University of Newcastle, Australia.
(10)Division of Gastroenterology, Johns Hopkins School of Medicine, Johns 
Hopkins-Sibley Memorial Hospital, Washington DC, USA.
(11)Gastroenterology Department, Alicante University General Hospital, Alicante 
Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.
(12)General Hospital Dr. Manuel Gea González, National Autonomous University of 
Mexico, Mexico City, Mexico.
(13)Division of Gastroenterology and Hepatology, The University of New Mexico 
School of Medicine, Albuquerque, New Mexico, USA.
(14)Department of Gastroenterology, Medical University of Silesia, Katowice, 
Poland and Department of Medicine II, Ludwig-Maximillian's Univeristy, Munich, 
Germany.
(15)Division of Gastroenterology, Hepatology and Nutrition and the Research and 
Learning Institutes, Hospital for Sick Children, Department of Paediatrics and 
the Wilson Centre, University of Toronto, Toronto, Ontario, Canada.
(16)Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Li 
Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; 
Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada.
(17)Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Liver 
Unit, University Hospitals Birmingham, Birmingham, UK.

Comment in
    Gastrointest Endosc. 2020 Nov;92(5):1146-1147.
    Gastrointest Endosc. 2020 Nov;92(5):1147.
    Gastrointest Endosc. 2021 Jan;93(1):271-272.
    Gastrointest Endosc. 2021 Jan;93(1):272-274.

BACKGROUND AND AIMS: Although coronavirus disease 2019 (COVID-19) has affected 
endoscopy services globally, the impact on trainees has not been evaluated. We 
aimed to assess the impact of COVID-19 on procedural volumes and on the 
emotional well-being of endoscopy trainees worldwide.
METHODS: An international survey was disseminated over a 3-week period in April 
2020. The primary outcome was the percentage reduction in monthly procedure 
volume before and during COVID-19. Secondary outcomes included potential 
variation of COVID-19 impact between different continents and rates and 
predictors of anxiety and burnout among trainees.
RESULTS: Across 770 trainees from 63 countries, 93.8% reported a reduction in 
endoscopy case volume. The median percentage reduction in total procedures was 
99% (interquartile range, 85%-100%), which varied internationally (P < .001) and 
was greatest for colonoscopy procedures. Restrictions in case volume and trainee 
activity were common barriers. A total of 71.9% were concerned that the COVID-19 
pandemic could prolonged training. Anxiety was reported in 52.4% of respondents 
and burnout in 18.8%. Anxiety was independently associated with female gender 
(odds ratio [OR], 2.15; P < .001), adequacy of personal protective equipment 
(OR, 1.75; P = .005), lack of institutional support for emotional health (OR, 
1.67; P = .008), and concerns regarding prolongation of training (OR, 1.60; P = 
.013). Modifying existing national guidelines to support adequate endoscopy 
training during the pandemic was supported by 68.9%.
CONCLUSIONS: The COVID-19 pandemic has led to restrictions in endoscopic volumes 
and endoscopy training, with high rates of anxiety and burnout among endoscopy 
trainees worldwide. Targeted measures by training programs to address these key 
issues are warranted to improve trainee well-being and support trainee 
education.

Copyright © 2020 American Society for Gastrointestinal Endoscopy. All rights 
reserved.

DOI: 10.1016/j.gie.2020.06.010
PMCID: PMC7287420
PMID: 32535193 [Indexed for MEDLINE]


4366. J Public Health (Oxf). 2020 Aug 18;42(3):633-634. doi: 10.1093/pubmed/fdaa086.

ChurchInAction: the role of religious interventions in times of COVID-19.

Del Castillo FA(1), Biana HT(2), Joaquin JJB(2).

Author information:
(1)Theology and Religious Education Department, De La Salle University, Manila 
1004, Philippines.
(2)Department of Philosophy, De La Salle University, Manila 1004, Philippines.

Comment in
    J Public Health (Oxf). 2021 Jun 7;43(2):e236-237.
    J Public Health (Oxf). 2021 Jun 7;43(2):e273-e274.

In a recently published letter to the editor of this journal, the authors have 
called for the need to establish psychological support structures that cater to 
people's mental health in this time of the coronavirus disease 2019 pandemic. To 
be more holistic, we extend this call to include people's spiritual well-being 
as well. We highlight the initiatives of the Philippines' religious sector. In 
particular, we report some of the interventions made by the Roman Catholic 
Church that have led to the social media hashtag, #ChurchInAction. These 
religious and spiritual interventions showcase the efforts of the Philippine 
Church and play an important role in providing assistance in time of public 
health crisis.

© Crown copyright 2020.

DOI: 10.1093/pubmed/fdaa086
PMCID: PMC7313866
PMID: 32533174 [Indexed for MEDLINE]


4367. Int J Environ Res Public Health. 2020 Jun 10;17(11):4148. doi: 
10.3390/ijerph17114148.

The Emergence of Risk Communication Networks and the Development of Citizen 
Health-Related Behaviors during the COVID-19 Pandemic: Social Selection and 
Contagion Processes.

Lim S(1), Nakazato H(2).

Author information:
(1)Public Management and Policy Analysis Program, Graduate School of 
International Relations, International University of Japan, Niigata 949 7277, 
Japan.
(2)School of Information and Communication, Meiji University, Tokyo 101 8301, 
Japan.

Amid the novel coronavirus pandemic, a variety of public health strategies have 
been implemented by governments worldwide. However, the fact that strict 
government mandates focus on physical distancing does not mean that social 
connectedness for voluntary risk communication among citizens should be 
sacrificed. Furthermore, we lack an understanding of citizens' behaviors 
regarding the voluntary adoption of public health measures and the control of 
mental wellbeing in the age of physical distancing. Key variables in the 
response to the global pandemic are the emergence of risk deliberation networks, 
voluntary compliance with government guidelines, and the restoration of 
citizens' subjective health. However, little is known about how citizens' 
health-related behaviors coevolve with social connections for sharing 
information and discussing urgent pandemic issues. The findings show that 
selection and social influence mechanisms coexist by affecting each citizen's 
health-related behaviors and community-led risk discourses in the face of the 
urgent health crisis.

DOI: 10.3390/ijerph17114148
PMCID: PMC7312553
PMID: 32532029 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


4368. Elife. 2020 Jun 12;9:e59634. doi: 10.7554/eLife.59634.

The challenges of lockdown for early-career researchers.

Byrom N(1).

Author information:
(1)Institute of Psychiatry, Psychology and Neurosciences, King's College London, 
London, United Kingdom.

Thousands of UK doctoral students and early-career researchers shared the 
repercussions of lockdown on their work and wellbeing.

© 2020, Byrom.

DOI: 10.7554/eLife.59634
PMCID: PMC7292644
PMID: 32530421 [Indexed for MEDLINE]

Conflict of interest statement: NB No competing interests declared


4369. Health Commun. 2021 Nov;36(13):1598-1605. doi: 10.1080/10410236.2020.1775439. 
Epub 2020 Jun 12.

Trapped in a Double Bind: Chinese Overseas Student Anxiety during the COVID-19 
Pandemic.

Ma H(1), Miller C(1).

Author information:
(1)Department of Communication, The University of Oklahoma.

The severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), the COVID-19 
disease cases stemming from it, and the resulting pandemic have imposed severe, 
distressing, physical, and psychological challenges on communities worldwide. 
The stressful situation faced by Chinese overseas students (COSs) has been 
particularly acute. With this population as the focus, the current study 
evaluated the psychological state of COSs abroad during the initial phases of 
the pandemic. Participants (N = 182) were recruited to complete an online survey 
(during April 7-14, 2020) assessing their physical and social circumstances, and 
sense of wellbeing. Results showed COSs experienced high levels of anxiety 
primarily stemming from discrimination from the media, fear of COVID-19, and 
mixed messages from their social connections. Feeling entrapped in a double bind 
(DbB) situation with their close relations significantly increased anxiety. 
Perceived social support negatively correlated with anxiety, and those 
experiencing a DbB felt the greatest stress, particularly those unable to 
effectively differentiate the opposing messages. Findings of the study, 
limitations, and implications are discussed.

DOI: 10.1080/10410236.2020.1775439
PMID: 32530311 [Indexed for MEDLINE]


4370. Psychol Trauma. 2020 Aug;12(S1):S217-S219. doi: 10.1037/tra0000736. Epub 2020 
Jun 11.

Aging veterans' mental health and well-being in the context of COVID-19: The 
importance of social ties during physical distancing.

Marini CM(1), Pless Kaiser A(2), Smith BN(2), Fiori KL(1).

Author information:
(1)The Gordon F. Derner School of Psychology, Adelphi University.
(2)National Center for PTSD, VA Boston Healthcare System.

Prior wartime trauma likely acts as a double-edged sword that promotes both 
aging veterans' vulnerability and resilience in the context of the current 
COVID-19 pandemic. During this stressful time, aging veterans may benefit from 
having an array of socially supportive network ties. We therefore suggest that 
clinicians working with veterans encourage veterans to (a) create or sustain 
positive social connections while maintaining physical distance and (b) call 
upon coping strategies that helped them manage past difficulties. (PsycInfo 
Database Record (c) 2020 APA, all rights reserved).

DOI: 10.1037/tra0000736
PMID: 32525383 [Indexed for MEDLINE]


4371. Psychol Trauma. 2020 Aug;12(S1):S165-S167. doi: 10.1037/tra0000918. Epub 2020 
Jun 11.

Implementing an emotional support and mental health response plan for healthcare 
workers during the COVID-19 pandemic.

Miotto K(1), Sanford J(2), Brymer MJ(3), Bursch B(1), Pynoos RS(3).

Author information:
(1)Department of Psychiatry and Biobehavioral Sciences, David Geffen School of 
Medicine at UCLA.
(2)Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA.
(3)Department of Psychiatry and Biobehavioral Sciences, UCLA/Duke University 
National Center for Child Traumatic Stress.

Institutions across the world are working to develop initiatives aimed at 
supporting the well-being of healthcare workers (HCWs) facing the psychological 
impacts of the novel coronavirus (COVID-19) pandemic. This Commentary identifies 
risks that HCWs are experiencing, reviews sources of fear and stress, and 
describes the implementation of a three-tiered model for the provision of 
emotional support and mental health services for clinical and nonclinical HCWs. 
The model recognizes the fluid, ever-evolving nature of the COVID-19 pandemic 
and includes proactive, visible, and easy-to-access supportive psychological 
services that expand the safety net and help address immediate and future mental 
health challenges of HCWs. (PsycInfo Database Record (c) 2020 APA, all rights 
reserved).

DOI: 10.1037/tra0000918
PMID: 32525378 [Indexed for MEDLINE]


4372. Psychol Trauma. 2020 Aug;12(S1):S63-S65. doi: 10.1037/tra0000756. Epub 2020 Jun 
11.

When time falls apart: The public health implications of distorted time 
perception in the age of COVID-19.

Holman EA(1), Grisham EL(2).

Author information:
(1)Sue & Bill Gross School of Nursing, University of California, Irvine.
(2)Department of Psychological Science, University of California, Irvine.

Collective trauma, like the COVID-19 pandemic, can dramatically alter how we 
perceive time and view our futures. Indeed, the pandemic has challenged us to 
cope with an ambiguous, invisible threat that has changed our way of life and 
made our futures, both near and far, less certain. In this commentary, we review 
existing literature on time perception in the context of stress and trauma and 
discuss its implications for mental health and well-being. (PsycInfo Database 
Record (c) 2020 APA, all rights reserved).

DOI: 10.1037/tra0000756
PMID: 32525373 [Indexed for MEDLINE]


4373. Encephale. 2020 Jun;46(3S):S85-S92. doi: 10.1016/j.encep.2020.05.011. Epub 2020 
Jun 7.

[How do children and adolescents with Attention Deficit Hyperactivity Disorder 
(ADHD) experience lockdown during the COVID-19 outbreak?].

[Article in French]

Bobo E(1), Lin L(2), Acquaviva E(3), Caci H(4), Franc N(1), Gamon L(2), Picot 
MC(2), Pupier F(1), Speranza M(5), Falissard B(6), Purper-Ouakil D(7).

Author information:
(1)Service de médecine psychologique de l'enfant et de l'adolescent 1 (MPEA1), 
CHU de Montpellier-Hôpital Saint-Eloi, 80 avenue Augustin-Fliche, 34295 
Montpellier cedex 5, France.
(2)Département d'informatique médicale, CHU de Montpellier, 80, avenue 
Augustin-Fliche, 34295 Montpellier cedex 5, France.
(3)Service de psychopathologie de l'enfant et de l'adolescent, CHU de 
Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France.
(4)CHU Lenval, 57, avenue de la Californie, 06200 Nice, France.
(5)CHU de Versailles, 177, rue de Versailles, 78157 Le-Chesnay cedex, France; 
CESP INSERM 1018 centre de recherche en épidemiologie et santé des populations, 
équipe psychiatrie, développement et trajectoires/TDAH et émotions, Montpellier, 
France.
(6)CESP INSERM 1018 centre de recherche en épidemiologie et santé des 
populations, équipe psychiatrie, développement et trajectoires/TDAH et émotions, 
Montpellier, France.
(7)Service de médecine psychologique de l'enfant et de l'adolescent 1 (MPEA1), 
CHU de Montpellier-Hôpital Saint-Eloi, 80 avenue Augustin-Fliche, 34295 
Montpellier cedex 5, France; CESP INSERM 1018 centre de recherche en 
épidemiologie et santé des populations, équipe psychiatrie, développement et 
trajectoires/TDAH et émotions, Montpellier, France. Electronic address: 
d-purper_ouakil@chu-montpellier.fr.

OBJECTIVES: During the COVID-19 pandemic, the French government has decided a 
general lockdown. This unprecedented situation has raised concerns about 
children's and adolescent's mental health. Children and adolescents diagnosed 
with attention deficit hyperactivity disorder (ADHD) may find this context of 
restrained activity particularly tricky. The objectives of our study are to 
gather information about the well-being and global life conditions of children 
and adolescents with ADHD during the COVID-19 outbreak in France.
METHODS: We designed a survey including both open-ended questions and 
questionnaire items for parents of children and adolescents with ADHD. Parents 
responded to the following open-ended questions: 1) "How is your child doing 
since the lockdown?" 2) "How is life at home since the lockdown?" 3) "If you had 
a remote service provision with a mental health professional (e.g. by telephone 
or video technology), please share your thoughts and any suggestions with us" 4) 
"Please share any other items that you think are important about ADHD symptoms 
of your child and the lockdown situation". This survey was posted on social 
media on the 6th of April and disseminated by French ADHD-parent and patient 
organizations. The present article reports the descriptive, qualitative and 
textometrical analyses of the survey.
RESULTS: Between day 20 and 30 of lockdown, 538 parents responded to the survey, 
and we included 533 responses in the final analysis. The vast majority of 
responders were women 95 % (95 % CI 93,50; 97,18) with children whose mean age 
was 10,5 (95 % CI 7.58; 13.44). Since the lockdown, 34.71 % (95 % CI 30.70; 
38.94) of children experienced a worsening in well-being, 34.33 % (95 % CI 
30.34; 38.56) showed no significant changes and 30.96 % (95 % CI 27.09; 35.10) 
were doing better according to their parents. The thematic analysis showed that 
an improvement of their children's anxiety was one of the main topics addressed 
by parents. This improvement related to less school-related strain and flexible 
schedules that respected their children's rhythm. Improved self-esteem was 
another topic that parents linked with a lesser exposure of their children to 
negative feed-back. Parents repeatedly reported both inattention and 
hyperactivity/impulsivity. However, optimal lockdown life conditions seemed to 
compensate for the impact of ADHD symptoms (e.g. sufficient space at home, 
presence of a garden). Some parents reported worsening of general well-being in 
their children, and this manifested as oppositional/defiant attitudes and 
emotional outbursts. Parents also cited sleep problems and anxiety in this 
context. As regards everyday life during lock-down, at-home schooling was 
another major topic-parents described that their children struggled to complete 
school-related tasks and that teachers seemed to have forgotten about academic 
accommodations. The lockdown situation seems to have raised parents' awareness 
of the role of inattention and ADHD symptoms in their children's learning 
difficulties. Due to potential selection biases, the results of our survey may 
not be generalizable to all children and adolescents with ADHD. The main 
strengths of this rapid survey-based study lies in the reactivity of the 
participants and the quality and diversity of their responses to the open-ended 
questions.
CONCLUSIONS: According to their parents, most children and adolescents with ADHD 
experience stability or improvement of their well-being. An improvement in 
school-related anxiety and the flexible adjustment to the children's' rhythms as 
well as parents' increased awareness of the difficulties their children 
experience are among the key topics in parents' descriptions.

OBJECTIFS: Le confinement général de la population française dans le contexte de 
la pandémie de COVID-19, liée au nouveau Coronavirus SARS-COV-2, est une 
situation potentiellement à risque pour les enfants avec un développement 
atypique. L’objectif de notre étude est de mieux comprendre l’état de santé 
mentale des enfants et adolescents avec le trouble déficit d’attention 
hyperactivité (TDAH) en période de confinement.
MÉTHODES: Cinq cent trente-huit patients ont répondu à un sondage anonyme en 
ligne, proposé via les réseaux sociaux et relayé ou posté sur le site des 
associations de personnes concernées par le TDAH durant la période de 
confinement.
RÉSULTATS: Une majorité des enfants et adolescents de notre enquête a connu soit 
un mieux-être soit un état général psychologique stable d’après leurs parents. 
Une diminution de l’anxiété est mise en lien avec l’interruption de la scolarité 
présentielle et un rythme « sur-mesure ». Pour certains, l’abandon des 
aménagements et le volume de tâches ont posé problème avec des attitudes 
d’opposition et d’évitement. Les parents décrivent également une prise de 
conscience des difficultés de leurs enfants, ce qui ressort comme un élément 
constructif. Les enfants dont l’état se dégrade ont à la fois des difficultés 
comportementales et émotionnelles. En ce qui concerne le recours aux soins, la 
téléconsultation comme outil de continuité de soins a été largement appréciée.
CONCLUSIONS: Avant les contraintes liées à la crise sanitaire, les aspects 
scolaires sont cités comme principaux facteurs influençant l’état émotionnel de 
l’enfant et de l’adolescent avec TDAH dans le contexte de confinement.

Copyright © 2020 L'Encéphale, Paris. Published by Elsevier Masson SAS. All 
rights reserved.

DOI: 10.1016/j.encep.2020.05.011
PMCID: PMC7276130
PMID: 32522407 [Indexed for MEDLINE]


4374. Clinics (Sao Paulo). 2020 Jun 3;75:e1963. doi: 10.6061/clinics/2020/e1963. 
eCollection 2020.

How Institutions Can Protect the Mental Health and Psychosocial Well-Being of 
Their Healthcare Workers in the Current COVID-19 Pandemic.

Fukuti P(1), Uchôa CLM(1), Mazzoco MF(1), Corchs F(1), Kamitsuji CS(1), Rossi 
L(2), Rios IC(2), Lancman S(1), Bonfa E(1)(2), Barros-Filho TEP(1), Miguel 
EC(1).

Author information:
(1)Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR.
(2)Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao 
Paulo, Sao Paulo, SP, BR.

DOI: 10.6061/clinics/2020/e1963
PMCID: PMC7247736
PMID: 32520224 [Indexed for MEDLINE]

Conflict of interest statement: No potential conflict of interest was reported.


4375. Can J Nurs Res. 2020 Sep;52(3):237-239. doi: 10.1177/0844562120931623. Epub 2020 
Jun 9.

Nurses' Mental Health and Well-Being: COVID-19 Impacts.

Stelnicki AM(1), Carleton RN(1), Reichert C(2).

Author information:
(1)Canadian Institute for Public Safety Research and Treatment, University of 
Regina, Regina, Saskatchewan, Canada.
(2)Canadian Federation of Nurses Unions, Ottawa, Ontario, Canada.

The editorial will introduce a special section on nurses' mental health and 
well-being that will showcase results from a groundbreaking pan-Canadian study 
of nurses' occupational stress. The article series highlights research efforts 
toward better supporting nurses' mental health. In this editorial, we discuss 
the importance of this research in light of the COVID-19 pandemic. We review the 
current stressors faced by nurses and anticipate how nurses' mental health and 
well-being will be impacted by COVID-19.

DOI: 10.1177/0844562120931623
PMID: 32515209 [Indexed for MEDLINE]


4376. Glob Health Res Policy. 2020 Jun 5;5:27. doi: 10.1186/s41256-020-00154-3. 
eCollection 2020.

Social isolation and loneliness among older adults in the context of COVID-19: a 
global challenge.

Wu B(1).

Author information:
(1)NYU Aging Incubator and Hartford Institute for Geriatric Nursing, 433 First 
Ave, 5th Floor, New York, NY 10010 USA.

We are experiencing a historical moment with an unprecedented challenge of the 
COVID-19 global pandemic. The outbreak of COVID-19 will have a long-term and 
profound impact on older adults' health and well-being. Social isolation and 
loneliness are likely to be one of the most affected health outcomes. Social 
isolation and loneliness are major risk factors that have been linked with poor 
physical and mental health status. This paper discusses several approaches that 
may address the issues of social isolation and loneliness. These approaches 
include promoting social connection as public health messaging, mobilizing the 
resources from family members, community-based networks and resources, 
developing innovative technology-based interventions to improve social 
connections, and engaging the health care system to begin the process of 
developing methods to identify social isolation and loneliness in health care 
settings.

© The Author(s) 2020.

DOI: 10.1186/s41256-020-00154-3
PMCID: PMC7272234
PMID: 32514427 [Indexed for MEDLINE]

Conflict of interest statement: Competing interestsThe authors declare that they 
have no competing interests.


4377. Epidemiol Health. 2020;42:e2020038. doi: 10.4178/epih.e2020038. Epub 2020 Jun 2.

Mental health outcomes of quarantine and isolation for infection prevention: a 
systematic umbrella review of the global evidence.

Hossain MM(1)(2), Sultana A(2), Purohit N(3).

Author information:
(1)Department of Health Promotion and Community Health Sciences, School of 
Public Health, Texas A&M University, College Station, TX, USA.
(2)Nature Study Society of Bangladesh, Khulna, Bangladesh.
(3)The IIHMR University, Jaipur, Rajasthan, India.

OBJECTIVES: Transmission of infectious diseases is often prevented by quarantine 
and isolation of the populations at risk. These approaches restrict the 
mobility, social interactions, and daily activities of the affected individuals. 
In recent coronavirus disease 2019 (COVID-19) pandemic, quarantine and isolation 
are being adopted in many contexts, which necessitates an evaluation of global 
evidence on how such measures impact the mental health outcomes among 
populations. This umbrella review aimed to synthesize the available evidence on 
mental health outcomes of quarantine and isolation for preventing infectious 
diseases.
METHODS: We searched nine major databases and additional sources and included 
articles if they were systematically conducted reviews, published as 
peer-reviewed journal articles, and reported mental health outcomes of 
quarantine or isolation in any population.
RESULTS: Among 1,364 citations, only eight reviews met our criteria. Most of the 
primary studies in those reviews were conducted in high-income nations and in 
hospital settings. These articles reported a high burden of mental health 
problems among patients, informal caregivers, and healthcare providers who 
experienced quarantine or isolation. Prevalent mental health problems among the 
affected individuals include depression, anxiety, mood disorders, psychological 
distress, posttraumatic stress disorder, insomnia, fear, stigmatization, low 
self-esteem, lack of self-control, and other adverse mental health outcomes.
CONCLUSIONS: This umbrella review found severe mental health problems among 
individuals and populations who have undergone quarantine and isolation in 
different contexts. This evidence necessitates multipronged interventions 
including policy measures for strengthening mental health services globally and 
promoting psychosocial wellbeing among high-risk populations.

DOI: 10.4178/epih.e2020038
PMCID: PMC7644933
PMID: 32512661 [Indexed for MEDLINE]

Conflict of interest statement: The author has no conflicts of interest to 
declare for this study.


4378. J Anxiety Disord. 2020 Aug;74:102248. doi: 10.1016/j.janxdis.2020.102248. Epub 
2020 May 28.

Media use and acute psychological outcomes during COVID-19 outbreak in China.

Chao M(1), Xue D(2), Liu T(3), Yang H(1), Hall BJ(4).

Author information:
(1)Key Research Base of Humanities and Social Sciences of the Ministry of 
Education, Academy of Psychology and Behavior, Tianjin Normal University, China; 
Faculty of Psychology, Tianjin Normal University, China; Center of Collaborative 
Innovation for Assessment and Promotion of Mental Health, China.
(2)Faculty of Psychology, Tianjin Normal University, China.
(3)Key Research Base of Humanities and Social Sciences of the Ministry of 
Education, Academy of Psychology and Behavior, Tianjin Normal University, China; 
Faculty of Psychology, Tianjin Normal University, China; Center of Collaborative 
Innovation for Assessment and Promotion of Mental Health, China. Electronic 
address: mikebonita@hotmail.com.
(4)Global and Community Mental Health Research Group, Department of Psychology, 
University of Macau, Macao (SAR), China.

The COVID-19 outbreak in China led to an extraordinary threat to public health 
and wellbeing. This study examined the psychological impact of media use among 
people indirectly exposed to the disease during the initial phase of the 
outbreak. We conducted an internet-based survey on January 28, 2020 (one week 
after the official declaration of person-to-person transmission of the 
coronavirus). Media use (media forms, content of media exposure, and media 
engagement) related to the outbreak and psychological outcomes (positive and 
negative affect, anxiety, depression, and stress) of 917 Chinese adults was 
assessed. A series of multivariable regressions were conducted. The results 
showed that use of new media, rather than traditional media, was significantly 
associated with more negative affect, depression, anxiety, and stress. Viewing 
stressful content (i.e., severity of the outbreak, reports from hospital) was 
associated with more negative affect and depression. Media engagement was also 
associated with more negative affect, anxiety, and stress. However, viewing 
heroic acts, speeches from experts, and knowledge of the disease and prevention 
were associated with more positive affect and less depression. The study 
suggested new media use and more media engagement was associated with negative 
psychological outcomes, while certain media content was associated with positive 
psychological impact. The present study highlights the need for timely public 
health communication from official sources and suggests that reduced exposure to 
new media may be beneficial.

Copyright © 2020 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.janxdis.2020.102248
PMCID: PMC7255752
PMID: 32505918 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest All authors 
declare that they have no conflicts of interest with this study.


4379. J Cancer Educ. 2024 Apr;39(2):103-105. doi: 10.1007/s13187-020-01786-2.

Changing the Landscape of Medical Oncology Training at the National University 
Hospital in the Philippines during the Coronavirus Disease 2019 (COVID-19) 
Pandemic.

Chua A Jr(1), Mendoza MJ(2), Ando M(2), Planilla CJ(2), Fernando G(2), Strebel 
HMJ(2), Ignacio J(2).

Author information:
(1)Division of Medical Oncology, Department of Medicine, University of the 
Philippines - Philippine General Hospital, Taft Avenue, Manila, Philippines. 
avchua@up.edu.ph.
(2)Division of Medical Oncology, Department of Medicine, University of the 
Philippines - Philippine General Hospital, Taft Avenue, Manila, Philippines.

Comment in
    J Cancer Educ. 2020 Dec;35(6):1068-1069.

Serving as one of the few training institutions of medical oncology in the 
Philippines, the University of the Philippines-Philippine General Hospital was 
faced with challenges brought by the coronavirus 2019 disease (COVID-19) 
pandemic. With the dismantling of routines and practices in the hospital, 
training activities such as daily rounds, conferences, and examinations were 
temporarily put on hold. Recognizing that the strength of any clinical training 
program is its wealth of patients, the immediate resumption of patient services, 
albeit limited at first, had been instrumental in ensuring the continuation of 
training in our institution. Opportunistic teaching-learning strategies between 
the faculty and fellows were devised. Innovative approaches to learning such as 
the use of online meeting platforms for division conferences, webinars, 
examinations, and other learning activities were initiated. Emphasis was given 
on the important considerations in the management of cancer patients during the 
COVID-19 pandemic. The emotional and psychological well-being of the faculty and 
fellows during this crisis were considered and a mental health assessment was 
conducted prior to the resumption of training activities.

© 2020. American Association for Cancer Education.

DOI: 10.1007/s13187-020-01786-2
PMCID: PMC7274564
PMID: 32504363 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


4380. In Vivo. 2020 Jun;34(3 Suppl):1685-1694. doi: 10.21873/invivo.11962.

The Effect of Coronavirus (COVID-19) on Breast Cancer Teamwork: A Multicentric 
Survey.

Vanni G(1), Materazzo M(2), Santori F(1), Pellicciaro M(1), Costesta M(1), 
Orsaria P(3), Cattadori F(4), Pistolese CA(5), Perretta T(5), Chiocchi M(5), 
Meucci R(1)(5), Lamacchia F(5), Assogna M(1), Caspi J(1), Granai AV(1), DE Majo 
A(1), Chiaravalloti A(6)(7), D'Angelillo MR(8), Barbarino R(8), Ingallinella 
S(1), Morando L(1), Dalli S(1), Portarena I(9), Altomare V(3), Tazzioli G(10), 
Buonomo OC(1).

Author information:
(1)Breast Unit, Department of Surgical Science, Policlinico Tor Vergata 
University, Rome, Italy.
(2)Breast Unit, Department of Surgical Science, Policlinico Tor Vergata 
University, Rome, Italy mrcmaterazzo@gmail.com.
(3)Department of Breast Surgery, University Campus Bio-Medico, Rome, Italy.
(4)UO Breast Surgery, Breast Unit, "Guglielmo da Saliceto" Hospital, Piacenza, 
Italy.
(5)Department of Diagnostic Imaging and Interventional Radiology, Molecular 
Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy.
(6)Department of Biomedicine and Prevention, Policlinico Tor Vergata University, 
Rome, Italy.
(7)IRCCS Neuromed, UOC Medicina Nucleare, Pozzilli, Italy.
(8)Radiotherapy Unit, Department of Oncology and Hematology, Policlinico Tor 
Vergata University, Rome, Italy.
(9)Department of Oncology, Policlinico Tor Vergata University, Rome, Italy.
(10)Oncologic Breast Surgery Unit, Azienda Ospedaliero-Universitaria Policlinico 
Hospital of Modena, Modena, Italy.

BACKGROUND/AIM: Despite the large amount of clinical data available of 
Coronavirus-19 (COVID-19), not many studies have been conducted about the 
psychological toll on Health Care Workers (HCWs).
PATIENTS AND METHODS: In this multicentric descriptive study, surveys were 
distributed among 4 different Breast Cancer Centers (BCC). BCCs were 
distinguished according to COVID-19 tertiary care hospital (COVID/No-COVID) and 
district prevalence (DP) (High vs. Low). DASS-21 score, PSS score and 
demographic data (age, sex, work) were evaluated.
RESULTS: A total of 51 HCWs were analyzed in the study. Age, work and sex did 
not demonstrate statistically significant values. Statistically significant 
distribution was found between DASS-21-stress score and COVID/No-COVID 
(p=0.043). No difference was found in the remaining DASS-21 and PSS scores, 
dividing the HCWs according to COVID-19-hospital and DP.
CONCLUSION: Working in a COVID-19-hospital represents a factor that negatively 
affects psychosocial well-being. However, DP seems not to affect the 
psychosocial well-being of BCC HCWs. During the outbreak, psychological support 
for low risk HCWs should be provided regardless DP.

Copyright© 2020, International Institute of Anticancer Research (Dr. George J. 
Delinasios), All rights reserved.

DOI: 10.21873/invivo.11962
PMCID: PMC8378028
PMID: 32503830 [Indexed for MEDLINE]

Conflict of interest statement: The Authors declare no conflicts of interest 
regarding this study.


4381. Int J Environ Res Public Health. 2020 Jun 3;17(11):3956. doi: 
10.3390/ijerph17113956.

Distress and Resilience in the Days of COVID-19: Comparing Two Ethnicities.

Kimhi S(1), Eshel Y(1), Marciano H(1)(2), Adini B(3).

Author information:
(1)Stress and Resilience Research Center, Psychology Department, Tel-Hai 
College, Tel Hai 12210, Israel.
(2)Ergonomics and Human Factors Unit, University of Haifa, Haifa 3498838, 
Israel.
(3)Department of Emergency Management and Disaster Medicine, School of Public 
Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, 
Israel.

The COVID-19 pandemic is an ongoing epidemic of coronavirus disease, caused by 
severe acute respiratory syndrome, which has spread recently worldwide. Efforts 
to prevent the virus from spreading include travel restrictions, lockdowns as 
well as national or regional quarantines throughout the international community. 
The major negative psychological outcome of the COVID-19 pandemic is the anxiety 
caused by it. The aim of the present study was to examine the level of concern 
and the contributions of modes of resilience, well-being and demographic 
attributes towards decreasing or enhancing anxiety and depression among two 
samples: Israeli Jews (majority group) and Israeli Arabs (minority group). These 
random samples included 605 Jews and 156 Arabs who participated in an internet 
survey. A previous study, which has been conducted in the context of terror 
attacks, has shown that compared to Israeli Jews, Israeli Arabs expressed a 
higher level of fear of war and lower levels of resilience supporting 
personality attributes. The results of the current study indicated a similar 
pattern that emerged in the context of the COVID-19 pandemic: the Israeli Arabs 
reported a higher level of distress and a lower level of resilience and 
well-being.

DOI: 10.3390/ijerph17113956
PMCID: PMC7312505
PMID: 32503205 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


4382. J Obstet Gynaecol Res. 2020 Aug;46(8):1235-1245. doi: 10.1111/jog.14321. Epub 
2020 Jun 4.

Clinical update on COVID-19 in pregnancy: A review article.

Ryan GA(1), Purandare NC(2), McAuliffe FM(1)(3), Hod M(4), Purandare CN(5).

Author information:
(1)Department of Obstetrics and Gynaecology, The National Maternity Hospital, 
Dublin, Ireland.
(2)Department of Obstetrics and Gynaecology, University Hospital Galway, Galway, 
Ireland.
(3)UCD Perinatal Research Centre, School of Medicine, University College Dublin, 
National Maternity Hospital, Dublin, Ireland.
(4)Mor Women Health Care Center, Tel Aviv University, Tel Aviv, Israel.
(5)Emeritus Dean, Indian College of Obstetricians and Gynaecologists, Mumbai, 
India.

Comment in
    J Obstet Gynaecol Res. 2020 Nov;46(11):2455.

The data pertaining to the COVID-19 pandemic has been rapidly evolving since the 
first confirmed case in December 2019. This review article presents a 
comprehensive analysis of the current data in relation to COVID-19 and its 
effect on pregnant women, including symptoms, disease severity and the risk of 
vertical transmission. We also review the recommended management of pregnant 
women with suspected or confirmed COVID-19 and the various pharmacological 
agents that are being investigated and may have a role in the treatment of this 
disease. At present, it does not appear that pregnant women are at increased 
risk of severe infection than the general population, although there are 
vulnerable groups within both the pregnant and nonpregnant populations, and 
clinicians should be cognizant of these high-risk groups and manage them 
accordingly. Approximately 85% of women will experience mild disease, 10% more 
severe disease and 5% critical disease. The most common reported symptoms are 
fever, cough, shortness of breath and diarrhea. Neither vaginal delivery nor 
cesarean section confers additional risks, and there is minimal risk of vertical 
transmission to the neonate from either mode of delivery. We acknowledge that 
the true effect of the virus on both maternal and fetal morbidity and mortality 
will only be evident over time. We also discuss the impact of social isolation 
can have on the mental health and well-being of both patients and colleagues, 
and as clinicians, we must be mindful of this and offer support as necessary.

© 2020 Japan Society of Obstetrics and Gynecology.

DOI: 10.1111/jog.14321
PMCID: PMC7300676
PMID: 32500549 [Indexed for MEDLINE]


4383. Psychiatry Res. 2020 Aug;290:113130. doi: 10.1016/j.psychres.2020.113130. Epub 
2020 May 27.

Depression, anxiety, stress levels of physicians and associated factors in 
Covid-19 pandemics.

Elbay RY(1), Kurtulmuş A(2), Arpacıoğlu S(2), Karadere E(2).

Author information:
(1)İstanbul Medeniyet Üniversitesi Göztepe Eğitim ve Araştırma Hastanesi, 
Merdivenköy Poliklinikleri, Merdivenköy Mahallesi, Ressam Salih Ermez Cd. No:14 
Kadıköy/İstanbul/TÜRKİYE. Electronic address: 
rumeysa.yenielbay@medeniyet.edu.tr.
(2)İstanbul Medeniyet Üniversitesi Göztepe Eğitim ve Araştırma Hastanesi, 
Merdivenköy Poliklinikleri, Merdivenköy Mahallesi, Ressam Salih Ermez Cd. No:14 
Kadıköy/İstanbul/TÜRKİYE.

AIM: To investigate anxiety, stress, and depression levels of physicians during 
the Covid-19 outbreak and explored associated factors in both clinical and 
general site.
METHODS: An online survey is conducted to asses psychological responses of 
healthcare workers and related factors during Covid-19 outbreak. It is consisted 
of three subsections covering the following areas: 1) sociodemographic data 2) 
information on individuals` working condition 3) Depression Anxiety and Stress 
Scale-21 (DAS-21).
RESULTS: Of all 442 participants, 286 (64.7%) had symptoms of depression, 224 
(51.6%) anxiety, and 182 (41.2%) stress. Being female, young, and single, having 
less work experience, working in frontline were associated with higher scores, 
whereas having a child was associated with lower scores in each subscale. 
Factors found to be associated with higher DAS-21 total scores in frontline 
workers were as follows: increased weekly working hours, increased number of 
Covid-19 patients cared for, lower level of support from peers and supervisors, 
lower logistic support, and lower feelings of competence during Covid-19 related 
tasks.
CONCLUSIONS: Our findings highlight the factors which need to be taken into 
consideration to protect the mental wellbeing of doctors while fighting with a 
disaster that has major impacts on society worldwide.

Copyright © 2020 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.psychres.2020.113130
PMCID: PMC7255248
PMID: 32497969 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest None.


4384. J Aging Soc Policy. 2020 Jul-Oct;32(4-5):365-372. doi: 
10.1080/08959420.2020.1759759. Epub 2020 Jun 4.

COVID-19: Implications for the Support of People with Social Care Needs in 
England.

Comas-Herrera A(1), Fernandez JL(2), Hancock R(3)(4), Hatton C(5), Knapp M(6), 
McDaid D(2), Malley J(1), Wistow G(7), Wittenberg R(2).

Author information:
(1)Assistant Professorial Research Fellow, Care Policy and Evaluation Centre, 
London School of Economics and Political Science , London, UK.
(2)Associate Professorial Research Fellow, Care Policy and Evaluation Centre, 
London School of Economics and Political Science , London, UK.
(3)Professor, Economics of Health and Welfare, Health Economics Group, Norwich 
Medical School, University of East Anglia , Norwich, UK.
(4)Occasional Professorial Research Fellow, Care Policy and Evaluation Centre, 
London School of Economics and Political Science , London, UK.
(5)Professor of Public Health and Disability, Centre for Disability Research, 
Lancaster University , Lancaster, UK.
(6)Professor of Health and Care Policy, Care Policy and Evaluation Centre, 
Department of Health Policy, London School of Economics and Political Science , 
London, UK.
(7)Visiting Professor, Care Policy and Evaluation Centre, London School of 
Economics and Political Science , London, UK.

This perspective examines the challenge posed by COVID-19 for social care 
services in England and describes responses to this challenge. People with 
social care needs experience increased risks of death and deteriorating physical 
and mental health with COVID-19. Social isolation introduced to reduce COVID-19 
transmission may adversely affect well-being. While the need for social care 
rises, the ability of families and social care staff to provide support is 
reduced by illness and quarantine, implying reductions in staffing levels. 
Consequently, COVID-19 could seriously threaten care availability and quality. 
The government has sought volunteers to work in health and social care to help 
address the threat posed by staff shortages at a time of rising need, and the 
call has achieved an excellent response. The government has also removed some 
barriers to effective coordination between health and social care, while 
introducing measures to promote the financial viability of care providers. The 
pandemic presents unprecedented challenges that require well-co-coordinated 
responses across central and local government, health services, and 
non-government sectors.

DOI: 10.1080/08959420.2020.1759759
PMID: 32497462 [Indexed for MEDLINE]


4385. Br J Community Nurs. 2020 Jun 2;25(6):294-298. doi: 10.12968/bjcn.2020.25.6.294.

Social prescribing: a 'natural' community-based solution.

Howarth M(1), Griffiths A(2), da Silva A(3), Green R(4).

Author information:
(1)Senior Lecturer in Nursing and Deputy Director (Programmes and training), 
University of Salford Manchester.
(2)Director of Science and Collections, Royal Horticultural Society (RHS).
(3)Programme Director, RHS Garden Bridgewater.
(4)Head of RHS Garden Bridgewater.

This paper discusses social prescribing as part of the wider NHS England 
universal personalised care model, and it describes how community nurses can 
engage with social prescribing systems to support community resilience. A case 
study based on the example of gardening, as a nature-based social prescription 
provided by the RHS Bridgewater Wellbeing Garden, is provided to illustrate the 
scope, reach and impact of non-medical, salutogenic approaches for community 
practitioners. The authors argue that social prescribing and, in particular, 
nature-based solutions, such as gardening, can be used as a non-medical 
asset-based approach by all health professionals working in the community as a 
way to promote health and wellbeing. They consider how the negative impact of 
social distancing resulting from COVID-19 restrictions could be diluted through 
collaboration between a holistic, social prescribing system and community staff. 
The paper presents a unique perspective on how community nurses can collaborate 
with link workers through social prescribing to help combat social isolation and 
anxiety and support resilience.

DOI: 10.12968/bjcn.2020.25.6.294
PMID: 32496851 [Indexed for MEDLINE]


4386. Indian J Public Health. 2020 Jun;64(Supplement):S201-S204. doi: 
10.4103/ijph.IJPH_492_20.

Development and Initial Validation of the COVID-19 Anxiety Scale.

Chandu VC(1), Pachava S(2), Vadapalli V(3), Marella Y(4).

Author information:
(1)Assistant Professor, Department of Public Health Dentistry, Sibar Institute 
of Dental Sciences, Guntur, Andhra Pradesh, India.
(2)Professor and Head, Department of Public Health Dentistry, Sibar Institute of 
Dental Sciences, Guntur, Andhra Pradesh, India.
(3)Professor, Department of Public Health Dentistry, Sibar Institute of Dental 
Sciences, Guntur, Andhra Pradesh, India.
(4)Assistant Professor, Department of Periodontology, Sibar Institute of Dental 
Sciences, Guntur, Andhra Pradesh, India.

BACKGROUND: Safeguarding the psychological well-being of the public is also an 
integral component of fighting COVID-19. However, there is limited availability 
of psychometric measures to document COVID-19-related anxiety among the general 
public.
OBJECTIVES: This study was aimed at developing a validated scale to measure 
COVID-19-related anxiety.
METHODS: Three hundred and seven subjects from different gender, educational 
categories participated in the study. Exploratory factor analysis for the 
determination of factor structure, Pearson's correlation test, and 
Kruskal-Wallis ANOVA were employed in data analysis using SPSS version 20 
software.
RESULTS: COVID-19 Anxiety Scale (CAS) demonstrated a two-component structure 
identified as: "fear of social interaction;" "illness anxiety." The final scale 
with seven items demonstrated good internal consistency reliability (Cronbach's 
Alpha 0.736). CAS exhibited good construct validity showing moderately negative 
correlation (Pearson's r = -0.417) with the self-rated mental health and 
resulted in higher scores among individuals with lower educational qualification 
(Kruskal-Wallis ANOVA χ2 [2, 303] = 38.01; P = 0.001).
CONCLUSION: CAS is a rapidly administrable, valid, and reliable tool that can be 
used to measure COVID-19-related anxiety among the Indian population.

DOI: 10.4103/ijph.IJPH_492_20
PMID: 32496255 [Indexed for MEDLINE]

Conflict of interest statement: None


4387. Int J Soc Psychiatry. 2020 Sep;66(6):560-565. doi: 10.1177/0020764020932202. 
Epub 2020 Jun 3.

The psychosocial effects of being quarantined following exposure to COVID-19: A 
qualitative study of Lebanese health care workers.

Fawaz M(1), Samaha A(1)(2)(3)(4).

Author information:
(1)Nursing Department, Faculty of Health Sciences, Beirut Arab University, 
Beirut, Lebanon.
(2)Faculty of Public Health, Lebanese University, Zahle, Lebanon.
(3)Faculty of Letters and Human Sciences, Lebanese University, Zahle, Lebanon.
(4)Department of Biomedical Sciences, Lebanese International University, Beirut, 
Lebanon.

BACKGROUND: Since the outbreak of the novel Coronavirus (COVID-19), health care 
professionals in Lebanon have been diligently serving as the frontline of 
defense. In the light of challenging economic and political circumstances, 
putting their community wellbeing as a priority, and abiding by quarantine and 
strict infection control measures, health care professionals risk both their 
physical and mental wellbeing.
OBJECTIVE: The aim of this study is to explore the psychosocial effects of being 
quarantined following exposure to COVID-19 among Lebanese health care 
professionals.
METHOD: An exploratory qualitative research design was employed, where 
semi-structured interviews were carried out involving a sample of 13 Lebanese 
health care providers working at various COVID-19 units.
RESULTS: The qualitative analysis has revealed four themes namely 'Fears of 
contracting and spreading the virus', 'Conflict between professional duty and 
family obligation', 'Stigma of being infected', and 'Inadequate or inaccurate 
information'.
CONCLUSION: COVID-19 quarantine has been posing intense psychological challenges 
among Lebanese health care workers which are worsened at times by the economic 
instability; thus, health care policymakers are urged to take proper action 
nationwide to alleviate longlisting implications and support the health care 
providers in fulfilling their mission.

DOI: 10.1177/0020764020932202
PMCID: PMC7270571
PMID: 32489149 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest: The author(s) declared no 
potential conflicts of interest with respect to the research, authorship and/or 
publication of this article.


4388. Int J Environ Res Public Health. 2020 May 31;17(11):3899. doi: 
10.3390/ijerph17113899.

The Impact of COVID-19 on Physical Activity Behavior and Well-Being of 
Canadians.

Lesser IA(1), Nienhuis CP(1).

Author information:
(1)Faculty of Health Sciences, Kinesiology Chilliwack campus at CEP, University 
of the Fraser Valley, 45190 Chilliwack, BC, Canada.

A global pandemic caused by the novel coronavirus (COVID-19) resulted in 
restrictions to daily living for Canadians, including social distancing and 
closure of city and provincial recreation facilities, national parks and 
playgrounds. The objective of this study was to assess how these preemptive 
measures impacted physical activity behaviour and well-being of Canadians. An 
online survey was utilized to measure participant physical activity behavior, 
nature exposure, well-being and anxiety levels. Results indicate that while 
40.5% of inactive individuals became less active, only 22.4% of active 
individuals became less active. Comparatively, 33% of inactive individuals 
became more active while 40.3% of active individuals became more active. There 
were significant differences in well-being outcomes in the inactive population 
between those who were more active, the same or less active (p < 0.001) but this 
was not seen in the active population. Inactive participants who spent more time 
engaged in outdoor physical activity had lower anxiety than those who spent less 
time in outdoor physical activity. Public health measures differentially 
affected Canadians who were active and inactive and physical activity was 
strongly associated with well-being outcomes in inactive individuals. This 
suggests that health promoting measures directed towards inactive individuals 
may be essential to improving well-being.

DOI: 10.3390/ijerph17113899
PMCID: PMC7312579
PMID: 32486380 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


4389. Psychiatry Res. 2020 Aug;290:113129. doi: 10.1016/j.psychres.2020.113129. Epub 
2020 May 27.

Burnout and somatic symptoms among frontline healthcare professionals at the 
peak of the Italian COVID-19 pandemic.

Barello S(1), Palamenghi L(2), Graffigna G(2).

Author information:
(1)EngageMinds HUB - Consumer, Food & Health Engagement Research Center, 
Department of Psychology, Università Cattolica del Sacro Cuore, Milano, Italy. 
Electronic address: serena.barello@unicatt.it.
(2)EngageMinds HUB - Consumer, Food & Health Engagement Research Center, 
Department of Psychology, Università Cattolica del Sacro Cuore, Milano, Italy.

Italy is among the most severely hit nations in terms of hospital patients' 
overload, and its healthcare workforce is struggling to cope with challenges 
that could threaten their own wellbeing. In this scenario, understanding the 
health-related consequences of COVID-19 outbreak on Italian frontline healthcare 
professionals is urgent. Our study provides a first account of the huge 
psycho-physical impact of COVID-19 outbreak for healthcare workers in Italy. 
Italian healthcare professionals reported relevant work-related psychological 
pressure, emotional burnout and somatic symptoms. This result requires attention 
as previous studies showed that emotional distress is associated with 
long-lasting effect on professionals' health, including risk of post-traumatic 
stress disorder.

Copyright © 2020 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.psychres.2020.113129
PMCID: PMC7255285
PMID: 32485487 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interests The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
paper.


4390. Brain Behav Immun. 2020 Oct;89:531-542. doi: 10.1016/j.bbi.2020.05.048. Epub 
2020 May 30.

COVID-19 pandemic and mental health consequences: Systematic review of the 
current evidence.

Vindegaard N(1), Benros ME(2).

Author information:
(1)Copenhagen Research Centre for Mental Health - CORE, Mental Health Centre 
Copenhagen, Copenhagen University Hospital, Gentofte Hospitalsvej 15, 4. sal, 
2900 Hellerup, Denmark; Department of Immunology and Microbiology, Faculty of 
Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 
Copenhagen N, Denmark.
(2)Copenhagen Research Centre for Mental Health - CORE, Mental Health Centre 
Copenhagen, Copenhagen University Hospital, Gentofte Hospitalsvej 15, 4. sal, 
2900 Hellerup, Denmark; Department of Immunology and Microbiology, Faculty of 
Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 
Copenhagen N, Denmark. Electronic address: Michael.eriksen.benros@regionh.dk.

BACKGROUND: During the COVID-19 pandemic general medical complications have 
received the most attention, whereas only few studies address the potential 
direct effect on mental health of SARS-CoV-2 and the neurotropic potential. 
Furthermore, the indirect effects of the pandemic on general mental health are 
of increasing concern, particularly since the SARS-CoV-1 epidemic (2002-2003) 
was associated with psychiatric complications.
METHODS: We systematically searched the database Pubmed including studies 
measuring psychiatric symptoms or morbidities associated with COVID-19 among 
infected patients and among none infected groups the latter divided in 
psychiatric patients, health care workers and non-health care workers.
RESULTS: A total of 43 studies were included. Out of these, only two studies 
evaluated patients with confirmed COVID-19 infection, whereas 41 evaluated the 
indirect effect of the pandemic (2 on patients with preexisting psychiatric 
disorders, 20 on medical health care workers, and 19 on the general public). 18 
of the studies were case-control studies/compared to norm, while 25 of the 
studies had no control groups. The two studies investigating COVID-19 patients 
found a high level of post-traumatic stress symptoms (PTSS) (96.2%) and 
significantly higher level of depressive symptoms (p = 0.016). Patients with 
preexisting psychiatric disorders reported worsening of psychiatric symptoms. 
Studies investigating health care workers found increased depression/depressive 
symptoms, anxiety, psychological distress and poor sleep quality. Studies of the 
general public revealed lower psychological well-being and higher scores of 
anxiety and depression compared to before COVID-19, while no difference when 
comparing these symptoms in the initial phase of the outbreak to four weeks 
later. A variety of factors were associated with higher risk of psychiatric 
symptoms and/or low psychological well-being including female gender, 
poor-self-related health and relatives with COVID-19.
CONCLUSION: Research evaluating the direct neuropsychiatric consequences and the 
indirect effects on mental health is highly needed to improve treatment, mental 
health care planning and for preventive measures during potential subsequent 
pandemics.

Copyright © 2020 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.bbi.2020.05.048
PMCID: PMC7260522
PMID: 32485289 [Indexed for MEDLINE]


4391. Ir J Psychol Med. 2022 Dec;39(4):406-408. doi: 10.1017/ipm.2020.74. Epub 2020 
Jun 2.

Could COVID-19 improve psychiatric awareness at the heart of the Middle East? - 
A personal reflection on Bahrain's response.

Negm HM(1).

Author information:
(1)Child & Adolescent Liaison Psychiatry, Children's Health Ireland at Crumlin, 
Dublin, Ireland.

This perspective offers a personal insight into COVID-19 in Bahrain along with 
the response to this unprecented pandemic. In a country where a robust health 
care system and economic prosperity have allowed it to cope with the medical 
sequelae, the mental health consequences may have been less anticipated but more 
problematic. An unforeseen positive emerging from the pandemic might be the 
nation's recognition of the importance of mental health well-being and a new 
openness to discussing it.

DOI: 10.1017/ipm.2020.74
PMCID: PMC7562783
PMID: 32484123 [Indexed for MEDLINE]

Conflict of interest statement: There are no conflicts of interest to disclose.


4392. Can J Psychiatry. 2020 Oct;65(10):736-738. doi: 10.1177/0706743720932041. Epub 
2020 Jun 2.

Feasibility and Preliminary Results of Effectiveness of Social Media-based 
Intervention on the Psychological Well-being of Suspected COVID-19 Cases during 
Quarantine.

Zhou L(1)(2), Xie RH(1)(2), Yang X(3), Zhang S(2)(4), Li D(4), Zhang Y(5), Liu 
J(1), Pakhale S(6)(7)(8), Krewski D(8)(9)(10), Wen SW(2)(7)(8)(11).

Author information:
(1)Department of Nursing, Nanhai Hospital of Southern Medical University, 
Foshan, Guangdong, China.
(2)General Practice Center, Nanhai Hospital of Southern Medical University, 
Foshan, Guangdong, China.
(3)Nursing School, Wuxi Taihu University, Jiangsu, China.
(4)Division of Quarantine, Nanhai Hospital of Southern Medical University, 
Foshan, Guangdong, China.
(5)Fever Clinic, Nanhai Hospital of Southern Medical University, Foshan, 
Guangdong, China.
(6)Division of Respirology, Department of Medicine, The Ottawa Hospital, 
Ontario, Canada.
(7)OMNI Research Group, Ottawa Hospital Research Institute, Ontario, Canada.
(8)School of Epidemiology and Public Health, Faculty of Medicine, University of 
Ottawa, Ontario, Canada.
(9)McLaughlin Centre for Population Health Risk Assessment, Faculty of Medicine, 
University of Ottawa, Ontario, Canada.
(10)Risk Science International, Ottawa, Ontario, Canada.
(11)Department of Obstetrics and Gynecology, Faculty of Medicine, University of 
Ottawa, Ontario, Canada.

DOI: 10.1177/0706743720932041
PMCID: PMC7502876
PMID: 32483978 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests: The 
author(s) declared no potential conflicts of interest with respect to the 
research, authorship, and/or publication of this article.


4393. Psychol Trauma. 2020 Aug;12(S1):S35-S37. doi: 10.1037/tra0000633. Epub 2020 Jun 
1.

Social and psychological consequences of the COVID-19 outbreak: The experiences 
of Taiwan and Hong Kong.

Lei MK(1), Klopack ET(1).

Author information:
(1)Department of Sociology.

This article discusses the value of studying past social and psychological 
responses to pandemics and natural disasters in understanding reactions to 
coronavirus disease of 2019 (COVID-19). By examining severe acute respiratory 
syndrome (SARS) experiences in both Taiwan and Hong Kong, we indicate that 
psychological trauma might be a pathway whereby the COVID-19 outbreak affects 
long-term health and well-being and that psychological and collective trauma 
caused by the COVID-19 may relate to future preparedness and risk awareness. We 
conclude with a consideration of social-psychological processes for future 
research. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

DOI: 10.1037/tra0000633
PMID: 32478548 [Indexed for MEDLINE]


4394. Psychol Trauma. 2020 Jul;12(5):534-535. doi: 10.1037/tra0000925. Epub 2020 Jun 
1.

COVID-19 in Malta: The mental health impact.

Grech P(1), Grech R(2).

Author information:
(1)Department of Mental Health, Faculty of Health Sciences, University of Malta.
(2)Faculty of Medicine and Surgery, University of Malta.

The COVID-19 pandemic has had a devastating impact on health, economies, and 
other societal pillars. The Maltese archipelago has also been affected by this 
viral threat. Due to Malta's characteristics as one of the smallest islands in 
Europe, the picture, which shall be portrayed in this article, may have some 
unique features, especially in terms of mental health and societal well-being. 
(PsycInfo Database Record (c) 2020 APA, all rights reserved).

DOI: 10.1037/tra0000925
PMID: 32478546 [Indexed for MEDLINE]


4395. Encephale. 2020 Jun;46(3S):S60-S65. doi: 10.1016/j.encep.2020.05.002. Epub 2020 
May 8.

[Mental health care in French correctional facilities during the Covid-19 
pandemic].

[Article in French]

Fovet T(1), Lancelevée C(2), Eck M(3), Scouflaire T(3), Bécache E(4), Dandelot 
D(5), Giravalli P(6), Guillard A(7), Horrach P(8), Lacambre M(9), Lefebvre 
T(10), Moncany AH(11), Touitou D(12), David M(13), Thomas P(14).

Author information:
(1)CHU de Lille, Pôle de psychiatrie, 59000 Lille, France; Université Lille, 
Inserm, U1172 - Lille Neuroscience & Cognition - Équipe Plasticity & 
Subjectivity, 59000 Lille, France. Electronic address: 
thomas.fovet@chru-lille.fr.
(2)Fédération de recherches en psychiatrie et santé mentale des Hauts-de-France 
(F2RSM Psy), Saint-André-Lez-Lille, France.
(3)CHU de Lille, Pôle de psychiatrie, 59000 Lille, France.
(4)UHSA Simone-Veil, Pôle de Santé Mentale des Détenus et de Psychiatrie Légale, 
centre hospitalier le Vinatier, Bron, France.
(5)UHSA, pôle psychiatrie médicolégale, centre hospitalier Cadillac, Cadillac, 
France.
(6)Pôle 11 : psychiatrie médecine addictologie en détention, médecine légale, 
UMR ADES AMU, AP-HM, Marseille, France.
(7)Pôle de psychiatrie en milieu pénitentiaire, EPSM Georges-Daumezon, Loiret, 
France.
(8)Département santé mentale-justice, pôle SMPR, CPN Nancy Laxou, centre 
hospitalier Lorquin, Lorquin, France.
(9)CHU de Montpellier, Montpellier, France.
(10)UHSA de Rennes, pôle de psychiatrie en milieu pénitentiaire, Centre 
hospitalier Guillaume Regnier, Rennes, France.
(11)Pôle de psychiatrie et conduites addictives en milieu pénitentiaire, centre 
hospitalier Marchant, Toulouse, France.
(12)UHSA Paul-Verlaine, groupe hospitalier Paul-Guiraud, 94800 Villejuif, 
France.
(13)Association des secteurs de psychiatrie en milieu pénitentiaire et de la 
fédération française de psychiatrie et co-référent de l'atelier « psychiatrie en 
milieu pénitentiaire » du Comité de pilotage de la psychiatrie, France.
(14)CHU de Lille, Pôle de psychiatrie, 59000 Lille, France; Université Lille, 
Inserm, U1172 - Lille Neuroscience & Cognition - Équipe Plasticity & 
Subjectivity, 59000 Lille, France.

OBJECTIVE: The impact of the Covid-19 pandemic on the 11 million people 
currently incarcerated worldwide is the subject of many concerns. Prisons and 
jails are filled with people suffering from many preexisting medical conditions 
increasing the risk of complications. Detainees' access to medical services is 
already limited and overcrowding poses a threat of massive contagion. Beyond the 
health impact of the crisis, the tightening of prison conditions worries. On 
March 16, 2020, in France, the lockdown measures have been accompanied by 
specific provisions for prisons: all facilities have suspended visitations, 
group activities and external interventions. Over 10,000 prisoners have been 
released to reduce the prison population and the risk of virus propagation. 
These adjustments had major consequences on the healthcare system in French 
prisons. The objectives of this article are to describe the reorganization of 
the three levels of psychiatric care for inmates in France in the context of 
Covid-19 pandemic and to have a look at the impact of lockdown measures and 
early releases on mental health of prisoners.
METHODS: This work is based on a survey conducted in April 2020 in France among 
psychiatric healthcare providers working in 42 ambulatory units for inmates and 
in the 9 full-time inpatient psychiatric wards exclusively for inmates called 
"UHSAs" (which stands for "unités hospitalières spécialement aménagées", and can 
be translated as "specially equipped hospital units"). A review of the 
international literature on mental healthcare system for inmates during the 
Covid-19 epidemic has also been performed.
RESULTS: The Covid-19 epidemic has been rather contained during the period of 
confinement in French prisons but the impact of confinement measures on the 
prison population is significant. The three levels of psychiatric care for 
inmates have implemented specific measures to ensure continuity of care, to 
support detainees during Coronavirus lockdown and to prevent an infection's 
spread. Among the most important are: limitation of medical consultations to 
serious and urgent cases, creation of "Covid units", cancellation of voluntary 
psychiatric hospitalizations, reinforcement of preventive hygiene measures and 
reshuffling of medical staff. Prolonged confinement has consequences on mental 
health of detainees. Currently, mental health workers are facing multiple 
clinical situations such as forced drug and substance withdrawal (linked to 
difficulties in supplying psychoactive substances), symptoms of anxiety (due to 
concerns for their own and their relatives' well-being) and decompensation among 
patients with severe psychiatric conditions. Early releases from prison may also 
raise some issues. People recently released from prison are identified as at 
high risk of death by suicide and drug overdose. The lack of time to provide the 
necessary link between health services within prisons and health structures 
outside could have serious consequences, emphasizing the well-known "revolving 
prison doors" effect.
DISCUSSION: The current lockdown measures applied in French jails and prisons 
point out the disparities between psychiatric care for inmates and psychiatric 
care for general population. Giving the high vulnerability of prison population, 
public health authorities should pay more attention to health care in prisons.

OBJECTIF: En France, les mesures de confinement ont été accompagnées de 
dispositions spécifiques pour les prisons : suspension des activités, parloirs 
et interventions extérieures. Plus de dix mille personnes détenues ont en outre 
été libérées pour diminuer le taux d’occupation des établissements et limiter la 
propagation du virus. L’objectif de cet article est de décrire la réorganisation 
des soins psychiatriques en milieu pénitentiaire en contexte de pandémie de 
Covid-19 et d’interroger les conséquences du confinement et des libérations 
anticipées sur la santé mentale des personnes détenues.
MÉTHODE: Ce travail s’appuie sur une enquête menée en avril 2020 auprès des 
soignants de 42 unités sanitaires en milieu pénitentiaire et des 9 unités 
hospitalières spécialement aménagées en France. Une synthèse de la littérature 
internationale sur la question des soins psychiatriques en milieu pénitentiaire 
durant l’épidémie de Covid-19 a également été réalisée.
RÉSULTATS: L’épidémie de Covid-19 semble avoir été plutôt contenue dans les 
prisons françaises au cours de la période de confinement mais le poids des 
mesures mises en place sur la population carcérale est important. Les 3 niveaux 
de soins psychiatriques en milieu pénitentiaire ont instauré des mesures 
spécifiques pour assurer la continuité des soins, accompagner les personnes 
incarcérées et contenir l’épidémie. Parmi les plus importantes, on note la 
restriction des consultations, la création de « secteurs Covid », la 
déprogrammation des hospitalisations non urgentes, le renforcement des mesures 
d’hygiène et le remaniement des effectifs. Actuellement, les soignants sont 
principalement confrontés à des sevrages forcés, des symptomatologies anxieuses 
et des décompensations de troubles psychiatriques chroniques. Certaines 
libérations anticipées sont aussi très préoccupantes, pouvant entraîner des 
ruptures de soins, par manque de préparation des relais de prise en charge.
DISCUSSION: Les remaniements en lien avec le confinement donnent une visibilité 
accrue au fossé qui sépare la psychiatrie en milieu libre de la psychiatrie en 
milieu pénitentiaire. Il nous apparaît important de rappeler la vulnérabilité 
des personnes incarcérées qui doivent impérativement être considérées dans les 
politiques de santé publique.

Copyright © 2020 L'Encéphale, Paris. Published by Elsevier Masson SAS. All 
rights reserved.

DOI: 10.1016/j.encep.2020.05.002
PMCID: PMC7205690
PMID: 32475693 [Indexed for MEDLINE]


4396. J Child Psychol Psychiatry. 2020 Jul;61(7):757-759. doi: 10.1111/jcpp.13278. 
Epub 2020 May 31.

Editorial Perspective: Perils and promise for child and adolescent sleep and 
associated psychopathology during the COVID-19 pandemic.

Becker SP(1)(2), Gregory AM(3).

Author information:
(1)Division of Behavioral Medicine and Clinical Psychology, Cincinnati 
Children's Hospital Medical Center, Cincinnati, OH, USA.
(2)Department of Pediatrics, University of Cincinnati College of Medicine, 
Cincinnati, OH, USA.
(3)Department of Psychology, Goldsmiths, University of London, London, UK.

Comment on
    J Sleep Res. 2020 Apr 4;:e13052.

It is anticipated that the novel coronavirus disease 2019 (COVID-19) pandemic 
and associated societal response will have wide-ranging impacts on youth 
development and mental health. Sleep is crucial for child and adolescent health 
and well-being, and the potential for sleep problems to emerge or worsen during 
and following the pandemic is high. This may be particularly true for children 
and adolescents who are at heightened risk for the onset of sleep and mental 
health disturbances and for those whom developmental changes impacting sleep are 
rapidly occurring. Youth with preexisting psychopathologies (including anxiety 
and depression) and neurodevelopmental conditions (including 
attention-deficit/hyperactivity disorder and autism spectrum disorder) could be 
especially vulnerable to disturbed sleep during this period of change and 
uncertainty. It is thus imperative that sleep considerations be part of research 
and clinical initiatives aimed at understanding and mitigating the impact of the 
COVID-19 pandemic in children and adolescents. This article considers ways in 
which the pandemic may impact sleep, including research and clinical 
implications.

© 2020 Association for Child and Adolescent Mental Health.

DOI: 10.1111/jcpp.13278
PMCID: PMC7300787
PMID: 32474941 [Indexed for MEDLINE]


4397. Ann Allergy Asthma Immunol. 2020 Nov;125(5):528-534. doi: 
10.1016/j.anai.2020.05.025. Epub 2020 May 29.

A butterfly flaps its wings: Extinction of biological experience and the origins 
of allergy.

Prescott SL(1).

Author information:
(1)The ORIGINS Project, Telethon Kids Institute, University of Western 
Australia, Perth Children's Hospital, Nedlands, Australia; inVIVO Planetary 
Health of the Worldwide Universities Network, West New York, New Jersey. 
Electronic address: susan.prescott@uwa.edu.au.

OBJECTIVE: To explore links between biodiversity on all scales and allergic 
disease as a measure of immune dysregulation.
DATA SOURCES: PubMed and Web of Science were searched using the keywords 
biodiversity, nature relatedness, allergic disease, microbiome, noncommunicable 
diseases, coronavirus disease 2019, and associated terms.
STUDY SELECTIONS: Studies were selected based on relevance to human health and 
biodiversity.
RESULTS: Contact with natural environments enriches the human microbiome, 
promotes regulated immune responses, and protects against allergy and both acute 
and chronic inflammatory disorders. These important links to ecopsychological 
constructs of the extinction of experience, which indicates that loss of direct, 
personal contact with biodiversity (wildlife and the more visible elements of 
the natural world), might lead to emotional apathy and irresponsible behaviors 
toward the environment.
CONCLUSION: The immune system is a useful early barometer of environmental 
effects and, by means of the microbiome, is a measure of the way in which our 
current experiences differ from our ancestral past. Although we would benefit 
from further research, efforts to increase direct, personal contact with 
biodiversity have clear benefits for multiple aspects of physical and mental 
health, the skin and gut microbiome, immune function, food choices, sleep, and 
physical activity and promote environmental responsibility.

Copyright © 2020 American College of Allergy, Asthma & Immunology. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.anai.2020.05.025
PMCID: PMC7256009
PMID: 32474160 [Indexed for MEDLINE]


4398. Br J Surg. 2020 Jul;107(8):e264. doi: 10.1002/bjs.11726. Epub 2020 May 28.

Mental wellbeing and burnout in surgical trainees: implications for the 
post-COVID-19 era.

Kadhum M(1)(2), Farrell S(3)(4), Hussain R(5), Molodynski A(6).

Author information:
(1)Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal 
Sciences, Botnar Research Centre, Oxford, UK.
(2)St George's University Hospitals NHS Foundation Trust, London, UK.
(3)Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University 
of Oxford, Oxford, UK.
(4)National Hospital for Neurology and Neurosurgery, University College London 
Hospitals, London, UK.
(5)Surrey and Borders NHS Foundation Trust, Leatherhead, UK.
(6)Oxford Health NHS Foundation Trust, Oxford, UK.

DOI: 10.1002/bjs.11726
PMCID: PMC7283838
PMID: 32463518 [Indexed for MEDLINE]


4399. Head Neck. 2020 Jul;42(7):1638-1644. doi: 10.1002/hed.26291. Epub 2020 May 28.

Impact of COVID-19 on the mental health of surgeons and coping strategies.

Balasubramanian A(1), Paleri V(2), Bennett R(2), Paleri V(1).

Author information:
(1)Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK.
(2)Lewisham Child and Adolescent Mental Health Services, South London and 
Maudsley NHS Foundation Trust, London, UK.

Unprecedented times call for extraordinary measures. While surgeons across the 
globe try to comprehend the evolving facade of the COVID-19 pandemic and 
improvise surgical practice to the best of their ability, the psychological 
impact of the stress on their own mental health and well-being has been 
underestimated. This paper aims to review the indirect and overt factors that 
may affect the mental health of a surgeon in the present circumstances. 
Furthermore, it will aim to highlight key coping mechanisms at an individual and 
institutional level, so as to mitigate the negative psychological impact on 
surgeons.

© 2020 Wiley Periodicals, Inc.

DOI: 10.1002/hed.26291
PMCID: PMC7283775
PMID: 32462783 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no potential conflict of 
interest.


4400. Ir J Psychol Med. 2020 Sep;37(3):192-197. doi: 10.1017/ipm.2020.70. Epub 2020 
May 28.

'Policing' a pandemic: Garda wellbeing and COVID-19.

Rooney L(1)(2), McNicholas F(1)(3)(4)(5).

Author information:
(1)Department of Child & Adolescent Psychiatry, University College Dublin, 
Dublin, Ireland.
(2)UCD Institute of Criminology and Criminal Justice, University College Dublin, 
Dublin, Ireland.
(3)Our Lady's Children's Hospital, Crumlin, Ireland.
(4)Lucena Clinic Services, Rathgar, Dublin, Ireland.
(5)School of Medicine and Medical Science, Geary Institute, University College 
Dublin, Dublin, Ireland.

In response to the global pandemic COVID-19, the Irish government has called 
upon the Garda Síochána to implement an unparalleled mode of policing to 
mitigate and contain the spread of the Coronavirus. Studies investigating 
smaller scale epidemics, such as Severe Acute Respiratory Syndrome (SARS), 
indicate that staff at the frontlines of an outbreak are exposed to an 
insuperable amount of stress and experience increased psychological morbidities 
as a result. Furthermore, research not only indicates that heighted levels of 
psychological distress are an occupational hazard associated with the law 
enforcement profession, but that members of the Garda Síochána feel their mental 
health needs are largely unmet by their organisation. Given the pandemic's 
propensity to expose officers to indeterminate echelons of physical and 
psychological threat; there has never been a more appropriate time to explore 
the potential burdens associated with 'policing' a pandemic, question the 
governments capacity to address the psychological support needs of frontline 
professionals, and plan future research for best practice.

DOI: 10.1017/ipm.2020.70
PMCID: PMC7298097
PMID: 32460953 [Indexed for MEDLINE]


4401. Int J Clin Pract. 2020 Sep;74(9):e13559. doi: 10.1111/ijcp.13559. Epub 2020 Jun 
28.

Well-being and education of urology residents during the COVID-19 pandemic: 
Results of an American National Survey.

Khusid JA(1), Weinstein CS(1), Becerra AZ(2), Kashani M(1), Robins DJ(1), Fink 
LE(1), Smith MT Jr(1), Weiss JP(1).

Author information:
(1)Department of Urology, SUNY Downstate College of Medicine, Brooklyn, NY, USA.
(2)Department of Surgery, Rush University Medical Center, Chicago, IL, USA.

Comment in
    Headache. 2020 Nov;60(10):2613-2617.

BACKGROUND: The rapid spread of COVID-19 has placed tremendous strain on the 
American healthcare system. Few prior studies have evaluated the well-being of 
or changes to training for American resident physicians during the COVID-19 
pandemic. We aim to study predictors of trainee well-being and changes to 
clinical practice using an anonymous survey of American urology residents.
METHODS: An anonymous, voluntary, 47-question survey was sent to all 
ACGME-accredited urology programmes in the United States. We executed a 
cross-sectional analysis evaluating risk factors of perception of anxiety and 
depression both at work and home and educational outcomes. Multiple linear 
regressions models were used to estimate beta coefficients and 95% confidence 
intervals.
RESULTS: Among ~1800 urology residents in the USA, 356 (20%) responded. Among 
these respondents, 24 had missing data leaving a sample size of 332. Important 
risk factors of mental health outcomes included perception of access to PPE, 
local COVID-19 severity and perception of susceptible household members. Risk 
factors for declination of redeployment included current redeployment, having 
children and concerns regarding ability to reach case minimums. Risk factors for 
concern of achieving operative autonomy included cancellation of elective cases 
and higher level of training.
CONCLUSIONS: Several potential actions, which could be taken by urology 
residency programme directors and hospital administration, may optimise urology 
resident well-being, morale, and education. These include advocating for 
adequate access to PPE, providing support at both the residency programme and 
institutional levels, instituting telehealth education programmes, and fostering 
a sense of shared responsibility of COVID-19 patients.

© 2020 John Wiley & Sons Ltd.

DOI: 10.1111/ijcp.13559
PMCID: PMC7283839
PMID: 32460433 [Indexed for MEDLINE]

Conflict of interest statement: None of the authors have any direct conflicts of 
interest regarding this research project. However, of note, as a general 
financial disclosure, Dr Jeffrey P. Weiss is a consultant for Ferring 
Pharmasciences and an advisory board member for the Institute for Bladder and 
Prostate Research. None of the other authors have financial disclosures.


4402. Int J Environ Res Public Health. 2020 May 22;17(10):3655. doi: 
10.3390/ijerph17103655.

A Preliminary Study of the Comfort in Patients with Leukemia Staying in a 
Positive Pressure Isolation Room.

You WY(1), Yeh TP(1)(2), Lee KC(1)(2), Ma WF(1)(2)(3).

Author information:
(1)Department of Nursing, China Medical University Hospital, Taichung 40402, 
Taiwan.
(2)School of Nursing, China Medical University, Taichung 40402, Taiwan.
(3)Brain Disease Research Center, China Medical University Hospital, Taichung 
40402, Taiwan.

Background and Aim: Patients with leukemia who are isolated in positive pressure 
rooms for infection prevention usually experience significant physical and 
psychological distress. This study aimed to examine changes in leukemia 
patients' comfort level during chemotherapy in isolation wards. Methods: A 
longitudinal survey was conducted with measures which were repeated four times. 
Data were collected before chemotherapy, on the first and second week after 
receiving chemotherapy in positive pressure isolation rooms, and on the third 
week in the non-isolated hematology ward. Each patient received six 
questionnaires measuring demographic data, comfort status, functional status, 
fatigue related to cancer therapy, anxiety level, and distress symptoms. A mixed 
model with repeated measure analysis was used to examine the changing 
trajectories in physical and psychological health. Results: Twenty-one patients 
completed the study. During the process, the highest score for comfort level was 
shown before chemotherapy, and this decreased from the second week under 
isolation. Anxiety and uncertainty (p < 0.05) declined over time, and emotional 
states improved during the recovery period in the third and fourth weeks outside 
isolation. Physical well-being (p < 0.01), cancer-related fatigue (p < 0.05), 
hemoglobin (p < 0.01) and white blood cell count (p < 0.05) began to rise two 
weeks after chemotherapy. Conclusion: Comfort levels declined after chemotherapy 
until the third week of treatment. Anxiety, fatigue and distress symptoms varied 
across the four time points of chemotherapy from isolation to return to the 
non-isolated ward. Health care professionals should be aware of psychological 
symptoms when patients are in isolation rooms, and interventions for promoting a 
humanized environment, quality of life, and comfort should be considered and 
provided along with the treatment stages of chemotherapy.

DOI: 10.3390/ijerph17103655
PMCID: PMC7277353
PMID: 32456113 [Indexed for MEDLINE]

Conflict of interest statement: All four authors took part in the study and 
reported no competing interests.


4403. Occup Med (Lond). 2020 Jul 17;70(5):375-381. doi: 10.1093/occmed/kqaa095.

Implementation and analysis of a telephone support service during COVID-19.

Matthewson J(1), Tiplady A(1), Gerakios F(1), Foley A(1), Murphy E(1).

Author information:
(1)Occupational Health Service, Newcastle upon Tyne Hospitals NHS Foundation 
Trust, Regent Point, Gosforth, Newcastle upon Tyne, UK.

BACKGROUND: During the COVID-19 pandemic, it has been essential for occupational 
health services (OHS) providers to react rapidly to increased demand and to 
utilize resources in novel ways. The impact of the COVID-19 pandemic on the 
psychological well-being of staff is already identified as an area of high risk; 
therefore, providing timely access to psychological support may be vital, 
although limited evidence is available on how these risks are best managed.
AIMS: To describe implementation and analysis of a psychology-led COVID-19 
telephone support line in a National Health Service OHS.
METHODS: Data from calls made to the support line were collected over the first 
4 weeks of service implementation. Numerical data including frequency of calls 
and average waiting time were first considered. A content analysis was then 
conducted on call notes to identify prevalence of themes.
RESULTS: Six hundred and fifty-five calls were received, and 362 notes included 
sufficient information for use within the content analysis. Frequency of calls 
peaked within the first week followed by a reduction in the number of calls 
received per day over time. Most calls included discussion around clarification 
of guidance (68%) with a smaller subset of calls offering support around anxiety 
(29%). Prevalence of themes did not appear to change over time.
CONCLUSIONS: Clear and timely information is vital to support the well-being of 
healthcare staff. A psychologically informed telephone support line was a good 
use of occupational health service resources in the interim while more tailored 
advice and services could be established.

© The Author(s) 2020. Published by Oxford University Press on behalf of the 
Society of Occupational Medicine. All rights reserved. For Permissions, please 
email: journals.permissions@oup.com.

DOI: 10.1093/occmed/kqaa095
PMCID: PMC7313817
PMID: 32449754 [Indexed for MEDLINE]


4404. Asian J Psychiatr. 2020 Jun;51:102159. doi: 10.1016/j.ajp.2020.102159. Epub 2020 
May 7.

Pandemics and psychiatry: Repositioning research in context of COVID-19.

Keshavan MS(1).

Author information:
(1)Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard 
Medical School, Boston, MA, USA. Electronic address: mkeshava@bidmc.harvard.edu.

The current Covid-19 pandemic is posing an unprecedented threat to global 
well-being and its mental health consequences are just becoming understood. 
While the crisis has led to a temporary halt in a lot of ongoing or planned 
psychiatric research, this pandemic is a natural experiment that can help the 
field to repurpose research to better understand the causes, presentations and 
outcome trajectories as well as treatments in psychiatry. Inter-disciplinary 
collaborations between researchers are needed to rapidly develop and share the 
emerging new knowledge of the mental health implications of Covid-19, This will 
help mount an effective response to the current as well as future pandemics.

Copyright © 2020. Published by Elsevier B.V.

DOI: 10.1016/j.ajp.2020.102159
PMCID: PMC7204673
PMID: 32442894 [Indexed for MEDLINE]


4405. Surg Endosc. 2020 Jul;34(7):2856-2862. doi: 10.1007/s00464-020-07631-3. Epub 
2020 May 20.

SAGES primer for taking care of yourself during and after the COVID-19 crisis.

Dort J(1), Romanelli J(2), Choudhury N(3), Flink BJ(4), Lak K(5), Levy S(6), 
Needleman BJ(7), Paget CJ 3rd(8), Telem D(9), Schwarz E(10), Zhang LP(11), Sylla 
P(11), Mellinger JD(12), Matthews BD(13), Feldman L(14), Pryor AD(15), Asbun 
HJ(16).

Author information:
(1)Inova Fairfax Medical Campus, Falls Church, VA, USA. jonathan.dort@inova.org.
(2)Baystate Health, Springfield, MA, USA.
(3)University of Tennessee Health Science Center, Memphis, TN, USA.
(4)Emory University School of Medicine, Atlanta, GA, USA.
(5)Medical College of Wisconsin, Milwaukee, WI, USA.
(6)Tulane University School of Medicine, New Orleans, LA, USA.
(7)Ohio State University School of Medicine, Columbus, OH, USA.
(8)Virginia Tech/Carilion School of Medicine, Roanoke, VA, USA.
(9)University of Michigan School of Medicine, Ann Arbor, MI, USA.
(10)SAGES, Los Angeles, CA, USA.
(11)Icahn School of Medicine At Mt Sinai, New York, NY, USA.
(12)SIU School of Medicine, Springfield, IL, USA.
(13)Atrium Health, Charlotte, NC, USA.
(14)McGill University, Montreal, QC, Canada.
(15)Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, 
USA.
(16)Miami Cancer Institute At Baptist Health, Miami, FL, USA.

COVID-19 is a pandemic which has affected almost every aspect of our life since 
starting globally in November 2019. Given the rapidity of spread and inadequate 
time to prepare for record numbers of sick patients, our surgical community 
faces an unforeseen challenge. SAGES is committed to the protection and care of 
patients, their surgeons and staff, and all who are served by the medical 
community at large. This includes physical health, mental health, and well-being 
of all involved. The fear of the unknown ahead can be paralyzing. International 
news media have chronicled the unthinkable situations that physicians and other 
health care providers have been thrust into as a result of the COVID-19 
pandemic. These situations include making life or death decisions for patients 
and their families regarding use of limited health care resources. It includes 
caring for patients with quickly deteriorating conditions and limited treatments 
available. Until recently, these situations seemed far from home, and now they 
are in our own hospitals. As the pandemic broadened its reach, the reality that 
we as surgeons may be joining the front line is real. It may be happening to you 
now; it may be on the horizon in the coming weeks. In this context, SAGES put 
together this document addressing concerns on clinician stressors in these times 
of uncertainty. We chose to focus on the emotional toll of the situation on the 
clinician, protecting vulnerable persons, reckoning with social isolation, and 
promoting wellness during this crisis. At the same time, the last part of this 
document deals with the "light at the end of the tunnel," discussing potential 
opportunities, lessons learned, and the positives that can come out of this 
crisis.

DOI: 10.1007/s00464-020-07631-3
PMCID: PMC7238959
PMID: 32435961 [Indexed for MEDLINE]


4406. Ir J Psychol Med. 2020 Sep;37(3):214-217. doi: 10.1017/ipm.2020.55. Epub 2020 
May 21.

Covid-19, child and adolescent mental health - Croatian (in)experience.

Franic T(1), Dodig-Curkovic K(2).

Author information:
(1)Clinical Hospital Centre Split, Medical School, University of Split, Split, 
Croatia.
(2)Clinical Hospital Centre Osijek, Medical School, University of Osijek, 
Osijek, Croatia.

The Covid-19 pandemic has caused unseen socio-economic changes all over the 
world, where enormous efforts are being made to preserve lives and maintain 
functional health systems. A secondary concern is to mitigate the severe 
economic consequences of the crisis. Different approaches have been adopted with 
varying outcomes and experiences. But regardless of the different approaches 
taken, one thing is common for all societies during this pandemic: fear and 
anxiety. This fear extends from concerns about the present situation, for the 
health and well-being of family members and loved ones from Covid-19 infection, 
to fears relating to how long the crisis will last, to the potential economic 
consequences of the pandemic (perhaps not seen in our lifetimes) and the 
ultimate fear of future uncertainty. Across the world, health systems are being 
faced with unprecedented challenges. At their core, these challenges are the 
same: how to beat Covid-19. Certainly, there are differences in how individual 
systems are organized and how they address the main issues arising from the 
pandemic while not forgetting the ongoing healthcare needs of the general 
population. In this paper, we share some perspectives from Croatia regarding 
Child and Adolescent Mental Health services (CAMHs) in these extraordinary 
circumstances. We give our personal insights on deficiencies in Child and 
Adolescent Mental Health Services prior to the arrival of Covid-19, which have 
contributed to difficulties in mitigating and managing the ongoing crisis.

DOI: 10.1017/ipm.2020.55
PMCID: PMC7272690
PMID: 32434602 [Indexed for MEDLINE]


4407. J Addict Med. 2020 Jul/Aug;14(4):e10-e12. doi: 10.1097/ADM.0000000000000690.

Gambling During the COVID-19 Crisis - A Cause for Concern.

Håkansson A(1), Fernández-Aranda F, Menchón JM, Potenza MN, Jiménez-Murcia S.

Author information:
(1)Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund 
University, Lund, Sweden (AH); Gambling Disorder Unit, Malmö Addiction Center, 
Malmö, Sweden (AH); CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), 
Instituto de Salud Carlos III, Madrid, Spain (FFA, SJM); Department of 
Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain (FFA, 
JMM, SJM); Department of Clinical Sciences, School of Medicine and Health 
Sciences, University of Barcelona, Barcelona, Spain (FFA, JMM, SJM); CIBER Salud 
Mental (CIBERSam), Instituto de Salud Carlos III, Madrid, Spain (JMM); 
Department of Psychiatry, Yale School of Medicine, New Haven, CT (MNP); The 
Connecticut Council on Problem Gambling, Wethersfield, CT (MNP); The Connecticut 
Mental Health Center, New Haven, CT (MNP); Department of Neuroscience, Yale 
University, New Haven, CT (MNP); and Child Study Center, Yale School of 
Medicine, New Haven, CT (MNP).

: The COVID-19 pandemic has the potential to worsen mental health problems in 
the general population, including increasing engagement in addictive behaviors. 
Here, we describe observations suggesting that the current crisis and its 
sequelae may worsen problem gambling. The current pandemic may impact financial 
and psychological well-being due to social isolation during spatial distancing, 
and these stressors in conjunction with substantial changes in gambling markets 
(land-based, online) during the pandemic may significantly influence gambling 
behaviors. This situation calls for rapid research initiatives in this area and 
preventive and regulatory measures by multiple stakeholders.

DOI: 10.1097/ADM.0000000000000690
PMCID: PMC7273946
PMID: 32433365 [Indexed for MEDLINE]

Conflict of interest statement: The authors report no conflicts of interest.


4408. Am J Geriatr Psychiatry. 2020 Oct;28(10):1058-1069. doi: 
10.1016/j.jagp.2020.05.009. Epub 2020 May 18.

Geriatric Mental Health and COVID-19: An Eye-Opener to the Situation of the Arab 
Countries in the Middle East and North Africa Region.

El Hayek S(1), Cheaito MA(2), Nofal M(3), Abdelrahman D(4), Adra A(5), Al Shamli 
S(6), AlHarthi M(7), AlNuaimi N(8), Aroui C(9), Bensid L(10), Emberish AM(11), 
Larnaout A(12), Radwan A(13), Slaih M(14), Al Sinawi H(15).

Author information:
(1)Department of Psychiatry, American University of Beirut, Beirut, Lebanon. 
Electronic address: samer.elhayek@gmail.com.
(2)Department of Emergency Medicine, American University of Beirut, Beirut, 
Lebanon.
(3)Helwan Mental Health Hospital, Cairo, Egypt.
(4)The Sudanese Medical Specialization Board, Khartoum, Sudan.
(5)Department of Psychiatry, Damascus University, Damascus, Syria.
(6)Oman Medical Specialty Board, Muscat, Oman.
(7)Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.
(8)Al Ain Hospital, Abu Dhabi, United Arab Emirates.
(9)Ibn Rushd Psychiatry University Center, Casablanca, Morocco.
(10)University of Algiers, Drid Hocine Hospital specialized in Psychiatry, 
Department A, Algiers, Algeria.
(11)Department of Psychiatry, University of Benghazi, Benghazi, Libya.
(12)Razi Hospital, Faculty of medicine of Tunis, Tunis El Manar University, Cite 
Romana, Tunis, Tunisia.
(13)Hamad Medical Corporation, Mental Health Service, Doha, Qatar.
(14)National Center for Mental Health, Ministry of Health, Jordan.
(15)Department of Behavioural Medicine, Sultan Qaboos University, Muscat, Oman.

While the detrimental ramifications of the COVID-19 outbreak on the mental 
wellbeing of the general public continue to unravel, older adults seem to be at 
high risk. As the geriatric population continues to grow in the Middle East and 
North Africa (MENA) region, it is essential to explore the influence of this 
outbreak on geriatric mental health, a topic often neglected. In this review, we 
depict the status of geriatric psychiatry in the Arab countries of the MENA 
region, exploring the variations from one nation to another. While some have a 
null exposure to the field, resources and expertise in other countries range 
from very limited to extensive. Furthermore, we highlight the measures 
implemented in the Arab region to address mental health during the COVID-19 
outbreak; these tend to be insufficient when targeting the geriatric population. 
Finally, we provide short- and long-term recommendations to stakeholders that 
aim at enhancing the mental healthcare of older adults in the Arab countries of 
the MENA region, particularly during this pandemic.

© 2020 American Association for Geriatric Psychiatry. Published by Elsevier Inc. 
All rights reserved.

DOI: 10.1016/j.jagp.2020.05.009
PMCID: PMC7233242
PMID: 32425474 [Indexed for MEDLINE]


4409. Proc Natl Acad Sci U S A. 2020 Jun 9;117(23):12595-12597. doi: 
10.1073/pnas.2006706117. Epub 2020 May 18.

Lessons from Hurricane Katrina for predicting the indirect health consequences 
of the COVID-19 pandemic.

Raker EJ(1), Zacher M(2), Lowe SR(3).

Author information:
(1)Department of Sociology, Harvard University, Cambridge, MA 02138; 
eraker@g.harvard.edu meghan_zacher@brown.edu.
(2)Population Studies and Training Center, Brown University, Providence, RI 
02912; eraker@g.harvard.edu meghan_zacher@brown.edu.
(3)Department of Social and Behavioral Sciences, Yale School of Public Health, 
New Haven, CT, 06510.

Comment in
    Proc Natl Acad Sci U S A. 2020 Oct 13;117(41):25200.
    Proc Natl Acad Sci U S A. 2020 Oct 13;117(41):25201-25202.

Beyond their immediate effects on mortality, disasters have widespread, indirect 
impacts on mental and physical well-being by exposing survivors to stress and 
potential trauma. Identifying the disaster-related stressors that predict health 
adversity will help officials prepare for the coronavirus disease 2019 
(COVID-19) pandemic. Using data from a prospective study of young, low-income 
mothers who survived Hurricane Katrina, we find that bereavement, fearing for 
loved ones' well-being, and lacking access to medical care and medications 
predict adverse mental and physical health 1 y postdisaster, and some effects 
persist 12 y later. Adjusting for preexisting health and socioeconomic 
conditions attenuates, but does not eliminate, these associations. The findings, 
while drawn from a demographically unique sample, suggest that, to mitigate the 
indirect effects of COVID-19, lapses in medical care and medication use must be 
minimized, and public health resources should be directed to those with 
preexisting medical conditions, their social networks, and the bereaved.

Copyright © 2020 the Author(s). Published by PNAS.

DOI: 10.1073/pnas.2006706117
PMCID: PMC7293707
PMID: 32424085 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


4410. Br J Psychiatry. 2020 Oct;217(4):537-539. doi: 10.1192/bjp.2020.109.

What should be done to support the mental health of healthcare staff treating 
COVID-19 patients?

Tracy DK(1), Tarn M(2), Eldridge R(2), Cooke J(2), Calder JDF(3), Greenberg 
N(4).

Author information:
(1)Nightingale Hospital, London; and Oxleas NHS Foundation Trust, London; and 
Department of Psychosis Studies, Institute of Psychiatry, Psychology and 
Neuroscience, King's College London, UK.
(2)Nightingale Hospital, London.
(3)Nightingale Hospital, London; and Department of Bioengineering, Imperial 
College London.
(4)Nightingale Hospital, London; and Health Protection Research Unit, Institute 
of Psychiatry, Psychology and Neuroscience, King's College London, UK.

There is an urgent need to provide evidence-based well-being and mental health 
support for front-line clinical staff managing the COVID-19 pandemic who are at 
risk of moral injury and mental illness. We describe the evidence base for a 
tiered model of care, and practical steps on its implementation.

DOI: 10.1192/bjp.2020.109
PMCID: PMC7294074
PMID: 32423523 [Indexed for MEDLINE]

Conflict of interest statement: N.G. runs a psychological health consultancy 
that provides resilience training for a wide range of organisations, including a 
few NHS teams. The views expressed are those of the authors and not necessarily 
those of the NHS, NIHR, Department of Health and Social Care, or Public Health 
England.


4411. J Relig Health. 2020 Oct;59(5):2205-2214. doi: 10.1007/s10943-020-01035-2.

Maintaining Health and Well-Being by Putting Faith into Action During the 
COVID-19 Pandemic.

Koenig HG(1)(2)(3)(4).

Author information:
(1)Department of Psychiatry and Behavioral Sciences, and Department of Medicine, 
Duke University Medical Center, Box 3400, Durham, NC, 27710, USA. 
Harold.Koenig@duke.edu.
(2)Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia. 
Harold.Koenig@duke.edu.
(3)Ningxia Medical University, Yinchuan, People's Republic of China. 
Harold.Koenig@duke.edu.
(4)Shiraz University of Medical Sciences, Shiraz, Iran. Harold.Koenig@duke.edu.

Anxiety and fear adversely affect the physiological systems that protect 
individuals from infection. This article comments on the role that religious 
faith and practice can play in helping individuals remain free from infection by 
the coronavirus and in helping to moderate the effects of infection if that 
should occur. The author provides six recommendations to help individuals 
maintain spiritual, mental, and physical resilience during these anxious times 
of the COVID-19 pandemic.

DOI: 10.1007/s10943-020-01035-2
PMCID: PMC7224109
PMID: 32409989 [Indexed for MEDLINE]

Conflict of interest statement: The author has no conflicts of interest.


4412. Asian J Psychiatr. 2020 Jun;51:102151. doi: 10.1016/j.ajp.2020.102151. Epub 2020 
May 5.

COVID-19 pandemic: New challenge to securing mental well-being in conflict 
settings.

Seidi PAM(1), Ardebil MD(2), Jaff D(3).

Author information:
(1)Research Center, University of Garmian, Kalar, Kurdistan Region, Iraq. 
Electronic address: Pegah.am.seidi@garmian.edu.krd.
(2)Independent Researcher, Ph.D. of Psychology, Tehran, Iran.
(3)Department of Maternal and Child Health, Gillings School of Global Public 
Health, University of North Carolina at Chapel Hill, NC, USA.

DOI: 10.1016/j.ajp.2020.102151
PMCID: PMC7198392
PMID: 32408247 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this 
correspondence.


4413. Cerebellum. 2020 Aug;19(4):562-568. doi: 10.1007/s12311-020-01139-1.

Management of Patients with Cerebellar Ataxia During the COVID-19 Pandemic: 
Current Concerns and Future Implications.

Manto M(1)(2), Dupre N(3), Hadjivassiliou M(4), Louis ED(5), Mitoma H(6), 
Molinari M(7), Shaikh AG(8), Soong BW(9)(10)(11), Strupp M(12), Van Overwalle 
F(13), Schmahmann JD(14).

Author information:
(1)Unité des Ataxies Cérébelleuses, Service de Neurologie, CHU-Charleroi, 6000, 
Charleroi, Belgium. mmanto@ulb.ac.be.
(2)CHU-Charleroi and Service des Neurosciences, University of Mons, 7000, Mons, 
Belgium. mmanto@ulb.ac.be.
(3)Department of Medicine, Faculty of Medicine, Université Laval & Neuroscience 
Axis, CHU de Québec-Université Laval, Quebec City, QC, Canada.
(4)Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Trust, 
Sheffield, UK.
(5)Department of Neurology and Neurotherapeutics, University of Texas 
Southwestern, Dallas, TX, USA.
(6)Department of Medical Education, Tokyo Medical University, Tokyo, Japan.
(7)IRCCS Fondazione S. Lucia, Rome, Italy.
(8)Department of Neurology, Case Western Reserve University, University 
Hospitals Cleveland Medical Center, Cleveland VA Medical Center, Cleveland, OH, 
USA.
(9)Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan.
(10)Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New 
Taipei City, Taiwan.
(11)Department of Neurology, Taipei Veterans General Hospital, and Brain 
Research Center, National Yang-Ming University, Taipei, Taiwan.
(12)Department of Neurology, Ludwig Maximilians University, Munich, Germany.
(13)Brain, Body and Cognition Lab, Faculty of Psychology, Vrije Universiteit 
Brussel, Brussels, Belgium.
(14)Ataxia Center, Cognitive Behavioral Neurology Unit, Laboratory for 
Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts 
General Hospital and Harvard Medical School, Boston, MA, USA.

The current worldwide severe acute respiratory syndrome coronavirus 2 
(SARS-CoV-2) pandemic that causes coronavirus disease 2019 (COVID-19) has 
brought some medical systems to the brink of collapse. This crisis is also 
negatively impacting the care of patients with non-COVID-19 conditions, 
including those with cerebellar ataxia (CA). Older patients with CA and those 
with immune-mediated ataxias on immunosuppressive medication are potentially at 
high risk of developing serious complications of the infection, although it is 
also possible that immunosuppressive agents may provide a defense against 
cytokine storm. This has implications for even greater attention to preventing 
contracting the disease through physical distancing and/or isolation. The CA 
patient population is also at higher risk because of the neurological 
complexities of their underlying disorder and the comorbid medical illnesses 
that often accompany the genetic ataxias. As the disruption of social patterns 
and healthcare delivery in response to the crisis continues, interruption of 
rehabilitation, speech and language therapy, and face-to-face consultations 
threatens to have a negative impact on the course and well-being of CA patients. 
Mental and physical health is also potentially at greater risk because the 
prevailing uncertainty and anxiety may be superimposed upon cerebellum-specific 
neuropsychological challenges. We identify and review some of the short- and 
long-term consequences of this global pandemic for the community of ataxia 
patients and their families and for the clinical and academic 
neurologists/ataxiologists caring for these patients. This includes the 
recognition that telemedicine has emerged as a principle means of 
caregiver-patient contact and that neurological manifestations of COVID-19 
including those specific to cerebellar neurobiology are increasingly recognized 
and will require close surveillance and monitoring. This COVID-19 Cerebellum 
Task Force consensus provides some guidance on how we may approach this 
uncertain time and consider preparing for the new realities we face in CA 
patient care once this acute crisis has passed.

DOI: 10.1007/s12311-020-01139-1
PMCID: PMC7220536
PMID: 32405955 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


4414. Brain Behav Immun. 2020 Jul;87:172-176. doi: 10.1016/j.bbi.2020.05.040. Epub 
2020 May 13.

Mental health consequences during the initial stage of the 2020 Coronavirus 
pandemic (COVID-19) in Spain.

González-Sanguino C(1), Ausín B(2), Castellanos MÁ(3), Saiz J(4), López-Gómez 
A(5), Ugidos C(4), Muñoz M(2).

Author information:
(1)Chair Against Stigma Grupo 5-Complutense University of Madrid, School of 
Psychology, Personality, Evaluation and Clinical Psychology Department, 
Complutense University of Madrid, Spain. Electronic address: clagon06@ucm.es.
(2)Chair Against Stigma Grupo 5-Complutense University of Madrid, School of 
Psychology, Personality, Evaluation and Clinical Psychology Department, 
Complutense University of Madrid, Spain.
(3)Chair Against Stigma Grupo 5-Complutense University of Madrid, School of 
Psychology, Psychobiology and Methodology in Behavioral Sciences Department, 
Complutense University of Madrid, Spain.
(4)Chair Against Stigma Grupo 5-Complutense University of Madrid, School of 
Psychology, Department of Social, Labor and Differential Psychology, Complutense 
University of Madrid, Spain.
(5)Chair Against Stigma Grupo 5-Complutense University of Madrid, School of 
Psychology, Complutense University of Madrid, Spain.

Comment in
    Rev Assoc Med Bras (1992). 2021 Aug;67(8):1083-1084.

The pandemic caused by Covid-19 has been an unprecedented social and health 
emergency worldwide. This is the first study in the scientific literature 
reporting the psychological impact of the Covid-19 outbreak in a sample of the 
Spanish population. A cross-sectional study was conducted through an online 
survey of 3480 people. The presence of depression, anxiety and post-traumatic 
stress disorder (PTSD) was evaluated with screening tests from 14 March. 
Sociodemographic and Covid-19-related data was collected. Additionally, 
spiritual well-being, loneliness, social support, discrimination and sense of 
belonging were assessed. Descriptive analyses were carried out and linear 
regression models compiled. The 18.7% of the sample revealed depressive, 21.6% 
anxiety and 15.8% PTSD symptoms. Being in the older age group, having economic 
stability and the belief that adequate information had been provided about the 
pandemic were negatively related to depression, anxiety and PTSD. However, 
female gender, previous diagnoses of mental health problems or neurological 
disorders, having symptoms associated with the virus, or those with a close 
relative infected were associated with greater symptomatology in all three 
variables. Predictive models revealed that the greatest protector for 
symptomatology was spiritual well-being, while loneliness was the strongest 
predictor of depression, anxiety and PTSD. The impact on our mental health 
caused by the pandemic and the measures adopted during the first weeks to deal 
with it are evident. In addition, it is possible to identify the need of greater 
psychological support in general and in certain particularly vulnerable groups.

Copyright © 2020 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.bbi.2020.05.040
PMCID: PMC7219372
PMID: 32405150 [Indexed for MEDLINE]


4415. Encephale. 2020 Jun;46(3S):S99-S106. doi: 10.1016/j.encep.2020.05.005. Epub 2020 
May 13.

[Appreciating COVID-19 as a child and adolescent psychiatrist on the move].

[Article in French]

Cohen D(1).

Author information:
(1)Service de psychiatrie de l'enfant et de l'adolescent, Sorbonne université, 
CNRS UMR 7222 « institut des systèmes intelligents et robotiques », AP-HP, 
Paris, France. Electronic address: david.cohen@aphp.fr.

COVID-19 is a multi-organ disease due to an infection with the SARS-CoV2 virus. 
It has become a pandemic in early 2020. The disease appears less devastating in 
children and adolescents. However, stress, quarantine and eventually mourning 
have major impacts on development. It is difficult to describe what this 
pandemic implies for a child psychiatrist, other than by giving a first-hand 
account. I propose to go through the main ethical questions that have arisen; to 
describe how my hospital team has reorganized itself to meet the new demands and 
questions, in particular by opening a unit dedicated to people with autism and 
challenging behaviors affected by COVID-19; and to address, in a context of 
national discussion, how the discipline has sought to understand the conditions 
of a certain well-being during quarantine. Finally, I will try to conclude with 
more speculative reflections on re-opening.

Le COVID-19 est une maladie multi-organes liée à une infection par le virus 
SARS-CoV2 qui est devenue une pandémie au début de l’année 2020. Difficile de 
décrire autrement qu’en témoignant à chaud ce que cette pandémie implique pour 
un psychiatre d’enfants. Je propose de parcourir les principales questions 
éthiques qui se sont posées ; de décrire comment mon équipe hospitalière s’est 
réorganisée pour faire face aux nouvelles demandes et questionnements, en 
particulier en ouvrant une unité dédiée aux personnes avec autisme et 
comportements défis atteints par le COVID-19 ; et d’aborder, dans un contexte de 
discussion nationale, comment la discipline a cherché à comprendre les 
conditions d’un certain bien-être pendant le confinement. Enfin, j’essaierai de 
terminer par des réflexions plus spéculatives concernant le déconfinement.

Copyright © 2020 L'Encéphale, Paris. Published by Elsevier Masson SAS. All 
rights reserved.

DOI: 10.1016/j.encep.2020.05.005
PMCID: PMC7218362
PMID: 32405083 [Indexed for MEDLINE]


4416. Ir J Psychol Med. 2020 Dec;37(4):259-263. doi: 10.1017/ipm.2020.41. Epub 2020 
May 14.

COVID-19, mental health and psychological first aid.

Minihan E(1), Gavin B(1), Kelly BD(2), McNicholas F(1).

Author information:
(1)School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland.
(2)Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health 
Sciences, Tallaght University Hospital, Dublin 24D24 NR0A, Ireland.

Crises such as the global pandemic of COVID-19 (coronavirus) elicit a range of 
responses from individuals and societies adversely affecting physical and 
emotional well-being. This article provides an overview of factors elicited in 
response to COVID-19 and their impact on immunity, physical health, mental 
health and well-being. Certain groups, such as individuals with mental illness, 
are especially vulnerable, so it is important to maximise the supports available 
to this population and their families during the pandemic. More broadly, the 
World Health Organization recommends 'Psychological First Aid' as a useful 
technique that can help many people in a time of crisis.

DOI: 10.1017/ipm.2020.41
PMCID: PMC7468678
PMID: 32404221 [Indexed for MEDLINE]


4417. Ir J Psychol Med. 2020 Sep;37(3):212-213. doi: 10.1017/ipm.2020.42. Epub 2020 
May 14.

Counseling clients during New York City's COVID-19 pandemic: observations on 
fundamental elements of emotions management.

Sweeney M(1).

Author information:
(1)Metropolitan Center for Cognitive Behavioral Therapy, New York, USA.

New York City is in the grip of the COVID-19 pandemic. Health care centers are 
stretched beyond capacity. Daily death rates are staggering. The city's 
population is hunkered down in fear. Our anxiety treatment center is treating 
patients via video appointments. We are helping anxious individuals adapt to 
tumultuous changes that we ourselves are experiencing. Our work in this time has 
reinforced our core beliefs about managing one's emotions; that difficult times 
require more active coping and that we all draw heavily from social support and 
familiarity to create a feeling of well-being. These principles and the 
experiences of our patients are discussed.

DOI: 10.1017/ipm.2020.42
PMCID: PMC7471568
PMID: 32404210 [Indexed for MEDLINE]


4418. Crit Care Nurs Clin North Am. 2020 Jun;32(2):167-190. doi: 
10.1016/j.cnc.2020.01.002. Epub 2020 Apr 8.

The Best Medicine: Personal Pets and Therapy Animals in the Hospital Setting.

Barchas D(1), Melaragni M(2), Abrahim H(3), Barchas E(4).

Author information:
(1)University of California San Francisco Medical Center, 505 Parnassus Avenue 
M902R, San Francisco, CA 94117, USA. Electronic address: 
denise.barchas@ucsf.edu.
(2)University of California San Francisco Medical Center, 505 Parnassus Avenue 
M902R, San Francisco, CA 94117, USA.
(3)University of California San Diego Health, Jacobs Medical Center, 5H mail 
code 7306, 9300 Campus Point Dr, La Jolla, CA 92037, USA.
(4)San Bruno Pet Hospital, 1111 El Camino Real, San Bruno, CA 94066, USA.

Companion animals can have a positive impact on people's health and well-being. 
Personal pet visitation and animal-assisted interventions (AAIs) can benefit 
patients' pain, blood pressure, stress, depression, and anxiety, as well as 
increasing mobility and socialization with staff and families. Implementing 
personal pet visitation and/or AAI programs requires the involvement of 
stakeholders from multiple disciplines. AAI is generally well received by staff. 
Animal presence in the intensive care unit carries few risks for humans and 
animals but is not risk free. Programs should be designed to minimize these 
risks. Effective planning can create programs that support patient-centered and 
family-centered care.

Copyright © 2020 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.cnc.2020.01.002
PMID: 32402314 [Indexed for MEDLINE]

Conflict of interest statement: Disclosure The authors have nothing to disclose.


4419. J Med Internet Res. 2020 May 22;22(5):e19434. doi: 10.2196/19434.

Telehealth Home Support During COVID-19 Confinement for Community-Dwelling Older 
Adults With Mild Cognitive Impairment or Mild Dementia: Survey Study.

Goodman-Casanova JM(1), Dura-Perez E(1), Guzman-Parra J(1), Cuesta-Vargas A(2), 
Mayoral-Cleries F(1).

Author information:
(1)Department of Mental Health, Regional University Hospital of Málaga, 
Biomedical Research Institute of Malaga (IBIMA), Málaga, Spain.
(2)Department of Physiotherapy, University of Málaga, Biomedical Research 
Institute of Malaga (IBIMA), Málaga, Spain.

BACKGROUND: The public health emergency of coronavirus disease (COVID-19) is 
rapidly evolving worldwide; some countries, including Spain, have implemented 
restrictive measures. Populations that are vulnerable to this outbreak and its 
physical and mental health effects include community-dwelling older adults with 
mild cognitive impairment or mild dementia. Telehealth is a potential tool to 
deliver health care and decrease exposure risk.
OBJECTIVE: The aims of this study were to explore the impact of confinement on 
the health and well-being of community-dwelling older adults with mild cognitive 
impairment or mild dementia, to provide television-based and telephone-based 
health and social support, and to study the effects of a television-based 
assistive integrated technology, TV-AssistDem (TeleVision-based ASSistive 
Integrated Service to supporT European adults living with mild DEMentia or mild 
cognitive impairment).
METHODS: A telephone-based survey was administered in Spain to 93 participants 
in the TV-AssistDem clinical trial from March 25 to April 6, 2020.
RESULTS: Of the respondents, 60/93 (65%) were women. The mean age was 73.34 (SD 
6.07), and 69/93 (74%) lived accompanied. Lockdown measures forced 17/93 
respondents (18%) to change their living arrangements. Health status was found 
to be optimal in 89/93 respondents (96%), with no COVID-19 symptoms. Grocery and 
pharmacy outings were performed by family members of 68/93 participants (73%); 
57 (61%) reported overall well-being, and 65 (70%) maintained their sleep 
quality. However, participants living alone reported greater negative feelings 
and more sleeping problems. Regarding leisure activities, 53/93 respondents 
(57%) took walks, 32 (35%) played memory games, 55 (60%) watched television, and 
91 (98%) telephoned relatives. 58/93 (64%) respondents reported accessing 
moderate or too much COVID-19 information, 89 (97%) received it from television, 
and 56 (62%) stated that their understanding of the information was extreme. 
39/93 (39%) respondents had contacted health and social services, while 29 (31%) 
requested information regarding these services during the telephone call. There 
were no significant differences in health and well-being between the 
intervention and control groups. Respondents with TV-AssistDem performed more 
memory exercises (24/93, 52% vs 8/93, 17.4%; P<.001) than control respondents.
CONCLUSIONS: Our findings suggest that during COVID-19 confinement, the physical 
and mental health and well-being was optimal for the majority of our vulnerable 
population. However, those living alone reported greater negative psychological 
effects and sleeping problems. Measures adopted to address the negative 
experiences of confinement included keeping informed about the situation, 
accessing health and social services, having a support network that prevents 
risk of exposure to COVID-19 and guarantees food and medical supplies, a daily 
routine with maintained sleeping habits and leisure activities, staying 
physically and mentally active with cognitive stimulation exercises, and 
ensuring social connectedness using technology. Television sets were preferred 
technological devices to access COVID-19 information, watch television as a 
recreational activity, and perform memory exercises as an intellectual activity. 
Television-based telehealth support using TV-AssistDem demonstrated potential 
for cognitive stimulation.
TRIAL REGISTRATION: ClinicalTrials.gov NCT03653234; 
https://clinicaltrials.gov/ct2/show/NCT03653234.

©Jessica Marian Goodman-Casanova, Elena Dura-Perez, Jose Guzman-Parra, Antonio 
Cuesta-Vargas, Fermin Mayoral-Cleries. Originally published in the Journal of 
Medical Internet Research (http://www.jmir.org), 22.05.2020.

DOI: 10.2196/19434
PMCID: PMC7247465
PMID: 32401215 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


4420. Drug Alcohol Rev. 2020 Jul;39(5):441-446. doi: 10.1111/dar.13088. Epub 2020 May 
12.

Assessing the validity of the Australian Treatment Outcomes Profile for 
telephone administration in drug health treatment populations.

Deacon RM(1)(2)(3), Mammen K(2)(3), Holmes J(3)(4), Dunlop A(3)(5)(6), Bruno 
R(7)(8), Mills L(1)(2)(3), Graham R(3)(9)(10), Lintzeris N(1)(2)(3).

Author information:
(1)Sydney School of Medicine (Central Clinical School), Faculty of Medicine and 
Health, The University of Sydney, Sydney, Australia.
(2)Drug and Alcohol Services, South Eastern Sydney Local Health District, 
Sydney, Australia.
(3)NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, 
Australia.
(4)Alcohol and other Drugs, Centre for Population Health, Ministry of Health, 
Sydney, Australia.
(5)Drug and Alcohol Services, Hunter New England Local Health District, 
Newcastle, Australia.
(6)Hunter Medical Research Institute, The University of Newcastle, Newcastle, 
Australia.
(7)National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.
(8)School of Psychological Sciences, University of Tasmania, Hobart, Australia.
(9)Drug Health, Western Sydney Local Health District, Sydney, Australia.
(10)School of Medicine, Western Sydney University, Sydney, Australia.

INTRODUCTION AND AIMS: The Australian Treatment Outcomes Profile (ATOP) is a 
brief clinical tool measuring recent substance use, health and wellbeing among 
clients attending alcohol and other drug (AOD) treatment services. It has 
previously been assessed for concurrent validity and inter-rater reliability. In 
this study we examine whether it is suitable for administration over the 
telephone.
DESIGN AND METHODS: We recruited a sample of 107 AOD clients across public 
sector specialist AOD treatment services in New South Wales, Australia between 
2016 and 2018. Participants had a mean age of 47 years and 46% were female. 
Participants completed a face-to-face ATOP and a phone ATOP with a researcher 
within 5 days. Comparisons between the two administration modes were undertaken 
using Spearman's rank correlation coefficient for continuous or ordinal 
variables, and Cohen's Kappa for nominal variables.
RESULTS: Among 107 participants, 59% were attending for alcohol treatment and 
41% for opioid treatment. Most ATOP items (76%) reached above 0.7 (good) or 0.9 
(excellent) agreement between face-to-face and telephone use.
DISCUSSION AND CONCLUSIONS: Our findings suggest that the ATOP is a suitable 
instrument for telephone monitoring of recent substance use, health and social 
functioning among AOD clients. Its validation for remote use over the telephone 
will support staff to monitor clients' risks and outcomes-of particular 
relevance in response to the COVID-19 pandemic in which services are 
increasingly relying on telework approaches to client monitoring.

© 2020 Australasian Professional Society on Alcohol and other Drugs.

DOI: 10.1111/dar.13088
PMID: 32395850 [Indexed for MEDLINE]


4421. Zhejiang Da Xue Xue Bao Yi Xue Ban. 2020 Feb 21;49(2):147-157. doi: 
10.3785/j.issn.1008-9292.2020.02.02.

[Management of COVID-19: the Zhejiang experience].

[Article in Chinese]

Xu K(1)(2), Cai H(1), Shen Y(1), Ni Q(1)(2), Chen Y(1), Hu S(1), Li J(1), Wang 
H(1), Yu L(1)(2), Huang H(1), Qiu Y(1), Wei G(1), Fang Q(1), Zhou J(1), Sheng 
J(1)(2), Liang T(1), Li L(1)(2).

Author information:
(1)The First Affiliated Hospital, Zhejiang University School of Medicine, 
Hangzhou 310003, China.
(2)State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, 
National Clinical Research Center for Infectious Diseases, Collaborative 
Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First 
Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, 
China.

The current epidemic situation of coronavirus disease 2019 (COVID-19) still 
remained severe. As the National Clinical Research Center for Infectious 
Diseases, the First Affiliated Hospital of Zhejiang University School of 
Medicine is the primary medical care center for COVID-19 in Zhejiang province. 
Based on the present expert consensus carried out by National Health Commission 
and National Administration of Traditional Chinese Medicine, our team summarized 
and established an effective treatment strategy centered on "Four-Anti and 
Two-Balance" for clinical practice. The "Four-Anti and Two-Balance" strategy 
included antivirus, anti-shock, anti-hyoxemia, anti-secondary infection, and 
maintaining of water, electrolyte and acid base balance and microecological 
balance. Meanwhile, integrated multidisciplinary personalized treatment was 
recommended to improve therapeutic effect. The importance of early viralogical 
detection, dynamic monitoring of inflammatory indexes and chest radiograph was 
emphasized in clinical decision-making. Sputum was observed with the highest 
positive rate of RT-PCR results. Viral nucleic acids could be detected in 
10%patients' blood samples at acute period and 50%of patients had positive 
RT-PCR results in their feces. We also isolated alive viral strains from feces, 
indicating potential infectiousness of feces.Dynamic cytokine detection was 
necessary to timely identifying cytokine storms and application of artificial 
liver blood purification system. The "Four-Anti and Two-Balance" strategy 
effectively increased cure rate and reduced mortality. Early antiviral treatment 
could alleviate disease severity and prevent illness progression, and we found 
lopinavir/ritonavir combined with abidol showed antiviral effects in COVID-19. 
Shock and hypoxemia were usually caused by cytokine storms. The artificial liver 
blood purification system could rapidly remove inflammatory mediators and block 
cytokine storm.Moreover, it also favored the balance of fluid, electrolyte and 
acid-base and thus improved treatment efficacy in critical illness. For cases of 
severe illness, early and also short period of moderate glucocorticoid was 
supported. Patients with oxygenation index below 200 mmHg should be transferred 
to intensive medical center. Conservative oxygen therapy was preferred and 
noninvasive ventilation was not recommended. Patients with mechanical 
ventilation should be strictly supervised with cluster ventilator-associated 
pneumonia prevention strategies. Antimicrobial prophylaxis was not recommended 
except for patients with long course of disease, repeated fever and elevated 
procalcitonin (PCT), meanwhile secondary fungal infection should be 
concerned.Some patients with COVID-19 showed intestinal microbial dysbiosis with 
decreased probiotics such as Lactobacillus and Bifidobacterium, so nutritional 
and gastrointestinal function should be assessed for all patients.Nutritional 
support and application of prebiotics or probiotics were suggested to regulate 
the balance of intestinal microbiota and reduce the risk of secondary infection 
due to bacterial translocation. Anxiety and fear were common in patients with 
COVID-19. Therefore,we established dynamic assessment and warning for 
psychological crisis. We also integrated Chinese medicine in treatment to 
promote disease rehabilitation through classification methods of traditional 
Chinese medicine. We optimized nursing process for severe patients to promote 
their rehabilitation. It remained unclear about viral clearance pattern after 
the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. 
Therefore, two weeks' quarantine for discharged patients was required and a 
regular following up was also needed.The Zhejiang experience and suggestions 
have been implemented in our center and achieved good results. However, since 
COVID-19 was a newly emerging disease, more work was warranted to improve 
strategies of prevention, diagnosis and treatment for COVID-19.

当前2019冠状病毒病（COVID-19）疫情仍处于胶着状态。浙江大学医学院附属第一医院是国家感染性疾病临床医学中心，浙江省COVID-19患者救治中心。疫情一线的专家集智攻关，以国家卫生健康委员会和国家中医药管理局发布的COVID-19诊治指南为依据，以抗病毒、抗休克、抗低氧血症、抗继发感染、维持水电解质和酸碱平衡、维持微生态平衡的“四抗二平衡”救治策略为核心，总结完善诊治方案，聚焦临床实践的一些具体问题，为COVID-19患者临床诊治提供借鉴。推荐以多学科协作诊治个性化治疗提高COVID-19患者救治质量。建议病原学检测、炎症指标监测和肺部影像学动态观察指导临床诊治。痰液的病毒核酸检测阳性率最高，约10%的急性期患者血液中检测到病毒核酸，50%的患者粪便中检测到病毒核酸，粪便中可分离出活病毒，须警惕粪便是否具有传染性；开展细胞因子等炎症指标监测有助于发现是否出现细胞因子风暴，判断是否需要人工肝血液净化治疗。通过以“四抗二平衡”为核心的综合治疗提高治愈率、降低病死率；早期抗病毒治疗能减少重症、危重症发生，前期使用阿比多尔联合洛匹那韦/利托那韦抗病毒显示出一定效果。休克和低氧血症多为细胞因子风暴所致，人工肝血液净化治疗能迅速清除炎症介质，阻断细胞因子风暴，对维持水电解质酸碱平衡也有很好的作用，可以提高危重型患者的疗效。重型病例疾病早期可适量、短程应用糖皮质激素。氧疗过程中，患者氧合指数小于200 
mmHg时应及时转入重症医学科治疗；采用保守氧疗策略，不推荐常规进行无创通气；机械通气患者应严格执行集束化呼吸机相关性肺炎预防管理策略；氧合指数大于150 
mmHg时，及早减、停镇静剂并撤机拔管。不推荐预防性使用抗菌药物，对于病程长，体温反复升高和血降钙素原水平升高的患者可酌情使用抗菌药物；要关注COVID-19患者继发真菌感染的诊治。COVID-19患者有肠道微生态紊乱，肠道乳酸杆菌、双歧杆菌等有益菌减少，推荐对所有患者进行营养和胃肠道功能评估，以营养支持和补充大剂量肠道微生态调节剂，纠正肠道微生态失衡，减少细菌移位和继发感染。COVID-19患者普遍存在焦虑和恐惧心理，应建立动态心理危机干预和处理。提倡中西医结合辨证施治；优化重型患者护理促进康复。严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染后病毒清除规律仍不明了，出院后仍须居家隔离2周，并定期随访。以上经验和建议在本中心实行，取得较好效果，但COVID-19是一种新的疾病，其诊治方案及策略仍有待进一步探索与完善。

DOI: 10.3785/j.issn.1008-9292.2020.02.02
PMCID: PMC8800711
PMID: 32391658 [Indexed for MEDLINE]


4422. Psychiatry Res. 2020 Jul;289:113045. doi: 10.1016/j.psychres.2020.113045. Epub 
2020 Apr 30.

How an Epidemic Outbreak Impacts Happiness: Factors that Worsen (vs. Protect) 
Emotional Well-being during the Coronavirus Pandemic.

Yang H(1), Ma J(2).

Author information:
(1)Johns Hopkins University, Baltimore, Maryland, USA.
(2)Peking University, Beijing, China.

What are the factors that worsen (vs. protect) emotional well-being during a 
pandemic outbreak such as COVID-19? Through two large-scale nationwide surveys 
(N1  = 11,131; N2  = 3,000) conducted in China immediately before versus during 
the coronavirus outbreak, we found that the onset of the coronavirus epidemic 
led to a 74% drop in overall emotional well-being. Factors associated with the 
likelihood of contracting the disease (e.g., residing near the epicenter), 
extent of potential harm (e.g., being an elderly), and relational issues (e.g., 
those within a marriage) exacerbated the detrimental effect of the outbreak on 
emotional well-being. Further, individuals' perception of their knowledge about 
coronavirus infection was another factor. Regardless of the actual amount of 
knowledge they possessed, those perceiving themselves as more knowledgeable, 
were able to experience more happiness during the outbreak. Higher perceived 
knowledge was associated with a stronger sense of control, which mediated the 
differences in emotional well-being. These patterns persisted even after 
controlling for a host of demographic and economic variables. In conclusion, 
public policies and mental health interventions aimed at boosting/protecting 
psychological well-being during epidemics should take account of these factors.

© 2020 The Authors.

DOI: 10.1016/j.psychres.2020.113045
PMCID: PMC7190485
PMID: 32388418 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that there are no conflicts 
of interest.


4423. Eur J Cardiovasc Nurs. 2020 Aug;19(6):486-494. doi: 10.1177/1474515120924530. 
Epub 2020 May 7.

Delivering healthcare remotely to cardiovascular patients during COVID-19 : A 
rapid review of the evidence.

Neubeck L(1)(2), Hansen T(3)(4), Jaarsma T(5)(6), Klompstra L(6), Gallagher 
R(2).

Author information:
(1)School of Health and Social Care, Edinburgh Napier University, UK.
(2)Sydney Nursing School, Charles Perkins Centre, University of Sydney, 
Australia.
(3)Department of Cardiology, Zealand University Hospital, Roskilde, Denmark.
(4)University of Southern Denmark, Department of Regional Health Research, 
Odense, Denmark.
(5)Julius Centre, University Medical Centre Utrecht, The Netherlands.
(6)Department of Health, Division of Nursing Sciences and Reproductive Health, 
Department of Health, Medicine and Caring Sciences, Linköping University, 
Sweden.

Comment in
    Eur J Cardiovasc Nurs. 2020 Aug;19(6):458-461.
    Eur J Cardiovasc Nurs. 2021 Feb 11;20(1):1-2.

BACKGROUND: Although attention is focused on addressing the acute situation 
created by the COVID-19 illness, it is imperative to continue our efforts to 
prevent cardiovascular morbidity and mortality, particularly during a period of 
prolonged social isolation which may limit physical activity, adversely affect 
mental health and reduce access to usual care. One option may be to deliver 
healthcare interventions remotely through digital healthcare solutions. 
Therefore, the aim of this paper is to bring together the evidence for remote 
healthcare during a quarantine situation period to support people living with 
cardiovascular disease during COVID-19 isolation.
METHODS: The PubMed, CINAHL and Google Scholar were searched using telehealth OR 
digital health OR mHealth OR eHealth OR mobile apps AND COVID-19 OR quarantine 
search terms. We also searched for literature relating to cardiovascular disease 
AND quarantine.
RESULTS: The literature search identified 45 potentially relevant publications, 
out of which nine articles were included. Three overarching themes emerged from 
this review: (1) preparing the workforce and ensuring reimbursement for remote 
healthcare, (2) supporting mental and physical health and (3) supporting usual 
care.
CONCLUSION: To support people living with cardiovascular disease during COVID-19 
isolation and to mitigate the effects of quarantine and adverse effect on mental 
and physical well-being, we should offer remote healthcare and provide access to 
their usual care.

DOI: 10.1177/1474515120924530
PMCID: PMC7717235
PMID: 32380858 [Indexed for MEDLINE]


4424. Int J Surg. 2020 Jun;78:147-148. doi: 10.1016/j.ijsu.2020.04.070. Epub 2020 May 
5.

Effects of the COVID-19 pandemic on mental well-being amongst individuals in 
society- A letter to the editor on "The socio-economic implications of the 
coronavirus and COVID-19 pandemic: A review".

Alradhawi M(1), Shubber N(2), Sheppard J(2), Ali Y(2).

Author information:
(1)UCL Medical School, University College London, United Kingdom. Electronic 
address: mohammad.alradhawi.17@ucl.ac.uk.
(2)UCL Medical School, University College London, United Kingdom.

Comment on
    Int J Surg. 2020 Jun;78:185-193.

DOI: 10.1016/j.ijsu.2020.04.070
PMCID: PMC7198428
PMID: 32380230 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest No conflicts 
of interest.


4425. Prog Urol. 2020 Jun-Jul;30(8-9):448-455. doi: 10.1016/j.purol.2020.04.015. Epub 
2020 Apr 23.

COVID19 pandemic impacts on anxiety of French urologist in training: Outcomes 
from a national survey.

Abdessater M(1), Rouprêt M(2), Misrai V(3), Matillon X(4), Gondran-Tellier B(5), 
Freton L(6), Vallée M(7), Dominique I(8), Felber M(1), Khene ZE(6), Fortier 
E(9), Lannes F(5), Michiels C(10), Grevez T(11), Szabla N(12), Boustany J(13), 
Bardet F(14), Kaulanjan K(15), Seizilles de Mazancourt E(4), Ploussard G(16), 
Pinar U(1), Pradere B(17); Association Française des Urologues en Formation 
(AFUF).

Author information:
(1)Sorbonne Université, GRC n(o) 5, Predictive onco-urology, AP-HP, Hôpital 
Pitié-Salpêtrière, Urology, 75013 Paris, France.
(2)Sorbonne Université, GRC n(o) 5, Predictive onco-urology, AP-HP, Hôpital 
Pitié-Salpêtrière, Urology, 75013 Paris, France. Electronic address: 
morgan.roupret@aphp.fr.
(3)Clinique Pasteur, 31300 Toulouse, France.
(4)Department of Urology and Transplantation, Edouard Herriot Hospital, Hospices 
Civils de Lyon, Lyon, France.
(5)Department of Urology, La Conception University Hospital, Assistance-Publique 
Marseille, Marseille, France.
(6)Department of Urology, University Hospital of Rennes, Rennes, France.
(7)Department of Urology, Poitiers University Hospital, Poitiers, France.
(8)Department of Urology, Groupe Hospitalier Diaconesses Croix Saint-Simon, 
Paris, France.
(9)Department of Urology, Montpellier University Hospital, Montpellier, France.
(10)Department of Urology, Bordeaux University Hospital, Bordeaux, France.
(11)Department of Urology, CHRU Tours, Francois Rabelais University, Tours, 
France.
(12)Department of Urology and Transplantation, Caen University Hospital, Caen, 
France.
(13)Department of Urology and Renal Transplantation, Henri Mondor University 
Hospital, Créteil, France.
(14)Department of Urology, Dijon University Hospital, Dijon, France.
(15)Department of Urology, CHU Pointe-à-Pitre, Pointe-à-Pitre, Guadeloupe.
(16)Department of Urology, Ramsay Santé, Clinique La Croix du Sud, Quint 
Fonsegrives, France.
(17)Department of Urology, CHRU Tours, Francois Rabelais University, Tours, 
France; Department of Urology, Comprehensive Cancer Center, Medical University 
of Vienna, Vienna, Austria.

INTRODUCTION: The COVID-19 outbreak in France is disturbing our health system. 
Urologists in training who are already known to have burnout, are in the front 
line to face this disease. The aim of our study was to assess the psychological 
impact of COVID-19 pandemic on young French urologists in training.
MATERIAL AND METHODS: A self-administered anonymous questionnaire evaluating the 
pandemic added stress, and its negative impact on work and training quality, was 
e-mailed to the members of the French Association of Urologists in Training 
(AFUF). The association includes all French junior and senior residents. The 
survey lasted 3 days. Multivariable analyses using logistic regression was 
performed to identify the predictive factors.
RESULTS: Two hundred and seventy-five (55.5%) of the 495 AFUF members responded 
to the questionnaire. More than 90% of responders felt more stressed by the 
pandemic. Fellows and senior residents were more likely to feel that the crisis 
had an important impact on their work quality (OR=1.76, IC95=[1.01-3.13]), even 
more when COVID 19 patients were present in their department (OR=2.31, 
IC95=[1.20-4.65]). Past medical history of respiratory disease (OR=2.57, 
IC95=[1.31-5.98]) and taking in charge COVID19 patients (OR=1.85, 
IC95=[0.98-3.59]) were additional risk factors.
CONCLUSION: COVID19 pandemic has a negative impact on young French urologists in 
training and on their work and training quality. Managing their psychosocial 
well-being during this time is as important as managing their physical health.
LEVEL OF EVIDENCE: 3.

INTRODUCTION: La pandémie actuelle de COVID19 en France met sous tension notre 
système de santé. Les internes d’urologie, représentant une population à risque 
reconnu de burnout, sont en première ligne pour faire face à cette nouvelle 
pathologie. L’objectif de cette étude était d’évaluer l’impact psychologique du 
COVID19 sur les urologues en formation.
MATÉRIELS ET MÉTHODES: Un questionnaire anonyme évaluant le stress surajouté par 
l’épidémie, la détérioration de la qualité de travail ainsi que le 
retentissement sur la formation médicale a été adressé par mail à tous les 
membres de l’Association française des urologues en formation (AFUF). L’AFUF 
regroupe tous les internes et CCA/assistant de France. Ce questionnaire est 
resté ouvert au total trois jours. Les facteurs associés aux critères de 
jugement étaient calculés par régression logistique multivariée.
RÉSULTATS: Au total 55,5 % des membres de l’AFUF ont répondu au questionnaire. 
Plus de 90 % des participants se sentaient plus stressés à cause de l’épidémie. 
L’épidémie était plus susceptible d’avoir un impact négatif sur la qualité de 
travail des urologues les plus expérimentés (OR = 1,76, IC95 = [1,01–3,13) et 
lorsqu’ils prenaient en charge des patients COVID19 dans leur service 
(OR = 2,31, IC95 = [1,20–4,65]). Le fait d’avoir un antécédent médical 
respiratoire (OR = 2,57, IC95 = [1,31–5,98]) et de s’occuper de patients COVID19 
(OR = 1,85, IC95 = [0,98–3,59]) étaient des facteurs de risque de stress chez 
les participants.
CONCLUSION: La pandémie de COVID19 entraîne une répercussion psychologique ainsi 
qu’une détérioration de la qualité de travail sur les jeunes urologues en 
formation français. La vigilance concernant des signaux d’épuisement doit être 
accrue en cette période de crise sanitaire.
NIVEAU DE PREUVE: 3.

Copyright © 2020 Elsevier Masson SAS. All rights reserved.

DOI: 10.1016/j.purol.2020.04.015
PMCID: PMC7177119
PMID: 32376208 [Indexed for MEDLINE]


4426. J Health Psychol. 2020 Jun;25(7):871-882. doi: 10.1177/1359105320925149. Epub 
2020 May 6.

Human needs in COVID-19 isolation.

Matias T(1), Dominski FH(2), Marks DF(3).

Author information:
(1)UFSC, Brazil.
(2)UDESC, Brazil.
(3)Independent Researcher, France.

To reduce the spread of COVID-19, the World Health Organization and the majority 
of governments have recommended that the entire human population should 
'stay-at-home'. A significant proportion of the population live alone or are 
vulnerable to mental health problems yet, in the vast majority of cases, 
individuals in social isolation have no access to mental healthcare. The only 
resource is people themselves using self-help, self-medication and self-care. 
During prolonged COVID-19 isolation, an in-built system of homeostasis can help 
rebalance activity, thought and feeling. Increased physical activity enables a 
reset of physical and mental well-being. During periods of lockdown, it is 
recommended that exercise should be as vigorously promoted as social distancing 
itself.

DOI: 10.1177/1359105320925149
PMID: 32375564 [Indexed for MEDLINE]


4427. Encephale. 2020 Jun;46(3S):S73-S80. doi: 10.1016/j.encep.2020.04.008. Epub 2020 
Apr 22.

[Health professionals facing the coronavirus disease 2019 (COVID-19) pandemic: 
What are the mental health risks?].

[Article in French]

El-Hage W(1), Hingray C(2), Lemogne C(3), Yrondi A(4), Brunault P(5), Bienvenu 
T(6), Etain B(7), Paquet C(8), Gohier B(9), Bennabi D(10), Birmes P(11), 
Sauvaget A(12), Fakra E(13), Prieto N(14), Bulteau S(15), Vidailhet P(16), Camus 
V(17), Leboyer M(18), Krebs MO(19), Aouizerate B(20).

Author information:
(1)Pôle de psychiatrie et d'addictiologie, CHRU de Tours, Tours, France; Inserm, 
UMR 1253, iBrain, université de Tours, Tours, France. Electronic address: 
wissam.el-hage@univ-tours.fr.
(2)Pôle hospitalo-universitaire de psychiatrie d'adultes du Grand Nancy, centre 
psychothérapique de Nancy, Laxou, France.
(3)Inserm, UMR S1266, université de Paris, institut de psychiatrie et 
neurosciences de Paris, Paris, France; Service de psychiatrie et d'addictologie 
de l'adulte et du sujet âgé, centre-université de Paris, hôpital européen 
Georges-Pompidou, AP-HP, Paris, France.
(4)Inserm, UPS, service de psychiatrie et de psychologie médicale de l'adulte, 
centre expert dépression résistante FondaMental, ToNIC Toulouse NeuroImaging 
Center, université de Toulouse, hôpital Purpan, CHU de Toulouse, Toulouse, 
France.
(5)Pôle de psychiatrie et d'addictiologie, CHRU de Tours, Tours, France; 
QualiPsy EE 1901, qualité de vie et santé psychologique, département de 
psychologie, université de Tours, Tours, France.
(6)Pôle de psychiatrie générale et universitaire, centre de référence régional 
des pathologies anxieuses et de la dépression, université de Bordeaux, CH 
Charles-Perrens, Bordeaux, France; Neurocentre Magendie, Inserm U1215, Bordeaux, 
France.
(7)Inserm, UMRS 1144, université de Paris, Paris, France; DMU Neurosciences, 
centre expert troubles bipolaires FondaMental, hôpital Fernand-Widal, AP-HP 
Nord, Paris, France.
(8)Inserm, UMRS 1144, université de Paris, Paris, France; DMU Neurosciences, 
centre de neurologie cognitive, hôpital Lariboisière, AP-HP Nord, Paris, France.
(9)UPRES, EA 4638, département de psychiatrie et d'addictologie, université 
d'Angers, CHU d'Angers, Angers, France.
(10)Service de psychiatrie de l'adulte, centre expert dépression résistante 
FondaMental, université Bourgogne Franche-Comté, CHU de Besançon, Besançon, 
France.
(11)Inserm, UPS, Toulouse NeuroImaging Center, université de Toulouse, Toulouse, 
France.
(12)EA 4334, Movement Interactions Performance (MIP), université de Nantes, CHU 
de Nantes, Nantes, France.
(13)Inserm U1028, CNRS UMR 5292, pôle universitaire de psychiatrie, équipe 
PsyR2, centre de recherche en neurosciences de Lyon, université St-Étienne-Lyon 
1, CHU Saint-Étienne, Saint-Étienne, France.
(14)Service de médecine légale, centre régional de psychotraumatologie Auvergne 
Rhône-Alpes, groupement hospitalier Édouard-Herriot, hospices civils de Lyon, 
Lyon, France.
(15)Inserm, U1246, SPHERE, université de Nantes et université de Tours, Nantes, 
France.
(16)Inserm, U1114, centre régional de psychotraumatologie Grand-Est, université 
de Strasbourg, Strasbourg, France.
(17)Pôle de psychiatrie et d'addictiologie, CHRU de Tours, Tours, France; 
Inserm, UMR 1253, iBrain, université de Tours, Tours, France.
(18)DMU IMPACT, département médico-universitaire de psychaitrie et 
d'addictologie, hôpital H. Mondor, AP-HP, Créteil, France; Fondation 
Fondamental, Créteil, France; UPEC, Inserm, université Paris Est Créteil, U955, 
équipe 15 Neuro-Psychiatrie translationnelle, Créteil, France.
(19)UMR 1266, Inserm, IPNP, CNRS, université Paris Descartes, GDR 3557-Institut 
de Psychiatrie, Paris, France; Service hospitalo-universitaire, GHU Paris 
Sainte-Anne, Paris, France.
(20)Pôle de psychiatrie générale et universitaire, centre de référence régional 
des pathologies anxieuses et de la dépression, université de Bordeaux, CH 
Charles-Perrens, Bordeaux, France.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has caused major 
sanitary crisis worldwide. Half of the world has been placed in quarantine. In 
France, this large-scale health crisis urgently triggered the restructuring and 
reorganization of health service delivery to support emergency services, medical 
intensive care units and continuing care units. Health professionals mobilized 
all their resources to provide emergency aid in a general climate of 
uncertainty. Concerns about the mental health, psychological adjustment, and 
recovery of health care workers treating and caring for patients with COVID-19 
are now arising. The goal of the present article is to provide up-to-date 
information on potential mental health risks associated with exposure of health 
professionals to the COVID-19 pandemic.
METHODS: Authors performed a narrative review identifying relevant results in 
the scientific and medical literature considering previous epidemics of 2003 
(SARS-CoV-1) and 2009 (H1N1) with the more recent data about the COVID-19 
pandemic. We highlighted most relevant data concerning the disease 
characteristics, the organizational factors and personal factors that may 
contribute to developing psychological distress and other mental health 
symptoms.
RESULTS: The disease characteristics of the current COVID-19 pandemic provoked a 
generalized climate of wariness and uncertainty, particularly among health 
professionals, due to a range of causes such as the rapid spread of COVID-19, 
the severity of symptoms it can cause in a segment of infected individuals, the 
lack of knowledge of the disease, and deaths among health professionals. Stress 
may also be caused by organizational factors, such as depletion of personal 
protection equipment, concerns about not being able to provide competent care if 
deployed to new area, concerns about rapidly changing information, lack of 
access to up-to-date information and communication, lack of specific drugs, the 
shortage of ventilators and intensive care unit beds necessary to care for the 
surge of critically ill patients, and significant change in their daily social 
and family life. Further risk factors have been identified, including feelings 
of being inadequately supported, concerns about health of self, fear of taking 
home infection to family members or others, and not having rapid access to 
testing through occupational health if needed, being isolated, feelings of 
uncertainty and social stigmatization, overwhelming workload, or insecure 
attachment. Additionally, we discussed positive social and organizational 
factors that contribute to enhance resilience in the face of the pandemic. There 
is a consensus in all the relevant literature that health care professionals are 
at an increased risk of high levels of stress, anxiety, depression, burnout, 
addiction and post-traumatic stress disorder, which could have long-term 
psychological implications.
CONCLUSIONS: In the long run, this tragic health crisis should significantly 
enhance our understanding of the mental health risk factors among the health 
care professionals facing the COVID-19 pandemic. Reporting information such as 
this is essential to plan future prevention strategies. Protecting health care 
professionals is indeed an important component of public health measures to 
address large-scale health crisis. Thus, interventions to promote mental 
well-being in health care professionals exposed to COVID-19 need to be 
immediately implemented, and to strengthen prevention and response strategies by 
training health care professionals on mental help and crisis management.

OBJECTIFS: La pandémie de la maladie à coronavirus (COVID-19) a provoqué une 
crise sanitaire majeure et mis en quarantaine la moitié de la population 
planétaire. En France, elle a provoqué une réorganisation en urgence de l’offre 
de soins mobilisant les soignants dans un climat d’incertitude. L’objectif du 
présent article est de faire le point sur les risques associés à l’exposition 
des soignants au COVID-19 pour leur santé mentale.
MÉTHODES: Les auteurs ont conduit une revue de la littérature internationale 
tenant compte des données des précédentes épidémies (SARS-CoV-1, H1N1) et des 
données plus récentes concernant le COVID-19.
RÉSULTATS: Les caractéristiques de cette pandémie (rapidité de diffusion, 
connaissances incertaines, sévérité, décès de soignants) ont installé un climat 
anxiogène. Des facteurs organisationnels peuvent être source de stress : déficit 
d’équipement de protection individuel, réaffectation de postes, manque de 
communication, manque de matériels de soins, bouleversement de la vie 
quotidienne familiale et sociale. D’autres facteurs de risque sont identifiés 
comme l’absence de soutien, la crainte de contaminer un proche, l’isolement ou 
la stigmatisation sociale, le haut niveau de stress au travail ou les patterns 
d’attachement insécure. Les soignants ont ainsi un risque augmenté d’anxiété, de 
dépression, d’épuisement, d’addiction et de trouble de stress post-traumatique.
CONCLUSIONS: Cette crise sanitaire devrait nous aider à mieux comprendre la 
vulnérabilité des soignants à la souffrance psychologique afin de renforcer les 
stratégies de prévention primaire et la formation aux enjeux psychologiques des 
soins, de la relation, et de la gestion des situations de crises sanitaires.

Copyright © 2020 L'Encéphale, Paris. Published by Elsevier Masson SAS. All 
rights reserved.

DOI: 10.1016/j.encep.2020.04.008
PMCID: PMC7174182
PMID: 32370984 [Indexed for MEDLINE]


4428. J Med Internet Res. 2020 May 19;22(5):e19556. doi: 10.2196/19556.

The Impact of Social Media on Panic During the COVID-19 Pandemic in Iraqi 
Kurdistan: Online Questionnaire Study.

Ahmad AR(#)(1)(2), Murad HR(#)(3).

Author information:
(1)Department of Administration, College of Humanities, University of Raparin, 
Ranya - Al Sulaimaniyah, Iraq.
(2)Department of International Relations & Diplomacy, Faculty of Administrative 
Sciences and Economics, Tishk International University, Erbil, Iraq.
(3)Department of Public Relations & Marketing, Technical College of 
Administration, Sulaimani Polytechnic University, Sulaimani, Iraq.
(#)Contributed equally

BACKGROUND: In the first few months of 2020, information and news reports about 
the coronavirus disease (COVID-19) were rapidly published and shared on social 
media and social networking sites. While the field of infodemiology has studied 
information patterns on the Web and in social media for at least 18 years, the 
COVID-19 pandemic has been referred to as the first social media infodemic. 
However, there is limited evidence about whether and how the social media 
infodemic has spread panic and affected the mental health of social media users.
OBJECTIVE: The aim of this study is to determine how social media affects 
self-reported mental health and the spread of panic about COVID-19 in the 
Kurdistan Region of Iraq.
METHODS: To carry out this study, an online questionnaire was prepared and 
conducted in Iraqi Kurdistan, and a total of 516 social media users were 
sampled. This study deployed a content analysis method for data analysis. 
Correspondingly, data were analyzed using SPSS software.
RESULTS: Participants reported that social media has a significant impact on 
spreading fear and panic related to the COVID-19 outbreak in Iraqi Kurdistan, 
with a potential negative influence on people's mental health and psychological 
well-being. Facebook was the most used social media network for spreading panic 
about the COVID-19 outbreak in Iraq. We found a significant positive statistical 
correlation between self-reported social media use and the spread of panic 
related to COVID-19 (R=.8701). Our results showed that the majority of youths 
aged 18-35 years are facing psychological anxiety.
CONCLUSIONS: During lockdown, people are using social media platforms to gain 
information about COVID-19. The nature of the impact of social media panic among 
people varies depending on an individual's gender, age, and level of education. 
Social media has played a key role in spreading anxiety about the COVID-19 
outbreak in Iraqi Kurdistan.

©Araz Ramazan Ahmad, Hersh Rasool Murad. Originally published in the Journal of 
Medical Internet Research (http://www.jmir.org), 19.05.2020.

DOI: 10.2196/19556
PMCID: PMC7238863
PMID: 32369026 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


4429. Int J Environ Res Public Health. 2020 Apr 26;17(9):2997. doi: 
10.3390/ijerph17092997.

Mitigating the Psychological Impact of COVID-19 on Healthcare Workers: A Digital 
Learning Package.

Blake H(1)(2), Bermingham F(3), Johnson G(4), Tabner A(4).

Author information:
(1)School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK.
(2)National Institute for Health Research (NIHR) Nottingham Biomedical Research 
Centre, Queen's Medical Centre, Nottingham NG7 2UH, UK.
(3)Leicester Medical School, University of Leicester, Lancaster Rd, Leicester 
LE1 7HA, UK.
(4)REMEDI Emergency Department, Royal Derby Hospital, Uttoxeter Rd, Derby DE22 
3NE, UK.

The coronavirus pandemic (COVID-19) will undoubtedly have psychological impacts 
for healthcare workers, which could be sustained; frontline workers will be 
particularly at risk. Actions are needed to mitigate the impacts of COVID-19 on 
mental health by protecting and promoting the psychological wellbeing of 
healthcare workers during and after the outbreak. We developed and evaluated a 
digital learning package using Agile methodology within the first three weeks of 
UK outbreak. This e-package includes evidence-based guidance, support and 
signposting relating to psychological wellbeing for all UK healthcare employees. 
A three-step rapid development process included public involvement activities 
(PPIs) (STEP 1), content and technical development with iterative peer review 
(STEP 2), and delivery and evaluation (STEP 3). The package outlines the actions 
that team leaders can take to provide psychologically safe spaces for staff, 
together with guidance on communication and reducing social stigma, peer and 
family support, signposting others through psychological first aid (PFA), 
self-care strategies (e.g., rest, work breaks, sleep, shift work, fatigue, 
healthy lifestyle behaviours), and managing emotions (e.g., moral injury, 
coping, guilt, grief, fear, anxiety, depression, preventing burnout and 
psychological trauma). The e-package includes advice from experts in mental 
wellbeing as well as those with direct pandemic experiences from the frontline, 
as well as signposting to public mental health guidance. Rapid delivery in STEP 
3 was achieved via direct emails through professional networks and social media. 
Evaluation included assessment of fidelity and implementation qualities. 
Essential content was identified through PPIs (n = 97) and peer review (n = 10) 
in STEPS 1 and 2. The most important messages to convey were deemed to be 
normalisation of psychological responses during a crisis, and encouragement of 
self-care and help-seeking behaviour. Within 7 days of completion, the package 
had been accessed 17,633 times, and healthcare providers had confirmed immediate 
adoption within their health and wellbeing provisions. Evaluation (STEP 3, n = 
55) indicated high user satisfaction with content, usability and utility. 
Assessment of implementation qualities indicated that the package was perceived 
to be usable, practical, low cost and low burden. Our digital support package on 
'psychological wellbeing for healthcare workers' is free to use, has been 
positively evaluated and was highly accessed within one week of release. It is 
available here: Supplementary Materials. This package was deemed to be 
appropriate, meaningful and useful for the needs of UK healthcare workers. We 
recommend provision of this e-package to healthcare workers alongside wider 
strategies to support their psychological wellbeing during and after the 
COVID-19 pandemic.

DOI: 10.3390/ijerph17092997
PMCID: PMC7246821
PMID: 32357424 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest


4430. JAMA Psychiatry. 2020 Sep 1;77(9):974-976. doi: 
10.1001/jamapsychiatry.2020.1276.

Mental Health in the Coronavirus Disease 2019 Emergency-The Italian Response.

de Girolamo G(1), Cerveri G(2), Clerici M(3)(4), Monzani E(5), Spinogatti F(6), 
Starace F(7), Tura G(8), Vita A(9)(10).

Author information:
(1)Unità Operativa di Psichiatria Epidemiologica e Valutativa, IRCCS Istituto 
Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
(2)Department of Mental Health and Addiction, ASST Lodi, Lodi, Italy.
(3)Department of Mental Health and Addiction, ASST Monza, Monza, Italy.
(4)Psychiatric Clinic, University of Milan Bicocca, Monza, Italy.
(5)Department of Mental Health and Addiction, ASST Bergamo Ovest, Treviglio, 
Italy.
(6)Department of Mental Health and Addiction, ASST Cremona, Cremona, Italy.
(7)Department of Mental Health and Addiction, AUSL di Modena, Modena, Italy.
(8)Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 
Brescia, Italy.
(9)Department of Mental Health and Addiction, ASST Brescia, Brescia, Italy.
(10)Psychiatric Clinic, University of Brescia, Brescia, Italy.

IMPORTANCE: This article briefly reports the experience of mental health 
services and the lessons learned during the coronavirus disease 2019 (COVID-19) 
crisis. In particular, this report offers opportunities to build on experience 
gained in managing the COVID-19 emergency in the Departments of Mental Health 
and Addiction (DMHAs) in Lombardy, the wealthiest Italian region, which has 
approximately 10 million inhabitants.
OBSERVATIONS: Italy has a National Mental Health System divided into 134 DMHAs, 
27 of which are in Lombardy. In the 4 weeks after the epidemic started, 
important changes occurred in the management of DMHAs in Lombardy. Many 
challenges have occurred in the management of health services. In many 
hospitals, entire wards, including some psychiatric wards, have been reorganized 
to admit patients with COVID-19, and many physicians and nurses have been 
diverted to wards managing patients with COVID-19. Most day facilities for 
patients with psychiatric needs have been temporarily closed, whereas in 
residential facilities, patients who usually are free to come and go during the 
day have had to be confined in the facilities with very limited or no leave. 
These changes have produced considerable stresses on people with severe mental 
disorders. Many outpatient clinics have limited appointments to those with the 
most urgent cases, and home visits, a common practice in most DMHAs, have been 
drastically reduced with potentially detrimental consequences for patients' 
well-being. Another potential detrimental consequence of being forced to stay at 
home has been an increase in the hours spent face to face with families with 
high amounts of conflict.
CONCLUSIONS AND RELEVANCE: Departments of Mental Health need to be equipped with 
appropriate e-health technologies and procedures to cope with situations such as 
the COVID-19 pandemic. Additionally, interventions are needed to mitigate the 
potentially harmful consequences of quarantine. Departments of Mental Health 
should be able to assume a leadership position in the psychosocial management of 
disasterlike situations, and this requires the acquisition of new skills, 
notably how to correctly inform the population about risk, train and disseminate 
effective preventive and management procedures for disasters, support health 
personnel and rescuers, and support those experiencing bereavement.

DOI: 10.1001/jamapsychiatry.2020.1276
PMID: 32352480 [Indexed for MEDLINE]


4431. AIDS Behav. 2020 Jul;24(7):2024-2032. doi: 10.1007/s10461-020-02894-2.

Characterizing the Impact of COVID-19 on Men Who Have Sex with Men Across the 
United States in April, 2020.

Sanchez TH(1), Zlotorzynska M(2), Rai M(2), Baral SD(3).

Author information:
(1)Rollins School of Public Health, Emory University, 1518 Clifton Road, 
Atlanta, GA, 30322, USA. Travis.Sanchez@emory.edu.
(2)Rollins School of Public Health, Emory University, 1518 Clifton Road, 
Atlanta, GA, 30322, USA.
(3)Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 
USA.

The COVID-19 pandemic is reinforcing health inequities among vulnerable 
populations, including men who have sex with men (MSM). We conducted a rapid 
online survey (April 2 to April 13, 2020) of COVID-19 related impacts on the 
sexual health of 1051 US MSM. Many participants had adverse impacts to general 
wellbeing, social interactions, money, food, drug use and alcohol consumption. 
Half had fewer sex partners and most had no change in condom access or use. Some 
reported challenges in accessing HIV testing, prevention and treatment services. 
Compared to older MSM, those 15-24 years were more likely to report economic and 
service impacts. While additional studies of COVID-19 epidemiology among MSM are 
needed, there is already evidence of emerging interruptions to HIV-related 
services. Scalable remote solutions such as telehealth and mailed testing and 
prevention supplies may be urgently needed to avert increased HIV incidence 
among MSM during the COVID-19 pandemic era.

DOI: 10.1007/s10461-020-02894-2
PMCID: PMC7189633
PMID: 32350773 [Indexed for MEDLINE]

Conflict of interest statement: The authors report no conflict of interest.


4432. BMC Pregnancy Childbirth. 2020 Apr 29;20(1):260. doi: 
10.1186/s12884-020-02956-2.

The experiences of mothers with preterm infants within the first-year post 
discharge from NICU: social support, attachment and level of depressive 
symptoms.

Leahy-Warren P(1), Coleman C(2), Bradley R(2), Mulcahy H(2).

Author information:
(1)School of Nursing and Midwifery, University College Cork, Brookfield Health 
Sciences Complex, College Road, Cork, T12 AK54, Ireland. Patricia.Leahy@ucc.ie.
(2)School of Nursing and Midwifery, University College Cork, Brookfield Health 
Sciences Complex, College Road, Cork, T12 AK54, Ireland.

BACKGROUND: The estimated global premature birth rate for 2014 was 10.6%, 
equating to an estimate of 14.84 million live premature births. The experience 
of premature birth does not impact solely on the infant and mother as 
individuals but occurs in the context of a critical point in time when they are 
developing a relationship with one another. The aim of this study was to 
investigate the relationships between social support, mother to infant 
attachment, and depressive symptoms of mothers with preterm infants within the 
first 12 months' post discharge from the Neonatal Intensive Care Unit (NICU).
METHODS: A correlational cross-sectional study design was used. Data were 
collected using a four-part online survey which included the Perinatal Social 
Support Questionnaire (PICSS), Maternal Postnatal Attachment Scale (MPAS) and 
the Edinburgh Postnatal Depression Scale (EPDS) with mothers of preterm infants 
(n = 140).
RESULTS: The prevalence of postnatal depression was 37.9% (95% CI: 29.8 to 
46.4%). In univariable analyses, history of depression (p = 0.005), aged 
35-39 years (p = 0.006), no formal social support (p = 0.040), less informal 
social supports (p = 0.018), lower overall maternal attachment (p < 0.001) and 
lower overall functional social support (p < 0.001) were significantly 
associated with a higher level of depressive symptoms. Lower scores on two of 
the maternal attachment subscales (quality of attachment and absence of 
hostility) and all four of the functional social support subscales were 
significantly associated with a higher level of depressive symptoms (p < 0.001 
for all). In the multivariable analysis, prior history of depression 
(p = 0.028), lower score of maternal attachment (p < 0.001) and lower emotional 
functional social support (p = 0.030) were significantly associated with a 
higher level of depressive symptoms.
CONCLUSION: Women who experience a premature birth, have a prior history of 
depression, poor infant attachment and poor emotional social support have a 
higher level of depressive symptoms. Results emphasise the need for 
professionals to encourage mobilisation of maternal formal and informal social 
supports. It is important to intervene early to address maternal emotional 
well-being and enhance the developing mother-preterm infant relationship.

DOI: 10.1186/s12884-020-02956-2
PMCID: PMC7191776
PMID: 32349685 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


4433. JMIR Public Health Surveill. 2020 May 6;6(2):e19297. doi: 10.2196/19297.

Agile Requirements Engineering and Software Planning for a Digital Health 
Platform to Engage the Effects of Isolation Caused by Social Distancing: Case 
Study.

Meinert E(1)(2), Milne-Ives M(1), Surodina S(3), Lam C(1)(4).

Author information:
(1)Digitally Enabled PrevenTative Health Research Group, Department of 
Paediatrics, University of Oxford, Oxford, United Kingdom.
(2)Department of Primary Care and Public Health, Imperial College London, 
London, United Kingdom.
(3)Skein Ltd, London, United Kingdom.
(4)Institute of Biomedical Engineering, University of Oxford, Oxford, United 
Kingdom.

BACKGROUND: Social distancing and shielding measures have been put in place to 
reduce social interaction and slow the transmission of the coronavirus disease 
(COVID-19). For older people, self-isolation presents particular challenges for 
mental health and social relationships. As time progresses, continued social 
distancing could have a compounding impact on these concerns.
OBJECTIVE: This project aims to provide a tool for older people and their 
families and peers to improve their well-being and health during and after 
regulated social distancing. First, we will evaluate the tool's feasibility, 
acceptability, and usability to encourage positive nutrition, enhance physical 
activity, and enable virtual interaction while social distancing. Second, we 
will be implementing the app to provide an online community to assist families 
and peer groups in maintaining contact with older people using goal setting. 
Anonymized data from the app will be aggregated with other real-world data 
sources to develop a machine learning algorithm to improve the identification of 
patients with COVID-19 and track for real time use by health systems.
METHODS: Development of this project is occurring at the time of publication, 
and therefore, a case study design was selected to provide a systematic means of 
capturing software engineering in progress. The app development framework for 
software design was based on agile methods. The evaluation of the app's 
feasibility, acceptability and usability shall be conducted using Public Health 
England's guidance on evaluating digital health products, Bandura's model of 
health promotion, the Reach Effectiveness Adoption Implementation Maintenance 
(RE-AIM) framework and the Nonadoption, Abandonment and Challenges to the 
Scale-up, Spread and Suitability (NASSS) framework.
RESULTS: Making use of a pre-existing software framework for health behavior 
change, a proof of concept was developed, and a multistage app development and 
deployment for the solution was created. Grant submissions to fund the project 
and study execution have been sought at the time of publication, and 
prediscovery iteration of the solution has begun. Ethical approval for a 
feasibility study design is being sought.
CONCLUSIONS: This case study lays the foundations for future app development to 
combat mental and societal issues arising from social distancing measures. The 
app will be tested and evaluated in future studies to allow continuous 
improvement of the app. This novel contribution will provide an evidence-based 
exemplar for future app development in the space of social isolation and 
loneliness.

©Edward Meinert, Madison Milne-Ives, Svitlana Surodina, Ching Lam. Originally 
published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 
06.05.2020.

DOI: 10.2196/19297
PMCID: PMC7205031
PMID: 32348293 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.


4434. Anesth Analg. 2020 Jul;131(1):43-54. doi: 10.1213/ANE.0000000000004912.

Battle Buddies: Rapid Deployment of a Psychological Resilience Intervention for 
Health Care Workers During the COVID-19 Pandemic.

Albott CS(1), Wozniak JR(1), McGlinch BP(2), Wall MH(2), Gold BS(2), Vinogradov 
S(1).

Author information:
(1)From the Departments of Psychiatry & Behavioral Sciences.
(2)Anesthesiology, School of Medicine, University of Minnesota, Minneapolis, 
Minnesota.

The outbreak of the coronavirus disease 2019 (COVID-19) and its rapid global 
spread have created unprecedented challenges to health care systems. Significant 
and sustained efforts have focused on mobilization of personal protective 
equipment, intensive care beds, and medical equipment, while substantially less 
attention has focused on preserving the psychological health of the medical 
workforce tasked with addressing the challenges of the pandemic. And yet, 
similar to battlefield conditions, health care workers are being confronted with 
ongoing uncertainty about resources, capacities, and risks; as well as exposure 
to suffering, death, and threats to their own safety. These conditions are 
engendering high levels of fear and anxiety in the short term, and place 
individuals at risk for persistent stress exposure syndromes, subclinical mental 
health symptoms, and professional burnout in the long term. Given the 
potentially wide-ranging mental health impact of COVID-19, protecting health 
care workers from adverse psychological effects of the pandemic is critical. 
Therefore, we present an overview of the potential psychological stress 
responses to the COVID-19 crisis in medical providers and describe preemptive 
resilience-promoting strategies at the organizational and personal level. We 
then describe a rapidly deployable Psychological Resilience Intervention founded 
on a peer support model (Battle Buddies) developed by the United States Army. 
This intervention-the product of a multidisciplinary collaboration between the 
Departments of Anesthesiology and Psychiatry & Behavioral Sciences at the 
University of Minnesota Medical Center-also incorporates evidence-informed 
"stress inoculation" methods developed for managing psychological stress 
exposure in providers deployed to disasters. Our multilevel, resource-efficient, 
and scalable approach places 2 key tools directly in the hands of providers: (1) 
a peer support Battle Buddy; and (2) a designated mental health consultant who 
can facilitate training in stress inoculation methods, provide additional 
support, or coordinate referral for external professional consultation. In 
parallel, we have instituted a voluntary research data-collection component that 
will enable us to evaluate the intervention's effectiveness while also 
identifying the most salient resilience factors for future iterations. It is our 
hope that these elements will provide guidance to other organizations seeking to 
protect the well-being of their medical workforce during the pandemic. Given the 
remarkable adaptability of human beings, we believe that, by promoting 
resilience, our diverse health care workforce can emerge from this monumental 
challenge with new skills, closer relationships, and greater confidence in the 
power of community.

DOI: 10.1213/ANE.0000000000004912
PMCID: PMC7199769
PMID: 32345861 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


4435. Eur Heart J Acute Cardiovasc Care. 2020 Apr;9(3):241-247. doi: 
10.1177/2048872620922795. Epub 2020 Apr 28.

Mental health care for medical staff and affiliated healthcare workers during 
the COVID-19 pandemic.

Walton M(1), Murray E(2), Christian MD(3).

Author information:
(1)Northwick Park Hospital (Accident and Emergency Department), London North 
West University Healthcare NHS Trust, UK.
(2)Centre for Medical Education, Barts and The London School of Medicine & 
Dentistry, Queen Mary University of London, UK.
(3)London's Air Ambulance, Royal London Hospital, UK.

The COVID-19 pandemic is an unprecedented challenge for society. Supporting the 
mental health of medical staff and affiliated healthcare workers (staff) is a 
critical part of the public health response. This paper details the effects on 
staff and addresses some of the organisational, team and individual 
considerations for supporting staff (pragmatically) during this pandemic. 
Leaders at all levels of health care organisations will find this a valuable 
resource.

DOI: 10.1177/2048872620922795
PMCID: PMC7189614
PMID: 32342698 [Indexed for MEDLINE]


4436. Nurs Health Sci. 2020 Sep;22(3):837-838. doi: 10.1111/nhs.12727. Epub 2020 Jun 
22.

Protecting the psychological well-being of healthcare workers affected by the 
COVID-19 outbreak: Perspectives from China.

Hu X(1), Huang W(1).

Author information:
(1)School of Nursing, West China Hospital, Sichuan University, Chengdu, China.

DOI: 10.1111/nhs.12727
PMCID: PMC7267142
PMID: 32335991 [Indexed for MEDLINE]


4437. Brain Behav Immun. 2020 Jul;87:80-81. doi: 10.1016/j.bbi.2020.04.053. Epub 2020 
Apr 23.

Loss and grief amidst COVID-19: A path to adaptation and resilience.

Zhai Y(1), Du X(2).

Author information:
(1)Department of Educational Psychology, Counseling, and Special Education, The 
Pennsylvania State University, University Park, PA, USA; The Edwin L. Herr 
Clinic, The Pennsylvania State University, University Park, PA, USA. Electronic 
address: zhai@psu.edu.
(2)Department of Food Science, The Pennsylvania State University, University 
Park, PA, USA.

The COVID-19 pandemic has posed an extreme threat to global health and become a 
leading cause of death worldwide. Loss, as a more encompassing theme, 
interweaves many aspects of people's life in this challenging time. Failure to 
address the pressing needs of those experiencing loss and grief may result in 
poor mental and physical health. Recognizing the uniqueness of each individual 
and their loss and grief will provide opportunities to develop tailored 
strategies that facilitate functional adaptation to loss and promote mental 
health and wellbeing in this crisis.

Copyright © 2020 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.bbi.2020.04.053
PMCID: PMC7177068
PMID: 32335197 [Indexed for MEDLINE]

Conflict of interest statement: We declare no competing interests.


4438. Metabolism. 2020 Jul;108:154248. doi: 10.1016/j.metabol.2020.154248. Epub 2020 
Apr 23.

Letter to the Editor: Mental Health and Psychological Distress in People with 
Diabetes during COVID-19.

Mukhtar S(1), Mukhtar S(2).

Author information:
(1)University of Management and Technology, Lahore, Pakistan. Electronic 
address: sonia.mukhtar12@gmail.com.
(2)Independent Researcher, Lahore, Pakistan.

DOI: 10.1016/j.metabol.2020.154248
PMCID: PMC7252044
PMID: 32335075 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest None.


4439. Asian J Psychiatr. 2020 Jun;51:102092. doi: 10.1016/j.ajp.2020.102092. Epub 2020 
Apr 14.

Epidemic of COVID-19 in China and associated Psychological Problems.

Ahmed MZ(1), Ahmed O(2), Aibao Z(3), Hanbin S(3), Siyu L(4), Ahmad A(5).

Author information:
(1)College of Psychology, Northwest Normal University, China. Electronic 
address: ahmedzahirdu@gmail.com.
(2)Department of Psychology, University of Chittagong, Chattogram-4331, 
Bangladesh.
(3)College of Psychology, Northwest Normal University, China.
(4)College of Tourism, Northwest Normal University, China.
(5)Policy Research Centre.bd, Dhaka, Bangladesh.

Comment in
    Support Care Cancer. 2020 Sep;28(9):4001-4004.

The world is experiencing pandemic of the COVID-19 now, a RNA virus that spread 
out from Wuhan, China. Two countries, China first and later Italy, have gone to 
full lock down due to rapid spread of this virus. Till to date, no 
epidemiological data on mental health problems due to outbreak of the COVID-19 
and mass isolation were not available. To meet this need, the present study was 
undertaken to assess the mental health status of Chinese people. An online 
survey was conducted on a sample of 1074 Chinese people, majority of whom from 
Hubei province. Lack of adequate opportunities to conduct face to face 
interview, anxiety, depression, mental well-being and alcohol consumption 
behavior were assessed via self-reported measures. Results showed higher rate of 
anxiety, depression, hazardous and harmful alcohol use, and lower mental 
wellbeing than usual ratio. Results also revealed that young people aged 21-40 
years are in more vulnerable position in terms of their mental health conditions 
and alcohol use. To address mental health crisis during this epidemic, it is 
high time to implement multi-faceted approach (i.e. forming multidisciplinary 
mental health team, providing psychiatric treatments and other mental health 
services, utilizing online counseling platforms, rehabilitation program, 
ensuring certain care for vulnerable groups, etc.).

Copyright © 2020 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.ajp.2020.102092
PMCID: PMC7194662
PMID: 32315963 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest I am MD Zahir 
Ahmed, on the behalf of authors, declare that we have no conflicts of interest 
to disclose.


4440. Psychiatr Danub. 2020 Spring;32(1):6-14. doi: 10.24869/psyd.2020.6.

COVID-19 Pandemia and Public and Global Mental Health from the Perspective of 
Global Health Securit.

Jakovljevic M(1), Bjedov S, Jaksic N, Jakovljevic I.

Author information:
(1)Department of Psychiatry and Psychological Medicine, University Hospital 
Centre Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia, psychiatry@kbc-zagreb.hr.

The Coronavirus disease 2019 (COVID-19) pandemic emerged in Wuhan, China and has 
spread all over the world and has caused huge threats to health and lives. It 
has affected different frontiers of lives and induced many psychiatric 
individual and collective problems such as panic, anxiety, depression, 
post-traumatic stress disorders, suspiciousness, infodemia, cacophony, 
xenophobia, racisms, etc. The COVID-19 outbreak has induced public and global 
mental health crisis as well as a huge psycho-social experiment. Psychiatry and 
other mental health sciences can play very useful role in supporting the 
well-being of COVID-19 patients and their families, healthcare personnel and the 
society. For successful fighting with present and future pandemics we have to 
learn more about psychiatric and psychological aspects of COVID-19 from the 
perspectives of public and global mental health.

DOI: 10.24869/psyd.2020.6
PMID: 32303023 [Indexed for MEDLINE]


4441. PLoS One. 2020 Apr 16;15(4):e0231924. doi: 10.1371/journal.pone.0231924. 
eCollection 2020.

Mental health problems and social media exposure during COVID-19 outbreak.

Gao J(1), Zheng P(1), Jia Y(1), Chen H(1), Mao Y(1), Chen S(1), Wang Y(1), Fu 
H(1), Dai J(1).

Author information:
(1)School of Public Health, Fudan University, Fudan Institute of Health 
communication, Shanghai, China.

Huge citizens expose to social media during a novel coronavirus disease 
(COVID-19) outbroke in Wuhan, China. We assess the prevalence of mental health 
problems and examine their association with social media exposure. A 
cross-sectional study among Chinese citizens aged≥18 years old was conducted 
during Jan 31 to Feb 2, 2020. Online survey was used to do rapid assessment. 
Total of 4872 participants from 31 provinces and autonomous regions were 
involved in the current study. Besides demographics and social media exposure 
(SME), depression was assessed by The Chinese version of WHO-Five Well-Being 
Index (WHO-5) and anxiety was assessed by Chinese version of generalized anxiety 
disorder scale (GAD-7). multivariable logistic regressions were used to identify 
associations between social media exposure with mental health problems after 
controlling for covariates. The prevalence of depression, anxiety and 
combination of depression and anxiety (CDA) was 48.3% (95%CI: 46.9%-49.7%), 
22.6% (95%CI: 21.4%-23.8%) and 19.4% (95%CI: 18.3%-20.6%) during COVID-19 
outbroke in Wuhan, China. More than 80% (95%CI:80.9%-83.1%) of participants 
reported frequently exposed to social media. After controlling for covariates, 
frequently SME was positively associated with high odds of anxiety (OR = 1.72, 
95%CI: 1.31-2.26) and CDA (OR = 1.91, 95%CI: 1.52-2.41) compared with less SME. 
Our findings show there are high prevalence of mental health problems, which 
positively associated with frequently SME during the COVID-19 outbreak. These 
findings implicated the government need pay more attention to mental health 
problems, especially depression and anxiety among general population and 
combating with "infodemic" while combating during public health emergency.

DOI: 10.1371/journal.pone.0231924
PMCID: PMC7162477
PMID: 32298385 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


4442. Front Psychiatry. 2020 Mar 31;11:145. doi: 10.3389/fpsyt.2020.00145. eCollection 
2020.

Changes in Working Conditions and Mental Health Among Intensive Care Physicians 
Across a Decade.

Beschoner P(1), von Wietersheim J(1), Jarczok MN(1), Braun M(2), 
Schönfeldt-Lecuona C(3), Jerg-Bretzke L(1), Steiner L(4).

Author information:
(1)Department of Psychosomatic Medicine and Psychotherapy, Ulm University 
Medical Center, Ulm, Germany.
(2)Clinic of Psychosomatics Kloster Dießen, Dießen am Ammersee, Germany.
(3)Department of Psychiatry and Psychotherapy III, Ulm University Medical 
Center, Ulm, Germany.
(4)III. Medical Clinic, University Medical Center Mannheim, Mannheim, Germany.

Background: International studies have shown that among physicians working in 
intensive care, a relatively high level of work load, an elevated risk of 
developing burnout and reduced mental health are frequent. The implementation of 
a legislative intervention in Germany with the goal to reduce the working hours 
of physicians, offered an opportunity to investigate the potential influence of 
occupational conditions on stress and mental health. The present study 
investigates working conditions, occupational stress and burnout risk in two 
samples of German Intensive Care Physicians in 2006 and 2016. The aim was to 
assess how occupational and private stress factors influenced burnout and 
Effort-Reward-Imbalance indices over this time-period. Methods: Intensive care 
physicians were surveyed during the annual conference of their profession in two 
cross-sectional studies (10-year gap). Data on demographic (occupational, 
family), medical history, and mental health (burnout and 
Effort-Reward-Imbalance) were assessed by paper pencil questionnaires. Results: 
In total, N = 2,085 physicians participated (2006: N = 1,403, 2016: N = 695), 
with N = 1,840 (2006 = 1,248; 2016 = 592) eligible for propensity score matching 
comparison. In general, more working hours per week and working days on weekends 
were associated with an increased effort/reward imbalance and higher burnout 
scores. From 2006 to 2016, reductions in working hours per week and days worked 
on weekends were accompanied by improvements in occupational stress 
(Effort-Reward-Imbalance) and by trend in mental health indices (burnout) after 
matching for differences in working conditions. Conclusions: The study presents 
the changes concerning occupational stress factors and mental wellbeing in 
physicians working in intensive care in 2016 as compared to 2006. These findings 
may promote the implementation of preventive strategies in the vocational 
context to protect health and productivity of physicians, especially intensive 
care physicians.

Copyright © 2020 Beschoner, von Wietersheim, Jarczok, Braun, Schönfeldt-Lecuona, 
Jerg-Bretzke and Steiner.

DOI: 10.3389/fpsyt.2020.00145
PMCID: PMC7136524
PMID: 32296349


4443. Am J Respir Crit Care Med. 2020 Jun 15;201(12):1473-1479. doi: 
10.1164/rccm.202003-0586UP.

Update in Sleep 2019.

Leary EB(1), Zinchuk A(2), Stone KL(3), Mehra R(4)(5)(6)(7).

Author information:
(1)Center for Sleep Sciences and Medicine, Department of Psychiatry and 
Behavioral Sciences, School of Medicine, Stanford University, Stanford, 
California.
(2)Section of Pulmonary, Critical Care and Sleep Medicine, Internal Medicine 
Department, School of Medicine, Yale University, New Haven, Connecticut.
(3)California Pacific Medical Center Research Institute, San Francisco, 
California.
(4)Sleep Disorders Center, Neurological Institute.
(5)Respiratory Institute.
(6)Heart, Vascular and Thoracic Institute, and.
(7)Department of Molecular Cardiology, Lerner Research Institute, Cleveland 
Clinic, Cleveland, Ohio.

DOI: 10.1164/rccm.202003-0586UP
PMID: 32293912 [Indexed for MEDLINE]


4444. Psychother Psychosom. 2020;89(4):200-214. doi: 10.1159/000507638. Epub 2020 Apr 
14.

A Rational Use of Clozapine Based on Adverse Drug Reactions, Pharmacokinetics, 
and Clinical Pharmacopsychology.

de Leon J(1)(2)(3), Ruan CJ(4)(5), Schoretsanitis G(6), De Las Cuevas C(7).

Author information:
(1)Mental Health Research Center at Eastern State Hospital, Lexington, Kentucky, 
USA, jdeleon@uky.edu.
(2)Psychiatry and Neurosciences Research Group (CTS-549), Institute of 
Neurosciences, University of Granada, Granada, Spain, jdeleon@uky.edu.
(3)Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apóstol 
Hospital, University of the Basque Country, Vitoria, Spain, jdeleon@uky.edu.
(4)The National Clinical Research Centre for Mental Disorders, Beijing Key 
Laboratory of Mental Disorders, and Laboratory of Clinical Psychopharmacology, 
Beijing Anding Hospital, Capital Medical University, Beijing, China.
(5)Advanced Innovation Center for Human Brain Protection, Capital Medical 
University, Beijing, China.
(6)Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen 
Oaks, New York, USA.
(7)Department of Internal Medicine, Dermatology and Psychiatry, University of La 
Laguna, San Cristóbal de La Laguna, Spain.

Comment in
    Schizophr Res. 2022 Feb;240:184-185.

Using Richardson and Davidson's model and the sciences of pharmacokinetics and 
clinical pharmacopsychology, this article reviewed the: (1) poor life expectancy 
associated with treatment-resistant schizophrenia (TRS), which may be improved 
in patients who adhere to clozapine; (2) findings that clozapine is the best 
treatment for TRS (according to efficacy, effectiveness and well-being); and (3) 
potential for clozapine to cause vulnerabilities, including potentially lethal 
adverse drug reactions such as agranulocytosis, pneumonia, and myocarditis. 
Rational use requires: (1) modification of the clozapine package insert 
worldwide to include lower doses for Asians and to avoid the lethality 
associated with pneumonia, (2) the use of clozapine levels for personalizing 
dosing, and (3) the use of slow and personalized titration. This may make 
clozapine as safe as possible and contribute to increased life expectancy and 
well-being. In the absence of data on COVID-19 in clozapine patients, clozapine 
possibly impairs immunological mechanisms and may increase pneumonia risk in 
infected patients. Psychiatrists should call their clozapine patients and 
families and explain to them that if the patient develops fever or flu-like 
symptoms, the psychiatrist should be called and should consider halving the 
clozapine dose. If the patient is hospitalized with pneumonia, the treating 
physician needs to assess for symptoms of clozapine intoxication since halving 
the dose may not be enough for all patients; consider decreasing it to one-third 
or even stopping it. Once the signs of inflammation and fever have disappeared, 
the clozapine dose can be slowly increased to the prior dosage level.

© 2020 S. Karger AG, Basel.

DOI: 10.1159/000507638
PMCID: PMC7206357
PMID: 32289791 [Indexed for MEDLINE]

Conflict of interest statement: This article received no support from any 
funding agency, commercial business, or not-for-profit institution. In the last 
3 years, the authors have had no commercial conflicts of interest.


4445. Psychiatry Res. 2020 Jun;288:112958. doi: 10.1016/j.psychres.2020.112958. Epub 
2020 Apr 4.

Unprecedented disruption of lives and work: Health, distress and life 
satisfaction of working adults in China one month into the COVID-19 outbreak.

Zhang SX(1), Wang Y(2), Rauch A(3), Wei F(4).

Author information:
(1)University of Adelaide, Adelaide, Australia. Electronic address: 
stephen.x.zhang@gmail.com.
(2)Tongji University, Shanghai, China. Electronic address: 
iriswang@tongji.edu.cn.
(3)University of Sydney, Sydney, Australia. Electronic address: 
andreas.rauch@sydney.edu.au.
(4)Tongji University, Shanghai, China. Electronic address: fwei@tongji.edu.cn.

We assess the health and wellbeing of normal adults living and working after one 
month of confinement to contain the COVID-19 outbreak in China. On Feb 20-21, 
2020, we surveyed 369 adults in 64 cities in China that varied in their rates of 
confirmed coronavirus cases on their health conditions, distress and life 
satisfaction. 27% of the participants worked at the office, 38% resorted to 
working from home, and 25% stopped working due to the outbreak. Those who 
stopped working reported worse mental and physical health conditions as well as 
distress. The severity of COVID-19 in an individual's home city predicts their 
life satisfaction, and this relationship is contingent upon individuals' 
existing chronic health issues and their hours of exercise. Our evidence 
supports the need to pay attention to the health of people who were not infected 
by the virus, especially for people who stopped working during the outbreak. Our 
results highlight that physically active people might be more susceptible to 
wellbeing issues during the lockdown. Policymakers who are considering 
introducing restrictive measures to contain COVID-19 may benefit from 
understanding such health and wellbeing implications.

Copyright © 2020 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.psychres.2020.112958
PMCID: PMC7146665
PMID: 32283450 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no competing interests.


4446. Acad Med. 2020 Aug;95(8):1136-1139. doi: 10.1097/ACM.0000000000003414.

Attending to the Emotional Well-Being of the Health Care Workforce in a New York 
City Health System During the COVID-19 Pandemic.

Ripp J(1), Peccoralo L(2), Charney D(3).

Author information:
(1)J. Ripp is senior associate dean for well-being and resilience, Icahn School 
of Medicine at Mount Sinai, and chief wellness officer, Mount Sinai Health 
System, New York, New York.
(2)L. Peccoralo is associate dean for faculty well-being and resilience, Icahn 
School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New 
York.
(3)D. Charney is Anne and Joel Ehrenkranz Dean, Icahn School of Medicine at 
Mount Sinai, and president for academic affairs, Mount Sinai Health System, New 
York, New York.

The COVID-19 pandemic has placed an enormous strain on health care workers, and 
its potential impact has implications for the physical and emotional well-being 
of the workforce. As hospital systems run well over capacity, facing possible 
shortages of critical care medical resources and personal protective equipment 
as well as clinician deaths, the psychological stressors necessitate a strong 
well-being support model for staff. At the Mount Sinai Health System (MSHS) in 
New York City, health care workers have been heroically providing frontline care 
to COVID-19 patients while facing their own appropriate fears for their personal 
safety in the setting of contagion. This moral obligation cannot be burdened by 
unacceptable risks; the health system's full support is required to address the 
needs of its workforce.In this Invited Commentary, the authors describe how an 
MSHS Employee, Faculty, and Trainee Crisis Support Task Force-created in early 
March 2020 and composed of behavioral health, human resources, and well-being 
leaders from across the health system-used a rapid needs assessment model to 
capture the concerns of the workforce related to the COVID-19 pandemic. The task 
force identified 3 priority areas central to promoting and maintaining the 
well-being of the entire MSHS workforce during the pandemic: meeting basic daily 
needs; enhancing communications for delivery of current, reliable, and 
reassuring messages; and developing robust psychosocial and mental health 
support options. Using a work group strategy, the task force operationalized the 
rollout of support initiatives for each priority area. Attending to the 
emotional well-being of health care workers has emerged as a central element in 
the MSHS COVID-19 response, which continues to be committed to the physical and 
emotional needs of a workforce that courageously faces this crisis.

DOI: 10.1097/ACM.0000000000003414
PMCID: PMC7176260
PMID: 32282344 [Indexed for MEDLINE]

Conflict of interest statement: Other disclosures: None reported.


4447. Nurse Educ Pract. 2020 Mar;44:102780. doi: 10.1016/j.nepr.2020.102780. Epub 2020 
Mar 31.

Hopelessness, helplessness and resilience: The importance of safeguarding our 
trainees' mental wellbeing during the COVID-19 pandemic.

Shaw SCK(1).

Author information:
(1)Department of Medical Education, Brighton and Sussex Medical School, 
Brighton, UK. Electronic address: S.Shaw2@bsms.ac.uk.

• The COVID-19 pandemic may put the mental wellbeing of trainees at risk. • 
Hopelessness, helplessness and burnout are important to be aware of. • We need 
to foster an open culture of trust and support. • We need to promote resilience 
in colleagues/trainees where possible.

DOI: 10.1016/j.nepr.2020.102780
PMCID: PMC7138173
PMID: 32272394 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest None.


4448. J Allergy Clin Immunol Pract. 2020 Jun;8(6):1781-1790.e3. doi: 
10.1016/j.jaip.2020.04.001. Epub 2020 Apr 4.

Clinician Wellness During the COVID-19 Pandemic: Extraordinary Times and Unusual 
Challenges for the Allergist/Immunologist.

Bansal P(1), Bingemann TA(2), Greenhawt M(3), Mosnaim G(4), Nanda A(5), 
Oppenheimer J(6), Sharma H(7), Stukus D(8), Shaker M(9).

Author information:
(1)Asthma and Allergy Wellness Center, St Charles, Ill.
(2)University of Rochester Division of Allergy, Immunology and Rheumatology, 
Rochester, NY.
(3)Section of Allergy/Immunology, Children's Hospital Colorado, Department of 
Pediatrics, University of Colorado School of Medicine, Aurora, Colo.
(4)Division of Pulmonary, Allergy and Critical Care, Department of Medicine, 
NorthShore University HealthSystem, Evanston, Ill.
(5)Asthma and Allergy Center, Lewisville and Flower Mound, Texas; Division of 
Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, 
Texas.
(6)UMDMJ Rutgers University School of Medicine, Newark, NJ.
(7)Children's National Hospital, George Washington University School of Medicine 
and Health Sciences, Washington, DC.
(8)Division of Allergy and Immunology, Nationwide Children's Hospital, The Ohio 
State University School of Medicine, Columbus, Ohio.
(9)Geisel School of Medicine and Dartmouth-Hitchcock Medical Center, Lebanon, 
NH. Electronic address: marcus.shaker@dartmouth.edu.

Comment in
    J Allergy Clin Immunol Pract. 2020 Sep;8(8):2834-2835.

The global spread of coronavirus disease 2019 (COVID-19) has caused sudden and 
dramatic societal changes. The allergy/immunology community has quickly 
responded by mobilizing practice adjustments and embracing new paradigms of care 
to protect patients and staff from severe acute respiratory syndrome coronavirus 
2 exposure. Social distancing is key to slowing contagion but adds to complexity 
of care and increases isolation and anxiety. Uncertainty exists across a new 
COVID-19 reality, and clinician well-being may be an underappreciated priority. 
Wellness incorporates mental, physical, and spiritual health to protect against 
burnout, which impairs both coping and caregiving abilities. Understanding the 
stressors that COVID-19 is placing on clinicians can assist in recognizing what 
is needed to return to a point of wellness. Clinicians can leverage easily 
accessible tools, including the Strength-Focused and Meaning-Oriented Approach 
to Resilience and Transformation approach, wellness apps, mindfulness, and 
gratitude. Realizing early warning signs of anxiety, depression, substance 
abuse, and posttraumatic stress disorder is important to access safe and 
confidential resources. Implementing wellness strategies can improve 
flexibility, resilience, and outlook. Historical parallels demonstrate that 
perseverance is as inevitable as pandemics and that we need not navigate this 
unprecedented time alone.

Copyright © 2020 American Academy of Allergy, Asthma & Immunology. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jaip.2020.04.001
PMCID: PMC7129776
PMID: 32259628 [Indexed for MEDLINE]


4449. Ann Clin Biochem. 2020 May;57(3):202-205. doi: 10.1177/0004563220921888. Epub 
2020 Apr 27.

Clinical utility of cardiac troponin measurement in COVID-19 infection.

Gaze DC(1)(2).

Author information:
(1)Clinical Biochemistry, University of Westminster, London, UK.
(2)Clinical Blood Sciences, South West London Pathology, St George's Healthcare 
NHS Foundation Trust, London, UK.

The novel coronavirus SARS-CoV-2 causes the disease COVID-19, a severe acute 
respiratory syndrome. COVID-19 is now a global pandemic and public health 
emergency due to rapid human-to-human transmission. The impact is far-reaching, 
with enforced social distancing and isolation, detrimental effects on individual 
physical activity and mental wellbeing, education in the young and economic 
impact to business. Whilst most COVID-19 patients demonstrate mild-to-moderate 
symptoms, those with severe disease progression are at a higher risk of 
mortality. As more is learnt about this novel disease, it is becoming evident 
that comorbid cardiovascular disease is associated with a greater severity and 
increased mortality. Many patients positive for COVID-19 demonstrate increased 
concentrations of cardiac troponin, creating confusion in clinical 
interpretation. While myocardial infarction is associated with acute infectious 
respiratory disease, the majority of COVID-19 patients demonstrate stable cTn 
rather than the dynamically changing values indicative of an acute coronary 
syndrome. Although full understanding of the mechanism of cTn release in 
COVID-19 is currently lacking, this mini-review assesses the limited published 
literature with a view to offering insight to pathophysiological mechanisms and 
reported treatment regimens.

DOI: 10.1177/0004563220921888
PMCID: PMC7364775
PMID: 32255359 [Indexed for MEDLINE]


4450. Worldviews Evid Based Nurs. 2020 Jun;17(3):182-184. doi: 10.1111/wvn.12439. Epub 
2020 Apr 22.

Clinician Mental Health and Well-Being During Global Healthcare Crises: Evidence 
Learned From Prior Epidemics for COVID-19 Pandemic.

Jun J(1), Tucker S(2)(3), Melnyk BM(3).

Author information:
(1)School of Nursing and Institute for Healthcare Policy and Innovation, 
University of Michigan, Ann Arbor, MI, USA.
(2)College of Nursing, Ohio State University, Columbus, OH, USA.
(3)Helene Fuld Health Trust National Institute for EBP, Ohio State University, 
Columbus, OH, USA.

DOI: 10.1111/wvn.12439
PMID: 32246793 [Indexed for MEDLINE]


4451. Singapore Med J. 2020 Jul;61(7):350-356. doi: 10.11622/smedj.2020046. Epub 2020 
Apr 3.

Narrative synthesis of psychological and coping responses towards emerging 
infectious disease outbreaks in the general population: practical considerations 
for the COVID-19 pandemic.

Chew QH(1), Wei KC(2), Vasoo S(3), Chua HC(4), Sim K(2).

Author information:
(1)Research Department, Institute of Mental Health, Singapore.
(2)West Region, Institute of Mental Health, Singapore.
(3)National Centre for Infectious Diseases, Singapore.
(4)East Region, Institute of Mental Health, Singapore.

INTRODUCTION: Emerging infectious disease outbreaks, such as the present 
coronavirus disease 2019 (COVID-19) pandemic, often have a psychological impact 
on the well-being of the general population, including survivors and caregivers. 
Our study aimed to synthesise extant literature regarding the combined 
psychological responses and coping methods used by the general population in 
past outbreaks.
METHODS: We conducted a narrative synthesis of the published literature over the 
last two decades with a quality appraisal of included articles that reported 
both psychological responses and coping strategies within infectious disease 
outbreaks.
RESULTS: A total of 144 papers were identified from the search, 24 of which were 
included in the review. Overall, 18 studies examined the psychosocial responses 
of the general population towards the severe acute respiratory syndrome 
epidemic, four studies focused on the Ebola epidemic and two studies covered the 
H1N1 outbreak. Common themes in psychological responses included anxiety/fears, 
depression, anger, guilt, grief and loss, post-traumatic stress and 
stigmatisation, but also a greater sense of empowerment and compassion towards 
others. Coping strategies adopted included problem-focused coping (seeking 
alternatives, self- and other-preservation), seeking social support, avoidance, 
and positive appraisal of the situation.
CONCLUSION: Amid the range of psychosocial responses seen in past infectious 
disease outbreaks, practical considerations for the current COVID-19 pandemic 
need to focus on the individual in the context of the larger social environment, 
with an emphasis on raising awareness of the range of possible psychosocial 
responses, access to psychological help, self-care, empowering self-support 
groups and sustained engagement with updated, reliable information about the 
outbreak.

Copyright: © Singapore Medical Association.

DOI: 10.11622/smedj.2020046
PMCID: PMC7926608
PMID: 32241071 [Indexed for MEDLINE]


4452. Psychiatry Res. 2020 May;287:112921. doi: 10.1016/j.psychres.2020.112921. Epub 
2020 Mar 16.

Prevalence and predictors of PTSS during COVID-19 outbreak in China hardest-hit 
areas: Gender differences matter.

Liu N(1), Zhang F(1), Wei C(2), Jia Y(1), Shang Z(1), Sun L(1), Wu L(1), Sun 
Z(1), Zhou Y(1), Wang Y(1), Liu W(3).

Author information:
(1)Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental 
Health, Naval Medical University, Shanghai 200433, China; The Emotion & 
Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical 
University, Shanghai 200433, China.
(2)Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental 
Health, Naval Medical University, Shanghai 200433, China.
(3)Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental 
Health, Naval Medical University, Shanghai 200433, China; The Emotion & 
Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical 
University, Shanghai 200433, China. Electronic address: 13024141970@163.com.

The outbreak of COVID-19 in China in December 2019 has been identified as a 
pandemic and a health emergency of global concern. Our objective was to 
investigate the prevalence and predictors of posttraumatic stress symptoms 
(PTSS) in China hardest-hit areas during COVID-19 outbreak, especially exploring 
the gender difference existing in PTSS. One month after the December 2019 
COVID-19 outbreak in Wuhan China, we surveyed PTSS and sleep qualities among 285 
residents in Wuhan and surrounding cities using the PTSD Checklist for DSM-5 
(PCL-5) and 4 items from the Pittsburgh Sleep Quality Index (PSQI). Hierarchical 
regression analysis and non-parametric test were used to analyze the data. 
Results indicated that the prevalence of PTSS in China hardest-hit areas a month 
after the COVID-19 outbreak was 7%. Women reported significant higher PTSS in 
the domains of re-experiencing, negative alterations in cognition or mood, and 
hyper-arousal. Participants with better sleep quality or less frequency of early 
awakenings reported lower PTSS. Professional and effective mental health 
services should be designed in order to aid the psychological wellbeing of the 
population in affected areas, especially those living in hardest-hit areas, 
females and people with poor sleep quality.

Copyright © 2020 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.psychres.2020.112921
PMCID: PMC7102622
PMID: 32240896 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors 
declare that they have no conflicts of interest.


4453. Otolaryngol Clin North Am. 2020 Jun;53(3):339-349. doi: 
10.1016/j.otc.2020.02.001. Epub 2020 Mar 18.

Sleep Apnea Treatment Considerations in Patients with Comorbidities.

Dhanda Patil R(1), Sarber KM(2).

Author information:
(1)Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati 
College of Medicine, Cincinnati, OH, USA; Otolaryngology-Head and Neck Surgery, 
Cincinnati VA Medical Center, Cincinnati, OH, USA. Electronic address: 
reenadhanda1@gmail.com.
(2)Department of Surgery, F. Edward Hébert School of Medicine, Uniformed 
Services University of the Health Sciences, Bethesda, MD, USA; Department of 
Otolaryngology, 96th Medical Group, Eglin Air Force Base, FL, USA.

A wide range of sleep, psychiatric, and medical comorbidities can present with 
obstructive sleep apnea (OSA), complicating treatment because of intolerance or 
low adherence to traditional modalities of therapy. Providers must have 
heightened awareness of how these comorbidities can affect their patients' OSA 
and work together as a team to optimize health and well-being in this complex 
population.

Published by Elsevier Inc.

DOI: 10.1016/j.otc.2020.02.001
PMID: 32199633 [Indexed for MEDLINE]

Conflict of interest statement: Disclosure The authors have nothing to disclose.


4454. BMJ Open. 2020 Mar 4;10(3):e035854. doi: 10.1136/bmjopen-2019-035854.

Impact of preterm birth on brain development and long-term outcome: protocol for 
a cohort study in Scotland.

Boardman JP(1)(2), Hall J(3), Thrippleton MJ(4), Reynolds RM(5), Bogaert D(6), 
Davidson DJ(6), Schwarze J(6), Drake AJ(5), Chandran S(2), Bastin ME(2), 
Fletcher-Watson S(2).

Author information:
(1)MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, 
UK James.Boardman@ed.ac.uk.
(2)Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, 
UK.
(3)MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, 
UK.
(4)Edinburgh Imaging, The University of Edinburgh, Edinburgh, UK.
(5)Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, 
UK.
(6)Centre for Inflammation Research, The University of Edinburgh, Edinburgh, UK.

INTRODUCTION: Preterm birth is closely associated with altered brain development 
and is a leading cause of neurodevelopmental, cognitive and behavioural 
impairments across the life course. We aimed to investigate neuroanatomic 
variation and adverse outcomes associated with preterm birth by studying a 
cohort of preterm infants and controls born at term using brain MRI linked to 
biosamples and clinical, environmental and neuropsychological data.
METHODS AND ANALYSIS: Theirworld Edinburgh Birth Cohort is a prospective 
longitudinal cohort study at the University of Edinburgh. We plan to recruit 300 
infants born at <33 weeks of gestational age (GA) and 100 healthy control 
infants born after 37 weeks of GA. Multiple domains are assessed: maternal and 
infant clinical and demographic information; placental histology; 
immunoregulatory and trophic proteins in umbilical cord and neonatal blood; 
brain macrostructure and microstructure from structural and diffusion MRI 
(dMRI); DNA methylation; hypothalamic-pituitary-adrenal axis activity; social 
cognition, attention and processing speed from eye tracking during infancy and 
childhood; neurodevelopment; gut and respiratory microbiota; susceptibility to 
viral infections; and participant experience. Main analyses include creation of 
novel methods for extracting information from neonatal structural and dMRI, 
regression analyses of predictors of brain maldevelopment and neurocognitive 
outcome associated with preterm birth, and determination of the quantitative 
predictive performance of MRI and other early life factors for childhood 
outcome.
ETHICS AND DISSEMINATION: Ethical approval has been obtained from the National 
Research Ethics Service (NRES), South East Scotland Research Ethics Committee 
(NRES numbers 11/55/0061 and 13/SS/0143 (phase I) and 16/SS/0154 (phase II)), 
and NHS Lothian Research and Development (2016/0255). Results are disseminated 
through open access journals, scientific meetings, social media, newsletters 
anda study website (www.tebc.ed.ac.uk), and we engage with the University of 
Edinburgh public relations and media office to ensure maximum publicity and 
benefit.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published 
by BMJ.

DOI: 10.1136/bmjopen-2019-035854
PMCID: PMC7059503
PMID: 32139495 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


4455. BMC Pediatr. 2020 Mar 4;20(1):105. doi: 10.1186/s12887-020-2002-9.

"The cord is the child": meanings and practices related to umbilical cord care 
in Central Uganda.

Mukunya D(1), Haaland MES(2), Tumwine JK(3), Tylleskar T(2), Nankabirwa V(2)(4), 
Moland KM(2).

Author information:
(1)Centre for Intervention Science in Maternal and Child Health 
(www.cismac.org), Center for International Health, University of Bergen, Bergen, 
Norway. zebdaevid@gmail.com.
(2)CISMAC, Center for International Health, University of Bergen, Bergen, 
Norway.
(3)Department of Pediatrics and Child Health, Makerere University, Kampala, 
Uganda.
(4)Department of Epidemiology and Biostatistics, School of Public Health, 
Makerere University, Kampala, Uganda.

BACKGROUND: Infections account for a quarter of all newborn deaths and the 
umbilical cord has been identified as a major route of newborn infections.
OBJECTIVE: To explore the meanings and practices related to the umbilical cord 
among caretakers of newborns in central Uganda.
METHODS: This was a qualitative study, designed to inform the design, and 
interpretation of a randomized controlled trial assessing the effectiveness of 
chlorhexidine use for the umbilical cord. We conducted 22 in-depth interviews 
exploring umbilical cord care practices among ten mothers, four health workers, 
five traditional birth attendants, and three men. We also conducted three focus 
group discussions with young mothers and elderly women. We used qualitative 
content analysis to analyze our findings and we borrow upon Mary Douglas' 
concepts of dirt to present our findings.
RESULTS: The umbilical cord had a symbolic position in newborn care. The way it 
was perceived and handled had far reaching consequences for the survival and 
wellbeing of the baby. The umbilical cord was a centre of anxiety, a possible 
gate to illness, a test of fatherhood and a signifier of parental 
responsibility. Hence, the umbilical cord and the way it was cared for played a 
part in the present and future survival of the baby, as well as the survival and 
wellbeing of the household. Persons other than the mother such as older female 
relatives were very influential in the care of the umbilical cord.
CONCLUSIONS: The umbilical cord carried symbolic meanings, which extended beyond 
the newborn and the newborn period, and in turn influenced the various practices 
of umbilical cord care. The important position of the cord in local newborn care 
practices should be recognized and taken into consideration when scaling up 
newborn care interventions in the country.

DOI: 10.1186/s12887-020-2002-9
PMCID: PMC7057479
PMID: 32131781 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


4456. J Pediatr Nurs. 2020 May-Jun;52:e77-e83. doi: 10.1016/j.pedn.2020.01.009. Epub 
2020 Feb 1.

The Impact of Web-Cameras on Parent-Infant Attachment in the Neonatal Intensive 
Care Unit.

Gibson R(1), Kilcullen M(2).

Author information:
(1)James Cook University, Australia. Electronic address: 
rachel.gibson@my.jcu.edu.au.
(2)James Cook University, Australia.

PROBLEM: The introduction of web-cameras in neonatal intensive care units 
(NICUs) has made it possible for parents to see their sick or premature infant 
when they cannot be close to them due to prolonged hospital admissions. However, 
there is a paucity of research into the impact of this technology on the 
wellbeing of families. A systematic review was conducted to identify previous 
research and suggest avenues for future inquiry.
ELIGIBILITY CRITERIA: Research studies written in English that investigated the 
impact of web-cameras on parent-infant attachment in the NICU were sought for 
inclusion. However, due to the dearth of studies focused on this question, the 
eligibility criteria were extended to include any study that assessed the impact 
of web-camera use on mechanisms that impact attachment quality, such as bonding, 
anxiety, stress, and depression.
RESULTS: A total of 152 articles were identified. After duplicates and other 
non-suitable articles were removed, three studies met eligibility criteria for 
review.
CONCLUSION: There are promising indications that the use of web-cameras in the 
NICU enhances parent-infant attachment by strengthening parents' feelings of 
closeness to their infants, increasing parental responsiveness and reducing 
parental stress and anxiety. However, while the overall effects appear to be 
positive, negative impacts affecting a small proportion of parents were 
identified. This highlights the need to identify who is most likely to benefit 
from web-camera technology and who requires alternative supports.
IMPLICATIONS: Web-cameras are a useful adjunct to methods of family-centred 
care, however, more research is needed to optimise their use and minimise 
potential harm.

Copyright © 2020 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.pedn.2020.01.009
PMID: 32014335 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest None.


4457. BMC Pediatr. 2020 Jan 29;20(1):38. doi: 10.1186/s12887-020-1929-1.

A comparative study of mothers of infants hospitalized in an open ward neonatal 
intensive care unit and a combined pod and single-family room design.

Feeley N(1)(2), Robins S(3), Genest C(4), Stremler R(5), Zelkowitz P(6), 
Charbonneau L(7).

Author information:
(1)Centre for Nursing Research, Jewish General Hospital, 3755 Côte-Ste-Catherine 
Rd, B- 621, Montréal, Québec, H3T 1E2, Canada. nancy.feeley@mcgill.ca.
(2)Ingram School of Nursing, McGill University, Montréal, Canada. 
nancy.feeley@mcgill.ca.
(3)Institute of Community and Family Psychiatry, Jewish General Hospital, 4333 
Côte Ste-Catherine Road, Montreal, Quebec, H3T 1E4, Canada.
(4)Faculty of Nursing, University of Montreal, 2375 Côte Ste-Catherine Road, 
Montréal, Québec, H3T 1A8, Canada.
(5)Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College 
Street, Suite 130, Toronto, Ontario, M5T 1P8, Canada.
(6)Department of Psychiatry, Jewish General Hospital Senior Investigator, Lady 
Davis Institute for Medical Research, 4333 Côte Ste-Catherine Road, Montréal, 
Québec, H3T 1E4, Canada.
(7)Neonatology, Jewish General Hospital, 3755 Côte-Ste-Catherine Rd, Montréal, 
Québec, H3T 1E2, Canada.

BACKGROUND: The well-being of mothers of infants requiring Neonatal Intensive 
Care Unit (NICU) hospitalization may be affected by the architectural design of 
the unit. A few recent studies suggest there may be some drawbacks of 
single-family rooms (SFRs) for infants and their mothers, such as isolation of 
mothers and reduced exposure to auditory stimulation for infants.
PURPOSE: To compare NICU-stress, symptoms of depression, perceptions of 
nurse-parent support and family-centered care, sleep disturbances, breastfeeding 
self-efficacy and readiness for discharge in mothers of infants cared for in an 
open ward (OW) to those cared for in a unit that includes both pods and SFRs.
METHODS: A pre-post quasi-experimental study was conducted in a Canadian level 3 
unit before and after transitioning to a new unit of 6-bed pods and SFRs. OW 
data were collected in 2014 and pod/SFR data 1 year after the transition in 2017 
to 2018. Mothers of infants hospitalized for at least 2 weeks completed 
questionnaires about stress, depressive symptoms, support, family-centered care, 
and sleep disturbances. In the week prior to discharge, they responded to 
breastfeeding self-efficacy and readiness for discharge questionnaires. They 
described their presence in the NICU at enrollment and again prior to discharge.
RESULTS: Pod/SFR mothers reported significantly less NICU-stress compared to OW 
mothers. OW mothers had greater sights and sounds stress and felt more 
restricted in their parental role. Pod/SFR mothers reported greater respect from 
staff. Controlling for maternal education, pod/SFR mothers perceived their 
infant's readiness for discharge to be greater than OW mothers. There were no 
significant differences between groups in depressive symptoms, nurse-parent 
support, sleep disturbances, and breastfeeding self-efficacy. At enrollment and 
again in the weeks preceding discharge, pod/SFR mothers were present 
significantly more hours per week than OW mothers, controlling for maternal 
education.
CONCLUSIONS: Further study of small pods is indicated as these units may be less 
stressful for parents, and enhance family-centered care, as well as maternal 
presence, compared to OWs.

DOI: 10.1186/s12887-020-1929-1
PMCID: PMC6988355
PMID: 31996178 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare they have no competing 
interests.


4458. Nurs Health Sci. 2020 Jun;22(2):445-453. doi: 10.1111/nhs.12679. Epub 2020 Jan 
23.

Emotional regulation training for intensive and critical care nurses.

Kharatzadeh H(1), Alavi M(2), Mohammadi A(3), Visentin D(4), Cleary M(5).

Author information:
(1)Department of Clinical Psychology, Faculty of Human Sciences, Shahed 
University, Tehran, Iran.
(2)Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, 
Isfahan University of Medical Sciences, Isfahan, Iran.
(3)Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical 
Sciences, Tehran, Iran.
(4)School of Health Sciences, College of Health and Medicine, University of 
Tasmania, Sydney, New South Wales, Australia.
(5)School of Nursing, College of Health and Medicine, University of Tasmania, 
Sydney, New South Wales, Australia.

Professional quality of life is related to psychological well-being for nurses 
with implications for quality patient care. This study evaluated the 
effectiveness of emotional regulation training on depression, anxiety and 
stress, and professional quality of life for intensive and critical care nurses. 
In this experimental comparison trial, 60 intensive and critical care nurses 
were randomly assigned to treatment and wait-list control groups. The treatment 
group received six sessions of emotional regulation training, while the 
wait-list control group received no treatment. Outcome measures were: the 
Cognitive Emotion Regulation Questionnaire; the Depression, Anxiety and Stress 
Scale; and the Professional Quality of Life Scale in a pre-post design. The 
treatment group demonstrated greater improvements in burnout and compassion 
satisfaction compared with the wait-list control group. No significant reduction 
in compassion fatigue was found compared with controls. Some cognitive coping 
strategies improved in the treatment group compared with controls, with greater 
reductions in depression, anxiety, and stress. This study indicates the benefits 
of implementing emotional regulation training programs to improve psychological 
well-being and professional quality of life for intensive and critical care 
nurses.

© 2020 John Wiley & Sons Australia, Ltd.

DOI: 10.1111/nhs.12679
PMID: 31975520 [Indexed for MEDLINE]


4459. ESC Heart Fail. 2020 Feb;7(1):130-137. doi: 10.1002/ehf2.12535. Epub 2020 Jan 9.

The social return on investment of a new approach to heart failure in the 
Spanish National Health System.

Merino M(1), Jiménez M(2), Manito N(3), Casariego E(4), Ivanova Y(2), 
González-Domínguez A(2), San Saturnino M(5), Hidalgo-Vega Á(6), Blanch C(7).

Author information:
(1)Department of Health Outcomes Research, Instituto Max Weber, Madrid, Spain.
(2)Department of Pharmacoeconomics and Market Access, Instituto Max Weber, 
Madrid, Spain.
(3)Department of Heart Failure and Transplant, Hospital Universitario de 
Bellvitge, Hospitalet de Llobregat, Barcelona, Spain.
(4)Department of Internal Medicine, Complejo Hospitalario de Lugo, Lugo, Spain.
(5)President, CardioAlianza, Barcelona, Spain.
(6)Economy and Health Research Seminar, Universidad de Castilla-La Mancha, 
Toledo, Spain.
(7)Early Access & Health Economics, Novartis, Barcelona, Spain.

AIMS: We aim to agree on a set of proposals to improve the current management of 
heart failure (HF) within the Spanish National Health System (SNHS) and apply 
the social return on investment (SROI) method to measure the social impact that 
these proposals would generate.
METHODS AND RESULTS: A multidisciplinary working team of 16 experts was set up, 
with representation from the main stakeholders regarding HF: medical specialists 
(cardiologists, internal medicine physicians, general practitioners, and 
geriatric physicians), nursing professionals, health management professionals, 
patients, and informal caregivers. This team established a set of proposals to 
improve the management of HF according to the main areas of HF care: emergency 
and hospitalization, primary care, cardiology, and internal medicine. A 
forecast-type SROI method, with a 1-year time frame, was applied to measure the 
social impact resulting from the implementation of these proposals. The required 
investment and social return were estimated and summarized into a ratio 
indicating how much social return could be generated for each euro invested. 
Intangible returns were included and quantified through financial proxies. The 
approach to improve the management of HF consisted of 28 proposals, including 
the implementation of a case management nurse network, standardization of 
operational protocols, psychological support, availability of echocardiography 
machines at emergency departments, stationary units and primary care, early 
specialist visits after hospital discharge, and cardiac rehabilitation units, 
among others. These proposals would benefit not only patients and their informal 
caregivers but also the SNHS. Regarding patients, proposals would increase their 
autonomy in everyday activities, decrease anxiety, increase psychological and 
physical well-being, improve pharmacological adherence and self-care, enhance 
understanding of the disease, delay disease progression, expedite medical 
assessment, and prevent the decrease in work productivity associated with HF 
management. Regarding informal caregivers, proposals would increase their 
quality of life; improve their social, economic, and emotional well-being; and 
reduce their care burden. The SNHS would benefit from shorter stays of HF 
patients at intensive care units and reduction of hospitalizations and 
admissions to emergency departments. The investment needed to implement these 
proposals would amount to €548m and yield a social return of €1932m, that is, 
€3.52 for each euro invested.
CONCLUSIONS: The current management of HF could be improved by a set of 
proposals that resulted in an overall positive social return, varying between 
areas of analysis. This may guide the allocation of healthcare resources and 
improve the quality of life of patients with HF.

© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on 
behalf of the European Society of Cardiology.

DOI: 10.1002/ehf2.12535
PMCID: PMC7083495
PMID: 31916416 [Indexed for MEDLINE]

Conflict of interest statement: M. M., M. J., Y. I., and A. G. are employees of 
the consultancy firm that received funds from Novartis Farmacéutica, S.A. to 
develop this study. E. C., M. S., and N. M. worked as experts for the 
consultancy firm. However, the participation of Novartis Farmacéutica, S.A. was 
limited to sponsoring the project.


4460. Mol Med. 2019 Dec 31;26(1):6. doi: 10.1186/s10020-019-0132-z.

Post-sepsis syndrome - an evolving entity that afflicts survivors of sepsis.

Mostel Z(1)(2), Perl A(3)(4), Marck M(3), Mehdi SF(3), Lowell B(3), Bathija 
S(3), Santosh R(3), Pavlov VA(5)(6), Chavan SS(5)(6), Roth J(3)(5)(6).

Author information:
(1)Laboratory of Diabetes and Diabetes-Related Research, Feinstein Institute for 
Medical Research, Northwell Health, Manhasset, NY, USA. zacharym@mail.tau.ac.il.
(2)Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. 
zacharym@mail.tau.ac.il.
(3)Laboratory of Diabetes and Diabetes-Related Research, Feinstein Institute for 
Medical Research, Northwell Health, Manhasset, NY, USA.
(4)Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
(5)Center for Bioelectronic Medicine and Biomedical Science, Feinstein Institute 
for Medical Research, Northwell Health, Manhasset, NY, USA.
(6)Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, 
NY, USA.

BACKGROUND: The sequelae of sepsis were once thought to be independent of sepsis 
itself and assumed to be either comorbid to sick patients or complications of 
critical illness. Recent studies have reported consistent patterns of functional 
disabilities in sepsis survivors that can last from months to years after 
symptoms of active sepsis had resolved. BODY: Post-sepsis syndrome is an 
emerging pathological entity that has garnered significant interest amongst 
clinicians and researchers over the last two decades. It is marked by a 
significantly increased risk of death and a poor health-related quality of life 
associated with a constellation of long-term effects that persist following the 
patient's bout with sepsis. These include neurocognitive impairment, functional 
disability, psychological deficits, and worsening medical conditions.
CONCLUSION: This "post-sepsis syndrome" has been the subject of active 
preclinical and clinical research providing new mechanistic insights and 
approaches linked to survivor well-being. Here we review important aspects of 
these research efforts and goals of care for patients who survive sepsis.

DOI: 10.1186/s10020-019-0132-z
PMCID: PMC6938630
PMID: 31892321 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests as defined by Molecular Medicine, or other interests that might be 
perceived to influence the results and discussion reported in this paper. All 
authors are members of the Feinstein Institute for Medical Research at Northwell 
Health and Dr. Valentin Pavlov is an executive editor at Molecular Medicine. As 
per the publisher-level peer review policy (“All submissions to BMC journals are 
assessed by an Editor, who will decide whether they are suitable for peer 
review. Where an Editor is on the author list or has any other competing 
interest regarding a specific manuscript, another member of the Editorial Board 
will be assigned to assume responsibility for overseeing peer review.”), Dr. 
Pavlov did not participate in the peer review for this manuscript.


4461. Chest. 2020 Apr;157(4):977-984. doi: 10.1016/j.chest.2019.12.003. Epub 2019 Dec 
23.

Sleep and Delirium in Adults Who Are Critically Ill: A Contemporary Review.

Pisani MA(1), D'Ambrosio C(2).

Author information:
(1)Yale University School of Medicine, New Haven, CT. Electronic address: 
margaret.pisani@yale.edu.
(2)Harvard Medical School, Boston, MA.

Sleep is important to health and well-being, and studies in healthy adults have 
demonstrated that sleep deprivation impacts respiratory, immune, and cognitive 
function. Historically, because of the nature of critical illness, sleep has not 
been considered a priority for patient care in the ICU. More recently, research 
has demonstrated that sleep is markedly abnormal in patients who are critically 
ill. In addition, there is often disruption of circadian rhythms. Delirium is a 
syndrome of acute alteration in mental status that occurs in the setting of 
contributing factors such as serious illness, medication, and drug or alcohol 
intoxication or withdrawal. Delirium is a frequent occurrence in critical 
illness, and research has demonstrated several adverse outcomes associated with 
delirium including persistent cognitive impairment and increased mortality. 
Sleep deprivation and delirium share many common symptoms. The similarity in 
symptoms between sleep disruption and delirium have prompted experts to draw 
links between the two and question both the relationship and its direction. In 
addition, the inclusion of sleep disturbance to the Diagnostic and Statistical 
Manual of Mental Disorders, 5th Edition in its constellation of symptoms used in 
diagnosing delirium has increased awareness of the link between sleep and 
delirium. This paper will review the literature on sleep in critical illness and 
the potential mechanisms and pathways that may connect sleep and delirium.

Copyright © 2019 American College of Chest Physicians. Published by Elsevier 
Inc. All rights reserved.

DOI: 10.1016/j.chest.2019.12.003
PMID: 31874132 [Indexed for MEDLINE]


4462. Rev Infirm. 2019 Dec;68(256):43-44. doi: 10.1016/j.revinf.2019.10.015.

[The wellness trolley: a tool to improve "better living in intensive care"].

[Article in French]

Descamps S(1), Bertrand F(2), Bazin M(2), Lartigue J(2), Comte de Luzy S(2).

Author information:
(1)Unité de réanimation chirurgicale, CHU de Bordeaux, groupe hospitalier 
Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France. Electronic address: 
descamps.sa@wanadoo.fr.
(2)Unité de réanimation chirurgicale, CHU de Bordeaux, groupe hospitalier 
Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France.

ICU services are a source of anxiety and stress. There are many barriers to 
well-being for the patients who are admitted. From this observation was born the 
surgical intensive care project of the Pellegrin Hospital in Bordeaux, which 
aims to create a wellness trolley. Its objective is to improve hospital 
conditions and the patient's experience.

Copyright © 2019. Publié par Elsevier Masson SAS.

DOI: 10.1016/j.revinf.2019.10.015
PMID: 31870481 [Indexed for MEDLINE]


4463. J Trauma Nurs. 2019 Nov/Dec;26(6):290-296. doi: 10.1097/JTN.0000000000000467.

A Call to Follow-Up: Results Regarding Trauma Clinic Follow-Up Patterns.

Trevino CM(1), Cooros JC, Chesney SA, deRoon-Cassini T, Carver TW, Milia DJ.

Author information:
(1)Medical College of Wisconsin, Milwaukee (Drs Trevino, deRoon-Cassini, Carver, 
and Milia); Dartmouth-Hitchcock Medical Center/Geisel School of Medicine at 
Dartmouth, Hanover, New Hampshire (Dr Cooros); and Marquette University, 
Milwaukee, Wisconsin (Ms Chesney).

The objective of this study was to assess the current practice pattern regarding 
posthospitalization follow-up of trauma patients among the members of the 
Eastern Association for the Surgery of Trauma (EAST). An anonymous online 
multiple-choice survey of EAST members in 2016 was conducted. Ten questions 
relating to the follow-up care of injured patients were presented to the Active, 
Senior, and Associate members of EAST. Data were screened for quantitative 
concerns prior to analysis. Of the 1,610 members surveyed, 289 responded (18%). 
Approximately 52% of respondents stated that their institution has a dedicated 
trauma follow-up clinic where most injured patients are seen after discharge. 
Less than 20% reported that nontrauma multidisciplinary providers are present in 
clinics. Most (89.5%) reported that follow-up is a single visit, unless a 
patient has long-standing issues. Only 3 respondents stated that patients are 
regularly seen 3+ months out from injury, and a significant minority (17.7%) 
acknowledged no set follow-up timeline. Only 3.6% of participants indicated that 
they have a psychologist embedded in the trauma team, and 11.5% reported that no 
system is currently in place to manage mental health. Despite more than 20 years 
of literature highlighting the long-term physical and mental health sequelae 
after trauma, these survey results demonstrate that there is a lack of 
standardized and multidisciplinary follow-up. Given the improvement in outcomes 
with the identification and treatment of these sequelae, greater attention 
should be paid to functional recovery, social and psychological well-being, and 
chronic pain.

DOI: 10.1097/JTN.0000000000000467
PMID: 31714489 [Indexed for MEDLINE]


4464. PLoS One. 2019 Nov 5;14(11):e0224488. doi: 10.1371/journal.pone.0224488. 
eCollection 2019.

Parent psychological wellbeing in a single-family room versus an open bay 
neonatal intensive care unit.

Tandberg BS(1)(2)(3), Flacking R(4), Markestad T(3), Grundt H(5), Moen A(1)(6).

Author information:
(1)Department of Paediatric and Adolescent Medicine, Drammen Hospital, Vestre 
Viken Hospital Trust, Drammen, Norway.
(2)Lovisenberg Diaconal University College, Oslo, Norway.
(3)Department of Clinical Science, Faculty of Medicine and Dentistry, University 
of Bergen, Bergen, Norway.
(4)School of Education, Health and Social Studies, Dalarna University, Falun, 
Sweden.
(5)Department of Paediatrics, Haukeland University Hospital, Bergen, Norway.
(6)Department of Neonatology, Oslo University Hospital, Oslo, Norway.

BACKGROUND: Studies of parents' psychological well-being in single-family rooms 
in neonatal intensive care units have shown conflicting results.
AIMS: To compare emotional distress in the form of depression, anxiety, stress 
and attachment scores among parents of very preterm infants cared for in a 
single-family rooms unit vs an open bay unit.
STUDY DESIGN: Prospective survey design.
SUBJECT: Parents (132) of 77 infants born at 28 0/7-32 0/7 weeks of gestation in 
the two units.
OUTCOME MEASURES: Duration of parental presence was recorded. Scores for 
depression (The Edinburgh Postnatal Depression Scale), anxiety (The 
State-Trait-Anxiety Inventory, Short Form Y), stress (The Parent Stressor Scale: 
neonatal intensive care unit questionnaire and The Parenting Stress Index-short 
form) and attachment (Maternal Postnatal Attachment Scale) measured 14 days 
after delivery, at discharge, expected term date and four months post-term.
RESULTS: Parents were present 21 hours/day in the single-family room unit vs 7 
hours/day in the Open bay unit. Ninety-three percent of the fathers in the 
single-family rooms unit were present more than 12 hours per day during the 
first week. Mothers in the single-family rooms had a significantly lower 
depression score -1.9 (95% CI: -3.6, -0.1) points from birth to four months 
corrected age compared to mothers in the Open bay unit, and 14% vs 52% scored 
above a cut-off point considered being at high risk for depression (p<0.005). 
Both mothers and fathers in the single-family rooms reported significantly lower 
stress levels during hospitalization. There were no differences between the 
groups for anxiety, stress or attachment scores after discharge.
CONCLUSION: The lower depression scores by the mothers and lower parental stress 
scores during hospitalization for both parents supports that single-family rooms 
care contribute to parents' psychological wellbeing.

DOI: 10.1371/journal.pone.0224488
PMCID: PMC6830777
PMID: 31689307 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing 
interests exist.


4465. Crit Care Nurs Clin North Am. 2019 Dec;31(4):527-536. doi: 
10.1016/j.cnc.2019.07.008. Epub 2019 Sep 23.

Burnout in Critical Care Nurses.

Browning SG(1).

Author information:
(1)School of Nursing, College of Behavioral and Health Sciences, Middle 
Tennessee State University, PO Box 81, 1301 East Main, Murfreesboro, TN 37132, 
USA. Electronic address: Stacey.Browning@mtsu.edu.

Burnout syndrome is a contested diagnosis with wide ranging effects on critical 
care nurses, patients and families, and health care organizations. Multiple 
evaluation tools exist, and the core components of the theoretic burnout tools 
are vague and ambiguous and overlap legitimate mental health diseases, such as 
depression. Applied therapeutic interventions support decreased perceived 
burnout and staff turnover and improved overall well-being of nurses. Research 
postulates that decreased levels of burnout are associated with improved quality 
of patient care, communication, and trust, combined with decreases in patient 
morbidity and mortality, and ultimately, a decrease in the overall financial 
cost of care.

Copyright © 2019 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.cnc.2019.07.008
PMID: 31685119 [Indexed for MEDLINE]


4466. Curr Pediatr Rev. 2020;16(3):183-193. doi: 10.2174/1573396315666191022102925.

Pediatric Acute-onset Neuropsychiatric Syndrome and Mycoplasma Pneumoniae 
Infection: A Case Report Analysis with a Metabolomics Approach.

Piras C(1), Pintus R(2), Pruna D(3), Dessì A(2), Atzori L(1), Fanos V(2).

Author information:
(1)Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy.
(2)Department of Surgical Sciences, Neonatal Intensive Care Unit, Puericulture 
Institute and Neonatal Section, Azienda Ospedaliera Universitaria, Cagliari, 
Italy.
(3)Pediatric Neurology and Epileptology Unit, Brotzu Hospital Trust, Cagliari, 
Italy.

Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) is a clinical condition 
characterized by a sudden and dramatic obsessive-compulsive disorder with a 
suggested post-infectious immune-mediated etiology. This condition is 
accompanied by an extensive series of relatively serious neuropsychiatric 
symptoms. The diagnosis of PANS is made by "exclusion", as the individual PANS 
symptoms overlap with a multiplicity of psychiatric disorders with the onset in 
childhood. A number of researchers accumulated evidence to support the 
hypothesis that PANS was closely associated with a number of infections. In the 
last decade, metabolomics played an essential role in improving the knowledge of 
complex biological systems and identifying potential new biomarkers as 
indicators of pathological progressions or pharmacologic responses to therapy. 
The metabolome is considered the most predictive phenotype, capable of 
recognizing epigenetic differences, reflecting more closely the clinical reality 
at any given moment and thus providing extremely dynamic data. In the present 
work, the most recent hypothesis and suggested mechanisms of this condition are 
reviewed and the case of a 10 - year-old girl with PANS is described, before and 
after clarithromycin treatment. The main results of this case report are 
discussed from a metabolomics point of view. The alteration of several metabolic 
pathways concerning the microbial activity highlights the possible role of the 
microbiome in the development of PANS. Furthermore, different metabolic 
perturbations at the level of protein biosynthesis, energy and amino acid 
metabolisms are observed and discussed. Based on our observations, it is 
believed that metabolomics is a promising technology to unravel the mysteries of 
PANS in the near future.

Copyright© Bentham Science Publishers; For any queries, please email at 
epub@benthamscience.net.

DOI: 10.2174/1573396315666191022102925
PMCID: PMC8193809
PMID: 31642785 [Indexed for MEDLINE]


4467. Z Gerontol Geriatr. 2019 Nov;52(Suppl 4):264-272. doi: 
10.1007/s00391-019-01623-2. Epub 2019 Oct 18.

Communication behavior of cognitively impaired older inpatients : A new setting 
for validating the CODEM instrument.

Schnabel EL(1), Wahl HW(2), Penger S(3), Haberstroh J(3).

Author information:
(1)Network Aging Research, Heidelberg University, Bergheimer Straße 20, 69115, 
Heidelberg, Germany. schnabel@nar.uni-heidelberg.de.
(2)Network Aging Research, Heidelberg University, Bergheimer Straße 20, 69115, 
Heidelberg, Germany.
(3)Interdisciplinary Ageing Research, Goethe University Frankfurt, Frankfurt, 
Germany.

BACKGROUND AND OBJECTIVE: Acutely ill older patients with cognitive impairment 
represent a major subgroup in acute care hospitals. In this context, 
communication plays a crucial role for patients' well-being, healthcare 
decisions, and medical outcomes. As validated measures are lacking, we tested 
the psychometric properties of an observational instrument to assess 
Communication Behavior in Dementia (CODEM) in the acute care hospital setting. 
As a novel feature, we were also able to incorporate linguistic and 
social-contextual measures.
MATERIAL AND METHODS: Data were drawn from a cross-sectional mixed methods study 
that focused on the occurrence of elderspeak during care interactions in two 
German acute care hospitals. A total of 43 acutely ill older patients with 
severe cognitive impairment (CI group, Mage ± SD = 83.6 ± 5.7 years) and 50 
without cognitive impairment (CU group, Mage ± SD = 82.1 ± 6.3 years) were 
observed by trained research assistants during a standardized interview 
situation and rated afterwards by use of CODEM.
RESULTS: Factor analysis supported the expected two-factor solution for the CI 
group, i.e., a verbal content and a nonverbal relationship aspect. Findings of 
the current study indicated sound psychometric properties of the CODEM 
instrument including internal consistency, convergent, divergent, and criterion 
validity.
CONCLUSION: CODEM represents a reliable and valid tool to examine the 
communication behavior of older patients with CI in the acute care hospital 
setting. Thus, CODEM might serve as an important instrument for researcher and 
healthcare professionals to describe and improve communication patterns in this 
environment.

Publisher: ZUSAMMENFASSUNG: HINTERGRUND UND ZIELSETZUNG: Akut erkrankte 
Patienten mit kognitiver Beeinträchtigung stellen eine bedeutsame Subgruppe in 
Akutkrankenhäusern dar. In diesem Zusammenhang spielt Kommunikation eine 
entscheidende Rolle für das Wohlbefinden der Patienten, medizinische 
Entscheidungen und Outcomes. Da es an validierten Maßen mangelt, testeten wir 
die psychometrischen Eigenschaften eines Beobachtungsinstrumentes zur Erfassung 
des Kommunikationsverhaltens von Demenzpatienten (KODEM) im 
Akutkrankenhaussetting. Dabei war es erstmalig möglich, linguistische und 
sozial-kontextuelle Maße einzubeziehen.
MATERIAL UND METHODEN: Die Daten stammten aus einer querschnittlichen 
„Mixed-method“-Studie, deren Fokus auf dem Vorkommen von Elderspeak während 
Pflegeinteraktionen in zwei deutschen Akutkrankenhäusern lag. Insgesamt 43 akut 
erkrankte ältere Patienten mit schwerer kognitiver Beeinträchtigung (KB-Gruppe; 
MAlter ± SD = 83,6 ± 5,7 Jahre) und 50 ohne kognitive Beeinträchtigung 
(KU-Gruppe; MAlter ± SD = 82,1 ± 6,3 Jahre) wurden von geschulten 
Forschungsassistenten während einer standardisierten Interviewsituation 
beobachtet und anschließend mittels KODEM beurteilt.
ERGEBNISSE: Die Faktorenanalyse bestätigte die erwartete Zwei-Faktoren-Lösung 
für die KB-Gruppe, d. h. einen verbalen Inhalts- und einen nonverbalen 
Beziehungsaspekt. Die Ergebnisse der vorliegenden Studie zeigten einwandfreie 
psychometrische Eigenschaften des KODEM-Instruments, was die interne Konsistenz, 
die konvergente, divergente und die Kriteriumsvalidität betrifft.
SCHLUSSFOLGERUNG: KODEM erwies sich als ein reliables und valides Instrument zur 
Erfassung des Kommunikationsverhaltens von älteren Patienten mit KB im 
Akutkrankenhaussetting. Somit könnte KODEM als ein wichtiges Hilfsmittel für 
Forscher und Gesundheitspersonal dienen, um Kommunikationsmuster in dieser 
Umgebung zu beschreiben und zu verbessen.

DOI: 10.1007/s00391-019-01623-2
PMCID: PMC6821670
PMID: 31628612 [Indexed for MEDLINE]

Conflict of interest statement: E.-L. Schnabel, H.-W. Wahl, S. Penger and 
J. Haberstroh declare that they have no competing interests.


4468. BMC Pregnancy Childbirth. 2019 Oct 10;19(1):345. doi: 10.1186/s12884-019-2505-2.

A qualitative cross-cultural analysis of NICU care culture and infant feeding in 
Finland and the U.S.

Holdren S(1), Fair C(2), Lehtonen L(3).

Author information:
(1)Department of Pediatrics, Turku University Hospital, Turku, Finland. 
sholdren@elon.edu.
(2)Public Health Studies & Department Chair, Elon University Department of 
Public Health Studies, Elon, North Carolina, USA.
(3)Department of Pediatrics, Neonatology & Professor of Pediatrics, Turku 
University Hospital, Turku, Finland.

BACKGROUND: The benefits of family-centered care for the health and well-being 
of preterm infants and their families include increased parent-infant closeness, 
improved lactation, and positive mental health outcomes; however, it is known 
that the extent to which family-centered care is adopted varies by unit. This 
study aimed to understand how differences in neonatal care culture in two units 
in Finland and the U.S. were translated to parents' infant feeding experiences 
in the hope of improving relationally focused feeding practices in both 
locations.
METHODS: This qualitative, cross-sectional study utilized narrative 
methodologies to understand the lived experiences of 15 families hospitalized in 
a tertiary neonatal intensive care unit in Finland (n = 8) and the U. S (n = 7).
RESULTS: A global theme of lactation as a means or an end showed that lactation 
and infant feeding were framed differently in each location. The three 
supporting themes that explain families' perceptions of their transition to 
parenthood, support as a family unit, and experience with lactation include: 
universal early postnatal challenges; culture and space-dependent nursing 
support; and controlled or empowering breastfeeding experiences.
CONCLUSIONS: Care culture plays a large role in framing all infant caring 
activities, including lactation and infant feeding. This study found that in the 
unit in Finland, breastfeeding was one method to achieve closeness with an 
infant, while in the unit in the U.S., pumping was only an end to promote infant 
nutritional health. Therefore, breastfeeding coupled with closeness was found to 
be supportive of a salutogenic, or health-promoting, care approach for the whole 
family.

DOI: 10.1186/s12884-019-2505-2
PMCID: PMC6785867
PMID: 31601193 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


4469. BMJ Open. 2019 Sep 3;9(8):e025062. doi: 10.1136/bmjopen-2018-025062.

Longitudinal Study of music Therapy's Effectiveness for Premature infants and 
their caregivers (LongSTEP): protocol for an international randomised trial.

Ghetti C(1)(2), Bieleninik Ł(2)(3), Hysing M(4)(5), Kvestad I(5), Assmus J(2), 
Romeo R(6), Ettenberger M(7)(8), Arnon S(9)(10), Vederhus BJ(11), Söderström 
Gaden T(2), Gold C(2).

Author information:
(1)GAMUT - The Grieg Academy Music Therapy Research Centre, The Grieg Academy - 
Department of Music, University of Bergen, Bergen, Norway Claire.Ghetti@uib.no.
(2)GAMUT - The Grieg Academy Music Therapy Research Centre, NORCE Norwegian 
Research Centre AS, Bergen, Norway.
(3)Institute of Psychology, Uniwersytet Gdanski, Gdansk, Poland.
(4)Department of Psychosocial Science, University of Bergen, Bergen, Norway.
(5)Regional Center for Child and Youth Mental Health and Child Welfare, NORCE 
Norwegian Research Centre AS, Bergen, Norway.
(6)King's Health Economics, King's College London, London, UK.
(7)Department of Patient and Family Care, Hospital Universitario Fundacion Santa 
Fe de Bogotá, Bogotá, Colombia.
(8)SONO - Centro de Musicoterapia, Bogota, Colombia.
(9)Neonatal Department, Meir Medical Center, Kfar Saba, Israel.
(10)Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
(11)Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.

INTRODUCTION: Preterm birth has major medical, psychological and socioeconomic 
consequences worldwide. Music therapy (MT) has positive effects on physiological 
measures of preterm infants and maternal anxiety, but rigorous studies including 
long-term follow-up are missing. Drawing on caregivers' inherent resources, this 
study emphasises caregiver involvement in MT to promote attuned, developmentally 
appropriate musical interactions that may be of mutual benefit to infant and 
parent. This study will determine whether MT, as delivered by a qualified music 
therapist during neonatal intensive care unit (NICU) hospitalisation and/or in 
home/municipal settings following discharge, is superior to standard care in 
improving bonding between primary caregivers and preterm infants, parent 
well-being and infant development. METHODS AND ANALYSIS: Design: international 
multicentre, assessor-blind, 2×2 factorial, pragmatic randomised controlled 
trial; informed by a completed feasibility study. Participants: 250 preterm 
infants and their parents. Intervention: MT focusing on parental singing 
specifically tailored to infant responses, will be delivered during NICU and/or 
during a postdischarge 6-month period. Primary outcome: changes in mother-infant 
bonding at 6-month corrected age (CA), as measured by the Postpartum Bonding 
Questionnaire. Secondary outcomes: mother-infant bonding at discharge and at 
12-month CA; child development over 24 months; and parental depression, anxiety 
and stress, and infant rehospitalisation, all over 12 months.
ETHICS AND DISSEMINATION: The Regional Committees for Medical and Health 
Research Ethics approved the study (2018/994/REK Nord, 03 July 2018). Service 
users were involved in development of the study and will be involved in 
implementation and dissemination. Dissemination of findings will apply to local, 
national and international levels.
TRIAL REGISTRATION NUMBER: NCT03564184.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No 
commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2018-025062
PMCID: PMC6731830
PMID: 31481362 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: ŁB, CGh and CGo conceived 
the study, developed the study design, and drafted the manuscript. JA developed 
the study design, provided statistical expertise in clinical trial design and is 
conducting the primary statistical analysis. IK, MH, RR, ME, SA, BV and TG 
contributed to the study design, with IK and MH contributing in particular the 
definition of outcomes. All authors contributed to refinement of the study 
protocol and approved the final manuscript.


4470. J Intensive Care Soc. 2019 Aug;20(3):196-203. doi: 10.1177/1751143718787753. 
Epub 2018 Jul 17.

A survey of moral distress in staff working in intensive care in the UK.

Colville GA(1)(2), Dawson D(3), Rabinthiran S(4), Chaudry-Daley Z(4), 
Perkins-Porras L(5).

Author information:
(1)Paediatric Psychology Service, St George's University Hospitals NHS 
Foundation Trust, London, UK.
(2)Population Health Research Institute, St George's, University of London, UK.
(3)Adult Intensive Care Units, St George's University Hospitals NHS Foundation 
Trust, London, UK.
(4)Medical School, St George's, University of London, UK.
(5)Institute of Medical and Behavioural Education, St George's, University of 
London, UK.

Elevated rates of burnout and post-traumatic stress have been found in staff 
working in critical care settings, but the aspect of moral distress has been 
harder to quantify until a recent revision of a scale previously designed for 
nurses, was adapted for use with a range of health professionals, including 
physicians. In this cross-sectional survey, n = 171 nurses and physicians 
working in intensive care in the United Kingdom completed the Moral Distress 
Scale-Revised in relation to their experiences at work. Mean (SD) Moral Distress 
Scale-Revised score was 70.2 (39.6). Significant associations were found with 
female gender (female 74.1 (40.2) vs. male 55.5 (33.8), p = 0.010); depression 
(r = 0.165, p = 0.035) and with intention to leave job (considering leaving 85.5 
(42.4) vs. not considering leaving 67.2 (38.6), p = 0.040). These results 
highlight the importance of considering the moral impact of work-related issues 
when addressing staff wellbeing in critical care settings.

DOI: 10.1177/1751143718787753
PMCID: PMC6693114
PMID: 31447911


4471. Nutrients. 2019 Aug 13;11(8):1887. doi: 10.3390/nu11081887.

Metabolic Endotoxemia: A Potential Underlying Mechanism of the Relationship 
between Dietary Fat Intake and Risk for Cognitive Impairments in Humans?

André P(1), Laugerette F(2), Féart C(3).

Author information:
(1)Team Lifelong Exposure Health and Aging, Inserm, Bordeaux Population Health 
Research Center, Univ. Bordeaux U1219, F-33000 Bordeaux, France. 
perrine.andre@u-bordeaux.fr.
(2)Univ-Lyon, CarMeN Laboratory, INRA U1397, Inserm U1060, Université Claude 
Bernard Lyon 1, INSA Lyon, Charles Mérieux Medical School, FR-69600 Oullins, 
France.
(3)Team Lifelong Exposure Health and Aging, Inserm, Bordeaux Population Health 
Research Center, Univ. Bordeaux U1219, F-33000 Bordeaux, France.

(1) Background: Nutrition is a major lifestyle factor that can prevent the risk 
of cognitive impairment and dementia. Diet-induced metabolic endotoxemia has 
been proposed as a major root cause of inflammation and these pathways emerge as 
detrimental factors of healthy ageing. The aim of this paper was to update 
research focusing on the relationship between a fat-rich diet and endotoxemia, 
and to discuss the potential role of endotoxemia in cognitive performances. (2) 
Methods: We conducted a non-systematic literature review based on the PubMed 
database related to fat-rich meals, metabolic endotoxemia and cognitive 
disorders including dementia in humans. A total of 40 articles out of 942 in the 
first screening met the inclusion criteria. (3) Results: Evidence suggested that 
a fat-rich diet, depending on its quality, quantity and concomitant healthy food 
components, could influence metabolic endotoxemia. Since only heterogeneous 
cross-sectional studies are available, it remains unclear to what extent 
endotoxemia could be associated or not with cognitive disorders and dementia. 
(4) Conclusions: A fat-rich diet has the capability to provide significant 
increases in circulating endotoxins, which highlights nutritional strategies as 
a promising area for future research on inflammatory-associated diseases. The 
role of endotoxemia in cognitive disorders and dementia remains unclear and 
deserves further investigation.

DOI: 10.3390/nu11081887
PMCID: PMC6722750
PMID: 31412673 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflicts of interest.


4472. Prim Care. 2019 Sep;46(3):373-386. doi: 10.1016/j.pop.2019.05.004. Epub 2019 Jun 
10.

Psychosocial Issues and Bereavement.

Strada EA(1).

Author information:
(1)Psychopharmacology Program, Alliant University, San Francisco, CA, USA. 
Electronic address: astrada23@gmail.com.

Patients with serious illness and their family caregivers face numerous ongoing 
psychological and social concerns and stressors throughout the disease 
trajectory. Common challenges relate to the need to manage the disease by making 
complex and often difficult medical decisions. In addition, the presence of 
psychological and psychiatric distress, including depression and anxiety, may 
significantly add to the overall symptom burden for the patient and family 
caregivers. These challenges negatively impact mood, cognitive function, 
interpersonal relationships, and medical decision making. If not recognized and 
adequately addressed, they can seriously undermine coping and resilience, 
eroding psychological well-being and quality of life.

Copyright © 2019 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.pop.2019.05.004
PMID: 31375187 [Indexed for MEDLINE]


4473. Aust Crit Care. 2020 Jul;33(4):317-325. doi: 10.1016/j.aucc.2019.06.002. Epub 
2019 Jul 29.

Families' perspectives of participation in patient care in an adult intensive 
care unit: A qualitative study.

Wong P(1), Redley B(2), Digby R(3), Correya A(4), Bucknall T(3).

Author information:
(1)Deakin University, School of Nursing and Midwifery, Faculty of Health, Centre 
for Quality and Patient Safety Research (QPS), 1 Gheringhap Street, Geelong, VIC 
3220, Australia. Electronic address: p.wong@deakin.edu.au.
(2)Deakin University, School of Nursing and Midwifery, Faculty of Health, Centre 
for Quality and Patient Safety Research (QPS), 1 Gheringhap Street, Geelong, VIC 
3220, Australia; Centre for Quality and Patient Safety Research-Monash Health 
Partnership, Monash Health.
(3)Deakin University, School of Nursing and Midwifery, Faculty of Health, Centre 
for Quality and Patient Safety Research (QPS), 1 Gheringhap Street, Geelong, VIC 
3220, Australia; Centre for Quality and Patient Safety Research-Alfred Health 
Partnership, Alfred Health.
(4)Monash Medical Centre, Monash Health.

BACKGROUND: When a relative is admitted to the intensive care unit (ICU), 
stress, anxiety, and failure to cope may place families, and the patient, at 
risk for adverse psychological outcomes. Family participation in patient care 
may improve patient and family outcomes. However, to date, little is known about 
how families perceive and participate in patient care in ICU, and there is 
limited research to guide clinicians about supporting family participation in 
this context.
OBJECTIVE: To describe family perspectives of participation in patient care in 
adult ICU.
METHODS: Using a qualitative design, observation and interview data were 
collected from a convenience sample of 30 family members in the ICU at two 
metropolitan hospitals in Melbourne, Australia. An independent third party was 
used to recruit potential participants. Naturalistic observations and 
semi-structured interviews explored families' actions and perceptions of 
participation. Data were integrated and subject to thematic analyses.
FINDINGS: The major theme Families as part of the healthcare team reflected 
family perspectives of their own significant contribution to supporting their 
relative's recovery while they were in ICU. Families' perception of their 
participation in patient care was characterised by three sub-themes: 1) 
Motivators for family participation; 2) Family roles during recovery; and 3) 
Influences on family participation. Families' perceived reassurance and 
companionship as important contributions to patient care.
CONCLUSION: Families perceived their contribution to the patient's psychosocial 
and emotional well-being to be one of the most important aspects of 
participation. Nevertheless, their role in the healthcare team was influenced by 
several motivational factors. Results of this study can inform further research 
to test the effectiveness of clinical practice and educational interventions 
aligned with family preferences to promote participation and enhance patient and 
family-centered care in ICU.

Copyright © 2019 Australian College of Critical Care Nurses Ltd. Published by 
Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.aucc.2019.06.002
PMID: 31371242 [Indexed for MEDLINE]


4474. Nurs Open. 2019 May 18;6(3):698-712. doi: 10.1002/nop2.287. eCollection 2019 
Jul.

Families of patients in ICU: A Scoping review of their needs and satisfaction 
with care.

Scott P(1), Thomson P(2), Shepherd A(2).

Author information:
(1)Intensive Care Unit Forth Valley Royal Hospital Larbert UK.
(2)School of Health Sciences University of Stirling Stirling UK.

AIM: To describe published literature on the needs and experiences of family 
members of adults admitted to intensive care and interventions to improve family 
satisfaction and psychological well-being and health.
DESIGN: Scoping review.
METHODS: Several selective databases were searched. English-language articles 
were retrieved, and data extracted on study design, sample size, sample 
characteristics and outcomes measured.
RESULTS: From 469 references, 43 studies were identified for inclusion. Four key 
themes were identified: (a) Different perspectives on meeting family needs; (b) 
Family satisfaction with care in intensive care; (c) Factors having an impact on 
family health and well-being and their capacity to cope; and (d) Psychosocial 
interventions. Unmet informational and assurance needs have an impact on family 
satisfaction and mental health. Structured written and oral information shows 
some effect in improving satisfaction and reducing psychological burden. Future 
research might include family in the design of interventions, provide details of 
the implementation process and have clearly identified outcomes.

DOI: 10.1002/nop2.287
PMCID: PMC6650754
PMID: 31367391

Conflict of interest statement: No conflict of interest.


4475. J Perinat Neonatal Nurs. 2019 Jul/Sep;33(3):268-275. doi: 
10.1097/JPN.0000000000000428.

Maternal Factors Associated With the Healthcare Utilization of 
Technology-Dependent Infants Following NICU Discharge.

Toly VB(1), Sattar A, Zauszniewski JA.

Author information:
(1)Frances Payne Bolton School of Nursing, Case Western Reserve University, 
Cleveland, Ohio (Drs Toly and Zauszniewski); and Department of Epidemiology and 
Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, 
Ohio (Dr Sattar).

This study examined the relationship of mothers' psychological well-being 
(depressive symptoms, posttraumatic stress symptoms) and resourcefulness with 
their technology-dependent infants' healthcare utilization (rehospitalization, 
emergency department [ED] visits) following discharge from the neonatal 
intensive care unit (NICU). This descriptive, correlational study was conducted 
at a large Midwest level 4 NICU in the United States. Mothers (n = 19) with a 
technology-dependent infant (eg, supplemental oxygen, feeding tubes) to be 
discharged home from the NICU within 2 to 3 weeks were interviewed face-to-face 
using standardized instruments. Infant rehospitalization and ED visit data were 
collected from the electronic medical record (EMR) for the first 3 months 
following the infant's discharge. Analyses included descriptive statistics and 
negative binomial regression. A majority of infants (72.2%) required at least 1 
hospitalization; 33% required at least one ED visit. Mothers' age and 
resourcefulness were significant predictors of ED visits while only 
resourcefulness predicted rehospitalizations. Neither depressive symptoms nor 
posttraumatic stress symptoms significantly predicted healthcare utilization. 
Maternal resourcefulness was the only main variable that significantly predicted 
both ED visits and hospitalizations and one of the few modifiable factors that 
could assist mothers with successfully coping with the complexity of caring for 
a technology-dependent infant. Future research should focus on interventions to 
enhance mothers' resourcefulness prior to their technology-dependent infant's 
NICU discharge.

DOI: 10.1097/JPN.0000000000000428
PMID: 31335857 [Indexed for MEDLINE]


4476. AIMS Public Health. 2019 May 5;6(2):160-183. doi: 
10.3934/publichealth.2019.2.160. eCollection 2019.

An integrative review: maternal engagement in the neonatal intensive care unit 
and health outcomes for U.S.-born preterm infants and their parents.

Klawetter S(1), Greenfield JC(2), Speer SR(3), Brown K(4), Hwang SS(5).

Author information:
(1)School of Social Work, Portland State University, Portland, OR, USA.
(2)Graduate School of Social Work, University of Denver, Denver, CO USA.
(3)Graduate School of Social Work, University of Denver, Denver, CO, USA.
(4)Graduate School of Social Work, University of Denver, Denver, CO USA; School 
of Public Health, University of Colorado, Aurora, CO, USA.
(5)School of Medicine, University of Colorado; Department of Pediatrics, 
Children's Hospital Colorado, Aurora, CO, USA.

Hospitals and perinatal organizations recognize the importance of family 
engagement in the neonatal intensive care unit (NICU). The Agency for Healthcare 
Research and Quality (AHRQ) defines family engagement as "A set of behaviors by 
patients, family members, and health professionals and a set of organizational 
policies and procedures that foster both the inclusion of patients and family 
members as active members of the health care team and collaborative partnerships 
with providers and provider organizations." In-unit barriers and facilitators to 
enhance family engagement are well studied; however, less is known specifically 
about maternal engagement's influence in the NICU on the health of infants and 
mothers, particularly within U.S. social and healthcare contexts. In this 
integrative review, we examine the relationship between maternal engagement in 
the NICU and preterm infant and maternal health outcomes within the U.S. Results 
from the 33 articles that met inclusion criteria indicate that maternal 
engagement in the NICU is associated with infant outcomes, maternal 
health-behavior outcomes, maternal mental health outcomes, maternal-child 
bonding outcomes, and breastfeeding outcomes. Skin-to-skin holding is the most 
studied maternal engagement activity in the U.S. preterm NICU population. 
Further research is needed to understand what types of engagement are most 
salient, how they should be measured, and which immediate outcomes are the best 
predictors of long-term health and well-being.

DOI: 10.3934/publichealth.2019.2.160
PMCID: PMC6606523
PMID: 31297402


4477. Enferm Intensiva (Engl Ed). 2020 Apr-Jun;31(2):60-70. doi: 
10.1016/j.enfi.2019.03.004. Epub 2019 Jun 26.

Burnout syndrome in intensive care professionals: relationships with health 
status and wellbeing.

[Article in English, Spanish]

Arrogante O(1), Aparicio-Zaldivar EG(2).

Author information:
(1)Departamento de Enfermería, Centro Universitario de Ciencias de la Salud San 
Rafael, Universidad Antonio de Nebrija, Madrid, España. Electronic address: 
oarrogan@nebrija.es.
(2)Unidad de Cuidados Intensivos, Hospital Universitario de Fuenlabrada, 
Fuenlabrada, Madrid, España.

OBJECTIVES: To determine the predictive models that include the dimensions of 
burnout that are predictors for physical/mental health, and 
subjective/psychological wellbeing perceived in intensive care professionals; to 
analyse the relationships between burnout syndrome, health status and wellbeing 
experienced by these professionals; and to establish sociodemographic 
differences in the variables evaluated.
METHOD: A correlational and cross-sectional study was conducted. A total of 52 
critical care professionals, mainly nurses, were recruited from an intensive 
care unit of Madrid. All participants were assessed with the questionnaires: 
Maslach Burnout Inventory-Human Services Survey, Short Form-12 Health Survey, 
Satisfaction With Life Scale, Positive and Negative Affect Schedule, and 
Psychological Well-Being Scales.
RESULTS: No significant sociodemographic differences were found. High levels in 
the three burnout dimensions were associated with poor physical/mental health 
and subjective/psychological wellbeing. High scores in emotional exhaustion and 
depersonalization, and low in personal accomplishment negatively predicted 
subjective and psychological well-being scales. The self-acceptance scale had 
the highest predictive validity. Emotional exhaustion was the only burnout 
dimension that negatively predicted physical and mental health.
CONCLUSIONS: Health status and levels of subjective/psychological wellbeing can 
be negatively influenced by the burnout syndrome experienced by intensive care 
professionals. As a result, the implementation of programmes to prevent and 
treat this syndrome is needed. These preventive interventions can positively 
impact not only the health and wellbeing of these professionals, but can also 
improve their ability to practice effectively, improve healthcare quality and 
patient security, and reduce the economic costs of health institutions. It is 
therefore imperative to implement burnout preventive programmes for intensive 
care professionals from universities to health institutions.

Copyright © 2019 Sociedad Española de Enfermería Intensiva y Unidades Coronarias 
(SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.

DOI: 10.1016/j.enfi.2019.03.004
PMID: 31253584 [Indexed for MEDLINE]


4478. Int J Nurs Stud. 2019 Sep;97:40-54. doi: 10.1016/j.ijnurstu.2019.04.016. Epub 
2019 May 4.

Coping by family members of critically ill hospitalised patients: An integrative 
review.

Rückholdt M(1), Tofler GH(2), Randall S(3), Buckley T(2).

Author information:
(1)University of Sydney, Australia; Hornsby Ku-Ring-Gai Hospital, Sydney, 
Australia. Electronic address: mruc7911@uni.sydney.edu.au.
(2)University of Sydney, Australia; Royal North Shore Hospital, Sydney, 
Australia.
(3)Royal North Shore Hospital, Sydney, Australia.

OBJECTIVES: To provide a comprehensive integrative review of research literature 
on 1) the coping strategies that are reported by adult family members following 
admission of their adult loved ones to the intensive care unit (ICU), 2) 
identify which coping strategies are associated with psychological response 
during this stressful experience, and 3) the factors that are associated with 
coping strategies.
DATA SOURCES: Electronic databases: MEDLINE, PubMed, CINAHL, PsycINFO, and 
EMBASE; reference lists of journal publications.
REVIEW METHODS: A total of 643 citations or abstracts were initially screened 
for content relevance, 15 were included in the integrative review, including 7 
quantitative, 3 qualitative and 5 mixed methods studies. Included studies were 
all conducted in the hospital intensive care unit.
RESULTS: Coping approaches such as self-distraction appear to be associated with 
lower psychological distress, and avoidant coping and denial associated with 
increased psychological distress including traumatic stress symptoms. Factors 
including social support, gender, age, relationship with the patient, decision 
maker role, and prior ICU experience can influence coping by family members. 
Uncertainty of the patient's prognosis and recovery heightens the intensity of 
the emotional response experienced by family members. Such family members appear 
at increased risk for experiencing depressive symptoms.
CONCLUSIONS: From the studies reviewed, it is unclear if coping approaches 
employed by family members mediate psychological responses such as anxiety and 
depressive symptoms, or whether coping is a response to psychological stress 
experienced following hospitalisation of their relative. Future research should 
focus on the relationship between coping and psychological, physiological and 
health related behaviours in family members following ICU admission that might 
contribute towards transient increased health risk during this time. 
Additionally, future research should explore potential interventions to modify 
coping and promote family well-being following hospitalisation.

Copyright © 2019. Published by Elsevier Ltd.

DOI: 10.1016/j.ijnurstu.2019.04.016
PMID: 31132688 [Indexed for MEDLINE]


4479. Anaesth Intensive Care. 2019 Mar;47(2):160-168. doi: 10.1177/0310057X19838910. 
Epub 2019 May 20.

Factors associated with impaired physical functioning and mental health in 
working-age patients attending a post-intensive care follow-up clinic three 
months after hospital discharge.

Niittyvuopio M(1), Liisanantti JH(1), Pikkupeura J(1), Spalding MB(1), Sälkiö 
S(1), Ala-Kokko TI(1).

Author information:
(1)Department of Anaesthesiology and Intensive Care, Oulu University Hospital, 
Finland.

Patients recovering from critical illness are often suffering from remarkable 
limitations in their everyday life. The purpose of this study was to find 
factors associated with poor physical functioning and mental health after 
critical illness. The study was conducted among patients who met the inclusion 
criteria of our post-intensive care unit follow-up clinic. The patients were 
invited to the follow-up clinic three months after hospital discharge. The 
participants filled out a RAND-36 questionnaire, underwent a clinical 
examination and were stratified to those with good or poor recovery according to 
physical functioning and emotional wellbeing. Altogether 332 out of 351 
follow-up clinic attendees had data available for analysis. In physical 
functioning 40% of patients achieved a poor outcome. In mental health the 
percentage was 8%. The patients with poor physical functioning had a longer 
hospital stay and were more likely to have received vasopressors. Eleven out of 
16 (69%) multitrauma patients had poor physical functioning. Patients with poor 
physical functioning had more memories of pain, achieved worse results in a 
six-minute walk test and were less likely to be able to move independently. The 
patients with poor mental health had higher delirium incidence and fewer 
memories of relatives' visits and of nurses. The conclusions of this study were 
that the memories of pain, multitrauma and longer hospital stay were associated 
with a poor physical functioning outcome. Delirium and a lack of memories of 
relatives and nurses were associated with a poor mental health outcome.

DOI: 10.1177/0310057X19838910
PMID: 31106561 [Indexed for MEDLINE]


4480. Injury. 2019 Oct;50(10):1605-1611. doi: 10.1016/j.injury.2019.05.003. Epub 2019 
May 4.

Resilient, recovering, distressed: A longitudinal qualitative study of parent 
psychosocial trajectories following child critical injury.

Foster K(1), Mitchell R(2), Van C(3), Young A(3), McCloughen A(3), Curtis K(4).

Author information:
(1)Australian Catholic University, School of Nursing, Midwifery & Paramedicine, 
115 Victoria Parade, Fitzroy, Victoria, 3065, Australia; Northwestern Mental 
Health, Melbourne Health, Grattan Street, Parkville, Victoria, 3050, Australia; 
Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of 
Health and Medicine, The University of Sydney, 88 Mallett Street, Camperdown, 
NSW, 2006, Australia. Electronic address: Kim.Foster@acu.edu.au.
(2)Australian Institute of Health Innovation, Macquarie University, Level 6, 75 
Talavera Road, Macquarie University, NSW, 2109, Australia.
(3)Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty 
of Health and Medicine, The University of Sydney, 88 Mallett Street, Camperdown, 
NSW, 2006, Australia.
(4)Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty 
of Health and Medicine, The University of Sydney, 88 Mallett Street, Camperdown, 
NSW, 2006, Australia; Illawarra Shoalhaven Local Health District, Wollongong 
Hospital, Loftus Street, Wollongong, NSW, 2500, Australia; Illawarra Health and 
Medical Research Institute, Building 32, University of Wollongong, Northfields 
Avenue, Wollongong, NSW, 2522, Australia; The George Institute for Global 
Health, Level 5, 1 King Street, Newtown, NSW, 2042, Australia.

INTRODUCTION: The psychological distress and risk of mental health problems for 
parents of children with critical injury is well-established. There has been 
little exploration, however, of parent experiences and psychosocial trajectories 
over time following child critical injury. To address this knowledge gap, a 
longitudinal qualitative study was conducted to explore parent experiences and 
support needs and identify parent psychosocial trajectories in the 12 months 
following child critical injury.
METHODS: Semi- structured in-depth interviews were conducted with 27 parents at 
three time points over a 12 month period: the immediate hospital period 
post-child injury, and 6 and 12 months following injury, resulting in a total of 
81 interviews. Data were analysed using a longitudinal within and across-case 
thematic analysis of patterns emerging over time.
FINDINGS: Three parent trajectory patterns were identified: resilient trajectory 
where parents were temporarily disrupted by the child's injury and 
hospitalisation, but recovered their mental and emotional wellbeing quickly, 
which was maintained over time; recovering trajectory where parents were 
initially disrupted at the time of injury but their mental and emotional 
wellbeing fluctuated over time and had not been fully restored by 12 months; and 
distressed trajectory where parents experienced significant psychosocial 
disruption due to their child's injury and struggled to adapt and regain their 
wellbeing over time, remaining emotionally distressed about the circumstances 
and impacts of the injury on their child and family. Illustrative narratives 
that represent each trajectory are presented.
CONCLUSIONS: This is the first qualitative study to report the psychosocial 
trajectories of parents of critically injured children. Clinical application of 
insights provided by these trajectories can assist clinicians to use targeted 
strategies to help strengthen parental adaptation and prevent adverse mental 
health outcomes, and address families' psychosocial support needs following 
child injury. Screening for parent psychological distress and post-traumatic 
stress disorder is needed from the time of the child's admission, and a 
dedicated trauma support role can facilitate an integrated care approach for 
children and families with complex needs across the care continuum.

Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.injury.2019.05.003
PMID: 31101410 [Indexed for MEDLINE]


4481. Nurs Womens Health. 2019 Jun;23(3):265-271. doi: 10.1016/j.nwh.2019.03.004. Epub 
2019 May 3.

Benefits of Infant Massage for Infants and Parents in the NICU.

Pados BF, McGlothen-Bell K.

Infant massage is an ancient therapeutic technique used around the world. For 
infants who experience painful procedures, are exposed to the stressful NICU 
environment, and are separated from their parents, infant massage has been 
promoted as a method to reduce stress and promote bonding. In this article, we 
review the current literature on infant massage in the NICU. There is evidence 
that infant massage has beneficial effects on preterm infants in the NICU, 
including shorter length of stay; reduced pain; and improved weight gain, 
feeding tolerance, and neurodevelopment. Parents who performed massage with 
their infants in the NICU reported experiencing less stress, anxiety, and 
depression. Neonatal nurses can obtain education and certification in infant 
massage and can teach parents infant massage techniques, thereby promoting the 
health and well-being of parent-infant dyads.

Copyright © 2019 AWHONN. Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.nwh.2019.03.004
PMID: 31059673 [Indexed for MEDLINE]


4482. Front Psychiatry. 2019 Apr 18;10:260. doi: 10.3389/fpsyt.2019.00260. eCollection 
2019.

Moderating Effect of Mindfulness on the Relationships Between Perceived Stress 
and Mental Health Outcomes Among Chinese Intensive Care Nurses.

Lu F(1)(2), Xu Y(1), Yu Y(3), Peng L(1), Wu T(1), Wang T(1), Liu B(1), Xie J(1), 
Xu S(1), Li M(1).

Author information:
(1)School of Psychology, Army Medical University, Chongqing, China.
(2)School of Nursing, Army Medical University, Chongqing, China.
(3)Department of Sociology, Sichuan International Studies University, Chongqing, 
China.

This study aimed to explore the potential moderating effect of mindfulness and 
its facets on the relationships among perceived stress and mental health 
outcomes (burnout, depression, anxiety, and subjective well-being) among Chinese 
intensive care nurses. A total of 500 Chinese intensive care nurses completed 
self-report measures of mindfulness, burnout syndromes, perceived stress, 
depression, anxiety, and subjective well-being. Correlation and hierarchical 
multiple regressions were applied for data analysis. Mindfulness moderated the 
effects of perceived stress on emotional exhaustion (the core component of 
burnout syndrome), depression, anxiety, positive affect, and negative affect but 
not on the other two dimensions of burnout and life satisfaction. Further 
analyses indicated that the ability to act with awareness was particularly 
crucial in improving the effects of perceived stress on depression. These 
results further broaden our understanding of the relationships between perceived 
stress and burnout, depression, anxiety, and subjective well-being by 
demonstrating that mindfulness may serve as a protective factor that alleviates 
or eliminates the negative effects of perceived stress on depression, anxiety, 
burnout syndrome, and subjective well-being and may instigate further research 
into targeted mindfulness interventions for Chinese intensive care nurses.

DOI: 10.3389/fpsyt.2019.00260
PMCID: PMC6482227
PMID: 31057445


4483. Pediatrics. 2019 May;143(5):e20182657. doi: 10.1542/peds.2018-2657.

Maternal Immigrant Status and Readiness to Transition to Home From the NICU.

McGowan EC(1)(2), Abdulla LS(3), Hawes KK(4)(2)(5), Tucker R(2), Vohr BR(4)(2).

Author information:
(1)Warren Alpert Medical School, emcgowan@wihri.org.
(2)Division of Neonatology, Department of Pediatrics, Women and Infants 
Hospital, Providence, Rhode Island; and.
(3)Brown University, Providence, Rhode Island.
(4)Warren Alpert Medical School.
(5)College of Nursing, The University of Rhode Island, Kingston, Rhode Island.

BACKGROUND AND OBJECTIVES: Evaluate effects of immigrant status on perceptions 
of discharge readiness in mothers of preterm infants <37 weeks' gestation and 
identify the impact of primary language and years in the United States.
METHODS: Immigrant (n = 176) and native (n = 556) mothers of preterm infants 
cared for in the NICU for >5 days between 2012 and 2015 completed the Fragile 
Infant Parental Readiness Evaluation (FIPRE), a NICU-discharge readiness 
questionnaire. Group comparisons were made on the basis of immigrant status. 
Regression models examined effects of immigrant status, primary language, and 
years in the United States on discharge readiness.
RESULTS: Immigrant mothers were more likely to be older, gravida >1, multiracial 
or people of color, and non-English speaking; have less than a high school 
education; and receive Medicaid but less likely to have child protective 
services involvement, substance abuse, and mental health disorder (MHD). Whereas 
rates of non-English primary language, low education, and Medicaid decreased, 
rates of MHDs increased with years in the United States. At NICU discharge, 
immigrant mothers had poorer perceptions of infant well-being, maternal 
well-being, maternal comfort, and time impact. In adjusted analyses, immigrant 
status, non-English primary language, and MHD predicted unfavorable scores. 
Among immigrant mothers, increased years in the United States and MHD predicted 
unfavorable scores.
CONCLUSIONS: Although findings suggest acculturation with increased years in the 
United States, immigrant mothers perceived less discharge readiness in multiple 
domains, highlighting the need for culturally competent care and discharge 
services specifically tailored to help this vulnerable population.

Copyright © 2019 by the American Academy of Pediatrics.

DOI: 10.1542/peds.2018-2657
PMCID: PMC6564064
PMID: 31036673 [Indexed for MEDLINE]

Conflict of interest statement: POTENTIAL CONFLICT OF INTEREST: The authors have 
indicated they have no potential conflicts of interest to disclose.


4484. Int J Circumpolar Health. 2019 Dec;78(1):1599275. doi: 
10.1080/22423982.2019.1599275.

Research and policy priorities for addressing prenatal exposure to opioids in 
Alaska.

Singleton R(1), Slaunwhite A(2), Herrick M(3), Hirschfeld M(1), Brunner L(4), 
Hallas C(1)(3), Truit S(3), Hanson S(3), Young M(5), Rider E(6).

Author information:
(1)a Alaska Native Tribal Health Consortium , Anchorage , AK , USA.
(2)b British Columbia Centre for Disease Control , Vancouver , Canada.
(3)c Southcentral Foundation , Anchorage , AK , USA.
(4)d Fairbanks Memorial Hospital , Fairbanks , AK , USA.
(5)e Division of Public Health , Department of Health and Social Services, State 
of Alaska , Anchorage , AK , USA.
(6)f Alaska Neonatology Associates.

The current opioid crisis in Alaska and the USA will negatively affect the 
health and wellbeing of future generations. The increasing number of infants 
born with neonatal opioid withdrawal syndrome (NOWS) has had a profound impact 
on families, health care providers and the child welfare system. This manuscript 
summarises the main themes of a Symposium held in Anchorage, Alaska with health 
care providers, researchers, elders and public health officials that focused on 
identifying emerging challenges, trends and potential solutions to address the 
increasing number of infants and children affected by maternal opioid use. Five 
areas of importance for research and policy development that would direct 
improvement in the care of infants with NOWS in Alaska are outlined with the 
goal of supporting a research agenda on opioid misuse and child health across 
the circumpolar north. Abbreviations: NOWS - neonatal opioid withdrawal 
syndrome; NAS - neonatal abstinence syndrome; MAT - medication-assisted 
treatment; NICU - neonatal intensive care unit; OATs - opioid agonist 
treatments; OCS - office of children's services; ANTHC - Alaska Native Tribal 
Health Consortium; OUD - opioid use disorder; SBIRT - screening, brief 
intervention and referral to treatment; ISPCTN - IDeA States Pediatric Clinical 
Trials Network; NIH - National Institutes of Health; ANMC - Alaska Native 
Medical Center; DHSS - Department of Health and Social Services; AAPP - All 
Alaska Pediatric Partnership.

DOI: 10.1080/22423982.2019.1599275
PMCID: PMC6493296
PMID: 31020919 [Indexed for MEDLINE]

Conflict of interest statement: No potential conflict of interest was reported 
by the authors.


4485. Neurosci Biobehav Rev. 2020 Oct;117:319-326. doi: 
10.1016/j.neubiorev.2019.04.009. Epub 2019 Apr 18.

At the forefront of psychoneuroimmunology in pregnancy: Implications for racial 
disparities in birth outcomes PART 1: Behavioral risks factors.

Christian LM(1).

Author information:
(1)Department of Psychiatry & Behavioral Health, The Ohio State University 
Wexner Medical Center, Columbus, OH, USA; The Institute for Behavioral Medicine 
Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA; 
Department of Psychology, The Ohio State University, Columbus, OH, USA; 
Department of Obstetrics and Gynecology, The Ohio State University Wexner 
Medical Center, Columbus, OH, USA. Electronic address: Lisa.Christian@osumc.edu.

Birth prior to full term is a substantial public health issue. In the US, 
˜400,000 babies per year are born preterm (<37 weeks), while>1 million are early 
term (37-386/7 weeks). Birth prior to full term confers risk both immediate and 
long term, including neonatal intensive care, decrements in school performance, 
and increased mortality risk from infancy through young adulthood. Risk for low 
birth weight and preterm birth are 1.5-2 times greater among African Americans 
versus Whites. Psychosocial stress related to being a member of a discriminated 
racial minority group contributes substantially to these racial disparities. 
Providing promising targets for intervention, depressed mood, anxiety, and poor 
sleep are each linked with exposure to chronic stress, including racial 
discrimination. A rigorous transdisciplinary approach addressing these gaps 
holds great promise for clinical impact in addressing racial disparities as well 
as ameliorating effects of stress on perinatal health more broadly. As will be 
reviewed in a companion paper, the mechanistic roles of physiological sequelae 
to stress - including neuroendocrine, inflammatory regulation, biological aging, 
and the microbiome - also require delineation.

Copyright © 2019 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.neubiorev.2019.04.009
PMCID: PMC6800611
PMID: 31005626 [Indexed for MEDLINE]


4486. Spec Care Dentist. 2019 May;39(3):262-273. doi: 10.1111/scd.12375. Epub 2019 Apr 
9.

Oral health care for patients with Alzheimer's disease: An update.

Marchini L(1), Ettinger R(2), Caprio T(3), Jucan A(4).

Author information:
(1)Department of Preventive and Community Dentistry, The University of Iowa 
College of Dentistry and Dental Clinics, Iowa City, Iowa.
(2)Department of Prosthodontics, The University of Iowa College of Dentistry and 
Dental Clinics, Iowa City, Iowa.
(3)Departments of Medicine, Public Health Science and Nursing, University of 
Rochester Medical Center, Rochester, New York.
(4)Departments of Dentistry and Medicine, University of Rochester Medical 
Center, Rochester, New York.

Alzheimer's disease and related disorders (ADRD) are among the age-associated 
chronic conditions that are most challenging to health care systems around the 
globe, as patients with dementia require full-time, intensive care for multiple 
years. Oral health care is negatively impacted by cognitive decline, and 
consequently poor oral health is common among people with ADRD. Poor oral health 
status is linked with many undesirable consequences for the well-being of people 
with ADRD, from excruciating local pain to life-threatening conditions, as 
aspiration pneumonia. In this paper, the authors provide an update on the most 
current concepts about Alzheimer's disease epidemiology, etiology, and 
management, current oral health care for patients with Alzheimer's disease, oral 
health promotion strategies for this population, as well as current research and 
future direction for improving oral health care for patients with Alzheimer's 
disease. It concludes that oral health care should be included in the patient's 
routine health care as early as possible in the progression of Alzheimer's 
disease for preventing rapid oral health deterioration. Establishing oral 
hygiene routines and providing dental treatment that is customized to the 
patients' individual needs and disease stage are important to achieve good oral 
health outcomes and prevent quality of life decline.

© 2019 Special Care Dentistry Association and Wiley Periodicals, Inc.

DOI: 10.1111/scd.12375
PMID: 30964560 [Indexed for MEDLINE]


4487. Curr Opin Anaesthesiol. 2019 Jun;32(3):412-420. doi: 
10.1097/ACO.0000000000000734.

The microbiome: implications for perioperative and critical care.

Lukovic E(1), Moitra VK(1), Freedberg DE(2)(3).

Author information:
(1)Division of Critical Care Medicine, Department of Anesthesiology.
(2)Division of Digestive and Liver Diseases, Department of Medicine.
(3)Department of Epidemiology, Mailman School of Public Health, Vagelos College 
of Physicians and Surgeons, Columbia University, New York, USA.

PURPOSE OF REVIEW: The host-microbiota relationship is integral in human health 
and can be rapidly disrupted in ways that may contribute to poor recovery from 
surgery or acute illness. We review key studies by organ system to understand 
the effect of perioperative and critical illness stress on the microbiota. 
Throughout the review, our focus is on potential interventions that may be 
mediated by the microbiome.
RECENT FINDINGS: Although any perioperative intervention can have a profound 
impact on the gut microbiota, it is less clear how such changes translate into 
altered health outcomes. Preoperative stress (anxiety, lack of sleep, fasting), 
intraoperative stress (surgery itself, volatile anesthetics, perioperative 
antibiotics, blood transfusions), and postoperative stress (sepsis, surgical 
site infections, acute respiratory distress syndrome, catecholamines, 
antibiotics, opioids, proton pump inhibitors) have all been associated with 
alterations of the commensal microflora. These factors (e.g. administration of 
antibiotics or opioids) can create a favorable environment for emergence of 
pathogen virulence and development of serious infections and multiorgan failure. 
Data to recommend therapies aimed at restoring a disrupted microbiota, such as 
probiotics/prebiotics and fecal microbiota transplants is currently scarce.
SUMMARY: The microbiome is likely to play an important role in the perioperative 
and ICU setting but existing data is largely descriptive. There is an expanding 
number of mechanistic studies that attempt to disentangle the complicated 
bi-directional relationship between the host and the resident microbiota. When 
these results are combined with ongoing clinical studies, we should be able to 
offer better therapies aimed at restoring the microbiota in the future.

DOI: 10.1097/ACO.0000000000000734
PMID: 30925514 [Indexed for MEDLINE]


4488. Aging Ment Health. 2020 Aug;24(8):1263-1270. doi: 10.1080/13607863.2019.1584788. 
Epub 2019 Mar 14.

Consequences on depression of combining grandparental childcare with other 
caregiving roles.

Arpino B(1), Gómez-León M(1).

Author information:
(1)Universitat Pompeu Fabra, Barcelona, Spain.

Objective: This study examines the effect of combining grandchild care with 
other care roles on depression among individuals aged 50 to 84. Previous 
research investigating the health consequences of multiple care roles among 
older adults found mixed evidence, with most studies being predominantly 
cross-sectional.Methods: We use longitudinal data from the Survey of Health, 
Ageing and Retirement in Europe (SHARE) to understand how grandparents' mental 
health, measured as depressive symptoms, is affected when combining multiple 
care roles. We estimate logistic regression models, for grandfathers and 
grandmothers separately, to investigate how depression at wave 2 is affected by 
multiple care roles at wave 1, controlling for depression at baseline.Results: 
Consistent with previous studies, we find that providing grandchild care only 
reduces risk of depression for grandmothers, but not for grandfathers. For both 
genders, we find a higher risk of depression among those who provide intensive 
care to co-residents. The negative effect of grandchild care on depression found 
for grandmothers disappears if they also provide other types of care. In 
particular, grandmothers who provide care both to grandchildren and to a sick or 
disabled person show a higher risk of depression compared to those who only 
provide grandchild care.Conclusions: While multiple caregiving roles are not 
common, it is important to understand their combined effect on caregivers' 
health. Grandmothers who provide childcare and other intensive types of care may 
lose the positive effects grandchild care exert over their wellbeing.

DOI: 10.1080/13607863.2019.1584788
PMID: 30870002 [Indexed for MEDLINE]


4489. J Clin Nurs. 2019 Jun;28(11-12):2124-2134. doi: 10.1111/jocn.14820. Epub 2019 
Mar 8.

The forgotten mothers of extremely preterm babies: A qualitative study.

Fowler C(1), Green J(1), Elliott D(1), Petty J(2), Whiting L(2).

Author information:
(1)University of Technology Sydney, Sydney, New South Wales, Australia.
(2)University of Hertfordshire, Hatfield, UK.

AIMS AND OBJECTIVES: To explore the experiences of mothers of extremely 
premature babies during their Neonatal Intensive Care Unit stay and transition 
home.
BACKGROUND: Mothers of extremely preterm infants (28 weeks' gestation or less) 
experience a continuum of regular and repeated stressful and traumatic events, 
during the perinatal period, during the Neonatal Intensive Care Unit stay, and 
during transition home.
METHOD: An interpretive description method guided this study. Ten mothers of 
extremely premature infants who had been at home for less than six months were 
recruited via a Facebook invitation to participate in semi-structured telephone 
interviews exploring their experiences in the Neonatal Intensive Care Unit and 
the transition home. The data were examined using a six-phase thematic analysis 
approach. The COREQ checklist has been used.
RESULTS: Two main themes emerged: (a) things got a bit dire; and (b) feeling a 
failure as a mother. Participants had a heightened risk of developing a mental 
disorder from exposure to multiple risk factors prior to and during birth, as 
well as during the postnatal period in the Neonatal Intensive Care Unit and 
their infant's transition to home. Mothers highlighted the minimal support for 
their mental health from healthcare professionals, despite their regular and 
repeated experience of traumatic events.
CONCLUSION: The mothers were at high risk of developing post-traumatic stress 
symptoms and/or other mental health issues. Of note, study participants relived 
the trauma of witnessing their infant in the Neonatal Intensive Care Unit, 
demonstrated hypervigilance behaviour and identified lack of relevant support 
needed when their infant was at home.
RELEVANCE TO CLINICAL PRACTICE: This study highlights the need for nurses to 
include a focus on the mothers' psychosocial needs. Supporting maternal mental 
health both improves maternal well-being and enables mothers to be emotionally 
available and responsive to their extremely preterm infant.

© 2019 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons 
Ltd.

DOI: 10.1111/jocn.14820
PMCID: PMC7328789
PMID: 30786101 [Indexed for MEDLINE]

Conflict of interest statement: No conflicts of interest have been declared by 
the authors.


4490. JMIR Res Protoc. 2019 Jan 17;8(1):e10935. doi: 10.2196/10935.

A Web-Based Recovery Program (ICUTogether) for Intensive Care Survivors: 
Protocol for a Randomized Controlled Trial.

Ewens B(1), Myers H(1), Whitehead L(1), Seaman K(1), Sundin D(1), Hendricks 
J(2).

Author information:
(1)School of Nursing and Midwifery, Edith Cowan University, Joondalup, 
Australia.
(2)School of Nursing, Midwifery and Social Science, CQUniveristy Australia, 
Brisbane, Australia.

BACKGROUND: Those who experience a critical illness or condition requiring 
admission to an intensive care unit (ICU) frequently experience physical and 
psychological complications as a direct result of their critical illness or 
condition and ICU experience. Complications, if left untreated, can affect the 
quality of life of survivors and impact health care resources. Explorations of 
potential interventions to reduce the negative impact of an ICU experience have 
failed to establish an evidence-based intervention.
OBJECTIVE: The aim of this study is to evaluate the impact of a Web-based 
intensive care recovery program on the mental well-being of intensive care 
survivors and to determine if it is a cost-effective approach.
METHODS: In total, 162 patients that survived an ICU experience will be 
recruited and randomized into 1 of 2 groups. The intervention group will receive 
access to the Web-based intensive care recovery program, ICUTogether, 2 weeks 
after discharge (n=81), and the control group will receive usual care (n=81). 
Mental well-being will be measured using the Hospital Anxiety and Depression 
Scale, The Impact of Events Scale-Revised and the 5-level 5-dimension EuroQoL at 
3 time points (2 weeks, 6 months, and 12 months post discharge). Family support 
will be measured using the Multidimensional Scale of Perceived Social Support at 
3 time points. Analysis will be conducted on an intention-to-treat basis using 
regression modeling. Covariates will include baseline outcome measures, study 
allocation (intervention or control), age, gender, length of ICU stay, APACHE 
III score, level of family support, and hospital readmissions. Participants' 
evaluation of the mobile website will be sought at 12 months postdischarge. A 
cost utility analysis conducted at 12 months from a societal perspective will 
consider costs incurred by individuals as well as health care providers.
RESULTS: Participant recruitment is currently underway. Recruitment is 
anticipated to be completed by December 2020.
CONCLUSIONS: This study will evaluate a novel intervention in a group of ICU 
survivors. The findings from this study will inform a larger study and wider 
debate about an appropriate intervention in this population.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/10935.

©Beverley Ewens, Helen Myers, Lisa Whitehead, Karla Seaman, Deborah Sundin, 
Joyce Hendricks. Originally published in JMIR Research Protocols 
(http://www.researchprotocols.org), 17.01.2019.

DOI: 10.2196/10935
PMCID: PMC6354195
PMID: 30664478

Conflict of interest statement: Conflicts of Interest: None declared.


4491. Injury. 2019 May;50(5):1082-1088. doi: 10.1016/j.injury.2019.01.004. Epub 2019 
Jan 10.

Parent experiences and psychosocial support needs 6 months following paediatric 
critical injury: A qualitative study.

Foster K(1), Mitchell R(2), Young A(3), Van C(3), Curtis K(4).

Author information:
(1)Australian Catholic University, School of Nursing, Midwifery & Paramedicine, 
115 Victoria Parade, Fitzroy, Victoria, 3065, Australia; Northwestern Mental 
Health, Melbourne Health, Grattan Street, Parkville, Victoria, 3050, Australia; 
Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of 
Health and Medicine, The University of Sydney, 88 Mallett Street, Camperdown NSW 
2006, Australia. Electronic address: Kim.Foster@acu.edu.au.
(2)Australian Institute of Health Innovation, Macquarie University, Level 6, 75 
Talavera Road, Macquarie University NSW 2109, Australia.
(3)Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty 
of Health and Medicine, The University of Sydney, 88 Mallett Street, Camperdown 
NSW 2006, Australia.
(4)Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty 
of Health and Medicine, The University of Sydney, 88 Mallett Street, Camperdown 
NSW 2006, Australia; Illawarra Shoalhaven Local Health District, Wollongong 
Hospital, Loftus Street, Wollongong NSW 2500, Australia; Illawarra Health and 
Medical Research Institute, Building 32, University of Wollongong, Northfields 
Avenue, Wollongong NSW 2522, Australia; The George Institute for Global Health, 
Level 5, 1 King Street, Newtown NSW 2042, Australia.

INTRODUCTION: Parents of critically injured children can experience high levels 
of psychological distress post-injury, however little is known about their 
experiences and needs following injury. This study aimed to explore parent 
experiences and psychosocial support needs in the six months following child 
critical injury.
METHODS: An interpretive qualitative design was used. Semi-structured interviews 
were conducted with 30 parents of 23 critically injured children. Interviews 
explored parent experiences and psychosocial support needs. Qualitative data 
were managed using NVIVO 10 and analysed thematically.
RESULTS: Four themes were identified: integrating back into home life; adjusting 
mentally and emotionally to injury; coping with injury as a family; and 
navigating resources to meet family needs. Parents and families experienced 
substantial ongoing emotional impacts at 6 months following child injury. 
Parents were unprepared for the negative changes in their child's psychological 
wellbeing and behaviour post injury, and parents' mental health was negatively 
impacted, with mothers more likely to seek emotional support than fathers. 
Parents reported receiving no psychosocial follow-up from the hospital and 
limited information about community services and accessing local community 
resources on returning home.
CONCLUSIONS: There is a need to include all family members in discharge 
planning, and to use a family-centred continuity-of-care approach from the time 
of child injury through to post-discharge recovery. To strengthen parent and 
family wellbeing, a biopsychosocial holistic approach is recommended, including 
cognitive-behavioural and other psychological strategies to help reduce distress 
for parents and all family members and strengthen their coping capacity. A 
dedicated family support coordinator role to facilitate care over the child 
recovery trajectory, and development of accessible online and e-psychosocial 
support resources for parents and families are recommended.

Copyright © 2019 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.injury.2019.01.004
PMID: 30655002 [Indexed for MEDLINE]


4492. Nutr Clin Pract. 2019 Feb;34(1):73-79. doi: 10.1002/ncp.10228. Epub 2018 Dec 18.

Fecal Microbiota Transplantation for the Critically Ill Patient.

Limketkai BN(1), Hendler S(1), Ting PS(2), Parian AM(2).

Author information:
(1)Division of Gastroenterology & Hepatology, Stanford University School of 
Medicine, Stanford, California.
(2)Division of Gastroenterology & Hepatology, Johns Hopkins University School of 
Medicine, Baltimore, Maryland.

The gut microbiome has been implicated in a diversity of diseases, such as 
irritable bowel syndrome, inflammatory bowel disease, hepatic steatosis, 
metabolic syndrome, obesity, and anxiety. Current research also suggests the 
presence of a bidirectional relationship between the composition of the gut 
microbiome and critical illness. In the critical care setting, multiple factors 
(eg, use of antibiotics, aberrant nutrition, bloodstream infections, bowel 
ischemia, and abnormal bowel motility) strongly contribute to intestinal 
dysbiosis. Conversely, early studies have associated intestinal dysbiosis with 
worse clinical outcomes in the intensive care unit (ICU), such as infection, 
organ failure, and mortality. The possibility of intestinal dysbiosis 
influencing these clinical outcomes has prompted the question of whether 
microbiome manipulation strategies, such as fecal microbiota transplantation 
(FMT), may have a role in the management of critical illness. After a literature 
search of FMT used in the ICU for indications other than Clostridium difficile 
infections, we found 4 case reports that describe the use of FMT in 5 critically 
ill patients with systemic inflammatory responses and no clear source of 
infection. This review discusses the relationship between the gut microbiome and 
critical illness, early data on the use of FMT in critical care, and safety 
considerations of FMT in the critically ill and immunocompromised populations.

© 2018 American Society for Parenteral and Enteral Nutrition.

DOI: 10.1002/ncp.10228
PMID: 30561131 [Indexed for MEDLINE]


4493. Nurs Crit Care. 2019 May;24(3):162-175. doi: 10.1111/nicc.12403. Epub 2018 Dec 
17.

Outcomes and experiences of relatives of patients discharged home after critical 
illness: a systematic integrative review.

Stayt LC(1), Venes TJ(2).

Author information:
(1)Faculty of Health and Life Sciences, Oxford Brookes University, Jack Straws 
Lane, Oxford, OX3 0FL, UK.
(2)Adult Intensive Care, Oxford University Hospital Trust, John Radcliffe 
Hospital, Headley Way, Oxford, OX3 9DU, UK.

BACKGROUND: Patients discharged from intensive care may experience psychological 
and physical deficits resulting in a long and complex rehabilitation upon 
discharge. Relatives are also vulnerable to psychological pathologies and 
diminished health-related quality of life following the patients' critical 
illness. Relatives often provide care during the patients' rehabilitation, which 
may influence their health.
AIM: To report the outcomes and experiences of relatives of patients discharged 
home after critical illness.
DESIGN: Systematic integrative review.
METHODS: Electronic databases Cumulative Index of Nursing and Allied Health 
Literature, PubMed, Embase®, and PsychINFO® were searched using keywords, 
synonyms, and medical subject headings. Reference lists of articles and critical 
care journals were manually searched. Studies eligible for inclusion reported 
primary research and were published in English between 2007 and 2017. Studies 
were appraised using the Critical Appraisal Skills Programme checklists. Data 
were extracted and then analysed according to framework.
FINDINGS: Twenty-five studies were included: 19 quantitative, 4 qualitative, and 
1 mixed method study. Three themes were identified: health and well-being, 
employment and lifestyle, and caregiving role. Health and well-being reports the 
incidence and significance of psychological morbidity such as post-traumatic 
stress disorder, anxiety, and depression. Employment and lifestyle describes the 
impact of caregiving on the relative's ability to work and engage in usual 
social activities. The final theme describes and discusses the caregiving role 
in terms of activities of daily living, knowledge and skills, and adaption to 
the role.
CONCLUSIONS: There is a significant and meaningful impact on outcomes and 
experiences of relatives of patients discharged home after critical illness. 
Relatives' caregiving is embedded within the context of their psychological 
morbidity and social adjustment.
RELEVANCE TO PRACTICE: If informal care giving is to be sustainable, there is a 
need to design effective strategies of supporting families through all stages of 
the critical illness trajectory.

© 2018 British Association of Critical Care Nurses.

DOI: 10.1111/nicc.12403
PMID: 30560592 [Indexed for MEDLINE]


4494. Medicines (Basel). 2018 Dec 16;5(4):134. doi: 10.3390/medicines5040134.

Music Therapy Self-Care Group for Parents of Preterm Infants in the Neonatal 
Intensive Care Unit: A Clinical Pilot Intervention.

Roa E(1)(2), Ettenberger M(3)(4).

Author information:
(1)Berklee College of Music, Boston, MA 02215, USA. eroafuentes@berklee.edu.
(2)SONO-Centro de Musicoterapia, Bogotá 11021, Colombia. 
eroafuentes@berklee.edu.
(3)SONO-Centro de Musicoterapia, Bogotá 11021, Colombia. 
mark.ettenberger@gmx.at.
(4)Clínica de la Mujer, Bogotá 11021, Colombia. mark.ettenberger@gmx.at.

Background: The parents of preterm infants face major mental health challenges 
in the Neonatal Intensive Care Unit (NICU). Family-centered music therapy 
actively integrates and empowers parents in their infants' care. With the aim to 
better understand and address parental needs separately from their babies' 
needs, a music therapy (MT) self-care group was implemented as part of clinical 
practice at the hospital Clínica de la Mujer, in Bogotá, Colombia. Methods: The 
group was provided for both parents, twice a week, in the NICU. Music guided 
relaxations, breathing techniques, and self-expression were at the center of the 
MT group sessions. The parents completed a pre/post self-administered Numeric 
Rating Scale (NRS), including anxiety levels, stress levels, mood and 
motivation. Results: The parents highly valued the MT self-care group in the 
NICU. On average, there was a 37% improvement in anxiety levels, 28% improvement 
in stress levels, and 12% improvement in mood, restfulness and motivation. Being 
able to relax, to distract themselves from their worries and having time for 
themselves are amongst the most frequently mentioned benefits. Conclusions: 
Addressing parents' needs separately from their babies' treatment, with 
culturally sensitive interventions aimed at improving parental mental health, is 
essential for continuing the development of family-centered music therapy 
interventions in the NICU.

DOI: 10.3390/medicines5040134
PMCID: PMC6313327
PMID: 30558347

Conflict of interest statement: The authors declare no conflict of interest.


4495. Nurs Crit Care. 2019 May;24(3):153-161. doi: 10.1111/nicc.12405. Epub 2018 Dec 
10.

A review of interventions supporting parent's psychological well-being after a 
child's intensive care unit discharge.

Bedford ZC(1), Bench S(1).

Author information:
(1)School of Health and Social Care, London South Bank University, London, UK.

BACKGROUND: Having a child admitted to a paediatric intensive care unit (PICU) 
is a highly stressful experience, and post-traumatic stress among parents is 
well documented. How best to support these parents is currently unclear.
AIM: To review research on interventions to support the psychological well-being 
of parents after their child's discharge from paediatric intensive care.
METHODS: Searches were conducted using Medline, PsycINFO, PubMed, CINAHL and The 
Cochrane library in January 2017. Study selection was carried out using 
pre-specified criteria. Following appraisal of methodological quality and risk 
of bias, data were extracted and analysed using a narrative synthesis.
RESULTS: Six quantitative studies met the inclusion criteria. Intervention types 
included follow-up appointments, telephone calls, educational information and 
post-admission interviews. Insufficient evidence was found to fully support any 
intervention in isolation, but findings support a clear trend that some form of 
follow up is beneficial.
CONCLUSIONS: Testing costly interventions is challenging and takes time. In the 
meantime, a low-cost intervention (such as an information leaflet) to raise 
awareness of potential problems in staff and to provide a support resource for 
parents is recommended.
RELEVANCE TO CLINICAL PRACTICE: Parents and carers of children admitted to PICU 
can develop post-traumatic stress symptoms after their child's discharge from 
PICU. This article addresses how best to support these parents to improve their 
psychological well-being.

© 2018 British Association of Critical Care Nurses.

DOI: 10.1111/nicc.12405
PMID: 30537005 [Indexed for MEDLINE]


4496. Complement Ther Med. 2018 Dec;41:240-246. doi: 10.1016/j.ctim.2018.07.009. Epub 
2018 Aug 1.

Physiological and emotional effects of pentatonic live music played for preterm 
neonates and their mothers in the Newborn Intensive Care Unit: A randomized 
controlled trial.

Ranger A(1), Helmert E(1), Bott TS(2), Ostermann T(3), Als H(4), Bassler D(5), 
Hautzinger M(6), Vagedes J(7).

Author information:
(1)ARCIM Institute, Fidlerstadt, Germany.
(2)Department of Pediatric Surgery Olgahospital, Stuttgart, Germany.
(3)Department of Psychology, University of Witten-Herdecke, Germany.
(4)Department of Psychiatry, Boston Children`s Hospital and Harvard Medical 
School, Boston, MA, USA.
(5)Department of Neonatology, Zurich University Hospital, Zurich, Switzerland.
(6)Department of Clinical Psychology and Psychotherapy, Institute of Psychology, 
University of Tübingen, Germany.
(7)ARCIM Institute, Fidlerstadt, Germany; University Hospital, Department of 
Neonatology, University of Tuebingen, Germany. Electronic address: 
j.vagedes@arcim-institute.de.

OBJECTIVE: Despite attempts to increase calmness in the Newborn Intensive Care 
Unit (NICU), preterm neonates still experience stress. The question arises how 
to further promote the infants' wellbeing. Therefore, the immediate effects of 
pentatonic live music on preterm infants and their mothers were examined.
DESIGN AND METHODS: In a two-centre randomized controlled trial with crossover 
design preterm infants were exposed sequentially to two conditions: live 
pentatonic harp music (LPHM) used in Anthroposophic Medicine or standard care. 
The order of the conditions was randomized within each subject. The primary 
outcome was change of the number of oxygen desaturations < 90%/h, whereas 
secondary outcomes were: heart rate, respiratory rate, oxygen saturation, heart 
rate variability (HRV), the perfusion index, pulse-transit-time and maternal 
anxiety and others not reported on in this article.
RESULTS: 21 preterm infants were randomized (14 girls), mean gestational age at 
measurement 35 + 0 weeks (SD 1 week). The primary outcome parameter showed no 
significant changes. Regarding the secondary outcomes the comparison of the 
pre-post-differences between the conditions showed significant effects for the 
HRV parameters pNN50 (ΔpNN50 = 1.46%, z = -2.47, p =  .001) and SDNN 
(ΔSDNN=-0.06 ms, z = -2.25, p =  .002). The music intervention significantly 
increased the values of pNN50 (Mdn 1.2% vs. 2.6%, p =  0.04) and marginally 
those of SDNN (Mdn 31.7 ms vs. 36.4 ms, p =  0.05). No changes were found in the 
other parameters.
CONCLUSIONS: While the use of music in the NICU had no effect on the number of 
oxygen desaturations, it increased two HRV parameters indicative of infants' 
parasympathetic tone.

Copyright © 2018. Published by Elsevier Ltd.

DOI: 10.1016/j.ctim.2018.07.009
PMID: 30477847 [Indexed for MEDLINE]


4497. IUBMB Life. 2019 Feb;71(2):152-165. doi: 10.1002/iub.1969. Epub 2018 Nov 22.

Lung inflammation and disease: A perspective on microbial homeostasis and 
metabolism.

Mendez R(1), Banerjee S(1)(2), Bhattacharya SK(2)(3), Banerjee S(1)(2).

Author information:
(1)Department of Surgery, Miller School of Medicine, University of Miami, Miami, 
FL, USA.
(2)Miami Integrative Metabolomics Research Center, University of Miami, Miami, 
FL, USA.
(3)Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA.

It is now well appreciated that the human microbiome plays a significant role in 
a number of processes in the body, significantly affecting its metabolic, 
inflammatory, and immune homeostasis. Recent research has revealed that almost 
every mucosal surface in the human body is associated with a resident commensal 
microbiome of its own. While the gut microbiome and its role in regulation of 
host metabolism along with its alteration in a disease state has been well 
studied, there is a lacuna in understanding the resident microbiota of other 
mucosal surfaces. Among these, the scientific information on the role of lung 
microbiota in pulmonary diseases is currently severely limited. Historically, 
lungs have been considered to be sterile and lung diseases have only been 
studied in the context of bacterial pathogenesis. Recently however, studies have 
revealed a resilient microbiome in the upper and lower respiratory tracts and 
there is increased evidence on its central role in respiratory diseases. 
Knowledge of lung microbiome and its metabolic fallout (local and systemic) is 
still in its nascent stages and attracting immense interest in recent times. In 
this review, we will provide a perspective on lung-associated metabolic 
disorders defined for lung diseases (e.g., chronic obstructive pulmonary 
disease, asthma, and respiratory depression due to infection) and correlate it 
with lung microbial perturbation. Such perturbations may be due to altered 
biochemical or metabolic stress as well. Finally, we will draw evidence from 
microbiome and classical microbiology literature to demonstrate how specific 
lung morbidities associate with specific metabolic characteristics of the 
disease, and with the role of microbiome in this context. © 2018 IUBMB Life, 
71(1):152-165, 2019.

© 2018 International Union of Biochemistry and Molecular Biology.

DOI: 10.1002/iub.1969
PMCID: PMC6352907
PMID: 30466159 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests. The 
authors declare no pertinent conflict of interest or competing interests.


4498. J Reprod Infant Psychol. 2019 Jul;37(3):267-276. doi: 
10.1080/02646838.2018.1548756. Epub 2018 Nov 19.

Neonatal intensive care unit admission and maternal postpartum depression.

Wyatt T(1), Shreffler KM(1), Ciciolla L(2).

Author information:
(1)a Human Development and Family Science , Oklahoma State University , Tulsa , 
OK , USA.
(2)b Department of Psychology , Oklahoma State University , Stillwater , OK , 
USA.

Objective: This study aimed to examine the impact of newborns' Neonatal 
Intensive Care Unit (NICU) admittance on maternal postpartum depression. 
Background: Prior research on the parental psychological impacts of a NICU 
admittance typically includes a hospital sample of parents following birth, so 
the causality of NICU admittance and maternal depressive symptomatology is 
unclear. Methods: 127 women across 38 counties in a South Central US state 
participated in online surveys in their third trimester and approximately six 
weeks post-birth in 2016. Pre- and post-birth assessments of depression were 
measured with the Center for Epidemiologic Studies Depression Scale (CES-D). 
NICU admittance was asked in the post-birth survey. t-Tests and multivariable 
regression analyses were used to determine predictors of NICU admittance and 
postnatal depressive symptomatology. Results: Findings indicate that prenatal 
depression does not differ significantly between mothers by NICU admission 
status, but NICU admission is a significant predictor of postpartum depressive 
symptomatology. Conclusions: Having a newborn admitted to the NICU is a risk 
factor for maternal postpartum depression. These findings have implications for 
practice; screening mothers in the NICU for depression as a target for 
intervention has the potential to improve maternal well-being, which in turn 
should enhance subsequent infant developmental outcomes.

DOI: 10.1080/02646838.2018.1548756
PMCID: PMC6526079
PMID: 30450956 [Indexed for MEDLINE]


4499. Clin Infect Dis. 2019 May 17;68(11):1847-1855. doi: 10.1093/cid/ciy802.

Pulmonary Metagenomic Sequencing Suggests Missed Infections in Immunocompromised 
Children.

Zinter MS(1), Dvorak CC(2), Mayday MY(1), Iwanaga K(3), Ly NP(3), McGarry ME(3), 
Church GD(3), Faricy LE(4), Rowan CM(5), Hume JR(6), Steiner ME(6)(7), Crawford 
ED(8)(9), Langelier C(10), Kalantar K(9), Chow ED(9), Miller S(11), Shimano 
K(2), Melton A(2), Yanik GA(12), Sapru A(1)(13), DeRisi JL(8)(9).

Author information:
(1)Division of Critical Care, University of California, San Francisco School of 
Medicine.
(2)Division of Allergy, Immunology, and Blood & Marrow Transplantation, 
University of California, San Francisco School of Medicine.
(3)Division of Pulmonology, Department of Pediatrics, Benioff Children's 
Hospital, University of California, San Francisco School of Medicine.
(4)Division of Pulmonology, Department of Pediatrics, University of Vermont 
School of Medicine, Burlington.
(5)Division of Critical Care, Department of Pediatrics, Riley Hospital for 
Children, Indiana University School of Medicine, Indianapolis.
(6)Division of Critical Care, University of Minnesota School of Medicine, 
Minneapolis.
(7)Hematology/Oncology, Department of Pediatrics, Masonic Children's Hospital, 
University of Minnesota School of Medicine, Minneapolis.
(8)Chan Zuckerberg Biohub, University of California-San Francisco School of 
Medicine.
(9)Department of Biochemistry & Biophysics, University of California-San 
Francisco School of Medicine.
(10)Division of Infectious Diseases, Department of Internal Medicine, University 
of California-San Francisco School of Medicine.
(11)Department of Laboratory Medicine, University of California-San Francisco 
School of Medicine.
(12)Division of Oncology, Department of Pediatrics, Motts Children's Hospital, 
University of Michigan School of Medicine, Ann Arbor.
(13)Division of Critical Care, Department of Pediatrics, Mattel Children's 
Hospital, University of California-Los Angeles, Geffen School of Medicine.

BACKGROUND: Despite improved diagnostics, pulmonary pathogens in 
immunocompromised children frequently evade detection, leading to significant 
mortality. Therefore, we aimed to develop a highly sensitive metagenomic 
next-generation sequencing (mNGS) assay capable of evaluating the pulmonary 
microbiome and identifying diverse pathogens in the lungs of immunocompromised 
children.
METHODS: We collected 41 lower respiratory specimens from 34 immunocompromised 
children undergoing evaluation for pulmonary disease at 3 children's hospitals 
from 2014-2016. Samples underwent mechanical homogenization, parallel RNA/DNA 
extraction, and metagenomic sequencing. Sequencing reads were aligned to the 
National Center for Biotechnology Information nucleotide reference database to 
determine taxonomic identities. Statistical outliers were determined based on 
abundance within each sample and relative to other samples in the cohort.
RESULTS: We identified a rich cross-domain pulmonary microbiome that contained 
bacteria, fungi, RNA viruses, and DNA viruses in each patient. Potentially 
pathogenic bacteria were ubiquitous among samples but could be distinguished as 
possible causes of disease by parsing for outlier organisms. Samples with 
bacterial outliers had significantly depressed alpha-diversity (median, 0.61; 
interquartile range [IQR], 0.33-0.72 vs median, 0.96; IQR, 0.94-0.96; P < .001). 
Potential pathogens were detected in half of samples previously negative by 
clinical diagnostics, demonstrating increased sensitivity for missed pulmonary 
pathogens (P < .001).
CONCLUSIONS: An optimized mNGS assay for pulmonary microbes demonstrates 
significant inoculation of the lower airways of immunocompromised children with 
diverse bacteria, fungi, and viruses. Potential pathogens can be identified 
based on absolute and relative abundance. Ongoing investigation is needed to 
determine the pathogenic significance of outlier microbes in the lungs of 
immunocompromised children with pulmonary disease.

© The Author(s) 2018. Published by Oxford University Press for the Infectious 
Diseases Society of America. All rights reserved. For permissions, e-mail: 
journals.permissions@oup.com.

DOI: 10.1093/cid/ciy802
PMCID: PMC6784263
PMID: 30239621 [Indexed for MEDLINE]


4500. Clin Perinatol. 2018 Sep;45(3):467-484. doi: 10.1016/j.clp.2018.05.008. Epub 
2018 Jun 19.

What Are We Measuring as Outcome? Looking Beyond Neurodevelopmental Impairment.

Kilbride HW(1), Aylward GP(2), Carter B(3).

Author information:
(1)Division of Neonatology, Department of Pediatrics, Children's Mercy-Kansas 
City, University of Missouri-Kansas City School of Medicine, 2401 Gillham Road, 
Kansas City, MO 64108, USA. Electronic address: hkilbride@cmh.edu.
(2)Division of Developmental and Behavioral Pediatrics, Southern Illinois 
University School of Medicine, PO Box 19658, Springfield, IL 62794-9658, USA.
(3)Division of Neonatology, Department of Pediatrics, Children's Mercy-Kansas 
City, University of Missouri-Kansas City School of Medicine, 2401 Gillham Road, 
Kansas City, MO 64108, USA.

Outcomes of neonatal intensive care unit (NICU) graduates have been categorized 
by rates of neurodevelopmental impairment at 2 years old. Although useful as 
metrics for research, these early childhood assessments may underestimate or 
overestimate later functional capabilities. Often overlooked are less severe but 
more prevalent neurobehavioral dysfunctions seen later in childhood, and chronic 
health concerns that may impact the child's quality of life (QoL). Comprehensive 
NICU follow-up should include measures of less severe cognitive/learning delays, 
physical/mental well-being, and the promotion of resilience in children and 
families. Studies are needed to identify QoL measures that will optimize 
children's assessments and outcomes.

Copyright © 2018 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.clp.2018.05.008
PMID: 30144850 [Indexed for MEDLINE]


4501. Am J Hosp Palliat Care. 2019 Mar;36(3):200-206. doi: 10.1177/1049909118792517. 
Epub 2018 Aug 5.

Association of Perceived Futile or Potentially Inappropriate Care With Burnout 
and Thoughts of Quitting Among Health-Care Providers.

Lambden JP(1)(2), Chamberlin P(1)(2), Kozlov E(1)(2), Lief L(2), Berlin DA(2), 
Pelissier LA(3), Yushuvayev E(3), Pan CX(3), Prigerson HG(1)(2).

Author information:
(1)Center for Research on End-Of-Life Care, Weill Cornell Medicine, NY, USA.
(2)Department of Medicine, Weill Cornell Medicine, NY, USA.
(3)Division of Geriatrics and Palliative Care Medicine, NewYork-Presbyterian 
/Queens, NY, USA.

BACKGROUND: Futile or potentially inappropriate care (futile/PIC) has been 
suggested as a factor contributing to clinician well-being; however, little is 
known about this association.
OBJECTIVE: To determine whether futile/PIC provision is associated with measures 
of clinician well-being.
DESIGN: Cross-sectional, self-administered, online questionnaire.
SETTING: Two New York City Hospitals.
PARTICIPANTS: Attending physicians, residents, nurses, and physician assistants 
in the fields of internal medicine, surgery, neurology, or intensive care.
EXPOSURE(S): Provision of perceived futile/PIC.
MEASUREMENTS: Main outcomes included (1) clinician burnout, measured using the 
Physician Worklife Study screen; (2) clinician depression, measured using the 
Patient Health Questionnaire; and (3) intention to quit, measured using 
questions assessing thoughts of quitting and how seriously it is being 
considered.
RESULTS: Of 1784 clinicians who received surveys, 349 participated. Across all 
clinicians, 91% reported that they either had or had possibly provided 
futile/PIC to a patient. Overall, 43.4% of clinicians screened positive for 
burnout syndrome, 7.8% screened positive for depression, and 35.5% reported 
thoughts of leaving their job as a result of futile/PIC. The amount of perceived 
futile/PIC provided was associated with burnout (odds ratio [OR] 3.8 [16-30 
patients vs 1-2 patients]; 95% confidence interval [CI]: 1.1-12.8) and having 
thoughts of quitting (OR, 7.4 [16-30 patients vs 1-2 patients]; 95% CI: 2.0-27), 
independent of depression, position, department, and the number of dying 
patients cared for.
CONCLUSIONS: A large majority of clinicians report providing futile/PIC, and 
such care is associated with measures of clinician well-being, including burnout 
and intention to quit.

DOI: 10.1177/1049909118792517
PMCID: PMC6363893
PMID: 30079753 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Conflicting Interests The authors 
declared no potential conflicts of interest with respect to the research, 
authorship, and/or publication of this article.


4502. J Perinat Neonatal Nurs. 2018 Jul/Sep;32(3):275-285. doi: 
10.1097/JPN.0000000000000353.

An Examination of the Moderating Effect of Proactive Coping in NICU Nurses.

Moore BM(1), Schellinger K.

Author information:
(1)Department of Psychology, Loma Linda University, Loma Linda, California (Ms 
Moore); and Department of Endocrinology, Rady Children's Hospital-San Diego, San 
Diego, California (Dr Schellinger).

Neonatal intensive care unit (NICU) nurses experience increased risk for 
depression, secondary traumatic stress, and burnout. This study examined whether 
the use of problem-solving or support-seeking strategies moderated the 
relationship between secondary traumatic stress levels, depressive symptomology, 
and burnout in NICU nurses. Multiple linear regression and a hierarchical 
stepwise technique were used to conduct moderation analyses. Results indicated 
that support-seeking coping skills significantly moderated the relationship 
between secondary traumatic stress symptoms and burnout symptoms. Coping did not 
moderate the relationship between depression and burnout. These findings can be 
used to inform the development of programs that could promote the well-being and 
coping of nurses experiencing mental health difficulties or burnout and foster a 
healthy work environment for all NICU nurses so that they can provide the best 
possible intervention to vulnerable infants. Future research should aim to 
identify interventions that promote coping in NICU nurses.

DOI: 10.1097/JPN.0000000000000353
PMID: 30036310 [Indexed for MEDLINE]


4503. J Burn Care Res. 2019 Jan 1;40(1):39-43. doi: 10.1093/jbcr/iry042.

Examining the Rates of Anxiety, Depression, and Burnout Among Providers at a 
Regional Burn Center.

Markiewitz N(1), Cox C(1), Krout K(1), McColl M(1), Caffrey JA(1)(2).

Author information:
(1)Johns Hopkins Adult Burn Center, Baltimore, Maryland.
(2)Department of Plastic and Reconstructive Surgery, Johns Hopkins University, 
School of Medicine, Baltimore, Maryland.

Burnout, defined by feelings of inefficacy, cynicism, and emotional exhaustion, 
affects the performance and well-being of health care providers. Burn care 
exposes providers to factors known to cause or worsen burnout, but no research 
has presented prevalence rates of burnout in this population. We estimate the 
rates of anxiety, depression, and burnout among nonphysician providers in a 
regional burn center and compare those rates to a reference population of 
critical care nurses. In our sample of 22 providers, 64% screened positive for 
anxiety; 32% for depression; 82% for emotional exhaustion; 18% for personal 
achievement burnout; and 54% for depersonalization. When compared with a 
national sample of critical care nurses, burn center providers demonstrated a 
significantly higher rate of anxiety (risk difference [RD]: 0.453, 95% 
confidence interval [CI] [0.244, 0.622]), a significantly higher rate of 
emotional exhaustion (RD: 0.207, 95% CI [0.001, 0.323]), and a significantly 
lower rate of personal achievement burnout (RD: -0.325, 95% CI [-0.442, 
-0.119]). These findings constitute the first evidence that many burn care 
providers meet criteria for burnout and that burnout in burn care providers may 
qualitatively differ from burnout in other critical care providers. Future 
research should identify burn care-specific predictors of burnout and determine 
the feasibility and efficacy of interventions to prevent and reduce burnout in 
burn care providers.

DOI: 10.1093/jbcr/iry042
PMID: 30032292 [Indexed for MEDLINE]


4504. Early Hum Dev. 2018 Aug;123:17-21. doi: 10.1016/j.earlhumdev.2018.07.001. Epub 
2018 Jul 19.

Activity based group therapy reduces maternal anxiety in the Neonatal Intensive 
Care Unit - a prospective cohort study.

John HB(1), Philip RM(2), Santhanam S(3), Padankatti SM(2), Sebastian T(4), 
Balan I(3), Rajapandian E(2).

Author information:
(1)Department of Neonatology, Christian Medical College, Vellore, India. 
Electronic address: himajb.cmc@gmail.com.
(2)Department of Occupational Therapy, Christian Medical College, Vellore, 
India.
(3)Department of Neonatology, Christian Medical College, Vellore, India.
(4)Department of Biostatistics, Christian Medical College, Vellore, India.

BACKGROUND: A large proportion of mothers in the Neonatal Intensive Care Unit 
(NICU) experience psychological distress, which is associated with adverse 
infant and parenting outcomes. Interventions addressing maternal anxiety in the 
NICU are scarce.
AIMS: To assess the effect of activity based group therapy on maternal anxiety 
in the NICU when compared to a control group.
STUDY DESIGN: The study was a prospective phase lag cohort study. In Phase 1 the 
control group was recruited and assessed using the State-Trait Anxiety Inventory 
(STAI-S) once at recruitment and again 4 weeks later. In phase 2, mothers were 
invited to take part in activity-based groups of 1 h duration once a week for 
4 weeks. The STAI-S was administered before and after every group session.
SUBJECTS: Mothers of babies admitted in the NICU who consented to participate, 
had a working knowledge of Tamil or English and were likely to stay for 4 weeks 
for the treatment were included.
OUTCOME MEASURES: State anxiety assessed using the STAI-S.
RESULTS: Seventeen mothers each in the control and experimental groups completed 
the study. In the experimental group, there was a significant reduction in the 
post-test anxiety scores when compared to the pre-test in the first (p = 0.005), 
third (p = 0.07) and fourth (p = 0.009) sessions. The post-test anxiety scores 
of the intervention group was significantly lower than that of the control group 
(p = 0.009).
CONCLUSION: Activity based group therapy is effective as an intervention in 
reducing maternal anxiety in the NICU.
SUMMARY: Anxiety in mothers of infants admitted in the NICU has been associated 
with adverse infant and parenting outcomes. This study evaluated the feasibility 
and effectiveness of an activity based group intervention to reduce anxiety 
levels in mothers in the NICU. The study was a prospective phase lag cohort 
study. Anxiety levels were assessed in mothers in the control group at 
recruitment and then 4 weeks later. In the intervention group, activity based 
group sessions were conducted once a week for 4 weeks. State anxiety was 
assessed before and after every group session. In the intervention group the 
anxiety levels were significantly lower in the post-test, when compared to the 
pre-test. Also the number of mothers suffering from moderate to severe anxiety 
and the anxiety scores in the post-test were significantly lower in the 
intervention group when compared to the control group. We conclude that activity 
based group sessions are effective in reducing the state anxiety in mothers in 
the NICU. Improving maternal psychological wellbeing may indirectly contribute 
to better infant outcomes.

Copyright © 2018 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.earlhumdev.2018.07.001
PMID: 30031995 [Indexed for MEDLINE]


4505. Curr Treat Options Pediatr. 2018 Mar;4(1):49-69. Epub 2018 Jan 24.

NICU Hospitalization: Long-Term Implications on Parenting and Child Behaviors.

Lean RE(1), Rogers CE(2), Paul RA(3), Gerstein ED(4).

Author information:
(1)Department of Psychiatry, Washington University School of Medicine, 660 South 
Euclid Avenue, Campus Box 8504, St. Louis, MO 63110, USA.
(2)Department of Pediatrics and Psychiatry, Washington University School of 
Medicine, 660 South Euclid Avenue, Campus Box 8504, St. Louis, MO 63110, USA.
(3)Department of Obstetrics and Gynecology, Washington University School of 
Medicine, 660 South Euclid Avenue, Campus Box 8219, St. Louis, MO 63110, USA.
(4)Department of Psychological Sciences, University of Missouri- St. Louis, 1 
University Blvd, St. Louis, MO 63118, USA. Phone 314-516-5398.

PURPOSE OF REVIEW: Parents of infants admitted to the Neonatal Intensive Care 
Unit (NICU) experience psychological distress, loss of the parenting role, and 
disruptions to parent-infant bonding. The inclusion of evidence-based practices 
to address these challenges in the NICU has largely been based upon short-term 
improvements in parent and infant functioning. However, less is known regarding 
the extent to which family-based interventions may also be associated with 
longer-term parenting behaviors and children's neurobehavioral outcomes.
RECENT FINDINGS: Comprehensive family-based NICU interventions demonstrate 
consistent links with later parental mental wellbeing, sensitive parenting 
behaviors, and children's cognitive and socioemotional development. Dyadic 
co-regulation activities implemented inconsistently and/or in isolation to other 
components of NICU interventions show mixed associations with outcomes, 
highlighting the need for multifaceted wrap-around care. Further research is 
needed to delineate associations between NICU interventions and children's 
neurological and language development, with follow-up beyond very early 
childhood in larger samples.
SUMMARY: Long-term associations may reflect the stability of early parental 
responses to NICU interventions and the extent to which parents continue to 
implement mental health and sensitive parenting techniques in the home. However, 
the transition of parental psychiatric care from hospital to community-based 
services upon NICU discharge remains a pertinent need for high-risk families. 
Remaining issues also concern the extent to which NICU interventions incorporate 
sociodemographic differences across families, and whether interventions are 
generalizable or feasible across hospitals. Despite variation across 
interventions and NICUs; supporting, educating, and partnering with parents is 
crucial to strengthen longer-term family functioning and alter the developmental 
trajectories of high-risk infants.

PMCID: PMC5986282
PMID: 29881666

Conflict of interest statement: Conflicts of Interest The authors have no 
commercial or financial conflicts of interest.


4506. Arch Womens Ment Health. 2018 Dec;21(6):791-799. doi: 10.1007/s00737-018-0862-x. 
Epub 2018 Jun 5.

A mindfulness intervention to reduce maternal distress in neonatal intensive 
care: a mixed methods pilot study.

Mendelson T(1), McAfee C(2), Damian AJ(3), Brar A(3), Donohue P(3)(4), Sibinga 
E(4).

Author information:
(1)Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 
tmendel1@jhu.edu.
(2)University of Texas at Austin, Austin, TX, USA.
(3)Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
(4)Johns Hopkins School of Medicine, Baltimore, MD, USA.

Mothers with an infant in the neonatal intensive care unit (NICU) are at risk 
for depression, anxiety, and trauma symptoms, with negative implications for 
maternal-infant bonding, maternal well-being, and infant development. Few 
interventions to promote NICU mothers' mental health, however, have been 
developed or tested. This pre-post pilot study assessed feasibility, 
acceptability, and preliminary outcomes of a mindfulness intervention for NICU 
mothers. Twenty-seven mothers were recruited from a university NICU and offered 
a mindfulness intervention via introductory video and audio-recorded practices. 
Participants completed a baseline self-report survey. After 2 weeks of engaging 
with intervention materials, participants completed a second survey and in-depth 
interview. Quantitative data were analyzed using paired t tests; qualitative 
data were analyzed using thematic coding. Twenty-four women (89%) completed the 
study. Quantitative data indicated significant improvements in depressive, 
anxiety, and trauma symptoms, negative coping, NICU-related stress, and sleep 
(p < 0.05). Qualitative data identified themes of perceived improvements in 
psychological distress and stress symptoms, self-care, and relationships. 
Findings support the mindfulness intervention's feasibility, acceptability, and 
potential promise for reducing maternal distress and promoting well-being. Use 
of video and audio modalities may facilitate program sustainability and scale 
up. Further research on the program is merited.

DOI: 10.1007/s00737-018-0862-x
PMID: 29872924 [Indexed for MEDLINE]


4507. Sleep Med. 2019 Jan;53:189-194. doi: 10.1016/j.sleep.2018.03.018. Epub 2018 Apr 
10.

CPAP therapy improves erectile function in patients with severe obstructive 
sleep apnea.

Schulz R(1), Bischof F(2), Galetke W(3), Gall H(4), Heitmann J(4), Hetzenecker 
A(2), Laudenburg M(3), Magnus TJ(4), Nilius G(5), Priegnitz C(6), Randerath 
W(6), Schröder M(5), Treml M(6), Arzt M(2); German Sleep Apnea Research Network 
(GERSAN).

Author information:
(1)Deutsche Klinik für Diagnostik (DKD) Helios-Klinik, Wiesbaden, Germany; 
Department of Internal Medicine, Justus Liebig-University Giessen, Universities 
of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung 
Research (DZL), Giessen, Germany. Electronic address: 
Richard.Schulz@helios-kliniken.de.
(2)University Hospital of Regensburg, Dept. of Sleep Medicine, Regensburg, 
Germany.
(3)Krankenhaus der Augustinerinnen, Köln, Germany.
(4)Department of Internal Medicine, Justus Liebig-University Giessen, 
Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German 
Center for Lung Research (DZL), Giessen, Germany.
(5)Helios-Klinik Hagen-Ambrock, Hagen, Germany.
(6)University of Witten-Herdecke, Krankenhaus Bethanien, Solingen, Germany.

OBJECTIVES: Erectile dysfunction (ED) is highly prevalent in obstructive sleep 
apnea (OSA), however, the effect of continuous positive airway pressure (CPAP) 
therapy on erectile function has not yet been thoroughly investigated in these 
patients.
METHODS: Ninety-four men with severe OSA (ie, with an 
apnea-hypopnea-index ≥ 30/h of sleep) were prospectively evaluated for the 
presence and severity of ED before and after 6-12 months of CPAP therapy. The 
abbreviated version of the International Index of Erectile Function, (the 
IIEF-5) was used to rate erectile function. Furthermore, all study participants 
responded to standard questionnaires of daytime sleepiness (Epworth Sleepiness 
Scale), quality of life (WHO Wellbeing 5 questionnaire) and depression (Major 
Depression Inventory).
RESULTS: ED as defined by an IIEF-5 score of ≤21 was present in 64 patients 
(68.1%). CPAP treatment significantly improved erectile function in those 
patients suffering from moderate and severe ED. Additionally, a trend for a 
correlation between the improvement of erectile function under CPAP and the 
hours of its use was observed. Finally, this effect was associated with larger 
improvements of quality of life in affected patients.
CONCLUSIONS: ED is very frequent in men with severe OSA and can at least partly 
be reversed by long-term CPAP therapy in most seriously affected patients. The 
beneficial effect on erectile function may depend on CPAP compliance and is 
accompanied by improvements of quality of life. Randomized controlled trials are 
needed to confirm these findings.

Copyright © 2018 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.sleep.2018.03.018
PMID: 29773460 [Indexed for MEDLINE]


4508. J Cardiovasc Nurs. 2018 Jul/Aug;33(4):E40-E49. doi: 
10.1097/JCN.0000000000000499.

Sleep Quality During and After Cardiothoracic Intensive Care and Psychological 
Health During Recovery.

Caruana N(1), McKinley S, Elliott R, Gholizadeh L.

Author information:
(1)Nittaya Caruana, MSN, RN Master of Nursing Student, University of Technology 
Sydney, New South Wales, Australia. Sharon McKinley, PhD, RN Researcher, School 
of Nursing and Midwifery, Faculty of Health, Deakin University, Melbourne, 
Victoria, Australia. Rosalind Elliott, PhD, RN Associate, Faculty of Health, 
University of Technology Sydney; and Clinical Nurse Consultant - Translational 
Research Co-ordinator Northern Sydney Local Health District, St Leonard, New 
South Wales, Australia. Leila Gholizadeh, PhD, RN Lecturer, Faculty of Health, 
University of Technology Sydney, New South Wales, Australia.

BACKGROUND: Intensive care patients experience poor sleep quality. Psychological 
distress and diminished health-related quality of life (HRQOL) are also common 
among former intensive care unit (ICU) patients. Coronary artery bypass graft 
(CABG) surgery is a frequent reason adults require treatment in ICU. The effect 
of on- versus off-pump surgery on sleep and recovery has not been reported.
OBJECTIVE: The aim of this study was to assess sleep quality of CABG patients 
during and after ICU, psychological well-being, HRQOL during recovery, and 
whether on- versus off-pump surgery affects sleep and recovery.
METHODS: Data were collected in the ICU and hospital ward, and 2 and 6 months 
after hospital discharge using validated self-report questionnaires.
RESULTS: The sample (n = 101) had a mean age of 66.6 ± 11.1 years, was 79% male, 
and had a median ICU stay of 2 (2-4) days and a mean body mass index of 27.3 ± 
4.3; 75% underwent on-pump surgery. Poor sleep was reported by 62% of the 
patients at 6 months and by 12% of the patients at all time points. Off-pump 
CABG patients had fewer posttraumatic stress symptoms (P = .02) and better 
physical HRQOL (P = .01). In multivariate analysis, prehospital insomnia (P = 
.004), and physical (P < .0005) and mental (P < .0005) HRQOL were independently 
associated with sleep quality at 6 months. There was no association between on- 
versus off-pump CABG and sleep quality at 6 months.
CONCLUSIONS: Sleep quality of postoperative CABG patients was poor in the ICU 
and hospital ward and up to 6 months after discharge from the hospital. Poor 
sleep quality at 6 months was associated with prehospital insomnia, and physical 
and mental HRQOL at 6 months, but not with on- versus off-pump surgery.

DOI: 10.1097/JCN.0000000000000499
PMID: 29771744 [Indexed for MEDLINE]


4509. Intensive Crit Care Nurs. 2019 Feb;50:103-110. doi: 10.1016/j.iccn.2018.04.007. 
Epub 2018 May 3.

The health promoting conversations intervention for families with a critically 
ill relative: A pilot study.

Ågren S(1), Eriksson A(2), Fredrikson M(3), Hollman-Frisman G(4), Orwelius L(5).

Author information:
(1)Department of Cardiothoracic Surgery and Department of Medical and Health 
Sciences, Linköping University, Sweden. Electronic address: 
Susanna.Agren@liu.se.
(2)Department of Intensive Care, Linköping University, County Council of 
Östergötland, Linköping, Sweden. Electronic address: 
Anna.J.Eriksson@regionostergotland.se.
(3)Division of Occupational and Environmental Medicine, Department of Clinical 
and Experimental Medicine and Forum Östergötland, Linköping University, 
Linköping, Sweden. Electronic address: Mats.fredrikson@liu.se.
(4)Anesthetics, Operations and Speciality Surgery Center and Department of 
Medical and Health Sciences, Linköping University, 581 85 Linköping, Sweden. 
Electronic address: Gunilla.Hollman.Frisman@liu.se.
(5)Department of Intensive Care, Clinical and Experimental Medicine, Linköping 
University, County Council of Östergötland, Linköping, Sweden. Electronic 
address: Lotti.Orvelius@regionostergotland.se.

BACKGROUND: After intensive care unit treatment, patients often have prolonged 
impairments that affect their physical, cognitive and mental health. Family 
members can face overwhelming and emotionally challenging situations and their 
concerns and needs must be addressed.
OBJECTIVE: We investigated the outcomes of pilot randomised control trial, a 
nurse-led family intervention, Health Promoting Conversations, which focused on 
family functioning and wellbeing in families with a critically ill member.
STUDY DESIGN: This randomised controlled pilot study used a pre-test, post-test 
design with intervention and control groups to investigate the outcomes of the 
nurse-led intervention in 17 families.
OUTCOME MEASURES: The Health Promoting Conversations intervention was evaluated 
using validated instruments that measure family functioning and family 
wellbeing: the General Functioning sub-scale from the McMaster Family Assessment 
Device; the Family Sense of Coherence, the Herth Hope Index, and the Medical 
Outcome Short-Form Health Survey. Descriptive and analytical statistical methods 
were used to analyse the data.
RESULTS: After 12 months, the intervention group reported better family 
functioning than the control group. The intervention group also had better 
social functioning and mental health after 12 months.
CONCLUSION: This intervention may improve family wellbeing by improving family 
function, reducing stress, and promoting better mental health.

Copyright © 2018 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.iccn.2018.04.007
PMID: 29731406 [Indexed for MEDLINE]


4510. Am J Crit Care. 2018 May;27(3):245-248. doi: 10.4037/ajcc2018908.

Effect of Dynamic Light Application on Cognitive Performance and Well-being of 
Intensive Care Nurses.

Simons KS(1), Boeijen ERK(2), Mertens MC(2), Rood P(2), de Jager CPC(2), van den 
Boogaard M(2).

Author information:
(1)Koen S. Simons is an intensivist, Department of Intensive Care Medicine, 
Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands, and Department of 
Intensive Care, Radboud University Medical Center, Nijmegen, the Netherlands. 
Enzio R. K. Boeijen is a student in nursing sciences, Paul Rood is a PhD 
student, and Mark van den Boogaard is an assistant professor, Department of 
Intensive Care, Radboud University Medical Center. Cornelis P. C. de Jager is an 
intensivist, Department of Intensive Care Medicine, Jeroen Bosch Hospital. 
Marlies C. Mertens is a psychologist, Department of Medical Psychology, Jeroen 
Bosch Hospital and at Eindhoven Corporation of Primary Health Care Centers 
(SGE), Eindhoven, the Netherlands. k.simons@jbz.nl.
(2)Koen S. Simons is an intensivist, Department of Intensive Care Medicine, 
Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands, and Department of 
Intensive Care, Radboud University Medical Center, Nijmegen, the Netherlands. 
Enzio R. K. Boeijen is a student in nursing sciences, Paul Rood is a PhD 
student, and Mark van den Boogaard is an assistant professor, Department of 
Intensive Care, Radboud University Medical Center. Cornelis P. C. de Jager is an 
intensivist, Department of Intensive Care Medicine, Jeroen Bosch Hospital. 
Marlies C. Mertens is a psychologist, Department of Medical Psychology, Jeroen 
Bosch Hospital and at Eindhoven Corporation of Primary Health Care Centers 
(SGE), Eindhoven, the Netherlands.

BACKGROUND: Exposure to bright light has alerting effects. In nurses, alertness 
may be decreased because of shift work and high work pressure, potentially 
reducing work performance and increasing the risk for medical errors.
OBJECTIVES: To determine whether high-intensity dynamic light improves cognitive 
performance, self-reported depressive signs and symptoms, fatigue, alertness, 
and well-being in intensive care unit nurses.
METHODS: In a single-center crossover study in an intensive care unit of a 
teaching hospital in the Netherlands, 10 registered nurses were randomly divided 
into 2 groups. Each group worked alternately for 3 to 4 days in patients' rooms 
with dynamic light and 3 to 4 days in control lighting settings. High-intensity 
dynamic light was administered through ceiling-mounted fluorescent tubes that 
delivered bluish white light up to 1700 lux during the daytime, versus 300 lux 
in control settings. Cognitive performance, self-reported depressive signs and 
symptoms, fatigue, and well-being before and after each period were assessed by 
using validated cognitive tests and questionnaires.
RESULTS: Cognitive performance, self-reported depressive signs and symptoms, and 
fatigue did not differ significantly between the 2 light settings. Scores of 
subjective well-being were significantly lower after a period of working in 
dynamic light.
CONCLUSIONS: Daytime lighting conditions did not affect intensive care unit 
nurses' cognitive performance, perceived depressive signs and symptoms, or 
fatigue. Perceived quality of life, predominantly in the psychological and 
environmental domains, was lower for nurses working in dynamic light.

© 2018 American Association of Critical-Care Nurses.

DOI: 10.4037/ajcc2018908
PMID: 29716912 [Indexed for MEDLINE]


4511. Pediatr Ann. 2018 Apr 1;47(4):e165-e171. doi: 10.3928/19382359-20180325-02.

NICU Graduates: The Role of the Allied Health Team in Follow-Up.

Orton JL, Olsen JE, Ong K, Lester R, Spittle AJ.

Infants who graduate from the neonatal intensive care unit, including those 
infants born preterm and/or with brain injury, are at increased risk of 
long-term neurodevelopmental impairments. The developmental allied health team, 
consisting of physical therapy, occupational therapy, and speech pathology, is 
crucial in early evaluation of gross motor, fine motor, feeding, and language 
development. Surveillance of neurodevelopment in the first year of life is 
essential to ensure early detection of specific developmental delays and 
impairments, and to ensure timely referral for early intervention. Early 
intervention is not only important in optimizing long-term outcomes for the 
child, but it also plays an important role in enhancing the parent-child 
relationship and parental well-being. In this review, we discuss the role of the 
developmental allied health team in the follow-up of high-risk infants, identify 
key assessment tools used in early neurodevelopmental surveillance, and provide 
recommendations regarding referral to intervention programs to optimize child 
and family outcomes. [Pediatr Ann. 2018;47(4):e165-e171.].

Copyright 2018, SLACK Incorporated.

DOI: 10.3928/19382359-20180325-02
PMID: 29668026 [Indexed for MEDLINE]


4512. Pediatr Crit Care Med. 2018 Jul;19(7):e358-e366. doi: 
10.1097/PCC.0000000000001556.

A Pilot Randomized Controlled Trial of an Intervention to Promote Psychological 
Well-Being in Critically Ill Children: Soothing Through Touch, Reading, and 
Music.

Rennick JE(1)(2)(3)(4)(5), Stremler R(6)(7), Horwood L(2)(5), Aita M(8)(9), 
Lavoie T(5), Majnemer A(5)(10), Antonacci M(1), Knox A(5), Constantin 
E(2)(4)(5).

Author information:
(1)Department of Nursing, The Montreal Children's Hospital, McGill University 
Health Centre, Montreal, Quebec, Canada.
(2)Department of Pediatrics, The Montreal Children's Hospital, McGill University 
Health Centre, Montreal, Quebec, Canada.
(3)Ingram School of Nursing, Faculty of Medicine McGill University, Montreal, 
Quebec, Canada.
(4)Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, 
Quebec, Canada.
(5)Research Institute, McGill University Health Centre, Montreal, Quebec, 
Canada.
(6)Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, 
Ontario, Canada.
(7)Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
(8)Faculté des sciences infirmières, Université de Montréal, Montreal, Quebec, 
Canada.
(9)Research Center, Centre hospitalier universitaire Sainte-Justine, Montreal, 
Quebec, Canada.
(10)School of Physical & Occupational Therapy, Faculty of Medicine, McGill 
University, Montreal, Quebec, Canada.

Comment in
    Pediatr Crit Care Med. 2018 Jul;19(7):690-691.

OBJECTIVES: To examine the feasibility and acceptability of a PICU Soothing 
intervention using touch, reading, and music.
DESIGN: Nonblinded, pilot randomized controlled trial.
SETTING: The PICU and medical-surgical wards of one Canadian pediatric hospital.
PATIENTS: Twenty PICU patients age 2-14 years old and their parents, randomized 
to an intervention group (n = 10) or control group (n = 10).
INTERVENTION: PICU Soothing consisted of: 1) parental comforting (touch and 
reading), followed by 2) a quiet period with music via soft headbands, 
administered once daily throughout hospitalization.
MEASUREMENTS AND MAIN RESULTS: Acceptability and feasibility of the intervention 
and methods were assessed via participation rates, observation, measurement 
completion rates, semistructured interviews, and telephone calls. Psychological 
well-being was assessed using measures of distress, sleep, and child and parent 
anxiety in the PICU, on the wards and 3 months post discharge. Forty-four 
percent of parents agreed to participate. Seventy percent and 100% of 
intervention group parents responded positively to comforting and music, 
respectively. Most intervention group parents (70%) and all nurses felt children 
responded positively. All nurses found the intervention acceptable and feasible. 
Measurement completion rates ranged from 70% to 100%. Pilot data suggested lower 
intervention group child and parent anxiety after transfer to hospital wards.
CONCLUSIONS: PICU Soothing is acceptable and feasible to conduct. Results 
support the implementation of a full-scale randomized controlled trial to 
evaluate intervention effectiveness.

DOI: 10.1097/PCC.0000000000001556
PMID: 29659416 [Indexed for MEDLINE]


4513. Early Hum Dev. 2018 May;120:31-39. doi: 10.1016/j.earlhumdev.2018.03.009. Epub 
2018 Apr 4.

Maternal mental health during the neonatal period: Relationships to the 
occupation of parenting.

Harris R(1), Gibbs D(2), Mangin-Heimos K(3), Pineda R(4).

Author information:
(1)Program in Occupational Therapy, Washington University School of Medicine, 
St. Louis, MO, USA.
(2)Barts Health NHS Trust, London, United Kingdom.
(3)Department of Pediatrics, Washington University School of Medicine, St. 
Louis, MO, USA; Department of Psychological and Brain Sciences, Washington 
University, St. Louis, MO, USA.
(4)Program in Occupational Therapy, Washington University School of Medicine, 
St. Louis, MO, USA; Department of Pediatrics, Washington University School of 
Medicine, St. Louis, MO, USA. Electronic address: pineda_r@kids.wustl.edu.

PURPOSE: To (1) examine the extent of a range of early mental health challenges 
in mothers with a very preterm infant hospitalized in the NICU and mothers of 
full-term infants, (2) identify family social background and infant medical 
factors associated with higher levels of maternal psychological distress, and 
(3) assess the relationship between maternal psychological distress and maternal 
perceptions of the parenting role, parenting confidence and NICU engagement.
METHODS: At hospital discharge 37 mothers of very preterm infants (≤32 weeks 
gestation) and 47 mothers of full-term infants (≥37 weeks gestation) completed 
structured assessments of their psychological wellbeing and transition to 
parenting. Mothers of very preterm infants were also questioned about their NICU 
visitation and involvement in infant care.
RESULTS: Sixty-four percent (n = 54) of mothers experienced psychological 
distress (n = 26, 70% of preterm; n = 28, 60% of full-term). Lower infant 
birthweight was associated with maternal psychological distress (p = .03). 
Mothers of very preterm infants had significantly more psychological distress 
related to having a Cesarean section delivery (p = .02). Higher levels of 
psychological distress were associated with lower levels of parenting confidence 
in mothers of both very preterm and full-term infants (p < .02).
CONCLUSION: Although parents of very preterm infants have higher rates of 
maternal mental health challenges, mothers of full-term infants at high social 
risk are also impacted.

Copyright © 2018 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.earlhumdev.2018.03.009
PMCID: PMC5951762
PMID: 29625369 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest: There are no conflicts of 
interest to report.


4514. J Am Psychiatr Nurses Assoc. 2018 Nov/Dec;24(6):495-509. doi: 
10.1177/1078390318765205. Epub 2018 Mar 26.

Parent Psychological Distress in the Neonatal Intensive Care Unit Within the 
Context of the Social Ecological Model: A Scoping Review.

Loewenstein K(1).

Author information:
(1)1 Kristy Loewenstein, MSN, RN-BC, PMHNP-BC, Medical University of South 
Carolina College of Nursing, Charleston, SC, USA; Zucker Hillside Hospital, 
Northwell Health, Glen Oaks, NY, USA.

BACKGROUND: Neonatal intensive care unit (NICU) parents are at risk for 
psychological distress and impaired mental health, and statistics related to 
parent psychological distress vary.
OBJECTIVE: To determine the scope of literature regarding the mental health and 
psychosocial well-being of parents in the NICU.
DESIGN: A scoping review within the Arksey and O'Malley framework and the SEM 
was undertaken to answer, "What factors contribute to parent's mental health in 
the NICU?" A systematic review of the literature was performed using the PRISMA 
methodology.
RESULTS: Common socioeconomic factors and infant and parent characteristics may 
place parents at a greater risk for developing distress. History of mental 
illness, family cohesion, birth trauma, altered parenting role, gestational age, 
birth weight, and severity of prematurity/illness emerged as themes.
CONCLUSION: Further research is required to provide a standard for the screening 
and assessment of parents' mental health and psychosocial well-being during a 
NICU hospitalization. The experiences of nonbirth parents in the NICU should be 
explored to examine the effects of the hospitalization on all types of parents.

DOI: 10.1177/1078390318765205
PMID: 29577790 [Indexed for MEDLINE]


4515. Arch Dis Child. 2018 Aug;103(8):784-789. doi: 10.1136/archdischild-2017-314051. 
Epub 2018 Mar 23.

Neurocognitive outcomes in children following immersion: a long-term study.

Manglick MP(1), Ross FI(1), Waugh MC(2), Holland AJA(1)(3), Cass DT(1), 
Soundappan SSV(1)(3).

Author information:
(1)Department of Paediatric Surgery, The Children's Hospital at Westmead, 
Sydney, New South Wales, Australia.
(2)Kids Rehabilitation Department, The Children's Hospital at Westmead, Sydney, 
New South Wales, Australia.
(3)Sydney Medical School, The University of Sydney, Sydney, New South Wales, 
Australia.

OBJECTIVE: To investigate long-term neurocognitive outcomes after a 
near-drowning incident in children who were deemed neurologically intact on 
discharge from hospital.
DESIGN: A prospective cohort study of near-drowning children.
SETTING: 95 drowning and near-drowning admissions, 0-16 years of age, from 
January 2009 to December 2013, to The Children's Hospital at Westmead, Sydney, 
NSW, Australia.
PARTICIPANTS: 23 children both met the criteria and had parental consent for the 
study.
MAIN OUTCOME MEASURES: Identification of the long-term deficits in behaviour, 
executive function, motor skills, communicative skills and well-being over a 
5-year period. Assessment was undertaken at 3-6 months, 1 year, 3 years and 5 
years after near-drowning at clinic visits. Physical developmental screening and 
executive function screening were done using Behavior Rating Inventory of 
Executive Function-Preschool version (BRIEF-P) and BRIEF.
RESULT: 95 drowning and near-drowning episodes occurred during the study period. 
10 (11%) children died, 28 were admitted to the paediatric intensive care unit 
and 64 directly to a ward. 3 children died in emergency department, 7 children 
had severe neurological deficit on discharge from the hospital. 23 were 
subsequently recruited into the study; 5 (22%) of these children had 
abnormalities in behaviour and/or executive function at some during their 
follow-up.
CONCLUSION: Children admitted to hospital following a near-drowning event 
warrant long-term follow-up to identify any subtle sequelae which might be 
amenable to intervention to ensure optimal patient outcome.

© Article author(s) (or their employer(s) unless otherwise stated in the text of 
the article) 2018. All rights reserved. No commercial use is permitted unless 
otherwise expressly granted.

DOI: 10.1136/archdischild-2017-314051
PMID: 29572222 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


4516. Interact Cardiovasc Thorac Surg. 2018 Jul 1;27(1):48-53. doi: 
10.1093/icvts/ivy036.

Health-related quality of life of patients after surgery for acute Type A aortic 
dissection.

Adam U(1)(2), Habazettl H(2), Graefe K(1), Kuppe H(1), Wundram M(1)(2), Kurz 
SD(1)(2).

Author information:
(1)Department of Anaesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
(2)Institute of Physiology, Charité-Universitätsmedizin Berlin, corporate member 
of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of 
Health, Berlin, Germany.

OBJECTIVES: Acute Type A aortic dissection (ATAAD) and the ensuing surgical 
therapy may be experienced as a traumatic event by patients. This study aimed at 
analysing the prevalence of post-traumatic stress disorder (PTSD) and the 
physical and mental well-being of survivors of surgically treated ATAAD.
METHODS: A total of 393 survivors were contacted and asked to fill in various 
health questionnaires.
RESULTS: Two hundred and ten (53%) patients returned the questionnaires. The 
mean follow-up was 51 ± 27.8 months. The results showed that 67.6% had high 
blood pressure, 12.9% had pre-existing diseases of the aorta and 31.5% or 27% of 
these groups were at risk for PTSD according to the health questionnaires. 
Duration of intensive care unit or hospital stay had no effect on the risk for 
PTSD. According to the questionnaire, Short Form 12, physical and mental 
well-being was significantly reduced in the patients compared to a large German 
norm sample, even after adjustment for differences in age between the 2 cohorts. 
Physical activity prior to the event was associated with improved physical and 
mental well-being but did not reduce the risk for PTSD.
CONCLUSIONS: Emergency surgery for ATAAD is associated with high risk for PTSD, 
which seems to negatively affect physical and mental well-being. More efforts 
should be directed at prevention and early diagnosis and therapy of PTSD. This 
study has evaluated 8-year trends in the presentation, diagnosis and outcomes 
such as physical and mental measures and prevalence rates of PTSD in patients 
who have undergone an emergency operation for ATAAD.

DOI: 10.1093/icvts/ivy036
PMID: 29474555 [Indexed for MEDLINE]


4517. Curr Opin Crit Care. 2018 Apr;24(2):118-123. doi: 10.1097/MCC.0000000000000487.

From dysmotility to virulent pathogens: implications of opioid use in the ICU.

Chapple LA(1)(2), Deane A(3)(4).

Author information:
(1)Discipline of Acute Care Medicine, School of Medicine, University of 
Adelaide.
(2)Intensive Care Research Unit, Royal Adelaide Hospital.
(3)National Health and Medical Research Council of Australia Centre for Research 
Excellence in Translating Nutritional Science to Good Health, University of 
Adelaide, Adelaide, South Australia.
(4)Intensive Care Unit, University of Melbourne, Royal Melbourne Hospital, 
Melbourne, Victoria, Australia.

PURPOSE OF REVIEW: Gastrointestinal dysmotility occurs frequently in the 
critically ill. Although the causes underlying dysmotility are multifactorial, 
both pain and its treatment with exogenous opioids are likely causative factors. 
The purpose of this review is to describe the effects of pain and opioids on 
gastrointestinal motility; outline the rationale for and evidence supporting the 
administration of opioid antagonists to improve dysmotility; and describe the 
potential influence opioids drugs have on the intestinal microbiome and 
infectious complications.
RECENT FINDINGS: Opioid drugs are frequently prescribed in the critically ill to 
alleviate pain. In health, opioids cause gastric dysmotility, yet the evidence 
for this in critical illness is inconsistent and limited to observational 
studies. Administration of opioid antagonists may improve gastrointestinal 
motility, but data are sparse, and these agents cannot be recommended outside of 
clinical trials. Although critical illness is associated with alterations in the 
microbiome, the extent to which opioid administration influences these changes, 
and the subsequent development of infection, remains uncertain.
SUMMARY: Replication of clinical studies from ambulant populations in critical 
care is required to ascertain the independent influence of opioid administration 
on gastrointestinal motility and infectious complications.

DOI: 10.1097/MCC.0000000000000487
PMID: 29461261 [Indexed for MEDLINE]


4518. Complement Ther Med. 2018 Feb;36:107-112. doi: 10.1016/j.ctim.2017.12.005. Epub 
2017 Dec 12.

The effects of reflexology on anxiety and pain in patients after abdominal 
hysterectomy: A randomised controlled trial.

Öztürk R(1), Sevil Ü(2), Sargin A(3), Yücebilgin MS(4).

Author information:
(1)Ege University Faculty of Nursing, Department of Women's Health and Diseases 
Nursing, Izmir, Turkey. Electronic address: rusenozturk85@hotmail.com.
(2)Ege University Faculty of Nursing, Department of Women's Health and Diseases 
Nursing, Izmir, Turkey.
(3)Ege University Faculty of Medical, Department of Anesthesiology and 
Reanimation, Izmir, Turkey.
(4)Ege University Faculty of Medical, Department of Gynecology and Obstetrics 
Department, Izmir, Turkey.

OBJECTIVES: This study aimed at finding out the effects of reflexology on pain, 
anxiety levels after abdominal hysterectomy.
DESING & METHODS: The study was performed on women hospitalized in the intensive 
care unit and gynecology services of Ege University Hospital in İzmir after 
abdominal hysterectomy between September 2013 and September 2014. This study was 
designed and conducted as a randomized controlled trial. The study sample 
consisted of 63 female patients: 32 in the experimental group and 31 in the 
control group. The postoperative daily monitoring sheet, Spielberger State 
Anxiety Inventory (SAI), was employed to collect research data and "visual 
analog scale" to evaluate pain levels.
RESULTS: The female patients' average age was found to be 47.23 ± 4.71. The 
three-day monitoring showed a significant difference between the experimental 
and control groups in terms of average pain levels and anxiety scores after 
reflexology (p < 0.05).
CONCLUSION: Foot reflexology may serve as an effective nursing intervention to 
increase the well-being and decrease the pain of female patients after abdominal 
hysterectomy, and nurses should be aware of the benefits of reflexology.

Copyright © 2017 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.ctim.2017.12.005
PMID: 29458915 [Indexed for MEDLINE]


4519. Clin Res Cardiol. 2018 Jun;107(6):471-478. doi: 10.1007/s00392-018-1208-4. Epub 
2018 Jan 30.

Impact of generalized anxiety disorder (GAD) on prehospital delay of acute 
myocardial infarction patients. Findings from the multicenter MEDEA study.

Fang XY(1)(2), Spieler D(1)(2), Albarqouni L(1), Ronel J(2), Ladwig KH(3)(4)(5).

Author information:
(1)Institute of Epidemiology, Mental Health Research Unit, Helmholtz Zentrum 
München, German Research Center for Environmental Health, Ingolstädter Landstr. 
1, 85764, Neuherberg, Germany.
(2)Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der 
Isar, Technische Universität München, Munich, Germany.
(3)Institute of Epidemiology, Mental Health Research Unit, Helmholtz Zentrum 
München, German Research Center for Environmental Health, Ingolstädter Landstr. 
1, 85764, Neuherberg, Germany. ladwig@helmholtz-muenchen.de.
(4)Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der 
Isar, Technische Universität München, Munich, Germany. 
ladwig@helmholtz-muenchen.de.
(5)Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partnersite Munich, 
Munich, Germany. ladwig@helmholtz-muenchen.de.

BACKGROUND: Anxiety has been identified as a cardiac risk factor. However, less 
is known about the impact of generalized anxiety disorder (GAD) on prehospital 
delay during an acute myocardial infarction (AMI). This study assessed the 
impact of GAD on prehospital delay and delay related cognition and behavior.
METHODS: Data were from the cross-sectional Munich examination of delay in 
patients experiencing acute myocardial infarction (MEDEA) study with a total of 
619 ST-elevated myocardial infarction (STEMI) patients. Data on 
socio-demographic, clinical and psycho-behavioral characteristics were collected 
at bedside. The outcome was assessed with the Generalized Anxiety Disorder scale 
(GAD-7). A GAD-7 score greater than or equal to 10 indicates general anxiety 
disorder.
RESULTS: A total of 11.47% (n = 71) MI patients suffered from GAD. GAD was 
associated with decreased odds of delay compared to patients without GAD (OR 
0.58, 95% CI 0.35-0.96), which was more significant in women (112 vs. 238 min, 
p = 0.02) than in men (150 vs. 198 min, p = 0.38). GAD was highly correlated 
with acute anxiety (p = 0.004) and fear of death (p = 0.005). Nevertheless, the 
effect remained significant after controlling for these two covariates. GAD 
patients were more likely to perceive a higher cardiovascular risk (OR 2.56, 95% 
CI 1.37-4.76) in 6 months before MI, which leads to the higher likelihood of 
making self-decision to go to the hospital (OR 2.68, 95% CI 1.48-4.85) in the 
acute phase. However, GAD was also highly associated with impaired psychological 
well-being, stress and fatigue (p < 0.0001).
CONCLUSIONS: In AMI patients, GAD was independently associated with less 
prehospital delay, but led to an impaired psychological state.

DOI: 10.1007/s00392-018-1208-4
PMID: 29383439 [Indexed for MEDLINE]


4520. BMJ Open. 2018 Jan 21;8(1):e019704. doi: 10.1136/bmjopen-2017-019704.

Investigating the application of motion accelerometers as a sleep monitoring 
technique and the clinical burden of the intensive care environment on sleep 
quality: study protocol for a prospective observational study in Australia.

Delaney LJ(1)(2), Currie MJ(1), Huang HC(2)(3), Litton E(4), Wibrow B(5), Lopez 
V(6), Haren FV(7)(8).

Author information:
(1)Faculty of Nursing, University of Canberra, Canberra, Australia.
(2)College of Health and Medicine; Australian National University, Canberra, 
Australia.
(3)Chronic Diseases Management and Respiratory and Sleep Medicine, Canberra 
Hospital, Canberra, Australia.
(4)Intensive Care Unit, St John of God Subiaco Hospital, Perth, Australia.
(5)Intensive Care Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia.
(6)Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, 
Singapore, Singapore.
(7)Intensive Care Unit, Canberra Hospital, Canberra, Australia.
(8)University of Canberra, Australian National University, Canberra, Australia.

INTRODUCTION: Sleep is a state of quiescence that facilitates the significant 
restorative processes that enhance individuals' physiological and psychological 
well-being. Patients admitted to the intensive care unit (ICU) experience 
substantial sleep disturbance. Despite the biological importance of sleep, sleep 
monitoring does not form part of standard clinical care for critically ill 
patients. There exists an unmet need to assess the feasibility and accuracy of a 
range of sleep assessment techniques that have the potential to allow widespread 
implementation of sleep monitoring in the ICU.
KEY MEASURES: The coprimary outcome measures of this study are to: determine the 
accuracy and feasibility of motion accelerometer monitoring (ie, actigraphy) and 
subjective assessments of sleep (nursing-based observations and patient 
self-reports) to the gold standard of sleep monitoring (ie, polysomnography) in 
evaluating sleep continuity and disturbance. The secondary outcome measures of 
the study will include: (1) the association between sleep disturbance and 
environmental factors (eg, noise, light and clinical interactions) and (2) to 
describe the sleep architecture of intensive care patients.
METHODS AND ANALYSIS: A prospective, single centre observational design with a 
within subjects' assessment of sleep monitoring techniques. The sample will 
comprise 80 adults (aged 18 years or more) inclusive of ventilated and 
non-ventilated patients, admitted to a tertiary ICU with a Richmond 
Agitation-Sedation Scale score between +2 (agitated) and -3 (moderate sedation) 
and an anticipated length of stay >24 hours. Patients' sleep quality, total 
sleep time and sleep fragmentations will be continuously monitored for 24 hours 
using polysomnography and actigraphy. Behavioural assessments (nursing 
observations) and patients' self-reports of sleep quality will be assessed 
during the 24-hour period using the Richards-Campbell Sleep Questionnaire, 
subjective sleepiness evaluated via the Karolinska Sleepiness Scale, along with 
a prehospital discharge survey regarding patients' perception of sleep quality 
and disturbing factors using the Little Sleep Questionnaire will be undertaken. 
Associations between sleep disturbance, noise and light levels, and the 
frequency of clinical interactions will also be investigated. Sound and 
luminance levels will be recorded at 1 s epochs via Extech SDL600 and SDL400 
monitoring devices. Clinical interactions will be logged via the electronic 
patient record system Metavision which documents patient monitoring and clinical 
care.
ETHICS AND DISSEMINATION: The relevant institutions have approved the study 
protocol and consent procedures. The findings of the study will contribute to 
the understanding of sleep disturbance, and the ability to implement sleep 
monitoring methods within ICUs. Understanding the contribution of a clinical 
environment on sleep disturbance may provide insight into the need to address 
clinical environmental issues that may positively influence patient outcomes, 
and could dispel notions that the environment is a primary factor in sleep 
disturbance. The research findings will be disseminated via presentations at 
national and international conferences, proceedings and published articles in 
peer-reviewed journals.
TRIAL REGISTRATION NUMBER: ACTRN12615000945527; Pre-results.

© Article author(s) (or their employer(s) unless otherwise stated in the text of 
the article) 2018. All rights reserved. No commercial use is permitted unless 
otherwise expressly granted.

DOI: 10.1136/bmjopen-2017-019704
PMCID: PMC5781106
PMID: 29358448 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


4521. Diabetes Metab Res Rev. 2018 May;34(4):e2975. doi: 10.1002/dmrr.2975. Epub 2018 
Feb 20.

Is metformin poised for a second career as an antimicrobial?

Malik F(1), Mehdi SF(1), Ali H(1), Patel P(1), Basharat A(1), Kumar A(1), Ashok 
F(1), Stein J(1)(2), Brima W(1), Malhotra P(3)(2), Roth J(1)(2).

Author information:
(1)Laboratory of Diabetes and Diabetes-Related Research, Feinstein Institute for 
Medical Research, Northwell Health, Manhasset, NY, USA.
(2)Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, 
NY, USA.
(3)Division of Infectious Diseases, Donald and Barbara Zucker School of Medicine 
at Hofstra/Northwell, Manhasset, NY, USA.

Metformin, a widely used antihyperglycaemic, has a good safety profile, 
reasonably manageable side-effects, is inexpensive, and causes a desirable 
amount of weight loss. In 4 studies of patients with tuberculosis (1 prospective 
and 3 retrospective), metformin administration resulted in better outcomes. In 
mice with several models of endotoxemia, metformin diminished levels of 
proinflammatory cytokines and improved survival. Laboratory studies showed 
effectiveness of the drug on multiple pathogens, including Trichinella spiralis, 
Staphylococcus aureus, Pseudomonas aeruginosa, hepatitis B virus, hepatitis C 
virus, and human immunodeficiency virus. Metformin administration in humans and 
mice produced major changes in the composition of the gut microbiota. These 
recently discovered microbe-modulating properties of the drug have led 
investigators to predict wide therapeutic utility for metformin. The recent 
easing in United States Food and Drug Administration (FDA) guidelines regarding 
administration of metformin to patients with kidney disease, and reduced anxiety 
about patient safety in terms of lactic acidosis, increase the probability of 
broadening of metformin's usage as a treatment of infectious agents. In this 
text we review articles pertinent to metformin's effects on microorganisms, both 
pathogens and commensals. We highlight the possible role of metformin in a wide 
range of infectious diseases and a possible expansion of its therapeutic profile 
in this field. A systematic review was done of PubMed indexed articles that 
examined the effects of metformin on a wide range of pathogens. Metformin was 
found to have efficacy as an antimicrobial agent in patients with tuberculosis. 
Mice infected with Trypanosomiasis cruzi had higher survival when also treated 
with metformin. The drug in vitro was active against T. spiralis, S. aureus, 
P. aeruginosa, and hepatitis B virus. In addition there is emerging literature 
on its role in sepsis. We conclude that metformin may have a potential role in 
the therapy for multiple infectious diseases. Metformin, in addition to its 
traditional effects on glucose metabolism, provides anti-microbial benefits in 
patients with tuberculosis and in a very wide range of other infections 
encounters in vitro and in vivo.

Copyright © 2017 John Wiley & Sons, Ltd.

DOI: 10.1002/dmrr.2975
PMID: 29271563 [Indexed for MEDLINE]


4522. J Gen Intern Med. 2018 Mar;33(3):298-304. doi: 10.1007/s11606-017-4222-8. Epub 
2017 Nov 28.

Communication Quality Predicts Psychological Well-Being and Satisfaction in 
Family Surrogates of Hospitalized Older Adults: An Observational Study.

Torke AM(1)(2)(3)(4), Callahan CM(5)(6), Sachs GA(5)(6), Wocial LD(7)(8), Helft 
PR(9), Monahan PO(10), Slaven JE(10), Montz K(5), Burke ES(5), Inger L(5).

Author information:
(1)Indiana University (IU) Center for Aging Research, Regenstrief Institute, 
Inc., Indianapolis, IN, USA. atorke@iu.edu.
(2)IU Division of General Internal Medicine and Geriatrics, Indianapolis, IN, 
USA. atorke@iu.edu.
(3)Fairbanks Center for Medical Ethics, IU Health, Indianapolis, IN, USA. 
atorke@iu.edu.
(4)Daniel F. Evans Center for Spiritual and Religious Values in Healthcare, IU 
Health, Indianapolis, IN, USA. atorke@iu.edu.
(5)Indiana University (IU) Center for Aging Research, Regenstrief Institute, 
Inc., Indianapolis, IN, USA.
(6)IU Division of General Internal Medicine and Geriatrics, Indianapolis, IN, 
USA.
(7)Fairbanks Center for Medical Ethics, IU Health, Indianapolis, IN, USA.
(8)IU School of Nursing, Indianapolis, IN, USA.
(9)Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA.
(10)IU Department of Biostatistics, Indianapolis, IN, USA.

Comment in
    J Gen Intern Med. 2018 Mar;33(3):332.

BACKGROUND: Many hospitalized older adults require family surrogates to make 
decisions, but surrogates may perceive that the quality of medical decisions is 
low and may have poor psychological outcomes after the patient's 
hospitalization.
OBJECTIVE: To determine the relationship between communication quality and 
high-quality medical decisions, psychological well-being, and satisfaction for 
surrogates of hospitalized older adults.
DESIGN: Observational study at three hospitals in a Midwest metropolitan area.
PARTICIPANTS: Hospitalized older adults (65+ years) admitted to medicine and 
medical intensive care units who were unable to make medical decisions, and 
their family surrogates. Among 799 eligible dyads, 364 (45.6%) completed the 
study.
MAIN MEASURES: Communication was assessed during hospitalization using the 
information and emotional support subscales of the Family Inpatient 
Communication Survey. Decision quality was assessed with the Decisional Conflict 
Scale. Outcomes assessed at baseline and 4-6 weeks post-discharge included 
anxiety (Generalized Anxiety Disorder-7), depression (Patient Health 
Questionnaire-9), post-traumatic stress (Impact of Event Scale-Revised), and 
satisfaction (Hospital Consumer Assessment of Healthcare Providers and Systems).
KEY RESULTS: The mean patient age was 81.9 years (SD 8.32); 62% were women, and 
28% African American. Among surrogates, 67% were adult children. Six to eight 
weeks post-discharge, 22.6% of surrogates reported anxiety (11.3% 
moderate-severe anxiety); 29% reported depression, (14.0% moderate-severe), and 
14.6% had high levels of post-traumatic stress. Emotional support was associated 
with lower odds of anxiety (adjusted odds ratio [AOR] = 0.65, 95% CI 0.50, 0.85) 
and depression (AOR = 0.80, 95% CI 0.65, 0.99) at follow-up. In multivariable 
linear regression, emotional support was associated with lower post-traumatic 
stress (β = -0.30, p = 0.003) and higher decision quality (β = -0.44, 
p < 0.0001). Information was associated with higher post-traumatic stress 
(β = 0.23, p = 0.022) but also higher satisfaction (β = 0.61, p < 0.001).
CONCLUSIONS: Emotional support of hospital surrogates is consistently associated 
with better psychological outcomes and decision quality, suggesting an 
opportunity to improve decision making and well-being.

DOI: 10.1007/s11606-017-4222-8
PMCID: PMC5834961
PMID: 29185176 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict 
of interest.


4523. Indian J Crit Care Med. 2017 Oct;21(10):640-645. doi: 
10.4103/ijccm.IJCCM_468_14.

Enhancing Hospital Well-being and Minimizing Intensive Care Unit Trauma: 
Cushioning Effects of Psychosocial Care.

Chivukula U(1), Hariharan M(1), Rana S(1), Thomas M(1), Andrew A(1).

Author information:
(1)Centre for Health Psychology, University of Hyderabad, Hyderabad, Telangana, 
India.

CONTEXT: Hospitalization has the potential to induce hospital anxiety, while 
admission in the Intensive Care Unit (ICU) is found to surpass the anxiety and 
result in what is termed as "ICU Trauma."
AIMS: This study aimed to determine the impact of psychosocial care and quality 
of ICU on ICU trauma and hospital well-being in patients who underwent coronary 
artery bypass grafting (CABG).
SETTINGS AND DESIGN: This correlational study involved 250 CABG patients, who 
were recruited from five major corporate hospitals.
PARTICIPANTS AND METHODS: The ICU Psychosocial Care Scale, Hospital Wellbeing 
Scale, and ICU Trauma Scale were used. Each of the participants was assessed 
individually. The ICU Practices Checklist was used to assess the environment of 
the ICU in the hospital.
STATISTICAL ANALYSIS USED: Descriptive statistics, correlation, and simple and 
multiple linear regression analyses were done.
RESULTS: The results revealed the significant contribution of psychosocial care 
in ICU in enhancing hospital well-being as well as minimizing ICU trauma of 
patients who underwent CABG. The results of multiple regressions clearly 
indicated that psychosocial care was a powerful predictor of hospital well-being 
and ICU trauma.
CONCLUSIONS: Although psychosocial care was not a component of hospital 
well-being and had a negative correlation with ICU trauma, it contributed 
significantly with a cushioning effect to minimize trauma and helped enhance the 
feelings and experiences of well-being among patients in ICU.

DOI: 10.4103/ijccm.IJCCM_468_14
PMCID: PMC5672668
PMID: 29142374

Conflict of interest statement: There are no conflicts of interest.


4524. Trials. 2017 Nov 15;18(1):542. doi: 10.1186/s13063-017-2283-y.

The ICU-Diary study: prospective, multicenter comparative study of the impact of 
an ICU diary on the wellbeing of patients and families in French ICUs.

Garrouste-Orgeas M(1)(2)(3), Flahault C(4), Fasse L(5), Ruckly S(6)(7), 
Amdjar-Badidi N(8), Argaud L(9), Badie J(10), Bazire A(11), Bige N(12), Boulet 
E(13), Bouadma L(6)(14), Bretonnière C(15)(16), Floccard B(17), Gaffinel A(18), 
de Forceville X(19), Grand H(20), Halidfar R(21), Hamzaoui O(22), Jourdain 
M(23)(24), Jost PH(25), Kipnis E(26), Large A(27), Lautrette A(28)(29), Lesieur 
O(30)(31), Maxime V(32), Mercier E(33), Mira JP(34), Monseau Y(35), 
Parmentier-Decrucq E(24), Rigaud JP(36), Rouget A(37), Santoli F(38), Simon 
G(39), Tamion F(40)(41), Thieulot-Rolin N(42), Thirion M(43), Valade S(44), 
Vinatier I(45), Vioulac C(4), Bailly S(6), Timsit JF(6)(7)(14).

Author information:
(1)Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM and 
Paris Diderot University, Department of Biostatistics - HUPNVS - AP-HP, UFR de 
Médecine - Bichat University Hospital, Paris, France. maite.garrouste@ihfb.org.
(2)Department of Biostatistics, Outcomerea, Paris, France. 
maite.garrouste@ihfb.org.
(3)Medical unit, French British Hospital Institute, Levallois-Perret, France. 
maite.garrouste@ihfb.org.
(4)Psychology laboratory and work process, Paris Descartes University, Paris, 
France.
(5)Laboratoire Psy-DREPI EA-7458, Bourgogne Franche Comté University, Dijon, 
France.
(6)Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM and 
Paris Diderot University, Department of Biostatistics - HUPNVS - AP-HP, UFR de 
Médecine - Bichat University Hospital, Paris, France.
(7)Department of Biostatistics, Outcomerea, Paris, France.
(8)Medical-Surgical ICU, General Hospital René Dubos, Pontoise, France.
(9)Medical ICU, Edouard Herriot University Hospital, Lyon, France.
(10)Medical-Surgical ICU, General Hospital Belfort-Montbeliard, Belfort, France.
(11)Medical ICU, La Cavale Blanche University Hospital, Brest, France.
(12)Medical ICU, Saint Antoine University Hospital, Paris, France.
(13)Medical ICU, Beaumont General Hospital, Beaumont, France.
(14)Medical ICU, Bichat University Hospital, Paris, France.
(15)Medical ICU, Nantes University Hospital, Nantes, France.
(16)EA3826, Laboratory of clinical and experimental therapeutics of infections, 
University of Nantes, Nantes, France.
(17)Medical ICU, Hospices Civils de Lyon, Edouard Herriot University Hospital, 
Lyon, France.
(18)Medical-Surgical ICU, Gustave Roussy Cancer Campus, Villejuif, France.
(19)Medical-Surgical ICU, Est Francilien Hospital network, Meaux, France.
(20)Medical-Surgical ICU, Hospital Robert Boulin, Libourne, France.
(21)Medical ICU, Albert Michallon University Hospital, Grenoble, France.
(22)Medical ICU, University Hospital Paris-Sud, Beclère University Hospital, 
Clamart, France.
(23)Lille University, Inserm U1190, Lille, France.
(24)Group of medical ICUs, Lille University Hospital, Lille, France.
(25)Surgical ICU, Henri Mondor University Hospital, Créteil, France.
(26)Surgical ICU, Lille University Hospital, Lille, France.
(27)Medical ICU, François Mitterrand University Hospital, Dijon, France.
(28)Medical ICU, Gabriel-Montpied University Hospital, Clermont Ferrand, France.
(29)LMGE UMR CNRS 6023, University of Clermont-Ferrand, Clermont Ferrand, 
France.
(30)Medical-Surgical ICU, General Hospital, La Rochelle, France.
(31)EA 4569, University Paris Descartes, Paris, France.
(32)Medical ICU, Raymond Poincaré University Hospital, Garches, France.
(33)CRICS group, Medical-Surgical ICU, Tours University Hospital, Tours, France.
(34)Medical ICU, Cochin University Hospital, Paris, France.
(35)Medical-Surgical ICU, General Hospital, Périgueux, France.
(36)Department of Intensive Care, Dieppe General Hôpital, Dieppe, France.
(37)Medical-Surgical ICU, Rangueil University Hospital, Toulouse, France.
(38)Medical ICU, General Hospital Robert Ballanger, Aulnay-Sous-Bois, France.
(39)Medical-Surgical ICU, General Hospital, Troyes, France.
(40)Medical ICU, University medical center, Rouen, France.
(41)INSERM U-1096, University of Rouen, Rouen, France.
(42)Medical-Surgical ICU, General Hôpital, Melun, France.
(43)Medical-Surgical ICU, General Hospital Victor Dupouy, Argenteuil, France.
(44)Medical ICU, Saint Louis University Hospital, Paris, France.
(45)Medical ICU, Les Oudaries Hospital, La Roche-sur-Yon, France.

BACKGROUND: Post-intensive care syndrome includes the multiple consequences of 
an intensive care unit (ICU) stay for patients and families. It has become a new 
challenge for intensivists. Prevention programs have been disappointing, except 
for ICU diaries, which report the patient's story in the ICU. However, the 
effectiveness of ICU diaries for patients and families is still controversial, 
as the interpretation of the results of previous studies was open to criticism 
hampering an expanded use of the diary. The primary objective of the study is to 
evaluate the post-traumatic stress syndrome in patients. The secondary 
objectives are to evaluate the post-traumatic stress syndrome in families, 
anxiety and depression symptoms in patients and families, and the recollected 
memories of patients. Endpoints will be evaluated 3 months after ICU discharge 
or death.
METHODS: A prospective, multicenter, randomized, assessor-blind comparative 
study of the effect of an ICU diary on patients and families. We will compare 
two groups: one group with an ICU diary written by staff and family and given to 
the patient at ICU discharge or to the family in case of death, and a control 
group without any ICU diary. Each of the 35 participating centers will include 
20 patients having at least one family member who will likely visit the patient 
during their ICU stay. Patients must be ventilated within 48 h after ICU 
admission and not have any previous chronic neurologic or acute condition 
responsible for cognitive impairments that would hamper their participation in a 
phone interview. Three months after ICU discharge or death of the patient, a 
psychologist will contact the patient and family by phone. Post-traumatic stress 
syndrome will be evaluated using the Impact of Events Scale-Revised 
questionnaire, anxiety and depression symptoms using the Hospital Anxiety and 
Depression Scale questionnaire, both in patients and families, and memory 
recollection using the ICU Memory Tool Questionnaire in patients. The content of 
a randomized sample of diaries of each center will be analyzed using a grid. An 
interview of the patients in the intervention arm will be conducted 6 months 
after ICU discharge to analyze in depth how they use the diary.
DISCUSSION: This study will provide new insights on the impact of ICU diaries on 
post-traumatic stress disorders in patients and families after an ICU stay.
TRIAL REGISTRATION: ClinicalTrial.gov, ID: NCT02519725 . Registered on 13 July 
2015.

DOI: 10.1186/s13063-017-2283-y
PMCID: PMC5688734
PMID: 29141694 [Indexed for MEDLINE]

Conflict of interest statement: AUTHORS’ INFORMATION: Not applicable. ETHICS 
APPROVAL AND CONSENT TO PARTICIPATE: The study (#2015-A00700-49) was approved by 
the Ethics Committee of the Necker University hospital, Paris, France 
(2015-05-01-SC)), the CNIL (Commission Nationale de l’Informatique et des 
Libertés; # HZB1693034n) and by the CCTIRS (Comité Consultatif sur les 
Traitements de l’Information en matière de Recherche dans le domaine de la 
Santé; # 15.1004). An amendment (2015-05-01 SC MC1) was obtained in February 
2016 to increase the number of centers and of eligible patients. Written 
informed consent will be required from each participating family by the primary 
investigator. In accordance with French law, at ICU discharge, the main primary 
investigator will require the consent from the patient to use his information 
and to copy the diary. For the decedents, the consent for the analysis of the 
diary content will be required from the family. To protect confidentiality, 
identification information will be delete from all study documents. CONSENT FOR 
PUBLICATION: No applicable. COMPETING INTERESTS: The authors declare that they 
have no competing interests. PUBLISHER’S NOTE: Springer Nature remains neutral 
with regard to jurisdictional claims in published maps and institutional 
affiliations.


4525. Am J Crit Care. 2017 Nov;26(6):456-465. doi: 10.4037/ajcc2017834.

Patients' Outcomes After Acute Respiratory Failure: A Qualitative Study With the 
PROMIS Framework.

Eakin MN(1), Patel Y(2), Mendez-Tellez P(2), Dinglas VD(2), Needham DM(2), 
Turnbull AE(2).

Author information:
(1)All are members of the Outcomes After Critical Illness and Surgery Group, 
Johns Hopkins University, Baltimore, Maryland. Michelle N. Eakin is an associate 
professor, Yashika Patel is a research assistant, and Victor D. Dinglas is a 
research associate, Division of Pulmonary and Critical Care Medicine, School of 
Medicine, Johns Hopkins University. Pedro Mendez-Tellez is an assistant 
professor, Department of Anesthesiology and Critical Care Medicine, School of 
Medicine, Johns Hopkins University. Dale M. Needham is a professor, Division of 
Pulmonary and Critical Care Medicine and Department of Physical Medicine and 
Rehabilitation, School of Medicine, Johns Hopkins University. Alison E. Turnbull 
is an assistant professor, Division of Pulmonary and Critical Care Medicine, 
School of Medicine and Department of Epidemiology, Bloomberg School of Public 
Health, Johns Hopkins University. Meakin1@jhmi.edu.
(2)All are members of the Outcomes After Critical Illness and Surgery Group, 
Johns Hopkins University, Baltimore, Maryland. Michelle N. Eakin is an associate 
professor, Yashika Patel is a research assistant, and Victor D. Dinglas is a 
research associate, Division of Pulmonary and Critical Care Medicine, School of 
Medicine, Johns Hopkins University. Pedro Mendez-Tellez is an assistant 
professor, Department of Anesthesiology and Critical Care Medicine, School of 
Medicine, Johns Hopkins University. Dale M. Needham is a professor, Division of 
Pulmonary and Critical Care Medicine and Department of Physical Medicine and 
Rehabilitation, School of Medicine, Johns Hopkins University. Alison E. Turnbull 
is an assistant professor, Division of Pulmonary and Critical Care Medicine, 
School of Medicine and Department of Epidemiology, Bloomberg School of Public 
Health, Johns Hopkins University.

BACKGROUND: As mortality rates for patients treated in intensive care units 
decrease, greater understanding of the impact of critical illness on patients' 
well-being is needed.
OBJECTIVE: To describe the survivorship experience of patients who had acute 
respiratory failure by using the Patient Reported Outcomes Measurement 
Information System (PROMIS) framework.
METHODS: A total of 48 adult patients who had acute respiratory failure 
completed at least 1 semistructured telephone-based interview between 5 and 18 
months after their stay in the intensive care unit. Participants were asked 
about overall well-being and important health outcomes.
RESULTS: Major themes were identified within each of the 3 PROMIS components: 
physical health, mental health, and social health. The following themes were 
particularly prominent: mobility impairments, pulmonary symptoms, fatigue, 
anxiety and depression symptoms, and decreased ability to work and participate 
in valued activities. Impacts on overall well-being and on relationships with 
friends and family members varied among the survivors. Some survivors reported 
gratitude, increased appreciation of life, and closer relationships to loved 
ones. Other survivors reported boredom, social isolation, and wishing they had 
not survived.
CONCLUSIONS: Survivors of acute respiratory failure reported substantial issues 
with their physical, mental, and social health. Holistic assessments of outcomes 
of survivors of critical illness should capture the complex beneficial and 
adverse impacts of critical illness on survivors' well-being and social health.

©2017 American Association of Critical-Care Nurses.

DOI: 10.4037/ajcc2017834
PMCID: PMC6385886
PMID: 29092868 [Indexed for MEDLINE]


4526. QJM. 2018 Feb 1;111(2):111-115. doi: 10.1093/qjmed/hcx209.

Pre-admission quality of life as predictor of outcome after acute care: the role 
of emotional well-being.

Belayachi J(1)(2)(3), El Khattate A(1), Bizrane M(1), Madani N(1)(2)(3), Abouqal 
R(1)(2)(3).

Author information:
(1)Acute Medical Unit, Ibn Sina University Hospital, 10000, Rabat, Morocco.
(2)Laboratory of Biostatistics, Clincial, and Epidemiological Research, Faculté 
de Médecineet de Pharmacie - Université Mohamed V Souissi, 10000, Rabat, 
Morocco.
(3)Faculté de Médecine et de Pharmacie - University Mohammed V, 10000, Rabat, 
Morocco.

PURPOSE: We sought to investigate whether pre-admission quality of life could 
act as a predictor of mortality among acutely ill patients, and which dimension 
of QOL has the greater impact on outcomes.
METHODS: Prospective cohort study including patients admitted to an acute 
medical unit of Rabat Ibn Sina University Hospital, Morocco, between June and 
September 2014. Characteristics of patients were recorded at admission. The 
primary exposure was pre-admission quality of life recorded using Euroqol five 
dimensions three level (EQ-5 D-3 L) and the primary outcome was 90-day 
mortality. We fit a Cox proportional hazards model to assess their association. 
We constructed six prediction models; each model included either EQ5D index or 
one of the five dimensions. We allowed all continuous variables to have a 
non-linear relationship with the primary outcome using restricted cubic spline 
with three knots.
RESULTS: We included 251 patients. The mean EQ5D index was 0.46 ± 0.5. The 
design of each prediction model was based on the significant findings of the 
univariate analysis including; bedside EQ5D index or one of the five dimensions 
of the EQ5D; age, history of chronic disease, Charlson Comorbidity Index and 
hemoglobinemia. Multi-variate Cox proportional adjusted hazard ratio (HR) 
derived from the six models, identified that EQ5D index was independently 
associated with 90-day mortality (HR: 0.48; 95% CI: 0.25; 0.91, P = 0.02), and 
that anxiety and depression dimension has the greater impact on outcome (HR: 
2.97; 95% CI: 1.38; 6.41, P = 0.005).
CONCLUSIONS: This study revealed that pre-admission health-related quality of 
life (HRQoL), and particularly pre-admission psychological HRQoL was associated 
with outcome of acutely ill patients 90 days after discharge.

© The Author 2017. Published by Oxford University Press on behalf of the 
Association of Physicians. All rights reserved. For Permissions, please email: 
journals.permissions@oup.com

DOI: 10.1093/qjmed/hcx209
PMID: 29088410 [Indexed for MEDLINE]


4527. Med Hypotheses. 2017 Oct;108:133-143. doi: 10.1016/j.mehy.2017.07.032. Epub 2017 
Jul 29.

The colon revisited or the key to wellness, health and disease.

Gonzalez-Correa CA(1), Mulett-Vásquez E(2), Miranda DA(3), Gonzalez-Correa 
CH(2), Gómez-Buitrago PA(2).

Author information:
(1)Universidad de Caldas, Calle 65 No 26 - 10, Research Group on Bioelectrical 
Impedance (GruBIE), Manizales, Caldas, Colombia. Electronic address: 
c.gonzalez@ucaldas.edu.co.
(2)Universidad de Caldas, Calle 65 No 26 - 10, Research Group on Bioelectrical 
Impedance (GruBIE), Manizales, Caldas, Colombia.
(3)Universidad Industrial de Santander, Carrera 27 calle 9, Research Group on 
Biological and Semiconductor Material Science (CIMBIOS), Bucaramanga, Colombia.

The hypothesis being advanced in this paper is that there is a new medical 
paradigm emerging from the biomedical research carried out in this century, 
mainly due to the explosion of the so called "omics" and associated techniques. 
The main idea is that there is a common pathway from wellbeing and health to 
chronic disease ("chronopathy") and even to death, which comprises following 
steps: 1) unhealthy diet, sedentary life style and permanent exposition to 
xenobiotics and all kinds of noxious stimuli;→2) intestinal dysbiosis;→3) 
alteration of the intestinal mucus layer (especially that of the colon);→4) 
disruption of the endothelial tight junctions;→5) metabolic 
endotoxemia+bacterial translocation;→6) inflammation;→7) exacerbation of the 
enteric nervous system (ENS) and consequent maladaptation and malfunctioning of 
the colon;→8) epigenetic manifestations;→9) "chronopathy" and premature death. 
Therefore, in order to maintain a good health or to improve or even reverse 
chronic diseases in a person, the main outcome to look for is a homeostatic 
balance of the intestinal microbiota (eubiosis), most of which is located in the 
colon. Lynn Margulis was one of the main scientists to highlight the importance 
of the role played by bacteria not only in the origin of all biological species 
now present on earth, but also on their role in global homeostasis. Bacteria do 
not rely on other living beings for their existence, while the latter depend 
completely on the former. Humans are no exemption, and new evidence emerges each 
day about the pivotal role of intestinal microbiota in human health, disease 
and, in general, in its wellbeing. The following facts about intestinal 
microbiota are nowadays generally accepted: there are about 10 times more 
bacteria in the gut than human cells in every human being; the microbioma is 
about 100-150 times bigger that the human genome, and there is a clear link 
between intestinal microbiota and many of the most common chronic diseases, from 
obesity and diabetes to depression and Parkinson disease and different kinds of 
cancer. The main implication of this theory is that we should become a sort of 
microbiota farmers, that is, we ought to be more conscious of our intestinal 
microbiota, take care of it and monitor it permanently. Thus, as part of our 
good life habits (healthy eating, physical exercise), we should probably undergo 
periodic seasons of fasting and colon cleansing, as it was common in older 
times.

Copyright © 2017 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.mehy.2017.07.032
PMID: 29055387 [Indexed for MEDLINE]


4528. J Adv Nurs. 2018 Mar;74(3):651-665. doi: 10.1111/jan.13472. Epub 2017 Nov 17.

Factors associated with change in health-related quality of life among 
individuals treated with long-term mechanical ventilation, a 6-year follow-up 
study.

Markussen H(1)(2), Lehmann S(1)(3), Nilsen RM(4), Natvig GK(2).

Author information:
(1)Department of Thoracic Medicine, Haukeland University Hospital, Bergen, 
Norway.
(2)Department of Global Public Health and Primary Care, University of Bergen, 
Bergen, Norway.
(3)Department of Clinical Science, University of Bergen, Bergen, Norway.
(4)Department of Health and Social Sciences, Western Norway University of 
Applied Sciences, Bergen, Norway.

AIMS: To examine changes and explanatory variables for changes in health-related 
quality of life in patients treated with long-term mechanical ventilation over a 
6-year period.
BACKGROUND: Long-term mechanical ventilation is a treatment for individuals with 
chronic hypercapnic respiratory failure, primarily caused by neuromuscular 
diseases, obesity hypoventilation syndrome, chronic obstructive pulmonary and 
restrictive thoracic diseases. Studies on long-term outcome on health-related 
quality of life and factors influencing it are lacking.
DESIGN: Prospective cohort study.
METHODS: Data were collected from the Norwegian Long-Term-Mechanical-Ventilation 
Registry and from patient-reported questionnaire in 2008 and 2014. 
Health-related quality of life was measured by the Severe Respiratory 
Insufficiency questionnaire, containing 49 items and seven subdomains. Linear 
mixed effects models were used to measure changes and identify factors for 
changes.
RESULTS: After 6 years, 60 patients were still participating, out of 127 at 
baseline. Health-related quality of life improved significantly in the total 
score and in four subdomains of the questionnaire. Satisfaction with training in 
long-term mechanical ventilation was an explanatory variable for improved 
'psychological well-being' and follow-up for improvement of 'anxiety'. Side 
effects of the treatment like facial soreness were associated with the total 
score. High age and high forced vital capacity were related to lower 'physical 
function' and improved 'social functioning', respectively.
CONCLUSION: Long-term mechanical ventilation over 6 years improved 
health-related quality of life in most patients. Patient training, follow-up and 
reduction of side effects, largely delivered by trained nurses, contribute to 
achieve the main goal of the treatment-improved health-related quality of life.

© 2017 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons 
Ltd.

DOI: 10.1111/jan.13472
PMID: 28983937 [Indexed for MEDLINE]


4529. BMJ Open. 2017 Sep 27;7(9):e014075. doi: 10.1136/bmjopen-2016-014075.

Mental well-being of patients from ethnic minority groups during critical care: 
a qualitative ethnographic study.

Van Keer RL(1), Deschepper R(1), Huyghens L(2), Bilsen J(1).

Author information:
(1)Mental Health and Wellbeing Research Group (MENT), Department of Public 
Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, 
Belgium.
(2)Critical care Department/Service of Intensive Care Medicine, Vrije 
Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium.

OBJECTIVES: To investigate the state of the mental well-being of patients from 
ethnic minority groups and possible related risk factors for the development of 
mental health problems among these patients during critical medical situations 
in hospital.
DESIGN: Qualitative ethnographic design.
SETTING: Oneintensive care unit (ICU) of a multiethnic urban hospital in 
Belgium.
PARTICIPANTS: 84 ICU staff members, 10 patients from ethnic-minority groups and 
their visiting family members.
RESULTS: Patients had several human basic needs for which they could not 
sufficiently turn to anybody, neither to their healthcare professionals, nor to 
their relatives nor to other patients. These needs included the need for social 
contact, the need to increase comfort and alleviate pain, the need to express 
desperation and participate in end-of-life decision making. Three interrelated 
risk factors for the development of mental health problems among the patients 
included were identified: First, healthcare professionals' mainly biomedical 
care approach (eg, focus on curing the patient, limited psychosocial support), 
second, the ICU context (eg, time pressure, uncertainty, regulatory frameworks) 
and third, patients' different ethnocultural background (eg, religious and 
phenotypical differences).
CONCLUSIONS: The mental state of patients from ethnic minority groups during 
critical care is characterised by extreme emotional loneliness. It is important 
that staff should identify and meet patients' unique basic needs in good time 
with regard to their mental well-being, taking into account important threats 
related to their own mainly biomedical approach to care, the ICU's structural 
context as well as the patients' different ethnocultural background.

© Article author(s) (or their employer(s) unless otherwise stated in the text of 
the article) 2017. All rights reserved. No commercial use is permitted unless 
otherwise expressly granted.

DOI: 10.1136/bmjopen-2016-014075
PMCID: PMC5623442
PMID: 28963277 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


4530. Dev Neuropsychol. 2017;42(6):387-403. doi: 10.1080/87565641.2017.1374961. Epub 
2017 Sep 26.

Delirium in the Critically Ill Child: Assessment and Sequelae.

Paterson RS(1)(2), Kenardy JA(1)(3), De Young AC(4), Dow BL(3), Long DA(2)(5).

Author information:
(1)a School of Psychology , The University of Queensland , Brisbane , Australia.
(2)c Paediatric Critical Care Research Group, Mater Research Institute, 
University of Queensland , Brisbane , QLD , Australia.
(3)b RECOVER Injury Research Centre , The University of Queensland , Brisbane , 
Australia.
(4)d Centre for Children's Burn and Trauma Research, The University of 
Queensland , Brisbane , Australia.
(5)e Paediatric Intensive Care Unit, Lady Cilento Children's Hospital , Brisbane 
, Australia.

Delirium is a common and serious neuropsychiatric complication in critically ill 
patients of all ages. In the context of critical illness, delirium may emerge as 
a result of a cascade of underlying pathophysiologic mechanisms and signals 
organ failure of the brain. Awareness of the clinical importance of delirium in 
adults is growing as emerging research demonstrates that delirium represents a 
serious medical problem with significant sequelae. However, our understanding of 
delirium in children lags significantly behind the adult literature. In 
particular, our knowledge of how to assess delirium is complicated by challenges 
in recognizing symptoms of delirium in pediatric patients especially in critical 
and intensive care settings, and our understanding of its impact on acute and 
long-term functioning remains in its infancy. This paper focuses on (a) the 
challenges associated with assessing delirium in critically ill children, (b) 
the current literature on the outcomes of delirium including morbidity following 
discharge from PICU, and care-giver well-being, and (c) the importance of 
assessment in determining impact of delirium on outcome. Current evidence 
suggests that delirium is a diagnostic challenge for clinicians and may play a 
detrimental role in a child's recovery after discharge from the pediatric 
intensive care unit (PICU). Recommendations are proposed for how our knowledge 
and assessment of delirium in children could be improved.

DOI: 10.1080/87565641.2017.1374961
PMID: 28949771 [Indexed for MEDLINE]


4531. Sci Rep. 2017 Sep 22;7(1):12203. doi: 10.1038/s41598-017-12156-2.

Dietary teasaponin ameliorates alteration of gut microbiota and cognitive 
decline in diet-induced obese mice.

Wang S(1)(2), Huang XF(3)(4), Zhang P(1)(5), Newell KA(1), Wang H(1), Zheng 
K(5), Yu Y(6)(7).

Author information:
(1)Illawarra Health and Medical Research Institute, School of Medicine, 
University of Wollongong, Northfield Avenue, Wollongong, NSW 2522, Australia.
(2)Department of Endocrinology and Metabolism, The people's hospital of Suzhou 
National New & Hi-Tech Industrial development Zone, Suzhou, Jiangsu, 215011, 
China.
(3)Illawarra Health and Medical Research Institute, School of Medicine, 
University of Wollongong, Northfield Avenue, Wollongong, NSW 2522, Australia. 
xhuang@uow.edu.au.
(4)Department of Pathogen Biology and Immunology, Jiangshu Key Laboratory of 
Immunity and Metabolism, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, 
China. xhuang@uow.edu.au.
(5)Department of Pathogen Biology and Immunology, Jiangshu Key Laboratory of 
Immunity and Metabolism, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, 
China.
(6)Illawarra Health and Medical Research Institute, School of Medicine, 
University of Wollongong, Northfield Avenue, Wollongong, NSW 2522, Australia. 
yinghua@uow.edu.au.
(7)Department of Pathogen Biology and Immunology, Jiangshu Key Laboratory of 
Immunity and Metabolism, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, 
China. yinghua@uow.edu.au.

A high-fat (HF) diet alters gut microbiota and promotes obesity related 
inflammation and cognitive impairment. Teasaponin is the major active component 
of tea, and has been associated with anti-inflammatory effects and improved 
microbiota composition. However, the potential protective effects of teasaponin, 
against HF diet-induced obesity and its associated alteration of gut microbiota, 
inflammation and cognitive decline have not been studied. In this study, obesity 
was induced in C57BL/6 J male mice by feeding a HF diet for 8 weeks, followed by 
treatment with oral teasaponin (0.5%) mixed in HF diet for a further 6 weeks. 
Teasaponin treatment prevented the HF diet-induced recognition memory impairment 
and improved neuroinflammation, gliosis and brain-derived neurotrophic factor 
(BDNF) deficits in the hippocampus. Furthermore, teasaponin attenuated the HF 
diet-induced endotoxemia, pro-inflammatory macrophage accumulation in the colon 
and gut microbiota alterations. Teasaponin also improved glucose tolerance and 
reduced body weight gain in HF diet-induced obese mice. The behavioral and 
neurochemical improvements suggest that teasaponin could limit unfavorable gut 
microbiota alterations and cognitive decline in HF diet-induced obesity.

DOI: 10.1038/s41598-017-12156-2
PMCID: PMC5610180
PMID: 28939875 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing 
interests.


4532. Biomed Res Int. 2017;2017:5192640. doi: 10.1155/2017/5192640. Epub 2017 Aug 21.

Self-Rated Health as a Predictor of Death after Two Years: The Importance of 
Physical and Mental Wellbeing Postintensive Care.

Vejen M(1), Bjorner JB(2)(3), Bestle MH(4), Lindhardt A(1), Jensen JU(5)(6).

Author information:
(1)Department of Anesthesiology and Intensive Care, Bispebjerg Hospital, 
Copenhagen, Denmark.
(2)Department of Public Health, Section of Social Medicine, Copenhagen 
University, Copenhagen, Denmark.
(3)Optum Outcomes, Lincoln, RI, USA.
(4)Department of Anesthesiology and Intensive Care, Nordsjællands Hospital, 
Hillerød, Denmark.
(5)Department of Respiratory Medicine, Herlev Gentofte Hospital, Hellerup, 
Denmark.
(6)CHIP & PERSIMUNE, Department of Infectious Diseases, Finsencenteret, 
Rigshospitalet, Copenhagen, Denmark.

INTRODUCTION: The objective of this study is, among half-year intensive care 
survivors, to determine whether self-assessment of health can predict two-year 
mortality.
METHODS: The study is a prospective cohort study based on the Procalcitonin and 
Survival Study trial. Half-year survivors from this 1200-patient multicenter 
intensive care trial were sent the SF-36 questionnaire. We used both a simple 
one-item question and multiple questions summarized as a Physical Component 
Summary (PCS) and a Mental Component Summary (MCS) score. The responders were 
followed for vital status 730 days after inclusion. Answers were dichotomized 
into a low-risk and a high-risk group and hazard ratios (HR) with 95% confidence 
interval (CI) were calculated by Cox proportional hazard analyses.
CONCLUSION: We found that self-rated health measured by a single question was a 
strong independent predictor of two-year all-cause mortality (HR: 1.8; 95% CI: 
1.1-3.0). The multi-item component scores of the SF-36 also predicted two-year 
mortality (PCS: HR: 2.9; 95% CI 1.7-5.0) (MCS: HR: 1.9; 95% CI 1.1-3.4). These 
results suggest that self-rated health questions could help in identifying 
patients at excess risk. Randomized controlled trials are needed to test whether 
our findings represent causality.

DOI: 10.1155/2017/5192640
PMCID: PMC5585588
PMID: 28904962 [Indexed for MEDLINE]


4533. Holist Nurs Pract. 2017 Sep/Oct;31(5):325-342. doi: 
10.1097/HNP.0000000000000227.

Complementary Health Approaches Used in the Intensive Care Unit.

Erdoğan Z(1), Atik D.

Author information:
(1)Ahmet Erdogan Vocational School of Health Services, Bülent Ecevit University, 
Zonguldak, Turkey (Dr Erdoğan); and Nursing Department, School of Health, 
Osmaniye Korkut Ata University, Osmaniye, Turkey (Dr Atik).

Intensive care units are care centers where, in order to provide the maximum 
benefit to individuals whose life is in danger, many lifesaving technological 
tools and devices are present, and morbidity and mortality rates are high. In 
the intensive care unit, when classic treatments fail or become unbearable 
because of side effects, complementary methods have been suggested to be the 
best alternative. Complementary health approaches are methods that are used both 
for the continuation and the improvement of the well-being of an individual and 
as additions to medical treatments that are based on a holistic approach. These 
applications are especially helpful in the treatment of the stresses, anxieties, 
and other symptoms of unstable patients in the intensive care unit who do not 
tolerate traditional treatment methods well, increasing their psychological and 
physiological well-being, helping them sleep and rest. In intensive care 
patients, in order to decrease the incidence of postoperative atrial 
fibrillation, antiemetic and medicine needs, mechanical ventilation duration, 
and the intensity of the disease as well as to cope with symptoms such as pain, 
anxiety, physiological parameters, dyspnea, and sleep problems, body-mind 
interventions such as massage, reflexology, acupressure, aromatherapy, music 
therapy, energy therapies (healing touch, therapeutic touch, the Yakson method), 
and prayer are used as complementary health approaches.

DOI: 10.1097/HNP.0000000000000227
PMID: 28786890


4534. J Pain Symptom Manage. 2017 Dec;54(6):898-908. doi: 
10.1016/j.jpainsymman.2017.06.003. Epub 2017 Aug 10.

Addressing Patient Emotional and Existential Needs During Serious Illness: 
Results of the Outlook Randomized Controlled Trial.

Steinhauser KE(1), Alexander S(2), Olsen MK(3), Stechuchak KM(4), Zervakis J(4), 
Ammarell N(5), Byock I(6), Tulsky JA(7).

Author information:
(1)Center for Health Services Research in Primary Care Durham VA Medical Center, 
Durham, North Carolina, USA; Department of Medicine, Division of General 
Internal Medicine, Duke University, Durham, North Carolina, USA; Palliative Care 
Section, Duke University, Durham, North Carolina, USA; Center for the Study of 
Aging and Human Development, Duke University, Durham, North Carolina, USA. 
Electronic address: karen.steinhauser@duke.edu.
(2)College of Health and Human Sciences, Purdue University, West Lafayette, 
Indiana, USA.
(3)Center for Health Services Research in Primary Care Durham VA Medical Center, 
Durham, North Carolina, USA; Department of Biostatistics and Bioinformatics, 
Duke University, Durham, North Carolina, USA.
(4)Center for Health Services Research in Primary Care Durham VA Medical Center, 
Durham, North Carolina, USA.
(5)School of Nursing, Duke University, Durham, North Carolina, USA.
(6)Providence Institute for Human Caring, Torrance, California, USA; Geisel 
School of Medicine, Dartmouth University, Hanover, New Hampshire, USA.
(7)Dana Farber Cancer Institute, Boston, Massachusetts, USA; Brigham and Women's 
Hospital, Boston, Massachusetts, USA.

CONTEXT: Few interventions exist to address patients' existential needs.
OBJECTIVES: Determine whether an intervention to address seriously ill patients' 
existential concerns improves preparation, completion (elements of quality of 
life [QOL] at end of life), and reduces anxiety and depression.
METHODS: A randomized controlled trial comparing outlook intervention, 
relaxation meditation (RM), and usual care (UC). Measures included primary-a 
validated measure of QOL at the end of life and secondary-Functional Assessment 
of Cancer Therapy-General, anxiety (Profile of Mood States), depression (Center 
for Epidemiological Studies-Depression Scale), and spiritual well-being 
(Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being). 
Qualitative interviews assessed outlook intervention acceptability. Enrolled 
patients were nonhospice eligible veterans with advanced cancer, congestive 
heart failure, chronic obstructive pulmonary disease, end-stage renal disease, 
or end-stage liver disease.
RESULTS: Patients (n = 221) were randomly assigned 1:1:1 to outlook, RM, and UC. 
Patients were 96% males, 46% with cancer, 58.4% married, and 43.9% of African 
American origin. Compared with UC, outlook participants had higher preparation 
(a validated measure of QOL at the end of life) (mean difference 1.1; 95% CI 
0.2, 2.0; P = 0.02) and mean completion (1.6; 95% CI 0.05, 3.1; P = 0.04) at the 
first but not second postassessment. Compared with RM, outlook participants did 
not show significant differences over time. Exploratory analyses indicated that 
in subgroups with cancer and low sense of peace, outlook participants had 
improved preparation at first and not second postassessment, as compared with UC 
(mean difference 1.4; 95% CI 0.03, 2.7; P = 0.04) (mean difference = 1.8; 95% CI 
0.3, 3.3; P = 0.02), respectively.
CONCLUSION: Outlook had an impact on social well-being and preparation compared 
with UC. The lack of impact on anxiety and depression differs from previous 
results among hospice patients. Results suggest that outlook is not 
demonstratively effective in populations not experiencing existential or 
emotional distress.

Copyright © 2017. Published by Elsevier Inc.

DOI: 10.1016/j.jpainsymman.2017.06.003
PMID: 28803082 [Indexed for MEDLINE]


4535. J Perinatol. 2017 Dec;37(12):1259-1264. doi: 10.1038/jp.2017.108. Epub 2017 Aug 
10.

The neonatal intensive parenting unit: an introduction.

Hall SL(1), Hynan MT(2), Phillips R(3), Lassen S(4), Craig JW(5), Goyer E(6), 
Hatfield RF(7), Cohen H(8).

Author information:
(1)St. John's Regional Medical Center, Oxnard, CA, USA.
(2)Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, 
USA.
(3)Division of Neonatology, Department of Pediatrics, Loma Linda University 
Children's Hospital, Loma Linda, CA, USA.
(4)Department of Pediatrics, University of Kansas Medical Center, Kansas City, 
KS, USA.
(5)School of Occupational Therapy, Brenau University, Gainesville, GA, USA.
(6)Family Advocacy Network, National Perinatal Association, Austin, TX, USA.
(7)Newborn Intensive Care Unit, University of Utah Medical Center, Salt Lake 
City, UT, USA.
(8)Neonatal Intensive Care Unit, Salem Hospital, Salem, OR, USA.

This paper describes a paradigm shift occurring in neonatal intensive care. Care 
teams are moving from a focus limited to healing the baby's medical problems 
towards a focus that also requires effective partnerships with families. These 
partnerships encourage extensive participation of mothers and fathers in their 
baby's care and ongoing bi-directional communication with the care team. The 
term Newborn Intensive Parenting Unit (NIPU) was derived to capture this 
concept. One component of the NIPU is family-integrated care, where parents are 
intimately involved in a baby's care for as many hours a day as possible. We 
describe six areas of potentially better practices (PBPs) for the NIPU along 
with descriptions of NIPU physical characteristics, operations, and a 
relationship-based culture. Research indicates the PBPs should lead to improved 
outcomes for NIPU babies, better mental health outcomes for their parents, and 
enhanced well-being of staff.

DOI: 10.1038/jp.2017.108
PMCID: PMC5718987
PMID: 28796241 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


4536. Pediatrics. 2017 Sep;140(3):e20162819. doi: 10.1542/peds.2016-2819. Epub 2017 
Aug 2.

Septic Episodes in a Premature Infant After In Utero Exposure to Rituximab.

Hay S(1)(2), Burchett S(2)(3), Odejide O(2)(4), Cataltepe S(2)(5).

Author information:
(1)Divisions of Newborn Medicine and susanne.hay@childrens.harvard.edu.
(2)Harvard Medical School, Boston, Massachusetts.
(3)Infectious Disease, Boston Children's Hospital, Boston, Massachusetts.
(4)Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, 
Massachusetts; and.
(5)Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 
Boston, Massachusetts.

Rituximab is an increasingly used immunotherapeutic agent for women of 
reproductive age for treatment of autoimmune diseases, leukemias, and lymphomas. 
Rituximab is a chimeric monoclonal antibody that targets B-cell surface antigen 
CD20 and can cross the placenta. Current evidence of the impact of this 
medication on the developing fetus is limited, but there is little to suggest 
that fetal exposure to this medication places an infant at increased risk of 
immunosuppression and subsequent infection. Here we report a case of in utero 
rituximab exposure that was associated with 2 severe septic episodes with 
Enterococcus faecalis, in a premature infant of 29 weeks' gestational age with a 
birth weight of 820 g. The patient had a critically depressed B-lymphocyte 
subset of 10% and undetectable immunoglobulin (Ig)G, IgM, and IgA levels at 37 
weeks' postmenstrual age. Interestingly, both episodes of sepsis coincided with 
transition from donor human milk to formula feeds. She was treated with 
intravenous immunoglobulin, antibiotics, and donor human milk. We postulate that 
placental transfer of rituximab, prematurity, and the low levels of protective 
maternal antibodies increased the susceptibility of this patient to sepsis by E 
faecalis, a resident of the normal gut flora, whereas the secretory IgA in donor 
human milk may have played a protective role.

Copyright © 2017 by the American Academy of Pediatrics.

DOI: 10.1542/peds.2016-2819
PMID: 28768852 [Indexed for MEDLINE]

Conflict of interest statement: POTENTIAL CONFLICT OF INTEREST: The authors have 
indicated they have no potential conflicts of interest to disclose.


4537. J R Coll Physicians Edinb. 2017 Jun;47(2):94-101. doi: 10.4997/JRCPE.2017.218.

How to deal with violent and aggressive patients in acute medical settings.

Harwood RH(1).

Author information:
(1)RH Harwood, Health Care of Older People, Nottingham University Hospitals NHS 
Trust, Queen's Medical Centre, Nottingham NG7 2UH, UK. Email: 
rowan.harwood@nuh.nhs.uk.

Dealing with violence and aggression is an area where health professionals often 
feel uncertain. Standing at the interface between medicine, psychiatry and law, 
the best actions may not be clear, and guidelines neither consistently 
applicable nor explicit. An aggressive, violent or abusive patient may be 
behaving anti-socially or criminally. But in acute medical settings it is more 
likely that a medical, mental health or emotional problem, or some combination 
thereof, is the explanation and usually we will not know the relative 
contribution of each element. We must assume that difficult behaviour represents 
the communication of distress or unmet need. We can prevent and de-escalate 
situations by understanding why they have arisen, identifying the need, and 
trying to anticipate or meet it. In these situations 'challenging behaviour' is 
much like any other presenting problem: the medical approach is to diagnose and 
treat, while trying to maintain safety and function. In addition, the 
person-centred approach of trying to understand and address psychological and 
emotional distress is required. Skilled communication, non-confrontation, 
relationship-building and negotiation represent the best way to manage 
situations and avoid harm. If an incident is becoming dangerous, doctors need to 
know how to act to defuse the situation, or make it safe. Doctors must know 
about de-escalation and non-drug approaches, but also be confident about when 
physical restraint and drug treatment are necessary, and how to go about using 
appropriate drugs, doses, monitoring and aftercare. There are necessary 
safeguards around using these approaches, from the perspectives of physical 
health, mental wellbeing, and human rights.

DOI: 10.4997/JRCPE.2017.218
PMID: 28675195 [Indexed for MEDLINE]


4538. Stress Health. 2018 Feb;34(1):135-142. doi: 10.1002/smi.2769. Epub 2017 Jun 30.

Value congruence and depressive symptoms among critical care clinicians: The 
mediating role of moral distress.

Lamiani G(1), Dordoni P(2), Argentero P(2).

Author information:
(1)Department of Biomedical Sciences, Humanitas University, Milan, Italy.
(2)Department of Brain and Behavioral Sciences, University of Pavia, Pavia, 
Italy.

Clinicians working in intensive care units are often exposed to several job 
stressors that can negatively affect their mental health. Literature has 
acknowledged the role of value congruence and job control in determining 
clinicians' psychological well-being and depressive symptoms. However, potential 
mediators of this association have been scarcely examined. This study aimed to 
test the mediating role of moral distress in the relationship between value 
congruence and job control, on the one hand, and depression, on the other hand. 
A cross-sectional study involving physicians, nurses, and residents working in 7 
intensive care units in the north of Italy was conducted. Clinicians were 
administered in the Italian Moral Distress Scale-Revised, the value and control 
subscales of the Areas of Worklife Scale, and the Beck Depression Inventory II. 
Structural equation modeling was used to test the mediation model. Analysis on 
170 questionnaires (response rate 72%) found no relations between job control 
and moral distress. A total indirect effect of value congruence on depression 
through moral distress (β = -.12; p = .02) was found. Moral distress contributes 
to the development of depressive symptoms among critical care clinicians who 
perceive a value incongruence with their organization and therefore should be 
addressed.

Copyright © 2017 John Wiley & Sons, Ltd.

DOI: 10.1002/smi.2769
PMID: 28664611 [Indexed for MEDLINE]


4539. BMJ Open. 2017 Jun 21;7(6):e015326. doi: 10.1136/bmjopen-2016-015326.

Pregnancy-specific stress, fetoplacental haemodynamics, and neonatal outcomes in 
women with small for gestational age pregnancies: a secondary analysis of the 
multicentre Prospective Observational Trial to Optimise Paediatric Health in 
Intrauterine Growth Restriction.

Levine TA(1)(2), Grunau RE(3)(4), Segurado R(5), Daly S(6), Geary MP(7), 
Kennelly MM(8), O'Donoghue K(9), Hunter A(10), Morrison JJ(11), Burke G(12), 
Dicker P(13), Tully EC(14), Malone FD(14), Alderdice FA(1)(15), McAuliffe 
FM(16).

Author information:
(1)School of Nursing and Midwifery, Queen's University Belfast, Belfast, 
Northern Ireland.
(2)Newborn Medicine, Brigham and Women's Hospital and Harvard Medical School, 
Boston, MA, USA.
(3)Department of Pediatrics, University of British Columbia, Vancouver, British 
Columbia, Canada.
(4)Child and Family Research Institute, Vancouver, British Columbia, Canada.
(5)UCD CSTAR and School of Public Health, Physiotherapy and Sports Science, 
University College Dublin, Dublin, Ireland.
(6)Department of Obstetrics and Gynaecology, Coombe Women and Infants University 
Hospital, Dublin, Ireland.
(7)Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland.
(8)University College Dublin Centre for Human Reproduction, Coombe Women and 
Infants University Hospital, Dublin, Ireland.
(9)Department of Obstetrics and Gynaecology, University College Cork, Cork 
University Maternity Hospital, Cork, Ireland.
(10)Department of Obstetrics and Gynaecology, Royal Jubilee Maternity Hospital, 
Belfast, Northern Ireland.
(11)Department of Obstetrics and Gynaecology, National University of Ireland, 
Galway, Ireland.
(12)Department of Obstetrics and Gynaecology, Mid-Western Regional Maternity 
Hospital, Limerick, Ireland.
(13)Department of Epidemiology and Public Health, Royal College of Surgeons in 
Ireland, Dublin, Ireland.
(14)Department of Obstetrics and Gynaecology, Royal College of Surgeons in 
Ireland, Dublin, Ireland.
(15)National Perinatal Epidemiology Unit, Oxford University, Oxford, UK.
(16)UCD Perinatal Research Centre, Obstetrics and Gynaecology, School of 
Medicine, University College Dublin, National Maternity Hospital, Dublin, 
Ireland.

OBJECTIVES: To examine associations between maternal pregnancy-specific stress 
and umbilical (UA PI) and middle cerebral artery pulsatility indices (MCA PI), 
cerebroplacental ratio, absent end diastolic flow (AEDF), birthweight, 
prematurity, neonatal intensive care unit admission and adverse obstetric 
outcomes in women with small for gestational age pregnancies. It was 
hypothesised that maternal pregnancy-specific stress would be associated with 
fetoplacental haemodynamics and neonatal outcomes.
DESIGN: This is a secondary analysis of data collected for a large-scale 
prospective observational study.
SETTING: This study was conducted in the seven major obstetric hospitals in 
Ireland and Northern Ireland.
PARTICIPANTS: Participants included 331 women who participated in the 
Prospective Observational Trial to Optimise Paediatric Health in Intrauterine 
Growth Restriction. Women with singleton pregnancies between 24 and 36 weeks 
gestation, estimated fetal weight <10th percentile and no major structural or 
chromosomal abnormalities were included.
PRIMARY AND SECONDARY OUTCOME MEASURES: Serial Doppler ultrasound examinations 
of the umbilical and middle cerebral arteries between 20 and 42 weeks gestation, 
Pregnancy Distress Questionnaire (PDQ) scores between 23 and 40 weeks gestation 
and neonatal outcomes.
RESULTS: Concerns about physical symptoms and body image at 35-40 weeks were 
associated with lower odds of abnormal UAPI (OR 0.826, 95% CI 0.696 to 0.979, 
p=0.028). PDQ score (OR 1.073, 95% CI 1.012 to 1.137, p=0.017), concerns about 
birth and the baby (OR 1.143, 95% CI 1.037 to 1.260, p=0.007) and concerns about 
physical symptoms and body image (OR 1.283, 95% CI 1.070 to 1.538, p=0.007) at 
29-34 weeks were associated with higher odds of abnormal MCA PI. Concerns about 
birth and the baby at 29-34 weeks (OR 1.202, 95% CI 1.018 to 1.421, p=0.030) 
were associated with higher odds of AEDF. Concerns about physical symptoms and 
body image at 35-40 weeks were associated with decreased odds of neonatal 
intensive care unit admission (OR 0.635, 95% CI 0.435 to 0.927, p=0.019).
CONCLUSIONS: These findings suggest that fetoplacental haemodynamics may be a 
mechanistic link between maternal prenatal stress and fetal and neonatal 
well-being, but additional research is required.

© Article author(s) (or their employer(s) unless otherwise stated in the text of 
the article) 2017. All rights reserved. No commercial use is permitted unless 
otherwise expressly granted.

DOI: 10.1136/bmjopen-2016-015326
PMCID: PMC5734406
PMID: 28637734 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


4540. Wien Med Wochenschr. 2018 Mar;168(3-4):67-75. doi: 10.1007/s10354-017-0575-1. 
Epub 2017 Jun 14.

The role of psychosomatic medicine in intensive care units.

[Article in English]

Abrahamian H(1), Lebherz-Eichinger D(2)(3).

Author information:
(1)Department of Internal Medicine, Otto Wagner Hospital, Baumgartner Höhe 1, 
1140, Vienna, Austria. heidemarie.abrahamian@wienkav.at.
(2)Department of Internal Medicine, Otto Wagner Hospital, Baumgartner Höhe 1, 
1140, Vienna, Austria.
(3)Department of Anesthesia, Medical University of Vienna, Währinger Gürtel 
18-20, 1090, Vienna, Austria.

Critically ill patients, their relatives, and intensive care staff are 
consistently exposed to stress. The principal elements of this exceptional 
burden are confrontation with a life-threatening disease, specific environmental 
conditions at the intensive care unit, and the social characteristics of 
intensive care medicine. The short- and long-term consequences of these 
stressors include a feeling of helplessness, distress, anxiety, depression, and 
even posttraumatic stress disorders. Not only the patients, but also their 
relatives and intensive care staff are at risk of developing such 
psychopathologies. The integration of psychosomatic medicine into the general 
concept of intensive care medicine is an essential step for the early 
identification of fear and anxiety and for understanding biopsychosocial 
coherence in critically ill patients. Preventive measures such as the 
improvement of individual coping strategies and enhancing the individual's 
resistance to stress are crucial aspects of improving wellbeing, as well as the 
overall outcome of disease. Additional stress-reducing measures reported in the 
published literature, such as hearing music, the use of earplugs and eye-masks, 
or basal stimulation, have been successful to a greater or lesser extent.

DOI: 10.1007/s10354-017-0575-1
PMID: 28616666 [Indexed for MEDLINE]


4541. BMJ Open. 2017 Jun 13;7(5):e015826. doi: 10.1136/bmjopen-2017-015826.

A qualitative analysis of the Three Good Things intervention in healthcare 
workers.

Rippstein-Leuenberger K(1)(2), Mauthner O(1), Bryan Sexton J(3), Schwendimann 
R(1).

Author information:
(1)Institute of Nursing Science, Department of Public Health, Faculty of 
Medicine, University of Basel, Basel, Switzerland.
(2)Kantonsspital Baselland, Liestal, Switzerland.
(3)Duke Patient Safety Center, Duke University Health System, Durham, North 
Carolina, USA.

BACKGROUND: Intensive care unit (ICU) personnel have an elevated prevalence of 
job-related burn-out and post-traumatic stress disorder, which can ultimately 
impact patient care. To strengthen healthcare workers' skills to deal with 
stressful events, it is important to focus not only on minimising suffering but 
also on increasing happiness, as this entails many more benefits than simply 
feeling good. Thus, the purpose of this study was to explore the content of the 
'good things' reported by healthcare workers participating in the 'Three Good 
Things' intervention.
METHODS: In a tertiary care medical centre, a sample of 89 neonatal ICU (NICU) 
healthcare professionals registered for the online intervention. Of these, 32 
individuals eventually participated fully in the 14-day online Three Good Things 
intervention survey. Daily emails reminded participants to reflect on and 
respond to the questions: "What are the three things that went well today?" and 
"What was your role in bringing them about?" To analyse their responses, we 
applied a thematic analysis, which was guided by our theoretical understanding 
of resilience.
RESULTS: Involving more than 1300 statements, the Three Good Things responses of 
the 32 study participants, including registered nurses, physicians and neonatal 
nurse practitioners, led to the identification of three main themes: (1) having 
a good day at work; (2) having supportive relationships and (3) making 
meaningful use of self-determined time.
CONCLUSIONS: The findings show the personal and professional relevance of 
supportive relationships strengthened by clear communication and common 
activities that foster positive emotions. The Three Good Things exercise 
acknowledges the importance of self-care in healthcare workers and appears to 
promote well-being, which might ultimately strengthen resilience.

© Article author(s) (or their employer(s) unless otherwise stated in the text of 
the article) 2017. All rights reserved. No commercial use is permitted unless 
otherwise expressly granted.

DOI: 10.1136/bmjopen-2017-015826
PMCID: PMC5623381
PMID: 28611090 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


4542. Nurs Child Young People. 2017 Jun 12;29(5):33-40. doi: 10.7748/ncyp.2017.e844.

Mental health and well-being of parents caring for a ventilator-dependent child.

Lee J(1), Lynn F(2).

Author information:
(1)Southern Health and Social Care Trust, Northern Ireland.
(2)Queen's University Belfast, Northern Ireland.

An integrative literature review was undertaken to determine the social and 
emotional effects on the mental health and well-being of parents of children 
requiring long-term ventilation at home. Six studies were included. Recurrent 
themes reported in the literature included lack of formal and informal support, 
financial adversity, limited access to respite care and feelings of social 
isolation. These themes were associated with depressive symptoms and were 
consistently reported to have a negative effect on parental mental health and 
well-being. Healthcare professionals have a part to play in improving parents' 
coping skills, resilience and resourcefulness to help reduce adverse social and 
emotional effects on their mental health and well-being.

DOI: 10.7748/ncyp.2017.e844
PMID: 28604218 [Indexed for MEDLINE]


4543. Ann Intern Med. 2017 Jul 4;167(1):1-7. doi: 10.7326/M17-0085. Epub 2017 Jun 6.

Presence of Human Hepegivirus-1 in a Cohort of People Who Inject Drugs.

Kandathil AJ(1), Breitwieser FP(1), Sachithanandham J(1), Robinson M(1), Mehta 
SH(1), Timp W(1), Salzberg SL(1), Thomas DL(1), Balagopal A(1).

Author information:
(1)From Johns Hopkins University and Johns Hopkins Bloomberg School of Public 
Health, Baltimore, Maryland.

Comment in
    Ann Intern Med. 2018 Jan 16;168(2):158.
    Ann Intern Med. 2018 Jan 16;168(2):157-158.
    Ann Intern Med. 2018 Jan 16;168(2):158-159.

BACKGROUND: Next-generation metagenomic sequencing (NGMS) has opened new 
frontiers in microbial discovery but has been clinically characterized in only a 
few settings.
OBJECTIVE: To explore the plasma virome of persons who inject drugs and to 
characterize the sensitivity and accuracy of NGMS compared with quantitative 
clinical standards.
DESIGN: Longitudinal and cross-sectional studies.
SETTING: A clinical trial (ClinicalTrials.gov: NCT01285050) and a 
well-characterized cohort study of persons who have injected drugs.
PARTICIPANTS: Persons co-infected with hepatitis C virus (HCV) and HIV.
MEASUREMENTS: Viral nucleic acid in plasma by NGMS and quantitative polymerase 
chain reaction (PCR).
RESULTS: Next-generation metagenomic sequencing generated a total of 600 million 
reads, which included the expected HIV and HCV RNA sequences. HIV and HCV reads 
were consistently identified only when samples contained more than 10 000 
copies/mL or IU/mL, respectively, as determined by quantitative PCR. A novel RNA 
virus, human hepegivirus-1 (HHpgV-1), was also detected by NGMS in 4 samples 
from 2 persons in the clinical trial. Through use of a quantitative PCR assay 
for HHpgV-1, infection was also detected in 17 (10.9%) of 156 members of a 
cohort of persons who injected drugs. In these persons, HHpgV-1 viremia 
persisted for a median of at least 4538 days and was associated with detection 
of other bloodborne viruses, such as HCV RNA and SEN virus D.
LIMITATION: The medical importance of HHpgV-1 infection is unknown.
CONCLUSION: Although NGMS is insensitive for detection of viruses with 
relatively low plasma nucleic acid concentrations, it may have broad potential 
for discovery of new viral infections of possible medical importance, such as 
HHpgV-1.
PRIMARY FUNDING SOURCE: National Institutes of Health.

DOI: 10.7326/M17-0085
PMCID: PMC5721525
PMID: 28586923 [Indexed for MEDLINE]


4544. BMJ Open. 2017 May 25;7(5):e014932. doi: 10.1136/bmjopen-2016-014932.

Effects of continuous positive airway pressure on neurocognitive architecture 
and function in patients with obstructive sleep apnoea: study protocol for a 
multicentre randomised controlled trial.

Xu H(1)(2)(3), Wang H(1)(2)(3), Guan J(1)(2)(3), Yi H(1)(2)(3), Qian Y(1)(2)(3), 
Zou J(1)(2)(3), Xia Y(1)(2)(3), Fu Y(1)(2)(3), Li X(1)(2)(3), Jiao X(1)(2)(3), 
Huang H(4), Dong P(5), Yu Z(5), Yang J(6), Xiang M(6), Li J(7), Chen Y(7), Wang 
P(8), Sun Y(8), Li Y(9), Zheng X(10), Jia W(10)(11), Yin S(1)(2)(3).

Author information:
(1)Department of Otolaryngology Head and Neck Surgery and Center of Sleep 
Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 
Shanghai, China.
(2)Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, 
China.
(3)Clinical Research Center, Shanghai Jiao Tong University School of Medicine, 
Shanghai, China.
(4)Department of Epidemiology, School of Public Health, Shanghai Jiao Tong 
University, Shanghai, China.
(5)Department of Otorhinolaryngology, Shanghai First People's Hospital, Shanghai 
Jiao Tong University, Shanghai, China.
(6)Department of Otolaryngology Head and Neck Surgery, Xinhua Hospital, 
Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
(7)Department of Otorhinolaryngology Head and Neck Surgery, Ren Ji Hospital, 
School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
(8)Department of Otolaryngology Head and Neck Surgery, Shanghai Ninth People's 
Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, 
Shanghai, China.
(9)Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth 
People's Hospital, Shanghai, China.
(10)Shanghai Key Laboratory of Diabetes Mellitus and Center for Translational 
Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 
Shanghai, China.
(11)Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, 
Hawaii, USA.

OBJECTIVES: Many clinical studies have indicated that obstructive sleep apnoea 
(OSA), the most common chronic sleep disorder, may affect neurocognitive 
function, and that treatment for continuous positive airway pressure (CPAP) has 
some neurocognitive protective effects against the adverse effects of OSA. 
However, the effects of CPAP treatment on neurocognitive architecture and 
function remain unclear. Therefore, this multicentre trial was designed to 
investigate whether and when neurocognitive architecture and function in 
patients with OSA can be improved by CPAP treatment and to explore the role of 
gut microbiota in improving neurocognitive function during treatment.
METHODS/DESIGN: This study will be a multicentre, randomised, controlled trial 
with allocation concealment and assessor blinding. A total of 148 eligible 
patients with moderate to severe OSA will be enrolled from five sleep centres 
and randomised to receive CPAP with best supportive care (BSC) intervention or 
BSC intervention alone. Cognitive function, structure and function of brain 
regions, gut microbiota, metabolites, biochemical variables, 
electrocardiography, echocardiography, pulmonary function and arterial stiffness 
will be assessed at baseline before randomisation and at 3, 6 and 12 months.
ETHICS AND DISSEMINATION: This study has been approved by the Medical Ethics 
Committee of Shanghai Jiao Tong University Affiliated Sixth People's Hospital 
(approval number 2015-79). The results from this study will be published in 
peer-reviewed journals and at relevant conferences.
TRIAL REGISTRATION NUMBER: NCT02886156; pre-results.

© Article author(s) (or their employer(s) unless otherwise stated in the text of 
the article) 2017. All rights reserved. No commercial use is permitted unless 
otherwise expressly granted.

DOI: 10.1136/bmjopen-2016-014932
PMCID: PMC5729992
PMID: 28550021 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


4545. Shock. 2017 Dec;48(6):657-665. doi: 10.1097/SHK.0000000000000900.

Interleukin-22 Prevents Microbial Dysbiosis and Promotes Intestinal Barrier 
Regeneration Following Acute Injury.

Hammer AM(1), Morris NL, Cannon AR, Khan OM, Gagnon RC, Movtchan NV, van 
Langeveld I, Li X, Gao B, Choudhry MA.

Author information:
(1)*Alcohol Research Program †Burn & Shock Trauma Research Institute ‡Department 
of Surgery §Department of Microbiology and Immunology ||Integrative Cell Biology 
Program ¶Stritch School of Medicine, Loyola University Chicago Health Sciences 
Division, Maywood, Illinois **Laboratory of Liver Diseases, National Institute 
on Alcohol Abuse and Alcoholism, NIH, Bethesda, Maryland.

Intestine barrier disruption and bacterial translocation can contribute to 
sepsis and multiple organ failure, leading causes of mortality in burn-injured 
patients. In addition, findings suggest that ethanol (alcohol) intoxication at 
the time of injury worsens symptoms associated with burn injury. We have 
previously shown that interleukin-22 (IL-22) protects from intestinal leakiness 
and prevents overgrowth of gram-negative bacteria following ethanol and burn 
injury, but how IL-22 mediates these effects has not been established. Here, 
utilizing a mouse model of ethanol and burn injury, we show that the combined 
insult results in a significant loss of proliferating cells within small 
intestine crypts and increases Enterobacteriaceae copies, despite elevated 
levels of the antimicrobial peptide lipocalin-2. IL-22 administration restored 
numbers of proliferating cells within crypts, significantly increased Reg3β, 
Reg3γ, lipocalin-2 AMP transcript levels in intestine epithelial cells, and 
resulted in complete reduction of Enterobacteriaceae in the small intestine. 
Knockout of signal transducer and activator of transcription factor-3 (STAT3) in 
intestine epithelial cells resulted in complete loss of IL-22 protection, 
demonstrating that STAT3 is required for intestine barrier protection following 
ethanol combined with injury. Together, these findings suggest that IL-22/STAT3 
signaling is critical to gut barrier integrity and targeting this pathway may be 
of beneficial clinical relevance following burn injury.

DOI: 10.1097/SHK.0000000000000900
PMCID: PMC5681896
PMID: 28498296 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: The authors have no 
conflicts of interest to declare


4546. J Obstet Gynecol Neonatal Nurs. 2018 Jan;47(1):114-121. doi: 
10.1016/j.jogn.2016.12.007. Epub 2017 May 5.

A Nurse-Based Model of Psychosocial Support for Emotionally Distressed Mothers 
of Infants in the NICU.

Davila RC, Segre LS.

Mothers whose infants are hospitalized in the NICU are frequently emotionally 
distressed, particularly early in the hospitalization. The Family-Centered 
Developmental Care philosophy, widely adopted by NICUs, calls for an expanded 
focus on the well-being of the entire family. In this article, we describe an 
innovative, nurse-delivered program for emotionally distressed mothers of 
infants in the NICU that includes screening and an empirically supported 
counseling approach: Listening Visits.

Copyright © 2018 AWHONN, the Association of Women's Health, Obstetric and 
Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jogn.2016.12.007
PMID: 28482172 [Indexed for MEDLINE]


4547. Nurs Crit Care. 2017 Jul;22(4):221-228. doi: 10.1111/nicc.12288. Epub 2017 Mar 
31.

A post cardiac surgery intervention to manage delirium involving families: a 
randomized pilot study.

Mailhot T(1), Cossette S(2), Côté J(3), Bourbonnais A(4), Côté MC(5), Lamarche 
Y(6), Denault A(7).

Author information:
(1)Montreal Heart Institute Research Center S-2490, University of Montreal, 5000 
Belanger Street, Montreal (Quebec) H1T 1C8, Canada.
(2)University of Montreal, Montreal Heart Institute Research Center S-2510, 5000 
Belanger Street, Montreal (Quebec) H1T 1C8, Canada.
(3)Centre de Recherche du Centre Hospitalier de l'Université de Montréal, 
University of Montreal, PO Box 6128, Downtown Branch, Montréal (Québec) H3C 3J7, 
Canada.
(4)University of Montreal, Chair of the Desjardins Research, Chair in Nursing 
Care for Older People and their Families, Centre de recherche de l'Institut 
universitaire de gériatrie de Montréal, PO Box 6128, Downtown Branch, Montréal 
(Québec) H3C 3J7, Canada.
(5)Department of Psychosomatics, Montreal Heart Institute, 5000 Belanger Street, 
Montreal (Quebec) H1T 1C8, Canada.
(6)Department of Cardiac Surgery, Montreal Heart Institute, 5000 Belanger 
Street, Montreal (Quebec) H1T 1C8, Canada.
(7)Department of Anesthesiology, Montreal Heart Institute, 5000 Belanger Street, 
Montreal (Quebec) H1T 1C8, Canada.

BACKGROUND: As many delirium manifestations (e.g., hallucinations or fears) are 
linked to patients' experiences and personality traits, it is suggested that 
interventions should be tailored to optimize its management. The inclusion of 
family members, as part of an intervention, has recently emerged as a solution 
to developing individualised patient care, but has never been assessed in 
post-cardiac surgery intensive care unit where almost half of patients will 
present with delirium.
AIMS: To assess the feasibility, acceptability and preliminary efficacy of an 
nursing intervention involving family caregivers (FC) in delirium management 
following cardiac surgery.
DESIGN: A randomized pilot study.
METHODS: A total of 30 patient/FC dyads were recruited and randomized to usual 
care (n = 14) or intervention (n = 16). The intervention was based on the Human 
Caring Theory, a mentoring model, and sources informing self-efficacy. It 
comprised seven planned encounters spread over 3 days between an intervention 
nurse and the FC, each including a 30-min visit at the patient's bedside. During 
this bedside visit, the FC used delirium management strategies, e.g. reorient 
the person with delirium. The primary indicator of acceptability was to obtain 
consent from 75% of approached FCs. The preliminary effect of the intervention 
on patient outcomes was assessed on (1) delirium severity using the Delirium 
Index, (2) occurrence of complications, such as falls, (3) length of 
postoperative hospital stay and (4) psycho-functional recovery using the 
Sickness Impact Profile. The preliminary effect on FC outcomes was assessed on 
FC anxiety and self-efficacy. Data were analysed using descriptive statistics, 
ANCOVAs and logistic regressions.
RESULTS: The primary indicator of obtaining consent from FC was achieved (77%). 
Of the 14 dyads, thirteen (93%) dyads received all seven encounters planned in 
the experimental intervention. Intervention group patients presented better 
psycho-functional recovery scores when compared with control group patients 
(p = 0·01). Mean delirium severity scores showed similar trajectories on days 1, 
2 and 3 in both groups.
CONCLUSION: The mentoring intervention was acceptable and feasible and shows 
promising results in improving patients and FC outcomes.
RELEVANCE TO CLINICAL PRACTICE: Nurses should involve, if willing, FC to 
participate in activities that optimise patient well-being FC to use recognized 
delirium management strategies like reorientation and reassurance.

© 2017 British Association of Critical Care Nurses.

DOI: 10.1111/nicc.12288
PMID: 28371230 [Indexed for MEDLINE]


4548. J Trauma Nurs. 2017 Mar/Apr;24(2):85-96. doi: 10.1097/JTN.0000000000000271.

Family Presence During Resuscitation After Trauma.

Leske JS(1), McAndrew NS, Brasel KJ, Feetham S.

Author information:
(1)College of Nursing, University of Wisconsin-Milwaukee (Drs Leske and Feetham 
and Ms McAndrew); Froedtert and the Medical College of Wisconsin-Froedtert 
Hospital, Milwaukee (Dr Leske and Ms McAndrew); Oregon Heath & Science 
University, Division of Trauma, Critical Care & Acute Care Surgery, Portland (Dr 
Brasel); and Children's National Health System, Washington, District of Columbia 
(Dr Feetham).

The purpose of this study was to examine the effects of family presence during 
resuscitation (FPDR) in patients who survived trauma from motor vehicle crashes 
(MVC) and gunshot wounds (GSW). A convenience sample of family members 
participated within three days of admission to critical care. Family members of 
140 trauma patients (MVC n = 110, 79%; GSW n = 30, 21%) participated. Family 
members ranged in age from 20-84 years (M = 46, SD = 15, Mdn = 47). The majority 
were female (n = 112, 80%) and related to the patient as spouse (n = 46, 33%). 
Participating in the FPDR option reduced anxiety (t = -2.43, p =.04), reduced 
stress (t = -2.86, p = .005), and fostered well-being (t = 3.46, p = .001). 
Results demonstrate the positive initial effects of FPDR on family members of 
patients surviving trauma injury.

DOI: 10.1097/JTN.0000000000000271
PMCID: PMC5343763
PMID: 28272181 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest: None declared.


4549. Am J Crit Care. 2017 Mar;26(2):128-135. doi: 10.4037/ajcc2017916.

Stress and Coping of Critical Care Nurses After Unsuccessful Cardiopulmonary 
Resuscitation.

McMeekin DE(1), Hickman RL Jr(2), Douglas SL(2), Kelley CG(2).

Author information:
(1)Dawn E. McMeekin was a DNP student at Case Western Reserve University, 
Cleveland, Ohio, when the study was done. She is now an advanced clinical 
education specialist at Baycare Health System, Dunedin, Florida. Ronald L. 
Hickman, Jr, is an associate professor, Carol G. Kelley is an assistant 
professor, and Sara L. Douglas is a professor, Case Western Reserve University. 
dawn.mcmeekin@baycare.org.
(2)Dawn E. McMeekin was a DNP student at Case Western Reserve University, 
Cleveland, Ohio, when the study was done. She is now an advanced clinical 
education specialist at Baycare Health System, Dunedin, Florida. Ronald L. 
Hickman, Jr, is an associate professor, Carol G. Kelley is an assistant 
professor, and Sara L. Douglas is a professor, Case Western Reserve University.

BACKGROUND: Participation by a critical care nurse in an unsuccessful 
resuscitation can create a unique heightened level of psychological stress 
referred to as postcode stress, activation of coping behaviors, and symptoms of 
posttraumatic stress disorder (PTSD).
OBJECTIVES: To explore the relationships among postcode stress, coping 
behaviors, and PTSD symptom severity in critical care nurses after experiencing 
unsuccessful cardiopulmonary resuscitations and to see whether institutional 
support attenuates these repeated psychological traumas.
METHODS: A national sample of 490 critical care nurses was recruited from the 
American Association of Critical-Care Nurses' eNewsline and social media. 
Participants completed the Post-Code Stress Scale, the Brief COPE (abbreviated), 
and the Impact of Event Scale-Revised, which were administered through an online 
survey.
RESULTS: Postcode stress and PTSD symptom severity were weakly associated (r = 
0.20, P = .01). No significant associations between coping behaviors and 
postcode stress were found. Four coping behaviors (denial, self-distraction, 
self-blame, and behavioral disengagement) were significant predictors of PTSD 
symptom severity. Severity of postcode stress and PTSD symptoms varied with the 
availability of institutional support.
CONCLUSIONS: Critical care nurses show moderate levels of postcode stress and 
PTSD symptoms when asked to recall an unsuccessful resuscitation and the coping 
behaviors used. Identifying the critical care nurses most at risk for PTSD will 
inform the development of interventional research to promote critical care 
nurses' psychological well-being and reduce their attrition from the profession.

©2017 American Association of Critical-Care Nurses.

DOI: 10.4037/ajcc2017916
PMID: 28249865 [Indexed for MEDLINE]


4550. J Pediatr. 2017 May;184:68-74. doi: 10.1016/j.jpeds.2017.01.052. Epub 2017 Feb 
22.

Maternal Mental Health and Neonatal Intensive Care Unit Discharge Readiness in 
Mothers of Preterm Infants.

McGowan EC(1), Du N(2), Hawes K(3), Tucker R(4), O'Donnell M(4), Vohr B(4).

Author information:
(1)Division of Neonatology, Department of Pediatrics, Women & Infants Hospital, 
Providence, RI. Electronic address: emcgowan@wihri.org.
(2)Yale New Haven Children's Hospital, New Haven, CT.
(3)Division of Neonatology, Department of Pediatrics, Women & Infants Hospital, 
Providence, RI; College of Nursing, University of Rhode Island, Kingston, RI.
(4)Division of Neonatology, Department of Pediatrics, Women & Infants Hospital, 
Providence, RI.

OBJECTIVE: To evaluate associations between maternal mental health disorders 
(MHDs) and discharge readiness for mothers of infants born preterm (<37 weeks). 
We hypothesized that mothers with a history of MHDs would report decreased 
perceptions of neonatal intensive care unit (NICU) discharge readiness compared 
with mothers without a history.
STUDY DESIGN: Mothers of infants born preterm in the NICU >5 days between 2012 
and 2015 and participating in a transition home program completed a discharge 
readiness questionnaire measuring perceptions of staff support, infant 
well-being (medical stability), maternal well-being (emotional 
readiness/competency), and maternal comfort (worry about infant). Greater scores 
are more optimal (range 0-100). Social workers obtained a history of MHDs. Group 
comparisons and regression analyses were run to predict decreased scores and 
maternal discharge readiness.
RESULTS: A total of 37% (315/850) of mothers reported a MHD. They were more 
likely to be white (64% vs 55% P = .05), single (64% vs 45% P ≤ .001), on 
Medicaid (61% vs 50% P = .002), and less likely to be non-English speaking (10% 
vs 22%, P  ≤ .001). Mothers with MHD perceived less NICU support (92 ± 13 vs 
94 ± 12, P = .005), less emotional readiness for discharge (78 ± 17 vs 81 ± 14, 
P = .04), and lower family cohesion (81 ± 24 vs 86 ± 19, P = .02) compared with 
mothers without MHD. Regression modeling (OR; CI) indicated that maternal 
history of MHDs predicted mother's decreased perception of infant well-being 
(1.56; 1.05-2.33) and her own well-being (1.99; 1.45-2.8) at discharge.
CONCLUSION: One-third of mothers reported a history of MHDs. This vulnerable 
group perceive themselves as less ready for discharge home with their infant, 
indicating an unmet need for provision of enhanced transition services.

Copyright © 2017 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jpeds.2017.01.052
PMID: 28237375 [Indexed for MEDLINE]


4551. Midwifery. 2017 Apr;47:1-7. doi: 10.1016/j.midw.2017.01.011. Epub 2017 Jan 21.

Midwives' experiences of working in an obstetric high dependency unit: A 
qualitative study.

Eadie IJ(1), Sheridan NF(2).

Author information:
(1)School of Nursing, Faculty of Medical & Health Sciences, University of 
Auckland, Private Bag 92019, Auckland 1142, New Zealand. Electronic address: 
izzyeadie@yahoo.com.
(2)School of Nursing, Faculty of Medical & Health Sciences, University of 
Auckland, Private Bag 92019, Auckland 1142, New Zealand.

OBJECTIVES: to understand the challenges experienced by midwives providing 
obstetric high dependency care and identify the training they perceive is needed 
for work in an obstetric high dependency unit.
DESIGN: sixteen midwives who worked in the obstetric high dependency unit 
participated in one of three focus groups. Focus groups lasted 60-90minutes and 
were conducted in the workplace and facilitated by author (IE). Data were 
digitally recorded, transcribed and analysed manually by author (IE), 
specifically using a 'codebook' model to generate codes, categories and themes.
SETTING: a purpose built, two-bed obstetric high dependency unit located in the 
delivery suite of a large, urban tertiary teaching hospital in New Zealand.
FINDINGS: five themes were conceptualised: Theme 1: 'high dependency care is not 
our bread and butter'; the midwives felt that working in the obstetric high 
dependency work did not constitute 'normal' midwifery work. Theme 2: 'we are 
family… embracing the baby and partner in HDU'; the midwives recognised that an 
obstetric high dependency unit enabled the mother and infant to be cared for 
together, was beneficial for maternal psychosocial wellbeing, and supported 
mother-infant bonding and breastfeeding. Theme 3: 'primum non nocere; First, do 
no harm'; the midwives voiced concern that they lacked the skills and training 
to provide obstetric high dependency care and considered this a potential risk 
to sick women in their care. Theme 4: 'graceful swans and headless chickens'; 
the midwives reported feelings of stress, anxiety, fear and of being overwhelmed 
by the demands of obstetric high dependency care. The more experienced midwives 
were able to portray calmness and poise despite lots going on beneath the 
surface. This was in contrast to other, often less experienced midwives, who 
appeared confused and less organised. Theme 5: 'please sir, can I have some more 
training?'; the midwives unanimously sought training in the provision of 
obstetric high dependency care and saw facilitation of training to be a 
responsibility of the hospital.
KEY CONCLUSIONS: midwives who are competent in obstetric high dependency care 
are well placed to provide holistic care to sick women within an obstetric high 
dependency unit. Midwives found this work challenging and identified the need 
for specific knowledge and skills beyond those required in the provision of care 
to well women. The midwives sought post-registration training in obstetric high 
dependency care. These findings are consistent with other studies reported in 
the literature.
IMPLICATIONS FOR PRACTICE: post-registration training must be made available to 
midwives providing high dependency care to sick women to ensure they have the 
specialised skills and knowledge for practice. Responsibility to facilitate 
training rests with hospitals providing this service.

Copyright © 2017 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.midw.2017.01.011
PMID: 28188998 [Indexed for MEDLINE]


4552. Ann Am Thorac Soc. 2017 Apr;14(4):505-512. doi: 10.1513/AnnalsATS.201612-1006PS.

Trainee Wellness: Why It Matters, and How to Promote It.

Sharp M(1), Burkart KM(2).

Author information:
(1)1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, 
Johns Hopkins University School of Medicine, Baltimore, Maryland; and.
(2)2 Division of Pulmonary, Allergy and Critical Care Medicine, Department of 
Medicine, College of Physicians and Surgeons, Columbia University, New York, New 
York.

Wellness is critical to physicians in training and the general physician 
workforce. At present, physicians in general and especially intensive care unit 
physicians are experiencing high rates of depression and burnout. The prevalence 
of burnout is greatest in resident and fellow trainees. The Accreditation 
Council for Graduate Medical Education has recognized the importance of 
physician wellness by proposing Common Program Requirements that pertain to 
trainee and faculty well-being. Several individual-focused, organizational, and 
structural strategies have been described in the literature as helpful in 
decreasing burnout. Successful implementation of a trainee wellness program 
requires institutional resources and collaborative efforts between the 
institution, leadership, faculty, and trainees. To ensure the greatest effect in 
reducing burnout, training programs and institutions should create programs that 
intervene at both the organizational and individual levels. Additional steps to 
implement a trainee wellness program include the following: (1) establish 
support from institutional and divisional leadership; (2) create a wellness 
committee; (3) perform a needs assessment; (4) assess trainee wellness and 
burnout; (5) perform targeted interventions; and (6) routinely reassess trainee 
wellness and burnout. More research is needed to identify and refine strategies 
that improve wellness and decrease burnout among physicians and trainees. As a 
community, we must take on the challenge of improving wellness among physicians 
for the benefit of our trainees, ourselves, and our patients.

DOI: 10.1513/AnnalsATS.201612-1006PS
PMID: 28165295 [Indexed for MEDLINE]


4553. J Palliat Med. 2017 Jun;20(6):638-641. doi: 10.1089/jpm.2016.0315. Epub 2017 Feb 
3.

Increased Symptom Expression among Patients with Delirium Admitted to an Acute 
Palliative Care Unit.

de la Cruz M(1), Yennu S(1), Liu D(2), Wu J(2), Reddy A(1), Bruera E(1).

Author information:
(1)1 Department of Palliative Rehabilitation and Integrative Medicine, The 
University of Texas MD Anderson Cancer Center , Houston, Texas.
(2)2 Department of Biostatistics, The University of Texas MD Anderson Cancer 
Center , Houston, Texas.

INTRODUCTION: Delirium is the most common neuropsychiatric condition in very ill 
patients and those at the end of life. Previous case reports found that 
delirium-induced disinhibition may lead to overexpression of symptoms. It 
negatively affects communication between patients, family members, and the 
medical team and can sometimes lead to inappropriate interventions. Better 
understanding would result in improved care. Our aim was to determine the effect 
of delirium on the reporting of symptom severity in patients with advanced 
cancer.
METHODS: We reviewed 329 consecutive patients admitted to the acute palliative 
care unit (APCU) without a diagnosis of delirium from January to December 2011. 
Demographics, Memorial Delirium Assessment Scale, Eastern Cooperative Oncology 
Group (ECOG) Performance status, and Edmonton Symptom Assessment Scale (ESAS) on 
two time points were collected. The first time point was on admission and the 
second time point for group A was day one (+two days) of delirium. For group B, 
the second time point was within two to four days before discharge from the 
APCU. Patients who developed delirium and those who did not develop delirium 
during the entire course of admission were compared using chi-squared test and 
Wilcoxon rank-sum test. Paired t-test was used to assess if the change of ESAS 
from baseline to follow-up was associated with delirium.
RESULTS: Ninety-six of 329 (29%) patients developed delirium during their 
admission to the APCU. The median time to delirium was two days. There was no 
difference in the length of stay in the APCU for both groups. Patients who did 
not have delirium expressed improvement in all their symptoms, while those who 
developed delirium during hospitalization showed no improvement in physical 
symptoms and worsening in depression, anxiety, appetite, and well-being.
CONCLUSION: Patients with delirium reported no improvement or worsening symptoms 
compared to patients without delirium. Screening for delirium is important in 
patients who continue to report worsening symptoms despite appropriate 
management.

DOI: 10.1089/jpm.2016.0315
PMCID: PMC5915265
PMID: 28157431 [Indexed for MEDLINE]

Conflict of interest statement: No competing financial interests exist.


4554. BMJ Open. 2017 Feb 2;7(2):e013824. doi: 10.1136/bmjopen-2016-013824.

Parental engagement and early interactions with preterm infants during the stay 
in the neonatal intensive care unit: protocol of a mixed-method and longitudinal 
study.

Stefana A(1), Lavelli M(1).

Author information:
(1)Department of Human Sciences, University of Verona, Verona, Italy.

INTRODUCTION: The preterm infants' developmental outcomes depend on biological 
and environmental risk factors. The environmental factors include prolonged 
parental separation, less exposure to early mother/father-infant interactions 
and the parents' ability to respond to the trauma of premature birth. In the 
case of premature birth, the father's ability to take an active part in the care 
of the infant from the start is essential. The parents' emotional closeness to 
the preterm infant hospitalised in the neonatal intensive care unit (NICU) may 
be crucial to the well-being of the newborn, the development of mutual 
regulation, the establishment of a functioning parent-infant affective 
relationship and the parents' confidence in their ability to provide care for 
their baby.
METHODS AND ANALYSIS: This is a mixed-method, observational and longitudinal 
study. The methodological strategy will include: (1) ethnographic observation in 
a level III NICU located in Italy for a duration of 18 months; (2) 3-minute 
video recordings of mother-infant and father-infant interaction in the NICU; (3) 
a semistructured interview with fathers during the infants' hospital stay; (4) 
3-minute video recordings of mother-infant and father-infant face-to-face 
interaction in the laboratory at 4 months of corrected age; (5) self-report 
questionnaires for parents on depression and quality of the couple relationship 
at the approximate times of the video recording sessions.
ETHICS AND DISSEMINATION: The study protocol was approved by the Ethical 
Committee for Clinical Trials of the Verona and Rovigo Provinces. Results aim to 
be published in international peer-reviewed journals, and presented at relevant 
national and international conferences. This research project will develop 
research relevant to (1) the quality and modalities of maternal and paternal 
communication with the preterm infant in the NICU; (2) the influence of 
maternal/paternal social stimulation on the infant behavioural states; (3) the 
quality and modalities of paternal support to the partner and possible 
influences on mother-infant relationship.

Published by the BMJ Publishing Group Limited. For permission to use (where not 
already granted under a licence) please go to 
http://www.bmj.com/company/products-services/rights-and-licensing/.

DOI: 10.1136/bmjopen-2016-013824
PMCID: PMC5293994
PMID: 28153932 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


4555. Nurs Crit Care. 2018 Mar;23(2):75-81. doi: 10.1111/nicc.12277. Epub 2017 Jan 25.

Patients' experience of thirst while being conscious and mechanically ventilated 
in the intensive care unit.

Kjeldsen CL(1), Hansen MS(2), Jensen K(3), Holm A(1), Haahr A(4), Dreyer 
P(5)(6).

Author information:
(1)Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, 
Aarhus, Denmark.
(2)Department of Heart Disease, Aarhus University Hospital, Skejby, Denmark.
(3)Department of Abdominal Surgery, Horsens Regional Hospital, Horsens, Denmark.
(4)Health, VIA University College, Aarhus, Denmark.
(5)Aarhus University Hospital, Department of Anaesthesiology and Intensive Care, 
Nørrebrogade 44, building 21.1, 8000 Aarhus C, Denmark.
(6)Institute of Public Health, Section of Nursing, Aarhus University, 
Høegh-Guldbergs Gade 6A, Building 1633, 8000 Aarhus C, Denmark.

BACKGROUND: Because of changes in sedation strategies, more patients in the 
intensive care unit (ICU) are conscious. Therefore, new and challenging tasks in 
nursing practice have emerged, which require a focus on the problems that 
patients experience. Thirst is one such major problem, arising because the 
mechanical ventilator prevents the patients from drinking when they have the 
urge to do so. To gain a deeper understanding of the patients' experiences and 
to contribute new knowledge in nursing care, this study focuses on the patients' 
experiences of thirst during mechanical ventilation (MV) while being conscious.
AIMS: To explore patients' experience of thirst while being conscious and 
mechanically ventilated.
DESIGN: This hermeneutic study used qualitative interviews of 12 patients.
METHOD: Data were analyzed based on content analysis. Interviews were conducted 
between September and October 2014 in two large ICUs in Denmark.
RESULT: Four themes relating to the patients' experiences of thirst during MV 
were identified: a paramount thirst, a different sense in the mouth, deprivation 
of the opportunity to quench thirst and difficulties associated with thirst.
CONCLUSION: Patients associate feelings of desperation, anxiety and 
powerlessness with the experience of thirst. These feelings have a negative 
impact on their psychological well-being. A strategy in the ICU that includes no 
sedation for critically ill patients in need of MV introduces new demands on the 
nurses who must care for patients who are struggling with thirst.
RELEVANCE TO CLINICAL PRACTICE: This study shows that despite several practical 
attempts to relieve thirst, it remains a paramount problem for the patients. ICU 
nurses need to increase their focus on issues of thirst and dry mouth, which are 
two closely related issues for the patients. Communication may be a way to 
involve the patients, recognize and draw attention to their problem.

© 2017 British Association of Critical Care Nurses.

DOI: 10.1111/nicc.12277
PMID: 28124464 [Indexed for MEDLINE]


4556. Early Hum Dev. 2017 Jan;104:27-31. doi: 10.1016/j.earlhumdev.2016.11.006. Epub 
2016 Dec 12.

Does maternal psychological distress affect neurodevelopmental outcomes of 
preterm infants at a gestational age of ≤32weeks.

Bozkurt O(1), Eras Z(2), Sari FN(3), Dizdar EA(3), Uras N(3), Canpolat FE(3), 
Oguz SS(3).

Author information:
(1)Department of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, 
Ankara, Turkey. Electronic address: dr_kalyoncu@hotmail.com.
(2)Department of Developmental Behavioral Pediatrics, Zekai Tahir Burak 
Maternity Teaching Hospital, Ankara, Turkey.
(3)Department of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, 
Ankara, Turkey.

BACKGROUND: There is some evidence that maternal psychological status in the 
prenatal and postnatal periods is associated with infants' cognitive, 
behavioural, and emotional functions.
AIM: The aim of this study was to examine the relationships of maternal 
depression and anxiety with neurodevelopmental outcomes of preterm infants with 
a gestational age of ≤32weeks, examined at a corrected age of 18 to 22months.
STUDY DESIGN: Cross-sectional study.
SUBJECTS: In total, 220 preterm infants with a gestational age of ≤32weeks who 
were born from January 2008 to September 2011 and admitted to the neonatal 
intensive care unit were prospectively examined.
OUTCOME MEASURES: Neurodevelopmental evaluation was performed at a corrected age 
of 18 to 22months by a developmental paediatrician using the Bayley Scales of 
Infant Development II (BSID-II). The Beck Depression Inventory and Beck Anxiety 
Inventory were used to assess maternal depression and anxiety at the same visit 
as the neurodevelopmental evaluation.
RESULTS: The depression scores of mothers of infants with a Mental Development 
Index (MDI) score of <70 were significantly higher than those of mothers of 
infants with an MDI score of >70 (16.3±12.8 vs 8.8±7.0, p<0.001). The depression 
scores of mothers of infants with neurodevelopmental impairment were also 
significantly higher than those without neurodevelopmental impairment (12.8±10.5 
vs 8.8±7.3, p=0.003). There was no relationship between the presence of cerebral 
palsy or a Psychomotor Developmental Index (PDI) score of <70 and the mothers' 
depression scores. Multiple regression analysis revealed that maternal 
depression and the occurrence of more than two sepsis attacks were associated 
with an MDI score of <70, and grade III to IV intraventricular haemorrhage was 
associated with neurodevelopmental impairment and a PDI score of <70.
CONCLUSION: Maternal depression is negatively associated with the 
neurodevelopment of preterm infants at a gestational age of ≤32weeks. Maternal 
psychological well-being should be taken into consideration during the long-term 
follow-up of preterm infants.

Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

DOI: 10.1016/j.earlhumdev.2016.11.006
PMID: 27978476 [Indexed for MEDLINE]


4557. BMC Pulm Med. 2016 Dec 1;16(1):172. doi: 10.1186/s12890-016-0336-8.

Immediate effect of CPAP titration on perceived health related quality of life: 
a prospective observational study.

Iacono Isidoro S(1), Salvaggio A(2), Lo Bue A(1), Romano S(1), Marrone O(1), 
Insalaco G(1).

Author information:
(1)National Research Council of Italy, Institute of Biomedicine and Molecular 
Immunology "A. Monroy", Via Ugo La Malfa, 153, Palermo, 90146, Italy.
(2)National Research Council of Italy, Institute of Biomedicine and Molecular 
Immunology "A. Monroy", Via Ugo La Malfa, 153, Palermo, 90146, Italy. 
salvaggio@ibim.cnr.it.

BACKGROUND: Perceived Health Related Quality of Life (HRQoL) is impaired in 
obstructive sleep apnea (OSA). This study examines changes in HRQoL aspects 
occurring immediately after CPAP titration. Furthermore, we analyzed variations 
in each gender and in patients undergoing home or laboratory-based CPAP 
titration pathways.
METHODS: Twohundredfive outpatients (151 M) (56.7 ± 10.3 years) were evaluated, 
before first visit and nocturnal diagnostic examination (T0), and the morning 
after CPAP titration (T1). Two self-reported HRQoL questionnaires were 
administered: Psychological General Well-Being Index (PGWBI), composed by six 
subscales, and 12-Item Short-Form Health Survey (SF-12), including Physical 
(PCS) and Mental Component Summaries (MCS). CPAP titration was performed using 
auto-adjusting CPAP units at patients' home or in the sleep laboratory.
RESULTS: PGWBI scores at T1 improved compared to T0 (p < 0.0001). A similar 
improvement was observed in SF-12 MCS (p = 0.0011), but not in SF-12 PCS. 
Changes were independent from anthropometric parameters, OSA severity and 
excessive daytime sleepiness. Gender comparisons showed better HRQoL in males at 
both times. At T0, patients who received home or laboratory CPAP titration 
pathways did not show any differences in PGWBI and SF-12 scores. At T1, PGWBI 
and SF-12 MCS improved in both home and laboratory groups.
CONCLUSIONS: This study gives evidence that first time CPAP application for 
titration can lead to a general increase in perceived well-being. Gender 
comparisons showed better perceived HRQoL with more subscales improvements in 
males after CPAP titration. The improvement was similar with both home and 
laboratory CPAP titration pathways.

DOI: 10.1186/s12890-016-0336-8
PMCID: PMC5133738
PMID: 27905903 [Indexed for MEDLINE]


4558. J Burn Care Res. 2017 Jan/Feb;38(1):e1-e7. doi: 10.1097/BCR.0000000000000465.

The Psychological Impact of First Burn Camp in Nicaragua.

Tropez-Arceneaux LL(1), Castillo Alaniz AT, Lucia Icaza I, Alejandra Murillo E.

Author information:
(1)From the APROQUEN Burn Center, New Orleans, Louisiana.

Asociacion Pro-Ninos Quemados de Nicaragua (APROQUEN) is a comprehensive burn 
center that provides a holistic and integrated approach to treating burns. 
APROQUEN has set the standards internationally with acute treatment for burns, 
intensive care, reconstructive surgeries, nutritional care, rehabilitation, 
occupational therapy, and psychological treatment. APROQUEN is excelling within 
Central and South America with life-saving techniques and quality of care. It is 
imperative that burn centers in Central America recognize that the treatment of 
a child with a burn injury surpasses physical care to include psychological 
treatment for the complete well-being of the child. It is necessary to provide 
the tools necessary to reintegrate the child back into their environment. 
APROQUEN developed and implemented the first burn camp in Latin America, "Confio 
en Mi" (I trust myself). The camp theme focused on self-esteem. The camp program 
included theory (educational) and practice (applied) components where the 
campers through "classroom type" activities had the opportunity to reflect and 
share with other campers and camp staff on self-esteem, depression, and anxiety. 
Participants were children who survived major burns (N = 33; 58% women; ages 
12-25; 61% <18) and were shown to have difficulty socializing. Comprehensive 
interviews were conducted to ensure fit for camp. Forty-two percent of the 
campers had not slept away from home since the burn injury. Mean TBSA = 20% and 
mean age at time of burn injury was 13. The majority of campers (46%) endured 
flame burn injuries, with 24% having scald injuries. Mean years postburn = 
4.8 + 3.2. Most campers (40%) were enrolled in secondary school, 30% in 
elementary school, and 21% in college. Standardized measures (CDI-2 Parent Form 
and Child Form, Rosenberg Scale, APROQUEN Burn Camp Measure Parent and Child 
Form, Beck Anxiety Inventory, and Beck Depression Inventory) were given to all 
campers prior to attending camp. The same measures were given 2 weeks after the 
camp and again at 6 months. Paired samples' t-tests were conducted and 
significance was set at P <.05. The results indicate that Camp Confio en Mi had 
a significant impact on campers' level of anxiety, depression, and self-esteem. 
Future burn camps are an important part of the continued advancement of 
postpediatric burn care in Nicaragua. This study reveals the importance of 
future researches necessity to focus on generalizing the results of this study 
to other children who have experienced similar burn injuries.

DOI: 10.1097/BCR.0000000000000465
PMID: 27893579 [Indexed for MEDLINE]


4559. Food Nutr Res. 2016 Nov 11;60:32162. doi: 10.3402/fnr.v60.32162. eCollection 
2016.

Quality of life in parents of preterm infants in a randomized nutritional 
intervention trial.

Nordheim T(1)(2), Rustøen T(3)(4), Iversen PO(5)(6), Nakstad B(1)(7).

Author information:
(1)Department of Pediatric and Adolescent Medicine, Akershus University 
Hospital, Nordbyhagen, Norway.
(2)Institute for Clinical Medicine, Campus Ahus, University of Oslo, 
Nordbyhagen, Norway; trond.nordheim@medisin.uio.no.
(3)Department of Research and Development, Division of Emergencies and Critical 
Care, Oslo University Hospital, Oslo, Norway.
(4)Department of Nursing Science, Institute of Health and Society, University of 
Oslo, Oslo, Norway.
(5)Department of Nutrition, Institute of Basic Medical Sciences, Faculty of 
Medicine, University of Oslo, Oslo, Norway.
(6)Department of Haematology, Oslo University Hospital, Oslo, Norway.
(7)Institute for Clinical Medicine, Campus Ahus, University of Oslo, 
Nordbyhagen, Norway.

BACKGROUND: Being a parent of a very-low birth weight (VLBW, birth weight <1,500 
g) infant is challenging because of the numerous complications these infants may 
encounter, many of which are caused by inadequate nutrition. Whether the burden 
to the parents increases when their VLBW infant participates in a randomized 
intervention trial (RCT) and is thus exposed to additional risk is unknown.
OBJECTIVE: To examine parental qualify of life (QoL) and well-being after 
participation of their VLBW infants in a nutrition RCT.
DESIGN: QoL and symptoms associated with well-being of parents of VLBW infants 
participating in a nutrition RCT (n=31) and of a reference group (parents of 
nonparticipating VBLW infants, n=31) were examined. Assessments were performed 
when their infants were in the neonatal intensive care unit (NICU) (time point 
T1) and concurrently at 3.5 years of age (time point T2). The parents completed 
the following questionnaires: Quality of Life Scale, Hospital Anxiety and 
Depression Scale, Lee Fatigue Scale (LFS), and General Sleeping Disturbance 
Scale (GSDS).
RESULTS: At T1, the QoL was better among RCT parents (p=0.02). At T2, the RCT 
parents reported less sleep disturbance symptoms (GSDS) (p=0.03) and more energy 
(LFS) (p=0.03).
CONCLUSION: The RCT participation of VLBW infants may have improved parental 
QoL. While in the neonatal unit, symptoms of anxiety and depression were common 
among all parents. The high incidence of anxiety and depression in parents must 
be considered in the care of parents in the NICU. Long-term effects of 
participation seem to be less sleep problems and more energy.

DOI: 10.3402/fnr.v60.32162
PMCID: PMC5107631
PMID: 27839532

Conflict of interest statement: and funding We declare that we have no conflicts 
of interest. Financial support was obtained from the Health Region South Eastern 
Trust of Norway and Akershus University Hospital.


4560. Rev Enferm. 2016 Nov-Dec;39(11-12):14-24.

[How do Sick People and Their Caregivers Live Non-Invasive Ventilation? 
Systematic Literature Review of Qualitative Research].

[Article in Spanish]

Tortajada Gómez N, Soler Blasco R, Toledano Gómez S, Aibar Díaz A, Fernández 
Fabrellas E, Lluch Bisbal MD.

INTRODUCTION: W know that non-invasive ventilation (NIV) is a basic ventilator 
support, but sometimes it fails, because of intolerance, lack of adherence, 
breach, etc. How can we anticipate that failure? We intend to explore the 
qualitative evidence on the experiences of people with this treatment and their 
formal and informal caregivers.
METHOD: Systematic literature review of original articles indexed from 2005 to 
2015, which study the NIV in adult population with qualitative methodology in 
six databases. Peer review of scientific quality with tool of the CASPe Program. 
Qualitative metasynthesis of the findings.
RESULTS: 15 articles met selection criteria, based on Grounded Theory and 
Phenomenology, which use interviews, observation and focus group, directed both 
patients, and families and health professionals. Its studies emphasize the 
feeling of anxiety and loss of control, although the NIV relieves them dyspnea 
(ambivalence). Search daily well-being through routines and active 
participation. Interaction dependence/autonomy, especially in decision-making, 
finding differences that make complex the process information and advance 
directives. Practical wisdom of nursing care 24 hours with patients id described 
basic, and difficulties being narrated: lack of time, overload of work, 
technocentrism, inexperience.
CONCLULSIONS: The qualitative evidence of treatment with VNI is varied although 
scarce; different plots (acute situations, chronic, terminals) are explored, 
from different points of view. The integration of these findings in our practice 
will help us to increase adherence and become the treatment successful, but 
especially to improve the quality of life of ventilated patients and their 
families.

PMID: 30256080 [Indexed for MEDLINE]


4561. Behav Brain Res. 2017 May 15;325(Pt B):303-310. doi: 10.1016/j.bbr.2016.10.020. 
Epub 2016 Oct 12.

Close Collaboration with Parents™ intervention to improve parents' psychological 
well-being and child development: Description of the intervention and study 
protocol.

Ahlqvist-Björkroth S(1), Boukydis Z(2), Axelin AM(3), Lehtonen L(4).

Author information:
(1)Department of Psychology, FI-20014, University of Turku, Finland. Electronic 
address: sarahl@utu.fi.
(2)Department of Pediatrics, FI-20014, University of Turku, Semmelweis Medical 
School & Institute of Psychology, Eotvos Lorand University, Budapest, Hungary. 
Electronic address: zboukydis@gmail.com.
(3)Department of Nursing Science, FI-20014, University of Turku, Finland. 
Electronic address: anna.axelin@utu.fi.
(4)Department of Pediatrics, FI-20014, University of Turku, Finland; Turku 
University Hospital, Finland. Electronic address: liisa.lehtonen@tyks.fi.

Parents of preterm infants commonly experience separation from their infant or 
exclusion from their role as primary caregivers during the hospital care of 
their infant, which may impair parent-infant bonding and parents' psychological 
well-being. Therefore, we developed the Close Collaboration with Parents™ 
intervention to improve staff skills in communicating and collaborating with 
parents in neonatal intensive care units (NICU), to increase parents' presence 
and participation into infant care, and to improve parent-infant bonding and, 
thereby, parents' psychological well-being and later child development. The 
Close Collaboration with Parents™ intervention was developed and carried out at 
Turku University Hospital. The intervention was based on developmental theories 
about early parenthood and parent-infant attachment. The training was targeted 
at both doctors and nurses. The goals of the training included understanding 
individual behaviors and responses of infants and the uniqueness of families, 
using receptive listening skills in communication with parents and making 
decisions collaboratively with them. By increasing the sensitivity of the staff 
to the individual needs of infants and parents and by increasing staff-parent 
collaboration in daily care, the intervention supported parents' presence and 
parents' participation in the care of their infant. The effectiveness of the 
intervention is being evaluated in a prospective study comparing the 
post-intervention cohort (n=113) to the baseline cohort (n=232). The outcomes 
include bonding, long-term psychological well-being of both mothers and fathers 
and child development up to 5 years of age. The Close Collaboration with 
Parents™ intervention potentially offers a preventive and salutogenic model to 
integrate parents and parenting in neonatal hospital care.

Copyright © 2016. Published by Elsevier B.V.

DOI: 10.1016/j.bbr.2016.10.020
PMID: 27743940 [Indexed for MEDLINE]


4562. Int J Environ Res Public Health. 2016 Sep 28;13(10):962. doi: 
10.3390/ijerph13100962.

A Brief Cognitive-Behavioral Psycho-Education (B-CBE) Program for Managing 
Stress and Anxiety of Main Family Caregivers of Patients in the Intensive Care 
Unit.

Chiang VC(1), Chien WT(2), Wong HT(3), Lee RL(4), Ha J(5), Leung SS(6), Wong 
DF(7).

Author information:
(1)School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China. 
vico.chiang@polyu.edu.hk.
(2)School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China. 
wai.tong.chien@polyu.edu.hk.
(3)School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China. 
frank.ht.wong@polyu.edu.hk.
(4)School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China. 
rainbow.l.p.lee@polyu.edu.hk.
(5)School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China. 
juana.ha@gmail.com.
(6)School of Nursing, Hong Kong Baptist Hospital, Hong Kong, China. 
sharronskleung@hkbh.org.hk.
(7)Department of Social Work and Social Administration, The University of Hong 
Kong, Hong Kong, China. dfkwong@hku.hk.

Having a loved one in the intensive care unit (ICU) is a stressful event, which 
may cause a high level of anxiety to the family members. This could threaten 
their wellbeing and ability to support the patients in, or after discharge from, 
the ICU. To investigate the outcomes of a brief cognitive-behavioral 
psycho-education program (B-CBE) to manage stress and anxiety of the main family 
caregivers (MFCs), a pragmatic quasi-experimental study involving 45 
participants (treatment group: 24; control group: 21) was conducted in an ICU. 
The Depression and Anxiety Stress Scale and the Critical Care Family Need 
Inventory were used to evaluate the primary outcomes on stress and anxiety, and 
satisfaction with family needs. The treatment group reported significantly 
better improvement in the information satisfaction score compared to the control 
group (p < 0.05; η² = 0.09). Overall main effects were observed on the stress (p 
< 0.01; η² = 0.20), anxiety (p < 0.01; η² = 0.18), depression (p < 0.05; η² = 
0.13), support satisfaction (p < 0.05; η² = 0.13), and comfort satisfaction (p < 
0.05; η² = 0.11) scores. The experience of this study suggest that MFCs are in 
great need of additional support like B-CBE to manage their stress and anxiety. 
Given the brevity of B-CBE, it is practical for critical care nurses to deliver 
and MFCs to take within the industrious context of an ICU. More studies are 
needed to investigate these types of brief psychological interventions.

DOI: 10.3390/ijerph13100962
PMCID: PMC5086701
PMID: 27690068

Conflict of interest statement: The authors declare no conflict of interest. The 
founding sponsor had no role in the design of the study; in the collection, 
analyses, or interpretation of data; in the writing of the manuscript, and in 
the decision to publish the results.


4563. Med J Aust. 2016 Oct 3;205(7):292-3. doi: 10.5694/mja16.00750.

The possible risks of proton pump inhibitors.

Gracie DJ(1), Ford AC(2).

Author information:
(1)Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK 
A.C.Ford@leeds.ac.uk.
(2)Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, 
Leeds, UK.

DOI: 10.5694/mja16.00750
PMID: 27681962 [Indexed for MEDLINE]


4564. Anaesth Crit Care Pain Med. 2017 Aug;36(4):223-228. doi: 
10.1016/j.accpm.2016.06.011. Epub 2016 Sep 23.

Burnout syndrome in critical care team members: A monocentric cross sectional 
survey.

Malaquin S(1), Mahjoub Y(2), Musi A(3), Zogheib E(4), Salomon A(5), Guilbart 
M(6), Dupont H(7).

Author information:
(1)Surgical Intensive Care Unit, Amiens University Hospital, 80000 Amiens, 
France. Electronic address: Malaquin.stephanie@chu-amiens.fr.
(2)Surgical Intensive Care Unit, Amiens University Hospital, 80000 Amiens, 
France; Inserm U1088, University of Picardy-Jules-Verne, 80000 Amiens, France. 
Electronic address: Mahjoub.yazine@chu-amiens.fr.
(3)Surgical Intensive Care Unit, Amiens University Hospital, 80000 Amiens, 
France. Electronic address: Arianna.musi@hotmail.com.
(4)Cardiac, Thoracic and Vascular Intensive Care Unit, Amiens University 
Hospital, 80000 Amiens, France; Inserm U1088, University of Picardy-Jules-Verne, 
80000 Amiens, France. Electronic address: Zogheib.elie@chu-amiens.fr.
(5)Neurological Intensive Care Unit, Amiens University Hospital, 80000 Amiens, 
France; Inserm U1088, University of Picardy-Jules-Verne, 80000 Amiens, France. 
Electronic address: Salomon.alexis@chu-amiens.fr.
(6)Cardiac, Thoracic and Vascular Intensive Care Unit, Amiens University 
Hospital, 80000 Amiens, France. Electronic address: 
Guilbart.mathieu@chu-amiens.fr.
(7)Surgical Intensive Care Unit, Amiens University Hospital, 80000 Amiens, 
France; Cardiac, Thoracic and Vascular Intensive Care Unit, Amiens University 
Hospital, 80000 Amiens, France; Neurological Intensive Care Unit, Amiens 
University Hospital, 80000 Amiens, France; Inserm U1088, University of 
Picardy-Jules-Verne, 80000 Amiens, France. Electronic address: 
Dupont.herve@chu-amiens.fr.

Comment in
    Anaesth Crit Care Pain Med. 2017 Aug;36(4):247-248.

INTRODUCTION: There has been a growing interest in evaluating the occurrence of 
burnout syndrome (BOS) among intensive care units (ICU) team over recent years. 
The aims of this study were to determine the prevalence of BOS among staff 
working in the Amiens University Hospital and to assess associated factors.
PATIENTS AND METHODS: Prospective observational study based on self-administered 
questionnaires filled in by physicians and non-physicians working in 3 ICUs. 
Demographic data, well-being assessment, work relationships, level of BOS and 
depressive symptoms were investigated. Logistic regression analysis was 
performed to identify variables independently associated with BOS.
RESULTS: One hundred and sixty-one questionnaires were analysed. Participation 
rate was 90%. Thirty-two respondents were physicians and 129 were 
non-physicians. The prevalence of BOS was 51% and was not significantly 
different between physicians and non-physicians (56% versus 50%; P=0.501). 
Respondents who reported BOS less frequently had regular leisure activities (54 
[66%] versus 70 [87%], P=0.001). In the BOS group, well-being was significantly 
lower (4.8±2.5/10 versus 6±2/10, P=0.001), a desire to leave the job was more 
frequently expressed (50 [61%] versus 32 [40%], P=0.009) and depressive symptoms 
were significantly more frequent (41 [50%] versus 21 [27%], P=0.002). Factors 
independently associated with BOS were regular leisure activities (OR 0.24 
[0.1-0.59]; P=0.002), the presence of depressive symptoms (OR 2.71 [1.26-5.84]; 
P=0.011) and a well-being visual analogue scale≥5 (OR 0.40 [0.18-0.89]; 
P=0.024).
CONCLUSIONS: BOS affects all ICU workers and is determined by multiple factors. 
Leisure activities and measures designed to improve well-being should be 
promoted.

Copyright © 2016 Société française d'anesthésie et de réanimation (Sfar). 
Published by Elsevier Masson SAS. All rights reserved.

DOI: 10.1016/j.accpm.2016.06.011
PMID: 27671976 [Indexed for MEDLINE]


4565. J Pediatr. 2016 Dec;179:61-67. doi: 10.1016/j.jpeds.2016.07.008. Epub 2016 Aug 
5.

Social Emotional Factors Increase Risk of Postpartum Depression in Mothers of 
Preterm Infants.

Hawes K(1), McGowan E(2), O'Donnell M(3), Tucker R(2), Vohr B(2).

Author information:
(1)Women and Infants Hospital of Rhode Island, Providence, RI; Alpert School of 
Medicine, Brown University, Providence, RI; College of Nursing, University of 
Rhode Island, Kingston, RI. Electronic address: khawes@wihri.org.
(2)Women and Infants Hospital of Rhode Island, Providence, RI; Alpert School of 
Medicine, Brown University, Providence, RI.
(3)Women and Infants Hospital of Rhode Island, Providence, RI.

Comment in
    J Pediatr. 2016 Dec;179:13-15.

OBJECTIVE: To examine the association of maternal mental health, perceptions of 
readiness at neonatal intensive care unit (NICU) discharge, and social risk 
factors with depressive symptoms 1 month postdischarge in mothers of early (<32 
weeks), moderate (32-33 weeks), and late (34-36 weeks) preterm infants. A 
secondary objective was to compare depressive symptoms among mothers in all 
preterm groups.
STUDY DESIGN: Mothers (n = 734) of preterm infants cared for >5 days in the NICU 
and participating in a Transition Home Program completed the Fragile Infant 
Parent Readiness Evaluation prior to discharge for perceptions of NICU staff 
support, infant well-being, maternal well-being (emotional 
readiness/competency), and maternal comfort (worry about infant). Mental health 
history and social risk factors were obtained. At 1 month postdischarge the 
Edinburgh Postnatal Depression Scale was administered. Group comparisons and 
logistic regression analyses were run to predict possible depression (Edinburgh 
Postnatal Depression Scale  ≥10).
RESULTS: Mothers of early, moderate, and late preterm infants reported similar 
rates of possible depression (20%, 22%, and 18%, respectively) 1 month after 
NICU discharge. History of mental health disorder, decreased perception of 
maternal well-being, decreased maternal comfort regarding infant, and decreased 
perception of family cohesion were associated with possible depression at 1 
month postdischarge.
CONCLUSIONS: Mothers with a previous mental health disorder and experiencing 
negative perceptions of self and infant at NICU discharge were at increased risk 
for depressive symptomatology 1 month postdischarge regardless of infant 
gestational age. Comprehensive mental health assessment prior to discharge is 
essential to identify women at risk and provide appropriate referral.

Copyright © 2016 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jpeds.2016.07.008
PMID: 27502105 [Indexed for MEDLINE]


4566. J Crit Care. 2016 Oct;35:195-9. doi: 10.1016/j.jcrc.2016.05.021. Epub 2016 May 
28.

Music therapy, a review of the potential therapeutic benefits for the critically 
ill.

Mofredj A(1), Alaya S(1), Tassaioust K(1), Bahloul H(1), Mrabet A(1).

Author information:
(1)Service de Réanimation, Centre Hospitalier Général, 13300 Salon de Provence, 
France.

Intensive care units are a stressful milieu for patients, particularly when 
under mechanical ventilation which they refer to as inhumane and anxiety 
producing. Anxiety can impose harmful effects on the course of recovery and 
overall well-being of the patient. Resulting adverse effects may prolong weaning 
and recovery time. Music listening, widely used for stress release in all areas 
of medicine, tends to be a reliable and efficacious treatment for those 
critically ill patients. It can abate the stress response, decrease anxiety 
during mechanical ventilation, and induce an overall relaxation response without 
the use of medication. This relaxation response can lower cardiac workload and 
oxygen consumption resulting in more effective ventilation. Music may also 
improve sleep quality and reduce patient's pain with a subsequent decrease in 
sedative exposure leading to an accelerated ventilator weaning process and a 
speedier recovery.

Copyright © 2016 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jcrc.2016.05.021
PMID: 27481759 [Indexed for MEDLINE]


4567. Neonatal Netw. 2016;35(4):240-2. doi: 10.1891/0730-0832.35.4.240.

Postpartum Mood Disorders Screening in the NICU.

Scheans P(1), Mischel R, Munson M, Bulaevskaya K.

Author information:
(1)Legacy Health in Portland, Oregon, USA.

Maternal depression is increasingly recognized as the leading complication of 
childbearing. A mother's mental health impacts the well-being and long-term 
outcomes of her children. This column will discuss a systematic approach to 
screening for maternal postpartum mood disorders (PPMDs) and referring women to 
resources according to an established algorithm. This work was undertaken in a 
tertiary referral NICU and performed by dedicated NICU personnel with the goals 
of optimizing NICU infants' outcomes and supporting maternal and family health 
and well-being.

DOI: 10.1891/0730-0832.35.4.240
PMID: 27461203 [Indexed for MEDLINE]


4568. BMC Health Serv Res. 2016 Jul 6;16 Suppl 3(Suppl 3):200. doi: 
10.1186/s12913-016-1423-5.

Proceedings of the 3rd IPLeiria's International Health Congress : Leiria, 
Portugal. 6-7 May 2016.

Tomás CC(1), Oliveira E(2)(3), Sousa D(2), Uba-Chupel M(3), Furtado G(3), Rocha 
C(4), Teixeira A(3), Ferreira P(3), Alves C(5)(6), Gisin S(7)(8), Catarino E(9), 
Carvalho N(9), Coucelo T(9), Bonfim L(9), Silva C(9), Franco D(10), González 
JA(11), Jardim HG(12), Silva R(13), Baixinho CL(14), Presado MªH(14), Marques 
MªF(14), Cardoso ME(14), Cunha M(15), Mendes J(15), Xavier A(16), Galhardo 
A(15), Couto M(15), Frade JG(17), Nunes C(18), Mesquita JR(19), Nascimento 
MS(20), Gonçalves G(21), Castro C(22), Mártires A(23), Monteiro MªJ(23), Rainho 
C(23), Caballero FP(24), Monago FM(25), Guerrero JT(26), Monago RM(27), Trigo 
AP(27), Gutierrez ML(26), Milanés GM(26), Reina MG(24), Villanueva AG(28), 
Piñero AS(29), Aliseda IR(26), Ramirez FB(24), Ribeiro A(30), Quelhas A(30), 
Manso C(30), Caballero FP(31), Guerrero JT(26), Monago FM(25), Santos RB(32), 
Jimenez NR(31), Nuñez CG(31), Gomez IR(31), Fernandez MªJL(31), Marquez LA(25), 
Moreno AL(26), Huertas MªJT(31), Ramirez FB(31), Seabra D(33), Salvador MªC(33), 
Braga L(34), Parreira P(35), Salgueiro-Oliveira A(35), Arreguy-Sena C(36), 
Oliveira BF(37), Henriques MªA(14), Santos J(38), Lebre S(38), Marques A(38), 
Festas C(39), Rodrigues S(39), Ribeiro A(39), Lumini J(39), Figueiredo AG(40), 
Hernandez-Martinez FJ(41), Campi L(42), Quintana-Montesdeoca MªP(43), 
Jimenez-Diaz JF(43), Rodriguez-De-Vera BC(43), Parente A(44), Mata MªA(44), 
Pereira AMª(44), Fernandes A(44), Brás M(44), Pinto MªR(45), Parreira P(46), 
Basto ML(47), Rei AC(48), Mónico LM(49), Sousa G(12), Morna C(12), Freitas 
O(12), Freitas G(12), Jardim A(12), Vasconcelos R(12), Horta LG(50), Rosa 
RS(50), Kranz LF(50), Nugem RC(50), Siqueira MS(50), Bordin R(50), Kniess R(51), 
Lacerda JT(51), Guedes J(52), Machado I(52), Almeida S(52), Zilhão A(52), Alves 
H(52), Ribeiro Ó(52), Amaral AP(53), Santos A(53), Monteiro J(53), Rocha 
MªC(53), Cruz R(53), Amaral AP(53), Lourenço M(53), Rocha MªC(53), Cruz R(53), 
Antunes S(53), Mendonça V(53), Andrade I(53), Osório N(53), Valado A(53), 
Caseiro A(53), Gabriel A(53), Martins AC(53), Mendes F(53), Cabral L(54), 
Ferreira M(54), Gonçalves A(54), Luz TD(55), Luz L(55), Martins R(56), Morgado 
A(57), Vale-Dias ML(57), Porta-Nova R(58), Fleig TC(59), Reuter ÉM(59), 
Froemming MB(59), Guerreiro SL(59), Carvalho LL(59), Guedelha D(40), Coelho 
P(40), Pereira A(40), Calha A(60), Cordeiro R(60), Gonçalves A(61), Certo A(61), 
Galvão A(61), Mata MªA(61), Welter A(62), Pereira E(62), Ribeiro S(63), Kretzer 
M(62), Jiménez-Díaz JF(43), Jiménez-Rodríguez C(43), Hernández-Martínez FJ(64), 
Rodríguez-De-Vera BDC(43), Marques-Rodrigues A(65), Coelho P(66), Bernardes 
T(66), Pereira A(66), Sousa P(62), Filho JG(62), Nazario N(62), Kretzer M(62), 
Amaral O(67), Garrido A(68), Veiga N(69), Nunes C(70), Pedro AR(70), Pereira 
C(67), Almeia A(71), Fernandes HM(71), Vasconcelos C(71)(72), Sousa N(71), Reis 
VM(71), Monteiro MJ(71), Mendes R(71)(73), Pinto IC(74), Pires T(75), Gama 
J(76), Preto V(77), Silva N(78), Magalhães C(79), Martins M(80), Duarte M(81), 
Paúl C(82)(83), Martín I(65), Pinheiro AA(84), Xavier S(85), Azevedo J(85), 
Bento E(85), Marques C(85), Marques M(85)(86), Macedo A(85)(86), Pereira AT(85), 
Almeida JP(87), Almeida A(87)(71), Alves J(87), Sousa N(87)(71), Saavedra 
F(87)(71), Mendes R(87)(71)(88), Maia AS(89), Oliveira MT(89), Sousa AR(89), 
Ferreira PP(90), Lopes LS(89), Santiago EC(91), Monteiro S(92), Jesus Â(92), 
Colaço A(92)(93), Carvalho A(92)(93), Silva RP(92)(94), Cruz A(92), Ferreira 
A(95), Marques C(95), Figueiredo JP(95), Paixão S(95), Ferreira A(95), Lopes 
C(95), Moreira F(95), Figueiredo JP(95), Ferreira A(95), Ribeiro D(95), Moreira 
F(95), Figueiredo JP(95), Paixão S(95), Fernandes T(96), Amado D(96), Leal 
J(96), Azevedo M(96), Ramalho S(96)(97), Mangas C(98), Ribeiro J(99), Gonçalves 
R(100), Nunes AF(101), Tuna AR(101), Martins CR(102), Forte HD(102), Costa 
C(103), Tenedório JA(104), Santana P(103), Andrade JA(105), Pinto JL(106), 
Campofiorito C(105), Nunes S(105), Carmo A(106), Kaliniczenco A(105), Alves 
B(107), Mendes F(108), Jesus C(108), Fonseca F(107), Gehrke F(105), Albuquerque 
C(54), Batista R(109), Cunha M(54), Madureira A(54), Ribeiro O(54), Martins 
R(54), Madeira T(110)(111)(112), Peixoto-Plácido C(110)(111)(112), Santos 
N(110)(111), Santos O(110)(111)(112), Bergland A(113), Bye A(113), Lopes 
C(110)(111), Alarcão V(110)(111)(112), Goulão B(110)(111), Mendonça N(110)(114), 
Nicola P(110)(111)(112), Clara JG(110)(111)(112), Gomes J(115)(97), Querido 
A(97), Tomás C(97), Carvalho D(115)(97), Cordeiro M(97), Rosa MC(116), Marques 
A(38), Brandão D(82)(117), Ribeiro Ó(82)(65)(118), Araújo L(82)(119), Paúl 
C(82)(83), Minghelli B(120)(121), Richaud S(121), Mendes AL(122), Marta-Simões 
J(122), Trindade IA(122), Ferreira C(122), Carvalho T(123)(124), Cunha 
M(123)(124), Pinto-Gouveia J(123), Fernandes MC(125), Rosa RS(125), Nugem 
RC(125), Kranz LF(125), Siqueira MS(125), Bordin R(125), Martins AC(53), 
Medeiros A(126), Pimentel R(126), Fernandes A(126), Mendonça C(126), Andrade 
I(53), Andrade S(53), Menezes RL(127), Bravo R(128), Miranda M(129), 
Ugartemendia L(129), Tena JMª(130), Pérez-Caballero FL(31), Fuentes-Broto 
L(131), Rodríguez AB(129), Carmen B(129), Carneiro MA(132), Domingues JN(133), 
Paixão S(133), Figueiredo J(133), Nascimento VB(132), Jesus C(108), Mendes 
F(108), Gehrke F(105), Alves B(132), Azzalis L(134), Fonseca F(132), Martins 
AR(101), Nunes A(101), Jorge A(135), Veiga N(136)(137), Amorim A(136), Silva 
A(136), Martinho L(136), Monteiro L(136), Silva R(136), Coelho C(136), Amaral 
O(54)(67), Coelho I(138), Pereira C(54)(67), Correia A(136)(137), Rodrigues 
D(139), Marante N(139), Silva P(139), Carvalho S(139), Araujo AR(139)(140), 
Ribeiro M(139)(140), Coutinho P(139)(140), Ventura S(139)(140), Roque 
F(139)(140), Calvo C(141), Reses M(141), Conde J(142), Ferreira A(142), 
Figueiredo J(142), Silva D(97), Seiça L(97), Soares R(97), Mourão R(97), Kraus 
T(97), Abreu AC(143), Padilha JM(144), Alves JM(145), Sousa P(146)(83), Oliveira 
M(146), Sousa J(147), Novais S(148), Mendes F(149), Pinto J(38), Cruz J(38), 
Marques A(38), Duarte H(150), Dixe MDA(150), Sousa P(150), Cruz I(151), Bastos 
F(151), Pereira F(151), Carvalho FL(152), Oliveira TT(152), Raposo VR(152), 
Rainho C(23), Ribeiro JC(153), Barroso I(23), Rodrigues V(23), Neves C(152), 
Oliveira TC(152), Oliveira B(147), Morais MªC(154)(155), Baylina P(156), 
Rodrigues R(46), Azeredo Z(157), Vicente C(158), Dias H(159), Sim-Sim M(160), 
Parreira P(35), Salgueiro-Oliveira A(35), Castilho A(35), Melo R(35), Graveto 
J(35), Gomes J(35), Vaquinhas M(35), Carvalho C(161), Mónico L(161), Brito 
N(162), Sarroeira C(163)(164)(165), Amendoeira J(163)(164)(165)(166), Cunha 
F(163)(164)(165), Cândido A(163)(164)(165), Fernandes P(167), Silva HR(167), 
Silva E(167), Barroso I(23), Lapa L(23), Antunes C(23), Gonçalves A(168), Galvão 
A(168), Gomes MªJ(168), Escanciano SR(169), Freitas M(170), Parreira P(35), 
Marôco J(171), Fernandes AR(97), Cabral C(97), Alves S(97), Sousa P(97), 
Ferreira A(172), Príncipe F(172), Seppänen UM(173), Ferreira M(172), Carvalhais 
M(172), Silva M(174), Ferreira M(175), Silva J(175), Neves J(175), Costa D(175), 
Santos B(175), Duarte S(175), Marques S(176), Ramalho S(150), Mendes I(35), 
Louro C(150), Menino E(150), Dixe M(150), Dias SS(150)(177), Cordeiro M(97), 
Tomás C(97), Querido A(97), Carvalho D(97)(115), Gomes J(97)(115), Valim 
FC(178), Costa JO(178), Bernardes LG(178), Prebianchi H(179), Rosa MC(180), 
Gonçalves N(158)(181), Martins MM(158)(181), Kurcgant P(182), Vieira A(66), 
Bento S(183), Deodato S(183), Rabiais I(183), Reis L(181), Torres A(184), Soares 
S(184), Ferreira M(184), Graça P(185), Leitão C(186), Abreu R(186), Bellém 
F(186), Almeida A(186), Ribeiro-Varandas E(186), Tavares A(186), Frade JG(187), 
Henriques C(187), Menino E(187), Louro C(187), Jordão C(187), Neco S(188), 
Morais C(189), Ferreira P(189), Silva CR(190)(181), Brito A(181), Silva A(181), 
Duarte H(150), Dixe MDA(150), Sousa P(150), Postolache G(191), Oliveira R(192), 
Moreira I(193), Pedro L(194), Vicente S(195), Domingos S(196), Postolache 
O(196), Silva D(62), Filho JG(62), Nazario N(62), Kretzer M(62), Schneider 
D(197), Marques FM(47), Parreira P(35), Carvalho C(161), Mónico LM(161), Pinto 
C(161), Vicente S(35), Breda SJ(161), Gomes JH(46), Melo R(46), Parreira P(46), 
Salgueiro A(46), Graveto J(46), Vaquinhas M(46), Castilho A(46), Jesus Â(92), 
Duarte N(92)(198), Lopes JC(92)(199), Nunes H(92)(147), Cruz A(92), 
Salgueiro-Oliveira A(35), Parreira P(35), Basto ML(35), Braga LM(34), Ferreira 
A(184), Araújo B(200), Alves JM(200), Ferreira M(184), Carvalhais M(184), Silva 
M(174), Novais S(201), Sousa AS(200)(202), Ferrito C(203), Ferreira PL(152), 
Rodrigues A(65), Ferreira M(184), Oliveira I(204), Ferreira M(175), Neves 
J(175), Costa D(175), Duarte S(175), Silva J(175), Santos B(175), Martins C(84), 
Macedo AP(84), Araújo O(84), Augusto C(84), Braga F(84), Gomes L(84), Silva 
MA(84), Rosário R(84), Pimenta L(97), Carreira D(97), Teles P(97), Barros T(97), 
Tomás C(97), Querido A(97), Carvalho D(97)(115), Gomes J(97)(115), Cordeiro 
M(97), Carvalho D(115)(97), Querido A(97), Tomás C(97), Gomes J(115)(97), 
Cordeiro M(97), Jácome C(205), Marques A(206), Capelas S(207), Hall A(208)(209), 
Alves D(210)(211), Lousada M(212), Loureiro MªH(35), Camarneiro A(35), Silva 
M(35), Mendes A(35), Pedreiro A(213), G.Silva A(197), Coelho ES(197), Melo 
F(214)(215), Ribeiro F(214)(216), Torres R(217), Costa R(214)(218), Pinho T(38), 
Jácome C(205), Marques A(38), Cruz B(219), Seabra D(161), Carreiras D(220), 
Ventura M(219), Cruz X(38), Brooks D(221), Marques A(38), Pinto MR(45), Parreira 
P(46), Lima-Basto M(222), Neves M(48), Mónico LM(49), Bizarro C(124), Cunha 
M(124), Galhardo A(124), Margarida C(124), Amorim AP(124), Silva E(223), Cruz 
S(201), Padilha JM(151), Valente J(224), Guerrero JT(225), Caballero FP(31), 
Santos RB(128), Gonzalez EP(225), Monago FM(226), Ugalde LU(128), Vélez MM(225), 
Tena MJ(31), Guerrero JT(130), Bravo R(128), Pérez-Caballero FL(31), Becerra 
IA(130), Agudelo MªE(130), Acedo G(130), Bajo R(130), Malheiro I(14), Gaspar 
F(14), Barros L(227), Furtado G(228)(229), Uba-Chupel M(228)(229), Marques 
M(228), Rama L(228), Braga M(228)(230), Ferreira JP(228), Teixeira AMª(228), 
Cruz J(231)(232), Barbosa T(231), Simões Â(231), Coelho L(231)(232), Rodrigues 
A(65), Jiménez-Díaz JF(233), Martinez-Hernandez F(233), Rodriguez-De-Vera 
B(233), Ferreira P(189), Rodrigues A(234), Ramalho A(235), Petrica J(235)(236), 
Mendes P(235), Serrano J(235)(236), Santo I(237), Rosado A(238), Mendonça 
P(239), Freitas K(239), Ferreira D(240), Brito A(240), Fernandes R(240), Gomes 
S(156), Moreira F(156)(241)(242), Pinho C(156)(243), Oliveira R(156)(243)(244), 
Oliveira AI(156)(243), Mendonça P(239), Casimiro AP(245), Martins P(239), Silva 
I(239), Evangelista D(246), Leitão C(247), Velosa F(248), Carecho N(197), Coelho 
L(247)(248), Menino E(150), Dixe A(150), Catarino H(150), Soares F(249), Gama 
E(115), Gordo C(150), Moreira E(92), Midões C(92), Santos M(92), Machado S(92), 
Oliveira VP(92), Santos M(92), Querido A(250), Dixe A(250), Marques R(250)(251), 
Charepe Z(183), Antunes A(252), Santos S(192), Rosa MC(180), Rosa MC(116), 
Marques SF(253), Minghelli B(120), CaroMinghelli E(120)(254), Luís MªJ(192), 
Brandão T(192), Mendes P(235), Marinho D(255), Petrica J(235)(236), Monteiro 
D(256), Paulo R(235)(257), Serrano J(235)(236), Santo I(237), Monteiro L(256), 
Ramalho F(256)(258), Santos-Rocha R(256)(258), Morgado S(256)(259), Bento 
T(256)(260), Sousa G(12), Freitas O(12), Silva I(12), Freitas G(12), Morna 
C(12), Vasconcelos R(12), Azevedo T(261), Soares S(154), Pisco J(262), Ferreira 
PP(90), Olszewer EO(263), Oliveira MT(264), Sousa AR(89), Maia AS(89), Oliveira 
ST(89), Santos E(156), Oliveira AI(156)(265), Maia C(156)(266), Moreira 
F(156)(241)(267), Santos J(156)(268), Mendes MF(156)(266), Oliveira 
RF(156)(266), Pinho C(156)(266), Barreira E(269), Pereira A(269), Vaz JA(269), 
Novo A(269), Silva LD(270)(271), Maia B(270), Ferreira E(270), Pires F(270), 
Andrade R(271)(272), Camarinha L(270), Silva LD(270)(271), Maia B(270), Ferreira 
E(270), Pires F(270), Andrade R(271)(272), Camarinha L(270), César AF(273), Poço 
M(274), Ventura D(275), Loura R(276), Gomes P(277), Gomes C(278), Silva C(279), 
Melo E(280), Lindo J(280), Domingos J(281), Mendes Z(281), Poeta S(281), 
Carvalho T(281), Tomás C(281)(282), Catarino H(281)(282), Dixe MªA(281)(282), 
Ramalho A(235), Rosado A(238), Mendes P(235), Paulo R(235)(257), Garcia I(237), 
Petrica J(235)(236), Rodrigues S(30), Meneses R(30), Afonso C(30), Faria L(30), 
Seixas A(30), Cordeiro M(97), Granjo P(283), Gomes JC(97), Souza NR(228), 
Furtado GE(228), Rocha SV(284), Silva P(272), Carvalho J(272), Morais MA(192), 
Santos S(192), Lebre P(192), Antunes A(285), Calha A(60), Xavier A(286), Cunha 
M(124), Pinto-Gouveia J(286), Alencar L(287)(54), Cunha M(287)(54), Madureira 
A(54), Cardoso I(124)(288), Galhardo A(124)(289), Daniel F(124)(290), Rodrigues 
V(124)(288), Luz L(291), Luz T(291), Ramos MR(292), Medeiros DC(293), Carmo 
BM(291), Seabra A(294), Padez C(295), Silva MC(295), Rodrigues A(296)(62), 
Coelho P(296), Coelho A(296), Caminha M(296), Matheus F(296), Mendes E(63), 
Correia J(63), Kretzer M(296), Hernandez-Martinez FJ(41), Jimenez-Diaz JF(43), 
Rodriguez-De-Vera BC(43), Jimenez-Rodriguez C(43), Armas-Gonzalez Y(42), 
Rodrigues C(46), Pedroso R(46), Apolinário-Hagen J(297), Vehreschild V(297), 
Veloso M(298), Magalhães C(298), Cabral I(298), Ferraz M(298), Nave F(299), 
Costa E(299), Matos F(299), Pacheco J(299), Dias A(236), Pereira C(236), Duarte 
J(236), Cunha M(236), Silva D(236), Mónico LM(161), Alferes VR(161), Brêda 
MªSJ(161), Carvalho C(161), Parreira PM(46), Morais MªC(300)(154), Ferreira 
P(300), Pimenta R(300), Boavida J(301), Pinto IC(302), Pires T(302)(303), Silva 
C(302), Ribeiro M(304)(305), Viega-Branco M(44), Pereira F(112), Pereira 
AMª(44), Almeida FM(62), Estevez GL(62), Ribeiro S(62), Kretzer MR(62), João 
PV(306), Nogueira P(307), Novais S(307), Pereira A(306)(308), Carneiro L(307), 
Mota M(306), Cruz R(309), Santiago L(101), Fontes-Ribeiro C(310), Furtado 
G(229)(56), Rocha SV(311), Coutinho AP(197), Neto JS(197), Vasconcelos LR(311), 
Souza NR(56), Dantas E(312), Dinis A(286), Carvalho S(286), Castilho P(286), 
Pinto-Gouveia J(286), Sarreira-Santos A(47)(170), Figueiredo A(47)(170), 
Medeiros-Garcia L(47)(170), Seabra P(47)(170), Rodrigues R(154), Morais 
MªC(154), Fernandes PO(313), Santiago C(45), Figueiredo MªH(151), Basto ML(47), 
Guimarães T(239), Coelho A(239), Graça A(239), Silva AM(239), Fonseca AR(239), 
Vale-Dias L(161), Minas B(161), Franco-Borges G(161), Simões C(314), Santos 
S(314), Serra A(315), Matos M(315), Jesus L(315), Tavares AS(316), Almeida 
A(316), Leitão C(316), Varandas E(316), Abreu R(316), Bellém F(316), Trindade 
IA(122), Ferreira C(122), Pinto-Gouveia J(122), Marta-Simões J(122), Amaral 
O(54), Miranda C(54), Guimarães P(54), Gonçalves R(54), Veiga N(69), Pereira 
C(54), Fleig TC(59), San-Martin EA(59), Goulart CL(59), Schneiders PB(59), 
Miranda NF(59), Carvalho LL(59), Silva AG(59), Topa J(317)(318), Nogueira 
C(161), Neves S(317)(318), Ventura R(319), Nazaré C(319), Brandão D(82)(117), 
Freitas A(117)(83), Ribeiro Ó(82)(320), Paúl C(83), Mercê C(256), Branco M(256), 
Almeida P(256), Nascimento D(256), Pereira J(256), Catela D(256), Rafael H(47), 
Reis AC(163), Mendes A(321)(322), Valente AR(322)(323), Lousada M(324), Sousa 
D(53), Baltazar AL(53), Loureiro MªH(53), Oliveira A(38), Aparício J(38), 
Marques A(325), Marques A(38), Oliveira A(38), Neves J(326), Ayoub R(326), Sousa 
L(327), Marques-Vieira C(170), Severino S(327), José H(328), Cadorio I(329), 
Lousada M(329)(38), Cunha M(53), Andrade D(53), Galhardo A(53), Couto M(53), 
Mendes F(53), Domingues C(330), Schukg S(331), Abrantes AM(332), Gonçalves 
AC(333), Sales T(332), Teixo R(332), Silva R(332), Estrela J(53), Laranjo 
M(332), Casalta-Lopes J(334), Rocha C(53), Simões PC(334), Sarmento-Ribeiro 
AB(335), Botelho MªF(332), Rosa MS(336), Fonseca V(337), Colaço D(337), Neves 
V(337), Jesus C(108), Hesse C(338), Rocha C(339), Osório N(108), Valado A(108), 
Caseiro A(108), Gabriel A(108), Svensson L(338), Mendes F(108), Siba WA(340), 
Pereira C(341), Tomaz J(341), Carvalho T(123)(124), Pinto-Gouveia J(123), Cunha 
M(123)(124), Duarte D(342), Lopes NV(342)(343), Fonseca-Pinto R(342)(344), 
Duarte D(342), Lopes NV(342)(343), Fonseca-Pinto R(342)(344), Martins AC(345), 
Brandão P(346)(347), Martins L(346), Cardoso M(348)(349), Morais N(350), Cruz 
J(38), Alves N(351), Faria P(351), Mateus A(351), Morouço P(351), Alves N(351), 
Ferreira N(351), Mateus A(351), Faria P(351), Morouço P(351), Malheiro I(14), 
Gaspar F(14), Barros L(227), Parreira P(35), Cardoso A(352), Mónico L(161), 
Carvalho C(161), Lopes A(353), Salgueiro-Oliveira A(35), Seixas A(354), Soares 
V(354), Dias T(354), Vardasca R(355), Gabriel J(355), Rodrigues S(354), Paredes 
H(356)(357), Reis A(356), Marinho S(356), Filipe V(356), Lains J(358), Barroso 
J(356), Da Motta C(286)(359), Carvalho CB(286)(359), Pinto-Gouveia J(286), 
Peixoto E(359), Gomes AA(360)(361), Costa V(362)(363), Couto D(360)(363), 
Marques DR(360)(364), Leitão JA(362)(365), Tavares J(360), Azevedo MH(364), 
Silva CF(360)(361), Freitas J(366), Parreira P(35), Marôco J(171), 
Garcia-Gordillo MA(367), Collado-Mateo D(367), Chen G(368), Iezzi A(369), Sala 
JA(367), Parraça JA(370), Gusi N(367), Sousa J(15), Marques M(15)(37), Jardim 
J(371), Pereira A(65), Simões S(15), Cunha M(15), Sardo P(372), Guedes J(373), 
Lindo J(372), Machado P(374), Melo E(372), Carvalho CB(286)(359), Benevides 
J(286), Sousa M(286), Cabral J(286), Da Motta C(286)(359), Pereira AT(375), 
Xavier S(375), Azevedo J(375), Bento E(375), Marques C(375), Carvalho R(376), 
Marques M(377), Macedo A(375), Silva AM(378), Alves J(378), Gomes AA(378)(361), 
Marques DR(378)(379), Azevedo MªH(379), Silva C(378)(361), Mendes A(342), Lee 
HD(380)(381), Spolaôr N(380), Oliva JT(380), Chung WF(380)(381), Fonseca-Pinto 
R(342)(344), Bairros K(382), Silva CD(382), Souza CA(382), Schroeder SS(382), 
Araújo E(383), Monteiro H(383), Costa R(383), Dias SS(383)(384)(187), Torgal 
J(383), Henriques CG(385)(97), Santos L(97), Caceiro EF(97), Ramalho 
SA(385)(97), Oliveira R(92)(65), Afreixo V(65), Santos J(92), Mota P(92), Cruz 
A(92), Pimentel F(65), Marques R(251), Dixe MªA(386), Querido A(386), Sousa 
P(387), Benevides J(359), Da Motta C(359)(286), Sousa M(359), Caldeira 
SN(359)(388), Carvalho CB(359)(286), Querido A(97), Tomás C(97), Carvalho 
D(97)(115), Gomes J(97)(115), Cordeiro M(97), Costa JO(389), Valim FC(389), 
Ribeiro LC(389), Charepe Z(390), Querido A(391), Figueiredo MªH(374), Aquino 
PS(392), Ribeiro SG(393), Pinheiro AB(392), Lessa PA(394), Oliveira MF(395), 
Brito LS(393), Pinto ÍN(393), Furtado AS(393), Castro RB(392), Aquino CQ(392), 
Martins ES(392), Pinheiro AB(392), Aquino PS(392), Oliveira LL(392), Pinheiro 
PC(392), Sousa CR(392), Freitas VA(392), Silva TM(392), Lima AS(392), Aquino 
CQ(392), Andrade KV(392), Oliveira CA(392), Vidal EF(396), Ganho-Ávila A(397), 
Moura-Ramos M(398), Gonçalves Ó(397), Almeida J(398)(399), Silva A(35), Brito 
I(35), Amado J(400), Rodrigo A(192), Santos S(192), Gomes F(192), Rosa MC(116), 
Marques SF(253), Luís S(401)(345), Cavalheiro L(345)(189), Ferreira P(152)(189), 
Gonçalves R(345)(189), Lopes RS(402)(403)(404), Cavalheiro L(404)(405), Ferreira 
P(405), Gonçalves R(404)(405), Fiorin BH(406)(407)(408), Santos MS(408), 
Oliveira ES(408), Moreira RL(406), Oliveira EA(408), Filho BL(406), Palmeira 
L(409), Garcia T(409), Pinto-Gouveia J(409), Cunha M(15), Cardoso S(409), 
Palmeira L(409), Cunha M(15), Pinto-Gouveia J(409), Marta-Simões J(122), Mendes 
AL(122), Trindade IA(122), Oliveira S(122), Ferreira C(122), Mendes AL(410), 
Marta-Simões J(410), Trindade IA(410), Ferreira C(410), Nave F(411), Campos 
M(342), Gaudêncio I(342), Martins F(342), Ferreira L(342)(344), Lopes 
N(342)(343), Fonseca-Pinto R(342)(344), Rodrigues R(412), Azeredo Z(157), 
Vicente C(158), Silva J(387), Sousa P(387), Marques R(387)(251), Mendes I(412), 
Rodrigues R(412), Azeredo Z(157), Vicente C(348), Vardasca R(355), Marques 
AR(355), Seixas A(354), Carvalho R(413), Gabriel J(355), Ferreira PP(90), 
Oliveira MT(264), Sousa AR(89), Maia AS(89), Oliveira ST(89), Costa PO(89), 
Silva MM(89), Arreguy-Sena C(36), Alvarenga-Martins N(36), Pinto PF(36), 
Oliveira DC(414), Parreira PD(46), Gomes AT(414), Braga LM(34), Araújo O(84), 
Lage I(84), Cabrita J(415), Teixeira L(158), Marques R(251), Dixe MªA(150), 
Querido A(150), Sousa P(183), Silva S(416), Cordeiro E(416), Pimentel J(416), 
Ferro-Lebres V(269), Souza JA(269), Tavares M(269), Dixe MªA(97), Sousa P(97), 
Passadouro R(115), Peralta T(115), Ferreira C(115), Lourenço G(115), Serrano 
J(235), Petrica J(235), Paulo R(235), Honório S(235), Mendes P(235), Simões 
A(40), Carvalho L(40), Pereira A(40), Silva S(417), Sousa P(151)(418), Padilha 
JM(151), Figueiredo D(38), Valente C(38), Marques A(38), Ribas P(76), Sousa 
J(76), Brandão F(419), Sousa C(419), Martins M(76)(420), Sousa P(183), Marques 
R(251), Mendes F(421), Fernandes R(421), Martins E(421), Magalhães C(421), 
Araújo P(422), Grande C(423), Mata MªA(44), Vieitez JG(169), Bianchini B(62), 
Nazario N(62), Filho JG(62), Kretzer M(62), Costa T(424)(181), Almeida 
A(424)(181), Baffour G(424)(181), Almeida A(424)(181), Costa T(424)(181), 
Baffour G(424)(181), Azeredo Z(157), Laranjeira C(157), Guerra M(157), Barbeiro 
AP(157), Ferreira R(425), Lopes S(321), Nunes L(321), Mendes A(321), Martins 
J(62), Schneider D(197), Kretzer M(62), Magajewski F(62), Soares C(321), Marques 
A(321), Batista M(426)(427), Castuera RJ(428), Mesquita H(426), Faustino A(426), 
Santos J(426), Honório S(426)(427), Vizzotto BP(429), Frigo L(429), Pivetta 
HF(430), Sardo D(181), Martins C(84), Abreu W(181), Figueiredo MªC(181), Batista 
M(426), Jimenez-Castuera R(428), Petrica J(426), Serrano J(426), Honório S(426), 
Paulo R(426), Mendes P(426), Sousa P(183), Marques R(251), Faustino A(235), 
Silveira P(235), Serrano J(235), Paulo R(235), Mendes P(235), Honório S(235), 
Oliveira C(431), Bastos F(181), Cruz I(181), Rodriguez CK(432), Kretzer MR(433), 
Nazário NO(433), Cruz P(434), Vaz DC(434)(150), Ruben RB(342), Avelelas F(435), 
Silva S(435), Campos MªJ(435), Almeida M(35), Gonçalves L(436), Antunes L(437), 
Sardo P(280), Guedes J(438), Simões J(280), Machado P(151), Melo E(280), Cardoso 
S(70), Santos O(439), Nunes C(70), Loureiro I(70), Santos F(440), Alves 
G(440)(441)(442), Soar C(443), Marsi TO(443), Silva E(236), Pedrosa D(444), Leça 
A(445), Silva D(236), Galvão A(76), Gomes M(76), Fernandes P(313), Noné A(76), 
Combadão J(446), Ramalhete C(446), Figueiredo P(446), Caeiro P(446), Fontana 
KC(51), Lacerda JT(51), Machado PO(51), Borges R(447), Barbosa F(448), Sá 
D(447), Brunhoso G(449), Aparício G(287), Carvalho A(450), Garcia AP(451), 
Fernandes PO(452)(453), Santos A(451), Veiga N(136)(137), Brás C(136), Carvalho 
I(136), Batalha J(136), Glória M(136), Bexiga F(136)(137), Coelho I(138), Amaral 
O(67), Pereira C(67), Pinho C(#)(454), Paraíso N(#)(455), Oliveira AI(454), Lima 
CF(456), Dias AP(456), Silva P(457)(458), Espada M(459)(460), Marques 
M(457)(461), Pereira A(457)(461), Pereira AMª(462), Veiga-Branco Mª(462), 
Pereira F(112), Ribeiro M(462), Lima V(454), Oliveira AI(454)(463), Pinho 
C(454)(463), Cruz G(454), Oliveira RF(454)(463)(464), Barreiros L(465)(466), 
Moreira F(454)(467)(468), Camarneiro A(35), Loureiro MªH(378), Silva M(35), 
Duarte C(469), Jesus Â(469), Cruz A(469), Mota M(470), Novais S(471), Nogueira 
P(471), Pereira A(470)(308), Carneiro L(471), João PV(470), Lima TM(472), 
Salgueiro-Oliveira A(35), Vaquinhas M(35), Parreira P(35), Melo R(35), Graveto 
J(35), Castilho A(35), Gomes JH(35), Medina MS(473), Blanco VG(474), Santos 
O(110)(111), Lopes E(110)(111), Virgolino A(110)(111), Dinis A(475), Ambrósio 
S(475), Almeida I(475), Marques T(475), Heitor MªJ(475)(476), Garcia-Gordillo 
MA(367), Collado-Mateo D(367), Olivares PR(477), Parraça JA(370), Sala JA(367), 
Castilho A(35), Graveto J(35), Parreira P(35), Oliveira A(35), Gomes JH(35), 
Melo R(35), Vaquinhas M(35), Cheio M(92), Cruz A(92), Pereira OR(478), Pinto 
S(479), Oliveira A(479), Manso MC(479)(480), Sousa C(479), Vinha AF(479)(480), 
Machado MªM(481), Vieira M(400), Fernandes B(239), Tomás T(239), Quirino D(239), 
Desouzart G(97), Matos R(482)(483), Bordini M(97), Mouroço P(351), Matos 
AR(472), Serapioni M(472), Guimarães T(316), Fonseca V(316), Costa A(316), 
Ribeiro J(316), Lobato J(316), Martin IZ(484), Björklund A(484), Tavares 
AI(189), Ferreira P(189)(152), Passadouro R(485), Morgado S(256)(486), Tavares 
N(487), Valente J(487), Martins AC(487), Araújo P(400), Fernandes R(421), Mendes 
F(421), Magalhães C(421), Martins E(421), Mendes P(235), Paulo R(235)(257), 
Faustino A(235), Mesquita H(235), Honório S(235)(257), Batista M(235)(257), 
Lacerda JT(51), Ortiga AB(488), Calvo MªC(51), Natal S(51), Pereira M(100), 
Ferreira M(54), Prata AR(489), Nelas P(54), Duarte J(54), Carneiro J(469), 
Oliveira AI(469)(490), Pinho C(469)(490), Couto C(469)(491), Oliveira 
RF(469)(490), Moreira F(469)(241)(468), Maia AS(492), Oliveira MT(492), Sousa 
AR(492), Ferreira PP(493), Souza GM(492), Almada LF(492), Conceição MA(492), 
Santiago EC(91), Rodrigues S(354), Domingues G(354), Ferreira I(354), Faria 
L(354), Seixas A(354), Costa AR(494), Jesus Â(494), Cardoso A(494)(495), 
Meireles A(494)(413), Colaço A(494)(496), Cruz A(494), Vieira VL(497), Vincha 
KR(497), Cervato-Mancuso AMª(497), Faria M(345), Reis C(345), Cova MP(498), 
Ascenso RT(499)(342), Almeida HA(342), Oliveira EG(342)(500), Santana M(342), 
Pereira R(342), Oliveira EG(342)(500), Almeida HA(342), Ascenso RT(342)(499), 
Jesus R(501), Tapadas R(501), Tim-Tim C(501), Cezanne C(501), Lagoa M(501), Dias 
SS(384)(187), Torgal J(501), Lopes J(342), Almeida H(342), Amado S(350), Carrão 
L(350), Cunha M(287), Saboga-Nunes L(502), Albuquerque C(287), Ribeiro O(54), 
Oliveira S(503), Morais MªC(154), Martins E(421), Mendes F(421), Fernandes 
R(421), Magalhães C(421), Araújo P(400), Pedro AR(504), Amaral O(54), Escoval 
A(504), Assunção V(505), Luís H(506), Luís L(507), Apolinário-Hagen J(297), 
Vehreschild V(297), Fotschl U(508), Lirk G(509), Martins AC(53), Andrade I(53), 
Mendes F(53), Mendonça V(53), Antunes S(53), Andrade I(53), Osório N(53), Valado 
A(53), Caseiro A(53), Gabriel A(53), Martins AC(53), Mendes F(53), Silva 
PA(428), Mónico LM(161), Parreira PM(46), Carvalho C(161), Carvalho C(161), 
Parreira PM(46), Mónico LM(161), Ruivo J(161), Silva V(181), Sousa P(181)(510), 
Padilha JM(181), Ferraz V(511), Aparício G(287), Duarte J(287), Vasconcelos 
C(72)(87), Almeida A(87)(71), Neves J(87), Correia T(87), Amorim H(87), Mendes 
R(87)(71)(88), Saboga-Nunes L(512), Cunha M(287), Albuquerque C(287), Pereira 
ES(167), Santos LS(167), Reis AS(167), Silva HR(167), Rombo J(167), Fernandes 
JC(167), Fernandes P(167), Ribeiro J(513), Mangas C(98), Freire A(100), Silva 
S(416), Francisco I(416), Oliveira A(416), Catarino H(150), Dixe MªA(150), Louro 
MªC(150), Lopes S(150), Dixe A(150), Dixe MªA(150), Menino E(150), Catarino 
H(150), Soares F(514), Oliveira AP(515), Gordo S(150), Kraus T(150), Tomás 
C(150), Queirós P(35), Rodrigues T(146), Sousa P(150), Frade JG(150), Lobão 
C(150), Moura CB(516), Dreyer LC(516), Meneghetti V(516), Cabral PP(516), Pinto 
F(517)(518), Sousa P(519)(520), Esteves MªR(518), Galvão S(53), Tytgat I(521), 
Andrade I(53), Osório N(53), Valado A(53), Caseiro A(53), Gabriel A(53), Martins 
AC(53), Mendes F(53), Casas-Novas M(53), Bernardo H(53), Andrade I(53), Sousa 
G(522), Sousa AP(522), Rocha C(53), Belo P(53), Osório N(53), Valado A(53), 
Caseiro A(53), Gabriel A(53), Martins AC(53), Mendes F(53), Martins F(84), 
Pulido-Fuentes M(523), Barroso I(23), Cabral G(153), Monteiro MJ(23), Rainho 
C(23), Prado A(497), Carvalho YM(497), Campos M(56), Moreira L(56), Ferreira 
J(56), Teixeira A(56), Rama L(56), Campos M(56), Moreira L(56), Ferreira J(56), 
Teixeira A(56), Rama L(56).

Author information:
(1)Health Sciences Research Unit: Nursing, Collegue of College of Health 
Technology of Coimbra, Coimbra, Portugal
(2)Sisters Hospitallers of the Sacred Heart of Jesus, Casa de Saúde Rainha Santa 
Isabel, Coimbra, Portugal
(3)Research Unit for Sport and Physical Activity, Faculty of Sport Sciences and 
Physical Education, University of Coimbra, Coimbra, Portugal
(4)Complementary Sciences- INESCC, Coimbra, Portugal
(5)CUF Hospitals, Lisbon, Portugal
(6)Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal
(7)Swiss Centre for Medical Simulation & Swiss Association of Simulation in 
Healthcare, 4031 Basel, Switzerland
(8)Basel University Hospital, 4056 Basel, Switzerland
(9)HELPO Association, 2750-318 Cascais, Portugal
(10)Centro de Linguística, Universidade de Lisboa, Lisboa, Portugal
(11)Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
(12)Universidade da Madeira, 9000-082 Funchal, Portugal
(13)Serviço de Saúde da Região Autónoma da Madeira, E.P.E., 9004-514 Funchal, 
Portugal
(14)Escola Superior de Enfermagem de Lisboa, 1700-063 Lisboa, Portugal
(15)Instituto Superior Miguel Torga, Coimbra, 3000-132 Coimbra Portugal
(16)Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo 
Comportamental, Universidade de Coimbra, Coimbra, 3001-802 Portugal
(17)Escola Superior de Saúde de Leiria & Unidade de Investigação em Saúde, 
Instituto Politécnico de Leiria, 2411-901 Leiria, Portugal
(18)National School of Public Health & Centro de Investigação em Saúde Pública, 
Universidade Nova de Lisboa, 1600-560 Lisboa, Portugal
(19)Agrarian Superior School, Polytechnic Institute of Viseu, 3500-606 Viseu, 
Portugal
(20)Laboratory of Microbiology, Department of Biological Sciences, Faculty of 
Pharmacy, University of Porto, 4050-313 Porto, Portugal
(21)Unit for Multidisciplinary Biomedical Research, Institute of Biomedical 
Sciences Abel Salazar, University of Porto, 4050-313 Porto, Portugal
(22)Agrupamento de Centros de Saúde (ACES) Baixo Mondego, 3080-199 Figueira da 
Foz, Portugal
(23)Universidade de Trás-os-Montes e Alto Douro, Vila Real, 5001-801 Portugal
(24)Centro de Salud La Paz, Badajoz, 06011 Badajoz España
(25)Centro de Salud San Fernando, Badajoz, 06006 Badajoz España
(26)Complejo Hospitalario Universitario de Badajoz, Badajoz, 06080 Badajoz 
España
(27)Hospital Don Benito-Villanueva, Don Benito, 06400 Badajoz España
(28)Centro de Salud Villanueva Norte, Villanueva de la Serena, 06700 Badajoz 
España
(29)Centro de Salud Gevora, 06180 Gévora, Badajoz España
(30)Universidade Fernando Pessoa, Porto, 4249-004 Portugal
(31)Centro de Salud La Paz, Badajoz, 06011 España
(32)Universidad de Extremadura, Badajoz, 06071 Badajoz España
(33)Faculty of Psychology and Education Sciences, University of Coimbra, 
Coimbra, 3001-802 Coimbra Portugal
(34)Universidade Federal de Viçosa, Viçosa, Minas Gerais 36570-900 Brasil
(35)Escola Superior de Enfermagem de Coimbra, 3046-851 Coimbra, Portugal
(36)Universidade Federal de Juiz de Fora, Juiz de Fora, Minas Gerais 36036-330 
Brasil
(37)Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal
(38)School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
(39)Universidade Fernando Pessoa, 4249-004 Porto, Portugal
(40)Escola Superior de Saúde Dr. Lopes Dias, Instituto Politécnico de Castelo 
Branco, 6000-767 Castelo Branco, Portugal
(41)Cabildo de Lanzarote, 35500 Arrecife, Lanzarote, Las Palmas España
(42)Servicio Canario de la Salud, 35500 Arrecife, Lanzarote, Las Palmas España
(43)Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, 
Las Palmas España
(44)Escola Superior de Saúde, Instituto Politécnico de Bragança, 5300-121 
Bragança, Portugal
(45)Escola Superior de Saúde de Santarém, Santarém, 2005-075 Portugal
(46)Escola Superior de Enfermagem de Coimbra, Coimbra, 3046-851 Portugal
(47)Escola Superior de Enfermagem de Lisboa, Lisboa, 1700-063 Portugal
(48)Hospital Distrital de Santarém, EPE, Santarém, 2005-177 Portugal
(49)Universidade de Coimbra, 3004-504 Coimbra, Portugal
(50)Federal University of Rio Grande do Sul, Porto Alegre Rio Grande do Sul, 
90050-170 Brasil
(51)Universidade Federal de Santa Catarina, Florianópolis, 88040-900 Brasil
(52)Instituto Superior de Serviço Social do Porto, 44600-362 Sra. da Hora, 
Portugal
(53)Escola Superior de Tecnologia da Saúde de Coimbra, São Martinho do Bispo, 
3046-854 Coimbra, Portugal
(54)Escola Superior de Saúde, Instituto Politécnico de Viseu, 3504-510 Viseu, 
Portugal
(55)Universidade Federal de Alagoas, Maceió, Alagoas, 57072-900 Brasil
(56)Faculdade de Ciências do Desporto e Educação Física, Universidade de 
Coimbra, 3040-248 Coimbra, Portugal
(57)Faculty of Psychology and Education Sciences, University of Coimbra, 
Coimbra, 3000-115 Portugal
(58)Escola Superior da Saúde da Cruz Vermelha Portuguesa, Lisboa, 1300-125 
Portugal
(59)Universidade de Santa Cruz do Sul, Santa Cruz do Sul, Rio Grande do Sul 
96815-900 Brasil
(60)Instituto Politécnico de Portalegre, 7301-901 Portalegre, Portugal
(61)Instituto Politécnico de Bragança, Bragança, 5300-121 Portugal
(62)Universidade do Sul de Santa Catarina, Palhoça, Santa Catarina 88137-270 
Brasil
(63)Secretaria Municipal de Saúde de Palhoça, Palhoça, Santa Catarina 88132-149 
Brasil
(64)Cabildo de Lanzarote, 35500 Lanzarote, Las Palmas España
(65)Universidade de Aveiro, 3810-193 Aveiro, Portugal
(66)Escola Superior de Saúde Dr. Lopes Dias, Castelo Branco, 6000-767 Portugal
(67)Centro de estudos em educação, tecnologias e saúde, Instituto Politécnico de 
Viseu, 3504-510 Viseu, Portugal
(68)Casa de Saúde de São Mateus, Viseu, 3500-106 Portugal
(69)Universidade Católica Portuguesa, Viseu, 3504-505 Portugal
(70)Escola Nacional de Saúde Pública, Lisboa, 1600-560 Portugal
(71)Research Centre Sports Sciences, Health Sciences and Human Development, 
University of Trás-os-Montes e Alto Douro, Vila Real, 5001-801 Portugal
(72)Polytechnic Institute of Viseu, Viseu, 3504-510 Portugal
(73)Unidade de Saúde Pública do ACES Douro I—Marão e Douro Norte, Administração 
Regional de Saúde do Norte, IP, 5000-524 Vila Real, Portugal
(74)Núcleo de Investigação e Intervenção no Idoso, Departamento de Tecnologias 
de Diagnóstico e Terapêutica, Escola Superior de Saúde, Instituto Politécnico de 
Bragança, Bragança, 5300-253 Portugal
(75)Centro de Investigação de Montanha, Escola Superior Agrária, Instituto 
Politécnico de Bragança, 5300-253 Bragança, Portugal
(76)Escola Superior de Saúde, Instituto Politécnico de Bragança, 5300-253 
Bragança, Portugal
(77)Programa de Prevenção e Controlo de Infeções e de Resistência aos 
Antimicrobianos, Unidade Local de Saúde do Nordeste, Bragança, 5301-852 Portugal
(78)Departamento de Urgência e Emergência Unidade, Unidade Local de Saúde do 
Nordeste, Bragança, 5301-852 Portugal
(79)Departamento de Enfermagem, Escola Superior de Saúde, Instituto Politécnico 
de Bragança, 5300-121 Bragança, Portugal
(80)Centro de Investigação em Desporto, Saúde e Desenvolvimento Humano, 
Departamento de Enfermagem, Escola Superior de Saúde, Instituto Politécnico de 
Bragança, 5300-121 Bragança, Portugal
(81)Health Superior School of Alto Ave, 4830-345 Póvoa de Lanhoso, Portugal
(82)Unidade de Investigação e Formação sobre Adultos e Idosos, Instituto de 
Ciências Biomédicas Abel Salazar, Universidade do Porto, 4050-313 Porto, 
Portugal
(83)Center for Health Technology and Services Research, Faculdade de Medicina, 
Universidade do Porto, 4200-450 Porto, Portugal
(84)Escola Superior de Enfermagem, Universidade do Minho, Braga, 4710-057 
Portugal
(85)Faculty of Medicine, University of Coimbra, 3000-354 Coimbra, Portugal
(86)Centro de responsabilidade integrado, Serviço Psiquiatria, Centro Hospitalar 
e Universitário de Coimbra, 3000-354 Coimbra, Portugal
(87)University of Trás-os-Montes e Alto Douro, Vila Real, 5001-801 Portugal
(88)Unidade de Saúde Pública, ACES Douro I, Marão e Douro Norte, Administração 
Regional de Saúde do Norte, 5000-524 Vila Real, Portugal
(89)Faculdade Nobre, Feira de Santana, Bahia 44001-008 Brasil
(90)Secretaria de Saúde do Estado da Bahia, Salvador, Bahia 41745-900 Brasil
(91)Hospital Estadual da Criança, Vila Valqueire, Rio de Janeiro Brasil
(92)Escola Superior de Tecnologia da Saúde, Instituto Politécnico do Porto, 
4400-330 Vila Nova de Gaia, Portugal
(93)Centro Hospitalar de São João, EPE, Porto, 4200-319 Porto Portugal
(94)Unidade Local de Saúde de Matosinhos, EPE, 4454 509 Senhora da Hora, 
Portugal
(95)College of Health Technology, Polytechnic Institute of Coimbra, São Martinho 
do Bispo, 3046-854 Coimbra, Portugal
(96)Escola Superior de Saúde de Leiria, Instituto Politécnico de Leiria, 
2411-901 Leiria, Portugal
(97)School of Health Sciences, Polytechnic institute of Leiria, 2411-901 Leiria, 
Portugal
(98)Unidade de Investigação Inclusão e Acessibilidade em Acção “iACT” e Escola 
Superior Educação e Ciências Sociais, Instituto Politécnico de Leiria, 2411-901 
Leiria, Portugal
(99)Unidade de Investigação em Saúde, Escola Superior de Saúde de Leiria eCADR& 
Centro de Investigação Didática e Tecnologia na Formação de Formadores, 
Universidade de Aveiro, 3810-193 Aveiro, Portugal
(100)Instituto Politécnico de Leiria, 2411-901 Leiria, Portugal
(101)Universidade da Beira Interior, Covilhã, 6201-001 Portugal
(102)Unidade de Saúde Pública, Agrupamento de Centros de Saúde Cova da Beira, 
6200-251 Covilhã, Portugal
(103)Centre of Studies on Geography and Spatial Planning, University of Coimbra, 
3000-043 Coimbra, Portugal
(104)Research Centre for Geography and Regional Planning, Universidade Nova de 
Lisboa, 1069-061 Lisboa, Portugal
(105)Biomedical Sciences Department, Paulista University, São Paulo, 04026-002 
Brazil
(106)Pharmacy Department, Paulista University, São Paulo, 04026-002 Brazil
(107)Molecular Laboratory of Diagnosis, ABC Medical School, Santo André, São 
Paulo 09080-650 Brazil
(108)Biomedical Science Department, College of Health Technology of Coimbra, 
Polytechnic Institute of Coimbra, São Martinho do Bispo, 3046-854 Coimbra, 
Portugal
(109)Hospital Sousa Martins, 6300-858 Guarda, Portugal
(110)Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, 
Universidade de Lisboa, 1649-028 Lisboa, Portugal
(111)Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de 
Lisboa, 1649-028 Lisboa, Portugal
(112)Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
(113)Oslo and Akershus University College of Applied Sciences, 0167 Oslo, Norway
(114)Newcastle University Institute for Ageing, Newcastle upon Tyne, NE4 5PL 
United Kingdom
(115)Hospital de Santo André, Centro Hospitalar de Leiria, 2410-197 Leiria, 
Portugal
(116)Secção Autónoma das Ciências da Saúde, Universidade de Aveiro, 3810-193 
Aveiro, Portugal
(117)Faculdade de Medicina da Universidade do Porto, 4200-450 Porto, Portugal
(118)Instituto Superior De Serviço Social Do Porto, 44600-362 Sra. da Hora, 
Portugal
(119)Escola Superior de Educação de Viseu, 3504-501 Viseu, Portugal
(120)Research in Education and Community Intervention, Escola Superior de Saúde 
Jean Piaget, Silves, 8300-025 Portugal
(121)Escola Superior de Saúde Jean Piaget, Silves, 8300-025 Portugal
(122)Cognitive and Behavioural Centre for Research and Intervention, Faculty of 
Psychology and Education Sciences, University of Coimbra, 3000-115 Coimbra, 
Portugal
(123)Centro de Investigação do Núcleo de Estudos e Intervenção 
Cognitivo-Comportamental, Faculdade de Psicologia e Ciências da Educação, 
Universidade de Coimbra, 3001-802 Coimbra, Portugal
(124)Instituto Superior Miguel Torga, Coimbra, 3000-132 Portugal
(125)Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul 
90050-170 Brasil
(126)Municipality of Nordeste, 9630 Nordeste, Azores Portugal
(127)University of Brasilia, Brasília, Distrito Federal 70910-900 Brasil
(128)Universidad de Extremadura, Badajoz, 06071 España
(129)Chrononutrition Laboratory, Department of Physiology, Faculty of Science, 
University of Extremadura, Badajoz, 06071 España
(130)Department of Anestesiology, Complejo Hospitalario Universitario de 
Badajoz, 06080 Badajoz, España
(131)Aragon Institute for Health Research, Zaragoza, 50009 España
(132)ABC Medical School, Santo André, São Paulo 09210-180 Brazil
(133)Department of Complementary Sciences, College of Health Technology of 
Coimbra, Polytechnic Institute of Coimbra, São Martinho do Bispo, 3046-854 
Coimbra, Portugal
(134)Federal University of São Paulo, Diadema campus, Diadema, São Paulo 
09913-030 Brazil
(135)Centro Hospitalar Cova da Beira, Covilhã, 6200-251 Portugal
(136)Departamento de Ciências da Saúde, Universidade Católica Portuguesa, Viseu, 
3504-505 Portugal
(137)Centro de Investigação Interdisciplinar em Saúde, Universidade Católica 
Portuguesa, 3504-505 Viseu, Portugal
(138)Unidade de Saúde Familiar Grão Vasco, Viseu, 3500-177 Portugal
(139)School of Health Sciences, Polytechnic Institute of Guarda, 6301-559 
Guarda, Portugal
(140)Research Unit for Inland Development, Polytechnic Institute of Guarda, 
6301-559 Guarda, Portugal
(141)Centro de Ciências da Saúde, Departamento de Saúde Pública, Universidade 
Federal de Santa Catarina, Florianópolis, Santa Catarina 88040-900 Brasil
(142)College of Health Technology, Polytechnic Institute of Coimbra, 340-162 
Coimbra, Portugal
(143)Oporto Portuguese Institute of Oncology FG, EPE, 4200-072 Porto, Portugal
(144)Porto Nursing School, 4200-072 Porto, Portugal
(145)Oporto Central Hospital, 4099-001 Porto, Portugal
(146)Escola Superior Escola Superior de Enfermagem do Porto, 4200-072 Porto, 
Portugal
(147)Centro Hospitalar do Porto, 4099-001 Porto, Portugal
(148)Instituto de Ciências da Saúde, Universidade Católica Portuguesa, 1649-023 
Lisboa, Portugal
(149)Escola Superior de Enfermagem de S. João de Deus, Universidade de Évora, 
7004-516 Évora, Portugal
(150)Health Research Unit & School of Health Sciences, Polytechnic institute of 
Leiria, 2411-901 Leiria, Portugal
(151)Escola Superior de Enfermagem do Porto, Porto, 4200-072 Portugal
(152)Faculdade de Economia, Universidade de Coimbra, 3004-512 Coimbra, Portugal
(153)Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, 5000-508 
Portugal
(154)Escola Superior de Saúde, Instituto Politécnico de Viana do Castelo, 
4900-347 Viana do Castelo, Portugal
(155)Centro de Estudos e Investigação em Saúde, Universidade de Coimbra, 
3004-512 Coimbra, Portugal
(156)Escola Superior de Tecnologia da Saúde do Porto, Instituto Politécnico do 
Porto, Vila Nova de Gaia, 4400-330 Portugal
(157)Research in Education and Community Intervention, Escola Superior de Saúde 
Jean Piaget, 4405-678 Gulpilhares, Vila Nova de Gaia Portugal
(158)Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, 
4050-313 Porto, Portugal
(159)Escola Superior de Saúde, Instituto Politécnico de Santarém, Santarém, 
2005-075 Portugal
(160)Escola Superior de Enfermagem S. João de Deus, Universidade de Évora, 
7000-811 Évora, Portugal
(161)Faculdade de Psicologia e Ciências da Educação, Universidade de Coimbra, 
3001-802 Coimbra, Portugal
(162)Instituto Politécnico de Viana do Castelo, 4900-347 Viana do Castelo, 
Portugal
(163)Escola Superior de Saúde, Instituto Politécnico de Santarém, 2005-075 
Santarém, Portugal
(164)Unidade de Investigação do Instituto Politécnico de Santarém, 2001-904 
Santarém, Portugal
(165)Unidade de Monitorização de Indicadores em Saúde, Instituto Politécnico de 
Santarém, 2005-075 Santarém, Portugal
(166)Life Quality Research Centre, Instituto Politécnico de Santarém, 2001-904 
Santarém, Portugal
(167)Hospital Prof. Doutor Fernando Fonseca E.P.E., Amadora, 2720-276 Portugal
(168)Instituto Politécnico de Bragança, Bragança, 5300-121 Bragança Portugal
(169)Universidad de León, 24004 León, España
(170)Instituto de Ciências da Saúde, Universidade Católica Portuguesa, Lisboa, 
1649-023 Portugal
(171)Instituto Universitário de Ciências Psicológicas, Sociais e da Vida, 
1149-041 Lisboa, Portugal
(172)Escola Superior de Enfermagem da Cruz Vermelha Portuguesa de Oliveira de 
Azeméis,, 3720-126 Oliveira de Azeméis, Portugal
(173)Oulu University of Applied Sciences, 90250 Oulu, Finlândia
(174)Unidade de Saúde Familiar - Espaço Saúde, Porto, 4100-503 Portugal
(175)Escola Superior de Enfermagem da Cruz Vermelha Portuguesa, 3720-126 
Oliveira de Azeméis, Portugal
(176)Administração Regional de Saúde de Lisboa e Vale do Tejo, 1749-096 Lisboa, 
Portugal
(177)Departamento de Saúde Pública & Centro de Estudos de Doenças Crónicas, 
Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 1169-056 Lisboa, 
Portugal
(178)Faculdade de Medicina, Universidade José do Rosario Vellano, Divinópolis, 
Minas Gerais 35502-634 Brasil
(179)Pontifícia Universidade Católica de Campinas, Campinas, São Paulo 13086-900 
Brasil
(180)Secção Autónoma das Ciências da Saúde, Universidade de Aveiro, Aveiro, 
3810-193 Portugal
(181)Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal
(182)Universidade de São Paulo, 05403-000 São Paulo, Brasil
(183)Universidade Católica Portuguesa, Lisboa, 1649-023 Portugal
(184)Escola Superior de Enfermagem da Cruz Vermelha Portuguesa de Oliveira de 
Azeméis, 3720-126 Oliveira de Azeméis, Portugal
(185)Academia de Teatro, 4465-095 S. Mamede de Infesta, Portugal
(186)Escola Superior de Tecnologia da Saúde de Lisboa, 1990-096 Lisboa, Portugal
(187)Unidade de Investigação em Saúde, Escola Superior de Saúde de Leiria, 
2411-901 Leiria, Portugal
(188)Hospital Santa Maria Maior de Barcelos, 4754-909 Barcelos, Portugal
(189)Centro de Estudos e Investigação em Saúde, Faculdade de Economia, 
Universidade de Coimbra, 3004-512 Coimbra, Portugal
(190)Universidade Católica Portuguesa/Porto, 4202-401 Porto, Portugal
(191)Instituto de Medicina Molecular, Universidade de Lisboa, 1649-028 Lisboa, 
Portugal
(192)Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz quebrada, 
1499-002 Lisboa Portugal
(193)Faculdade de Medicina, Universidade de Porto, 4200-319 Porto, Portugal
(194)Escola Superior de Tecnologias de Saúde, Instituto Politécnico de Lisboa, 
1990-096 Lisboa, Portugal
(195)Escola Superior de Saúde, Universidade Atlântica, 2745-615 Barcarena, 
Portugal
(196)Instituto de Telecomunicações, Lisboa, 1049-001 Portugal
(197)Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina 
88040-900 Brasil
(198)Farmácia Outeiro do Linho, 4440-762 Valongo, Portugal
(199)Hospital Militar Regional n.°1, Porto, 4150-113 Portugal
(200)Universidade Católica Portuguesa, Porto, 4202-401 Portugal
(201)Administração Regional de Saúde do Norte, Porto, 4000-447 Portugal
(202)Centro Hospitalar De São João, E.P.E., Porto, 4200-319 Portugal
(203)Escola Superior de Saúde, Instituto Politécnico de Setúbal, 2910-761 
Setúbal, Portugal
(204)Ordem dos Enfermeiros da zona Centro, Coimbra, 3000-076 Portugal
(205)Research Centre in Physical Activity, Health and Leisure, Faculty of 
Sports, University of Porto, 4200-450 Porto, Portugal
(206)Lab 3R – Respiratory Research and Rehabilitation Laboratory, School of 
Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
(207)Unidade de Surdos, Escola de Referência para a Educação Bilingue, 3830-195 
Ílhavo, Portugal
(208)Center for Research and Development in Mathematics and Applications, 
University of Aveiro, 3810-193 Aveiro, Portugal
(209)Department of Mathematics, University of Aveiro, 3810-193 Aveiro, Portugal
(210)School of Health Care, Polytechnic Institute of Setúbal, 2910-761 Setúbal, 
Portugal
(211)Centro de Linguística da Universidade de Lisboa, Faculdade de Letras, 
Universidade de Lisboa, 1600-214 Lisboa, Portugal
(212)Center for Health Technology and Services Research, School of Health 
Sciences, University of Aveiro, Aveiro, 3810-193 Portugal
(213)Unidade de Investigação em Ciências da Saúde: Enfermagem, Escola Superior 
de Enfermagem de Coimbra, 3046-851 Coimbra, Portugal
(214)School of Health Sciences, University of Aveiro, Aveiro, 3810-193 Aveiro, 
Portugal
(215)Peroneo Centro Terapêutico Lda, Amieiro, Montemor-o-velho, 3140-021 Arazede 
Portugal
(216)Institute for Research in Biomedicine, University of Aveiro, Aveiro, 
3810-292 Portugal
(217)Department of Physiotherapy, North Polytechnic Institute of Health, Gandra, 
4585-116 Portugal
(218)Center for Health Technology and Services Research, University of Aveiro, 
Aveiro, 3810-193 Portugal
(219)Irmandade da Misericórdia de Albergaria-a-Velha, 3850-069 
Albergaria-a-Velha, Portugal
(220)Gabinete de Apoio Psicológico, Instituto Superior Miguel Torga, Coimbra, 
3000-132 Portugal
(221)Rehabilitation Science Institute and Department of Physical Therapy, 
University of Toronto, Toronto, Ontario M5S 1A1 Canada
(222)Unidade de Investigação & Desenvolvimento em Enfermagem, Escola Superior de 
Enfermagem de Lisboa, Lisboa, 1700-063 Portugal
(223)Centro de Tratamento Internacional VillaRamadas, 2460-355 Cela, Alcobaça, 
Portugal
(224)Faculdade de Economia, Universidade do Porto, 4200-464 Porto, Portugal
(225)Complejo Hospitalario Universitario de Badajoz, Badajoz, 06080 España
(226)Centro de Salud San Fernando, Badajoz, 06006 España
(227)Faculdade de Psicologia, Universidade de Lisboa, 1649-013 Lisboa, Portugal
(228)Centro de Investigação do Desporto e da Atividade Física, Faculdade de 
Ciências do Desporto e Educação Física, 3040-156 Coimbra, Portugal
(229)Fundação Capes, Ministério da Educação, 70.040-020 Brasília, Distrito 
Federal Brasil
(230)Faculty of Medicine, University of Porto, Porto, 4200-450 Portugal
(231)School of Education and Social Sciences, Polytechnic Institute of Leiria, 
Leiria, 2411-901 Portugal
(232)Life Quality Research Centre – IPLeiria Branch, Polytechnic Institute of 
Leiria, Leiria, 2411-901 Portugal
(233)Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran 
Canaria, España
(234)Unidade de Cuidados na Comunidade da Ponte da Barca, 4980-620 Ponte da 
Barca, Portugal
(235)Escola Superior de Educação, Instituto Politécnico de Castelo Branco, 
6000-767 Castelo Branco, Portugal
(236)Centro de Estudos em Educação, Tecnologias e Saúde, Escola Superior de 
Saúde, Instituto Politécnico de Viseu, 3504-510 Viseu, Portugal
(237)Studio Osteopatico Franchi, 6512 Giubiasco, Switzerland
(238)Faculty of Human Kinetics, University of Lisbon, 1649-028 Lisboa, Portugal
(239)Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de 
Lisboa, 1549-020 Lisboa, Portugal
(240)Escola Superior Desporto De Rio Maior, Instituto Politécnico de Santarém, 
2040-413 Rio Maior, Portugal
(241)Department of Legal Medicine and Forensic Sciences, Faculty of Medicine, 
University of Porto, 4200-319 Porto, Portugal
(242)Portugal & Pharmaceutical Services, Centro Hospitalar de Vila Nova de 
Gaia/Espinho, EPE, Vila Nova de Gaia, 4400-129 Portugal
(243)Núcleo de Investigação e Intervenção em Farmácia, Centro de Investigação em 
Saúde e Ambiente, Instituto Politécnico do Porto, Vila Nova de Gaia, 4400-330 
Portugal
(244)Secção Autónoma de Ciências da Saúde, Universidade de Aveiro, 3810-193 
Aveiro, Portugal
(245)Hospital SAMS – Serviços de Assistência Médico-social do Sindicato dos 
Bancários, 1849-017 Lisboa, Portugal
(246)North Tyneside General Hospital, Tyne and Wear, NE29 8NH Newcastle UK
(247)Life Quality Research Centre, Instituto Politécnico de Castelo Branco, 
6000-767 Castelo Branco, Portugal
(248)School of Education and Social Sciences, Polytechnic Institute of Leiria, 
2411-901 Leiria, Portugal
(249)Unidade de Saúde Pública, ACES Pinhal Litoral, ARS Centro, 3100-462 Pombal, 
Portugal
(250)Health Research Unit, School of Health Sciences, Polytechnic institute of 
Leiria, 2411-901 Leiria, Portugal
(251)Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, 1649-035 Lisboa, 
Portugal
(252)Associação Portuguesa de Pais e Amigos do Cidadão Deficiente Mental, 
6200-050 Covilhã, Portugal
(253)Unidade de Cuidados na Comunidade, Centro de Saúde de Anadia, 3780-780 
Anadia, Portugal
(254)Fisiatris - Recuperação Física, Lda, Sacavém, 2685-010 Portugal
(255)Research Centre of Sports Sciences, Health Sciences and Human Development, 
Universidade da Beira Interior, Covilhã, 6201-001 Covilhã Portugal
(256)Escola Superior de Desporto de Rio Maior, Instituto Politécnico de 
Santarém, 2040-413 Rio Maior, Portugal
(257)Research, Education and Community Intervention, Instituto Piaget, 3515-776 
Galifonge, Viseu Portugal
(258)Centro Interdisciplinar de Estudo da Performance Humana, Faculdade de 
Motricidade Humana, Universidade Nova de Lisboa, 1499-002 Cruz Quebrada, 
Portugal
(259)Centro de Investigação e Qualidade de Vida, Instituto Politécnico de 
Santarém, 2040-413 Rio Maior, Portugal
(260)Research Centre in Sports Sciences, Health and Human Development, 
University of Trás-os-Montes and Alto Douro, Vila Real, 5001-801 Portugal
(261)Lar Cantinho dos Avós - Santa Casa da Misericórdia de Melgaço, 4960-570 
Melgaço, Portugal
(262)Unidade Local de Saúde do Alto Minho, EPE, 4904-858 Viana do Castelo, 
Portugal
(263)Fundação de amparo à pesquisa e inovação do Espírito Santo, Vitória, 
Esprito Santo 29066-380 Brasil
(264)Universidade Estadual de Feira de Santana, Feira de Santana, Bahia 
44036-900 Brasil
(265)Centro de Investigação em Saúde e Ambiente, Instituto Politécnico do Porto, 
Vila Nova de Gaia, 4400-330 Portugal
(266)Hospital de Santo Antonio, Centro Hospitalar do Porto, EPE, 4099-001 Porto, 
Portugal
(267)Pharmaceutical Services, Centro Hospitalar de Vila Nova de Gaia/Espinho, 
EPE, Vila Nova de Gaia, 4400-129 Portugal
(268)Centro Hospitalar de São João, EPE, Porto, 4200-319 Portugal
(269)Escola Superior de Saúde, Instituto Politécnico de Bragança, Bragança, 
5300-253 Portugal
(270)Unidade Local de Saúde da Guarda, E.P.E, 6300-858 Guarda, Portugal
(271)Clínica Espregueira-Mendes Sports Centre, FIFA Medical Centre of 
Excellence, 4350-415 Porto, Portugal
(272)Faculdade de Desporto, Universidade do Porto, 4200-450 Porto, Portugal
(273)Centro de Ação Social do Concelho de Ílhavo, 3830-201 Ílhavo, Portugal
(274)Zelar, Serviços de Apoio Domiciliário, 3810-232 Aveiro, Portugal
(275)Walk’In Clinics, Esgueira, 3800-042 Aveiro, Portugal
(276)São João de Deus Clinic, 1749-098 Lisboa, Portugal
(277)Arrabida Hospital, 4400-346 Vila Nova de Gaia, Portugal
(278)Yasmin Residence, 2500-064 Caldas da Rainha, Portugal
(279)Faro unit, Algarve Hospital, 8000-386 Faro, Portugal
(280)School of Health Sciences, University of Aveiro, Aveiro, 3810-193 Portugal
(281)School of Health Sciences, Polytechnic institute of Leiria, Leiria, 
2411-901 Portugal
(282)Health Research Unit, Polytechnic institute of Leiria, Leiria, 2411-901 
Portugal
(283)Instituto de Ciências Sociais da Universidade de Lisboa, Universidade de 
Lisboa, 1600-189 Lisboa, Portugal
(284)Núcleo de Estudos em Saúde da População, Universidade Estadual do Sudoeste 
da Bahia, Itapetinga, Bahia 45700-000 Brasil
(285)Casa de Saúde da Idanha, Instituto das Irmãs Hospitaleiras, 2605-077 Belas, 
Portugal
(286)Cognitive-Behavioural Research Centre, Faculty of Psychology and Education 
Sciences, University of Coimbra, 3001-802 Coimbra, Portugal
(287)Centro de estudos em educação, tecnologias e saúde, Escola Superior de 
Saúde, Instituto Politécnico de Viseu, 3504-510 Viseu, Portugal
(288)Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
(289)Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo 
Comportamental, Universidade de Coimbra, 3001-802 Coimbra, Portugal
(290)Centre for Health Studies and Research, University of Coimbra, 3004-512 
Coimbra, Portugal
(291)Universidade Federal de Alagoas, Maceió, 57072-900 Alagoas Brasil
(292)Instituto Federal de Alagoas, Maceió, 57035-660 Alagoas Brasil
(293)Centro Universitário Cesmac, Maceió, 57051-160 Alagoas Brasil
(294)Universidade do Porto, Porto, 4099-002 Portugal
(295)Universidade de Coimbra, Coimbra, 3004-504 Portugal
(296)Escola Superior de Saúde Dr. Lopes Dias, Instituto Politécnico de Castelo 
Branco, Castelo Branco, 6000-767 Portugal
(297)Department for Health Psychology, FernUniversität in Hagen, 58084 Hagen, 
Germany
(298)Universidade Federal do Pará, Belém, Pará 66075-110 Brasil
(299)Escola Superior de Saúde, Universidade do Algarve, Faro, 8000-510 Portugal
(300)Centro de Estudos e Investigação em Saúde, Faculdade de Economia,, 
Universidade de Coimbra, 3004-512 Coimbra, Portugal
(301)Direção geral de Saúde (DGS), 1049-005 Lisboa, Portugal
(302)Instituto Politécnico de Bragança, Bragança, 5300-253 Portugal
(303)Centro de Investigação de Montanha, Escola Superior Agrária, 5300-253 
Bragança, Portugal
(304)Escola Superior Agrária, Instituto Politécnico de Bragança, 5300-253 
Bragança, Portugal
(305)Centro de Estudos Transdisciplinares para o Desenvolvimento, Universidade 
de Trás-os-Montes e Alto Douro, 5000-801 Vila Real, Portugal
(306)Research Centre for Sports Sciences, Health Sciences and Human Development, 
University of Trás-os-Montes e Alto Douro, Vila Real, 5001-801 Portugal
(307)Department of Sport Sciences, Exercise and Health, University of 
Trás-os-Montes e Alto Douro, Vila Real, 5001-801 Portugal
(308)Polytechnic Institute of Setúbal, 2910-761 Setúbal, Portugal
(309)College of Health Technology of Coimbra, Polytechnic Institute of Coimbra, 
São Martinho do Bispo, 3046-854 Coimbra Portugal
(310)Departamento de Farmacologia e Terapêutica, Faculdade de Medicina, 
Universidade de Coimbra, Coimbra, 3000-548 Portugal
(311)Universidade Estadual do Sudoeste da Bahia, Itapetinga, Bahia 45700-000 
Brasil
(312)Universidade Tiradentes, Aracaju, Sergipe & Laboratório de Biociências da 
Motricidade Humana, 49030-620 Aracaju, Brazil
(313)Escola Superior de Tecnologia e Gestão, Instituto Politécnico de Bragança, 
5300-253 Bragança, Portugal
(314)Universidade de Lisboa, 1649-003 Lisboa, Portugal
(315)Universidade de Aveiro, Aveiro, 3810-193 Portugal
(316)Escola superior de tecnologia da saúde de Lisboa, 1990-096 Lisboa, Portugal
(317)Instituto Superior da Maia, 4475-690 Avioso São Pedro, Portugal
(318)Centro Interdisciplinar de Estudos de Género, Instituto Superior de 
Ciências Sociais e Políticas, 1300-663 Lisboa, Portugal
(319)College of Health Technology, Polytechnic Institute of Coimbra, São 
Martinho do Bispo, 3046-854 Coimbra Portugal
(320)Universidade de Aveiro, 3810–193 Aveiro, Portugal e Instituto Superior De 
Serviço Social Do Porto, 44600-362 Sra. da Hora, Portugal
(321)School of Health Sciences, Polytechnic Institute of Setúbal, 2910-761 
Setúbal, Portugal
(322)Institute of Electronics and Informatics Engineering of Aveiro, 3810-193 
Aveiro, Portugal
(323)Department of Education, University of Aveiro, 3810-193 Aveiro, Portugal
(324)Center for Health Technology and Services Research & School of Health 
Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
(325)Pediatrics Emergency Department, Hospital Lusíadas, Porto, 4050 113 
Portugal
(326)Centro Hospitalar do Baixo Vouga, Aveiro, 3814-501 Portugal
(327)Hospital Curry Cabral, Centro Hospitalar Lisboa Central, 1069-166 Lisboa, 
Portugal
(328)Centro de Formação Multiperfil, Luanda, PR - 56Q Angola
(329)Center for Health Technology and Services Research, University of Aveiro, 
Aveiro, 3810-193 Aveiro Portugal
(330)Centre of Investigation in Environment, Genetics and Oncobiology, Faculty 
of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
(331)Biomedical Laboratory Sciences Department, University of Gothenburg, S-405 
30 Gothenburg, Sweden
(332)Biophysics and Biomathematics Institute, Institute for Biomedical Imaging 
and Life Sciences, Faculty of Medicine, University of Coimbra, 3000-354 Coimbra, 
Portugal
(333)Oncobiology and Haematology Laboratory of Applied Molecular Biology & 
Clinical University of Hematology, Faculty of Medicine, University of Coimbra, 
3000-354 Coimbra, Portugal
(334)Radiation Oncology Department, Coimbra Hospital and Universitary Centre, 
3000-075 Coimbra, Portugal
(335)Clinical University of Hematology, Coimbra Hospital and Universitary 
Centre, 3000-075 Coimbra, Portugal
(336)Imunology Institute, Faculty of Medicine, University of Coimbra, 3000-354 
Coimbra, Portugal
(337)Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de 
Lisboa, Lisboa, 1549-020 Portugal
(338)Department of Clinical Chemistry and Transfusion Medicine, Sahlgrenska 
University Hospital, Göteborg, 413 45 Göteborg Switzerland
(339)Complementary Sciences Department, College of Health Technology of Coimbra, 
Polytechnic Institute of Coimbra, São Martinho do Bispo, 3046-854 Coimbra, 
Portugal
(340)Medical Laboratory Sciences Department, Al-Quds University, Abu Dis, P.O 
Box 89, Abu Dis, Palestinian National Authority
(341)Blood Bank Service, Coimbra Hospital and Universitary Center, 3000-075 
Coimbra, Portugal
(342)Escola Superior de Tecnologia e Gestão, Instituto Politécnico de Leiria, 
2411-901 Leiria, Portugal
(343)Centre for the Research and Technology of Agro-Environmental and Biological 
Sciences, University of Trás-os-Montes and Alto Douro, 5001-801 Vila Real, 
Portugal
(344)Instituto de Telecomunicações, Instituto Politécnico de Leiria, 2411-901 
Leiria, Portugal
(345)Escola Superior de Tecnologia da Saúde de Coimbra, São Martinho do Bispo, 
3046-854 Coimbra Portugal
(346)Escola Superior de Saúde, Universidade de Aveiro, 3810-193 Aveiro, Portugal
(347)Center for Health Technology and Services Research, Universidade do Porto, 
4200-450 Porto, Portugal
(348)Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, 
Porto, 4050-313 Porto Portugal
(349)Interdisciplinary Centre of Marine and Environmental Research, Universidade 
do Porto, 4050-123 Porto, Portugal
(350)School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 
Leiria, Portugal
(351)Centre for Rapid and Sustainable Product Development, Polytechnic Institute 
of Leiria, 2430-028 Marinha Grande, Portugal
(352)Birmingham Hospitals, Birmingham, B15 2GW United Kingdom
(353)Instituto Superior de Ciências Sociais e Políticas, 1300-663 Lisboa, 
Portugal
(354)Universidade Fernando Pessoa, Porto, 4249-004 Porto Portugal
(355)Faculdade de Engenharia, Universidade do Porto, 4200-465 Porto, Portugal
(356)Universidade de Trás-os-Montes e Alto Douro, Vila Real, 5001-801 Vila Real, 
Portugal
(357)Instituto de Engenharia de Sistemas e Computadores, Tecnologia e Ciência, 
4200-465 Porto, Portugal
(358)Centro de Medicina de Reabilitação da Região Centro - Rovisco Pais, 
3064-908 Tocha, Portugal
(359)Azores University, São Miguel, 9501-855 Ponta Delgada Portugal
(360)Department of Education and Psychology, University of Aveiro, Aveiro, 
3810-193 Aveiro Portugal
(361)Center for Health Technology and Services Research, Faculty of Medicine, 
University of Porto, Porto, 4200-450 Porto Portugal
(362)Faculty of Psychology and Education Sciences, University of Coimbra, 
Coimbra, 3000-115 Coimbra Portugal
(363)Centro de investigação em educação e ciências do comportamento, 
Universidade de Aveiro, Aveiro, 3810-193 Aveiro Portugal
(364)Instituto de Imagem Biomédica e Ciências da Vida, Faculdade de Medicina, 
Universidade de Coimbra, Coimbra, 3000-548 Coimbra Portugal
(365)Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo 
Comportamental, Universidade de Coimbra, Coimbra, 3001-802 Coimbra Portugal
(366)Instituto de Ciências da Saúde, Universidade Católica Portuguesa, Lisboa, 
1649-023 Lisboa Portugal
(367)University of Extremadura, Badajoz, 06071 Badajoz España
(368)Flinders Health Economics Group, Flinders University, Adelaide, 5001 
Australia
(369)Centre for Health Economics, Monash University, Victoria, 3800 Australia
(370)Universidade de Évora, 7004-516 Évora, Portugal
(371)Centro de Literaturas e Culturas Lusófonas e Europeias, Universidade de 
Lisboa, 1600-214 Lisboa, Portugal
(372)School of Health Sciences, University of Aveiro, Aveiro, 3810-193 Aveiro 
Portugal
(373)Centro Hospitalar do Baixo Vouga, Aveiro, 3814-501 Aveiro, Portugal
(374)Escola Superior de Enfermagem do Porto, Porto, 4200-072 Porto Portugal
(375)Department of Psychological Medicine, Faculty of Medicine, University of 
Coimbra, 3000-354 Coimbra, Portugal
(376)Unidade de Saúde Familiar – Topázio, Eiras, 3020-171 Coimbra Portugal
(377)Instituto Superior Miguel Torga, Coimbra, 3000 Coimbra Portugal
(378)University of Aveiro, Aveiro, 3810-193 Aveiro Portugal
(379)Instituto de Imagem Biomédica e Ciências da Vida, Faculdade de Medicina, 
Universidade de Coimbra, 3000-548 Coimbra, Portugal
(380)Laboratory of Bioinformatics, Graduate Program in Engineering and 
Computing, West Paraná State University, Cascavel, Paraná 85819-110 Brasil
(381)Universidade Estadual de Campinas, Campinas, São Paulo 13083-970 Brasil
(382)Fundação Universidade Regional de Blumenau, Blumenau, Santa Catarina 
89012-900 Brasil
(383)Departamento de Saúde Pública, Faculdade de Ciências Médicas, Universidade 
Nova de Lisboa, 1169-056 Lisboa, Portugal
(384)Centro de Estudos de Doenças Crónicas, Universidade Nova de Lisboa, 
1150-082 Lisboa, Portugal
(385)Health Research Unit, Polytechnic institute of Leiria, 2411-901 Leiria, 
Portugal
(386)Health Research Unit & School of Health Sciences, Polytechnic Institute of 
Leiria, 2411-901 Leiria, Portugal
(387)Universidade Católica Portuguesa, Lisboa, 1649-023 Lisboa Portugal
(388)Centro Interdisciplinar de Ciências Sociais, Universidade dos Açores, São 
Miguel, 9501-855 Ponta Delgada, Região Autónoma dos Açores Portugal
(389)Faculdade de Medicina, Universidade José do Rosario Vellano, Divinópolis, 
Minas Gerais, 35502-634 Brasil
(390)Universidade Católica Portuguesa, Lisboa, 1649-023 Lisboa, Portugal
(391)Health Research Unit, School of Health Sciences, Polytechnic Institute of 
Leiria, 2411-901 Leiria, Portugal
(392)Federal University of Ceará, Fortaleza, Ceará 60020-181 Brazil
(393)Federal University of Piauí, Teresina, Piauí, 64049-550 Brazil
(394)Federal Institute of Education, Science and Technology of Ceará, Fortaleza, 
Ceará, 60040-531 Brazil
(395)Federal University of Cariri, Juazeiro do Norte, Ceará, 63048-080 Brazil
(396)Federal University of Cariri, Juazeiro do Norte, Ceará 63048-080 Brazil
(397)Centro de Investigação em Psicologia, Escola de Psicologia, Universidade do 
Minho, 4710-057 Braga, Portugal
(398)Cognitive and Behavioural Centre for Research and Intervention, Faculty of 
Psychology and Educational Sciences, University of Coimbra, 3000-115 Coimbra, 
Portugal
(399)PROACTION Laboratory, 3001-802 Coimbra, Portugal
(400)Universidade Católica Portuguesa, Porto, 4202-401 Porto Portugal
(401)Cáritas Diocesana de Coimbra - Centro Rainha Santa Isabel, 3030-382 
Coimbra, Portugal
(402)Cáritas Diocesana de Coimbra, Centro Rainha Santa Isabel, 3030-382 Coimbra 
Portugal
(403)Fundação Mário da Cunha Brito, 3360-908 S. Pedro de Alva, Portugal
(404)Escola Superior de Tecnologia da Saúde de Coimbra, Instituto Politécnico de 
Coimbra, São Martinho do Bispo, 3046-854 Coimbra, Portugal
(405)Centro de Estudos e Investigação em Saúde da Universidade Coimbra, 
Faculdade de Economia, Universidade de Coimbra, 3004-512 Coimbra, Portugal
(406)Universidade Federal de São Paulo, São Paulo, 04021-001 Brasil
(407)Escola superior de Ciências da Santa Casa de Misericórdia de Vitória, 
Vitória- Esprito Santo, 29045-402 Brasil
(408)Faculdade Católica Salesiana do Espírito Santo, Vitória- Esprito Santo, 
29017-950 Brasil
(409)Cognitive-Behavioural Research Centre, Faculty of Psychology and Education 
Sciences, University of Coimbra, Coimbra, 3001-802 Coimbra Portugal
(410)Cognitive and Behavioural Centre for Research and Intervention, Faculty of 
Psychology and Education Sciences, University of Coimbra, Coimbra, 3000-115 
Coimbra Portugal
(411)Centro de Estudos em Saúde, Escola Superior de Saúde, Universidade do 
Algarve, 8000-510 Faro, Portugal
(412)Escola Superior de Enfermagem de Coimbra, Coimbra, 3046-851 Coimbra 
Portugal
(413)Centro Hospitalar do Porto, Porto, 4099-001 Porto Portugal
(414)Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 20550-900 Brasil
(415)Faculdade de Farmácia, Universidade de Lisboa, 1649-003 Lisboa, Portugal
(416)Unidade de Saúde Pública, Centro Hospitalar do Baixo Vouga, Aveiro, 
3814-501 Portugal
(417)Centro Hospitalar do Porto, Porto, 4099-001 Portugal
(418)Center for Health Technology and Services Research, Faculty of Medicine, 
University of Porto, Porto, 4099-002 Portugal
(419)Centro Hospitalar Tâmega e Sousa, Penafiel, 4564-007 Portugal
(420)Centro de Investigação em Desporto, Saúde e Desenvolvimento Humano, Escola 
Superior de Saúde, Instituto Politécnico de Bragança, Bragança, 5300-253 
Portugal
(421)Centro de Estudos em Educação, Tecnologias e Saúde, Escola Superior de 
Educação de Viseu, 3504-501 Viseu, Portugal
(422)Universidade Católica Portuguesa – Porto, 4202-401 Porto, Portugal
(423)Unidade Local de Saúde do Nordeste, Bragança, 5301-852 Portugal
(424)Instituto de Ciências da Saúde, Universidade Católica Portuguesa, Porto, 
4202-401 Porto Portugal
(425)Escola Superior de Saúde, Instituto Politécnico de Santarém, Santarém, 
2005-075 Santarém, Portugal
(426)Instituto Politécnico de Castelo Branco, 6000-767 Castelo Branco, Portugal
(427)Research in Education and Community Intervention, Instituto Piaget, 
3515-776 Galifonge, Viseu Portugal
(428)Universidad de Extremadura, 10003 Cáceres, España
(429)Centro Universitário Franciscano, Santa Maria, Rio Grande do Sul 97010-032 
Brasil
(430)Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul 
97105-900 Brasil
(431)Unidade de Transplante Hepático e Pancreático, Centro Hospitalar do Porto, 
4099-001 Porto, Portugal
(432)Universidade Estadual Paulista ‘Júlio de Mesquita Filho”, 01049-010 São 
Paulo, Brazil
(433)Universidade do Sul de Santa Catarina, Palhoça, Santa Catarina 88137-270 
Brazil
(434)Coimbra Chemistry Centre, Chemistry Department, University of Coimbra, 
3004-535 Coimbra, Portugal
(435)MARE, Instituto Politécnico de Leiria, Peniche, 2520-641 Portugal
(436)Hospital Arcebispo João Crisóstomo, Cantanhede, 3060 Cantanhede Portugal
(437)Hospital José Luciano de Castro, Anadia, 3780-226 Anadia Portugal
(438)Hospital de Aveiro, Centro Hospitalar do Baixo Vouga E.P.E., Aveiro, 
3814-501 Portugal
(439)Instituto de Medicina Preventiva, Faculdade de Medicina de Lisboa, 
Universidade de Lisboa, 1649-028 Lisboa, Portugal
(440)Faculty of Health Sciences, University of Beira Interior, Covilhã, 6200-506 
Covilhã Portugal
(441)Health Sciences Research Centre, University of Beira Interior, Covilhã, 
6200-506 Covilhã Portugal
(442)Centre for Neuroscience and Cell Biology, University of Coimbra, 3004-504 
Coimbra, Portugal
(443)Universidade do Vale do Paraíba, São José dos Campos, São Paulo 12244-000 
Brasil
(444)Maternidade Daniel de Matos, Centro Hospitalar e Universitário de Coimbra, 
3000-075 Coimbra, Portugal
(445)Hospital Dr. Nélio Mendonça, Região Autónoma da Madeira, Funchal, 9004-514 
Portugal
(446)Universidade New Atlântica, 2745-615 Barcarena, Portugal
(447)Universidade Federal do Amapá, Macapá, Amapá 68903-419 Brasil
(448)Universidade Federal do Sergipe, São Cristóvão, Sergipe 49100-000 Brasil
(449)Centro Hospitalar de Trás –os-Montes e Alto Douro, Vila Real, 5000-508 
Portugal
(450)Escola Superior de Enfermagem de Vila Real, Universidade de Trás –os-Montes 
e Alto Douro, Vila Real, 5000-232 Lordelo Portugal
(451)Health Sciences Research Centre, Faculty of Health Sciences, University of 
Beira Interior, Covilhã, 6201-001 Portugal
(452)Unidade de Investigação Aplicada em Gestão, Instituto Politécnico de 
Bragança, Bragança, 5300-253 Portugal
(453)Research Unit in Business Sciences, University of Beira Interior, Covilhã, 
6201-001 Portugal
(454)Escola Superior de Tecnologia da Saúde do Porto, Instituto Politécnico do 
Porto, Vila Nova de Gaia, 4400-330 Vila Nova de Gaia, Portugal
(455)Universidade Federal da Bahia, Salvador da Bahia, 0170-115 Brazil
(456)Centro de Investigação e de Tecnologias Agro-Ambientais e Biológicas, 
Universidade de Trás-os-Montes e Alto Douro, 5001-801 Vila Real, Portugal & 
Universidade do Minho, 4704-553 Braga, Portugal
(457)Universidade da Beira Interior, Covilhã, 6201-001 Covilhã, Portugal
(458)Associação de Melhoramentos Pró Outeiro, Oliveira de Azeméis, 3720-514 
Santiago de Riba-Ul Portugal
(459)School of Education, Polytechnic Institute of Setúbal, 2910-761 Setúbal, 
Portugal
(460)Centro Interdisciplinar da Performance Humana, Faculdade de Motricidade 
Humana, Universidade de Lisboa, 1499-002 Cruz Quebrada, Portugal
(461)Research Centre Sports Sciences, Health Sciences and Human Development, 
University of Trás-os-Montes e Alto Douro, Vila Real, 5001-801 Vila Real, 
Portugal
(462)Escola Superior de Saúde de Bragança, Instituto Politécnico de Bragança, 
5300-121 Bragança, Portugal
(463)Centro de Investigação em Saúde e Ambiente, Instituto Politécnico do Porto, 
Vila Nova de Gaia, 4400-330 Vila Nova de Gaia, Portugal
(464)Secção Autónoma das Ciências da Saúde, Universidade de Aveiro, Aveiro, 
3810-193 Aveiro, Portugal
(465)UCBIO-REQUIMTE Rede de Química e Tecnologia, 4051-401 Porto, Portugal
(466)Departamento de Ciências Químicas, Faculdade de Farmácia, Universidade do 
Porto, Porto, 4050-313 Porto Portugal
(467)Department of Legal Medicine and Forensic Sciences, Faculty of Medicine, 
University of Porto, Porto, 4200-319 Porto Portugal
(468)Pharmaceutical Services, Centro Hospitalar de Vila Nova de Gaia/Espinho, 
EPE, Vila Nova de Gaia, 4400-129 Vila Nova de Gaia, Portugal
(469)Escola Superior de Tecnologia da Saúde do Porto, Instituto Politécnico do 
Porto, Vila Nova de Gaia, 4400-330 Vila Nova de Gaia Portugal
(470)Research Centre for Sports Sciences, Health Sciences and Human Development, 
University of Trás-os-Montes e Alto Douro, Vila Real, 5001-801 Vila Real 
Portugal
(471)Department of Sport Sciences, Exercise and Health, University of 
Trás-os-Montes e Alto Douro, Vila Real, 5001-801 Vila Real Portugal
(472)Centro de Estudos Sociais, Universidade de Coimbra, 3000-995 Coimbra, 
Portugal
(473)GyM Prevención, Burgos, 09007 Burgos, España
(474)Universidad de Burgos, 09001 Burgos, España
(475)Faculdade de Medicina da Universidade de Lisboa, Lisboa, 1649-028 Lisboa 
Portugal
(476)Hospital Beatriz Ângelo, Loures, 2674-514 Loures Portugal
(477)Universidad Autonoma de Chile, Talca, 1670 Talca Chile
(478)Escola Superior de Saúde, Instituto Politécnico de Bragança, Bragança, 
5300-121 Bragança Portugal
(479)Unidade de Investigação UFP em Energia, Ambiente e Saúde & Centro de 
Estudos em Biomedicina, Fundação Fernando Pessoa, Porto, 4249-004 Porto Portugal
(480)REQUIMTE/LAQV, Departamento de Ciências Químicas, Faculdade de Farmácia, 
Universidade do Porto, 4050-313 Porto, Portugal
(481)Escola Superior de Enfermagem, Universidade do Minho, Braga, 4710-057 Braga 
Portugal
(482)Life Quality Research Centre, Polytechnic Institute of Santarém, 2001-904 
Santarém, Portugal
(483)Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal
(484)Jönköping University Foundation, 551 11 Jönköping, Sweden
(485)ACES Pinhal Litoral, ARS Centro, Coimbra, 3001-553 Coimbra Portugal
(486)Instituto Superior de Ciências Policiais e Segurança Interna, 1349-040 
Lisboa, Portugal
(487)Escola Superior de Tecnologia da Saúde de Coimbra, Instituto Politécnico de 
Coimbra, São Martinho do Bispo, 3046-854 Coimbra Portugal
(488)Secretaria de estado da saúde de Santa Catarina, Florianópolis, Santa 
Catarina 88015-130 Brasil
(489)Hospital Pêro da Covilhã, Centro Hospitalar Cova da Beira EPE, 6200-251 
Covilhã, Portugal
(490)Centro de Investigação em Saúde e Ambiente, Instituto Politécnico do Porto, 
Vila Nova de Gaia, 4400-330 Vila Nova de Gaia Portugal
(491)Serviços farmacêuticos, Hospital Pedro Hispano, Unidade Local de Saúde de 
Matosinhos, EPE, 4454 509 Senhora da Hora, Portugal
(492)Faculdade Nobre, Feira de Santana, Bahia, 44001-008 Brasil
(493)Secretaria de Saúde do Estado da Bahia, Salvador, Bahia, 41745-900 Brasil
(494)Escola Superior de Tecnologia da Saúde, Instituto Politécnico do Porto, 
Vila Nova de Gaia, 4400-330 Vila Nova de Gaia Portugal
(495)Instituto Português de Oncologia do Porto FG, EPE, Porto, 4200-072 Porto 
Portugal
(496)Centro Hospitalar São João, Porto, 4200-319 Porto Portugal
(497)Universidade de São Paulo, São Paulo, 05403-000 Brasil
(498)VOID – Software Development, 2415-767 Leiria, Portugal
(499)Centre for Research in Informatics and Communications, Polytechnic 
Institute of Leiria, 2411-901 Leiria, Portugal
(500)Instituto de Engenharia de Sistemas e Computadores de Coimbra, 3000-033 
Coimbra, Portugal
(501)Nova Medical School, Universidade Nova de Lisboa, 1169-056 Lisboa, Portugal
(502)Escola Nacional de Saúde Publica, Lisboa, 1600-560 Lisboa Portugal
(503)Escola Superior de Tecnologia e Saúde, Instituto Politécnico do Porto, 
4400-330 Vila Nova de Gaia, Portugal
(504)Escola Nacional de Saúde Pública, Lisboa, 1600-560 Lisboa Portugal
(505)Escola Superior de Saúde, Instituto Politécnico de Portalegre, Portalegre, 
7301-901 Portalegre Portugal
(506)Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, 1649-003 
Lisboa Portugal
(507)Escola Superior de Saúde, Instituto Politécnico de Leiria, 2411-901 Leiria, 
Portugal
(508)Department of Biomedical Sciences, University of Applied Sciences Salzburg, 
A-5412 Puch, Salzburg Austria
(509)Department of Medical and Bioinformatics, University of Applied Sciences 
Upper Austria, Hagenberg, A-4232 Hagenberg Austria
(510)Center for Health Technology and Services Research, Faculty of Medicine, 
University of Porto, 4099-002 Porto, Portugal
(511)Centro Hospitalar de Trás–os-Montes e Alto Douro, Vila Real, 5000-508 
Portugal
(512)Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Publica, 
1600-560 Lisboa, Portugal
(513)Escola Superior de Saúde de Leiria eCADR& Centro de Investigação Didática e 
Tecnologia na Formação de Formadores, Universidade de Aveiro, 3810-193 Aveiro, 
Portugal
(514)Unidade de Saúde Pública - ACES Pinhal Litoral, ARS Centro, 3100-462 
Pombal, Portugal
(515)Consulta Externa de Pediatria, Centro Hospitalar de Leiria, 2410-197 
Leiria, Portugal
(516)Universidade do Oeste do Paraná, Foz do Iguaçu, Paraná 85851-100 Brasil
(517)Centro de Investigação Interdisciplinar em Saúde, Universidade Católica 
Portuguesa/Porto, 4202-401 Porto, Portugal
(518)Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da 
Saúde, Cooperativa De Ensino Superior Politécnico Universitário, Instituto 
Politécnico de Saúde do Norte, 4585-116 Gandra, Portugal
(519)Escola Superior de Enfermagem do Porto, Porto, 4200-072 Porto, Portugal
(520)Centre for Health Technology and Services Research, Faculdade de Medicina 
da Universidade do Porto, 4200-450 Porto, Portugal
(521)University Thomas More, B - 2800 Mechelen, Belgium
(522)Instituto Português do Sangue e da Transplantação, Lisboa, 1000-208 
Portugal
(523)Facultad de Terapia Ocupacional, Logopedia y Enfermería, Universidad de 
Castilla-La Mancha, 45600 Talavera de la Reina, Toledo España
(#)Contributed equally

S1 Health literacy and health education in adolescence Catarina Cardoso Tomás S2 
The effect of a walking program on the quality of life and well-being of people 
with schizophrenia Emanuel Oliveira, D. Sousa, M. Uba-Chupel, G. Furtado, C. 
Rocha, A. Teixeira, P. Ferreira S3 Diagnosis and innovative treatments - the way 
to a better medical practice Celeste Alves S4 Simulation-based learning and how 
it is a high contribution Stefan Gisin S5 Formative research about 
acceptability, utilization and promotion of a home fortification programme with 
micronutrient powders (MNP) in the Autonomous Region of Príncipe, São Tomé and 
Príncipe Elisabete Catarino, Nelma Carvalho, Tiago Coucelo, Luís Bonfim, Carina 
Silva S6 Safety culture of the patient: a reflexion about the therapeutic 
approach on the patient with vocal pathology Débora Franco S7 About wine, 
fortune cookies and patient experience Jesús Alcoba González O1 The 
psychological impact on the emergency crews after the disaster event on February 
20, 2010 Helena G. Jardim, Rita Silva O2 Musculoskeletal disorders in midwives 
Cristina L. Baixinho, Mª Helena Presado, Mª Fátima Marques, Mário E. Cardoso O3 
Negative childhood experiences and fears of compassion: Implications for 
psychological difficulties in adolescence Marina Cunha, Joana Mendes, Ana 
Xavier, Ana Galhardo, Margarida Couto O4 Optimal age to give the first dose of 
measles vaccine in Portugal João G. Frade, Carla Nunes, João R. Mesquita, Maria 
S. Nascimento, Guilherme Gonçalves O5 Functional assessment of elderly in 
primary care Conceição Castro, Alice Mártires, Mª João Monteiro, Conceição 
Rainho O6 Smoking and coronary events in a population of Spanish health-care 
centre: An observational study Francisco P. Caballero, Fatima M. Monago, Jose T. 
Guerrero, Rocio M. Monago, Africa P. Trigo, Milagros L. Gutierrez, Gemma M. 
Milanés, Mercedes G. Reina, Ana G. Villanueva, Ana S. Piñero, Isabel R. Aliseda, 
Francisco B. Ramirez O7 Prevalence of musculoskeletal injuries in Portuguese 
musicians Andrea Ribeiro, Ana Quelhas, Conceição Manso O8 Hip fractures, 
psychotropic drug consumption and comorbidity in patients of a primary care 
practice in Spain Francisco P. Caballero, Jose T. Guerrero, Fatima M. Monago, 
Rafael B. Santos, Nuria R. Jimenez, Cristina G. Nuñez, Inmaculada R. Gomez, Mª 
Jose L. Fernandez, Laura A. Marquez, Ana L. Moreno, Mª Jesus Tena Huertas, 
Francisco B. Ramirez O9 The role of self-criticism and shame in social anxiety 
in a clinical SAD sample Daniel Seabra, Mª Céu Salvador O10 Obstruction and 
infiltration: a proposal of a quality indicator Luciene Braga, Pedro Parreira, 
Anabela Salgueiro-Oliveira, Cristina Arreguy-Sena, Bibiana F. Oliveira, Mª 
Adriana Henriques O11 Balance and anxiety and depression symptoms in old age 
people Joana Santos, Sara Lebre, Alda Marques O12 Prevalence of postural changes 
and risk factors in school children and adolescents in a northern region (Porto) 
Clarinda Festas, Sandra Rodrigues, Andrea Ribeiro, José Lumini O13 Ischemic 
stroke vs. haemorrhagic stroke survival rate Ana G. Figueiredo O14 
Chronobiological factors as responsible for the appearance of locomotor 
pathology in adolescents Francisco J. Hernandez-Martinez, Liliana Campi, Mª Pino 
Quintana-Montesdeoca, Juan F. Jimenez-Diaz, Bienvenida C. Rodriguez-De-Vera O15 
Risk of malnutrition in the elderly of Bragança Alexandra Parente, Mª Augusta 
Mata, Ana Mª Pereira, Adília Fernandes, Manuel Brás O16 A Lifestyle Educational 
Programme for primary care diabetic patients: the design of a complex nursing 
intervention Mª Rosário Pinto, Pedro Parreira, Marta L. Basto, Ana C. Rei, 
Lisete M. Mónico O17 Medication adherence in elderly people Gilberta Sousa, 
Clementina Morna, Otília Freitas, Gregório Freitas, Ana Jardim, Rita Vasconcelos 
O18 Hospitalization for cervical cancer of residents in the metropolitan region 
of Porto Alegre, Southern Brazil, 2012 to 2014 Lina G. Horta, Roger S. Rosa, 
Luís F. Kranz, Rita C. Nugem, Mariana S. Siqueira, Ronaldo Bordin O19 Oncologic 
assistance of high complexity: evaluation of regulating accesses Rosiane Kniess, 
Josimari T. Lacerda O20 Perceived barriers for using health care services by the 
older population as seen by the social sector: findings from the Vila Nova de 
Gaia Gerontological Plan Joana Guedes, Idalina Machado, Sidalina Almeida, 
Adriano Zilhão, Helder Alves, Óscar Ribeiro O21 Sleep difficulties and 
depressive symptoms in college students Ana P. Amaral, Ana Santos, Joana 
Monteiro, Mª Clara Rocha, Rui Cruz O22 Psychopathological symptoms and 
medication use in higher education Ana P. Amaral, Marina Lourenço, Mª Clara 
Rocha, Rui Cruz O23 Sexually transmitted diseases in higher education 
institutions Sandra Antunes, Verónica Mendonça, Isabel Andrade, Nádia Osório, 
Ana Valado, Armando Caseiro, António Gabriel, Anabela C. Martins, Fernando 
Mendes O24 Alcohol consumption and suicide ideation in higher education students 
Lídia Cabral, Manuela Ferreira, Amadeu Gonçalves O25 Quality of life in 
university students Tatiana D. Luz, Leonardo Luz, Raul Martins O26 Male and 
female adolescent antisocial behaviour: characterizing vulnerabilities in a 
Portuguese sample Alice Morgado, Maria L. Vale-Dias O27 Risk factors for mental 
health in higher education students of health sciences Rui Porta-Nova O28 
International classification of functioning disability and health as reflexive 
reasoning in primary attention in health Tânia C. Fleig, Éboni M. Reuter, Miriam 
B. Froemming, Sabrina L. Guerreiro, Lisiane L. Carvalho O29 Risk factors and 
cardiovascular disease in Portalegre Daniel Guedelha, P. Coelho, A. Pereira O30 
Health status of the elderly population living in Portalegre historic city 
centre: A longitudinal study António Calha, Raul Cordeiro O31 Student’s sleep in 
higher education: sleep quality among students of the IPB Ana Gonçalves, Ana 
Certo, Ana Galvão, Mª Augusta Mata O32 Trend in mortality from cervical cancer 
in the metropolitan area of Florianópolis, state of Santa Catarina, Brazil, 2000 
to 2013 Aline Welter, Elayne Pereira, Sandra Ribeiro, Marcia Kretzer O33 
Adherence to treatment in the elderly in an urban environment in Spain 
Juan-Fernando Jiménez-Díaz, Carla Jiménez-Rodríguez, Francisco-José 
Hernández-Martínez, Bienvenida-Del-Carmen Rodríguez-De-Vera, Alexandre 
Marques-Rodrigues O34 Beira Baixa Blood Pressure Study (Study PABB) Patrícia 
Coelho, Tiago Bernardes, Alexandre Pereira O35 Trends in cervical cancer 
mortality statistics in Santa Catarina State, Brazil, by age group and 
macro-region, from 2000 to 2013 Patrícia Sousa, João G. Filho, Nazare Nazario, 
Marcia Kretzer O36 Sleep problems among Portuguese adolescents: a public health 
issue Odete Amaral, António Garrido, Nélio Veiga, Carla Nunes, Ana R. Pedro, 
Carlos Pereira O37 Association between body fat and health-related quality of 
life in patients with type 2 diabetes António Almeia, Helder M. Fernandes, 
Carlos Vasconcelos, Nelson Sousa, Victor M. Reis, M. João Monteiro, Romeu Mendes 
O38 Therapy adherence and polypharmacy in non-institutionalized elderly from 
Amares county, Portugal Isabel C. Pinto, Tânia Pires, João Gama O39 Prevalence 
of surgical site infection in adults at a hospital unit in the North of Portugal 
Vera Preto, Norberto Silva, Carlos Magalhães, Matilde Martins O40 Frailty 
phenotype in old age: implications to intervention Mafalda Duarte, Constança 
Paúl, Ignácio Martín O41 Portuguese women: sexual symptoms in perimenopause 
Arminda A. Pinheiro O42 Predictive ability of the Perinatal Depression Screening 
and Prevention Tool – preliminary results of the categorical approach Sandra 
Xavier, Julieta Azevedo, Elisabete Bento, Cristiana Marques, Mariana Marques, 
António Macedo, Ana T. Pereira O43 Aging and muscle strength in patients with 
type 2 diabetes: cross sectional analysis José P. Almeida, António Almeida, 
Josiane Alves, Nelson Sousa, Francisco Saavedra, Romeu Mendes O44 Accessibility 
of the elderly in the prevention of hypertension in a family health unit Ana S. 
Maia, Michelle T. Oliveira, Anderson R. Sousa, Paulo P. Ferreira, Luci S. Lopes, 
Eujcely C. Santiago O45 Community Health screenings and self-reported chronic 
diseases Sílvia Monteiro, Ângelo Jesus, Armanda Colaço, António Carvalho, Rita 
P. Silva, Agostinho Cruz O46 Evaluation of indoor air quality in Kindergartens 
Ana Ferreira, Catarina Marques, João P. Figueiredo, Susana Paixão O47 
Atmospheric exposure to chemical agents under the occupational activity of 
pathology technicians Ana Ferreira, Carla Lopes, Fernando Moreira, João P. 
Figueiredo O48 Occupational exposure to air pollutants in night entertainment 
venues workers Ana Ferreira, Diana Ribeiro, Fernando Moreira, João P. 
Figueiredo, Susana Paixão O49 Beliefs and attitudes of young people towards 
breastfeeding Telma Fernandes, Diogo Amado, Jéssica Leal, Marcelo Azevedo, Sónia 
Ramalho O50 Profiling informal caregivers: surveying needs in the care of the 
elderly Catarina Mangas, Jaime Ribeiro, Rita Gonçalves O51 Visual health in 
teenagers Amélia F Nunes, Ana R. Tuna, Carlos R. Martins, Henriqueta D. Forte 
O52 Amenable mortality and the geographic accessibility to healthcare in 
Portugal Cláudia Costa, José A. Tenedório, Paula Santana O53 Bacterial 
contamination of door handles in a São Paulo See Metropolitan Cathedral public 
restrooms in Brazil J. A. Andrade, J. L. Pinto, C. Campofiorito, S. Nunes, A. 
Carmo, A. Kaliniczenco, B. Alves, F. Mendes, C. Jesus, F. Fonseca, F. Gehrke O54 
Adherence of patients to rehabilitation programmes Carlos Albuquerque, Rita 
Batista, Madalena Cunha, António Madureira, Olivério Ribeiro, Rosa Martins O55 
Prevalence of malnutrition among Portuguese elderly living in nursing homes: 
preliminary results of the PEN-3S project Teresa Madeira, Catarina 
Peixoto-Plácido, Nuno Santos, Osvaldo Santos, Astrid Bergland, Asta Bye, Carla 
Lopes, Violeta Alarcão, Beatriz Goulão, Nuno Mendonça, Paulo Nicola, João G. 
Clara O56 Relation between emotional intelligence and mental illness in health 
students João Gomes, Ana Querido, Catarina Tomás, Daniel Carvalho, Marina 
Cordeiro P1 Fall risk factors in people older than 50 years old – a pilot report 
Marlene C. Rosa, Alda Marques P2 What about the Portuguese oldest old? A global 
overview using census data Daniela Brandão, Óscar Ribeiro, Lia Araújo, Constança 
Paúl P3 Prevalence of injuries in senior amateur volleyball athletes in Alentejo 
and Algarve clubs, Portugal: factors associated Beatriz Minghelli, Sylvina 
Richaud P4 Shame feelings and quality of life: the role of acceptance and 
decentring Ana L. Mendes, Joana Marta-Simões, Inês A. Trindade, Cláudia Ferreira 
P5 Assessment of social support during deployment in portuguese colonial war 
veterans Teresa Carvalho, Marina Cunha, José Pinto-Gouveia P6 Hospitalization 
for acute viral bronchiolitis of residents in the metropolitan region of Porto 
Alegre, Southern Brazil, 2012 to 2014 Morgana C. Fernandes, Roger S. Rosa, Rita 
C. Nugem, Luís F. Kranz, Mariana S. Siqueira, Ronaldo Bordin P7 Falls-risk 
screening – an opportunity for preventing falls in the elderly from Nordeste 
Anabela C. Martins, Anabela Medeiros, Rafaela Pimentel, Andreia Fernandes, 
Carlos Mendonça, Isabel Andrade, Susana Andrade, Ruth L. Menezes P8 Aging 
provokes chronodisruption in mature people in temperature circadian rhythm 
Rafael Bravo, Marta Miranda, Lierni Ugartemendia, José Mª Tena, Francisco L. 
Pérez-Caballero, Lorena Fuentes-Broto, Ana B. Rodríguez, Barriga Carmen P9 The 
influence of climate and pollution factors in dengue cases of great ABC region, 
São Paulo M. A. Carneiro, J. N. Domingues, S. Paixão, J. Figueiredo, V. B. 
Nascimento, C. Jesus, F Mendes, F. Gehrke, B. Alves, L. Azzalis, F. Fonseca P10 
Visual function and impact of visual therapy in children with learning 
disabilities: a pilot study Ana R. Martins, Amélia Nunes, Arminda Jorge P11 
Edentulism and the need of oral rehabilitation among institutionalized elderly 
Nélio Veiga, Ana Amorim, André Silva, Liliana Martinho, Luís Monteiro, Rafael 
Silva, Carina Coelho, Odete Amaral, Inês Coelho, Carlos Pereira, André Correia 
P12 Therapy adherence of outpatients in the pharmacy services of a hospital unit 
Diana Rodrigues, Nídia Marante, Pedro Silva, Sara Carvalho, André Rts Araujo, 
Maximiano Ribeiro, Paula Coutinho, Sandra Ventura, Fátima Roque P13 Universal 
access and comprehensive care of oral health: an availability study Cristina 
Calvo, Manoela Reses P14 Is the respiratory function of children a predictor of 
air quality? Coimbra as a case study Jorge Conde, Ana Ferreira, João Figueiredo 
P15 Meaning-in-life of college students David Silva, Luís Seiça, Raquel Soares, 
Ricardo Mourão, Teresa Kraus O57 Training needs for nurses in palliative care 
Ana C. Abreu, José M. Padilha, Júlia M. Alves O58 Impact of computerized 
information systems in the global nurses’ workload: nurses’ perceptions and 
real-time Paulino Sousa, Manuel Oliveira, Joana Sousa O59 The perspective of 
health care professionals on self-care in hereditary neurodegenerative disease: 
a qualitative study Sónia Novais, Felismina Mendes O60 Contribution for 
health-related physical fitness reference values in healthy adolescents Joana 
Pinto, Joana Cruz, Alda Marques School of Health Sciences, University of Aveiro, 
3810-193 Aveiro, Portugal O61 Perception of learning, satisfaction and 
self-efficacy of nursing students about High-Fidelity Simulation Hugo Duarte, 
Maria Dos Anjos Dixe, Pedro Sousa O62 Analysis of statements of diagnosis about 
health deviation in self-care requisites customized in a Nursing Practice 
Support System (SAPE®): Management of therapeutic regimen Inês Cruz, Fernanda 
Bastos, Filipe Pereira O63 Hybrid management and hospital governance: doctors 
and nurses as managers Francisco L. Carvalho, Teresa T. Oliveira, Vítor R. 
Raposo O64 Time management in health professionals Conceição Rainho, José C. 
Ribeiro, Isabel Barroso, Vítor Rodrigues O65 Financial rewards and wellbeing in 
primary health care Carmo Neves, Teresa C. Oliveira O66 Patient safety promotion 
in the operating room Bárbara Oliveira, Mª Carminda Morais, Pilar Baylina O67 
Difficulties and needs of pre-graduate nursing students in the area of 
Geriatrics/Gerontology Rogério Rodrigues, Zaida Azeredo, Corália Vicente O68 
Teaching and learning sexuality in nursing education Hélia Dias, Margarida 
Sim-Sim O69 Entrepreneurial Motivations Questionnaire: AFC and CFA in academy 
Pedro Parreira, Anabela Salgueiro-Oliveira, Amélia Castilho, Rosa Melo, João 
Graveto, José Gomes, Marina Vaquinhas, Carla Carvalho, Lisete Mónico, Nuno Brito 
O70 Nursing intervention to patient with Permanent Pacemakers and Implantable 
Cardioverter Defibrillators: a qualitative analysis Cassilda Sarroeira, José 
Amendoeira, Fátima Cunha, Anabela Cândido, Patrícia Fernandes, Helena R. Silva, 
Elsa Silva O71 Alcohol consumption among nursing students: where does education 
fail? Isabel Barroso, Leila Lapa, Cristina Antunes O72 Labour stress in nursing 
Ana Gonçalves, Ana Galvão, Mª José Gomes, Susana R. Escanciano O73 The influence 
of safe staff nursing in patient satisfaction with nursing care Maria Freitas, 
Pedro Parreira, João Marôco O74 Intention to use eHealth strategies with nursing 
students Ana R. Fernandes, Cremilde Cabral, Samuel Alves, Pedro Sousa O75 
Community Based Mental Health: contributions of an interdisciplinary 
international program for students in higher health education António Ferreira, 
Fernanda Príncipe, Ulla-Maija Seppänen, Margarida Ferreira, Maribel Carvalhais, 
Marilene Silva O76 Study of satisfaction at work of graduates in nursing: 
2002-2014 Manuela Ferreira, Joana Silva, Jéssica Neves, Diana Costa, Bruno 
Santos, Soraia Duarte O77 Health professionals’ attitudes towards breastfeeding 
Sílvia Marques, Sónia Ramalho, Isabel Mendes O78 Continuity of nursing care to 
person with type 2 diabetes Clarisse Louro, Eva Menino, Maria Dixe, Sara S. Dias 
O79 Stigma toward mental illness among future health professionals Marina 
Cordeiro, Catarina Tomás, Ana Querido, Daniel Carvalho, João Gomes O80 Working 
with fears and anxieties of medical students in search of a humanized care 
Frederico C. Valim, Joyce O. Costa, Lúcia G. Bernardes P16 Surgical paediatrics 
patients’ psycho prophylaxis at a teaching hospital Helena Prebianchi P17 
Patient-perceived outcomes in physiotherapy – a pilot study Marlene Cristina 
Rosa P18 Building competencies for managers in nursing Narcisa Gonçalves, Maria 
M. Martins, Paulina Kurcgant P19 Theoretical basis underlying physiotherapy 
practice in stroke rehabilitation André Vieira P20 When the life-cycle ends: the 
nurse’s confrontation with death Sandrina Bento, Sérgio Deodato, Isabel Rabiais 
P21 Nursing students’ opinion about the supervision relationship during their 
first clinical experience Laura Reis P22 Nursing Relational Laboratory: 
Pedagogical, dialogic and critical project Ana Torres, Sérgio Soares, Margarida 
Ferreira, Pedro Graça P23 Job satisfaction of bioscientists at a Lisbon hospital 
Céu Leitão, Renato Abreu, Fernando Bellém, Ana Almeida, Edna Ribeiro-Varandas, 
Ana Tavares P24 Sociodemographic and professional profile of nurses and its 
relation with the importance of family in nursing practices João G. Frade, 
Carolina Henriques, Eva Menino, Clarisse Louro, Célia Jordão P25 Professional 
satisfaction of rehabilitation nurses Sofia Neco, Carminda Morais, Pedro 
Ferreira P26 The person living with a stoma: the formalization of knowledge in 
nursing Carla R. Silva, Alice Brito, Antónia Silva P27 Validation of the 
Portuguese versions of the nursing students’ perceptions of learning and learner 
satisfaction with simulation tool Hugo Duarte, Maria Dos Anjos Dixe, Pedro Sousa 
P28 Physiotherapists’ perceived knowledge on technologies for electronic health 
records for physiotherapy Gabriela Postolache, Raul Oliveira, Isabel Moreira, 
Luísa Pedro, Sónia Vicente, Samuel Domingos, Octavian Postolache P29 Quality of 
life and physical activity of medicine undergraduate students in the University 
of Southern Santa Catarina, Brazil Darlen Silva, João G. Filho, Nazare Nazario, 
Marcia Kretzer, Dulcineia Schneider P30 The curricular skills for decision 
making education in a Nursing Degree Fátima M. Marques P31 Effect of nurses’ 
mobilization in satisfaction at work and turnover: An empirical study in the 
hospital setting Pedro Parreira, Carla Carvalho, Lisete M. Mónico, Carlos Pinto, 
Sara Vicente, São João Breda P32 Entrepreneurial skills of students of 
polytechnic higher education in Portugal: Business influences José H. Gomes, 
Rosa Melo, Pedro Parreira, Anabela Salgueiro, João Graveto, Marina Vaquinhas, 
Amélia Castilho P33 Design and assessment of e-learning modules for Pharmacology 
Ângelo Jesus, Nuno Duarte, José C. Lopes, Hélder Nunes, Agostinho Cruz P34 
Perspective of nurses involved in an action-research study on the changes 
observed in care provision: results from a focus group Anabela 
Salgueiro-Oliveira, Pedro Parreira, Marta L. Basto, Luciene M. Braga P35 Use of 
peer feedback by nursing students during clinical training: teacher’s perception 
António Ferreira, Beatriz Araújo, José M. Alves, Margarida Ferreira, Maribel 
Carvalhais, Marilene Silva, Sónia Novais P36 What’s new on endotracheal 
suctioning recommendations Ana S. Sousa, Cândida Ferrito P37 Assessment of the 
nurses satisfaction on the Central Region of Portugal Pedro L. Ferreira, 
Alexandre Rodrigues, Margarida Ferreira, Isabel Oliveira P38 Study of graduate’s 
satisfaction with the school of nursing Manuela Ferreira, Jéssica Neves, Diana 
Costa, Soraia Duarte, Joana Silva, Bruno Santos P39 Partnership between the 
school of nursing and the hospital: Supervisors´ perspectives Cristina Martins, 
Ana P. Macedo, Odete Araújo, Cláudia Augusto, Fátima Braga, Lisa Gomes, Maria A. 
Silva, Rafaela Rosário P40 Coping strategies of college students Luís Pimenta, 
Diana Carreira, Patrícia Teles, Teresa Barros P41 Emotional intelligence and 
mental health stigma in health students Catarina Tomás, Ana Querido, Daniel 
Carvalho, João Gomes, Marina Cordeiro P42 Stigma of mental health assessment: 
Comparison between health courses Daniel Carvalho, Ana Querido, Catarina Tomás, 
João Gomes, Marina Cordeiro O81 Short- and long-term effects of pulmonary 
rehabilitation in mild COPD Cristina Jácome, Alda Marques O82 Phonological 
awareness programme for preschool children Sylvie Capelas, Andreia Hall, Dina 
Alves, Marisa Lousada O83 REforma ATIVA: An efficient health promotion program 
to be implemented during retirement Mª Helena Loureiro, Ana Camarneiro, 
Margarida Silva, Aida Mendes, Ana Pedreiro O84 Intervention for men who batter 
women, a case report Anne G.Silva, Elza S. Coelho O85 Immediate effects of Bowen 
Therapy on muscle tone and flexibility Flávio Melo, Fernando Ribeiro, Rui 
Torres, Rui Costa O86 Predictive equation for incremental shuttle walk test in 
adolescents Tânia Pinho, Cristina Jácome, Alda Marques O87 Life satisfaction and 
psychopathology in institutionalized elderly people: The results of an adapted 
Mindfulness-Based Stress Reduction program Bárbara Cruz, Daniel Seabra, Diogo 
Carreira, Maria Ventura O88 Outcome changes in COPD rehabilitation: exploring 
the relationship between physical activity and health-related outcomes Joana 
Cruz, Dina Brooks, Alda Marques O89 Assessing the effectiveness of a Complex 
Nursing Intervention M Rosário Pinto, Pedro Parreira, Marta Lima-Basto, Miguel 
Neves, Lisete M. Mónico O90 Psychotherapeutic intervention in addiction 
disorders: Change in psychopathological symptoms and emotional states Carla 
Bizarro, Marina Cunha, Ana Galhardo, Couto Margarida, Ana P. Amorim, Eduardo 
Silva O91 Economic impact of a nursing intervention program to promote 
self-management in COPD Susana Cruz, José M. Padilha, Jorge Valente O92 
Multimodal acute pain management during uterine artery embolization in treatment 
of uterine myomas José T. Guerrero, Francisco P. Caballero, Rafael B. Santos, 
Estefania P. Gonzalez, Fátima M. Monago, Lierni U. Ugalde, Marta M. Vélez, Maria 
J. Tena O93 Fluid administration strategies in major surgery: Goal-directed 
therapy José T. Guerrero, Rafael Bravo, Francisco L. Pérez-Caballero, Isabel A. 
Becerra, Mª Elizabeth Agudelo, Guadalupe Acedo, Roberto Bajo O94 Development and 
implementation of a self-management educational programme using lay-led’s in 
adolescents Spina Bifida: A pilot study Isabel Malheiro, Filomena Gaspar, Luísa 
Barros O95 Influence of chair-based yoga exercises on salivary anti-microbial 
proteins in institutionalized frail-elderly women: a preliminary study Guilherme 
Furtado, Mateus Uba-Chupel, Mariana Marques, Luís Rama, Margarida Braga, José P. 
Ferreira, Ana Mª Teixeira O96 High intensity interval training vs moderate 
intensity continuous training impact on diabetes 2 João Cruz, Tiago Barbosa, 
Ângela Simões, Luís Coelho O97 Family caregiver of people with pressure ulcer: 
Nursing intervention plan Alexandre Rodrigues, Juan-Fernando Jiménez-Díaz, 
Francisco Martinez-Hernández, Bienvenida Rodriguez-De-Vera, Pedro Ferreira, 
Alexandrina Rodrigues O98 Chronic effects of exercise on motor memory 
consolidation in elderly people André Ramalho, João Petrica, Pedro Mendes, João 
Serrano, Inês Santo, António Rosado O99 Impression cytology of the ocular 
surface: Collection technique and sample processing Paula Mendonça, Kátia 
Freitas O100 Does sport practice affect the reaction time in neuromuscular 
activity? Dora Ferreira, António Brito, Renato Fernandes O101 Efficiency of the 
enteral administration of fibbers in the treatment of chronic obstipation Sofia 
Gomes, Fernando Moreira, Cláudia Pinho, Rita Oliveira, Ana I. Oliveira O102 Fast 
decalcifier in compact bone and spongy bone Paula Mendonça, Ana P. Casimiro, 
Patrícia Martins, Iryna Silva O103 Health promotion in the elderly – 
Intervention project in dementia Diana Evangelista O104 Prevention of 
musculoskeletal disorders through an exercise protocol held in labour context 
Catarina Leitão, Fábia Velosa, Nélio Carecho, Luís Coelho O105 Knowledge of 
teachers and other education agents on diabetes type 1: Effectiveness of an 
intervention program Eva Menino, Anjos Dixe, Helena Catarino, Fátima Soares, 
Ester Gama, Clementina Gordo O106 Treatment of diabetic peripheral neuropathic 
pain: a systematic review of clinical trials of phase II and III Eliana Moreira, 
Cristiana Midões, Marlene Santos O107 New drugs for osteoporosis treatment: 
Systematic review of clinical trials of phase II and III Sara Machado, Vânia P. 
Oliveira, Marlene Santos O108 Promoting hope at the end of life: Effectiveness 
of an Intervention Programme Ana Querido, Anjos Dixe, Rita Marques, Zaida 
Charepe P43 Psychomotor therapy effects on adaptive behaviour and motor 
proficiency of adults with intellectual disability Ana Antunes, Sofia Santos P44 
The effect of exercise therapy in multiple sclerosis – a single study case 
Marlene C. Rosa P45 Physical condition and self-efficacy in people with fall 
risk – a preliminary study Marlene C. Rosa, Silvana F. Marques P46 Shock waves: 
their effectiveness in improving the symptoms of calcifying tendinitis of the 
shoulder Beatriz Minghelli, Eulália Caro P47 Pacifier – construction and pilot 
application of a parenting intervention for parents of babies until six months 
in primary health care Mª José Luís, Teresa Brandão P48 The influence of Motor 
Imagery in fine motor skills of individuals with disabilities Pedro Mendes, 
Daniel Marinho, João Petrica, Diogo Monteiro, Rui Paulo, João Serrano, Inês 
Santo P49 Evaluation of the effects of a walking programme on the fall risk 
factors in older people – a longitudinal pilot study Lina Monteiro, Fátima 
Ramalho, Rita Santos-Rocha, Sónia Morgado, Teresa Bento P50 Nursing intervention 
programme in lifestyles of adolescents Gilberta Sousa, Otília Freitas, Isabel 
Silva, Gregório Freitas, Clementina Morna, Rita Vasconcelos P51 The person 
submitted to hip replacement rehabilitation, at home Tatiana Azevedo, Salete 
Soares, Jacinta Pisco P52 Effects of Melatonin use in the treatment of 
neurovegetative diseases Paulo P. Ferreira, Efrain O. Olszewer, Michelle T. 
Oliveira, Anderson R. Sousa, Ana S. Maia, Sebastião T. Oliveira P53 Review of 
Phytotherapy and other natural substances in alcohol abuse and alcoholism Erica 
Santos, Ana I. Oliveira, Carla Maia, Fernando Moreira, Joana Santos, Maria F. 
Mendes, Rita F. Oliveira, Cláudia Pinho P54 Dietary programme impact on 
biochemical markers in diabetics: systematic review Eduarda Barreira, Ana 
Pereira, Josiana A. Vaz, André Novo P55 Biological approaches to knee 
osteoarthritis: platelet-rich plasma and hyaluronic acid Luís D. Silva, Bruno 
Maia, Eduardo Ferreira, Filipa Pires, Renato Andrade, Luís Camarinha P56 
Platelet-rich plasma and hyaluronic acid intra-articular injections for the 
treatment of ankle osteoarthritis Luís D. Silva, Bruno Maia, Eduardo Ferreira, 
Filipa Pires, Renato Andrade, Luís Camarinha P57 The impact of preventive 
measures in the incidence of diabetic foot ulcers: a systematic review Ana F. 
César, Mariana Poço, David Ventura, Raquel Loura, Pedro Gomes, Catarina Gomes, 
Cláudia Silva, Elsa Melo, João Lindo P58 Dating violence among young adolescents 
Joana Domingos, Zaida Mendes, Susana Poeta, Tiago Carvalho, Catarina Tomás, 
Helena Catarino, Mª Anjos Dixe P59 Physical activity and motor memory in pedal 
dexterity André Ramalho, António Rosado, Pedro Mendes, Rui Paulo, Inês Garcia, 
João Petrica P60 The effects of whole body vibration on the electromyographic 
activity of thigh muscles Sandra Rodrigues, Rui Meneses, Carlos Afonso, Luís 
Faria, Adérito Seixas P61 Mental health promotion in the workplace Marina 
Cordeiro, Paulo Granjo, José C. Gomes P62 Influence of physical exercise on the 
self-perception of body image in elderly women: A systematic review of 
qualitative studies Nelba R. Souza, Guilherme E. Furtado, Saulo V. Rocha, Paula 
Silva, Joana Carvalho O109 Psychometric properties of the Portuguese version of 
the Éxamen Geronto-Psychomoteur (P-EGP) Marina Ana Morais, Sofia Santos, Paula 
Lebre, Ana Antunes O110 Symptoms of depression in the elderly population of 
Portugal, Spain and Italy António Calha O111 Emotion regulation strategies and 
psychopathology symptoms: A comparison between adolescents with and without 
deliberate self-harm Ana Xavier, Marina Cunha, José Pinto-Gouveia O112 
Prevalence of physical disability in people with leprosy Liana Alencar, Madalena 
Cunha, António Madureira O113 Quality of life and self-esteem in type 1 and type 
2 diabetes mellitus patients Ilda Cardoso, Ana Galhardo, Fernanda Daniel, Vítor 
Rodrigues O114 Cross-cultural comparison of gross motor coordination in children 
from Brazil and Portugal Leonardo Luz, Tatiana Luz, Maurício R. Ramos, Dayse C. 
Medeiros, Bruno M. Carmo, André Seabra, Cristina Padez, Manuel C. Silva O115 
Electrocardiographic differences between African and Caucasian people António 
Rodrigues, Patrícia Coelho, Alexandre Coelho O116 Factors associated with 
domestic, sexual and other types of violence in the city of Palhoça - Brazil 
Madson Caminha, Filipe Matheus, Elenice Mendes, Jony Correia, Marcia Kretzer 
O117 Tinnitus prevalence study of users of a hospital of public management - 
Spain Francisco J. Hernandez-Martinez, Juan F. Jimenez-Diaz, Bienvendida C. 
Rodriguez-De-Vera, Carla Jimenez-Rodriguez, Yadira Armas-Gonzalez O118 
Difficulties experienced by parents of children with diabetes mellitus of 
preschool age in therapeutic and nutritional management Cátia Rodrigues, Rosa 
Pedroso O119 E-mental health - “nice to have” or “must have”? Exploring the 
attitudes towards e-mental health in the general population Jennifer 
Apolinário-Hagen, Viktor Vehreschild O120 Violence against children and 
adolescents and the role of health professionals: Knowing how to identify and 
care Milene Veloso, Celina Magalhães, Isabel Cabral, Maira Ferraz O121 Marital 
violence. A study in the Algarve population Filipe Nave, Emília Costa, Filomena 
Matos, José Pacheco O122 Clinical factors and adherence to treatment in ischemic 
heart disease António Dias, Carlos Pereira, João Duarte, Madalena Cunha, Daniel 
Silva O123 Can religiosity improve optimism in participants in states of 
illness, when controlling for life satisfaction? Lisete M. Mónico, Valentim R. 
Alferes, Mª São João Brêda, Carla Carvalho, Pedro M. Parreira O124 Empowerment, 
knowledge and quality of life of people with diabetes type 2 in the Alto Minho 
Health Local Unit Mª Carminda Morais, Pedro Ferreira, Rui Pimenta, José Boavida 
O125 Antihypertensive therapy adherence among hypertensive patients from 
Bragança county, Portugal Isabel C. Pinto, Tânia Pires, Catarina Silva O126 
Subjective perception of sexual achievement - An exploratory study on people 
with overweight Maria Ribeiro, Maria Viega-Branco, Filomena Pereira, Ana Mª 
Pereira O127 Physical activity level and associated factors in hypertensive 
individuals registered in the family health strategy of a basic health unit from 
the city of Palhoça, Santa Catarina, Brazil Fabrícia M. Almeida, Gustavo L. 
Estevez, Sandra Ribeiro, Marcia R. Kretzer O128 Perception of functional fitness 
and health in non-institutionalised elderly from rural areas Paulo V. João, 
Paulo Nogueira, Sandra Novais, Ana Pereira, Lara Carneiro, Maria Mota O129 
Medication adherence in patients with type 2 diabetes mellitus treated at 
primary health care in Coimbra Rui Cruz, Luiz Santiago, Carlos Fontes-Ribeiro 
O130 Multivariate association between body mass index and multi-comorbidities in 
elderly people living in low socio-economic status context Guilherme Furtado, 
Saulo V. Rocha, André P. Coutinho, João S. Neto, Lélia R. Vasconcelos, Nelba R. 
Souza, Estélio Dantas O131 Metacognition, rumination and experiential avoidance 
in Borderline Personality Disorder Alexandra Dinis, Sérgio Carvalho, Paula 
Castilho, José Pinto-Gouveia O132 Health issues in a vulnerable population: 
nursing consultation in a public bathhouse in Lisbon Alexandra Sarreira-Santos, 
Amélia Figueiredo, Lurdes Medeiros-Garcia, Paulo Seabra O133 The perception of 
quality of life in people with multiple sclerosis accompanied in External 
Consultation of the Local Health Unit of Alto Minho Rosa Rodrigues, Mª Carminda 
Morais, Paula O. Fernandes O134 Representation of interaction established 
between immigrant women and nurse during pregnancy to postpartum, from the 
perspective of immigrant women Conceição Santiago, Mª Henriqueta Figueiredo, 
Marta L. Basto O135 Illness perceptions and medication adherence in hypertension 
Teresa Guimarães, André Coelho, Anabela Graça, Ana M. Silva, Ana R. Fonseca O136 
A Portuguese study on adults’ intimate partner violence, interpersonal trust and 
hope Luz Vale-Dias, Bárbara Minas, Graciete Franco-Borges P63 QOL’ predictors of 
people with intellectual disability and general population Cristina Simões, 
Sofia Santos P64 Content validation of the Communication Disability Profile 
(CDP) - Portuguese Version Ana Serra, Maria Matos, Luís Jesus P65 Study of 
biochemical and haematological changes in football players Ana S. Tavares, Ana 
Almeida, Céu Leitão, Edna Varandas, Renato Abreu, Fernando Bellém P66 Body image 
dissatisfaction in inflammatory bowel disease: exploring the role of chronic 
illness-related shame Inês A. Trindade, Cláudia Ferreira, José Pinto-Gouveia, 
Joana Marta-Simões P67 Obesity and sleep in the adult population - a systematic 
review Odete Amaral, Cristiana Miranda, Pedro Guimarães, Rodrigo Gonçalves, 
Nélio Veiga, Carlos Pereira P68 Frequency of daytime sleepiness and obstructive 
sleep apnea risk in COPD patients Tânia C. Fleig, Elisabete A. San-Martin, 
Cássia L. Goulart, Paloma B. Schneiders, Natacha F. Miranda, Lisiane L. 
Carvalho, Andrea G. Silva P69 Working with immigrant-origin clients: discourses 
and practices of health professionals Joana Topa, Conceição Nogueira, Sofia 
Neves P70 Systemic Lupus Erythematosus – what are audiovestibular changes? Rita 
Ventura, Cristina Nazaré P71 Mental disorders in the oldest old: findings from 
the Portuguese national hospitalization database Daniela Brandão, Alberto 
Freitas, Óscar Ribeiro, Constança Paúl P72 Recurrence analysis in postural 
control in children with cerebral palsy Cristiana Mercê, Marco Branco, Pedro 
Almeida, Daniela Nascimento, Juliana Pereira, David Catela P73 The experience of 
self-care in the elderly with COPD: contributions to reflect proximity care 
Helga Rafael P74 Culturally competent nurses: managing unpredictability in 
clinical practice with immigrants Alcinda C. Reis O137 Paediatric speech and 
language screening: An instrument for health professionals Ana Mendes, Ana R. 
Valente, Marisa Lousada O138 Anthropometric and nutritional assessment in 
bodybuilders Diana Sousa, Ana L. Baltazar, Mª Helena Loureiro O139 Computerized 
adventitious respiratory sounds in children with lower respiratory tract 
infections Ana Oliveira, José Aparício, Alda Marques O140 Role of computerized 
respiratory sounds as a marker in LRTI Alda Marques, Ana Oliveira, Joana Neves, 
Rodrigo Ayoub O141 Confirmatory factor analysis of the Personal Wellbeing Index 
in people with chronic kidney disease Luís Sousa, Cristina Marques-Vieira, Sandy 
Severino, Helena José O142 Phonological awareness skills in school aged children 
Inês Cadorio, Marisa Lousada O143 Assessment of early memories of warmth and 
safeness in interaction with peers: its relationship with psychopathology in 
adolescence Marina Cunha, Diogo Andrade, Ana Galhardo, Margarida Couto O144 The 
molecular effects induced by single shot irradiation on a diffuse large B cell 
lymphoma cell line Fernando Mendes, Cátia Domingues, Susann Schukg, Ana M. 
Abrantes, Ana C. Gonçalves, Tiago Sales, Ricardo Teixo, Rita Silva, Jéssica 
Estrela, Mafalda Laranjo, João Casalta-Lopes, Clara Rocha, Paulo C. Simões, Ana 
B. Sarmento-Ribeiro, Mª Filomena Botelho, Manuel S. Rosa O145 Morpho-functional 
characterization of cardiac chambers by Transthoracic Echocardiography, in young 
athletes of gymnastics competition Virgínia Fonseca, Diogo Colaço, Vanessa Neves 
O146 Prevalence of the antibodies of the new histo-blood system – FORS system 
Carlos Jesus, Camilla Hesse, Clara Rocha, Nádia Osório, Ana Valado, Armando 
Caseiro, António Gabriel, Lola Svensson, Fernando Mendes, Wafa A. Siba, Cristina 
Pereira, Jorge Tomaz O147 Assessment of the war-related perceived threat in 
Portuguese Colonial War Veterans Teresa Carvalho, José Pinto-Gouveia, Marina 
Cunha O148 Pulse transit time estimation for continuous blood pressure 
measurement: A comparative study Diana Duarte, Nuno V. Lopes, Rui Fonseca-Pinto 
O149 Blood pressure assessment during standard clinical manoeuvres: A 
non-invasive PPT based approach Diana Duarte, Nuno V. Lopes, Rui Fonseca-Pinto 
O150 Development and initial validation of the Activities and Participation 
Profile related to Mobility (APPM) Anabela C. Martins O151 MEASYCare-2010 
Standard–A geriatric evaluation system in primary health care: Reliability and 
validity of the latest version in Portugal Piedade Brandão, Laura Martins, 
Margarida Cardoso O152 Interrater and intrarater reliability and agreement of 
the range of shoulder flexion in the standing upright position through 
photographic assessment Nuno Morais, Joana Cruz O153 Three-dimensional 
biofabrication techniques for tissue regeneration Nuno Alves, Paula Faria, Artur 
Mateus, Pedro Morouço O154 A new computer tool for biofabrication applied to 
tissue engineering Nuno Alves, Nelson Ferreira, Artur Mateus, Paula Faria, Pedro 
Morouço O155 Development and psychometric qualities of a scale to measure the 
functional independence of adolescents with motor impairment Isabel Malheiro, 
Filomena Gaspar, Luísa Barros O156 Organizational Trust in Health services: 
Exploratory and Confirmatory factor analysis of the Organizational Trust 
Inventory- Short Form (OTI-SF) Pedro Parreira, Andreia Cardoso, Lisete Mónico, 
Carla Carvalho, Albino Lopes, Anabela Salgueiro-Oliveira O157 Thermal symmetry: 
An indicator of occupational task asymmetries in physiotherapy Adérito Seixas, 
Valter Soares, Tiago Dias, Ricardo Vardasca, Joaquim Gabriel, Sandra Rodrigues 
O158 A study of ICT active monitoring adoption in stroke rehabilitation Hugo 
Paredes, Arsénio Reis, Sara Marinho, Vítor Filipe, João Barroso O159 Paranoia 
Checklist (Portuguese Version): Preliminary studies in a mixed sample of 
patients and healthy controls Carolina Da Motta, Célia B. Carvalho, José 
Pinto-Gouveia, Ermelindo Peixoto O160 Reliability and validity of the Composite 
Scale on Morningness: European Portuguese version, in adolescents and young 
adults Ana A. Gomes, Vanessa Costa, Diana Couto, Daniel R. Marques, José A. 
Leitão, José Tavares, Maria H. Azevedo, Carlos F. Silva O161 Evaluation scale of 
patient satisfaction with nursing care: Psychometric properties evaluation João 
Freitas, Pedro Parreira, João Marôco O162 Impact of fibromyalgia on quality of 
life: Comparing results from generic instruments and FIQR Miguel A. 
Garcia-Gordillo, Daniel Collado-Mateo, Gang Chen, Angelo Iezzi, José A. Sala, 
José A. Parraça, Narcis Gusi O163 Preliminary study of the adaptation and 
validation of the Rating Scale of Resilient Self: Resilience, self-harm and 
suicidal ideation in adolescents Jani Sousa, Mariana Marques, Jacinto Jardim, 
Anabela Pereira, Sónia Simões, Marina Cunha O164 Development of the first 
pressure ulcer in inpatient setting: Focus on length of stay Pedro Sardo, 
Jenifer Guedes, João Lindo, Paulo Machado, Elsa Melo O165 Forms of 
Self-Criticizing and Self-Reassuring Scale: Adaptation and early findings in a 
sample of Portuguese children Célia B. Carvalho, Joana Benevides, Marina Sousa, 
Joana Cabral, Carolina Da Motta O166 Predictive ability of the Perinatal 
Depression Screening and Prevention Tool – Preliminary results of the 
dimensional approach Ana T. Pereira, Sandra Xavier, Julieta Azevedo, Elisabete 
Bento, Cristiana Marques, Rosa Carvalho, Mariana Marques, António Macedo O167 
Psychometric properties of the BaSIQS-Basic Scale on insomnia symptoms and 
quality of sleep, in adults and in the elderly Ana M. Silva, Juliana Alves, Ana 
A. Gomes, Daniel R. Marques, Mª Helena Azevedo, Carlos Silva O168 Enlightening 
the human decision in health: The skin melanocytic classification challenge Ana 
Mendes, Huei D. Lee, Newton Spolaôr, Jefferson T. Oliva, Wu F. Chung, Rui 
Fonseca-Pinto O169 Test-retest reliability household life study and health 
questionnaire Pomerode (SHIP-BRAZIL) Keila Bairros, Cláudia D. Silva, Clóvis A. 
Souza, Silvana S. Schroeder O170 Characterization of sun exposure behaviours 
among medical students from Nova Medical School Elsa Araújo, Helena Monteiro, 
Ricardo Costa, Sara S. Dias, Jorge Torgal O171 Spirituality in pregnant women 
Carolina G. Henriques, Luísa Santos, Elisa F. Caceiro, Sónia A. Ramalho O172 
Polypharmacy in older patients with cancer Rita Oliveira, Vera Afreixo, João 
Santos, Priscilla Mota, Agostinho Cruz, Francisco Pimentel O173 Quality of life 
of caregivers of people with advanced chronic disease: Translation and 
validation of the quality of life in life threatening illness - family carer 
version (QOLLTI-C-PT) Rita Marques, Mª Anjos Dixe, Ana Querido, Patrícia Sousa 
O174 The psychometric properties of the brief Other as Shamer Scale for Children 
(OAS-C): preliminary validation studies in a sample of Portuguese children Joana 
Benevides, Carolina Da Motta, Marina Sousa, Suzana N. Caldeira, Célia B. 
Carvalho O175 Measuring emotional intelligence in health care students – 
Revalidation of WLEIS-P Ana Querido, Catarina Tomás, Daniel Carvalho, João 
Gomes, Marina Cordeiro O176 Health indicators in prenatal assistance: The impact 
of computerization and of under-production in basic health centres Joyce O. 
Costa, Frederico C. Valim, Lígia C. Ribeiro O177 Hope genogram: Assessment of 
resources and interaction patterns in the family of the child with cerebral 
palsy Zaida Charepe, Ana Querido, Mª Henriqueta Figueiredo O178 The influence of 
childbirth type in postpartum quality of life Priscila S. Aquino, Samila G. 
Ribeiro, Ana B. Pinheiro, Paula A. Lessa, Mirna F. Oliveira, Luísa S. Brito, 
Ítalo N. Pinto, Alessandra S. Furtado, Régia B. Castro, Caroline Q. Aquino, 
Eveliny S. Martins O179 Women’s beliefs about pap smear test and cervical 
cancer: influence of social determinants Ana B Pinheiro, Priscila S. Aquino, 
Lara L. Oliveira, Patrícia C. Pinheiro, Caroline R. Sousa, Vívien A. Freitas, 
Tatiane M. Silva, Adman S. Lima, Caroline Q. Aquino, Karizia V. Andrade, Camila 
A. Oliveira, Eglidia F. Vidal O180 Validity of the Portuguese version of the 
ASI-3: Is anxiety sensitivity a unidimensional or multidimensional construct? 
Ana Ganho-Ávila, Mariana Moura-Ramos, Óscar Gonçalves, Jorge Almeida O181 
Lifestyles of higher education students: the influence of self-esteem and 
psychological well-being Armando Silva, Irma Brito, João Amado P75 Assessing the 
quality of life of persons with significant intellectual disability: Portuguese 
version of Escala de San Martín António Rodrigo, Sofia Santos, Fernando Gomes 
P76 Childhood obesity and breastfeeding - A systematic review Marlene C. Rosa, 
Silvana F. Marques P77 Cross-cultural adaptation of the Foot and Ankle Ability 
Measure (FAAM) for the Portuguese population Sara Luís, Luís Cavalheiro, Pedro 
Ferreira, Rui Gonçalves P78 Cross-cultural adaptation of the Patient-Rated Wrist 
Evaluation score (PRWE) for the Portuguese population Rui S. Lopes, Luís 
Cavalheiro, Pedro Ferreira, Rui Gonçalves P79 Cross-cultural adaptation of the 
Myocardial Infraction Dimensional Assessment Scale (MIDAS) for Brazilian 
Portuguese language Bruno H. Fiorin, Marina S. Santos, Edmar S. Oliveira, Rita 
L. Moreira, Elizabete A. Oliveira, Braulio L. Filho P80 The revised Portuguese 
version of the Three-Factor Eating Questionnaire: A confirmatory factor analysis 
Lara Palmeira, Teresa Garcia, José Pinto-Gouveia, Marina Cunha P81 Assessing 
weight-related psychological inflexibility: An exploratory factor analysis of 
the AAQW’s Portuguese version Sara Cardoso, Lara Palmeira, Marina Cunha; José 
Pinto-Gouveia P82 Validation of the Body Appreciation Scale-2 for Portuguese 
women Joana Marta-Simões, Ana L. Mendes, Inês A. Trindade, Sara Oliveira, 
Cláudia Ferreira P83 The Portuguese validation of the Dietary Intent Scale Ana 
L. Mendes, Joana Marta-Simões, Inês A. Trindade, Cláudia Ferreira P84 
Construction and validation of the Inventory of Marital Violence (IVC) Filipe 
Nave P85 Portable continuous blood pressure monitor system Mariana Campos, Iris 
Gaudêncio, Fernando Martins, Lino Ferreira, Nuno Lopes, Rui Fonseca-Pinto P86 
Construction and validation of the Scale of Perception of the Difficulties in 
Caring for the Elderly (SPDCE) Rogério Rodrigues, Zaida Azeredo, Corália Vicente 
P87 Development and validation of a comfort rating scale for the elderly 
hospitalized with chronic illness Joana Silva, Patrícia Sousa, Rita Marques P88 
Construction and validation of the Postpartum Paternal Quality of Life 
Questionnaire (PP-QOL) Isabel Mendes, Rogério Rodrigues, Zaida Azeredo, Corália 
Vicente P89 Infrared thermal imaging: A tool for assessing diabetic foot ulcers 
Ricardo Vardasca, Ana R. Marques, Adérito Seixas, Rui Carvalho, Joaquim Gabriel 
P90 Pressure ulcers in an intensive care unit: An experience report Paulo P. 
Ferreira, Michelle T. Oliveira, Anderson R. Sousa, Ana S. Maia, Sebastião T. 
Oliveira, Pablo O. Costa, Maiza M. Silva P91 Validation of figures used in 
evocations: instrument to capture representations Cristina Arreguy-Sena, 
Nathália Alvarenga-Martins, Paulo F. Pinto, Denize C. Oliveira, Pedro D. 
Parreira, Antônio T. Gomes, Luciene M. Braga P92 Telephone assistance to 
decrease burden in informal caregivers of stroke older people: Monitoring and 
diagnostic evaluation Odete Araújo, Isabel Lage, José Cabrita, Laetitia Teixeira 
P93 Hope of informal caregivers of people with chronic and advanced disease Rita 
Marques, Mª Anjos Dixe, Ana Querido, Patrícia Sousa P94 Functionality and 
quality information from the Portuguese National Epidemiological Surveillance 
System Sara Silva, Eugénio Cordeiro, João Pimentel P95 Resting metabolic rate 
objectively measured vs. Harris and Benedict formula Vera Ferro-Lebres, Juliana 
A. Souza, Mariline Tavares O182 Characteristics of non-urgent patients: 
Cross-sectional study of an emergency department Mª Anjos Dixe, Pedro Sousa, Rui 
Passadouro, Teresa Peralta, Carlos Ferreira, Georgina Lourenço O183 Physical 
fitness and health in children of the 1st Cycle of Education João Serrano, João 
Petrica, Rui Paulo, Samuel Honório, Pedro Mendes O184 The impact of physical 
activity on sleep quality, in children Alexandra Simões, Lucinda Carvalho, 
Alexandre Pereira O185 What is the potential for using Information and 
Communication Technologies in Arterial Hypertension self-management? Sara Silva, 
Paulino Sousa, José M. Padilha O186 Exploring psychosocial factors associated 
with risk of falling in older patients undergoing haemodialysis Daniela 
Figueiredo, Carolina Valente, Alda Marques O187 Development of pressure ulcers 
on the face in patients undergoing non-invasive ventilation Patrícia Ribas, 
Joana Sousa, Frederico Brandão, Cesar Sousa, Matilde Martins O188 The elder 
hospitalized: Limiting factors of comfort Patrícia Sousa, Rita Marques O189 
Physical activity and health state self-perception by Portuguese adults 
Francisco Mendes, Rosina Fernandes, Emília Martins, Cátia Magalhães, Patrícia 
Araújo O190 Satisfaction with social support in the elderly of the district of 
Bragança Carla Grande, Mª Augusta Mata, Juan G. Vieitez O191 Prevalence of death 
by traumatic brain injury and associated factors in intensive care unit of a 
general hospital, Brazil Bruna Bianchini, Nazare Nazario, João G. Filho, Marcia 
Kretzer O192 Relation between family caregivers burden and health status of 
elderly dependents Tânia Costa, Armando Almeida, Gabriel Baffour O193 Phenomena 
sensitive to nursing care in day centre Armando Almeida, Tânia Costa, Gabriel 
Baffour O194 Frailty: what do the elderly think? Zaida Azeredo, Carlos 
Laranjeira, Magda Guerra, Ana P. Barbeiro O195 The therapeutic self-care as a 
nursing-sensitive outcome: A correlational study Regina Ferreira O196 
Phonetic-phonological acquisition for the European Portuguese from 18 months to 
6 years and 12 months Sara Lopes, Liliana Nunes, Ana Mendes O197 Quality of life 
of patients undergoing liver transplant surgery Julian Martins, Dulcineia 
Schneider, Marcia Kretzer, Flávio Magajewski O198 Professional competences in 
health: views of older people from different European Countries Célia Soares, 
António Marques O199 Life satisfaction of working adults due to the number of 
hours of weekly exercise Marco Batista, Ruth J. Castuera, Helena Mesquita, 
António Faustino, Jorge Santos, Samuel Honório O200 Therapeutic itinerary of 
women with breast cancer in Santa Maria City/RS Betina P. Vizzotto, Leticia 
Frigo, Hedioneia F. Pivetta O201 The breastfeeding prevalence at 4 months: 
Maternal experience as a determining factor Dolores Sardo O202 The impact of the 
transition to parenthood in health and well-being Cristina Martins, Wilson 
Abreu, Mª Céu Figueiredo P96 Self-determined motivation and well-being in 
Portuguese active adults of both genders Marco Batista, Ruth Jimenez-Castuera, 
João Petrica, João Serrano, Samuel Honório, Rui Paulo, Pedro Mendes P97 The 
geriatric care: ways and means of comforting Patrícia Sousa, Rita Marques P98 
The influence of relative age, subcutaneous adiposity and physical growth on 
Castelo Branco under-15 soccer players 2015 António Faustino, Paulo Silveira, 
João Serrano, Rui Paulo, Pedro Mendes, Samuel Honório P99 Data for the 
diagnostic process focused on self-care – managing medication regime: An 
integrative literature review Catarina Oliveira, Fernanda Bastos, Inês Cruz P100 
Art therapy as mental health promotion for children Cláudia K. Rodriguez, Márcia 
R. Kretzer, Nazaré O. Nazário P101 Chemical characterization of fungal chitosan 
for industrial applications Pedro Cruz, Daniela C. Vaz, Rui B. Ruben, Francisco 
Avelelas, Susana Silva, Mª Jorge Campos P102 The impact of caring older people 
at home Maria Almeida, Liliana Gonçalves, Lígia Antunes P103 Development of the 
first pressure ulcer in an inpatient setting: Focus on patients’ characteristics 
Pedro Sardo, Jenifer Guedes, João Simões, Paulo Machado, Elsa Melo P104 
Association between General Self-efficacy and Physical Activity among 
Adolescents Susana Cardoso, Osvaldo Santos, Carla Nunes, Isabel Loureiro O203 
Characterization of the habits of online acquisition of medicinal products in 
Portugal Flávia Santos, Gilberto Alves O204 Waiting room – A space for health 
education Cláudia Soar, Teresa O. Marsi O205 Safey culture evaluation in 
hospitalized children Ernestina Silva, Dora Pedrosa, Andrea Leça, Daniel Silva 
O206 Sexual Self-awareness and Body Image Ana Galvão, Maria Gomes, Paula 
Fernandes, Ana Noné O207 Perception of a Portuguese population regarding the 
acquisition and consumption of functional foods Jaime Combadão, Cátia Ramalhete, 
Paulo Figueiredo, Patrícia Caeiro O208 The work process in primary health care: 
evaluation in municipalities of southern Brazil Karine C. Fontana, Josimari T. 
Lacerda, Patrícia O. Machado O209 Exploration and evaluation of potential 
probiotic lactic acid bacteria isolated from Amazon buffalo milk Raphaelle 
Borges, Flávio Barbosa, Dayse Sá O210 Road safety for children: Using children’s 
observation, as a passenger Germana Brunhoso, Graça Aparício, Amâncio Carvalho 
O211 Perception and application of quality-by-design by the Pharmaceutical 
industry in Portugal Ana P. Garcia, Paula O. Fernandes, Adriana Santos O212 Oral 
health among Portuguese children and adolescents: a public health issue Nélio 
Veiga, Carina Brás, Inês Carvalho, Joana Batalha, Margarida Glória, Filipa 
Bexiga, Inês Coelho, Odete Amaral, Carlos Pereira O213 Plant species as a 
medicinal resource in Igatu-Chapada Diamantina (Bahia, Brazil) Cláudia Pinho, 
Nilson Paraíso, Ana I. Oliveira, Cristóvão F. Lima, Alberto P. Dias O214 
Characterization of cognitive and functional performance in everyday tasks: 
Implications for health in institutionalised older adults Pedro Silva, Mário 
Espada, Mário Marques, Ana Pereira O215 BMI and the perception of the importance 
given to sexuality in obese and overweight people Ana Mª Pereira, Mª 
Veiga-Branco, Filomena Pereira, Maria Ribeiro O216 Analysis and comparison of 
microbiological contaminations of two different composition pacifiers Vera Lima, 
Ana I. Oliveira, Cláudia Pinho, Graça Cruz, Rita F. Oliveira, Luísa Barreiros, 
Fernando Moreira O217 Experiences of couple relationships in the transition to 
retirement Ana Camarneiro, Mª Helena Loureiro, Margarida Silva O218 Preventive 
and corrective treatment of drug-induced calcium deficiency: an analysis in a 
community pharmacy setting Catarina Duarte, Ângelo Jesus, Agostinho Cruz O219 
Profile of mood states in physically active elderly subjects: Is there a 
relation with health perception? Maria Mota, Sandra Novais, Paulo Nogueira, Ana 
Pereira, Lara Carneiro, Paulo V. João O220 (Un)Safety behaviour at work: the 
role of education towards a health and safety culture Teresa Maneca Lima O221 
Analysis of the entrepreneurial profile of students attending higher education 
in Portugal: the Carland Entrepreneurship Index application Anabela 
Salgueiro-Oliveira, Marina Vaquinhas, Pedro Parreira, Rosa Melo, João Graveto, 
Amélia Castilho, José H. Gomes O222 Evaluation of welfare and quality of life of 
pregnant working women regarding the age of the pregnant María S. Medina, 
Valeriana G. Blanco O223 Psychological wellbeing protection among unemployed and 
temporary workers: Uncovering effective community-based interventions with a 
Delphi panel Osvaldo Santos, Elisa Lopes, Ana Virgolino, Alexandra Dinis, Sara 
Ambrósio, Inês Almeida, Tatiana Marques, Mª João Heitor O224 Chilean population 
norms derived from the Health-related quality of life SF-6D Miguel A. 
Garcia-Gordillo, Daniel Collado-Mateo, Pedro R. Olivares, José A. Parraça, José 
A. Sala O225 Motivation of college students toward Entrepreneurship: The 
influence of social and economic instability Amélia Castilho, João Graveto, 
Pedro Parreira, Anabela Oliveira, José H. Gomes, Rosa Melo, Marina Vaquinhas 
O226 Use of aromatic and medicinal plants, drugs and herbal products in Bragança 
city Mónia Cheio, Agostinho Cruz, Olívia R. Pereira O227 Edible flowers as new 
novel foods concept for health promotion Sara Pinto, Adriana Oliveira, M. 
Conceição Manso, Carla Sousa, Ana F. Vinha O228 The influence of leisure 
activities on the health and welfare of older people living in nursing homes Mª 
Manuela Machado, Margarida Vieira O229 Risk of falling, fear of falling and 
functionality in community-dwelling older adults Beatriz Fernandes, Teresa 
Tomás, Diogo Quirino O230 Musculoskeletal pain and postural habits in children 
and teenage students Gustavo Desouzart, Rui Matos, Magali Bordini, Pedro Mouroço 
O231 What's different in Southern Europe? The question of citizens’ 
participation in health systems Ana R. Matos, Mauro Serapioni O232 Occupational 
stress in Portuguese police officers Teresa Guimarães, Virgínia Fonseca, André 
Costa, João Ribeiro, João Lobato O233 Is occupational therapy culturally 
relevant to promote mental health in Burkina Faso? Inmaculada Z. Martin, Anita 
Björklund P105 Pay-for-performance satisfaction and quality in primary care Aida 
I. Tavares, Pedro Ferreira, Rui Passadouro P106 Economic development through 
life expectancy lenses Sónia Morgado P107 What is the effectiveness of exercise 
on smoking cessation to prevent clinical complications of smoking? Nuno Tavares, 
João Valente, Anabela C. Martins P108 A systematic review of the effects of yoga 
on mental health Patrícia Araújo, Rosina Fernandes, Francisco Mendes, Cátia 
Magalhães, Emília Martins P109 Healthy lifestyle: comparison between higher 
education students that lived until adult age in rural and urban environment 
Pedro Mendes, Rui Paulo, António Faustino, Helena Mesquita, Samuel Honório, 
Marco Batista P110 Evaluation of the Mobile Emergency Care Service (SAMU) in 
Brazil Josimari T. Lacerda, Angela B. Ortiga, Mª Cristina Calvo, Sônia Natal 
P111 Bioactive compounds - antioxidant activity of tropical fruits Marta Pereira 
P112 Use of non-pharmacological methods to relieve pain in labour Manuela 
Ferreira, Ana R. Prata, Paula Nelas, João Duarte P113 Mechanical safety of 
pacifiers sold in Portuguese pharmacies and childcare stores Juliana Carneiro, 
Ana I. Oliveira, Cláudia Pinho, Cristina Couto, Rita F. Oliveira, Fernando 
Moreira P114 The importance of prenatal consultation: Information to pregnant 
women given on a unit of primary care Ana S. Maia, Michelle T. Oliveira, 
Anderson R. Sousa, Paulo P. Ferreira, Géssica M. Souza, Lívia F. Almada, Milena 
A. Conceição, Eujcely C. Santiago P115 Influence of different backpack loading 
conditions on neck and lumbar muscles activity of elementary school children 
Sandra Rodrigues, Gabriela Domingues, Irina Ferreira, Luís Faria, Adérito Seixas 
P116 Efficacy and safety of dry extract Hedera helix in the treatment of 
productive cough Ana R. Costa, Ângelo Jesus, Américo Cardoso, Alexandra 
Meireles, Armanda Colaço, Agostinho Cruz P117 A portrait of the evaluation 
processes of education groups in primary health care Viviane L. Vieira, Kellem 
R. Vincha, Ana Mª Cervato-Mancuso P118 Benefits of vitamins C and E in 
sensorineural hearing loss: a review Melissa Faria, Cláudia Reis P119 BODY 
SNAPSHOT – a web-integrated anthropometric evaluation system Marco P. Cova, Rita 
T. Ascenso, Henrique A. Almeida, Eunice G. Oliveira P120 Anthropometric 
evaluation and variation during pregnancy Miguel Santana, Rafael Pereira, Eunice 
G. Oliveira, Henrique A. Almeida, Rita T. Ascenso P121 Knowledge of college 
students on the amendments of their eating habits and physical activity index in 
the transition to higher education Rita Jesus, Rodrigo Tapadas, Carolina 
Tim-Tim, Catarina Cezanne, Matilde Lagoa, Sara S. Dias, Jorge Torgal P122 
Muscular activity of a rally race car driver João Lopes, Henrique Almeida, 
Sandra Amado, Luís Carrão O234 Literacy and results in health Madalena Cunha, 
Luís Saboga-Nunes, Carlos Albuquerque, Olivério Ribeiro O235 Literacy promotion 
and empowerment of type 2 diabetics elderly in four family health units of the 
group of health centers of Dão Lafões Suzete Oliveira, Mª Carminda Morais O236 
Mediterranean diet, health and life quality among Portuguese children Emília 
Martins, Francisco Mendes, Rosina Fernandes, Cátia Magalhães, Patrícia Araújo 
O237 Health literacy, from data to action - translation, validation and 
application of the European Health Literacy Survey in Portugal (HLS-EU-PT) Ana 
R. Pedro, Odete Amaral, Ana Escoval O238 Oral health literacy evaluation in a 
Portuguese military population Victor Assunção, Henrique Luís, Luís Luís O239 
Preferences to Internet-based cognitive behavioural therapy – do attachment 
orientations matter? Jennifer Apolinário-Hagen, Viktor Vehreschild O240 A 
comparative transnational study in health literacy between Austria and Portugal 
Ulrike Fotschl, Gerald Lirk, Anabela C. Martins, Isabel Andrade, Fernando Mendes 
O241 Health literacy and social behaviours: relationship with sexually 
transmitted diseases? Verónica Mendonça, Sandra Antunes, Isabel Andrade, Nádia 
Osório, Ana Valado, Armando Caseiro, António Gabriel, Anabela C. Martins, 
Fernando Mendes O242 Parenting styles and attachment to parents: what 
relationships? Paula A. Silva, Lisete M. Mónico, Pedro M. Parreira, Carla 
Carvalho O243 Work-life balance in health professionals and professors: 
comparative study of workers with shift work and fixed schedule Carla Carvalho, 
Pedro M. Parreira, Lisete M. Mónico, Joana Ruivo O244 Technology literacy in 
self-management of diabetes Vânia Silva, Paulino Sousa, José M. Padilha O245 
Satisfaction with therapeutic education and its relationship with clinical 
variables in children with type 1 diabetes Vera Ferraz, Graça Aparício, João 
Duarte O246 Nutrition-related knowledge in middle-age and older patients with 
type 2 diabetes Carlos Vasconcelos, António Almeida, Joel Neves, Telma Correia, 
Helena Amorim, Romeu Mendes O247 Validating the HLS-EU-(PT) questionnaire to 
measure health literacy in adolescents (CrAdLiSa project: HLS-EU-PT) Luís 
Saboga-Nunes, Madalena Cunha, Carlos Albuquerque O248 Health education in people 
with coronary heart disease: Experience of the cardiology department of a 
hospital on the outskirts of Lisbon Elsa S. Pereira, Leonino S. Santos, Ana S. 
Reis, Helena R. Silva, João Rombo, Jorge C. Fernandes, Patrícia Fernandes O249 
Information and training needs of informal caregivers of individuals with stroke 
sequelae: a qualitative survey Jaime Ribeiro, Catarina Mangas, Ana Freire O250 
Prevention of psychoactive substances consumption in students from 6th grade of 
Albergaria-a-Velha´s School Group Sara Silva, Irene Francisco, Ana Oliveira O251 
Promoting healthy sexuality: shared responsibility for family, youth and 
educators Helena Catarino, Mª Anjos Dixe, Mª Clarisse Louro O252 Sexual risk 
behaviour in adolescents and young people Saudade Lopes, Anjos Dixe O253 
Knowledge of school staff on type 1 diabetes Mª Anjos Dixe, Eva Menino, Helena 
Catarino, Fátima Soares, Ana P. Oliveira, Sara Gordo, Teresa Kraus O254 Sexual 
health in adolescents: the impact of information search in literacy Catarina 
Tomás, Paulo Queirós, Teresa Rodrigues P123 Improving basic life support skills 
in adolescents through a training programme Pedro Sousa, João G. Frade, Catarina 
Lobão P124 Difficulties in sexual education reported by basic education teachers 
in the city of Foz do Iguaçu - Brazil Cynthia B. Moura, Laysa C. Dreyer, Vanize 
Meneghetti, Priscila P. Cabral P125 Breast cancer survivors: subjects and 
resources for information. A qualitative systematic review Francisca Pinto, 
Paulino Sousa, Mª Raquel Esteves P126 Relationship between health literacy and 
prevalence of STI in Biomedical Laboratory Science students Sofia Galvão, Ite 
Tytgat, Isabel Andrade, Nádia Osório, Ana Valado, Armando Caseiro, António 
Gabriel, Anabela C. Martins, Fernando Mendes P127 Health literacy, risk 
behaviours and sexually transmitted diseases among blood donors Mónica 
Casas-Novas, Helena Bernardo, Isabel Andrade, Gracinda Sousa, Ana P. Sousa, 
Clara Rocha, Pedro Belo, Nádia Osório, Ana Valado, Armando Caseiro, António 
Gabriel, Anabela C. Martins, Fernando Mendes P128 Promoting literacy in 
pregnancy health-care Fátima Martins, Montserrat Pulido-Fuentes P129 The 
lifestyles of the operating assistants of education Isabel Barroso, Gil Cabral, 
M. João Monteiro, Conceição Rainho P130 Experiences of service-learning health 
and the literary art: reflections about the health education Alessandro Prado, 
Yara M. Carvalho P131 Life long swimming – a European Erasmus + project Maria 
Campos, Liliana Moreira, José Ferreira, Ana Teixeira, Luís Rama

DOI: 10.1186/s12913-016-1423-5
PMCID: PMC4943498
PMID: 27409075


4569. Chest. 2016 Jul;150(1):17-26. doi: 10.1016/j.chest.2016.02.649.

An Official Critical Care Societies Collaborative Statement-Burnout Syndrome in 
Critical Care Health-care Professionals: A Call for Action.

Moss M(1), Good VS(2), Gozal D(3), Kleinpell R(4), Sessler CN(5).

Author information:
(1)Division of Pulmonary Sciences and Critical Care Medicine, University of 
Colorado School of Medicine, Aurora, CO.
(2)Cox Health System, Springfield, MO.
(3)Sections of Pediatric Sleep Medicine and Pulmonology, Department of 
Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The 
University of Chicago, Chicago, IL.
(4)Center for Clinical Research and Scholarship, Rush University Medical Center, 
and Rush University College of Nursing, Chicago, IL.
(5)Division of Pulmonary Disease and Critical Care Medicine, Virginia 
Commonwealth University Health System, Medical College of Virginia Hospitals and 
Physicians, Richmond, VA. Electronic address: Curtis.sessler@vcuhealth.org.

Comment in
    Chest. 2016 Jul;150(1):1-2.

Burnout syndrome (BOS) occurs in all types of health-care professionals and is 
especially common in individuals who care for critically ill patients. The 
development of BOS is related to an imbalance of personal characteristics of the 
employee and work-related issues or other organizational factors. BOS is 
associated with many deleterious consequences, including increased rates of job 
turnover, reduced patient satisfaction, and decreased quality of care. BOS also 
directly affects the mental health and physical well-being of the many critical 
care physicians, nurses, and other health-care professionals who practice 
worldwide. Until recently, BOS and other psychological disorders in critical 
care health-care professionals remained relatively unrecognized. To raise 
awareness of BOS, the Critical Care Societies Collaborative (CCSC) developed 
this call to action. The present article reviews the diagnostic criteria, 
prevalence, causative factors, and consequences of BOS. It also discusses 
potential interventions that may be used to prevent and treat BOS. Finally, we 
urge multiple stakeholders to help mitigate the development of BOS in critical 
care health-care professionals and diminish the harmful consequences of BOS, 
both for critical care health-care professionals and for patients.

Copyright © 2016 American College of Chest Physicians. Published by Elsevier 
Inc. All rights reserved.

DOI: 10.1016/j.chest.2016.02.649
PMID: 27396776 [Indexed for MEDLINE]


4570. Arch Pediatr. 2016 Sep;23(9):913-20. doi: 10.1016/j.arcped.2016.04.023. Epub 
2016 Jul 4.

Kangaroo supported diagonal flexion positioning: New insights into skin-to-skin 
contact for communication between mothers and very preterm infants.

Buil A(1), Carchon I(2), Apter G(3), Laborne FX(4), Granier M(4), Devouche E(3).

Author information:
(1)Centre hospitalier sud francilien, 116, boulevard Jean-Jaures, 91106 Corbeil 
Essonnes cedex, France; Université Paris Descartes, Laboratoire LPPS, EA4057, 
71, avenue Edouard-Vaillant, 92774 Boulogne Billancourt, France. Electronic 
address: audebuil11@gmail.com.
(2)Ecole Pratique des Hautes Etudes, Laboratoire CHART, 4-14, rue Ferrus, 75014 
Paris, France.
(3)EPS Erasme, Laboratoire RePPEr, 14, rue de l'Abbaye, 92160 Antony, France.
(4)Centre hospitalier sud francilien, 116, boulevard Jean-Jaures, 91106 Corbeil 
Essonnes cedex, France.

OBJECTIVE: Skin-to-skin contact shows benefits in the relationship developed 
between a mother and her premature infant. In the skin-to-skin session, 
face-to-face exchanges are impossible in vertical infant positioning. We 
therefore undertook an observational, prospective, single-center study using 
kangaroo "supported diagonal flexion" (SDF) positioning. The first aim was to 
evaluate the safety of kangaroo SDF positioning compared to the usual vertical 
positioning. The second aim was to evaluate SDF positioning on early 
communication between the mother and her infant and to improve their well-being.
PARTICIPANTS AND SETTING: Fifteen mothers and their very premature infants 
(birth 26<32 weeks' gestation) were assigned to one of the two kangaroo 
positioning modes, either the current vertical positioning (n=7) or SDF 
positioning (n=8).
DESIGN: Physiological variables and critical events were recorded before, 
during, and after ten successive skin-to-skin contact sessions. The first and 
last sessions were videotaped to allow later behavioral measurements. Mothers' 
risk for depression and feelings about the way they experienced communication 
with their infant were assessed through questionnaires.
RESULTS: In terms of the infant's physiology, no negative effects were 
associated with SDF positioning in comparison with the usual vertical 
positioning. SDF positioning led to fewer disorganized gestures, negative 
vocalizations, and drowsiness, in favor of more deep sleep. SDF led to more 
mother-infant eye-to-eye contact as well as maternal vocalizations, smiles, and 
caressing, although these differences did not reach significance. The score for 
the risk of postnatal depression decreased significantly between the first and 
the last session in the SDF group, whereas it did not change in the vertical 
positioning group.
CONCLUSION: These results support the idea that the kangaroo SDF positioning 
technique is physiologically safe, has obvious immediate benefits on mothers' 
infant-directed communicative behaviors, and respects the baby's naturally 
flexed and asymmetrical tonic neck posture. It is an innovative, inexpensive, 
easy-to-use technique in daily practice, by all healthcare professionals working 
in a neonatal intensive care unit. These data suggest that the current kangaroo 
positioning technique could be improved. More studies are needed to confirm the 
benefits and safety of the kangaroo SDF positioning in larger groups of preterm 
infants.

Copyright © 2016 Elsevier Masson SAS. All rights reserved.

DOI: 10.1016/j.arcped.2016.04.023
PMID: 27388909 [Indexed for MEDLINE]


4571. Am J Crit Care. 2016 Jul;25(4):368-76. doi: 10.4037/ajcc2016133.

An Official Critical Care Societies Collaborative Statement: Burnout Syndrome in 
Critical Care Health Care Professionals: A Call for Action.

Moss M(1), Good VS(1), Gozal D(1), Kleinpell R(1), Sessler CN(2).

Author information:
(1)Marc Moss is from the Division of Pulmonary Sciences and Critical Care 
Medicine, University of Colorado School of Medicine, Aurora, Colorado. Vicki S. 
Good is from Cox Health System, Springfield, Missouri. David Gozal is from the 
Sections of Pediatric Sleep Medicine and Pulmonology, Department of Pediatrics, 
Pritzker School of Medicine, Biological Sciences Division, The University of 
Chicago, Chicago, Illinois. Ruth Kleinpell is from the Center for Clinical 
Research and Scholarship, Rush University Medical Center, and Rush University 
College of Nursing, Chicago, Illinois. Curtis N. Sessler is from the Division of 
Pulmonary Disease and Critical Care Medicine, Virginia Commonwealth University 
Health System, Medical College of Virginia Hospitals and Physicians, Richmond, 
Virginia.
(2)Marc Moss is from the Division of Pulmonary Sciences and Critical Care 
Medicine, University of Colorado School of Medicine, Aurora, Colorado. Vicki S. 
Good is from Cox Health System, Springfield, Missouri. David Gozal is from the 
Sections of Pediatric Sleep Medicine and Pulmonology, Department of Pediatrics, 
Pritzker School of Medicine, Biological Sciences Division, The University of 
Chicago, Chicago, Illinois. Ruth Kleinpell is from the Center for Clinical 
Research and Scholarship, Rush University Medical Center, and Rush University 
College of Nursing, Chicago, Illinois. Curtis N. Sessler is from the Division of 
Pulmonary Disease and Critical Care Medicine, Virginia Commonwealth University 
Health System, Medical College of Virginia Hospitals and Physicians, Richmond, 
Virginia. Curtis.sessler@vcuhealth.org.

Burnout syndrome (BOS) occurs in all types of health care professionals and is 
especially common in individuals who care for critically ill patients. The 
development of BOS is related to an imbalance of personal characteristics of the 
employee and work-related issues or other organizational factors. BOS is 
associated with many deleterious consequences, including increased rates of job 
turnover, reduced patient satisfaction, and decreased quality of care. BOS also 
directly affects the mental health and physical well-being of the many critical 
care physicians, nurses, and other health care professionals who practice 
worldwide. Until recently, BOS and other psychological disorders in critical 
care health care professionals remained relatively unrecognized. To raise 
awareness of BOS, the Critical Care Societies Collaborative (CCSC) developed 
this call to action. The present article reviews the diagnostic criteria, 
prevalence, causative factors, and consequences of BOS. It also discusses 
potential interventions that may be used to prevent and treat BOS. Finally, we 
urge multiple stakeholders to help mitigate the development of BOS in critical 
care health care professionals and diminish the harmful consequences of BOS, 
both for critical care health care professionals and for patients.

©2016 American Association of Critical-Care Nurses.

DOI: 10.4037/ajcc2016133
PMID: 27369038 [Indexed for MEDLINE]


4572. Am J Respir Crit Care Med. 2016 Jul 1;194(1):106-13. doi: 
10.1164/rccm.201604-0708ST.

A Critical Care Societies Collaborative Statement: Burnout Syndrome in Critical 
Care Health-care Professionals. A Call for Action.

Moss M, Good VS, Gozal D, Kleinpell R, Sessler CN.

Burnout syndrome (BOS) occurs in all types of health-care professionals and is 
especially common in individuals who care for critically ill patients. The 
development of BOS is related to an imbalance of personal characteristics of the 
employee and work-related issues or other organizational factors. BOS is 
associated with many deleterious consequences, including increased rates of job 
turnover, reduced patient satisfaction, and decreased quality of care. BOS also 
directly affects the mental health and physical well-being of the many critical 
care physicians, nurses, and other health-care professionals who practice 
worldwide. Until recently, BOS and other psychological disorders in critical 
care health-care professionals remained relatively unrecognized. To raise 
awareness of BOS, the Critical Care Societies Collaborative (CCSC) developed 
this call to action. The present article reviews the diagnostic criteria, 
prevalence, causative factors, and consequences of BOS. It also discusses 
potential interventions that may be used to prevent and treat BOS. Finally, we 
urge multiple stakeholders to help mitigate the development of BOS in critical 
care health-care professionals and diminish the harmful consequences of BOS, 
both for critical care health-care professionals and for patients.

DOI: 10.1164/rccm.201604-0708ST
PMID: 27367887 [Indexed for MEDLINE]


4573. Curr Opin Pharmacol. 2016 Aug;29:34-41. doi: 10.1016/j.coph.2016.05.003. Epub 
2016 Jun 16.

Well-being and immune response: a multi-system perspective.

Lasselin J(1), Alvarez-Salas E(2), Grigoleit JS(3).

Author information:
(1)Institute of Medical Psychology and Behavioral Immunobiology, University 
Hospital Essen, Hufelandstr. 55, 45122 Essen, Germany; Department of Clinical 
Neuroscience, Division for Psychology, Karolinska Institutet, Nobels väg 9, 171 
65 Solna, Stockholm, Sweden; Stress Research Institute, Stockholm University, 
Frescati Hagväg 16A, 106 91 Stockholm, Sweden.
(2)Molecular Neurophysiology, Department of Neuroscience Research, National 
Institute of Psychiatry, Calzada México-Xochimilco 101, Tlalpan, 14370 México, 
D.F., Mexico.
(3)Laboratory of Neuronal Structure and Function, The Salk Institute for 
Biological Studies, 10010N Torrey Pines Rd, La Jolla, CA 92037, USA. Electronic 
address: jgrigoleit@salk.edu.

Whereas it is well-established that inflammation and other immune responses can 
change how we feel, most people are still surprised to hear that, conversely, 
well-being and its violations also affect our immune system. Here we show that 
those effects are highly adaptive and bear potential for both research and 
therapeutic applications. The studies discussed in this review demonstrate that 
immunity is tuned by ones emotions, personality, and social status as well as by 
other life style variables like sleep, nutrition, obesity, or exercise. We 
further provide a short excursion on the effects of stress and depression on 
immunity and discuss acute experimental endotoxemia as a model to study the 
effects of well-being on the innate immune response in humans.

Copyright © 2016 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.coph.2016.05.003
PMID: 27318753 [Indexed for MEDLINE]


4574. Crit Care Med. 2016 Jul;44(7):1414-21. doi: 10.1097/CCM.0000000000001885.

An Official Critical Care Societies Collaborative Statement: Burnout Syndrome in 
Critical Care Healthcare Professionals: A Call for Action.

Moss M(1), Good VS, Gozal D, Kleinpell R, Sessler CN.

Author information:
(1)1Division of Pulmonary Sciences and Critical Care Medicine, University of 
Colorado School of Medicine, Aurora, CO. 2Cox Health System, Springfield, MO. 
3Sections of Pediatric Sleep Medicine and Pulmonology, Department of Pediatrics, 
Pritzker School of Medicine, Biological Sciences Division, The University of 
Chicago, Chicago, IL. 4Center for Clinical Research and Scholarship, Rush 
University Medical Center, and Rush University College of Nursing, Chicago, IL. 
5Division of Pulmonary Disease and Critical Care Medicine, Virginia Commonwealth 
University Health System, Medical College of Virginia Hospitals and Physicians, 
Richmond, VA.

Comment in
    Crit Care Med. 2016 Jul;44(7):1446-8.
    Crit Care Med. 2016 Dec;44(12):e1252-e1253.
    Crit Care Med. 2016 Dec;44(12):e1253-e1254.

Burnout syndrome (BOS) occurs in all types of healthcare professionals and is 
especially common in individuals who care for critically ill patients. The 
development of BOS is related to an imbalance of personal characteristics of the 
employee and work-related issues or other organizational factors. BOS is 
associated with many deleterious consequences, including increased rates of job 
turnover, reduced patient satisfaction, and decreased quality of care. BOS also 
directly affects the mental health and physical well-being of the many critical 
care physicians, nurses, and other healthcare professionals who practice 
worldwide. Until recently, BOS and other psychological disorders in critical 
care healthcare professionals remained relatively unrecognized. To raise 
awareness of BOS, the Critical Care Societies Collaborative (CCSC) developed 
this call to action. The present article reviews the diagnostic criteria, 
prevalence, causative factors, and consequences of BOS. It also discusses 
potential interventions that may be used to prevent and treat BOS. Finally, we 
urge multiple stakeholders to help mitigate the development of BOS in critical 
care healthcare professionals and diminish the harmful consequences of BOS, both 
for critical care healthcare professionals and for patients.

DOI: 10.1097/CCM.0000000000001885
PMID: 27309157 [Indexed for MEDLINE]


4575. Int J Nephrol Renovasc Dis. 2016 May 23;9:119-28. doi: 10.2147/IJNRD.S89128. 
eCollection 2016.

Health status, renal function, and quality of life after multiorgan failure and 
acute kidney injury requiring renal replacement therapy.

Faulhaber-Walter R(1), Scholz S(2), Haller H(3), Kielstein JT(3), Hafer C(4).

Author information:
(1)Department of Renal and Hypertensive Disease, Medical School Hannover, 
Hannover, Germany; Facharztzentrum Aarberg, Waldshut-Tiengen, Germany.
(2)Department of Renal and Hypertensive Disease, Medical School Hannover, 
Hannover, Germany; Sanitaetsversorgungszentrum Wunstorf, Wunstorf, Germany.
(3)Department of Renal and Hypertensive Disease, Medical School Hannover, 
Hannover, Germany.
(4)Department of Renal and Hypertensive Disease, Medical School Hannover, 
Hannover, Germany; HELIOS Klinikum Erfurt, Erfurt, Germany.

BACKGROUND: Critically ill patients with acute kidney injury (AKI) in need of 
renal replacement therapy (RRT) may have a protracted and often incomplete 
rehabilitation. Their long-term outcome has rarely been investigated.
STUDY DESIGN: Survivors of the HANnover Dialysis OUTcome (HANDOUT) study were 
evaluated after 5 years for survival, health status, renal function, and quality 
of life (QoL). The HANDOUT study had examinded mortality and renal recovery of 
patients with AKI receiving either standard extendend or intensified dialysis 
after multi organ failure.
RESULTS: One hundred fifty-six former HANDOUT participants were analyzed. 
In-hospital mortality was 56.4%. Five-year survival after AKI/RRT was 40.1% 
(86.5% if discharged from hospital). Main causes of death were cardiovascular 
complications and sepsis. A total of 19 survivors presented to the outpatient 
department of our clinic and had good renal recovery (mean estimated glomerular 
filtration rate 72.5±30 mL/min/1.73 m(2); mean proteinuria 89±84 mg/d). One 
person required maintenance dialysis. Seventy-nine percent of the patients had a 
pathological kidney sonomorphology. The Charlson comorbidity score was 2.2±1.4 
and adjusted for age 3.3±2.1 years. Numbers of comorbid conditions averaged 
2.38±1.72 per patient (heart failure [52%] > chronic kidney disease/myocardial 
infarction [each 29%]). Median 36-item short form health survey (SF-36™) index 
was 0.657 (0.69 physical health/0.66 mental health). Quality-adjusted life-years 
after 5 years were 3.365.
CONCLUSION: Mortality after severe AKI is higher than short-term prospective 
studies show, and morbidity is significant. Kidney recovery as well as general 
health remains incomplete. Reduction of QoL is minor, and social rehabilitation 
is very good. Affectivity is heterogeneous, but most patients experience 
emotional well-being. In summary, AKI in critically ill patients leads to 
incomplete rehabilitation but acceptable QoL after 5 years.

DOI: 10.2147/IJNRD.S89128
PMCID: PMC4883815
PMID: 27284261


4576. BMC Psychiatry. 2016 May 27;16:169. doi: 10.1186/s12888-016-0861-2.

Take A Breath: study protocol for a randomized controlled trial of an online 
group intervention to reduce traumatic stress in parents of children with a life 
threatening illness or injury.

Rayner M(1), Muscara F(2), Dimovski A(2), McCarthy MC(3), Yamada J(2), Anderson 
VA(2), Burke K(4), Walser R(5), Nicholson JM(6).

Author information:
(1)Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's 
Hospital, Flemington Road, Parkville, Victoria, 3052, Australia. 
meredith.rayner@mcri.edu.au.
(2)Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's 
Hospital, Flemington Road, Parkville, Victoria, 3052, Australia.
(3)Children's Cancer Centre, The Royal Children's Hospital, Flemington Road, 
Parkville, Victoria, 3052, Australia.
(4)Parenting and Family Support Centre, School of Psychology, The University of 
Queensland, Brisbane, Queensland, 4072, Australia.
(5)University of California, Berkeley and TL Consultation Services, Menlo Park, 
California, USA.
(6)Judith Lumley Centre, La Trobe University, 215 Franklin St, Melbourne, 
Victoria, 3000, Australia.

BACKGROUND: A substantial proportion of parents whose child is diagnosed with a 
life-threatening illness, experience high levels of distress that can lead to 
long-term difficulties in mental health, family functioning and child 
adjustment. This study evaluates the efficacy of an Acceptance Commitment 
Therapy-based group intervention designed to reduce distress symptoms in these 
parents. The program is delivered using videoconferencing to overcome factors 
that prevent participation in traditional face-to-face therapy.
METHOD/DESIGN: The study is a randomized control trial of the Take A Breath 
group intervention for parents demonstrating elevated symptoms of acute stress, 
delivered via videoconferencing in six 90 min group sessions. Participants are 
the primary caregivers of children aged 0 to 18 years admitted for a life 
threatening illness or injury to the Oncology, Cardiology, Neurology or 
Intensive Care Departments of a tertiary pediatric hospital. Parents will be 
randomized to intervention or waitlist control 4-10 months after their child's 
diagnosis. Measures will be collected prior to and immediately post intervention 
for intervention and waitlist parents to assess program efficacy. Intervention 
parents will be followed up at 6 months to assess the maintenance of program 
effects. We predict that intervention parents will show fewer symptoms post 
intervention than waitlist parents (primary outcomes: traumatic stress, 
depression, anxiety, stress symptoms), reflecting improvements in the 
psychological skills addressed in the intervention (mediating factors). It is 
anticipated that reductions in mental health difficulties for intervention 
parents will be maintained up to 6 months post-intervention and will be 
associated with broader improvements in parents' adjustment, child adjustment 
and child wellbeing (secondary outcomes).
DISCUSSION: This study is unique in evaluating a group intervention delivered to 
parents of children affected by of a diverse range life-threatening illness or 
injury. Online communication technology is employed to reduce participation 
barriers. If proven efficacious, this trans-diagnostic approach offers the 
potential for broad use as part of the suite of psychosocial services provided 
to families through tertiary pediatric settings.
TRIAL REGISTRATION: ACTRN12611000090910 . Trial Registration Date: 14/09/2011 
Protocol Date/version: September 2015, version M Study Status: Ongoing.

DOI: 10.1186/s12888-016-0861-2
PMCID: PMC4884427
PMID: 27234569 [Indexed for MEDLINE]


4577. Rehabil Psychol. 2016 May;61(2):141-150. doi: 10.1037/rep0000074.

Posttraumatic stress symptoms in intensive care patients: An exploration of 
associated factors.

Elliott R(1), McKinley S(2), Fien M(3), Elliott D(1).

Author information:
(1)Faculty of Health, University of Technology Sydney.
(2)Royal North Shore Hospital.
(3)eHealth NSW.

PURPOSE/OBJECTIVE: To explore demographic, clinical, and psychological factors 
in intensive care unit (ICU), including self-reported sleep quality and 
experiences that were associated with posttraumatic stress (PTS) symptoms 6 
months after discharge from hospital.
RESEARCH METHOD/DESIGN: A prospective survey was conducted (N = 222). On the day 
of transfer to the hospital ward, ICU patients reported pain and state-anxiety 
levels, as well as ICU and prehospital sleep quality. Two months after hospital 
discharge, they reported sleep quality at home and experiences in ICU. Six 
months after hospital discharge, sleep quality, PTS symptoms (measured with the 
Posttraumatic Stress Disorder Checklist-Specific; PCL-S; VA National Center for 
PTSD, 2014) and psychological well-being (using Depression, Anxiety and Stress 
Scales-21; DASS-21; Ware, Kosinski, & Keller, 1994) were reported. Descriptive 
data analyses were performed and factors associated with PTS symptoms were 
explored with multiple linear regression.
RESULTS: The sample was predominately male (65%), with a mean age 57 years. At 
baseline, pain intensity was low (M ± SD; 2.25 ± 1.14) and state-anxiety levels 
were moderate (2.50 ± 2.90). At 6 months, 30% of the sample demonstrated 
depression, and 13.5% (mean PCL-S score: 26.54 ± 10.52) reported symptoms 
reflective of PTS. The regression model explained 68.2% of the variance in the 
PCL-S score. Higher PTS scores were independently associated with frightening 
experiences in ICU, higher stress and depression scores, pain intensity at 
baseline, and sleep quality at 6 months.
CONCLUSION/IMPLICATIONS: Continuing symptoms of PTS were evident in 14% of the 
cohort. Screening for prevention and treatment of delirium while a patient is in 
ICU is essential, and psychological screening and follow-up during recovery 
would therefore also be beneficial for many patients. (PsycINFO Database Record

(c) 2016 APA, all rights reserved).

DOI: 10.1037/rep0000074
PMID: 27196857 [Indexed for MEDLINE]


4578. N Engl J Med. 2016 May 12;374(19):1831-41. doi: 10.1056/NEJMoa1511160.

One-Year Outcomes in Caregivers of Critically Ill Patients.

Cameron JI(1), Chu LM(1), Matte A(1), Tomlinson G(1), Chan L(1), Thomas C(1), 
Friedrich JO(1), Mehta S(1), Lamontagne F(1), Levasseur M(1), Ferguson ND(1), 
Adhikari NK(1), Rudkowski JC(1), Meggison H(1), Skrobik Y(1), Flannery J(1), 
Bayley M(1), Batt J(1), dos Santos C(1), Abbey SE(1), Tan A(1), Lo V(1), Mathur 
S(1), Parotto M(1), Morris D(1), Flockhart L(1), Fan E(1), Lee CM(1), Wilcox 
ME(1), Ayas N(1), Choong K(1), Fowler R(1), Scales DC(1), Sinuff T(1), 
Cuthbertson BH(1), Rose L(1), Robles P(1), Burns S(1), Cypel M(1), Singer L(1), 
Chaparro C(1), Chow CW(1), Keshavjee S(1), Brochard L(1), Hébert P(1), Slutsky 
AS(1), Marshall JC(1), Cook D(1), Herridge MS(1); RECOVER Program Investigators 
(Phase 1: towards RECOVER); Canadian Critical Care Trials Group.

Author information:
(1)From the Department of Occupational Science and Occupational Therapy (J.I.C., 
L.C.), Rehabilitation Sciences Institute (J.I.C., S.Mathur, P.R.), Toronto 
Rehabilitation Institute, University Health Network (J.I.C., J.F., M.B.), 
Department of Medicine, Toronto General Research Institute, Institute of Medical 
Science, University Health Network (L.M.C., A.M., G.T., C.T., N.D.F., J.F., 
M.B., V.L., M.P., D.M., L.F., E.F., M.E.W., P.R., S.B., M.C., L.S., C.C., 
C.-W.C., S.K., M.S.H.), Interdepartmental Division of Critical Care (J.O.F., S. 
Mehta, N.D.F., N.K.J.A., J.B., C.S., M.P., C.M.L., R.F., D.C.S., T.S., B.H.C., 
C.C., C.-W.C., L.B., A.S.S., M.S.H.), Departments of Medicine and Critical Care 
(J.O.F., J.B., C.S., L.R., L.B., J.C.M.) and Keenan Research Center at the Li Ka 
Shing Knowledge Institute (L.B., A.S.S., J.C.M.), St. Michael's Hospital, 
Department of Medicine and Anesthesia, Mount Sinai Hospital (S. Mehta, C.M.L., 
L.R., L.S.), Department of Critical Care Medicine, Sunnybrook Health Sciences 
Centre (N.K.J.A., R.F., D.C.S., T.S., B.H.C., L.R.), Interdepartmental Division 
of Physiatry (J.F., M.B.), Department of Psychiatry, University Health Network 
(S.E.A., A.T.), and Department of Physical Therapy (S. Mathur), University of 
Toronto, Toronto, the Departments of General Internal Medicine and Critical 
Care, St. Joseph's Healthcare (J.C.R.), and the Departments of Pediatrics (K.C.) 
and Medicine (D.C.), Division of Critical Care and Clinical Epidemiology and 
Biostatistics, McMaster University, Hamilton, ON, Centre de Recherche du Centre 
Hospitalier Universitaire de Sherbrooke (F.L., P.H.) and the School of 
Rehabilitation and Research Centre on Aging, Health and Social Services Centre 
(M.L.), University of Sherbrooke, Sherbrooke, QC, the Department of Critical 
Care, University of Ottawa, Ottawa (H.M.), the Department of Medicine Division 
of Critical Care, Maisonneuve Rosemont Hospital, University of Montreal, 
Montreal (Y.S.), and the Department of Medicine, St. Paul's H

Comment in
    N Engl J Med. 2016 Sep 8;375(10):1000-2.
    N Engl J Med. 2016 Sep 8;375(10):1000.
    N Engl J Med. 2016 Sep 8;375(10):1000-2.
    J Thorac Dis. 2016 Oct;8(10 ):E1232-E1234.
    Am J Respir Crit Care Med. 2017 Oct 15;196 (8):1068-1070.

BACKGROUND: Few resources are available to support caregivers of patients who 
have survived critical illness; consequently, the caregivers' own health may 
suffer. We studied caregiver and patient characteristics to determine which 
characteristics were associated with caregivers' health outcomes during the 
first year after patient discharge from an intensive care unit (ICU).
METHODS: We prospectively enrolled 280 caregivers of patients who had received 7 
or more days of mechanical ventilation in an ICU. Using hospital data and 
self-administered questionnaires, we collected information on caregiver and 
patient characteristics, including caregiver depressive symptoms, psychological 
well-being, health-related quality of life, sense of control over life, and 
effect of providing care on other activities. Assessments occurred 7 days and 3, 
6, and 12 months after ICU discharge.
RESULTS: The caregivers' mean age was 53 years, 70% were women, and 61% were 
caring for a spouse. A large percentage of caregivers (67% initially and 43% at 
1 year) reported high levels of depressive symptoms. Depressive symptoms 
decreased at least partially with time in 84% of the caregivers but did not in 
16%. Variables that were significantly associated with worse mental health 
outcomes in caregivers were younger age, greater effect of patient care on other 
activities, less social support, less sense of control over life, and less 
personal growth. No patient variables were consistently associated with 
caregiver outcomes over time.
CONCLUSIONS: In this study, most caregivers of critically ill patients reported 
high levels of depressive symptoms, which commonly persisted up to 1 year and 
did not decrease in some caregivers. (Funded by the Canadian Institutes of 
Health Research and others; ClinicalTrials.gov number, NCT00896220.).

DOI: 10.1056/NEJMoa1511160
PMID: 27168433 [Indexed for MEDLINE]


4579. J Pediatr Psychol. 2016 Jul;41(6):643-50. doi: 10.1093/jpepsy/jsw016. Epub 2016 
Mar 26.

Sleep Disturbance in Caregivers of Children With Respiratory and Atopic Disease.

Meltzer LJ(1), Booster GD(2).

Author information:
(1)Division of Behavioral Health, Department of Pediatrics, National Jewish 
Health meltzerL@njhealth.org.
(2)Division of Behavioral Health, Department of Pediatrics, National Jewish 
Health.

OBJECTIVE: To examine sleep patterns and sleep disturbances in caregivers of 
children with chronic illness.
METHODS: Caregivers of children with atopic dermatitis (AD, n = 35), asthma (AS, 
n = 27), atopic dermatitis and asthma (AD + AS, n = 57), ventilator assistance 
(VENT, n = 61), or typically developing (HEALTHY, n = 63) completed the 
Pittsburgh Sleep Quality Index, the Insomnia Severity Index, and three items 
examining reasons for parent sleep disruption.
RESULTS: Compared with healthy families, caregivers of children with chronic 
illness reported poorer sleep quality, more symptoms of insomnia, and chronic 
partial sleep deprivation. VENT and AD caregivers had higher rates of sleep 
disruptions due to caregiving, whereas AS caregivers reported more sleep 
disruptions from stress about the child's health.
CONCLUSIONS: Deficient and poor-quality sleep in caregivers of children with 
chronic illness may have a significant impact on their health and well-being, as 
well as caregiving responsibilities. These data provide important information 
for pediatric psychologists working with these families.

© The Author 2016. Published by Oxford University Press on behalf of the Society 
of Pediatric Psychology. All rights reserved. For permissions, please e-mail: 
journals.permissions@oup.com.

DOI: 10.1093/jpepsy/jsw016
PMCID: PMC6080487
PMID: 27017428 [Indexed for MEDLINE]


4580. MCN Am J Matern Child Nurs. 2016 Jul/Aug;41(4):221-229. doi: 
10.1097/NMC.0000000000000248.

Mothers' Psychological Distress and Feeding of Their Preterm Infants.

Park J(1), Thoyre S, Estrem H, Pados BF, Knafl GJ, Brandon D.

Author information:
(1)Jinhee Park is an Assistant Professor, Boston College Connell School of 
Nursing, Chestnut Hill, MA. The author can be reached via e-mail at 
jinhee.park@bc.eduSuzanne Thoyre is a Francis Hill Fox Distinguished Term 
Professor, University of North Carolina at Chapel Hill School of Nursing, Chapel 
Hill, NC.Hayley Estremi is a Postdoctoral Associate, Duke University School of 
Nursing, Durham, NC.Britt F. Pados is an Assistant Professor, University of 
North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC.George J. Knafl 
is a Professor, University of North Carolina at Chapel Hill School of Nursing, 
Chapel Hill, NC.Debra Brandon is an Associate Professor and Director of PhD and 
Postdoctoral Programs, Duke University School of Nursing, Durham, NC.

PURPOSE: To examine the change in psychological distress of mothers of preterm 
infants and its association with maternal feeding behaviors as the infant 
transitions to full oral feeding.
STUDY DESIGN AND METHODS: This descriptive exploratory study used a subset of 
data from a study of the effects of a coregulated feeding intervention for 34 
mothers and hospitalized preterm infants in a Level-III neonatal intensive care 
unit (NICU). Maternal psychological distress was measured by maternal worry 
(Child Health Worry Scale), depression (Center for Epidemiology-Depression 
Scale), and role stress (Parental Stress Scale: NICU-Role Alteration) at three 
time points: within 1 week prior to the first oral feeding (T1), and at 
achievement of half (T2) and full oral feeding (T3). Feedings were videotaped at 
T2 and T3. An observational coding system measured maternal feeding behaviors. 
Linear mixed modeling evaluated the change in maternal psychological distress 
and its association with mothers' feeding behaviors as the infant transitioned 
to full oral feeding.
RESULTS: Maternal depressive symptoms were highest at T1 and declined over time. 
Maternal worry and role stress were also highest at T1 but remained stable from 
T2 to T3. Increased maternal psychological distress, particularly depressive 
symptoms and role stress, were associated with less use of developmentally 
supportive feeding behaviors, that is, minimizing tactile stimulation, providing 
steady touch to contain or stabilize the infant, and regulating milk flow.
CLINICAL IMPLICATIONS: Supporting maternal psychological well-being while 
infants are learning to feed orally may be an appropriate target for 
interventions to support mother-infant early feeding interactions.

DOI: 10.1097/NMC.0000000000000248
PMCID: PMC5045740
PMID: 27011000 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.


4581. J Vet Emerg Crit Care (San Antonio). 2016 May;26(3):384-92. doi: 
10.1111/vec.12458. Epub 2016 Mar 11.

Evaluation of a virtual pet visit system with live video streaming of patient 
images over the Internet in a companion animal intensive care unit in the 
Netherlands.

Robben JH(1), Melsen DN(2), Almalik O(2), Roomer W(3), Endenburg N(4).

Author information:
(1)Intensive Care Unit, Department of Clinical Sciences of Companion Animals, 
Faculty of Veterinary Medicine, Utrecht University, Utrecht, NL-3584 CM, the 
Netherlands.
(2)HAS University of Applied Sciences, 's-Hertogenbosch NL-5223 DE, the 
Netherlands.
(3)Faculty of Veterinary Medicine, Utrecht University, Utrecht, NL-3584 CM, the 
Netherlands.
(4)Department of Animals in Science and Society, Utrecht University, Utrecht, 
NL-3584 CM, the Netherlands.

OBJECTIVE: To evaluate the impact of a virtual pet visit system ("TelePet" 
System, TPS) on owners and staff of a companion animal ICU.
DESIGN: Longitudinal interventional study (2010-2013).
SETTING: Companion animal ICU at a university veterinary medical teaching 
hospital.
STUDY POPULATIONS: Pet owners, ICU technicians.
INTERVENTIONS: The introduction of the TPS, with live video streaming of patient 
images over the Internet, in a companion animal ICU.
MEASUREMENTS AND MAIN RESULTS: Pet owners experienced TPS as a valuable extra 
service. Most TPS users (72.4%) experienced less anxiety and felt less need 
(40.4% of TPS users) to visit their hospitalized pet in person. Most users 
(83.5%) shared TPS access with their family. The introduction of the TPS did not 
improve overall owner satisfaction, except for the score on "quality of medical 
treatment." Seven of 26 indicators of owner satisfaction were awarded higher 
scores by TPS users than by TPS nonusers in the survey after the introduction of 
the system. However, the lack of randomization of owners might have influenced 
findings. The enthusiasm of the ICU technicians for the system was tempered by 
the negative feedback from a small number of owners. Nevertheless they 
recognized the value of the system for owners. The system was user friendly and 
ICU staff and TPS users experienced few technical problems.
CONCLUSIONS: As veterinary healthcare is moving toward a more client-centered 
approach, a virtual pet visit system, such as TPS, is a relatively simple 
application that may improve the well-being of most owners during the 
hospitalization of their pet.

© Veterinary Emergency and Critical Care Society 2016.

DOI: 10.1111/vec.12458
PMID: 26970055 [Indexed for MEDLINE]


4582. Intensive Care Med. 2016 Jun;42(6):995-1002. doi: 10.1007/s00134-016-4260-4. 
Epub 2016 Mar 7.

CAESAR: a new tool to assess relatives' experience of dying and death in the 
ICU.

Kentish-Barnes N(1), Seegers V(2)(3), Legriel S(4), Cariou A(5)(6), Jaber 
S(7)(8), Lefrant JY(9)(10), Floccard B(11), Renault A(12), Vinatier I(13), 
Mathonnet A(14), Reuter D(1), Guisset O(15), Cracco C(16), Seguin A(17), 
Durand-Gasselin J(18), Éon B(19), Thirion M(20), Rigaud JP(21), Philippon-Jouve 
B(22), Argaud L(11)(23), Chouquer R(24), Adda M(25), Papazian L(25)(26), Dedrie 
C(27), Georges H(28), Lebas E(29), Rolin N(30), Bollaert PE(31)(32), Lecuyer 
L(33), Viquesnel G(17), Léone M(25)(26), Chalumeau-Lemoine L(34), Cohen-Solal 
Z(1), Garrouste-Orgeas M(35), Tamion F(36), Falissard B(2), Chevret S(37)(38), 
Azoulay E(39)(40).

Author information:
(1)Assistance Publique-Hôpitaux de Paris, Famiréa Research Group, Saint-Louis 
University Hospital, Paris, France.
(2)Paris-Sud Innovation Group in Mental Health, UMR 669, INSERM, Paris-Sud 
University, Paris, France.
(3)Data Management Research Department DRCI, Angers Hospital and SFR ICAT, 
University of Angers, Angers, France.
(4)Versailles Hospital, Versailles, France.
(5)Assistance Publique-Hôpitaux de Paris, Cochin University Hospital, Paris, 
France.
(6)Paris Descartes University, Paris, France.
(7)Saint Eloi University Hospital, Montpellier, France.
(8)Montpellier 1 University, Montpellier, France.
(9)Carémeau University Hospital, Nîmes, France.
(10)Nîmes University, Nîmes, France.
(11)Hospices Civils de Lyon, Edouard Herriot University Hospital, Lyon, France.
(12)Cavale Blanche University Hospital, Brest, France.
(13)Les Oudairies Hospital, La Roche Sur Yon, France.
(14)Hospital de la Source, Orléans, France.
(15)Saint André University Hospital, Bordeaux, France.
(16)Angoulême Hospital, Angoulême, France.
(17)Caen University Hospital, Caen, France.
(18)Sainte Musse Hospital, Toulon, France.
(19)La Timone University Hospital, Marseille, France.
(20)Victor Dupouy Hospital, Argenteuil, France.
(21)Dieppe Hospital, Dieppe, France.
(22)Roanne Hospital, Roanne, France.
(23)Lyon Est University, Lyon, France.
(24)Annecy Hospital, Annecy, France.
(25)Hôpital Nord University Hospital, Marseille, France.
(26)Aix-Marseille University, Marseille, France.
(27)Roubaix Hospital, Roubaix, France.
(28)Chatilliez Hospital, Tourcoing, France.
(29)Bretagne Atlantique Hospital, Vannes, France.
(30)Marc Jacquet Hospital, Melun, France.
(31)Nancy University Hospital, Nancy, France.
(32)Lorraine University, Nancy, France.
(33)Sud Francilien Hospital, Evry, France.
(34)Gustave Roussy Institut, Villejuif, France.
(35)Saint Joseph Hospital, Paris, France.
(36)Rouen University Hospital, Rouen, France.
(37)Biostatistics and Clinical Epidemiology research team, U1153, INSERM, Paris 
Diderot Sorbonne University, Paris, France.
(38)Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Service de 
Biostatistique et Information Médicale, Paris, France.
(39)Assistance Publique-Hôpitaux de Paris, Famiréa Research Group, Saint-Louis 
University Hospital, Paris, France. elie.azoulay@sls.aphp.fr.
(40)Biostatistics and Clinical Epidemiology research team, U1153, INSERM, Paris 
Diderot Sorbonne University, Paris, France. elie.azoulay@sls.aphp.fr.

Comment in
    Intensive Care Med. 2016 Oct;42(10 ):1651-1652.
    Intensive Care Med. 2016 Oct;42(10 ):1653-1654.
    J Thorac Dis. 2016 Jul;8(7):E611-4.
    J Thorac Dis. 2016 Aug;8(8):1865-8.
    J Thorac Dis. 2016 Aug;8(8):E781-3.

PURPOSE: To develop an instrument designed specifically to assess the experience 
of relatives of patients who die in the intensive care unit (ICU).
METHODS: The instrument was developed using a mixed methodology and validated in 
a prospective multicentre study. Relatives of patients who died in 41 ICUs 
completed the questionnaire by telephone 21 days after the death, then completed 
the Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised and 
Inventory of Complicated Grief after 3, 6, and 12 months.
RESULTS: A total of 600 relatives were included, 475 in the main cohort and 125 
in the reliability cohort. The 15-item questionnaire, named CAESAR, covered the 
patient's preferences and values, interactions with/around the patient and 
family satisfaction. We defined three groups based on CAESAR score tertiles: 
lowest (≤59, n = 107, 25.9 %), middle (n = 185, 44.8 %) and highest (≥69, 
n = 121, 29.3 %). Factorial analysis showed a single dimension. Cronbach's alpha 
in the main and reliability cohorts was 0.88 (0.85-0.90) and 0.85 (0.79-0.89), 
respectively. Compared to a high CAESAR score, a low CAESAR score was associated 
with greater risks of anxiety and depression at 3 months [1.29 (1.13-1.46), 
p = 0.001], post-traumatic stress-related symptoms at 3 [1.34 (1.17-1.53), 
p < 0.001], 6 [OR = 1.24 (1.06-1.44), p = 0.008] and 12 [OR = 1.26 (1.06-1.50), 
p = 0.01] months and complicated grief at 6 [OR = 1.40 (1.20-1.63), p < 0.001] 
and 12 months [OR = 1.27 (1.06-1.52), p = 0.01].
CONCLUSIONS: The CAESAR score 21 days after death in the ICU is strongly 
associated with post-ICU burden in the bereaved relatives. The CAESAR score 
should prove a useful primary endpoint in trials of interventions to improve 
relatives' well-being.

DOI: 10.1007/s00134-016-4260-4
PMID: 26951427 [Indexed for MEDLINE]


4583. Assist Inferm Ric. 2015 Oct-Dec;34(4):188-93. doi: 10.1702/2110.22862.

[Mechanical ventilation and early weaning: a qualitative study on patient's 
experiences in an intensive care unit].

[Article in Italian]

Simeone S, Perrone M, Dell'Angelo G, Rea T, Gargiulo G, Ferrigno S, Vosa C.

SUMMARY: Mechanical ventilation and early weaning: a qualitative study on 
patient's experiences in an intensive care unit.
INTRODUCTION: The weaning from mechanical ventilation of intensive care unit 
(ICU) patients may cause anxiety. The feelings and experience during this 
procedure may affect their physical and psychological wellbeing.
AIM: To describe patients' feelings during intubation time and weaning.
METHOD: Phenomenological study on 16 patients who underwent an off pump bypass 
and mechanical ventilation <24 hours. The patients were contacted 5-7 days after 
discharge from ICU.
RESULTS: The analysis of the interviews generated three issues arising from 
patients' experience: the discomfort mainly for the endotracheal tube, the fear 
of extubation and sense of safety for the presence of the nurse.
CONCLUSIONS: Mechanical ventilation and weaning, in spite of the evolution of 
the anesthetic techniques, continue to generate unpleasant feelings.

DOI: 10.1702/2110.22862
PMID: 26779875 [Indexed for MEDLINE]


4584. Alcohol Res. 2015;37(2):223-36.

The Gastrointestinal Microbiome: Alcohol Effects on the Composition of 
Intestinal Microbiota.

Engen PA(1), Green SJ(1), Voigt RM(1), Forsyth CB(1), Keshavarzian A(2).

Author information:
(1)Rush University Medical Center, Chicago, Illinois.
(2)Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, 
the Netherlands.

The excessive use of alcohol is a global problem causing many adverse 
pathological health effects and a significant financial health care burden. This 
review addresses the effect of alcohol consumption on the microbiota in the 
gastrointestinal tract (GIT). Although data are limited in humans, studies 
highlight the importance of changes in the intestinal microbiota in 
alcohol-related disorders. Alcohol-induced changes in the GIT microbiota 
composition and metabolic function may contribute to the well-established link 
between alcohol-induced oxidative stress, intestinal hyperpermeability to 
luminal bacterial products, and the subsequent development of alcoholic liver 
disease (ALD), as well as other diseases. In addition, clinical and preclinical 
data suggest that alcohol-related disorders are associated with quantitative and 
qualitative dysbiotic changes in the intestinal microbiota and may be associated 
with increased GIT inflammation, intestinal hyperpermeability resulting in 
endotoxemia, systemic inflammation, and tissue damage/organ pathologies 
including ALD. Thus, gut-directed interventions, such as probiotic and synbiotic 
modulation of the intestinal microbiota, should be considered and evaluated for 
prevention and treatment of alcohol-associated pathologies.

PMCID: PMC4590619
PMID: 26695747 [Indexed for MEDLINE]


4585. Alcohol Res. 2015;37(2):209-22.

The First Line of Defense: The Effects of Alcohol on Post-Burn Intestinal 
Barrier, Immune Cells, and Microbiome.

Hammer AM(1), Morris NL(1), Earley ZM(1), Choudhry MA(2).

Author information:
(1)Program in Integrative Cellular Biology, Loyola University Chicago Health 
Sciences Division, Maywood, Illinois.
(2)Burn and Shock Trauma Research Institute, Loyola University Chicago Health 
Sciences Division, Maywood, Illinois.

Alcohol (ethanol) is one of the most globally abused substances, and is one of 
the leading causes of premature death in the world. As a result of its 
complexity and direct contact with ingested alcohol, the intestine represents 
the primary source from which alcohol-associated pathologies stem. The gut is 
the largest reservoir of bacteria in the body, and under healthy conditions, it 
maintains a barrier preventing bacteria from translocating out of the intestinal 
lumen. The intestinal barrier is compromised following alcohol exposure, which 
can lead to life-threatening systemic complications including sepsis and 
multiple organ failure. Furthermore, alcohol is a major confounding factor in 
pathology associated with trauma. Experimental data from both human and animal 
studies suggest that alcohol perturbs the intestinal barrier and its function, 
which is exacerbated by a "second hit" from traumatic injury. This article 
highlights the role of alcohol-mediated alterations of the intestinal epithelia 
and its defense against bacteria within the gut, and the impact of alcohol on 
intestinal immunity, specifically on T cells and neutrophils. Finally, it 
discusses how the gut microbiome both contributes to and protects the intestines 
from dysbiosis after alcohol exposure and trauma.

PMCID: PMC4590618
PMID: 26695746 [Indexed for MEDLINE]


4586. Birth Defects Res C Embryo Today. 2015 Dec;105(4):252-64. doi: 
10.1002/bdrc.21115. Epub 2015 Dec 10.

The very low birth weight infant microbiome and childhood health.

Groer MW(1), Gregory KE(2)(3), Louis-Jacques A(1), Thibeau S(4), Walker WA(5).

Author information:
(1)Morsani College of Medicine, University of South Florida College of Nursing, 
Tampa, Florida.
(2)Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 
Harvard Medical School, Boston, Massachusetts.
(3)Department of Nursing, Brigham and Women's Hospital, Harvard Medical School, 
Boston, Massachusetts.
(4)Ochsner Health System, New Orleans, Louisiana.
(5)Mucosal Immunology and Biology Research Center, Massachusetts General 
Hospital, Harvard Medical School, Boston, Massachusetts.

This review describes current understandings about the nature of the very low 
birth weight infant (VLBW) gut microbiome. VLBW infants often experience 
disruptive pregnancies and births, and prenatal factors can influence the 
maturity of the gut and immune system, and disturb microbial balance and 
succession. Many VLBWs experience rapid vaginal or Caesarean births. After birth 
these infants often have delays in enteral feeding, and many receive little or 
no mother's own milk. Furthermore the stressors of neonatal life in the hospital 
environment, common use of antibiotics, invasive procedures and maternal 
separation can contribute to dysbiosis. These infants experience 
gastrointestinal dysfunction, sepsis, transfusions, necrotizing enterocolitis, 
oxygen toxicity, and other pathophysiological conditions that affect the normal 
microbiota. The skin is susceptible to dysbiosis, due to its fragility and 
contact with NICU organisms. Dysbiosis in early life may resolve but little is 
known about the timing of the development of the signature gut microbiome in 
VLBWs. Dysbiosis has been associated with a number of physical and behavioral 
problems, including autism spectrum disorders, allergy and asthma, 
gastrointestinal disease, obesity, depression, and anxiety. Dysbiosis may be 
prevented or ameliorated in part by prenatal care, breast milk feeding, skin to 
skin contact, use of antibiotics only when necessary, and vigilance during 
infancy and early childhood.

© 2015 Wiley Periodicals, Inc.

DOI: 10.1002/bdrc.21115
PMID: 26663857 [Indexed for MEDLINE]


4587. BMJ Open. 2015 Nov 27;5(11):e006852. doi: 10.1136/bmjopen-2014-006852.

Evaluating the feasibility and effectiveness of a critical care discharge 
information pack for patients and their families: a pilot cluster randomised 
controlled trial.

Bench S(1), Day T(1), Heelas K(2), Hopkins P(2), White C(3), Griffiths P(4).

Author information:
(1)Florence Nightingale Faculty of Nursing and Midwifery, King's College, 
London, UK.
(2)Critical Care Unit, King's College Hospital NHS Foundation Trust, London, UK.
(3)ICU Steps Charity, Milton Keynes, UK.
(4)Faculty of Health Sciences, University of Southampton, Southampton, UK.

OBJECTIVES: To evaluate the feasibility and effectiveness of an information 
pack, based on self-regulation theory, designed to support patients and their 
families immediately before, during and after discharge from an intensive care 
unit (ICU).
DESIGN AND SETTING: Prospective assessor-blinded pilot cluster randomised 
controlled trial (RCT; in conjunction with a questionnaire survey of trial 
participants' experience) in 2 ICUs in England.
PARTICIPANTS: Patients (+/- a family member) who had spent at least 72 h in an 
ICU, declared medically fit for discharge to a general ward.
RANDOMISATION: Cluster randomisation (by day of discharge decision) was used to 
allocate participants to 1 of 3 study groups.
INTERVENTION: A user-centred critical care discharge information pack (UCCDIP) 
containing 2 booklets; 1 for the patient (which included a personalised 
discharge summary) and 1 for the family, given prior to discharge to the ward.
PRIMARY OUTCOME: Psychological well-being measured using Hospital Anxiety and 
Depression Scores (HADS), assessed at 5±1 days postunit discharge and 
28 days/hospital discharge. Statistical significance (p≤0.05) was determined 
using χ(2) and Kruskal-Wallis (H).
RESULTS: 158 patients were allocated to: intervention (UCCDIP; n=51), control 1: 
ad hoc verbal information (n=59), control 2: booklet published by ICUsteps 
(n=48). There were no statistically significant differences in the primary 
outcome. The a priori enrolment goal was not reached and attrition was high. 
Using HADS as a primary outcome measure, an estimated sample size of 286 is 
required to power a definitive trial.
CONCLUSIONS: Findings from this pilot RCT provide important preliminary data 
regarding the circumstances under which an intervention based on the principles 
of UCCDIP could be effective, and the sample size required to demonstrate this.
TRIAL REGISTRATION NUMBER: Current Controlled Trials ISRCTN47262088; results.

Published by the BMJ Publishing Group Limited. For permission to use (where not 
already granted under a licence) please go to 
http://www.bmj.com/company/products-services/rights-and-licensing/

DOI: 10.1136/bmjopen-2014-006852
PMCID: PMC4663421
PMID: 26614615 [Indexed for MEDLINE]


4588. Nurs Crit Care. 2016 May;21(3):137-45. doi: 10.1111/nicc.12064. Epub 2015 Nov 
18.

Association between job strain, mental health and empathy among intensive care 
nurses.

Gosselin E(1)(2), Bourgault P(1), Lavoie S(1).

Author information:
(1)École des sciences infirmières, Faculté de médecine et des sciences de la 
santé, Université de Sherbrooke, Québec, Canada.
(2)Centre hospitalier universitaire de Sherbrooke, Québec, Canada.

BACKGROUND: Nursing shortage is a worldwide issue. It could influence factors 
such as job strain, nurses' mental health and nurse empathy towards patients.
AIM: The aim of the study is to explore the associations between job strain, 
psychological distress, psychological well-being and empathy in intensive care 
units (ICUs).
DESIGN: A cross-sectional descriptive correlational design.
METHODS: Data were collected using questionnaires and an observation tool 
completed by three observers during a standardized clinical simulation (SCS). A 
total of 26 nurses practicing in three ICUs participated in the study, which 
took place over 3 days in December 2011.
RESULTS: One dimension of job strain, psychological demand, was associated with 
two subscales of mental health (psychological distress positively and 
psychological well-being negatively). Positive correlations were demonstrated 
between psychological distress and nurse empathy as perceived by both the 
observers and the actor who played the role of patient.
CONCLUSION: Some associations have been confirmed between job strain, 
psychological distress, psychological well-being and empathy in the ICU while 
others needs further investigation.
RELEVANCE TO CLINICAL PRACTICE: It is important to reduce psychological demand 
among intensive care nurses in order to prevent psychological distress. The 
exploration of the connection between empathy and psychological distress should 
be advanced. This study suggests that SCSs provide an innovative approach that 
is useful for research.

© 2015 British Association of Critical Care Nurses.

DOI: 10.1111/nicc.12064
PMID: 26581404 [Indexed for MEDLINE]


4589. JBI Database System Rev Implement Rep. 2015 Oct;13(10):123-32. doi: 
10.11124/jbisrir-2015-2287.

Parents' experiences of transition when their infants are discharged from the 
Neonatal Intensive Care Unit: a systematic review protocol.

Aagaard H(1), Uhrenfeldt L, Spliid M, Fegran L.

Author information:
(1)1Department of Pediatrics, Aarhus University Hospital, Denmark2Danish Center 
of Systematic Synthesis in Nursing: an Affiliate Center of the Joanna Briggs 
Institute; The Center of Clinical Guidelines - Clearing House, Aalborg 
University Denmark3Faculty of Health and Sport Sciences, University of Agder, 
Kristiansand, Norway4Clinical Research Unit, Randers Regional Hospital, 
Denmark5Department of Health Science and Technology, Aalborg University, 
Denmark.

REVIEW QUESTION/OBJECTIVE: The objective of this review is to identify, appraise 
and synthesize the best available studies exploring parents' experiences of 
transition when their infants are discharged from the Neonatal Intensive Care 
Unit (NICU).The review questions are:
BACKGROUND: Giving birth to a premature or sick infant is a stressful event for 
parents. The parents' presence and participation in the care of the infant is 
fundamental to reduce this stress and to provide optimal care for both the 
premature or sick infant and family. A full term pregnancy is estimated to last 
between 37 and 40 weeks. Preterm infants born before 28 week (5.1%) are defined 
as extremely preterm, while those who are born between 28 to 31 weeks (10.3%) 
are defined as very preterm. The majority of the preterm (84.1%) are born 
between 32 to 37 week and may have significant medical problems requiring 
prolonged hospitalization.The prevalence of preterm birth is increasing 
worldwide. More than one in ten babies are born preterm annually. This is equal 
to 15 million preterm infants born globally and the second largest direct cause 
of deaths in children below five. The highest rates of preterm birth are in 
Sub-Saharan Africa and South Asia (more than 60%) and the lowest rates are in 
Northern Africa, Western Asia, Latin America and the Caribbean. The preterm 
birth rates in the developing countries vary widely and follow a different 
pattern than in high income countries.The preterm birth rate has increased 
between 1990 and 2010 with an average of 0.8% annually in almost all countries. 
Morbidity among critically ill newborn and preterm infants vary widely from no 
late effects to severe complications, such as visual or hearing impairment, 
chronic lung disease, growth failure in infancy and specific learning 
impairments, dyslexia and reduced academic achievement. Full term infants may 
also experience significant health problems requiring neonatal intensive care. 
The most common reasons for a full term infant to be admitted to a NICU after 
birth are temperature instability, hypoglycemia, respiratory distress, 
hyperbilirubinemia and neonatal mortality. Admission of a full term newborn 
infant from home within the first four weeks after birth is due to jaundice, 
dehydration, respiratory complications, feeding difficulties, urinary tract 
infection, diarrhea and meningitis.In the last two to three decades, 
technological advances in neonatalogy have improved the survival rates of 
critically ill and preterm infants.Two major issues have influenced the design 
of the NICU wards: i) the increased volume of preterm infants with extremely low 
gestational age who need neonatalogy assistance, and ii) the impact of the 
parents' presence in the NICU to support the infant's development.The health 
status of preterm babies can have a significant impact on the family wellbeing 
and function. The separation between the preterm infant and the parents is a 
threat to the attachment and bonding process. Worldwide, there has been a 
paradigm shift in the NICUs over the last decade, inviting parents to be 
admitted together with the infant or at least to spend most of the day together 
with their critical ill and preterm infant in the NICU. Parental involvement 
increases the performing of Kangaroo Mother Care during the admission in the 
NICU and increases parental preparedness for discharge to home. This change 
prepares the parents to take over tasks such as nurturing and feeding. The 
parents are the most important caregivers for the infant during the admission in 
the NICU and their co-admission increases the bonding and prepare the parents 
for the transition discharged to home.Family centered care (FCC) based on a 
partnership between families and professionals is described as essential in 
current research on neonatal care. Family centered care is facilitated by 
parental involvement, communication based on mutuality and respect, and 
unrestricted parental presence in the NICU. According to Mikkelsen and 
Frederiksen, the central attribute of FCC is partnership with the core value of 
mutuality and common goals.A NICU is a high-tech setting where highly 
specialized professionals care for premature or critically ill infants. During 
the infants' hospitalization, the relationship between parents and nurses 
evolves through an interchange of roles and responsibilities. However, this 
collaboration is challenging due to a discrepancy between parents' and nurses' 
expectations of their roles.To facilitate parents' skin-to-skin contact and 
involvement in their infant's care, NICUs are now redesigned to facilitate 
parents' "24-hour" presence, also called "rooming-in". Seporo et al. describes 
several benefits with "rooming-in" the NICUs. Staying in the same room increases 
infants' and parents' possibility for "skin-to-skin care". This improves the 
infant's sleep time and temperature regulation, decreased crying and need for 
oxygen, increases parental confidence and positive infant-parent interaction. 
Parents' experience of "skin-to-skin care" and "rooming in" may help parents to 
be acquainted with their infant and thus prepare for the transition to home. 
However, despite these positive effects of rooming-in, some negative effects, 
e.g. less sleep and lack of privacy, have been described by parents who have 
stayed with their child in a pediatric unit.The hospitalization may challenge 
the normal attachment process and parents' confidence as caregivers; parents' 
preparation for bringing the infant home is thus essential. The infant's 
discharge from the NICU is experienced as a moment of mixed feelings. Going home 
is a happy event, but at the same time it is combined with parental anxiety. 
Parents' pervasive uncertainty, medical concerns and adjustment to the new 
parental and partner-adjustment role are common concerns. To make parents 
confident and prepared for taking their infant home tailored information, 
guidance and hands-on experience caring for their infant before discharge is 
crucial.During the literature research we became aware of a systematic narrative 
review protocol by Parascandolo et al.'s concerning nurses', midwives', doctors' 
and parents' experiences of the preterm infants' discharge to home. The aim of 
our comprehensive review is to perform a metasynthesis on parents' perspectives 
and their experiences of transition from discharge from NICU to home. We will 
include qualitative primary studies to offer a deeper understanding of the 
parent perspective.

DOI: 10.11124/jbisrir-2015-2287
PMID: 26571288 [Indexed for MEDLINE]


4590. J Immunol. 2015 Dec 1;195(11):5169-77. doi: 10.4049/jimmunol.1501369. Epub 2015 
Nov 2.

M2b Monocytes Provoke Bacterial Pneumonia and Gut Bacteria-Associated Sepsis in 
Alcoholics.

Tsuchimoto Y(1), Asai A(1), Tsuda Y(1), Ito I(2), Nishiguchi T(2), Garcia MC(2), 
Suzuki S(3), Kobayashi M(2), Higuchi K(1), Suzuki F(4).

Author information:
(1)Second Department of Internal Medicine, Osaka Medical College, Takatsuki 
569-8686, Japan;
(2)Department of Internal Medicine, The University of Texas Medical Branch, 
Galveston, TX 77555; and.
(3)Department of Biostatistics, University of North Texas Health Science Center, 
Fort Worth, TX 76107.
(4)Department of Internal Medicine, The University of Texas Medical Branch, 
Galveston, TX 77555; and fsuzuki@utmb.edu.

Chronic alcohol consumption markedly impairs host antibacterial defense against 
opportunistic infections. γ-irradiated NOD-SCID IL-2Rγ(null) mice inoculated 
with nonalcoholic PBMCs (control PBMC chimeras) resisted Klebsiella pneumonia 
and gut bacteria-associated sepsis, whereas the chimeras created with alcoholic 
PBMCs (alcoholic PBMC chimeras) were very susceptible to these infections. M1 
monocytes (IL-12(+)IL-10(-)CD163(-)CD14(+) cells), major effector cells in 
antibacterial innate immunity, were not induced by a bacterial Ag in alcoholic 
PBMC cultures, and M2b monocytes (CCL1(+)CD163(+)CD14(+) cells), which 
predominated in alcoholic PBMCs, were shown to be inhibitor cells on the 
Ag-stimulated monocyte conversion from quiescent monocytes to M1 monocytes. 
CCL1, which functions to maintain M2b macrophage properties, was produced by M2b 
monocytes isolated from alcoholic PBMCs. These M2b monocytes reverted to 
quiescent monocytes (IL-12(-)IL-10(-)CCL1(-)CD163(-)CD14(+) cells) in cultures 
supplemented with CCL1 antisense oligodeoxynucleotide, and the subsequent 
quiescent monocytes easily converted to M1 monocytes under bacterial Ag 
stimulation. Alcoholic PBMC chimeras treated with CCL1 antisense 
oligodeoxynucleotide were resistant against pulmonary infection by K. pneumoniae 
and sepsis stemming from enterococcal translocation. These results indicate that 
a majority of monocytes polarize to an M2b phenotype in association with alcohol 
abuse, and this polarization contributes to the increased susceptibility of 
alcoholics to gut and lung infections. Bacterial pneumonia and gut 
bacteria-associated sepsis, frequently seen in alcoholics, can be controlled 
through the polarization of macrophage phenotypes.

Copyright © 2015 by The American Association of Immunologists, Inc.

DOI: 10.4049/jimmunol.1501369
PMID: 26525287 [Indexed for MEDLINE]


4591. Alcohol. 2015 Dec;49(8):767-72. doi: 10.1016/j.alcohol.2015.09.002. Epub 2015 
Oct 8.

Summary of the 2014 Alcohol and Immunology Research Interest Group (AIRIG) 
meeting.

Hammer AM(1), Morris NL(1), Cannon AR(1), Shults JA(1), Curtis B(2), Casey 
CA(3), Sueblinvong V(4), Persidsky Y(5), Nixon K(6), Brown LA(7), Waldschmidt 
T(8), Mandrekar P(9), Kovacs EJ(10), Choudhry MA(11).

Author information:
(1)Alcohol Research Program, Burn and Shock Trauma Research Institute, 
Department of Surgery, Loyola University Chicago Health Sciences Campus, 
Maywood, IL, United States; Integrative Cell Biology Program, Loyola University 
Chicago Health Sciences Campus, Maywood, IL, United States.
(2)Alcohol Research Program, Burn and Shock Trauma Research Institute, 
Department of Surgery, Loyola University Chicago Health Sciences Campus, 
Maywood, IL, United States.
(3)Department of Internal Medicine, University of Nebraska Medical Center, 
Omaha, NE, United States; Department of Veterans' Affairs Research, Omaha, NE, 
United States.
(4)Department of Medicine, Emory University, Atlanta, GA, United States.
(5)Department of Pathology and Laboratory Medicine, Temple University School of 
Medicine, Philadelphia, PA, United States.
(6)Department of Pharmaceutical Sciences, University of Kentucky, Lexington, KY, 
United States.
(7)Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Emory 
University School of Medicine, Atlanta, GA, United States.
(8)Department of Pathology, University of Iowa Carver College of Medicine, Iowa 
City, IA, United States.
(9)Department of Medicine, University of Massachusetts School of Medicine, 
Worcester, MA, United States.
(10)Alcohol Research Program, Burn and Shock Trauma Research Institute, 
Department of Surgery, Loyola University Chicago Health Sciences Campus, 
Maywood, IL, United States; Integrative Cell Biology Program, Loyola University 
Chicago Health Sciences Campus, Maywood, IL, United States; Department of 
Microbiology and Immunology, Loyola University Chicago Health Sciences Campus, 
Maywood, IL, United States.
(11)Alcohol Research Program, Burn and Shock Trauma Research Institute, 
Department of Surgery, Loyola University Chicago Health Sciences Campus, 
Maywood, IL, United States; Integrative Cell Biology Program, Loyola University 
Chicago Health Sciences Campus, Maywood, IL, United States; Department of 
Microbiology and Immunology, Loyola University Chicago Health Sciences Campus, 
Maywood, IL, United States. Electronic address: mchoudhry@luc.edu.

On November 21, 2014 the 19th annual Alcohol and Immunology Research Interest 
Group (AIRIG) meeting was held at Loyola University Chicago Health Sciences 
Campus in Maywood, Illinois. The meeting focused broadly on inflammatory cell 
signaling responses in the context of alcohol and alcohol-use disorders, and was 
divided into four plenary sessions focusing on the gut and liver, lung 
infections, general systemic effects of alcohol, and neuro-inflammation. One 
common theme among many talks was the differential roles of macrophages 
following both chronic and acute alcohol intoxication. Macrophages were shown to 
play significant roles in regulating inflammation, oxidative stress, and viral 
infection following alcohol exposure in the liver, lungs, adipose tissue, and 
brain. Other work examined the role of alcohol on disease progression in a 
variety of pathologies including psoriasis, advanced stage lung disease, and 
cancer.

Copyright © 2015 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.alcohol.2015.09.002
PMCID: PMC4691366
PMID: 26520175 [Indexed for MEDLINE]


4592. Neuropsychiatr Dis Treat. 2015 Oct 7;11:2583-9. doi: 10.2147/NDT.S87118. 
eCollection 2015.

Clinical correlates of complicated grief among individuals with acute coronary 
syndromes.

Pini S(1), Gesi C(1), Abelli M(1), Cardini A(1), Lari L(1), Felice F(2), Di 
Stefano R(2), Mazzotta G(3), Bovenzi F(4), Bertoli D(5), Borelli L(4), Michi 
P(1), Oligeri C(3), Balbarini A(2), Manicavasagar V(6).

Author information:
(1)Department of Clinical and Experimental Medicine, Psychiatry Sector, 
University of Pisa, Pisa, Italy.
(2)Department of Surgical, Medical, Molecular and Critical Area Pathology, 
University of Pisa, Pisa, Italy.
(3)Unit of Cardiology, Ospedale Sant'Andrea, La Spezia, Italy.
(4)Cardio-Respiratory Department, Ospedale Campo di Marte, Lucca, Italy.
(5)Unit of Cardiology, Ospedale San Bartolomeo, Sarzana (SP), Italy.
(6)Black Dog Institute, University of New South Wales, Sydney, NSW, Australia.

OBJECTIVE: The study aimed at exploring bereavement and complicated grief (CG) 
symptoms among subjects without a history of coronary heart disease (CHD) at the 
time of a first acute coronary syndrome (ACS) and to evaluate the relationship 
of CG symptoms and ACS.
METHOD: Overall, 149 subjects with ACS (namely, acute myocardial infarct with or 
without ST-segment elevation or unstable angina), with no previous history of 
CHD, admitted to three cardiac intensive care units were included and evaluated 
by the Structured Clinical Interview for Complicated Grief (SCI-CG), Hamilton 
Depression Rating Scale, Hamilton Anxiety Rating Scale, and the 36-item 
Short-Form Health Survey (MOS-SF-36).
RESULTS: Of the total sample of 149 subjects with ACS, 118 (79.2%) met criteria 
for DSM-5 persistent complex bereavement disorder. Among these, subjects who 
lost a partner, child, or sibling were older (P=0.008), less likely to be 
working (P=0.032), and more likely to be suffering from hypertension (P=0.021), 
returned higher scores on the SCI-CG (P=0.001) and developed the index ACS more 
frequently between 12 and 48 months after the death than those who lost a parent 
or another relative (P≤0.0001). The occurrence of ACS 12-48 months (P=0.019) 
after the loss was positively correlated with SCI-CG scores. An inverse 
relationship with SCI-CG scores was observed for patients who experienced ACS 
more than 48 months after the loss (P=0.005). The SCI-CG scores significantly 
predicted lower scores on the "general health" domain of MOS-SF-36 (P=0.030), as 
well as lower scores on "emotional well-being" domain (P=0.010).
CONCLUSION: A great proportion of subjects with ACS report the loss of a loved 
one. Among these, the loss of a close relative and the severity of CG symptoms 
are associated with poorer health status. Our data corroborate previous data 
indicating a strong relationship between CG symptoms and severe cardiac 
problems.

DOI: 10.2147/NDT.S87118
PMCID: PMC4605234
PMID: 26504390


4593. Nurs Crit Care. 2016 Mar;21(2):88-96. doi: 10.1111/nicc.12158. Epub 2015 Oct 20.

How diaries written for critically ill influence the relatives: a systematic 
review of the literature.

Nielsen AH(1), Angel S(2).

Author information:
(1)Department of Anesthesiology, Regional Hospital of West Jutland, Holstebro, 
Denmark.
(2)Department of Nursing Science, Institute of Public Health, Aarhus University, 
Denmark.

BACKGROUND: Diaries written by nurses for the critically ill patient helps 
relatives cope and support the patient. When relatives participate in writing a 
diary for the critically ill, patients appreciate it. Furthermore, the diary may 
reduce post-traumatic stress disorder, anxiety and depression in patients and 
relatives.
AIM: To explore how relatives perceive reading and writing in the diary and how 
it affects their well-being.
SEARCH STRATEGIES: A systematic search was carried out in the databases PubMed, 
Embase, CiNAHL and PsycINFO and supplemented by a citation search in Scopus on 
four-selected articles. Finally, 10 articles were included in this review 
structured by the Matrix method.
INCLUSION CRITERIA: (a) Original scientific work, (b) relatives participation 
and experience of the diary as subject and (c) diaries studied in an intensive 
care unit setting.
FINDINGS: Relatives were given instructions on how to write in the diary. They 
expressed strong feelings in the diary in a very different way than health care 
staff. The relatives used the diary themselves to gain understanding and to 
cope. The diary has been shown to prevent post-traumatic stress symptoms.
CONCLUSION: The relatives express their love for the patient, when they author 
the diary and this may be beneficial to the relatives as it helps them cope and 
support the patient. The organized account of the time in the intensive care 
unit in the diary may explain the diary's ability to reduce the occurrence of 
post-traumatic stress disorder; however, further research is needed to confirm 
this. How relatives interact through writing and reading a diary, originally 
intended for the patient, is unclear.
RELEVANCE TO CLINICAL PRACTICE: Providing relatives with a diary may help them 
cope. However, caution should be taken as possible adverse effects related to 
the interaction between relatives in the diary may not yet be known.

© 2015 British Association of Critical Care Nurses.

DOI: 10.1111/nicc.12158
PMID: 26487425 [Indexed for MEDLINE]


4594. Intensive Crit Care Nurs. 2015 Oct;31(5):269-75. doi: 
10.1016/j.iccn.2015.05.001. Epub 2015 Jul 23.

Intensive care nurses' opinions and current practice in relation to delirium in 
the intensive care setting.

Glynn L(1), Corry M(2).

Author information:
(1)St. James' Hospital, Dublin 8, Ireland. Electronic address: 
glynnlisa@ymail.com.
(2)School of Nursing & Midwifery, Trinity College Dublin, Ireland. Electronic 
address: corrym@tcd.ie.

BACKGROUND: Delirium is a frequently encountered syndrome that negatively 
impacts on the well-being of the critically ill patient. Although international 
guidelines promote delirium monitoring, little is known regarding Irish 
intensive care (ICU) nurses' opinions and current practice in relation to 
delirium monitoring.
AIM: To ascertain ICU nurses' opinions on delirium among the critically ill and 
establish if delirium monitoring is part of current practice in the Republic of 
Ireland.
METHODS: A descriptive quantitative survey design was employed, utilising a 
self-report questionnaire. Participants were registered nurses selected using 
convenience sampling from two of the largest and leading teaching hospitals in 
the Republic of Ireland. The overall response rate was 70% (n=151/216).
FINDINGS: The majority of participants 143 (95%) recognised delirium as a 
serious problem and 93% considered delirium to be an under-diagnosed syndrome 
that requires active medical intervention. Only 17.9% reported screening for 
delirium and 4% ranked delirium important to monitor in the ICU setting. The 
majority of participants never attended a lecture (79%) or read an article (68%) 
pertaining to delirium.
CONCLUSION: The findings provide further evidence of the theory practice gap 
that is likely to exist internationally in settings where best practice 
guidelines on the management of delirium in the ICU setting are not implemented.

Copyright © 2015 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.iccn.2015.05.001
PMID: 26210795 [Indexed for MEDLINE]


4595. Acta Paediatr. 2015 Nov;104(11):e475. doi: 10.1111/apa.13126. Epub 2015 Sep 11.

Research on improving parental well-being in a neonatal intensive care unit had 
a number of flaws.

García Fernández M(1), Vázquez Sellán A(2).

Author information:
(1)Sant John of God Hospital, Barcelona, Spain.
(2)Health Science Universitary Center Sant Rafael-Nebrija, Madrid, Spain.

Comment in
    Acta Paediatr. 2015 Nov;104(11):e476.

Comment on
    Acta Paediatr. 2015 Jul;104(7):e300-5.

DOI: 10.1111/apa.13126
PMID: 26175130 [Indexed for MEDLINE]


4596. BMC Psychiatry. 2015 Jul 8;15:153. doi: 10.1186/s12888-015-0519-5.

Parent distress reactions following a serious illness or injury in their child: 
a protocol paper for the take a Breath Cohort Study.

Muscara F(1), Burke K(2), McCarthy MC(3), Anderson VA(4), Hearps SJ(5), Hearps 
SJ(6), Dimovski A(7), Nicholson JM(8).

Author information:
(1)Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's 
Hospital, Flemington Road, Parkville, VIC, 3052, Australia. 
frank.muscara@mcri.edu.au.
(2)Parenting and Family Support Centre, School of Psychology, The University of 
Queensland, Brisbane, QLD, 4072, Australia. k.burke1@uq.edu.au.
(3)Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's 
Hospital, Flemington Road, Parkville, VIC, 3052, Australia. 
Maria.McCarthy@rch.org.au.
(4)Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's 
Hospital, Flemington Road, Parkville, VIC, 3052, Australia. 
vicki.anderson@mcri.edu.au.
(5)Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's 
Hospital, Flemington Road, Parkville, VIC, 3052, Australia. 
stephen.hearps@mcri.edu.au.
(6)Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's 
Hospital, Flemington Road, Parkville, VIC, 3052, Australia. 
simone.hearps@mcri.edu.au.
(7)Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's 
Hospital, Flemington Road, Parkville, VIC, 3052, Australia. 
anica.dimovski@mcri.edu.au.
(8)Judith Lumley Centre, La Trobe University, 215 Franklin St, Melbourne, VIC, 
3000, Australia. j.nicholson@latrobe.edu.au.

BACKGROUND: Diagnosis of life threatening childhood illness or injury can lead 
to significant distress reactions in parents, with many experiencing clinically 
significant levels of post-traumatic stress symptoms. These symptoms can have 
long-term adverse impacts on parent mental health, family functioning, and the 
adjustment of the ill child. Independent studies have found such reactions in 
several different illness groups. However, very little research has 
systematically compared the prevalence, impact and trajectories over time of 
post-traumatic stress symptoms in parents across different childhood illness 
groups with an acute life threat. The current study seeks to map the course of 
post-traumatic stress reactions in parents of children with various life 
threatening illnesses over an 18 month period, and identify factors that predict 
successful adaptation in families.
METHOD/DESIGN: The current study described is of a prospective, longitudinal 
design. The sample included parents of children admitted to four major hospital 
departments at the Royal Children's Hospital, Melbourne, Australia, for a life 
threatening illness or injury. Eligible parents were those who were caregivers 
of children aged 0-to 18-years admitted to the Oncology, Cardiology, Neurology 
and Pediatric Intensive Care Unit. Parents were recruited acutely, and completed 
self-report questionnaires at four time-points: within the first 4 weeks (T1:); 
then at 4 months (T2); 7 months (T3); and 19 months (T4) after admission. 
Questionnaires assessed parent and child mental health and wellbeing, and a 
number of risk and reliance factors such child illness factors, parent 
demographic factors, and psychosocial factors.
DISCUSSION: This study is one of the first to document the trajectory of 
post-traumatic stress responses in parents of very ill children, across illness 
groups. Given that it will also identify risk and resilience factors, and map 
the course of parent outcomes over an 18 monthperiod, it has the potential to 
inform novel strategies for intervention.

DOI: 10.1186/s12888-015-0519-5
PMCID: PMC4495936
PMID: 26152134 [Indexed for MEDLINE]


4597. Curr Pharm Des. 2015;21(24):3438-42. doi: 10.2174/1381612821666150706111155.

Entrainment of the Human Circadian Clock to the Light-Dark Cycle and its Impact 
on Patients in the ICU and Nursing Home Settings.

Ritchie HK, Stothard ER, Wright KP(1).

Author information:
(1)Department of Integrative Physiology, University of Colorado Boulder, 
Boulder, Colorado 80309, USA. Kenneth.Wright@colorado.edu.

A robust circadian timekeeping system is important for human health and 
well-being. Inappropriately timed light exposure can cause circadian and sleep 
disruption, which has been shown to have negative health consequences. Lighting 
in medical care facilities, such as the NICU, ICU, and nursing homes, is not 
typically controlled and may be associated with circadian disruption observed in 
such settings. Cycled lighting and increased exposure to sunlight in medical 
care facilities have been shown to have positive effects on patient recovery and 
well-being, and expedite hospital discharge. Additional clinical research is 
needed to determine the optimal light exposure timing, duration, intensity, and 
spectrum to best promote recovery, health and well-being in the context of 
medical care.

DOI: 10.2174/1381612821666150706111155
PMID: 26144935 [Indexed for MEDLINE]


4598. BMJ Open. 2015 May 25;5(5):e008035. doi: 10.1136/bmjopen-2015-008035.

Extra Physiotherapy in Critical Care (EPICC) Trial Protocol: a randomised 
controlled trial of intensive versus standard physical rehabilitation therapy in 
the critically ill.

Thomas K(1), Wright SE(1), Watson G(2), Baker C(1), Stafford V(1), Wade C(1), 
Chadwick TJ(2), Mansfield L(1), Wilkinson J(2), Shen J(2), Deverill M(2), Bonner 
S(3), Hugill K(3), Howard P(3), Henderson A(3), Roy A(4), Furneval J(4), 
Baudouin SV(1).

Author information:
(1)Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
(2)Institute of Health and Society, Newcastle University, Newcastle upon Tyne, 
UK.
(3)South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK.
(4)City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK.

INTRODUCTION: Patients discharged from Critical Care suffer from excessive 
longer term morbidity and mortality. Physical and mental health measures of 
quality of life show a marked and immediate fall after admission to Critical 
Care with some recovery over time. However, physical function is still 
significantly reduced at 6 months. The National Institute for Health and Care 
Excellence clinical guideline on rehabilitation after critical illness, 
identified the need for high-quality randomised controlled trials to determine 
the most effective rehabilitation strategy for critically ill patients at risk 
of critical illness-associated physical morbidity. In response to this, we will 
conduct a randomised controlled trial, comparing physiotherapy aimed at early 
and intensive patient mobilisation with routine care. We hypothesise that this 
intervention will improve physical outcomes and the mental health and functional 
well-being of survivors of critical illness.
METHODS AND ANALYSIS: 308 adult patients who have received more than 48 h of 
non-invasive or invasive ventilation in Critical Care will be recruited to a 
patient-randomised, parallel group, controlled trial, comparing two intensities 
of physiotherapy. Participants will be randomised to receive either standard or 
intensive physiotherapy for the duration of their Critical Care admission. 
Outcomes will be recorded on Critical Care discharge, at 3 and 6 months 
following initial recruitment to the study. The primary outcome measure is 
physical health at 6 months, as measured by the SF-36 Physical Component 
Summary. Secondary outcomes include assessment of mental health, activities of 
daily living, delirium and ventilator-free days. We will also include a health 
economic analysis.
ETHICS AND DISSEMINATION: The trial has ethical approval from Newcastle and 
North Tyneside 2 Research Ethics Committee (11/NE/0206). There is a Trial 
Oversight Committee including an independent chair. The results of the study 
will be submitted for publication in peer-reviewed journals and presented at 
national and international scientific meetings.
TRIAL REGISTRATION NUMBER: ISRCTN20436833.

Published by the BMJ Publishing Group Limited. For permission to use (where not 
already granted under a licence) please go to 
http://group.bmj.com/group/rights-licensing/permissions.

DOI: 10.1136/bmjopen-2015-008035
PMCID: PMC4452749
PMID: 26009576 [Indexed for MEDLINE]


4599. Annu Rev Nurs Res. 2015;33:249-66. doi: 10.1891/0739-6686.33.249.

Chapter 8 Military Personnel With Traumatic Brain Injuries and Insomnia Have 
Reductions in PTSD and Improved Perceived Health Following Sleep Restoration: A 
Relationship Moderated by Inflammation.

Barr T, Livingston W, Guardado P, Baxter T, Mysliwiec V, Gill J.

BACKGROUND: Up to one-third of deployed military personnel sustain a traumatic 
brain injury (TBI). TBIs and the stress of deployment contribute to the 
vulnerability for chronic sleep disturbance, resulting in high rates of insomnia 
diagnoses as well as symptoms of posttraumatic stress disorder (PTSD), 
depression, and declines in health-related quality of life (HRQOL). Inflammation 
is associated with insomnia; however, the impact of sleep changes on comorbid 
symptoms and inflammation in this population is unknown.
METHODS: In this study, we examined the relationship between reported sleep 
changes and the provision of the standard of care, which could include one or 
more of the following: cognitive behavioral therapy (CBT), medications, and 
continuous positive airway pressure (CPAP). We compared the following: (a) the 
group with a decrease in the Pittsburgh Sleep Quality Index (PSQI; restorative 
sleep) and (b) the group with no change or increase in PSQI (no change). 
Independent t tests and chi-square tests were used to compare the groups on 
demographic and clinical characteristics, and mixed between-within subjects 
analysis of variance tests were used to determine the effect of group 
differences on changes in comorbid symptoms. Linear regression models were used 
to examine the role of inflammation in changes in symptoms and HRQOL.
RESULTS: The sample included 70 recently deployed military personnel with TBI, 
seeking care for sleep disturbances. Thirty-seven participants reported 
restorative sleep and 33 reported no sleep changes or worse sleep. The two 
groups did not differ in demographic characteristics or clinical symptoms at 
baseline. The TBI+restored sleep group had significant reductions in PTSD and 
depression over the 3-month period, whereas the TBI+no change group had a slight 
increase in both PTSD and depression. The TBI+restored sleep group also had 
significant changes in HRQOL, including the following HRQOL subcomponents: 
physical functioning, role limitations in physical health, social functioning, 
emotional well-being, energy/fatigue, and general health perceptions. In a 
linear regression model using a forced entry method, the dependent variable of 
change in C-reactive protein (CRP) concentrations was significantly related to 
changes in PTSD symptoms and HRQOL in the TBI+restored sleep group, with 
R2=0.43, F33,3=8.31, p<.01.
CONCLUSIONS: Military personnel with TBIs who have a reduction in insomnia 
symptoms following a standard-of-care treatment report less severe symptoms of 
depression and PTSD and improved HRQOL, which relate to decreased plasma 
concentrations of CRP. These findings suggest that treatment for sleep 
disturbances in this TBI+military population is associated with improvements in 
health and decreases in inflammation. The contributions of inflammation-induced 
changes in PTSD and depression in sleep disturbances in TBI + military personnel 
require further study.

DOI: 10.1891/0739-6686.33.249
PMID: 25946388 [Indexed for MEDLINE]


4600. Cochrane Database Syst Rev. 2015 May 1;2015(5):CD006174. doi: 
10.1002/14651858.CD006174.pub3.

Intrapartum fetal scalp lactate sampling for fetal assessment in the presence of 
a non-reassuring fetal heart rate trace.

East CE(1), Leader LR, Sheehan P, Henshall NE, Colditz PB, Lau R.

Author information:
(1)School of Nursing and Midwifery/Maternity Services, Monash University/Monash 
Health, 246 Clayton Road, Clayton, Victoria, Australia, 3168.

Update of
    Cochrane Database Syst Rev. 2010;(3):CD006174.

BACKGROUND: Fetal scalp blood sampling for lactate estimation may be considered 
following identification of an abnormal or non-reassuring fetal heart rate 
pattern. The smaller volume of blood required for this test, compared with the 
more traditional pH estimation, may improve sampling rates. The appropriate use 
of this practice mandates systematic review of its safety and clinical 
effectiveness prior to widespread introduction.
OBJECTIVES: To evaluate the effectiveness and risks of fetal scalp lactate 
sampling in the assessment of fetal well-being during labour, compared with no 
testing or alternative testing.
SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials 
Register (31 January 2015).
SELECTION CRITERIA: All published and unpublished randomised and 
quasi-randomised trials that compared fetal scalp lactate testing with no 
testing or alternative testing to evaluate fetal status in the presence of a 
non-reassuring cardiotocograph during labour.
DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures of 
the Cochrane Pregnancy and Childbirth Group. Two review authors independently 
assessed the studies.
MAIN RESULTS: The search identified two completed randomised controlled trials 
(RCTs) and two ongoing trials. The two published RCTs considered outcomes for 
3348 mother-baby pairs allocated to either lactate or pH estimation of fetal 
blood samples when clinically indicated in labour. Overall, the published RCTs 
were of low or unclear risk of bias. There was a high risk of performance bias, 
because it would not have been feasible to blind clinicians or participants.No 
statistically significant between-group differences were found for neonatal 
encephalopathy (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.32 to 3.09, 
one study, 2992 infants) or death. No studies reported neonatal seizures. We had 
planned to report death with other morbidities, for example, neonatal 
encephalopathy; however, the data were not available in a format suitable for 
this, therefore death due to congenital abnormality was considered alone. The 
three reported neonatal deaths occurred in babies with diaphragmatic hernias (n 
= 2) or congenital cardiac fibrosis (n = 1). All three babies had been 
randomised to the pH group and were not acidaemic at birth.There were no 
statistically significant differences for any of the pre-specified secondary 
fetal/neonatal/infant outcomes for which data were available. This included low 
Apgar score at five minutes (RR 1.13, 95% CI 0.76 to 1.68, two studies, 3319 
infants) and admission to neonatal intensive care units (RR 1.02, 95% CI 0.83 to 
1.25, one study, 2992 infants), or metabolic acidaemia (RR 0.91, 95% CI 0.60 to 
1.36, one study, 2675 infants) considered within the studies, either overall or 
where data were available for those where fetal blood sampling had occurred 
within 60 minutes of delivery.Similar proportions of fetuses underwent 
additional tests to further evaluate well-being during labour, including scalp 
pH if in the lactate group or scalp lactate if in the pH group (RR 0.22, 95% CI 
0.04 to 1.30, two studies, 3333 infants;Tau² 1.00, I² = 58%). Fetal blood 
sampling attempts for lactate and pH estimation were successful in 98.7% and 
79.4% of procedures respectively in the one study that reported this 
outcome.There were no significant between-group differences in mode of birth or 
operative birth for non-reassuring fetal status, either for all women, or within 
the group where the fetal blood sample had been taken within 60 minutes of 
delivery (for example, caesarean section for all enrolled, RR 1.09, 95% CI 0.97 
to 1.22, two studies, 3319 women; operative delivery for non-reassuring fetal 
status for all enrolled RR 1.02, 95% CI 0.93 to 1.11, one study, 2992 
women).Neither study reported on adverse effects of fetal scalp lacerations or 
maternal anxiety.
AUTHORS' CONCLUSIONS: When further testing to assess fetal well-being in labour 
is indicated, fetal scalp blood lactate estimation is more likely to be 
successfully undertaken than pH estimation. Further studies may consider 
subgroup analysis by gestational age, the stage of labour and sampling within a 
prolonged second stage of labour. Additionally, we await the findings from the 
ongoing studies that compare allocation to no fetal blood sample with sampling 
for lactate and address longer-term neonatal outcomes, maternal satisfaction 
with intrapartum fetal monitoring and an economic analysis.

DOI: 10.1002/14651858.CD006174.pub3
PMCID: PMC10823414
PMID: 25929461 [Indexed for MEDLINE]

Conflict of interest statement: C East is the principal investigator for an 
ongoing randomised controlled trial that will be included in this review upon 
completion. Two review authors not involved in that trial will evaluate it for 
inclusion in the review and abstract the results.


4601. Pediatr Crit Care Med. 2015 Jun;16(5):e141-9. doi: 10.1097/PCC.0000000000000424.

Mental and physical well-being following admission to pediatric intensive care.

Als LC(1), Picouto MD, Hau SM, Nadel S, Cooper M, Pierce CM, Kramer T, Garralda 
ME.

Author information:
(1)1Centre for Mental Health, Department of Medicine, Imperial College London, 
London, United Kingdom. 2Department of Child and Adolescent Psychiatry and 
Psychology, Sant Joan de Déu Hospital, Universitat de Barcelona, Barcelona, 
Spain. 3Department of Paediatric Intensive Care, St Mary's Hospital, Imperial 
College Healthcare NHS Trust, London, United Kingdom. 4Department of Paediatric 
Intensive Care, Great Ormond Street Hospital, Great Ormond Street Hospital for 
Children NHS Trust, London, United Kingdom.

OBJECTIVE: To assess mental and physical well-being in school-aged children 
following admission to pediatric intensive care and to examine risk factors for 
worse outcome.
DESIGN: A prospective cohort study.
SETTING: Two PICUs.
SUBJECTS: A consecutive sample of 88 patients 5-16 years old (median age, 10.00 
yr; interquartile range, 6.00-13.00 yr) admitted to PICU from 2007 to 2010 with 
septic illness, meningoencephalitis, or other critical illnesses were assessed a 
median of 5 months following discharge and outcomes compared with 100 healthy 
controls.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Parents completed questionnaires documenting 
child mental and physical well-being, including the Strengths and Difficulties 
Questionnaires, Chalder Fatigue Scale, and Child Sleep Habits Questionnaire. 
Children over 8 years completed the Impact of Event Scale -8. The children 
admitted to PICU scored worse on all measures in comparison with the healthy 
controls, with 20% scoring at risk for psychiatric disorder, 34% with high 
levels of post-traumatic stress symptoms, 38% at risk for fatigue disorder, and 
80% scoring at risk for sleep disturbance. In the PICU group, multivariable 
regression analyses identified septic illness as an independent predictor of 
post-traumatic stress symptoms and family status, past child health problems, 
and PICU length of stay as predictors of reduced general mental well-being.
CONCLUSIONS: Our findings indicate that a significant minority of school-aged 
children admitted to PICU are at risk for reduced mental and physical well-being 
in the short term. Symptoms of poor mental well-being were linked to both 
vulnerability factors and critical illness factors.

DOI: 10.1097/PCC.0000000000000424
PMID: 25901544 [Indexed for MEDLINE]


4602. Holist Nurs Pract. 2015 May-Jun;29(3):136-43. doi: 10.1097/HNP.0000000000000083.

The effect of need-based spiritual/religious intervention on spiritual 
well-being and anxiety of elderly people.

Elham H(1), Hazrati M, Momennasab M, Sareh K.

Author information:
(1)Department of Geriatric Nursing (Ms Elham), Community Based Psychiatric Care 
Research Center (Ms Hazrati), and Department of Nursing (Ms Momennasab), Fatimah 
(PBUH) School of Nursing and Midwifery, and Department of Epidemiology, School 
of Health (Dr Sareh), Shiraz University of Medical Sciences, Shiraz, Iran.

Anxiety and spiritual distress are the most common problems among the patients 
admitted in intensive care units. The elderly are more vulnerable to this 
problem due to impairment of their adaptation mechanisms. Hence, helping to 
reduce anxiety is one of the most effective nursing interventions. Therefore, 
this study aimed at investigating the effect of need-based spiritual/religious 
interventions on spiritual well-being (SWB) and anxiety of the elderly admitted 
to coronary care unit (CCU). This quasi-experimental study with pre- and 
posttest control group design was conducted on 66 patients admitted to CCU of 
Imam Reza hospital in Lar, southern Iran, in 2014. After obtaining informed 
consents, the data were collected using the Spielberger State-Trait Anxiety 
Inventory, the SWB Scale, and a demographic questionnaire. The questionnaires 
were completed through interviewing the patients before and after the 
intervention. The participants of the intervention group underwent 60- to 
90-minute sessions of spiritual and religious need-based interventions for 3 
consecutive days. The results showed a significant increase in the mean scores 
of SWB in the intervention group after the intervention (P = .001). Also, a 
significant decrease was found in mean scores of trait and state anxiety in the 
intervention group in comparing to control group (P < .001). Moreover, a 
significant correlation was observed between the mean scores of SWB and state 
and trait anxiety. Spiritual/religious interventions could enhance SWB and 
reduce anxiety in the elderly admitted to CCU.

DOI: 10.1097/HNP.0000000000000083
PMID: 25882263 [Indexed for MEDLINE]


4603. Mil Med. 2015 Apr;180(4):475-82. doi: 10.7205/MILMED-D-14-00197.

Adherence to positive airway pressure therapy in U.S. military personnel with 
sleep apnea improves sleepiness, sleep quality, and depressive symptoms.

Mysliwiec V(1), Capaldi VF 2nd(2), Gill J(3), Baxter T(1), O'Reilly BM(1), 
Matsangas P(4), Roth BJ(1).

Author information:
(1)Department of Pulmonary, Sleep Medicine, Critical Care, Madigan Army Medical 
Center, 9040A Fitzsimmons Avenue, Tacoma, WA 98431.
(2)Walter Reed Army Institute of Research, 508 Robert Grant Avenue, Silver 
Spring, MD 20910.
(3)National Institutes of Health, 10 Center Drive, Bethesda, MD 20892.
(4)Department of Operations Research, Naval Postgraduate School, 1411 Cunningham 
Road, Monterey, CA 93943.

OBJECTIVES: Obstructive sleep apnea (OSA) is frequently diagnosed in U.S. 
military personnel. OSA is associated with sleepiness, poor sleep quality, and 
service-related illnesses of insomnia, depression, post-traumatic stress 
disorder, and traumatic brain injury.
METHODS: Observational study of active duty military personnel with OSA and 
adherence to positive airway pressure (PAP) assessed with smart chip technology.
RESULTS: 58 men with mean age 36.2 ± 7.7 years, mean body mass index 31.4 ± 3.7 
with mean apnea-hypopnea index (AHI) 19.1 ± 19.0 are reported. 23 (39.7%) 
participants were adherent to PAP, and 35 (60.3%) were nonadherent. No 
significant differences in baseline demographics, apnea-hypopnea index, 
service-related illnesses, or clinical instrument scores. Military personnel 
adherent to PAP had significantly improved sleepiness (p = 0.007), sleep quality 
(p = 0.013), depressive symptoms (p = 0.01), energy/fatigue (p = 0.027), and 
emotional well-being (p = 0.024). Participants with moderate-severe OSA were 
more likely to be in the adherent group when compared with participants 
diagnosed with mild OSA.
CONCLUSIONS: Military personnel with OSA have low adherence to PAP. Adherence is 
associated with improved depressive symptoms, sleepiness, sleep quality, 
energy/fatigue, emotional well-being, and social functioning. Future research 
should focus on interventions to improve the management of OSA in military 
personnel.

Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

DOI: 10.7205/MILMED-D-14-00197
PMID: 25826354 [Indexed for MEDLINE]


4604. J Crit Care. 2015 Jun;30(3):599-605. doi: 10.1016/j.jcrc.2015.02.016. Epub 2015 
Mar 5.

Psychological experience of patients 3 months after a stay in the intensive care 
unit: A descriptive and qualitative study.

Chahraoui K(1), Laurent A(2), Bioy A(3), Quenot JP(4).

Author information:
(1)Laboratoire de Psychopathologie et de Psychologie Médicale, Université de 
Bourgogne, 21000 Dijon, France. Electronic address: 
Khadija.Chahraoui@u-bourgogne.fr.
(2)Université de Franche-Comté, Laboratoire de Psychologie, 25000 Besançon, 
France. Electronic address: alexandra.laurent@univ-fcomte.fr.
(3)Laboratoire de Psychopathologie et de Psychologie Médicale, Université de 
Bourgogne, 21000 Dijon, France. Electronic address: antoine.bioy@u-bourgogne.fr.
(4)Service de Réanimation Médicale, University Hospital Le Bocage, 14 rue Paul 
Gaffarel, 21079 Dijon, France. Electronic address: 
jean-pierre.quenot@chu-dijon.fr.

PURPOSE: The purpose was to describe psychological experiences of patients 3 
months after a stay in the intensive care unit (ICU) using qualitative methods.
METHODS: Twenty patients underwent clinical interview lasting 1 hour and 
completed the Impact of Event Scale-Revised and Hospital Anxiety and Depression 
questionnaires. All interviews were recorded and coded using thematic analysis.
RESULTS: All patients (100%) reported that they could not remember their ICU 
stay; half reported confused memories (50%) or disorientation (50%). Negatives 
memories were also reported (20%-45%), namely, pain, distress, sleep 
difficulties, noise, fear, feeling of abandonment; 20% reported positive 
memories. At 3 months, for 10 (50%) of 20 patients, their ICU experience was 
characterized by anxiety; 3 (15%) of 20 presented posttraumatic stress disorder; 
7 (35%) of 20 reported a feeling of well-being with positive life changes. 
Well-being seems to be associated with use of coping strategies, such as active 
coping, positive reframing, optimism, humor, acceptance, leisure activities, and 
family support.
CONCLUSION: Our study highlights the need to investigate patients' memories of 
ICU and the coping strategies used by patients to improve their ICU experience. 
Our findings suggest that a systematic follow-up consultation after ICU 
discharge would be useful for monitoring of post-ICU psychological outcomes.

Copyright © 2015 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jcrc.2015.02.016
PMID: 25776895 [Indexed for MEDLINE]


4605. Front Cell Neurosci. 2015 Feb 2;9:28. doi: 10.3389/fncel.2015.00028. eCollection 
2015.

Systemic inflammation and the brain: novel roles of genetic, molecular, and 
environmental cues as drivers of neurodegeneration.

Sankowski R(1), Mader S(2), Valdés-Ferrer SI(3).

Author information:
(1)Elmezzi Graduate School of Molecular Medicine , Manhasset, NY , USA ; 
Feinstein Institute for Medical Research , Manhasset, NY , USA.
(2)Feinstein Institute for Medical Research , Manhasset, NY , USA.
(3)Elmezzi Graduate School of Molecular Medicine , Manhasset, NY , USA ; 
Feinstein Institute for Medical Research , Manhasset, NY , USA ; Department of 
Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán , 
México City , Mexico.

The nervous and immune systems have evolved in parallel from the early 
bilaterians, in which innate immunity and a central nervous system (CNS) 
coexisted for the first time, to jawed vertebrates and the appearance of 
adaptive immunity. The CNS feeds from, and integrates efferent signals in 
response to, somatic and autonomic sensory information. The CNS receives input 
also from the periphery about inflammation and infection. Cytokines, chemokines, 
and damage-associated soluble mediators of systemic inflammation can also gain 
access to the CNS via blood flow. In response to systemic inflammation, those 
soluble mediators can access directly through the circumventricular organs, as 
well as open the blood-brain barrier. The resulting translocation of 
inflammatory mediators can interfere with neuronal and glial well-being, leading 
to a break of balance in brain homeostasis. This in turn results in cognitive 
and behavioral manifestations commonly present during acute infections - 
including anorexia, malaise, depression, and decreased physical activity - 
collectively known as the sickness behavior (SB). While SB manifestations are 
transient and self-limited, under states of persistent systemic inflammatory 
response the cognitive and behavioral changes can become permanent. For example, 
cognitive decline is almost universal in sepsis survivors, and a common finding 
in patients with systemic lupus erythematosus. Here, we review recent genetic 
evidence suggesting an association between neurodegenerative disorders and 
persistent immune activation; clinical and experimental evidence indicating 
previously unidentified immune-mediated pathways of neurodegeneration; and novel 
immunomodulatory targets and their potential relevance for neurodegenerative 
disorders.

DOI: 10.3389/fncel.2015.00028
PMCID: PMC4313590
PMID: 25698933


4606. J Adv Nurs. 2015 Jul;71(7):1611-23. doi: 10.1111/jan.12625. Epub 2015 Feb 6.

The influence of authentic leadership and empowerment on nurses' relational 
social capital, mental health and job satisfaction over the first year of 
practice.

Read EA(1), Laschinger HK(2).

Author information:
(1)Arthur and Sonia Labatt Family School of Nursing, The University of Western 
Ontario, London, Ontario, Canada.
(2)Arthur Labatt Family Nursing Research Chair in Human Resource Optimization, 
Arthur and Sonia Labatt Family School of Nursing, The University of Western 
Ontario, London, Ontario, Canada.

AIMS: To examine a theoretical model testing the effects of authentic 
leadership, structural empowerment and relational social capital on the mental 
health and job satisfaction of new graduate nurses over the first year of 
practice.
BACKGROUND: Relational social capital is an important interpersonal 
organizational resource that may foster new graduate nurses' workplace 
well-being and promote retention. Evidence shows that authentic leadership and 
structural empowerment are key aspects of the work environment that support new 
graduate nurses; however, the mediating role of relational social capital has 
yet to be explored.
DESIGN: A longitudinal survey design was used to test the hypothesized model.
METHODS: One hundred ninety-one new graduate nurses in Ontario with <2 years of 
experience completed mail surveys in January-March 2010 and 1 year later in 
2011. Path analysis using structural equation modelling was used to test the 
theoretical model.
RESULTS: Participants were mostly female, working full time in medicine/surgery 
or critical care. All measures demonstrated acceptable reliability and validity. 
Path analysis results supported our hypothesized model; structural empowerment 
mediated the relationship between authentic leadership and nurses' relational 
social capital, which in turn had a negative effect on mental health symptoms 
and a positive effect on job satisfaction. All indirect paths in the model were 
significant.
CONCLUSION: By creating structurally empowering work environments, authentic 
leaders foster relational social capital among new graduate nurses leading to 
positive health and retention outcomes.

© 2015 John Wiley & Sons Ltd.

DOI: 10.1111/jan.12625
PMID: 25656433 [Indexed for MEDLINE]


4607. J Clin Diagn Res. 2014 Dec;8(12):WC01-3. doi: 10.7860/JCDR/2014/10293.5297. Epub 
2014 Dec 5.

Psychological evaluation of patients in critical care/intensive care unit and 
patients admitted in wards.

Sharma B G(1), Evs M(2), Ms K(3), B G(4).

Author information:
(1)Student, AJ Institute of Medical Sciences and Research , Kuntikana, 
Mangalore, India .
(2)Professor & HOD, Department of Medicine, AJ Institute of Medical Sciences and 
Research , Kuntikana, Mangalore, India .
(3)Associate Professor, Department of Community Medicine, Kasturba Medical 
College , Manipal University, Mangalore, India .
(4)Additional Professor, Department of Physiology, Kasturba Medical College , 
Manipal University, Mangalore, India .

BACKGROUND: Psychological assessment for depression, anxiety and stress among 
ICU patients and the patients admitted to ward in a hospital in India. This 
aspect did not get much attention in India so far. Such studies were common in 
developed countries. Therefore we decided in this study, to analyse the 
psychological status responses from the hospitalised patients in Mangalore using 
a validated questionnaire.
AIM: To assess and compare the depression, anxiety and stress Scores from the 
patients admitted in Intensive Care Unit (ICU) and those admitted to ward.
MATERIALS AND METHODS: Eighty patients admitted to hospital, 40 from ICU and 40 
admitted to ward were recruited. They were explained the procedure and after 
taking an informed consent, they were administered Depression, Anxiety, Stress 
Scale (DASS) Questionnaire, which contains 42-item questionnaire which includes 
three self-report scales designed to measure the negative emotional states of 
depression, anxiety and stress. The responses were computed and tabulated. We 
analysed the responses with Student's t-test and Chi-square test, p<0.05 
accepted as statistically significant.
RESULTS: The results revealed significantly elevated stress, depression and 
anxiety among the ICU patients when compared to those in the ward (p<0.001). 
Above normal anxiety and stress levels were also seen in the ward patients, 
compared to the scores in normal range. 50% and 25% respectively showed mild and 
normal depression scores in ward patients, compared to 12% and 5% in those 
admitted to ICU. This trend was also true for Anxiety and stress scores.
CONCLUSION: From the results we found that there were elevated depression, 
anxiety and stress levels among the patients and this was significantly higher 
in ICU patients. Various factors could influence the psychological wellbeing of 
the patients, including the hospital environment, care givers, presence of 
family members nearby apart from the seriousness of illness, apprehensions about 
possibility of death. Such studies were rare among Indian patients. The findings 
of this study could be useful in incorporating suitable psychological help to 
the patients in hospitals to improve their recovery and wellbeing.

DOI: 10.7860/JCDR/2014/10293.5297
PMCID: PMC4316320
PMID: 25654014


4608. J Intensive Care Soc. 2015 Feb;16(1):37-44. doi: 10.1177/1751143714554896. Epub 
2014 Dec 9.

Project Post Intensive Care eXercise (PIX): A qualitative exploration of 
intensive care unit survivors' perceptions of quality of life post-discharge and 
experience of exercise rehabilitation.

Walker W(1), Wright J(2), Danjoux G(3), Howell SJ(4), Martin D(5), Bonner S(2).

Author information:
(1)Tees Esk and Wear Valleys NHS Trust, UK.
(2)Critical Care Department, The James Cook University Hospital, Middlesbrough, 
UK.
(3)Department of Anaesthesia, The James Cook University Hospital, Middlesbrough, 
UK.
(4)Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, 
Leeds, UK.
(5)Health and Social Care Institute, Teesside University, Middlesbrough, UK.

Patients who survive critical illness often report deterioration in health 
related quality of life. This has not been shown to improve following 
post-intensive care unit (ICU) self-directed exercise. The Post Intensive Care 
eXercise (PIX) study demonstrated improved objectively measured fitness 
following a supervised exercise programme following critical illness and also 
suggested beneficial effects on physical and mental health. The qualitative arm 
of the PIX study reported here utilised focus groups to explore in more detail 
recovery from critical illness, quality of life following hospital discharge, 
perceptions of the exercise programme and it's impact on perceived well-being. 
Sixteen participants (eight of whom underwent the supervised exercise programme) 
were allocated to four psychologist lead focus groups. Themes identified after 
hospital discharge centred on social isolation, abandonment, vulnerability and 
reduced physical activity. However, patients in the exercise group described 
exercise training as motivating, increasing energy levels and sense of 
achievement, social interaction and confidence. This study adds to the sparse 
literature on the patient experience post critical illness. It supports the 
improvements in physical and mental health suggested with exercise in the PIX 
study and would support further research in relation to the effects of 
supervised exercise and rehabilitation programmes post critical illness. It 
recommends that future comparative outcome studies in this patient population 
also include interview-based assessment as part of assessment of quality of life 
and an individual's functional status.

DOI: 10.1177/1751143714554896
PMCID: PMC5593289
PMID: 28979373


4609. Palliat Med. 2015 Mar;29(3):223-30. doi: 10.1177/0269216314560008. Epub 2015 Jan 
29.

A pre-test and post-test study of the physical and psychological effects of 
out-of-home respite care on caregivers of children with life-threatening 
conditions.

Remedios C(1), Willenberg L(2), Zordan R(2), Murphy A(3), Hessel G(3), Philip 
J(2).

Author information:
(1)Centre for Palliative Care, St Vincent's Hospital, Fitzroy, VIC, Australia 
cremedios@mercy.com.au.
(2)Centre for Palliative Care, St Vincent's Hospital, Fitzroy, VIC, Australia.
(3)Very Special Kids, Malvern, VIC, Australia.

BACKGROUND: Respite services are recommended as an important support for 
caregivers of children with life-threatening conditions. However, the benefits 
of respite have not been convincingly demonstrated through quantitative 
research.
AIM: To determine the impact of out-of home respite care on levels of fatigue, 
psychological adjustment, quality of life and relationship satisfaction among 
caregivers of children with life-threatening conditions.
DESIGN: A mixed-methods, pre-test and post-test study
SETTING/PARTICIPANTS: A consecutive sample of 58 parental caregivers whose 
children were admitted to a children's hospice for out-of-home respite over an 
average of 4 days.
RESULTS: Caregivers had below-standard levels of quality of life compared to 
normative populations. Paired t-tests demonstrated that caregivers' average 
psychological adjustment scores significantly improved from pre-respite 
(mean = 13.9, standard error = 0.71) to post-respite (mean = 10.7, standard 
error = 1); p < 0.001, 95% confidence interval: 1.25-5.11). Furthermore, 
caregivers' average fatigue scores significantly improved from pre-respite 
(mean = 14.3, standard error = 0.85) to post-respite (mean = 10.9, standard 
error = 1.01; p < 0.001, 95% confidence interval: 1.69-7.94), and caregivers' 
average mental health quality of life scores significantly improved from 
pre-respite (mean = 44.2, standard error = 1.8) to post-respite (mean = 49.1, 
standard error = 1.6; p < 0.01, 95% confidence interval: -9.56 to 0.36). 
Qualitative data showed caregivers sought respite for relief from intensive care 
provision and believed this was essential to their well-being.
CONCLUSION: Findings indicate the effectiveness of out-of-home respite care in 
improving the fatigue and psychological adjustment of caregivers of children 
with life-threatening conditions. Study outcomes inform service provision and 
future research efforts in paediatric palliative care.

© The Author(s) 2015.

DOI: 10.1177/0269216314560008
PMID: 25634634 [Indexed for MEDLINE]


4610. Psychol Health Med. 2016;21(1):20-6. doi: 10.1080/13548506.2014.997763. Epub 
2015 Jan 9.

The acute psychobiological impact of the intensive care experience on relatives.

Turner-Cobb JM(1), Smith PC(1), Ramchandani P(1), Begen FM(1), Padkin A(2).

Author information:
(1)a Department of Psychology , University of Bath , Claverton Down, Bath BA2 
7AY , UK.
(2)b Intensive Care Unit , Royal United Hospital NHS Trust , Combe Park, Bath , 
UK.

There is a growing awareness amongst critical care practitioners that the impact 
of intensive care medicine extends beyond the patient to include the 
psychological impact on close family members. Several studies have addressed the 
needs of relatives within the intensive care context but the psychobiological 
impact of the experience has largely been ignored. Such impact is important in 
respect to health and well-being of the relative, with potential to influence 
patient recovery. The current feasibility study aimed to examine the acute 
psychobiological impact of the intensive care experience on relatives. Using a 
mixed methods approach, quantitative and qualitative data were collected 
simultaneously. Six relatives of patients admitted to the intensive care unit 
(ICU) of a District General Hospital, were assessed within 48 h of admission. 
Qualitative data were provided from semi-structured interviews analysed using 
interpretative phenomenological analysis. Quantitative data were collected using 
a range of standardised self-report questionnaires measuring coping responses, 
emotion, trauma symptoms and social support, and through sampling of diurnal 
salivary cortisol as a biomarker of stress. Four themes were identified from 
interview: the ICU environment, emotional responses, family relationships and 
support. Questionnaires identified high levels of anxiety, depression and trauma 
symptoms; the most commonly utilised coping techniques were acceptance, seeking 
support through advice and information, and substance use. Social support 
emerged as a key factor with focused inner circle support relating to family and 
ICU staff. Depressed mood and avoidance were linked to greater mean cortisol 
levels across the day. Greater social network and coping via self-distraction 
were related to lower evening cortisol, indicating them as protective factors in 
the ICU context. The experience of ICU has a psychological and physiological 
impact on relatives, suggesting the importance of identifying cost-effective 
interventions with evaluations of health benefits to both relatives and 
patients.

DOI: 10.1080/13548506.2014.997763
PMCID: PMC4662102
PMID: 25572144 [Indexed for MEDLINE]


4611. J Clin Sleep Med. 2015 Mar 15;11(3):251-8. doi: 10.5664/jcsm.4538.

Sleep patterns, sleep instability, and health related quality of life in parents 
of ventilator-assisted children.

Meltzer LJ(1), Sanchez-Ortuno MJ(2), Edinger JD(1), Avis KT(3).

Author information:
(1)National Jewish Health, Denver, CO.
(2)University of Murcia, Murcia, Spain.
(3)University of Alabama at Birmingham, Birmingham, AL.

STUDY OBJECTIVES: Parents of children with chronic illnesses have poorer health 
related quality of life (HRQoL), shorter sleep duration, and poorer sleep 
quality than parents of healthy children. However, night-to-night variability of 
sleep in parents has not previously been considered. This study compared the 
sleep patterns of parents of ventilator-assisted children (VENT) and healthy, 
typically developing children (HEALTHY), and examined the relationship between 
sleep variability and perceived HRQoL.
METHODS: Seventy-nine mothers and 33 fathers from 42 VENT families (n = 56) and 
40 HEALTHY (n = 56) families completed the SF-36 and wore an actigraph for 2 
weeks. Reported bedtime and wake time, along with actigraphic total sleep time 
(TST), wake after sleep onset (WASO), and sleep efficiency (SE) were examined 
using both average values and night-tonight instability (mean square successive 
differences).
RESULTS: VENT parents showed significantly later bedtimes, shorter TST, longer 
WASO, and lower SE than HEALTHY parents. VENT parents also exhibited greater 
instability in their reported wake time, WASO, and SE. Adjusting for family type 
and gender, greater instability of wake times, WASO and SE were related to 
poorer SF-36 subscale scores, while averaged sleep values were not.
CONCLUSIONS: Many parents of ventilator-assisted children experience deficient 
sleep and show significant instability in their sleep, which was related to 
HRQoL. Similar to shift workers, variable sleep schedules that may result from 
caregiving responsibilities or stress may impact parental caregivers' health and 
well-being. Additional studies are needed to determine how support and other 
interventions can reduce sleep disruptions in parental caregivers.

© 2014 American Academy of Sleep Medicine.

DOI: 10.5664/jcsm.4538
PMCID: PMC4346646
PMID: 25515280 [Indexed for MEDLINE]


4612. Br J Nurs. 2014;23(14 Suppl):S11-4.

The role of dressings in the prevention of vascular access device infections.

Hodson J.

The risk of a catheter-related bloodstream infection (CRBSI) is an ever-present 
spectre for a patient with a vascular access device (VAD) in situ. The morbidity 
associated with these infections is high and incurs substantial costs. Worse 
still, thousands of patients with a VAD die of a CRBSI each year. Healthcare 
providers are championing the implementation of strategies that minimise or even 
eliminate the risk of CRBSIs, as these will improve patient outcomes and reduce 
healthcare costs. However, it is not only the financial implications of CRBSIs 
that must be considered. The impact of a CRBSI on the physical, emotional and 
mental wellbeing of a patient cannot be underestimated. This article will 
consider how the use of dressings can reduce the risk of CRBSI.

PMID: 25373251 [Indexed for MEDLINE]


4613. Rev Med Chir Soc Med Nat Iasi. 2014 Jul-Sep;118(3):738-42.

The HIV-positive patient in intensive care--psychological profile.

Manciuc C, Dorobăţ CM, Roşu F, Astărăstoae V, Largu MA.

AIM: This paper aims to outline the profile of HIV-positive patients in 
intensive care, in terms of psycho-emotional and vital parameters.
MATERIAL AND METHODS: We evaluated the HIV-positive patients that required 
intensive care (IC), from January 2011 to December 2013, in the HIV/AIDS 
Regional of the "Sf. Parascheva" Infectious Diseases Clinical Hospital Iaşi.
RESULTS: From January 2011 to December 2013, the HIV/AIDS Regional Centre in 
Iaşi recorded 2649 hospitalizations, of which 0.67% (18 cases) required 
intensive medical care. Of these 10 were males and 8 females, aged between 24 
and 65 years with a median of 24 years. There were 29 deaths (1.09% of all 
hospitalizations), 11 of which in intensive therapy (38% of all deaths)--7 men 
and 4 women. CD4 counts in persons requiring IC care were between 1 and 112/mm3, 
and most naive patients who died were late-presenters. The main diseases 
diagnosed were pulmonary tuberculosis and pneumocystosis, the main cause of 
death being multiple organ failure. The duration of hospitalization ranged 
between 4.5 and 30 days. Treatment success rate was correlated with the CD4 and 
biological status: liver and renal failure, respiratory failure, meningeal coma, 
hypoproteinemia, diselectrolitemia. From a psychological perspective, patients 
that arrived in the intensive care showed a history of non-compliance and 
non-adherence, a personality structure often marked by a lack of respect for 
them, indifference or ignorance regarding the factors that generate well-being.
CONCLUSIONS: HIV-positive patients in the position of requiring intensive care 
showed a marked immunological collapse due to abandonment of therapy or late 
detection.

PMID: 25341294 [Indexed for MEDLINE]


4614. Curr Pharm Biotechnol. 2014;15(8):738-78. doi: 
10.2174/1389201015666140827104918.

Biochemical, Biomedical and Metabolic Aspects of Imidazole-Containing Dipeptides 
with the Inherent Complexity to Neurodegenerative Diseases and Various States of 
Mental Well-Being: A Challenging Correction and Neurotherapeutic Pharmaceutical 
Biotechnology for Treating Cognitive Deficits, Depression and Intellectual 
Disabilities.

Babizhayev MA(1).

Author information:
(1)Innovative Vision Products, Inc., Moscow Office: Ivanovskaya 20, Suite 74 
Moscow 121334 Russia. markbabizhayev@mail.ru.

The activities of carnosine (β-alanyl-L-histidine), carnosine imidazole 
containing dipeptide based derivatives (N-acetylcarnosine, carcinine, 
homocarnosine) and a carnosine degrading enzyme (serum carnosinase (EC 
3.4.13.20); [human tissue carnosinase (EC 3.4.13.3), CN2 (CNDP2)] ) activities 
have been discrepantly linked to neuropathophysiological processes. 
Approximately 82% of the U.S. population will experience normal age-related 
cognitive decline, as compared to the precipitous losses that are associated 
with dementing disorders. Interventions designed to promote health and function 
through everyday activity and specific pharmaco-nutritional therapeutic 
treatments may enhance brain plasticity in key regions that support executive 
function. Cognitive health is multidimensional cascade of functions. It 
encompasses an array of functions, including general intellectual ability, 
memory, language, allowing a person to interact effectively and appropriately 
with the environment. The risk factors for reduced physical and cognitive 
functions in elderly people, as identified in longitudinal studies, relate to 
comorbidities, critical care situations, physical and psychosocial health, 
environmental conditions, social circumstances, nutrition, and lifestyle. 
Depression and dementia are both common in older adults; cognitive functioning 
declines slightly with normal aging; depression itself can be associated with 
cognitive impairment and dementia. In this study the role of carnosine and 
related neuron specific naturally-occurring endogenous imidazole-containing 
dipeptide pharmacoperones (N-acetylcarnosine, carcinine) is revealed presently 
in a surprisingly large amounts in long-lived human tissues to correct 
conformational abnormalities leading to distinct neurodegeneration and 
age-related disease states, treating cognitive deficits, depression and 
intellectual disabilities. Carnosine serves as a physiological buffering agent 
and a metal ion (e.g., zinc and copper) chelator, endowed with ferroxidase type 
activity; possess anti-aging functions, and free-radical scavenging activity, is 
capable of delaying senescence and extending the life-span of cultured human 
fibroblasts; is able to kill transformed cells and protect cells against 
aldehydes and amyloid peptide fragment. Carnosine and carcinine exhibit a 
well-documented anti-glycating activity against the glycation of proteins, 
including low-density lipoproteins, glucose degradation products, esterase, 
histones. A tissue carnosine-degrading enzyme (CN2) colocalized with the 
activity of histidine decarboxylase to histamine neurons in the hypothalamic 
tuberomammillary nucleus (TMN) plays a key role in the neuro-transmission and 
neuroregulation roles of imidazole-containing based dipeptides. Carnosine 
released from skeletal muscle during exercise may be transported into 
TMN-histamine neurons and hydrolyzed. Timing of carnosine present in the chicken 
broth, the specific patented nutraceutical composition (Can-C Plus™), 1% 
N-acetylcarnosine lubricant eye drops or 1% carcinine lubricant eye drops 
formulations are important targeting posology vehicles that are involved in many 
CNS functions through the central brain histamine system including the vision 
enhancement functions, physiological regulation of cognitive functions, arousal; 
anxiety; activation of the sympathetic nervous system; the stress-related 
release of hormones from the pituitary and of central aminergic 
neurotransmitters; antinociception; water retention and suppression of eating. 
The roles for the carnosine-stimulated/mediated neuronal histamine system are 
proposed as a danger and physiological response system active in protection from 
neurodegenerative diseases and in management of cognitive deficits, depression 
and intellectual disabilities.

DOI: 10.2174/1389201015666140827104918
PMID: 25158972 [Indexed for MEDLINE]


4615. Complement Ther Clin Pract. 2014 Aug;20(3):147-51. doi: 
10.1016/j.ctcp.2014.03.002. Epub 2014 Apr 4.

The effects of family-friend visits on anxiety, physiological indices and 
well-being of MI patients admitted to a coronary care unit.

Lolaty HA(1), Bagheri-Nesami M(2), Shorofi SA(3), Golzarodi T(4), Charati JY(5).

Author information:
(1)Department of Psychiatric Nursing, School of Nursing & Midwifery, Mazandaran 
University of Medical Sciences, Sari, Iran. Electronic address: 
azimihamideh@gmail.com.
(2)Department of Medical-Surgical Nursing, School of Nursing & Midwifery, 
Mazandaran University of Medical Sciences, Sari, Iran. Electronic address: 
anna30432003@yahoo.com.
(3)Department of Medical-Surgical Nursing, School of Nursing & Midwifery, 
Mazandaran University of Medical Sciences, Sari, Iran; Traditional and 
Complementary Medicine Research Centre, Mazandaran University of Medical 
Sciences, Sari, Iran; Flinders University, Adelaide, Australia. Electronic 
address: afshin.shorofi@flinders.edu.au.
(4)School of Nursing & Midwifery, Mazandaran University of Medical Sciences, 
Sari, Iran. Electronic address: Bahar_Golzaroodi@yahoo.com.
(5)Department of Biostatistics, School of Health Sciences, Mazandaran University 
of Medical Sciences, Sari, Iran. Electronic address: jamshid_1380@yahoo.com.

OBJECTIVE: To investigate the effect of family-friend visits on anxiety, 
physiological indices and well-being of patients with acute myocardial 
infarction.
METHODS: A checklist was used to gather socio-demographic data and physiologic 
indices including blood pressure, heart rate, respiratory rate, and arterial 
oxygen saturation. The short-form of the Spielberger state anxiety inventory, a 
visual analog scale well-being and cardiac monitoring devices were used for 
collecting data.
RESULTS: Patients exhibited a lower heart rate and respiratory rate in the 
normal range during the 10-min visiting period and within 10 and 30 min after 
the visiting period. The arterial oxygen saturation increased in this period. 
After the visiting period, patients exhibited an increase in the sense of 
well-being and a decrease in the level of anxiety.
CONCLUSION: Family-friend visits can improve MI patients' sense of well-being 
and decrease their anxiety. Moreover, the visits can help to keep the 
physiological indices within normal limits.

Copyright © 2014 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.ctcp.2014.03.002
PMID: 25129882 [Indexed for MEDLINE]


4616. J Psychosoc Nurs Ment Health Serv. 2014 Jul;52(7):24-9. doi: 
10.3928/02793695-20140324-02. Epub 2014 Mar 31.

"It broke our hearts": understanding parents' lived experiences of their child's 
admission to an acute mental health care facility.

Ward L, Gwinner K.

Comment in
    J Psychosoc Nurs Ment Health Serv. 2014 Sep;52(9):5.

This article reports the evaluative findings of an Early Psychosis Education 
Program (EPEP) designed to support parents caring for their child who was 
recently admitted to the psychiatric intensive care unit of an inpatient mental 
health care facility in Australia. The EPEP offered education on mental illness, 
treatment options, and medication, as well as information on the recovery model 
of care. The EPEP was facilitated by two RNs and was evaluated for educational 
effectiveness using a simple pre- and postevaluation questionnaire. The 
evaluation revealed two themes expressed by parents: "We didn't see it coming," 
and "Hopelessness and helplessness." The themes highlighted the parents' lack of 
mental health care knowledge prior to the EPEP, which had a significant impact 
on the parents' experiences and well-being. The evaluative findings highlighted 
a need for a nurse-led EPEP within the community. A community EPEP has the 
potential to strengthen the partnership between parents, families, and mental 
health service providers and to help with the provision of a recovery framework 
of care.

Copyright 2014, SLACK Incorporated.

DOI: 10.3928/02793695-20140324-02
PMID: 24694246 [Indexed for MEDLINE]


4617. J Perinatol. 2014 Jul;34(7):555-61. doi: 10.1038/jp.2014.43. Epub 2014 Mar 20.

Very preterm birth: maternal experiences of the neonatal intensive care 
environment.

Woodward LJ(1), Bora S(2), Clark CA(3), Montgomery-Hönger A(4), Pritchard VE(5), 
Spencer C(6), Austin NC(7).

Author information:
(1)1] Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 
Harvard Medical School, Boston, MA, USA [2] Department of Psychology, University 
of Canterbury, Christchurch, New Zealand.
(2)Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 
Harvard Medical School, Boston, MA, USA.
(3)Department of Psychology, Prevention Science Institute, University of Oregon, 
OR, USA.
(4)Department of Psychology, University of Canterbury, Christchurch, New 
Zealand.
(5)Department of Psychology, Aberystwyth University, Ceredigion, Wales, UK.
(6)Neonatal Service, Christchurch Women's Hospital, Christchurch, New Zealand.
(7)1] Neonatal Service, Christchurch Women's Hospital, Christchurch, New Zealand 
[2] Department of Pediatrics, University of Otago, Christchurch, New Zealand.

OBJECTIVE: Examine sources, predictors and child outcomes associated with 
neonatal intensive care unit (NICU)-related stress for mothers of infants born 
very preterm (VPT).
STUDY DESIGN: Participants were 133 mothers of VPT infants admitted to a 
regional level-III NICU. At term equivalent, mothers completed the Parental 
Stressor Scale: NICU and were interviewed about their psychological well-being 
and family circumstances. Infant clinical data were also collected. At corrected 
age 4 years, 49 children were assessed for cognition, language and 
socio-emotional development.
RESULT: Mothers reported moderate to low stress, with parental role alteration 
considered most stressful and parent-staff communications least stressful. 
Predictors of overall stress included maternal educational underachievement, 
stressful life events, postnatal depression and infant unsettled-irregular 
behavior. NICU-related stress was associated with child anxiety and poorer 
language development.
CONCLUSION: Parental well-being is an important focus of care in the neonatal 
setting. Strategies are needed to optimize early engagement and reduce stress 
levels to assist improved child outcomes.

DOI: 10.1038/jp.2014.43
PMCID: PMC4154363
PMID: 24651730 [Indexed for MEDLINE]


4618. BMJ Open. 2014 Jan 15;4(1):e004230. doi: 10.1136/bmjopen-2013-004230.

Protocol for a longitudinal qualitative study: survivors of childhood critical 
illness exploring long-term psychosocial well-being and needs--The SCETCH 
Project.

Manning JC(1), Hemingway P, Redsell SA.

Author information:
(1)School of Health Sciences, Faculty of Medicine and Health Sciences, 
University of Nottingham, Nottingham, UK.

INTRODUCTION: Life-threatening critical illness affects over a quarter of a 
million children and adolescents (0-18 years old) annually in the USA and the 
UK. Death from critical illness is rare; however, survivors and their families 
can be exposed to a complex array of negative physical, psychological and social 
problems. Currently, within the literature, there is a distinct paucity of child 
and adolescent survivor self-reports, thus limiting our understanding of how 
survivors perceive this adversity and subsequently cope and grow in the 
long-term following their critical illness. This study aims to explore and 
understand psychosocial well-being and needs of critical illness survivors, 6-20 
months post paediatric intensive care admission.
METHODS AND ANALYSIS: A longitudinal, qualitative approach will provide a 
platform for a holistic and contextualised exploration of outcomes and 
mechanisms at an individual level. Up to 80 participants, including 20 childhood 
critical illness survivors and 60 associated family members or health 
professionals/teachers, will be recruited. Three interviews, 7-9 weeks apart, 
will be conducted with critical illness survivors, allowing for the exploration 
of psychosocial well-being over time. A single interview will be conducted with 
the other participants enabling the exploration of contextual information and 
how psychosocial well-being may inter-relate between critical illness survivors 
and themselves. A 'tool box' of qualitative methods (semi-structured interviews, 
draw and tell, photo-elicitation, graphic-elicitation) will be used to collect 
data. Narrative analysis and pattern matching will be used to identify emergent 
themes across participants.
ETHICS AND DISSEMINATION: This study will provide an insight and understanding 
of participants' experiences and perspectives of surviving critical illness in 
the long term with specific relation to their psychosocial well-being. Multiple 
methods will be used to ensure that the findings are effectively disseminated to 
service users, clinicians, policy and academic audiences. The study has full 
ethical approval from the East Midlands Research Ethics Committee and has 
received National Health Service (NHS) governance clearance.

DOI: 10.1136/bmjopen-2013-004230
PMCID: PMC3902363
PMID: 24435896 [Indexed for MEDLINE]


4619. BMC Res Notes. 2014 Jan 13;7:33. doi: 10.1186/1756-0500-7-33.

Gut microeukaryotes during anorexia nervosa: a case report.

Gouba N, Raoult D, Drancourt M(1).

Author information:
(1)Aix Marseille Université, URMITE, UMR63, CNRS 7278, IRD 198, Inserm 1095, 
Marseille 13005, France. michel.drancourt@univmed.fr.

BACKGROUND: Few studies have focused on eukaryote community in the human gut. 
Here, the diversity of microeukaryotes in the gut microbiota of an anorexic 
patient was investigated using molecular and culture approaches.
CASE PRESENTATION: A 21-year-old Caucasian woman was admitted in an intensive 
care unit for severe malnutrition in anorexia nervosa. One stool specimen was 
collected from the anorexic patient, culture and polymerase chain reaction-based 
explorations yielded a restricted diversity of fungi but four microeukaryotes 
Tetratrichomonas sp., Aspergillus ruber, Penicillium solitum and Cladosporium 
bruhnei previously undescribed in the human gut.
CONCLUSIONS: Establishing microeukaryote repertoire in gut microbiota 
contributes to the understanding of its role in human health.

DOI: 10.1186/1756-0500-7-33
PMCID: PMC3895777
PMID: 24418238 [Indexed for MEDLINE]


4620. Intensive Crit Care Nurs. 2014 Jun;30(3):145-51. doi: 
10.1016/j.iccn.2013.11.002. Epub 2013 Dec 3.

Psychological wellbeing, health related quality of life and memories of 
intensive care and a specialised weaning centre reported by survivors of 
prolonged mechanical ventilation.

Rose L(1), Nonoyama M(2), Rezaie S(3), Fraser I(4).

Author information:
(1)Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College 
Street, Room 276, Toronto, ON, Canada M5T IP8; Provincial Centre of Weaning 
Excellence/Prolonged Ventilation Weaning Centre, Toronto East General Hospital, 
825 Coxwell Avenue, Toronto, ON, Canada M4C 3E7; Mt Sinai Hospital and the Li Ka 
Shing Knowledge Institute, St Michael's Hospital, Canada. Electronic address: 
louise.rose@utoronto.ca.
(2)Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College 
Street, Room 276, Toronto, ON, Canada M5T IP8. Electronic address: 
nonoyama@utoronto.ca.
(3)Provincial Centre of Weaning Excellence/Prolonged Ventilation Weaning Centre, 
Toronto East General Hospital, 825 Coxwell Avenue, Toronto, ON, Canada M4C 3E7. 
Electronic address: shrez@tegh.on.ca.
(4)Provincial Centre of Weaning Excellence/Prolonged Ventilation Weaning Centre, 
Toronto East General Hospital, 825 Coxwell Avenue, Toronto, ON, Canada M4C 3E7; 
Division of Respirology, Faculty of Medicine, University of Toronto, Canada. 
Electronic address: ifras@tegh.on.ca.

OBJECTIVE: To compare memories and recall of intensive care unit and specialised 
weaning centre admission, characterise health-related quality of life and 
psychological morbidity, and examine the relationship between delusional 
memories and psychological outcomes.
METHODS: We recruited participants following hospitalisation that included ICU 
admission and subsequent weaning in a specialised centre. We administered 
validated questionnaires to assess memory and recall of both care locations, 
anxiety, depression, post-traumatic stress symptomatology and health-related 
quality of life.
RESULTS: Of 53 eligible patients discharged from the weaning centre over seven 
years, we recruited 27 participants. Participants had similar numbers of factual 
and feeling memories but reported more delusional memories for ICU than the 
weaning centre (1.6 vs. 0.7, P=0.004). Nine (39%) participants scored ≥ 11 on 
the hospital anxiety and depression scale (anxiety) and were more likely to 
experience delusional memories (P=0.008). Thirst (70%), no control (70%), noise 
(65%) were most frequently recalled ICU experiences. Procedures (83%), night 
awakening (70%), inability to sleep (70%) most frequently recalled from the 
weaning centre.
CONCLUSION: Delusional memories and anxiety disorder were prevalent and 
associated suggesting interventions to ameliorate delusional memories may reduce 
anxiety. Difficulty sleeping and thirst were common experiences.

Copyright © 2013 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.iccn.2013.11.002
PMID: 24308899 [Indexed for MEDLINE]


4621. J Pain Symptom Manage. 2014 Jun;47(6):1028-34. doi: 
10.1016/j.jpainsymman.2013.07.015. Epub 2013 Nov 15.

Characteristics and outcomes of patients admitted to the acute palliative care 
unit from the emergency center.

Shin SH(1), Hui D(2), Chisholm GB(3), Kwon JH(4), San-Miguel MT(5), Allo JA(2), 
Yennurajalingam S(2), Frisbee-Hume SE(2), Bruera E(6).

Author information:
(1)Department of Palliative Care and Rehabilitation Medicine, University of 
Texas M. D. Anderson Cancer Center, Houston, Texas, USA; Department of Internal 
Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
(2)Department of Palliative Care and Rehabilitation Medicine, University of 
Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
(3)Department of Biostatistics, University of Texas M. D. Anderson Cancer 
Center, Houston, Texas, USA.
(4)Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym 
University, Chuncheon, Republic of Korea.
(5)Department of Palliative Medicine, Clinica Universidad de Navarra, Pamplona, 
Spain.
(6)Department of Palliative Care and Rehabilitation Medicine, University of 
Texas M. D. Anderson Cancer Center, Houston, Texas, USA. Electronic address: 
ebruera@mdanderson.org.

CONTEXT: Most patients admitted to acute palliative care units (APCUs) are 
transferred from inpatient oncology units. We hypothesized that patients 
admitted to APCUs from emergency centers (ECs) have symptom burdens and outcomes 
that differ from those of transferred inpatients.
OBJECTIVES: The purpose of this retrospective cohort study was to compare the 
symptom burdens and survival rate of patients admitted to an APCU from an EC 
with those of inpatients transferred to the APCU.
METHODS: Among the 2568 patients admitted to our APCU between September 1, 2003 
and August 31, 2008, 312 (12%) were EC patients. We randomly selected 300 
inpatients transferred to the APCU as controls (The outcome data were 
unavailable for two patients). We retrieved data on patient demographics, cancer 
diagnosis, Edmonton Symptom Assessment System scores, discharge outcomes, and 
overall survival from time of admission to the APCU.
RESULTS: The EC patients had higher rates of pain, fatigue, nausea, and insomnia 
and were less likely to be delirious. They were more than twice as likely to be 
discharged alive than transferred inpatients. Kaplan-Meier plot tests for 
product-limit survival estimate from admission to APCU for EC patients and 
inpatients were statistically significant (median survival 34 vs. 31 days, 
P<0.0001). In multivariate analysis, EC admission (odds ratio [OR]=1.8593, 95% 
confidence interval [CI] 1.1532-2.9961), dyspnea (OR=0.8533, 95% CI 
0.7892-0.9211), well-being (OR=1.1192, 95% CI 1.0234-1.2257), and delirium 
(OR=0.3942, 95% CI 0.2443-0.6351) were independently associated with being 
discharged alive.
CONCLUSION: The EC patients have a higher acute symptom burden and are more 
likely to be discharged alive than transferred inpatients. The APCU was 
successful at managing symptoms and facilitating the discharge of both 
inpatients and EC patients to the community although the patients had severe 
symptoms on admission.

Copyright © 2014 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. 
All rights reserved.

DOI: 10.1016/j.jpainsymman.2013.07.015
PMID: 24246788 [Indexed for MEDLINE]


4622. J Palliat Med. 2013 Dec;16(12):1602-9. doi: 10.1089/jpm.2013.0211. Epub 2013 Nov 
16.

The impact on the family carer of motor neurone disease and intervention with 
noninvasive ventilation.

Baxter SK(1), Baird WO, Thompson S, Bianchi SM, Walters SJ, Lee E, Ahmedzai SH, 
Proctor A, Shaw PJ, McDermott CJ.

Author information:
(1)1 School of Health and Related Research, University of Sheffield , Sheffield, 
United Kingdom .

BACKGROUND: The diagnosis of motor neurone disease (MND) has a profound effect 
on the functioning and well-being of both the patient and their family, with 
studies describing an increase in carer burden and depression as the disease 
progresses.
AIM: This study aimed to assess whether patient use of noninvasive ventilation 
(NIV) impacted on their family carer, and to explore other sources of carer 
burden.
DESIGN: The study used qualitative interviews and scaled measures of carer 
health and well-being completed at three monthly intervals until patient end of 
life.
PARTICIPANTS: Sixteen family carers were followed up over a period ranging from 
one month to two years.
RESULTS: NIV was perceived as having little impact on carer burden. The data 
however highlighted a range of sources of other burdens relating to the physical 
strain of caring. The Medical Outcomes Study Short Form (SF-36 Health Survey) 
Physical Component Summary (PCS) scores were considerably below that of the 
Mental Component Summary (MCS) score at baseline and at all following time 
points. Carers described the physical effort associated with patient care and 
role change; the challenge inherent in having time away; and problems relating 
to the timing of equipment and service delivery.
CONCLUSIONS: NIV can be recommended to patients without concerns regarding 
increasing carer burden. The predominant source of burden described related to 
the physical impact of caring for a patient with MND. Services face challenges 
if this physical burden is to be reduced by providing equipment at an optimal 
time and successfully coordinating their input.

DOI: 10.1089/jpm.2013.0211
PMCID: PMC3868397
PMID: 24236958 [Indexed for MEDLINE]


4623. Am J Occup Ther. 2013 Nov-Dec;67(6):692-700. doi: 10.5014/ajot.2013.007682.

Art-based occupation group reduces parent anxiety in the neonatal intensive care 
unit: a mixed-methods study.

Mouradian LE(1), DeGrace BW, Thompson DM.

Author information:
(1)Laurie E. Mouradian, ScD, ATR, OTR/L, is Associate Professor and Program 
Director, School of Occupational Therapy, Husson University, 1 College Circle, 
Bangor, ME 04401; Mouradianl@Husson.edu. At the time of the study, she was 
Program Director, Oklahoma Infant Transition Program, and Co-Director, Sooner 
Newborn Individualized Developmental Care and Assessment Program Training 
Center, University of Oklahoma Health Sciences Center, Oklahoma City.

OBJECTIVE: We examined whether an art-based occupation group using scrapbooking 
in the neonatal intensive care unit (NICU) would reduce parent stress, 
operationalized as anxiety. We also wanted to understand the parents' lived 
experience of the group.
METHOD: Forty parents from a Level 3 NICU in a large metropolitan hospital 
participated. We administered the State-Trait Anxiety Inventory preactivity and 
postactivity along with a brief interview.
RESULTS: The decline in parents' mean state anxiety (12.7 points, SD = 11.8; p < 
.0001) was clinically significant. The decline in mean trait anxiety (2.6 
points, SD = 5.2; p = .0036) was statistically significant but not clinically 
meaningful. Parents said that participation offered distraction and engagement, 
pleasure, relaxation, a sense of hope, and an opportunity to share.
CONCLUSION: An art-based occupation group using scrapbooking was an effective 
brief intervention to reduce parent anxiety in the neonatal intensive care unit; 
parent interviews suggested that participation has broad clinical implications 
for parent well-being.

Copyright © 2013 by the American Occupational Therapy Association, Inc.

DOI: 10.5014/ajot.2013.007682
PMID: 24195903 [Indexed for MEDLINE]


4624. Acta Paediatr. 2013 Dec;102(12):e539-45. doi: 10.1111/apa.12393. Epub 2013 Sep 
30.

Factors associated with feeding difficulties in the very preterm infant.

Crapnell TL(1), Rogers CE, Neil JJ, Inder TE, Woodward LJ, Pineda RG.

Author information:
(1)Program in Occupational Therapy, Washington University School of Medicine, 
St. Louis, MO, USA.

Comment in
    Acta Paediatr. 2016 Oct;105(10 ):1123-4.

AIM: To investigate early medical and family factors associated with later 
feeding risk in preterm infants.
METHODS: For this longitudinal study, 136 infants born ≤30 weeks gestation were 
enrolled. Medical and social background factors were assessed at term equivalent 
age. Infants underwent magnetic resonance imaging, neurobehavioral evaluation 
and feeding assessment. Parent involvement in the neonatal intensive care unit 
was tracked, and maternal mental health was assessed at neonatal intensive care 
unit discharge. At age 2 years, feeding outcome was assessed using the Eating 
Subscale of the Infant-Toddler Social Emotional Assessment (n = 80). 
Associations between feeding problems at age 2 years and (i) early medical 
factors, (ii) neurobehavioral functioning and feeding at term equivalent age, 
(iii) cerebral structure and (iv) maternal mental health were investigated using 
regression.
RESULTS: Eighteen (23%) children had feeding problems at age 2 years. Feeding 
problems were associated with early hypotonia (p = 0.03; β = 0.29) and lower 
socio-economic status (p = 0.046; β = -0.22). No associations were observed 
between early medical factors, early feeding performance, cerebral structure 
alterations or maternal well-being and feeding outcome.
CONCLUSION: Early hypotonia may disrupt the development of oral-motor skills. 
Hypotonia and poor feeding also may share a common aetiology. Associations with 
lower socio-economic status highlight the potential influence of family 
background factors in feeding problems in the preterm infant.

©2013 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

DOI: 10.1111/apa.12393
PMCID: PMC3873367
PMID: 23952198 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest: There are no conflicts of 
interest to report.


4625. J Perinatol. 2013 Dec;33(12):924-8. doi: 10.1038/jp.2013.93. Epub 2013 Aug 15.

Emotional distress in mothers of preterm hospitalized infants: a feasibility 
trial of nurse-delivered treatment.

Segre LS(1), Chuffo-Siewert R, Brock RL, O'Hara MW.

Author information:
(1)College of Nursing, University of Iowa, Iowa City, IA, USA.

OBJECTIVE: Mothers of preterm infants in a hospital neonatal intensive care unit 
(NICU) are at risk for clinically significant depression and anxiety, but for 
these women their own treatment is likely a secondary priority. This study 
evaluated the feasibility, acceptability and effectiveness of an evidence-based, 
nurse-delivered, on-site depression treatment: listening visits (LVs).
STUDY DESIGN: Therapeutic LVs were delivered on site to 23 distressed mothers of 
NICU infants. The intervention was conducted by a neonatal nurse practitioner 
and the outcome was examined in an open-trial, pre-post evaluation.
RESULT: A part-time nurse practitioner delivered six LVs to each participant 
within a 1-month time frame. LVs were associated with significantly improved 
mood and well-being in mothers. The majority of eligible women took advantage of 
LVs and felt satisfied with their care.
CONCLUSION: This open trial provides 'proof-of-concept', with results that 
warrant further evaluation in a multisite randomized controlled trial.

DOI: 10.1038/jp.2013.93
PMCID: PMC3838439
PMID: 23949835 [Indexed for MEDLINE]


4626. J Trauma Acute Care Surg. 2013 Jul;75(1):179-84. doi: 
10.1097/ta.0b013e3182984a7d.

Does caring for trauma patients lead to psychological stress in surgeons?

Warren AM(1), Jones AL, Shafi S, Roden-Foreman K, Bennett MM, Foreman ML.

Author information:
(1)Division of Trauma, Baylor University Medical Center, Dallas, Texas 75246, 
USA. annmariw@baylorhealth.edu

BACKGROUND: Symptoms identical to posttraumatic stress disorder (PTSD) have been 
shown to occur in caregivers of trauma patients. Secondary traumatic stress 
(STS) characterizes those who exhibit PTSD symptoms related to indirect exposure 
to a stressor. We hypothesized that caring for trauma patients is associated 
with symptoms of PTSD/STS.
METHODS: Surgeons in various specialties (n = 133) were surveyed from January to 
May 2012 at two regional surgical conferences. Symptoms of PTSD were identified 
using the Secondary Traumatic Stress Scale (STSS) using specific diagnostic 
criteria to measure the psychological impact of exposure to trauma patients. 
Resilience was measured using the Connor-Davidson Resilience Scale 10 items. The 
amount of time caring for trauma patients was used as a measure of risk 
exposure. The relationship between STSS, resilience, and exposure to trauma 
patients was measured with p < 0.05 considered significant.
RESULTS: Twenty-eight surgeons (22%) met diagnostic symptom criteria for PTSD as 
measured by the STSS. Approximately two thirds of the surgeons (86 of 133, 65%) 
exhibited at least one symptom of STS. However, the magnitude of exposure to 
trauma patients was similar between surgeons with and without PTSD symptoms (p = 
0.2177). Higher resilience scores were associated with lower STS scores (r = 
-0.369, p < 0.0001). Most importantly, surgeons who met symptom criteria for 
PTSD exhibited significantly lower resilience scores (31 [3.4] vs. 34 [3.9], p < 
0.0001).
CONCLUSION: Symptoms of PTSD as measured by the STSS were reported in two thirds 
of study participants but did not correlate with time spent for caring for 
trauma patients. One in five reported symptoms consistent with a PTSD. Lower 
resilience scores correlated with risk of symptoms and may be used to identify 
those surgeons most at risk. Efforts to better identify, address, and moderate 
these psychological consequences of surgical care may improve both the emotional 
well-being and the vocational performance of surgeons.

DOI: 10.1097/ta.0b013e3182984a7d
PMID: 23940866 [Indexed for MEDLINE]


4627. Ann Intensive Care. 2013 Jul 1;3(1):19. doi: 10.1186/2110-5820-3-19.

How caregivers view patient comfort and what they do to improve it: a French 
survey.

Lombardo V(1), Vinatier I, Baillot ML, Franja V, Bourgeon-Ghittori I, Dray S, 
Jeune S, Mossadegh C, Reignier J, Souweine B, Roch A; Société de Réanimation de 
Langue Française (SRLF).

Author information:
(1)The Nurses' board of the Société de Réanimation de Langue Française (SRLF), 
Paris, France. antoine.roch@ap-hm.fr.

BACKGROUND: Intensive care unit (ICU) patients are exposed to many sources of 
discomfort. Most of these are related to the patient's condition, but ICU design 
or how care is organized also can contribute. The present survey was designed to 
describe the opinions of ICU caregivers on sources of patient discomfort and to 
determine how they were dealt with in practice. The architectural and 
organizational characteristics of ICUs also were analyzed in relation to patient 
comfort.
METHODS: An online, closed-ended questionnaire was developed. ICU caregivers 
registered at the French society of intensive care were invited to complete this 
questionnaire.
RESULTS: A total of 915 staff members (55% nurses) from 264 adult and 28 
pediatric ICUs completed the questionnaire. Analysis of the answers reveals 
that: 68% of ICUs had only single-occupancy rooms, and 66% had natural light in 
each room; ICU patients had access to television in 59% of ICUs; a clock was 
present in each room in 68% of ICUs. Visiting times were <4 h in 49% of adult 
ICUs, whereas 64% of respondents considered a 24-h policy to be very useful or 
essential to patients' well-being. A nurse-driven analgesia protocol was 
available in 42% of units. For caregivers, the main sources of patient 
discomfort were anxiety, feelings of restraint, noise, and sleep disturbances. 
Paramedics generally considered discomfort related to thirst, lack of privacy, 
and the lack of space and time references, whereas almost 50% of doctors ignored 
these sources of discomfort. Half of caregivers indicated they assessed sleep 
quality. A minority of caregivers declared regular use of noise-reduction 
strategies. Twenty percent of respondents admitted to having non-work-related 
conversations during patient care, and only 40% indicated that care often was or 
always was provided without closing doors. Family participation in care was 
planned in very few adult ICUs.
CONCLUSIONS: Results of this survey showed that ICUs are poorly equipped to 
ensure patient privacy and rest. Access by loved ones and their participation in 
care also is limited. The data also highlighted that some sources of discomfort 
are less often taken into account by caregivers, despite being considered to 
contribute significantly.

DOI: 10.1186/2110-5820-3-19
PMCID: PMC3700816
PMID: 23815804


4628. Zh Mikrobiol Epidemiol Immunobiol. 2013 Mar-Apr;(2):112-20.

[Intestinal-brain axis. Neuronal and immune-inflammatory mechanisms of brain and 
intestine pathology].

[Article in Russian]

Bondarenko VM, Riabichenko EV.

Mutually directed connections between intestine and brain are implemented by 
endocrine, neural and immune systems and nonspecific natural immunity. Intestine 
micro flora as an active participant of intestine-brain axis not only influences 
intestine functions but also stimulates the development of CNS in perinatal 
period and interacts with higher nervous centers causing depression and 
cognitive disorders in pathology. A special role belongs to intestine microglia. 
Apart from mechanic (protective) and trophic functions for intestine neurons, 
glia implements neurotransmitter, immunologic, barrier and motoric functions in 
the intestine. An interconnection between intestine barrier function and 
hematoencephalic barrier regulation exists. Chronic endotoxinemia as a result of 
intestine barrier dysfunction forms sustained inflammation state in 
periventricular zone of the brain with consequent destabilization of 
hematoencephalic barriers and spread oF inflammation to other parts of the brain 
resulting in neurodegradation development.

PMID: 23805681 [Indexed for MEDLINE]


4629. Postepy Hig Med Dosw (Online). 2013 May 13;67:402-12. doi: 
10.5604/17322693.1049285.

[Surface proteins of bacteria of the genus Bifidobacterium].

[Article in Polish]

Dylus E(1), Buda B, Górska-Frączek S, Brzozowska E, Gamian A.

Author information:
(1)Instytut Immunologii i Terapii Doświadczalnej im L. Hirszfelda, Polskiej 
Akademii Nauk we Wrocławiu.

Beneficial effects due to the presence of probiotic bacteria of the genus 
Bifidobacterium in the human intestinal tract are still an interesting object of 
study. So far activities have been confirmed of bifidobacteria in stimulation of 
the host immune system, stimulation of tumor cell apoptosis, improvement of 
bowel motility, alleviation of symptoms of lactose intolerance, cholesterol 
lowering capacity, prevention and treatment of diarrhea and irritable bowel 
syndrome, alleviation of allergy or atopic dermatitis, maintenance of 
homeostasis of the intestine, and stimulation of the development of normal 
intestinal microflora in infants. A multitude of therapeutic properties 
encourages researchers to investigate the possibility of using the potential of 
Bifidobacterium in the prevention and treatment of other conditions such as 
rheumatoid arthritis and depression. Although it is known that the beneficial 
effects are due to intestinal mucosal colonization by these bacteria, the cell 
components responsible for the colonization are still not determined. In 
addition to the beneficial effects of probiotic administration, there were also 
negative effects including sepsis. Therefore research has been directed to 
identify specific components of Bifidobacterium responsible for probiotic 
effects. Currently researchers are focused on identifying, isolating and 
evaluating the properties of surface proteins that are probably involved in the 
adhesion of bacterial cells to the intestinal epithelium, improving 
colonization. This paper is an overview of current knowledge on Bifidobacterium 
surface proteins. The ways of transport and anchoring proteins in Gram-positive 
bacterial cells, the assembly of cell wall, and a description of the genus 
Bifidobacterium are presented.

DOI: 10.5604/17322693.1049285
PMID: 23756375 [Indexed for MEDLINE]


4630. JAMA Pediatr. 2013 Jun;167(6):544-8. doi: 10.1001/jamapediatrics.2013.1379.

Impact of specific medical interventions in early childhood on increasing the 
prevalence of later intellectual disability.

Brosco JP(1), Sanders LM, Dowling M, Guez G.

Author information:
(1)Department of Pediatrics, University of Miami Miller School of Medicine, 
Miami, FL, USA. jbrosco@miami.edu

IMPORTANCE: For the past 100 years, medicine in industrialized nations has 
become increasingly focused on specific medical interventions designed to 
improve the health of individual patients. Substantial evidence suggests that 
broader improvements in public health, nutrition, and economic well-being are 
more salient than medical or surgical interventions for the remarkable decrease 
in infant and child deaths since 1900. Less is known about the impact of 
specific medical interventions on morbidity such as intellectual disability 
(ID).
OBJECTIVE: To explore the impact of medical interventions in early childhood on 
increasing the prevalence of later ID, as reported in the literature from 1950 
through 2000.
DESIGN: We reviewed the medical literature and other data from 1950 through 2000 
to construct estimates of the condition-specific prevalence of ID over time. We 
further explored the existing literature to document historically relevant 
influences on condition-specific prevalence, including the introduction of 
effective interventions, the timing of these introductions, and the likelihood 
of their widespread use.
SETTING: Twentieth century United States and Western Europe.
PARTICIPANTS: Populations of children who received a life-saving intervention 
within the first 5 years of life and were evaluated for ID after 5 years of age.
MAIN OUTCOME MEASURES: Case-specific prevalence of ID from 1950 through 2000.
RESULTS: Low birth weight is associated with approximately 10% to 15% of the 
total prevalence of ID. No other new medical therapies introduced during this 
period were associated with a clinically significant increase in ID prevalence.
CONCLUSIONS AND RELEVANCE: Previous research has shown that specific medical 
interventions, such as newborn screening for congenital thyroid deficiency and 
phenylketonuria, have decreased the prevalence of ID approximately 16% in the 
United States since 1950. These results suggest that other medical 
interventions, particularly the advent of intensive care technologies, have also 
increased the prevalence of ID.

DOI: 10.1001/jamapediatrics.2013.1379
PMID: 23699900 [Indexed for MEDLINE]


4631. J Burn Care Res. 2013 Mar-Apr;34(2):249-54. doi: 10.1097/BCR.0b013e318283d175.

Impact of a nursing-driven sleep hygiene protocol on sleep quality.

Faraklas I(1), Holt B, Tran S, Lin H, Saffle J, Cochran A.

Author information:
(1)Burn Center at the University of Utah, University of Utah Health Sciences 
Center, Salt Lake City, USA.

The purpose of this study was to evaluate the impact on sleep quality of a 
nursing-driven sleep hygiene protocol (SHP) instituted in a single burn-trauma 
intensive care unit. Criteria for eligibility were adult patients admitted to 
the Burn Service who were not delirious, able to respond verbally, and had not 
received general anesthesia in the prior 24 hours. Patients were surveyed using 
the validated Richards-Campbell Sleep Questionnaire prior to implementation 
("PRE"; May to December 2010) and following implementation ("POST"; January to 
August 2011) of a SHP that sought to minimize environmental stimuli and limit 
disruptions during the night. This analysis includes only initial survey 
responses from each patient. A total of 130 patients were surveyed, 81 PRE and 
49 POST; 60% were burn admissions. There was no significant difference in 
responses to the questionnaire between burn and nonburn patients. All patients 
in the POST group were significantly older and more frequently endorsed taking 
sleep medication at home. Although not significant, POST patients reported 
falling asleep somewhat more quickly, but no other differences were identified 
between the two groups. Among patients who reported having sleep difficulties 
prior to admission, POST patients not only reported a significantly higher pain 
score than PRE patients, but also reported significant improvement in falling 
asleep and being able to go back to sleep. Frequency of complaints of sleep 
disruption was unchanged between PRE and POST patients. POST patients did 
complain significantly less than PRE patients about sleep disruptions by 
clinicians. Implementation of the SHP permitted acutely injured or ill patients 
in our intensive care unit to fall asleep more quickly and to experience fewer 
sleep disruptions. A sleep protocol may be helpful in improving sleep and 
overall well-being of burn center patients.

DOI: 10.1097/BCR.0b013e318283d175
PMID: 23412331 [Indexed for MEDLINE]


4632. Hematology Am Soc Hematol Educ Program. 2012;2012:290-1. doi: 
10.1182/asheducation-2012.1.290.

What is the evidence that hydroxyurea improves health-related quality of life in 
patients with sickle cell disease?

Darbari DS(1), Panepinto JA.

Author information:
(1)Division of Hematology, Center for Cancer and Blood Disorders, Children's 
National Medical Center, Washington, DC 20010, USA. ddarbari@cnmc.org

A 10-year-old male patient with homozygous sickle cell disease presents for a 
follow-up clinic visit after a recent hospitalization for a painful 
vasoocclusive event. His parents mention that in the past year he has had 4 
hospitalizations for vasoocclusive events, 2 of which were complicated by the 
development of acute chest syndrome that resulted in transfer to the intensive 
care unit. He has missed many school days and may be retained a grade this year. 
He feels particularly sad about missing the school field trip that occurred 
during his last hospitalization. He also reports that he is not able to keep up 
with his friends when participating in physical activities at school. The 
child's parents are worried that he may be depressed. You as the provider 
discuss the option of hydroxyurea therapy. His parents ask if hydroxyurea would 
improve his overall well-being and functioning.

DOI: 10.1182/asheducation-2012.1.290
PMID: 23233594 [Indexed for MEDLINE]


4633. J Trauma Nurs. 2012 Jul-Sep;19(3):190-4. doi: 10.1097/JTN.0b013e318261d041.

Challenges in conducting research after family presence during resuscitation.

Leske JS(1), McAndrew NS, Evans CR, Garcia AE, Brasel KJ.

Author information:
(1)College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, 
USA. jsl@uwm.edu

Family presence during resuscitation (FPDR) is an option occurring in clinical 
practice. National clinical guidelines on providing the option of FPDR are 
available from the American Association of Critical-Care Nurses, American Heart 
Association, Emergency Nurses Association, and Society of Critical Care 
Medicine. The FPDR option currently remains controversial, underutilized, and 
not the usual practice with trauma patients. This article is based on the 
methodological and practical research challenges associated with an ongoing 
study to examine the effects of the FPDR option on family outcomes in patients 
experiencing critical injury after motor vehicle crashes and gunshot wounds. The 
primary aim of this study was to examine the effects of the FPDR option on 
family outcomes of anxiety, stress, well-being, and satisfaction and compare 
those outcomes in families who participate in FPDR to those families who do not 
participate in FPDR. Examples of real clinical challenges faced by the 
researchers are described throughout this article. Research challenges include 
design, sampling, inclusion/exclusion criteria, human subjects, and procedures. 
Recruitment of family members who participated in the FPDR option is a complex 
process, especially after admission to the critical care unit.

DOI: 10.1097/JTN.0b013e318261d041
PMID: 22955717 [Indexed for MEDLINE]


4634. Br J Psychiatry. 2012 Sep;201(3):239-46. doi: 10.1192/bjp.bp.111.098970. Epub 
2012 Jul 12.

Morale in the English mental health workforce: questionnaire survey.

Johnson S(1), Osborn DP, Araya R, Wearn E, Paul M, Stafford M, Wellman N, Nolan 
F, Killaspy H, Lloyd-Evans B, Anderson E, Wood SJ.

Author information:
(1)Mental Health Sciences Unit, University College London, Charles Bell House, 
67-73 Riding House Street, London W1W 7EY, UK. s.johnson@ucl.ac.uk

Comment in
    Br J Psychiatry. 2012 Sep;201(3):178-9.

BACKGROUND: High-quality evidence on morale in the mental health workforce is 
lacking.
AIMS: To describe staff well-being and satisfaction in a multicentre UK National 
Health Service (NHS) sample and explore associated factors.
METHOD: A questionnaire-based survey (n = 2258) was conducted in 100 wards and 
36 community teams in England. Measures included a set of frequently used 
indicators of staff morale, and measures of perceived job characteristics based 
on Karasek's demand-control-support model.
RESULTS: Staff well-being and job satisfaction were fairly good on most 
indicators, but emotional exhaustion was high among acute general ward and 
community mental health team (CMHT) staff and among social workers. Most morale 
indicators were moderately but significantly intercorrelated. Principal 
components analysis yielded two components, one appearing to reflect emotional 
strain, the other positive engagement with work. In multilevel regression 
analyses factors associated with greater emotional strain included working in a 
CMHT or psychiatric intensive care unit (PICU), high job demands, low autonomy, 
limited support from managers and colleagues, age under 45 years and junior 
grade. Greater positive engagement was associated with high job demands, 
autonomy and support from managers and colleagues, Black or Asian ethnic group, 
being a psychiatrist or service manager and shorter length of service.
CONCLUSIONS: Potential foci for interventions to increase morale include CMHTs, 
PICUs and general acute wards. The explanatory value of the 
demand-support-control model was confirmed, but job characteristics did not 
fully explain differences in morale indicators across service types and 
professions.

DOI: 10.1192/bjp.bp.111.098970
PMID: 22790677 [Indexed for MEDLINE]


4635. J Obstet Gynaecol. 2012 Jul;32(5):434-8. doi: 10.3109/01443615.2012.658892.

Clinical manifestations of obstructive sleep apnoea in pregnancy: more than 
snoring and witnessed apnoeas.

Bourjeily G(1), Barbara N, Larson L, He M.

Author information:
(1)Department of Medicine, The Miriam Hospital, Women's Medicine Collaborative 
of Lifespan, 146 West River Street, Providence, RI 02904, USA. 
ghada_bourjeily@brown.edu

Sleep disordered breathing and its symptoms have been associated with a 
multitude of fetal and maternal complications including gestational hypertensive 
disorders, gestational diabetes and possibly pre-term labour and other markers 
of alterations in fetal wellbeing. The disease remains underdiagnosed in the 
general population but likely also in pregnancy, mostly because providers do not 
appropriately screen for the disorder. Sleep disordered breathing may manifest 
differently in women, since women report more fatigue and less snoring than men 
do. This paper discusses typical presentations of sleep disordered breathing but 
also reports some less obvious presentations to help providers recognise those 
manifestations and screen for the disorder when warranted. Our case series 
describes patients with diagnoses such as chronic hypertension, pre-eclampsia, 
pulmonary hypertension, nocturnal asthma and panic attacks, who were diagnosed 
with sleep disordered breathing and offered treatment with CPAP during 
pregnancy.

DOI: 10.3109/01443615.2012.658892
PMID: 22663313 [Indexed for MEDLINE]


4636. Brain Inj. 2012;26(10):1192-200. doi: 10.3109/02699052.2012.672790. Epub 2012 
May 30.

Depression, anxiety and quality-of-life among relatives of patients with severe 
brain injury: the acute phase.

Norup A(1), Welling KL, Qvist J, Siert L, Mortensen EL.

Author information:
(1)Department of Neurorehabilitation, Traumatic Brain Injury Unit, Copenhagen 
University Hospital, Glostrup, Denmark. anne.norup@hvh.regionh.dk

PRIMARY OBJECTIVE: To investigate the emotional well-being of relatives of 
patients with a severe brain injury in the acute setting, as well as risk 
factors associated with high anxiety and depression scores and impaired 
quality-of-life.
RESEARCH DESIGN: Clinical convenience sample.
METHODS AND PROCEDURES: Participants included 45 relatives of patients with 
severe brain injury recruited at a NICU. All relatives completed selected scales 
from the SCL-90-R and SF-36 ∼ 14 days after injury. Data concerning the 
condition of the patient were also collected.
MAIN OUTCOME AND RESULTS: Of the relatives, 51% and 69% reported anxiety and 
depression, respectively, as well as significantly impaired quality-of-life 
compared to normal reference populations. Regression analysis revealed that up 
to 20% of the variance in depression and anxiety scores could be explained by 
the CRASH 2 Mortality prediction.
CONCLUSIONS: The majority of the relatives had severely impaired quality-of-life 
and symptoms of anxiety and depression during the patient's NICU stay. Future 
research is required to explore stressors and evaluate effects of psychological 
intervention in the acute setting.

DOI: 10.3109/02699052.2012.672790
PMID: 22646665 [Indexed for MEDLINE]


4637. Crit Care Med. 2012 Jul;40(7):2033-40. doi: 10.1097/CCM.0b013e31824e1b43.

Impact of an intensive care unit diary on psychological distress in patients and 
relatives*.

Garrouste-Orgeas M(1), Coquet I, Périer A, Timsit JF, Pochard F, Lancrin F, 
Philippart F, Vesin A, Bruel C, Blel Y, Angeli S, Cousin N, Carlet J, Misset B.

Author information:
(1)Medical ICU, Saint Joseph Hospital Network, Paris, France. mgarrouste@hpsj.fr

Comment in
    Crit Care Med. 2012 Jul;40(7):2231-2.

OBJECTIVE: To assess the impact of an intensive care unit diary on the 
psychological well-being of patients and relatives 3 and 12 months after 
intensive care unit discharge.
DESIGN: Prospective single-center study with an intervention period between two 
control periods.
SETTING: Medical-surgical intensive care unit in a 460-bed tertiary hospital.
PATIENTS: Consecutive patients from May 2008 to November 2009 and their 
relatives. Study inclusion occurred after the fourth day in the intensive care 
unit.
INTERVENTIONS: A diary written by both the patient's relatives and the intensive 
care unit staff.
MEASUREMENTS AND MAIN RESULTS: Patients and relatives completed the Hospital 
Anxiety and Depression Scale and Peritraumatic Dissociative Experiences 
Questionnaire 3 months after intensive care unit discharge, and completed the 
Impact of Events Scale assessing posttraumatic stress-related symptoms 12 months 
after intensive care unit discharge. Of the 378 patients admitted during the 
study period, 143 were included (48 in the prediary period, 49 in the diary 
period, and 46 in the postdiary period). In relatives, severe posttraumatic 
stress-related symptoms after 12 months varied significantly across periods 
(prediary 80%, diary 31.7%, postdiary 67.6%; p<.0001). Similar results were 
obtained in the posttraumatic stress-related symptom score after 12 months in 
the surviving patients (prediary 34.6 ± 15.9, diary 21 ± 12.2, and postdiary 
29.8 ± 15.9; p = .02).
CONCLUSIONS: The intensive care unit diary significantly affected posttraumatic 
stress-related symptoms in relatives and surviving patients 12 months after 
intensive care unit discharge.

DOI: 10.1097/CCM.0b013e31824e1b43
PMID: 22584757 [Indexed for MEDLINE]


4638. Int J Ment Health Nurs. 2012 Jun;21(3):248-58. doi: 
10.1111/j.1447-0349.2012.00822.x.

Meeting the physical health-care needs of people with substance misuse problems: 
evaluation of a nurse-led blood-borne virus programme.

Callaghan P(1), Phillips P, Khalil E, Carter T.

Author information:
(1)School of Nursing, Midwifery and Physiotherapy, University of Nottingham, 
Nottingham, UK. patrick.callaghan@nottingham.ac.uk

People who inject substances are at high risk of many physical health problems. 
The Blood-Borne Virus Programme (BBVP) is a nurse-led health screening programme 
for blood-borne conditions in substance misusers. The aim of this study was to 
evaluate the service delivery, organization, and outcomes of the BBVP. The 
researchers used a case study with three units of analysis: BBVP clinical 
activities during 1 year using a prospective audit; service users' (n = 20) and 
professional stakeholders' (n = 10) experiences of the BBVP using semistructured 
interviews; and service users' (n = 132) satisfaction with the BBVP using a 
satisfaction measure. The BBVP conducted 4450 consultations with 1940 service 
users; 847 of whom were new, and presented with many health problems 
compromising their physical health. The BBVP provided a range of interventions 
meeting its users' physical health needs. Users and other stakeholders were very 
satisfied with the service, and suggested ways in which the service might 
improve. The BBVP appeared to meet the physical health-care needs of people 
dependent on drugs. Nurse-led services, such as the BBVP, offer a solution that, 
in the view of users and professional stakeholders, is impacting significantly 
on the physical health and well-being of people dependent on drugs.

© 2012 The Authors. International Journal of Mental Health Nursing © 2012 
Australian College of Mental Health Nurses Inc.

DOI: 10.1111/j.1447-0349.2012.00822.x
PMID: 22533332 [Indexed for MEDLINE]


4639. Crit Care Nurs Clin North Am. 2012 Mar;24(1):149-56. doi: 
10.1016/j.ccell.2012.01.009. Epub 2012 Jan 31.

The stigma of a psychiatric diagnosis: prevalence, implications and nursing 
interventions in clinical care settings.

Farley-Toombs C(1).

Author information:
(1)Strong Memorial Hospital, Rochester, NY 14642, USA. 
Carole_Farleytoombs@urmc.rochester.edu

The stigma associated with psychiatric and substance abuse disorders is a 
formidable barrier to the achievement of health and well-being for persons who 
carry such a diagnosis or who exhibit symptoms. Attitudes of nurses and 
treatment providers toward patients with comorbid psychiatric and substance 
abuse disorders can be influenced by stigma, which can have a negative impact on 
the therapeutic process and development of trust necessary to support good 
patient outcomes. Understanding the interrelated components of stigma, including 
labeling, stereotypes, and discrimination, can help nurses to reduce its impact 
in clinical care settings to improve the care experience for patients and 
nurses. Implementing interventions based on the core values of the nurse-patient 
relationship to enhance understanding, mutual trust, and acceptance of 
differences can contribute to improved communication and patient assessments in 
an effort to improve patient outcomes.

DOI: 10.1016/j.ccell.2012.01.009
PMID: 22405719 [Indexed for MEDLINE]


4640. Soc Sci Med. 2012 Apr;74(7):958-65. doi: 10.1016/j.socscimed.2011.12.030. Epub 
2012 Feb 2.

Stress and health-related well-being among mothers with a low birth weight 
infant: the role of sleep.

Lee SY(1), Hsu HC.

Author information:
(1)Byrdine F. Lewis School of Nursing, Georgia State University, P.O. Box 4019, 
Atlanta, GA 30302-4019, USA. slee29@gsu.edu

This U.S.A.-based study examined the quantitative and qualitative 
characteristics of sleep, as well as the role of sleep, in the association of 
stress with depression, fatigue, and health-related quality of life (H-QOL) 
among mothers with a low-birth-weight, preterm infant in the neonatal intensive 
care unit at early postpartum. Fifty-five first-time mothers kept a sleep diary 
and filled out a battery of questionnaires. The wrist actigraphy method was also 
applied to collect information on maternal sleep. We tested a path model, with 
sleep disturbance and depression mediating the effect of stress on 
health-related well-being. Results showed that the majority of the study 
participants were stressed, depressed, fatigued, and at risk for poor physical 
and mental health. Poor sleep quality as perceived by mothers was significantly 
associated with their stress, fatigue, and poor mental and physical H-QOL. A 
cascading effect was found in the path model where maternal stress contributed 
to poor sleep quality and depression, which in turn contributed to poor mental 
H-QOL. In addition, poor sleep quality was associated with fatigue, which in 
turn contributed to poor physical and mental H-QOL. The underlying 
neurobiological mechanisms through which sleep affects the stress-health 
relation are discussed. The implications of sleep for intervention and 
prevention are also addressed.

Published by Elsevier Ltd.

DOI: 10.1016/j.socscimed.2011.12.030
PMCID: PMC3464912
PMID: 22342365 [Indexed for MEDLINE]


4641. BMC Pediatr. 2012 Feb 7;12:14. doi: 10.1186/1471-2431-12-14.

Family nurture intervention (FNI): methods and treatment protocol of a 
randomized controlled trial in the NICU.

Welch MG(1), Hofer MA, Brunelli SA, Stark RI, Andrews HF, Austin J, Myers MM; 
Family Nurture Intervention (FNI) Trial Group.

Collaborators: Afifi L, Bateman DA, Beatrice S B, Carnazza KE, Chang CY, Farrell 
PA, Ewelina S F, Fifer WP, Grieve P, Hane AA, Jaffe J, Johnson JG, Karim Q, 
Kofman S, Koukaz YA, Lorenz JM, Ludwig RJ, McKiernan MT, Merle D, Polin RS, 
Sahni R.

Author information:
(1)Department of Psychiatry, College of Physicians & Surgeons, 1051 Riverside 
Drive, Unit 40, New York, NY,10032, USA. mgw13@columbia.edu

Erratum in
    BMC Pediatr. 2012;12:107.

BACKGROUND: The stress that results from preterm birth, requisite acute care and 
prolonged physical separation in the Neonatal Intensive Care Unit (NICU) can 
have adverse physiological/psychological effects on both the infant and the 
mother. In particular, the experience compromises the establishment and 
maintenance of optimal mother-infant relationship, the subsequent development of 
the infant, and the mother's emotional well-being. These findings highlight the 
importance of investigating early interventions that are designed to overcome or 
reduce the effects of these environmental insults and challenges.
METHODS: This study is a randomized controlled trial (RCT) with blinded 
assessment comparing Standard Care (SC) with a novel Family Nurture Intervention 
(FNI). FNI targets preterm infants born 26-34 weeks postmenstrual age (PMA) and 
their mothers in the NICU. The intervention incorporates elements of 
mother-infant interventions with known efficacy and organizes them under a new 
theoretical context referred to collectively as calming activities. This 
intervention is facilitated by specially trained Nurture Specialists in three 
ways: 1) In the isolette through calming interactions between mother and infant 
via odor exchange, firm sustained touch and vocal soothing, and eye contact; 2) 
Outside the isolette during holding and feeding via the Calming Cycle; and 3) 
through family sessions designed to engage help and support the mother. In 
concert with infant neurobehavioral and physiological assessments from birth 
through 24 months corrected age (CA), maternal assessments are made using 
standard tools including anxiety, depression, attachment, support systems, 
temperament as well as physiological stress parameters. Quality of mother-infant 
interaction is also assessed. Our projected enrolment is 260 families (130 per 
group).
DISCUSSION: The FNI is designed to increase biologically important activities 
and behaviors that enhance maternally-mediated sensory experiences of preterm 
infants, as well as infant-mediated sensory experiences of the mother. 
Consequently, we are enlarging the testing of preterm infant neurodevelopment 
beyond that of previous research to include outcomes related to mother-infant 
interactions and mother-infant co-regulation. Our primary objective is to 
determine whether repeated engagement of the mother and her infant in the 
intervention's calming activities will improve the infant's developmental 
trajectory with respect to multiple outcomes. Our secondary objective is to 
assess the effectiveness of FNI in the physiological and psychological 
co-regulation of the mother and infant. We include aspects of neurodevelopment 
that have not been comprehensively measured in previous NICU interventions.
TRIAL REGISTRATION: ClinicalTrials.gov: NCT01439269.

DOI: 10.1186/1471-2431-12-14
PMCID: PMC3394087
PMID: 22314029 [Indexed for MEDLINE]


4642. Dimens Crit Care Nurs. 2012 Jan-Feb;31(1):37-45. doi: 
10.1097/DCC.0b013e31823a55b8.

Exploration of the association between professional interactions and emotional 
distress of intensive care unit nursing personnel.

Karanikola MN(1), Papathanassoglou ED, Kalafati M, Stathopoulou H.

Author information:
(1)Cyprus University of Technology-School of Nursing, Limassol. 
maria.karanikola@cut.ac.cy

: Several studies provide evidence for the association between the quality of 
collaboration among intensive care unit (ICU) professionals and patients' 
outcomes, as well as nurses' moral distress and professional satisfaction. 
However, potential associations between collaboration and nurses' mental health 
indices have not been explored. The aim of this descriptive correlational study 
was to investigate the degree of satisfaction from interaction among ICU nursing 
personnel, as well as between ICU nursing personnel and physicians, and 
potential associations with ICU nursing personnel's anxiety symptoms. The sample 
consisted of ICU nursing personnel from 11 adult general hospitals in Greece (n 
= 229). Hamilton's Anxiety scale was applied for the quantitative assessment of 
anxiety symptoms and Stamps' Index of Work Satisfaction for the appraisal of 
nursing personnel's satisfaction from professional interactions. Demographic, 
vocational, and educational data were also recorded. Descriptive statistics were 
explored, and group comparisons, correlation, and regression analysis were used. 
The average satisfaction score from interaction among nursing personnel was 
moderate to high (5.3 [SD, 1.0]) and from nurse-to-physician interaction was 
moderate (4.0 [SD, 1.4]) (scale range, 1-7). The score of satisfaction from 
nurse-to-physician interaction was negatively mildly correlated with 
participants' (a) total anxiety score (τ = -0.160, P = .001), (b) tension (τ = 
-0.125, P = .015), and (c) depressive symptoms (τ = -0.148, P = .005). Weak 
negative correlations were detected between satisfaction from interaction among 
nursing personnel and participants' (a) total anxiety state (τ = -0.139, P = 
.003), (b) tension (τ = -0.137, P = .008), and (c) sleep disturbances (τ = 
-0.150, P = .003). Overall, female respondents had higher levels of anxiety 
symptoms than male respondents (Mann-Whitney U, P = .007). Satisfaction from 
professional interaction was not a strong predictor of anxiety symptoms among 
ICU nursing personnel (R² = 0.046, ?0.15). Nursing personnel in Greek ICUs seem 
to be satisfied with the quality of relationships among them, as well as with 
physicians. Despite that anxiety symptoms associate with the degree of 
satisfaction from professional interaction, the latter may not be a significant 
indicator of ICU nurses' well-being. Further qualitative research is needed to 
identify mediating factors.

DOI: 10.1097/DCC.0b013e31823a55b8
PMID: 22156812 [Indexed for MEDLINE]


4643. Eksp Klin Gastroenterol. 2011;(5):42-7.

[Quality of life of patients with hyperendotoxemia after hemicolectomy].

[Article in Russian]

Li IA, Drozdov VN.

The concept of "health" is defined by the World Health Organization (WHO) as a 
state of complete physical, mental and social well-being and not merely the 
absence of disease. Currently, one of the most widely used questionnaires of 
general type is the SF-36 Health Status Survey, proposed the Boston Institute 
for Health and created on the basis of other already existing tools for 
assessing QOL. Translated into Russian and testing methodology was conducted by 
the Institute of clinical and pharmacological studies (St. Petersburg). Any 
surgical intervention, in particular the removal of part of the colon can lead 
to a restriction of all aspects (physical, mental and social) of a normal human 
life. The goal of treatment of any disease should be considered as improving the 
quality of life of the patient on a background of positive clinical dynamics, 
assessing the quality of life indicators, which depend on many external and 
internal factors.
AIM: to study the quality of life of patients after hemicolectomy, depending on 
the type of colon resection and the level of endotoxemia.
RESULTS: Analysis of quality of life of patients after undergoing 
surgery--hemicolectomy carried out using questionnaire SF-36 indicates a decline 
in general condition and mental health in patients after left-sided 
hemicolectomy. The study showed a close pathogenetic relationship between 
endotoxemia and decreased quality of life of patients after hemicolectomy.

PMID: 21916234 [Indexed for MEDLINE]


4644. J Acoust Soc Am. 2011 Sep;130(3):1348-58. doi: 10.1121/1.3607418.

Soundscape evaluations in two critical healthcare settings with different 
designs.

Okcu S(1), Ryherd EE, Zimring C, Samuels O.

Author information:
(1)College of Architecture, Georgia Institute of Technology, Atlanta, Georgia 
30332, USA. selen.okcu@gatech.edu

Intensive care units (ICUs) have important but challenging sound environments. 
Alarms and equipment generate high levels of noise and ICUs are typically 
designed with hard surfaces. A poor sound environment can add to stress and make 
auditory tasks more difficult for clinicians. However few studies have linked 
more detailed analyses of the sound environment to nurse wellbeing and 
performance. This study is aimed at understanding the relationships between 
objective acoustic measures and self-reported nurse outcomes. Two 20-bed ICUs 
with similar patient acuity and treatment models were tested: A recently built 
neurological ICU and a 1980s-era medical-surgical ICU. The medical-surgical ICU 
was perceived as louder, more annoying, and having a greater negative impact of 
noise on work performance, health outcomes, and anxiety as compared to the 
neurological ICU. Surprisingly, there were little differences between two ICU 
sound environments based on traditional overall noise measures. The objective 
differences between the occupied sound environments in the two units only 
emerged through a more comprehensive analysis of the "occurrence rate" of peak 
and maximum levels, frequency content, and the speech interference level. 
Furthermore, mid-level transient sound occurrence rates were significantly and 
positively correlated to perceived annoyance and loudness levels.

© 2011 Acoustical Society of America

DOI: 10.1121/1.3607418
PMID: 21895076 [Indexed for MEDLINE]


4645. Pain Manag Nurs. 2011 Sep;12(3):163-72. doi: 10.1016/j.pmn.2010.03.009. Epub 
2010 Sep 15.

Critical care nurses' experiences: "a good relationship with the patient is a 
prerequisite for successful pain relief management".

Lindberg JO(1), Engström Å.

Author information:
(1)Division of Nursing, Department of Health Science, Luleå University of 
Technology, Luleå, Sweden.

There is a lack of studies describing how critical care nurses experience 
assessing and treating pain in patients receiving postoperative care in an 
intensive care unit (ICU). The aim of this study was to describe those 
experiences. Qualitative personal interviews with six critical care nurses in an 
ICU in northern Sweden were conducted during 2009. The interview texts were 
subjected to qualitative content analysis, which resulted in the formulation of 
one theme and four categories. It was important to be able to recognize signs of 
pain in patients unable to communicate verbally. In older patients, anxiety 
could be interpreted as an indication of pain. Pain was primarily assessed by 
means of a visual analog scale. Being unable to treat pain successfully was 
experienced as failing in one's work. Pharmacologic treatment was always the 
first choice for relief. The environment was experienced as a hindrance to 
optimal nursing care, because all postoperative patients shared a room with only 
curtains between them. The work of assessing and treating pain in patients 
receiving postoperative care is an important and frequent task for critical care 
nurses, and knowledge in the field is essential if the patients are to receive 
optimal nursing care and treatment. Patients cared for in an ICU might benefit 
from nonpharmacologic treatment. Being without pain after surgery implies 
increased well-being and shorter hospitalization for the patient.

Copyright © 2011 American Society for Pain Management Nursing. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.pmn.2010.03.009
PMID: 21893305 [Indexed for MEDLINE]


4646. Internist (Berl). 2011 Aug;52(8):925-33. doi: 10.1007/s00108-011-2803-x.

[Geriatric assessment. Development, status quo and perspectives].

[Article in German]

Lüttje D(1), Varwig D, Teigel B, Gilhaus B.

Author information:
(1)Medizinische Klinik IV, Geriatrie und Palliativmedizin, Klinikum Osnabrück, 
Am Finkenhügel 1, 49076 Osnabrück. dieter.luettje@klinikum-os.de.

Multimorbidity is typical for geriatric patients. Problems not identified in 
time may lead to increased hospitalisation or prolonged hospital stay. Problems 
of multimorbidity are not covered by most guidelines or clinical pathways. The 
geriatric assessment supports standard clinical and technical assessment. 
Geriatric identification screening is basic for general practitioners and in 
emergency rooms to filter those patients bearing a special risk. Geriatric basic 
assessment covers most of the problems relevant for people in old age, revealing 
even problems that had so far been hidden. It permits to structure a 
comprehensive and holistic therapeutic approach and to evaluate the targets of 
treatment relevant for independent living and well-being. This results in 
reduction of morbidity and mortality. Assessment tools focusing on pain, 
nutrition and frailty should be added to the standardized geriatric basic 
assessment in Germany.

DOI: 10.1007/s00108-011-2803-x
PMID: 21750936 [Indexed for MEDLINE]


4647. Zh Mikrobiol Epidemiol Immunobiol. 2011 Jan-Feb;(1):79-82.

[Immunological and bacteriological monitoring of patients with pneumonia and 
influenza A/H1N1 infection].

[Article in Russian]

Shapovalov KG, Belokrinitskaia TE, Burdinskaia ZhS, Maliarchikov AV.

AIM: To study features of immune status and causative agents of severe pneumonia 
in patients with influenza A/H1N1.
MATERIALS AND METHODS: Fifty-seven isolates from 43 patients with pneumonia, 
which complicated pandemic influenza A/ H1N1 and treated in Chita city clinical 
hospital No.1 as well as 32 immunograms were retrospectively studied. Comparison 
of immunologic and epidemiologic status of patients with influenza A/ H1N1 
complicated by pneumonia was performed. Data on dynamics of epidemic process and 
outcomes are presented.
RESULTS: It was established that severe course of influenza A/H1N1 complicated 
by pneumonia characterized by relative lymphopenia, 2-fold decrease of CD3+ 
cells, 2.9-fold decrease of CD4+ cells, and 1.7-fold decrease of CD8+ 
lymphocytes. Degree of changes in parameters of cellular immunity corresponded 
to severity of pneumonia. Bacteriologic tests showed that there was 
contamination of respiratory tract of patients with influenza A/H1N1 by 
opportunistic microflora, predominantly by Streptococcus mitis.
CONCLUSION: In patients with severe form of influenza A/H1N1, which complicated 
by development of pneumonia, depression of T-cell immunity with contamination of 
respiratory tract by opportunistic microflora and prolonged course of pathologic 
process was observed.

PMID: 21446172 [Indexed for MEDLINE]


4648. J Trauma. 2011 Jun;70(6):1524-31. doi: 10.1097/TA.0b013e3181f053c2.

Quality of life after severe trauma: results from the global trauma trial with 
recombinant Factor VII.

Christensen MC(1), Banner C, Lefering R, Vallejo-Torres L, Morris S.

Author information:
(1)Regulatory Affairs, Novo Nordisk A/S, Søborg, Denmark. mcrc@novonordisk.com

BACKGROUND: Physical disability and psychologic morbidity are frequent and 
important complications of severe trauma injury with serious consequences for 
long-term health-related quality of life (HRQOL). Little prospective data exist, 
however, in a global trauma population on the risk factors for poor HRQOL.
METHODS: The CONTROL trial was a prospective, randomized, double-blinded, 
multicenter, placebo-controlled trial conducted from August 2005 to September 
2008. HRQOL was assessed 3 months after injury using the Polytrauma Outcome 
Chart (Glasgow Outcomes Scale, Short Form 36, European Quality of Life-5 
Dimensions (EQ-5D), and Trauma Outcome Profile). Multivariate stepwise 
regression analysis identified predictors of poor HRQOL.
RESULTS: Three hundred forty-seven (72%) patients completed at least one HRQOL 
instrument. Three percent had an EQ-5D score <0 (worse than death); 92% had a 
score <0.87 (average score in the general population). All HRQOL instruments 
identified physical functioning and activities of daily living as the dimensions 
of health most significantly affected by trauma injury. Mental functioning was 
also significantly affected according to the Trauma Outcome Profile. Independent 
predictors of poor HRQOL were higher age, female gender, extremity injury, blunt 
injury, intensive care unit stay >3 days, repeated nonadherence to transfusion 
guidelines, and inability to work postinjury.
CONCLUSIONS: Three months after severe trauma injury, survivors report very poor 
HRQOL. Physical wellbeing is generally more negatively affected than mental 
wellbeing. A trauma-specific HRQOL instrument reveals more diverse mental health 
problems than generic instruments. In a global trauma population, postinjury 
HRQOL is predicted by demographic and socioeconomic characteristics, type of 
injury, and treatment received.

DOI: 10.1097/TA.0b013e3181f053c2
PMID: 21378585 [Indexed for MEDLINE]


4649. Crit Care Med. 2011 May;39(5):1029-35. doi: 10.1097/CCM.0b013e31820ead45.

Outcomes, long-term quality of life, and psychologic assessment of fulminant 
myocarditis patients rescued by mechanical circulatory support.

Mirabel M(1), Luyt CE, Leprince P, Trouillet JL, Léger P, Pavie A, Chastre J, 
Combes A.

Author information:
(1)Service de Réanimation Médicale, Institut de Cardiologie, Hôpital 
Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université 
Pierre-et-Marie-Curie, Paris, France.

Comment in
    Crit Care Med. 2011 May;39(5):1211-3.

OBJECTIVE: Myocarditis is a rare disease that may progress rapidly to refractory 
cardiogenic shock and death. In such situations, emergent initiation of 
mechanical circulatory assistance is the only therapeutic option to rescue these 
dying patients. This study was designed to evaluate the outcomes, health-related 
quality of life and frequencies of anxiety, depression and posttraumatic stress 
disorder symptoms in fulminant myocarditis patients rescued by mechanical 
circulatory assistance, since these major components of outcome evaluation after 
serious illnesses have not yet been assessed in this setting.
DESIGN: A retrospective, single-center, observational study and a 
cross-sectional survey to assess health-related quality of life by the Short 
Form-36 questionnaire and frequencies of anxiety, depression and posttraumatic 
stress disorder symptoms by the Hospital Anxiety and Depression Scale and the 
Impact of Event Scale, respectively.
SETTING: An 18-bed tertiary intensive care unit in a university hospital.
PATIENTS: We analyzed the short- and long-term outcomes of 41 patients 
hospitalized at our institution between 2003 and 2009 and who received either a 
Thoratec BiVAD (Thoratec, Pleasanton, CA) (n = 6) or extracorporeal membrane 
oxygenation (n = 35) to combat refractory cardiogenic shock due to fulminant 
myocarditis.
MEASUREMENTS AND MAIN RESULTS: Intensive care unit survival was 68%, and four 
(10%) patients underwent heart transplantation. Independent predictors of 
in-intensive care unit death were Simplified Acute Physiology Score II ≥56 (odds 
ratio = 10.23) and troponin Ic ≥12 μg/L (odds ratio = 7.49) at admission. 
Complete follow-up (median, 525 days) was available for 26 of 28 survivors. 
Compared to age- and sex-matched controls, Short Form-36 evaluation of 
health-related quality of life revealed satisfactory mental health and vitality 
but persistent physical and psychosocial-related difficulties. Lastly, anxiety, 
depression, and/or posttraumatic stress disorder symptoms were reported by 38%, 
27% and 27% of the patients, respectively.
CONCLUSIONS: Mechanical circulatory assistance rescued 68% of patients with 
refractory circulatory failure due to fulminant myocarditis. Greater disease 
severity and higher troponin Ic levels at extracorporeal membrane oxygenation 
initiation predicted poorer prognosis. Because up to one-third of the patients 
reported anxiety, depression, and/or posttraumatic stress disorder symptoms, 
strategies aimed at attenuating their emotional and psychologic distress might 
significantly improve their long-lasting well-being.

DOI: 10.1097/CCM.0b013e31820ead45
PMID: 21336134 [Indexed for MEDLINE]


4650. J Adv Nurs. 2011 May;67(5):1091-101. doi: 10.1111/j.1365-2648.2010.05558.x. Epub 
2011 Jan 7.

The effect of nurse-facilitated family participation in the psychological care 
of the critically ill patient.

Black P(1), Boore JR, Parahoo K.

Author information:
(1)Nursing School of Nursing, University of Ulster, Coleraine, Northern Ireland. 
p.black@ulster.ac.uk

AIM: This paper is a report of a Neuman systems model-guided study of the 
effects of nurse-facilitated family participation in psychological care on the 
extent of patient delirium and psychological recovery following critical 
illness.
BACKGROUND: Psychological disturbances resulting from critical illness have been 
well documented in international literature. Few studies have tested 
interventions designed to alleviate such disturbances.
METHODS: A comparative time series design was used. A total of 170 critically 
ill patients and families participated in the study - 83 in the control group 
and 87 in the intervention group. Data were collected during critical illness 
and subsequent recovery using the Therapeutic Intervention Scoring System-28, 
Intensive Care Delirium Screening Checklist and the Sickness Impact Profile. The 
study was carried out in Northern Ireland, data collection taking place from 
January 2004 to December 2005.
RESULTS/FINDINGS: Nurse-facilitated family participation in psychological care 
did not significantly reduce the incidence of delirium among patients in 
critical care, but patients receiving intervention demonstrated better 
psychological recovery and wellbeing than the control group at 4, 8 and 12 weeks 
after admission to critical care.
CONCLUSION: Nurse-facilitated family participation in the psychological care may 
strengthen the lines of defence and resistance against the stressors experienced 
by the patient during critical illness and improve psychological recovery.

© 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

DOI: 10.1111/j.1365-2648.2010.05558.x
PMID: 21214624 [Indexed for MEDLINE]


4651. J Trauma. 2010 Nov;69(5):1092-9; discussion 1099-100. doi: 
10.1097/TA.0b013e3181e84222.

Family presence during trauma resuscitation: ready for primetime?

Pasquale MA(1), Pasquale MD, Baga L, Eid S, Leske J.

Author information:
(1)College of Nursing, Cedar Crest College, Allentown, Pennsylvania 18104, USA. 
mpasqual@cedarcrest.edu

BACKGROUND: The concept of family presence during trauma resuscitation (FPTR) 
remains controversial. Healthcare providers have expressed concern that 
resuscitation of severely injured trauma patients is inappropriate for family 
members as they may have psychologic distress, disrupt resuscitative efforts, or 
misinterpret provider actions, which can ultimately impact satisfaction with 
care. The minimal evidence that exists is descriptive or anecdotal.
METHODS: Using a previously developed FPTR protocol, a prospective, comparative 
study assessing 50 adult family members, who were present (n = 25) or not 
present (n = 25) with their severely injured adult family member during 
resuscitation, was conducted. Family member anxiety was assessed using 
State-Trait Anxiety Inventory, satisfaction using a Revised-Critical Care Family 
Needs Inventory, and well-being using Family Member Well-being Index within 48 
hours of intensive care unit admission. Mean total scores were compared for both 
groups with independent t tests. Significance was set at p < 0.05.
RESULTS: Age and Injury Severity Score were statistically equivalent in all 
patients. Anxiety, satisfaction, and well-being were not statistically different 
in family members present compared with those not present during resuscitation. 
There were no untoward events during resuscitation efforts. Family members 
present felt they benefited the patient and gained a better understanding of the 
situation. Conversely, family members not present commented that they would have 
preferred to have been present during resuscitation.
CONCLUSIONS: Family members present during trauma resuscitation suffered no ill 
psychologic effects and scored equivalent to those family members who were not 
present on anxiety, satisfaction, and well-being measures. Quality of care 
during trauma resuscitation was maintained. The fact that all the family members 
would repeat experience again supports the idea that FPTR was not too traumatic 
for those who chose to be present.

DOI: 10.1097/TA.0b013e3181e84222
PMID: 21068614 [Indexed for MEDLINE]


4652. Med Klin (Munich). 2010 Oct;105(10):739-41. doi: 10.1007/s00063-010-1126-5. Epub 
2010 Oct 28.

[Fatal sepsis due to capnocytophaga canimorsus after dog bite].

[Article in German]

Handrick W(1), Schwede I, Steffens U.

Author information:
(1)Institut für Medizinische Diagnostik Oderland, Am Kleistpark 1, 
Frankfurt/Oder, Germany. W.Handrick@Institut-Oderland.de

A 56-year-old man was bitten by a dog. 8 days later he was admitted to a 
hospital because of severe deterioration of his clinical situation. He developed 
the clinical picture of fulminant sepsis. In spite of aggressive intensive care 
therapy the patient died 24 hours later. Capnocytophaga canimorsus was 
identified from initial blood cultures. This gram-negative rod is part of the 
normal oral flora of dogs and cats. It can be spread to humans by bites, licking 
or scratches and causes severe infections, especially in persons with special 
risk factors (splenectomy, alcoholism). The mortality rate in the published 
cases is 25-30%.

DOI: 10.1007/s00063-010-1126-5
PMID: 20981594 [Indexed for MEDLINE]


4653. Sleep Breath. 2011 Sep;15(3):549-59. doi: 10.1007/s11325-010-0399-3. Epub 2010 
Aug 5.

Visual analogical well-being scale for sleep apnea patients: validity and 
responsiveness : a test for clinical practice.

Spanish Group of Breathing Sleep Disorders(1); Masa JF, Jiménez A, Durán J, 
Carmona C, Monasterio C, Mayos M, Terán J, Barbé F, Rubio M, Failde I, Mota M, 
Montserrat JM.

Author information:
(1)San Pedro de Alcántara Hospital, Cáceres, Spain. fmasa@separ.es

INTRODUCTION: Health-related quality-of-life (HRQL) tests used in sleep 
apnea-hypopnea syndrome (SAHS) are time-consuming, complicating their 
application in clinical practice. The objective was to examine the validity and 
responsiveness of a simple visual analogical well-being scale (VAWS) for the 
clinical use.
METHOD: The subjects proceed from a cohort of SAHS patients treated with CPAP 
for 12 weeks. We correlated the VAWS with other HRQL tests, related clinical and 
polysomnographic measures to concurrent and construct validities. Responsiveness 
by: (1) comparison of HRQL tests between before and after treatment and effect 
size. (2) Association of the change with treatment between VAWS with other HRQL 
tests and between VAWS with clinical parameters.
RESULTS: At baseline, VAWS correlated with all HRQL tests but better with 
functional outcomes in sleep questionnaires (FOSQ) and European quality-of-life 
questionnaire (EuroQol) thermometer. VAWS and FOSQ correlated better with 
clinical variables than other HRQL tests. VAWS captures the magnitude change 
with treatment similarly to FOSQ but better than other HRQL tests.
CONCLUSION: VAWS is a very simple test which measures HRQL in SAHS. It could be 
a useful tool in clinical practice, primarily for the responsiveness of 
treatment.

DOI: 10.1007/s11325-010-0399-3
PMID: 20686860 [Indexed for MEDLINE]


4654. J Neurol. 2010 Dec;257(12):2024-31. doi: 10.1007/s00415-010-5653-x. Epub 2010 
Jul 13.

Factors associated with long-term functional outcomes and psychological sequelae 
in Guillain-Barre syndrome.

Khan F(1), Pallant JF, Ng L, Bhasker A.

Author information:
(1)Department of Medicine, Dentistry and Health Sciences, University of 
Melbourne and Royal Melbourne Hospital, 34-54 Poplar Road Parkville, Melbourne, 
VIC, 3052, Australia. fary.khan@mh.org.au

To examine factors impacting long-term health-related outcomes in survivors of 
Guillain-Barre syndrome (GBS). Seventy-six consecutive patients with definite 
GBS admitted to the Royal Melbourne Hospital (1996-2009) were reviewed in the 
neurorehabilitation clinics. They underwent a structured interview designed to 
assess the impact of GBS on their current activity and restriction in 
participation using validated questionnaires: Functional Independence Measure 
(FIM), Perceived Impact of Problem Profile (PIPP) and Depression Anxiety Stress 
Scale (DASS). Their sociodemographic and disease severity data were obtained 
from the medical record. The 76 patients [60% male, mean age 56 years, median 
time since GBS 6 years (range 1-14 years)] showed good functional recovery 
(median motor FIM score 90). However, 16% reported moderate to extreme impact on 
their ability to participate in work, family, and social activities; and 22% 
substantial impact on mood, confidence and ability to live independently. More 
reported moderate to extreme depression (18%), anxiety (22%) and stress (17%) 
compared with the normative Australian population (13%). Factors associated with 
poorer current level of functioning and wellbeing included: females, older 
patients (57+ years), acute hospital stay (>11 days), those treated in intensive 
care and those discharged to rehabilitation. No associations were found between 
the Medical Research Council (MRC) Motor Scale Rating scores at admission, nor 
time since GBS diagnosis (≤6 vs. >6 years) on outcomes used.
CONCLUSION: GBS is complex and requires long-term management of psychological 
sequelae impacting activity and participation.

DOI: 10.1007/s00415-010-5653-x
PMID: 20625757 [Indexed for MEDLINE]


4655. J Pediatr Nurs. 2010 Aug;25(4):250-7. doi: 10.1016/j.pedn.2009.01.007. Epub 2009 
Apr 3.

The relationship between home nursing coverage, sleep, and daytime functioning 
in parents of ventilator-assisted children.

Meltzer LJ(1), Boroughs DS, Downes JJ.

Author information:
(1)University of Pennsylvania School of Medicine, Philadelphia, PA, USA. 
meltzerl@email.chop.edu

This descriptive study examined the relationship between home-care nursing 
support, sleep, and daytime functioning in familial caregivers of 
ventilator-assisted children. Thirty-six primary caregivers (27 mothers, 7 
fathers, 1 foster mother, and 1 grandmother) of ventilator-assisted children 
completed measures of home nursing support, sleep, depression, fatigue, and 
daytime sleepiness. Daytime nursing coverage was not related to caregiver sleep 
or daytime functioning, but caregivers with less nighttime nursing coverage had 
significantly shorter sleep onset latency than caregivers with some night 
nursing (16-48 hours/week). Caregivers with regular night nursing (>48 
hours/week) had a total sleep time of almost 1 hour more than caregivers without 
regular night nursing (<or=48 hours/week). Caregivers with clinically 
significant symptoms of depression and sleepiness received significantly fewer 
hours of night nursing per week than caregivers without significant symptoms of 
depression or sleepiness. Home nursing support, in particular night nursing, is 
important for the health and well-being of familial caregivers of 
ventilator-assisted children.

Copyright 2010 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.pedn.2009.01.007
PMCID: PMC2932665
PMID: 20620805 [Indexed for MEDLINE]


4656. Dtsch Med Wochenschr. 2010 Jul;135(27):1368-71. doi: 10.1055/s-0030-1262420. 
Epub 2010 Jun 29.

[Factitious recurrent septicemia and gastrointestinal corrosive burns].

[Article in German]

Löbermann M(1), Hemmer C, Andree H, Mau R, Grimm K, Reisinger EC.

Author information:
(1)Abteilung für Tropenmedizin und Infektionskrankheiten, Universität Rostock.

HISTORY AND ADMISSION FINDINGS: A 39-year-old woman was admitted for the 
treatment of recurrent septicemia, corrosive esophageal and gastric mucosal 
injury, and bloody stools.
INVESTIGATIONS: A search of her hospital room provided evidence of a 
self-inflicted disorder. Bacteremia with typical fecal flora had been caused by 
self-injected intravenous inoculation of stool and the esophageal ulcers by 
swallowed vinegar.
TREATMENT AND COURSE: The patient was initially treated with meropenem. After 
initial clinical and psychological stabilization the patient refused further 
psychiatric or psychosomatic treatment.
CONCLUSION: Fluctuating or bizarre symptoms and unusual diagnostic findings may 
indicate self-inflicted disorders, in which the symptoms of illness are caused 
by the afflicted person him/herself.

Georg Thieme Verlag KG Stuttgart, New York.

DOI: 10.1055/s-0030-1262420
PMID: 20589583 [Indexed for MEDLINE]


4657. Nurs Crit Care. 2010 May-Jun;15(3):118-28. doi: 
10.1111/j.1478-5153.2009.00383.x.

Psychological support and outcomes for ICU patients.

Papathanassoglou ED(1).

Author information:
(1)Department of Nursing, Cyprus University of Technology, Siakoleion Centre for 
Health Studies, 2252 Latsia, Nicosia, Cyprus. e.papathanassoglou@cut.ac.cy

AIMS AND OBJECTIVES: To critically review evidence on the effects of 
psychological support during intensive care unit (ICU) treatment on adult ICU 
patients' psychological and physiological outcomes. Evidence from intervention 
studies on imagery and relaxation has been included, as well.
BACKGROUND: Stress and negative emotions may have both immediate, as well as 
long-term effects on ICU patients' psychological and physical well-being, and 
they are linked to delayed physical recovery. DESIGN, METHODS: A narrative 
critical review methodology was employed. Databases searched included Medline, 
CINAHL, PubMed, PsychInfo and the Cochrane Library. Experimental, 
quasi-experimental or pretest-posttest peer-reviewed intervention studies 
published since 1970 were included.
RESULTS: Fourteen studies: seven on nurse led relaxation, three on guided 
imagery, one on nurse-patient interaction, two on physician-patient interaction 
and one correlational study on perceived social support were included. The 
results suggest significant improvements in patients' outcomes: improved vital 
signs, decrease in pain ratings, anxiety, rate of complications and length of 
stay, and improved sleep and patient satisfaction. Eight studies employed 
randomized experimental, four quasi-experimental and two descriptive 
correlational designs. Two studies explored effects on patients' sleep, and two 
on procedure-related pain.
CONCLUSIONS: The literature is limited in exploring the effects of nurse-patient 
interactions. The amount and quality of psychosocial support in the ICU, as well 
as imagery and relaxation techniques, are linked to short-term and long-term 
patients' outcomes.
RELEVANCE TO CLINICAL PRACTICE: ICU nurses need to engage in psychological 
support in a systematic way, and to acknowledge the high priority of support 
interventions.

DOI: 10.1111/j.1478-5153.2009.00383.x
PMID: 20500650 [Indexed for MEDLINE]


4658. Cochrane Database Syst Rev. 2010 Mar 17;(3):CD006174. doi: 
10.1002/14651858.CD006174.pub2.

Intrapartum fetal scalp lactate sampling for fetal assessment in the presence of 
a non-reassuring fetal heart rate trace.

East CE(1), Leader LR, Sheehan P, Henshall NE, Colditz PB.

Author information:
(1)Department of Obstetrics and Gynaecology, University of Melbourne, Pregnancy 
Research Centre, Department of Perinatal Medicine, Royal Women's Hospital, 20 
Flemington Road, Parkville, Victoria, Australia, 3052.

Update in
    Cochrane Database Syst Rev. 2015;5:CD006174.

BACKGROUND: Fetal blood sampling for lactate estimation may be considered 
following identification of an abnormal or non-reassuring fetal heart rate 
pattern. The smaller volume of blood required for this test, compared with the 
more traditional pH estimation, may improve sampling rates. The appropriate use 
of this practice mandates systematic review of its safety and clinical 
effectiveness prior to widespread introduction.
OBJECTIVES: To evaluate the effectiveness and risks of fetal scalp lactate 
sampling in the assessment of fetal well-being during labour, compared with no 
testing or alternative testing.
SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's 
Trials Register (November 2009).
SELECTION CRITERIA: All published and unpublished randomised and 
quasi-randomised trials that compared fetal scalp lactate testing with no 
testing or alternative testing to evaluate fetal status in the presence of a 
non-reassuring cardiotocograph during labour.
DATA COLLECTION AND ANALYSIS: Two review authors assessed the studies 
independently.
MAIN RESULTS: The two identified randomised trials considered outcomes for 3348 
mother-baby pairs allocated to either lactate or pH estimation of fetal blood 
samples in labour. There were no statistically significant differences for any 
fetal/neonatal/infant outcomes, including low Apgar score at five minutes, 
admission to neonatal intensive care units or neonatal encephalopathy, or for 
low umbilical arterial pH, base deficit or metabolic acidaemia. There was a 
statistically higher success rate for lactate compared with pH estimation (risk 
ratio 1.10, 95% confidence interval 1.08 to 1.12, n = 2992). There were no 
significant between-group differences in mode of birth or operative birth for 
non-reassuring fetal status. No studies reported outcomes of maternal 
satisfaction with fetal monitoring, anxiety, length of hospital stay or economic 
analysis.
AUTHORS' CONCLUSIONS: When further testing to assess fetal well-being in labour 
is indicated, fetal scalp blood lactate estimation is more likely to be 
successfully undertaken than pH estimation. Action cut-off lactate values need 
to consider the lactate meter used. Further studies may consider sub-group 
analysis by gestational age, the stage of labour and sampling within a prolonged 
second stage of labour. Additionally, future studies may address longer-term 
neonatal outcomes, maternal satisfaction with intrapartum fetal monitoring and 
an economic analysis.

DOI: 10.1002/14651858.CD006174.pub2
PMID: 20238343 [Indexed for MEDLINE]


4659. Nurs Times. 2010 Feb 9-15;106(5):20-3.

How telling stories helps patients to recover psychologically after intensive 
care.

Williams SL.

BACKGROUND: Studies have shown both the risk of post traumatic stress following 
intensive care unit treatment, and the helpfulness of telling trauma stories for 
psychological recovery.
AIM: This article is based on recent doctoral research exploring the impact of 
unexpected life threatening events after admission to hospital.
METHOD: The original research used a qualitative design blending discourse, 
narrative and phenomenological approaches, guided by sensitivity to 
participants' evolving work of pulling stories together. Patients chosen from 
ICU discharge summaries showing a critical life threatening event after 
admission gave unstructured interviews soon after discharge from hospital and a 
year later.
RESULTS: This article focuses on one particular finding, showing that critical 
illness can make it difficult for patients to construct personal stories of 
their experience. Limited evidence suggested overcoming those difficulties meant 
they had an improved sense of wellbeing a year after discharge.
DISCUSSION: Stories are an essential way in which humans make sense of their 
experience, which is crucial both for responding appropriately and for personal 
wellbeing following traumatic life events. Therefore, difficulties in "storying" 
significant experience can have a negative impact on wellbeing.
CONCLUSION: Some patients need help piecing together stories of their critical 
illness experience.

PMID: 20222486 [Indexed for MEDLINE]


4660. J Pediatr Nurs. 2010 Apr;25(2):89-97. doi: 10.1016/j.pedn.2009.11.004.

Staff perception one year after implementation of the the newborn individualized 
developmental care and assessment program (NIDCAP).

Solhaug M(1), Bjørk IT, Sandtrø HP.

Author information:
(1)Childrens Department Rikshospitalet University Hospital, Oslo, Norway. 
marit.solhaug@akribe.no <marit.solhaug@akribe.no>

The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) 
was piloted at one NICU. Staff perception of impact and the feasibility of 
applying the program was explored in a survey and a focus group interview. 
NIDCAP was perceived to impact positively on infant well-being and parents' way 
of caring. Although the influence of NIDCAP on staff working conditions and job 
perfomance was overall positive, their perceptions varied. Presence of the 
NIDCAP observer and empowerment of parents was challenging to some nurses, 
especially in terms of decision making in care. Conflicts of interest occurred 
between staff member need of light and infant need of light reduction.

DOI: 10.1016/j.pedn.2009.11.004
PMID: 20185059 [Indexed for MEDLINE]


4661. Am J Hosp Palliat Care. 2010 Aug;27(5):316-9. doi: 10.1177/1049909109358309. 
Epub 2010 Feb 18.

Psychosocial concerns in patients with advanced cancer: an observational study 
at regional cancer centre, India.

Mishra S(1), Bhatnagar S, Philip FA, Singhal V, Singh Rana SP, Upadhyay SP, 
Chauhan G.

Author information:
(1)Unit of Anesthesiology, Dr B.R. Ambedkar, Institute Rotary Cancer Hospital, 
All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. 
mseema17@yahoo.co.in

INTRODUCTION: The diagnosis and treatment of cancer is associated with 
substantial physical, psychological, and social morbidity. The objective of this 
study was to identify the prevalence of psychosocial concerns in the patients 
with advanced cancer admitted to our institute.
MATERIALS AND METHODS: A total of 100 patients admitted to the inpatient 
palliative care unit of our institute were enrolled in this study. A descriptive 
questionnaire that dealt with the patient's psychological acceptance of the 
disease and emotional distress that accompanies the diagnosis was prepared. 
Patient's social and spiritual needs were addressed, and the future concerns 
that the patient is preoccupied with were discussed on a one-on-one basis with 
the patient himself or herself.
RESULTS: It was found that a majority of patients, though aware of their 
diagnosis, were not aware of the disease prognosis. There was a generalized 
anxiety regarding the treatment of the disease and fear of suffering. Most 
patients preferred to keep the revelation of the diagnosis to those close to 
them and not reveal it publicly. Financial drain out of resources was a major 
concern. Future concerns about their own fitness, the settlement of their 
children, and the family's well-being were seen commonly in almost all the 
patients.
CONCLUSIONS: Attention to psychosocial and spiritual health needs of patients 
with cancer is an integral part of an effective palliation, though they are less 
commonly expressed but are strongly felt by patients with cancer. It is 
therefore recommended that all clinicians and health care providers should 
address psychosocial health needs as a part of their routine practice.

DOI: 10.1177/1049909109358309
PMID: 20167832 [Indexed for MEDLINE]


4662. Ter Arkh. 2010;82(11):37-40.

[Myonecrosis in users of injecting drugs (a clinical case)].

[Article in Russian]

Shestakova IV, Iushchuk ND, Tishkevich OL.

Myonecrosis remains one of the severest manifestations of skin and soft tissue 
infections. Clostridia (C. perfringens, C. novyi, C. septicum, C. sordellii, C. 
histolyticum) are dominant and Staphylococcus aureus, Streptococcus pyogenes, 
Bacillus cereus, and Bacteriodes fragilis are much less in the etiology of 
myonecrosis. Cases of gas gangrene have recently become more frequent among 
injection drug users all over the world. Russia has become the largest opiate 
market in Europe and consumption of these narcotic drugs is annually growing. In 
the Russian Federation, a larger number of injection drug users uniquely results 
in a rise of cases of Clostridium- and mixed flora-induced myonecrosis. Gas 
gangrene in HIV-positive drug abusers seems to rapidly progress to multiple 
organ failure and to show high death rates, rather than to develop a localized 
form. The analyzed case of mixed flora-induced gas gangrene is of interest to 
physicians of any specialties who can encounter this wound infection in 
HIV-positive patients.

PMID: 21381347 [Indexed for MEDLINE]


4663. J Obstet Gynecol Neonatal Nurs. 2009 Nov-Dec;38(6):676-685. doi: 
10.1111/j.1552-6909.2009.01064.x.

Impaired sleep and well-being in mothers with low-birth-weight infants.

Lee SY(1), Kimble LP(2).

Author information:
(1)Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, GA.. 
Electronic address: slee29@gsu.edu.
(2)Piedmont Healthcare Endowed Chair in Nursing, Georgia Baptist College of 
Nursing of Mercer University, Atlanta, GA.

OBJECTIVE: To explore relationships between impaired sleep and well-being in 
mothers with low-birth-weight infants in the neonatal intensive care unit.
DESIGN: Cross-sectional descriptive exploratory design.
SETTING: Neonatal intensive care unit in metropolitan Atlanta, GA.
PARTICIPANTS: Twenty second-week postpartum, first-time mothers who had a 
low-birth-weight infant hospitalized in the neonatal intensive care unit.
METHODS: Self-report data were collected for sleep, fatigue, depression, and 
well-being. Total sleep time, wake after sleep onset, circadian activity 
rhythms, and light exposure were measured using a wrist actigraph.
RESULTS: Mothers reported clinically significant sleep disturbance and fatigue 
severity. Actigraphy showed the average nighttime total sleep time was less than 
7 hours with 19%+/-2.2% wake after sleep onset, and the total daytime sleep was 
more than an hour. Mothers also experienced moderate depressive symptoms. 
Maternal well-being as measured by the Medical Outcomes Short Form-36, version 2 
was approximately 1 SD below the mean scores of age-matched women in the general 
U.S. population.
CONCLUSION: Mothers of hospitalized low-birth-weight infants are vulnerable. The 
presence of sleep disturbances and negative physical and mental health 
indicators warrants further study. Intervention is needed to promote sleep for 
new mothers during postpartum recovery, especially mothers who are dealing with 
a medically ill infant.

DOI: 10.1111/j.1552-6909.2009.01064.x
PMCID: PMC6556893
PMID: 19930281 [Indexed for MEDLINE]


4664. Child Adolesc Psychiatry Ment Health. 2009 Oct 15;3(1):33. doi: 
10.1186/1753-2000-3-33.

A pilot study on peritraumatic dissociation and coping styles as risk factors 
for posttraumatic stress, anxiety and depression in parents after their child's 
unexpected admission to a Pediatric Intensive Care Unit.

Bronner MB(1), Kayser AM, Knoester H, Bos AP, Last BF, Grootenhuis MA.

Author information:
(1)Psychosocial Department, Emma Children's Hospital Academic Medical Center, 
University of Amsterdam, Amsterdam, The Netherlands. m.b.bronner@amc.nl

AIM: To study the prevalence of posttraumatic stress disorder (PTSD), anxiety 
and depression in parents three months after pediatric intensive care treatment 
of their child and examine if peritraumatic dissocation and coping styles are 
related to these mental health problems.
METHODS: This is a prospective cohort study and included parents of children 
unexpectedly admitted to the Pediatric Intensive Care Unit (PICU) from January 
2006 to March 2007. At three months follow-up parents completed PTSD (n = 115), 
anxiety and depression (n = 128) questionnaires. Immediately after discharge, 
parents completed peritraumatic dissocation and coping questionnaires. Linear 
regression models with generalized estimating equations examined risk factors 
for mental health problems.
RESULTS: Over 10% of the parents were likely to meet criteria for PTSD and 
almost one quarter for subclinical PTSD. Respectively 15% to 23% of the parents 
reported clinically significant levels of depression and anxiety. Peritraumatic 
dissocation was most strongly associated with PTSD, anxiety as well as 
depression. Avoidance coping was primarily associated with PTSD.
CONCLUSION: A significant number of parents have mental health problems three 
months after unexpected PICU treatment of their child. Improving detection and 
raise awareness of mental health problems is important to minimize the negative 
effect of these problems on parents' well-being.

DOI: 10.1186/1753-2000-3-33
PMCID: PMC2770447
PMID: 19832987


4665. Crit Care Med. 2010 Jan;38(1):167-74. doi: 10.1097/CCM.0b013e3181c031b3.

Early somatosensory evoked potential grades in comatose traumatic brain injury 
patients predict cognitive and functional outcome.

Houlden DA(1), Taylor AB, Feinstein A, Midha R, Bethune AJ, Stewart CP, Schwartz 
ML.

Author information:
(1)Department of Surgical Neuromonitoring, Sunnybrook Health Sciences Centre, 
Toronto, ON, Canada. david.houlden@sunnybrook.ca

Comment in
    Crit Care Med. 2010 Jan;38(1):325-6.

OBJECTIVES: To relate early somatosensory evoked potential grades from comatose 
traumatic brain injury patients to neuropsychological and functional outcome 1 
yr later; to determine the day (within the first week after traumatic brain 
injury) that somatosensory evoked potential grade best correlates with outcome; 
to determine whether somatosensory evoked potential grade improvement in the 
first week after traumatic brain injury is associated with improved outcome.
DESIGN: Prospective cohort study.
SETTING: Critical care unit at a university hospital.
PATIENTS: Median nerve somatosensory evoked potentials were obtained from 81 
comatose patients with traumatic brain injury. Somatosensory evoked potential 
grades were calculated from results obtained on days 1, 3, and 7 after traumatic 
brain injury. Glasgow Outcome Scale, Barthel Index, Rivermead Head Injury 
Follow-up Questionnaire, General Health Questionnaire, Stroop Color-Word Test, 
Paced Auditory Serial Addition Task, and Symbol-Digit Modalities Test scores 
were obtained 1 yr after injury.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Somatosensory evoked potential grade on days 1, 
3, and 7 related significantly with Glasgow Outcome Scale and Barthel scores 
(day 3 better than day 1) but did not relate with Rivermead Head Injury 
Follow-up Questionnaire or General Health Questionnaire scores. Day 3 and day 7 
somatosensory evoked potential grades related significantly with Stroop scores. 
Day 3 somatosensory evoked potential grades related significantly with 
Symbol-Digit Modalities Test scores. Patients with bilaterally present but 
abnormal somatosensory evoked potentials, whose somatosensory evoked potential 
grade improved between days 1 and 3, had marginally better functional outcome 
than those without somatosensory evoked potential grade improvement.
CONCLUSIONS: Day 3 somatosensory evoked potential grade related to 
information-processing speed, working memory, and the ability to attend to tasks 
1 yr after traumatic brain injury. Day 3 somatosensory evoked potential grade 
had the strongest relationship with functional outcome. Somatosensory evoked 
potential grades were not related to emotional well-being.

DOI: 10.1097/CCM.0b013e3181c031b3
PMID: 19829103 [Indexed for MEDLINE]


4666. Psychosomatics. 2009 May-Jun;50(3):263-9. doi: 10.1176/appi.psy.50.3.263.

Emotional and behavioral changes in parents of children affected by 
hemolytic-uremic syndrome associated with verocytotoxin-producing Escherichia 
coli: a qualitative analysis.

Pollock KG(1), Duncan E, Cowden JM.

Author information:
(1)Health Protection Scotland, Clifton House, Clifton Place, Glasgow G37LN, 
Scotland. Kevin.Pollock@hps.scot.nhs.uk

BACKGROUND: The long-term clinical outcome for children affected by hemolytic 
uremic syndrome associated with verocytotoxin-producing Escherichia coli 
(VTEC-HUS) is well documented, but the parental experience is not.
OBJECTIVE: The authors investigated the effects of the critical-care 
hospitalization for this condition on well-being of patients' families.
METHOD: A group of 30 parents completed a free-response format survey when their 
child presented to the hospital; 19 of this cohort completed a 1-year follow-up.
RESULTS: Content analysis demonstrated that this cohort of parents experienced 
long-term emotional distress and substantive disruption to family and daily 
life.
DISCUSSION: These results corroborate anecdotal clinical observations. The 
authors suggest future research initiatives and best practices to reduce 
parental distress.

DOI: 10.1176/appi.psy.50.3.263
PMID: 19567766 [Indexed for MEDLINE]


4667. Nurs Crit Care. 2009 Jul-Aug;14(4):175-9. doi: 10.1111/j.1478-5153.2009.00332.x.

Communication, swallowing and feeding in the intensive care unit patient.

Batty S(1).

Author information:
(1)Speech and Language Therapy, Royal Hallamshire Hospital, Glossop Road, 
Sheffield, UK. sally.batty@sth.nhs.uk

BACKGROUND: It is not uncommon for patients requiring a period of time in the 
intensive care unit (ICU) to experience difficulties with communication and/or 
swallowing, either as a result of their illness or as a result of the treatments 
they receive. These difficulties can be both short term and long term and 
require timely and appropriate intervention in order to improve the patient's 
experience and expedite recovery/rehabilitation.
AIMS: The purpose of this article is to provide critical care nurses with an 
update on aspects of communication, swallowing and feeding in the ICU. The paper 
will focus on each area in relation to the current evidence base and factors of 
'best practice' (as determined by expert opinion). IMPLICATIONS FOR CRITICAL 
CARE NURSING PRACTICE: Enabling communication can improve well-being, increase 
compliance and reduce length of stay; Simple modes of communication, e.g. 
writing/gesture/pictures can be very effective; Coded eye blinking may be 
unreliable because of confusion with reflexive blinking; Non-oral nutrition will 
generally not meet the psychological and physical needs and benefits of oral 
intake; Not all patients with a tracheostomy in situ will experience dysphagia; 
however, those considered 'at risk' should have their swallow assessed by an 
appropriately trained professional, e.g. speech and language therapist/dysphagia 
trained professional; An inflated tracheostomy cuff will not prevent aspiration. 
The decision to commence oral intake in the presence of an inflated cuff should 
be made as a team and take into consideration the patient's medical and 
psychological status; The use of blue dye to assess the swallow carries a high 
false-negative rate and cannot be relied on alone to predict either the presence 
or the absence of aspiration.
CONCLUSION: There is still much more research to be performed and evidence to be 
gained regarding the input into communication, swallowing and feeding in the 
ICU; however, a full-team approach to these areas can have very positive effects 
on the patient's experience.

DOI: 10.1111/j.1478-5153.2009.00332.x
PMID: 19531034 [Indexed for MEDLINE]


4668. Am J Crit Care. 2009 May;18(3):200-9; quiz 210. doi: 10.4037/ajcc2009252.

Symptoms experienced by family members of patients in intensive care units.

McAdam JL(1), Puntillo K.

Author information:
(1)School of Nursing at Dominican University of California, San Rafael, USA. 
jennifer.mcadam@dominican.edu

Concern for the family members of patients who are at high risk of dying in 
intensive care units is both a necessary and integral part of providing holistic 
nursing care. When patients are at high risk of dying, their families experience 
burdens such as decision making and treatment choices that can cause the 
families psychological and physical symptoms, most commonly stress, anxiety, and 
depression. These symptoms in turn can affect family members' general 
well-being. Since the late 1990s, several quantitative and qualitative studies 
have been done to assess symptoms in such family members. In this review of the 
literature, the current state of the science on symptoms experienced by family 
members of patients in the intensive care unit is reviewed and critiqued. Risk 
factors associated with an increase in symptoms experienced are discussed. 
Overall, surveys that use self-report measures were the most common study 
design. Limitations of the studies include convenience sampling, small sample 
sizes, and a lack of description of patients' characteristics, all of which make 
comparison and use of findings difficult. Recommendations to address gaps in the 
literature are highlighted, and future research goals are discussed.

DOI: 10.4037/ajcc2009252
PMID: 19411580 [Indexed for MEDLINE]


4669. Ann N Y Acad Sci. 2009 Mar;1157:71-80. doi: 10.1111/j.1749-6632.2008.04120.x.

Exploring altered consciousness states by magnetic resonance imaging in brain 
injury.

Lescot T(1), Galanaud D, Puybasset L.

Author information:
(1)Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital 
and Pierre et Marie Curie University, Paris, France.

Traumatic brain injury (TBI) occurs abruptly, involves multiple specialized 
teams, calls on the health-care system in its emergency dimension, and engages 
the well-being of the patient and his relatives for a lifetime period. 
Clinicians in charge of these patients are faced with issues of uppermost 
importance: medical issues such as predicting the long-term neurological outcome 
of the comatose patient; ethical issues because of the influence of intensive 
care on the long-term survival of patients in a vegetative and minimally 
conscious state; legal issues because of the law that has set the concept of 
proportionality of care as the legal rule; and social issues as the result of 
the very high cost of these pathologies. Today's larger availability of magnetic 
resonance imaging (MRI) in ventilated patients and the recent improvements in 
hardware and in imaging techniques that have made the last-developed imaging 
techniques such as diffusion tensor imaging and magnetic resonance spectroscopy 
available in brain-trauma patients, are changing the paradigm in neurointensive 
care regarding outcome prediction. The old paradigm that no individual prognosis 
could be made at the subacute phase in TBI patients does not hold true anymore. 
This major change opens new challenging ethical questions. This review focuses 
on the brain explorations that are required, such as MRI, magnetic resonance 
spectroscopy, and diffusion tensor imaging, to provide the clinician with a 
multimodal assessment of the brain state to predict outcome of coma. Such an 
assessment will become mandatory in the near future to answer the crucial 
question of proportionality of care in these patients.

DOI: 10.1111/j.1749-6632.2008.04120.x
PMID: 19351357 [Indexed for MEDLINE]


4670. Sleep Med. 2009 Oct;10(9):993-9. doi: 10.1016/j.sleep.2009.01.007. Epub 2009 Mar 
29.

Psychological variables as predictors of adherence to treatment by continuous 
positive airway pressure.

Poulet C(1), Veale D, Arnol N, Lévy P, Pepin JL, Tyrrell J.

Author information:
(1)UFR SHS, Université Pierre Mendès France/Grenoble II, France.

STUDY OBJECTIVES: We examined whether psychological variables enable us to 
predict adherence to CPAP in order to construct a predictive model to identify 
patients at risk of abandoning treatment.
METHOD: One hundred and twenty-two Obstructive Sleep Apnoea (OSA) patients were 
studied before and one month after beginning CPAP treatment. All patients 
completed four psychological evaluation instruments before CPAP treatment: a 
health perception questionnaire (Nottingham Health Profile: NHP), a mental 
health rating scale (Hospital Anxiety and Depression Scale: HADS) and two 
disease-specific questionnaires that measure the patient's understanding of OSA 
and its treatment (Apnea Knowledge Test: AKT) and his attitudes to OSA and CPAP 
(Apnea Beliefs Scale: ABS).
RESULTS: Thirty percent of the participants were non-adherent at one month. 
Decision-tree analysis indicated that it was possible to correctly classify 
85.7% of non-adherent patients using three baseline factors (Emotional reactions 
score [NHP], age, and total score on ABS). Logistic regression analyses 
confirmed these two psychological variables as independent predictors of 
adherence.
CONCLUSION: Assessing psychological well-being and subjective health status at 
onset of CPAP enables the identification of patients at risk of abandoning CPAP 
treatment. This subgroup could then be targeted early to receive supportive and 
educational measures to improve adherence rates.

DOI: 10.1016/j.sleep.2009.01.007
PMID: 19332381 [Indexed for MEDLINE]


4671. Nurs Crit Care. 2009 Mar-Apr;14(2):75-85. doi: 10.1111/j.1478-5153.2008.00322.x.

Ventilatory weaning: a case study of protracted weaning.

Pattison N(1), Watson J.

Author information:
(1)Critical Care Unit, Royal Marsden Hospital, London, UK. 
nataliepattison@hotmail.com

BACKGROUND: Dysfunctional ventilatory weaning response (DVWR) is characterized 
by interrupted and prolonged weaning. This reflective analysis presents how 
using nursing diagnoses in critical care can raise awareness of, and provide 
strategies for, managing problems related to ventilatory weaning.
AIM: To examine and reflect upon why one patient took so long to wean from the 
ventilator using the structured approach of instrumental case study and nursing 
diagnosis to explain aspects of the weaning process.
ANALYSIS: This case study examines one patient's experiences around ventilatory 
weaning using selected nursing diagnoses, exploring the implications that 
physiological, social, emotional and psychological factors have on both weaning 
and healing processes in critical care. By using dialogue, an explicit texture 
is presented of how one patient felt, with particular resonance to the 
relationships she had and the impact they made. Various nursing diagnoses proved 
useful in determining why this patient had an extended weaning trajectory and 
included DVWR, ineffective breathing pattern, impaired spontaneous ventilation, 
anxiety and impaired verbal communication. There were specific points of 
interest, in particular her anxiety, which proved a major factor, and her 
significantly improved functional status after the critical care episode. A DVWR 
may be minimized by nursing presence, reassurance and respect for patient 
autonomy. Complex anatomy and physiology contributes to protracted weaning and a 
DVWR and is compounded by anxiety. Furthermore, there is a significant element 
of nursing care, timely reassurance and presence, which can have a positive 
impact on patient well-being.
CONCLUSIONS: This reflective analysis highlights the benefits and importance of 
the nurse-patient relationship during what was a very protracted ventilatory 
wean. This shared trajectory enabled significant patient empowerment, and this 
case study gives the patient the voice she temporarily lost.

DOI: 10.1111/j.1478-5153.2008.00322.x
PMID: 19243524 [Indexed for MEDLINE]


4672. Crit Care Med. 2009 Apr;37(4):1251-5. doi: 10.1097/CCM.0b013e31819c1496.

Stressful intensive care unit medical crises: How individual responses impact on 
team performance.

Piquette D(1), Reeves S, LeBlanc VR.

Author information:
(1)Department of Critical Care, Sunnybrook Health Sciences Centre (DP), Toronto, 
Ontario, Canada. dominique.piquette@sunnybrook.ca

Comment in
    Crit Care Med. 2009 Apr;37(4):1494-5.

BACKGROUND: Intensive care units (ICUs) are recognized as stressful 
environments. However, the conditions in which stressors may affect health 
professionals' performance and well-being and the conditions that potentially 
lead to impaired performance and staff psychological distress are not well 
understood.
OBJECTIVES: The purpose of this study was to determine healthcare professionals' 
perceptions regarding the factors that lead to stress responses and performance 
impairments during ICU medical crises.
DESIGN: A qualitative study in a university-affiliated ICU in Canada.
METHODOLOGY: We conducted 32 individual semistructured interviews of ICU nurses, 
staff physicians, residents, and respiratory therapists in a 
university-affiliated hospital. The transcripts of the audiotaped interviews 
were analyzed using an inductive thematic methodology.
RESULTS: Increased workload, high stakes, and heavy weight of responsibility 
were recognized as common stressors during ICU crises. However, a high level of 
individual and team resources available to face such demands was also reported. 
When the patient's condition was changing or deteriorating unpredictably or when 
the expected resources were unavailable, crises were assessed by some team 
members as threatening, leading to individual distress. Once manifested, this 
emotional distress was strongly contagious to other team members. The ensuing 
collective anxiety was perceived as disruptive for teamwork and deleterious for 
individual and collective performance.
CONCLUSIONS: Individual distress reactions to ICU crises occurred in the 
presence of unexpectedly high demands unmatched by appropriate resources and 
were contagious among other team members. Given the high uncertainty surrounding 
many ICU medical crises, strategies aimed at preventing distress contagion among 
ICU health professionals may improve team performance and individual well-being.

DOI: 10.1097/CCM.0b013e31819c1496
PMID: 19242320 [Indexed for MEDLINE]


4673. J Spec Pediatr Nurs. 2008 Oct;13(4):281-91. doi: 
10.1111/j.1744-6155.2008.00163.x.

Implementation and evaluation of an individualized developmental care program in 
a neonatal intensive care unit.

Bredemeyer S(1), Reid S, Polverino J, Wocadlo C.

Author information:
(1)Faculty of Nursing and Midwifery, University of Sydney, NSW, Australia. 
sandie@email.cs.nsw.gov.au

PURPOSE: This study aims to detect differences in outcomes for very preterm 
infants after the introduction of developmental care in a neonatal nursery, and 
to evaluate the effect of developmental care on parental well-being.
DESIGN AND METHODS: Prospective before and after cohort study of very preterm 
babies, with education for all staff between cohorts.
RESULTS: No significant differences were found between cohorts for short-term 
outcomes for babies or parental anxiety levels or depression. All infants scored 
within normal temperament ranges at 4 months.
PRACTICE IMPLICATIONS: Developmental care is a safe practice model. The 
interdisciplinary study facilitated professional development and increased the 
knowledge of nurses.

DOI: 10.1111/j.1744-6155.2008.00163.x
PMID: 19238716 [Indexed for MEDLINE]


4674. Crit Care Med. 2009 Jan;37(1):184-91. doi: 10.1097/CCM.0b013e31819287f7.

Evaluation of the effect of prospective patient diaries on emotional well-being 
in intensive care unit survivors: a randomized controlled trial.

Knowles RE(1), Tarrier N.

Author information:
(1)Division of Clinical Psychology, University of Manchester, Manchester M13 
9PL, United Kingdom.

Comment in
    Crit Care Med. 2009 Jan;37(1):356-7.
    Nurs Crit Care. 2009 May-Jun;14(3):155-6.
    Crit Care Med. 2009 Jun;37(6):2145; author reply 2145-6.

OBJECTIVE: To evaluate the effect of a prospective diary intervention on levels 
of anxiety and depression in a group of intensive care unit survivors.
DESIGN: Pragmatic randomized controlled trial.
SETTING: Adult intensive care unit, medical/surgical wards of a district general 
hospital and community bases.
PATIENTS: A total of 36 patients who were admitted to the intensive care unit 
between March 2006 and March 2007 for a minimum of 48 hrs.
INTERVENTIONS: Prospective diary kept by nursing staff for the duration of the 
patient's stay on intensive care unit, containing daily information about their 
physical condition, procedures and treatments, events occurring on the unit, and 
significant events from outside the unit.
MEASUREMENT AND MAIN RESULTS: At initial assessment, almost half of patients 
fell into the "disorder likely" category on the Hospital Anxiety and Depression 
Scale (44% for anxiety and 47.2% for depression). Paired-samples Student's t 
tests to compare the Hospital Anxiety and Depression Scale scores at time 1 and 
time 2 in the two participant groups revealed that the experimental group 
displayed statistically significant decreases in both anxiety (t (1,17) = 2.65, 
p < 0.05) and depression (t (1,17) = 3.33, p < 0.005) scores, while the control 
group did not, a difference attributed to the diary intervention.
CONCLUSIONS: Survivors of critical illnesses are likely to experience clinically 
significant symptoms of anxiety and depression following their discharge from 
hospital. The prospective diary intervention designed to help patients 
understand what happened to them in intensive care and it has a significant 
positive impact on anxiety and depression scores almost 2 months after patients' 
discharge from intensive care unit. Attempts to replicate these results using 
larger samples are therefore encouraged, with the aim of informing best practice 
guidelines.

DOI: 10.1097/CCM.0b013e31819287f7
PMID: 19050634 [Indexed for MEDLINE]


4675. Death Stud. 2008;32(7):621-45. doi: 10.1080/07481180802215627.

Meaning in life and personal growth among pediatric physicians and nurses.

Taubman-Ben-Ari O(1), Weintroub A.

Author information:
(1)School of Social Work, Bar Ilan University, Ramat Gan, 52900 Isreal. 
taubman@mail.biu.ac.il

Studies examining medical teams indicate that exposure to the terminally ill 
often has detrimental effects on their physical and emotional well-being. 
However, recent theoretical developments suggest that this exposure might also 
have positive implications. The current study sought to examine 2 positive 
outcomes, meaning in life and personal growth, among physicians and nurses 
working with hospitalized children and exposed to different levels of patient 
mortality. In addition, the contribution of level of secondary traumatization 
and the personal resources of professional self-esteem and optimism were 
examined. The sample consisted of 58 physicians and 66 nurses working in 
pediatric hemato-oncology, pediatric intensive care units, and pediatric 
internal medicine wards in Israel. The findings indicate that a higher level of 
exposure to patient death, higher optimism, and professional self-esteem, and 
lower secondary traumatization predicted the sense of meaning in life, whereas 
occupation, as well as higher professional self-esteem and higher level of 
secondary traumatization, especially among lower professional self-esteem 
individuals, predicted a higher experience of personal growth. In addition, 
nurses reported higher levels of professional self-esteem, secondary 
traumatization, and personal growth than physicians. The theoretical and 
practical implications of the results are discussed.

DOI: 10.1080/07481180802215627
PMID: 18924291 [Indexed for MEDLINE]


4676. Arch Dis Child Fetal Neonatal Ed. 2009 Mar;94(2):F98-F104. doi: 
10.1136/adc.2007.135921. Epub 2008 Jul 17.

Psychological stress of parents of preterm infants enrolled in an early 
discharge programme from the neonatal intensive care unit: a prospective 
randomised trial.

Sáenz P(1), Cerdá M, Díaz JL, Yi P, Gorba M, Boronat N, Barreto P, Vento M.

Author information:
(1)Neonatal Research Unit, Servicio de Neonatología, Hospital Universitario 
Materno Infantil La Fe, Avenida de Campanar 21, Valencia, Spain.

BACKGROUND: Psychological stress of parents of preterm infants is aggravated by 
prolonged hospitalisation. Early discharge programmes (EDPs) have been 
implemented to alleviate this situation.
OBJECTIVE: To evaluate parental psychological stress in an EDP for the first 3 
months after neonatal intensive care unit (NICU) discharge.
DESIGN/METHODS: Prospective randomised trial comparing parents of preterm 
infants assigned to EDP (n = 72) or standard discharge programme (SDP) (standard 
discharge) (n = 68). At discharge, parents were evaluated using the Hospital 
Anxiety and Depression Scale (HAD), and the Likert Scale for well-being every 10 
days for 3 months. Parental narrative of Worrying and Helping issues was 
assessed using a semi-structured interview.
RESULTS: Length of stay was greater in the SDP group (p<0.01). HAD showed no 
differences in anxiety, but SDP mothers scored higher in depression (p<0.05). 
Altogether, parents reported a worrisome emotional condition (EDP 87.2%; SDP 
80%), which decreased at the end of the study (EDP 45.2%; SDP 34.5%). Their 
baby's physical well-being was the most relevant issue in the narrative for 
Worrying and Helping issues at discharge (EDP 69.2%; SDP 67.5%); however, it 
decreased at the end of the study (EDP 22.6%; SDP 24.1%). At discharge, the 
paediatrician's support was more for the SDP group. No differences on the 
Well-Being Scale were found, but the EDP group always scored better.
CONCLUSIONS: Vulnerability of parents enrolled in an EDP did not increase after 
hospital discharge. Physical well-being of the baby was the most important issue 
for both groups. EDP parents requested less paediatric support and scored higher 
in the Well-being verbatim.

DOI: 10.1136/adc.2007.135921
PMID: 18635681 [Indexed for MEDLINE]


4677. Crit Care Med. 2008 Mar;36(3):801-6. doi: 10.1097/CCM.0B013E3181652FEE.

Short- and long-term follow-up of intensive care unit patients after sedation 
with isoflurane and midazolam--a pilot study.

Sackey PV(1), Martling CR, Carlswärd C, Sundin O, Radell PJ.

Author information:
(1)Section of Anesthesiology and Intensive Care Medicine, Karolinska Institutet, 
Stockholm, Sweden. peter.sackey@karolinska.se

Comment in
    Crit Care Med. 2008 Mar;36(3):1006-7.

OBJECTIVE: To compare memories from the intensive care unit (ICU) and short- and 
long-term psychological morbidity in patients after sedation with intravenous 
midazolam or inhaled isoflurane.
DESIGN: Prospective long-term follow-up after randomized controlled trial.
SETTING: General ICU at Karolinska University Hospital, Solna, Stockholm.
PATIENTS: Forty patients in need of sedation during ventilator treatment.
INTERVENTIONS: Patients were randomized to receive isoflurane or midazolam for 
goal-directed sedation until extubation or for a maximum of 96 hrs.
MEASUREMENTS AND MAIN RESULTS: For short-term follow-up, doctors', nurses', and 
physiotherapists' notes from the 4 days following exposure to the study drugs 
were reviewed for words indicating adequate or pathologic cognitive and 
psychological recovery. For long-term follow-up, all 6-month survivors received 
questionnaires including the ICU Memory Tool (ICU-MT), Hospital Anxiety and 
Depression Scale (HADS), Impact of Event Scale (IES), and Well-Being Index. 
Additionally, several screening questions for previous posttraumatic stress 
symptoms were included. In the short term follow-up, no significant differences 
were found between groups. In the long-term follow-up, a trend toward fewer 
hallucinations/delusions after isoflurane sedation than after midazolam (two of 
ten isoflurane patients vs. five of seven midazolam patients) was found (p = 
.06). None of the five solely isoflurane-sedated patients reported 
hallucinations/delusions from the ICU. There was no difference in groups in 
long-term psychological morbidity as measured with HADS and IES. Memories of 
negative feelings in the ICU (ICU-MT) were associated with high HADS and IES 
scores (Fisher's exact test, p = .02 and p = .01, respectively).
CONCLUSIONS: Sedation of ICU patients with isoflurane may result in fewer 
delusional memories or hallucinations from the ICU compared with more commonly 
used intravenous sedation. Memories of negative feelings from the ICU were 
associated with symptoms of depression or anxiety or symptoms indicating 
posttraumatic stress disorder. Further study of memory and 
cognitive/psychological recovery after prolonged isoflurane sedation beyond 96 
hrs is warranted.

DOI: 10.1097/CCM.0B013E3181652FEE
PMID: 18431266 [Indexed for MEDLINE]


4678. J Adv Nurs. 2008 May;62(3):276-92. doi: 10.1111/j.1365-2648.2007.04568.x.

Short- and long-term impact of critical illness on relatives: literature review.

Paul F(1), Rattray J.

Author information:
(1)School of Nursing and Midwifery, University of Dundee, Tayside Campus, 
Ninewells Hospital, Dundee, UK. f.paul@dundee.ac.uk

AIM: This paper is a report of a literature review undertaken to identify the 
short- and long-term impact of critical illness on relatives.
BACKGROUND: Patients in intensive care can experience physical and psychological 
consequences, and their relatives may also experience such effects. Although it 
is recognized that relatives have specific needs, it is not clear whether these 
needs are always met and whether further support is required, particularly after 
intensive care.
DATA SOURCES: The following databases were searched for the period 1950-2007: 
Medline, British Nursing Index and Archive, EMBASE, CINAHL, PsycINFO and EMB 
Reviews--Cochrane Central Register of Clinical Trials.
SEARCH METHODS: Search terms focused on adult relatives of critically ill adult 
patients during and after intensive care. Recurrent topics were categorized to 
structure the review, i.e. 'relatives needs', 'meeting relatives' needs', 
'interventions', 'satisfaction', 'psychological outcomes' and 'coping'.
RESULTS: Studies have mainly identified relatives' immediate needs using the 
Critical Care Family Needs Inventory. There are few studies of interventions to 
meet relatives' needs and the short- and long-term effects of critical illness 
on relatives.
CONCLUSION: Despite widespread use of the Critical Care Family Needs Inventory, 
factors such as local or cultural differences may influence relatives' needs. 
Relatives may also have unidentified needs, and these needs should be explored. 
Limited research has been carried out into interventions to meet relatives' 
needs and the effects of critical illness on their well-being, yet some 
relatives may experience negative psychological consequences far beyond the 
acute phase of the illness.

DOI: 10.1111/j.1365-2648.2007.04568.x
PMID: 18426451 [Indexed for MEDLINE]


4679. Aust Crit Care. 2005 Feb;18(1):17-8, 20-4. doi: 10.1016/s1036-7314(05)80020-7.

Life beyond severe traumatic injury: an integrative review of the literature.

Halcomb E(1), Daly J, Davidson P, Elliott D, Griffiths R.

Author information:
(1)School of Nursing, Family and Community Health College of Social and Health 
Sciences, University of Western Sydney, NSW.

It is only recently that recognition of the serious and debilitating sequelae of 
trauma has prompted exploration of outcomes beyond survival, such as disability, 
health status and quality of life. This paper aims to review the literature 
describing outcomes following severe traumatic injury to provide clinicians with 
a greater understanding of the recovery trajectory following severe trauma and 
highlight the issues faced by those recovering from such injury. Electronic 
databases, published reference lists and the Internet were searched to identify 
relevant literature. The heterogeneous nature of published literature in this 
area prohibited a systematic approach to inclusion of papers in this review. 
Trauma survivors report significant sequelae that influence functional status, 
psychological wellbeing, quality of life and return to productivity following 
severe injury. Key themes that emerge from the review include: current trauma 
systems which provide inadequate support along the recovery trajectory; 
rehabilitation referral which is affected by geographical location and provider 
preferences; a long-term loss of productivity in both society and the workplace; 
a high incidence of psychological sequelae; a link between poor recovery and 
increased drug and alcohol consumption; and valued social support which can 
augment recovery. Future research to evaluate interventions which target the 
recovery needs of the severely injured patients is recommended. Particular 
emphasis is required to develop systematic, sustainable and cost-effective 
follow-up to augment the successes of existing acute trauma services in 
providing high quality acute resuscitation and definitive trauma management.

DOI: 10.1016/s1036-7314(05)80020-7
PMID: 18038530 [Indexed for MEDLINE]


4680. Issues Ment Health Nurs. 2007 Jun;28(6):593-605. doi: 10.1080/01612840701354505.

Sleep disturbance, fatigue, and stress among Chinese-American parents with ICU 
hospitalized infants.

Lee SY(1), Lee KA, Rankin SH, Weiss SJ, Alkon A.

Author information:
(1)Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, 
Georgia 30302-4019, USA. slee29@gsu.edu

The purpose of this study is to describe Chinese-American parents' sleep 
disturbances and fatigue in relation to their stress levels, resulting from the 
hospitalization of their infants in intensive care units (ICUs). Four sets of 
data were collected: (1) Parents' demographic data and infant's medical records; 
(2) Subjective sleep data gathered from the General Sleep Disturbance Scale, 
from sleep diary descriptions, and objective sleep data from wrist actigraphy 
recordings; (3) Fatigue severity from the Numerical Rating Scale-Fatigue; and 
(4) Data from the Parental Stressor Scale: Infant Hospitalization. A majority of 
the mothers (93%) and fathers (60%) experienced sleep problems after their 
infants were admitted to the ICU. Mothers reported greater sleep disturbances 
and more severe fatigue than did fathers. Actigraphy records showed that mothers 
experienced much more wakeful time during the night than did fathers. In both 
gender categories, less total sleep time was related to reports of higher 
parental stress, and higher morning fatigue was related to subjectively reported 
sleep disturbances. Findings from this preliminary study demonstrate significant 
relationships among parents' perceived stress, impaired sleep, and fatigue 
severity during the infant's hospitalization period. Findings suggest 
implications for education of both ICU parents and staffs. This study could be 
replicated with a bigger sample size to further examine the relationships 
between parental stress and well-being.

DOI: 10.1080/01612840701354505
PMID: 17613158 [Indexed for MEDLINE]


4681. J Obstet Gynecol Neonatal Nurs. 2007 Jul-Aug;36(4):366-75; quiz 376. doi: 
10.1111/j.1552-6909.2007.00158.x.

Feeding outcomes of extremely premature infants after neonatal care.

Thoyre SM(1).

Author information:
(1)School of Nursing, Carrington Hall, University of North Carolina at Chapel 
Hill, NC 27599-7460, USA. thoyre@email.unc.edu

Feeding is a primary concern for families of extremely preterm (EP) infants 
following discharge from neonatal care. An increasing number of EP children are 
being referred for treatment of feeding problems, including eating only a few 
types of food or very small portions, difficulty transitioning to textured 
foods, and refusing food. These issues have the potential for significant 
consequences for the children's growth and development as well as their family's 
well-being. An understanding of the kinds of feeding problems faced by families 
of EP infants can help nurses guide families to be ready for and respond to 
these issues. In this article, the evidence for and the nature of feeding 
problems in EP children after discharge from neonatal care are examined.

DOI: 10.1111/j.1552-6909.2007.00158.x
PMID: 17594415 [Indexed for MEDLINE]


4682. J Perinat Neonatal Nurs. 2007 Apr-Jun;21(2):140-8; quiz 149-50. doi: 
10.1097/01.JPN.0000270631.96864.d3.

Sleep in the neonatal intensive care unit.

Bertelle V(1), Sevestre A, Laou-Hap K, Nagahapitiye MC, Sizun J.

Author information:
(1)Neonatal Intensive Care Unit, Department of Paediatrics, University Hospital, 
Sherbrooke, Québec, Canada. Valerie.Bertelle@USherbrooke.ca

Recent experimental data suggest a strong role for sleep in brain development. 
As sleep is the predominant behavioral state in the term and especially the 
preterm newborn, these data underline the importance of respecting sleep 
duration and organization within the different sleep states. Polysomnography is 
the preferred technique used for identification of sleep state; however, 
behavioral observations-under the condition that the observer is well 
trained-may prove as efficient. Newborns hospitalized in the neonatal intensive 
care unit are exposed to many stimuli and care activities that disrupt their 
sleep organization and may have irreversible effects on their brain development. 
In order to improve the long-term neurobehavioral outcome of these high-risk 
subjects, a consistent care approach is proposed. Application of the Neonatal 
Individualized Developmental Care and Assessment Program decreases environmental 
stressful events and promotes harmonious well-being behaviors, based on an 
individual approach. This strategy has encouraging results, showing an increase 
in sleep duration under Neonatal Individualized Developmental Care and 
Assessment Program conditions, but further studies are needed to assess its 
long-term neurobehavioral impact.

DOI: 10.1097/01.JPN.0000270631.96864.d3
PMID: 17505234 [Indexed for MEDLINE]


4683. J Clin Nurs. 2007 Apr;16(4):777-85. doi: 10.1111/j.1365-2702.2006.01634.x.

Does the experimental design capture the effects of complementary therapy? A 
study using reflexology for patients undergoing coronary artery bypass graft 
surgery.

Gunnarsdottir TJ(1), Jonsdottir H.

Author information:
(1)School of Nursing, University of Minnesota, MN, USA. thoraj@hi.is

AIM: Our purpose was to pilot test whether reflexology may reduce anxiety in 
patients undergoing Coronary Artery Bypass Graft Surgery in Iceland.
BACKGROUND: Nurses need to study the effects of complementary therapies in 
general and particularly those that may be beneficial to decrease patients' 
anxiety. It has been assumed that reflexology lessens anxiety, but research is 
needed to substantiate such expectations.
DESIGN: A pilot study using randomized design with experimental and control 
groups.
METHODS: Nine patients were recruited and randomly assigned into groups with 
five patients assigned into an experimental group receiving reflexology for 30 
minutes and four patients into control group which rested for 30 minutes. 
Anxiety and physiological variables were measured pre- and post-reflexology 
sessions once a day over five days.
RESULTS: The anxiety scores were lower for patients in the control group on all 
measures. Systolic blood pressure lowered significantly more in the control 
group than in the treatment group. No significant changes were observed for 
other variables. Patients' comments and responses overwhelmingly suggested 
increased well-being due to both experimental and control intervention.
CONCLUSION: This study showed little evidence to support reflexology as a mean 
of reducing anxiety in CABG patients. Several methodological problems were 
identified that need to be considered further.
RELEVANCE TO CLINICAL PRACTICE: It is suggested that reflexology should be 
tailored to individual needs and research methods used that allow for capturing 
its holistic nature. Further scholarly work is warranted to explore several 
methodological issues in studying complementary therapies in a highly complex 
treatment situation.

DOI: 10.1111/j.1365-2702.2006.01634.x
PMID: 17402960 [Indexed for MEDLINE]


4684. Chest. 2007 Jun;131(6):1685-93. doi: 10.1378/chest.06-1398. Epub 2007 Mar 30.

Sleep and well-being of ICU housestaff.

Parthasarathy S(1), Hettiger K, Budhiraja R, Sullivan B.

Author information:
(1)Section of Pulmonary and Critical Care Medicine, Southern Arizona Veterans 
Administration Health Care System, 3601 South Sixth Ave, Tucson, AZ 85723, USA. 
spartha@arc.arizona.edu

BACKGROUND: Our understanding of the effect of the Accreditation Council for 
Graduate Medical Education (ACGME)-mandated work-hour limitation on physicians' 
quality of life, sleepiness, and sleep-work habits is evolving. In this study, 
we sought to determine the effect of work-hour reduction on quality of life in 
residents and fellows (ICU housestaff) when subject to the ACGME-compliant 
schedule of one institution. To determine the effect of work-hour reduction on 
subjective and objective measures of sleepiness in ICU housestaff at a center.
METHODS: A single-center study of 34 residents and 10 fellows who were studied 
before and after the ACGME-mandated work-hour limitation went into effect in 
July 2003.
RESULTS: In a single center, after the work-hour reduction, residents reported 
statistically significant but minor improvements in sleep time, subjective 
sleepiness, and some aspects of quality of life (p < 0.05). Both before and 
after work-hour limitations, subjective sleepiness and quality-of-life indexes 
deteriorated during the course of the ICU rotation. Following work-hour 
reductions, subjective sleepiness improved (p < 0.05), but objective sleepiness 
was unchanged (p = 0.6). Moreover, after the implementation of work-hour 
reductions, 59%, 43%, and 25% of the ICU team had mean sleep latency < 10, 7, 
and 5 min, respectively, with 14% of the team manifesting sleep-onset rapid eye 
movement periods (signifying severe sleepiness) before beginning their extended 
work-hour period.
CONCLUSIONS: In ICU housestaff, at a single center, small benefits to quality of 
life and subjective sleepiness were realized by an ACGME-compliant work-hour 
schedule. Significant levels of objective sleepiness, however, remained. Further 
measures may need to be undertaken to address the persistence of sleepiness in 
ICU housestaff. These findings may not be generalized outside of the scheduling 
system studied.

DOI: 10.1378/chest.06-1398
PMID: 17400688 [Indexed for MEDLINE]


4685. BMJ. 2007 Jan 6;334(7583):28. doi: 10.1136/bmj.39017.675648.BE. Epub 2006 Dec 1.

Provision of taped conversations with neonatologists to mothers of babies in 
intensive care: randomised controlled trial.

Koh TH(1), Butow PN, Coory M, Budge D, Collie LA, Whitehall J, Tattersall MH.

Author information:
(1)Institute of Women's and Children's Health, Townsville Hospital, Douglas, QLD 
4814, Australia. guan_koh@health.qld.gov.au

Comment in
    BMJ. 2007 Jan 6;334(7583):1.
    Semin Fetal Neonatal Med. 2007 Jun;12(3):224-5.

OBJECTIVE: To determine whether providing mothers of babies in neonatal 
intensive care units with audiotapes of their conversations with a neonatologist 
improves recall of information and psychological wellbeing.
DESIGN: Randomised, single blinded trial.
SETTING: Neonatal intensive care unit, North Queensland, Australia.
PARTICIPANTS: 200 mothers of babies in a neonatal intensive care unit.
INTERVENTIONS: Mothers given (n=102) or not given (n=98) audiotapes of their 
conversations with a neonatologist.
MAIN OUTCOME MEASURES: Recall of information, attitudes to and use of the tape, 
satisfaction with conversations, postnatal depression, anxiety, general health, 
and stress about parenting, at 10 days and four and 12 months.
RESULTS: 91% (n=93) of mothers in the tape group listened to the tape (once by 
day 10, twice by four months, and three times by 12 months; range 1-10). At 10 
days and four months, mothers in the tape group recalled significantly more 
information about diagnosis, treatment, and outcome than mothers in the control 
group. At four months mothers in the tape group were 75% more likely to recall 
all of the information about treatment than mothers in the control group (59% v 
34%; risk ratio 1.75, 95% confidence interval 1.27 to 2.4). Six mothers, all in 
the control group, could not recall their conversations. No statistically 
significant differences were found between the groups in satisfaction with 
conversations (10 days), postnatal depression and anxiety scores (10 days, four 
and 12 months), and stress about parenting (12 months).
CONCLUSION: Providing the mothers of babies in neonatal intensive care units 
with audiotapes of conversations with a neonatologist enhanced their recall of 
information (up to four months). The taped conversations did not affect the 
mothers' wellbeing or satisfaction with the neonatologist.
TRIAL REGISTRATION: Australian Clinical Trials Registry 12606000478516.

DOI: 10.1136/bmj.39017.675648.BE
PMCID: PMC1764090
PMID: 17142256 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.


4686. Dtsch Med Wochenschr. 2006 Nov 3;131(44):2461-4. doi: 10.1055/s-2006-955030.

[Burnout and stress disorders in intensive care doctors].

[Article in German]

Kinzl JF(1), Traweger C, Biebl W, Lederer W.

Author information:
(1)Klinische Abteilung für Psychosomatische Medizin, Universitätsklinik für 
Psychiatrie, Medizinische Universität Innsbruck. johann.kinzl@uklibk.ac.at

BACKGROUND AND OBJECTIVE: The various acute and chronic demands and burdens put 
ICU staff at greater risk for developing psychological and stress disorders. It 
was the aim of this study to assess the prevalence rates of burnout-syndrome in 
anesthetists, and to evaluate the contribution of working conditions to the 
development of burnout.
METHODS: Self-reporting questionnaires were used to assess emotional well-being 
and physical health, burnout-syndrome (Maslach Burnout Inventory), and working 
conditions (Instrument for Stress-Oriented Task Analysis) in 89 anaesthetists 
(56 males, 33 females).
RESULTS: One quarter of the anaesthetists show high values on the subscales 
"emotional exhaustion" or "depersonalization", and one fifth low values on the 
subscale "lack of personal accomplishment". About one quarter of the probands 
may be seen as "at risk for burnout". Feelings of ill-health are relatively 
frequent in both sexes. Long working hours and night duties, the cooperation 
with members of different occupational groups, and small working place resources 
are seen as particular stresses.
CONCLUSION: Burnout-syndrome and psychosomatic symptoms are frequent in 
intensive care doctors. But preventive measures such as adequate resources at 
the work place and supervision can influence personal behavior and working 
conditions, and thus reduce the risk of burnout.

DOI: 10.1055/s-2006-955030
PMID: 17066355 [Indexed for MEDLINE]


4687. Pneumologie. 2006 Sep;60(9):539-46. doi: 10.1055/s-2006-932152.

[Quality of life in patients with home mechanical ventilation].

[Article in German]

Windisch W(1), Criée CP.

Author information:
(1)Abteilung Pneumologie, Universitätsklinik Freiburg. 
windisch@med1.ukl.uni-freibrug.de

Health-related quality of life (HRQL) is defined as a psychological construct 
describing the subjectively experienced health status based on different 
components of health including physical state, psychological well-being, social 
relations and functional capacities. Assessment of HRQL has become steadily more 
essential in order to evaluate the costs and benefits of modern treatment 
modalities in patients with chronic and incurable diseases. This is particularly 
true for patients with home mechanical ventilation (HMV) and severe objective 
limitations in daily living. Modern instruments such as the Severe Respiratory 
Insufficiency (SRI) Questionnaire have been specifically designed for clinical 
trials which aim at assessing the effects of HMV on HRQL in these patients. 
Recent work has shown that mental health in clinically stable patients following 
establishment of HMV can be normal despite substantial physical handicaps. 
Further, HRQL has been shown to be predominantly influenced by the underlying 
disease. Accordingly, there is increasing evidence that HMV provides beneficial 
effects on HRQL in patients with neuromuscular and thoracic rib cage diseases, 
but in contrast, this remains still controversial in patients with COPD. Here, 
prospective controlled trials using modern specific instruments for HRQL 
assessment are required in the future to reliably evaluate the effects of HMV on 
HRQL in patients with COPD.

DOI: 10.1055/s-2006-932152
PMID: 17006789 [Indexed for MEDLINE]


4688. Infect Immun. 2006 Sep;74(9):5221-6. doi: 10.1128/IAI.00208-06.

Morphine withdrawal lowers host defense to enteric bacteria: spontaneous sepsis 
and increased sensitivity to oral Salmonella enterica serovar Typhimurium 
infection.

Feng P(1), Truant AL, Meissler JJ Jr, Gaughan JP, Adler MW, Eisenstein TK.

Author information:
(1)Department of Microbiology and Immunology, Temple University School of 
Medicine, 3400 North Broad Street, Philadelphia, PA 19140, USA.

Understanding the consequences of drug withdrawal on immune function and host 
defense to infection is important. We, and others, previously demonstrated that 
morphine withdrawal results in immunosuppression and sensitizes to 
lipopolysaccharide-induced septic shock. In the present study, the effect of 
morphine withdrawal on spontaneous sepsis and on oral infection with Salmonella 
enterica serovar Typhimurium was examined. Mice were chronically exposed to 
morphine for 96 h by implantation of a slow-release morphine pellet. Abrupt 
withdrawal was induced by removal of the pellet. In the sepsis model, bacterial 
colonization was examined and bacterial species were identified by necropsy of 
various tissues. It was found that at 48 h postwithdrawal, morphine-treated mice 
had enteric bacteria that were detected in the Peyer's patches (4/5), mesenteric 
lymph nodes (4/5), spleens (4/10), livers (6/10), and peritoneal cavities 
(8/10). In placebo pellet-withdrawn mice, only 2/40 cultures were positive. The 
most frequently detected organisms in tissues of morphine-withdrawn mice were 
Enterococcus faecium followed by Klebsiella pneumoniae. Both organisms are part 
of the normal gastrointestinal flora. In the infection model, mice were orally 
inoculated with S. enterica 24 h post-initiation of abrupt withdrawal from 
morphine. Withdrawal significantly decreased the mean survival time and 
significantly increased the Salmonella burden in various tissues of infected 
mice compared to placebo-withdrawn animals. Elevated levels of the 
proinflammatory cytokines were observed in spleens of morphine-withdrawn mice, 
compared to placebo-withdrawn mice. These findings demonstrate that morphine 
withdrawal sensitizes to oral infection with a bacterial pathogen and 
predisposes mice to bacterial sepsis.

DOI: 10.1128/IAI.00208-06
PMCID: PMC1594820
PMID: 16926415 [Indexed for MEDLINE]


4689. Palliat Support Care. 2004 Dec;2(4):371-8. doi: 10.1017/s1478951504040490.

Spiritual issues and needs: perspectives from patients with advanced cancer and 
nonmalignant disease. A qualitative study.

Grant E(1), Murray SA, Kendall M, Boyd K, Tilley S, Ryan D.

Author information:
(1)Division of Community Health Sciences, University of Edinburgh, Edinburgh, 
UK. Liz.Grant@ed.ac.uk

OBJECTIVE: Health care professionals and policy makers acknowledge that 
spiritual needs are important for many patients with life-limiting illnesses. We 
asked such patients to describe their spiritual needs and how these needs may 
impinge on their physical, psychological, and social well-being. Patients were 
also encouraged to explain in what ways their spiritual needs, if they had any, 
could be addressed.
METHODS: We conducted two qualitative interviews, 3 months apart, with 20 
patients in their last year of life: 13 patients with advanced cancer and 7 with 
advanced nonmalignant illness. We also interviewed each patient's general 
practitioner. Sixty-six interviews were tape-recorded, transcribed, and 
analyzed.
RESULTS: Patients' spiritual needs centered around their loss of roles and 
self-identity and their fear of dying. Many sought to make sense of life in 
relation to a nonvisible or sacred world. They associated anxiety, 
sleeplessness, and despair with such issues, which at times resulted in them 
seeking support from health professionals. Patients were best able to engage 
their personal resources to meet these needs when affirmed and valued by health 
professionals.
SIGNIFICANCE OF RESULTS: Enabling patients to deal with their spiritual needs 
through affirmative relationships with health professionals may improve quality 
of life and reduce use of health resources. Further research to explore the 
relationship between spiritual distress and health service utilization is 
indicated.

DOI: 10.1017/s1478951504040490
PMID: 16594399 [Indexed for MEDLINE]


4690. Burns. 2006 May;32(3):269-75. doi: 10.1016/j.burns.2006.01.012. Epub 2006 Mar 9.

Delayed death in burns and the allegations of medical negligence.

Sharma BR(1).

Author information:
(1)Department of Forensic Medicine and Toxicology, Govt. Medical College & 
Hospital, # 1156-B, Sector-32 B, Chandigarh 160030, India. drbrsharma@yahoo.com

Comment in
    Burns. 2007 Feb;33(1):123-4.

Burns and deaths due to burns to remain an important public health and social 
problem in India. Most of the victims, who survive the initial 24h after burns, 
succumb to infection of the burnt area and its complications. Burns cause 
devitalization of tissues, leaving extensive raw areas, which usually remain 
moist due to the outflow of serous exudate. This exposed, moist area along with 
the dead and devitalized tissue provides the optimum environment favoring 
colonization and proliferation of numerous microorganisms, which is further 
enhanced by the depression of the immune response. All these factors, i.e., 
disruption of the skin barrier, a large cutaneous bacterial load, the 
possibility of the normal bacterial flora turning into opportunistic pathogens 
and the severe depression of the immune system, contribute towards sepsis in a 
burns victim, which usually is life threatening. Despite various advances in 
infection control measures, early detection of microorganisms and newer, broader 
spectrum antibiotics, management of burn septicemia still remains a challenge. 
Pulmonary, cardiac and other complications also contribute to the delayed deaths 
following severe burn.

DOI: 10.1016/j.burns.2006.01.012
PMID: 16527413 [Indexed for MEDLINE]


4691. BMC Health Serv Res. 2006 Feb 13;6:9. doi: 10.1186/1472-6963-6-9.

Impact of briefly-assessed depression on secondary prevention outcomes after 
acute coronary syndrome: a one-year longitudinal survey.

McGee HM(1), Doyle F, Conroy RM, De La Harpe D, Shelley E.

Author information:
(1)Health Services Research Centre, Department of Psychology, Royal College of 
Surgeons in Ireland, Dublin 2, Ireland. hmcgee@rcsi.ie

BACKGROUND: Patients with acute coronary syndromes (ACS) are at increased risk 
of further acute cardiac events. Secondary prevention aims to decrease morbidity 
and mortality post-ACS. Depression is related to increased risk in this 
population, and to poorer secondary prevention activities. However, lengthy 
depression assessment techniques preclude depression assessment in routine care. 
The present study investigated the relationship of briefly-assessed depression 
with secondary prevention outcomes one year post-ACS.
METHODS: Following ethics committee approval, hospitals recruited patients for a 
national survey of ACS. Consenting patients with ACS completed a brief 
depression scale during hospitalisation. The predictive validity of two brief 
scales was independently assessed, with groups combined for the overall sample. 
Participants then completed a one-year longitudinal follow-up postal survey of 
secondary prevention activities.
RESULTS: The response rate for follow-up was 86% (n = 681). Proportions taking 
anti-platelet (88% v 87%; p = 0.334) and lipid-lowering (83% v 84%; p = 0.437) 
therapies remained unchanged. Prevalence of smoking (40% v 22%; p < 0.001), and 
median number of cigarettes smoked (20 v 10; p < 0.001) were significantly 
reduced at one year. Fifty-six per cent of patients reported attending cardiac 
rehabilitation programmes. Of those aged < 65 years at baseline, 54% had 
returned to work at one year. A majority (56%) reported feeling physically 
better. Prevalence of depression was unchanged in those who completed a 
depression scale at both time points (15% v 17%; p = 0.434). Baseline depression 
did not predict taking anti-platelet, blood pressure or cholesterol medications 
(all p > 0.05), but did predict continuation of smoking (OR = 2.3, 95% CI 
1.3-4.0, p = 0.003), a higher (above median) number of general practitioner 
visits (OR = 2.1, 95% CI 1.3-3.4, p = 0.005), failure to return to work (OR = 
0.4, 95% CI 0.2-0.8, p = 0.015), and not feeling better (OR = 0.6, 95% CI 
0.3-1.0, p = 0.05) at one year.
CONCLUSION: Rapid depression assessment can be used to help identify patients 
with ACS at risk of a range of poorer secondary prevention outcomes. The results 
provide support for the routine screening of depression in acute settings. 
Strategies to increase rates of smoking cessation, return to work, general 
well-being and decrease health service use by depressed patients may need to 
incorporate some element of treatment for depression.

DOI: 10.1186/1472-6963-6-9
PMCID: PMC1402285
PMID: 16476160 [Indexed for MEDLINE]


4692. Taehan Kanho Hakhoe Chi. 2005 Aug;35(5):798-809. doi: 
10.4040/jkan.2005.35.5.798.

[The relationship between early neo-maternal exposure, and maternal attachment, 
maternal self-esteem and postpartum depression in the mothers of NICU infants].

[Article in Korean]

Ahn YM(1), Kim MR.

Author information:
(1)Department of Nursing, College of Medicine, Inha University, Incheon, Korea. 
aym@inha.ac.kr

PURPOSE: This study was performed to investigate the quantities of three 
neo-maternal exposures; visiting frequency, auditory contact and physical 
contact, and to examine the relationship between the quantities of each exposure 
and maternal attachment, maternal self-esteem and postpartum depression in 40 
mothers of NICU babies during the first week in the NICU.
METHOD: Each neo-maternal exposure was counted at every mother's visit to the 
newborn and maternal attachment, maternal self-esteem and postpartum depression 
were measured using the maternal attachment inventory, the maternal self-report 
inventory and Edinburgh Postpartum Depression Scale (EPDS) on the first and 
seventh day in the NICU.
RESULT: The Mean of each neo-maternal exposure was 8.77(2.81) for the visiting 
frequency, 5.82(3.66) for the auditory contact and 5.60(2.89) for the physical 
contact during 7 days in the NICU. No significant changes were found in the 
scores of maternal attachment, maternal self-esteem and postpartum depression 
between the first and the seventh day in the NICU. The quantities of 
neo-maternal exposures were positively related to the scores of maternal 
attachment and maternal self-esteem but not related to postpartum depression.
CONCLUSION: The results of the study suggest the lack of early neo-maternal 
exposure in cases of NICU hospitalization negate its beneficial effects on 
maternal psychological well-being in increasing maternal attachment and 
self-esteem. More efforts are needed for the neo-maternal interaction and the 
reevaluation of NICU visitation hours in order to promote maternal-infant 
interaction.

DOI: 10.4040/jkan.2005.35.5.798
PMID: 16208075 [Indexed for MEDLINE]


4693. J Coll Physicians Surg Pak. 2005 Jul;15(7):387-90.

Outcome of home mechanical ventilation.

Salahuddin N(1), Haider K, Husain SJ, Ali AB, Siddiqui S, Hameed F, Manasia R.

Author information:
(1)Department of Medicine, Section of Pulmonary and Critical Care Medicine, The 
Aga Khan University Hospital, Karachi.

OBJECTIVE: To determine the outcome of patients discharged home on portable 
ventilator.
DESIGN: Descriptive study.
PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi from 
January 2000 to December 2004.
PATIENTS AND METHODS: All ventilator-dependent patients discharged home were 
contacted. Survivors were administered the EQ-5D Quality-of-Life instrument. 
SPSS version 13 was used to analyze data.
RESULTS: Eleven patients were discharged home on invasive ventilation. Mean age 
was 49 years (range 10-98 years). Cause of ventilatory failure were cervical 
spine trauma in 36%, primary neurological disease in 27%, critical illness 
neuropathy and respiratory failure in 18% each. Survival rate was 73%, with 
three deaths. Mean duration of ventilation was 9.45 months (95% CI 3.24, 15.67). 
Rate of successful weaning after discharge was 36%, with 4 patients off all 
forms of ventilatory support and 2 on only nocturnal support. A 2.8 (95% CI 0.5, 
16.6) relative risk towards successful weaning was associated with the presence 
of a family member as the primary care giver. Mean scores on the EQ-5D 
descriptive tool were; mobility 2 (-/+0.82), self-care 2 (-/+0.82), usual 
activities 1.86 (-/+0.69), pain/discomfort 1.43(-/+0.79), anxiety/depression 
1.29 (-/+0.76). Mean score on the EQ-VAS was 48.2(-/+ 27.3).
CONCLUSION: In carefully selected patients, home ventilation is a viable option 
with the expectation of successful weaning and survival. Patients discharged 
home on ventilation reported a reasonably good quality of life with 
proportionately more problems related to independence compared to overall 
well-being.

PMID: 16197864 [Indexed for MEDLINE]


4694. Neuroimmunomodulation. 2005;12(5):255-69. doi: 10.1159/000087104.

Cytokine dysregulation, inflammation and well-being.

Elenkov IJ(1), Iezzoni DG, Daly A, Harris AG, Chrousos GP.

Author information:
(1)Division of Rheumatology, Immunology and Allergy, Georgetown University 
Medical Center, Washington, D.C., USA.

Cytokines mediate and control immune and inflammatory responses. Complex 
interactions exist between cytokines, inflammation and the adaptive responses in 
maintaining homeostasis, health, and well-being. Like the stress response, the 
inflammatory reaction is crucial for survival and is meant to be tailored to the 
stimulus and time. A full-fledged systemic inflammatory reaction results in 
stimulation of four major programs: the acute-phase reaction, the sickness 
syndrome, the pain program, and the stress response, mediated by the 
hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. Common 
human diseases such as atopy/allergy, autoimmunity, chronic infections and 
sepsis are characterized by a dysregulation of the pro- versus anti-inflammatory 
and T helper (Th)1 versus Th2 cytokine balance. Recent evidence also indicates 
the involvement of pro-inflammatory cytokines in the pathogenesis of 
atherosclerosis and major depression, and conditions such as visceral-type 
obesity, metabolic syndrome and sleep disturbances. During inflammation, the 
activation of the stress system, through induction of a Th2 shift, protects the 
organism from systemic 'overshooting' with Th1/pro-inflammatory cytokines. Under 
certain conditions, however, stress hormones may actually facilitate 
inflammation through induction of interleukin (IL)-1, IL-6, IL-8, IL-18, tumor 
necrosis factor-alpha and C-reactive protein production and through activation 
of the corticotropin-releasing hormone/substance P-histamine axis. Thus, a 
dysfunctional neuroendocrine-immune interface associated with abnormalities of 
the 'systemic anti-inflammatory feedback' and/or 'hyperactivity' of the local 
pro-inflammatory factors may play a role in the pathogenesis of atopic/allergic 
and autoimmune diseases, obesity, depression, and atherosclerosis. These 
abnormalities and the failure of the adaptive systems to resolve inflammation 
affect the well-being of the individual, including behavioral parameters, 
quality of life and sleep, as well as indices of metabolic and cardiovascular 
health. These hypotheses require further investigation, but the answers should 
provide critical insights into mechanisms underlying a variety of common human 
immune-related diseases.

Copyright (c) 2005 S. Karger AG, Basel

DOI: 10.1159/000087104
PMID: 16166805 [Indexed for MEDLINE]


4695. Br J Nurs. 2005 Jul 14-27;14(13):708-14. doi: 10.12968/bjon.2005.14.13.18452.

Psychological implications of admission to critical care.

Pattison N(1).

Author information:
(1)Critical Care Nursing, Royal Marsden NHS Foundation Trust, London, UK.

Admission to critical care can have far-reaching psychological effects because 
of the distinct environment. Critical care services are being re-shaped to 
address long-term sequelae, including post-traumatic stress disorder, anxiety 
and depression. The long-term consequences of critical illness not only cost the 
individual, but also have implications for society, such as diminished areas of 
health-related quality-of-life in sleep, reduced ability to return to work and 
enjoy recreational activities (Audit Commission, 1999; Hayes et al, 2000). The 
debate around the phenomenon of intensive care unit (ICU) syndrome is discussed 
with reference to current thinking. After critical care, patients may experience 
amnesia, continued hallucinations or flashbacks, anxiety, depression, and dreams 
and nightmares. Nursing care for patients while in the critical care environment 
can have a positive effect on psychological well-being. Facilitating 
communication, explaining care and rationalizing interventions, ensuring 
patients are oriented as to time and place, reassuring patients about transfer, 
providing patients,where possible, with information about critical care before 
admission and considering anxiolytic use, are all practices that have a 
beneficial effect on patient care. Follow-up services can help patients come to 
terms with their experiences of critical illness and provide the opportunity for 
them to access further intervention if desired. Working towards providing 
optimal psychological care will have a positive effect on patients' 
psychological recovery and may also help physical recuperation after critical 
care.

DOI: 10.12968/bjon.2005.14.13.18452
PMID: 16116371 [Indexed for MEDLINE]


4696. J Matern Fetal Neonatal Med. 2005 Jul;18(1):39-45. doi: 
10.1080/14767050500127740.

Physical well-being in women with a history of severe preeclampsia.

Roes EM(1), Raijmakers MT, Schoonenberg M, Wanner N, Peters WH, Steegers EA.

Author information:
(1)Department of Obstetrics and Gynecology, University Medical Centre, Nijmegen, 
The Netherlands.

OBJECTIVE: To evaluate the physical and mental health of women with a history of 
severe preeclampsia.
METHODS: In a historical cohort study 131 former patients with a history of 
severe preeclampsia and 127 control patients received questionnaires about 
experienced physical and mental complaints after delivery. At a follow-up visit 
blood pressure, body mass index, and proteinuria were measured and venous blood 
was drawn.
RESULTS: Former patients experienced significantly (p < 0.001) more frequent 
problems of headache (31% vs. 2%), right upper quadrant pain (16% vs. 1%), 
visual disturbances (21% vs. 1%), tiredness (66% vs. 27%), subjective loss of 
concentration (37% vs. 16%), and mental health (37% vs. 6%) compared with 
controls. When present, these health problems, except for tiredness, lasted 
significantly more often beyond six months postpartum compared to controls. 
Admittance to the intensive care unit was associated with headache, and 
subjective loss of memory and concentration over a longer period of time. The 
risk of recurrence of severe preeclampsia was a subject of concern in 20% of 
former patients. At follow-up, systolic and diastolic blood pressures were 
significantly higher (p < 0.001) among former patients.
CONCLUSION: Patients with a history of severe preeclampsia more frequently 
reported physical and mental complaints, also during a longer period of time.

DOI: 10.1080/14767050500127740
PMID: 16105790 [Indexed for MEDLINE]


4697. Respir Physiol Neurobiol. 2006 Feb 28;150(2-3):105-17. doi: 
10.1016/j.resp.2005.04.013.

Physiological and pathophysiological down-regulation of cough.

Widdicombe J(1), Singh V.

Author information:
(1)University of London, 116 Pepys Road, London, SW20 8NY, UK. 
johnwiddicombej@aol.com

Recent clinical studies have emphasized the up-regulation (sensitization) of 
cough in pathological conditions of the airways. However there are also many 
situations where voluntary and reflex cough can be down-regulated. These 
include: (1) chemical stimulation of breathing by hypercapnia or hypoxia or 
both, establishing that cough sensitivity can be inversely related to drive to 
breathing; (2) voluntary inhibition of cough, probably similar in mechanism to 
the depression of cough that can be induced by hypnosis and other branches of 
alternative medicine; (3) the placebo effect of many antitussive treatments; (4) 
sleep; (5) general anaesthesia; (6) central nervous disorders such as coma, 
stroke, Parkinson's disease and several other conditions where the defect in the 
protective reflexes may lead to aspiration pneumonia; (7) increased activity in 
various afferent inputs from viscera in the thorax and abdomen; (8) a number of 
bronchopulmonary clinical disorders. The list is long, but regrettably the 
nervous mechanisms of these down-regulations have been little studied. In 
addition there are a number of situations, such as exercise, coitus, talking and 
singing which, while important to coughing humans, have been not investigated in 
relation to cough. Most of the studies have been with experimental animals, and 
their extension to human research is desirable. In view of the importance of 
cough and other defensive reflexes in maintaining human well-being, far more 
research is needed. The field is wide-open.

DOI: 10.1016/j.resp.2005.04.013
PMID: 15878697 [Indexed for MEDLINE]


4698. J Adv Nurs. 2005 May;50(4):356-62. doi: 10.1111/j.1365-2648.2005.03400.x.

Communication with critically ill patients.

Alasad J(1), Ahmad M.

Author information:
(1)Department of Clinical Nursing, University of Jordan, Amman, Jordan. 
jalasad@ju.edu.jo

AIM: This paper reports a study that investigated the experiences of a group of 
critical care Jordanian nurses concerning verbal communication with critically 
ill patients.
BACKGROUND: There is evidence that communication in critical care settings is 
not sufficiently implemented in practice. Inadequate nurse-patient communication 
results in increased levels of stress and anxiety. Verbal communication can help 
patients preserve their self-identity and self-esteem, which in turn will 
enhance their well-being and optimism.
METHOD: The study was guided by the phenomenological hermeneutics of Heidegger. 
Data were generated in 2002 from in-depth interviews and overt participant 
observation, and analysed qualitatively.
FINDINGS: Unconscious patients received less verbal communication and 
interaction than verbally responsive patients.
CONCLUSION: Communication with sedated or unconscious patients in intensive care 
units should not be viewed as only an interactive process. Rather, it should be 
perceived as the means to give the information and support that such patients 
need.

DOI: 10.1111/j.1365-2648.2005.03400.x
PMID: 15842442 [Indexed for MEDLINE]


4699. South Med J. 2005 Mar;98(3):282-8. doi: 10.1097/01.SMJ.0000154773.11986.39.

Music as therapy.

Kemper KJ(1), Danhauer SC.

Author information:
(1)Department of Pediatrics, Section of Hematology and Oncology, Wake Forest 
University School of Medicine, Medical Center Blvd., WinstonSalem, NC 27157, 
USA. rfoley@wfubmc.edu

Music is widely used to enhance well-being, reduce stress, and distract patients 
from unpleasant symptoms. Although there are wide variations in individual 
preferences, music appears to exert direct physiologic effects through the 
autonomic nervous system. It also has indirect effects by modifying caregiver 
behavior. Music effectively reduces anxiety and improves mood for medical and 
surgical patients, for patients in intensive care units and patients undergoing 
procedures, and for children as well as adults. Music is a low-cost intervention 
that often reduces surgical, procedural, acute, and chronic pain. Music also 
improves the quality of life for patients receiving palliative care, enhancing a 
sense of comfort and relaxation. Providing music to caregivers may be a 
cost-effective and enjoyable strategy to improve empathy, compassion, and 
relationship-centered care while not increasing errors or interfering with 
technical aspects of care.

DOI: 10.1097/01.SMJ.0000154773.11986.39
PMID: 15813154 [Indexed for MEDLINE]


4700. Chest. 2005 Jan;127(1):166-70. doi: 10.1378/chest.127.1.166.

Psychosocial situation and physical health in 50 patients > 1 year after lung 
transplantation.

Goetzmann L(1), Scheuer E, Naef R, Vetsch E, Buddeberg C, Russi EW, Boehler A.

Author information:
(1)Department of Psychosocial Medicine, University Hospital Zurich, Zurich, 
Switzerland. lutz.goetzmann@usz.ch

BACKGROUND: Lung transplants have been performed worldwide since the early 
1980s. While numerous studies have been published on somatic aspects after lung 
transplantation, there is considerably less information available on 
psychosocial aspects and on the correlation between the physical and the 
psychosocial state of health after transplantation.
METHODS: Between 1992 and 2002, 125 patients underwent lung transplantation at 
University Hospital Zurich. To be included into the study, patients had to have 
received a lung transplant > 12 months previously and to have good knowledge of 
the German or Italian languages. With the aid of standardized questionnaires, 
psychosocial variables such as levels of anxiety and depression, self-esteem, 
and social support were determined. In addition, self-assessments of physical 
and psychological health were obtained. The medical data included information on 
FEV1, complications such as pulmonary infections, acute or chronic allograft 
rejection, and assessment of the patient's physical and psychological health by 
the treating doctors.
RESULTS: The overall degree of anxiety and depression of the lung transplant 
recipients was comparable to standard samples of an average population. However, 
male lung transplant recipients were significantly more depressed than female 
recipients. Self-esteem was higher than in clinical comparison samples. 
Preceding pulmonary complications had long-lasting effects on the level of 
anxiety, whereas nonpulmonary complications did not have such an effect.
CONCLUSIONS: Overall, the psychological well-being of patients after lung 
transplantation is similar to the normal population. Subgroups of patients with 
increased psychological distress have been identified.

DOI: 10.1378/chest.127.1.166
PMID: 15653979 [Indexed for MEDLINE]


4701. Phys Med Rehabil Clin N Am. 2005 Feb;16(1):285-305, xi. doi: 
10.1016/j.pmr.2004.06.003.

The role of rehabilitation medicine and palliative care in the treatment of 
patients with end-stage disease.

Olson E(1), Cristian A.

Author information:
(1)Department of Geriatrics and Adult Development, Mount Sinai School of 
Medicine, 130 West Kingsbridge Road, Routing number 00EX, Bronx, NY 10468, USA. 
ellen.olson@med.va.gov

Rehabilitation medicine and palliative care share many common goals. They strive 
to maximize physical function and emotional well-being to the highest extent 
possible given the nature of the underlying disease process. Many patients with 
end-stage disease experience symptoms and functional losses that diminish their 
quality of life. This article outlines the benefits that active rehabilitation 
therapy can provide to patients in the terminal stages of their disease and some 
of the ethical and practical issues faced in the planning and provision of this 
care.

DOI: 10.1016/j.pmr.2004.06.003
PMID: 15561556 [Indexed for MEDLINE]


4702. Sleep Med. 2004 Sep;5(5):507-8. doi: 10.1016/j.sleep.2004.06.004.

Effectiveness of mirtazapine in the treatment of sleep apnea/hypopnea syndrome 
(SAHS).

Castillo JL(1), Menendez P, Segovia L, Guilleminault C.

Author information:
(1)Sleep Laboratory, Clínica Santa María, University of Chile, Santiago, Chile. 
jcastill@med.uchile.cl

Several drugs have been described as possible treatments for Sleep 
Apnea/Hypopnea Syndrome (SAHS) but the data available does not support their 
use. In an animal model of central apnea the use of mirtazapine produced a 
significant reduction of apneas. We present a male patient, 82 years old, with 
excessive daytime sleepiness and loud snoring during at least 10 years. An 
overnight polysomnography (PSG) revealed an apnea/hypopnea index of 54.9 events 
per hour of sleep with a minimum pulse oximetric saturation (SaO(2)) of 78% and 
an arousal index of 40.4 per hour. A nasal CPAP titration in the second half of 
the night showed suppression of apneas with a CPAP level of 8 cmH(2)O. The 
patient refused to use the CPAP device and began with 15 mg of mirtazapine at 
bedtime. A second PSG performed after 3 months of mirtazapine showed a 
significant reduction in the apnea/hypopnea index (9.3 events per hour of sleep; 
81% minimal oxygen saturation (SaO(2))). Clinically, the patient and his wife 
reported a clear reduction of excessive daytime sleepiness and an improvement in 
self-reported functioning and well-being without any important side effects. 
This successful case appears to be the first report with mirtazapine in human 
SAHS and supports the need for an appropriate clinical trial with this drug.

DOI: 10.1016/j.sleep.2004.06.004
PMID: 15341898 [Indexed for MEDLINE]


4703. Amyotroph Lateral Scler Other Motor Neuron Disord. 2004 Mar;5(1):55-60. doi: 
10.1080/14660820310016066.

Validation of quality of life instruments in ALS.

Bourke SC(1), McColl E, Shaw PJ, Gibson GJ.

Author information:
(1)Northumbria Healthcare Trust and Freeman Hospital, UK. sbourke@doctors.org.uk

BACKGROUND: Non-invasive ventilation (NIV) probably improves survival in ALS, 
but its effect on quality of life (QoL) is less clear. Most potentially useful 
QoL instruments have not been validated in this context.
METHODS: We assessed the validity (multi-trait multi-method analysis), internal 
consistency (Cronbach's alpha), test-retest stability (intra-class correlations) 
and response to disease severity and NIV (effect size) of two generic 
instruments, the Short Form 36 (SF-36) and the General Well-being Schedule; two 
specific instruments, the Chronic Respiratory Disease Questionnaire (CRQ) and 
the Sleep Apnoea QoL Index (SAQLI), and a scale of daytime sleepiness, the 
Epworth Sleepiness Scale (ESS) in 23 subjects with ALS. Functional status, limb 
and axial muscle strength, and maximum inspiratory pressure were assessed, 
together with the QoL measurements, every two months.
RESULTS: All instruments showed good or excellent validity, internal consistency 
and test-retest stability overall. Subjects without symptomatic respiratory 
compromise had difficulty identifying activities for the CRQ dyspnoea domain and 
symptoms for the SAQLI symptoms domain. Marked floor effects were observed in 
the physical function and role domains of the SF-36. Domains assessing 
sleep-related problems and mental health showed greater effect of differences in 
respiratory function than functional status, and the greatest response to NIV.
CONCLUSIONS: Of the generic instruments the SF-36 was most useful, but limited 
by floor effects. Of the specific instruments, the SAQLI symptoms domain was 
most responsive to NIV, but this instrument took longer to complete, and several 
items were inappropriate. The CRQ and ESS are valid and responsive alternatives.

DOI: 10.1080/14660820310016066
PMID: 15204025 [Indexed for MEDLINE]


4704. Pediatrics. 2004 Jun;113(6):e597-607. doi: 10.1542/peds.113.6.e597.

Creating opportunities for parent empowerment: program effects on the mental 
health/coping outcomes of critically ill young children and their mothers.

Melnyk BM(1), Alpert-Gillis L, Feinstein NF, Crean HF, Johnson J, Fairbanks E, 
Small L, Rubenstein J, Slota M, Corbo-Richert B.

Author information:
(1)School of Nursing, University of Rochester, Rochester, New York 14642, USA. 
bernadette_melnyk@urmc.rochester.edu

OBJECTIVE: Increasing numbers of children in the United States (ie, 
approximately 200 children per 100,000 population) require intensive care 
annually, because of advances in pediatric therapeutic techniques and a changing 
spectrum of pediatric disease. These children are especially vulnerable to a 
multitude of short- and long-term negative emotional, behavioral, and academic 
outcomes, including a higher risk of posttraumatic stress disorder (PTSD) and a 
greater need for psychiatric treatment, compared with matched hospitalized 
children who do not require intensive care. In addition, the parents of these 
children are at risk for the development of PTSD, as well as other negative 
emotional outcomes (eg, depression and anxiety disorders). There has been little 
research conducted to systematically determine the effects of interventions 
aimed at improving psychosocial outcomes for critically ill children and their 
parents, despite recognition of the adverse effects of critical care 
hospitalization on the nonphysiologic well-being of patients and their families. 
The purpose of this study was to evaluate the effects of a preventive 
educational-behavioral intervention program, the Creating Opportunities for 
Parent Empowerment (COPE) program, initiated early in the intensive care unit 
hospitalization on the mental health/psychosocial outcomes of critically ill 
young children and their mothers.
DESIGN: A randomized, controlled trial with follow-up assessments 1, 3, 6, and 
12 months after hospitalization was conducted with 174 mothers and their 2- to 
7-year-old children who were unexpectedly hospitalized in the pediatric 
intensive care units (PICUs) of 2 children's hospitals. The final sample of 163 
mothers ranged in age from 18 to 52 years, with a mean of 31.2 years. Among the 
mothers reporting race/ethnicity, the sample included 116 white (71.2%), 33 
African American (20.3%), 3 Hispanic (1.8%), and 2 Indian (1.2%) mothers. The 
mean age of the hospitalized children was 50.3 months. Ninety-nine children 
(60.7%) were male and 64 (39.3%) were female. The major reasons for 
hospitalization were respiratory problems, accidental trauma, neurologic 
problems, and infections. Fifty-seven percent (n = 93) of the children had never 
been hospitalized overnight, and none had experienced a previous PICU 
hospitalization.
INTERVENTIONS: Mothers in the experimental (COPE) group received a 3-phase 
educational-behavioral intervention program 1) 6 to 16 hours after PICU 
admission, 2) 2 to 16 hours after transfer to the general pediatric unit, and 3) 
2 to 3 days after their children were discharged from the hospital. Control 
mothers received a structurally equivalent control program. The COPE 
intervention was based on self-regulation theory, control theory, and the 
emotional contagion hypothesis. The COPE program, which was delivered with 
audiotapes and matching written information, as well as a parent-child activity 
workbook that facilitated implementing the audiotaped information, focused on 
increasing 1) parents' knowledge and understanding of the range of behaviors and 
emotions that young children typically display during and after hospitalization 
and 2) direct parent participation in their children's emotional and physical 
care. The COPE workbook, which was provided to parents and children after 
transfer from the PICU to the general pediatric unit, contained 3 activities to 
be completed before discharge from the hospital, ie, 1) puppet play to encourage 
expression of emotions in a nonthreatening manner, 2) therapeutic medical play 
to assist children in obtaining some sense of mastery and control over the 
hospital experience, and 3) reading and discussing Jenny's Wish, a story about a 
young child who successfully copes with a stressful hospitalization.
OUTCOME MEASURES: Primary outcomes included maternal anxiety, negative mood 
state, depression, maternal beliefs, parental stress, and parent participation 
in their children's care, as well as child adjustment, which was assessed with 
the Behavioral Assessment System for Children (parent form). RESn (parent form).
RESULTS: COPE mothers reported significantly less parental stress and 
participated more in their children's physical and emotional care on the 
pediatric unit, compared with control mothers, as rated by nurses who were 
blinded with respect to study group. In comparison with control mothers, COPE 
mothers reported less negative mood state, less depression, and fewer PTSD 
symptoms at certain follow-up assessments after hospitalization. In addition, 
COPE mothers reported stronger beliefs regarding their children's likely 
responses to hospitalization and how they could enhance their children's 
adjustment, compared with control mothers. COPE children, in comparison with 
control children, exhibited significantly fewer withdrawal symptoms 6 months 
after discharge, as well as fewer negative behavioral symptoms and externalizing 
behaviors at 12 months. COPE mothers also reported less hyperactivity and 
greater adaptability among their children at 12 months, compared with control 
mothers. One year after discharge, a significantly higher percentage of control 
group children (25.9%) exhibited clinically significant behavioral symptoms, 
compared with COPE children (2.3%). In addition, 6 and 12 months after 
discharge, significantly higher percentages of control group children exhibited 
clinically significant externalizing symptoms (6 months, 14.3%; 12 months, 
22.2%), compared with COPE children (6 months, 1.8%; 12 months, 4.5%).
CONCLUSIONS: The findings of this study indicated that mothers who received the 
COPE program experienced improved maternal functional and emotional coping 
outcomes, which resulted in significantly fewer child adjustment problems, in 
comparison with the control group. With the increasing prevalence of 
attention-deficit/hyperactivity disorder and externalizing problems among 
children and the documented lack of mental health screening and early 
intervention services for children in this country, the COPE intervention could 
help protect this high-risk population of children from developing these 
troublesome problems. As a result, the mental health status of children after 
critical care hospitalization could be improved. With routine provision of the 
COPE program in PICUs throughout the country, family burdens and costs 
associated with the mental health treatment of these problems might be 
substantially reduced.

DOI: 10.1542/peds.113.6.e597
PMID: 15173543 [Indexed for MEDLINE]


4705. Mil Med. 2004 Mar;169(3):194-7. doi: 10.7205/milmed.169.3.194.

Management of postirradiation infection: lessons learned from animal models.

Brook I(1), Elliott TB, Ledney GD, Shoemaker MO, Knudson GB.

Author information:
(1)Radiation Medicine Department, Armed Forces Radiobiology Research Institute, 
Bethesda, MD 20889-5603, USA.

Ionizing radiation depresses host defenses and enhances susceptibility to local 
and systemic infection due to endogenous or exogenous microorganisms. Exposure 
of mice to a lethal dose of ionizing 60Co-gamma radiation induces a dose-related 
reduction in the number of both aerobic and anaerobic bacteria from 10(10-12) to 
10(4-6) per gram of stool within 4 days. The number of anaerobic bacteria stays 
low, but the number of Enterobacteriaceae per gram of stool increases 
significantly up to 10(9) by the 12th day after irradiation. This increase is 
associated with bacterial translocation of these organisms and fatal bacteremia. 
The use of quinolones in the irradiated animals was effective in controlling 
systemic endogenous Gram-negative infection after irradiation. Supplementation 
with penicillin prevented treatment failures due to Streptococcus spp. and 
increased survival. Quinolones given for 21 days also were effective in 
management of systemic exogenous infections due to orally ingested Klebsiella 
pneumoniae and Pseudomonas aeruginosa. Effectiveness of quinolones may be 
attributed to inhibition of exogenous organism growth within the gut lumen while 
preserving the anaerobic gut flora as well as their systemic antibacterial 
activity. Based on these findings, antimicrobial agents recommended for therapy 
of infection after exposure to irradiation are: ciprofloxacin, levofloxacin, 
ceftriaxone, cefepime, gentamicin +/- amoxicillin, or vancomycin.

DOI: 10.7205/milmed.169.3.194
PMID: 15080238 [Indexed for MEDLINE]


4706. CMAJ. 2004 Mar 16;170(6):965-70. doi: 10.1503/cmaj.1030442.

Fellowship training, workload, fatigue and physical stress: a prospective 
observational study.

Parshuram CS(1), Dhanani S, Kirsh JA, Cox PN.

Author information:
(1)Department of Critical Care Medicine, Hospital for Sick Children, Tornto, ON. 
chris@sickkids.ca

Comment in
    CMAJ. 2004 Mar 16;170(6):975-6.
    CMAJ. 2004 Sep 28;171(7):709; author reply 709; discussion 709-10.

BACKGROUND: Fatigue in physician trainees may compromise patient safety and the 
well-being of the trainees and limit the educational opportunities provided by 
training programs. Anecdotal evidence suggests that the on-call workload and 
physical demands experienced by trainees are significant despite duty-hour 
regulation and support from nursing staff, other trainees and staff physicians.
METHODS: We measured the workload and the level of fatigue and physical stress 
of 11 senior fellows during 35 shifts in the critical care unit at the Hospital 
for Sick Children in Toronto. We determined number of rostered hours, number of 
admissions and discharges, number and type of procedures, nurse:patient ratios 
and related measures of workload. Fellows self-reported the number of pages they 
received and the amount of time they slept. We estimated physical stress by 
using a commercially available pedometer to measure the distance walked, by 
using ambulatory electrocardiographic monitoring to determine arrhythmias and by 
determining urine specific gravity and ketone levels to estimate hydration.
RESULTS: The number of rostered hours were within current Ontario guidelines. 
The mean shift duration was 25.5 hours (range 24-27 hours). The fellows worked 
on average 69 hours (range 55-106) per week. On average during a shift, the 
fellows received 41 pages, were on non-sleeping breaks for 1.2 hours, slept 1.9 
hours and walked 6.3 km. Ketonuria was found in participants in 7 (21%) of the 
33 shifts during which it was measured. Arrhythmia (1 atrial, 1 ventricular) or 
heart rate abnormalities occurred in all 6 participants. These fellows were the 
most senior in-house physician for a mean of 9.4 hours per shift and were 
responsible for performing invasive procedures in two-thirds of their shifts.
INTERPRETATION: Established Canadian and proposed American guidelines expose 
trainees to significant on-call workload, physical stress and sleep deprivation.

DOI: 10.1503/cmaj.1030442
PMCID: PMC359430
PMID: 15023923 [Indexed for MEDLINE]


4707. Cochrane Database Syst Rev. 2003;(4):CD004423. doi: 10.1002/14651858.CD004423.

Preoperative fasting for adults to prevent perioperative complications.

Brady M(1), Kinn S, Stuart P.

Author information:
(1)Nursing Research Initiative for Scotland, Cowcaddens Road, Glasgow, UK, G4 
0BA.

Comment in
    Evid Based Nurs. 2004 Apr;7(2):44.
    Br J Perioper Nurs. 2004 Jun;14(6):245.
    Can J Surg. 2005 Oct;48(5):409-11.

BACKGROUND: Fasting before general anaesthesia aims to reduce the volume and 
acidity of stomach contents during surgery, thus reducing the risk of 
regurgitation/aspiration. Recent guidelines have recommended a shift in fasting 
policy from the standard 'nil by mouth from midnight' approach to more relaxed 
policies which permit a period of restricted fluid intake up to a few hours 
before surgery. The evidence underpinning these guidelines however, was 
scattered across a range of journals, in a variety of languages, used a variety 
of outcome measures and methodologies to evaluate fasting regimens that differed 
in duration and the type and volume of intake permitted during a restricted 
fasting period. Practice has been slow to change.
OBJECTIVES: To systematically review the effect of different preoperative 
fasting regimens (duration, type and volume of permitted intake) on 
perioperative complications and patient wellbeing (including aspiration, 
regurgitation and related morbidity, thirst, hunger, pain, nausea, vomiting, 
anxiety) in different adult populations.
SEARCH STRATEGY: Electronic databases, conference proceedings and reference 
lists from relevant articles were searched for studies of preoperative fasting 
in August 2003 and experts in the area were consulted.
SELECTION CRITERIA: Randomised controlled trials which compared the effect on 
postoperative complications of different preoperative fasting regimens on adults 
were included.
DATA COLLECTION AND ANALYSIS: Details of the eligible studies were independently 
extracted by two reviewers and where relevant information was unavailable from 
the text attempts were made to contact the authors.
MAIN RESULTS: Thirty eight randomised controlled comparisons (made within 22 
trials) were identified. Most were based on 'healthy' adult participants who 
were not considered to be at increased risk of regurgitation or aspiration 
during anaesthesia. Few trials reported the incidence of 
aspiration/regurgitation or related morbidity but relied on indirect measures of 
patient safety i.e. intra-operative gastric volume and pH. There was no evidence 
that the volume or pH of participants' gastric contents differed significantly 
depending on whether the groups were permitted a shortened preoperative fluid 
fast or continued a standard fast. Fluids evaluated included water, coffee, 
fruit juice, clear fluids and other drinks (e.g. isotonic drink, carbohydrate 
drink). Participants given a drink of water preoperatively were found to have a 
significantly lower volume of gastric contents than the groups that followed a 
standard fasting regimen. This difference was modest and clinically 
insignificant. There was no indication that the volume of fluid permitted during 
the preoperative period (i.e. low or high) resulted in a difference in outcomes 
from those participants that followed a standard fast. Few trials specifically 
investigated the preoperative fasting regimen for patient populations considered 
to be at increased risk during anaesthesia of regurgitation/aspiration and 
related morbidity.
REVIEWER'S CONCLUSIONS: There was no evidence to suggest a shortened fluid fast 
results in an increased risk of aspiration, regurgitation or related morbidity 
compared with the standard 'nil by mouth from midnight' fasting policy. 
Permitting patients to drink water preoperatively resulted in significantly 
lower gastric volumes. Clinicians should be encouraged to appraise this evidence 
for themselves and when necessary adjust any remaining standard fasting policies 
(nil-by-mouth from midnight) for patients that are not considered 'at-risk' 
during anaesthesia.

DOI: 10.1002/14651858.CD004423
PMID: 14584013 [Indexed for MEDLINE]


4708. Metabolism. 2003 Oct;52(10 Suppl 2):36-8. doi: 10.1016/s0026-0495(03)00300-7.

Dysphagia and aspiration pneumonia in patients with Alzheimer's disease.

Kalia M(1).

Author information:
(1)Department of Neurosurgery, Jefferson Medical College, Philadelphia, PA 
19107, USA.

Dysphagia and aspiration pneumonia are the 2 most serious medical conditions 
seen in late-stage Alzheimer's disease (AD) patients. Pseudobulbar dysphagia is 
associated with weight loss, which is not always prevented by optimizing the 
management of the dysphagia. Failure of basic homeostatic mechanisms appears to 
play an important role in the nutritional status of these patients. Aspiration 
pneumonia is the most common cause of death in end-stage AD. The primary 
problems that predispose to aspiration pneumonia include a reduced level of 
consciousness, dysphagia, loss of the gag reflex, periodontal disease, and the 
mechanical effects of inserting various tubes into the respiratory and 
gastrointestinal tracts. The bacterial flora involved include the indigenous 
oral flora (among which aerobes predominate) and, in the hospital or nursing 
home setting, nosocomially acquired pathogens such as Staphylococcus aureus and 
various aerobic and facultative gram-negative bacilli that may colonize in 
patients. In addition to treatment with antibiotics, adequate symptomatic 
treatment of AD patients with pneumonia is a priority in order to relieve 
suffering.

DOI: 10.1016/s0026-0495(03)00300-7
PMID: 14577062 [Indexed for MEDLINE]


4709. J Clin Epidemiol. 2003 Aug;56(8):752-9. doi: 10.1016/s0895-4356(03)00088-x.

The Severe Respiratory Insufficiency (SRI) Questionnaire: a specific measure of 
health-related quality of life in patients receiving home mechanical 
ventilation.

Windisch W(1), Freidel K, Schucher B, Baumann H, Wiebel M, Matthys H, Petermann 
F.

Author information:
(1)Department of Pneumology, University Hospital Freiburg, Killianstrasse 5, 
D-79106 Freiburg, Germany. windisch@med1.ukl.uni-freiburg.de

BACKGROUND AND OBJECTIVE: The objective of this study was to develop a specific 
instrument for measuring health-related quality of life (HRQL) in patients 
receiving home mechanical ventilation (HMV).
METHODS: The Severe Respiratory Insufficiency (SRI) Questionnaire was developed 
and tested for its psychometric properties following a multicentric clinical 
trial including 226 patients receiving HMV (mean age 57.3+/-14.0 years).
RESULTS: Forty-nine items passed the selection process and were allocated to 
seven subscales: Respiratory Complaints, Physical Functioning, Attendant 
Symptoms and Sleep, Social Relationships, Anxiety, Psychologic Well-Being, and 
Social Functioning. Cronbach's alpha was >0.7 in all subscales and >0.8 in four 
subscales indicating high internal consistency reliability. Construct validity 
was confirmed by factor analysis, indicating one summary scale that accounts for 
59.8% of the variance. Concurrent validity was confirmed by correlating 
subscales of the SRI and the SF-36 (0.21<r<0.79). Item-scale correlations 
revealed a high item discriminant validity. In addition, different diagnostic 
groups could be discriminated by the SRI. Here, the overall best HRQL was 
measured in the following order: patients with kyphoscoliosis, miscellaneous 
disorders, neuromuscular diseases, post-tuberculosis, and chronic obstructive 
pulmonary disease (P<.05).
CONCLUSION: The SRI is a new multidimensional instrument with high psychometric 
properties designed to measure specific HRQL in patients with SRI receiving HMV.

DOI: 10.1016/s0895-4356(03)00088-x
PMID: 12954467 [Indexed for MEDLINE]


4710. Hum Reprod. 2003 Jun;18(6):1234-43. doi: 10.1093/humrep/deg257.

Morbidity in a Danish national cohort of 472 IVF/ICSI twins, 1132 non-IVF/ICSI 
twins and 634 IVF/ICSI singletons: health-related and social implications for 
the children and their families.

Pinborg A(1), Loft A, Schmidt L, Andersen AN.

Author information:
(1)The Fertility Clinic, University of Copenhagen, Rigshospitalet, Denmark. 
apinborg@rh.dk

BACKGROUND: There is a lack of knowledge on child health as well as family 
well-being in IVF/ICSI twins.
METHODS: These data originated from questionnaires completed by mothers taking 
part in a national cohort study of twin and singleton births occurring in 
Denmark in 1997. The overall response rate was 83%. The three cohorts consisted 
of all IVF/ICSI twin children (n = 472), all IVF/ICSI singletons (n = 634) and 
all non-IVF/ICSI twin children (n = 1132) born in Denmark in 1997.
RESULTS: No major differences in physical health were observed between IVF/ICSI 
twins and non-IVF/ICSI twins. Compared with IVF/ICSI singletons, more IVF/ICSI 
twins were admitted to a neonatal intensive care unit (NICU) (P < 0.01) and more 
had surgical interventions (P = 0.03) and special needs (P = 0.02), moreover 
they had poorer speech development (P < 0.01). Correspondingly, IVF/ICSI twin 
mothers rated their infant's general health poorer than IVF/ICSI singleton 
mothers did. All discrepancies between IVF/ICSI twins and singletons disappeared 
after stratification for birthweight except for NICU admissions and speech 
development. Multiple logistic regression analyses showed that both IVF/ICSI and 
non-IVF/ICSI twin parents experienced more marital stress [odds ratio (OR) 2.9, 
95% CI 2.2-3.8] and that twins had more impact on the mother's life (OR 1.7, 95% 
CI 1.2-2.4) compared with singletons. Nevertheless, the only predictor of low 
divorce/separation risk was IVF/ICSI treatment.
CONCLUSION: Our study indicates that physical health of IVF/ICSI twins is 
comparable with that of non-IVF/ICSI twins. However, physical health of IVF/ICSI 
twins is poorer and the implications for the families stronger compared with 
IVF/ICSI singletons.

DOI: 10.1093/humrep/deg257
PMID: 12773452 [Indexed for MEDLINE]


4711. J Obstet Gynecol Neonatal Nurs. 2003 Mar-Apr;32(2):161-71. doi: 
10.1177/0884217503252035.

Posttraumatic stress symptoms in mothers of premature infants.

Holditch-Davis D(1), Bartlett TR, Blickman AL, Miles MS.

Author information:
(1)School of Nursing, University of North Carolina at Chapel Hill, 27599-7460, 
USA. diane_hd@unc.edu

OBJECTIVE: To examine mothers' responses to having a premature infant in the 
neonatal intensive-care unit and to determine the degree to which they appear 
similar to a posttraumatic stress response.
DESIGN: Mothers were enrolled in this descriptive, correlational study shortly 
before the infant was discharged from the hospital. Data were collected at 
enrollment and when the infant was 6 months old, corrected for prematurity.
PARTICIPANTS: A convenience sample of 30 mothers of high-risk premature infants.
INTERVENTIONS: None.
MAIN OUTCOME MEASURES: A semistructured interview of the mothers was conducted 
at 6 months corrected age. Interview responses were analyzed to identify three 
symptoms related to posttraumatic stress disorder: re-experiencing, avoidance, 
and increased arousal. Other measures focused on maternal psychological 
well-being--neonatal intensive-care unit stress, depressive symptoms, and worry 
about the infant--and demographic characteristics. Infant illness severity 
included birth weight, length of mechanical ventilation, multiple birth, and the 
severity of neurological insults.
RESULTS: All mothers interviewed had at least one posttraumatic symptom, 12 had 
two, and 16 had three symptoms. Twenty-six mothers reported increased arousal; 
re-experiencing and avoidance were reported by 24 mothers each. The number, but 
not the type, of posttraumatic stress symptoms was related to maternal 
psychological well-being. Maternal demographic characteristics, except marital 
status, and infant illness severity, were unrelated to posttraumatic stress 
symptoms.
CONCLUSIONS: These mothers appeared to be experiencing emotional responses 
similar to posttraumatic stress reactions at 6 months after their child's 
expected birth date. Since maternal emotional responses may affect the parenting 
of premature infants, additional nursing research is needed provide a basis for 
interventions with these highly vulnerable mothers and infants.

DOI: 10.1177/0884217503252035
PMID: 12685667 [Indexed for MEDLINE]


4712. Acta Anaesthesiol Scand. 2003 Mar;47(3):278-83. doi: 
10.1034/j.1399-6576.2003.00064.x.

Analgesia following music and therapeutic suggestions in the PACU in ambulatory 
surgery; a randomized controlled trial.

Nilsson U(1), Rawal N, Enqvist B, Unosson M.

Author information:
(1)Department of Medicine and Care, Faculty of Health Science, Linköping, 
Sweden. ulrica.nilsson@orebroll.se

BACKGROUND: This study was designed to determine whether music (M), or music in 
combination with therapeutic suggestions (M/TS) could improve the postoperative 
recovery in the immediate postoperative in daycare surgery.
METHODS: One-hundred and eighty-two unpremedicated patients who underwent 
varicose vein or open inguinal hernia repair surgery under general anaesthesia 
were randomly assigned to (a). listening to music (b). music in combination with 
therapeutic suggestions or (c). blank tape in the immediate postoperative 
period. The surgical technique, anaesthesia and postoperative analgesia were 
standardized. Analgesia, the total requirement of morphine, nausea, fatigue, 
well-being, anxiety, headache, urinary problems, heart rate and oxygen 
saturation were studied as outcome variables.
RESULTS: Pain intensity (VAS) was significantly lower (P = 0.002) in the M 
(2.1), and the M/TS (1.9) group compared with the control group (2.9) and a 
higher oxygen saturation in M (99.2%) and M/TS (99.2%) group compared with the 
control (98.0%), P < 0.001, were found. No differences were noted in the other 
outcome variables.
CONCLUSION: This controlled study has demonstrated that music with or without 
therapeutic suggestions in the early postoperative period has a beneficial 
effect on patients' experience of analgesia. Although statistically significant, 
the improvement in analgesia is modest in this group of patients with low 
overall pain levels.

DOI: 10.1034/j.1399-6576.2003.00064.x
PMID: 12648193 [Indexed for MEDLINE]


4713. Heart Lung. 2003 Jan-Feb;32(1):52-8. doi: 10.1067/mhl.2003.8.

A randomized, controlled trial of 1 week of continuous positive airway pressure 
treatment on quality of life.

Profant J(1), Ancoli-Israel S, Dimsdale JE.

Author information:
(1)Department of Psychiatry, University of California, San Diego, USA.

BACKGROUND: This study examines the effect of continuous positive airway 
pressure (CPAP) treatment on quality of life (QOL)in patients with obstructive 
sleep apnea.
METHODS: Thirty-nine patients with sleep apnea were studied. Health-related 
quality of life was measured (HRQL) with the use of the Medical Outcomes Survey 
(MOS) instrument, before and after patients were randomized to receive either 1 
week of CPAP or placebo-CPAP (CPAP administered at ineffective pressure).
RESULTS: CPAP was not found to have a specific effect on QOL as compared with 
placebo-CPAP. However, several aspects of HRQL improved in both groups over time 
in this study. Time effects were found in the following subscales of the MOS: 
satisfaction with physical functioning; effects of pain; pain severity; 
cognitive functioning; mental health index I; psychological well-being I; 
depression/behavioral-emotional control; anxiety I; psychological distress I; 
positive affect II; mental health index II; psychological distress II; anxiety 
II; psychological well-being II; mental health index III; role limitations due 
to emotional problems; and physical/physiologic functioning.
CONCLUSIONS: CPAP treatment does appear to improve several aspects of HRQL. 
However, this improvement may reflect a nonspecific response (ie, placebo) 
because comparable improvements were observed in both the active treatment group 
and the placebo treatment group. Additional study with placebo-CPAP designs is 
warranted.

DOI: 10.1067/mhl.2003.8
PMID: 12571548 [Indexed for MEDLINE]


4714. Death Stud. 2002 Dec;26(10):837-49. doi: 10.1080/07481180290106607.

Post-mortem organ donation and grief: a study of consent, refusal and well-being 
in bereavement.

Cleiren MP(1), Van Zoelen AA.

Author information:
(1)Leiden University, Leiden, Netherlands. cleiren@fsw.leidenuniv.nl

Concern about the grief processes of organ donors' families are reported by 
medical staff as a reason not to ask for organ donation. Objectives of the 
current study were to examine the relation between consenting to a post-mortem 
organ donation procedure and subsequent process of grief in the bereaved. A 
cross-section survey was conducted in a representative time-sample of 95 
bereaved who lost a first-degree family member on intensive care wards in 27 
Dutch hospitals. In 36 cases an organ donation procedure took place, in 23 cases 
consent was refused and in 36 cases no request for organ donation was made to 
the bereaved. The authors found there were no differences in levels of 
depression and problems with detachment from the deceased between bereaved 
(first-degree family members) who participated in an organ donation procedure, 
those who refused consent, and families who were not approached for poet-mortem 
organ donation. No differences were found in levels of main outcome measures 
between three donation conditions. However, dissatisfaction with hospital care 
was associated with depressive and grief symptoms. The results indicate that 
consenting to organ donation in itself neither hinders nor furthers the grief 
process.

DOI: 10.1080/07481180290106607
PMID: 12440423 [Indexed for MEDLINE]


4715. Pneumologie. 2002 Oct;56(10):610-20. doi: 10.1055/s-2002-34609.

[Health-related auality of life (HRQL) in patients receiving home mechanical 
ventilation].

[Article in German]

Windisch W(1), Freidel K, Matthys H, Petermann F.

Author information:
(1)Abteilung Pneumologie, Universitätsklinik Freiburg, Germany.

Evaluation of health-related quality of life (HRQL) has become steadily more 
essential during the last two decades in research and health care practice in 
order to evaluate the human and financial costs and benefits of modern medical 
techniques. HRQL in its definition is based on different components of health 
including physical state, psychological well-being, social relations and 
functional capacities that are influenced by a persons experience, beliefs, 
expectations, and perceptions. For the purpose of assessment of HRQL several 
instruments have been developed. Generic instruments are not specific to any 
particular disease and are therefore most commonly used for general survey 
research on health allowing comparisons between disease states. In contrast, 
disease-specific questionnaires which are necessary in order to focus on domains 
most relevant to a particular disease are thought to be more sensitive than 
generic instruments following therapeutic interventions. Home mechanical 
ventilation (HMV) delivered noninvasively by a facial mask is a well established 
treatment for chronic hypercapnic respiratory failure. It is widely accepted 
that survival improves following institution of HMV in most patients with chest 
wall deformities or neuromuscular diseases while this is still controversially 
discussed in patients with COPD. However, patients receiving HMV usually have 
severe respiratory insufficiency with a past medical history of several years or 
decades, and suffer from end stage disease with objectively severe limitations 
of daily living. In addition, HMV is a time consuming and cost intensive 
therapy. Therefore, several studies have been conducted in the last decade to 
evaluate HRQL in patients receiving HMV. Recent studies using generic 
questionnaires have shown impairments in HRQL in patients receiving HMV compared 
to normals. This was primarily attributed to severe limitations in physical 
health, but not in mental health indicating that if severe physical limitation 
occurs in advanced respiratory disease this will not necessarily lead to mental 
limitation. In addition, limitations in HRQL in patients with HMV were not 
substantially higher than in patients with different chronic disease being not 
dependent on HMV. Improvements in HRQL following the institution of HMV were 
only mild or even insignificant in patients with COPD, but patients with 
restrictive ventilatory disorders are suspected to have more benefits. However, 
well validated disease-specific questionnaires which are designed to be more 
sensitive in the assessment of changes in HRQL than generic instruments have 
been introduced recently for patients with severe respiratory failure, but the 
influence of HMV to HRQL remains still unclear, since prospective studies using 
these questionnaires have yet not been finished.

DOI: 10.1055/s-2002-34609
PMID: 12375223 [Indexed for MEDLINE]


4716. Prog Urol. 2002 Jun;12(3):377-83.

[Penile prostheses and infection].

[Article in French]

Schoepen Y(1), Staerman F.

Author information:
(1)Département d'Urologie-Andrologie, Hôpital Robert Debré, avenue du Général 
Koenig, 51092-Reims.

Comment in
    Prog Urol. 2003 Apr;13(2):346.

Infection of penile prostheses, estimated to occur in 3% of cases, represent the 
major complication of this type of prosthesis. Early sepsis occurs during the 
first week and presents in the form of frank clinical features (pain, erythema, 
penile discharge); highly virulent bacteria are isolated, such as Staphylococcus 
aureus. Late sepsis occurs after an interval of several weeks to several months 
with less specific clinical features; Staphylococcus epidermidis is isolated in 
more than 50% of cases. Conventional treatment of these infections consists of 
antibiotics adapted to the local flora and removal of the prosthesis, sometimes 
followed by deferred reimplantation. Prosthetic material salvage procedures are 
now proposed. Patient-related risk factors for infection include diabetes, 
urinary tract infection and immunodepression, while procedure-related risk 
factors include the length of hospital stay, poor operative technique, prolonged 
operating time and iatrogenic urethral injuries. Prevention of sepsis of penile 
prostheses is based on prevention of these risk factors and prophylactic 
antibiotics or prolonged antibiotic therapy.

PMID: 12189743 [Indexed for MEDLINE]


4717. Zh Mikrobiol Epidemiol Immunobiol. 2002 May-Jun;(3):30-4.

[Course and outcomes of infectious endocarditis in HIV-infected patients].

[Article in Russian]

Iushchuk ND(1), Filippov PG, Filippov MG, Nagibina MV.

Author information:
(1)State Medical Stomatological University, Moscow, Russia.

39 patients with acute infectious endocarditis were observed; of these, 28 
patients had HIV infection at different stages of the disease. The specific 
features of the course of acute infectious endocarditis in HIV-infected patients 
were established. The severe course of acute septic endocarditis was observed in 
those patients whose parameters of the cell-mediated immune system (cells CD4+) 
were in the state of compensation or subcompensation. At different stages of HIV 
infection different clinical syndromes of infectious endocarditis prevailed. In 
patients with HIV infection the combined lesions of the heart valve apparatus 
were observed and mixed microflora was isolated from the blood more frequently. 
The development of acute septic endocarditis negatively affected the course of 
HIV infection and was manifested by a rapid decrease in the amount of CD4 
lymphocytes.

PMID: 12141034 [Indexed for MEDLINE]


4718. Palliat Med. 2002 Jul;16(4):331-8. doi: 10.1191/0269216302pm544oa.

Psychosocial-spiritual correlates of death distress in patients with 
life-threatening medical conditions.

Chibnall JT(1), Videen SD, Duckro PN, Miller DK.

Author information:
(1)Department of Psychiatry, Saint Louis University School of Medicine, Missouri 
63104, USA. chibnajt@slu.edu

The purpose of this study was to identify demographic, disease, health care, and 
psychosocial-spiritual factors associated with death distress (death-related 
depression and anxiety). Cross-sectional baseline data from a randomized 
controlled trial were used. Outpatients (n=70) were recruited from an urban 
academic medical centre and proprietary hospital. All patients had 
life-threatening medical conditions, including cancer; pulmonary, cardiac, 
liver, or kidney disease; HIV/AIDS; or geriatric frailty. Measures of death 
distress, physical symptom severity, depression and anxiety symptoms, spiritual 
well-being, social support, patient-perceived physician communication, and 
patient-perceived quality of health care experiences were administered. In a 
hierarchical multiple regression model, higher death distress was significantly 
associated with living alone, greater physical symptom severity, more severe 
depression symptoms, lower spiritual well-being, and less physician 
communication as perceived by the patient. Death distress as a unique 
experiential construct was discriminable among younger patients with specific, 
diagnosable life-threatening conditions, but less so among geriatric frailty 
patients. The findings suggest that the experience of death distress among 
patients with life-threatening medical conditions is associated with the 
psychosocial-spiritual dimensions of the patient's life. Attention to these 
dimensions may buffer the negative affects of death distress.

DOI: 10.1191/0269216302pm544oa
PMID: 12132546 [Indexed for MEDLINE]


4719. Mil Med. 2002 Feb;167(2 Suppl):105-6.

Management of postirradiation sepsis.

Brook I(1), Elliott TB, Ledney GD, Knudson GB.

Author information:
(1)Radiation Medicine Department, Armed Forces Radiobiology Research Institute, 
8901 Wisconsin Avenue, Bethesda, MD 20889-5603, USA.

Ionizing radiation depresses the immune defenses and enhances susceptibility to 
local and systemic infection due to endogenous or exogenous microorganisms. 
Exposure to a lethal dose of ionizing cobalt-60 gamma radiation induces a 
dose-related reduction in the number of both aerobic and anaerobic bacteria from 
10(10-12) to 10(4-6) per gram of stool within 4 days. Whereas the number of 
anaerobic bacteria stays low, the number of Enterobacteriaceae per gram of stool 
increases significantly--up to 10(9) by the 12th day following irradiation. This 
increase is associated with bacterial translocation of these organisms and fatal 
bacteremia. The use of quinolones was effective in controlling systemic 
endogenous Gram-negative infection following irradiation. Supplementation with 
penicillin prevented treatment failures due to Streptococci and increased 
survival. Quinolones given for 21 days were also effective in the management of 
systemic exogenous infections due to orally ingested Klebsiella pneumoniae and 
Pseudomonas aeruginosa. Quinolones may be effective because they inhibit growth 
of the exogenous organism within the gut lumen while preserving the anaerobic 
gut flora and their systemic antibacterial activity. Coadministration of 
antimicrobials effective against anaerobes may be required for the management of 
polymicrobial infections. The availability of both oral and parenteral routes of 
administration, the advantage of achieving selective inhibition of potential 
pathogens in the gut, and the ability to treat systemic infection make the 
quinolones promising agents for the therapy of endogenous and exogenous 
infections after irradiation.

PMID: 11873487 [Indexed for MEDLINE]


4720. Lancet. 2002 Jan 12;359(9301):99-107. doi: 10.1016/s0140-6736(02)07366-x.

Patient volume, staffing, and workload in relation to risk-adjusted outcomes in 
a random stratified sample of UK neonatal intensive care units: a prospective 
evaluation.

Tucker J(1); UK Neonatal Staffing Study Group.

Author information:
(1)Dugald Baird Centre for Research on Women's Health, Department of Obstetrics 
and Gynaecology, University of Aberdden, UK. j.s.tucker@abdn.ac.uk

Comment in
    Lancet. 2002 Jan 12;359(9301):95-6.

BACKGROUND: UK recommendations suggest that large neonatal intensive-care units 
(NICUs) have better outcomes than small units, although this suggestion remains 
unproven. We assessed whether patient volume, staffing levels, and workload are 
associated with risk-adjusted outcomes, and with costs or staff wellbeing.
METHODS: 186 UK NICUs were stratified according to volume of patients, nursing 
provision, and neonatal consultant provision. Primary outcomes were hospital 
mortality, mortality or cerebral damage, and nosocomial bacteraemia. We studied 
13515 infants of all birthweights consecutively admitted to 54 randomly selected 
NICUs. Multiple logistic regression analyses were done with every primary 
outcome as the dependent variable. Staff wellbeing and stress were assessed by 
anonymous mental health index (MHI)-5 questionnaires.
FINDINGS: Data were available for 13334 (99%) infants. High-volume NICUs treated 
the sickest infants and had highest crude mortality. Risk-adjusted mortality and 
mortality or cerebral damage were unrelated to patient volume or staffing 
provision; however, nosocomial bacteraemia was less frequent in NICUs with low 
neonatal consultant provision (odds ratio 0.65, 95% CI 0.43-0.98). Mortality was 
raised with increasing workload in all types of NICUs. Infants admitted at full 
capacity versus half capacity were about 50% more likely to die, but there was 
wide uncertainty around this estimate. Most staff had MHI-5 scores that 
suggested good mental health.
INTERPRETATION: The implications of this report for staffing policy, medicolegal 
risk management, and ethical practice remain to be tested. Centralisation of 
only the sickest infants could improve efficiency, provided that this does not 
create excessive workload for staff. Assessment of increased staffing levels 
that are closer to those in adult intensive care might be appropriate.

DOI: 10.1016/s0140-6736(02)07366-x
PMID: 11809250 [Indexed for MEDLINE]


4721. Crit Care Clin. 2001 Oct;17(4):821-42. doi: 10.1016/s0749-0704(05)70182-2.

Anxiety, delirium, and pain in the intensive care unit.

Szokol JW(1), Vender JS.

Author information:
(1)Northwestern University School of Medicine, Chicago, USA. Szokol@nwu.edu

Anxiety, agitation, delirium, and pain are common findings in the ICU. These 
unhealthy states may lead to increased irritability, discomfort, hypertension, 
tachycardia, cardiac ischemia, harmful motor activity, and psychologic disquiet 
for the patient. The appropriate treatment of these conditions may lead to 
decreased morbidity and mortality in the critically ill patient. Unfortunately, 
the management of anxiety, agitation, delirium, and pain in the intensive care 
unit is not ideal. Many patients interviewed after an ICU stay rate their pain 
control as poor and their memories of their stay as unpleasant. Furthermore, 
many caregivers lack sufficient understanding of the appropriate or indicated 
uses of drugs to allay patients' fears and pain. The use of suitable protocols 
for the proper titration of sedation of mechanically ventilated patients and 
monitoring of the level of sedation in ventilated patients may decrease the 
amount of time that patients are ventilated and may alleviate some of the 
emotional stresses of recall of painful procedures or uncomfortable mechanical 
ventilation. Future research into protocols for the care of the critically ill 
patient can enhance the overall well-being of these patients.

DOI: 10.1016/s0749-0704(05)70182-2
PMID: 11762263 [Indexed for MEDLINE]


4722. Psychosom Med. 2001 Sep-Oct;63(5):830-4. doi: 10.1097/00006842-200109000-00017.

Antepartum depressive symptomatology is associated with adverse obstetric and 
neonatal outcomes.

Chung TK(1), Lau TK, Yip AS, Chiu HF, Lee DT.

Author information:
(1)Department of Obstetrics and Gynaecology, The Chinese University of Hong 
Kong, Prince of Wales Hospital, Sha Tin, NT, Hong Kong. tonychung@cuhk.edu.hk

OBJECTIVE: The purpose of this study was to examine if depressive symptomatology 
in pregnancy is associated with adverse obstetric and neonatal outcomes.
METHOD: In a prospective observational study, 959 women were followed up 
longitudinally from early pregnancy to postpartum. The level of depression was 
measured at baseline (first antepartum visit) and in late pregnancy using the 
Beck Depression Inventory (BDI). Adverse obstetric and neonatal outcomes were 
recorded at delivery.
RESULTS: Depression in late pregnancy was associated with increased risk of 
epidural analgesia (33% vs. 19%, p =.01, adjusted RR = 2.56, 95% CI 1.24-5.30), 
operative deliveries (caesarean sections and instrumental vaginal deliveries) 
(39% vs. 27%, p =.02, adjusted RR = 2.28, 95% CI 1.15-4.53), and admission to 
neonatal care unit (24% vs. 19%, p =.03, adjusted RR = 2.18, 95% CI 1.02-4.66). 
These effects remained significant even when controlled for potential 
confounders, such as antepartum complications.
CONCLUSION: Previous studies have shown that antepartum anxiety or stress was 
associated with growth retardation, premature delivery, and epidural analgesia. 
Our findings add to this body of evidence, which together suggest an adverse 
impact of antepartum psychological morbidity on maternal and neonatal 
well-being.

DOI: 10.1097/00006842-200109000-00017
PMID: 11573032 [Indexed for MEDLINE]


4723. Intensive Care Med. 2001 Aug;27(8):1297-304. doi: 10.1007/s001340101017.

Delirium in an intensive care unit: a study of risk factors.

Dubois MJ(1), Bergeron N, Dumont M, Dial S, Skrobik Y.

Author information:
(1)Division of Critical Care, Université de Montréal, Montréal, Canada.

OBJECTIVES: (1) To establish risk factors for the development of delirium in an 
intensive care unit (ICU) and (2) to determine the effect of delirium on 
morbidity, mortality and length of stay.
DESIGN: Prospective study.
SETTING: Sixteen-bed medical/surgical ICU in a university hospital.
PATIENTS: Two hundred and sixteen consecutive patients admitted to the ICU for 
more than 24 h during 5 months were included in the study.
INTERVENTIONS: Medical history, selected laboratory values, drugs received and 
factors that may influence patient psychological and emotional well-being were 
noted. All patients were screened with a delirium scale. A psychiatrist 
confirmed the diagnosis of delirium. Major complications such as self-extubation 
and removal of catheters, as well as mortality and length of stay were recorded.
RESULTS: Forty patients (19%) developed delirium; of these, one-third were not 
agitated. In the multivariate analysis hypertension, smoking history, abnormal 
bilirubin level, epidural use and morphine were statistically significantly 
associated with delirium. Traditional factors associated with the development of 
delirium on general ward patients were not significant in our study. Morbidity 
(self-extubation and removal of catheters), but not mortality, was clearly 
increased.
CONCLUSION: Predictive risk factors for the development of delirium in studies 
outside the ICU may not be applicable to critically ill patients. Delirium is 
associated with increased morbidity. Awareness of patients at risk may lead to 
better recognition and earlier intervention.

DOI: 10.1007/s001340101017
PMID: 11511942 [Indexed for MEDLINE]


4724. Best Pract Res Clin Obstet Gynaecol. 2001 Aug;15(4):507-22. doi: 
10.1053/beog.2001.0197.

Anaesthesia and analgesia for the critically ill parturient.

Rout CC(1).

Author information:
(1)Department of Anaesthetics, School of Clinical Sciences, Nelson R Mandela 
Medical School, University of Natal, 719 Umbilo Road, Durban, Congella 4013, 
South Africa.

Anaesthetic and analgesic techniques in the critically ill are determined 
largely by the nature of the presenting illness. The commonest conditions likely 
to present as life-threatening emergencies are pre-eclampsia, obstetric 
haemorrhage, cardiac disease and severe sepsis. Issues dictating choice of 
anaesthetic technique are the patient's ability to maintain her airway, 
coagulation status, intravascular volume and haemodynamic dependence upon 
sympathetic drive, and requirements for ventilatory support and intensive care. 
Fetal well-being is an issue in the antepartum period, uteroplacental blood flow 
should be maintained and hypotension avoided. Maternal survival takes priority, 
however, and occasionally general anaesthetic techniques must be used which lead 
to neonatal respiratory depression and requirement for ventilatory support. 
Anaesthesia itself is associated with known hazards. The risks of each technique 
must be balanced against possible benefits in the context of the presenting 
illness.

Copyright 2001 Harcourt Publishers Ltd.

DOI: 10.1053/beog.2001.0197
PMID: 11478812 [Indexed for MEDLINE]


4725. Med Wieku Rozwoj. 2000;4(2 Suppl 3):105-17.

[The "Kangaroo" ward].

[Article in Polish]

Vial-Courmont M(1).

Author information:
(1)Oddział Noworodkowy Szpitala im. A. Beclere, Clamart, France.

The "Kangaroo mother" is a symbol of gentle care for the newborn in continuous 
closeness with his/her mother. This concept was for the first time introduced to 
neonatal care in Columbia as a way of compensating for technical and personnel 
shortages. In France, the first Kangaroo ward was established in the academic 
hospital in Clamart, near Paris in 1987. This ward is designed for premature 
babies of gestational age of more than 31 weeks and with birth weight more than 
1500 g as well as for newborns with non-life threatening conditions and not 
requiring intensive care. Handling the child, skin-to-skin contact and 
breast-feeding are not treated as therapeutic means but as important elements of 
the relationship between the child and his/her parents. The author discusses in 
detail the organisation of care in the Kangaroo ward and analyses its advantages 
and disadvantages for both parents and the medical staff. Apart from providing 
continuous contact between the mother and the child, the important advantages of 
this system of care are: less maternal anxiety, well-being of the child, more 
efficient participation of mothers in caring for their children. The role of the 
paediatrician in perinatal care is stressed and the principles of neonatal 
organisation are discussed.

PMID: 11328975 [Indexed for MEDLINE]


4726. Br J Anaesth. 2000 Sep;85(3):479-81. doi: 10.1093/bja/85.3.479.

Anaesthetic management of a pregnant patient in a persistent vegetative state.

Ayorinde BT(1), Scudamore I, Buggy DJ.

Author information:
(1)University Department of Anaesthesia, University Hospitals of Leicester, UK.

Pregnancy in a patient in a persistent vegetative state presents challenging 
therapeutic questions about the level of supportive management required, the 
assessment of fetal well-being, the timing and mode of delivery and the 
anaesthetic management of labour and delivery. We report the case of a 29-yr-old 
woman who had a favourable fetal outcome despite suffering hypoxic brain damage 
after a suicide attempt by a drug overdose. She was managed until the onset of 
labour on an intensive care unit and had a spontaneous vaginal delivery assisted 
by epidural anaesthesia.

DOI: 10.1093/bja/85.3.479
PMID: 11103197 [Indexed for MEDLINE]


4727. AACN Clin Issues. 2000 Feb;11(1):105-19. doi: 10.1097/00044067-200002000-00012.

Healing touch: applications in the acute care setting.

Umbreit AW(1).

Author information:
(1)Fairview University Medical Center, Minneapolis, Minnesota, USA.

Nursing has been dedicated throughout its history to addressing the physical, 
psychologic, and spiritual aspects of the patient that influence the healing 
process. Current nursing practice in acute care is focused increasingly on 
monitoring equipment, giving medications, and administering medical treatments 
in a fast-paced environment that affords few opportunities for the deeper human 
connectedness between the nurse and the one who is ill and suffering. Healing 
touch (HT) is an energy-based complementary therapy fostering that nurse-patient 
connection. Nurses are beginning to use HT with their patients to assist in 
easing pain and anxiety, promote relaxation, accelerate wound healing, diminish 
depression, and increase a patient's sense of well-being. This article reports a 
conceptual framework for use of HT in acute care settings, describes specific HT 
techniques, and reviews numerous studies that have reported positive outcomes of 
HT as a noninvasive complementary therapy.

DOI: 10.1097/00044067-200002000-00012
PMID: 11040557 [Indexed for MEDLINE]


4728. Nihon Rinsho. 2000 Aug;58(8):1734-7.

[Sleep medicine in USA and European countries--now and then].

[Article in Japanese]

Nagai A(1), Takubo T.

Author information:
(1)Tokyo Women's Medical University, First Department of Medicine.

In looking to the future in a field such as sleep medicine, there seems to be 
two general areas: (1) the scientific accomplishments that are likely to 
transpire in the years ahead and (2) how sleep medicine will be practiced in our 
evolving medical system. As the care of apnea patients becomes more standardized 
and effective, sleep medicine must be expanded scientifically and clinically, 
thereby becoming a complete and mature field. Advancing basic science and 
technology is likely to improve the well-being of patients with sleep disorders.

PMID: 10944945 [Indexed for MEDLINE]


4729. Tidsskr Nor Laegeforen. 2000 Apr 10;120(10):1186-90.

[Examples of the use of music in clinical medicine].

[Article in Norwegian]

Myskja A(1), Lindbaek M.

Author information:
(1)Seksjon for allmennmedisin, Universitetet i Oslo.

Music has been an element in medical practice throughout history. There is 
growing interest in music as a therapeutic tool. Since there is no generally 
accepted standard for how, when and where music should be applied within a 
medical framework, this literature study endeavours to present an overview of 
central areas of application of music in medicine. It further attempts to find 
tentative conclusions that may be drawn from existing clinical research on the 
efficacy of music as a medical tool. Traditionally, music has been linked to the 
treatment of mental illness, and has been used successfully to treat anxiety and 
depression and improve function in schizophrenia and autism. In clinical 
medicine several studies have shown analgetic and anxiolytic properties that 
have been used in intensive care units, both in diagnostic procedures like 
gastroscopy and in larger operations, in preoperative as well as postoperative 
phases, reducing the need for medication in several studies. The combination of 
music with guided imagery and deep relaxation has shown reduction of symptoms 
and increased well-being in chronic pain syndromes, whether from cancer or 
rheumatic origin. Music has been used as support in pregnancy and gestation, in 
internal medicine, oncology, paediatrics and other related fields. The use of 
music with geriatric patients could prove to be especially fruitful, both in its 
receptive and its active aspect. Studies have shown that music can improve 
function and alleviate symptoms in stroke rehabilitation, Parkinson's disease, 
Alzheimer's disease and other forms of dementia. The role of music in medicine 
is primarily supportive and palliative. The supportive role of music has a 
natural field of application in palliative medicine and terminal care. Music is 
well tolerated, inexpensive, with good compliance and few side effects.

PMID: 10863351 [Indexed for MEDLINE]


4730. Isr Med Assoc J. 2000 Apr;2(4):278-81.

Talismans and amulets in the Pediatric Intensive Care Unit: legendary powers in 
contemporary medicine.

Barr J(1), Berkovitch M, Matras H, Kocer E, Greenberg R, Eshel G.

Author information:
(1)Pediatric Intensive Care Unit, Assaf Harofeh Medical Center, Zerifin, Israel. 
jbarr@post.tau.ac.il

Comment in
    Isr Med Assoc J. 2000 Aug;2(8):643.

BACKGROUND: For centuries talismans and amulets have been used in many cultures 
for their legendary healing powers.
METHODS: We asked the parents of every child (Jews and Arabs) admitted to the 
Pediatric Intensive Care Unit over a 2 month period to complete a questionnaire, 
which included demographic data on the patient and the family, the use of 
talismans or other folk medicine practices, and the perception of the effects of 
these practices on the patient's well-being. A different questionnaire was 
completed by the ICU staff members on their attitude toward the use of amulets.
RESULTS: Thirty percent of the families used amulets and talismans in the ICU, 
irrespective of the socioeconomic status of the family or the severity of the 
patient's illness. Amulets and talismans were used significantly more by 
religious Jews, by families with a higher parental educational level, and where 
the hospitalized child was very young. The estimated frequency of amulet use by 
the children's families, as perceived by the staff, was significantly higher 
than actual use reported by the parents. In Jewish families the actual use of 
amulets was found to be 30% compared to the 60% rate estimated by the medical 
staff; while in Moslem families the actual use was zero compared to the staff's 
estimation of about 36%. Of the 19 staff members, 14 reported that the use of 
amulets seemed to reduce the parents' anxiety, while 2 claimed that amulet use 
sometimes interfered with the staff's ability to carry out medical treatment.
CONCLUSIONS: The use of talismans in a technologically advanced western society 
is more frequent than may have been thought. Medical and paramedical personnel 
dealing with very ill patients should be aware of the emotional and 
psychological implications of such beliefs and practices on patients and their 
families.

PMID: 10804902 [Indexed for MEDLINE]


4731. Crit Care Med. 1999 Dec;27(12):2678-83. doi: 10.1097/00003246-199912000-00012.

The effect of stress doses of hydrocortisone during septic shock on 
posttraumatic stress disorder and health-related quality of life in survivors.

Schelling G(1), Stoll C, Kapfhammer HP, Rothenhäusler HB, Krauseneck T, Durst K, 
Haller M, Briegel J.

Author information:
(1)Department of Anaesthesiology, Ludwig-Maximilians-University, Munich, 
Germany. Gustav.Schelling@ana.med.uni-muenchen.de

OBJECTIVES: The exposure to intense physical and psychological stress during 
intensive care can result in posttraumatic stress disorder (PTSD) in survivors. 
Cortisol is a biological stress mediator that can have a protective effect 
during severe stress. The administration of stress doses of hydrocortisone 
during treatment in the intensive care unit could theoretically result in a 
lower incidence of PTSD. We tested this hypothesis in survivors of septic shock.
DESIGN: A retrospective case-controlled analysis.
SETTING: A 20-bed multidisciplinary intensive care unit of a tertiary-care 
university hospital.
PATIENTS: We identified 27 patients who received standard therapy for septic 
shock. These patients served as controls and were compared with an equal number 
of patients who received hydrocortisone in addition to standard treatment. These 
patients were selected from our database with regard to age (+/-4 yrs), gender, 
and cause of septic shock to be as similar as possible with control patients.
INTERVENTIONS: Patients from the hydrocortisone group had received stress doses 
of hydrocortisone (100 mg bolus, followed by 0.18 mg/kg/hr) in addition to 
standard treatment. Patients from the control group received standard 
protocol-driven treatment only. PTSD was diagnosed with the Posttraumatic Stress 
Syndrome-10 inventory, a self-report scale for diagnosis of PTSD. Health-related 
quality of life was measured using the Medical Outcomes Study Short-Form Survey 
(Medical Outcomes Trust, Boston, MA), which consists of 36 questions.
MEASUREMENTS AND MAIN RESULTS: Patients who received hydrocortisone during 
septic shock had a significantly lower incidence of PTSD than patients who 
received standard treatment only (5 of 27 vs. 16 of 27; p = .01) and had 
significantly higher scores on the mental health index of the Medical Outcomes 
Study Short-Form health-related quality-of-life questionnaire (68 vs. 44 points; 
p = .009).
CONCLUSIONS: Data from this study support the hypothesis that the administration 
of stress doses of hydrocortisone in doses equivalent to the maximal endocrine 
secretion rate during septic shock reduces the incidence of PTSD and improves 
emotional well-being in survivors. This hypothesis should be tested in a 
prospective randomized trial.

DOI: 10.1097/00003246-199912000-00012
PMID: 10628609 [Indexed for MEDLINE]


4732. J Trauma. 1999 May;46(5):765-71; discussion 771-3. doi: 
10.1097/00005373-199905000-00003.

Outcome after major trauma: 12-month and 18-month follow-up results from the 
Trauma Recovery Project.

Holbrook TL(1), Anderson JP, Sieber WJ, Browner D, Hoyt DB.

Author information:
(1)Department of Family and Preventive Medicine, University of California, San 
Diego 92103-8213, USA.

BACKGROUND: The importance of outcome after major injury has continued to gain 
attention in light of the ongoing development of sophisticated trauma care 
systems in the United States. The Trauma Recovery Project (TRP) is a large 
prospective epidemiologic study designed to examine multiple outcomes after 
major trauma in adults aged 18 years and older, including quality of life, 
functional outcome, and psychologic sequelae such as depression and 
posttraumatic stress disorder (PTSD). Patient outcomes were assessed at 
discharge and at 6, 12, and 18 months after discharge. The specific objectives 
of the present report are to describe functional outcomes at the 12-month and 
18-month follow-ups in the TRP population and to examine the association of 
putative risk factors with functional outcome.
METHODS: Between December 1, 1993, and September 1, 1996, 1,048 eligible trauma 
patients triaged to four participating trauma center hospitals in the San Diego 
Regionalized Trauma System were enrolled in the TRP study. The admission 
criteria for patients were as follows: (1) age 18 years or older; (2) Glasgow 
Coma Scale score on admission of 12 or greater; and (3) length of stay greater 
than 24 hours. Functional outcome after trauma was measured before and after 
injury using the Quality of Well-Being (QWB) Scale, an index sensitive to the 
well end of the functioning continuum (0 = death, 1.000 = optimum functioning). 
Follow-up at 12 months after discharge was completed for 806 patients (79%), and 
follow-up at 18 months was completed for 780 patients (74%). Follow-up contact 
at any of the study time points (6, 12, or 18 months) was achieved for 926 (88%) 
patients.
RESULTS: The mean age was 36 +/- 14.8 years, and 70% of the patients were male; 
52% were white, 30% were Hispanic, and 18% were black or other. Less than 40% of 
study participants were married or living together. The mean Injury Severity 
Score was 13 +/- 8.5, with 85% blunt injuries and a mean length of stay of 7 +/- 
9.2 days. QWB scores before injury reflected the norm for a healthy adult 
population (mean, 0.810 +/- 0.171). At the 12-month follow-up, there were very 
high levels of functional limitation (QWB mean score, 0.670 +/- 0.137). Only 18% 
of patients followed at 12 months had scores above 0.800, the norm for a healthy 
population. There was no improvement in functional limitation at the 18-month 
follow-up (QWB mean score, 0.678 +/- 0.130). The majority of patients (80%) at 
the 18-month follow-up continued to have QWB scores below the healthy norm of 
0.800. Postinjury depression, PTSD, serious extremity injury, and intensive care 
unit days were significant independent predictors of 12-month and 18-month QWB 
outcome.
CONCLUSION: This study demonstrates a prolonged and profound level of functional 
limitation after major trauma at 12-month and 18-month follow-up. This is the 
first report of long-term outcome based on the QWB Scale, a standardized 
quality-of-life measure, and provides new and provocative evidence that the 
magnitude of dysfunction after major injury has been underestimated. Postinjury 
depression, PTSD, serious extremity injury, and intensive care unit days are 
significantly associated with 12-month and 18-month QWB outcome.

DOI: 10.1097/00005373-199905000-00003
PMID: 10338392 [Indexed for MEDLINE]


4733. J Clin Nurs. 1999 Jan;8(1):13-21. doi: 10.1046/j.1365-2702.1999.00201.x.

The psychological consequences of source isolation: a review of the literature.

Gammon J(1).

Author information:
(1)Smansea Institute of Higher Education, Faculty of Humanities, Education and 
Healthcare, West Glamorgan, UK.

Source isolation can be an extremely frightening and anxiety provoking 
experience. With the many epidemiological changes that are prevalent in the UK 
today the need to care for individuals in source isolation is becoming 
increasingly important to prevent the spread of infection in hospitals. However, 
the psychological effects of source isolation are not well understood or 
researched. This review defines and examines the historical developments of 
source isolation and then discusses related research which suggests possible 
effects of source isolation on an individual's psychological well-being. 
Research which has determined the effects of sensory deprivation and social 
isolation are discussed, together with literature on the intensive care 
syndrome. This review highlights the lack of research on the psychological 
effects of source isolation. Furthermore, literature and research on related 
aspects of isolation suggests very serious effects are noted on the 
psychological well-being of individuals. Whilst a cessation of source isolation 
is not an option, urgent research is required to examine what nurse 
interventions can be implemented to ameliorate these negative effects.

DOI: 10.1046/j.1365-2702.1999.00201.x
PMID: 10214165 [Indexed for MEDLINE]


4734. Respir Med. 1998 Dec;92(12):1311-20. doi: 10.1016/s0954-6111(98)90135-4.

Non-invasive home ventilation in patients over 75 years of age: tolerance, 
compliance, and impact on quality of life.

Janssens JP(1), Cicotti E, Fitting JW, Rochat T.

Author information:
(1)Department of Geriatrics, Geneva University Hospitals, Switzerland.

The adequacy of domiciliary non-invasive positive pressure ventilation (NIHV) 
for hypercapnic restrictive pulmonary disease in patients aged 75 years or above 
has been questioned, because of a lower life expectancy, a higher risk of 
neuropsychological impairment and a lower potential for adapting to NIHV. This 
study aims to illustrate that the use of NIHV is possible and efficient in this 
age group. In our referral area, all patients under NIHV have been included in a 
database since 1994; at the end of 1996, all patients in whom NIHV had been 
initiated at age 75 years or above were studied. We performed a cross-sectional 
study of six patients (two men, four women, age: 79 +/- 3 years at time of 
study) who had been under NIHV for 31 +/- 17 months. Patients underwent 
pulmonary function testing, assessment of respiratory muscle strength, physical 
disability and neuropsychological performance, tolerance and compliance to NIHV, 
and health-related quality of life (SF-36, St. George Respiratory Questionnaire: 
SGRQ). Hospitalization rates were recorded for the year prior and the 2 yr 
following initiation of NIHV. By the time of the study, all patients showed 
improved arterial blood gases when compared to values before NIHV (PaCO2: 46 +/- 
9 vs 66 +/- 10 mmHg, P = 0.04). Patients adapted well to NIHV, with minor 
side-effects and an average daily use of ventilator of 10.5 +/- 2 h. None of the 
patients showed signs of emotional disturbance. SF-36 scores for mental health, 
subjective well-being and vitality, or social functioning, did not differ from 
that of age-matched controls. SGRQ scores were similar to those published for 
younger patients under NIHV. Use of health care facilities was similar to that 
of younger patients under NIHV; hospitalization rates decreased significantly 
after initiating NIHV (40 +/- 31 days for year before NIHV, vs 13 +/- 14 days 
and 0.8 +/- 0.4 days for the 2 yr following NIHV, P = 0.02). Age above 75 years 
should not be considered per se as a contraindication to NIHV in patients with 
well-accepted indications for this treatment. Our results suggest that in this 
age group, the cost/benefit ratio of NIHV may be favourable.

DOI: 10.1016/s0954-6111(98)90135-4
PMID: 10197223 [Indexed for MEDLINE]


4735. Am J Respir Crit Care Med. 1999 Feb;159(2):461-7. doi: 
10.1164/ajrccm.159.2.9803121.

Randomized placebo-controlled crossover trial of continuous positive airway 
pressure for mild sleep Apnea/Hypopnea syndrome.

Engleman HM(1), Kingshott RN, Wraith PK, Mackay TW, Deary IJ, Douglas NJ.

Author information:
(1)Department of Respiratory Medicine, University of Edinburgh, United Kingdom.

Comment in
    Am J Respir Crit Care Med. 2001 Mar;163(4):809-10.

The minimal disease severity at which patients with the sleep apnea/hypopnea 
syndrome (SAHS) gain benefit from treatment is not well characterized, although 
a pilot study of continuous positive airway pressure (CPAP) therapy showed 
daytime improvements in patients with 5 to 15 apneas + hypopneas per hour slept 
(AHI). We have thus performed a second, larger, randomized, placebo- controlled 
study in a prospective series of 34 patients (13 female) with mild SAHS (AHI 5 
to 15) and daytime sleepiness. Patients spent 4 wk on CPAP treatment and 4 wk on 
an oral placebo, with randomization of treatment order, and daytime assessments 
on the last day of each treatment. Effective CPAP use averaged 2.8 +/- 2.1 h 
(mean +/- SD) per night. Compared with placebo, CPAP improved symptom score (p < 
0.01), subjective (Epworth; p < 0.01) but not objective (maintenance of 
wakefulness test; p > 0.2) sleepiness, performances on 2 of 7 cognitive tasks (p 
< 0.02), depression score (p < 0.01), and five subscales of the SF-36 
health/functional status questionnaire (p </= 0.03). Fourteen of 34 patients 
preferred CPAP. In 14 patients with AHI in the range 5 to 10, symptoms, 
cognitive function, psychological well-being and quality of life were improved. 
These results confirm benefits for daytime function after CPAP treatment for 
mild SAHS, but highlight unacceptability of CPAP in many such patients.

DOI: 10.1164/ajrccm.159.2.9803121
PMID: 9927358 [Indexed for MEDLINE]


4736. Am Surg. 1998 Aug;64(8):718-21; discussion 721-2.

The effects of bacterial overgrowth and hemorrhagic shock on mucosal immunity.

Gordon DM(1), Diebel LN, Liberati DM, Myers TA.

Author information:
(1)Department of Surgery, Wayne State University, Detroit, Michigan, USA.

Impairment in systemic and mucosal immune function is noted after hemorrhagic 
shock (HS). Overgrowth of gut microflora is common after shock insults and may 
act as a reservoir for intensive care unit-acquired infections and subsequent 
remote organ failure. Secretory immunoglobulin A (IgA), the principle 
immunoglobulin in intestinal secretions, is the first line of defense of mucosal 
surfaces. Although HS and gut bacterial overgrowth are often temporarily 
related, their combined effect on IgA is unknown and served as the basis for 
this study. After sham or HS, self-filling blind loops (SFBL) were created to 
affect bacterial overgrowth. Intestinal secretions were obtained 7 days later 
from SFBL and jejunal segments for quantitative culture. Gut washings were also 
obtained and secretory IgA levels determined by enzyme-linked immunosorbent 
assay. Bacterial overgrowth in the SFBL was associated with significant 
increases in IgA levels in the sham group only. IgA levels were depressed in 
both jejunal and SFBL segments in the HS group. Impaired humoral mucosal defense 
may be important mechanistically in the development of nosocomial infections and 
organ failure after HS, particularly with concurrent gut bacterial overgrowth.

PMID: 9697899 [Indexed for MEDLINE]


4737. Semin Oncol. 1998 Apr;25(2 Suppl 6):33-4.

Approach to the seriously ill or terminal cancer patient who has a poor 
appetite.

Seligman PA(1), Fink R, Massey-Seligman EJ.

Author information:
(1)Department of Medicine, University of Colorado Health Sciences Center, Denver 
80220, USA.

Lack of appetite is a frequent complaint of patients with serious illness and is 
particularly bothersome to cancer patients and their families. As patients enter 
the terminal phase of their illness, poor appetite becomes an even more 
distressing problem that affects not only physical symptoms but also functional, 
social, and psychological aspects of a patient's quality of life. Family and 
friends frequently relate a patient's poor appetite as a specific contributor to 
their perception of lack of health. We have investigated a number of ways to 
approach the seriously ill or terminal cancer patient who has a poor appetite 
with education, dietary changes (including the use of smaller, more frequent 
meals but still providing the patient's favorite foods), and at times dietary 
supplements. Appetite stimulants such as Megace Oral Suspension (Bristol-Myers 
Squibb, Princeton, NJ) are used not so much for facilitating weight gain as for 
adding to the quality of life, including social and psychological well-being, by 
allowing patients to enjoy foods they like in a social family setting.

PMID: 9625381 [Indexed for MEDLINE]


4738. Anasthesiol Intensivmed Notfallmed Schmerzther. 1997 Nov;32(11):665-71. doi: 
10.1055/s-2007-995133.

[A comparison of the effect of propofol in 3 subhypnotic doses within the 
framework of tumor chemotherapy].

[Article in German]

Uhlig T(1), Hüppe M, Pestel G, Keck S.

Author information:
(1)Klinik für Anästhesiologie, Medizinische Universität Lübeck.

PURPOSE: In anaesthesia and critical care propofol is often used as a hypnotic 
or sedative. There are some reports showing propofol as a mood-altering drug. 
The use of propofol in subanaesthetic doses, for example in antineoplastic 
chemotherapy, led to similar results. In previous studies it was hypothesised 
that these mood effects could also reduce chemotherapy-induced nausea and 
vomiting. The present prospective randomised double-blind study evaluated mood 
effects of different subanaesthetic doses of propofol in oncology patients who 
received antineoplastic chemotherapy.
METHODS: Propofol was applied in a double-blind and randomised manner as follows 
(N = 8 per group): Initial bolus of 0.1 mg/kg followed by a continuous infusion 
of 1.0 mg/kgxh (group 1), 1.5 mg/kgxh (group 2) or 2.0 mg/kgxh (group 3). 
Dependent variables were as behavioural (i.e. nausea and vomiting) as aspects of 
mood as somatic aspects.
RESULTS: Subanaesthetic doses of propofol showed different effects. In respect 
of somatic variables some well-known results were replicated, showing highest 
reduction of blood pressure under highest dose of propofol. With regard to 
psychic variables no deterioration of mood or feeling tone was seen. Rather, a 
reduction of anxiety and especially under 2.0 mg/kgxh an induction of well-being 
occurred. However, even propofol was used as the only "anti-emetic" drug, 
patients reported no induction of nausea and vomiting during antineoplastic 
chemotherapy.
CONCLUSIONS: Further studies are needed to specify the "anti-emetic" effects of 
subhypnotic propofol in antineoplastic chemotherapy. Especially a comparison 
with a standard drug for the prevention of nausea and vomiting, such as 
ondansetron, will have to be conducted. The results of this study showed that a 
dose of propofol of 1.0 mg/kgxh after an initial bolus of 0.1 mg/kg is a useful 
reference dose.

DOI: 10.1055/s-2007-995133
PMID: 9498886 [Indexed for MEDLINE]


4739. Enferm Intensiva. 1996 Oct-Dec;7(4):147-51.

[Informing the families of patients admitted to an intensive care unit].

[Article in Spanish]

Zazpe Oyarzun MC(1).

Author information:
(1)Unidad de Cuidados Intensivos. Clinica Universitaria de Navarra, Pamplona.

The admission of a patient to the intensive care unit (ICU) disturbs the 
family's normal function. Family members are confronted by a new and difficult 
situation and react with worry and anxiety. They have different needs, 
particularly for information and assurance. Only effective communication between 
the family and health-care team helps. The conditions affecting human 
communication were analyzed, with emphasis on the situations typical of the 
hospital environment that negatively influence communication. A bibliographic 
review was made of useful strategies for improving communication with families. 
To conclude, recommendations are made for facilitating communication, improving 
the family's well-being, and easing their adjustment to the disease process.

PMID: 9214895 [Indexed for MEDLINE]


4740. Gut. 1996 Oct;39(4):587-93. doi: 10.1136/gut.39.4.587.

Role of the gut in the pathophysiology of extrahepatic biliary obstruction.

Clements WD(1), Parks R, Erwin P, Halliday MI, Barr J, Rowlands BJ.

Author information:
(1)Department of Surgery, Queens University of Belfast, UK.

BACKGROUND: Gram negative septic events are the commonest source of morbidity 
and mortality as a result of surgery in jaundiced patients. The large intestine 
provides the major source of Gram negative bacteria in mammals and is implicated 
in the pathogenesis of systemic endotoxaemia in obstructive jaundice. Bile salts 
have an important part in maintaining indigenous microecological homeostasis 
through their emulsifying properties.
AIMS: The aim was to investigate the effects of biliary obstruction and isolated 
external biliary diversion on gastro-intestinal structure and caecal bacterial 
flora in relation to bacterial translocation.
METHOD: Six groups of adult male Wistar rats were studied (no operation, sham 
operated, and bile duct ligated (BDL) for one and three weeks and a 
choledocho-vesical fistula (CDVF) for one week). At the end of the study period 
plasma was assayed for evidence of endotoxaemia and the animals were tested for 
bacterial translocation to the mesenteric lymph node complex (MLNC), liver, 
lungs, and spleen. Quantitative and qualitative bacteriological studies were 
performed on the caecal contents and segments of colon and terminal ileum were 
washed and prepared for histological assessment.
RESULTS: Bacterial translocation was significantly increased in the BDL1 (68.8%) 
and BDL3 (60%) groups compared with the sham1 (6.3%), sham3 (9.1%), No operation 
(0%), and CDVF1 (16.7%) groups. Although translocation was more pronounced in 
the BDL1 group, this was almost exclusively to the MLNC compared with the more 
widespread translocation to other organs in the BDL3 group. The BDL3 group was 
the only group with significantly raised concentrations of endotoxin and 
anticore glycolipid. The caecal Gram negative aerobic counts were significantly 
increased in the BDL1 and CDVF1 groups compared with all other groups. There was 
evidence of structural abnormalities in the terminal ileum of rats jaundiced for 
three weeks, but not in the other groups.
CONCLUSIONS: Biliary obstruction for one and three weeks promotes bacterial 
translocation although the mechanisms may be different. Absence of intralumenal 
bile results in a significant but self limiting increase in the Gram negative 
aerobic population, which may account for translocation in the early stages of 
biliary obstruction. As the duration of biliary obstruction increases systemic 
endotoxaemia is a consistent feature which, combined with factors such as 
immunological depression and physical disruption of gut barrier function, may 
promote bacterial translocation perpetuating systemic sepsis.

DOI: 10.1136/gut.39.4.587
PMCID: PMC1383274
PMID: 8944570 [Indexed for MEDLINE]


4741. Am J Crit Care. 1996 Jul;5(4):309-13.

Quality of life for critical care patients: a concept analysis.

Bond AE(1).

Author information:
(1)Brigham Young University, Provo, Utah, USA.

Confusion, misunderstanding, and ethical concerns may interfere with patients' 
choices for appropriate treatment and subsequent quality of life. Such concerns 
did not originate from recent technological advances but from the ancient Greeks 
and Romans who honored health more than life, and the early Christians who 
honored life more than health. These opposing concepts reflect differing notions 
of quality of life. Determining the quality of life involves personal 
issues--the cognitive ability to evaluate one's own life; the perception of a 
satisfactory state of social, emotional, physical, and mental health; and an 
acceptable feeling of well-being despite physical limitations. In contrast, and 
often conflict, are objective evaluations of treatment outcomes, 
morbidity/mortality statistics, cost/benefit analyses, and age studies performed 
in an attempt to determine quality of life by persons other than the patient.

PMID: 8811157 [Indexed for MEDLINE]


4742. Palliat Med. 1996 Jan;10(1):35-41. doi: 10.1177/026921639601000106.

Evaluation of the psychological status of ventilatory-supported patients with 
ALS/MND.

McDonald ER(1), Hillel A, Wiedenfeld SA.

Author information:
(1)New Road Map Foundation, Seattle, Washington, USA.

Many medical professionals feel that a choice of long-term ventilatory support 
leads to a life of hopeless desperation. We compared the sociodemographic, 
physical and psychological status of 18 amyotrophic lateral sclerosis/motor 
neurone disease (ALS/MND) patients on ventilatory support for 1 to 120 months 
with that of 126 nonventilatory-supported ALS/MND patients. Patients filled out 
a comprehensive data form and completed ten psychological tests. A composite 
psychological status score was computed, representing a continuum from 
psychological distress to psychological well-being. Mann-Whitney and chi 2 tests 
were used to compare the two groups. There were no significant differences in 
sociodemographic makeup, depression, hopelessness, overall quality of life or 
psychological well-being. However, ventilatory-supported patients had a more 
internal health locus of control. Many patients on ventilatory support were able 
to live high quality lives. When ventilatory support is an option, we suggest 
that medical professionals be supportive of the patient's choices and recognise 
that a decision for ventilatory support is probably the best predictor of an 
acceptable quality of life on a ventilator.

DOI: 10.1177/026921639601000106
PMID: 8821186 [Indexed for MEDLINE]


4743. J Neurosci Nurs. 1995 Feb;27(1):11-23. doi: 10.1097/01376517-199502000-00003.

Received support and psychological adjustment in critically-injured patients and 
their family.

Grossman M(1).

Author information:
(1)McGill University, Montreal, PQ, Canada.

A pilot study was conducted to identify support behaviors associated with the 
psychological adjustment of 39 critically-injured patients and 39 family 
members. Although the majority of critically-injured patients recover 
physically, current work shows that psychological difficulties persist. This 
study hypothesized that the psychological adjustment of critically-injured 
patients and family members will be a function of the type of support received. 
The second hypothesis was that support behaviors associated with psychological 
adjustment will differ between critically-injured patients and family members. 
Patients and family members completed the following paper and pencil 
instruments: The Instrument of Socially Supportive Behaviors, the Well-being 
Scale, State/Trait Anxiety Scale, Life Experience Survey, The Blishen 
Occupational Index and a demographic questionnaire. Using multiple regression 
with backward elimination, squared semi-partial correlations and partial F, 
cross-sectional data showed that the measure of well-being but not anxiety was 
related to different types of support behaviors in partial support of the first 
hypothesis. Support for the second hypothesis was provided by the finding that 
the critically-injured patient's level of well-being was positively associated 
with nondirect support and instrumental aid, and negatively with direct 
guidance. In contrast, instrumental aid was found to be associated with poor 
well-being in family members. The findings offer neuroscience nurses insights 
into the types of support that may enhance the well-being of critically-injured 
patients and their family members.

DOI: 10.1097/01376517-199502000-00003
PMID: 7769323 [Indexed for MEDLINE]


4744. AACN Clin Issues. 1995 Feb;6(1):63-9. doi: 10.1097/00044067-199502000-00009.

Nursing care of domestic violence victims in acute and critical care settings.

Fishwick N.

Nursing care of domestic violence victims has focused on emergency settings, 
primary health-care settings, and mental health-care settings. Nurses in other 
acute and critical care settings also care for domestic violence victims, though 
the focus of nursing care may be confined to the medical reason for the person's 
hospital stay. However, as we come to fully appreciate the psychobiologic nature 
of health, illness, and healing, it becomes clear that abuse and violence in a 
patient's home life holds consequences for one's current and future well-being. 
Though hospital stays are often brief, important groundwork can be accomplished 
to identify and assist patients involved in abusive relationships.

DOI: 10.1097/00044067-199502000-00009
PMID: 7736306 [Indexed for MEDLINE]


4745. Wien Med Wochenschr. 1995;145(17-18):510-1.

[Subjective well-being in obstructive sleep apnea syndrome before and after 
nCPAP therapy].

[Article in German]

Hetzel C(1), Weess HG, Schröder A, Steinberg R.

Author information:
(1)Pfalzklinik Landeck, Klingenmünster, Deutschland.

18 obstructive sleep apnea patients (mean time of nCPAP-treatment: 412 nights) 
were asked about their subjective well-being before therapy and under treatment 
with nCPAP. Also their wifes were asked to give an outer appraisal. Both groups 
reported a clear reduction of general well-being before therapy and significant 
improvements in excessive daytime sleepiness, depression, physical and psychical 
complaints and the rate of patients accidents under nCPAP. In context with a 
good compliance of therapy these results indicate that the nCPAP-treatment was 
subjectively experienced as effective.

PMID: 8588390 [Indexed for MEDLINE]


4746. Can J Anaesth. 1994 Nov;41(11):1113-6. doi: 10.1007/BF03015663.

Anaesthesia for caesarean section in a patient with Watson's syndrome.

Conway JB(1), Posner M.

Author information:
(1)Department of Anaesthesia, University of Ottawa, Ottawa Civic Hospital, 
Ontario.

Watson's syndrome is an uncommon genetic disorder whose features include mental 
retardation and pulmonary valvular stenosis. The purpose of this report is to 
describe one management strategy used successfully to anaesthetize a woman with 
this disorder who presented for Caesarean section. Epidural anaesthesia using 
0.5% bupivacaine without epinephrine in 2-3 ml boluses to a total dose of 15 ml 
was administered over 30 min. Invasive haemodynamic monitoring in the form of 
arterial and central venous catheters were used to guide therapy and help ensure 
maternal and fetal well-being. Intravenous ketamine in doses of 10-20 mg every 
five minutes to a total dose of 245 mg (4.5 mg.kg-1) was used to overcome the 
patient's uncooperative nature and facilitate invasive procedures. Postoperative 
analgesia was provided using 3 mg epidural morphine. The patient was observed in 
the intensive care unit for the first postoperative day and experienced an 
uncomplicated intra- and postoperative course. We conclude that this technique 
represents a safe and effective method for anaesthetizing patients with this 
complicated problem for Caesarean section.

DOI: 10.1007/BF03015663
PMID: 7828260 [Indexed for MEDLINE]


4747. Am Fam Physician. 1994 Jun;49(8):1815-20.

Anaerobic lung infections.

Vincent MT(1), Goldman BS.

Author information:
(1)State University of New York Health Science Center, Brooklyn College of 
Medicine.

Aspiration is the leading cause of anaerobic lung infections. Risk factors for 
these infections include a depressed level of consciousness, a history of 
seizure, general anesthesia, central nervous system or neuromuscular disease, 
cerebrovascular accident, impaired swallowing and use of a tracheal or 
nasogastric tube. Clinical presentation includes fever, weight loss, malaise and 
cough productive of foul-smelling sputum. Diagnosis is based on radiographic 
findings, clinical features and a characteristic morphology of mixed flora on 
Gram stain of uncontaminated pulmonary specimens. The diagnosis is confirmed by 
isolation of organisms, usually polymicrobial, on culture. Treatment includes 
proper drainage, debridement of necrotic tissue and an antibiotic regimen (often 
initially empiric) with an agent active against anaerobic and aerobic organisms.

PMID: 8203319 [Indexed for MEDLINE]


4748. Child Health Care. 1993 Summer;22(3):217-26. doi: 10.1207/s15326888chc2203_4.

Parental visitation in the post-anesthesia care unit: a means to lessen anxiety.

Bru G(1), Carmody S, Donohue-Sword B, Bookbinder M.

Author information:
(1)Memorial Sloan-Kettering Cancer Center, New York.

Programs that assist parents and children with coping during hospitalization may 
minimize the emotional trauma of hospitalization and improve both child and 
family well-being. The purpose of this study was to determine the effect of 
parental visitation in the Post-Anesthesia Care Unit (PACU) on pre- and 
postoperative anxiety levels of pediatric patients and parents. Sixty-eight 
patient-parent pairs were enrolled in the study: 20 before implementing parental 
visitation and 48 following implementation. Although no differences were found 
in children's anxiety levels pre- to postoperatively, the anxiety levels of 
parents who visited their children in the PACU were significantly lower 
postoperatively.

DOI: 10.1207/s15326888chc2203_4
PMID: 10127890 [Indexed for MEDLINE]


4749. Pediatrics. 1994 Feb;93(2):241-6.

Family-based intervention improves maternal psychological well-being and feeding 
interaction of preterm infants.

Meyer EC(1), Coll CT, Lester BM, Boukydis CF, McDonough SM, Oh W.

Author information:
(1)Department of Pediatrics, Women and Infants' Hospital, Providence, RI 02905.

OBJECTIVE: To determine the efficacy of an individualized, family-based 
intervention with preterm infants and their families.
DESIGN: Randomized, repeated measures intervention outcome study.
SETTING: Level III neonatal intensive care nursery.
PATIENTS: Random sample of 34 preterm infants < or = 1500 g and their families.
INTERVENTIONS: Individualized, family-based intervention during the 
hospitalization and transition to home addressed problems identified by parents 
in four domains including: infant behavior and characteristics, family 
organization and functioning, caregiving environment, and home discharge and 
community resources.
MEASUREMENTS AND MAIN RESULTS: Standardized questionnaires were administered at 
baseline and discharge to mothers, and predischarge bottle-feeding interactions 
were videotaped and coded by two blinded observers. Results were in favor of 
intervention (Int) versus control (Con) mothers (baseline; discharge) (P < .05) 
on the Parental Stressor Scale Sights and Sounds subscale (Int 2.4 +/- 1.0; 2.0 
+/- 0.8 vs Con 2.4 +/- 0.9; 2.6 +/- 0.8); Child's Appearance and Behavior 
subscale (Int 2.8 +/- 1.0; 2.5 +/- 1.1 vs Con 2.8 +/- 0.8; 3.1 +/- 0.6); and 
Total Stressor Score (Int 93.9 +/- 36.6; 72.3 +/- 41.8 vs Con 87.5 +/- 26.7; 
87.8 +/- 26.2). On the Beck Depression Inventory, intervention mothers had 
significant decreases in depressive symptoms (39%; 11%) vs control mothers (31%; 
44%). Maternal self-esteem in both groups improved over time. There were no 
significant group differences in family environment. During feeding 
interactions, intervention infants grimaced (P < .001) and gagged (P < .05) less 
than controls. Intervention mothers less frequently interrupted feedings (P < 
.001); less frequently stimulated infant sucking (P < .01); smiled more (P < 
.001); vocalized more (P < .01); demonstrated greater sensitivity to infant 
behavior (P < .001), better quality of physical contact (P < .001), and more 
positive affect (P < .01).
CONCLUSIONS: Individualized, family-based intervention appears to reduce 
maternal stress and depression, and to enhance early mother-infant feeding 
interactions. Further research is needed to determine whether these short-term 
beneficial effects persist beyond the newborn period.

PMID: 8121735 [Indexed for MEDLINE]


4750. Respir Med. 1994 Jan;88(1):21-6. doi: 10.1016/0954-6111(94)90169-4.

Quality of life of patients treated by home mechanical ventilation due to 
restrictive ventilatory disorders.

Pehrsson K(1), Olofson J, Larsson S, Sullivan M.

Author information:
(1)Department of Lung Medicine, Renströmska Hospital, Göteborg, Sweden.

The quality of life of patients with hypoventilation and home mechanical 
ventilation (HMV) has not been well described. Modern quality of life assessment 
techniques were therefore introduced in a cross-sectional study of patients 
treated with HMV. The aim was to study various aspects of the patient's quality 
of life and relate them to the underlying diseases, blood gases and the type of 
ventilatory connection. The study comprised 39 patients, most of them ventilated 
only during the night (n = 35). Nasal ventilation predominated (n = 29). 
Patients treated with HMV reported satisfactory levels of both psychosocial 
functioning and mental well-being that compared well with a general population 
group. Their quality of sleep was generally good. The quality of life measures 
were mainly influenced by the patients' underlying disease. Patients with 
scoliosis expressed in almost all instances the best quality of life. The 
quality of life of patients with ventilation by tracheostomy was reported to be 
at least as good as that of patients with nasal ventilation. The global quality 
of life estimation was mainly determined by the mental state of the patients and 
their sleep quality and only to a minor extent by physical handicaps. In 
conclusion, the patients treated with HMV reported good psychosocial functioning 
and mental well-being, in spite of severe physical limitations and dependence on 
regular nocturnal ventilation.

DOI: 10.1016/0954-6111(94)90169-4
PMID: 8029509 [Indexed for MEDLINE]


4751. Nurs Clin North Am. 1993 Jun;28(2):443-57.

The impact of technology on patients and families.

Halm MA(1), Alpen MA.

Author information:
(1)Critical Care Nursing Division, University of Iowa Hospitals and Clinics, 
Iowa City.

The continuing evolution of the highly specialized, technologic manner in which 
we provide care in critical care units has potentially hazardous effects on the 
physical and psychological well-being of patients and family members. Although 
the ICU environment possesses characteristics that make patients and families 
prone to undesirable sequelae, critical care nurses can employ creative 
strategies to minimize the impact of bedside technology that is so important for 
the survival and recovery of the critically ill patient. Strategies to reduce 
the psychological impact of the ICU environment begin with a psychosocial 
assessment of the meaning patients and families attach to bedside technology. 
This assessment will strengthen nurse, patient, and family interactions, as well 
as guide patient and family education and sensory information to reduce fear and 
anxiety often associated with threatening procedures. Facilitating touch and 
family involvement in the patient's care during visitation is another strategy 
to humanize the technologic environment. Managing the environment is essential 
to reduce the physical impact of the ICU environment. Nurses can manipulate the 
use of equipment to reduce crowding and noise at the bedside, foster familiar 
activities to stimulate the patient's other senses, and facilitate sleep 
patterns by structuring nursing activities and providing comfort measures. These 
nursing interventions will reduce the effects of sensory overload/deprivation 
and sleep deprivation and, it is hoped, prevent ICU psychosis.

PMID: 8516184 [Indexed for MEDLINE]


4752. Intensive Care Nurs. 1991 Dec;7(4):230-5. doi: 10.1016/0266-612x(91)90048-v.

The psychological impact of intensive therapy: the role of nurses.

Stanton DJ.

The concept of intensive therapy has developed since the early 1950s following 
the poliomyelitis epidemic when patients required respiratory assistance. 
Intermittent positive pressure ventilation and the development of large 
integrated general intensive therapy units where all critically ill patients 
could be managed has resulted. The environment in the intensive therapy units 
(ITUs) has thus become increasingly sophisticated with the use of highly 
specialised equipment. This has led to changes in the role of nurses in critical 
care areas. As intensive therapy nurses require considerable technical knowledge 
comparisons have been made with their role and that of a technician. The aim in 
this paper is to emphasise the importance of the nurses' role in caring for 
patients in intensive therapy units, by highlighting the psychological impact an 
intensive therapy unit may have on patients and how a nurse may promote 
psychological well-being.

DOI: 10.1016/0266-612x(91)90048-v
PMID: 1765638 [Indexed for MEDLINE]


4753. Intensive Care Nurs. 1991 Jun;7(2):114-9. doi: 10.1016/0266-612x(91)90018-m.

Motivational strategies for intensive care nurses.

Coombs M.

Motivation plays an important part in people's lives--at work and at play. A 
motivated individual displays energy, enthusiasm and determination. The 
frustration that is experienced in a demotivating climate can have implications 
for an individual's mental health and physical well-being. It is suggested that 
this state of affairs must surely not be allowed to exist - for the sake of the 
nurses, clients and organisations. Using a broad review of the motivational 
theories, this paper draws on resultant common themes. From this, a framework is 
proposed on which are based suggestions that can be used by critical care nurses 
to facilitate nurse motivation, with all the concomitant effects this may have.

DOI: 10.1016/0266-612x(91)90018-m
PMID: 2061585 [Indexed for MEDLINE]


4754. Matern Child Nurs J. 1990 Fall;19(3):211-20.

Affects and cognitions of mothers and fathers of preterm infants.

Casteel JK.

This descriptive study examined the feelings and thoughts of mothers and fathers 
of preterm infants. Responses were solicited while the infant was in a special 
care nursery as well as in the home. Mothers and fathers responses between the 
hospital and the home setting were compared as were maternal and paternal 
responses. General systems theory was the conceptual orientation of this study. 
This framework provided a perspective on the generation and analysis of 
affective and cognitive responses of parents following the birth of a premature 
infant. An open-ended, semi-structured interview was conducted in the special 
care nursery when the infant was 5 days old. A second interview was conducted 
when the preterm infant had been home for 5 days. The 18 mother-father dyads wer 
interviewed twice as dyadic units. The dyads were married and shared the same 
domicile, spoke and understood English, and resided within eighty miles of the 
special care nursery. There were 11 males and 7 females in the infant sample, 
with a mean gestational age of 34.9 weeks and a mean birthweight of 2281.7. The 
interviews were content analyzed and responses of the parent dyads categorized 
into meaningful sets within an a priori construct of affects and cognitions. A 
z-statistic was used to examine differences in the proportion of responses. The 
affective category was comprised of both positive and negative responses. 
Positive responses were amazement, confidence, love, and well-being. Negative 
responses were anxiety, fear, helplessness, and sadness. The cognitive category 
was comprised of three kinds of responses: protection, provision, and 
attachment.

PMID: 2136576 [Indexed for MEDLINE]


4755. Crit Care Nurs Clin North Am. 1989 Dec;1(4):767-74.

Immunosuppression of the burned patient.

Robins EV.

Erratum in
    Crit Care Nurs Clin North Am 1990 Mar;2(1):preceding xiii.

The burn patient is highly susceptible to infection due to the loss of the skin 
as a barrier to microorganisms. Immune defenses are activated in response to the 
burn injury; however, some of these defenses are altered. Neutrophil chemotaxis 
is compromised by decreased perfusion caused by hypovolemia and the formation of 
microthrombi. Chemotaxis and phagocytosis are dependent on complement components 
that are reduced in a large burn wound. Neutrophil intracellular killing power 
is reduced as oxygen delivery to the wound is decreased. Humoral immunity is 
altered with the drop in IgG levels. Cell-mediated immunity is depressed and T 
cell lymphocyte counts are deceased. Suppressor T cells are generated. Specific 
sources of infection for the burn patient include the patient's own bacterial 
flora; hospital personnel; respiratory equipment; and catheters, both urinary 
and intravascular. The best control for burn wound infection is the closure of 
the wound by early excision and grafting. When lack of donor sites prohibits 
this surgical therapy, control centers on the environment and wound care 
techniques. The selection of wound topical antibiotics on the basis of visual 
inspection and surface culturing assists in the prevention of burn wound sepsis. 
When wound sepsis does occur, systemic antibiotics are instituted. Although burn 
wound sepsis is an obvious cause of death for the burn patient, it is not the 
primary cause. Increasing sophistication in fluid resuscitation and in intensive 
care therapy has resulted in patients living beyond the initial insult and the 
following few days. Burn patient mortality is now associated with a syndrome 
presenting clinically as sepsis but without any identifiable septic 
source.(ABSTRACT TRUNCATED AT 250 WORDS)

PMID: 2697225 [Indexed for MEDLINE]


4756. J Pediatr Health Care. 1989 Sep-Oct;3(5):237-45. doi: 
10.1016/0891-5245(89)90003-5.

Parental perceptions of vulnerability of formerly premature infants.

Culley BS, Perrin EC, Chaberski MJ.

This study explores a possible precursor of the vulnerable child syndrome, a 
constellation of behaviors thought to develop as a result of excessive parental 
anxiety. Healthy 3-year-old children who had been born prematurely were compared 
to children born at term, using a single instrument. Mothers of premature 
infants reported a significantly greater sense of vulnerability about their 
children than did mothers of term infants. Antecedents and correlates of 
vulnerability are explored. Mothers with more education reported a greater sense 
of vulnerability than did less well-educated mothers, while mothers who reported 
greater well-being and marital satisfaction reported a lower sense of 
vulnerability. A greater sense of vulnerability was associated with more 
behavior problems and more somatic and internalizing symptoms. The data have 
important implications for nurses caring for infants in neonatal intensive care 
units, as well as in pediatric ambulatory and hospital settings.

DOI: 10.1016/0891-5245(89)90003-5
PMID: 2778593 [Indexed for MEDLINE]


4757. Geriatrics. 1989 Aug;44 Suppl A:28-31.

Treatment of nosocomial pneumonia: monotherapy versus combination therapy.

Greco T(1).

Author information:
(1)Section of Inflammatory Diseases, Saint Mary's Hospital, Waterbury, 
Connecticut.

Pneumonia accounts for 15% of all nosocomial infections, and mortality case 
rates are as high as 60%. Aspiration of oropharyngeal flora is the most common 
antecedent to nosocomial pneumonia. Patients with chronic lung disease, 
depressed levels of consciousness, or who are intubated are at increased risk of 
developing pneumonia. We conducted two comparative, prospective studies using 
monotherapy with third-generation cephalosporins--the first comparing 
cefoperazone with combination therapy, and the second comparing cefoperazone 
monotherapy with ceftazidime monotherapy--for the treatment of nosocomial 
pneumonia in mildly to moderately ill patients. We found that both cefoperazone 
monotherapy and ceftazidime monotherapy were as effective as standard two-drug 
combinations (clindamycin/gentamicin or cefazolin/gentamicin). When total 
antibiotic costs were compared, cefoperazone monotherapy was the least expensive 
regimen.

PMID: 2777095 [Indexed for MEDLINE]


4758. J Clin Microbiol. 1989 May;27(5):1132-4. doi: 10.1128/jcm.27.5.1132-1134.1989.

Gardnerella vaginalis bacteremia from pulmonary abscess in a male alcohol 
abuser.

Legrand JC(1), Alewaeters A, Leenaerts L, Gilbert P, Labbe M, Glupczynski Y.

Author information:
(1)Département d'Hématologie-Oncologie, Hôpital Civil de Charleroi, Belgium.

A case of Gardnerella vaginalis bacteremia is reported. This bacteremia occurred 
in a male alcohol abuser who developed definite signs of pulmonary abscess and 
empyema. Streptococcus milleri grew from another blood culture, but Gardnerella 
vaginalis was also isolated from a bronchoscopic aspirate and pleural drainage 
sample as part of mixed flora containing anaerobes, Streptococcus species, 
Neisseria sicca, and a Haemophilus sp. We discuss the possible pathogenic 
character of G. vaginalis outside the genital tract from a review of the 
literature.

DOI: 10.1128/jcm.27.5.1132-1134.1989
PMCID: PMC267503
PMID: 2787333 [Indexed for MEDLINE]


4759. Dimens Crit Care Nurs. 1989 May-Jun;8(3):159-68. doi: 
10.1097/00003465-198905000-00010.

Substance abuse among nurses: types of drugs.

Smith HL, Mangelsdorf KL, Louderbough AW, Piland NF.

Substance abuse among nurses can have significant ramifications for patient 
care, productivity, and personal well-being. Existing evidence suggests that 
critical care nurses are especially vulnerable to pressures that induce 
substance abuse. Consequently, critical care leaders and nurses need to be 
prepared to help their impaired colleagues. This paper provides several valuable 
guidelines for addressing substance abuse based on an exploratory study of the 
types of drugs or substances most frequently abused among nurses.

DOI: 10.1097/00003465-198905000-00010
PMID: 2656150 [Indexed for MEDLINE]


4760. Radiat Res. 1988 Jul;115(1):1-25.

Use of antibiotics in the management of postirradiation wound infection and 
sepsis.

Brook I(1).

Author information:
(1)Armed Forces Radiobiology Research Institute, Bethesda, Maryland 20814-5145.

Ionizing gamma irradiation depresses the host defenses and enhances the 
susceptibility of the immunocompromised host to local and systemic infection due 
to endogenous or exogenous microorganisms. Trauma and wounding act 
synergistically and decrease the survival after exposure to irradiation. The 
current antimicrobial agents suitable for controlling serious infections and 
their use in post irradiation local and systemic infection with and without 
trauma are discussed. The experience gained in managing immunocompromised 
patients following chemotherapy is reviewed. Empiric single agent or combination 
agent therapy should be directed at the eradication of potential gram-negative 
as well as gram-positive pathogens. The most important organisms known to cause 
these infections are Pseudomonas sp. and Enterobacteriaceae. Management of 
intra-abdominal infections following trauma should include early surgical 
correlation and antimicrobials directed against the Bacteroides fragilis group 
and Enterobacteriaceae. Staphylococcus aureus and Streptococcus pyogenes cause 
most skin and soft tissue infections following trauma. Chemoprophylaxis of 
enteric sources of systemic infection can be achieved by antimicrobials that 
selectively inhibit the Enterobacteriaceae sp. and preserve the anaerobic flora. 
The management of infection in the injured and irradiated host includes 
supportive and restorative therapy. Supportive therapy includes débridement and 
cleansing of wounds, fluids, immunoglobulin, and antimicrobials. Restorative 
therapy includes definite surgery repair and replenishment of the immune system 
by use of immunomodulators, growth factors, and bone marrow transplantation. 
Further studies are needed to examine the usefulness of presently available 
drugs and experimental agents in the irradiated and traumatized host.

PMID: 3293098 [Indexed for MEDLINE]


4761. Dan Med Bull. 1987 Dec;34(6):322-3.

Rothia dentocariosa septicaemia in a patient with chronic lymphocytic leukaemia 
and toxic granulocytopenia.

Pers C(1), Kristiansen JE, Jønsson V, Hansen NE.

Author information:
(1)Department of Clinical Microbiology, Copenhagen County Hospitals, Denmark.

Rothia dentocariosa is part of the human oral flora and has only rarely been 
reported as a cause of clinical infection. We report the isolation of Rothia 
dentocariosa from the blood of a septicaemic patient with chronic lymphocytic 
leukaemia and bone marrow depression following treatment with clomipramine and 
zuclopentixol.

PMID: 3436159 [Indexed for MEDLINE]


4762. Jpn J Antibiot. 1987 Mar;40(3):630-40.

[Clinical and pharmacokinetic evaluations of cefuzonam in children].

[Article in Japanese]

Meguro H, Arimasu O, Shiraishi H, Kobayashi M, Fuji R, Mashiko J.

A new parenteral cephalosporin antibiotic, cefuzonam (L-105, CZON), was 
evaluated for its safety, efficacy and pharmacokinetics in children. Twenty-two 
cases of bacterial infections including pneumonia, lung abscess, sepsis, urinary 
tract infection and soft tissue infections were treated with CZON. Clinical 
effective rate was 95%. Serum half-lives of CZON were 1.04-1.33 hours in 
children with normal renal and hepatic functions. Significant depressions of the 
normal fecal flora were observed and diarrhea or loose stool was encountered in 
7 of the 22 treated cases (32%).

PMID: 3613083 [Indexed for MEDLINE]


4763. J Trauma. 1986 May;26(5):419-25. doi: 10.1097/00005373-198605000-00002.

A biochemical basis for depressed ketogenesis in sepsis.

Vary TC, Siegel JH, Nakatani T, Sato T, Aoyama H.

Several investigators have demonstrated a diminished rate of ketogenesis during 
inflammatory or infectious states despite the availability of free fatty acids 
supplied to the liver. The biochemical mechanism for this effect is unknown. 
Malonyl-CoA has been proposed to be a regulator of ketogenesis. Malonyl-CoA 
levels are low in states of rapid ketogenesis such as starvation or diabetes and 
high in states of reduced ketogenesis such as carbohydrate feeding. In the 
present study, the effect of an intra-abdominal abscess on the level of hepatic 
malonyl-CoA was investigated in four groups of animals (fed control, sterile 
inflammation, small chronic septic abscess, large chronic septic abscess). Liver 
samples were frozen in situ 5 days following the intraperitoneal introduction of 
a rat-fecal agar pellet inoculated with a known bacterial flora which generated 
an abscess [sterile inflammatory; B. fragilis 10(8)/ml + E. coli 10(2)/ml 
(small, 0.8 ml or large, 1.5 ml) abscess pellet]. The level of malonyl-CoA in 
normal fed rats was 5.0 +/- 0.6 nmol/gm wet wt (n = 9). The malonyl-CoA level 
was not altered in animals with a sterile inflammation. However, hepatic 
malonyl-CoA levels were significantly increased in small (10 +/- 1 nmole/gm wet 
wt) (p less than 0.05; n = 9) or large (12 +/- 1 nmol/gm wet wt) (p less than 
0.01; n = 14) septic abscess rats compared to control fed and sterile 
inflammatory rats. Hepatic ketone bodies (beta-hydroxybutyrate and acetoacetate) 
did not increase in sepsis over control or sterile inflammation.(ABSTRACT 
TRUNCATED AT 250 WORDS)

DOI: 10.1097/00005373-198605000-00002
PMID: 3701891 [Indexed for MEDLINE]


4764. Infection. 1985 Nov-Dec;13(6):251-6. doi: 10.1007/BF01645432.

Acanthamoeba, an opportunistic microorganism: a review.

Martinez AJ, Janitschke K.

Granulomatous amebic encephalitis due to Acanthamoeba spp. usually occurs in 
chronically ill and debilitated individuals. Some of these patients may have 
received immunosuppressive therapy. Another infection due to Acanthamoeba spp. 
has been corneal ulcerations which usually occur after minimal trauma to the 
corneal epithelium (1). In contrast, primary amebic meningoencephalitis due to 
Naegleria fowleri usually occurs in healthy, young individuals with a history of 
swimming in heated swimming pools, in manmade lakes or with recent contact with 
contaminated water and practising water-related sports. Subclinical infections 
due to free-living amebas are probably common in healthy individuals with the 
protozoa living as "normal flora" in the nose and throat. It is possible that in 
humans, antibodies and cell-mediated immunity protect the host in such ordinary 
circumstances against invasive infection. In debilitated and chronically ill 
individuals, depressed cellmediated immunity may allow these protozoa to 
proliferate, allowing a fulminant "opportunistic" infection to develop. In the 
case of acanthamoebic keratitis, it is important to keep in mind that the 
temperature and moist environment of the eye serve as a good medium for the 
growth and proliferation of the amebas and is not necessarily associated with 
immunosuppression but rather with trauma. This review confirms that 
opportunistic free-living amebic infections occur with increased frequency in 
patients treated with steroids, radiotherapy, chemotherapeutic drugs or with 
broad-spectrum antibiotics and suggest that the mechanism of such infection may 
be depressed cell-mediated immunity or some other alteration of the immune 
system, like acquired immunodeficiency syndrome (AIDS).

DOI: 10.1007/BF01645432
PMID: 2867047 [Indexed for MEDLINE]


4765. Chest. 1985 Feb;87(2):267-9. doi: 10.1378/chest.87.2.267.

Biofeedback and hypnosis in weaning from mechanical ventilators.

LaRiccia PJ, Katz RH, Peters JW, Atkinson GW, Weiss T.

Weaning patients from mechanical ventilation can be hindered by both physical 
and psychologic factors. Biofeedback has been used successfully as an adjunct in 
difficult weaning problems. We have used a combination of hypnosis and 
biofeedback to wean a patient with neurologic disease who previously failed 
weaning by standard procedures. A 30-year-old woman with respiratory failure 
secondary to multiple sclerosis with transverse myelitis was given eight 
sessions of biofeedback over 12 days in which the movements of her chest wall, 
as monitored by magnetometers, were displayed on an oscilloscope. The patient 
was praised for targeted respiratory rate, amplitude, and rhythm. These sessions 
included hypnosis in which the patient was given suggestions of well-being and 
that she could breathe as she had five years earlier. In this manner the patient 
was successfully weaned. Respiratory biofeedback and hypnosis appear to be 
useful adjuncts in weaning patients from ventilators.

DOI: 10.1378/chest.87.2.267
PMID: 3967537 [Indexed for MEDLINE]


4766. Lancet. 1983 Sep 3;2(8349):558-60. doi: 10.1016/s0140-6736(83)90581-0.

Recurrent nosocomial polymicrobial sepsis secondary to child abuse.

Halsey NA, Frentz JM, Tucker TW, Sproles T, Redding J, Daum RS.

Munchausen syndrome by proxy is a rare form of child abuse that can cause great 
diagnostic difficulties. We treated an 8-year-old boy who had recurrent 
polymicrobial sepsis over 6 years. An extensive evaluation to determine the 
infectious focus and to exclude immunodeficiency was carried out before it was 
determined that his mother had repeatedly introduced material containing faecal 
or vaginal bacterial flora into his intravenous lines.

DOI: 10.1016/s0140-6736(83)90581-0
PMID: 6136704 [Indexed for MEDLINE]


4767. Dtsch Med Wochenschr. 1980 Apr 18;105(16):556-60. doi: 10.1055/s-2008-1070705.

[The effects of "relaxing music" on patients, doctors and nursing staff of a 
medical intensive care unit (author's transl)].

[Article in German]

Neuhof H, Klapp BF, Gerlach O, Koch HU, Hundhausen T, Lasch HG.

With the intention of reducing the psychological stress and anxiety of patients 
during their admission to the medical intensive care unit, specially selected 
and prepared instrumental music was played over a loud speaker to the patient 
cubicles. The patients' opinions on the programme and their subjective state of 
health were determined by a questionnaire. 78% of the patients felt that their 
well-being was improved by the music. With the exception of 7%, who were 
disturbed by the music, all other patients found it reassuring, diverting, 
hypnotic or entertaining. In addition to the patients 11 doctors and 16 nurses 
from the intensive care unit as well as 38 doctors and 80 nurses from 39 medical 
intensive care units in German university clinics and large hospitals were asked 
for their opinions on the use of music for intensive care patients.

DOI: 10.1055/s-2008-1070705
PMID: 7363834 [Indexed for MEDLINE]


4768. Arch Intern Med. 1978 Aug;138(8):1224-7.

Pharyngeal colonization by gram-negative bacilli in aspiration-prone persons.

Mackowiak PA, Martin RM, Jones SR, Smith JW.

We compared the prevalence of Gram-negative bacilli in the pharyngeal flora of 
two groups of patients with a known predilection for Gram-negative bacillary 
pneumonia (chronic alcoholics and diabetics), two other groups of 
aspiration-prone persons with no known predilection for Gram-negative bacillary 
pneumonia (epileptics and narcotic addicts), and normal control subjects. 
Quantitative cultures of saline gargles showed pharyngeal Gram-negative bacilli 
to be significantly (P less than .05) more prevalent among alcoholics (35%) and 
diabetics (36%) but not epileptics (17%) or addicts (20%) than controls (18%). 
Counts of greater than or equal to 100 Gram-negative bacilli per milliliter were 
also significantly more common in alcoholics (14%) and diabetics (24%) than 
controls (5%, P less than .05). Enterobacter sp, Klebsiella pneumoniae, and 
Escherichia coli were the most common Gram-negative bacilli isolated. Increased 
colonization by Gram-negative bacilli might be a factor contributing to the 
propensity of alcoholics and diabetics for Gram-negative pneumonia.

PMID: 677978 [Indexed for MEDLINE]


4769. Ciba Found Symp. 1978;(59):53-76. doi: 10.1002/9780470720417.ch5.

ABCs of perinatal medicine.

Hobel CJ.

The purpose of this paper is to illustrate the continuum of perinatal risks 
responsible for developmental handicaps in infancy. The first step is the 
Assessment of risks during pregnancy so that intervention can occur naturally in 
the process of preventive health care. A valid risk-assessment system has been 
developed which can facilitate identification of the high-risk pregnancy. New 
methods of perinatal care during the Birth process are now available which allow 
active intervention aimed at reducing the likelihood of a high-risk patient 
delivering an infant destined to become handicapped. During the neonatal period 
Critical care has been shown to reduce morbidity and mortality. However, the 
perinatal profile of the handicap is not yet complete enough to fully explain 
developmental delay. A new health care strategy based on prospective risk 
assessment and early intervention must now be seriously considered which will 
allow technological medicine to continue to improve well-being.

DOI: 10.1002/9780470720417.ch5
PMID: 251502 [Indexed for MEDLINE]


4770. Heart Lung. 1976 Sep-Oct;5(5):765-71.

Sepsis--the Wayne State University Symposium--part III. Bacteremia and 
endotoxemia: a discussion of their roles in the pathophysiology of gram-negative 
sepsis.

Sibbald WJ.

Bacteremia, or the presence of live bacteria in the bloodstream, does not seem a 
prerequisite for septic shock. Indeed, only a small portion of all patients who 
sustain gram-negative bacteremia ever develop the shock syndrome. Endotoxin in 
the laboratory model is capable of producing a number of pathophysiological 
alterations which can partly explain the varied picture of septic shock seen in 
man. Endotoxin is released from gram-negative bacteria upon their death, and it 
probably acts as an antigen which reacts with antibody and subsequently 
activates the complement cascade. The resultant production of vasoactive 
polypeptides and release of histamine from mast cells might account for the 
increased vascular permeability and early hyperdynamic cardiovascular function 
seen in septic shock. These changes may also contribute to ultimate stagnation 
and pooling in the peripheral microcirculation. Endotoxin is a potent stimulus 
to the sympathoadrenal system which causes varying effects on the periphery. 
Continued catecholamine stimulation at the periphery may ultimately contribute 
to stagnant anoxia by an effect on pre- and postcapillary sphincters. Endotoxin, 
by itself, will not directly impair cardiac contractility, but evidence for 
depressed function implies an interaction of endotoxin with other biochemical 
systems, such as vasoactive polypeptides, to indirectly produce the observed 
effects. Expression of a hemodynamic model closely approximating human septic 
shock requires, in addition to a source of endotoxin, a focus of inflammation. 
Such a focus, in all probability, supplies some as yet unidentified factor(s) 
which help produce the observed increase in cardiac output. The Limulus test has 
confirmed the presence of endotoxemia in gram-negative shock and has raised 
questions about the contribution of gut flora to the propagation of the 
syndrome. An enterogenous source of endotoxin may also be important in patients 
in whom a source of inflammation is not readily observable. Gram-negative shock 
remains an important and grave clinical problem. Knowledge about the relative 
roles of endotoxin various foci of inflammation, and generation of vasoactive 
peptides is accumulating slowly. Hopefully, by creating a clearer understanding 
of the pathophysiology, such knowledge will ultimately result in further 
improvement in our efforts to prevent and treat this syndrome.

PMID: 823128 [Indexed for MEDLINE]